DAFTAR STOK OBAT DAN PERBEKALAN KESEHATAN PER 30 JUNI 2017

SUMBER APBD II ( DAK DAN DAU)

PUSKESMAS: SEMBERANG

NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN

1 2 3 4 9
I OBAT GENERIK
1 Akarbose tablet/kaplet 50 mg Tablet DAK 2016 657.00
2 Alopurinol tablet 100 mg Tablet DAK 2016 95.00
3 Alopurinol tablet 100 mg Tablet DAK 2015 90.00
4 Alopurinol tablet 100 mg Tablet DAK 2017 117.00
5 Alprazolam 0,5 mg Tablet DAK 2015 185.00
6 Alprazolam 0,5 mg Tablet DAK 2016 144.00
7 Alprazolam 0,5 mg Tablet DAK 2014 185.00
8 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2016 3,627.00
9 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2015 3,290.00
10 Ambroxol tablet 30 mg Tablet DAK 2017 985.00
11 Ambroxol tablet 30 mg Tablet DAK 2016 143.68
12 Ambroxol tablet 30 mg Tablet DAK 2015 125.00
13 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2017 17,375.00
14 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2017 3,080.00
15 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2015 4,200.00
16 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2016 3,349.00
17 Aminofilina tablet 200 mg DAK 2016 124.94
Tablet
18 Aminofilina tablet 200 mg Tablet salut selaput DAK 2017 97.00
19 Aminofilina tablet 200 mg DAK 2015 86.00
Tablet
20 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2015 123.00
21 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2016 165.00
22 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2017 171.00
23 Amlodipin 5 mg Tablet DAK 2017 91.00
24 Amlodipin 5 mg Tablet DAK 2016 1,333.33
25 Amlodipin 5 mg Tablet DAK 2015 197.00
Amoksisilin kapsul/kaplet/tablet scored
Kaptab
26 500 mg DAK 2017 191.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet
27 500 mg DAK 2016 233.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet
28 500 mg DAK 2015 279.00
29 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2017 1,920.00
30 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2016 2,200.00
31 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2015 2,560.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
32 ml DAK 2017 3,797.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
33 ml DAK 2015 4,730.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
34 ml DAK 2016 4,147.00
35 Antalgin injeksi 250 mg/ml - 2 ml Ampul DAK 2013 1,500.74
36 Antasida DOEN suspensi Botol 60 ml DAK 2016 2,106.00
37 Antasida DOEN suspensi Botol 60 ml ABT 2015 2,300.00
38 Antasida DOEN suspensi Botol 60 ml DAK 2015 2,300.00
39 Antasida DOEN suspensi Botol 60 ml DAK 2017 1,962.00
 Antasida DOEN tablet
kunyah,kombinasi: Tablet
40 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2015 78.00
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet
41 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2017 59.00
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet kunyah
42 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2016 64.00
200 mg
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
43 IU/g DAK 2015 2,767.00
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
44 IU/g DAK 2017 3,365.00
Anti Diare Kombinasi Kaolin 986
Botol 60 ml
45 mg+Pektin 40 mg DAK 2016 8,000.00
Anti Diare Kombinasi Kaolin 986
Botol 60 ml
46 mg+Pektin 40 mg DAK 2017 6,190.00
Antifungi DOEN kombinasi :
Asam Benzoat 6 % + pot plastik 30 gram
47 DAK 2017 4,972.00
Asam Salisilat
Antifungi DOEN3 kombinasi
% :
Asam Benzoat 6 % + pot plastik 30 gram
48 DAK 2016 4,782.00
Asam Salisilat 3 %
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
49 150 mg + Heksaklorofen 2,5 mg DAK 2015 3,350.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
50 150 mg + Heksaklorofen 2,5 mg DAK 2016 3,502.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
51 150 mg + Heksaklorofen 2,5 mg DAK 2017 3,300.00
Antimigren DOEN tablet kombinasi :
Tablet
52 Ergotamin Tartrat 1 mg + Kofein 50 mg DAK 2017 204.00
Antimigren + Paracetamol 400 mg,
Tablet
53 Acetosal 250 mg, Caffeine 65 mg DAK 2016 605.00
54 Aqua pro Injeksi steril, bebas pirogen Ampul 25 ml DAK 2015 2,200.00
55 Air untuk Injeksi 25 ml Ampul 25 ml DAK 2017 2,750.00
56 OTSU SWI 25 ML - Air untuk Injeksi 25 DAK 2016 2,750.00
Ampul 25 ml
ml
ACT (Artesunate tablet 50 mg +
Tablet
57 Amodiaquine anhydrida tablet 200 mg) DAK 2015 1,409.00
58 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2016 120.00
Asam askorbat (vitamin C)
Tablet
59 tablet/kapsul/kaplet 250 mg DAK 2017 118.00
60 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2017 120.00
Asam Folat tablet/kapsul/kaplet 0,4
Tablet
61 mg(Afolat) DAK 2015 140.00
Asam Folat tablet/kapsul/kaplet 0,4
Tablet
62 mg(Afolat) DAK 2016 68.00
63 Asam Mefenamat 500 mg Kaptap Salut Selaput DAK 2017 102.00
64 Asam Mefenamat 500 mg Tablet DAK 2016 113.00
65 Asam Traneksamat 500 mg Tablet DAK 2017 1,540.00
66 Asam Traneksamat 500 mg Tablet DAK 2016 1,540.00
67 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2016 2,789.00
68 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2017 2,530.00
69 Asetosal 100 mg Tablet DAK 2015 127.00
70 Asetosal 100 mg Tablet DAK 2016 153.00
 Asam asetilsalisilat (asetosal)
Tablet
71 tablet/kapsul/kaplet 100 mg DAK 2017 154.00
72 Asiklovir krim 5 % Tube 5 gram DAK 2016 2,997.00
73 Asiklovir krim 5 % Tube 5 gram DAK 2017 9,550.00
74 Asiklovir tablet 400 mg Tablet DAK 2015 354.00
75 Asiklovir tablet 400 mg Tablet DAK 2016 368.00
76 Asiklovir tablet/kapsul/kaplet 400 mg Tablet DAK 2017 415.00
NEW ANTIDES - Attapulgite 600 mg
Tablet
77 tablet DAK 2016 173.00
78 Atapulgit tablet 600 mg (Pularex) Tablet DAK 2014 220.00
79 Atropin inj 0,25 mg / ml Ampul 1 ml DAK 2016 1,672.00
80 Azitromisin tablet 500 mg Tablet DAK 2016 1,900.00
kombinasi: ferro fumarat 60 mg + as.
Folat 0,4 mg tablet salut gula (tablet Tablet Salut Gula
81 tambah darah) DAK 2017 410.00
(Tablet Tambah Darah Kombinasi) :
Ferrous Fumarate 250 mg, Manganese
Sulfate 0,2 mg, Cupric Sulfate 0,2 mg, Tablet
Folic Acid 4 mg, Cyanocobalamin 7,5
82 mg DAK 2016 660.00
Plastik-Dus-serbuk 50
Bedak salisil serbuk 2%
83 gram DAK 2017 1,071.00
BEROTEC SOLUTION - Fenoterol HBr
Botol
84 solution 0,1% DAK 2016 125,750.00
85 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2017 151.00
86 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2016 170.00
87 Bisoprolol tablet/kapsul/kaplet 5 mg Tablet salut selaput DAK 2017 298.00
88 Bisoprolol tablet 5 mg Tablet DAK 2016 399.00
Betametason krim0,1% (Sebagai
Tube 5 gram
89 Valerat) DAK 2016 1,435.00
90 Betametason krim 0,1 o/o Tube 5 gram DAK 2015 1,558.00
Betametason krim0,1% (Sebagai
Tube 5 gram
91 Valerat) DAK 2017 1,450.00
92 Bisakodil suppositoria 10mg Supp DAK 2017 5,800.00
Bisakodil suppositoria 10 mg(Stolax
Supp
93 supp) DAK 2015 6,045.00
Bisakodil suppositoria 10 mg(keluar e-
Supp
94 catalog) DAK 2015 6,040.00
DULCOLAX SUPP ADULT 10MG
Supp
95 Bisakodil suppositoria 10mg DAK 2016 5,800.00
DULCOLAX SUPP INFANT - Bisakodil
Supp
96 suppositoria 5 mg DAK 2016 5,670.00
97 Bisakodil suppositoria 5 mg Supp DAK 2017 5,800.00
98 Bisakodil tablet/kapsul/kaplet 5 mg Tablet salut enterik DAK 2017 317.00
99 Cetirizine tablet 10 mg Tablet DAK 2015 190.00
100 Cetirizine tablet 10 mg Tablet salut selaput DAK 2017 115.00
101 Cetirizine tablet 10 mg Tablet DAK 2016 154.00
102 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2016 2,950.00
103 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2015 8,799.00
104 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2017 3,300.00
105 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,745.00
106 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,822.00
107 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2014 1,544.00
108 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,544.00
109 Deksametason tablet 0,5 mg Tablet DAK 2016 120.00
