LAPORAN PEMAKAIAN DAN LEMBAR PERM

(LPLPO) DANA JKN

PUSKESMAS : GLAGAH
SUB UNIT :
KECAMATAN : GLAGAH
KABUPATEN : LAMONGAN
PROPINSI : JAWA TIMUR

HARGA (Rp.) per tablet

/vial/ampul/kapsul/kaplet/dst.

NO NAMA BARANG KEMASAN

TH TH TH
GUDAN
G OBAT
PUSKES UGD KIA GIGI
MAS
2017 2018 2019

1 2 3 4 5 6 1 2 3 4

OBAT-OBATAN
1 Antrain Inj. Ampul 11,500 500 1 1 1
2 Antrain Inj. Ampul 9,966
3 Adona Ac 2 ml inj Ampul 11,500
4 air untuk injeksi amp 25ml OTSU-WI ampul 2,750
5 air untuk injeksi amp 25ml OTSU-WI ampul 2,860
6 air untuk injeksi amp 25ml OTSU-WI Ampul 2,860
7 Albendazol sub 200 mg/5 ml botol 3,849
8 Albendazol sub 200 mg/5 ml botol 3,849
9 Albendazol susp 200 mg/5 ml Botol 4,000
10 Albendazol tab 400 mg tab 392
11 Albendazol tab 400 mg tab 404
12 Albendazol tab 400 mg tab 404
13 Alinamin inj Ampul 10,450
box,10 strips @
14 Alopurinol tab 100 mg
10 tablets
90

box,10 strips @
15 Alopurinol tab 100 mg
10 tablets
97

16 Alopurinol tab 100 mg Tab 97

dus, 10 blister
17 Alopurinol tab 300 mg
@ 10 tablet
210

dus, 10 blister
18 Alopurinol tab 300 mg
@ 10 tablet
210

19 Alopurinol tab 300 mg Tab 210

20 Ambroxol syrup 15 mg/mL botol 5,280
21 Ambroxol syrup 15mg/ml botol 60 ml 5,645
22 Ambroxol syrup 15mg/ml botol 60 ml 5,280
23 Ambroxol tab 30 mg box 10 x 10's 143
24 Ambroxol tab 30 mg box 10 x 10's 198
25 Ambroxol tab 30 mg box 10 x 10's 198
26 Ambroxol tab 30 mg tab 171
dus 30 ampul
27 Aminofilin injeksi 24 mg/ml
@ 10 ml
2,998

dus 30 ampul
28 Aminofilin injeksi 24 mg/ml
@ 10 ml
2,789

29 Aminofilin injeksi 24 mg/ml ampul 2,789

botol @ 100
30 Aminoflin tablet scored 200 mg .
tab
90

botol @ 100
31 Aminoflin tablet scored 200 mg .
tab
89

dus, 10 strip @
32 Amitriptilin tablet salut 25 mg (HCl)
10 tss
143

dus, 10 strip @
33 Amitriptilin tablet salut 25 mg (HCl)
10 tss
167

34 Amitriptilin tablet salut 25 mg (HCl) Tab sal 167

box, 3 strip @
35 Amlodipin tab 10 mg
10 tablets
337

box, 3 strip @
36 Amlodipin tab 10 mg
10 tablets
93

37 Amlodipin tab 10 mg Tab 93

box, 3 strip @
38 Amlodipin tab 5 mg
10 tablets
105

box, 3 strip @
39 Amlodipin tab 5 mg
10 tablets
70

40 Amlodipin tab 5 mg Tab 70

41 Amoksisilin sir forte 250 mg/5 ml btl @ 60 ml 3,473
42 Amoksisilin sir forte 250 mg/5 ml btl @ 60 ml 2,090
43 Amoksisilin sir forte 250 mg/5 ml btl @ 60 ml 2,000
44 Amoksisilin sir forte 250 mg/5 ml btl @ 60 ml 3,400
45 Amoksisilin sir forte 250 mg/5 ml Botol 3,400
46 Amoksisilin sir forte 250 mg/5 ml Botol 2,000
dus, 10 strip @
47 Amoksisilin tab 500 mg
10 tablet
232

dus, 10 strip @
48 Amoksisilin tab 500 mg
10 tablet
233

dus, 10 strip @
49 Amoksisilin tab 500 mg
10 tablet
233

dus, 10 strip @
50 Amoksisilin tab 500 mg
10 tablet
233

dus,10 vial @
51 Ampisilin serb inj 1000 mg/vial
1g
8,237

dus,10 vial @
52 Ampisilin serb inj I,v. 1000 mg/vial
1g
5,700
 dus,10 vial @
53 Ampisilin serb inj I,v. 1000 mg/vial
1g
8,237

Analgesik Krim ( Methyl salicylate, Eugenol, tube @ 15

54 Menthol ) gram
15,400

kotak 5 ampul
55 analgesik non narkotik injeksi
@ 2 ml
9,185

kotak 5 ampul
56 analgesik non narkotik injeksi
@ 2 ml
8,360

tube @ 20
57 Analgesik Non Narkotika Krim Topikal (Coverpain)
gram
20,900

Anestetik lokal gigi kombinasi : lidokain hcl 2% +

58 epinefrin 1 : 80.000 inj 2 ml
Ampul 1,145

dus 10 x 10
59 Antalgin tablet 500 mg
tablet
144

dus 10 x 10
60 Antalgin tablet 500 mg
tablet
253

dus 10 x 10
61 Antalgin tablet 500 mg
tablet
242

62 Antalgin tablet 500 mg tablet 253

Antasida DOEN I tablet kunyah, kombinasi :

dus, 10 strip @
63 Aluminium Hidroksida 200 mg Magnesium
10 tablet
62
Hidroksida 200 mg

Antasida DOEN I tablet kunyah, kombinasi :

dus, 10 strip @
64 Aluminium Hidroksida 200 mg Magnesium
10 tablet
54
Hidroksida 200 mg

Antasida DOEN II suspensi kombinasi : aluminium

65 hidroksida 200 mg + magnesium hidroksida 200 mg
botol @ 60 ml 1,923

Antasida DOEN II suspensi, kombinasi : Aluminium

66 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 botol @ 60 ml 1,995
mg/5ml

Antasida DOEN II suspensi, kombinasi : Aluminium

67 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 botol @ 60 ml 1,995
mg/5ml
 Antasida DOEN II suspensi, kombinasi : Aluminium
68 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 Botol 2,228
mg/5ml

Antasida, kombinasi : aluminium hidroksida 200 mg

69 + magnesium hidroksida 200 mg
Tab 54

70 Anti Bisa Ular vial 5 ml 640,530

71 Anti Bisa Ular vial 5 ml 479,996
72 Anti Depresi box 50 tablet 4,840
73 Anti Diare box 100 kaplet 198
74 Anti histamin ( Recodril ) inj vial 5,001
75 Anti influenza kaplet (MOLEXFLU) box 150's 360
76 Anti influenza kaplet (MOLEXFLU) box 150's 396
Anti Influenza kaplet : (Tiap kaplet : Parasetamol
77 500 mg,Phenylprophanolamine HCl 12,5 mg, kaplet 414
Chlorpheniramine Maleate 2 mg)

Anti mikroba + kortikosteroid tetes mata (Litrol

78 Tetes Mata)
botol @ 5 ml 19,965

dus, 5 strip @
79 Anti parkinson doen (Levopar)
10 tablet
1,168

80 anti septik GEL botol 22,000

81 anti septik solution 60 ml (Betadine sol) botol 23,890
Antibiotika mata + kortikosteroid ( Polymyxin B
82 sulphate 6000 IU, Neomycin sulphate 3,5 mg, botol @ 5 ml 19,965
dexamethasone 1,0 mg)

Antibiotika mata + kortikosteroid ( Polymyxin B

83 sulphate 6000 IU, Neomycin sulphate 3,5 mg, botol @ 5 ml 15,400
dexamethasone 1,0 mg)

Antibiotika mata + kortikosteroid ( Polymyxin B

84 sulphate 6000 IU, Neomycin sulphate 3,5 mg, botol @ 5 ml 16,500
dexamethasone 1,0 mg)

Antifungi salep, kombinasi : asam benzoat 6%+

85 asam salisilat 3%
Tube 4,496

Antifungi salep, kombinasi :asam benzoat 6%

86 +asam salisilat 3% (whitfield)
Pot @ 30 gram 3,930

Antifungi salep, kombinasi :asam benzoat 6%

87 +asam salisilat 3% (whitfield)
Pot @ 30 gram 4,496

Antihemoroid : ( Ekstrak Gratophylli Folium 80 %

88 dan Citrus Biofavonoid 20 % )
tablet 2,090

89 Antihemoroid supp Supp 3,045

Antihemoroid, kombinasi: bismut subgalat 150 mg
dus/ 3 blister x
90 + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+
10's
3,045
seng oksida 120 mg + sup ad 2 g

Antihemoroid, kombinasi: bismut subgalat 150 mg

91 + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ Supp 3,167
seng oksida 120 mg + sup ad 2 g

Antihemoroid, kombinasi: bismut subgalat 150 mg

dus/ 3 blister x
92 + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+
10's
3,167
seng oksida 120 mg + sup ad 2 g
 Antihemoroid, kombinasi: bismut subgalat 150 mg
93 + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ Supp 3,167
seng oksida 120 mg + sup ad 2 g

Antihemoroid, kombinasi: bismut subgalat 150 mg

94 + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ supp 3,167
seng oksida 120 mg + sup ad 2 g

Antiparkinson DOEN tablet kombinasi : Benserazid dus, 5 strip @

95 25 mg Levodopa 100 mg (LEVOPAR) 10 tablet
1,298

Antispasmodik ( Tiap Kaplet : Hyoscine

96 butylbromide 10 mg , Methampyrone 250 mg )
kaplet 3,080

97 Antispasmodik (DORMI COMPOSITUM) box 100 kaplet 1,948

98 Antispasmodik (DORMI COMPOSITUM) box 100 kaplet 3,080
99 Aqua pro injeksi botol 2,860
botol @ 100
100 Asam Ascorbat (vitamin C) tab 50 mg tablet
104

botol @ 100
101 Asam Ascorbat (vitamin C) tab 50 mg tablet
105

102 Asam asetilsalisilat (asetosal) tab 80 mg Tab 99

dus 10 strip x
103 Asam Asetilsalisilat (ASETOSAL) tab 80mg 10 tab
92

dus 10 strip x
104 Asam Asetilsalisilat (ASETOSAL) tab 80mg 10 tab
99

105 Asam askorbat (vitamin C) tab 50 mg Tab 105

dus, 10 strip @
106 Asam Folat tab 0,4 mg 10 tablet
55

107 Asam folat tab 1 mg Tab 74

dus, 10 strip @
108 Asam Folat tabl 1 mg 10 tablet
70

dus 10 strip x
109 Asam mefenamat kaps 500 mg 10 tab
170

dus 10 strip x
110 Asam mefenamat kaps 500 mg 10 tab
103

111 Asam mefenamat kaps 500 mg Kaps 103

dus, 10 ampul
112 Asam traneksamat injeksi 50 mg/ml @ 5 ml
1,956

dus, 10 ampul
113 Asam traneksamat injeksi 50 mg/ml @ 5 ml
1,748

114 Asam traneksamat injeksi 50 mg/ml Ampul 1,748

115 Asetat Ringer / Asering SOFT BAG Botol 9,646
Dus, 25 tube @
116 Asiklovir krim 5 % 5 gram
3,200

Dus, 25 tube @
117 Asiklovir krim 5 % 5 gram
3,146

118 Asiklovir krim 5 % Tube 13,970

dus, 10 blister
119 Asiklovir Tab 200 mg @ 10 tablet
240

dus, 10 blister
120 Asiklovir Tab 200 mg @ 10 tablet
236
121 Asiklovir tab 200 mg Tab 236
dus, 10 blister
122 Asiklovir tab 400 mg @ 10 tablet
349

dus, 10 blister
123 Asiklovir Tab 400 mg @ 10 tablet
349

dus, 10 blister
124 Asiklovir Tab 400 mg @ 10 tablet
380

125 Asiklovir tab 400 mg Tab 384

dus, 10 blister
126 Asiklovir tablet 200 mg @ 10 tablet
249

127 Aspilets tab tab 114

128 Aspilets tab tab 740
129 Atapulgit 600 mg Tab 129
130 Atapulgit 600 mg Tab 136
131 Atapulgit 600 mg Tab 136
132 Atenolol tab 100 mg Tab 705
133 Atenolol tab 100 mg tab 705
134 Atenolol tab 50 mg tab 310
135 Atenolol tab 50 mg tab 297
136 Atenolol tab 50 mg Tab 297
dus 100
137 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) ampul@1ml
1,672

dus 100
138 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) ampul@1ml
1,595

139 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595

140 Atropin tab 0,5 mg tab 95
141 Atropin tab 0,5 mg tab 95
142 Atropin tab 0,5 mg Tab 105
143 Bahan tumpat sementara (CAVIT W) Jar 245,000
144 Bahan tumpat sementara lar, serb botol 135,300
145 Bahan tumpatan sementara lar, serb Botol 135,500
146 Becefort syrup Botol 17,366

147 Bedak salisil serb 2% dus @ 50 gram 1,020

148 Bedak salisil serb 2% dus @ 50 gram 2,200

149 Bedak salisil serb 2% dus 1,128

150 Betahistin mesilas tablet Tab 149
151 Betametason krim 0,1 % tube 5 gram 1,340
152 Betametason krim 0,1% tube 5 gram 1,349
153 Betametason krim 0,1% tube 5 gram 1,340
154 Betametason krim 0,1% tube 5 gram 1,340
155 Bisakodil sup 10 mg Supp 5,900
156 Bisakodil sup 5 mg supp 6,000
157 Bonding kit 968,000
158 Bonding pcs 968,000
159 Borax gliserin 15ml botol 5,300
160 Borax gliserin 15ml botol 3,179
161 cefadroksil kapsul 500 mg tab 409
162 cefadroksil kapsul 500 mg tab 600
163 cefadroksil kapsul 500 mg tab 600
164 Cefadroxyl syrup kering 125 mg/ 5 ml botol 3,980
165 Cefadroxyl syrup kering 125 mg/ 5 ml botol 7,850
166 Cefotaxim injeksi vial 4,898
167 Cefotaxim injeksi vial 4,200
168 Cefotaxim injeksi vial 4,200
169 Ceftriaxone inj vial 9,000
170 Ceftriaxone inj vial 12,350

171 CHKM botol 68,750

172 ciprofloxacin Tab 500 mg tab 240

173 ciprofloxacin Tab 500 mg tab 265

174 ciprofloxacin Tab 500 mg tab 265

dus, 100 ampul

175 Deksametason inj 5 mg/ml (i.v./i.m.) @ 1 ml
1,567

dus, 100 ampul

176 Deksametason inj 5 mg/ml (i.v./i.m.) @ 1 ml
1,097

dus, 100 ampul

177 Deksametason inj 5 mg/ml (i.v./i.m.) @ 1 ml
1,097

dus, 10 srtip @
178 Deksametason tab 0,5 mg 10 tablet
32

dus, 10 srtip @
179 Dexametason tab 0,5 mg 10 tablet
41

dus, 10 srtip @
180 Dexametason tab 0,5 mg 10 tablet
32

181 Diazepam inj 5 mg/ml (i.v./i.m.) ampul 5,769

182 Diazepam inj 5 mg/ml (i.v./i.m.) ampul 1,735
183 Diazepam inj 5 mg/ml (i.v./i.m.) ampul 1,735
184 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul 1,735

dus 5 alubag @
185 Diazepam lar rektal 5 mg/2,5 ml 1 tube @ 2,5ml
12,573

dus 5 alubag @
186 Diazepam lar rektal 5 mg/2,5 ml (STESOLID) 1 tube @ 2,5ml
12,573

dus, 10 srtip @
187 Diazepam tab 2 mg 10 tablet
103

dus, 10 srtip @
188 Diazepam tab 5 mg 10 tablet
118
 dus, 10 srtip @
189 Diazepam tab 5 mg 10 tablet
109

dus, 10 srtip @
190 Diazepam tab 5 mg 10 tablet
109

dus @ 30
191 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul
1,175

dus @ 30
192 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul
1,095

dus @ 30
193 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul
1,095

194 Digoksin tab 0,25 mg Box 10 x 10 tab 104

195 Digoxin tab 0,25 mg Box 10 x 10 tab 105

196 Digoxin tab 0,25 mg Box 10 x 10 tab 104

box 10 strip @
197 Dimenhidrinat tab 50 mg 10 tablet
142

box 10 strip @
198 Dimenhidrinat tab 50 mg 10 tablet
105

199 Dimenhidrinat tab 50 mg Tab 105

200 Domperidon susp 5 mg/5 ml Botol 2,700
201 Domperidon susp 5 mg/5ml btl @ 60 ml 3,000
202 Domperidon susp 5 mg/5ml btl @ 60 ml 2,700
203 Domperidon tab 10 mg dus 10 x 10's 118
204 Domperidon tab 10 mg dus 10 x 10's 85
205 Domperidon tab 10 mg dus 10 x 10's 85
206 Domperidon tab 10 mg Tab 85
207 DOMPERIDONE SYR btl @ 60 ml 15,180
dus @ 30
208 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) ampul
1,749

dus @ 30
209 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) ampul
1,408

210 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,408

211 Erela Tetes Telinga botol 4,800
box 10 strip @
212 Ergotamin tab 1 mg + kaffein 50 mg 10 tablet
173

213 Ergotamin tab 1 mg + kaffein 50 mg Tab 173

ktk 10 x 10
214 Eritromisin kaps 250 mg kapsul
557

ktk 10 x 10
215 Eritromisin kaps 250 mg kapsul
497

216 Eritromisin kaps 500 mg dus, 10 blister @ 10 kss 730

217 Eritromisin kaps 500 mg dus, 10 blister @ 10 kss 750

218 Eritromisin kaps 500 mg Kaps 750

219 Eritromisin sir 200 mg/5 ml botol @ 60 ml 6,700
220 Eritromisin sir 200 mg/5 ml botol @ 60 ml 6,090
221 Eritromisin sir 200 mg/5 ml Botol 6,090
222 Etanol 70 % cairan btl @ 100 ml 6,804
223 Etanol 70 % cairan btl @ 100 ml 3,200
224 Etanol 70 % cairan Botol 3,520
225 Etil Klorida semprot 100 ml btl @ 100 ml 126,500
226 Etil Klorida semprot 100 ml btl @ 100 ml 352,000
227 Etil klorida semprot 100 ml Botol 140,800
228 Eugenol botol 18,100
229 Eugenol botol 18,824
230 Eugenol Botol 18,824
231 Febrinex syrup botol 15,855
232 Fenitoin Na 100 mg tab 158
233 Fenitoin Na inj 50 mg/ml Ampul 3,738
234 Fenitoin Na inj 50 mg/ml Ampul 3,738
235 Fenobarbital 30 mg tab 171
dus @ 30
236 Fenobarbital injeksi i.m/i.v. 50 mg/ml ampul
1,740

dus @ 30
237 Fenobarbital injeksi i.m/i.v. 50 mg/ml ampul
1,857

dus @ 10 x
238 Fenoksimetil penisilin (penisilin V) tab 250 mg 10's
350

dus @ 10 x
239 Fenoksimetil penisilin (penisilin V) tab 250 mg 10's
350

240 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 385

dus @ 10 x
241 Fenoksimetil penisilin (penisilin V) tab 500 mg 10's
605

dus @ 10 x
242 Fenoksimetil penisilin (penisilin V) tab 500 mg 10's
629

243 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 629

dus @ 10 x
244 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) 10's
5,750

dus @ 10 x
245 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) 10's
3,550

dus @ 10 x
246 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) 10's
3,682

247 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Ampul 3,682

dus @ 10 x
248 Fitomenadion (vitamin K 1) tab sal 10 mg 10's
686

dus @ 10 x
249 Fitomenadion (vitamin K 1) tab sal 10 mg 10's
691

dus @ 10 x
250 Fitomenadion (vitamin K 1) tab sal 10 mg 10's
710

251 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710

252 Fluocinolone Acetonide, Neomycin sulfat cream botol 18,700
253 Fluocinolone Acetonide, Neomycin sulfat cream botol 17,000
dus, 25 ampul
254 Furosemid inj 10 mg/ml (i.v./i.m.) @ 2 ml
6,050
 dus, 25 ampul
255 Furosemid inj 10 mg/ml (i.v./i.m.) @ 2 ml
1,333

256 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 2,420

dus, 10 strip @
257 Furosemid tab 40 mg 10 tablet
78

dus, 10 strip @
258 Furosemid tab 40 mg 10 tablet
77

259 Furosemid tab 40 mg Tab 77

Garam oralit kombinasi : natrium klorida 0,52 g +
260 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + Sachet 237
glukosa anhidrat 2,7 g

Garam oralit kombinasi : natrium klorida 0,52 g +

261 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + Sachet 257
glukosa anhidrat 2,7 g

Garam oralit kombinasi : natrium klorida 0,52 g +

262 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + Sachet 257
glukosa anhidrat 2,7 g

dus, 10 blister
263 Gemfibrozil kapsul 300 mg @ 12 kapsul
496

dus, 10 blister
264 Gemfibrozil kapsul 300 mg @ 12 kapsul
372

265 Gemfibrozil kapsul 300 mg tab 407

266 Genoin Tetes Mata botol 7,500
267 Gentamicin SK tube 2,500
268 Gentamysin sulfat tetes mata 0,3% botol 4,232
269 Gentian Violet botol 1,980
270 Gentian Violet botol 4,200
Glass ionomer ART (Atraumatic Restorative
271 Treatment) lar Botol 631,000

Glass ionomer ART (Atraumatic Restorative

272 Treatment) lar Botol 652,300

Glass ionomer ART (Atraumatic Restorative

273 Treatment) lar Botol 652,300

274 Gleseril Guayakolat 50 mg (guaifenesin) tablet 128

275 Gleseril Guayakolat 50 mg (guaifenesin) tablet 107
box 10 strip @
276 Glibenklamid tab 5 mg 10 tablet
92

box 10 strip @
277 Glibenklamid tab 5 mg 10 tablet
119

box 10 strip @
278 Glibenklamid tab 5 mg 10 tablet
119

279 Glibenklamid tab 5 mg Tab 119

280 Glikazid tablet 80mg tab 220
281 Glikazid tablet 80mg (GLUCODEX) dus, 100 tablet 210
282 Glikazid tablet 80mg (GLUCODEX) dus, 100 tablet 220
283 Glimepirid tab 1 mg Tab 174
284 Glimepirid tab 2 mg Tab 207
285 Glimepiride tabt 1 mg ktk 10x10 tablet 194

286 Glimepiride tabt 1 mg ktk 10x10 tablet 174

287 Glimepiride tabt 1 mg ktk 10x10 tablet 174

dus 5 strip @
288 Glimepiride tabt 2 mg 10 tablet
289

dus 5 strip @
289 Glimepiride tabt 2 mg 10 tablet
207

dus 5 strip @
290 Glimepiride tabt 2 mg 10 tablet
207

291 Gliseril Guaiyacolat GG tablet 78

292 Gliseril Guaiyacolat GG tablet 157
293 Gliseril gualicolat tab 157

294 Glukosa Larutan Infus 10% steril 500 ml botol @ 500 ml 7,500

295 Glukosa Larutan Infus 10% steril 500 ml botol @ 500 ml 7,500

296 Glukosa Larutan Infus 10% steril 500 ml Botol 7,500

297 Glukosa larutan infus 5 % steril 500 ml botol @ 500 ml 6,900

298 Glukosa larutan infus 5 % steril 500 ml botol @ 500 ml 6,900

299 Glukosa Larutan Infus 5% 1/4 NS steril 500 ml botol @ 500 ml 9,250

300 Glukosa Larutan Infus 5% 1/4 NS steril 500 ml botol @ 500 ml 9,724

301 Glukosa Larutan Infus 5% 1/4 NS steril 500 ml Botol 9,724

302 Glukosa Larutan Infus 5% steril 500 ml Botol 6,900
dus @ 10 x
303 Griseofulvin (micronized) tab 125 mg 10's
374

dus @ 10 x
304 Griseofulvin (micronized) tab 125 mg 10's
210

305 Griseofulvin (micronized) tab 125 mg Tab 210

306 Gutta percha kotak 62,920
307 Gutta percha point box 120pcs 62,920
308 Haloperidol inj 5 mg/ml (i.m.) vial 4,974
309 Haloperidol inj 5 mg/ml (i.m.) Vial 5,471
dus, 10 blister
310 Haloperidol tab 0,5 mg @ 10 tablet
56

dus, 10 blister
311 Haloperidol tab 2 mg @ 10 tablet
84

312 Haloperidol tab 2 mg Tab 84

dus, 10 blister
313 Haloperidol tab 5 mg @ 10 tablet
69

dus, 10 blister
314 Haloperidol tab 5 mg @ 10 tablet
56

315 Haloperidol tab 5 mg Tab 56

316 Haloperidol tts 2 mg/ml Botol 17,099
317 Haloperidol tts 2 mg/ml Botol 12,600
318 Haloperidol tts 2 mg/ml Botol 18,700
319 Hidroklorotiazid tab 25 mg Tab 155
320 Hidrokortison krim 2,5% tube 5 gr 2,640
321 Hidrokortison krim 2,5% tube 5 gr 2,475
322 Hidrokortison krim 2,5% tube 5 gr 2,475
323 Hidrokortison krim 2,5% Tube 2,475
324 Hydroclorotiazid tab 25mg tab 149
325 Hydroclorotiazid tab 25mg tab 155
326 Hydroclorotiazid tab 25mg tab 155
327 Ibuprofen susp 100 mg/5ml botol 2,475
328 Ibuprofen susp 100 mg/5ml botol 2,550
329 Ibuprofen susp 100 mg/mL Botol 2,550
330 Ibuprofen tab 200 mg dus 10 x 10's 105
331 Ibuprofen tab 200 mg dus 10 x 10's 105
332 Ibuprofen tab 200 mg Tab 105
333 Ibuprofen tab 400 mg dus 10 x 10's 127
334 Ibuprofen tab 400 mg dus 10 x 10's 122
335 Ibuprofen tab 400 mg Tab 122
dus, 10 strip @
336 Isosorbid dinitrat tab 5 mg 10 tablet
89

dus, 10 strip @
337 Isosorbid dinitrat tab 5 mg 10 tablet
89

338 Isosorbid dinitrat tab 5 mg Tab 89

339 Kalisum Hidroksida bubuk, pasta (CALCIDOR) box 207,350
340 Kalisum Hidroksida bubuk, pasta (CALCIDOR) box 207,350
dus 24 ampul
341 Kalsium glukonat inj 100 mg/ml @ 10 ml
9,955

dus 24 ampul
342 Kalsium glukonat inj 100 mg/ml @ 10 ml
10,351

343 Kalsium glukonat inj 100 mg/ml Ampul 10,351

344 Kalsium hidroksida bubuk, pasta Tube 207,350
dus 10 strip @
345 Kalsium laktat (kalk) tab 500 mg 10 tablet
63

dus 10 strip @
346 Kalsium laktat (kalk) tab 500 mg 10 tablet
59

dus, 10 strip @
347 Kalsium laktat (kalk) tab 500 mg 10 tablet
59

dus, 10 strip @
348 Kaptopril tab 12,5 mg 10 tablet
62

dus, 10 strip @
349 Kaptopril tab 25 mg 10 tablet
75

dus, 10 strip @
350 Kaptopril tab scored 12,5 mg 10 tablet
59

dus, 10 strip @
351 Kaptopril tab scored 12,5 mg 10 tablet
62
 dus, 10 strip @
352 Kaptopril tab scored 25 mg 10 tablet
80

dus, 10 strip @
353 Kaptopril tab scored 25 mg 10 tablet
80

dus, 10 blister
354 Karbamazepin tablet 200 mg @ 10 tablet
228

dus, 10 blister
355 Karbamazepin tablet 200 mg @ 10 tablet
230

356 Karbamazepin tablet 200 mg TAB 230

Fenol 100 mg /
357 karbogliserin tetes telinga 10% 1 ml
2,500

dus, 5 strip @
358 Ketokonazol tab 200 mg 10 tablet
280

dus, 5 strip @
359 Ketokonazol tab 200 mg 10 tablet
270

360 Ketokonazol tab 200 mg Tab 270

361 Ketokonazole krim 2% tube 10 gr 2,596
362 Ketokonazole krim 2% tube 10 gr 2,569
363 Ketorolac inj ampul 7,500
364 Klindamisin 150 mg Tab 715
365 Klindamisin 300 mg Tab 583
dus, 10 strip @
366 Klobazam tablet 10 mg 10 tablet
970

dus, 10 strip @
367 Klobazam tablet 10 mg 10 tablet
739

ktk 10 x 10
368 Kloramfenikol kaps 250 mg tablet
600

ktk 10 x 10
369 Kloramfenikol kaps 250 mg tablet
310

ktk 10 x 10
370 Kloramfenikol kaps 250 mg tablet
310

371 Kloramfenikol kaps 250 mg Kaps 310

ktk 10 x 10
372 Kloramfenikol kaps 500 mg tablet
1,199

ktk 10 x 10
373 Kloramfenikol kaps 500 mg tablet
1,090

ktk 10 x 10
374 Kloramfenikol kaps 500 mg tablet
1,090

375 Kloramfenikol kaps 500 mg kaps 1,090

376 kloramfenikol salep kulit 2% tube 3,008
377 kloramfenikol salep kulit 2% tube 3,038
378 Kloramfenikol salep kulit 2% Tube 3,038
379 kloramfenikol salep mata 1% tube 5 gr 1,810
380 kloramfenikol salep mata 1% tube 5 gr 1,881
381 Kloramfenikol salep mata 1% Tube 1,861
382 Kloramfenikol susp 125 mg/ 5 ml botol, 60 ml 4,700
383 Kloramfenikol susp 125 mg/ 5 ml botol, 60 ml 4,700
384 Kloramfenikol susp 125 mg/5 ml Botol 4,700
385 Klorampenikol TM (RECO) botol 8,625
386 klorfeniramin tab 4 mg tab 36
387 klorfeniramin tab 4 mg tab 22
388 Klorfeniramin tab 4 mg Tab 22

