Daftar Obat Forkab 2015

DAFTAR HARGA OBAT E-KATALOG JAWA BARAT TAHUN 2015
No Nama Obat Generik Nama Dagang
1 ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida

tablet 200 mg) n/a
2
Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera
3 Air untuk injeksi (Aqua pro Injeks) 20 ml n/a
4
Air untuk Injeksi 25 ml Otsu SWI 25 ml
5 Air untuk irigasi lar infus 1000 ml WIDA WI UNICAP
6
Akarbose tablet/kaplet 100 mg n/a
7
Akarbose tablet/kaplet 50 mg n/a
8
Albendazol suspensi 200 mg/5 ml n/a
9
Albendazol tablet/kapsul/kaplet 400 mg n/a
10 Albumin serum normal (human albumin) injeksi 20%, 100
ml Zenalb
11 Albumin serum normal (human albumin) injeksi 20%, 50 ml Zenalb
12 Albumin serum normal (human albumin) injeksi 25%, 100
ml Albuminar 25
13 Albumin serum normal (human albumin) injeksi 25%, 20 ml PLASBUMIN 25% 20 ML
14 Albumin serum normal (human albumin) injeksi 25%, 50 ml PLASBUMIN 25% 50 ML
15 Albumin serum normal (human albumin) injeksi 5% 250 ml PLASBUMIN 5% 250 ML
16 Albumin serum normal (human albumin) injeksi 5% 50 ml PLASBUMIN 5% 50 ML
17
Alopurinol tablet/kapsul/kaplet 100 mg n/a
18
Alopurinol tablet/kapsul/kaplet 300 mg n/a
19
Alprazolam tablet/kapsul/kaplet 0,25 mg n/a
20
Alprazolam tablet/kapsul/kaplet 0,5 mg n/a
21 Alprazolam tablet/kapsul/kaplet 1 mg n/a
22
Alteplase injeksi 50 mg/vial Actilyse
23
Amfoterisin B salep mata 1% Fungicide
24 Amikasin injeksi 250 mg/ml Glybotic 250 mg /ml
25
Aminofilin injeksi 24 mg/ml n/a
26
Aminofilin tablet scored 200 mg n/a
27 Aminofilin tablet/kapsul/kaplet 150 mg n/a
28 Amiodaron injeksi 150 mg/3 ml Cordarone
29 Amiodaron tablet/kaplet 200 mg Kendaron Tablet
30
Amitriptilin tablet salut 25 mg (HCl) n/a
31
Amlodipin tablet 10 mg n/a
32
Amlodipin tablet 5 mg n/a
33 Amoksisilin kapsul/kaplet 250 mg n/a
34
Amoksisilin kapsul/kaplet/tablet scored 500 mg n/a
35 Amoksisilin sirup kering forte 250 mg/5 ml n/a
36 Amoksisilin sirup kering 125 mg/ 5 ml n/a
37 Ampisilin serbuk injeksi i.v. 1000 mg/vial n/a
38 Analog insulin long acting inj 100 UI/ml, vial/cartridge Lantus Solostar 100IU/ml
disposible/penfill cartridge (Insulin glargine 100 IU/ml) 5pens x3ml
39 Analog insulin mix acting inj 100 UI/ml, Analog insulin mix
acting inj 100 UI/ml (Premix 30% Insulin Aspart + 70%
Protaminated Insulin Aspart (Analogue)) Novomix Flexpen
40
Analog Insulin Mix Insulin Inj 100 UI/ml Humalog Mix 25 Kwikpen
Analog insulin mix insulininj 100 UI/ml, vial/cartridge

41 disposible/penfill cartridge (25% insulin lispro, 75% insulin
lispro protamine suspension, (rDNA)) Humalog Mix 25
42
Analog Insulin Rapid Acting Inj 100 UI/ml Humalog Kwikpen
43
Analog insulin rapid acting inj 100 UI/ml, vial/cartridge
disposible/penfill cartridge (Insulin Aspart (Analogue)) Novorapid Flexpen
44 Analog insulin rapid acting inj 100 UI/ml, vial/cartridge
disposible/penfill cartridge (Insulin Aspart (Analogue)) Novorapid Vial
45 Analog insulin rapid actinginj 100 UI/ml, vial/cartridge Apidra Solostar 100IU/ml
disposible/penfill cartridge (Insulin glulisine 100 IU/ml) 5pens x3ml
46 Analog insulin rapid actinginj 100 UI/ml, vial/cartridge
disposible/penfill cartridge (Insulin lispro (rDNA origin)) Humalog
47
Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg
48 Antasida DOEN I tablet kunyah, kombinasi : Aluminium
Hidroksida 200 mg Magnesium Hidroksida 200 mg n/a
Antasida DOEN II suspensi, kombinasi : Aluminium
49 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 mg/5
ml n/a
50 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g
Polimiksin 10.000 IU/g n/a
51 Antihemoroid, kombinasi: bismut subgalat 150 mg
heksaklorofen 2,5 mg lidokain 10 mg seng oksida 120 mg n/a
52 Antimalaria DOEN kombinasi : Pirimetamin 25 mg
Sulfadoksin 500 mg n/a
53 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg n/a
54 Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg
Levodopa 100 mg Levopar Tablet
55 Artemether injeksi 80 mg/ml Artem
56
Artesunate injeksi i.v./i.m. 60 mg/ml Artesunate
57 Asam Asetilsalisilat (asetosal) tablet 100 mg n/a
58
Asam Asetilsalisilat (asetosal) tablet/kaplet/kapsul 80 mg Miniaspi 80
59 Asam Askorbat (Vitamin C) tablet 250 mg n/a
60 Asam Askorbat (Vitamin C) tablet 50 mg n/a
61
Asam Folat tablet/kapsul/kaplet 0,4 mg Starfolat
62
Asam Folat tablet/kapsul/kaplet 1 mg n/a
63
Asam Ibandronat injeksi 6mg/6ml Bondronat
64
Asam Mefenamat kapsul/kaplet 250 mg n/a
65
Asam Mefenamat kapsul/kaplet 500 mg n/a
66 Asam pipemidat kapsul 400 mg Urotractin 400 mg
67
Asam traneksamat injeksi 50 mg/ml n/a
68
Asam zoledronat injeksi 4mg/5mL ZOMETA
69 Asiklovir salep mata 3% Temiral Eye Oint
70
Asiklovir tablet/kapsul/kaplet 200 mg n/a
71 Asiklovir tablet/kapsul/kaplet 400 mg n/a
72 Asparaginase serbuk injeksi 10.000 UI/vial Leunase
73
Atapulgit tablet 600 mg Pularex
74 Atenolol tablet/kapsul/kaplet 100 mg Betablok
75
Atenolol tablet/kapsul/kaplet 50 mg Farnormin
76
Atrakurium injeksi 25 mg/2,5 ml Tracrium
77
Atropin injeksi i.v./i.m./s.k. 0,25 mg/ml n/a
78
Atropin Sulfat tablet 0,5 mg n/a
79
Atropin Sulfat tetes mata 0,5% Cendo Tropin 0,5%
80
Atropin Sulfat tetes mata 1% Cendo Tropin 1%
81
Azitromisin sir kering 200 mg/ 5 mL n/a
82 Azitromisin tablet 500 mg n/a
83
Azitromisin tablet 250 mg n/a
84
Bedak salisil serbuk 2% n/a
85 Benzatin Benzil Penisilin 1,2 juta IU/ vial n/a
86
Benzatin Benzil Penisilin 2,4 juta IU/vial n/a
87
Beractant injeksi / suspensi 25 mg/mL Survanta
88
Beraprost sodium tablet 20 mcg Dorner
89 Betametason krim 0,1% (sebagai Valerat) n/a
90 Betametason tetes mata 1 mg/ml Betam Ophtal ED
91 Bevasizumab injeksi 25 mg/ml (Skema Risk Sharing sesuai
Kepmenkes RI Nomor HK.02.02/Menkes/223/2014) Avastin
92
Bikalutamid tablet salut 150 mg Casodex 150 mg
93
Bikalutamid tablet salut 50 mg Casodex 50 mg
94 Bisakodil suppositoria 10 mg Stolax supp
95
Bisakodil suppositoria 5 mg Dulcolax Supp Infant
96
Bisoprolol tablet 2,5 mg Concor 2.5
97 Bisoprolol tablet 5 mg n/a
98 Bleomisin serbuk injeksi 15 mg/ampul BLEOCIN
99 Bromokriptin tablet 2,5 mg Cripsa tab
100
Budesonid inhaler 200 mcg/puff, 100 dosis Pulmicort Turbuhaler
101 Budesonid inhaler 200 mcg/puff, 200 dosis Obucort Swinghaler
102
Budesonid respules / cairan inhaler 0,25mg/mL Pulmicort Respules
103 Budesonid-formoterol (fixed combination) inhaler 160/4,5 Symbicort Turbuhaler
mcg 160/4.5 mcg
104 Budesonid-formoterol (fixed combination) inhaler 80/4,5
mcg Symbicort 80/4.5 mcg
105 Bupivakain injeksi 0,50% (HCl) + glukosa 8% n/a
106 Bupivakain injeksi 0,50% (P.V) Bunascan
107
Dabigatran eteksilat kapsul 75 mg Pradaxa
108
Dabigatran eteksilat kapsul 110 mg Pradaxa
109
Dakarbazin serbuk injeksi 200 mg/vial DBL Dacarbazine
110
Daunorubisin serbuk injeksi 20 mg/vial DAUNOCIN
111
Deferasiroks tablet disp/ eff 250 mg Exjade 250 mg Tab
112
Deferasiroks tablet disp/ eff 500 mg Exjade 500 mg Tab
113 Deferipron larutan oral 100 mg/mL Ferriprox Oral Solution
114
Deferipron tablet 500 mg Ferriprox tablet
115
Deferoksamin Mesilat serbuk injeksi 500 mg Desferal
116
Deksametason injeksi i.v./i.m. 5 mg/ml n/a
117
Deksametason tablet 0,5 mg n/a
118
Desogestrel tablet 75 mcg Cerazette
119
Desoksimetason krim 0,25% DEXIGEN
120
Desoksimetason krim 0,25% n/a
121 Desoksimetason salep 0,25% Dexocort
122
Diazepam larutan rektal 5 mg/2,5 mL STESOLID
123
Diazepam injeksi i.v./i.m 5 mg/ml n/a
124
Diazepam larutan rektal 10 mg/2,5 mL STESOLID
125
Diazepam tablet/kapsul/kaplet 2 mg n/a
126
Dietilkarbamazin tablet scored 100 mg n/a
127 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) n/a
128 Digoksin injeksi 0,25 mg/ml Fargoxin inj
129
Digoksin tablet 0,25 mg n/a
130
Diltiazem HCl tablet 30 mg n/a
131 Herbesser Powder
Diltiazem infus injeksi 50 mg Injection 50mg
132 Diltiazem injeksi 25 mg/5 mL Farmabes Injeksi 25 mg
133
Diltiazem Kapsul SR 100 mg Herbesser CD 100
134
Diltiazem Kapsul SR 200 mg Herbesser CD 200
135 Dimenhidrinat tablet 50 mg n/a
136
Dinatrium edetat tetes mata 0,35% E.D.T.A
137 Dinatrium klodronat infus kons 60 mg/mL Bonefos Infus 60 mg / 5 ml
138 Dobutamin injeksi 50 mg/mL DOBURAN
139
Doksazosin mesilat tablet 1 mg Cardura 1mg
140
Doksazosin mesilat tablet 2 mg Cardura 2mg
141
Doksisiklin tablet/kapsul/kaplet 100 mg n/a
142
Doksorubisin serbuk injeksi i.v. 10 mg/vial Doxorubicin Actavis 10 mg
143
Doksorubisin serbuk injeksi i.v. 50 mg/vial Doxorubicin Actavis 50 mg
144 Domperidon suspensi/sirup 5 mg/5 ml n/a
145 Domperidon tablet 10 mg n/a
146 Domperidon tetes 5 mg/mL n/a
147 Dopamin injeksi 40 mg/ml UDOPA
148
Dosetaksel injeksi 20 mg/0,5 ml n/a
149 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg
pentetate calcium trisodium/mL Renalscan KaeF
150
Dutasterid kaps lunak 0,5 mg Avodart
151 Efavirens tablet salut 600 mg n/a
152 Efedrin Inj 50 mg/ml n/a
153
Eksemestan tablet 25 mg Aromasin
154
Enoksaparin sodium inj 20 mg/0,2 mL Lovenox 2000 ANTI-XA
155
156
157 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml n/a
158 Epirubisin serb injeksi 50 mg/25ml Epirubisin Kalbe
159 Epirubisin serb injeksi 10 mg/5 ml n/a
160
Ergokalsiferol (vitamin D3/D2) kapsul 50.000 UI D-Vit FT
161
Ergokalsiferol (vitamin D3/D2) suspensi 10.000 UI/ml D-Vit Syrup
162 Eritromisin kapsul/kaplet 250 mg n/a
163
Eritromisin kapsul/kaplet 500 mg n/a
164
Eritromisin sirup kering 200 mg/ 5 ml n/a
165
Eritropoetin-alfa inj 10000 UI/mL Hemapo 10.000 IU
166
Eritropoetin-alfa inj 2000 UI/mL Eprex 2000
167
Eritropoetin-alfa inj 3000 UI/mL Hemapo 3000
168
Eritropoetin-beta inj 2000 UI/0,3 mL Recormon
169 Etambutol tablet 250 mg (HCl) n/a
170
Etambutol tablet salut 500 mg (HCl) n/a
171 Etanol 70% cairan n/a
172
Etinilestradiol tablet 0,05 mg Lynoral
173
Etonogestrel implan 68 mcg Implanon
174 Etoposid injeksi 20 mg/ml Posyd
175 Eugenol cairan n/a
176
Everolimus tab 0,25 mg Certican 0,25 mg Tab
177
Everolimus tab 0,5 mg Certican 0,5 mg Tab
178 Faktor IX kompleks serbuk injeksi 1.000 UI/vial + pelarut 10

ml Nonafact 1000 IU
179
Faktor IX kompleks serbuk injeksi 500 UI/vial + pelarut 5 ml Nonafact 500 IU
180 Faktor koagulasi II 14-35 UI, faktor koagulasi VII 7-20 UI,
faktor koagulasi IX 25 UI, faktor koagulasi X 14-35 UI Cofact 500 IU/20 ml
181 Faktor Koagulasi II 14-35 UI, Faktor Koagulasi VIII 7-20 UI,
Faktor Koagulasi IX 25 UI, Faktor Koagulasi X 14-35 UI (250
IU/10ml) Cofact 250 IU
182 Faktor VIIa (rekombinan) serb inj 1 mg/vial + pelarut untuk

injeksi Novoseven
183 Faktor VIII (konsentrat) serb inj 230 -340 UI Haemoctin
184 Faktor VIII (konsentrat) serb inj 250 UI/vial + pelarut 5 Ml KOATE 250 UI
185 Faktor VIII (konsentrat) serb inj 480 - 600 UI KOATE DVI 500 IU
186
Fenitoin injeksi 50 mg/ml n/a
187 Fenitoin kapsul/kaplet 100 mg n/a
188
Fenitoin Na Inj 100 mg/2 ml n/a
189 Fenobarbital injeksi i.m./i.v. 50 mg/ml n/a
190
Fenobarbital tablet/kapsul/kaplet 100 mg n/a
191
Fenofibrat kaps 100 mg n/a
192
Fenofibrat kaps 300 mg n/a
193
Fenoksimetil penisilin (penisilin V) tab 125 mg Fenocin
194 Fenoksimetil penisilin (penisilin V) tablet/kapsul/kaplet 500
mg n/a
195 Fenoksimetil penisilin (penisilin V) tablet/kapsul/kaplet 250
mg n/a
196
Fenoterol HBr ih 100 mcg/puff Berotec MDI
197
Fenoterol HBr inh solution 0,1% Berotec Solution
198 Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 10 ml n/a
199 Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 2 ml n/a
200 Fentanil patch 12,5 mcg/jam Durogesic 12,5 MU Matrix
201 Fentanil patch 25 mcg/jam Durogesic 25 MU Matrix
202 Fentanil patch 50 mcg/jam Durogesic 50 MU Matrix
203 Filgrastim inj 300 mcg/mL Leucogen
204
Finasterid tab 5 mg Prostacom
205
Fitomenadion (Vit.K1) tablet salut gula 10 mg n/a
206 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml n/a
207 Fludarabin inj 50 mg Fludara IV LYO
208
Fludarabin tab 10 mg Fludara Oral
209
Flufenazin injeksi i.m. 25 mg/ml Sikzonoate Injeksi
210
Flukonazol injeksi 2 mg/ml n/a
211 Flukonazol tablet/kaplet/kapsul 50 mg Diflucan 50mg
212 Flukonazol tablet/kapsul 150 mg n/a
213
Fluoksetin tablet 10 mg Foransi 10
214 Fluoksetin tablet 20 mg NOPRES
215 Fluorometolon tetes mata 0,1 % Ocuflam ED
216 Fluorourasil inj 250 mg/mL Curacil
217 Fluorourasil inj 500 mg/ 5 mL Curacil
218
Flusinolon asetonid krim 0,025% SYNARCUS
219
Flutikason furoat intranasal spray Avamys
220
Flutikason propionat nebules 0,5 mg Flixotide Nbules
221
Fondaparinuks inj 2,5 mg/0,5 mL Arixtra
222 Fraksi protein plasma lar inf 5% Plasmanate
223
Furosemid injeksi i.v./i.m. 10 mg/ml n/a
224
Furosemid tablet 40 mg n/a
225 Gadobutrol macrocyclic 5 mg Gadovist 5 mg
226 Gadobutrol macrocyclic 7,5 mg Gadovist 7,5 mg
227 Gadoksetat disodium 0,25 mmol gadoxetate disodium/mL Primovist
228
Gansiklovir serb inj 500 mg (50 mg/mL) Cymevene
Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g

229 kalium klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g
Glukosa Anhidrat 2,70 g n/a
230
Gefitinib tab 250 mg Iressa 250 mg
231
Gemfibrozil kapsul/kaplet 300 mg n/a
232
Gemfibrozil tablet 600 mg n/a
233 Gemsitabin inj 1000 mg/vial Gemzar 1000 mg
234 Gemsitabin inj 200 mg/vial n/a
235 Gentamisin injeksi 40 mg/ ml n/a
236 Gentamisin salep mata 0,3% Genoint Salep Mata
237
Gentamisin tetes mata 0,3% n/a
238
Glibenklamid tablet 5 mg n/a
239
Gliklazid tab 80 mg Glicab
240
Gliklazid tab 30 mg Diamicron MR 30
241 Gliklazid tablet lepas lambat 60 Mg Diamicron MR 60
242
Glikuidon tab 30 mg n/a
243 Glimepiride tablet 1 mg n/a
247
Glipizid tablet/kaplet/kapsul 10 mg Glucotrol 10 mg
248
Glipizid tablet/kaplet/kapsul 5 mg Glucotrol 5 mg
249 DBL Gliceryl Trinitrate 50
Gliseril trinitrat inj 50 mg/10 mL mg/10 ml inj.
250 Gliseril trinitrat kaps SR 2,5 mg Nitrokaf Retard
251 Gliseril trinitrat kaps SR 5 mg Nitrokaf Forte
252
Gliseril trinitrat tab sublingual 0,5 mg Nitral
253 Gliserin lar 50% Gliserin lar 50%
254 Glukosa larutan infus 10 % steril n/a
255 Glukosa larutan infus 5 % steril n/a
256
Goserelin asetat inj 10,8 mg/vial Zoladex 10,8 mg
257
Goserelin asetat inj 3,6 mg Zoladex 3,6 mg
258
Griseofulvin tablet 125 mg n/a
259
Haloperidol inj 50 mg/mL Haldol Decanoas
260
Haloperidol injeksi i.m 5 mg/ml Lodomer Injeksi
261
Haloperidol tablet 0,5 mg n/a
262
Haloperidol tablet 5 mg n/a
263
Haloperidol tablet 1,5 mg n/a
264
Haloperidol tablet 2 mg Lodomer 2
265
Haloperidol tts 2 mg/mL LODOMER DROPS
266 Halotan Inhalasi Halothane
267 Heparin injeksi i.v./s.k. 5000 UI/ml Inviclot
268
Hepatitis B imunoglobulin (human) Hyperhep B
269
Hidrokortison krim 1% n/a
270 Hidrokortison krim 2,5 % n/a
271 Hidroksi Urea tablet/kaplet/kapsul 500 mg HYDROXYUREA MEDAC
272
Hiosin butilbromid injeksi 20 mg/ml n/a
273
Homatropin tetes mata 2% Homatro 2%
274
Human Insulin Intermediate Acting Inj 100 UI/ml Humulin N Kwikpen
275 Human insulin intermediate acting inj 100 UI/ml, vial
(Human Insulin (Intermediate-Acting)) Insulatard Vial
276 Human insulin intermediate acting inj 100 UI/ml, vial
(Insulin human Basal) Humulin N Vial
277
Human insulin intermediate acting inj 100 UI/ml,penfill
cartridge (Human Insulin (Intermediate-Acting)) Insulatard Penfill
278 Human insulin intermediate acting inj 100 UI/ml,penfill

cartridge (Insulin human Basal) Humulin N Cart
279 Human insulin intermediate acting inj 100 UI/ml,penfill
cartridge (Insulin human Basal) Sansulin N
280 Human insulin intermediate acting inj 100iu/ml, vial Insuman Basal vial 5ml,
(Insulin Human Basal) 100iu/ml
281 Human insulin mix inj 100iu/ml, vial (Insulin Human Comb Insuman Comb 25 vial
25) 5ml, 100iu/ml
282
Human Insulin Mix Insulin Inj 100 UI/ml Humulin 30/70 Kwikpen
283
Human insulin mix insulin inj 100 UI/ml, penfill cartridge
(Human Insulin (Premix: 30% Soluble + 70 % NPH Insulin)) Mixtard Penfill
284 Human insulin mix insulin inj 100 UI/ml, penfill cartridge
(Insulin human Comb) Humulin 30/70 Cart
285 Human insulin mix insulin inj 100 UI/ml, vial (Human
Insulin (Premix: 30% Soluble + 70 % NPH Insulin)) Mixtard Vial
286 Human insulin mix insulin inj 100 UI/ml, vial (Insulin human
Comb) Humulin 30/70 Vial
287
Human Insulin Short Acting Inj 100 UI/ml Humulin R Kwikpen
288
Human insulin short acting inj 100 UI/ml, penfill cartridge
(Human Insulin (Short Acting)) Actrapid Penfill
289 Human insulin short acting inj 100 UI/ml, penfill cartridge
(Insulin human Rapd) Sansulin R
290 Human insulin short acting inj 100 UI/ml, penfill cartridge
(Insulin human Rapd) Humulin R Cart
291 Human insulin short acting inj 100 UI/ml, vial (Human
Insulin (Short Acting)) Actrapid Vial
292 Human insulin short acting inj 100 UI/ml, vial (Insulin
human Rapd) Humulin R Vial
293 Human insulin short acting inj 100iu/ml, vial (Insulin Insuman Rapid vial 5ml,
Human Rapid) 100iu/ml
294 Human tetanus imunoglobulinn injeksi i.m. 250 UI Tetagam
295 Ibuprofen sirup 100 mg/5 ml n/a
296 Ibuprofen suspensi 200 mg/5 ml n/a
297
Ibuprofen tablet 200 mg n/a
298
Ibuprofen tablet 400 mg n/a
299
Ifosfamid serbuk injeksi 1000 mg/vial Holoxan injeksi 1000
Imanitib Mesilat tablet salut selaput 100 mg (Skema Risk

