Kemasan dan

Nama Nama
NO Nama Obat Kwantum Satuan
Penyedia/ Merk Distributor
Kemasan

1 2 3 4 5 6
OBAT - OBATAN
1 Air untuk injeksi amp 25 25,000 vial PT. Otsuka PT. Merapi
ml / OTSU SWI 25 ML Indonesia Utama Pharma
2 Amoksisilin tab 500 mg 100,000 kaplet PT. Merapi
PT. Mersifarma
Utama Pharma
3 Asam asetilsalisilat 20,000 tablet PT. Merapi
(asetosal) tab 80 mg/ PT. Mersifarma Utama Pharma
MINIASPI 80 MG
4 Feniton injeksi 50 mg/ml 200 ampul PT. Merapi
PT. Mersifarma
Utama Pharma
5 Flufenazin Decanoate inj 2,000 ampul, 1 ml PT. Merapi
25 mg/ml (i.m.)/ PT. Mersifarma Utama Pharma
SIKZONOATE INJ
6 Haloperidol inj 5 mg/ml 240 ampul PT. Merapi
PT. Mersifarma
(i.m.) Utama Pharma
7 Klorpromazin tab sal 100 120,000 tablet PT. Merapi
PT. Mersifarma
mg (HCl) Utama Pharma
8 Risperidone tablet 2 mg 30,000 tablet PT. Merapi
PT. Mersifarma
Utama Pharma
9 Magnesium sulfat inj 150 vial, 25 ml PT. Otsuka PT. Merapi
20%/ OTSU MGSO4 Indonesia Utama Pharma
20%
10 Magnesium sulfat inj 150 vial, 25 ml PT. Otsuka PT. Merapi
40% / OTSU MGSO4 Indonesia Utama Pharma
40%
11 Digoksin tab 0,25 mg 50,000 tablet PT. Yarindo PT. Rajawali
Farmatama Nusindo
Indonesia
12 Doksisiklin kaps 100 mg 5,000 kapsul PT. Yarindo PT. Rajawali
Farmatama Nusindo
Indonesia
13 Griseofulvin (micronized) 20,000 tablet PT. Phapros PT. Rajawali
tab 125 mg Nusindo
Indonesia
14 Ibuprofen tab 200 mg 20,000 tablet PT. Yarindo PT. Rajawali
Farmatama Nusindo
Indonesia
15 Salbutamol tab 2 mg 200,000 tablet PT. Yarindo PT. Rajawali
Farmatama Nusindo
Indonesia
16 Difenhidramin inj 10 2,100 ampul, 1 ml PT. Phapros PT. Rajawali
mg/ml (i.v./i.m.) Nusindo
Indonesia
17 Fenobarbital injeksi 120 ampul PT. Phapros PT. Rajawali
50mg/ml Nusindo
Indonesia
18 Fitomenadion (vitamin K 20,000 tablet PT. Phapros PT. Rajawali
1) tab sal 10 mg Nusindo
Indonesia
19 Garam oralit kombinasi : 20,000 sachet PT. Phapros PT. Rajawali
natrium klorida 0,52 g + Nusindo
kalium klorida 0,30 g + Indonesia
trinatrium sitrat 0,58 g +
glukosa anhidrat 2,7 g

