PEMERINTAH KOTA PALOPO

RSUD dr. PALEMMAI TANDI

Jl. Samiun No. 2, Telp. 0853-4577-4072
PALOPO

DAFTAR HARGA OBAT & BMHP

JANUARI 2023

NO URAIAN SATUAN HARGA SATUAN KET

1 OBAT FAKTUR JUAL

1 Acetylcystein 200 mg Kapsul Rp 777.00 Rp 1,010
2 Acetylcystein 200 mg infus Botol Rp 183,338.70 Rp 238,340
3 Acyclovir 400 mg Tablet Rp 889.13 Rp 1,156
4 Acyclovir crem 5% Tube Rp 4,768.23 Rp 6,199
5 Adalat Oros 30 mg Tablet Rp 3,986.00 Rp 5,182
6 Albunorm 25% 100 ml Botol Rp 1,579,799.70 Rp 2,053,740 retriksi 3 btl/minggu
7 Albunorm 25% 100 ml Botol Rp 1,746,585.00 Rp 2,270,561 retriksi 3 btl/minggu
8 Allopurinol 100 mg Tablet Rp 87.87 Rp 114
9 Allopurinol 300 mg Tablet Rp 357.50 Rp 465
10 Alprazolam 0,5 mg Tablet Rp 78.00 Rp 101
11 Alprazolam 1 mg Tablet Rp 544.50 Rp 708
12 Amoxan paed drop Botol Rp 25,530.00 Rp 33,189 Umum
13 Amoxicillin 125 mg dry syrup Botol Rp 2,600.00 Rp 3,380
14 Amoxicillin 250 mg dry syrup Botol Rp 3,510.00 Rp 4,563
15 Amoxicillin 500 mg Tablet Rp 550.98 Rp 716
16 Amoxicillin 500 mg Tablet Rp 656.02 Rp 853
17 Ambroxol elixir Botol Rp 2,966.81 Rp 3,857
18 Ambroxol 30 mg Tablet Rp 111.00 Rp 144
19 Amiodaron Ampul Rp 6,504.60 Rp 8,456
20 Amlodipin 10 mg Tablet Rp 74.00 Rp 96
21 Amlodipin 5 mg Tablet Rp 422.40 Rp 549
22 Aminoleban 500 Bag Rp 72,800.02 Rp 94,640
23 Aminophylline injeksi Ampul Rp 22,200.00 Rp 28,860
24 Amiparen 500 Bag Rp 96,650.00 Rp 125,645
25 Amitriptillin 25 mg Tablet Rp 194.50 Rp 253
26 Ampicillin 1 gr Vial Rp 9,240.00 Rp 12,012
27 Analsik Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
28 Antasida doen Tablet Rp 54.00 Rp 70
29 Antasida suspensi Botol Rp 3,436.18 Rp 4,467
30 Apidra solostar Flexpen Rp 91,020.00 Rp 118,326
31 Arkine 2 mg Tablet Rp 606.06 Rp 788
32 Asam ascorbid acid 200 mg/2 ml Injeksi Rp 4,975.00 Rp 6,468
33 Asam mefenamat 500 mg Tablet Rp 210.00 Rp 273
34 Asam folat 400 mg Tablet Rp 45.00 Rp 59
35 Asam folat 1 g Tablet Rp 61.00 Rp 79
36 Asam tranexamat 500 mg Tablet Rp 1,918.08 Rp 2,494
37 Asam tranexamat 250 mg /5 ml injeksi Ampul Rp 2,002.00 Rp 2,603
38 Asam tranexamat 500 mg/ml Ampul Rp 9,435.00 Rp 12,266
39 Asam valproat 250 mg/mlsyrup Botol Rp 12,752.00 Rp 16,578
40 Asering Botol Rp 9,591.51 Rp 12,469
41 Atracurium 50 mg/5 ml Ampul Rp 38,850.00 Rp 50,505
42 Atracurium 25 mg/5 ml Ampul Rp 9,877.89 Rp 12,841
43 Atorvastatin calcium 20 mg Tablet Rp 471.00 Rp 612
44 Atropin sulfat Injeksi Ampul Rp 1,718.00 Rp 2,233
45 Aqua pro injeksi 25 ml Botol Rp 2,648.46 Rp 3,443
46 Aqua pro injeksi 1 L Botol Rp 35,614.35 Rp 46,299
47 Azitromycin 500 mg Tablet Rp 1,412.75 Rp 1,837
48 Bamgetol 200 mg Tablet Rp 2,172.27 Rp 2,824
49 Baquinor 0,3% ED Botol Rp 37,573.60 Rp 48,846
50 Beneuron Tablet Rp 832.50 Rp 1,082 Retriksi 7 Tablet
51 Benoson N crem Tube Rp 18,499.80 Rp 24,050 Umum
52 Benutrion VE Botol Rp 62,658.40 Rp 81,456
53 Betahistin 6 mg Tablet Rp 92.00 Rp 120
54 Betahistin HCl 24 mg Tablet Rp 4,989.75 Rp 6,487
55 Betametason crem Tube Rp 1,534.02 Rp 1,994
56 Berotec 0,1 mg Botol Rp 87,719.97 Rp 114,036
57 Bfluid 500 ml Softbag Rp 77,063.00 Rp 100,182
58 Bio TT Ampul Rp 60,500.00 Rp 78,650
59 Biovitan syrup Botol Rp 4,116.77 Rp 5,352
60 Bisoprolol 2,5 mg Tablet Rp 136.00 Rp 177
61 Bisoprolol 5 mg Tablet Rp 264.00 Rp 343
62 Briclot Tablet Rp 16,650.00 Rp 21,645
63 Brilinta 90 mg Tablet Rp 8,480.40 Rp 11,025 Retriksi 6 tablet
64 Calcium Lactat 500 mg Tablet Rp 117.00 Rp 152
65 Calcium gluconas 10 ml Ampul Rp 1,501.20 Rp 1,952
66 Candesartan 8 mg Tablet Rp 214.00 Rp 278
67 Candesartan 16 mg Tablet Rp 1,836.05 Rp 2,387
68 Captopril 12,5 mg Tablet Rp 95.46 Rp 124
69 Captopril 25 mg Tablet Rp 137.75 Rp 179
70 Captopril 50 mg Tablet Rp 234.48 Rp 305
71 Carbazocrome Ampul Rp 11,246.52 Rp 14,620
72 Carmed 10% crem Tube Rp 36,083.33 Rp 46,908
73 Carmed 20% crem Tube Rp 45,715.30 Rp 59,430
74 Cepezet 100 mg Tablet Rp 1,110.00 Rp 1,443
75 Cephaflox 1 gr Vial Rp 198,135.00 Rp 257,576 Umum/ Jasarahrja
76 Cetrizine syrup Botol Rp 3,977.80 Rp 5,171
77 Cetrizine 10 mg Tablet Rp 81.00 Rp 105
78 Cefadroxil 500 mg Kapsul Rp 800.00 Rp 1,040
79 Cefadroxil 500 mg Kapsul Rp 1,002.07 Rp 1,303
80 Cefadroxil syrup 125 mg Botol Rp 3,890.00 Rp 5,057
81 Cefadroxil syrup 250 mg Botol Rp 12,375.00 Rp 16,088
82 Cefoperazone Vial Rp 53,280.00 Rp 69,264
83 Ceftazidime 1 gr Vial Rp 11,825.00 Rp 15,372
84 Cefixime 100 mg/5 ml Botol Rp 5,242.00 Rp 6,815
85 Cefixime 100 mg Kapsul Rp 463.00 Rp 602
86 Cefixime 100 mg Kapsul Rp 999.98 Rp 1,300
87 Cefixime 200 mg Kaplet Rp 756.00 Rp 983
88 Cefotaxime 1 gr Vial Rp 5,999.55 Rp 7,799
89 Ceftriaxon 1 gr Vial Rp 2,925.00 Rp 3,803
90 Cefuroxime 1 gr Vial Rp 57,200.00 Rp 74,360
91 Cendo Astenof 0,6 ml Botol Rp 4,551.00 Rp 5,916
92 Cendo catarlent 0,6 ml Botol Rp 4,440.00 Rp 5,772
93 Cendo conver 2% 0,6 ml MD Botol Rp 3,579.75 Rp 4,654
94 Cendo Efrisel 10% Botol Rp 16,927.35 Rp 22,006
95 Cendo LFX 0,6 ml Botol Rp 15,318.00 Rp 19,913
96 Cendo Lyteers ED Botol Rp 24,975.00 Rp 32,468
97 Cendo Hyalub ED Botol Rp 59,107.50 Rp 76,840
98 Cendo Hyalub 0,6 ml MD Botol Rp 12,654.00 Rp 16,450
99 Cendo Midriatil 0,5% Botol Rp 5,855.25 Rp 7,612
100 Cendo Midriatil 1 % ED Botol Rp 42,457.50 Rp 55,195
101 Cendo Natacen 0,6 ml Botol Rp 9,240.75 Rp 12,013
102 Cendo P. Pred Botol Rp 8,491.50 Rp 11,039
103 Cendo Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
104 Cendo protagenta 0,6 ml MD Botol Rp 7,964.25 Rp 10,354
105 Cendo Timol 0,5% 0,6 ml MD Botol Rp 5,716.50 Rp 7,431
106 Cendo Tobroson 0,6 ml Botol Rp 6,438.00 Rp 8,369
107 Cendo xytrol 5 ml Botol Rp 30,247.50 Rp 39,322
108 Cilostazol 100 mg Tablet Rp 6,792.50 Rp 8,830
109 Cimetidine 200 mg Tablet Rp 412.85 Rp 537
110 Ciprofloxacin Infus Botol Rp 8,100.00 Rp 10,530
111 Ciprofloxacin 500 mg Tablet Rp 539.98 Rp 702
112 Ciprofloxacin 500 mg Tablet Rp 475.01 Rp 618
113 Citicholin 250 mg/2 ml Ampul Rp 22,275.00 Rp 28,958
114 Citicholin 500 mg/4 ml Ampul Rp 24,420.00 Rp 31,746
115 Citicolin 500 mg Tablet Rp 6,845.00 Rp 8,899
116 Chloroquin 150 mg Tablet Rp 1,505.74 Rp 1,957
117 Chlorpheniramine Maleat (CTM) Tablet Rp 62.99 Rp 82
118 Clindamycin 300 mg Kapsul Rp 1,334.78 Rp 1,735
119 Clindamycin 150 mg Kapsul Rp 732.60 Rp 952
120 Clobazam 10 mg Tablet Rp 384.00 Rp 499
121 Clonidine 0,15 mg Tablet Rp 146.00 Rp 190
122 Clopidogrel 75 mg Tablet Rp 580.23 Rp 754
123 Clozapine 25 mg Tablet Rp 477.00 Rp 620
124 Codein 10 mg Tablet Rp 610.50 Rp 794
125 Colchicine 0,5 Tablet Rp 671.00 Rp 872
126 Colistine 0,25 MIU Tablet Rp 2,553.00 Rp 3,319
127 Cotrimoxasole suspensi Botol Rp 5,954.30 Rp 7,741
128 Cotrimoxazole 480 mg Tablet Rp 253.97 Rp 330
129 Curcuma Force Tablet Rp 876.15 Rp 1,139
130 Curcuma 20 mg Tablet Rp 482.02 Rp 627
131 Daily C 500 mg Tablet Rp 577.50 Rp 751
132 DC2 Tablet Rp 8,116.88 Rp 10,552 Retriksi 3 tablet
133 Depakote 250 mg Kaplet Rp 8,880.00 Rp 11,544
134 Desolex crem 10 gr Tube Rp 25,080.00 Rp 32,604 Umum
135 Dexamethason 5 mg/ml Ampul Rp 2,109.00 Rp 2,742
136 Dexamethason 0,5 mg Tablet Rp 132.09 Rp 172
137 Dexketoprofen 50 mg/2 ml Ampul Rp 26,640.00 Rp 34,632
138 Dexketoprofen 25 mg Tablet Rp 3,441.00 Rp 4,473 Retriksi 6 tablet
139 Dexosimethason 0,25 mg crem 10 g Tube Rp 9,079.80 Rp 11,804

140 Dexosimethason 0,25 mg crem 15 g Tube Rp 13,800.00 Rp 17,940

141 Dextrose 10% Botol Rp 7,200.30 Rp 9,360
142 Dextrose 10% Botol Rp 8,350.53 Rp 10,856
143 Dextrose 5% Botol Rp 6,626.70 Rp 8,615
144 Dextrose 5% Botol Rp 7,685.64 Rp 9,991
145 Dextrose 5% 100 ml piggy bag Botol Rp 13,786.20 Rp 17,922
146 Dextrose 40% Botol Rp 6,998.55 Rp 9,098
147 Diazepam 2 mg Tablet Rp 70.00 Rp 91
148 Diazepam 5 mg/ml inj. Ampul Rp 1,559.00 Rp 2,027
149 Diazepam 5 mg rectal Rectube Rp 13,546.00 Rp 17,610
150 Diazepam 10 mg rectal Rectube Rp 19,693.00 Rp 25,601
151 Dibekacin 100 mg Ampul Rp 79,920.00 Rp 103,896
152 Digoxin 0,25 mg Tablet Rp 114.40 Rp 149
153 Diltiazem Tablet Rp 1,665.00 Rp 2,165
154 Dimenhidrinat 50 mg Tablet Rp 109.99 Rp 143
155 Dipenhidramin 15 mg/15 ml Ampul Rp 5,390.00 Rp 7,007
156 Divalproex sodium 250 mg Kaplet Rp 3,229.00 Rp 4,198
157 Divalproex sodium 500 mg Kaplet Rp 1,505.00 Rp 1,957
158 Dobutamin 250 mg/5 ml Ampul Rp 30,885.75 Rp 40,151
159 Dobutamin 50 mg Ampul Rp 9,004.00 Rp 11,705
160 Dolgesic Injeksi Ampul Rp 11,988.00 Rp 15,584
161 Domavit Softcap Rp 2,741.70 Rp 3,564 Retriksi 7 Tablet
162 Domperidon 10 mg Tablet Rp 155.01 Rp 202
163 Domperidone syrup Botol Rp 4,437.28 Rp 5,768
164 Donepezil Tablet Rp 1,680.00 Rp 2,184
165 Dopamet (methyldopa) Tablet Rp 1,023.00 Rp 1,330
166 Dopamin 200 mg/5 ml Ampul Rp 3,945.00 Rp 5,129
167 Dorium Kaplet Rp 4,884.00 Rp 6,349 Retriksi 6 tablet
168 Doxycycline 100 mg Kapsul Rp 281.69 Rp 366
169 Dulcolax 5 mg tablet Tablet Rp 1,586.85 Rp 2,063
170 Dulcolax 5 mg Suppo Rp 5,084.90 Rp 6,610
171 Dulcolax 10 mg Suppo Rp 4,325.00 Rp 5,623
172 Duloxta 60 Tablet Rp 14,499.38 Rp 18,849 Retriksi 6 tablet
173 Durogesic 12,5 MU Patch Rp 63,775.05 Rp 82,908
174 Eperison HCl 50 mg Tablet Rp 1,170.13 Rp 1,521
175 Ephedrine injeksi Ampul Rp 6,485.95 Rp 8,432
176 Ephineprine injeksi Ampul Rp 2,904.00 Rp 3,775
177 Erdostein 300 mg Kapsul Rp 2,594.63 Rp 3,373
178 Ericaf Tablet Rp 3,330.00 Rp 4,329
179 Erytromicin suspensi Botol Rp 12,210.00 Rp 15,873
180 Euthyrox 50 mg Tablet Rp 728.56 Rp 947
181 Eterocoxib 60 mg Tablet Rp 4,440.00 Rp 5,772 Retriksi 6 tablet
182 Euthyrox 100 mg Tablet Rp 3,828.00 Rp 4,976
183 Farbion Injeksi Ampul Rp 11,000.00 Rp 14,300
184 Farbivent 2,5 ml Ampul Rp 3,951.60 Rp 5,137
185 Fargoxin 2 ml njeksi Ampul Rp 49,500.00 Rp 64,350
186 Fasorbid 10 mg Tablet Rp 300.30 Rp 390
187 Fentanyl citrate Inj 2 ml Ampul Rp 29,767.98 Rp 38,698
188 Fladystine ovula Suppo Rp 15,484.50 Rp 20,130
189 Flunarizine 5 mg Tablet Rp 1,665.00 Rp 2,165
190 Forumen tetes telinga Botol Rp 29,082.00 Rp 37,807
191 Fosen Enema Botol Rp 94,905.00 Rp 123,377
192 Furosemid injeksi Ampul Rp 969.00 Rp 1,260
193 Furosemid 40 mg Tablet Rp 144.79 Rp 188
194 Gabapentine 300 mg Kapsul Rp 1,050.00 Rp 1,365
195 Gabapentine 100 mg Kapsul Rp 1,110.00 Rp 1,443
196 Gabatin 300 mg Kapsul Rp 9,990.00 Rp 12,987 Umum
197 Gabaxa Botol Rp 247,227.00 Rp 321,395
198 Gelafusal infusion 500 ml Bag Rp 145,015.00 Rp 188,520
199 Genoint tetes mata Botol Rp 13,320.00 Rp 17,316
200 Gentamicin salep kulit Tube Rp 2,963.70 Rp 3,853
201 Gentamicin 0,3% 5 gram Tube Rp 40,376.25 Rp 52,489
202 Gentamicin 40 mg/ml injeksi Ampul Rp 3,385.50 Rp 4,401
203 Glauseta Tablet Rp 2,876.00 Rp 3,739
204 Glauseta Tablet Rp 3,355.42 Rp 4,362 Retriksi 6 tablet
205 Glibenclamid 5 mg Tablet Rp 333.00 Rp 433
206 Gliclazide 80 mg Tablet Rp 214.00 Rp 278
207 Glimepirid 2 mg Tablet Rp 123.00 Rp 160
208 Glimepirid 4 mg Tablet Rp 2,032.70 Rp 2,643
209 Granisetron 1 mg Ampul Rp 22,200.00 Rp 28,860
210 Griseofulvin 125 mg Tablet Rp 500.00 Rp 650
211 Harnal 0,2 Tablet Rp 7,859.99 Rp 10,218
212 Harnal OCAS Tablet Rp 4,356.00 Rp 5,663
213 Heparin sodium Ampul Rp 46,635.00 Rp 60,626
214 Hepatosol Vanila Pcs Rp 36,815.00 Rp 47,860
215 Herbesser CD 200 Tablet Rp 5,196.82 Rp 6,756
216 Hervis 0,35 gr Tablet Rp 40,792.50 Rp 53,030
217 Hexymer 2 mg Tablet Rp 427.35 Rp 556
218 Histapan Tablet Rp 804.75 Rp 1,046 Retriksi 6 tablet
219 Human Albumin 20% Botol Rp 913,227.04 Rp 1,187,195 Retriksi 3 botol/minggu

220 Hydrocortison salep kulit Tube Rp 6,136.00 Rp 7,977

221 Hyosine injeksi Ampul Rp 6,188.05 Rp 8,044
222 Hyson Injeksi Ampul Rp 97,402.43 Rp 126,623 Jasaraharja/Umum
223 Hyoscine butylbromide 10 mg Tablet Rp 1,050.00 Rp 1,365
224 Hystolan 20 mg Tablet Rp 4,795.20 Rp 6,234
225 Ibuprofen 400 mg Tablet Rp 215.00 Rp 280
226 Ibuprofen 200 mg Tablet Rp 155.00 Rp 201
227 Ibuprofen suspensi Botol Rp 9,075.00 Rp 11,798
228 Ifalmin Kapsul Rp 5,500.00 Rp 7,150 Retriksi 3 tablet
229 Imboost Force Kaplet Rp 5,701.90 Rp 7,412 Retriksi 3 tablet
230 Indop (Dopamin) Ampul Rp 19,057.50 Rp 24,775
231 Imitatin 1 gr Vial Rp 170,829.00 Rp 222,078 Jasaraharja/Umum
232 Interlac Sachet Rp 11,072.25 Rp 14,394 Retriksi 4 bungkus
233 Inviclot Vial Rp 65,340.00 Rp 84,942
234 Iremax Tablet Rp 990.68 Rp 1,288 Retriksi 6 tablet
235 Isoflurane 250 ml Botol Rp 827,672.50 Rp 1,075,974
236 Isoniazid 100 mg Tablet Rp 444.00 Rp 577
237 Isoniazid 300 mg Tablet Rp 666.00 Rp 866
238 Isosorbid dinitrate 5 mg Tablet Rp 99.90 Rp 130
239 Isosorbid dinitrate 1 mg/ml Ampul Rp 33,000.00 Rp 42,900
240 Kaen 3B Botol Rp 11,500.00 Rp 14,950
241 Kaen 3B Botol Rp 12,770.55 Rp 16,602
242 Kaen 4B Botol Rp 10,858.02 Rp 14,115
243 Kaen 4B Botol Rp 13,769.55 Rp 17,900
244 Kaen Mg3 Botol Rp 10,560.00 Rp 13,728
245 Kalium diklofenak 50 mg Tablet Rp 333.00 Rp 433
246 KCL 7,46 Botol Rp 3,470.97 Rp 4,512
247 Ketoconazole salep Tube Rp 8,800.00 Rp 11,440
248 Ketoconazole 200 mg Tablet Rp 495.00 Rp 644
249 Ketorolac injeksi Ampul Rp 10,519.47 Rp 13,675
250 Kidmin 200 ml Bag Rp 54,620.04 Rp 71,006
251 Kina Tablet Rp 2,200.00 Rp 2,860
252 KSR 600 mg Tablet Rp 1,842.00 Rp 2,395
253 Kutoin Tablet Rp 1,391.94 Rp 1,810
254 KTM Injeksi Vial Rp 190,920.00 Rp 248,196
255 Lactafit Tablet Rp 3,330.00 Rp 4,329 Umum
256 Lactogen Lactofree Kaleng Rp 101,817.90 Rp 132,363 Umum
257 Lactogen Premature Kaleng Rp 101,909.10 Rp 132,482 Umum
258 Lactulosa syrup Botol Rp 27,472.50 Rp 35,714
259 Lametic syrup Botol Rp 102,300.00 Rp 132,990 Umum
260 Lametic 8 mg/4 ml Ampul Rp 68,200.00 Rp 88,660 Umum
261 Lanabal 500 mcg Kapsul Rp 2,750.00 Rp 3,575 Umum
262 Lanfix 200 Kapsul Rp 37,400.00 Rp 48,620 Umum
263 Lanzoprasole 30 mg Kapsul Rp 278.00 Rp 361
264 Lantus solostar Flexpen Rp 89,910.00 Rp 116,883
265 Laxadine syrup 30 ml Botol Rp 42,900.00 Rp 55,770
266 Laxadine emulsi 60 ml Botol Rp 47,730.00 Rp 62,049
267 Laxalosan syrup Botol Rp 61,050.00 Rp 79,365 Umum
268 L Bio Sachet Rp 8,172.38 Rp 10,624 Retriksi 6/4 bungkus
269 Lesichol 300 Softcap Rp 13,200.00 Rp 17,160 Umum
270 Levetiracetam 500 mg Tablet Rp 4,117.00 Rp 5,352
271 Levopar Tablet Rp 5,772.00 Rp 7,504
272 Levoben 100 mg Tablet Rp 2,997.00 Rp 3,896
273 Levofloxacin 500 mg Tablet Rp 373.01 Rp 485
274 Levofloxacin Infus Botol Rp 25,641.00 Rp 33,333
275 Levofloxacin 750 mg/150 ml Botol Rp 103,646.25 Rp 134,740
276 Levothyroxine 100 mcg Tablet Rp 890.01 Rp 1,157
277 Lidokain 2% Injeksi Ampul Rp 891.00 Rp 1,158
278 Lidokain compositum Ampul Rp 847.00 Rp 1,101
279 Lisinopril 10 mg Tablet Rp 149.00 Rp 194
280 Lodomer 2 mg Tablet Rp 1,212.12 Rp 1,576
281 Loperamid 2 mg Tablet Rp 89.00 Rp 116
282 Loratadine 10 mg Tablet Rp 162.00 Rp 211
283 Lycalvit 60 ml Botol Rp 47,932.50 Rp 62,312 Umum
284 Lycopect Tablet Rp 387.97 Rp 504
285 Maganol Infus Botol Rp 56,610.00 Rp 73,593 Umum
286 Manitol 20% Botol Rp 43,894.93 Rp 57,063
287 Maxiflon 400 mg Tablet Rp 37,296.00 Rp 48,485 Umum/Jasaraharja
288 MgSO4 40% Botol Rp 4,699.74 Rp 6,110
289 Mecobalamin 500 mg Kapsul Rp 577.50 Rp 751
290 Meloxicam 7,5 mg Tablet Rp 298.04 Rp 387
291 Meloxicam 15 mg Tablet Rp 246.98 Rp 321
292 Meprovent Inhalasi Botol Rp 5,328.00 Rp 6,926
293 Meropenem 1 gr Vial Rp 44,400.00 Rp 57,720
294 Mersibion 5000 injeksi Ampul Rp 4,001.55 Rp 5,202
295 Metamizole injeksi Ampul Rp 5,045.45 Rp 6,559
296 Metamizole 500 mg Tablet Rp 333.00 Rp 433
297 Metformin 500 mg Tablet Rp 179.99 Rp 234
298 Methylergometrin 0,125 mg Tablet Rp 261.00 Rp 339
299 Methylergometrin 2 mg inj. Ampul Rp 1,069.00 Rp 1,390
300 Methylprednisolon 125 mg Injeksi Vial Rp 10,912.41 Rp 14,186
301 Methylprednisolon 125 mg Injeksi Vial Rp 14,208.00 Rp 18,470
302 Methylprednisolon 4 mg Tablet Rp 239.65 Rp 312
303 Methylprednisolon 4 mg Tablet Rp 203.00 Rp 264
304 Methylprednisolon 8 mg Tablet Rp 566.70 Rp 737
305 Metoclopramid 5 mg injeksi Ampul Rp 1,883.00 Rp 2,448
306 Metoclopramid 10 mg Tablet Rp 66.00 Rp 86
307 Metronidazole infus Botol Rp 5,938.50 Rp 7,720
308 Metronidazole 500 mg Tablet Rp 236.00 Rp 307
309 Miconazole 2% Tube Rp 1,916.97 Rp 2,492
310 Midanest 5 mg Ampul Rp 19,980.00 Rp 25,974
311 Miniaspi 80 mg Tablet Rp 89.00 Rp 116
312 Miriwash 500 ml Softbag Rp 145,854.00 Rp 189,610
313 Misoprostol 200 Mcg Tablet Rp 4,717.50 Rp 6,133
314 Mometason Furoate crem Tube Rp 6,025.00 Rp 7,832
315 Morfina 10 mg/ml Ampul Rp 30,272.65 Rp 39,354
316 Moxifloxacin 400 mg Tablet Rp 9,877.99 Rp 12,841
317 Moxifloxacin 400 mg Tablet Rp 11,954.70 Rp 15,541
318 Moxifloxacin 400 Infus Botol Rp 47,148.00 Rp 61,292
319 MST Continue 10 mg Tablet Rp 15,762.00 Rp 20,491
320 Mupirocin crem 5 gr Tube Rp 17,482.50 Rp 22,727
321 Myores Tablet Rp 4,870.13 Rp 6,331 Retriksi 6 tablet
322 Natrium Chlorida 0,9% (NaCl) 500 ml Botol Rp 6,963.03 Rp 9,052
323 Natrium diklofenak 25 mg Tablet Rp 114.99 Rp 149
324 Natrium diklofenak 50 mg Tablet Rp 153.18 Rp 199
325 NaCl Piggybag 100 ml Botol Rp 6,702.00 Rp 8,713
326 Natur E Softcap Rp 1,271.86 Rp 1,653
327 Neostigmin Injeksi Ampul Rp 9,435.00 Rp 12,266
328 New antides Tablet Rp 194.61 Rp 253
329 New diatabs Tablet Rp 825.00 Rp 1,073
330 Nicardipin Injeksi Ampul Rp 8,341.00 Rp 10,843
331 Nifedipin 10 mg Tablet Rp 164.67 Rp 214
332 Nitrokaf retard Tablet Rp 1,650.00 Rp 2,145
333 Norelut Tablet Rp 4,495.50 Rp 5,844
334 Norit Tablet Rp 400.00 Rp 520
335 Noreprinefrin Bitartrate Ampul Rp 6,673.00 Rp 8,675
336 Novapyron Tablet Rp 518.00 Rp 673
337 Noxetine 20 mg Tablet Rp 11,100.00 Rp 14,430
338 NTG (glyceryl trinitrate) Tablet Rp 60,775.00 Rp 79,008
339 Nystatin drop Botol Rp 17,759.99 Rp 23,088
340 Obat batuk hitam (OBH) syrup Botol Rp 6,468.00 Rp 8,408
341 Ofloxacin 400 mg Tablet Rp 583.00 Rp 758
342 Omeprazole 40 mg injeksi Vial Rp 6,993.00 Rp 9,091
343 Omeprazole 20 mg Kapsul Rp 338.00 Rp 439
344 Ondansetron 4 mg Injeksi Ampul Rp 972.00 Rp 1,264
345 Ondansetron 8 mg/4 ml inj. Ampul Rp 4,400.04 Rp 5,720
346 Ondansetron 4 mg Tablet Rp 506.99 Rp 659
347 Onoiwa Kapsul Rp 5,994.00 Rp 7,792 Retriksi 3 tablet
348 Oralit Sachet Rp 869.30 Rp 1,130
349 Oste Forte Sachet Rp 5,144.87 Rp 6,688 Retriksi 3 tablet
350 Ottogenta Injeksi Ampul Rp 6,600.00 Rp 8,580
351 Ottopain eye drop Botol Rp 83,041.88 Rp 107,954 Khusus RI
352 Otsu salin 3% Botol Rp 30,610.45 Rp 39,794
353 Oxytetracyclin salep kulit Tube Rp 5,550.00 Rp 7,215
354 Oxytocin injeksi Ampul Rp 1,348.00 Rp 1,752
355 Paracetamol infus Botol Rp 13,875.00 Rp 18,038
356 Paracetamol 500 mg Tablet Rp 209.00 Rp 272
357 Paracetamol syrup Botol Rp 1,171.00 Rp 1,522
358 Patral Tablet Rp 7,881.00 Rp 10,245 Umum
359 Pehacain injeksi Ampul Rp 2,670.15 Rp 3,471
360 Peptisol Vanila Box Rp 23,865.00 Rp 31,025 Umum
361 Perifas Tablet Rp 2,442.00 Rp 3,175
362 Permethrin 10 mg Tube Rp 7,303.80 Rp 9,495
363 Permethrine 15 mg Tube Rp 11,466.03 Rp 14,906
364 Pervita Kaplet Rp 1,648.35 Rp 2,143 Retriksi 7 Tablet
365 Pethidina 50mg/ml Ampul Rp 13,521.80 Rp 17,578
366 Phenytoin sodium 50 mg/ml Ampul Rp 23,448.75 Rp 30,483
367 Piracetam 800 mg Tablet Rp 632.03 Rp 822
368 Piracetam 3 gr Ampul Rp 14,368.20 Rp 18,679
369 Polidemicin ED Botol Rp 31,524.00 Rp 40,981
370 Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
371 Poro Suppositoria 125 mg Suppo Rp 8,800.00 Rp 11,440
372 Poro Suppositoria 250 mg Suppo Rp 12,320.00 Rp 16,016
373 Pramipexole 0,125 mg Tablet Rp 1,413.00 Rp 1,837
374 Pramipexole 0,375 ER Tablet Rp 3,050.00 Rp 3,965
375 Prednison 5 mg Tablet Rp 126.00 Rp 164
376 Pregabalin 75 mg Tablet Rp 3,608.00 Rp 4,690
377 Pregnolin 5 mg Tablet Rp 3,996.00 Rp 5,195
378 Prohepar Kapsul Rp 5,555.54 Rp 7,222 Retriski 3 Kapsul
379 Propanolol 10 mg Tablet Rp 98.29 Rp 128
380 Propofol 20 ml Ampul Rp 10,382.94 Rp 13,498
381 Propyltiouracil 100 mg Tablet Rp 440.00 Rp 572
382 Provital plus Tablet Rp 6,710.00 Rp 8,723 Retriksi 3 Kaplet
383 Pyrantel 125 mg Tablet Rp 512.67 Rp 666
384 Pyrazinamide 500 mg Tablet Rp 777.00 Rp 1,010
385 Phytomenadion 10 mg Tablet Rp 781.00 Rp 1,015
386 Quanocain spinal 2 mg/4 ml Ampul Rp 52,250.00 Rp 67,925
387 Ramipril 5 mg Tablet Rp 263.00 Rp 342
388 Ranitidin 50 mg/2 ml Ampul Rp 4,995.00 Rp 6,494
389 Ranitidin 50 mg/2 ml Ampul Rp 3,907.20 Rp 5,079
390 Ranitidin 150 mg Tablet Rp 178.71 Rp 232
391 Rebamipid Tablet Rp 3,330.00 Rp 4,329 Retriksi 6 tablet
392 Recalus Kapsul Rp 5,272.50 Rp 6,854 Retriksi 6 tablet
393 Reco tetes telinga Botol Rp 16,650.00 Rp 21,645
394 Recustein dry syrup Botol Rp 60,500.00 Rp 78,650
395 Recolfar 0,5 mg Tablet Rp 5,500.00 Rp 7,150
396 Regivell 20 mg Botol Rp 58,275.00 Rp 75,758
397 Ringer Lactat (RL) Botol Rp 7,773.33 Rp 10,105
398 Rifampicin 600 mg Kapsul Rp 3,595.00 Rp 4,674
399 Risperidon 2 mg Tablet Rp 272.99 Rp 355
400 Rocuronium Bromide 50 mg Ampul Rp 38,933.25 Rp 50,613
401 Ryzodeg Flex Pen Rp 113,018.20 Rp 146,924
402 Sagestam 40 mg inj Ampul Rp 16,500.00 Rp 21,450 Umum
403 Sagestam salep mata Tube Rp 41,514.00 Rp 53,968
404 Salbutamol 4 mg Tablet Rp 112.39 Rp 146
405 Salbutamol 2 mg Tablet Rp 113.28 Rp 147
406 Salbutamol sol 1 mg/ml Ampul Rp 5,449.00 Rp 7,084
407 Sanbe Tears ED Botol Rp 25,086.00 Rp 32,612
408 Sanmol Infus Botol Rp 22,582.95 Rp 29,358 Umum
409 Sanmol drop Botol Rp 18,426.00 Rp 23,954 Umum
410 Sanmol syrup Botol Rp 14,652.00 Rp 19,048 Umum
411 Santa E Kapsul Rp 4,662.00 Rp 6,061 Retriksi 3 tablet
412 Scabimite crem Tube Rp 66,000.00 Rp 85,800 Umum
413 Scobutrin Tablet Rp 3,190.00 Rp 4,147
414 Sevoflurane 250 ml Botol Rp 1,104,330.00 Rp 1,435,629
415 Sibital Injeksi Ampul Rp 10,890.00 Rp 14,157
416 Simarc 2 mg Tablet Rp 889.35 Rp 1,156
417 Simvastatin 10 mg Tablet Rp 76.77 Rp 100
418 Simvastatin 20 mg Tablet Rp 151.36 Rp 197
419 Spironolacton 25 mg Tablet Rp 222.00 Rp 289
420 Spironolacton 100 mg Kapsul Rp 552.00 Rp 718
421 Striatamin Kapsul Rp 5,371.99 Rp 6,984
422 Sucralfate suspensi 100 ml Botol Rp 9,390.60 Rp 12,208
423 Sucralfate 500 mg Tablet Rp 265.00 Rp 345
424 Sulfadiazine silver 35 gr Tube Rp 18,725.69 Rp 24,343
425 Sulfitis 500 mg Tablet Rp 2,590.00 Rp 3,367
426 Suprafenid Suppo Rp 10,656.00 Rp 13,853
427 Symbicort 160 dos Botol Rp 166,840.76 Rp 216,893
428 Tablet tambah darah Tablet Rp 255.00 Rp 332
429 Tamsolusin 0,4 mg Tablet Rp 4,356.00 Rp 5,663
430 Tenofovir 300 mg Tablet Rp 2,260.37 Rp 2,938
431 Tetagam P Vial Rp 146,800.00 Rp 190,840
432 Tison 4 Tablet Rp 3,520.00 Rp 4,576
433 Thiamazole 5 mg Tablet Rp 605.00 Rp 787
434 Thiamazole 10 mg Tablet Rp 990.00 Rp 1,287
435 Thiamphenicol 500 mg Tablet Rp 1,013.21 Rp 1,317
436 Thyrozol 5 mg Tablet Rp 679.00 Rp 883
437 Thyrozol 10 mg Tablet Rp 1,325.00 Rp 1,723
438 Tremenza Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
439 Trihexyphenidil 2 mg Tablet Rp 63.00 Rp 82
440 Triamcinolon 4 mg Tablet Rp 884.61 Rp 1,150
441 Triamcinolon 10 mg/ml Vial Rp 33,500.00 Rp 43,550
442 Triamcinolon crem Tube Rp 27,000.00 Rp 35,100
443 Trilac injeksi Vial Rp 180,000.00 Rp 234,000 Umum
444 Tuberculin Tes Vial Rp 738,150.00 Rp 959,595
445 Umarone Vial Rp 192,500.00 Rp 250,250 Umum
446 Ursodeoxycholic Acid 250 mg Tablet Rp 1,864.00 Rp 2,423
447 Vaksin TT Vial Rp 116,217.00 Rp 151,082
448 Valdimex 5 mg Tablet Rp 1,210.00 Rp 1,573
449 Venodenol injeksi Ampul Rp 166,500.00 Rp 216,450
450 Vitamin A IPI Tablet Rp 172.72 Rp 225
451 Vitamin B com Tablet Rp 60.00 Rp 78
452 Vitamin B6 Tablet Rp 140.80 Rp 183
453 Vitamin B1 Tablet Rp 246.00 Rp 320
454 Vitamin C 50 mg Tablet Rp 46.42 Rp 60
455 Vitamin C 500 mg Tablet Rp 495.00 Rp 644
456 Vitamin D3 Tablet Rp 1,357.14 Rp 1,764 Retriksi 6 tablet
457 Vitamin k injeksi Ampul Rp 8,880.00 Rp 11,544
458 Vitrolenta Botol Rp 36,352.50 Rp 47,258
459 Vitsap Tablet Rp 3,404.00 Rp 4,425 Retriksi 3 tablet
460 Vosea Tablet Rp 550.00 Rp 715
461 Warfarin 2 mg Tablet Rp 698.00 Rp 907
462 Wiaflox 500 Tablet Rp 14,850.00 Rp 19,305 Umum
463 Widahes 500 ml Botol Rp 91,020.00 Rp 118,326
464 Wida D5 1/2 NS Botol Rp 10,450.00 Rp 13,585
465 Wida D5 1/4 NS Botol Rp 10,404.99 Rp 13,526
466 Xiety 10 mg Tablet Rp 4,870.12 Rp 6,331
467 Zinc sulfat 20 mg Tablet Rp 250.98 Rp 326
468 Zinc sulfat drop Botol Rp 5,445.66 Rp 7,079
469 Zinc sulfate sirup Botol Rp 4,395.60 Rp 5,714
470 Zollocid 20 mg Kapsul Rp 9,900.00 Rp 12,870
471 Zolmia Tablet Rp 7,770.00 Rp 10,101 Retriksi 6 tablet
Bahan Medis Pakai Habis
2
(BMHP)
1 AgNO3 3% 100 ml Botol Rp 512,820.00 Rp 666,666
2 Alkohol 70% Pcs Rp 55,500.00 Rp 72,150
3 Alkohol swab Pcs Rp 159.54 Rp 207
4 Ambu bag dewasa Pcs Rp 677,875.00 Rp 881,238
5 Ambu bag anak Pcs Rp 677,875.00 Rp 881,238
6 Aproon/celemek Pcs Rp 4,173.60 Rp 5,426
7 Assucryl 1 Pcs Rp 47,932.02 Rp 62,312
8 Assucryl 2 Pcs Rp 75,081.52 Rp 97,606
9 Assucryl 2/0 Pcs Rp 64,355.61 Rp 83,662
10 Assucryl 3/0 Pcs Rp 64,355.58 Rp 83,662
11 Assucryl 4/0 Pcs Rp 82,590.66 Rp 107,368
12 Bio Pen Electrosurgical pencil Pcs Rp 46,065.00 Rp 59,885
Bisturi No. 10 (Surgical blades 10) Pcs
13
serenity
Rp 1,665.00 Rp 2,165
Bisturi No. 11 (Surgical blades 11) Pcs
14
serenity
Rp 1,665.00 Rp 2,165
15 Bisturi No. 15 (Biss mess OM 15) Pcs Rp 781.00 Rp 1,015
Bisturi No. 20 (Surgical blades 20) Pcs
16
serenity
Rp 609.40 Rp 792

