1.

SATUAN KERJA ADALAH NAMA APOTEK, FKTP, FKRTL atau DINKES PROVINSI dan KAB/KOTA
2. SISA STOK PER 31 DESEMBER 2021 ADALAH SISA STOK PER 31 DESEMBER 2021 DI SATUAN KERJA
3. PREDIKSI PENGADAAN TAHUN 2021 ADALAH PREDIKSI JUMLAH YANG DIRENCANAKAN UNTUK DIADAKAN TAHUN 2022
4. PEMAKAIAN RATA-RATA PER BULAN SELAMA 2021 ADALAH PEMAKAIAN RATA-RATA PER BULAN DI SATKER SELAMA TAHUN
5. PREDIKSI SISA STOK 31 DESEMBER 2022 ADALAH SISA STOK PER 31 DESEMBER 2021 DITAMBAH PREDIKSI PENGADAAN TAH
6. JUMLAH KEBUTUHAN TAHUN 2023 ADALAH PEMAKAIAN RATA-RATA PER BULAN SELAMA 2021 DIKALI 15 BULAN DALAM SA
7. RENCANA KEBUTUHAN TAHUN 2023 ADALAH JUMLAH KEBUTUHAN YANG DIHITUNG BERDASARKAN METODE KONSUMSI D
8. RENCANA PENGADAAN TAHUN 2023 ADALAH RENCANA UNTUK PENGADAAN DI TAHUN 2023 DALAM SATUAN TERKECIL SE
9. RENCANA PENGADAAN TAHUN 2022 ADALAH OTOMATIS TERISI DARI SISTEM JIKA SATKER TELAH MENGIRIMKAN PELAPOR
10. REALISASI PENGADAAN TAHUN 2021 ADALAH REALISASI PENGADAAN OBAT JKN BAIK E-PURCHASING MAUPUN MANUAL

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN RUJUKAN TINGKAT LANJU

SATUAN KERJA : RSUD PROF.DR.H.M CHATIB QUZWAIN

NO NAMA OBAT SATUAN

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

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

2 Abacavir 300 mg Tablet/kaplet/kapsul

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

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

59 Analog Insulin long acting inj 100 IU/mL, vial/cartridge Vial/Cartridge/Penfill

disposible/penfill cartridge
60 Analog insulin rapid acting inj 100 IU/mL cartridge disposible/ penfi
61 Analog insulin rapid acting inj 100 IU/mL Vial @10 ml
62 Analog Insulin: insulin basal inj 100 IU/mL vial/disposable cartridge/p
63 Analog Insulin: insulin basal inj 300 IU/mL vial/disposable cartridge/p
64 Analog Insulin: insulin prandial inj 100 IU/mL vial/disposable cartridge/p
65 Anastrozol tab 1 mg tablet/kapsul/kaplet
66 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 ampul/vial
inj 2 ml
67 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium tablet/kapsul/kaplet
hidroksida 200 mg
68 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium botol 60 ml
hidroksida 200 mg
69 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps

70 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiksin B 10.000 Tube

UI/g
71 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% pot 30 g

72 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen Suppositoria

2,5 mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g

73 Aquadest cairan 500 ml Botol 500 ml

74 Aripiprazol oral solution 1 mg/ml botol
75 Aripiprazol tab 5 mg tablet/kapsul/kaplet
76 Aripiprazol tab discmelt 10 mg tab discmelt/tab cepat lar
77 Aripiprazol tab discmelt 15 mg tab discmelt/ tab cepat lar
78 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial
79 Articulating paper kertas warna penanda oklusi Kertas warna penanda okl
80 Asam asetat tetes telinga 2% Botol
81 Asam asetilsalisilat (asetosal) tab 100 mg tablet sal enterik/kaplet s
82 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet
83 Asam askorbat (vitamin C) tab 250 mg Tab
84 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet
85 Asam folat tab 0,4 mg tablet/kapsul/kaplet
86 Asam folat tab 1 mg tablet/kapsul/kaplet
87 Asam folat tab 5 mg Tab
88 Asam Fusidat tts mata 1% catchcover, botol @ 0,6 m
89 Asam fusidat tts mata 1% Botol @5 ml
90 Asam ibandronat inj 1 mg/ml ampul/vial
91 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet
92 Asam mefenamat kaps 500 mg tablet/kapsul/kaplet/kapt
93 Asam pipemidat kaps 400 mg tablet/kapsul/kaplet
94 Asam retinoat krim 0,05% Tube/pot
95 Asam retinoat krim 0,1% Tube @ 10 gram
96 Asam retinoat krim 0,1% Tube @ 20 gram
97 Asam salisilat lar 0,1% Botol
98 Asam salisilat salep 10% Tube
 99 Asam salisilat salep 2% Tube
100 Asam salisilat salep 5% Tube
101 Asam traneksamat inj 100 mg/ml ampul/vial
102 Asam traneksamat inj 50 mg/ml Ampul
103 Asam traneksamat tab 500 mg ampul/vial
104 Asam ursodeoksikolat kaps 250 mg tablet/kapsul/kaplet
105 Asam zoledronat inf 4 mg/100 ml Botol
106 Asam Zoledronat Inf 5 mg/100 ml Botol
107 Asetazolamid tab 250 mg tablet/kapsul/kaplet
108 Asiklovir salep mata 3% tube
109 Asiklovir serb inj 250 mg Ampul/vial
110 Asiklovir tab 200 mg tablet/kapsul/kaplet
111 Asiklovir tab 400 mg tablet/kapsul/kaplet
112 Asparaginase serb inj 10.000 UI/vial Vial
113 Atapulgit 600 mg tablet/kapsul/kaplet
114 Atapulgit tab 630 mg tablet/kapsul/kaplet
115 Atapulgit tablet 650 mg tablet/kapsul/kaplet
116 Atapulgit tablet 750 mg Tab
117 Atenolol tab 100 mg tablet/kapsul/kaplet
118 Atenolol tab 50 mg tablet/kapsul/kaplet
119 Atorvastatin tab 10 mg tablet salut selaput/kaplet
120 Atorvastatin tab 20 mg tablet salut selaput/kaplet
121 Atrakurium inj 10 mg/ml (i.v) ampul/vial @ 2,5 ml
122 Atrakurium inj 10 mg/ml (i.v) ampul/vial @ 5 ml
123 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
124 Atropin tab 0,5 mg Tab
125 Atropin tts mata 0,5% Botol
126 Atropin tts mata 1% Botol
127 Azatioprin tab 50 mg Tab
128 Azitromisin serb inj 500 mg ampul/vial
129 Azitromisin sir kering 200 mg/5 ml maks botol @60 ml
130 Azitromisin tab 250 mg tablet/kapsul/kaplet
131 Azitromisin tab 500 mg tablet salut selaput/kaplet
132 Bahan tumpatan sementara lar, serb Botol
133 Barium sulfat serb 92 g/100 ml Botol
134 Barium sulfat serb 92 g/100 ml Disposible plastic bag @ 4
135 Barium sulfat susp 95% Botol plastik
136 Basiliksimab Inj 20 mg Vial
137 Bedak salisil serb 2% Dus/Sachet/Plastik
138 Bedakuilin fumarat tab 100 mg tablet/kapsul/kaplet
139 Bendamustin serb inj 100 mg Vial
140 Bendamustin serb inj 25 mg Vial
141 Benzatin penisilin inj 1,2 juta UI/ml (i.m.) Vial
142 Benzatin penisilin inj 2,4 juta UI/ml (i.m.) Vial
143 Beraprost sodium tab 20 mcg tablet/kapsul/kaplet
144 Betahistin tab 24 mg Tab
145 Betahistin tab 6 mg tablet/kapsul/kaplet
146 Betaksolol tts mata 0,5% Botol @ 5 ml
147 Betaksolol tts mata 0,5% Catchcover, botol 0,6 ml
148 Betametason krim 0,1% tube 5 gram
149 Betametason krim 0,5 mg/g Tube
150 Betametason salep 0,1% tube 5 gram
151 Betametason tts mata 1 mg/ml botol @5 ml
152 Betametason tts mata 1 mg/ml catchcover, botol 0,6 mL
153 Bikalutamid tab sal 150 mg tablet salut/kaplet salut
154 Bikalutamid tab sal 50 mg tablet salut/kaplet salut
155 Bisakodil sup 10 mg Suppositoria
156 Bisakodil sup 5 mg Suppositoria
157 Bisakodil tab sal 5 mg tablet/kapsul/kaplet
158 Bisoprolol tab 1,25 mg tablet/kapsul/kaplet
159 Bisoprolol tab 10 mg tablet salut selaput/kaple
160 Bisoprolol tab 2,5 mg tablet/kapsul/kaplet
161 Bisoprolol tab 5 mg tablet salut selaput/kaple
162 Bleomisin serb inj 15 mg/ml Vial
163 Bortezomib serb inj 3,5 mg ampul/vial
164 Brinzolamid tetes mata Botol
165 Bromokriptin tab 2,5 mg Tab
166 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml
167 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules
168 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml
169 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules
170 Budesonid serb ih 100 mcg/dosis Botol
171 Budesonid serb ih 200 mcg/dosis 100 dosis
172 Budesonid serb ih 200 mcg/dosis 200 dosis
173 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), Turbuhaler
120 dosis
174 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), rapihaler
120 dosis
175 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 60 Turbuhaler
dosis
176 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg rapihaler
177 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg Turbuhaler
178 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8% vial/ampul @4 ml
179 Bupivakain inj 5 mg/ml (p.v.) ampul/vial
180 Busulfan tab salut 2 mg Tab
181 Cardioplegia inj ampul/vial
182 Cisaprid tab 5 mg tablet
183 Copper T set/buah
184 Dabigatran eteksilat kaps 110 mg tablet/kapsul/kaplet
185 Dabigatran eteksilat kaps 75 mg tablet/kapsul/kaplet
186 Dakarbazin serb inj 100 mg/vial Vial
187 Dakarbazin serb inj 200 mg/vial Vial
188 Daklatasvir tab sal selaput 30 mg Tab
189 Daklatasvir tab sal selaput 60 mg Tab
190 Daktinomisin inj 0,5 mg/vial (i.v.) Vial
191 Dapson tab scored 100 mg Tab
192 Daunorubisin serb inj 20 mg/vial Vial
193 Deferasiroks tab disp 250 mg Tab
194 Deferasiroks tab disp 500 mg tablet dispersible/kaplet d
195 Deferasiroks tab sal selaput 180 mg tablet salut selaput
196 Deferasiroks tab sal selaput 360 mg tablet salut selaput
197 Deferipron lar oral 100 mg/ml Botol
198 Deferipron tab sal 500 mg tab salut selaput/kaplet s
199 Deferoksamin mesilat serb inj 500 mg/vial Vial
200 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial
201 Deksametason tab 0,5 mg tablet/kapsul/kaplet
202 Deksmedetomidin Inj 100 mcg/ml ampul/vial
203 Delamanid tab 50 mg tablet/kapsul/kaplet
204 Desfluran cairan ih Botol
205 Desmopresin nasal spray 10 mcg/puff Botol
206 Desmopresin tab 0,1 mg Tab
207 Desmopresin tab 0,2 mg Tab
208 Desogestrel tab 75 mcg Tab
209 Desoksimetason gel 0,05% Tube
210 Desoksimetason krim 0,25% tube 10 g
211 Desoksimetason krim 0,25% tube 15 g
212 Desoksimetason salep 0,25% tube 10 g
213 Dialisis peritoneal, larutan intraperitoneal - Extraneal ultrabag
214 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL
215 Diazepam enema 5 mg/2,5 ml tube @ 2,5 mL
216 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial
217 Diazepam tab 2 mg tablet/kapsul/kaplet
218 Diazepam tab 5 mg tablet/kapsul/kaplet
219 Dienogest tab 2 mg tablet/kapsul/kaplet
220 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet
221 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial
222 Diflukortolon valerat salep berlemak 0,1% Tube
223 Digoksin inj 0,25 mg/ml ampul/vial
224 Digoksin tab 0,25 mg tablet/kapsul/kaplet
225 Diltiazem hcl inj 5 mg/5 ml Ampul
226 Diltiazem inj 25 mg/5 ml ampul/vial
227 Diltiazem kaps SR 100 mg Kapsul lepas lambat
228 Diltiazem kaps SR 200 mg Kapsul lepas lambat
229 Diltiazem serb inj 10 mg/10 ml Ampul
230 Diltiazem serb inj 50 mg/vial Vial
231 Diltiazem tab 30 mg Tab
232 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet
233 Dinatrium edetat tts mata 0,35% (3,5 mg/ml) Botol
234 Dinatrium klodronat inj 60 mg/ml Botol
235 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3- Vial
dimercaptosuccinic acid/vial
236 Dobutamin inj 12,5 mg/ml ampul/vial
237 Dobutamin inj 25 mg/ml ampul/vial
238 Dobutamin inj 50 mg/ml ampul/vial
239 Doksazosin tab 1 mg tablet/kapsul/kaplet
240 Doksazosin tab 2 mg tablet/kapsul/kaplet
241 Doksisiklin kaps 100 mg tablet/kapsul/kaplet
242 Doksisiklin kaps 50 mg tablet/kapsul/kaplet
243 Doksorubisin serb inj 10 mg/vial (i.v.) Vial
244 Doksorubisin serb inj 50 mg/vial Vial
245 Dolutegravir tab 50 mg tablet/kapsul/kaplet
246 Domperidon susp 5 mg/5 ml botol @60 ml
247 Domperidon tab 10 mg tablet/kapsul/kaplet
248 Domperidon tts 5 mg/ml Botol
249 Donepezil tab 5 mg tablet salut selaput/kaplet
250 Donepezil tab eff 10 mg tablet dispersible /kaplet
251 Dopamin inj 40 mg/ml ampul/vial
252 Dosetaksel inj 20 mg Vial
253 Dosetaksel inj 40 mg/ml (vial 0,5 ml) Vial
254 Dosetaksel inj 40 mg/ml (vial 2 ml) Vial
255 Dosetaksel inj 80 mg Vial
256 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate Vial
calcium trisodium/ml
257 Dutasterid kaps 0,5 mg Kaps lunak
258 Efavirenz tab 200 mg Tablet
259 Efavirenz tab sal 600 mg tablet salut selaput/kaplet
260 Efedrin inj 50 mg/ml ampul/vial
261 Eksemestan tab 25 mg tablet salut gula
262 Eltrombopag tab sal selaput 25 mg Tab
263 Eltrombopag tab sal selaput 50 mg Tab
264 Enoksaparin sodium inj 20 mg/0,2 ml Ampul
265 Enoksaparin sodium inj 40 mg/0,4 ml Ampul
266 Enoksaparin sodium inj 60 mg/0,6 ml Ampul
267 Entekavir tab sal selaput 0,5 mg tablet salut selaput/kaplet
268 Entekavir tab sal selaput 1 mg tablet salut selaput/kaplet
269 Epinefrin (adrenalin) inj 1 mg/ml Ampul
270 Epirubisin serb inj 2 mg/ml, vial 25 ml Vial 25 ml
271 Epirubisin serb inj 2 mg/ml, vial 5 ml Vial 5 ml
272 Epirubisin serb inj 50 mg Vial 25 mL
273 Ergokalsiferol (vitamin D2) kaps 50.000 UI Kaps
274 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml Botol
275 Ergotamin tab 1 mg Tab
276 Eribulin inj 0,44 mg/ml ampul/vial
277 Eritromisin kaps 250 mg tablet/kapsul/kaplet
278 Eritromisin sir 200 mg/5 ml Botol @ 60 ml
279 Eritromisin tab 500 mg tablet/kapsul/kaplet
280 Eritropoetin-alfa inj 10.000 IU Vial
281 Eritropoetin-alfa inj 2.000 IU Vial
282 Eritropoetin-alfa inj 3.000 IU Vial
283 Eritropoetin-alfa inj 4.000 IU Vial
284 Eritropoetin-beta inj 2000 UI/0,3 ml Vial
285 Eritropoietin-alfa inj 40.000 IU ampul/vial
286 Eritropoietin-Alfa Inj 4000 IU/0,5 ml Ampul
287 Erlotinib tab sal selaput 100 mg tablet salut selaput/kaplet
288 Erlotinib tab sal selaput 150 mg tablet salut selaput/kaplet
289 Esomeprazole inj 40 mg/vial ampul/vial
290 Estrogen terkonjugasi tab sal 0,625 mg tablet salut gula/kaplet sa
291 Etambutol tab 400 mg tablet/kapsul/kaplet
292 Etanercept inj 50 mg/ml ampul/vial
293 Etanol 70% cairan 70% Botol
294 Etil klorida semprot 100 ml Botol
295 Etonogestrel implan 68 mg Set
296 Etoposid inj 20 mg/ml Vial
297 Eugenol Botol
298 Everolimus tab 0,25 mg tablet/kapsul/kaplet
299 Everolimus tab 0,5 mg tablet/kapsul/kaplet
300 Everolimus tab 0,75 mg tablet/kapsul/kaplet
301 Faktor IX Kompleks Inj 50 IU/mL ampul/vial
302 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml Vial
303 Faktor IX kompleks serb inj 500 UI/vial + pelarut Vial
304 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor Vial
koagulasi IX 25 UI, faktor koagulasi X 14-35 serb inj 250 IU/10 ml

