POLRI DAERAH JAWA TIMUR

BIDANG KEDOKTERAN DAN KESEHATAN

RS BHAYANGKARA TK IV WAHYU TUTUKO BOJONEGORO

RENCANA KEBUTUHAN OBAT MATKES SATKER ::RSB TK IV. WAHYU TUTUKO BOJONEGORO
DALAM 1 TAHUN ANGGARAN ::DPK PUSDOKKES
TAHUN ::2010

HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
1 2 3 4 5 6 7

1 ANALGETIKA, ANTI PIRETIKA

1 Tramadol Inj Ampul 100 Rp 525 Rp 52,500
2 Profenid supp ( Ketoprofen ) Suppo 25 Rp 12,500 Rp 312,500
3 Ketopain Inj ( Ketorolac ) Ampul 25 Rp 36,300 Rp 907,500
4 Lidodex Hcl Inj Ampul 30 Rp 72,600 Rp 2,178,000
5 Lidocain Inj Ampul 50 Rp 1,200 Rp 60,000

2 ANTI INFLAMASI
1 Kalium Diklofenak 50 mg Tablet 100 Rp 700 Rp 70,000
2 Pirosikam 10 mg Tablet 100 Rp 400 Rp 40,000
3 Meloxicam 7,5 mg Tablet 100 Rp 1,500 Rp 150,000
4 Piracetam 1200 mg Tablet 200 Rp 1,500 Rp 300,000
5 Natrium Diklofenak Cream / sejenis Tube 50 Rp 15,000 Rp 750,000

3 ANTI INFLUENZA
1 Corhinza / sejenis Tablet 100 Rp 500 Rp 50,000
2 Flurin syr Botol 50 Rp 4,500 Rp 225,000
3 Megaflu Tab Tablet 200 Rp 400 Rp 80,000

B. OBAT PSIKOFARMA
1 HIPNOTIK, SEDATIF
1 Succinil Choline 200 mg Vial 5 Rp154,800 Rp 774,000
2 Regivel Ampul 10 Rp 58,000 Rp 580,000
3 Ketamin 100 mg Vial 5 Rp159,400 Rp 797,000
4 Alganax ( alpazolam ) Tablet 100 Rp 1,200 Rp 120,000
5 Codein 10 mg Tablet 500 Rp 200 Rp 100,000

C OBAT CARDIO VASKULER

ANTI ANGGINA
1 ISDN Tablet 100 Rp 150 Rp 15,000

1 ANTI HIPERTENSI
1 Furosemide 40 mg / Mederisik Tablet 300 Rp 200 Rp 60,000
2 Farsix inj/ Furosemide inj Tablet 50 Rp 7,300 Rp 365,000

2 VASODILATOR
1 Propanolol 10 mg Tablet 300 Rp 200 Rp 60,000
2 Farmalat 10 mg / Nifedipin 10 mg Tablet 300 Rp 400 Rp 120,000

3 HAEMOSTATIK
1 Crome Inj / Carbasocrom Inj Ampul 20 Rp 19,700 Rp 394,000
2 Vit K Ampul 100 Rp 1,500 Rp 150,000
3 Adona inj Ampul 50 Rp 2,500 Rp 125,000

D OBAT SALURAN NAFAS

1. ANTI TUSIF EXPEKTORAN
1 OBH Plus Botol 20 Rp 2,500 Rp 50,000
2 Pinkid cough syr Botol 100 Rp 3,500 Rp 350,000
3 Yavon ( Mucohexin ) Tablet 300 Rp 300 Rp 90,000
4 Dextral tab Tablet 300 Rp 400 Rp 120,000
5 Bisolvon Nebul Botol 5 Rp 57,200 Rp 286,000

Page 1
 HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
2. ANTI ASMA
1 Proast Syr Tablet 50 Rp 4,500 Rp 225,000
2 Salbutamol 4 mg Tablet 100 Rp 400 Rp 40,000

