REKAPITULASI PERSEDIAAN OBAT DAN ALKES

NAMA SPPD : RSUD MASENREMPULU

NAMA KEPALA SKPD : dr. H. SISWANDI, M. Kes
PENANGGUNG JAWAB IFRS : ALHAM MUCHTAR, S.Si, Apt.
BULAN : Januari - Juni 2016
Tablet
No Uraian Jumlah satuan

A. Tablet
1 Acyclovir 200 mg 0 tablet
2 Acyclovir 400 mg 880 tablet
3 Allopurinol 100 mg 8030 tablet
4 Alprazolam 1 mg 2200 tablet
5 Alprazolam 0,5 mg 8910 tablet
6 Ambroxol 30 mg 29040 tablet
7 Aminophilin 200 mg 330 tablet
8 Amitryptilin 25 mg 6270 tablet
9 Amoxicillin 500 mg 9350 tablet
10 Amlodipine 5 mg 16676 tablet
11 Amlodipine 10 mg @ 30 33880 tablet
12 Antasida Doen 1210 tablet
13 Asam Mefenamat 500 mg 23430 tablet
14 Asam Tranexamat 500 mg 0 tablet
15 aspilet 100 mg 0 tablet
16 Bamgetol 200 Mg 5940 tablet
17 Betahistin 1265 tablet
18 Calsium laktat 0 tablet
19 Captopril 12,5 mg 0 tablet
20 Captopril 25 mg 5170 tablet
21 Captopril 50 mg 825 tablet
22 Carbamazepine 200 mg 1100 tablet
23 Cefadroxil 500 mg @ 50 kap 0 tablet
24 Cefadroxil 500 mg @ 100 30690 tablet
25 Ceterizine 10 mg 22165 tablet
26 Chloramphenicol 250 mg 330 tablet
27 chloroquine 150 mg 880 tablet
28 Cimetidin 0 tablet
29 Ciprofloxacin 500 mg 23100 tablet
30 Citicolin 500 mg 9405 tablet
31 Clindamicin 150 mg 110 tablet
32 Clindamicin 300 mg 550 tablet
33 Clobazam 10 mg 3080 tablet
34 Clozapin 25 mg 2200 tablet
35 Clonidine 0,5 mg 2750 tablet
36 Clopidogrel 75 mg 11319 tablet
37 CPZ 100 mg 7700 tablet
38 CTM 4 mg 5500 tablet
39 Codein 20 Mg 6490 tablet
40 Cotrimoksazole tablet 2200 tablet
41 Dexamethason 0,5 mg 4950 tablet
42 Diazepam 2 mg 7040 tablet
43 Digoxin 7810 tablet
44 Diltiazem 20900 tablet
45 DMP 0 tablet
46 Dimenhidrinat 50 mg 660 tablet
47 Domperidon 15400 tablet
48 Doxicyclin 100 mg 550 tablet
49 Erythromicin 250 mg 0 tablet
50 Etambutol 550 tablet
51 Fargoxin 0,25 mg 2200 tablet
52 Fenitoin Na 100 mg 440 tablet
53 Ferrosi Sulfat 0 tablet
54 Flunarizin 5 mg 4620 tablet
55 Furosemid 40 mg 22770 tablet
56 Gabapentin 300 mg 6435 tablet
57 GG 4400 tablet
58 Glibenclamid 1650 tablet
59 Glimepirid 2 Mg 10890 tablet
60 Griseopulvin 220 tablet
61 Haloperodol 1,5 mg 18260 tablet
62 Haloperidol 5 mg 7480 tablet
63 Hemobion 8360 tablet
64 Heximer 2 mg 20625 tablet
65 HCT 25 mg 1210 tablet
66 Ibuprofen 200 mg 10780 tablet
67 Ibuprofen 400 mg 1650 tablet
68 INH 100 mg 0 tablet
69 INH 300 mg 0 tablet
70 ISDN 8800 tablet
71 Irbesartan 300 MG 23650 tablet
72 Ketoconazole 200 mg 5225 tablet
73 Ketoprofen 100 mg 1100 tablet
74 Ketoprofen 50 mg 5060 tablet
75 Levofloxasin 500 Mg 1925 tablet
76 Loperamid 4730 tablet
77 Mecobalamin 10835 tablet
78 Meloxicam 15 mg 13090 tablet
79 Meloxicam 7,5 mg 4730 tablet
80 metoclopramide 10 mg 2035 tablet
81 Metformin 500 mg 14850 tablet
 82 Metilergometin 0,125 mg 20570 tablet
83 Methyl Prednisolon 16 mg 2222 tablet
84 Methyl Prednisolon 4 mg 18590 tablet
85 Methyl Prednisolon 8 mg 25850 tablet
86 Metronidazole 500 mg 7370 tablet
87 Merlopam 2 mg 2970 tablet
88 Miniaspi 80 mg 9350 tablet
89 Natrium Diklofenak 50 mg 10725 tablet
90 Nifedipin 10 mg 2475 tablet
91 Nopres 5148 tablet
92 Omeprazole 20 mg 38082 tablet
93 Ondancetron 4 mg 44550 tablet
94 Ondancetron 8 mg 0 tablet
95 Papaverin 40 mg 4950 tablet
96 Paracetamol 500 mg 33000 tablet
97 Phenitoin Sodium 100 Mg 21670 tablet
98 Phenobarbital 30 mg 1650 tablet
99 Piracetam 800 mg 1760 tablet
100 Piracetam 1200 Mg 1100 tablet
101 Pirazinamid 500 3850 tablet
102 Piroxicam 20 mg 1100 tablet
103 Prednison 5 mg 2420 tablet
104 Propanolol 10 mg 4400 tablet
105 Propanolol 40 mg 10670 tablet
106 Primolut -N 3795 tablet
107 PTU 8404 tablet
108 Pyrantel 5060 tablet
109 Ranitidin 26620 tablet
110 Rifampicin 15400 tablet
111 Risperidon 1 mg 2860 tablet
112 Risperidon 2 mg 8195 tablet
113 Salbutamol 2 mg 5500 tablet
114 Salbutamol 4 mg 8470 tablet
115 simvastatin 10 mg 11440 tablet
116 Simvastatin 20 mg 22264 tablet
117 Spironolakton 25 mg 11440 tablet
118 spironolakton 100 mg 10450 tablet
119 Stelosi 5 mg 1650 tablet
120 Sulfasalazine 0 tablet
121 Tetracyclin 250 mg 0 tablet
122 tetracyclin 500 mg 0 tablet
123 Tramadol 500 mg 825 tablet
124 vastigo 6 mg 4950 tablet
125 Vitamin A 20000 SI 990 tablet
126 Vitamin A 6000SI 0 tablet
127 Vitamin B1 12540 tablet
128 Vitamin B6 18150 tablet
129 Vitamin B12 24750 tablet
130 Vitamin B Comp 28600 tablet
131 Vitamin C 13200 tablet
132 Zink Tablet 3850 tablet
133 Aminofilin 24 mg/ml 290.4 ampul
134 Ampicillin Vial 88 vial
135 Anesfar 16.5 ampul
136 Anti hemoroid sus 165 biji
137 Asam Tranexamat 250 mg/5 0 ampul
138 Aqua Pro Injeksi 3212 botol
139 Asam Tranexamat 500 mg/5m 660 ampul
140 Atropin Sulfat 0,25 mg/ml 440 ampul
141 Bunascan Spinal 0,5% 522.5 ampul
142 Bupivacain Spinal 165 ampul
143 Calsium Glukonas 26.4 ampul
144 Cefotaxim (isi 2 Vial) 1166 vial
145 Cefotaxim (isi 10 vial 3300 vial
146 Ceftriaxon ( isi 2 Vial) 2217.6 vial
147 Ceftriaxon (isi 10 Vial) 5720 vial
148 Citicolin inj 125mg/ml 2618 ampul
149 Citicolin 250/2 ml 1111 ampul
150 Cyanocobalamin 0 ampul
151 Carba Zochrome Inj 132 ampul
152 Ceftasidime 0 vial
153 Dexamathason Injeksi 3630 ampul
154 Dexketoprofen Trometamol 1639 ampul
155 Diphenhidramin 165 ampul
156 Dobutamin Glolini 0 ampul
157 Dopamin glulini 200 mg 5.5 ampul
158 Ephedrin HCl 154 ampul
159 Epinefrin 5.5 ampul
160 Farelax 0 ampul
161 Farmabes Inj 504.9 ampul
162 Fitomenadion 0 ampul
163 Fendex 50 Mg 55 ampul
164 Ferbivent 0 ampul
165 Fentanyl 1034 ampul
166 Fortanes 115.5 ampul
167 Furosemid Injeksi 2887.5 ampul
168 Gentamicin Injeksi 40mg @5 1402.5 ampul
169 Haldol 0 ampul
170 Isofluran 250 ml/terrel 4.4 botol
171 Ketoprofen Injeksi 0 ampul
172 Ketorolac 10 mg/ml @ 10 A 0 ampul
173 Ketorolac 10 mg @ 12 A 0 ampul
174 Ketorolac 30 mg/ml @ 12 3128.4 ampul
175 Ketorolac 30 mg/ml @ 6 9213.6 ampul
176 Ketorolac 30 mg/ml @ 10 0 ampul
177 KTM 0 ampul
178 Levemir Flex Pen 753.5 ampul
179 Lidocain Injeksi 2750 ampul
180 Metronidazol Infus @16 316.8 botol
181 Metronidazol Infus @ 24 1047.2 botol
182 Metronidazol Infus @ 50 825 botol
183 Morphine Injeksi 0 ampul
184 Metil ergometrin 880 ampul
185 Novorapid Flex Pen 638 pcs
186 Novomix -30 Flex Pen 687.5 pcs
187 Ondancetron Injeksi 3300 ampul
188 Oxytocin 1650 ampul
189 Papaverin inj 0 ampul
190 Pehacain Inj 137.5 ampul
191 Pethidin 66 ampul
192 Paracetamol infus 1518 botol
193 Piracetam Injeksi 1 gr 0 vial
194 Pirasetam inj 3 gr @ 4 1720.4 vial
195 Pirasetam inj 3 gr @ 10 0 vial
196 Phytomenadion Inj 2 % 264 ampul
197 Phytomenadion Inj 10 % 99 ampul
198 Phenitoin Sodium 88 ampul
199 Pitogin 110 ampul
200 Ranitidin Injeksi @ 10 A 13035 ampul
201 Ranitidin inj @ 25 A 5940 ampul
202 Ranitidin Inj @ 100 3630 ampul
203 Recofol 374 botol
204 Sevodex 250 ml 1.1 ampul
205 Sedacum 0,1 % 220 ampul
206 Sojourn (Sevofluran) 0 ampul
207 Sohobion inj 5192 ampul
208 Sotatic inj 2585 ampul
209 Terrel (isofluran) 15.4 ampul
210 Tramadol Injeksi 0 ampul
211 Tramus 104.5 ampul
212 Vaksin TT 0 ampul
213 Valdimex 687.5 ampul
214 Vascon inj 55 ampul
215 Ziksonoate 0 ampul
216 Ceftriaxon (isi 100 Vial) 3190 ampul
217 Amoxicillin Syrup Kering 168.3 botol
218 Ambroxol Syr 863.5 botol
219 Antasida Suspensi 275 botol
220 As. Palvroat 25 Mg Syr 110 botol
221 Cefadroxil Syrup 422.4 botol
222 Chloramfenicol 125 Mg Syr 2.2 botol
223 Cotrimoxazole Suspensi 110 botol
224 Domperidone Syr 133.1 botol
225 DMP Syrup 0 botol
226 Erytrhromicin Syrup 20.9 botol
227 Ibuprofen Suspensi 0 botol
228 Oralit 0 botol
229 Paracetamol Syrup 605 botol
230 Cefixime syr 600 mg/30 ml 110 botol
231 Acyclovir Cream @ 25 59.4 tube
232 Bedak salisil 0 pot
233 Betametason Cream 5 Gr 55 tube
234 Betametason Cream @ 25 110 tube
235 Ethyl Clorida 0 tube
236 Fuson Salep 0 tube
237 Gentamicin Slp Kulit @ 1 T 88 tube
238 Gentamicin Slp Kulit @ 10 66 tube
239 Gentamicin Slp Kulit @ 25 0 tube
240 Hidrocortison Slp Kulit 5 Gr 26.4 tube
241 Hidrocortison Slp Kulit @ 2 79.2 tube
242 Miconazole Cream 55 tube
243 Oxytetraciclin Slp Kulit @ 82.5 tube
244 Oxytetraciclin Slp Mata 27.5 tube
245 ABB 16 0 pcs
246 ABB 18 1925 pcs
247 ABB 20 5280 pcs
248 ABB 22 660 pcs
249 ABB 24 550 pcs
250 ABB 26 411.4 pcs
251 AQUASONIC PARKER 5.5 pcs
252 BISTURI 11 220 pcs
253 BISTURI 15 855.8 pcs
254 BISTURI 20 770 pcs
255 BISTURI 22 440 pcs
256 CANGKANG 0 28.6 pcs
257 CANGKANG 1 16.5 pcs
258 CANULA O2 BAYI 94.6 pcs
259 CANULA O2 ANAK 138.6 pcs
260 CANULA O2 DEWASA 1536.7 pcs
261 CAT GUT 3/0 528 pcs
262 DISPO 1 CC 6710 pcs
263 DISPO 3 CC 34980 pcs
264 DISPO 5 CC 5280 pcs
265 DISPO 10 CC 10340 pcs
266 DISPO 20 CC 107.8 pcs
267 DISPO 50 CC BIASA 126.5 pcs
268 DISPO 50 CAT TIP 198 pcs
269 ELEKTRODA 2640 pcs
270 ETT 2,5 3.3 pcs
271 ETT 3,0 9.9 pcs
272 ETT 3,5 3.3 pcs
273 ETT 4,0 2.2 pcs
274 ETT 4,5 2.2 pcs
275 ETT 5,0 4.4 pcs
276 ETT 5,5 4.4 pcs
277 ETT 6,0 5.5 pcs
278 ETT 6,5 4.4 pcs
279 ETT 7,0 12.1 pcs
280 ETT 7,5 1.1 pcs
281 Formalin ta 0 pcs
282 FOLEY CATETER 8 20.9 pcs
283 FOLEY CATETER 10 6.6 pcs
284 FOLEY CATETER 12 18.7 pcs
285 FOLEY CATETER 14 17.6 pcs
286 FOLEY CATETER 16 50.6 pcs
287 FOLEY CATETER 3 WAY 24 46.2 pcs
288 FOLEY CATETER 18 1320 pcs
289 FM CREPE 4' 105.6 pcs
290 FM CREPE 6' 55 pcs
291 GUDEL 3 0 pcs
292 GUDEL 4 1.1 pcs
293 GUDEL 5 0 pcs
294 GUDEL 6 0 pcs
295 GYPSONA 4 ' POLIGIPS 78.1 pcs
296 GYPSONA 6' POLIGIPS 27.5 pcs
297 HANDSCOEN N STERIL S 90420 pcs
298 HANDSCOEN N STERIL M 14190 pcs
299 HANDSCOEN STERIL 7 10076 pcs
300 HANDSCOEN STERIL 7,5 2640 pcs
301 HANDSCOEN STERIL 8 440 pcs
302 HIPAPIX 152.9 pcs
303 INFUSET DEWASA 6270 pcs
304 INFUSET ANAK 519.2 pcs
305 JARUM KULIT 12 24.2 pcs
306 JARUM KULIT 13 0 pcs
307 JARUM OTOT 12 31.9 pcs
308 JARUM INSULIN NEEDLE 1320 pcs
309 KAPAS 250 GR 246.4 pcs
310 KASA 568.15 pcs
311 KERTAS EKG 90.2 pcs
312 KERTAS USG 24.2 pcs
313 K-Y JELLY 119.9 pcs
314 LEUKOPLAST 543.4 pcs
315 LOUMATULLE 187 pcs
316 MAAG SLANG 3,5 44 pcs
317 MAAG SLANG 5 36.3 pcs
318 MAAG SLANG 8 20.9 pcs
319 MAAG SLANG 10 0 pcs
320 MAAG SLANG 12 16.5 pcs
321 MAAG SLANG 16 40.7 pcs
322 MAAG SLANG 18 185.9 pcs
323 MASKER 25379.2 pcs
324 PERFUSOR LETUNG 74.8 pcs
325 NURSE CUP 1760 pcs
326 Silkam 3/0 B B 1.1 pcs
327 Silkam 0 B B 1.1 pcs
328 SOFTBAND 4' 36.3 pcs
329 SOFTBAND 6' 9.9 pcs
330 SPINOCAND 25 660 pcs
331 SPINOCAND 26 27.5 pcs
332 SPINOCAND 27 0 pcs
333 SUCTION CATHETER 6 67.1 pcs
334 SUCTION CATHETER 8 15.4 pcs
335 SUCTION CATHETER 10 26.4 pcs
336 SUCTION CATHETER 12 23.1 pcs
337 SUCTION CATHETER 14 15.4 pcs
338 SUCTION CATHETER 16 19.8 pcs
339 TERMOMETER 26.4 pcs
340 TRANSFUSI SET 1210 pcs
341 TREE WAY (CONECTA) 169.4 pcs
342 T VIO 0 (90 CM) V 12 910.8 pcs
343 T VIO 1 (90CM) V 15 31.9 pcs
344 T VIO 2-0 V 9 66 pcs
345 T VIO 2-0 TUPPER CUT 26.4 pcs
346 T VIO 3-0 (76CM) V 4 448.8 pcs
347 T NYLON 3-0 (76CM) N 32 291.5 pcs
348 T NYLON 5-0 (76CM) N 46 198 pcs
349 URINE BAG 1188 pcs
350 UROGARD 2500 34.1 pcs
351 BENANG ASSUCRYL 1 138.6 pcs
352 BENANG ASSUCRYL 2-0 272.8 pcs
353 BENANG ASSUCRYL 3-0 257.4 pcs
354 BENANG NYLON 3/0 AST 356.4 pcs
355 BENANG NYLON 5/0 AST 111.1 pcs
356 CROMICH CAT GUT 1/0 66 pcs
357 MASKER O2 SIMPLE MASK 62.7 pcs
358 MASKER O2 ANAK 25.3 pcs
359 MASKER DWS(KANTUNG) 46.2 pcs
360 Magnisium sulfat (GI) 0 pcs
361 Benang Monosoft 3-0 158.4 pcs
362 Benang Monosoft 5-0 39.6 pcs
363 Benang Polisorb 2-0 79.2 pcs
364 Benang Polisorb 3-0 277.2 pcs
365 Benang Polisorb 5-0 39.6 pcs
366 Benang Polisorb 0 79.2 pcs
367 Benang Polisorb 1 0 pcs
368 Premilen Mesh 11 pcs
369 CAT GUT 2/0 39.6 pcs
370 Baju Operasi (H) 0 pcs
371 Baju Operasi (L) 0 pcs
372 Mitella 4.4 pcs
373 ALKOHOL 410.3 botol
374 ALKOHOL 300 ml 33 botol
375 ASERING 902 botol
376 Aquadest 0 botol
377 BETADIN 176.55 botol
378 CIDEX 1 L 2.2 botol
379 DESTROSE 5 % 2508 botol
380 DESTROSE 10 % 247.5 botol
381 DESTROSE 40 % 103.4 botol
382 FARBIVENT 2,5 ML 165 botol
383 FORMALIN Cair 1.1 botol
384 H2O2 2.2 botol
385 KA_EN 3 B 44 botol
386 MG SO 4 20 % 23.1 botol
387 MG SO 4 40 % 78.1 botol
388 MANITOL 302.5 botol
389 NACL PIGGY BACK 264 botol
390 NACL 5412 botol
391 RIVANOL 3.85 botol
392 RINGER LAKTAT 500 ml 22701.8 botol
393 RINGER LAKTAT 1000 ml 880 botol
394 WIDHA HES 130 572 botol
395 WIDHA KDN 1 126.5 botol
396 WIDHA KN 1 81.4 botol
397 WIDHA KN 2 264 botol
398 WIDHA KDN 2 242 botol
399 Etil klorida 3.3 botol
400 Browi 0 botol
401 alkohol swab 78.1 pcs
402 Aminofluid 11 botol
 1. SATUAN KERJA ADALAH NAMA INSTANSI (RSUD / RSUP / RSTNI / RSPOLRI / RS)
2 RENCANA KEBUTUHAN TAHUN 2016 ADALAH ESTIMASI JUMLAH KEBUTUHAN OBAT SELAMA SATU TAHUN
. PADA TAHUN 2016 DALAM SATUAN TERKECIL SEPERTI : TABLET / KAPSUL / KAPLET / BOTOL / AMPUL / VIAL /
3. SURAT PENGANTAR DAN LAMPIRAN HARUS DI TANDATANGANI OLEH KEPALA SATUAN KERJA DAN DIBERI S
4. SURAT PENGANTAR DAN LAMPIRAN DALAM BENTUK EXCEL DIKIRIM MELALUI EMAIL KE : obat.publik@kemkes
5. MOHON UNTUK TIDAK MELAKUKAN PENAMBAHAN MAUPUN PENGURANGAN BARIS/KOLOM PADA FORMAT
RKO METADON HANYA DI ISI OLEH RS PENGAMPU DAN SATELIT PTRM DI PROVINSI YANG BELUM MEMPUNYAI
RS PENGAMPU.

