RENCANA KEBUTUHAN OBAT DAN PERBEKALAN KESEHATAN

PUSKESMAS BERBEK
KABUPATEN NGANJUK TAHUN 2023

PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%
Antihemoroid, kombinasi: bismut subgalat 150
mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg

Kotrimoksazol (dewasa) kombinasi :

Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
 Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
 89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
KALAN KESEHATAN

N 2023

USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
 RENCANA KEBUTUHAN OBAT DAN PERBEKALAN KESEHATAN
PUSKESMAS BERBEK
KABUPATEN NGANJUK TAHUN 2023

PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%
Antihemoroid, kombinasi: bismut subgalat 150
mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg

Kotrimoksazol (dewasa) kombinasi :

Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
 Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
 89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
KALAN KESEHATAN

N 2023

USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0

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0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa) kombinasi :
Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
 Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
 6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
 97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa) kombinasi :
Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
 Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
 6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
 97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa) kombinasi :
Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
 Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
 6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
 97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml
Bahan tumpatan sementara lar, serb Botol
Etil klorida semprot 100 ml Botol 194,250.00
Eugenol Botol 44,400.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
 88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa) kombinasi :
Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
 Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
 6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
 97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa) kombinasi :
Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
 Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
 6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
 97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
 65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 PEMAKAIAN
HARGA SATUAN + PPn
NO NAMA OBAT KEMASAN RATA-RATA PER
(HNA+PPn)
BULAN
(1) (2) (3) (4) (6)

OBAT FORNAS DAN DOEN

Air untuk injeksi amp 20 ml Ampul 2,000.00
Air untuk injeksi amp 25 ml Ampul 2,651.00
Albendazol susp 200 mg/5 ml Botol 4,730.00
Albendazol tab 400 mg Tab 390.00
Alopurinol tab 100 mg Tab 200.00
Alopurinol tab 300 mg Tab 200.00
Ambroksol tab. 30 mg Tablet 97.00
Aminofilin inj 24 mg/ml Ampul 4,400.00
Aminofilin tab 200 mg Tab 262.00
Amitriptilin tab sal 25 mg Tab sal 175.00
Amlodipin tab 10 mg Tab 70.00
Amlodipin tab 5 mg Tab 53.00
Amoksisilin sir 125 mg/5 ml Botol 2,050.00
Amoksisilin sir forte 250 mg/5 ml Botol 3,948.00
Amoksisilin tab 250 mg Tab 184.00
Amoksisilin tab 500 mg Tab 402.00
Ampisilin serb inj 1000 mg/vial Vial 9,900.00
Anestetik lokal gigi kombinasi : lidokain hcl 2%
Vial 803.00
+ epinefrin 1 : 80.000 inj 2 ml

Antasida, kombinasi : aluminium hidroksida 200

Tab 54.00
mg + magnesium hidroksida 200 mg

Antasida, kombinasi : aluminium hidroksida 200

Botol 1,679.00
mg + magnesium hidroksida 200 mg

Anti Parkinson kombinasi : benzerasid 25 mg +

Kaps 1,298.00
levodopa 100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+
Tube 2,924.00
Polimiskin B 10.000 UI/g
Antifungi salep, kombinasi : asam benzoat 6%+
Tube 3,477.00
asam salisilat 3%

Antihemoroid, kombinasi: bismut subgalat 150

mg + heksaklorofen 2,5 mg + lidokain lidokain Botol 3,250.00
10 mg+ seng oksida 120 mg + sup ad 2 g

