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 : RS Sumber Waras

NO NAMA OBAT SATUAN

1 153-Sm-EDTMP (ethylenediamine tetramethylene phosphonic acid) 44 Tab

mg Ca/Na EDTMP, 5-46 ?g samarium, dan 1850 ± 185 mbq samarium 153
per ml

2 Adefovir dipivoksil tab 10 mg tablet/kapsul/kapl

3 Adenosin inj 3 mg/mL ampul/vial
4 Afatinib tab sal selaput 20 mg tablet salut selap
5 Afatinib tab sal selaput 30 mg tablet salut selap
6 Afatinib tab sal selaput 40 mg tablet salut selapu
7 Air untuk injeksi amp 20 ml ampul/vial/botol
8 Air untuk injeksi amp 25 ml ampul/vial/botol 2
9 Air untuk irigasi Flexy bag 500 ml
10 Air untuk irigasi lar inf 1000 ml botol @ 1.000 mL
11 Akarbose tab 100 mg tablet/kapsul/kapl
12 Akarbose tab 50 mg tablet/kapsul/kapl
13 Albendazol susp 200 mg/5 ml Botol
14 Albendazol tab 400 mg tablet/kapsul/kapl
15 Albumin serum normal (human albumin) inj 20% 100 ml Botol
16 Albumin serum normal (human albumin) inj 20% 50 ml Botol
17 Albumin serum normal (human albumin) inj 25% 100 ml Botol
18 Albumin serum normal (human albumin) inj 25% 20 ml Botol
19 Albumin serum normal (human albumin) inj 25% 50 ml Botol
20 Albumin serum normal (human albumin) inj 5% 250 ml Botol
21 Albumin serum normal (human albumin) inj 5% 50 ml Botol
22 Alendronat Tab 70 mg tablet/kapsul/kapl
23 Alopurinol tab 100 mg Tab
24 Alopurinol tab 300 mg tablet/kapsul/kapl
25 Alprazolam tab 0,25 mg tablet/kapsul/kapl
26 Alprazolam tab 0,5 mg tablet/kapsul/kapl
27 Alprazolam tab 1 mg tablet/kapsul/kapl
28 Alteplase serb inj 50 mg/vial Vial
29 Amfoterisin B inj 50 mg/10 ml (i.v.) Ampul
30 Amfoterisin B salep mata 1% Tube
31 Amfoterisin B salep mata 3% Tube
32 Amikasin inj 250 mg/ml vial/ampul
33 Aminofilin inj 24 mg/ml ampul/vial 10 ml
34 Aminofilin tab 150 mg tablet/kapsul/kapl
35 Aminofilin Tab 200 mg tablet/kapsul/kapl
36 Amiodaron inj 150 mg/3 ml ampul/vial
37 Amiodaron tab 200 mg Tab
38 Amitriptilin tab sal 25 mg tablet/kapsul/kapl
39 Amlodipin tab 10 mg tablet/kapsul/kapl
40 Amlodipin tab 5 mg tablet/kapsul/kapl
41 Amoksisilin drops 100 mg/ml Botol
42 Amoksisilin sir forte 250 mg/5 ml botol 60 ml
43 Amoksisilin sir kering 125 mg/5 ml Botol
44 Amoksisilin tab 250 mg tablet/kapsul/kapl
45 Amoksisilin tab 500 mg tablet/kapsul/kapl
46 Ampisilin serb inj 1000 mg/vial ampul/vial
47 Ampisilin serb inj 250 mg/vial Vial
48 Analog insulin : fast acting inj 100 UI/ml (kemasan vial, cartridge Vial/Cartridge
disposible, penfil cartridge)
49 Analog insulin : intermediate acting inj 100 UI/ml (kemasan vial, cartridge vial/cartridge
disposible, penfill cartridge)
50 Analog insulin : mix insulin (inj 100 UI/ml) Vial/Cartridge
51 Analog insulin intermediate acting combine with short or long acting inj Penfill
100 IU/ml (25% insulin lispro), vial/cartridge diposible/penfill cartridge

52 Analog insulin intermediate acting combine with short or long acting inj Penfill
100 IU/ml (50% insulin lispro), vial/cartridge diposible/penfill cartridge

53 Analog Insulin long acting inj 100 IU/mL, vial/cartridge disposible/penfill Vial/Cartridge/Penf
cartridge
54 Anastrozol tab 1 mg tablet/kapsul/kapl
55 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 inj 2 ampul/vial
ml
56 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium botol 60 ml
hidroksida 200 mg
57 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium tablet/kapsul/kapl
hidroksida 200 mg
58 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps
59 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiksin B 10.000 UI/g Tube

60 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% pot 30 g

61 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 Suppositoria
mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g

62 Aripiperazol oral solution 1 mg/ml botol

63 Aripiperazol tab discmelt 10 mg tab discmelt/tab ce
64 Aripiperazol tab discmelt 15 mg tab discmelt/ tab c
65 Aripiprazol tab 5 mg tablet/kapsul/kapl
66 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial
67 Articulating paper kertas warna penanda oklusi Kertas warna penan
68 Asam asetat tetes telinga 2% Botol
69 Asam asetilsalisilat (asetosal) tab 100 mg tablet sal enterik/k
70 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kapl
71 Asam askorbat (vitamin C) tab 250 mg Tab
72 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kapl
73 Asam folat tab 0,4 mg tablet/kapsul/kapl
74 Asam folat tab 1 mg tablet/kapsul/kapl
75 Asam folat tab 5 mg Tab
76 Asam fusidat tts mata 1% Botol
77 Asam ibandronat inj 1 mg/ml ampul/vial
78 Asam mefenamat kaps 250 mg tablet/kapsul/kapl
79 Asam mefenamat kaps 500 mg tablet/kapsul/kapl
80 Asam pipemidat kaps 400 mg tablet/kapsul/kapl
81 Asam retinoat krim 0,1% Tube @ 20 gram
82 Asam retinoat krim 0,1% Tube @ 10 gram
83 Asam salisilat lar 0,1% Botol
84 Asam salisilat salep 10% Tube
85 Asam salisilat salep 2% Tube
86 Asam salisilat salep 5% Tube
87 Asam traneksamat inj 100 mg/ml ampul/vial
88 Asam traneksamat inj 50 mg/ml Ampul
89 Asam traneksamat tab 500 mg ampul/vial
90 Asam ursodeoksikolat kaps 250 mg tablet/kapsul/kapl
91 Asam zoledronat inf 4 mg/100 ml Botol
92 Asam Zoledronat Inf 5 mg/100 ml Botol
93 Asetazolamid tab 250 mg tablet/kapsul/kapl
94 Asiklovir salep mata 3% tube
95 Asiklovir tab 200 mg tablet/kapsul/kapl
96 Asiklovir tab 400 mg tablet/kapsul/kapl
97 Asparaginase serb inj 10.000 UI/vial Vial
98 Atapulgit 600 mg tablet/kapsul/kapl
99 Atapulgit tab 630 mg tablet/kapsul/kapl
100 Atapulgit tablet 650 mg tablet/kapsul/kapl
101 Atapulgit tablet 750 mg Tab
102 Atenolol tab 100 mg tablet/kapsul/kapl
103 Atenolol tab 50 mg tablet/kapsul/kapl
104 Atorvastatin tab 10 mg tablet salut selapu
105 Atorvastatin tab 20 mg tablet salut selapu
106 Atrakurium inj 10 mg/ml (i.v) ampul/vial @ 5 ml
107 Atrakurium inj 10 mg/ml (i.v) ampul/vial @ 2,5 m
108 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
109 Atropin tab 0,5 mg Tab
110 Atropin tts mata 0,5% Botol
111 Atropin tts mata 1% Botol
112 Azatioprin tab 50 mg Tab
113 Azitromisin serb inj 500 mg ampul/vial
114 Azitromisin sir kering 200 mg/5 ml maks botol @60 m
115 Azitromisin tab 250 mg tablet/kapsul/kapl
116 Azitromisin tab 500 mg tablet salut selapu
117 Bahan tumpatan sementara lar, serb Botol
118 Barium sulfat serb 92 g/100 ml Botol
119 Barium sulfat serb 92 g/100 ml Disposible plastic
120 Barium sulfat susp 2,2% Botol
121 Barium sulfat susp 55% Botol
122 Barium sulfat susp 65% Botol
123 Barium sulfat susp 95% Botol plastik
124 Basiliksimab Inj 20 mg Vial
125 Bedak salisil serb 2% Dus/Sachet/Plastik
126 Bedakuilin fumarat tab 100 mg tablet/kapsul/kapl
127 Bendamustin serb inj 100 mg Vial
128 Bendamustin serb inj 25 mg Vial
129 Benzatin penisilin inj 1,2 juta UI/ml (i.m.) Vial
130 Benzatin penisilin inj 2,4 juta UI/ml (i.m.) Vial
131 Beractant susp 25 mg/ml (intratekal) Botol
132 Beraprost sodium tab 20 mcg tablet/kapsul/kapl
133 Betahistin tab 24 mg Tab
134 Betahistin tab 6 mg tablet/kapsul/kapl
135 Betaksolol tts mata 0,5% Botol @ 5 ml
136 Betaksolol tts mata 0,5% Catchcover, botol
137 Betametason krim 0,1% tube 5 gram
138 Betametason krim 0,5 mg/g Tube
139 Betametason salep 0,1% tube 5 gram
140 Betametason tts mata 1 mg/ml botol
141 Bikalutamid tab sal 150 mg tablet salut/kaplet
142 Bikalutamid tab sal 50 mg tablet salut/kaplet
143 Bisakodil sup 10 mg Suppositoria
144 Bisakodil sup 5 mg Suppositoria
145 Bisakodil tab sal 5 mg tablet/kapsul/kapl
146 Bisoprolol tab 1,25 mg tablet/kapsul/kapl
147 Bisoprolol tab 10 mg tablet salut selapu
148 Bisoprolol tab 2,5 mg tablet/kapsul/kapl
149 Bisoprolol tab 5 mg tablet salut selap
150 Bleomisin serb inj 15 mg/ml Vial
151 Brinzolamid tetes mata Botol
152 Bromokriptin tab 2,5 mg Tab
153 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml
154 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules
155 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml
156 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules
157 Budesonid serb ih 100 mcg/dosis Botol
158 Budesonid serb ih 200 mcg/dosis 200 dosis
159 Budesonid serb ih 200 mcg/dosis 100 dosis
160 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 120 Botol
dosis
161 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 60 dosis Botol