RENCANA KEBUTUHAN OBAT PADA FASILITAS KESEHATAN RUJUKAN TINGKAT LANJUTAN (FKRTL) TAHUN 2017

SATUAN KERJA : RSUD MASSENREMPULU ENREKANG

SISA STOK N RATA- RENCANA
PER 31 RATA PER KEBUTUHA KETERANG
NO NAMA OBAT SATUAN
DESEMBER BULAN N TAHUN AN
2016 SELAMA 2017

153-Sm-EDTMP (ethylenediamine Tab 0 0 0

tetramethylene phosphonic acid) 44 mg
Ca/Na EDTMP, 5-46 μg samarium, dan
1 1850 ± 185 mbq samarium 153 per ml

Adefovir dipivoksil tab 10 mg Tab 0 0 0

2
Air untuk injeksi amp 25 ml Ampul 0 3000 40000
3
Air untuk irigasi lar inf 1000 ml Botol 0 0 0
4
Akarbose tab 100 mg Tab 0 400 5500
5
6 Akarbose tab 50 mg Tab 0 400 5500
Albendazol susp 200 mg/5 ml Botol 0 0 0
7

8
Albendazol tab 400 mg Tab 0 0 0

9
Albumin serum normal (human albumin) Vial 0 5 65
inj 25%
Albumin serum normal (human albumin) Vial 0 5 65
inj 20%
10
Albumin serum normal (human albumin) Vial 0 5 65
inj 5%
11
Alopurinol tab 100 mg Tab 900 100 1500
12
Alopurinol tab 300 mg Tab 0 0 0
13

14
Alprazolam tab 0,25 mg Tab 0 1000 15000

15 Alprazolam tab 0,5 mg Tab 0 2000 30000

16
Alprazolam tab 1 mg Tab 0 2000 30000
 Alteplase serb inj 50 mg/vial Vial 0 0 0
17
Amfoterisin B inj 50 mg/10 ml (i.v.) Ampul 0 0 0
18
Amfoterisin B salep mata 1% Tube 0 0 0
19
Amfoterisin B salep mata 3% Tube 0 0 0
20
Amidotrizoat 370 mg/Ml Vial 0 0 0
21