E OBAT SALURAN CERNA

1. ANTASIDA / H2 ANTAGONIS / PPI
1 Mylacyid Tablet 300 Rp 600 Rp 180,000
2 Plantacid Syr/ Lambucid Syr Botol 100 Rp 6,500 Rp 650,000
3 Acran inj Ampul 50 Rp 25,500 Rp 1,275,000
4 Acran Tab Tablet 300 Rp 1,500 Rp 450,000
5 Ardium Tablet 100 Rp 1,500 Rp 150,000
6 Profat syr Botol 25 Rp 42,900 Rp 1,072,500

2 ANTI SPASMODIK
1 Panzo Inj Tablet 10 Rp132,000 Rp 1,320,000
2 OMZ inj Ampul 25 Rp145,200 Rp 3,630,000
3 Gitas Inj / Buscopan Inj Ampul 50 Rp 20,000 Rp 1,000,000

3 ANTI EMETIKA
1 Tomit inj Ampul 100 Rp 9,500 Rp 950,000
2 Vometa Drop Botol 25 Rp 21,000 Rp 525,000
3 Domperidon Syr Botol 50 Rp 8,500 Rp 425,000

4 ANTI DIARE
1 Questran Zak 50 Rp 11,000 Rp 550,000
2 Oralit Zak 50 Rp 500 Rp 25,000
3 New Antides Tablet 200 Rp 200 Rp 40,000

5 LAKSANTIVES
1 Dulcolax Supp Suppo 25 Rp 16,000 Rp 400,000
2 Microlax Sup Tube 25 Rp 17,800 Rp 445,000

F ANTI ALERGI
1 CORTICOSTEROID
1 Pritacort (Dextamine) Tablet 300 Rp 400 Rp 120,000
2 Omegtamine Tablet 300 Rp 500 Rp 150,000
3 Medixon inj Vial 10 Rp 50,000 Rp 500,000
4 Heptasan Tablet 400 Rp 500 Rp 200,000

G ANTI DIABETIK
1 Amaryl 2 mg Tablet 200 Rp 4,000 Rp 800,000
2 Glucobay 100 mg Tablet 200 Rp 1,500 Rp 300,000
3 Actrapid inj Vial 15 Rp350,000 Rp 5,250,000

H OBAT HEPATITIS
1 Sensikol Tablet 300 Rp 800 Rp 240,000
2 Lipirol Tablet 100 Rp 11,000 Rp 1,100,000

I VITAMIN
1 Inlacta DHA Tablet 300 Rp 3,000 Rp 900,000
2 folavit 400 mg Tablet 200 Rp 3,500 Rp 700,000
3 Sakavit/Muvit Syr / Lytamin Syr Botol 100 Rp 6,500 Rp 650,000
4 Becom C Tablet 300 Rp 600 Rp 180,000
5 Solvitral Tablet 300 Rp 500 Rp 150,000
6 Neurosanbe 5000 inj Vial 100 Rp 8,500 Rp 850,000
7 Neurobion 5000 Tablet Tablet 300 Rp 1,200 Rp 360,000

Page 2
 HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
J ANTI INFEKSI / ANTI BIOTIK
1 Taxegram 1gr Vial 15 Rp120,000 Rp 3,962,500
2 Taxegram 500 mg Vial 15 Rp 80,500 Rp 2,012,500
3 Terfacef Vial 15 Rp200,000 Rp 5,975,000
4 Anbacim inj Vial 10 Rp 84,700 Rp 847,000
5 Dofacef inj Vial 10 Rp 62,000 Rp 620,000

L ANTI FUNGI / VIRAL

1 Acyclovir 200 / Herax 200 mg / Acyfar Tablet 400 Rp 700 Rp 280,000
2 Acyclovir Cream / Acyfar cream Tube 60 Rp 4,500 Rp 270,000
3 Acyclovir TM Botol 25 Rp 10,000 Rp 250,000

M OBAT TETES / SALEP

1 Cendo Xitrol TM Botol 20 Rp 28,000 Rp 560,000
2 RecoTT Botol 30 Rp 6,500 Rp 195,000
3 Sanbe tears Botol 30 Rp 11,000 Rp 330,000
4 Licogenta salp Tube 20 Rp 6,500 Rp 130,000
5 Pain Killa cream 30 gr / Salfamen Tube 150 Rp 15,000 Rp 2,250,000

