Daftar Harga Obat Asuransi 24

JL.
Surabaya - Malang KM 50, Suwayuwo-Sukorejo-Pasuruan Tlp/Fax(0343) 639625

Email : rs_sahabat@rssahabat.com , Website : www.rssahabat.com, Kodepos:67161
DAFTAR HARGA OBAT DAN ALAT ALAT KESEHATAN

15 MARET 2018
Harga
No. Nama Obat dan Alkes Satuan
(Rp.)
1 AMINOPHYLLINE INJEKSI 10 CC (LMS) AMP 7,673
2 ASAM TRANEXAMAT INJEKSI 500 MG / ML (NV)-OGB AMP 8,593
3 BIOSAT 1.5 INJEKSI (MRP) AMP 204,600
BUCAIN SPINAL INJEKSI 20 MG/4 ML (bupivacaine
4 AMP 75,020
HCL) (BERN)
BUSCOPAN INJEKSI 20 MG/ML (hyocine N
5 AMP 40,821
butilbromide) (LMS)
6 CALCII GLUCONAS INJEKSI 100 MG/ML (LMS) AMP 27,848
7 CARBAZOCHROME INJEKSI 50 MG/10 ML (NV)-OGB AMP 16,259
8 CITICOLINE INJEKSI 250 MG/2 ML (NV)-OGB AMP 17,732
9 CORTIDEX INJEKSI (dexamethasone) (SN) AMP 7,898
10 DEXAMETHASON INJEKSI 1 ML (LMS) AMP 2,979
11 DEXKETOPROFEN 25 MG INJEKSI (NULAB) AMP 36,010
12 DEXPAIN INJEKSI (dexketoprofen) (NV)OGB AMP 47,740
13 DIAZEPAM 5 MG/ ML (2ML/AMPUL) AMP 24,800
14 DOPAMIN GUINILIN INJEKSI 200 (KF) AMP 96,844
15 DUROGESIC 12,5 MU MATRIX (KF)** AMP 155,496
16 EPHEDRIN HCL INJEKSI 50 MG/ML (MHK) AMP 34,100
17 EPINEPHRINE INJEKSI 0,1% (RS) AMP 15,345
18 ETHIGOBAL INJEKSI (mecobalamine) (GRD) AMP 27,860
19 GENTAMICIN INJEKSI (KF) AMP 4,578
20 GETIDIN INJEKSI (ranitidine) (GRD) AMP 25,916
21 GOTROPIL INJEKSI 3 GR (piracetam) (GRD) AMP 66,836
HERBESER POWDER INJEKSI 50 MG (diltiazem)
22 AMP 334,800
(AAM)
23 KEREN INJEKSI (dexketroprefen) (NULAB) AMP 66,018
24 KETOROLAC INJEKSI 30 MG (NV)-OGB AMP 16,573
25 LIDOCAIN 40 MG/2 ML BERNO (LMS) AMP 2,046
26 LIDODEX INJEKSI (lidocain) (BERN) AMP 75,020
27 MECOBALAMIN INJEKSI 500 MG AMP 10,912
28 METHYLPREDNISOLONE INJEKSI (PHAPROS) (LMS) AMP 64,108
29 METOCLORAMIDE INJEKSI (BERN) (LMS) AMP 5,456
30 METOLON INJEKSI (metoclopramide) (LMS) AMP 12,276
31 METVELL INJEKSI (methylergometrine) (NV)OBG AMP 11,765
32 MILOZ INJEKSI 5 MG (midazolam) (NV)ANS AMP 27,280
33 MORFINA INJEKSI 10 MG/ML (KF)** AMP 13,019
JL.Surabaya - Malang KM 50, Suwayuwo-Sukorejo-Pasuruan Tlp/Fax(0343) 639625
34 N-EPI INJEKSI (norepinephrine bitartrate) (NV)ANS AMP 111,600

35 NATRIUM CHLORIDA 25 ML (OTSU) AMP 6,820
36 NEUROSANBE INJEKSI (b1,b6,b12) (SN) AMP 6,431
37 NICARDIPINE HCL INJEKSI (NV)-OGB AMP 109,120
38 NUCOLINE INJEKSI (citicoline) (GRD) AMP 81,840
39 NUFIROM INJEKSI (cefopirom) (GRD) AMP 343,387
40 NUPOVEL INJEKSI 20 ML (propofol) (NV)ANS AMP 115,940
41 ONDANE INJEKSI 4 MG (ondasentron) (GRD) AMP 39,556
42 ONDANE INJEKSI 8 MG (ondasentron) (GRD) AMP 73,520
43 ONDANSETRON INJEKSI 4 MG (NV)-OGB AMP 9,548
44 ONDANSETRON INJEKSI 8 MG (NV)-OGB AMP 21,824
45 OTTOGENTA INJEKSI 80 MG (gentamycine) (OTTO) AMP 12,276
46 OXYLA INJEKSI (oxytocin) (NV)OBG AMP 15,686
47 PANTERA INJEKSI 40 MG (pantoprazole) (NULAB) AMP 187,277
48 PEHACAIN INJEKSI 2 ML (LMS) AMP 3,860
49 PETHIDIN HCL INJEKSI (KF)** AMP 16,357
50 PHENYTOIN INJEKSI 100 MG/2ML (NV)-OGB AMP 44,330
51 PIRACETAM INJEKSI 1 GR (NV)-OGB AMP 8,184
52 PIRACETAM INJEKSI 3 GR (NV)-OGB AMP 25,575
53 PLASMINEX INJEKSI (asam tranexamat) (SN) AMP 15,727
54 PROTERINE INJEKSI (isoxoprine) (NV)OBG AMP 25,916
55 RAIVAS INJEKSI (norepinephrine bitartrate) (DX) AMP 111,600
56 RANITIDIN INJEKSI 50 MG (NV)-OGB AMP 4,297
57 REGIVELL INJEKSI 4 ML (bupivacaine hcl) (NV)ANS AMP 81,840
58 SAGESTAM INJEKSI (gentamycine) (SN) AMP 12,303
59 SANKORBIN INJEKSI 1000 mg (ascorbat acid) (SN) AMP 34,045
60 SANPICILLIN INJEKSI (ampicillin) (SN) AMP 20,276
61 SANTAGESIK INJEKSI (metamizole) (SN) AMP 11,744
62 SCOPAMIN INJEKSI 20 MG/ML (OTT) AMP 19,505
63 SIBITAL 200 INJEKSI (penobarbital) (MRP)** AMP 12,276
64 STENIROL INJEKSI (methylprednisolone) (GRD) AMP 114,576
65 SULFAS ATROPIN INJEKSI (LMS) AMP 2,480
66 SYNTOCINON AMP 2 ML 10 AM AMP 15,376
67 TERANOL INJEKSI 30 MG (ketorolac) (GRD) AMP 47,740
68 TRADOSIK INJEKSI (tramadol) (SN)** AMP 24,763
69 URESIX INJEKSI (furosemide) (SN) AMP 10,557
70 VALISANBE INJEKSI (diazepam) (SN)** AMP 22,233
71 VITAMIN K (phitomenadion) INJEKSI (SRY) AMP 6,138
72 XEVOLAC INJEKSI 30 MG (ketorolac) (NV)ANS AMP 45,012
73 ZYFORT INJEKSI (b1,b6,b12) (NV)-OGB AMP 7,843
74 PHAROLIT SERBUK (oralite) (LMS) BKS 1,517
75 ALKOHOL SWAB ONEMED BOX 28,644
76 BIOSANBE KAPSUL (SN) BOX 1,147