22 Amikasin inj 250 mg/ml Vial 0 0 0

23
Amilorid tab 2,5 mg Tab 0 0 0
24 Amilorid tab 5 mg Tab 0 0 0
25 Aminofilin tab 150 mg Tab 0 0 0
26 Aminofilin inj 24 mg/ml Ampul 0 150 2000
27 Aminofilin tab 200 mg Tab 300 100 1500
Amiodaron inj 150 mg/3 ml Ampul 0 0 0

28
Amiodaron tab 200 mg Tab 0 0 0

29
Amitriptilin tab sal 25 mg Tab sal 5500 1250 16500

30
Amlodipin tab 10 mg Tab 2500 1000 13000
31
Amlodipin tab 5 mg Tab 1700 500 6500
32
Amoksisilin sir forte 250 mg/5 ml Botol 0 0 0

33
Amoksisilin sir kering 125 mg/5 ml Botol 74 20 260

34
Amoksisilin tab 250 mg Tab 0 0 0

35
Amoksisilin tab 500 mg Tab 6600 1500 20000

36
 Ampisilin serb inj 1000 mg/vial Vial 0 0 0

37
Ampisilin serb inj 250 mg/vial Vial 0 0 0

38
Analog insulin : rapid acting (inj 100 UI/ml Vial 0 30 400
(kemasan vial, cartridge disposible,
penfill cartridge)

39
Analog insulin :long acting (inj 100 UI/ml Vial 0 10 130
(kemasan vial, cartridge disposible,
penfill cartridge)

40
Analog insulin :mix insulin (inj 100 UI/ml Vial 0 15 200
(kemasan vial, cartridge disposible,
penfill cartridge)

41
 Anastrozol tab 1 mg Tab 0 0 0
42
Anestetik lokal gigi kombinasi : lidokain Vial 0 250 3300
hcl 2% + epinefrin 1 : 80.000 inj 2 ml

43
Antasida, kombinasi : aluminium Tab 4000 1250 15000
hidroksida 200 mg + magnesium kunyah
hidroksida 200 mg

44
Antasida, kombinasi : aluminium Botol 50 40 525
hidroksida 200 mg + magnesium
hidroksida 200 mg

45
Antibakteri, kombinasi : basitrasin 500 Tube 0 0 0
UI/g+ Polimiskin B 10.000 UI/g

46
 Antifungi salep, kombinasi : asam Tube 0 0 0
benzoat 6%+ asam salisilat 3%

47
Antihemoroid, kombinasi: bismut Botol 0 40 500
subgalat 150 mg + heksaklorofen 2,5 mg
+ lidokain lidokain 10 mg+ seng oksida
120 mg + sup ad 2 g

48
0

Antimalaria kombinasi : sulfadoksin 500

Kaps 0 0
mg + primetamin 25 mg

49
 0

Anti Parkinson kombinasi : benzerasid 25

Kaps 0 0
mg + levodopa 100 mg

50
Artemether inj 80 mg/ml Ampul 0 0 0

51
Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 0 0 0

52
Kertas 0 0 0
warna
Articulating paper kertas warna penanda o penanda
oklusi
53
Asam asetilsalisilat (asetosal) tab 100 mg Tab 0 1000 13500

54
Asam asetilsalisilat (asetosal) tab 80 mg Tab 0 0 0

55
Asam askorbat (vitamin C) tab 250 mg Tab 0 0 0

56
Asam askorbat (vitamin C) tab 50 mg Tab 4500 500 6500

57
 Asam folat tab 0,4 mg Tab 0 0 0

58
Asam folat tab 1 mg Tab 0 0 0
59
Asam folat tab 5 mg Tab 0 500 6500
60
Asam ibandronat inj 6 mg/6 ml Vial 0 0 0

61
62 Asam mefenamat kaps 250 mg Kaps 0 0 0
63 Asam mefenamat kaps 500 mg Kaps 0 5000 65000
Asam pipemidat kaps 400 mg Kaps 0 0 0

64
Asam retinoat krim 0,1% Tube 0 0 0

65
Asam salisilat lar 0,1% Botol 0 0 0

66
Asam salisilat salep 10% Tube 0 0 0

67
Asam salisilat salep 2% Tube 0 0 0

68
Asam salisilat salep 5% Tube 0 0 0

69
Asam traneksamat inj 100 mg/ml Ampul 235 100 1500

70
 Asam traneksamat inj 50 mg/ml Ampul 0 0 0

71
Asam traneksamat tab 500 mg Tab 0 50 1000

72
Asam ursodeoksikolat kaps 250 mg Kaps 0 0 0

73
Asam zoledronat inj 4 mg/5 ml Vial 0 0 0

74
Asetazolamid tab 250 mg Tab 0 0 0

75
76 Asiklovir salep mata 3% Tube 0 0 0
Asiklovir tab 200 mg Tab 100 100 1500

77
Asiklovir tab 400 mg Tab 400 200 3000

78
Asparaginase serb inj 10.000 UI/vial Vial 0 0 0

79
80 Atapulgit Tab 0 0 0
Atenolol tab 50 mg Tab 0 0 0
81
Atenolol tab 100 mg Tab 0 0 0

82
Atrakurium inj 25 mg/2,5 ml Vial 0 50 600

83
 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 210 140 2000

84
Atropin inj 1 mg/ml (i.m./i.v./s.k) Ampul 0 0 0

85
Atropin tab 0,5 mg Tab 0 0 0

86
Atropin tts mata 0,5% Botol 0 0 0

87
Atropin tts mata 1% Botol 0 0 0
88
Azatioprin tab 50 mg Tab 0 0 0
89
Azitromisin sir kering 200 mg/5 ml Botol 0 0 0

90
Azitromisin tab 250 mg Tab 0 0 0

91
Azitromisin tab 500 mg Tab 0 0 0

92
Bahan tumpatan sementara lar, serb Botol 0 0 0

93
Barium sulfat serb 92 g/100 ml Botol 0 0 3

94
Barium sulfat susp 2,2% Botol 0 0 0

95
 Barium sulfat susp 55% Botol 0 0 0

96
Barium sulfat susp 65% Botol 0 0 0

97
Bedak salisil serb 2% Botol 8 15 200

98
Benzatin penisilin inj 2,4 juta UI/ml (i.m.) Vial 0 0 0

99
Benzatin penisilin inj 1,2 juta UI/ml (i.m.) Vial 0 0 0

100
101 Beractant susp 25 mg/ml (intratekal) Botol 0 0 0
Beraprost sodium tab 20 mcg Tab 0 0 0

102
Betametason tts mata 1 mg/ml Botol 0 0 0

103
Betametason krim 0,1% Tube 240 20 300

104
Betametason krim 0,5 mg/g Tube 0 0 0

105
Betametason salep 0,1% Tube 0 0 0

106
Bevasizumab inj 25 mg/ml Vial 0 0 0

107
 Bikalutamid tab sal 150 mg Tab 0 0 0

108
Bikalutamid tab sal 50 mg Tab 0 0 0

109
Bisakodil sup 10 mg Botol 0 10 130

110
Bisakodil sup 5 mg Botol 0 5 65
111
Bisakodil tab sal 5 mg Tab sal 0 225 3000

112
Bisoprolol tab 2,5 mg Tab 0 0 0

113
Bisoprolol tab 5 mg Tab 0 0 0
114
Bleomisin serb inj 15 mg/ml Vial 0 0 0

115
Bromokriptin tab 2,5 mg Tab 0 0 0

116
117 Budesonid cairan ih 0,25mg/ml Botol 0 0 0
118 Budesonid ih 200 mcg/dosis Botol 0 0 0
119 Budesonid serb ih 100 mcg/dosis Botol 0 0 0
Budesonid-formoterol (fixed Botol 0 0 0
combination)* ih 160/4,5 mcg