Page 3
 POLRI DAERAH JAWA TIMUR
BIDANG KEDOKTERAN DAN KESEHATAN
RS BHAYANGKARA TK IV WAHYU TUTUKO BOJONEGORO

RENCANA KEBUTUHAN ALKES HABIS PAKAI SATKER ::RSB TK IV. WAHYU TUTUKO BOJONEGORO
MATKES DALAM 1 TAHUN ANGGARAN ::DPK PUSDOKKES
TAHUN ::2010

HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
1 2 3 4 5 6 7

A ALAT INFUS / INJEKSI DLL

1 Alkohol 70% 1lt Liter 40 Rp 22,000 Rp 880,000
2 Alphadine / Molexdine / Povidone Iodine 1 lt Liter 40 Rp 52,000 Rp 2,080,000
3 Aqua dest / Water Inj Flash 100 Rp 2,000 Rp 200,000
4 Aqua gel Liter 10 Rp 25,000 Rp 250,000
5 Rol 20 Rp 15,000 Rp 300,000
6 Artiflex / poliban 4 Rol 20 Rp 18,000 Rp 360,000
7 Artiflex / poliban 6 Rol 20 Rp 20,000 Rp 400,000
8 Bactigras / Daryantule / Grasolind Box 20 Rp 10,000 Rp 200,000
9 Benang Cat gut Cromic no 3/0 Biodinamic Rol 1 Rp 1,050,000 Rp 1,050,000
10 Benang Cat gut cromic no 1 Biodinamic Rol 1 Rp 1,025,000 Rp 1,025,000
11 Benang Cat gut Cromic no 0 Biodinamic Rol 1 Rp 1,000,000 Rp 1,000,000
12 Benang Cat gut Cromic no 2/0 Biodinamic Rol 1 Rp 1,035,000 Rp 1,035,000
13 Benang Cat gut Plain no 1Biodinamic Rol 1 Rp 1,045,000 Rp 1,045,000
14 Benang Cat gut Plain no 0 Biodinamic Rol 1 Rp 950,000 Rp 950,000
15 Benang Cat gut Plain no 2/0 Biodinamic Rol 1 Rp 950,000 Rp 950,000
16 Benang Cat gut Plain no 3/0 Biodinamic Rol 1 Rp 900,000 Rp 900,000
17 Benang Premilene no. 1 Set 10 Rp 70,000 Rp 700,000
18 Benang Premilene no. 2/0 Set 10 Rp 69,000 Rp 690,000
19 Benang Premilene no. 3/0 Set 10 Rp 70,000 Rp 700,000
20 Benang Premilene no. 4/0 Set 10 Rp 70,000 Rp 700,000
21 Benang Safil no. 1 Set 10 Rp 70,000 Rp 700,000
22 Benang Safil no. 2/0 Set 10 Rp 70,000 Rp 700,000
23 Benang Safil no. 3/0 Set 10 Rp 78,000 Rp 780,000
24 Benang Safil no. 4/0 Set 10 Rp 80,000 Rp 800,000
25 Benang Zide no. 1 Rol 4 Rp 460,000 Rp 1,840,000
26 Benang Zide no. 2 Rol 4 Rp 490,000 Rp 1,960,000
27 Benang Zide no. 3/0 Rol 4 Rp 460,000 Rp 1,840,000
28 Blood Donor set Buah 500 Rp 20,000 Rp 10,000,000
29 Cairan D 5 % Kolf 200 Rp 3,500 Rp 700,000
30 Cairan KAEN 3B Kolf 200 Rp 14,500 Rp 2,900,000
31 Cairan Na CL 0,5 LTR Kolf 500 Rp 4,000 Rp 2,000,000
32 Cairan Na CL 1 LTR Kolf 500 Rp 10,000 Rp 5,000,000
33 Cairan RD 5 Kolf 300 Rp 7,000 Rp 2,100,000
34 Cairan RL Kolf 500 Rp 4,500 Rp 2,250,000
35 Disp Syr 1 cc ( Terumo ) Buah 500 Rp 5,000 Rp 2,500,000
36 Disp. Syr 10 cc ( Terumo ) Buah 500 Rp 5,000 Rp 2,500,000
37 Disp. Syr 2,5 / 3 cc ( Terumo) Buah 500 Rp 2,800 Rp 1,400,000
38 Disp. Syr 5 cc ( Treumo ) Buah 500 Rp 4,000 Rp 2,000,000
39 Film RO 24 X 30 cm Box 1 Rp 700,000 Rp 700,000
40 Film RO 30 X 40 cm Box 1 Rp 725,000 Rp 725,000
41 Film RO 35 X 35 cm Box 1 Rp 750,000 Rp 750,000
42 Foley catheter no. 16 ( Rusch ) Buah 30 Rp 27,000 Rp 810,000
43 Foley catheter no. 18 ( Rusch ) Buah 30 Rp 27,000 Rp 810,000
44 Gypsona / poligyp 3 Rol 30 Rp 20,000 Rp 600,000
45 Gypsona / poligyp 4 Rol 30 Rp 25,000 Rp 750,000
46 Gypsona / Polygyp 6 Rol 30 Rp 29,000 Rp 870,000
47 Hansaplast Plester Box 500 Rp 500 Rp 250,000
48 Infuset Dewasa ( Terumo ) Buah 100 Rp 14,500 Rp 1,450,000
49 Infuset Pedriatric ( Terumo ) Buah 50 Rp 14,000 Rp 700,000
50 Kapas 1 Kg Rol 25 Rp 30,000 Rp 750,000
51 Kasa hidrofil 40 x 80 Rol 30 Rp 89,000 Rp 2,670,000
52 Masker Focal Dos 500 Rp 1,000 Rp 500,000
53 Nasal oxygen Buah 20 Rp 20,000 Rp 400,000

