PEMERINTAHAN KABUPATEN MIMIKA

DINAS KESEHATAN
Alamat : Kantor Pusat Pemerintahan Kab.Mimika Jl. Poros Kuala Kencana Timika - PAPUA 99913
Email : dinkes.kabupatenmimika@gmail.com / Hp.0812 4042 4130, 0812 4042 4171

Pekerjaan Belanja Obat - obatan - Obat (DAK)

NOMOR : 440 / 1296 / 2021

Pada hari ini Jumat, tanggal Sepuluh bulan September tahun Dua Ribu Dua Puluh Satu, kami yang bertandatangan di bawah ini, telah melakukan Acara Negosiasi Teknis dan Harga
dokumen penawaran pekerjaan tersebut di atas . Hasil Negosiasi Harga dijelaskan sebagai berikut :

HARGA SAT.
JENIS PEKERJAAN ORIGINAL HARGA SAT. CCO VOLUME JML HARGA ( Rp. )
NO SAT. CONTRACT
Original
SEMULA MENJADI ( Rp. ) ( Rp. ) CCO Original Contract CCO
Contract
1 2 3 4 5 6 7 8
1 Amoxycillin syrup kering 125mg/5ml Etil Klorida Spray Botol 4,091 104,500 5,000 196 20,454,550 20,482,000
2 Parasetamol Drop Parasetamol Drop Botol 9,091 9,091 1,000 1,000 9,090,910 9,090,910
3 Thiamin HCL (Vit B1) injeksi 100 mg/1 ml Thiamin HCL (Vit B1) injeksi 100 mg/1 ml Box@100 ampl 152,727 152,727 15 15 2,290,909 2,290,909
4 Zink Syrup (Zink Kid Syrup) Zink Syrup (Zink Kid Syrup) Botol 6,000 6,000 3,000 3,000 18,000,000 18,000,000
5 Kloramfenikol tetes telinga 3% Kloramfenikol tetes telinga 3% Botol 3,364 3,364 2,000 2,000 6,727,280 6,727,280
6 Pirantel Pamoat Sirup (Kombatrin) Pirantel Pamoat Sirup (Kombatrin) Ampul 15,091 15,091 1,000 1,000 15,090,910 15,090,910
7 Gentian Violet Larutan 1% Gentian Violet Larutan 1% Botol 10,182 10,182 300 300 3,054,546 3,054,546
8 Diazepam 5 mg /2,5 ml (Stesolid) Diazepam 5 mg /2,5 ml (Stesolid) Tube 20,182 20,182 200 200 4,036,364 4,036,364
9 Ambroxol sirup 15 mg/ml Ambroxol sirup 15 mg/ml Botol 11,636 11,636 1,500 1,500 17,454,540 17,454,540
10 Antasida DOEN Syrup 60ml Antasida DOEN Syrup 60ml Botol 3,455 3,455 2,000 2,000 6,909,100 6,909,100
11 Multivitamin Syrup 60 ml Multivitamin Syrup 60 ml Botol 43,182 43,182 1,000 1,000 43,181,820 43,181,820
12 Obat Batuk Hitam (OBH) Sirup Obat Batuk Hitam (OBH) Sirup Botol 14,545 14,545 2,000 2,000 29,090,900 29,090,900
13 Ketokonazole cream 2% 15 mg Ketokonazole cream 2% 15 mg Tube 4,455 4,455 1,000 1,000 4,454,550 4,454,550
14 Gentamycin Salep Kulit 0,1 % Gentamycin Salep Kulit 0,1 % Tube 6,091 6,091 1,500 1,500 9,136,365 9,136,365
15 Ictyol salep Ictyol salep Pot 17,091 17,091 500 500 8,545,455 8,545,455
16 Oksitetrasiklin HCI 3% salep kulit Oksitetrasiklin HCI 3% salep kulit Tube 4,636 4,636 1,000 1,000 4,636,360 4,636,360
17 Asiklovir 5% krim Asiklovir 5% krim Tube 2,348 2,348 2,000 2,000 4,696,360 4,696,360
18 Ketokonazole tab 200 mg Ketokonazole tab 200 mg Box 25,364 25,364 500 500 12,681,820 12,681,820
19 Primakuin tablet 15 mg Alkohol 70 % 1000 ml Botol 67,273 75,000 600 538 40,363,638 40,350,000
20 Parasetamol tablet 500 mg Parasetamol tablet 500 mg Box 100 tab 8,818 8,818 12,554 12,554 110,703,432 110,703,432
21 Asiklovir tab 200mg Asiklovir tab 200mg Tablet 282 282 15,000 15,000 4,227,300 4,227,300
22 Vitamin B Kompleks tablet Vitamin B Kompleks tablet Box 100 tab 17,727 17,727 800 800 14,181,816 14,181,816
23 Ambroxol Tablet 30 mg Ambroxol Tablet 30 mg Box 36,636 36,636 600 600 21,981,816 21,981,816
24 Loperamide HCI 2 mg Loperamide HCI 2 mg Box 15,545 15,545 200 200 3,109,090 3,109,090
25 Ibuprofen Tablet 400mg Ibuprofen Tablet 400mg Box 43,273 43,273 300 300 12,981,819 12,981,819
26 Gliseril Guayakolat tablet 100mg Gliseril Guayakolat tablet 100mg Box 61,909 61,909 100 100 6,190,909 6,190,909
27 Tablet Tambah Darah Tablet Tambah Darah Box 14,364 14,364 1,500 1,500 21,545,460 21,545,460
28 Salisil Bedak 2% Salisil Bedak 2% Bks 2,091 2,091 2,300 2,300 4,809,093 4,809,093
29 Klorfeniramin Maleat (CTM) tab 4 mg Klorfeniramin Maleat (CTM) tab 4 mg Box 100 tab 50,636 50,636 300 300 15,190,908 15,190,908
30 Tiamin HCI (Vit B1) tablet 50 mg Tiamin HCI (Vit B1) tablet 50 mg Box 100 tab 25,091 25,091 500 500 12,545,455 12,545,455
31 Cefixime 100mg kapsul Cefixime 100mg kapsul Box 40,361 40,361 1 1 40,361 40,361
32 Kalium Permanganat Serbuk (PK) Kalium Permanganat Serbuk (PK) Pot 9,818 9,818 500 500 4,909,090 4,909,090
33 Cetrizen 100 mg Kapsul) Cetrizen 100 mg Kapsul) Kapsul 151 151 20,000 20,000 3,018,200 3,018,200

