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    1. The document is a format for the needs assessment of medical equipment and supplies for the National Health Insurance program. 2. It includes a table listing 35 items needed, including examination room supplies, emergency room supplies, maternal and child health supplies, and village post supplies. 3. For each item, it specifies the name, brand/type, and supplier including quantity, unit, unit price, and total price.

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    1. The document is a format for the needs assessment of medical equipment and supplies for the National Health Insurance program. 2. It includes a table listing 35 items needed, including examination room supplies, emergency room supplies, maternal and child health supplies, and village post supplies. 3. For each item, it specifies the name, brand/type, and supplier including quantity, unit, unit price, and total price.

    Copyright:

    © All Rights Reserved
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    Download as xlsx, pdf, or txt
    108 views10 pages

    ALKES

    Uploaded by

    yohanes jurus
    1. The document is a format for the needs assessment of medical equipment and supplies for the National Health Insurance program. 2. It includes a table listing 35 items needed, including examination room supplies, emergency room supplies, maternal and child health supplies, and village post supplies. 3. For each item, it specifies the name, brand/type, and supplier including quantity, unit, unit price, and total price.

    Copyright:

    © All Rights Reserved
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    of 10

    FORMAT KEBUTUHAN ALA

    No Nama Obat/BMHP Merk/Type


    1 2 3
    RUANG PEMERIKSAAN UMUM
    42000000-AKS-000455542 PRIMAMED
    1 Anuskop SCHWERT Anuscope Hirschmann 22 mm /
    Anuskop
    42000000-AKS-000455589
    Garpu tala 512 Hz, 1024 Hz,
    2 PRIMAMED SCHWERT Garpu Tala Hartmann
    2084 Hz
    set isi 3 ( 512 , 1024 , 2048 Hz ) / Tuning Fork
    42000000-AKS-000456254
    3 Handle kaca laring
    MEDICA Handle Kaca Laring 47-150
    42000000-AKS-000458162
    4 Kaca laring 2, 4, 5, 6
    MEDICA Kaca Laring 47-176 ~ 47-184
    42000000-AKS-000455541
    PRIMAMED SCHWERT Percussion Hammer
    5 Palu reflex
    Taylor 20cm , 8" / Reflex Hammer / Palu
    pengukur refleks
    42000000-AKS-000456257
    6 Spekulum hidung MEDICA Speculum Hidung (Lempert), SS 41-
    100, 41-102, 41-104
    42000000-AKS-000064951
    7 Spatula lidah logam OTTO-LEIBINGER Other Instruments - Tongue
    Spatula
    RUANGAN TINDAKAN DAN RUANGAN GAWAT DARURAT
    8 Neck Collar 42000000-AKS-000408336
    JAYAMAS Onemed Cervical Collar Universal
    9 Forceps aligator 42000000-AKS-000456247
    MEDICA Aligator Forceps 39-291

    Forceps bayonet panjang


    10 42000000-AKS-000068155
    14,5 cm
    KARL STORZ Forceps, bayonet-shaped, 14.5 cm

