RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN TINGKAT PERTAMA (FKTP) TAHUN 2022

SATUAN KERJA :

PEMAKAIAN
JUMLAH RENCANA RENCANA RENCANA REALISASI
SISA STOK PER RATA-RATA PER
NO NAMA OBAT SATUAN KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN PENGADAAN
DESEMBER 2020 BULAN SELAMA
TAHUN 2022 TAHUN 2022 TAHUN 2022 TAHUN 2021 TAHUN 2020
2020
(a) (b) (c) = (b) x 18 (d) = (c) - (a) (e) (f) (g)
1 Air untuk injeksi amp 20 ml ampul/vial/botol 0 0

2 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL 0 0

3 Albendazol susp 200 mg/5 ml Botol 0 0

4 Albendazol tab 400 mg tablet/kapsul/kaplet 0 0

5 Alopurinol tab 100 mg Tab 0 0

6 Alopurinol tab 300 mg tablet/kapsul/kaplet 0 0

7 Aminofilin inj 24 mg/ml ampul/vial 10 ml 0 0

8 Aminofilin tab 150 mg tablet/kapsul/kaplet 0 0

9 Aminofilin Tab 200 mg tablet/kapsul/kaplet 0 0

10 Amitriptilin tab sal 25 mg tablet/kapsul/kaplet 0 0

11 Amlodipin tab 10 mg tablet/kapsul/kaplet 0 0

12 Amlodipin tab 5 mg tablet/kapsul/kaplet 0 0

13 Amoksisilin drops 100 mg/ml Botol 0 0

14 Amoksisilin sir forte 250 mg/5 ml botol 60 ml 0 0
15 Amoksisilin sir kering 125 mg/5 ml Botol 0 0

16 Amoksisilin tab 250 mg tablet/kapsul/kaplet 0 0

17 Amoksisilin tab 500 mg tablet/kapsul/kaplet 0 0

18 Ampisilin serb inj 1000 mg/vial ampul/vial 0 0

19 Ampisilin serb inj 250 mg/vial Vial 0 0

20 Anestetik lokal gigi kombinasi : lidokain hcl ampul/vial 0 0

2% + epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium

21 hidroksida 200 mg + magnesium tablet/kapsul/kaplet 0 0
hidroksida 200 mg

Antasida, kombinasi : aluminium

22 hidroksida 200 mg + magnesium botol 60 ml 0 0
hidroksida 200 mg
Anti Parkinson kombinasi : benzerasid 25
23 Kaps 0 0
mg + levodopa 100 mg

24 Antifungi salep, kombinasi : asam benzoat pot 30 g 0 0

6%+ asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat

25 150 mg + heksaklorofen 2,5 mg + lidokain Suppositoria 0 0
lidokain 10 mg+ seng oksida 120 mg + sup
ad 2 g

26 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial 0 0

Articulating paper kertas warna penanda Kertas warna penanda

27 0 0
oklusi oklusi
28 Asam asetat tetes telinga 2% Botol 0 0
29 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet 0 0

30 Asam askorbat (vitamin C) tab 250 mg Tab 0 0

31 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet 0 0

32 Asam folat tab 0,4 mg tablet/kapsul/kaplet 0 0

33 Asam folat tab 1 mg tablet/kapsul/kaplet 0 0

34 Asam folat tab 5 mg Tab 0 0

35 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet 0 0

tablet/kapsul/kaplet/kapta
36 Asam mefenamat kaps 500 mg 0 0
b
37 Asam salisilat lar 0,1% Botol 0 0
38 Asam salisilat salep 10% Tube 0 0
39 Asam salisilat salep 2% Tube 0 0
40 Asam salisilat salep 5% Tube 0 0

41 Asiklovir tab 200 mg tablet/kapsul/kaplet 0 0

42 Asiklovir tab 400 mg tablet/kapsul/kaplet 0 0

43 Atapulgit 600 mg tablet/kapsul/kaplet 0 0

44 Atapulgit tab 630 mg tablet/kapsul/kaplet 0 0

45 Atapulgit tablet 650 mg tablet/kapsul/kaplet 0 0

46 Atapulgit tablet 750 mg Tab 0 0

47 Atenolol tab 100 mg tablet/kapsul/kaplet 0 0

48 Atenolol tab 50 mg tablet/kapsul/kaplet 0 0

49 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 0

50 Atropin tab 0,5 mg Tab 0 0
51 Bahan tumpatan sementara lar, serb Botol 0 0
52 Bedak salisil serb 2% Dus/Sachet/Plastik 0 0