Antimalaria kombinasi : sulfadoksin 500 mg +

Kaps 2,160.00
primetamin 25 mg
Artemether inj 80 mg/ml Ampul
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
Asam asetilsalisilat (asetosal) tab 80 mg Tab 89.00
Asam askorbat (vitamin C) tab 250 mg Tab 256.00
Asam askorbat (vitamin C) tab 50 mg Tab 105.00
Asam Askorbat (vitamin C) tab 500 mg Tablet 478.00
Asam folat tab 0,4 mg Tab 63.00
Asam folat tab 1 mg Tab 56.00
Asam mefenamat kaps 250 mg Kaps
Asam mefenamat kaps 500 mg Kaps 111.00
Asam salisilat lar 0,1% Botol
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab 617.00
Asiklovir tab 400 mg Tab 407.00
Atapulgit 600 mg Tab 737.00
Atenolol tab 50 mg Tab 330.00
Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00
Atropin tab 0,5 mg Tab
Bahan tumpatan sementara lar, serb Botol
Bedak salisil serb 2% Botol 6,485.00
Benzatin benzil penisilin inj 1,2jt Ampul 12,185.00
Benzatin benzil penisilin inj 2,4 jt Ampul 14,500.00
Betahistin Dihydrochloride Tab 24mg Tablet 4,945.00
Betametason krim 0,5 mg/g Tube 1,450.00
Betametason tts mata 1 mg/ml Botol 27,500.00
Bisakodil sup 10 mg Botol 5,900.00
Bisakodil sup 5 mg Botol 5,670.00
Bisakodil tab sal 5 mg Tab sal 216.00
Budesonid cairan ih 0,5 mg/ml Botol
Budesonid serb ih 100 mcg/ dosis Botol 101,000.00
Budesonid serb ih 200 mcg/ dosis Botol 106,000.00
Deksametason inj 5 mg/ml (i.v./i.m.) Vial 924.00
Deksametason tab 0,5 mg Tab 178.00
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00
Diazepam lar rektal 10 mg/2,5 ml Botol 18,277.00
Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00
Diazepam tab 2 mg Tab 45.00
Diazepam tab 5 mg Tab 108.00
Dietilkarbamazin tab 100 mg Tab
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 781.00
Digoksin tab 0,25 mg Tab 130.00
Diltiazem serb inj 50 mg Ampul 148,500.00
Diltiazem tab 30 mg Tab 133.00
Dimenhidrinat tab 50 mg Tab 108.00
Doksisiklin kaps 100 mg Kaps 280.00
Domperidon syr 5 mg/5 ml Botol
Domperidon tab 10 mg Tab
Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,515.00
Eritromisin kaps 250 mg Kaps 566.00
Eritromisin sir 200 mg/5 ml Botol 11,655.00
Eritromisin tab 500 mg tab 775.00
Etambutol tab 500 mg Tab 600.00
Etil klorida semprot 100 ml Botol 194,250.00
Etonogrestel implan 68 mg implan
Eugenol Botol 44,400.00
Fenitoin Na kaps 100 mg Kaps 158.00
Fenitoin Na kaps 30 mg Kaps 142.00
Fenitoin Sodium Inj Ampul 3,738.00
Fenobarbital tab 100 mg Tab
Fenobarbital tab 30 mg Tab 182.00
Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 400.00

Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 600.00

Fenol Gliserol tts telinga 10 % Botol 3,300.00
Fitomenadion (vitamin K 1) inj 10 mg/ml Ampul
Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,386.00
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00
Flufenazin inj 25 mg/ml Ampul 79,860.00
Fluoksetin kaps 20 mg kapsul 225.00
Framisetin sulfat tulle 1% tulle 8,990.00
Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 923.00
Furosemid tab 40 mg Tab 322.00
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 280.00
+ glukosa anhidrat 2,7 g
Glibenklamid tab 2,5 mg Tab
Glibenklamid tab 5 mg Tab 17.00
Glimepirid tab 1 mg Tab 218.00
Glimepirid tab 2 mg Tab 123.00
Glimepirid tab 3 mg Tablet 143.00
Glipizid tab 5 mg Tab
Gliseril guaiakolat tab 100 mg Tablet 110.00
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 1,500.00
Gliserin tts 10 mg/ml Botol
Gliserin tts cairan obat luar 100 mg/ml Botol
Glukosa Larutan Infus 10% steril 100 ml Botol
Glukosa Larutan Infus 10% steril 250 ml Botol
Glukosa Larutan Infus 10% steril 500 ml Botol 7,000.00
Glukosa Larutan Infus 5% steril 100 ml Botol
Glukosa Larutan Infus 5% steril 250 ml Botol
Glukosa Larutan Infus 5% steril 500 ml Botol 6,627.00
Griseofulvin (micronized) tab 125 mg Tab 210.00
Griseofulvin tab 500 mg Tablet 906.00
Haloperidol inj 5 mg/ml (i.m.) Vial 12,524.00
Haloperidol inj 50 mg/ml Ampul 101,300.00
Haloperidol tab 1,5 mg Tab 198.00
Haloperidol tab 2 mg Tab 110.00
Haloperidol tab 5 mg Tab 55.00
Hidroklorotiazid tab 25 mg Tab 200.00
Hidrokortison krim 2,5% Tube 2,325.00
Hidrokortison serb inj 100 mg/vial Vial 50,600.00
Hiosina butilbromida tab 10 mg Tab 1,900.00
Ibuprofen sir 100 mg/5 ml Botol 2,670.00
Ibuprofen sir 200 mg/5 ml Botol 4,943.00
Ibuprofen tab 200 mg Tab 105.00
Ibuprofen tab 400 mg Tab 450.00
Isosorbid dinitrat tab 5 mg Tab 190.00
Kalium diklofenak salep ( Voltadex) Tube 25,850.00
Kalsium glukonat inj 100 mg/ml Ampul 5,775.00
Kalsium laktat (kalk) tab 500 mg Tab 60.00
Kaptopril tab 12,5 mg Tab 62.00
Kaptopril tab 25 mg Tab 74.00
Kaptopril tab 50 mg Tab 125.00
Karbamazepin tab 200 mg Tab 245.00
Karbogliserin tts telinga 10 % Botol 2,500.00
Ketokonazol krim 2% tube 2,349.00
Ketokonazol scalp sol 2% Botol 25,015.00
Ketokonazol tab 200 mg Tab 288.00
Ketorolak Inj. 30 mg Ampul 3,663.00
Klindamisin tab 150 mg tab 759.00
Klindamisin tab 300 mg tab 578.00
Kloramfenikol kapsul 500 mg Kapsul 1,090.00
Kloramfenikol salep kulit 2% Tube 3,038.00
Kloramfenikol salep mata 1% Tube 9,546.00
Kloramfenikol susp 125 mg/5 ml Botol 3,955.00
Kloramfenikol tts mata 0,5% Botol 11,438.00
Kloramfenikol tts telinga 10% Botol 8,580.00
Klorfeniramin tab 4 mg Tab 110.00
Klorfenol kamfer mentol (CHKM) Botol 120,000.00
Klorheksidin 4% Botol 58,300.00
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol 105,000.00
Klorpromazin inj 25 mg/ml (i.m.) Ampul 181.00
Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,412.00
Klorpromazin tab sal 100 mg Tab sal 501.00
Klorpromazin tab sal 25 mg Tab sal 181.00
Kodein tab 20 mg Tab 1,210.00
Kodein tab 10 mg Tab 571.00
Kombinasi (DHP) tablet salut selaput :
tablet salut
dihidroartemisin 40 mg, piperakuin 320 mg
Kombinasi : artemether 20 mg + lumefantrin
Kaps
120 mg
Kombinasi : artesunat tab 50 mg + amodiakuin
Tab
tab 200

