LAMPIRAN
PERATURAN BADAN TENAGA NUKLIR NASIONAL
REPUBLIK INDONESIA
NOMOR 1 TAHUN 2020
TENTANG
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
77 Kertas Pembatas Odner Index Divider Cardboards 6043 A-Z A4 1 Pak 26,000
109 Penanda kertas /halaman/pembatas/ Sticky Notes Berat 13 gram 1 Pak 29,000
Joyko [75x15 MM] MS-SN-568 100
110 Penanda kertas /halaman/Post-Its 1 Pad 6,000
Lembar
111 Penggaris Besi Kenko 60 cm 1 Buah 27,000
112 Penggaris Plastik Butterfly Ukuran 30 cm 1 Buah 4,000
113 Penggaris Plastik Butterfly Ukuran 50 cm 1 Buah 11,000
114 Penggaris Plastik Butterfly Ukuran 60 cm 1 Buah 19,500
115 Penghapus white board Ukuran Kecil 1 Buah 9,000
116 Penghapusan Karet Pensil Ukuran Kecil Joyko B40 Hitam (40 pcs) - DAS26 1 Pak 60,000
139 Stop Map Balik Cover Carton Stop Map Batik (Folio) /Cover Carton 1 Buah 8,000
B. BAHAN KIMIA
164 Benzyl Alcohol Special Grade (Benzaldehyd) E-Merck1.00987.2500 2.5 liter 5,265,000
Benzyldimethyltetradecylammonium
178 E-Merck8.14363.0100 100 ml 839,000
Chlorid
Benzyltriethylammonium Chloride For
179 E-Merck8.10298.0100 100 ml 744,000
Synthesis
180 Benzyltrimethylammonium Hydroxide E-Merck8.01816.0100 100 ml 839,000
181 Beryllium Standard Solution E-Merck1.70207.0100 100 ml 1,454,000
182 Betain Hydrochloride For Synthesis E-Merck8.14633.0100 100 ml 750,000
183 Biphenyl For Synthesis E-Merck8.03090.1000 1 kg 1,414,000
184 Biphenyl-2-Ol For Synthesis E-Merck8.21007.1000 1 kg 2,415,000
185 Biphenyl-4-Ol For Synthesis E-Merck8.01959.0100 100 gram 853,000
Bis(1-Aminoguanidinium) Sulfate For
186 E-Merck8.20073.0250 250 ml 1,837,000
Synthesis
187 Bis(2-Chloroethyl) Ether For Synthesis E-Merck8.01678.0250 250 ml 707,000
Bis(2-Chloroethyl)Ammonium Chloride For
188 E-Merck8.20159.0100 100 ml 978,000
Synthesisi
189 Bis(2-Ethylhexyl) Adipate For Synthesis E-Merck8.01453.0100 100 ml 700,000
190 Bis(2-Ethylhexyl) Amine For Synthesis E-Merck8.18191.0250 250 ml 1,290,000
Bis-(4-Fluorophenyl)-Methanol For
197 E-Merck8.40054.0010 10 ml 1,072,000
Synthesis
203 Boric Acid For Analysis Emsure E-Merck1.00165.0100 100 gram 729,000
204 Boric Acid, Mb Grade E-Merck203667-0.5KGCN 500 gram 1,179,000
205 Boron Standard Solution Traceable E-Merck1.19500.0100 100 ml 862,000
206 Boron Trifluoride-Acetic Acid-Complex E-Merck8.14775.0250 250 ml 2,597,000
207 Boron Trifluoride-Diethyl Ether Complex E-Merck8.01647.0250 250 ml 1,120,000
208 Bpls Agar For The Isolation Of Salmonell E-Merck1.07232.0500 500 gram 3,413,000
225 Cadmium Acetate Dihydrate For Analysis E-Merck1.02003.0500 500 gram 5,136,000
233 Calcium Nitrate Tetrahydrate For Analysis E-Merck1.02121.0500 500 gram 1,027,000
237 Cerium(IV) Sulfate Tetrahydrate For Anal E-Merck1.02274.0100 100 gram 3,894,000
244 Cobalt(II) Sulfate Heptahydrate For Analysis E-Merck1.02556.0100 100 gram 2,807,000
253 Copper(II) Chloride Dihydrate For Analys E-Merck1.02733.0250 250 gram 1,539,000
254 Copper(II) Nitrate Trihydrate For Analys E-Merck1.02753.0250 250 gram 1,465,000
255 Copper(II) Oxide Powder For Analysis E-Merck1.02766.0100 100 gram 3,596,000
256 Copper(II) Sulfate Anhydrous For Analysis E-Merck1.02791.0250 250 gram 1,541,000
287 Deoxycholate Lactose Agar For Microbiology E-Merck1.02894.0500 500 gram 3,264,000
355 Ethanol 96% Extra Pure Ph Eur,Usp E-Merck1.00967.2500 2.5 liter 3,203,000
356 Ethanol 96% Extra Pure Ph.Eur.,Bp E-Merck1.00971.1000 1 liter 864,000
357 Ethanol 96% Reag. Ph Eur E-Merck1.59010.0500 500 ml 2,252,000
358 Ethanol Absolute Emplura® E-Merck8.18760.1000 1 liter 526,000
364 Ethanol Gradient Grade For Liquid Chroma E-Merck1.11727.1000 1 liter 1,076,000
397 Ethyl Methyl Ketone For Analysis Emsure® E-Merck1.09708.1000 1 liter 1,577,000
402 Ethyl Vinyl Ether (Stabilised With Potasium E-Merck8.01391.0100 100 ml 739,000
436 Formic Acid 89-91% For Analysis Emsure E-Merck1.00253.1000 1 liter 1,278,000
437 Formic Acid 98-100% For Analysis Emsure E-Merck1.00264.1000 1 liter 1,329,000
438 Formic Acid 98-100% For Analysis Emsure E-Merck1.00264.2500 2.5 liter 2,636,000
451 Gluconic Acid Potassium Salt For Synthes E-Merck8.20601.0100 100 ml 711,000
452 Gluconic Acid Sodium Salt For Synthesis E-Merck8.22058.0100 100 ml 575,000
456 Glycerol About 85% Extra Pure Ph Eur,Bp E-Merck1.04091.1000 1 liter 4,124,000
457 Glycerol About 85% For Analysis Emsure® E-Merck1.04094.1000 1 liter 2,853,000
481 Hydrochloric Acid 32% For Analysis Emsur E-Merck1.00319.1000 1 liter 741,000
484 Hydrochloric Acid Fuming 37% Extra Pure E-Merck1.00314.1000 1 liter 1,043,000
485 Hydrochloric Acid Fuming 37% For Analysis E-Merck1.00317.1000 1 liter 539,000
489 Hydrofluoric Acid 40% For Analysis Emsur E-Merck1.00338.0500 500 ml 1,031,000
491 Hydrofluoric Acid 48% For Analysis Emsure E-Merck1.00334.0500 500 ml 1,247,000
514 Iminodiacetic Acid Disodium Salt Hydrate E-Merck8.41784.0100 100 gram 5,019,000
529 Iron(II) Chloride Tetrahydrate For Analysis E-Merck1.03861.0250 250 gram 1,448,000
534 Iron(III) Chloride Anhydrous For Synthes E-Merck8.03945.0500 500 gram 1,061,000
535 Iron(III) Chloride Hexahydrate P.A. Emsu E-Merck1.03943.0250 250 gram 1,184,000
583 Kligler Agar For The Identification Of G E-Merck1.03913.0500 500 gram 2,276,000
584 Kovacs Indole Reagent For Microbiology E-Merck1.09293.0100 100 gram 929,000
601 Lead(II) Chloride Anhydrous For Synthesis E-Merck8.07383.0100 100 gram 647,000
602 Lead(II) Fluoride Granules About 1-4 Mm E-Merck1.07388.0100 100 gram 2,918,000
604 Lead(II) Nitrate For Analysis Emsure E-Merck1.07398.0100 100 gram 989,000
605 Leifson Agar Deoxycholate Citrate Agar E-Merck1.02896.0500 500 gram 2,723,000
606 Leucognost® Fixing Mixture E-Merck1.12327.0500 500 ml 1,123,000
607 Levulinic Acid For Synthesis E-Merck8.14254.0100 100 gram 771,000
608 L-Glutamic Acid For Biochemistry E-Merck1.00291.0250 250 gram 1,850,000
L-Glutamic Acid Hydrochloride For
609 E-Merck8.14632.0250 250 gram 923,000
Synthesis
613 Lithium Carbonate For Analysis Emsure E-Merck1.05680.0250 250 gram 2,743,000
614 Lithium Carbonate Pure E-Merck1.05670.1000 1 kg 2,743,000
615 Lithium Chloride For Analysis Emsure E-Merck1.05679.0100 100 gram 1,666,000
616 Lithium Chloride For Analysis Emsure E-Merck1.05679.0250 250 gram 2,539,000
617 Lithium Standard Solution E-Merck1.70223.0100 100 ml 842,000
618 Lithium Sulfate Monohydrate For Analysis E-Merck1.05694.0250 250 gram 1,394,000
628 Magnesium Nitrate Hexahydrate For Analys E-Merck1.05853.0500 500 gram 1,505,000
630 Magnesium Perchlorate Hydrate For Analys E-Merck1.05874.0100 100 gram 2,853,000
650 Mercury(I) Nitrate Dihydrate For Analysis E-Merck1.04437.0250 250 gram 4,489,000
N,N'-Dicyclohexylcarbodiimide For
675 E-Merck8.02954.0250 250 gram 1,798,000
Synthesis
N,O-Bis(Trimethylsilyl)Acetamide For
692 E-Merck8.18727.0025 25 gram 1,299,000
Synthesis
717 Nickel(II) Chloride Anhydrous For Synthe E-Merck8.06722.0100 100 gram 2,659,000
718 Nickel(II) Chloride Hexahydrate For Anal E-Merck1.06717.0250 250 gram 1,744,000
719 Nickel(II) Nitrate Hexahydrate For Analy E-Merck1.06721.0100 100 gram 1,580,000
720 Nickel(II) Sulfate Hexahydrate Extra Pur E-Merck1.06726.1000 1 kg 4,611,000
721 Nicotinic Acid For Synthesis E-Merck8.18714.1000 1 kg 2,875,000
722 Ninhydrin Gr For Analysis E-Merck1.06762.0010 10 gram 1,237,000
723 Nitric Acid 65% For Analysis Emsure E-Merck1.00456.1000 1 liter 1,174,000
724 Nitric Acid 65% Suprapure E-Merck1.00441.0250 250 ml 3,164,000
725 Nitric Acid 69% For Analysis Emsure E-Merck1.01799.1000 1 liter 1,233,000
726 Nitrobenzene For Synthesis E-Merck8.06770.1000 1 liter 1,085,000
727 Nitroethane For Synthesis E-Merck8.06843.0100 100 ml 931,000
728 Nitromethane For Synthesis E-Merck8.20894.1000 1 liter 4,023,000
N-Lauryl Sarcosine Sodium Salt For
729 E-Merck8.14715.0100 100 ml 804,000
Synthesis
740 N-Pentane For Organic Trace Analysis Sup E-Merck1.07288.1000 1 liter 3,629,000
743 Nutrient Agar For Microbiology (20 G For) E-Merck1.05450.0500 500 gram 1,861,000
- 25 -
753 Oxalic Acid Dihydrate For Analysis Emsur E-Merck1.00495.0500 500 ml 1,447,000
765 Peptone Water (Buffered) For Microbiolog E-Merck1.07228.0500 500 gram 1,120,000
792 Phthalimide Potassium Salt For Synthesis E-Merck8.07302.0100 100 gram 1,106,000
800 Plate Count Agar Casein-Peptone Dextrose E-Merck1.05463.0500 500 gram 1,448,000
802 Polyethylene Glycol 4000 For Gas Chromat E-Merck1.09727.0100 100 gram 3,507,000
803 Polyethylene Glycol Dimethyl Ether 500 F E-Merck8.14171.0500 500 gram 3,220,000
813 Potassium Chlorate For Analysis Emsure E-Merck1.04944.0100 100 gram 2,151,000
827 Potassium Hydrogen Phthalate For Analysis E-Merck1.04874.0250 250 gram 1,365,000
829 Potassium Hydrogen Sulfate For Analysis E-Merck1.04885.0500 500 gram 1,633,000
840 Potassium Iodate For Analysis Emsure E-Merck1.05051.0100 100 gram 2,075,000
841 Potassium Iodide For Analysis Emsure E-Merck1.05043.0250 250 gram 1,787,000
842 Potassium Methylate For Synthesis E-Merck8.20746.0100 100 gram 1,382,000
843 Potassium Nitrate For Analysis Emsure E-Merck1.05063.0500 500 gram 986,000
844 Potassium Nitrite Cryst. For Analysis E-Merck1.05067.0250 250 gram 2,191,000
879 Pyrocatechol Monoethyl Ether For Synthes E-Merck8.01917.0250 250 gram 1,934,000
896 Salmonella Enrichment Broth Acc. To Rapp E-Merck1.07700.0500 500 gram 1,974,000
897 Salmosyst Broth Base For Microbiology E-Merck1.10153.0500 500 gram 3,332,000
917 Simmons Citrate Agar For The Identificat E-Merck1.02501.0500 500 gram 3,187,000
918 Skim Milk Powder For Microbiology E-Merck1.15363.0500 500 gram 910,000
919 Sodalime Pellets With Indicator E-Merck1.06839.1000 1 kg 2,251,000
920 Sodium Acetate Anhydrous E-Merck1.06236.1000 1 kg 1,873,000
- 29 -
927 Sodium Borohydride (Tablets) For Synthesis E-Merck8.18823.0100 100 gram 3,465,000
939 Sodium Chloride For Analysis Emsure E-Merck1.06404.0500 500 gram 792,000
940 Sodium Chloride Peptone Broth (Buffered) E-Merck1.10582.0500 500 gram 2,398,000
951 Sodium Fluoride For Analysis Emsure E-Merck1.06449.0250 250 gram 1,458,000
970 Sodium Molybdate Dihydrate For Analysis E-Merck1.06521.0100 100 gram 2,555,000
971 Sodium Nitrate For Analysis Emsure E-Merck1.06537.0500 500 gram 1,039,000
972 Sodium Nitrite Cryst. For Synthesis E-Merck8.22285.1000 1 kg 1,004,000
973 Sodium Nitrite Extra Pure Ph Eur,Usp E-Merck1.06544.1000 1 kg 1,887,000
974 Sodium Nitrite For Analysis Emsure E-Merck1.06549.0100 100 gram 798,000
975 Sodium Perborate Tetrahydrate Pure E-Merck1.06560.1000 1 kg 1,526,000
Sodium Perchlorate Monohydrate P.A.