305 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor Vial
koagulasi IX 25 UI, faktor koagulasi X 14-35 serb inj 500 UI/20 ml UI

306 Faktor viia (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi ampul/vial

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

308 Faktor VIII (konsentrat) serb inj 480 - 600 UI Vial
309 Faktor VIII serb inj 1000 mg/vial Vial
310 Faktor VIII serb inj 250 IU Vial
311 Faktor VIII serb inj 500 IU Vial
312 Fenilefrin drops 10% Botol
313 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml
314 Fenitoin Na kaps 100 mg Kaps
315 Fenitoin Na kaps 30 mg Kaps
316 Fenobarbital inj 100 mg/mL ampul/vial
317 Fenobarbital inj 50 mg/ml Ampul
318 Fenobarbital tab 100 mg Tab
319 Fenobarbital tab 30 mg tablet/kapsul/kaplet
320 Fenofibrat kaps 100 mg tablet/kapsul/kaplet
321 Fenofibrat kaps 300 mg tablet/kapsul/kaplet
322 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
323 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab
324 Fenoterol hbr aerosol 100 mcg/puff Botol
325 Fenoterol hbr cairan ih 0,1% Botol
326 Fentanil inj 0,05 mg/ml (ampul 10 ml) ampul/vial, @ 10 mL
327 Fentanil inj 0,05 mg/ml (ampul 2 ml) ampul @ 2 mL
328 Fentanil patch 12,5 mcg/jam Patch
329 Fentanil patch 25 mcg/jam Patch
330 Fentanil patch 50 mcg/jam Patch
331 Ferrakrilum cairan 1% Botol
332 Filgrastim inj 300 mcg/ml ampul/vial
333 Finasterid tab 5 mg tablet/kapsul/kaplet
334 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial
335 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
336 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) tablet salut gula/kaplet sa
337 Fludarabin inj 50 mg/vial Vial
338 Fludarabin tab sal 10 mg tablet salut/kaplet salut
339 Flufenazin inj 25 mg/ml (i.m.) Vial
340 Flukonazol inj 2 mg/ml Ampul
341 Flukonazol kaps 150 mg tablet/kapsul/kaplet
342 Flukonazol kaps 50 mg Kaps
343 Fluoksetin kaps 10 mg tablet/kapsul/kaplet
344 Fluoksetin kaps 20 mg tablet/kapsul/kaplet
345 Fluor kapl 1 mg Kaplet
346 Fluor sediaan topikal Tube
347 Fluorescein Sodium/ Natrium Fluoresein inj 100 mg/mL Ampul/vial
348 Fluoro deoxy glucose (FDG) Vial
349 Fluorometolon tts mata 0,1% botol @5 ml
350 Fluorometolon tts mata 0,1% catchcover, botol 0,6 mL
351 Fluorourasil inj 50 mg/mL (@ 10 mL) Ampul
352 Fluorourasil inj 50 mg/mL (@ 5 mL) Ampul
353 Flusinolon asetonid krim 0,025% tube @ 5g
354 Flusinolon asetonid salep 0,025% Tube 10 g
355 Flutikason furoat intranasal spray Botol
356 Flutikason propionat cairan ih 0,5 mg/dosis Botol
357 Flutikason Propionat MDI 50 mcg/semprot Botol
358 Fluvoksamin tab sal selaput 100 mg tablet salut selaput
359 Fluvoksamin tab sal selaput 50 mg tablet salut selaput
360 Fondaparinuks inj 2,5 mg/0,5 ml ampul/vial/prefilled syrin
361 Formokresol Botol
362 Fosfomisin Trometamol granula 3 g Sachet
363 Fraksi protein plasma lar inf 5% Botol
364 Framisetin Sulfat Tulle 1% Patch
365 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial
366 Furosemid tab 40 mg tablet/kapsul/kaplet
367 Gabapentin kaps 100 mg tablet/kapsul/kaplet
368 Gabapentin kaps 300 mg tablet/kapsul/kaplet
369 Gadobutrol Macrocyclic 5 ml Prefilled Syringe @ 5 ml
370 Gadobutrol Macrocyclic 7,5 ml Prefilled Syringe @ 7,5 ml
371 Gadoksetat disodium 0,25 mmol gadoksetat disodium/ml Vial
372 Gadoteric acid inj 279,32 mg/ml Vial @10 ml
373 Gadoteric acid inj 279,32 mg/ml Vial @15 ml
374 Gadoteric acid inj 279,32 mg/ml Vial @20 ml
375 Galactose microparticle 200-400 mg micropart/ml Vial
376 Gansiklovir serb inj 500 mg/vial Vial
377 Garam Fe, setara dengan Fe elemental 15 mg/5 mL Botol
378 Garam Fe, setara dengan Fe elemental 60 mg Botol
379 Garam Fe, setara dengan Fe elemental 60 mg Sachet
380 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 sachet
g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g