77 CREAM PAGI ACNE 1 (KK) BOX 80,600
78 DIABETASOL COKLAT 180 GR BOX 45,260
79 DIABETASOL VANILA 180 GR (CTR) BOX 51,095
80 ENTRASOL GOLD 185 VANILA (CTR) BOX 42,605
81 ENTRASOL GOLD 370 PLAIN (CTR) BOX 53,823
82 HBSAG STRIP ANSWER 50 (MHK) BOX 343,728
83 ID BAND BABY BLUE ONEMED (3M) BOX 129,580
84 ID BAND BABY PINK ONEMED (3M) BOX 129,580
85 ID BAND DWS BLUE OM BOX 1,296
86 ID BAND DWS PINK OM BOX 1,240
87 IMP FF BABY AWAL 0-6 200 GRAM (FF) BOX 24,502
88 IMP FF BABY AWAL 0-6 400 GRAM (FF) BOX 49,600
89 NUTRIBABY ROYAL ACTIDUO 400 GR (BBL) BOX 132,334
90 NUTRICIA BEBELOVE 1 200 GR (BBL) BOX 41,214
91 NUTRICIA PRONUTRA 1 400 GR (BBL) BOX 120,304
92 SGM ANANDA (0-6 BULAN ) 120 GRAM (3RS) BOX 12,276
93 SUSU SGM BBLR 200 GRAM (3RS) BOX 43,681
94 ALBOTHYL CONCENTRATE 10 ML (LMS) BTL 47,740
95 ALERFED SYRUP 60 ML (pseudo,tripol) (GRD)** BTL 32,736
96 ALKOHOL 70% 1 L BRATACO BTL 37,510
97 ALKOHOL 95% 100 ML BTL 9,920
ALLETROL EYE DROPS (dexamethason, neomycin,
98 BTL 14,076
polymixin) (LMS)
99 ALLOCLAIR PLUS ORAL RINSE (APT) BTL 142,600
100 AMBROXOL SYRUP (PROMED) BTL 5,456
101 AMOXAN PAED DROP (amoxicillin) (SN) BTL 28,248
102 AMOXICILLIN DRY SYRUP 125 MG (HJ) (LMS) BTL 7,502
103 ANTASIDA DOEN SYRUP (LMS) BTL 12,951
104 BATUGIN ELIXIR 300 ML (KF) BTL 47,119
105 BIOTHICOL DRY SYRUP (thiamfenicol) (SN) BTL 26,462
BREATHY 0.9% TETES HIDUNG 30 ML (nacl)
106 BTL 24,800
(NV)PEDIA
107 BRIGHTENING FACIAL WASH (KK) BTL 62,248
108 CALDECE TABLET (SN) BTL 34,987
109 CEFADROXYL DRY SYRUP 250 MG (NV)OGB BTL 24,552
110 CEFIXIME DRY SYRUP 30 ML (NV)OGB BTL 37,510
111 CIPROFLOXACIN INFUS 200 MG (NV)-OGB BTL 70,680
112 CONSTULOZ SYRUP 120ML (lactulose) (AMS) BTL 95,480
113 COTRIMOXAZOL SUSPENSI (KF) BTL 6,712
114 CREAM PAGI 1 (KK) BTL 55,800
115 CREAM PAGI ACNE 2 (KK) BTL 86,800
116 CUPANOL SYRUP (paracetamol) (GRD) BTL 24,552

117 DEHIDRALYTE SOLUTION 200 ML (oralite) (NV)PEDIA BTL 20,460
118 dermalon 4.0 btl 273,073
DEXYCLAV DRY SYRUP (amoxocillin, clavulanic acid)
119 BTL 70,928
(DX)AB
DEXYCLAV DRY SYRUP FORTE (amoxocillin, clavulanic
120 BTL 104,346
acid) (DX)AB
121 DHAVIT SYRUP 60 ML (GRD) BTL 41,261
122 DOMPERIDONE SYRUP 60 ML (HJ) (LMS) BTL 15,686
123 DULCOLACTOL SYRUP BTL 78,120
124 ERYSANBE DRY SYRUP (erytromicin) (SN) BTL 27,826
125 ERYTROMICIN DRY SYRUP (KF) BTL 15,468
126 ETERFIX INFUS 50 ML (paracetamol) (NV)PEDIA BTL 61,380
127 EXTROPECT SYRUP (ambroxol) (GRD) BTL 34,782
128 FORUMEN EAR DROPS 10 ML (docusate sodium) (SN) BTL 32,259
129 GAS O2 - MP 6 M3 MP (SGI) BTL 62,000
130 GAS O2 - MR I M3 RELASI (SGI) BTL 31,000
131 HUSTADIN SYRUP (ctm,dmp,pseudo) (GRD) BTL 22,506
132 IKALEP TABLET (falproic acid) (IKAPH) BTL 5,882
133 ISPRINOL SYRUP 60 ML (methisoprinol) (NV)PEDIA BTL 102,300
LAXADINE SYRUP 60 ML (phenol,parafin,glycerin)
134 BTL -
(AMS)
135 LEFOS INFUS 500 MG/100 ML (levofloxacin) (GRD) BTL 382,602
136 LEOMOXYL 125 MG DRY SYRUP (amoxicillin) (GRD) BTL 27,962
LEOMOXYL FORTE 250 MG DRY SYRUP (amoxicillin)
137 BTL 44,262
(GRD)
138 LEVOFLOXACIN INFUS 100 (NV)-OGB BTL 109,120
139 LOOSE POWDER ACNE (KK) BTL 48,980
140 LOOSE POWDER NORMAL (KK) BTL 48,608
141 METRONIDAZOLE INFUS 100 ML (NV)-OGB BTL 49,377
142 MOIST FACIAL WASH (KK) BTL 62,248
143 MOISTURIZING CREAM (KK) BTL 63,364
144 MOLAFATE SUSPENSI (sucralfate) (MLX) BTL 25,234
145 MONELL DROP 10 ML (domperidon) (NV)PEDIA BTL 57,970
146 MONELL SUSPENSI 60 ML (domperidon) (NV)PEDIA BTL 57,970
147 NEBACETIN POWDER (LMS) BTL 22,940
NEOKAOMINAL SUSPENSI 60 ML (kaollin, pektin)
148 BTL 9,821
(MLX)
149 NIGHT CREAM ACNE 1 (KK) BTL 90,520
150 NIGHT CREAM ACNE 2 (KK) BTL 90,520
151 NIGHT CREAM C (KK) BTL 86,800
152 NIGHT CREAM D (KK) BTL 89,280
153 NIGHT CREAM K (KK) BTL 86,800

154 NUCEF DRY SYRUP (cefixime) (GRD) BTL 106,392
155 NUCRAL SUSPENSI 100 ML (sucralfate) (GRD) BTL 66,154
156 NULAGYL INFUS (metronidazol) (GRD) BTL 104,278
157 NYNDIA DROP (nistatin) (GRD) BTL 47,740
158 OBH ITRASAL SYRUP (LMS) BTL 5,866
159 OILY FACIAL WASH (KK) BTL 70,060
160 ONDANE SYRUP 60 ML (ondasentron) (GRD) BTL 111,439
161 OREZINC SYRUP 60ML (NV)PEDIA BTL 43,937
162 PARACETAMOL INFUS (NV)-OGB BTL 57,970
163 PARACETAMOL SYRUP 120 MG/5ML (LMS) BTL 3,080
164 PEHIDROL 3 % 800 ML (H2O2) ONEMED (3M) BTL 30,008
165 PLASBUMIN (albumin human) 20% USP (MPI) BTL 1,116,000
166 POVIDONE IODINE 1 LITER BRATACO (3M) BTL 90,024
167 PROFEN SUSPENSI (ibuprofen) (GRD) BTL 28,644
168 Q CEF DRY SYRUP (cefadroxyl) (GRD) BTL 61,380
169 RANIVEL SYRUP 60 ML (ranitidine) (NV)PEDIA BTL 75,020
170 RYVEL DROP 10 ML (cetirizin) (NV)PEDIA BTL 68,200
171 RYVEL SYRUP (cetirizin) (NV)PEDIA BTL 68,200
172 SAN B PLEX DROP (SN) BTL 21,824
173 SANBE KIDS EMULSION (SN) BTL 44,807
174 SANMAG SUSPENSI 120 ML (mg,al,simeticon) (SN) BTL 31,645
175 SANMOL DROPS 30 ML (paracetamol) (SN) BTL 19,710
176 SANPRIMA SYRUP 60 ML (trime,sulfa) (SN) BTL 32,190
177 STIK ASAM URAT EASY TOUCH (ROSTH) BTL 109,120
178 STIK GLUCOSA EASY TOUCH (ROSTH) BTL 102,300
179 STIK KOLESTROL EASY TOUCH (ROSTH) BTL 197,780
180 SUNSCREEN FOUNDATION SPF 50 (KK) BTL 62,744
181 SUNSCREEN LOTION SPF 30 (KK) BTL 53,816
182 SUNSCREEN LOTION SPF 50 (KK) BTL 56,296
THIAMFILEX DRY SYRUP 125 MG (thiamfenicol)
183 BTL 8,866
(MLX)
184 TONER OILY (KK) BTL 58,032
185 TRILAC INJEKSI (triamcinolone) (NV) BTL 136,400
186 ULTRASONIC GEL 250 ML ONEMED (3M) BTL 17,732
187 VELLEPSY SYRUP 120 ML (falproic acid) (NV)PEDIA BTL 102,300
188 VOSEDON SUSPENSI (domperidon) (SN) BTL 36,828
189 VOSTRIN DRY SYRUP 60 ML (erdoestein) (NV)-PEDIA BTL 51,150
190 WIDAL SALMONELLA 4 (O, H, AH, BH) (SAM) BTL 545,600
191 XE SKIN 30 GR (XP) BTL 54,560
192 ZAMEL DROP 16 ML (NV)PEDIA BTL 45,012
193 ZAMEL SYRUP 60 ML (NV)PEDIA BTL 45,012
194 ZIBRAMAX DRY SYRUP (azitromicyn) (GRD) BTL 120,509

