STOK OPNAME IFRS DATU SANGGUL RANTAU PER 31 DESEMBER 2020

NO NAMA OBAT/BAKHP SATUAN STOK PEMA- PEMA- GUDANG APT RJ APT RI STOK HARGA
AWAL KAIAN SUKAN & IGD AKHIR SATUAN
1 Acarbose 100 mg tablet 662 600 500 562 562 960
2 Acarbose 50 mg tablet 836 310 500 300 536 190 1,026 690
3 Allopurinol 100 tablet 9 574 2,000 1,000 245 190 1,435 210
4 Alpentin 100 mg tablet 2,521 2,818 2,500 1,500 624 79 2,203 1,150
5 Alprazolam 0,5 mg tablet 942 111 831 831 585
6 Ambroxol tablet 2,012 135 1,100 577 200 1,877 155
7 Aminefron tablet 184 54 200 100 130 100 330 6,865
8 Amitriptilin tablet 337 335 1,000 300 495 207 1,002 187
9 Amlodipin 10 tablet 19,296 5,497 12,200 1,442 157 13,799 395
10 Amlodipin 5 tablet 2,607 2,500 4,500 3,000 719 888 4,607 81
11 Amoksisilin 500 tablet 7 0 7 7 462
12 Amoksisilin asam klavulanat tablet 0 30 90 30 30 60 4,355
13 Amvar tablet 483 377 300 300 33 73 406 7,315
14 Analtram tablet 351 274 300 150 102 125 377 9,405
15 Anemolat tablet 1,461 1,328 14 119 133 204
16 Ar gout tablet 207 40 60 40 67 167 3,919
17 arcapec tablet 939 0 600 35 304 939 1,149
18 Aricef evess tablet 54 0 54 54 12,485
19 Arkine tablet 711 558 2,000 1,500 373 280 2,153 724
20 Asam Folat tablet 0 354 5,000 3,500 645 501 4,646 86
21 Asam mefenamat 500 tablet 8,721 2,449 5,000 349 923 6,272 252
22 Asam traneksamat 500 tablet 1,222 148 400 420 254 1,074 1,583
23 Asetylsistein tablet 1,376 549 400 74 353 827 880
24 Asiklovir 400 tablet 862 0 600 149 113 862 935
25 Aspilet tablet 4,131 1,176 2,300 511 144 2,955 113
26 Asta plus tablet 460 90 210 90 70 370 8,883
27 Asthin force tablet 137 1 60 26 50 136 8,959
28 Atevir tablet 120 30 60 30 90 39,072
29 Atorvastatin tablet 2,635 1,368 300 822 145 1,267 993
30 Azitromycin tablet 502 282 93 127 220 9,350
31 Bamgetol tablet 1,936 930 2,000 2,000 561 445 3,006 1,386
32 Betahistin tablet 1,631 274 1,000 229 128 1,357 119
33 Betaone 2,5 tablet 946 2,019 5,000 3,500 113 314 3,927 595
34 Biocal95 tablet 392 36 240 72 44 356 3,498
35 Bisoprolol 5 tablet 1,244 2,291 3,000 600 1,215 138 1,953 248
36 Brainact 500 mg tablet 539 0 300 124 115 539 13,407
37 Cal 95 tablet 269 20 180 6 63 249 4,598
38 Calos tablet 624 265 180 172 7 359 688
39 Canderin 16 mg tablet 75 0 60 15 75 7,920
40 Canderin 8 mg tablet 120 0 90 30 120 6,160
41 Candesartan 16 mg tablet 6,854 6,376 12,000 11,700 331 447 12,478 1,048
42 Candesartan 8 mg tablet 1,885 7,061 10,000 4,200 192 432 4,824 629
43 Captopril 12,5 tablet 0 2 1,000 500 300 198 998 84
44 Captopril 25 tablet 517 1,028 1,000 305 184 489 121
45 Carbamazepin 200 tablet 5 0 5 5 330
46 Carpiaton 25 tablet 100 0 100 100 1,386
47 Cataflam 50 mg tablet 255 112 74 69 143 6,243
48 Cefadroksil 500 tablet 8,584 1,210 6,200 680 494 7,374 581
49 Cefila tablet 554 30 300 112 112 524 20,378
50 Cefixim 100 tablet 3,114 1,019 1,500 307 288 2,095 749
51 Cefixim 200 tablet 3,622 1,375 1,800 227 220 2,247 2,430
52 Cefixstar tablet 225 10 150 65 215 20,350
53 Cetirizin tablet 745 516 1,800 1,440 310 279 2,029 298
54 Cilostazol tablet 440 240 49 151 200 9,405
55 Ciprofloksasin 500 tablet 2,663 473 1,500 412 278 2,190 330
56 Citicolin 1000 mg tablet 423 135 150 4 134 288 9,240
57 Citicolin 500 mg tablet 527 442 300 150 103 132 385 4,501
58 Clindamisin 300 tablet 369 205 300 200 216 48 464 1,398
59 Clindamycin 150 mg tablet 3 0 3 3 1,661
60 Clobazam tablet 415 205 210 210 916
 61 Clopidogrel tablet 2,167 4,563 12,000 8,040 1,385 179 9,604 1,469
62 Clovertil tablet 130 0 30 45 55 130 13,585
63 Codein 10 tablet 2,095 335 1,760 1,760 623
64 Cotrimoksasol 960 tablet 1,086 13 600 240 233 1,073 358
65 CPZ 100 mg tablet 276 5 194 77 271 264
66 Curcuma tablet 994 283 514 197 711 1,052
67 Cycloprogynova tablet 147 0 63 42 42 147 7,978
68 Deolit tablet 120 0 90 30 120 8,883
69 Deksametason tablet 1,235 213 600 135 287 1,022 93
70 Depakot 250 mg tablet 1,900 361 900 539 100 1,539 2,954
71 Depakote 500 mg tablet 1,454 810 3,000 3,000 180 464 3,644 5,928
72 Dexketoprofen tablet 255 0 255 255 2,145
73 Diatab tablet 685 193 300 103 89 492 558
74 Diazepam 2 mg tablet 494 162 332 332 136
75 Diltiazem tablet 94 0 94 94 205
76 Donepezil tablet 467 149 90 168 60 318 4,620
77 Dopamet tablet 1,177 461 300 224 192 716 1,088
78 Dulkolax 5 tablet 66 13 20 10 23 53 1,510
79 Eperison tablet 1,933 1,525 1,500 1,500 234 174 1,908 2,682
80 Erdomex tablet 175 0 40 58 77 175 4,180
81 Estazor tablet 76 100 150 32 94 126 9,405
82 Etambutol 500 tablet 449 86 255 108 363 880
83 Euthyrox tablet 361 136 100 25 100 225 1,072
84 Exjade 250 tablet 179 32 56 91 147 77,459
85 Eye bright tablet 217 20 60 89 48 197 5,225
86 Fargoxin tablet 994 239 300 320 135 755 263
87 Farmacrol F tablet 248 27 107 114 221 888
88 Farmadral 10 mg tablet 427 0 57 370 427 150
89 Farsix tablet 303 0 4 299 303 1,045
90 Fenofibrat 100 tablet 270 176 94 94 1,320
91 Fenofibrat 160 mg tablet 300 140 160 160 2,035
92 Fenolip tablet 111 0 60 51 111 10,450
93 Ferriprox tablet 530 270 500 500 260 760 33,000
94 Flamicort tablet 245 6 150 56 33 239 3,388
95 Fluconazol tablet 170 20 10 20 120 150 17,600
96 Flunarizin 5 mg tablet 2,379 688 500 920 271 1,691 1,980
97 Folaplus tablet 1,926 66 1,600 170 90 1,860 888
98 Foransi 10 mg tablet 302 20 90 152 40 282 4,002
99 Foransi 20 mg tablet 320 0 90 170 60 320 5,335
100 Furosemid tablet 2,681 2,248 3,000 2,000 1,263 170 3,433 242
101 gabapentin 300 mg tablet 1,985 150 1,700 135 1,835 9,373
102 Gastrul tablet 10 0 150 60 10 90 160 11,495
103 Gavistal tablet 109 0 20 89 109 470
104 GCM tablet 146 0 90 46 10 146 6,270
105 Gemfibrozyl tablet 584 0 240 186 158 584 405
106 Glauseta tablet 1,396 915 306 175 481 4,864
107 Glikuidon tablet 2,115 1,438 3,000 2,000 993 684 3,677 1,204
108 Glimepirid 2 mg tablet 2,242 3,350 2,000 682 210 892 207
109 Glucosamin 500 mg tablet 1,500 166 1,000 264 70 1,334 1,198
110 Griseofulvin tablet 70 0 70 70 416
111 Haloperidol 0,5 tablet 541 185 225 131 356 88
112 Harnal 0,2mg tablet 355 54 140 156 5 301 7,788
113 Harnal 0,4mg tablet 1,193 935 900 900 240 18 1,158 6,281
114 HB vit tablet 461 0 210 68 183 461 2,403
115 HCT tablet 3,614 1,240 1,000 1,281 93 2,374 163
116 Hepa-merz sachet 30 20 10 10 10 20 39,083
117 Hepatin tablet 60 18 22 20 42 5,225
118 Hystolan tablet 518 3 250 5 260 515 4,752
119 Ibuprofen 400 mg tablet 1,058 390 300 262 106 668 299
120 Imboost force tablet 470 7 300 30 133 463 5,808
121 Imunos tablet 601 46 300 96 159 555 7,681
122 Infimox tablet 10 0 10 10 25,025
123 INH 100 mg tablet 583 13 300 120 150 570 143
124 INH 300 mg tablet 3,630 163 2,900 471 96 3,467 170
125 Interdoxin 100 mg tablet 110 28 100 100 22 60 182 7,628
126 Interhistin tablet 47 0 47 47 868
127 Interpril 10 tablet 30 0 30 30 5,342
128 ISDN tablet 1,375 285 500 355 235 1,090 89
129 Kalk tablet 4,682 75 4,000 434 173 4,607 152
130 Kalnex tablet 1,285 0 1,000 80 205 1,285 3,432
131 Ketoprofen 100 mg tablet 321 149 150 22 172 1,148
132 KSR tablet 1,114 358 1,000 1,000 710 46 1,756 1,842
133 Lameson tablet 24 0 20 4 24 3,583
134 Lanzoprazol tablet 3,805 2,796 4,000 4,200 448 361 5,009 500
135 Lapibal tablet 484 164 500 500 129 191 820 2,352
136 Lapifed tablet 70 0 67 3 70 2,613
137 Lapiflox tablet 264 18 150 22 74 246 1,358
138 Lapistan tablet 180 0 80 100 180 1,358
139 Lasal 2 mg tablet 346 0 100 100 146 346 1,307
140 Laz 30 mg tablet 535 30 400 65 40 505 14,256
141 L-Bio sachet 274 57 141 76 217 7,315
142 Leparson tablet 1,111 331 200 380 200 780 3,288
143 Levofloksasin tablet 1,410 86 700 415 209 1,324 750
144 Lisinopril 10 mg tablet 1,198 408 383 407 790 370
145 Loratadin tablet 133 10 50 40 33 123 333
146 Luminal tablet 1,268 433 835 835 197
147 Maltiron tablet 718 433 145 140 285 1,568
148 Maxcef 500 mg tablet 374 48 100 3 223 326 9,928
149 Maxpro tablet 508 115 150 73 170 393 19,855
150 Maxtan 500 mg tablet 256 70 180 6 186 1,307
151 Mecobalamin tablet 5,584 3,126 10,000 10,000 2,318 140 12,458 539
152 Mecola tablet 60 0 60 60 3,448
153 Mefix tablet 551 120 300 10 121 431 1,254
154 Meloksikam 15 tablet 2,851 581 1,500 330 440 2,270 863
155 Meloksikam 7,5 tablet 897 1,180 2,000 1,500 72 145 1,717 457
156 Mertigo tablet 239 20 100 34 85 219 3,590
157 Mestinon tablet 150 0 150 150 7,513
158 Metformin 500 tablet 6,125 6,595 5,000 2,000 2,011 519 4,530 165
159 Metronidazol 500 tablet 1,529 325 500 559 145 1,204 211
160 Metylprednisolon 16 mg tablet 2,541 21 1,400 882 238 2,520 974
161 Metylprednisolon 8 mg tablet 1,842 180 900 554 208 1,662 492
162 Micardis 40 mg tablet 1,656 0 1,100 400 156 1,656 3,045
163 Micardis 80 mg tablet 113 10 60 10 33 103 5,409
164 Misoprostol tablet 27 56 150 60 61 121 3,850
165 Monecto tablet 399 0 150 99 150 399 2,822
166 MST continus 10 mg tablet 55 84 180 151 151 15,620
167 Myonal tablet 698 0 200 405 93 698 7,464
168 Myonep tablet 4 0 4 4 5,016
169 Myores tablet 239 44 100 10 85 195 4,703
170 Myotonic tablet 141 51 500 500 28 62 590 2,769
171 Microgest 100 mg tablet 0 0 90 30 30 30 90 12,540
172 Na diklofenak 50 tablet 80 210 2,800 2,450 120 100 2,670 141
173 Na Fenitoin 100 mg tablet 3,049 1,722 5,000 5,000 1,158 169 6,327 484
174 Natto tablet 210 10 150 50 200 7,818
175 Neurobat tablet 2,729 1,026 1,000 452 251 1,703 2,646
176 Nevox xr tablet 90 0 60 30 90 2,359
177 Nipedipin tablet 3,380 756 1,500 581 543 2,624 163
178 Nitrokaf 2,5 tablet 344 748 1,000 200 226 170 596 1,794
179 Norelut tablet 483 74 250 50 109 409 4,541
180 Ofloxacin tablet 24 0 24 24 873
181 Omed tablet 83 3 200 80 60 140 280 11,798
182 Omeprazol tablet 3,884 1,020 1,900 727 237 2,864 368
183 Oseltamivir tablet 216 192 300 200 124 324 16,500
184 Oskom tablet 60 30 30 30 6,793
185 Osteonat tablet 11 0 8 3 11 44,995
186 Parasetamol 500 tablet 7,040 2,584 2,000 1,353 1,103 4,456 216
187 Patral tablet 527 152 300 75 375 6,793
188 Piracetam 1200 mg tablet 31 0 31 31 1,293
189 Piracetam 800 mg tablet 235 0 100 100 35 235 771
190 Pirazinamid 500 mg tablet 528 98 300 43 87 430 355
191 Preabor tablet 384 6 300 70 8 378 3,685
192 Prednison tablet 1,525 527 462 536 998 182
193 Pregabalin tablet 997 666 1,120 1,120 187 144 1,451 5,157
194 Prelin 75 tablet 55 0 28 27 55 9,330
195 Primakuin tablet 99 0 99 99 113
196 Pro TB 2 kid tablet 84 0 84 84 3,300
197 Pro TB 3 kid tablet 84 0 28 56 84 4,556
198 Prolevox tablet 50 0 50 50 32,395
199 Proliver tablet 401 30 150 64 157 371 5,329
200 Promavit tablet 434 1 300 133 433 3,448
201 Proneuron tablet 804 270 534 534 1,254
202 Propanolol 10 tablet 3,628 779 2,000 727 122 2,849 93
203 PTU tablet 2,895 545 1,000 1,077 273 2,350 587
204 Pyrexin 500 tablet 17,281 80 16,000 611 590 17,201 298
205 Ramipril 5 mg tablet 1,438 949 2,000 1,500 676 313 2,489 263
206 Ranitidin tablet 2,926 2,372 554 554 154
207 Renapar tablet 514 224 100 190 290 2,403
208 Renax tablet 403 0 200 65 138 403 7,937
209 Retaphyl SR tablet 2 0 2 2 1,292
210 Rhinofed tablet 146 15 131 131 1,870
211 Rifampisin 300 mg tablet 485 90 16 379 395 1,403
212 Rifampisin 450 tablet 1,881 120 1,300 315 146 1,761 1,108
213 Rifampisin 600 tablet 500 300 200 200 2,405
214 Salbutamol 2 mg tablet 1,936 203 1,000 400 333 1,733 98
215 Salbutamol 4 mg tablet 2,639 639 1,500 500 2,000 103
216 SF + asam folat (tablet tambah darah) tablet 1,116 145 300 320 351 971 544
217 Sifrol 0,125 tablet 600 300 300 300 300 600 4,401
218 Sifrol 0,375 tablet 195 90 60 45 105 8,300
219 Simciti tablet 177 45 60 47 25 132 9,405
220 Simcobal tablet 1,392 0 800 340 252 1,392 2,038
221 Simdrol 4 mg tablet 460 0 200 80 180 460 3,031
222 Simfix tablet 948 200 450 125 173 748 19,333
223 Simflox 500 mg tablet 141 20 35 86 121 12,018
224 Simlev tablet 53 0 10 43 53 31,350
225 Simprofen tablet 188 0 60 128 188 6,270
226 Simvastatin 10 tablet 6,474 2,042 2,000 2,088 344 4,432 148
227 Simzen tablet 63 0 30 10 23 63 3,762
228 Sistenol tablet 2,337 542 1,500 179 116 1,795 2,115
229 Sodium bicarbonat tablet 313 0 200 113 313 176
230 Spironolakton 100 mg tablet 950 102 400 145 303 848 661
231 Spironolakton 25 tablet 1,536 850 163 523 686 226
232 Stalevo tablet 60 30 30 60 60 8,800
233 Stator tablet 161 15 30 15 101 146 17,248
234 Supramox 500 mg tablet 633 169 100 167 197 464 2,508
235 TB vit tablet 660 54 500 101 5 606 784
236 Tebokan tablet 156 0 70 86 156 5,841
237 Thyrozol tablet 484 210 204 70 274 1,286
238 Tomit tablet 515 250 100 11 154 265 941
239 Tracetate tablet 333 167 300 300 66 100 466 21,945
240 Tramadol tablet 1,000 511 300 5 184 489 702
241 Triamcinolon tablet 304 8 70 226 296 745
242 Tyarit tablet 58 1 30 10 17 57 4,510
243 Ulsidex tablet 301 15 100 14 172 286 368
244 Utrogeston 100 mg tablet 219 182 24 13 37 10,973
245 Utrogeston 200 mg tablet 196 7 75 32 82 189 22,990
246 Vaclo tablet 60 0 30 30 60 13,200
247 Vectrin tablet 311 0 200 40 71 311 5,280
248 Venosmil tablet 112 0 60 10 42 112 10,725
249 Veridin tablet 133 149 150 88 46 134 7,054
250 Vip albumin tablet 273 259 600 300 100 214 614 6,468
251 Vit b kompl tablet 102 66 33 3 36 104
252 Vit B12 tablet 653 0 332 321 653 55
253 Vit C 50 mg tablet 903 321 300 83 199 582 120
254 Xarelto 20mg tablet 56 0 28 28 56 34,758
255 Xiety tablet 167 0 67 100 167 4,180
256 Zegavit tablet 898 315 500 15 68 583 3,861
257 Zegavit refocusing tablet 150 0 150 150 3,762