381 Gefitinib tab 250 mg tablet/kapsul/kaplet

382 Gemfibrozil kaps 300 mg tablet/kapsul/kaplet
383 Gemfibrozil kaps 600 mg tablet/kapsul/kaplet
384 Gemsitabin inj 1000 mg/vial Vial
385 Gemsitabin inj 200 mg/vial Vial
386 Gentamisin inj 40 mg/ml ampul/vial
387 Gentamisin salep mata 0,3% Tube
388 Gentamisin tsts mata 1% Botol
389 Gentamisin tts mata 0,3% Botol
390 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter Sachet
5g
391 Glass ionomer ART (Atraumatic Restorative Treatment) lar Botol
392 Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial
393 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet
394 Glibenklamid tab 5 mg tablet/kapsul/kaplet
395 Gliklazid tab 80 mg Tab
396 Gliklazid tab MR 30 mg Tab
397 Gliklazid tab SR 60 mg tablet lepas lambat/kaple
398 Glikopironium serb ih 50 mcg kapsul
399 Glikuidon tab 30 mg tablet/kapsul/kaplet
400 Glimepirid tab 1 mg tablet/kapsul/kaplet
401 Glimepirid tab 2 mg tablet/kapsul/kaplet
402 Glimepirid tab 3 mg tablet/kapsul/kaplet
403 Glimepirid tab 4 mg tablet/kapsul/kaplet
404 Glipizid tab 10 mg tablet/kapsul/kaplet
405 Glipizid tab 5 mg tablet/kapsul/kaplet
406 Gliseril trinitrat inj 5 mg/ml Ampul
407 Gliseril trinitrat kaps lepas lambat 2,5 mg kapsul lepas lambat
408 Gliseril trinitrat kaps lepas lambat 5 mg kapsul lepas lambat
409 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet
410 Gliserin lar 50% Botol
411 Gliserin tts 100 mg/ml Botol
412 Glukosa Larutan Infus 10% steril 100 ml Botol
413 Glukosa Larutan Infus 10% steril 250 ml Botol
414 Glukosa Larutan Infus 10% steril 500 ml Botol
415 Glukosa Larutan Infus 40% Ampul @25 ml
416 Glukosa Larutan Infus 5% steril 100 ml Botol
417 Glukosa Larutan Infus 5% steril 250 ml Botol
418 Glukosa Larutan Infus 5% steril 500 ml Botol
419 Goserelin asetat inj 10,8 mg/vial Vial
420 Goserelin asetat inj 3,6 mg/vial Vial
421 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet
422 Griseofulvin (micronized) tab 500 mg Tab
423 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kaplet
424 Gutta percha dan paper points 15 - 40 mm Roll
425 Gutta percha dan paper points 45 - 80 mm Roll
426 Haloperidol inj 5 mg/ml (i.m.) Vial
427 Haloperidol inj 50 mg/ml (decanoat) Vial
428 Haloperidol tab 0,5 mg tablet/kapsul/kaplet
429 Haloperidol tab 1,5 mg tablet/kapsul/kaplet
430 Haloperidol tab 2 mg tablet/kapsul/kaplet
431 Haloperidol tab 5 mg tablet/kapsul/kaplet
432 Haloperidol tts 2 mg/ml botol
433 Halotan ih Botol
434 Hemodialisa lar Botol
435 Heparin, Na inj 5.000 UI/ml (i.v./s.k.) Vial
436 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml Ampul
437 Hepatitis B imunoglobulin (human) Inj 220 IU/ml Syringe
438 Hidrogen peroksida cairan 3% Botol
439 Hidroklorotiazid tab 12,5 mg Tab
440 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet
441 Hidrokortison krim 1% tube @ 5 g
442 Hidrokortison krim 2,5% tube @ 5 g
443 Hidrokortison serb inj 100 mg Vial
444 Hidrokortison Tab 20 mg Tab
445 Hidroksi klorokuin tab 200 mg Tab
446 Hidroksi urea tab 500 mg tablet/kapsul/kaplet
447 Hiosina butilbromida inj 20 mg/ml ampul/vial
448 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet
449 Homatropin tts mata 2% Botol
450 Human insulin : mix insulin inj 100 UI/ml vial/ cartridge disposible/
451 Human insulin : mix insulin inj 100 UI/ml Vial @10 mL
452 Human Insulin intermediate acting combine with short or long Cartridge, Penfill Cartridg
acting inj 100 IU/mL, cartridge disposible/penfill cartridge

453 Human insulin intermediate acting combine with short or long Vial
acting inj 100 IU/mL, Vial 10 mL
454 Human Insulin intermediate acting inj 100 IU/ml, cartridge Cartridge, Penfill Cartridg
disposible/penfill cartridge
455 Human Insulin intermediate acting inj 100 IU/Ml, Vial 10 mL Vial
456 Human Insulin intermediate acting inj 100 IU/mL, Vial 5 mL Vial
457 Human insulin short acting inj 100 IU/ml Vial @10 mL
458 Human insulin short acting inj 100 IU/ml Cartridge disposible/penfil
459 Human Insulin: insulin basal inj 100 IU/mL vial/disposable cartridge/p
460 Human Insulin: insulin prandial inj 100 IU/mL vial/disposable cartridge/p
461 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
462 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul
463 Hydromorphone HCl tab oros 16 mg tablet lepas lambat/kaple
464 Hydromorphone HCl tab oros 8 mg tablet lepas lambat/kaple
465 Ibuprofen Inj 100 mg/ml ampul/vial
466 Ibuprofen sir 100 mg/5 ml botol @ 60 ml
467 Ibuprofen sir 200 mg/5 ml botol @ 60 ml
468 Ibuprofen tab 200 mg tablet/kapsul/kaplet
469 Ibuprofen tab 400 mg tablet/kapsul/kaplet
470 Idarubisin serb inj 20 mg Vial
471 Ifosfamid serb inj 1000 mg/vial Vial
472 Ifosfamid serb inj 2000 mg/vial Vial
473 Ifosfamid serb inj 500 mg/vial Vial
474 Iloprost ih 10 mcg/mL ampul/vial
475 Imatinib mesilat tab 100 mg tablet/kapsul/kaplet
476 Imatinib Mesilat tab 400 mg tablet/kapsul/kaplet
477 Imidafenasin tab sal selaput 0,1 mg tablet salut selaput
478 Imidapril tab 10 mg tablet/kapsul/kaplet
479 Imidapril tab 5 mg tablet/kapsul/kaplet
480 Imunoglobulin Intravena Inj 50 mg/ml, untuk terapi GBS (Guillain Vial
Bare Syndrom)
481 Indakaterol serb ih 150 mcg Kaps
482 Indakaterol serb ih 300 mcg Kaps
483 Iodiksanol vial 320 mg Iodium/100 ml ampul/vial/botol
484 Iodiksanol vial 320 mg Iodium/50 ml ampul/vial/botol
485 Iodium 131 Botol
486 Iodohippurate sodium I 131 37-74 mbq/ multiple-dose Vial
487 Ioheksol 180 - 300 mg Iodium/mL (300 mg/20 mL) ampul/vial/botol
488 Ioheksol 240-350 mg Iodium/ml (300 mg/75 ml) Vial
489 Ioheksol 240-350 mg Iodium/ml (350 mg/75 ml) ampul/vial/botol
490 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/100 ml) ampul/vial/botol
491 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/50 ml) Vial
492 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/100 ml) ampul/vial/botol
493 Ioheksol Inj 180 - 300 mg Iodium/mL (300 mg/50 ml) ampul/vial/botol
494 Iopamidol 300 - 370 mg Iodium/mL (300 mg/100 mL) Ampul/vial/botol @ 100
495 Iopamidol 300 - 370 mg Iodium/mL (300 mg/50 mL) Ampul/vial/botol @ 50 m
496 Iopamidol 300 - 370 mg Iodium/mL (370 mg/100 mL) Vial
497 Iopamidol 300 - 370 mg Iodium/mL (370 mg/200 mL) Vial
498 Iopamidol 300 - 370 mg Iodium/mL (370 mg/50 mL) ampul/vial/botol
499 Iopromid 300 - 370 mg (300 mg/100 mL) Vial
500 Iopromid 300 - 370 mg (300 mg/50 mL) Vial
501 Iopromid 300 - 370 mg (370 mg/100 mL) Vial
502 Iopromid 300 - 370 mg (370 mg/50 mL) Vial
503 Ipratropium bromida aerosol 20 mcg/semprot Botol
504 Ipratropium bromida cairan ih 0,025% Botol
505 Irbesartan tab 150 mg tablet/kapsul/kaplet
506 Irbesartan tab 300 mg tablet/kapsul/kaplet
507 Irinotekan inf 20 mg/ml Ampul/vial @ 5 mL
508 Irinotekan inf 20 mg/ml Ampul/vial @ 2 mL
509 Irinotekan inj 20 mg/ml Ampul/vial @ 2 mL
510 Irinotekan inj 20 mg/ml Ampul/vial @ 5 mL
511 Isofluran inhalasi 100 ml Botol
512 Isofluran inhalasi 250 ml botol @ 250 mL
513 Isoniazid tab 100 mg Tab
514 Isoniazid tab 300 mg Tab
515 Isosorbid dinitrat inj 1 mg/ml (i.v) ampul/vial
516 Isosorbid dinitrat tab 10 mg tablet/kapsul/kaplet
517 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet
518 Itrakonazol Kaps 100 mg tablet/kapsul/kaplet
519 IUD Cu T 380 A Set
520 IUD Levonorgestrel Set
521 Ivabradin tab 5 mg tablet /kapsul/kaplet
522 k.y jelly Tube gel
523 Kalamin Tube
524 Kalium aspartat tab 300 mg tablet salut selaput/kaplet
525 Kalium klorida / Potasium klorida injeksi 25 mg 7,46%, 25 mL Ampul/vial
526 Kalium klorida tab SR 600 mg tablet lepas lambat/kaple
527 Kalsitriol kaps lunak 0,25 mcg kapsul lunak
528 Kalsitriol kaps lunak 0,5 mcg kapsul lunak
529 Kalsium Folinat (Leukovorin, Ca) Inj 10 mg/ml ampul/vial
530 Kalsium folinat (leukovorin, Ca) tab 15 mg Tab
531 Kalsium glukonat inj 100 mg/ml ampul/vial
532 Kalsium hidroksida bubuk, pasta Tube
533 Kalsium hipoklorit Sachet
534 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet
535 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet
536 Kalsium polistirena sulfonat ktg 5 g Sachet
537 Kandesartan tab 16 mg tablet/kapsul/kaplet
538 Kandesartan tab 8 mg tablet/kapsul/kaplet
539 Kapesitabin tab sal 500 mg tab salut/kaplet salut
540 Kaptopril tab 12,5 mg tablet/kaplet
541 Kaptopril tab 25 mg tablet/kaplet
542 Kaptopril tab 50 mg tablet/kaplet
543 Karbamazepin sir 100 mg/5 ml Botol
544 Karbamazepin Tab 200 mg Tablet
545 Karbimazol tab 5 mg tablet/kapsul/kaplet
546 Karbogliserin tts telinga 10 % Botol
547 Karboksimetilselulosa tts mata Botol
548 Karboplatin Inj 10 mg (vial 45 ml) Vial
549 Karboplatin inj 10 mg/ml (vial 15 ml Vial
550 Karvedilol kaps 6,25 mg tablet/kapsul/kaplet
551 Karvedilol tab 25 mg tablet/kapsul/kaplet
552 Ketamin inj 100 mg/ml (i.v.) ampul/vial
553 Ketamin inj 50 mg/ml (i.v.) ampul/vial
554 Ketokonazol krim 2% Tube 10 g
555 Ketokonazol scalp sol 2% botol
556 Ketokonazol tab 200 mg tablet/kapsul/kaplet
557 Ketoprofen Inj 25 mg/ml ampul/vial
558 Ketoprofen sup 100 mg Suppositoria
559 Ketorolak inj 30 mg/ml ampul/vial
560 Klaritromisin sir kering 125 mg/5 ml botol maks 60 mL
561 Klaritromisin sir kering 250 mg/5 ml Botol
562 Klaritromisin tab 500 mg tablet salut selaput/kaplet
563 Klindamisin kaps 150 mg Kaps
564 Klindamisin kaps 300 mg tablet/kapsul/kaplet
565 Klobazam tab 10 mg tablet/kapsul/kaplet
566 Klobetasol propionat krim 0,05% tube
567 Klobetasol propionat salep 0,05% tube
568 Klofazimin, micronized kaps 50 mg Kapsul
569 Klofazimin, micronizedkaps 100 mg kapsul
570 Klomipramin tab 25 Tab
571 Klonazepam kaps 2 mg tablet salut selaput/kaplet
572 Klonidin inj 150 mcg/ml Vial
573 Klonidin tab 0,15 mg tablet/kapsul/kaplet
574 Klopidogrel tab 75 mg tablet salut selaput/kaplet
575 Klopidogrel tab sal selaput 300 mg tablet salut selaput/kaplet
576 Kloral hidrat lar Botol
577 Klorambusil tab sal selaput 5 mg tab sal selaput
578 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet
579 Kloramfenikol kaps 500 mg tablet/kapsul/kaplet
580 Kloramfenikol salep mata 1% tube @ 5 gram
581 Kloramfenikol serb inj 1.000 mg/ml vial/ampul
582 Kloramfenikol susp 125 mg/5 ml botol 60 ml
583 Kloramfenikol tetes telinga 3% Botol
584 Kloramfenikol tts mata 0,5% botol
585 Kloramfenikol tts mata 1% Botol
586 Klorfeniramin tab 4 mg tablet/kapsul/kaplet
587 Klorfenol kamfer mentol (CHKM) Botol
588 Klorheksidin lar 0,2% Botol
589 Klorheksidin lar 15% Botol
590 Klorokuin tab 250 mg Tablet
591 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial
592 Klorpromazin inj 5 mg/ml (i.m.) ampul/vial
593 Klorpromazin tab sal 100 mg tablet salut selaput/kaplet
594 Klorpromazin tab sal 25 mg Tab sal
595 Klortalidon tab 50 mg Tab
596 Klotrimazol tab vagina 100 mg Tab
597 Klozapin tab 100 mg tablet
598 Klozapin tab 25 mg tablet
599 Kodein tab 10 mg tablet/kapsul/kaplet
600 Kodein tab 15 mg tablet/kapsul/kaplet
601 Kodein tab 20 mg tablet/kapsul/kaplet
602 Kolestiramin serb, 4 g Ampul
603 Kolkisin tab 500 mcg Tab
604 Komb: Deksametason 0,1% Thymol 5% Paraklorphenol 30 Botol
605 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab tablet salut selaput/kaplet
sal selaput
606 Kombinasi : (Ampisilin 1000 mg + Sulbaktam 500 mg) serb inj 1500 ampul/vial
mg
607 Kombinasi : (Sefoperazon 500 mg + Sulbaktam 500 mg) serb inj 1000 ampul/vial
mg
608 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg + Nevirapin 50 mg) Tab dispersible
Ped Triple FDC
609 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg ampul/vial