300 Sharing sesuai Kepmenkes RI Nomor
HK.02.02/Menkes/223/2014) Glivec
301
Imidapril tab 10 mg Tanapress 10mg
302
Imidapril tab 5 mg Tanapress 5mg
303 Iopamidol 200-300 mg Iodium/mL (300mg @ vial 100ml) Iopamiro
309 Iopromide 300-370 mg Iodium/mL (300 mg / 100 ml) Ultravist 300/100 mg
313
Ipratropium bromida inhalasi 20 mcg/semprot Atrovent HFA
314 Atrovent solution for
Ipratropium bromida nebulizer 0,025% inhalation 0.025%
315
Irbesartan tab 150 mg n/a
316
Irbesartan tab 300 mg n/a
317 Irinotekan inf 20 mg/ml n/a
318 Isofluran inhalasi Terrell
319
Isoniazid tablet/kapsul/kaplet 100 mg n/a
320
Isoniazid tablet/kapsul/kaplet 300 mg n/a
321 Isosorbid Dinitrat injeksi i.v 10 mg/10 ml Farsorbid inj
322
Isosorbid Dinitrat tablet sublingual 5 mg n/a
323
Isosorbid dinitrat tablet/kaplet/kapsul 10 mg Isonat
324
Kalium aspartat tab 300 mg Kalipar
325
Kalium Klorida tablet 600 mg KSR
326
Kalsium Folinat (Leukovorin Ca) inj 50 mg/ml DBL Leucovorin
327
Kalsium Glukonat injeksi i.v 10% (100 mg/ml) Kalsium glukonat
328
Kalsium Laktat (Kalk) tablet/kapsul/kaplet 500 mg n/a
329
Kalsium polistirena sulfonat ktg 5 g KALQUEST
330
Kanamisin inj 1000 mg/ vial n/a
331
Kandesartan tab 16 mg n/a
332
Kandesartan tab 8 mg n/a
333
Kapesitabin tab 500 mg Xeloda
334
Kaptopril tablet 50 mg n/a
335
Kaptopril tablet scored 25 mg n/a
336
Kaptopril tablet scored12,5 mg n/a
337 Tegretol Syrup
Karbamazepin sirup 100 mg/5 ml 100mg/5ml, 120ml
338
Karbamazepin tablet 200 mg n/a
339
Karbimazol tab 5 mg Neo-Mercazole
340 Karbogliserin tetes telinga
Karbogliserin tetes telinga 10% 10%
341
Karboplatin 150 mg / 15 ml DBL Carboplatin 150 mg
342
Karboplatin 450 mg / 45 ml DBL Carboplatin 450 mg
343 Karvediol tablet/kaplet/kapsul 6,25 mg V - BLOC
344
Ketamin injeksi i.v. 100 mg/ml KTM
345
Ketamin injeksi i.v. 50 mg/ml Ketamin Hameln
346 Ketokonazol krim 2% n/a
347
Ketokonazol krim 2% n/a
348
Ketokonazol krim 2% n/a
349 Ketokonazol scalp sol 2% Zoloral SS
350
Ketokonazol tablet 200 mg n/a
351 Ketoprofen supositoria 100 mg Protofen Supp
352 Ketorolac injeksi 30 mg/ml n/a
353
Klaritromisin tab 500 mg ORIXAL
354
Klindamisin kapsul/kaplet 150 mg n/a
355
Klindamisin kapsul/kaplet 300 mg n/a
356
Klobazam tab 10 mg n/a
357
Klonidin injeksi i.v 0,15 mg/ml (HCL) (150) Catapres Injeksi
358 Klonidin tablet 0,15 mg n/a
359
Klopidogrel tab 75 mg n/a
360
Kloramfenikol salep kulit 2% Bufacetin
361 Kloramfenikol salep mata 1 % n/a
362 Kloramfenikol serb inj 1000 mg/mL Colsancetine Injeksi
363 Kloramfenikol suspensi 125 mg/ 5 ml n/a
364
Klorfeniramina Maleat (CTM) tablet/kapsul/kaplet 4 mg n/a
365 Klorpromazin injeksi i.m. 25 mg/ml (HCl) n/a
366 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) n/a
367
Klorpromazin tablet salut 100 mg (HCl) n/a
368 Klorpromazin tablet salut 25 mg (HCl) n/a
369
Klozapin 100 mg n/a
370
Klozapin 25 mg n/a
371 Kodein tablet 10 mg n/a
374 Kolekalsiferol (vitamin D3) kapsul lunak 0,25 mcg Ostriol
375 Kolkisin tablet/kaplet/kapsul 500 mcg Recolfar
376
Koloid HES BM 130 000 lar inf 6% Voluven
377 Kombinasi : Ipratropium bromida inhalasi 0,5 mg
Salbutamol 2,5 mg Combivent UDV
378 Kombinasi injeksi depot : Medroksi progesteron asetat 25
mg Estradiol sipionat 5 mg n/a
379
Kombinasi suspensi : Parafin + gliserin + fenolftalein Laxadine Emulsi 60 ml
380 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam
folat 0,25 mg n/a
381 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam
folat 0,25 mg n/a
382 Kombinasi tetes mata 2,5 mg/mL: Natrium klorida 8,664
mg; Kalium klorida 1,32 mg Cendo Lyteers
383
Kombinasi: Artemether 20 mg; Lumefantrin 120 mg Coartem
384 Kombinasi: Levodopa 100 mg; Karbidopa 25 mg;

Entekapon 200 mg Stalevo
385
Kombinasi: Lopinavir 200 mg; Ritonavir (LPV/r) 50 mg Aluvia
386 Kombinasi: Salmeterol 25 mcg; Flutikason propionat 50
mcg Seretide Inhaler 50 mcg
mcg Seretide Diskus 100 mcg
mcg Seretide Diskus 250 mcg
389 Kontrasepsi pil oral, kombinasi :* Levonorgestrel 150 mcg
Etinilestradiol 30 mcg n/a
390 Kotrimoksazol DOEN I (dewasa) kombinasi :
Sulfametoksazol 400 mg Trimetoprim 80 mg n/a
391 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +
Trimetoprim 40 mg / 5 ml n/a
392 Kuinin (Kina) tablet 200 mg n/a
393 Kuinin injeksi i.v. 25% (sebagai 2 HCl) n/a
394 Kuinin tablet 222 mg (H2SO4.7H2O) n/a
395 Laktulosa sir 3,335 g/5 mL n/a
396 Lamivudin tablet/kaplet/kapsu 100 mg Heplav
397 Lamivudine tablet 150 mg n/a
398
Lansoprazol inj 30 mg/ml Prosogan Inj.
399
Lanzoprazol kapsul/kaplet 30 mg n/a
400
Lapatinib tab 250 mg Tykerb
401
Larutan mengandung Asam Amino (Asam Amino 10%) Kalbamin
402 Larutan mengandung Asam Amino (Asam Amino 100 g,
Total N 15,7 g, Na+ 2 mEq, Asetat 120 mEq) Amiparen
Sorbitol 50 g, Cl- 52 mEq) Pan-amin G
Glukosa 7,3 % dan elektrolit) 1000 ml Aminofluid
Glukosa 7,3 % dan elektrolit) 500 ml Aminofluid
Larutan mengandung Asam Amino (Asam Amino 5%

406 dengan BCAA 45%, L-Ornithine L Aspartate 8.03 gr/L,
Sorbitol 50 gr/L, Xylitol 50 gr/L) Aminofusin Hepar
407 Larutan mengandung Asam Amino (Asam Amino 6%,
mengandung Taurine 0,24 gr/l) Aminosteril Infant 6%
Larutan mengandung Asam Amino (Asam Amino 7%,

408 Komposisi: Asam Amino esensial: Asam Amino non
esensial = 60 : 40) Nephrosteril
Larutan mengandung Asam Amino (Asam Amino 72.05 g,
409 Total N 11.53 g, AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46
mEq) Kidmin
410 Larutan mengandung Asam Amino (Asam Amino 79.9 g,
Total N 12.2 g, Na+ 14 mEq, Cl 94 mEq) Aminoleban
411
Larutan mengandung Asam Amino (Asam amino 8%) Aminosteril N-Hepa
412 Larutan mengandung Asam Amino (Asam Amino esensial
7%+Xylitol 10 g/L) Eas Pfrimer
Larutan mengandung Asam Amino (BCAA 25 gr/L, L-

413 Ornithine L Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7
gr/L, Piridoxin 0.12 gr/L) Comafusin Hepar
Larutan mengandung Asam Amino (Kombinasi Asam

414 aminno 50 g/L, Sorbitol 50 g/L, Xylitol 50 g/L, Asam
Askorbat (Vit C) 0.4 g/L, Inositol 0.5 g/L, Nikotinamida
(Niasinamida) 0.06 g/L, Piridoksin HCl (Vit B6) 0.04 g/L,
Riboflavin Natrium Fosfat 2.5 mg/L, elektrolit) Aminofusin L600
415 Larutan mengandung Asam Amino (Kombinasi Asam amino
50 g/L, vitamin dan elektrolit) Aminofusin Paed

416 Amino: 34gr, Glukosa: 97gr, Lipid: 51gr dan Elektrolit
(Kalori = 1000 kkal, Akses peripheral)) Kabiven 1440 ml

417 Amino: 45gr, Glukosa: 130gr, Lipid: 68gr dan Elektrolit
(Kalori = 1400 kkal, Akses peripheral)) Kabiven 1920 ml
418
Larutan mengandung Asam Amino (Kombinasi Glukosa dan
elektrolit 150 gr + Asam Amino 48 gr dgn akses sentral) Combiflex Plus (790 kcal)
419
Larutan mengandung Asam Amino (Kombinasi Glukosa dan
elektrolit 80 gr + Asam Amino 40 gr ) Combiflex peri (480 kcal)
420 Larutan mengandung Elektrolit (Kalium Klorida) Otsu - KCl 7,46%
421 Larutan mengandung Elektrolit (Larutan Ringer Laktat) Wida RL
422 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq,
Ca 3 mEq, Asetat 28 mEq) Asering
423 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa
18.75 gr) KA EN 1B
Larutan mengandung Elektrolit (Sodium Lactate sol (50%)

424 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2
gr/L, elektrolit) Totilac
Larutan mengandung Elektrolit (Tiap 1000 ml mengandung
425 electrolit: Sodium 145 mmol/l, Potassium 4.0 mmol/l,
Calcium 2.5 mmol/l, Magnesium 1.0 mmol/l, Chloride 118
mmol/l, Acetate 24 mmol/l, Malate 5.0 mmol/l) Ringerfundin 500 mL
426 Larutan mengandung Karbohidrat (Fructose 120 g, glucose
66 g, Xylitol 60 g/ L + elektrolit) Triofusin 1000
427 Larutan mengandung Karbohidrat (Fructose 60 g, glucose
33 g, Xylitol 30 g/ L) Triofusin 500
428
Larutan mengandung Karbohidrat (Maltose 100 gr) Martos
Larutan mengandung Karbohidrat + Elektrolit (25.00g
maltose, 3.00 g sodium chloride, 0.15 g potassium
429 chloride, 0.10 g calcium chloride dihydrate dan 1.55 g
sodium lactate) Potacol inj
430 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na,
K, Cl, Ca, Mg, Sorbitol 50 gr/L) Tutofusin OPS
431 Larutan mengandung Karbohidrat + Elektrolit (Asam amino
28 gr/L, Glukosa 100 gr/L, elektrolit) Clinimix N9G20E
432 Larutan mengandung Karbohidrat + Elektrolit (Asam amino
28 gr/L, Glukosa 75 gr/L, elektrolit) Clinimix N9G15E
433 Larutan mengandung Karbohidrat + Elektrolit (Fructose 60
g, glucose 33 g, Xylitol 30 g/ L) Triofusin E1000
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25

434 g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk
injeksi ad 1000 ml) Wida HSD
435 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g
; Natrium Chloride 9 g, air untuk injeksi ad 1000 ml) Wida D5-NS
436 Larutan mengandung Karbohidrat + Elektrolit (Glukosa:
25,0 g; NaCl: 4,5 g) WIDA 2A
55.0 g; NaCl: 2.25 g) WIDA D5-1/4NS
55.0 g; NaCl: 4.5 g) WIDA D5-1/2NS
Larutan mengandung Karbohidrat + Elektrolit (Larutan

439 nutrisi kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca.
4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g) Futrolit
440 Larutan mengandung Karbohidrat + Elektrolit (Larutan
Ringer & Glukosa 5%) Wida RD
441 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g,
KCL 1.5g, Glukosa 100 gr) KA ENMG 3
442 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr,
KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr) KA EN 3B
443 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr,
Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr) KA EN 3A
444 Larutan mengandung Lipid ( Infus Lipid Emulsi MCT/LCT Lipofundin MCT/LCT 1%
20% 100 ml) 100
445
Larutan mengandung Lipid (Emulsi lemak 20%) Intralipid
446 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT Lipofundin MCT/LCT 1%
20% 250 ml) 250
Larutan mengandung Lipid (Kombinasi Glukosa dan

447 elektrolit 180 gr + Asam Amino 71.8 gr + Lipid 50 gr dgn Nutriflex Lipid Special
akses sentral) 1250
448 Larutan mengandung Lipid (Kombinasi Glukosa dan

elektrolit 80 gr + Asam Amino 40 gr + Lipid MCT/LCT 50 gr) Nutriflex Lipid Peri 1250
Larutan mengandung Lipid (Kombinasi Glukosa dan

449 elektrolit 90 gr + Asam Amino 35.9 gr + Lipid 25 gr dgn
akses sentral) Nutriflex Lipid Special 625
450
Latanoprost tetes mata 0,01% Cendo Glaopen
451 Latanoprost tts mata 0,005% btl@2,5ml Xalatan 0,005%
452
Lenograstim inj 263 mcg/mL Granocyte 34 1vl HSA Free

453
Letrozol tablet/kaplet/kapsul 2,5 mg FEMARA
454
Leuprorelin asetat inj depot 1,88 mg Tapros 1.88mg
455
Leuprorelin asetat inj depot 11,25 mg Tapros 3M
456
Leuprorelin asetat inj depot 3,75 mg TAPROS 3.75 MG
457
Levofloksasin inf 5 mg/mL n/a
458
Levofloksasin tablet 500 mg n/a
459 Levofloksasin tts mata 0,5% Optiflox
460
Levotiroksin tablet/kaplet/kapsul 100 mcg Euthyrox 100
461
Levotiroksin tablet/kaplet/kapsul 50 mcg Euthyrox 50
462
Lidokain injeksi 2% (HCL) n/a
463
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml n/a
464
Lidokain jeli 2% Xylocaine Jelly 2%
465 Xylocaine Spray 10 mg /
Lidokain semprot 10% dosis
466
Lisinopril tablet 10 mg n/a
467
Lisinopril tablet 5 mg n/a
468
Litium karbonat tablet 200 mg Frimania 200
469
Litium karbonat tablet 400 mg Frimania 400
470
Loperamid tablet 2 mg n/a
471
Loratadin tablet 10 mg n/a
472
Lorazepam tablet 0,5 mg MERLOPAM 0,5 mg
473
Lorazepam tablet 2 mg Merlopam 2
474
Low molecule feri sucrose inj amp 100 mg/5 mL DIALIFER
475
Magnesium sulfat injeksi 20% OTSU-MgSO4 20
476
Magnesium sulfat injeksi 40% OTSU-MgSO4 40
477
Manitol n/a
478
Maprotilin HCl tab 25 mg Ludios
479
Maprotilin HCl tab 50 mg Sandepril 50
480 MDP (methylene diphosphonate) 1 mg methylene
diphosphonic acid/mL Bonescan KaeF
481
Mebendazol tablet 500 mg Vermox 500
482
Medroksi Progesteron Asetat tablet/kaplet/kapsul 100 mg Provera 100mg
483
Melfalan tablet 2 mg Alkeran
484 Meropenem inj 1 g n/a
485 Meropenem serb inj 500 mg/vial n/a
486
Mesna inj 100 mg/mL Uromitexan injeksi.
487 Metadon sir 50mg/5ml n/a
488
Metformin HCl tablet 500 mg n/a
489
Metformin HCl tablet 850 mg n/a
490
Metildopa tablet salut 250 mg DOPAMET
491 Metilergometrin Maleat (Metilergometrin) tablet salut
0,125 mg n/a
492
Metilergometrin Maleat injeksi 0,200 mg-1 ml n/a
493
Metilfenidat kapsul LA 20 mg Ritalin LA
494
Metilfenidat tablet SR 10 mg RITALIN
495
Metilprednisolon inj 125 mg/2 mL n/a
496 Metilprednisolon inj 500 mg/8 mL n/a
497
Metilprednisolon tablet 16 mg n/a
498
499
500 Metoklopramid drop botol 10 mL GAVISTAL drops
501 Metoklopramide sirup 5 mg/ 5 ml LEXAPRAM SIRUP
502 Metoklopramide tablet 5 mg n/a
503 Metotreksat serb inj 50 mg/2 mL Methotrexate Kalbe
504
Metotreksat serbuk injeksi i.v/i.m./i.t. 5 mg METHOTREXATE EBEWE
505 METHOTREXATE EBEWE
Metotreksat tablet/kaplet/kapsul 2,5 mg 2.5 MG
506
Metronidazol infus 500 mg/100 ml n/a
507 Metronidazol ovula 500 mg Vagizol
508
Metronidazol sirup 125 mg/5 Ml Farizol
509
Metronidazol supositoria 500 mg Flagyl
510
Metronidazol tablet 250 mg n/a
511
Metronidazol tablet 500 mg n/a
512 MIBG (meta-iodobenzylguanidine) Endoneuroscan KaeF 1
513 MIBI (metoxy iso butyl iso nitril) 5-mL reaction vial Cardioscan KaeF
514
Midazolam injeksi i.v. 1 mg/ml Dormicum
515
Midazolam injeksi i.v. 5 mg/ml Dormicum
516 Mikafungin Na serb inj 50 mg Mycamine
517
Mikofenolat Mofetil 500 mg Cellcept
518 Mikonazol krim/salep 2 % (Nitrat) n/a
519 Mitomisin C (crystallin) serbuk inj 10 mg/vial Mitomycin C
520 Modified fluid gelatine BM 30 000 lar inf 4% Gelofusine 4%
521
Moksifloksasin tetes mata 0,5% Vigamox
522
Mometason furoat krim 0,1% n/a
523 Morfin HCL inj 10 mg/ml n/a
524
Morfin HCL tablet SR 10 mg MST Continus 10 mg
525
Morfin HCL tablet SR 15 mg MST Continus 15 mg
526 Morfin tablet 10 mg n/a
527 N-asetil sistein inj. nebules 100 mg N-ace cairan inhalasi
528 Nacl 0,9% n/a
529
Nadroparin inj 9500 Axa/mL syringe 0,3 mL Fraxiparine 0.3 ml
530
Nadroparin inj 9500 Axa/mL, syringe 0,4 mL Fraxiparine 0.4 ml
531
Nadroparin inj 9500 Axa/mL, syringe 0,6 mL Fraxiparine 0.6 ml
532 Nalokson injeksi 0,4 mg/ml Nokoba
533 Natrium Bikarbonat injeksi i.v 8,4% Meylon
534
Natrium Diklofenak tablet 50 mg n/a
535 Natrium fosfat lar oral 45 mL Fleet Phosphosoda
536 Natrium fusidat salep 20 mg/g Fucilex Ointment
537
Neostigmin injeksi 0,5 mg/ml Neostigmin Hameln inj
538 Nevirapin tablet 200 mg n/a
539 Nifedipin tab 20 mg, slow release; oros Adalat Oros 20 mg
540 Nifedipin tab 30 mg, oros Adalat Oros 30 mg
541
Nifedipin tablet/kapsul 10 mg n/a
542 Nikardipin inj 10 mg/vial n/a
543 Nilotinib kapsul 200 mg (Skema Risk Sharing sesuai
Kepmenkes RI Nomor HK.02.02/Menkes/223/2014) Tasigna
544 Nistatin tablet salut 500.000 IU/ g n/a
545 Nistatin vaginal tablet 100.000 IU/ g n/a
546 Norepinefrin injeksi 1 mg/ml Raivas
547 Noretisteron tablet 5 mg Primolut N
548 Obat Antituberkulosis FDC Kategori 1 n/a
549 Obat Antituberkulosis FDC Kategori 2 n/a
550 Obat Antituberkulosis FDC Kategori Anak n/a
551 Obat Antituberkulosis FDC Sisipan n/a
552
Obat Antituberkulosis Kategori 1 dewasa n/a
553
Obat Antituberkulosis Kategori anak n/a

