1.

SATUAN KERJA ADALAH NAMA APOTEK, KLINIK, FKTP, FKRTL, DINKES PROVINSI dan KAB/KOTA atau BKKBN
2. JUMLAH KEBUTUHAN TAHUN 2021 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2020 DIKALI 18 BULAN DALAM SA
3. RENCANA KEBUTUHAN TAHUN 2021 ADALAH RENCANA KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI
4. RENCANA PENGADAAN TAHUN 2021 ADALAH RENCANA OBAT DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPL
5. SURAT PENGANTAR DAN LAMPIRAN HARUS DI TANDATANGANI OLEH KEPALA SATUAN KERJA DAN DIBERI STEMPEL
6. MOHON UNTUK TIDAK MELAKUKAN PENAMBAHAN MAUPUN PENGURANGAN BARIS/KOLOM PADA FORMAT

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN RUJUKAN TINGKAT LANJU

SATUAN KERJA : PRASETYA HUSADA

NO NAMA OBAT SISA STOK PER 31 PEMAKAIAN JUMLAH

DESEMBER 2019 RATA-RATA KEBUTUHAN
PER BULAN TAHUN
SELAMA 2021
2019

(a) (b) (c) = (b) x 15

1 153-Sm-EDTMP (ethylenediamine tetramethylene 0 0 0
phosphonic acid) 44 mg Ca/Na EDTMP, 5-46 ?g samarium,
dan 1850 ± 185 mbq samarium 153 per ml

2 Adefovir dipivoksil tab 10 mg 0 0 0

3 Adenosin inj 3 mg/mL 0 0 0
4 Afatinib tab sal selaput 20 mg 0 0 0
5 Afatinib tab sal selaput 30 mg 0 0 0
6 Afatinib tab sal selaput 40 mg 0 0 0
7 Air untuk injeksi amp 20 ml 0 0 0
8 Air untuk injeksi amp 25 ml 311 871 13065
9 Air untuk irigasi 200 43 645
10 Air untuk irigasi lar inf 1000 ml 0 0 0
11 Akarbose tab 100 mg 700 6000 90000
12 Akarbose tab 50 mg 0 0 0
13 Albendazol susp 200 mg/5 ml 0 0 0
14 Albendazol tab 400 mg 0 0 0
15 Albumin serum normal (human albumin) inj 20% 100 ml 0 0 0

16 Albumin serum normal (human albumin) inj 20% 50 ml 0 0 0

17 Albumin serum normal (human albumin) inj 25% 100 ml 0 0 0

18 Albumin serum normal (human albumin) inj 25% 20 ml 0 0 0

19 Albumin serum normal (human albumin) inj 25% 50 ml 0 0 0

20 Albumin serum normal (human albumin) inj 5% 250 ml 0 0 0

21 Albumin serum normal (human albumin) inj 5% 50 ml 0 0 0

22 Alendronat Tab 70 mg 0 0 0
23 Alopurinol tab 100 mg 500 5000 75000
24 Alopurinol tab 300 mg 200 138 2070
25 Alprazolam tab 0,25 mg 0 0 0
26 Alprazolam tab 0,5 mg 0 0 0
27 Alprazolam tab 1 mg 0 0 0
28 Alteplase serb inj 50 mg/vial 0 0 0
29 Amfoterisin B inj 50 mg/10 ml (i.v.) 0 0 0
30 Amfoterisin B salep mata 1% 0 0 0
31 Amfoterisin B salep mata 3% 0 0 0
32 Amikasin inj 250 mg/ml 10 17 255
33 Aminofilin inj 24 mg/ml 12 48 720
34 Aminofilin tab 150 mg 0 0 0
35 Aminofilin Tab 200 mg 33 48 720
36 Amiodaron inj 150 mg/3 ml 4 16 240
37 Amiodaron tab 200 mg 4 9 135
38 Amitriptilin tab sal 25 mg 0 1139 17085
39 Amlodipin tab 10 mg 600 7922 118830
40 Amlodipin tab 5 mg 300 365 5475
41 Amoksisilin drops 100 mg/ml 0 0 0
42 Amoksisilin sir forte 250 mg/5 ml 0 0 0
43 Amoksisilin sir kering 125 mg/5 ml 15 31 465
44 Amoksisilin tab 250 mg 0 0 0
45 Amoksisilin tab 500 mg 100 55 825
46 Ampisilin serb inj 1000 mg/vial 0 0 0
47 Ampisilin serb inj 250 mg/vial 100 164 2460
48 Analog insulin : fast acting inj 100 UI/ml (kemasan vial, 20 106.0833333 1591.25
cartridge disposible, penfil cartridge)
49 Analog insulin : intermediate acting inj 100 UI/ml 15 59.41666667 891.25
(kemasan vial, cartridge disposible, penfill cartridge)

50 Analog insulin : mix insulin (inj 100 UI/ml) 30 68.66666667 1030

51 Analog insulin intermediate acting combine with short or 0 0 0
long acting inj 100 IU/ml (25% insulin lispro), vial/cartridge
diposible/penfill cartridge
52 Analog insulin intermediate acting combine with short or 40 60.91666667 913.75
long acting inj 100 IU/ml (50% insulin lispro), vial/cartridge
diposible/penfill cartridge

53 Analog Insulin long acting inj 100 IU/mL, vial/cartridge 45 182.5 2737.5
disposible/penfill cartridge
54 Anastrozol tab 1 mg 0 0 0
55 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 0 0 0
1 : 80.000 inj 2 ml
56 Antasida, kombinasi : aluminium hidroksida 200 mg + 200 390 5850
magnesium hidroksida 200 mg
57 Antasida, kombinasi : aluminium hidroksida 200 mg + 15 65 975
magnesium hidroksida 200 mg
58 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 240 580.3333333 8705
100 mg
59 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiksin B 0 0 0
10.000 UI/g
60 Antifungi salep, kombinasi : asam benzoat 6%+ asam 0 0 0
salisilat 3%
61 Antihemoroid, kombinasi: bismut subgalat 150 mg + 0 0 0
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng
oksida 120 mg + sup ad 2 g

62 Aripiperazol oral solution 1 mg/ml 0 0 0

63 Aripiperazol tab discmelt 10 mg 0 0 0
64 Aripiperazol tab discmelt 15 mg 0 0 0
65 Aripiprazol tab 5 mg 0 0 0
66 Artesunat serb inj 60 mg/ml (i.v./i.m.) 0 0 0
67 Articulating paper kertas warna penanda oklusi 0 0 0
68 Asam asetat tetes telinga 2% 0 0 0
69 Asam asetilsalisilat (asetosal) tab 100 mg 0 0 0
70 Asam asetilsalisilat (asetosal) tab 80 mg 500 3375.916667 50638.75
71 Asam askorbat (vitamin C) tab 250 mg 0 0 0
72 Asam askorbat (vitamin C) tab 50 mg 200 633.4166667 9501.25
73 Asam folat tab 0,4 mg 100 1165.333333 17480
74 Asam folat tab 1 mg 0 0 0
75 Asam folat tab 5 mg 0 0 0
76 Asam fusidat tts mata 1% 0 0 0
77 Asam ibandronat inj 1 mg/ml 0 0 0
78 Asam mefenamat kaps 250 mg 0 0 0
79 Asam mefenamat kaps 500 mg 300 3319.75 49796.25
80 Asam pipemidat kaps 400 mg 0 0 0
81 Asam retinoat krim 0,1% 0 0 0
82 Asam retinoat krim 0,1% 0 0 0
83 Asam salisilat lar 0,1% 0 0 0
84 Asam salisilat salep 10% 0 0 0
85 Asam salisilat salep 2% 0 0 0
 86 Asam salisilat salep 5% 0 0 0
87 Asam traneksamat inj 100 mg/ml 50 363.5 5452.5
88 Asam traneksamat inj 50 mg/ml 0 0 0
89 Asam traneksamat tab 500 mg 100 518 7770
90 Asam ursodeoksikolat kaps 250 mg 300 770.5833333 11558.75
91 Asam zoledronat inf 4 mg/100 ml 0 0 0
92 Asam Zoledronat Inf 5 mg/100 ml 0 0 0
93 Asetazolamid tab 250 mg 23 46.83333333 702.5
94 Asiklovir salep mata 3% 0 0 0
95 Asiklovir tab 200 mg 0 0 0
96 Asiklovir tab 400 mg 12 18.25 273.75
97 Asparaginase serb inj 10.000 UI/vial 0 0 0
98 Atapulgit 600 mg 200 762.9166667 11443.75
99 Atapulgit tab 630 mg 0 0 0
100 Atapulgit tablet 650 mg 0 0 0
101 Atapulgit tablet 750 mg 0 0 0
102 Atenolol tab 100 mg 0 0 0
103 Atenolol tab 50 mg 0 0 0
104 Atorvastatin tab 10 mg 0 0 0
105 Atorvastatin tab 20 mg 300 1784.666667 26770
106 Atrakurium inj 10 mg/ml (i.v) 2 15.66666667 235
107 Atrakurium inj 10 mg/ml (i.v) 0 0 0
108 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) 32 28.08333333 421.25
109 Atropin tab 0,5 mg 0 0 0
110 Atropin tts mata 0,5% 0 0 0
111 Atropin tts mata 1% 0 0 0
112 Azatioprin tab 50 mg 0 0 0
113 Azitromisin serb inj 500 mg 3 7.833333333 117.5
114 Azitromisin sir kering 200 mg/5 ml 0 0 0
115 Azitromisin tab 250 mg 0 0 0
116 Azitromisin tab 500 mg 44 156.0833333 2341.25
117 Bahan tumpatan sementara lar, serb 0 0 0
118 Barium sulfat serb 92 g/100 ml 0 0 0
119 Barium sulfat serb 92 g/100 ml 0 0 0
120 Barium sulfat susp 2,2% 0 0 0
121 Barium sulfat susp 55% 0 0 0
122 Barium sulfat susp 65% 0 0 0
123 Barium sulfat susp 95% 0 0 0
124 Basiliksimab Inj 20 mg 0 0 0
125 Bedak salisil serb 2% 0 0 0
126 Bedakuilin fumarat tab 100 mg 0 0 0
127 Bendamustin serb inj 100 mg 0 0 0
128 Bendamustin serb inj 25 mg 0 0 0
129 Benzatin penisilin inj 1,2 juta UI/ml (i.m.) 0 0 0
130 Benzatin penisilin inj 2,4 juta UI/ml (i.m.) 0 0 0
131 Beractant susp 25 mg/ml (intratekal) 0 0 0
132 Beraprost sodium tab 20 mcg 0 0 0
133 Betahistin tab 24 mg 0 0 0
134 Betahistin tab 6 mg 100 617.8333333 9267.5
135 Betaksolol tts mata 0,5% 0 0 0
136 Betaksolol tts mata 0,5% 0 0 0
137 Betametason krim 0,1% 0 0 0
138 Betametason krim 0,5 mg/g 0 0 0
139 Betametason salep 0,1% 0 13 195
140 Betametason tts mata 1 mg/ml 0 0 0
141 Bikalutamid tab sal 150 mg 0 0 0
142 Bikalutamid tab sal 50 mg 0 0 0
143 Bisakodil sup 10 mg 10 19.5 292.5
144 Bisakodil sup 5 mg 0 0 0
145 Bisakodil tab sal 5 mg 12 78 1170
146 Bisoprolol tab 1,25 mg 0 624 9360
147 Bisoprolol tab 10 mg 0 0 0
148 Bisoprolol tab 2,5 mg 200 1248 18720
149 Bisoprolol tab 5 mg 500 4062.25 60933.75
150 Bleomisin serb inj 15 mg/ml 0 0 0
151 Brinzolamid tetes mata 0 0 0
152 Bromokriptin tab 2,5 mg 0 0 0
153 Budesonid cairan ih 0,25mg/ml 0 0 0
154 Budesonid cairan ih 0,25mg/ml, respoules 2 ml 0 0 0
155 Budesonid cairan ih 0,5 mg/ml 0 0 0
156 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml 0 0 0
157 Budesonid serb ih 100 mcg/dosis 0 0 0
158 Budesonid serb ih 200 mcg/dosis 2 15.66666667 235
159 Budesonid serb ih 200 mcg/dosis 0 0 0
160 Budesonid-formoterol (fixed combination) 160/4,5 mg 0 0 0
(inhalasi), 120 dosis
161 Budesonid-formoterol (fixed combination) 160/4,5 mg 0 0 0
(inhalasi), 60 dosis
162 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg 0 0 0