INJEKSI
1 Actrapid vial 12 5 3 4 7 144,763
2 Adona inj ampul 39 16 10 13 23 16,016
3 Aminofilin ampul 205 102 60 43 103 3,071
4 Amiodaron injeksi ampul 56 0 30 26 56 8,700
5 Ampisilin ampul 486 16 300 170 470 9,504
6 Antrain ampul 842 202 400 240 640 4,400
7 Aqua 1 liter botol 111 27 80 4 84 12,100
8 Aqua p i vial 5,523 1,459 3,360 276 428 4,064 2,860
9 Arixtra syringe 10 27 30 13 13 273,800
10 Artesunat vial 20 0 10 10 20 14,250
11 Asam traneksamat 500 ampul 108 220 400 200 88 288 2,374
12 Atracorium b vial 49 7 25 17 42 30,294
13 Atropin Sulfat inj ampul 149 7 142 142 1,859
14 ATS 1500 vial 10 3 7 7 131,000
15 Bactesyn ini 0,75 ampul 82 0 50 32 82 51,703
16 Brainact injeksi 500 mg ampul 71 0 50 21 71 75,075
17 Bucain ampul 55 0 25 30 55 55,963
18 Bunascan ampul 69 55 50 50 14 64 65,340
19 Calsium gluconat inj ampul 68 17 48 3 51 10,351
20 Cedocard inj ampul 25 0 20 5 25 71,280
21 Cefazoline vial 97 85 100 60 52 112 12,650
22 Cefotaxim 1 gr vial 994 170 700 124 824 4,708
23 Ceftamax inj vial 40 0 20 20 40 229,900
24 Ceftazidim vial 110 15 40 55 95 17,160
25 Ceftien injeksi ampul 72 0 50 22 72 194,370
26 Ceftriaxon vial 1,412 721 691 691 5,148
27 Ceftrimax injeksi vial 37 0 20 17 37 219,450
28 Cefxon injeksi vial 75 80 50 20 25 45 219,450
29 Cetadop ampul 97 11 25 61 86 6,160
30 Citicolin inj 250/2ml ampul 384 85 299 299 11,000
31 Citicolin inj 500/2ml ampul 10 13 500 450 47 497 28,600
32 Covifor inj vial 10 2 5 3 8 1,650,000
33 Criac inj ampul 124 8 80 36 116 198,550
34 D40% botol 436 70 240 126 366 10,010
35 Deksametason ampul 137 288 300 149 149 1,210
36 Diazepam Inj ampul 93 27 66 66 8,762
37 Difenhidramin 1 ml ampul 151 32 300 300 119 419 1,865
38 Dobutamin ampul 87 2 50 35 85 14,643
39 Durogesic 12 mcg patch 5 0 5 5 108,454
40 Efineftrin ampul 140 45 60 35 95 1,822
41 Efotax vial 48 0 20 28 48 141,075
42 Esomeprasol injeksi vial 150 186 300 245 19 264 29,376
43 Euvax 1 ml vial 7 0 7 7 87,846
44 Etanyl ampul 8 0 8 8 40,700
45 Exocid vial 17 14 50 30 23 53 151,525
46 Fargoxin injeksi ampul 13 0 5 8 13 41,800
47 Farmabes inj ampul 100 0 70 30 100 113,256
48 Fartison injeksi ampul 15 0 15 15 99,275
49 Fentanyl injeksi ampul 71 98 150 123 123 37,400
50 Fibrion ampul 3 1 1 1 2 3,399,999
51 Flamicort injeksi vial 16 1 5 5 5 15 137,500
52 Fresofol 1% ampul 135 18 50 67 117 13,108
53 Furamin injeksi ampul 44 12 50 50 32 82 11,535
54 Futaxon injeksi vail 45 0 30 15 45 182,325
55 Gastridin injeksi ampul 63 38 25 25 24,013
56 Gastrofer inj ampul 32 0 25 7 32 94,875
57 Herbeser ampul 11 1 10 10 154,400
58 Inviclot vial 16 2 10 4 14 43,995
59 Kalnex injeksi ampul 86 22 40 24 64 15,015
60 KCl botol 28 0 20 8 28 3,223
61 Ketamin vial 2 0 2 2 68,948
 62 Ketorolac inj 30 mg ampul 1,035 668 2,000 1,700 667 2,367 1,296
63 KTM injeksi ampul 20 0 20 20 114,995
64 Lactopain injeksi ampul 117 16 50 51 101 41,800
65 Lansoprazol inj vial 132 207 290 190 25 215 90,090
66 Lanxium 40mg inj vial 69 7 28 34 62 111,375
67 Lapibal inj ampul 106 1 50 55 105 26,125
68 Lapixim injeksi ampul 31 0 20 11 31 156,750
69 Lasix injeksi ampul 1,500 74 1,125 301 1,426 8,108
70 Levemir inj pen 143 128 150 100 40 25 165 83,950
71 Lidokain ampul 545 189 200 55 101 356 1,458
72 Mecobalamin inj ampul 678 135 500 43 543 6,160
73 Meropenem 1 gr vial 52 51 100 40 61 101 59,862
74 Methylergometrin injeksi ampul 290 32 258 258 3,278
75 Metyl prednisolon 125 mg vial 92 59 33 33 11,449
76 Meylon botol 20 0 10 10 20 8,333
77 MgSO4 20% ampul 0 0 30 15 15 30 3,200
78 MgSO4 40% ampul 49 43 30 36 36 3,796
79 Miloz inj ampul 114 17 97 97 42,075
80 Morphin injeksi ampul 55 6 49 49 34,050
81 Na Fenitoin inj ampul 66 23 100 100 43 143 12,728
82 Neostigmin inj ampul 32 2 50 50 30 80 8,200
83 Neurobat ampul 437 324 600 280 433 713 12,210
84 Nikardipin injeksi ampul 101 26 50 25 75 24,004
85 Novomix inj pen 52 17 11 24 35 110,968
86 Novorapid flexi pen pcs 160 148 100 50 14 48 112 87,000
87 NTG ampul 20 0 10 10 20 71,500
88 Octalbin 20% 100 ml botol 3 4 10 9 9 1,510,000
89 Octalbin 20% 50 ml botol 5 0 5 5 765,000
90 Oksitosyn injeksi ampul 1,237 417 600 220 820 1,232
91 Omeprasol inj ampul 837 327 400 110 510 10,002
92 Ondansetron 4 mg ampul 165 293 1,000 700 172 872 1,259
93 Pantoprazol injeksi vial 343 8 200 135 335 24,007
94 Pehacain inj ampul 170 44 100 26 126 2,646
95 Petidin injeksi ampul 33 1 32 32 19,481
96 Picyn inj vial 80 36 25 19 44 51,703
97 Pirasetam inj 3gr ampul 101 0 50 51 101 16,421
98 Ranitidin ampul 2,284 569 1,300 415 1,715 1,188
99 Regivel injeksi ampul 2 0 2 2 69,300
100 Roculax injeksi ampul 47 2 20 25 45 61,600
101 SABU vial 5 0 2 3 5 512,204
102 Salticin inj ampul 166 29 88 49 137 14,520
103 Sibital injeksi ampul 130 2 128 128 9,900
104 Simdrol 125 mg ampul 28 8 20 20 91,960
105 Simexim inj ampul 40 0 20 20 40 151,525
106 Sojourn botol 15 8 7 7 1,326,500
107 Streptomycin injeksi ampul 161 0 56 49 56 161 5,980
108 Terrel botol 2 0 2 2 2,856
109 Tetagam vial 32 18 10 4 14 188,661
110 Tomit ampul 101 136 200 100 65 165 11,956
111 Tramadol ampul 440 30 300 110 410 5,378
112 Ulvice inj ampul 177 60 50 67 117 29,700
113 Vaksin serum PPD vial 0 1 5 2 1 1 4 772,475
114 Vancep injeksi vial 21 0 10 11 21 209,000
115 Vascon vial 126 20 100 6 106 99,275
116 Vasodrin injeksi ampul 188 6 182 182 41,800
117 Vit K ampul 332 133 120 79 199 4,236

