RKO - RS. Medika Lestari Tahun 2023

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 : RS. Medika Lestari
NO NAMA OBAT
1 153-Sm-EDTMP (ethylenediamine tetramethylene phosphonic acid) 44

mg Ca/Na EDTMP, 5-46 ?g samarium, dan 1850 ± 185 mbq samarium 153
per ml
2 Abacavir 300 mg
3 Adefovir dipivoksil tab 10 mg
4 Adenosin inj 3 mg/mL
5 Afatinib tab sal selaput 20 mg
8 Air untuk injeksi
9 Air untuk injeksi
10 Air untuk injeksi
11 Air untuk injeksi amp 20 ml
12 Air untuk injeksi amp 25 ml
13 Air untuk irigasi
14 Air untuk irigasi inf
15 Air untuk irigasi lar inf 1000 ml
16 Akarbose tab 100 mg
17 Akarbose tab 50 mg
18 Albendazol susp 200 mg/5 ml
19 Albendazol tab 400 mg
20 Albumin serum normal (human albumin) inj 20% 100 ml
27 Alendronat Tab 70 mg
28 Alopurinol tab 100 mg
29 Alopurinol tab 300 mg
30 Alprazolam tab 0,25 mg
31 Alprazolam tab 0,5 mg
32 Alprazolam tab 1 mg
33 Alteplase serb inj 50 mg/vial
34 Amfoterisin B inj 50 mg/10 ml (i.v.)
35 Amfoterisin B salep mata 1%
36 Amfoterisin B salep mata 3%
37 Amikasin inj 250 mg/ml
38 Aminofilin inj 24 mg/ml
39 Aminofilin tab 150 mg
40 Aminofilin Tab 200 mg
41 Amiodaron inj 150 mg/3 ml
42 Amiodaron tab 200 mg
43 Amitriptilin tab sal 25 mg
44 Amlodipin tab 10 mg
45 Amlodipin tab 5 mg
46 Amoksisilin drops 100 mg/ml
49 Amoksisilin sir forte 250 mg/5 ml
50 Amoksisilin sir kering 125 mg/5 ml
51 Amoksisilin tab 250 mg
52 Amoksisilin tab 500 mg
53 Ampisilin serb inj 1000 mg/vial
54 Ampisilin serb inj 250 mg/vial
55 Analog insulin : intermediate acting inj 100 UI/ml (kemasan vial, cartridge
disposible, penfill cartridge)
56 Analog insulin : mix insulin (inj 100 UI/ml)
57 Analog insulin intermediate acting combine with short or long acting inj
100 IU/ml (25% insulin lispro), vial/cartridge diposible/penfill cartridge
58 Analog insulin intermediate acting combine with short or long acting inj
100 IU/ml (50% insulin lispro), vial/cartridge diposible/penfill cartridge
59 Analog Insulin long acting inj 100 IU/mL, vial/cartridge disposible/penfill

cartridge
60 Analog insulin rapid acting inj 100 IU/mL
61 Analog insulin rapid acting inj 100 IU/mL
62 Analog Insulin: insulin basal inj 300 IU/mL
63 Anastrozol tab 1 mg
64 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 inj 2
ml
65 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium
hidroksida 200 mg
66 Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium
hidroksida 200 mg
67 Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg
68 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiksin B 10.000 UI/g
69 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3%

70 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5
mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g
71 Aquadest cairan 500 ml

72 Aripiprazol oral solution 1 mg/ml
73 Aripiprazol tab 5 mg
74 Aripiprazol tab discmelt 10 mg
75 Aripiprazol tab discmelt 15 mg
76 Artesunat serb inj 60 mg/ml (i.v./i.m.)
77 Articulating paper kertas warna penanda oklusi
78 Asam asetat tetes telinga 2%
79 Asam asetilsalisilat (asetosal) tab 100 mg
80 Asam asetilsalisilat (asetosal) tab 80 mg
81 Asam askorbat (vitamin C) tab 250 mg
82 Asam askorbat (vitamin C) tab 50 mg
83 Asam folat tab 0,4 mg
84 Asam folat tab 1 mg
85 Asam folat tab 5 mg
86 Asam Fusidat tts mata 1%
87 Asam fusidat tts mata 1%
88 Asam ibandronat inj 1 mg/ml
89 Asam mefenamat kaps 250 mg
90 Asam mefenamat kaps 500 mg
91 Asam pipemidat kaps 400 mg
92 Asam retinoat krim 0,05%
95 Asam salisilat lar 0,1%
96 Asam salisilat salep 10%
99 Asam traneksamat inj 100 mg/ml
100 Asam traneksamat inj 50 mg/ml
101 Asam traneksamat tab 500 mg
102 Asam ursodeoksikolat kaps 250 mg
103 Asam zoledronat inf 4 mg/100 ml
104 Asam Zoledronat Inf 5 mg/100 ml
105 Asetazolamid tab 250 mg
106 Asiklovir salep mata 3%
107 Asiklovir serb inj 250 mg
108 Asiklovir tab 200 mg
109 Asiklovir tab 400 mg
110 Asparaginase serb inj 10.000 UI/vial
111 Atapulgit 600 mg
112 Atapulgit tab 630 mg
113 Atapulgit tablet 650 mg
114 Atapulgit tablet 750 mg
115 Atenolol tab 100 mg
116 Atenolol tab 50 mg
117 Atorvastatin tab 10 mg
118 Atorvastatin tab 20 mg
119 Atrakurium inj 10 mg/ml (i.v)
120 Atrakurium inj 10 mg/ml (i.v)
121 Atropin inj 0,25 mg/ml (i.m./i.v./s.k)
122 Atropin tab 0,5 mg
123 Atropin tts mata 0,5%
124 Atropin tts mata 1%
125 Azatioprin tab 50 mg
126 Azitromisin serb inj 500 mg
127 Azitromisin sir kering 200 mg/5 ml
128 Azitromisin tab 250 mg
129 Azitromisin tab 500 mg
130 Bahan tumpatan sementara lar, serb
131 Barium sulfat serb 92 g/100 ml
132 Barium sulfat serb 92 g/100 ml
133 Barium sulfat susp 95%
134 Basiliksimab Inj 20 mg
135 Bedak salisil serb 2%
136 Bedakuilin fumarat tab 100 mg
137 Bendamustin serb inj 100 mg
138 Bendamustin serb inj 25 mg
139 Benzatin penisilin inj 1,2 juta UI/ml (i.m.)
140 Benzatin penisilin inj 2,4 juta UI/ml (i.m.)
141 Beraprost sodium tab 20 mcg
142 Betahistin tab 24 mg
143 Betahistin tab 6 mg
144 Betaksolol tts mata 0,5%
145 Betaksolol tts mata 0,5%
146 Betametason krim 0,1%
147 Betametason krim 0,5 mg/g
148 Betametason salep 0,1%
149 Betametason tts mata 1 mg/ml
150 Betametason tts mata 1 mg/ml
151 Bikalutamid tab sal 150 mg
152 Bikalutamid tab sal 50 mg
153 Bisakodil sup 10 mg
154 Bisakodil sup 5 mg
155 Bisakodil tab sal 5 mg
156 Bisoprolol tab 1,25 mg
157 Bisoprolol tab 10 mg
158 Bisoprolol tab 2,5 mg
159 Bisoprolol tab 5 mg
160 Bleomisin serb inj 15 mg/ml
161 Bortezomib serb inj 3,5 mg
162 Brinzolamid tetes mata
163 Bromokriptin tab 2,5 mg
164 Budesonid cairan ih 0,25mg/ml
165 Budesonid cairan ih 0,25mg/ml, respoules 2 ml
166 Budesonid cairan ih 0,5 mg/ml
167 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml
168 Budesonid serb ih 100 mcg/dosis
171 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 120
dosis
172 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 120
dosis
173 Budesonid-formoterol (fixed combination) 160/4,5 mg (inhalasi), 60 dosis
174 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg

175 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg
176 Bupivakain heavy inj 5 mg/ml (hcl) + glukosa 8%
177 Bupivakain inj 5 mg/ml (p.v.)
178 Busulfan tab salut 2 mg
179 Cardioplegia inj
180 Cisaprid tab 5 mg
181 Copper T
182 Dabigatran eteksilat kaps 110 mg
183 Dabigatran eteksilat kaps 75 mg
184 Dakarbazin serb inj 100 mg/vial
185 Dakarbazin serb inj 200 mg/vial
186 Daklatasvir tab sal selaput 30 mg
187 Daklatasvir tab sal selaput 60 mg
188 Daktinomisin inj 0,5 mg/vial (i.v.)
189 Dapson tab scored 100 mg
190 Daunorubisin serb inj 20 mg/vial
191 Deferasiroks tab disp 250 mg
192 Deferasiroks tab disp 500 mg
193 Deferasiroks tab sal selaput 180 mg
194 Deferasiroks tab sal selaput 360 mg
195 Deferipron lar oral 100 mg/ml
196 Deferipron tab sal 500 mg
197 Deferoksamin mesilat serb inj 500 mg/vial
198 Deksametason inj 5 mg/ml (i.v./i.m.)
199 Deksametason tab 0,5 mg
200 Deksmedetomidin Inj 100 mcg/ml
201 Delamanid tab 50 mg
202 Desfluran cairan ih
203 Desmopresin nasal spray 10 mcg/puff
204 Desmopresin tab 0,1 mg
205 Desmopresin tab 0,2 mg
206 Desogestrel tab 75 mcg
207 Desoksimetason gel 0,05%
208 Desoksimetason krim 0,25%
209 Desoksimetason krim 0,25%
210 Desoksimetason salep 0,25%
211 Dialisis peritoneal, larutan intraperitoneal - Extraneal
212 Diazepam enema 10 mg/2,5 ml
213 Diazepam enema 5 mg/2,5 ml
214 Diazepam inj 5 mg/ml (i.v./i.m.)
215 Diazepam tab 2 mg
216 Diazepam tab 5 mg
217 Dienogest tab 2 mg
218 Dietilkarbamazin tab 100 mg
219 Difenhidramin inj 10 mg/ml (i.v./i.m.)
220 Diflukortolon valerat salep berlemak 0,1%
221 Digoksin inj 0,25 mg/ml
222 Digoksin tab 0,25 mg
223 Diltiazem hcl inj 5 mg/5 ml
224 Diltiazem inj 25 mg/5 ml
225 Diltiazem kaps SR 100 mg
226 Diltiazem kaps SR 200 mg
227 Diltiazem serb inj 10 mg/10 ml
228 Diltiazem serb inj 50 mg/vial
229 Diltiazem tab 30 mg
230 Dimenhidrinat tab 50 mg
231 Dinatrium edetat tts mata 0,35% (3,5 mg/ml)
232 Dinatrium klodronat inj 60 mg/ml
233 DMSA (dimercapto succinic acid) 1,1 mg meso-2, 3-dimercaptosuccinic
acid/vial
234 Dobutamin inj 12,5 mg/ml
235 Dobutamin inj 25 mg/ml
236 Dobutamin inj 50 mg/ml
237 Doksazosin tab 1 mg
238 Doksazosin tab 2 mg
239 Doksisiklin kaps 100 mg
240 Doksisiklin kaps 50 mg
241 Doksorubisin serb inj 10 mg/vial (i.v.)
242 Doksorubisin serb inj 50 mg/vial
243 Dolutegravir tab 50 mg
244 Domperidon susp 5 mg/5 ml
245 Domperidon tab 10 mg
246 Domperidon tts 5 mg/ml
247 Donepezil tab 5 mg
248 Donepezil tab eff 10 mg
249 Dopamin inj 40 mg/ml
250 Dosetaksel inj 20 mg
251 Dosetaksel inj 40 mg/ml (vial 0,5 ml)
252 Dosetaksel inj 40 mg/ml (vial 2 ml)
253 Dosetaksel inj 80 mg
254 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg pentetate
calcium trisodium/ml
255 Dutasterid kaps 0,5 mg
256 Efavirenz tab 200 mg
257 Efavirenz tab sal 600 mg
258 Efedrin inj 50 mg/ml
259 Eksemestan tab 25 mg
260 Eltrombopag tab sal selaput 25 mg
261 Eltrombopag tab sal selaput 50 mg
262 Enoksaparin sodium inj 20 mg/0,2 ml
265 Entekavir tab sal selaput 0,5 mg
266 Entekavir tab sal selaput 1 mg
267 Epinefrin (adrenalin) inj 1 mg/ml
268 Epirubisin serb inj 2 mg/ml, vial 25 ml
269 Epirubisin serb inj 2 mg/ml, vial 5 ml
270 Epirubisin serb inj 50 mg
271 Ergokalsiferol (vitamin D2) kaps 50.000 UI
272 Ergokalsiferol (vitamin D2) susp 10.000 UI/ml
273 Ergotamin tab 1 mg
274 Eribulin inj 0,44 mg/ml
275 Eritromisin kaps 250 mg
276 Eritromisin sir 200 mg/5 ml
277 Eritromisin tab 500 mg
278 Eritropoetin-alfa inj 10.000 IU
282 Eritropoetin-beta inj 2000 UI/0,3 ml
283 Eritropoietin-alfa inj 40.000 IU
284 Eritropoietin-Alfa Inj 4000 IU/0,5 ml
285 Erlotinib tab sal selaput 100 mg
286 Erlotinib tab sal selaput 150 mg
287 Esomeprazole inj 40 mg/vial
288 Estrogen terkonjugasi tab sal 0,625 mg
289 Etambutol tab 400 mg
290 Etanercept inj 50 mg/ml
291 Etanol 70% cairan 70%
292 Etil klorida semprot 100 ml
293 Etonogestrel implan 68 mg
294 Etoposid inj 20 mg/ml
295 Eugenol
296 Everolimus tab 0,25 mg
299 Faktor IX Kompleks Inj 50 IU/mL
300 Faktor IX kompleks serb inj 1.000 UI/vial + pelarut 10 ml
301 Faktor IX kompleks serb inj 500 UI/vial + pelarut
302 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi
IX 25 UI, faktor koagulasi X 14-35 serb inj 250 IU/10 ml
303 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI, faktor koagulasi
IX 25 UI, faktor koagulasi X 14-35 serb inj 500 UI/20 ml UI
304 Faktor viia (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi
305 Faktor VIII (konsentrat) serb inj 230 -340 UI