163 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% 41 93.66666667 1405

164 Bupivakain inj 5 mg/ml (p.v.) 0 0 0
165 Busulfan tab salut 2 mg 0 0 0
166 Cardioplegia inj 0 0 0
167 Coal tar lar 5 % 0 0 0
168 Copper T 0 0 0
169 Dabigatran eteksilat kaps 110 mg 0 0 0
170 Dabigatran eteksilat kaps 75 mg 0 0 0
171 Dakarbazin serb inj 100 mg/vial 0 0 0
172 Dakarbazin serb inj 200 mg/vial 0 0 0
173 Daklatasvir tab sal selaput 30 mg 0 0 0
174 Daklatasvir tab sal selaput 60 mg 0 0 0
175 Daktinomisin inj 0,5 mg/vial (i.v.) 0 0 0
176 Dapson tab scored 100 mg 0 0 0
177 Daunorubisin serb inj 20 mg/vial 0 0 0
178 Deferasiroks tab disp 250 mg 0 0 0
179 Deferasiroks tab disp 500 mg 0 0 0
180 Deferipron lar oral 100 mg/ml 0 0 0
181 Deferipron tab sal 500 mg 0 0 0
182 Deferoksamin mesilat serb inj 500 mg/vial 0 0 0
183 Deksametason inj 5 mg/ml (i.v./i.m.) 123 546 8190
184 Deksametason tab 0,5 mg 344 780 11700
185 Deksametason tab 4 mg 0 0 0
186 Deksmedetomidin Inj 100 mcg/ml 0 0 0
187 Desfluran cairan ih 0 0 0
188 Desmopresin nasal spray 10 mcg/puff 0 0 0
189 Desmopresin tab 0,1 mg 0 0 0
190 Desmopresin tab 0,2 mg 0 0 0
191 Desogestrel tab 75 mcg 0 0 0
192 Desoksimetason gel 0,05% 0 0 0
193 Desoksimetason krim 0,25% 0 0 0
194 Desoksimetason salep 0,25% 5 15.66666667 235
195 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 0 0 0
1,5%
196 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 0 0 0
2,5%
197 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 0 0 0
4,25%
198 Dialisa peritoneal, lar intraperitonial 0 0 0
199 Diazepam enema 10 mg/2,5 ml 2 62.41666667 936.25
200 Diazepam enema 5 mg/2,5 ml 1 15.66666667 235
201 Diazepam inj 5 mg/ml (i.v./i.m.) 14 26 390
202 Diazepam tab 2 mg 0 0 0
203 Diazepam tab 5 mg 131 312 4680
204 Dienogest tab 2 mg 0 0 0
205 Dietilkarbamazin tab 100 mg 0 0 0
206 Difenhidramin inj 10 mg/ml (i.v./i.m.) 97 187.25 2808.75
207 Diflukortolon valerat salep berlemak 0,1% 0 0 0
208 Digoksin inj 0,25 mg/ml 34 78 1170
209 Digoksin tab 0,25 mg 0 0 0
210 Diltiazem hcl inj 5 mg/5 ml 0 0 0
211 Diltiazem hcl tab 30 mg 0 0 0
212 Diltiazem inj 25 mg/5 ml 0 0 0
213 Diltiazem kaps SR 100 mg 0 0 0
214 Diltiazem kaps SR 200 mg 0 0 0
215 Diltiazem serb inj 10 mg/10 ml 0 0 0
216 Diltiazem serb inj 50 mg/vial 0 0 0
217 Diltiazem tab 30 mg 300 936 14040
218 Dimenhidrinat tab 50 mg 100 312 4680
219 Dinatrium edetat tts mata 0,35% (3,5 mg/ml) 0 0 0
220 Dinatrium klodronat inj 60 mg/ml 0 0 0
221 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3- 0 0 0
dimercaptosuccinic acid/vial
222 Dobutamin inj 12,5 mg/ml 0 0 0
223 Dobutamin inj 25 mg/ml 0 0 0
224 Dobutamin inj 50 mg/ml 23 31.25 468.75
225 Doksazosin mesilat tab 1 mg 0 0 0
226 Doksazosin mesilat tab 2 mg 0 0 0
227 Doksazosin tab 1 mg 0 0 0
228 Doksazosin tab 2 mg 0 0 0
229 Doksisiklin kaps 100 mg 55 312 4680
230 Doksisiklin kaps 50 mg 0 0 0
231 Doksorubisin serb inj 10 mg/vial (i.v.) 0 0 0
232 Doksorubisin serb inj 50 mg/vial 0 0 0
233 Domperidon susp 5 mg/5 ml 13 117 1755
234 Domperidon tab 10 mg 321 4368 65520
235 Domperidon tts 5 mg/ml 0 0 0
236 Donepezil tab 5 mg 97 312 4680
237 Donepezil tab eff 10 mg 0 0 0
238 Dopamin inj 40 mg/ml 15 46.83333333 702.5
239 Dosetaksel inj 20 mg 0 0 0
240 Dosetaksel inj 40 mg/ml (vial 0,5 ml) 0 0 0
241 Dosetaksel inj 40 mg/ml (vial 2 ml) 0 0 0
242 Dosetaksel inj 80 mg 0 0 0
243 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg 0 0 0
pentetate calcium trisodium/ml
244 Dutasterid kaps 0,5 mg 44 117 1755
245 Efavirens tab sal 600 mg 0 0 0
246 Efavirenz tab 200 mg 0 0 0
247 Efedrin inj 50 mg/ml 56 234 3510
248 Eksemestan tab 25 mg 0 0 0
249 Eltrombopag tab sal selaput 25 mg 0 0 0
250 Eltrombopag tab sal selaput 50 mg 0 0 0
251 Enoksaparin sodium inj 20 mg/0,2 ml 0 0 0
252 Enoksaparin sodium inj 40 mg/0,4 ml 0 0 0
253 Enoksaparin sodium inj 60 mg/0,6 ml 0 0 0
254 Entekavir tab sal selaput 0,5 mg 0 0 0
255 Entekavir tab sal selaput 1 mg 0 0 0
256 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) 0 0 0
257 Epinefrin (adrenalin) inj 1 mg/ml 78 156 2340
258 Epirubisin serb inj 2 mg/ml, vial 25 ml 0 0 0
259 Epirubisin serb inj 2 mg/ml, vial 5 ml 0 0 0
260 Epirubisin serb inj 50 mg 0 0 0
261 Ergokalsiferol (vitamin D2) kaps 50.000 UI 0 0 0
262 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml 0 0 0
263 Ergotamin tab 1 mg 0 0 0
264 Eritromisin kaps 250 mg 0 0 0
265 Eritromisin sir 200 mg/5 ml 12 39 585
266 Eritromisin tab 500 mg 100 312 4680
267 Eritropoetin-alfa inj 10.000 IU 0 0 0
268 Eritropoetin-alfa inj 2.000 IU 0 0 0
269 Eritropoetin-alfa inj 3.000 IU 0 0 0
270 Eritropoetin-alfa inj 4.000 IU 0 0 0
271 Eritropoetin-beta inj 2000 UI/0,3 ml 0 0 0
272 Eritropoietin-Alfa Inj 4000 IU/0,5 ml 0 0 0
273 Erlotinib tab sal selaput 100 mg 0 0 0
274 Erlotinib tab sal selaput 150 mg 0 0 0
275 Esomeprazole inj 40 mg/vial 0 0 0
276 Estrogen terkonjugasi tab sal 0,625 mg 0 0 0
277 Etanol 70% cairan 70% 0 0 0
278 Etil klorida semprot 100 ml 0 6.25 93.75
279 Etinilestradiol tab 0,5 mg 0 0 0
280 Etonogestrel implan 68 mg 0 0 0
281 Etoposid inj 20 mg/ml 0 0 0
282 Etoposid kaps 100 mg 0 0 0
283 Eugenol 0 0 0
284 Everolimus tab 0,25 mg 0 0 0
285 Everolimus tab 0,5 mg 0 0 0
286 Faktor IX Kompleks Inj 50 IU/mL 0 0 0
287 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml 0 0 0

288 Faktor IX kompleks serb inj 500 UI/vial + pelarut 0 0 0

289 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, 0 0 0
faktor koagulasi IX 25 UI, faktor koagulasi X 14-35 serb inj
250 IU/10 ml

290 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, 0 0 0
faktor koagulasi IX 25 UI, faktor koagulasi X 14-35 serb inj
500 UI/20 ml UI

291 Faktor viia (rekombinan) serb inj 1 mg/vial + pelarut untuk 0 0 0

injeksi
292 Faktor VIII (konsentrat) serb inj 230 -340 UI 0 0 0
293 Faktor VIII (konsentrat) serb inj 480 - 600 UI 0 0 0
294 Faktor VIII serb inj 1000 mg/vial 0 0 0
295 Faktor VIII serb inj 2000 mg/vial 0 0 0
296 Faktor VIII serb inj 250 IU 0 0 0
297 Faktor VIII serb inj 500 IU 0 0 0
298 Fenilefrin drops 10% 0 0 0
299 Fenitoin Na inj 50 mg/ml 0 0 0
300 Fenitoin Na kaps 100 mg 200 1092 16380
301 Fenitoin Na kaps 30 mg 0 0 0
302 Fenobarbital inj 100 mg/mL 0 0 0
303 Fenobarbital inj 50 mg/ml 0 0 0
304 Fenobarbital tab 100 mg 0 0 0
305 Fenobarbital tab 30 mg 0 0 0
306 Fenofibrat kaps 100 mg 0 0 0
307 Fenofibrat kaps 300 mg 0 0 0
308 Fenoksimetil penisilin (penisilin V) tab 125 mg 0 0 0
309 Fenoksimetil penisilin (penisilin V) tab 250 mg 0 0 0
310 Fenoksimetil penisilin (penisilin V) tab 500 mg 0 0 0
311 Fenoterol hbr aerosol 100 mcg/puff 0 0 0
312 Fenoterol hbr cairan ih 0,1% 0 0 0
313 Fentanil inj 0,05 mg/ml (ampul 10 ml) 0 0 0
314 Fentanil inj 0,05 mg/ml (ampul 2 ml) 5 117 1755
315 Fentanil patch 12,5 mcg/jam 0 0 0
316 Fentanil patch 25 mcg/jam 0 0 0
317 Ferrakrilum cairan 1% 0 0 0
318 Ferro fumarat kaps lunak 300 mg 0 0 0
319 Ferro sulfat sir. 150 mg/5 ml 0 0 0
320 Ferro sulfat tab salut 300 mg 0 0 0
321 Filgrastim inj 300 mcg/ml 0 0 0
322 Finasterid tab 5 mg 0 0 0
323 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) 56 156.5833333 2348.75
324 Fitomenadion (vitamin K 1) tab sal 10 mg 0 0 0
325 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) 0 0 0
326 Fludarabin inj 50 mg/vial 0 0 0
327 Fludarabin tab sal 10 mg 0 0 0
328 Flufenazin inj 25 mg/ml (i.m.) 0 0 0
329 Flukonazol inj 2 mg/ml 0 0 0
330 Flukonazol kaps 150 mg 32 41.75 626.25
331 Flukonazol kaps 50 mg 0 0 0
332 Fluoksetin kaps 10 mg 0 0 0
333 Fluoksetin kaps 20 mg 100 539.8333333 8097.5
334 Fluor kapl 1 mg 0 0 0
335 Fluor sediaan topikal 0 0 0
336 Fluoresein injeksi 10% 0 0 0
337 Fluoresein tts mata 2,5 mg/ml 0 0 0
338 Fluoro deoxy glucose (FDG) 0 0 0
339 Fluorometolon tts mata 0,1% 0 0 0
340 Fluorourasil Inj 25 mg/ml 0 0 0
341 Fluorourasil inj 250 mg/ml 0 0 0
342 Fluorourasil inj 50 mg/mL (@ 10 mL) 0 0 0
343 Fluorourasil inj 50 mg/mL (@ 5 mL) 0 0 0
344 Fluorourasil serb inj 250 mg 0 0 0
345 Flusinolon asetonid krim 0,025% 0 0 0
346 Flusinolon asetonid salep 0,025% 0 0 0
347 Flutikason furoat intranasal spray 0 0 0
348 Flutikason propionat cairan ih 0,5 mg/dosis 0 0 0
349 Flutikason Propionat MDI 50 mcg/semprot 0 0 0
350 Fondaparinuks inj 2,5 mg/0,5 ml 32 83.83333333 1257.5
351 Formokresol 0 0 0
352 Fosfomisin Trometamol granula 3 g 0 0 0
353 Fraksi protein plasma lar inf 5% 0 0 0
354 Framisetin Sulfat Tulle 1% 0 0 0
355 Furosemid inj 10 mg/ml (i.v./i.m.) 111 638.0833333 9571.25
356 Furosemid tab 40 mg 200 3879.75 58196.25
357 Gabapentin kaps 100 mg 0 0 0
358 Gabapentin kaps 300 mg 400 2964 44460
359 Gadobutrol Macrocyclic 5 ml 0 0 0
360 Gadobutrol Macrocyclic 7,5 ml 0 0 0
361 Gadoksetat disodium 0,25 mmol gadoksetat disodium/ml 0 0 0

362 Galactose microparticle 200-400 mg micropart/ml 0 0 0

363 Gansiklovir serb inj 500 mg/vial 0 0 0
364 Garam oralit kombinasi : natrium klorida 0,52 g + kalium 50 156 2340
klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat
2,7 g