110 Deksametason tablet 0,5 mg Tablet DAK 2017 149.07
111 Deksametason tablet 0,5 mg Tablet DAK 2015 68.00
 Dekstrometorfan sirup 10 mg/5
Botol 60 ml
112 ml(calortusin ) DAK 2014 3,609.00
Dekstrometorfan sirup 10 mg/5
Botol 60 ml
113 ml(calortusin ) DAK 2015 3,608.00
Dektromethorphan tablet 15mg
Tablet
114 ( Ramaflu ) DAK 2015 275.00
Dektromethorphan tablet 15mg
Tablet
115 ( Ramaflu ) DAK 2014 275.00
116 DEPAKENE - Valproat sirup 250 mg/5 DAK 2016 41,800.00
Botol
ml
DEPAKOTE TAB 250 MG - Valproat
Tablet
117 tablet salut 250 mg DAK 2016 1,750.00
118 Diazepam tablet 2 mg Tablet DAK 2015 46.00
119 Diazepam tablet 2 mg Tablet DAK 2014 125.40
120 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul DAK 2017 15,600.00
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube
121 (STESOLID) DAK 2015 18,461.00
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube
122 (STESOLID) DAK 2016 18,458.00
123 Diazepam enema 10 mg/2,5 mL Allubag DAK 2017 19,378.00
Diazepam larutan rectal 5 mg/ 2,5
Tube
124 ml(STESOLID) DAK 2015 12,751.00
Diazepam larutan rectal 5 mg/ 2,5
Tube
125 ml(STESOLID) DAK 2016 12,749.00
126 Diazepam enema 5 mg/2,5 mL Allubag DAK 2017 13,384.00
127 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,222.00
128 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,156.00
129 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,354.00
130 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2013 1,056.00
131 Digoksin tablet/kapsul/kaplet 0,25 mg Tablet DAK 2017 109.00
132 Digoksin tablet 0,25 mg Tablet DAK 2016 108.00
133 Digoksin tablet 0,25 mg Tablet DAK 2015 103.00
134 Doksisiklin tablet/kapsul/kaplet 100 mg kapsul DAK 2017 299.00
135 Doksisiklin tab 100 mg Tablet DAK 2016 309.00
136 Domperidon 10 mg Tablet DAK 2015 174.00
137 Domperidon tablet/kapsul/kaplet 10 mg Tablet DAK 2014 110.00
138 Domperidon 10 mg Tablet DAK 2016 118.00
139 Domperidon suspensi/sirup 5 mg/5 ml Botol 60 ml DAK 2015 3,490.00
140 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2017 17,000.00
141 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2016 3,180.00
DOPAMET - Metildopa tablet salut 250
Tablet
142 mg DAK 2016 1,001.00
DOPAMET - Metildopa tablet salut 250
Tablet
143 mg DAK 2017 1,050.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul
144 mg/ml DAK 2015 8,910.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul
145 mg/ml DAK 2016 2,354.00
146 Eritromisin kaplet 500mg Kaplet DAK 2016 766.00
147 Eritromisin tablet/kapsul/kaplet 500 mg Kaptab DAK 2017 766.00
148 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2017 6,461.00
149 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2016 7,039.00
150 Ethambutol 500 mg Tab Tablet DAK 2016 688.00
151 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2013 2,354.22
152 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2015 3,327.75
153 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2014 3,450.00
154 Etanol 70 % Botol DAK 2014 2,625.00
155 Etil Klorida semprot Botol DAK 2017 110,000.00
156 Etil Klorida semprot Botol DAK 2015 115,000.00
157 Etil Klorida semprot Botol DAK 2016 115,500.00
158 Eugenol cairan Botol DAK 2014 18,333.00
159 FARNORMIN - Atenolol 50 mg Tablet DAK 2016 330.00
160 Fenitoin Kapsul/Kaplet 100 mg Kaplet DAK 2016 154.00
161 Fenitoin injeksi 50 mg/ml (100 mg/2 ml) DAK 2017 6,231.00
162 Fenobarbital tablet 30 mg Tablet DAK 2015 70.10
163 Fenobarbital tablet 30 mg Tablet DAK 2017 132.00
164 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2017 2,500.00
165 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2015 1,108.79
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
166 mg/ml DAK 2014 4,356.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
167 mg/ml DAK 2015 3,754.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
168 mg/ml DAK 2016 4,083.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet Salut Gula
169 10 mg DAK 2017 790.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet
170 10 mg DAK 2016 796.00
FLIXOTIDE NBULES - Flutikason
Nebules 2 ml
171 Propionat nebules 0,5 mg DAK 2016 14,500.00
Flutikason propionat (micronized) 0,5
mg/dosis (Flutikason propionat nebules Nebules 2 ml
172 0,5 mg) DAK 2017 14,500.00
173 Furosemid tablet 40 mg Tablet DAK 2015 96.00
174 Furosemid tablet 40 mg Tablet DAK 2017 111.00
175 Furosemid tablet 40 mg Tablet DAK 2016 181.73
176 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2017 2,058.00
177 Furosemid injeksi Ampul DAK 2015 2,012.00
178 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2016 -
179 Gabapentin 300 mg Kaplet DAK 2016 1,639.00
180 Gabapentin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 1,254.00
Garam oralit kombinasi : natrium klorida
0,52 g + kalium klorida 0,30 g +
Sachet 4,26 gram
trinatrium sitrat 0,58 g + glukosa
181 anhidrat 2,7 g DAK 2016 274.00
Garam Oralit I serbuk, kombinasi:
Natrium klorida 0,52 g + kalium klorida
Sachet
0,30 g + Trinatrium sitrat dihidrat 0,58 g
182 + Glukosa Anhidrat 2,70 g DAK 2017 273.00
183 Garam Oralit serbuk,kombinasi Sachet DAK 2015 317.00
184 Gemfibrozil kapsul/kaplet 300 mg Tablet DAK 2015 318.00
185 Gemfibrozil tablet/kapsul/kaplet 300 mg Tablet DAK 2016 436.00
186 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2016 1,835.16
187 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2017 7,180.00
188 Gentamicin TM 0,3 % Botol 5 ml DAK 2016 4,600.00
189 Gentamicin TM 0,3 % Botol 5 ml DAK 2015 3,513.00
190 Gentamisin tetes mata 0,3% Botol 5 ml DAK 2017 4,800.00
191 Gentian violet 1 o/o Botol 10 ml DAK 2015 2,189.00
192 Gentian violet 1 o/o Botol 10 ml DAK 2017 3,812.00
193 Gentian violet 1 o/o Botol 10 ml DAK 2016 2,925.00
194 Glass Ionomer Cement (Fuji IX) Set DAK 2016 919,300.00
195 Glass Ionomer Cement (Fuji VII) Set DAK 2016 1,225,700.00
196 Glass Ionomer Cement (Fuji VII) Set DAK 2017 617,798.00
197 Glass Ionomer Cement (GC IX) Set DAK 2015 434,460.00
198 Glibenklamid tablet 5 mg Tablet DAK 2016 108.00
199 Glibenklamid tablet 5 mg Tablet DAK 2017 90.00
200 Glibenklamid tablet 5 mg Tablet DAK 2015 61.00
Glibenklamid tablet 5 mg (keluar e-
Tablet
201 catalog) DAK 2015 60.00
202 GLICAB - Gliklazid tab 80 mg Tablet DAK 2016 245.00
203 Gliklazid tablet/kapsul/kaplet 80 mg Tablet DAK 2017 218.00
204 Glimepiride tablet/kapsul/kaplet 2 mg Tablet DAK 2017 231.00
205 Glimepiride tablet 2 mg Tablet DAK 2016 296.00
206 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2016 36.52
207 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2017 108.00
208 Glukosa larutan infus 10% Botol plastik 500 ml DAK 2016 7,500.00
209 Glukosa larutan infus 5 % steril Botol plastik 500 ml DAK 2016 6,900.00
210 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2017 6,900.00
211 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2015 5,720.00
212 Griseofulvin tablet 125 mg, micronized Tablet DAK 2016 264.00
213 Griseofulvin tablet 125 mg, micronized Tablet DAK 2015 224.00
214 Griseofulvin tablet 125 mg, micronized Tablet DAK 2017 266.00
215 Haloperidol 1.5 mg Tablet DAK 2015 76.00
216 Haloperidol 1.5 mg Tablet DAK 2014 76.00
217 Haloperidol 1.5 mg Tablet DAK 2016 74.00
HALDOL DECANOAS - Haloperidol inj
Ampul 1 ml
218 50 mg/ml DAK 2016 97,500.00
219 Haloperidol inj 50 mg/mL Ampul 1 ml DAK 2017 97,500.00
LODOMER DROPS - Haloperidol tts 2
Botol 15 ml
220 mg/mL DAK 2016 18,499.00
221 Haloperidol tts 2 mg/mL Botol 15 ml DAK 2017 18,100.00
222 Dus, 1 syringe @ 0,5 DAK 2017 1,300,000.00
Hepatitis B imunoglobullin
ml
223 Hidroklorotiazid tab 25 mg Tablet DAK 2017 171.00
224 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2016 2,712.00
225 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2017 2,838.00
226 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2015 2,868.00
227 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2017 1,760.00