20 Klorpromazin inj 25 300 ampul PT. Phapros PT. Rajawali

mg/ml (i.m.) Nusindo
Indonesia
21 Nistatin tab salut 500.000 1,500 tablet PT. Phapros PT. Rajawali
UI Nusindo
Indonesia
22 Nistatin tab vaginal 1,000 tab vag PT. Phapros PT. Rajawali
100.000 UI Nusindo
Indonesia
23 Bedak salisil serb 2% 3,294 kotak, 50 g PT. Rama PT. Rajawali
Emerald Nusindo
Indonesia
24 Klorfeniramin maleat tab 1,500,000 tablet PT. Rama PT. Rajawali
4 mg Emerald Nusindo
Indonesia
25 Diazepam inj 5 mg/ml 900 ampul, 5 ml PT. Indofarma PT. Indofarma
(i.v./i.m.) Global Medika
26 Fenobarbital tab 30 mg 100,000 tablet PT. Indofarma PT. Indofarma
Global Medika
27 Haloperidol tab 0,5 mg 10,000 tablet PT. Indofarma PT. Indofarma
Global medika
28 Haloperidol tab 1,5 mg 10,000 tablet PT. Indofarma PT. Indofarma
Global medika
29 Haloperidol tab 5 mg 20,000 tablet PT. Indofarma PT. Indofarma
Global medika
30 Isosorbid dinitrat tab 5 30,000 tablet PT. Indofarma PT. Indofarma
mg Global Medika
31 Zinc tab disp 20 mg 100,000 tablet PT. Indofarma PT. Indofarma
Global Medika
32 Zinc sirup 10mg/ml 500 botol, 60 ml PT. Indofarma PT. Indofarma
Global Medika
33 Gentamisin inj 40 mg/ml 3,000 ampul, 2 ml PT. Indofarma PT. Indofarma
Global Medika
34 Amitriptilin tab sal 25 mg 7,000 tablet PT. Indofarma PT. Indofarma
Global Medika
35 Atapulgit tablet 600 mg/ 100,000 tablet PT. Indofarma
PT. Zenith Phar
PULAREX Global Medika
36 Larutan Mengandung 500 botol, 500 ml PT. Widatra PT. Indofarma
Karbohidrat + Elektrolit Bhakti Global Medika
(D5-1/2 NS) / WIDA D5-
1/2 NS
37 Larutan Mengandung 1,000 botol, 500 ml PT. Widatra PT. Indofarma
Karbohidrat + Elektrolit Bhakti Global Medika
(D5-1/4 NS) / WID D5-
1/4 NS
38 NaCl 0,9% Larutan 5,000 botol, 500 ml PT. Widatra PT. Indofarma
Bhakti Global Medika
39 Ringer Laktat Larutan 40,000 botol, 500 ml PT. Widatra PT. Indofarma
Bhakti Global Medika
40 Antihemoroid, kombinasi: 10,000 supp PT. Kimia PT. Kimia Farma
bismut subgalat 150 mg Farma TD
+ heksaklorofen 2,5 mg +
lidokain lidokain 10 mg+
seng oksida 120 mg +
sup ad 2 g

41 Asam askorbat (vitamin 700,000 tablet PT. Kimia PT. Kimia Farma
C) tab 50 mg Farma TD
42 Betametason krim 0,5 2,000 tube, 5 g PT. Kimia PT. Kimia Farma
mg/g Farma TD
43 Diazepam tab 2 mg 200,000 tablet PT. Kimia PT. Kimia Farma
Farma TD
44 Dimenhidrinat tab 50 mg 60,000 tablet PT. Kimia PT. Kimia Farma
Farma TD
45 Eritromisin sir 200 mg/5 5,000 botol, 60 ml PT. Kimia Farma
PT. Phytokemo
ml TD
46 Fenitoin Na kaps 100 mg 50,000 kapsul PT. PT. Kimia Farma
Ikapharmindo TD
47 Glimepirid tab 1 mg 70,000 tablet PT. Kimia PT. Kimia Farma
Farma TD
48 Hidrokortison krim 2,5% 2,400 tube, 5 g PT. Kimia PT. Kimia Farma
Farma TD
49 Ketoprofen supposituria 500 supp PT. Kimia PT. Kimia Farma
100 mg/ PROTOFEN Farma TD
SUPP.
50 Kloramfenikol salep mata 4,000 tube, 5 g PT. Kimia PT. Kimia Farma
1% Farma TD
51 Kodein tab 10 mg 20,000 tablet PT. Kimia PT. Kimia Farma
Farma TD
52 Metronidazol tablet 500 40,000 tablet PT. Kimia Farma
PT. Phytokemo
mg TD
53 Mikonazol krim 2% 3,000 tube, 10 g PT. Kimia PT. Kimia Farma
Farma TD
54 Piridoksin (vitamin B6) 350,000 tablet PT. Kimia PT. Kimia Farma
tab 10 mg Farma TD
55 Vitamin B kompleks 400,000 tablet PT. Kimia PT. Kimia Farma
Farma TD
56 Eugenol Cairan 50 btl, 10 ml PT. Kimia PT. Kimia Farma
Farma TD
57 Ampisilin serb inj 1000 50,000 vial PT. Bernofarm PT. Metro Drugs
mg/vial Indonesia