SIRUP
1 Ambroxol 15 mg/5 ml botol 163 4 130 11 18 159 4,352
2 Amoksisilin botol 14 9 4 1 5 4,620
3 Ancefa botol 15 1 5 1 8 14 42,845
4 Antasid botol 160 20 100 24 16 140 2,239
5 Asam valproat sirup botol 123 26 80 12 5 97 17,787
6 Azitromicin sirup botol 72 1 65 2 4 71 26,353
7 Batugin 300 ml botol 25 8 5 8 4 17 43,913
8 Calnic plus sirup botol 12 1 2 4 5 11 76,824
9 Cefadroksil forte botol 24 9 4 11 15 14,850
10 Cefixim sirup botol 32 16 8 8 16 6,850
11 Cetirizin botol 89 14 45 8 22 75 12,528
12 Domperidon sirup botol 29 7 8 14 22 5,750
13 Enystin drop botol 9 3 3 3 6 43,758
14 Eritromisin botol 4 0 3 1 4 11,653
15 Erysanbe botol 16 7 5 4 9 19,959
16 Ferriprox sirup botol 5 0 2 3 5 2,015,977
17 Gastrinal sirup botol 55 10 10 19 16 45 31,350
18 Ibuprofen botol 200 6 170 12 12 194 5,034
19 Imunvit sirup botol 29 0 20 2 7 29 100,428
20 Inpepsa botol 22 13 3 6 9 68,970
21 Interzink sirup botol 92 16 50 2 24 76 24,750
22 Kamolas drop botol 36 1 10 3 22 35 30,096
23 Kamolas sirup botol 27 3 5 5 14 24 30,096
24 Lacon sirup botol 26 16 30 30 10 40 56,430
25 Lapicef sirup botol 20 0 15 5 20 57,684
26 Lapifed sirup botol 4 3 1 1 27,588
27 Maltiron sirup botol 28 5 10 3 10 23 43,890
28 Maxpro sirup botol 17 3 5 4 5 14 85,536
29 Meprotrim botol 11 2 5 4 9 20,790
30 Mucos drop botol 19 0 10 5 4 19 43,264
31 Mucos sirup botol 25 2 15 5 3 23 20,698
32 OBH botol 17 12 5 5 3,762
33 Optalvit sirup botol 5 0 4 1 5 75,240
34 Parasetamol botol 193 15 105 14 59 178 3,792
35 Parasetamol drop botol 111 6 80 18 7 105 9,175
36 Procelles botol 18 0 5 8 5 18 43,890
37 Promuba botol 2 0 2 2 2 4 53,797
38 Propepsa sirup botol 5 0 5 5 70,422
39 Psidii sirup botol 58 0 50 8 58 41,818
40 Pyrexin botol 0 3 10 4 3 7 10,560
41 Ranivel sirup botol 25 2 15 5 3 23 71,148
42 Relafen sirup botol 33 1 20 3 9 32 21,946
43 Renalyt botol 4 2 12 5 9 14 18,018
44 Renasisten drop botol 10 0 7 3 10 62,700
45 Rinocet botol 40 1 30 7 2 39 66,075
46 Salbutamol sirup botol 15 3 9 3 12 5,335
47 Sim DHA botol 3 0 3 3 56,430
48 Simfix sirup botol 9 0 5 4 9 87,780
49 Simzen drop botol 13 2 10 1 11 68,970
50 Sukralfat sirup botol 22 23 50 30 9 10 49 9,847
51 Supralisyn sirup 60 ml botol 33 14 5 7 7 19 27,588
52 Supralysin drop botol 19 18 30 30 1 31 34,486
53 Supramox 125 mg sirup botol 21 2 4 15 19 25,080
54 Supramox drop botol 14 0 5 5 5 9 19 26,334
55 Supramox forte sirup botol 15 0 5 10 2 8 20 37,620
56 Vectrin sirup botol 5 2 2 1 3 50,688
57 Vometa drop botol 26 0 15 8 3 26 50,054
58 Vometa sirup botol 15 0 10 3 2 15 48,053
59 Zibramax sirup botol 5 0 3 2 5 97,185