228 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2016 2,745.00
229 Ibuprofen tablet 200 mg Tablet DAK 2017 108.00
230 Ibuprofen tablet/kapsul/kaplet 200 mg Tablet DAK 2016 111.00
231 Ibuprofen tablet 400 mg Tablet DAK 2016 133.00
232 Ibuprofen tablet 400 mg Tablet DAK 2017 113.00
233 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2017 2,560.00
234 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2016 2,560.00
235 Isoniazid tablet/kapsul/kaplet 100 mg Tablet DAK 2017 85.00
236 Isoniazid tablet/kapsul/kaplet 300 mg Tablet DAK 2017 182.00
237 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2015 98.00
238 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2016 93.00
239 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2017 95.00
240 KALIPAR - Kalium aspartat tab 300 mg Tablet DAK 2016 690.00
Kalium aspartat tablet/kapsul/kaplet 300
Kaptab salut selaput
241 mg DAK 2017 682.00
Kalsium Laktat (Kalk)
Tablet
242 tablet/kapsul/kaplet 500 mg DAK 2016 69.00
Kalsium Laktat (Kalk)
Tablet
243 tablet/kapsul/kaplet 500 mg DAK 2017 57.00
Kalsium Laktat (Kalk)
Tablet
244 tablet/kapsul/kaplet 500 mg DAK 2015 76.00
245 Kaptopril 25 mg Tablet DAK 2016 72.00
246 Kaptopril tablet/kaplet scored 25 mg Tablet DAK 2017 86.00
247 Kaptopril 25 mg Tablet DAK 2015 97.00
248 Kandesartan tab 8 mg Tablet DAK 2016 4,015.00
249 Kandesartan tablet/kapsul/kaplet 8 mg Tablet DAK 2017 770.00
Karbamazepin tablet/kapsul/kaplet 200
Tablet
250 mg DAK 2016 306.00
251 Karbamazepin tablet 200 mg Tablet DAK 2015 269.00
252 Ketoprofen supositoria 100 mg Supp DAK 2017 2,640.00
253 Ketokonazol krim 2% Tube 10 gram DAK 2016 2,605.00
254 Ketokonazol krim 2% Tube 10 gram DAK 2017 2,790.00
255 Ketokonazol tablet 200 mg Tablet DAK 2016 292.00
256 Ketokonazol tablet/kapsul/kaplet 200 DAK 2017 297.00
Tablet
mg
257 Ketokonazol tablet 200 mg Tablet DAK 2015 320.00
258 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2017 1,320.00
259 Ketorolac injeksi 30 mg Ampul 1 ml DAK 2014 2,665.00
260 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2016 1,383.00
261 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2016 660.00
262 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 589.00
263 Klopidogrel tablet 75 mg Tablet DAK 2016 2,100.00
264 Klopidogrel tablet/kapsul/kaplet 75 mg Tablet salut selaput DAK 2017 1,799.00
CHLORAMEX - Kloramfenikol kapsul
Kapsul
265 500 mg DAK 2016 1,155.00
Kloramfenikol tablet/kapsul/kaplet 250
Kapsul
266 mg DAK 2017 502.29
267 Kloramfenikol kapsul 250 mg Kapsul DAK 2010 198.92
268 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2017 1,850.00
269 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2016 1,850.00
270 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2017 4,982.00
271 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2016 4,000.00
272 Kloramfenikol tetes mata 0,5 % Botol plastik 10 ml DAK 2017 3,850.00
Kloramfenikol tetes mata 0,5 % (Reco
Botol plastik 10 ml
273 TM) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml
274 TT) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml
275 TT) DAK 2017 7,370.00
276 Kloramfenikol tetes telinga 3 % Botol plastik 10 ml DAK 2015 5,060.00
Klorfeniramina Maleat (CTM)
Tablet
277 tablet/kapsul/kaplet 4 mg DAK 2016 45.00
Klorfeniramina Maleat (CTM)
Tablet
278 tablet/kapsul/kaplet 4 mg DAK 2015 53.00
279 Klorfeniramina Maleat (CTM) tablet 4 DAK 2014 100.10
Tablet
mg
280 (HCl) Ampul 1 ml DAK 2016 1,425.00
281 (HCl) Ampul 1 ml DAK 2017 1,349.00
282 Klorpromazin tablet salut 25 mg (HCl) Tablet DAK 2016 170.00
283 Klorpromazin tablet salut 100 mg (HCl) Tablet DAK 2015 153.00
284 Klozapin 25 mg Tablet DAK 2016 1,550.00
285 Kodein tablet/kapsul/kaplet 10 mg Tablet DAK 2017 632.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
286 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2016 2,225.00
kotrimoksazol (anak) kombinasi tiap 5
ml suspensi: sulfametoksazol 200 mg + Botol 60 ml
287 trimetoprim 40 mg DAK 2017 2,462.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
288 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2015 2,298.00
 Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
289 200 mg + Trimetoprim 40 mg/ 5 Ml ABT 2015 2,298.00
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg + trimetoprim Kaptab
290 160 mg DAK 2017 327.00
kotrimoksazol forte
kombinasi:sulfametoksazol 800 mg + Tablet
291 trimetoprim 160 mg DAK 2015 420.00
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg trimetoprim Tablet
292 160 mg DAK 2016 344.00
293 Laktulosa sir 3,335 g/5 mL Botol DAK 2016 14,500.00
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml
294 3A injection) DAK 2017 10,285.00
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml
295 3B injection) DAK 2017 10,285.00
296 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2015 40,000.00
297 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2016 40,000.00
298 Lidokain jelli 2% syringe 10 gram DAK 2017 40,000.00
Lidokain Komp.injeksi, Kombinasi :
Lidokain HCL 12 % Ampul 2 ml
299 + Epinefrin 1 : 80.000 - 2 ml DAK 2015 1,499.00
300 Lidokain injeksi 2% (HCL) Ampul DAK 2016 875.00
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml
301 80.000 - 2 mL DAK 2016 2,122.00
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml
302 80.000 - 2 mL DAK 2017 2,227.00
303 Lisinopril tablet/kapsul/kaplet 5 mg Tablet DAK 2016 410.00
304 Loperamid Tablet DAK 2017 85.00
305 Loperamid tablet 2 mg Tablet DAK 2016 90.00
306 Loratadin tablet/kapsul/kaplet 10 mg Tablet DAK 2016 149.00
307 Loratadin tablet/kapsul/kaplet 10 mg Kaptab DAK 2017 134.00
OTSU-MGSO4 40 - Magnesium sulfat
Ampul 25 ml
308 injeksi 40% DAK 2016 3,650.00
309 Magnesium sulfat injeksi 40% Ampul 25 ml DAK 2017 3,650.00
310 Metamizol injeksi 500 mg/ml Ampul 2 ml DAK 2017 3,050.00
311 Metil prednisolon tab 4 mg Tablet DAK 2016 209.00
Metilprednisolon tablet/kapsul/kaplet 4
Tablet
312 mg DAK 2017 165.00
313 Metilprednisolon inj 125 mg/2 mL Dus DAK 2015 22,000.00
314 Metilprednisolon inj 125 mg/2 mL Dus DAK 2016 14,750.00
Metilergametrin (Maleat) tablet salut
Tablet
315 0,125 mg DAK 2016 222.20
Metilergametrin (Maleat) tablet salut
Tablet Salut
316 0,125 mg DAK 2017 270.60
Metilergametrin Maleat inj 0,200 mg - 1
Ampul
317 ml DAK 2015 2,750.00
Metilergametrin Maleat inj 0,200 mg - 1
318 ml Ampul DAK 2014 4,917.00
Metilergametrin Maleat inj 0,200 mg - 1
319 ml Ampul DAK 2016 2,684.00
320 Metoclopramide tablet 10 mg Tablet DAK 2016 100.00
Metoklopramide tablet/kapsul/kaplet 10
321 mg Tablet DAK 2017 93.00
322 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2017 3,904.00
323 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2016 4,395.00
 LEXAPRAM SIRUP - Metoklopramide
324 sirup 5 mg/ 5 ml Botol 60 ml DAK 2016 2,750.00
325 Metoklopramide sirup 5 mg/ 5 ml Botol 60 ml DAK 2017 2,950.00
326 Metformin 400 mg Tablet DAK 2016 108.00
Metformin HCl tablet/kapsul/kaplet 500
Kaptap ss
327 mg DAK 2017 103.00
328 Metronidazol infus 5 mg/ ml Botol @100 mL DAK 2017 9,680.00
329 Metronidazole infus Botol @100 mL DAK 2010 21,759.00
330 Metronidazol tablet/kapsul/kaplet 500 DAK 2017 115.00
Tablet
mg
331 Metronidazol tablet 500 mg Tablet DAK 2016 750.00
332 Metronidazole sirup 125mg/ 5ml Botol 60 ml DAK 2016 3,800.00
333 Metronidazol sirup 125 mg/5 ml Botol 60 ml DAK 2017 3,800.00
334 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2016 3,737.00
335 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2017 5,500.00
336 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2015 3,075.00
337 Natrium Bikarbonat tablet 500 mg Tablet DAK 2016 22.00
338 Natrim Diklofenak 50 mg tab Tablet DAK 2016 161.00
Natrium diklofenak tablet/kapsul/kaplet
Tablet salut enterik
339 50 mg DAK 2017 135.00
340 Natrim Diklofenak 50 mg tab Tablet DAK 2015 193.00