389 Klorfeniramina Maleat ( CTM ) tablet 4 mg box 10 x 10 "s 22

390 Klorfeniramina Maleat ( CTM ) tablet 4 mg box 10 x 10 "s 22

391 Klorfenol kamfer mentol (CHKM) botol @ 20 ml 85,800

392 Klorfenol kamfer mentol (CHKM) Btl 20 mL 85,800
393 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,243
394 Klorpromazin tab sal 100 mg Tab sal 147
395 klorpromazin tab sal 100mg tab sal 144
396 klorpromazin tab sal 100mg tab sal 147
397 klozapin 100 mg tab 3,288
398 Klozapin 100 mg tab 3,288
399 klozapin 25 mg tab 1,550
400 klozapin 25 mg tab 1,121
401 Klozapin 25 mg tab 1,121
402 Kodein tab 10 mg tab 500
403 Kodein tab 10 mg tab 571
404 Kodein tab 10 mg Tab 571
Kombinasi tablet salut : Fero sulfat 200 mg Asam kotak @ 10 x
405 Folat 0,25 mg 10 tab
73

406 Komposit ( bahan tumpat dengan sinar) kit 3,120,700

407 Komposit ( bahan tumpat dengan sinar) kit 2,926,000
408 Komposit ( bahan tumpat dengan sinar) kit 2,926,000
Kotrimoksazol (dewasa) kombinasi : dus, 10 strip @
409 sulfametoksazol 400 mg+ trimetoprim 80 mg 10 tablet
151

Kotrimoksazol (dewasa) kombinasi :

410 sulfametoksazol 400 mg+ trimetoprim 80 mg Kotak 129

Kotrimoksazol (dewasa) kombinasi : dus, 10 strip @

411 sulfametoksazol 400 mg+ trimetoprim 80 mg 10 tablet
125

Kotrimoksazol (dewasa) kombinasi :

412 sulfametoksazol 400 mg+ trimetoprim 80 mg kotak 151

Kotrimoksazol (dewasa) kombinasi :

413 sulfametoksazol 400 mg+ trimetoprim 80 mg Tab 125

Kotrimoksazol (dewasa) kombinasi :

414 sulfametoksazol 800 mg+ trimetoprim 160 mg Tab 299

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

415 suspensi : sulfametoksazol 200 mg + trimetoprim botol, 60 ml 2,286
40 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

416 suspensi : sulfametoksazol 200 mg + trimetoprim botol, 60 ml 2,052
40 mg

Kotrimoksazol (dewasa) kombinasi tiap 5 ml

417 suspensi : sulfametoksazol 200 mg + trimetoprim Botol 2,052
40 mg
 Larutan mengandung Karbohidrat + elektrolit (NaCl
418 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr ,Dextrosa 27 botol @ 500 ml 10,050
gr) (KA EN 3 B)

Larutan mengandung Karbohidrat + elektrolit (NaCl

419 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr ,Dextrosa 27 botol @ 500 ml 10,696
gr) (KA EN 3 B)

Larutan mengandung Karbohidrat + Elektrolit (Nacl

420 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 Botol 10,696
gr) (KA EN 3B)

Larutan Mengandung Karbohidrat+Elektrolit (D5-

421 1/4NS) Botol 9,724

Larutan Mengandung Karbohidrat+Elektrolit (WIDA

422 D5-1/4NS) Botol 9,350

423 Lidocain Injeksi 2 % (HCl) Vial 1,149

Lidokain injeksi 2 % (HCl) + Epinefrin 1:.80000 - 2 dus, 30 ampul
424 ml @ 2 ml
1,760

Lidokain injeksi 2 % (HCl) + Epinefrin 1:.80000 - 2 dus, 30 ampul

425 ml @ 2 ml
1,149

426 Lisinopril tab 5mg tablet 269

427 Lisinopril tab 5mg tablet 209
dus,10 strip @
428 Loperamid tab 2 mg 10 tablet
80

dus,10 strip @
429 Loperamid tab 2 mg 10 tablet
94

430 Loperamid tab 2 mg Tab 103

dus, 5 strip @
431 Loratadin tab 10 mg 10 tablet
123

dus, 5 strip @
432 Loratadin tab 10 mg 10 tablet
275

433 Loratadin tab 10 mg Tab 123

434 Magnesium sulfat inj 20% Vial 3,328

435 magnesium sulfat inj 20% (OTSU-MgSO4) ampul @ 25 ml 3,318

436 magnesium sulfat inj 20% (OTSU-MgSO4) ampul @ 25 ml 3,328

437 magnesium sulfat inj 40% VIal 3,650

438 magnesium sulfat inj 40% VIal 3,796
439 Magnesium sulfat inj 40% Vial 3,796
440 Metamizole 1 g / 2 ml Inj ampul 6,050
dus, 10 blister
441 Metformin tab 500 mg @ 10 tablet
94

dus, 10 blister
442 Metformin tab 500 mg @ 10 tablet
96

443 Metformin tab 500 mg Tab 96

dus 100 ampul
444 Metilergometrin inj 0,2 mg/ml @ 1ml
2,684

dus 100 ampul

445 Metilergometrin inj 0,2 mg/ml @ 1ml
2,959

446 Metilergometrin inj 0,2 mg/ml Ampul 2,959

 ktk 10 x 10
447 Metilergometrin tab salut 0,125 mg tablet salut
133

448 Metilergometrin tab salut 0,125 mg tab sal 271

449 Metilergometrin tab salut 0,125 mg tab sal 210
ktk 10 x 10
450 Metilergometrin tab salut 0,125 mg tablet salut
210

451 Metilergometrin tab salut 0,125 mg tab sal 210

452 Metilergometrin tab salut 0,125 mg Tab sal 210
dus, 10 blister
453 Metilprednisolon tablet 4 mg @ 10 tablet
150

dus, 10 blister
454 Metilprednisolon tablet 4 mg @ 10 tablet
134

455 Metilprednisolon tablet 4 mg tab 134

456 metoklopramid tab 10 mg tab 87
457 metoklopramid tab 10 mg tab 80
458 Metoklopramid tab 10 mg Tab 80

459 Metronidazol lar inf 5 mg/ml botol @ 100 ml 8,110

11 strip @ 10
460 Metronidazol tablet 500 mg tablet
113

12 strip @ 10
461 Metronidazol tablet 500 mg tablet
124

462 Metronidazol tablet 500 mg tab 124

463 Mikonazol krim 2 % tube 3,250
464 Mikonazol krim 2 % tube 3,414
465 Mikonazol krim 2% Tube 3,414
466 Mukolitik dan Ekspektoran sirup (OBH MOLEX) botol 60 ml 5,340
467 Mukolitik dan Ekspektoran sirup (OBH MOLEX) botol 60 ml 5,500
468 Multivitamin + Mineral Drops botol @10 ml 6,050

469 Multivitamin + Mineral Drops (RECOVIT DROPS) botol @ 10 ml 5,500

470 Multivitamin + Mineral Drops (RECOVIT DROPS) botol @ 10 ml 6,050

471 Multivitamin + Mineral suspensi botol 60 ml 9,000

472 Nacl 0,9 % Larutan infus botol 500 ml 5,827
473 Nacl 0,9 % Larutan infus (SATORIA) botol 100 ml 6,410
474 Nacl 0,9 % Larutan infus (WIDATRA) botol 500 ml 6,410
475 NaCl 0,9% Larutan Botol 6,410

476 Natrium Diclofenac tab 50 mg dus @ 5 x 10's 122

477 Natrium Diclofenac tab 50 mg dus @ 5 x 10's 115

478 Natrium Diclofenac tab 50 mg dus @ 5 x 10's 115

479 Natrium Diklofenak tab 25 mg dus @ 5 x 10's 120

480 Natrium Diklofenak tab 25 mg dus @ 5 x 10's 128

481 Natrium diklofenak tab 25 mg Tab 128

482 Natrium diklofenak tab 50 mg Tab 115
483 Natrium divalproat 250 mg Tab 1,200
dus, 10 strip @
484 Nifedipin tab 10 mg 10 tablet ss
104

dus, 10 strip @
485 Nifedipin tab 10 mg 10 tablet ss
132

486 Nifedipin TAB 10 mg Tab 114

dus @ 10 x
487 Nistatin tab vaginal 100.000 IU/g 10's
545

dus @ 10 x
488 Nistatin tab vaginal 100.000 IU/g 10's
560

489 Nistatin tab vaginal 100.000 UI Tab 560

dus @ 10 x
490 Nistatin tablet salut 500.000 IU/g 10's
765

dus @ 10 x
491 Nistatin tablet salut 500.000 IU/g 10's
790

492 Nistatin tablet salut 500.000 IU/g tab 790

493 Novorapid unit 87,000
Obat Batuk dan Flu sirop ( Parasetamol;
494 Dexchlorpheniramin maleate; thiocol ; sorbitol syrup botol 15,855
with chocolate flavor )

Obat Batuk dan Flu sirop ( Parasetamol;

495 Dexchlorpheniramin maleate; thiocol ; sorbitol syrup botol 15,855
with chocolate flavor )
496 Obat Antispasmodik(Dormi) Kotak 2800

Obat Batuk sirup ( Vitex Trifolia folium ( Daun

legundi ) 1 g; Zingiber Officinale Rhizoma (jahe
497 gajah) 0,25 g; Abrus Precatorius Folium (daun btl 60 ml 12,100
saga) 0,25 g; Phaleria Macrocarpa Fructus (buah
mahkota dewa) 0,20 g

498 Obat Batuk & antihistamin syr ( Herbakof sirup) Botol 12100
499 Obat Batuk & Flu syr ( DEXMOLEX) Botol 11000
Obat Batuk dan Anti Histamin sirup ( Tial 5 ml :
500 Dextromethorphan HBr 7,5 mg, Dipenhydramine botol 60 ml 11,550
maleate 1 mg )
501 Obat Batuk sirup (DEXMOLEX) botol 100 ml 11,000
502 Obat Demam dan influenza (sirup) botol 15,840
503 Obat Sariawan & Radang (Bufacomb) Tube 15000
504 Obat Sariawan & Radang (Bufacomb) Tube 16500
Obat Sariawan dan Radang rongga mulut
505 ( Triamcinolone Acetonide 1 mg ) tube @ 5 g 16,500
 Obat Sariawan dan Radang rongga mulut
506 ( Triamcinolone Acetonide 1 mg ) tube @ 5 gr 16,500

Obat Sariawan dan Radang rongga mulut

507 (Bufacomb) tube @ 5 g 15,000

508 Obat Tetes Mata ( Anti mikroba + kortikosteroid ) Botol 15000

509 Obat Tetes Mata ( Anti mikroba + kortikosteroid ) Botol 16500
510 Obat tetes Telinga (RECO) Botol 7000
511 Obat tetes Telinga (RECO) Botol 7700
Obat Tetes Telinga Antibiotik ( Kloramfenikol base
512 10 mg / ml ) botol @ 10 ml 7,700

Obat Tetes Telinga Antibiotik ( Kloramfenikol base

513 10 mg / ml ) botol @10 ml 7,700

OBH : ( Glicyrrhizae Succus 167 mg, Ammonium

514 Chlorida 100 mg ) botol 100 ml 5,500

OBH : ( Glicyrrhizae Succus 167 mg, Ammonium

515 Chlorida 100 mg ) botol 60 ml 5,500

OBH : ( Glicyrrhizae Succus 167 mg, Ammonium

516 Chlorida 100 mg ) botol 100 ml 6,050

517 Oksitetrasiklin salep kulit 1 % tube @ 5 g 2,772

518 Oksitetrasiklin salep kulit 1 % tube @ 5 g 2,772
519 Oksitetrasiklin salep kulit 3 % tube 5 gram 2,200
520 Oksitetrasiklin salep mata 1 % steril tube @ 5 g 2,500
521 Oksitetrasiklin salep mata 3 % tube @ 5 g 2,000
dus 100 ampul
522 Oksitosin inj 10 UI/ml @ 1 ml
1,900

dus 100 ampul

523 oksitosin inj 10 UI/ml @ 1 ml
1,199

524 Oksitosin inj 10 UI/ml Ampul 1,199

dus strip 3 x 10
525 omeprazol Kaps 20 mg kapsul
130

dus strip 3 x 10
526 omeprazol Kaps 20 mg kapsul
130

dus strip 3 x 10
527 omeprazol Kaps 20 mg kapsul
130

528 Omeprazol kaps 20 mg Kaps 130

529 ondansentron inj 4mg/2ml ampul 4,600
530 Oxytetrasiklin S K 2% tube 2,010
531 Oxytetrasiklin S M tube 2,772
532 Oxytetrasiklin S M tube 2,772
533 Paper point box 120 pcs 49,500
534 Paper point box 120 pcs 62,920
535 Paper point kotak 62,920
536 Parasetamol drop 60 mg/0.6 mL botol 6,649
537 Parasetamol drop 60 mg/0.6 mL botol 6,649
538 Parasetamol drop 60 mg/0.6 mL Botol 6,649
539 Parasetamol Sir 120 mg / 5 ml botol 60 ml 1,010
540 Parasetamol Sir 120 mg / 5 ml botol 60 ml 1,107
541 Parasetamol sir 120 mg/5 ml Botol 1,107
 dus, 10 strip @
542 Parasetamol tab 500 mg 10 kss
132

dus, 10 strip @
543 Parasetamol tab 500 mg 10 kss
53

544 Parasetamol tab 500 mg Tab 53

545 Pasta devitalisasi (non arsen) Tube 286,000
546 Pasta devitalisasi (non arsen) Pot 6 gr 286,000
547 pehacain inj ampul 3,080
548 Permethrin/ Permetrin Krim 5% Tube 11,825
549 Piracetam 800 mg tablet 801
550 Piracetam injksi 200 mg/5ml ampul 5,463
dus, 25 blister
551 Pirantel pamoat tab Scored 125 mg @ 4 tablet
269

dus, 25 blister
552 Pirantel pamoat tab Scored 125 mg @ 4 tablet
291

553 Pirantel pamoat tab scored 125 mg Tab 287

botol plastik @
554 Piridoksin ( Vit. B6 ) tab 10 mg (HCL) 100 tablet
118

botol plastik @
555 Piridoksin ( Vit. B6 ) tab 10 mg (HCL) 100 tablet
123

botol plastik @
556 Piridoksin ( Vit. B6 ) tab 10 mg (HCL) 100 tablet
123

557 Piridoksin (vitamin B6) tab 10 mg Tab 123

box 10 strip@
558 Piroksikam kapsul/kaplet/tablet 20 mg 11
124

box 10 strip@
559 Piroksikam kapsul/kaplet/tablet 20 mg 12
121

560 povidon iodin lar 100 mg/ml botol 6,550

561 povidon iodin lar 100 mg/ml botol 3,700
562 Povidon iodin lar 100 mg/ml Botol 60 ml 7,700
kotak @ 10 x
563 Prednison tab 5 mg 10 tab
69

kotak @ 10 x
564 Prednison tab 5 mg 10 tab
68

565 Prednison tab 5 mg Tab 68

dus, 10 strip @
566 Propanolol tab 10 mg (HCl) 10 tablet
52

dus, 10 strip @
567 Propanolol tab 10 mg (HCl) 10 tablet
54

568 Propiltiourasil tab 100 mg Tab 399

kotak @ 10 x
569 Propiltourasil tb 100 mg 10 tab
380

kotak @ 10 x
570 Propiltourasil tb 100 mg 10 tab
327

571 Propranolol tab 10 mg Tab 54

dus, 10 ampul
572 Ranitidin injeksi 25 mg/ 2ml @ 2 ml
1,458

dus, 10 ampul
573 Ranitidin injeksi 25 mg/ 2ml @ 2 ml
2,760
 dus, 10 ampul
574 Ranitidin injeksi 25 mg/ 2ml @ 2 ml
1,155

575 Ranitidin injeksi 25 mg/ 2ml Ampul 1,155

dus, 10 strip @
576 Ranitidin tab 150 mg 10 tss
105

dus, 10 strip @
577 Ranitidin tab 150 mg 10 tss
209

dus, 10 strip @
578 Ranitidin tab 150 mg 10 tss
209

579 Ranitidin tab 150 mg Tab 116

580 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 284

581 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 288
582 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 288
583 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 505
584 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 517
585 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 517
586 Ringer Asetat (ASERING) botol 500 ml 9,275
587 Ringer Asetat (ASERING) botol 500 ml 9,646
588 Ringer Asetat (ASERING) botol 500 ml 9,646
589 Ringer Laktat Larutan Botol 7,150
590 Ringer Laktat larutan Infus botol 500 ml 7,150
591 Ringer Laktat larutan Infus botol 500 ml 7,150
592 Ringer Laktat larutan Infus (Otsu) botol 500 ml 7,150
593 Ringer Laktat larutan Infus (Otsu) botol 500 ml 7,150

594 Risperidon tablet 2 mg botol 495

595 Risperidon tablet 2 mg botol 273

596 Risperidon tablet 2 mg Botol 273

597 Rivanol 300 cc botol 3,000
598 Rivanol 300 cc botol 3,000
599 Rivanol 300 cc Botol 2,420
600 Salbutamol cairan ih 0,1% Botol 4,400
dus, 4 x 5 botol
601 Salbutamol cairan ih. 0,1 %(VENTOLIN NEBULE) plastik @ 2,5 4,000
ml

dus, 4 x 5 botol
602 Salbutamol cairan ih. 0,1 %(VENTOLIN NEBULE) plastik @ 2,5 4,000
ml
603 Salbutamol tab 2 mg Tab 63
strip @ 10
604 Salbutamol tab 2 mg ( sebagai sulfat ) tablet
108

strip @ 10
605 Salbutamol tab 2 mg ( sebagai sulfat ) tablet
63

606 Salbutamol tab 4 mg Tab 70

607 Salbutamol tab 4 mg ( sebagai sulfat ) tablet 80
608 Salbutamol tab 4 mg ( sebagai sulfat ) tablet 70
 Salep 2-4 , Kombinasi : Asam Salisilat 2 % +
609 Belerang endap 4 % Pot @ 30 gram 2,527

Salep 2-4 , Kombinasi : Asam Salisilat 2 % +

610 Belerang endap 4 % Pot @ 30 gram 2,620

Salep 2-4, kombinasi : asam salisilat 2 %+ belerang

611 endap 4 % Tube 2,620

dus, 10 strip@
612 Sefadroksil kapsul 500 mg 10 kapsul
516

dus, 10 strip@
613 Sefadroksil kapsul 500 mg 10 kapsul
478

614 Sefadroksil kapsul 500 mg kaps 478

615 Sefadroksil sirup kering 125 mg/5ml Botol 3,299
dus, 10 vial @
616 Sefotaksim injeksi 1 gram 1g
4,898

dus, 10 vial @
617 Sefotaksim injeksi 1 gram 1g
4,200

618 Sefotaksim injeksi 1 gram Vial 4,200

619 Semen Zink Phospate set 220,220
620 Semen Zink Phospate (Multifix P/L) btl 206,250
621 Semen Zink Phospate (Multifix P/L) btl 220,220
622 Serum Anti Bisa Ular ( A.B.U. I ) vial @ 5 ml 479,996
Serum Anti Tetanus (ATS) cairan i.m 1500UI
623 (BIOSAT) ampul 1 ml 130,999

624 Serum Anti Tetanus ( A.T.S ) cairan i.m 1500 UI/ml ampul @ 1 ml 130,999

625 Setirizin tablet 10 mg tab 90

626 Setirizine tablet 10 mg tab 96
627 Setirizine tablet 10 mg tab 90
628 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul @ 1 ml 968
629 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul @ 1 ml 1,035
630 Sianokobalamin (vitamin B12) injeksi 500 mcg Ampul 1,320
631 Sianokobalamin (vitamin B12) tab 50 mcg Tab sal 51
632 Sianokobalamin (vitamin B12) tab 50 mcg Tab sal 46
633 Sianokobalamin (vitamin B12) tab 50 mcg Tab sal 46
634 Sianokobalamin (vitamin B12) tab 50 mcg Tab sal 46
635 Sikzonoat inj 25mg/mL Vial 57,500
636 Sikzonoat inj 25mg/mL Vial 57,500
637 Sikzonoat inj 25mg/mL Vial 59,800
dus 10 strip @
638 Simetidin tab 200 mg 10 tablet
178

dus 10 strip @
639 Simetidin tab 200 mg 10 tablet
200

dus 10 strip @
640 Simetidin tab 200 mg 10 tablet
220

dus 3 strip@
641 Simvastatin tab sal 10 mg 10 kss
101

dus 3 strip@
642 Simvastatin tab sal 10 mg 10 kss
110
643 Simvastatin tab sal 10 mg Tab sal 110
644 Simvastatin tab sal 20 mg tab 229
645 Simvastatin tab sal 20 mg tab 205
646 Simvastatin tab sal 20 mg Tab 205
dus, 10 blister
647 Siprofloksasin tab scored 500 mg @ 10 tab ss
240

dus, 10 blister
648 Siprofloksasin tab scored 500 mg @ 10 tab ss
265

649 Siprofloksasin tab scored 500 mg Tab 264

650 Spironolakton tab 100 mg Tab 539
651 Spironolakton tab 25 mg Vial 1,417
652 Spironolakton tab 25 mg Vial 195
653 Spironolakton tab 25 mg Vial 195
654 sukralfat susp 500mg/5ml, 100ml vial 8,338
Tablet tambah darah Kombinasi Ferro fumarat 60
655 mg + as. Folat 0.4 mg tablet salut Tab sal 354

Tablet tambah darah Kombinasi Ferro fumarat 60

656 mg + as. Folat 0.4 mg tablet salut Tab sal 354

dus, 10 strip @
657 Tetrasiklin kaps 250 mg 10 kapsul
166

dus, 10 strip @
658 Tetrasiklin kaps 250 mg 10 kapsul
174

659 Tetrasiklin kaps 250 mg Kaps 174

dus, 10 strip @
660 Tetrasiklin kaps 500 mg 10 kapsul
310

dus, 10 strip @
661 Tetrasiklin kaps 500 mg 10 kapsul
303

662 Tetrasiklin kaps 500 mg Botol 303

dus, 10 strip @
663 Tiamin ( Vitamin B1 ) tablet 50 mg 10 tablet
82

dus, 10 strip @
664 Tiamin ( Vitamin B1 ) tablet 50 mg 10 tablet
85

665 Tiamin ( Vitamin B1 ) tablet 50 mg tab 85

dus, 10 strip @
666 Triheksifenidil tab 2 mg 10 tablet
80

dus, 10 strip @
667 Triheksifenidil tab 2 mg 10 tablet
85

668 Triheksifenidil tab 2 mg tab 85

669 Valsartan tablet 655
botol plastik @
670 Vitamin B Compleks 100 tablet
115

botol plastik @
671 Vitamin B Compleks 100 tablet
83

kotak 10 ampul
672 Vitamin B Kombinasi 5000 injeksi (ikaneuron) @ 3 ml
1,875

673 Vitamin B kompleks tab 83

674 Vitamin B-Complex injeksi vial @ 20 ml 8,250
675 Vitamin B-Complex injeksi vial @ 20 ml 8,250
676 Vitamin dengan Mineral suspensi (anabion) botol @ 60 ml 6,000
Vitamin Kombinasi Injeksi ( Thiamin HCl 100mg ,
kotak 10 ampul
677 Piridoksin HCl 100 mg, Sianokobalamin 5000 mcg / @ 3 ml
5,500
3 ml )

Vitamin Kombinasi Injeksi ( Thiamin HCl 100mg ,

kotak 10 ampul
678 Piridoksin HCl 100 mg, Sianokobalamin 5000 mcg / @ 3 ml
6,050
3 ml )