INFUS
1 Aminofluid botol 42 18 10 14 24 84,227
2 Aminofusin paediatrik botol 15 1 10 4 14 68,400
3 Asering botol 50 240 480 240 50 290 11,575
4 Ciprofloksasin inf botol 157 4 39 114 153 12,239
5 Comafusin hepar botol 57 1 50 6 56 270,270
6 Cravox botol 10 0 5 5 10 426,360
7 D10% botol 172 17 100 55 155 13,249
8 D5 1/2NS botol 73 40 200 200 33 233 12,816
9 D5 1/4NS botol 145 35 40 70 110 12,672
10 D5% botol 55 61 200 140 54 194 8,280
11 Futrolit botol 812 40 672 100 772 49,667
12 Gelafusal botol 34 8 20 6 26 174,017
13 KAEN 3B botol 372 36 200 136 336 13,577
14 Levofloksasin infus botol 204 54 160 160 150 310 22,792
15 Lipomed botol 3 1 1 1 2 92,569
16 Manitol botol 20 18 40 20 22 42 45,504
17 Metronidazol botol 241 180 280 200 141 341 9,900
18 Movibet botol 16 0 10 6 16 221,760
19 Moxifloxacin botol 10 0 7 3 10 224,400
20 NaCL botol 1,455 820 2,500 2,580 555 3,135 7,692
21 Nacl pygibag botol 762 105 600 57 657 14,573
22 Parasetamol infus botol 325 256 500 450 119 569 36,465
23 RL botol 1,211 1,179 2,300 1,800 532 2,332 7,397
24 Sanbehes botol 55 7 24 24 48 186,254
25 Valamin botol 5 2 2 1 3 51,610

OBAT LUAR
1 Akilen TT botol 12 3 5 4 9 74,260
2 Alloclair gargle botol 12 2 5 2 3 10 108,900
3 Alloclair gell tube 3 2 1 1 101,640
4 Asiklovir cr tube 68 2 25 20 21 66 4,349
5 Astenof botol 4 0 2 2 4 26,334
6 Avamys pcs 20 2 10 4 4 18 128,544
7 Berotec ih botol 26 48 50 5 16 7 28 99,828
8 Betadin kumur botol 15 0 15 15 4 11 30 14,269
9 Betametason krem tube 48 3 25 10 10 45 1,869
10 Breathy nasal drop botol 9 1 3 3 2 8 25,872
11 Carmed gell tube 6 2 4 4 30,305
12 Carpin TM botol 10 2 10 10 3 5 18 19,438
13 Cenfresh MDS strip 260 194 500 480 54 32 566 28,842
14 Chloramphenicol SM tube 32 0 24 4 4 32 2,310
15 Combivent nebul ampul 1,259 127 1,080 11 41 1,132 5,460
16 Conver 2% botol 20 1 10 4 5 19 17,160
17 Desoksimetason krem tube 8 6 2 2 13,800
18 Desolex crem tube 15 2 10 2 1 13 27,258
19 Dulcolax supp 10 supp 892 7 500 225 160 885 19,800
20 Dulcolax supp 5 supp 57 0 28 29 57 19,129
21 Efrisel TM botol 26 1 20 5 25 19,125
22 Elox botol 3 0 3 3 77,220
23 Eyefresh plus MDS strip 49 4 33 12 45 44,885
24 Fita joint botol 5 0 3 2 5 78,370
25 Floxa MDS strip 57 45 140 100 37 15 152 33,545
26 Flutias batang 21 3 10 4 4 18 138,600
27 Formalin cair botol 2 0 2 2 68,000
28 Forumen TT botol 19 2 10 4 3 17 32,047
29 Fusycom tube 4 2 1 1 2 41,800
30 Genta EO tube 43 18 10 5 10 25 45,614
31 Genta TM botol 18 0 13 5 18 35,584
32 Gentamycin SK tube 169 71 30 38 30 98 2,360
33 Hidrokortison tube 31 10 12 3 6 21 3,847
34 Hyalub MDS strip 61 10 20 4 27 51 71,478
35 Iliadin Moist botol 12 3 4 3 2 9 19,965
36 Iliadin spray botol 15 3 5 2 5 12 47,362
37 Inerson tube 17 0 10 2 5 17 81,510
38 Iodosorb powder bungkus 22 0 14 8 22 65,800
39 Karyuni botol 68 9 50 9 59 47,124
40 Ketokonazol krem tube 42 2 25 15 40 3,160
41 Ketomed shampoo botol 13 2 5 6 11 41,905
42 Latipres TM botol 15 5 10 10 212,356
43 Lentricular MDS strip 79 21 20 15 23 58 41,696
44 LFX MDS strip 171 31 100 20 20 140 86,526
45 Lyteers MDS strip 70 4 29 37 66 24,139
46 Mebo krem tube 17 5 30 30 1 11 42 99,694
47 Mikonazol krem tube 9 1 4 4 8 3,689
48 Mydriatil botol 82 5 50 16 11 77 37,162
49 Nasalin botol 4 1 1 2 3 114,048
50 Nistatin vagina supp 157 0 10 147 157 9,943
51 Otilon TT botol 21 10 7 4 11 48,391
52 Pantocain TM botol 30 21 5 4 9 15,205
53 Permetrine botol 26 3 10 6 7 23 47,520
54 Pirotop crem tube 15 1 5 7 2 14 42,515
55 Polydex MDS strip 54 4 20 3 27 50 33,232
56 Polynel MDS strip 32 12 20 20 22,415
57 Pronalges supp supp 340 243 50 47 97 17,622
58 Provagin supp 88 2 20 34 32 86 9,817
59 Pulmicort resp ampul 242 58 100 84 184 11,670
60 Seretide box 25 18 5 2 7 140,024
61 Sodermix tube 19 3 5 6 5 16 106,590
62 Spiriva Respimate pcs 30 27 40 30 13 43 543,600
63 Stesolid rectal 5 ampul 28 5 23 23 31,363
64 Stratrol TM botol 9 3 5 1 6 22,885
65 Sulfadiazin silver tube 12 2 10 10 4 6 20 24,840
66 Symbicort box 36 42 50 10 12 22 44 161,141
67 Tantum Verde botol 25 0 5 5 15 25 20,790
68 Tarivid TM botol 34 3 20 11 31 61,565
69 TCA 90 sol 20ml botol 4 0 4 4 198,000
70 Timol MDS strip 72 63 80 60 14 15 89 32,291
71 Tobro MDS strip 48 0 10 28 10 48 36,366
72 Tobroson MDS strip 54 9 20 20 26 19 65 36,366
73 Trombophob tube 13 1 5 3 4 12 62,704
74 Tropin botol 50 1 35 5 9 49 14,108
75 Vasacon 0,6 ml MDS strip 78 4 40 24 10 74 18,983
76 Venosmil gell tube 7 0 5 1 1 7 193,050
77 Ventolin nebul ampul 684 132 200 161 191 552 4,800
78 Vitrolenta botol 64 5 35 14 10 59 41,069
79 Xitrol MDS strip 175 57 80 14 24 118 30,567
80 Xitrol EO tube 69 16 40 4 9 53 44,987
81 Xylocain spray botol 1 0 1 1 212,650