162 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg Botol

163 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% vial/ampul @4 ml
164 Bupivakain inj 5 mg/ml (p.v.) ampul/vial
165 Busulfan tab salut 2 mg Tab
166 Cardioplegia inj ampul/vial
167 Coal tar lar 5 % Botol
168 Copper T set/buah
169 Dabigatran eteksilat kaps 110 mg tablet/kapsul/kapl
170 Dabigatran eteksilat kaps 75 mg tablet/kapsul/kapl
171 Dakarbazin serb inj 100 mg/vial Vial
172 Dakarbazin serb inj 200 mg/vial Vial
173 Daklatasvir tab sal selaput 30 mg Tab
174 Daklatasvir tab sal selaput 60 mg Tab
175 Daktinomisin inj 0,5 mg/vial (i.v.) Vial
176 Dapson tab scored 100 mg Tab
177 Daunorubisin serb inj 20 mg/vial Vial
178 Deferasiroks tab disp 250 mg Tab
179 Deferasiroks tab disp 500 mg tablet dispersible/
180 Deferipron lar oral 100 mg/ml Botol
181 Deferipron tab sal 500 mg tab salut selaput/k
182 Deferoksamin mesilat serb inj 500 mg/vial Vial
183 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial
184 Deksametason tab 0,5 mg tablet/kapsul/kapl
185 Deksametason tab 4 mg Tab
186 Deksmedetomidin Inj 100 mcg/ml ampul/vial
187 Desfluran cairan ih Botol
188 Desmopresin nasal spray 10 mcg/puff Botol
189 Desmopresin tab 0,1 mg Tab
190 Desmopresin tab 0,2 mg Tab
191 Desogestrel tab 75 mcg Tab
192 Desoksimetason gel 0,05% Tube
193 Desoksimetason krim 0,25% tube 15 g
194 Desoksimetason salep 0,25% tube 10 g
195 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 1,5% Botol
196 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 2,5% Botol
197 Dialisa Peritoneal : Lar intraperitoneal dengan dekstrose 4,25% Botol
198 Dialisa peritoneal, lar intraperitonial Botol
199 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL
200 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL
201 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial
202 Diazepam tab 2 mg tablet/kapsul/kapl
203 Diazepam tab 5 mg tablet/kapsul/kapl
204 Dienogest tab 2 mg tablet/kapsul/kapl
205 Dietilkarbamazin tab 100 mg tablet/kapsul/kapl
206 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial
207 Diflukortolon valerat salep berlemak 0,1% Tube
208 Digoksin inj 0,25 mg/ml ampul/vial
209 Digoksin tab 0,25 mg tablet/kapsul/kapl
210 Diltiazem hcl inj 5 mg/5 ml Ampul
211 Diltiazem hcl tab 30 mg tablet/kapsul/kapl
212 Diltiazem inj 25 mg/5 ml ampul/vial
213 Diltiazem kaps SR 100 mg Kapsul lepas lamba
214 Diltiazem kaps SR 200 mg Kapsul lepas lamba
215 Diltiazem serb inj 10 mg/10 ml Ampul
216 Diltiazem serb inj 50 mg/vial Vial
217 Diltiazem tab 30 mg Tab
218 Dimenhidrinat tab 50 mg tablet/kapsul/kapl
219 Dinatrium edetat tts mata 0,35% (3,5 mg/ml) Botol
220 Dinatrium klodronat inj 60 mg/ml Botol
221 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3-dimercaptosuccinic Vial
acid/vial
222 Dobutamin inj 12,5 mg/ml ampul/vial
223 Dobutamin inj 25 mg/ml ampul/vial
224 Dobutamin inj 50 mg/ml ampul/vial
225 Doksazosin mesilat tab 1 mg tablet/kapsul/kapl
226 Doksazosin mesilat tab 2 mg tablet/kapsul/kapl
227 Doksazosin tab 1 mg Tab
228 Doksazosin tab 2 mg Tab
229 Doksisiklin kaps 100 mg tablet/kapsul/kapl
230 Doksisiklin kaps 50 mg tablet/kapsul/kapl
231 Doksorubisin serb inj 10 mg/vial (i.v.) Vial
232 Doksorubisin serb inj 50 mg/vial Vial
233 Domperidon susp 5 mg/5 ml botol @60 ml
234 Domperidon tab 10 mg tablet/kapsul/kapl
235 Domperidon tts 5 mg/ml Botol
236 Donepezil tab 5 mg tablet salut selapu
237 Donepezil tab eff 10 mg tablet dispersible /
238 Dopamin inj 40 mg/ml ampul/vial
239 Dosetaksel inj 20 mg Vial
240 Dosetaksel inj 40 mg/ml (vial 0,5 ml) Vial
241 Dosetaksel inj 40 mg/ml (vial 2 ml) Vial
242 Dosetaksel inj 80 mg Vial
243 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate Vial
calcium trisodium/ml
244 Dutasterid kaps 0,5 mg Kaps lunak
245 Efavirens tab sal 600 mg tablet salut selapu
246 Efavirenz tab 200 mg Tablet
247 Efedrin inj 50 mg/ml ampul/vial
248 Eksemestan tab 25 mg tablet salut gula
249 Eltrombopag tab sal selaput 25 mg Tab
250 Eltrombopag tab sal selaput 50 mg Tab
251 Enoksaparin sodium inj 20 mg/0,2 ml Ampul
252 Enoksaparin sodium inj 40 mg/0,4 ml Ampul
253 Enoksaparin sodium inj 60 mg/0,6 ml Ampul
254 Entekavir tab sal selaput 0,5 mg tablet salut selapu
255 Entekavir tab sal selaput 1 mg tablet salut selapu
256 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) ampul/vial
257 Epinefrin (adrenalin) inj 1 mg/ml Ampul
258 Epirubisin serb inj 2 mg/ml, vial 25 ml Vial 25 ml
259 Epirubisin serb inj 2 mg/ml, vial 5 ml Vial 5 ml
260 Epirubisin serb inj 50 mg Vial
261 Ergokalsiferol (vitamin D2) kaps 50.000 UI Kaps
262 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml Botol
263 Ergotamin tab 1 mg Tab
264 Eritromisin kaps 250 mg tablet/kapsul/kapl
265 Eritromisin sir 200 mg/5 ml Botol @ 60 ml
266 Eritromisin tab 500 mg tablet/kapsul/kapl
267 Eritropoetin-alfa inj 10.000 IU Vial
268 Eritropoetin-alfa inj 2.000 IU Vial
269 Eritropoetin-alfa inj 3.000 IU Vial
270 Eritropoetin-alfa inj 4.000 IU Vial
271 Eritropoetin-beta inj 2000 UI/0,3 ml Vial
272 Eritropoietin-Alfa Inj 4000 IU/0,5 ml Ampul
273 Erlotinib tab sal selaput 100 mg tablet salut selapu
274 Erlotinib tab sal selaput 150 mg tablet salut selapu
275 Esomeprazole inj 40 mg/vial ampul/vial
276 Estrogen terkonjugasi tab sal 0,625 mg tablet salut gula/ka
277 Etanol 70% cairan 70% Botol
278 Etil klorida semprot 100 ml Botol
279 Etinilestradiol tab 0,5 mg Tab
280 Etonogestrel implan 68 mg Set
281 Etoposid inj 20 mg/ml Vial
282 Etoposid kaps 100 mg Kaps
283 Eugenol Botol
284 Everolimus tab 0,25 mg tablet/kapsul/kapl
285 Everolimus tab 0,5 mg tablet/kapsul/kapl
286 Faktor IX Kompleks Inj 50 IU/mL ampul/vial
287 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml Vial
288 Faktor IX kompleks serb inj 500 UI/vial + pelarut Vial
289 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi Vial
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, faktor koagulasi Vial
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 injeksi ampul/vial

292 Faktor VIII (konsentrat) serb inj 230 -340 UI Vial

293 Faktor VIII (konsentrat) serb inj 480 - 600 UI Vial
294 Faktor VIII serb inj 1000 mg/vial Vial
295 Faktor VIII serb inj 2000 mg/vial Vial
296 Faktor VIII serb inj 250 IU Vial
297 Faktor VIII serb inj 500 IU Vial
298 Fenilefrin drops 10% Botol
299 Fenitoin Na inj 50 mg/ml ampul @ 2 ml
300 Fenitoin Na kaps 100 mg Kaps
301 Fenitoin Na kaps 30 mg Kaps
302 Fenobarbital inj 100 mg/mL ampul/vial
303 Fenobarbital inj 50 mg/ml Ampul
304 Fenobarbital tab 100 mg Tab
305 Fenobarbital tab 30 mg tablet/kapsul/kapl
306 Fenofibrat kaps 100 mg tablet/kapsul/kapl
307 Fenofibrat kaps 300 mg tablet/kapsul/kapl
308 Fenoksimetil penisilin (penisilin V) tab 125 mg Tab
309 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
310 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab
311 Fenoterol hbr aerosol 100 mcg/puff Botol
312 Fenoterol hbr cairan ih 0,1% Botol
313 Fentanil inj 0,05 mg/ml (ampul 10 ml) ampul/vial, @ 10
314 Fentanil inj 0,05 mg/ml (ampul 2 ml) ampul @ 2 mL
315 Fentanil patch 12,5 mcg/jam Patch
316 Fentanil patch 25 mcg/jam Patch
317 Ferrakrilum cairan 1% Botol
318 Ferro fumarat kaps lunak 300 mg Kaps lunak
319 Ferro sulfat sir. 150 mg/5 ml Botol
320 Ferro sulfat tab salut 300 mg Tab sal
321 Filgrastim inj 300 mcg/ml ampul/vial
322 Finasterid tab 5 mg tablet/kapsul/kapl
323 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial
324 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
325 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet salut gula/ka
326 Fludarabin inj 50 mg/vial Vial
327 Fludarabin tab sal 10 mg tablet salut/kaplet
328 Flufenazin inj 25 mg/ml (i.m.) Vial
329 Flukonazol inj 2 mg/ml Ampul
330 Flukonazol kaps 150 mg tablet/kapsul/kapl
331 Flukonazol kaps 50 mg Kaps
332 Fluoksetin kaps 10 mg tablet/kapsul/kapl
333 Fluoksetin kaps 20 mg tablet/kapsul/kapl
334 Fluor kapl 1 mg Kaplet
335 Fluor sediaan topikal Tube
336 Fluoresein injeksi 10% Ampul
337 Fluoresein tts mata 2,5 mg/ml Botol
338 Fluoro deoxy glucose (FDG) Vial
339 Fluorometolon tts mata 0,1% botol
340 Fluorourasil Inj 25 mg/ml Vial
341 Fluorourasil inj 250 mg/ml Ampul
342 Fluorourasil inj 50 mg/mL (@ 10 mL) Ampul
343 Fluorourasil inj 50 mg/mL (@ 5 mL) Ampul
344 Fluorourasil serb inj 250 mg Ampul
345 Flusinolon asetonid krim 0,025% tube @ 5g
346 Flusinolon asetonid salep 0,025% Tube 10 g
347 Flutikason furoat intranasal spray Botol
348 Flutikason propionat cairan ih 0,5 mg/dosis Botol
349 Flutikason Propionat MDI 50 mcg/semprot Botol
350 Fondaparinuks inj 2,5 mg/0,5 ml ampul/vial/prefille
351 Formokresol Botol
352 Fosfomisin Trometamol granula 3 g Sachet
353 Fraksi protein plasma lar inf 5% Botol
354 Framisetin Sulfat Tulle 1% Patch
355 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial
356 Furosemid tab 40 mg tablet/kapsul/kaple
357 Gabapentin kaps 100 mg tablet/kapsul/kapl
358 Gabapentin kaps 300 mg tablet/kapsul/kapl
359 Gadobutrol Macrocyclic 5 ml Prefilled Syringe @
360 Gadobutrol Macrocyclic 7,5 ml Prefilled Syringe @
361 Gadoksetat disodium 0,25 mmol gadoksetat disodium/ml Vial
362 Galactose microparticle 200-400 mg micropart/ml Vial
363 Gansiklovir serb inj 500 mg/vial Vial
364 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g + sachet
trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g
365 Gefitinib tab 250 mg tablet/kapsul/kaple
366 Gemfibrozil kaps 300 mg tablet/kapsul/kaple
367 Gemfibrozil kaps 600 mg tablet/kapsul/kaple
368 Gemsitabin inj 1000 mg/vial Vial
369 Gemsitabin inj 200 mg/vial Vial
370 Gentamisin inj 10 mg/ml Ampul
371 Gentamisin inj 40 mg/ml ampul/vial
372 Gentamisin inj 80 mg/ml Ampul
373 Gentamisin salep mata 0,3% Tube
374 Gentamisin tsts mata 1% Botol
375 Gentamisin tts mata 0,3% Botol
376 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter 5 g Sachet