554 Octreotide Acetate0,05 - 6 mg/mL Octide
555 Ofloksasin tets telinga 3% Tarivid Otic Solution
556
Ofloxacin tablet 200 mg n/a
557
Ofloxacin tablet 400 mg n/a
558 Oksaliplatin serbuk injeksi 100 mg / vial ELOXATIN
559 Oksaliplatin serbuk injeksi 50 mg / vial ELOXATIN
560 Oksimetazolin tetes hidung 0,025% Ilaidin Drops
561 Oksimetazolin tetes hidung 0,050% Iliadin Spray
562
Oksitosin injeksi 10 IU/ml Oxytocin "S"
563
Oktreotid 10 mg Sandostatin LAR

564 Olanzapin inj 10 mg/vial Zyprexa IM
565
Olopatadin tts mata 0,1% Patanol
566
Omeprazol injeksi 40 mg/ 10 ml n/a
567 Omeprazol kapsul/kaplet 20 mg n/a
568 ondansetron inj 4 mg/ 2 mL n/a
569
Ondansetron tab 4 mg n/a
570
Ondansetron tablet 8 mg n/a
571
Paket CAPD Awal (Komposisi: 1 unit Transfer Set, 2 unit

Ultaclam, 1 unit Tenckoff Catheter, Titanium Adaptor) n/a
572 Paket CAPD Pergantian Transfer Set per 6 bulan n/a
Larutan Dialisa 1.5%:

Dianeal Low Calcium with
1,5% Dextrose; Larutan
573 Dialisa 2.5%: Dianeal Low
Calcium with 2,5%
Dextrose; Larutan Dialisa
Paket CAPD Rutin 120 ( 4x ganti cairan perhari dengan 4.25%: Dianeal Low
komposisi Larutan Dialisa 1.5 %, Larutan Dialisa 2.5 %, Calcium with 4.25%
Larutan Dialisa 4.25 %, Minicap) Dextrose
574 SINDAXEL 100 MG/16,67
Paklitaksel inj 100 mg/vial ML
575 SINDAXEL 260mg/43.33
Paklitaksel inj 300 mg/vial ML
576
Paklitaksel injeksi 30 mg/vial SINDAXEL 30 MG/5 ML
577 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) n/a
578 Parasetamol sirup 120 mg / 5 ml n/a
579
Parasetamol tablet 500 mg n/a
580
Parasetamol tetes 60 mg/0,6 mL FASIDOL
581
Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Pegasys
582
Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Pegasys
583
Pegylated Interferon alfa-2b serb inj 100 mcg Pegintron Vial 100 Mcg
584
Pegylated Interferon alfa-2b serb inj 120 mcg Pegintron Pen 120 Mcg
585
Pegylated Interferon alfa-2b serb inj 50 mcg Pegintron
586
Pegylated Interferon alfa-2b serb inj 80 mcg Pegintron Vial 80 Mcg

587 Perak sulfadiazin krim 1% BURNAZIN 35 GR
588
Perindoprilarginin tab 5 mg Bioprexum 5 mg
589
Permetrin krim 5% Scabimite Cream 10
590 Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml (HCl) n/a
591 Pioglitazon tab 15 mg DECULIN 15 MG
592 Pioglitazon tab 30 mg DECULIN 30 MG
593 Pirantel suspensi 125 mg/5 ml n/a
594
Pirantel tablet score (base) 125 mg n/a
595
Pirazinamid tablet 500 mg n/a
596 Piridoksin (vitamin B6) inj 100 mg/mL n/a
597 Polikresulen cairan Aptil
598 Povidon Iodida larutan 10% 1000 ml n/a
602
Pramipeksol tab ER 0,375 mg Sifrol ER 0,375mg
603
Pramipeksol tab ER 0,750 mg Sifrol ER 0,750mg
604
Pravastatin tablet 20 mg n/a
605
Primakuin tablet 15 mg n/a
606
Probenesid tablet/kapsul/kaplet 500 mg Probenid
607 Prokain Benzilpenisilin serbuk injeksi 3 juta IU/vial n/a
608
Propanolol tablet 10 mg ( HCl ) n/a
609 Propiltiourasil tablet/kapsul/kaplet 100 mg n/a
610
Propofol injeksi i.v., bolus 1% Fresofol 1% MCT/LCT
611
Propranolol tablet 40 mg (HCl) n/a
612
Quetiapin tab 200 mg Seroquel XR 200 mg
613
614
615 Cardace 2.5mg 6x10 s
Ramipril tablet 2,5 mg tablet
616
Ramipril tablet 5 mg n/a
617
Ramipril tablet/kaplet/kapsul 10 mg n/a
618
Ranitidin injeksi 25 mg/ml n/a
619
Ranitidin tablet 150 mg n/a
620
Retinol (Vitamin A) 100.000 IU n/a
621 Retinol (Vitamin A) 200.000 IU kapsul lunak n/a
622
Rifampisin tablet/kapsul/kaplet 300 mg n/a
623
624
625 Ringer Laktat larutan infus n/a
626
Risperidon tablet 1 mg n/a
627
628
629 Rituksimab injeksi 10 mg/ml (Skema Risk Sharing sesuai
Kepmenkes RI Nomor HK.02.02/Menkes/223/2014) Mabthera
630 Rivaroksaban tab 10 mg Xarelto 10 mg
633
Rokuronium injeksi i.v. 50 mg/5ml Esmeron
634
Ropinirol Tablet Salut 2 mg Requip PD 24 Hour 2 mg
635
636
637
Salbutamol cairan ih 0,1% Ventolin Nebules
638
Salbutamol inhalasi/aerosol 100 mcg/dosis Ventolin Inhaler
639
Salbutamol serb inh 200 mcg/kaps Ventolin Rotacaps
640
Salbutamol serb inh 200 mcg/kaps + rotahaler Ventolin Rotahaler
641
Salbutamol tablet 2 mg (sebagai Sulfat) n/a
642 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap
4% n/a
643 Sefadroksil sirup kering 125 mg/5ml n/a
644
Sefadroksil kapsul/kaplet 250 mg n/a
645
Sefadroksil kapsul/kaplet 500 mg n/a
646 Sefadroksil sir kering 250 mg/5 mL n/a
647
Sefaleksin kapsul/kaplet 500 mg n/a
648 Sefazolin serbuk injeksi 1 g/vial n/a
649
Sefepim inj 1 g n/a
650
Sefiksim kapsul/kaplet 100 mg n/a
651
Sefiksim sirup kering 100 mg/ 5 ml n/a
652
Sefoperazon inj 1 g n/a
653
Sefotaksim injeksi 0,5 g n/a
654
Sefotaksim injeksi 1 g n/a
655
Sefpodoksim proksetil tab 100 mg Banadoz 100
656 Seftazidim injeksi 1 g n/a
657
Seftriakson serbuk injeksi 1 g/vial n/a
658
Sefuroksim tablet/kapsul/kaplet 250 mg Zinnat 250 mg
659 Sefuroksim serbuk injeksi 750 mg/vial Sharox inj
660
Sefuroksim tab 500 mg Zinnat 500
661 Sertralin tab 50 mg Fatral
662 Setirizin sirup 5 mg/5 ml n/a
663
Setirizin tablet 10 mg n/a
664 Setuksimab infus 5 mg/ml (Skema Risk Sharing sesuai
Kepmenkes RI Nomor HK.02.02/Menkes/223/2014) Erbitux
665 Sevofluran ih, btl Sojourn
666 Sianokobalamin (vitamin B12) injeksi 500 mcg n/a
667
Sianokobalamin (vitamin B12) tablet/kapsul/kaplet 50 mcg n/a
668
Siklofosfamid serbuk injeksi i.v. 1000 mg Cyclovid 1000 mg
669
Siklofosfamid serbuk injeksi i.v. 200 mg Cyclovid 200 mg
670
Siklofosfamid serbuk injeksi i.v. 500 mg CYCLOVID 500
671 Sandimmun Neoral 100mg
Siklosporin kaps 100 mg Kap
672 Sandimmun Neoral 25mg
Siklosporin kapsul lunak 25 mg Kap
673 Silostazol tablet/kapsul/kaplet 100 mg Citaz
674
Simvastatin scored tablet 10 mg n/a
675
Simvastatin tablet 20 mg n/a
676 Siprofloksasin infus 2% n/a
677
Siprofloksasin tablet 500 mg (sebagai HCl) n/a
678 Sisplatin serbuk injeksi 10 mg Cisplatin
679 Sisplatin serbuk injeksi 50 mg Cisplatin
680
Sitarabin serbuk injeksi i.m./i.v./s.k. 1gr/10ml DBL Cytarabun
681
Spiramisin tablet 500 mg n/a
682
Spironolakton tablet 100 mg n/a
683
Spironolakton tablet 25 mg n/a
684 Stavudin tablet/kapsul/kaplet 30 mg n/a
685 Streptokinase injeksi 1,5 juta UI/vial Streptase
686 Streptomisin serbuk injeksi i.v 1000 mg/ml n/a
687 Sufentanyl Injeksi
Sufentanil injeksi iv, epidural 5 mcg/ml iv.Epidural 5 mcg / ml
688 Sukralfat susp 500 mg/5 mL Ulsafate
689
Sukralfat tab 500 mg ULSIDEX
690
Takrolimus kaps 0.5 mg Prograf
691
Takrolimus kaps 1 mg Prograf
692
Tamsulosin tab 0,2 mg Harnal D
693
Tamsulosin tab 0,2 mg Harnal D
694
Tamsulosin tab SR 0,4 mg Harnal OCAS
695
Telbivudin tab 600 mg Sebivo 600 mg Tab
696
Telmisartan tab 40mg Micardis 40mg
697
Telmisartan tab 80 mg Micardis 80mg
698
Temozolamid kaps 100 mg Temodal
699
Temozolamid kaps 20 mg Temodal
700 Tenofovir tab 300 mg n/a
701
Teofilin tab SR 300 mg Rethapyl
702 Teofilin tablet 150 mg Bronsolvan
703
Terazosin HCl tablet/kapsul/kaplet 1 mg HYTROZ 1MG
704
Terazosin HCl tablet/kapsul/kaplet 2 mg HYTROZ 3MG
705
Terbutalin cairan ih 2,5 mg/mL Bricasma Respules
706 Terbutalin tablet 2,5 mg Molasma Tablet
707 Bricasma Turbuhaler 0,5
Terbutalin turbu (serbuk ih) 0,50 mg mg
708
Testoteron soft capsul 40 mg Andriol Testocaps
709
Tetrakain HCl tetes mata 0,5% Pantocain 0.5%
710
Tetrasiklin kapsul/kaplet 250 mg n/a
711
Tetrasiklin tablet/kapsul/kaplet 500 mg n/a
712
Tiamazol tab 10 mg Thyrozol 10
713
Tiamazol tab 5 mg Thyrozol 5
714
Timolol tetes mata 0,25% Isotic Adretor 0,25%
715
Timolol tetes mata 0,5% Isotic Adretor 0,5%
716 Spiriva powder for
Tiotropium 18 mcg refill inhalation 18mcg 30s
717
Tiotropium kaps 18 mcg + handihaller Spiriva 10s + Handihaler
718
Tramadol injeksi 50 mg/ml n/a
Trastuzumab serbuk injeksi 440 mg/vial (Skema Risk

719 Sharing sesuai Kepmenkes RI Nomor
HK.02.02/Menkes/223/2014) Herceptin
720
Travoprost tetes mata 0,004% Travatan
721
Triamsinolon asetonid nasal spray 55 mcg/puff Nasacort AQ
722 Triamsinolon inj 10 mg/mL Flamicort
723 Trifluoperazin tablet 5 mg n/a
724
Tropikamid tetes mata 1% Cendo Mydriatil 1%
725
Urea krim 10% Soft U Derm
726 Vaksin BCG (Harga pengadaan di Kementerian Kesehatan
Pusat franco ibukota provinsi (DIPA Kemkes)) BCG Vaccine (GS)
Pusat franco ibukota provinsi (DIPA Kemkes)) BCG Vaccine (SII)
Pusat franco ibukota provinsi (DIPA Kemkes)) BCG Vaccine SSI
729 Vaksin BCG (Harga pengadaan di Provinsi franco ibukota
Provinsi (Non DIPA Kemkes)) BCG Vaccine (SII)
Provinsi (Non DIPA Kemkes)) BCG Vaccine SSI
Provinsi (Non DIPA Kemkes)) BCG Vaccine (GS)
732 Vaksin BCG Kering (BF) (Harga pengadaan di Kementerian
Kesehatan Pusat franco ibukota provinsi (DIPA Kemkes)) n/a
733 Vaksin BCG Kering (BF) (Harga pengadaan di Provinsi
franco ibukota Provinsi (Non DIPA Kemkes)) n/a
734 Vaksin Campak Kering (Harga pengadaan di Kementerian
Kesehatan Pusat franco ibukota provinsi (DIPA Kemkes)) n/a
735 Vaksin Campak Kering (Harga pengadaan di Provinsi franco
ibukota Provinsi (Non DIPA Kemkes)) n/a
736 Vaksin DTP-HB-Hib (Harga pengadaan di Kementerian
Kesehatan Pusat franco ibukota provinsi (DIPA Kemkes)) Pentabio
737 Vaksin DTP-HB-Hib (Harga pengadaan di Provinsi franco
ibukota Provinsi (Non DIPA Kemkes)) Pentabio
Vaksin Hepatitis B Rekombinan (Harga pengadaan di

738 Kementerian Kesehatan Pusat franco ibukota provinsi
(DIPA Kemkes)) n/a
739 Vaksin Hepatitis B Rekombinan (Harga pengadaan di
Provinsi franco ibukota Provinsi (Non DIPA Kemkes)) n/a
Vaksin Jerap DT (Adsorbed DT Vaccine) (Harga pengadaan

740 di Kementerian Kesehatan Pusat franco ibukota provinsi
(DIPA Kemkes)) n/a
741 Vaksin Jerap DT (Adsorbed DT Vaccine) (Harga pengadaan
di Provinsi franco ibukota Provinsi (Non DIPA Kemkes)) n/a
Vaksin Jerap Td (Adsorbed Td Vaccine) (Harga pengadaan

742 di Kementerian Kesehatan Pusat franco ibukota provinsi
(DIPA Kemkes)) n/a
743 Vaksin Jerap Td (Adsorbed Td Vaccine) (Harga pengadaan
di Provinsi franco ibukota Provinsi (Non DIPA Kemkes)) n/a
744
Vaksin Meningitis Meningokokus Menveo

745
Vaksin polio inj (Vaksin Poliomyelitis yang diinaktifkan) Imovax Polio
Vaksin Poliomyelitis Oral (Harga pengadaan di

746 Kementerian Kesehatan Pusat franco ibukota provinsi
(DIPA Kemkes)) n/a
747 Vaksin Poliomyelitis Oral (Harga pengadaan di Provinsi
franco ibukota Provinsi (Non DIPA Kemkes)) n/a
748 Vaksin rabies, untuk manusia serbuk injeksi s.k./i.k. +

booster Verorab
749
Vaksin rabies, untuk manusia serbuk injeksi s.k./i.k. +
booster RABIPUR
750 Vaksin TT (Harga pengadaan di Kementerian Kesehatan
Pusat franco ibukota provinsi (DIPA Kemkes)) n/a
751 Vaksin TT (Harga pengadaan di Provinsi franco ibukota
Provinsi (Non DIPA Kemkes)) n/a
752
Valasiklovir tablet/kapsul/kaplet 500 mg Valvir
753
Valgansiklovir tab 450 mg Valcyte
754 Valproat sirup 250 mg/5 ml Ikalep
755
Valproat tab SR 250 mg Depakote ER 250 mg
756
Valproat tab SR 500 mg Depakote ER 500 mg
757
Valproat tablet salut 250 mg Depakote Tab 250 mg
758
Valsartan tab 80 mg Diovan 80mg Tab
759
Valsartan tab 160 mg DIOVAN 160 MG
760 Vankomisin serbuk injeksi 500 mg/vial Vancep
761
Verapamil tab 240 mg Isoptin 240 mg
762 Verapamil tablet 80 mg (HCl) n/a
763 Vinblastin serbuk injeksi 10 mg Vinblastine
764 Vinkristin serb inj i.v 2 mg/vial Vincristine Kalbe
765 Vinkristin serbuk injeksi i.v. 1 mg Vincristine Kalbe
766
Vinorelbin inj. 10 mg/ml Navelbine injeksi 10
767 Vitamin B Kompleks tablet n/a
768 Zidofudin 100 mg n/a
769 Zidovudin 300 mg + Lamivudine 150 mg n/a
770
Zinc drop 10 mg/mL Zincpro Drops
771 Zinc sir 10 mg/mL Zinkid
772 Zinc sir 20 mg/5 Ml Zircum Kid Sirup
773 Zinc tablet dispersible20 mg n/a
A BARAT TAHUN 2015
Harga Satuan
Nama Penyedia Kemasan Tanggal Berlaku Harga
Terkecil (Rp)
PT. Kimia Farma 1 blister@24 tablet 1,375.00 4/23/2013 10:24
PT. SmithKline
Beecham Dus, 3 Blister @ 10
Phamaceuticals kapsul 27,500.00 3/18/2014 20:03
PT. Ikapharmindo Vial 20 ml 2,030.00 1/5/2015 14:07
PT Otsuka Dus, 120 ampul PE
Indonesia @ 25ML 2,200.00 4/28/2015 11:26
PT. Widatra Bhakti Btl @ 1000 ml 7,500.00 9/28/2014 21:46
Dus, 10 strip
PT. Dexa Medica @10tablet 990 12/5/2014 22:08
Dus, 10 strip
PT. Dexa Medica @10tablet 780 12/5/2014 22:08
Dus, 10 dus @ 1
PT. Indofarma botol @ 10 ml 3,849.00 4/23/2013 10:24
Dus, 5 strip @ 6
PT. Holi Pharma tablet 338 3/15/2014 16:05

PT. Ferron Par Dus, botol @ 100
Pharmaceuticals ml 1,515,000.00 1/5/2015 14:07
PT. Dipa Pharmalab botol @ 20 ml 321,552.00 1/5/2015 14:07
Box, 10 strips @ 10
PT. Pertiwi Agung tablets 86 3/15/2014 16:05
Dus, 10 blister @ 10
PT. Bernofarm tablet 199.5 3/15/2014 16:05
Dus, 10 Strip @ 10
PT. Dexa Medica tablet 380 3/15/2014 16:05
PT. Otto 1 box 10 Strip X 10
Pharmaceuticals tablet 176 3/15/2014 16:05
PT. Kimia Farma Ktk 10x10 tablet 233 3/15/2014 16:05
Dus, 1 vial@50mg +
PT. Boehringer 1 vial pelarut @
Ingelheim 50ml 3,800,000.00 6/27/2014 19:33
PT. Cendo Industri
Farmasi tube 3.5 gr 18,500.00 4/3/2014 21:30
PT. Sanbe Farma Vial 2 ml 50,500.00 3/16/2014 18:23
dus 30 ampul @10
PT. Lucas Djaja ml 3,822.00 4/23/2013 10:24
PT. Marin Liza Botol @ 100 tablet
Farmasi salut selaput 90 3/15/2014 16:05
PT. Erela Btl
Dus,@6100 tablet
ampul @3 80 9/28/2014 21:46
PT. Aventis Pharma ml 12,480.00 3/16/2014 18:23
PT. Darya Varia strip 1,200.00 3/16/2014 18:23
Dus, 10 strip @ 10
PT. Indofarma tss 112 4/23/2013 10:24
Box, 3 strips @ 10
Box, 3 strips @ 10
PT. Novapharin dus 10 X 10'S 211 3/15/2014 16:05
Dus, 10 strip @ 10
PT. Bernofarm kaptab 272 3/15/2014 16:05
PT. Holi Pharma Dus, Botol 60 ml 4,045.00 3/15/2014 16:05
PT. Novapharin btl @ 60 ml 2,445.00 4/23/2013 10:24
PT. Bernofarm Dus, 10 vial @ 1 g 5,100.00 3/15/2014 16:05
dus, 5 solostar pen
PT. Aventis Pharma @ 3ml 85,000.00 4/3/2014 21:30
Injeksi 100 IU/ml,

Flexpen disposible 3
PT. Ferron Par ml (1 box isi 5
Pharmaceuticals flexpen disposible) 106,000.00 4/3/2014 21:30
Dus, 5 Prefilled pen
PT. Bayer Indonesia @ 3 ml 102,990.00 4/27/2015 18:36
PT. Bayer Indonesia Penfill cartridge 97,500.00 3/18/2014 20:03

Injeksi 100 IU/ml,

Flexpen disposible 3
Pharmaceuticals flexpen disposible) 85,345.00 4/3/2014 21:30
PT. Ferron Par
Pharmaceuticals Dus, vial 10 ml 200,000.00 4/3/2014 21:30
dus, 5 solostar pen
PT. Aventis Pharma @ 3ml 79,165.00 3/18/2014 20:03
PT. Bayer Indonesia Penfill cartridge 79,167.00 3/18/2014 20:03
PT. AstraZeneca Dus, 2 blister @ 14
indonesia Tablet 32,000.00 4/3/2014 21:30
PT. Promedrahardjo Dus, 10 Strip@10
Farmasi Industri Tablet 75 3/15/2014 16:05
PT. Rama Emerald
Multi Sukses Boto 60 ml 2,100.00 3/15/2014 16:05
PT. Indofarma Dus, 25 tube @ 5 g 2,516.00 3/15/2014 16:05

DUS, 10 SUPP @ 2
PT. Kimia Farma GRAM 3,045.00 4/23/2015 15:45
PT. Kimia Farma ktk 10 x 10 tablet 520 3/15/2014 16:05