Kombinasi : deksametason asetat 0,1%, thymol

botol
5%, paraklorphenol 30 %, campor 64%

Kombinasi : Desogestrel 150 mcg Etinilestradiol

Tab
30 mcg

Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 275.00

Kombinasi : ferro fumarat 180 mg, asam folat

tablet salut 249.00
0,4 mg
Kombinasi : levonorgestrel 150 mcg +
Tab 1,350.00
etinilestradiol 30 mcg
Kombinasi : sulfadoksin 500 mg, pirimetamin 25
kapsul
mg
Kombinasi : triamsinolon asetonit,
pasta
dementilklortetrasiklin
Kombinasi: difenhidramin 2%, kalamin 5%, zinc
botol lotion 15,200.00
10%, gliserin 5%
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Botol 3,502.00
2,5 mg nebules
Kombinasi Kaolin 700 mg, Pektin 50 mg tablet Tablet
715.00

Kombinasi: lidokain, medisinal creosote phenol,

botol
eugenol, benzil alkohol
Komposit resin Set

Kotrimoksazol (dewasa) kombinasi :

Tab 126.00
sulfametoksazol 400 mg+ trimetoprim 80 mg
Kotrimoksazol (dewasa) kombinasi :
Tab 325.00
sulfametoksazol 800 mg+ trimetoprim 160 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

suspensi : sulfametoksazol 200 mg + Botol 6,930.00
trimetoprim 40 mg

Larutan mengandung Elektrolit (Kalium Klorida) Botol

Larutan mengandung Elektrolit (Na 130 mEq,

Botol 9,275.00
Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq)