17 Breathing sircuit child Pcs Rp 72,800.46 Rp 94,641

18 Breathing sircuit infant Pcs Rp 72,800.46 Rp 94,641
19 Breket Pcs Rp 20,125.00 Rp 26,163
20 Burrowl Pcs Rp 116,550.00 Rp 151,515
21 Canofix - PU 6 x 8 cm Pcs Rp 6,882.05 Rp 8,947
22 Cervical collar Pcs Rp 133,584.00 Rp 173,659
23 Cat gut chromic 3/0 Pcs Rp 16,500.00 Rp 21,450
24 Chromic 1 HRG Pcs Rp 51,913.59 Rp 67,488
25 Chromic 2 HRG Pcs Rp 44,905.05 Rp 58,377
26 Chromic 2/0 HRG Pcs Rp 40,665.96 Rp 52,866
27 Chromic 3/0 HR Pcs Rp 34,410.00 Rp 44,733
28 Chromic 4/0 HR Pcs Rp 41,295.33 Rp 53,684
29 Cat gut chromic 2/0 Pcs Rp 7,683.32 Rp 9,988
30 Combo pack (Infus set) Pcs Rp 21,450.00 Rp 27,885
31 Comy Bag (Colostomy bag) Pcs Rp 27,600.00 Rp 35,880
32 Cutimed gel 15 gr Tube Rp 52,110.00 Rp 67,743
33 Cutimed siltec 10x10 cm Sac Rp 61,600.00 Rp 80,080
34 Cutimed sorbact 7 x 9 cm Pcs Rp 32,800.00 Rp 42,640
35 Daryantuell Pcs Rp 17,181.80 Rp 22,336
36 Electroda dewasa Pcs Rp 1,266.18 Rp 1,646
37 Elektrode (Anak) Pcs Rp 1,266.18 Rp 1,646
38 Elektrode Bayi Pcs Rp 1,276.50 Rp 1,659
39 Endotracheal Tube 2,5 Pcs Rp 21,580.00 Rp 28,054
40 Endotracheal Tube 3 Pcs Rp 21,580.00 Rp 28,054
41 Endotracheal Tube 3,5 Pcs Rp 32,090.96 Rp 41,718
42 Endotracheal Tube 4,0 Pcs Rp 17,036.00 Rp 22,147
43 Endotracheal Tube 4,5 Pcs Rp 21,579.76 Rp 28,054
44 Endotracheal Tube 5,0 Pcs Rp 21,579.76 Rp 28,054
45 Endotracheal Tube 5,5 Pcs Rp 21,579.76 Rp 28,054
46 Endotracheal Tube 6,0 Pcs Rp 26,565.00 Rp 34,535
47 Endotracheal Tube 6,5 Pcs Rp 16,947.00 Rp 22,031
48 Endotracheal Tube 7,0 Pcs Rp 21,579.95 Rp 28,054
49 Endotracheal Tube 7,5 Pcs Rp 21,579.75 Rp 28,054
50 Endotracheal Tube 8,0 Pcs Rp 21,579.51 Rp 28,053
51 Eye protector bayi Pcs Rp 42,550.00 Rp 55,315
52 Feeding tube 3,5 R Pcs Rp 12,273.03 Rp 15,955
53 Feeding tube No. 5 R 100 cm Pcs Rp 14,077.14 Rp 18,300
54 Feeding tube No.8 Pcs Rp 12,099.40 Rp 15,729
55 Feeding tube No.8 100 cm Pcs Rp 14,077.14 Rp 18,300
56 Fm Crepe 10 cm Roll Rp 48,800.00 Rp 63,440
57 Fm crepe 15 cm Roll Rp 57,319.99 Rp 74,516
58 Filapeau 5/0 Pcs Rp 56,998.27 Rp 74,098
59 Filapeau 2/0 Pcs Rp 38,000.00 Rp 49,400
60 Folley cateter no. 6 Pcs Rp 16,610.03 Rp 21,593
61 Folley cateter no. 8 Pcs Rp 16,610.03 Rp 21,593
62 Folley cateter no. 8 silicon 30 ml Pcs Rp 16,447.64 Rp 21,382
63 Folley cateter no. 10 Pcs Rp 16,610.03 Rp 21,593
64 Folley cateter no. 12 Pcs Rp 12,489.72 Rp 16,237
65 Folley cateter no. 14 Pcs Rp 12,489.72 Rp 16,237
66 Folley cateter 16 Pcs Rp 12,489.72 Rp 16,237
67 Folley cateter 18 Pcs Rp 12,489.72 Rp 16,237
68 Folley cateter 18 Silicon 30 ml Pcs Rp 17,325.00 Rp 22,523
69 Folley cateter 20 FR Pcs Rp 17,325.00 Rp 22,523
70 Folley cateter 22 FR Pcs Rp 12,489.72 Rp 16,237
71 Folley cateter 24 FR Pcs Rp 12,489.72 Rp 16,237
72 Folley cateter 18 3 way Pcs Rp 32,670.00 Rp 42,471
73 Folley cateter 20 3 way Pcs Rp 39,930.00 Rp 51,909
74 Folley cateter 22 3 way Pcs Rp 32,670.00 Rp 42,471
75 Folley cateter 24 3 way Pcs Rp 32,890.00 Rp 42,757
76 Fuji Film 26 x 36 (Dry Film) Pcs Rp 37,444.00 Rp 48,677
77 Guedel airway 90 MM Kuning Pcs Rp 19,374.00 Rp 25,186
78 Guedel airway 80 MM (2) Hijau Pcs Rp 19,374.00 Rp 25,186
79 Guedel airway 70 MM (1) Putih Pcs Rp 37,290.00 Rp 48,477
80 Guedel airway 60 MM (0) Hitam Pcs Rp 19,374.00 Rp 25,186
81 Guedel airway 50 MM (00) Biru Pcs Rp 14,000.00 Rp 18,200
82 Guedel airway 40 MM (000) Pink Pcs Rp 20,999.99 Rp 27,300
83 H2O2 3% 100 ml Botol Rp 16,650.00 Rp 21,645
84 H2O2 3% 800 ml Botol Rp 33,033.00 Rp 42,943
85 H2O2 5% Botol Rp 40,404.00 Rp 52,525
86 Handrub Baymed 0,5% Botol Rp 37,152.63 Rp 48,298
87 Handwash 500 ml (Baymed 4%) Botol Rp 42,483.83 Rp 55,229
88 Handscoon gynecolog 6,5 Pairs Rp 37,504.20 Rp 48,755
89 Handscoon gynecolog size M Pairs Rp 37,504.20 Rp 48,755
90 Handscoon steril no. 6,0 Pairs Rp 13,562.73 Rp 17,632
91 Handscoon steril no. 6,5 Pairs Rp 13,686.02 Rp 17,792
92 Handscoon steril no. 7,5 Pairs Rp 13,686.00 Rp 17,792
93 Handscoon steril no. 7.0 Pairs Rp 13,562.73 Rp 17,632
94 Handscoon steril no. 8,0 Pairs Rp 13,177.56 Rp 17,131
95 Handscoon non steril size S Pcs Rp 1,252.08 Rp 1,628
96 Handscoon non steril size M Pcs Rp 1,252.08 Rp 1,628
97 Handscoon non steril size L Pcs Rp 1,252.08 Rp 1,628
98 Hazmat (Full body) Pcs Rp 436,975.00 Rp 568,068
99 Hazmat Coverall Pcs Rp 102,500.00 Rp 133,250
100 Id bracelet dewasa biru Pcs Rp 1,452.00 Rp 1,888
101 Id bracelet dewasa PINK Pcs Rp 933.51 Rp 1,214
102 Id bracelet for child blue Pcs Rp 933.51 Rp 1,214
103 Id bracelet for child pink Pcs Rp 933.51 Rp 1,214
104 Infus set micro Pcs Rp 7,150.00 Rp 9,295
105 Infus set makro y set Pcs Rp 8,596.00 Rp 11,175
106 IV. Canula 16 G (Abbocath 16) Pcs Rp 6,674.32 Rp 8,677
107 IV. Canula 18 G (Abbocath 18) Pcs Rp 6,152.84 Rp 7,999
108 IV. Canula 20 (Abbocath 20) Pcs Rp 7,215.00 Rp 9,380
109 IV. Canula 22 (Abbocath 22) Pcs Rp 6,152.84 Rp 7,999
110 IV. Cateter 24 (Abbocath 24) Pcs Rp 6,152.84 Rp 7,999
111 IV. Canula 26 (Abbocath 26) Pcs Rp 15,537.80 Rp 20,199
112 Jackson rees pedriatic Pcs Rp 283,375.00 Rp 368,387
113 Jackson rees dewasa Pcs Rp 270,249.59 Rp 351,324
114 Kantong Jenazah Pcs Rp 217,250.00 Rp 282,425
115 Kapas pembalut 250 gr Roll Rp 16,697.95 Rp 21,707
116 Kapsul kosong no. 00 Pcs Rp 133.20 Rp 173
117 Kapsul kosong no. 0 Pcs Rp 99.90 Rp 130
118 Kasa hydrofil 40 x 80 cm Roll Rp 16,613.52 Rp 21,598
119 Kasa steril OM 16 x 16 Pcs Rp 574.98 Rp 747
120 Kertas EKG 80 x 30 Roll Rp 162,423.10 Rp 211,150
121 Kertas perkamen Pack Rp 14,430.00 Rp 18,759
122 Kertas Puyer press Pcs Rp 1,789.33 Rp 2,326
123 Klorsept 25 Pcs Rp 1,789.33 Rp 2,326
124 Leukoplas 1625 (besar) Roll Rp 82,500.00 Rp 107,250
125 Leukoplas/ plester 1 x 5 (Kecil) Roll Rp 12,675.00 Rp 16,478
126 Mask Anastesi size 1 Pcs Rp 48,750.98 Rp 63,376
127 Mask Anastesi size 2 Pcs Rp 48,750.98 Rp 63,376
128 Mask Anastesi size 4 Pcs Rp 48,750.98 Rp 63,376
129 Masker Anastesi 5 Pcs Rp 48,750.39 Rp 63,376
130 Masker Anastesi 6 Pcs Rp 48,750.39 Rp 63,376
131 Masker kerudung Pcs Rp 2,860.00 Rp 3,718
132 Masker N95 Pcs Rp 21,175.00 Rp 27,528
133 Masker KN95 Pcs Rp 9,035.00 Rp 11,746
134 Microfline/Pen Needle 31Gx55M Pcs Rp 1,695.00 Rp 2,204
135 Mitela Ukuran S (Arm Sling S) Pcs Rp 21,275.00 Rp 27,658
136 Mitela Ukuran M (Arm Sling M) Pcs Rp 21,275.00 Rp 27,658
137 Mitela Ukuran L (Arm Sling L) Pcs Rp 21,275.00 Rp 27,658
138 My Jelly Tube Rp 35,520.00 Rp 46,176
139 Nasal canula neonatus Pcs Rp 9,750.24 Rp 12,675
140 Nasal canula bayi Pcs Rp 9,250.00 Rp 12,025
141 Nasal canula dewasa Pcs Rp 9,657.00 Rp 12,554
142 Nasal Canula Anak Pcs Rp 9,657.00 Rp 12,554
143 Needle Spinocain 27 Pcs Rp 66,000.00 Rp 85,800
144 No Pain spray Botol Rp 96,570.00 Rp 125,541
145 Nurse cup Pcs Rp 781.68 Rp 1,016
146 Object glass Pcs Rp 281.18 Rp 366
147 Optime 1 Pcs Rp 75,744.31 Rp 98,468
148 Optime 2 Pcs Rp 95,399.12 Rp 124,019
149 Optime 2/0 Pcs Rp 74,026.33 Rp 96,234
150 Optime 3/0 Pcs Rp 75,023.03 Rp 97,530
151 Oxygen Mask adult elognated Pcs Rp 11,404.00 Rp 14,825
152 Oxygen Mask pedriatik Pcs Rp 27,500.00 Rp 35,750
153 Oxygen Mask S (Infant) Pcs Rp 16,899.75 Rp 21,970
154 Oxygen mask nebulizer size M Pcs Rp 22,390.50 Rp 29,108
155 Oxygen mask Nebulizer size L Pcs Rp 31,900.00 Rp 41,470
156 Oxygen mask nebulizer bayi Pcs Rp 26,000.00 Rp 33,800

157 Oxygen mask nebulizer size S (infant) Pcs Rp 26,000.00 Rp 33,800

158 Oxygen mask Non rebreathing dewasa Pcs Rp 20,800.00 Rp 27,040

159 Oxygen mask Non rebreathing child Pcs Rp 25,098.92 Rp 32,629

160 Oxygen mask Non rebreathing Bayi Pcs Rp 20,800.00 Rp 27,040

161 Oxygen mask Non rebreathing S (Infant) Pcs Rp 21,702.32 Rp 28,213

162 Paper X ray pcs Rp 8,325.00 Rp 10,823
163 Papsmear Kit Size S Kit Rp 22,264.00 Rp 28,943
164 Papsmear Kit Size M Kit Rp 22,264.00 Rp 28,943
165 Perfusor 150 mg (Extension) Pcs Rp 17,708.06 Rp 23,020
166 Perfusor Pcs Rp 41,677.17 Rp 54,180
167 Plastik seal secutity lock Pcs Rp 11,743.80 Rp 15,267
168 Poliban 10 cm x 2,7 mm Roll Rp 16,539.99 Rp 21,502
169 Poliban 15 cm x 2,7 mm Roll Rp 21,899.99 Rp 28,470
170 Polifix 10 x 5 cm Roll Rp 82,966.55 Rp 107,857
171 Poligyp 10 cm x 2,7 mm Roll Rp 23,540.00 Rp 30,602
172 Poligyp 15 cm x 2,7 mm Roll Rp 31,059.99 Rp 40,378
173 Polypropylene 5/0 Pcs Rp 53,629.65 Rp 69,719
174 Polypropylene 4/0 Pcs Rp 53,629.65 Rp 69,719
175 Polypropylene 3/0 Pcs Rp 53,629.65 Rp 69,719
176 Polypropylene 2/0 Pcs Rp 53,629.65 Rp 69,719
177 Polypropylene 1 HR Pcs Rp 53,629.65 Rp 69,719
178 Postofix - PU 10x25 Pcs Rp 29,377.14 Rp 38,190
179 Postofix - PU 10x15 Pcs Rp 16,650.00 Rp 21,645
180 Postofix - PU 10x10 Pcs Rp 13,320.00 Rp 17,316
181 Povidone iodine 10% 1 L Botol Rp 80,811.76 Rp 105,055
182 Povidone iodine 300 ml Botol Rp 30,636.00 Rp 39,827
183 Prontosan sol Botol Rp 96,505.33 Rp 125,457
184 Redax Drentech compact Pcs Rp 787,905.00 Rp 1,024,277
185 Safety Box 5 L Pcs Rp 12,652.49 Rp 16,448
186 Scanlux Botol Rp 201,354.00 Rp 261,760
187 Silk 2-0 Apex Pcs Rp 49,610.00 Rp 64,493
188 Silk 2/0 Remedi Pcs Rp 5,375.00 Rp 6,987
189 Silk 1 HRG Pcs Rp 47,301.56 Rp 61,492
190 Silk 2 HRG Pcs Rp 47,193.87 Rp 61,352
191 Silk 2/0 HR Pcs Rp 38,935.47 Rp 50,616
192 Silk 3-0 Apex Pcs Rp 53,240.00 Rp 69,212
193 Silk 3-0 Pcs Rp 7,400.00 Rp 9,620
194 Silk 0 Pcs Rp 39,817.47 Rp 51,763
195 Spinocain 25 Pcs Rp 32,617.00 Rp 42,402
196 Spinocain 26 Pcs Rp 32,617.00 Rp 42,402
197 Spoit 50 cc (cateter tip hijau) Pcs Rp 11,817.86 Rp 15,363
198 Spoit 50 cc Pcs Rp 6,930.88 Rp 9,010
199 Spoit 50 cc (Iuer Slip) Pcs Rp 6,795.82 Rp 8,835
200 Spoit 20 cc (Lubang samping) Pcs Rp 1,888.74 Rp 2,455
201 Spoit 10 cc Pcs Rp 2,015.00 Rp 2,620
202 Spoit 5 cc Pcs Rp 1,430.00 Rp 1,859
203 Spoit 3 cc Pcs Rp 1,274.00 Rp 1,656
204 Spoit 1 cc Pcs Rp 1,447.98 Rp 1,882
205 Stomach Tube (Maag slang) 12 Pcs Rp 12,542.64 Rp 16,305
206 Stomatch tube (Maag slang) 14 Pcs Rp 12,542.64 Rp 16,305
207 Stomatch tube (Maag slang) 16 Pcs Rp 12,542.64 Rp 16,305
208 Stomach Tube (Maag Slang) 18 Pcs Rp 12,542.64 Rp 16,305
209 Suction cateter no. 6 Pcs Rp 3,711.99 Rp 4,826
210 Suction cateter FG 8 Pcs Rp 4,764.12 Rp 6,193
211 Suction cateter FG 10 Pcs Rp 8,880.00 Rp 11,544
212 Suction cateter FG 12 Pcs Rp 8,880.00 Rp 11,544
213 Suction cateter no. 14 Pcs Rp 4,996.75 Rp 6,496
214 Suction cateter no. 16 Pcs Rp 8,880.00 Rp 11,544
215 Suction cateter no. 18 Pcs Rp 4,996.83 Rp 6,496
216 Suction conecting tube Pcs Rp 34,840.00 Rp 45,292
217 T-chromic cat gut 1 Pcs Rp 69,375.00 Rp 90,188
218 T-chromic cat gut 2 Pcs Rp 69,375.00 Rp 90,188
219 T-chromic cat gut 2-0 Pcs Rp 63,603.00 Rp 82,684
220 T-chromic cat gut 3-0 Pcs Rp 58,275.00 Rp 75,758
221 T-chromic cat gut 4-0 Pcs Rp 66,600.00 Rp 86,580
222 Three way stop cock Pcs Rp 13,208.45 Rp 17,171
223 T- Hemocel 5 x 7,5 cm Pcs Rp 75,177.27 Rp 97,730
224 T-Hernia Mesh 6 x10 cm Pcs Rp 151,140.00 Rp 196,482
225 T-Hernia Mesh 5 x 7,5 cm Pcs Rp 101,454.00 Rp 131,890
226 T-Lene 2-0 Pcs Rp 81,141.00 Rp 105,483
227 T-Lene 3-0 Pcs Rp 80,919.00 Rp 105,195
228 T-Lene 4-0 Pcs Rp 77,145.00 Rp 100,289
229 T-Lene 5-0 Pcs Rp 77,145.00 Rp 100,289
230 Transfusi set (Blood Transfusi set) Pcs Rp 12,544.96 Rp 16,308
231 Transofix Pcs Rp 4,643.13 Rp 6,036
232 T-Silk 1 Pcs Rp 55,389.00 Rp 72,006
233 T-Silk 2-0 Pcs Rp 40,737.00 Rp 52,958
234 T-Silk 3-0 Pcs Rp 43,512.00 Rp 56,566
235 T-Silk 3-0 Pcs Rp 45,621.00 Rp 59,307
236 Torniquet Pcs Rp 22,850.96 Rp 29,706
237 Trocar Thoracic cateter tube No. 22 Pcs Rp 217,905.00 Rp 283,277
238 Tvio 1 Pcs Rp 86,691.00 Rp 112,698
239 T-Vio 2 Pcs Rp 99,990.00 Rp 129,987
240 T-Vio 2-0 Pcs Rp 80,142.00 Rp 104,185
241 T-vio 3-0 Pcs Rp 77,478.00 Rp 100,721
242 T-vio 4-0 Pcs Rp 83,472.00 Rp 108,514
243 Umbilical cold (Penjepit Tali Pusat) Pcs Rp 1,306.95 Rp 1,699
244 Upad 60x90 pcs Rp 4,084.80 Rp 5,310
245 Urine bag Pcs Rp 6,309.24 Rp 8,202
246 Urogard Pcs Rp 131,257.50 Rp 170,635
247 Urobag Pcs Rp 6,072.00 Rp 7,894
248 USG Jelly 250 ml Botol Rp 16,631.91 Rp 21,621
249 USG Jelly 5 L Botol Rp 185,999.37 Rp 241,799
250 USG Paper Sony Roll Rp 288,000.00 Rp 374,400
251 Xpresif 10x5 Roll Rp 44,400.00 Rp 57,720
MATA
1 Appalens plus 18,0 Pcs Rp 194,250.00 Rp 252,525
2 Appalens plus 18,5 Pcs Rp 194,250.00 Rp 252,525
3 Appalens plus 19.0 Pcs Rp 194,250.00 Rp 252,525
4 Appalens plus 19.5 Pcs Rp 194,250.00 Rp 252,525
5 Appalens plus 20.0 Pcs Rp 194,250.00 Rp 252,525
6 Appalens plus 20.5 Pcs Rp 194,250.00 Rp 252,525
7 Appalens plus 21.0 Pcs Rp 194,250.00 Rp 252,525
8 Appalens plus 21.5 Pcs Rp 194,250.00 Rp 252,525
9 Appalens plus 22.0 Pcs Rp 194,250.00 Rp 252,525
10 Appalens plus 22.5 Pcs Rp 194,250.00 Rp 252,525
11 Appalens plus 23.0 Pcs Rp 194,250.00 Rp 252,525
12 Appasamy cohesisc 1,8% Pcs Rp 421,800.00 Rp 548,340
13 Appasamy appavisc 3 ml (Visco) Pcs Rp 122,100.00 Rp 158,730
14 Mani opthalmic 27 Keratone Pcs Rp 290,820.00 Rp 378,066
15 Mani opthalmic 26 cresene Pcs Rp 290,820.00 Rp 378,066
16 Mata pisau B Braun 15 Pcs Rp 8,103.00 Rp 10,534
17 Miochol/ Carbacol Pcs Rp 66,600.00 Rp 86,580
18 Needle Terumo 27 Pcs Rp 1,853.70 Rp 2,410
19 Nylon 10/0 Pcs Rp 170,765.00 Rp 221,995
20 Rhed-ID/ Trypan Blue Pcs Rp 66,600.00 Rp 86,580
21 SP PGA 8/0 Pcs Rp 182,650.00 Rp 237,445

Palopo, Januari 2022

Kepala Instalasi Farmasi

RSUD dr. Palemmai Tandi
Syuriani, S.Si., Apt.
Nip. 19830605 200903 2 003
 PEMERINTAH KOTA PALOPO
RSUD dr. PALEMMAI TANDI
Jl. Samiun No. 2, Telp. 0853-4577-4072
PALOPO

DAFTAR HARGA OBAT & BMHP

FEBRUARI 2023

NO URAIAN SATUAN HARGA SATUAN KET

1 OBAT FAKTUR JUAL

1 Acetylcystein 200 mg Kapsul Rp 777.00 Rp 1,010
2 Acetylcystein 200 mg infus Botol Rp 183,338.70 Rp 238,340
3 Acyclovir 400 mg Tablet Rp 889.13 Rp 1,156
4 Acyclovir crem 5% Tube Rp 4,768.23 Rp 6,199
5 Adalat Oros 30 mg Tablet Rp 3,986.00 Rp 5,182
6 Albunorm 25% 100 ml Botol Rp 1,579,799.70 Rp 2,053,740 retriksi 3 btl/minggu
7 Albunorm 25% 100 ml Botol Rp 1,746,585.00 Rp 2,270,561 retriksi 3 btl/minggu
8 Allopurinol 100 mg Tablet Rp 87.87 Rp 114
9 Allopurinol 300 mg Tablet Rp 357.50 Rp 465
10 Alprazolam 0,5 mg Tablet Rp 78.00 Rp 101
11 Alprazolam 1 mg Tablet Rp 544.50 Rp 708
12 Amoxan paed drop Botol Rp 25,530.00 Rp 33,189 Umum
13 Amoxicillin 125 mg dry syrup Botol Rp 2,600.00 Rp 3,380
14 Amoxicillin 250 mg dry syrup Botol Rp 3,510.00 Rp 4,563
15 Amoxicillin 500 mg Tablet Rp 550.98 Rp 716
16 Amoxicillin 500 mg Tablet Rp 656.02 Rp 853
17 Ambroxol elixir Botol Rp 2,966.81 Rp 3,857
18 Ambroxol 30 mg Tablet Rp 111.00 Rp 144
19 Amikacin 250 mg Injeksi Vial Rp 17,050.00 Rp 22,165
20 Amiodaron Ampul Rp 6,504.60 Rp 8,456
21 Amlodipin 10 mg Tablet Rp 1,501.00 Rp 1,951
22 Amlodipin 5 mg Tablet Rp 422.40 Rp 549
23 Amlodipin 5 mg Tablet Rp 852.00 Rp 1,108
24 Aminoleban 500 Bag Rp 72,800.02 Rp 94,640
25 Aminophylline injeksi Ampul Rp 22,200.00 Rp 28,860
26 Amiparen 500 Bag Rp 96,649.92 Rp 125,645
27 Amitriptillin 25 mg Tablet Rp 233.10 Rp 303
28 Ampicillin 1 gr Vial Rp 9,240.00 Rp 12,012
29 Analsik Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
30 Antasida doen Tablet Rp 54.00 Rp 70
31 Antasida suspensi Botol Rp 3,436.18 Rp 4,467
32 Apidra solostar Flexpen Rp 91,020.00 Rp 118,326
33 Arkine 2 mg Tablet Rp 606.06 Rp 788
34 Asam ascorbid acid 200 mg/2 ml Injeksi Rp 4,975.00 Rp 6,468
35 Asam mefenamat 500 mg Tablet Rp 210.00 Rp 273
36 Asam folat 400 mg Tablet Rp 45.00 Rp 59
37 Asam folat 1 g Tablet Rp 61.00 Rp 79
38 Asam tranexamat 500 mg Tablet Rp 1,918.08 Rp 2,494
39 Asam tranexamat 250 mg /5 ml injeksi Ampul Rp 2,002.00 Rp 2,603
40 Asam tranexamat 500 mg/ml Ampul Rp 9,435.00 Rp 12,266
41 Asam valproat 250 mg/mlsyrup Botol Rp 12,752.00 Rp 16,578
42 Asering Botol Rp 9,591.51 Rp 12,469
43 Atracurium 50 mg/5 ml Ampul Rp 38,850.00 Rp 50,505
44 Atracurium 25 mg/5 ml Ampul Rp 9,877.89 Rp 12,841
45 Atorvastatin calcium 20 mg Tablet Rp 471.00 Rp 612
46 Atorvastatin calcium 20 mg Tablet Rp 575.00 Rp 747
47 Atropin sulfat Injeksi Ampul Rp 3,778.02 Rp 4,911
48 Aqua pro injeksi 25 ml Botol Rp 2,954.82 Rp 3,841
49 Aqua pro injeksi 1 L Botol Rp 35,614.35 Rp 46,299
50 Azitromycin 500 mg Tablet Rp 1,892.99 Rp 2,461
51 Bamgetol 200 mg Tablet Rp 2,172.27 Rp 2,824
52 Baquinor 0,3% ED Botol Rp 37,573.60 Rp 48,846
53 Beneuron Tablet Rp 832.50 Rp 1,082 Retriksi 7 Tablet
54 Benoson N crem Tube Rp 18,499.80 Rp 24,050 Umum
55 Benutrion VE Botol Rp 62,658.40 Rp 81,456
56 Betahistin 6 mg Tablet Rp 92.00 Rp 120
57 Betahistin HCl 24 mg Tablet Rp 4,989.75 Rp 6,487
58 Betametason crem Tube Rp 1,534.02 Rp 1,994
59 Berotec 0,1 mg Botol Rp 87,721.07 Rp 114,037
60 Bfluid 500 ml Softbag Rp 77,063.00 Rp 100,182
61 Bio TT Ampul Rp 60,500.00 Rp 78,650
62 Biovitan syrup Botol Rp 4,116.77 Rp 5,352
63 Bisoprolol 2,5 mg Tablet Rp 149.00 Rp 194
64 Bisoprolol 5 mg Tablet Rp 264.00 Rp 343
65 Briclot Tablet Rp 16,650.00 Rp 21,645
66 Brilinta 90 mg Tablet Rp 8,480.40 Rp 11,025 Retriksi 6 tablet
67 Calcium Lactat 500 mg Tablet Rp 117.00 Rp 152
68 Calcium gluconas 10 ml Ampul Rp 1,501.20 Rp 1,952
69 Candesartan 8 mg Tablet Rp 315.00 Rp 409
70 Candesartan 16 mg Tablet Rp 1,836.05 Rp 2,387
71 Candesartan 16 mg Tablet Rp 495.00 Rp 644
72 Captopril 12,5 mg Tablet Rp 95.46 Rp 124
73 Captopril 25 mg Tablet Rp 137.75 Rp 179
74 Captopril 50 mg Tablet Rp 234.48 Rp 305
75 Carbazocrome Ampul Rp 11,246.52 Rp 14,620
76 Carmed 10% crem Tube Rp 36,083.33 Rp 46,908
77 Carmed 20% crem Tube Rp 45,715.30 Rp 59,430
78 Cepezet 100 mg Tablet Rp 1,110.00 Rp 1,443
79 Cephaflox 1 gr Vial Rp 198,135.00 Rp 257,576 Umum/ Jasarahrja
80 Cetrizine syrup Botol Rp 3,977.80 Rp 5,171
81 Cetrizine 10 mg Tablet Rp 81.00 Rp 105
82 Cefadroxil 500 mg Kapsul Rp 800.00 Rp 1,040
83 Cefadroxil 500 mg Kapsul Rp 1,002.07 Rp 1,303
84 Cefadroxil syrup 125 mg Botol Rp 3,890.00 Rp 5,057
85 Cefadroxil syrup 250 mg Botol Rp 12,375.00 Rp 16,088
86 Cefoperazone Vial Rp 53,280.00 Rp 69,264
87 Cefoperazone 1 gr Vial Rp 12,050.00 Rp 15,665
88 Ceftazidime 1 gr Vial Rp 11,825.00 Rp 15,372
89 Cefixime 100 mg/5 ml Botol Rp 5,242.00 Rp 6,815
90 Cefixime 100 mg Kapsul Rp 463.00 Rp 602
91 Cefixime 100 mg Kapsul Rp 999.98 Rp 1,300
92 Cefixime 200 mg Kaplet Rp 756.00 Rp 983
93 Cefotaxime 1 gr Vial Rp 5,999.55 Rp 7,799
94 Ceftriaxon 1 gr Vial Rp 2,925.00 Rp 3,803
95 Cefuroxime 1 gr Vial Rp 57,200.00 Rp 74,360
96 Cendo Astenof 0,6 ml Botol Rp 4,551.00 Rp 5,916
97 Cendo catarlent 0,6 ml Botol Rp 4,440.00 Rp 5,772
98 Cendo conver 2% 0,6 ml MD Botol Rp 3,579.75 Rp 4,654
99 Cendo Efrisel 10% Botol Rp 16,927.35 Rp 22,006
100 Cendo LFX 0,6 ml Botol Rp 15,318.00 Rp 19,913
101 Cendo Lyteers ED Botol Rp 24,975.00 Rp 32,468
102 Cendo Hyalub ED Botol Rp 59,107.50 Rp 76,840
103 Cendo Hyalub 0,6 ml MD Botol Rp 12,654.00 Rp 16,450
104 Cendo Midriatil 0,5% Botol Rp 5,855.25 Rp 7,612
105 Cendo Midriatil 1 % ED Botol Rp 42,457.50 Rp 55,195
106 Cendo Natacen 0,6 ml Botol Rp 9,240.75 Rp 12,013
107 Cendo P. Pred Botol Rp 8,491.50 Rp 11,039
108 Cendo Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
109 Cendo protagenta 0,6 ml MD Botol Rp 7,964.25 Rp 10,354
110 Cendo Timol 0,5% 0,6 ml MD Botol Rp 5,716.50 Rp 7,431
111 Cendo Tobroson 0,6 ml Botol Rp 6,438.00 Rp 8,369
112 Cendo xytrol 5 ml Botol Rp 30,247.50 Rp 39,322
113 Cilostazol 100 mg Tablet Rp 6,792.50 Rp 8,830
114 Cimetidine 200 mg Tablet Rp 412.85 Rp 537
115 Ciprofloxacin Infus Botol Rp 8,100.00 Rp 10,530
116 Ciprofloxacin 500 mg Tablet Rp 539.98 Rp 702
117 Ciprofloxacin 500 mg Tablet Rp 475.01 Rp 618
118 Citicholin 250 mg/2 ml Ampul Rp 22,275.00 Rp 28,958
119 Citicholin 500 mg/4 ml Ampul Rp 24,420.00 Rp 31,746
120 Citicolin 500 mg Tablet Rp 4,440.00 Rp 5,772
121 Chloroquin 150 mg Tablet Rp 1,505.74 Rp 1,957
122 Chlorpheniramine Maleat (CTM) Tablet Rp 62.99 Rp 82
123 Clindamycin 300 mg Kapsul Rp 1,334.78 Rp 1,735
124 Clindamycin 150 mg Kapsul Rp 921.30 Rp 1,198
125 Clobazam 10 mg Tablet Rp 384.00 Rp 499
126 Clonidine 0,15 mg Tablet Rp 146.00 Rp 190
127 Clopidogrel 75 mg Tablet Rp 580.23 Rp 754
128 Clozapine 25 mg Tablet Rp 477.00 Rp 620
129 Codein 10 mg Tablet Rp 610.50 Rp 794
130 Colchicine 0,5 Tablet Rp 671.00 Rp 872
131 Colchicine 0,5 Tablet Rp 1,665.00 Rp 2,165
132 Colistine 0,25 MIU Tablet Rp 2,553.00 Rp 3,319
133 Cotrimoxasole suspensi Botol Rp 5,954.30 Rp 7,741
134 Cotrimoxazole 480 mg Tablet Rp 253.97 Rp 330
135 Curcuma Force Tablet Rp 876.15 Rp 1,139
136 Curcuma 20 mg Tablet Rp 482.02 Rp 627
137 Daily C 500 mg Tablet Rp 577.50 Rp 751
138 DC2 Tablet Rp 8,116.88 Rp 10,552 Retriksi 3 tablet
139 Depakote 250 mg Kaplet Rp 8,880.00 Rp 11,544
140 Desolex crem 10 gr Tube Rp 25,080.00 Rp 32,604 Umum
141 Dexamethason 5 mg/ml Ampul Rp 1,427.39 Rp 1,856
142 Dexamethason 0,5 mg Tablet Rp 132.09 Rp 172
143 Dexketoprofen 50 mg/2 ml Ampul Rp 26,640.00 Rp 34,632
144 Dexketoprofen 25 mg Tablet Rp 3,441.00 Rp 4,473 Retriksi 6 tablet
145 Dexosimethason 0,25 mg crem 10 g Tube Rp 9,079.80 Rp 11,804

146 Dexosimethason 0,25 mg crem 15 g Tube Rp 13,800.00 Rp 17,940

147 Dextrose 10% Botol Rp 7,200.30 Rp 9,360
148 Dextrose 10% Botol Rp 8,350.53 Rp 10,856
149 Dextrose 5% Botol Rp 6,626.70 Rp 8,615
150 Dextrose 5% Botol Rp 7,685.64 Rp 9,991
151 Dextrose 5% 100 ml piggy bag Botol Rp 13,786.20 Rp 17,922
152 Dextrose 40% Botol Rp 7,770.00 Rp 10,101
153 Diazepam 2 mg Tablet Rp 70.00 Rp 91
154 Diazepam 5 mg/ml inj. Ampul Rp 1,559.00 Rp 2,027
155 Diazepam 5 mg rectal Rectube Rp 13,546.00 Rp 17,610
156 Diazepam 10 mg rectal Rectube Rp 19,693.00 Rp 25,601
157 Dibekacin 100 mg Ampul Rp 79,920.00 Rp 103,896
158 Digoxin 0,25 mg Tablet Rp 114.40 Rp 149
159 Diltiazem Tablet Rp 1,665.00 Rp 2,165
160 Dimenhidrinat 50 mg Tablet Rp 109.99 Rp 143
161 Dipenhidramin 15 mg/15 ml Ampul Rp 5,390.00 Rp 7,007
162 Divalproex sodium 250 mg Kaplet Rp 3,229.00 Rp 4,198
163 Divalproex sodium 500 mg Kaplet Rp 1,505.00 Rp 1,957
164 Dobutamin 250 mg/5 ml Ampul Rp 30,885.75 Rp 40,151
165 Dobutamin 50 mg Ampul Rp 9,004.00 Rp 11,705
166 Dolgesic Injeksi Ampul Rp 11,988.00 Rp 15,584
167 Domavit Softcap Rp 2,741.70 Rp 3,564 Retriksi 7 Tablet
168 Domperidon 10 mg Tablet Rp 155.01 Rp 202
169 Domperidone syrup Botol Rp 4,437.28 Rp 5,768
170 Donepezil Tablet Rp 1,680.00 Rp 2,184
171 Dopamet (methyldopa) Tablet Rp 1,023.00 Rp 1,330
172 Dopamin 200 mg/5 ml Ampul Rp 3,945.00 Rp 5,129
173 Dorium Kaplet Rp 4,884.00 Rp 6,349 Retriksi 6 tablet
174 Doxycycline 100 mg Kapsul Rp 281.69 Rp 366
175 Dulcolax 5 mg tablet Tablet Rp 1,586.85 Rp 2,063
176 Dulcolax 5 mg Suppo Rp 5,084.90 Rp 6,610
177 Dulcolax 10 mg Suppo Rp 4,325.00 Rp 5,623
178 Duloxta 60 Tablet Rp 14,499.38 Rp 18,849 Retriksi 6 tablet
179 Durogesic 12,5 MU Patch Rp 63,775.05 Rp 82,908
180 Eperison HCl 50 mg Tablet Rp 1,170.13 Rp 1,521
181 Ephedrine injeksi Ampul Rp 6,485.95 Rp 8,432
182 Ephineprine injeksi Ampul Rp 2,904.00 Rp 3,775
183 Erdostein 300 mg Kapsul Rp 2,594.63 Rp 3,373
184 Ericaf Tablet Rp 3,330.00 Rp 4,329
185 Erytromicin suspensi Botol Rp 12,210.00 Rp 15,873
186 Euthyrox 50 mg Tablet Rp 728.56 Rp 947
187 Etoricoxib 60 mg Tablet Rp 4,440.00 Rp 5,772 Retriksi 6 tablet
188 Euthyrox 100 mg Tablet Rp 3,828.00 Rp 4,976
189 Farbion Injeksi Ampul Rp 11,000.00 Rp 14,300
190 Farbivent 2,5 ml Ampul Rp 3,951.60 Rp 5,137
191 Fargoxin 2 ml njeksi Ampul Rp 49,500.00 Rp 64,350
192 Fasorbid 10 mg Tablet Rp 300.30 Rp 390
193 Fentanyl citrate Inj 2 ml Ampul Rp 29,767.98 Rp 38,698
194 Fladystine ovula Suppo Rp 15,484.50 Rp 20,130
195 Flunarizine 5 mg Tablet Rp 1,665.00 Rp 2,165
196 Forumen tetes telinga Botol Rp 29,082.00 Rp 37,807
197 Fosen Enema Botol Rp 94,905.00 Rp 123,377
198 Furosemid injeksi Ampul Rp 969.00 Rp 1,260
199 Furosemid 40 mg Tablet Rp 144.79 Rp 188
200 Gabapentine 300 mg Kapsul Rp 1,000.00 Rp 1,300
201 Gabapentine 100 mg Kapsul Rp 1,110.00 Rp 1,443
202 Gabatin 300 mg Kapsul Rp 9,990.00 Rp 12,987 Umum
203 Gabaxa Botol Rp 247,227.00 Rp 321,395
204 Gelafusal infusion 500 ml Bag Rp 145,015.00 Rp 188,520
205 Genoint tetes mata Botol Rp 13,320.00 Rp 17,316
206 Gentamicin salep kulit Tube Rp 2,963.70 Rp 3,853
207 Gentamicin 0,3% 5 gram Tube Rp 40,376.25 Rp 52,489
208 Gentamicin 40 mg/ml injeksi Ampul Rp 3,385.50 Rp 4,401
209 Glauseta Tablet Rp 2,876.00 Rp 3,739
210 Glauseta Tablet Rp 3,355.42 Rp 4,362 Retriksi 6 tablet
211 Glibenclamid 5 mg Tablet Rp 333.00 Rp 433
212 Gliclazide 80 mg Tablet Rp 214.00 Rp 278
213 Glimepirid 2 mg Tablet Rp 220.00 Rp 286
214 Glimepirid 4 mg Tablet Rp 2,032.70 Rp 2,643
215 Granisetron 1 mg Ampul Rp 22,200.00 Rp 28,860
216 Griseofulvin 125 mg Tablet Rp 500.00 Rp 650
217 Harnal 0,2 Tablet Rp 7,859.99 Rp 10,218
218 Harnal OCAS Tablet Rp 4,356.00 Rp 5,663
219 Heparin sodium Ampul Rp 46,635.00 Rp 60,626
220 Hepatosol Vanila Pcs Rp 36,815.00 Rp 47,860
221 Herbesser CD 200 Tablet Rp 5,196.82 Rp 6,756
222 Hervis 0,35 gr Tablet Rp 40,792.50 Rp 53,030
223 Hexymer 2 mg Tablet Rp 427.35 Rp 556
224 Histapan Tablet Rp 804.75 Rp 1,046 Retriksi 6 tablet
225 Human Albumin 20% Botol Rp 913,227.04 Rp 1,187,195 Retriksi 3 botol/minggu