PT. Kimia Farma Btl 100 tablet 135 3/15/2014 16:05
Dus, 5 strip @ 10
PT. Meprofarm tablet 1,500.00 3/16/2014 18:23
PT. Kimia Farma Dus 6 amp @ 1ml 22,000.00 3/18/2014 20:03
Dus, 1 Vial @ 60 mg
PT. Pharma + 1 Ampul Pelarut
Laboratories @ 1 mL 38,999.00 4/27/2015 18:36
PT. Phapros, Tbk Dus @ 10 X 10 's 116 3/15/2014 16:05
PT. Mersifarma KOTAK @ 10 x 10
Tirmaku Mercusana TAB 148 9/28/2014 21:46
PT. Kimia Farma ktk
Dus10x10 tablet
10 strip x 10 159 3/15/2014 16:05
PT. Kimia Farma tab 95 3/18/2014 20:03
Dus, 10 strip @10
PT. Marin Liza
Farmasi Botol @ 100 tablet 48 3/15/2014 16:05
PT. Boehringer
Ingelheim Boks, 1 ampul 2,209,000.00 4/3/2014 21:30
dus, 10 blister @ 10
PT. Afifarma kapsul 158 4/23/2015 15:45
PT. Bernofarm kaptab ss 112 4/23/2013 10:24
PT. Sanbe Farma Strip 1,815.00 3/16/2014 18:23
Dus, 10 ampul @ 5
PT. Bernofarm ml 2,950.00 3/15/2014 16:05
PT. Novartis Dus, 1 vial plastik @
Indonesia 5ml 900,000.00 9/28/2014 21:46
PT. Sanbe Farma Tube 3,5 gram 24,750.00 3/16/2014 18:23
PT. Indofarma tablet 237 3/15/2014 16:05
PT. Kimia Farma ktk 10x10 tablet 345 3/15/2014 16:05
PT. Widatra Bhakti 10.000 UI/Vial 1,039,500.00 4/3/2014 21:30
PT. Zenith Dus 5 strip @ 10
Pharmaceuticals tablet 190 3/16/2014 18:23
PT Kalbe Farma strip 700 1/5/2015 14:07
Box @ 10 strip 10
PT. Pratapa Nirmala tab 352 4/23/2015 15:45
PT. Glaxo Wellcome Dus, 5 ampul @ 2.5
Indonesia ml 20,000.00 3/16/2014 18:23
PT. Ethica Industri
Farmasi 100 AMPUL @ 1 ML 1,350.00 4/23/2015 15:45
Dus, 10 strip @ 10
PT. Cendo Industri
Farmasi Botol 5ml 13,500.00 12/5/2014 22:08
PT. Cendo Industri
Farmasi Botol 5ml 13,500.00 12/5/2014 22:08
PT. Soho Industri
Pharmasi botol @ 60 ml 34,400.00 3/15/2014 16:05
PT. Kimia Farma ktk 2x10 tablet 4,500.00 3/15/2014 16:05
PT. Soho Industri
Pharmasi Strip 3,333.00 3/18/2014 20:03
PT. Rama Emerald
Multi Sukses Dus @ 50 gram 1,250.00 3/15/2014 16:05
PT. Phapros, Tbk Ds 10 vial x 1,2 Jt IU 9,800.00 4/23/2013 10:24
10 vial @ 2.400.000
PT. Phapros, Tbk IU 13,400.00 4/23/2013 10:24
PT. Abbott
Indonesia Vial 3,200,000.00 3/18/2014 20:03
Box/ 3 blister @ 10
PT. Combiphar Tablet 3,600.00 3/16/2014 19:08
PT. Kimia Farma Tube 5 gr 1,520.00 3/15/2014 16:05
PT. Sanbe Farma botol @ 5 ml 25,106.00 9/28/2014 21:46
PT. Boehringer
Ingelheim Dus, 1 vial @ 4 ml 4,803,697.00 9/28/2014 22:55
PT. Sanbe Farma Supp 6,045.00 3/16/2014 18:23
PT. Boehringer
Ingelheim 1 Box @ 6's 4,990.00 1/5/2015 14:07
Dus 10 blister @ 10
PT. Merck Tbk tablet 746 7/21/2014 21:09
PT. Pratapa Nirmala Box 3 X 10 tab 645 4/23/2013 10:24
PT Kalbe Farma Vial 304,000.00 7/21/2014 21:09
PT. Caprifarmindo Box 3 x 10'S 247,089.00 3/16/2014 19:08
PT. AstraZeneca Dus, 1 Turbuhaler
indonesia
PT Otsuka @ 100 dosis 93,000.00 4/3/2014 21:30
Indonesia Unit, 200 dosis 106,000.00 12/5/2014 22:08
PT. AstraZeneca Dus, 4 pak @ 5
indonesia respules @ 2 ml 8,900.00 4/3/2014 21:30
indonesia @ 120 dosis 117,600.00 3/16/2014 19:08
indonesia @ 605dosis
Dus, ampul @ 4 110,500.00 4/3/2014 21:30
PT. Dexa Medica ml 25,600.00 7/21/2014 21:08
PT. Pratapa Nirmala ampul 30,800.00 7/21/2014 21:09
PT. Boehringer Dus, 3 blister @ 10
Ingelheim kapsul 12,936.00 5/21/2014 20:01
PT. Boehringer Dus, 3 blister @ 10
Ingelheim kapsul 12,936.00 5/21/2014 20:01
PT. Tempo Scan
Pacific vial @ 20 ml 305,000.00 9/5/2014 23:17
PT. Novell
Pharmaeutical
Laboratories vial 275,000.00 7/21/2014 21:09
PT. Novartis Dus, 4 blister @ 7
Indonesia tablet 76,000.00 3/16/2014 19:08
PT. Sydna Farma Dus, Botol @ 500ml 2,600,000.00 4/3/2014 21:30
Dus, Botol @ 100
PT. Sydna Farma tablet 25,300.00 4/3/2014 21:30
PT. Novartis Dus, 10 vial @
Indonesia 500mg 112,000.00 4/3/2014 21:30
Dus, 100 ampul @ 1
PT. Indofarma ml 1,580.00 3/15/2014 16:05
PT. Merck Sharp Dus, 1 Blister @ 28
Dohme Pharma Tbk tablet 70,000.00 8/6/2014 18:35
PT. Ifars
Pharmaceutical
Laboratories Dus, tube @ 5 g 5,700.00 9/28/2014 21:46
Kotak, tube @ 15
PT. Dexa Medica gram 9,983.00 3/16/2014 19:30
PT. Kimia Farma Dus Tube 10 gram 9,818.00 4/23/2015 15:45
PT. Actavis Dus, 5 alubag @ 1
Indonesia tube @ 2,5ml 11,525.00 9/28/2014 21:46
Dus, 30 ampul @ 2
PT. Indofarma ml 4,180.00 3/15/2014 16:05
PT. Actavis Dus, 5 alubag @ 1
Indonesia tube @ 2,5ml 16,748.00 9/28/2014 21:46
Botol Plastik @ 100
PT. Kimia Farma tablet 45 1/5/2015 14:07
Dus, 10 blister @10
PT. Lucas Djaja ampul
Box @ @ 1 ml 2
5 ampul 1,054.00 3/15/2014 16:05
PT. Pratapa Nirmala mL 22,000.00 9/28/2014 21:46
PT. Yarindo
Farmatama Box 10 X 10 Tab 97 4/23/2013 10:24
Dus, 10 strip @ 10
PT. Tanabe
Indonesia 10 vial @ 50mg 127,667.00 3/18/2014 20:03
PT. Pratapa Nirmala Vial 5 mL 46,667.00 3/18/2014 20:03
PT. Tanabe 3 blister @ 10
Indonesia kapsul 3,667.00 3/18/2014 20:03
PT. Kimia Farma Btl 100 tablet 104 4/23/2013 10:24
PT. Cendo Industri
Farmasi botol 15 ml 37,500.00 4/3/2014 21:30
PT. Bayer Indonesia ampul 124,955.00 9/28/2014 21:46
PT. Dipa Pharmalab ampul @ 5 ml 26,700.00 7/21/2014 21:09
Dus, 5 blister @10's
PT. Pfizer Indonesia tab 3,480.00 3/16/2014 18:23
Dus, 5 blister @10's
PT. Pfizer Indonesia tab 5,480.00 3/16/2014 18:23
PT. Yarindo Box @ 10 strip 10
Farmatama kapsul 270 1/5/2015 14:07
PT. Actavis
Indonesia Dus, 1 vial @ 10 mg 55,500.00 3/16/2014 18:23
PT. Actavis
Indonesia Dus, 1 vial @ 50 mg 274,125.00 3/16/2014 18:23
PT. Novapharin dus 10 X 10'S 167 4/23/2013 10:24
PT. Bernofarm Dus, botol @ 10 ml 15,600.00 3/15/2014 16:05
PT. Dipa Pharmalab ampul @ 5 ml 9,840.00 7/21/2014 21:09
Dus, 1 vial @0,5 ml+

1 vial pelarut @1,5
PT. Sanbe Farma ml 970,200.00 4/3/2014 21:30
PT. Kimia Farma Dus @ 5 vial 455,000.00 8/6/2014 18:35
PT. SmithKline
Beecham Dus, Botol Plastik @
Phamaceuticals 30 Tablet 7,100.00 3/18/2014 20:03
PT. Kimia Farma Botol 30 tab 6,375.00 6/16/2014 19:59
PT. Bernofarm Ampul @ 1 ml 12,990.00 7/21/2014 21:08
Dus, 2 blister @ 15
PT. Pfizer Indonesia tablet 42,600.00 4/3/2014 21:30
dus, 2 prefilled
PT. Aventis Pharma syringe @ 0,2 ml 40,740.00 3/18/2014 20:03
dus, 2 prefilled
dus, 2 prefilled
PT. Phapros, Tbk Dus @ 30 Ampul 8,100.00 3/15/2014 16:05
PT Kalbe Farma Vial @ 25 ml 500,000.00 3/16/2014 18:23
PT. Sanbe Farma Dus, 1 vial @5 ml 128,000.00 4/3/2014 21:30
PT. Gracia Dus 3 strip @ 10
Pharmindo Flash tablet 650 3/16/2014 19:08
PT. Gracia Dus, Botol Plastik @
Pharmindo 100 mL 8,000.00 4/3/2014 21:30
PT. Kimia Farma ktk 10 x 10 kapsul 497 4/23/2013 10:24
PT. Indofarma kss 930 4/23/2013 10:24
PT. Phyto Kemo
Agung Farma Botol @60 ml 7,700.00 3/15/2014 16:05
vial/ampul (Prefilled
PT Kalbe Farma Syringe) 275,000.00 9/28/2014 21:46
PT. Soho Industri Dus, 6 prefilled
Pharmasi syrenge @ 0.5 ml 133,875.00 9/28/2014 21:46
Prefilled Syringe @
PT Kalbe Farma 1ml 128,000.00 5/21/2014 20:01
PT. Boehringer
Ingelheim Boks, 6 ampul 139,500.00 4/3/2014 21:30
Dus, 10 strip @ 10
PT. Indofarma tss 451 4/23/2013 10:24
PT. Merck Sharp Dus, botol @ 100
Dohme Pharma Tbk tablet 1,360.00 8/6/2014 18:35
PT. Merck Sharp Dus, 1 blister @ 1
Dohme Pharma Tbk subdermal implant 128,779.00 3/24/2014 14:34
PT. Combiphar Vial 100mg/5ml 100,000.00 3/16/2014 18:23
PT. Kimia Farma Botol 10 ml 16,667.00 3/18/2014 20:03
Dus, 1 vial @ 1000

IU+ 1 vial pelarut @
PT. Graha Farma 10ml 8,500,000.00 4/27/2015 18:36
Dus, 1 vial @ 500
IU+ 1 vial pelarut @
PT. Graha Farma 5ml 4,423,500.00 4/27/2015 18:36
PT. Graha Farma Dual, vial 500 IU 4,400,000.00 12/11/2014 2:12
Dus, vial @ 250 IU+

1 vial pelarut @10
mL+ transfer
PT. Graha Farma needle+swab 2,095,000.00 4/23/2015 15:45
KOTAK @ 1 VIAL
PT. Ferron Par SERBUK OBAT &
Pharmaceuticals INFUSION KIT 9,200,000.00 4/3/2014 21:30
PT. Kimia Farma vial 1,133,000.00 9/28/2014 21:46
PT. Dipa Pharmalab Vial/ampul 990,000.00 1/5/2015 14:07
PT. Dipa Pharmalab vial 2,150,000.00 9/28/2014 21:46
PT. Mersifarma
Tirmaku Mercusana KOTAK @ 10 ampul 20,250.00 3/15/2014 16:05
PT. Ikapharmindo Botol @ 100 133 4/23/2013 10:24
PT. Mersifarma
Dus, 10 strip @ 10
PT. Hexpharm Jaya Dus, 3 strip @ 10
Laboratories kapsul 1,075.00 3/18/2014 20:03
Laboratories kapsul 1,375.00 3/18/2014 20:03
PT. Actavis
Indonesia Dus 45 x 12 tab 235 4/3/2014 21:30
PT. Phapros, Tbk Ds 10 str x 10's 510 9/28/2014 21:46
PT. Phapros, Tbk 10 X 10 290 1/5/2015 14:07

PT. Boehringer
Ingelheim Box, canister 10mL 72,900.00 8/6/2014 18:35
PT. Boehringer Dus, Canister 200
Ingelheim dosis 117,500.00 4/3/2014 21:30
PT. Kimia Farma Dus 5 ampul@ 10ml 128,000.00 3/18/2014 20:03
PT. Kimia Farma Dus 5 ampul@ 2ml 33,914.00 3/18/2014 20:03
PT. Kimia Farma Dus @ 5 patch 80,000.00 4/3/2014 21:30
PT. Kimia Farma Dus@ 5 patch 153,000.00 3/18/2014 20:03
PT. Kimia Farma Dus@ 5 patch 285,000.00 3/18/2014 20:03
PT Kalbe Farma pfs @ 0,5 ml 375,000.00 3/16/2014 18:23
Box, isi 3 Strip @ 10
PT. Combiphar tab 2,950.00 7/21/2014 21:09
PT. Marin Liza Botol @ 100 tablet
Farmasi salut gula 634 4/23/2013 10:24
PT. Phapros, Tbk dus @ 30 ampul 3,417.00 8/6/2014 18:35
PT. Aventis Pharma Dus, 5 vial @ 50 mg 1,248,319.00 4/3/2014 21:30
Dus, 4 blister @ 5
PT. Aventis Pharma tablet salut selaput 275,000.00 4/3/2014 21:30
PT. Mersifarma
Tirmaku Mercusana Dus, 5 ampul @ 1ml 55,000.00 3/16/2014 19:08
PT. Novell
Pharmaeutical
Laboratories Botol 38,000.00 3/15/2014 16:05
PT. Pfizer Indonesia Blister 4,862.00 9/28/2014 21:46
PT. Kimia Farma ktk 1 x 10 kapsul 22,000.00 3/15/2014 16:05
PT. Gracia
Pharmindo strip 419 3/16/2014 18:23
PT. Dexa Medica DUS, 30 TABLET 410 3/16/2014 18:23
PT. Sanbe Farma botol @ 5 ml 30,493.00 9/28/2014 21:46
PT Kalbe Farma vial @ 1 ml 24,500.00 3/16/2014 18:23
PT. Ifars
Pharmaceutical
Laboratories Dus, Tube 5 g 2,400.00 3/16/2014 18:23
PT. Glaxo Wellcome Dus, Botol 120
Indonesia Dosis Spay 93,333.00 3/18/2014 20:03
Dus, 2 flow wrap@

PT. Glaxo Wellcome 5 nebules @ 1 dosis
Indonesia (2ml) 12,917.00 3/18/2014 20:03
PT. Glaxo Wellcome
Indonesia Dus, 2 pfs 0.5 ml 241,667.00 3/18/2014 20:03
PT. Dipa Pharmalab dus, vial @ 250 ml 972,000.00 8/6/2014 18:35
Dus, 25 ampul @ 2
PT. Indofarma ml 1,829.00 4/23/2013 10:24
Dus, 10 strip @ 10
PT. Bayer Indonesia Prefilled Syringe 275,000.00 8/6/2014 18:35
PT. Bayer Indonesia Prefilled Syringe 412,500.00 8/6/2014 18:35
PT. Bayer Indonesia Prefilled Syringe 2,570,000.00 8/6/2014 18:35
PT. Boehringer
Ingelheim Boks, 1 ampul 399,500.00 4/3/2014 21:30
PT. Rama Emerald

Multi Sukses Kotak 100 Shachet 285 3/15/2014 16:05
indonesia tablet 295,000.00 4/3/2014 21:30
PT. Indofarma kapsul 289 4/23/2013 10:24
PT. Indofarma kaptab 679 4/23/2013 10:24
PT. Bayer Indonesia vial
Dus, 1 vial @200 1,098,900.00 3/16/2014 18:23
PT. Sanbe Farma mg
Dus, 5 ampul @ 2 330,000.00 4/3/2014 21:30
PT. Indofarma ml 3,399.00 4/23/2013 10:24
PT. Erela Tube @ 3,5 gr 2,600.00 3/16/2014 18:23
Dus, botol plastik 5
PT. Indofarma ml 3,194.00 3/15/2014 16:05
PT. Indofarma kaptab 56 3/15/2014 16:05
PT. Tempo Scan
Pacific Strip 235 3/16/2014 18:23
Dus, 6 strip @ 10
PT. Pradja Pharin tablet lepas lambat 638 4/3/2014 21:30
PT. Darya Varia Box, 30 Tablet 5,500.00 12/5/2014 22:08
Dus, 10 Strip @ 10
Dus, botol@TAB
PT. Pfizer Indonesia 10MG 30 3,207.00 1/5/2015 14:07
Dus, botol@TAB
PT. Pfizer Indonesia 10MG 31 3,000.00 1/5/2015 14:07
PT. Tempo Scan 1 box isi 5 ampul 10
Pacific ml 119,900.00 4/28/2015 11:39
PT. Kimia Farma Dus 10x10 1,493.00 4/3/2014 21:30
PT. Kimia Farma Dus 10x10 2,171.00 4/3/2014 21:30
PT. Actavis
Indonesia Btl @ 30 tablet 1,500.00 3/18/2014 20:03
PT. Lucas Djaja Glycerin 100 ml 5,333.00 3/18/2014 20:03
PT. Widatra Bhakti botol @ 500 ml 5,700.00 4/23/2013 10:24
PT. Widatra Bhakti botol @ 500 ml 5,200.00 4/23/2013 10:24
PT. AstraZeneca Dus, 1 syringe @
indonesia 10.8 mg 2,300,000.00 4/3/2014 21:30
indonesia 3.6 mg 840,000.00 4/3/2014 21:30
PT. Soho Industri
Pharmasi Dus 5 Ampul@1mL 83,333.00 3/18/2014 20:03
PT. Mersifarma
PT. Mersifarma
Tirmaku Mercusana BOTOL @ 15 ML 16,500.00 10/24/2014 21:14
PT. Dexa Medica Botol 641,500.00 3/18/2014 20:03
PT. Pratapa Nirmala vial 42,900.00 7/21/2014 21:09
Dus, 1 syringe @
PT. Dipa Pharmalab 0.5 mL 1,328,000.00 5/22/2014 14:25
PT. Marin Liza
Farmasi tube @ 5 ml 2,570.00 4/23/2013 10:24
PT. Kimia Farma Tube 5 gr 2,798.00 4/23/2013 10:24
PT. Dipa Pharmalab vial 5,400.00 9/28/2014 21:46
PT. Otto
Pharmaceuticals box 5ampul @1 ml 4,500.00 3/18/2014 20:03
PT. Cendo Industri
Farmasi Botol 5ml 18,000.00 12/5/2014 22:08
PT. Ferron Par
PT. Bayer Indonesia Dus, vial 10 ml 138,000.00 4/3/2014 21:30
Injeksi 100 IU/ml,

penfill disposible 3
Pharmaceuticals penfill disposible) 76,125.00 4/3/2014 21:30
Dus Isi 5
penfill/cartridge @
PT. Bayer Indonesia 3ml 76,125.00 4/3/2014 21:30
penfillcartridge @
PT. Sanbe Farma 3ml 75,000.00 4/3/2014 21:30
PT. Aventis Pharma Dus, 1 Vial @ 5 ml 72,000.00 4/13/2015 15:52

Injeksi 100 IU/ml,

Dus Isi 5
penfill/cartridge @
PT. Ferron Par

Injeksi 100 IU/ml,

penfill cartridge @
PT. Sanbe Farma 3ml 75,000.00 4/3/2014 21:30
Dus Isi 5
penfill/cartridge @
PT. Ferron Par

PT. Dexa Medica Prefilled syringe 170,000.00 8/6/2014 18:35
PT. Indofarma Dus, botol 60 ml 3,499.00 3/15/2014 16:05
PT. Indofarma Dus, botol 60 ml 4,499.00 4/23/2013 10:24
PT. Yarindo
Farmatama botol @ 100 tablet 110 4/23/2013 10:24
Dus, 10 strip @ 10
PT. Mugi
Laboratories Dus, 1 vial @ 1 g 1,329,163.00 4/3/2014 21:30

Indonesia tablet salut selaput 211,000.00 9/28/2014 22:55
Indonesia tablet
Dus, botol @ 100 2,120.00 3/18/2014 20:03
PT. Dipa Pharmalab ml 350,000.00 4/3/2014 21:30
PT. Dipa Pharmalab Dus, vial @ 30 ml 122,000.00 5/21/2014 10:06
PT. Dipa Pharmalab Dus,
Dus, vial @@
botol 50100
ml 166,000.00 4/3/2014 21:30
PT. Dipa Pharmalab ml 369,000.00 4/3/2014 21:30
PT. Bayer Indonesia Botol 245,000.00 4/3/2014 21:30
PT. Boehringer
Ingelheim Box, canister 10mL 80,000.00 8/6/2014 18:35
PT. Boehringer
Ingelheim Box, bottle 20mL 90,000.00 12/5/2014 22:08
Dus, 5 blister @ 10
PT. Indofarma kss 1,425.00 3/15/2014 16:05
Dus, 5 blister @ 10
PT. Indofarma kss 2,470.00 3/15/2014 16:05
PT. Sanbe Farma Dus, 1 vial @2 ml 510,000.00 4/3/2014 21:30
PT. Pratapa Nirmala Botol 100 mL 270,000.00 9/28/2014 21:46
PT. Phyto Kemo
Agung Farma Botol 100 tablet 65 9/28/2014 21:46
PT. Phyto Kemo
Agung Farma Botol 100 tablet 158 9/28/2014 21:46
PT. Pratapa Nirmala vial 33,000.00 7/21/2014 21:09
Dus, 10 strip @ 10
Dus, 5 strip @ 10
PT. Kimia Farma tablet 189 1/5/2015 14:07
PT. Tempo Scan
Pacific Strip 694 3/16/2014 18:23
Dus, 10 strip @ 10
PT. Merck Tbk tablet 1,580.00 4/3/2014 21:30
PT. Tempo Scan
Pacific Vial 50 mg/5 ml 82,000.00 7/21/2014 21:09
PT. Ethica Industri
Farmasi Ampul 7,800.00 4/3/2014 21:30
Dus,10 Strip @ 10
PT. Afifarma tablet 70 9/28/2014 21:46
PT. Novell
Pharmaeutical
Laboratories kantong 5 g 7,700.00 9/28/2014 21:46
PT. Hexpharm Jaya
Dus, 3 Blister @ 10
PT. Dexa Medica tablet 4,900.00 3/15/2014 16:05
Dus, 3 Blister @ 10
PT. Boehringer
Ingelheim Boks, 120 tablet 27,500.00 4/3/2014 21:30
Dus, 10 strip @ 10
Dus, 10 strip @10
PT. Errita Pharma tablet 80 3/15/2014 16:05
Dus, 10 strip @ 10
PT. Novartis Dus, botol @ 120
Indonesia ml 44,770.00 3/16/2014 19:30
PT. Nicholas
Laboratories Dus,botol 100
Indonesia tablet 875 4/3/2014 21:30
PT. Lucas Djaja Fenol 100 mg / 1 ml 2,042.00 3/18/2014 20:03

