Nama Pabrik Obat

PRAKIRAAN USULAN JUMLAH KEBUTUHAN OBAT INSTALASI FARMASI TAHU
NO. NAMA OBAT SPESIFIKASI NAMA DAGANG SAT
ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI NON STEROID DAN ANTIPIRAI

Analgetik Narkotika
Alprazolam Tablet 0.5 mg N/A Tab

1
Fentanil Injeksi 0.05 mg/mL, 2 mL N/A Amp

2
Fentanil Patch 25 mcg/ h Durogesik patch Pcs

3
Klobazam Tablet 10 mg N/A Tab

4
Kodein Tablet 10 mg N/A Tab

5
Lorazepam Tablet 0.5 mg Merlopam Tab

6
Lorazepam 2 mg N/A Tab

7
Morfin Injeksi 10 mg/mL N/A Amp

8
Petidin HCl Injeksi 50 mg/ mL, 2 mL N/A Amp

9
Analgetik Non Narkotika
Asam Mefenamat Kaplet 500 mg N/A Tab

1
Dexketoprofen Trometamol Injeksi 25 mg/ mL, 2 mL Lantidex Amp

2
Ibuprofen Tablet 400 mg N/A Tab

3
Ibuprofen syr 200mg/5ml,60ml N/A Botol

4
Ketoprofen Suppositoria 100 mg Suprafenid Suppo

5
ketoprofen Tablet 100 mg N/A Tab

6
Ketorolak Injeksi 30 mg/mL N/A Amp

7
Metamizol injeksi 500 mg/ mL, 2 mL N/A Amp

8
Meloksikam Tablet 15 mg N/A Tab

9
Meloksikam Tablet
10 7.5 mg N/A Tab
Natrium Diklofenak Tablet 50 mg N/A Tab

11
Natrium Diklofenak Tablet 25 mg N/A Tab

12
10 mg/ mL, 100
Parasetamol Infus N/A Botol
mL
13
Parasetamol OD 60 mg/mL, 15 mL Botol

14
Parasetamol Sirup 120 mg/mL, 60 mL N/A Botol

15
Parasetamol Suppositoria 250 mg Pamol Supp

16
Parasetamol Suppositoria 160 mg Pyrexin Suppo

17
Parasetamol Suppositoria 125 mg Pamol Suppo

18
Parasetamol Tablet 500 mg N/A Tab

19
Tramadol Injeksi 50 mg/mL N/A Amp

20
Tramadol Kapsul 50 mg Dolgesic Kaps

21
Antipirai
Alopurinol Tablet 100 mg N/A Tab

1
Alopurinol Tablet 300 mg N/A Tab

2
ANASTETIK DAN OBAT PROSEDUR PREOPERATIF
Anastetik Lokal
1 N/A Btl
Etil Klorida 100ml Spray
Komb Bupivakain dan Glukosa Injeksi 5 mg/ mL; 8% Bunascan Spinal Amp
2
3 Levobupivakain Injeksi 5 mg/ mL, 10 mL levica Amp
Lidocain HCl Injeksi 20 mg dan Epinefrin

2 mL Pehacain Amp
12.5 mcg
4
5 Lidokain HCl Gel 2%, 10 g Xylocain Tube
Lidokain HCl Injeksi 20 mg/ mL N/A Amp

6
7 Lidokain HCl Oral Spray 10 mg/ dosis Xylocain Btl
8 Mepicavain 2%, Adrenalin 1:1000 N/A Amp
Anastetik Umum dan Oksigen

Isofluran Ih 250 mL Forane Btl
1
Sevofluran 250 ml Sojourn Botol

2
Tiopental Sod Serbuk Injeksi 500 mg N/A Vial

3
Ketamin Injeksi 100 mg/ mL, 10 mLKTM Vial

4
Propofol Injeksi 1%, 20 mL N/A Amp

5
Obat Prosedur Pre Operatif
Atropin Sulfat Injeksi 0.25 mg/ mL N/A Amp

1
Midazolam HCl Injeksi 1 mg/ mL, 5 mL Fortanest Amp

2
Midazolam HCl Injeksi 5 mg/ mL, 3 mL Fortanest Amp

3
Antihistamin dan Antianafilaksi
Deksametason Injeksi 5 mg/ mL N/A Amp

1
Deksametason Tablet 0.5 mg N/A Tab
2
Difenhidramin Injeksi 10 mg/ mL N/A Amp

3
Epinefrin Injeksi 1 mg/ mL N/A Amp

4
Klorfeniramin Maleat Tab 4 mg CTM Tab

5
Granisentron HCI Injeksi 1 mg/ mL Granesis

6 Amp
Loratadin Tablet 10 mg N/A Tab

7
Setirizin HCl Sirup 5 mg/ 5 mL LERIXIN Botol

8
Setirizin HCl Tablet 10 mg N/A Tab

9
ANTIDOTUM
Khusus
Efedrin HCl Injeksi 50 mg/ mL N/A Amp

1
Kalsium Glukonat Injeksi 100 mg/ mL, 10 mLN/A Amp

2
Kalsium Polistiren Sulfonat
3 5 gr N/A Sach
Nalokson Injeksi 0.4 mg/mL Nokoba Amp

4
Natrium Bikarbonat Injeksi 8.4 %, 25 mL Meylon Flc

5
Natrium Bikarbonat Tablet 500 mg N/A Tab

6
Neostigmin Injeksi 0.5 mg/ mL N/A Amp

7
ANTIINFEKSI
Antelmintik
Albendazol Tablet
1 400 mg N/A Tab
Antibiotika Beta Laktam
Amikasin Sulfat Injeksi 250 mg/ mL N/A Vial

1
Amoksisilin DS 125 mg/ 5 mL, 60 mN/A Botol

2
Amoksisilin Kaplet 500 mg N/A Tab
3
Amoksisilin OD 100 mg/ mL, 15 mLAmoxan Btl

4
Amoksisilin dan Klavulanat DS 125 mg; 31.25 mg/ Clanexi Botol

5
Amoksisilin dan Klavulanat Injeksi 1g; 0.2 g Clanexi Vial

6
Amoksisilin dan Klavulanat Kaplet 500 mg; 125 mg Clanexi Kaps

7
Ampisilin dan Sulbaktam Injeksi 500 mg; 250 mg; 75Bactesyn Vial
8
Ampisilin Injeksi
9 1g N/A Vial
Meropenem Injeksi 0.5 g N/A Vial

10
Meropenem Injeksi 1g N/A Vial

11
Sefadroksil DS 125 mg/ 5 mL, 60 mN/A Botol

12
Sefadroksil Kapsul 500 mg N/A kapsul

13
Sefepime Injeksi 1g N/A Vial

14
Sefiksim DS 100 mg/ 5 mL, 30 mN/A Botol

15
Sefiksim Kapsul 100 mg N/A Tab
16
Sefotaksim Injeksi 1g N/A Vial

17
Seftazidim Injeksi 1g N/A Vial

18
Seftriakson Injeksi 1g N/A Vial

19
Sefazolin Injeksi 1g N/A Vial

20
Antibiotika Golongan Kloramfenikol
Kloramfenikol Salep Mata 1% N/A Tube

1
125mg/5mL
2 Kloramfenikol suspensi N/A Btl
Antibiotika Golongan Makrolid
Azitromisin Kaplet 500 mg N/A Tab

1
Azitromisin vial 0.5q N/A Vial

2
Eritromisin Ds 125 mg/ 5 mL, 60 mEryra Botol
3
Eritromisin Kaplet 500 mg N/A Kapl

4
Klindamisin Kapsul 150 mg N/A Kaps

5
Klindamisin Kapsul 300 mg N/A Kaps

6
Spiramisin Tablet
7 500 mg N/A Tab
Antibiotika Aminoglikosida
Gentamisin Injeksi 40 mg/ mL, 2 mL Sagestam 40 Amp

1
Gentamisin Salep Kulit 0.1%, 5 g N/A Tube

2
Gentamisin Salep mata 3 mg/ g; 3.5 mg N/A Tube

3
Gentamisin Tetes Mata

4 0.3%, 5 mL N/A Btl
Metronidazol Infus 5 mg/ mL, 100 mL N/A Botol

5
Metronidazol Tablet 500 mg N/A Tab
6
Antibiotika Golongan Kuinolon
Levofloksasin Infus 5 mg/ mL, 100 mL N/A Botol

1
Levofloksasin Tablet 500 mg N/A Tab

2
Moksifloksasin Infus 1.6 mg/ mL, 250 mLGarena Btl

5
Ofloksasin Tablet 200 mg N/A Tab

6
Ofloksasin Tablet 400 mg N/A Tab

7
Siprofloksasin Infus 2 mg/ mL, 100 mL N/A Btl

8
Siprofloksasin Tablet 500 mg N/A Tab

9
Etambutol tablet 500 mg N/A Tab

1
Rifampisin Kaplet 450 mg N/A Kapl

2
Rifampisin Kaplet 600 mg N/A Kapl
3
Antivirus
Asiklovir Krim 5%, 5 g Tube Krim

1
Asiklovir Tablet 400 mg N/A Tab

2
Asiklovir Tablet 200 mg N/A Tab

3
Antibiotika Golongan Sulfonamida
Kotrimoksazol DOEN I: Sulfametoksazol

400 mg/ 80 mg N/A Tab
dan Trimetoprim
1
Kotrimoksazol DOEN II Suspensi:

200 mg; 40 mg/ 5 N/A Btl
Sulfametoksazol dan Trimetoprim
2
ANTIFUNGI
Oral
Flukonazol Infus 2,0 mg/ml N/A BOTOL
1
Ketokonazol Krim 2%, 10 g N/A Tube