levofloksasin 500 mg Tablet 409.00

Levonorgestrel implan 2 rods, 75 mg (3-4
Set
tahun)
Lidokain gel 2% Tube
Lidokain inj 2% (HCl) Ampul 847.00
Lidokain salp 5 % Tube
Lidokain spray oral 10% Botol 177,216.00
Lisinopril tab 10 mg Tab 139.00
Loratadin tab 10 mg Tab 109.00
Magnesium sulfat inj 20% Vial 3,580.00
Magnesium sulfat inj 40% Vial 4,090.00
Mebhydroline napadisylate 50 mg (Interhistin) Tab
Meloxicam 15 mg Tab 1,377.00
Metformin tab 500 mg Tab 77.00
Metformin tab 850 mg Tab 185.00
Methisoprinol 500 mg Tab 3,510.00
Metilergometrin inj 0,2 mg/ml Ampul 1,032.00
Metilergometrin tab salut 0,125 mg Tab sal 214.00
Metilprednisolon tab 4 mg Tab 134.00
Metoklopramid tab 10 mg Tab 66.00
Metoklopramid tab 5 mg Tab 115.00
Metronidazol lar inf 5 mg/ml Botol 8,110.00
Metronidazol sir 125 mg/5 Ml Botol 3,950.00
Metronidazol tab 250 mg tab 89.00
Metronidazol tab 500 mg tab 133.00
Mikonazol krim 2% Tube 1,900.00
Mikonazol serb 2% Tube 25,500.00
NaCl 0,9% Larutan 500 ml Botol 6,800.00
N-asetil sistein kaps 200 mg kapsul 1,095.00
Natrium bikarbonat tab 500 mg tab
Natrium diklofenak tab 25 mg Tab 145.00
Natrium diklofenak tab 50 mg Tab 99.00
Natrium hipoklorit cairan konsentrat 5% Botol 75,000.00
Natrium hipoklorit tetes mata 1 mg/ml botol
Natrium tiosulfat inj 25% (i.v.) Ampul
Nifedipin kaps 10 mg Kaps 244.00
Nistatin susp 100.000 UI/ml Botol 30,613.00
Nistatin tab 500.000 UI tablet salut 745.00
Nistatin tab vaginal 100.000 UI Tab 760.00
Obat Anti Tuberculosis FDC Kategori Anak Paket 248,010.00
Obat Anti Tuberculosis FDC Kategori I Paket 415,469.00
Obat Anti Tuberculosis FDC Kategori II Paket 1,384,983.00
Obat Anti Tuberculosis FDC Kategori Sisipan Paket 159,985.00
Obat Anti Tuberculosis KDT Dosis Harian Paket 402,688.00
Obat Anti Tuberculosis Kombipak Dewasa Paket 317,018.00
Obat Malaria Tab 1,900.00
Oksitetrasiklin 1% salep mata Tube 3,500.00
Oksitosin inj 10 UI/ml Ampul 1,126.00
Olopatadin tts mata 0,1% Botol 72,500.00
Omeprazol inj 40 mg/10 ml Vial 5,047.00
Omeprazol kaps 20 mg Kaps 462.00
Ondansetron 4 mg Tab Tab 1,760.00
Ondansetron Inj. 4 mg/2ml Ampul 1,070.00
Parasetamol drop 100 mg/ml botol 4,976.00
Parasetamol sir 120 mg/5 ml Botol 1,181.00
Parasetamol tab 500 mg Tab 259.00
Pasta devitalisasi (non arsen) Tube 600,000.00
Pasta pengisi saluran akar (pasta) Tube 420,000.00
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube 24,090.00
Permetrin krim 5 % Tube 11,250.00
Pirantel pamoat susp 125 mg/5 ml Botol
Pirantel pamoat tab scored 125 mg Tab 291.00
Pirantel pamoat tab scored 250 mg Tab
Pirazinamid tab 500 mg Tab
Piridoksin (vitamin B6) inj 100 mg/ml Ampul
Piridoksin (vitamin B6) tab 10 mg Tab 67.00
Piridoksin (vitamin B6) tab 25 mg Tab 222.00
Povidon iodin lar 100 mg/ml Botol 30 ml 2,163.00
Povidon iodin lar 100 mg/ml Botol 60 ml 23,890.00
Povidon iodin lar 100 mg/ml Botol 300 ml 18,000.00
Povidon iodin lar 100 mg/ml Botol 1000 ml
Prazikuantel tab 600 mg tab
Prednison tab 5 mg Tab 73.00
Primakuin tab 15 mg Tab 235.00
Probenesid tab 500 mg Tab 1,780.00
Propiltiourasil tab 100 mg Tab 429.00
Propranolol tab 10 mg Tab 106.00
Pyrimetamine 25 mg Tab 1,320.00
Ranitidin Inj. 25 mg/ml Ampul 814.00
Ranitidin tab 150 mg Tab 216.00
