No Nama Obat Satuan Harga / (Rp) Quantity Total (Rp)

1 Amiodaron injeksi 150 mg/3 ml ampul/vial 6,446 12 77,352

2 Glukosa larutan infus (D5%) 500 ml botol 6,627 260 1,723,020
3 Aminofilin injeksi 24 mg/ ml ampul/vial 2,868 48 137,664
4 Ampicillin serbuk injeksi 1 gr/vial ampul/vial 10,340 200 2,068,000
5 Asiklovir 400 mg tablet 473 500 236,500
6 Diphenhidramin Injeksi 10 mg ampul/vial 902 30 27,060
7 Fenobarbital injeksi 50mg tablet 1,700 30 51,000
8 Fitomenadion (Vit K1) 10 mg tablet 847 300 254,100
9 Fitomenadion (Vit K1) Injeksi ampul/vial 4,000 150 600,000
10 Kaptopril 12,5 mg tablet 75 500 37,500
11 Kaptopril 25 mg tablet 75 500 37,500
12 Lidokain Compositum Injeksi ampul/vial 924 400 369,600
13 Metilprednisolon serbuk injeksi 125 mg ampul 11,440 300 3,432,000
14 Natrium diklofenak 50 mg tablet 127 800 101,600
15 Nistatin tab 500.000 IU tablet 957 100 95,700
16 Nistatin vaginal tab 100.000 IU suppo 550 100 55,000
17 Ranitidin Injeksi 25 mg/ml ampul 891 800 712,800
18 Zinc tab disp 20 mg tablet 275 2,000 550,000
19 Fenobarbital tab 100 mg tablet 183 100 18,300
20 Hidrokortisin krim 2,5% tube 2,556 25 63,900
21 Klopidogrel 75 mg tablet 633 1,000 633,000
22 Kodein 10 mg tablet 605 500 302,500
23 Simvastatin 20 mg tablet 165 1,600 264,000
24 Tablet tambah darah (Asam Folat 0,4 mg + tablet 260 500 130,000
25 Ringer Laktat Larutan Infus botol 7,703 1,100 8,473,300
26 Akarbose 100mg tablet 950 500 475,000
27 Akarbose 50 mg tablet 700 500 350,000
39 Atorvastatin Calcium 20 mg tablet 467 1,050 490,350
40 Azitromsin Sirup Kering 200 mg/ 5 ml botol 24,850 50 1,242,500
41 Bisoprolol 2,5 mg tablet 135 500 67,500
42 Bisoprolol 5 mg tablet 143 2,000 286,000
45 Fluoksetin 20 mg tablet 387 2,000 774,000
46 Furosemid injeksi 10 mg/ ml ampul/vial 969 400 387,600
47 Gabapentin 300 mg kapsul 673 1,000 673,000
48 Glimepirid 4 mg tablet 198 500 99,000
53 Kandesartan 16 mg tablet 319 1,000 319,000
54 Kandesartan 8 mg tablet 212 2,500 530,000
56 Ketorolak injeksi 30 mg/ ml ampul 923 1,000 923,000
59 Klozapin 100 mg tablet 1,253 1,000 1,253,000
60 Klozapin 25 mg tablet 473 2,000 946,000
63 Lisinopril 5 mg tablet 150 300 45,000
66 Meropenem serb injeksi 500mg ampul/vial 17,173 20 343,460
69 Metilprednisolon serbuk injeksi 500 mg ampul/vial 74,297 12 891,564
72 Nikardipin injeksi 10mg/vial ampul 8,266 10 82,660
 75 Olanzapin 10 mg tablet 4,625 1,020 4,717,500
76 Olanzapin 5 mg tablet 823 720 592,560
78 Omeprazol Serbuk Injeksi 40mg/10ml ampul/vial 5,397 500 2,698,500
79 Ondansetron injeksi 2 mg/ml ampul 963 300 288,900
82 Propiltiourasil 100 mg tablet 462 1,500 693,000
83 Ramipril 2,5mg tablet 240 300 72,000
84 Ramipril 5 mg tablet 158 600 94,800
86 Risperidon 1 mg tablet 133 3,000 399,000
87 Risperidon 2 mg tablet 130 5,000 650,000
88 Risperidon 3 mg tablet 259 1,000 259,000
90 Sefiksim 200 mg kapsul 749 500 374,500
91 Seftriakson serbuk injeksi 1 g ampul/vial 2,899 900 2,609,100
93 Siprofloksasin infus 2 mg/ml botol 8,100 50 405,000
95 Sprinolakton 100 mg tablet 557 100 55,700
96 Sprinolakton 25 mg tablet 230 500 115,000
98 Valproic Acid sirup 250 mg/ 5 ml botol 13,413 40 536,520
99 Valsartan tab 80 mg tablet 415 300 124,500
132 Novorapid (analog insulin fast acting) 100 IU/ml pen/200 130 89,500 11,635,000
129 Levemir Flexpen / Ryzodeg (analog insulin long acting pen/100 70 89,000 6,230,000
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