2
Ketokonazol Tablet 200 mg N/A Tab

3
Nistatin OD 100.000 IU/ mL, 12 Nymiko Botol

4
Nistatin Tablet Vagina 100.000 IU

5 N/A Tab
HORMON, ANTIHORMON, IMUNOSUPRESAN DAN SITOTOKSIK
Hidroksi Urea Kaplet 500 mg Medac Tab

1
Hidrokortison Injeksi 100 mg Fartison Vial

2
Hidrokortison Krim 2.5%, 5 g N/A Tube

3
Metil Prednisolon Injeksi 500 mg N/A Vial

4
Metil Prednisolon Injeksi 125 mg N/A Vial

5
Metil Prednisolon Tablet 4 mg N/A Tab

6
Metil Prednisolon Tablet 16 mg N/A Tab
7
Mikofenolat Mofetil Tablet 500 mg Cellcept Tab

8
Prednison Tablet 5mg N/A Tab

9
HORMON TIROID DAN ANTI TIROID
Tiamizol Tablet 10 mg Thyrozol Tab

1
Levotiroksi 50 mg 50 mg Eutyrox Tab

2
Propiltiourasil Tablet 100 mg N/A Tab

3
HORMON REPRODUKSI DAN OKSITOSIK
Hormon Reproduksi
Alilestrenol Tablet 5 mg Preabor Tab

1
Bromokriptin mesilat 2.5 mg cripsa Tab

2
Klomifen sitrat 50 mg Blesifen Tab
3
Progesteron 200 mg Microgest Tab

4
Noretisteron Tablet 5 mg Noresteril Tab

5
Oksitosik
Misoprostol Tablet 200 mcg Invitec Tab

1
Oksitosin Injeksi 10 IU/ mL N/A Amp

2
DIURETIK DAN ANTIDIURETIK
Diuretik
Furosemid Injeksi 10 mg/ mL N/A Amp

1
Furosemid Tablet 40 mg N/A Tab

2
Hidroklortiazid Tablet 25 mg HCT Tab

3
Manitol Infus 250ml N/A Plabot
4
Manitol Infus 20%, 500 mL N/A Botol

5
Spironolakton Tablet 25 mg N/A Tab

6
Spironolakton Tablet 100 mg N/A Tab

7
Antidiuretik
Vasopresin Injeksi 20 IU/ mL Farpresin Vial

1
OBAT KARDIOVASKULAR
Antiangina
Amiodaron HCl Injeksi 50 mg/ mL, 3 mL N/A Amp

1
Amiodaron HCl Tablet 200 mg Kendaron Tab

2
Diltiazem HCl Tablet 30 mg N/A Tab

3
Digoksin Injeksi 0.25 mg/ mL Fargoxin Amp
4
Digoksin Tablet 0.25 mg N/A Tab

5
Gliseril Trinitrat Kapsul SR 2.5 mg Nitrokaf Retard Tab

6
Isosorbid Dinitrat Tablet 5 mg ISDN Tab

7
Isosorbid Dinitrat Injeksi 1 mg/ml Fasorbid Vial

8
Nitrogliserin Injeksi 1 mg/ mL, 10 mL NTG Amp

9
Propanolol Tablet 40 mg N/A Tab

10
Propanolol Tablet 10 mg N/A Tab

11
Antihipertensi
Amlodipin Tablet 10 mg N/A Tab

1
Amlodipin Tablet 5 mg N/A Tab

2
Bisoprolol Tablet 5 mg N/A Tab

3
Bisoprolol Tablet 2,5 mg N/A Tab
4
Irbesartan Tablet 150 mg

5 N/A Tab
Irbesartan Tablet 300 mg

6 N/A Tab
Kaptopril Tablet 50 mg N/A Tab

7
Kaptopril Tablet 25 mg N/A Tab

8
Kaptopril Tablet 12.5 mg N/A Tab

9
Klonidin Tablet 0.15 mg N/A Tab

10
Klonidin Injeksi 150 mcg/ mL N/A Amp

11
Metildopa Tablet 150 mg Dopamet Tab

12
Nebivolol Tablet 5 mg Nebilete Tab

13
Nifedipin Tablet 10 mg N/A Tab

14
Nikardipin HCl Injeksi 1 mg/ mL, 10 mL N/A Amp

15
Nimodipin Tablet 30 mg N/A Tab

16
Valsartan Tablet 80 mg Diovan Tab
17
Valsartan Tablet 160 mg N/A Tab

18
Antiplatelet
Asam Asetil Salisilat Tablet 80 mg Aspilet Tab

1
Klopidogrel Tablet 75 mg N/A Tab

2
Obat Syok Kardiogenik dan Sepsis
Dobutamin Injeksi 50 mg/ mL N/A Amp

1
Dopamin Injeksi 40 mg/ mL, 5 mL Cetadop Amp

2
Norepinefrin Injeksi 1 mg/ mL N/A Amp

3
Antihiperlipidemia
Gemfibrozil Kapsul 300 mg N/A Tab
1
Simvastatin Tablet 20 mg N/A Tab

2
Simvastatin Tablet 10 mg N/A Tab

3
Antihipertropi Prostat
Tamsulosin Tablet SR 0.4 mg Harnal Ocas Tab

1
Dutasterid Kapsul 0.5 mg Avodart Kaps

2
ANTIDIABETES
Oral
Glibenklamid Tablet 5 mg N/A Tab

1
Glimepirid Tablet 2 mg N/A Tab

2

3
4
Gliquidon Tablet 30 mg N/A Tab

5
Metformin Tablet 500 mg N/A Tab

6
Parenteral
Analog Insulin Rapid Acting: Insulin

100 IU/ mL, 3 mL Novorapid Fp
Aspart Injeksi
1
Analog Insulin Intermediate Acting:

100 IU/ mL, 3 mL Novomix Fp
Insulin Aspart Basal 30/70 Injeksi
2
Analog Insulin Long Acting : Insulin

100 IU/ mL, 3 mL Levemir FP
Detemir Injeksi
3
Analog Insulin Long Acting : Insulin

100 IU/ mL, 3 mL Sansulin Log G Fp
Detemir Injeksi
4
Human Insulin Fast Acting: rDNA 100 IU/ mL, 10 mL

5 Fp
ANTIEPILEPSI DAN ANTI KONVULSAN
Amitriptilin Tablet 25 mg N/A Tab

1
Diazepam Injeksi 10 mg/ 2 mL Stesolid Amp
2
Diazepam RT 10 mg/ 2.5 mL Stesolid Tube

3
Diazepam RT 5 mg/ 2.5 mL Stesolid Tube

4
Diazepam Tablet 2 mg N/A Tab

5
Fenobarbital Injeksi 100 mg/ mL, 2 mL Sibital/Pental Amp

6
Fenobarbital Tablet 30 mg N/A Tab

7
Gabapentin Kapsul 100 mg Alpentin Tab

8
Gabapentin Tablet 300 mg N/A Tab

9
Magnesium Sulfat Injeksi 20%, 25 mL Otsu Flc

10
Magnesium Sulfat Injeksi 40%, 25 mL Otsu Flc

11
Natrium Divalproeks Kaplet SR 250 mg Depakote Tab

12
Natrium Divalproeks Kaplet SR 500 mg Depakote Tab

13
Natrium Fenitoin Injeksi 50 mg/ mL, 2 mL Kutoin Amp

14
Natrium Fenitoin Kapsul 100 mg KUtoin Tab
15
Sodium Valproat Sirup 250 mg/ 5 mL N/A Botol

16
Karbamazepin Kaplet 200 mg Bamgetol Tab

17
ANTIPARKINSON
Flufenazin Injeksi 25 mg/ mL Sikzanoat Amp

1
Haloperidol injeksi 5 mg/ mL N/A Amp

2
Haloperidol OD 2 mg/ mL N/A Botol

3
Haloperidol Tablet 5 mg N/A Tab

4
Haloperidol Tablet 1.5 mg N/A Tab

5
Klozapin Tablet 25 mg N/A Tab

6
Komb Levodopa dan Benserazid HCl

100 mg; 25 mg N/A Tab
Tablet
7
Klorpromazin Tablet 100 mg CPZ Tab

8
Litium Karbonat Tablet 200 mg Primania Tab
9
Pramipeksol Tablet SR 0.375 mg Sifrol Tab

10
Risperidon Tablet 2 mg N/A Tab

11
Triheksifenidil Tablet 2 mg Arkine Tab

12
Trifluoperazin Tablet 5 mg N/A

13 Tab
ANTIMIGRAIN DAN ANTIVERTIGO
Betahistin Mesilat Tablet 6 mg N/A Tab

1
Dimenhidrinat Tablet 50 mg N/A Tab

2
Flunarizin Tablet 10 mg N/A Tab

3
NOOTROPIK DAN NEUROTROPIK
Sitikolin Injeksi 125 mg/ mL, 2 mL N/A Amp

1
Sitikolin Tablet 500 mg N/A kaps
2
Pirasetam Injeksi 3 g/ 15 mL N/A Amp

3
Pirasetam Kaplet 1200 mg N/A Tab

4
Pirasetam Kaplet 400 mg N/A Tab

5
RELAKSAN OTOT PERIFER DAN PENGHAMBAT KOLINESTERASE
Atrakurium Besilat Injeksi 10 mg/ mL, 2.5 mL Notrixum Amp

1
Rokuronium Injeksi 10 mg/ mL, 5 mL Rocum Amp

2
OBAT SALURAN CERNA
Obat Saluran Cerna
Antasida DOEN I: Al Hidroksida dan Mg

200 mg; 200 mg N/A Tab
Hidroksida Tablet
1
Antasida DOEN II: Al Hidroksida dan Mg

200 mg; 200 mg/ 5 N/A BOTOL
Hidroksida Suspensi
2
Komb parafin,gliseril dan Fenoftalin
60 mL Kompolax Tab
Suspensi
3
Lansoprazol 30 mg N/A CAPSUL

4
Omeprazol Injeksi 40 mg N/A Vial

5
Omeprazol Kapsul 20 mg N/A kapsul

6
Ranitidin Injeksi 25 mg/ mL, 2 mL N/A Amp

7
Ranitidin Tablet 150 mg N/A Tab

8
Sukralfat Suspensi 500 mg/ 5 mL, 100 N/A BOTOL

9
Sukralfat Tablet 500 mg Ulsidex Tab

10
Supplemen mengandung Lactobacillus 1.00 x 109 CFU;
plantarum, Streptococcus thermophilus, 500 mg Rillus Tab
Bifidobacterium bifidum dan FOG
11
Supplemen mengandung Streptococcus
thermophilus, Lactobacillus rhamnosus, 1.25 x 109 CFU;
Lactobacillus acidophilus, Liprolac Sact
2.5 g
Bifidobacterium longum, Bifidobacterium
12 bifidum, FOG dan Vitamin
Antiemetik
Domperidon Suspensi 5 mg/ 5 mL, 60 mL N/A Btl