120
 Budesonid-formoterol (fixed Botol 0 0 0
combination)* ih 80/4,5 mcg

121
Bupivakain heavy inj 5 mg/ml (hcl) + Ampul 0 0 0
glukosa 8%

122
Bupivakain inj 5 mg/ml (p.v.) Ampul 5 70 1000

123
Busulfan tab salut 2 mg Tab 0 0 0

124
Coal tar lar 5 % Botol 0 0 0
125
126 Copper T set/buah 0 0 0
Dabigatran eteksilat kaps 110 mg Kaps 0 0 0

127
Dabigatran eteksilat kaps 75 mg Kaps 0 0 0

128
Dakarbazin serb inj 100 mg/vial Vial 0 0 0

129
Dakarbazin serb inj 200 mg/vial Vial 0 0 0

130
 Daktinomisin inj 0,5 mg/vial (i.v.) Vial 0 0 0

131
Dapson tab scored 100 mg Tab 0 0 0

132
Daunorubisin serb inj 20 mg/vial Vial 0 0 0

133
Deferasiroks tab disp 250 mg Tab 0 0 0

134
Deferasiroks tab disp 500 mg Tab 0 0 0

135
Deferipron lar oral 100 mg/ml Botol 0 0 0

136
Deferipron tab sal 500 mg Botol 0 0 0

137
Deferoksamin mesilat serb inj 500 Vial 0 0 0
mg/vial

138
Deksametason tab 0,5 mg Tab 0 1100 15000

139
Deksametason tab 4 mg Tab 0 0 0

140
 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 200 1000 13000

141
Desmopresin tab 0,1 mg Tab 0 0 0

142
Desmopresin tab 0,2 mg Tab 0 0 0

143
Desogestrel tab 75 mcg Tab 0 0 0

144
Desoksimetason gel 0,05% Tube 0 0 0

145
Desoksimetason krim 0,25% Tube 0 0 0

146
Desoksimetason salep 0,25% Tube 0 0 0

147
Dialisa peritoneal lar intraperitonial Botol 0 0 0

148
Diazepam inj 5 mg/ml (i.v./i.m.) Vial 0 25 350

149
Diazepam lar rektal 10 mg/2,5 ml Botol 0 0 0

150
Diazepam lar rektal 5 mg/2,5 ml Botol 0 5 65

151
 Diazepam tab 2 mg Tab 0 1500 20000
152
Diazepam tab 5 mg Tab 0 0 0
153
Dietilkarbamazin tab 100 mg Tab 0 0 0

154
Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 0 35 500

155
Diflukortolon valerat salep berlemak Tube 0 0 0
0,1%

156
Digoksin inj 0,25 mg/ml Vial 0 0 0

157
Digoksin tab 0,25 mg Tab 3500 1125 15000

158
Diltiazem hcl inj 5 mg/5 ml Ampul 0 0 0

159
Diltiazem hcl tab 30 mg Tab 5000 1125 15000

160
Diltiazem inj 25 mg/5 ml Ampul 0 0 0

161
Diltiazem kaps SR 100 mg Kaps 0 0 0

162
Diltiazem kaps SR 200 mg Kaps 0 0 0

163
Diltiazem serb inj 10 mg/10 ml Ampul 0 0 0

164
 Diltiazem serb inj 50 mg/vial Vial 0 0 0

165
Diltiazem tab 30 mg Tab 0 0 0
166
Dimenhidrinat tab 50 mg Tab 0 0 0

167
Dinatrium edetat tts mata 0,35% Botol 0 0 0

168
Dinatrium klodronat infus kons 60 mg/ml Botol 0 0 0

169
DMSA (dimercapto succinic acid) 1,1 mg Vial 0 0 0
meso-2, 3-dimercaptosuccinic acid/vial

170
Dobutamin inj 12,5 mg/ml Vial 0 0 0

171
Dobutamin inj 25 mg/ml Vial 0 0 0

172
Dobutamin inj 50 mg/ml Vial 0 0 5

173
Doksazosin mesilat tab 1 mg Tab 0 0 0

174
Doksazosin mesilat tab 2 mg Tab 0 0 0

175
 Doksazosin tab 1 mg Tab 0 0 0

176
Doksazosin tab 2 mg Tab 0 0 0

177
Doksisiklin kaps 100 mg Kaps 0 0 0

178
Doksisiklin kaps 50 mg Kaps 0 0 0

179
Doksorubisin serb inj 10 mg/vial (i.v.) Vial 0 0 0

180
Doksorubisin serb inj 50 mg/vial Vial 0 0 0

181
Domperidon susp 5 mg/5 ml Botol 0 0 0

182
Domperidon tab 10 mg Tab 0 0 0

183
Domperidon tts 5 mg/ml Botol 0 400 5000

184
Dopamin inj 40 mg/ml Vial 0 0 10

185
Dosetaksel inj 20 mg/0,5 ml Ampul 0 0 0

186
Dosetaksel inj 80 mg/2 ml Ampul 0 0 0

187
 DTPA (diethylene triamine pentaacetic Vial 0 0 0
acid) 2,06-2,5 mg pentetate calcium
trisodium/ml

188
Dutasterid kaps 0,5 mg Kaps 0 0 0

189
Efavirens tab sal 600 mg Tab sal 0 0 0

190
Efedrin inj 50 mg/ml Ampul 0 115 1500
191
Eksemestan tab 25 mg Tab 0 0 0

192
Enoksaparin sodium inj 20 mg/0,2 ml Ampul 0 0 0

193
Enoksaparin sodium inj 40 mg/0,4 ml Ampul 0 0 0

194
Enoksaparin sodium inj 60 mg/0,6 ml Ampul 0 0 0

195
 Epinefrin (adrenalin) inj 0,1% Ampul 0 0 0
(i.v./s.k./i.m.)

196
Epinefrin (adrenalin) inj 1 mg/ml Ampul 0 35 500

197
Epirubisin serb inj 10 mg/5 ml Vial 0 0 0

198
Epirubisin serb inj 50 mg/25 ml Vial 0 0 0

199
Ergokalsiferol (vitamin D2) kaps 50.000 Kaps 0 0 0
UI

200
Ergokalsiferol (vitamin D2) susp 10.000 Botol 0 0 0
UI/ml

201
Ergotamin tab 1 mg Tab 0 0 0
202
Eritromisin kaps 250 mg Kaps 0 0 0

203
Eritromisin sir 200 mg/5 ml Botol 0 0 0

204
Eritromisin tab 500 mg Tab 0 0 0

205
Eritropoetin-alfa inj 10.000 UI/ml Vial 0 0 0

206
 Eritropoetin-alfa inj 2.000 UI/ml Vial 0 0 0

207
Eritropoetin-alfa inj 3.000 UI/ml Vial 0 0 0

208
Eritropoetin-beta inj 2000 UI/0,3 ml Vial 0 0 0

209
Estrogen terkonjugasi tab sal 0,3 mg Tab sal 0 0 0

210
Estrogen terkonjugasi tab sal 0,625 mg Tab sal 0 0 0

211
Etambutol tab 250 mg Tab 0 0 0

212
Etambutol tab 400 mg Tab 0 0 0

213
Etambutol tab 500 mg Tab 300 375 5000

214
Etanol 70% cairan 70% Botol 0 50 700

215
216 Etil klorida semprot 100 ml Botol 0 0 5
Etinilestradiol tab 0,05 mg Tab 0 0 0

217
Etinilestradiol tab 0,5 mg Tab 0 0 0

218
 Etoposid inj 20 mg/ml Vial 0 0 0

219
Etoposid kaps 100 mg Kaps 0 0 0

220
221 Eugenol Botol 0 0 5
Everolimus tab 0,25 mg Tab 0 0 0

222
Everolimus tab 0,5 mg Tab 0 0 0

223
Faktor IX kompleks serb inj 1.000 UI/vial Vial 0 0 0
+ pelarut 25 ml

224
Faktor IX kompleks serb inj 500 UI/vial + Vial 0 0 0
pelarut

225
Faktor koagulasi II 14-35 UI, faktor Vial 0 0 0
koagulasi VII 7-20 UI, faktor koagulasi IX
25 UI, faktor koagulasi X 14-35 serb inj
500 UI/10 ml UI

226
 Faktor viia (rekombinan) serb inj 1 Vial 0 0 0
mg/vial + pelarut untuk injeksi

227
Faktor VIII (konsentrat) serb inj 230 -340 Vial 0 0 0
UI

228
Faktor VIII (konsentrat) serb inj 250 Vial 0 0 0
UI/vial + pelarut 5 ml

229
Faktor VIII (konsentrat) serb inj 480 - 600 Vial 0 0 0
UI

230
Faktor VIII (konsentrat) serb inj 500 Vial 0 0 0
UI/vial + pelarut 5 ml

231
Fenitoin Na inj 100 mg/2 ml Ampul 0 0 0

232
Fenitoin Na inj 50 mg/ml Ampul 0 0 0

233
Fenitoin Na kaps 100 mg Kaps 0 0 0

234
 Fenitoin Na kaps 50 mg Kaps 0 0 0

235
Fenobarbital inj 50 mg/ml Ampul 0 0 200

236
Fenobarbital tab 100 mg Tab 0 0 0

237
Fenobarbital tab 30 mg Tab 0 400 5000

238
Fenofibrat kaps 100 mg Kaps 0 0 0

239
Fenofibrat kaps 300 mg Kaps 0 0 0

240
Fenoksimetil penisilin (penisilin V) tab Tab 0 0 0
125 mg

241
Fenoksimetil penisilin (penisilin V) tab Tab 0 0 0
250 mg

242
Fenoksimetil penisilin (penisilin V) tab Tab 0 0 0
500 mg

243
Fenoterol hbr aerosol 100 mcg/puff Botol 0 0 0

244
 Fenoterol hbr cairan ih 0,1% Botol 0 0 0

245
246 Fentanil inj 0,05 mg/ml (i.v.) Vial 148 75 1000
247 Fentanil patch 12,5 mcg/jam Pack 0 0 0
248 Fentanil patch 25 mcg/jam Pack 0 0 0
249 Fentanil patch 50 mcg/jam Pack 0 0 0
Ferro fumarat kaps lunak 300 mg Kaps lunak 0 0 0

250
Ferro sulfat sir. 15 mg/5 ml Botol 0 0 0

251
Ferro sulfat tab salut 300 mg Tab sal 1000 225 3000

252
Filgrastim inj 300 mcg/ml Vial 0 0 0

253
Finasterid tab 5 mg Tab 0 0 0
254
Fitomenadion (vitamin K 1) inj 2 mg/ml Vial 0 50 700
(i.m.)

255
Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 0 0 0

256
Fludarabin inj 50 mg/vial Vial 0 0 0

257
 Fludarabin tab sal 10 mg Tab 0 0 0

258
Flufenazin inj 25 mg/ml (i.m.) Vial 0 0 0

259
Flukonazol inj 2 mg/ml Ampul 0 0 0

260
Flukonazol kaps 150 mg Kaps 0 0 0

261
Flukonazol kaps 50 mg Kaps 0 0 0

262
Fluoksetin kaps 10 mg Kaps 0 0 0

263
Fluoksetin kaps 20 mg Kaps 0 0 0

264
265 Fluor sediaan topikal Tube 0 0 0
266 Fluor tab 0,5 mg Tab 0 0 0
267 Fluor kapl 1 mg Kaplet 0 0 0
Fluoresein tts mata 2,5 mg/ml Botol 0 0 0

268
Fluoro deoxy glucose (FDG) Vial 0 0 0

269
Fluorometolon tts mata 0,1% Botol 0 0 0

270
Fluorourasil inj 250 mg/ml Ampul 0 0 0

271
 Fluorourasil inj 50 mg/ml (i.v.) Ampul 0 0 0

272
Fluorourasil serb inj 250 mg Ampul 0 0 0

273
Flusinolon asetonid krim 0,025% Tube 0 0 0

274
Flusinolon asetonid salep 0,025% Tube 0 0 0

275
Flutikason furoat intranasal spray Botol 0 0 0

276
Flutikason propionat cairan ih 0,5 Botol 0 0 0
mg/dosis

277
Fondaparinuks inj 2,5 mg/0,5 ml Vial 0 0 0

278
Paraformaldehid lar buffer 10% Botol 0 0 0

279
Paraformaldehid tab 1 g Tab 0 0 1500

280
Formokresol Botol 0 0 0
281
Fraksi protein plasma lar inf 5% Botol 0 0 0

282
 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 400 150 2000

283
Furosemid tab 40 mg Tab 0 1125 15000

284
Gadobutrol macrocyclic Macrocycli 0 0 0
c

285
Gadodiamid inj 287 mg/10 ml Vial 0 0 0

286
Gadoksetat disodium 0,25 mmol Vial 0 0 0
gadoksetat disodium/ml

287
Galactose microparticle 200-400 mg Vial 0 0 0
micropart/ml

288
Gansiklovir serb inj 500 mg/vial Vial 0 0 0

289
 Garam oralit kombinasi : natrium klorida Sachet 0 0 100
0,52 g + kalium klorida 0,30 g + trinatrium
sitrat 0,58 g + glukosa anhidrat 2,7 g

290
Gefitinib tab 250 mg Tab 0 0 0

291
Gemfibrozil kaps 300 mg Kaps 0 0 0

292
Gemfibrozil kaps 600 mg Kaps 0 0 0

293
Gemsitabin inj 1000 mg/vial Vial 0 0 0

294
Gemsitabin inj 200 mg/vial Vial 0 0 0

295
Gentamisin inj 10 mg/ml Ampul 0 0 0

296
Gentamisin inj 40 mg/ml Ampul 100 260 3500

297
Gentamisin inj 80 mg/ml Ampul 0 0 0

298
 Gentamisin salep mata 0,3% Tube 0 0 0

299
Gentamisin tts mata 0,3% Botol 0 0 0

300
Glass ionomer ART (Atraumatic Sachet 0 0 0
Restorative Treatment) cocoa butter 5 g

301
302 Glass ionomer ART (Atraumatic Restorative Treatment)
Botol lar 0 0 0
303 Glass ionomer ART (Atraumatic Restorative Treatment)
Vial serb0 0 0
Glibenklamid tab 2,5 mg Tab 0 0 0

304
Glibenklamid tab 5 mg Tab 2000 750 10000

305
Gliklazid tab 80 mg Tab 0 0 0

306
Gliklazid tab MR 30 mg Tab 0 0 0

307
Gliklazid tab SR 60 mg Tab 0 0 0

308
Glikuidon tab 30 mg Tab 0 0 0
309
Glimepirid tab 1 mg Tab 0 0 0

310
 Glimepirid tab 2 mg Tab 0 0 0

311
Glimepirid tab 3 mg Tab 0 0 0

312
Glimepirid tab 4 mg Tab 0 0 0

313
Glipizid tab 10 mg Tab 0 0 0
314
Glipizid tab 5 mg Tab 0 0 0
315
Gliseril trinitrat inj 10 mg/ml Ampul 0 0 0

316
Gliseril trinitrat inj 50 mg/ml Ampul 0 0 0

317
Gliseril trinitrat kaps SR 2,5 mg Kaps 0 0 0

318
Gliseril trinitrat kaps SR 5 mg Kaps 0 0 0

319
Gliseril trinitrat tab sublingual 0,5 mg Tab sub 0 0 0

320
Gliserin lar 50% Botol 0 0 0
321
Gliserin tts 10 mg/ml Botol 0 0 0

322
Gliserin tts 100 mg/ml Botol 0 0 0

323
 Goserelin asetat inj 10,8 mg/vial Vial 0 0 0

324
Goserelin asetat inj 3,6 mg/vial Vial 0 0 0

325
Griseofulvin (micronized) tab 125 mg Tab 0 0 0

326
Griseofulvin (micronized) tab 500 mg Tab 0 0 0

327
Griseofulvin (micronized) tab scored 250 Tab 0 0 0
mg

328
Gutta percha dan paper points 15 - 40 Roll 0 0 5
mm

329
Gutta percha dan paper points 45 - 80 Roll 0 0 5
mm

330
Haloperidol inj 5 mg/ml (i.m.) Vial 0 0 0

331
 Haloperidol inj 50 mg/ml Vial 0 0 0

332
Haloperidol tab 0,5 mg Tab 0 0 0

333
Haloperidol tab 1,5 mg Tab 0 7500 10000

334
Haloperidol tab 2 mg Tab 0 0 0

335
Haloperidol tab 5 mg Tab 0 7500 10000

336
Haloperidol tts 2 mg/ml Botol 0 0 0

337
338 Halotan ih Botol 0 0 0
Hemodialisa lar konsentrat basis asetat Botol 0 0 0