    Guedei Airway 42000000-AKS-000456154


    11 ROMSONS Guedel Airways, Oropharyngeal
    (Oropharingeal Airway)
    Airways
    No Nama Obat/BMHP Merk/Type
    1 2 3
    Gunting bedah standar, 42000000-AKS-000064967
    12 unjung bengkok panjang 10 OTTO-LEIBINGER Other Instruments - Surgical
    cm Scissor Bengkok 10 Cm
    Gunting bedah standar, 42294203-AKS-000428510
    13 unjung tajam/tumpul ALMEDIKA Surgical Scissors Blund Straight 16
    panjang 16 cm Cm
    Gunting bedah standar, 42294206-AKS-000432084
    14 unjung tajam/tajam panjang ALMEDIKA Surgical Scissors Sharp Straight 16
    16 cm cm
    42000000-AKS-000433975
    15 Gunting pembalut
    FRIMED LISTER Bandage Scissors 14,0 cm
    42000000-AKS-000108235
    16 Gunting pembuka jahitan DERBY DENTAL DD420-1 Surgical Scissors -
    Spencer 9 cm
    42000000-AKS-000064975
    17 Klem ateri lurus OTTO-LEIBINGER Other Instruments - Arteri
    Clem Lurus
    42000000-AKS-000064977
    18 Klem arteri bengkok OTTO-LEIBINGER Other Instruments - Arteri
    Clem Bengkok
    42000000-AKS-000064994
    19 Korentang, penjepit sponge OTTO-LEIBINGER Other Instruments -
    Korentang/Sponge & Dressing Forcep
    42000000-AKS-000064973
    20 Pinset sirurgis OTTO-LEIBINGER Other Instruments - Pinset
    Chirurgis
    42000000-AKS-000064971
    21 Pinset Anatomis OTTO-LEIBINGER Other Instruments - Pinset
    Anatomo
    42000000-AKS-000462825
    22 Stetoskop dewasa ADC-USA Stetoscope Adult ADSCOPE
    ( Stainless Steel ) - ADSCOPE 603 BK
    42000000-AKS-000462830
    23 Stetoskop anak ADC-USA Stetoscope Pediatric ADSCOPE
    ( Stainless steel Scope ) - ADSCOPE 604 BK
    No Nama Obat/BMHP Merk/Type
    1 2 3
    RUANG KESEHATAN IBU, ANAK (KIA), KB, DAN IMUNISASI
    24 Termometer Air Raksa 42000000-AKS-000050930
    GP CARE Clinical Thermometer
    42000000-AKS-000112038
    25 Baki instrumen A CLASS NIERBAKEN / KIDNEY BOWL /
    DISH (DEEP 204*130mm) - INSTRUMENT
    RUANG RAWAT INAP
    42000000-AKS-000112038
    26 Baki instrumen A CLASS NIERBAKEN / KIDNEY BOWL /
    DISH (DEEP 204*130mm) - INSTRUMENT
    POSYANDU BALITA
    27 Timbangan Dacin 42000000-AKS-000418011 SANI-INDONESIA Timbangan Dacin

    42000000-AKS-000057406
    28 Termometer Digital
    MICROLIFE Digital Ear Thermometer FR1DL1
    POSYANDU LANSIA
    42182805-AKS-000410326
    29 Timbangan Badan Digital ELITECH - INDONESIA ELITECH PATIENT
    SCALE / TIMBANGAN BADAN DIGITAL
    DIGIT-PRO
    42000000-AKS-000057406
    30 Termometer Digital
    MICROLIFE Digital Ear Thermometer FR1DL1
    42000000-AKS-000462825
    31 Stetoskop dewasa ADC-USA Stetoscope Adult ADSCOPE
    ( Stainless Steel ) - ADSCOPE 603 BK

    32 Termometer Aneroid 42000000-AKS-000051776


    MPM ERKA Tensimeter Aneroid Swicth Simplex
    POSKESDES/POLINDES/PUSTU

    33 Termometer Aneroid 42000000-AKS-000051776


    MPM ERKA Tensimeter Aneroid Swicth Simplex
    No Nama Obat/BMHP Merk/Type
    1 2 3
    42000000-AKS-000462825
    34 Stetoskop dewasa ADC-USA Stetoscope Adult ADSCOPE
    ( Stainless Steel ) - ADSCOPE 603 BK
    42000000-AKS-000057406
    35 Termometer Digital
    MICROLIFE Digital Ear Thermometer FR1DL1
    JUMLAH

    Mengetahui PLT Kepala Puskesmas Terang

    Falentinus Mance
    NIP : 19770223 199703 1 001
    FORMAT KEBUTUHAN ALAT KESEHATAN DANA JKN

    Penyedia/Distributor Jumlah Satuan Harga Satuan Total Harga


    4 5 6 7 8=5*7

    PT. Daya Prima Mandiri Jaya 2 buah Rp 3,498,000 Rp 6,996,000

    PT. Daya Prima Mandiri Jaya 1 set Rp 2,494,100 Rp 2,494,100

    PT. Gebang Surya Harapan 1 buah Rp 151,300 Rp 151,300

    PT. Gebang Surya Harapan 1 set Rp 252,000 Rp 252,000

    PT. Daya Prima Mandiri Jaya 1 buah Rp 228,000 Rp 228,000

    PT. Gebang Surya Harapan 1 buah Rp 324,000 Rp 324,000

    PT. Andini Sarana 3 buah Rp 220,366 Rp 661,098

    buah Rp 116,160
    PT. Jayamas Medica 1 Rp 116,160
    PT. Gebang Surya Harapan buah Rp 252,000
    2 Rp 504,000

    PT. Advance Medicare Corpora buah Rp 791,198


    2 Rp 1,582,396

    buah Rp 4,439
    PT. Endo Indonesia 2 Rp 8,878
    Penyedia/Distributor Jumlah Satuan Harga Satuan Total Harga
    4 5 6 7 8=5*7