1
Domperidon Tablet 10 mg N/A Tab
2
Metoklopramid injeksi 5 mg/ mL Sotatic Amp

3
Ondansentron Injeksi 2 mg/ mL, 2 mL N/A Amp

4
Ondansentron tablet 4 mg N/A Tab

5
Antispasmodik
Hiosin N Butil Bromida Injeksi 20 mg/ mL Gitas Amp

1
Hiosin N Butil Bromida Tablet 10 mg Scobutrin Tab

2
Antidiare
Attapulgit Tablet 600 mg New Antidates Tab

1
Laksatif, Katatartik
Bisakodil Suppositoria 10 mg Dulcolax Supp
1
Bisakodil Suppositoria 5 mg Dulcolax Supp

2
Laktulosa Sirup 3.335 g/ 5 mL, 120 N/A BOTOL

3
KOLETIOLITIK
Asam Ursodeoksikolat Kapsul 250 mg N/A Kaps

1
ANTIHEMOROID
Antihemoroid Supp: Komb. Bismut

Subgalat, Heksaklorofen, Lidokain dan 2g N/A suppo
Seng Oksida
1
OBAT SALURAN NAFAS
Antiasma Dan PPOK
Aminofilin Injeksi 24 mg/ mL, 10 mL N/A Amp

1
Aminofilin Tablet 200 mg N/A Tab
2
Fenoterol HBr Aerosol Ih 100 mcg/ Puff Berotec Botol

3
Flutikason Furoat Spray 27.5 mcg/ Spray ; 1Avamys Botol

4
Flutikason Propionat Ih 0.5 mg, 2 mL Flixotide Resp

5
Komb Budesonid dan Formoterol Ih 160 mcg; 4.5 mcg, Symbicort Botol
6
Komb Ipratopium Br dan Salbutamol Ih 0.5 mg; 2.5 mg, 2.5Combivent Resp
7
Komb Salmeterol dan Flutikason

50 mcg; 100 mcg, 1Seretide Can
Propionat Ih
8
Rotahaller Ventolin Buah

9
Salbutamol DS 2 mg N/A Botol

10
Salbutamol Ih 1 mg/ mL Ventolin Resp

11
0.1mg/dosis, 200
Salbutamol Inhaler Ventolin Botol
dosis
12
Salbutamol Sulphate 100 mcg/dose SALBULIN Botol

13
Salbutamol Tablet 4 mg N/A Tab

14
Salbutamol Tablet 2 mg N/A Tab
15
Teofilin Tablet 150 mg Bronsolvan Tab

16
Terbutalin Sulfat Tablet 2.5 mg

17 N/A Tab
Mukolitik Dan Ekspetoran
Ambroksol Sirup 15 mg/ 5 mL, 60 mLN/A BOTOL

1
Ambroksol Tablet 30 mg N/A Tab

2
Bromheksin HCl Injeksi 2 mg/ mL, 2 mL Solvinex Amp

3
N Asetil Sistein Inhalasi 100 mg/ mL N-Ace Amp

4
N Asetil Sistein Kapsul 200 mg n-ace Tab

5
DECONGESTAN
Pseudoefedrin HCl Tab dan Tripolidin Tabl60 mg; 2.5 mg Tremenza Tab
1
ANTIKOAGULANSIA
Asam Traneksamat Injeksi 100 mg/ mL, 5 mL N/A Amp

1
Asam Traneksamat Tablet 500 mg Kalnex Tab

2
Deferipron Kaplet 500 mg Ferriprox Tab

3
Deferoksamin Mesilat Serbuk Injeksi 500 mg

4 N/A Vial
Fitomenadion Injeksi 10 mg/ mL N/A Amp

5
Fitomenadion Tablet 10 mg N/A Tab

6
Fondaparinuks Injeksi 2.5 mg/ 0.5 mL Arixtra Amp

7
Karbazokrom Na Sulfonat Injeksi 5 mg/mL, 10 mL Chrome Amp

8
Heparin Sod Injeksi 5000 IU/ mL Inviclot Vial

9
Metilergometrin Maleat Injeksi 0.2 mg/ mL N/A Tab

10
Metilergometrin Maleat Tablet 0.125 mg N/A Tab

11
ANTIANEMIA
Asam Folat Tablet 1 mg N/A Tab

1
Komb. Ferro Fumarat dan Asam Folat

60 mg; 0.4 mg Tablet Tambah Darah Tab
Tablet
2
Komb. Ferro Fumarat, Mangan Sulfat,
Tembaga Sulfat, Vitamin C, 300 mg; 0.2 mg; 0. Hemafort Tab
Sianokobalamin dan Asam Folat Tablet
3
Ferro Sulfat Kapsul 250 mg Kaps

4 N/A
Sianokobalamin (Vitamin B12) Injeksi 500 mcg/ mL N/A Amp

5
Sianokobalamin (Vitamin B12) Tablet 50 mcg N/A Tab

6
VITAMIN DAN MINERAL
D-Alfatokoferol (Vitamin E) Kaplet 400 IU Santa E Kapl

1
D-Alfatokoferol (Vitamin E) Kaplet 200 IU Santa E Kapl

2
Hialuronat Injeksi 10 mg/ mL, 2 mL Umarone Amp

3
Mekobalamin Kapsul 500 mg Megabal Tab
4
Piridoksin (Vitamin B6) Tablet 10 mg N/A Tab

5
Retinol (Vitamin A) Kapsul 100000 IU N/A Tab

6
Tiamin HCl (Vitamin B1) Tablet 50 mg N/A Tab

7
Asam Askorbat (Vitamin c ) injeksi 200mg/ml Prove-c 1000 Amp

8
Asam Askorbat (Vitamin C) Tablet 500 mg N/A Tab

9
Asam Askorbat (Vitamin C) Tablet 50 mg N/A Tab

10
Vitamin B Komplek Tablet N/A Tab

11
Kalsium Laktat Tablet 500 mg N/A Tab

12
SERUM DAN VAKSIN
1 Anti Bisa Ular 250 IU N/A Syr
Human Tetanus Ig Injeksi 250 IU Tetagam Vial

2
Hepatitis B Imunoglobulin 220 IU/ mL, 0.5 mL Hyperhep Syringe
3
Hepatitis B Recombinan N/A SYRING

4
CAIRAN PENGGANTI PLASMA DAN PLASMA EKSPANDER
Gelatin Poli Suksinat Infus 4%, 500 mL Gelofusine BOTOL

1
Larutan Infus mengandung Koloid HES

6%, 500 mL Voluven Plabot
BM 13.000
2
Larutan Infus mengandung Koloid HES

6%, 500 mL Widabes Plabot
BM 13.000
3
Human Albumin Injeksi 20%, 100 mL Plasbumin Botol

4

5

6
LARUTAN ELEKTROLIT DAN NUTRISI
Oral
Kalium Aspartat 300 mg ASPAR-K Tab
1
Kalium Klorida Injeksi 7.46%, 25 mL KCL Plabot

2
Larutan Elektrolit Serbuk Oral: Komb.
Natrium Klorida 0.52 g, Kalium Klorida
4.129 g Oralit Sact
0.30 g,Trinatrium Sitrat Dihidrat 0.58 g
3 dan Glukosa Anhidrat 2.70 g
Zink OD 10 mg/ mL Zinc Pro Botol

4
Zink Sirup 20 mg/ 5 mL N/A Botol

5
Zink Tablet 20 mg N/A Tab

6
Kalium Klorida Injeksi SR 600 mg KSR Tab
LARUTAN MENGANDUNG ASAM AMINO
Larutan Nutrisi Parenteral mengandung

Asam Amino 30 gr, Glukosa 3.7 % dan 500 mL Aminofluid Soft bag
Elektrolit, Double Chamber
1
Asam Amino 30 gr, Glukosa 3.7 % dan 500 mL Bfluid infus BAG
Elektrolit, Double Chamber
2
Asam Amino 55 dengan BCAA 45%, L
Ornithin L Aspartat 8.03 g/ L, Sorbitol 50 501 mL
Aminofusin Hepar BOTOL
3 g/ L, Xylitol 50 g/ L

6%, 100 mL Aminosteril Infant Btl
Asam Amino dan Taurin
4
Asam Amino, Glukosa dan Elektrolit,
1000 mL Clinimix BAG
Double Chamber (Asam Amino 28 g/ L,
5 Glukosa 75 gr/ L dan Elektrolit)
Asam Amino, Vitamin dan Elektrolit 250 mL Aminofusin Paed BOTOL
(Asan Amino 50 g/L)
6
Larutan nutrisi parental mengandung

500 mL KAEN 3 B Plabot
eletrolit

20%, 100 mL Smoflipid BOTOL
Lipid

komb Glukosa dan Elektrolit: Na 30 mEq, 500 mL N/A Plabot
Cl 20 mEq, Laktat 10 mEq dan Glukosa 40
8g
LARUTAN MENGANDUNG KARBOHIDRAT
Glukosa Larutan Infus Steril 5%, 500 mL N/A Plabot

1
Glukosa Larutan Infus Steril 10%, 500 mL N/A Plabot

2
Glukosa Larutan Steril Injeksi 40%, 25 mL Otsu Flc

3
LARUTAN MENGANDUNG KARBOHIDRAT DAN ELEKTROLIT
Larutan Infus Steril mengandung Glukosa

500 mL Wida Plabot
25 g dan NaCl 2.25 g (D5 1/4 NS)
1
500 mL widatra Plabot
25 g dan NaCl 4.5 g (D5 1/2 NS)
2

500 mg Otsu Plabot
dan NaCl (D10 1/5 NS)
3
Larutan Infus Steril mengandung KCl
0.15% dalam Glukosa 2.5% dan NaCl 500 mL widatra Plabot
0.45% (KDN-1)
4

500 mL Wida Plabot
0.15% dalam NaCl 0.9% (KN-1)
5
komb Glukosa dan Elektrolit: Na 30 mEq,
Cl 20 mEq, Laktat 10 mEq dan Glukosa 40 500 mL KAEN 4A Plabot
g

500 mL widatra Plabot
0.15% dalam NaCl 0.9% (KN-2)
6
Larutan Infus Steril mengandung KCl 0.3
% dalam Glukosa 2.5% dan NaCl 0.45% 500 mL N/A Plabot
(KDN-2)
7
LARUTAN MENGANDUNG LIPID

1 Larutan Nutrisi Parenteral mengandung
Komb Glukosa dan Elektrolit 80 g, Asam
Amino 40 g, Lipid MCT/LCT 50 g, Triple 1250 mL
Nutriflex Peri Soft bag
Chamber
LARUTAN MENGANDUNG ELEKTROLIT
Natrium Klorida Larutan Infus Steril 3%, 500 mL Otsu SALIN Plabot
1
Natrium Klorida Larutan Infus Steril 0.9%, 100 mL Otsu Botol
2
Natrium Klorida Larutan Infus Steril 0.9%,500 mL N/A Plabot