Real Cost 495,331,126 495,344,938

PPN 10% 49,533,113 49,534,494
Jumlah 544,864,238 544,879,431
Dibulatkan 544,864,000 544,879,000

PEJABAT PENANDATANGAN KONTRAK

PPTK
PT. KIMIA FARMA TRADING AND DISTRIBUTION

AHMAD ALWY S.FARM.,APT REYNOLD RIZAL UBRA, S.SI., M.Epid

MAXI TANDI PAYUK, S.Si., Apt NIP. 19740801 199403 1 005
Direktur NIP. 19860311 201512 1 001
27,450
616320
515700
 PEMERINTAHAN KABUPATEN MIMIKA
DINAS KESEHATAN
Alamat : Kantor Pusat Pemerintahan Kab.Mimika Jl. Poros Kuala Kencana Timika - PAPUA 99913
Email : dinkes.kabupatenmimika@gmail.com / Hp.0812 4042 4130, 0812 4042 4171

Pekerjaan Pengadaan Obat PKD ( APBD )

NOMOR : 440 / 1299 / 2021

Pada hari ini Jumat, tanggal Sepuluh bulan September tahun Dua Ribu Dua Puluh Satu, kami yang bertandatangan di bawah ini, telah melakukan Acara Negosiasi Teknis dan Harga
dokumen penawaran pekerjaan tersebut di atas . Hasil Negosiasi Harga dijelaskan sebagai berikut :