BAKHP
1 Alkohol 70% btl/300 ml 421 119 282 20 302 18,000
2 Alkohol 95% btl/1 ltr 5 0 5 5 85,800
3 Alkohol swab pcs 10,272 3,379 6,000 683 210 6,893 198
4 Allevyn 7,5x7,5 pcs 91 0 70 21 91 63,241
5 Anyosime DD1 botol 5 2 3 3 3,390,000
6 APD set refocusing set 1,200 0 1,200 1,200 1,501,500
7 Appablade (MST 15) pcs 15 5 6 4 10 231,000
8 Appalens 19,5 pcs 3 0 2 1 3 140,976
9 Appalens 20 pcs 5 0 5 5 334,018
10 Appalens 20,5 pcs 3 0 2 1 3 143,000
11 Appalens 21 pcs 4 1 1 2 3 143,000
12 Appalens 21,5 pcs 2 1 2 2 1 3 143,000
13 Appalens 22 pcs 3 3 2 1 1 2 143,000
14 Appalens 22,5 pcs 1 1 2 1 1 2 143,000
15 Appalens 23 pcs 0 0 2 1 1 2 143,000
16 Appalens 23,5 pcs 3 1 1 1 2 143,000
17 Appalens 26,5 pcs 3 0 2 1 3 143,000
18 Appron pcs 4,100 200 3,900 3,900 9,504
19 Atramat PGA 5/0 round pcs 17 0 12 5 17 142,330
20 Atramat Silk 3/0 cutting pcs 6 0 6 6 72,105
21 Aximed wound drain 400 ml no 10 pcs 6 0 3 3 6 158,405
22 Aximed wound drain 400 ml no 14 pcs 3 0 3 3 158,405
23 Baby eyes blinder (eye care) pcs 17 0 15 2 17 62,700
24 Bactigras pcs 174 119 300 200 21 134 355 12,936
25 Benang nilon 10/0 pcs 17 0 17 17 333,527
26 Biotek infusion pump pcs 5 0 5 5 280,463
27 Bisturi 11 pcs 127 0 127 127 3,960
28 Bisturi 12 pcs 100 0 100 100 3,960
29 Bisturi 15 pcs 254 74 100 80 180 3,960
30 Bisturi 20 pcs 311 49 200 62 262 3,960
31 Body wash gloves bungkus 84 0 25 59 84 21,946
32 Camera drape pcs 27 5 15 7 22 142,798
33 Catgut cromic 1 SMI pcs 24 0 24 24 52,200
34 Catacol pcs 43 2 30 11 41 108,346
35 Catgut cromic 2/0 75 cm pcs 0 10 60 36 14 50 40,080
36 Catgut cromic 3/0 pcs 49 5 36 8 44 40,080
37 Ceratone (MSL 27) pcs 11 2 6 3 9 265,400
38 Certovix pcs 12 0 5 7 12 660,000
39 Chlorethyl pcs 5 4 1 1 150,000
40 Colostomy bag 3 pcs 47 10 20 17 37 4,224
41 Colostomy bag all size pcs 81 17 30 12 22 64 10,032
42 Cotton bud pcs 1,211 171 500 540 1,040 4,800
43 Couter aeron bovie pcs 18 2 10 6 16 369,600
44 Couter pen pcs 71 44 25 2 27 112,200
45 Cresen knife MCU 26 pcs 30 0 30 30 261,360
46 Crogut 1 pcs 0 7 12 5 5 82,500
47 Crogut 2 pcs 0 4 12 8 8 60,500
48 Cohevisc pcs 15 0 15 15 462,000
49 Desinfektan 5 liter galon 21 3 18 18 424,000
50 Disposable perlak (bed liner) pcs 40 40 100 100 100 62,172
51 Elastomull haft 8x4 box 50 10 20 20 40 66,660
52 Elektroda pcs 1,351 282 900 169 1,069 3,960
53 ETT 2,5 pcs 3 4 3 2 2 46,886
54 ETT 3,5 pcs 11 6 5 5 57,024
55 ETT 4 pcs 27 0 10 17 27 46,886
56 ETT 4,5 pcs 40 0 30 10 40 30,096
57 ETT 5 pcs 6 0 3 3 6 86,400
58 ETT 5,5 pcs 6 0 2 4 6 86,400
59 ETT 6 pcs 10 7 3 3 86,400
60 ETT 6,5 pcs 10 1 5 4 9 86,400
61 ETT 7 pcs 10 5 5 5 27,827
62 ETT 7,5 pcs 6 6 10 10 10 27,827
63 ETT 8 pcs 11 6 5 5 27,827
64 ETT non king king no 3 pcs 3 0 3 3 184,413
65 ETT non king king no 3,5 pcs 6 0 6 6 184,413
66 ETT non kingking 6,5 pcs 10 0 5 5 10 215,520
67 Extension tube pcs 161 54 100 7 107 22,176
68 Eye drape pcs 35 9 10 16 26 74,000
69 Eyeshild drop pcs 232 9 200 23 223 17,840
70 Face hield pcs 780 0 780 780 52,800
71 FC 14 pcs 20 2 10 4 4 18 33,000
72 FC 16 pcs 105 162 500 400 7 36 443 29,040
73 FC 18 pcs 97 16 40 18 23 81 29,040
74 FC 3 way 22 pcs 9 1 10 10 8 18 79,200
75 FC 3 way 24 pcs 22 3 10 10 19 29 96,599
76 FC 6 pcs 20 1 10 9 19 258,720
77 FC 8 pcs 23 3 10 3 7 20 60,720
78 Fixomul 10x5 cm 32,735 19,227 50,000 50,000 578 12,930 63,508 216
79 Flourescein strip box 154 0 100 54 154 4,620
80 Formalin buffer botol 1 0 1 1 442,350
81 Gelang anak pink pcs 204 0 204 204 1,482
82 Gipson 3 pcs 32 1 10 21 31 74,518
83 Gipsona 4 pcs 42 12 20 10 30 27,780
84 Gipsona 6 pcs 24 2 10 12 22 36,486
85 Gudel 0 pcs 61 0 50 11 61 31,870
86 Gudel 00 pcs 42 0 30 12 42 31,870
87 Gudel 000 pcs 11 0 5 6 11 31,870
88 Gudel 1 pcs 12 1 5 6 11 31,870
89 Gudel 2 pcs 8 1 20 20 7 27 31,870
90 Gudel 3 pcs 53 19 30 4 34 39,600
91 Gudel 4 pcs 22 0 15 7 22 26,400
92 H2O2 botol 1 3 5 3 3 42,000
93 Handrub botol 196 114 82 82 79,200
94 Handscrub botol 119 46 73 73 125,400
95 Handscrub galon 5 0 5 5 495,000
96 Hand sanitizer botol 37 0 37 37 200,000
 97 Hazmat pcs 170 70 100 100 363,000
98 Hernia mesh 6x11 pcs 15 10 24 24 5 29 290,400
99 HS NS M pasang 9,000 10,597 5,000 853 2,550 3,403 1,214
100 HS panjang karet merah pasang 88 0 88 88 132,000
101 HS obsgyn NS refocusing pasang 1,490 0 1,490 1,490 132,000
102 HS obsgyn NS DID pasang 300 0 300 300 220,000
103 HS sensiflex 6 pasang 97 96 1 1 11,990
104 HS sensiflex 6,5 pasang 99 33 36 30 66 11,990
105 HS sensiflex 7,5 pasang 800 799 1 1 11,990
106 HS alphatex salvex no. 9 (ansell) pasang 88 12 68 8 76 66,000
107 HS steril remedi 7 (gynecolog) pasang 200 0 200 200 45,000
108 HS steril remedi 7,5 (gynecolog) pasang 200 0 200 200 45,000
109 HS steril ortho 7,5 pasang 313 167 4 142 146 22,734
110 HS steril 6,5 pasang 1,600 338 950 312 1,262 12,100
111 HS steril 7 pasang 4,850 621 3,600 36 593 4,229 12,100
112 HS steril 7,5 pasang 1,000 250 750 750 12,100
113 HS steril 8 pasang 200 83 117 117 22,000
114 HMEF pcs 50 0 25 25 50 49,500
115 Inflo 26 pcs 194 64 50 80 130 16,500
116 Infuset pcs 0 95 2,020 1,400 525 1,925 8,400
117 Infuset mikro OI 34 pcs 572 53 300 219 519 9,504
118 Intrafix pcs 119 0 110 9 119 38,610
119 Intrasit gell pcs 5 4 24 10 4 11 25 19,140
120 IV 3000 pcs 543 179 200 164 364 6,336
121 Jarum kulit pcs 165 0 165 165 3,520
122 Jarum lantus pcs 1,228 987 2,000 1,000 850 391 2,241 2,353
123 Jarum otot pcs 49 0 49 49 3,520
124 Jelly galon 1 2 4 3 3 330,000
125 Kalvis pcs 18 2 10 6 16 106,920
126 Kalvisol pcs 26 1 13 12 25 223,938
127 Kantong mayat pcs 4 0 4 4 363,000
128 Kapas 250 gr pcs 47 9 30 8 38 84,606
129 Kapas berlemak pcs 2 0 2 2 33,000
130 Kapsul kosong 0 pcs 3,000 0 3,000 3,000 96
131 Kapsul kosong 00 pcs 1,000 0 1,000 1,000 132
132 Kapsul kosong 1 sak 0 1,000 2,000 1,000 1,000 96
133 Kapsul kosong 2 sak 3,000 0 3,000 3,000 117
134 Kasa 10 x 10 pcs 11,470 2,770 8,000 30 670 8,700 2,442
135 Kasa 16x16 pcs 0 68 5,000 4,000 482 450 4,932 4,950
136 Kasa 2x80 lipat pcs 100 5 95 95 18,018
137 Kasa 15x50 pcs 129 13 75 41 116 49,500
138 Kasa 4x10 pcs 900 0 900 900 4,213
139 Kasa 4x15 pcs 3,608 184 2,700 224 500 3,424 2,534
140 Kasa 4x5 pcs 6 0 6 6 792
141 Kasa 5x5 pcs 3,630 840 520 550 1,720 2,790 1,188
142 Kasa 7 x7 pcs 10,210 2,468 3,000 832 3,910 7,742 1,650
143 Kasa depper kecil bungkus 90 0 90 90 5,280
144 Kasa rll 1/5 pcs 261 15 236 10 246 4,514
145 Kertas CTG pcs 2,700 600 2,100 2,100 1,540
146 Kertas ECG M pcs 35 0 35 35 95,400
147 Kertas ECG S pcs 12 0 12 12 43,890
148 Kertas ECG L pcs 10 10 50 50 50 297,000
149 Kertas EKG buku bk 3 0 3 3 918,720
150 Kertas USG pcs 14 0 14 14 401,500
151 LMA 1 pcs 39 0 35 4 39 165,704
152 LMA 1,5 pcs 6 0 3 3 6 165,704
153 LMA 2 pcs 18 0 12 6 18 234,960
154 LMA 2,5 pcs 1 0 1 1 831,600
155 LMA 3 pcs 10 5 10 12 3 15 234,960
156 LMA 4 pcs 12 3 5 4 9 165,704
157 LMA 5 pcs 10 1 7 2 9 234,960
158 Masker blud 3 ply pcs 1,247 197 1,050 1,050 924
159 Masker refocusing 3 ply pcs 25,050 15,550 9,500 9,500 5,200
160 Masker DID 3 ply pcs 14,950 0 14,950 14,950 9,200
161 Masker dengan penutup mata pcs 160 0 160 160 14,520
162 Masker N95 pcs 536 381 120 3 32 155 46,200
163 Masker nebulizer anak pcs 309 6 250 5 48 303 52,800
164 Masker nebulizer dewasa pcs 157 13 138 6 144 39,600
165 Masker NRM pcs 115 46 50 19 69 39,600
166 Mede blue pcs 4 3 10 5 6 11 120,384
167 Melolin 10x10 pcs 200 0 180 20 200 10,032
168 Milcide AB galon 4 0 4 4 1,758,333
169 Mop cup pcs 962 1,810 3,000 1,700 72 380 2,152 2,310
170 Mucus extractor pcs 58 47 100 80 31 111 27,060
171 Nasal oksigen anak pcs 143 8 100 35 135 10,560
172 Nasal oksigen anak sungkup pcs 94 5 80 9 89 44,352
173 Nasal oksigen bayi pcs 65 5 50 10 60 15,840
174 Nasal oksigen dewasa pcs 495 120 300 75 375 10,890
175 Nasal Oksigen dewasa sungkup pcs 94 19 75 75 19,800
176 Nasal oksigen infant pcs 71 20 50 1 51 8,580
177 Nasopharyn air way no 4 pcs 13 0 5 8 13 198,000
178 Nasopharyn air way no 6 pcs 12 0 10 2 12 198,000
179 Nasopharyn air way no 7 pcs 12 0 5 7 12 198,000
180 Nelaton cateter 10 pcs 13 0 13 13 14,520
181 Nelaton cateter 12 pcs 12 0 12 12 14,520
182 Neo eye 18 pcs 13 0 3 10 13 244,200
183 Neo eye 18,5 pcs 9 0 4 5 9 249,062
184 Neo eye 20 pcs 9 0 5 4 9 244,200
185 Neo eye 24 pcs 1 0 1 1 244,200
186 Neo eye 24,5 pcs 2 0 2 2 244,200
187 Neo eye 26 pcs 5 0 3 2 5 244,200
188 Neo eye 26,5 pcs 1 0 1 1 207,552
189 Neo eye 27,5 pcs 1 0 1 1 249,062
190 Neo eye 28,5 pcs 1 0 1 1 249,062
191 NGT 12 pcs 109 5 95 9 104 12,430
192 NGT 14 pcs 108 1 100 7 107 12,430
193 NGT 16 pcs 10 15 20 10 5 15 18,446
194 NGT 18 pcs 137 7 100 30 130 18,446
195 NGT 3,5 pcs 76 1 50 25 75 19,008
196 NGT 5 (100 cm) pcs 13 1 10 2 12 20,529
197 NGT 5 (40 cm) pcs 192 27 50 67 48 165 16,892
198 NGT 8 ( 40 cm) pcs 207 24 50 81 52 183 21,669
199 NGT 8 100 cm pcs 181 3 100 78 178 18,058
200 Opsite 20 X 10 pcs 288 63 160 27 38 225 34,848
201 Opsite 6,5 x 5 pcs 318 8 100 2 208 310 10,824
202 Optima 20 pcs 10 6 4 4 123,200
203 Optima 21 pcs 9 4 5 5 123,200
204 Optima acrylic fordable no 20 pcs 10 0 10 10 358,000
205 Optima acrylic fordable no 21 pcs 10 0 10 10 358,000
206 Oxylock pcs 4 0 2 2 4 132,000
207 Patient return electrode cord cable pcs 2 0 2 2 34,320
208 Patient return electrode for pad pcs 85 5 80 80 33,000
209 Perifix pcs 3 0 3 3 372,000
210 Plester roll 32 13 19 19 42,638
211 Povidon Iodin 1000 ml botol 20 17 24 21 6 27 179,186
212 Povidon Iodin 60 ml botol 165 3 96 40 26 162 28,747
213 PP 1/0 pcs 102 4 36 62 98 62,238
214 PP 2/0 cutting pcs 77 23 36 18 54 37,344
215 PP 3/0 pcs 0 33 180 84 63 147 37,344
216 PP 5/0 cutting pcs 34 10 60 60 24 84 37,344
217 PP 5/0 round pcs 24 2 12 10 22 69,089
218 PP 6/0 cutting pcs 36 3 12 21 33 246,575
219 PP 6/0 round pcs 12 0 12 12 12 24 82,835
220 PP 7/0 tapper pcs 0 0 12 12 12 78,179
221 Rigit cervical Collar M pcs 4 0 2 2 4 303,600
222 Rigit cervical Collar S pcs 3 0 1 2 3 303,600
223 Ring pesarium 70 pcs 2 0 1 1 2 552,024
224 Ring pesarium 80 pcs 5 0 2 3 5 552,024
225 Sansulin pen pcs 5 0 3 8 8 327,000
226 Selang silicon roll 1 0 1 1 4,204,200
227 Sendok obat pcs 9,500 0 9,500 9,500 739
228 Septalkan spray 750ml botol 42 3 39 39 263,801
229 Shepard w/ wire pcs 16 0 10 6 16 132,000
230 Silk black 1 SMI pcs 68 3 36 29 65 25,560
231 Silk black 2/0 SMI pcs 27 25 36 12 26 38 25,080
232 Silk black 3/0 roll 1 0 1 1 21,945
233 Silk black 3/0 SMI pcs 0 7 60 12 41 53 24,360
234 Silkpro 1 pcs 13 0 13 13 59,400
235 Snare ware pcs 91 0 91 91 62,430
236 Soda lime pcs 1 0 1 1 26,334
237 Sofban 3 pcs 41 1 20 20 40 18,206
238 Sofban 4 pcs 27 3 8 16 24 18,990
239 Sofban 6 pcs 20 0 12 8 20 37,891
240 Soft cervical collar L pcs 2 0 1 1 2 277,200
241 Soft cervical collar XL pcs 1 0 1 1 277,200
242 Spinocan 25 pcs 189 21 100 68 168 39,187
243 Spinocan 27 pcs 32 38 50 25 19 44 48,258
244 Spirometer gulung lebar 11 cm roll 1 0 1 1 171,600
245 Sponjel pcs 34 4 20 10 30 63,360
246 Spuit 1 cc pcs 1,921 1,006 7,200 7,100 98 917 8,115 2,587
247 Spuit 10 cc pcs 1,563 2,251 8,000 6,300 100 912 7,312 2,244
248 Spuit 20 cc pcs 223 60 50 27 86 163 8,110
249 Spuit 3 cc pcs 8,949 3,033 3,500 100 2,316 5,916 1,366
250 Spuit 5 cc pcs 2,959 1,637 12,000 12,000 17 1,305 13,322 1,920
251 Spuit 50 cc LP pcs 456 58 320 78 398 8,316
252 Spuit 60 cc LT pcs 257 23 150 84 234 23,100
253 Steranios botol 2 0 2 2 835,200
254 Suction cateter no 10 pcs 23 0 23 23 11,616
255 Suction cateter no 12 pcs 63 9 40 14 54 3,619
256 Suction cateter no 16 pcs 105 0 20 85 105 13,939
257 Suction cateter no 6 pcs 27 5 20 2 22 13,939
258 Suction cateter no 8 pcs 136 21 100 15 115 18,480
259 Suction conecting tube roll 30 0 25 5 30 44,000
260 Surflo 16 pcs 179 0 150 29 179 10,026
261 Surflo 18 pcs 14 8 6 6 7,524
262 Surflo 20 pcs 74 312 2,000 1,600 162 1,762 7,524
263 Surflo 22 pcs 532 298 1,000 1,100 134 1,234 7,524
264 Surflo 24 pcs 701 129 1,000 1,400 172 1,572 7,524
265 Surgycril 1 pcs 68 94 144 108 10 118 125,016
266 Surgycril 2/0 HR 36 pcs 0 42 120 48 30 78 82,334
267 Surgycril 3/0 pcs 24 49 144 84 35 119 78,624
268 Surgycril 4/0 pcs 16 3 13 13 78,742
269 Surgycril 6/0 pcs 6 0 6 6 96,204
270 Surgycril 8/0 pcs 43 0 24 19 43 504,108
271 T cromic 0 90 cm pcs 30 1 24 5 29 59,495
272 T lene 1/0 round pcs 24 0 12 12 24 100,800
273 T lene polyvinilene 5,0 90 cm round pcs 22 0 12 10 22 132,850
274 Tensocrepe 3 " roll 4 2 30 20 4 8 32 35,354
275 Tensocrepe 4" roll 43 13 12 4 14 30 42,173
276 Tensocrepe 6" roll 32 6 12 14 26 53,772
277 Thoracic trochar no 20 pcs 5 0 4 1 5 257,400
278 Thoracic trochar no 24 pcs 7 0 5 2 7 257,400
279 Ticryl 1/0 100 cm tapper pcs 53 32 60 60 21 81 92,400
280 Ticryl 2/0 75 cm tapper pcs 45 23 60 60 22 82 91,080
281 Ticryl 3/0 75 cm tapper pcs 71 7 48 16 64 81,840
282 Tracheostomy cuffed fr. 7,0 pcs 2 0 2 2 442,200
283 Tracheostomy cuffed fr. 7,5 pcs 2 0 2 2 442,200
284 Transofix pcs 181 27 100 54 154 9,108
285 Tri way pcs 216 112 50 54 104 6,600
286 Tri way buntut pcs 331 285 46 46 6,600
287 T-Vio 1/0 pcs 74 31 36 7 43 94,560
288 T-Vio 2/0 pcs 62 24 24 14 38 87,480
289 T-Vio 2/0 episiotomy pcs 32 0 24 8 32 76,464
290 T-Vio 3/0 cutting pcs 26 6 60 60 20 80 78,720
291 Umbilical cord claim pcs 2,234 72 2,000 162 2,162 4,708
292 Urin bag pcs 600 155 400 9 36 445 7,920
293 Urogard pcs 5 0 5 5 45,707
294 Viscaid 1,5 1 ml pcs 32 15 17 17 290,400
020
TOTAL
HARGA
539,520
707,940
301,350
2,533,450
486,135
290,935
2,265,450
187,374
5,450,605
373,167
3,234
261,300
2,969,890
3,545,685
27,132
654,473
1,078,911
674,190
1,558,772
399,556
1,580,544
1,700,142
727,760
805,970
333,915
3,286,710
1,218,424
3,516,480
1,258,131
2,057,000
4,166,316
161,483
2,336,565
1,245,288
484,344
7,226,373
1,144,902
246,992
594,000
739,200
13,076,944
3,034,296
83,832
59,169
1,650
138,600
892,749
4,284,294
10,678,072
1,569,155
5,460,210
4,375,250
604,642
1,881,000
722,700
2,661,120
1,732,885
648,672
4,983
192,360
14,108,276
1,766,050
1,096,480
384,134
71,544
747,972
1,172,766
1,065,960
95,046
4,546,206
21,601,632
546,975
274,536
45,152
19,270
1,469,160
779,008
80,030
5,117,256
731,500
1,185,030
319,440
241,200
11,386,473
1,029,325
198,565
196,248
64,050
316,635
124,080
325,600
1,159,950
25,080,000
809,732
2,640,000
3,348,180
1,651,680
1,128,564
1,707,200
830,786
17,199,455
1,839,200
51,230
915,420
236,520
2,339,584
4,427,108
184,644
1,598,132
29,120
31,328
2,344,188
7,273,398
1,107,783
386,962
781,660
219,450
2,447,280
199,732
2,689,104
4,262,955
250,250
81,510
589,390
1,388,296
 40,796
160,260
97,010
700,264
4,410,120
197,456
3,234,552
85,992
2,504,500
1,928,640
182,910
334,068
244,440
452,222
7,199,280
1,587,355
2,564,640
993,000
292,300
40,959
164,495
446,880
3,236,528
7,803,015
243,102
6,714,862
206,880
540,474
1,959,010
784,669
786,210
1,126,950
747,450
254,044
2,454,480
817,704
5,042,520
557,127
465,850
1,125,978
2,358,620
5,209,872
20,064
917,085
1,633,710
1,128,600
376,470
3,062,268
1,563,600
4,506,138
212,310
427,712
1,069,224
1,857,269
20,952
3,303,440
1,053,952
5,346,000
203,790
494,945
962,496
2,547,375
40,083
181,185
152,650
 1,392,930
181,636
7,482,807
513,150
11,187
277,200
382,704
1,619,750
1,977,059
1,492,984
669,636
264,957
1,379,450
5,125,898
654,607
85,316
696,870
3,198,611
2,584
244,970
554,185
1,951,188
481,000
169,834
206,000
528,224
2,640,600
871,500
1,241,460
2,836,896
1,394,260
14,461,084
1,454,178
1,661,550
1,178,760
655,936
237,006
3,796,425
55,088
560,528
155,036
528,000
2,518,208
1,163,712
475,104
911,196
352,364
249,365
10,226,370
343,278
220,520
257,070
105,248
406,001
4,345,110
792,000
1,642,080
1,201,200
945,236
3,971,352
3,744
35,915
69,840
1,946,448
698,060
 2,250,963
564,300