377 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol

378 Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial
379 Glibenklamid tab 2,5 mg tablet/kapsul/kaple
380 Glibenklamid tab 5 mg tablet/kapsul/kaple
381 Gliklazid tab 80 mg Tab
382 Gliklazid tab MR 30 mg Tab
383 Gliklazid tab SR 60 mg tablet lepas lamba
384 Glikopironium serb ih 50 mcg kapsul
385 Glikuidon tab 30 mg tablet/kapsul/kaple
386 Glimepirid tab 1 mg tablet/kapsul/kaple
387 Glimepirid tab 2 mg tablet/kapsul/kaple
388 Glimepirid tab 3 mg tablet/kapsul/kaple
389 Glimepirid tab 4 mg tablet/kapsul/kaple
390 Glipizid tab 10 mg tablet/kapsul/kaple
391 Glipizid tab 5 mg tablet/kapsul/kaple
392 Gliseril trinitrat inj 10 mg/ml Ampul
393 Gliseril trinitrat inj 5 mg/ml Ampul
394 Gliseril trinitrat kaps lepas lambat 2,5 mg kapsul lepas lamba
395 Gliseril trinitrat kaps lepas lambat 5 mg kapsul lepas lamba
396 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kapl
397 Gliserin lar 50% Botol
398 Gliserin tts 100 mg/ml Botol
399 Glukosa Larutan Infus 10% steril 100 ml Botol
400 Glukosa Larutan Infus 10% steril 250 ml Botol
401 Glukosa Larutan Infus 10% steril 500 ml Botol
402 Glukosa Larutan Infus 40% Ampul @25 ml
403 Glukosa Larutan Infus 5% steril 100 ml Botol
404 Glukosa Larutan Infus 5% steril 250 ml Botol
405 Glukosa Larutan Infus 5% steril 500 ml Botol
406 Goserelin asetat inj 10,8 mg/vial Vial
407 Goserelin asetat inj 3,6 mg/vial Vial
408 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kapl
409 Griseofulvin (micronized) tab 500 mg Tab
410 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kapl
411 Gutta percha dan paper points 15 - 40 mm Roll
412 Gutta percha dan paper points 45 - 80 mm Roll
413 Haloperidol inj 5 mg/ml (i.m.) Vial
414 Haloperidol inj 50 mg/ml (decanoat) Vial
415 Haloperidol tab 0,5 mg tablet/kapsul/kapl
416 Haloperidol tab 1,5 mg tablet/kapsul/kapl
417 Haloperidol tab 2 mg tablet/kapsul/kapl
418 Haloperidol tab 5 mg tablet/kapsul/kapl
419 Haloperidol tts 2 mg/ml botol
420 Halotan ih Botol
421 Hemodialisa lar konsentrat basis asetat Botol
422 Hemodialisa lar konsentrat basis natrium bikarbonat Botol
423 Heparin, Na inj 5.000 UI/ml (i.v./s.k.) Vial
424 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml Ampul
425 Hepatitis B imunoglobulin (human) Inj 220 IU/ml Vial
426 Hidrogen peroksida cairan 3% Botol
427 Hidrogen peroksida lar. Konsentrat 3% Botol
428 Hidroklorotiazid tab 12,5 mg Tab
429 Hidroklorotiazid tab 25 mg tablet/kapsul/kapl
430 Hidrokortison krim 1% tube @ 5 g
431 Hidrokortison krim 2,5% tube @ 5 g
432 Hidrokortison serb inj 100 mg Vial
433 Hidrokortison Tab 20 mg Tab
434 Hidroksi klorokuin tab 200 mg Tab
435 Hidroksi urea tab 500 mg tablet/kapsul/kapl
436 Hiosina butilbromida inj 20 mg/ml ampul/vial
437 Hiosina butilbromida tab 10 mg tablet/kapsul/kapl
438 Homatropin tts mata 2% Botol
439 Human insulin fast acting inj 100 IU/ml, cartridge disposible/penfill Cartridge, Penfill C
cartridge
440 Human insulin fast acting inj 100 IU/ml, Vial 10 mL Vial
441 Human insulin fast acting inj 100 IU/ml, Vial 5 mL Vial
442 Human Insulin intermediate acting combine with short or long acting inj Cartridge, Penfill C
100 IU/mL, cartridge disposible/penfill cartridge
443 Human insulin intermediate acting combine with short or long acting inj Vial
100 IU/mL, Vial 10 mL
444 Human Insulin intermediate acting inj 100 IU/ml, cartridge Cartridge, Penfill C
disposible/penfill cartridge
445 Human insulin intermediate acting inj 100 IU/mL, Vial 10 mL Vial
446 Human Insulin intermediate acting inj 100 IU/Ml, Vial 10 mL Vial
447 Human Insulin intermediate acting inj 100 IU/mL, Vial 5 mL Vial
448 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
449 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul
450 Hydromorphone HCl tab oros 16 mg tablet lepas lamba
451 Hydromorphone HCl tab oros 8 mg tablet lepas lamba
452 Ibuprofen sir 100 mg/5 ml botol @ 60 ml
453 Ibuprofen sir 200 mg/5 ml botol @ 60 ml
454 Ibuprofen tab 200 mg tablet/kapsul/kapl
455 Ibuprofen tab 400 mg tablet/kapsul/kapl
456 Idarubisin serb inj 20 mg Vial
457 Ifosfamid serb inj 1000 mg/vial Vial
458 Ifosfamid serb inj 2000 mg/vial Vial
459 Ifosfamid serb inj 500 mg/vial Vial
460 Iloprost ih 10 mcg/mL ampul/vial
461 Imatinib mesilat tab 100 mg tablet/kapsul/kapl
462 Imatinib Mesilat tab 400 mg tablet/kapsul/kapl
463 Imidapril tab 10 mg tablet/kapsul/kapl
464 Imidapril tab 5 mg tablet/kapsul/kapl
465 Imunoglobulin Intravena Inj 50 mg/ml, untuk terapi GBS (Guillain Bare Vial
Syndrom)
466 Imunoglobullin Intravena inj 250 mg/50 ml Botol
467 Indakaterol serb ih 150 mcg Kaps
468 Indakaterol serb ih 300 mcg Kaps
469 Iodiksanol vial 320 mg Iodium/100 ml ampul/vial/botol
470 Iodiksanol vial 320 mg Iodium/50 ml ampul/vial/botol
471 Iodium 131 Botol
472 Iodohippurate sodium I 131 37-74 mbq/ multiple-dose Vial
473 Ioheksol 180 - 300 mg Iodium/mL (300 mg/20 mL) ampul/vial/botol
474 Ioheksol 240-350 mg Iodium/ml (300 mg/75 ml) Vial
475 Ioheksol 240-350 mg Iodium/ml (350 mg/75 ml) ampul/vial/botol
476 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/100 ml) ampul/vial/botol
477 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/50 ml) Vial
478 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/100 ml) ampul/vial/botol
479 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/50 ml) ampul/vial/botol
480 Iopamidol 200 - 300 mg Iodium/mL (300 mg/100 mL) ampul/vial/botol
481 Iopamidol 200 - 300 mg Iodium/mL (300 mg/200 mL) Vial
482 Iopamidol 200 - 300 mg Iodium/mL (300 mg/50 mL) ampul/vial/botol
483 Iopamidol 300 - 370 mg Iodium/mL (370 mg/100 mL) Vial
484 Iopamidol 300 - 370 mg Iodium/mL (370 mg/200 mL) Vial
485 Iopamidol 300 - 370 mg Iodium/mL (370 mg/50 mL) ampul/vial/botol
486 Iopamidol inj 200-370 mg Iodium/ml Vial
487 Iopromid 240 -370 mg Iodium/ml Vial
488 Iopromid 300 - 370 mg (300 mg/100 mL) Vial
489 Iopromid 300 - 370 mg (300 mg/50 mL) Vial
490 Iopromid 300 - 370 mg (370 mg/100 mL) Vial
491 Iopromid 300 - 370 mg (370 mg/50 mL) Vial
492 Ipratropium bromida aerosol 20 mcg/semprot Botol
493 Ipratropium bromida cairan ih 0,025% Botol
494 Ipratropium bromida ih 20mcg/puff Botol
495 Irbesartan tab 150 mg tablet/kapsul/kapl
496 Irbesartan tab 300 mg tablet/kapsul/kapl
497 Irinotekan inf 20 mg/ml Ampul
498 Irinotekan inj 20 mg/ml Ampul
499 Isofluran inhalasi 100 ml Botol
500 Isofluran inhalasi 250 ml botol @ 250 mL
501 Isoniazid tab 100 mg Tab
502 Isoniazid tab 300 mg Tab
503 Isosorbid dinitrat inj 1 mg/ml (i.v) ampul/vial
504 Isosorbid dinitrat tab 10 mg tablet/kapsul/kapl
505 Isosorbid dinitrat tab 5 mg tablet/kapsul/kapl
506 Itrakonazol Kaps 100 mg tablet/kapsul/kapl
507 IUD Cu T 380 A Set
508 IUD Levonorgestrel Set
509 Ivabradin tab 5 mg tablet /kapsul/kapl
510 k.y jelly Tube gel
511 Kalamin Tube
512 Kalium aspartat tab 300 mg tablet salut selapu
513 Kalium klorida tab siap larut 300 mg Tab
514 Kalium klorida tab SR 600 mg tablet lepas lamba
515 Kalsitriol kaps lunak 0,25 mcg kapsul lunak
516 Kalsitriol kaps lunak 0,5 mcg kapsul lunak
517 Kalsium Folinat (Leukovorin, Ca) Inj 10 mg/ml ampul/vial
518 Kalsium folinat (leukovorin, Ca) tab 15 mg Tab
519 Kalsium glukonat inj 100 mg/ml ampul/vial
520 Kalsium hidroksida bubuk, pasta Tube
521 Kalsium hipoklorit Sachet
522 Kalsium karbonat tab 500 mg tablet/kapsul/kapl
523 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kapl
524 Kalsium polistirena sulfonat ktg 5 g Sachet
525 Kanamisin inj 1.000 mg/ vial Vial
526 Kandesartan tab 16 mg tablet/kapsul/kapl
527 Kandesartan tab 8 mg tablet/kapsul/kapl
528 Kapesitabin tab sal 500 mg tab salut/kaplet sa
529 Kaptopril tab 12,5 mg tablet/kaplet
530 Kaptopril tab 25 mg tablet/kaplet
531 Kaptopril tab 50 mg tablet/kaplet
532 Karbamazepin sir 100 mg/5 ml Botol
533 Karbamazepin tab 100 mg Tab
534 Karbamazepin Tab 200 mg Tablet
535 Karbimazol tab 5 mg tablet/kapsul/kapl
536 Karbo adsorben tab 0,5 g Tab
537 Karbogliserin tts telinga 10 % Botol
538 Karboksimetilselulosa tts mata Botol
539 Karboplatin Inj 10 mg (vial 45 ml) Vial
540 Karboplatin inj 10 mg/ml (vial 15 ml Vial
541 Karvedilol kaps 6,25 mg tablet/kapsul/kapl
542 Karvedilol tab 25 mg tablet/kapsul/kapl
543 Ketamin inj 100 mg/ml (i.v.) ampul/vial
544 Ketamin inj 50 mg/ml (i.v.) ampul/vial
545 Ketokonazol krim 2% Tube 10 g
546 Ketokonazol scalp sol 2% botol
547 Ketokonazol tab 200 mg tablet/kapsul/kapl
548 Ketoprofen Inj 25 mg/ml ampul/vial
549 Ketoprofen sup 100 mg Suppositoria
550 Ketorolak inj 30 mg/ml ampul/vial
551 Klaritromisin sir kering 125 mg/5 ml botol maks 60 mL
552 Klaritromisin sir kering 250 mg/5 ml Botol
553 Klaritromisin tab 500 mg tablet salut selapu
554 Klindamisin kaps 150 mg Kaps
555 Klindamisin kaps 300 mg tablet/kapsul/kapl
556 Klobazam tab 10 mg tablet/kapsul/kapl
557 Klobetasol propionat krim 0,05% tube
558 Klobetasol propionat salep 0,05% tube
559 Klofazimin, micronized kaps 50 mg Kapsul
560 Klofazimin, micronizedkaps 100 mg kapsul
561 Klomipramin tab 25 Tab
562 Klonazepam kaps 2 mg tablet salut selapu
563 Klonidin inj 150 mcg/ml Vial
564 Klonidin tab 0,15 mg tablet/kapsul/kapl
565 Klopidogrel tab 75 mg tablet salut selapu
566 Klopidogrel tab sal selaput 300 mg tablet salut selapu
567 Kloral hidrat lar Botol
568 Klorambusil tab 2 mg Tab
569 Klorambusil tab sal selaput 5 mg tab sal selaput
570 Kloramfenikol kaps 250 mg tablet/kapsul/kapl
571 Kloramfenikol kaps 500 mg tablet/kapsul/kapl
572 Kloramfenikol salep kulit 2% tube 15g
573 Kloramfenikol salep mata 1% tube @ 5 gram
574 Kloramfenikol serb inj 1.000 mg/ml vial/ampul
575 Kloramfenikol susp 125 mg/5 ml botol 60 ml
576 Kloramfenikol tetes telinga 3% Botol
577 Kloramfenikol tts mata 0,5% botol
578 Kloramfenikol tts mata 1% Botol
579 Klorfeniramin tab 4 mg tablet/kapsul/kapl
580 Klorfenol kamfer mentol (CHKM) Botol
581 Klorheksidin lar 0,2% Botol
582 Klorheksidin lar 15% Botol
583 Klorokuin tab 250 mg Tablet
584 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial
585 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial
586 Klorpromazin tab sal 100 mg tablet salut selapu
587 Klorpromazin tab sal 25 mg Tab sal
588 Klortalidon tab 50 mg Tab
589 Klotrimazol tab vagina 100 mg Tab
590 Klozapin tab 100 mg tablet
591 Klozapin tab 25 mg tablet
592 Kodein tab 10 mg tablet/kapsul/kapl
593 Kodein tab 15 mg tablet/kapsul/kapl
594 Kodein tab 20 mg tablet/kapsul/kapl
595 Kolekalsiferol (vitamin D3) kaps lunak 0,25 mcg Kaps lunak
596 Kolekalsiferol (vitamin D3) kaps lunak 0,5 mcg Kaps lunak
597 Kolestiramin serb, 4 g Ampul
598 Kolkisin tab 500 mcg Tab
599 Koloid HES BM 130 000 lar inf 6% Botol
600 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab sal tablet salut selapu
selaput
601 Kombinasi : (Ampisilin 1000 mg + Sulbaktam 500 mg) serb inj 1500 mg ampul/vial