365 Gefitinib tab 250 mg 0 0 0

366 Gemfibrozil kaps 300 mg 240 1784.666667 26770
367 Gemfibrozil kaps 600 mg 0 0 0
368 Gemsitabin inj 1000 mg/vial 0 0 0
369 Gemsitabin inj 200 mg/vial 0 0 0
370 Gentamisin inj 10 mg/ml 0 0 0
371 Gentamisin inj 40 mg/ml 121 160.1666667 2402.5
372 Gentamisin inj 80 mg/ml 0 0 0
373 Gentamisin salep mata 0,3% 12 46.83333333 702.5
374 Gentamisin tsts mata 1% 12 36.41666667 546.25
375 Gentamisin tts mata 0,3% 0 0 0
376 Glass ionomer ART (Atraumatic Restorative Treatment) 0 0 0
cocoa butter 5 g
377 Glass ionomer ART (Atraumatic Restorative Treatment) lar 0 0 0

378 Glass ionomer ART (Atraumatic Restorative Treatment) 0 0 0

serb
379 Glibenklamid tab 2,5 mg 0 0 0
380 Glibenklamid tab 5 mg 100 238.75 3581.25
381 Gliklazid tab 80 mg 200 438.4166667 6576.25
382 Gliklazid tab MR 30 mg 0 0 0
383 Gliklazid tab SR 60 mg 0 0 0
384 Glikopironium serb ih 50 mcg 0 0 0
385 Glikuidon tab 30 mg 522 815.9166667 12238.75
386 Glimepirid tab 1 mg 431 1638 24570
387 Glimepirid tab 2 mg 532 2106 31590
388 Glimepirid tab 3 mg 321 440 6600
389 Glimepirid tab 4 mg 700 1499.166667 22487.5
390 Glipizid tab 10 mg 0 0 0
391 Glipizid tab 5 mg 0 0 0
392 Gliseril trinitrat inj 10 mg/ml 0 0 0
393 Gliseril trinitrat inj 5 mg/ml 0 0 0
394 Gliseril trinitrat kaps lepas lambat 2,5 mg 0 0 0
395 Gliseril trinitrat kaps lepas lambat 5 mg 0 0 0
396 Gliseril trinitrat tab 0,5 mg 0 0 0
397 Gliserin lar 50% 0 0 0
398 Gliserin tts 100 mg/ml 0 0 0
399 Glukosa Larutan Infus 10% steril 100 ml 0 0 0
400 Glukosa Larutan Infus 10% steril 250 ml 0 0 0
401 Glukosa Larutan Infus 10% steril 500 ml 0 0 0
402 Glukosa Larutan Infus 40% 0 0 0
403 Glukosa Larutan Infus 5% steril 100 ml 0 0 0
404 Glukosa Larutan Infus 5% steril 250 ml 0 0 0
405 Glukosa Larutan Infus 5% steril 500 ml 40 62.41666667 936.25
406 Goserelin asetat inj 10,8 mg/vial 0 0 0
407 Goserelin asetat inj 3,6 mg/vial 0 0 0
408 Griseofulvin (micronized) tab 125 mg 0 0 0
409 Griseofulvin (micronized) tab 500 mg 0 0 0
410 Griseofulvin (micronized) tab scored 250 mg 0 0 0
411 Gutta percha dan paper points 15 - 40 mm 0 0 0
412 Gutta percha dan paper points 45 - 80 mm 0 0 0
413 Haloperidol inj 5 mg/ml (i.m.) 0 0 0
414 Haloperidol inj 50 mg/ml (decanoat) 0 0 0
415 Haloperidol tab 0,5 mg 0 0 0
416 Haloperidol tab 1,5 mg 0 0 0
417 Haloperidol tab 2 mg 0 0 0
418 Haloperidol tab 5 mg 53 156 2340
419 Haloperidol tts 2 mg/ml 0 0 0
420 Halotan ih 0 0 0
421 Hemodialisa lar konsentrat basis asetat 0 0 0
422 Hemodialisa lar konsentrat basis natrium bikarbonat 0 0 0

423 Heparin, Na inj 5.000 UI/ml (i.v./s.k.) 0 0 0

424 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml 0 0 0

425 Hepatitis B imunoglobulin (human) Inj 220 IU/ml 0 0 0

426 Hidrogen peroksida cairan 3% 0 0 0
427 Hidrogen peroksida lar. Konsentrat 3% 0 0 0
428 Hidroklorotiazid tab 12,5 mg 0 0 0
429 Hidroklorotiazid tab 25 mg 300 1349.416667 20241.25
430 Hidrokortison krim 1% 21 31.25 468.75
431 Hidrokortison krim 2,5% 66 113.1666667 1697.5
432 Hidrokortison serb inj 100 mg 0 0 0
433 Hidrokortison Tab 20 mg 0 0 0
434 Hidroksi klorokuin tab 200 mg 0 0 0
435 Hidroksi urea tab 500 mg 0 0 0
436 Hiosina butilbromida inj 20 mg/ml 0 0 0
437 Hiosina butilbromida tab 10 mg 0 0 0
438 Homatropin tts mata 2% 0 0 0
439 Human insulin fast acting inj 100 IU/ml, cartridge 0 0 0
disposible/penfill cartridge
440 Human insulin fast acting inj 100 IU/ml, Vial 10 mL 0 0 0
441 Human insulin fast acting inj 100 IU/ml, Vial 5 mL 0 0 0
442 Human Insulin intermediate acting combine with short or 0 0 0
long acting inj 100 IU/mL, cartridge disposible/penfill
cartridge

443 Human insulin intermediate acting combine with short or 0 0 0

long acting inj 100 IU/mL, Vial 10 mL
444 Human Insulin intermediate acting inj 100 IU/ml, cartridge 0 0 0
disposible/penfill cartridge
445 Human Insulin intermediate acting inj 100 IU/Ml, Vial 10 0 0 0
mL
446 Human insulin intermediate acting inj 100 IU/mL, Vial 10 0 0 0
mL
447 Human Insulin intermediate acting inj 100 IU/mL, Vial 5 0 0 0
mL
448 Human tetanus imunoglobulin inj 250 UI (i.m.) 0 0 0
449 Human tetanus imunoglobulin inj 500 UI (i.m.) 2 39 585
450 Hydromorphone HCl tab oros 16 mg 0 0 0
451 Hydromorphone HCl tab oros 8 mg 0 0 0
452 Ibuprofen sir 100 mg/5 ml 0 0 0
453 Ibuprofen sir 200 mg/5 ml 13 102.5833333 1538.75
454 Ibuprofen tab 200 mg 0 0 0
455 Ibuprofen tab 400 mg 321 1092 16380
456 Idarubisin serb inj 20 mg 0 0 0
457 Ifosfamid serb inj 1000 mg/vial 0 0 0
458 Ifosfamid serb inj 2000 mg/vial 0 0 0
459 Ifosfamid serb inj 500 mg/vial 0 0 0
460 Iloprost ih 10 mcg/mL 0 0 0
461 Imatinib mesilat tab 100 mg 0 0 0
462 Imatinib Mesilat tab 400 mg 0 0 0
463 Imidapril tab 10 mg 0 0 0
464 Imidapril tab 5 mg 0 0 0
465 Imunoglobulin Intravena Inj 50 mg/ml, untuk terapi GBS 0 0 0
(Guillain Bare Syndrom)
466 Imunoglobullin Intravena inj 250 mg/50 ml 0 0 0
467 Indakaterol serb ih 150 mcg 0 0 0
468 Indakaterol serb ih 300 mcg 0 0 0
469 Iodiksanol vial 320 mg Iodium/100 ml 0 0 0
470 Iodiksanol vial 320 mg Iodium/50 ml 0 0 0
471 Iodium 131 0 0 0
472 Iodohippurate sodium I 131 37-74 mbq/ multiple-dose 0 0 0

473 Ioheksol 180 - 300 mg Iodium/mL (300 mg/20 mL) 0 0 0

474 Ioheksol 240-350 mg Iodium/ml (300 mg/75 ml) 0 0 0
475 Ioheksol 240-350 mg Iodium/ml (350 mg/75 ml) 0 0 0
476 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/100 ml) 0 0 0

477 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/50 ml) 0 0 0

478 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/100 ml) 0 0 0

479 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/50 ml) 0 0 0

480 Iopamidol 200 - 300 mg Iodium/mL (300 mg/100 mL) 0 0 0
481 Iopamidol 200 - 300 mg Iodium/mL (300 mg/200 mL) 0 0 0
482 Iopamidol 200 - 300 mg Iodium/mL (300 mg/50 mL) 0 0 0
483 Iopamidol 300 - 370 mg Iodium/mL (370 mg/100 mL) 0 0 0
484 Iopamidol 300 - 370 mg Iodium/mL (370 mg/200 mL) 0 0 0
485 Iopamidol 300 - 370 mg Iodium/mL (370 mg/50 mL) 0 0 0
486 Iopamidol inj 200-370 mg Iodium/ml 0 0 0
487 Iopromid 240 -370 mg Iodium/ml 0 0 0
488 Iopromid 300 - 370 mg (300 mg/100 mL) 0 0 0
489 Iopromid 300 - 370 mg (300 mg/50 mL) 0 0 0
490 Iopromid 300 - 370 mg (370 mg/100 mL) 0 0 0
491 Iopromid 300 - 370 mg (370 mg/50 mL) 0 0 0
492 Ipratropium bromida aerosol 20 mcg/semprot 0 0 0
493 Ipratropium bromida cairan ih 0,025% 21 31.25 468.75
494 Ipratropium bromida ih 20mcg/puff 0 0 0
495 Irbesartan tab 150 mg 400 67.75 1016.25
496 Irbesartan tab 300 mg 34 78 1170
497 Irinotekan inf 20 mg/ml 0 0 0
498 Irinotekan inj 20 mg/ml 0 0 0
499 Isofluran inhalasi 100 ml 0 0 0
500 Isofluran inhalasi 250 ml 2 9.416666667 141.25
501 Isoniazid tab 100 mg 0 0 0
502 Isoniazid tab 300 mg 73 468 7020
503 Isosorbid dinitrat inj 1 mg/ml (i.v) 20 46.83333333 702.5
504 Isosorbid dinitrat tab 10 mg 0 0 0
505 Isosorbid dinitrat tab 5 mg 0 0 0
506 Itrakonazol Kaps 100 mg 0 0 0
507 IUD Cu T 380 A 0 0 0
508 IUD Levonorgestrel 0 0 0
509 Ivabradin tab 5 mg 0 0 0
510 k.y jelly 0 0 0
511 Kalamin 0 0 0
512 Kalium aspartat tab 300 mg 0 0 0
513 Kalium klorida tab siap larut 300 mg 0 0 0
514 Kalium klorida tab SR 600 mg 100 230.9166667 3463.75
515 Kalsitriol kaps lunak 0,25 mcg 231 2328.75 34931.25
516 Kalsitriol kaps lunak 0,5 mcg 0 0 0
517 Kalsium Folinat (Leukovorin, Ca) Inj 10 mg/ml 0 0 0
518 Kalsium folinat (leukovorin, Ca) tab 15 mg 0 0 0
519 Kalsium glukonat inj 100 mg/ml 0 0 0
520 Kalsium hidroksida bubuk, pasta 0 0 0
521 Kalsium hipoklorit 0 0 0
522 Kalsium karbonat tab 500 mg 0 0 0
523 Kalsium laktat (kalk) tab 500 mg 300 752 11280
524 Kalsium polistirena sulfonat ktg 5 g 0 0 0
525 Kanamisin inj 1.000 mg/ vial 0 0 0
526 Kandesartan tab 16 mg 700 9735.916667 146038.75
527 Kandesartan tab 8 mg 555 3380.583333 50708.75
528 Kapesitabin tab sal 500 mg 0 0 0
529 Kaptopril tab 12,5 mg 311 411.9166667 6178.75
530 Kaptopril tab 25 mg 312 505.5 7582.5
531 Kaptopril tab 50 mg 60 140.4166667 2106.25
532 Karbamazepin sir 100 mg/5 ml 0 0 0
533 Karbamazepin tab 100 mg 0 0 0
534 Karbamazepin Tab 200 mg 112 246.5 3697.5
535 Karbimazol tab 5 mg 0 0 0
536 Karbo adsorben tab 0,5 g 0 0 0
537 Karbogliserin tts telinga 10 % 0 0 0
538 Karboksimetilselulosa tts mata 0 0 0
539 Karboplatin Inj 10 mg (vial 45 ml) 0 0 0
540 Karboplatin inj 10 mg/ml (vial 15 ml 0 0 0
541 Karvedilol kaps 6,25 mg 322 570 8550
542 Karvedilol tab 25 mg 0 0 0
543 Ketamin inj 100 mg/ml (i.v.) 5 4.75 71.25
544 Ketamin inj 50 mg/ml (i.v.) 0 0 0
545 Ketokonazol krim 2% 55 111.1666667 1667.5
546 Ketokonazol scalp sol 2% 0 0 0
547 Ketokonazol tab 200 mg 211 208 3120
548 Ketoprofen Inj 25 mg/ml 0 0 0
549 Ketoprofen sup 100 mg 121 156 2340
550 Ketorolak inj 30 mg/ml 322 780 11700
551 Klaritromisin sir kering 125 mg/5 ml 0 0 0
552 Klaritromisin sir kering 250 mg/5 ml 0 0 0
553 Klaritromisin tab 500 mg 0 0 0
554 Klindamisin kaps 150 mg 0 0 0
555 Klindamisin kaps 300 mg 100 117 1755
556 Klobazam tab 10 mg 400 741 11115
557 Klobetasol propionat krim 0,05% 0 0 0
558 Klobetasol propionat salep 0,05% 0 0 0
559 Klofazimin, micronized kaps 50 mg 0 0 0
560 Klofazimin, micronizedkaps 100 mg 0 0 0
561 Klomipramin tab 25 0 0 0
562 Klonazepam kaps 2 mg 0 0 0
563 Klonidin inj 150 mcg/ml 12 15.66666667 235
564 Klonidin tab 0,15 mg 400 1179.416667 17691.25
565 Klopidogrel tab 75 mg 500 6503.666667 97555
566 Klopidogrel tab sal selaput 300 mg 0 0 0
567 Kloral hidrat lar 0 0 0
568 Klorambusil tab 2 mg 0 0 0
569 Klorambusil tab sal selaput 5 mg 0 0 0
570 Kloramfenikol kaps 250 mg 0 0 0
571 Kloramfenikol kaps 500 mg 0 0 0
572 Kloramfenikol salep kulit 2% 0 0 0
573 Kloramfenikol salep mata 1% 31 39.08333333 586.25
574 Kloramfenikol serb inj 1.000 mg/ml 0 0 0
575 Kloramfenikol susp 125 mg/5 ml 0 0 0
576 Kloramfenikol tetes telinga 3% 0 0 0
577 Kloramfenikol tts mata 0,5% 0 0 0
578 Kloramfenikol tts mata 1% 21 16.66666667 250
579 Klorfeniramin tab 4 mg 211 1248 18720
580 Klorfenol kamfer mentol (CHKM) 0 0 0
581 Klorheksidin lar 0,2% 0 0 0
582 Klorheksidin lar 15% 0 0 0
583 Klorokuin tab 250 mg 0 0 0
584 Klorpromazin inj 25 mg/ml (i.m.) 0 0 0
585 Klorpromazin inj 5 mg/ml (i.m.) 0 0 0
586 Klorpromazin tab sal 100 mg 0 0 0
587 Klorpromazin tab sal 25 mg 0 0 0
588 Klortalidon tab 50 mg 0 0 0
589 Klotrimazol tab vagina 100 mg 0 0 0
590 Klozapin tab 100 mg 0 0 0
591 Klozapin tab 25 mg 0 0 0
592 Kodein tab 10 mg 211 936 14040
593 Kodein tab 15 mg 212 715 10725
594 Kodein tab 20 mg 222 1092 16380
595 Kolekalsiferol (vitamin D3) kaps lunak 0,25 mcg 0 0 0
596 Kolekalsiferol (vitamin D3) kaps lunak 0,5 mcg 0 0 0
597 Kolestiramin serb, 4 g 0 0 0
598 Kolkisin tab 500 mcg 0 0 0
599 Koloid HES BM 130 000 lar inf 6% 4 27.33333333 410
600 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 0 0 0
320 mg tab sal selaput
601 Kombinasi : (Ampisilin 1000 mg + Sulbaktam 500 mg) serb 2 55.91666667 838.75
inj 1500 mg
602 Kombinasi : (Sefoperazon 500 mg + Sulbaktam 500 mg) 0 0 0
serb inj 1000 mg
603 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg + 0 0 0
Nevirapin 50 mg) Ped Triple FDC
604 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 0 0 0
750 mg
605 Kombinasi : artemether 20 mg + lumefantrin 120 mg 0 0 0
606 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 0 0 0