1,013,341
368,368
316,313
487,200
4,466,880
2,816,000
1,016,400
11,623,040
3,559,400
285,000
683,712
1,272,348
263,978
917,000
4,239,646
5,330,325
3,077,965
4,181,760
527,901
1,782,000
1,416,800
3,879,392
9,196,000
1,630,200
13,994,640
3,557,268
8,119,650
9,875,250
529,760
3,289,000
14,214,200
13,200,000
23,031,800
3,663,660
180,290
578,292
781,435
1,244,655
542,270
173,090
6,771,600
7,755,264
614,922
325,600
8,030,825
543,400
11,325,600
1,489,125
4,600,200
6,799,998
2,062,500
1,533,636
945,870
8,204,625
600,325
3,036,000
1,544,000
615,930
960,960
90,244
137,896
 3,067,632
2,299,900
4,221,800
19,369,350
6,905,250
2,743,125
4,859,250
11,562,008
13,851,750
519,048
3,344,880
6,046,062
845,724
377,817
166,660
96,000
136,656
4,081,275
1,668,450
1,820,104
656,000
8,705,730
1,800,300
3,883,880
9,744,000
1,430,000
13,590,000
3,825,000
1,010,240
5,101,020
1,097,848
8,042,345
333,396
623,392
2,274,932
1,658,521
2,037,420
138,600
2,772,000
2,561,020
1,989,240
1,267,200
1,839,200
6,061,000
9,285,500
962,780
5,712
2,641,254
1,972,740
2,204,980
3,474,900
3,089,900
4,389,000
10,523,150
7,607,600
842,964