226 Hydrocortison salep kulit Tube Rp 6,136.00 Rp 7,977

227 Hyosine injeksi Ampul Rp 6,188.05 Rp 8,044
228 Hyson Injeksi Ampul Rp 97,402.43 Rp 126,623 Jasaraharja/Umum
229 Hyoscine butylbromide 10 mg Tablet Rp 1,050.00 Rp 1,365
230 Hystolan 20 mg Tablet Rp 4,795.20 Rp 6,234
231 Ibuprofen 400 mg Tablet Rp 215.00 Rp 280
232 Ibuprofen 200 mg Tablet Rp 155.00 Rp 201
233 Ibuprofen suspensi Botol Rp 9,075.00 Rp 11,798
234 Ifalmin Kapsul Rp 5,500.00 Rp 7,150 Retriksi 3 tablet
235 Imboost Force Kaplet Rp 5,701.90 Rp 7,412 Retriksi 3 tablet
236 Indop (Dopamin) Ampul Rp 19,057.50 Rp 24,775
237 Imitatin 1 gr Vial Rp 170,829.00 Rp 222,078 Jasaraharja/Umum
238 Interlac Sachet Rp 11,072.25 Rp 14,394 Retriksi 4 bungkus
239 Inviclot Vial Rp 65,340.00 Rp 84,942
240 Iremax Tablet Rp 990.68 Rp 1,288 Retriksi 6 tablet
241 Isoflurane 250 ml Botol Rp 827,672.50 Rp 1,075,974
242 Isoniazid 100 mg Tablet Rp 444.00 Rp 577
243 Isoniazid 300 mg Tablet Rp 666.00 Rp 866
244 Isosorbid dinitrate 5 mg Tablet Rp 99.90 Rp 130
245 Isosorbid dinitrate 1 mg/ml Ampul Rp 33,000.00 Rp 42,900
246 Kaen 3B Botol Rp 11,500.00 Rp 14,950
247 Kaen 3B Botol Rp 12,770.55 Rp 16,602
248 Kaen 4B Botol Rp 10,858.02 Rp 14,115
249 Kaen 4B Botol Rp 13,769.55 Rp 17,900
250 Kaen Mg3 Botol Rp 10,560.00 Rp 13,728
251 Kalium diklofenak 50 mg Tablet Rp 333.00 Rp 433
252 KCL 7,46 Botol Rp 3,470.97 Rp 4,512
253 Ketoconazole salep Tube Rp 8,800.00 Rp 11,440
254 Ketoconazole 200 mg Tablet Rp 495.00 Rp 644
255 Ketorolac injeksi Ampul Rp 1,475.00 Rp 1,918
256 Kidmin 200 ml Bag Rp 54,619.77 Rp 71,006
257 Kina Tablet Rp 2,200.00 Rp 2,860
258 KSR 600 mg Tablet Rp 1,842.00 Rp 2,395
259 Kutoin Tablet Rp 1,391.94 Rp 1,810
260 KTM Injeksi Vial Rp 190,920.00 Rp 248,196
261 Lactafit Tablet Rp 3,330.00 Rp 4,329 Umum
262 Lactogen Lactofree Kaleng Rp 101,817.90 Rp 132,363 Umum
263 Lactogen Premature Kaleng Rp 101,909.10 Rp 132,482 Umum
264 Lactulosa syrup Botol Rp 27,472.50 Rp 35,714
265 Lametic syrup Botol Rp 102,300.00 Rp 132,990 Umum
266 Lametic 8 mg/4 ml Ampul Rp 68,200.00 Rp 88,660 Umum
267 Lanabal 500 mcg Kapsul Rp 2,750.00 Rp 3,575 Umum
268 Lanfix 200 Kapsul Rp 37,400.00 Rp 48,620 Umum
269 Lanzoprasole 30 mg Kapsul Rp 278.00 Rp 361
270 Lantus solostar Flexpen Rp 89,910.00 Rp 116,883
271 Laxadine syrup 30 ml Botol Rp 42,900.00 Rp 55,770
272 Laxadine emulsi 60 ml Botol Rp 47,730.00 Rp 62,049
273 Laxalosan syrup Botol Rp 61,050.00 Rp 79,365 Umum
274 L Bio Sachet Rp 8,172.38 Rp 10,624 Retriksi 6/4 bungkus
275 Lesichol 300 Softcap Rp 13,200.00 Rp 17,160 Umum
276 Levetiracetam 500 mg Tablet Rp 4,117.00 Rp 5,352
277 Levopar Tablet Rp 5,772.00 Rp 7,504
278 Levoben 100 mg Tablet Rp 2,997.00 Rp 3,896
279 Levofloxacin 500 mg Tablet Rp 373.01 Rp 485
280 Levofloxacin Infus Botol Rp 23,100.00 Rp 30,030
281 Levothyroxine 100 mcg Tablet Rp 890.01 Rp 1,157
282 Lidokain 2% Injeksi Ampul Rp 891.00 Rp 1,158
283 Lidokain compositum Ampul Rp 847.00 Rp 1,101
284 Lisinopril 10 mg Tablet Rp 149.00 Rp 194
285 Lodomer 2 mg Tablet Rp 1,212.12 Rp 1,576
286 Loperamid 2 mg Tablet Rp 89.00 Rp 116
287 Loratadine 10 mg Tablet Rp 162.00 Rp 211
288 Lycalvit 60 ml Botol Rp 47,932.50 Rp 62,312 Umum
289 Lycopect Tablet Rp 387.97 Rp 504
290 Maganol Infus Botol Rp 56,610.00 Rp 73,593 Umum
291 Manitol 20% Botol Rp 39,650.28 Rp 51,545
292 Maxiflon 400 mg Tablet Rp 37,296.00 Rp 48,485 Umum/Jasaraharja
293 MgSO4 40% Botol Rp 5,661.00 Rp 7,359
294 Mecobalamin 500 mg Kapsul Rp 577.50 Rp 751
295 Meloxicam 7,5 mg Tablet Rp 298.04 Rp 387
296 Meloxicam 15 mg Tablet Rp 246.98 Rp 321
297 Meprovent Inhalasi Botol Rp 5,328.00 Rp 6,926
298 Meropenem 1 gr Vial Rp 44,400.00 Rp 57,720
299 Mersibion 5000 injeksi Ampul Rp 4,001.55 Rp 5,202
300 Metamizole injeksi Ampul Rp 5,045.45 Rp 6,559
301 Metamizole 500 mg Tablet Rp 333.00 Rp 433
302 Metformin 500 mg Tablet Rp 179.99 Rp 234
303 Methylergometrin 0,125 mg Tablet Rp 261.00 Rp 339
304 Methylergometrin 2 mg inj. Ampul Rp 1,069.00 Rp 1,390
305 Methylprednisolon 125 mg Injeksi Vial Rp 16,873.11 Rp 21,935
306 Methylprednisolon 4 mg Tablet Rp 239.65 Rp 312
307 Methylprednisolon 4 mg Tablet Rp 203.00 Rp 264
308 Methylprednisolon 8 mg Tablet Rp 566.70 Rp 737
309 Metoclopramid 5 mg injeksi Ampul Rp 1,883.00 Rp 2,448
310 Metoclopramid 10 mg Tablet Rp 66.00 Rp 86
311 Metronidazole infus Botol Rp 5,938.50 Rp 7,720
312 Metronidazole 500 mg Tablet Rp 236.00 Rp 307
313 Miconazole 2% Tube Rp 1,916.97 Rp 2,492
314 Midanest 5 mg Ampul Rp 19,980.00 Rp 25,974
315 Miniaspi 80 mg Tablet Rp 89.00 Rp 116
316 Miriwash 500 ml Softbag Rp 145,854.00 Rp 189,610
317 Misoprostol 200 Mcg Tablet Rp 4,717.50 Rp 6,133
318 Mometason Furoate crem Tube Rp 6,025.00 Rp 7,832
319 Morfina 10 mg/ml Ampul Rp 30,272.65 Rp 39,354
320 Moxifloxacin 400 mg Tablet Rp 10,770.00 Rp 14,001
321 Moxifloxacin 400 Infus Botol Rp 47,148.00 Rp 61,292
322 MST Continue 10 mg Tablet Rp 15,762.00 Rp 20,491
323 Mupirocin crem 5 gr Tube Rp 17,482.50 Rp 22,727
324 Myores Tablet Rp 4,870.13 Rp 6,331 Retriksi 6 tablet
325 Natrium Chlorida 0,9% (NaCl) 500 ml Botol Rp 6,963.03 Rp 9,052
326 Natrium diklofenak 25 mg Tablet Rp 114.99 Rp 149
327 Natrium diklofenak 50 mg Tablet Rp 322.01 Rp 419
328 NaCl Piggybag 100 ml Botol Rp 6,702.00 Rp 8,713
329 Natur E Softcap Rp 1,271.86 Rp 1,653
330 Neostigmin Injeksi Ampul Rp 9,435.00 Rp 12,266
331 New antides Tablet Rp 194.61 Rp 253
332 New diatabs Tablet Rp 825.00 Rp 1,073
333 Nicardipin Injeksi Ampul Rp 8,341.00 Rp 10,843
334 Nifedipin 10 mg Tablet Rp 164.67 Rp 214
335 Nitrokaf retard Tablet Rp 1,650.00 Rp 2,145
336 Norelut Tablet Rp 4,495.50 Rp 5,844
337 Norit Tablet Rp 400.00 Rp 520
338 Noreprinefrin Bitartrate Ampul Rp 6,673.00 Rp 8,675
339 Novapyron Tablet Rp 518.00 Rp 673
340 Novorapid Flexpen Flexpen Rp 90,314.00 Rp 117,408
341 Noxetine 20 mg Tablet Rp 11,100.00 Rp 14,430
342 NTG (glyceryl trinitrate) Tablet Rp 60,775.00 Rp 79,008
343 Nystatin drop Botol Rp 17,759.99 Rp 23,088
344 Obat batuk hitam (OBH) syrup Botol Rp 6,468.00 Rp 8,408
345 Ofloxacin 400 mg Tablet Rp 583.00 Rp 758
346 Omeprazole 40 mg injeksi Vial Rp 8,500.00 Rp 11,050
347 Omeprazole 20 mg Kapsul Rp 338.00 Rp 439
348 Ondansetron 4 mg Injeksi Ampul Rp 972.00 Rp 1,264
349 Ondansetron 8 mg/4 ml inj. Ampul Rp 4,400.04 Rp 5,720
350 Ondansetron 4 mg Tablet Rp 506.99 Rp 659
351 Onoiwa Kapsul Rp 5,994.00 Rp 7,792 Retriksi 3 tablet
352 Oralit Sachet Rp 869.30 Rp 1,130
353 Oste Forte Sachet Rp 5,144.87 Rp 6,688 Retriksi 3 tablet
354 Ottogenta Injeksi Ampul Rp 6,600.00 Rp 8,580
355 Ottopain eye drop Botol Rp 83,041.88 Rp 107,954 Khusus RI
356 Otsu salin 3% Botol Rp 30,610.45 Rp 39,794
357 Oxytetracyclin salep kulit Tube Rp 5,550.00 Rp 7,215
358 Oxytocin injeksi Ampul Rp 1,348.00 Rp 1,752
359 Oxytocin injeksi Ampul Rp 3,296.70 Rp 4,286
360 Paracetamol infus Botol Rp 14,358.96 Rp 18,667
361 Paracetamol 500 mg Tablet Rp 209.00 Rp 272
362 Paracetamol syrup Botol Rp 1,171.00 Rp 1,522
363 Patral Tablet Rp 7,881.00 Rp 10,245 Umum
364 Pehacain injeksi Ampul Rp 2,670.15 Rp 3,471
365 Peptisol Vanila Box Rp 23,865.00 Rp 31,025 Umum
366 Perifas Tablet Rp 2,442.00 Rp 3,175
367 Permethrin 10 mg Tube Rp 7,303.80 Rp 9,495
368 Permethrine 15 mg Tube Rp 11,466.03 Rp 14,906
369 Pervita Kaplet Rp 1,648.35 Rp 2,143 Retriksi 7 Tablet
370 Pethidina 50mg/ml Ampul Rp 13,521.80 Rp 17,578
371 Phenytoin sodium 50 mg/ml Ampul Rp 23,448.75 Rp 30,483
372 Piracetam 800 mg Tablet Rp 632.03 Rp 822
373 Piracetam 3 gr Ampul Rp 14,368.20 Rp 18,679
374 Polidemicin ED Botol Rp 31,524.00 Rp 40,981
375 Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
376 Poro Suppositoria 125 mg Suppo Rp 8,800.00 Rp 11,440
377 Poro Suppositoria 250 mg Suppo Rp 12,320.00 Rp 16,016
378 Pramipexole 0,125 mg Tablet Rp 1,413.00 Rp 1,837
379 Pramipexole 0,375 ER Tablet Rp 3,050.00 Rp 3,965
380 Prednison 5 mg Tablet Rp 126.00 Rp 164
381 Pregabalin 75 mg Tablet Rp 3,608.00 Rp 4,690
382 Pregnolin 5 mg Tablet Rp 4,395.60 Rp 5,714
383 Prohepar Kapsul Rp 5,555.54 Rp 7,222 Retriski 3 Kapsul
384 Propanolol 10 mg Tablet Rp 77.00 Rp 100
385 Propanolol 40 mg Tablet Rp 135.00 Rp 175
386 Propofol 20 ml Ampul Rp 10,382.94 Rp 13,498
387 Propyltiouracil 100 mg Tablet Rp 440.00 Rp 572
388 Provital plus Tablet Rp 6,710.00 Rp 8,723 Retriksi 3 Kaplet
389 Pyrantel 125 mg Tablet Rp 512.67 Rp 666
390 Pyrazinamide 500 mg Tablet Rp 777.00 Rp 1,010
391 Phytomenadion 10 mg Tablet Rp 781.00 Rp 1,015
392 Quanocain spinal 2 mg/4 ml Ampul Rp 52,250.00 Rp 67,925
393 Ramipril 5 mg Tablet Rp 263.00 Rp 342
394 Ramipril 10 mg Tablet Rp 703.60 Rp 915
395 Ranitidin 50 mg/2 ml Ampul Rp 4,995.00 Rp 6,494
396 Ranitidin 50 mg/2 ml Ampul Rp 3,907.20 Rp 5,079
397 Ranitidin 150 mg Tablet Rp 178.71 Rp 232
398 Rebamipid Tablet Rp 3,330.00 Rp 4,329 Retriksi 6 tablet
399 Recalus Kapsul Rp 5,272.50 Rp 6,854 Retriksi 6 tablet
400 Reco tetes telinga Botol Rp 16,650.00 Rp 21,645
401 Recustein dry syrup Botol Rp 60,500.00 Rp 78,650
402 Recolfar 0,5 mg Tablet Rp 5,500.00 Rp 7,150
403 Regivell 20 mg Botol Rp 58,275.00 Rp 75,758
404 Ringer Lactat (RL) Botol Rp 7,773.33 Rp 10,105
405 Rifampicin 600 mg Kapsul Rp 2,513.99 Rp 3,268
406 Risperidon 2 mg Tablet Rp 272.99 Rp 355
407 Rocuronium Bromide 50 mg Ampul Rp 35,075.00 Rp 45,598
408 Ryzodeg Flex Pen Rp 113,018.20 Rp 146,924
409 Sagestam 40 mg inj Ampul Rp 16,500.00 Rp 21,450 Umum
410 Sagestam salep mata Tube Rp 41,514.00 Rp 53,968
411 Salbutamol 4 mg Tablet Rp 112.39 Rp 146
412 Salbutamol 2 mg Tablet Rp 113.28 Rp 147
413 Salbutamol sol 1 mg/ml Ampul Rp 5,449.00 Rp 7,084
414 Sanbe Tears ED Botol Rp 25,086.00 Rp 32,612
415 Sanmol Infus Botol Rp 22,582.95 Rp 29,358 Umum
416 Sanmol drop Botol Rp 18,426.00 Rp 23,954 Umum
417 Sanmol syrup Botol Rp 14,652.00 Rp 19,048 Umum
418 Santa E Kapsul Rp 4,662.00 Rp 6,061 Retriksi 3 tablet
419 Scabimite crem Tube Rp 66,000.00 Rp 85,800 Umum
420 Scobutrin Tablet Rp 3,190.00 Rp 4,147
421 Sevoflurane 250 ml Botol Rp 1,104,330.00 Rp 1,435,629
422 Sibital Injeksi Ampul Rp 10,890.00 Rp 14,157
423 Simarc 2 mg Tablet Rp 889.35 Rp 1,156
424 Simvastatin 10 mg Tablet Rp 495.00 Rp 644
425 Simvastatin 20 mg Tablet Rp 151.36 Rp 197
426 Spironolacton 25 mg Tablet Rp 222.00 Rp 289
427 Spironolacton 100 mg Kapsul Rp 552.00 Rp 718
428 Striatamin Kapsul Rp 5,189.25 Rp 6,746
429 Sucralfate suspensi 100 ml Botol Rp 9,390.60 Rp 12,208
430 Sucralfate 500 mg Tablet Rp 265.00 Rp 345
431 Sulfadiazine silver 35 gr Tube Rp 18,725.69 Rp 24,343
432 Sulfitis 500 mg Tablet Rp 2,590.00 Rp 3,367
433 Suprafenid Suppo Rp 10,656.00 Rp 13,853
434 Symbicort 160 dos Botol Rp 166,840.76 Rp 216,893
435 Tablet tambah darah Tablet Rp 255.00 Rp 332
436 Tamsolusin 0,4 mg Tablet Rp 4,356.00 Rp 5,663
437 Tenofovir 300 mg Tablet Rp 2,260.37 Rp 2,938
438 Tetagam P Vial Rp 146,800.00 Rp 190,840
439 Tison 4 Tablet Rp 3,520.00 Rp 4,576
440 Thiamazole 5 mg Tablet Rp 605.00 Rp 787
441 Thiamazole 10 mg Tablet Rp 990.00 Rp 1,287
442 Thiamphenicol 500 mg Tablet Rp 1,013.21 Rp 1,317
443 Thyrozol 5 mg Tablet Rp 679.00 Rp 883
444 Thyrozol 10 mg Tablet Rp 1,325.00 Rp 1,723
445 Tremenza Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
446 Trihexyphenidil 2 mg Tablet Rp 63.00 Rp 82
447 Triamcinolon 4 mg Tablet Rp 884.61 Rp 1,150
448 Triamcinolon 10 mg/ml Vial Rp 33,500.00 Rp 43,550
449 Triamcinolon crem Tube Rp 27,000.00 Rp 35,100
450 Trilac injeksi Vial Rp 180,000.00 Rp 234,000 Umum
451 Tuberculin Tes Vial Rp 738,150.00 Rp 959,595
452 Umarone Vial Rp 192,500.00 Rp 250,250 Umum
453 Ursodeoxycholic Acid 250 mg Tablet Rp 2,050.00 Rp 2,665
454 Vaksin TT Vial Rp 116,217.00 Rp 151,082
455 Valdimex 5 mg Tablet Rp 1,210.00 Rp 1,573
456 Venodenol injeksi Ampul Rp 166,500.00 Rp 216,450
457 Vitamin A IPI Tablet Rp 172.72 Rp 225
458 Vitamin B com Tablet Rp 60.00 Rp 78
459 Vitamin B6 Tablet Rp 140.80 Rp 183
460 Vitamin B1 Tablet Rp 246.00 Rp 320
461 Vitamin C 50 mg Tablet Rp 46.42 Rp 60
462 Vitamin C 500 mg Tablet Rp 495.00 Rp 644
463 Vitamin D3 Tablet Rp 1,357.14 Rp 1,764 Retriksi 6 tablet
464 Vitamin k injeksi Ampul Rp 8,880.00 Rp 11,544
465 Vitrolenta Botol Rp 36,352.50 Rp 47,258
466 Vitsap Tablet Rp 3,404.00 Rp 4,425 Retriksi 3 tablet
467 Vosea Tablet Rp 550.00 Rp 715
468 Warfarin 2 mg Tablet Rp 698.00 Rp 907
469 Wiaflox 500 Tablet Rp 14,850.00 Rp 19,305 Umum
470 Widahes 500 ml Botol Rp 91,020.00 Rp 118,326
471 Wida D5 1/2 NS Botol Rp 10,450.00 Rp 13,585
472 Wida D5 1/4 NS Botol Rp 10,404.99 Rp 13,526
473 Xiety 10 mg Tablet Rp 4,870.12 Rp 6,331
474 Zinc sulfat 20 mg Tablet Rp 250.98 Rp 326
475 Zinc sulfat drop Botol Rp 5,445.66 Rp 7,079
476 Zinc sulfate sirup Botol Rp 4,395.60 Rp 5,714
477 Zollocid 20 mg Kapsul Rp 9,900.00 Rp 12,870
478 Zolmia Tablet Rp 7,770.00 Rp 10,101 Retriksi 6 tablet
Bahan Medis Pakai Habis
2
(BMHP)
1 AgNO3 3% 100 ml Botol Rp 512,820.00 Rp 666,666
2 Alkohol 70% Pcs Rp 55,500.00 Rp 72,150
3 Alkohol swab Pcs Rp 159.54 Rp 207
4 Ambu bag dewasa Pcs Rp 677,875.00 Rp 881,238
5 Ambu bag anak Pcs Rp 677,875.00 Rp 881,238
6 Aproon/celemek Pcs Rp 4,173.60 Rp 5,426
7 Assucryl 1 Pcs Rp 47,932.02 Rp 62,312
8 Assucryl 2 Pcs Rp 75,081.52 Rp 97,606
9 Assucryl 2/0 Pcs Rp 64,355.61 Rp 83,662
10 Assucryl 3/0 Pcs Rp 64,355.58 Rp 83,662
11 Assucryl 4/0 Pcs Rp 82,590.66 Rp 107,368
12 Bio Pen Electrosurgical pencil Pcs Rp 46,065.00 Rp 59,885
Bisturi No. 10 (Surgical blades 10) Pcs
13
serenity
Rp 1,665.00 Rp 2,165
 Bisturi No. 11 (Surgical blades 11)
14
serenity
Pcs Rp 1,665.00 Rp 2,165
15 Bisturi No. 15 (Biss mess OM 15) Pcs Rp 781.00 Rp 1,015
Bisturi No. 20 (Surgical blades 20) Pcs
16
serenity
Rp 609.40 Rp 792

17 Breathing sircuit child Pcs Rp 72,800.46 Rp 94,641

18 Breathing sircuit infant Pcs Rp 72,800.46 Rp 94,641
19 Breket Pcs Rp 20,125.00 Rp 26,163
20 Burrowl Pcs Rp 116,550.00 Rp 151,515
21 Canofix - PU 6 x 8 cm Pcs Rp 6,882.05 Rp 8,947
22 Cervical collar Pcs Rp 133,584.00 Rp 173,659
23 Cat gut chromic 3/0 Pcs Rp 16,500.00 Rp 21,450
24 Chromic 1 HRG Pcs Rp 51,913.59 Rp 67,488
25 Chromic 2 HRG Pcs Rp 44,905.05 Rp 58,377
26 Chromic 2/0 HRG Pcs Rp 40,665.96 Rp 52,866
27 Chromic 3/0 HR Pcs Rp 34,410.00 Rp 44,733
28 Chromic 4/0 HR Pcs Rp 41,295.33 Rp 53,684
29 Cat gut chromic 2/0 Pcs Rp 7,683.32 Rp 9,988
30 Combo pack (Infus set) Pcs Rp 21,450.00 Rp 27,885
31 Comy Bag (Colostomy bag) Pcs Rp 27,600.00 Rp 35,880
32 Cutimed gel 15 gr Tube Rp 52,110.00 Rp 67,743
33 Cutimed siltec 10x10 cm Sac Rp 61,600.00 Rp 80,080
34 Cutimed sorbact 7 x 9 cm Pcs Rp 32,800.00 Rp 42,640
35 Daryantuell Pcs Rp 17,181.80 Rp 22,336
36 Electroda dewasa Pcs Rp 4,386.72 Rp 5,703
37 Elektrode (Anak) Pcs Rp 1,266.18 Rp 1,646
38 Elektrode Bayi Pcs Rp 1,276.50 Rp 1,659
39 Endotracheal Tube 2,5 Pcs Rp 21,580.00 Rp 28,054
40 Endotracheal Tube 3 Pcs Rp 21,580.00 Rp 28,054
41 Endotracheal Tube 3,5 Pcs Rp 32,090.96 Rp 41,718
42 Endotracheal Tube 4,0 Pcs Rp 17,036.00 Rp 22,147
43 Endotracheal Tube 4,5 Pcs Rp 21,579.76 Rp 28,054
44 Endotracheal Tube 5,0 Pcs Rp 21,579.76 Rp 28,054
45 Endotracheal Tube 5,5 Pcs Rp 21,579.76 Rp 28,054
46 Endotracheal Tube 6,0 Pcs Rp 26,565.00 Rp 34,535
47 Endotracheal Tube 6,5 Pcs Rp 16,947.00 Rp 22,031
48 Endotracheal Tube 7,0 Pcs Rp 21,579.95 Rp 28,054
49 Endotracheal Tube 7,5 Pcs Rp 21,579.75 Rp 28,054
50 Endotracheal Tube 8,0 Pcs Rp 21,579.51 Rp 28,053
51 Eye protector bayi Pcs Rp 42,550.00 Rp 55,315
52 Feeding tube 3,5 R Pcs Rp 12,273.03 Rp 15,955
53 Feeding tube No. 5 R 100 cm Pcs Rp 14,077.14 Rp 18,300
54 Feeding tube No.8 Pcs Rp 12,099.40 Rp 15,729
55 Feeding tube No.8 100 cm Pcs Rp 14,077.14 Rp 18,300
56 Fm Crepe 10 cm Roll Rp 48,800.00 Rp 63,440
57 Fm crepe 15 cm Roll Rp 57,319.99 Rp 74,516
58 Filapeau 5/0 Pcs Rp 47,948.67 Rp 62,333
59 Filapeau 4/0 Pcs Rp 44,841.34 Rp 58,294
60 Filapeau 2/0 Pcs Rp 38,000.00 Rp 49,400
61 Folley cateter no. 6 Pcs Rp 16,610.03 Rp 21,593
62 Folley cateter no. 8 Pcs Rp 16,610.03 Rp 21,593
63 Folley cateter no. 8 silicon 30 ml Pcs Rp 16,447.64 Rp 21,382
64 Folley cateter no. 10 Pcs Rp 16,610.03 Rp 21,593
65 Folley cateter no. 12 Pcs Rp 12,489.72 Rp 16,237
66 Folley cateter no. 14 Pcs Rp 12,489.72 Rp 16,237
67 Folley cateter 16 Pcs Rp 12,489.72 Rp 16,237
68 Folley cateter 18 Pcs Rp 12,489.72 Rp 16,237
69 Folley cateter 18 Silicon 30 ml Pcs Rp 17,325.00 Rp 22,523
70 Folley cateter 20 FR Pcs Rp 17,325.00 Rp 22,523
71 Folley cateter 22 FR Pcs Rp 12,489.72 Rp 16,237
72 Folley cateter 24 FR Pcs Rp 12,489.72 Rp 16,237
73 Folley cateter 18 3 way Pcs Rp 32,670.00 Rp 42,471
74 Folley cateter 20 3 way Pcs Rp 39,930.00 Rp 51,909
75 Folley cateter 22 3 way Pcs Rp 32,670.00 Rp 42,471
76 Folley cateter 24 3 way Pcs Rp 32,890.00 Rp 42,757
77 Fuji Film 26 x 36 (Dry Film) Pcs Rp 39,220.00 Rp 50,986
78 Guedel airway 90 MM Kuning Pcs Rp 19,374.00 Rp 25,186
79 Guedel airway 80 MM (2) Hijau Pcs Rp 19,374.00 Rp 25,186
80 Guedel airway 70 MM (1) Putih Pcs Rp 37,290.00 Rp 48,477
81 Guedel airway 60 MM (0) Hitam Pcs Rp 19,374.00 Rp 25,186
82 Guedel airway 50 MM (00) Biru Pcs Rp 14,000.00 Rp 18,200
83 Guedel airway 40 MM (000) Pink Pcs Rp 20,999.99 Rp 27,300
84 H2O2 3% 100 ml Botol Rp 16,650.00 Rp 21,645
85 H2O2 3% 800 ml Botol Rp 33,033.00 Rp 42,943
86 H2O2 5% Botol Rp 40,404.00 Rp 52,525
87 Handrub Baymed 0,5% Botol Rp 37,152.63 Rp 48,298
88 Handwash 500 ml (Baymed 4%) Botol Rp 42,483.83 Rp 55,229
89 Handscoon gynecolog 6,5 Pairs Rp 37,504.20 Rp 48,755
90 Handscoon gynecolog size M Pairs Rp 37,504.20 Rp 48,755
91 Handscoon steril no. 6,0 Pairs Rp 13,562.73 Rp 17,632
92 Handscoon steril no. 6,5 Pairs Rp 13,686.02 Rp 17,792
93 Handscoon steril no. 7,5 Pairs Rp 13,686.00 Rp 17,792
94 Handscoon steril no. 7.0 Pairs Rp 13,562.73 Rp 17,632
95 Handscoon steril no. 8,0 Pairs Rp 13,177.56 Rp 17,131
96 Handscoon non steril size S Pcs Rp 1,252.08 Rp 1,628
97 Handscoon non steril size M Pcs Rp 1,252.08 Rp 1,628
98 Handscoon non steril size L Pcs Rp 1,252.08 Rp 1,628
99 Hazmat (Full body) Pcs Rp 436,975.00 Rp 568,068
100 Hazmat Coverall Pcs Rp 102,500.00 Rp 133,250
101 Id bracelet dewasa biru Pcs Rp 1,452.00 Rp 1,888
102 Id bracelet dewasa PINK Pcs Rp 933.51 Rp 1,214
103 Id bracelet for child blue Pcs Rp 933.51 Rp 1,214
104 Id bracelet for child pink Pcs Rp 933.51 Rp 1,214
105 Infus set micro Pcs Rp 7,150.00 Rp 9,295
106 Infus set makro y set Pcs Rp 8,596.00 Rp 11,175
107 IV. Canula 16 G (Abbocath 16) Pcs Rp 6,674.32 Rp 8,677
108 IV. Canula 18 G (Abbocath 18) Pcs Rp 6,152.84 Rp 7,999
109 IV. Canula 20 (Abbocath 20) Pcs Rp 7,215.00 Rp 9,380
110 IV. Canula 22 (Abbocath 22) Pcs Rp 6,152.84 Rp 7,999
111 IV. Cateter 24 (Abbocath 24) Pcs Rp 6,152.84 Rp 7,999
112 IV. Canula 26 (Abbocath 26) Pcs Rp 15,537.80 Rp 20,199
113 Jackson rees pedriatic Pcs Rp 283,375.00 Rp 368,387
114 Jackson rees dewasa Pcs Rp 270,249.59 Rp 351,324
115 Kantong Jenazah Pcs Rp 217,250.00 Rp 282,425
116 Kapas pembalut 250 gr Roll Rp 16,697.95 Rp 21,707
117 Kapsul kosong no. 00 Pcs Rp 133.20 Rp 173
118 Kapsul kosong no. 0 Pcs Rp 99.90 Rp 130
119 Kapsul kosong no. 1 Pcs Rp 99.90 Rp 130
120 Kapsul kosong no. 2 Pcs Rp 99.90 Rp 130
121 Kasa hydrofil 40 x 80 cm Roll Rp 16,613.52 Rp 21,598
122 Kasa steril OM 16 x 16 Pcs Rp 574.98 Rp 747
123 Kertas EKG 80 x 30 Roll Rp 162,423.10 Rp 211,150
124 Kertas perkamen Pack Rp 14,430.00 Rp 18,759
125 Kertas Puyer press Pcs Rp 1,789.33 Rp 2,326
126 Klorsept 25 Pcs Rp 1,789.33 Rp 2,326
127 Leukoplas 1625 (besar) Roll Rp 82,500.00 Rp 107,250
128 Leukoplas/ plester 1 x 5 (Kecil) Roll Rp 12,675.00 Rp 16,478
129 Mask Anastesi size 1 Pcs Rp 48,750.98 Rp 63,376
130 Mask Anastesi size 2 Pcs Rp 48,750.98 Rp 63,376
131 Mask Anastesi size 4 Pcs Rp 48,750.98 Rp 63,376
132 Masker Anastesi 5 Pcs Rp 48,750.39 Rp 63,376
133 Masker Anastesi 6 Pcs Rp 48,750.39 Rp 63,376
134 Masker kerudung Pcs Rp 2,860.00 Rp 3,718
135 Masker N95 Pcs Rp 21,175.00 Rp 27,528
136 Masker KN95 Pcs Rp 9,035.00 Rp 11,746
137 Microfline/Pen Needle 31Gx55M Pcs Rp 1,695.00 Rp 2,204
138 Mitela Ukuran S (Arm Sling S) Pcs Rp 21,275.00 Rp 27,658
139 Mitela Ukuran M (Arm Sling M) Pcs Rp 21,275.00 Rp 27,658
140 Mitela Ukuran L (Arm Sling L) Pcs Rp 21,275.00 Rp 27,658
141 My Jelly Tube Rp 35,520.00 Rp 46,176
142 Nasal canula neonatus Pcs Rp 9,750.24 Rp 12,675
143 Nasal canula bayi Pcs Rp 9,250.00 Rp 12,025
144 Nasal canula dewasa Pcs Rp 9,657.00 Rp 12,554
145 Nasal Canula Anak Pcs Rp 9,657.00 Rp 12,554
146 Needle Spinocain 27 Pcs Rp 66,000.00 Rp 85,800
147 No Pain spray Botol Rp 96,570.00 Rp 125,541
148 Nurse cup Pcs Rp 781.68 Rp 1,016
149 Object glass Pcs Rp 281.18 Rp 366
150 Optime 1 Pcs Rp 75,744.31 Rp 98,468
151 Optime 2 Pcs Rp 95,399.12 Rp 124,019
152 Optime 2/0 Pcs Rp 74,026.33 Rp 96,234
153 Optime 3/0 Pcs Rp 75,023.03 Rp 97,530
154 Oxygen Mask adult elognated Pcs Rp 11,404.00 Rp 14,825
155 Oxygen Mask pedriatik Pcs Rp 27,500.00 Rp 35,750
156 Oxygen Mask S (Infant) Pcs Rp 16,899.75 Rp 21,970
157 Oxygen mask nebulizer size M Pcs Rp 22,390.50 Rp 29,108
158 Oxygen mask Nebulizer size L Pcs Rp 31,900.00 Rp 41,470
159 Oxygen mask nebulizer bayi Pcs Rp 26,000.00 Rp 33,800