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

390 Glass ionomer ART (Atraumatic Restorative Treatment) serb
391 Glibenklamid tab 2,5 mg
392 Glibenklamid tab 5 mg
393 Gliklazid tab 80 mg
394 Gliklazid tab MR 30 mg
395 Gliklazid tab SR 60 mg
396 Glikopironium serb ih 50 mcg
397 Glikuidon tab 30 mg
398 Glimepirid tab 1 mg
402 Glipizid tab 10 mg
403 Glipizid tab 5 mg
404 Gliseril trinitrat inj 5 mg/ml
405 Gliseril trinitrat kaps lepas lambat 2,5 mg
406 Gliseril trinitrat kaps lepas lambat 5 mg
407 Gliseril trinitrat tab 0,5 mg
408 Gliserin lar 50%
409 Gliserin tts 100 mg/ml
410 Glukosa Larutan Infus 10% steril 100 ml
413 Glukosa Larutan Infus 40%
417 Goserelin asetat inj 10,8 mg/vial
418 Goserelin asetat inj 3,6 mg/vial
419 Griseofulvin (micronized) tab 125 mg
420 Griseofulvin (micronized) tab 500 mg
421 Griseofulvin (micronized) tab scored 250 mg
422 Gutta percha dan paper points 15 - 40 mm
423 Gutta percha dan paper points 45 - 80 mm
424 Haloperidol inj 5 mg/ml (i.m.)
425 Haloperidol inj 50 mg/ml (decanoat)
426 Haloperidol tab 0,5 mg
427 Haloperidol tab 1,5 mg
428 Haloperidol tab 2 mg
429 Haloperidol tab 5 mg
430 Haloperidol tts 2 mg/ml
431 Halotan ih
432 Hemodialisa lar
433 Heparin, Na inj 5.000 UI/ml (i.v./s.k.)
434 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml
435 Hepatitis B imunoglobulin (human) Inj 220 IU/ml
436 Hidrogen peroksida cairan 3%
437 Hidroklorotiazid tab 12,5 mg
438 Hidroklorotiazid tab 25 mg
439 Hidrokortison krim 1%
440 Hidrokortison krim 2,5%
441 Hidrokortison serb inj 100 mg
442 Hidrokortison Tab 20 mg
443 Hidroksi klorokuin tab 200 mg
444 Hidroksi urea tab 500 mg
445 Hiosina butilbromida inj 20 mg/ml
446 Hiosina butilbromida tab 10 mg
447 Homatropin tts mata 2%
448 Human insulin : mix insulin inj 100 UI/ml
449 Human insulin : mix insulin inj 100 UI/ml
450 Human Insulin intermediate acting combine with short or long acting inj
100 IU/mL, cartridge disposible/penfill cartridge
451 Human insulin intermediate acting combine with short or long acting inj
100 IU/mL, Vial 10 mL
452 Human Insulin intermediate acting inj 100 IU/ml, cartridge
disposible/penfill cartridge
453 Human Insulin intermediate acting inj 100 IU/Ml, Vial 10 mL
454 Human Insulin intermediate acting inj 100 IU/mL, Vial 5 mL
455 Human insulin short acting inj 100 IU/ml
456 Human insulin short acting inj 100 IU/ml
457 Human tetanus imunoglobulin inj 250 UI (i.m.)
458 Human tetanus imunoglobulin inj 500 UI (i.m.)
459 Hydromorphone HCl tab oros 16 mg
460 Hydromorphone HCl tab oros 8 mg
461 Ibuprofen Inj 100 mg/ml
462 Ibuprofen sir 100 mg/5 ml
463 Ibuprofen sir 200 mg/5 ml
464 Ibuprofen tab 200 mg
465 Ibuprofen tab 400 mg
466 Idarubisin serb inj 20 mg
467 Ifosfamid serb inj 1000 mg/vial
470 Iloprost ih 10 mcg/mL
471 Imatinib mesilat tab 100 mg
472 Imatinib Mesilat tab 400 mg
473 Imidafenasin tab sal selaput 0,1 mg
474 Imidapril tab 10 mg
475 Imidapril tab 5 mg
476 Imunoglobulin Intravena Inj 50 mg/ml, untuk terapi GBS (Guillain Bare
Syndrom)
477 Indakaterol serb ih 150 mcg
478 Indakaterol serb ih 300 mcg
479 Iodiksanol vial 320 mg Iodium/100 ml
480 Iodiksanol vial 320 mg Iodium/50 ml
481 Iodium 131
482 Iodohippurate sodium I 131 37-74 mbq/ multiple-dose
483 Ioheksol 180 - 300 mg Iodium/mL (300 mg/20 mL)
484 Ioheksol 240-350 mg Iodium/ml (300 mg/75 ml)
485 Ioheksol 240-350 mg Iodium/ml (350 mg/75 ml)
486 Ioheksol Inj 140 - 350 mg Iodium/mL (350 mg/100 ml)
490 Iopamidol 300 - 370 mg Iodium/mL (300 mg/100 mL)
495 Iopromid 300 - 370 mg (300 mg/100 mL)
496 Iopromid 300 - 370 mg (300 mg/50 mL)
497 Iopromid 300 - 370 mg (370 mg/100 mL)
498 Iopromid 300 - 370 mg (370 mg/50 mL)
499 Ipratropium bromida aerosol 20 mcg/semprot
500 Ipratropium bromida cairan ih 0,025%
501 Irbesartan tab 150 mg
502 Irbesartan tab 300 mg
503 Irinotekan inf 20 mg/ml
504 Irinotekan inf 20 mg/ml
505 Irinotekan inj 20 mg/ml
506 Irinotekan inj 20 mg/ml
507 Isofluran inhalasi 100 ml
508 Isofluran inhalasi 250 ml
509 Isoniazid tab 100 mg
510 Isoniazid tab 300 mg
511 Isosorbid dinitrat inj 1 mg/ml (i.v)
512 Isosorbid dinitrat tab 10 mg
513 Isosorbid dinitrat tab 5 mg
514 Itrakonazol Kaps 100 mg
515 IUD Cu T 380 A
516 IUD Levonorgestrel
517 Ivabradin tab 5 mg
518 k.y jelly
519 Kalamin
520 Kalium aspartat tab 300 mg
521 Kalium klorida / Potasium klorida injeksi 25 mg 7,46%, 25 mL
522 Kalium klorida tab SR 600 mg
523 Kalsitriol kaps lunak 0,25 mcg
524 Kalsitriol kaps lunak 0,5 mcg
525 Kalsium Folinat (Leukovorin, Ca) Inj 10 mg/ml
526 Kalsium folinat (leukovorin, Ca) tab 15 mg
527 Kalsium glukonat inj 100 mg/ml
528 Kalsium hidroksida bubuk, pasta
529 Kalsium hipoklorit
530 Kalsium karbonat tab 500 mg
531 Kalsium laktat (kalk) tab 500 mg
532 Kalsium polistirena sulfonat ktg 5 g
533 Kandesartan tab 16 mg
534 Kandesartan tab 8 mg
535 Kapesitabin tab sal 500 mg
536 Kaptopril tab 12,5 mg
537 Kaptopril tab 25 mg
538 Kaptopril tab 50 mg
539 Karbamazepin sir 100 mg/5 ml
540 Karbamazepin Tab 200 mg
541 Karbimazol tab 5 mg
542 Karbogliserin tts telinga 10 %
543 Karboksimetilselulosa tts mata
544 Karboplatin Inj 10 mg (vial 45 ml)
545 Karboplatin inj 10 mg/ml (vial 15 ml
546 Karvedilol kaps 6,25 mg
547 Karvedilol tab 25 mg
548 Ketamin inj 100 mg/ml (i.v.)
549 Ketamin inj 50 mg/ml (i.v.)
550 Ketokonazol krim 2%
551 Ketokonazol scalp sol 2%
552 Ketokonazol tab 200 mg
553 Ketoprofen Inj 25 mg/ml
554 Ketoprofen sup 100 mg
555 Ketorolak inj 30 mg/ml
556 Klaritromisin sir kering 125 mg/5 ml
557 Klaritromisin sir kering 250 mg/5 ml
558 Klaritromisin tab 500 mg
559 Klindamisin kaps 150 mg
560 Klindamisin kaps 300 mg
561 Klobazam tab 10 mg
562 Klobetasol propionat krim 0,05%
563 Klobetasol propionat salep 0,05%
564 Klofazimin, micronized kaps 50 mg
565 Klofazimin, micronizedkaps 100 mg
566 Klomipramin tab 25
567 Klonazepam kaps 2 mg
568 Klonidin inj 150 mcg/ml
569 Klonidin tab 0,15 mg
570 Klopidogrel tab 75 mg
571 Klopidogrel tab sal selaput 300 mg
572 Kloral hidrat lar
573 Klorambusil tab sal selaput 5 mg
574 Kloramfenikol kaps 250 mg
575 Kloramfenikol kaps 500 mg
576 Kloramfenikol salep mata 1%
577 Kloramfenikol serb inj 1.000 mg/ml
578 Kloramfenikol susp 125 mg/5 ml
579 Kloramfenikol tetes telinga 3%
580 Kloramfenikol tts mata 0,5%
581 Kloramfenikol tts mata 1%
582 Klorfeniramin tab 4 mg
583 Klorfenol kamfer mentol (CHKM)
584 Klorheksidin lar 0,2%
585 Klorheksidin lar 15%
586 Klorokuin tab 250 mg
587 Klorpromazin inj 25 mg/ml (i.m.)
588 Klorpromazin inj 5 mg/ml (i.m.)
589 Klorpromazin tab sal 100 mg
590 Klorpromazin tab sal 25 mg
591 Klortalidon tab 50 mg
592 Klotrimazol tab vagina 100 mg
593 Klozapin tab 100 mg
594 Klozapin tab 25 mg
595 Kodein tab 10 mg
598 Kolestiramin serb, 4 g
599 Kolkisin tab 500 mcg
600 Komb: Deksametason 0,1% Thymol 5% Paraklorphenol 30
601 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab sal
selaput
602 Kombinasi : (Ampisilin 1000 mg + Sulbaktam 500 mg) serb inj 1500 mg
603 Kombinasi : (Sefoperazon 500 mg + Sulbaktam 500 mg) serb inj 1000 mg
604 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg + Nevirapin 50 mg) Ped