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 308.00
Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 553.00
Ringer Laktat Larutan Botol 7,630.00
Risperidon tab 2 mg tab 123.00
Salbutamol cairan ih 0,1% Botol 4,000.00
Salbutamol tab 2 mg Tab 120.00
Salbutamol tab 4 mg Tab 83.00
Salep 2-4, kombinasi : asam salisilat 2 %+
Tube 1,410.00
belerang endap 4 %
Salep kombinasi : Betametason 1 mg + Tube 14,823.00
Neomisin sulf
Serum anti bisa ular : A.B.U. I (khusus ular dari
Vial 517,132.00
luar ) inj (i.m./i.v.) Papua
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m
Vial 2,528,900.00
10.000 UI/
Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 140,187.00
Setirizin sir 5 mg/5 ml. Botol 2,090.00
Sianokobalamin (vitamin B12) inj 500 mcg Ampul 969.00
Sianokobalamin (vitamin B12) tab 50 mcg Tab 63.00
Simvastatin tab sal 10 mg Tab sal 68.00
Simvastatin tab sal 20 mg Tab sal 150.00
Siprofloksasin tab scored 500 mg Tab 248.00
Siprofloksasin tetes mata 3 mg/ml botol 20,000.00
Spironolakton tab 25 mg Tab 2,954.00
Streptomisin serb inj 1.000 mg/vial Vial 7,000.00
Sulfadiazin tab 500 mg tab
Surgical ginggival pack Tube
Terbutalin Sulfat 1,5 mg/5ml Ampul 6,459.00
Terbutalin inj 0,5 mg/ml Ampul
Tetrahydrozoline HCl (Visto) Tetes Mata Botol 12,826.00
Tetrakain tts mata 0,5% Botol 11,500.00
Tetrasiklin kaps 250 mg Kaps 163.00
Tetrasiklin kaps 500 mg Kaps 303.00
Thiamfenikol 500 mg Kaps 297.00
Thiamfenikol sirup Botol 11,000.00
Thiamin tab 50 mg tab 70.00
 Triheksifenidil tab 2 mg Tab 63.00
Tuberkulin protein purifed derivate serb inj 2
ampul 900,000.00
TU/0,1 ml
Urea krim 20% tube 6,809.00
Vaksin BCG inj (i.k) Vial 97,780.00
Vaksin campak inj (s.k.) Vial 28,204.00
Vaksin Hepatitis B imunoglobulin (human) inj
Ampul 23,490.00
0,5 ml (HBO) Uniject
Vaksin Human Papiloma Virus (HPV) Vial 161,036.00
Vaksin Influenza Vial 88,800.00
Vaksin IPV Injeksi 0,5 ml Vial 142,793.00
Vaksin jerap difteri tetanus (Td) Vial
Vaksin jerap difteri tetanus pertusis (DTP) inj
Vial 17,450.00
(i.m.)
Vaksin Jerap DT (Absorbed DT Vaccine) Cairan Vial 17450
Injeksi (40+15) lf/ml
Vaksin Jerap TD (Absorbed TD Vaccine) Cairan
Vial 16995
Injeksi (4+15) lf/ml
Vaksin jerap tetanus (tetanus adsorbed toxoid)
Vial
inj (i.m.)
Vaksin kombinasi DPT-HB-Hib Vial
Vaksin Measles Rubella (MR) Vial 152,600.00
Vaksin Meningitis Vial 135,000.00
Vaksin PCV Vial
Vaksin Pentabio DPT-HB-HIB Injeksi 2,5 ml Vial 85,103.00
Vaksin Polio B-OPV drops 10 dosis Vial 19,540.00
Valproat sir 250 mg/5 ml Botol 15,789.00
Valproat tab sal 250 mg Tab sal 2,800.00
Vitamin B kompleks Tab 57.00
Zinc Drop 10 mg/ml Botol 5,051.00
Zinc sir 20 mg/5 ml Botol 2,489.00
Zinc tab disp 20 mg Tab 208.00
OBAT PKD DILUAR FORNAS
1 Asiklovir krim tube 3,758.00
2 Kombinasi Dekstrometorphan syrup botol 11,550.00
3 Kombinasi Dekstrometorphan tablet tablet 389.00
4 Metamizol Na Inj. 500 mg/2ml Ampul 2,407.00
5 Metampiron tab 500 mg Tab 290.00
6 Metoklopramid inj 5 mg/ml Ampul 3,960.00
7 Obat Batuk Hitam Botol 4,389.00
8 Pirasetam inj 1g/5ml ampul 26,125.00
9 Sefotaksim serbuk inj 1 g vial 4,898.00
OBAT KHUSUS UNTUK PENYAKIT JIWA
1 Alprazolam tab 1 mg tablet 1,540.00
2 Clozapin tab 100 mg tablet 997.00
3 Clozapin tab 25 mg tablet 1,550.00