195 ACETYLCYSTEINE 200 MG (NULB) CAP 1,228
196 CALOMA PLUS SOFT (NV)OBG CAP 3,751
197 CEFADROXYL CAPSUL 500 MG (DX) CAP 1,042
198 CEFIXIME 100 MG KAPSUL (NULB) CAP 2,969
199 CHANNA CAPSUL (ext. ophiocephalus striatus) (KF) CAP 8,252
200 DOXYCYCLINE KAPSUL 100 MG (LMS) CAP 450
201 ETHIGOBAL KAPSUL (mecobalamine) (GRD) CAP 2,933
202 EVOTHYL CAPSUL 100 MG (fenofibrate) (GRD) CAP 6,302
203 EVOTHYL CAPSUL 300 MG (fenofibrate) (GRD) CAP 16,354
204 FENOFIBRATE CAPSUL 300 MG (HJ) (LMS) CAP 5,456
205 GABAPENTIN KAPSUL 300 MG (NULAB) CAP 6,015
206 GALEPSI CAPSUL 300 MG (gabapentin) (GRD) CAP 13,367
207 GEMFIBROZIL CAPSUL 300 MG (LMS) CAP 677
208 HEPA BALANCE CAP 6,820
209 INDANOX KAPSUL 300 MG (clindamicyn) (GRD) CAP 5,551
210 INHIPRAZ 30 CAPSUL (lansoprazole) (BERNO) CAP 16,368
211 LANSOPRAZOLE CAPSUL 30 MG (NV)OGB CAP 1,676
LEXATRANS CAPSUL 500 MG (asam tranexamat)
212 CAP 1,719
(MLX)
213 MECOBALAMIN KAPSUL 500 MCG (NV)OGB CAP 955
214 NORSEC CAPSUL (omeprazole) (GRD) CAP 17,855
215 NUCEF KAPSUL 100 MG (cefixime) (GRD) CAP 25,234
216 NULACTA CAPSUL (GRD) CAP 5,456
217 NULACTA PLUS CAPSUL (GRD) CAP 7,952
218 OMEPRAZOLE CAPSUL 20 MG (NV)OGB CAP 506
219 PHENYTOIN CAPSUL (IKAPH) CAP 750
220 PROLACTA FOR MOTHER (NV)OBG CAP 6,479
221 PROLIC KAPSUL 300 MG (clindamycin) (SN) CAP 9,092
222 Q CEF CAPSUL 500 MG (cefadroxyl) (GRD) CAP 61,380
223 SANGOBION CAPSUL (LMS) CAP 1,350
224 SICLIDONE CAPSUL 100 MG (doxycycline) (SN) CAP 6,643
225 STARCEF CAPSUL 100 MG (Cefixime) (DX)AB CAP 26,257
226 THIAMFILEX CAPSUL 500 MG (thiamfenicol) (MLX) CAP 1,500
227 TRADOSIK CAPSUL (tramadol) (SN)** CAP 4,931
228 URSODEOXYCOLIC ACID CAPSUL 250 MG (NV)OGB CAP 5,729
229 URSOLIC 250 MG CAPSUL (ursodeoxycolic) (GRD) CAP 12,412
UTROGESTAN TABLET 100 MG (Micronised
230 CAP 14,322
Progesterone) (LP)
231 VITAMAM 1 KAPSUL (NV)OBG CAP 4,092
234 FUNGASOL CREAM (ketokonazole) (GRD) CRM 33,418

235 MICONAZOLE CREAM 2% (KF) (LMS) CRM 4,433
236 MOLAVIR CREAM 5% 5 GRAM (MLX) CRM 10,639
237 AMINOFLUID L 500 ML (OTSU) FLS 83,811
238 AQUABIDEST / WATER FOR INJ 25 ML (OTSU) FLS 7,911
239 ASERING- 5 INFUS 500 ML (OTSU) FLS 33,009
240 BEFLUID INFUS 500 ML (OTSU) FLS 255,750
241 COMBIVENT NEBULES (Ipratropium Bromida) (LMS) FLS 20,416
242 DEXTROSE 1/2 NS (D5% 1/2) (WIDA) FLS 12,122
243 DEXTROSE 1/4 NS (D5 1/4) (OTSU) FLS 20,869
244 DEXTROSE 10 % (WIDA) FLS 9,300
245 DEXTROSE 40% (D40%) (OTSU) FLS 12,412
246 DEXTROSE 5 % (D5%) (WIDA) FLS 9,412
247 DEXTROSE 5% + NS (OTSU) FLS 18,005
248 INSTO EYE DROPS (LMS) FLS 13,504
249 KAEN 3B INFUS (OTSU) FLS 13,264
250 KAEN 4B INFUS (OTSU) FLS 27,280
251 KAEN MG3 INFUS (OTSU) FLS 11,904
252 KCL INFUS 25 ML (OTSU) FLS 3,843
253 KONICARE MINYAK PUTIH 60 ML (LMS) FLS 12,822
254 KONICARE MINYAK TELON 60 ML (LMS) FLS 12,822
255 MANITOL INFUS (OTSU) FLS 120,305
256 MEYLON 8.4% 25 ML (OTSU) FLS 7,688
257 MGSO4 20% 25 ML (OTSU) FLS 12,412
258 MGSO4 40% 25 ML (OTSU) FLS 4,707
259 MINYAK TAWON CC (LMS) FLS 20,460
260 NATRIUM CHLORIDA (PZ) 100 ML (OTSU) FLS 18,823
261 NATRIUM CHLORIDA (PZ) 1000 ML (WIDA) FLS 25,780
262 NATRIUM CHLORIDA (PZ) 500 ML (WIDA) FLS 7,948
263 RD INFUS (WIDA) FLS 17,129
264 RD5% INFUS (OTSU) FLS 21,960
265 RINGER LACTAT INFUS (RL) 500ML (WIDA) FLS 8,866
266 WIDAHES 130 INFUS 500 ML (WIDA) FLS 82,506
267 AQUABIDEST DM 20 LT (BRATACO) GLN 93,000
268 DEVELOPER (AUM) GLN 992,000
269 FIXER (AUM) GLN 806,000
270 MINOSIL HANDRUB 5 L (LMS) GLN 1,350,360
271 ULTRASONIC GEL 5 LTR GLN 214,830
272 ASERING SOFTBAG 500 ML (OTSU) INF 11,961
273 FUTROLIT INFUS (SN) INF 72,224
274 BENDERA KENTAL MANIS 385 ML KAL 13,606
275 LACTAMAM KAPLET (NV)OBG KAP 4,092
276 NUZYM KAPSUL (co enzym Q10) (GRD) KAP 8,184

HIBICET5 LT (chlorhexidine gluconate, Setrimida
277 LT 1,343,540
(ROSTH)
278 RC10 T ROLL CHROMIC 2-0 100 M (TRITON) M 17,050
279 RC11 T ROLL CHROMIC 2 75 M (TRITON) M 22,733
282 ASEPTIC GELL 5000 ML ONEMED (3M) ML 61
283 KTM-100 MG INJEKSI 10 ML (ketamin) (GRD) ML 248,248
284 B-Z CLEANSER 70 ML (SWITCH OGG LIQUID) (SAM) PAC 1,091,200
285 HEMOLYSIN (LYSE) (SAM) PAC 3,205,400
286 HYPERPHEP INJEKSI (0.5 ML) DIPA (PPG) PAC 1,612,000
287 PRODE CLEANER 50 ML (SAM) PAC 682,000
288 PURPLE CAP K3 EDTA 3 ML @100 (SAM) PAC 3,137
289 RED CAP PLAIN @100 (NO ADDITIVE) (SAM) PAC 313,720
290 STIKPAN PLASTIK LOKAL PAC 37,200
291 3 WAY STOPCOCK JMS (ROTH) PCS 49,104
292 ABBOCATH NO. 26 (ROSTH) PCS 55,413
293 AKURAT TEST KEHAMILAN (LMS) PCS 11,253
294 ALANINE AMINOTRANSFERASE REAGENT LAB (SAM) PCS 818,400
295 ARM SLING AUDY (L) (3M) PCS 25,234
296 ARM SLING AUDY (M) (3M) PCS 25,234
ASPARTATE AMINOTRANSFERASE REAGENT LAB
297 PCS 818,400
(SAM)
298 BLOOD LANCET ONEMED (3M) PCS 20,733
299 BLOOD SET OB - 1 OTSUKA (ROSTH) PCS 43,648
300 BLOOD UREUM NITROGEN (SAM) PCS 1,364,000
301 BP9 T DIO 3-0, 1 (TRITON) PCS 187,550
302 C27 T CHROMIC CATGUT CHROMIC 2-0 (TRITON) PCS 81,840
303 C43 T CHROMIC CATGUT CHROMIC 3-0 (TRITON) PCS 75,020
304 CANGKANG KAPSUL NO. 0 (BRT) PCS 124
309 CLEANSER REAGENT LAB (SAM) PCS 1,295,800
310 CREATININE REAGENT LAB (SAM) PCS 477,400
311 CRYSTAL HBsAg (device) (SAM) PCS 868,000
312 DERMAFIX T 10 X 25 ONEMED (3M) PCS 26,598
313 DILUENT REAGENT LAB (SAM) PCS 2,046,000
314 DIRUI H10 - urine Strip - 10 Parameters (SAM) PCS 491,040
315 DUMIN RECTAL 12 5MG / 2.5 ML (ACT) PCS 17,495
316 ELEKTRODE ECG 3M (ROSTH) PCS 4,894