Triple FDC
605 Kombinasi : Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg
606 Kombinasi : artemether 20 mg + lumefantrin 120 mg
607 kombinasi : benserazid 25 mg + levodopa 100 mg
608 Kombinasi : Brinzolamid 1% + Timolol 0,5%, tts mata
609 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg
610 Kombinasi : ergotamin 1 mg+ kafein 50 mg
611 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut
612 Kombinasi : Indakaterol 110 mcg + Glycopyrronium 50 mcg serb ih + alat
breezhaler
613 Kombinasi : Ipratropium bromida 0,02 mg + fenoterol HBr 0,05 mg
aerosol
614 Kombinasi : levodopa 100 mg+Karbidopa 25 mg + entekapon 200 mg
615 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg

616 Kombinasi : medroksi progesteron asetat+ estradiol sipionat inj depot 25
mg + 5 mg
617 Kombinasi : Meglumin amidotrizoat + Sodium amidotrizoat inj 76%
618 Kombinasi : Sefiksim 400 mg + Azitromisin 1000 mg

619 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg
620 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 mg
621 Kombinasi : Travoprost 0,004% + Timolol 0,5%, tts mata

622 Kombinasi : triamsinolon + dementilklortetrasiklin
623 Kombinasi : zidovudin 300 mg +lamivudin 150 mg
624 Kombinasi KDT/FDC mengandung: (medroksi progesteron asetat 120 mg
+ estradiol sipionat 10 mg) inj
625 Kombinasi KDT/FDC mengandung: (salmeterol 50 mcg + flutikason
propionat 250 mcg) serb ih
626 Kombinasi KDT/FDC mengandung: (salmeterol 50 mcg + flutikason
propionat 500 mcg) serb ih
627 Kombinasi KDT/FDC mengandung: (tiotropium 2,5 mcg + olodaterol 2,5
mcg) cairan ih
628 Kombinasi KDT/FDC mengandung: (tiotropium 2,5 mcg + olodaterol 2,5
mcg) cairan ih, refill
629 Kombinasi KDT/FDC, setiap mL mengandung: latanoprost 0,05 mg +
timolol 5 mg tetes mata
630 Kombinasi KDT/FDC, setiap mL mengandung: latanoprost 0,05 mg +
timolol 5 mg tetes mata
631 Kombinasi, setiap ml mengandung: natrium klorida 4,40 mg + kalium
klorida 0,80 mg (tetes mata)
634 Kombinasi: Amoksisilin 1.000 mg + Asam klavulanat 200 mg, Inj 1.200 mg
635 Kombinasi: Elbasvir 50 mg dan Grazoprevir 100 mg tablet salut selaput
636 Kombinasi: Ipratropium bromida 0,5 mg + Salbutamol 2,5 mg, cairan ih
637 Kombinasi: kaolin 550 mg + pektin 20 mg

638 Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 mg, tab 250 mg
639 Kombinasi: parafin + gliserin + fenolftalein
640 Kombinasi: salmeterol 25 mcg + flutikason propionat 50 mcg ih 50
mcg/puff
mcg/puff
mcg/puff
643 Kombinasi: salmeterol 50 mcg+ flutikason propionat 250 mcg ih 250
mcg/puff
644 Kombinasi: Tenofovir 300 mg + Lamivudin 300 mg + Dolutegravir 50 mg,
tablet
645 Komibinasi: lidokain + medisinal creosote phenol + eugenol + benzil
alkohol, cairan
646 Komposit resin
647 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+
trimetoprim 80 mg
648 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 800 mg+
trimetoprim 160 mg
649 Kotrimoksazol kombinasi tiap 5 ml suspensi : sulfametoksazol 200 mg +
trimetoprim 40 mg
650 Kuinin inj 25% (i.v.)
651 Kuinin tab 200 mg
652 Laktulosa sir 3,335 g/5 ml
653 Lamivudin (3TC) tab 150 mg
654 Lamivudin tab 100 mg
655 Lamotrigin Tab 100 mg
656 Lamotrigin tab 50 mg
657 Lamotrigin tab dispersible 25 mg
658 Lansoprazol inj 30 mg/ml
659 Lansoprazol kaps 30 mg
660 Lapatinib tab 250 mg
661 Larutan mengandung Asam Amino (Asam Amino 10%)
662 Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g,
Na+ 2 mEq, Asetat 120 mEq)
663 Larutan mengandung Asam Amino (Asam Amino 15 g, Glukosa 37,5 g,
Tiamin HCl 0,75 mg, elektrolit)
664 Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl-52
mEq)
665 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan
elektrolit) 1000 ml
666 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan
elektrolit) 500 ml
667 Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 75 g,
Tiamin HCl 1,5 mg, elektrolit)
668 Larutan mengandung Asam Amino (Asam Amino 5% dengan BCAA 45%, L-
Ornithine L Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol 50 gr/L)
669 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung

Taurine 0,24 gr/l) : Aminosteril Infant 6%
670 Larutan mengandung Asam Amino (Asam Amino 7% (total protein 17,5 g)
dengan kandungan asam amino esensial (EAA) dan non esensial (NEAA)
yang seimbang EAA : NEAA = 60 : 40))
671 Larutan mengandung Asam Amino (Asam Amino 72.05 g, Total N 11.53 g,
AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 mEq)
672 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g,
Na+ 14 mEq, Cl 94 mEq)
673 Larutan mengandung Asam Amino (Asam amino 8%) : Aminosteril N-
Hepa
674 Larutan mengandung Asam Amino (Asam Amino 9%, Komposisi: Asam
Amino esensial: Asam Amino non esensial = 60 : 40)
675 Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10
g/L)
676 Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Aspartate
10 gr/L, Xylitol 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12 gr/L)
677 Larutan mengandung Asam Amino (Glutamine 20 g)

678 Larutan mengandung Asam Amino (Kombinasi : asam amino, glukosa, dan
lipid) (Lipid Peri 1250)
679 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi lemak,
dan asam amino) (Lipid Special 1250)
680 Larutan mengandung Asam Amino (Kombinasi : glukosa, emulsi lemak,
dan asam amino) (Lipid Special 625)
681 Larutan mengandung asam amino (kombinasi AA 50 g/L, sorbitol 50 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)
682 Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L,

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

(Glukosa 103 g, Asam amino 46 g, Elektrolit, Lipid 41 g dengan Fish Oil 6,1
g)

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

(Glukosa 63 g, Asam amino 25 g, Elektrolit, Lipid 19 g dengan Fish Oil 2,8
g)
690 Larutan Mengandung Asam amino + Elektrolit + Karbohidrat + Lipid
(Kombinasi Asam amino 56,9 g, Lipid 40 g, Glukosa 110 g dan Elektrolit)
691 Larutan mengandung Asam Amino + Elektrolit + Karbohidrat + Lipid

(Kombinasi Asam Amino: 34gr, Glukosa: 97gr, Lipid: 51gr dan Elektrolit
(Kalori = 1000 kkal, Akses peripheral))
692 Larutan mengandung asam amino + Karbohidrat + Lipid (Glukosa 63 g,

Asam amino 25 g, Lipid 19 g dengan Fish Oil 2,8 g)
693 Larutan mengandung elektrolit (CaCl2H2O 0,165 gr, KCl 0,15 gr, NaCl 4,3
gr)
694 Larutan mengandung Elektrolit (Kalium Klorida)
695 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) (KN1)
696 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2)
697 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3
mEq, Asetat 28 mEq) Ringer Asetat
698 Larutan mengandung Elektrolit (Na 130 mEq, K 4 mEq, Cl 109 mEq, Ca 3
mEq, Asetat 28 mEq) Ringer Asetat
699 Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L,
Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)
700 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung 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)
701 Larutan Mengandung Fosfat Anorganik (NaH2PO4/KH2PO4)

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

sodium chloride, 0.15 g potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)
711 Larutan mengandung Karbohidrat + Elektrolit (27.500 g dextrose
monohydrate, 3.00 g sodium chloride, 0.15 g potassium chloride, 0.10 g
calcium chloride dihydrate dan 1.900 g sodium acetate trihydrate)
712 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg,
Sorbitol 50 gr/L)
713 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L,
Glukosa 100 gr/L, elektrolit)
714 Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L,
Glukosa 75 gr/L, elektrolit)
715 Larutan mengandung karbohidrat + elektrolit (Dextran 40 50 gr,
CaCl2H2O 0,1 gr, KCl 0,15 gr, NaCl 3 gr, Na lactate 1,55 gr)
716 Larutan mengandung Karbohidrat + Elektrolit (Dextrose 5%, NaCL 0,45%,
KCl) (HSD)
717 Larutan mengandung Karbohidrat + Elektrolit (Fructose 120 g, glucose 66
g, Xylitol 60 g/ L + elektrolit)
718 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl 2,0 g,
KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
719 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium
Chloride 9 g, air untuk injeksi ad 1000 ml) (D5-NS)
720 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 110.0 g; NaCl:
1.80 g) (D10-1/5NS)
721 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5
g)
722 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25
g) (D5-1/4NS)
g) (D5-1/4NS)
g) (D5-1/2NS)
725 Larutan mengandung karbohidrat + elektrolit (Kombinasi NaCl 18,6 g, KCl
0,3 g, CaCl2 0,48 g, dextrose 50 g per 1000 ml)
726 Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi kombinasi
infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ,
Asetat 38mEQ, Sorbitol 50g)
727 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa

5%)
728 Larutan mengandung Karbohidrat + Elektrolit (NaCl 0.585 gr, KCl 0.3 gr,
Na Lactat 0.56 gr, Dekstrosa 18,75 gr) (KA EN 4B)
729 Larutan mengandung Karbohidrat + Elektrolit (NaCl 0.585 gr, Na Lactat
0.56 gr, anhydrous dekstrosa 20 gr) (KA EN 4A)
730 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.125 gr, Dekstrosa
18.75 gr) (KA EN 1B)
731 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g,
Glukosa 100 gr)
732 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Na
Lactate 2.24 g, Glukosa 100 gr)
733 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na
Lactat 2.24 gr, Dekstrosa 27 gr) (KA EN 3B)
734 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat
2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) (KA EN 3A)
735 Larutan mengandung Lipid (Emulsi lemak 20%)
736 Larutan mengandung Lipid (Highly refined fish oil, Glyserol dan purified
egg phospolipid)
737 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 100 ml)
738 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 250 ml)
739 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr +

Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)
Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)
742 Larutan Mengandung Vitamin yang larut dalam lemak (Vitamin A,D,E,K)
743 Larutan Mengandung Vitamin yang larut dalam lemak (Vitamin A,D,E,K)
infant
744 Latanoprost tts mata 0,005%
745 Latanoprost tts mata 0,005%
746 Leflunomid tab sal selaput 20 mg
747 Lenograstim inj 263 mcg/vial
748 Letrozol tab 2,5 mg
749 Leuprorelin asetat serb inj 1,88 mg
754 Levetirasetam tab 250 mg
755 levetirasetam tab 500 mg
756 Levofloksasin inf 5 mg/ml
757 Levofloksasin inf 5 mg/ml
758 Levofloksasin tab 250 mg
759 Levofloksasin tab 500 mg
760 Levofloksasin tts mata 0,5%
761 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun)
762 Levotiroksin tab 100 mcg
763 Levotiroksin tab 50 mcg
764 Lidokain gel 2%
765 Lidokain inj 100 mg, vial (i.v.)
766 Lidokain inj 2% (infiltr/p.v.)
767 Lidokain salep 5%
768 Lidokain spray oral 10%
769 Linestrenol tab 0,5 mg
770 Linestrenol tablet 5 mg
771 Liquor carbonis detergens lar 5%
772 Lisinopril tab 10 mg
775 Litium karbonat tab 200 mg
776 Litium karbonat tab 400 mg
777 Loperamid tab 2 mg
778 Lopinavir 100 mg + Ritonavir 25 mg
779 Loratadin tab 10 mg
780 Lorazepam tab 0,5 mg
781 Lorazepam tab 1 mg
782 Lorazepam tab sal 2 mg
783 Low molecule feri sucrose inj amp 100 mg/5 ml
784 MAA (macro agregate albumin) 0,11-2,5 mg albumin aggregated/reaction
vial
785 MAG3 (mercapto acetyl tri glysine) 1 mg betiatide/vial
786 Magnesium sulfat inj 20%
790 Magnesium sulfat serb, ktg 30 g
791 Manitol lar infus 20%
794 Maprotilin hcl tab sal 25 mg
795 Maprotilin hcl tab sal 50 mg
796 MDP (methylene diphosphonate) 1 mg methylene diphosphonic acid/ml
797 Mebendazol sir 100 mg/5 ml

798 Mebendazol tab 100 mg
799 Mebendazol tab 500 mg
800 Medroksi progesteron asetat inj 150 mg/ml
801 Medroksi Progesteron Asetat Inj 50 mg/ml
802 Medroksi progesteron asetat tab 10 mg
805 Melfalan tab 2 mg
806 Merkaptopurin tab 50 mg
807 Meropenem serb inj 1000 mg/vial
808 Meropenem serb inj 500 mg/vial
809 Mesalazin enema 4 gram
810 Mesalazin tab sal 250 mg
811 Mesna inj 100 mg/ml
812 Metadon sir 50 mg/5 ml
813 Metamizol Inj 500 mg/ml
814 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg
815 Metformin tab 500 mg