4 Clobazam tab 10 mg tablet 970.00
5 Lorazepam tab 2 mg tablet 715.00
6 Metadon HCl 50 mg/5 ml btl 1 L 275,000.00
7 Trifluoroperasin tab 5 mg tablet 220.00
8
OBAT PMS/AIDS
1 Dolutegravir 50 mg tablet 70.00
2 Efavirenz tab 300 mg tablet
3 Efavirenz tab 600 mg tablet 7,050.00
4 Kombinasi tab Lopinavir 200 mg + Ritonavir 50 tablet 5,150.00
Kombinasi tab Tenofovir 300 mg + Lamivudin
tablet 3,499.00
5 300 mg + Dolutegravir 50 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 10,115.00
6 Emiricitabine 200 mg
Kombinasi tab Tenofovir tab 300 mg +
tablet 6,800.00
7 Lamivudine 300 mg + Efivirenz 600 mg
Kombinasi tab Zidovudin 300 mg + Lamivudin
tablet 3,848.00
8 150 mg
9 Lamivudin tab 150 mg tablet 1,640.00
10 Nevirapin tab 200 mg tablet 2,415.00
11 Tenofovir tab 300 mg tablet 2,240.00
12 Zidovudin kaps 100 mg tablet 1,583.00
OBAT PROGRAM
1 Azitromisin tab 500 mg tablet 1,900.00
2 Cefiksim tab 100 mg tablet 590.00
3 Curcuma tab 200 mg (Hepato Protektor) tablet 7,600.00
4 Gentamisin inj 40 mg/ml ampul 3,399.00
5 Isoniazid tab 300 mg tablet 150.00
6 Mineral Mix sachet 2,695.00
7 Oseltamivir/Tamiflu 75 mg tablet 0.00
8 Rifampisin 75 mg + Isoniazid 50 mg (3HR) tablet 979.00
9 Rifapentin 300 mg + Isoniazid 300 mg (3HP) tablet 6,546.00
10 Taburia sachet 1,000.00
11 Vitamin Syrup botol 60ml 11,000.00
BAHAN MEDIS HABIS PAKAI
1 ADS 0,05 ml pcs 1,460.00
2 ADS 0,5 ml pcs 1,190.00
3 ADS 10 ml pcs 1,106.00
4 ADS 20 ml pcs 1,887.00
5 Alat suntik 1 ml pcs 687.00
 6 Alat suntik 2.5 ml pcs 1,000.00
7 Alat suntik 3 ml pcs 569.00
8 Alat suntik 5 ml pcs 1,439.00
9 Alkohol Swab pcs 300.00
10 APD paket 385,000.00
11 Besturi Mess pcs
12 Blood lancet kotak 100 pcs 8,900.00
13 Blood Tranfusion set pcs 17,595.00
14 Catgut Chromic sachet 919.00
15 Catgut Plain sachet 1,235.00
16 Catton Aplikator Steril kotak 100 pcs 3,025.00
17 Coper Glass kotak 50 biji 71,500.00
18 Foley Cateter No.16 &18 pcs 19,869.00
19 Gel EKG botol
20 Handschoon steril No.6,7 pasang 6,600.00
21 Handschoon non steril nitril Ukuran S box/100
22 Handschoon non steril latex pcs 1,190.00
23 I.V. Cateter 18,20,22 pcs 5,838.00
24 Infus Set anak buah 20,900.00
25 Infus Set dewasa buah 14,850.00
26 Jarum jahit sachet 12 pcs
27 Kapas Adsorb. 250 g roll 16,000.00
28 Kapas berlemak 500 g roll
29 Kassa 36 m x 80 cm roll
30 Kassa elastis 4 x 10 cm roll
31 Kassa Kompres 40x40 roll 1,447.00
32 Kassa pembalut 2mx80cm roll
33 Kassa pembalut 4mx15cm roll 4,003.00
34 Kassa steril 16 x 16 box/16 6,200.00
35 Kertas Lensa Pack 48,400.00
36 Kertas Printer buah 28,750.00
37 Kertas saring lembar 15,000.00
38 Klorheksidin 4% botol
39 Kondom pcs 448.00
40 Lubricant Jelly pcs 331.00
41 Lysol botol 1 liter 41,000.00
42 Masker pcs 700.00
43 Nasal canula buah 6,600.00
44 Nasal oksigen pcs 6,453.00
45 Nurse Cap buah 369.00
46 Obyek Glass box 72 22,247.00
47 Pembungkus puyer/medicine pocket lbr 250.00
48 Plester 5 Yard x 2 inch Rol
49 Plester bulat transparan Pcs 1,014.00
50 Pot sputum pcs 2,275.00
51 Safety box biji 16,500.00
52 Salisil Spirtus 10 % botol
53 Sendok takar pcs
54 Silk 3/0 pcs 15,229.00
55 Softa-Man 100 ml botol 100 ml 32,000.00
56 Softa-Man 500 ml botol 500 ml 65,500.00
57 Stik pemeriksaan asam urat
58 Stik pemeriksaan gula tes 3,200.00