317 ENDOTRACHEAL TUBE (ETT) 5,5 PORTEX (3M) PCS 24,800
318 ENDOTRACHEAL TUBE (ETT) 6 PORTEX (3M) PCS 24,800
319 ENDOTRACHEAL TUBE (ETT) 7 PORTEX (3M) PCS 86,800
320 ENDOTRACHEAL TUBE (ETT) 7,5 PORTEX (3M) PCS 24,800
321 EXTENSION TUBE 2.5 ML 75 CM TERUMO (3M) PCS 22,915
322 FEEDING TUBE NO. 5 ; 40 CM (ROSTH) PCS 47,740
323 FEEDING TUBE NO. 8 (ROSHT) PCS 52,514
324 FOLEY CATHETER 3 WAY RUSCH NO 22 (ROSTH) PCS 74,400
325 FOLLEY CATETHER NO. 14 (RS) PCS 18,600
326 FOLLEY CATETHER NO. 18 (RS) PCS 16,368
327 FOLLEY CATHETER 3 WAY RUSCH NO 24 (3M) PCS 115,940
328 FOLLEY CATHETER NO. 16 COSMO (3M) PCS 14,632
329 GELITA SPON (ROSTH) PCS 86,800
330 GUEDEL AIRWAY 1 / 6 CLEAR RUSH HITAM (MAYO) PCS 115,940
331 GUEDEL AIRWAY 2 / 7 CLEAR RUSH PUTIH (MAYO) PCS 115,940
332 GUEDEL AIRWAY 3 / 8 CLER RUSH HIJAU (MAYO) PCS 115,940
333 GUEDEL AIRWAY 5 / 10 CLEAR RUSH MERAH (MAYO) PCS 115,940
334 HALOGEN LAMP (SAM) PCS 1,636,800
335 HANDSCON NON STERIL MAXTER EXAM GLOVE UK. L PCS 682
336 HANDSCON NON STERIL MAXTER EXAM GLOVE UK. M PCS 682
337 HANDSCON NON STERIL MAXTER EXAM GLOVE UK. S PCS 682
338 HANDSCON NON STERIL SENSI GLOVE UK. L (3M) PCS 806
339 HANDSCON NON STERIL SENSI GLOVE UK. S (3M) PCS 764
340 HANDSCON STERIL GYNOLOG NO. 7,5 (ROSTH) PCS 43,648
341 HANDSCON STERIL MAXTER NO. 6,5 PCS 5,183
342 HANDSCON STERIL MAXTER NO. 7 PCS 5,183
343 HANDSCON STERIL MAXTER NO. 7.5 PCS 5,183
344 HANDSCON STERIL MAXTER NO. 8 PCS 5,251
345 HANSAPLAST PLESTER STANDART PCS 409
346 HDL CHOLESTEROL (SAM) PCS 1,860,000
347 HR30 SILKAM 0 B BRAUN (RS) PCS 99,200
348 INFLO IV CATH / ABBOCATH NO. 24 (ROSTH) PCS 32,736
349 INFUS SET ANAK TERUMO PCS 25,916
350 INFUS SET DEWASA TIPE Y NIPRO PCS 8,593
351 INJECTION PLUG (INSTOPPER) B BRAUND (3M) PCS 8,184
352 INNOMED FOAM DRESSING 10X10CM PCS 47,120
353 IV CATH SURFLO NO. 16 TERUMO PCS 29,760
358 KASA STERIL 16X16 HEXA HUSADA (3M) PCS 4,774

359 KERTAS LAKMUS BIRU PCS 43,400
360 KERTAS LAKMUS MERAH PCS 43,400
361 KERTAS PUYER PCS 124
362 LAMINARIA L (ROSTH) PCS 179,800
363 LEVEMIR FLEXPEN (NOVO) PCS 104,098
364 LOMATUEL (ROSTH) PCS 17,732
365 M130 T MONO 2-0 90 CM (TRITON) PCS 147,039
366 M49 T MONO POLYGLECAPRONE 1 90 CM (TRITON) PCS 156,860
367 MASKER + NASAL O2 NRBM ANAK PCS 40,920
368 MASKER + NASAL O2 NRBM DEWASA PCS 65,199
369 MASKER DIAPRO JILBAB PCS 450
370 MASKER DIAPRO KARET PCS 496
371 MASKER DIAPRO TALI PCS 546
372 MASKER NEBULIZER ANAK PCS 35,464
373 MASKER NEBULIZER DEWASA PCS 35,464
374 MASKER O2 ANAK PCS 18,600
375 MASKER O2 BAYI PCS 16,368
376 MASKER O2 DEWASA PCS 18,600
377 MESS NO. 10 (ROSTH) PCS 4,774
381 MICROLAX GELL TUBE RECTAL 5 ML (LMS) PCS 25,575
382 MUCUS EXTRACTOR JMS (3M) PCS 49,104
383 N32 T NYLON 3-0 76 CM (TRITON) PCS 73,520
384 N46 T NYLON 5-0 76 CM (TRITON) PCS 75,020
385 NASAL CANULA O2 ANAK PCS 10,503
386 NASAL CANULA O2 BAYI PCS 10,503
387 NASAL CANULA O2 DEWASA PCS 10,503
388 NEEDLE NO. 23 TERUMO PCS 2,232
391 NEOFLON IV CATH NO. 26 (3M) PCS 55,413
392 NOVA T 380 (BAYER) (AAM) PCS 223,200
393 NOVO TWIS 32G (NOVO) PCS 2,583
394 NOVOMIX 30 FLEXPEN (NOVO) PCS 136,400
395 NOVORAPID FLEXPEN (NOVO) PCS 107,880
396 RIGID ADJUSTABLE COLLAR PCS 266,600
397 S24 T SILK 2-0 76 CM (TRITON) PCS 54,560
398 S25 T SILK 2-0 76 CM (TRITON) PCS 66,018
399 S84 T-SILK 1 90 CM (TRITON) PCS 54,560
400 SAGESTAM SALEP MATA (gentamycine) (SN) PCS 46,171

401 SAGESTAM TETES MATA (gentamycine) (SN) PCS 36,351
402 SCALVEIN NO.27 TERUMO (ROSTH) PCS 25,234
403 SENSITIF TEST PACK (KU) PCS 27,280
404 SPALK BAYI 10 X 5 WINZY (3M) PCS 6,138
405 SPALK BAYI 15 X 5 WINZY (3M) PCS 8,184
406 SPALK KAKI 80 X 10 WINZY (3M) PCS 36,828
407 SPALK KAKI 90 X10 WINZY (3M) PCS 21,080
408 SPINOCAN NO. 26 (3M) PCS 39,680
409 SPINOCAN NO. 27 (3M) PCS 47,120
410 SPUIT 1 CC TUBERCULIN TERUMO PCS 8,730
411 SPUIT 10 CC NIPRO PCS 1,610
412 SPUIT 20 CC TERUMO PCS 17,323
413 SPUIT 3 CC NIPRO PCS 982
414 SPUIT 3 CC TERUMO (3M) PCS 6,274
415 SPUIT 5 CC NIPRO PCS 1,214
416 SPUIT 50 CC LUBANG PINGGIR NIPRO PCS 6,970
SPUIT 50 CC LUBANG TENGAH TERUMO (catheter
417 PCS 54,560
trip)
STESOLID 10 MG/2.5ML RECTAL TUBE (diazepam)
418 PCS 48,613
(ACT)
STESOLID 5 MG/2.5ML RECTAL TUBE (diazepam)
419 PCS 32,409
(ACT)
420 STOMACH TUBE NO. 12 TERUMO (ROSTH) PCS 47,740
422 STOMACH TUBE NO. 16 TERUMO (3M) PCS 45,830
424 SUCTION CATH NO. 8 HOSPITECH (3M) PCS 9,548
425 SUCTION CATH NO.12 HOSPITECH (3M) PCS 9,548
426 SUCTION CATH NO.16 HOSPITECH (3M) PCS 9,548
427 SUSU SGM LLM 200 GRAM (3RS) PCS 40,812
428 T VIO 3-0 (RS) PCS 110,980
429 TEMPRATUR SUHU BADAN PCS 22,320
430 TENSI DIGITAL HEM 7120 (OMRON) PCS 527,000
431 TES KEHAMILAN ONEMED (LMS) PCS 2,728
432 UMBILICAL CORD CLAMP JMS PCS 47,740
433 UNDERPAD 60 X 90 NON STERIL SENSIPAD (3M) PCS 5,704
434 UNDERPAD STERIL 60 X 90 ONEMED (3M) PCS 10,912
435 URINAL PEREMPUAN (RS) PCS 12,400
436 URINE BAG STERILE GEA (3M) PCS 5,592
437 V15 T VIO 1 (TRITON) PCS 124,533
438 V16 T VIO 1 (TRIT0N) PCS 121,396
439 VASOFIX IV CHAT NO. 22 (3M) PCS 10,850