607 kombinasi : benserazid 25 mg + levodopa 100 mg 0 0 0

608 Kombinasi : Brinzolamid 1% + Timolol 0,5%, tts mata 0 0 0

609 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg 0 0 0

610 Kombinasi : ergotamin 1 mg+ kafein 50 mg 0 0 0

611 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab 0 0 0
salut
612 Kombinasi : Indakaterol 110 mcg + Glycopyrronium 50 0 0 0
mcg serb ih + alat breezhaler
613 Kombinasi : Ipratropium bromida 0,02 mg + fenoterol HBr 0 0 0
0,05 mg aerosol
614 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + 0 0 0
entekapon 200 mg
615 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 0 0 0
mcg
616 Kombinasi : medroksi progesteron asetat+ estradiol 0 0 0
sipionat inj depot 25 mg + 5 mg
617 Kombinasi : Meglumin amidotrizoat + Sodium 0 0 0
amidotrizoat inj 76%
618 Kombinasi : Sefiksim 400 mg + Azitromisin 1000 mg 0 0 0
619 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg 0 0 0
620 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + 0 0 0
Efavirenz 600 mg
621 Kombinasi : Travoprost 0,004% + Timolol 0,5%, tts mata 0 0 0

622 Kombinasi : triamsinolon + dementilklortetrasiklin 0 0 0

623 Kombinasi : zidovudin 300 mg +lamivudin 150 mg 0 0 0
624 Kombinasi, setiap ml mengandung: natrium klorida 4,40 0 0 0
mg + kalium klorida 0,80 mg (tetes mata)
625 Kombinasi, setiap ml mengandung: natrium klorida 4,40 0 0 0
mg + kalium klorida 0,80 mg (tetes mata)
626 Kombinasi, setiap ml mengandung: natrium klorida 4,40 0 0 0
mg + kalium klorida 0,80 mg (tetes mata)
627 Kombinasi: Amoksisilin 1.000 mg + Asam klavulanat 200 0 0 0
mg, Inj 1.200 mg
628 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg 0 0 0
nebules
629 Kombinasi: kaolin 550 mg + pektin 20 mg 0 0 0
630 Kombinasi: Latanoprost 0,05 mg + Timolol 5 mg, tts mata 0 0 0

631 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 0 0 0

250 mg
632 Kombinasi: parafin + gliserin + fenolftalein 0 0 0
633 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 10 31.25 468.75
mcg ih 50 mcg/puff
634 Kombinasi: salmeterol 50 mcg + flutikason propionat 100 0 0 0
mcg ih 100 mcg/puff
635 Kombinasi: salmeterol 50 mcg + flutikason propionat 500 4 3.916666667 58.75
mcg ih 500 mcg/puff
636 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 12 21.91666667 328.75
mcg ih 250 mcg/puff
637 Kombinasi: spironolakton 25 mg + tiabutazin 2,5 mg 0 0 0
638 Komposit resin 0 0 0
639 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 0 0 0
mg+ trimetoprim 80 mg
640 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 100 624 9360
mg+ trimetoprim 160 mg
641 Kotrimoksazol kombinasi tiap 5 ml suspensi : 0 0 0
sulfametoksazol 200 mg + trimetoprim 40 mg
642 Kuinin inj 25% (i.v.) 0 0 0
643 Kuinin tab 200 mg 0 0 0
644 Laktulosa sir 3,335 g/5 ml 23 78 1170
645 Lamivudin (3TC) tab 150 mg 0 0 0
646 Lamivudin tab 100 mg 0 0 0
647 Lamotrigin Tab 100 mg 0 0 0
648 Lamotrigin tab 50 mg 0 0 0
649 Lamotrigin tab dispersible 25 mg 0 0 0
650 Lansoprazol inj 30 mg/ml 360 1922.083333 28831.25
651 Lansoprazol kaps 30 mg 0 0 0
652 Lapatinib tab 250 mg 0 0 0
653 Larutan mengandung Asam Amino (Asam Amino 10%) 0 0 0

654 Larutan mengandung Asam Amino (Asam Amino 100 g, 0 0 0

Total N 15,7 g, Na+ 2 mEq, Asetat 120 mEq)
655 Larutan mengandung Asam Amino (Asam Amino 27 g, 0 0 0
Sorbitol 50 g, Cl-52 mEq)
656 Larutan mengandung Asam Amino (Asam Amino 30 g, 0 0 0
Glukosa 7,3 % dan elektrolit) 1000 ml
657 Larutan mengandung Asam Amino (Asam Amino 30 g, 0 0 0
Glukosa 7,3 % dan elektrolit) 500 ml
658 Larutan mengandung Asam Amino (Asam Amino 5% 0 0 0
dengan BCAA 45%, L-Ornithine L Aspartate 8.03 gr/L,
Sorbitol 50 gr/L, Xylitol 50 gr/L)

659 Larutan mengandung Asam Amino (Asam Amino 6%, 2 31.25 468.75
mengandung Taurine 0,24 gr/l) : Aminosteril Infant 6%

660 Larutan mengandung Asam Amino (Asam Amino 7% (total 0 0 0

protein 17,5 g) dengan kandungan asam amino esensial
(EAA) dan non esensial (NEAA) yang seimbang EAA : NEAA
= 60 : 40))

661 Larutan mengandung Asam Amino (Asam Amino 72.05 g, 0 0 0

Total N 11.53 g, AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46
mEq)

662 Larutan mengandung Asam Amino (Asam Amino 79.9 g, 0 0 0

Total N 12.2 g, Na+ 14 mEq, Cl 94 mEq)
663 Larutan mengandung Asam Amino (Asam amino 8%) : 0 0 0
Aminosteril N-Hepa
664 Larutan mengandung Asam Amino (Asam Amino 9%, 0 0 0
Komposisi: Asam Amino esensial: Asam Amino non
esensial = 60 : 40)

665 Larutan mengandung Asam Amino (Asam Amino esensial 0 0 0

7%+Xylitol 10 g/L)
666 Larutan mengandung Asam Amino (BCAA 25 gr/L, L- 0 0 0
Ornithine L Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7
gr/L, Piridoxin 0.12 gr/L)

667 Larutan mengandung Asam Amino (Glutamine 20 g) 0 0 0

668 Larutan mengandung Asam Amino (Kombinasi : asam 0 0 0
amino, glukosa, dan lipid) (Lipid Peri 1250)
669 Larutan mengandung Asam Amino (Kombinasi : glukosa, 0 0 0
emulsi lemak, dan asam amino) (Lipid Special 1250)
670 Larutan mengandung Asam Amino (Kombinasi : glukosa, 0 0 0
emulsi lemak, dan asam amino) (Lipid Special 625)

671 Larutan mengandung asam amino (kombinasi AA 50 g/L, 0 0 0

sorbitol 50 g/L, Xylitol 50 g/L, vit C 0,4 g/L, Inositol 0,5 g/L,
Niasinamid 0,06 g/L, vit B6 0,04 g/L, Riboplavin Na Fosfat
2,5 mg/L, elektrolit)

672 Larutan mengandung Asam Amino (Kombinasi Asam 0 0 0

amino 50 g/L, vitamin dan elektrolit)
673 Larutan mengandung Asam Amino (Kombinasi Glukosa 0 0 0
dan elektrolit 150 gr + Asam Amino 48 gr dgn akses
sentral)

674 Larutan mengandung Asam Amino (Kombinasi Glukosa 0 0 0

dan elektrolit 80 gr + Asam Amino 40 gr)
675 Larutan mengandung Asam Amino + Elektrolit + 0 0 0
Karbohidrat + Lipid (Kombinasi Asam Amino: 45gr,
Glukosa: 130gr, Lipid: 68gr dan Elektrolit (Kalori = 1400
kkal, Akses peripheral))

676 Larutan mengandung asam amino + elektrolit + 0 0 0

Karbohidrat + Lipid (Glukosa 103 g, Asam amino 46 g,
Elektrolit, Lipid 41 g dengan Fish Oil 6,1 g)

677 Larutan mengandung asam amino + elektrolit + 0 0 0

Karbohidrat + Lipid (Glukosa 135 g, Asam amino 60 g,
Elektrolit, Lipid 54 g dengan Fish Oil 8 g)

678 Larutan mengandung asam amino + elektrolit + 0 0 0

Karbohidrat + Lipid (Glukosa 63 g, Asam amino 25 g,
Elektrolit, Lipid 19 g dengan Fish Oil 2,8 g)

679 Larutan Mengandung Asam amino + Elektrolit + 0 0 0

Karbohidrat + Lipid (Kombinasi Asam amino 56,9 g, Lipid
40 g, Glukosa 110 g dan Elektrolit)

680 Larutan mengandung Asam Amino + Elektrolit + 0 0 0

Karbohidrat + Lipid (Kombinasi Asam Amino: 34gr,
Glukosa: 97gr, Lipid: 51gr dan Elektrolit (Kalori = 1000 kkal,
Akses peripheral))

681 Larutan mengandung Elektrolit (Kalium Klorida) 21 46.83333333 702.5

682 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) 0 0 0
(KN1)
683 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) 0 0 0