339
Hemodialisa lar konsentrat basis natrium Botol 0 0 0
bikarbonat

340
Heparin, Na inj 5.000 UI/ml (i.v./s.k.) Vial 0 0 0

341
342 Hepatitis B imunoglobulin (human) inj 0,5 Ampul 0 0 0
Hidroksi klorokuin tab 200 mg Tab 0 0 0

343
 Hidroksi klorokuin tab 400 mg Tab 0 0 0

344
Hidrogen peroksida cairan 3% Botol 2 1 12

345
Hidrogen peroksida lar. Konsentrat 3% Botol 0 0 0

346
Hidroklorotiazid tab 12,5 mg Tab 0 0 0

347
Hidroklorotiazid tab 25 mg Tab 0 750 10000

348
Hidrokortison inj 100 mg/vial Vial 0 0 0

349
Hidrokortison krim 1% Tube 0 0 0

350
Hidrokortison krim 2,5% Tube 0 20 300

351
Hidrokortison serb inj 100 mg/vial Vial 0 0 0

352
Hidrokortison tab 10 mg Tab 0 0 0

353
Hidroksi progesteron inj 125 mg/ml Vial 0 0 0

354
 Hidroksi urea tab 500 mg Tab 0 0 0

355
Hidroxyl ethyl starch lar inf 6% Botol 0 0 0

356
Hiosina butilbromida inj 20 mg/ml Ampul 0 0 0

357
Hiosina butilbromida tab 10 mg Tab 0 0 0

358
Homatropin tts mata 2% Botol 0 0 0

359
Human insulin : intermediate acting inj Vial 0 30 400
100 UI/ml (kemasan vial/ cartridge
disposible, penfill cartridge)

360
Human insulin : mix insulin inj 100 UI/ml Vial 0 10 130
(kemasan vial, cartridge disposible,
penfill cartridge)

361
 Human insulin : short acting inj 100 UI/ml Vial 0 15 200
(kemasan vial, cartridge disposible,
penfill cartridge)

362
Human tetanus imunoglobulin inj 250 UI Ampul 0 0 250
(i.m.)

363
Human tetanus imunoglobulin inj 500 UI Ampul 0 0 0
(i.m.)

364
Ibuprofen sir 100 mg/5 ml Botol 0 10 150

365
Ibuprofen sir 200 mg/5 ml Botol 0 0 0

366
Ibuprofen tab 200 mg Tab 0 180 2500

367
Ibuprofen tab 400 mg Tab 0 375 5000

368
Ifosfamid serb inj 1000 mg/vial Vial 0 0 0

369
 Ifosfamid serb inj 500 mg/vial Vial 0 0 0

370
Imatinib mesilat tab 100 mg Tab 0 0 0

371
Imidapril tab 10 mg Tab 0 0 0
372
373 Imidapril tab 5 mg Tab 0 0 0
Interferon alfa inj 18 miu Set 0 0 0

374
Iodiksanol vial 320 mg Iodium/50 ml Vial 0 0 0

375
Iodium 131 Botol 0 0 0
376
Iodohippurate sodium I 132 37-74 mbq/ Vial 0 0 0
multiple-dose

377
Ioheksol 180-300 mg Iodium/ml Vial 0 0 0

378
Ioheksol 240-350 mg Iodium/ml Vial 0 0 0

379
Ioheksol inj 140-350 mg Iodium/ml Vial 0 0 0

380
 Iopamidol 200-300 mg Iodium/ml Vial 0 0 0

381
382 Iopamidol 300-370 mg Iodium/ml Vial 0 0 0
Iopamidol inj 200-370 mg Iodium/ml Vial 0 0 0

383
Iopromid 240 -370 mg Iodium/ml Vial 0 0 0

384
Iopromid 300-370 mg Iodium/ml Vial 0 0 0

385
Ipratropium bromida ih 20mcg/puff Botol 0 0 0

386
Ipratropium bromida ih padat 20 mcg Puff 0 0 0

387
Ipratropium bromida nebulizer 0,025% Botol 0 0 0

388
Irbesartan tab 150 mg Tab 0 100 1500

389
Irbesartan tab 300 mg Tab 0 100 1500

390
391 Irinotekan inf 20 mg/ml Ampul 0 0 0
392 Irinotekan inj 20 mg/ml Ampul 0 0 0
 Isofluran ih Botol 0 1 12
393
Isoniazid tab 100 mg Tab 0 0 0

394
Isoniazid tab 300 mg Tab 0 2500 35000

395
Isosorbid dinitrat inj 10 mg/10 ml Vial 0 0 0

396
Isosorbid dinitrat tab 10 mg Tab 400 150 2000

397
Isosorbid dinitrat tab 5 mg Tab 0 0 0

398
399 Kalamin Tube 0 0 0
Kalium aspartat tab 300 mg Tab 0 0 0

400
Kalium klorida tab siap larut 300 mg Tab 0 0 0

401
Kalium klorida tab SR 600 mg Tab 0 0 0

402
Kalsium folinat (leukovorin, Ca) inj 3 Vial 0 0 0
mg/ml

403
Kalsium folinat (leukovorin, Ca) inj 50 Vial 0 0 0
mg/ml

404
 Kalsium folinat (leukovorin, Ca) tab 15 Tab 0 0 0
mg

405
Kalsium glukonat inj 100 mg/ml Ampul 0 0 0

406
Kalsium hidroksida bubuk, pasta Tube 0 0 0

407
Kalsium karbonat tab 500 mg Tab 0 0 0

408
Kalsium laktat (kalk) tab 500 mg Tab 0 375 5000

409
Kalsium polistirena sulfonat ktg 5 g Sachet 0 0 0

410
Kanamisin inj 1.000 mg/ vial Vial 0 0 0

411
Kandesartan tab 16 mg Tab 0 0 0

412
Kandesartan tab 8 mg Tab 0 0 0

413
Kapesitabin tab sal 500 mg Tab sal 0 0 0

414
Kaptopril tab 12,5 mg Tab 0 0 1000

415
 Kaptopril tab 25 mg Tab 8800 2000 25000
416
Kaptopril tab 50 mg Tab 9500 100 0
417
Karbamazepin sir 100 mg/5 ml Botol 0 0 0

418
Karbamazepin tab 200 mg Tab 0 300 4000

419
Karbimazol tab 5 mg Tab 0 0 0

420
Karbo adsorben tab 0,5 g Tab 0 0 0

421
Karbogliserin tts telinga 10 % Botol 0 0 0

422
Karboksimetilselulosa tts mata Botol 0 0 0

423
Karboplatin inj 150 mg/15 ml Vial 0 0 0

424
Karboplatin inj 450 mg/45 ml Vial 0 0 0

425
Karboplatin inj 50 mg/5 ml Vial 0 0 0

426
Karvediol kaps 6,25 mg Kaps 0 0 0

427
Ketamin inj 100 mg/ml (i.v.) Ampul 0 25 350

428
 Ketamin inj 50 mg/ml (i.v.) Ampul 0 0 0

429
Ketokonazol tab 200 mg Tab 500 40 0

430
Ketokonazol krim 2% Tube 0 5 50

431
Ketokonazol scalp sol 2% Tube 0 0 0

432
Ketoprofen sup 100 mg Botol 0 0 0

433
Ketorolak inj 30 mg/ml Ampul 380 2000 25000

434
Klaritromisin tab 500 mg Tab 0 0 0

435
Klindamisin kaps 150 mg Kaps 0 75 1000

436
Klindamisin kaps 300 mg Kaps 750 100 1000

437
Klobazam tab 10 mg Tab 0 0 5000
438
Klofazimin, micronizedkaps 100 mg kapsul 0 0 0

439
Klomifen sitrat tab 50 mg Tab 0 0 0

440
Klomipramin tab 25 Tab 0 0 0

441
 Klonidin inj 150 mcg/ml Vial 0 0 0

442
Klonidin tab 0,15 mg Tab 300 300 4000

443
Klopidogrel tab 75 mg Tab 0 0 1000

444
Kloral hidrat lar Botol 0 0 0
445
Klorambusil tab 2 mg Tab 0 0 0

446
Kloramfenikol tts mata 0,5% Botol 0 0 0

447
Kloramfenikol tts mata 1% Botol 0 0 0

448
Kloramfenikol kaps 250 mg Kaps 0 100 2000

449
Kloramfenikol kaps 500 mg Kaps 0 0 0

450
Kloramfenikol salep kulit 2% Tube 0 0 0

451
Kloramfenikol salep mata 1% Tube 0 0 0

452
Kloramfenikol serb inj 1.000 mg/ml Vial 0 0 0

453
Kloramfenikol susp 125 mg/5 ml Botol 0 0 25

454
 Klorfeniramin tab 4 mg Tab 3000 375 3000

455
Klorfenol kamfer mentol (CHKM) Botol 0 0 0

456
457 Klorheksidin lar 0,2% Botol 0 0 0
Klorheksidin lar 15% Botol 0 0 0

458
Klorpromazin inj 25 mg/ml (i.m.) Ampul 0 0 0

459
Klorpromazin inj 5 mg/ml (i.m.) Ampul 0 0 0

460
Klorpromazin tab sal 100 mg Tab sal 3000 1000 12000

461
Klorpromazin tab sal 25 mg (sbg Tab sal 0 0 0
antipsikosis)

462
463 Klortalidon tab 50 mg Tab 0 0 0
Klotrimazol tab vagina 100 mg Tab 0 0 0

464
Klozapin tab 100 mg Tab 0 0 0

465
Klozapin tab 25 mg Tab 0 0 0
466
467 Kodein tab 10 mg Tab 0 0 0
 Kodein tab 15 mg Tab 0 0 0
468
469 Kodein tab 20 mg Tab 0 0 0
Kolekalsiferol (vitamin D3) kaps lunak Kaps lunak 0 0 0
0,25 mcg

470
Kolekalsiferol (vitamin D3) kaps lunak 0,5 Kaps lunak 0 0 0
mcg

471
Kolestiramin serb, 4 g Ampul 0 0 0

472
473 Kolkisin tab 500 mcg Tab 0 0 0
Koloid HES BM 130 000 lar inf 6% Botol 0 0 0