610 Kombinasi : artemether 20 mg + lumefantrin 120 mg tablet/kapsul/kaplet

611 kombinasi : benserazid 25 mg + levodopa 100 mg tablet dispersible/kaplet d
612 Kombinasi : Brinzolamid 1% + Timolol 0,5%, tts mata Botol
613 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab
614 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet
615 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut tablet salut gula

616 Kombinasi : Indakaterol 110 mcg + Glycopyrronium 50 mcg serb ih + Botol

alat breezhaler
617 Kombinasi : Ipratropium bromida 0,02 mg + fenoterol HBr 0,05 mg Botol
aerosol
618 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + entekapon 200 tablet/kapsul/kaplet
mg
619 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg tab salut gula
620 Kombinasi : medroksi progesteron asetat+ estradiol sipionat inj Vial
depot 25 mg + 5 mg
621 Kombinasi : Meglumin amidotrizoat + Sodium amidotrizoat inj 76% Vial

622 Kombinasi : Sefiksim 400 mg + Azitromisin 1000 mg Paket

623 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab
624 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 Tab
mg
625 Kombinasi : Travoprost 0,004% + Timolol 0,5%, tts mata Botol
626 Kombinasi : triamsinolon + dementilklortetrasiklin Pasta tube
627 Kombinasi : zidovudin 300 mg +lamivudin 150 mg Tab
628 Kombinasi KDT/FDC mengandung: (medroksi progesteron asetat ampul/vial
120 mg + estradiol sipionat 10 mg) inj
629 Kombinasi KDT/FDC mengandung: (salmeterol 50 mcg + flutikason Diskus
propionat 250 mcg) serb ih
630 Kombinasi KDT/FDC mengandung: (salmeterol 50 mcg + flutikason Diskus
propionat 500 mcg) serb ih
631 Kombinasi KDT/FDC mengandung: (tiotropium 2,5 mcg + olodaterol Cartridge
2,5 mcg) cairan ih
632 Kombinasi KDT/FDC mengandung: (tiotropium 2,5 mcg + olodaterol Cartridge
2,5 mcg) cairan ih, refill
633 Kombinasi KDT/FDC, setiap mL mengandung: latanoprost 0,05 mg + Botol 2,5 mL
timolol 5 mg tetes mata
634 Kombinasi KDT/FDC, setiap mL mengandung: latanoprost 0,05 mg + catchcover, botol @ 0,6 m
timolol 5 mg tetes mata
635 Kombinasi, setiap ml mengandung: natrium klorida 4,40 mg + kalium Botol Plastik @ 15 ml
klorida 0,80 mg (tetes mata)
636 Kombinasi, setiap ml mengandung: natrium klorida 4,40 mg + kalium Catchcover, botol plastik
klorida 0,80 mg (tetes mata)
637 Kombinasi, setiap ml mengandung: natrium klorida 4,40 mg + kalium Botol plastik @ 5 ml
klorida 0,80 mg (tetes mata)
638 Kombinasi: Amoksisilin 1.000 mg + Asam klavulanat 200 mg, Inj vial
1.200 mg
639 Kombinasi: Elbasvir 50 mg dan Grazoprevir 100 mg tablet salut tablet salut selaput
selaput
640 Kombinasi: Ipratropium bromida 0,5 mg + Salbutamol 2,5 mg, cairan Ampul/vial
ih
641 Kombinasi: kaolin 550 mg + pektin 20 mg Tab
642 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 250 mg Tab

643 Kombinasi: parafin + gliserin + fenolftalein Botol

644 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 mcg ih 50 aerosol can/canister
mcg/puff
645 Kombinasi: salmeterol 50 mcg + flutikason propionat 100 mcg ih 100 Botol
mcg/puff
646 Kombinasi: salmeterol 50 mcg + flutikason propionat 500 mcg ih 500 Botol
mcg/puff
647 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 mcg ih 250 Botol
mcg/puff
648 Kombinasi: Tenofovir 300 mg + Lamivudin 300 mg + Dolutegravir 50 Tablet/kapsul/kaplet
mg, tablet
649 Komibinasi: lidokain + medisinal creosote phenol + eugenol + benzil Botol
alkohol, cairan
650 Komposit resin Set
651 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ tab/kaptab
trimetoprim 80 mg
652 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+ tab/kaptab
trimetoprim 160 mg
653 Kotrimoksazol kombinasi tiap 5 ml suspensi : sulfametoksazol 200 botol 60 mL
mg + trimetoprim 40 mg
654 Kuinin inj 25% (i.v.) Vial
655 Kuinin tab 200 mg tablet/kapsul/kaplet
656 Laktulosa sir 3,335 g/5 ml botol @ 60 mL
657 Lamivudin (3TC) tab 150 mg tablet/kapsul/kaplet
658 Lamivudin tab 100 mg tablet/kapsul/kaplet
659 Lamotrigin Tab 100 mg Tab
660 Lamotrigin tab 50 mg Tablet
661 Lamotrigin tab dispersible 25 mg tablet dispersible/kaplet d
662 Lansoprazol inj 30 mg/ml Vial
663 Lansoprazol kaps 30 mg tablet/kapsul/kaplet
664 Lapatinib tab 250 mg tablet/kapsul/kaplet
665 Larutan mengandung Asam Amino (Asam Amino 10%) Botol
666 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 Botol
g, Na+ 2 mEq, Asetat 120 mEq)
667 Larutan mengandung Asam Amino (Asam Amino 15 g, Glukosa 37,5 Softbag @500 mL
g, Tiamin HCl 0,75 mg, elektrolit)
668 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Botol
Cl-52 mEq)
669 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % Botol
dan elektrolit) 1000 ml
670 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % Botol
dan elektrolit) 500 ml
671 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 75 g, Softbag @1.000 mL
Tiamin HCl 1,5 mg, elektrolit)
672 Larutan mengandung Asam Amino (Asam Amino 5% dengan BCAA Botol
45%, L-Ornithine L Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol 50
gr/L)

673 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Botol
Taurine 0,24 gr/l) : Aminosteril Infant 6%
674 Larutan mengandung Asam Amino (Asam Amino 7% (total protein Botol
17,5 g) dengan kandungan asam amino esensial (EAA) dan non
esensial (NEAA) yang seimbang EAA : NEAA = 60 : 40))

675 Larutan mengandung Asam Amino (Asam Amino 72.05 g, Total N Botol
11.53 g, AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 mEq)

676 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 Botol
g, Na+ 14 mEq, Cl 94 mEq)
677 Larutan mengandung Asam Amino (Asam amino 8%) : Aminosteril Botol
N-Hepa
678 Larutan mengandung Asam Amino (Asam Amino 9%, Komposisi: Botol
Asam Amino esensial: Asam Amino non esensial = 60 : 40)

679 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol Botol
10 g/L)
680 Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Botol
Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12
gr/L)