PT. Tempo Scan
Pacific vial @ 15 ml 190,000.00 9/5/2014 23:17
PT. Tempo Scan
Pacific vial @ 45 ml 408,000.00 9/5/2014 23:17
PT Kalbe Farma strip 1,360.00 9/28/2014 21:46
PT. Guardian
Pharmatama Vial @ 10 ml 110,000.00 3/16/2014 18:23
Box, isi 1 vial @ 10
PT. Combiphar ml 60,300.00 7/21/2014 21:09
PT. Kimia Farma tube 10 gr 2,569.00 4/23/2013 10:24
PT. Hexpharm Jaya
Laboratories tube 5 gr 2,850.00 4/23/2013 10:24
PT. Novell
Pharmaeutical Box isi 1 Tube @ 15
Laboratories g 4,700.00 4/23/2013 10:24
PT. Ikapharmindo Botol 80 ml 28,000.00 9/28/2014 21:46
Dus, 5 Strip @ 10
PT. Dexa Medica tablet 300.00 4/23/2013 10:24
PT. Kimia Farma dus 2 's @ 10 supp 2,722.00 7/21/2014 21:09
PT. Ifars
Pharmaceutical Dus, 3 Strip @ 10
Laboratories Kaplet salut selaput 3,200.00 3/16/2014 18:23
Dus, 5 blister @ 10
Dus, 5 blister @ 10
Dus, 10 Strip @ 10
PT. Boehringer Box, 10 ampoules
Ingelheim @ 1mL 30,600.00 8/6/2014 18:35
PT. Kimia Farma Ktk 10X10 TAB 184 4/23/2013 10:24
Laboratories tab 3,400.00 3/15/2014 16:05
Box isi 24 tube @
PT. Bufa Aneka 15 gram 3,524.00 4/23/2015 15:45
PT. Erela Tube @ 5 gram 1,600.00 4/23/2013 10:24
PT. Sanbe Farma vial 7,260.00 1/5/2015 14:07
PT. Bernofarm Botol @ 60 ml 3,680.00 4/23/2013 10:24
PT. Rama Emerald kotak,10strip@10
Multi Sukses tablet 51 4/23/2015 15:45
PT. Mersifarma
Tirmaku Mercusana Kotak @ 10 x 10 tab 144 1/5/2015 14:07
PT. Phapros, Tbk 10 X 10 68 1/5/2015 14:07
Tirmaku Mercusana TAB 5,000.00 4/3/2014 21:30
PT. Kimia Farma ktk 10x10 tablet 1,100.00 4/23/2013 10:24
PT. Pratapa Nirmala Btl @ 30 kapsul 2,500.00 9/28/2014 21:46
PT. Pratapa Nirmala Box @ 3 strip 10 tab 3,950.00 4/23/2015 15:45
PT. Fresenius Kabi Botol Plastik @ 500
Combiphar ml 33,000.00 7/21/2014 21:09
PT. Boehringer
Ingelheim 1 dus @ 20 vial 5,990.00 1/5/2015 14:07
PT. Triyasa
Nagamas Farma Vial 5,350.00 12/5/2014 22:08
PT. Galenium
Pharmasia
Laboratories Botol @ 60 ml 12,450.00 3/16/2014 19:08
Dus, 100 Sachet @
PT. Erela 30 Tablet 42 3/15/2014 16:05
PT. Kimia Farma 1 sase @30 tablet 50 3/15/2014 16:05

PT. Cendo Industri
Farmasi botol 15 ml 15,750.00 4/3/2014 21:30
Dus, botol plastik @

PT. Novartis 30 tablet salut
Indonesia selaput 8,900.00 4/3/2014 21:30
PT. Abbott
Indonesia botol @ 120 tablet 6,100.00 8/6/2014 18:35
PT. Glaxo Wellcome Dus, Botol 120
Indonesia Dosis 90,667.00 3/18/2014 20:03
PT. Glaxo Wellcome Dus, foil strip @ 60
Indonesia dosis 100,833.00 3/18/2014 20:03
PT. Glaxo Wellcome Dus, foil strip @ 60
Indonesia dosis 113,333.00 3/18/2014 20:03
Dus, 100 blister @
PT. Kimia Farma 28 tablet 2,089.00 1/5/2015 14:07
Dus, 10 strip @ 10
PT. Holi Pharma kaptab 149 3/15/2014 16:05
PT. Lucas Djaja Botol @ 60 ml 2,145.00 3/15/2014 16:05

PT. Kimia Farma ktk 60 tablet 670 4/23/2013 10:24
PT. Kimia Farma ktk 100 amp @ 2 ml 6,200.00 4/23/2013 10:24
PT. Kimia Farma Botol 60 tablet 1,400.00 4/23/2013 10:24
PT. Takeda
Indonesia Serbuk vial 82,042.00 4/3/2014 21:30
Dus, 2 strip @ 10
PT. SmithKline
Beecham Dus, 7 Blister @ 10
Phamaceuticals tablet 67,200.00 3/18/2014 20:03
PT. Finusolprima
Farma Internasional botol 500 ml 56,300.00 4/3/2014 21:30
PT Otsuka
Indonesia Softbag 500 ML 56,300.00 3/18/2014 20:03
PT Otsuka
PT Otsuka Double Chamber
PT Otsuka Double Chamber
PT Kalbe Farma botol 500 mL 75,350.00 4/3/2014 21:30

PT. Fresenius Kabi
Combiphar Botol Gelas 100 ml 36,667.00 4/14/2014 9:16
PT. Fresenius Kabi

PT Otsuka
PT Otsuka
PT. Fresenius Kabi
PT. Finusolprima
PT. Finusolprima
PT. Fresenius Kabi Bag (3 Chamber)

Combiphar 1440 ml 295,240.00 4/14/2014 9:16
PT. Fresenius Kabi Bag (3 Chamber)

Combiphar 1920 ml 343,842.00 4/14/2014 9:16
Bag Double
chamber (Dua
compartement),
PT. Phapros, Tbk 1000 mL 322,000.00 4/3/2014 21:30
Bag Double
chamber (Dua
compartement),
PT. Phapros,
PT Otsuka Tbk 1000 mL 218,700.00 4/3/2014 21:30
Indonesia Ampoel 25 ML 2,050.00 3/18/2014 20:03
PT. Widatra Bhakti Botol 1000 ml 8,000.00 4/3/2014 21:30
PT Otsuka Plastic Bottle 500
Indonesia ML 9,000.00 4/3/2014 21:30
Indonesia ML 9,000.00 4/3/2014 21:30
PT Kalbe Farma flexybag 250 mL 87,000.00 4/3/2014 21:30

LDPE (Low Density
Poly Ethilene), botol
PT. Phapros, Tbk plastik 12,650.00 4/3/2014 21:30
PT Kalbe Farma Flexy bag 500 mL 42,350.00 4/3/2014 21:30

Indonesia ML 29,167.00 3/18/2014 20:03

Indonesia ML 55,500.00 4/12/2014 17:56

Botol Plastik 1000
PT Kalbe Farma mL 210,000.00 5/21/2014 20:01
Botol Plastik 1000
PT Kalbe Farma mL 199,000.00 4/3/2014 21:30
PT. Sanbe Farma softbag 500ml 35,750.00 4/3/2014 21:30

Indonesia ML 9,167.00 3/18/2014 20:03
Indonesia ML 10,000.00 4/3/2014 21:30
Indonesia ML 10,000.00 4/3/2014 21:30
20%, Botol Kaca
@100 ml, single
PT. Phapros, Tbk bottle 105,500.00 4/3/2014 21:30
PT. Fresenius Kabi
20%, Botol Kaca

@250 ml, single
PT. Phapros, Tbk bottle 210,000.00 4/3/2014 21:30
Bag, 3 chamber ( 3
kompartemen),
PT. Phapros, Tbk 1250 ml 591,000.00 4/3/2014 21:30
Bag, 3 chamber ( 3
kompartemen),
PT. Phapros, Tbk 1250 ml 511,000.00 4/3/2014 21:30
Bag, 3 chamber ( 3
kompartemen), 625
PT. Phapros, Tbk ml 358,000.00 4/3/2014 21:30
PT. Cendo Industri
Farmasi strip 5 x 0.6 ml 72,000.00 4/3/2014 21:30
PT. Pfizer Indonesia dus, Botol @ 2,5 ml 127,000.00 8/6/2014 18:35
Dus, 1 vial @ 263

mcg + 1 prefilled
syringe pelarut @ 1
PT. Aventis Pharma ml 550,000.00 8/6/2014 18:35
PT. Takeda
Indonesia Vial 700,000.00 4/3/2014 21:30
PT. Takeda
Indonesia Vial 2,700,000.00 4/3/2014 21:30
PT. Takeda
Indonesia Vial 500,000.00 9/28/2014 21:46
PT. Infion Box, 1 Botol @ 100
Pharmaceutical ml 40,000.00 3/15/2014 16:05
PT. Erela Btl @ 5 ml 13,068.00 9/28/2014 21:46
Dus 4 blister @ 25
Dus 4 blister @ 25
PT. Merck Tbk tablet 637.5 4/28/2015 11:14
Dus, 100 ampul @ 2
PT. Bernofarm ml 839 3/15/2014 16:05
Dus, 30 ampul @ 2
PT. Indofarma ml 1,363.00 4/23/2013 10:24
indonesia 10 g 40,000.00 4/3/2014 21:30
PT. AstraZeneca Dus,Botol @ 50 ml
indonesia (500 dosis) 142,000.00 9/28/2014 21:46
PT. Novell
Pharmaeutical Box ,3 Strip @ 10
Laboratories tablet 600 4/23/2013 10:24
PT. Novell
PT. Ifars
Laboratories Tablet 89 4/23/2013 10:24
PT. Novell
Pharmaeutical
Laboratories ampul 52,000.00 7/21/2014 21:09
PT Otsuka Dus, 120 ampul
Indonesia plastik @ 25 ml 2,800.00 4/28/2015 11:14
PT Otsuka Dus, 120 ampul
Indonesia plastik @ 25 ml 3,500.00 4/28/2015 11:14
PT. Finusolprima
PT. Soho Industri
Pharmasi Strip 1,200.00 3/16/2014 18:23
PT. Kimia Farma Dus @ 5 vial 473,000.00 8/6/2014 18:35
PT. Taisho
Pharmaceutical Dus,24 Catch @ 1
Indonesia Tbk tablet 7,140.00 3/18/2014 20:03
Dus, 10 blister @10
PT. Pfizer Indonesia tablet 6,125.00 12/5/2014 22:08
PT. Glaxo Wellcome Box, Tablet 2
Indonesia mg/25's 12,210.00 4/3/2014 21:30
PT. Bernofarm Dus, 1 vial @ 1 g 54,000.00 3/15/2014 16:05
PT. Bernofarm Dus, 1 vial @ 0,5 g 44,960.00 7/21/2014 21:08
PT. Mugi
Laboratories Dus, 15 Ampul 74,998.00 4/3/2014 21:30
PT. Kimia Farma Botol 1000 ml 254,100.00 3/18/2014 20:03
PT. Bernofarm tablet 112.5 4/23/2013 10:24
PT. Bernofarm kaptab 197.5 4/23/2013 10:24
PT. Actavis Dus, 10 Strip @ 10
Indonesia tablet salut selaput 800 9/28/2014 21:46
ktk 10 x 10 tablet
PT. Kimia Farma salut 154 4/23/2013 10:24
PT. Ethica Industri
Farmasi ampul @ 1 ml 2,750.00 1/5/2015 14:07

PT. Novartis 30 kapsul pelepasan
Indonesia lambat 6,537.00 4/3/2014 21:30
Dus, 1 Vial @125mg

+ 1 ampul pelarut
PT. Dexa Medica @ 2ml
Dus, 1 vial @ 500 19,500.00 7/21/2014 21:08
PT. Bernofarm mg 89,990.00 7/21/2014 21:08
PT. Mahakam Beta
Farma Strip 635 4/23/2013 10:24
PT. Natura Dus, 10 Blister @ 10
Laboratoria Prima Tablet 205 4/23/2013 10:24
Dus, 10 Blister @ 10
PT. Meprofarm Dus, Botol 10 ml 5,280.00 9/28/2014 21:46
PT. Molex Ayus BOTOL 60 ML 2,600.00 9/28/2014 21:46
PT. Sandoz Box 10 ampul @ 1
Indonesia ml 21,120.00 9/28/2014 21:46
PT. Sandoz Box, bottle @ 50
Indonesia tab 1,680.00 9/28/2014 21:46
PT. Natura Dus, 1 Botol @ 100
Laboratoria Prima ml 9,950.00 4/23/2013 10:24
PT. Kimia Farma dus 1 's @ 5 ovula 3,850.00 9/28/2014 21:46
PT. Ifars
Pharmaceutical
Laboratories Dus, botol 60ml 4,100.00 4/23/2015 15:45
Dus, 2 blister @ 5
PT. Aventis Pharma suppositoria 3,220.00 3/16/2014 18:23
PT. Phyto Kemo
Agung Farma 10 strip @ 10 tab 110 4/23/2013 10:24
PT. Phyto Kemo
Agung Farma 10 strip @ 10 tab 160 4/23/2013 10:24
PT. Kimia Farma vial 1,925,000.00 9/28/2014 21:46
PT. Kimia Farma Dus @ 5 vial 1,237,500.00 5/21/2014 20:01
PT. Boehringer
Ingelheim Boks 10 amp 6,119.00 3/16/2014 18:23
PT. Boehringer
Ingelheim Boks 5 amp 12,060.00 3/16/2014 18:23
PT. Combiphar Dus,1 vial@50mg 260,000.00 4/3/2014 21:30
PT. Boehringer
PT. Kimia Farma Tube 10 gram 3,000.00 4/23/2013 10:24
PT. Widatra Bhakti 10 mg /Vial 697,000.00 4/3/2014 21:30
PT. Phapros, Tbk Btl @ 500 ml 72,000.00 9/28/2014 21:46
PT. Tempo Scan botol, tetes mata 3
Pacific ml 77,000.00 4/3/2014 21:30
PT. Guardian
Pharmatama tube 10 gram 17,820.00 3/15/2014 16:05
PT. Kimia Farma Dus 10 amp @ 1 ml 8,400.00 3/18/2014 20:03
PT. Mahakam Beta Dus, 6 strip @ 10
Farma tablet 15,620.00 4/3/2014 21:30
PT. Mahakam Beta Dus, 6 strip @ 10
Farma tablet 22,990.00 4/3/2014 21:30
PT. Pratapa Nirmala Box @ 5 ampul 13,200.00 9/28/2014 21:46
PT. Glaxo Wellcome Dus, 5 blister @ 2
Indonesia pfs 0.3 ml 54,144.00 3/18/2014 20:03
Indonesia pfs 0.4 ml 66,640.00 3/18/2014 20:03
Indonesia pfs
Dus,0.6 ml
5 Ampul @ 94,962.00 3/18/2014 20:03
PT. Pratapa Nirmala 2ml 61,600.00 3/16/2014 18:23
PT Otsuka
Indonesia Ampoel 25 ML 6,200.00 3/18/2014 20:03
PT. Novell
Pharmaeutical Box ,5 Blister @ 10
PT. Combiphar Botol, 45 ml 33,900.00 5/21/2014 20:01
PT. Molex Ayus Tube 5 gr 6,490.00 3/16/2014 18:23
PT. Pharma Health Box, isi 5 ampul @ 1
Care ml 9,500.00 7/21/2014 21:09
PT. Kimia Farma btl 60 tablet 2,800.00 4/23/2013 10:24
PT. Bayer Indonesia blister 2,999.00 3/16/2014 18:23
Dus, 10 Strip @ 10
PT. Dexa Medica tablet salut selaput 100 3/15/2014 16:05
PT. Pratapa Nirmala Box @ 1 vial 66,000.00 4/23/2015 15:45
PT. Dexa Medica ampul 52,000.00 7/21/2014 21:09
PT. Phapros, Tbk Paket 359,900.00 4/23/2013 10:24
PT. Indofarma Paket 1,199,990.00 4/23/2013 10:24
PT. Phapros, Tbk Paket 214,900.00 4/23/2013 10:24
PT. Indofarma Paket@84 tablet 160,000.00 4/23/2013 10:24
Dus, 1 dus @ 60
blister @ 8 tablet
tahap intensif
kategori 1 + 1 Dus
@ 54 blister @ 3
tablet tahap
PT. Indofarma lanjutan kategori 1 288,199.00 4/23/2013 10:24
Dus, 60 sachet
tahap intensif @ (1
tablet Isoniazid, 2
kapsul Rifampicin, 2
tablet
Pyrazinamide) + 120
sachet tahap
lanjutan @ (1 tablet
Isoniazid, 2 kapsul
PT. Indofarma Rifampicin) 171,195.00 4/23/2013 10:24
PT. Pratapa Nirmala Box @ 5 ampul 80,000.00 9/28/2014 21:46
PT Kalbe Farma Btl @ 5 ml 48,500.00 1/5/2015 14:07
PT. Novell
PT. Novell
PT. Aventis Pharma Dus, 1 vial @ 20 ml 1,100,000.00 9/5/2014 23:17
PT. Aventis Pharma Dus, 1 vial @ 10 ml 550,000.00 9/5/2014 23:17
PT. Merck Tbk botol @ 10 ml 27,550.00 3/16/2014 18:23
PT. Merck Tbk botol 15 ml 29,000.00 4/23/2015 15:45
PT. Ethica Industri
Farmasi ampul @ 1 ml 2,200.00 9/28/2014 21:46
Dus, vial @ 355m +

1 prefilled syringe
PT. Novartis pelarut @ 2,5 ml + 2
Indonesia jarum suntik 2,950,000.00 4/3/2014 21:30
PT. Bayer Indonesia Vial 120,000.00 5/21/2014 20:01
PT. Tempo Scan botol, tetes mata 5
Pacific ml 68,000.00 9/6/2014 1:27
PT. Natura
Laboratoria Prima Dus, 1 Vial @ 40 mg 36,000.00 3/15/2014 16:05
PT. Novapharin dus
Dus,10 X 3'S @
5 Ampul 211 4/23/2013 10:24
PT. Indofarma 2ml 2,400.00 3/15/2014 16:05
PT. Yarindo
Farmatama Box 3 X 10 Tab 716 3/15/2014 16:05
PT. Yarindo
Farmatama Box 3 X 10 Tab 1,189.00 3/15/2014 16:05
Transfer Set: Set;

Ultaclam: Kantong
Plastik; Tenckoff
Catheter: Box;
Titanium Adaptor:
PT Kalbe Farma Kantong Plastik 1,902,240.00 3/15/2014 16:14
PT Kalbe Farma Set 219,540.00 3/15/2014 16:14
Larutan Dialisa 1.5

%: 2.000 ml;
Larutan Dialisa 2.5
%: 2.000 ml;
Larutan Dialisa 4.25
%: 2.000 ml;
Minicap: Kantong
PT Kalbe Farma Plastik 5,522,580.00 3/16/2014 19:49
PT. Actavis Vial 6mg/ml
Indonesia (100mg/16.67ml) 984,000.00 9/5/2014 23:17
Indonesia (260mg/43.33ml) 3,000,000.00 9/5/2014 23:17
Indonesia (30mg/5ml) 274,560.00 9/5/2014 23:17
PT. Indofarma Dus, 15 botol 5,200.00 5/20/2014 18:46
PT. Afifarma botol 60 ml 1,438.00 4/23/2013 10:24
PT. Imfarmind Dus, 10 strip @ 10
Farmasi industri kaptab 89 4/23/2013 10:24
PT. Ifars
Pharmaceutical
Laboratories Dus, botol @ 15 ml 6,450.00 7/21/2014 21:09
PT. Boehringer
Ingelheim Boks, 1 pfs 1,077,815.00 3/16/2014 19:08
PT. Boehringer
Ingelheim Boks, 1 pfs 1,248,220.00 3/16/2014 19:08
Dus, 1 vial 100 mcg

+ 1 ampul pelarut
PT. Merck Sharp 0,7 ml + 1 syringe +
Dohme Pharma Tbk 2 jarum 973,500.00 4/3/2014 21:30
Dus, 1 prefilled
syringe (serbuk
injeksi 120mcg +
PT. Merck Sharp pelarut 0.5 ml) + 1
Dohme Pharma Tbk jarum 1,135,000.00 4/3/2014 21:30
Dus, 1 vial 50 mcg +

1 ampul pelarut 0,7
PT. Merck Sharp ml + 1 syringe + 2
Dohme Pharma Tbk jarum 915,000.00 8/6/2014 18:35
Dus, 1 vial 80 mcg +

1 ampul pelarut 0,7
PT. Merck Sharp ml + 1 syringe + 2
Dohme Pharma Tbk jarum 915,810.00 4/3/2014 21:30
PT. Darya Varia tube @ 35 gram 23,000.00 7/21/2014 21:09