976 E-Merck1.06564.0100 100 gram 1,656,000
Emsu
977 Sodium Peroxide For Synthesis E-Merck8.14606.0100 100 gram 1,695,000
978 Sodium Peroxide Granular Gr For Analysis E-Merck1.06563.0100 100 gram 2,435,000
980 Sodium Phenolate Trihydrate For Synthesi E-Merck8.20873.0100 100 gram 1,290,000
985 Sodium Sulfanilate Dihydrate For Synthes E-Merck8.22145.0250 250 gram 2,300,000
995 Sodium Sulfite Anhydrous For Analysis E-Merck1.06657.0500 500 gram 989,000
997 Sodium Tartrate Dihydrate Water Standard E-Merck1.06664.0100 100 gram 1,848,000
1006 Sodium Tungstate Dihydrate For Analysis E-Merck1.06673.0250 250 gram 3,467,000
1008 Solvent For Volumetric Karl Fischer Titre E-Merck1.88015.1000 1 liter 2,369,000
1009 Solvent Oils & Fats Solvent For Volumetre E-Merck1.88016.1000 1 liter 2,898,000
1018 Succinic Acid For Analysis Emsure E-Merck1.00682.0250 250 gram 1,413,000
1019 Succinic Acid For Synthesis E-Merck8.22260.1000 1 kg 1,700,000
1020 Succinic Anhydride For Synthesis E-Merck8.00683.1000 1 kg 1,610,000
1021 Succinimide For Synthesis E-Merck8.07971.1000 1 kg 4,597,000
1022 Succinodinitrile For Synthesis E-Merck8.22143.0250 250 gram 2,828,000
1023 Sulfanilic Acid For Synthesis E-Merck8.22338.1000 1 kg 1,801,000
1024 Sulfanilic Acid Gr For Analysis Acs E-Merck1.00686.0100 100 gram 1,051,000
1025 Sulfur For External Use Ph Eur,Bp E-Merck1.07983.2500 2.5 kg 2,563,000
Sulfur Trioxide Pyridine Complex For
1026 E-Merck8.18112.0100 100 ml 1,905,000
Synthesis
1027 Sulfuric Acid 10% E-Merck4.80704.1001 1 liter 1,932,000
1028 Sulfuric Acid 25% For Analysis Emsure E-Merck1.00716.1000 1 liter 344,000
1029 Sulfuric Acid 40% For Determination Of G E-Merck1.09286.2500 2.5 liter 770,000
1030 Sulfuric Acid 62% For Analysis D. Of Fat E-Merck4.80531.1000 1 liter 1,867,000
1031 Sulfuric Acid 90-91% For Gerber Fat Dete E-Merck1.00729.0500 500 ml 1,207,000
1032 Sulfuric Acid 95-97% For Analysis Emsure E-Merck1.00731.1000 1 liter 359,000
1033 Sulfuric Acid 95-98% Extra Pure Ph Eur,B E-Merck1.00713.1000 1 liter 1,916,000
1034 Sulfuric Acid 96% For The Determination E-Merck1.08131.1000 1 liter 2,008,000
1035 Sulfuric Acid 98% For Analysis Emsure E-Merck1.12080.1000 1 liter 422,000
1036 Sulfuric Acid 98% For The Determination E-Merck1.00748.0500 500 ml 1,476,000
1055 Titanium(IV) Oxide Tablets Black About 2 E-Merck1.11771.0100 100 gram 1,512,000
1085 Tri-Sodium Citrate Dihydrate P.A. Emsure E-Merck1.06448.0500 500 gram 1,358,000
1093 Urea Broth For Detecting Microorganisms E-Merck1.08483.0500 500 gram 1,793,000
1116 Yeast Extract Granulated, For Microbiology E-Merck1.03753.0500 500 gram 2,479,000
Yeast Peptone Agar Acc. To Swedish
1117 E-Merck1.13116.0500 500 gram 3,052,000
Standard
Yttrium Standard Solution Traceable to
1118 E-Merck1.19809.0100 100 ml 966,000
Synthesis
1119 Ziehl-Neelsen Carbol-Fuchsin Solution E-Merck1.09215.0100 100 ml 612,000
1120 Zinc Acetate Dihydrate Extra Pure Usp,Ph E-Merck1.08800.1000 1 liter 4,359,000
1121 Zinc Acetate Dihydrate For Analysis E-Merck1.08802.0250 250 gram 1,089,000
1123 Zinc Chloride For Analysis Emsure E-Merck1.08816.0250 250 gram 1,139,000
1124 Zinc Chloride Technipur(Tm) E-Merck1.16763.0250 250 gram 3,840,000
1126 Zinc Granular For Analysis, Particle E-Merck1.08780.0500 500 gram 3,466,000
1127 Zinc Iodide For Analysis Emsure E-Merck1.08828.0025 25 gram 2,182,000
1128 Zinc Iodide Starch Solution For Analysis E-Merck1.05445.0500 500 gram 1,353,000
1129 Zinc Nitrate Tetrahydrate For Analysis E-Merck1.08833.1000 1 kg 4,051,000
1130 Zinc Oxide Extra Pure Ph Eur,Bp,Usp E-Merck1.08846.1000 1 kg 1,066,000
1131 Zinc Oxide For Analysis Acs E-Merck1.08849.1000 1 kg 2,319,000
1132 Zinc Powder For Analysis Particle Siz E-Merck1.08789.0500 500 gram 2,183,000
1134 Zinc Sulfate Heptahydrate For Analysis E-Merck1.08883.0500 500 gram 1,097,000
Zirconium(IV) Acetylacetonate For
1135 E-Merck8.08915.0100 100 ml 2,125,000
Synthesis
Zirconium(IV) Chloride Anhydrous, For
1136 E-Merck8.08913.0250 250 gram 1,311,000
Synthesis
1137 Zirconium(IV) Oxide Chloride Octahydrate E-Merck1.08917.0100 100 gram 4,911,000
- 34 -
57 Crucible porcelain + tutup 50ml; Cole Parmer, SN- 63100-52 1 buah 977,000
58 Crucible Vycor+ cover Coleparmer, EW-34526-64 1 buah 2,844,000
59 Crucible porcelain + tutup 50 ml; lokal 1 buah 85,000
60 Crucible filter 50 ml; lokal 1 buah 554,000
61 Dow corning grease Cole Parmer, EJ-79751-30 1 buah 1,004,000
62 Erlenmeyer 100 ml; Cole Parmer, RZ-61000-87 1 pak 354,000
63 Erlenmeyer 125 ml; Cole Parmer, RZ-34503-04 1 pak 2,614,000
64 Erlenmeyer 250 ml; Cole Parmer, RZ-34503-08 1 pak 406,000
65 Erlenmeyer 50 ml; Cole Parmer, RZ-61000-85 1 pak 1,057,000
66 Film radiografi grade D 7. 4 x 10"; Lokal 1 buah 2,206,000
67 Film radiografi grade D 7. 4 x 15"; Lokal 1 buah 3,307,000
Milipore 25 mm, 100/pack; Cole
68 Filter bakteri 1 pak 3,575,000
Parmer, SN-02915-04
69 Filter Buchner keramik, vol.25 mL; Iwaki, L127C/1 1 pak 901,000
70 Flexy glass Lokal 1 pak 309,000
71 Nitrogen cair Lokal 1 liter 17,000
72 Nitrogen cair (khusus Yogyakarta) Lokal 1 liter 22,000
73 Gelas ukur transparent PP 100 ml; Cole Parmer, SN-0637-76 1 buah 316,000
74 Gelas ukur transparent PP 25 mL; Cole Parmer, SN-0637-76 1 buah 316,000
75 Gelas ukur transparent PP 50 ml; Cole Parmer, SN-0637-74 1 buah 316,000
76 Gelas ukur 100 ml; VWR, 89001-162 1 buah 336,000
77 Gelas Ukur 100 ml; Iwaki, 3022-100-N, Pyrex 1 buah 120,000
78 Gelas Ukur 1000 ml; Iwaki, Pyrex,3022-1000-N 1 buah 547,000
79 Gelas Ukur 25 ml; Iwaki, 3022-25-N, Pyrex 1 buah 99,000
80 Gelas Ukur 250 ml; Iwaki, Pyrex, 3022-250-N 1 buah 206,000
81 Gelas ukur 50 ml; VWR, 89001-160 1 buah 241,000
82 Gelas Ukur 50 ml; Iwaki, 3022-50-N, Pyrex 1 buah 100,000
83 Gelas Ukur 500 ml; Iwaki, Pyrex, 3022-500-N 1 buah 344,000
84 Glass cleaner Lokal 1 buah 44,000
85 Glass wool LAB Cole Parmer, RZ-34552-01 1 buah 978,000
86 Gunting bedah SS Fisher, 08-940 1 buah 540,000
87 Hand soap 320 ml; Lokal 1 buah 45,000
88 Jarum 20 G 11/2 Tw Lokal 1 buah 16,000
89 Kain Majun Lokal warna putih 1 kg 22,000
90 Kantong plastik Limbah, Hitam Lokal,100cmx80cmx0,1mm 1 buah 16,000
91 Kantong plastik Limbah, Kuning Lokal,100cmx80cmx0,1mm 1 buah 17,000
92 Kantong plastik tahan panas kapasitas 2 Kg ; Lokal 1 kg 22,000
93 Kantong plastik kapasitas 1 ons; Lokal 1 kg 92,000
94 Kantong plastik kapasitas 2 Kg; Lokal 1 kg 110,000
95 Kantong plastik kapasitas 5 Kg; Lokal 1 kg 110,000
96 Kantong plastik clip bening 3cm x 5cm 100 pcs per pak 1 pak 6,000
97 Kantong plastik clip bening 4cm x 6cm 100 pcs per pak 1 pak 8,000
98 Kantong plastik clip bening 5cm x 8cm 100 pcs per pak 1 pak 9,000
99 Kantong plastik clip bening 7cm x 10cm 100 pcs per pak 1 pak 13,000
100 Kantong plastik clip bening 8cm x 12cm 100 pcs per pak 1 pak 17,000
100 pcs per pak
101 Kantong plastik clip bening 11cm x 17cm 1 pak 23,000
102 Kantong plastik clip bening16cm x 25cm 100 pcs per pak 1 pak 44,000
100 pcs per pak
103 Kantong plastik clip bening 20cm x 30cm 1 pak 66,000
104 Kantong plastik clip bening 25cm x 35cm 100 pcs per pak 1 pak 87,000
- 36 -
105 Kantong plastik clip bening 30cm x 40cm 100 pcs per pak 1 pak 102,000
106 Kantong plastik clip bening 35cm x 45cm 100 pcs per pak 1 pak 145,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
A. SUKU CADANG ELEKTRIK
1 ACB (Air Circuit Breaker) 800 A 1 buah 70,600,000
2 ACB (Air Circuit Breaker) 1600 A 1 buah 65,000,000
3 ACB (Air Circuit Breaker) 2500 A 1 buah 90,700,000
4 Batteray - accu kering Accu kering 12 V, 12 AH 1 buah 600,000
5 Batteray timer button cell AG-13 1 buah 46,000
6 Battery Cartridge UPS APC RBC 55 (2 batere) 1 pack 3,000,000
7 Battery Cartridge UPS APC RBC 44 (2 batere) 1 pack 3,000,000
8 Battery kering 12 V 7 AH 1 buah 310,000
9 Cable marker tipe Huruf/Angka 1 pak 54,000
10 Cable ties 100 mm (100 buah/pak) 1 pak 73,000
11 Cable ties 200 mm (100 buah/pak) 1 pak 65,000
12 Cable ties 300 mm (100 buah/pak) 1 pak 65,000
Stainless Steel Hose Clamp, 14.4mm
13 Clamp Hose 1 box 486,000
Width TH-30006
14 Clamp meter Digital, 2007 A 1 buah 1,730,000
15 Contact Cleaner 390 DCS/2 1 kaleng 112,000
16 Contact strap Type 5827 / Type 5829, L 100 mm 1 buah 593,000
17 Contactor RH 1131 1 APOO 1 buah 1,615,000
18 Contactor CA-DN 65 A 240 V DC 1 buah 2,400,000
19 Contactor DC-Operation 3TF4022 – 0BM4, Size 0 1 buah 2,400,000
20 Contactor AC-3 3TF4122 – OAPO, Size 0 1 buah 2,847,000
21 Contactor AC-3 3TF4022 – OAPO, Size 0 1 buah 2,329,000
22 Contactor AC-3 3TF4422 – OAPO, Size 1 1 buah 2,623,000
23 Digital weekly time switch H5S 1 buah 1,865,000
24 Electric Valve Actuator DEUFRA AS 25, 3 ph, 0,04 kW 1 unit 2,070,000
25 Fitting Lampu Tungsten Halogen , 1000 W 1 buah 140,000
26 Fitting sekering AXLE, 10x38 32A 690V 1 buah 75,000
27 Flexible Cable 70 mm2 1 meter 115,000
28 Flexible Cable 90 mm2 1 meter 247,000
29 Flexible Cable 120 mm2 1 meter 308,000
30 Flow control switch 15A, 220V, IT. Sika 1 buah 5,175,000
31 Flow control JSF-2E 15A 220V 1 buah 4,327,000
32 Free Zone, Benchtop shell Freezers 230 V, 50 Hz; 1,5 A 1 unit 141,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
Philips • LED Tube 600mm 10W/830 T8
67 Lampu LED Tube 1 buah 348,000
AP I
Philips • LED Tube 600mm 10W/840 T8
68 Lampu LED 1 buah 348,000
AP I
Philips • LED Tube 600mm 10W/865 T8
69 Lampu LED 1 buah 348,000
AP I
70 Lampu LED Hannochs Bulb 3 Watt Premier 1 buah 17,000
71 Lampu LED Hannochs Bulb 5 Watt Premier 1 buah 21,000
72 Lampu LED Hannochs Bulb 7 Watt Premier 1 buah 24,000
73 Lampu LED Hannochs Bulb 9 Watt Premier 1 buah 28,000
74 Lampu LED Hannochs Bulb 11 Watt Premier 1 buah 32,000
75 Lampu LED Hannochs Ultima 6 Watt 1 buah 600,000
76 Lampu LED Hannochs Ultima 10 Watt 1 buah 648,000
77 Lampu LED Hannochs Ultima 14 Watt 1 buah 680,000
78 Lampu LED Hannochs 45w jumbo 440lm 1 buah 188,000
79 Lampu LED Hannochs Premier 20w Putih 1 buah 222,000
80 Lampu Essential (SL) 8W 240 V-CP/12 1 buah 90,000
81 Lampu Floodlight 50 W 1 buah 430,000
82 Lampu sorot Halogen Halogen 1000W QVF 137 1 buah 500,000
83 Lampu Hiled Downlight 15 W 1 buah 480,000
84 Lampu Hiled Floodlight RGB 50 W 1 buah 2,800,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
130 Sekering lift 30A, 14x51, 500V 1 dos 853,000
131 Sekering lift 5A, 14x51, 250V 1 dos 507,000
132 Selenoid Valve R22 capacity 9-12 ton 1 buah 8,381,000