53 Betametason krim 0,1% tube 5 gram 0 0

54 Betametason krim 0,5 mg/g Tube 0 0
55 Betametason salep 0,1% tube 5 gram 0 0
56 Betametason tts mata 1 mg/ml botol 0 0
57 Bisakodil sup 10 mg Suppositoria 0 0
58 Bisakodil sup 5 mg Suppositoria 0 0

59 Bisakodil tab sal 5 mg tablet/kapsul/kaplet 0 0

60 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml 0 0

Budesonid cairan ih 0,25mg/ml, respoules
61 respoules 0 0
2 ml
62 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml 0 0
Budesonid cairan ih 0,5 mg/ml, respoules
63 respoules 0 0
2 ml
64 Budesonid serb ih 100 mcg/dosis Botol 0 0
65 Budesonid serb ih 200 mcg/dosis 100 dosis 0 0
66 Budesonid serb ih 200 mcg/dosis 200 dosis 0 0
67 Coal tar lar 5 % Botol 0 0
68 Copper T set/buah 0 0
69 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 0 0

70 Deksametason tab 0,5 mg tablet/kapsul/kaplet 0 0

71 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0 0

72 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL 0 0
73 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 0 0

74 Diazepam tab 2 mg tablet/kapsul/kaplet 0 0

75 Diazepam tab 5 mg tablet/kapsul/kaplet 0 0

76 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 0 0

77 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 0 0

78 Digoksin tab 0,25 mg tablet/kapsul/kaplet 0 0

79 Diltiazem hcl tab 30 mg tablet/kapsul/kaplet 0 0

80 Diltiazem kaps SR 100 mg Kapsul lepas lambat 0 0

81 Diltiazem kaps SR 200 mg Kapsul lepas lambat 0 0

82 Diltiazem tab 30 mg Tab 0 0

83 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet 0 0

84 Doksisiklin kaps 100 mg tablet/kapsul/kaplet 0 0

85 Domperidon susp 5 mg/5 ml botol @60 ml 0 0

86 Domperidon tab 10 mg tablet/kapsul/kaplet 0 0

87 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) ampul/vial 0 0

88 Epinefrin (adrenalin) inj 1 mg/ml Ampul 0 0

89 Ergotamin tab 1 mg Tab 0 0

90 Eritromisin kaps 250 mg tablet/kapsul/kaplet 0 0

91 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0 0

92 Eritromisin tab 500 mg tablet/kapsul/kaplet 0 0

tablet salut gula/kaplet

93 Estrogen terkonjugasi tab sal 0,625 mg 0 0
salut gula

94 Etanol 70% cairan 70% Botol 0 0

95 Etil klorida semprot 100 ml Botol 0 0
96 Etonogestrel implan 68 mg Set 0 0
97 Eugenol Botol 0 0
98 Fenitoin Na inj 50 mg/ml ampul @ 2 ml 0 0
99 Fenitoin Na kaps 100 mg Kaps 0 0
100 Fenitoin Na kaps 30 mg Kaps 0 0
101 Fenobarbital tab 100 mg Tab 0 0

102 Fenobarbital tab 30 mg tablet/kapsul/kaplet 0 0

103 Fenoksimetil penisilin (penisilin V) tab 250 Tab 0 0
mg

104 Fenoksimetil penisilin (penisilin V) tab 500 Tab 0 0

mg
105 Ferro fumarat kaps lunak 300 mg Kaps lunak 0 0
106 Ferro sulfat sir. 150 mg/5 ml Botol 0 0
107 Ferro sulfat tab salut 300 mg Tab sal 0 0
Fitomenadion (vitamin K 1) inj 2 mg/ml
108 ampul/vial 0 0
(i.m.)