602 Kombinasi : (Sefoperazon 500 mg + Sulbaktam 500 mg) serb inj 1000 mg ampul/vial

603 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg + Nevirapin 50 mg) Ped Tablet

Triple FDC
604 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg ampul/vial
605 Kombinasi : artemether 20 mg + lumefantrin 120 mg tablet/kapsul/kapl
606 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab
607 kombinasi : benserazid 25 mg + levodopa 100 mg tablet dispersible/
608 Kombinasi : Brinzolamid 1% + Timolol 0,5%, tts mata Botol
609 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab
610 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kapl
611 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut tablet salut gula
612 Kombinasi : Indakaterol 110 mcg + Glycopyrronium 50 mcg serb ih + alat Botol
breezhaler
613 Kombinasi : Ipratropium bromida 0,02 mg + fenoterol HBr 0,05 mg Botol
aerosol
614 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + entekapon 200 mg tablet/kapsul/kapl

615 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg tab salut gula
616 Kombinasi : medroksi progesteron asetat+ estradiol sipionat inj depot 25 Vial
mg + 5 mg
617 Kombinasi : Meglumin amidotrizoat + Sodium amidotrizoat inj 76% Vial

618 Kombinasi : Sefiksim 400 mg + Azitromisin 1000 mg Paket

619 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab
620 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 mg Tab

621 Kombinasi : Travoprost 0,004% + Timolol 0,5%, tts mata Botol

622 Kombinasi : triamsinolon + dementilklortetrasiklin Pasta tube
623 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab
624 Kombinasi, setiap ml mengandung: natrium klorida 4,40 mg + kalium Catchcover, botol p
klorida 0,80 mg (tetes mata)
625 Kombinasi, setiap ml mengandung: natrium klorida 4,40 mg + kalium Botol plastik @ 5 m
klorida 0,80 mg (tetes mata)
626 Kombinasi, setiap ml mengandung: natrium klorida 4,40 mg + kalium Botol Plastik @ 15
klorida 0,80 mg (tetes mata)
627 Kombinasi: Amoksisilin 1.000 mg + Asam klavulanat 200 mg, Inj 1.200 mg vial

628 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules ampul/vial

629 Kombinasi: kaolin 550 mg + pektin 20 mg Tab
630 Kombinasi: Latanoprost 0,05 mg + Timolol 5 mg, tts mata botol
631 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 250 mg Tab
632 Kombinasi: parafin + gliserin + fenolftalein Botol
633 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 mcg ih 50 aerosol can/canist
mcg/puff
634 Kombinasi: salmeterol 50 mcg + flutikason propionat 100 mcg ih 100 Botol
mcg/puff
635 Kombinasi: salmeterol 50 mcg + flutikason propionat 500 mcg ih 500 Botol
mcg/puff
636 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 mcg ih 250 Botol
mcg/puff
637 Kombinasi: spironolakton 25 mg + tiabutazin 2,5 mg Tab
638 Komposit resin Set
639 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ tab/kaptab
trimetoprim 80 mg
640 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ tab/kaptab
trimetoprim 160 mg
641 Kotrimoksazol kombinasi tiap 5 ml suspensi : sulfametoksazol 200 mg + botol 60 mL
trimetoprim 40 mg
642 Kuinin inj 25% (i.v.) Vial
643 Kuinin tab 200 mg tablet/kapsul/kapl
644 Laktulosa sir 3,335 g/5 ml botol @ 60 mL
645 Lamivudin (3TC) tab 150 mg tablet/kapsul/kapl
646 Lamivudin tab 100 mg tablet/kapsul/kapl
647 Lamotrigin Tab 100 mg Tab
648 Lamotrigin tab 50 mg Tablet
649 Lamotrigin tab dispersible 25 mg tablet dispersible/
650 Lansoprazol inj 30 mg/ml Vial
651 Lansoprazol kaps 30 mg tablet/kapsul/kapl
652 Lapatinib tab 250 mg tablet/kapsul/kapl
653 Larutan mengandung Asam Amino (Asam Amino 10%) Botol
654 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g, Botol
Na+ 2 mEq, Asetat 120 mEq)
655 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl-52 Botol
mEq)
656 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 1000 ml
657 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan Botol
elektrolit) 500 ml
658 Larutan mengandung Asam Amino (Asam Amino 5% dengan BCAA 45%, L- Botol
Ornithine L Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol 50 gr/L)

659 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Botol
Taurine 0,24 gr/l) : Aminosteril Infant 6%
660 Larutan mengandung Asam Amino (Asam Amino 7% (total protein 17,5 g) Botol
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, Total N 11.53 g, Botol
AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 mEq)
662 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g, Botol
Na+ 14 mEq, Cl 94 mEq)
663 Larutan mengandung Asam Amino (Asam amino 8%) : Aminosteril N- Botol
Hepa
664 Larutan mengandung Asam Amino (Asam Amino 9%, Komposisi: Asam Botol
Amino esensial: Asam Amino non esensial = 60 : 40)
665 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10 Botol
g/L)
666 Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Aspartate Botol
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) Botol

668 Larutan mengandung Asam Amino (Kombinasi : asam amino, glukosa, dan Botol
lipid) (Lipid Peri 1250)
669 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi lemak, Botol
dan asam amino) (Lipid Special 1250)
670 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi lemak, Botol
dan asam amino) (Lipid Special 625)
671 Larutan mengandung asam amino (kombinasi AA 50 g/L, sorbitol 50 g/L, Botol
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 amino 50 g/L, Botol
vitamin dan elektrolit)
673 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 150 Botol
gr + Asam Amino 48 gr dgn akses sentral)
674 Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 80 Botol
gr + Asam Amino 40 gr)
675 Larutan mengandung Asam Amino + Elektrolit + Karbohidrat + Lipid Botol
(Kombinasi Asam Amino: 45gr, Glukosa: 130gr, Lipid: 68gr dan Elektrolit
(Kalori = 1400 kkal, Akses peripheral))

676 Larutan mengandung asam amino + elektrolit + Karbohidrat + Lipid Bag

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

677 Larutan mengandung asam amino + elektrolit + Karbohidrat + Lipid Bag

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

678 Larutan mengandung asam amino + elektrolit + Karbohidrat + Lipid Bag

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

679 Larutan Mengandung Asam amino + Elektrolit + Karbohidrat + Lipid Botol

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

680 Larutan mengandung Asam Amino + Elektrolit + Karbohidrat + Lipid Botol

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

681 Larutan mengandung Elektrolit (Kalium Klorida) Botol

682 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) (KN1) Botol
683 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) Botol
684 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3 Softbag @ 500 ml
mEq, Asetat 28 mEq) Ringer Asetat
685 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3 Botol plastik @ 50
mEq, Asetat 28 mEq) Ringer Asetat
686 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN Botol
1B)
687 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)

688 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit: Botol

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 0,15%+NaCl Botol

0,45%) (KDN1)
690 Larutan mengandung Karbohidrat + Elektrolit (D2,5%+KCL 0,3%+NaCl Botol
0,45%) (KDN2)
691 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Xylitol 60 Botol
g/ L)
692 Larutan mengandung Karbohidrat (Fructose 200 g, glucose 110 g, Xylitol Botol
100 g/ L)
693 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 Botol
g/ L)
694 Larutan mengandung Karbohidrat (Maltose 10%) Botol
695 Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 g Botol
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, Na, K, Cl, Ca, Mg, Botol
Sorbitol 50 gr/L)
697 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 100 gr/L, elektrolit)
698 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 75 gr/L, elektrolit)
699 Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%, NaCL 0,45%, Botol
KCl) (HSD)
700 Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, glucose 66 Botol
g, Xylitol 60 g/ L + elektrolit)
701 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl 2,0 g, Botol
KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
702 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Botol
Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
703 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 Botol
g)
704 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 Botol
g) (D5-1/4NS)
705 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 Botol
g) (D5-1/2NS)
706 Larutan mengandung karbohidrat + elektrolit (Kombinasi NaCl 18,6 g, KCl Botol
0,3 g, CaCl2 0,48 g, dextrose 50 g per 1000 ml)
707 Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi kombinasi Botol
infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ,
Asetat 38mEQ, Sorbitol 50g)

708 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa Botol
5%)
709 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol
Glukosa 100 gr)
710 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Na Botol
Lactate 2.24 g, Glukosa 100 gr)
711 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Botol
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
712 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat Botol
2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
713 Larutan mengandung Lipid (Emulsi lemak 20%) Botol
714 Larutan mengandung Lipid (Highly refined fish oil, Glyserol dan purified Botol
egg phospolipid)
715 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 100 ml) Botol