440 X RAY FILM FUJI GREEN 30 X 40 (3M) PCS 39,529
441 X RAY FILM FUJI GREEN 35 X 35 (3M) PCS 39,529
442 GYPSONA 3'' S01 33,775
443 GYPSONA 4'' S01 47,286
444 GYPSONA 6'' S01 62,007
445 JARUM HEATING CUT NO. 24 SE TH (ROSTH) S01 13,950
446 JARUM HEATING CUT NO. 28 SE TH (ROSTH) S01 13,950
447 JARUM HEATING NO. 18 SE TH (ROSTH) S01 13,950
448 JARUM HEATING NO. 21 SE TH (ROSTH) S01 13,950
449 JARUM HEATING ROUND NO. 28 SE TH (ROSTH) S01 13,950
450 T-PLAIN 3-0 75 RB S01 64,480
451 PAKET OPERASI SC BHP DAN OBAT RS S32 1,736,000
452 FM CREPE 3" (3M) S38 74,202
453 FM CREPE 4" (3M) S38 88,387
454 FM CREPE 6" (3M) S38 124,387
455 HYPAFIX 10 CM X 5 M (3M) S38 138,386
456 HYPAFIX 15 CM X 5 M (3M) S38 191,282
457 KAPAS 1000 GR (3M) S38 69,905
458 KAPAS 250 GR (3M) S38 17,050
459 KASA 40 x 80 HYDROPIL ASIH HUSADA (ROSTH) S38 170,500
460 KERTAS EKG FUKUDA 30 X 50 S38 24,552
461 KERTAS USG SONNY UPP-110HG S38 351,912
462 LEUKOPLAST 1625 HP (3X5) (3M) S38 50,858
463 POLIBAND 4" S38 27,553
464 POLIGYP 4" S38 39,829
465 VERBAN 10 CM (ROSTH) S38 2,581
466 VERBAN 5 CM (ROSTH) S38 1,173
467 FISHERMANS ANISEED 1/12/24/25 GR (AAM) SAC 11,445
468 L BIO SACHET (LAPI) SAC 8,184
469 LACBON GRANUL SACHET 1 GR (KF) SAC 1,951
470 LACTO B SACHET (NV)PEDIA SAC 7,366
471 N90 T NYLON 2-0 76 CM (TRITON) SAC 72,292
472 NEO MUNE 40 GR (OTSU) SAC 391,468
473 PAN ENTERAL 40 GR (OTSU) SAC 279,620
474 PROTEN RASA VANILLA (OTSU) SAC 13,231
475 SEQUEST SACHET (cholestyramine) (NV)PEDIA SAC 25,575
476 ALAT TEST GCU EASY TOUCH (3M) SET 272,800
477 ANTIHEMOROID SUPP (KF) SUP 4,092
478 DULCOLAC SUPP 10 MG ADULT/DEWASA (LMS) SUP 26,799
479 NAZOVEL SUPPOSITORIA (ketoprofen) (NV)OBG SUP 20,255
480 TRICHODAZOL PLUS OVULA (metronidazol,nistatin) SUP 16,573
(SN)
481 CEFADROXIL 125MG/60ML SYRUP SYR 10,169
482 ACYCLOVIR TABLET 200MG (NV) OGB TAB 601
483 ACYCLOVIR TABLET 400 MG (NV)OGB TAB 782
484 ADALAT OROS TABLET (KU) TAB 11,048
485 ALERFED TABLET (pseudo,tripol) (GRD)** TAB 2,311
486 ALGANAX TABLET 0,5 MG (alprazolam) (GRD)** TAB 4,126
487 ALINAMIN FORTE TABLET (LMS) TAB 1,137
488 ALLOPURINOL TABLET 100 MG (HJ) (LMS) TAB 252
489 ALLOPURINOL TABLET 300 MG (HJ) (LMS) TAB 341
490 ALPARA TABLET (pct, pp, ctm, dmp) (MLX) TAB 847
491 ALPRAZOLAM TABLET 1 MG (KF)** TAB 1,116
492 AMBROXOL TABLET 30 MG (NV)OGB TAB 262
493 AMITRIPTYLLINE TABLET 25 MG (YR) TAB 232
494 AMLODIPINE TABLET 10 MG (NULAB) TAB 2,100
495 AMLODIPINE TABLET 5 MG (NULAB) TAB 1,190
496 AMOXICILLIN TABLET 500 MG (HJ) (LMS) TAB 459
497 ANALSIK TABLET (methamphyron, diazepam) (SN)** TAB 1,882
498 ANTASIDA DOEN TABLET (LMS) TAB 225
499 ASAM MEFENAMAT TABLET 500 MG (PROMED) TAB 525
ASPILET CHEWABLE TABLET (acetylsalicylic acid)
500 TAB 723
(KF)
501 ATAROC TABLET 25 MG (NV)PEDIA TAB 2,933
502 ATORVASTATIN TABLET 10 MG (LMS) TAB 3,410
503 ATORVASTATIN TABLET 20 MG (NV)OGB TAB 5,456
504 ATORVASTATIN TABLET 40 MG (NV)OGB TAB 5,456
505 AVIL TABLET TAB 2,138
506 AVODART TAB TAB 11,843
507 AZITROMYCIN 500 MG TAB OGB TAB 12,276
BAMGETOL TABLET 200 MG (carbamazepine)
508 TAB 2,455
(MERSI)
509 BDM TABLET 5X10 TAB 2,455
510 BECOM C TABLET (SN) TAB 1,678
511 BECOM ZET TABLET (SN) TAB 2,237
512 BETAHISTIN TABLET 6 MG (NV)OGB TAB 1,146
513 BEVIZIL TAB TAB 1,860
514 BIO ATP TAB TAB 2,768
515 BIOTHICOL CAPSUL 500 MG (thiamfenicol) (SN) TAB 4,617
516 BISACODYL TABLET 5 MG (NV)OGB TAB 464
517 BISOLVON 8 MG TABL TAB 2,253
518 BISOPROLOL FUMARATE TABLET 5 MG (NV)OGB TAB 2,879
519 BLEDSTOP TAB TAB 702
520 BODREXIN TAB TAB 198

BRAXIDIN TABLET (chlordiazepoxide, clidinium)
521 TAB 1,173
(SN)**
522 BRONKRIS TAB TAB 118
BUSCOPAN TABLET 10 MG (hyocine N butilbromide)
523 TAB 3,685
(LMS)
524 CALOS CHEWABLE TAB TAB 1,066
525 CALSIFAR TAB TAB 159
526 CANDESARTAN TABLET 16 MG (NV)OGB TAB 8,866
527 CANDESARTAN TABLET 8 MG (NV)OGB TAB 6,138
528 CAPTOPRIL TABLET 25 MG (HJ) (LMS) TAB 171
529 CAVIPLEX TAB TAB 521
530 CEDANTRON TAB TAB 21,784
531 CEFIXIME 200 MG KAPSUL (NV) TAB 5,001
532 CETIRIZINE TABLET 10 MG (NV)OGB TAB 389
533 CHLORPROMAZINE TABLET (CPZ) TAB 930
534 CIFLOS TABLET 500 MG (ciprofloxacin) (GRD) TAB 17,186
535 CIMETIDIN TAB OGB TAB 177
536 CINULA TAB TAB 5,281
537 CIPROFLOXACIN TABLET 500MG (NV)OGB TAB 827
538 CITAZ 100 TAB TAB 13,590
539 CITICOLINE TABLET 500 MG (NV)OGB TAB 8,184
540 CLARITIN TAB TAB 8,258
541 CLIAD TABL TAB 2,237
542 CLINDAMYCIN CAPSUL 150 MG (NV)OGB TAB 988
543 CLINDAMYCIN CAPSUL 300 MG (NV)OGB TAB 1,706
544 CLOBAZAM 10 MG TABLET (DX) (AAM)** TAB 1,178
545 CLOMIFENE 50MG TAB TAB 7,876
546 CLOPIDOGREL TABLET 75 MG OGB (LMS) TAB 6,002
547 CODEIN TABLET 15 MG (KF)** TAB 1,273
548 CODEIN TABLET 20 MG (KF)** TAB 2,013
549 CODIKAF TABLET 20 MG (codein) (KF)** TAB 2,128
550 CODIPRONT KAPSUL (KF)** TAB 10,199
551 CODITAM TABLET (paracetamol, codein) (KF)** TAB 5,592
552 COLFIN TAB TAB 653
553 CONCOR 2,5 MG TAB TAB 7,852
554 CORTIDEX TABLET (dexamethasone) (SN) TAB 355
555 COTRIMOXAZOL TABLET (LMS) TAB 409
556 CRAVIT TAB TAB 45,880
557 CROFED TAB TAB 1,223
558 CTM TABLET 4 MG (LMS) TAB 66
559 CURCUMA TABLET (LMS) TAB 1,180
560 DANSERA TAB TAB 5,905