HARGA SAT.
JENIS PEKERJAAN ORIGINAL HARGA SAT. CCO VOLUME JML HARGA ( Rp. )
NO SAT. CONTRACT
Original
SEMULA MENJADI ( Rp. ) ( Rp. ) CCO Original Contract CCO
Contract
1 2 3 4 5 6 7 8
1 Deksametason injeksi 5 Mg/ml - 1 ml Parasetamol tablet 500 mg Dus 100 275,455 34,004 20 3,704 5,509,091 125,950,816
2 nistatin drops (Fungatin/Mycostatin) nistatin drops (Fungatin/Mycostatin) Botol 138,455 138,455 100 100 13,845,455 13,845,455
3 gentamycin sulfate tetes mata 0,3% gentamycin sulfate tetes mata 0,3% Botol 7,000 7,000 1,200 1,200 8,400,000 8,400,000
4 Norit tab Norit tab Botol 75,364 75,364 120 120 9,043,637 9,043,637
5 Lidokain 2% Non Adrenalin Ambroxol Tablet 30 Mg Dus 251,182 40,300 100 1,279 25,118,182 51,543,700
6 Fenol Gliserol tetes telinga 10% Botol 3,636 480 1,745,453 -
7 pirantel pamoat sirup (Kombantrin) pirantel pamoat sirup (Kombantrin) Botol 15,091 15,091 600 600 9,054,546 9,054,546
8 Ambroxol sirup 15 mg/ml Ambroxol sirup 15 mg/ml Botol 11,364 11,364 1,000 1,000 11,363,640 11,363,640
9 Hidrokortison krim 2,5% Tube 4,909 2,400 11,781,816 -
10 Asiklovir 5% krim Asiklovir 5% krim Tube 2,348 2,348 6,000 6,000 14,089,080 14,089,080
11 miconazole 2% krim Tube 5,182 5,000 25,909,100 -
12 Ketokonazole cream 2% 15g Ketokonazole cream 2% 15g Tube 4,455 4,455 5,000 5,000 22,272,750 22,272,750
Antifungi DOEN Kombinasi As Benzoat 6% + Antifungi DOEN Kombinasi As Benzoat 6% +
13 Pot 3,636 3,636 1,000 1,000
As Salisilat 3% As Salisilat 3% 3,636,360 3,636,360
14 Levertraan salep Levertraan salep Dus 5,909 5,909 500 500 2,954,545 2,954,545
15 Gentamycin 0,3 salep mata 5 gr Gentamycin 0,3 salep mata 5 gr Tube 4,455 4,455 1,200 1,200 5,345,460 5,345,460
16 Parasetamol tablet 500 mg Parasetamol tablet 500 mg Dus 100 8,818 8,818 10,001 10,001 88,190,618 88,190,618
17 Loratadine 10 mg tab Loratadine 10 mg tab Dus 13,455 13,455 100 100 1,345,455 1,345,455
18 Gliseril Guayakolat tablet 100 mg Gliseril Guayakolat tablet 100 mg Dus 100 61,909 61,909 200 200 12,381,818 12,381,818
19 bromhexin tab 8 mg bromhexin tab 8 mg Dus 100 28,909 28,909 200 200 5,781,818 5,781,818
20 Natrium Diklofenak tab 50 mg Natrium Diklofenak tab 50 mg Dus 15,364 15,364 1,000 1,000 15,363,640 15,363,640
21 Amoksisilin tab 500 mg Dus 100 41,818 550 22,999,999 -
22 piridoksin Hcl (Vit B6) tablet 10 mg piridoksin Hcl (Vit B6) tablet 10 mg Botol 36,727 36,727 100 100 3,672,727 3,672,727
23 Metformin tab 500 mg Tablet 109 6,000 654,540 -
24 Domperidone 10 mg tab Dus 100 25,000 600 15,000,000 -
25 Klorfeniramin Maleat (CTM) 4 mg Klorfeniramin Maleat (CTM) 4 mg Dus 100 50,636 50,636 300 300 15,190,908 15,190,908
26 Griseofulvin tablet 125 mg, micronized Dus 100 50,636 500 25,318,180 -
27 Omeprazole kap 20 mg Omeprazole kap 20 mg Dus 30 25,364 25,364 100 100 2,536,364 2,536,364
28 piroxycam 10 mg piroxycam 10 mg Dus 100 37,000 37,000 200 200 7,400,000 7,400,000
29 kaptopril 25 mg tablet Dus 100 14,818 200 2,963,636 -
30 Metronidazol tab 500 mg Dus 100 25,545 200 5,109,090 -
31 Guafenisin tablet 100 mg Guafenisin tablet 100 mg Tablet 195 195 100,000 100,000 19,545,000 19,545,000
32 Loperamide Hcl 2 mg tablet Loperamide Hcl 2 mg tablet Dus 15,545 15,545 200 200 3,109,090 3,109,090
33 pirantel tabelt 125 mg Dus 67,455 200 13,490,910 -
34 papaverin 40 mg tab papaverin 40 mg tab Dus 100 22,091 22,091 100 100 2,209,091
35 Cetrizine 10 mg kapsul Cetrizine 10 mg kapsul Kapsul 151 151 30,000 30,000 4,527,300
36 sefadroxil kapsul 500 mg sefadroxil kapsul 500 mg Kapsul 534 534 10,000 10,000 5,336,400
37 kalium permanganat serbuk (PK) kalium permanganat serbuk (PK) Pot 9,818 9,818 1,000 1,000 9,818,180

Real Cost 452,013,879 452,017,427

PPN 10% 45,201,388 45,201,743
Jumlah 497,215,267 497,219,170
Dibulatkan 497,200,000 497,200,000

PEJABAT PENANDATANGAN KONTRAK

PPTK
PT. KIMIA FARMA TRADING AND DISTRIBUTION

AHMAD ALWY S.FARM.,APT REYNOLD RIZAL UBRA, S.SI., M.Epid

MAXI TANDI PAYUK, S.Si., Apt NIP. 19740801 199403 1 005
Direktur NIP. 19860311 201512 1 001
120,441,725
616320
515700