716 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 250 ml) Botol

717 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr + Botol
Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)
718 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 80 gr + Botol
Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
719 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 90 gr + Botol
Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)
720 Latanoprost tts mata 0,005% botol @ 2,5 mL
721 Leflunomid tab sal selaput 20 mg tablet salut selapu
722 Lenograstim inj 263 mcg/vial Vial
723 Letrozol tab 2,5 mg tablet/kapsul/kapl
724 Leuprorelin asetat serb inj 1,88 mg Vial
725 Leuprorelin asetat serb inj 11,25 mg Vial
726 Leuprorelin asetat serb inj 22,5 mg Vial
727 Leuprorelin asetat serb inj 3,75 mg ampul/vial
728 Leuprorelin asetat serb inj 7,5 mg Vial
729 Levetirasetam tab 250 mg Tablet
730 levetirasetam tab 500 mg Tablet
731 Levofloksasin inf 5 mg/ml vial / botol / flex
732 Levofloksasin inf 5 mg/ml vial/ botol/ flexy
733 Levofloksasin tab 500 mg tablet salut selapu
734 Levofloksasin tts mata 0,5% botol @ 5mL
735 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set
736 Levotiroksin tab 100 mcg tablet/kaplet/kaps
737 Levotiroksin tab 50 mcg tablet/kaplet/kaps
738 Lidokain gel 2% syringe/syringe pla
739 Lidokain inj 1 % (infltr) Vial
740 Lidokain inj 100 mg, vial (i.v.) Vial
741 Lidokain inj 2% (infiltr/p.v.) ampul/vial
742 Lidokain spray oral 10% botol
743 Linestrenol tab 0,5 mg tablet/kapsul/kapl
744 Linestrenol tablet 5 mg Tab
745 Lisinopril tab 10 mg tablet/kapsul/kapl
746 Lisinopril tab 20 mg Tab
747 Lisinopril tab 5 mg tablet/kapsul/kapl
748 Litium karbonat tab 200 mg tablet/kapsul/kapl
749 Litium karbonat tab 400 mg tablet/kapsul/kapl
750 Loperamid tab 2 mg Tab
751 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput
752 Loratadin tab 10 mg tablet/kapsul/kapl
753 Lorazepam tab 0,5 mg tablet/kapsul/kapl
754 Lorazepam tab 1 mg tablet/kapsul/kapl
755 Lorazepam tab sal 2 mg Tab sal
756 Low molecule feri sucrose inj amp 100 mg/5 ml ampul/vial
757 Lugol Botol
758 MAA (macro agregate albumin) 0,11-2,5 mg albumin aggregated/reaction Vial
vial
759 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial Vial
760 Magnesium sulfat inj 20% ampul/vial
761 Magnesium sulfat inj 20% ampul/vial @25 ml
762 Magnesium sulfat inj 40% ampul/vial @25 ml
763 Magnesium sulfat inj 40% ampul/vial
764 Magnesium sulfat serb, ktg 30 g Sachet
765 Manitol lar infus 20% Botol @ 250 ml
766 Manitol lar infus 20% Botol @ 500 ml
767 Manitol lar infus 20% Botol @ 100 ml
768 Maprotilin hcl tab sal 25 mg Tab sal
769 Maprotilin hcl tab sal 50 mg tablet salut selapu
770 MDP (methylene diphosphonate) 1 mg methylene diphosphonic acid/ml Vial

771 Mebendazol sir 100 mg/5 ml Botol

772 Mebendazol tab 100 mg Tan
773 Mebendazol tab 500 mg tablet/kapsul/kapl
774 Medroksi progesteron asetat inj 150 mg/ml ampul/vial
775 Medroksi progesteron asetat inj 200 mg/ml Vial
776 Medroksi Progesteron Asetat Inj 50 mg/ml ampul/vial
777 Medroksi progesteron asetat tab 10 mg tablet/kapsul/kapl
778 Medroksi progesteron asetat tab 100 mg tablet/kapsul/kapl
779 Medroksi progesteron asetat tab 250 mg Tab
780 Medroksi progesteron asetat tab 5 mg Tab
781 Melfalan tab 2 mg tablet/kapsul/kapl
782 Merkaptopurin tab 50 mg Tab
783 Meropenem serb inj 1000 mg/vial ampul/vial
784 Meropenem serb inj 500 mg/vial ampul/vial
785 Mesalazin tab sal 250 mg tablet salut enterik
786 Mesna inj 100 mg/ml Vial
787 Metadon sir 50 mg/5 ml Botol 1000 ml
788 Metamizol Inj 500 mg/ml Ampul
789 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut

790 Metformin tab 500 mg tablet/kapsul/kapl

791 Metformin tab 850 mg tablet/kapsul/kapl
792 Metildopa tab sal 250 mg tablet/kapsul/kapl
793 Metilergometrin inj 0,2 mg/ml ampul/vial
794 Metilergometrin tab salut 0,125 mg tablet/kaplet salut
795 Metilfenidat tab lepas lambat 18 mg tablet/kapsul/kapl
796 Metilfenidat tab lepas lambat 36 mg tablet/kapsul/kapl
797 Metilfenidat tab SR 10 mg tablet/kapsul/kapl
798 Metilfenidat tab SR 20 mg Tab
799 Metilprednisolon inj 125 mg/2 ml ampul/vial
800 Metilprednisolon inj 500 mg/8 ml ampul/vial
801 Metilprednisolon tab 16 mg tablet/kapsul/kapl
802 Metilprednisolon tab 4 mg tablet/kapsul/kapl
803 Metilprednisolon tab 8 mg tablet/kapsul/kapl
804 Metoklopramid drop 2 mg/ml botol @ 10mL
805 Metoklopramid inj 5 mg/ml ampul/vial
806 Metoklopramid sir 5 mg/5 ml Botol
807 Metoklopramid tab 10 mg tablet/kapsul/kapl
808 Metoklopramid tab 5 mg tablet/kapsul/kapl
809 Metoprolol tartat inj 1 mg/ml Ampul
810 Metotreksat Inj 10 mg/ml Vial
811 Metotreksat inj 2,5 mg/ml Vial
812 Metotreksat serb inj 25 mg/ml Vial
813 Metotreksat serb inj 5 mg/vial Vial
814 Metotreksat tab 2,5 mg Tab
815 Metronidazol lar inf 5 mg/ml botol
816 Metronidazol ovula 500 mg Ovula
817 Metronidazol sup 500 mg Suppositoria
818 Metronidazol susp 125 mg/5 ml Botol @ 60 ml
819 Metronidazol susp 125 mg/5 ml Botol @ 100 ml
820 Metronidazol tab 250 mg tablet/kapsul/kapl
821 Metronidazol tab 500 mg tablet/kapsul/kapl
822 MIBG (meta-iodobenzylguanidine) Vial
823 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial Vial
824 Midazolam inj 1 mg/ml (i.v.) Vial
825 Midazolam inj 5 mg/ml (i.v.) Vial
826 Mikafungin Na serb inj 50 mg/vial Vial
827 Mikofenolat mofetil tab 500 mg tablet/kapsul/kapl
828 Mikofenolat Sodium Tab Sal 180 mg tablet salut/kaplet
829 Mikofenolat Sodium Tab Sal 360 mg tablet salut/kaplet
830 Mikonazol krim 2% tube
831 Mikonazol serb 2% botol / sachet
832 Milrinone inj 1 mg/ml ampul/vial
833 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, Magnesium Sachet
Chloride Anhydrous, Potassium Chloride, Zinc Acetate)

834 Mitomisin serb inj 10 mg Vial

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

959 Perak sulfadiazin krim 1% Tube
960 Perindoprilarginin tab 5 mg tablet/kapsul/kapl
961 Permetrin krim 5 % Tube
962 Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial
963 Pilokarpin tts mata 2% Botol 5 ml
964 Pilokarpin tts mata 2% Catchcover, botol
965 Pioglitazon tab 15 mg tablet
966 Pioglitazon tab 30 mg tablet/kapsul/kapl
967 Pirantel pamoat susp 125 mg/5 ml Botol
968 Pirantel pamoat tab 500 mg Tab
969 Pirantel pamoat tab scored 125 mg tablet/kapsul/kapl
 970 Pirantel pamoat tab scored 250 mg Tab
971 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
972 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl
973 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kapl
974 Piridostigmin tab sal 60 mg tablet/kapsul/kapl
975 Pirimetamin tab 25 mg Tablet
976 Podofilin tingtur 25 % Botol
977 Polietilen glikol Botol
978 Polikresulen Botol
979 Povidon iodin lar 100 mg/ml botol 30 mL
980 Povidon iodin lar 100 mg/ml botol @ 60 mL
981 Povidon iodin lar 100 mg/ml Botol 300 ml
982 Povidon iodin lar 100 mg/ml botol @ 1.000 mL
983 Pramipeksol tab 0,125 mg tablet/kapsul/kapl
984 Pramipeksol tab ER 0,375 mg tablet lepas lamba
985 Pramipeksol tab ER 0,750 mg tablet lepas lamba
986 Pravastatin tab 10 mg Tab
987 Pravastatin tab 20 mg tablet/kapsul/kapl
988 Prazikuantel tab scored 300 mg Tab
989 Prazikuantel tab scored 600 mg Tab
990 Prednisolon tts mata 10 mg/ml Botol
991 Prednison tab 5 mg tablet/kapsul/kapl
992 Primakuin tab 15 mg Tab
993 Probenesid tab 500 mg tablet/kapsul/kapl
994 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial
995 Prokaterol HCl cairan ih 30 mcg Botol
996 Prokaterol HCl cairan ih 50 mcg Botol
997 Prokaterol HCl serb ih 10 mcg Botol
998 Propiltiourasil tab 100 mg tablet/kapsul/kapl
999 Propofol inj 1% (i.v. Bolus) ampul/vial
1000 Propranolol inj 1 mg/ml (i.v.) Ampul
1001 Propranolol tab 10 mg tablet/kapsul/kapl
1002 Propranolol tab 40 mg tablet/kapsul/kapl
1003 Prostaglandin (PGE 1) Inj 500 mcg/ml Vial
1004 Protamin sulfat inj 10 mg/ml (i.m.) Ampul
1005 Quetiapin tab 100 mg tablet/kapsul/kapl
1006 Quetiapin tab SR 200 mg tablet SR/kaplet SR
1007 Quetiapin tab SR 300 mg tab SR
1008 Quetiapin tab SR 400 mg tablet SR/kaplet SR
1009 Ramipril tab 10 mg tablet/kapsul/kapl
1010 Ramipril tab 2,5 mg tablet/kapsul/kapl
1011 Ramipril tab 5 mg tablet/kapsul/kapl
1012 Ranibizumab inj 10 mg/ml Vial
1013 Ranitidin inj 25 mg/ml ampul/vial
1014 Ranitidin tab 150 mg tablet/kapsul/kapl
1015 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak
1016 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak
1017 Ribavirin tab 200 mg tab sal selaput
1018 Rifampisin kaps 300 mg tablet/kapsul/kapl
1019 Rifampisin tab 450 mg tablet/kapsul/kapl
1020 Rifampisin tab 600 mg tablet/kapsul/kapl
1021 Rilpivirine 25 mg tablet
1022 Ringer Laktat Larutan Botol
1023 Ringer Laktat Larutan 1000 ml Botol
1024 Risedronat tab sal selaput 35 mg tablet salut selaput
1025 Risperidon oral solution 1 mg/mL botol
1026 Risperidon tab 3 mg tablet/kapsul/kapl
1027 Risperidon tab sal 1 mg tablet/kapsul/kapl
1028 Risperidon tab sal 2 mg tablet/kapsul/kapl
1029 Rituksimab inf 10 mg/ml (vial 10 ml) Vial
1030 Rituksimab Inf 10 mg/ml (vial 50 ml) Vial
1031 Rituksimab inj 100 mg/ml Ampul
1032 Rituksimab inj 500 mg/ml Ampul
1033 Rivaroksaban tab sal 10 mg tablet salut/kaplet
1034 Rivaroksaban tab sal 15 mg tablet salut/kaplet
1035 Rivaroksaban tab sal 20 mg tablet salut/kaplet
1036 Rokuronium inj 50 mg/5 ml (i.v.) ampul/vial
1037 Ropinirol tab lepas lambat 2 mg tablet lepas lamba
1038 Ropinirol tab lepas lambat 4 mg tablet lepas lamba
1039 Ropinirol tab lepas lambat 8 mg tablet lepas lamba
1040 Ropivakain Inj 7,5 mg/ml ampul/polyamp/via
1041 Rosuvastatin tab 10 mg tablet/kapsul/kapl
1042 Salbutamol aerosol 100 mcg canister / botol
1043 Salbutamol cairan ih 0,1% ampul/vial/botol
1044 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler Botol
1045 Salbutamol lar ih 0,5 % Botol
1046 Salbutamol nebules vial 2,5 mg Vial
1047 Salbutamol sir 2 mg/5 ml Botol
1048 Salbutamol tab 2 mg tablet/kapsul/kapl
1049 Salbutamol tab 4 mg tablet/kapsul/kapl
1050 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 15 gram
1051 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 30 gram
1052 Secukinumab serb inj 150 mg Vial
1053 Sefadroksil kaps 250 mg tablet/kapsul/kapl
1054 Sefadroksil kaps/tab 500 mg tablet/kapsul/kapl
1055 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL
1056 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL
1057 Sefaleksin kaps 500 mg tablet/kapsul/kapl
1058 Sefazolin serb inj 1 g/vial ampul/vial
1059 Sefepim serb inj 1000 mg/vial ampul/vial
1060 Sefiksim sir 100 mg/5 ml botol
1061 Sefiksim tab 100 mg Tab
1062 Sefiksim Tab 200 mg Tablet
1063 Sefoperazon serb inj 1.000 mg/vial ampul/vial
1064 Sefotaksim inj 500 mg/vial ampul/vial
1065 Sefotaksim serb inj 1.000 mg/vial ampul/vial
1066 Sefpirom serb inj 1000 mg ampul/vial
1067 Sefpodoksim proksetil tab sal 100 mg Tab
1068 Seftazidim serb inj 1.000 mg/vial ampul/vial
1069 Seftriakson serb inj 1.000 mg/vial ampul/vial
1070 Sefuroksim serb inj 750 mg/vial ampul/vial
1071 Sefuroksim tab 250 mg tablet salut selapu
1072 Sefuroksim tab sal 500 mg tablet salut selapu
1073 Sertralin tab sal 50 mg tablet salut/kaplet
1074 Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) inj (i.m./i.v.) Vial