133 Solenoid valve 2A/250 V 1 buah 1,314,000
134 Solenoid Valve 48VDC Joucomatic air operated 1 buah 1,304,000
ON-Delay, 15 time setting ranges
Solid – State Time Relays, Screw
135 Off-Delay, 7 time setting ranges 1 buah 4,220,000
Connection
Start-Delay, 1 time setting ranges,
136 Spacer kuningan p;1cm, baut M3 1 buah 12,000
137 Steker 16 A / 220 V 1 buah 44,000
138 Steker T 16 A / 220 V 1 buah 125,000
139 Stop Kontak 2 lubang 16 Amp, 220 V 1 buah 32,000
140 Stop Kontak 4 lubang 16 Amp, 220 V 1 buah 21,000
141 Stop Kontak In-bow 10 Amp 1 buah 21,000
142 Stop Kontak Out -bow 10 Amp 1 buah 17,000
Stop Kontak (2Slot) + Chip Kosong
143 Stop Kontak tanam 1 buah 306,000
(1Slot) D25400-99
Stop Kontak (2Slot) + Outlet Data CAT5e
144 Stop Kontak tanam 1 buah 335,000
(1Slot) D25474-99
Stop Kontak (2Slot) + Outlet Telepon
145 Stop Kontak tanam 1 buah 328,000
(1Slot) D25471-99
146 Switch DPST red 6A/250V + lp.indikator 1 buah 77,000
147 Switch elektrik 220 V, 3 posisi 1 NO, 1 NC 1 buah 158,000
148 Terminal Box 32 mm 1 buah 120,000
149 Terminal Kabel Ø 4 mm 1 buah 17,000
150 Terminal Kabel Ø 10 mm 1 buah 21,000
151 Terminal Kabel Ø 16 mm 1 buah 21,000
152 Terminal Kabel Ø 35 mm 1 buah 32,000
153 Terminal Kabel Ø 50 mm 1 buah 40,000
154 Terminal Kabel Ø 120 mm 1 buah 78,000
155 Themis terminal relay TER008 1 buah 1,040,000
156 Thermal overload Relay 1NO + 1NC,12-19A 1 buah 238,000
157 Thermo expansion valve TER 55-HW 100 1 buah 5,000,000
158 Timer 2-60s, SZM 51, 500W 250V 6A 1 buah 757,000
159 Timer swiches H3CR-8 1 buah 621,000
160 Traffic Signal Lamp 6945E/60 W 1 buah 85,000
161 Wire Roop for Governor FC dia. 8 mm 1 meter 95,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
29 IC Operasional Amplifier LM 310 1 buah 62,000
30 IC Operasional Amplifier CA 3100 1 buah 38,000
31 IC Operasional Amplifier LM 358 1 buah 24,000
32 IC Regulator MC / LM 78xx seri 1 buah 39,000
33 IC Regulator MC / LM 79xx seri 1 buah 38,000
34 IC Regulator LM 35 1 buah 48,000
35 IC Regulator UA723CN 1 buah 38,000
36 IC 10 H 1 buah 830,000
37 IC 4N25 1 buah 19,000
38 IC 4N35 1 buah 19,000
39 IC 8500 ACTV 8419 1 buah 4,145,000
40 IC AD 5422 1 buah 485,000
41 IC AD 574 1 buah 1,023,000
42 IC AD 7541 1 buah 915,000
43 IC ATMEGA 16 / ATMEGA 8535 1 buah 184,000
44 IC CA 3086 1 buah 162,000
45 IC CD 2545 1 buah 120,000
46 IC IN - 5218 / IN-3086 1 buah 276,000
47 IC L 297 / L 298 1 buah 93,000
48 IC MAX 232 1 buah 39,000
49 IC MM 54C02 V 1 buah 335,000
50 IC MOC 3021 / MOC 3041 1 buah 39,000
51 IC NC-1350 1 buah 389,000
52 IC NE 555 1 buah 22,000
53 IC SG 1524 V 1 buah 744,000
54 IC TL 082 1 buah 22,000
55 Isolasi Kabel 12,5 mm PLM 100 (A) 12/8 1 buah 49,000
56 Isolasi Kabel 27 mm PLM 100 (A) 27/8 1 buah 120,000
57 Isolasi Kabel 40 mm PLM 100 (A) 40/13 1 buah 192,000
58 Kabel Coaxial RG 58 1 meter 49,000
59 Kabel data loger Laplink 1 buah 949,000
60 Kabel Power NYYHY 3 x 1,5 (serabut) 1 meter 22,000
61 Kabel Power NYYHY 2 x 1,5 (serabut) 1 meter 17,000
62 Kabel serabut Isi 8 1 meter 34,000
63 Kabel Tunggal Dia 1,5 mm 1 roll 219,000
64 Kabel Tunggal Dia 2,5 mm 1 roll 347,000
65 Kabel Tunggal Dia 1,5 mm 1 roll 219,000
66 Kabel Tunggal Dia 2,5 mm 1 roll 359,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
91 Relay Board 992-001 1 set 330,000
92 Resistor -multi turn cermet trimmer 1 K - 100 K / 0,5 W, seri 1 buah 24,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
31 Bearing 6001 2Z 1 buah 64,000
32 Bearing 6004 2Z 1 buah 100,000
33 Bearing 6005 2Z 1 buah 150,000
34 Bearing 6007 2Z 1 buah 227,000
35 Bearing 6008 2Z 1 buah 288,000
36 Bearing 6009 2Z 1 buah 359,000
37 Bearing 6201 2Z 1 buah 76,000
38 Bearing 6202 2Z 1 buah 100,000
39 Bearing 6203 2Z 1 buah 130,000
40 Bearing 6204 2Z 1 buah 152,000
41 Bearing 6205 2Z 1 buah 203,000
42 Bearing 6206 2Z 1 buah 235,000
43 Bearing 6207 2Z 1 buah 268,000
44 Bearing 6208 2Z 1 buah 307,000
45 Bearing 6209 2Z 1 buah 335,000
46 Bearing 6210 2Z 1 buah 391,000
47 Bearing 6211 2Z 1 buah 483,000
48 Bearing 6212 2Z 1 buah 590,000
49 Bearing 6213 2Z 1 buah 720,000
50 Bearing 6306 2Z 1 buah 406,000
51 Bearing 6302 C3 1 buah 132,000
52 Bearing 6304 C3 1 buah 189,000
53 Bearing 6305 C3 1 buah 227,000
54 Bearing 6306 C3 1 buah 270,000
55 Bearing 6307 C3 1 buah 305,000
56 Bearing 6308 C3 1 buah 404,000
57 Bearing 6309 2Z.C3 1 buah 497,000
58 Bearing 6310 2Z 1 buah 550,000
59 Bearing 6310 2Z.C3 1 buah 528,000
60 Bearing 7305 B. C3 1 buah 416,000
61 Bearing 7319 B.UA 1 buah 6,050,000
62 Bearing NU 206 E. C3 1 buah 862,000
63 Bearing NU 207 E. C3 1 buah 1,072,000
64 Bearing UCP 206 D1 1 buah 1,072,000
65 Bearing NU 416 1 buah 6,076,000
66 Belt type VNN 37 x 10 x 900 LI D68 1 buah 173,000
67 Belt Genset 1557 LW/12.5 La 1 buah 173,000
68 Besi apollo medium 40 X 40 mm 1 batang 130,000
69 Besi As f 20 mm 1 meter 130,000
70 Besi As f 12 mm 1 meter 75,000
71 Besi As f 16 mm 1 meter 88,000
72 Besi As f 25 mm 1 meter 203,000
73 Besi As f 25 mm 1 meter 286,000
74 Besi hollow medium 3 X 3 cm 1 buah 189,000
75 Besi hollow medium 4 X 4 cm 1 buah 254,000
76 Besi siku-siku 2.5 X 2.5 cm 1 batang 93,000
77 Besi siku-siku 3 X 3 cm 1 batang 125,000
78 Besi siku-siku 4 X 4 cm 1 batang 135,000
79 Besi siku-siku 5 X 5 cm 1 batang 179,000
80 Bolt + Nut M 10 x 50 stainlees steel 1 buah 19,000
81 Bolt + Nut M 6 x 30 stainlees steel 1 buah 16,000
82 Bolt + Nut M 6 x 50 stainlees steel 1 buah 18,000
83 Buldog Ø 3 mm 1 buah 106,000
84 Buldog Ø 6 mm 1 buah 212,000
85 Carabiner 4 " SS AISI 316 1 buah 135,000
86 Carabiner 2,5 " SS AISI 316 1 buah 125,000
87 Carabiner 1 " SS AISI 316 1 buah 106,000
88 Carabiner 4 " SS AISI 316 segitiga 1 buah 120,000
89 Center drill 10 mm 1 buah 184,000
90 Center punch 1 buah 162,000
91 Chemical Respirator NP 305 1 buah 211,000
92 Combination square set Mty 30 cm 1 set 1,206,000
93 Counter operasi Genset D2866TF 1 buah 670,000
94 Countersink D2866TF 1 buah 404,000
95 Dempul besi 1 kaleng 146,000
96 Dial indikator Mty 1 buah 781,000
97 Double Niple Diameter 1" 1 buah 42,000
98 Double Nipple SS ½” 1 buah 42,000
99 Double nipple galvanis Sch. 40 Diameter ½ ” 1 buah 57,000
- 46 -
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
100 El Bow SS ¾ “ 1 buah 81,000
101 El Bow SS 1“ 1 buah 58,000
102 Elbow 45o PVC Diameter 1" 1 buah 158,000
103 Elbow 90o PVC Diameter 1" 1 buah 311,000
104 Elbow 90o PVC Diameter 2" 1 buah 329,000
105 Elbow galvanis Sch. 40 Diameter ½ ” 1 buah 152,000
106 Elbow PVC Class AW diameter 1 ½ ” 1 buah 125,000
107 Elbow PVC Diameter ½ ” (AW) 1 buah 86,000
108 Elbow SS ½” SS ½” 1 buah 281,000
Elektrocardiografi, Cardiertte,
109 CE 0470 1 buah 4,425,000
daedalus
110 Elektroda las Rb 2.6 mm 1 box 203,000
111 Elektroda las SS 2 mm 1 box 482,000
112 Element Coolant SS9274095 CPN39907175 1 buah 1,712,000
113 Element SparatorSS39831888 CPN 42554368 1 buah 1,944,000
114 End mill (pisau frais) uk. 16 mm - mata empat 1 buah 1,049,000
115 End mill (pisau frais) uk. 18 mm - mata empat 1 buah 345,000
116 End mill (pisau frais) uk. 19 mm - mata empat 1 buah 781,000
117 Filter Core, H-48 1 buah 550,000
118 Filter Lube For Genset (LF-670) 1 buah 1,712,000
119 Filter masker filter isi ulang untuk NP305 1 buah 22,000
120 Filter oli For Genset 1 buah 6,901,000
121 Filter penyaring cucian 40 cmx20 cm/5 K 1 buah 345,000
122 Filter Uliterak AK 10/3 1 buah 7,090,000
123 Filter Water For Genset (WF-2076) 1 buah 844,000
124 Fitting elbow selang PU 8/6 1 buah 487,000
125 Fitting nepple selang PU 8/6 1 buah 244,000
126 Fitting tee selang PU 8/6 1 buah 1,646,000
127 Flexi glass t = 10mm 1 lembar 3,809,000
128 Freon R 22 (1 can = 3,5 kg ) 1 tabung 2,174,000
129 Fuel Filter, FS-1201 1 buah 1,294,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
163 Kawat Las Electrode SS-308, Diameter = 3,2 mm 1 kg 184,000
202 Oli SAE 90 STP Shynthetic Gear Oil SAE 90 GL-5 946ml 1 pc 87,000
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
228 Plat ss 1.5mm, 120 X 240 cm 1 lembar 3,983,000
229 Plat ss 1mm, 120 X 240 cm 1 lembar 1,810,000
bahan POM hitam, diameter as 3 mm,
230 Puli lengan 1 buah 249,000
dimeter belt 24 mm
231 Receiver valve 1/4" FL x 1/4" NPT 1 buah 700,000
232 Rod SS 304 Diameter 3/4", Panjang 40cm 1 buah 276,000
233 Roda diameter 5 cm 1 buah 66,000
diameter 24 mm, dalam 2 mm, bahan
234 Roda depan 1 buah 254,000
POM-B, alur 3R0.5
235 Roll meter 50 meter ( ATS ) 1 buah 51,000
236 Roll meter magnet 1 buah 185,000
237 Roller bearing No. 22308 SM C3 1 buah 2,488,000
238 Roller bearing NUP 2215 SM C3 1 buah 528,000
239 Roller bearing No. 21310 ES C3 1 buah 781,000
240 Roller bearing No. 22310 SM C3 1 buah 1,363,000
241 Roller bearing NU 2215E C3 1 buah 179,000
242 Roller Bearing Hoist Crane 1 buah 1,949,000
max pressure : 150 Psi, temp. 35 - 112
243 Rotameter Dwyer 1 buah 4,425,000
F
bahan POM putih, sisi luar D40x7,
244 Rumah bearing lengan 1 buah 421,000
D74x11, D60x21, sisi dalam M32x28
245 Screw driver obeng mini, 7 macam, krisbow 1 set 515,000
246 Seal O-ring diameter dalam 4 mm 1 buah 16,000
247 Seal O-ring diameter dalam 9 mm 1 buah 16,000
248 Seal O-ring diameter dalam 80 mm 1 buah 29,000
249 Seal O-ring diameter dalam 24 mm 1 buah 22,000
250 Seal O-ring diameter dalam 45 mm 1 buah 22,000
251 Selenoid valve For Mesin Cuci National NA-9550D 1 buah 7,751,000
252 Shaft Exhaust Fan Ø 32 mm, SS-316 1 unit 3,645,000
253 Shaft Protection Sleeve DIN 1.4122 1 unit 6,976,000
254 Slang PU 8/6, orange 1 meter 254,000
255 Sling SS Ø 3 mm 1 meter 157,000
256 Sling SS Ø 6 mm 1 meter 227,000
257 Sling/wire seamless Diameter 3mm, bahan SS 304 1 meter 90,000
258 Slot Flat Head Machine Screw, M6,SS 1 buah 196,000
259 Snei dan Tap 1 set 17 ukuran 1 set 746,000
260 Spacer kuningan p; 2cm, baut M3 1 buah 2,019,000
261 Sprayer cat tabung di atas 1 buah 196,000
262 Spring clip Type 10434 size 3/6 mm 1 buah 18,000
263 Spring Pin, Ø 4 mm, Grade 8.8 1 buah 18,000
264 Spring Pin, Ø 5 mm, Grade 8.8 1 buah 22,000
265 Spring Pin, Ø 6 mm, Grade 8.8 1 buah 238,000
266 Stainless steel pejal diameter 6 mm 1 batang 716,000
267 Stand dial indikator 1 buah 1,438,000
268 Straight Grinding Pneumatic, Ø 6 mm s/d Ø 80 mm 1 buah 1,438,000
269 Thinner 20 liter 1 galon 373,000
270 Thinner cobra 1 liter 37,000
271 Three Way Valve uk ½ " 1 buah 889,000