109 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 0 0

110 Fitomenadion (vitamin K1) inj 10 mg/ml tablet salut gula/kaplet 0 0

(i.m) salut gula

111 Fluoksetin kaps 10 mg tablet/kapsul/kaplet 0 0

112 Fluor kapl 1 mg Kaplet 0 0

113 Fluor sediaan topikal Tube 0 0
114 Fluoresein tts mata 2,5 mg/ml Botol 0 0
115 Formokresol Botol 0 0
116 Framisetin Sulfat Tulle 1% Patch 0 0
117 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial 0 0

118 Furosemid tab 40 mg tablet/kapsul/kaplet 0 0

119 Galactose microparticle 200-400 mg Vial 0 0

micropart/ml

Garam oralit kombinasi : natrium klorida

120 0,52 g + kalium klorida 0,30 g + trinatrium sachet 0 0
sitrat 0,58 g + glukosa anhidrat 2,7 g

121 Gentamisin salep mata 0,3% Tube 0 0

122 Gentamisin tts mata 0,3% Botol 0 0

Glass ionomer ART (Atraumatic

123 Sachet 0 0
Restorative Treatment) cocoa butter 5 g
124 Glass ionomer ART (Atraumatic Botol 0 0
Restorative Treatment) lar

Glass ionomer ART (Atraumatic

125 Vial 0 0
Restorative Treatment) serb

126 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet 0 0

127 Glibenklamid tab 5 mg tablet/kapsul/kaplet 0 0

128 Glikuidon tab 30 mg tablet/kapsul/kaplet 0 0

129 Glimepirid tab 1 mg tablet/kapsul/kaplet 0 0

130 Glimepirid tab 2 mg tablet/kapsul/kaplet 0 0

131 Glipizid tab 5 mg tablet/kapsul/kaplet 0 0

132 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet 0 0

133 Gliserin tts 100 mg/ml Botol 0 0

134 Glukosa Larutan Infus 10% steril 100 ml Botol 0 0

135 Glukosa Larutan Infus 10% steril 250 ml Botol 0 0

136 Glukosa Larutan Infus 10% steril 500 ml Botol 0 0

137 Glukosa Larutan Infus 40% Ampul @25 ml 0 0

138 Glukosa Larutan Infus 5% steril 100 ml Botol 0 0
139 Glukosa Larutan Infus 5% steril 250 ml Botol 0 0
140 Glukosa Larutan Infus 5% steril 500 ml Botol 0 0

141 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet 0 0

Griseofulvin (micronized) tab scored 250

142 tablet/kapsul/kaplet 0 0
mg

143 Gutta percha dan paper points 15 - 40 mm Roll 0 0

144 Gutta percha dan paper points 45 - 80 mm Roll 0 0

145 Haloperidol inj 5 mg/ml (i.m.) Vial 0 0

146 Haloperidol tab 0,5 mg tablet/kapsul/kaplet 0 0

147 Haloperidol tab 1,5 mg tablet/kapsul/kaplet 0 0

148 Haloperidol tab 2 mg tablet/kapsul/kaplet 0 0

149 Haloperidol tab 5 mg tablet/kapsul/kaplet 0 0

150 Haloperidol tts 2 mg/ml botol 0 0

Hepatitis B imunoglobulin (human) inj 150
151 Ampul 0 0
IU/1,5 ml
152 Hidrogen peroksida cairan 3% Botol 0 0

153 Hidrogen peroksida lar. Konsentrat 3% Botol 0 0

154 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet 0 0

155 Hidrokortison krim 2,5% tube @ 5 g 0 0

156 Hidrokortison serb inj 100 mg Vial 0 0

157 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet 0 0

Human tetanus imunoglobulin inj 250 UI

158 Ampul 0 0
(i.m.)
Human tetanus imunoglobulin inj 500 UI
159 Ampul 0 0
(i.m.)
160 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 0 0
161 Ibuprofen sir 200 mg/5 ml botol @ 60 ml 0 0

162 Ibuprofen tab 200 mg tablet/kapsul/kaplet 0 0

163 Ibuprofen tab 400 mg tablet/kapsul/kaplet 0 0

Ipratropium bromida aerosol 20

164 Botol 0 0
mcg/semprot
165 Ipratropium bromida cairan ih 0,025% Botol 0 0
166 Ipratropium bromida ih 20mcg/puff Botol 0 0
167 Isoniazid tab 100 mg Tab 0 0
168 Isoniazid tab 300 mg Tab 0 0