474
Obat Anti Tuberculosis FDC Kategori I Paket 0 0 0

475
Obat Anti Tuberculosis FDC Kategori Paket 0 0 0
II

476
Obat Anti Tuberculosis FDC Kategori Paket 0 0 0
Sisipan

477
Obat Anti Tuberculosis FDC Kategori Paket 0 0 0
Anak

478
 Obat Anti Tuberculosis Kombipak Paket 0 0 0
Dewasa

479
Obat Anti Tuberculosis Kombipak Anak Paket 0 0 0

480
Kombinasi : artesunat tab 50 mg + Tab 0 0 0
amodiakuin tab 200

481
Kombinasi : levodopa 100 Tab 0 0 0
mg+Karbidopa 25 mg + entekapon 200
mg

482
Kombinasi : levonorgestrel 150 mcg + Tab 0 0 0
etinilestradiol 30 mcg

483
Kombinasi : zidovudin 300 mg Tab 0 0 0
+lamivudin 150 mg

484
 Kombinasi : artemether 20 mg + Kaps 0 0 0
lumefantrin 120 mg

485
Kombinasi : ergotamin 1 mg+ kafein 50 Tab 0 0 0
mg

486
Kombinasi : ferro sulfat 200 mg+ as. Tab sal 0 0 0
Folat 0,25 mg

487
Kombinasi : medroksi progesteron Vial 0 0 0
asetat+ estradiol sipionat inj depot 25 mg
+ 5 mg

488
Kombinasi: ipratropium Br 0,5 mg+ Botol 0 0 0
salbutamol 2,5 mg nebules

489
 Kombinasi: salmeterol 25 mcg + Botol 0 0 0
flutikason propionat 50 mcg ih 50
mcg/puff

490
Kombinasi: salmeterol 50 mcg Botol 0 0 0
+flutikason propionat 100 mcg ih 50
mcg/puff

491
Kombinasi: salmeterol 50 mcg+ Botol 0 0 0
flutikason propionat 250 mcg ih 250
mcg/puff

492
Kombinasi: kaolin 550 mg + pektin 20 mg 0

493 Tab 0 0
 Kombinasi: lopinavir 200 mg + ritonavir Tab 0 0 0
(LVP) 50 mg, tab 250 mg

494
Kombinasi: natrium klorida 8,664 mg + Botol 0 0 0
kalium klorida 1,32 mg (tetes mata)

495
Kombinasi: parafin + gliserin + Botol 0 0 0
fenolftalein

496
Kombinasi: spironolakton 25 mg + Tab 0 0 0
tiabutazin 2,5 mg

497
498 Komposit resin Set 0 0 0
Kotrimoksazol (dewasa) kombinasi : Tab 700 100 1000
sulfametoksazol 400 mg+
trimetoprim 80 mg

499
 Kotrimoksazol (dewasa) kombinasi : Tab 0 0 0
sulfametoksazol 800 mg+
trimetoprim 160 mg

500
Kotrimoksazol (dewasa) kombinasi tiap 5 Botol 53 5 25
ml suspensi : sulfametoksazol 200 mg +
trimetoprim 40 mg

501
Kuinin inj 25% (i.v.) Vial 0 0 0
502
Kuinin tab 200 mg Tab 0 0 0
503
Kuinin tab 222 mg Tab 0 0 0
504
Kuinin tab 250 mg Tab 0 0 0
505
506 Laktulosa sir 3,335 g/5 ml Botol 0 0 0
Lamivudin tab 100 mg Tab 0 0 0

507
Lamivudin (3TC) tab 150 mg Tab 0 0 0

508
Lansoprazol inj 30 mg/ml Vial 0 0 0

509
 Lansoprazol kaps 30 mg Kaps 0 0 1000

510
511 Lapatinib tab 250 mg Tab 0 0 0
512 Ringer Laktat Larutan Botol 4740 1800 25000
513 Glukosa Larutan Infus 5% steril Botol 1040 900 10000
514 Glukosa Larutan Infus 10% steril Botol 40 20 200
515 NaCl 0,9% Larutan Botol 1280 900 10000
516 Larutan Mengandung Karbohidrat + Elektrol Botol 0 0 0
517 Larutan Mengandung Karbohidrat + Elektro Botol 0 0 0
518 Larutan Mengandung Karbohidrat + Elektro Botol 0 0 0
519 Larutan Mengandung Karbohidrat + Elektr Botol 0 0 0
520 Larutan Mengandung Asam amino (Aminost Botol 0 0 0
521 Larutan Mengandung Lipid (Intralipid) Botol 0 0 0
522 Latanoprost tts mata 0,005% Botol 0 0 0
523 Latanoprost tts mata 0,01% Botol 0 0 0
Lenograstim inj 263 mcg/vial Vial 0 0 0

524
Letrozol tab 2,5 mg Tab 0 0 0

525
Leuprorelin asetat serb inj 1,88 mg Vial 0 0 0

526
Leuprorelin asetat serb inj 11,25 mg Vial 0 0 0

527
Leuprorelin asetat serb inj 3,75 mg Vial 0 0 0

528
Levofloksasin inf 5 mg/ml Botol 0 0 0

529
Levofloksasin tab 500 mg Tab 0 0 0

530
531 Levofloksasin tts mata 0,5% Botol 0 0 0
 Levonorgestrel implan 2 rods, 75 mg (3-4 Set 0 0 0
tahun)

532
Levotiroksin tab 100 mcg Tab 0 0 0

533
Levotiroksin tab 50 mcg Tab 0 0 0

534
Lidokain gel 2% Tube 0 0 0
535
Lidokain inj 1 % (infltr) Vial 0 0 0

536
Lidokain inj 100 mg, vial (i.v.) Vial 0 0 0

537
538 Lidokain inj 2% (hcl) Vial 0 1000 15000
Lidokain inj 2% (infiltr/p.v.) Ampul 0 0 0

539
Lidokain inj 5% + glukosa (dekstrosa) 5 Ampul 0 0 0
%

540
541 Lidokain pasta 5% (hcl) Tube 0 0 0
Lidokain semprot 10% Botol 0 0 0

542
543 Lidokain semprot 15% (hcl) Botol 0 0 0
Linestrenol tab 0,5 mg Tab 0 0 0

544
545 Lisinopril tab 10 mg Tab 0 0 0
546 Lisinopril tab 20 mg Tab 0 0 0
547 Lisinopril tab 5 mg Tab 0 0 0
548 Litium karbonat tab 200 mg Tab 0 0 0
Litium karbonat tab 400 mg Tab 0 0 0

549
Loperamid tab 2 mg Tab 0 0 1000

550
Loratadin tab 10 mg Tab 0 0 1000
551
Lorazepam tab 0,5 mg Tab 0 0 0

552
Lorazepam tab 1 mg Tab 0 0 0

553
Lorazepam tab sal 2 mg Tab sal 0 0 4000

554
Low molecular weight iron dextran inj Ampul 0 0 0
100mg/2 ml

555
Low molecule feri sucrose inj amp 100 Ampul 0 0 0
mg/5 ml

556
557 Lugol Botol 0 0 0
 MAA (macro agregate albumin) 0,11-2,5 Vial 0 0 0
mg albumin aggregated/reaction vial

558
MAG3 (mercapto acetyl tri glysine) 1 mg Vial 0 0 0
betiatide/vial

559
Magnesium sulfat inj 20% Vial 2 3 50

560
Magnesium sulfat inj 40% Vial 0 5 65

561
Magnesium sulfat serb, ktg 30 g Sachet 0 0 0

562
Manitol lar infus 20% Botol 0 0 0

563
Maprotilin hcl tab sal 25 mg Tab sal 0 0 0

564
Maprotilin hcl tab sal 50 mg Tab sal 0 0 0

565
 MDP (methylene diphosphonate) 1 mg Vial 0 0 0
methylene diphosphonic acid/ml

566
Mebendazol sir 50 mg/ml Botol 0 0 0

567
Mebendazol tab 100 mg Tan 0 0 0

568
Mebendazol tab 500 mg Tab 0 0 0

569
Medroksi progesteron asetat inj 200 Vial 0 0 0
mg/ml

570
Medroksi progesteron asetat inj depo 150 Set/buah 0 0 0
mg

571
Medroksi progesteron asetat tab 10 mg Tab 0 0 0

572
Medroksi progesteron asetat tab 100 mg Tab 0 0 0

573
 Medroksi progesteron asetat tab 250 mg Tab 0 0 0

574
Medroksi progesteron asetat tab 5 mg Tab 0 0 0

575
Medroksi progesteron asetat tab 500 mg Tab 0 0 0

576
Melfalan tab 2 mg Tab 0 0 0
577
Merkaptopurin tab 50 mg Tab 0 0 0

578
Meropenem serb inj 1000 mg/vial Vial 0 0 0

579
Meropenem serb inj 500 mg/vial Vial 0 0 0

580
Mesalazin tab sal 250 mg Tab 0 0 0

581
582 Mesna inj 100 mg/ml 0 0 0
Metadon sir 50 mg/5 ml Botol 1000 0 0 0
ml

583
 Metenamin mandelat (heksamin Tab salut 0 0 0
mandelat) tab salut enterik 500 mg

584
Metformin tab 500 mg Tab 10900 1500 15000

585
Metformin tab 850 mg Tab 0 0 0

586
Metildopa tab sal 250 mg Tab 0 0 0

587
Metilergometrin inj 0,2 mg/ml Ampul 0 0 700

588
Metilergometrin tab salut 0,125 mg Tab sal 0 0 1000

589
Metilfenidat tab SR 10 mg Tab 0 0 0

590
Metilfenidat tab SR 20 mg Tab 0 0 0

591
Metilprednisolon inj 125 mg/2 ml Vial 0 0 0

592
Metilprednisolon inj 500 mg/8 ml Vial 0 0 0

593
 Metilprednisolon tab 16 mg Tab 6000 50 0

594
Metilprednisolon tab 4 mg Tab 7500 4000 45000

595
Metilprednisolon tab 8 mg Tab 4500 900 7500

596
Metoklopramid tab 5 mg Tab 0 0 0

597
Metoklopramid drop botol 10 ml Botol 0 0 0

598
Metoklopramid inj 5 mg/ml Vial 0 0 500

599
Metoklopramid sir 5 mg/5 ml Botol 0 0 50

600
Metoklopramid tab 10 mg Tab 0 0 1000

601
Metotreksat serb inj 5 mg/vial Vial 0 0 0

602
Metotreksat serb inj 50 mg/2 ml Vial 0 0 0

603
Metotreksat tab 2,5 mg Tab 0 0 0

604
Metronidazol lar inf 5 mg/ml Botol 48 450 6000

605
Metronidazol ovula 500 mg Supp 0 0 0

606
 Metronidazol sir 125 mg/5 Ml Botol 0 0 0

607
Metronidazol sup 500 mg Botol 0 0 0

608
Metronidazol tab 250 mg Tab 0 0 0

609
Metronidazol tab 500 mg Tab 200 75 1000

610
MIBG (meta-iodobenzylguanidine) Vial 0 0 0
octreotide acetate 0,05 - 6 mg/ml

611
MIBI (metoxy iso butyl isonitril) 5-ml Vial 0 0 0
reaction vial

612
Midazolam inj 1 mg/ml (i.v.) Vial 0 0 1000

613
Midazolam inj 5 mg/ml (i.v.) Vial 0 0 0

614
Mikafungin Na serb inj 50 mg/vial Vial 0 0 0

615
 Mikofenolat mofetil tab 500 mg Tab 0 0 0

616
Mikonazol krim 2% Tube 0 10 150
617
Mikonazol serb 2% Tube 0 0 0
618
Mitomisin C (crystallin) inj 2 mg/ml Vial 0 0 0

619
Mitomisin C (crystallin) serb inj 10 mg/vial Vial 0 0 0

620
Modified fluid gelatine BM 30 000 lar inf Botol 0 0 0
4%

621
622 Moksifloksasin tts mata 0,5% Botol 0 0 0
Mometason furoat krim 0,1% Tube 0 0 0

623
624 Morfin Hcl inj 10 mg/ml (i.m./s.k./i.v.) Vial 0 0 0
625 Morfin Hcl tab 10 mg Tab 0 0 0
626 Morfin Hcl tab SR 10 mg Tab 0 0 0
627 Morfin Hcl tab SR 15 mg Tab 0 0 0
628 Morfin Hcl tab SR 30 mg Tab 0 0 0
Nadroparin inj 10 mg/ml Vial 0 0 0