Vitamin Kombinasi Kaplet ( Thiamin HCl 100mg , kotak 10 ampul

679 Piridoksin HCl 100 mg, Sianokobalamin 5000 mcg ) @ 3 ml
2,063

box 5 ampul
680 Vitamin Neurotropik @3 ml
5,390

Vitamin tambah darah ( Anti Anemia ) kotak 10 strip

681 (HEMAFORT) @ 10 dragee
825

682 Zinc sir 20 mg/5 ml botol @ 100 ml 6,290

683 Zinc sir 20 mg/5 ml botol @ 100 ml 2,972

684 Zinc sir 20 mg/5 ml botol @ 100 ml 2,972

dus, 10 strip @
685 Zinc tab disp 20 mg 10 tablet 513
dispersible

dus, 10 strip @
686 Zinc tab disp 20 mg 10 tablet 524
dispersible

dus, 10 strip @
687 Zinc tab disp 20 mg 10 tablet 524
dispersible
PROLANIS
688 ACARBOSE 100 MG Tab 779
689 ACARBOSE 50 MG Tab 562
ADALAT OROS 20 Nifedipine/ Nifedipin tab lepas
690 lambat 20 mg Tab 3,350

ADALAT OROS 30 Nifedipine/ Nifedipin tab lepas

691 lambat 30 mg Tab 3,700

692 Alpentine 100 mg box/100 1,045

693 BETAHISTIN MESILATE 6 mg Tab 110
694 Bisoprolol 5 mg box/100 597
695 Bisoprolol tablet/kapsul/kaplet 2,5 mg Tab 597
696 Bricasma injeksi 0,5 mg/ml Ampul 11,960
697 Bricasma respule 2,5 mg/ml respule 7,124
698 CLOPIDOGREL 75 mg Kaps 1,318
699 Clopidogrel 75 mg box/30 1,198
700 Glibenklamid tab 2.5 mg Tab 180
701 GLIMEPIRID 3 mg Tab 245
702 Glimepiride 3 mg box/100 223
703 KANDESARTAN 16 mg Tab 898
704 KANDESARTAN 8 mg Tab 519
705 LANTUS SOLOSTAR PEN 83,950
706 Levemir Flexpen Pcs 76,318

LEVEMIR FLEXPEN Analog insulin long acting inj

707 100 IU/mL, vial/cartridge disposible/penfill cartridge PEN 83,950

708 Lisinopril 10 mg box/100 209

Lisinopril dihydrate/ Lisinopril/ Lisinopril tablet
709 kapsul/kaplet 10 mg Tab 259

Lisinopril dihydrate/ Lisinopril/ Lisinopril tablet

710 kapsul/kaplet 5 mg Tab 209

NOVORAPID Analog insulin fast acting inj 100 IU/

711 mL, vial/cartridge disposible/penfill cartridge PEN 87,000

712 Novorapid flexpen pcs 87,000

Pioglitazone/ pioglitazone hydrochloride (HCL)/
713 pioglitazon tablet 15 mg Tab 2,145

714 Pulmicort respule 0,25 mg/ml respule 9,725

715 Pulmicort respule 0,5 mg/ml respule 13,242
716 Pulmicort turbohaler 200 mcg/200 dosis can 105,040
717 Ramipril 5 mg box/100 223
718 Ramipril tablet/kapsul/kaplet 5 mg Tab 245
719 Spironolactone 25 mg box/100 177
Spironolactone/ Spironolakton tablet/kapsul/kaplet
720 25 mg Tab 195

SYMBICORT 80/4.5 (60 DOSIS) kombinasi, setiap

721 dosis mengandung : Budesonid 80 mcg Formoterol Pcs 125,840
4,5 mcg (inhalasi)
722 Valsartan 80 mg box/30 655
723 Valsartan tablet 160 mg TAB 999
BMHP
724 AC Swab kotak 10,000
725 AC Swab kotak 15,730
726 AC SWAB CHG + 0.5% kotak/100 19,680
727 Alat suntik sekali pakai 1 ml (NIPRO) 100 pcs/ktk 990
728 Alat suntik sekali pakai 1 ml (NIPRO) 100 pcs/ktk 990
Alat suntik sekali pakai 10 cc Luer Lock With
729 100 pcs/ktk 1200
Needle 21 G x 1-1/2"
730 Alat suntik sekali pakai 10 cc With Needle 100 pcs/ktk 925
731 Alat suntik sekali pakai 10 cc With Needle 100 pcs/ktk 932
732 Alat suntik sekali pakai 10 ml (NIPRO) 100 pcs/ktk 1,298
733 Alat suntik sekali pakai 10 ml (NIPRO) 100 pcs/ktk 1,298
Alat suntik sekali pakai 1cc Luer Slip Tuberculin
734 100 pcs/ktk 1,023
with Needle 26Gx1 1/4"
735 Alat suntik sekali pakai 1cc With Needle 100 pcs/ktk 650
736 Alat suntik sekali pakai 1cc With Needle 100 pcs/ktk 649
737 Alat suntik sekali pakai 20 cc Without Needle 100 pcs/ktk 1,500
738 Alat suntik sekali pakai 20 cc Without Needle 100 pcs/ktk 1,507
Alat suntik sekali pakai 20 ml Luer Slip Without
739 100 pcs/ktk 2,090
Needle

740 Alat suntik sekali pakai 20 ml tanpa jarum (NIPRO) set 2,700

741 Alat suntik sekali pakai 3 cc With Needle 100 pcs/ktk 650
742 Alat suntik sekali pakai 3 cc With Needle 100 pcs/ktk 649
Alat suntik sekali pakai 3 cc Luer Lock With Needle
743 100 pcs/ktk 779
23 G x 1 1/4"
Alat suntik sekali pakai 3 cc Luer Luer Lock with
744 100 pcs/ktk 924
Needle 23Gx1 1/4"
745 Alat suntik sekali pakai 3 ml 100 pcs/ktk 748
746 Alat suntik sekali pakai 3 ml (NIPRO) 100 pcs/ktk 792
747 Alat suntik sekali pakai 3 ml (NIPRO) 100 pcs/ktk 779
748 Alat suntik sekali pakai 3 ml (TERUMO) 100 pcs/ktk 1,138
749 Alat suntik sekali pakai 3 ml (TERUMO) 100 pcs/ktk 957
Alat suntik sekali pakai 5 cc Luer Lock With Needle
750 100 pcs/ktk 968
22 G x 1-1/2"
751 Alat suntik sekali pakai 5 cc With Needle 100 pcs/ktk 750
752 Alat suntik sekali pakai 5 cc With Needle 100 pcs/ktk 704
753 Alat suntik sekali pakai 5 ml 100 pcs/ktk 924
754 Alat suntik sekali pakai 5 ml (NIRPO) 100 pcs/ktk 979
755 Alat suntik sekali pakai 5 ml (NIRPO) 100 pcs/ktk 979
Alat suntik sekali pakai 5cc Luer Luer Lock with
756 100 pcs/ktk 1,045
Needle 22Gx1 1/2"
757 ALKOHOL + Clorhexidin Swab kotak/100 15,730
758 Alkohol 70 % 1 liter botol 1 liter 25,000
759 Alkohol 70 % 1 liter botol 1 liter 25,000
760 Alkohol 70 % 1 liter botol 1 liter 25,000
761 Alkohol 70 % 300 ml botol 1 liter 8,250
762 Alkohol 70 % 300 mL botol 1 liter 8,000
763 Antiseptik dan disinfektan botol 40,000
764 Antiseptik dan disinfektan botol 34,500
765 Antiseptik dan Disinfektan 500 ml 34,500
766 Blood Lancet No.26 G box/ 100 pcs 14,566
767 Blood Lancet No.26 G box/ 100 pcs 14,566
768 Blood Lancet No.26 G kotak/100 16,000
769 Blood Lancet No.26 G kotak/100 14,566
770 Blood Lancet No.28 G box/ 100 pcs 14,566
771 Blood transfusion set box/ 100 pcs 13,420
772 Blood transfusion set box/ 100 pcs 3,600
773 Blood transfusion set box/ 100 pcs 3,600
774 Blood transfusion set box/ 100 pcs 5,500
775 Blood transfusion set box/ 100 pcs 6,700
776 Cat Gut Chromic 1 HR-48 mm pcs 48,000
777 Cat Gut Chromic 1 HR-48 mm (SMI) pcs 47,190
778 Cat Gut Chromic 2/0 75C + jarum 1/2 30m R pcs 329,967
779 Cat Gut Chromic 2/0 HR-26 mm pcs 36,080
780 Cat Gut Chromic 2/0 HR-26 mm pcs 39,688
781 Cat Gut Chromic 3/0 75C + jarum 1/2 22m R pcs 329,967
782 Cat Gut Chromic 3/0 HR-26 mm pcs 33,525
783 Cat Gut Chromic 3/0 HR-26 mm pcs 35,000
784 Cat Gut Plain 1 HR-37 mm pcs 42,130
785 Cat Gut Plain 1 HR-37 mm pcs 38,300
786 Cat Gut Plain 2/0 70C + jarum 1/2 25m R pcs 391,072
787 Cat Gut Plain 2/0 HR-26 mm pcs 36,000
788 Cat Gut Plain 2/0 HR-26 mm (SMI) pcs 34,300
789 Cat Gut Plain 3/0 70C + jarum 1/2 25m R pcs 360,520
790 Cat Gut Plain 3/0 HR-26 mm pcs 36,000
791 Cat Gut Plain 3/0 HR-26 mm (SMI) pcs 34,300
Chromic Cat Gut 2/0 75C + jarum 1/2 30m R
792 Box isi 12 24,998
(Demetech)
Chromic Cat Gut 3/0 75C + jarum 1/2 22m R
793 Box isi 12 24,998
(Demetech)
794 Dermafix T 10x20 pcs 9,036
795 Dermafix T 10x25 pcs 13,770
796 Dermafix T 10x8 pcs 4,212
797 Dermafix T 5x7 pcs 1,629
798 Dermafix 10 x 20 box isi 10 pcs 13,761
799 Dermafix 10 x 20 box isi 10 pcs 9,036
800 Dermafix 10 x 25 box isi 10 pcs 9,031
801 Dermafix 10 x 25 box isi 10 pcs 13,770
802 Dermafix T 10x12 (Onemed) box isi 10 pcs 6,309
803 Dermafix T 10x15 (Onemed) box isi 10 pcs 8,316
804 Dermafix T 10x15 (Onemed) box isi 10 pcs 8,316
805 Dermafix T 10x8 (Onemed) box isi 10 pcs 4,212
806 Dermafix T 10x8 (Onemed) box isi 10 pcs 4,212
807 Dermafix T 5x7 (Onemed) box isi 10 pcs 1,629
808 Dermafix T S IV (Onemed) box isi 10 pcs 2,052
809 Disposible Needle No. 23 100 pcs/ktk 60,500
810 Disposible Needle No. 23 G x 1 1/4' 100 pcs/ktk 470
811 Disposible Needle No. 23 G x 1 1/4' 100 pcs/ktk 369
812 Disposible Needle No. 23 G x 1 1/4' Pcs 330
813 Disposible Needle No. 23 G x 11/4" 1 box/100 pcs 36,905
814 Disposible Needle No. 24 G x 1 1/4' 100 pcs/ktk 442
815 Disposible Needle No. 24 G x 1 1/4' 100 pcs/ktk 369
816 Disposible Needle No. 24 G x 1 1/4' 100 pcs/ktk 330
817 Disposible Needle No. 24 G x 1" 100 pcs/ktk 36,905
818 Disposible Needle No. 25 G x 1 1/4' 100 pcs/ktk 605
819 Disposible Needle No. 25 G x 1 1/4' 100 pcs/ktk 369
820 Disposible Needle No. 25 G x 1 1/4' 100 pcs/ktk 330
821 Disposible Needle No. 25 G x 1" 100 pcs/ktk 36,905
822 Folley Cateter 2 way No.12 kotak 8,000
823 Folley Cateter 2 way No.14 kotak 8,000
824 Folley Cateter 2 way No.16 kotak 8,000
825 Folley Cateter 2 way No.16 kotak 8,000
826 Folley Cateter 2 way No.18 kotak 8,000
827 Folley Cateter 2 way No.18 kotak 8,000
828 Folley Cateter 2 way No.20 kotak 8,000
829 Folley Cateter 2 way No.20 kotak 8,000
830 Folley Cateter 2 way No.22 kotak 8,000
831 Folley Cateter 2 way No.24 kotak 8,000
832 Folley Cateter 3 way No.22 kotak 32,500
833 Folley Cateter No.14 pcs 7,999
834 Folley Cateter No.14 pcs 13,090
835 Folley Cateter No.16 pcs 7,999
836 Folley Cateter No.16 pcs 10,340
837 Folley Cateter No.18 pcs 7,999
838 Folley Cateter No.19 pcs 13,090
839 Folley Cateter ped No.10 pcs 30,000
840 Folley Cateter ped No.6 pcs 36,500
841 Folley Cateter ped No.8 pcs 30,000
842 Folley Catheter 2 Way NO. 10 pcs 35,200
843 Folley Catheter 2 Way no. 14 pcs 80,000
844 Folley Catheter 2 Way no. 16 pcs 80,000
845 Folley Catheter 2 Way no. 18 pcs 80,000
846 Folley Catheter 2 Way no. 20 pcs 80,000
847 Folley Catheter 2 Way no. 22 pcs 80,000
848 Folley Catheter 2 Way no. 24 pcs 80,000
849 Folley Catheter 2 Way NO. 8 pcs 35,200
850 Folley Catheter 2 Way NO.6 pcs 41,000
851 Folley Catheter 3 Way NO. 22 pcs 44,000
852 Folley Catheter 3 Way no. 22 pcs 325,000
853 Folley Catheter Ped no. 10 pcs 300,000
854 Folley Catheter Ped no. 6 pcs 365,000
855 Folley Catheter Ped no. 8 pcs 300,000
856 Folley chateter 2 way no. 10 pcs 11,800
857 Folley chateter 2 way no. 12 pcs 11,800
858 Folley chateter 2 way no. 12 pcs 9,200
859 Folley chateter 2 way no. 14 pcs 11,800
860 Folley chateter 2 way no. 14 pcs 9,200
861 Folley chateter 2 way no. 16 pcs 11,800
862 Folley chateter 2 way no. 16 pcs 9,200
863 Folley chateter 2 way no. 18 pcs 11,800
864 Folley chateter 2 way no. 18 pcs 9,200
865 Folley chateter 2 way no. 20 pcs 11,800
866 Folley chateter 2 way no. 20 pcs 9,200
867 Folley chateter 2 way no. 22 pcs 11,800
868 Folley chateter 2 way no. 22 pcs 9,200
869 Folley chateter 2 way no. 24 pcs 11,800
870 Folley chateter 2 way no. 24 pcs 9,200
871 Folley chateter 2 way no. 6 pcs 11,800
872 Folley chateter 2 way no. 8 pcs 11,800
873 FollyFolley Catheter 2 Way no. 12 pcs 80,000
874 Handscoon (L) pcs 41,250
875 Hypafix 5cm x 5 m roll 65,500
876 Hypafix 5cm x 5 m roll 76,200
877 Infus set anak (stera) buah 3,498
878 Infus set anak (stera) buah 3,500
879 infus set dewasa (stera) buah 7,920
880 infus set dewasa (stera) buah 3,200
881 Infusion Set (Anak) COSMOMED pcs 4,400
882 Infusion set anak OTSU OI pcs 7,920
883 Infusion Set Anak Stera pcs 3,500
884 Infusion Set Dewasa ( 20 drops/ml ) pcs 8,140
885 Infusion Set Dewasa ( 20 drops/ml ) (Nipro) set / kantong 4,975
886 Infusion Set Dewasa ( 20 drops/ml ) (Otsu Y set) set / kantong 3,190
887 Infusion Set Dewasa ( 20 drops/ml ) (Otsu Y set) set / kantong 3,200
888 Infusion Set Dewasa COSMOMED pcs 4,200
889 Infusion Set Dewasa JAYAMAS Stera pcs 3,200
890 Infusion set Dewasa OTSU Y pcs 7,920

891 Infusion Set Pediatric ( 60 drops/ml) (Otsuka OI 34) set / kantong 7,920

892 Infusion Set Pediatric ( 60 drops/ml) (Otsuka OI 34) set / kantong 3,500

893 IV Cannula with Safety Wings No. 20 pcs 4,700

894 IV Cannula with Safety Wings No. 24 COSMOMED pcs 4,700

895 IV Cannula with Safety Wings No.22 COSMOMED pcs 4,700

896 IV Cannula with Safety Wings No.26 COSMOMED pcs 4,700

897 IV Cateter No. 18 G (Nipro) 50 bh / ktk 7,018

898 IV Cateter No. 18 G (Nipro) 50 bh / ktk 3,800
899 IV Cateter No. 20 G pcs 12,631
900 IV Cateter No. 20 G STERA pcs 3,800
901 IV Cateter No. 22 50 bh / ktk 7,700
902 IV Cateter No. 22 50 bh / ktk 7,700
903 IV Cateter No. 22 50 bh / ktk 3,800
904 IV Cateter No. 22 50 bh / ktk 3,800
905 IV Cateter No. 22 G pcs 12,631
906 IV Cateter No. 22 G STERA pcs 3,800
907 IV Cateter No. 24 G STERA pcs 3,800
908 IV Cateter No. 26 G pcs 13,476
909 IV Cateter No. 26 G STERA pcs 4,100
910 IV Cateter No. 26 G WINFLON 50 bh / ktk 4,100
911 IV Catheter 22 G - Otsucath pcs 7,700
912 IV Catheter 20 G - Otsucath pcs 7,700
913 IV Catheter 24 G - Otsucath pcs 7,700
914 Iv Catheter no. 20 50 bh / ktk 3,795
915 Iv Catheter no. 20 50 bh / ktk 7,000
916 Iv Catheter no. 20 50 bh / ktk 3,800
917 Iv Catheter no. 20 50 bh / ktk 3,800
918 Iv Catheter no. 24 50 bh / ktk 7,700
919 Iv Catheter no. 24 50 bh / ktk 3,795
920 Iv Catheter no. 24 50 bh / ktk 3,795
921 IV DRESSING S IV pcs 2,052.54
922 IV DRESSING 6 X 7 S (ID67S) BOX/100 220,000.00
923 Kapas berlemak 500 gr roll 583
924 Kapas Berlemak 500 gr SURYA HUSADA pcs 21,500
925 kapas berlemak 500g Onemed pCS 16,500
926 Kapas Onemed 500 gram roll 27,280
927 Kapas Onemed 500 gram roll 27,280
928 Kapas pembalut / absorben 250 mg roll 748
929 Kapas pembalut / absorben 250 mg roll 13,400
930 Kapas pembalut / absorben 250 mg pcs 12,500
931 Kapas pembalut / absorben 500 mg roll 1,496
932 Kapas pembalut / absorben 500 mg pcs 27,280
933 Kasa 40 x 40 JAYAMAS pcs 1,600
934 Kasa 40 cm x 40 AHMADARIS pcs 1,800
935 Kasa 40 cm x 40 SURYA HUSADA pcs 1,618
936 Kasa 40 X 80 cm UTAMA roll 103,000

937 Kasa hydrofil Steril 16 x16 cm SURYA HUSADA Pcs 5,950

938 Kasa hydrofil Steril 16 x16 cm UTAMA box / 16 5,950

939 Kasa hydrofil Steril 16 x16 cm UTAMA box / 17 5,950
940 Kasa hydrofil Steril 16 x16 cm UTAMA Pcs 5,500
941 Kasa Pembalut Hidrofil 4 m x 10 cm pcs 1,584

942 Kasa Pembalut Hidrofil 4 m x 10 cm AHMADARIS pcs 2,300

943 Kasa Pembalut Hidrofil 4 m x 10 cm ONEMED pcs 1,500

Kasa Pembalut Hidrofil 4 m x 10 cm SURYA
944 pcs 1,600
HUSADA
945 Kasa Pembalut Hidrofil 4 m x 15 cm pcs 2,100
946 Kasa Pembalut Hidrofil 4 m x 3 cm pcs 590

947 Kasa Pembalut Hidrofil 4 m x 3 cm AHMADARIS pcs 800

948 Kasa Pembalut Hidrofil 4 m x 3 cm ONEMED pcs 590

949 Kasa Pembalut Hidrofil 4 m x 3 cm UTAMA pcs 580
950 Kasa Pembalut Hidrofil 4 m x 5 cm pcs 750
951 Kasa 40 x 80 cm roll 105,000
952 Kasa 40 x 80 cm roll 108,500
953 Kasa 40 x 80 cm roll 105,000
954 Kasa 40 x 80 cm ONEMED roll 105,000
955 kasa 40 x 80 cm SURYA HUSADA roll 108,500
956 Kasa Hidrofil 2m x 80cm roll 118,182
957 Kasa Hidrofil 2m x 80cm roll 143,000
958 Kasa Hidrofil 2m x 80cm roll 7,700
959 Kasa Hidrofil 2m x 80cm AHMADARIS Roll 9,400
960 Kasa Hidrofil 2m x 80cm ONEMED Roll 7,800
961 Kasa Hidrofil 2m x 80cm SURYA HUSADA Roll 7,930
962 kasa hidrofil 40 x 16 cm roll 36,960
963 Kasa hydrofil steril 16 x 16 JAYAMAS Pcs 8,000
964 Kasa Kompres steril 40 x 40 buah 1,600
965 Kasa Kompres steril 40 x 40 buah 1,600
966 Kasa Pembalut Hidrofil 4 m x 15 cm roll 2,090
967 Kasa Pembalut Hidrofil 4 m x 15 cm roll 2,100

968 Kasa Pembalut Hidrofil 4 m x 15 cm AHMADARIS pcs 3,800

969 Kasa Pembalut Hidrofil 4 m x 15 cm ONEMED pcs 2,100

Kasa Pembalut Hidrofil 4 m x 15 cm SURYA
970 pcs 2,240
HUSADA
971 Kasa Pembalut Hidrofil 4 m x 5 cm roll 748
972 Kasa Pembalut Hidrofil 4 m x 5 cm roll 750

973 Kasa Pembalut Hidrofil 4 m x 5 cm AHMADARIS pcs 1,100

974 Kasa Pembalut Hidrofil 4 m x 5 cm ONEMED pcs 750

Kasa Pembalut Hidrofil 4 m x 5 cm SURYA
975 pcs 800
HUSADA
976 kasa pembalut hidrofil 4m x 10cm roll 1,496
977 kasa pembalut hidrofil 4m x 10cm roll 1,584
978 kasa pembalut hidrofil 4m x 3cm roll 583
979 kasa pembalut hidrofil 4m x 3cm roll 590
980 kasa Stiril 16 x 16 cm roll 6,800
981 Leukoplast 44,400
982 Masker Earloop box/50 pcs 439
983 Masker Nebulizer dws pcs 33,000
984 Masker Oksigen anak pcs 13,552
985 Masker Oksigen anak pcs 13,552
986 Masker Oksigen dewasa pcs 13,552
987 Masker Oksigen dewasa pcs 13,552
988 Masker Plus 3 Ply Plus Earloop (Jilbab) box/50 pcs 440
989 Masker Tie On box/50 pcs 439
990 Nasal Canula Adult / selang oksigen dewasa 50 pcs/ karton 11,000
991 Nasal Canula Adult / selang oksigen dewasa 50 pcs/ karton 9,350
 Nasal Canula Adult / selang oksigen dewasa
992 pcs 5,500
BESMED
Nasal Canula Adult / selang oksigen dewasa
993 pcs 5,900
COSMOMED

994 Nasal Canula Adult / selang oksigen dewasa MMP pcs 5,082

995 Nasal Canula Child / selang Oksigen anak 50 pcs/ karton 9,350
996 Nasal Canula Child / selang Oksigen anak 50 pcs/ karton 9,350
Nasal Canula Child / selang Oksigen anak
997 pcs 5,500
BESMED
Nasal Canula Child / selang Oksigen anak
998 pcs 5,900
COSMOMED

999 Nasal Canula Child / selang Oksigen anak MMP pcs 5,082

Nasal Canula INFANT / selang oksigen bayi

1000 pcs 5,500
BESMED
Nasal Canula infant / selang oksigen bayi
1001 pcs 5,900
COSMOMED

1002 Nasal Canula INFANT / selang oksigen bayi MMP pcs 5,082

1003 Omeprazol Kapsul Dewasa tab 140

1004 Oxyflow Soft Dewasa 5,500
Plain Cat Gut 2/0 70C + jarum 1/2 25m R Box isi 12
1005 355,520
(Demetech) sachet
Plain Cat Gut 3/0 70C + jarum 1/2 25m R Box isi 12
1006 327,745
(Demetech) sachet
1007 Plester Bulat transparan roll 38,500
1008 Plester Bulat transparan roll 30,000
1009 Plester Non Woven Roll 10cm x 5m roll 41,360
1010 Plester Non Woven Roll 5cm x 5m roll 23,760
1011 Plester Rol Kain 1.25 cm x 4.5 m roll 5,789
1012 Plester Rol Kain 5 cm x 4.5 m roll 25,404
1013 Plester Ultrafix roll 39,600
1014 safety box pcs 15,708
1015 safety box pcs 15,715
1016 Safety Box 5 L DOCARE kotak 21,500.00
1017 Safety Box 5 L ONEMED kotak 15,715.35
1018 Sarung Tangan No Powder kotak/100 pcs 65,000
1019 Sarung Tangan No Powder L Box/100 pcs 583
1020 Sarung Tangan No Powder L Box/100 pcs 572
1021 Sarung Tangan No Powder L Box/100 pcs 583
1022 Sarung Tangan No Powder M Box/100 pcs 583
1023 Sarung Tangan No Powder M Box/100 pcs 660
1024 Sarung Tangan No Powder M Box/100 pcs 572
1025 Sarung Tangan No Powder M Box/100 pcs 583
1026 Sarung Tangan No Powder S Box/100 pcs 583
1027 Sarung Tangan No Powder S Box/100 pcs 583
1028 Sarung Tangan No Powder XS Box/100 pcs 660
Sarung Tangan dengan Powder MMP
1029 box 100 pcs 46,200
EXAMINATION GLOVE
1030 Sarung Tangan dengan Powder ONEMED BOX/50 pcs 19,360

1031 Sarung Tangan Non steril dengan Powder Size L Box 50 pasang 653

Sarung Tangan Non steril dengan Powder Size M

1032 Box 50 pasang 653
(Ansell)
1033 Sarung Tangan Steril TOP GLOVE E CARE pcs 4,500

1034 Sarung Tangan Steril 7,5 Box 50 pasang 4,180

1035 Sarung Tangan Steril Bebas Powder pcs 10,153

1036 Sarung Tangan Steril Bebas Powder Size 6,5 Box 50 pasang 10,153

1037 Sarung Tangan Steril Bebas Powder Size 7 Box 50 pasang 10,153

1038 Sarung Tangan Steril Bebas Powder Size 7,5 Box 50 pasang 10,153

Sarung Tangan steril bebas Powder TOP GLOVE

1039 Pcs 5,940
ECARE
1040 Sarung Tangan Steril COSMOMED pcs 4,100

1041 Sarung Tangan Steril dengan Powder Size 6,5-7 Box 50 pasang 7,623

1042 Sarung Tangan Steril dengan Powder Size 7,5 Box 50 pasang 7,623

1043 Sarung Tangan Steril dengan Powder Size 7-7.7 Box 50 pasang 7,623

1044 Sarung Tangan Steril dengan Powder Size 7-7.9 Box 50 pasang 7,623

1045 Sarung Tangan Steril MMP MEDIDENT pcs 5,000

1046 Sarung Tangan Steril SAFEGLOVE pcs 4,180
1047 Sarung tangan steril TRO-SENSOSURGE pcs 6,595
1048 saveglove exam L pcs 35,618
1049 saveglove exam L pcs
1050 saveglove exam M pcs 35,618
1051 saveglove exam M pcs
1052 Selang Oksigen Anak pcs 5,500
1053 Selang Oksigen Anak pcs 5,500
1054 Selang Oksigen Bayi pcs 5,500
1055 Selang Oksigen Bayi pcs 5,500
1056 Selang Oksigen Dewasa pcs 5,500
1057 Selang Oksigen Dewasa pcs 5,500
1058 Serbuk Enzymatic utk sterilisasi alat Box / 25 pcs 801,000