3
Natrium Klorida Larutan Infus Steril 0.9%,1000 mL N/A Plabot

4
Asetat Ringer Larutan Infus Steril 500 mL Asering BAG

5
Ringer Laktat Larutan Infus Steril 500 mL N/A Plabot

6
AQUA
Aquabidest Pro Injeksi 25 mL Otsu Flc

1
Aquabidest Pro Irigasi 1000 mL N/A Plabot

2
OBAT TELINGA, HIDUNG DAN TENGGOROKAN
1 Antiseptik Obat Kumur Hexetidine 100ml N/A Btl
3 Na Fusidat tetes Telinga 10ml N/A Btl

Ofloksasin Tetes Telinga 3%, 5 mL Akilen Botol
5
Oksimetazolin Tetes Hidung 0.05% Iliadin Botol

7
Oksimetazolin Tetes Hidung 0.0025 Iliadin Botol

9
Triamsinolon Nasal Spray 55 mcg/ Puff Nasacort Botol

11
OBAT TOPIKAL KULIT
Betametason Valerat Krim 0.1%, 5 g N/A Krim

1
Asam fusidat krim 20% 20% Fusilex Tube

2
Oksitetrasiklin salep kulit 3%, 5 g N/A Tube

3
Perak Sulfadiazin Krim 1%, 35 g N/A Tube

4
OBAT TB PARU
Isoniazid Tablet 300 mg N/A Tab

1
OBAT MATA
Asetazolamid Tablet 250 mg Cendo Glaucon Tab

1
Larutan steril tetes mata timolol maleat 0.5% 5mg/ml Isotic BOTOL
2
Larutan Tetes Mata Steril Atropin Sulfat 10 mg Cendo Tropin Botol

3
Larutan Tetes Mata Steril Fenilefrin

100 mg, 10% Cendo Efrisel Botol
Hidroklorida
4
Larutan Tetes Mata Steril Fluorometolon 1 mg, 0.6mlx5md Cendo Minidose Posop Mdus
5
Larutan Tetes Mata Steril Kalium Iodida 5 mg, 5 mL Cendo Catarlent Botol
6
Larutan Tetes Mata Steril Komb
Deksametason Sodium Fosfat 1 mg,
Neomisin Sulfat 5 mg, Polimiksin B Sulfat 0.6mlx5md
Cendo Polydex Mdus
7 10000IU

0.6mlx5md Cendo Minidose Eyefresh Mdus
Hipromelosa 3 mg, Dekstran 70 1 mg
8
Cendo Minidose Eyefresh
Hipromelosa 5 mg, Dekstran 70 1 mg, 0.6mlx5md Mdus
Plus
Gliserol
9
Larutan Tetes Mata Steril Komb Kalium

5 mL Cendo Vitrolenta Botol
Iodida 5 mg, Natrium Iodida 10 mg
10
Polimiksin B Sulfat 10000IU, Neomisin 0.6mlx5md Cendo Polygran Mdus
Sulfat 2.5mg, Gramisidin 0.025 mg
11
Larutan Tetes Mata Steril Komb Sodium
0.6mlx5md Cendo Lyteers Mdus
Klorida 4.4 mg, Potasium Klorida 0.8 mg
12
Larutan Tetes Mata Steril Komb Cendo Minidose
Tobramisin 3 mg, Deksametason Sodium 0.6mlx5md Mdus
Tobroson
Fosfat 1 mg
13
Larutan Tetes Mata Steril Natamisin 50mg, 0.6mlx5md Cendo Natacen Mdus
14
Larutan Tetes Mata Steril Polivinil Cendo Minidose

20 mg, 0.6mlx5md Mdus
Pirolidon Protagent A
15
Larutan Tetes Mata Steril Prednisolon

Asetat 10 mg, 0.6mlx5md Cendo Minidose P-Pred Mdus
16
Larutan Tetes Mata Steril Tetrakain

0.02 mg, 0.5%,5ml Cendo Pantocain Botol
Hidroklorida
17
Larutan Tetes Mata Steril Tropikamid 5 mg, 0.5%,5ml Cendo Mydriatil Botol
18
Larutan Tetes Mata Steril Tropikamid 5 mg, 1 %,5ml Cendo Mydriatil Botol
19
Cendo Hyaluronate Sodium 5 ml Hyalub Botol

20
Oxymetazolin Hcl 15 mg/5 ml Asthenof Botol

21
Larutan Tetes Mata Steril Levofloksasin 5 mg, 0.6mlx5md Cendo Minidose LFX Mdus
22
Larutan Tetes Mata Steril Ofloksasin 3 mg, 0.6mlx5md Cendo Floxa Mdus
23
Levofloksasin Tetes Mata 0.5% Optiflox Botol

24
Neomycin Sulfate,Polymyxin B
3.5 mg / 1000 iu/1 Polidemisin salep mata Tube
Sulfate,Dexamethasone
25
Oksitetrasiklin salep mata 0.01 N/A Tube

26
LAIN-LAIN
Ekstrak Akar Pelargonium sidoida Tablet Kaloba Tab

1
Klaritomisin Tablet 500 mg N/A Tab

3
Kloroquin N/A Tab

4
Komb
multivitamin,mineral,likopene,asam folat Ultravita Tab
tablet
5
Kombinasi Ekstrak Echinacea,Black

Imboost Force Tab
eldeberry dan Zink picolinate Tablet
7
Sacharin Tab N/A Pot

8
Kurkuma Tablet Tab

9
Na Diklofenak krim 100mg Voltaren Tube

10
Oseltamivir kapsul 75 mg N/A Tab

11
Probiotik 1,5 gr N/A SACT
12
Kombinasi mengandung meyil salisilat,

Painkila Tube
mentol, eugenol 30mg
13
TOTAL PRAKIRAAN KE
OBAT INSTALASI FARMASI TAHUN 2021
NAMA PABRIK OBAT
PT. KIMIA FARMA
PT. DEXA MEDICA
PT. KIMIA FARMA
PT. MERSIFARMA
PT. KIMIA FARMA
TOTAL
PT. BERNOFARM
PT. PERTIWI AGUNG
PT. TEMPO SCAN PACIFIC
PT. BERNOFARM
PT. ETHICA INDUSTRI FARMASI
PT. BERNOFARM
PT. HEXAPHARM JAYA
PT. PHAPROS
PT. PHAPROS
PT. MERSIFARMA
PT. INDO FARMA
PT. MERSIFARMA
PT. INTERBAT
PT. INTERBAT
PT. BERNOFARM
PT. MERSIFARMA
PT. MERSIFARMA
TOTAL
PT. MERSIFARMA
PT. HEXAPHARM JAYA

TOTAL
PT. PRATAPA NIRMALA
PT. DEXA MEDICA
PT. PHAPROS
PT. TANABE FARMA
TOTAL
PT. ABBOTS INDONESIA
PT. PRATAPA NIRMALA
PT. IKAPHARMINDO PUTRAMAS
PT. FRESENIUS
TOTAL
PT. NOVELL PHARMACEUTICAL
TOTAL
PT. PHAPROS
PT. PROMEDRAHARDJO FARMASI INDUSTRI
PT. PHAPROS
PT. PHAPROS
PT. PIM PHARMACEUTICAL
PT. RAMA EMERALD MULTI SUKSES
TOTAL
PT. PT. ETHICA INDUSTRI FARMASI

PT. PRATAPA NIRMALA
PT. OTSUKA INDONESIA
PT. PIM PHARMACEUTICALS
PT. FARMA HEALTH CARE
TOTAL
TOTAL
PT. PHAPROS
PT. PYRIDAM FARMA

PT. DANKOS FARMA
PT. SANBE FARMA
PT. SANBE FARMA
PT. DEXA MEDICA
PT. HOLI FARMA
PT. BERNOFARM
PT. DARYA VARIA LABORATORIES
PT. PHARMA LABORATORIES

PT. HEXAPHARM JAYA
PT. DEXA MEDICA
PT. BERNOFARM
PT. DEXA MEDICA
TOTAL
PT. KIMIA FARMA
TOTAL
PT. KIMIA FARMA

TOTAL
PT. BERNOFARM
PT. KIMIA FARMA
TOTAL
PT. PROMERAHARDJO FARMASI INDONESIA
PT. PRATAPA NIRMALA
PT. INDO FARMA
PT. INDO FARMA
PT. BERNOFARM
PT. HEXAPHARM
TOTAL
PT. KIMIA FARMA
PT. INDO FARMA

PT. INDO FARMA
TOTAL
PT. INDO FARMA
PT. INDO FARMA
PT. KIMIA FARMA
TOTAL
PT. SANBE FARMA
TOTAL
PT. PHAPROS
PT. PHAPROS
PT. MOLEX AYUS

PT. DEXA MEDICA
PT. HOLI FARMA
TOTAL
PT. MERCK
PT. MERCK
TOTAL
PT. SANBE FARMA
PT. SANBE FARMA

PT. SANBE FARMA
PT. GUARDIAN PHARMATAMA
TOTAL
PT. DANKOS FARMA
TOTAL
PT. DEXA MEDICA
PT. KIMIA FARMA

PT. FINUSOIPRIMA FARMA INTERNASIONAL
TOTAL
PT. PRATAPA NIRMALA
TOTAL
PT. DARYA FARIA
PT. DARYA FARIA
PT. KIMIA FARMA

PT. YARINDO FARMATAMA
PT. KIMIA FARMA
PT. HOLI FARMA
PT. HOLI FARMA
TOTAL
PT. ACTAVIS INDONESIA
PT. KIMIA FARMA

TOTAL
TOTAL
PT. DEXA MEDICA
PT. DEXA MEDICA
TOTAL
PT. INDO FARMA
PT. HEXAPHARM
TOTAL
PT. COMBIPHAR
PT. SMITHKLINE BEECHAM PHARMACEUTICALS
TOTAL
PT. DEXA MEDICA