58 Metformin tab 500 mg 200,000 tablet PT. Bernofarm PT. Metro Drugs
Indonesia

59 Sefiksim tab 100 mg 5,000 kapsul PT. Bernofarm PT. Metro Drugs
Indonesia

60 Omeprazol inj 40 mg/10 7,000 vial PT. Natura PT. Metro Drugs
ml Laboratoria Prima Indonesia

61 Ranitidin injeksi 25 mg/2 60,000 ampul, 2 ml PT. Natura PT. Metro Drugs
ml Laboratoria Prima Indonesia

62 Atropin inj 0,25 mg/ml 300 ampul, 1 ml PT. Ethica PT. Parit Padang
(i.m./i.v./s.k) Industri Farmasi Global

63 Kalsium glukonat inj 100 288 ampul PT. Ethica PT. Parit Padang
mg/ml / CA GLUCONAS Industri Farmasi Global

64 Metilergometrin inj 0,2 100 ampul PT. Ethica PT. Parit Padang
mg/ml Industri Farmasi Global

65 Oksitosin inj 10 UI/ml 15,000 ampul, 1 ml PT. Ethica PT. Parit Padang
Industri Farmasi Global

66 Haloperidol Decanoate 3,000 ampul, 1 ml PT. Parit Padang

PT. Soho Industr
inj 50 mg/ml Global
67 Kaptopril tab 25 mg 550,000 tablet PT. Errita PT. Millenium
Pharma Pharmacon
Internasional
68 Diazepam lar rektal 10 300 tube, 2,5 g PT. Actavis PT. Anugrah
mg/2,5 ml / STESOLID Indonesia Argon Medica

69 Ketokonazol tab 200 mg 10,000 tablet PT. Dexa PT. Anugrah

Medica Argon Medica
70 Nifedipin kaps 10 mg 150,000 tablet PT. Dexa PT. Anugrah
Medica Argon Medica
71 Propranolol tab 10 mg 100,000 tablet PT. Dexa PT. Anugrah
Medica Argon Medica
72 Ranitidin tab 150 mg 100,000 tablet PT. Dexa PT. Anugrah
Medica Argon Medica
73 Bisakodil sup 5 mg / 300 supp PT. Boeringer PT. Tempo
DULCOLAX SUPP Ingelheim
INFANT
74 Kombinasi:ipratropium Br 6,000 vial PT. Boeringer PT. Tempo
0,5 mg+ salbutamol 2,5 Ingelheim
mg nebules /
COMBIVENT UDV
PROSES UPLOAD
75 Alopurinol tab 100 mg 400,000 tablet PT. PT. Indofarma
Shamparindo Global Medika
Perdana
76 Furosemid tab 40 mg 30,000 tablet PT. PT. Indofarma
Shamparindo Global Medika
Perdana
77 Furosemid inj 10 mg/ml 300 ampul, 2 ml PT. Indofarma PT. Indofarma
(i.v./i.m.) Global Medika
79 Aminofilin inj 24 mg/ml 1,200 ampul, 10 ml PT. Phapros PT. Rajawali
Nusindo
Indonesia
80 Antasida, kombinasi : 100,000 tablet PT. Erela PT. Rajawali
aluminium hidroksida Nusindo
200 mg + magnesium Indonesia
hidroksida 200 mg
81 Antasida, kombinasi : 3,000 botol, 60 ml PT. Rama PT. Rajawali
aluminium hidroksida Emerald Nusindo
200 mg + magnesium Indonesia
hidroksida 200 mg
82 Eritromisin tab 500 mg 40,000 kaplet PT. Rama PT. Rajawali
Emerald Nusindo
Indonesia
83 Anestetik lokal gigi 30,000 ampul, 2 ml PT. Lucas Djaja PT. Rajawali
kombinasi :lidokain hcl Nusindo
2% + epinefrin 1 : 80.000 Indonesia
inj 2 ml
84 Sianokobalamin (vitamin 2,500 ampul, 1 ml PT. Lucas Djaja PT. Rajawali
B12) inj 500 mcg/ml Nusindo
Indonesia
85 Antifungi salep, 2,400 pot, 30 g PT. Marin Liza PT. Rajawali
kombinasi : asam Nusindo
benzoat 6%+ asam Indonesia
salisilat 3%
86 Salep 2-4, kombinasi : 1,200 pot, 30 g PT. Marin Liza PT. Rajawali
asam salisilat 2 %+ Farma Nusindo
belerang endap 4 % Indonesia
87 Amoksisilin sir forte 250 2,000 botol, 60 ml PT. Holi Pharma PT. Sapta Sari
mg/5 ml Tama
88 Sefadroksil kaps/tab 500 5,000 kapsul PT. Holi Pharma PT. Sapta Sari
mg Tama
89 Bisakodil sup 10 mg 100 supp PT. Boeringer PT. Tempo
Ingelheim
90 Deksametason tab 0,5 200,000 tablet PT. PromedraharjPT. Millenium
mg Pharmacon
Internasional
91 Amlodipin tab 5 mg 20,000 tablet PT. PromedraharjPT. Millenium
Pharmacon
Internasional
92 Kloramfenikol serb inj 10,000 vial PT. Actavis PT. Anugrah
1.000 mg/ml Indonesia Argon Medica
93 Ibuprofen tab 400 mg 100,000 tablet PT. Phytokemo PT. Kimia Farma
TD
94 Omeprazol kaps 20 mg 35,000 tablet PT. Novapharin PT. Kimia Farma
TD
PEJABAT PEMBUAT KOMITMEN
DINAS KESEHATAN
KABUPATEN JOMBANG
TAHUN ANGGARAN 2016
 