160 Oxygen mask nebulizer size S (infant) Pcs Rp 26,000.00 Rp 33,800

161 Oxygen mask Non rebreathing dewasa Pcs Rp 20,800.00 Rp 27,040

162 Oxygen mask Non rebreathing child Pcs Rp 25,098.92 Rp 32,629

163 Oxygen mask Non rebreathing Bayi Pcs Rp 20,800.00 Rp 27,040

Oxygen mask Non rebreathing S Pcs
164
(Infant) Rp 21,702.32 Rp 28,213
165 Paper X ray pcs Rp 8,325.00 Rp 10,823
166 Papsmear Kit Size S Kit Rp 22,264.00 Rp 28,943
167 Papsmear Kit Size M Kit Rp 22,264.00 Rp 28,943
168 Perfusor 150 mg (Extension) Pcs Rp 17,708.06 Rp 23,020
169 Perfusor Pcs Rp 41,677.17 Rp 54,180
170 Plastik seal secutity lock Pcs Rp 11,743.80 Rp 15,267
171 Poliban 10 cm x 2,7 mm Roll Rp 16,539.99 Rp 21,502
172 Poliban 15 cm x 2,7 mm Roll Rp 21,899.99 Rp 28,470
173 Polifix 10 x 5 cm Roll Rp 82,966.55 Rp 107,857
174 Poligyp 10 cm x 2,7 mm Roll Rp 23,540.00 Rp 30,602
175 Poligyp 15 cm x 2,7 mm Roll Rp 31,059.99 Rp 40,378
176 Polypropylene 5/0 Pcs Rp 53,629.65 Rp 69,719
177 Polypropylene 4/0 Pcs Rp 53,629.65 Rp 69,719
178 Polypropylene 3/0 Pcs Rp 53,629.65 Rp 69,719
179 Polypropylene 2/0 Pcs Rp 53,629.65 Rp 69,719
180 Polypropylene 1 HR Pcs Rp 53,629.65 Rp 69,719
181 Postofix - PU 10x25 Pcs Rp 29,377.14 Rp 38,190
182 Postofix - PU 10x15 Pcs Rp 16,650.00 Rp 21,645
183 Postofix - PU 10x10 Pcs Rp 13,320.00 Rp 17,316
184 Povidone iodine 10% 1 L Botol Rp 80,811.76 Rp 105,055
185 Povidone iodine 300 ml Botol Rp 30,636.00 Rp 39,827
186 Prontosan sol Botol Rp 96,505.33 Rp 125,457
187 Redax Drentech compact Pcs Rp 787,905.00 Rp 1,024,277
188 Safety Box 5 L Pcs Rp 12,652.49 Rp 16,448
189 Scanlux Botol Rp 201,354.00 Rp 261,760
190 Silk 2-0 Apex Pcs Rp 49,610.00 Rp 64,493
191 Silk 2/0 Remedi Pcs Rp 5,375.00 Rp 6,987
192 Silk Black 1 Pcs Rp 17,325.89 Rp 22,524
193 Silk 1 HRG Pcs Rp 47,301.56 Rp 61,492
194 Silk 2 HRG Pcs Rp 47,193.87 Rp 61,352
195 Silk 2/0 HR Pcs Rp 38,935.47 Rp 50,616
196 Silk 3-0 Apex Pcs Rp 53,240.00 Rp 69,212
197 Silk 3-0 Pcs Rp 7,400.00 Rp 9,620
198 Silk 0 Pcs Rp 39,817.47 Rp 51,763
199 Spinocain 25 Pcs Rp 32,617.00 Rp 42,402
200 Spinocain 26 Pcs Rp 32,617.00 Rp 42,402
201 Spoit 50 cc (cateter tip hijau) Pcs Rp 11,817.86 Rp 15,363
202 Spoit 50 cc Pcs Rp 6,930.88 Rp 9,010
203 Spoit 50 cc (Iuer Slip) Pcs Rp 6,795.82 Rp 8,835
204 Spoit 20 cc (Lubang samping) Pcs Rp 1,183.65 Rp 1,539
205 Spoit 10 cc Pcs Rp 1,639.30 Rp 2,131
206 Spoit 5 cc Pcs Rp 1,430.00 Rp 1,859
207 Spoit 3 cc Pcs Rp 1,095.92 Rp 1,425
208 Spoit 1 cc Pcs Rp 1,447.98 Rp 1,882
209 Stomach Tube (Maag slang) 12 Pcs Rp 12,542.64 Rp 16,305
210 Stomatch tube (Maag slang) 14 Pcs Rp 12,542.64 Rp 16,305
211 Stomatch tube (Maag slang) 16 Pcs Rp 12,542.64 Rp 16,305
212 Stomach Tube (Maag Slang) 18 Pcs Rp 12,542.64 Rp 16,305
213 Suction cateter no. 6 Pcs Rp 3,711.99 Rp 4,826
214 Suction cateter FG 8 Pcs Rp 4,764.12 Rp 6,193
215 Suction cateter FG 10 Pcs Rp 8,880.00 Rp 11,544
216 Suction cateter FG 12 Pcs Rp 8,880.00 Rp 11,544
217 Suction cateter no. 14 Pcs Rp 4,996.75 Rp 6,496
218 Suction cateter no. 16 Pcs Rp 8,880.00 Rp 11,544
219 Suction cateter no. 18 Pcs Rp 4,996.83 Rp 6,496
220 Suction conecting tube Pcs Rp 34,840.00 Rp 45,292
221 T-chromic cat gut 1 Pcs Rp 69,375.00 Rp 90,188
222 T-chromic cat gut 2 Pcs Rp 69,375.00 Rp 90,188
223 T-chromic cat gut 2-0 Pcs Rp 63,603.00 Rp 82,684
224 T-chromic cat gut 3-0 Pcs Rp 58,275.00 Rp 75,758
225 T-chromic cat gut 4-0 Pcs Rp 66,600.00 Rp 86,580
226 Three way stop cock Pcs Rp 9,838.40 Rp 12,790
227 T- Hemocel 5 x 7,5 cm Pcs Rp 75,177.27 Rp 97,730
228 T-Hernia Mesh 6 x10 cm Pcs Rp 151,140.00 Rp 196,482
229 T-Hernia Mesh 5 x 7,5 cm Pcs Rp 101,454.00 Rp 131,890
230 T-Lene 2-0 Pcs Rp 81,141.00 Rp 105,483
231 T-Lene 3-0 Pcs Rp 80,919.00 Rp 105,195
232 T-Lene 4-0 Pcs Rp 77,145.00 Rp 100,289
233 T-Lene 5-0 Pcs Rp 77,145.00 Rp 100,289
234 T-Nylon 5-0 Pcs Rp 50,838.00 Rp 66,089
235 Transfusi set (Blood Transfusi set) Pcs Rp 12,544.96 Rp 16,308
236 Transofix Pcs Rp 4,643.13 Rp 6,036
237 T-Silk 1 Pcs Rp 55,389.00 Rp 72,006
238 T-Silk 2-0 Pcs Rp 40,737.00 Rp 52,958
239 T-Silk 3-0 Pcs Rp 43,512.00 Rp 56,566
240 T-Silk 3-0 Pcs Rp 45,621.00 Rp 59,307
241 Torniquet Pcs Rp 22,850.96 Rp 29,706
242 Trocar Thoracic cateter tube No. 22 Pcs Rp 217,905.00 Rp 283,277
243 Tvio 1 Pcs Rp 86,691.00 Rp 112,698
244 T-Vio 2 Pcs Rp 99,990.00 Rp 129,987
245 T-Vio 2-0 Pcs Rp 80,142.00 Rp 104,185
246 T-vio 3-0 Pcs Rp 77,478.00 Rp 100,721
247 T-vio 4-0 Pcs Rp 83,472.00 Rp 108,514
248 Umbilical cold (Penjepit Tali Pusat) Pcs Rp 1,306.95 Rp 1,699
249 Upad 60x90 pcs Rp 4,084.80 Rp 5,310
250 Urine bag Pcs Rp 6,309.24 Rp 8,202
251 Urogard Pcs Rp 131,257.50 Rp 170,635
252 Urobag Pcs Rp 6,072.00 Rp 7,894
253 USG Jelly 250 ml Botol Rp 16,631.91 Rp 21,621
254 USG Jelly 5 L Botol Rp 185,999.37 Rp 241,799
255 USG Paper Sony Roll Rp 288,000.00 Rp 374,400
256 Xpresif 10x5 Roll Rp 44,400.00 Rp 57,720
MATA
1 Appalens plus 18,0 Pcs Rp 194,250.00 Rp 252,525
2 Appalens plus 18,5 Pcs Rp 194,250.00 Rp 252,525
3 Appalens plus 19.0 Pcs Rp 194,250.00 Rp 252,525
4 Appalens plus 19.5 Pcs Rp 194,250.00 Rp 252,525
5 Appalens plus 20.0 Pcs Rp 194,250.00 Rp 252,525
6 Appalens plus 20.5 Pcs Rp 194,250.00 Rp 252,525
7 Appalens plus 21.0 Pcs Rp 194,250.00 Rp 252,525
8 Appalens plus 21.5 Pcs Rp 194,250.00 Rp 252,525
9 Appalens plus 22.0 Pcs Rp 194,250.00 Rp 252,525
10 Appalens plus 22.5 Pcs Rp 194,250.00 Rp 252,525
11 Appalens plus 23.0 Pcs Rp 194,250.00 Rp 252,525
12 Appasamy cohesisc 1,8% Pcs Rp 421,800.00 Rp 548,340
13 Appasamy appavisc 3 ml (Visco) Pcs Rp 122,100.00 Rp 158,730
14 Mani opthalmic 27 Keratone Pcs Rp 290,820.00 Rp 378,066
15 Mani opthalmic 26 cresene Pcs Rp 290,820.00 Rp 378,066
16 Mata pisau B Braun 15 Pcs Rp 8,103.00 Rp 10,534
17 Miochol/ Carbacol Pcs Rp 66,600.00 Rp 86,580
18 Needle Terumo 27 Pcs Rp 1,853.70 Rp 2,410
19 Nylon 10/0 Pcs Rp 170,765.00 Rp 221,995
20 Rhed-ID/ Trypan Blue Pcs Rp 66,600.00 Rp 86,580
21 SP PGA 8/0 Pcs Rp 182,650.00 Rp 237,445

Palopo, Januari 2022

Kepala Instalasi Farmasi

RSUD dr. Palemmai Tandi

Syuriani, S.Si., Apt.

Nip. 19830605 200903 2 003
 PEMERINTAH KOTA PALOPO
RSUD dr. PALEMMAI TANDI
Jl. Samiun No. 2, Telp. 0853-4577-4072
PALOPO

DAFTAR HARGA OBAT & BMHP

MARET 2023

NO URAIAN SATUAN HARGA SATUAN KET

1 OBAT FAKTUR JUAL

1 Acetylcystein 200 mg Kapsul Rp 777.00 Rp 1,010
2 Acetylcystein 200 mg infus Botol Rp 183,338.70 Rp 238,340
3 Acyclovir 400 mg Tablet Rp 889.13 Rp 1,156
4 Acyclovir crem 5% Tube Rp 4,768.23 Rp 6,199
5 Adalat Oros 30 mg Tablet Rp 3,986.00 Rp 5,182
7 Albunorm 25% 100 ml Botol Rp 1,746,585.00 Rp 2,270,561 retriksi 3 btl/minggu
8 Allopurinol 100 mg Tablet Rp 270.00 Rp 351
9 Allopurinol 300 mg Tablet Rp 357.50 Rp 465
10 Alprazolam 0,5 mg Tablet Rp 78.00 Rp 101
11 Alprazolam 1 mg Tablet Rp 544.50 Rp 708
12 Amoxan paed drop Botol Rp 25,530.00 Rp 33,189 Umum
13 Amoxicillin 125 mg dry syrup Botol Rp 2,600.00 Rp 3,380
14 Amoxicillin 250 mg dry syrup Botol Rp 3,510.00 Rp 4,563
15 Amoxicillin 500 mg Tablet Rp 518.00 Rp 673
16 Amoxicillin 500 mg Tablet Rp 656.02 Rp 853
17 Ambroxol elixir Botol Rp 2,966.81 Rp 3,857
18 Ambroxol 30 mg Tablet Rp 200.00 Rp 260
19 Amikacin 250 mg Injeksi Vial Rp 17,050.00 Rp 22,165
20 Amiodaron Ampul Rp 6,504.60 Rp 8,456
21 Amlodipin 10 mg Tablet Rp 520.00 Rp 676
22 Amlodipin 5 mg Tablet Rp 422.40 Rp 549
23 Amlodipin 5 mg Tablet Rp 852.00 Rp 1,108
24 Aminoleban 500 Bag Rp 72,800.02 Rp 94,640
25 Aminophylline injeksi Ampul Rp 22,200.00 Rp 28,860
26 Amiparen 500 Bag Rp 96,000.00 Rp 124,800
27 Amitriptillin 25 mg Tablet Rp 233.10 Rp 303
28 Ampicillin 1 gr Vial Rp 10,050.00 Rp 13,065
29 Analsik Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
30 Antasida doen Tablet Rp 54.00 Rp 70
31 Antasida suspensi Botol Rp 3,436.18 Rp 4,467
32 Apidra solostar Flexpen Rp 90,313.59 Rp 117,408
33 Arkine 2 mg Tablet Rp 606.06 Rp 788
34 Asam ascorbid acid 200 mg/2 ml Injeksi Rp 4,975.00 Rp 6,468
35 Asam mefenamat 500 mg Tablet Rp 210.00 Rp 273
36 Asam folat 400 mg Tablet Rp 45.00 Rp 59
37 Asam folat 1 g Tablet Rp 61.00 Rp 79
38 Asam tranexamat 500 mg Tablet Rp 1,700.00 Rp 2,210
39 Asam tranexamat 250 mg /5 ml injeksi Ampul Rp 2,002.00 Rp 2,603
40 Asam tranexamat 500 mg/ml Ampul Rp 2,425.00 Rp 3,152
41 Asam valproat 250 mg/mlsyrup Botol Rp 12,752.00 Rp 16,578
42 Asering Botol Rp 8,750.13 Rp 11,375
43 Atracurium 50 mg/5 ml Ampul Rp 38,850.00 Rp 50,505
44 Atracurium 25 mg/5 ml Ampul Rp 9,877.89 Rp 12,841
45 Atorvastatin calcium 20 mg Tablet Rp 471.00 Rp 612
46 Atorvastatin calcium 20 mg Tablet Rp 575.00 Rp 747
47 Atropin sulfat Injeksi Ampul Rp 3,778.02 Rp 4,911
48 Aqua pro injeksi 25 ml Botol Rp 2,954.82 Rp 3,841
49 Aqua pro injeksi 1 L Botol Rp 35,614.35 Rp 46,299
50 Azitromycin 500 mg Tablet Rp 1,892.99 Rp 2,461
51 Bamgetol 200 mg Tablet Rp 2,172.27 Rp 2,824
52 Baquinor 0,3% ED Botol Rp 37,573.60 Rp 48,846
53 Beneuron Tablet Rp 832.50 Rp 1,082 Retriksi 7 Tablet
54 Benoson N crem Tube Rp 18,499.80 Rp 24,050 Umum
55 Benutrion VE Botol Rp 62,658.40 Rp 81,456
56 Betahistin 6 mg Tablet Rp 92.00 Rp 120
57 Betahistin HCl 24 mg Tablet Rp 4,989.75 Rp 6,487
58 Betametason crem Tube Rp 1,534.02 Rp 1,994
59 Berotec 0,1 mg Botol Rp 87,721.07 Rp 114,037
60 Bfluid 500 ml Softbag Rp 77,063.00 Rp 100,182
Bfluid 500 ml Softbag Rp 97,899.78 Rp 127,270
61 Bio TT Ampul Rp 60,500.00 Rp 78,650
62 Biovitan syrup Botol Rp 4,116.77 Rp 5,352
63 Bisoprolol 2,5 mg Tablet Rp 149.00 Rp 194
64 Bisoprolol 5 mg Tablet Rp 264.00 Rp 343
66 Brilinta 90 mg Tablet Rp 8,480.40 Rp 11,025 Retriksi 6 tablet
67 Calcium Lactat 500 mg Tablet Rp 117.00 Rp 152
68 Calcium gluconas 10 ml Ampul Rp 1,501.20 Rp 1,952
69 Candesartan 8 mg Tablet Rp 315.00 Rp 409
70 Candesartan 16 mg Tablet Rp 1,836.05 Rp 2,387
71 Candesartan 16 mg Tablet Rp 495.00 Rp 644
72 Captopril 12,5 mg Tablet Rp 95.46 Rp 124
73 Captopril 25 mg Tablet Rp 137.75 Rp 179
74 Captopril 50 mg Tablet Rp 234.48 Rp 305
75 Carbazocrome Ampul Rp 10,584.96 Rp 13,760
76 Carmed 10% crem Tube Rp 36,083.33 Rp 46,908
77 Carmed 20% crem Tube Rp 45,715.30 Rp 59,430
78 Cepezet 100 mg Tablet Rp 1,110.00 Rp 1,443
79 Cephaflox 1 gr Vial Rp 198,135.00 Rp 257,576 Umum/ Jasarahrja
80 Cetrizine syrup Botol Rp 3,977.80 Rp 5,171
81 Cetrizine 10 mg Tablet Rp 206.00 Rp 268
82 Cefadroxil 500 mg Kapsul Rp 800.00 Rp 1,040
83 Cefadroxil 500 mg Kapsul Rp 1,002.07 Rp 1,303
84 Cefadroxil syrup 125 mg Botol Rp 3,890.00 Rp 5,057
85 Cefadroxil syrup 250 mg Botol Rp 12,375.00 Rp 16,088
86 Cefoperazone Vial Rp 53,280.00 Rp 69,264
87 Cefoperazone 1 gr Vial Rp 17,750.00 Rp 23,075
88 Ceftazidime 1 gr Vial Rp 11,825.00 Rp 15,372
89 Cefixime 100 mg/5 ml Botol Rp 5,242.00 Rp 6,815
90 Cefixime 100 mg Kapsul Rp 463.00 Rp 602
91 Cefixime 100 mg Kapsul Rp 999.98 Rp 1,300
92 Cefixime 200 mg Kaplet Rp 1,705.00 Rp 2,216
93 Cefotaxime 1 gr Vial Rp 6,700.00 Rp 8,710
94 Ceftriaxon 1 gr Vial Rp 6,400.00 Rp 8,320
95 Cefuroxime 1 gr Vial Rp 57,200.00 Rp 74,360
96 Cendo Astenof 0,6 ml Botol Rp 4,551.00 Rp 5,916
97 Cendo catarlent 0,6 ml Botol Rp 4,440.00 Rp 5,772
98 Cendo conver 2% 0,6 ml MD Botol Rp 3,579.75 Rp 4,654
99 Cendo Efrisel 10% Botol Rp 16,927.35 Rp 22,006
100 Cendo LFX 0,6 ml Botol Rp 15,318.00 Rp 19,913
101 Cendo Lyteers ED Botol Rp 24,975.00 Rp 32,468
102 Cendo Hyalub ED Botol Rp 59,107.50 Rp 76,840
103 Cendo Hyalub 0,6 ml MD Botol Rp 12,654.00 Rp 16,450
104 Cendo Midriatil 0,5% Botol Rp 5,855.25 Rp 7,612
105 Cendo Midriatil 1 % ED Botol Rp 42,457.50 Rp 55,195
106 Cendo Natacen 0,6 ml Botol Rp 9,240.75 Rp 12,013
107 Cendo P. Pred Botol Rp 8,491.50 Rp 11,039
108 Cendo Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
109 Cendo protagenta 0,6 ml MD Botol Rp 7,964.25 Rp 10,354
110 Cendo Timol 0,5% 0,6 ml MD Botol Rp 5,716.50 Rp 7,431
111 Cendo Tobroson 0,6 ml Botol Rp 6,438.00 Rp 8,369
112 Cendo xytrol 5 ml Botol Rp 30,247.50 Rp 39,322
113 Cilostazol 100 mg Tablet Rp 6,792.50 Rp 8,830
115 Ciprofloxacin Infus Botol Rp 8,100.00 Rp 10,530
116 Ciprofloxacin 500 mg Tablet Rp 539.98 Rp 702
117 Ciprofloxacin 500 mg Tablet Rp 475.01 Rp 618
118 Citicholin 250 mg/2 ml Ampul Rp 22,275.00 Rp 28,958
119 Citicholin 500 mg/4 ml Ampul Rp 24,420.00 Rp 31,746
120 Citicolin 500 mg Tablet Rp 4,440.00 Rp 5,772
121 Chloroquin 150 mg Tablet Rp 1,505.74 Rp 1,957
122 Chlorpheniramine Maleat (CTM) Tablet Rp 62.99 Rp 82
123 Clindamycin 300 mg Kapsul Rp 1,334.78 Rp 1,735
124 Clindamycin 150 mg Kapsul Rp 921.30 Rp 1,198
125 Clobazam 10 mg Tablet Rp 384.00 Rp 499
126 Clonidine 0,15 mg Tablet Rp 146.00 Rp 190
127 Clopidogrel 75 mg Tablet Rp 580.23 Rp 754
128 Clozapine 25 mg Tablet Rp 477.00 Rp 620
129 Codein 10 mg Tablet Rp 610.50 Rp 794
130 Colchicine 0,5 Tablet Rp 671.00 Rp 872
131 Colchicine 0,5 Tablet Rp 1,665.00 Rp 2,165
132 Colistine 0,25 MIU Tablet Rp 2,553.00 Rp 3,319
133 Cotrimoxasole suspensi Botol Rp 5,954.30 Rp 7,741
134 Cotrimoxazole 480 mg Tablet Rp 253.97 Rp 330
135 Curcuma Force Tablet Rp 876.15 Rp 1,139
136 Curcuma 20 mg Tablet Rp 482.02 Rp 627
137 Daily C 500 mg Tablet Rp 577.50 Rp 751
138 DC2 Tablet Rp 8,116.88 Rp 10,552 Retriksi 3 tablet
139 Depakote 250 mg Kaplet Rp 8,880.00 Rp 11,544
140 Desolex crem 10 gr Tube Rp 25,080.00 Rp 32,604 Umum
141 Dexamethason 5 mg/ml Ampul Rp 1,427.39 Rp 1,856
142 Dexamethason 0,5 mg Tablet Rp 132.09 Rp 172
Dexketoprofen 50 mg/2 ml Ampul Rp 24,531.00 Rp 31,890
Dexketoprofen 25 mg Tablet Rp 3,302.00 Rp 4,293 Retriksi 6 tablet
145 Dexosimethason 0,25 mg crem 10 g Tube Rp 9,079.80 Rp 11,804

146 Dexosimethason 0,25 mg crem 15 g Tube Rp 13,800.00 Rp 17,940

147 Dextrose 10% Botol Rp 7,200.30 Rp 9,360
148 Dextrose 10% Botol Rp 8,350.53 Rp 10,856
149 Dextrose 5% Botol Rp 6,626.70 Rp 8,615
150 Dextrose 5% Botol Rp 7,685.64 Rp 9,991
D5 1/2 NS Botol Rp 10,280.00 Rp 13,364
D5 1/4 NS Botol Rp 10,280.00 Rp 13,364
151 Dextrose 5% 100 ml piggy bag Botol Rp 13,786.20 Rp 17,922
152 Dextrose 40% Botol Rp 7,770.00 Rp 10,101
153 Diazepam 2 mg Tablet Rp 70.00 Rp 91
154 Diazepam 5 mg/ml inj. Ampul Rp 1,559.00 Rp 2,027
155 Diazepam 5 mg rectal Rectube Rp 13,546.00 Rp 17,610
156 Diazepam 10 mg rectal Rectube Rp 19,693.00 Rp 25,601
157 Dibekacin 100 mg Ampul Rp 79,920.00 Rp 103,896
158 Digoxin 0,25 mg Tablet Rp 114.40 Rp 149
159 Diltiazem Tablet Rp 1,665.00 Rp 2,165
160 Dimenhidrinat 50 mg Tablet Rp 109.99 Rp 143
161 Dipenhidramin 15 mg/15 ml Ampul Rp 5,390.00 Rp 7,007
162 Divalproex sodium 250 mg Kaplet Rp 2,310.00 Rp 3,003
163 Divalproex sodium 500 mg Kaplet Rp 1,505.00 Rp 1,957
164 Dobutamin 250 mg/5 ml Ampul Rp 30,885.75 Rp 40,151
165 Dobutamin 50 mg Ampul Rp 9,004.00 Rp 11,705
166 Dolgesic Injeksi Ampul Rp 11,988.00 Rp 15,584
167 Domavit Softcap Rp 2,741.70 Rp 3,564 Retriksi 7 Tablet
168 Domperidon 10 mg Tablet Rp 155.01 Rp 202
169 Domperidone syrup Botol Rp 4,437.28 Rp 5,768
170 Donepezil Tablet Rp 1,680.00 Rp 2,184
171 Dopamet (methyldopa) Tablet Rp 1,023.00 Rp 1,330
172 Dopamin 200 mg/5 ml Ampul Rp 3,945.00 Rp 5,129
173 Dorium Kaplet Rp 4,884.00 Rp 6,349 Retriksi 6 tablet
174 Doxycycline 100 mg Kapsul Rp 281.69 Rp 366
175 Dulcolax 5 mg tablet Tablet Rp 1,586.85 Rp 2,063
176 Dulcolax 5 mg Suppo Rp 5,084.90 Rp 6,610
177 Dulcolax 10 mg Suppo Rp 4,325.00 Rp 5,623
178 Duloxta 60 Tablet Rp 14,499.38 Rp 18,849 Retriksi 6 tablet
179 Durogesic 12,5 MU Patch Rp 63,775.05 Rp 82,908
180 Eperison HCl 50 mg Tablet Rp 1,170.13 Rp 1,521
181 Ephedrine injeksi Ampul Rp 6,485.95 Rp 8,432
182 Ephineprine injeksi Ampul Rp 2,904.00 Rp 3,775
183 Erdostein 300 mg Kapsul Rp 2,594.63 Rp 3,373
184 Ericaf Tablet Rp 3,330.00 Rp 4,329
185 Erytromicin suspensi Botol Rp 12,210.00 Rp 15,873
186 Euthyrox 50 mg Tablet Rp 728.56 Rp 947
187 Etoricoxib 60 mg Tablet Rp 4,440.00 Rp 5,772 Retriksi 6 tablet
188 Euthyrox 100 mg Tablet Rp 3,828.00 Rp 4,976
189 Farbion Injeksi Ampul Rp 11,000.00 Rp 14,300
190 Farbivent 2,5 ml Ampul Rp 3,951.60 Rp 5,137
191 Fargoxin 2 ml njeksi Ampul Rp 49,500.00 Rp 64,350
192 Fasorbid 10 mg Tablet Rp 300.30 Rp 390
193 Fentanyl citrate Inj 2 ml Ampul Rp 29,500.47 Rp 38,351
194 Fladystine ovula Suppo Rp 15,484.50 Rp 20,130
195 Flunarizine 5 mg Tablet Rp 1,200.00 Rp 1,560
196 Forumen tetes telinga Botol Rp 29,082.00 Rp 37,807
197 Fosen Enema Botol Rp 94,905.00 Rp 123,377
198 Furosemid injeksi Ampul Rp 969.00 Rp 1,260
199 Furosemid 40 mg Tablet Rp 144.79 Rp 188
200 Gabapentine 300 mg Kapsul Rp 1,000.00 Rp 1,300
201 Gabapentine 100 mg Kapsul Rp 1,110.00 Rp 1,443
202 Gabatin 300 mg Kapsul Rp 9,990.00 Rp 12,987 Umum
203 Gabaxa Botol Rp 247,227.00 Rp 321,395
204 Gelafusal infusion 500 ml Bag Rp 145,015.00 Rp 188,520
205 Genoint tetes mata Botol Rp 13,320.00 Rp 17,316
206 Gentamicin salep kulit Tube Rp 2,963.70 Rp 3,853
207 Gentamicin 0,3% 5 gram Tube Rp 40,376.25 Rp 52,489
208 Gentamicin 40 mg/ml injeksi Ampul Rp 3,385.50 Rp 4,401
209 Glauseta Tablet Rp 2,876.00 Rp 3,739
210 Glauseta Tablet Rp 3,355.42 Rp 4,362 Retriksi 6 tablet
211 Glibenclamid 5 mg Tablet Rp 333.00 Rp 433
212 Gliclazide 80 mg Tablet Rp 214.00 Rp 278
213 Glimepirid 2 mg Tablet Rp 220.00 Rp 286
214 Glimepirid 4 mg Tablet Rp 2,032.70 Rp 2,643
215 Granisetron 1 mg Ampul Rp 22,200.00 Rp 28,860
216 Griseofulvin 125 mg Tablet Rp 500.00 Rp 650
217 Harnal 0,2 Tablet Rp 7,859.99 Rp 10,218
218 Harnal OCAS Tablet Rp 4,356.00 Rp 5,663
219 Heparin sodium Ampul Rp 46,635.00 Rp 60,626
220 Hepatosol Vanila Pcs Rp 36,815.00 Rp 47,860
221 Herbesser CD 200 Tablet Rp 5,196.82 Rp 6,756
222 Hervis 0,35 gr Tablet Rp 40,792.50 Rp 53,030
223 Hexymer 2 mg Tablet Rp 427.35 Rp 556
224 Histapan Tablet Rp 804.75 Rp 1,046 Retriksi 6 tablet
225 Human Albumin 20% Botol Rp 913,227.04 Rp 1,187,195 Retriksi 3 botol/minggu

226 Hydrocortison salep kulit Tube Rp 6,136.00 Rp 7,977

227 Hyosine injeksi Ampul Rp 6,188.05 Rp 8,044
228 Hyson Injeksi Ampul Rp 97,402.43 Rp 126,623 Jasaraharja/Umum
229 Hyoscine butylbromide 10 mg Tablet Rp 1,050.00 Rp 1,365
230 Hystolan 20 mg Tablet Rp 4,995.00 Rp 6,494
231 Ibuprofen 400 mg Tablet Rp 215.00 Rp 280
232 Ibuprofen 200 mg Tablet Rp 155.00 Rp 201
233 Ibuprofen suspensi Botol Rp 9,075.00 Rp 11,798
234 Ifalmin Kapsul Rp 5,500.00 Rp 7,150 Retriksi 3 tablet
235 Imboost Force Kaplet Rp 5,701.90 Rp 7,412 Retriksi 3 tablet
236 Indop (Dopamin) Ampul Rp 19,057.50 Rp 24,775
237 Imitatin 1 gr Vial Rp 170,829.00 Rp 222,078 Jasaraharja/Umum
238 Interlac Sachet Rp 11,072.25 Rp 14,394 Retriksi 4 bungkus
239 Inviclot Vial Rp 65,340.00 Rp 84,942
240 Iremax Tablet Rp 990.68 Rp 1,288 Retriksi 6 tablet
241 Isoflurane 250 ml Botol Rp 827,672.50 Rp 1,075,974
242 Isoniazid 100 mg Tablet Rp 444.00 Rp 577
243 Isoniazid 300 mg Tablet Rp 666.00 Rp 866
244 Isosorbid dinitrate 5 mg Tablet Rp 99.90 Rp 130
245 Isosorbid dinitrate 1 mg/ml Ampul Rp 33,000.00 Rp 42,900
246 Kaen 3B Botol Rp 11,500.00 Rp 14,950
247 Kaen 3B Botol Rp 12,770.55 Rp 16,602
248 Kaen 4B Botol Rp 10,858.02 Rp 14,115
249 Kaen 4B Botol Rp 13,769.55 Rp 17,900
250 Kaen Mg3 Botol Rp 10,560.00 Rp 13,728
251 Kalium diklofenak 50 mg Tablet Rp 333.00 Rp 433
252 KCL 7,46 Botol Rp 3,470.97 Rp 4,512
253 Ketoconazole salep Tube Rp 8,800.00 Rp 11,440
254 Ketoconazole 200 mg Tablet Rp 495.00 Rp 644
255 Ketorolac injeksi Ampul Rp 1,475.00 Rp 1,918
256 Kidmin 200 ml Bag Rp 54,619.77 Rp 71,006
257 Kina Tablet Rp 2,200.00 Rp 2,860
258 KSR 600 mg Tablet Rp 1,842.00 Rp 2,395
259 Kutoin Tablet Rp 1,391.94 Rp 1,810
260 KTM Injeksi Vial Rp 190,920.00 Rp 248,196
261 Lactafit Tablet Rp 2,997.00 Rp 3,896 Umum
262 Lactogen Lactofree Kaleng Rp 101,817.90 Rp 132,363 Umum
263 Lactogen Premature Kaleng Rp 101,909.10 Rp 132,482 Umum
264 Lactulosa syrup Botol Rp 27,472.50 Rp 35,714
265 Lametic syrup Botol Rp 102,300.00 Rp 132,990 Umum
266 Lametic 8 mg/4 ml Ampul Rp 68,200.00 Rp 88,660 Umum
267 Lanabal 500 mcg Kapsul Rp 2,750.00 Rp 3,575 Umum
268 Lanfix 200 Kapsul Rp 37,400.00 Rp 48,620 Umum
269 Lanzoprasole 30 mg Kapsul Rp 278.00 Rp 361
270 Lantus solostar Flexpen Rp 89,808.99 Rp 116,752
271 Laxadine syrup 30 ml Botol Rp 42,900.00 Rp 55,770
272 Laxadine emulsi 60 ml Botol Rp 47,730.00 Rp 62,049
273 Laxalosan syrup Botol Rp 61,050.00 Rp 79,365 Umum
274 L Bio Sachet Rp 8,172.38 Rp 10,624 Retriksi 6/4 bungkus
275 Lesichol 300 Softcap Rp 13,200.00 Rp 17,160 Umum
276 Levetiracetam 500 mg Tablet Rp 4,117.00 Rp 5,352
277 Levopar Tablet Rp 904.00 Rp 1,175
278 Levoben 100 mg Tablet Rp 2,997.00 Rp 3,896
279 Levofloxacin 500 mg Tablet Rp 373.01 Rp 485
280 Levofloxacin Infus Botol Rp 23,100.00 Rp 30,030
281 Levothyroxine 100 mcg Tablet Rp 890.01 Rp 1,157
282 Lidokain 2% Injeksi Ampul Rp 891.00 Rp 1,158
283 Lidokain compositum Ampul Rp 847.00 Rp 1,101
284 Lisinopril 10 mg Tablet Rp 149.00 Rp 194
285 Lodomer 2 mg Tablet Rp 1,212.12 Rp 1,576
286 Loperamid 2 mg Tablet Rp 89.00 Rp 116
287 Loratadine 10 mg Tablet Rp 162.00 Rp 211
288 Lycalvit 60 ml Botol Rp 47,932.50 Rp 62,312 Umum
289 Lycopect Tablet Rp 387.97 Rp 504
290 Maganol Infus Botol Rp 56,610.00 Rp 73,593 Umum
291 Manitol 20% Botol Rp 39,650.28 Rp 51,545
292 Maxiflon 400 mg Tablet Rp 37,296.00 Rp 48,485 Umum/Jasaraharja
293 MgSO4 40% Botol Rp 5,661.00 Rp 7,359
294 Mecobalamin 500 mg Kapsul Rp 577.50 Rp 751
295 Meloxicam 7,5 mg Tablet Rp 319.49 Rp 415
296 Meloxicam 15 mg Tablet Rp 406.09 Rp 528
297 Meprovent Inhalasi Botol Rp 3,502.05 Rp 4,553
298 Meropenem 1 gr Vial Rp 46,810.00 Rp 60,853
299 Mersibion 5000 injeksi Ampul Rp 4,001.55 Rp 5,202
300 Metamizole injeksi Ampul Rp 5,045.45 Rp 6,559
301 Metamizole 500 mg Tablet Rp 333.00 Rp 433
302 Metformin 500 mg Tablet Rp 179.99 Rp 234
303 Methylergometrin 0,125 mg Tablet Rp 261.00 Rp 339
304 Methylergometrin 2 mg inj. Ampul Rp 1,069.00 Rp 1,390
305 Methylprednisolon 125 mg Injeksi Vial Rp 16,873.11 Rp 21,935
306 Methylprednisolon 4 mg Tablet Rp 239.65 Rp 312
307 Methylprednisolon 4 mg Tablet Rp 203.00 Rp 264
308 Methylprednisolon 8 mg Tablet Rp 566.70 Rp 737
309 Metoclopramid 5 mg injeksi Ampul Rp 1,883.00 Rp 2,448
310 Metoclopramid 10 mg Tablet Rp 66.00 Rp 86
311 Metronidazole infus Botol Rp 5,938.50 Rp 7,720
312 Metronidazole 500 mg Tablet Rp 236.00 Rp 307
313 Miconazole 2% Tube Rp 1,916.97 Rp 2,492
314 Midanest 5 mg Ampul Rp 19,980.00 Rp 25,974
315 Miniaspi 80 mg Tablet Rp 89.00 Rp 116
316 Miriwash 500 ml Softbag Rp 109,854.00 Rp 142,810
317 Misoprostol 200 Mcg Tablet Rp 4,717.50 Rp 6,133
318 Mometason Furoate crem Tube Rp 6,025.00 Rp 7,832
319 Morfina 10 mg/ml Ampul Rp 30,272.65 Rp 39,354
320 Moxifloxacin 400 mg Tablet Rp 10,770.00 Rp 14,001
321 Moxifloxacin 400 Infus Botol Rp 47,148.00 Rp 61,292
322 MST Continue 10 mg Tablet Rp 15,762.00 Rp 20,491
323 Mupirocin crem 5 gr Tube Rp 17,482.50 Rp 22,727
324 Myores Tablet Rp 4,870.13 Rp 6,331 Retriksi 6 tablet
325 Natrium Chlorida 0,9% (NaCl) 500 ml Botol Rp 6,963.03 Rp 9,052
326 Natrium diklofenak 25 mg Tablet Rp 114.99 Rp 149
327 Natrium diklofenak 50 mg Tablet Rp 200.00 Rp 260
328 NaCl Piggybag 100 ml Botol Rp 7,125.00 Rp 9,263
329 Natur E Softcap Rp 1,271.86 Rp 1,653
330 Neostigmin Injeksi Ampul Rp 9,435.00 Rp 12,266
331 New antides Tablet Rp 194.61 Rp 253
332 New diatabs Tablet Rp 825.00 Rp 1,073
333 Nicardipin Injeksi Ampul Rp 20,500.00 Rp 26,650
334 Nifedipin 10 mg Tablet Rp 164.67 Rp 214
335 Nitrokaf retard Tablet Rp 1,650.00 Rp 2,145
336 Norelut Tablet Rp 4,995.00 Rp 6,494
337 Norit Tablet Rp 400.00 Rp 520
338 Noreprinefrin Bitartrate Ampul Rp 6,673.00 Rp 8,675
339 Novapyron Tablet Rp 518.00 Rp 673
340 Novorapid Flexpen Flexpen Rp 90,314.00 Rp 117,408
341 Noxetine 20 mg Tablet Rp 11,100.00 Rp 14,430
342 NTG (glyceryl trinitrate) Tablet Rp 60,775.00 Rp 79,008
343 Nystatin drop Botol Rp 17,759.99 Rp 23,088
344 Obat batuk hitam (OBH) syrup Botol Rp 6,468.00 Rp 8,408
345 Ofloxacin 400 mg Tablet Rp 583.00 Rp 758
346 Omeprazole 40 mg injeksi Vial Rp 8,500.00 Rp 11,050
347 Omeprazole 20 mg Kapsul Rp 429.00 Rp 558
348 Ondansetron 4 mg Injeksi Ampul Rp 1,400.00 Rp 1,820
349 Ondansetron 8 mg/4 ml inj. Ampul Rp 4,400.04 Rp 5,720
350 Ondansetron 4 mg Tablet Rp 506.99 Rp 659
351 Onoiwa Kapsul Rp 5,994.00 Rp 7,792 Retriksi 3 tablet
352 Oralit Sachet Rp 869.30 Rp 1,130
353 Oste Forte Sachet Rp 5,144.87 Rp 6,688 Retriksi 3 tablet
354 Ottogenta Injeksi Ampul Rp 6,600.00 Rp 8,580
355 Ottopain eye drop Botol Rp 83,041.88 Rp 107,954 Khusus RI
356 Otsu salin 3% Botol Rp 30,610.45 Rp 39,794
357 Oxytetracyclin salep kulit Tube Rp 5,550.00 Rp 7,215
358 Oxytocin injeksi Ampul Rp 1,348.00 Rp 1,752
359 Oxytocin injeksi Ampul Rp 3,296.70 Rp 4,286
360 Paracetamol infus Botol Rp 14,358.96 Rp 18,667
361 Paracetamol 500 mg Tablet Rp 214.00 Rp 278
362 Paracetamol syrup Botol Rp 1,171.00 Rp 1,522
363 Patral Tablet Rp 7,881.00 Rp 10,245 Umum
364 Pehacain injeksi Ampul Rp 3,150.87 Rp 4,096
365 Peptisol Vanila Box Rp 23,865.00 Rp 31,025 Umum
366 Perifas Tablet Rp 2,442.00 Rp 3,175
367 Permethrin 10 mg Tube Rp 7,303.80 Rp 9,495
368 Permethrine 15 mg Tube Rp 11,466.03 Rp 14,906
369 Pervita Kaplet Rp 1,665.00 Rp 2,165 Retriksi 7 Tablet
370 Pethidina 50mg/ml Ampul Rp 13,521.80 Rp 17,578
371 Phenytoin sodium 50 mg/ml Ampul Rp 23,448.75 Rp 30,483
372 Piracetam 800 mg Tablet Rp 632.03 Rp 822
373 Piracetam 3 gr Ampul Rp 14,368.20 Rp 18,679
374 Polidemicin ED Botol Rp 31,524.00 Rp 40,981
375 Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
376 Poro Suppositoria 125 mg Suppo Rp 8,800.00 Rp 11,440
377 Poro Suppositoria 250 mg Suppo Rp 12,320.00 Rp 16,016
378 Pramipexole 0,125 mg Tablet Rp 1,413.00 Rp 1,837
379 Pramipexole 0,375 ER Tablet Rp 3,050.00 Rp 3,965
380 Prednison 5 mg Tablet Rp 126.00 Rp 164
381 Pregabalin 75 mg Tablet Rp 3,608.00 Rp 4,690
382 Pregnolin 5 mg Tablet Rp 4,395.60 Rp 5,714
383 Prohepar Kapsul Rp 5,555.54 Rp 7,222 Retriski 3 Kapsul
384 Propanolol 10 mg Tablet Rp 77.00 Rp 100
385 Propanolol 40 mg Tablet Rp 135.00 Rp 175
386 Propofol 20 ml Ampul Rp 10,382.94 Rp 13,498
387 Propyltiouracil 100 mg Tablet Rp 440.00 Rp 572
388 Provital plus Tablet Rp 6,710.00 Rp 8,723 Retriksi 3 Kaplet
389 Pyrantel 125 mg Tablet Rp 512.67 Rp 666
390 Pyrazinamide 500 mg Tablet Rp 777.00 Rp 1,010
391 Phytomenadion 10 mg Tablet Rp 781.00 Rp 1,015
392 Quanocain spinal 2 mg/4 ml Ampul Rp 52,250.00 Rp 67,925
393 Ramipril 5 mg Tablet Rp 263.00 Rp 342
394 Ramipril 10 mg Tablet Rp 703.60 Rp 915
395 Ranitidin 50 mg/2 ml Ampul Rp 4,995.00 Rp 6,494
396 Ranitidin 50 mg/2 ml Ampul Rp 3,907.20 Rp 5,079
Ranitidin 50 mg/2 ml Ampul Rp 1,500.00 Rp 1,950
397 Ranitidin 150 mg Tablet Rp 150.00 Rp 195
398 Rebamipid Tablet Rp 3,330.00 Rp 4,329 Retriksi 6 tablet
399 Recalus Kapsul Rp 5,272.50 Rp 6,854 Retriksi 6 tablet
400 Reco tetes telinga Botol Rp 16,650.00 Rp 21,645
401 Recustein dry syrup Botol Rp 60,500.00 Rp 78,650
402 Recolfar 0,5 mg Tablet Rp 5,500.00 Rp 7,150
403 Regivell 20 mg Botol Rp 58,275.00 Rp 75,758
404 Ringer Lactat (RL) Botol Rp 7,773.33 Rp 10,105
405 Rifampicin 600 mg Kapsul Rp 2,513.99 Rp 3,268
Rincobal 500 mg Kapsul Rp 1,510.00 Rp 1,963
406 Risperidon 2 mg Tablet Rp 272.99 Rp 355
407 Rocuronium Bromide 50 mg Ampul Rp 35,071.67 Rp 45,593
408 Ryzodeg Flex Pen Rp 113,018.20 Rp 146,924
409 Sagestam 40 mg inj Ampul Rp 16,500.00 Rp 21,450 Umum
410 Sagestam salep mata Tube Rp 41,514.00 Rp 53,968
411 Salbutamol 4 mg Tablet Rp 112.39 Rp 146
412 Salbutamol 2 mg Tablet Rp 113.28 Rp 147
413 Salbutamol sol 1 mg/ml Ampul Rp 4,440.00 Rp 5,772
414 Sanbe Tears ED Botol Rp 25,086.00 Rp 32,612
415 Sanmol Infus Botol Rp 22,582.95 Rp 29,358 Umum
416 Sanmol drop Botol Rp 18,426.00 Rp 23,954 Umum
417 Sanmol syrup Botol Rp 14,652.00 Rp 19,048 Umum
418 Santa E Kapsul Rp 4,662.00 Rp 6,061 Retriksi 3 tablet
419 Scabimite crem Tube Rp 66,000.00 Rp 85,800 Umum
420 Scobutrin Tablet Rp 3,190.00 Rp 4,147
421 Sevoflurane 250 ml Botol Rp 1,104,330.00 Rp 1,435,629
422 Sibital Injeksi Ampul Rp 10,890.00 Rp 14,157
423 Simarc 2 mg Tablet Rp 889.35 Rp 1,156
424 Simvastatin 10 mg Tablet Rp 495.00 Rp 644
425 Simvastatin 20 mg Tablet Rp 151.36 Rp 197
426 Spironolacton 25 mg Tablet Rp 222.00 Rp 289
427 Spironolacton 100 mg Kapsul Rp 552.00 Rp 718
428 Striatamin Kapsul Rp 5,189.25 Rp 6,746
429 Sucralfate suspensi 100 ml Botol Rp 7,865.00 Rp 10,225
430 Sucralfate 500 mg Tablet Rp 265.00 Rp 345
431 Sulfadiazine silver 35 gr Tube Rp 18,725.69 Rp 24,343
432 Sulfitis 500 mg Tablet Rp 3,219.00 Rp 4,185
433 Suprafenid Suppo Rp 10,656.00 Rp 13,853
434 Symbicort 160 dos Botol Rp 166,840.76 Rp 216,893
435 Tablet tambah darah Tablet Rp 255.00 Rp 332
436 Tamsolusin 0,4 mg Tablet Rp 4,356.00 Rp 5,663
437 Tenofovir 300 mg Tablet Rp 2,260.37 Rp 2,938
438 Tetagam P Vial Rp 146,800.00 Rp 190,840
439 Tison 4 Tablet Rp 3,520.00 Rp 4,576
440 Thiamazole 5 mg Tablet Rp 605.00 Rp 787
441 Thiamazole 10 mg Tablet Rp 990.00 Rp 1,287
442 Thiamphenicol 500 mg Tablet Rp 1,013.21 Rp 1,317
443 Thyrozol 5 mg Tablet Rp 679.00 Rp 883
444 Thyrozol 10 mg Tablet Rp 1,325.00 Rp 1,723
445 Tremenza Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
446 Trihexyphenidil 2 mg Tablet Rp 63.00 Rp 82
447 Triamcinolon 4 mg Tablet Rp 884.61 Rp 1,150
448 Triamcinolon 10 mg/ml Vial Rp 44,955.00 Rp 58,442
449 Triamcinolon crem Tube Rp 27,000.00 Rp 35,100
450 Trilac injeksi Vial Rp 180,000.00 Rp 234,000 Umum
451 Tuberculin Tes Vial Rp 738,150.00 Rp 959,595
452 Umarone Vial Rp 192,500.00 Rp 250,250 Umum
453 Ursodeoxycholic Acid 250 mg Tablet Rp 2,050.00 Rp 2,665
454 Vaksin TT Vial Rp 116,217.00 Rp 151,082
455 Valdimex 5 mg Tablet Rp 1,210.00 Rp 1,573
456 Venodenol injeksi Ampul Rp 166,500.00 Rp 216,450
457 Vitamin A IPI Tablet Rp 172.72 Rp 225
458 Vitamin B com Tablet Rp 60.00 Rp 78
459 Vitamin B6 Tablet Rp 140.80 Rp 183
460 Vitamin B1 Tablet Rp 246.00 Rp 320
461 Vitamin C 50 mg Tablet Rp 46.42 Rp 60
462 Vitamin C 500 mg Tablet Rp 495.00 Rp 644
463 Vitamin D3 1,000 mg (Yavit D) Tablet Rp 2,042.00 Rp 2,655 Retriksi 6 tablet
464 Vitamin k injeksi Ampul Rp 8,880.00 Rp 11,544
465 Vitrolenta Botol Rp 36,352.50 Rp 47,258
466 Vitsap Tablet Rp 3,404.00 Rp 4,425 Retriksi 3 tablet
467 Vosea Tablet Rp 550.00 Rp 715
468 Warfarin 2 mg Tablet Rp 698.00 Rp 907
469 Wiaflox 500 Tablet Rp 14,850.00 Rp 19,305 Umum
470 Widahes 500 ml Botol Rp 91,020.00 Rp 118,326
473 Xiety 10 mg Tablet Rp 4,870.12 Rp 6,331
474 Zinc sulfat 20 mg Tablet Rp 250.98 Rp 326
475 Zinc sulfat drop Botol Rp 5,445.66 Rp 7,079
476 Zinc sulfate sirup Botol Rp 4,395.60 Rp 5,714
477 Zollocid 20 mg Kapsul Rp 9,900.00 Rp 12,870
478 Zolmia Tablet Rp 7,770.00 Rp 10,101 Retriksi 6 tablet
Bahan Medis Pakai Habis
2
(BMHP)
1 AgNO3 3% 100 ml Botol Rp 512,820.00 Rp 666,666
2 Alkohol 70% Pcs Rp 55,500.00 Rp 72,150
3 Alkohol swab Pcs Rp 159.54 Rp 207
4 Ambu bag dewasa Pcs Rp 677,875.00 Rp 881,238
5 Ambu bag anak Pcs Rp 677,875.00 Rp 881,238
6 Aproon/celemek Pcs Rp 4,173.60 Rp 5,426
7 Assucryl 1 Pcs Rp 47,932.02 Rp 62,312
8 Assucryl 2 Pcs Rp 75,081.52 Rp 97,606
9 Assucryl 2/0 Pcs Rp 64,355.61 Rp 83,662
10 Assucryl 3/0 Pcs Rp 64,355.58 Rp 83,662
11 Assucryl 4/0 Pcs Rp 82,590.66 Rp 107,368
12 Bio Pen Electrosurgical pencil Pcs Rp 46,065.00 Rp 59,885
Bisturi No. 10 (Surgical blades 10)
13
serenity
Pcs Rp 1,665.00 Rp 2,165
Bisturi No. 11 (Surgical blades 11)
14
serenity
Pcs Rp 1,665.00 Rp 2,165
15 Bisturi No. 15 (Biss mess OM 15) Pcs Rp 781.00 Rp 1,015
Bisturi No. 20 (Surgical blades 20) Pcs
16
serenity
Rp 609.40 Rp 792