59 Stik pemeriksaan kolesterol
60 Sunclin 1 Liter botol 1 liter
61 Tensoplass Dewasa kotak/100
62 Umbilical cord pcs 2,750.00
63 Underpad pcs 3,885.00
64 Urine Bag pcs 4,235.00
REAGEN
Kit ukuran 4 x 60
Albumin
1 ml
2 Aquabidest 1 lt botol 1 lt 20,000.00
3 Blue Tipp biji 227.00
4 BTA Zehl Neelsen kit 176,760.00
5 Combina - 3 (Urinalisys) tube/100 tes 86,000.00
30 Eter Alkohol botol 70,000.00
31 HBS Ag Stick/anti HbsAg strip 185,475.00
Kit ukuran 4 x 38
HDL Cholesterol 6,015,130.00
32 ml, 4 x 11 ml
33 Hidrogen Peroksida (H2O2) botol 1 liter 20,570.00
39 Larutan Etanol Asam botol 67,850.00
40 Larutan Karbol Fuksin Botol 100 ml 67,850.00
41 Larutan Air Fuksin botol 100 ml
42 Larutan Ammon.Oksalat Botol 100 ml
43 Larutan Anisol Botol 100 ml 402,500.00
44 Larutan As.Sulfos. 20 % Botol 100 ml 273,600.00
45 Larutan Asam Asetat Botol 100 ml 4,400.00
46 Larutan Barium Kloride Botol 100 ml 34,200.00
47 Larutan Benedict Botol 100 ml 19,950.00
48 Larutan Brand Spirtus Botol 100 ml 55,000.00
49 Larutan Carbol Gentian Violet Botol 100 ml
50 Larutan Cat Wright Botol 50 ml 207,100.00
51 Larutan EDTA Botol 250 ml 184,000.00
52 Larutan Eosin Botol 100 ml 176,225.00
53 Larutan Etanol 70 % Botol 100 ml 40,250.00
54 Larutan Fauchet Botol 100 ml 175,750.00
55 Larutan Gabbet Botol 100 ml
56 Larutan Giemsa Stain Botol 100 ml 356,250.00
57 Larutan Gram Set Botol
58 Larutan Hayem Botol 100 ml 29,450.00
59 Larutan Hcl.0.1 N Botol 250 ml
60 Larutan Iodium 1 % Botol 100 ml
61 Larutan Kinyoun Botol 100 ml 82,500.00
62 Larutan KOH Botol 100 ml 20,900.00
63 Larutan Lugol Botol 100 ml
64 Larutan Metanol Botol 100 ml 46,000.00
65 Larutan Metilen Biru Botol 100 ml 67,850.00
66 Larutan Minyak Emersi Botol 100 ml 650,000.00
67 Larutan Na.Citrat 3.8 N botol
68 Larutan Schlesinger Botol 100 ml
69 Larutan Turk Botol 100 ml 60,950.00
70 LDL Cholesterol ukuran 4 x 23 ml, 4 x 7 ml 6,982,030.00
71 Lysoglobin H 18 Light botol 500 ml
72 Mangan kit 250 tes 6,982,030.00
73 Medonic Series Dilud botol 20 liter 0.00
74 Medonic Series Lyse botol 5 liter 0.00
75 Microcuvete Heamocue 301 box/200 stik 0.00
76 Nitrit kit 335 tes 2,980,000.00
77 PH Paper box 100 strips 300,000.00
78 Poch Pack D (II) Sysmex botol 5 liter 0.00
79 Poch Pack L (II) Sysmex botol 500 ml 0.00
80 Podophilli tct 10 % botol 0.00
81 Rees Ecker 100 Ml Botol 100 ml 46,550.00
82 Rinse Solution kit 0.00
83 RPR test kit kit 30,000.00
84 Sarung Tangan Karet pasang 17,175.00
85 SGOT Kit ukuran 4 x 21 ml, 4 x 6 ml 521,070.00
86 SGPT Kit ukuran 4 x 36 ml, 4 x 9 ml 521,070.00
87 Shipilis Intech box 40 test 0.00
88 Shipilis SD kotak 10,667.00
89 Spectroquant Total Hardness box 25 test 3,142,950.00
90 Sulfat kit 200 tes 5,490,000.00
91 Sulfide kit 220 tes 4,020,000.00
92 Tabung Vacuum EDTA (purple top) box/100 pcs 169,092.00
93 Tabung Vacuum Plain (Red top) box/100 pcs 169,092.00
94 TCA botol 0.00
95 Tes Mantox (PPD RT 23) ampul 770,000.00
96 Test Gol.Darah A,B,O set 4 vial/10 ml 116,600.00
 97 Test Gula urine pcs 1,045.00
98 Test Kehamilan pcs 1,900.00
99 Total Protein kit 6x 100ml 2,097,470.00
100 Trigliseric Kit ukuran 6 x 20 ml 2,464,440.00
101 Uric Acid kit 8 x 20 ml 1,632,510.00
102 Urine Analisis 10 SG Mission Exp tube 253,000.00