4
 HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
54 Needle no. 23 ( Terumo ) Buah 300 Rp 1,000 Rp 300,000
55 New Polivix 10 X 4 Rol 30 Rp 35,000 Rp 1,050,000
56 New Polivix 15 X 4 Rol 30 Rp 30,000 Rp 900,000
57 New Polivix 5 X 4 Rol 30 Rp 25,000 Rp 750,000
58 Plester Rol Rol 50 Rp 25,000 Rp 1,250,000
59 Sarung Tangan Non Steril Box 500 Rp 1,000 Rp 500,000
60 Sarung tangan steril 7,5 Medigrip plus Pasang 250 Rp 9,500 Rp 2,375,000
61 Sarung tangan steril 8 Medigrip Plus Pasang 250 Rp 9,000 Rp 2,250,000
62 Spinocan no. 25 Buah 10 Rp 100,000 Rp 1,000,000
63 Surflo no. 18 ( Terumo ) Buah 100 Rp 27,000 Rp 2,700,000
64 Surflo no. 20 ( Terumo ) Buah 100 Rp 27,000 Rp 2,700,000
65 Surflo no. 22 (Terumo ) Buah 100 Rp 27,000 Rp 2,700,000
66 Surflo no. 24 ( Terumo ) Buah 100 Rp 27,000 Rp 2,700,000
67 Tensocrepe / FM Crape 3 inch Rol 20 Rp 36,000 Rp 720,000
68 Tensocrepe / FM Crepe 4 inch Rol 20 Rp 43,000 Rp 860,000
69 Tensocrepe / FM Crepe 6 Inch Rol 20 Rp 45,000 Rp 900,000
70 Urine Bag Buah 100 Rp 5,000 Rp 500,000
71 Verband / kasa 10 x 5 Rol 100 Rp 3,000 Rp 300,000
72 Verband / kasa 5 x 5 Rol 100 Rp 1,500 Rp 150,000