681 Larutan mengandung Asam Amino (Glutamine 20 g) Botol

682 Larutan mengandung Asam Amino (Kombinasi : asam amino, Botol
glukosa, dan lipid) (Lipid Peri 1250)
683 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi Botol
lemak, dan asam amino) (Lipid Special 1250)
684 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi Botol
lemak, dan asam amino) (Lipid Special 625)
685 Larutan mengandung asam amino (kombinasi AA 50 g/L, sorbitol 50 Botol
g/L, 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)

686 Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L, Botol
vitamin dan elektrolit)
687 Larutan mengandung Asam Amino (Kombinasi Glukosa dan Botol
elektrolit 150 gr + Asam Amino 48 gr dgn akses sentral)
688 Larutan mengandung Asam Amino (Kombinasi Glukosa dan Botol
elektrolit 80 gr + Asam Amino 40 gr)
689 Larutan mengandung Asam Amino (N(2)-L-Alanyl-L-Glutamine/ N(2)- Botol/vial
L-Alanyl-L-Glutamine 20%)
690 Larutan mengandung Asam Amino + Elektrolit + Karbohidrat + Lipid Botol
(Kombinasi Asam Amino: 45gr, Glukosa: 130gr, Lipid: 68gr dan
Elektrolit (Kalori = 1400 kkal, Akses peripheral))

691 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)

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

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

693 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)

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

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

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

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

696 Larutan mengandung asam amino + Karbohidrat + Lipid (Glukosa 63 Bag

g, Asam amino 25 g, Lipid 19 g dengan Fish Oil 2,8 g)

697 Larutan mengandung elektrolit (CaCl2H2O 0,165 gr, KCl 0,15 gr, Botol plastik @500 ml
NaCl 4,3 gr)
698 Larutan mengandung Elektrolit (Kalium Klorida) Botol
699 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) (KN1) Botol
700 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) Botol
701 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Softbag @ 500 ml
Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
702 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Botol plastik @ 500 ml
Ca 3 mEq, Asetat 28 mEq) Ringer Asetat
703 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)

704 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung Botol

electrolit: 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)

705 Larutan Mengandung Fosfat Anorganik (NaH2PO4/KH2PO4) Botol

dengan/tanpa vitamin yang larut dalam air
706 Larutan mengandung Karbohidrat + Elektrolit (D2,5%+KCL 0,15% Botol
+NaCl 0,45%) (KDN1)
707 Larutan mengandung Karbohidrat + Elektrolit (D2,5%+KCL 0,3% Botol
+NaCl 0,45%) (KDN2)
708 Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Botol
Xylitol 60 g/ L)
709 Larutan mengandung Karbohidrat (Fructose 15 mg, glucose softbag
monohydrate 30 mg, xylitol 15 mg)
710 Larutan mengandung Karbohidrat (Fructose 200 g, glucose 110 g, Botol
Xylitol 100 g/ L)
711 Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Botol
Xylitol 30 g/ L)
712 Larutan mengandung Karbohidrat (Maltose 10%) Botol
713 Larutan mengandung Karbohidrat + Elektrolit (25.00g dextrose Botol plastik @500 ml
anhidrat, 3.00 g sodium chloride, 0.15 g potassium chloride, 0.10 g
calcium chloride dihydrate dan 1.55 g sodium lactate)

714 Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 Botol plastik @500 ml
g sodium chloride, 0.15 g potassium chloride, 0.10 g calcium
chloride dihydrate dan 1.55 g sodium lactate)

715 Larutan mengandung Karbohidrat + Elektrolit (27.500 g dextrose Botol 500 ml

monohydrate, 3.00 g sodium chloride, 0.15 g potassium chloride,
0.10 g calcium chloride dihydrate dan 1.900 g sodium acetate
trihydrate)

716 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Botol
Mg, Sorbitol 50 gr/L)
717 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 100 gr/L, elektrolit)
718 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Botol
Glukosa 75 gr/L, elektrolit)
719 Larutan mengandung karbohidrat + elektrolit (Dextran 40 50 gr, Botol plastik @500 ml
CaCl2H2O 0,1 gr, KCl 0,15 gr, NaCl 3 gr, Na lactate 1,55 gr)
720 Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%, NaCL Botol
0,45%, KCl) (HSD)
721 Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, Botol
glucose 66 g, Xylitol 60 g/ L + elektrolit)
722 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl Botol
2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)

723 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Botol

Natrium Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
724 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 110.0 g; botol/softbag
NaCl: 1.80 g) (D10-1/5NS)
725 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: Botol
4,5 g)
726 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: botol/softbag @ 100 mL
2.25 g) (D5-1/4NS)
727 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: botol/softbag @ 500 mL
2.25 g) (D5-1/4NS)
728 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: Botol
4.5 g) (D5-1/2NS)
729 Larutan mengandung karbohidrat + elektrolit (Kombinasi NaCl 18,6 Botol
g, KCl 0,3 g, CaCl2 0,48 g, dextrose 50 g per 1000 ml)
730 Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi Botol
kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ,
Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g)

731 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Botol

Glukosa 5%)
732 Larutan mengandung Karbohidrat + Elektrolit (NaCl 0.585 gr, KCl 0.3 Botol plastik @500 ml
gr, Na Lactat 0.56 gr, Dekstrosa 18,75 gr) (KA EN 4B)
733 Larutan mengandung Karbohidrat + Elektrolit (NaCl 0.585 gr, Na Botol plastik @500 ml de
Lactat 0.56 gr, anhydrous dekstrosa 20 gr) (KA EN 4A)
734 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.125 gr, Botol
Dekstrosa 18.75 gr) (KA EN 1B)
735 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol
Glukosa 100 gr)
736 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Botol
Na Lactate 2.24 g, Glukosa 100 gr)
737 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 Botol
gr, Na Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
738 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Botol
Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
739 Larutan mengandung Lipid (Emulsi lemak 20%) Botol
740 Larutan mengandung Lipid (Highly refined fish oil, Glyserol dan Botol
purified egg phospolipid)
741 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 100 ml) Botol

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

743 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr Botol
+ Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)

744 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 80 gr + Botol

Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
745 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 90 gr + Botol
Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)

746 Larutan Mengandung Vitamin yang larut dalam lemak (Vitamin Botol
A,D,E,K)
747 Larutan Mengandung Vitamin yang larut dalam lemak (Vitamin Botol
A,D,E,K) infant
748 Latanoprost tts mata 0,005% botol @ 2,5 mL
749 Latanoprost tts mata 0,005% catchcover, botol @ 0,6 m
750 Leflunomid tab sal selaput 20 mg tablet salut selaput/kaplet
751 Lenograstim inj 263 mcg/vial Vial
752 Letrozol tab 2,5 mg tablet/kapsul/kaplet
753 Leuprorelin asetat serb inj 1,88 mg Vial
754 Leuprorelin asetat serb inj 11,25 mg Vial
755 Leuprorelin asetat serb inj 22,5 mg Vial
756 Leuprorelin asetat serb inj 3,75 mg ampul/vial
757 Leuprorelin asetat serb inj 7,5 mg Vial
758 Levetirasetam tab 250 mg Tablet
759 levetirasetam tab 500 mg Tablet
760 Levofloksasin inf 5 mg/ml vial / botol / flexy bag @1
761 Levofloksasin inf 5 mg/ml vial/ botol/ flexy bag @ 1
762 Levofloksasin tab 250 mg tablet/kapsul/kaplet
763 Levofloksasin tab 500 mg tablet salut selaput/kaplet
764 Levofloksasin tts mata 0,5% botol @ 5mL
765 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set
766 Levotiroksin tab 100 mcg tablet/kaplet/kapsul
767 Levotiroksin tab 50 mcg tablet/kaplet/kapsul
768 Lidokain gel 2% syringe/syringe plastik
769 Lidokain inj 100 mg, vial (i.v.) Vial
770 Lidokain inj 2% (infiltr/p.v.) ampul/vial
771 Lidokain salep 5% Tube
772 Lidokain spray oral 10% botol
773 Linestrenol tab 0,5 mg tablet/kapsul/kaplet
774 Linestrenol tablet 5 mg Tab
775 Liquor carbonis detergens lar 5% Botol
776 Lisinopril tab 10 mg tablet/kapsul/kaplet
777 Lisinopril tab 20 mg Tab
778 Lisinopril tab 5 mg tablet/kapsul/kaplet
779 Litium karbonat tab 200 mg tablet/kapsul/kaplet
780 Litium karbonat tab 400 mg tablet/kapsul/kaplet
781 Loperamid tab 2 mg Tab
782 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput
783 Loratadin tab 10 mg tablet/kapsul/kaplet
784 Lorazepam tab 0,5 mg tablet/kapsul/kaplet
785 Lorazepam tab 1 mg tablet/kapsul/kaplet
786 Lorazepam tab sal 2 mg Tab sal
787 Low molecule feri sucrose inj amp 100 mg/5 ml ampul/vial
788 MAA (macro agregate albumin) 0,11-2,5 mg albumin Vial
aggregated/reaction vial
789 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial Vial
790 Magnesium sulfat inj 20% ampul/vial @25 ml
791 Magnesium sulfat inj 20% ampul/vial
792 Magnesium sulfat inj 40% ampul/vial @25 ml
793 Magnesium sulfat inj 40% ampul/vial
794 Magnesium sulfat serb, ktg 30 g Sachet
795 Manitol lar infus 20% Botol @ 500 ml
796 Manitol lar infus 20% Botol @ 100 ml
797 Manitol lar infus 20% Botol @ 250 ml
798 Maprotilin hcl tab sal 25 mg Tab sal
799 Maprotilin hcl tab sal 50 mg tablet salut selaput/kaplet
800 MDP (methylene diphosphonate) 1 mg methylene diphosphonic Vial
acid/ml
801 Mebendazol sir 100 mg/5 ml Botol
802 Mebendazol tab 100 mg Tan
803 Mebendazol tab 500 mg tablet/kapsul/kaplet
804 Medroksi progesteron asetat inj 150 mg/ml ampul/vial
805 Medroksi Progesteron Asetat Inj 50 mg/ml ampul/vial
806 Medroksi progesteron asetat tab 10 mg tablet/kapsul/kaplet
807 Medroksi progesteron asetat tab 100 mg tablet/kapsul/kaplet
808 Medroksi progesteron asetat tab 5 mg Tab
809 Melfalan tab 2 mg tablet/kapsul/kaplet
810 Merkaptopurin tab 50 mg Tab
811 Meropenem serb inj 1000 mg/vial ampul/vial
812 Meropenem serb inj 500 mg/vial ampul/vial
813 Mesalazin enema 4 gram enema
814 Mesalazin tab sal 250 mg tablet salut enterik/kaplet
815 Mesna inj 100 mg/ml Vial
816 Metadon sir 50 mg/5 ml Botol 1000 ml
817 Metamizol Inj 500 mg/ml Ampul
818 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut

819 Metformin tab 500 mg tablet/kapsul/kaplet

820 Metformin tab 850 mg tablet/kapsul/kaplet
821 Metildopa tab sal 250 mg tablet/kapsul/kaplet
822 Metilergometrin inj 0,2 mg/ml ampul/vial
823 Metilergometrin tab salut 0,125 mg tablet/kaplet salut selapu
824 Metilfenidat tab 10 mg tablet/kapsul/kaplet
825 Metilfenidat tab lepas lambat 18 mg tablet/kapsul/kaplet
826 Metilfenidat tab lepas lambat 36 mg tablet/kapsul/kaplet
827 Metilprednisolon inj 125 mg/2 ml ampul/vial
828 Metilprednisolon inj 500 mg/8 ml ampul/vial
829 Metilprednisolon tab 16 mg tablet/kapsul/kaplet
830 Metilprednisolon tab 4 mg tablet/kapsul/kaplet
831 Metilprednisolon tab 8 mg tablet/kapsul/kaplet
832 Metoklopramid inj 5 mg/ml ampul/vial
833 Metoklopramid tab 10 mg tablet/kapsul/kaplet
834 Metoklopramid tab 5 mg tablet/kapsul/kaplet
835 Metoksi polietilen glikol-epoetin beta inj 50 mcg/0,3 ml ampul/vial
836 Metoksi polietilen glikol-epoetin beta inj 75 mcg/0,3 ml ampul/vial
837 Metoprolol tartat inj 1 mg/ml Ampul
838 Metotreksat Inj 10 mg/ml Vial
839 Metotreksat inj 2,5 mg/ml Vial
840 Metotreksat serb inj 25 mg/ml Vial
841 Metotreksat serb inj 5 mg/vial Vial
842 Metotreksat tab 2,5 mg Tab
843 Metronidazol lar inf 5 mg/ml botol
844 Metronidazol ovula 500 mg Ovula
845 Metronidazol sup 500 mg Suppositoria
846 Metronidazol susp 125 mg/5 ml Botol @ 100 ml
847 Metronidazol susp 125 mg/5 ml Botol @ 60 ml
848 Metronidazol tab 250 mg tablet/kapsul/kaplet
849 Metronidazol tab 500 mg tablet/kapsul/kaplet
850 MIBG (meta-iodobenzylguanidine) Vial
851 MIBI (metoxy iso butyl isonitril) 5-ml reaction vial Vial
852 Midazolam inj 1 mg/ml (i.v.) Vial
853 Midazolam inj 5 mg/ml (i.v.) Vial
854 Mikafungin Na serb inj 50 mg/vial Vial
855 Mikofenolat mofetil tab 500 mg tablet/kapsul/kaplet
856 Mikofenolat Sodium Tab Sal 180 mg tablet salut/kaplet salut
857 Mikofenolat Sodium Tab Sal 360 mg tablet salut/kaplet salut
858 Mikonazol krim 2% tube
859 Mikonazol serb 2% botol / sachet
860 Milrinone inj 1 mg/ml ampul/vial
861 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, Sachet
Magnesium Chloride Anhydrous, Potassium Chloride, Zinc Acetate)

862 Mitomisin serb inj 10 mg Vial

863 Mitomisin serb inj 2 mg Vial
864 Moksifloksasin inf 1,6 mg/mL vial/ampul/botol/softbag
865 Moksifloksasin tab 400 mg tablet salut selaput/kaplet
866 Moksifloksasin tts mata 0,5% Botol
867 Mometason furoat krim 0,1% tube 10 gram
868 Mometason furoat krim 0,1% Tube 5 gram
869 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) Vial
870 Morfin Hcl tab 10 mg tablet/kapsul/kaplet
871 Morfin Hcl tab SR 10 mg tablet lepas lambat/kaple
872 Morfin Hcl tab SR 15 mg tablet lepas lambat/kaple
873 Morfin Hcl tab SR 30 mg Tab
874 Mupirosin krim 2% tube
875 Mupirosin salep 2% tube
876 N-asetil sistein granula 200 mg Sachet
877 N-asetil sistein ih 100 mg/ml Botol
878 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet
879 NaCl 0,9% Larutan Botol @1.000 mL
880 NaCl 0,9% Larutan Botol @25 ml
881 NaCl 0,9% Larutan Botol @250 ml
882 NaCl 0,9% Larutan Botol @500 ml
883 NaCl 0,9% Larutan Botol @100 ml
884 NaCl 0,9% Larutan Ampul/botol @ 10 mL
885 NaCl 3% Larutan Botol plastik @500 ml
886 Nadroparin inj 9.500 Axa/ml syringe 0,3 Ml Vial
887 Nadroparin inj 9.500 Axa/ml, syringe 0,4 ml Vial
888 Nadroparin inj 9.500 Axa/ml, syringe 0,6 ml Vial
889 Nalokson inj 0,4 mg/ml Ampul
890 Natamisin tts mata 5% (50 mg/ml) catchcover, botol @ 0,6 m
891 Natamisin tts mata 5% (50 mg/ml) botol @ 15 mL
892 Natamisin tts mata 5% (50 mg/ml) Botol @5 ml
893 Natrium aminohipurat inj 200 mg/ml (i.v.) Ampul
894 Natrium bikarbonat inj 8,4% (i.v.) Vial
895 Natrium bikarbonat tab 500 mg tablet/kapsul/kaplet
896 Natrium diklofenak inj 25 mg/mL ampul/vial
897 Natrium diklofenak tab 25 mg tablet salut enterik/kaple
898 Natrium diklofenak tab 50 mg tablet salut enterik/kaple
899 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL
900 Natrium fluoresein tts mata 2% Botol
901 Natrium fosfat lar oral botol
902 Natrium fusidat krim 20 mg/g tube
903 Natrium fusidat salep 20 mg/g Tube
904 Natrium hialuronat tts mata botol
905 Natrium hipoklorit cairan konsentrat 5% Botol
906 Natrium klorida tts mata 50 mg/mL ampul/vial
907 Natrium tiosulfat inj 25% (i.v.) Ampul
908 Neostigmin inj 0,5 mg/ml Vial
909 Nevirapin tab 200 mg tablet/kapsul/kaplet
910 Nifedipin kaps 10 mg tablet/kapsul/kaplet
911 Nifedipin tab SR 20 mg tablet lepas lambat/kaple
912 Nifedipin tab SR 30 mg tablet lepas lambat/kaple
913 Nikardipin inj 10 mg/vial ampul/vial
914 Nilotinib kaps 150 mg tablet/kapsul/kaplet
915 Nilotinib tab 200 mg tablet/kapsul/kaplet
916 Nimodipin inf 0,2 mg/ml ampul/vial/botol
917 Nimodipin tab 30 mg tablet salut selaput/kaplet
918 Nistatin susp 100.000 UI/ml botol/vial
919 Nistatin tab salut 500.000 UI tablet salut gula/kaplet sa
920 Nistatin tab vaginal 100.000 UI tablet/kaplet
921 Nitrogen oksida ih, gas dlm tabung Botol
922 Nomegestrol asetat Kaps/tab 5 mg tablet/kapsul/kaplet
923 Norepinefrin inj 1 mg/ml ampul/vial
924 Noretisteron tab 5 mg tablet/kapsul/kaplet
925 Obat Anti Tuberculosis FDC Kategori Anak paket
926 Obat Anti Tuberculosis FDC Kategori I paket
927 Obat Anti Tuberculosis FDC Kategori II paket
928 Obat Anti Tuberculosis FDC Kategori Sisipan paket
929 Obat Anti Tuberculosis Kombipak Anak Paket
930 Obat Anti Tuberculosis Kombipak Dewasa paket
931 Ofloksasin tab 200 mg tablet salut selaput/ kaple
932 Ofloksasin tab 400 mg tablet salut selaput/ kaple
933 Ofloksasin tts telinga 3% Botol @ 5 mL
934 Oksaliplatin serb inj 100 mg/vial Vial
935 Oksaliplatin serb inj 50 mg/vial Vial
936 Oksigen ih, gas dlm tabung Botol
937 Oksikodon inj 10 mg/ml Ampul/vial @2 mL
938 Oksikodon inj 10 mg/ml Ampul/vial @1 mL
939 Oksikodon kapsul 10 mg Kaps
940 Oksikodon kapsul 20 mg Kaps
941 Oksikodon kapsul 5 mg tablet/kapsul/kaplet
942 Oksikodon larutan oral 5 mg/5 ml Botol
943 Oksikodon larutan oral concentrate 10 mg/ml Botol
944 Oksikodon tab lepas lambat 10 mg Tab
945 Oksikodon tab lepas lambat 15 mg Tab
946 Oksikodon tab lepas lambat 20 mg Tab
947 Oksimetazolin tts hidung 0,025% botol @ 10 mL
948 Oksimetazolin tts hidung 0,050% botol @ 10 mL
949 Oksitetrasiklin 1% Salep Mata tube
950 Oksitetrasiklin hcl inj 50 mg/ml (i.m.) Vial
951 Oksitosin inj 10 UI/ml ampul/vial
952 Okskarbazepin susp 60 mg/mL botol
953 Oktreotid asetat 0,05 - 6 mg/ml ampul/vial
954 Oktreotid LAR serb inj 20 mg Vial
955 Oktreotid LAR serb inj 30 mg vial
956 Olanzapin inj 10 mg/2 ml Ampul
957 Olanzapin tab sal 10 mg tablet salut selaput/ kaple
958 Olanzapin tab sal 5 mg tablet salut selaput/ kaple
959 Olodaterol cairan ih 2,5 mcg/semprot Botol
960 Olodaterol cairan ih 2,5 mcg/semprot, refill cartridge
961 Olopatadin tts mata 0,1% Botol
962 Omeprazol inj 40 mg/10 ml ampul/vial
963 Omeprazol kaps 20 mg tablet/kapsul/kaplet
964 Ondansetron inj 2 mg/ml ampul/vial
965 Ondansetron tab 4 mg tablet/kapsul/kaplet
966 Ondansetron tab 8 mg tablet/kapsul/kaplet
967 Paklitaksel inj 6 mg/ml, vial@16,7 ml (inj 100 mg) Vial
968 Paklitaksel inj 6 mg/ml, vial@5 ml (inj 30 mg) Vial
969 Paklitaksel inj 6 mg/ml, vial@50 ml (inj 300 mg) Vial
970 Paliperidon palmitat Inj 100 mg/mL Ampul
 971 Paliperidon palmitat Inj 150 mg/1,5 mL Ampul
972 Paliperidon palmitat Inj 75 mg/0,75 mL Ampul
973 Pankuronium inj 2 mg/ml Ampul
974 Paraformaldehid lar buffer 10% Botol
975 Paraformaldehid tab 1 g Tab
976 Parasetamol drips (infus) 1000 mg/100 ml vial/ flexybag/botol @ 10
977 Parasetamol sir 120 mg/5 ml botol @ 60 mL
978 Parasetamol tab 500 mg tablet/kapsul/kaplet
979 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL
980 Pasta devitalisasi (non arsen) Tube
981 Pasta pengisi saluran akar (pasta) Tube
982 Pazopanib tab sal selaput 200 mg tablet salut selaput/kaplet
983 Pazopanib tab sal selaput 400 mg tablet salut selaput/kaplet
984 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Vial
985 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Vial
986 Pegylated interferon alfa-2b serb inj 100 mcg/ml Vial
987 Pegylated interferon alfa-2b serb inj 50 mcg/ml Vial
988 Pegylated interferon alfa-2b serb inj 80 mcg/ml Vial
989 Pemetreksed serb inj 500 mg Vial
990 Pengganti plasma golongan gelatin inf Botol
991 Perak nitrat lar 20% Botol
992 Perak sulfadiazin krim 1% Tube
993 Perindoprilarginin tab 5 mg tablet/kapsul/kaplet
994 Permetrin krim 5 % Tube 10 g
995 Permetrin krim 5 % Tube 30 g
996 Permetrin krim 5 % Tube 15 g
997 Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial
998 Pilokarpin tts mata 2% Botol 5 ml
999 Pilokarpin tts mata 2% Catchcover, botol 0,6 ml
1000 Pioglitazon tab 15 mg tablet
1001 Pioglitazon tab 30 mg tablet/kapsul/kaplet
1002 Pirantel pamoat susp 125 mg/5 ml Botol
1003 Pirantel pamoat tab 500 mg Tab
1004 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet
1005 Pirantel pamoat tab scored 250 mg Tab
1006 Pirazinamid tab 500 mg tablet/kapsul/kaplet
1007 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
1008 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl
1009 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet
1010 Piridostigmin tab sal 60 mg tablet/kapsul/kaplet
1011 Pirimetamin tab 25 mg Tablet
1012 Podofilin tingtur 25 % Botol
1013 Polietilen glikol Botol
1014 Polikresulen Botol
1015 Povidon iodin lar 100 mg/ml Botol 300 ml
1016 Povidon iodin lar 100 mg/ml botol @ 1.000 mL
1017 Povidon iodin lar 100 mg/ml botol 30 mL
1018 Povidon iodin lar 100 mg/ml botol @ 60 mL
1019 Povidon iodin lar obat kumur 1% Botol
1020 Povidon iodin tts mata 2,5% botol/strip
1021 Pramipeksol tab 0,125 mg tablet/kapsul/kaplet
1022 Pramipeksol tab ER 0,375 mg tablet lepas lambat/kaple
1023 Pramipeksol tab ER 0,750 mg tablet lepas lambat/kaple
1024 Pravastatin tab 10 mg Tab
1025 Pravastatin tab 20 mg tablet/kapsul/kaplet
1026 Prazikuantel tab scored 600 mg Tab
1027 Prednisolon tts mata 10 mg/ml Botol @5mL
1028 Prednisolon tts mata 10 mg/ml catchcover, botol @ 0,6 m
1029 Prednison tab 5 mg tablet/kapsul/kaplet
1030 Pregabalin kaps 75 mg Kapsul
1031 Primakuin tab 15 mg Tab
1032 Probenesid tab 500 mg tablet/kapsul/kaplet
1033 Produk untuk Dialisis Peritoneal Paket
1034 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) ampul/vial
1035 Prokaterol HCl cairan ih 30 mcg Vial
1036 Prokaterol HCl cairan ih 50 mcg Botol
1037 Prokaterol HCl serb ih 10 mcg Botol
1038 Propiltiourasil tab 100 mg tablet/kapsul/kaplet
1039 Propofol inj 1% (i.v. Bolus) ampul/vial
1040 Propranolol inj 1 mg/ml (i.v.) Ampul
1041 Propranolol tab 10 mg tablet/kapsul/kaplet
1042 Propranolol tab 40 mg tablet/kapsul/kaplet
1043 Prostaglandin (PGE 1) Inj 500 mcg/ml Vial
1044 Protamin sulfat inj 10 mg/ml (i.m.) Ampul
1045 Quetiapin tab 100 mg tablet/kapsul/kaplet
1046 Quetiapin tab pelepasan lambat 150 mg tablet SR
1047 Quetiapin tab pelepasan lambat 200 mg tablet SR/kaplet SR
1048 Quetiapin tab pelepasan lambat 300 mg tab SR
1049 Quetiapin tab pelepasan lambat 400 mg tablet SR/kaplet SR
1050 Ramipril tab 10 mg tablet/kapsul/kaplet
1051 Ramipril tab 2,5 mg tablet/kapsul/kaplet
1052 Ramipril tab 5 mg tablet/kapsul/kaplet
1053 Ranibizumab inj 10 mg/ml Vial
1054 Ranitidin inj 25 mg/ml ampul/vial
1055 Ranitidin tab 150 mg tablet/kapsul/kaplet
1056 Remifentanil inj 1 mg ampul/vial
1057 Remifentanil inj 2 mg ampul/vial
1058 Remifentanil inj 5 mg ampul/vial
1059 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak
1060 Retinol (vitamin A) kaps lunak 200.000 UI kaps lunak
1061 Ribavirin tab 200 mg tab sal selaput
1062 Rifampisin kaps 300 mg tablet/kapsul/kaplet
1063 Rifampisin tab 450 mg tablet/kapsul/kaplet
1064 Rifampisin tab 600 mg tablet/kapsul/kaplet
1065 Rifapentin tablet 150 mg Tablet/kapsul/kaplet
1066 Rilpivirine 25 mg tablet
1067 Ringer Laktat Larutan Botol
1068 Ringer Laktat Larutan 1000 ml Botol
1069 Risedronat tab sal selaput 35 mg tablet salut selaput / kapl
1070 Risperidon oral solution 1 mg/mL botol
1071 Risperidon tab 3 mg tablet/kapsul/kaplet
1072 Risperidon tab sal 1 mg tablet/kapsul/kaplet
1073 Risperidon tab sal 2 mg tablet/kapsul/kaplet
1074 Rituksimab inf 10 mg/ml (vial 10 ml) Vial
1075 Rituksimab Inf 10 mg/ml (vial 50 ml) Vial
1076 Rituksimab inj 100 mg/ml Ampul
1077 Rituksimab inj 500 mg/ml Ampul
1078 Rivaroksaban tab sal 10 mg tablet salut/kaplet salut
1079 Rivaroksaban tab sal 15 mg tablet salut/kaplet salut
1080 Rivaroksaban tab sal 20 mg tablet salut/kaplet salut
1081 Rokuronium inj 50 mg/5 ml (i.v.) ampul/vial
1082 Ropinirol tab lepas lambat 2 mg tablet lepas lambat/kaple
1083 Ropinirol tab lepas lambat 4 mg tablet lepas lambat/kaple
1084 Ropinirol tab lepas lambat 8 mg tablet lepas lambat/kaple
1085 Ropivakain Inj 7,5 mg/ml ampul/polyamp/vial
1086 Rosuvastatin tab 10 mg tablet/kapsul/kaplet
1087 Sacubitril valsartan tab sal selaput 24,3/25,7 mg tablet salut selaput
1088 Sacubitril valsartan tab sal selaput 48,6/51,4 mg tablet salut selaput
1089 Sacubitril valsartan tab sal selaput 97,2/102,8 mg tablet salut selaput
1090 Salbutamol aerosol 100 mcg canister / botol
1091 Salbutamol cairan ih 1 mg/mL ampul/vial/botol
1092 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler Botol
1093 Salbutamol sir 2 mg/5 ml Botol
1094 Salbutamol tab 2 mg tablet/kapsul/kaplet
1095 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 15 gram