17 Breathing sircuit child Pcs Rp 72,800.46 Rp 94,641

18 Breathing sircuit infant Pcs Rp 72,800.46 Rp 94,641
19 Breket Pcs Rp 20,125.00 Rp 26,163
20 Burrowl Pcs Rp 116,550.00 Rp 151,515
21 Canofix - PU 6 x 8 cm Pcs Rp 6,882.05 Rp 8,947
22 Cervical collar Pcs Rp 133,584.00 Rp 173,659
23 Cat gut chromic 3/0 Pcs Rp 16,500.00 Rp 21,450
24 Chromic 1 HRG Pcs Rp 51,913.59 Rp 67,488
25 Chromic 2 HRG Pcs Rp 44,905.05 Rp 58,377
26 Chromic 2/0 HRG Pcs Rp 40,665.96 Rp 52,866
27 Chromic 3/0 HR Pcs Rp 34,410.00 Rp 44,733
28 Chromic 4/0 HR Pcs Rp 41,295.33 Rp 53,684
29 Cat gut chromic 2/0 Pcs Rp 7,683.32 Rp 9,988
30 Combo pack (Infus set) Pcs Rp 21,450.00 Rp 27,885
31 Comy Bag (Colostomy bag) Pcs Rp 27,600.00 Rp 35,880
32 Cutimed gel 15 gr Tube Rp 52,110.00 Rp 67,743
33 Cutimed siltec 10x10 cm Sac Rp 61,600.00 Rp 80,080
34 Cutimed sorbact 7 x 9 cm Pcs Rp 32,800.00 Rp 42,640
35 Daryantuell Pcs Rp 17,181.80 Rp 22,336
36 Electroda dewasa Pcs Rp 4,386.72 Rp 5,703
37 Elektrode (Anak) Pcs Rp 1,266.18 Rp 1,646
38 Elektrode Bayi Pcs Rp 1,276.50 Rp 1,659
39 Endotracheal Tube 2,5 Pcs Rp 21,580.00 Rp 28,054
40 Endotracheal Tube 3 Pcs Rp 21,580.00 Rp 28,054
41 Endotracheal Tube 3,5 Pcs Rp 32,090.96 Rp 41,718
42 Endotracheal Tube 4,0 Pcs Rp 17,036.00 Rp 22,147
43 Endotracheal Tube 4,5 Pcs Rp 21,579.76 Rp 28,054
44 Endotracheal Tube 5,0 Pcs Rp 21,579.76 Rp 28,054
45 Endotracheal Tube 5,5 Pcs Rp 21,579.76 Rp 28,054
46 Endotracheal Tube 6,0 Pcs Rp 26,565.00 Rp 34,535
47 Endotracheal Tube 6,5 Pcs Rp 16,947.00 Rp 22,031
48 Endotracheal Tube 7,0 Pcs Rp 21,579.95 Rp 28,054
49 Endotracheal Tube 7,5 Pcs Rp 21,579.75 Rp 28,054
50 Endotracheal Tube 8,0 Pcs Rp 21,579.51 Rp 28,053
51 Eye protector bayi Pcs Rp 42,550.00 Rp 55,315
52 Feeding tube 3,5 R Pcs Rp 12,273.03 Rp 15,955
53 Feeding tube No. 5 R 100 cm Pcs Rp 14,077.14 Rp 18,300
54 Feeding tube No.8 Pcs Rp 12,099.40 Rp 15,729
55 Feeding tube No.8 100 cm Pcs Rp 14,077.14 Rp 18,300
56 Fm Crepe 10 cm Roll Rp 48,800.00 Rp 63,440
57 Fm crepe 15 cm Roll Rp 57,319.99 Rp 74,516
58 Filapeau 5/0 Pcs Rp 47,948.67 Rp 62,333
59 Filapeau 4/0 Pcs Rp 44,841.34 Rp 58,294
60 Filapeau 2/0 Pcs Rp 38,000.00 Rp 49,400
61 Folley cateter no. 6 Pcs Rp 16,610.03 Rp 21,593
62 Folley cateter no. 8 Pcs Rp 16,610.03 Rp 21,593
63 Folley cateter no. 8 silicon 30 ml Pcs Rp 16,447.64 Rp 21,382
64 Folley cateter no. 10 Pcs Rp 16,610.03 Rp 21,593
65 Folley cateter no. 12 Pcs Rp 12,489.72 Rp 16,237
66 Folley cateter no. 14 Pcs Rp 12,489.72 Rp 16,237
67 Folley cateter 16 Pcs Rp 12,489.72 Rp 16,237
68 Folley cateter 18 Pcs Rp 12,489.72 Rp 16,237
69 Folley cateter 18 Silicon 30 ml Pcs Rp 17,325.00 Rp 22,523
70 Folley cateter 20 FR Pcs Rp 17,325.00 Rp 22,523
71 Folley cateter 22 FR Pcs Rp 12,489.72 Rp 16,237
72 Folley cateter 24 FR Pcs Rp 12,489.72 Rp 16,237
73 Folley cateter 18 3 way Pcs Rp 32,670.00 Rp 42,471
74 Folley cateter 20 3 way Pcs Rp 39,930.00 Rp 51,909
75 Folley cateter 22 3 way Pcs Rp 32,670.00 Rp 42,471
76 Folley cateter 24 3 way Pcs Rp 32,890.00 Rp 42,757
77 Fuji Film 26 x 36 (Dry Film) Pcs Rp 39,220.00 Rp 50,986
78 Guedel airway 90 MM Kuning Pcs Rp 19,374.00 Rp 25,186
79 Guedel airway 80 MM (2) Hijau Pcs Rp 19,374.00 Rp 25,186
80 Guedel airway 70 MM (1) Putih Pcs Rp 37,290.00 Rp 48,477
81 Guedel airway 60 MM (0) Hitam Pcs Rp 19,374.00 Rp 25,186
82 Guedel airway 50 MM (00) Biru Pcs Rp 14,000.00 Rp 18,200
83 Guedel airway 40 MM (000) Pink Pcs Rp 20,999.99 Rp 27,300
84 H2O2 3% 100 ml Botol Rp 16,650.00 Rp 21,645
85 H2O2 3% 800 ml Botol Rp 33,033.00 Rp 42,943
86 H2O2 5% Botol Rp 40,404.00 Rp 52,525
87 Handrub Baymed 0,5% Botol Rp 37,152.63 Rp 48,298
88 Handwash 500 ml (Baymed 4%) Botol Rp 42,483.83 Rp 55,229
89 Handscoon gynecolog 6,5 Pairs Rp 37,504.20 Rp 48,755
90 Handscoon gynecolog size M Pairs Rp 37,504.20 Rp 48,755
91 Handscoon steril no. 6,0 Pairs Rp 13,562.73 Rp 17,632
92 Handscoon steril no. 6,5 Pairs Rp 13,686.02 Rp 17,792
93 Handscoon steril no. 7,5 Pairs Rp 13,686.00 Rp 17,792
94 Handscoon steril no. 7.0 Pairs Rp 13,562.73 Rp 17,632
95 Handscoon steril no. 8,0 Pairs Rp 13,177.56 Rp 17,131
96 Handscoon non steril size S Pcs Rp 1,252.08 Rp 1,628
97 Handscoon non steril size M Pcs Rp 1,252.08 Rp 1,628
98 Handscoon non steril size L Pcs Rp 1,252.08 Rp 1,628
99 Hazmat (Full body) Pcs Rp 436,975.00 Rp 568,068
100 Hazmat Coverall Pcs Rp 102,500.00 Rp 133,250
101 Id bracelet dewasa biru Pcs Rp 1,452.00 Rp 1,888
102 Id bracelet dewasa PINK Pcs Rp 933.51 Rp 1,214
103 Id bracelet for child blue Pcs Rp 933.51 Rp 1,214
104 Id bracelet for child pink Pcs Rp 933.51 Rp 1,214
105 Infus set micro Pcs Rp 7,150.00 Rp 9,295
106 Infus set makro y set Pcs Rp 8,596.00 Rp 11,175
107 IV. Canula 16 G (Abbocath 16) Pcs Rp 6,674.32 Rp 8,677
108 IV. Canula 18 G (Abbocath 18) Pcs Rp 6,152.84 Rp 7,999
109 IV. Canula 20 (Abbocath 20) Pcs Rp 7,215.00 Rp 9,380
110 IV. Canula 22 (Abbocath 22) Pcs Rp 6,152.84 Rp 7,999
111 IV. Cateter 24 (Abbocath 24) Pcs Rp 6,152.84 Rp 7,999
112 IV. Canula 26 (Abbocath 26) Pcs Rp 15,537.80 Rp 20,199
113 Jackson rees pedriatic Pcs Rp 283,375.00 Rp 368,387
114 Jackson rees dewasa Pcs Rp 270,249.59 Rp 351,324
115 Kantong Jenazah Pcs Rp 217,250.00 Rp 282,425
116 Kapas pembalut 250 gr Roll Rp 16,697.95 Rp 21,707
117 Kapsul kosong no. 00 Pcs Rp 133.20 Rp 173
118 Kapsul kosong no. 0 Pcs Rp 99.90 Rp 130
119 Kapsul kosong no. 1 Pcs Rp 99.90 Rp 130
120 Kapsul kosong no. 2 Pcs Rp 99.90 Rp 130
121 Kasa hydrofil 40 x 80 cm Roll Rp 16,613.52 Rp 21,598
122 Kasa steril OM 16 x 16 Pcs Rp 574.98 Rp 747
123 Kertas EKG 80 x 30 Roll Rp 162,423.10 Rp 211,150
124 Kertas perkamen Pack Rp 14,430.00 Rp 18,759
125 Kertas Puyer press Pcs Rp 1,789.33 Rp 2,326
126 Klorsept 25 Pcs Rp 1,789.33 Rp 2,326
127 Leukoplas 1625 (besar) Roll Rp 82,500.00 Rp 107,250
128 Leukoplas/ plester 1 x 5 (Kecil) Roll Rp 12,675.00 Rp 16,478
129 Mask Anastesi size 1 Pcs Rp 48,750.98 Rp 63,376
130 Mask Anastesi size 2 Pcs Rp 48,750.98 Rp 63,376
131 Mask Anastesi size 4 Pcs Rp 48,750.98 Rp 63,376
132 Masker Anastesi 5 Pcs Rp 48,750.39 Rp 63,376
133 Masker Anastesi 6 Pcs Rp 48,750.39 Rp 63,376
134 Masker kerudung Pcs Rp 2,860.00 Rp 3,718
135 Masker N95 Pcs Rp 21,175.00 Rp 27,528
136 Masker KN95 Pcs Rp 9,035.00 Rp 11,746
137 Microfline/Pen Needle 31Gx55M Pcs Rp 1,695.00 Rp 2,204
138 Mitela Ukuran S (Arm Sling S) Pcs Rp 21,275.00 Rp 27,658
139 Mitela Ukuran M (Arm Sling M) Pcs Rp 21,275.00 Rp 27,658
140 Mitela Ukuran L (Arm Sling L) Pcs Rp 21,275.00 Rp 27,658
141 My Jelly Tube Rp 35,520.00 Rp 46,176
142 Nasal canula neonatus Pcs Rp 9,750.24 Rp 12,675
143 Nasal canula bayi Pcs Rp 9,250.00 Rp 12,025
144 Nasal canula dewasa Pcs Rp 9,657.00 Rp 12,554
145 Nasal Canula Anak Pcs Rp 9,657.00 Rp 12,554
146 Needle Spinocain 27 Pcs Rp 66,000.00 Rp 85,800
147 No Pain spray Botol Rp 96,570.00 Rp 125,541
148 Nurse cup Pcs Rp 781.68 Rp 1,016
149 Object glass Pcs Rp 281.18 Rp 366
150 Optime 1 Pcs Rp 75,744.31 Rp 98,468
151 Optime 2 Pcs Rp 95,399.12 Rp 124,019
152 Optime 2/0 Pcs Rp 74,026.33 Rp 96,234
153 Optime 3/0 Pcs Rp 75,023.03 Rp 97,530
154 Oxygen Mask adult elognated Pcs Rp 11,404.00 Rp 14,825
155 Oxygen Mask pedriatik Pcs Rp 27,500.00 Rp 35,750
156 Oxygen Mask S (Infant) Pcs Rp 16,899.75 Rp 21,970
157 Oxygen mask nebulizer size M Pcs Rp 22,390.50 Rp 29,108
158 Oxygen mask Nebulizer size L Pcs Rp 31,900.00 Rp 41,470
159 Oxygen mask nebulizer bayi Pcs Rp 26,000.00 Rp 33,800

160 Oxygen mask nebulizer size S (infant) Pcs Rp 26,000.00 Rp 33,800

161 Oxygen mask Non rebreathing dewasa Pcs Rp 20,800.00 Rp 27,040

162 Oxygen mask Non rebreathing child Pcs Rp 25,098.92 Rp 32,629

163 Oxygen mask Non rebreathing Bayi Pcs Rp 20,800.00 Rp 27,040

Oxygen mask Non rebreathing S Pcs
164
(Infant) Rp 21,702.32 Rp 28,213
165 Paper X ray pcs Rp 8,325.00 Rp 10,823
166 Papsmear Kit Size S Kit Rp 22,264.00 Rp 28,943
167 Papsmear Kit Size M Kit Rp 22,264.00 Rp 28,943
168 Perfusor 150 mg (Extension) Pcs Rp 17,708.06 Rp 23,020
169 Perfusor Pcs Rp 41,677.17 Rp 54,180
170 Plastik seal secutity lock Pcs Rp 11,743.80 Rp 15,267
171 Poliban 10 cm x 2,7 mm Roll Rp 16,539.99 Rp 21,502
172 Poliban 15 cm x 2,7 mm Roll Rp 21,899.99 Rp 28,470
173 Polifix 10 x 5 cm Roll Rp 82,966.55 Rp 107,857
174 Poligyp 10 cm x 2,7 mm Roll Rp 23,540.00 Rp 30,602
175 Poligyp 15 cm x 2,7 mm Roll Rp 31,059.99 Rp 40,378
176 Polypropylene 5/0 Pcs Rp 53,629.65 Rp 69,719
177 Polypropylene 4/0 Pcs Rp 53,629.65 Rp 69,719
178 Polypropylene 3/0 Pcs Rp 53,629.65 Rp 69,719
179 Polypropylene 2/0 Pcs Rp 53,629.65 Rp 69,719
180 Polypropylene 1 HR Pcs Rp 53,629.65 Rp 69,719
181 Postofix - PU 10x25 Pcs Rp 29,377.14 Rp 38,190
182 Postofix - PU 10x15 Pcs Rp 16,650.00 Rp 21,645
183 Postofix - PU 10x10 Pcs Rp 13,320.00 Rp 17,316
184 Povidone iodine 10% 1 L Botol Rp 80,811.76 Rp 105,055
185 Povidone iodine 300 ml Botol Rp 30,636.00 Rp 39,827
186 Prontosan sol Botol Rp 96,505.33 Rp 125,457
187 Redax Drentech compact Pcs Rp 787,905.00 Rp 1,024,277
188 Safety Box 5 L Pcs Rp 12,652.49 Rp 16,448
189 Scanlux Botol Rp 201,354.00 Rp 261,760
190 Silk 2-0 Apex Pcs Rp 49,610.00 Rp 64,493
191 Silk 2/0 Remedi Pcs Rp 5,375.00 Rp 6,987
192 Silk Black 1 Pcs Rp 17,325.89 Rp 22,524
193 Silk 1 HRG Pcs Rp 47,301.56 Rp 61,492
194 Silk 2 HRG Pcs Rp 47,193.87 Rp 61,352
195 Silk 2/0 HR Pcs Rp 38,935.47 Rp 50,616
196 Silk 3-0 Apex Pcs Rp 53,240.00 Rp 69,212
197 Silk 3-0 Pcs Rp 7,400.00 Rp 9,620
198 Silk 0 Pcs Rp 39,817.47 Rp 51,763
199 Spinocain 25 Pcs Rp 32,617.00 Rp 42,402
200 Spinocain 26 Pcs Rp 32,617.00 Rp 42,402
201 Spoit 50 cc (cateter tip hijau) Pcs Rp 11,817.86 Rp 15,363
202 Spoit 50 cc Pcs Rp 6,930.88 Rp 9,010
203 Spoit 50 cc (Iuer Slip) Pcs Rp 6,795.82 Rp 8,835
204 Spoit 20 cc (Lubang samping) Pcs Rp 1,183.65 Rp 1,539
205 Spoit 10 cc Pcs Rp 1,639.30 Rp 2,131
206 Spoit 5 cc Pcs Rp 1,430.00 Rp 1,859
207 Spoit 3 cc Pcs Rp 1,095.92 Rp 1,425
208 Spoit 1 cc Pcs Rp 1,447.98 Rp 1,882
209 Stomach Tube (Maag slang) 12 Pcs Rp 12,542.64 Rp 16,305
210 Stomatch tube (Maag slang) 14 Pcs Rp 12,542.64 Rp 16,305
211 Stomatch tube (Maag slang) 16 Pcs Rp 12,542.64 Rp 16,305
212 Stomach Tube (Maag Slang) 18 Pcs Rp 12,542.64 Rp 16,305
213 Suction cateter no. 6 Pcs Rp 3,711.99 Rp 4,826
214 Suction cateter FG 8 Pcs Rp 4,764.12 Rp 6,193
215 Suction cateter FG 10 Pcs Rp 8,880.00 Rp 11,544
216 Suction cateter FG 12 Pcs Rp 8,880.00 Rp 11,544
217 Suction cateter no. 14 Pcs Rp 4,996.75 Rp 6,496
218 Suction cateter no. 16 Pcs Rp 8,880.00 Rp 11,544
219 Suction cateter no. 18 Pcs Rp 4,996.83 Rp 6,496
220 Suction conecting tube Pcs Rp 34,840.00 Rp 45,292
221 T-chromic cat gut 1 Pcs Rp 69,375.00 Rp 90,188
222 T-chromic cat gut 2 Pcs Rp 69,375.00 Rp 90,188
223 T-chromic cat gut 2-0 Pcs Rp 63,603.00 Rp 82,684
224 T-chromic cat gut 3-0 Pcs Rp 58,275.00 Rp 75,758
225 T-chromic cat gut 4-0 Pcs Rp 66,600.00 Rp 86,580
226 Three way stop cock Pcs Rp 9,838.40 Rp 12,790
227 T- Hemocel 5 x 7,5 cm Pcs Rp 75,177.27 Rp 97,730
228 T-Hernia Mesh 6 x10 cm Pcs Rp 151,140.00 Rp 196,482
229 T-Hernia Mesh 5 x 7,5 cm Pcs Rp 101,454.00 Rp 131,890
230 T-Lene 2-0 Pcs Rp 81,141.00 Rp 105,483
231 T-Lene 3-0 Pcs Rp 80,919.00 Rp 105,195
232 T-Lene 4-0 Pcs Rp 77,145.00 Rp 100,289
233 T-Lene 5-0 Pcs Rp 77,145.00 Rp 100,289
234 T-Nylon 5-0 Pcs Rp 50,838.00 Rp 66,089
235 Transfusi set (Blood Transfusi set) Pcs Rp 12,544.96 Rp 16,308
236 Transofix Pcs Rp 4,643.13 Rp 6,036
237 T-Silk 1 Pcs Rp 55,389.00 Rp 72,006
238 T-Silk 2-0 Pcs Rp 40,737.00 Rp 52,958
239 T-Silk 3-0 Pcs Rp 43,512.00 Rp 56,566
240 T-Silk 3-0 Pcs Rp 45,621.00 Rp 59,307
241 Torniquet Pcs Rp 22,850.96 Rp 29,706
242 Trocar Thoracic cateter tube No. 22 Pcs Rp 217,905.00 Rp 283,277
243 Tvio 1 Pcs Rp 86,691.00 Rp 112,698
244 T-Vio 2 Pcs Rp 99,990.00 Rp 129,987
245 T-Vio 2-0 Pcs Rp 80,142.00 Rp 104,185
246 T-vio 3-0 Pcs Rp 77,478.00 Rp 100,721
247 T-vio 4-0 Pcs Rp 83,472.00 Rp 108,514
248 Umbilical cold (Penjepit Tali Pusat) Pcs Rp 1,306.95 Rp 1,699
249 Upad 60x90 pcs Rp 4,084.80 Rp 5,310
250 Urine bag Pcs Rp 6,309.24 Rp 8,202
251 Urogard Pcs Rp 131,257.50 Rp 170,635
252 Urobag Pcs Rp 6,072.00 Rp 7,894
253 USG Jelly 250 ml Botol Rp 16,631.91 Rp 21,621
254 USG Jelly 5 L Botol Rp 185,999.37 Rp 241,799
255 USG Paper Sony Roll Rp 288,000.00 Rp 374,400
256 Xpresif 10x5 Roll Rp 44,400.00 Rp 57,720
MATA
1 Appalens plus 18,0 Pcs Rp 194,250.00 Rp 252,525
2 Appalens plus 18,5 Pcs Rp 194,250.00 Rp 252,525
3 Appalens plus 19.0 Pcs Rp 194,250.00 Rp 252,525
4 Appalens plus 19.5 Pcs Rp 194,250.00 Rp 252,525
5 Appalens plus 20.0 Pcs Rp 194,250.00 Rp 252,525
6 Appalens plus 20.5 Pcs Rp 194,250.00 Rp 252,525
7 Appalens plus 21.0 Pcs Rp 194,250.00 Rp 252,525
8 Appalens plus 21.5 Pcs Rp 194,250.00 Rp 252,525
9 Appalens plus 22.0 Pcs Rp 194,250.00 Rp 252,525
10 Appalens plus 22.5 Pcs Rp 194,250.00 Rp 252,525
11 Appalens plus 23.0 Pcs Rp 194,250.00 Rp 252,525
12 Appasamy cohesisc 1,8% Pcs Rp 421,800.00 Rp 548,340
13 Appasamy appavisc 3 ml (Visco) Pcs Rp 122,100.00 Rp 158,730
14 Mani opthalmic 27 Keratone Pcs Rp 290,820.00 Rp 378,066
15 Mani opthalmic 26 cresene Pcs Rp 290,820.00 Rp 378,066
16 Mata pisau B Braun 15 Pcs Rp 8,103.00 Rp 10,534
17 Miochol/ Carbacol Pcs Rp 66,600.00 Rp 86,580
18 Needle Terumo 27 Pcs Rp 1,853.70 Rp 2,410
19 Nylon 10/0 Pcs Rp 170,765.00 Rp 221,995
20 Rhed-ID/ Trypan Blue Pcs Rp 66,600.00 Rp 86,580
21 SP PGA 8/0 Pcs Rp 182,650.00 Rp 237,445

Palopo, Januari 2022

Kepala Instalasi Farmasi

RSUD dr. Palemmai Tandi

Syuriani, S.Si., Apt.

Nip. 19830605 200903 2 003
 PEMERINTAH KOTA PALOPO
RSUD dr. PALEMMAI TANDI
Jl. Samiun No. 2, Telp. 0853-4577-4072
PALOPO

DAFTAR HARGA OBAT & BMHP

Apr-23

NO URAIAN SATUAN HARGA SATUAN KET

1 OBAT FAKTUR JUAL

1 Acetylcystein 200 mg Kapsul Rp 777.00 Rp 1,010
2 Acetylcystein 200 mg infus Botol Rp 183,338.70 Rp 238,340
3 Acyclovir 400 mg Tablet Rp 889.13 Rp 1,156
4 Acyclovir crem 5% Tube Rp 4,768.23 Rp 6,199
5 Adalat Oros 30 mg Tablet Rp 3,986.00 Rp 5,182
6 Albunorm 25% 100 ml Botol Rp 1,746,585.00 Rp 2,270,561 retriksi 3 btl/minggu
7 Allopurinol 100 mg Tablet Rp 270.00 Rp 351
8 Allopurinol 300 mg Tablet Rp 357.50 Rp 465
9 Alprazolam 0,5 mg Tablet Rp 78.00 Rp 101
10 Alprazolam 1 mg Tablet Rp 544.50 Rp 708
11 Amoxan paed drop Botol Rp 25,530.00 Rp 33,189 Umum
12 Amoxicillin 125 mg dry syrup Botol Rp 2,600.00 Rp 3,380
13 Amoxicillin 250 mg dry syrup Botol Rp 3,510.00 Rp 4,563
14 Amoxicillin 500 mg Tablet Rp 518.00 Rp 673
15 Amoxicillin 500 mg Tablet Rp 656.02 Rp 853
16 Ambroxol elixir Botol Rp 2,966.81 Rp 3,857
17 Ambroxol 30 mg Tablet Rp 200.00 Rp 260
18 Amikacin 250 mg Injeksi Vial Rp 17,050.00 Rp 22,165
19 Amiodaron Ampul Rp 6,504.60 Rp 8,456
20 Amlodipin 10 mg Tablet Rp 520.00 Rp 676
21 Amlodipin 5 mg Tablet Rp 422.40 Rp 549
22 Amlodipin 5 mg Tablet Rp 852.00 Rp 1,108
23 Aminoleban 500 Bag Rp 72,800.02 Rp 94,640
24 Aminophylline injeksi Ampul Rp 22,200.00 Rp 28,860
25 Amiparen 500 Bag Rp 96,000.00 Rp 124,800
26 Amitriptillin 25 mg Tablet Rp 210.00 Rp 273
27 Ampicillin 1 gr Vial Rp 10,050.00 Rp 13,065
28 Analsik Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
29 Antasida doen Tablet Rp 54.00 Rp 70
30 Antasida suspensi Botol Rp 3,436.18 Rp 4,467
31 Apidra solostar Flexpen Rp 90,313.59 Rp 117,408
32 Arkine 2 mg Tablet Rp 606.06 Rp 788
33 Asam ascorbid acid 200 mg/2 ml Injeksi Rp 4,975.00 Rp 6,468
34 Asam mefenamat 500 mg Tablet Rp 210.00 Rp 273
35 Asam folat 400 mg Tablet Rp 45.00 Rp 59
36 Asam folat 1 g Tablet Rp 61.00 Rp 79
37 Asam tranexamat 500 mg Tablet Rp 1,700.00 Rp 2,210
38 Asam tranexamat 250 mg /5 ml injeksi Ampul Rp 2,002.00 Rp 2,603
39 Asam tranexamat 500 mg/ml Ampul Rp 2,425.00 Rp 3,152
Asam valproat 250 mg/mlsyrup
40
(Sodium Valproat)
Botol Rp 12,752.00 Rp 16,578
41 Asam valproat 250 mg/mlsyrup Botol Rp 15,500.00 Rp 20,150
42 Atracurium 50 mg/5 ml Ampul Rp 38,850.00 Rp 50,505
43 Atracurium 25 mg/5 ml Ampul Rp 9,877.89 Rp 12,841
44 Atorvastatin calcium 20 mg Tablet Rp 471.00 Rp 612
45 Atorvastatin calcium 20 mg Tablet Rp 575.00 Rp 747
46 Atropin sulfat Injeksi Ampul Rp 3,778.02 Rp 4,911
47 Aqua pro injeksi 25 ml Botol Rp 2,954.82 Rp 3,841
48 Aqua pro injeksi 1 L Botol Rp 35,614.35 Rp 46,299
49 Azitromycin 500 mg Tablet Rp 1,892.99 Rp 2,461
50 Bamgetol 200 mg Tablet Rp 2,325.17 Rp 3,023
51 Baquinor 0,3% ED Botol Rp 37,573.60 Rp 48,846
52 Beneuron Tablet Rp 440.00 Rp 572
53 Benoson N crem Tube Rp 18,499.80 Rp 24,050 Umum
54 Benutrion VE Botol Rp 62,658.40 Rp 81,456
55 Betahistin 6 mg Tablet Rp 209.00 Rp 272
56 Betahistin HCl 24 mg Tablet Rp 4,718.00 Rp 6,133
57 Betametason crem Tube Rp 1,534.02 Rp 1,994
58 Berotec 0,1 mg Botol Rp 87,721.07 Rp 114,037
59 Bfluid 500 ml Softbag Rp 77,063.00 Rp 100,182
60 Bfluid 500 ml Softbag Rp 97,899.78 Rp 127,270
61 Bio TT Ampul Rp 60,500.00 Rp 78,650
62 Biovitan syrup Botol Rp 4,116.77 Rp 5,352
63 Bisoprolol 2,5 mg Tablet Rp 149.00 Rp 194
64 Bisoprolol 5 mg Tablet Rp 264.00 Rp 343
65 Bucain Spinal 0,5% Ampul Rp 57,000.00 Rp 74,100
66 Brilinta 90 mg Tablet Rp 8,480.40 Rp 11,025 Retriksi 6 tablet
67 Calcium Lactat 500 mg Tablet Rp 117.00 Rp 152
68 Calcium gluconas 10 ml Ampul Rp 1,501.20 Rp 1,952
69 Candesartan 8 mg Tablet Rp 315.00 Rp 409
70 Candesartan 16 mg Tablet Rp 1,836.05 Rp 2,387
71 Candesartan 16 mg Tablet Rp 495.00 Rp 644
72 Captopril 12,5 mg Tablet Rp 94.00 Rp 122
73 Captopril 25 mg Tablet Rp 137.75 Rp 179
74 Captopril 50 mg Tablet Rp 234.48 Rp 305
75 Carbazocrome Ampul Rp 10,584.96 Rp 13,760
76 Carmed 10% crem Tube Rp 36,075.00 Rp 46,898
77 Carmed 20% crem Tube Rp 45,715.30 Rp 59,430
78 Cepezet 100 mg Tablet Rp 1,110.00 Rp 1,443
79 Cephaflox 1 gr Vial Rp 198,135.00 Rp 257,576 Umum/ Jasarahrja
80 Cetrizine syrup Botol Rp 4,274.00 Rp 5,556
81 Cetrizine 10 mg Tablet Rp 206.00 Rp 268
82 Cefadroxil 500 mg Kapsul Rp 775.00 Rp 1,007
83 Cefadroxil 500 mg Kapsul Rp 1,002.07 Rp 1,303
84 Cefadroxil syrup 125 mg Botol Rp 3,890.00 Rp 5,057
85 Cefadroxil syrup 250 mg Botol Rp 12,375.00 Rp 16,088
86 Cefoperazone Vial Rp 56,610.00 Rp 73,593
87 Cefoperazone 1 gr Vial Rp 17,750.00 Rp 23,075
88 Ceftazidime 1 gr Vial Rp 11,825.00 Rp 15,372
89 Cefixime 100 mg/5 ml syrup Botol Rp 9,261.98 Rp 12,041
90 Cefixime 100 mg Kapsul Rp 463.00 Rp 602
91 Cefixime 100 mg Kapsul Rp 999.98 Rp 1,300
92 Cefixime 200 mg Kaplet Rp 1,705.00 Rp 2,216
93 Cefotaxime 1 gr Vial Rp 6,700.00 Rp 8,710
94 Ceftriaxon 1 gr Vial Rp 6,400.00 Rp 8,320
95 Cefuroxime 1 gr Vial Rp 57,200.00 Rp 74,360
96 Cendo Astenof 0,6 ml Botol Rp 4,551.00 Rp 5,916
97 Cendo catarlent 0,6 ml Botol Rp 4,440.00 Rp 5,772
98 Cendo Cenfresh 0,6 ml MD Botol Rp 4,600.00 Rp 5,980
99 Cendo conver 2% 0,6 ml MD Botol Rp 3,579.75 Rp 4,654
100 Cendo Efrisel 10% Botol Rp 16,927.35 Rp 22,006
101 Cando Floxa 0,6 ml MD Botol Rp 5,938.50 Rp 7,720
102 Cendo LFX 0,6 ml Botol Rp 15,318.00 Rp 19,913
103 Cendo Lyteers ED Botol Rp 22,500.00 Rp 29,250
104 Cendo Hyalub ED Botol Rp 59,107.50 Rp 76,840
105 Cendo Hyalub 0,6 ml MD Botol Rp 12,654.00 Rp 16,450
106 Cendo Hyalub 0,6 ml MD Botol Rp 11,400.00 Rp 14,820
107 Cendo Midriatil 0,5% Botol Rp 5,855.25 Rp 7,612
108 Cendo Midriatil 1 % ED Botol Rp 38,250.00 Rp 49,725
109 Cendo Natacen 0,6 ml Botol Rp 9,240.75 Rp 12,013
110 Cendo Polynel 0,6 ml MD Botol Rp 3,574.00 Rp 4,646
111 Cendo P. Pred Botol Rp 8,491.50 Rp 11,039
112 Cendo Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
113 Cendo protagenta 0,6 ml MD Botol Rp 7,964.25 Rp 10,354
114 Cendo Timol 0,5% 0,6 ml MD Botol Rp 5,716.50 Rp 7,431
115 Cendo Tobroson 0,6 ml Botol Rp 6,438.00 Rp 8,369
116 Cendo Tobro 0,6 ml MD Botol Rp 4,245.75 Rp 5,519
117 Cendo xytrol 5 ml Botol Rp 30,247.50 Rp 39,322
118 Cendo xyitrol 0,6 ml MD Botol Rp 5,411.25 Rp 7,035
119 Cilostazol 100 mg Tablet Rp 7,000.00 Rp 9,100
120 Ciprofloxacin Infus Botol Rp 8,100.00 Rp 10,530
121 Ciprofloxacin 500 mg Tablet Rp 539.98 Rp 702
122 Ciprofloxacin 500 mg Tablet Rp 475.01 Rp 618
123 Citicholin 250 mg/2 ml Ampul Rp 22,275.00 Rp 28,958
124 Citicholin 500 mg/4 ml Ampul Rp 24,420.00 Rp 31,746
125 Citicolin 500 mg Tablet Rp 4,000.00 Rp 5,200
126 Chloroquin 150 mg Tablet Rp 1,505.74 Rp 1,957
127 Chlorpheniramine Maleat (CTM) Tablet Rp 51.00 Rp 66
128 Clindamycin 300 mg Kapsul Rp 1,334.78 Rp 1,735
129 Clindamycin 150 mg Kapsul Rp 778.00 Rp 1,011
130 Clobazam 10 mg Tablet Rp 384.00 Rp 499
131 Clonidine 0,15 mg Tablet Rp 146.00 Rp 190
132 Clopidogrel 75 mg Tablet Rp 580.23 Rp 754
133 Clozapine 25 mg Tablet Rp 477.00 Rp 620
134 Codein 10 mg Tablet Rp 610.50 Rp 794
135 Colchicine 0,5 Tablet Rp 671.00 Rp 872
136 Colchicine 0,5 Tablet Rp 1,665.00 Rp 2,165
137 Colistine 0,25 MIU Tablet Rp 2,553.00 Rp 3,319
138 Comafusin Hepar Botol Rp 87,999.98 Rp 114,400
139 Cotrimoxasole suspensi Botol Rp 5,954.30 Rp 7,741
140 Cotrimoxazole 480 mg Tablet Rp 253.97 Rp 330
141 Curcuma Force Tablet Rp 876.15 Rp 1,139
142 Curcuma 20 mg Tablet Rp 482.02 Rp 627
143 Daily C 500 mg Tablet Rp 577.50 Rp 751
144 DC2 Tablet Rp 8,116.88 Rp 10,552 Retriksi 3 tablet
145 Depakote 250 mg Kaplet Rp 8,880.00 Rp 11,544
146 Desolex crem 10 gr Tube Rp 25,080.00 Rp 32,604 Umum
147 Dexamethason 5 mg/ml Ampul Rp 1,427.39 Rp 1,856
148 Dexamethason 0,5 mg Tablet Rp 132.09 Rp 172
149 Dexketoprofen 50 mg/2 ml Ampul Rp 24,531.00 Rp 31,890
150 Dexketoprofen 25 mg Tablet Rp 3,302.00 Rp 4,293 Retriksi 6 tablet
151 Dexosimethason 0,25 mg crem 10 g Tube Rp 9,079.80 Rp 11,804