629
Nadroparin inj 9.500 Axa/ml syringe 0,3 Vial 0 0 0
Ml

630
 Nadroparin inj 9.500 Axa/ml, syringe 0,4 Vial 0 0 0
ml

631
Nadroparin inj 9.500 Axa/ml, syringe 0,6 Vial 0 0 0
ml

632
Nalokson inj 0,4 mg/ml Ampul 0 0 0

633
N-asetil sistein ih 100 mg/ml Botol 0 0 0

634
N-asetil sistein kaps 200 mg Kaps 0 0 2000

635
Natamisin tts mata 5% Botol 0 0 0

636
Natamisin tts mata 50 mg/ml Botol 0 0 0

637
Natrium aminohipurat inj 200 mg/ml (i.v.) Ampul 0 0 0

638
Natrium bikarbonat High alert medicine. Vial 0 0 0

639
 Natrium bikarbonat inj 8,4% (i.v.) Vial 0 0 0

640
Natrium bikarbonat tab 500 mg Tab 0 0 0

641
Natrium diklofenak tab 25 mg Tab 0 0 1000

642
Natrium diklofenak tab 50 mg Tab 500 375 5000

643
644 Natrium fluoresein tts mata 2% Botol 0 0 0
Natrium fosfat btl, 133 ml Botol 0 0 0

645
Natrium fosfat lar oral 45 ml Botol 0 0 0

646
Natrium fusidat krim 20 mg/g Tube 0 0 0

647
Natrium fusidat salep 20 mg/g Tube 0 0 0

648
Natrium hipoklorit cairan konsentrat 5% Botol 0 0 0

649
Natrium tiosulfat inj 25% (i.v.) Ampul 0 0 0

650
Neostigmin inj 0,5 mg/ml Vial 0 0 0

651
 Nevirapin tab 200 g Tab 0 0 0
652
Nifedipin kaps 10 mg Kaps 0 0 1000

653
Nifedipin tab SR 20 mg Tab 0 0 0

654
Nifedipin tab SR 30 mg Tab 0 0 0

655
Nikardipin inj 10 mg/vial Vial 0 0 0

656
Nikotinamid tab 100 mg Tab 0 0 0

657
Nikotinamid tab 20 mg Tab 0 0 0

658
Nikotinamid tab 5 mg Tab 0 0 0

659
Nilotinib tab 200 mg Tab 0 0 0

660
Nistatin susp 100.000 UI/ml Botol 0 0 0

661
Nistatin tab salut 500.000 UI Tab 0 0 0

662
Nistatin tab vaginal 100.000 UI Tab 0 0 0

663
 Nitrofurantoin tab 50 mg Tab 0 0 0

664
Nitrogen oksida ih, gas dlm tabung Botol 0 0 0

665
Norepinefrin inj 1 mg/ml Ampul 0 0 0

666
Noretisteron tab 5 mg Tab 0 0 0

667
Ofloksasin tab 200 mg Tab 0 0 0

668
Ofloksasin tab 400 mg Tab 0 0 0

669
Ofloksasin tts telinga 3% Botol 0 0 0

670
Oksaliplatin serb inj 100 mg/vial Vial 0 0 0

671
Oksaliplatin serb inj 50 mg/vial Vial 0 0 0

672
Oksigen ih, gas dlm tabung Botol 0 0 0

673
Oksimetazolin tts hidung 0,025% Botol 0 0 0

674
 Oksimetazolin tts hidung 0,050% Botol 0 0 0

675
Oksitetrasiklin hcl inj 250 mg/3 ml (i.m.) Vial 0 0 0

676
Oksitetrasiklin hcl inj 50 mg/ml (i.m.) Vial 0 0 0

677
Oksitetrasiklin hcl inj 500 mg/ml Vial 0 0 0

678
Oksitosin inj 10 UI/ml Ampul 0 375 5000

679
Oktreotid inj 10 mg/ml Ampul 0 0 0

680
Olanzapin inj 10 mg/2 ml Ampul 0 0 0

681
Olanzapin tab sal 10 mg Tab sal 0 0 2500

682
Olanzapin tab sal 5 mg Tab 0 0 2500

683
Olopatadin tts mata 0,1% Botol 0 0 0

684
Omeprazol inj 40 mg/10 ml Vial 0 0 0

685
 Omeprazol kaps 20 mg Kaps 0 400 5000

686
Ondansetron inj 2 mg/ml Vial 0 100 1500

687
Ondansetron tab 4 mg Tab 0 0 0

688
Ondansetron tab 8 mg Tab 0 0 0

689
Paklitaksel inj 100 mg/vial Vial 0 0 0

690
Paklitaksel inj 30 mg/vial Vial 0 0 0

691
Paklitaksel inj 300 mg/vial Vial 0 0 0

692
Parasetamol drips (infus) 1000 mg/100 Botol 0 0 0
ml

693
Parasetamol sir 120 mg/5 ml Botol 0 40 500

694
Parasetamol tab 500 mg Tab 17400 2000 26000

695
Parasetamol tts 60 mg/0,6 ml Botol 0 0 0

696
Pasta devitalisasi (non arsen) Tube 0 0 0

697
 Pasta pengisi saluran akar (pasta) Tube 0 0 0

698
Pegylated interferon alfa-2a inj 135 Vial 0 0 0
mcg/0,5 ml

699
Pegylated interferon alfa-2a inj 180 Vial 0 0 0
mcg/0,5 ml

700
Pegylated interferon alfa-2b serb inj 100 Vial 0 0 0
mcg/ml

701
Pegylated interferon alfa-2b serb inj 120 Vial 0 0 0
mcg/ml

702
Pegylated interferon alfa-2b serb inj 50 Vial 0 0 0
mcg/ml

703
Pegylated interferon alfa-2b serb inj 80 Vial 0 0 0
mcg/ml

704
 Pengganti plasma kombinasi : poligelin Botol 0 0 0
(ekivalen dengan 0,63 g nitrogen 17,5 g ;
natrium klorida 0,19 g ; kalsium klorida
0,19 g ; kalsium (terikat pada polipeptida)
0,125 g

705
Perak nitrat lar 20% Botol 0 0 1

706
Perak sulfadiazin krim 2 % Tube 0 0 0

707
Perak sulfadiazin krim 1% Tube 0 0 0

708
Perindoprilarginin tab 5 mg Tab 0 0 0

709
Permetrin krim 5 % Tube 0 0 0
710
Petidin inj 50 mg/ml (i.m./s.k./i.v.) Vial 0 0 0

711
 Pilokarpin tts mata 2% Botol 0 0 0

712
Pioglitazon tab 15 mg Tab 0 0 0

713
Pioglitazon tab 30 mg Tab 0 0 0

714
Pirantel pamoat susp 125 mg/5 ml Botol 0 0 0

715
Pirantel pamoat tab 500 mg Tab 0 0 0

716
Pirantel pamoat tab scored 125 mg Tab 100 0 0

717
Pirantel pamoat tab scored 250 mg Tab 0 0 0

718
Pirazinamid tab 500 mg Tab 4800 2500 35000

719
Piridoksin (vitamin B6) inj 100 mg/ml Ampul 0 0 0

720
Piridoksin (vitamin B6) tab 10 mg Tab 0 750 10000

721
 Piridoksin (vitamin B6) tab 25 mg Tab 0 0 0

722
Piridostigmin tab sal 60 mg Tab sal 0 0 0

723
724 Podofilin tingtur 25 % Botol 0 0 0
Polietilen glikol Botol 0 0 0
725
Polikresulen Botol 0 0 0
726
Povidon iodin lar 100 mg/ml Botol 30 ml 0 0 0

727
Povidon iodin lar 100 mg/ml Botol 60 ml 0 0 0

728
Povidon iodin lar 100 mg/ml Botol 300 0 0 0
ml

729
Povidon iodin lar 100 mg/ml Botol 1000 10 20 260
ml

730
Pramipeksol tab ER 0,375 mg Tab 0 0 0

731
Pramipeksol tab ER 0,750 mg Tab 0 0 0

732
Pravastatin tab 10 mg Tab 0 0 0

733
Pravastatin tab 20 mg Tab 0 0 0

734
 Prazikuantel tab scored 300 mg Tab 0 0 0

735
Prazikuantel tab scored 600 mg Tab 0 0 0

736
Prednisolon tts mata 10 mg/ml Botol 0 0 0

737
Prednison tab 5 mg Tab 0 500 6000
738
Primakuin tab 15 mg Tab 0 0 100
739
Probenesid tab 500 mg Tab 0 0 0

740
Prokain benzilpenisilin serb inj 1 juta Tab 0 0 0
UI/vial (i.m.)

741
Prokain benzilpenisilin serb inj 3 juta Vial 0 0 0
UI/vial (i.m.)

742
Propiltiourasil tab 100 mg Tab 2100 100 1200

743
Propofol inj 1% (i.v. Bolus) Ampul 0 0 0

744
Propranolol inj 1 mg/ml (i.v.) Ampul 0 0 0

745
 Propranolol tab 10 mg Tab 0 0 10000

746
Propranolol tab 40 mg Tab 0 0 0

747
Protamin sulfat inj 10 mg/ml (i.m.) Ampul 0 0 0

748
Quetiapin tab SR 200 mg Tab 0 0 0

749
Quetiapin tab SR 300 mg Tab 0 0 0

750
Quetiapin tab SR 400 mg Tab 0 0 0

751
Ramipril tab 10 mg Tab 0 0 0
752
Ramipril tab 5 mg Tab 0 0 0
753
Ramipril tab 2,5 mg Tab 0 0 0

754
Ranitidin inj 25 mg/ml Ampul 4500 2000 25000

755
Ranitidin tab 150 mg Tab 6000 2000 25000

756
Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 0 0 0

757
 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 0 0 0

758
759 Ribavirin tab 200 mg Tab 0 0 0
Rifampisin kaps 300 mg Kaps 0 0 0

760
Rifampisin tab 450 mg Tab 0 2500 35000

761
Rifampisin tab 600 mg Tab 0 0 0

762
Risperidon tab 3 mg Tab 0 0 0

763
Risperidon tab sal 1 mg Tab sal 0 0 20000

764
Risperidon tab sal 2 mg Tab sal 0 0 50000

765
Rituksimab inj 100 mg/ml Ampul 0 0 0

766
Rituksimab inj 500 mg/ml Ampul 0 0 0

767
Rivaroksaban tab sal 10 mg Tab sal 0 0 0

768
Rivaroksaban tab sal 15 mg Tab sal 0 0 0

769
Rivaroksaban tab sal 20 mg Tab sal 0 0 0

770
 Rokuronium inj 50 mg/5 ml (i.v.) Vial 0 0 0

771
Ropinirol tab sal 2 mg Tab sal 0 0 0

772
Ropinirol tab sal 4 mg Tab sal 0 0 0

773
Ropinirol tab sal 8 mg Tab sal 0 0 0

774
775 Salbutamol aerosol 100 mcg Botol 0 0 0
776 Salbutamol cairan ih 0,1% Botol 0 0 0
777 Salbutamol cairan serb ih 200 mcg/kaps + Botol 0 0 0
778 Salbutamol inj 50 mcg/ml Botol 0 0 0
779 Salbutamol lar ih 0,5 % Botol 0 0 0
780 Salbutamol nebules vial 2,5 mg Vial 0 0 0
781 Salbutamol sir 2 mg/5 ml Botol 0 0 0
782 Salbutamol tab 2 mg Tab 100 350 5000
783 Salbutamol tab 4 mg Tab 900 500 6500
Salep 2-4, kombinasi : asam salisilat 2 Tube 0 0 0
%+ belerang endap 4 %