341 Natrium Klorida larutan infus 0,9 % DAK 2017 6,410.00
Botol plastik 500 ml
Steril
Natrium Klorida larutan infus 0,9 %
342 Botol plastik 500 ml DAK 2015 5,170.00
Steril
Natrium Klorida larutan infus 0,9 %
343 Botol plastik 500 ml DAK 2016 6,410.00
Steril
344 Nifedipin tablet/kapsul/kaplet 10 mg Tablet salut selaput DAK 2017 110.00
345 Nifedipin tablet 10 mg Tablet DAK 2015 110.00
346 Nifedipin tablet 10 mg Tablet DAK 2016 123.00
347 Nistatin vaginal tablet 100.000 IU/ g Tablet Vaginal DAK 2017 627.00
348 Nistatin vaginal tablet 100.000 IU/ g Supp DAK 2016 602.00
349 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet Salut Gula DAK 2017 881.00
350 Nistatin tablet salut 500.000 UI/g Tablet DAK 2015 704.00
351 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet DAK 2016 857.00
352 Nystatin drop Botol 12 ml DAK 2016 38,425.00
353 Nystatin drop Botol 12 ml DAK 2017 24,198.00
354 Obat Anti Tuberculosis FDC Kategori I Paket DAK 2017 430,538.00
355 OAT FDC Kategori 1 Dewasa Paket DAK 2013 395,900.00
356 OAT FDC Kategori 2 Dewasa Paket DAK 2016 1,379,984.00
357 Obat Anti Tuberculosis FDC Kategori II Paket DAK 2017 1,435,178.00
358 Obat Antituberkulosis Kategori 1 DAK 2014 317,015.00
Paket
dewasa
Obat Anti Tuberculosis FDC Kategori
Paket
359 Sisipan DAK 2016 183,984.00
"Dus, 12 blister @ 28
Obat Anti Tuberculosis FDC Kategori tablet dispersibel Dus, 6
Anak blister @ 28 tablet
360 dispersibel" DAK 2017 257,125.00
Obat Anti Tuberculosis FDC Kategori
Paket
361 Anak DAK 2016 247,234.00
362 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2016 7,149.00
363 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2017 6,000.00
Obat batuk Antitusif sirup Kombinasi
Botol 60 ml
364 Dextromethorphan HBr DAK 2016 9,875.00
Obat batuk Antitusif tablet Kombinasi
Tablet
365 Dextromethorphan HBr DAK 2016 548.00
Obat batuk sirup Kombinasi
Botol 60 ml
366 Dextromethorphan HBr DAK 2017 11,800.00
Obat batuk tablet Kombinasi
Tablet
367 Dextromethorphan HBr DAK 2017 704.00
368 Ofloksasin tab 400 mg Tablet DAK 2010 960.00
369 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2016 1,649.36
370 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2017 1,640.00
371 Oksitetrasiklin HCI salep mata 1 % Tube 3,5 gram DAK 2017 2,772.00
372 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2015 2,772.00
373 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2016 2,772.00
374 Oksitosin injeksi 10 IU/ml(Tiacinon) Ampul DAK 2015 1,900.00
375 Oksitosin injeksi 10 IU / ml - ml Ampul DAK 2014 5,890.50
OXYTOCIN INJLQ 10 IU Oksitosin inj
Ampul
376 10 UI/ml DAK 2016 1,900.00
377 Omeprazole Injeksi 40mg / 10ml Vial DAK 2016 18,537.00
378 Omeprazol injeksi 40 mg/ 10 ml Vial DAK 2017 14,924.00
379 Omeprazole kapsul Kapsul DAK 2016 164.00
380 Omeprazole kapsul Kapsul DAK 2015 221.00
381 Omeprazol tablet/kapsul/kaplet 20 mg Kapsul DAK 2017 148.00
382 Ondansetron tablet/kapsul/kaplet 4 mg Tablet DAK 2016 542.00
383 Ondansetron tablet/kapsul/kaplet 4 mg Tablet salut selaput DAK 2017 523.00
384 Ondansetron inj 2 mg/ml (4 mg/ 2 mL) Ampul 2 ml DAK 2017 1,254.00
Ondansetron Injeksi 2 mg/ ml (4 mg/ 2
Ampul 2 ml
385 ml) DAK 2016 1,650.00
386 Ondansetron inj 4 mg/ 2 mL Ampul 2 ml DAK 2015 2,400.00
387 PANTOCAIN 0.5% Botol DAK 2016 11,500.00
388 Parasetamol infus Dus, Botol @ 1000 mg DAK 2016 27,225.00
Parasetamol drips (infus) 1000 mg/100
Dus, Botol @ 1000 mg
389 mL DAK 2017 12,939.00
390 Parasetamol sirup 120 mg / 5 ml Botol Plastik @ 60 Ml DAK 2017 1,013.00
391 Parasetamol sirup 120 mg/ 5ml Botol Plastik @ 60 Ml DAK 2016 1,119.00
392 Parasetamol drop Botol Plastik @ 60 Ml DAK 2015 5,720.00
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml
393 (60mg/0,6ml) (G) DAK 2017 6,850.00
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml
394 (60mg/0,6ml) (G) DAK 2016 5,980.00
395 Parasetamol tablet 100 mg Tablet DAK 2016 106.59
396 Parasetamol tablet 100 mg Tablet DAK 2013 34.51
397 Parasetamol tablet 500 mg Tablet DAK 2016 174.00
398 Parasetamol tablet/kapsul/kaplet 500 DAK 2017 51.00
Tablet
mg
399 Parasetamol tablet 500 mg Tablet DAK 2015 88.00
400 Perak sulfadiazin krim 1% tube 35 g DAK 2017 20,700.00
Petidin injeksi i.m/s.k/i.v lambat 50
Ampul
401 mg/ml (HCl) DAK 2015 15,950.00
402 Piracetam 400 mg Tablet DAK 2016 541.24
403 Piracetam Inj 1 g/5 ml Ampul DAK 2016 15,840.00
404 Piracetam Inj 1 g/5 ml Ampul DAK 2017 6,600.00
405 Pirantel tablet 125 mg Tablet DAK 2014 318.00
406 Pirantel tablet score (base) 125 mg Tablet DAK 2016 318.00
407 Pirazinamid 500 mg Tablet DAK 2017 238.00
408 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2015 148.00
Piridoksin (Vitamin B6) tab/kap/kapl 10
Tablet
409 mg (HCl) DAK 2017 136.00
410 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2016 136.00
411 Piroksikam 20 mg Tablet DAK 2016 213.95
412 Piroksikam 20 mg Tablet DAK 2017 130.00
413 Piroksikam 20 mg Tablet DAK 2015 105.00
414 Povidon lodida larutan 10 % Botol 300 ml DAK 2013 14,350.00
415 Povidon lodida larutan 10 % Botol 300 ml DAK 2015 15,386.00
416 Povidon lodida larutan 10 % Botol 300 ml DAK 2014 15,386.00
417 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2016 102.00
418 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2017 85.00
419 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2015 125.00
420 Prednison tablet/kapsul/kaplet 5 mg Tablet ABT 2015 125.00
421 Primakuin tablet 15 mg Tablet DAK 2015 205.00
422 Propranolol HCI tablet 10 mg Tablet DAK 2016 69.00
423 Propranolol tablet/kapsul/kaplet 10 mg Tablet DAK 2017 59.00
424 Propranolol HCI tablet 10 mg Tablet DAK 2015 80.00
425 Proiltiourasil tablet 100 mg Tablet DAK 2014 299.27
426 Proiltiourasil tablet 100 mg Tablet DAK 2015 351.00
Propiltiourasil tablet/kapsul/kaplet 100
Tablet
427 mg DAK 2016 320.00
428 Vaksin rabies Vial DAK 2017 174,500.00
429 Ranitidin tablet 150 mg Tablet DAK 2015 128.00
430 Ranitidin tablet/kapsul/kaplet 150 mg Tablet salut selaput DAK 2017 110.00
431 Ranitidin tablet 150 mg Tablet DAK 2016 119.00
432 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2016 1,595.18
433 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2017 1,677.00
434 Ranitidin Injeksi 25 mg/ml Ampul 2 ml DAK 2015 3,960.00
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul
435 lunak DAK 2016 327.00
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul
436 lunak DAK 2015 286.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul lunak
437 lunak DAK 2017 585.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul
438 lunak ABT 2015 505.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul
439 lunak DAK 2016 536.00
440 Rifampisin tablet/kapsul/kaplet 600 mg Kaptap ss DAK 2017 1,274.00
441 Ringer laktat larutan infus Botol plastik 500 ml DAK 2014 5,720.00
442 Ringer laktat larutan infus Botol plastik 500 ml DAK 2017 7,150.00
443 Ringer Laktat Botol DAK 2016 7,150.00
444 Risperidon 2 mg Tablet DAK 2016 495.00
Salbutamol tablet/kapsul/kaplet 4 mg
Tablet
445 (sebagai Sulfat) DAK 2017 86.00
446 Salbutamol tablet 2 mg Tablet DAK 2015 65.00
447 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet DAK 2016 84.00
448 Salbutamol sirup Dus, botol @ 100 ml DAK 2016 5,463.00
449 Salbutamol sirup Dus, botol @ 100 ml DAK 2017 4,916.00
Salbutamol cairan ih 0,1%(Ventolin
Nebules
450 Nebules) DAK 2017 14,124.00
VENTOLIN NEBULES - Salbutamol
Nebules
451 cairan ih 0,1% DAK 2016 4,000.00
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
452 Belerang Endap 4 % DAK 2017 2,907.00
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
453 Belerang Endap 4 % DAK 2016 2,797.00
454 Salisil Bedak 2 % Kotak DAK 2016 1,066.00
455 Salisil Bedak 2 % Kotak DAK 2015 4,000.00
SCABIMITE CREAM 10 - Permetrin
Tube @ 10 g
456 krim 5% DAK 2016 12,155.00
457 Permetrin Krim 5% Tube @ 10 g DAK 2017 12,155.00