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

859 Mitomisin serb inj 2 mg
860 Moksifloksasin inf 1,6 mg/mL
861 Moksifloksasin tab 400 mg
862 Moksifloksasin tts mata 0,5%
863 Mometason furoat krim 0,1%
864 Mometason furoat krim 0,1%
865 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.)
866 Morfin Hcl tab 10 mg
867 Morfin Hcl tab SR 10 mg
870 Mupirosin krim 2%
871 Mupirosin salep 2%
872 N-asetil sistein granula 200 mg
873 N-asetil sistein ih 100 mg/ml
874 N-asetil sistein kaps 200 mg
875 NaCl 0,9% Larutan
881 NaCl 3% Larutan
882 Nadroparin inj 9.500 Axa/ml syringe 0,3 Ml
883 Nadroparin inj 9.500 Axa/ml, syringe 0,4 ml
884 Nadroparin inj 9.500 Axa/ml, syringe 0,6 ml
885 Nalokson inj 0,4 mg/ml
886 Natamisin tts mata 5% (50 mg/ml)
889 Natrium aminohipurat inj 200 mg/ml (i.v.)
890 Natrium bikarbonat inj 8,4% (i.v.)
891 Natrium bikarbonat tab 500 mg
892 Natrium diklofenak inj 25 mg/mL
893 Natrium diklofenak tab 25 mg
894 Natrium diklofenak tab 50 mg
895 Natrium Diklofenak Tetes Mata 1 mg/ml
896 Natrium fluoresein tts mata 2%
897 Natrium fosfat lar oral
898 Natrium fusidat krim 20 mg/g
899 Natrium fusidat salep 20 mg/g
900 Natrium hialuronat tts mata
901 Natrium hipoklorit cairan konsentrat 5%
902 Natrium klorida tts mata 50 mg/mL
903 Natrium tiosulfat inj 25% (i.v.)
904 Neostigmin inj 0,5 mg/ml
905 Nevirapin tab 200 mg
906 Nifedipin kaps 10 mg
907 Nifedipin tab SR 20 mg
908 Nifedipin tab SR 30 mg
909 Nikardipin inj 10 mg/vial
910 Nilotinib kaps 150 mg
911 Nilotinib tab 200 mg
912 Nimodipin inf 0,2 mg/ml
913 Nimodipin tab 30 mg
914 Nistatin susp 100.000 UI/ml
915 Nistatin tab salut 500.000 UI
916 Nistatin tab vaginal 100.000 UI
917 Nitrogen oksida ih, gas dlm tabung
918 Nomegestrol asetat Kaps/tab 5 mg
919 Norepinefrin inj 1 mg/ml
920 Noretisteron tab 5 mg
921 Obat Anti Tuberculosis FDC Kategori Anak
922 Obat Anti Tuberculosis FDC Kategori I
923 Obat Anti Tuberculosis FDC Kategori II
924 Obat Anti Tuberculosis FDC Kategori Sisipan
925 Obat Anti Tuberculosis Kombipak Anak
926 Obat Anti Tuberculosis Kombipak Dewasa
927 Ofloksasin tab 200 mg
928 Ofloksasin tab 400 mg
929 Ofloksasin tts telinga 3%
930 Oksaliplatin serb inj 100 mg/vial
931 Oksaliplatin serb inj 50 mg/vial
932 Oksigen ih, gas dlm tabung
933 Oksikodon inj 10 mg/ml
934 Oksikodon inj 10 mg/ml
935 Oksikodon kapsul 10 mg
938 Oksikodon larutan oral 5 mg/5 ml
939 Oksikodon larutan oral concentrate 10 mg/ml
940 Oksikodon tab lepas lambat 10 mg
943 Oksimetazolin tts hidung 0,025%
944 Oksimetazolin tts hidung 0,050%
945 Oksitetrasiklin 1% Salep Mata
946 Oksitetrasiklin hcl inj 50 mg/ml (i.m.)
947 Oksitosin inj 10 UI/ml
948 Okskarbazepin susp 60 mg/mL
949 Oktreotid asetat 0,05 - 6 mg/ml
950 Oktreotid LAR serb inj 20 mg
951 Oktreotid LAR serb inj 30 mg
952 Olanzapin inj 10 mg/2 ml
953 Olanzapin tab sal 10 mg
954 Olanzapin tab sal 5 mg
955 Olodaterol cairan ih 2,5 mcg/semprot
956 Olodaterol cairan ih 2,5 mcg/semprot, refill
957 Olopatadin tts mata 0,1%
958 Omeprazol inj 40 mg/10 ml
959 Omeprazol kaps 20 mg
960 Ondansetron inj 2 mg/ml
961 Ondansetron tab 4 mg
962 Ondansetron tab 8 mg
963 Paklitaksel inj 6 mg/ml, vial@16,7 ml (inj 100 mg)
964 Paklitaksel inj 6 mg/ml, vial@5 ml (inj 30 mg)
965 Paklitaksel inj 6 mg/ml, vial@50 ml (inj 300 mg)
966 Paliperidon palmitat Inj 100 mg/mL
967 Paliperidon palmitat Inj 150 mg/1,5 mL
968 Paliperidon palmitat Inj 75 mg/0,75 mL
969 Pankuronium inj 2 mg/ml
970 Paraformaldehid lar buffer 10%
971 Paraformaldehid tab 1 g
972 Parasetamol drips (infus) 1000 mg/100 ml
973 Parasetamol sir 120 mg/5 ml
974 Parasetamol tab 500 mg
975 Parasetamol tts 60 mg/0,6 ml
976 Pasta devitalisasi (non arsen)
977 Pasta pengisi saluran akar (pasta)
978 Pazopanib tab sal selaput 200 mg
979 Pazopanib tab sal selaput 400 mg
980 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml
981 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml
982 Pegylated interferon alfa-2b serb inj 100 mcg/ml
985 Pemetreksed serb inj 500 mg
986 Pengganti plasma golongan gelatin inf
987 Perak nitrat lar 20%
988 Perak sulfadiazin krim 1%
989 Perindoprilarginin tab 5 mg
990 Permetrin krim 5 %
993 Petidin inj 50 mg/ml (i.m./s.k./i.v.)
994 Pilokarpin tts mata 2%
995 Pilokarpin tts mata 2%
996 Pioglitazon tab 15 mg
997 Pioglitazon tab 30 mg
998 Pirantel pamoat susp 125 mg/5 ml
999 Pirantel pamoat tab 500 mg
1000 Pirantel pamoat tab scored 125 mg
1001 Pirantel pamoat tab scored 250 mg
1002 Pirazinamid tab 500 mg
1003 Piridoksin (vitamin B6) inj 100 mg/ml
1004 Piridoksin (vitamin B6) tab 10 mg
1005 Piridoksin (vitamin B6) tab 25 mg
1006 Piridostigmin tab sal 60 mg
1007 Pirimetamin tab 25 mg
1008 Podofilin tingtur 25 %
1009 Polietilen glikol
1010 Polikresulen
1011 Povidon iodin lar 100 mg/ml
1015 Povidon iodin lar obat kumur 1%
1016 Povidon iodin tts mata 2,5%
1017 Pramipeksol tab 0,125 mg
1018 Pramipeksol tab ER 0,375 mg
1019 Pramipeksol tab ER 0,750 mg
1020 Pravastatin tab 10 mg
1021 Pravastatin tab 20 mg
1022 Prazikuantel tab scored 600 mg
1023 Prednisolon tts mata 10 mg/ml
1024 Prednisolon tts mata 10 mg/ml
1025 Prednison tab 5 mg
1026 Pregabalin kaps 75 mg
1027 Primakuin tab 15 mg
1028 Probenesid tab 500 mg
1029 Produk untuk Dialisis Peritoneal
1030 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.)
1031 Prokaterol HCl cairan ih 30 mcg
1032 Prokaterol HCl cairan ih 50 mcg
1033 Prokaterol HCl serb ih 10 mcg
1034 Propiltiourasil tab 100 mg
1035 Propofol inj 1% (i.v. Bolus)
1036 Propranolol inj 1 mg/ml (i.v.)
1037 Propranolol tab 10 mg
1038 Propranolol tab 40 mg
1039 Prostaglandin (PGE 1) Inj 500 mcg/ml
1040 Protamin sulfat inj 10 mg/ml (i.m.)
1041 Quetiapin tab 100 mg
1042 Quetiapin tab pelepasan lambat 150 mg
1046 Ramipril tab 10 mg
1047 Ramipril tab 2,5 mg
1048 Ramipril tab 5 mg
1049 Ranibizumab inj 10 mg/ml
1050 Ranitidin inj 25 mg/ml
1051 Ranitidin tab 150 mg
1052 Remifentanil inj 1 mg
1055 Retinol (vitamin A) kaps lunak 100.000 UI
1056 Retinol (vitamin A) kaps lunak 200.000 UI
1057 Ribavirin tab 200 mg
1058 Rifampisin kaps 300 mg
1059 Rifampisin tab 450 mg
1060 Rifampisin tab 600 mg
1061 Rifapentin tablet 150 mg
1062 Rilpivirine 25 mg
1063 Ringer Laktat Larutan
1064 Ringer Laktat Larutan 1000 ml
1065 Risedronat tab sal selaput 35 mg
1066 Risperidon oral solution 1 mg/mL
1067 Risperidon tab 3 mg
1068 Risperidon tab sal 1 mg
1069 Risperidon tab sal 2 mg
1070 Rituksimab inf 10 mg/ml (vial 10 ml)
1071 Rituksimab Inf 10 mg/ml (vial 50 ml)
1072 Rituksimab inj 100 mg/ml
1073 Rituksimab inj 500 mg/ml
1074 Rivaroksaban tab sal 10 mg
1077 Rokuronium inj 50 mg/5 ml (i.v.)
1078 Ropinirol tab lepas lambat 2 mg
1081 Ropivakain Inj 7,5 mg/ml
1082 Rosuvastatin tab 10 mg
1083 Sacubitril valsartan tab sal selaput 24,3/25,7 mg
1086 Salbutamol aerosol 100 mcg
1087 Salbutamol cairan ih 1 mg/mL
1088 Salbutamol cairan serb ih 200 mcg/kaps + rotahaler
1089 Salbutamol sir 2 mg/5 ml
1090 Salbutamol tab 2 mg
1091 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 %
1092 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 %
1093 Secukinumab serb inj 150 mg
1094 Sefadroksil kaps 250 mg
1095 Sefadroksil kaps/tab 500 mg
1096 Sefadroksil sir kering 125 mg/5 ml
1097 Sefadroksil sir kering 250 mg/5 ml
1098 Sefaleksin kaps 500 mg
1099 Sefazolin serb inj 1 g/vial
1100 Sefepim serb inj 1000 mg/vial
1101 Sefiksim sir 100 mg/5 ml
1102 Sefiksim tab 100 mg
1103 Sefiksim Tab 200 mg
1104 Sefoperazon serb inj 1.000 mg/vial
1105 Sefotaksim inj 500 mg/vial
1106 Sefotaksim serb inj 1.000 mg/vial
1107 Sefpirom serb inj 1000 mg
1108 Sefpodoksim proksetil tab sal 100 mg
1109 Seftazidim serb inj 1.000 mg/vial
1110 Seftriakson serb inj 1.000 mg/vial
1111 Sefuroksim serb inj 750 mg/vial
1112 Sefuroksim tab 250 mg
1113 Sefuroksim tab sal 500 mg
1114 Sertralin tab sal 50 mg
1115 Serum anti bisa ular : A.B.U. I (khusus ular dari luar Papua) inj (i.m./i.v.)
1116 Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.)
1117 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/
1118 Serum antirabies inj 100 UI/ml
1119 Serum antirabies inj 200 UI/ml
1120 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.)
1121 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.)
1122 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.)
1123 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m)
1124 Setirizin sir 5 mg/5 ml.
1125 Setirizin tab 10 mg
1126 Setuksimab inj 5 mg/ml
1127 Sevelamer karbonat Tab 800 mg
1128 Sevofluran cairan ih 250 ml
1129 Sianokobalamin (vitamin B12) inj 500 mcg/ml
1130 Sianokobalamin (vitamin B12) tab 50 mcg
1131 Siklofosfamid serb inj 1000 mg/vial (i.v.)
1134 Siklopentolat tetes mata 1%
1135 Siklosporin inj 100 mg/ml
1136 Siklosporin inj 50 mg/ml
1137 Siklosporin kaps 100 mg
1138 Siklosporin kaps lunak 25 mg
1139 Siklosporin Kaps lunak 50 mg
1140 Sildenafil sirup kering 10 mg/ml
1141 Sildenafil Tab 20 mg
1142 Silodosin tab 4 mg
1143 Silostazol kaps SR 100 mg
1144 Silostazol tab 100 mg
1145 Simvastatin tab sal 10 mg
1146 Simvastatin tab sal 20 mg
1147 Simvastatin tab sal selaput 40 mg
1148 Siprofloksasin inf 2 mg/ml
1149 Siprofloksasin tab scored 500 mg
1150 Sisplatin serb inj 10 mg
1151 Sisplatin serb inj 50 mg
1152 Sitagliptin tab sal selaput 100 mg
1153 Sitarabin serb inj 100 mg
1154 Sitarabin serb inj 100 mg
1155 Sodium Glycerophosphate 216 mg
1156 Sodium hialuronat Inj 10 mg/ml
1157 Sofosbuvir tab sal selaput 400 mg
1158 Solifenasin tab 10 mg
1159 Solifenasin tab 5 mg
1160 Somatostatin serb Inj 3000 mcg/mL
1161 Soybean oil 200 g, ovolecithin 12 g, glycerol 22 g, Na hydroxide
1162 Spiramisin tab 500 mg
1163 Spironolakton tab 100 mg
1164 Spironolakton tab 25 mg
1165 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial
1166 Streptokinase serb inj 1,5 juta UI/vial
1167 Streptomisin serb inj 1.000 mg/vial
1168 Sufentanil inj 5 mcg/ml (i.v.)
1169 Sugammadeks inj 100 mg/ml
1170 Sukralfat susp 500 mg/5 ml
1171 Sukralfat tab 500 mg
1172 Suksinilkolin inj 20 mg/ml (i.v./i.m.)
1173 Suksinilkolin inj 50 mg/ml (i.v./i.m.)
1174 Suksinilkolin serb inj 100 mg/vial (i.v./i.m.)
1175 Sulfadiazin tab 500 mg
1176 Sulfasalazin kapl sal enterik 500 mg
1177 Sulfur colloid 4,5 mg gelatin/reaction vial
1178 Surfaktan susp 25 mg/ml (intratrakeal)
1179 Surgical ginggival pack
1180 Takrolimus kaps 0,5 mg
1181 Takrolimus kaps 1 mg
1182 Takrolimus kaps lepas lambat 0,5 mg
1183 Takrolimus kaps lepas lambat 1 mg
1184 Tamoksifen tab 10 mg
1185 Tamoksifen tab 20 mg
1186 Tamsulosin tab 0,2 mg
1187 Tamsulosin tab SR 0,4 mg
1188 Technetium 99m 740 mbq - 3,7 gbq (20 to 100 millicuries)/ml
1189 Telbivudin tab 600 mg
1190 Telmisartan tab 40 mg
1191 Telmisartan tab 80 mg
1192 Temozolamid kaps 100 mg
1193 Temozolamid kaps 20 mg
1194 Tenofovir tab 300 mg
1195 Teofilin tab 150 mg
1196 Teofilin tab SR 300 mg
1197 Terazosin hcl tab 1 mg
1198 Terazosin hcl tab 2 mg
1199 Terbinafin tab 250 mg
1200 Terbutalin cairan ih 2,5 mg/ml
1201 Terbutalin inj 0,5 mg/ml
1202 Terbutalin serb ih 0,50 mg/dose
1203 Terbutalin sir 1,5 mg/5 ml
1204 Terbutalin tab 2,5 mg
1205 Testosteron inj 250 mg/ml (vial 1 ml)
1206 Testosteron Inj 250 mg/ml (vial 4 ml)
1207 Testosteron kaps lunak 40 mg
1208 Tetanus toxoid inj
1209 Tetrakain tts mata 0,5%
1210 Tetrasiklin kaps 250 mg
1211 Tetrasiklin kaps 500 mg
1212 Tetrasiklin Salep Mata 1%
1213 Thallous Chloride Tl-202 1 mg methylene diphosphonic acid/ml
1214 Tiamazol tab 10 mg
1215 Tiamazol tab 5 mg
1216 Tiamin (vitamin B1) tab 50 mg
1217 Tikagrelor tab 90 mg
1218 Timolol tts mata 0,25%
1219 Timolol tts mata 0,5%
1220 Tiopental serb inj 500 mg/amp (i.v. Bolus)
1221 Tiopental serb serb inj 1.000 mg/amp (i.v.)
1222 Tiotropium cairan ih 2,5 mcg/semprot, refill
1223 Tiotropium respimat ih 5 mcg/semprot
1224 Tiotropium respimat ih 5 mcg/semprot
1225 Tobramisin tetes mata 0,3%
1226 Tobramisin tetes mata 0,3%
1227 Topiramat tab 100 mg
1230 Tosilizumab inf 400 mg/20 mL
1231 Tosilizumab inf 80 mg/4 mL
1232 Tramadol inj 50 mg/ml
1233 Trastuzumab serb inj 440 mg/vial
1234 Travoprost tts mata 0,004%
1235 Triamsinolon asetonid nasal spray 55 mcg/puff
1236 Triamsinolon inj 10 mg/ml
1237 Triamsinolon inj 40 mg/ml
1238 Trifluoperazin tab sal 5 mg
1239 Triheksifenidil tab 2 mg
1240 Tropikamid tts mata 0,5%
1241 Tropikamid tts mata 0,5%
1242 Tropikamid tts mata 1%
1243 Tropikamid tts mata 1%
1244 Tuberkulin protein purified derivative 1:10 (i.k)
1245 Urea krim 10 %
1246 Urea krim 20 %
1247 Vaksin BCG inj (i.k)
1248 Vaksin bivalen OPV (b-OPV) drops 10 dosis
1249 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) 0,5 ml
(i.m)
1250 Vaksin HPV (Human Papilloma Virus), vial 0,5 mL
1251 Vaksin Influenza
1252 Vaksin Japanese Enchepalitis (J.E)
1253 Vaksin jerap difteri tetanus (DT)
1254 Vaksin jerap difteri tetanus (Td)
1255 Vaksin kombinasi DPT-HB-Hib
1256 Vaksin measless rubella (MR) Inj 0,5 mL (s.k)
1257 Vaksin Meningitis Meningokokus
1258 Vaksin polio IPV inj 0,5 ml
1259 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster
1260 Vaksin rabies, untuk manusia serb Inj 2,5 IU
1261 Vaksin Yellow Fever
1262 Valasiklovir tab 500 mg
1263 Valgansiklovir tab sal 450 mg
1264 Valproat sir 250 mg/5 ml
1265 Valproat tab lepas lambat 250 mg
1266 Valproat tab lepas lambat 500 mg
1267 Valproat tab sal enterik 250 mg
1268 Valsartan tab 160 mg
1269 Valsartan tab 80 mg
1270 Vankomisin serb inj 500 mg/vial
1271 Vasopresin inj 20 UI/ml (i.m./s.k.)
1272 Verapamil inj 2,5 mg/ml
1273 Verapamil tab 240 mg
1274 Verapamil tab 80 mg
1275 Vildagliptin tab 50 mg
1276 Vinblastin inj 1 mg/ml
1277 Vinkristin inj 1 mg/ml (vial 1 mL)
1278 Vinkristin inj 1 mg/ml (vial 2 mL)
1279 Vinorelbin inj 10 mg/ml, kemasan 1 ml
1280 Vinorelbin inj 10 mg/ml, kemasan 5 ml
1281 Vitamin B kompleks
1282 Vitamin C 500 mg minimal non acidic 250 mg
1283 Vorikonazol inj 200 mg
1284 Vorikonazol tab sal selaput 200 mg
1285 Warfarin tab 1 mg
1286 Warfarin tab 2 mg
1287 Zidovudin kaps 100 mg
1288 Zinc drops 10 mg/ml
1289 Zinc sir 20 mg/5 ml
1290 Zinc tab disp 20 mg
1291 Zonisamid tab sal selaput 100 mg
PROVINSI dan KAB/KOTA
EMBER 2021 DI SATUAN KERJA
NG DIRENCANAKAN UNTUK DIADAKAN TAHUN 2022
KAIAN RATA-RATA PER BULAN DI SATKER SELAMA TAHUN 2021
1 DESEMBER 2021 DITAMBAH PREDIKSI PENGADAAN TAHUN 2022 DIKURANGI (12 x PEMAKAIAN RATA-RATA PER BULAN TAHUN 2021)
TA PER BULAN SELAMA 2021 DIKALI 15 BULAN DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL /
N YANG DIHITUNG BERDASARKAN METODE KONSUMSI DIKURANGI DENGAN PREDIKSI SISA STOK PER 31 DESEMBER 2022
ENGADAAN DI TAHUN 2023 DALAM SATUAN TERKECIL SEPERTI: TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PU
ARI SISTEM JIKA SATKER TELAH MENGIRIMKAN PELAPORAN RKO TAHUN 2022
AAN OBAT JKN BAIK E-PURCHASING MAUPUN MANUAL SELAMA TAHUN 2023
KESEHATAN RUJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2023
SATUAN SISA STOK PER 31 PREDIKSI PEMAKAIAN