1075 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial

1076 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial
1077 Serum antirabies inj 100 UI/ml Vial
1078 Serum antirabies inj 200 UI/ml Vial
1079 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
1080 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
1081 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
1082 Setirizin sir 5 mg/5 ml. botol @ 60 mL
1083 Setirizin tab 10 mg tablet/kapsul/kapl
1084 Setuksimab inj 5 mg/ml Vial
1085 Sevelamer karbonat Tab 800 mg Tab
1086 Sevofluran cairan ih 250 ml botol
1087 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial
1088 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kapl
1089 Siklofosfamid serb inj 1000 mg/vial (i.v.) Vial
1090 Siklofosfamid serb inj 200 mg/vial (i.v.) Vial
1091 Siklofosfamid serb inj 500 mg/vial (i.v.) Vial
1092 Siklopentolat tetes mata 1% Botol
1093 Siklosporin inj 100 mg/ml Ampul
1094 Siklosporin inj 50 mg/ml Ampul
1095 Siklosporin kaps 100 mg kaps lunak
1096 Siklosporin kaps lunak 25 mg kaps lunak
1097 Siklosporin Kaps lunak 50 mg Kaps lunak
1098 Sildenafil Tab 20 mg Tab
1099 Silodosin tab 4 mg Tab
1100 Silostazol kaps SR 100 mg tablet/kapsul/kapl
1101 Silostazol tab 100 mg Tab
1102 Simvastatin tab sal 10 mg tablet/kapsul/kaple
1103 Simvastatin tab sal 20 mg tablet/kapsul/kaple
1104 Simvastatin tab sal selaput 40 mg Tab sal
1105 Siprofloksasin inf 2 mg/ml vial/ botol 100 ml
1106 Siprofloksasin tab scored 500 mg tablet salut selapu
1107 Siprofloksasin tetes mata 3 mg/ml Catchcover, botol
1108 Sisplatin serb inj 10 mg Vial
1109 Sisplatin serb inj 50 mg Vial
1110 Sitarabin inj 50 mg Vial
1111 Sitarabin serb inj 100 mg (i.m./i.v./s.k.) Vial
1112 Sofosbuvir tab sal selaput 400 mg tablet salut selaput
1113 Solifenasin tab 10 mg tablet/kapsul/kapl
1114 Solifenasin tab 5 mg tablet/kapsul/kapl
1115 Somatostatin serb Inj 3000 mcg/mL Vial
1116 Soybean oil 200 g, ovolecithin 12 g, glycerol 22 g, Na hydroxide Softbag @ 250 ml
1117 Spiramisin tab 250 mg Tab
1118 Spiramisin tab 500 mg tablet salut selapu
1119 Spironolakton tab 100 mg tablet/kapsul/kapl
1120 Spironolakton tab 25 mg tablet/kapsul/kapl
1121 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial
1122 Stavudin tab 30 mg Tab
1123 Streptokinase serb inj 1,5 juta UI/vial Vial
1124 Streptomisin serb inj 1.000 mg/vial ampul/vial
1125 Sufentanil inj 5 mcg/ml (i.v.) Ampul
1126 Sugammadeks inj 100 mg/ml Vial
1127 Sukralfat susp 500 mg/5 ml botol
1128 Sukralfat tab 500 mg tablet/kapsul/kapl
1129 Suksinilkolin inj 20 mg/ml (i.v./i.m.) Vial
1130 Suksinilkolin inj 50 mg/ml (i.v./i.m.) Vial
1131 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) Vial
1132 Sulfadiazin tab 500 mg tablet/kapsul/kapl
1133 Sulfasalazin kapl sal enterik 500 mg tablet salut enteri
1134 Sulfur colloid 4,5 mg gelatin/reaction vial Vial
1135 Surfaktan susp 25 mg/ml (intratrakeal) Botol
1136 Surgical ginggival pack Tube
1137 Takrolimus kaps 0,5 mg tablet/kapsul/kapl
1138 Takrolimus kaps 1 mg tablet/kapsul/kapl
1139 Takrolimus kaps lepas lambat 0,5 mg kapsul lepas lamba
1140 Takrolimus kaps lepas lambat 1 mg kapsul lepas lamba
1141 Tamoksifen tab 10 mg Tablet
1142 Tamoksifen tab 20 mg Tab
1143 Tamsulosin tab 0,2 mg tablet/kapsul/kapl
1144 Tamsulosin tab SR 0,4 mg tab lepas lambat /
1145 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 millicuries)/ml Set
1146 Telbivudin tab 600 mg tablet/kapsul/kapl
1147 Telmisartan tab 40 mg tablet/kapsul/kapl
1148 Telmisartan tab 80 mg tablet/kapsul/kapl
1149 Temozolamid kaps 100 mg tablet/kapsul/kapl
1150 Temozolamid kaps 20 mg tablet/kapsul/kapl
1151 Tenofovir tab 300 mg tablet salut selapu
1152 Teofilin tab 150 mg tablet/kapsul/kapl
1153 Teofilin tab SR 300 mg tablet lepas lamba
1154 Terazosin hcl tab 1 mg tablet/kapsul/kapl
1155 Terazosin hcl tab 2 mg tablet/kapsul/kapl
1156 Terbinafin tab 250 mg tablet/kapsul/kapl
1157 Terbutalin cairan ih 2,5 mg/ml Botol
1158 Terbutalin inj 0,5 mg/ml ampul/vial
1159 Terbutalin serb ih 0,50 mg/dose Vial
1160 Terbutalin sir 1,5 mg/5 ml botol
1161 Terbutalin tab 2,5 mg tablet/kapsul/kapl
1162 Testosteron inj 250 mg/ml (vial 1 ml) Vial
1163 Testosteron Inj 250 mg/ml (vial 4 ml) Vial
1164 Testosteron kaps lunak 40 mg kapsul lunak
1165 Tetanus toxoid inj Ampul
1166 Tetrakain tts mata 0,5% Botol
1167 Tetrasiklin kaps 250 mg tablet/kapsul/kapl
1168 Tetrasiklin kaps 500 mg tablet/kapsul/kapl
1169 Tetrasiklin Salep Mata 1% Tube
1170 Thallous Chloride Tl-202 1 mg methylene diphosphonic acid/ml Set
1171 Tiamazol tab 10 mg tablet salut selap
1172 Tiamazol tab 5 mg tablet salut selap
1173 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kapl
1174 Tikagrelor tab 90 mg tablet/kapsul/kapl
1175 Timolol tts mata 0,25% botol @ 5 mL
1176 Timolol tts mata 0,5% botol @ 5 mL
1177 Tiopental serb inj 500 mg/amp (i.v. Bolus) Ampul
1178 Tiopental serb serb inj 1.000 mg/amp (i.v.) Ampul
1179 Tiotropium respimat ih 5 mcg/semprot Botol
1180 Tiotropium respimat ih 5 mcg/semprot Handihaler
1181 Tobramisin tetes mata 0,3% Botol @ 5 ml
1182 Tobramisin tetes mata 0,3% Catchcover, botol
1183 Topiramat tab 100 mg tablet/kapsul/kapl
1184 Topiramat tab 25 mg tablet/kapsul/kapl
1185 Topiramat tab 50 mg tablet/kapsul/kapl
1186 Tosilizumab inf 400 mg/20 mL vial
1187 Tosilizumab inf 80 mg/4 mL vial
1188 Trastuzumab serb inj 440 mg/vial ampul/vial
1189 Travoprost tts mata 0,004% Botol
1190 Triamsinolon asetonid nasal spray 55 mcg/puff Botol
1191 Triamsinolon inj 10 mg/ml Ampul
1192 Triamsinolon inj 40 mg/ml ampul/vial
1193 Trifluoperazin tab sal 5 mg tablet salut selapu
1194 Triheksifenidil tab 2 mg tablet/kapsul/kapl
1195 Tropikamid tts mata 0,5% Catchcover, botol
1196 Tropikamid tts mata 0,5% Botol @ 5 ml
1197 Tropikamid tts mata 1% Botol
1198 Tuberkulin protein purified derivative 1:10 (i.k) Ampul
1199 Urea krim 10 % pot
1200 Vaksin BCG inj (i.k) Vial
1201 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
1202 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) 0,5 ml Vial
(i.m)
1203 Vaksin Influenza Vial
1204 Vaksin Japanese Enchepalitis (J.E) Vial
1205 Vaksin jerap difteri tetanus (DT) Vial
1206 Vaksin jerap difteri tetanus (Td) Vial
1207 Vaksin kombinasi DPT-HB-Hib Vial
1208 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial
1209 Vaksin Meningitis Meningokokus Vial
1210 Vaksin polio IPV inj 0,5 ml Vial
1211 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial
1212 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial
1213 Vaksin Yellow Fever Vial
1214 Valasiklovir tab 500 mg tablet/kapsul/kapl
1215 Valgansiklovir tab sal 450 mg tablet salut/kaplet
1216 Valproat sir 250 mg/5 ml botol @ 120 ml
1217 Valproat tab sal 250 mg tablet salut enterik
1218 Valproat tab sal 500 mg Tab sal
1219 Valproat tab sal enterik 200 mg Tab
1220 Valproat tab SR 250 mg tabet lepas lambat
1221 Valproat tab SR 500 mg tabet lepas lambat
1222 Valsartan tab 160 mg tablet/kapsul/kapl
1223 Valsartan tab 80 mg tablet salut/kaplet
1224 Vankomisin serb inj 500 mg/vial Vial
1225 Vasopresin inj 20 UI/ml (i.m./s.k.) Vial
1226 Verapamil inj 2,5 mg/ml Vial
1227 Verapamil tab 240 mg tablet lepas lamba
1228 Verapamil tab 80 mg tablet/kapsul/kapl
1229 Vildagliptin tab 50 mg Tab
1230 Vinblastin inj 1 mg/ml Ampul
1231 Vinkristin inj 1 mg/ml (vial 1 mL) Vial
1232 Vinkristin inj 1 mg/ml (vial 2 mL) Vial
1233 Vinorelbin inj 10 mg/ml, kemasan 1 ml Vial
1234 Vinorelbin inj 10 mg/ml, kemasan 5 ml Vial
1235 Vitamin B kompleks tablet
1236 Vorikonazol inj 200 mg vial
1237 Vorikonazol tab sal selaput 200 mg tablet/kapsul/kapl
1238 Warfarin tab 1 mg tablet/kapsul/kapl
1239 Warfarin tab 2 mg tablet/kapsul/kapl
1240 Zidovudin kaps 100 mg tablet/kapsul/kapl
1241 Zinc drops 10 mg/ml Botol
1242 Zinc serb 10 mg Sachet
1243 Zinc sir 10 mg/ml Botol
1244 Zinc sir 20 mg/5 ml botol
1245 Zinc tab disp 20 mg tablet dispersible
 /KOTA atau BKKBN
MA 2020 DIKALI 18 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PU
BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN SISA STOK PER 31 DESEMBER 2020
IL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2021 BERDASAR
KERJA DAN DIBERI STEMPEL
OLOM PADA FORMAT

UJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2021

SISA STOK PER 31 PEMAKAIAN JUMLAH RENCANA RENCANA RENCANA

DESEMBER 2019 RATA-RATA PER KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN
BULAN SELAMA TAHUN 2021 TAHUN 2021 TAHUN 2021 TAHUN 2020
2019

(a) (b) (c) = (b) x 15 (d) = (c) - (a) (e) (f)

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40 458 6870 6830 7000 6000
600 960 14400 13800 14000 14040
0 0 0 0 0 0
100 208 3120 3020 3200 2970
200 416 6240 6040 7000 3600
400 1000 15000 14600 15000 10800
0 0 0 0 0 0
0 0 0 0 0 0
12 58 870 858 858 720
12 25 375 363 370 360
12 33 495 483 500 420
0 0 0 0 0 0
12 25 375 363 380 324
0 0 0 0 0 0
10 16 240 230 230 108
0 0 0 0 0 0
 500 1833 27495 26995 27000 21600
500 1250 18750 18250 19000 12000
0 0 0 0 0 0
500 833 12495 11995 12000 8400
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 300
0 0 0 0 0 200
40 66 990 950 950 720
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30 33 495 465 500 720
300 666 9990 9690 10000 8400
500 1000 15000 14500 15000 13200
4000 8333 124995 120995 120000 114000
1500 2500 37500 36000 40000 36000
12 25 375 363 363 600
12 25 375 363 363 600
12 25 375 363 363 540
0 0 0 0 0 0
100 666 9990 9890 10000 8160
0 0 0 0 0 0
0 0 0 0 0 0
30 50 750 720 750 840

30 84 1260 1230 1500 1080

10 33 495 485 500 432

10 41 615 605 650 648

0 0 0 0 0 0

10 41 615 605 650 648

0 0 0 0 0 0
15 33 495 480 500 432

50 208 3120 3070 3500 2544

200 333 4995 4795 6000 5424

 100 208 3120 3020 4000 2856
8 8 120 112 120 111

8 8 120 112 120 111

8 16 240 232 250 111

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
7 7 105 98 100 111
0 0 0 0 0 0
1000 3333 49995 48995 50000 46452
200 583 8745 8545 9000 7128
300 1500 22500 22200 22000 17859
0 0 0 0 0 0
500 9583 143745 143245 143000 113100
0 0 0 0 0 0
10 8 120 110 114 217
0 0 0 0 0 0
0 0 0 0 0 0
500 5000 75000 74500 74500 69600
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 16 240 236 236 200
6 16 240 234 234 200
7 16 240 233 233 200
100 583 8745 8645 9000 7080
0 0 0 0 0 0
400 1333 19995 19595 20000 16800
100 125 1875 1775 2000 1632
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 312
0 0 0 0 0 210
0 0 0 0 0 0
200 416 6240 6040 6500 5940
0 0 0 0 0 0
100 416 6240 6140 6000 5940
0 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 333 4995 4895 5000 4020
100 250 3750 3650 4000 3588
0 0 0 0 0 0
0 0 0 0 0 0
40 75 1125 1085 1100 912
0 0 0 0 0 0
4 5 75 71 70 99
4 5 75 71 70 99
0 0 0 0 0 0
5 7 105 100 100 99
5 5 75 70 80 59
0 0 0 0 0 0
20 33 495 475 480 594
0 0 0 0 0 0
2 7 105 103 120 99
0 0 0 0 0 0
2 7 105 103 120 99
2 7 105 103 120 99
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1000 2500 37500 36500 38000 32880
0 0 0 0 0 99
0 0 0 0 0 0
10 12 180 170 200 198
8 12 180 172 200 198
8 12 180 172 200 198
8 12 180 172 200 198
0 0 0 0 0 0
0 0 0 0 0 0
8 20 300 292 300 297
8 13 195 187 200 198
 50 150 2250 2200 2500 1960
0 0 0 0 0 0
500 1500 22500 22000 22000 19622
0 0 0 0 0 0
1000 2500 37500 36500 37000 30492
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 41 615 595 560 554

22 66 990 968 970 871

0 0 0 0 0 0
0 0 0 0 0 0
20 133 1995 1975 1975 1782
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
5 12 180 175 175 158
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
200 916 13740 13540 13540 11400
200 916 13740 13540 13540 11544
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10 83 1245 1235 1235 1140
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
2 11 165 163 165 132
4 20 300 296 300 276
8 150 2250 2242 2242 1824
100 250 3750 3650 3700 3120
50 100 1500 1450 1500 1320
0 0 0 0 0 0
0 0 0 0 0 0
20 45 675 655 655 594
0 0 0 0 0 0
10 41 615 605 620 612
300 1666 24990 24690 25000 21408
14 41 615 601 600 594
50 150 2250 2200 2200 1980
12 37 555 543 550 594
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 166 2490 2470 2500 2495
6 12 180 174 170 198
0 0 0 0 0 0
0 0 0 0 0 0

100 250 3750 3650 3700 3240

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 250 3750 3650 3700 3720
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
10 37 555 545 550 480
400 750 11250 10850 10000 11040
12 37 555 543 550 594
30 125 1875 1845 1900 1544
0 0 0 0 0 0
12 45 675 663 0 594
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10 41 615 605 600 594
0 0 0 0 0 0
10 15 225 215 215 198
40 91 1365 1325 1325 1188
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12 37 555 543 545 456
 0 0 0 0 0 0
0 0 0 0 0 0
10 15 225 215 215 198
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
2 4 60 58 62 60
2 4 60 58 62 60
2 4 60 58 62 60
2 4 60 58 62 60
0 0 0 0 0 0
0 0 0 0 0 0
1000 3083 46245 45245 45200 37200
0 0 0 0 0 0
0 0 0 0 0 0
20 41 615 595 620 600
0 0 0 0 0 0
200 791 11865 11665 12000 10000
30 158 2370 2340 2500 1920
40 158 2370 2330 2500 1920
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 7 105 101 110 99
3 6 90 87 90 80
5 30 450 445 460 360
50 141 2115 2065 2065 1800
0 0 0 0 0 0
5 10 150 145 145 120
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1000 3750 56250 55250 55250 47000
0 0 0 0 0 0
0 0 0 0 0 0
50 333 4995 4945 5000 4000
40 416 6240 6200 6200 5700
50 166 2490 2440 2440 2000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 45 675 655 655 600
30 45 675 645 645 594
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10 33 495 485 485 600
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 47 705 685 685 600
40 41 615 575 575 500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
150 650 9750 9600 9600 8000
300 2416 36240 35940 35940 30000
200 4666 69990 69790 69790 60000
300 1041 15615 15315 15315 13200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
100 625 9375 9275 9275 7800
100 375 5625 5525 5525 5000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40 333 4995 4955 4955 4200
0 0 0 0 0 0
9 20 300 291 291 250
0 0 0 0 0 0
8 16 240 232 240 250
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 3666 54990 54890 55000 44400
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
200 333 4995 4795 4800 4200
100 1833 27495 27395 27500 22080
150 2500 37500 37350 37500 35000
100 1250 18750 18650 18700 15000
90 7166 107490 107400 107500 90000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 100 1500 1480 1500 1200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
 22 291 4365 4343 4500 3750
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40 250 3750 3710 3800 3050
3 6 90 87 90 84
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 6 90 86 90 80
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 475 7125 7025 7100 6000
5 10 150 145 150 140
14 41 615 601 650 550
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 150 2250 2250 0 1980
0 15 225 225 0 190
0 141 2115 2115 0 1900
0 13 195 195 0 200
0 50 750 750 0 650

0 50 750 750 0 650

0 50 750 750 0 650
0 45 675 675 0 650

0 45 675 675 0 650

6 41 615 609 610 650

5 45 675 670 680 650

 9 50 750 741 750 650
12 50 750 738 750 650
10 24 360 350 400 300
6 13 195 189 190 200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12 45 675 663 670 600
0 0 0 0 0 0
200 750 11250 11050 11000 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 13 195 191 200 200
12 31 465 453 450 400
2 3 45 43 50 50
5 8 120 115 115 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50 250 3750 3700 3700 3000
150 808 12120 11970 12000 10000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 458 6870 6770 6800 6000
200 1000 15000 14800 15000 12000
10 25 375 365 400 400
0 0 0 0 0 0
400 2750 41250 40850 40850 33500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40 150 2250 2210 2200 2000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 25 375 371 370 300
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
1000 3458 51870 50870 51000 42000
0 0 0 0 0 0
0 0 0 0 0 0
1500 5916 88740 87240 87500 71800
1600 6833 102495 100895 100000 82700
0 0 0 0 0 0
30 75 1125 1095 1095 1000
60 125 1875 1815 1800 1600
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 750 11250 11150 12000 9900
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12 37 555 543 543 500
12 37 555 543 543 500
0 0 0 0 0 0
0 0 0 0 0 0
10 15 225 215 245 200
12 15 225 213 213 200
10 37 555 545 545 550
4 4 60 56 60 60
30 50 750 720 720 6200
5 12 180 175 175 180
4 20 300 296 296 300
200 625 9375 9175 9200 8000
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 1916 28740 28540 29000 23400
100 1000 15000 14900 15000 13000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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 1666 24990 24790 24790 20700
300 2000 30000 29700 29700 25000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12 15 225 213 215 200
12 15 225 213 215 200
0 0 0 0 0 0
0 0 0 0 0 0
10 16 240 230 250 220
12 25 375 363 370 350
12 25 375 363 370 350
12 25 375 363 370 350
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
13 45 675 662 670 600
0 0 0 0 0 0
0 0 0 0 0 0
100 325 4875 4775 4800 4000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 458 6870 6770 7000 5800
100 458 6870 6770 7000 5800
200 5833 87495 87295 88000 75000
200 2416 36240 36040 36000 30000
300 2083 31245 30945 31000 26000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

6 8 120 114 120 100

12 23 345 333 350 300

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
100 3833 57495 57395 58000 49000
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

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

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

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

10 20 300 290 300 300

0 0 0 0 0 0

0 0 0 0 0 0

30 250 3750 3720 3700 3350

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

0 0 0 0 0 0

26 62 930 904 900 800

12 25 375 363 0 396

0 0 0 0 0 0
0 0 0 0 0 0
40 116 1740 1700 1700 1500

0 0 0 0 0 0

10 20 300 290 300 290

0 0 0 0 0 0
0 0 0 0 0 0
20 41 615 595 600 550
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
150 2250 33750 33600 34000 28000
0 0 0 0 0 0
20 41 615 595 600 590
10 29 435 425 425 396