1059 Sesi Glove S Box 50 pasang 50,255

Box isi 12
1060 Silk 2/0 75C + jarum 3/8 30m C 219,978
sachet
 Box isi 12
1061 Silk 2/0 75C + jarum 3/8 30m C (Demetech) 15,500
sachet
1062 Silk 2/0 DS- 30 mm pcs 24,260
Box isi 12
1063 Silk 3/0 75C + jarum 3/8 26m C 219,978
sachet
Box isi 12
1064 Silk 3/0 75C + jarum 3/8 26m C (Demetech) 15,500
sachet
1065 Silk 3/0 DS - 24 mm pcs 22,400
Box isi 12
1066 Silk Black 2/0 HR - 26 mm 1,861
sachet
Box isi 12
1067 Silk Black 3/0 HR -26 mm 1,806
sachet
1068 Spalk 10 x 5 cm buah 4,076
1069 Spalk 10 x 5 cm buah 4,158
1070 Spalk 5 x 15 buah 8,250
1071 Spalk 5 x 15 buah 5,198
1072 Suction Cateter No.10 pcs 3,100
1073 Suction Cateter No.10 pcs 3,520
1074 Suction Cateter No.10 pcs 3,597
1075 Suction Cateter No.10 (ONEMED) pcs 4,345
1076 Suction Cateter No.10 (ONEMED) pcs 4,345
1077 Suction Cateter No.12 pcs 3,100
1078 Suction Cateter No.12 pcs 3,520
1079 Suction Cateter No.12 (ONEMED) pcs 4,345
1080 Suction Cateter No.12 (ONEMED) pcs 4,345
1081 Suction Cateter No.14 pcs 3,100
1082 Suction Cateter No.14 pcs 3,520
1083 Suction Cateter No.16 pcs 3,100
1084 Suction Cateter No.16 pcs 3,520
1085 Suction Cateter No.16 pcs 3,597
1086 Suction Cateter No.16 (ONEMED) pcs 4,345
1087 Suction Cateter No.16 (ONEMED) pcs 4,345
1088 Suction Cateter No.18 (ONEMED) pcs 4,345
1089 Suction Cateter No.18 (ONEMED) pcs 4,345
1090 Suction Cateter No.6 pcs 3,100
1091 Suction Cateter No.6 pcs 3,520
1092 Suction Cateter No.6 pcs 3,597
1093 Suction Cateter No.6 (ONEMED) pcs 4,345
1094 Suction Cateter No.6 (ONEMED) pcs 4,345
1095 Suction Cateter No.8 pcs 3,100
1096 Suction Cateter No.8 pcs 3,520
1097 Suction Cateter No.8 pcs 3,597
1098 Suction Cateter No.8 (ONEMED) pcs 4,345
1099 Suction Cateter No.8 (ONEMED) pcs 4,345
1100 Suction Cateter No12 pcs 3,597
1101 Suction Cateter No14 pcs 3,597
1102 Surflo no. 20 pcs 13,225
1103 Surflo no. 22 pcs 12,500
1104 Surflo no. 22 pcs 12,500
1105 Surflo no. 24 pcs 12,500
1106 Surgical mask 3 ply earloop box/49 594
1107 Surgical mask 3 ply plus earloop box/50 440
1108 Surgical mask 3 ply plus earloop box/50 440
1109 Surgical mask 3 ply tie on box/50 440
1110 Surgical mask 3 ply tie on box/50 440
1111 Surgical mask earloop box/50 330
1112 Surgical mask earloop box/50 439
1113 Surgical Mask Earloop/ TIE ON IMASKE box 50 pcs 19,800
1114 Surgical Mask Earloop/ TIE ON Onemed box 50 pcs 16,500
1115 Surgical mask tie on box/50 600
1116 Surgical mask tie on box/50 439
1117 SURGICAL MASK TIE ON /EAR LOOP box 50 pcs 21,945

1118 Surgical mask-masker Tie On BEAUTY KASATAMA box/50 439

1119 Surgical mask-masker Tie On BEAUTY KASATAMA box/50 439

1120 Underpad pcs 7,800

1121 Underpad pcs 4,620
1122 Underpad pcs 4,162
1123 Underpad BOX/10 41,624
1124 Underpad 60 x 90 pcs 4,620
1125 Underpad 60x90 pcs 4,620
1126 Urin bag standard steril 2 lt (T valve) buah 2,992
1127 Urin bag standard steril 2 lt (T valve) buah 3,000
1128 Urin bag steril 2 lt buah 3,000
1129 Urine Bag standard steril no hanger pcs 4,800
1130 Urine Bag standard steril NO hanger pcs 3,000
1131 Urine Bag standard steril with hanger pcs 5,808

JUMLAH OBAT
JUMLAH BMHP
JUMLAH TOTAL

HARGA
OBAT JKN BELI SENDIRI KEMASAN OBAT BELI
SENDIRI
1 Antrain Inj. Amp
dus, 10 strip @
2 Acarbose 10 tablet
3 Acyclofir cream Tube
4 Acyclovir 200 mg tab
 5 Asiklovir 400 mg box/50
6 Adona Ac 2 ml inj ampul
7 Aito tts mata
8 Albendazol 400 mg Tablet
9 Alinamin injeksi / Furamin inj ampul
10 Allopurinol 100 mg kotak
11 Allopurinol 300 mg kotak
12 Alprazolam 0,5 mg Tablet
13 Ambroxol syr botol
14 Ambroxol tablet 30 mg box 10 x 10's
15 Aminofilin inj 24 mg/ml ampul
16 Aminofilin tab kotak
botol @ 100
17 Aminoflin tablet scored 200 mg .
tab
dus, 10 strip @
18 Amitriptilin tablet salut 25 mg (HCl) 10 tss
19 Amlodipin 10 mg Tablet
20 Amlodipin 5 mg tablet tablet
21 Amoksisilin 500 mg tab kotak
22 amox sirup kering 125mg/5ml btl60ml
23 Amoxcicillin (ETAMOX DRY SIRUP) BOTOL
24 Amoxicilin 500 mg kaplet
25 Amoxicilin syrup botol
26 Amoxicillin 500mg 10T Box/100
27 Amoxicillin Dry sirup 125mg/5ml botol
28 Analgesik Non Narkotik Injeksi (NOVALDO) ampul
dus 10 x 10
29 Antalgin tablet 500 mg
tablet
30 Antasida Doen Tablet
31 Antasida DOEN tablet tablet
32 Antasida Doen Erela 10T Box/100
33 Antasida Doen Srp Kaleng
34 Antasida Syr botol
35 Antasida syrup Botol
36 anti anemia (Novabion) Tablet
37 Anti anemia (Samcobion tablet) tablet
38 Anti asma komb (Teosal) tab
39 Anti Bakteri Topikal Tetes telinga (RECO) botol @ 10 ml
40 Anti Diare Ank Sacet
41 Anti Flu tablet (Calortusin) tablet
42 Anti Flu tablet (Tera -F) tablet
43 Anti influenza kaplet (MOLEXFLU) box 150's
44 Anti influenza syrup botol
45 Anti Spasmodik (Dormi) tablet tablet
46 Antihemoroid (Superhoid sup) Sup
47 Antiinfluenza ( demacolin) Tablet
48 Antrain injeksi ampul

49 Aqua pro injeksi steril, bebas pirogen(OTSU 25) Ampul @ 25 ml

50 Asam askorbat (Vit.C) tablet tablet

51 Asam Mefenamat 500mg tablet
52 Asam Traneksamat ( Nexitra) tab
53 Asam Traneksamat inj ampul
dus, 10 ampul
54 Asam traneksamat injeksi 50 mg/ml
@ 5 ml
55 Asam Traneksamat Tab tab
56 Asam Tranexamat ( nexitra) Tablet
57 Asering botol
58 Aspilet (asetosal) Tablet
59 Atapulgit Tablet
60 Azitromicin Tablet
61 B Complex AFI 10 Tab Box/100
62 Bactoprim forte tab
63 Bahan tumpat sementara (CAVIT W) Jar
64 betadine 5 botol
65 Betahistin Mesilat tab
66 Bioplacenton gel Tube
67 Bioran inj amp
68 Bisakodil (Dulcolax Sup ) tube
69 Bisakodil 10 mg (Dulcolax Sup ) Supp
70 Bisakodil 5 mg (Dulcolax Sup ) Supp
71 Bisakodil suppositoria supp
72 Bisakodil tab tab
73 Bisolvon solution ampul
74 Bisoprolol (Concor 2,5 mg) Tablet
dus, 5 blister @
75 Bisoprolol 5mg
10 tablet
76 Bisoprolol tablet 2.5mg (concor) tablet
77 Borax Gliseril botol
78 Bufacomb krim Tube
79 Calcium Lactat 500 mg tablet
80 Calcium Laktat Tablet
dus, 3 strip @
81 Candesartan
10 tablet
82 CANDESARTAN 16 MG BOX / 30
83 candesartan 8 mg tab
84 Captopril 12,5 mg Box/10
85 Captopril 25 mg Tablet
86 carbaochrome inj (Saldona inj) amp
87 Carbazochrome Inj 1 Amp Amp
88 Cefadroksil syr botol
89 Cefadroxil 500 Dexa 10T Box/100
 90 Cefadroxyl 500 mg Tablet
91 Cefadroxyl syrup 125 mg/ 5 ml Botol
92 Cefixim 100 mg Tablet
93 Cefotaxim Inj 1 vial Hexapharma Vial
94 Cefotaxim injeksi Vial
95 Ceftriaxone inj Vial
96 Cetrizin Tab tab
97 Chloramfenicol 500 mg Kapsul
98 Chlorpromazin 100 mg Tablet
99 Ciprofloxacin 10T-Nova Box/100
100 Ciprofloxacin Tab 500 mg tablet
101 Cithicolin inj amp
box,5 strips @
102 Clindamisin 300 mg
10 tablets
103 Clindamycin 300 mg Tablet
104 Clopidogrel 75 mg Tablet
105 Clozapin 100 mg Tablet
106 Clozapin 25 mg Tablet
107 Codein 10 mg box/100
108 Coro-sorb Tablet
109 Cotrim Syp botol
110 Cotrim Tab Box/100
111 CTM Tablet
112 Curcuma + vit b syrup Botol
113 Curcuma + vit b tab Tablet
114 Curcuma tab tab
115 D40% botol
116 D5%1/4NS btl60ml
dus, 10 srtip @
117
Deksametason tablet 0,5 mg 10 tablet
118 Dexametason inj 5 mg ampul
119 Dexametason/Novadex Tablet
120 Diazepam inj 5 mg/ml ampul
121 Difenhidramin inj 10 mg/ml ampul
122 Digoxin Tablet
123 Digoxin tab 0,25mg tablet
124 Dimenhidrinat 50 mg kotak
125 Dimetilpolisiloksan (Disflatyl) tab
126 Diphenhidramin amp / vial
127 Domperidon 10 mg Tablet
128 Doksisiklin 100 mg tab
129 epinefrin inj. amp
130 Erelamicetin Tetes telinga Botol
131 Eritromycin tab kotak
132 Erlamicetin Tetes mata Botol
133 Erlamycetin plus Tetes mata Botol
134 Erytromycin dry syr botol
135 Etil Klorida semprot 100 ml btl @ 100 ml
136 Fitomenadion injeksi Ampul
dus @ 30
137 Fitomenadion Injeksi 2 mg/ml
ampul
dus @ 30
138 Fitomenadion Tab 10 mg
ampul
139 Furosemid Tablet
140 Furosemid inj ampul
141 Furosemide tab kotak
dus, 5 strip @
142 Gabapentin 100 mg
10 kapsul
143 Garam Oralit sach
144 Garam Oralit serbuk kombinasi sachet
145 Gelang tangan biji
146 Gembifrozil 300 mg kapsul kapsul
147 GENTAMISIN (Genoint Salp Kulit) Tube
148 Gentamisin (Genoint tts mata) botol
149 Gentian violet botol
150 Glibenklamid (RENABETIC) Tablet
151 Glibenklamid 5 mg Tablet
152 Glicazid (Glucodex) tablet tablet
153 Glicazid (Glucodex) tablet tablet
154 Gliceril guaiacolat Tablet
155 Glimepirid 2 mg Tablet
box,10 strips @
156 Glimepiride 3 mg
10 tablets
kotak @ 10 x
157 Glimepiride 4mg
10 tab
158 Gliseril Guayakolat (G.G) tablet tablet
159 Glucosa 5 % Botol

160 Glukosa Larutan Infus 5% steril botol @ 500 ml

161 Griseofulvin tab 125 mg kotak

162 Griseofulvin tablet 125 mg tablet
163 Haloperidol 5 mg ( Lodomer 5 mg ) tab
164 Hyoscine butilbromid Tablet
165 Hyoscine butilbromid inj ampul
166 Hyosin butilbromid + parasetamol (Scopma Plus) Tablet
167 Ibu profen supp (Proris supp) Sup
168 Ibuprofen 200 mg Tablet
169 Ibuprofen 400 mg Tablet
170 Iktiol Salep Kulit Tube
171 insulin long anting inj pen
172 ISDN kotak
173 Isoniazid 300 mg Tablet
 dus, 10 strip @
174
Isosorbid Dinitrat tablet sublingual 5 mg 10 tablet
175 KAEN - 3B botol
dus, 10 strips
176 Kalsium latkat (Kalk) tablet 500 mg
@ 10 tablet
177 Kandesartan 8 mg Tablet
178 Kaolin Pektin ( NOVADIAR ) Botol
179 kaolin+pektin (Diaform) Tablet
180 Karbamazepin tablet tab
181 Kaptopril 25 mg tablet
dus, 10 strip @
182 Kaptopril tablet scored 25 mg
10 tablet
183 Ketokonazole Tablet
184 Ketoprofen Supp Supp
185 Ketorolac inj amp
ktk 10 x 10
186 Kloramfenikol kaplet 250 mg
tablet
187 Kloramfenikol Tetes Telinga Tube
188 Klorampenikol 250 mg capsul
189 Klorampenikol TM (RECO) botol

190 box 10 x 10 "s

Klorfeniramina Maleat ( CTM ) tablet 4 mg
191 Kodein 10 mg Tablet
dus, 10 blister
192 Kodein tab 20 mg
@ 10 tablet
193 Kotrimoksazol tab dewasa tab
194 Lansoprazol 30 mg Strip
195 Lantus solostar 5pen/box
196 Lanzoprazole Tablet
197 Larutan D 40 Botol
198 Larutan D 5 1/2 NS Botol
199 Lesipar Strip
box,10 strips @
200 Lesipar 300 mg
10 tablets
201 Levofloxacin 500 mg Tablet
202 Lidocain amp
203 Lidocain hcl+epinefrin (Pehacain injeksi) ampul
204 Lidocain inj 2 % + Epinefrin inj ampul

205 Ampul
Lidocain Injeksi 2%(HCL)+Epinefrin 1:80.000-2mL
206 Lidocaine inj 2 % ampul
207 Lidokain 2% injeksi ampul

208 Lidokain injeksi 2 % (HCl) + Epinefrin dus, 30 ampul

1:.80000 - 2 ml @ 2 ml
box,10 strips @
209 Lisinopril tablet 10 mg
10 tablets
210 Loperamid tablet 2 mg tablet
 dus, 5 strip @
211 Loratadin tablet 10 mg
10 tablet
212 Meloxicam 15 mg Tablet
213 metamizol (Novalgin injeksi) 5 amp/box
214 Metamizol inj (norages INJEKSI) AMPUL
215 metamizol inj (Santagesik inj) amp
216 Metformin HCl tablet 500 mg tablet
217 Metil Ergometrin tablet tablet
dus 100 ampul
218 Metilergometrin inj 0,2 mg/ml
@ 1ml
219 Metoklopramid kotak
220 Metoklopramid (Sotatic Inj) tab
dus, 10 blister
221 Metronidazol 250 mg @ 10 tablet
222 Metronidazol 500 mg tablet tablet
223 Metronidazole sup Sup
224 MgSO4 botol
225 MOLex OBH botol
226 Molexflu Tablet
227 Molexflu 10T Box/150
228 Multivitamin (Thialysin syrup) botol
229 multivitamin (truvit) botol
230 multivitamin (Tyalisin syr) Botol

231 Multivitamin + Mineral Drops (RECOVIT DROPS) botol

232 Multivitamin anak (Seltifort syr) Botol

233 Multivitamin syp Botol
234 multivitamin syr Botol
235 My jelly tube
236 Nacl 0,9 % Larutan infus botol 500 ml
237 Natrium Diclofenac Tablet
238 Neurotropic / Meribion Tablet
239 Neurotropic / Neurodex Tablet
240 Neurotropic / Vastral Tablet
241 Neurotropik BOX / 100
242 Neurotropik tab
243 Neurotropik injeksi AMPUL
244 Neurotropik tablet tablet
245 Nifedipin 10 mg Tablet
246 Novorapid insulin 5pen/box
247 O B H Molex Botol
dus, 10 strip @
248 Obat Batuk dan Antihistamin (DEXTRAL FORTE)
10 tablet
249 obat batuk dan antihistamin (DEXTROFEN) btl60ml
250 Obat batuk pilek (Lodecon tab) tab
251 Obat panas batuk pilek syr Botol
252 Obat Radang Kulit + Anti Bakteri (BRAVODERM N Tube
CREAM)
253 Obat Tetes Mata (Reco) tube
254 OBH sirup botol
255 OBH surya itrasal syrup Botol
256 Omeprazol kap
257 Omeprazole 20 mg kotak
258 Omeprazole injeksi amp
259 Ondansetron - injeksi ampul
260 PTU Tablet
261 Paracetamol 500 mg Tablet
262 Paracetamol syr Botol
263 Paracetamoll 500-10T PIM Box/100
264 Parasetamol tablet tablet
265 Pencahar (Microlax 5 ml) Tube
266 Phenytoin kapsul kapsul
267 Phenobarbital 30 mg tab
268 Piracetam 1200 mg kaplet
269 Piracetam 800 mg Tablet
270 Piracetam inj 1 g amp
271 Piracetam inj 3 gr ampul
272 Piracetam injeksi ampul
273 Pirantel pamoat tablet 125 mg Tablet
274 Pirazinamid tab tab
botol plastik @
275
Piridoksin (vitamin B6) tab 10 mg 100 tablet
276 Piridoksin 10mg kotak
box 10 strip @
277 Piroksikam kapsul/kaplet/tablet 20 mg
10 tablet
278 Prebiotik saset
279 prednisone tab kotak
dus, 10 strip @
280
Propanolol 10 mg 10 tablet
dus, 10 strip @
281 Propanolol tablet 40 mg (HCl) 10 tablet
kotak @ 10 x
282 Propiltourasil tb 100 mg
10 tab
283 Ranitidin inj Amp
284 Ranitidin injeksi 25 mg/ 2ml ampul
285 Ranitidin tablet Tablet
dos 10 strip @
286 Ranitidin tablet 150 mg
tab
287 Ranitidine inj 1amp Hexapharm Yarindo Amp
288 Rifampicin 450 mg Tablet
289 Ringer Laktat Wida Tutup Karet Botol
290 Ringer Laktat CAIRAN BOX
291 Risperidon tab
292 Risperidon 2 mg Tablet
293 RISPERIDON 2MG BOX
294 Salbutamol 4mg Kotak

295 Salbutamol cairan inh. 0,1 %(VENTOLIN NEBULE) ampul

296 Salp - 24 Tube

297 Scabimid Salep Kulit Tube
dus,10 strip @
298 Sefadroksil kapsul 500 mg
10 tablet
299 Sefadroxil kasul 500mg kapsul
300 Semen Zink Phospate (Multifix P/L) botol
301 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul @ 1 ml
302 Sianokobalamin injeksi ampul
dus 10 strip @
303
Simetidin 10 tablet
dus 10 strip @
304
Simetidin tab 200 mg 10 tablet
305 Simvastatin 10 mg kotak
306 Simvastatin 10mg 10-Tab Box/30
307 Spironolacton 25 mg Tablet
308 Thiamfenichol sirup btl
box,10 strips @
309 Thiamfenichol tab
10 tablets
310 Thiamin 50 mg kotak
311 Thiavit 0,5 ml (Vit.K1) injks ampul
dus, 10 strip @
312 Tiamin ( Vitamin B1 ) tablet 50 mg
10 tablet
313 Trifluoperazin MERAPI tab
314 Trihexiphenidil tablet tab
315 Tyamfenikol tab tab
316 Vastigo Tablet
317 Vastigo ( betahistin) box 100
box 10 strip@
318 Vastral
10
319 Vit.B1 tablet tablet
320 Vitamin + penambah darah (Hemafort) kotak
321 Vitamin anak syr Botol
322 Vitamin B1 5mg PIM 1T Kaleng
323 Vitamin B6 10 Mg 1 Tab Yekatrim Kaleng
Vitamin Kombinasi tablet ( Thiamin HCl 100mg ,
324 Piridoksin HCl 100 mg, Sianokobalamin 5000 mcg / dus,1010tablet
strip @
3 mg )/ IKANEURON Tablet
325 Vitamin syr anak Botol
326 Wida BES ( Asering ) Botol
327 Wida D5 1/4 Botol
328 Widal box
329 Yarindo Amlodipine 5mg 10-Tab Box/30

330 Zink syr 20 mg/5 ml botol @ 100 ml

331 Zink tab kotak

PROLANIS
332 ACARBOSE 100 MG Tab
333 ACARBOSE 50 MG Tab

334 ADALAT OROS 20 Nifedipine/ Nifedipin tab lepas Tab

lambat 20 mg

335 ADALAT OROS 30 Nifedipine/ Nifedipin tab lepas Tab

lambat 30 mg
336 Alpentine 100 mg box/100
337 BETAHISTIN MESILATE 6 mg Tab
338 Bisoprolol 5 mg box/100
339 Bisoprolol tablet/kapsul/kaplet 2,5 mg Tab
340 Bricasma injeksi 0,5 mg/ml Ampul
341 Bricasma respule 2,5 mg/ml respule
342 CLOPIDOGREL 75 mg Kaps
343 Glibenklamid tab 2.5 mg Tab
344 Glimepiride 3 mg box/100
345 KANDESARTAN 16 mg Tab
346 KANDESARTAN 8 mg Tab
347 LANTUS SOLOSTAR PEN
348 Levemir Flexpen Pcs

349 LEVEMIR FLEXPEN Analog insulin long acting inj PEN

100 IU/mL, vial/cartridge disposible/penfill cartridge

350 Lisinopril 10 mg box/100

351 Lisinopril dihydrate/ Lisinopril/ Lisinopril tablet Tab

kapsul/kaplet 10 mg

352 Lisinopril dihydrate/ Lisinopril/ Lisinopril tablet

Tab
kapsul/kaplet 5 mg

353 NOVORAPID Analog insulin fast acting inj 100 IU/ PEN
mL, vial/cartridge disposible/penfill cartridge
354 Novorapid flexpen pcs

355 Pioglitazone/ pioglitazone hydrochloride (HCL)/ Tab

pioglitazon tablet 15 mg
356 Pulmicort respule 0,25 mg/ml respule
357 Pulmicort respule 0,5 mg/ml respule
358 Pulmicort turbohaler 200 mcg/200 dosis can
359 Ramipril 5 mg box/100
360 Ramipril tablet/kapsul/kaplet 5 mg Tab
361 Spironolactone 25 mg box/100