DESEMBER 2021 PENGADAAN RATA-RATA PER
TAHUN 2022 BULAN SELAMA
2021
(a) (b) (c)

Tab 0 0 0
Tablet/kaplet/kapsul 0 0 0
tablet/kapsul/kaplet 0 0 0
ampul/vial 0 0 0
tablet salut selaput/kaplet salut sel 0 0 0
Botol 250 ml 0 0 0
ampul/vial/botol 10 mL 0 0 0
Botol 100 ml 0 0 0
ampul/vial/botol 0 0 0
ampul/vial/botol 25 mL 120 5760 420
Flexy bag 500 ml 0 0 0
Botol 500 ml 0 0 0
botol @ 1.000 mL 30 120 15
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Tab 300 8400 650
Vial 0 0 0
Ampul 0 0 0
Tube 0 0 0
Tube 0 0 0
vial/ampul 0 0 0
ampul/vial 10 ml 32 300 20
ampul/vial 0 240 20
Tab 53 1000 100
Botol @20 ml 0 0 0
Botol @15 ml 0 0 0
Botol @10 ml 15 360 30
botol 60 ml 5 240 20
Botol 17 360 20
ampul/vial 32 360 20
Vial 21 360 20
vial/cartridge 15 1800 150
Vial/Cartridge 0 0 0
Penfill 0 375 25
Penfill 0 0 0
Vial/Cartridge/Penfill 25 900 75
Vial @10 ml 0 0 0
cartridge disposible/ penfill cartridg 0 0 0
vial/disposable cartridge/penfil cart 0 0 0
ampul/vial 0 0 0
botol 60 ml 0 0 0
Kaps 120 7200 600

Tube 0 0 0
pot 30 g 0 0 0
Suppositoria 13 360 30
Botol 500 ml 0 0 0
botol 0 0 0
tab discmelt/tab cepat larut/disinteg 0 0 0
tab discmelt/ tab cepat larut/ disint 0 0 0
ampul/vial 0 0 0
Kertas warna penanda oklusi 0 0 0
Botol 0 0 0
tablet sal enterik/kaplet salut enteri 0 0 0
Tab 653 48000 4000
Tab 0 0 0
catchcover, botol @ 0,6 mL 0 0 0
Botol @5 ml 0 0 0
ampul/vial 0 0 0
tablet/kapsul/kaplet/kaptab 1548 60000 5000
Tube/pot 0 0 0
Tube @ 20 gram 0 0 0
Tube @ 10 gram 0 0 0
Botol 0 0 0
Tube 0 0 0
Tube 0 0 0
Tube 0 0 0
ampul/vial 109 3000 250
Ampul 0 0 0
ampul/vial 653 7200 600
Botol 0 0 0
Botol 0 0 0
tube 13 120 15
Ampul/vial 0 0 0
Vial 0 0 0
Tab 312 6000 500
ampul/vial @ 5 ml 10 180 15
ampul/vial @ 2,5 ml 0 0 0
Ampul 100 2400 200
Tab 0 0 0
Botol 0 0 0
Botol 0 0 0
Tab 0 0 0
maks botol @60 ml 24 120 10
Botol 0 0 0
Botol 0 0 0
Disposible plastic bag @ 400 g 0 0 0
Botol plastik 0 0 0
Vial 0 0 0
Dus/Sachet/Plastik 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Tab 0 0 0
Catchcover, botol 0,6 ml 0 0 0
Botol @ 5 ml 0 0 0
tube 5 gram 7 120 10
Tube 0 0 0
tube 5 gram 0 0 0
catchcover, botol 0,6 mL 0 0 0
botol @5 ml 0 0 0
tablet salut/kaplet salut 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
Botol 0 0 0
Tab 0 0 0
Botol @ 4 ml 0 0 0
respoules 20 480 40
Botol @ 4 ml 0 0 0
respoules 10 720 60
Botol 0 0 0
200 dosis 0 0 0
100 dosis 0 0 0
Turbuhaler 0 0 0
rapihaler 0 0 0
Turbuhaler 0 0 0
Turbuhaler 0 0 0
rapihaler 0 0 0
vial/ampul @4 ml 0 0 0
Tab 0 0 0
ampul/vial 0 0 0
tablet 0 0 0
set/buah 0 0 0
Vial 0 0 0
Vial 0 0 0
Tab 0 0 0
Tab 0 0 0
Vial 0 0 0
Tab 0 0 0
Vial 0 0 0
Tab 0 0 0
tablet dispersible/kaplet dispersible 0 0 0
tablet salut selaput 0 0 0
Botol 0 0 0
tab salut selaput/kaplet salut selapu 0 0 0
Vial 0 0 0
ampul/vial 230 6000 500
ampul/vial 0 0 0
Botol 0 0 0
Botol 0 0 0
Tab 0 0 0
Tab 0 0 0
Tab 0 0 0
Tube 0 0 0
tube 15 g 0 0 0
tube 10 g 0 0 0
tube 10 g 0 0 0
ultrabag 0 0 0
tube @ 2,5 mL 0 0 0
tube @ 2,5 mL 0 0 0
ampul/vial 0 0 0
ampul/vial 0 0 0
Tube 0 0 0
ampul/vial 0 0 0
Ampul 0 0 0
ampul/vial 0 0 0
Kapsul lepas lambat 0 0 0
Kapsul lepas lambat 0 0 0
Ampul 0 0 0
Vial 0 0 0
Tab 0 0 0
Botol 0 0 0
Botol 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Vial 0 0 0
botol @60 ml 21 600 50
Botol 0 0 0
tablet dispersible /kaplet dispersible 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Kaps lunak 0 0 0
Tablet 0 0 0
tablet salut gula 0 0 0
Tab 0 0 0
Tab 0 0 0
Ampul 0 0 0
Ampul 0 0 0
Ampul 0 0 0
tablet salut selaput/kaplet salut sela 0 0 0
Ampul 145 200 20
Vial 25 ml 0 0 0
Vial 5 ml 0 0 0
Vial 25 mL 0 0 0
Kaps 0 0 0
Botol 0 0 0
Tab 0 0 0
ampul/vial 0 0 0
Botol @ 60 ml 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
Ampul 0 0 0
ampul/vial 0 0 0
tablet salut gula/kaplet salut gula 12 240 20
ampul/vial 0 0 0
Botol 0 0 0
Botol 0 0 0
Set 0 0 0
Vial 0 0 0
Botol 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Botol 0 0 0
ampul @ 2 ml 32 120 10
Kaps 340 14400 1200
Kaps 0 0 0
ampul/vial 0 0 0
Ampul 0 0 0
Tab 0 0 0
Tab 0 0 0
Tab 0 0 0
Botol 0 0 0
Botol 0 0 0
ampul/vial, @ 10 mL 0 0 0
ampul @ 2 mL 0 0 0
Patch 0 0 0
Patch 0 0 0
Patch 0 0 0
Botol 0 0 0
ampul/vial 0 0 0
Tab sal 238 1200 1000
Vial 0 0 0
Vial 0 0 0
Ampul 0 0 0
Kaps 0 0 0
Kaplet 0 0 0
Tube 0 0 0
Ampul/vial 0 0 0
Vial 0 0 0
catchcover, botol 0,6 mL 0 0 0
botol @5 ml 0 0 0
Ampul 0 0 0
Ampul 0 0 0
tube @ 5g 0 0 0
Tube 10 g 0 0 0
Botol 0 0 0
Botol 59 600 50
Botol 0 0 0
ampul/vial/prefilled syringe 0 0 0
Botol 0 0 0
Sachet 0 0 0
Botol 0 0 0
Patch 0 0 0
ampul/vial 459 6000 500
Prefilled Syringe @ 5 ml 0 0 0
Prefilled Syringe @ 7,5 ml 0 0 0
Vial 0 0 0
Vial @15 ml 0 0 0
Vial @20 ml 0 0 0
Vial @10 ml 0 0 0
Vial 0 0 0
Vial 0 0 0
Botol 0 0 0
Sachet 0 0 0
Botol 540 15000 2000
sachet 23 400 35
Vial 0 0 0
Vial 0 0 0
Tube 59 1800 150
Botol 0 0 0
Botol 0 0 0
Sachet 0 0 0
Botol 0 0 0
Vial 0 0 0
Tab 0 0 0
Tab 321 3600 300
tablet lepas lambat/kaplet lepas la 0 0 0
kapsul 0 0 0
Ampul 0 0 0
kapsul lepas lambat 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 20 480 40
Ampul @25 ml 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 59 2400 200
Vial 0 0 0
Vial 0 0 0
Tab 0 0 0
Roll 0 0 0
Roll 0 0 0
Vial 0 0 0
Vial 0 0 0
botol 0 0 0
Botol 2 36 3
Botol 0 0 0
Vial 70 1200 100
Ampul 0 0 0
Syringe 0 0 0
Botol 0 0 0
Tab 0 0 0
tube @ 5 g 13 120 10
tube @ 5 g 0 0 0
Vial 0 0 0
Tab 0 0 0
Tab 0 0 0
ampul/vial 0 0 0
Botol 0 0 0
Vial @10 mL 0 0 0
vial/ cartridge disposible/ penfill car 0 0 0
Cartridge, Penfill Cartridge 0 0 0
Vial 0 0 0
Cartridge, Penfill Cartridge 0 0 0
Vial 0 0 0
Vial 0 0 0
Cartridge disposible/penfill cartridg 0 0 0
Vial @10 mL 0 0 0
Ampul 0 0 0
Ampul 0 0 0
ampul/vial 0 0 0
botol @ 60 ml 24 576 48
botol @ 60 ml 32 288 24
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Kaps 0 0 0
Kaps 0 0 0
Botol 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Ampul/vial/botol @ 100 mL 0 0 0
Ampul/vial/botol @ 50 mL 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Botol 2 180 15
Botol 2 12 2
Ampul/vial @ 2 mL 0 0 0
Botol 0 0 0
botol @ 250 mL 0 0 0
Tab 0 0 0
Tab 432 1200 100
ampul/vial 3 120 10
Set 0 0 0
Set 0 0 0
tablet /kapsul/kaplet 0 0 0
Tube gel 0 0 0
Tube 0 0 0
Ampul/vial 0 0 0
kapsul lunak 23 1200 50
kapsul lunak 0 0 0
ampul/vial 0 0 0
Tab 0 0 0
ampul/vial 3 360 30
Tube 0 0 0
Sachet 0 0 0
Sachet 0 0 0
tab salut/kaplet salut 0 0 0
tablet/kaplet 1206 48000 4000
Botol 0 0 0
Tablet 231 8400 700
Botol 0 0 0
Botol 0 0 0
Vial 0 0 0
Vial 0 0 0
ampul/vial 2 60 5
ampul/vial 0 0 0
Tube 10 g 23 240 20
botol 0 0 0
ampul/vial 0 0 0
Suppositoria 0 0 0
ampul/vial 437 24000 2000
botol maks 60 mL 0 0 0
Botol 0 0 0
Kaps 219 2400 200
tube 0 0 0
tube 0 0 0
Kapsul 0 0 0
kapsul 0 0 0
Tab 0 0 0
Vial 0 0 0
Botol 0 0 0
tab sal selaput 0 0 0
tube @ 5 gram 12 240 20
vial/ampul 0 0 0
botol 60 ml 0 0 0
Botol 0 0 0
botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Tablet 0 0 0
ampul/vial 0 0 0
ampul/vial 0 0 0
Tab sal 0 0 0
Tab 0 0 0
Tab 0 0 0
tablet 0 0 0
tablet 0 0 0
Ampul 0 0 0
Tab 0 0 0
Botol 0 0 0
ampul/vial 0 0 0
ampul/vial 0 0 0
Tab dispersible 0 0 0
ampul/vial 0 0 0
Botol 0 0 0
Tab 0 0 0
tablet salut gula 0 0 0
Botol 0 0 0
Botol 0 0 0
tab salut gula 0 0 0