B ALKES LAIN-LAIN
1 Laringoskope Buah 10 Rp 100,000 Rp 1,000,000
2 Klem Sedang Buah 10 Rp 125,000 Rp 1,250,000
3 Ring Klem Buah 5 Rp 200,000 Rp 1,000,000
4 Muller Buah 2 Rp 150,000 Rp 300,000
5 Raspa Buah 2 Rp 150,000 Rp 300,000
6 Curratage Othopedi Buah 2 Rp 250,000 Rp 500,000
7 Happman Buah 2 Rp 200,000 Rp 400,000
8 Tapper Set 2 Rp 250,000 Rp 500,000
9 Screw Drever Buah 2 Rp 200,000 Rp 400,000
10 Ellis Klem Buah 2 Rp 500,000 Rp 1,000,000
11 Pincet Cirogis Buah 3 Rp 150,000 Rp 450,000
12 Pincet Anatomis Buah 3 Rp 75,000 Rp 225,000
13 Hak Femur Buah 2 Rp 250,000 Rp 500,000
14 Bak Intrumen Besar Buah 3 Rp 350,000 Rp 1,050,000
15 Reduction Buah 2 Rp 300,000 Rp 600,000
16 Timan Buah 2 Rp 300,000 Rp 600,000
17 Korentang set + wadah Set 2 Rp 300,000 Rp 600,000
18 Tromol Ukuran 37 X 25 cm Buah 3 Rp 450,000 Rp 1,350,000
19 Tromol Ukuran 18 X 18 cm Buah 3 Rp 225,000 Rp 675,000
20 Right Angel Buah 2 Rp 300,000 Rp 600,000
21 Kanula Cauther Buah 2 Rp 500,000 Rp 1,000,000
22 Gunting Jaringan Buah 3 Rp 300,000 Rp 900,000
23 Gunting Benang Buah 3 Rp 300,000 Rp 900,000
24 Gunting AJ Buah 3 Rp 300,000 Rp 900,000
26 Nerbeken Buah 3 Rp 10,000 Rp 30,000
27 Guardel Airways no.3,4,5,6,7 Set 2 Rp 60,000 Rp 120,000
28 Spekulum One Handle Buah 3 Rp 60,000 Rp 180,000

C ALKES GIGI
1 Cresophene Botol 1 Rp 436,500 Rp 436,500
2 Curaspon/Spongostan Box 2 Rp 412,000 Rp 824,000
3 Dental Mercury 100 g Botol 1 Rp 120,000 Rp 120,000
4 Dental Needle/Citoject Box 2 Rp 140,000 Rp 280,000
5 Dimond Burs Hight Speed Box 1 Rp 207,000 Rp 207,000
6 Eugenol Botol 2 Rp 44,000 Rp 88,000
7 Fisure Burs Long Buah 3 Rp 115,000 Rp 345,000
8 Fuji II Mini 10 g/1,5 ml Set 2 Rp 100,000 Rp 200,000
9 Fuji IX Set 2 Rp 340,000 Rp 680,000
10 Gips Putih Kg 2 Rp 10,000 Rp 20,000
11 Glass Ionomer Set 1 Rp 580,000 Rp 580,000
12 Injeksi Pehacain Dos 2 Rp 25,000 Rp 50,000
13 Iodoform Pot 2 Rp 50,000 Rp 100,000

4
 HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
14 Septocain Capsule Kaleng 1 Rp 350,000 Rp 350,000
15 Stone Biru Kg 2 Rp 38,500 Rp 77,000
16 Scandonest Box 1 Rp 334,000 Rp 334,000
17 Xylonor Spray Botol 1 Rp 549,000 Rp 549,000
JUMLAH Rp170,511,500

Bojonegoro, Maret 2010

KARUMKIT BHAYANGKARA TK IV
WAHYU TUTUKO BOJONEGORO

dr. CHRISTINA H, Sp.P

KOMPOL NRP 69030410

4
4
 POLRI DAERAH JAWA TIMUR
BIDANG KEDOKTERAN DAN KESEHATAN
RS BHAYANGKARA TK IV. WAHYU TUTUKO BOJONEGORO

RENCANA KEBUTUHAN OBAT MATKES DALAM 1TAHUN SATKER :RSB TK IV. WAHYU TUTUKO BOJONEGORO
ANGGARAN :APBN PUSDOKKES
TAHUN :2010

HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
1 2 3 4 5 5 6
A. OBAT PRODUKSI BIDFIPOL

1 FINEURON TABLET 500 Rp 301 150,500

2 FINEURON 5000 TABLET 500 Rp 601 300,500
3 MEFIPOL TABLET 500 Rp 142 71,000
4 BUSCOPOL PLUS TABLET 500 Rp 428 214,000
5 AMOXYPOL 500 MG TABLET 500 Rp 500 250,000

B.1. ANALGETIK / ANTI PIRETIK

1 Analsik Tablet 300 Rp 800 240,000
2 Antrain inj ( Metamizol ) Ampul 200 Rp 11,000 2,200,000
3 Asam Mefenamat 500 mg Tablet 1500 Rp 250 375,000
5 Paracetamol 500 mg Tablet 1500 Rp 100 150,000
6 Paracetamol Syr Botol 250 Rp 2,500 625,000
7 Mersilon Tablet 300 Rp 2,000 600,000

C. OBAT CARDIO VASKULER

1 ANTI HIPERTENSI
1 Farmoten 12,5 mg / Captropil 12,5 mg Tablet 1000 Rp 374 374,000
2 Farmotten 25 / captropil 25 Tablet 1000 Rp 627 627,000

2 VASODILATOR
1 Amlodipin 10 mg / Divask 10 mg Tablet 200 Rp 2,800 560,000
2 Bisoprolol Tablet 100 Rp 8,500 850,000

3 HAEMOSTATIK
1 As.Traneksamat 500 mg / Kalnex Tablet 200 Rp 1,200 240,000
2 Inj. Transamin / Plasminec inj / Kalnex inj Ampul 75 Rp 8,000 600,000

4 GLIKOSIDA JANTUNG
1 Fargoxin 0,25 mg Tablet 100 Rp 300 30,000

D. OBAT SALURAN NAFAS

1. ANTI TUSIF EXPEKTORAN
1 Dextrometorphan HBR Tablet 300 Rp 100 30,000
2 Excocin syr Botol 75 Rp 3,000 225,000
3 Molapect 30 mg / Ambroxol 30 mg Tablet 200 Rp 650 130,000
4 Mucohexin 8 mg / Solvax Tablet 200 Rp 450 90,000
5 Bisolvon Inj Ampul 50 Rp 10,000 500,000

2. ANTI ASMA
1 Amynophilin 200 mg Tablet 100 Rp 100 10,000
2 Nairet Inj Tablet 100 Rp 9,500 950,000
3 Amynophilin Inj Ampul 50 Rp 4,500 225,000
4 Salbutamol 4 mg Tablet 100 Rp 250 25,000

E. OBAT SALURAN CERNA

1. ANTASIDA / H2 ANTAGONIS / PPI
1 Antasida Doen Tablet 300 Rp 100 30,000
2 Antasida Doen Syr Botol 100 Rp 3,000 300,000
3 Cimetidine / Gastricon Tablet 300 Rp 200 60,000
4 Sanmag Syr Tablet 25 Rp 18,500 462,500
5 Braxidin Tablet Botol 400 Rp 800 320,000

2. ENZIM
1 Excelase Tablet 100 Rp 2,000 200,000

3. ANTI SPASMODIK .
1 Omeperazol Tablet 300 Rp 1,000 300,000
2 Spasmeco plus Tablet 250 Rp 2,000 500,000
3 Unthecol / Buscopan / Spasmeco Tablet 250 Rp 1,500 375,000

4. ANTI EMETIKA

Page 8
 HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
1 2 3 4 5 5 6
1 Invomit Inj Tablet 25 Rp 25,000 625,000
2 Vosea (Methoclopramide) Tablet 200 Rp 150 30,000
3 Yoridon/ Vesperum/Domperidon 10 mg Tablet 200 Rp 500 100,000
4 Metroclopramide inj / Primperan Inj Ampul 50 Rp 7,000 350,000