362 Spironolactone/ Spironolakton tablet/kapsul/kaplet Tab

25 mg
 SYMBICORT 80/4.5 (60 DOSIS) kombinasi, setiap
363 dosis mengandung : Budesonid 80 mcg Formoterol Pcs
4,5 mcg (inhalasi)
364 Valsartan 80 mg box/30
365 Valsartan tablet 160 mg TAB
BMHP TAMBAHAN
366 AC Swab box
367 Acarbose 50 mg Box/100 pcs
368 Alat GCU Easy Touch Unit
369 Alat HB quik-Check Unit
370 Alat suntik 10 cc Buah
371 Alat suntik 3 cc Buah
372 Alat suntik 5 cc 100 pcs/ktk
373 Alat suntik 50 cc Buah
374 Alat suntik sekali pakai 1 ml 100 pcs/kotak
375 Alkohol 100ml botol
376 Alkohol 70 % 1 lt botol
377 Aseptan 500 cc + pump Botol
378 Aseptic gel Botol
379 Auto clik device OM Buah
380 Bak instrumen 509 B Buah
381 Bak Instrument 508 Buah
382 Battery For Cardiocare Buah
383 Bein Lurus Buah
384 Benang Cromic Rol
385 Benang Side rol
386 Bengkok Buah
387 Blood Lancet No.26 G box/100
388 Blood set Buah
389 Blood transfusion set box/ 100 pcs
390 Blue tip Pak
391 Blue tip " 500 S Pak
392 Bola ECG + metal Buah
393 Bola tensi + pentil Buah
394 Bowl + tutup Buah
395 Bowl karet Buah
396 Bracket ABS Buah
397 Bracket bed Pasien Nylon Om Buah
398 Bun Urea Kit
399 Camphenol 15 ml botol
400 candesartan 8 mg box/30
401 candesartan 16 mg box/31
402 Cat Gut Chromic 2/0 + jarum 1/2 GT 35 mm box/24
403 Cat Gut Chromic 3/0 HR-26 mm SMI box/24
404 Cat Gut cromic 2/0 100 m Rol
405 Cat Gut cromic 3/0 100 m Rol
406 Cat Gut Plain 2 /0 + jarum 1/2 GT 35 mm box/24
407 CAT GUT PLAIN 2 / 0 HR 26 MM KOTAK /12
408 Cat gut plain 2/0 box/24
409 Cat Gut plain 2/0 100 m Rol
410 CAT GUT PLAIN 3 / 0 HR 26 MM KOTAK /12
411 Cat gut plain 3/0 box/24
412 Cat Gut Plain 3/0 100 m ROL
413 Cat Gut Plain 3/0 HR-26 mm (SMI) box/24
414 Catgut chromic 3/0 HR-26 mm box/24
415 Cell clean Botol
416 Cellpack galon / botol
417 Chateter no 14 pcs
418 Colostomy bag conatex Buah
419 Cotton Roll Prodental Pcs
420 Creatine R1 = 50 ml x 4,R2=10 mlx4 Buah
421 Cryer ss Buah
422 Cuticell
423 Dariantul Lmbr
424 Diluent Midray M 30 galon
425 Disposible needle 23 G 100 pcs/ktk
426 Disposible needle 24 G box/100
427 Disposible needle 25 G Buah
428 Dopler HE BIBI Bistos Buah
429 EDTA Cair 10% 100ml
430 Elite Cement mini Pak
431 filtec z 250 kit set
432 Folly Cateter No.14 Buah
433 Folly Cateter No.16 Buah
434 Folly Cateter No.18 Buah
435 Frescopore 1,25 cm x 9,10 m Pcs
436 Gel USG pcs
437 Gloco strip Gluco DR box
438 Glove non Sterile powder (L) box
439 Glove non Sterile powder (M) box
440 GOT AST Kit
441 GPT ALT Kit
442 Gutta percha dentplus 15-40 Pcs
443 Hand rub btl
444 Hand scrub E care botol
445 Handscoon "M" Box
446 Handscoon "S" Box
447 Handscoon ( L ) Box
448 Handskun maxter box
449 Hanscrub 5 liter jurigen
450 HBSAG strip Buah
451 HDL Botol
452 Hecting 11 set
453 Hecting 12 set
454 Hecting 14 set
455 Hipafix 5 cm x 5 m Rol
456 Humasens Glucosa Test Dus
457 Humasens Kholesterol Test Dus
458 Humasens urid Acid Test Dus
459 hypafix 10x5 roll
460 Hypafix 5cm x 5 m rol
461 Hypafix 5x10 rol
462 I.V Chateter 18 (Surflo) pcs
463 ID Band dewasa Blue Buah
464 ID Band dewasa pink Buah
465 Inf set dewasa pcs
466 INFLO NO 20 PCS
467 Infus set anak pcs
468 Infus set dewasa pcs
469 INFUSET GEA PCS
470 IV Catheter no. 20 Buah
471 IV Catheter no. 22(Otsucath) Buah
472 IV Catheter no. 24 Buah
473 IV Catheter no. 26 Buah
474 Jarum G 11 Sutura Set
475 Jarum G 12 sutura Set
476 Jarum G 14 Sutura Buah
477 Jarum haeting pcs
478 Jarum jahit pcs
479 Kabel ECG Unit
480 Kaca mulut + handle buah
481 Kantong plastik 80 x 60 Pak
482 kantong puyer pak
483 Kapas 100Grm pcs
484 Kapas pembalut 250 gr Rol
485 Kapas Surya Husada 250 gram roll
486 Kapsul kosong Pak
487 Kasa pembalut hidrofil 4m x 15cm roll
488 kasa hidrofil 40 x 80 cm roll
489 Kassa 16X16 cm Dus
490 Kassa hydrofil 40X80 Rol
491 Kertas puyer Pak
492 Ketac Universal HM RF A3 Buah
493 Ketac Universal HM RF Licuit Buah
494 Kholesterol 10 ml x 10 kit
495 Kholesterol 10 ml x 7 kit
496 Kholesterol 40 ml x 4 kit
497 KOH 100 ml botol
498 Kresek (plastik) Pak
499 Lampu Halogen Potometer Buah
500 Lancet 28 G Box
501 Larutan Clorin Botol
502 Leucoplast 1825 Roll
503 Leucoplast 3x5 Rol
504 Leucoplast 7,5 cm x 4,5 m Rol
505 Leucoplast jumbo roll
506 Leukoplast rol
507 Lomatule pcs
508 Lomatull (Sufra tull) pcs
509 Lyse M 30 Botol
510 M - Diluent 20 lt galon
511 M- 18 EZ cleanser botol
512 M- 18 Lyse Botol
513 M.18 Rinse 20 Lt galon
514 Manset ABN Buah
515 Masker Hijab 1 Pcs Pcs
516 Masker Kesehatan ( jilbab ) box
517 Masker Kesehatan ( jilbab ) box
518 Masker Nebulizer Anak Buah
519 Masker Nebulizer Dewasa Buah
520 Masker Oksigen dewasa Buah
521 Masker tali ISHS box
522 Maxter Exam box
523 Measuring tupe Buah
524 Medical pouch steril Buah
525 Medical Wastel kontainer Buah
526 Medi-grip sterile surgical gloves 6,5 Pcs
527 Medi-grip sterile surgical gloves 7 Pcs
528 Mesin Celin dental Buah
529 Mess pcs
530 Mess 11 pcs
531 Mezotropil 25 mg ( MGSO4 ) Botol
532 Milrub Buah
533 my gell tube
534 MY-Jelly Tube
535 Nasal Canul O2 dws Buah
536 Object glass box
537 Odex botol
538 Oksigen besar Unit
539 Oksigen kecil Unit
540 OM Haeactnail Buah
541 Orafilplus 40 gr buah
542 Oxyflow nasal O2 anak Buah
543 Oxygen besar Tabung
544 Oxygen Kecil Tabung
545 P. chirugis 14 cm Buah
546 P.Anatomi 14 cm Buah
547 Paper point 45-80 dentplus Pcs
548 Pinset bengkok Buah
549 Plastik 1 kg Pak
550 Plastik 1/2 kg pak
551 Poster gigi Buah
552 Poster gigi timbul Buah
553 PP test Pcs
554 Probe cleaner Btl
555 R/Golda A Buah
556 R/Golda AB Buah
557 R/Golda B Buah
558 R/Golda O Buah
559 Reagen widal O,H,A,B set
560 Regulator O2 Buah
561 Rinse Midray M 30 galon
562 Sarung Tangan No Powder M Box/100 pcs
563 Sarung Tangan No Powder S 100 pcs/ktk
564 Sarung Tangan S kotak
565 Sarung tangan steril 7,5 pasang
566 Selang o2 anak pcs
567 sendok sirup biji
568 SGPT kit
569 Silk 2/0 100 m Rol
570 Single bond universal Pcs
571 Slik Black 0 HR-37 mm box/12 sachet
572 Slik Black 1 DS-24 mm box/12 sachet
573 Sofratule (1) Buah
574 Sofratule (2) Buah
575 Spalek anak pcs
576 Spalk 100x10x8cm Buah
577 Spalk 10x5 cm Buah
578 Spalk 5 x 15 Buah
579 Spalk 50x8x7 Buah
580 Spalk 70x10x8 Buah
581 Spalk 80x10x8cm Buah
582 Spet 10 cc pcs
583 SPUIT 3 CC PCS
584 Spuit 3cc (stera) Pcs
585 Spuit 5cc (stera) Pcs
586 Sputum pot buah
587 Standar infus buah
588 Stetoscope Set
589 Stic GDA Easy touc Biji
590 Stic GDA on call redi Tube
591 Stic HB Quick-Check box
592 Stick HIV Card mono Buah
593 Stick HIV Card Orien Buah
594 Stick UL 3 P Tube
595 Stik cholesterol Easy touch Box
596 stik GDA On Call Pluss box
597 Stik IgG AgM Dengue box
598 Stik UA Easy touch Biji
599 Stomalitolizer Botol
600 Surflo no. 18 Buah
601 Surflo no. 20 buah
602 Surflo no. 22 Buah
603 Surflo no. 24 Buah
604 Surflo no. 26 Buah
605 Surgical mask 3 ply tie on box/50
606 Surgical mask earloop box/50
607 Surgical Masker Tie On kotak
608 Tabung EDTA Ungu Tabung
609 Tabung K3EDTA box
610 Tabung plain box
611 Tabung Plastik Tabung
612 Tabung Zero Tabung
613 Tambah Darah kotak
614 Tensi meter DIG Omron Buah
615 Tensocrep 3 Buah
616 Tensocrep 4 Buah
617 Termometer Air raksa Buah
618 Termometer Digital Buah
619 Termometer kulkas Buah
620 Termometer ruangan Buah
621 Thermal paper Roll
622 Timer Lab OM Buah
623 Tong spatel Set
624 Tricresolformalina 10 ml botol
625 Trigliserida kit
626 Ultrafix 5x1 pcs
627 Under pad pcs
628 Underpad pcs
629 Urid Acid (10 biji) Tube
630 Urid Acid 5 ml x 10 kit
631 Urin Bag pcs
632 Urin bag steril 2 lt Buah
633 Urologi - Folley chateter 2 way no. 16 box/10
634 Urologi - Folley chateter 2 way no. 18 box/10
635 USG gel 250 ml Botol
636 USG gel 5 LT galon
637 Vaculab Buah
638 Vaculab 3 ml EDTA box
639 Vaculab 5 ml EDTA box
640 Vaculab plain box
641 Vaselin swab
642 Verban 10 cm Rol
643 Verban 5 cm Rol
644 Wall disp Buah
645 Widal R/ set
646 Wire buah
647 Yellow tip Bag

JUMLAH TOTAL

Yang Meminta
Yang / Mengetahui
Meminta / Mengetahui Mengetahui / Menyetujui
Kepala Dinas Tk II
Kepala Puskesmas
Kepala Puskesmas

(......................................)

(..............................)
(..............................)
R PERMINTAAN ASET OBAT
JKN
PELAPORAN BULAN :
PERMINTAAN BULAN :
TAHUN :

VOLUME GUD

PUSTU
LABOR POLI PERAW Apotek Total
AT LANSI ATAN GEMP PUSTU KARAN
TANGG DUKUH MENG SUDAN OL KARAN DUDUK G WEDO WONO KONAN
UNGPR TUNGG ANTI GAN PENDO G TURI LOR AGUN RO REJO G
IGEL AL WO G
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 1 1 1 1 1 1 1 1 1 6 1 1 1 1 1
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Yang Menyerahkan
Petugas GFK / Puskesmas
ujui

(......................................)
.....)
 STOK AWAL

E GUDANG OBAT DAN UNIT PELAYANAN PUSKESMAS

POLINDES/POSKESDES Total
POLIN
DES/P
MARG BAPUH RAYUN WANG OSKES
GLAGA PASI MEDA BANGK MELUN SOKO OANYA DES JATIRE KENTO PANGG MEND
BEGAN GGUM EN
H NG OK TUR BARU NGGO NG ANG UGO
R UK
21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36

1 1 1 1 1 1 1 1 1 1 1 16 1 1 1 1
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 JUMLAH
TOTAL VOLUME GUDANG OBAT
STOK PUSKESMAS
AWAL TOTAL NOMINAL
GUDANG
OBAT DAN STOK AWAL DAN
UNIT
PONKESDES UNIT PUSKESMAS Rp
Total PELAYANA
N Terima Lainnya
PONKE
PUSKESMA Dari IFK
BAPUH SDES
MELU MORO BANDU S
8 9 10 11 12
WUR CALAN NG

37 38 39 40 41 42 43 44 45 46 47 1 2

1 1 1 1 1 1 1 1 12 541 6,221,500 50 0
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6,221,500
ANG OBAT
MAS

TOTAL
NOMINAL
PENERIMAAN PUSTU
TOTAL GUDANG ONAT
GUDANG Rp LABOR POLI PERAW Apotek
UGD KIA GIGI
OBAT DAN AT LANSI ATAN
LAINNYA TANGG DUKUH MENG SUDAN GEMP
OL
UNGPR TUNGG ANTI GAN PENDO
IGEL AL WO
3 4 5 6 7 8 9 10 11 12 13 14 15 16

50 575,000 1 2 3 4 5 6 7 1 2 3 4 5
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0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
575,000
0
575,000

0 0

0 0
0 0
0 0
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0 0
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0 0
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0 0
0 0
0 0
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0 0
0 0
0 0
0 0
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0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
0 0
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0 0
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0 0
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0 0
0 0
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0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
575,000
 PENERIMAAN

VOLUME UNIT PELAYANAN PUSKESMAS

POLINDES/POSKESDES
Total
PUSTU KARAN MARG BAPUH
KARAN DUDUK G WEDO WONO KONAN GLAGA PASI MEDA BANGK MELUN SOKO OANYA
G TURI LOR AGUN RO REJO G H NG OK TUR BARU BEGAN
R
G
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

6 21 1 2 3 4 5 6 7 8 9 10 11 12 13 14
0
0
0
0
0
0
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0

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0

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0
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0
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0
0
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0
0

0
0

0
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0
0
0
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0

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0
0

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

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 Total PONKESDES
POLIN Total
DES/P PONKE
RAYUN WANG OSKES BAPUH SDES
GGUM EN DES JATIRE KENTO PANGG MEND MELU MORO BANDU 8 9 10 11 12
NGGO NG ANG UGO WUR CALAN NG
UK
33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48

15 16 136 1 2 3 4 5 6 7 8 9 10 11 12 78
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0

0 0

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

0 0

0 0
0 0

0 0

0 0

0 0

0 0
0 0

0 0

0 0
0 0

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0 0
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0 0

0 0

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0 0

0 0

0 0
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0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

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

0 0

0 0

0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0

0 0

0 0
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0 0

0 0

0 0
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0 0
0 0

0 0

0 0
0 0

0 0

0 0
0 0

0 0
0 0

0 0

0 0

0 0
0 0

0 0

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 NOMINAL TOTAL NOMINAL
JUMLAH PENERIMAA VOLUME PERSEDIAAN
VOLUME UNIT GUDANG GUDANG OBAT
UNIT PELAYANAN OBAT Rp LABOR POLI PERAW Apotek
PELAYANA PUSKESMAS Rp UGD KIA GIGI AT LANSI ATAN
N TANGG
PUSKESMA UNGPR
S IGEL
49 50 1 2 3 4 5 6 7 8 9 10

263 3,024,500 287 3,300,500 2 3 4 5 6 7 8 2

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3,024,500 3,300,500
 PERSEDIAAN

VOLUME UNIT PELAYANAN PUSKESMAS

PUSTU POLINDES/POSKESDES
Total
GEMP PUSTU KARAN
DUKUH MENG SUDAN OL KARAN DUDUK G WEDO WONO KONAN GLAGA PASI MEDA BANGK MELUN
TUNGG ANTI GAN PENDO G TURI LOR AGUN RO REJO G H NG OK TUR
AL WO G
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

3 4 5 6 7 27 2 3 4 5 6 7 8 9 10 11
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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

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

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

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

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

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

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

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

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

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

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

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

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

Yang Menerima
Petugas Puskesmas / sub
unit

(......................................)
SMAS

Total PONKESDES
POLIN
DES/P
MARG RAYUN WANG OSKES BAPUH
SOKO OANYA BAPUH BEGAN GGUM DES JATIRE KENTO PANGG MEND MELU MORO BANDU 8 9
BARU EN NGGO NG ANG UGO WUR CALAN NG
R UK
27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42

12 13 14 15 16 17 152 2 3 4 5 6 7 8 9 10
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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

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

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

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

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

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

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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
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 JUMLAH
TOTAL
VOLUME VOLUME GUDANG OBAT
NOMINAL
PERSEDIAA TOTAL
N PESEDIAAN TOTAL
GUDANG
OBAT DAN GUDANG OBAT NOMINAL
DAN UNIT JUMLAH GUDANG OBAT
UNIT TOTAL
Total PELAYAAN PELAYANAN PUSKESMAS
PUSKESMAS Rp Gudang LAINNY VOLUME DAN LAINNYA Rp UGD
PONKE A KIA
Obat A GUDANG
SDES PUSKESMA OBAT DAN
10 11 12 S JUMLAH LAINNYA

43 44 45 46 47 48 1 2 3 4 5 6

11 12 13 90 591 6,796,500 263 263 3,024,500 1 1

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6,796,500 3,024,500

6,796,500
 PENGELUA

PUSTU
LABOR POLI PERAW Apotek Total
GIGI AT LANSI ATAN GEMP PUSTU KARAN
TANGG DUKUH MENG SUDAN OL KARAN DUDUK G WEDO WONO
UNGPR TUNGG ANTI GAN PENDO G TURI LOR AGUN RO REJO
IGEL AL WO G
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

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NGELUARAN/PEMAKAIN

VOLUME UNIT PELAYANAN PUSKEMAS

POLINDES/POSKESDES Total
POLIN
DES/P
MARG BAPUH RAYUN WANG OSKES
KONAN GLAGA PASI MEDA BANGK MELUN SOKO OANYA DES JATIRE KENTO PANGG
BEGAN GGUM EN
G H NG OK TUR BARU NGGO NG ANG
R UK
23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38

1 1 1 1 1 1 1 1 1 1 1 1 16 1 1 1
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 JUMLAH
TOTAL
VOLUME TOTAL NOMINAL
UNIT UNIT
PELAYANA PELAYANAN
PONKESDES N PUSKESMAS Rp
Total PUSKESMA Gudan
PONKE S UGD
g Obat
BAPUH SDES
MEND MELU MORO BANDU 8 9 10 11 12
UGO WUR CALAN NG

39 40 41 42 43 44 45 46 47 48 49 50 1 2

1 1 1 1 1 1 1 1 1 12 41 471,500 287 1
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6,796,500
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LABOR POLI PERAW Apotek Total
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TANGG DUKUH MENG SUDAN OL KARAN DUDUK G WEDO
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:
:
:

SISA STOK

VOLUME GUDANG OBAT DAN UNIT PELAYANAN PUSKEMAS

Polindes
Total
Polinde
MARG BAPUH RAYUN WANG s
WONO KONAN GLAGA PASI MEDA BANGK MELUN SOKO OANYA JATIRE KENTO
BEGAN GGUM EN
REJO G H NG OK TUR BARU NGGO NG
R UK
19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

4 5 6 7 8 9 10 11 12 13 14 15 16 136 1 2
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0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

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 :
:
:

JUMLAH
VOLUME TOTAL NOMINAL
SISA STOK SISA STOK
GUDANG GUDANG OBAT
DAN UNIT DAN UNIT
Poskesdes PELAYANA PELAYANAN
Total N PUSKESMAS Rp
Poskes PUSKESMA
des S
BAPUH
PANGG MEND MELU MORO BANDU 8 9 10 11 12
ANG UGO WUR CALAN NG

35 36 37 38 39 40 41 42 43 44 45 46 47

3 4 5 6 7 8 9 10 11 12 78 550 6,325,000
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0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
6,325,000
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
( LPLPO ) PKD
PUSKESMAS
: GLAGAH
SUB UNIT :
KECAMATAN
: GLAGAH
KABUPATEN
: LAMONGAN
PROPINSI
: JAWA TIMUR

HARGA (Rp.) per tablet

/vial/ampul/kapsul/kaplet/dst.
KEMASA
NO NAMA BARANG
N
TH TH TH
GUDAN
G OBAT
PUSKES UGD KIA GIGI
2017 2018 2,019
MAS
1 2 3 4 5 6 1 2 3 4

OBAT-OBATAN
1 Acyclovir Cream 5 % Tube 3,000 500 1 1 1
2 Acyclovir Cream 5 % Tube 3,146
3 Acyclovir Cream 5 % Tube 13,970
4 Acyclovir tab 200 mg Tab 236
5 Acyclovir tab 200 mg Tab 240
6 Acyclovir tab 200 mg Tab 249
7 Acyclovir tab 200 mg Tab 471
8 Acyclovir tab 400 mg Tab 349
9 Acyclovir tab 400 mg Tab 168
10 Acyclovir tab 400 mg Tab 380
11 Acyclovir tab 400 mg Tab 384
12 Air untuk injeksi amp 25 ml Ampul 2,860
13 Albendazol susp 200 mg/5 ml Botol 4,000
14 Albendazole Susp 200 mg/5 ml Botol 3,849
15 Albendazole Susp 200 mg/5 ml Botol 3,849
16 Albendazole tab 400mg Kotak 392
17 Albendazole tab 400mg Kotak 404
18 Albothyl Concentrate Botol 37,510
19 Albothyl Concentrate Botol 37,510
20 Albothyl Concentrate Botol 37,510
21 Allupurinol tab 100 mg Kotak 90
22 Allupurinol tab 100 mg Kotak 97
23 Allupurinol tab 300 mg Kotak 210
24 Allupurinol tab 300 mg kotak 200
25 Allupurinol tab 300 mg Kotak 210
26 Alopurinol tab 100 mg Tab 97
27 Alopurinol tab 300 mg Tab 210
28 Alprazolam 1 mg Kotak 162
29 Alprazolam 1 mg Kotak 162
30 Alprazolam tab 0,5 mg Kotak 214
31 Alprazolam tab 0,5 mg Kotak 214
32 Ambroxol sirup 15ml/ml Botol 3,200
33 Ambroxol sirup 15ml/ml Botol 5,280
34 Ambroxol tab 30 mg tab 198
35 Ambroxol tab 30 mg tab 171
36 Ambroxol tab 30 mg (KF) tab 155
37 Ambroxol tab 30 mg (nova) tab 195
38 Ambroxol tab 30 mg (nova) tab 198
39 Aminophillin inj. 24 mg/ml Kotak 3,345
40 Aminophillin inj. 24 mg/ml Kotak 2,789
41 Aminophillin tab 200 mg Tab 91
42 Aminophillin tab 200 mg Tab 89
43 Amitriptilin tab 25 mg Tab 112
44 Amitriptilin tab 25 mg Tab 143
45 Amitriptilin tab 25 mg Tab 167
46 Amitriptilin tab sal 25 mg Tab sal 167
47 Amlodipin tab 10 mg Kotak 176
48 Amlodipin tab 10 mg Kotak 330
49 Amlodipin tab 10 mg Kotak 93
50 Amlodipin tab 10 mg Tab 93
51 Amlodipin tab 5 mg Kotak 105
52 Amlodipin tab 5 mg Kotak 187
53 Amlodipin tab 5 mg Kotak 70
54 Amlodipin tab 5 mg Tab 70
Amoksisilin sirup kering 125 mg/5
55 Botol 2,000
ml
Amoksisilin sirup kering 125 mg/5
56 Botol 2,090
ml
Amoksisilin sirup kering 125 mg/5
57 Botol 2,000
ml
58 Amoksisilin tab 500 mg Tab 233
59 Amoxicillin tab 250 mg Tab 211
60 Amoxicillin tab 250 mg Tab 211
61 Amoxicillin tab 500 mg Tab 232
62 Amoxicillin tab 500 mg Tab 261
63 Amoxicillin tab 500 mg Tab 233
64 Ampisilin serb inj 1000 mg/vial Kotak 8,000
65 Ampisilin serb inj 1000 mg/vial Kotak 8,000
66 Ampisilin serb inj 1000 mg/vial Vial 8,237
Analgesik Krim ( Methyl salicylate, tube @ 15
67 16,500
Eugenol, Menthol ) gram

kotak 5
68 analgesik non narkotik inj ampul @ 2 8,360
ml

kotak 5
69 analgesik non narkotik inj ampul @ 2 9,185
ml
Analgesik Non Narkotika Krim tube @ 15
70 20,900
Topikal gram
Anestetik lokal gigi kombinasi :
71 lidokain hcl 2% + epinefrin 1 : Amp 1,845
80.000 inj 2 ml
 Anestetik lokal gigi kombinasi :
72 lidokain hcl 2% + epinefrin 1 : Amp
80.000 inj 2 ml

Anestetik lokal gigi kombinasi :

73 lidokain hcl 2% + epinefrin 1 : Ampul 1,145
80.000 inj 2 ml
74 Antalgin tab 500 mg Kotak 232
75 Antalgin tab 500 mg Kotak 135
76 Antalgin tab 500 mg Kotak 242
77 Antalgin tablet 500 mg tablet 253
Antasida, kombinasi : aluminium
78 hidroksida 200 mg + magnesium Kotak 62
hidroksida 200 mg

Antasida, kombinasi : aluminium

79 hidroksida 200 mg + magnesium botol 2,025
hidroksida 200 mg

Antasida, kombinasi : aluminium

80 hidroksida 200 mg + magnesium Kotak 72
hidroksida 200 mg

Antasida, kombinasi : aluminium

81 hidroksida 200 mg + magnesium botol 2,160
hidroksida 200 mg

Antasida, kombinasi : aluminium

82 hidroksida 200 mg + magnesium Kotak 54
hidroksida 200 mg

Antasida, kombinasi : aluminium

83 hidroksida 200 mg + magnesium botol 1,995
hidroksida 200 mg

Antasida, kombinasi : aluminium

84 hidroksida 200 mg + magnesium Tab 54
hidroksida 200 mg
85 Anti Depresi ta 4,840
86 Anti Diare tab 198
Anti Influenza & demam sirup
87 Kotak 14,400
(Febrinex sirup)
Anti Influenza & demam sirup
88 Kotak 14,400
(Febrinex sirup)
89 Anti Influenza (Molexflu) Kotak 360
90 Anti Influenza (Molexflu) Kotak 396

Anti Influenza kaplet : (Tiap kaplet :

Parasetamol 500
91 mg,Phenylprophanolamine HCl 12,5 kaplet 414
mg, Chlorpheniramine Maleate 2
mg)

92 Anti migren Botol 135

93 Anti migren Botol 135

Antibiotika mata + kortikosteroid

( Polymyxin B sulphate 6000 IU, botol @ 5
94 16,500
Neomycin sulphate 3,5 mg, ml
dexamethasone 1,0 mg)

Antihemoroid : ( Ekstrak Gratophylli

95 Folium 80 % dan Citrus Biofavonoid tablet 2,090
20 % )
 Antihemoroid, kombinasi: bismut
subgalat 150 mg + heksaklorofen
96 Kotak 3,045
2,5 mg + lidokain lidokain 10 mg+
seng oksida 120 mg + sup ad 2 g

Antihemoroid, kombinasi: bismut

subgalat 150 mg + heksaklorofen
97 Kotak 3,045
2,5 mg + lidokain lidokain 10 mg+
seng oksida 120 mg + sup ad 2 g

98 Antiseptik Salep 5 g ( BETADINE) Tube 7,039

Antiseptik Solution 60 ml
99 Botol 23,890
( BETADINE sol)

Antispasmodik ( Tiap Kaplet :

100 Hyoscine butylbromide 10 mg , kaplet 3,080
Methampyrone 250 mg )

Antispasmodik (DORMI box 100

101 3,080
COMPOSITUM) kaplet
102 Aqua pro injeksi steril Amp 2,750
103 Aqua pro injeksi steril Amp 2,860
Asam asetilsalisilat (asetosal) tab
104 Tab 99
80 mg
Asam askorbat (vitamin C) tab 50
105 Botol 104
mg
Asam askorbat (vitamin C) tab 50
106 Kotak 105
mg
Asam askorbat (vitamin C) tab 50
107 Tab 105
mg
108 Asam folat tab 1 mg Botol 67 67
109 Asam folat tab 1 mg Botol 84
110 Asam folat tab 1 mg Botol 70
111 Asam mefenamat kaps 500 mg Kaps 103
112 Asam Mefenamat kapsul 500 mg Kotak 106
113 Asam Mefenamat kapsul 500 mg Kotak 103
114 Asam traneksamat inj 50 mg/ml Amp 1,748
115 Asam traneksamat inj 50 mg/ml Amp 2,950
116 Asam traneksamat inj 50 mg/ml Amp 1,748
117 Asering infus Botol 9,275
118 Asering infus Botol 9,646
119 Asering infus (WIDA BES) Botol 9,646