Vial 0 0 0
Vial 0 0 0
Paket 0 0 0
Tab 0 0 0
Tab 0 0 0
Botol 0 0 0
Pasta tube 0 0 0
Tab 0 0 0
ampul/vial 0 0 0
Diskus 13 600 50
Diskus 6 360 30
Cartridge 0 0 0
Cartridge 0 0 0
Botol 2,5 mL 0 0 0
Botol plastik @ 5 ml 0 0 0
Botol Plastik @ 15 ml 0 0 0
Catchcover, botol plastik @ 0, 0 0 0
vial 0 0 0
Ampul/vial 26 1200 100
Tab 236 6000 500

Tab 0 0 0
Botol 0 0 0
aerosol can/canister 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Tablet/kapsul/kaplet 0 0 0
Botol 0 0 0
Set 0 0 0
tab/kaptab 329 2400 200
tab/kaptab 123 1200 100
botol 60 mL 9 288 24
Vial 0 0 0
botol @ 60 mL 16 260 30
Tab 0 0 0
Tablet 0 0 0
Vial 0 0 0
Botol 0 0 0
Botol 0 0 0
Softbag @500 mL 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 12 288 24
Softbag @1.000 mL 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol/vial 0 0 0
Botol 0 0 0
Bag 0 0 0
Bag 0 0 0
Bag 0 0 0
Botol 0 0 0
Botol 0 0 0
Bag 0 0 0
Botol plastik @500 ml 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Softbag @ 500 ml 0 0 0
Botol plastik @ 500 ml 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
softbag 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0

Botol 500 ml 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
botol/softbag 0 0 0
Botol 0 0 0
botol/softbag @ 500 mL 0 0 0
botol/softbag @ 100 mL 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol plastik @500 ml dengan penut 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0

botol @ 2,5 mL 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Tablet 0 0 0
Tablet 0 0 0
vial/ botol/ flexy bag @ 100 ml 54 3000 150
vial / botol / flexy bag @150 21 600 50
botol @ 5mL 0 0 0
pack/ sachet/ set 0 0 0
tablet/kaplet/kapsul 0 0 0
tablet/kaplet/kapsul 0 0 0
syringe/syringe plastik 0 0 0
Vial 0 0 0
ampul/vial 126 2400 200
Tube 0 0 0
botol 0 0 0
Tab 0 0 0
Botol 0 0 0
Tab 0 0 0
Tab 125 3600 300
Tab sal 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Vial 0 0 0
ampul/vial @25 ml 0 0 0
ampul/vial 0 0 0
ampul/vial @25 ml 0 0 0
ampul/vial 0 0 0
Sachet 0 0 0
Botol @ 250 ml 0 0 0
Botol @ 100 ml 12 84 5
Botol @ 500 ml 32 288 24
Tab sal 0 0 0
Vial 0 0 0
Botol 0 0 0
Tan 0 0 0
ampul/vial 0 0 0
ampul/vial 0 0 0
Tab 0 0 0
Tab 0 0 0
enema 0 0 0
tablet salut enterik/kaplet salut ente 0 0 0
Vial 0 0 0
Botol 1000 ml 0 0 0
Ampul 0 0 0
Tab salut 0 0 0