30 tablet salut
PT. Pradja Pharin selaput 2,420.00 4/3/2014 21:30
PT. Galenium
Pharmasia
Laboratories Tube @ 10 g 11,475.00 3/16/2014 19:08
PT. Kimia Farma Ktk 10 ampx2ml 14,500.00 3/15/2014 16:05
PT. Dexa Medica 30 TAB/BOX 3,120.00 3/16/2014 18:23
PT. Dexa Medica 30 TAB/BOX 4,525.00 3/16/2014 18:23
PT. Holi Pharma Botol 60 ml 8,360.00 3/15/2014 16:05
Dus, 25 Blister @ 4
Dus 10 strip @ 10
PT. Ikapharmindo Ampul 1 ml 1,000.00 1/5/2015 14:07
PT. Pratapa Nirmala Dus, Botol @ 10ml 17,393.00 3/16/2014 18:23
PT. Afifarma botol @ 1000 ml 37,109.00 3/15/2014 16:05
PT. Kimia Farma btl 60 ml 5,998.00 1/5/2015 14:07
PT. Boehringer Dus, 3 alu blister @
Ingelheim 10 tablet 7,200.00 3/16/2014 19:08
PT. Boehringer Dus, 3 alu blister @
Ingelheim 10 tablet 11,268.00 3/16/2014 19:08
PT. Novell
Laboratories tablet 2,300.00 4/23/2013 10:24
Dus,10 blister @10
PT. Phapros, Tbk tablet 205 4/23/2013 10:24
Dus, 10 strip @ 10
PT. Bernofarm Vial @ 3 juta IU 7,190.00 3/15/2014 16:05
Dus, 10 Strip @ 10
PT. Indofarma Botol @ 100 Tablet 319 9/28/2014 21:46
PT. Fresenius Kabi
Combiphar Ampul 15,642.00 7/21/2014 21:09
Dus, 10 strip @ 10
PT. Pharma Health Dus, 6 blister @ 10
Care tablet 995 7/21/2014 21:09
Dus, 10 Strip @ 10
PT. Dexa Medica kaptab 580 4/23/2013 10:24
PT. Novell
Pharmaeutical Dus, 10 strip @ 10
Laboratories tablet 1,013.00 9/28/2014 21:46
PT. Natura Dus, 10 Ampul @ 2
Dus, 10 Strip @ 10
PT. Dexa Medica tablet salut selaput 120 4/23/2013 10:24
Botol 50 kapsul
PT. Kimia Farma lunak 260 3/18/2014 20:03
PT. Lucas Djaja Botol 50 Kapsul 459 7/10/2014 15:53
Dus, 10 strip @ 10
Dus, 10 strip @ 10
Dus, 10 strip @10
PT. Indofarma kaptab 1,100.00 4/23/2015 15:45
PT. Widatra Bhakti botol 500 ml 5,200.00 4/23/2013 10:24
Dus, 5 Blister @ 10
Dus, 5 Blister @ 10
PT. Boehringer
Ingelheim Dus, 1 vial @ 10 ml 3,164,805.00 9/28/2014 22:55
PT. Bayer Indonesia Blister 23,500.00 5/21/2014 20:01
PT. Merck Sharp
Dohme Pharma Tbk Dus, 10 vial @ 5 ml 46,539.00 4/23/2015 15:45
Indonesia Tablet lepas Lambat 5,248.00 3/18/2014 20:03
PT. Glaxo Wellcome Dus, 4x5 Botol
Indonesia [email protected] ml 6,600.00 9/28/2014 21:46
PT. Glaxo Wellcome
Indonesia Dus, botol 200 dosis 63,750.00 3/18/2014 20:03
PT. Glaxo Wellcome Dus, 10 Blister @ 10
Indonesia Kapsul 431 3/18/2014 20:03
PT. Glaxo Wellcome
Indonesia Dus, 1 Rotahaler 5,867.00 3/18/2014 20:03
PT. Yarindo
Farmatama strip @ 10 tablet 59 4/23/2013 10:24
PT. Marin Liza
Farmasi Pot @ 30 gram 2,000.00 3/15/2014 16:05
PT. Hexpharm Jaya
Laboratories strip 513 4/23/2013 10:24
Dus, 10 strip @ 10
PT. Holi Pharma kapsul 509 4/23/2013 10:24
PT. Ifars
Laboratories Kapsul
Dus, 2 Vial @ 1 1,000.00 4/23/2013 10:24
PT. Yarindo Box 2 Vial @
Farmatama 1000mg 48,060.00 3/15/2014 16:05
PT. Bernofarm kapsul 859 4/23/2013 10:24
PT. Ifars
Pharmaceutical
Laboratories Dus, Botol 30 ml 8,800.00 4/23/2013 10:24
PT. Yarindo
Farmatama vial 38,500.00 7/21/2014 21:08
PT. Hexpharm Jaya
PT. Natura
Laboratoria Prima Dus, 10 Vial @ 1 g 2,950.00 4/23/2013 10:24
PT. Sandoz Dus, 3 blister @ 10
Indonesia tablet
Dus, 2 Vial @ 1 3,700.00 3/16/2014 19:08
PT. Natura
Laboratoria Prima Dus, 10 Vial @ 1 g 3,300.00 3/15/2014 16:05
Indonesia Tablet salut selaput 4,752.00 9/28/2014 21:46
Indonesia Tablet salut selaput 7,200.00 3/16/2014 18:23
PT. Pratapa Nirmala strip @ 10 tab 3,300.00 7/21/2014 21:09
PT. Indofarma Botol @ 60 ml 7,999.00 3/15/2014 16:05
Box, 10 strips @ 10
PT. Pertiwi Agung capsules 181 3/15/2014 16:05
PT. Merck Tbk Dus, 1 vial @ 20 ml 3,650,000.00 9/28/2014 22:55
PT. Pratapa Nirmala tabung/botol 1,320,000.00 7/21/2014 21:09
PT. Lucas Djaja 100 ampul @ 1 ml 1,078.00 4/23/2013 10:24
Dus, 10 Strip @ 10
PT. Afifarma tablet 57 1/5/2015 14:07
PT. Novell
Pharmaeutical
PT. Novell
Pharmaeutical
PT. Novell
Pharmaeutical
Laboratories Vial 120,000.00 9/28/2014 21:46
Indonesia kapsul lunak 43,000.00 3/16/2014 19:08
Indonesia kapsul lunak 12,000.00 3/16/2014 19:08
PT. Dankos Farma strip 7,000.00 1/5/2015 14:07
PT. Natura Dus, 3 Strip @ 10
Laboratoria Prima Kaplet salut selaput 169 3/15/2014 16:05
PT. Natura Dus, 3 Strip @ 10
Laboratoria Prima Kaplet salut selaput 391 4/23/2013 10:24
PT. Dexa Medica Vial 200 ml 13,000.00 4/23/2013 10:24
PT. Bernofarm tab ss 255 4/23/2013 10:24
PT Kalbe Farma vial 22,000.00 9/5/2014 23:17
PT Kalbe Farma vial 93,000.00 9/5/2014 23:17
PT. Tempo Scan
Pacific dus, 1 vial @ 10 ml 575,000.00 8/6/2014 18:35
Dus, 5 strip @ 10
PT. Indofarma tablet 1,499.00 4/23/2013 10:24
Dus, 10 Strip @ 10
Dus, 10 Strip @ 10
PT. Kimia Farma Botol @ 60 tablet 930 1/5/2015 14:07
PT. Dexa Medica Vial 3,290,000.00 5/21/2014 20:01
PT. Phapros, Tbk Dus @ 56 Vial 3,650.00 4/23/2013 10:24
PT. Kimia Farma dus 5 amp @ dus 10 127,000.00 3/18/2014 20:03

PT. Combiphar Botol, 100 ml 13,425.00 7/21/2014 21:09
DUS, 10 STRIP @ 10
PT. Dexa Medica TAB 424 9/28/2014 21:46
Pounch @ 5 blister
PT. Combiphar @ 10 capsule 11,167.00 3/18/2014 20:03
Dus, 1 pouch @5
PT. Combiphar blister@10 kaps 21,500.00 4/3/2014 21:30
Box @ 2 blister @
PT. Combiphar 14 tablet 5,800.00 3/18/2014 20:03
Box/ 2 blister @ 14
PT. Combiphar tablet 5,800.00 3/16/2014 19:08
Box/ 3 blister @ 10
PT. Combiphar Tablet 6,800.00 3/16/2014 19:08
PT. Boehringer Dus, 2 alu-blister
Ingelheim @10 tablet 3,900.00 6/27/2014 19:33
PT. Boehringer Box, 2 blisters @10
Ingelheim tablets 6,500.00 8/6/2014 18:35
PT. Merck Sharp Dus, 5 sachet @ 1
Dohme Pharma Tbk kapsul 1,120,000.00 8/6/2014 18:35
PT. Merck Sharp Dus, 5 sachet @ 1
Dohme Pharma Tbk kapsul 223,000.00 8/6/2014 18:35
Dus 10-s @ 10
PT. Kimia Farma Kaptab 1,050.00 3/16/2014 18:23
PT Kalbe Farma strip 250 1/5/2015 14:07
DUS, 10 BLISTER @
PT. Dexa Medica 10 TAB 1,669.00 9/28/2014 21:46
DUS, 10 BLISTER @
PT. Dexa Medica 10 TAB 2,949.00 9/28/2014 21:46
PT. AstraZeneca Dus, 2 pak @ 5
indonesia respules 6,250.00 4/3/2014 21:30
PT. Molex Ayus Box 50's 99 3/16/2014 18:23
indonesia @ 200 dosis 71,100.00 4/8/2014 18:23
PT. Merck Sharp Dus, 6 blister @ 10
Dohme Pharma Tbk kapsul lunak 6,200.00 8/6/2014 18:35
PT. Cendo Industri
Farmasi botol 5 ml 11,500.00 4/3/2014 21:30
Dus, 10 strip @ 10
PT. Holi Pharma kapsul 148 4/23/2013 10:24
DUS,10 STRIP @ 10
PT. Afifarma KAPSUL 300 9/28/2014 21:46
PT. Merck Tbk tablet 1,135.00 4/3/2014 21:30
Dus, Botol Plastik @
Dus, Botol Plastik @
PT. Boehringer Box, 3 blisters @10
Ingelheim capsules 13,867.27 12/5/2014 22:08
PT. Boehringer Dus, 1 blister @10
Ingelheim kapsul + handihaler 152,543.00 3/16/2014 19:08
PT. Natura Dus, 10 Ampul @ 2
Dus, 1 vial @ 440

PT. Boehringer mg + 1 vial pelarut
Ingelheim @ 20 ml ### 9/28/2014 22:55
PT. Tempo Scan botol, tetes mata
Pacific 2,5 ml 115,000.00 4/3/2014 21:30
Dus, botol plastik
PT. Aventis Pharma 120 dosis 90,000.00 4/3/2014 21:30
PT. Dexa Medica Dus,1 vial@ 5ml 65,500.00 4/23/2015 15:45
PT. Darya Varia strip 405 4/23/2013 10:24
PT. Cendo Industri
Farmasi Botol 5ml 36,500.00 12/5/2014 22:08
PT. Galenium
Pharmasia
Laboratories tube 6,400.00 3/16/2014 18:23
PT. Bio Farma 20 ds / amp / vial 59,950.00 5/22/2015 14:48

PT. Bio Farma 10 ds / vial 28,204.00 5/22/2015 14:48
PT. Bio Farma 1 ds / pouch 20,900.00 5/22/2015 14:48
PT. Bio Farma 1 ds / pouch 24,585.00 5/22/2015 14:48
PT. Bio Farma 10 ds/ vial 16,500.00 5/22/2015 14:48
Dus, 1 dosis @ (1
vial serbuk injeksi +
PT. Novartis 1 vial larutan injeksi
Indonesia @ 0,6 ml) 307,400.00 5/22/2015 15:37
1 vial of 10ml (10
PT. Aventis Pharma d's) 285,000.00 4/3/2014 21:30
Dus, 1 vial@ 1dosis

+ 1 Syringe @ 0,5
PT. Bio Farma ml NaCl 4% 78,000.00 1/5/2015 14:07
Dus, 1 vial serbuk +

1 ampul @ 1 ml
PT. Novartis pelarut + 1 syringe
Indonesia & jarum suntik 78,500.00 9/28/2014 21:46

PT. Soho Industri
Pharmasi 5 strip @ 10 kaptab 5,390.00 4/23/2015 15:45
PT. Boehringer
PT. Abbott
Indonesia Tablet 2,793.00 3/16/2014 19:08
PT. Abbott
PT. Abbott
Indonesia Tablet salut 250 mg 1,680.00 9/28/2014 21:46
DUS, 3 ALU-ALU
PT. Novartis STRIP @ 10 tablet
Indonesia salut selaput. 3,900.00 3/16/2014 19:08
DUS, 3 ALU-ALU
PT. Novartis STRIP @ 10 tablet
Indonesia salut selaput. 6,500.00 4/3/2014 21:30
PT. Abbott
PT. Kimia Farma Ktk 10X10 TAB 234 4/23/2013 10:24
PT. Combiphar Vial 10mg/10ml 210,000.00 3/16/2014 18:23
PT. Mugi
Laboratories Dus, 1 vial
Dus 10 strip@x110
ml 1,229,998.00 5/21/2014 14:16
PT. Kimia Farma tab 107 4/23/2013 10:24
PT. Kimia Farma Botol 60 Kapsul 1,575.00 12/5/2014 22:08
Drops 10 mg/ml,
PT. Combiphar Botol @15 @
Dus, botol ml100 12,840.00 3/16/2014 18:23
PT. Indofarma ml 14,980.00 4/23/2015 15:45
PT. Meprofarm Dus, botol 60 ml 7,400.00 3/16/2014 18:23
DAFTAR OBAT FORMULARIUM KABUPATEN
NO NAMA OBAT SATUAN Pabrik Obat Ekatalog
1 Adenosin IV Ampul
2 Air untuk injeksi amp 25 ml Ampul PT Otsuka Indonesia
3 Albendazol susp 200 mg/5 ml Botol PT. Indofarma
4 Albendazol tab 400 mg Tab PT. Holi Pharma
5 Alopurinol tab 100 mg Tab PT. Pertiwi Agung
6 Alopurinol tab 300 mg Tab PT. Bernofarm
7 Ambroxol syrup 15mg/5ml BOTOL
8 Ambroxol tab 30 mg TABLET
9 Amilorid tab 5 mg Tab
10 Aminofilin tab 150 mg Tab PT. Erela
11 Aminofilin inj 24 mg/ml Ampul PT. Lucas Djaja
12 Aminofilin tab 200 mg Tab PT. Marin Liza Farmasi
13 Amitriptilin tab sal 25 mg Tab sal PT. Indofarma
14 Amlodipin tab 10 mg Tab PT. Pertiwi Agung
15 Amlodipin tab 5 mg Tab PT. Pertiwi Agung
Amoksisilin 500 mg + Asam Klavulanat 125mg
16 (Amoksiklav 625mg) Tab
17 Amoksisilin sir forte 250 mg/5 ml Botol PT. Holi Pharma

18 Amoksisilin sir kering 125 mg/5 ml Botol PT. Novapharin
Amoksisilin tab 250 mg
19 Tab PT. Novapharin
20 Amoksisilin tab 500 mg Tab PT. Bernofarm

21 Ampisilin serb inj 1000 mg/vial Vial PT. Bernofarm
22 Ampisilin serb inj 250 mg/vial Vial
Analog insulin : rapid acting (inj 100 UI/ml (kemasan vial, PT. Ferron Par
23 cartridge disposible, penfill cartridge) Vial
Pharmaceuticals
Analog insulin :long acting (inj 100 UI/ml (kemasan vial,
24 cartridge disposible, penfill cartridge) Vial PT. Aventis Pharma
Analog insulin :mix insulin (inj 100 UI/ml (kemasan vial,

25 cartridge disposible, penfill cartridge) Vial PT. Bayer Indonesia
Anestetik lokal gigi kombinasi : lidokain hcl 2% +
26 epinefrin 1 : 80.000 inj 2 ml Ampul PT Indofarmad
27 Antalgin Injeksi 250 mg/ ml AMPUL

28 Antalgin tab (Metampiron) 500 mg TABLET
Antasida, kombinasi : aluminium hidroksida 200 mg + PT. Promedrahardjo
29 magnesium hidroksida 200 mg Tab kunyah
Farmasi Industri
Antasida, kombinasi : aluminium hidroksida 200 mg + PT. Rama Emerald Multi
30 magnesium hidroksida 200 mg Botol
Sukses
Anti Parkinson kombinasi : benzerasid 25 mg + levodopa
31 Kaps PT. Meprofarm
100 mg
Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin B
32 10.000 UI/g Tube PT. Indofarma
Antifungi salep, kombinasi : asam benzoat 6%+ asam

33 salisilat 3% Tube
Antihemoroid, kombinasi: Graptophylli Folium 14 mg,

34 Citrus Bioflavonoid 50 mg Kapsul
Antihemoroid, kombinasi: biSalep Mataut subgalat 150

35 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ Supp PT. Kimia Farma
seng oksida 120 mg + sup ad 2 g
Antimalaria kombinasi : sulfadoksin 500 mg +

36 Kaps PT. Kimia Farma
primetamin 25 mg
37 Artemether inj 80 mg/ml Ampul PT. Kimia Farma
38 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial PT. Pharma Laboratories
Kertas warna
39 Articulating paper kertas warna penanda oklusi
penanda oklusi
40 Asam asetilsalisilat (asetosal) tab 100 mg Tab PT. Phapros, Tbk

Asam asetilsalisilat (asetosal) tab 80 mg PT. Mersifarma Tirmaku
41 Tab
Mercusana
42 Asam askorbat (vitamin C) tab 250 mg Tab PT. Kimia Farma
43 Asam askorbat (vitamin C) tab 50 mg Tab PT. Kimia Farma
44 Asam folat tab 0,4 mg Tab PT. Dexa Medica
45 Asam folat tab 1 mg Tab PT. Marin Liza Farmasi
46 Asam folat tab 5 mg Tab
47 Asam mefenamat kaps 250 mg Kaps PT. Afifarma
48 Asam mefenamat kaps 500 mg Kaps PT. Bernofarm
49 Asam salisilat lar 0,1% Botol
50 Asam salisilat salep 5% Tube
51 Asam traneksamat inj 100 mg/ml Ampul
52 Asam traneksamat tab 500 mg Tab
53 Asetazolamid HCl Tablet 500mg Tab
54 Asiklovir Salep Mata 3% Tube PT. Sanbe Farma
55 Asiklovir tab 200 mg Tab PT. Indofarma
56 Asiklovir tab 400 mg Tab PT. Kimia Farma
PT. Zenith
57 Atapulgit Tab
Pharmaceuticals
58 Atenolol tab 100 mg Tab PT Kalbe Farma
59 Atenolol tab 50 mg Tab PT. Pratapa Nirmala
60 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul PT. Ethica Industri Farmasi
61 Atropin tab 0,5 mg Tab PT. Indofarma
62 Azitromisin 500mg Tablet Tablet PT. Kimia Farma
63 Bahan tumpatan sementara lar, serb Botol
PT. Rama Emerald Multi
64 Bedak salisil serb 2% Botol
Sukses
65 Benzatin penisilin inj 2,4 juta UI/ml (i.m.) Vial PT. Phapros, Tbk
66 Betahistin Mesilat 6mg Tablet
67 Betametason Tetes mata 1 mg/ml Botol PT. Sanbe Farma
68 Betametason krim 0,1% Tube PT. Kimia Farma
69 Betametason krim 0,5 mg/g Tube
70 Bioplacenton jelly Tube
71 Bisakodil sup 10 mg Botol PT. Sanbe Farma
72 Bisakodil sup 5 mg Botol PT. Boehringer Ingelheim
73 Bisakodil tab sal 5 mg Tab sal
74 Bisoprolol tab 5 mg Tab PT. Pratapa Nirmala
75 Bromhexin Syrup Botol
76 Bromhexin Tablet 8 mg TABLET
77 Coal tar lar 5 % Botol
78 Copper T set/buah
79 Dapson 100mg Tablet
80 Deksametason tab 0,5 mg Tab PT. Indofarma
81 Deksametason inj 5 mg/ml (i.v./i.m.) Vial PT. Indofarma
82 Dekstran Infus Botol
83 Diazepam inj 5 mg/ml (i.v./i.m.) Vial PT. Indofarma
84 Diazepam lar rektal 10 mg/2,5 ml Botol PT. Actavis Indonesia
85 Diazepam lar rektal 5 mg/2,5 ml Botol PT. Actavis Indonesia
86 Diazepam tab 2 mg Tab PT. Kimia Farma
87 Diazepam tab 5 mg Tab
88 Dietilkarbamazin tab 100 mg Tab PT. Holi Pharma
89 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul PT. Lucas Djaja
90 Digoksin tab 0,25 mg Tab PT. Yarindo Farmatama
91 Diltiazem hcl tab 30 mg Tab PT. Indofarma
92 Diltiazem kaps SR 100 mg Kaps PT. Tanabe Indonesia
93 Diltiazem kaps SR 200 mg Kaps PT. Tanabe Indonesia
94 Diltiazem tab 30 mg Tab PT. Indofarma
95 Dimenhidrinat tab 50 mg Tab PT. Kimia Farma
96 Dimetilpolisiloksan aktif 40 mg (Mis: Dysflatyl) TABLET PT. Pharos
97 Dobutamin inj Tablet PT. Dipa Pharmalab
98 Doksazosin tab 1 mg Tab PT. Pfizer Indonesia
99 Doksazosin tab 2 mg Tab PT. Pfizer Indonesia
100 Doksisiklin kaps 100 mg Kaps PT. Yarindo Farmatama
101 Domperidon susp 5 mg/5 ml Botol PT. Novapharin
102 Domperidon tab 10 mg Tab PT. Novapharin
103 Donepzil Tablet Tablet PT. Fahrenheit
104 Dopamin Inj Tablet PT. Dipa Pharmalab
105 Efedrin HCl Tetes Hidung 0,5% Botol
106 Efedrin HCl Tetes Hidung 0,5% Botol
107 Ekstrak Belladone 10 mg TABLET
108 Enzim Pencernaan Tablet Tablet
109 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul
110 Epinefrin (adrenalin) inj 1 mg/ml Ampul PT. Phapros
111 Ergotamin tab 1 mg Tab
112 Eritromisin kaps 250 mg Kaps PT. Kimia Farma
PT. Phyto Kemo Agung
113 Eritromisin sir 200 mg/5 ml Botol
Farma
114 Eritromisin tab 500 mg Tab PT. Indofarma
115 Etakridine ( Rivanol ) 0,1 % BOTOL
116 Etambutol tab 250 mg Tab PT. Kimia Farma
117 Etambutol tab 500 mg Tab PT. Indofarma
118 Etanol 70% cairan 70% Botol PT. Novapharin
119 Etil klorida semprot 100 ml Botol
120 Eugenol Botol PT. Kimia Farma
121 Fenilbutazone Tablet 200mg TABLET
122 Fenitoin Na inj 100 mg/2 ml Ampul PT. Mersifarma
123 Fenitoin Na inj 50 mg/ml Ampul PT. Mersifarma
124 Fenitoin Na kaps 100 mg Kaps PT. Ikapharmindo
125 Fenitoin Na kaps 30 mg Kaps
126 Fenobarbital inj 50 mg/ml Ampul PT. Phapros
127 Fenobarbital tab 100 mg Tab PT. Indofarma
128 Fenobarbital tab 30 mg Tab
129 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab PT. Phapros
130 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab PT. Phapros
131 Ferro fumarat kaps lunak 300 mg Kaps lunak
132 Ferro sulfat sir. 15 mg/5 ml Botol
133 Ferro sulfat tab salut 300 mg Tab sal
134 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial PT. Phapros
135 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal PT. Marin Liza Farmasi
136 Flucloxacillin 500 mg Tablet Tablet
137 Flumetolon Tetes Mata Botol PT. Sanbe Farma
138 Fluor sediaan topikal Tube
139 Fluor tab 0,5 mg Tab
140 Fluor kapl 1 mg Kaplet
141 Fluoresein Tetes mata 2,5 mg/ml Botol
142 Formokresol Botol
143 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul PT. Indofarma
144 Furosemid tab 40 mg Tab PT. Indofarma
145 Galactose microparticle 200-400 mg micropart/ml Vial
146 Galantamin Tablet Tablet
Garam oralit kombinasi : natrium klorida 0,52 g + kalium
klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat PT. Rama Emerald Multi
147 Sachet
2,7 g Sukses
148 Gentamisin inj 40 mg/ml Ampul PT. Indofarma