120 Asetat Ringer / Asering SOFT BAG Botol 9,646

121 Asetosal kaplet 80 mg (miniaspi) Kotak 148

122 Asetosal kaplet 80 mg (miniaspi) Kotak 99
123 Atapulgit 600 mg Tab 136
124 Atenolol tab 50 mg Tab 297
125 Atropin inj 0.25 mg/ml Amp 1,672
126 Atropin inj 0.25 mg/ml Amp 1,595
127 Atropin tab 0,5 mg Tab 105
128 Atropin tab 0.5 mg Kotak 95
129 Atropin tab 0.5 mg Kotak 95
130 Bahan Tumpat Sementara Jar 135,300
131 Bedak salisil serbuk 2 % Box 1,025
132 Bedak salisil serbuk 2 % box 1,250
133 Bedak salisil serbuk 2 % Box 2,200
134 BETAHISTIN MESILATE 6 mg Tab 110
135 Betametason krim 0,1 % Tube 1,349
136 Betametason krim 0,1 % Tube 1,520
137 Betametason krim 0,1 % Tube 1,340
138 Betametason krim 0,1 % Tube 1,340
139 Bisakodil sup 5 mg supp 6,000
Bisakodil suppositoria 10 MG
140 supp 5,900
(DULCOLAX SUPP)
Bisoprolol tablet/kapsul/kaplet 2,5
141 Tab 597
mg
142 Bonding pcs 968,000
143 Bonding pcs 968,000
144 Bricasma injeksi 0,5 mg/ml Ampul 11,960
145 Bricasma respule 2,5 mg/ml respule 7,124
146 Captopril 12,5 mg Kotak 62
147 Captopril 12,5 mg Kotak 59
148 Captopril 12,5 mg Kotak 62
149 Captopril 25 mg Kotak 68
150 Captopril 25 mg Kotak 75
151 Cetirizin tablet 10 mg Kotak 143
152 Cetirizin tablet 10 mg Kotak 90
153 CHKM Botol 70,000
154 CHKM Botol 68,750
155 Cifrofloxacin tab.500 mg Kotak 265
156 Cifrofloxacin tab.500 mg Kotak 281
157 Cifrofloxacin tab.500 mg Kotak 265
158 CLOPIDOGREL 75 mg Kaps 1,318

159 Deksametason inj 5 mg/ml (i.v./i.m.) Ampul 1,097

160 Deksametason tab 0,5 mg Kotak 44

161 Deksametason tab 0,5 mg Kotak 62
162 Deksametason tab 0,5 mg Kotak 32
163 Deksametason tab 0,5 mg Tab 32
164 Depakote Botol 120,000
165 Devitalisasi Pasta (Pulp X) pot 339,700
166 Devitalisasi Pasta (Pulp X) pot 339,700
167 Dexamethasone inj 5 mg/ml Kotak 1,567
168 Dexamethasone inj 5 mg/ml Kotak 1,518
169 Dexamethasone inj 5 mg/ml Kotak 1,097
170 Diazepam inj 5 mg/mL Amp 5,769
171 Diazepam inj 5 mg/mL Amp 1,735
172 Diazepam inj 5 mg/mL Amp 1,735
173 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul 1,735
174 Diazepam lar rektal 10 mg/2.5 mL Botol 16,742
175 Diazepam lar rektal 10 mg/2.5 mL Botol 16,742
176 Diazepam lar rektal 5 mg/2.5 mL Botol 12,573
177 Diazepam lar rektal 5 mg/2.5 mL Botol 11,517
178 Diazepam tab 2 mg Botol 86
179 Diazepam tab 5 mg kotak 117
180 Diazepam tab 5 mg Tab 109
181 Diazepam tab 5 mg Botol 118
182 Diazepam tab 5 mg Botol 109
183 Difenhidramin HCL inj 10 mg/mL Kotak 1,175
184 Difenhidramin HCL inj 10 mg/mL Kotak 1,095
185 Digoksin tab 0,25 mg Kotak 105
186 Digoksin tab 0,25 mg Kotak 104
187 Digoksin tab 0,25 mg Tab 104
188 Digoksin tablet 0,25 mg Kotak 97
189 Dimenhidrinat tab 50 mg Botol 99
190 Dimenhidrinat tab 50 mg Botol 105
191 Doksisiklin 100 mg Kotak 270
192 Doksisiklin 100 mg Kotak 270
193 Domperidon susp 5 mg/5 ml Botol 3,000
194 Domperidon susp 5 mg/5 ml Botol 2,700
195 Domperidon susp 5 mg/5 ml Botol 2,700
196 Domperidon tab 10 mg Kotak 118
197 Domperidon tab 10 mg Kotak 85
198 Domperidon tab 10 mg Kotak 85
199 Domperidon tab 10 mg Tab 85
200 Domperidone Syr botol 3,333
201 Domperidone tab 10mg box 167
202 Epinefrin (adrenalin) inj 1 mg/ mL Kotak 2,204
203 Epinefrin (adrenalin) inj 1 mg/ mL Kotak 1,408
204 Epinefrin inj 1 mg/ml kotak 8,100

205 Ergotamin tab 1 mg + kaffein 50 mg Tab 173

206 Erithromycin sirup kering 200 mg botol 7,700

207 Eritromisin kaps 500 mg Kotak 730
208 Eritromisin kaps 500 mg Kaps 750
209 Erytromisin kapsul 250 mg Kotak 557
210 Erytromisin kapsul 250 mg Kotak 497
Erytromisin kaptab salut selaput
211 Kotak 750
500 mg

212 Erytromisin sirup kering 200 mg /ml Kotak 6,700

213 Erytromisin sirup kering 200 mg /ml Kotak 6,090

214 Erytromisin susp 200 mg/5 mL Botol 6,150

215 Erytromisin susp 200 mg/5 mL Botol 6,150
216 Etanol 70% cairan Botol 2,500
217 Etanol 70% cairan Botol 2,500
218 Etanol 70% cairan Botol 3,200
219 Etanol 70% cairan Botol 3,520
220 Etil klorida semprot 100 ml Botol 207,500
221 Etil klorida semprot 100 ml Botol 352,000
222 Etil klorida semprot 100 ml Botol 140,800
223 Eugenol Botol 18,824
224 Eugenol cairan Botol 18,100
225 Eugenol cairan Botol 18,824
226 Fenitoin Na 100 mg tab 158
Fenitoin Na inj. 50 mg/ml (100 mg/2
227 Amp 3,738
ml)
228 Fenobarbital 30 mg tab 171
229 Fenobarbital inj 50 mg/ml Kotak 1,740
230 Fenobarbital inj 50 mg/ml Kotak 1,857
231 Fenoksimetil P. tab 250 mg Kotak 350
232 Fenoksimetil P. tab 250 mg Kotak 350
233 Fenoksimetil P. tab 500 mg Kotak 605
234 Fenoksimetil P. tab 500 mg Kotak 629
Ferro fumarat 60 mg + as. Folat 0.4
235 Kotak 355
mg tablet salut
Ferro fumarat 60 mg + as. Folat 0.4
236 Kotak 354
mg tablet salut
Fitomenadion (vitamin K 1) inj 2
237 Kotak 3,550
mg/ml (i.m.)
Fitomenadion (vitamin K 1) inj 2
238 Kotak 3,682
mg/ml (i.m.)
Fitomenadion (vitamin K 1) inj 2
239 Ampul 3,682
mg/ml (i.m.)
Fitomenadion (vitamin K 1) tab sal
240 Botol 691
10 mg
Fitomenadion (vitamin K 1) tab sal
241 Botol 710
10 mg
Fitomenadion (vitamin K 1) tab sal
242 Tab sal 710
10 mg
243 Fitomenadion Tab. salut 10 mg Botol 630
244 Flufenazin inj 25 mg/ml Amp 59,800
Fluocinolone Acetonide, Neomycin
245 botol 15,950
sulfat cream
246 Fluoxetin ( Frestin ) Kapsul 4,400
247 Furosemid inj 10 mg/ml (i.v./i.m.) Kotak 1,333
248 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 1,333
249 Furosemid tab 40 mg Strip 78
250 Furosemid tab 40 mg Strip 95
251 Furosemid tab 40 mg Strip 77
252 Furosemid tab 40 mg Tab 77
253 Galpain Cream Tube 20,900
254 Galpain cream Kotak 19,000
Garam oralit kombinasi : natrium
klorida 0,52 g + kalium klorida 0,30
255 Kotak 237
g + trinatrium sitrat 0,58 g + glukosa
anhidrat 2,7 g

Garam oralit kombinasi : natrium

klorida 0,52 g + kalium klorida 0,30
256 Kotak 257
g + trinatrium sitrat 0,58 g + glukosa
anhidrat 2,7 g
 Garam oralit kombinasi : natrium
klorida 0,52 g + kalium klorida 0,30
257 Sachet 257
g + trinatrium sitrat 0,58 g + glukosa
anhidrat 2,7 g

258 Gemfibrozil kaps 300 mg Kotak 496

259 Gemfibrozil kaps 300 mg Kotak 289
260 Gemfibrozil kaps 300 mg Kotak 372
261 Gentamysin inj 40 mg/ml Amp 3,399
262 Gentamysin inj 40 mg/ml Amp 3,399

263 Gentamysin sulfat tetes mata 0,3% botol 4,232

264 Glass Ionomer Botol 631,000

265 Glass Ionomer Botol 652,300
Glass ionomer ART (Atraumatic
266 Botol 652,300
Restorative Treatment) lar
Glass Ionomer Cement ART
267 set 652,300
(Atraumatic Restorative Treatment)

glassionometer cement ( ketac

268 set 631,000
universal HM RF A3 + HM RF Liq

269 Glibenclamide 5 mg box 78

270 Glibenclamide 5 mg kotak 120
271 Glibenklamid tab 5 mg Kotak 119
272 Glibenklamid tab 5 mg Tab 119
273 glikazid tab 80mg (Glucodex) Kotak 210
274 glikazid tab 80mg (Glucodex) Kotak 220
275 Glikazid tablet 80mg tab 220
276 GLIMEPIRID 3 mg Tab 245
277 Glimepirid tab 1 mg Tab 174
278 Glimepirid tab 2 mg Tab 207
279 Glimepiride tab 1 mg Kotak 194
280 Glimepiride tab 1 mg Kotak 174
281 glimepiride tab 2 mg Kotak 289
282 glimepiride tab 2 mg Kotak 207
283 glimepiride tab 3 mg Kotak 404
284 glimepiride tab 3 mg Kotak 404
285 Gliseovulvin 125mg kotak 340
286 Gliseril gualicolat tab 157
287 glucose 1/4 NS botol 9,350
288 Glucose 1/4 NS infus Botol 9,250
289 Glucose 1/4 NS infus Botol 9,724
Glukosa Larutan Infus 10% steril
290 Botol 7,500
500 ml
Glukosa Larutan Infus 10% steril
291 Botol 7,500
500 ml
Glukosa Larutan Infus 5% steril 500
292 Botol 6,900
ml
Glukosa Larutan Infus 5% steril 500
293 Botol 6,900
ml
Glukosa Larutan Infus 5% steril 500
294 Botol 6,900
ml
 Griseofulvin (micronized) tab 125
295 Kotak 374
mg
Griseofulvin (micronized) tab 125
296 Kotak 210
mg
Griseofulvin (micronized) tab 125
297 Tab 210
mg
298 Gutta percha set 90,200
299 Gutta percha Kotak 62,920
300 Gutta percha Kotak 62,920
301 Gutta percha kotak 62,920
302 H C T tab 25 mg Botol 149
303 H C T tab 25 mg Kotak 155
304 Halloperidol tts 2 mg/ 15ml Botol 17,099
305 Halloperidol tts 2 mg/ 15ml Botol 12,600
306 Haloperidol inj 5 mg/ml (i.m.) Amp 4,974
307 Haloperidol tab 2 mg Kotak 84
308 Haloperidol tab 2 mg Tab 84
309 Haloperidol tab 5 mg Kotak 75
310 Haloperidol tab 5 mg Kotak 56
311 Haloperidol tab 5 mg Tab 56
312 Haloperidol tab. 0,5 mg Kotak 56
313 Hidroklorotiazid tab 25 mg Tab 155
314 Hidrokortison krim 2,5% Tube 2,650
315 Hidrokortison krim 2,5% Tube 2,475
316 Hidrokortison krim 2,5% Tube 2,475
317 Hidrokortison tab 25 % Tube 155
318 Hidrokortison tab 25 % Tube 155
319 Ibuprofen susp 100 mg/mL Botol 2,475
320 Ibuprofen susp 100 mg/mL Botol 2,550
321 Ibuprofen susp 100 mg/mL Botol 2,550
322 Ibuprofen tab 200 mg Botol 105
323 Ibuprofen tab 200 mg Botol 105
324 Ibuprofen tab 200 mg Tab 105
325 Ibuprofen tab 400 mg Botol 127
326 Ibuprofen tab 400 mg Botol 122
327 Ibuprofen tab 400 mg Tab 122
isosorbid dinitrat sublingual 5 mg
328 Kotak 88
tab
329 Isosorbid dinitrat tab 5 mg Kotak 89
330 Isosorbid dinitrat tab 5 mg Kotak 89
331 Isosorbid dinitrat tab 5 mg Tab 89
332 Kalsium glukonat inj 100 mg/ml Amp 9,955
333 Kalsium glukonat inj 100 mg/ml Amp 10,351
334 Kalsium glukonat inj 100 mg/ml Ampul 10,351
Kalsium Hydroksida Pasta
335 Kotak 207,350
(Calcidor)
336 Kalsium laktat (kalk) tab 500 mg Kotak 63
337 Kalsium laktat (kalk) tab 500 mg Kotak 59
338 Kalsium laktat (kalk) tab 500 mg Tab 59
339 Kalsiun Hidroksida Pasta (Ultracal) Kotak 255,900

340 Kalsiun Hidroksida Pasta (Ultracal) Kotak 199,400

341 KANDESARTAN 8 mg Tab 519

342 Kaptopril tab 12,5 mg Tab 62
343 Kaptopril tab 25 mg Tab 75
344 Karbamazepin tablet 200 mg Kotak 270
345 Karbamazepin tablet 200 mg Kotak 230
346 Karbamazepin tablet 200 mg TAB 230
347 Ketoconacole krim 2% Tube 2,569
348 Ketoconacole krim 2% Tube 2,569
349 Ketokonazol tab 200 mg Tab 270
350 Ketokonazole tab 200 mg Kotak 280
351 Ketokonazole tab 200 mg Kotak 270
352 Ketokonazole tablet 200 mg Kotak 300
353 Klindamisin 150 mg Tab 715
354 Klindamisin 300 mg Tab 583
355 klobazam 10 mg box 900
356 Klobazam 10 mg tab Kotak 970
357 Klobazam 10 mg tab Kotak 739
358 Kloramfenikol kaps 250 mg Kaleng 310
359 Kloramfenikol kaps 250 mg Kaleng 310
360 Kloramfenikol kaps 250 mg Kaps 310
361 Kloramfenikol kaps 500 mg kaps 1,090
362 Kloramfenikol salep kulit 2% Tube 3,038
363 Kloramfenikol susp 125 mg/5 ml Botol 4,700
364 Kloramfenikol susp 125 mg/5 ml Botol 4,700
365 Kloramfenikol susp 125 mg/5 ml Botol 4,700
366 Kloramfenikol tab 500 mg Kotak 1,048
367 Kloramfenikol tab 500 mg Kotak 1,090
368 Kloramphenicol cap 250 mg box 249
369 Kloramphenicol SM 1 % Tube 1,798
370 Kloramphenicol SM 1 % Tube 1,881
371 Klorfeniramin ( CTM ) tab 4 mg Kotak 51
372 Klorfeniramin tab 4 mg Tab 22
373 Klorfeniramin tab 4 mg (CTM) Kotak 42
374 Klorfeniramin tab 4 mg (CTM) Kotak 22
375 Klorpromazin inj 25 mg Kotak 1,240
376 Klorpromazin inj 25 mg Kotak 1,240
377 Klorpromazin tab sal 100 mg Tab sal 147
378 Klorpromazin tab salut 100 mg Kotak 144
379 Klorpromazin tab salut 100 mg Kotak 147
380 Klozapin 100 mg Kotak 5,000
381 Klozapin 100 mg Kotak 3,288
382 Klozapin 100 mg tab 3,288
383 Klozapin 25 mg tab 1,121
384 Klozapin 25 mg Kotak 1,550
385 Klozapin 25 mg Kotak 1,121
386 Kodein tab 10 mg Kotak 500
387 Kodein tab 10 mg Kotak 571
388 Kodein tab 10 mg Tab 571
389 Kodein tabl 20 mg Kotak 1,100
390 Kodein tablet 20 mg Kotak 1,100
Kombinasi tablet salut (Tablet
391 Saset 354
Tambah Darah)
Komposit ( bahan tumpat dengan
392 Kit 2,926,000
sinar)
Komposit ( bahan tumpat dengan
393 kit 2,926,000
sinar)
394 komposit (Hiltex Z250 Kit) kit 2,837,000
395 komposit (Hiltex Z250 Kit) kit 2,926,000
Kotrimoksazol (dewasa) kombinasi :
396 sulfametoksazol 400 mg+ Kotak 151
trimetoprim 80 mg

Kotrimoksazol (dewasa) kombinasi :

397 sulfametoksazol 400 mg+ Kotak 151
trimetoprim 80 mg

Kotrimoksazol (dewasa) kombinasi :

398 sulfametoksazol 400 mg+ Tab 125
trimetoprim 80 mg
399 Kotrimoksazol suspensi Botol 2,140
400 Kotrimoksazol suspensi Botol 2,052
401 Kotrimoksazole suspensi botol 2,167
402 Kotrimoksazole tab dewasa kotak 138

Larutan mengandung Karbohidrat +

Elektrolit (Nacl 1.75 gr, KCl 1.5 gr,
403 Botol 10,050
Na Lactat 2.24 gr, Dekstrosa 27 gr)
(KA EN 3B)

Larutan mengandung Karbohidrat +

Elektrolit (Nacl 1.75 gr, KCl 1.5 gr,
404 Botol 10,696
Na Lactat 2.24 gr, Dekstrosa 27 gr)
(KA EN 3B)

Larutan mengandung Karbohidrat +

Elektrolit (Nacl 1.75 gr, KCl 1.5 gr,
405 Botol 10,696
Na Lactat 2.24 gr, Dekstrosa 27 gr)
(KA EN 3B)

406 Lidocain Injeksi 2 % (HCl) Vial 1,149

Lidocain injeksi 2% + Epinefrin
407 Amp 1,760
1:80.000 - inj 2 Ml
Lidocain injeksi 2% + Epinefrin
408 Amp 1,149
1:80.000 - inj 2 Ml
Lidokain injeksi 2% + Epinefrin
409 Amp 1,845
1:80.000 - inj 2 Ml
410 Lisinopril tablet 5mg tablet 269
411 Lisinopril tablet 5mg tablet 209
412 Loperamid 10 mg kotak 89
413 Loperamid tab 10 mg Kotak 80
414 Loperamid tab 10 mg Kotak 94
415 Loperamid tab 2 mg Kotak 80
416 Loperamid tab 2 mg Kotak 94
417 Loperamid tab 2 mg Tab 103
418 Loratadin tab 10 mg Kotak 250
419 Loratadin tab 10 mg Kotak 275
420 Loratadin tab 10 mg Tab 123
421 Loratadine tab 10 mg Kotak 154
422 Lorazepam tab 2 mg (Merlopam) Kotak 1,341
423 Lorazepam tab 2 mg (Merlopam) Kotak 1,341
424 Magnesium sulfat inj 20 % Amp 3,200
425 Magnesium sulfat inj 20 % Amp 3,328
426 Magnesium sulfat inj 20% Vial 3,328
427 Magnesium sulfat inj 40 % Amp 3,650
428 Magnesium sulfat inj 40 % Amp 3,796
429 Magnesium sulfat inj 40% Vial 3,796
Metamizol Sodium Inj
430 Ampul 7,600
( NORAGES )
431 Metamizol Sodium Tablet Tablet 220
432 Metamizole 1 g / 2 ml Inj ampul 6,050
433 Metformin 500 mg kotak 113
434 Metformin tab 500 mg Kotak 94
435 Metformin tab 500 mg Kotak 94
436 Metformin tab 500 mg Tab 96
437 Methyl Ergometrin Inj. 0.25 mg/ml Kotak 2,684
438 Methyl Ergometrin Inj. 0.25 mg/ml Kotak 2,684
Methyl Ergometrin tablet salut 0.25
439 Kotak 154
mg
Methyl Ergometrin tablet salut 0.25
440 Kotak 210
mg
441 Metilprednisolon tablet 4 mg Kotak 150
442 Metilprednisolon tablet 4 mg Kotak 134
443 Metilprednisolon tablet 4 mg tab 134
444 Metoklopamide tab 10 mg Kotak 87
445 Metoklopamide tab 10 mg Kotak 80
446 Metronidazol infus 500 mg/100 ml Botol 9,950
447 Metronidazol infus 500 mg/100 ml Botol 9,950
448 Metronidazol susp 125 mg/ 5mL Botol 3,800
449 Metronidazol susp 125 mg/ 5mL Botol 3,800
450 Metronidazol tablet 250 mg Kotak 110
451 Metronidazol tablet 250 mg Kotak 110
452 Metronidazol tablet 500 mg Kotak 133
453 Metronidazol tablet 500 mg Kotak 133
454 Metronidazol tablet 500 mg tab 124
455 metronidazole 500 mg tab kotak 160
456 Metronidazole Syr Pcs 4,500
457 miconazole cream Tube 3,000
458 Mikonazol krim/salep 2 % Tube 3,250
459 Mikonazol krim/salep 2 % Tube 3,414
Mukolitik & ekspektoran sirup (OBH
460 Botol 5,340
Molex sirup)
Mukolitik & ekspektoran sirup (OBH
461 Botol 5,000
Molex sirup)
 Mukolitik & ekspektoran sirup (OBH
462 Botol 5,500
Molex sirup)
botol @ 10
463 Multivitamin + Mineral Drops 5,500
ml
botol @ 10
464 Multivitamin + Mineral Drops 6,050
ml
465 NaCl 0,9% Larutan Botol 5,827
466 NaCl 0,9% Larutan Botol 6,410
467 NaCl 0,9% Larutan Botol 6,410
468 Natrium Diklofenac tab 25 mg Kotak 145
469 Natrium Diklofenac tab 25 mg Kotak 128
470 Natrium Diklofenac tab 50 mg Kotak 159
471 Natrium Diklofenac tab 50 mg Kotak 115
472 Natrium diklofenak tab 25 mg Tab 128
473 Natrium diklofenak tab 50 mg Tab 115
474 Nifedipin tab kotak 110
475 Nifedipin TAB 10 mg Tab 114
476 Nifedipin Tab 10 mg tablet Kotak 104
477 Nifedipin Tab 10 mg tablet Kotak 132
478 Nistatin 100.000 IU/g tab.Vag Kotak 523
479 Nistatin 100.000 IU/g tab.Vag Kotak 480
480 Nistatin 100.000 IU/g tab.Vag Kotak 560
481 Novorapid unit 87,000
482 Nystatin tablet 500.000 IU Kotak 745
483 Nystatin tablet 500.000 IU Kotak 790

Obat Batuk dan Flu sirop

( Parasetamol; Dexchlorpheniramin
484 botol 15,855
maleate; thiocol ; sorbitol syrup with
chocolate flavor )

485 Obat Antispasmodik(Dormi) Kotak 2,800

Obat Batuk sirup ( Vitex Trifolia

folium ( Daun legundi ) 1 g; Zingiber
Officinale Rhizoma (jahe gajah)
486 0,25 g; Abrus Precatorius Folium btl 60 ml 12,100
(daun saga) 0,25 g; Phaleria
Macrocarpa Fructus (buah mahkota
dewa) 0,20 g

Obat Batuk & antihistamin syr

487 Botol 12,100
( Herbakof sirup)

488 Obat Batuk & Flu syr ( DEXMOLEX) Botol 11,000

Obat Batuk Hitam ( Ika

489 Botol 4,840
Pharma )
490 Obat Demam dan influenza (sirup) botol 15,840
491 Obat radang kulit (Bravoderm N ) Tube 14,000
Obat Sariawan & Radang
492 Tube 15,000
(Bufacomb)
Obat Sariawan & Radang
493 Tube 14,500
(Bufacomb)
Obat Sariawan & Radang
494 Tube 16,500
(Bufacomb)
 Obat Sariawan dan Radang rongga
tube @ 5
495 mulut ( Triamcinolone Acetonide 1 16,500
gr
mg )

Obat Tetes Mata ( Anti mikroba +

496 Botol 15,000
kortikosteroid )
Obat Tetes Mata ( Anti mikroba +
497 Botol 16,500
kortikosteroid )
498 Obat tetes Telinga (RECO) Botol 7,000
499 Obat tetes Telinga (RECO) Botol 6,500
500 Obat tetes Telinga (RECO) Botol 7,700
Obat Tetes Telinga Antibiotik botol @10
501 8,250
( Kloramfenikol base 10 mg / ml ) ml
502 OBH botol 4,950

OBH : ( Glicyrrhizae Succus 167

503 botol 60 ml 5,500
mg, Ammonium Chlorida 100 mg )

504 Oksi Tetra. HCl slp Mata 1 % Tube 2,772

505 Oksi Tetra. HCl slp Mata 1 % Tube 2,520
506 Oksi Tetra. HCl slp Mata 1 % Tube 2,772
507 oksitetra salep kulit Tube 1,827
508 Oksitetra Salep Kulit 3 % Tube 2,000
509 Oksitetra Salep Kulit 3 % Tube 2,000
tube 5
510 Oksitetrasiklin salep kulit 3 % 2,200
gram
511 Oksitosin inj.10 UI/ml Kotak 1,900
512 Oksitosin inj.10 UI/ml Kotak 1,199
513 Omeprazol kaps 20 mg Kotak 160
514 Omeprazol kaps 20 mg Kotak 130
515 Omeprazol kaps 20 mg Kaps 130
516 Pan amin larutan infus Botol 45,950
517 Pan amin larutan infus Botol 45,950
518 Paper point Kotak 49,500
519 Paper point kotak 62,920
520 Parasetamol drop 100 mg/ml Botol 5,200
521 Parasetamol drop 60 mg/0.6 mL Botol 6,649
522 Parasetamol sir 120 mg/5 ml Botol 1,107
Parasetamol Sirup 120 mg / 5 ml
523 Botol 1,010
(mersi)
Parasetamol Sirup 120 mg / 5 ml
524 Botol 1,107
(mersi)
Parasetamol Sirup 120 mg / 5 ml
525 Botol 3,500
(nova)
526 Parasetamol tab 500 mg Kotak 132
527 Parasetamol tab 500 mg Kotak 53
528 Parasetamol tab 500 mg Tab 53
529 Permethrin/ Permetrin Krim 5% Tube 11,825
530 Pirantel Pamoat tablet 125 mg Kotak 291
531 Pirantel Pamoat tablet 125 mg Kotak 291
532 Piridoksin (vitamin B6) tab 10 mg Botol 123
533 Piridoksin (vitamin B6) tab 10 mg Botol 123
534 Piridoksin (vitamin B6) tab 10 mg Tab 123
535 Piridoksin HCl tablet 10 mg Botol 118
536 Piroksikam tablet 20 mg Kotak 110
537 Piroksikam tablet 20 mg Kotak 118
538 Piroksikam tablet 20 mg Kotak 121
539 Povidon iodin lar 100 mg/ml Botol 6,550
540 Povidon iodin lar 100 mg/ml Botol 3,700