 
 
NUR KAMALIA, SKM. M.Si
Penata Tk. I
NIP. 19650101 198603 2 036
 
PEJABAT PEMBUAT KOMITMEN
DINAS KESEHATAN
KABUPATEN JOMBANG
TAHUN ANGGARAN 2016
 
 
 
NUR KAMALIA, SKM. M.Si
Penata Tk. I
NIP. 19650101 198603 2 036
 
PEJABAT PEMBUAT KOMITMEN
DINAS KESEHATAN
KABUPATEN JOMBANG
TAHUN ANGGARAN 2016
 
 
 
NUR KAMALIA, SKM. M.Si
Penata Tk. I
NIP. 19650101 198603 2 036
 
Harga Per
Satuan Jumlah Harga
Kemasan
( Rp ) ( Rp )
7 9

2,750 68,750,000

261 26,100,000

148 2,960,000

20,250 4,050,000

57,500 115,000,000

6,250 1,500,000

144 17,280,000

1,008 30,240,000

3,200 480,000

3,650 547,500

97 4,850,000

270 1,350,000

209 4,180,000

110 2,200,000

59 11,800,000
 1,050 2,205,000

1,800 216,000

630 12,600,000

288 5,760,000

1,100 330,000

640 960,000

480 480,000

1,250 4,117,500

51 76,500,000

4,180 3,762,000

135 13,500,000

59 590,000

69 690,000

96 1,920,000

88 2,640,000

474 47,400,000

14,980 7,490,000

3,399 10,197,000
 112 784,000

190 19,000,000

9,400 4,700,000

9,350 9,350,000

6,410 32,050,000

7,150 286,000,000

3,045 30,450,000

104 72,800,000

1,520 3,040,000

45 9,000,000

104 6,240,000

7,700 38,500,000

154 7,700,000

265 18,550,000

2,798 6,715,200

2,722 1,361,000

1,600 6,400,000

500 10,000,000

160 6,400,000
 3,000 9,000,000

118 41,300,000

115 46,000,000

18,100 905,000

5,100 255,000,000

112.5 22,500,000

859 4,295,000

36,000 252,000,000

1,140 68,400,000

1,350 405,000

9,955 2,867,040

2,750 275,000

1,900 28,500,000

97,500 292,500,000

84 46,200,000

16,748 5,024,400

300 3,000,000

110 16,500,000
 65 6,500,000

120 12,000,000

4,990 1,497,000

5,990 35,940,000

90 36,000,000

78 2,340,000

1,895 568,500

3,345 4,014,000

62 6,200,000

2,025 6,075,000

730 29,200,000

1,845 55,350,000

1,098 2,745,000

4,158 9,979,200
2,429 2,914,800

3,984 7,968,000

516 2,580,000

5,800 580,000

44 8,800,000

105 2,100,000

7,954 79,540,000

127 12,700,000

160 5,600,000

93
2,477,548,140
BAT PEMBUAT KOMITMEN
S KESEHATAN
PATEN JOMBANG
N ANGGARAN 2016

KAMALIA, SKM. M.Si

a Tk. I
9650101 198603 2 036
BAT PEMBUAT KOMITMEN
S KESEHATAN
PATEN JOMBANG
N ANGGARAN 2016

KAMALIA, SKM. M.Si

a Tk. I
9650101 198603 2 036
BAT PEMBUAT KOMITMEN
S KESEHATAN
PATEN JOMBANG
N ANGGARAN 2016

KAMALIA, SKM. M.Si

a Tk. I
9650101 198603 2 036
 Harga Per
Kemasan dan Satuan
NO Nama Obat Kwantum Satuan Kemasan
Kemasan
( Rp )