149 Gentamisin Krim Tube
150 Gentamisin Salep Mata Tube PT. Erela
151 Gentian Violet Botol
Glass ionomer ART (Atraumatic Restorative Treatment)
152 cocoa butter 5 g Sachet
153 Glass ionomer ART (Atraumatic Restorative Treatment) Botol

154 lar
Glass ionomer ART (Atraumatic Restorative Treatment) Vial
155 serb
Glibenklamid tab 2,5 mg Tab
156 Glibenklamid tab 5 mg Tab PT. Indofarma
157 Glimepirid tab 1 mg Tab PT. Kimia Farma
158 Glimepirid tab 2 mg Tab PT. Kimia Farma
159 Glipizid tab 5 mg Tab PT. Pfizer Indonesia
160 Gliseril Guayakolat 100 mg TABLET
161 Gliseril Guayakolat Syrup Botol
162 Gliseril trinitrat tab sublingual 0,5 mg Tab sub PT. Actavis Indonesia
163 Gliserin lar 50% Botol PT. Lucas Djaja
164 Gliserin Tts 10 mg/ml Botol
165 Gliserin Tts 100 mg/ml Botol
166 Glukosa Larutan Infus 10% steril Botol PT. Widatra Bhakti
167 Glukosa Larutan Infus 40% Steril VIAL
168 Glukosa Larutan Infus 5% steril Botol PT. Widatra Bhakti
169 Griseofulvin (micronized) tab 125 mg Tab PT. Indofarma
170 Griseofulvin (micronized) tab scored 250 mg Tab
171 Guttaa percha dan paper points 15 - 40 mm Roll
172 Guttaa percha dan paper points 45 - 80 mm Roll
173 Haloperidol Decanoas inj Ampul PT Soho industri Farmasi
174 Haloperidol inj 5 mg/ml (i.m.) Vial PTMersifarma TM
175 Haloperidol tab 0,5 mg Tab PT Indofarma
176 Haloperidol tab 1,5 mg Tab PT Indofarma
177 Haloperidol tab 2 mg Tab PT Mersifarma TM
178 Haloperidol tab 5 mg Tab PT Indofarma
179 Haloperidol Tetes 2 mg/ml Botol PT Mersifarma TM
180 Hepatitis B imunoglobulin (human) inj 0,5 ml Ampul PT Dipa Pharmalab
181 Hidrogen peroksida cairan 3% Botol
182 Hidrogen peroksida lar. Konsentrat 3% Botol 1000ml
183 Hidroklorotiazid tab 25 mg Tab
184 Hidrokortison krim 2,5% Tube PT Kimia Farma
185 Hidrokortison serb inj 100 mg/vial Vial
186 Hiosina butilbromida inj 20 mg/ml Ampul PT Otto Pharmacetical
187 Hiosina butilbromida tab 10 mg Tab
188 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul PT Dexa Medica
189 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul
190 Ibuprofen sir 100 mg/5 ml Botol PT Indofarma
191 Ibuprofen sir 200 mg/5 ml Botol PT Indofarma
192 Ibuprofen tab 200 mg Tab PT Yarindo F
193 Ibuprofen tab 400 mg Tab PT Holi Farma
194 Ipratropium bromida ih padat 20 mcg Puff PT Boehringer ingelheim
195 Ipratropium bromida nebulizer 0,025% Botol PT Boehringer ingelheim
196 Isoniazid tab 100 mg Tab PT Phyto Kemo Agung
197 Isoniazid tab 300 mg Tab PT Phyto Kemo Agung
198 Isosorbid dinitrat tab 5 mg Tab PT Indofarma
199 Jeli USG TUBE
200 Kalamin Tube
201 Kalium Diklofenak 50mg TABLET
202 Kalsium glukonat inj 100 mg/ml Ampul PT Ethica IF
203 Kalsium hidroksida bubuk, pasta Tube
204 Kalsium karbonat tab 500 mg Tab
205 Kalsium laktat (kalk) tab 500 mg Tab PT Afifarma
206 Kaptopril tab 12,5 mg Tab PT Indofarma
207 Kaptopril tab 25 mg Tab PT Errita Pharma
208 Kaptopril tab 50 mg Tab PT Indofarma
209 Karbamazepin sir 100 mg/5 ml Botol PT Novartis Indonesia
210 Karbamazepin tab 200 mg Tab PT Indofarma
211 Karbo adsorben tab 0,5 g Tab
212 Karbogliserin Tetes Telinga 10 % Botol PT Lucas Djaja
213 Karboksimetil Selulosa Tetes Mata Botol
214 KCl 0,5 g Tablet Tab PT Merck Tbk
215 Ketokonazol tab 200 mg Tab PT Dexa Medica
216 Ketokonazol krim 2% Tube 15g PT. Novell PL
217 Klindamisin kaps 150 mg Kaps PT Indofarma
218 Klindamisin kaps 300 mg Kaps PT Indofarma
219 Klobazam tab 10 mg Tab PT Dexa Medica
220 Klofazimin, micronizedkaps 100 mg kapsul
221 Klonidin tab 0,15 mg Tab PT Kimia Farma
222 Klopidogrel tab 75 mg Tab PT Hexpharm Jaya
223 Kloramfenikol Tetes Mata 0,5% Botol
224 Kloramfenikol Tetes mata 1% Botol
225 Kloramfenikol + Hidrokortison Tetes Mata Botol
226 Kloramfenikol kaps 250 mg Kaps
227 Kloramfenikol salep kulit 2% Tube PT Bufa Aneka
228 Kloramfenikol salep mata 1% Tube PT Erela
229 Kloramfenikol susp 125 mg/5 ml Botol PT Bernofarm
230 Kloramfenikol Tetes Telinga 3 % 5 ml BOTOL
231 Klorfeniramin tab 4 mg Tab PT Rama Emerald
232 Klorfenol kamfer mentol (CHKM) Botol
233 Klorheksidin lar 0,2% obat kumur Botol
234 Klorheksidin lar 15% Botol
235 Klorpromazin inj 25 mg/ml (i.m.) Ampul PT Phapros
236 Klorpromazin inj 5 mg/ml (i.m.) Ampul PT Phapros
237 Klorpromazin tab sal 100 mg Tab sal PT Mersifarma TM
238 Klorpromazin tab sal 25 mg Tab sal PT Phapros
239 Klortalidon tab 50 mg Tab
240 Kodein tab 10 mg Tab PT Kimia Farma
241 Kodein tab 20 mg Tab PT Kimia Farma
242 Kolkisin Tablet 500 mg Tablet PT Pratapa Nirmala
Kombinasi : levonorgestrel 150 mcg +
243 etinilestradiol 30 mcg Tab PT Kimia Farma
244 Kombinasi : artemether 20 mg + lumefantrin 120 Kaps

mg
245 Kombinasi : artesunat tab 50 mg + amodiakuin Tab
tab 200
246 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab PT Kimia Farma
247 Kombinasi : ferro sulfat 200 mg+ as. Folat 0,25 Tab sal PT Kimia Farma
mg
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
248 2,5 mg nebules Botol PT Boehringer ingelheim
249 Kombinasi: kaolin 550 mg + pektin 20 mg Tab

250 Kombinasi: parafin + gliserin + fenolftalein Botol PT Galenium Pharmasia
251 Komposit resin Set
Kotrimoksazol (dewasa) kombinasi :
252 sulfametoksazol 400 mg+ trimetoprim 80 mg Tab PT Holi Farma
Kotrimoksazol (dewasa) kombinasi :

253 sulfametoksazol 800 mg+ trimetoprim 160 mg Tab
Kotrimoksazol (dewasa) kombinasi tiap 5 ml

254 suspensi : sulfametoksazol 200 mg + trimetoprim Botol PT Lucas Djaja
40 mg
255 Kuinin inj 25% (i.v.) Vial PT Kimia Farma
256 Kuinin tab 200 mg Tab PT Kimia Farma
257 Kuinin tab 222 mg Tab PT Kimia Farma
258 Kuinin tab 250 mg Tab
259 Laktulosa Syrup 3,335g/5ml Botol PT Ikapharmindo
260 Lamivudin Tablet 100 mg tablet PT Kimia Farma
261 Larutan Benedict 100 ml BOTOL
262 Larutan Eosin 2 % 100 ml BOTOL
263 Larutan Etanol asam 100 ml BOTOL
264 Larutan Giemsa stain 100 ml BOTOL
265 Larutan Iodine Test BOTOL
266 Larutan Karbol Fuksin 100 ml BOTOL
267 Larutan Metilen Biru BOTOL
268 Larutan Turk BOTOL
269 Levertrans Salep POT
270 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) Set
271 Lidokain gel 2% Tube PT Astra Zeneca
272 Lidokain inj 2% (hcl) Vial PT Bernofarm
273 Lidokain inj 5% + glukosa (dekstrosa) 5 % Ampul
274 Lidokain pasta 5% (hcl) Tube
275 Lidokain semprot 15% (hcl) Botol
276 Linestrenol tab 0,5 mg Tab
277 Lisol BOTOL 1000ML PT JMI
278 Lomotil Tablet Tablet
279 Loperamid Tablet 2 mg Tablet PT Ifars PL
280 Loratadin tab 10 mg Tab PT Promedrahardjo
281 Lugol Botol
282 Magnesium sulfat inj 20% Vial PT Otsuka
283 Magnesium sulfat inj 40% Vial PT Otsuka
284 Magnesium sulfat serb, ktg 30 g Sachet
285 Mebendazol sir 50 mg/ml Botol
286 Mebendazol tab 100 mg Tan
287 Mebendazol tab 500 mg Tab PT Taisho PI
288 Medroksi progesteron asetat inj depo 150 mg Set/buah PT Pfizer I
289 Meloxicam 15mg TABLET
290 Mentol Krim Tube
Metenamin mandelat (heksamin mandelat) tab
291 salut enterik 500 mg Tab salut
292 Metformin tab 500 mg Tab PT Bernofarm

293 Metformin tab 850 mg Tab PT Bernofarm
294 Metildopa tab sal 250 mg Tab PT Actavis I
295 Metilergometrin inj 0,2 mg/ml Ampul PT Ethica
296 Metilergometrin tab salut 0,125 mg Tab sal PT Kimia Farma
297 Metilprednisolon tab 4 mg Tab PT Natura LP
298 Metisoprinol tablet 500mg Tablet
299 Metoklopramid tab 5 mg Tab PT Kimia Farma
300 Metoklopramid drop botol 10 ml Botol PT Meprofarm
301 Metoklopramid inj 5 mg/ml Vial
302 Metoklopramid sir 5 mg/5 ml Botol PT Molex Ayus
303 Metoklopramid tab 10 mg Tab
304 Metronidazol lar inf 5 mg/ml Botol PT Natura LP
305 Metronidazol ovula 500 mg Supp PT Kimia Farma
306 Metronidazol sir 125 mg/5 Ml Botol PT Ifars PL
307 Metronidazol sup 500 mg Botol PT Aventis P
308 Metronidazol tab 250 mg Tab PT Phyto Kemo Agung
309 Metronidazol tab 500 mg Tab PT Phyto Kemo Agung
310 Mikonazol krim 2% Tube PT Kimia Farma
311 Mikonazol serb 2% Tube
312 Mometason furoat krim 0,1% Tube PT. Guardian Pharmatama
313 Multivitamin dan Mineral Syrup Botol
314 Multivitamin dan MineralTablet Tablet salut gula
315 NaCl 0,9% Larutan Botol PT Widatra Bhakti
316 Natrium bikarbonat inj 8,4% (i.v.) Vial PT Otsuka I
317 Natrium bikarbonat tab 500 mg Tab
318 Natrium diklofenak gel Tube
319 Natrium diklofenak tab 25 mg Tab
320 Natrium diklofenak tab 50 mg Tab PT Novel PL
321 Natrium hipoklorit cairan konsentrat 5% Botol
322 Natrium tiosulfat inj 25% (i.v.) Ampul
323 Neomisin Tablet 500mg Tablet
324 Nevirapine tablet 200mg tablet PT Kimia Farma
325 Nifedipin kaps 10 mg Kaps PT Dexa Medica
326 Nikotinamid tab 100 mg Tab
329 Nistatin susp 100.000 UI/ml Botol
330 Nistatin tab vaginal 100.000 UI Tab PT Phapros
331 Nitrofurantoin tab 50 mg Tab
332 Norepinefrin inj 1 mg/ml Ampul PT Dexa Medica
333 Obat Anti Tuberculosis FDC Kategori Anak Paket PT Phapros
334 Obat Anti Tuberculosis FDC Kategori I Paket PT Phapros
335 Obat Anti Tuberculosis FDC Kategori II Paket PT Indofarma
336 Obat Anti Tuberculosis FDC Kategori Sisipan Paket PT Indofarma
337 Obat Anti Tuberculosis Kombipak Anak Paket PT Indofarma
338 Obat Anti Tuberculosis Kombipak Dewasa Paket PT Indofarma
339 Obat Batuk Flu Syrup Kombinasi Botol
340 Obat Batuk Hitam ( OBH ) BOTOL
341 Obat Diare Syrup (Kombinasi ATapulgit 700mg + Pektin 66 BOTOL

mg per 15 ml)
Obat Diare Tablet (Kombinasi Atapulgit 700mg + Pektin 50
342 mg) Tablet
343 Obat Flu Tablet ( Kombinasi: Parasetamol 500mg, TABLET

Triprolidin HCl 2,5mg, Pseudoefedrin 30mg)
344 Ofloxacin Tetes Telinga Botol PT Kalbe Farma
345 Oksigen ih, gas dlm tabung Botol
346 Oksimetazolin Tetes Hidung 0,025% Botol PT Merck Tbk
347 Oksimetazolin Tetes Hidung 0,050% Botol PT Merck Tbk
348 Oksitertrasiklin Salep Mata Tube
349 Oksitosin inj 10 UI/ml Ampul PT Ethica
350 Olopatadin Tetes Mata 0,1% Botol PT Tempo Scan P
351 Omeprazol inj 40 mg/10 ml Vial PT Natura LP
352 Omeprazol kaps 20 mg Kaps PT Novapharin
353 Ondansetron inj 2 mg/ml Vial PT Indofarma
354 Ondansetron tab 4 mg Tab PT Yarindo F
355 Papaverin 40 mg/ ml injeksi AMPUL
356 Paraformaldehid tab 1 g Tab
357 Parasetamol sir 120 mg/5 ml Botol PT Afifarma
358 Parasetamol tab 500 mg Tab PT Infarmind FI
359 Parasetamol tablet 130mg/5ml Sase
360 Parasetamol Tetes 60 mg/0,6 ml Botol PT Indofarma
361 Pasta devitalisasi (non arsen) Tube
362 Pasta pengisi saluran akar (pasta) Tube
363 Perak nitrat lar 20% Botol
364 Perak sulfadiazin krim 1% Tube PT Darya Varia
365 Permetrin krim 5 % Tube PT Galenium Pharmasia
366 Pirantel pamoat susp 125 mg/5 ml Botol PT Holi Farma
367 Pirantel pamoat tab 500 mg Tab
368 Pirantel pamoat tab scored 125 mg Tab PT Holi Farma
369 Pirantel pamoat tab scored 250 mg Tab
370 Pirazinamid tab 500 mg Tab PT Holi Farma
371 Piridoksin (vitamin B6) inj 100 mg/ml Ampul PT Ikapharmindo
372 Piridoksin (vitamin B6) tab 10 mg Tab
373 Piridoksin (vitamin B6) tab 25 mg Tab
374 Piroxicam 20 mg KAPSUL
375 Povidon iodin lar 100 mg/ml Botol 30 ml PT Afifarma
376 Povidon iodin lar 100 mg/ml Botol 60 ml PT Kimia Farma
379 Prednison tab 5 mg Tab
380 Primakuin tab 15 mg Tab PT Phapros
381 Probenesid tab 500 mg Tab
382 Prokain benzilpenisilin serb inj 1 juta UI/vial Tab
(i.m.)
383 Prokain benzilpenisilin serb inj 3 juta UI/vial Vial PT Bernofarm
(i.m.)
384 Propiltiourasil tab 100 mg Tab PT Indofarma
385 Propranolol tab 10 mg Tab
386 Propranolol tab 40 mg Tab PT Holi Farma
387 Ranitidin inj 25 mg/ml Ampul PT Natura LP
388 Ranitidin tab 150 mg Tab PT Dexa Medica
389 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak PT Kimia Farma
390 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak PT Lucas Djaja
391 Rifampisin kaps 300 mg Kaps PT Indofarma
392 Rifampisin tab 450 mg Tab PT Indofarma
393 Rifampisin tab 600 mg Tab PT Indofarma
394 Ringer Laktat Larutan Botol PT Widatra Bhakti
395 Ripastigmin Tablet Tablet
396 Risperidon tab sal 2 mg Tab sal PT Mersifarma TM
397 Sacharum Lactis kaleng
398 Salbutamol aerosol 100 mcg Botol PT Glaxo Wellcome
399 Salbutamol cairan ih 0,1% Botol PT Glaxo Wellcome
400 Salbutamol lar ih 0,5 % Botol
401 Salbutamol tab 2 mg Tab PT Yarindo F
402 Salbutamol tab 4 mg Tab
Salep 2-4, kombinasi : asam salisilat 2 %+
403 belerang endap 4 % Tube PT Marin LF
404 Sefadroksil kaps/tab 500 mg Tab PT Holi Farma

405 Sefaleksin 500 mg Tablet Tablet PT Ifars PL
406 Sefiksim sir 100 mg/5 ml Botol PT Ifars PL
407 Sefiksim tab 100 mg Tab PT Bernofarm
408 Sefotaksim serb inj 1.000 mg/vial Vial PT Natura LP
409 Seftriakson serb inj 1.000 mg/vial Vial PT Natura LP
Serum anti bisa ular : A.B.U. I (khusus ular dari
410 luar ) inj (i.m./i.v.) Papua Vial PT Biofarma
Serum anti bisa ular :A.B.U.II (khusus ular dari

411 Papua) inj (i.m./i.v.) Vial PT Biofarma
412 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m Vial

10.000 UI/
413 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m Vial PT Biofarma
20.000 UI/
414 Serum antirabies inj 100 UI/ml Vial
415 Serum antirabies inj 200 UI/ml Vial
416 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 Vial
UI/vial (i.m /i.v.) (A.T.S) inj 1500 UI/amp (i.m.)
417 Serum antitetanus Ampul PT Biofarma
418 Serum antitetanus (A.T.S) inj 20.000 UI/vial Vial
(i.m /i.v.)
419 Setirizin sir 5 mg/5 ml. Botol PT Indofarma
420 Setirizin tab 10 mg Tab PT Pertiwi Agung
421 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial PT Lucas Djaja
422 Sianokobalamin (vitamin B12) tab 50 mcg Tab PT Afifarma
423 Simetidine Tablet 200 mg TABLET
424 Simvastatin tab sal 10 mg Tab sal PT Natura LP
425 Simvastatin tab sal 20 mg Tab sal PT Natura LP
426 Siprofloksasin tab scored 500 mg Tab PT Bernofarm
427 Siproheptadin Tablet Tab
428 Somatostatin tablet Tablet
429 Spironolakton tab 25 mg Tab PT Dexa Medica
Stannous pyrophosphate 27,6 mg sodium
430 pyrophosphate/vial Vial
431 Streptomisin serb inj 1.000 mg/vial Vial PT Phapros

432 Sukralfat Syrup 500 mg/5ml Botol PT Combiphar
433 Sulfasetamida Na. Tetes Mata 15 % 5ml BOTOL
434 Surgical ginggival pack Tube
Tablet Tambah Darah (Kombinasi:Besi
(II)Fumarat 300mg,MnSulfat 0,4mg,
435
Tembaga(II)Sulfat 0,4mg, Asam Folat 2mg, Tablet
Vitamin B12 15Mcg, Faktor intrinsik 25mg,
Serbuk Sorbitol 30mg)
436 Telmisartan tab 40 mg Tab PT Boehringer ingelheim