PT. KIMIA FARMA
PT. HEXAPHARM
TOTAL
PT. ANUGRAH ARGON MEDICA
PT. SANBE FARMA
TOTAL

PT. YARINDO INDONESIA
PT. MERSI FARMA
PT. DEXA MEDICA
PT. MERSI FARMA

PT. MERSI FARMA
PT. MEPROFARM
PT. MERSI FARMA
TOTAL
PT. MERSI FARMA
PT. MERSI FARMA
PT. MERSI FARMA
PT. MERSI FARMA
PT. DEXA MEDICA
PT. PYRIDAM FARMA
PT. MERSI FARMA

PT. BOEHRINGER INGELHEIM INDONESIA
PT. MERSI FARMA
PT. MERSI FARMA
TOTAL
PT. DEXA MEDICA
PT. BERNOFARM
TOTAL
PT. HEXAPHARM
PT. BERNOFARM
TOTAL
PT. ETERCON FARMA
TOTAL
PT. MERSI FARMA
PT. LUCAS DJAYA

PT. IFARS
PT. ETERCON PHARMA
PT. QUANTUM LABS
PT. DEXA MEDICA
PT. KALBE FARMA
TOTAL
PT. DEXA MEDICA
TOTAL
PT. DIPA PHARMALAB INTERSAINS
TOTAL
PT. TROPICA MAS PHARMACEUTICALS
TOTAL
PT. IKAPHARMINDO PUTRAMAS
TOTAL
TOTAL
PT. KIMIA FARMA
TOTAL
PT. LUCAS DJAYA

PT. GLAXO WELCOME INDONESIA
PT. INDO FARMA
PT. IMEDCO DJAJA
PT. KIMIA FARMA

PT. KIMIA FARMA
TOTAL
PT. BERNOFARM
PT. PROMERAHARDJO FARMASI INDONESIA
PT. PRATAPA NIRMALA
PT. INDO FARMA
TOTAL
PT. SANBE FARMA

TOTAL
PT. FERRON PHARMACEUTICALS
PT. QUAMED
PT. FERRON PHARMACEUTICALS
PT. KIMIA FARMA

TOTAL
PT. MARTIN LIZA FARMASI
PT. KIMIA FARMA
PT. PHAPROS
PT. LUCAS DJAYA
TOTAL
PT. PERTIWI AGUNG
PT. SANBE FARMA
PT. PRATAPA NIRMALA

PT. KIMIA FARMA
PT. KIMIA FARMA
PT. NOVAPHARIN
PT. KIMIA FARMA
PT. MARIN LIZA FARMASI
PT. MERSI FARMA
TOTAL
PT. BIO FARMA
PT. DEXA MEDICA

PT. GRIFOLS THERAPEUTICS
TOTAL
PT. DEXA MEDICA
PT. FRESENIUS KABI
TOTAL
PT. TANABE INDONESIA
PT. KIMIA FARMA
PT. COMBIPHAR
PT. TEMPO SCAN PASIFIC
PT. PHAPROS
PT. MERCK
TOTAL

PT. FRESENIUS KABI
TOTAL
TOTAL
PT. WIDATRA BHAKTI

PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
TOTAL
TOTAL

PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
PT. WIDATRA BHAKTI
TOTAL
TOTAL
PT. SANBE FARMA
PT. MERCK
PT. MERCK
PT. AVENTIS PHARMA
TOTAL
PT. KIMIA FARMA
PT. MOLEX AYUS
PT. KIMIA FARMA
PT. DARYA FARIA
TOTAL
TOTAL
PT. CENDO
PT. PRATAPA NIRMALA
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. CENDO
PT. ERELA
PT. SANBE FARMA
TOTAL
PT. PHAPROS
PT. SANBE FARMA
PT. KIMIA FARMA
PT. CAPRIFARMINDO LABS
PT. SOHO GLOBAL HEALTH
PT. SOHO GLOBAL HEALTH

TOTAL
TOTAL PRAKIRAAN KEBUTUHAN OBAT TAHUN 2021

PRAKIRAAN KEBUTUHAN
NO. NAMA BMHP SPESIFIKASI
ANTISEPTIK - DESINFEKTAN
1 Larutan amonium propionat, heksamilen biguanida hidroklorida 5L
2 Larutan ferakrilum 1%, 100 mL
3 Larutan alkohol 70%, 1 L
4 Larutan alkohol 70 %, 300 mL
5 Larutan alkohol dalam tisu
6 Larutan alkohol 95%, 2.5 L
7 Larutan alkohol absolut 2,5 L
8 Larutan povidon iodin 10% 300 mL
9 Larutan povidon iodin 10% 30 mL
10 Larutan klorheksidin glukonat 0.5%; 500 mL
11 Larutan klorheksidin glukonat 4%; 500 mL
12 Larutan glutraladehida 2%, 5 L
13 Larutan propan-1-ol 750 mL
14 Larutan kokopropilendiamina 1000 mL
15 Larutan lisol 1000 mL
16 Larutan asam asetat 2%, 500 mL
17 Larutan formaldehida 10%, 5 L
18 Larutan hidrogen peroksida 3%, 100 mL
Softaman 100 mL
Desinfektan enzymatic 1000 mL
19 Soda Lime 5L
BENANG BEDAH
Benang Bedah polyglycolide violet, braided, coated, synthetic 1, 90 cm, reverse
1
absorbable cutting
Benang Bedah surgicryl polyglactine, braided synthetic 1, 90 cm, tapper
2
absorbable surgical suture point
Benang Bedah polyglicolide violet, braided, coated, synthetic 2-0, 90 cm,
3
absorbable tapercut
Benang Bedah surgicryl monofilament polydioxanone, 3-0, 75 cm, tapper
4
monofillament, synthetic absorbable suture point
Benang Bedah polyglicolide violet, braided, coated, synthetic 3-0, 76 cm,
5
absorbable reverse cutting
Benang Bedah polyglactin 910 violet, braided, coated, synthetic 3-0, 80 cm,
6
fast absorbable reverse cutting
Benang Bedah polyglycolide violet, braided, coated, synthetic 3-0, 76 cm, round
7
absorbable bodied
Benang Bedah surgicryl polyglactine, braided synthetic 3-0, 75 cm, taper
8
Benang Bedah polyglicolide violet, braided, coated, synthetic 5-0, 76 cm, round
9
absorbable bodied
Benang Bedah surgicryl polyglactine, braided synthetic 2, 90 cm, taper
10
2, 40 mm, 90 cm,
Benang Bedah polyglicolide violet, braided, coated, synthetic
11 round bodied
absorbable
2, 90 heavy
cm, 48mm,
Benang Bedah polyglicolide violet, braided, coated, synthetic
12 round bodied
absorbable
heavy
Benang Bedah surgicryl rapid polyglactine, braided synthetic 2-0, 75 cm, taper
13
Benang Bedah surgicryl polyglactine, braided synthetic 2-0, 75 cm, taper
14
Benang Bedah polyglicolide violet, braided, coated, synthetic 2-0, 90 cm, round
15
absorbable bodied
Benang Bedah polyglicolic acid, braided, coated, absorbable
16 2-0, 90 cm, taper
surgical suture
Benang Bedah polyglicolic acid, braided, coated, absorbable
17 4-0, 90 cm, taper
surgical suture
Benang Bedah polyglactin 910 violet, braided, coated, synthetic 2-0, 110 cm,
18
fast absorbable tapercut
Benang Bedah polypropylene monofilament, non absorbable 2-0, 75 cm,
19
surgical suture cutting
3-0, 76 cm,
Benang Bedah polyvinylidene fluoride, blue monofillament,
20 reverse cutting
synthetic non absorbable
extra75
6-0, sharp
cm,
21 double round
bodied
4-0, 76 cm,
22 reverse cutting
extra76
5-0, sharp
cm,
23 reverse cutting
extra sharp
Benang Bedah polypropylene-polyethylene monofilament, non-
24 2-0, 75 cm, Taper
absorbable surgical suture
Benang Bedah polypropylene monofilament, non absorbable
25 1, 100 cm, tapper
surgical suture
Benang Bedah polypropylene monofilament, non absorbable
26 0, 100 cm, taper
surgical suture
Benang Bedah treated silk, black braided, natural non 1, 90 cm, round
27
absorbable bodied
Benang Bedah silk braided black, braided nonabsorbable
2-0, 75 cm, tapper
surgical suture
Benang Bedah silk braided black, braided nonabsorbable 2-0, 75 cm,
28
surgical suture reverse cutting
2-0, 76 cm,
Benang Bedah treated silk, black braided, natural non
29 reverse cutting
absorbable
extra76
3-0, sharp
cm,
Benang Bedah treated silk, black braided, natural non
30 reverse cutting
absorbable
extra sharp
Benang Bedah silk braided, coated, non absorbale surgical 3-0, 75 cm,
31
suture cutting
Benang Bedah treated silk, black braided, natural non 3-0, 76 cm, round
32
absorbable bodied
4-0, 76 cm,
Benang Bedah treated polyester, black braided coated, natural
33 reverse cutting
non absorbable
extra sharp
Benang Bedah chromic catgut, monofillament, natural 2, 90 cm, round
34
absorbable bodied heavy
Benang Bedah chromic catgut, monofillament, natural 2-0, 90 cm, round
35
absorbable bodied
2-0, 75 cm, taper
36 Benang Bedah catgut chrom absorbable surgical suture
point
0, 75 cm, 37 mm,
Benang Bedah catgut plain, absorbable surgical suture
taper point,
1, 75 cm, 37 mm,
37 Benang Bedah catgut plain, absorbable surgical suture
taper point,
3-0, 76 cm,
38 Benang Bedah plain catgut, monofillament, natural absorbable
reverse cutting
4-0, 76 cm,
39 Benang Bedah plain catgut, monofillament, natural absorbable
reverse cutting
Benang Bedah nylon, black monofillament, synthetic non- 2-0, 76 cm,
40 Imcompetent
absorbable reverse cutting
cervix tape, 65
41 Benang Bedah white polyester tape, synthetic non absorbable mm, 30 cm, round
Imcompetent
bodied double
cervix tape, 50
42 Benang Bedah white polyester tape, synthetic non absorbable blunt
mm, 30 cm, round
bodied double
Benang Bedah treated polyester, green braided coated, synthetic 2, 4x75blunt
cm, taper-
43
non absorbable cut heavy
Benang Bedah polyglecaprone25 violet, monofillament, 1, 90 cm, round
44
synthetic absorbale bodied
Benang Bedah polyglecaprone25 violet, monofillament, 3-0, 76 cm,
45
synthetic absorbale reverse cutting
Benang Bedah polyglecaprone25 violet, monofillament, 3-0, 76 cm, round
46
4-0, 76 cm,
Benang Bedah polyglecaprone25 violet, monofillament,
47 reverse cutting
synthetic absorbale
extra sharp
Benang Bedah polyglecaprone25 violet, monofillament, 4-0, 76 cm, round
48
5-0, 60 cm,
Benang Bedah polyglecaprone25 violet, monofillament,
49 reverse cutting
synthetic absorbale
extra sharp
Benang Bedah polypropylene knitted mesh, synthetic non
7.5 x 15 cm
absorbable, medium weight, large pore
Benang Bedah polypropylene knitted mesh, synthetic non
50 6 x 11 cm
absorbable, medium weight, large pore
ELectrosurgical
1 Electrosurgical Control Pencil 3m
2 Electrosurgical Patient ARDE
GELANG
1 Gelang Identitas Anak Biru
2 Gelang Identitas Anak Pink
3 Gelang Identitas Dewasa Biru
4 Gelang Identitas Dewasa Pink
5 Gelang Resiko Alergi Merah
6 Klip Gelang Resiko Alergi Merah
7 Klip Gelang Resiko Jatuh Kuning
8 Klip Gelang Resiko DNR Ungu
9 Kartu Pasien
Adhesive Tape
1 Adhesive Tape 10 cm x 5 cm
2 Adhesive Tape 15 cm x 5 cm
BANDAGE
1 Gypsona 7,5 x 3,5, 3"
2 Gypsona 10 X 3,5, 4"
3 Gypsona 15 X 3,5, 6"