691,968
23,100
599,830
313,460
1,725,339
1,871,063
746,521
 845,064
222,750
109,600
939,600
126,509
262,548
46,612
179,633
10,079,885
1,410,750
976,596
2,912,412
620,730
1,881,000
1,053,360
722,304
2,257,200
1,153,680
27,588
1,009,470
1,197,504
187,110
822,016
476,054
18,810
376,200
674,976
963,375
790,020
215,188
352,110
2,425,444
73,920
1,636,404
702,272
252,252
627,000
2,576,925
64,020
169,290
790,020
758,670
482,503
524,172
1,069,066
476,520
500,346
752,400
152,064
1,301,404
720,795
485,925

2,021,448
957,600
3,356,750
1,872,567
15,135,120
4,263,600
2,053,595
2,986,128
1,393,920
1,606,320
38,342,924
 4,524,442
4,561,872
7,065,520
185,138
1,911,168
3,375,900
3,548,160
2,244,000
24,114,420
9,574,461
20,748,585
17,249,804
8,940,211
154,830

668,340
1,089,000
101,640
287,034
105,336
2,313,792
2,795,184
428,070
84,105
206,976
121,220
349,884
16,324,572
73,920
6,180,720
326,040
27,600
354,354
17,523,000
1,090,353
478,125
231,660
2,019,825
391,850
5,098,840
2,494,800
136,000
544,799
83,600
1,140,350
640,512
231,280
80,787
3,645,378
179,685
568,344
1,385,670
1,447,600
2,780,316
126,400
460,955
2,123,560
2,418,368
12,113,640
1,593,174
4,187,148
29,512
2,861,474
342,144
 1,561,051
532,301
136,845
1,092,960
595,210
1,661,600
448,300
1,709,334
844,262
2,147,280
980,168
1,705,440
23,374,800
721,349
137,310
496,800
7,090,204
519,750
1,908,515
792,000
2,873,899
1,745,568
2,363,790
752,448
691,292
1,404,742
1,351,350
2,649,600
2,423,071
3,606,906
2,384,311
212,650

5,436,000
429,000
1,364,814
5,754,931
10,170,000
1,801,800,000
2,310,000
422,928
1,670,090
429,000
429,000
429,000
286,000
286,000
286,000
286,000
429,000
37,065,600
2,419,610
432,630
950,430
475,215
1,065,900
4,592,280
5,669,959
1,402,315
502,920
396,000
712,800
1,037,520
1,843,464
 3,141,556
1,252,800
4,442,186
2,004,000
1,763,520
2,388,600
7,920,000
150,000
156,288
642,048
4,992,000
5,913,600
3,029,400
7,840,800
412,500
484,000
6,930,000
7,632,000
6,217,200
2,666,400
4,233,240
93,772
285,120
1,265,922
1,203,840
518,400
518,400
259,200
777,600
139,135
278,270
139,135
553,239
1,106,478
2,155,200
2,372,832
1,924,000
3,978,320
41,184,000
594,000
12,864,720
2,352,240
1,425,600
2,801,371
4,915,680
1,214,400
13,717,728
711,480
442,350
302,328
2,310,058
833,400
802,692
1,944,070
1,338,540
350,570
350,570
860,490
1,346,400
580,800
126,000
6,494,400
9,154,200
2,475,000
7,400,000
 36,300,000
8,421,600
4,131,242
11,616,000
196,680,000
66,000,000
11,990
791,340
11,990
5,016,000
9,000,000
9,000,000
3,319,164
15,270,200
51,170,900
9,075,000
2,574,000
2,475,000
2,145,000
16,170,000
4,932,576
4,594,590
478,500
2,306,304
580,800
5,273,073
172,480
990,000
1,710,720
5,598,450
1,452,000
3,215,028
66,000
288,000
132,000
96,000
351,000
21,245,400
24,413,400
1,711,710
5,742,000
3,791,700
8,676,416
4,752
3,314,520
12,774,300
475,200
1,110,444
3,234,000
3,339,000
526,680
14,850,000
2,756,160
5,621,000
6,462,456
994,224
4,229,280
831,600
3,524,400
1,491,336
2,114,640
970,200
49,400,000
137,540,000
2,323,200
 7,161,000
15,998,400
5,702,400
2,732,400
1,324,224
2,006,400
7,033,332
4,971,120
3,003,660
1,425,600
3,947,328
950,400
4,083,750
1,485,000
437,580
2,574,000
2,376,000
2,376,000
188,760
174,240
3,174,600
2,241,558
2,197,800
244,200
488,400
1,221,000
207,552
249,062
249,062
1,292,720
1,330,010
276,690
2,397,980
1,425,600
246,348
2,787,180
3,965,427
3,214,253
7,840,800
3,355,440
492,800
616,000
3,580,000
3,580,000
528,000
68,640
2,640,000
1,116,000
810,122
4,838,022
4,657,014
6,099,324
2,016,576
5,489,568
3,136,896
1,519,958
8,136,975
1,988,040
938,148
1,214,400
910,800
1,104,048
2,760,120
2,616,000
4,204,200
 7,020,500
10,288,239
2,112,000
1,661,400
953,040
21,945
1,291,080
772,200
5,681,130
26,334
728,240
455,760
757,820
554,400
277,200
6,583,416
2,123,352
171,600
1,900,800
20,995,128
16,408,128
1,321,930
8,081,256
25,578,240
3,309,768
5,405,400
1,670,400
267,168
195,426
1,463,595
306,658
2,125,200
1,320,000
1,794,654
45,144
13,257,288
9,284,616
11,827,728
14,751,888
6,422,052
9,356,256
1,023,646
577,224
21,676,644
1,725,355
2,419,200
2,922,700
1,131,328
1,265,190
1,398,072
1,287,000
1,801,800
7,484,400
7,468,560
5,237,760
884,400
884,400
1,402,632
686,400
303,600
4,066,080
3,324,240
2,446,848
6,297,600
10,178,696
 3,524,400
228,535
4,936,800
4,706,392,512
 DAFTAR OBAT DILUAR FORNAS
1. Peresepan obat diluar fornas untuk pasien bpjs harus melampirkan formulir obat diluar fornas,
kecuali obat diluar fornas yang sudah di SK kan direktur, boleh diresepkan tanpa form diluar fornas.
2. Peresepan obat paten sesuai fornas utk pasien bpjs, maka diberikan generiknya, kecuali generiknya
kosong atau tidak ada generiknya.