272 Three Way Valve uk ¼ " 1 buah 550,000
273 Triplek 12mm, 120 X 240 cm 1 lembar 453,000
274 V BELT SPB 3350 mm 1 buah 839,000
275 V BELT SPB 3150 mm 1 buah 700,000
276 V BELT SPB 2800 mm 1 buah 587,000
277 V BELT SPZ 2360 mm 1 buah 469,000
278 V BELT SPZ 2500 mm 1 buah 469,000
279 V BELT SPA 2240 mm 1 buah 428,000
280 V BELT A 1525 mm 1 buah 297,000
281 V BELT SPA 2500 mm 1 buah 469,000
282 V BELT SPA 1500 mm 1 buah 282,000
283 V BELT A 13 x 1625 mm 1 buah 362,000
284 V BELT SPZ 1000 mm 1 buah 130,000
285 V BELT VB 12,5 x 1250 mm 1 buah 141,000
286 V BELT A 13 x 1450 mm 1 buah 238,000
287 V BELT VB 9,5 x 1400 La 1 buah 182,000
288 V BELT SPZ 937 1 buah 125,000
289 V BELT Y 13 x 1500 mm 1 buah 621,000
290 V BELT SPB 3350 mm 1 buah 593,000
291 V BELT SPB 3150 mm 1 buah 383,000
292 V BELT SPB 2800 mm 1 buah 663,000
- 49 -
(dalam Rupiah)
NO NAMA BARANG/ URAIAN SPESIFIKASI / KODE /ACUAN SATUAN HARGA
293 V BELT SPZ 2360 mm 1 buah 345,000
294 V BELT SPZ 2500 mm 1 buah 437,000
295 V BELT SPA 2240 mm 1 buah 157,000
296 V BELT A 1525 mm 1 buah 189,000
297 V BELT SPA 2500 mm 1 buah 282,000
298 V BELT SPA 1500 mm 1 buah 282,000
299 V BELT A 13 x 1625 mm 1 buah 593,000
300 V BELT SPZ 1000 mm 1 buah 685,000
301 V BELT VB 12,5 x 1250 mm 1 buah 141,000
302 V BELT A 13 x 1450 mm 1 buah 429,000
303 V BELT VB 9,5 x 1400 La 1 buah 731,000
304 V BELT B 95 1 buah 670,000
305 V BELT SPZ 937 1 buah 889,000
306 V BELT B 69 1 buah 889,000
307 V BELT DIN 2215-10X6X1400 L1 Rubber 1 buah 932,000
308 Valve SS ¾ “ 1 buah 1,788,000
309 Van Blade unit CGAA 213E 1 buah 1,319,000
310 V-belt AHU office Fenner B 86 1 buah 889,000
311 V-belt blower VAC Fenner B105 1 buah 340,000
312 V-belt Cooling tower Fenner SPA 1600 1 buah 1,788,000
313 V-belt exhaust fan C5102 Fenner SPB 2840 1 buah 3,413,000
314 V-belt exhaust fan C5103 Fenner SPA 2300 1 buah 100,000
315 V-belt exhaust fan C5201 Fenner SPZ1470 1 buah 873,000
316 Vertical shaft vans unit CGAA 213E 1 buah 416,000
317 Water Filter, WF-2076 1 buah 717,000
318 Water mur galvanis dia. ½ ” 1 buah 96,000
319 WD 40 382ml / 12.9 Fl Oz 1 kaleng 87,000
- 50 -
143 Pull Handle Dekkson PH DKS 855 19X152 SSS 1 psg 900,000
B. Pekerjaan BANGUNAN
C. PEKERJAAN PENGECATAN
1 Pekerjaan mengerok cat lama 1 m² 20,000
D. JASA PEKERJA/TUKANG
1 pekerja 1 hari 157,000
2 tukang gali 1 hari 180,000
3 Kepala tukang batu 1 hari 200,000
4 tukang batu 1 hari 180,000
5 Kepala tukang kayu 1 hari 200,000
6 Tukang kayu 1 hari 180,000
7 Kepala tukang besi 1 hari 200,000
8 Tukang besi 1 hari 180,000
9 Kepala tukang cat 1 hari 200,000
10 Tukang cat 1 hari 180,000
11 Tukang babat rumput 1 hari 157,000
12 Tukang pipa 1 hari 180,000
13 operator alat berat 1 hari 180,000
14 Tukang las 1 hari 180,000
- 55 -
2 Laboratory Examination
a Routin Haematology
1.Hemoglobin
2.Eritrosit
3.Leukosit d.LED
4.Trombosit
5.Hematokrit
6.Diff/Hitung jenis leukosit(eusinofil,basofil,batang/staff,segment, limfosit dan monosit)
7.MCV,MCH,MCHC
8.Morfologi Darah Tepi
c Kimia Darah
1.Fungsi Hati (SGOT, SGPT, Bilirubin Direk dan Indirek, Gamma GT,
Albumin, Globulin)
2.Fungsi Ginjal (Ureum, Creatinin, Uric Acid)
3.Profil Lemak (Total Cholesterol, LDL,HDL, Trigliseride )
4.Gula Darah (GD Puasa, GD 2 Jam PP, Hba1c)
d Serologi
1.HbsAg
2.AntiHbs
3 Elektrokardiografi (EKG)
4 Foto Rontgen Thoraks PA
5 USG Abdomen
2 Laboratory Examination
a Routin Haematology
1.Hemoglobin
2.Eritrosit
3.Leukosit d.LED
4.Trombosit
5.Hematokrit
6.Diff/Hitung jenis leukosit(eusinofil,basofil,batang/staff,segment, limfosit dan monosit)
7.MCV,MCH,MCHC
8.Morfologi Darah Tepi
c Kimia Darah
1.Fungsi Hati (SGOT, SGPT, Bilirubin Direk dan Indirek, Gamma GT,
Albumin, Globulin)
2.Fungsi Ginjal (Ureum, Creatinin, Uric Acid)
3.Profil Lemak (Total Cholesterol, LDL,HDL, Trigliseride )
4.Gula Darah (GD Puasa, GD 2 Jam PP, Hba1c)
d Serologi
1.HbsAg
2.AntiHbs
3 Elektrokardiografi (EKG)
4 Foto Rontgen Thoraks PA
5 USG Abdomen
6 Treadmill
7 Audiometri
8 Spirometri
- 57 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
I. OBAT-OBATAN UMUM
29 Ampisilin 500 mg kaplet Generik Kaplet, Box = 100 buah Box 80,000
32 Antidia tablet Non Generik Tablet, Box = 100 buah Box 58,000
33 Antimo tablet Non Generik Tablet, Strip = 2 tablet Strip 9,000
34 Antox kapsul Non Generik Tablet, box = 60 buah Box 611,000
35 Ardium HD tablet Non Generik Tablet, Box = 100 buah Box 781,000
36 Arsinal tablet Non Generik Tablet, Box = 100 buah Box 204,000
37 Asam Mefenamat tablet Generik Tablet, Box = 100 buah Box 54,000
38 Asam Traneksanat tablet Generik Tablet, Box = 100 buah Box 377,000
39 Ascardia 160 mg tablet Non Generik Tablet, Box = 100 buah Box 263,000
40 Ascardia 80 mg tablet Non Generik Tablet, Box = 100 buah Box 119,000
41 Asetazolamid 250 mg tablet Generik Tablet, Box = 100 buah Box 38,000
42 Asetosal 500 mg tablet Generik Tablet, Box = 100 buah Box 33,000
- 58 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
43 Aspar K tablet Non Generik Tablet, Box = 100 buah Box 377,000
44 Aspilet 80 mg tablet Non Generik Tablet, Box = 100 buah Box 109,000
45 Atenolol 100 mg tablet Generik Tablet, Box = 100 buah Box 54,000
58 Benoxuric 300 tablet Non Generik Tablet, Box = 100 buah Box 593,000
59 Berotek MDI inhaler Non Generik Inhaler, botol = 10 mL Botol 243,000
60 Berryvision Tablet Non Generik Tablet, Box = 100 buah Box 569,000
Gargle kumur, botol = 100
61 Betadine gargle kumur Non Generik Botol 24,000
mL
62 Betahistin mesilat 6 mg tablet Non Generik Tablet, box = 30 buah Box 58,000
63 Betametason 0,5 mg tablet Non Generik Tablet, Box = 100 buah Box 15,000
83 Bufect tablet Non Generik Tablet, box = 100 buah Box 105,000
84 Burnazin krim Non Generik Krim, tube = 35 g Tube 100,000
85 Buscopan plus tablet Non Generik Tablet, Box = 100 buah Box 586,000
- 59 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
89 Calfera tablet Non Generik Tablet, Box = 100 buah Box 65,000
95 Captopril 12,5 mg tablet Generik Tablet, box = 100 buah Box 18,000
97 Cardio Aspirin tablet Non Generik Tablet, Box = 100 buah Box 88,000
101 Cavit D3 tablet Non Generik Tablet, Box = 100 buah Box 323,000
Tablet efferv, Botol = 10
102 CDR tablet effervescent Non Generik Botol 60,000
buah
103 Cedocard tablet Non Generik Tablet, box = 60 buah Box 119,000
104 Cefadroxil 500 mg tablet Generik Kapsul, box = 100 buah Kapsul 120,000
105 Cefila 100 mg kapsul Non Generik Kapsul, box = 30 buah Kapsul 923,000
106 Cefixime 200 mg kapsul Generik Kapsul, box = 50 buah Kapsul 611,000
107 Cefixime sirup kering Generik Sirup kering, botol = 30 ml Sirup 34,000
Larutan Tetes Mata, botol =
108 Cendo Fenicol Tetes Mata Non Generik Botol 48,000
5 ml
109 Cendo Lyteers Tetes Mata Non Generik Cairan, Botol=15ml Botol 44,000
Larutan Tetes Mata, botol =
110 Cendo Pantocain Tetes Mata Non Generik Botol 26,000
5 ml
Larutan Tetes Mata, Strip =
111 Cendo Xitrol Minidose Tetes Mata Non Generik Strip 62,000
5 fls, 1 fls = 0,6 ml
Larutan Tetes Mata, botol =
112 Cendo Xitrol Tetes Mata Non Generik Botol 54,000
5 ml
113 Ceptik 100 mg kapsul Non Generik Kapsul, box = 30 buah Box 1,134,000
114 Ceptik sirup kering Non Generik Sirup kering, botol = 30 ml Botol 153,000
115 Cerebrofort Gold Sirup Non Generik Sirup, botol = 200 ml Botol 45,000
116 Cetirizine tablet Generik Tablet, box = 50 buah Box 30,000
117 Chloramfecort Krim Non Generik Krim, tube= 10gr Tube 24,000
118 Ciprofloxacin 500 mg tablet Generik Tablet, box = 100 buah Box 80,000
119 Clindamycin 300 kapsul Generik Kapsul, box = 50 buah Box 67,000
120 Clindamycin Novell 300 mg kapsul Generik Berlogo Kapsul, box = 50 buah Box 116,000
121 Clinium 1% Gel Non Generik Gel, tube = 15 gram Tube 64,000
122 Clobazam 10 mg tablet Generik Tablet, box = 100 buah Box 199,000
123 Clopidogrel tablet Generik Tablet, box = ... buah Box 606,000
124 Co-amoxiclav Generik Tablet, box = 30 buah Box 291,000
125 Co-amoxiclav sirup kering Generik Sirup kering, botol = 6 ml Botol 60,000
126 Colme Tetes Mata Non Generik Larutan, botol = 8 ml Botol 50,000
- 60 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
127 Colme Tetes Telinga Non Generik Larutan, botol = 8 ml Botol 60,000
128 Combantrin tablet Non Generik Tablet, box = 50 buah Box 498,000
129 Combantrin tablet Non Generik Tablet, box = 30 buah Box 297,000
Larutan Nebulizer, Box = 10
130 Combivent Nebulizer Non Generik Box 364,000
buah
131 Comtusi Sirup Non Generik Sirup, botol = 100ml Botol 101,000
132 Coten 30 mg tablet Non Generik Tablet, box = 30 buah Box 47,000
133 Coten 30 mg tablet Non Generik Tablet, box = 100 buah Box 297,000
134 Cotrimoxazole 480 mg tablet Generik Tablet, box = 100 buah Box 65,000
135 Counterpain Cool krim Non Generik Krim, tube = 30 gram Tube 65,000
136 Counterpain krim Non Generik Krim, tube = 30 gram Tube 81,000
Air mineral cup, karton = 48
137 Crystalline air mineral Non Generik Karton 41,000
cup
138 Curcuma tablet Non Generik Tablet, box = 100 buah Box 175,000
139 D Vit Sirup Non Generik Sirup, botol = 100 ml Botol 68,000
140 Danason tablet Non Generik Tablet, box = 200 buah Box 40,000
141 Degirol tablet Non Generik Tablet, box = 100 buah Box 142,000
142 Dexacap 12,5 mg tablet Non Generik Tablet, box = 60 buah Box 25,000
143 Dexacap 25 mg tablet Non Generik Tablet, box = 60 buah Box 38,000
144 Dexamethasone 0,5 mg tablet Generik Tablet, box = 100 buah Box 12,000
145 Dexanta tablet Non Generik Tablet, box = 100 buah Box 48,000
146 Dexazol tablet Non Generik Tablet, box = 50 buah Box 73,000
148 Dextamine tablet Non Generik Tablet, box = 300 buah Box 901,000
149 Dexteem Plus tablet Non Generik Tablet, box = 100 buah Box 42,000
150 Dextral tablet Non Generik Tablet, box = 100 buah Box 155,000
151 Dexymox 500 mg tablet Non Generik Tablet, box = 100 buah Box 142,000
153 Diabemin 500 mg tablet Non Generik Tablet, box = 100 buah Box 56,000
154 Diaformin XR tablet Non Generik Tablet, box = 100 buah Box 317,000
155 Diflam 50 mg tablet Non Generik Tablet, box = 50 buah Box 295,000
156 Digenta krim Non Generik Krim, tube = 10 gram Tube 141,000
157 Digoksin 0,0625 mg tablet Generik Tablet, botol = 100 buah Botol 16,000
158 Digoxin 0.25 mg tablet Generik Tablet, box = 100 buah Box 24,000
159 Dimenhidrinat 50 mg Tablet Generik Tablet, botol = 100buah Botol 57,000
160 Disflatyl tablet Non Generik Tablet, box = 100 buah Box 115,000