541 Povidon iodin lar 100 mg/ml Botol 60 ml 7,700

542 Povidon iodin lar 60 ml Botol 5,998

543 Prednison tab 5 mg Kotak 69
544 Prednison tab 5 mg Kotak 68
545 Prednison tab 5 mg Tab 68
546 Prednisone Tab Tablet 62
547 Propanolol tab 10 mg Botol 52
548 Propanolol tab 10 mg Botol 54
549 Propanolol tablet 10 mg Botol 180
550 Propiltiourasil tab 100 mg Kotak 380
551 Propiltiourasil tab 100 mg Kotak 418
552 Propranolol tab 10 mg Tab 54
553 Pulmicort respule 0,25 mg/ml respule 9,725
554 Pulmicort respule 0,5 mg/ml respule 13,242
Pulmicort turbohaler 200 mcg/200
555 can 105,040
dosis
556 Ranitidin injeksi 25 mg/ 2ml Kotak 1,390
557 Ranitidin injeksi 25 mg/ 2ml Kotak 1,140
558 Ranitidin injeksi 25 mg/ 2ml Kotak 1,155
559 Ranitidin injeksi 25 mg/ 2ml Ampul 1,155
560 Ranitidin tab 150 mg Kotak 105
561 Ranitidin tab 150 mg Kotak 209
562 Ranitidin tab 150 mg Tab 116
563 Ranitidin tablet 150 mg Kotak 120
564 Resperidone 2 mg tab kotak 1,008
Retinol (vitamin A) kaps lunak
565 Botol 284
100.000 UI
Retinol (vitamin A) kaps lunak
566 Botol 288
100.000 UI
Retinol (vitamin A) kaps lunak
567 Kaps lunak 288
100.000 UI
Retinol (vitamin A) kaps lunak
568 Botol 505
200.000 UI
Retinol (vitamin A) kaps lunak
569 Botol 517
200.000 UI
Retinol (vitamin A) kaps lunak
570 Kaps lunak 517
200.000 UI
571 Ringer Asetat larutan infus Botol 7,150
572 Ringer Asetat larutan infus Botol 7,150
Ringer Lactat larutan Infus (otsu
573 Botol 6,500
RL)
 Ringer Lactat larutan Infus (otsu
574 Softbag 6,500
RL)
Ringer Lactat larutan Infus
575 Softbag 7,150
(SANBE)

576 Ringer Lactat larutan Infus (widatra) Botol 7,150

577 Ringer Lactat larutan Infus (widatra) Botol 7,150

578 Risperidon tablet 2 mg Kotak 495

579 Risperidon tablet 2 mg Kotak 273
580 Risperidon tablet 2 mg Botol 273
581 Rivanol 300 cc Botol 2,550
582 Rivanol 300 cc Botol 3,000
583 Rivanol 300 cc Botol 3,000
584 Rivanol 300 cc Botol 2,420
585 Salbutamol 2 mg tab kotak 59
586 Salbutamol 4 mg tab kotak 89
587 Salbutamol cairan ih 0,1 % Botol 4,000
588 Salbutamol cairan ih 0,1 % Botol 4,000
589 Salbutamol cairan ih 0,1% Botol 4,400
590 Salbutamol tab 2 mg Kotak 66
591 Salbutamol tab 2 mg Kotak 63
592 Salbutamol tab 2 mg Tab 63
593 Salbutamol tab 4 mg Kotak 83
594 Salbutamol tab 4 mg Kotak 70
595 Salbutamol tab 4 mg Tab 70
596 Salep 2-4 Kotak 2,429
597 Salep 2-4 Kotak 2,620
598 Sefadroksil kapsul 500 mg Kotak 516
599 Sefadroksil kapsul 500 mg Kotak 478
600 Sefadroksil kapsul 500 mg kaps 478

601 Sefadroksil sirup kering 125 mg/5ml Botol 3,299

602 Sefotaksim injeksi 1 gram Kotak 4,898

603 Sefotaksim injeksi 1 gram Kotak 4,200
604 Sefotaksim injeksi 1 gram Vial 4,200
605 Selang oksigen dewasa pcs 9,500
606 Semen Seng Set 114,400
607 Semen Seng Fosfat (multifix) Set 206,250
608 Semen Seng Fosfat (multifix) Set 220,220
609 Semen Zink Phospate set 220,220
610 Serum A T S 1500 IU (Biosat-1.5) Vial 130,999
611 Serum Anti Bisa Ular (Biosave) Vial 479,996
Serum Anti Tetanus ( A.T.S ) cairan ampul @ 1
612 130,999
i.m 1500 UI/ml ml
613 Setirizin tablet 10 mg tab 90
614 setirizine tab 10 mg Kotak 96
615 setirizine tab 10 mg Kotak 90
Sianokobalamin (vitamin B12)
616 Amp 968
injeksi 500 mcg
 Sianokobalamin (vitamin B12)
617 Amp 1,098
injeksi 500 mcg
Sianokobalamin (vitamin B12)
618 Amp 1,035
injeksi 500 mcg
Sianokobalamin (vitamin B12)
619 Ampul 1,320
injeksi 500 mcg
Sianokobalamin (vitamin B12) tablet
620 Kotak 46
50 mcg
Sianokobalamin (vitamin B12) tablet
621 Kotak 46
50 mcg
622 Sikzonoat inj 25mg/mL Amp 57,500
623 Sikzonoat inj 25mg/mL Amp 57,500
624 Sikzonoat inj 25mg/mL Vial 59,800
625 Simetidin tablet 200 mg Kotak 200
626 Simetidin tablet 200 mg Kotak 163
627 Simetidin tablet 200 mg Kotak 220
628 Simvastatin tab 10 mg Kotak 131
629 Simvastatin tab 10 mg Kotak 110
630 Simvastatin tab sal 20 mg Tab 205
Simvastatin tablet/kaplet/salut 20
631 Kotak 252
mg
Simvastatin tablet/kaplet/salut 20
632 Kotak 205
mg
633 Siprofloksasin tab scored 500 mg Kotak 240
634 Siprofloksasin tab scored 500 mg Kotak 265
635 Siprofloksasin tab scored 500 mg Tab 264
636 Spironolakton tab 100 mg 539
637 Spironolakton tab 25 mg Vial 195
638 Spironolakton tab 25 mg Vial 195
639 Spironolakton tab 25 mg Vial 195
640 Sulfadoksin tab kotak 520

SYMBICORT 80/4.5 (60 DOSIS)

kombinasi, setiap dosis
641 Pcs 125,840
mengandung : Budesonid 80 mcg
Formoterol 4,5 mcg (inhalasi)

642 Tetracyclin 250 mg kotak 149

643 Tetracyclin cap 250 mg Botol 166
644 Tetracyclin cap 250 mg Botol 174
645 Tetracyclin cap 500 mg Kotak 310
646 Tetracyclin cap 500 mg Kotak 303
647 Thiamin ( Vit B 1 ) tablet 50 mg Kotak 86
648 Tiamin ( Vitamin B1 ) tablet 50 mg Kotak 82
649 Tiamin ( Vitamin B1 ) tablet 50 mg Kotak 85
650 Tiamin ( Vitamin B1 ) tablet 50 mg tab 85
651 Trifuoperazin 5 mg Kotak 269
652 Trifuoperazin 5 mg Tab 259
653 Triheksifenidil tab 2 mg Kotak 80
654 Triheksifenidil tab 2 mg Kotak 85
655 Triheksifenidil tab 2 mg tab 85
656 tumpatan sementara (cavit) pot 131,000
657 tumpatan sementara (cavit) pot 135,300
Valproat tab salut enterik
658 Kotak 1,200
( DEPAKOTE tab)
659 Valsartan tablet 655
660 Valsartan tablet 160 mg TAB 999
661 Vit b kombinasi kotak 890
Vitamin & Mineral drop (Recovit
662 Botol 5,500
drop)
Vitamin & Mineral drop (Recovit
663 Botol 5,500
drop)
Vitamin & Mineral Suspensi (Vical
664 Botol 9,000
Suspensi)
665 Vitamin B Complex inj Vial 8,250
666 Vitamin B Complex inj Vial 8,250
Vitamin B kombinasi 200 kaplet
667 Kotak 979
(Bioron)
Vitamin B kombinasi 200 kaplet
668 Kotak 979
(Bioron)
Vitamin B kombinasi 5000 inj
669 Amp 4,083
(ikaneuron)
670 Vitamin B Kompleks Kotak 115
671 Vitamin B Kompleks Kotak 83
672 Vitamin B kompleks tab 83
673 vitamin Hemafort kotak 759

Vitamin Kombinasi Injeksi ( Thiamin

ampul @ 3
674 HCl 100mg , Piridoksin HCl 100 mg, 7,700
ml
Sianokobalamin 5000 mcg / 3 ml )

Vitamin Kombinasi Kaplet ( Thiamin

675 HCl 100mg , Piridoksin HCl 100 mg, kaplet 2,090
Sianokobalamin 5000 mcg )

676 Vitamin Neurotropik injeksi Amp 5,390

677 Vitamin tambah darah (Anti Anemia) dus 825

678 Vitamin tambah darah (Hemafort) Kotak 920

679 Yodin Povidon 10 % 30 ml Botol 2,163
680 Yodin Povidon 10 % 30 ml Botol 2,163
681 Yodin Povidon 10 % 300 ml Botol 14,203
682 Yodin Povidon 10 % 300 ml Botol 14,203
683 Yodin Povidon 10 % 60 ml Botol 5,998
684 Yodin Povidon 10 % 60 ml Botol 5,998
685 Zinc sir 20 mg/5 ml Botol 6,290
686 Zinc sir 20 mg/5 ml Botol 2,972
687 Zinc sir 20 mg/5 ml botol 2,972
688 Zinc tab disp 20 mg Kotak 514
689 Zinc tab disp 20 mg Kotak 524
690 Zinc tab disp 20 mg Tab 524
691 Zink Syr botol 5,500
BMHP
692 Alat Suntik 1 ml (NIPRO) Kotak 990
693 Alat Suntik 1 ml (NIPRO) Kotak 990
Alat Suntik 10 cc Luer Lock With
694 pcs 1,200
Needle 21 G x 1-1/2"
695 Alat Suntik 10 ml Kotak 1,298
696 Alat Suntik 10 ml Kotak 1,298
Alat Suntik 3 cc Luer Lock With
697 pcs 779
Needle 23 G x 1 1/4"
698 Alat Suntik 3 ml Kotak 792
699 Alat Suntik 3 ml (NIPRO) Kotak 792
Alat Suntik 5 cc Luer Lock With
700 pcs 968
Needle 22 G x 1-1/2"
701 Alat Suntik 5 ml Kotak 979
702 Alat Suntik 5 ml (NIPRO) Kotak 979
703 Alkazyme Sachet 25 mg pack 801,000
704 Alkazyme Sachet 25 mg pack 801,000
705 ALKOHOL + Clorhexidin Swab Kotak 9,999
706 ALKOHOL + Clorhexidin Swab Kotak 15,730
707 ALKOHOL + Clorhexidin Swab kotak/100 15,730
708 Alkohol 70 % 300 mL botol 8,000
709 Antiseptik dan Disinfektan 500 ml 34,500
710 Aseptan 500cc + pump Botol 34,496
711 Aseptan 500cc + pump Botol 34,500
712 Blood Lancet No.26 G kotak/100 14,566
713 Blood Transfusi set (Nipro) pcs 13,420
714 Blood transfusion set pcs 3,600
Cat Gut Chromic 2/0 75C + jarum Box isi 12
715 27,497
1/2 30m R sachet
Cat Gut Chromic 3/0 75C + jarum Box isi 12
716 27,497
1/2 22m R sachet
Cat Gut Plain 2/0 70C + jarum 1/2 Box isi 12
717 32,589
25m R sachet
718 Cat Gut Plain 2/0 HR-26 mm pcs 36,000
Cat Gut Plain 3/0 70C + jarum 1/2 Box isi 12
719 30,043
25m R sachet
720 Cat Gut Plain 3/0 HR-26 mm pcs 36,000
721 CATGUT CHROMIC 2/0 pcs 22,500.00
CATGUT CHROMIC SMI 3/0 HR 26
722 Sachet 32,800.00
MM
723 CATGUT PLAIN 2/0 pcs 26,667

724 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet 34,300.00

725 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet 34,300.00

726 COSMOMED Infusion Set (Anak) pcs 4,400

COSMOMED Infusion Set

727 pcs 4,200
(Dewasa)
1 box/100
728 Disposible Needle 23 G x 11/4" 36,905
pcs
1 box/100
729 Disposible Needle 24 G x 1" 36,905
pcs
 1 box/100
730 Disposible Needle 25 G x 1" 36,905
pcs
731 Disposible needle no 23 Pcs 334
732 Disposible needle No.23 G 1 1/4" Kotak 335
733 Disposible needle No.23 G 1 1/4" Kotak 335
734 Disposible needle No.24 G 2 Kotak 335
735 Disposible needle No.24 G 3 Kotak 335
736 Disposible needle No.25 G 2 Kotak 335
737 Disposible needle No.25 G 3 Kotak 335
738 Folley Catheter 2 Way no. 12 BOX/10 80,000
739 Folley Catheter 2 Way no. 14 BOX/10 80,000
740 Folley Catheter 2 Way no. 16 BOX/10 80,000
741 Folley Catheter 2 Way no. 18 BOX/10 80,000
742 Folley Catheter 2 Way no. 20 BOX/10 80,000
743 Folley Catheter 2 Way no. 22 BOX/10 80,000
744 Folley Catheter 2 Way no. 24 BOX/10 80,000
I V Cathether no 20 (Otsucath
745 Biji 7,700
no.20)
I V Cathether no 20 (Otsucath
746 Biji 7,700
no.20)
I V Cathether no 22 (Otsucath
747 Biji 7,700
no.22)
I V Cathether no 22 (Otsucath
748 Biji 7,700
no.22)
I V Cathether no 24 (Otsucath
749 Biji 7,700
no.24)
750 Infus Set Anak Pcs 7,920
751 Infus Set Dewasa Set 7,920
752 Infus Set Dewasa Set 6,930
753 Infussert anak Pcs 3,200
IV Cannula with Safety Wings
754 pcs 4,700
No.22 COSMOMED
755 IV Cateter No. 26 G pcs 13,476
756 IV Catheter NO 20 G Otsucath pcs 8,250
757 IV Catheter NO 24 G Otsucath pcs 8,250
IV Catheter no 26 ( Ttrovenocath
758 Biji 13,476
plus 26G)
759 IV DRESSING 6 X 7 S (ID67S) BOX/100 220,000
760 Jarum 24 G pcs 369
761 kapas berlemak 500g ONEMED pCS 16,500
762 Kapas Pembalut 250 gr pcs 7,500
763 Kapas Pembalut 250 gram Biji 13,400
764 Kapas Pembalut 250 gram Biji 12,500
765 Kasa 40 x 40 JAYAMAS pcs 1,600
Kasa Pembalut Hidrofil 4 m x 10
766 pcs 1,500
cm ONEMED
767 Kasa 16x16 steril Kotak 7900
768 Kasa 40 x 80 cm ONEMED roll 105,000
769 Kasa 40x16 Pcs 32,000
770 Kasa 4x10 Pcs 2,000
771 Kasa 4x10 cm Roll 1,499

772 Kasa 4x5 Pcs 1,500

773 Kasa 4x5 cm Roll 749

774 Kasa Hidrofil 2m x 80cm ONEMED Roll 7,800

Kasa hydrofil steril 16 x 16

775 Pcs 8,000
JAYAMAS

776 Kasa Hydrofil Steril 16x16 cm Biji 5,950

777 Kasa Kompres Steril 40x40 cm Biji 1,618

Kasa Pembalut Hidrofil 4 m x 15 cm

778 pcs 2,100
ONEMED
Kasa Pembalut Hidrofil 4 m x 5 cm
779 pcs 750
ONEMED

780 Masker 3 ply ear loop Kotak 21,945

781 Masker 3 ply tie on Kotak 21,945

782 Masker kesehatan Ear loop pcs 439

Masker Oksigen Anak

783 pcs 23,650
( HOSPITECH oxygen mask)
Masker Oksigen Dewasa
784 pcs 23,650
( HOSPITECH oxygen mask)
Nasal Canula Adult / selang oksigen
785 pcs 5,082
dewasa MMP
Nasal Canula Child / selang
786 pcs 5,082
Oksigen anak MMP
Nasal Canula INFANT / selang
787 pcs 5,082
oksigen bayi MMP

Nassal canula Anak (HOSPITECH

788 pcs 9,350
NASSAL CANULA)

Nassal canula Dewasa

789 pcs 9,350
(HOSPITECH NASSAL CANULA)

790 Plester T 10x20 pcs 9,036

791 Plester T 10x25 pcs 13,770

792 Plester T 10x8 pcs 4,212

793 Plester T 5x7 pcs 1,629

794 Plester "3 M " 1/2 Inch (24/bx) rol 10,953

795 Plester "3 M " 1/2 Inch (24/bx) rol 10,953

796 plester 3 M roll 23,625

797 Plester Non Woven Roll 10cm x 5m roll 41,360

798 Plester Non Woven Roll 5cm x 5m roll 23,760

799 Plester Rol Kain 1.25 cm x 4.5 m roll 6,500

800 Plester Rol Kain 5 cm x 4.5 m roll 28,500

801 Safety Box dus 15,715

802 Safety Box 5 L ONEMED kotak 15,715

 kotak/100
803 Sarung Tangan No Powder 65,000
pcs
Box/100
804 Sarung Tangan No Powder L 572
pcs
Box/100
805 Sarung Tangan No Powder L 583
pcs
Box/100
806 Sarung Tangan No Powder M 572
pcs
Box/100
807 Sarung Tangan No Powder M 583
pcs
Box/100
808 Sarung Tangan No Powder S 583
pcs
Box/100
809 Sarung Tangan No Powder S 583
pcs
Box/100
810 Sarung Tangan No Powder XS 660
pcs
811 Sarung tangan 6,5 psg 6,930

Sarung tangan Maxter exam non

812 Kotak 58,300.00
Powder L
Sarung tangan Maxter exam non
813 Kotak 58,300.00
Powder M
Sarung tangan Maxter exam non
814 Kotak 58,300.00
Powder S
Sarung Tangan Non steril dengan Box 50
815 653
Powder Size L pasang
Sarung Tangan Non steril dengan Box 50
816 653
Powder Size M (Ansell) pasang
Sarung Tangan Steril Bebas Box 50
817 10,153
Powder Size 6,5 pasang
Sarung Tangan Steril Bebas Box 50
818 10,153
Powder Size 7 pasang
Sarung Tangan Steril Bebas Box 50
819 10,153
Powder Size 7,5 pasang

820 Sarung Tangan Steril COSMOMED pcs 4,100

Sarung Tangan Steril dengan Box 50

821 7,623
Powder Size 6,5-7 pasang
Sarung Tangan Steril dengan Box 50
822 7,623
Powder Size 7,5 pasang
Sarung Tangan Steril dengan Box 50
823 7,623
Powder Size 7-7.7 pasang
Sarung Tangan Steril dengan Box 50
824 7,623
Powder Size 7-7.9 pasang
Box isi 12
825 Silk 2/0 75C + jarum 3/8 30m C 18,332
sachet
Silk 2/0 75C + jarum 3/8 30m C
826 Kotak 15,000
(Demetech)
Silk 2/0 75C + jarum 3/8 30m C
827 Kotak 15,000
(Demetech)
Box isi 12
828 Silk 3/0 75C + jarum 3/8 26m C 18,332
sachet
Silk 3/0 75C + jarum 3/8 26m C
829 Kotak 15,000
(Demetech)
Silk 3/0 75C + jarum 3/8 26m C
830 Kotak 15,000
(Demetech)

831 SILK BLACK 2/0 DS 30 MM (SMI) Sachet 24,260.00

832 SILK BLACK 3/0 DS 24 MM (SMI) Sachet 22,400.00

833 Stoma bag buah 24,200

834 Suction Cateter No.16 HOSPITECH pcs 3,597

835 Suction Cateter No12 HOSPITECH pcs 3,597

836 Suction Cateter No14 HOSPITECH pcs 3,597

837 Surgical glove medi 7 Pcs 10,153

838 Surgical glove medi 8 Pcs 10,153

839 Surgical glove medi 6.5-7.5 Pcs 6,930

840 Surgical glove medi 6.5-7.5 Pcs 6,930

Surgical Mask Earloop plus

841 box 50 pcs 22,000
Onemed

842 Surgical tape 2' rol 15,333

843 Umbical pcs 2,750

844 Underpad Nice Care Pcs 4,620

845 Underpad ONEMED BOX/10 41,624

Urine Bag standard steril with

846 pcs 5,808
hanger ONEMED

JUMLAH TOATAL

HARGA OBAT
OBAT TAMBAHAN
TAMBAHAN

1 Acyclovir Cream 5 % Tube

2 Acyclovir tab 200 mg Tab
3 Acyclovir tab 400 mg Tab
4 Air untuk injeksi amp 25 ml Ampul
5 Albendazole Susp 200 mg/5 ml Botol
6 Albendazole tab 400mg Kotak
7 Albothyl Concentrate Botol
8 Allupurinol tab 100 mg Kotak
9 Allupurinol tab 300 mg Kotak
10 Alprazolam 1 mg Kotak
11 Alprazolam tab 0,5 mg Kotak
12 Ambroxol sirup 15ml/ml Botol
13 Ambroxol tab 30 mg tab
14 Aminophillin inj. 24 mg/ml Kotak
15 Aminophillin tab 200 mg Tab
16 Amitriptilin tab 25 mg Tab
17 Amlodipin tab 10 mg Tab
18 Amlodipin tab 5 mg Tab
Amoksisilin sirup kering 125 mg/5
19 Botol
ml
20 Amoxicillin tab 250 mg Tab
21 Amoxicillin tab 500 mg Tab
22 Ampisilin serb inj 1000 mg/vial Vial
Analgesik Krim ( Methyl salicylate, tube @ 15
23
Eugenol, Menthol ) gram

kotak 5
24 analgesik non narkotik inj ampul @ 2
ml

Analgesik Non Narkotika Krim tube @ 15

25
Topikal gram

Anestetik lokal gigi kombinasi :

26 lidokain hcl 2% + epinefrin 1 : Ampul
80.000 inj 2 ml
27 Antalgin tab 500 mg Kotak
Antasida, kombinasi : aluminium
28 hidroksida 200 mg + magnesium Kotak
hidroksida 200 mg

Antasida, kombinasi : aluminium

29 hidroksida 200 mg + magnesium botol
hidroksida 200 mg
30 Anti Depresi ta
31 Anti Diare tab
Anti Influenza & demam sirup
32 Kotak
(Febrinex sirup)
33 Anti Influenza (Molexflu) Kotak
34 Anti migren Botol

Antibiotika mata + kortikosteroid

( Polymyxin B sulphate 6000 IU, botol @ 5
35
Neomycin sulphate 3,5 mg, ml
dexamethasone 1,0 mg)

Antihemoroid : ( Ekstrak Gratophylli

36 Folium 80 % dan Citrus Biofavonoid tablet
20 % )

Antihemoroid, kombinasi: bismut

subgalat 150 mg + heksaklorofen
37 Kotak
2,5 mg + lidokain lidokain 10 mg+
seng oksida 120 mg + sup ad 2 g

38 Antiseptik Salep 5 g ( BETADINE) Tube

Antiseptik Solution 60 ml
39 Botol
( BETADINE sol)

Antispasmodik ( Tiap Kaplet :

40 Hyoscine butylbromide 10 mg , kaplet
Methampyrone 250 mg )

Antispasmodik (DORMI box 100

41
COMPOSITUM) kaplet
42 Aqua pro injeksi steril Amp
Asam asetilsalisilat (asetosal) tab
43 Tab
80 mg
Asam askorbat (vitamin C) tab 50
44 Tab
mg
45 Asam folat tab 1 mg Botol
46 Asam Mefenamat kapsul 500 mg Kotak
47 Asam traneksamat inj 50 mg/ml Amp
48 Asering infus Botol

49 Asetat Ringer / Asering SOFT BAG Botol

50 Asetosal kaplet 80 mg (miniaspi) Kotak

51 Atapulgit 600 mg Tab
52 Atenolol tab 50 mg Tab
53 Atropin inj 0.25 mg/ml Amp
54 Atropin tab 0.5 mg Kotak
55 Bahan Tumpat Sementara Jar
56 Bedak salisil serbuk 2 % Box
57 BETAHISTIN MESILATE 6 mg Tab
58 Betametason krim 0,1 % Tube
59 Bioron inj amp
60 Bisakodil sup 5 mg supp
Bisakodil suppositoria 10 MG
61 supp
(DULCOLAX SUPP)
Bisoprolol tablet/kapsul/kaplet 2,5
62 Tab
mg
63 Bonding pcs
64 Bricasma injeksi 0,5 mg/ml Ampul
65 Bricasma respule 2,5 mg/ml respule
66 Captopril 12,5 mg Kotak
67 Captopril 25 mg Kotak
68 Cetirizin tablet 10 mg Kotak
69 CHKM Botol
70 Cifrofloxacin tab.500 mg Kotak
71 CLOPIDOGREL 75 mg Kaps
72 Deksametason tab 0,5 mg Tab
73 Depakote Botol
74 Devitalisasi Pasta (Pulp X) pot
75 Dexamethasone inj 5 mg/ml Kotak
76 Diazepam inj 5 mg/mL Amp
77 Diazepam lar rektal 10 mg/2.5 mL Botol
78 Diazepam lar rektal 5 mg/2.5 mL Botol
79 Diazepam tab 2 mg Botol
80 Diazepam tab 5 mg Botol
81 Difenhidramin HCL inj 10 mg/mL Kotak
82 Digoksin tablet 0,25 mg Kotak
83 Dimenhidrinat tab 50 mg Botol
84 Doksisiklin 100 mg Kotak
85 Domperidon susp 5 mg/5 ml Botol
86 Domperidon tab 10 mg Tab
87 Domperidone Syr botol
88 Domperidone tab 10mg box
89 Epinefrin (adrenalin) inj 1 mg/ mL Kotak
90 Epinefrin inj 1 mg/ml kotak

91 Ergotamin tab 1 mg + kaffein 50 mg Tab

92 Erithromycin sirup kering 200 mg botol
93 Eritromisin kaps 500 mg Kaps
94 Erytromisin kapsul 250 mg Kotak
Erytromisin kaptab salut selaput
95 Kotak
500 mg

96 Erytromisin sirup kering 200 mg /ml Kotak

97 Erytromisin susp 200 mg/5 mL Botol

98 Etanol 70% cairan Botol
99 Etil klorida semprot 100 ml Botol
100 Eugenol cairan Botol
101 Fenitoin Na 100 mg tab
Fenitoin Na inj. 50 mg/ml (100 mg/2
102 Amp
ml)
103 Fenobarbital 30 mg tab
104 Fenobarbital inj 50 mg/ml Kotak
105 Fenoksimetil P. tab 250 mg Kotak
106 Fenoksimetil P. tab 500 mg Kotak
Ferro fumarat 60 mg + as. Folat 0.4
107 Kotak
mg tablet salut
Fitomenadion (vitamin K 1) inj 2
108 Ampul
mg/ml (i.m.)
Fitomenadion (vitamin K 1) tab sal
109 Tab sal
10 mg
110 Fitomenadion Tab. salut 10 mg Botol
111 Flufenazin inj 25 mg/ml Amp
Fluocinolone Acetonide, Neomycin
112 botol
sulfat cream
113 Fluoxetin ( Frestin ) Kapsul
114 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul
115 Furosemid tab 40 mg Tab
116 Galpain Cream Tube
117 Galpain cream Kotak
Garam oralit kombinasi : natrium
klorida 0,52 g + kalium klorida 0,30
118 Sachet
g + trinatrium sitrat 0,58 g + glukosa
anhidrat 2,7 g