NO NAMA OBAT/BAKHP SATUAN NO NAMA OBAT/BAKHP SATUAN

1 Ambroxol tablet 40 Lapifed tablet

2 Aminefron tablet 41 Lopivia tablet
3 Amoksisilin asam klavulanat tablet 42 L-Bio sachet
4 Amvar tablet 43 L Vit D3 5000 IU tablet
5 Analtram tablet 44 L-Vit D3 1000 IU tablet
6 Asta plus tablet 45 Maltiron tablet
7 Asthin force tablet 46 Mecobalamin tablet
8 Avigan tablet 47 Mecola tablet
9 Brainact 500 mg tablet 48 Melidox tablet
10 Cal 95 tablet 49 MeIxam tablet
11 Cataflam 50 mg tablet 50 Meloksikam 15 tablet
12 Citicolin 1000 mg tablet 51 Meloksikam 7,5 tablet
13 Citicolin 500 mg tablet 52 Misoprostol tablet
14 Clovertil tablet 53 Monecto tablet
15 Curcuma tablet 54 Myonal tablet
16 DC 2 tablet 55 Myonep tablet
17 Dexketoprofen tablet 56 Myores tablet
18 Dtrivit 400 tablet 57 Microgest 100 mg tablet
19 Dtrivit 1000 tablet 58 Microgest 200 mg tablet
20 Dogmatil tablet 59 Neurobat tablet
21 Elxion tablet 60 Optalvit plus tablet
22 Eperison tablet 61 Oskom tablet
23 Eye bright tablet 62 Osteonat tablet
24 Fapiviravir tablet 63 Patral tablet
25 Flunarizin 5 mg tablet 64 Piracetam 800 mg tablet
26 Fluvir tablet 65 Preabor tablet
27 Folaplus tablet 66 Procalma tablet
28 Gastrul tablet 67 Procolic tablet
29 Glucosamin 250 mg tablet 68 Prohelic tablet
30 Glucosamin 500 mg tablet 69 Pro TB 2 kid tablet
31 Hepa-merz sachet 70 Pro TB 3 kid tablet
32 Hepatin tablet 71 Proliver tablet
33 Hystolan tablet 72 Promavit tablet
34 Imboost force tablet 73 Proneuron tablet
35 Imunos tablet 74 Rebamid 100 mg tablet
36 Interhistin tablet 75 Renax tablet
37 Ivermectin tablet 76 Rhinofed tablet
38 Labumin tablet 77 Santa E tablet
39 Lapibal tablet 78 Sim-Ce eff tablet
NO NAMA OBAT/BAKHP SATUAN NO NAMA OBAT/BAKHP SATUAN
79 Simciti tablet 12 Lanos sirup
80 Simcobal tablet 13 Lanos drop
81 Sistenol tablet 14 Lapifed sirup botol
82 Syalox 300 mg tablet 15 Maltiron sirup botol
83 TB vit tablet 16 Mucos drop botol
84 Tebokan spesial tablet 17 Mucos sirup botol
85 Tracetate tablet 18 MG 4-0 botol
86 Tramadol tablet 19 OBH botol
87 Venosmil tablet 20 Optalvit sirup botol
88 Veridin tablet 21 Procelles botol
89 Vip albumin tablet 22 Rhinofed sirup botol
90 Xiety tablet 23 Sim DHA botol
91 Zegavit tablet 24 Supralisyn sirup 60 ml botol
25 Supralysin drop botol
INJEKSI 26 Vectrin sirup botol
1 Adona inj ampul
2 Anbacim inj 1 gr vial INFUS
3 Cefim inj vial 1 Miriwash infus botol
4 Citicolin inj 500/2ml ampul
5 Covifor inj vial OBAT LUAR
6 Desrem injeksi vial 1 Akilen tm botol
7 Euvax 1 ml vial 2 Alloclair gargle botol
8 Furamin injeksi vial 3 Alloclair gell tube
9 Lapibal inj ampul 4 Asiklovir cr tube
10 Levica inj vial 5 Astenof botol
11 Mecobalamin inj ampul 6 Astenof mds strip
12 Neurobat ampul 7 Augentonic tm botol
13 Pantoprazol injeksi ampul 8 Baquinor tm botol
14 Pirasetam inj 3gr ampul 9 Betadin kumur btg
15 Remdac inj vial 10 Betason N krem tube
16 Tofedex ampul 11 Bioplacenton tube
17 Ulvice inj ampul 12 Braliflex plus tm tube
18 Vivena inj ampul 13 Breathy nasal drop botol
19 Venodenol inj ampul 14 Carpin TM botol
15 Cenfresh MDS tube
SIRUP 16 Conver 2% botol
1 Apyalis drop botol 17 Desolex crem tube
2 Ambroxol 15 mg/5 ml botol 18 Emla krem ampul
3 Batugin 120 ml botol 19 Eyefresh plus MDS strip
4 Cal 95 kid sirup botol 20 Fita joint tube
5 Calnic botol 21 Floxa MDS tube
6 Calnic plus sirup botol 22 Fluorocein supp
7 Ferriz drop botol 23 Forumen TT supp
8 Ferriz sirup botol 24 Gentamycin SK botol
9 Gastrinal sirup botol 25 Iodosorb powder tube
10 Inpepsa botol 26 Latipres TM tube
11 Lameson sirup botol 27 Lentricular MDS strip
NO NAMA OBAT/BAKHP SATUAN
28 Ocu fresh tm pcs
29 Otilon TT btl
30 Polidemisin tm strip
31 Polidemisin salep mata strip
32 Polydex MDS botol
33 Polynel MDS tube
34 Sanbe tears tm strip
35 Sanbreth TH tube
36 Sodermix tube
37 Stratrol TM strip
38 Tantum Verde botol
39 TCA 90 sol 20ml botol
40 Tobroson MDS tube
41 Trombophob pcs
42 Vagistin ovula tube
43 Vasacon A 0,6 ml MDS tube
44 Vaselin album 50 gr botol
45 Vaselin 5 gr tube
46 Venosmil gell tube
47 Vitrolenta ampul
48 Xitrol MDS botol
49 Xitrol EO botol
m diluar fornas.
cuali generiknya
 DAFTAR OBAT DILUAR FORNAS
1. Peresepan obat diluar fornas untuk pasien bpjs harus melampirkan formulir obat diluar fornas,
kecuali obat diluar fornas yang sudah di SK kan direktur, boleh diresepkan tanpa form diluar fornas.
2. Peresepan obat paten sesuai fornas utk pasien bpjs, maka diberikan generiknya, kecuali generiknya
kosong atau tidak ada generiknya.

NO NAMA OBAT/BAKHP SATUAN

1 Ambroxol tablet
2 Aminefron tablet
3 Amoksisilin asam klavulanat tablet
4 Amvar tablet
5 Analtram tablet
6 Asta plus tablet
7 Asthin force tablet
8 Avigan tablet
9 Brainact 500 mg tablet
Biocal tablet
10 Cal 95 tablet
11 Cataflam 50 mg tablet
12 Citicolin 1000 mg tablet
13 Citicolin 500 mg tablet
14 Clovertil tablet
15 Curcuma tablet
16 DC 2 tablet
17 Dexketoprofen tablet
18 Dtrivit 400 tablet
19 Dtrivit 1000 tablet
20 Dogmatil tablet
21 Elxion tablet
22 Eperison tablet
23 Eye bright tablet
24 Fapiviravir tablet
25 Flunarizin 5 mg tablet
26 Fluvir tablet
27 Folaplus tablet
28 Gastrul tablet
29 Glucosamin 250 mg tablet
30 Glucosamin 500 mg tablet
HB vit tablet
31 Hepa-merz sachet
32 Hepatin tablet
Hyfolic tablet
33 Hystolan tablet
34 Imboost force tablet
35 Imunos tablet
36 Interhistin tablet
37 Ivermectin tablet
38 Labumin tablet
39 Lapibal tablet
40 Lapifed tablet
41 Lopivia tablet
Latorec tablet
42 L-Bio sachet
43 L Vit D3 5000 IU tablet
44 L-Vit D3 1000 IU tablet
45 Maltiron tablet
46 Mecobalamin tablet
47 Mecola tablet
48 Melidox tablet
49 MeIxam tablet
50 Meloksikam 15 tablet
51 Meloksikam 7,5 tablet
Metilev tablet
52 Misoprostol tablet
53 Monecto tablet
54 Myonal tablet
55 Myonep tablet
56 Myores tablet
57 Microgest 100 mg tablet
58 Microgest 200 mg tablet
59 Neurobat tablet
60 Optalvit plus tablet
61 Oskom tablet
62 Osteonat tablet
63 Patral tablet
64 Piracetam 800 mg tablet
65 Preabor tablet
66 Procalma tablet
67 Procolic tablet
68 Prohelic tablet
69 Pro TB 2 kid tablet
70 Pro TB 3 kid tablet
71 Proliver tablet
72 Promavit tablet
73 Proneuron tablet
74 Rebamid 100 mg tablet
75 Renax tablet
76 Rhinofed tablet
77 Santa E tablet
78 Sim-Ce eff tablet
79 Simciti tablet
80 Simcobal tablet
81 Sistenol tablet
82 Syalox 300 mg tablet
83 TB vit tablet
84 Tebokan spesial tablet
85 Tracetate tablet 97
86 Tramadol tablet 19
Uritos tablet 26
87 Venosmil tablet 1
88 Veridin tablet 49
89 Vip albumin tablet 192
90 Xiety tablet
91 Zegavit tablet

INJEKSI
1 Adona inj ampul
2 Anbacim inj 1 gr vial
3 Cefim inj vial
4 Citicolin inj 500/2ml ampul
5 Covifor inj vial
6 Desrem injeksi vial
7 Euvax 1 ml vial
8 Furamin injeksi vial
9 Lapibal inj ampul
10 Levica inj vial
11 Mecobalamin inj ampul
12 Neurobat ampul
13 Pantoprazol injeksi ampul
14 Pirasetam inj 3gr ampul
15 Remdac inj vial
16 Tofedex ampul
17 Ulvice inj ampul
18 Vivena inj ampul
19 Venodenol inj ampul

SIRUP
1 Apyalis drop botol
2 Ambroxol 15 mg/5 ml botol
3 Batugin 120 ml botol
4 Cal 95 kid sirup botol
5 Calnic botol
6 Calnic plus sirup botol
7 Ferriz drop botol
8 Ferriz sirup botol
9 Gastrinal sirup botol
10 Inpepsa botol
11 Lameson sirup botol
12 Lanos sirup botol
13 Lanos drop botol
14 Lapifed sirup botol
15 Maltiron sirup botol
16 Mucos drop botol
17 Mucos sirup botol
18 MG 4-0 botol
19 OBH botol
20 Optalvit sirup botol
21 Procelles botol
22 Rhinofed sirup botol
23 Sim DHA botol
24 Supralisyn sirup 60 ml botol
25 Supralysin drop botol
26 Vectrin sirup botol

INFUS
1 Miriwash infus botol

OBAT LUAR
1 Akilen tm botol
2 Alloclair gargle botol
3 Alloclair gell tube
4 Asiklovir cr tube
5 Astenof botol
6 Astenof mds strip
7 Augentonic tm botol
8 Baquinor tm botol
9 Betadin kumur btg
10 Betason N krem tube
11 Bioplacenton tube
12 Braliflex plus tm tube
13 Breathy nasal drop botol
14 Carpin TM botol
15 Cenfresh MDS tube
16 Conver 2% botol
17 Desolex crem tube
18 Emla krem ampul
19 Eyefresh plus MDS strip
20 Fita joint tube
21 Floxa MDS tube
22 Fluorocein supp
23 Forumen TT supp
24 Gentamycin SK botol
25 Iodosorb powder tube
26 Latipres TM tube
27 Lentricular MDS strip
28 Ocu fresh tm pcs
29 Otilon TT btl
30 Polidemisin tm strip
31 Polidemisin salep mata strip
32 Polydex MDS botol
33 Polynel MDS tube
34 Sanbe tears tm strip
35 Sanbreth TH tube
36 Sodermix tube
37 Stratrol TM strip
38 Tantum Verde botol
39 TCA 90 sol 20ml botol
40 Tobroson MDS tube
41 Trombophob pcs
42 Vagistin ovula tube
43 Vasacon A 0,6 ml MDS tube
44 Vaselin album 50 gr botol
45 Vaselin 5 gr tube
46 Venosmil gell tube
47 Vitrolenta ampul
48 Xitrol MDS botol
49 Xitrol EO botol
m diluar fornas.
cuali generiknya