152 Dexosimethason 0,25 mg crem 15 g Tube Rp 13,800.00 Rp 17,940

153 Dextrose 10% Botol Rp 7,200.30 Rp 9,360
154 Dextrose 10% Botol Rp 8,350.53 Rp 10,856
155 Dextrose 5% Botol Rp 6,626.70 Rp 8,615
156 Dextrose 5% Botol Rp 7,685.64 Rp 9,991
157 D5 1/2 NS Botol Rp 10,280.00 Rp 13,364
158 D5 1/4 NS Botol Rp 10,280.00 Rp 13,364
159 Dextrose 5% 100 ml piggy bag Botol Rp 13,786.20 Rp 17,922
160 Dextrose 40% Botol Rp 7,770.00 Rp 10,101
161 Diazepam 2 mg Tablet Rp 70.00 Rp 91
162 Diazepam 5 mg/ml inj. Ampul Rp 1,559.00 Rp 2,027
163 Diazepam 5 mg rectal Rectube Rp 13,546.00 Rp 17,610
164 Diazepam 10 mg rectal Rectube Rp 19,693.00 Rp 25,601
165 Dibekacin 100 mg Ampul Rp 79,920.00 Rp 103,896
166 Digoxin 0,25 mg Tablet Rp 114.40 Rp 149
167 Diltiazem Tablet Rp 1,665.00 Rp 2,165
168 Dimenhidrinat 50 mg Tablet Rp 109.99 Rp 143
169 Dipenhidramin 15 mg/15 ml Ampul Rp 5,390.00 Rp 7,007
170 Dipenhidramin 10 mg/ml Ampul Rp 1,332.00 Rp 1,732
171 Divalproex sodium 250 mg Kaplet Rp 2,310.00 Rp 3,003
172 Divalproex sodium 500 mg Kaplet Rp 1,505.00 Rp 1,957
173 Dobutamin 250 mg/5 ml Ampul Rp 30,885.75 Rp 40,151
174 Dobutamin 50 mg Ampul Rp 9,004.00 Rp 11,705
175 Dolgesic Injeksi Ampul Rp 11,988.00 Rp 15,584
176 Domavit Softcap Rp 3,931.00 Rp 5,110 Retriksi 7 Tablet
177 Domperidon 10 mg Tablet Rp 253.00 Rp 329
178 Domperidone syrup Botol Rp 4,437.28 Rp 5,768
179 Donepezil Tablet Rp 1,680.00 Rp 2,184
180 Dopamet (methyldopa) Tablet Rp 1,023.00 Rp 1,330
181 Dopamin 200 mg/5 ml Ampul Rp 3,945.00 Rp 5,129
182 Dorium Kaplet Rp 5,328.00 Rp 6,926 Retriksi 6 tablet
183 Doxycycline 100 mg Kapsul Rp 281.69 Rp 366
184 Dulcolax 5 mg tablet Tablet Rp 1,586.85 Rp 2,063
185 Dulcolax 5 mg Suppo Rp 5,084.90 Rp 6,610
186 Dulcolax 10 mg Suppo Rp 4,325.00 Rp 5,623
187 Duloxta 60 Tablet Rp 14,499.38 Rp 18,849 Retriksi 6 tablet
188 Durogesic 12,5 MU Patch Rp 63,774.38 Rp 82,907
189 Eperison HCl 50 mg Tablet Rp 1,170.13 Rp 1,521
190 Ephedrine injeksi Ampul Rp 6,485.95 Rp 8,432
191 Ephineprine injeksi Ampul Rp 2,904.00 Rp 3,775
192 Erdostein 300 mg Kapsul Rp 2,594.63 Rp 3,373
193 Ericaf Tablet Rp 3,330.00 Rp 4,329
194 Erytromicin suspensi Botol Rp 12,210.00 Rp 15,873
195 Euthyrox 50 mg Tablet Rp 728.56 Rp 947
196 Etoricoxib 60 mg Tablet Rp 3,552.00 Rp 4,618 Retriksi 6 tablet
197 Euthyrox 100 mg Tablet Rp 3,828.00 Rp 4,976
198 Farbion Injeksi Ampul Rp 11,000.00 Rp 14,300
199 Farbivent 2,5 ml Ampul Rp 3,951.60 Rp 5,137
200 Fargoxin 2 ml njeksi Ampul Rp 49,500.00 Rp 64,350
201 Fasorbid 10 mg Tablet Rp 300.30 Rp 390
202 Fenofibrate 300 mg Tablet Rp 820.00 Rp 1,066
203 Fentanyl citrate Inj 2 ml Ampul Rp 29,500.47 Rp 38,351
204 Fladystine ovula Suppo Rp 15,484.50 Rp 20,130
205 Flunarizine 5 mg Tablet Rp 1,200.00 Rp 1,560
206 Forumen tetes telinga Botol Rp 29,082.00 Rp 37,807
207 Fosen Enema Botol Rp 94,905.00 Rp 123,377
208 Furosemid injeksi Ampul Rp 969.00 Rp 1,260
209 Furosemid 40 mg Tablet Rp 221.00 Rp 287
210 Gabapentine 300 mg Kapsul Rp 1,000.00 Rp 1,300
211 Gabapentine 100 mg Kapsul Rp 1,110.00 Rp 1,443
212 Gabatin 300 mg Kapsul Rp 9,990.00 Rp 12,987 Umum
213 Gabaxa Botol Rp 247,227.00 Rp 321,395
214 Gelafusal infusion 500 ml Bag Rp 145,015.00 Rp 188,520
215 Genoint tetes mata Botol Rp 13,320.00 Rp 17,316
216 Gentamicin salep kulit Tube Rp 2,963.70 Rp 3,853
217 Gentamicin 0,3% 5 gram Tube Rp 40,376.25 Rp 52,489
218 Gentamicin 40 mg/ml injeksi Ampul Rp 3,385.50 Rp 4,401
219 Glauseta Tablet Rp 2,876.00 Rp 3,739
220 Glauseta Tablet Rp 3,355.42 Rp 4,362 Retriksi 6 tablet
221 Glibenclamid 5 mg Tablet Rp 333.00 Rp 433
222 Gliclazide 80 mg Tablet Rp 214.00 Rp 278
223 Glimepirid 2 mg Tablet Rp 220.00 Rp 286
224 Glimepirid 4 mg Tablet Rp 2,032.70 Rp 2,643
225 Granisetron 1 mg Ampul Rp 22,200.00 Rp 28,860
226 Griseofulvin 125 mg Tablet Rp 500.00 Rp 650
227 Harnal 0,2 Tablet Rp 7,859.99 Rp 10,218
228 Harnal OCAS Tablet Rp 4,356.00 Rp 5,663
229 Heparin sodium Ampul Rp 46,635.00 Rp 60,626
230 Hepatosol Vanila Pcs Rp 36,815.00 Rp 47,860
231 Herbesser CD 200 Tablet Rp 5,196.82 Rp 6,756
232 Hervis 0,35 gr Tablet Rp 40,792.50 Rp 53,030
233 Hexymer 2 mg Tablet Rp 427.35 Rp 556
234 Histapan Tablet Rp 804.75 Rp 1,046 Retriksi 6 tablet
235 Human Albumin 20% Botol Rp 913,227.04 Rp 1,187,195 Retriksi 3 botol/minggu

236 Hydrocortison salep kulit Tube Rp 6,136.00 Rp 7,977

237 Hyosine injeksi Ampul Rp 6,188.05 Rp 8,044
238 Hyson Injeksi Ampul Rp 97,402.43 Rp 126,623 Jasaraharja/Umum
239 Hyoscine butylbromide 10 mg Tablet Rp 1,050.00 Rp 1,365
240 Hystolan 20 mg Tablet Rp 4,995.00 Rp 6,494
241 Ibuprofen 400 mg Tablet Rp 215.00 Rp 280
242 Ibuprofen 200 mg Tablet Rp 155.00 Rp 201
243 Ibuprofen suspensi Botol Rp 9,075.00 Rp 11,798
244 Ifalmin Kapsul Rp 5,500.00 Rp 7,150 Retriksi 3 tablet
245 Imboost Force Kaplet Rp 5,701.90 Rp 7,412 Retriksi 3 tablet
246 Indop (Dopamin) Ampul Rp 19,057.50 Rp 24,775
247 Imitatin 1 gr Vial Rp 170,829.00 Rp 222,078 Jasaraharja/Umum
248 Interlac Sachet Rp 11,704.95 Rp 15,216 Retriksi 4 bungkus
249 Inviclot Vial Rp 65,340.00 Rp 84,942
250 Iremax Tablet Rp 990.68 Rp 1,288 Retriksi 6 tablet
251 Isoflurane 250 ml Botol Rp 827,672.50 Rp 1,075,974
252 Isoniazid 100 mg Tablet Rp 444.00 Rp 577
253 Isoniazid 300 mg Tablet Rp 666.00 Rp 866
254 Isosorbid dinitrate 5 mg Tablet Rp 99.90 Rp 130
255 Isosorbid dinitrate 1 mg/ml Ampul Rp 33,000.00 Rp 42,900
256 Kaen 3B Botol Rp 11,500.00 Rp 14,950
257 Kaen 3B Botol Rp 12,770.55 Rp 16,602
258 Kaen 4B Botol Rp 10,858.02 Rp 14,115
259 Kaen 4B Botol Rp 13,769.55 Rp 17,900
260 Kaen Mg3 Botol Rp 10,560.00 Rp 13,728
261 Kalium diklofenak 50 mg Tablet Rp 333.00 Rp 433
262 KCL 7,46 Botol Rp 3,470.97 Rp 4,512
263 Ketoconazole salep Tube Rp 8,800.00 Rp 11,440
264 Ketoconazole 200 mg Tablet Rp 495.00 Rp 644
265 Ketorolac injeksi Ampul Rp 1,475.00 Rp 1,918
266 Kidmin 200 ml Bag Rp 54,619.77 Rp 71,006
267 Kina Tablet Rp 2,200.00 Rp 2,860
268 KSR 600 mg Tablet Rp 1,842.00 Rp 2,395
269 Kutoin Tablet Rp 1,492.12 Rp 1,940
270 KTM Injeksi Vial Rp 190,920.00 Rp 248,196
271 Lactafit Tablet Rp 2,997.00 Rp 3,896 Umum
272 Lactogen Lactofree Kaleng Rp 101,817.90 Rp 132,363 Umum
273 Lactogen Premature Kaleng Rp 101,909.10 Rp 132,482 Umum
274 Lactulosa syrup Botol Rp 18,912.00 Rp 24,586
275 Lametic syrup Botol Rp 102,300.00 Rp 132,990 Umum
276 Lametic 8 mg/4 ml Ampul Rp 68,200.00 Rp 88,660 Umum
277 Lanabal 500 mcg Kapsul Rp 2,750.00 Rp 3,575 Umum
278 Lanfix 200 Kapsul Rp 37,400.00 Rp 48,620 Umum
279 Lanzoprasole 30 mg Kapsul Rp 278.00 Rp 361
280 Lantus solostar Flexpen Rp 89,808.99 Rp 116,752
281 Laxadine syrup 30 ml Botol Rp 42,900.00 Rp 55,770
282 Laxadine emulsi 60 ml Botol Rp 47,730.00 Rp 62,049
283 Laxalosan syrup Botol Rp 61,050.00 Rp 79,365 Umum
284 L Bio Sachet Rp 8,963.25 Rp 11,652 Retriksi 5/3 bungkus
285 Lesichol 300 Softcap Rp 13,200.00 Rp 17,160 Umum
286 Levetiracetam 500 mg Tablet Rp 4,117.00 Rp 5,352
287 Levopar Tablet Rp 904.00 Rp 1,175
288 Levoben 100 mg Tablet Rp 2,997.00 Rp 3,896
289 Levofloxacin 500 mg Tablet Rp 373.01 Rp 485
290 Levofloxacin 750 mg Tablet Rp 4,403.00 Rp 5,724
291 Levofloxacin Infus Botol Rp 23,100.00 Rp 30,030
292 Levothyroxine 100 mcg Tablet Rp 890.01 Rp 1,157
293 Lidokain 2% Injeksi Ampul Rp 1,341.00 Rp 1,743
294 Lidokain compositum Ampul Rp 1,531.98 Rp 1,992
295 Lisinopril 10 mg Tablet Rp 149.00 Rp 194
296 Lisinopril 5 mg Tablet Rp 220.00 Rp 286
297 Lodomer 2 mg Tablet Rp 1,212.12 Rp 1,576
298 Loperamid 2 mg Tablet Rp 89.00 Rp 116
299 Loratadine 10 mg Tablet Rp 162.00 Rp 211
300 Lycalvit 60 ml Botol Rp 47,932.50 Rp 62,312 Umum
301 Lycopect Tablet Rp 387.97 Rp 504
302 Maganol Infus Botol Rp 56,610.00 Rp 73,593 Umum
303 Manitol 20% Botol Rp 39,650.28 Rp 51,545
304 Maxiflon 400 mg Tablet Rp 37,296.00 Rp 48,485 Umum/Jasaraharja
305 MgSO4 40% Botol Rp 5,661.00 Rp 7,359
306 Mecobalamin 500 mg Kapsul Rp 710.40 Rp 924
307 Meloxicam 7,5 mg Tablet Rp 319.49 Rp 415
308 Meloxicam 15 mg Tablet Rp 406.09 Rp 528
309 Meprovent Inhalasi Botol Rp 3,502.05 Rp 4,553
310 Meropenem 0,5 gr Vial Rp 24,000.00 Rp 31,200
311 Meropenem 1 gr Vial Rp 46,810.00 Rp 60,853
312 Mersibion 5000 injeksi Ampul Rp 4,001.55 Rp 5,202
313 Metamizole injeksi Ampul Rp 5,045.45 Rp 6,559
314 Metamizole 500 mg Tablet Rp 333.00 Rp 433
315 Metformin 500 mg Tablet Rp 179.99 Rp 234
316 Metformin 500 mg Tablet Rp 221.00 Rp 287
317 Methylergometrin 0,125 mg Tablet Rp 313.00 Rp 407
318 Methylergometrin 2 mg inj. Ampul Rp 1,069.00 Rp 1,390
319 Methylprednisolon 125 mg Injeksi Vial Rp 14,208.00 Rp 18,470
320 Methylprednisolon 4 mg Tablet Rp 239.65 Rp 312
321 Methylprednisolon 4 mg Tablet Rp 203.00 Rp 264
322 Methylprednisolon 8 mg Tablet Rp 566.70 Rp 737
323 Metoclopramid 5 mg injeksi Ampul Rp 1,883.00 Rp 2,448
324 Metoclopramid 10 mg Tablet Rp 66.00 Rp 86
325 Metronidazole infus Botol Rp 5,938.50 Rp 7,720
326 Metronidazole 500 mg Tablet Rp 221.00 Rp 287
327 Miconazole 2% Tube Rp 1,916.97 Rp 2,492
328 Midanest 5 mg Ampul Rp 19,980.00 Rp 25,974
329 Migratop 25 mg Tablet Rp 3,988.60 Rp 5,185
330 Miniaspi 80 mg Tablet Rp 89.00 Rp 116
331 Miriwash 500 ml Softbag Rp 109,854.00 Rp 142,810
332 Misoprostol 200 Mcg Tablet Rp 4,717.50 Rp 6,133
333 Mometason Furoate crem Tube Rp 6,025.00 Rp 7,832
334 Morfina 10 mg/ml Ampul Rp 30,272.65 Rp 39,354
335 Moxifloxacin 400 mg Tablet Rp 10,770.00 Rp 14,001
336 Moxifloxacin 400 Infus Botol Rp 47,148.00 Rp 61,292
337 MST Continue 10 mg Tablet Rp 15,762.00 Rp 20,491
338 Mupirocin crem 5 gr Tube Rp 22,395.45 Rp 29,114
339 Myores Tablet Rp 4,995.00 Rp 6,494 Retriksi 6 tablet
340 Natrium Chlorida 0,9% (NaCl) 500 ml Botol Rp 6,975.45 Rp 9,068
341 Natrium diklofenak 25 mg Tablet Rp 114.99 Rp 149
342 Natrium diklofenak 50 mg Tablet Rp 200.00 Rp 260
343 NaCl Piggybag 100 ml Botol Rp 7,125.00 Rp 9,263
344 Natur E Softcap Rp 1,271.86 Rp 1,653
345 Neostigmin Injeksi Ampul Rp 9,990.00 Rp 12,987
346 Neostigmin Injeksi Ampul Rp 8,880.00 Rp 11,544
347 New antides Tablet Rp 194.61 Rp 253
348 New diatabs Tablet Rp 825.00 Rp 1,073
349 Nicardipin Injeksi Ampul Rp 20,500.00 Rp 26,650
350 Nifedipin 10 mg Tablet Rp 164.00 Rp 213
351 Nitrokaf retard Tablet Rp 1,650.00 Rp 2,145
352 Norelut Tablet Rp 4,995.00 Rp 6,494
353 Norit Tablet Rp 400.00 Rp 520
354 Noreprinefrin Bitartrate Ampul Rp 6,673.00 Rp 8,675
355 Novapyron Tablet Rp 518.00 Rp 673
356 Novorapid Flexpen Flexpen Rp 90,314.00 Rp 117,408
357 Noxetine 20 mg Tablet Rp 11,100.00 Rp 14,430
358 NTG (glyceryl trinitrate) Tablet Rp 60,775.00 Rp 79,008
359 Nystatin drop Botol Rp 17,759.99 Rp 23,088
360 Obat batuk hitam (OBH) syrup Botol Rp 6,468.00 Rp 8,408
361 Ofloxacin 400 mg Tablet Rp 583.00 Rp 758
362 Omeprazole 40 mg injeksi Vial Rp 8,500.00 Rp 11,050
363 Omeprazole 20 mg Kapsul Rp 429.00 Rp 558
364 Ondansetron 4 mg Injeksi Ampul Rp 1,400.00 Rp 1,820
365 Ondansetron 8 mg/4 ml inj. Ampul Rp 4,400.04 Rp 5,720
366 Ondansetron 4 mg Tablet Rp 506.99 Rp 659
367 Onoiwa Kapsul Rp 5,994.00 Rp 7,792 Retriksi 3 tablet
368 Oralit Sachet Rp 869.30 Rp 1,130
369 Oste Forte Sachet Rp 5,144.87 Rp 6,688 Retriksi 3 tablet
370 Ottogenta Injeksi Ampul Rp 6,600.00 Rp 8,580
371 Ottopain eye drop Botol Rp 83,041.88 Rp 107,954 Khusus RI
372 Otsu salin 3% Botol Rp 30,610.45 Rp 39,794
373 Oxytetracyclin salep kulit Tube Rp 5,550.00 Rp 7,215
374 Oxytocin injeksi Ampul Rp 1,348.00 Rp 1,752
375 Oxytocin injeksi Ampul Rp 3,296.70 Rp 4,286
376 Paracetamol infus Botol Rp 14,358.96 Rp 18,667
377 Paracetamol 500 mg Tablet Rp 214.00 Rp 278
378 Paracetamol syrup Botol Rp 1,171.00 Rp 1,522
379 Patral Tablet Rp 7,881.00 Rp 10,245 Umum
380 Pehacain injeksi Ampul Rp 3,150.87 Rp 4,096
381 Peptisol Vanila Box Rp 23,865.00 Rp 31,025 Umum
382 Perifas Tablet Rp 2,442.00 Rp 3,175
383 Permethrin 10 mg Tube Rp 7,303.80 Rp 9,495
384 Permethrine 15 mg Tube Rp 11,466.03 Rp 14,906
385 Pervita Kaplet Rp 1,665.00 Rp 2,165 Retriksi 7 Tablet
386 Pethidina 50mg/ml Ampul Rp 15,295.02 Rp 19,884
387 Phenytoin sodium 50 mg/ml Ampul Rp 23,448.75 Rp 30,483
388 Piracetam 800 mg Tablet Rp 632.03 Rp 822
389 Piracetam 3 gr Ampul Rp 14,368.20 Rp 18,679
390 Polidemicin ED Botol Rp 31,524.00 Rp 40,981
391 Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
392 Poro Suppositoria 125 mg Suppo Rp 8,800.00 Rp 11,440
393 Poro Suppositoria 250 mg Suppo Rp 12,320.00 Rp 16,016
394 Pramipexole 0,125 mg Tablet Rp 1,413.00 Rp 1,837
395 Pramipexole 0,375 ER Tablet Rp 3,050.00 Rp 3,965
396 Prednison 5 mg Tablet Rp 126.00 Rp 164
397 Pregabalin 75 mg Tablet Rp 3,608.00 Rp 4,690
398 Pregnolin 5 mg Tablet Rp 4,395.60 Rp 5,714
399 Prohepar Kapsul Rp 5,555.54 Rp 7,222 Retriski 3 Kapsul
400 Propanolol 10 mg Tablet Rp 77.00 Rp 100
401 Propanolol 40 mg Tablet Rp 135.00 Rp 175
402 Propofol 20 ml Ampul Rp 10,382.94 Rp 13,498
403 Propyltiouracil 100 mg Tablet Rp 440.00 Rp 572
404 Provital plus Tablet Rp 6,710.00 Rp 8,723 Retriksi 3 Kaplet
405 Pyrantel 125 mg Tablet Rp 512.67 Rp 666
406 Pyrazinamide 500 mg Tablet Rp 777.00 Rp 1,010
407 Phytomenadion 10 mg Tablet Rp 781.00 Rp 1,015
408 Quanocain spinal 2 mg/4 ml Ampul Rp 52,250.00 Rp 67,925
409 Ramipril 5 mg Tablet Rp 263.00 Rp 342
410 Ramipril 10 mg Tablet Rp 703.60 Rp 915
411 Ranitidin 50 mg/2 ml Ampul Rp 4,995.00 Rp 6,494
412 Ranitidin 50 mg/2 ml Ampul Rp 3,907.20 Rp 5,079
413 Ranitidin 50 mg/2 ml Ampul Rp 1,500.00 Rp 1,950
414 Ranitidin 150 mg Tablet Rp 150.00 Rp 195
415 Rebamipid Tablet Rp 3,108.00 Rp 4,040 Retriksi 6 tablet
416 Recalus Kapsul Rp 5,272.50 Rp 6,854 Retriksi 6 tablet
417 Reco tetes telinga Botol Rp 16,650.00 Rp 21,645
418 Recustein dry syrup Botol Rp 60,500.00 Rp 78,650
419 Recolfar 0,5 mg Tablet Rp 5,500.00 Rp 7,150
420 Regivell 20 mg Botol Rp 61,605.00 Rp 80,087
421 Ringer Lactat (RL) Botol Rp 8,498.00 Rp 11,047
422 Ringer lactat B Braun Botol Rp 9,156.39 Rp 11,903
423 Rifampicin 600 mg Kapsul Rp 2,513.99 Rp 3,268
424 Rincobal 500 mg Kapsul Rp 1,510.00 Rp 1,963
425 Risperidon 2 mg Tablet Rp 272.99 Rp 355
426 Rocuronium Bromide 50 mg Ampul Rp 35,071.67 Rp 45,593
427 Ryzodeg Flex Pen Rp 113,018.03 Rp 146,923
428 Sagestam 40 mg inj Ampul Rp 16,500.00 Rp 21,450 Umum
429 Sagestam salep mata Tube Rp 41,514.00 Rp 53,968
430 Salbutamol 4 mg Tablet Rp 112.39 Rp 146
431 Salbutamol 2 mg Tablet Rp 113.28 Rp 147
432 Salbutamol sol 1 mg/ml Ampul Rp 4,440.00 Rp 5,772
433 Sanbe Tears ED Botol Rp 25,086.00 Rp 32,612
434 Sanmol Infus Botol Rp 22,582.95 Rp 29,358 Umum
435 Sanmol drop Botol Rp 18,426.00 Rp 23,954 Umum
436 Sanmol syrup Botol Rp 14,652.00 Rp 19,048 Umum
437 Sansulin Flexpen Rp 89,802.61 Rp 116,743
438 Santa E Kapsul Rp 4,662.00 Rp 6,061 Retriksi 3 tablet
439 Scabimite crem Tube Rp 66,000.00 Rp 85,800 Umum
440 Scobutrin Tablet Rp 3,190.00 Rp 4,147
441 Sevoflurane 250 ml Botol Rp 887,911.00 Rp 1,154,284
442 Sibital Injeksi Ampul Rp 15,295.80 Rp 19,885
443 Simarc 2 mg Tablet Rp 889.35 Rp 1,156
444 Simvastatin 10 mg Tablet Rp 495.00 Rp 644
445 Simvastatin 20 mg Tablet Rp 121.33 Rp 158
446 Spironolacton 25 mg Tablet Rp 222.00 Rp 289
447 Spironolacton 100 mg Kapsul Rp 552.00 Rp 718
448 Striatamin Kapsul Rp 5,371.99 Rp 6,984
449 Sucralfate suspensi 100 ml Botol Rp 7,865.00 Rp 10,225
450 Sucralfate 500 mg Tablet Rp 265.00 Rp 345
451 Sulfadiazine silver 35 gr Tube Rp 18,725.69 Rp 24,343
452 Sulfitis 500 mg Tablet Rp 3,219.00 Rp 4,185
453 Suprafenid Suppo Rp 10,822.50 Rp 14,069
454 Symbicort 160 dos Botol Rp 166,840.76 Rp 216,893
455 Tablet tambah darah Tablet Rp 255.00 Rp 332
456 Tamsolusin 0,4 mg Tablet Rp 4,356.00 Rp 5,663
457 Tenofovir 300 mg Tablet Rp 2,260.37 Rp 2,938
458 Tetagam P Vial Rp 146,800.00 Rp 190,840
459 Tison 4 Tablet Rp 3,520.00 Rp 4,576
460 Thiamazole 5 mg Tablet Rp 555.00 Rp 722
461 Thiamazole 10 mg Tablet Rp 990.00 Rp 1,287
462 Thiamphenicol 500 mg Tablet Rp 1,013.21 Rp 1,317
463 Thyrozol 5 mg Tablet Rp 679.00 Rp 883
464 Thyrozol 10 mg Tablet Rp 1,325.00 Rp 1,723
465 Tremenza Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
466 Trihexyphenidil 2 mg Tablet Rp 63.00 Rp 82
467 Triamcinolon 4 mg Tablet Rp 884.61 Rp 1,150
468 Triamcinolon 10 mg/ml Vial Rp 44,955.00 Rp 58,442
469 Triamcinolon crem Tube Rp 27,000.00 Rp 35,100
470 Trilac injeksi Vial Rp 180,000.00 Rp 234,000 Umum
471 Tuberculin Tes Vial Rp 738,150.00 Rp 959,595
472 Umarone Vial Rp 192,500.00 Rp 250,250 Umum
473 Ursodeoxycholic Acid 250 mg Tablet Rp 2,050.00 Rp 2,665
474 Vaksin TT Vial Rp 116,217.00 Rp 151,082
475 Valdimex 5 mg Tablet Rp 1,210.00 Rp 1,573
476 Venodenol injeksi Ampul Rp 166,500.00 Rp 216,450
477 Vitamin A IPI Tablet Rp 172.72 Rp 225
478 Vitamin B com Tablet Rp 60.00 Rp 78
479 Vitamin B6 Tablet Rp 140.80 Rp 183
480 Vitamin B1 Tablet Rp 246.00 Rp 320
481 Vitamin C 50 mg Tablet Rp 46.42 Rp 60
482 Vitamin C 500 mg Tablet Rp 495.00 Rp 644
483 Vitamin D3 1,000 mg (Yavit D) Tablet Rp 2,042.00 Rp 2,655 Retriksi 6 tablet
484 Vitamin k injeksi Ampul Rp 8,880.00 Rp 11,544
485 Vitrolenta Botol Rp 36,352.50 Rp 47,258
486 Vitsap Tablet Rp 3,404.00 Rp 4,425 Retriksi 3 tablet
487 Vosea Tablet Rp 550.00 Rp 715
488 Warfarin 2 mg Tablet Rp 698.00 Rp 907
489 Wiaflox 500 Tablet Rp 14,850.00 Rp 19,305 Umum
490 Widahes 500 ml Botol Rp 91,020.00 Rp 118,326
491 Xiety 10 mg Tablet Rp 4,870.12 Rp 6,331
492 Zinc sulfat 20 mg Tablet Rp 250.98 Rp 326
493 Zinc sulfat drop Botol Rp 5,445.66 Rp 7,079
494 Zinc sulfate sirup Botol Rp 4,395.60 Rp 5,714
495 Zollocid 20 mg Kapsul Rp 9,900.00 Rp 12,870
496 Zolmia Tablet Rp 7,770.00 Rp 10,101 Retriksi 6 tablet
Bahan Medis Pakai Habis
2
(BMHP)
1 AgNO3 3% 100 ml Botol Rp 512,820.00 Rp 666,666
2 Alkohol 70% Pcs Rp 55,500.00 Rp 72,150
3 Alkohol swab Pcs Rp 159.54 Rp 207
4 Ambu bag dewasa Pcs Rp 677,875.00 Rp 881,238
5 Ambu bag anak Pcs Rp 677,875.00 Rp 881,238
6 Aproon/celemek Pcs Rp 4,173.60 Rp 5,426
7 Assucryl 1 Pcs Rp 47,932.02 Rp 62,312
8 Assucryl 2 Pcs Rp 75,081.52 Rp 97,606
9 Assucryl 2/0 Pcs Rp 64,355.61 Rp 83,662
10 Assucryl 3/0 Pcs Rp 64,355.58 Rp 83,662
11 Assucryl 4/0 Pcs Rp 82,590.66 Rp 107,368
12 Bio Pen Electrosurgical pencil Pcs Rp 46,065.00 Rp 59,885
Bisturi No. 10 (Surgical blades 10) Pcs
13
serenity
Rp 1,665.00 Rp 2,165
Bisturi No. 11 (Surgical blades 11)
14
serenity
Pcs Rp 1,665.00 Rp 2,165
15 Bisturi No. 15 (Biss mess OM 15) Pcs Rp 781.00 Rp 1,015
Bisturi No. 20 (Surgical blades 20)
16
serenity
Pcs Rp 609.40 Rp 792
17 Breathing sircuit child Pcs Rp 72,800.46 Rp 94,641
18 Breathing sircuit infant Pcs Rp 72,800.46 Rp 94,641
19 Breket Pcs Rp 20,125.00 Rp 26,163
20 Burrowl Pcs Rp 116,550.00 Rp 151,515
21 Canofix - PU 6 x 8 cm Pcs Rp 6,882.05 Rp 8,947
22 Cervical collar Pcs Rp 133,584.00 Rp 173,659
23 Cat gut chromic 3/0 Pcs Rp 16,500.00 Rp 21,450
24 Chromic 1 HRG Pcs Rp 51,913.59 Rp 67,488
25 Chromic 2 HRG Pcs Rp 44,905.05 Rp 58,377
26 Chromic 2/0 HRG Pcs Rp 40,665.96 Rp 52,866
27 Chromic 3/0 HR Pcs Rp 34,410.00 Rp 44,733
28 Chromic 4/0 HR Pcs Rp 41,295.33 Rp 53,684
29 Cat gut chromic 2/0 Pcs Rp 7,683.32 Rp 9,988
30 Combo pack (Infus set) Pcs Rp 21,450.00 Rp 27,885
31 Comy Bag (Colostomy bag) Pcs Rp 27,600.00 Rp 35,880
32 Cutimed gel 15 gr Tube Rp 52,110.00 Rp 67,743
33 Cutimed siltec 10x10 cm Sac Rp 61,600.00 Rp 80,080
34 Cutimed sorbact 7 x 9 cm Pcs Rp 32,800.00 Rp 42,640
35 Daryantuell Pcs Rp 17,181.80 Rp 22,336
36 Electroda dewasa Pcs Rp 4,386.72 Rp 5,703
37 Elektrode (Anak) Pcs Rp 1,266.18 Rp 1,646
38 Elektrode Bayi Pcs Rp 1,276.50 Rp 1,659
39 Endotracheal Tube 2,5 Pcs Rp 21,580.00 Rp 28,054
40 Endotracheal Tube 3 Pcs Rp 21,580.00 Rp 28,054
41 Endotracheal Tube 3,5 Pcs Rp 32,090.96 Rp 41,718
42 Endotracheal Tube 4,0 Pcs Rp 17,036.00 Rp 22,147
43 Endotracheal Tube 4,5 Pcs Rp 21,579.76 Rp 28,054
44 Endotracheal Tube 5,0 Pcs Rp 21,579.76 Rp 28,054
45 Endotracheal Tube 5,5 Pcs Rp 21,579.76 Rp 28,054
46 Endotracheal Tube 6,0 Pcs Rp 26,565.00 Rp 34,535
47 Endotracheal Tube 6,5 Pcs Rp 16,947.00 Rp 22,031
48 Endotracheal Tube 7,0 Pcs Rp 21,579.95 Rp 28,054
49 Endotracheal Tube 7,5 Pcs Rp 21,579.75 Rp 28,054
50 Endotracheal Tube 8,0 Pcs Rp 21,579.51 Rp 28,053
51 Eye protector bayi Pcs Rp 42,550.00 Rp 55,315
52 Feeding tube 3,5 R Pcs Rp 12,273.03 Rp 15,955
53 Feeding tube No. 5 R 100 cm Pcs Rp 14,077.14 Rp 18,300
54 Feeding tube No.8 Pcs Rp 12,099.40 Rp 15,729
55 Feeding tube No.8 100 cm Pcs Rp 14,077.14 Rp 18,300
56 Fm Crepe 10 cm Roll Rp 48,800.00 Rp 63,440
57 Fm crepe 15 cm Roll Rp 57,319.99 Rp 74,516
58 Filapeau 5/0 Pcs Rp 47,948.67 Rp 62,333
59 Filapeau 4/0 Pcs Rp 44,841.34 Rp 58,294
60 Filapeau 2/0 Pcs Rp 38,000.00 Rp 49,400
61 Folley cateter no. 6 Pcs Rp 16,610.03 Rp 21,593
62 Folley cateter no. 8 Pcs Rp 16,610.03 Rp 21,593
63 Folley cateter no. 8 silicon 30 ml Pcs Rp 16,447.64 Rp 21,382
64 Folley cateter no. 10 Pcs Rp 16,610.03 Rp 21,593
65 Folley cateter no. 12 Pcs Rp 12,489.72 Rp 16,237
66 Folley cateter no. 14 Pcs Rp 12,489.72 Rp 16,237
67 Folley cateter 16 Pcs Rp 12,489.72 Rp 16,237
68 Folley cateter 18 Pcs Rp 12,489.72 Rp 16,237
69 Folley cateter 18 Silicon 30 ml Pcs Rp 17,325.00 Rp 22,523
70 Folley cateter 20 FR Pcs Rp 17,325.00 Rp 22,523
71 Folley cateter 22 FR Pcs Rp 12,489.72 Rp 16,237
72 Folley cateter 24 FR Pcs Rp 12,489.72 Rp 16,237
73 Folley cateter 18 3 way Pcs Rp 32,670.00 Rp 42,471
74 Folley cateter 20 3 way Pcs Rp 39,930.00 Rp 51,909
75 Folley cateter 22 3 way Pcs Rp 32,670.00 Rp 42,471
76 Folley cateter 24 3 way Pcs Rp 32,890.00 Rp 42,757
77 Fuji Film 26 x 36 (Dry Film) Pcs Rp 39,220.00 Rp 50,986
78 Guedel airway 90 MM Kuning Pcs Rp 19,374.00 Rp 25,186
79 Guedel airway 80 MM (2) Hijau Pcs Rp 19,374.00 Rp 25,186
80 Guedel airway 70 MM (1) Putih Pcs Rp 37,290.00 Rp 48,477
81 Guedel airway 60 MM (0) Hitam Pcs Rp 19,374.00 Rp 25,186
82 Guedel airway 50 MM (00) Biru Pcs Rp 14,000.00 Rp 18,200
83 Guedel airway 40 MM (000) Pink Pcs Rp 20,999.99 Rp 27,300
84 H2O2 3% 100 ml Botol Rp 16,650.00 Rp 21,645
85 H2O2 3% 800 ml Botol Rp 33,033.00 Rp 42,943
86 H2O2 5% Botol Rp 40,404.00 Rp 52,525
87 Handrub Baymed 0,5% Botol Rp 37,152.63 Rp 48,298
88 Handwash 500 ml (Baymed 4%) Botol Rp 42,483.83 Rp 55,229
89 Handscoon gynecolog 6,5 Pairs Rp 37,504.20 Rp 48,755
90 Handscoon gynecolog size M Pairs Rp 37,504.20 Rp 48,755
91 Handscoon steril no. 6,0 Pairs Rp 13,562.73 Rp 17,632
92 Handscoon steril no. 6,5 Pairs Rp 13,686.02 Rp 17,792
93 Handscoon steril no. 7,5 Pairs Rp 13,686.00 Rp 17,792
94 Handscoon steril no. 7.0 Pairs Rp 13,562.73 Rp 17,632
95 Handscoon steril no. 8,0 Pairs Rp 13,177.56 Rp 17,131
96 Handscoon non steril size S Pcs Rp 1,252.08 Rp 1,628
97 Handscoon non steril size M Pcs Rp 1,252.08 Rp 1,628
98 Handscoon non steril size L Pcs Rp 1,252.08 Rp 1,628
99 Hazmat (Full body) Pcs Rp 436,975.00 Rp 568,068
100 Hazmat Coverall Pcs Rp 102,500.00 Rp 133,250
101 Id bracelet dewasa biru Pcs Rp 1,452.00 Rp 1,888
102 Id bracelet dewasa PINK Pcs Rp 933.51 Rp 1,214
103 Id bracelet for child blue Pcs Rp 933.51 Rp 1,214
104 Id bracelet for child pink Pcs Rp 933.51 Rp 1,214
105 Infus set micro Pcs Rp 7,150.00 Rp 9,295
106 Infus set makro y set Pcs Rp 8,596.00 Rp 11,175
107 IV. Canula 16 G (Abbocath 16) Pcs Rp 6,674.32 Rp 8,677
108 IV. Canula 18 G (Abbocath 18) Pcs Rp 6,152.84 Rp 7,999
109 IV. Canula 20 (Abbocath 20) Pcs Rp 7,215.00 Rp 9,380
110 IV. Canula 22 (Abbocath 22) Pcs Rp 6,152.84 Rp 7,999
111 IV. Cateter 24 (Abbocath 24) Pcs Rp 6,152.84 Rp 7,999
112 IV. Canula 26 (Abbocath 26) Pcs Rp 15,537.80 Rp 20,199
113 Jackson rees pedriatic Pcs Rp 283,375.00 Rp 368,387
114 Jackson rees dewasa Pcs Rp 270,249.59 Rp 351,324
115 Kantong Jenazah Pcs Rp 217,250.00 Rp 282,425
116 Kapas pembalut 250 gr Roll Rp 16,697.95 Rp 21,707
117 Kapsul kosong no. 00 Pcs Rp 133.20 Rp 173
118 Kapsul kosong no. 0 Pcs Rp 99.90 Rp 130
119 Kapsul kosong no. 1 Pcs Rp 99.90 Rp 130
120 Kapsul kosong no. 2 Pcs Rp 99.90 Rp 130
121 Kasa hydrofil 40 x 80 cm Roll Rp 16,613.52 Rp 21,598
122 Kasa steril OM 16 x 16 Pcs Rp 574.98 Rp 747
123 Kertas EKG 80 x 30 Roll Rp 162,423.10 Rp 211,150
124 Kertas perkamen Pack Rp 14,430.00 Rp 18,759
125 Kertas Puyer press Pcs Rp 183.33 Rp 238
126 Klorsept 25 Pcs Rp 1,789.33 Rp 2,326
127 Leukoplas 1624 H (2x5) Roll Rp 38,349.97 Rp 49,855
128 Leukoplas/ plester 1 x 5 (Kecil) Roll Rp 12,675.00 Rp 16,478
129 Mask Anastesi size 1 Pcs Rp 48,750.98 Rp 63,376
130 Mask Anastesi size 2 Pcs Rp 48,750.98 Rp 63,376
131 Mask Anastesi size 4 Pcs Rp 48,750.98 Rp 63,376
132 Masker Anastesi 5 Pcs Rp 48,750.39 Rp 63,376
133 Masker Anastesi 6 Pcs Rp 48,750.39 Rp 63,376
134 Masker kerudung Pcs Rp 2,860.00 Rp 3,718
135 Masker N95 Pcs Rp 21,175.00 Rp 27,528
136 Masker KN95 Pcs Rp 9,035.00 Rp 11,746
137 Microfline/Pen Needle 31Gx55M Pcs Rp 1,695.00 Rp 2,204
138 Mitela Ukuran S (Arm Sling S) Pcs Rp 21,275.00 Rp 27,658
139 Mitela Ukuran M (Arm Sling M) Pcs Rp 21,275.00 Rp 27,658
140 Mitela Ukuran L (Arm Sling L) Pcs Rp 21,275.00 Rp 27,658
141 My Jelly Tube Rp 35,520.00 Rp 46,176
142 Nasal canula neonatus Pcs Rp 9,750.24 Rp 12,675
143 Nasal canula bayi Pcs Rp 9,250.00 Rp 12,025
144 Nasal canula dewasa Pcs Rp 9,657.00 Rp 12,554
145 Nasal Canula Anak Pcs Rp 9,657.00 Rp 12,554
146 Needle Spinocain 27 Pcs Rp 66,000.00 Rp 85,800
147 No Pain spray Botol Rp 96,570.00 Rp 125,541
148 Nurse cup Pcs Rp 781.68 Rp 1,016
149 Object glass Pcs Rp 281.18 Rp 366
150 Optime 1 Pcs Rp 75,744.31 Rp 98,468
151 Optime 2 Pcs Rp 95,399.12 Rp 124,019
152 Optime 2/0 Pcs Rp 74,026.33 Rp 96,234
153 Optime 3/0 Pcs Rp 75,023.03 Rp 97,530
154 Oxygen Mask adult elognated Pcs Rp 11,404.00 Rp 14,825
155 Oxygen Mask pedriatik Pcs Rp 27,500.00 Rp 35,750
156 Oxygen Mask S (Infant) Pcs Rp 16,899.75 Rp 21,970
157 Oxygen mask nebulizer size M Pcs Rp 22,390.50 Rp 29,108
158 Oxygen mask Nebulizer size L Pcs Rp 31,900.00 Rp 41,470
159 Oxygen mask nebulizer bayi Pcs Rp 26,000.00 Rp 33,800