119 Gemfibrozil kaps 300 mg Kotak

120 Gentamysin inj 40 mg/ml Amp

121 Gentamysin sulfat tetes mata 0,3% botol

122 Glass Ionomer Botol

Glass ionomer ART (Atraumatic
123 Botol
Restorative Treatment) lar

glassionometer cement ( ketac

124 set
universal HM RF A3 + HM RF Liq

125 Glibenklamid tab 5 mg Tab

126 Glikazid tablet 80mg tab
127 GLIMEPIRID 3 mg Tab
128 Glimepirid tab 1 mg Tab
129 Glimepirid tab 2 mg Tab
130 glimepiride tab 3 mg Kotak
131 Gliseovulvin 125mg kotak
132 Gliseril gualicolat tab
133 Glucose 1/4 NS infus Botol
Glukosa Larutan Infus 10% steril
134 Botol
500 ml
Glukosa Larutan Infus 5% steril 500
135 Botol
ml
Griseofulvin (micronized) tab 125
136 Tab
mg
137 Gutta percha kotak
138 H C T tab 25 mg Kotak
139 Halloperidol tts 2 mg/ 15ml Botol
140 Haloperidol inj 5 mg/ml (i.m.) Amp
141 Haloperidol tab 2 mg Tab
142 Haloperidol tab 5 mg Tab
143 Haloperidol tab. 0,5 mg Kotak
144 Herbacof syrup botol
145 Hidroklorotiazid tab 25 mg Tab
146 Hidrokortison krim 2,5% Tube
147 Hidrokortison tab 25 % Tube
148 Ibuprofen susp 100 mg/mL Botol
149 Ibuprofen tab 200 mg Tab
150 Ibuprofen tab 400 mg Tab
151 Isosorbid dinitrat tab 5 mg Tab
152 Kalsium glukonat inj 100 mg/ml Ampul
Kalsium Hydroksida Pasta
153 Kotak
(Calcidor)
154 Kalsium laktat (kalk) tab 500 mg Tab

155 Kalsiun Hidroksida Pasta (Ultracal) Kotak

156 KANDESARTAN 8 mg Tab

157 Kaptopril tab 12,5 mg Tab
158 Kaptopril tab 25 mg Tab
159 Karbamazepin tablet 200 mg TAB
160 Ketoconacole krim 2% Tube
161 Ketokonazole tab 200 mg Kotak
162 Klindamisin 150 mg Tab
163 Klindamisin 300 mg Tab
164 Klobazam 10 mg tab Kotak
165 Kloramfenikol kaps 250 mg Kaps
166 Kloramfenikol kaps 500 mg kaps
167 Kloramfenikol salep kulit 2% Tube
168 Kloramfenikol susp 125 mg/5 ml Botol
169 Kloramfenikol tab 500 mg Kotak
170 Kloramphenicol cap 250 mg box
171 Kloramphenicol SM 1 % Tube
172 Klorfeniramin tab 4 mg (CTM) Kotak
173 Klorpromazin inj 25 mg Kotak
174 Klorpromazin tab salut 100 mg Kotak
175 Klozapin 100 mg tab
176 Klozapin 25 mg Kotak
177 Kodein tab 10 mg Tab
178 Kodein tablet 20 mg Kotak
Kombinasi tablet salut (Tablet
179 Saset
Tambah Darah)
Komposit ( bahan tumpat dengan
180 kit
sinar)
181 komposit (Hiltex Z250 Kit) kit
Kotrimoksazol (dewasa) kombinasi :
182 sulfametoksazol 400 mg+ Tab
trimetoprim 80 mg
183 Kotrimoksazole suspensi botol
184 Kotrimoksazole tab dewasa kotak

Larutan mengandung Karbohidrat +

Elektrolit (Nacl 1.75 gr, KCl 1.5 gr,
185 Botol
Na Lactat 2.24 gr, Dekstrosa 27 gr)
(KA EN 3B)

186 Lidocain Injeksi 2 % (HCl) Vial

Lidokain injeksi 2% + Epinefrin
187 Amp
1:80.000 - inj 2 Ml
188 Lisinopril tablet 5mg tablet
189 Loperamid tab 10 mg Kotak
190 Loperamid tab 2 mg Tab
191 Loratadine tab 10 mg Kotak
192 Lorazepam tab 2 mg (Merlopam) Kotak
193 Magnesium sulfat inj 20% Vial
194 Magnesium sulfat inj 40% Vial
Metamizol Sodium Inj
195 Ampul
( NORAGES )
196 Metamizol Sodium Tablet Tablet
197 Metamizole 1 g / 2 ml Inj ampul
198 Metformin tab 500 mg Tab
199 Methyl Ergometrin Inj. 0.25 mg/ml Kotak
Methyl Ergometrin tablet salut 0.25
200 Kotak
mg
201 Metilprednisolon tablet 4 mg tab
202 Metoklopamide tab 10 mg Kotak
203 Metronidazol infus 500 mg/100 ml Botol
204 Metronidazol susp 125 mg/ 5mL Botol
205 Metronidazol tablet 250 mg Kotak
206 Metronidazol tablet 500 mg tab
207 Metronidazole Syr Pcs
208 miconazole cream Tube
209 Mikonazol krim/salep 2 % Tube
Mukolitik & ekspektoran sirup (OBH
210 Botol
Molex sirup)
botol @ 10
211 Multivitamin + Mineral Drops
ml
212 NaCl 0,9% Larutan Botol
213 Natrium Diklofenac tab 25 mg Kotak
214 Natrium Diklofenac tab 50 mg Kotak
215 Nifedipin Tab 10 mg tablet Kotak
216 Nistatin 100.000 IU/g tab.Vag Kotak
217 Novorapid unit
218 Nystatin tablet 500.000 IU Kotak

Obat Batuk dan Flu sirop

( Parasetamol; Dexchlorpheniramin
219 botol
maleate; thiocol ; sorbitol syrup with
chocolate flavor )

220 Obat Antispasmodik(Dormi) Kotak

Obat Batuk sirup ( Vitex Trifolia

folium ( Daun legundi ) 1 g; Zingiber
Officinale Rhizoma (jahe gajah)
221 0,25 g; Abrus Precatorius Folium btl 60 ml
(daun saga) 0,25 g; Phaleria
Macrocarpa Fructus (buah mahkota
dewa) 0,20 g

222 Obat Batuk & Flu syr ( DEXMOLEX) Botol

Obat Batuk Hitam ( Ika

223 Botol
Pharma )
224 Obat Demam dan influenza (sirup) botol
225 Obat radang kulit (Bravoderm N ) Tube
Obat Sariawan & Radang
226 Tube
(Bufacomb)

Obat Sariawan dan Radang rongga

tube @ 5
227 mulut ( Triamcinolone Acetonide 1
gr
mg )

Obat Tetes Mata ( Anti mikroba +

228 Botol
kortikosteroid )
229 Obat tetes Telinga (RECO) Botol
Obat Tetes Telinga Antibiotik botol @10
230
( Kloramfenikol base 10 mg / ml ) ml

OBH : ( Glicyrrhizae Succus 167

231 botol 60 ml
mg, Ammonium Chlorida 100 mg )

232 Oksi Tetra. HCl slp Mata 1 % Tube

tube 5
233 Oksitetrasiklin salep kulit 3 %
gram
234 Oksitosin inj.10 UI/ml Kotak
235 Omeprazol kaps 20 mg Kaps
236 Pan amin larutan infus Botol
237 Paper point kotak
238 Parasetamol drop 100 mg/ml Botol
239 Parasetamol drop 60 mg/0.6 mL Botol
Parasetamol Sirup 120 mg / 5 ml
240 Botol
(nova)
241 Parasetamol tab 500 mg Tab
242 Permethrin/ Permetrin Krim 5% Tube
243 Pirantel Pamoat tablet 125 mg Kotak
244 Piridoksin (vitamin B6) tab 10 mg Tab
245 Piridoksin HCl tablet 10 mg Botol
246 Piroksikam tablet 20 mg Kotak

247 Povidon iodin lar 100 mg/ml Botol 60 ml

248 Povidon iodin lar 60 ml Botol

249 Prednison tab 5 mg Tab
250 Propanolol tablet 10 mg Botol
251 Propiltiourasil tab 100 mg Kotak
252 Propranolol tab 10 mg Tab
253 Pulmicort respule 0,25 mg/ml respule
254 Pulmicort respule 0,5 mg/ml respule
Pulmicort turbohaler 200 mcg/200
255 can
dosis
256 Ranitidin injeksi 25 mg/ 2ml Ampul
257 Ranitidin tablet 150 mg Kotak
258 Resperidone 2 mg tab kotak
Retinol (vitamin A) kaps lunak
259 Kaps lunak
100.000 UI
Retinol (vitamin A) kaps lunak
260 Kaps lunak
200.000 UI
261 Ringer Asetat larutan infus Botol
262 Risperidon tablet 2 mg Botol
263 Rivanol 300 cc Botol
264 Salbutamol 2 mg tab kotak
265 Salbutamol 4 mg tab kotak
266 Salbutamol cairan ih 0,1% Botol
267 Salbutamol tab 2 mg Tab
268 Salbutamol tab 4 mg Tab
269 Salep 2-4 Kotak
270 Safti box
271 Sefadroksil kapsul 500 mg kaps

272 Sefadroksil sirup kering 125 mg/5ml Botol

273 Sefotaksim injeksi 1 gram Vial

274 Selang oksigen dewasa pcs
275 Semen Seng Fosfat (multifix) Set
276 Semen Zink Phospate set
277 Serum A T S 1500 IU (Biosat-1.5) Vial
278 Serum Anti Bisa Ular (Biosave) Vial
Serum Anti Tetanus ( A.T.S ) cairan ampul @ 1
279
i.m 1500 UI/ml ml
280 setirizine tab 10 mg Kotak
Sianokobalamin (vitamin B12)
281 Ampul
injeksi 500 mcg
Sianokobalamin (vitamin B12) tablet
282 Kotak
50 mcg
283 Sikzonoat inj 25mg/mL Vial
284 Simetidin tablet 200 mg Kotak
285 Simvastatin tab 10 mg Kotak
 Simvastatin tablet/kaplet/salut 20
286 Kotak
mg
287 Siprofloksasin tab scored 500 mg Tab
288 Spironolakton tab 100 mg
289 Spironolakton tab 25 mg Vial
290 Sulfadoksin tab kotak

SYMBICORT 80/4.5 (60 DOSIS)

kombinasi, setiap dosis
291 Pcs
mengandung : Budesonid 80 mcg
Formoterol 4,5 mcg (inhalasi)

292 Tetracyclin cap 250 mg Botol

293 Tetracyclin cap 500 mg Kotak
294 Tiamin ( Vitamin B1 ) tablet 50 mg tab
295 Trifadium 2 mg
296 Trifuoperazin 5 mg Tab
297 Triheksifenidil tab 2 mg tab
298 tumpatan sementara (cavit) pot
Valproat tab salut enterik
299 Kotak
( DEPAKOTE tab)
300 Valsartan tablet 160 mg TAB
301 Vit b kombinasi kotak
Vitamin & Mineral drop (Recovit
302 Botol
drop)
Vitamin & Mineral Suspensi (Vical
303 Botol
Suspensi)
304 Vitamin B Complex inj Vial
Vitamin B kombinasi 200 kaplet
305 Kotak
(Bioron)
Vitamin B kombinasi 5000 inj
306 Amp
(ikaneuron)
307 Vitamin B kompleks tab
308 vitamin Hemafort kotak

Vitamin Kombinasi Injeksi ( Thiamin

ampul @ 3
309 HCl 100mg , Piridoksin HCl 100 mg,
ml
Sianokobalamin 5000 mcg / 3 ml )

Vitamin Kombinasi Kaplet ( Thiamin

310 HCl 100mg , Piridoksin HCl 100 mg, kaplet
Sianokobalamin 5000 mcg )

311 Vitamin Neurotropik injeksi Amp

312 Vitamin tambah darah (Anti Anemia) dus

313 Vitamin tambah darah (Hemafort) Kotak

314 Yodin Povidon 10 % 30 ml Botol
315 Yodin Povidon 10 % 300 ml Botol
316 Yodin Povidon 10 % 60 ml Botol
317 Zinc sir 20 mg/5 ml botol
318 Zinc tab disp 20 mg Tab
319 Zink Syr botol
BMHP
320 Alat Suntik 1 ml Kotak
321 Alat Suntik 10 ml Kotak
322 Alat Suntik 3 ml Kotak
323 Alat Suntik 5 ml Kotak
324 Alkazyme Sachet 25 mg pack
325 ALKOHOL + Clorhexidin Swab kotak/100
326 Alkohol 70 % 300 mL botol
327 Antiseptik dan Disinfektan 500 ml
328 Aseptan 500cc + pump Botol
329 Blood Lancet No.26 G kotak/100
330 Blood Transfusi set (Nipro) pcs
331 Blood transfusion set pcs
Cat Gut Chromic 2/0 75C + jarum Box isi 12
332
1/2 30m R sachet
Cat Gut Chromic 3/0 75C + jarum Box isi 12
333
1/2 22m R sachet
Cat Gut Plain 2/0 70C + jarum 1/2 Box isi 12
334
25m R sachet
335 Cat Gut Plain 2/0 HR-26 mm pcs
Cat Gut Plain 3/0 70C + jarum 1/2 Box isi 12
336
25m R sachet
337 Cat Gut Plain 3/0 HR-26 mm pcs
338 CATGUT CHROMIC 2/0 pcs
CATGUT CHROMIC SMI 3/0 HR 26
339 Sachet
MM
340 CATGUT PLAIN 2/0 pcs

341 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet

342 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet

343 COSMOMED Infusion Set (Anak) pcs

COSMOMED Infusion Set

344 pcs
(Dewasa)
1 box/100
345 Disposible Needle 23 G x 11/4"
pcs
1 box/100
346 Disposible Needle 24 G x 1"
pcs
1 box/100
347 Disposible Needle 25 G x 1"
pcs
348 Folley Catheter 2 Way no. 12 BOX/10
349 Folley Catheter 2 Way no. 14 BOX/10
350 Folley Catheter 2 Way no. 16 BOX/10
351 Folley Catheter 2 Way no. 18 BOX/10
352 Folley Catheter 2 Way no. 20 BOX/10
353 Folley Catheter 2 Way no. 22 BOX/10
354 Folley Catheter 2 Way no. 24 BOX/10
I V Cathether no 20 (Otsucath
355 Biji
no.20)
I V Cathether no 22 (Otsucath
356 Biji
no.22)
 I V Cathether no 24 (Otsucath
357 Biji
no.24)
358 Infus Set Anak Pcs
359 Infus Set Dewasa Set
IV Cannula with Safety Wings
360 pcs
No.22 COSMOMED
361 IV Catheter NO 20 G Otsucath pcs
362 IV Catheter NO 24 G Otsucath pcs
IV Catheter no 26 ( Ttrovenocath
363 Biji
plus 26G)
364 IV DRESSING 6 X 7 S (ID67S) BOX/100
365 Jarum 24 G pcs
366 kapas berlemak 500g ONEMED pCS
367 Kapas Pembalut 250 gram Biji
368 Kasa 40 x 40 JAYAMAS pcs
Kasa Pembalut Hidrofil 4 m x 10
369 pcs
cm ONEMED
370 Kasa 16x16 steril Kotak
371 Kasa 40 x 80 cm ONEMED roll
372 Kasa 40x16 Pcs
373 Kasa 4x10 cm Roll
374 Kasa 4x5 cm Roll

375 Kasa Hidrofil 2m x 80cm ONEMED Roll

Kasa hydrofil steril 16 x 16

376 Pcs
JAYAMAS
377 Kasa Hydrofil Steril 16x16 cm Biji
378 Kasa Kompres Steril 40x40 cm Biji
Kasa Pembalut Hidrofil 4 m x 5 cm
379 pcs
ONEMED
380 Masker 3 ply tie on Kotak
381 Masker kesehatan Ear loop pcs
Masker Oksigen Anak
382 pcs
( HOSPITECH oxygen mask)
Masker Oksigen Dewasa
383 pcs
( HOSPITECH oxygen mask)
Nasal Canula Adult / selang oksigen
384 pcs
dewasa MMP
Nasal Canula Child / selang
385 pcs
Oksigen anak MMP
Nasal Canula INFANT / selang
386 pcs
oksigen bayi MMP

Nassal canula Anak (HOSPITECH

387 pcs
NASSAL CANULA)

Nassal canula Dewasa

388 pcs
(HOSPITECH NASSAL CANULA)

389 Plester T 10x20 pcs

390 Plester T 10x25 pcs
391 Plester T 10x8 pcs
392 Plester T 5x7 pcs
393 Plester "3 M " 1/2 Inch (24/bx) rol
394 plester 3 M roll

395 Plester Non Woven Roll 10cm x 5m roll

396 Plester Non Woven Roll 5cm x 5m roll

397 Plester Rol Kain 1.25 cm x 4.5 m roll

398 Plester Rol Kain 5 cm x 4.5 m roll
399 Safety Box dus
400 Safety Box 5 L ONEMED kotak
kotak/100
401 Sarung Tangan No Powder
pcs
Box/100
402 Sarung Tangan No Powder L
pcs
Box/100
403 Sarung Tangan No Powder M
pcs
Box/100
404 Sarung Tangan No Powder S
pcs
Box/100
405 Sarung Tangan No Powder XS
pcs
406 Sarung tangan 6,5 psg
Sarung tangan Maxter exam non
407 Kotak
Powder L
Sarung tangan Maxter exam non
408 Kotak
Powder M
Sarung tangan Maxter exam non
409 Kotak
Powder S
Sarung Tangan Non steril dengan Box 50
410
Powder Size L pasang
Sarung Tangan Non steril dengan Box 50
411
Powder Size M (Ansell) pasang
Sarung Tangan Steril Bebas Box 50
412
Powder Size 6,5 pasang
Sarung Tangan Steril Bebas Box 50
413
Powder Size 7 pasang
Sarung Tangan Steril Bebas Box 50
414
Powder Size 7,5 pasang

415 Sarung Tangan Steril COSMOMED pcs

Sarung Tangan Steril dengan Box 50

416
Powder Size 6,5-7 pasang
Sarung Tangan Steril dengan Box 50
417
Powder Size 7,5 pasang
Sarung Tangan Steril dengan Box 50
418
Powder Size 7-7.7 pasang
Sarung Tangan Steril dengan Box 50
419
Powder Size 7-7.9 pasang
Box isi 12
420 Silk 2/0 75C + jarum 3/8 30m C
sachet
Silk 2/0 75C + jarum 3/8 30m C
421 Kotak
(Demetech)
 Silk 2/0 75C + jarum 3/8 30m C
422 Kotak
(Demetech)
Box isi 12
423 Silk 3/0 75C + jarum 3/8 26m C
sachet
Silk 3/0 75C + jarum 3/8 26m C
424 Kotak
(Demetech)

425 SILK BLACK 2/0 DS 30 MM (SMI) Sachet

426 SILK BLACK 3/0 DS 24 MM (SMI) Sachet

427 Stoma bag buah

428 Suction Cateter No.16 HOSPITECH pcs

429 Suction Cateter No12 HOSPITECH pcs

430 Suction Cateter No14 HOSPITECH pcs

431 Surgical glove medi 7 Pcs

432 Surgical glove medi 8 Pcs
433 Surgical glove medi 6.5-7.5 Pcs
434 Surgical glove medi 6.5-7.5 Pcs
Surgical Mask Earloop plus
435 box 50 pcs
Onemed
436 Surgical tape 2' dus
437 Umbical pcs
438 Underpad Nice Care Pcs
439 Underpad ONEMED BOX/10
Urine Bag standard steril with
440 pcs
hanger ONEMED

Yang Meminta / Mengetahui

Kepala Puskesmas

(..............................)
LEMBAR PERMINTAAN ASET OBAT
LPO ) PKD
PELAPORAN BULAN :
PERMINTAAN BULAN :
TAHUN :

PUSTU
LABOR POLI PERAW Apotek GEMP Total KARAN
AT LANSI ATAN TANGG DUKUH PUSTU DUDUK G
MENG SUDAN OL KARAN
UNGPR TUNGG ANTI GAN PENDO G TURI LOR AGUN
IGEL AL
5 6 7 8 9 10 11 12 WO
13 14 15 16 G
17

1 1 1 1 1 1 1 1 1 1 6 1 1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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Mengetahui / Menyetujui
Kepala Dinas Tk II

(......................................)
 STOK AWAL

VOLUME GUDANG OBAT DAN UNIT PELAYANAN PUSKESMAS

POLINDES/POSKESDES
MARG BAPUH RAYUN
WEDO WONO KONAN GLAGA PASI MEDA BANGK MELUN SOKO OANYA BEGAN GGUM
RO REJO G H NG OK TUR BARU
R UK
18 19 20 21 22 23 24 25 26 27 28 29 30

1 1 1 1 1 1 1 1 1 1 1 1 1
 Yang Menyerahkan
Petugas GFK / Puskesmas

(......................................)
 Total
POLIN PONKESDES
DES/P BAPUH
WANG OSKES JATIRE KENTO PANGG MEND MELU MORO BANDU 8 9 10 11
EN DES NGGO NG ANG UGO WUR CALAN NG
31 32 33 34 35 36 37 38 39 40 41 42 43

1 16 1 1 1 1 1 1 1 1 1 1 1
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 JUMLA
H
TOTAL
STOK
AWAL TOTAL NOMINAL
GUDAN STOK AWAL DAN Gudang Obat
G OBAT UNIT
DAN
Total UNIT PUSKESMAS Rp Terima NOMILAN LABOR
PONKE PELAYA GUDANG OBAT UGD KIA GIGI
Dari IFK AT
12 SDES NAN Rp
44 45
PUSKES
46 47 1 2 3 4 5 6
MAS

1 12 541 1,623,000 50 150,000 1 2 3 4

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1,623,000 150,000
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 PENERIMAAN

VOLUME UNIT PELAYANAN PUSKESMAS

POLINDES/POSKESDES
MARG BAPUH RAYUN
WONO KONAN GLAGA PASI MEDA BANGK MELUN SOKO OANYA BEGAN GGUM WANG
REJO G H NG OK TUR BARU EN
R UK
20 21 22 23 24 25 26 27 28 29 30 31 32

4 5 6 7 8 9 10 11 12 13 14 15 16
 Total
POLIN PONKESDES
DES/P BAPUH
OSKES JATIRE KENTO PANGG MEND MELU MORO BANDU 8 9 10 11 12
DES NGGO NG ANG UGO WUR CALAN NG
33 34 35 36 37 38 39 40 41 42 43 44 45

136 1 2 3 4 5 6 7 8 9 10 11 12
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0
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0
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 JUMLAH
VOLUME NOMINAL TOTAL
UNIT PENERIMAA
PELAYANA UNIT NOMILAN
N PELAYANAN Gudang
Total PUSKESMA PUSKESMAS Rp GUDANG OBAT
Obat LABOR POLI
PONKE Rp UGD KIA GIGI
S AT LANSI
SDES
46 47 48 1 2 3 4 5 6 7

78 263 789,000 287 861,000 2 3 4 5 6

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0 0 0 0 0 0 0 0 0 0 0 0 0
 PERSEDIAAN

VOLUME UNIT PELAYANAN PUSKESMAS

Total
POLINDES/POSKESDES POLIN
MARG BAPUH RAYUN DES/P
KONAN GLAGA PASI MEDA BANGK MELUN SOKO OANYA BEGAN GGUM WANG OSKES
G H NG OK TUR BARU EN DES
R UK
21 22 23 24 25 26 27 28 29 30 31 32 33

6 7 8 9 10 11 12 13 14 15 16 17 152
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
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0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
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Yang Menerima
Petugas Puskesmas / sub
unit

(......................................)
 PONKESDES Total
BAPUH PONKE
JATIRE KENTO PANGG MEND MELU MORO BANDU 8 9 10 11 12 SDES
NGGO NG ANG UGO WUR CALAN NG
34 35 36 37 38 39 40 41 42 43 44 45 46

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g Obat GUDANG
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A
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47 48 1 2 3 4 5 6 7 8

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1,773,000 789,000
 PENGELUARAN/P

VOLUME U

PUSTU PO
GEMP Total KARAN
Apotek TANGG DUKUH
MENG SUDAN OL KARAN PUSTU DUDUK G WEDO WONO KONAN
UNGPR TUNGG ANTI GAN PENDO G TURI LOR AGUN RO REJO G
IGEL AL
9 10 11 12 13 WO
14 15 16 17 G
18 19 20 21

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0
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0

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0
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0
0
0
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0
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0
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0
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0
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0
PENGELUARAN/PEMAKAIN

VOLUME UNIT PELAYANAN PUSKESMAS

Total
POLINDES/POSKESDES POLIN
MARG BAPUH RAYUN DES/P
GLAGA PASI MEDA BANGK MELUN SOKO OANYA BEGAN GGUM WANG OSKES JATIRE
H NG OK TUR BARU EN DES NGGO
R UK
22 23 24 25 26 27 28 29 30 31 32 33 34

1 1 1 1 1 1 1 1 1 1 1 16 1
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0
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0
0
0
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0
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0
0
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0
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0
0
0
0
0

0
0

0
0
0

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

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0
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0
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0

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0
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0

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0
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0
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0
 JUMLAH
TOTAL
VOLUME
UNIT
PELAYANA
PONKESDES Total N
BAPUH PONKE PUSKESMA
KENTO PANGG MEND MELU MORO BANDU 8 9 10 11 12 SDES S
NG ANG UGO WUR CALAN NG
35 36 37 38 39 40 41 42 43 44 45 46 47

1 1 1 1 1 1 1 1 1 1 1 12 41
0 0
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TOTAL NOMINAL
UNIT
PELAYANAN
PUSKESMAS Rp Pustu
Gudang LABOR POLI PERAW Apotek
UGD KIA GIGI TANGG DUKUH
Obat AT LANSI ATAN
UNGPR TUNGG
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123,000

1,773,000
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VOLUME GUDANG OBAT DAN UNIT PELAYANAN PU

Pustu Polindes
GEMP Total KARAN
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 JUMLAH
VOLUME TOTAL NOMINAL
SISA STOK SISA STOK
GUDANG GUDANG OBAT
DAN UNIT DAN UNIT
PELAYANA PELAYANAN
Poskesdes Total N
BAPUH Poskes PUSKESMA PUSKESMAS Rp
MELU MORO BANDU 8 9 10 11 12 des
WUR CALAN NG S
37 38 39 40 41 42 43 44 45 46 47

5 6 7 8 9 10 11 12 78 550 1,650,000
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