784
Sefadroksil kaps 250 mg Vial 0 0 2500

785
Sefadroksil kaps/tab 500 mg Tab 9500 4500 60000

786
Sefadroksil sir kering 125 mg/5 ml Botol 140 35 500

787
 Sefadroksil sir kering 250 mg/5 ml Botol 0 0 0

788
Sefaleksin kaps 250 mg Kaps 0 0 0

789
Sefaleksin kaps 500 mg Kaps 0 0 0

790
Sefazolin serb inj 1 g/vial Vial 0 0 0

791
Sefepim serb inj 1000 mg/vial Vial 0 0 0

792
Sefiksim sir 100 mg/5 ml Botol 0 0 0

793
Sefiksim tab 100 mg Tab 0 0 0

794
Sefoperazon serb inj 1.000 mg/vial Vial 0 0 0

795
Sefotaksim inj 500 mg/vial Vial 0 0 0

796
Sefotaksim serb inj 1.000 mg/vial Vial 5472 1125 15000

797
Sefpodoksim proksetil tab sal 100 mg Tab 0 0 0

798
 Seftazidim serb inj 1.000 mg/vial Vial 0 0 0

799
Seftriakson serb inj 1.000 mg/vial Vial 1728 1150 15000

800
Sefuroksim serb inj 750 mg/vial Vial 0 0 0

801
Sefuroksim tab 250 mg Tab 0 0 0

802
Sefuroksim tab sal 500 mg Tab 0 0 0

803
804 Sertralin tab sal 50 mg Tab sal 0 0 0
Serum anti bisa ular : A.B.U. I (khusus Vial 0 0 0
ular dari luar ) inj (i.m./i.v.) Papua

805
Serum anti bisa ular :A.B.U.II (khusus Vial 0 0 0
ular dari Papua) inj (i.m./i.v.)

806
 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj Vial 0 0 0
i.m 10.000 UI/

807
Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj Vial 0 0 0
i.m 20.000 UI/

808
Serum antirabies inj 100 UI/ml Vial 0 0 0

809
Serum antirabies inj 200 UI/ml Vial 0 0 0

810
Serum antitetanus (A.T.S) (i.m.) Inj Vial 0 0 0
10.000 UI/vial (i.m /i.v.)

811
Serum antitetanus (A.T.S) inj 1500 Ampul 0 0 0
UI/amp (i.m.)

812
Serum antitetanus (A.T.S) inj 20.000 Vial 0 0 0
UI/vial (i.m /i.v.)

813
814 Setirizin sir 5 mg/5 ml. Botol 0 0 0
 Setirizin tab 10 mg Tab 960 0 1200
815
Setuksimab inj 5 mg/ml Vial 0 0 0

816
Sevofluran cairan ih 250 ml Botol 0 3 35

817
Sianokobalamin (vitamin B12) inj 500 Vial 0 0 0
mcg/ml

818
Sianokobalamin (vitamin B12) tab 50 Tab 0 750 10000
mcg

819
Siklofosfamid serb inj 1000 mg/vial (i.v.) Vial 0 0 0

820
Siklofosfamid serb inj 200 mg/vial (i.v.) Vial 0 0 0

821
Siklofosfamid serb inj 500 mg/vial (i.v.) Vial 0 0 0

822
Siklofosfamid tab sal 50 mg Tab 0 0 0

823
Siklosporin inj 50 mg/ml Ampul 0 0 0

824
 Siklosporin kaps 100 mg Kaps 0 0 0

825
Siklosporin kaps lunak 25 mg Kaps 0 0 0

826
Silostazol tab 100 mg Tab 0 0 0

827
Simvastatin tab sal 10 mg Tab sal 0 150 2000

828
Simvastatin tab sal 20 mg Tab sal 1590 375 5000

829
Siprofloksasin inf 2 mg/ml Botol 0 0 0

830
Siprofloksasin tab scored 500 mg Tab 14600 3000 40000

831
Sisplatin serb inj 10 mg Vial 0 0 0

832
Sisplatin serb inj 50 mg Vial 0 0 0

833
Sitarabin serb inj 100 mg (i.m./i.v./s.k.) Vial 0 0 0

834
Sitarabin serb inj 500 mg/10 ml Vial 0 0 0

835
Spiramisin tab 250 mg Tab 0 0 0

836
 Spiramisin tab 500 mg Tab 0 0 0

837
Spironolakton tab 100 mg Tab 0 0 5000

838
Spironolakton tab 25 mg Tab 0 0 5000

839
Stannous pyrophosphate 27,6 mg Vial 0 0 0
sodium pyrophosphate/vial

840
Stavudin tab 30 mg Tab 0 0 0
841
Streptokinase serb inj 1,5 juta UI/vial Vial 0 0 0

842
Streptomisin serb inj 1.000 mg/vial Vial 0 0 0

843
Sufentanil inj 5 mcg/ml (i.v.) Ampul 0 0 0

844
Sukralfat susp 500 mg/5 ml Botol 0 0 0

845
Sukralfat tab 500 mg Tab 0 0 0

846
Suksinilkolin inj 20 mg/ml (i.v./i.m.) Vial 0 0 0

847
 Suksinilkolin inj 50 mg/ml (i.v./i.m.) Vial 0 0 0

848
Suksinilkolin serb inj 100 mg/vial (i.v./i.m.) Vial 0 0 0

849
Sulfasalazin kapl sal enterik 500 mg Kaps salut 0 0 0

850
Sulfur colloid 4,5 mg gelatin/reaction vial Vial 0 0 0

851
Surgical ginggival pack Tube 0 0 0

852
Takrolimus kaps 0,5 mg Kaps 0 0 0

853
Takrolimus kaps 1 mg Kaps 0 0 0

854
Tamoksifen tab 20 mg Tab 0 0 0

855
Tamsulosin tab 0,2 mg Tab 0 0 0

856
Tamsulosin tab SR 0,4 mg Tab 0 0 0

857
 Technetium 99m 740 mbq - 3,7 gbq (20 Set 0 0 0
to 100 millicuries)/ml

858
Telbivudin tab 600 mg Tab 0 0 0

859
Telmisartan tab 40 mg Tab 0 0 0

860
Telmisartan tab 80 mg Tab 0 0 0

861
Temozolamid kaps 100 mg Kaps 0 0 0

862
Temozolamid kaps 20 mg Kaps 0 0 0

863
Tenofovir tab 300 mg Tab 0 0 0

864
Teofilin tab 100 mg Tab 0 0 0

865
Teofilin tab 150 mg Tab 0 0 0

866
Teofilin tab SR 300 mg Tab 0 0 0

867
Terazosin hcl tab 1 mg Tab 0 0 0

868
Terazosin hcl tab 2 mg Tab 0 0 0

869
 Terbutalin cairan ih 2,5 mg/ml Botol 0 0 0

870
Terbutalin inj 0,5 mg/ml Vial 0 0 0

871
Terbutalin serb ih 0,50 mg/dose Vial 0 0 0

872
Terbutalin sir 1,5 mg/5 ml Botol 0 0 0

873
Terbutalin tab 2,5 mg Tab 0 0 0

874
Testosteron inj 250 mg/ml Tab 0 0 0

875
Testosteron kaps lunak 40 mg Kaps 0 0 0

876
Testoteron kombinasi : Kaps 0 0 0
benserazin 25 mg
+levodopa 100 mg

877
Tetanus toxoid inj Ampul 0 0 0
878
Tetrakain tts mata 0,5% Botol 0 0 0

879
Tetrasiklin kaps 250 mg Kaps 0 0 0

880
 Tetrasiklin kaps 500 mg Kaps 0 350 5000

881
Thallous Chloride Tl-202 1 mg methylene Set 0 0 0
diphosphonic acid/ml

882
Tiamazol tab 10 mg Tab 0 0 0
883
Tiamazol tab 5 mg Tab 0 0 0
884
Tiamin (vitamin B1) tab 50 mg Tab 0 750 10000

885
Timolol tts mata 0,25% Botol 0 0 0

886
Timolol tts mata 0,5% Botol 0 0 0

887
Tiopental serb inj 500 mg/amp (i.v. Bolus) Ampul 0 0 0

888
Tiopental serb serb inj 1.000 mg/amp Ampul 0 0 0
(i.v.)

889
Tiotropium serb ih 18 mcg + handihaller Botol 0 0 0

890
 Tiotropium serb ih 18 mcg, refill Botol 0 0 0

891
Tramadol inj 50 mg/ml Ampul 0 0 100

892
Trastuzumab serb inj 440 mg/vial Vial 0 0 0

893
Travoprost tts mata 0,004% Botol 0 0 0

894
Triamsinolon inj 10 mg/ml Ampul 0 0 0

895
Triamsinolon asetonid nasal spray 55 Botol 0 0 0
mcg/puff

896
Trifluoperazin tab sal 5 mg Tab sal 0 0 0

897
Triheksifenidil tab 2 mg Tab 0 0 0

898
Tropikamid tts mata 1% Botol 0 0 0

899
Tuberkulin protein purified derivative 1:10 Ampul 0 0 0
(i.k)

900
Urea krim 10 % Tube 0 0 0
901
902 Vaksin BCG inj (i.k) Vial 0 0 0
903 Vaksin campak inj (s.k.) Vial 0 0 0
904 Vaksin jerap difteri tetanus pertusis (DTP) i Vial 0 0 0
905 Vaksin jerap difteri tetanus (DT) Vial 0 0 0
906 Vaksin jerap tetanus (tetanus adsorbed toxoi Vial 0 0 0
907 Vaksin kombinasi DPT + hepatitis B inj (i.m Vial 0 0 20000
908 Vaksin polio cairan steril 10 dosis Vial 0 0 0
909 Vaksin polio drops 10 dosis Vial 0 0 0
Vaksin rabies, untuk manusia serb inj Vial 0 0 0
(s.k./i.k) + booster

910
Valasiklovir tab 500 mg Tab 0 0 0

911
Valgansiklovir tab sal 450 mg Tab sal 0 0 0

912
Valproat sir 250 mg/5 ml Botol 0 0 0

913
Valproat tab sal 250 mg Tab sal 0 0 0

914
Valproat tab sal 500 mg Tab sal 0 0 0

915
Valproat tab sal enterik 200 mg Tab 0 0 0

916
Valproat tab SR 500 mg Tab 0 0 0

917
Valproat tab SR 250 mg Tab 0 0 0

918
 Valsartan tab 160 mg Tab 0 0 0

919
Valsartan tab 80 mg Tab 0 0 0
920
Vankomisin serb inj 500 mg/vial Vial 0 0 0

921
Vasopresin inj 20 UI/ml (i.m./s.k.) Vial 0 0 0

922
Verapamil inj 2,5 mg/ml Vial 0 0 0

923
Verapamil tab 80 mg Tab 0 0 0
924
Verapamil tab 240 mg Tab 0 0 0

925
Vinblastin serb inj 10 mg/ml Vial 0 0 0

926
Vinkristin serb inj 1 mg (i.v.) Vial 0 0 0

927
Vinkristin serb inj 2 mg/2 ml (i.v.) Vial 0 0 0

928
Vinorelbin inj 10 mg/ml Vial 0 0 0

929
Warfarin tab 2 mg Tab 0 0 0
930
Warfarin tab 1 mg Tab 0 0 0
931
Zidovudin kaps 300 mg Kaps 0 0 0

932
 Zinc sir 10 mg/ml Botol 0 0 0
933
Zinc tab disp 20 mg Tab 0 0 0

934
Zinc serb 10 mg Sachet 0 0 0
935
Zinc sir 20 mg/5 ml Botol 0 0 0

936
Vitamin B kompleks Tab 0 750 10000
937

KEPALA SATKER BERTANGGUNGJAWAB ATAS ISI USULAN RENCANA KEBUTUHAN OBAT TERSEBUT DIATAS

KEPALA SATUAN KERJA

dr.H.Siswandi.M.Kes
( ................................................................... )
Nip.19641218 199903 1 001
TERSEBUT DIATAS