    PT. Andini Sarana buah Rp 277,804


    2 Rp 555,608
    CV. Almas buah Rp 16,000
    3 Rp 48,000

    buah
    CV. Almas 3 Rp 16,000 Rp 48,000
    PT. Karya Pratama buah Rp 293,300
    1 Rp 293,300

    PT. Kirana Jaya Lestari buah Rp 288,809


    3 Rp 866,427

    PT. Andini Sarana buah Rp 267,283


    2 Rp 534,566

    PT. Andini Sarana buah Rp 272,117


    2 Rp 544,234

    buah Rp 555,323
    PT. Andini Sarana 1 Rp 555,323

    PT. Andini Sarana buah Rp 120,562


    3 Rp 361,686

    PT. Andini Sarana buah Rp 120,562


    3 Rp 361,686

    PT. Global Systech Medika buah Rp 726,000


    1 Rp 726,000

    PT. Global Systech Medika buah Rp 726,000


    1 Rp 726,000
    Penyedia/Distributor Jumlah Satuan Harga Satuan Total Harga
    4 5 6 7 8=5*7

    PT. Global Pharma Indonesia buah Rp 11,500


    1 Rp 11,500

    PT. Bintang Anugerah Cahaya


    buah Rp 94,600
    Abadi
    5 Rp 473,000
    PT. Bintang Anugerah Cahaya
    buah Rp 94,600
    Abadi
    5 Rp 473,000

    PT. Sani Tiara Prima unit Rp 739,800


    6 Rp 4,438,800
    unit
    PT. Sekarguna Medika 10 Rp 429,600 Rp 4,296,000

    unit
    PT. Sinko Prima Alloy 6 Rp 603,900 Rp 3,623,400
    unit
    PT. Sekarguna Medika 10 Rp 429,600 Rp 4,296,000

    PT. Global Systech Medika buah Rp 726,000


    6 Rp 4,356,000

    buah
    PT. Mega Pratama Medicalindo 6 Rp 800,000 Rp 4,800,000

    buah
    PT. Mega Pratama Medicalindo 6 Rp 800,000 Rp 4,800,000
    Penyedia/Distributor Jumlah Satuan Harga Satuan Total Harga
    4 5 6 7 8=5*7

    PT. Global Systech Medika buah Rp 726,000


    6 Rp 4,356,000
    unit
    PT. Sekarguna Medika 10 Rp 429,600 Rp 4,296,000
    JUMLAH

    Verifikator
    Ongkos Kirim Jumlah
    9=8*20% 10=8+9

    Rp 1,399,200 Rp 8,395,200

    Rp 498,820 Rp 2,992,920

    Rp 30,260 Rp 181,560

    Rp 50,400 Rp 302,400

    Rp 45,600 Rp 273,600

    Rp 64,800 Rp 388,800

    Rp 132,220 Rp 793,318

    Rp 23,232 Rp 139,392

    Rp 100,800 Rp 604,800

    Rp 316,479 Rp 1,898,875

    Rp 1,776 Rp 10,654
    Ongkos Kirim Jumlah
    9=8*20% 10=8+9

    Rp 111,122 Rp 666,730
    Rp 9,600 Rp 57,600

    Rp 9,600 Rp 57,600

    Rp 58,660 Rp 351,960

    Rp 173,285 Rp 1,039,712

    Rp 106,913 Rp 641,479

    Rp 108,847 Rp 653,081

    Rp 111,065 Rp 666,388

    Rp 72,337 Rp 434,023

    Rp 72,337 Rp 434,023

    Rp 145,200 Rp 871,200

    Rp 145,200 Rp 871,200
    Ongkos Kirim Jumlah
    9=8*20% 10=8+9

    Rp 2,300 Rp 13,800

    Rp 94,600 Rp 567,600
    Rp 94,600 Rp 567,600

    Rp 887,760 Rp 5,326,560

    Rp 859,200 Rp 5,155,200

    Rp 724,680 Rp 4,348,080

    Rp 859,200 Rp 5,155,200

    Rp 871,200 Rp 5,227,200

    Rp 960,000 Rp 5,760,000

    Rp 960,000 Rp 5,760,000
    Ongkos Kirim Jumlah
    9=8*20% 10=8+9

    Rp 871,200 Rp 5,227,200

    Rp 859,200 Rp 5,155,200
    Rp 70,990,154

    Tim Perencana
    1. dr. Aditya Rosyid Dwi Anwar
    Dokter

    2. Ahmad Yani
    Kepala Rawat Inap
    3. Inggrid Roswita Tokan, S. Farm., Apt.
    Pengelola Farmasi

    4. Elisabeth J. Adepatiloy
    Bidan

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