161 Dom tablet Non Generik Tablet, box = 30 buah Box 52,000
162 Dom tablet Non Generik Tablet, box = 100 buah Box 151,000
163 Domperidon tablet Generik Tablet, Box = 100 buah Box 41,000
164 Doxycycline 100 mg tablet Generik Tablet, box = 100 buah Box 151,000
165 Doxycycline 100 mg tablet Generik Tablet, box = 30 buah Box 52,000
166 Dramamine tablet Non Generik Tablet, Box = 100 buah Tablet 330,000
167 Dumin 500 mg tablet Non Generik Kaplet, boks = 1000 buah Box 693,000
168 Dumocalcin tablet Non Generik Tablet, Box = 100 buah Box 58,000
169 Eclide 100 mg tablet Non Generik Tablet, Box = 100 buah Box 169,000
- 61 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
170 Eflin tablet Non Generik Tablet, box = 100 buah Box 227,000
171 Emturnas forte tablet Non Generik Tablet, box = 100 buah Box 38,000
Tablet effervescent, botol =
172 Enervon C tablet effervescent Non Generik Botol 46,000
10 buah
173 Enervon C tablet Non Generik Tablet, box = 100 buah Box 180,000
174 Enzyplex tablet Non Generik Tablet, Box = 100 buah Box 175,000
175 Erlamycetin Salep Mata Non Generik Salep Mata, tube = 5 g Tube 11,000
176 Erlamycetin Tetes Mata Non Generik Tetes Mata, Botol = 5 mL Botol 19,000
177 Erlamycetin Tetes Telinga Non Generik Tetes Telinga, Botol = 5 mL Botol 27,000
178 Eryra 500 mg tablet Non Generik Tablet, box = 100 buah Box 205,000
179 Erythrin 500 mg tablet Non Generik Kaplet, botol = 50 buah Botol 554,000
180 Erythromycin 500 mg tablet Generik Kaplet, box = 50 buah Box 270,000
181 Esvat 20 mg tablet Non Generik Tablet, box = 30 buah Box 65,000
182 Etabion tablet Non Generik Tablet, Box = 100 buah Box 169,000
183 Ethambutol HCL 250 mg tablet Generik Tablet, box = 200 buah Box 146,000
184 Exaflam tablet Non Generik Tablet, box = 50 buah Box 260,000
185 Farmalat tablet Non Generik Tablet,box = 100 buah Box 61,000
186 Farnormin 50 mg tablet Non Generik Tablet, box = 100 buah Box 75,000
188 Farsix tablet Non Generik Tablet, box = 100 buah Box 178,000
189 Fasidol plus tablet Non Generik Tablet, box = 100 buah Box 57,000
191 Fasorbid 5 mg tablet Non Generik Tablet, box = 100 buah Box 38,000
192 Fenamin tablet Non Generik Tablet, box = 100 buah Box 88,000
193 Fenitoin 100 mg kapsul Generik Kapsul, box = 100 buah Box 26,000
194 Fenitoin Natrium 30 mg kapsul Generik Kapsul, box = 100 buah Box 20,000
195 Fenofibrat 100 mg tablet Generik Tablet, box = 30 buah Box 92,000
196 Fenofibrat 300 mg tablet Generik Tablet, box = 30 buah Box 154,000
199 Ferlin sirup Non Generik Sirup, botol = 100 ml Botol 75,000
200 Fexazol krim Non Generik Krim, tube = 5 gram Tube 13,000
Tablet isap, box = isi 300
201 FG Troches Non Generik Box 525,000
buah
202 FG Troches Non Generik Tablet, box = 120 buah Box 236,000
Salut selaput, box = 60
203 Fitbon Non Generik Box 169,000
buah
204 Fituno Non Generik Tablet, box = 300 buah Box 249,000
205 Fladex Non Generik Tablet, box = 100 buah Box 75,000
206 Flamar gel 20g Non Generik Jel, tube = 20gr Tube 48,000
208 Flammar 25 mg tablet Non Generik Tablet, Box = 100 buah Box 135,000
- 62 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
209 Flammar Gel Non Generik Gel, tube = ... Gr Tube 29,000
210 Flexor DS Kaplet Non Generik Kaplet, box = 60 buah Box 587,000
211 Flexor Kaplet Non Generik Kaplet, box = 30 buah Box 170,000
212 Flu Tab, tablet Non Generik Tablet, box = 120 buah Box 152,000
213 Flunarizin tablet Non Generik Tablet, Box = 100 buah Box 71,000
214 Flutrop tablet Non Generik Tablet, box = 100 buah Box 114,000
215 Folavit tablet Non Generik Tablet, box = 100 buah Box 127,000
216 Forelax tablet Non Generik Tablet, box = 50 buah Box 334,000
217 Forres 50 tablet Non Generik Tablet, box = 50 buah Box 463,000
219 Frego 5 mg tablet Non Generik Tabet, box = 50 buah Box 455,000
220 Fungares krim Non Generik Krim, tube = 5 gram Tube 34,000
221 Furosemid 40 mg tablet Generik Tablet, box = 100 buah Box 22,000
222 Gameksan 1% Lotion Non Generik Lotion, botol = 30 mL Botol 5,000
223 Gemfibrozil 300 kapsul Generik Kapsul, box = 100 buah Box 131,000
224 Gentalex krim Non Generik Krim, tube = 5 gram Tube 7,000
227 Gitas Plus kapsul Non Generik Kapsul, box = 50 buah Box 535,000
228 Glemipered 1 mg tablet Non Generik Tablet, Box = 100 buah Box 189,000
229 Glemipered 2 mg tablet Non Generik Tablet, Box = 100 buah Box 256,000
230 Glibenclamid 5 mg tablet Generik Tablet, Box = 100 buah Box 60,000
231 Glikos 850 mg tablet Non Generik Tablet, box = 100 buah Box 70,000
234 Glimepiride 3 tablet Generik Tablet, box = 100 buah Box 149,000
235 Glitaven Sirup Non Generik Sirup, botol = 100 ml Botol 73,000
236 Glucophance tablet Non Generik Tablet, Box = 100 buah Box 371,000
237 Glucosamine MPL tablet Non Generik Tablet, box = 100 buah Box 438,000
Larutan Steril, botol = 25
238 Glukosa 40% Larutan Steril Non Generik Box 31,000
mL, box = 10 buah
239 Glunor XR 500 tablet Non Generik Tablet, box = 30 buah Box 102,000
240 Gluvas 1 mg tablet Non Generik Tablet, box = 50 buah Box 194,000
241 Goron tablet Non Generik Tablet, box = 100 buah Box 324,000
242 Hansaplast Elastis Plester Kain Non Generik Plester, box = 100 lembar Box 43,000
243 Hansaplast Koyo (Hangat) Non Generik Koyo, box = 100 lembar Box 118,000
244 HCT tablet Generik Tablet, box = 100 buah Box 42,000
245 Hexadol sirup Non Generik Sirup, botol = 100 ml Botol 44,000
246 Hico Gel Non Generik Gel, tube = 10 gram Tube 33,000
248 Hidrocortisone 2,5% krim Generik Krim, tube =5 gram Tube 18,000
249 Histapan tablet Non Generik Tablet, box = 100 buah Box 103,000
- 63 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
250 Hufagrip batuk pilek, sirup NPP Sirup, botol = 60 ml Botol 27,000
253 Ibuprofen 400 mg tablet Generik Tablet, box = 100 buah Box 44,000
254 Ichtiol salep Non Generik Salep, box = 12 buah Box 132,000
255 Imboost kaplet Non Generik Kaplet, box = 30 buah Box 326,000
256 Imodium 2mg tablet Non Generik Tablet, strip = 10 buah Strip 135,000
257 Indexon tablet Non Generik Tablet, box = 100 buah Box 117,000
259 Internolol tablet Non Generik Tablet, box = 30 buah Box 178,000
260 Interzinc tablet Non Generik Tablet, box = 10 buah Box 57,000
261 Intunal Forte tablet Non Generik Tablet, box = 100 buah Box 155,000
267 ISDN 5 mg tablet Generik Tablet, Box = 100 buah Box 41,000
268 Isoric 300 tablet Non Generik Tablet, box = 50 buah Box 343,000
270 Kalium Diklofenac 50 mg tablet Generik Tablet, box = 50 buah Box 48,000
271 Kalium Klorida 300 mg tablet Generik Tablet, tube = 10 buah Tube 7,000
272 Kenalog in orabase, krim Non Generik Krim, tube = 5 gram Tube 90,000
274 Ketoconazole 200 mg tablet Generik Tablet, box = 50 buah Box 40,000
275 Ketoprofen 100 mg tablet Generik Kapsul, box = 100 buah Box 283,000
276 Kloramfenikol 0,5% Tetes Mata Generik Tetes Telinga, botol = 5 mL Botol 6,000
277 Kloramfenikol 3 % Tetes Mata Generik Tetes Telinga, botol = 5 mL Botol 4,000
278 Klorfeson salep Non Generik Krim, tube = 5 gram Tube 19,000
279 Klorokuin 250 mg tablet Generik Kapsul, box = 100 buah Box 23,000
281 Kuinidin 200 mg tablet Generik Kapsul, box = 100 buah Box 88,000
Granul sachet, sachet = 1
282 L Bio granul sachet Non Generik Sachet 14,000
gr, box = 30 buah
283 L Bio kapsul Non Generik Kapsul, box = 30 buah Box 290,000
284 L Cisin tablet Non Generik Tablet, box = 30 buah Box 181,000
Granul sachet, sachet = 1
285 Lacto B granul sachet Non Generik Box 357,000
gr, box = 40 buah
286 Lactrin tablet Non Generik Tablet, box = 30 buah Box 115,000
287 Laflanac 25 mg tablet Non Generik Tablet, box = 100 buah Box 23,000
288 Lambucid tablet Non Generik Tablet, box = 200 buah Box 88,000
289 Laminine tablet Non Generik Kapsul, box = 30 buah Box 1,111,000
- 64 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
290 Lanovit tablet Non Generik Tablet, box = 50 buah Box 112,000
292 Lapibroz 600 kaplet Non Generik Kaplet, box = 30 buah Box 190,000
293 Lasal 2 mg tablet Non Generik Tablet, box = 100 buah Box 161,000
294 Lasal sirup Non Generik Sirup, botol = 100 ml Botol 41,000
296 Latibet tablet Non Generik Tablet, box = 100 buah Box 48,000
297 Lelap tablet Non Generik Tablet, box = 100 buah Box 442,000
298 Levemir Flexpen Non Generik Flexpen, box = 5 buah Box 1,205,000
299 Levofloxacin tablet Generik Tablet, box = 100 buah Box 122,000
300 Lexacorton krim Non Generik Krim, tube = 5 gram Tube 11,000
301 Lexcomet tablet Non Generik Tablet, box = 100 buah Box 122,000
302 Lexcomet tablet Non Generik Tablet, box = 50 buah Box 85,000
303 Lexigo tablet Non Generik Tablet, box = 30 buah Box 27,000
304 Licokalk tablet Non Generik Tablet, box = 100 buah Box 33,000
305 Lincocin 500 mg kapsul Non Generik Kapsul, box = 30 buah Box 561,000
306 Lincomycin 500 mg kapsul Generik Kapsul, box = 60 buah Box 137,000
307 Lipitor tablet Non Generik Tablet, Box = 100 buah box 667,000
308 Lisinopril 20 mg tablet Generik Kapsul, box = 100 buah Box 46,000
309 Livron B plex tablet Non Generik Tablet, Box = 100 buah box 54,000
310 Lodia tablet Non Generik Tablet, box = 60 buah Box 93,000
311 Loperamid tablet Generik Tablet, Box = 100 buah Box 59,000
313 Loric 300 mg tablet Non Generik Tablet, box = 100 buah Box 116,000
314 Lostacef 125 mg sirup Non Generik Sirup kering, botol = 60 ml Botol 19,000
315 Lostacef 250 mg sirup Non Generik Sirup kering, botol = 60 ml Botol 26,000
316 L-zink Sirup Non Generik Sirup, botol = 100ml Botol 57,000
317 Maganol tablet Non Generik Kaplet, box = 120 buah Box 100,000
318 Magtral tablet Non Generik Tablet, Box = 100 buah Box 108,000
319 Mebendazol 100 mg/mL sirup Generik Sirup, botol 30 mL Botol 8,000
320 Mebendazol 500 mg tablet Generik Kapsul, box = 100 buah Box 50,000
321 Mebo krim Non Generik Krim, tube = 20 gram Tube 162,000
322 Mecobalamin tablet Generik Tablet, Box = 100 buah Box 125,000
323 Mecolin kapsul Non Generik Kapsul, box = 50 buah Box 186,000
324 Mefinal tablet Non Generik Tablet, Box = 100 buah Box 223,000
325 Mefinter 500 mg kapsul Non Generik Kapsul, box = 50 buah Box 369,000
326 Megabal kapsul Non Generik Kapsul, box = 100 buah Box 369,000
327 Meloxicam 7,5 mg Generik Tablet, box = 100 buah Box 175,000
329 Merislon 6 mg tablet Non Generik Tablet, box = 100 buah Box 828,000
330 Mertigo tablet Non Generik Tablet, Box = 100 buah Box 505,000
- 65 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