561 DEMACOLIN TAB TAB 454
562 DEPAKOTE TAB TAB 14,334
563 DEXAMETHASONE TABLET 0,5 MG (PROMED) TAB 150
564 DEXANTA TAB TAB 210
DEXTEEM PLUS TABLET (dexchlorpheniramine
565 TAB 471
Maleat, dexamethasone) (LMS)
566 DEXTRAL FORTE TABLET (dmp, gg, pp, ctm) (MLX) TAB 989
567 DEXTRAL TABLET (dmp, gg, pp, ctm) (MLX) TAB 627
568 DIGEST TABL 30 MG TAB 2,026
569 DIGOXIN TABLET 0.25 MG (YR) (LMS) TAB 177
570 DILTIAZEM 30 MG TAB OGB TAB 248
571 DIMENHIDRINATE 50 MG TABLET (KF) TAB 177
572 DISOLF TAB TAB 8,060
573 DISUDRIN TABLET TAB 668
574 DOMPERIDONE TABLET 10 MG (NULAB) TAB 551
575 DOPAMET 250 MG TABLET(Methyldopa) (ACT) TAB 2,551
576 DORBIGOT TAB 500 TAB 2,567
577 DUVADILAN TABLET TAB 7,502
578 ELKANA TAB TAB 868
579 EPERISONE HCL TABLET 50MG (NV)OGB TAB 3,819
580 ERAPHAGE TABLET (metformin) (GRD) TAB 1,684
581 ERYSANBE KAPLET (500 MG (erytromicin) (SN) TAB 3,355
582 ERYTROMICIN TABLET 500 MG (LMS) TAB 1,550
583 ETAFLOX TAB TAB 471
584 ETHAMBUTOL TABLET 500 MG (KF) TAB 854
585 EUTHYROX TABLET 100 MG (KU) TAB 2,976
586 EXAFLAM TABLET 50 MG (natrium diklofenak) (GRD) TAB 3,601
587 EXTROPECT TABLET (ambroxol) (GRD) TAB 1,500
588 EYEVIT TAB TAB 4,428
589 FARGOXIN TAB TAB 374
590 FARSIX 40 MG TABLET TAB 1,257
591 FARSORBID 5 MG TABLET TAB 167
592 FASORBID TABLET 5 MG (KL) TAB 213
593 FLAMAR 50MG TAB TAB 2,046
594 FLASICOX TAB TAB 831
595 FLUNARIZIN TABLET 10 MG (NULAB) TAB 1,876
596 FLUNARIZINE TABLET 5 MG (NULAB) TAB 1,705
597 FOLAVIT TABLET 400 IU (asam folat) (SN) TAB 1,050
598 FORASMA 2.5MG TAB (terbutalin sulfate) (GRD) TAB 1,637
599 FORCANOX TABLET (itraconazole) (GRD) TAB 25,269
600 FORELAX TABLET (eperison Hcl) (GRD) TAB 6,138
601 FORMALIN TAB TAB 1,860

602 FORMUNO TABLET (SN) TAB 7,979
603 FREGO 10 MG TAB TAB 12,276
604 FUNGASOL TABLET (ketokonazol) (GRD) TAB 6,902
605 FUROSEMIDE INJEKSI 10 mg/ml (DX) TAB 4,392
606 FUROSEMIDE TABLET 40 MG (KF) TAB 137
607 GALFLUX TABLET (domperidone) (GRD) TAB 5,401
608 GENICOL TABLET 500 MG (thiamfenicol) (GRD) TAB 5,251
609 GLAMAROL TABLET 2 MG (glimepiride) (GRD) TAB 5,183
610 GLIBENCLAMIDE TABLET 5 MG (LMS) TAB 112
611 GLIDIAB TAB TAB 1,327
612 GLIMEPIRIDE 2 MG TABLET (NULAB) TAB 1,955
613 GLIMEPIRIDE 4 MG TABLET (NULAB) TAB 2,182
614 GLUCOSAMIN TABLET 500 (MDK) (LMS) TAB 1,091
615 GLYCERYL GUAIACOLATE TABLET (GG) (LMS) TAB 124
616 GORALGYN TABLET (b1,b6,12,methampyron) (GRD) TAB 1,555
617 GOTROPIL TABLET 1200 MG (piracetam) (GRD) TAB 6,752
618 GOTROPIL TABLET 800 MG (piracetam) (GRD) TAB 4,501
619 GRAFALIN 4 TAB TAB 206
620 GRATAZON TAB TAB 136
621 HARNAL OCAS TAB TAB 20,616
622 HCT 25MG TAB TAB 159
623 HEPLAV TABLET (lamivudine) 100 MG (KF) TAB 6,593
624 HEPTASAN TABLET 4 MG (cyproheptadine HCL) (SN) TAB 254
625 HEXCAM 15 MG TAB TAB 976
HISTAPAN TABLET 50 MG (mebhydroline
626 TAB 839
napadisylate) (SN)
627 HISTIGO TAB TAB 407
628 HUFAMAG PLUS TAB TAB 244
629 IBUPROFEN TABLET 400 MG (LMS) TAB 254
630 IKALEP SYRUP 120 ML (falproic acid) (IKAPH) TAB 86,800
INFATRIM TABLET (sulfamethoxazole
631 TAB 384
(SMZ),trimethoprin) (MLX)
632 INFELON TAB TAB 7,508
633 INTUNAL-FORTE TAB TAB 991
634 IRONYL TABLET (GRD) TAB 3,137
635 ISONIAZID 300MG TAB (KF) TAB 236
636 ISOSORBIDE DINITRATE TABLET 5 MG (YR) (LMS) TAB 150
637 KALBIOTIC 500 MG TAB TAB 3,001
638 KALNEX 500 MG TAB TAB 4,501
639 KALTROFEN 100 MG TAB TAB 6,887
640 KETOCONAZOLE TABLET 200 MG (LMS) TAB 508
641 KETOKONAZOLE TABLET 200 MG (DX) (LMS) TAB 461

642 KLINSET CAPTAB TAB 4,340
643 KONIDIN TAB TAB 1,612
644 LAPIBION TAB TAB 1,951
645 LAPIFED TAB TAB 3,151
646 LAPISIV T TABLET TAB 1,364
647 LAPISTAN 500 MG TAB TAB 1,800
648 LASIX TAB TAB 6,071
649 LEOMOXYL TABLET 500 MG (amoxicillin) (GRD) TAB 4,276
650 LERZIN TABLET TAB 469
651 LEVOFLOXACIN TABLET 500 MG (NULB) TAB 1,431
652 LEXIGO TAB TAB 343
653 LIBRAX TAB TAB 3,050
654 LILUNG 500MG TAB TAB 624
655 LISINOPRIL TABLET 5 MG (NV)OGB TAB 436
656 LOKEV TAB. TAB 511
657 LOPAMID TAB TAB 360
658 LOPITEN TABLET 10 MG (amlodipine) (GRD) TAB 14,254
659 LOPITEN TABLET 5 MG (amlodipine) (GRD) TAB 8,252
660 LORAN TABLET 10 MG (loratadin) (GRD) TAB 6,977
661 LORATADINE TABLET 10 MG (NV)OGB TAB 413
662 LUPIN 5 MG TAB TAB 4,753
663 LYRICA 75 MG TAB TAB 14,404
664 MAGANOL TABLET (paracetamol) (GRD) TAB 614
665 MAGTRAL TAB TAB 175
666 MEFINAL TABLET 500 MG (asam mefenamat) (SN) TAB 1,678
667 MELOXICAM TABLET 15 MG (NULAB) TAB 1,487
668 MELOXICAM TABLET 7.5 MG (NULAB) TAB 858
669 MEPTIN TABLET 50MG TAB 6,547
670 METFORMIN TABLET 500 MG (DX) (LMS) TAB 225
671 METHYLPREDNISOLONE TABLET 16 MG (HJ) TAB 806
672 METHYLPREDNISOLONE TABLET 4 MG (NULAB) TAB 546
673 METHYLPREDNISOLONE TABLET 8 MG (NV)OGB TAB 798
674 METRONIDAZOLE TABLET 500 MG (LMS) TAB 345
METVELL TABLET 0.125 MG (methylergometrin)
675 TAB 3,376
(NV)OBG
676 MINIASPI 80 MG TAB TAB 532
677 MINKOSA TAB TAB 108
678 MISOPROSTOL TABLET 200 MCG (NULAB) TAB 7,502
679 MITADEX TAB TAB 154
680 MST CONTINUS TAB. 10 MG TAB 17,608
681 MUCERA TAB TAB 930
682 MUCOHEXIN TABLET TAB 775