160 Oxygen mask nebulizer size S (infant) Pcs Rp 26,000.00 Rp 33,800

161 Oxygen mask Non rebreathing dewasa Pcs Rp 20,800.00 Rp 27,040

162 Oxygen mask Non rebreathing child Pcs Rp 25,098.92 Rp 32,629

163 Oxygen mask Non rebreathing Bayi Pcs Rp 20,800.00 Rp 27,040

Oxygen mask Non rebreathing S Pcs
164
(Infant) Rp 21,702.32 Rp 28,213
165 Paper X ray pcs Rp 8,325.00 Rp 10,823
166 Papsmear Kit Size S Kit Rp 22,264.00 Rp 28,943
167 Papsmear Kit Size M Kit Rp 22,264.00 Rp 28,943
168 Perfusor 150 mg (Extension) Pcs Rp 17,708.06 Rp 23,020
169 Perfusor Pcs Rp 41,677.17 Rp 54,180
170 Plastik seal secutity lock Pcs Rp 11,743.80 Rp 15,267
171 Poliban 10 cm x 2,7 mm Roll Rp 16,539.99 Rp 21,502
172 Poliban 15 cm x 2,7 mm Roll Rp 21,899.99 Rp 28,470
173 Polifix 10 x 5 cm Roll Rp 82,966.55 Rp 107,857
174 Poligyp 10 cm x 2,7 mm Roll Rp 23,540.00 Rp 30,602
175 Poligyp 15 cm x 2,7 mm Roll Rp 31,059.99 Rp 40,378
176 Polypropylene 5/0 Pcs Rp 53,629.65 Rp 69,719
177 Polypropylene 4/0 Pcs Rp 53,629.65 Rp 69,719
178 Polypropylene 3/0 Pcs Rp 53,629.65 Rp 69,719
179 Polypropylene 2/0 Pcs Rp 53,629.65 Rp 69,719
180 Polypropylene 1 HR Pcs Rp 53,629.65 Rp 69,719
181 Postofix - PU 10x25 Pcs Rp 29,377.14 Rp 38,190
182 Postofix - PU 10x15 Pcs Rp 16,650.00 Rp 21,645
183 Postofix - PU 10x10 Pcs Rp 13,320.00 Rp 17,316
184 Povidone iodine 10% 1 L Botol Rp 80,811.76 Rp 105,055
185 Povidone iodine 300 ml Botol Rp 30,636.00 Rp 39,827
186 Prontosan sol Botol Rp 96,505.33 Rp 125,457
187 Redax Drentech compact Pcs Rp 787,905.00 Rp 1,024,277
188 Safety Box 5 L Pcs Rp 12,652.49 Rp 16,448
189 Scanlux Botol Rp 201,354.00 Rp 261,760
190 Silk 2-0 Apex Pcs Rp 49,610.00 Rp 64,493
191 Silk 2/0 Remedi Pcs Rp 5,375.00 Rp 6,987
192 Silk Black 1 Pcs Rp 17,325.89 Rp 22,524
193 Silk 1 HRG Pcs Rp 47,301.56 Rp 61,492
194 Silk 2 HRG Pcs Rp 47,193.87 Rp 61,352
195 Silk 2/0 HR Pcs Rp 38,935.47 Rp 50,616
196 Silk 3-0 Apex Pcs Rp 53,240.00 Rp 69,212
197 Silk 3-0 Pcs Rp 7,400.00 Rp 9,620
198 Silk 0 Pcs Rp 39,817.47 Rp 51,763
199 Spinocain 25 Pcs Rp 32,617.00 Rp 42,402
200 Spinocain 26 Pcs Rp 32,617.00 Rp 42,402
201 Spoit 50 cc (cateter tip hijau) Pcs Rp 11,817.86 Rp 15,363
202 Spoit 50 cc Pcs Rp 6,930.88 Rp 9,010
203 Spoit 50 cc (Iuer Slip) Pcs Rp 6,795.82 Rp 8,835
204 Spoit 20 cc (Lubang samping) Pcs Rp 1,183.65 Rp 1,539
205 Spoit 10 cc Pcs Rp 1,639.30 Rp 2,131
206 Spoit 5 cc Pcs Rp 1,430.00 Rp 1,859
207 Spoit 3 cc Pcs Rp 1,095.92 Rp 1,425
208 Spoit 1 cc Pcs Rp 1,447.98 Rp 1,882
209 Stomach Tube (Maag slang) 12 Pcs Rp 12,542.64 Rp 16,305
210 Stomatch tube (Maag slang) 14 Pcs Rp 12,542.64 Rp 16,305
211 Stomatch tube (Maag slang) 16 Pcs Rp 12,542.64 Rp 16,305
212 Stomach Tube (Maag Slang) 18 Pcs Rp 12,542.64 Rp 16,305
213 Suction cateter no. 6 Pcs Rp 3,711.99 Rp 4,826
214 Suction cateter FG 8 Pcs Rp 4,764.12 Rp 6,193
215 Suction cateter FG 10 Pcs Rp 8,880.00 Rp 11,544
216 Suction cateter FG 12 Pcs Rp 8,880.00 Rp 11,544
217 Suction cateter no. 14 Pcs Rp 4,996.75 Rp 6,496
218 Suction cateter no. 16 Pcs Rp 8,880.00 Rp 11,544
219 Suction cateter no. 18 Pcs Rp 4,996.83 Rp 6,496
220 Suction conecting tube Pcs Rp 34,840.00 Rp 45,292
221 T-chromic cat gut 1 Pcs Rp 69,375.00 Rp 90,188
222 T-chromic cat gut 2 Pcs Rp 69,375.00 Rp 90,188
223 T-chromic cat gut 2-0 Pcs Rp 63,603.00 Rp 82,684
224 T-chromic cat gut 3-0 Pcs Rp 58,275.00 Rp 75,758
225 T-chromic cat gut 4-0 Pcs Rp 66,600.00 Rp 86,580
226 Three way stop cock Pcs Rp 2,501.94 Rp 3,253
227 T- Hemocel 5 x 7,5 cm Pcs Rp 75,177.27 Rp 97,730
228 T-Hernia Mesh 6 x10 cm Pcs Rp 151,140.00 Rp 196,482
229 T-Hernia Mesh 5 x 7,5 cm Pcs Rp 101,454.00 Rp 131,890
230 T-Lene 2-0 Pcs Rp 81,141.00 Rp 105,483
231 T-Lene 3-0 Pcs Rp 80,919.00 Rp 105,195
232 T-Lene 4-0 Pcs Rp 77,145.00 Rp 100,289
233 T-Lene 5-0 Pcs Rp 77,145.00 Rp 100,289
234 T-Nylon 5-0 Pcs Rp 50,838.00 Rp 66,089
235 Transfusi set (Blood Transfusi set) Pcs Rp 12,544.96 Rp 16,308
236 Transofix Pcs Rp 4,643.13 Rp 6,036
237 T-Silk 1 Pcs Rp 55,389.00 Rp 72,006
238 T-Silk 2-0 Pcs Rp 40,737.00 Rp 52,958
239 T-Silk 3-0 Pcs Rp 43,512.00 Rp 56,566
240 T-Silk 3-0 Pcs Rp 45,621.00 Rp 59,307
241 Torniquet Pcs Rp 22,850.96 Rp 29,706
242 Trocar Thoracic cateter tube No. 22 Pcs Rp 217,905.00 Rp 283,277
243 Tvio 1 Pcs Rp 86,691.00 Rp 112,698
244 T-Vio 2 Pcs Rp 99,990.00 Rp 129,987
245 T-Vio 2-0 Pcs Rp 80,142.00 Rp 104,185
246 T-vio 3-0 Pcs Rp 77,478.00 Rp 100,721
247 T-vio 4-0 Pcs Rp 83,472.00 Rp 108,514
248 Umbilical cold (Penjepit Tali Pusat) Pcs Rp 1,306.95 Rp 1,699
249 Upad 60x90 pcs Rp 4,084.80 Rp 5,310
250 Urine bag Pcs Rp 6,309.24 Rp 8,202
251 Urogard Pcs Rp 131,257.50 Rp 170,635
252 Urobag Pcs Rp 6,072.00 Rp 7,894
253 USG Jelly 250 ml Botol Rp 16,631.91 Rp 21,621
254 USG Jelly 5 L Botol Rp 185,999.37 Rp 241,799
255 USG Paper Sony Roll Rp 288,000.00 Rp 374,400
256 Xpresif 10x5 Roll Rp 44,400.00 Rp 57,720
MATA
1 Appalens plus 18,0 Pcs Rp 194,250.00 Rp 252,525
2 Appalens plus 18,5 Pcs Rp 194,250.00 Rp 252,525
3 Appalens plus 19.0 Pcs Rp 194,250.00 Rp 252,525
4 Appalens plus 19.5 Pcs Rp 194,250.00 Rp 252,525
5 Appalens plus 20.0 Pcs Rp 194,250.00 Rp 252,525
6 Appalens plus 20.5 Pcs Rp 194,250.00 Rp 252,525
7 Appalens plus 21.0 Pcs Rp 194,250.00 Rp 252,525
8 Appalens plus 21.5 Pcs Rp 194,250.00 Rp 252,525
9 Appalens plus 22.0 Pcs Rp 194,250.00 Rp 252,525
10 Appalens plus 22.5 Pcs Rp 194,250.00 Rp 252,525
11 Appalens plus 23.0 Pcs Rp 194,250.00 Rp 252,525
12 Appasamy cohesisc 1,8% Pcs Rp 421,800.00 Rp 548,340
13 Appasamy appavisc 3 ml (Visco) Pcs Rp 122,100.00 Rp 158,730
14 Mani opthalmic 27 Keratone Pcs Rp 290,820.00 Rp 378,066
15 Mani opthalmic 26 cresene Pcs Rp 290,820.00 Rp 378,066
16 Mata pisau B Braun 15 Pcs Rp 8,103.00 Rp 10,534
17 Miochol/ Carbacol Pcs Rp 66,600.00 Rp 86,580
18 Needle Terumo 27 Pcs Rp 1,853.70 Rp 2,410
19 Nylon 10/0 Pcs Rp 170,765.00 Rp 221,995
20 Rhed-ID/ Trypan Blue Pcs Rp 66,600.00 Rp 86,580
21 SP PGA 8/0 Pcs Rp 182,650.00 Rp 237,445

Palopo, Januari 2022

Kepala Instalasi Farmasi

RSUD dr. Palemmai Tandi

Syuriani, S.Si., Apt.

Nip. 19830605 200903 2 003
 PEMERINTAH KOTA PALOPO
RSUD dr. PALEMMAI TANDI
Jl. Samiun No. 2, Telp. 0853-4577-4072
PALOPO

DAFTAR HARGA OBAT & BMHP

May-23

NO URAIAN SATUAN HARGA SATUAN KET

1 OBAT FAKTUR JUAL

1 Acetylcystein 200 mg Kapsul Rp 777.00 Rp 1,010
2 Acetylcystein 200 mg infus Botol Rp 183,338.70 Rp 238,340
3 Acyclovir 400 mg Tablet Rp 889.13 Rp 1,156
4 Acyclovir crem 5% Tube Rp 4,768.23 Rp 6,199
5 Adalat Oros 30 mg Tablet Rp 3,986.00 Rp 5,182
6 Albunorm 25% 100 ml Botol Rp 1,746,585.00 Rp 2,270,561 retriksi 3 btl/minggu
7 Allopurinol 100 mg Tablet Rp 270.00 Rp 351
8 Allopurinol 300 mg Tablet Rp 357.50 Rp 465
9 Alprazolam 0,5 mg Tablet Rp 78.00 Rp 101
10 Alprazolam 1 mg Tablet Rp 544.50 Rp 708
11 Amoxan paed drop Botol Rp 25,530.00 Rp 33,189 Umum
12 Amoxicillin 125 mg dry syrup Botol Rp 2,600.00 Rp 3,380
13 Amoxicillin 250 mg dry syrup Botol Rp 3,510.00 Rp 4,563
14 Amoxicillin 500 mg Tablet Rp 518.00 Rp 673
15 Amoxicillin 500 mg Tablet Rp 656.02 Rp 853
16 Ambroxol elixir Botol Rp 2,966.81 Rp 3,857
17 Ambroxol 30 mg Tablet Rp 200.00 Rp 260
18 Amikacin 250 mg Injeksi Vial Rp 17,050.00 Rp 22,165
19 Amiodaron Ampul Rp 6,504.60 Rp 8,456
20 Amlodipin 10 mg Tablet Rp 520.00 Rp 676
21 Amlodipin 5 mg Tablet Rp 422.40 Rp 549
22 Amlodipin 5 mg Tablet Rp 852.00 Rp 1,108
23 Aminoleban 500 Bag Rp 72,800.02 Rp 94,640
24 Aminophylline injeksi Ampul Rp 22,200.00 Rp 28,860
25 Amiparen 500 Bag Rp 96,000.00 Rp 124,800
26 Amitriptillin 25 mg Tablet Rp 210.00 Rp 273
27 Ampicillin 1 gr Vial Rp 10,050.00 Rp 13,065
28 Analsik Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
29 Antasida doen Tablet Rp 54.00 Rp 70
30 Antasida suspensi Botol Rp 3,436.18 Rp 4,467
31 Apidra solostar Flexpen Rp 90,313.59 Rp 117,408
32 Arkine 2 mg Tablet Rp 606.06 Rp 788
33 Asam ascorbid acid 200 mg/2 ml Injeksi Rp 4,975.00 Rp 6,468
34 Asam mefenamat 500 mg Tablet Rp 210.00 Rp 273
35 Asam folat 400 mg Tablet Rp 45.00 Rp 59
36 Asam folat 1 g Tablet Rp 61.00 Rp 79
37 Asam tranexamat 500 mg Tablet Rp 1,700.00 Rp 2,210
38 Asam tranexamat 250 mg /5 ml injeksi Ampul Rp 2,002.00 Rp 2,603
39 Asam tranexamat 500 mg/ml Ampul Rp 2,425.00 Rp 3,152
Asam valproat 250 mg/mlsyrup
40
(Sodium Valproat)
Botol Rp 12,752.00 Rp 16,578
41 Asam valproat 250 mg/mlsyrup Botol Rp 15,500.00 Rp 20,150
42 Atracurium 50 mg/5 ml Ampul Rp 38,850.00 Rp 50,505
43 Atracurium 25 mg/5 ml Ampul Rp 9,877.89 Rp 12,841
44 Atorvastatin calcium 20 mg Tablet Rp 471.00 Rp 612
45 Atorvastatin calcium 20 mg Tablet Rp 575.00 Rp 747
46 Atropin sulfat Injeksi Ampul Rp 3,778.02 Rp 4,911
47 Aqua pro injeksi 25 ml Botol Rp 2,954.82 Rp 3,841
48 Aqua pro injeksi 1 L Botol Rp 35,614.35 Rp 46,299
49 Azitromycin 500 mg Tablet Rp 1,892.99 Rp 2,461
50 Bamgetol 200 mg Tablet Rp 2,325.17 Rp 3,023
51 Baquinor 0,3% ED Botol Rp 37,573.60 Rp 48,846
52 Beneuron Tablet Rp 440.00 Rp 572
53 Benoson N crem Tube Rp 18,499.80 Rp 24,050 Umum
54 Benutrion VE Botol Rp 62,658.40 Rp 81,456
55 Betahistin 6 mg Tablet Rp 209.00 Rp 272
56 Betahistin HCl 24 mg Tablet Rp 4,718.00 Rp 6,133
57 Betametason crem Tube Rp 1,534.02 Rp 1,994
58 Berotec 0,1 mg Botol Rp 87,721.07 Rp 114,037
59 Bfluid 500 ml Softbag Rp 77,063.00 Rp 100,182
60 Bfluid 500 ml Softbag Rp 97,899.78 Rp 127,270
61 Bio TT Ampul Rp 60,500.00 Rp 78,650
62 Biovitan syrup Botol Rp 4,116.77 Rp 5,352
63 Bisoprolol 2,5 mg Tablet Rp 149.00 Rp 194
64 Bisoprolol 5 mg Tablet Rp 264.00 Rp 343
Bucain Spinal 0,5% Ampul Rp 57,000.00 Rp 74,100
65 Brilinta 90 mg Tablet Rp 8,480.40 Rp 11,025 Retriksi 6 tablet
66 Calcium Lactat 500 mg Tablet Rp 117.00 Rp 152
67 Calcium gluconas 10 ml Ampul Rp 1,501.20 Rp 1,952
68 Candesartan 8 mg Tablet Rp 315.00 Rp 409
69 Candesartan 16 mg Tablet Rp 1,836.05 Rp 2,387
70 Candesartan 16 mg Tablet Rp 495.00 Rp 644
71 Captopril 12,5 mg Tablet Rp 94.00 Rp 122
72 Captopril 25 mg Tablet Rp 137.75 Rp 179
73 Captopril 50 mg Tablet Rp 234.48 Rp 305
74 Carbazocrome Ampul Rp 10,584.96 Rp 13,760
75 Carmed 10% crem Tube Rp 36,075.00 Rp 46,898
76 Carmed 20% crem Tube Rp 45,715.30 Rp 59,430
77 Cepezet 100 mg Tablet Rp 1,110.00 Rp 1,443
78 Cephaflox 1 gr Vial Rp 198,135.00 Rp 257,576 Umum/ Jasarahrja
79 Cetrizine syrup Botol Rp 4,274.00 Rp 5,556
80 Cetrizine 10 mg Tablet Rp 206.00 Rp 268
81 Cefadroxil 500 mg Kapsul Rp 775.00 Rp 1,007
82 Cefadroxil 500 mg Kapsul Rp 1,002.07 Rp 1,303
83 Cefadroxil syrup 125 mg Botol Rp 3,890.00 Rp 5,057
84 Cefadroxil syrup 250 mg Botol Rp 12,375.00 Rp 16,088
85 Cefoperazone Vial Rp 56,610.00 Rp 73,593
86 Cefoperazone 1 gr Vial Rp 17,750.00 Rp 23,075
87 Ceftazidime 1 gr Vial Rp 11,825.00 Rp 15,372
88 Cefixime 100 mg/5 ml syrup Botol Rp 9,261.98 Rp 12,041
89 Cefixime 100 mg Kapsul Rp 463.00 Rp 602
90 Cefixime 100 mg Kapsul Rp 999.98 Rp 1,300
91 Cefixime 200 mg Kaplet Rp 1,705.00 Rp 2,216
92 Cefotaxime 1 gr Vial Rp 6,700.00 Rp 8,710
93 Ceftriaxon 1 gr Vial Rp 6,400.00 Rp 8,320
94 Cefuroxime 1 gr Vial Rp 57,200.00 Rp 74,360
95 Cendo Astenof 0,6 ml Botol Rp 4,551.00 Rp 5,916
96 Cendo catarlent 0,6 ml Botol Rp 4,440.00 Rp 5,772
97 Cendo Cenfresh 0,6 ml MD Botol Rp 4,600.00 Rp 5,980
98 Cendo conver 2% 0,6 ml MD Botol Rp 3,579.75 Rp 4,654
99 Cendo Efrisel 10% Botol Rp 16,927.35 Rp 22,006
100 Cando Floxa 0,6 ml MD Botol Rp 5,938.50 Rp 7,720
101 Cendo LFX 0,6 ml Botol Rp 15,318.00 Rp 19,913
102 Cendo Lyteers ED Botol Rp 22,500.00 Rp 29,250
103 Cendo Hyalub ED Botol Rp 59,107.50 Rp 76,840
104 Cendo Hyalub 0,6 ml MD Botol Rp 12,654.00 Rp 16,450
105 Cendo Hyalub 0,6 ml MD Botol Rp 11,400.00 Rp 14,820
106 Cendo Midriatil 0,5% Botol Rp 5,855.25 Rp 7,612
107 Cendo Midriatil 1 % ED Botol Rp 38,250.00 Rp 49,725
108 Cendo Natacen 0,6 ml Botol Rp 9,240.75 Rp 12,013
109 Cendo Polynel 0,6 ml MD Botol Rp 3,574.00 Rp 4,646
110 Cendo P. Pred Botol Rp 8,491.50 Rp 11,039
111 Cendo Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
112 Cendo protagenta 0,6 ml MD Botol Rp 7,964.25 Rp 10,354
113 Cendo Timol 0,5% 0,6 ml MD Botol Rp 5,716.50 Rp 7,431
114 Cendo Tobroson 0,6 ml Botol Rp 6,438.00 Rp 8,369
115 Cendo Tobro 0,6 ml MD Botol Rp 4,245.75 Rp 5,519
116 Cendo xytrol 5 ml Botol Rp 30,247.50 Rp 39,322
117 Cendo xyitrol 0,6 ml MD Botol Rp 5,411.25 Rp 7,035
118 Cilostazol 100 mg Tablet Rp 7,000.00 Rp 9,100
119 Ciprofloxacin Infus Botol Rp 8,100.00 Rp 10,530
120 Ciprofloxacin 500 mg Tablet Rp 539.98 Rp 702
121 Ciprofloxacin 500 mg Tablet Rp 475.01 Rp 618
122 Citicholin 250 mg/2 ml Ampul Rp 22,275.00 Rp 28,958
123 Citicholin 500 mg/4 ml Ampul Rp 24,420.00 Rp 31,746
124 Citicolin 500 mg Tablet Rp 4,000.00 Rp 5,200
125 Chloroquin 150 mg Tablet Rp 1,505.74 Rp 1,957
126 Chlorpheniramine Maleat (CTM) Tablet Rp 51.00 Rp 66
127 Clindamycin 300 mg Kapsul Rp 1,334.78 Rp 1,735
128 Clindamycin 150 mg Kapsul Rp 778.00 Rp 1,011
129 Clobazam 10 mg Tablet Rp 384.00 Rp 499
130 Clonidine 0,15 mg Tablet Rp 146.00 Rp 190
131 Clopidogrel 75 mg Tablet Rp 580.23 Rp 754
132 Clozapine 25 mg Tablet Rp 477.00 Rp 620
133 Codein 10 mg Tablet Rp 610.50 Rp 794
134 Colchicine 0,5 Tablet Rp 671.00 Rp 872
135 Colchicine 0,5 Tablet Rp 1,665.00 Rp 2,165
136 Colistine 0,25 MIU Tablet Rp 2,553.00 Rp 3,319
137 Comafusin Hepar Botol Rp 87,999.98 Rp 114,400
138 Cotrimoxasole suspensi Botol Rp 5,954.30 Rp 7,741
139 Cotrimoxazole 480 mg Tablet Rp 253.97 Rp 330
140 Curcuma Force Tablet Rp 876.15 Rp 1,139
141 Curcuma 20 mg Tablet Rp 482.02 Rp 627
142 Daily C 500 mg Tablet Rp 577.50 Rp 751
143 DC2 Tablet Rp 8,116.88 Rp 10,552 Retriksi 3 tablet
144 Depakote 250 mg Kaplet Rp 8,880.00 Rp 11,544
145 Desolex crem 10 gr Tube Rp 25,080.00 Rp 32,604 Umum
146 Dexamethason 5 mg/ml Ampul Rp 1,427.39 Rp 1,856
147 Dexamethason 0,5 mg Tablet Rp 132.09 Rp 172
148 Dexketoprofen 50 mg/2 ml Ampul Rp 24,531.00 Rp 31,890
149 Dexketoprofen 25 mg Tablet Rp 3,302.00 Rp 4,293 Retriksi 6 tablet
150 Dexosimethason 0,25 mg crem 10 g Tube Rp 9,079.80 Rp 11,804

151 Dexosimethason 0,25 mg crem 15 g Tube Rp 13,800.00 Rp 17,940

152 Dextrose 10% Botol Rp 7,200.30 Rp 9,360
153 Dextrose 10% Botol Rp 8,350.53 Rp 10,856
154 Dextrose 5% Botol Rp 6,626.70 Rp 8,615
155 Dextrose 5% Botol Rp 7,685.64 Rp 9,991
156 D5 1/2 NS Botol Rp 10,280.00 Rp 13,364
157 D5 1/4 NS Botol Rp 10,280.00 Rp 13,364
158 Dextrose 5% 100 ml piggy bag Botol Rp 13,786.20 Rp 17,922
159 Dextrose 40% Botol Rp 7,770.00 Rp 10,101
160 Diazepam 2 mg Tablet Rp 70.00 Rp 91
161 Diazepam 5 mg/ml inj. Ampul Rp 1,559.00 Rp 2,027
162 Diazepam 5 mg rectal Rectube Rp 13,546.00 Rp 17,610
163 Diazepam 10 mg rectal Rectube Rp 19,693.00 Rp 25,601
164 Dibekacin 100 mg Ampul Rp 79,920.00 Rp 103,896
165 Digoxin 0,25 mg Tablet Rp 114.40 Rp 149
166 Diltiazem Tablet Rp 1,665.00 Rp 2,165
167 Dimenhidrinat 50 mg Tablet Rp 109.99 Rp 143
168 Dipenhidramin 15 mg/15 ml Ampul Rp 5,390.00 Rp 7,007
169 Dipenhidramin 10 mg/ml Ampul Rp 1,332.00 Rp 1,732
170 Divalproex sodium 250 mg Kaplet Rp 2,310.00 Rp 3,003
171 Divalproex sodium 500 mg Kaplet Rp 1,505.00 Rp 1,957
172 Dobutamin 250 mg/5 ml Ampul Rp 30,885.75 Rp 40,151
173 Dobutamin 50 mg Ampul Rp 9,004.00 Rp 11,705
174 Dolgesic Injeksi Ampul Rp 11,988.00 Rp 15,584
175 Domavit Softcap Rp 3,931.00 Rp 5,110 Retriksi 7 Tablet
176 Domperidon 10 mg Tablet Rp 253.00 Rp 329
177 Domperidone syrup Botol Rp 4,437.28 Rp 5,768
178 Donepezil Tablet Rp 1,680.00 Rp 2,184
179 Dopamet (methyldopa) Tablet Rp 1,023.00 Rp 1,330
180 Dopamin 200 mg/5 ml Ampul Rp 3,945.00 Rp 5,129
181 Dorium Kaplet Rp 5,328.00 Rp 6,926 Retriksi 6 tablet
182 Doxycycline 100 mg Kapsul Rp 281.69 Rp 366
183 Dulcolax 5 mg tablet Tablet Rp 1,586.85 Rp 2,063
184 Dulcolax 5 mg Suppo Rp 5,084.90 Rp 6,610
185 Dulcolax 10 mg Suppo Rp 4,325.00 Rp 5,623
186 Duloxta 60 Tablet Rp 14,499.38 Rp 18,849 Retriksi 6 tablet
187 Durogesic 12,5 MU Patch Rp 63,774.38 Rp 82,907
188 Eperison HCl 50 mg Tablet Rp 1,170.13 Rp 1,521
189 Ephedrine injeksi Ampul Rp 6,485.95 Rp 8,432
190 Ephineprine injeksi Ampul Rp 2,904.00 Rp 3,775
191 Erdostein 300 mg Kapsul Rp 2,594.63 Rp 3,373
192 Ericaf Tablet Rp 3,330.00 Rp 4,329
193 Erytromicin suspensi Botol Rp 12,210.00 Rp 15,873
194 Euthyrox 50 mg Tablet Rp 728.56 Rp 947
195 Etoricoxib 60 mg Tablet Rp 3,552.00 Rp 4,618 Retriksi 6 tablet
196 Euthyrox 100 mg Tablet Rp 3,828.00 Rp 4,976
197 Farbion Injeksi Ampul Rp 11,000.00 Rp 14,300
198 Farbivent 2,5 ml Ampul Rp 3,951.60 Rp 5,137
199 Fargoxin 2 ml njeksi Ampul Rp 49,500.00 Rp 64,350
200 Fasorbid 10 mg Tablet Rp 300.30 Rp 390
201 Fenofibrate 300 mg Tablet Rp 820.00 Rp 1,066
202 Fentanyl citrate Inj 2 ml Ampul Rp 29,500.47 Rp 38,351
203 Fladystine ovula Suppo Rp 15,484.50 Rp 20,130
204 Flunarizine 5 mg Tablet Rp 1,200.00 Rp 1,560
205 Forumen tetes telinga Botol Rp 29,082.00 Rp 37,807
206 Fosen Enema Botol Rp 94,905.00 Rp 123,377
207 Furosemid injeksi Ampul Rp 969.00 Rp 1,260
208 Furosemid 40 mg Tablet Rp 221.00 Rp 287
209 Gabapentine 300 mg Kapsul Rp 1,000.00 Rp 1,300
210 Gabapentine 100 mg Kapsul Rp 1,110.00 Rp 1,443
211 Gabatin 300 mg Kapsul Rp 9,990.00 Rp 12,987 Umum
212 Gabaxa Botol Rp 247,227.00 Rp 321,395
213 Gelafusal infusion 500 ml Bag Rp 145,015.00 Rp 188,520
214 Genoint tetes mata Botol Rp 13,320.00 Rp 17,316
215 Gentamicin salep kulit Tube Rp 2,963.70 Rp 3,853
216 Gentamicin 0,3% 5 gram Tube Rp 40,376.25 Rp 52,489
217 Gentamicin 40 mg/ml injeksi Ampul Rp 3,385.50 Rp 4,401
218 Glauseta Tablet Rp 2,876.00 Rp 3,739
219 Glauseta Tablet Rp 3,355.42 Rp 4,362 Retriksi 6 tablet
220 Glibenclamid 5 mg Tablet Rp 333.00 Rp 433
221 Gliclazide 80 mg Tablet Rp 214.00 Rp 278
222 Glimepirid 2 mg Tablet Rp 220.00 Rp 286
223 Glimepirid 4 mg Tablet Rp 2,032.70 Rp 2,643
224 Granisetron 1 mg Ampul Rp 22,200.00 Rp 28,860
225 Griseofulvin 125 mg Tablet Rp 500.00 Rp 650
226 Harnal 0,2 Tablet Rp 7,859.99 Rp 10,218
227 Harnal OCAS Tablet Rp 4,356.00 Rp 5,663
228 Heparin sodium Ampul Rp 46,635.00 Rp 60,626
229 Hepatosol Vanila Pcs Rp 36,815.00 Rp 47,860
230 Herbesser CD 200 Tablet Rp 5,196.82 Rp 6,756
231 Hervis 0,35 gr Tablet Rp 40,792.50 Rp 53,030
232 Hexymer 2 mg Tablet Rp 427.35 Rp 556
233 Histapan Tablet Rp 804.75 Rp 1,046 Retriksi 6 tablet
234 Human Albumin 20% Botol Rp 913,227.04 Rp 1,187,195 Retriksi 3 botol/minggu