169 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet 0 0

170 IUD Cu T 380 A Set 0 0

171 IUD Levonorgestrel Set 0 0
172 Kalamin Tube 0 0
173 Kalsium glukonat inj 100 mg/ml ampul/vial 0 0
174 Kalsium hidroksida bubuk, pasta Tube 0 0

175 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet 0 0

176 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet 0 0

177 Kaptopril tab 12,5 mg tablet/kaplet 0 0

178 Kaptopril tab 25 mg tablet/kaplet 0 0
179 Kaptopril tab 50 mg tablet/kaplet 0 0
180 Karbamazepin sir 100 mg/5 ml Botol 0 0
181 Karbamazepin tab 100 mg Tab 0 0
182 Karbamazepin Tab 200 mg Tablet 0 0
183 Karbo adsorben tab 0,5 g Tab 0 0
184 Karbogliserin tts telinga 10 % Botol 0 0

185 Ketokonazol tab 200 mg tablet/kapsul/kaplet 0 0

186 Klindamisin kaps 150 mg Kaps 0 0

187 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0 0

188 Klofazimin, micronized kaps 50 mg Kapsul 0 0

189 Klofazimin, micronizedkaps 100 mg kapsul 0 0

190 Klonidin tab 0,15 mg tablet/kapsul/kaplet 0 0

191 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 0 0

192 Kloramfenikol salep kulit 2% tube 15g 0 0

193 Kloramfenikol salep mata 1% tube @ 5 gram 0 0
194 Kloramfenikol susp 125 mg/5 ml botol 60 ml 0 0
195 Kloramfenikol tetes telinga 3% Botol 0 0
196 Kloramfenikol tts mata 0,5% botol 0 0
197 Kloramfenikol tts mata 1% Botol 0 0

198 Klorfeniramin tab 4 mg tablet/kapsul/kaplet 0 0

199 Klorfenol kamfer mentol (CHKM) Botol 0 0

200 Klorheksidin lar 0,2% Botol 0 0
201 Klorheksidin lar 15% Botol 0 0
202 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial 0 0
203 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial 0 0

204 Klorpromazin tab sal 100 mg tablet salut selaput/kaplet 0 0

salut selaput

205 Klorpromazin tab sal 25 mg Tab sal 0 0

206 Klortalidon tab 50 mg Tab 0 0
207 Klozapin tab 100 mg tablet 0 0
208 Klozapin tab 25 mg tablet 0 0

209 Kodein tab 10 mg tablet/kapsul/kaplet 0 0

Kombinasi (DHP) : dihidroartemisin 40 mg tablet salut selaput/kaplet

210 0 0
+ Piperakuin 320 mg tab sal selaput salut selaput

211 Kombinasi : artemether 20 mg + tablet/kapsul/kaplet 0 0

lumefantrin 120 mg

212 Kombinasi : artesunat tab 50 mg + Tab 0 0

amodiakuin tab 200

213 Kombinasi : Desogestrel 150 mcg Tab 0 0

Etinilestradiol 30 mcg

214 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet 0 0

Kombinasi : Ferro fumarat 60 mg + asam

215 tablet salut gula 0 0
folat 0,4 mg tab salut
 Kombinasi : levonorgestrel 150 mcg +
216 tab salut gula 0 0
etinilestradiol 30 mcg

Kombinasi : Tenofovir 300 mg +

217 Tab 0 0
Emtrisitabin 200 mg

218 Kombinasi : Tenofovir 300 mg + Lamivudin Tab 0 0

300 mg + Efavirenz 600 mg

219 Kombinasi: ipratropium Br 0,5 mg+ ampul/vial 0 0

salbutamol 2,5 mg nebules

220 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 0 0

221 Komposit resin Set 0 0

Kotrimoksazol (dewasa) kombinasi :
222 sulfametoksazol 400 mg+ trimetoprim 80 tab/kaptab 0 0
mg
Kotrimoksazol (dewasa) kombinasi :
223 sulfametoksazol 800 mg+ trimetoprim 160 tab/kaptab 0 0
mg