1096 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % pot 30 gram

1097 Secukinumab serb inj 150 mg Vial

1098 Sefadroksil kaps 250 mg tablet/kapsul/kaplet
1099 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet
1100 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL
1101 Sefadroksil sir kering 250 mg/5 ml botol @ 60 mL
1102 Sefaleksin kaps 500 mg tablet/kapsul/kaplet
1103 Sefazolin serb inj 1 g/vial ampul/vial
1104 Sefepim serb inj 1000 mg/vial ampul/vial
1105 Sefiksim sir 100 mg/5 ml botol
1106 Sefiksim tab 100 mg Tab
1107 Sefiksim Tab 200 mg Tablet
1108 Sefoperazon serb inj 1.000 mg/vial ampul/vial
1109 Sefotaksim inj 500 mg/vial ampul/vial
1110 Sefotaksim serb inj 1.000 mg/vial ampul/vial
1111 Sefpirom serb inj 1000 mg ampul/vial
1112 Sefpodoksim proksetil tab sal 100 mg Tab
1113 Seftazidim serb inj 1.000 mg/vial ampul/vial
1114 Seftriakson serb inj 1.000 mg/vial ampul/vial
1115 Sefuroksim serb inj 750 mg/vial ampul/vial
1116 Sefuroksim tab 250 mg tablet salut selaput/kaplet
1117 Sefuroksim tab sal 500 mg tablet salut selaput/kaplet
1118 Sertralin tab sal 50 mg tablet salut/kaplet salut
1119 Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) inj Vial
(i.m./i.v.)
1120 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial

1121 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial
1122 Serum antirabies inj 100 UI/ml Vial
1123 Serum antirabies inj 200 UI/ml Vial
1124 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial
1125 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
1126 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial
1127 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial
1128 Setirizin sir 5 mg/5 ml. botol @ 60 mL
1129 Setirizin tab 10 mg tablet/kapsul/kaplet
1130 Setuksimab inj 5 mg/ml Vial
1131 Sevelamer karbonat Tab 800 mg Tab
1132 Sevofluran cairan ih 250 ml botol
1133 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial
1134 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet
1135 Siklofosfamid serb inj 1000 mg/vial (i.v.) Vial
1136 Siklofosfamid serb inj 200 mg/vial (i.v.) Vial
1137 Siklofosfamid serb inj 500 mg/vial (i.v.) Vial
1138 Siklopentolat tetes mata 1% Botol
1139 Siklosporin inj 100 mg/ml Ampul
1140 Siklosporin inj 50 mg/ml Ampul
1141 Siklosporin kaps 100 mg kaps lunak
1142 Siklosporin kaps lunak 25 mg kaps lunak
1143 Siklosporin Kaps lunak 50 mg Kaps lunak
1144 Sildenafil sirup kering 10 mg/ml Botol
1145 Sildenafil Tab 20 mg Tab
1146 Silodosin tab 4 mg Tab
1147 Silostazol kaps SR 100 mg tablet/kapsul/kaplet
1148 Silostazol tab 100 mg Tab
1149 Simvastatin tab sal 10 mg tablet/kapsul/kaplet/table
1150 Simvastatin tab sal 20 mg tablet/kapsul/kaplet/table
1151 Simvastatin tab sal selaput 40 mg Tab sal
1152 Siprofloksasin inf 2 mg/ml vial/ botol 100 ml
1153 Siprofloksasin tab scored 500 mg tablet salut selaput/kaplet
1154 Sisplatin serb inj 10 mg Vial
1155 Sisplatin serb inj 50 mg Vial
1156 Sitagliptin tab sal selaput 100 mg tablet salut selaput/kaplet
1157 Sitarabin serb inj 100 mg ampul/vial @ 10 mL
1158 Sitarabin serb inj 100 mg ampul/vial @ 1 mL
1159 Sodium Glycerophosphate 216 mg Ampul/vial
1160 Sodium hialuronat Inj 10 mg/ml ampul/vial
1161 Sofosbuvir tab sal selaput 400 mg tablet salut selaput / kapl
1162 Solifenasin tab 10 mg tablet/kapsul/kaplet
1163 Solifenasin tab 5 mg tablet/kapsul/kaplet
1164 Somatostatin serb Inj 3000 mcg/mL Vial
1165 Soybean oil 200 g, ovolecithin 12 g, glycerol 22 g, Na hydroxide Softbag @ 250 ml