7,5 cm x 3,5 cm,
4 Bantalan Sintetis
3"
10 cm x 2,7 cm,
5 Bantalan Sintetis
4"
15 cm x 2,7 cm,
6 Bantalan Sintetis
6"
DRESSING
1 Dressing Penutup Luka Anti Air 8 x 15 cm
2 Dressing Penutup Luka Anti Air 25 x 10 cm
3 Dressing Penutup Luka Bakar 10 cm x 10 cm
Leukoplast 7.5 cm x 4.5 m

6 cm x 7 cm with
Semillas
notch
Semillas 10 cm x 12 cm
Askina Soft Clear 9 x 25 cm
Askina Derm 6 x 7 cm
Askina Gel 15 g
Elastis Perban 7.5 cm x 4.5 m, 3''
4 Elastis Perban 11 cm x 4,5 m, 4"
5 Elastis Perban 15 cm x 4,5 m, 6"
KASSA
1 Kasa Hidrofil 40 x 80
2 Kasa Hidrofil Steril 16 x 16
3 Kapas Pembalut 100 g
4 Kapas Pembalut 250 g
5 Kapas Pembalut 1.000 g
KERTAS EKG - USG
2 Kertas CTG
3 Kertas CTG 112x100-150
4 Kertas EKG
5 Kertas EKG 50 mm x 30
type 812 R, 216
6 Kertas EKG
mm x 30 m
7 Kertas EKG 25 m
110 mm x 140
8 Kertas EKG
mm x 200 Lembar
80 mm x 90 mm x
9 Kertas EKG
200 Lembar
210 MM x 150
10 Kertas EKG MM x 200
Lembar
110 HG , 110 mm
11 Kertas USG
x 18 m
Elektroda
1 Elektroda Dewasa, 50 Pcs
2 Elektroda Anak, 50 Pcs
GEL USG
1 Gel USG 250 mL
2 Gel USG 5L
MASKER
1 Masker N95 1860 S
2 Masker Bedah Tali 1 box 50 pcs
3 Masker NRM Anak
4 Masker NRM Dewasa
5 Masker Nebu Anak
6 Masker Nebu Dewasa
7 Masker Sungkup Oksigen Bayi
8 Masker Sungkup Oksigen Anak
9 Masker Sungkup Oksigen Dewasa
10 Nasal Kanula Bayi
11 Nasal Kanula Anak
12 Nasal Kanula Dewasa
JARUM
1 Jarum Jahit Dalam No. 12
2 Jarum Jahit Dalam No. 13
3 Jarum Nald Heacting GT 13 12 Pcs

4 Jarum Nald Heacting no 9 12 Pcs
7 Jarum Nald Insulin 100 pcs
8 Jarum Jahit Otot No. 13
9 Jarum Nald Heacting GR 10 12 Pcs
Three Way Stopcock
1 Three Way Stopcock
2 Extention Tube 150 cm
CVC
1 Certofix Duo Paed S413 F 4, 13 cm
2 Certofix Duo Paed S513 F 5, 13 cm
4 Certofix Duo V 720 F 7, 20 cm
NELLATON
1 Nellaton Catheter No. 18

Rectal Tube No. 28
Rectal Tube No. 30
Rectal Tube No. 32
5 Rectal Tube No. 12
SARUNG TANGAN
1 Sarung Tangan Non Steril S, 100 Pcs
2 Sarung Tangan Non Steril M, 100 Pcs
3 Sarung Tangan Non Steril L, 100 Pcs
4 Sarung Tangan Steril Size 6,5
5 Sarung Tangan Steril Size 7
6 Sarung Tangan Steril Size 7.5
7 Sarung Tangan Steril No. 8
8 Sarung Tangan Steril Panjang No. 6,5, S
9 Sarung Tangan Steril Panjang No. 7,5, M
BISTURI - SPINAL NEEDLE - TRANSOFIX - PERIFIX
1 Bisturi No. 10, 100 Pcs
5 Spinocan Spinal Needle 25 G x 3 ½”
6 Transofik
7 Perifix filter 400
SUCTION
1 Suction Catheter No. 06

CORD UMBILICAL
1 Umbilical Klem
PAD - COMY BAG - URINE BAG
1 Under Pad Non Steril 60 x 90 cm
2 Under Pad Steril 60 x 90 cm
3 Colostomy Bag
4 Urine bag 2L
PLASTIK
1 Plastik Obat Klip 5 x 8 cm
2 Plastik Obat 15 x 25 cm
10 Plastik Obat 12 x 25 cm
11 Kantong Plastik 1 kg
12 Kantong Plastik 2 kg,
13 Kantong Plastik 10 kg,
BMHP MATA
1 Plester mata
2 BMHP Mata Stab Knives 2,75 degree
3 BMHP Mata Stab Knives 15 degree
4 BMHP Mata Crescent Knives, Angled, Bevel Up 2.0 mm
5 BMHP Mata 3L Sterile Ophtalmic Drape 100 cm x 70 cm
6 BMHP Mata Larutan OPTH Trypan Blue Ophtalmic 0.6 mg
7 BMHP Mata Larutan OPTH Carbachol Intraocular Sol' 0.0001
8 BMHP Mata Larutan OPTH HPMC 2%, 2 mL

12.50 x 5.50 mm
9 BMHP Mata One Piece PMMA Posterior
+ 90.00 D
12.50 x 5.50 mm
+ 20.00 D
12.50 x 5.50 mm
+ 20.50 D
12.50 x 5.50 mm
+ 21.00 D
12.50 x 5.50 mm
+ 21.50 D
12.50 x 5.50 mm
+ 22.00 D
6-0 Conventional
15 BMHP Mata Benang Bedah polypropylene Catting, 13 mm
3/8c
10-0, 6.5 mm 3/8
16 BMHP Mata Benang Bedah polyamide
c
17 BMHP Mata Benang Bedah Silk 5-0, 75 cm, 16mm
18 BMHP Mata Benang Bedah polyglatin 910 violet 7-0, 6.5 mm 3/8 c
BMHP Mata Benang Bedah nylon, black monofillament, non- 10-0, 30 cm, side
19
absorbable cutting lancet
20 BMHP Mata Slit Knife, Unibevel, Angled 2.75 mm
21 BMHP MATA Sub Tenon Cannula 19g x 25 mm
TRNSFER SET
1 Transfusi Set
2 Transfusi Set
3 Infusion Set Mikro 20 drop/ min
4 Infusion Set Makro 60 drop/ min
LAIN - LAIN
1 Safety Box 5L
2 Tounge Spatel Kayu
3 Pot Urine
4 Kantung puyer
Beriplast
Pot 10 mL
Botol Kaca 60 mL
Pot 20 mL
Spalk
1 Spalk 100 cm
2 Spalk 30 cm
3 Spalk 50 cm
4 Spalk 70 cm
APD
1 APD Universal Set
2 APD Gaun Disposable
3 APD Nurse Cap Tiap Bungkus @1

PCS : Baju
Hazmat, Nurse
4 APD Paket Hazmat Baju
Cap, Proton Hand
Schoen No.7 dan
5 APD Cover Shoes Plastik
6 APD Face Shield Head Gear With Clear Visor
7 APD Kaca Mata Google 0
8 Termometer Infrared
LMA
1 Laringeal Mask Airway No. 1
2 Laringeal Mask Airway No. 1,5

4 Laringeal Mask Airway No. 2,5
6 Laringeal Mask Airway No.4
7 Laringeal Mask Airway No.5
ETT
1 Endotracheal Tube without Cuff No. 2,5
2 Endotracheal Tube Non King King With Cuff with Stylet No. 6.5
3 Endotracheal Tube with Cuff No. 7.0
7 Endotracheal Tube without Cuff No. 5
9 Endotracheal Tube without Cuff No. 3.0
10 Endotracheal Tube without Cuff No. 3,5
Endotracheal Tube without Cuff No. 4.0
12 Endotracheal Tube Non King King With Cuff with Stylet No. 4,5
AIRWAYS
60 mm, no. 0,
1 Guedel Airway
hitam
70 mm, no. 1,
2 Guedel Airway
putih
80 mm, no. 2,
3 Guedel Airway
hijau
90 mm, no. 3,
4 Guedel Airway
kuning
Guedel Airway 40 mm
100 mm, no. 4,
5 Guedel Airway
merah
SYRINGE
1 Dispuit Syringe with Needle 1 cc
2 Dispuit Syringe without Needle 50 mL - LL

50 mL - Lubang
3 Dispuit Syringe without Needle Tengah, Luer
Lock

20 cc, Lubang
7 Dispuit Syringe without Needle Slip Tip
Samping, Tip
20 cc, Lubang
30 mLLock
- Lubang
Lock
10 Dispuit Syringe without Needle Slip Tip 50 cc
11 Dispuit Syringe without Needle 50 cc

50 mL - Lubang
12 Dispuit Syringe without Needle
Samping
IV CATHETHER
1 IV Catheter No. 16
Stomach Tube
1 Stomach Tube No.16