5. ANTI DIARE
1 Imodium Tablet Tablet 150 Rp 4,000 600,000
2 Smecta Zak 100 Rp 2,500 250,000
3 Kaolimec Syr Botol 50 Rp 3,500 175,000

6. LAKSANTIVES
1 Dulcolax Tablet 150 Rp 800 120,000
2 Dulcolax 5 mg Supp Supp 50 Rp 9,000 450,000
3 Dulcolax 10 mg Supp Supp 50 Rp 13,000 650,000

F. ANTI ALERGI
1. ANTI HISTAMIN
1 Histapan Tablet 300 Rp 200 60,000

2. CORTICOSTEROID
1 Dexamethazon tablet Tablet 500 Rp 100 50,000
2 Dexamethasone Inj / Cortidex Inj Ampul 250 Rp 2,000 500,000

G. ANTI DIABETIK
1 Fomel / Forbetes 500 mg (metformin) Tablet 800 Rp 300 240,000
2 Glibenclamide/Samclamide Tablet 800 Rp 100 80,000

H. VITAMIN
1 Mecobex Tablet 500 Rp 800 400,000
2 Panviton Tablet 200 Rp 1,000 200,000
3 Pehavral (B 1 + B2 + B12) Tablet 300 Rp 500 150,000
4 Recovit Plus Tablet 300 Rp 500 150,000
5 Recovit Syr Botol 100 Rp 4,000 400,000
6 Asam Folat 100 mg Tablet 300 Rp 1,000 300,000
7 Inlacta DHA Botol 300 Rp 2,500 750,000

I. ANTI INFEKSI / ANTI BIOTIK

1 Amoxixilin 500 mg / Rindomox 500 mg / Amoxan 500 mg Kaplet 800 Rp 500 400,000
2 Amoxyllin Syr 125 mg/Sulfanox / Vibramox syr Botol 50 Rp 3,000 150,000
3 Camicetine / Chloramex 500 mg Kapsul 200 Rp 1,200 240,000
4 Cefadroxil 500 mg / Cefat 500 mg Tablet 400 Rp 2,000 800,000
5 Cefotaxime Inj Vial 300 Rp 13,000 3,900,000
6 Ceftriaxone Inj Vial 300 Rp 14,000 4,200,000
7 Chloramphenikol syr / Medichichlor / Danfenicol Botol 50 Rp 5,000 250,000
8 Thiamphenicol Syr Tablet 50 Rp 5,500 275,000
9 Cyprofloxaxin 500 mg /Mecoquin 500 mg Kapsul 200 Rp 1,800 360,000
10 Infatrim Syr ( Cotrimoxaxole ) Botol 50 Rp 4,000 200,000
11 Erytromycin/ Thromillin Syr Botol 50 Rp 6,000 300,000
12 Fasiprim / Primavon ( Cotrimoxazole ) Kaplet 200 Rp 500 100,000
14 Erytromycin 500 mg Vial 200 Rp 1,000 200,000
15 Lincomycin/ Zumalin / Lincyn 500 mg Kaplet 200 Rp 1,500 300,000

J. ANTI KOLESTEROL
1 Hipophyl / Mersikol 300 mg Tablet 200 Rp 2,000 400,000
2 Lesvatin (Simvastatin) Tablet 200 Rp 500 100,000
3 Lipitor Tablet 100 Rp 9,000 900,000

K. OKSITOSIKUM
1 Cytotex Tablet 100 Rp 18,000 1,800,000
2 Methergin Inj Ampul 100 Rp 4,500 450,000
3 Metil Ergometrine Tablet 100 Rp 400 40,000
4 Oxitocyn Inj / Pitogen Inj Ampul 100 Rp 4,000 400,000

L. KOENZYM DAN METABOLITRIKUM

1 Brainact 250 Inj Ampul 100 Rp 30,000 3,000,000

M. ANTI FUNGI / VIRAL

1 Sporend 5 gr / Moladerm Cream Tube 30 Rp 3,500 105,000
2 Acyclovir Tablet 400 mg Tablet 200 Rp 1,100 220,000
3 Tericortin Zalf Tube 40 Rp 4,500 180,000