Kotrimoksazol kombinasi tiap 5 ml

224 suspensi : sulfametoksazol 200 mg + botol 60 mL 0 0
trimetoprim 40 mg

225 Kuinin inj 25% (i.v.) Vial 0 0

226 Kuinin tab 200 mg tablet/kapsul/kaplet 0 0

227 Laktulosa sir 3,335 g/5 ml botol @ 60 mL 0 0

228 Larutan mengandung Elektrolit (Kalium Botol 0 0

Klorida)

229 Larutan mengandung Elektrolit (KCl 0,15%, Botol 0 0

NaCL 0,9%) (KN1)

230 Larutan mengandung Elektrolit (KCl Botol 0 0

0,3%,NaCl 0,9%) (KN2)
Larutan mengandung Elektrolit (Na 130
231 mEq, K 4 mEq, Cl 109 mEq, Ca 3 mEq, Softbag @ 500 ml 0 0
Asetat 28 mEq) Ringer Asetat
 Larutan mengandung Elektrolit (Na 130
232 mEq, K 4 mEq, Cl 109 mEq, Ca 3 mEq, Botol plastik @ 500 ml 0 0
Asetat 28 mEq) Ringer Asetat

Larutan mengandung Elektrolit (NaCl

233 Botol 0 0
1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B)

Larutan mengandung Elektrolit (Sodium

Lactate sol (50%) 113 gr/L, Potassium
234 Botol 0 0
Chloride 0.3 gr/L, Calcium Chloride 0.2
gr/L, elektrolit)

Larutan mengandung Elektrolit (Tiap 1000

ml mengandung electrolit: Sodium 145
mmol/l, Potassium 4.0 mmol/l, Calcium
235 Botol 0 0
2.5 mmol/l, Magnesium 1.0 mmol/l,
Chloride 118 mmol/l, Acetate 24 mmol/l,
Malate 5.0 mmol/l)

Larutan mengandung Karbohidrat

236 (Fructose 120 g, glucose 66 g, Xylitol 60 g/ Botol 0 0
L)

Larutan mengandung Karbohidrat

237 (Fructose 200 g, glucose 110 g, Xylitol 100 Botol 0 0
g/ L)

Larutan mengandung Karbohidrat

238 (Fructose 60 g, glucose 33 g, Xylitol 30 g/ Botol 0 0
L)
Larutan mengandung Karbohidrat
239 Botol 0 0
(Maltose 10%)

Larutan mengandung Karbohidrat +

Elektrolit (25.00g maltose, 3.00 g sodium
240 chloride, 0.15 g potassium chloride, 0.10 g Botol 0 0
calcium chloride dihydrate dan 1.55 g
sodium lactate)

Larutan mengandung Karbohidrat +

241 Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Botol 0 0
Sorbitol 50 gr/L)
 Larutan mengandung Karbohidrat +
242 Elektrolit (Dextrose 5%, NaCL 0,45%, KCl) Botol 0 0
(HSD)

Larutan mengandung Karbohidrat +

243 Elektrolit (Fructose 120 g, glucose 66 g, Botol 0 0
Xylitol 60 g/ L + elektrolit)

Larutan mengandung Karbohidrat +

Elektrolit (Glukosa 25 g, NaCl 2,0 g, KCl 1,3
244 Botol 0 0
g, Natrium Laktat 3,1 g, air untuk injeksi ad
1000 ml)

Larutan mengandung Karbohidrat +

245 Elektrolit (Glukosa 55 g ; Natrium Chloride Botol 0 0
9 g, air untuk injeksi ad 1000 ml) (D5-NS)

Larutan mengandung Karbohidrat +

246 Botol 0 0
Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 g)
Larutan mengandung Karbohidrat +
247 Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 g) Botol 0 0
(D5-1/4NS)

Larutan mengandung Karbohidrat +

248 Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 g) Botol 0 0
(D5-1/2NS)

Larutan mengandung Karbohidrat +

Elektrolit (Larutan nutrisi kombinasi infus
249 per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Botol 0 0
Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ,
Sorbitol 50g)

Larutan mengandung Karbohidrat +

250 Botol 0 0
Elektrolit (Larutan Ringer & Glukosa 5%)

Larutan mengandung Karbohidrat +

251 Elektrolit (NaCl 1.75 g, KCL 1.5g, Glukosa Botol 0 0
100 gr)

Larutan mengandung Karbohidrat +

252 Elektrolit (NaCl 1.75 g, KCL 1.5g, Na Botol 0 0
Lactate 2.24 g, Glukosa 100 gr)
 Larutan mengandung Karbohidrat +
253 Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Botol 0 0
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)