331 Metformin 500 mg tablet Generik Tablet, box = 100 buah Box 31,000
332 Metformin 850 mg tablet Generik Tablet, Box = 100 buah Box 81,000
333 Metil prednisolon tablet Generik Tablet, Box = 100 buah Box 81,000
334 Metolon tablet Non Generik Tablet, box = 100 buah Box 104,000
335 Metrison 4 mg tablet Non Generik Tablet, box = 100 buah Box 463,000
336 Metronidazol Novell tablet Generik Berlogo Tablet, Box = 100 buah Box 91,000
337 Metronidazol tablet Generik Tablet, box = 100 buah Box 47,000
340 Minyak Kayu Putih "Cap Lang" Non Generik Larutan, botol = 60 ml Botol 32,000
341 Minyak Kayu Putih "Sidola" Non Generik Larutan, botol = 15 ml Botol 10,000
342 Minyak Kayu Putih "Sidola" Non Generik Larutan, botol = 30 ml Botol 20,000
343 Minyak Tawon DD 30 ml Non Generik Larutan, botol = 30 ml Botol 35,000
344 Minyak Telon "Konicare" Non Generik Larutan, botol = 30 ml Botol 18,000
345 Moladerm krim Non Generik Krim, tube = 10 gram Tube 11,000
347 Molagit tablet Non Generik Tablet, box = 150 buah Box 107,000
348 Molakrim, krim Non Generik Krim, tube = 30 gram Tube 24,000
349 Molaneuron tablet Non Generik Tablet, box = 50 buah Box 45,000
350 Molapect sirup Non Generik Sirup, botol =60 mL Botol 21,000
351 Molavir krim Non Generik Krim, tube = 5 gram Tube 14,000
352 Molazol tablet Non Generik Tablet, box = 100 buah Box 53,000
354 Molexflu tablet Non Generik Tablet, box = 100 buah Box 93,000
355 Mometason krim Non Generik Krim, tube = 5 gram Tube 40,000
356 Motilex tablet Non Generik Tablet, box = 100 buah Box 249,000
357 Mucera tablet Non Generik Tablet, box = 100 buah Box 155,000
358 Mucohexin sirup Non Generik Sirup, botol = 120 ml Botol 25,000
359 Mucohexin tablet Non Generik Tablet, box = 100 buah Box 79,000
360 Mucos Drop Non Generik Sirup, botol = 20ml Botol 68,000
361 Musin sirup Non Generik Sirup, botol = 120 ml Botol 81,000
362 Musin tablet Non Generik Tablet, Box = 100 buah Box 135,000
363 Nasamol tablet Non Generik Tablet, Box = 100 buah Box 48,000
364 Natrium Diclofenac 50 mg tablet Generik Tablet, box = 50 buah Box 21,000
365 Neo Kaominal sirup Non Generik Larutan, botol = 30 ml Botol 13,000
366 Neomisin 500 mg kapsul Generik Kapsul, box = 100 buah Box 67,000
367 Nephrolit Non Generik Tablet, box = 100 buah Box 92,000
368 Nerva Plus Non Generik Kaplet, box = 50 buah Box 255,000
369 Neuralgin XR 500 Non Generik Kaplet, box = 100 buah Box 126,000
370 Neurobat tablet Non Generik Tablet, box = 100 buah Box 457,000
371 Neurobion Non Generik Kaplet, box = 250 buah Box 662,000
- 66 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
372 Neurodex Non Generik Tablet, box = 100 buah Box 229,000
373 Neurohax 5000 Non Generik Tablet, box = 50 buah Box 192,000
375 Nevox XR 500 Non Generik Tablet, box = 30 buah Box 112,000
376 Nevox XR 500 Non Generik Tablet, box = 30 buah Box 112,000
377 New diatab Non Generik Tablet, Box = 100 buah Box 107,000
378 Nicoflam Non Generik Tablet, Box = 100 buah Box 162,000
379 Nifedipine 10 mg Generik Tablet, box = 100 buah Box 30,000
380 Nilapur 300 mg Non Generik Tablet, Box = 100 buah Box 159,000
381 Nodiar tablet Non Generik Tablet, box = 100 buah Box 108,000
382 Noperten Non Generik Tablet, Box = 100 buah Box 159,000
383 Norit Carbo Activatus tablet Non Generik Tablet, pot = 20 buah Pot 26,000
384 Novatrim sirup Non Generik Sirup, botol = 60 ml Botol 13,000
385 Novomix 30 Flexpen Non Generik Flexpen, box = 5 buah Box 1,209,000
386 Nucral Sirup Non Generik Sirup, botol = 100 ml Box 90,000
387 Nucral tablet Non Generik Tablet, box = 60 buah Box 189,000
388 Nufit kaplet Non Generik Kaplet, box = 20 buah Box 256,000
391 OBH Combi Batuk Berdahak Non Generik Sirup, botol = 100 ml Botol 41,000
392 OBH Combi Batuk Kering Non Generik Sirup, botol = 100 ml Botol 41,000
393 OBH Combi Batuk Pilek Non Generik Sirup, botol = 100 ml Botol 34,000
394 OBH Nelco Special sirup Non Generik Sirup, botol = 100 ml Botol 56,000
395 Omega-3 Fish Oil 1000 Wellness Non Generik Softcapsul, botol = 150 buah Botol 337,000
397 Omeprazole Novell kapsul Generik Berlogo Kapsul, Box = 30 buah Box 68,000
398 Opiglit 15 mg tablet Non Generik Tablet, box = 30 buah Box 202,000
400 Opimox tablet Non Generik Tablet, Box = 100 buah Box 357,000
401 Opipas tablet Non Generik Tablet, Box = 100 buah Box 525,000
402 Opistan tablet Non Generik Tablet, box = 100 buah Box 105,000
403 Opram tablet Non Generik Tablet, box = 100 buah Box 87,000
404 Orphen tablet Non Generik Tablet, box = 100 buah Box 29,000
405 Ostela Forte Non Generik Tablet, box = 30 buah Box 404,000
406 Otopain Tetes Telinga Non Generik Tetes Telinga, botol = 8 ml Botol 95,000
407 Oxytetracycline 1% Salep Mata Generik Krim, Tube = 3,5gr Tube 19,000
408 Pamol 125 mg suppositoria Non Generik Suppositoria, box = 12 buah Box 216,000
409 Pamol 250 mg suppositoria Non Generik Suppositoria, box = 12 buah Box 311,000
411 Pamol tablet Non Generik Tablet, Box = 100 buah Box 311,000
412 Panadol biru, tablet Non Generik Tablet, Box = 100 buah Box 47,000
413 Papaverin 40 mg tablet Generik Tablet, box = 100 buah Box 81,000
- 67 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
414 Paracetamol 500 tablet Generik Tablet, box = 100 buah Box 19,000
415 Paramex tablet Non Generik Tablet, Box = 100 buah Box 125,000
416 Paratusin Sirup Non Generik Sirup, botol = 60ml Botol 46,000
417 Pasaba cough & flu sirup Non Generik Sirup, botol = 60 ml Botol 11,000
418 Perilax tablet Non Generik Tablet, box = 50 buah Box 340,000
419 Pharmaton Formula kapsul Non Generik Kapsul, box = 20 buah Box 354,000
420 Pharolit sachet Non Generik Sachet, box = 60 buah Box 119,000
421 Piracetam 400 mg tablet Generik Tablet, box = 100 buah Box 95,000
422 Piroksikam 10 mg tablet Generik Tablet, box = 100 buah Box 18,000
423 Piroksikam 20 mg tablet Generik Tablet, box = 100 buah Box 22,000
424 PK serbuk, pot Non Generik Pot, Box = 12 pot Box 62,000
425 Plasminex tablet Non Generik Tablet, box = 100 buah Box 396,000
426 Polysilane tablet Non Generik Tablet, box = 40 buah Box 62,000
429 Povidone Iodine Solution Non Generik Solution, botol = 60ml Botol 22,000
432 Prazikuantel 600 mg tablet Generik Tablet, box = 100 buah Box 356,000
433 Prednison tablet Generik Tablet, pot = 100 buah Pot 27,000
434 Pritacort tablet Non Generik Tablet, box = 100 buah Box 120,000
435 Pritagesic tablet Non Generik Tablet, box = 100 buah Box 83,000
436 Pritavit kaplet Non Generik Kaplet, box = 100 buah Box 149,000
437 Prodexon kaplet Non Generik Kaplet, box = 100 buah Box 65,000
438 Prometazin 25 mg tablet Generik Tablet, box = 100 buah Box 11,000
439 Pronalges tablet Non Generik Tablet, box = 50 buah Box 205,000
440 Proneuron kaplet Non Generik Kaplet, box = 200 buah Box 537,000
441 Propanolol 10 mg tablet Generik Tablet, box = 100 buah Box 14,000
442 Propil Tio Urasil 50 mg tablet Generik Tablet, box = 100 buah Box 442,000
443 Provagin ovula Non Generik Ovula, box = 10 buah Box 202,000
444 Pulmicort Respules Non Generik Respules, Box= 10 Respules Box 451,000
449 Ranitidin 150 mg tablet Generik Tablet, box = 100 buah Box 61,000
Tablet efferves, botol = 10
450 Redoxon tablet effervescent Non Generik Botol 56,000
buah
451 Rhinofed sirup Non Generik Sirup, Botol = 60 ml Botol 54,000
452 Rhinos Drop Non Generik Sirup, botol = 10ml Botol 77,000
453 Rillus Tablet Non Generik Tablet, box = 30 buah Box 364,000
454 Sagestam salep Non Generik Salep, tube = 10 gram Tube 22,000
- 68 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
456 Salbutamol tablet Generik Tablet, Box = 100 buah Box 41,000
457 Salonpas koyo Non Generik Lembar, box = 120 lembar Box 101,000
458 Sanadryl DMP Sirup Non Generik Sirup, botol = 60ml Botol 22,000
459 Sangobion sirup VITA TONIK Non Generik Sirup, Botol=400 ml Botol 54,000
460 Sangobion Tab Non Generik Tablet, box = 250 buah Box 471,000
461 Sanmol forte sirup Non Generik Sirup, botol = 60 ml Botol 38,000
463 Sanmol tablet Non Generik Tablet, box = 100 buah Box 48,000
464 Sanprima forte tablet Non Generik Tablet, box = 100 buah Box 295,000
465 Scabimite Salep Non Generik Salep, tube = 10 gram Tube 72,000
466 Scopma tablet Non Generik Tablet, Box = 100 buah Box 330,000
467 Sefiksim 50 mg kapsul Generik Tablet, box = 30 buah Box 63,000
468 Selespurin 100 mg tablet Non Generik Tablet, box = 100 buah Box 42,000
469 Selespurin 300 mg tablet Non Generik Tablet, box = 100 buah Box 60,000
474 Solaxin tablet Non Generik Tablet, Box = 100 buah Box 754,000
475 Solvinex sirup Non Generik Sirup, botol = 100 ml Botol 25,000
476 Spasminal tablet Non Generik Tablet, Box = 100 buah Box 88,000
477 Spiramycin 500 mg tablet Generik Tablet, box = 50 buah Box 191,000
478 Spiranter 500 mg tablet Non Generik Tablet, box = 100 buah Box 1,447,000
479 Starmuno Kids Sirup Non Generik Sirup, botol = 60ml Botol 122,000
480 Stator 10 mg tablet Non Generik Tablet, box = 30 buah Box 833,000
481 Stator 20 mg tablet Non Generik Tablet, box = 300 buah Box 889,000
482 Stesolid Rectal Tube 10 mg NPP Larutan rectal, tube = 2,5 ml Tube 330,000
483 Stesolid Rectal Tube 5 mg NPP Larutan rectal, tube = 2,5 ml Tube 220,000
484 Stimuno Forte kapsul Non Generik Kapsul, Box = 60 buah Box 142,000
485 Sucralfat sirup Non Generik Sirup, botol = 100 ml Botol 61,000
486 Superhoid suppositoria Non Generik Supposituria, box = 6 buah Box 54,000
487 Suprafenid suppositoria Non Generik Supposituria, box = 10 buah Box 175,000
488 Talk Salisil bedak Non Generik Bedak Talk, pot = 60 gram Pot 11,000
489 Talk Salisil KF bedak Non Generik Bedak Talk, Pot = 60 gram Pot 12,000
490 Talk Salisil IKA bedak Non Generik Bedak Talk, Botol = 80 gram Botol 23,000
491 Tensivas tablet Non Generik Tablet, Box = 100 buah Box 488,000
492 Teofilin 150 mg tablet Generik Tablet, box = 100 buah Box 12,000
493 Tera F kaplet Non Generik Kaplet, box = 100 buah Box 63,000
494 Teranol tablet Non Generik Tablet, box = 30 buah Box 247,000
- 69 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
495 Terbutalin 2,5 mg tablet Generik Tablet, box = 50 buah Box 11,000
496 Test pack kehamilan Sensitif strip Non Generik Strip, unit = 1 strip Unit 35,000
497 Thiamfilex 500 mg tablet Non Generik Tablet, box = 100 buah Box 116,000
498 Thiamphenicol 500 mg Generik Tablet, box = 100 buah Box 223,000