684 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 0 0 0

109 mEq, Ca 3 mEq, Asetat 28 mEq) Ringer Asetat

685 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 0 0 0

109 mEq, Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
686 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 0 0 0
18.75 gr) (KA EN 1B)
687 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 0 0 0
113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2
gr/L, elektrolit)

688 Larutan mengandung Elektrolit (Tiap 1000 ml 0 0 0

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

689 Larutan mengandung Karbohidrat + Elektrolit (D2,5%+KCL 0 0 0

0,15%+NaCl 0,45%) (KDN1)
690 Larutan mengandung Karbohidrat + Elektrolit (D2,5%+KCL 0 0 0
0,3%+NaCl 0,45%) (KDN2)
691 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 0 0 0
66 g, Xylitol 60 g/ L)
692 Larutan mengandung Karbohidrat (Fructose 200 g, glucose 0 0 0
110 g, Xylitol 100 g/ L)
693 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 0 0 0
33 g, Xylitol 30 g/ L)
694 Larutan mengandung Karbohidrat (Maltose 10%) 0 0 0
695 Larutan mengandung Karbohidrat + Elektrolit (25.00g 0 0 0
maltose, 3.00 g sodium chloride, 0.15 g potassium
chloride, 0.10 g calcium chloride dihydrate dan 1.55 g
sodium lactate)

696 Larutan mengandung Karbohidrat + Elektrolit (Acetate, 0 0 0

Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L)
697 Larutan mengandung Karbohidrat + Elektrolit (Asam 0 0 0
amino 28 gr/L, Glukosa 100 gr/L, elektrolit)
698 Larutan mengandung Karbohidrat + Elektrolit (Asam 0 0 0
amino 28 gr/L, Glukosa 75 gr/L, elektrolit)
699 Larutan mengandung Karbohidrat + Elektrolit (Dextrose 0 0 0
5%, NaCL 0,45%, KCl) (HSD)
700 Larutan mengandung Karbohidrat + Elektrolit (Fructose 0 0 0
120 g, glucose 66 g, Xylitol 60 g/ L + elektrolit)

701 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 0 0 0

g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk
injeksi ad 1000 ml)

702 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 0 0 0

g ; Natrium Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-
NS)

703 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 0 0 0

25,0 g; NaCl: 4,5 g)
704 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 0 0 0
55.0 g; NaCl: 2.25 g) (D5-1/4NS)
705 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 0 0 0
55.0 g; NaCl: 4.5 g) (D5-1/2NS)
706 Larutan mengandung karbohidrat + elektrolit (Kombinasi 0 0 0
NaCl 18,6 g, KCl 0,3 g, CaCl2 0,48 g, dextrose 50 g per 1000
ml)

707 Larutan mengandung Karbohidrat + Elektrolit (Larutan 0 0 0

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

708 Larutan mengandung Karbohidrat + Elektrolit (Larutan 0 0 0

Ringer & Glukosa 5%)
709 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, 0 0 0
KCL 1.5g, Glukosa 100 gr)
710 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, 0 0 0
KCL 1.5g, Na Lactate 2.24 g, Glukosa 100 gr)
711 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 112 249.6666667 3745
gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN
3B)

712 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 0 0 0

gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN
3A)

713 Larutan mengandung Lipid (Emulsi lemak 20%) 0 0 0

714 Larutan mengandung Lipid (Highly refined fish oil, Glyserol 0 0 0
dan purified egg phospolipid)
715 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 0 0 0
20% 100 ml)
716 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 0 0 0
20% 250 ml)
717 Larutan mengandung Lipid (Kombinasi Glukosa dan 0 0 0
elektrolit 180 gr + Asam Amino 71.8 gr + Lipid 50 gr dgn
akses sentral)

718 Larutan mengandung Lipid (Kombinasi Glukosa dan 0 0 0

elektrolit 80 gr + Asam Amino 40 gr + Lipid MCT/LCT 50 gr)

719 Larutan mengandung Lipid (Kombinasi Glukosa dan 0 0 0

elektrolit 90 gr + Asam Amino 35.9 gr + Lipid 25 gr dgn
akses sentral)

720 Latanoprost tts mata 0,005% 0 0 0

721 Leflunomid tab sal selaput 20 mg 0 0 0
722 Lenograstim inj 263 mcg/vial 0 0 0
723 Letrozol tab 2,5 mg 0 0 0
724 Leuprorelin asetat serb inj 1,88 mg 0 0 0
725 Leuprorelin asetat serb inj 11,25 mg 0 0 0
726 Leuprorelin asetat serb inj 22,5 mg 0 0 0
727 Leuprorelin asetat serb inj 3,75 mg 0 0 0
728 Leuprorelin asetat serb inj 7,5 mg 0 0 0
729 Levetirasetam tab 250 mg 0 0 0
730 levetirasetam tab 500 mg 0 0 0
731 Levofloksasin inf 5 mg/ml 0 0 0
732 Levofloksasin inf 5 mg/ml 0 0 0
733 Levofloksasin tab 500 mg 231 624 9360
734 Levofloksasin tts mata 0,5% 0 0 0
735 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) 0 0 0
736 Levotiroksin tab 100 mcg 32 240.25 3603.75
737 Levotiroksin tab 50 mcg 0 0 0
738 Lidokain gel 2% 0 0 0
739 Lidokain inj 1 % (infltr) 0 0 0
740 Lidokain inj 100 mg, vial (i.v.) 0 0 0
741 Lidokain inj 2% (infiltr/p.v.) 14 624.0833333 9361.25
742 Lidokain spray oral 10% 0 0 0
743 Linestrenol tab 0,5 mg 0 0 0
744 Linestrenol tablet 5 mg 0 0 0
745 Lisinopril tab 10 mg 421 2252.666667 33790
746 Lisinopril tab 20 mg 121 1026.5 15397.5
747 Lisinopril tab 5 mg 0 0 0
748 Litium karbonat tab 200 mg 0 0 0
749 Litium karbonat tab 400 mg 0 0 0
750 Loperamid tab 2 mg 201 156 2340
751 Lopinavir 100 mg + Ritonavir 25 mg 0 0 0
752 Loratadin tab 10 mg 100 156 2340
753 Lorazepam tab 0,5 mg 0 0 0
754 Lorazepam tab 1 mg 0 0 0
755 Lorazepam tab sal 2 mg 50 62.41666667 936.25
756 Low molecule feri sucrose inj amp 100 mg/5 ml 0 0 0
757 Lugol 0 0 0
758 MAA (macro agregate albumin) 0,11-2,5 mg albumin 0 0 0
aggregated/reaction vial
759 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial 0 0 0

760 Magnesium sulfat inj 20% 0 0 0

761 Magnesium sulfat inj 20% 30 46.83333333 702.5
762 Magnesium sulfat inj 40% 0 0 0
763 Magnesium sulfat inj 40% 10 62.41666667 936.25
764 Magnesium sulfat serb, ktg 30 g 0 0 0
765 Manitol lar infus 20% 40 31.25 468.75
766 Manitol lar infus 20% 0 0 0
767 Manitol lar infus 20% 0 0 0
768 Maprotilin hcl tab sal 25 mg 0 0 0
769 Maprotilin hcl tab sal 50 mg 0 0 0
770 MDP (methylene diphosphonate) 1 mg methylene 0 0 0
diphosphonic acid/ml
771 Mebendazol sir 100 mg/5 ml 0 0 0
772 Mebendazol tab 100 mg 0 0 0
773 Mebendazol tab 500 mg 0 0 0
774 Medroksi progesteron asetat inj 150 mg/ml 0 0 0
775 Medroksi progesteron asetat inj 200 mg/ml 0 0 0
776 Medroksi Progesteron Asetat Inj 50 mg/ml 0 0 0
777 Medroksi progesteron asetat tab 10 mg 0 0 0
778 Medroksi progesteron asetat tab 100 mg 0 0 0
779 Medroksi progesteron asetat tab 250 mg 0 0 0
780 Medroksi progesteron asetat tab 5 mg 0 0 0
781 Melfalan tab 2 mg 0 0 0
782 Merkaptopurin tab 50 mg 0 0 0
783 Meropenem serb inj 1000 mg/vial 20 46.83333333 702.5
784 Meropenem serb inj 500 mg/vial 0 0 0
785 Mesalazin tab sal 250 mg 0 0 0
786 Mesna inj 100 mg/ml 0 0 0
787 Metadon sir 50 mg/5 ml 0 0 0
788 Metamizol Inj 500 mg/ml 500 2165.333333 32480
789 Metenamin mandelat (heksamin mandelat) tab salut 0 0 0
enterik 500 mg
790 Metformin tab 500 mg 1000 12310 184650
791 Metformin tab 850 mg 76 176.3333333 2645
792 Metildopa tab sal 250 mg 31 156 2340
793 Metilergometrin inj 0,2 mg/ml 22 40.33333333 605
794 Metilergometrin tab salut 0,125 mg 20 234 3510
795 Metilfenidat tab lepas lambat 18 mg 0 0 0
796 Metilfenidat tab lepas lambat 36 mg 0 0 0
797 Metilfenidat tab SR 10 mg 0 0 0
798 Metilfenidat tab SR 20 mg 0 0 0
799 Metilprednisolon inj 125 mg/2 ml 10 93.66666667 1405
800 Metilprednisolon inj 500 mg/8 ml 0 0 0
801 Metilprednisolon tab 16 mg 100 1313.583333 19703.75
802 Metilprednisolon tab 4 mg 200 1985.833333 29787.5
803 Metilprednisolon tab 8 mg 0 0 0
804 Metoklopramid drop 2 mg/ml 0 0 0
805 Metoklopramid inj 5 mg/ml 211 845 12675
806 Metoklopramid sir 5 mg/5 ml 12 31.25 468.75
807 Metoklopramid tab 10 mg 20 78 1170
808 Metoklopramid tab 5 mg 0 0 0
809 Metoprolol tartat inj 1 mg/ml 0 0 0
810 Metotreksat Inj 10 mg/ml 0 0 0
811 Metotreksat inj 2,5 mg/ml 0 0 0
812 Metotreksat serb inj 25 mg/ml 0 0 0
813 Metotreksat serb inj 5 mg/vial 0 0 0
814 Metotreksat tab 2,5 mg 0 0 0
815 Metronidazol lar inf 5 mg/ml 20 140.4166667 2106.25
816 Metronidazol ovula 500 mg 13 30.75 461.25
817 Metronidazol sup 500 mg 0 0 0
818 Metronidazol susp 125 mg/5 ml 0 0 0
819 Metronidazol susp 125 mg/5 ml 0 0 0
820 Metronidazol tab 250 mg 0 0 0
821 Metronidazol tab 500 mg 400 468 7020
822 MIBG (meta-iodobenzylguanidine) 0 0 0
823 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial 0 0 0
824 Midazolam inj 1 mg/ml (i.v.) 0 0 0
825 Midazolam inj 5 mg/ml (i.v.) 13 132.6666667 1990
826 Mikafungin Na serb inj 50 mg/vial 0 0 0
827 Mikofenolat mofetil tab 500 mg 0 0 0
828 Mikofenolat Sodium Tab Sal 180 mg 0 0 0
829 Mikofenolat Sodium Tab Sal 360 mg 0 0 0
830 Mikonazol krim 2% 5 23.41666667 351.25
831 Mikonazol serb 2% 0 0 0
832 Milrinone inj 1 mg/ml 0 0 0
833 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper 0 0 0
sulfate, Magnesium Chloride Anhydrous, Potassium
Chloride, Zinc Acetate)