437 Telmisartan tab 80 mg Tab PT Boehringer ingelheim
438 Tenofovir Tablet Tablet
439 Teofilin tab 100 mg Tab
440 Teofilin tab 150 mg Tab
441 Teofilin tab SR 300 mg Tab PT Kimia Farma
442 Tetanus toxoid inj Ampul
443 Tetrakain Tetes mata 2% Botol
444 Tetrakain Tetes mata 0,5% Botol PT Cendo IF
445 Tetrasiklin kaps 250 mg Kaps PT Holi Farma
446 Tetrasiklin kaps 500 mg Kaps PT Afifarma
447 Thiamfenikol kap 500mg KAPSUL
448 Thiamfenikol Syrup BOTOL
449 Thiamin HCL (Vit. B1 ) Injek.100 mg AMPUL
450 Thiamin HCL (Vit. B1) 100 mg TABLET
451 Timolol 0,5% Tetes Mata Botol PT Pratapa Nirmala
452 Tiotropium serb ih 18 mcg + handihaller Botol PT Boehringer ingelheim
453 Tiotropium serb ih 18 mcg, refill Botol PT Boehringer ingelheim
454 Triheksifenidil tab 2 mg Tab
455 Urea krim 10 % Tube PT Galenium Pharmasia
456 Vaksin BCG inj (i.k) Vial
457 Vaksin campak inj (s.k.) Vial
458 Vaksin jerap difteri tetanus pertusis (DTP) inj Vial
(i.m.)
459 Vaksin jerap difteri tetanus (DT) Vial
460 Vaksin jerap tetanus (tetanus adsorbed toxoid) Vial
inj (i.m.)
461 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial
462 Vaksin polio cairan steril 10 dosis Vial
463 Vaksin polio drops 10 dosis Vial
464 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + Vial
booster
465 Valproat sir 250 mg/5 ml Botol PT Ikapharmindo
466 Valproat tab sal 250 mg Tab sal PT Abbot I
467 Valproat tab sal 500 mg Tab sal
468 Vitamin B kompleks Tab PT Kimia Farma
Vitamin Neurotropik (Kombinasi: Vit B1 100mg,
469 Vit B6 200mg, Vit B12 200Mcg) Tablet salut gula
470 Zidofudin Tablet 100 mg Tablet PT Kimia Farma

471 Zinc sir 10 mg/ml Botol PT Indofarma
472 Zinc tab disp 20 mg Tab PT Kimia Farma
473 Zinc serb 10 mg Sachet
474 Zinc sir 20 mg/5 ml Botol PT Meprofarm
MULARIUM KABUPATEN
Harga Sesuai
Standar Harga
Harga Obat E
Pembakuan Berdasarkan KETERANGAN
katalog
Biaya Kegiatan Sumber Lain
Th 2015
2,200.00
3,849.00
338.00
86.00
199.50
4245.00
168.00
88.1 SK Menkes
436/MENKES/SK/XI/2013
90.00
80.00
3,822.00
112.00
330.00
187.00
SK Menkes
5050 436/MENKES/SK/XI/2013
4,045.00
2,445.00
211.00
272.00
5,100.00
200,000.00
85,000.00
102,990.00
1,363.00
1332 SK Menkes
148.9 436/MENKES/SK/XI/2013
SK Menkes
75.00
2,100.00
1,500.00
2,516.00
1717 SK Menkes
200 SK Menkes
3,045.00
520.00
22,000.00
38,999.00
116.00
148.00
159.00
95.00
84.00
48.00
46.95 SK Menkes
158.00 436/MENKES/SK/XI/2013
112.00
24,750.00
237.00
345.00
190.00
700.00
352.00
1,350.00
74.00
4,500.00
1,250.00
13,400.00
559.00
25,106.00
1,520.00
6,045.00
4,990.00
645.00
38.48 SK Menkes
43.96 SK Menkes
35490.4 SK Menkes
4,180.00 35490 436/MENKES/SK/XI/2013
SK Menkes
16,748.00 436/MENKES/SK/XI/2013
11,525.00
45.00
317.00
136.00
1,054.00
97.00
134.00
3,667.00
4,015.00
134.00
104.00
695.00
26,700.00
3,480.00
5,480.00
270.00
3,333.00
167.00
19,360.00
9,840.00
37.96 SK Menkes
3555.00
8,100.00
6174.00
497.00
7,700.00
930.00
7058.00
314.00
451.00
2,500.00
135935.00
16,667.00
80.92 SK Menkes
20,250.00 436/MENKES/SK/XI/2013
20,250.00
133.00
92.9 SK Menkes
1,800.00
220.00
47.00
290.00
510.00
65.00
3,417.00
634.00
30,493.00
32.88 SK Menkes
40.47 436/MENKES/SK/XI/2013
SK Menkes
1,892.00
85.00
285.00
3,399.00
2635.00
2,600.00
450 SK Menkes
82.00
56.00
265.00
436.00
3,000.00
37.00
1,500.00
5,333.00
5,700.00
1450 SK Menkes
5,200.00 436/MENKES/SK/XI/2013
219.00
449.55 SK Menkes
83,333.00
6,250.00
59.00
69.00
126.00
96.00
16,500.00
###
36750.00
55.00
2,798.00
4,500.00
1421.00
170,000.00
3,499.00
4,499.00
110.00
149.00
80,000.00
90,000.00
65.00
158.00
88.00
707 SK Menkes
7,800.00 436/MENKES/SK/XI/2013
43.3 SK Menkes
70.00
62.00
80.00
140.00
44,770.00
245.00
1666.00
2,024.00
1,580.00
300.00
4,700.00
361.00
553.00
900.00
2076 SK Menkes
184.00 436/MENKES/SK/XI/2013
3,400.00
6150
245.00
3,524.00
1,600.00
3,680.00
1598 SK Menkes
51.00 436/MENKES/SK/XI/2013
121001.00
1,100.00
1,050.00
144.00
68.00
500.00
850.00
3,950.00
2,089.00
1373 SK Menkes
135.00 436/MENKES/SK/XI/2013
50.00
5,990.00
12,450.00
149.00
2,145.00
6,200.00
670.00
540.00
14,500.00
2,000.00
36,300.00 Harga dr distributor
40,000.00
839.00
41,000.00
89.00
154.00
2,800.00
3,500.00
1025 SK Menkes
3396 436/MENKES/SK/XI/2013
SK Menkes
216 436/MENKES/SK/XI/2013
SK Menkes
7,140.00 436/MENKES/SK/XI/2013
6,125.00
1198 SK Menkes
112.50
197.50
800.00
2,750.00
154.00
205.00
3300 harga dr pabrik
108.00
5,280.00
999 SK Menkes 436/MENKES/SK/XI/2013
2,600.00
109.89 SK Menkes
9,950.00 436/MENKES/SK/XI/2013
3,850.00
4,100.00
3,220.00
110.00
160.00
3,000.00
17,820.00
708 Harga dr Pabrik

4,700.00
6,200.00
34.00
151 Harga dr pabrik

200.00
20350 Harga Pengadaan tahun lalu ditambah 10%
2997 SK Menkes
316 436/MENKES/SK/XI/2013
SK Menkes
2,800.00 436/MENKES/SK/XI/2013
100.00
480.00
52,000.00
214,900.00
359,900.00
###
160,000.00
171,195.00
288,199.00
2882.00
5000 harga dari internet

412.5 harga pengadaan tahun lalu ditambah 10%
797.5 harga dari pabrik

48,500.00
88046.00
27,550.00
29,000.00
1920 harga pengadaan 2 tahun lalu ditambah 20%
2,200.00
68,000.00
36,000.00
211.00
2,400.00
1,189.00
1380 harga pengadaan 2 tahun lalu ditambah 20%
1,438.00
89.00
990 Harga dari pabrik
5,200.00
23,000.00
11,475.00
8,360.00
296.00
206.00
1,000.00
17.4 SK Menkes
41.00 436/MENKES/SK/XI/2013
105 SK Menkes
2,163.00 436/MENKES/SK/XI/2013
5,998.00
14,203.00
37,109.00
86.00
205.00
7,190.00
319.00
86.00
106.00
1,140.00
120.00
260.00
459.00
610.00
790.00
1,100.00
5,200.00
1,008.00
313500 Harga pengadaan th lalu ditambah 10%
63,750.00
6,600.00
59.00
93 Harga dr Pabrik
2,000.00
509.00
1,000.00
8,800.00
859.00
2,950.00
3,300.00
283.602 SK Menkes No. 089/MENKES/III/2014
52,000,003 SK Menkes No. 089/MENKES/III/2014
7,999.00
181.00
1,078.00
57.00
114.8 SK Menkes
169.00 436/MENKES/SK/XI/2013
391.00
255.00
315.00
3,650.00
13,425.00
3441
726 Harga dr Pabrik
3,900.00
6,500.00
1,050.00
11,500.00
148.00
300.00
860.00
18191.00
80.92 SK Menkes
9,722.00 436/MENKES/SK/XI/2013
152,543.00
13,867.00
61.00
6,400.00
40,000.00
1,680.00
107.00
1,575.00
14,980.00
473.00
7,400.00
DAFTAR HARGA BAHAN MEDIS HABIS PAKAI
No Nama BMHP Satuan Pabrik Harga

1 Alat suntik sekali pakai 1 ml + jarum pcs JMI 650.00
2 Alat suntik sekali pakai 10 cc + jarum pcs JMI 925.00
3 Alat suntik sekali pakai 2.5 ml + jarum pcs JMI 650.00
4 Alat Suntik sekali pakai 20 cc tanpa jarum pcs JMI 1,500.00
7 Alat Suntik sekali pakai 50 cc tanpa jarum pcs JMI 3,400.00
8 Alcohol swab Box @ 100 JMI 10,000.00
9 Bioplacenton Tulle Pak 10x10 Enseval 104,000.00
10 Bisturi(Surgical blade (steril)) pcs Bbraun 300,000.00
11 blood tranfusion set pcs Prima AN 7,446.00
12 Catgut Chromic/benang bedah no. 2/0 - 3/0 rol
13 Catgut Chromic/benang bedah no. 2/0 + jarum Box/sase JMI 134000 (24bh)
14 Catgut Chromic/benang bedah no. 3/0 + jarum Box/sase JMI 134000 (24bh)
15 Catgut Plain / benang bedah no. 2/0 + jarum Box/sase JMI 134000 (24bh)
16 Catgut Plain / benang bedah no. 2/0 - 3/0 rol
17 Catgut Plain / benang bedah no. 3/0 + jarum Box/sase JMI 134000 (24bh)
18 Etakridin (Rivanol) Botol 300ml JMI 2,550.00
19 Etanol 70 % 1000 ml BOTOL JMI 21,500.00
20 ETT (endotracheal tube) No. 6 Pcs
21 ETT (endotracheal tube) No. 7 Pcs
22 ETT (endotracheal tube) No. 7,5 Pcs
23 Falopian tube ring (tuba ring) pcs
24 Foley Catheter 2 way No. 12 pcs JMI 8,000.00
33 Folley Catheter No. 10 Pediatrik pcs JMI 3,600.00
34 Folley Catheter No. 8 Pediatrik pcs JMI 3,600.00
35 Hecting needle (tanpa benang) untuk kulit pcs
36 Hecting needle (tanpa benang) untuk otot pcs
37 Hidrogen Peroksida Lar. 3 % BOTOL 100 ml
38 Implant Cardiovascular Pcs
39 Implant Orthopedi Pcs
40 Infusion set anak pcs Otsuka 7,920.00
41 Infusion set dewasa pcs Otsuka 7,920.00
42 IUD Pcs
43 IV catheter no 18 G pcs Otsuka 7,700.00
47 Kapas berlemak 500 gr pcs Surya Husada 20,000.00
48 Kapas pembalut / absorben 250 gr pcs Surya Husada 12,400.00
49 kasa hidrophil 40 y x 80 cm roll Surya Husada 104,500.00
50 Kasa Kompres 16x16 steril KOTAK @ 16 Lembar Surya Husada 5,750.00
51 Kasa Kompres 40x40 steril Lembar Surya Husada 1,550.00
52 Kasa Pembalut 2 mx 80 cm ROL Surya Husada
53 Kasa Pembalut 36 mx 80 cm ROL Surya Husada
54 kasa pembalut elastic 3 inch roll
55 kasa pembalut elastic 4 inch roll
56 Kasa Pembalut Hidrofil 4 y x 15 cm ROL Surya Husada 2,070.00
57 Kasa Pembalut Hidrofil 4 y x 3 cm ROL
58 Kasa pembalut hydrohil 4 y x 10 cm roll Surya Husada 1,480.00
59 Kasa pembalut hydrohil 4 y x 5 cm roll Surya Husada 740.00
60 Kasa Pembalut Hidrofil 4 m x 15 cm ROL
61 Kasa Pembalut Hidrofil 4 m x 3 cm ROL
62 Kasa pembalut hydrohil 4 m x 10 cm roll
63 Kasa pembalut hydrohil 4 m x 5 cm roll
64 Klorin Cair Lar. 5% BOTOL
65 Kondom Pcs MRB 16,000.00
66 Larutan Benedict 100 ml BOTOL 100 ml 36,300.00
67 Larutan Eosin 2 % 100 ml BOTOL 100 ml 363,000.00
68 Larutan Etanol asam 100 ml BOTOL 100 ml 90,750.00
69 Larutan Giemsa stain 100 ml BOTOL 100 ml 550,500.00
70 Larutan Iodine Test BOTOL 10ml 1,750.00
71 Larutan Karbol Fuksin 100 ml BOTOL 100 ml 90,750.00
72 Larutan Metilen Biru BOTOL 100 ml 90,750.00
73 Larutan Turk BOTOL 100 ml 48,400.00
74 Lisol Botol 1 L JMI 41,000.00
75 Lubricating Jelly 5 g sachet Smiths 2,080.00
76 Lubricating Jelly 82 g Tube Smiths 34,528.00
77 masker 3 Ply non woven ear loop box @ 50 Surya Husada 15,500.00
78 Masker 3 ply non woven tie on box @ 50 Surya Husada 15,500.00
79 Masker N95 single valve Buah
80 Matrix band (pita matriks) 5mm x 10mm pcs
81 Mucus extractor (penyedot lendir bayi baru lahir) Pcs
82 nelathon Catheter (10 Fr) pcs JMI 6,400.00
85 NGT No 8 Buah Bio Axion H 7,700.00
89 Pembalut gips roll
90 Pembalut pasca melahirkan Pcs
91 Plester (adhesive tape) roll
92 PP test Buah
93 Sacharum Lactis kaleng
94 Sarung tangan bedah steril No. 6 pasang Terumo 6,325.00
95 Sarung tangan bedah steril No. 6.5 pasang Terumo 6,325.00
100 Sarung tangan Gynecology Pasang 12,000.00
101 Sarung tangan periksa No. S,ML Box @ 100 JMI 46,200.00
102 Semen seng fosfat cairan/dental cement pcs
103 Semen seng fosfat serbuk/dental cement pcs
104 Silk (benang bedah sutera) no. 3/0 rol Enseval MP 717,750.00
105 Silk (benang bedah sutera) no. 3/0 + jarum pcs SMI 13,616.00
106 strip Test Asam Urat Pak @ 25 Test 300,000.00
107 Strip Test Glukosa Pak @ 50 Test 300,000.00
108 Strip Test Kolesterol Pak @ 10 Test 300,000.00
109 Suction tip pcs
110 Surgical blade (steril) pcs
111 Temporary Stopping Fletcher cairan Pcs
112 Temporary Stopping Fletcher serbuk Pcs
113 Test HIV I (Vikia) Buah
114 Test HIV II (intec) Buah
115 Test HIV III (Onco) Buah
116 Test Siphylis Buah
117 Umbilical Cord Klem Steril Nylon Box @ 50 JMI 50,000.00
118 Under pad (perlak sekali pakai) Pcs
119 Urine bag steril pcs JMI 3,000.00
120 Wing Needle no. 23 G pcs
Pabrik Harga Pabrik Harga Pabrik Harga
Terumo 1,540.0 Bio AH 748.0 Sinar RU 990.0
Terumo 1,790.0 Bio AH 1,188.0 Sinar RU 1,298.0
Terumo 3,080.0
Terumo 957.0 Bio AH 748.0 Sinar RU 792.0
Terumo 1,348.0 Bio AH 847.0 Sinar RU 979.0
Terumo 13,976.0
SMI 246535 (12 bh) Enseval MP 30,500.0

SMI 246535 (12 bh) Enseval MP 28,750.0
SMI 258447 (12bh) Enseval MP 30,500.0
Enseval MP 717,750.0
SMI 258447 (12bh) Enseval MP 24,583.0
Bbraun 17,670.0 Prima AN 3,023.0 JMI 3,500.0

Bbraun 17,391.0 Prima AN 2,930.0 JMI 3,200.0
RNI 7,334.0 Bbraun 8,750.0 Bio AH 5,500.0

RNI 7,334.0 Bbraun 8,750.0 Bio AH 5,500.0
RNI 7,334.0 Bbraun 8,750.0 Bio AH 5,500.0
RNI 7,334.0 Bbraun 8,750.0 Bio AH 5,500.0
Ahmadaris DRC 34,000.0


Ahmadaris DRC 800.0
Terumo 8,841.0
Terumo 10,010.0
Global D 6,595.0 Megah MP 7,865.0

Global D 6,595.0 Prima AN 4,558.0
Global D 6,595.0 Megah MP 7,865.0 Prima AN 4,558.0
Bio Axion H 39,600.0 Jembatan D 47,600.0
Bbraun 25,567.0
Pabrik Harga
Prima AN 700.0
Prima AN 1,230.0
Prima AN 739.0
Prima AN 816.0
MMP 6,435.0
Sinar RU 7,018.0
Sinar RU 7,018.0
Sinar RU 7,018.0
Sinar RU 7,018.0

Daftar Obat Forkab 2015

Uploaded by

Copyright:

Available Formats

Daftar Obat Forkab 2015

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Daftar Obat Forkab 2015

Uploaded by

Copyright:

Available Formats

DAFTAR HARGA OBAT E-KATALOG JAWA BARAT TAHUN 2015

No Nama Obat Generik Nama Dagang

1 ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida

Analog insulin mix insulininj 100 UI/ml, vial/cartridge

178 Faktor IX kompleks serbuk injeksi 1.000 UI/vial + pelarut 10

182 Faktor VIIa (rekombinan) serb inj 1 mg/vial + pelarut untuk

Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g

278 Human insulin intermediate acting inj 100 UI/ml,penfill

Imanitib Mesilat tablet salut selaput 100 mg (Skema Risk

384 Kombinasi: Levodopa 100 mg; Karbidopa 25 mg;

Larutan mengandung Asam Amino (Asam Amino 5%

Larutan mengandung Asam Amino (Asam Amino 7%,

Larutan mengandung Asam Amino (BCAA 25 gr/L, L-

Larutan mengandung Asam Amino (Kombinasi Asam

Larutan mengandung Asam Amino (Kombinasi Asam

Larutan mengandung Asam Amino (Kombinasi Asam

Larutan mengandung Elektrolit (Sodium Lactate sol (50%)

Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25

Larutan mengandung Karbohidrat + Elektrolit (Larutan

Larutan mengandung Lipid (Kombinasi Glukosa dan

448 Larutan mengandung Lipid (Kombinasi Glukosa dan

Larutan mengandung Lipid (Kombinasi Glukosa dan

Lenograstim inj 263 mcg/mL Granocyte 34 1vl HSA Free

Obat Antituberkulosis Kategori 1 dewasa n/a

Obat Antituberkulosis Kategori anak n/a

Oktreotid 10 mg Sandostatin LAR

Paket CAPD Awal (Komposisi: 1 unit Transfer Set, 2 unit

Larutan Dialisa 1.5%:

Pegylated Interferon alfa-2b serb inj 50 mcg Pegintron

Pegylated Interferon alfa-2b serb inj 80 mcg Pegintron Vial 80 Mcg

Trastuzumab serbuk injeksi 440 mg/vial (Skema Risk

Vaksin Hepatitis B Rekombinan (Harga pengadaan di

Vaksin Jerap DT (Adsorbed DT Vaccine) (Harga pengadaan

Vaksin Jerap Td (Adsorbed Td Vaccine) (Harga pengadaan

Vaksin Meningitis Meningokokus Menveo

Vaksin Poliomyelitis Oral (Harga pengadaan di

748 Vaksin rabies, untuk manusia serbuk injeksi s.k./i.k. +

PT. Kimia Farma 1 blister@24 tablet 1,375.00 4/23/2013 10:24

PT. Ikapharmindo Vial 100 ml 750,000.00 7/21/2014 21:09

Injeksi 100 IU/ml,

PT. Bayer Indonesia Penfill cartridge 97,500.00 3/18/2014 20:03

Injeksi 100 IU/ml,

PT. Indofarma Dus, 25 tube @ 5 g 2,516.00 3/15/2014 16:05

PT. Kimia Farma ktk 10 x 10 tablet 520 3/15/2014 16:05

Dus, 1 vial @0,5 ml+

PT. Kimia Farma Dus @ 5 vial 455,000.00 8/6/2014 18:35

Dus, 1 vial @ 1000

PT. Graha Farma Dual, vial 500 IU 4,400,000.00 12/11/2014 2:12

Dus, vial @ 250 IU+

PT. Phapros, Tbk Ds 10 str x 10's 510 9/28/2014 21:46

PT. Phapros, Tbk 10 X 10 290 1/5/2015 14:07

Dus, 2 flow wrap@

PT. Rama Emerald

PT. Bayer Indonesia Dus, vial 10 ml 138,000.00 4/3/2014 21:30

Injeksi 100 IU/ml,

PT. Aventis Pharma Dus, 1 Vial @ 5 ml 72,000.00 4/13/2015 15:52

PT. Aventis Pharma Dus, 1 Vial @ 5 ml 72,000.00 4/13/2015 15:52

Injeksi 100 IU/ml,

PT. Bayer Indonesia Dus, vial 10 ml 138,000.00 4/3/2014 21:30