499 Thiamycin 500 mg tablet Generik Kapsul, box = 100 buah Box 768,000
500 Thrombo Aspilet tablet Non Generik Tablet, Box = 100 buah Box 101,000
502 Thrombophob Gel Non Generik Gel, tube = 20 gram Tube 92,000
503 Tolak Angin sachet Non Generik Sachet, box= 12 sachet Box 46,000
504 Tranec kaplet Non Generik Kaplet, box = 50 buah Box 247,000
505 Transamin tablet Non Generik Tablet, Box = 100 buah Box 397,000
506 Tremenza Tablet NPP Tablet, box = 100 buah Box 26,000
508 Triamcort tablet Non Generik Tablet, box = 100 buah Box 512,000
509 Tricela tablet Non Generik Tablet, Box = 100 buah Box 61,000
510 Trilac 4 mg tablet Non Generik Tablet, box = 30 buah Box 229,000
511 Triomin E tablet Non Generik Tablet, box = 100 buah Box 324,000
513 Ultraproct N krim Non Generik Krim, tube =10 gram Tube 182,000
514 Ultraproct N suppositoria Non Generik Suppositoria, box = 10 buah Box 155,000
515 Urineg tablet Non Generik Tablet, box = 100 buah Box 478,000
516 Urinter 400 kapsul Non Generik Kapsul, box = 100 buah Box 870,000
517 Valproat 150 mg tablet Generik Tablet, botol = 50 buah Botol 25,000
518 Valproat 250 mg tablet Generik Tablet, botol = 50 buah Botol 37,000
519 Vastigo tablet Non Generik Tablet, box = 100 buah Box 135,000
520 Ventolin inhaler Non Generik Inhaler, Box = 1 buah Box 182,000
Nebules 2,5mL, box = 20
521 Ventolin nebules Non Generik Box 317,000
buah
522 Veridin tablet Non Generik Tablet, box = 30 buah Box 321,000
523 Versilon 4 mg tablet Non Generik Tablet, box = 100 buah Box 289,000
524 Versyl tablet Non Generik Tablet, box = 50 buah Box 162,000
525 Vibramox forte sirup Non Generik Sirup kering, botol = 60 ml Botol 22,000
526 Vicks Inhaler Non Generik Inhaler, tube = 0,5 ml Tube 22,000
527 Vicks Vaporub Non Generik Obat gosok, pot = 25 gram Pot 32,000
528 Visine Tetes Mata Non Generik Tetes Mata, Botol = 6 ml Botol 24,000
529 Vitamin B1 100 mg tablet Generik Tablet, box = 100 buah Box 17,000
530 Vitamin B6 tablet Generik Tablet, Botol = 100 buah Botol 27,000
531 Vitamin C 100 mg tablet Generik Tablet, box = 100 buah Box 11,000
532 Vitamin C 25 mg tablet Generik Tablet, Botol = 500 buah Botol 27,000
533 Vitamin K 10 mg tablet Generik Tablet, botol = 500 buah Botol 69,000
534 Voltadex gel Non Generik Gel, Tube = 20 gram Tube 42,000
- 70 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
535 Voltadex tablet Non Generik Tablet, Box = 50 buah Box 54,000
536 Voltaren Emulgel Non Generik Gel, tube = 10 gram Tube 74,000
537 Vometraz 4 mg tablet Non Generik Tablet, Box = 10 buah Box 25,000
538 Vometraz 4 mg tablet Non Generik Tablet, box = 100 buah Box 74,000
539 Vometraz 8 mg tablet Non Generik Tablet, Box = 10 buah Box 42,000
540 Vometraz 8 mg tablet Non Generik Tablet, box = 100 buah Botol 48,000
542 Vosedon tablet Non Generik Tablet, box = 100 buah Box 361,000
543 Vosteon tablet Non Generik Tablet, box = 30 buah Pot 193,000
544 Wellmove tablet Non Generik Tablet, Box = 60 buah Box 236,000
545 Xanturic 300 tablet Non Generik Tablet, box = 50 buah Box 90,000
546 Yusimox sirup kering Non Generik Sirup kering, botol = 60 ml Botol 13,000
547 Zegren tablet Non Generik Tablet, box = 100 buah Box 196,000
548 Zenibroz kaplet Non Generik Kaplet, box = 30 buah Box 77,000
550 Zensoderm krim Non Generik Krim, tube =10 gram Tube 106,000
551 Zentra kaplet Non Generik Kaplet, box = 100 buah Box 167,000
552 Zinc sulfate sirup Non Generik Sirup, botol = 60 ml Botol 13,000
553 Aqua pro Injeksi Non Generik Vial 25 mL, Box = 1 vial Vial 17,000
554 Benodon Injeksi Non Generik Vial 15 mL, Box = 10 vial Box 283,000
555 Decadryl Injeksi Non Generik Vial 15 mL, Box = 10 vial Box 438,000
556 Decadryl Injeksi Non Generik Vial 5 mL, Box = 10 vial Vial 37,000
559 Getidin Injeksi Non Generik Ampul mL, Box = 5 ampul Box 155,000
560 Indexon Injeksi Non Generik Ampul mL, Box = 5 ampul Box 88,000
561 Kalnex Injeksi Non Generik Ampul 5 mL, Box = 10 ampul Box 245,000
565 Lignocain Injeksi Non Generik Ampul, box = 10 ampul ampul 1,481,000
566 Metoklopramide 5mg/mL Injeksi Generik Ampul, box = 10 buah Box 21,000
567 Nairet Injeksi Non Generik Ampul, box = 5 ampul Box 186,000
568 Neurobion 5000 Injeksi Non Generik Ampul, box = 10 pasang Box 297,000
569 Neuroboran Injeksi Non Generik Vial 9 mL, Box = 10 vial Box 218,000
570 Ondane 4 mg Injeksi Non Generik Ampul, box = 5 buah Box 227,000
571 Ondane 8 mg Injeksi Non Generik Ampul, box = 5 buah Box 401,000
572 Primperan Injeksi Non Generik Ampul 2 mL, Box = 6 ampul Box 68,000
573 Ratinal Injeksi Non Generik Vial 2 mL, Box = 5 vial Box 186,000
574 Scopamin Injeksi Non Generik Ampul 1 mL, Box = 5 ampul Box 159,000
- 71 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
575 Teranol Injeksi Non Generik Ampul, box = 6 buah Box 350,000
576 Tomit Injeksi Non Generik Ampul 2 mL, Box = 5 ampul Box 101,000
577 Trilac Injeksi Non Generik Vial 5 mL, Box = 10 vial Box 186,000
578 Vitamin B1 100 mg/mL njeksi Generik Ampul, box = 30 buah Box 49,000
587 Dispossible Syringe 3 ml "Terumo" Non Generik Box = 100 buah Box 471,000
588 Dissposible Syringe 5 ml "Terumo" Non Generik Box = 100 buah Box 438,000
589 Dispossible Syringe 10 ml "Terumo" Non Generik Box = 100 buah Box 438,000
590 Abbocath Intravena Venisystems Non Generik Ukuran 20G Buah 19,000
591 Adrenalin Injeksi / Epinefrin Injeksi Generik Ampul, box = 10 ampul Ampul 18,000
592 Alcohol Swab "Onemed" Non Generik Box = 100 buah Box 41,000
593 Atropin 0,25 mg/mL Injeksi Generik Ampul, box = 100 ampul Box 875,000
594 Betadine solution Non Generik Cairan, botol = 30 ml Botol 31,000
595 Betadine solution Non Generik Cairan, botol = 15 ml Botol 17,000
596 Braided Silk Suture "Ethicon-Mersilk" Non Generik Sachet Sachet 213,000
597 Buscopan 20 mg/ml Non Generik Cairan, boks = 10 ampul Boks 60,000
598 Catgut Silk with Needle "OneMed" Non Generik Sachet Sachet 30,000
599 Cortison Asetat Injeksi Non Generik Vial 10 mL, Box = 10 vial Box 371,000
600 Cotton bud Non Generik Pak Pak 11,000
Cum stainless, pinset, gunting, needle
601 Non Generik Unit = 1 unit Unit 54,000
holder (bahan bedah minor)
602 Daryant-Tulle Non Generik Lembar, boks = 5 lembar Box 350,000
605 Diazepam 5 mg/mL Injeksi NPP Ampul, box = 30 ampul Box 162,000
606 Epinefrin Injeksi / Adrenalin Injeksi Generik Ampul, box = 10 buah Ampul 18,000
607 EpiPen / Epinefrin in Auto Injector Non Generik Pen Auto Injector, box = 2 buah Box 6,728,000
608 Glukosa 10 % larutan infus Non Generik Larutan Infus, botol = 500 mL Botol 11,000
609 Glukosa 40 % larutan infus Non Generik Ampul, box = 10 ampul Ampul 27,000
610 Glukosa 5 % larutan infus Non Generik Larutan Infus, botol = 500 mL Botol 10,000
612 H2O2 solution 100 mL Non Generik Larutan 3%, Botol Botol 13,000
- 72 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
614 Hansaplast Plester Kain Elastis Non Generik Lembar, boks = 100 lembar Box 48,000
Hansaplast Plester Roll Kain 1,25 cm
615 Non Generik Roll, box = 10 roll Box 59,000
x1m
616 Hypafix Plester Rol 5cm x 1 m Non Generik Plester Rol 5cm x 1 m Rol 88,000
617 Hypafix Plester Rol 10cm x 1 m Non Generik Plester Rol 10cm x 1 m Rol 162,000
618 Hypafix Plester Rol 20cm x 1 m Non Generik Plester Rol 20cm x 1 m Rol 404,000
619 Infus Set Terumo Non Generik Ukuran 1 ml 20 tetes Buah 14,000
620 ISDN 10 mg tablet Generik Tablet, box = 100 buah Box 41,000
621 ISDN 5 mg tablet Generik Tablet, box = 100 buah Box 21,000
622 Kanul Oksigen Nasal Bmed Non Generik Ukuran dewasa Buah 10,000
626 Kasa Steril Hidrofil "Husada" Non Generik Box = 10 buah Box 16,000
627 Kasa Steril Hidrofil Lestari Non Generik Box = 16 buah Box 9,000
628 Kasa Perban Gulung 10 cm Lestari Non Generik Pack = 5 roll Pack 18,000
629 Kasa Perban Gulung 5 cm Lestari Non Generik Pack = 10 roll Pack 17,000
630 Kasa Perban Elastis Policrepe 6 inch Non Generik Roll = 1 buah Roll 162,000
631 Kasa Perban Elastis Policrepe 3 inch Non Generik Roll = 1 buah Roll 108,000
632 Kateter urine/Folley Catheter Silikon Non Generik Ukuran 16 Buah 14,000
633 Ketoprofen 100 mg suppositoria Generik Suppositoria, box = 10 buah Box 122,000
634 Klorpromazin 25 mg/mL Injeksi Generik Ampul 2ml, box = 30 ampul Box 50,000
635 Klorpromazin 5 mg/mL Injeksi Generik Ampul 2ml, box = 30 ampul Box 45,000
637 Minyak Angin Roll Fresh Care Strong Non Generik Cairan, botol = 10 ml Botol 23,000
638 Minyak Kayu Putih "Cap Lang" Non Generik Cairan, botol = 15 ml Botol 10,000
639 Minyak Kayu Putih Cap Lang Non Generik Cairan, botol = 30 ml Botol 17,000
640 NaCl 0,9% larutan infus Non Generik Larutan, vial = 25 mL Vial 14,000
641 NaCl 0,9% larutan infus Non Generik Larutan Infus, Botol = 500 mL Botol 10,000
642 NaCl 0.9% larutan infus Non Generik Larutan Infus, Botol = 1000 mL Botol 21,000
647 Primperan 5 mg/ml Non Generik Cairan, boks = 6 ampul Boks 87,000
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
653 Salbutamol 1 mg/ml larutan inhaler Non Generik Larutan inhaler, botol = 5 ml Botol 34,000
654 Selang oksigen set Non Generik Selang set set 14,000
655 Sofratulle Gauge Non Generik Gause, box = 10 lembar Box 235,000
658 Urine Bag Steril Non Generik Urine Bag, buah Buah 8,000
659 Ventolin nebules, larutan Non Generik Ampul, box = 20 ampul Box 377,000
660 Accutrend Cholesterol Non Generik Strip, pot = 25 buah Pot 688,000
661 Accutrend Glucose Non Generik Strip, pot = 25 buah Pot 403,000
662 Accutrend Trigliserida Non Generik Strip, pot = 25 buah Pot 803,000
663 Lancet Accu Chek Softclik Non Generik Lancet, box = 100 buah Box 211,000
664 Strip Asam Urat Easytouch Non Generik Strip, Box = 25 buah Box 249,000
665 Strip Glukosa Easytouch Non Generik Strip, Box = 25 buah Box 249,000
666 Strip Hb Family Dr Non Generik Strip, Box = 10 buah Box 42,000
667 Strip Kolesterol Easytouch Non Generik Strip, Box = 10 buah Box 249,000
671 Vaksin Hepatitis B "Engerix B" Non Generik Injeksi Ampul 108,000
674 Water-based Fogging Agent Non Generik Cairan, botol = 1 liter Botol 76,000
675 Hi-Cook Butane Gas Cartridge Non Generik Kaleng 230 g Kaleng 30,000
Pestisida Smash 100 EC Cypermetrin
676 Non Generik Cairan, botol = 500 ml Botol 88,000
100 g/L
-
677 Aseptic Gel OneMed Non Generik Cairan, jerigen = 5 liter Jerigen 303,000
678 Blood Lancet Non Generik Lancet, box = 100 buah Box 40,000
679 Botol plastik 60 ml Non Generik Volume 60 ml Buah 3,000
Charm Fragrance Extra Comfort Maxi