834 Mitomisin serb inj 10 mg 0 0 0

835 Mitomisin serb inj 2 mg 0 0 0
836 Modified fluid gelatine BM 30 000 lar inf 4% 0 0 0
837 Moksifloksasin inf 1,6 mg/mL 0 0 0
838 Moksifloksasin tab 400 mg 0 0 0
839 Moksifloksasin tts mata 0,5% 0 0 0
840 Mometason furoat krim 0,1% 0 0 0
841 Mometason furoat krim 0,1% 0 0 0
842 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) 20 46.83333333 702.5
843 Morfin Hcl tab 10 mg 0 0 0
844 Morfin Hcl tab SR 10 mg 0 0 0
845 Morfin Hcl tab SR 15 mg 0 0 0
846 Morfin Hcl tab SR 30 mg 0 0 0
847 Mupirosin krim 2% 0 0 0
848 Mupirosin salep 2% 0 0 0
849 N-asetil sistein granula 200 mg 0 0 0
850 N-asetil sistein ih 100 mg/ml 0 0 0
851 N-asetil sistein kaps 200 mg 200 1803.5 27052.5
852 NaCl 0,9% Larutan 0 0 0
853 NaCl 0,9% Larutan 300 1872 28080
854 NaCl 0,9% Larutan 0 0 0
855 Nadroparin inj 10 mg/ml 0 0 0
856 Nadroparin inj 9.500 Axa/ml syringe 0,3 Ml 0 0 0
857 Nadroparin inj 9.500 Axa/ml, syringe 0,4 ml 0 0 0
858 Nadroparin inj 9.500 Axa/ml, syringe 0,6 ml 0 0 0
859 Nalokson inj 0,4 mg/ml 0 0 0
860 Natamisin tts mata 5% 0 0 0
861 Natamisin tts mata 50 mg/ml 0 0 0
862 Natrium aminohipurat inj 200 mg/ml (i.v.) 0 0 0
863 Natrium bikarbonat inj 8,4% (i.v.) 0 0 0
864 Natrium bikarbonat tab 500 mg 12 39 585
865 Natrium diklofenak inj 25 mg/mL 0 0 0
866 Natrium diklofenak tab 25 mg 0 0 0
867 Natrium diklofenak tab 50 mg 200 313.8333333 4707.5
868 Natrium Diklofenak Tetes Mata 1 mg/ml 0 0 0
869 Natrium fluoresein tts mata 2% 0 0 0
870 Natrium fosfat lar oral 0 0 0
871 Natrium fusidat krim 20 mg/g 0 0 0
872 Natrium fusidat salep 20 mg/g 0 0 0
873 Natrium hialuronat tts mata 0 0 0
874 Natrium hipoklorit cairan konsentrat 5% 0 0 0
875 Natrium klorida tts mata 50 mg/mL 0 0 0
876 Natrium tiosulfat inj 25% (i.v.) 0 0 0
877 Neostigmin inj 0,5 mg/ml 2 39 585
878 Nevirapin tab 200 mg 0 0 0
879 Nifedipin kaps 10 mg 0 0 0
880 Nifedipin tab SR 20 mg 0 0 0
881 Nifedipin tab SR 30 mg 500 1723.833333 25857.5
882 Nikardipin inj 10 mg/vial 0 0 0
883 Nikotinamid tab 100 mg 0 0 0
884 Nikotinamid tab 5 mg 0 0 0
885 Nilotinib kaps 150 mg 0 0 0
886 Nilotinib tab 200 mg 0 0 0
887 Nimodipin inf 0,2 mg/ml 0 0 0
888 Nimodipin tab 30 mg 0 0 0
889 Nistatin susp 100.000 UI/ml 14 62.41666667 936.25
890 Nistatin tab salut 500.000 UI 0 0 0
891 Nistatin tab vaginal 100.000 UI 5 62.41666667 936.25
892 Nitrofurantoin tab 50 mg 0 0 0
893 Nitrogen oksida ih, gas dlm tabung 0 6.5 97.5
894 Nomegestrol asetat Kaps/tab 5 mg 0 0 0
895 Norepinefrin inj 1 mg/ml 0 78 1170
896 Noretisteron tab 5 mg 15 124.8333333 1872.5
897 Obat Anti Tuberculosis FDC Kategori Anak 0 0 0
898 Obat Anti Tuberculosis FDC Kategori I 0 0 0
899 Obat Anti Tuberculosis FDC Kategori II 0 0 0
900 Obat Anti Tuberculosis FDC Kategori Sisipan 0 0 0
901 Obat Anti Tuberculosis Kombipak Anak 0 0 0
902 Obat Anti Tuberculosis Kombipak Dewasa 0 0 0
903 Ofloksasin tab 200 mg 0 0 0
904 Ofloksasin tab 400 mg 0 0 0
905 Ofloksasin tts telinga 3% 0 0 0
906 Oksaliplatin serb inj 100 mg/vial 0 0 0
907 Oksaliplatin serb inj 50 mg/vial 0 0 0
908 Oksigen ih, gas dlm tabung 10 1092 16380
909 Oksikodon inj 10 mg/ml 0 0 0
910 Oksikodon kapsul 10 mg 0 0 0
911 Oksikodon kapsul 20 mg 0 0 0
912 Oksikodon kapsul 5 mg 0 0 0
913 Oksikodon tab lepas lambat 10 mg 0 0 0
914 Oksikodon tab lepas lambat 15 mg 0 0 0
915 Oksikodon tab lepas lambat 20 mg 0 0 0
916 Oksimetazolin tts hidung 0,025% 0 0 0
917 Oksimetazolin tts hidung 0,050% 0 0 0
918 Oksitetrasiklin 1% Salep Mata 0 0 0
919 Oksitetrasiklin hcl inj 50 mg/ml (i.m.) 0 0 0
920 Oksitosin inj 10 UI/ml 50 884 13260
921 Okskarbazepin susp 60 mg/mL 0 0 0
922 Oktreotid asetat 0,05 - 6 mg/ml 0 0 0
923 Oktreotid LAR serb inj 20 mg 0 0 0
924 Oktreotid LAR serb inj 30 mg 0 0 0
925 Olanzapin inj 10 mg/2 ml 0 0 0
926 Olanzapin tab sal 10 mg 0 0 0
927 Olanzapin tab sal 5 mg 0 0 0
928 Olodaterol cairan ih 2,5 mcg/semprot 0 0 0
929 Olopatadin tts mata 0,1% 0 0 0
930 Omeprazol inj 40 mg/10 ml 30 249.6666667 3745
931 Omeprazol kaps 20 mg 500 5719 85785
932 Ondansetron inj 2 mg/ml 100 236.5 3547.5
933 Ondansetron tab 4 mg 231 156 2340
934 Ondansetron tab 8 mg 0 0 0
935 Paklitaksel inj 6 mg/ml, vial@16,7 ml (inj 100 mg) 0 0 0
936 Paklitaksel inj 6 mg/ml, vial@5 ml (inj 30 mg) 0 0 0
937 Paklitaksel inj 6 mg/ml, vial@50 ml (inj 300 mg) 0 0 0
938 Paliperidon palmitat Inj 100 mg/mL 0 0 0
939 Paliperidon palmitat Inj 150 mg/1,5 mL 0 0 0
940 Paliperidon palmitat Inj 50 mg/0,5 mL 0 0 0
941 Paliperidon palmitat Inj 75 mg/0,75 mL 0 0 0
942 Pankuronium inj 2 mg/ml 0 0 0
943 Paraformaldehid lar buffer 10% 0 0 0
944 Paraformaldehid tab 1 g 0 0 0
945 Parasetamol drips (infus) 1000 mg/100 ml 50 156 2340
946 Parasetamol sir 120 mg/5 ml 43 455 6825
947 Parasetamol tab 500 mg 677 3207.75 48116.25
948 Parasetamol tts 60 mg/0,6 ml 0 93.66666667 1405
949 Pasta devitalisasi (non arsen) 0 0 0
950 Pasta pengisi saluran akar (pasta) 0 0 0
951 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml 0 0 0
952 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml 0 0 0
953 Pegylated interferon alfa-2b serb inj 100 mcg/ml 0 0 0
954 Pegylated interferon alfa-2b serb inj 50 mcg/ml 0 0 0
955 Pegylated interferon alfa-2b serb inj 80 mcg/ml 0 0 0
956 Pemetreksed serb inj 500 mg 0 0 0
957 Pengganti plasma kombinasi : poligelin (ekivalen dengan 0 0 0
0,63 g nitrogen 17,5 g ; natrium klorida 0,19 g ; kalsium
klorida 0,19 g ; kalsium (terikat pada polipeptida) 0,125 g

958 Perak nitrat lar 20% 0 0 0

959 Perak sulfadiazin krim 1% 0 0 0
960 Perindoprilarginin tab 5 mg 0 0 0
961 Permetrin krim 5 % 0 0 0
962 Petidin inj 50 mg/ml (i.m./s.k./i.v.) 10 31.25 468.75
963 Pilokarpin tts mata 2% 0 0 0
964 Pilokarpin tts mata 2% 0 0 0
965 Pioglitazon tab 15 mg 0 0 0
966 Pioglitazon tab 30 mg 300 714.5 10717.5
967 Pirantel pamoat susp 125 mg/5 ml 0 0 0
968 Pirantel pamoat tab 500 mg 0 0 0
969 Pirantel pamoat tab scored 125 mg 0 2 30
970 Pirantel pamoat tab scored 250 mg 0 0 0
971 Piridoksin (vitamin B6) inj 100 mg/ml 0 0 0
972 Piridoksin (vitamin B6) tab 10 mg 0 0 0
973 Piridoksin (vitamin B6) tab 25 mg 200 2424.25 36363.75
974 Piridostigmin tab sal 60 mg 0 0 0
975 Pirimetamin tab 25 mg 0 0 0
976 Podofilin tingtur 25 % 0 0 0
977 Polietilen glikol 0 0 0
978 Polikresulen 0 0 0
979 Povidon iodin lar 100 mg/ml 0 0 0
980 Povidon iodin lar 100 mg/ml 0 0 0
981 Povidon iodin lar 100 mg/ml 2 31.25 468.75
982 Povidon iodin lar 100 mg/ml 0 0 0
983 Pramipeksol tab 0,125 mg 0 0 0
984 Pramipeksol tab ER 0,375 mg 0 274.5833333 4118.75
985 Pramipeksol tab ER 0,750 mg 0 0 0
986 Pravastatin tab 10 mg 0 0 0
 987 Pravastatin tab 20 mg 0 0 0
988 Prazikuantel tab scored 300 mg 0 0 0
989 Prazikuantel tab scored 600 mg 0 0 0
990 Prednisolon tts mata 10 mg/ml 0 0 0
991 Prednison tab 5 mg 0 0 0
992 Primakuin tab 15 mg 0 0 0
993 Probenesid tab 500 mg 0 0 0
994 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) 0 0 0
995 Prokaterol HCl cairan ih 30 mcg 0 0 0
996 Prokaterol HCl cairan ih 50 mcg 0 0 0
997 Prokaterol HCl serb ih 10 mcg 0 0 0
998 Propiltiourasil tab 100 mg 144 468 7020
999 Propofol inj 1% (i.v. Bolus) 0 0 0
1000 Propranolol inj 1 mg/ml (i.v.) 0 62.41666667 936.25
1001 Propranolol tab 10 mg 400 1092 16380
1002 Propranolol tab 40 mg 400 149.8333333 2247.5
1003 Prostaglandin (PGE 1) Inj 500 mcg/ml 0 0 0
1004 Protamin sulfat inj 10 mg/ml (i.m.) 0 0 0
1005 Quetiapin tab 100 mg 0 0 0
1006 Quetiapin tab SR 200 mg 0 0 0
1007 Quetiapin tab SR 300 mg 0 0 0
1008 Quetiapin tab SR 400 mg 0 0 0
1009 Ramipril tab 10 mg 160 376 5640
1010 Ramipril tab 2,5 mg 100 1148.166667 17222.5
1011 Ramipril tab 5 mg 0 65 975
1012 Ranibizumab inj 10 mg/ml 0 0 0
1013 Ranitidin inj 25 mg/ml 100 2279.166667 34187.5
1014 Ranitidin tab 150 mg 150 1248 18720
1015 Retinol (vitamin A) kaps lunak 100.000 UI 0 0 0
1016 Retinol (vitamin A) kaps lunak 200.000 UI 0 0 0
1017 Ribavirin tab 200 mg 0 0 0
1018 Rifampisin kaps 300 mg 0 0 0
1019 Rifampisin tab 450 mg 0 0 0
1020 Rifampisin tab 600 mg 0 0 0
1021 Rilpivirine 25 mg 0 0 0
1022 Ringer Laktat Larutan 200 1872 28080
1023 Ringer Laktat Larutan 1000 ml 0 0 0
1024 Risedronat tab sal selaput 35 mg 0 0 0
1025 Risperidon oral solution 1 mg/mL 0 0 0
1026 Risperidon tab 3 mg 0 0 0
1027 Risperidon tab sal 1 mg 0 0 0
1028 Risperidon tab sal 2 mg 150 312 4680
1029 Rituksimab inf 10 mg/ml (vial 10 ml) 0 0 0
1030 Rituksimab Inf 10 mg/ml (vial 50 ml) 0 0 0
1031 Rituksimab inj 100 mg/ml 0 0 0
1032 Rituksimab inj 500 mg/ml 0 0 0
1033 Rivaroksaban tab sal 10 mg 0 0 0
1034 Rivaroksaban tab sal 15 mg 0 0 0
1035 Rivaroksaban tab sal 20 mg 0 0 0
1036 Rokuronium inj 50 mg/5 ml (i.v.) 0 0 0
1037 Ropinirol tab lepas lambat 2 mg 0 0 0
1038 Ropinirol tab lepas lambat 4 mg 0 0 0
1039 Ropinirol tab lepas lambat 8 mg 0 0 0
1040 Ropivakain Inj 7,5 mg/ml 0 0 0
1041 Rosuvastatin tab 10 mg 0 0 0
1042 Salbutamol aerosol 100 mcg 6 13.75 206.25
1043 Salbutamol cairan ih 0,1% 0 11 165
1044 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler 0 0 0
1045 Salbutamol lar ih 0,5 % 0 0 0
1046 Salbutamol nebules vial 2,5 mg 31 780 11700
1047 Salbutamol sir 2 mg/5 ml 0 0 0
1048 Salbutamol tab 2 mg 0 0 0
1049 Salbutamol tab 4 mg 500 1953.083333 29296.25
1050 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 0 0 0
4%
1051 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 0 0 0
4%
1052 Secukinumab serb inj 150 mg 0 0 0
1053 Sefadroksil kaps 250 mg 0 0 0
1054 Sefadroksil kaps/tab 500 mg 600 3120 46800
1055 Sefadroksil sir kering 125 mg/5 ml 43 102.25 1533.75
1056 Sefadroksil sir kering 250 mg/5 ml 0 0 0
1057 Sefaleksin kaps 500 mg 0 0 0
1058 Sefazolin serb inj 1 g/vial 0 0 0
1059 Sefepim serb inj 1000 mg/vial 0 0 0
1060 Sefiksim sir 100 mg/5 ml 0 0 0
1061 Sefiksim tab 100 mg 700 6240 93600
1062 Sefiksim Tab 200 mg 0 0 0
1063 Sefoperazon serb inj 1.000 mg/vial 121 187.25 2808.75
1064 Sefotaksim inj 500 mg/vial 0 0 0
1065 Sefotaksim serb inj 1.000 mg/vial 134 327.5833333 4913.75
1066 Sefpirom serb inj 1000 mg 0 0 0
1067 Sefpodoksim proksetil tab sal 100 mg 0 0 0
1068 Seftazidim serb inj 1.000 mg/vial 20 62.41666667 936.25
1069 Seftriakson serb inj 1.000 mg/vial 367 1497.583333 22463.75
1070 Sefuroksim serb inj 750 mg/vial 0 0 0
1071 Sefuroksim tab 250 mg 0 0 0
1072 Sefuroksim tab sal 500 mg 0 0 0
1073 Sertralin tab sal 50 mg 0 0 0
1074 Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) 0 0 0
inj (i.m./i.v.)
1075 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj 0 0 0
(i.m./i.v.)
1076 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ 0 0 0