1 Aminofilin tab 200 mg 250,000 tablet 100

2 Fitomenadion (vitamin K 1) inj 2 mg/ml 2,500 ampul 4,272
(i.m.)
3 Gliserin lar 50% 200 botol, 100 ml 6,667
4 Karbogliserin tts telinga 10 % 3,600.00 botol 2,553
5 Natrium diklofenak tab 50 mg 100,000 tablet 220
6 Klorpromazin tab sal 25 mg (HCl) 5,000 tablet 85
7 Deksametason inj 5 mg/ml (i.v./i.m.) 7,000 ampul, 1 ml 1,975
8 Glibenklamid tab 5 mg 185,000 tablet 163
9 Kalsium laktat (kalk) tab 500 mg 180,000 tablet 88
10 Karbamazepin tab 200 mg 10,000 tablet 307
11 Parasetamol sir 120 mg/5 ml 15,000 botol, 60 ml 1,798
12 Povidon iodin lar 100 mg/ml 100 botol, 300 ml 17,754
13 Propiltiourasil tab 100 mg 10,000 tablet 399
14 Tetrasiklin kaps 500 mg 70,000 kapsul 375
15 Prednison tab 5 mg 150,000 tablet 143
16 Sefadroksil sir kering 125 mg/5 ml 500 botol, 60 ml 6,120
17 Asam mefenamat kaps 500 mg 200,000 kaplet 140
18 Siprofloksasin tab scored 500 mg 100,000 tablet 532
19 Loratadin tab 10 mg 30,000 tablet 193
20 Parasetamol tab 500 mg 1,000,000 tablet 99
21 Etanol 70% cairan 70% 200,000 botol, 100 ml 3,125
22 Kloramfenikol kaps 250 mg 100,000 tablet 312
23 Metilergometrin tab salut 0,125 mg 10,000 tablet 193
24 Ambroxol tablet 30 mg 250,000 tablet 157
25 Aquadest steril 300 botol, 500 ml 27,500
26 Bisakodil tab sal 5 mg 5,000 tablet 1,288
27 D 40 inj 300 ampul 4,950
28 Gliseril Guayakolat tablet 100 mg 2,000,000 tablet 55
29 Hidrogen peroksida cairan 3% 500 botol, 100 ml 4,950
30 Kloramfenikol Tetes Mata 1% 15,000 botol, 5 ml 7,563
31 Kloramfenikol Tetes Telinga 3 % 8,000 botol, 5 ml 2,625
32 Metamizole injeksi 1 gr/2ml 7,500 ampul, 2 ml 11,250
33 Obat Batuk Hitam (OBH) cairan 100 ml 8,000 botol, 100 ml 2,625

34 Serum anti bisa ular : A.B.U. I (khusus 90 vial, 5 ml 591,250

ular dari luar ) inj (i.m./i.v.) Papua

35 Serum antitetanus (A.T.S) inj 1500 400 ampul, 2 ml 158,125

UI/amp (i.m.)
36 Thiamfenikol kapsul 500 mg 30,000 kapsul 1,100
37 Tiamin (Vitamin B1) tablet 50 mg 2,500,000 tablet 170
(HCl/Nitrat)
38 Triheksifenidil tab 2 mg 100,000 tablet 545
OBAT GIGI 0
39 Etil Klorida spray 500 vial/can/100 ml 131,250

40 Glass Ionomer Cement ART 100 set/botol 493,750

41 Monochlor Kamfer Mentol ( CHKM ) 50 btl, 10 ml 68,750
Jumlah Harga

( Rp )

25,000,000

10,680,000
1,333,400
9,190,800
22,000,000
425,000
13,825,000
30,155,000
15,840,000
3,070,000
26,970,000
1,775,400
3,990,000
26,250,000
21,450,000
3,060,000
28,000,000
53,200,000
5,790,000
99,000,000
625,000,000
31,200,000
1,930,000
39,250,000
8,250,000
6,440,000
1,485,000
110,000,000
2,475,000
113,445,000
21,000,000
84,375,000

21,000,000

53,212,500

63,250,000
33,000,000
 425,000,000
54,500,000 9341
- 134

65,625,000
49,375,000
3,437,500

2,214,254,600

1,597,558,648