680 Non Generik Pack, pack = 18 buah Pack 34,000
Non Wing
Charm Fragrance Extra Comfort Maxi
681 Non Generik Pack, pack = 18 buah Pack 34,000
Wing
682 Jelly USG Non Generik Cairan, jerigen = 5 liter Jerigen 337,000
683 Kantong Obat Kertas 10 x 15 cm Non Generik Lembar, pack = 100 lembar Pack 23,000
684 Kantong plastik putih kecil Non Generik Lembar, pack = 100 lembar Pack 26,000
685 Kantong Plastik Putih No.15 Non Generik Lembar, pack = 100 lembar Pack 30,000
- 74 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
692 Pipet obat 1 ml Non Generik Pipet, unit = 1 unit Unit 7,000
693 Pipet obat 5 ml Non Generik Pipet, unit = 1 unit Unit 23,000
694 Plastik kresek kecil Non Generik Lembar, pack = 100 lembar Pack 21,000
695 Plastik Obat Klip 8.7 x 13 cm Non Generik Lembar, pack = 100 lembar Pack 12,000
696 Plastik Obat Klip Besar Non Generik Lembar, pack = 100 lembar Pack 15,000
697 Plastik Obat Klip Kecil (10 x 7) Non Generik Lembar, pack = 100 lembar Pack 7,000
698 Plastik Obat Klip Kecil (10 x 7) Non Generik Lembar, pack = 100 lembar Pack 7,000
699 Plastik Obat Klip Sedang Non Generik Lembar, pack = 100 lembar Pack 10,000
700 Sarung Tangan Lateks Remedi Non Generik Box = 50 pasang Box 75,000
701 Sarung Tangan Nitril Remedi Non Generik Box = 50 pasang Box 108,000
702 Spatel Lidah Kayu Non Generik Pack = 50 buah Pack 34,000
703 Tissue Facial 900 gram Non Generik Lembar, pack = 900 gram Pack 56,000
704 Tissue Rol Tessa Non Generik Rol Rol 11,000
VII. OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) PELAYANAN GIGI
705 Absorbent paper points 15-40 Non Generik Box = 200 buah Box 146,000
706 Alginat, Fast Set, merk GC Non Generik Pak = 500 gram Pack 155,000
707 Alkohol 70% Non Generik Cairan, botol = 1 liter Botol 68,000
708 Alloclair plus gel Non Generik Gel, tube= 8 mL Tube 142,000
711 Arkansas Stone Silinder Hijau Non Generik Buah Buah 23,000
712 Arkansas Stone Silinder Merah Non Generik Buah Buah 23,000
713 Articulating Paper double check Non Generik Lembar, pak = 12 x 12 lembar Pack 162,000
714 Articulating paper horseshoe Non Generik Lembar, pak = 6 x 12 lembar Pack 337,000
719 Bond Force Tokuyama Non Generik Cairan, Botol = 5 ml Botol 913,000
722 Brush CA Kecil point Non Generik Sikat, buah Buah 14,000
723 Bur Diamond Meisinger A 801 016 Non Generik Buah Buah 49,000
724 Bur Diamond Meisinger A 805 012 Non Generik Buah Buah 49,000
- 75 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
725 Bur Diamond Meisinger A 805 018 Non Generik Buah Buah 49,000
726 Bur Diamond Meisinger A 808 012 Non Generik Buah Buah 49,000
727 Bur Diamond Meisinger B 389 012 Non Generik Buah Buah 52,000
728 Bur Diamond Meisinger B 833C 018 Non Generik Buah Buah 60,000
729 Bur Diamond Meisinger B 837L 014 Non Generik Buah Buah 64,000
730 Bur Diamond Meisinger B 858 016 Non Generik Buah Buah 64,000
731 Bur Diamond Meisinger B 858C 014 Non Generik Buah Buah 64,000
732 Bur Diamond Meisinger C 802LG 012 Non Generik Buah Buah 51,000
733 Bur Diamond Meisinger C 802LG 016 Non Generik Buah Buah 64,000
734 Cairan Saline Non Generik Cairan, botol = 500 ml Botol 135,000
737 Calcetin Cavity Liner paste 7g Non Generik Pasta, syringe = 7 gram Syringe 619,000
742 Caviton merk GC Non Generik Pasta, pot = 30 gram Pot 269,000
743 Caviton Pink Non Generik Pasta, pot = 30 gram Pot 213,000
744 Caviton White Non Generik Pasta, pot = 30 gram Pot 213,000
745 Celluloid strip Non Generik Strip, Pack = 100 lembar Box 290,000
746 Celluloid strip "Dentamedica" Non Generik Strip, Pack = 100 lembar Pack 162,000
747 Celluloid Strip Svenska Non Generik Strip, Pack = 100 lembar Pack 223,000
748 Ceram X Sphere TEC One Non Generik Pasta, syringe, 3 gram Syringe 848,000
752 Chloraethyl Spray Non Generik Cairan, botol = 100 ml Botol 162,000
753 Chloraethyl Spray Botol Kaca Non Generik Cairan, botol = 100 ml Botol 424,000
754 Cito Ject Needle, uk. 0,3 x 33mm Non Generik Box = 100 buah Box 229,000
755 Clip dental chain Non Generik Buah Buah 34,000
756 Cocoa butter merk GC Non Generik Pasta, tube = 10 gram Tube 163,000
757 Composite estelite quick Non Generik Pasta, syringe = 3,6 gram Syringe 963,000
758 Composite flowable quick Non Generik Pasta, syringe = 3,6 gram syringe 640,000
765 Cresotin Paste Tehnodent Non Generik Pasta, pot = 25 g Pot 438,000
767 Dental bib + kantong hijau Non Generik Pack = 100 buah Pack 106,000
- 76 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
770 Dental floss pick Non Generik Pack = 100 buah Pack 135,000
771 Dental microbrush applicator Non Generik Pack = 100 buah Pack 88,000
772 Dental poli bib Non Generik Pack = 500 buah Pack 393,000
774 Dental x-ray film Non Generik Box = 25 buah Box 519,000
775 Dentin conditioner Non Generik Cairan, botol = 25 gram Botol 210,000
776 Dentin Conditioner Mini Pack 6 gr Non Generik Cairan, botol = 6 g Botol 168,000
777 Dentsply XP Bond Non Generik Cairan, botol = 4,5 ml Botol 1,427,000
782 Dissposible Syringe 10 cc "Terumo" Non Generik Box = 100 buah Box 471,000
783 Dissposible Syringe 3 cc "Terumo" Non Generik Box = 100 buah Box 438,000
785 Endometason,merk 'N-Metasone' Non Generik Powder, botol, 14 gram Botol 808,000
791 Ethylchloride spray Non Generik Cairan, botol = 100 ml Spray 337,000
794 Exterpatie / Barbed Broach Svenska Non Generik Set = 10 buah Set 171,000
796 Filtek Z350 XT Flowable (3M) Non Generik Cairan, syringe = 2 gram Syringe 828,000
797 Fletcher powder Non Generik Powder, Pot = 100 gr Pot 68,000
798 Fuji 9 Gold Label Non Generik Powder + Liquid, pack Pack 1,144,000
799 Fuji I merk GC Non Generik Powder + Liquid, pack Pack 1,353,000
800 Fuji I minipack Non Generik Powder + Liquid, pack Pack 537,000
802 Fuji IX GP minipack Non Generik Powder + Liquid, pack Pack 551,000
803 Fuji IX universal Non Generik Powder + Liquid, pack Pack 2,221,000
804 G-aenial Anterior & Posterior Non Generik Pasta, syringe = 2,7 ml Syringe 1,076,000
805 G-Aenial Bond Bottle Refill GC Non Generik Liquid, botol = 5 ml Botol 1,317,000
806 G-aenial Bond merk GC Non Generik Liquid, botol = 5 ml Botol 1,343,000
807 G-aenial Posterior A3.5 Non Generik Pasta, syringe = 2,7 ml Syringe 850,000
- 77 -
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
808 G-aenial Universal Flow Non Generik Pasta, syringe = 3,4 ml Syringe 1,354,000
809 Gengigel Sachet Non Generik Sachet, box = 100 sachet Box 1,200,000
812 Grinding Strip Non Generik Lembar, pack = 12 lembar Pack 34,000
813 Gutta percha 15-40 Non Generik Point, pack = 120 points Pack 108,000
Gutta percha points 45-80 Sure-endo
814 Non Generik Point, pack = 120 points Pack 169,000
Korea
815 Hexidin 2% OneMed Non Generik Cairan, botol = 100 ml Botol 69,000
816 Hidrogen peroksida (H2O2) 3% Non Generik Cairan, botol = 800 ml Botol 38,000
817 Jarum K-file 15-40 Non Generik Set = 6 buah Set 317,000
818 Jarum Irigasi Nomor 28G Non Generik Box = 50 buah Box 209,000
819 Jarum K-file 45-80 Non Generik Set = 6 buah Set 317,000
820 Jarum lentulo no 25-40 Non Generik Set = 4 buah Set 252,000
822 Kapas Gulung Non Generik Pack = 1000 gram Pack 54,000
823 Kassa steril "Husada" 16 x 16 Non Generik Lembar , box = 16 lembar Box 21,000
824 Kassa steril gulung Non Generik Gulung = 1000 gram Gulung 135,000
826 Kin mouth wash Non Generik Cairan, botol = 250 ml Botol 223,000
827 Larutan desinfektan ODEX - OneMed Non Generik Cairan, botol = 500 ml Botol 128,000
828 Lem fiber splint Non Generik Liquid, botol Botol 2,624,000
829 Masker 3 ply earloop Non Generik Lembar, box = 50 lembar Box 62,000
830 Masker Hijab Non Generik Lembar, box = 50 lembar Box 62,000
831 Masker tali Non Generik Lembar, box = 50 lembar Box 48,000
833 Micro Applicator Brush Non Generik Pack = 50 buah Pack 270,000
835 Moldano biru Non Generik Bubuk, pack = 1000 gram Kg 109,000
837 NaOCl 2.5% OneMed Non Generik Cairan, botol = 500 ml Botol 52,000
838 Oli Pelumas handpiece MD400 W&H Non Generik Cairan, botol Botol 933,000
841 Paper point no.15-40 Non Generik Set = 120 buah Set 115,000
842 Pehacain Injeksi Non Generik Cairan, box = 20 ampule Box 86,000
(dalam Rupiah)
SPESIFIKASI/
NO NAMA BARANG/URAIAN KATEGORI SATUAN HARGA
KODE/ ACUAN
849 Pulp X Devitalisasi Non Generik Pasta, pot = 6 gram Pot 404,000
850 Rockle's Non Generik Cairan, botol = 13 ml Botol 781,000
851 Saliva Ejector Non Generik Pack Pack 171,000
852 Sarung Tangan Nitrile Size S Non Generik Lembar, box = 100 lembar Box 202,000
853 Sarung Tangan Nitrile Size XS Non Generik Lembar, box = 100 lembar Box 84,000
857 Septoject 0,3 x 12 mm Non Generik Box = 100 buah Box 263,000
858 Septoject 0,3 x 16 mm Non Generik Box = 100 buah Box 263,000
859 Septoject 0,3 x 25 mm Non Generik Box = 100 buah Box 263,000
860 Slaber Disposible Non Generik Pack = 100 buah Pack 96,000
862 Sof-Lex 3M Spiral Mini Kit Non Generik Set Set 434,000
863 Solare Flo A2 GC Non Generik Pasta, syringe = 0,56 ml Syringe 297,000
864 Solare Flo A3 GC Non Generik Pasta, syringe = 0,56 ml Syringe 297,000
865 Solare Komposit, Anterior merk GC Non Generik Pasta, syringe = 2 ml Syringe 471,000
Solare Sculpt Syringe A2 1.9g (1ml)
866 Non Generik Pasta, syringe = 1 ml Syringe 474,000
GC
867 Solare X Komposit, Posterior merk GC Non Generik Pasta, syringe = 1 ml Syringe 471,000
868 Spet one pro classic (liquid) Non Generik Cairan, botol Botol 808,000
869 Spet one pro spray Non Generik Botol Botol 808,000
870 ST. House Hold (S,M,L) Non Generik Pack Pack 169,000
871 Stain Remover OCO Non Generik Cairan, botol = 15 ml Botol 256,000
872 Steri One Plus OneMed Non Generik Cairan, botol = 500 ml Botol 91,000
873 Sterile Pouch 7 x 200 cm OneMed Non Generik Gulung Gulung 485,000
874 Sterile Pouch 9 x 200 cm OneMed Non Generik Gulung Gulung 976,000
875 Suture needle dengan benang Non Generik Buah Buah 108,000
879 Topical anaesthesi Gel Non Generik Pasta, pot = 30 gram Pot 263,000
881 Tutup Oly W&H 400 ml Non Generik Buah Buah 149,000
4 Penjilidan
- Lakban besar 1 eks 15,000
- Spiral plastik ukuran kecil 1 eks 7,000
- Spiral plastik ukuran sedang 1 eks 15,000
- Spiral plastik ukuran besar 1 eks 25,000
- Spiral kawat ukuran kecil 1 eks 15,000
- Spiral kawat ukuran sedang 1 eks 20,000
- Spiral kawat ukuran besar 1 eks 25,000
5 Penggandaan
- A4 / F4 b/w 1 hal 300
- A3 b/w 1 hal 1,000
- A4 / F4 berwarna 1 hal 4,000
- A3 berwarna 1 hal 8,000