103 Urine Rapid Test tes 0.00
104 Vacum needle box/50 pcs 130,000.00
105 Vaselin pot 0.00
106 Waste Plastik lembar 0.00
107 Widal set/4 x 5 ml 561,000.00
108 X-Ray (Developer) botol 0.00
109 X-Ray (Fixer) botol 0.00
110 Xylol botol 0.00
111 Yellow Tipp biji 176.00
112 Zeng kit 3,410,000.00
CETAK
1 Buku register obat buku 38,500.00
2 Buku resep buku 7,970.00
3 Kartu gudang lembar 1,320.00
4 Kartu stok lembar 743.00
5 Plastik obat (klip) pcs 48.00
6 Etiket pcs 23.00
7 Plastik sablon pcs 415.00
8 Tas plastik sablon pcs 415.00
OBAT PKD DILUAR FORNAS YANG MASIH ADA STOK
1 Bisoprolol fumarat tab 5 mg tablet 654.00
2 Bromheksin HCl tab 8 mg tablet 139.00
3 Etakridin 0,1 % botol 5,358.00
4 Fenobarbital inj 50 mg/ml ampul 1,800.00
5 Gelofusin botol 500 ml 101,776.00
6 Gentian violet 1 % larutan botol 900.00
7 Gliseril Guaiakolat tab 100 mg tablet 8,100.00
8 Glukosa 40 % botol 500 ml 6,900.00
9 Haloperidol tab 0,5 mg tablet 59.00
10 Hiosin N Butilbromid inj 20 mg/ml ampul 1,900.00
11 Neomisin sulfat 5 mg tube
12 Kotrimoksazole tab 120 mg tablet
13 Loperamide tab 2 mg tablet
14 Metampiron inj 250 mg/ml ampul
15 OBH Plus botol
16 Oksitetra salep kulit 3 % tube
17 Oksitetra salep mata 15 % tube
18 Pirasetam tab 800 mg tablet
19 Piroksikam kaps 20 mg kapsul
20 Ranitidin inj 25 mg / 2 ml ampul 1,215.00
21 Salep kombinasi : Betametason 1 mg + Neomisin tube 14,823.00
22 Prednisolon 2,5 mg tube
23 Salep Triamcinolon asetonid tube
24 Seftriakson inj 1 gr vial
25 Setirizin tab 10 mg tablet 1,945.00
26 Simetidin inj 100 mg ampul
27 Simetidin tab 200 mg tablet
28 Sulfasetamid tetes mata 15 % botol
29 Telimsartan tab 40 mg tablet
30 Thiamfenikol sirup botol
31 Tramadol tab 50 mg tablet
32 Vitamin tab kombinasi tablet
LAIN-LAIN
1 Alat Laboratorium Malaria paket 1,472,268.00
2 Box slide pcs 77,690.00
3 Cartridge Genexpert pcs 252,400.00
4 Feeding Tube no. 6 pcs 7,370.00
5 Feeding Tube no. 8 pcs 7,370.00
6 Handhschoon obgyn pasang 38,720.00
7 HIV 1 (SD, Indec) Tes 11,500.00
8 HIV 2 Tes 11,500.00
9 HIV 3 Tes 10,500.00
10 HIV/Siphillis Duo tes 17,724.00
11 Iodin tes tes kit 31,650.00
12 MDT MB Anak blister 20,207.00
13 MDT MB Dewasa blister 28,424.00
14 MDT PB Anak blister 8,891.00
15 MDT PB Dewasa blister 8,891.00
16 Mucus extrator bh 7,040.00
17 Obat Anti Malaria ampul 4,216.00
18 Paket Obat Bencana paket 2,400,000.00
19 Prontosan botol 164,000.00
20 Rapid Syphilis ktk/100 2,790,000.00
21 RDT DBD COMBO tes 110,089.00
22 RDT Malaria tes 19,854.00
23 Reagen penghitung CD4 C tes
24 Reagen penghitung CD4 M tes 154,440.00
25 RPR Syphilis kit/500 pcs 3,987,500.00
26 Stabimed botol 620,000.00
27 Alat suntik JPS 3 ml biji 1,210.00
28 Diluent 5P 20 liter box 1,500,000.00
29 Lyse 1 Liter botol 1,450,000.00
30 Cleaner 1 Liter botol 285,000.00
31 Blood Control CBC 3D Normal 2 ml vial 380,000.00
32 Speculum vagina Disposible S Buah 12,650.00
33 Speculum vagina Disposible M Buah 12,650.00
 USULAN
KEBUTUHAN TH TOTAL Rp
2023
(8) (9)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0
0 0

0 0

0 0

0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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Kepala UPTD Puskesmas Berbek

dr. Rita Trisariningrum

NIP. 19800907 20093 2 001