Larutan mengandung Karbohidrat +

254 Elektrolit (Nacl 2.34 gr, Na Laktat 2.24 gr, Botol 0 0
KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)

Levonorgestrel implan 2 rods, 75 mg (3-4

255 pack/ sachet/ set 0 0
tahun)

256 Lidokain gel 2% syringe/syringe plastik 0 0

257 Lidokain inj 2% (infiltr/p.v.) ampul/vial 0 0

258 Lidokain spray oral 10% botol 0 0

259 Linestrenol tab 0,5 mg tablet/kapsul/kaplet 0 0

260 Loperamid tab 2 mg Tab 0 0

261 Loratadin tab 10 mg tablet/kapsul/kaplet 0 0

262 Lorazepam tab 0,5 mg tablet/kapsul/kaplet 0 0

263 Lorazepam tab 1 mg tablet/kapsul/kaplet 0 0

264 Lorazepam tab sal 2 mg Tab sal 0 0

265 Lugol Botol 0 0
266 Magnesium sulfat inj 20% ampul/vial 0 0

267 Magnesium sulfat inj 20% ampul/vial @25 ml 0 0

268 Magnesium sulfat inj 40% ampul/vial @25 ml 0 0

269 Magnesium sulfat inj 40% ampul/vial 0 0

270 Magnesium sulfat serb, ktg 30 g Sachet 0 0
271 Mebendazol sir 100 mg/5 ml Botol 0 0
272 Mebendazol tab 100 mg Tan 0 0

273 Mebendazol tab 500 mg tablet/kapsul/kaplet 0 0

274 Medroksi progesteron asetat inj 150 ampul/vial 0 0
mg/ml

275 Medroksi Progesteron Asetat Inj 50 mg/ml ampul/vial 0 0

276 Metenamin mandelat (heksamin Tab salut 0 0

mandelat) tab salut enterik 500 mg

277 Metformin tab 500 mg tablet/kapsul/kaplet 0 0

278 Metformin tab 850 mg tablet/kapsul/kaplet 0 0

279 Metilergometrin inj 0,2 mg/ml ampul/vial 0 0

280 Metilergometrin tab salut 0,125 mg tablet/kaplet salut selaput 0 0

281 Metilprednisolon tab 4 mg tablet/kapsul/kaplet 0 0

282 Metoklopramid inj 5 mg/ml ampul/vial 0 0

283 Metoklopramid tab 10 mg tablet/kapsul/kaplet 0 0

284 Metoklopramid tab 5 mg tablet/kapsul/kaplet 0 0

285 Metronidazol lar inf 5 mg/ml botol 0 0

286 Metronidazol susp 125 mg/5 ml Botol @ 60 ml 0 0
287 Metronidazol susp 125 mg/5 ml Botol @ 100 ml 0 0

288 Metronidazol tab 250 mg tablet/kapsul/kaplet 0 0

289 Metronidazol tab 500 mg tablet/kapsul/kaplet 0 0

290 Mikonazol krim 2% tube 0 0

291 Mikonazol serb 2% botol / sachet 0 0
Mineral Mix (Bismuth Subcitrate
Tripotasium, Copper sulfate, Magnesium
292 Sachet 0 0
Chloride Anhydrous, Potassium Chloride,
Zinc Acetate)