12 29 435 423 450 396

10 15 225 215 215 198

12 20 300 288 290 297

12 21 315 303 300 297

10 29 435 425 430 396

12 45 675 663 660 594

10 15 225 215 215 198

0 0 0 0 0 0

6 8 120 114 114 99

0 0 0 0 0 0

8 15 225 217 217 198

9 21 315 306 310 297

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

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
20 45 675 655 655 594

0 0 0 0 0 0

0 0 0 0 0 0

5 7 105 100 105 99

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

6 7 105 99 100 99

12 37 555 543 545 500

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

0 0 0 0 0 0

10 24 360 350 350 297

4 7 105 101 105 99

5 7 105 100 100 99

0 0 0 0 0 0

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

6 15 225 219 220 198

4 7 105 101 100 99

0 0 0 0 0 0
4 7 105 101 100 99

4 7 105 101 100 99

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

5 7 105 100 100 99

0 0 0 0 0 0

0 0 0 0 0 0

4 7 105 101 100 99

4 4 60 56 60 59

4 4 60 56 60 59

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

120 333 4995 4875 4800 4400

5 7 105 100 110 99

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

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12 58 870 858 858 750
200 2416 36240 36040 36000 29800
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
40 83 1245 1205 1300 1200
20 83 1245 1225 1300 1200
4 5 75 71 70 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
100 158 2370 2270 2200 1980
0 0 0 0 0 0
 30 54 810 780 780 700
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
10 15 225 215 220 198
0 0 0 0 0 0
0 0 0 0 0 0
30 75 1125 1095 1100 990
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30 75 1125 1095 1100 990
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12 37 555 543 540 500
4 7 105 101 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
200 1083 16245 16045 16000 13600
0 0 0 0 0 0

5000 16250 243750 238750 240000 200000

500 2333 34995 34495 35000 30000
300 833 12495 12195 13000 12000
20 41 615 595 600 600
 30 91 1365 1335 1400 1200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 333 4995 4895 4800 4000
12 41 615 603 650 600
300 1500 22500 22200 22000 20000
2000 4166 62490 60490 60000 52000
1000 2416 36240 35240 35000 29700
0 0 0 0 0 0
300 500 7500 7200 7200 6200
0 0 0 0 0 0
30 75 1125 1095 1100 1000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
8 15 225 217 220 200
0 0 0 0 0 0
0 0 0 0 0 0
100 250 3750 3650 3700 3500
10 15 225 215 215 198
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
300 625 9375 9075 9000 8000
0 0 0 0 0 0
0 0 0 0 0 0
14 25 375 361 360 300
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
 15 25 375 360 360 300
100 150 2250 2150 2200 2000
0 0 0 0 0 0
0 0 0 0 0 0
20 166 2490 2470 2500 2200
5 8 120 115 120 100
0 0 0 0 0 0
40 75 1125 1085 1100 900
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 41 615 595 600 500
30 75 1125 1095 1100 1000
0 0 0 0 0 0
0 0 0 0 0 0
600 1666 24990 24390 25000 23000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
5 7 105 100 100 99
5 7 105 100 100 99
0 0 0 0 0
10 15 225 215 215 198
0 0 0 0 0 0
0 0 0 0 0 0
100 233 3495 3395 3300 3000
500 1500 22500 22000 22000 20000
5 6 90 85 85 80
5 6 90 85 85 80
0 0 0 0 0 0
4 8 120 116 116 100
4 8 120 116 116 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
4 8 120 116 116 100
0 0 0 0 0 0
700 1833 27495 26795 26500 22800
0 0 0 0 0 0
0 0 0 0 0 0
 40 50 750 710 700 600
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
12 30 450 438 440 400
5 5 75 70 70 60
0 0 0 0 0 0
5 5 75 70 70 60
0 0 0 0 0 0
10 21 315 305 300 297
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
200 291 4365 4165 4200 4000
10 25 375 365 365 350
10 16 240 230 230 200
10 16 240 230 230 200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10 17 255 245 230 200
10 17 255 245 230 200
0 0 0 0 0 0
0 0 0 0 0 0
400 500 7500 7100 7500 6200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 5600
0 0 0 0 0 50000
0 0 0 0 0 3400
0 0 0 0 0 9600
0 0 0 0 0 100
0 0 0 0 0 100
0 0 0 0 0 100
0 0 0 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 3500
0 0 0 0 0 6000
0 0 0 0 0 50000
0 0 0 0 0 700
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 198
0 0 0 0 0 32000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 14000
0 0 0 0 0 1200
0 0 0 0 0 600
0 0 0 0 0 1100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 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
0 0 0 0 0 26000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 17000
0 0 0 0 0 600
0 0 0 0 0 0
0 0 0 0 0 30000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 400
0 0 0 0 0 0
0 0 0 0 0 15000
0 0 0 0 0 130000
0 0 0 0 0 600
0 0 0 0 0 400
0 0 0 0 0 0
0 0 0 0 0 5000
0 0 0 0 0 32000
0 0 0 0 0 20000
0 0 0 0 0 0
0 0 0 0 0 131000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2000
0 0 0 0 0 2000
0 0 0 0 0 2000
0 0 0 0 0 0
0 0 0 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 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
0 0 0 0 0 0
0 0 0 0 0 700
0 0 0 0 0 400
0 0 0 0 0 1000
0 0 0 0 0 0
0 0 0 0 0 5000
0 0 0 0 0 80100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 53000
0 0 0 0 0 0
0 0 0 0 0 400
0 0 0 0 0 0
0 0 0 0 0 8540
0 0 0 0 0 900
0 0 0 0 0 3000
0 0 0 0 0 70000
0 0 0 0 0 43000
0 0 0 0 0 620
0 0 0 0 0 0
0 0 0 0 0 18520
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 4500
0 0 0 0 0 40500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 3366
0 0 0 0 0 210

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2600
0 0 0 0 0 1000
0 0 0 0 0 0
0 0 0 0 0 125000
0 0 0 0 0 90
0 0 0 0 0 0
0 0 0 0 0 90
0 0 0 0 0 0
0 0 0 0 0 40000
0 0 0 0 0 200
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 198
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 7920
0 0 0 0 0 0
0 0 0 0 0 2673
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 3960
0 0 0 0 0 0
 0 0 0 0 0 25000
0 0 0 0 0 0
12 41 615 603 603 600
200 2666 39990 39790 40000 35000
0 0 0 0 0 0
5 7 105 100 100 90
5 7 105 100 100 90
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
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 1000 15000 14800 15000 12800
100 2583 38745 38645 38000 36700
0 0 0 0 0 0
0 0 0 0 0 0
3 3 45 42 50 40
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
80 166 2490 2410 2400 2500
12 37 555 543 540 500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 375 5625 5525 5500 4750
0 0 0 0 0 0
60 333 4995 4935 5000 4250
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50 150 2250 2200 2500 1900
 50 150 2250 2200 2500 1900
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
50 291 4365 4315 4300 4000
50 375 5625 5575 5600 4800
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 25 375 355 355 300
10 25 375 365 365 350
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
100 375 5625 5525 5500 5000
100 375 5625 5525 5500 5000
120 125 1875 1755 1700 2000
0 0 0 0 0 0
10 58 870 860 860 800
14 75 1125 1111 1200 1000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
30 75 1125 1095 1100 1000
0 0 0 0 0 0
0 0 0 0 0 0
40 150 2250 2210 2200 1900
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
100 291 4365 4265 5000 3500
0 0 0 0 0 0
12 33 495 483 483 400
10 25 375 365 365 300
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
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
10 15 225 215 215 198
12 150 2250 2238 2200 1980
0 0 0 0 0 0
0 0 0 0 0 0
30 50 750 720 750 600
0 0 0 0 0 0
100 125 1875 1775 1775 2000
100 125 1875 1775 1775 1500
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 35
0 0 0 0 0 50
0 0 0 0 0 0
0 0 0 0 0 0
2000 4583 68745 66745 67000 55450
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
5 5 75 70 90 60
0 0 0 0 0 0
0 0 0 0 0 0
6 4 60 54 60 45
0 0 0 0 0 0
AL / TUBE / SACCHET / PUFF

N TAHUN 2021 BERDASARKAN PERKIRAAN ANGGARAN YANG DIPEROLEH TAHUN 2021

REALISASI KETERANGAN
PENGADAAN
TAHUN 2019

(g) (h)
0

0
0
0
0
0
5500
11000
0
2500
5000
12000
0
0
700
300
400
0
300
0
200
0
 22000
15000
0
10000
0
0
0
0
0
800
0
0
0
400
8000
12000
100000
30000
300
300
300
0
8000
0
0
600

1000

400
500

500

0
400

2500

4000
 2500
90

90
200

0
0
0
0
0
0
90
0
40000
7000
18000
0
115000
0
100
0
0
60000
0
0
0
0
200
200
200
7000
0
16000
1500
0
0
0
0
0
5000
0
5000
0
 0
0
0
0
4000
3000
0
0
900
0
60
60
0
90
60
0
400
0
90
0
90
90
0
0
0
0
0
0
0
0
0
0
0
0
30000
0
0
150
150
150
150
0
0
250
160
 1800
0
18000
0
30000
0
0
0
0
0
0
0
0
0
0
500

800

0
0
1600
0
0
0
150
0
0
0
0
0
0
0
0
0
0
0
0
0
0
11000
11000
0
0
0
 0
0
0
0
0
1000
0
0
0
0
0
130
250
1800
3000
1200
0
0
550
0
500
20000
500
1800
450
0
0
0
0
0
2000
150
0
0

3000
0
0
0
0
0
0
3000
0
0
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450
9000
450
1500
0
550
0
0
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0
0

0
0
0
0
0
0
0
0
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0
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0
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0
0
0
0
0
0
500
0
190
1100
0
0
0
0
0
0
0
0
450
 0
0
190
0
0
0
0
0
0
0
0
0
0
0

0
0
55
55
55
55
0
0
37000
0
0
500
0
9500
1900
1900
0
0
0
90
79
360
1700
0
120
 0
0
0
45000
0
0
4000
5000
2000
0
0
0
0
0
0
550
550
0
0
0
0
0
0
0
0
400
0
0
0
0
0
570
500
0
0
0
0
0
7800
29000
56000
12500
0
0
0
 0
0
0

0
7500
4500
0
0
0
4000
0
250
0
200
0

0
0
0
44000
0
0
0
0
4000
22000
30000
15000
86000
0
0
0
0
0
0
0
0
0
0
0
1200
0
0
0
3500
0
0
0
0
0
0
0
0
0
0
0
0
3000
74
0
0
0
76
0
0
0
0
0
5700
120
500
0
0
0
1800
186
1700
160
600

600
600
550

550

500

550
 600
600
290
160
0
0
0
550
0
9000
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
160
380
45
95
0
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0
0
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0
0
0
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9700
0
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5500
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300
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33000
0
0
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0
0
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1800
0
0
0
0
0
300
0
0
0
0
41500
0
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71000
82000
0
900
1500
0
0
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9000
 0
0
0
0
450
450
0
0
190
190
450
55
600
150
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7500
0
0
0
0
23000
12000
0
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0
0
0
0
0
20000
24000
0
0
0
0
0
0
180
185
0
0
200
300
300
300
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0
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550
0
0
3900
0
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5500
70000
29000
25000
0
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92

270

0
0
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46000
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0
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0
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0
0
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250

3000
0
0
0
0
0

750

300

0
0
1400

250

0
0
500
0
0
0
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27000
0
500
350

350

180

250

250

350

550

180

90

190

260

0
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0
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90

90

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0
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290

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90

90

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50

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90
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0

0
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700
29000
0
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0
0
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1000
1000
60
0
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1900
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0
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195000
28000
11000
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0
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4000
500
18000
50000
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0
6000
0
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0
0
0
0
180
0
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180
0
0
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0
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0
0
0
0
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0
0
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 300
1800
0
0
2000
100
0
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0
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0
0
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0
0
20000
0
0
0
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90
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0
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0
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2800
18000
80
80
0
100
100
0
0
0
0
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0
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0
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360
55
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0
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0
0
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