1166 Spiramisin tab 500 mg tablet salut selaput/kaplet

1167 Spironolakton tab 100 mg tablet/kapsul/kaplet
1168 Spironolakton tab 25 mg tablet/kapsul/kaplet
1169 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial

1170 Streptokinase serb inj 1,5 juta UI/vial Vial

1171 Streptomisin serb inj 1.000 mg/vial ampul/vial
1172 Sufentanil inj 5 mcg/ml (i.v.) Ampul
1173 Sugammadeks inj 100 mg/ml Vial
1174 Sukralfat susp 500 mg/5 ml botol
1175 Sukralfat tab 500 mg tablet/kapsul/kaplet
1176 Suksinilkolin inj 20 mg/ml (i.v./i.m.) Vial
1177 Suksinilkolin inj 50 mg/ml (i.v./i.m.) Vial
1178 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) Vial
1179 Sulfadiazin tab 500 mg tablet/kapsul/kaplet
1180 Sulfasalazin kapl sal enterik 500 mg tablet salut enterik/kaple
1181 Sulfur colloid 4,5 mg gelatin/reaction vial Vial
1182 Surfaktan susp 25 mg/ml (intratrakeal) Botol
1183 Surgical ginggival pack Tube
1184 Takrolimus kaps 0,5 mg tablet/kapsul/kaplet
1185 Takrolimus kaps 1 mg tablet/kapsul/kaplet
1186 Takrolimus kaps lepas lambat 0,5 mg kapsul lepas lambat
1187 Takrolimus kaps lepas lambat 1 mg kapsul lepas lambat
1188 Tamoksifen tab 10 mg Tablet
1189 Tamoksifen tab 20 mg Tab
1190 Tamsulosin tab 0,2 mg tablet/kapsul/kaplet
1191 Tamsulosin tab SR 0,4 mg tab lepas lambat / kaplet
1192 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 millicuries)/ml Set
1193 Telbivudin tab 600 mg tablet/kapsul/kaplet
1194 Telmisartan tab 40 mg tablet/kapsul/kaplet
1195 Telmisartan tab 80 mg tablet/kapsul/kaplet
1196 Temozolamid kaps 100 mg tablet/kapsul/kaplet
1197 Temozolamid kaps 20 mg tablet/kapsul/kaplet
1198 Tenofovir tab 300 mg tablet salut selaput/kaplet
1199 Teofilin tab 150 mg tablet/kapsul/kaplet
1200 Teofilin tab SR 300 mg tablet lepas lambat/kaple
1201 Terazosin hcl tab 1 mg tablet/kapsul/kaplet
1202 Terazosin hcl tab 2 mg tablet/kapsul/kaplet
1203 Terbinafin tab 250 mg tablet/kapsul/kaplet
1204 Terbutalin cairan ih 2,5 mg/ml Botol
1205 Terbutalin inj 0,5 mg/ml ampul/vial
1206 Terbutalin serb ih 0,50 mg/dose Vial
1207 Terbutalin sir 1,5 mg/5 ml botol
1208 Terbutalin tab 2,5 mg tablet/kapsul/kaplet
1209 Testosteron inj 250 mg/ml (vial 1 ml) Vial
1210 Testosteron Inj 250 mg/ml (vial 4 ml) Vial
1211 Testosteron kaps lunak 40 mg kapsul lunak
1212 Tetanus toxoid inj Ampul
1213 Tetrakain tts mata 0,5% Botol
1214 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet
1215 Tetrasiklin kaps 500 mg tablet/kapsul/kaplet
1216 Tetrasiklin Salep Mata 1% Tube
1217 Thallous Chloride Tl-202 1 mg methylene diphosphonic acid/ml Set

1218 Tiamazol tab 10 mg tablet salut selaput/kaple

1219 Tiamazol tab 5 mg tablet salut selaput/kaple
1220 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet
1221 Tikagrelor tab 90 mg tablet/kapsul/kaplet
1222 Timolol tts mata 0,25% botol @ 5 mL
1223 Timolol tts mata 0,5% botol @ 5 mL
1224 Tiopental serb inj 500 mg/amp (i.v. Bolus) Ampul
1225 Tiopental serb serb inj 1.000 mg/amp (i.v.) Ampul
1226 Tiotropium cairan ih 2,5 mcg/semprot, refill Cartridge
1227 Tiotropium respimat ih 5 mcg/semprot Botol
1228 Tiotropium respimat ih 5 mcg/semprot Handihaler
1229 Tobramisin tetes mata 0,3% Catchcover, botol 0,6 ml
1230 Tobramisin tetes mata 0,3% Botol @ 5 ml
1231 Topiramat tab 100 mg tablet/kapsul/kaplet
1232 Topiramat tab 25 mg tablet/kapsul/kaplet
1233 Topiramat tab 50 mg tablet/kapsul/kaplet
1234 Tosilizumab inf 400 mg/20 mL vial
1235 Tosilizumab inf 80 mg/4 mL vial
1236 Tramadol inj 50 mg/ml ampul/vial
1237 Trastuzumab serb inj 440 mg/vial ampul/vial
1238 Travoprost tts mata 0,004% Botol
1239 Triamsinolon asetonid nasal spray 55 mcg/puff Botol
1240 Triamsinolon inj 10 mg/ml Ampul
1241 Triamsinolon inj 40 mg/ml ampul/vial
1242 Trifluoperazin tab sal 5 mg tablet salut selaput/kaple
1243 Triheksifenidil tab 2 mg tablet/kapsul/kaplet
1244 Tropikamid tts mata 0,5% Botol @ 5 ml
1245 Tropikamid tts mata 0,5% Catchcover, botol 0,6 ml
1246 Tropikamid tts mata 1% Botol @ 5 ml
1247 Tropikamid tts mata 1% Botol @ 0,6 ml
1248 Tuberkulin protein purified derivative 1:10 (i.k) Ampul
1249 Urea krim 10 % Tube/pot
1250 Urea krim 20 % Tube/pot
1251 Vaksin BCG inj (i.k) Vial
1252 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial
1253 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) Vial
0,5 ml (i.m)
1254 Vaksin HPV (Human Papilloma Virus), vial 0,5 mL Ampul/vial
1255 Vaksin Influenza Vial
1256 Vaksin Japanese Enchepalitis (J.E) Vial
1257 Vaksin jerap difteri tetanus (DT) Vial
1258 Vaksin jerap difteri tetanus (Td) Vial
1259 Vaksin kombinasi DPT-HB-Hib Vial
1260 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial
1261 Vaksin Meningitis Meningokokus Vial
1262 Vaksin polio IPV inj 0,5 ml Vial
1263 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial
1264 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial
1265 Vaksin Yellow Fever Vial
1266 Valasiklovir tab 500 mg tablet/kapsul/kaplet
1267 Valgansiklovir tab sal 450 mg tablet salut/kaplet salut
1268 Valproat sir 250 mg/5 ml botol @ 120 ml
1269 Valproat tab lepas lambat 250 mg tabet lepas lambat/kaplet
1270 Valproat tab lepas lambat 500 mg tabet lepas lambat/kaplet
1271 Valproat tab sal enterik 250 mg tablet salut enterik/ kaple
1272 Valsartan tab 160 mg tablet/kapsul/kaplet
1273 Valsartan tab 80 mg tablet salut/kaplet salut
1274 Vankomisin serb inj 500 mg/vial Vial
1275 Vasopresin inj 20 UI/ml (i.m./s.k.) Vial
1276 Verapamil inj 2,5 mg/ml Vial
1277 Verapamil tab 240 mg tablet lepas lambat/kaple
1278 Verapamil tab 80 mg tablet/kapsul/kaplet
1279 Vildagliptin tab 50 mg Tab
1280 Vinblastin inj 1 mg/ml Ampul
1281 Vinkristin inj 1 mg/ml (vial 1 mL) Vial
1282 Vinkristin inj 1 mg/ml (vial 2 mL) Vial
1283 Vinorelbin inj 10 mg/ml, kemasan 1 ml Vial
1284 Vinorelbin inj 10 mg/ml, kemasan 5 ml Vial
1285 Vitamin B kompleks tablet
1286 Vitamin C 500 mg minimal non acidic 250 mg Tablet/kapsul/kaplet/tab s
1287 Vorikonazol inj 200 mg vial
1288 Vorikonazol tab sal selaput 200 mg tablet/kapsul/kaplet
1289 Warfarin tab 1 mg tablet/kapsul/kaplet
1290 Warfarin tab 2 mg tablet/kapsul/kaplet
1291 Zidovudin kaps 100 mg tablet/kapsul/kaplet
1292 Zinc drops 10 mg/ml Botol
1293 Zinc sir 20 mg/5 ml botol
1294 Zinc tab disp 20 mg tablet dispersible
1295 Zonisamid tab sal selaput 100 mg Tab sal selaput
 UNTUK DIADAKAN TAHUN 2022
ER BULAN DI SATKER SELAMA TAHUN 2021
TAMBAH PREDIKSI PENGADAAN TAHUN 2022 DIKURANGI (12 x PEMAKAIAN RATA-RATA PER BULAN TAHUN 2021)
MA 2021 DIKALI 15 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PU
ERDASARKAN METODE KONSUMSI DIKURANGI DENGAN PREDIKSI SISA STOK PER 31 DESEMBER 2022
N 2023 DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIA
KER TELAH MENGIRIMKAN PELAPORAN RKO TAHUN 2022
E-PURCHASING MAUPUN MANUAL SELAMA TAHUN 2023

UJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2023

SISA STOK PER 31 PREDIKSI PEMAKAIAN PREDIKSI SISA STOK 31 JUMLAH

DESEMBER 2021 PENGADAAN RATA-RATA PER DESEMBER 2022 KEBUTUHAN
TAHUN 2022 BULAN SELAMA TAHUN 2023
2021

(a) (b) (c) (d) = (a)+(b)-(12x(c)) (e) = (c) x 15

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0 0 0 0 0
0 0 0 0 0
N TAHUN 2021)
/ AMPUL / VIAL / TUBE / SACCHET / PUFF
BE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2022 BERDASARKAN
RENCANA RENCANA RENCANA
KEBUTUHAN PENGADAAN PENGADAAN
TAHUN 2023 TAHUN 2023 TAHUN 2022
(f) = (e) - (d) (g) (h)
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
8560 9000 10000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
REALISASI KETERANGAN
PENGADAAN
TAHUN 2021
(i) (j)
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
6000
0 0
0 0
200 0
0 0
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0 0 0 0
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0 0 450 0

0 0 5000 0

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0 0 10000 0

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0 0 1000 0

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