293 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet 0 0

 Botol plastik/botol plastik
294 NaCl 0,9% Larutan 0 0
pi

295 NaCl 0,9% Larutan Botol 0 0

296 NaCl 0,9% Larutan ampul/botol plastik/botol 0 0

plas

tablet salut enterik/kaplet

297 Natrium diklofenak tab 25 mg 0 0
salut enterik

298 Natrium diklofenak tab 50 mg tablet salut enterik/kaplet 0 0

salut enterik

299 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL 0 0

300 Natrium hipoklorit cairan konsentrat 5% Botol 0 0

301 Natrium tiosulfat inj 25% (i.v.) Ampul 0 0

302 Nifedipin kaps 10 mg tablet/kapsul/kaplet 0 0

303 Nikotinamid tab 100 mg Tab 0 0

304 Nikotinamid tab 5 mg Tab 0 0
305 Nistatin susp 100.000 UI/ml botol/vial 0 0

tablet salut gula/kaplet

306 Nistatin tab salut 500.000 UI 0 0
salut gula

307 Nistatin tab vaginal 100.000 UI tablet/kaplet 0 0

308 Nitrofurantoin tab 50 mg Tab 0 0
309 Norepinefrin inj 1 mg/ml ampul/vial 0 0

310 Obat Anti Tuberculosis FDC Kategori Anak paket 0 0

311 Obat Anti Tuberculosis FDC Kategori I paket 0 0

312 Obat Anti Tuberculosis FDC Kategori II paket 0 0

Obat Anti Tuberculosis FDC Kategori

313 paket 0 0
Sisipan

314 Obat Anti Tuberculosis Kombipak Anak Paket 0 0

315 Obat Anti Tuberculosis Kombipak Dewasa paket 0 0

316 Oksigen ih, gas dlm tabung Botol 0 0

317 Oksimetazolin tts hidung 0,025% botol @ 10 mL 0 0
318 Oksimetazolin tts hidung 0,050% botol @ 10 mL 0 0
319 Oksitetrasiklin 1% Salep Mata tube 0 0
320 Oksitosin inj 10 UI/ml ampul/vial 0 0
321 Olopatadin tts mata 0,1% Botol 0 0
322 Omeprazol inj 40 mg/10 ml ampul/vial 0 0

323 Omeprazol kaps 20 mg tablet/kapsul/kaplet 0 0

324 Paraformaldehid tab 1 g Tab 0 0

325 Parasetamol sir 120 mg/5 ml botol @ 60 mL 0 0

326 Parasetamol tab 500 mg tablet/kapsul/kaplet 0 0

327 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 0

328 Pasta devitalisasi (non arsen) Tube 0 0
329 Pasta pengisi saluran akar (pasta) Tube 0 0
330 Perak nitrat lar 20% Botol 0 0
331 Perak sulfadiazin krim 1% Tube 0 0
332 Permetrin krim 5 % Tube 0 0
333 Pirantel pamoat susp 125 mg/5 ml Botol 0 0
334 Pirantel pamoat tab 500 mg Tab 0 0

335 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet 0 0

336 Pirantel pamoat tab scored 250 mg Tab 0 0

337 Piridoksin (vitamin B6) inj 100 mg/ml Ampul 0 0
338 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl 0 0

339 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet 0 0

340 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 0

341 Povidon iodin lar 100 mg/ml botol 30 mL 0 0
342 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 0
343 Povidon iodin lar 100 mg/ml Botol 300 ml 0 0

344 Prednison tab 5 mg tablet/kapsul/kaplet 0 0

345 Primakuin tab 15 mg Tab 0 0

346 Probenesid tab 500 mg tablet/kapsul/kaplet 0 0

347 Prokain benzilpenisilin serb inj 3 juta ampul/vial 0 0

UI/vial (i.m.)

348 Propiltiourasil tab 100 mg tablet/kapsul/kaplet 0 0

349 Propranolol tab 10 mg tablet/kapsul/kaplet 0 0

350 Ranitidin tab 150 mg tablet/kapsul/kaplet 0 0

351 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak 0 0

352 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak 0 0

353 Rifampisin kaps 300 mg tablet/kapsul/kaplet 0 0

354 Ringer Laktat Larutan Botol 0 0

355 Risperidon tab sal 1 mg tablet/kapsul/kaplet 0 0

356 Risperidon tab sal 2 mg tablet/kapsul/kaplet 0 0

357 Salbutamol cairan ih 0,1% ampul/vial/botol 0 0

358 Salbutamol lar ih 0,5 % Botol 0 0
359 Salbutamol sir 2 mg/5 ml Botol 0 0

360 Salbutamol tab 2 mg tablet/kapsul/kaplet 0 0

361 Salbutamol tab 4 mg tablet/kapsul/kaplet 0 0

362 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 30 gram 0 0

belerang endap 4 %
Salep 2-4, kombinasi : asam salisilat 2 %+
363 pot 15 gram 0 0
belerang endap 4 %
Serum anti bisa ular : A.B.U. I (khusus ular
364 Vial 0 0
dari luar Papua) inj (i.m./i.v.)
Serum anti bisa ular :A.B.U.II (khusus ular
365 Vial 0 0
dari Papua) inj (i.m./i.v.)
366 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj Vial 0 0
i.m 10.000 UI/
367 Serum antirabies inj 100 UI/ml Vial 0 0
368 Serum antirabies inj 200 UI/ml Vial 0 0