1077 Serum antirabies inj 100 UI/ml 0 0 0

1078 Serum antirabies inj 200 UI/ml 0 0 0
1079 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) 0 0 0

1080 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) 0 0 0

1081 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) 0 0 0

1082 Setirizin sir 5 mg/5 ml. 34 78 1170

1083 Setirizin tab 10 mg 322 2556.916667 38353.75
1084 Setuksimab inj 5 mg/ml 0 0 0
1085 Sevelamer karbonat Tab 800 mg 0 0 0
1086 Sevofluran cairan ih 250 ml 0 0 0
1087 Sianokobalamin (vitamin B12) inj 500 mcg/ml 0 0 0
1088 Sianokobalamin (vitamin B12) tab 50 mcg 0 0 0
1089 Siklofosfamid serb inj 1000 mg/vial (i.v.) 0 0 0
1090 Siklofosfamid serb inj 200 mg/vial (i.v.) 0 0 0
1091 Siklofosfamid serb inj 500 mg/vial (i.v.) 0 0 0
1092 Siklopentolat tetes mata 1% 0 0 0
1093 Siklosporin inj 100 mg/ml 0 0 0
1094 Siklosporin inj 50 mg/ml 0 0 0
1095 Siklosporin kaps 100 mg 0 0 0
1096 Siklosporin kaps lunak 25 mg 0 0 0
1097 Siklosporin Kaps lunak 50 mg 0 0 0
1098 Sildenafil Tab 20 mg 0 0 0
1099 Silodosin tab 4 mg 0 0 0
1100 Silostazol kaps SR 100 mg 0 0 0
1101 Silostazol tab 100 mg 300 1248 18720
1102 Simvastatin tab sal 10 mg 322 1845.5 27682.5
1103 Simvastatin tab sal 20 mg 655 3361.833333 50427.5
1104 Simvastatin tab sal selaput 40 mg 0 0 0
1105 Siprofloksasin inf 2 mg/ml 22 106.5833333 1598.75
1106 Siprofloksasin tab scored 500 mg 0 188 2820
1107 Siprofloksasin tetes mata 3 mg/ml 0 0 0
1108 Sisplatin serb inj 10 mg 0 0 0
1109 Sisplatin serb inj 50 mg 0 0 0
1110 Sitarabin inj 50 mg 0 0 0
1111 Sitarabin serb inj 100 mg (i.m./i.v./s.k.) 0 0 0
1112 Sofosbuvir tab sal selaput 400 mg 0 0 0
1113 Solifenasin tab 10 mg 0 0 0
1114 Solifenasin tab 5 mg 0 0 0
1115 Somatostatin serb Inj 3000 mcg/mL 0 0 0
1116 Soybean oil 200 g, ovolecithin 12 g, glycerol 22 g, Na 0 0 0
hydroxide
1117 Spiramisin tab 250 mg 0 0 0
1118 Spiramisin tab 500 mg 0 0 0
1119 Spironolakton tab 100 mg 200 1084.25 16263.75
1120 Spironolakton tab 25 mg 500 4887.416667 73311.25
1121 Stannous pyrophosphate 27,6 mg sodium 0 0 0
pyrophosphate/vial
1122 Stavudin tab 30 mg 0 0 0
1123 Streptokinase serb inj 1,5 juta UI/vial 0 0 0
1124 Streptomisin serb inj 1.000 mg/vial 0 0 0
1125 Sufentanil inj 5 mcg/ml (i.v.) 0 0 0
1126 Sugammadeks inj 100 mg/ml 0 0 0
1127 Sukralfat susp 500 mg/5 ml 32 124.8333333 1872.5
1128 Sukralfat tab 500 mg 0 0 0
1129 Suksinilkolin inj 20 mg/ml (i.v./i.m.) 0 0 0
1130 Suksinilkolin inj 50 mg/ml (i.v./i.m.) 0 0 0
1131 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) 0 0 0
1132 Sulfadiazin tab 500 mg 0 0 0
1133 Sulfasalazin kapl sal enterik 500 mg 0 0 0
1134 Sulfur colloid 4,5 mg gelatin/reaction vial 0 0 0
1135 Surfaktan susp 25 mg/ml (intratrakeal) 0 0 0
1136 Surgical ginggival pack 0 0 0
1137 Takrolimus kaps 0,5 mg 0 0 0
1138 Takrolimus kaps 1 mg 0 0 0
1139 Takrolimus kaps lepas lambat 0,5 mg 0 0 0
1140 Takrolimus kaps lepas lambat 1 mg 0 0 0
1141 Tamoksifen tab 10 mg 0 0 0
1142 Tamoksifen tab 20 mg 0 0 0
1143 Tamsulosin tab 0,2 mg 0 0 0
1144 Tamsulosin tab SR 0,4 mg 131 1170 17550
1145 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 0 0 0
millicuries)/ml
1146 Telbivudin tab 600 mg 0 0 0
1147 Telmisartan tab 40 mg 267 1458.666667 21880
1148 Telmisartan tab 80 mg 0 4775.166667 71627.5
1149 Temozolamid kaps 100 mg 0 0 0
1150 Temozolamid kaps 20 mg 0 0 0
1151 Tenofovir tab 300 mg 0 0 0
1152 Teofilin tab 150 mg 0 0 0
1153 Teofilin tab SR 300 mg 312 1560 23400
1154 Terazosin hcl tab 1 mg 0 0 0
1155 Terazosin hcl tab 2 mg 0 0 0
1156 Terbinafin tab 250 mg 0 0 0
1157 Terbutalin cairan ih 2,5 mg/ml 0 0 0
1158 Terbutalin inj 0,5 mg/ml 0 0 0
1159 Terbutalin serb ih 0,50 mg/dose 0 0 0
1160 Terbutalin sir 1,5 mg/5 ml 0 0 0
1161 Terbutalin tab 2,5 mg 50 33.33333333 500
1162 Testosteron inj 250 mg/ml (vial 1 ml) 0 0 0
1163 Testosteron Inj 250 mg/ml (vial 4 ml) 0 0 0
1164 Testosteron kaps lunak 40 mg 0 0 0
1165 Tetanus toxoid inj 0 0 0
1166 Tetrakain tts mata 0,5% 0 0 0
1167 Tetrasiklin kaps 250 mg 0 0 0
1168 Tetrasiklin kaps 500 mg 0 0 0
1169 Tetrasiklin Salep Mata 1% 0 0 0
1170 Thallous Chloride Tl-202 1 mg methylene diphosphonic 0 0 0
acid/ml
1171 Tiamazol tab 10 mg 21 947 14205
1172 Tiamazol tab 5 mg 0 0 0
1173 Tiamin (vitamin B1) tab 50 mg 230 126.4166667 1896.25
1174 Tikagrelor tab 90 mg 0 0 0
1175 Timolol tts mata 0,25% 0 0 0
1176 Timolol tts mata 0,5% 13 70.66666667 1060
1177 Tiopental serb inj 500 mg/amp (i.v. Bolus) 0 0 0
1178 Tiopental serb serb inj 1.000 mg/amp (i.v.) 0 0 0
1179 Tiotropium respimat ih 5 mcg/semprot 0 0 0
1180 Tiotropium respimat ih 5 mcg/semprot 0 0 0
1181 Tobramisin tetes mata 0,3% 0 0 0
1182 Tobramisin tetes mata 0,3% 0 0 0
1183 Topiramat tab 100 mg 0 0 0
1184 Topiramat tab 25 mg 0 0 0
1185 Topiramat tab 50 mg 0 0 0
1186 Tosilizumab inf 400 mg/20 mL 0 0 0
1187 Tosilizumab inf 80 mg/4 mL 0 0 0
1188 Trastuzumab serb inj 440 mg/vial 0 0 0
1189 Travoprost tts mata 0,004% 0 0 0
1190 Triamsinolon asetonid nasal spray 55 mcg/puff 0 0 0
1191 Triamsinolon inj 10 mg/ml 23 93.66666667 1405
1192 Triamsinolon inj 40 mg/ml 0 0 0
1193 Trifluoperazin tab sal 5 mg 0 0 0
1194 Triheksifenidil tab 2 mg 433 468 7020
1195 Tropikamid tts mata 0,5% 0 0 0
1196 Tropikamid tts mata 0,5% 0 0 0
1197 Tropikamid tts mata 1% 0 0 0
1198 Tuberkulin protein purified derivative 1:10 (i.k) 0 0 0
1199 Urea krim 10 % 0 0 0
1200 Vaksin BCG inj (i.k) 0 0 0
1201 Vaksin bivalen OPV (b-OPV) drops 10 dosis 0 0 0
1202 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device 21 156 2340
(Uniject) 0,5 ml (i.m)
1203 Vaksin Influenza 0 0 0
1204 Vaksin Japanese Enchepalitis (J.E) 0 0 0
1205 Vaksin jerap difteri tetanus (DT) 0 0 0
1206 Vaksin jerap difteri tetanus (Td) 0 0 0
1207 Vaksin kombinasi DPT-HB-Hib 0 0 0
1208 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) 0 0 0
1209 Vaksin Meningitis Meningokokus 0 0 0
1210 Vaksin polio IPV inj 0,5 ml 0 0 0
1211 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0 0 0

1212 Vaksin rabies, untuk manusia serb Inj 2,5 IU 0 0 0

1213 Vaksin Yellow Fever 0 0 0
1214 Valasiklovir tab 500 mg 0 0 0
1215 Valgansiklovir tab sal 450 mg 0 0 0
1216 Valproat sir 250 mg/5 ml 22 97.5 1462.5
1217 Valproat tab sal 250 mg 100 734.8333333 11022.5
1218 Valproat tab sal 500 mg 0 0 0
1219 Valproat tab sal enterik 200 mg 0 0 0
1220 Valproat tab SR 250 mg 0 0 0
1221 Valproat tab SR 500 mg 0 0 0
1222 Valsartan tab 160 mg 100 401 6015
1223 Valsartan tab 80 mg 121 234 3510
1224 Vankomisin serb inj 500 mg/vial 0 0 0
1225 Vasopresin inj 20 UI/ml (i.m./s.k.) 0 0 0
1226 Verapamil inj 2,5 mg/ml 0 0 0
1227 Verapamil tab 240 mg 0 0 0
1228 Verapamil tab 80 mg 0 0 0
1229 Vildagliptin tab 50 mg 0 0 0
1230 Vinblastin inj 1 mg/ml 0 0 0
1231 Vinkristin inj 1 mg/ml (vial 1 mL) 0 0 0
1232 Vinkristin inj 1 mg/ml (vial 2 mL) 0 0 0
1233 Vinorelbin inj 10 mg/ml, kemasan 1 ml 0 0 0
1234 Vinorelbin inj 10 mg/ml, kemasan 5 ml 0 0 0
1235 Vitamin B kompleks 210 3193.25 47898.75
1236 Vorikonazol inj 200 mg 0 0 0
1237 Vorikonazol tab sal selaput 200 mg 0 0 0
1238 Warfarin tab 1 mg 0 0 0
1239 Warfarin tab 2 mg 100 315.1666667 4727.5
1240 Zidovudin kaps 100 mg 0 0 0
1241 Zinc drops 10 mg/ml 0 0 0
1242 Zinc serb 10 mg 0 0 0
1243 Zinc sir 10 mg/ml 0 0 0
1244 Zinc sir 20 mg/5 ml 14 93.58333333 1403.75
1245 Zinc tab disp 20 mg 0 0 0
DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
RKAN METODE KONSUMSI DIKURANGI DENGAN SISA STOK PER 31 DESEMBER 2020
I: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2021 BERDASARKAN PERK
N DIBERI STEMPEL
DA FORMAT