Stomach Tube No. 12
Stomach Tube No. 14
2 Stomach Tube No. 18
5 Feeding Tube No. 3.5
6 Feeding Tube No. 2,5
7 Feeding Tube No. 5
8 Feeding Tube No. 8
Feeding Tube No. 6
9 Feeding Tube No.10
FOLLEY CATHETER
1 Folley Catheter 2 Way No.06
2 Folley Catheter 2 Way No. 8
Folley Catheter 2 Way No. 10
8 Folley Catheter 3 Way No.22
9 Urocare Folley Catheter 3 Way No.24
ARMSLING - CORSET - SKIN TRAKSI
1 Armsling S
2 Armsling M
3 Armsling L
Cervical Collar L
Cervical Collar M
4 Cervical Collar S
5 Corset LSO M
6 Corset LSO L
7 Corset LSO XL
8 Corset TLSO M
9 Corset TLSO L
10 Corset TLSO XL
11 Skin Traksi Anak 6 cm x 2.7
12 Skin Traksi Dewasa 8 cm x 4 mm
Bone Wax - CURASPON
1 Bone Wax
2 Curaspon
BMHP FISIOTERAPI
Adhesive Elektroda Foam 40 x40
Sponge Cover Elektroda
BMHP GIGI
1 BMHP Gigi Dycal Radiopaque Ca Hydroxide Compasition
2 BMHP Gigi Endometasone
3 BMHP Gigi Eugetin 1 box @ 1 pcs
4 BMHP Gigi Gutta Percha 45- 80 mm 1 box @ 100 pcs
5 BMHP Gigi Ketac Universal HM RF A 3.5 Powder 1 bks @ 1 pcs
6 BMHP Gigi Ketac Universal HM RF Liq

7 BMHP Gigi Pulp-X 6g
8 BMHP Gigi Saliva Ejector 100 Pcs
9 BMHP Gigi Solarex Posterior X-A3.5 GC 2 mL
10 BMHP Gigi Caviton white 1 box @ 1 pcs
11 BMHP Gigi Devital
12 BMHP Gigi Disposable Dental Needle 16 mm, 100 Pcs
13 BMHP Gigi Cement Base
14 BMHP Gigi Bubuk Fletcher
15 BMHP Gigi Eugenol
16 BMHP Chloretyl Spray

ISO 001/801L0
17 BMHP Gigi Mata Bor Diamond Bur Round
014
18 BMHP Gigi Mata Bor Diamond Bur Fissure 837L 012
Arkansas
19 BMHP Gigi Bur Poles Arkansas Putih,Tipe Flame,
Round Fissure
20 BMHP Gigi Bonding
TOTAL PRAKIRAAN KEBUTUHAN BAHAN MEDIS PAKAI TAHUN 2021
KET
BMHP permintaan terbaru
PRAKIRAAN KEBUTUHAN BAHAN MEDIS PAKAI TAHUN 2021
NAMA DAGANG SAT HARGA
Anios Aniosyme DD1 Galon Rp 1,677,740.00
Hemolok Botol Rp 92,565.00
Onemed Botol Rp 28,749.60
Onemed Alcohol Swabs Pcs Rp 132.00
Bio Optica Botol Rp 66,000.00
Bio Optica Botol Rp 847,000.00
E-Care Antiseptic Hand Rub Botol Rp 62,015.97
E-Care Antiseptic Hand Scrub Botol Rp 75,479.97
Anios Steranios Galon Rp 537,695.00
Bbraun Meliseptol Foam pure Botol Rp 141,000.21
Bbraun Stabimed Botol Rp 619,999.60
Onemed Lysol Concentrate Botol Rp 47,146.00
N/A Botol Rp 441,000.00
Bio Optica Galon Rp 935,000.00
N/A Botol Rp 33,600.00
Helizym Botol Rp 375,001.00
Sofnolime Galon Rp 913,000.00

Triton T-Vio V41 Pcs Rp 72,900.00
SMI Surgicryl 910 Pcs Rp 102,792.00
SMI Surgicryl Monofilament Pcs Rp 102,239.97
Triton T-Vio V63z Pcs Rp 62,071.90
SMI Surgicryl 910 pcs Rp 82,576.00
Triton T-Vio V38 pcs Rp 74,200.00
SMI Surgicryl Rapid PCS Rp 83,301.00
Bbraun Safil Pcs Rp 88,829.90
Bbraun Safil Pcs Rp 88,829.90
Triton T-Vio V66z Pcs Rp 76,464.00
BBraun Premilene Pcs Rp 51,989.30
Triton T-Lene L19 Pcs Rp 73,600.00
Triton T-Lene L74 Pcs Rp 178,000.00
Triton T-Lene L18 pcs Rp 178,000.00
Triton T-Lene L17 pcs Rp 178,000.00
Bbraun Optilene pcs Rp 95,547.76
Bbraun Optilene pcs Rp 159,144.20

Bbraun Optilene Pcs Rp 140,140.00
Triton T-Silk S84 Pcs Rp 50,399.98
SMI Silk Pcs Rp 52,755.01
SMI Silk Pcs Rp 52,755.01
BBraun Silkam Black Pcs Rp 39,600.00
Triton T-Chromic C29 Pcs Rp 63,100.00
Triton T-Chromic C27 Pcs Rp 57,800.00
SMI Catgut Chromic Pcs Rp 68,792.00
SMI Catgut Plain Pcs Rp 58,212.00
SMI Catgut Plain pcs Rp 67,045.00
Triton T-Plain P121 Pcs Rp 56,900.00
Triton T-Plain P30 Pcs Rp 57,200.00
Triton T-Nylon N90 Pcs Rp 50,800.00
Triton T-Bond ICT21 Pcs Rp 269,500.00
Triton T-Bond ICT22 PCs Rp 269,500.00
Triton T-Bond B107 Pcs Rp 193,000.00
Triton T-Mono M49 Pcs Rp 112,100.00

Triton T-Hernia Mesh Pcs Rp 600,600.00
Triton T-Hernia Mesh MM18 Pcs Rp 148,900.00
Harum Pen Pcs Rp 22,000.00
MEGADYNE Pcs Rp 143,000.00
Pcs Rp 1,500.00
Pcs Rp 1,500.00
Pcs Rp 1,500.00
Pcs Rp 1,500.00
Pcs Rp 1,020.00
Pcs Rp 660.00
Pcs Rp 660.00
Pcs Rp 660.00
Pcs Rp 2,200.00
Fixomull roll Rp 89,999.98
Fixomull roll Rp 142,599.99
N/A roll Rp 23,568.16
N/A roll Rp 32,996.48
N/A roll Rp 43,268.75
Soffban Synthetic roll Rp 22,838.82

Leukomed T Plus Pcs Rp 16,362.50
Opsite Post Op Pcs Rp 35,200.00
Cuticell Pcs Rp 5,520.00
Plester Coklat Pcs
N/A Pcs Rp 2,685.00
N/A Pcs Rp 9,230.00
N/A Pcs Rp 33,000.00
N/A Pcs Rp 10,313.00
N/A Pcs Rp 808,764.00
N/A Pcs Rp 55,660.00
Uniflex Pcs Rp 24,800.00
Uniflex Pcs Rp 33,700.00
Jayamas Roll Rp 148,500.00
Onemed Box Rp 9,680.00
N/A Roll Rp 107,400.00
N/A roll Rp 13,750.00
n/A roll Rp 60,016.00
CTG Paper For AM 1400 Roll Rp 59,400.00
BTL ECG Pack Rp 164,000.00
Mortara Rim Rp 440,000.00
N/A Roll Rp 165,000.00
Cardipia Roll Rp 220,000.00
SONOMED Roll Rp 56,000.00
ENDO GE, Hellige Contrast,

Pack Rp 204,360.00
2036970-001, MAC-800)
ENDO GE, Hellige Contrast,
Pack Rp 113,760.00
2036970-001, MAC-600)
ENDO 210 MM x 150 MM, KENZ
Pack Rp 290,500.00
Cardico
Durico Roll Rp 277,200.00
MEDICO ELECTRODE PRIMED

Pcs Rp 1,376.83
ECG Electrode MSGLT-08GRT
MEDICO ELECTRODE PRIMED
Pcs Rp 1,314.00
ECG Electrode MSGST-37
Onemed Galon Rp 180,136.00
3M Pcs Rp 9,900.00
Sinar Ogan pcs Rp 3,106.14
Besmed Pcs Rp 27,104.00
Maxiflow Pcs Rp 15,972.00
Oxyflow Pcs Rp 6,050.00
Oxyflow pcs Rp 6,050.00
Onemed Pcs Rp 1,201.75
Onemed Sach Rp 27,500.00

Novotwist Pcs Rp 2,083.00
Bbraun Discofix pcs Rp 20,000.20
Bbraun Original Perfusor Line PCS Rp 37,000.70
Bbraun Pcs Rp 816,750.00
Bbraun Pcs Rp 816,750.00
Bbraun PCS Rp 595,300.20
N/A Pcs Rp 13,000.00
N/A Pcs Rp 13,000.00
N/A Pcs Rp 13,000.00
N/A Pcs Rp 13,000.00

N/A Pcs Rp 29,700.00
N/A Pcs Rp 29,700.00
N/A Pcs Rp 29,700.00
N/A Pcs Rp 16,203.00
ASAP Box Rp 61,710.00
Gammex Psg Rp 11,545.45
TERUMO Psg Rp 40,735.00
TERUMO Psg Rp 40,735.00
BBraun Pcs Rp 2,500.00
BBraun pcs Rp 2,790.00
BBraun pcs Rp 3,400.00
N/A Pcs Rp 314,299.70
Onemed pcs Rp 4,781.00

Aximed pcs Rp 4,779.50
Top pcs Rp 4,000.00
U Pad pcs Rp 8,388.60
TROGE Pcs Rp 8,069.94
N/A Bks Rp 3,850.00
N/A Bks Rp 4,400.00
N/A Bks Rp 46,000.00
N/A Bks Rp 5,170.00
N/A Bks Rp 6,050.00
N/A Bks Rp 7,700.00
N/A Bks Rp 10,450.00
N/A Bks Rp 4,400.00
N/A Bks Rp 16,500.00
N/A Bks Rp 2,640.00
N/A Bks Rp 2,750.00
N/A Bks Rp 2,750.00
N/A Ikat Rp 15,400.00
N/A Pcs Rp 16,500.00