369 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 Vial 0 0

UI/vial (i.m /i.v.)
Serum antitetanus (A.T.S) inj 1500 UI/amp
370 Ampul 0 0
(i.m.)
Serum antitetanus (A.T.S) inj 20.000
371 Vial 0 0
UI/vial (i.m /i.v.)
372 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 0
Sianokobalamin (vitamin B12) inj 500
373 ampul/vial 0 0
mcg/ml

374 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet 0 0

tablet/kapsul/kaplet/table
375 Simvastatin tab sal 10 mg t salut selaput/kaplet salut 0 0
selaput

tablet/kapsul/kaplet/table
376 Simvastatin tab sal 20 mg t salut selaput/kaplet salut 0 0
selaput

377 Simvastatin tab sal selaput 40 mg Tab sal 0 0

tablet salut selaput/kaplet

378 Siprofloksasin tab scored 500 mg 0 0
salut selaput

379 Siprofloksasin tetes mata 3 mg/ml Catchcover, botol 0,6 ml 0 0

380 Spironolakton tab 25 mg tablet/kapsul/kaplet 0 0

Stannous pyrophosphate 27,6 mg sodium

381 Vial 0 0
pyrophosphate/vial
382 Streptomisin serb inj 1.000 mg/vial ampul/vial 0 0
383 Surgical ginggival pack Tube 0 0
 tablet salut selaput/kaplet
384 Tenofovir tab 300 mg 0 0
salut selaput

385 Tetanus toxoid inj Ampul 0 0

386 Tetrakain tts mata 0,5% Botol 0 0

387 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet 0 0

388 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet 0 0

389 Tetrasiklin Salep Mata 1% Tube 0 0

390 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet 0 0

391 Timolol tts mata 0,25% botol @ 5 mL 0 0

392 Timolol tts mata 0,5% botol @ 5 mL 0 0

393 Triheksifenidil tab 2 mg tablet/kapsul/kaplet 0 0

394 Urea krim 10 % pot 0 0

395 Vaksin BCG inj (i.k) Vial 0 0

396 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial 0 0

Vaksin Hepatitis Rekombinan Inj Prefilled

397 Vial 0 0
Injection Device (Uniject) 0,5 ml (i.m)

398 Vaksin Influenza Vial 0 0

399 Vaksin Japanese Enchepalitis (J.E) Vial 0 0
400 Vaksin jerap difteri tetanus (DT) Vial 0 0
401 Vaksin jerap difteri tetanus (Td) Vial 0 0
402 Vaksin kombinasi DPT-HB-Hib Vial 0 0
Vaksin measless rubella (MR) Inj 0,5 mL
403 Vial 0 0
(s.k)
404 Vaksin Meningitis Meningokokus Vial 0 0
405 Vaksin polio IPV inj 0,5 ml Vial 0 0
406 Vaksin rabies, untuk manusia serb inj Vial 0 0
(s.k./i.k) + booster

407 Vaksin rabies, untuk manusia serb Inj 2,5 Vial 0 0

IU
408 Vaksin Yellow Fever Vial 0 0
409 Valproat sir 250 mg/5 ml botol @ 120 ml 0 0

tablet salut enterik/ kaplet

410 Valproat tab sal 250 mg 0 0
salut enterik

411 Valproat tab sal 500 mg Tab sal 0 0

412 Vitamin B kompleks tablet 0 0
413 Zinc drops 10 mg/ml Botol 0 0
414 Zinc serb 10 mg Sachet 0 0
415 Zinc sir 10 mg/ml Botol 0 0
416 Zinc sir 20 mg/5 ml botol 0 0
417 Zinc tab disp 20 mg tablet dispersible 0 0
KETERANGAN

(h)