458 Sefiksim sirup kering 100 mg/ 5 ml Botol DAK 2015 9,400.00
459 Sefiksim sirup kering 100 mg/5 ml Botol DAK 2016 7,690.00
460 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2016 649.00
461 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2015 899.00
462 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2016 9,840.00
463 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2017 4,133.00
464 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml ABT 2015 5,286.00
465 Sefadroksil kapsul/kaplet 500 mg Kapsul DAK 2016 557.00
466 Sefadroksil tablet/kapsul/kaplet 500 mg Kapsul DAK 2017 455.00
467 Sefadroksil kapsul 500 mg Kapsul DAK 2015 525.00
468 Seftriaksone Injeksi 1 g Vial DAK 2016 27,500.00
469 Seftriaksone Injeksi 1 g Vial DAK 2017 11,650.00
470 Sefotaksim Injeksi 1 g Vial DAK 2016 5,884.00
471 Sianocobalamin (Vit.B12) tablet 50 mg Tablet DAK 2016 126.50
Sianokobalamin (vitamin B12)
Tablet
472 tablet/kapsul/kaplet 50 mcg DAK 2017 55.00
Sianokobalamin (vitamin B12)
Tablet
473 tablet/kapsul/kaplet 50 mcg DAK 2015 63.00
Sianokobalamin (vitamin B12)
Tablet
474 tablet/kapsul/kaplet 50 mcg ABT 2015 63.00
Sianokobalamin (vitamin B12) injeksi
Ampul 1 ml
II 500 mcg DAK 2017 1,117.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml
A mcg/ml - 1ml DAK 2016 1,226.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml
1 mcg/ml - 1ml DAK 2015 1,050.00
2 Simvastatin scored tablet 10 mg Tablet DAK 2016 135.00
3 Simvastatin tablet/kaplet/salut 10 mg Tablet salut selaput DAK 2017 113.00
4 Simvastatin 10 mg Tablet DAK 2015 320.00
5 Siprofloksasin tab scored 500 mg Tablet salut selaput DAK 2017 254.00
6 Siprofloksasin tab scored 500 mg Tablet DAK 2016 298.00
7 Spironolactone 25 mg Tablet DAK 2016 314.00
8 Spironolakton tablet/kapsul/kaplet 25 DAK 2017 277.00
Tablet
mg
9 Serum BioSAVE (ABU I) Dus, 1 Vial @ 5 ml DAK 2016 591,250.00
Serum anti bisa ular (A.B.U) I cairan inj
Dus, 1 Vial @ 5 ml
10 (i.m./i.v) DAK 2017 462,000.00
Serum Anti Bisa Ular Polivalen injeksi 5
Dus, 1 Vial @ 5 ml
11 ml ( ABU I ) DAK 2015 472,000.00
12 Serum BioSAT-1.5 (ATS 1500 UI) Ampul 1 ml DAK 2016 158,125.00
Serum antitetanus (A.T.S) cairan inj
Ampul 1 ml
13 1500 IU/amp (i.m) DAK 2017 126,500.00
Serum Anti Tetanus injeksi 1.500
Ampul 1 ml
14 IU/ampul ( A.T.S ) DAK 2015 125,000.00
STREPTOMISIN SERBUK INJ IV 1000
Vial
15 mg/ml DAK 2016 5,750.00
16 Sukralfat susp 500 mg / 5 ml, 100 ml Botol 100 ml DAK 2016 10,100.00
17 Sukralfat susp 500 mg/5 mL, 100 ml Botol 100 ml DAK 2017 9,192.00
18 Sukralfat tablet/kapsul/kaplet 500 mg Tablet DAK 2017 296.00
19 ULSIDEX - Sukralfat tab 500 mg Tablet DAK 2016 368.00
SUPRAFENID Ketoprofen supositoria
Supp
20 100 mg DAK 2016 2,789.00
21 Teofilin tablet/kapsul/kaplet 150 mg Tablet DAK 2017 328.00
22 Teofilin tablet 150 mg(Bronsolvan) Tablet DAK 2016 310.00
23 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2016 329.00
24 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2015 325.00
25 Thiamphenicol 500 mg kaps Kapsul DAK 2016 984.51
26 Thiamphenicol 500 mg kaps Kapsul DAK 2017 865.00
27 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2016 21,950.00
28 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2017 6,500.00
Tiamin HCI ( Vit.B1 injeksi 100 mg/ml -
Ampul
29 1 ml ) DAK 2013 750.00
 Tiamin HCI/Mononitrat (Vit.B1) tablet 50
Tablet
30 mg DAK 2015 37.00
Tiamin (Vitamin B1) tablet/kapsul/kaplet
Tablet
31 50 mg (HCl/ Nitrat) DAK 2017 87.00
Tiamin HCI/Mononitrat (Vit.B1) tablet
Tablet
32 100 mg DAK 2016 91.00
33 Tramadol tablet 50 mg Tablet DAK 2016 329.68
34 Tramadol tablet 50 mg Tablet DAK 2015 320.00
35 Tramadol tablet/ Kapsul 50 mg Tablet DAK 2017 325.00
36 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2016 1,984.00
37 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2017 1,720.00
38 Trifluoperazine 5mg Tablet DAK 2016 786.00
39 Triheksifenidil tablet/kapsul/kaplet 2 mg Tablet DAK 2017 80.00
40 Triheksifenidil tablet 2 mg Tablet DAK 2015 600.00
41 Triheksifenidil tablet 2 mg Tablet DAK 2016 498.30
42 Valproat sirup 250 mg/5 ml Dus, Botol @ 100 mL DAK 2017 26,987.00
43 Valsartan tab 80 mg Tablet DAK 2016 1,800.00
44 Vitamin B Kompleks tablet Tablet DAK 2016 132.00
45 Vitamin B Kompleks tablet Tablet DAK 2017 132.00
46 Vitamin B Kompleks tablet Tablet DAK 2015 112.00
47 Vitamin B Kompleks tablet Tablet ABT 2015 168.00
48 Zinc sir 20 mg/5 ml Dus, Botol @ 60 ml DAK 2017 4,959.00
49 Zinc sir 20 mg/5 Ml( Zircum Kid Sirup) Dus, Botol @ 60 ml DAK 2016 6,500.00
50 Zinc tablet dispersible20 mg Tablet DAK 2016 592.00
51 Zink Tablet DAK 2015 521.00
52 Zinc tablet dispersible 20 mg Tablet dispersible DAK 2017 586.00
53 Truvit sirup Dus, Botol @ 60 ml DAU 2016 10,890.00
II ALAT KESEHATAN
A BAHAN MEDIS HABIS PAKAI
1 Alat suntik sekali pakai 1 ml Piece DAK 2016 1,012.60
2 Alat suntik sekali pakai 1 ml Piece DAK 2017 1,012.60
3 Alat suntik sekali pakai 2,5 ml Piece DAK 2014 1,141.80
4 Alat suntik sekali pakai 3 ml Piece DAK 2016 1,006.50
5 Alat suntik sekali pakai 3 ml Piece DAK 2017 1,006.50
6 Alat suntik sekali pakai 5 ml Piece DAK 2016 1,132.16
7 Alat suntik sekali pakai 5 ml Piece DAK 2017 1,132.16
8 Alat suntik sekali pakai 10 ml Piece DAK 2017 1,588.44
9 Alat suntik sekali pakai 20 ml Piece DAK 2016 2,383.88
10 Alat suntik sekali pakai 50 ml Piece DAK 2016 4,892.20
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece
11 DAK 2017 1,240.00
24GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece
12 26 GX3/8" DAK 2017 1,650.00
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece
13 DAK 2016 1,240.00
23GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece
14 DAK 2016 1,650.00
27GX3/8"
15 Alkohol Swab 4-ply Piece DAK 2016 244.00
16 Bioplasenton Tulle 10 x 10 (CBPCD) Sachet DAK 2016 10,950.00
17 Blood Lancet (21,26,28 G) Piece DAK 2016 160.23
18 Blood Transfusion Set Piece DAK 2017 17,513.10
Benang Bedah SMI
Sachet
19 CATGUT PLAIN SMI 2/0 HR 26 MM DAK 2015 26,583.00
20 CATGUT CHROMIC SMI 2/0 HR 26 DAK 2016 33,785.00
Sachet
MM
21 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2016 35,285.00
22 CATGUT CHROMIC SMI 2/0 HR 26 DAK 2017 33,785.00
Sachet
MM
23 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2017 35,285.00
24 CATGUT CHROMIC SMI 3/0 HR 26 DAK 2017 33,785.00
Sachet
MM
25 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2017 35,285.00
Benang Bedah SMI
Sachet
26 CATGUT PLAIN SMI 3/0 HR 26 MM DAK 2015 26,583.00
27 CATGUT CHROMIC SMI 3/0 HR 26 DAK 2016 33,785.00
Sachet
MM
28 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2016 35,285.00
Catgut / Benang bedah No.3/0 dengan
Sachet
29 jarum bedah DAK 2012 27,041.67
30 Folley Catheter 2 Way no. 22 Piece DAK 2016 10,000.00
31 Foley Catheter No.16 Piece DAK 2013 9,300.00
32 Foley Catheter No.16 Piece DAK 2015 10,440.00
FOLEYCATH, 2 way latex foley cath,
Piece
33 no. 16 DAK 2016 13,420.00
FOLEYCATH, 2 way latex foley cath,
Piece
34 no. 18 DAK 2016 13,420.00
35 Foley Catheter No.18 Piece DAK 2014 9,344.50
36 Foley Catheter No.18 Piece DAK 2015 10,440.00
37 FEMALE CATHETER, no. 18 Piece DAK 2016 6,978.40
38 EXAMINATION GLOVES, size M Piece DAK 2017 563.64
39 EXAMINATION GLOVES, size S Piece DAK 2017 563.64
40 EXAMINATION GLOVES, size M Piece DAK 2016 563.64
41 CHIRURGIC GLOVES, size 7.5 Piece DAK 2016 9,272.00
Sarung Tangan Obgyn Steril ( Obgyn
pasang
42 glove ) DAK 2017 24,200.00
43 Infusion set anak (Micro) Piece DAK 2014 4,400.00
Infus Set Anak PEDIATRIC SET (60
Piece
44 drops/ml) DAK 2017 6,222.00
Infusion Set Pediatric (60 drops/ml)
Bbraun Intrafix Primeline with Piece
45 Microdropper DAK 2015 20,320.50
Infus Set Anak PEDIATRIC SET (60
Piece
46 drops/ml) DAK 2016 6,222.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
47 DAK 2016 5,856.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