N/A Pcs Rp 173,800.00
N/A Pcs Rp 87,266.67
Eagle Pcs Rp 163,800.00
3L Pcs Rp 56,250.00
Optiblu Pcs Rp 65,000.00
Optichol Pcs Rp 65,000.00
Swiss Visc PFS Pcs Rp 88,000.00
Excelens Pcs Rp 81,250.00
PROLENE Pcs Rp 124,663.00
ETHILON Pcs Rp 158,928.00
MERSILK Pcs Rp 35,904.00
Vicryl pcs Rp 260,241.67
Sharpoint Microsuture Pcs Rp 192,500.00
Unique Edge pcs Rp 242,000.00
Anodyne Surgical Pcs Rp 132,000.00
BBraun Sangofix Blood

Pcs Rp 21,328.00
Administration Set
TERUMO TERUFUSION BLOOD
Pcs Rp 13,976.00
ADM SET - TB*U800L
Pcs Rp 7,920.00
Pcs Rp 8,399.50
N/A Pcs Rp 220.00
N/A Pcs Rp 1,478.40
Pcs Rp 125.00
pcs Rp 3,239,500.00
pcs Rp 220.00
pcs Rp 2,200.00
pcs Rp 541.00
pcs Rp 130,000.00
pcs Rp 50,000.00
pcs Rp 80,000.00
pcs Rp 110,000.00
Hogy Set Rp 677,999.30
N/A pcs Rp 62,779.00
N/A Pcs Rp 40,000.00
Bks Rp 225,455.00
pcs Rp 7,079.00
Pcs Rp 250,000.00
Google Pcs Rp 27,999.99
Jumper pcs Rp 980,000.00
Work pcs Rp 162,000.00

Work Pcs Rp 165,600.00
Flexicare Pcs Rp 27,720.00
Flexicare Pcs Rp 27,720.00
Flexicare pcs Rp 27,720.00
Aximed Pcs Rp 29,040.00

N/A Pcs Rp 13,831.00
BD Pcs Rp 1,770.00
BBraun Omnifix Luer Lock Pcs Rp 16,125.00
BD Precise Syringe pcs Rp 2,886.00
BD Pcs Rp 1,200.00
BD pcs Rp 1,604.44
BD Pcs Rp 1,650.60
BBraun Omnifix Luer Lock Pcs Rp 9,675.00
Stera Spuit 50 CC (Lubang

Pcs Rp 8,575.72
Tengah)/Cateter Tip
Terumo Pcs Rp 7,018.00
Terumo pcs Rp 6,930.00
Terumo Surflo pcs Rp 6,272.64
Terumo Surflo pcs Rp 6,272.64
Terumo Surflo Pcs Rp 6,273.00

Pcs Rp 5,941.71
Uro Care pcs Rp 36,300.00
Uro One Pcs Rp 8,799.12
Uro One pcs
Urocare Jayamas Pcs Rp 8,799.12
Urocare Pcs Rp 8,799.12
Uro One Jayamas Pcs Rp 10,648.00
Uro One pcs Rp 13,300.00
Urocare Pcs Rp 35,750.00
Urocare Jayamas Pcs Rp 35,750.00
N/A Pcs Rp 64,955.00

N/A Pcs Rp 17,424.00
N/A Pcs Rp 17,424.00
N/A Pcs Rp 64,955.00
N/A Pcs Rp 64,955.00
N/A Pcs Rp 64,955.00
Stella Pcs Rp 506,000.00
Tensoplast Roll Rp 111,320.00
Tensoplast Roll Rp 163,185.00
pcs Rp 52,700.00
pcs Rp 82,800.00
BTL pcs Rp 214,500.00
Pcs Rp 71,500.00
Hydcal Technew Set Rp 178,166.67
Denpro Box Rp 212,838.34
N/A bks Rp 396,000.00
N/A Box Rp 25,628.77
3M bks Rp 489,500.00
3M Box Rp 166,100.00
Denpro Box Rp 227,000.00
Svenska Dentorama Pack Rp 112,000.00
GC Box Rp 251,900.00
N/A bks Rp 16,500.00
BMHP Gigi Devital Set Rp 269,333.34
Dochem Box Rp 132,755.56
Set Rp 55,000.00
Botol Rp 50,000.00
Botol Rp 185,000.00
Botol Rp 100,000.00
Mani Bur Set Rp 65,000.00
Mani Bur Set Rp 85,000.00
Set Rp 80,000.00
Botol Rp 62,500.00
BAHAN MEDIS PAKAI TAHUN 2021

S PAKAI TAHUN 2021
NAMA PABRIK
PT. Prima Alkesindo Nusantara
PT. Jembatan Dua
PT. Onemed
PT. Onemed
PT. Onemed
PT. Bio Optica
PT. Bio Optica
PT. Jayamas Medika Industri/Onemed
PT. Sterin Laboratories
PT. Sterin Laboratories
PT. Prima Alkesindo Nusantara
PT. Bbraun
PT. Bbraun
PT. Bio Optica
PT. Molecular LTD

PT. Triton Manufacture
PT. Rajawali Nusindo
PT. Bbraun
PT. Bbraun
PT. Bbraun
PT. Bbraun
PT. Bbraun
PT. Bbraun
PT. Bbraun

PT. HARUM BEWA PERSADA
PT. ENSEVAL MEDIKA PRIMA
PT, PRIMANUSA MUKTI UTAMA
PT. BSN MEDICAL INDONESIA

PT. ENDO INDONESIA

PT. ENDO INDONESIA
PT. DURICO C8T
PT. TOTAL MEDICA PERSADA
PT. TOTAL MEDICA PERSADA
PT. ENSEVAL MEDIKA PRIMA

PT. BBRAUN
PT. BBRAUN
PT. BBRAUN
PT. BBRAUN
PT. BBRAUN
PT. TIARA KENCANA
PT. TIARA KENCANA
PT. TIARA KENCANA
PT. ANSELL
PT. ANSELL
PT. ANSELL
PT. ANSELL
PT. TERUMO INDONESIA
PT. BBRAUN MEDICAL INDUSTRI
PT. JAYAMAS MEDICA INDUSTRI / ONEMED

PT. TROGE MEDICAL GMBH

PT. MEGA MEDICAL ABADI
PT. BBRAUN

PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA
PT. DWI ARSI GRAHA



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PRAKIRAAN USULAN JUMLAH KEBUTUHAN OBAT INSTALASI FARMASI TAHU

NO. NAMA OBAT SPESIFIKASI NAMA DAGANG SAT

ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI NON STEROID DAN ANTIPIRAI

Alprazolam Tablet 0.5 mg N/A Tab

Fentanil Injeksi 0.05 mg/mL, 2 mL N/A Amp

Fentanil Patch 25 mcg/ h Durogesik patch Pcs

Klobazam Tablet 10 mg N/A Tab

Kodein Tablet 10 mg N/A Tab

Lorazepam Tablet 0.5 mg Merlopam Tab

Lorazepam 2 mg N/A Tab

Morfin Injeksi 10 mg/mL N/A Amp

Petidin HCl Injeksi 50 mg/ mL, 2 mL N/A Amp

Asam Mefenamat Kaplet 500 mg N/A Tab

Dexketoprofen Trometamol Injeksi 25 mg/ mL, 2 mL Lantidex Amp

Ibuprofen Tablet 400 mg N/A Tab

Ibuprofen syr 200mg/5ml,60ml N/A Botol

Ketoprofen Suppositoria 100 mg Suprafenid Suppo

ketoprofen Tablet 100 mg N/A Tab

Ketorolak Injeksi 30 mg/mL N/A Amp

Metamizol injeksi 500 mg/ mL, 2 mL N/A Amp

Meloksikam Tablet 15 mg N/A Tab

Natrium Diklofenak Tablet 50 mg N/A Tab

Natrium Diklofenak Tablet 25 mg N/A Tab

Parasetamol OD 60 mg/mL, 15 mL Botol

Parasetamol Sirup 120 mg/mL, 60 mL N/A Botol

Parasetamol Suppositoria 250 mg Pamol Supp

Parasetamol Suppositoria 160 mg Pyrexin Suppo

Parasetamol Suppositoria 125 mg Pamol Suppo

Parasetamol Tablet 500 mg N/A Tab

Tramadol Injeksi 50 mg/mL N/A Amp

Tramadol Kapsul 50 mg Dolgesic Kaps

Alopurinol Tablet 100 mg N/A Tab

Alopurinol Tablet 300 mg N/A Tab

3 Levobupivakain Injeksi 5 mg/ mL, 10 mL levica Amp

Lidocain HCl Injeksi 20 mg dan Epinefrin

5 Lidokain HCl Gel 2%, 10 g Xylocain Tube

Lidokain HCl Injeksi 20 mg/ mL N/A Amp

7 Lidokain HCl Oral Spray 10 mg/ dosis Xylocain Btl

8 Mepicavain 2%, Adrenalin 1:1000 N/A Amp

Anastetik Umum dan Oksigen

Sevofluran 250 ml Sojourn Botol

Tiopental Sod Serbuk Injeksi 500 mg N/A Vial

Ketamin Injeksi 100 mg/ mL, 10 mLKTM Vial

Propofol Injeksi 1%, 20 mL N/A Amp

Obat Prosedur Pre Operatif

Atropin Sulfat Injeksi 0.25 mg/ mL N/A Amp

Midazolam HCl Injeksi 1 mg/ mL, 5 mL Fortanest Amp

Midazolam HCl Injeksi 5 mg/ mL, 3 mL Fortanest Amp

Antihistamin dan Antianafilaksi

Deksametason Injeksi 5 mg/ mL N/A Amp

Difenhidramin Injeksi 10 mg/ mL N/A Amp

Epinefrin Injeksi 1 mg/ mL N/A Amp

Klorfeniramin Maleat Tab 4 mg CTM Tab

Granisentron HCI Injeksi 1 mg/ mL Granesis

Loratadin Tablet 10 mg N/A Tab

Setirizin HCl Sirup 5 mg/ 5 mL LERIXIN Botol

Setirizin HCl Tablet 10 mg N/A Tab

Efedrin HCl Injeksi 50 mg/ mL N/A Amp

Kalsium Glukonat Injeksi 100 mg/ mL, 10 mLN/A Amp

Nalokson Injeksi 0.4 mg/mL Nokoba Amp

Natrium Bikarbonat Injeksi 8.4 %, 25 mL Meylon Flc

Natrium Bikarbonat Tablet 500 mg N/A Tab