683 MUCOPECT 30 MG TAB TAB 3,068
684 MXN TABLET (moxifloxacin HCl) (DX) TAB 54,014
685 MYLOXAN TAB TAB 185
686 MYOTONIC TAB TAB 3,975
687 NADIFEN TAB TAB 254
688 NALETAL TABLET 100 MG (cilostazole) (GRD) TAB 9,548
689 NALETAL TABLET 50 MG (cilostazole) (GRD) TAB 9,548
690 NATRIUM DICLOFENAC 50 MG TABLET (NV)OGB TAB 337
691 NEPHROLIT TAB TAB 657
692 NEURODEX TABLET (b1,b6,b12) (LMS) TAB 750
693 NEUROHAX 5000 TABLET (b1,b6,b12) (GRD) TAB 3,001
694 NEUROHAX TABLET (b1,b6,b12) (GRD) TAB 1,637
NEUROSANBE PLUS TABLET (b1,b6,12,methampyron)
695 TAB 1,330
(SN)
696 NEUROSANBE TABLET (b1,b6,b12) (SN) TAB 1,398
697 NEVRADIN E TAB TAB 2,604
698 NEW DIATAB TABLET (attapilgite active) (LMS) TAB 691
699 NIFEDIN TABLET (nifedipin) (SN) TAB 838
700 NIFEDIPIN TABLET 10 MG (LMS) TAB 160
701 NIRCEF CAPSUL (cefdinir) (DX) TAB 21,282
702 NOBOR TABLET 5 MG (allylestrerol) (GRD) TAB 4,774
703 NOPROSTOL TABLET 0,2 MG (misoprostol) (NV)OBG TAB 13,463
704 NORESTIL TABLET 5 MG (norethisterone) (GRD) TAB 6,002
705 NOXETINE 20 MG TABLET (fluoxetine) (NV) TAB 7,843
706 NUCOXI TABLET 15 MG (meloxicam) (NULAB) TAB 11,321
707 NUCOXI TABLET 7.5 MG (meloxicam) (NULAB) TAB 6,956
708 NUFAGRABION TAB TAB 2,120
709 NUFIT KAPLET (GRD) TAB 9,412
710 NUVISION TAB TAB 6,138
711 OMEDOM TAB TAB 234
712 OMEROXOL TABLET TAB 181
713 OMETILSON TAB TAB 371
714 ONDANSETRON TABLET 4 MG (LMS) TAB 1,910
715 ONDANSETRON TABLET 8 MG (NULAB) TAB 3,451
716 ONDAVEL TABLET 4 MG (ondansetron) (NV)OBG TAB 23,188
717 OPOX TABLET 2 MG (loperamide) (GRD) TAB 1,800
718 OPUS TABL TAB 6,547
719 OSTELOX TABLET 15 MG (meloxicam) (SN) TAB 11,608
720 PAMOL TAB TAB 569
721 PANADOL TABLET TAB 830
722 PARACETAMOL TABLET 500 MG (LMS) TAB 270
723 PERVITA TABLET (SN) TAB 1,746

PINFETIL TABLET 50 MG (clomiphene citrate)
724 TAB 12,699
(NV)OBG
725 PIRACETAM TABLET 1200 MG (NV)OGB TAB 1,604
726 PIRACETAM TABLET 800 MG (NULAB) TAB 996
727 PIROXICAM TABLET 20 MG (KF) TAB 161
728 PLANTACID TABLET TAB 254
729 PLASMINEX TABLET (asam tranexamat) (SN) TAB 3,424
730 PLAVIX TAB TAB 31,827
731 PONSAMIC TABLET 500 MG (asam mefenamat) (GRD) TAB 1,841
732 POSPARGIN TAB TAB 703
733 PREABOR TAB TAB 3,714
734 PREDNISON 5MG TAB TAB 149
735 PROPANOLOL TABLET 10 MG (LMS) TAB 95
736 PROPYLTHIOURACIL TABLET 100 MG (PTU) (DX) TAB 535
737 PRORENAL TABLET (essential ketoacids) (NV) TAB 8,184
738 PROSTER 200 TABLET (misoprostol) (GRD) TAB 14,322
739 PROTERINE TABLET 20 MG (isoxoprine) (NV)OBG TAB 6,138
740 PROTHYRA TAB TAB 5,559
741 PYRAZINAMIDE TABLET 500 MG (PROMED) (LMS) TAB 356
742 QITAL TAB TAB 9,176
743 RAMIPRIL 5MG TAB TAB 792
744 RANITIDIN TABLET 150 MG (DX) TAB 273
745 RIFAMPICIN TABLET 450 MG TABLET (KF) TAB 1,407
746 RISPERIDONE TABLET 2 MG (NULAB) TAB 2,945
747 RIZODAL TABLET 2 MG (risperidone) (GRD) TAB 9,821
748 ROMILAR TAB TAB 1,130
749 ROSIDON TAB TAB 196
750 ROSUVASTATIN CALCIUM TABLET 20 MG (NULAB) TAB 6,002
ROVATOR 20 MG TABLET (Rosuvastatin Calcium)
751 TAB 15,754
(GRD)
752 RYDIAN TABLET (cetirizine) (GRD) TAB 6,002
753 SALBUTAMOL TABLET 2 MG (LMS) TAB 104
754 SALBUTAMOL TABLET 4 MG (KF) TAB 125
755 SAMCOFENAC 50 MG TAB TAB 198
756 SAMTACID TABLET TAB 175
757 SANAZET 500 MG TAB TAB 1,798
SANFULIQ TABLET (curcuma, silybin, choline, B comp,
758 TAB 6,152
E) (SN)
SANMAG TABLET (mg,al,papaverin,chlordiapoxide,vit)
759 TAB 1,091
(SN)**
760 SANTA E 200 TABLET (SN) TAB 2,448
761 SANTA E 400 TABLET (SN) TAB 4,829

762 SCOPAMIN TABLET 10 MG (OTT) TAB 2,387
763 SELVIM TAB TAB 464
764 SESDEN TAB TAB 2,561
765 SIMVASTATIN TABLET 10 MG (NV)OGB TAB 600
766 SIMVASTATIN TABLET 20 MG (INFI) (LMS) TAB 1,272
767 SISTENOL CAPLET (DX) TAB 2,356
768 SITRO TAB TAB 6,448
769 SOMEROL 4 MG TAB TAB 2,324
770 SPASMINAL TABLET (LMS) TAB 791
771 SPIRAMYCIN 500MG TAB TAB 2,564
772 SPIROLA 100 MG TAB TAB 5,022
773 SPIRONOLACTON TABLET 100 MG (DX) TAB 1,308
774 SPIRONOLACTON TABLET 25 MG (DX) TAB 429
775 STABIXIN INJ TAB 179,800
776 STENIROL 4 MG TABLET (methylprednisolon) (GRD) TAB 4,092
777 STENIROL 8 MG TABLET (methylprednisolon) (GRD) TAB 6,274
778 STIMOX TABLET TAB 5,599
779 STROMAG 100 TABLET (GRD) TAB 932
780 TANAKAN TAB TAB 6,884
781 TANAPRES TAB 10 MG TAB 19,048
782 TEGRETOL CR 200 TAB TAB 6,200
783 TEOSAL TABLET (salbutamol,theophylline) (LMS) TAB 259
784 TERANOL TABLET (ketorolac) (GRD) TAB 6,820
THROMBO ASPILETS TABLET (acetylsalicylic acid)
785 TAB 966
(LMS)
786 TISMALIN TAB TAB 946
787 TISOLON - 4 TAB TAB 3,013
788 TOLAK ANGIN TAB TAB 246
789 TREMENZA TABLET (pseudo,tripol) (SN)** TAB 1,794
790 TRIAMCINOLONE 4MG TAB TAB 988
791 TRIAMCORT TABLET TAB 4,072
792 TRICHODAZOL 500 TABLET (metronidazole) (SN) TAB 2,101
793 TRIFEDRIN TAB TAB 1,240
794 TRILAC TABLET 4 mg (triamcinolone) (NV) TAB 4,774
795 TROVENSIS TABLET TAB 17,075
796 TUZALOS TABLET (paracetamol,dmp,pseudo) (SN) TAB 1,118
797 UNALIUM TABLET 10 MG (flunarizine) (GRD) TAB 9,889
798 UNALIUM TABLET 5 MG (flunarizine) (GRD) TAB 7,161
799 VADROL TAB TAB 363
800 VALDIMEX 5 MG TAB TAB 496
801 VALISANBE TABLET 2 MG (diazepam) (SN)** TAB 266
802 VALISANBE TABLET 5 MG (diazepam) (SN)** TAB 416