48 DAK 2017 5,856.00
49 IV Catheter 16 G x 2" Piece DAK 2017 9,158.00
50 IV-CATH WP, with wings & port, no. 18 Piece DAK 2016 8,540.00
I.V Catheter (with port) VASOFIX IV
Piece
51 G18 X 45 MM Green DAK 2015 10,062.50
52 IV-Cath NP, pen type, no. 18 Piece DAK 2017 7,320.00
53 IV-CATH WP, with wings & port, no. 20 Piece DAK 2016 8,540.00
I.V Catheter (with port) VASOFIX IV
Piece
54 G20 X 33 MM Pink DAK 2015 10,062.50
I.V Catheter (with port) VASOFIX IV
Piece
55 G22 X 25 MM Blue DAK 2015 10,062.50
56 IV-CATH WP, with wings & port, no. 22 Piece DAK 2016 8,540.00
57 IV-Cath NP, pen type, no. 22 Piece DAK 2017 7,320.00
I.V Catheter (with port) VASOFIX IV
Piece
58 G24 X 0.75 " DAK 2015 10,062.50
59 IV-CATH WP, with wings & port, no. 24 Piece DAK 2016 8,540.00
60 IV-Cath NP, pen type, no. 24 Piece DAK 2017 7,320.00
61 IV-Cath NP, pen type, no. 26 Piece DAK 2017 9,394.00
62 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2017 28,745.25
63 Kapas pembalut / Absorben 250 gram Roll DAK 2015 28,452.86
64 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2016 28,750.00
65 Kasa 36 x 80 Roll DAK 2015 142,376.60
66 Kasa Hidrofil DRC 36m x 80cm Roll DAK 2016 141,400.00
67 Kasa 36 x 80 Roll DAK 2014 60,720.00
68 Kasa Steril DRC 16cm x 16cm (16 DAK 2016 8,650.50
Box
pads)
Kasa Steril DRC 16cm x 16cm (16
69 Box DAK 2017 8,650.36
pads)
70 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2016 7,375.00
71 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2017 9,000.00
72 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2017 2,475.75
73 kasa 4 x 10 cm Roll DAK 2015 2,439.24
74 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2016 2,475.43
75 Surgical Mask Tie On Piece DAK 2017 412.50
76 Masker Piece ABT 2015 574.20
77 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 2016 550.00
78 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 2017 550.00
NGT
Terumo SAFEED Feeding Tube 3.5 (35 Piece
79 cm) DAK 2015 8,841.00
NGT
Terumo SAFEED Feeding Tube 5 fr (40 Piece
80 cm) DAK 2015 8,841.00
NGT
Terumo SAFEED Stomach Tube 14 fr Piece
81 (125 cm) DAK 2015 10,010.00
NGT
Terumo SAFEED Stomach Tube 16 fr Piece
82 (125 cm) DAK 2015 10,010.00
NGT
Terumo SAFEED Stomach Tube 18 fr Piece
83 (125 cm) DAK 2015 10,010.00
84 Oxyflow nasal oxygen bayi Piece DAK 2015 6,050.00
85 Oxyflow nasal oxygen anak Piece DAK 2015 6,050.00
86 NASAL OXYGEN, O2 cannula, size S Piece DAK 2016 8,052.00
87 NASAL OXYGEN, O2 cannula, size S Piece DAK 2017 8,052.00
88 NASAL OXYGEN, O2 cannula, size M Piece DAK 2016 8,052.00
89 NASAL OXYGEN, O2 cannula, size M Piece DAK 2017 8,052.00
90 NASAL OXYGEN, O2 cannula, size L Piece DAK 2016 8,052.00
91 NASAL OXYGEN, O2 cannula, size L Piece DAK 2017 8,052.00
Plester Leukoplast Hospital 7.50 cm x
Roll
92 4.5 m DAK 2016 35,532.00
93 Plester Polifix 10 cm x 5 m Roll DAK 2017 76,314.14
94 Pembalut Elastis 10 cm x 4,55 m Roll DAK 2017 45,507.00
95 Scalpel Blades Nomor 10 Piece DAK 2017 3,300.00
96 SILK BLACK 3/0 HR 26 MM Sachet DAK 2016 20,685.00
Benang Bedah SMI
Sachet
97 SILK BLACK 3/0 DS 24 MM DAK 2015 18,364.00
98 Onemed U Pad Steril 60 x 90 cm Blister DAK 2016 9,533.15
99 Onemed U Pad Steril 60 x 90 cm Blister DAK 2017 9,533.15
Onemed Umbilical Cord Klem Steril
Piece
100 Nylon DAK 2016 1,250.00
101 Urine Bag Piece DAK 2015 3,915.00
URINE DRAINAGE BAG, T valve, with
Piece
102 hanger DAK 2016 6,710.00
103 Alkohol 70% Botol 1 L DAK 2016 27,950.00
104 Alkohol 70% Botol 100 ml DAK 2017 8,300.00
105 My Jelly 82 gram Tube @ 82 gr DAK 2016 36,936.83
106 Lysol 1 liter Botol 1 L DAK 2016 53,300.00
107 Povidone Iodine 300 ml Botol @ 300 ml DAK 2016 23,400.00
108 Povidone Iodine 300 ml Botol @ 300 ml DAK 2017 23,400.00
109 Rivanol 300 cc Botol @ 300 ml DAK 2017 3,750.00
110 Rivanol 300 cc Botol @ 300 ml DAK 2016 3,315.00
Cairan Antiseptika pencuci alat
Botol 1 Liter
111 instrumen DAK 2017 141,406.33
Cairan Antiseptika pencuci tangan
Botol 500 ml
112 tanpa dibilas DAK 2017 83,027.33
Cairan Antispetika pencuci tangan
Botol 500 ml
113 dengan dibilas DAK 2017 64,769.00
B REAGENSIA
1 Total Cholesterol Test Strip 10's Strip DAK 2016 23,354.00
2 Uric Test Strip 25's Strip DAK 2016 5,154.00
3 Glucose Test Strip 50's Strip DAK 2016 3,093.34
4 Total Cholesterol Test Strip 10's Strip DAK 2017 23,566.00
5 Uric Test Strip 25's Strip DAK 2017 5,238.80
6 Glucose Test Strip 50's Strip DAK 2017 3,188.24
Anti-A Monoclonal Golongan Darah
Vial 10 ml
7 (Vial 10 ml) DAK 2016 80,825.00
Anti-A,B Monoclonal Golongan Darah
Vial 10 ml
8 (Vial 10 ml) DAK 2016 105,135.00
Anti-B Monoclonal Golongan Darah
Vial 10 ml
9 (Vial 10 ml) DAK 2016 80,825.00
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml
10 10 ml) DAK 2016 126,695.00
Anti-A Monoclonal Golongan Darah
Vial 10 ml
11 (Vial 10 ml) DAK 2017 74,512.50
Anti-A,B Monoclonal Golongan Darah
Vial 10 ml
12 (Vial 10 ml) DAK 2017 98,822.50
Anti-B Monoclonal Golongan Darah
Vial 10 ml
13 (Vial 10 ml) DAK 2017 74,512.50
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml
14 10 ml) DAK 2017 120,382.50
15 Rapid test Vikia HIV 1/2 Kit DAK 2016 519,750.00
16 Anti HIV 1/2 Cassette each DAK 2017 15,297.00
17 Gluco Protein tes Piece DAK 2017 1,150.00
18 Gluco Protein Piece DAK 2016 1,150.00
19 Ultra One Test Hamil Piece DAK 2016 2,133.00
20 HCG Strip each DAK 2017 7,181.00
21 Malaria Pf & Pv Cassette each DAK 2017 53,180.00
22 Hb strip Dr Family test Tes DAK 2017 24,200.00
23 HBsAg Strip each DAK 2017 10,967.00
24 R.Detergent urit (urit 3000 plus) Gallon 5 L DAK 2017 278,300.00
25 R.Dilluen urit (urit 3000 plus) Gallon 20 L DAK 2017 1,012,000.00
26 R.Lytic urit (urit 3000 plus) Botol 1 L DAK 2017 1,113,200.00
27 Rapid tes Dengue (IgG-IgM) Device Tes DAK 2017 124,100.00
28 Hayem 1x100mL Botol 100 ml DAK 2017 29,450.00
29 Aquadest Botol 1 Liter DAK 2017 19,448.00
30 Asam Asetat 6 % Botol 100 ml DAK 2017 29,000.00
31 Asam Sulfosalisilat 20% 1x100mL Botol 100 ml DAK 2017 328,700.00
32 EDTA 10% 1x100mL Botol 100 ml DAK 2017 74,100.00
33 Eosin 2% 1x100mL Botol 100 ml DAK 2017 176,225.00
34 HCl 0,1N 1x100mL Botol 100 ml DAK 2017 19,950.00
35 Immersion Oil 1x100mL Botol 50 ml DAK 2017 367,650.00
36 KOH 10% 1x100mL Botol 100 ml DAK 2017 20,900.00
37 Methanol PA Botol 100 ml DAK 2017 94,000.00
38 Na Citrate 3,13% 1x100mL Botol 100 ml DAK 2017 19,475.00
39 Rees Ecker 1x100mL Botol 100 ml DAK 2017 46,550.00
40 Turk 1x100mL Botol 100 ml DAK 2017 23,750.00
41 Salmonella Typhi H Widal Test Vial 5 ml DAK 2017 72,972.50
42 Salmonella Typhi O Widal Test Vial 5 ml DAK 2017 72,972.50
43 Salmonella Paratyphi AH Widal Test Vial 5 ml DAK 2017 72,972.50
44 Salmonella Paratyphi AO Widal Test Vial 5 ml DAK 2017 72,972.50
45 Salmonella Paratyphi BH Widal Test Vial 5 ml DAK 2017 72,972.50
46 Salmonella Paratyphi BO Widal Test Vial 5 ml DAK 2017 72,972.50
47 Salmonella Paratyphi CH Widal Test Vial 5 ml DAK 2017 72,972.50
48 Salmonella Paratyphi CO Widal Test Vial 5 ml DAK 2017 72,972.50
C OBAT DAN BMPH LAIN-LAIN
1 Aminofilina tablet 200 mg DAK 2013 93.00
Tablet
2 Furosemid tablet 40 mg Tablet DAK 2013 92.00
3 Aminofilina tablet 200 mg DAK 2013 93.31
Tablet
4 Amlodipin 5 mg Tablet DAK 2013 241.00
5 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2014 4,730.00
Antimigren DOEN tablet kombinasi :
Tablet
6 Ergotamin Tartrat 1 mg + Kofein 50 mg DAK 2015 149.00
7 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2013 1,108.00
8 Gemfibrozil kap/tablet 300 mg Tablet DAK 2016 436.00
9 Parasetamol sirup 120 mg/ 5ml Botol Plastik @ 60 Ml DAK 2015 1,535.00
10 Handschoon ( sarung tangan) Piece DAK 2015 424.00
11 IV Catheter G20 Piece DAK 2012 8,566.25
12 IV Catheter G22 Piece DAK 2012 8,566.20
13 Kapas pembalut / Absorben 250 gram Roll DAK 2014 8,250.00
Plester Leukoplast Hospital 7.50 cm x
Roll
14 4.5 m DAK 2012 25,980.00
17