Page 9
 HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
1 2 3 4 5 5 6

N. OBAT TETES / SALEP

1 Bevalex Cream / Skinzon Cream Tube 50 Rp 4,500 225,000
2 Bismecon Jelly Tube 50 Rp 8,500 425,000
3 Chloramphenikol TM Tube 50 Rp 6,500 325,000

Page 10
 POLRI DAERAH JAWA TIMUR
BIDANG KEDOKTERAN DAN KESEHATAN
RS BHAYANGKARA TK IV. WAHYU TUTUKO BOJONEGORO

RENCANA KEBUTUHAN ALKES HABIS PAKAI SATKER :RSB TK IV. WAHYU TUTUKO BOJONEGORO
MATKES DALAM 1 TAHUN ANGGARAN :APBN PUSDOKKES
TAHUN :2010

HARGA KET
NO NAMA OBAT SATUAN JUMLAH
SATUAN JUMLAH
1 2 3 4 5 5 6

A ALKES LAIN - LAIN

1 Suction Besar Set 1 Rp 25,000,000 Rp 25,000,000
2 Meja operasi Set 1 Rp 19,000,000 Rp 19,000,000
3 Lampu Tindakan Operasi ( Tegak) Set 1 Rp 10,000,000 Rp 10,000,000
4 Stetoscope ( Resister ) Buah 1 Rp 450,000 Rp 450,000
5 Stetoscope Pediatric ( Resister ) Buah 1 Rp 450,000 Rp 450,000
6 Termometer Rectal Buah 1 Rp 100,000 Rp 100,000
7 Stelisator Simic 42 cm Buah 1 Rp 2,750,000 Rp 2,750,000
8 Klem Usus / Darem Klem Buah 1 Rp 60,000 Rp 60,000
9 Klem Lurus sedang Buah 1 Rp 55,000 Rp 55,000
10 Gunting Benang Buah 1 Rp 55,000 Rp 55,000
11 Toniquet anak - anak Buah 2 Rp 35,000 Rp 70,000
12 Torniquet Dewasa Buah 2 Rp 35,000 Rp 70,000
13 Manometer O2 Buah 2 Rp 250,000 Rp 500,000
14 Cucing Buah 2 Rp 55,000 Rp 110,000
15 Nerbeken Stainlis Steel Buah 2 Rp 55,000 Rp 110,000
16 Tensimeter Lapangan ( Resister ) Buah 2 Rp 350,000 Rp 700,000
17 GDA + Stik Set 1 Rp 1,250,000 Rp 1,250,000
18 Klem Cyrogis / Koker Sedang Buah 2 Rp 55,000 Rp 110,000
19 1/2 Koker Pemecah Ketuban Buah 2 Rp 55,000 Rp 110,000
20 Lampu Operasi Set 1 Rp 10,000,000 Rp 10,000,000
21 Monitor Pasien Set 1 Rp 63,000,000 Rp 63,000,000

B ALKES GIGI
1 Air Turbin HP Spray Kaleng 1 Rp 50,000 Rp 50,000
2 Alginate Zak 1 Rp 99,500 Rp 99,500
3 Alvogyl Botol 1 Rp 292,000 Rp 292,000
4 Amalgam Botol 1 Rp 266,500 Rp 266,500
5 Articulating Paper Box 1 Rp 176,500 Rp 176,500
6 Calcidor/Dycal Pot 1 Rp 224,500 Rp 224,500
7 Cavit G Botol 1 Rp 120,000 Rp 120,000
8 Caviton Botol 1 Rp 110,000 Rp 110,000
9 Cemen Phosphat Set 1 Rp 70,000 Rp 70,000
10 CHKM Botol 1 Rp 56,500 Rp 56,500
JUMLAH Rp 175,480,000

Bojonegoro, Maret 2010

KARUMKIT BHAYANGKARA TK IV
WAHYU TUTUKO BOJONEGORO

dr. CHRISTINA H, Sp.P

KOMPOL NRP 69030410

Page 11