235 Hydrocortison salep kulit Tube Rp 6,136.00 Rp 7,977

236 Hyosine injeksi Ampul Rp 6,188.05 Rp 8,044
237 Hyson Injeksi Ampul Rp 97,402.43 Rp 126,623 Jasaraharja/Umum
238 Hyoscine butylbromide 10 mg Tablet Rp 1,050.00 Rp 1,365
239 Hystolan 20 mg Tablet Rp 4,995.00 Rp 6,494
240 Ibuprofen 400 mg Tablet Rp 215.00 Rp 280
241 Ibuprofen 200 mg Tablet Rp 155.00 Rp 201
242 Ibuprofen suspensi Botol Rp 9,075.00 Rp 11,798
243 Ifalmin Kapsul Rp 5,500.00 Rp 7,150 Retriksi 3 tablet
244 Imboost Force Kaplet Rp 5,701.90 Rp 7,412 Retriksi 3 tablet
245 Indop (Dopamin) Ampul Rp 19,057.50 Rp 24,775
246 Imitatin 1 gr Vial Rp 170,829.00 Rp 222,078 Jasaraharja/Umum
247 Interlac Sachet Rp 11,704.95 Rp 15,216 Retriksi 4 bungkus
248 Inviclot Vial Rp 65,340.00 Rp 84,942
249 Iremax Tablet Rp 990.68 Rp 1,288 Retriksi 6 tablet
250 Isoflurane 250 ml Botol Rp 827,672.50 Rp 1,075,974
251 Isoniazid 100 mg Tablet Rp 444.00 Rp 577
252 Isoniazid 300 mg Tablet Rp 666.00 Rp 866
253 Isosorbid dinitrate 5 mg Tablet Rp 99.90 Rp 130
254 Isosorbid dinitrate 1 mg/ml Ampul Rp 33,000.00 Rp 42,900
255 Kaen 3B Botol Rp 11,500.00 Rp 14,950
256 Kaen 3B Botol Rp 12,770.55 Rp 16,602
257 Kaen 4B Botol Rp 10,858.02 Rp 14,115
258 Kaen 4B Botol Rp 13,769.55 Rp 17,900
259 Kaen Mg3 Botol Rp 10,560.00 Rp 13,728
260 Kalium diklofenak 50 mg Tablet Rp 333.00 Rp 433
261 KCL 7,46 Botol Rp 3,470.97 Rp 4,512
262 Ketoconazole salep Tube Rp 8,800.00 Rp 11,440
263 Ketoconazole 200 mg Tablet Rp 495.00 Rp 644
264 Ketorolac injeksi Ampul Rp 1,475.00 Rp 1,918
265 Kidmin 200 ml Bag Rp 54,619.77 Rp 71,006
266 Kina Tablet Rp 2,200.00 Rp 2,860
267 KSR 600 mg Tablet Rp 1,842.00 Rp 2,395
268 Kutoin Tablet Rp 1,492.12 Rp 1,940
269 KTM Injeksi Vial Rp 190,920.00 Rp 248,196
270 Lactafit Tablet Rp 2,997.00 Rp 3,896 Umum
271 Lactogen Lactofree Kaleng Rp 101,817.90 Rp 132,363 Umum
272 Lactogen Premature Kaleng Rp 101,909.10 Rp 132,482 Umum
273 Lactulosa syrup Botol Rp 18,912.00 Rp 24,586
274 Lametic syrup Botol Rp 102,300.00 Rp 132,990 Umum
275 Lametic 8 mg/4 ml Ampul Rp 68,200.00 Rp 88,660 Umum
276 Lanabal 500 mcg Kapsul Rp 2,750.00 Rp 3,575 Umum
277 Lanfix 200 Kapsul Rp 37,400.00 Rp 48,620 Umum
278 Lanzoprasole 30 mg Kapsul Rp 278.00 Rp 361
279 Lantus solostar Flexpen Rp 89,808.99 Rp 116,752
280 Laxadine syrup 30 ml Botol Rp 42,900.00 Rp 55,770
281 Laxadine emulsi 60 ml Botol Rp 47,730.00 Rp 62,049
282 Laxalosan syrup Botol Rp 61,050.00 Rp 79,365 Umum
283 L Bio Sachet Rp 8,963.25 Rp 11,652 Retriksi 5/3 bungkus
284 Lesichol 300 Softcap Rp 13,200.00 Rp 17,160 Umum
285 Levetiracetam 500 mg Tablet Rp 4,117.00 Rp 5,352
286 Levopar Tablet Rp 904.00 Rp 1,175
287 Levoben 100 mg Tablet Rp 2,997.00 Rp 3,896
288 Levofloxacin 500 mg Tablet Rp 373.01 Rp 485
289 Levofloxacin 750 mg Tablet Rp 4,403.00 Rp 5,724
290 Levofloxacin Infus Botol Rp 23,100.00 Rp 30,030
291 Levothyroxine 100 mcg Tablet Rp 890.01 Rp 1,157
292 Lidokain 2% Injeksi Ampul Rp 1,341.00 Rp 1,743
293 Lidokain compositum Ampul Rp 1,531.98 Rp 1,992
294 Lisinopril 10 mg Tablet Rp 149.00 Rp 194
295 Lisinopril 5 mg Tablet Rp 220.00 Rp 286
296 Lodomer 2 mg Tablet Rp 1,212.12 Rp 1,576
297 Loperamid 2 mg Tablet Rp 89.00 Rp 116
298 Loratadine 10 mg Tablet Rp 162.00 Rp 211
299 Lycalvit 60 ml Botol Rp 47,932.50 Rp 62,312 Umum
300 Lycopect Tablet Rp 387.97 Rp 504
301 Maganol Infus Botol Rp 56,610.00 Rp 73,593 Umum
302 Manitol 20% Botol Rp 39,650.28 Rp 51,545
303 Maxiflon 400 mg Tablet Rp 37,296.00 Rp 48,485 Umum/Jasaraharja
304 MgSO4 40% Botol Rp 5,661.00 Rp 7,359
305 Mecobalamin 500 mg Kapsul Rp 710.40 Rp 924
306 Meloxicam 7,5 mg Tablet Rp 319.49 Rp 415
307 Meloxicam 15 mg Tablet Rp 406.09 Rp 528
308 Meprovent Inhalasi Botol Rp 3,502.05 Rp 4,553
309 Meropenem 0,5 gr Vial Rp 24,000.00 Rp 31,200
310 Meropenem 1 gr Vial Rp 46,810.00 Rp 60,853
311 Mersibion 5000 injeksi Ampul Rp 4,001.55 Rp 5,202
312 Metamizole injeksi Ampul Rp 5,045.45 Rp 6,559
313 Metamizole 500 mg Tablet Rp 333.00 Rp 433
314 Metformin 500 mg Tablet Rp 179.99 Rp 234
315 Metformin 500 mg Tablet Rp 221.00 Rp 287
316 Methylergometrin 0,125 mg Tablet Rp 313.00 Rp 407
317 Methylergometrin 2 mg inj. Ampul Rp 1,069.00 Rp 1,390
318 Methylprednisolon 125 mg Injeksi Vial Rp 14,208.00 Rp 18,470
319 Methylprednisolon 4 mg Tablet Rp 239.65 Rp 312
320 Methylprednisolon 4 mg Tablet Rp 203.00 Rp 264
321 Methylprednisolon 8 mg Tablet Rp 566.70 Rp 737
322 Metoclopramid 5 mg injeksi Ampul Rp 1,883.00 Rp 2,448
323 Metoclopramid 10 mg Tablet Rp 66.00 Rp 86
324 Metronidazole infus Botol Rp 5,938.50 Rp 7,720
325 Metronidazole 500 mg Tablet Rp 221.00 Rp 287
326 Miconazole 2% Tube Rp 1,916.97 Rp 2,492
327 Midanest 5 mg Ampul Rp 19,980.00 Rp 25,974
328 Migratop 25 mg Tablet Rp 3,988.60 Rp 5,185
329 Miniaspi 80 mg Tablet Rp 89.00 Rp 116
330 Miriwash 500 ml Softbag Rp 109,854.00 Rp 142,810
331 Misoprostol 200 Mcg Tablet Rp 4,717.50 Rp 6,133
332 Mometason Furoate crem Tube Rp 6,025.00 Rp 7,832
333 Morfina 10 mg/ml Ampul Rp 30,272.65 Rp 39,354
334 Moxifloxacin 400 mg Tablet Rp 10,770.00 Rp 14,001
335 Moxifloxacin 400 Infus Botol Rp 47,148.00 Rp 61,292
336 MST Continue 10 mg Tablet Rp 15,762.00 Rp 20,491
337 Mupirocin crem 5 gr Tube Rp 22,395.45 Rp 29,114
338 Myores Tablet Rp 4,995.00 Rp 6,494 Retriksi 6 tablet
339 Natrium Chlorida 0,9% (NaCl) 500 ml Botol Rp 6,975.45 Rp 9,068
340 Natrium diklofenak 25 mg Tablet Rp 114.99 Rp 149
341 Natrium diklofenak 50 mg Tablet Rp 200.00 Rp 260
342 NaCl Piggybag 100 ml Botol Rp 7,125.00 Rp 9,263
343 Natur E Softcap Rp 1,271.86 Rp 1,653
344 Neostigmin Injeksi Ampul Rp 9,990.00 Rp 12,987
 Neostigmin Injeksi Ampul Rp 8,880.00 Rp 11,544
345 New antides Tablet Rp 194.61 Rp 253
346 New diatabs Tablet Rp 825.00 Rp 1,073
347 Nicardipin Injeksi Ampul Rp 20,500.00 Rp 26,650
348 Nifedipin 10 mg Tablet Rp 164.00 Rp 213
349 Nitrokaf retard Tablet Rp 1,650.00 Rp 2,145
350 Norelut Tablet Rp 4,995.00 Rp 6,494
351 Norit Tablet Rp 400.00 Rp 520
352 Noreprinefrin Bitartrate Ampul Rp 6,673.00 Rp 8,675
353 Novapyron Tablet Rp 518.00 Rp 673
354 Novorapid Flexpen Flexpen Rp 90,314.00 Rp 117,408
355 Noxetine 20 mg Tablet Rp 11,100.00 Rp 14,430
356 NTG (glyceryl trinitrate) Tablet Rp 60,775.00 Rp 79,008
357 Nystatin drop Botol Rp 17,759.99 Rp 23,088
358 Obat batuk hitam (OBH) syrup Botol Rp 6,468.00 Rp 8,408
359 Ofloxacin 400 mg Tablet Rp 583.00 Rp 758
360 Omeprazole 40 mg injeksi Vial Rp 8,500.00 Rp 11,050
361 Omeprazole 20 mg Kapsul Rp 429.00 Rp 558
362 Ondansetron 4 mg Injeksi Ampul Rp 1,400.00 Rp 1,820
363 Ondansetron 8 mg/4 ml inj. Ampul Rp 4,400.04 Rp 5,720
364 Ondansetron 4 mg Tablet Rp 506.99 Rp 659
365 Onoiwa Kapsul Rp 5,994.00 Rp 7,792 Retriksi 3 tablet
366 Oralit Sachet Rp 869.30 Rp 1,130
367 Oste Forte Sachet Rp 5,144.87 Rp 6,688 Retriksi 3 tablet
368 Ottogenta Injeksi Ampul Rp 6,600.00 Rp 8,580
369 Ottopain eye drop Botol Rp 83,041.88 Rp 107,954 Khusus RI
370 Otsu salin 3% Botol Rp 30,610.45 Rp 39,794
371 Oxytetracyclin salep kulit Tube Rp 5,550.00 Rp 7,215
372 Oxytocin injeksi Ampul Rp 1,348.00 Rp 1,752
373 Oxytocin injeksi Ampul Rp 3,296.70 Rp 4,286
374 Paracetamol infus Botol Rp 14,358.96 Rp 18,667
375 Paracetamol 500 mg Tablet Rp 214.00 Rp 278
376 Paracetamol syrup Botol Rp 1,171.00 Rp 1,522
377 Patral Tablet Rp 7,881.00 Rp 10,245 Umum
378 Pehacain injeksi Ampul Rp 3,150.87 Rp 4,096
379 Peptisol Vanila Box Rp 23,865.00 Rp 31,025 Umum
380 Perifas Tablet Rp 2,442.00 Rp 3,175
381 Permethrin 10 mg Tube Rp 7,303.80 Rp 9,495
382 Permethrine 15 mg Tube Rp 11,466.03 Rp 14,906
383 Pervita Kaplet Rp 1,665.00 Rp 2,165 Retriksi 7 Tablet
384 Pethidina 50mg/ml Ampul Rp 15,295.02 Rp 19,884
385 Phenytoin sodium 50 mg/ml Ampul Rp 23,448.75 Rp 30,483
386 Piracetam 800 mg Tablet Rp 632.03 Rp 822
387 Piracetam 3 gr Ampul Rp 14,368.20 Rp 18,679
388 Polidemicin ED Botol Rp 31,524.00 Rp 40,981
389 Polydex 0,6 ml MD Botol Rp 5,883.00 Rp 7,648
390 Poro Suppositoria 125 mg Suppo Rp 8,800.00 Rp 11,440
391 Poro Suppositoria 250 mg Suppo Rp 12,320.00 Rp 16,016
392 Pramipexole 0,125 mg Tablet Rp 1,413.00 Rp 1,837
393 Pramipexole 0,375 ER Tablet Rp 3,050.00 Rp 3,965
394 Prednison 5 mg Tablet Rp 126.00 Rp 164
395 Pregabalin 75 mg Tablet Rp 3,608.00 Rp 4,690
396 Pregnolin 5 mg Tablet Rp 4,395.60 Rp 5,714
397 Prohepar Kapsul Rp 5,555.54 Rp 7,222 Retriski 3 Kapsul
398 Propanolol 10 mg Tablet Rp 77.00 Rp 100
399 Propanolol 40 mg Tablet Rp 135.00 Rp 175
400 Propofol 20 ml Ampul Rp 10,382.94 Rp 13,498
401 Propyltiouracil 100 mg Tablet Rp 440.00 Rp 572
402 Provital plus Tablet Rp 6,710.00 Rp 8,723 Retriksi 3 Kaplet
403 Pyrantel 125 mg Tablet Rp 512.67 Rp 666
404 Pyrazinamide 500 mg Tablet Rp 777.00 Rp 1,010
405 Phytomenadion 10 mg Tablet Rp 781.00 Rp 1,015
406 Quanocain spinal 2 mg/4 ml Ampul Rp 52,250.00 Rp 67,925
407 Ramipril 5 mg Tablet Rp 263.00 Rp 342
408 Ramipril 10 mg Tablet Rp 703.60 Rp 915
409 Ranitidin 50 mg/2 ml Ampul Rp 4,995.00 Rp 6,494
410 Ranitidin 50 mg/2 ml Ampul Rp 3,907.20 Rp 5,079
411 Ranitidin 50 mg/2 ml Ampul Rp 1,500.00 Rp 1,950
412 Ranitidin 150 mg Tablet Rp 150.00 Rp 195
413 Rebamipid Tablet Rp 3,108.00 Rp 4,040 Retriksi 6 tablet
414 Recalus Kapsul Rp 5,272.50 Rp 6,854 Retriksi 6 tablet
415 Reco tetes telinga Botol Rp 16,650.00 Rp 21,645
416 Recustein dry syrup Botol Rp 60,500.00 Rp 78,650
417 Recolfar 0,5 mg Tablet Rp 5,500.00 Rp 7,150
418 Regivell 20 mg Botol Rp 61,605.00 Rp 80,087
419 Ringer Lactat (RL) Botol Rp 8,498.00 Rp 11,047
420 Ringer lactat B Braun Botol Rp 9,156.39 Rp 11,903
421 Rifampicin 600 mg Kapsul Rp 2,513.99 Rp 3,268
422 Rincobal 500 mg Kapsul Rp 1,510.00 Rp 1,963
423 Risperidon 2 mg Tablet Rp 272.99 Rp 355
424 Rocuronium Bromide 50 mg Ampul Rp 35,071.67 Rp 45,593
425 Ryzodeg Flex Pen Rp 113,018.03 Rp 146,923
426 Sagestam 40 mg inj Ampul Rp 16,500.00 Rp 21,450 Umum
427 Sagestam salep mata Tube Rp 41,514.00 Rp 53,968
428 Salbutamol 4 mg Tablet Rp 112.39 Rp 146
429 Salbutamol 2 mg Tablet Rp 113.28 Rp 147
430 Salbutamol sol 1 mg/ml Ampul Rp 4,440.00 Rp 5,772
431 Sanbe Tears ED Botol Rp 25,086.00 Rp 32,612
432 Sanmol Infus Botol Rp 22,582.95 Rp 29,358 Umum
433 Sanmol drop Botol Rp 18,426.00 Rp 23,954 Umum
434 Sanmol syrup Botol Rp 14,652.00 Rp 19,048 Umum
435 Sansulin Flexpen Rp 89,802.61 Rp 116,743
436 Santa E Kapsul Rp 4,662.00 Rp 6,061 Retriksi 3 tablet
437 Scabimite crem Tube Rp 66,000.00 Rp 85,800 Umum
438 Scobutrin Tablet Rp 3,190.00 Rp 4,147
439 Sevoflurane 250 ml Botol Rp 887,911.00 Rp 1,154,284
440 Sibital Injeksi Ampul Rp 15,295.80 Rp 19,885
441 Simarc 2 mg Tablet Rp 889.35 Rp 1,156
442 Simvastatin 10 mg Tablet Rp 495.00 Rp 644
443 Simvastatin 20 mg Tablet Rp 121.33 Rp 158
444 Spironolacton 25 mg Tablet Rp 222.00 Rp 289
445 Spironolacton 100 mg Kapsul Rp 552.00 Rp 718
446 Striatamin Kapsul Rp 5,371.99 Rp 6,984
447 Sucralfate suspensi 100 ml Botol Rp 7,865.00 Rp 10,225
448 Sucralfate 500 mg Tablet Rp 265.00 Rp 345
449 Sulfadiazine silver 35 gr Tube Rp 18,725.69 Rp 24,343
450 Sulfitis 500 mg Tablet Rp 3,219.00 Rp 4,185
451 Suprafenid Suppo Rp 10,822.50 Rp 14,069
452 Symbicort 160 dos Botol Rp 166,840.76 Rp 216,893
453 Tablet tambah darah Tablet Rp 255.00 Rp 332
454 Tamsolusin 0,4 mg Tablet Rp 4,356.00 Rp 5,663
455 Tenofovir 300 mg Tablet Rp 2,260.37 Rp 2,938
456 Tetagam P Vial Rp 146,800.00 Rp 190,840
457 Tison 4 Tablet Rp 3,520.00 Rp 4,576
458 Thiamazole 5 mg Tablet Rp 555.00 Rp 722
459 Thiamazole 10 mg Tablet Rp 990.00 Rp 1,287
460 Thiamphenicol 500 mg Tablet Rp 1,013.21 Rp 1,317
461 Thyrozol 5 mg Tablet Rp 679.00 Rp 883
462 Thyrozol 10 mg Tablet Rp 1,325.00 Rp 1,723
463 Tremenza Tablet Rp 1,720.50 Rp 2,237 Retriksi 6 tablet
464 Trihexyphenidil 2 mg Tablet Rp 63.00 Rp 82
465 Triamcinolon 4 mg Tablet Rp 884.61 Rp 1,150
466 Triamcinolon 10 mg/ml Vial Rp 44,955.00 Rp 58,442
467 Triamcinolon crem Tube Rp 27,000.00 Rp 35,100
468 Trilac injeksi Vial Rp 180,000.00 Rp 234,000 Umum
469 Tuberculin Tes Vial Rp 738,150.00 Rp 959,595
470 Umarone Vial Rp 192,500.00 Rp 250,250 Umum
471 Ursodeoxycholic Acid 250 mg Tablet Rp 2,050.00 Rp 2,665
472 Vaksin TT Vial Rp 116,217.00 Rp 151,082
473 Valdimex 5 mg Tablet Rp 1,210.00 Rp 1,573
474 Venodenol injeksi Ampul Rp 166,500.00 Rp 216,450
475 Vitamin A IPI Tablet Rp 172.72 Rp 225
476 Vitamin B com Tablet Rp 60.00 Rp 78
477 Vitamin B6 Tablet Rp 140.80 Rp 183
478 Vitamin B1 Tablet Rp 246.00 Rp 320
479 Vitamin C 50 mg Tablet Rp 46.42 Rp 60
480 Vitamin C 500 mg Tablet Rp 495.00 Rp 644
481 Vitamin D3 1,000 mg (Yavit D) Tablet Rp 2,042.00 Rp 2,655 Retriksi 6 tablet
482 Vitamin k injeksi Ampul Rp 8,880.00 Rp 11,544
483 Vitrolenta Botol Rp 36,352.50 Rp 47,258
484 Vitsap Tablet Rp 3,404.00 Rp 4,425 Retriksi 3 tablet
485 Vosea Tablet Rp 550.00 Rp 715
486 Warfarin 2 mg Tablet Rp 698.00 Rp 907
487 Wiaflox 500 Tablet Rp 14,850.00 Rp 19,305 Umum
488 Widahes 500 ml Botol Rp 91,020.00 Rp 118,326
489 Xiety 10 mg Tablet Rp 4,870.12 Rp 6,331
490 Zinc sulfat 20 mg Tablet Rp 250.98 Rp 326
491 Zinc sulfat drop Botol Rp 5,445.66 Rp 7,079
492 Zinc sulfate sirup Botol Rp 4,395.60 Rp 5,714
493 Zollocid 20 mg Kapsul Rp 9,900.00 Rp 12,870
494 Zolmia Tablet Rp 7,770.00 Rp 10,101 Retriksi 6 tablet
Bahan Medis Pakai Habis
2
(BMHP)
1 AgNO3 3% 100 ml Botol Rp 512,820.00 Rp 666,666
2 Alkohol 70% Pcs Rp 35,187.00 Rp 45,743
3 Alkohol swab Pcs Rp 159.54 Rp 207
4 Ambu bag dewasa Pcs Rp 677,875.00 Rp 881,238
5 Ambu bag anak Pcs Rp 677,875.00 Rp 881,238
6 Aproon/celemek Pcs Rp 4,173.60 Rp 5,426
7 Assucryl 1 Pcs Rp 47,932.02 Rp 62,312
8 Assucryl 2 Pcs Rp 75,081.52 Rp 97,606
9 Assucryl 2/0 Pcs Rp 64,355.61 Rp 83,662
10 Assucryl 3/0 Pcs Rp 64,355.58 Rp 83,662
11 Assucryl 4/0 Pcs Rp 82,590.66 Rp 107,368
12 Bio Pen Electrosurgical pencil Pcs Rp 46,065.00 Rp 59,885
Bisturi No. 10 (Surgical blades 10)
13
serenity
Pcs Rp 1,665.00 Rp 2,165
Bisturi No. 11 (Surgical blades 11) Pcs
14
serenity
Rp 1,665.00 Rp 2,165
15 Bisturi No. 15 (Biss mess OM 15) Pcs Rp 781.00 Rp 1,015
Bisturi No. 20 (Surgical blades 20) Pcs
16
serenity
Rp 609.40 Rp 792

17 Breathing sircuit child Pcs Rp 72,800.46 Rp 94,641

18 Breathing sircuit infant Pcs Rp 72,800.46 Rp 94,641
19 Breket Pcs Rp 20,125.00 Rp 26,163
20 Burrowl Pcs Rp 116,550.00 Rp 151,515
21 Canofix - PU 6 x 8 cm Pcs Rp 6,882.05 Rp 8,947
22 Cervical collar Pcs Rp 133,584.00 Rp 173,659
23 Cat gut chromic 3/0 Pcs Rp 16,500.00 Rp 21,450
24 Chromic 1 HRG Pcs Rp 51,913.59 Rp 67,488
25 Chromic 2 HRG Pcs Rp 44,905.05 Rp 58,377
26 Chromic 2/0 HRG Pcs Rp 40,665.96 Rp 52,866
27 Chromic 3/0 HR Pcs Rp 34,410.00 Rp 44,733
28 Chromic 4/0 HR Pcs Rp 41,295.33 Rp 53,684
29 Cat gut chromic 2/0 Pcs Rp 7,683.32 Rp 9,988
30 Combo pack (Infus set) Pcs Rp 21,450.00 Rp 27,885
31 Comy Bag (Colostomy bag) Pcs Rp 27,600.00 Rp 35,880
32 Cutimed gel 15 gr Tube Rp 52,110.00 Rp 67,743
33 Cutimed siltec 10x10 cm Sac Rp 61,600.00 Rp 80,080
34 Cutimed sorbact 7 x 9 cm Pcs Rp 32,800.00 Rp 42,640
35 Daryantuell Pcs Rp 17,181.80 Rp 22,336
36 Electroda dewasa Pcs Rp 4,386.72 Rp 5,703
37 Elektrode (Anak) Pcs Rp 1,266.18 Rp 1,646
38 Elektrode Bayi Pcs Rp 1,276.50 Rp 1,659
39 Endotracheal Tube 2,5 Pcs Rp 21,580.00 Rp 28,054
40 Endotracheal Tube 3 Pcs Rp 21,580.00 Rp 28,054
41 Endotracheal Tube 3,5 Pcs Rp 32,090.96 Rp 41,718
42 Endotracheal Tube 4,0 Pcs Rp 17,036.00 Rp 22,147
43 Endotracheal Tube 4,5 Pcs Rp 21,579.76 Rp 28,054
44 Endotracheal Tube 5,0 Pcs Rp 21,579.76 Rp 28,054
45 Endotracheal Tube 5,5 Pcs Rp 21,579.76 Rp 28,054
46 Endotracheal Tube 6,0 Pcs Rp 26,565.00 Rp 34,535
47 Endotracheal Tube 6,5 Pcs Rp 16,947.00 Rp 22,031
48 Endotracheal Tube 7,0 Pcs Rp 21,579.95 Rp 28,054
49 Endotracheal Tube 7,5 Pcs Rp 21,579.75 Rp 28,054
50 Endotracheal Tube 8,0 Pcs Rp 21,579.51 Rp 28,053
51 Eye protector bayi Pcs Rp 42,550.00 Rp 55,315
52 Feeding tube 3,5 R Pcs Rp 12,273.03 Rp 15,955
53 Feeding tube No. 5 R 100 cm Pcs Rp 14,077.14 Rp 18,300
54 Feeding tube No.8 Pcs Rp 12,099.40 Rp 15,729
55 Feeding tube No.8 100 cm Pcs Rp 14,077.14 Rp 18,300
56 Fm Crepe 10 cm Roll Rp 48,800.00 Rp 63,440
57 Fm crepe 15 cm Roll Rp 57,319.99 Rp 74,516
58 Filapeau 5/0 Pcs Rp 47,948.67 Rp 62,333
59 Filapeau 4/0 Pcs Rp 44,841.34 Rp 58,294
60 Filapeau 2/0 Pcs Rp 38,000.00 Rp 49,400
61 Folley cateter no. 6 Pcs Rp 16,610.03 Rp 21,593
62 Folley cateter no. 8 Pcs Rp 16,610.03 Rp 21,593
63 Folley cateter no. 8 silicon 30 ml Pcs Rp 16,447.64 Rp 21,382
64 Folley cateter no. 10 Pcs Rp 16,610.03 Rp 21,593
65 Folley cateter no. 12 Pcs Rp 12,489.72 Rp 16,237
66 Folley cateter no. 14 Pcs Rp 12,489.72 Rp 16,237
67 Folley cateter 16 Pcs Rp 12,489.72 Rp 16,237
68 Folley cateter 18 Pcs Rp 12,489.72 Rp 16,237
69 Folley cateter 18 Silicon 30 ml Pcs Rp 17,325.00 Rp 22,523
70 Folley cateter 20 FR Pcs Rp 17,325.00 Rp 22,523
71 Folley cateter 22 FR Pcs Rp 12,489.72 Rp 16,237
72 Folley cateter 24 FR Pcs Rp 12,489.72 Rp 16,237
73 Folley cateter 18 3 way Pcs Rp 32,670.00 Rp 42,471
74 Folley cateter 20 3 way Pcs Rp 39,930.00 Rp 51,909
75 Folley cateter 22 3 way Pcs Rp 32,670.00 Rp 42,471
76 Folley cateter 24 3 way Pcs Rp 32,890.00 Rp 42,757
77 Fuji Film 26 x 36 (Dry Film) Pcs Rp 39,220.00 Rp 50,986
78 Guedel airway 90 MM Kuning Pcs Rp 19,374.00 Rp 25,186
79 Guedel airway 80 MM (2) Hijau Pcs Rp 19,374.00 Rp 25,186
80 Guedel airway 70 MM (1) Putih Pcs Rp 37,290.00 Rp 48,477
81 Guedel airway 60 MM (0) Hitam Pcs Rp 19,374.00 Rp 25,186
82 Guedel airway 50 MM (00) Biru Pcs Rp 14,000.00 Rp 18,200
83 Guedel airway 40 MM (000) Pink Pcs Rp 20,999.99 Rp 27,300
84 H2O2 3% 100 ml Botol Rp 16,650.00 Rp 21,645
85 H2O2 3% 800 ml Botol Rp 33,033.00 Rp 42,943
86 H2O2 5% Botol Rp 40,404.00 Rp 52,525
87 Handrub Baymed 0,5% Botol Rp 37,152.63 Rp 48,298
88 Handwash 500 ml (Baymed 4%) Botol Rp 42,700.00 Rp 55,510
89 Handscoon gynecolog 6,5 Pairs Rp 37,504.20 Rp 48,755
90 Handscoon gynecolog size M Pairs Rp 37,504.20 Rp 48,755
91 Handscoon steril no. 6,0 Pairs Rp 13,562.73 Rp 17,632
92 Handscoon steril no. 6,5 Pairs Rp 13,686.02 Rp 17,792
93 Handscoon steril no. 7,5 Pairs Rp 13,686.00 Rp 17,792
94 Handscoon steril no. 7.0 Pairs Rp 13,562.73 Rp 17,632
95 Handscoon steril no. 8,0 Pairs Rp 13,177.56 Rp 17,131
96 Handscoon non steril size S Pcs Rp 1,252.08 Rp 1,628
97 Handscoon non steril size M Pcs Rp 1,252.08 Rp 1,628
98 Handscoon non steril size L Pcs Rp 1,252.08 Rp 1,628
99 Hazmat (Full body) Pcs Rp 436,975.00 Rp 568,068
100 Hazmat Coverall Pcs Rp 102,500.00 Rp 133,250
101 Id bracelet dewasa biru Pcs Rp 1,452.00 Rp 1,888
102 Id bracelet dewasa PINK Pcs Rp 933.51 Rp 1,214
103 Id bracelet for child blue Pcs Rp 933.51 Rp 1,214
104 Id bracelet for child pink Pcs Rp 933.51 Rp 1,214
105 Infus set micro Pcs Rp 7,150.00 Rp 9,295
106 Infus set makro y set Pcs Rp 8,596.00 Rp 11,175
107 IV. Canula 16 G (Abbocath 16) Pcs Rp 6,674.32 Rp 8,677
108 IV. Canula 18 G (Abbocath 18) Pcs Rp 6,152.84 Rp 7,999
109 IV. Canula 20 (Abbocath 20) Pcs Rp 7,215.00 Rp 9,380
110 IV. Canula 22 (Abbocath 22) Pcs Rp 6,152.84 Rp 7,999
111 IV. Cateter 24 (Abbocath 24) Pcs Rp 6,152.84 Rp 7,999
112 IV. Canula 26 (Abbocath 26) Pcs Rp 15,537.80 Rp 20,199
113 Jackson rees pedriatic Pcs Rp 283,375.00 Rp 368,387
114 Jackson rees dewasa Pcs Rp 270,249.59 Rp 351,324
115 Kantong Jenazah Pcs Rp 217,250.00 Rp 282,425
116 Kapas pembalut 250 gr Roll Rp 16,697.95 Rp 21,707
117 Kapsul kosong no. 00 Pcs Rp 133.20 Rp 173
118 Kapsul kosong no. 0 Pcs Rp 99.90 Rp 130
119 Kapsul kosong no. 1 Pcs Rp 99.90 Rp 130
120 Kapsul kosong no. 2 Pcs Rp 99.90 Rp 130
121 Kasa hydrofil 40 x 80 cm Roll Rp 16,613.52 Rp 21,598
122 Kasa steril OM 16 x 16 Pcs Rp 574.98 Rp 747
123 Kertas EKG 80 x 30 Roll Rp 162,423.10 Rp 211,150
124 Kertas perkamen Pack Rp 14,430.00 Rp 18,759
125 Kertas Puyer press Pcs Rp 183.33 Rp 238
126 Klorsept 25 Pcs Rp 1,789.33 Rp 2,326
127 Leukoplas 1624 H (2x5) Roll Rp 38,349.97 Rp 49,855
128 Leukoplas/ plester 1 x 5 (Kecil) Roll Rp 12,675.00 Rp 16,478
129 Mask Anastesi size 1 Pcs Rp 48,750.98 Rp 63,376
130 Mask Anastesi size 2 Pcs Rp 48,750.98 Rp 63,376
131 Mask Anastesi size 4 Pcs Rp 48,750.98 Rp 63,376
132 Masker Anastesi 5 Pcs Rp 48,750.39 Rp 63,376
133 Masker Anastesi 6 Pcs Rp 48,750.39 Rp 63,376
134 Masker kerudung Pcs Rp 2,860.00 Rp 3,718
135 Masker N95 Pcs Rp 21,175.00 Rp 27,528
136 Masker KN95 Pcs Rp 9,035.00 Rp 11,746
137 Microfline/Pen Needle 31Gx55M Pcs Rp 1,695.00 Rp 2,204
138 Mitela Ukuran S (Arm Sling S) Pcs Rp 21,275.00 Rp 27,658
139 Mitela Ukuran M (Arm Sling M) Pcs Rp 21,275.00 Rp 27,658
140 Mitela Ukuran L (Arm Sling L) Pcs Rp 21,275.00 Rp 27,658
141 My Jelly Tube Rp 35,520.00 Rp 46,176
142 Nasal canula neonatus Pcs Rp 9,750.24 Rp 12,675
143 Nasal canula bayi Pcs Rp 9,250.00 Rp 12,025
144 Nasal canula dewasa Pcs Rp 9,657.00 Rp 12,554
145 Nasal Canula Anak Pcs Rp 9,657.00 Rp 12,554
146 Needle Spinocain 27 Pcs Rp 66,000.00 Rp 85,800
147 No Pain spray Botol Rp 96,570.00 Rp 125,541
148 Nurse cup Pcs Rp 781.68 Rp 1,016
149 Object glass Pcs Rp 281.18 Rp 366
150 Optime 1 Pcs Rp 75,744.31 Rp 98,468
151 Optime 2 Pcs Rp 95,399.12 Rp 124,019
152 Optime 2/0 Pcs Rp 74,026.33 Rp 96,234
153 Optime 3/0 Pcs Rp 75,023.03 Rp 97,530
154 Oxygen Mask adult elognated Pcs Rp 11,404.00 Rp 14,825
155 Oxygen Mask pedriatik Pcs Rp 27,500.00 Rp 35,750
156 Oxygen Mask S (Infant) Pcs Rp 16,899.75 Rp 21,970
157 Oxygen mask nebulizer size M Pcs Rp 22,390.50 Rp 29,108
158 Oxygen mask Nebulizer size L Pcs Rp 31,900.00 Rp 41,470
159 Oxygen mask nebulizer bayi Pcs Rp 26,000.00 Rp 33,800

160 Oxygen mask nebulizer size S (infant) Pcs Rp 26,000.00 Rp 33,800

161 Oxygen mask Non rebreathing dewasa Pcs Rp 20,800.00 Rp 27,040

162 Oxygen mask Non rebreathing child Pcs Rp 25,098.92 Rp 32,629

163 Oxygen mask Non rebreathing Bayi Pcs Rp 20,800.00 Rp 27,040
Oxygen mask Non rebreathing S Pcs
164
(Infant) Rp 21,702.32 Rp 28,213
165 Paper X ray pcs Rp 8,325.00 Rp 10,823
166 Papsmear Kit Size S Kit Rp 22,264.00 Rp 28,943
167 Papsmear Kit Size M Kit Rp 22,264.00 Rp 28,943
168 Perfusor 150 mg (Extension) Pcs Rp 17,708.06 Rp 23,020
169 Perfusor Pcs Rp 41,677.17 Rp 54,180
170 Plastik seal secutity lock Pcs Rp 11,743.80 Rp 15,267
171 Poliban 10 cm x 2,7 mm Roll Rp 16,539.99 Rp 21,502
172 Poliban 15 cm x 2,7 mm Roll Rp 21,899.99 Rp 28,470
173 Polifix 10 x 5 cm Roll Rp 82,966.55 Rp 107,857
174 Poligyp 10 cm x 2,7 mm Roll Rp 23,540.00 Rp 30,602
175 Poligyp 15 cm x 2,7 mm Roll Rp 31,059.99 Rp 40,378
176 Polypropylene 5/0 Pcs Rp 53,629.65 Rp 69,719
177 Polypropylene 4/0 Pcs Rp 53,629.65 Rp 69,719
178 Polypropylene 3/0 Pcs Rp 53,629.65 Rp 69,719
179 Polypropylene 2/0 Pcs Rp 53,629.65 Rp 69,719
180 Polypropylene 1 HR Pcs Rp 53,629.65 Rp 69,719
181 Postofix - PU 10x25 Pcs Rp 29,377.14 Rp 38,190
182 Postofix - PU 10x15 Pcs Rp 16,650.00 Rp 21,645
183 Postofix - PU 10x10 Pcs Rp 13,320.00 Rp 17,316
184 Povidone iodine 10% 1 L Botol Rp 80,811.76 Rp 105,055
185 Povidone iodine 300 ml Botol Rp 30,636.00 Rp 39,827
186 Prontosan sol Botol Rp 96,505.33 Rp 125,457
187 Redax Drentech compact Pcs Rp 787,905.00 Rp 1,024,277
188 Safety Box 5 L Pcs Rp 12,652.49 Rp 16,448
189 Scanlux Botol Rp 201,354.00 Rp 261,760
190 Silk 2-0 Apex Pcs Rp 49,610.00 Rp 64,493
191 Silk 2/0 Remedi Pcs Rp 5,375.00 Rp 6,987
192 Silk Black 1 Pcs Rp 17,325.89 Rp 22,524
193 Silk 1 HRG Pcs Rp 47,301.56 Rp 61,492
194 Silk 2 HRG Pcs Rp 47,193.87 Rp 61,352
195 Silk 2/0 HR Pcs Rp 38,935.47 Rp 50,616
196 Silk 3-0 Apex Pcs Rp 53,240.00 Rp 69,212
197 Silk 3-0 Pcs Rp 7,400.00 Rp 9,620
198 Silk 0 Pcs Rp 39,817.47 Rp 51,763
199 Spinocain 25 Pcs Rp 32,617.00 Rp 42,402
200 Spinocain 26 Pcs Rp 32,617.00 Rp 42,402
201 Spoit 50 cc (cateter tip hijau) Pcs Rp 11,817.86 Rp 15,363
202 Spoit 50 cc Pcs Rp 6,930.88 Rp 9,010
203 Spoit 50 cc (Iuer Slip) Pcs Rp 6,795.82 Rp 8,835
204 Spoit 20 cc (Lubang samping) Pcs Rp 1,183.65 Rp 1,539
205 Spoit 10 cc Pcs Rp 1,639.30 Rp 2,131
206 Spoit 5 cc Pcs Rp 1,430.00 Rp 1,859
207 Spoit 3 cc Pcs Rp 1,095.92 Rp 1,425
208 Spoit 1 cc Pcs Rp 1,447.98 Rp 1,882
209 Stomach Tube (Maag slang) 12 Pcs Rp 12,542.64 Rp 16,305
210 Stomatch tube (Maag slang) 14 Pcs Rp 12,542.64 Rp 16,305
211 Stomatch tube (Maag slang) 16 Pcs Rp 12,542.64 Rp 16,305
212 Stomach Tube (Maag Slang) 18 Pcs Rp 12,542.64 Rp 16,305
213 Suction cateter no. 6 Pcs Rp 3,711.99 Rp 4,826
214 Suction cateter FG 8 Pcs Rp 4,764.12 Rp 6,193
215 Suction cateter FG 10 Pcs Rp 8,880.00 Rp 11,544
216 Suction cateter FG 12 Pcs Rp 8,880.00 Rp 11,544
217 Suction cateter no. 14 Pcs Rp 4,996.75 Rp 6,496
218 Suction cateter no. 16 Pcs Rp 8,880.00 Rp 11,544
219 Suction cateter no. 18 Pcs Rp 4,996.83 Rp 6,496
220 Suction conecting tube Pcs Rp 34,840.00 Rp 45,292
221 T-chromic cat gut 1 Pcs Rp 69,375.00 Rp 90,188
222 T-chromic cat gut 2 Pcs Rp 69,375.00 Rp 90,188
223 T-chromic cat gut 2-0 Pcs Rp 63,603.00 Rp 82,684
224 T-chromic cat gut 3-0 Pcs Rp 58,275.00 Rp 75,758
225 T-chromic cat gut 4-0 Pcs Rp 66,600.00 Rp 86,580
226 Three way stop cock Pcs Rp 2,501.94 Rp 3,253
227 T- Hemocel 5 x 7,5 cm Pcs Rp 75,177.27 Rp 97,730
228 T-Hernia Mesh 6 x10 cm Pcs Rp 151,140.00 Rp 196,482
229 T-Hernia Mesh 5 x 7,5 cm Pcs Rp 101,454.00 Rp 131,890
230 T-Lene 2-0 Pcs Rp 81,141.00 Rp 105,483
231 T-Lene 3-0 Pcs Rp 80,919.00 Rp 105,195
232 T-Lene 4-0 Pcs Rp 77,145.00 Rp 100,289
233 T-Lene 5-0 Pcs Rp 77,145.00 Rp 100,289
234 T-Nylon 5-0 Pcs Rp 50,838.00 Rp 66,089
235 Transfusi set (Blood Transfusi set) Pcs Rp 12,544.96 Rp 16,308
236 Transofix Pcs Rp 4,643.13 Rp 6,036
237 T-Silk 1 Pcs Rp 55,389.00 Rp 72,006
238 T-Silk 2-0 Pcs Rp 40,737.00 Rp 52,958
239 T-Silk 3-0 Pcs Rp 43,512.00 Rp 56,566
240 T-Silk 3-0 Pcs Rp 45,621.00 Rp 59,307
241 Torniquet Pcs Rp 22,850.96 Rp 29,706
242 Trocar Thoracic cateter tube No. 22 Pcs Rp 217,905.00 Rp 283,277
243 Tvio 1 Pcs Rp 86,691.00 Rp 112,698
244 T-Vio 2 Pcs Rp 99,990.00 Rp 129,987
245 T-Vio 2-0 Pcs Rp 80,142.00 Rp 104,185
246 T-vio 3-0 Pcs Rp 77,478.00 Rp 100,721
247 T-vio 4-0 Pcs Rp 83,472.00 Rp 108,514
248 Umbilical cold (Penjepit Tali Pusat) Pcs Rp 1,306.95 Rp 1,699
249 Upad 60x90 pcs Rp 4,084.80 Rp 5,310
250 Urine bag Pcs Rp 6,309.24 Rp 8,202
251 Urogard Pcs Rp 131,257.50 Rp 170,635
252 Urobag Pcs Rp 6,072.00 Rp 7,894
253 USG Jelly 250 ml Botol Rp 16,631.91 Rp 21,621
254 USG Jelly 5 L Botol Rp 185,999.37 Rp 241,799
255 USG Paper Sony Roll Rp 288,000.00 Rp 374,400
256 Xpresif 10x5 Roll Rp 44,400.00 Rp 57,720
MATA
1 Appalens plus 18,0 Pcs Rp 194,250.00 Rp 252,525
2 Appalens plus 18,5 Pcs Rp 194,250.00 Rp 252,525
3 Appalens plus 19.0 Pcs Rp 194,250.00 Rp 252,525
4 Appalens plus 19.5 Pcs Rp 194,250.00 Rp 252,525
5 Appalens plus 20.0 Pcs Rp 194,250.00 Rp 252,525
6 Appalens plus 20.5 Pcs Rp 194,250.00 Rp 252,525
7 Appalens plus 21.0 Pcs Rp 194,250.00 Rp 252,525
8 Appalens plus 21.5 Pcs Rp 194,250.00 Rp 252,525
9 Appalens plus 22.0 Pcs Rp 194,250.00 Rp 252,525
10 Appalens plus 22.5 Pcs Rp 194,250.00 Rp 252,525
11 Appalens plus 23.0 Pcs Rp 194,250.00 Rp 252,525
12 Appasamy cohesisc 1,8% Pcs Rp 421,800.00 Rp 548,340
13 Appasamy appavisc 3 ml (Visco) Pcs Rp 122,100.00 Rp 158,730
14 Mani opthalmic 27 Keratone Pcs Rp 290,820.00 Rp 378,066
15 Mani opthalmic 26 cresene Pcs Rp 290,820.00 Rp 378,066
16 Mata pisau B Braun 15 Pcs Rp 8,103.00 Rp 10,534
17 Miochol/ Carbacol Pcs Rp 66,600.00 Rp 86,580
18 Needle Terumo 27 Pcs Rp 1,853.70 Rp 2,410
19 Nylon 10/0 Pcs Rp 170,765.00 Rp 221,995
20 Rhed-ID/ Trypan Blue Pcs Rp 66,600.00 Rp 86,580
21 SP PGA 8/0 Pcs Rp 182,650.00 Rp 237,445

Palopo, Januari 2022

Kepala Instalasi Farmasi
RSUD dr. Palemmai Tandi

Syuriani, S.Si., Apt.

Nip. 19830605 200903 2 003