STOK AWAL PER

01 JAN 2017
6

- 0
500 47500
- 0
- 0
170 31450
- 0
- 0
121 438867
- 0
- 0
200 28736
- 0
- 0
- 0
- 0
- 0
- 0
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- 0
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3,700 862100

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48 105600
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0
- 0
35 73710
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 - 0

- 0

6,000 384000

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20 160000

- 0

- 0

- 0

10 33500

- 0

- 0

- 0

- 0
5 11000
- 0
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- 0
1,800 216000

- 0
- 0

- 0

- 0
- 0
2,300 259900
- 0
- 0
- 0
- 0
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 - 0
- 0
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100 35400
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- 0
50 11000
- 0
- 0

- 0

2,700 1782000

- 0

- 0
- 0
300 51000
- 0
- 0

- 0
- 0

- 0
- 0

- 0

- 0

- 0

- 0
- 0
- 0
800 152000
- 0
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29 85550
- 0
- 0
- 0
- 0
- 0
- 0
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800 54400
 - 0

100 360800

500 137500

- 0
- 0

- 0
90 4140
- 0
- 0

- 0

- 0
- 0

- 0

- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
100 11800
- 0
- 0
- 0

- 0

- 0

- 0

- 0
- 0
- 0
- 0
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5 16638.75
- 0
2 5250
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 - 0
1 115500
1 18333
- 0
- 0
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60 4206
- 0
- 0
- 0

- 0

- 0

20 81660

- 0

200 159200

- 0

- 0
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- 0

500 137000

- 0
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- 0
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37 170200
- 0
- 0
- 0
- 0
24 70200
- 0
- 0
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- 0
 - 0
- 0

- 0
- 0
- 0
- 0
- 0
1,000 36520
- 0
- 0
- 0
- 0
- 0
400 105600
- 0
- 0
- 0
- 0
- 0

- 0
- 0

- 0
- 0
- 0
- 0
48 130176
- 0
- 0
- 0
- 0
- 0
- 0
400 53200
- 0
- 0
50 128000
- 0
- 0
- 0
- 0
- 0
- 0

- 0

4,800 331200

- 0

- 0
3,200 230400
- 0
- 0
- 0
 - 0

- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0

- 0

- 0
- 0
- 0
- 0
- 0
- 0
- 0

- 0

25 178125

- 0
- 0

1,400 63000

- 0
- 0
- 0
- 0
- 0
- 0
470 728500
- 0

100 222500

- 0

- 0
 - 0

- 0

- 0

500 172000
- 0

- 0

- 0
- 0
- 0
- 0

30 44970
- 0

- 0

- 0
- 0
- 0
- 0
500 74500
- 0

- 0
- 0
- 0
- 0

- 0
- 0
- 0

- 0

- 0

- 0

- 0

90 241560
- 0

- 0
- 0
- 0
 - 0
- 0
500 54000

- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
- 0
100 2200
1,100 177100

- 0
- 0
- 0
- 0
10 64100
- 0
- 0
- 0
- 0
- 0
- 0
- 0
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- 0

- 0

- 0
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- 0

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- 0

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 50 82468
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- 0
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54 60426
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56 334880
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5,600 974400
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- 0
- 0
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100 31800
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- 0
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400 85580
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1,000 105000
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4 61544
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 - 0
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- 0
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- 0
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1,000 128000
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- 0

- 0

- 0

- 0

- 0
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5 28600
- 0
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- 0
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900 75600
- 0
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- 0

- 0

- 0

- 0
53 56498
- 0

10 121550
- 0
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 - 0
- 0
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200 111400
- 0
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- 0
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- 0

- 0

- 0

500 31500

- 0

- 0

- 0
- 0
0 0
120 38400
0 0
400 119200
0 0
0 0
0 0

0 0

0 0
0 0

0 0

0 0

0 0
50 505000
0 0
0 0
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 1097500
0 0

0 0
 0 0

0 0

3700 336700
0 0
0 0
0 0
0 0
0 0
500 393000
0 0
0 0
100 49830
0 0
0 0
2800 369600
0 0
0 0
0 0
0 0
0 0
300 177600
0 0
0 0
20 217800
0
0
0 0
0 0
0 0
100 100650
0 0
100 113216
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0
100 24400
10 109500
100 16023
0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0

24 649000
0 0
0 0
0 0

0 0

20 268400
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
0 0

0 0

0 0

0 0

8 46848

0 0
0 0
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0 0
0 0
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0 0

0 0
10 85400
0 0

0 0
0 0
0 0
0
0 0
 0 0
2 57500
0 0
0 0
0 0
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0 0
0 0
0 0
0 0
50 121962
0 0
0 0
800 459360
0 0
0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

2 71064
0
0
0
0 0

0 0
4 38132.6
0 0

40 50000
0 0

0 0
0 0
0 0
23 849547.09
 0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0
0 0
60 1401240
50 257700
75 232000.857142857
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0
0 0
97 206901
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
600 55800
800 73600
600 55986
300 72300
75 354750