803 VALSARTAN TABLET 160 MG (NV)OGB TAB 8,866
804 VALSARTAN TABLET 80 MG (NV)OGB TAB 5,456
805 VESPERUM TAB TAB 234
806 VITAMIN B KOMPLEKS TABLET 50 MG (KF) TAB 179
807 VITAMIN B6 TABLET 10 MG (LMS) TAB 160
808 VITAMIN C TABLET 50 MG (LMS) TAB 94
809 VOLTADEX 50MG TAB TAB 614
810 VOMISTOP FLAST TABLET TAB 5,251
811 VOSEDON TABLET (domperidone) (SN) TAB 2,939
812 XIDANE CAPSUL (natural astaxanthin) (GRD) TAB 9,412
813 YUSIMOX TAB TAB 477
814 ZIBRAMAX TABLET 500 MG (azitromicyn) (GRD) TAB 42,761
815 ZINK DISPERSIBEL TAB (KIMIA FARMA) TAB 744
BENZOLAC CL CREAM 10 GR (benzoil peroksida)
816 TUB 32,736
(SDM)
817 BETAMETASON CREAM 0.1% 5 GR (KF) (LMS) TUB 2,512
BETASON-N CREAM 5 GR (betamethasone
818 TUB 16,709
valerate,Neomycin sulfate) (KF)
BEVALEX KRIM 5 GRAM (betamethasone, neomycin)
819 TUB 14,049
(MLX)
BIOPLACENTON GEL 15 GRAM (placenta ext,
820 TUB 19,778
neomycin sulfate) (LMS)
821 BURNAZIN CREAM 35 G (silver sulphadiazine) (KF) TUB 64,947
822 CARMED CREAM 10% 40 GR (urea) (SDM) TUB 35,873
CLIDACOR GEL 1 % 10 GR (clindamycin phosphate)
823 TUB 25,916
(XP)
CLIDACOR T GEL 15 GR (clindamycin
824 TUB 40,920
phophate,tretinoin) (XP)
825 DERMADES CREAM 10 GR (desonide) (XP) TUB 26,598
826 DESOLEX CREAM 10 GR (desonide) (SDM) TUB 28,167
827 DESOXIMETASONE CREAM 0.25% 15 GR (NV)OGB TUB 26,377
ELOPRO OINTMENT 10 GR (clobetasol propionate)
828 TUB 36,146
(XP)
ELOX CREAM 5 GR (mometasone furoate anhydrous)
829 TUB 60,016
(GRD)
830 ESTESIA CREAM 5 GR (lidocaine, prilocaine) (XP) TUB 61,380
831 FLEET ENEMA TUB 161,481
832 FULADIC CREAM 5 GR (asam fusidat) (GRD) TUB 73,520
833 FUNGARES CREAM 10 GR (mikonazole nitrate) (GRD) TUB 25,507
834 FUSIPAR CREAM 10 GR (asam fusidat) (XP) TUB 57,288
GENOLON CREAM 10 GRAM (gentamycine
835 TUB 47,740
sulfate,fluocinnolone acetonide) (GRD)
836 GENTALEX CREAM 5 G (gentamycine) (MLX) TUB 4,433

837 HYDROCORTISONE CREAM 2,5% (LMS) TUB 4,961
838 KETOKONAZOLE CREAM 2% 10 GR (LMS) TUB 8,680
839 KETOKONAZOLE CREAM 2% 15 GR (LMS) TUB 11,780
840 KETOMED CREAM 15 GR (ketokonazole) (SDM) TUB 32,463
841 KETOMED SS 60 ML (ketokonazole) (SDM) TUB 49,650
KLODERMA CREAM 10 GR (clobentasol propionate)
842 TUB 37,510
(SDM)
KLODERMA CREAM 5 GR (clobentasol propionate)
843 TUB 33,480
(SDM)
LAFALOS KRIM (menthol,eugenol,methyl salocylate)
844 TUB 15,977
(SN)
845 LAMODEX CREAM (clobetasol propionate) (GRD) TUB 56,715
846 LITTLE PAM SKIN BARRIER CREAM (XP) TUB 80,600
LUMIQUIN CREAM
847 TUB 70,928
(hydroquinone,tretinoin,fluocinolone acetonide) (XP)
MEDIKLIN TR GEL 15 GR (clindamycin
848 TUB 45,384
phosphate,tretinoin) (SDM)
849 MEDSCAB CREAM 30 GR (permethrin) (SDM) TUB 81,158
MESONE CREAM 10 GR (mometason furoate
850 TUB 76,384
anhydrous) (XP)
MESONE CREAM 5 GR (mometason furoate
851 TUB 42,284
anhydrous) (XP)
MOFACORT CREAM 5 GR (mometason furoate
852 TUB 43,171
anhydrous) (SDM)
853 MOMETASONE CREAM 0.1% 10 GR (NV)OGB TUB 27,280
854 MOMETASONE CREAM 0.1% 5 GR (NV)OGB TUB 17,050
855 MUPIROCIN OINTMENT 10 GR (NV)OGB TUB 34,100
856 MY JELLY LUBRICATING (3M) TUB 38,192
857 PIROTOP 5 GR (mupirocin calcium) (SDM) TUB 45,762
858 RETICOR 0.025 CREAM (tretinoin) (XP) TUB 27,280
861 SAGESTAM CREAM 10 GRAM (gentamycine) (SN) TUB 15,481
862 SCABICORE CREAM 30 GR (permethrin) (XP) TUB 85,932
863 SCABIMITE CREAM 10 GR (permethrin) (LMS) TUB 51,150
864 SCABIMITE CREAM 30 GR (permethrin) (LMS) TUB 96,162
865 SCACID KRIM 10 GRAM (permethrin) (GRD) TUB 45,353
THECORT CREAM 5 GR (miconazole nitrate 2%,
866 TUB 71,610
hydrocortison 1%) (GRD)
867 THROMBOPOB GEL 20 GR (MBS) TUB 64,449
868 CEFOPERAZONE SULBACTAM INJEKSI 1 GRAM (DX) VL 136,400
869 CEFOTAXIME INJEKSI (DEXA) VL 8,593
870 CEFTRIAXON INJEKSI 1 GR (HJ) (LMS) VL 13,640

871 CEPHAFLOX INJEKSI 1 GR (ceftriaxone) (GRD) VL 265,980
872 CINAM INJEKSI (ampisillin,sulbactam) (SN) VL 180,730
873 COLSANCENTIN INJEKSI (cloramphenicol) (SN) VL 12,931
874 DOBUTAMINE HCL INJEKSI 250 MG/5ML (NV)OGB VL 50,604
875 GOFORAN INJEKSI (cefotaxim) (GRD) VL 203,236
876 MEREM INJEKSI 1 GR (meropenem) GRD) VL 583,110
877 MEROPENEM INJEKSI (QL) (LMS) VL 67,579
878 NORSEC INJEKSI (omeprazole) (GRD) VL 185,504
NOVERON INJEKSI 5 ML (rocoronium bromide)
879 VL 136,400
(NV)ANS
880 NUBAC INJEKSI (cefoperazon,sulbactam) (GRD) VL 225,060
881 OMEPRAZOLE INJEKSI (NV)-OGB VL 68,200
882 PANTOPRAZOLE SODIUM INJEKSI 40 GRAM (NV)-OGB VL 80,476
883 SANMOL INFUS (paracetamol) (SN) VL 77,202
884 SIDIADRYL INJEKSI (dipenhidramine) (LMS) VL 13,640
VELUTINE INHALATION 2.5 MG/4 ML (salbutamol
885 VL 9,548
sulphate) (NV)PEDIA
886 VICCILLIN INJEKSI 500 MG (ampicillin) (MEIJI) VL 11,253

Daftar Harga Obat Asuransi 24

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Surabaya - Malang KM 50, Suwayuwo-Sukorejo-Pasuruan Tlp/Fax(0343) 639625

DAFTAR HARGA OBAT DAN ALAT ALAT KESEHATAN

34 N-EPI INJEKSI (norepinephrine bitartrate) (NV)ANS AMP 111,600

76 BIOSANBE KAPSUL (SN) BOX 1,147

116 CUPANOL SYRUP (paracetamol) (GRD) BTL 24,552

153 NIGHT CREAM K (KK) BTL 86,800

194 ZIBRAMAX DRY SYRUP (azitromicyn) (GRD) BTL 120,509

234 FUNGASOL CREAM (ketokonazole) (GRD) CRM 33,418

276 NUZYM KAPSUL (co enzym Q10) (GRD) KAP 8,184

316 ELEKTRODE ECG 3M (ROSTH) PCS 4,894

358 KASA STERIL 16X16 HEXA HUSADA (3M) PCS 4,774

400 SAGESTAM SALEP MATA (gentamycine) (SN) PCS 46,171

439 VASOFIX IV CHAT NO. 22 (3M) PCS 10,850

520 BODREXIN TAB TAB 198

560 DANSERA TAB TAB 5,905

601 FORMALIN TAB TAB 1,860

641 KETOKONAZOLE TABLET 200 MG (DX) (LMS) TAB 461

682 MUCOHEXIN TABLET TAB 775

723 PERVITA TABLET (SN) TAB 1,746

761 SANTA E 400 TABLET (SN) TAB 4,829

802 VALISANBE TABLET 5 MG (diazepam) (SN)** TAB 416

836 GENTALEX CREAM 5 G (gentamycine) (MLX) TUB 4,433

870 CEFTRIAXON INJEKSI 1 GR (HJ) (LMS) VL 13,640

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