tablet/kaplet salut selaput 94 1200 100
ampul/vial 0 0 0
ampul/vial 0 0 0
ampul/vial 0 0 0
Ampul 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Tab 0 0 0
botol 50 600 50
Ovula 0 0 0
Suppositoria 0 0 0
Botol @ 60 ml 6 120 10
Botol @ 100 ml 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
tube 12 100 10
botol / sachet 0 0 0
ampul/vial 0 0 0
Sachet 0 0 0
Vial 0 0 0
Vial 0 0 0
vial/ampul/botol/softbag 0 0 0
Botol 0 0 0
Tube 5 gram 0 0 0
tube 10 gram 0 0 0
Vial 0 0 0
Tab 0 0 0
tube 0 0 0
tube 0 0 0
Sachet 0 0 0
Botol 0 0 0
Botol @100 ml 0 0 0
Ampul/botol @ 10 mL 0 0 0
Botol @500 ml 65 4800 400
Botol @1.000 mL 63 3000 250
Botol @25 ml 0 0 0
Botol @250 ml 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Ampul 0 0 0
Botol @5 ml 0 0 0
botol @ 15 mL 0 0 0
Ampul 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
tablet salut enterik/kaplet salut ent 0 0 0
botol 5 mL 0 0 0
Botol 0 0 0
botol 0 0 0
tube 0 0 0
Tube 0 0 0
botol 0 0 0
Botol 0 0 0
ampul/vial 0 0 0
Ampul 0 0 0
Vial 20 240 20
ampul/vial 0 0 0
botol/vial 32 360 30
tablet/kaplet 0 0 0
Botol 0 0 0
ampul/vial 0 0 0
paket 3 60 5
paket 7 180 15
paket 0 0 0
paket 0 0 0
Paket 0 0 0
paket 0 0 0
tablet salut selaput/ kaplet salut sel 239 3600 300
Botol @ 5 mL 0 0 0
Vial 0 0 0
Vial 0 0 0
Botol 0 0 0
Ampul/vial @2 mL 0 0 0
Ampul/vial @1 mL 0 0 0
Kaps 0 0 0
Kaps 0 0 0
Botol 0 0 0
Botol 0 0 0
Tab 0 0 0
Tab 0 0 0
Tab 0 0 0
botol @ 10 mL 0 0 0
botol @ 10 mL 0 0 0
tube 0 0 0
Vial 0 0 0
ampul/vial 165 2400 200
botol 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
vial 0 0 0
Ampul 0 0 0
Botol 0 0 0
cartridge 0 0 0
Botol 0 0 0
ampul/vial 321 8400 700
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Ampul 0 0 0
Ampul 0 0 0
Ampul 0 0 0
Ampul 0 0 0
Botol 0 0 0
Tab 0 0 0
vial/ flexybag/botol @ 100 ml 32 1800 150
botol @ 60 mL 64 1728 100
botol @ 15 mL 12 864 72
Tube 0 0 0
Tube 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Botol 0 0 0
Botol 0 0 0
Tube 0 0 0
Tube 15 g 0 0 0
Tube 10 g 0 0 0
Tube 30 g 0 0 0
Vial 0 0 0
Botol 5 ml 0 0 0
tablet 123 7200 600
Botol 0 0 0
Tab 0 0 0
Tab 0 0 0
Ampul 0 0 0
tab/kap/kapl 134 6000 500
Tablet 0 0 0
Botol 0 0 0
Botol 0 0 0
Botol 0 0 0
botol 30 mL 0 0 0
botol @ 60 mL 12 240 10
Botol 300 ml 0 0 0
botol @ 1.000 mL 3 120 10
Botol 0 0 0
botol/strip 0 0 0
Tab 0 0 0
Tab 0 0 0
Botol @5mL 0 0 0
Kapsul 0 0 0
Tab 0 0 0
Paket 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Botol 0 0 0
Botol 0 0 0
ampul/vial 0 0 0
Ampul 0 0 0
Vial 0 0 0
Ampul 0 0 0
tablet SR 0 0 0
tablet SR/kaplet SR 0 0 0
tab SR 0 0 0
tablet SR/kaplet SR 0 0 0
Vial 0 0 0
ampul/vial 1054 48000 40000
ampul/vial 0 0 0
ampul/vial 0 0 0
ampul/vial 0 0 0
kaps lunak 0 0 0
kaps lunak 0 0 0
Tablet/kapsul/kaplet 0 0 0
tablet 0 0 0
Botol 320 36000 3000
Botol 0 0 0
tablet salut selaput / kaplet salut se 0 0 0
botol 0 0 0
Vial 0 0 0
Vial 0 0 0
Ampul 0 0 0
Ampul 0 0 0
ampul/vial 0 0 0
ampul/polyamp/vial 0 0 0
canister / botol 0 0 0
Botol 0 0 0
Botol 32 4320 360
pot 30 gram 0 0 0
pot 15 gram 0 0 0
Vial 0 0 0
botol @ 60 mL 16 600 50
botol @ 60 mL 18 360 30
ampul/vial 0 0 0
ampul/vial 0 0 0
botol 13 1800 150
Tab 659 18000 1500
Tablet 239 36000 3000
ampul/vial 0 0 0
ampul/vial 0 0 0
ampul/vial 239 21600 1800
ampul/vial 0 0 0
Tab 0 0 0
ampul/vial 7 240 20
ampul/vial 458 21600 1800
ampul/vial 0 0 0
Vial 2 60 5
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Ampul 5 240 20
Vial 0 0 0
Ampul/vial 0 0 0
botol @ 60 mL 21 600 50
Vial 0 0 0
Tab 0 0 0
botol 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Botol 0 0 0
Ampul 0 0 0
Ampul 0 0 0
kaps lunak 0 0 0
kaps lunak 0 0 0
Kaps lunak 0 0 0
Botol 0 0 0
Tab 0 0 0
Tab 0 0 0
Tab 0 0 0
tablet/kapsul/kaplet/tablet salut sel 239 12000 1000
tablet/kapsul/kaplet/tablet salut sel 218 6000 500
Tab sal 0 0 0
vial/ botol 100 ml 5 240 20
Vial 0 0 0
Vial 0 0 0
ampul/vial @ 10 mL 0 0 0
ampul/vial @ 1 mL 0 0 0
Ampul/vial 0 0 0
ampul/vial 0 0 0
tablet salut selaput / kaplet salut se 0 0 0
Vial 0 0 0
Softbag @ 250 ml 0 0 0
Vial 0 0 0
Vial 0 0 0
ampul/vial 0 0 0
Ampul 0 0 0
Vial 0 0 0
botol 34 7200 600
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Botol 0 0 0
Tube 0 0 0
Tablet 0 0 0
Tab 0 0 0
tab lepas lambat / kaplet lepas lamb 0 0 0
Set 0 0 0
Botol 0 0 0
ampul/vial 0 0 0
Vial 0 0 0
botol 8 180 15
Vial 0 0 0
Vial 0 0 0
kapsul lunak 0 0 0
Ampul 0 0 0
Botol 0 0 0
Tube 0 0 0
Set 0 0 0
botol @ 5 mL 0 0 0
botol @ 5 mL 0 0 0
Ampul 2 120 10
Ampul 0 0 0
Cartridge 0 0 0
Handihaler 0 0 0
Botol 0 0 0
Botol @ 5 ml 0 0 0
vial 0 0 0
vial 0 0 0
ampul/vial 178 1200 100
ampul/vial 0 0 0
Botol 0 0 0
Botol 0 0 0
Ampul 0 0 0
ampul/vial 0 0 0
Botol @ 5 ml 0 0 0
Botol @ 0,6 ml 0 0 0
Botol @ 5 ml 0 0 0
Ampul 0 0 0
Tube/pot 0 0 0
Tube/pot 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 23 600 50
Ampul/vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
botol @ 120 ml 5 240 20
tabet lepas lambat/kaplet lepas lam 98 4300 360
tabet lepas lambat/kaplet lepas lam 187 3600 300
tablet salut enterik/ kaplet salut ent 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Tab 0 0 0
Ampul 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
Vial 0 0 0
tablet 549 18000 1500
Tablet/kapsul/kaplet/tab sal selaput/ 0 0 0
vial 0 0 0
Botol 0 0 0
botol 17 360 30
tablet dispersible 1654 48000 2000
Tab sal selaput 0 0 0
AIAN RATA-RATA PER BULAN TAHUN 2021)
/ KAPSUL / KAPLET / BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF
STOK PER 31 DESEMBER 2022
BOTOL / AMPUL / VIAL / TUBE / SACCHET / PUFF YANG AKAN DIADAKAN TAHUN 2022 BERDASARKAN
PREDIKSI SISA STOK 31 JUMLAH RENCANA RENCANA RENCANA

DESEMBER 2022 KEBUTUHAN KEBUTUHAN PENGADAAN PENGADAAN
TAHUN 2023 TAHUN 2023 TAHUN 2023 TAHUN 2022
(d) = (a)+(b)-(12x(c)) (e) = (c) x 15 (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 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
840 6300 5460 6300 6800
0 0 0 0 0
0 0 0 0 0
0 225 225 225 750
200 7500 7300 7500 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
900 9750 8850 9750 9000
210 7500 7290 7500 7500
0 0 0 0 0
0 0 0 0 4500
0 0 0 0 750
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
92 300 208 300 300
0 0 0 0 0
0 3000 3000 3000 4500
0 300 300 300 0
0 1500 1500 1500 1350
0 37500 37500 37500 0
0 135000 135000 135000 75000
287 105000 104713 105000 67500
0 0 0 0 0
0 0 0 0 0
15 450 435 450 720
5 300 295 300 0
137 300 163 300 720
0 0 0 0 0
367 7500 7133 7500 10500
152 300 148 300 300
141 300 159 300 400
15 2250 2235 2250 2250
0 0 0 0 0
75 375 300 300 0
0 0 0 0 0
25 1125 1100 1100 750
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
120 9000 8880 9000 7500

0 0 0 0 0
0 0 0 0 0
13 450 437 450 375
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
549 75000 74451 75000 37500
653 60000 59347 60000 0
128 7500 7372 7500 7500
0 0 0 0 0
237 15000 14763 15000 15000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
1548 75000 73452 75000 75000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
109 3750 3641 3750 4500
0 0 0 0 0
653 9000 8347 9000 7500
576 3150 2574 3200 3500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 225 225 225 360
0 0 0 0 0
0 4500 4500 4500 4500
0 6000 6000 6000 6000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
312 7500 7188 7500 7500
0 0 0 0 0
0 0 0 0 0
0 3000 3000 3000 3000
0 3000 3000 3000 2250
10 225 215 225 200
0 0 0 0 0
100 3000 2900 3000 1500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
23 750 727 750 300
24 150 126 150 75
0 0 0 0 0
0 7500 7500 7500 3000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
189 52500 52311 52500 45000
0 0 0 0 0
0 0 0 0 0
7 150 143 150 150
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
52 225 173 225 150
12 150 138 150 75
0 0 0 0 0
0 0 0 0 0
12 4500 4488 4500 3000
567 45000 44433 45000 10500
0 30000 30000 30000 7500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
20 600 580 600 0
0 0 0 0 0
10 900 890 900 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
75 1125 1050 1125 1125
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
230 7500 7270 7500 3000
349 15000 14651 15000 7500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 10500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
876 30000 29124 30000 22500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
200 4500 4300 4500 3000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 300 300 300 300

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
21 750 729 750 360
540 30000 29460 30000 30000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
25 300 275 300 750
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
105 300 195 300 300
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 15000 15000 15000 1500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
12 300 288 300 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
32 150 118 150 150
340 18000 17660 0 18000
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
210 3000 2790 3000 1500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
45 750 705 750 1500
0 15000 15000 15000 1500
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
59 750 691 750 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
459 7500 7041 7500 5300
790 75000 74210 75000 45000
138 30000 29862 30000 11250
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PENGADAAN
TAHUN 2021
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1.

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN RUJUKAN TINGKAT LANJU

SATUAN KERJA : RS. Medika Lestari

1 153-Sm-EDTMP (ethylenediamine tetramethylene phosphonic acid) 44

59 Analog Insulin long acting inj 100 IU/mL, vial/cartridge disposible/penfill

69 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3%

71 Aquadest cairan 500 ml

174 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg

305 Faktor VIII (konsentrat) serb inj 230 -340 UI

389 Glass ionomer ART (Atraumatic Restorative Treatment) lar

604 Kombinasi : (Zidovudin 60 mg + Lamivudin 30 mg + Nevirapin 50 mg) Ped

615 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg

618 Kombinasi : Sefiksim 400 mg + Azitromisin 1000 mg

621 Kombinasi : Travoprost 0,004% + Timolol 0,5%, tts mata

635 Kombinasi: Elbasvir 50 mg dan Grazoprevir 100 mg tablet salut selaput

636 Kombinasi: Ipratropium bromida 0,5 mg + Salbutamol 2,5 mg, cairan ih

637 Kombinasi: kaolin 550 mg + pektin 20 mg

669 Larutan mengandung Asam Amino (Asam Amino 6%, mengandung

677 Larutan mengandung Asam Amino (Glutamine 20 g)

682 Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L,

687 Larutan mengandung asam amino + elektrolit + Karbohidrat + Lipid

688 Larutan mengandung asam amino + elektrolit + Karbohidrat + Lipid

689 Larutan mengandung asam amino + elektrolit + Karbohidrat + Lipid

691 Larutan mengandung Asam Amino + Elektrolit + Karbohidrat + Lipid

692 Larutan mengandung asam amino + Karbohidrat + Lipid (Glukosa 63 g,

700 Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit:

701 Larutan Mengandung Fosfat Anorganik (NaH2PO4/KH2PO4)

710 Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 g

727 Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa

739 Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr +

797 Mebendazol sir 100 mg/5 ml

815 Metformin tab 500 mg

858 Mitomisin serb inj 10 mg

KESEHATAN RUJUKAN TINGKAT LANJUT (FKRTL) TAHUN 2023

SATUAN SISA STOK PER 31 PREDIKSI PEMAKAIAN

(a) (b) (c)

Kaps 120 7200 600

Cartridge, Penfill Cartridge 0 0 0

tab salut gula 0 0 0

catchcover, botol @ 0,6 mL 0 0 0

Catchcover, botol plastik @ 0, 0 0 0

tablet salut selaput 0 0 0

Ampul/vial 26 1200 100

Tab 236 6000 500

tab/kaptab 123 1200 100

Botol plastik @500 ml 0 0 0

Botol plastik @ 500 ml 0 0 0

Botol plastik @500 ml 0 0 0

Botol plastik @500 ml 0 0 0

Botol plastik @500 ml 0 0 0

Botol plastik @500 ml dengan penut 0 0 0

catchcover, botol @ 0,6 mL 0 0 0

tablet/kapsul/kaplet 2310 120000 10000

PREDIKSI SISA STOK 31 JUMLAH RENCANA RENCANA RENCANA

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

25 1125 1100 1100 750

120 9000 8880 9000 7500

0 300 300 300 300

13 750 737 750 0

6 450 444 450 0

26 1500 1474 1500 750

236 7500 7264 7500 0

123 1500 1377 1500 1500