N TINGKAT LANJUT (FKRTL) TAHUN 2021

RENCANA RENCANA RENCANA REALISASI KETERANGAN

KEBUTUHA PENGADAAN PENGADAAN PENGADAAN
N TAHUN TAHUN 2021 TAHUN 2020 TAHUN 2019
2021

(d) = (c) - (a)(e) (f) (g) (h)

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
12754 12535.2 10446 8356.8
445 0 0 0
0 0 0 0
89300 99964.8 83304 66643.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0
 0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
74500 72940.8 60784 48627.2
1870 1999.2 1666 1332.8
0 0 0 0
0 2808 2340 1872
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
245 247.2 206 164.8
708 696 580 464
0 0 0 0
687 696 580 464
236 224.4 187 149.6
131 135.6 113 90.4
17085 16399.2 13666 10932.8
118230 114073.2 95061 76048.8
5175 52497.6 43748 34998.4
0 0 0 0
0 0 0 0
450 450 375 300
0 0 0 0
725 794.4 662 529.6
0 0 0 0
2360 2359.2 1966 1572.8
1571.25 1527.6 1273 1018.4

876.25 855.6 713 570.4

1000 988.8 824 659.2

0 0 0 0
 873.75 877.2 731 584.8

2692.5 2628 2190 1752

0 0 0 0
0 0 0 0

5650 5616 4680 3744

960 936 780 624

8465 8356.8 6964 5571.2

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
50138.75 48613.2 40511 32408.8
0 0 0 0
9301.25 9121.2 7601 6080.8
17380 16780.8 13984 11187.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
49496.25 47804.4 39837 31869.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
5402.5 5234.4 4362 3489.6
0 0 0 0
7670 7459.2 6216 4972.8
11258.75 11096.4 9247 7397.6
0 0 0 0
0 0 0 0
679.5 674.4 562 449.6
0 0 0 0
0 0 0 0
261.75 262.8 219 175.2
0 0 0 0
11243.75 10986 9155 7324
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
26470 25699.2 21416 17132.8
233 225.6 188 150.4
0 0 0 0
389.25 404.4 337 269.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
114.5 112.8 94 75.2
0 0 0 0
0 0 0 0
2297.25 2247.6 1873 1498.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
9167.5 8896.8 7414 5931.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
195 187.2 156 124.8
0 0 0 0
0 0 0 0
0 0 0 0
282.5 280.8 234 187.2
0 0 0 0
1158 1123.2 936 748.8
9360 8985.6 7488 5990.4
0 0 0 0
18520 17971.2 14976 11980.8
60433.75 58496.4 48747 38997.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
233 225.6 188 150.4
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

1364 1348.8 1124 899.2

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
8067 7862.4 6552 5241.6
11356 11232 9360 7488
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
230 225.6 188 150.4
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
934.25 898.8 749 599.2
234 225.6 188 150.4
376 374.4 312 249.6
0 0 0 0
4549 4492.8 3744 2995.2
0 0 0 0
0 0 0 0
2711.75 2696.4 2247 1797.6
0 0 0 0
1136 1123.2 936 748.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
13740 13478.4 11232 8985.6
4580 4492.8 3744 2995.2
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
445.75 450 375 300
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
4625 4492.8 3744 2995.2
0 0 0 0
0 0 0 0
0 0 0 0
1742 1684.8 1404 1123.2
65199 62899.2 52416 41932.8
0 0 0 0
4583 4492.8 3744 2995.2
0 0 0 0
687.5 674.4 562 449.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

1711 1684.8 1404 1123.2

0 0 0 0
0 0 0 0
3454 3369.6 2808 2246.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2262 2246.4 1872 1497.6
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
573 561.6 468 374.4
4580 4492.8 3744 2995.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
93.75 90 75 60
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
16180 15724.8 13104 10483.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1750 1684.8 1404 1123.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2292.75 2254.8 1879 1503.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
594.25 601.2 501 400.8
0 0 0 0
0 0 0 0
7997.5 7773.6 6478 5182.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1225.5 1207.2 1006 804.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
9460.25 9188.4 7657 6125.6
57996.25 55868.4 46557 37245.6
0 0 0 0
44060 42681.6 35568 28454.4
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
2290 2246.4 1872 1497.6

0 0 0 0
26530 25699.2 21416 17132.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2281.5 2306.4 1922 1537.6
0 0 0 0
690.5 674.4 562 449.6
534.25 524.4 437 349.6
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
3481.25 3438 2865 2292
 6376.25 6313.2 5261 4208.8
0 0 0 0
0 0 0 0
0 0 0 0
11716.75 11749.2 9791 7832.8
24139 23587.2 19656 15724.8
31058 30326.4 25272 20217.6
6279 6336 5280 4224
21787.5 21588 17990 14392
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
896.25 898.8 749 599.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2287 2246.4 1872 1497.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
 0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
19941.25 19431.6 16193 12954.4
447.75 450 375 300
1631.5 1629.6 1358 1086.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
583 561.6 468 374.4
0 0 0 0
0 0 0 0
0 0 0 0
1525.75 1477.2 1231 984.8
0 0 0 0
16059 15724.8 13104 10483.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
447.75 450 375 300
0 0 0 0
616.25 975.6 813 650.4
1136 1123.2 936 748.8
0 0 0 0
0 0 0 0
0 0 0 0
139.25 135.6 113 90.4
 0 0 0 0
6947 6739.2 5616 4492.8
682.5 674.4 562 449.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
3363.75 3325.2 2771 2216.8
34700.25 33534 27945 22356
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
10980 10828.8 9024 7219.2
0 0 0 0
0 0 0 0
145338.75 140197.2 116831 93464.8
50153.75 48680.4 40567 32453.6
0 0 0 0
5867.75 5931.6 4943 3954.4
7270.5 7279.2 6066 4852.8
2046.25 2022 1685 1348
0 0 0 0
0 0 0 0
3585.5 3549.6 2958 2366.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
8228 8208 6840 5472
0 0 0 0
66.25 68.4 57 45.6
0 0 0 0
1612.5 1600.8 1334 1067.2
 0 0 0 0
2909 2995.2 2496 1996.8
0 0 0 0
2219 2246.4 1872 1497.6
11378 11232 9360 7488
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1655 1684.8 1404 1123.2
10715 10670.4 8892 7113.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
223 225.6 188 150.4
17291.25 16983.6 14153 11322.4
97055 93652.8 78044 62435.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
555.25 562.8 469 375.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
229 240 200 160
18509 17971.2 14976 11980.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
13829 13478.4 11232 8985.6
10513 10296 8580 6864
16158 15724.8 13104 10483.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
406 393.6 328 262.4
0 0 0 0

836.75 805.2 671 536.8

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
 0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0
458.75 450 375 300

0 0 0 0

54.75 56.4 47 37.6

316.75 315.6 263 210.4

0 0 0 0
0 0 0 0
0 0 0 0

9260 8985.6 7488 5990.4

0 0 0 0

0 0 0 0
0 0 0 0
1147 1123.2 936 748.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
28471.25 27678 23065 18452
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

466.75 450 375 300

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0
 0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

681.5 674.4 562 449.6

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
 0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

3633 3595.2 2996 2396.8

0 0 0 0

0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
9129 8985.6 7488 5990.4
0 0 0 0
0 0 0 0
3571.75 3459.6 2883 2306.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
9347.25 8986.8 7489 5991.2
0 0 0 0
0 0 0 0
0 0 0 0
33369 32438.4 27032 21625.6
15276.5 14781.6 12318 9854.4
0 0 0 0
0 0 0 0
0 0 0 0
2139 2246.4 1872 1497.6
0 0 0 0
2240 2246.4 1872 1497.6
0 0 0 0
0 0 0 0
886.25 898.8 749 599.2
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0

0 0 0 0
672.5 674.4 562 449.6
0 0 0 0
926.25 898.8 749 599.2
0 0 0 0
428.75 450 375 300
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
682.5 674.4 562 449.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
31980 31180.8 25984 20787.2
0 0 0 0

183650 177264 147720 118176

2569 2539.2 2116 1692.8
2309 2246.4 1872 1497.6
583 580.8 484 387.2
3490 3369.6 2808 2246.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1395 1348.8 1124 899.2
0 0 0 0
19603.75 18915.6 15763 12610.4
29587.5 28596 23830 19064
0 0 0 0
0 0 0 0
12464 12168 10140 8112
456.75 450 375 300
1150 1123.2 936 748.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
2086.25 2022 1685 1348
448.25 442.8 369 295.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6620 6739.2 5616 4492.8
0 0 0 0
0 0 0 0
0 0 0 0
1977 1910.4 1592 1273.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
346.25 337.2 281 224.8
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
682.5 674.4 562 449.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
26852.5 25970.4 21642 17313.6
0 0 0 0
27780 26956.8 22464 17971.2
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
573 561.6 468 374.4
0 0 0 0
0 0 0 0
4507.5 4519.2 3766 3012.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
583 561.6 468 374.4
0 0 0 0
0 0 0 0
0 0 0 0
25357.5 24823.2 20686 16548.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
922.25 898.8 749 599.2
0 0 0 0
931.25 898.8 749 599.2
0 0 0 0
97.5 93.6 78 62.4
0 0 0 0
1170 1123.2 936 748.8
1857.5 1797.6 1498 1198.4
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
16370 15724.8 13104 10483.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
13210 12729.6 10608 8486.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
3715 3595.2 2996 2396.8
85285 82353.6 68628 54902.4
3447.5 3405.6 2838 2270.4
2109 2246.4 1872 1497.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 2290 2246.4 1872 1497.6
6782 6552 5460 4368
47439.25 46191.6 38493 30794.4
1405 1348.8 1124 899.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
458.75 450 375 300
0 0 0 0
0 0 0 0
0 0 0 0
10417.5 10288.8 8574 6859.2
0 0 0 0
0 0 0 0
30 28.8 24 19.2
0 0 0 0
0 0 0 0
0 0 0 0
36163.75 34909.2 29091 23272.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
466.75 450 375 300
0 0 0 0
0 0 0 0
4118.75 3954 3295 2636
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
6876 6739.2 5616 4492.8
0 0 0 0
936.25 898.8 749 599.2
15980 15724.8 13104 10483.2
1847.5 2157.6 1798 1438.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5480 5414.4 4512 3609.6
17122.5 16533.6 13778 11022.4
975 936 780 624
0 0 0 0
34087.5 32820 27350 21880
18570 17971.2 14976 11980.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 5616 0
0 0 0 0
0 0 0 0
0 0 0 0
27880 26956.8 22464 17971.2
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
4530 4492.8 3744 2995.2
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
200.25 198 165 132
165 158.4 132 105.6
0 0 0 0
0 0 0 0
11669 11232 9360 7488
0 0 0 0
0 0 0 0
28796.25 28124.4 23437 18749.6
0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
46200 44928 37440 29952
1490.75 1472.4 1227 981.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
92900 89856 74880 59904
0 0 0 0
2687.75 2696.4 2247 1797.6
0 0 0 0
4779.75 4717.2 3931 3144.8
0 0 0 0
0 0 0 0
916.25 898.8 749 599.2
22096.75 21565.2 17971 14376.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0

1136 1123.2 936 748.8

38031.75 36819.6 30683 24546.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
18420 17971.2 14976 11980.8
27360.5 26575.2 22146 17716.8
49772.5 48410.4 40342 32273.6
0 0 0 0
1576.75 1534.8 1279 1023.2
2820 2707.2 2256 1804.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
16063.75 15613.2 13011 10408.8
72811.25 70378.8 58649 46919.2
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1840.5 1797.6 1498 1198.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
17419 16848 14040 11232
0 0 0 0

0 0 0 0
21613 21004.8 17504 14003.2
71627.5 68762.4 57302 45841.6
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
23088 22464 18720 14976
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
450 480 400 320
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

14184 13636.8 11364 9091.2

0 0 0 0
1666.25 1820.4 1517 1213.6
0 0 0 0
0 0 0 0
1047 1017.6 848 678.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1382 1348.8 1124 899.2
0 0 0 0
0 0 0 0
6587 6739.2 5616 4492.8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
2319 2246.4 1872 1497.6

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1440.5 1404 1170 936
10922.5 10581.6 8818 7054.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5915 5774.4 4812 3849.6
3389 3369.6 2808 2246.4
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
47688.75 45982.8 38319 30655.2
0 0 0 0
0 0 0 0
0 0 0 0
4627.5 4538.4 3782 3025.6
0 0 0 0
0 0 0 0
0 0 0 0
 0 0 0 0
1389.75 1347.6 1123 898.4
0 0 0 0
/ TUBE / SACCHET / PUFF

AHUN 2021 BERDASARKAN PERKIRAAN ANGGARAN YANG DIPEROLEH TAHUN 2021