200 29800
24 26592
200 87200
50 76750
500 212000
4 34265
3 25698.6
6 49500

2 51960
0
 DAFTAR PENERIMAAN OBAT D
APBD II TAHUN 2
PUSKESMAS SEMB

NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN

1 2 3 4 9
I OBAT GENERIK
1 Akarbose tablet/kaplet 50 mg Tablet DAK 2016 657.00
2 Alopurinol tablet 100 mg Tablet DAK 2016 95.00
3 Alopurinol tablet 100 mg Tablet DAK 2015 90.00
4 Alopurinol tablet 100 mg Tablet DAK 2017 117.00
5 Alprazolam 0,5 mg Tablet DAK 2015 185.00
6 Alprazolam 0,5 mg Tablet DAK 2016 144.00
7 Alprazolam 0,5 mg Tablet DAK 2014 185.00
8 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2016 3,627.00
9 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2015 3,290.00
10 Ambroxol tablet 30 mg Tablet DAK 2017 985.00
11 Ambroxol tablet 30 mg Tablet DAK 2016 143.68
12 Ambroxol tablet 30 mg Tablet DAK 2015 125.00
13 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2017 17,375.00
14 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2017 3,080.00
15 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2015 4,200.00
16 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2016 3,349.00
17 Aminofilina tablet 200 mg DAK 2016 124.94
Tablet
18 Aminofilina tablet 200 mg Tablet salut selaput DAK 2017 97.00
19 Aminofilina tablet 200 mg DAK 2015 86.00
Tablet
20 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2015 123.00
21 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2016 165.00
22 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2017 171.00
23 Amlodipin 5 mg Tablet DAK 2017 91.00
24 Amlodipin 5 mg Tablet DAK 2016 1,333.33
25 Amlodipin 5 mg Tablet DAK 2015 197.00
Amoksisilin kapsul/kaplet/tablet scored
Kaptab
26 500 mg DAK 2017 191.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet
27 500 mg DAK 2016 233.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet
28 500 mg DAK 2015 279.00
29 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2017 1,920.00
30 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2016 2,200.00
31 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2015 2,560.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
32 ml DAK 2017 3,797.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
33 ml DAK 2015 4,730.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
34 ml DAK 2016 4,147.00
35 Antalgin injeksi 250 mg/ml - 2 ml Ampul DAK 2013 1,500.74
36 Antasida DOEN suspensi Botol 60 ml DAK 2016 2,106.00
37 Antasida DOEN suspensi Botol 60 ml ABT 2015 2,300.00
38 Antasida DOEN suspensi Botol 60 ml DAK 2015 2,300.00
39 Antasida DOEN suspensi Botol 60 ml DAK 2017 1,962.00
Antasida DOEN tablet
kunyah,kombinasi: Tablet
40 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2015 78.00
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet
41 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2017 59.00
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet kunyah
42 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2016 64.00
200 mg
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
43 IU/g DAK 2015 2,767.00
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
44 IU/g DAK 2017 3,365.00
Anti Diare Kombinasi Kaolin 986
Botol 60 ml
45 mg+Pektin 40 mg DAK 2016 8,000.00
Anti Diare Kombinasi Kaolin 986
Botol 60 ml
46 mg+Pektin 40 mg DAK 2017 6,190.00
Antifungi DOEN kombinasi :
Asam Benzoat 6 % + pot plastik 30 gram
47 DAK 2017 4,972.00
Asam Salisilat 3 %
Antifungi DOEN kombinasi :
Asam Benzoat 6 % + pot plastik 30 gram
48 DAK 2016 4,782.00
Asam Salisilat 3 %
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
49 150 mg + Heksaklorofen 2,5 mg DAK 2015 3,350.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
50 150 mg + Heksaklorofen 2,5 mg DAK 2016 3,502.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
51 150 mg + Heksaklorofen 2,5 mg DAK 2017 3,300.00
Antimigren DOEN tablet kombinasi :
Tablet
52 Ergotamin Tartrat 1 mg + Kofein 50 mg DAK 2017 204.00
Antimigren + Paracetamol 400 mg,
Tablet
53 Acetosal 250 mg, Caffeine 65 mg DAK 2016 605.00
54 Aqua pro Injeksi steril, bebas pirogen Ampul 25 ml DAK 2015 2,200.00
55 Air untuk Injeksi 25 ml Ampul 25 ml DAK 2017 2,750.00
56 OTSU SWI 25 ML - Air untuk Injeksi 25 DAK 2016 2,750.00
Ampul 25 ml
ml
ACT (Artesunate tablet 50 mg +
Tablet
57 Amodiaquine anhydrida tablet 200 mg) DAK 2015 1,409.00
58 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2016 120.00
Asam askorbat (vitamin C)
Tablet
59 tablet/kapsul/kaplet 250 mg DAK 2017 118.00
60 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2017 120.00
Asam Folat tablet/kapsul/kaplet 0,4
Tablet
61 mg(Afolat) DAK 2015 140.00
Asam Folat tablet/kapsul/kaplet 0,4
Tablet
62 mg(Afolat) DAK 2016 68.00
63 Asam Mefenamat 500 mg Kaptap Salut Selaput DAK 2017 102.00
64 Asam Mefenamat 500 mg Tablet DAK 2016 113.00
65 Asam Traneksamat 500 mg Tablet DAK 2017 1,540.00
66 Asam Traneksamat 500 mg Tablet DAK 2016 1,540.00
67 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2016 2,789.00
68 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2017 2,530.00
69 Asetosal 100 mg Tablet DAK 2015 127.00
70 Asetosal 100 mg Tablet DAK 2016 153.00
Asam asetilsalisilat (asetosal)
Tablet
71 tablet/kapsul/kaplet 100 mg DAK 2017 154.00
72 Asiklovir krim 5 % Tube 5 gram DAK 2016 2,997.00
73 Asiklovir krim 5 % Tube 5 gram DAK 2017 9,550.00
74 Asiklovir tablet 400 mg Tablet DAK 2015 354.00
75 Asiklovir tablet 400 mg Tablet DAK 2016 368.00
76 Asiklovir tablet/kapsul/kaplet 400 mg Tablet DAK 2017 415.00
NEW ANTIDES - Attapulgite 600 mg
Tablet
77 tablet DAK 2016 173.00
78 Atapulgit tablet 600 mg (Pularex) Tablet DAK 2015 220.00
79 Atropin inj 0,25 mg / ml Ampul 1 ml DAK 2016 1,672.00
80 Azitromisin tablet 500 mg Tablet DAK 2016 1,900.00
kombinasi: ferro fumarat 60 mg + as.
Folat 0,4 mg tablet salut gula (tablet Tablet Salut Gula
81 tambah darah) DAK 2017 410.00
(Tablet Tambah Darah Kombinasi) :
Ferrous Fumarate 250 mg, Manganese
Sulfate 0,2 mg, Cupric Sulfate 0,2 mg, Tablet
Folic Acid 4 mg, Cyanocobalamin 7,5
82 mg DAK 2016 660.00
Plastik-Dus-serbuk 50
Bedak salisil serbuk 2%
83 gram DAK 2017 1,071.00
BEROTEC SOLUTION - Fenoterol HBr
Botol
84 solution 0,1% DAK 2016 125,750.00
85 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2017 151.00
86 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2016 170.00
87 Bisoprolol tablet/kapsul/kaplet 5 mg Tablet salut selaput DAK 2017 298.00
88 Bisoprolol tablet 5 mg Tablet DAK 2016 399.00
Betametason krim0,1% (Sebagai
Tube 5 gram
89 Valerat) DAK 2016 1,435.00
90 Betametason krim 0,1 o/o Tube 5 gram DAK 2015 1,558.00
Betametason krim0,1% (Sebagai
Tube 5 gram
91 Valerat) DAK 2017 1,450.00
92 Bisakodil suppositoria 10mg Supp DAK 2017 5,800.00
Bisakodil suppositoria 10 mg(Stolax
Supp
93 supp) DAK 2015 6,045.00
Bisakodil suppositoria 10 mg(keluar e-
Supp
94 catalog) DAK 2015 6,040.00
DULCOLAX SUPP ADULT 10MG
Supp
95 Bisakodil suppositoria 10mg DAK 2016 5,800.00
DULCOLAX SUPP INFANT - Bisakodil
Supp
96 suppositoria 5 mg DAK 2016 5,670.00
97 Bisakodil suppositoria 5 mg Supp DAK 2017 5,800.00
98 Bisakodil tablet/kapsul/kaplet 5 mg Tablet salut enterik DAK 2017 317.00
99 Cetirizine tablet 10 mg Tablet DAK 2015 190.00
100 Cetirizine tablet 10 mg Tablet salut selaput DAK 2017 115.00
101 Cetirizine tablet 10 mg Tablet DAK 2016 154.00
102 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2016 2,950.00
103 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2015 8,799.00
104 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2017 3,300.00
105 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,745.00
106 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,822.00
107 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2014 1,544.00
108 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,544.00
109 Deksametason tablet 0,5 mg Tablet DAK 2016 120.00
110 Deksametason tablet 0,5 mg Tablet DAK 2017 149.07
111 Deksametason tablet 0,5 mg Tablet DAK 2015 68.00
Dekstrometorfan sirup 10 mg/5
Botol 60 ml
112 ml(calortusin ) DAK 2014 3,609.00
Dekstrometorfan sirup 10 mg/5
Botol 60 ml
113 ml(calortusin ) DAK 2015 3,608.00
Dektromethorphan tablet 15mg
Tablet
114 ( Ramaflu ) DAK 2015 275.00
Dektromethorphan tablet 15mg
Tablet
115 ( Ramaflu ) DAK 2014 275.00
116 DEPAKENE - Valproat sirup 250 mg/5 DAK 2016 41,800.00
Botol
ml
DEPAKOTE TAB 250 MG - Valproat
Tablet
117 tablet salut 250 mg DAK 2016 1,750.00
118 Diazepam tablet 2 mg Tablet DAK 2015 46.00
119 Diazepam tablet 2 mg Tablet DAK 2016 125.40
120 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul DAK 2017 15,600.00
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube
121 (STESOLID) DAK 2015 18,461.00
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube
122 (STESOLID) DAK 2016 18,458.00
123 Diazepam enema 10 mg/2,5 mL Allubag DAK 2017 19,378.00
Diazepam larutan rectal 5 mg/ 2,5
Tube
124 ml(STESOLID) DAK 2015 12,751.00
Diazepam larutan rectal 5 mg/ 2,5
Tube
125 ml(STESOLID) DAK 2016 12,749.00
126 Diazepam enema 5 mg/2,5 mL Allubag DAK 2017 13,384.00
127 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,222.00
128 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,156.00
129 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,354.00
130 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2013 1,056.00
131 Digoksin tablet/kapsul/kaplet 0,25 mg Tablet DAK 2017 109.00
132 Digoksin tablet 0,25 mg Tablet DAK 2016 108.00
133 Digoksin tablet 0,25 mg Tablet DAK 2015 103.00
134 Doksisiklin tablet/kapsul/kaplet 100 mg kapsul DAK 2017 299.00
135 Doksisiklin tab 100 mg Tablet DAK 2016 309.00
136 Domperidon 10 mg Tablet DAK 2015 174.00
137 Domperidon tablet/kapsul/kaplet 10 mg Tablet DAK 2014 110.00
138 Domperidon 10 mg Tablet DAK 2016 118.00
139 Domperidon suspensi/sirup 5 mg/5 ml Botol 60 ml DAK 2015 3,490.00
140 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2017 17,000.00
141 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2016 3,180.00
DOPAMET - Metildopa tablet salut 250
Tablet
142 mg DAK 2016 1,001.00
DOPAMET - Metildopa tablet salut 250
Tablet
143 mg DAK 2017 1,050.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul
144 mg/ml DAK 2015 8,910.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul
145 mg/ml DAK 2016 2,354.00
146 Eritromisin kaplet 500mg Kaplet DAK 2016 766.00
147 Eritromisin tablet/kapsul/kaplet 500 mg Kaptab DAK 2017 766.00
148 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2017 6,461.00
149 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2016 7,039.00
150 Ethambutol 500 mg Tab Tablet DAK 2016 688.00
151 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2013 2,354.22
152 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2015 3,327.75
153 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2014 3,450.00
154 Etanol 70 % Botol DAK 2014 2,625.00
155 Etil Klorida semprot Botol DAK 2017 110,000.00
156 Etil Klorida semprot Botol DAK 2015 115,000.00
157 Etil Klorida semprot Botol DAK 2016 115,500.00
158 Eugenol cairan Botol DAK 2014 18,333.00
159 FARNORMIN - Atenolol 50 mg Tablet DAK 2016 330.00
160 Fenitoin Kapsul/Kaplet 100 mg Kaplet DAK 2016 154.00
161 Fenitoin injeksi 50 mg/ml (100 mg/2 ml) DAK 2017 6,231.00
162 Fenobarbital tablet 30 mg Tablet DAK 2015 70.10
163 Fenobarbital tablet 30 mg Tablet DAK 2017 132.00
164 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2017 2,500.00
165 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2015 1,108.79
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
166 mg/ml DAK 2014 4,356.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
167 mg/ml DAK 2015 3,754.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
168 mg/ml DAK 2016 4,083.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet Salut Gula
169 10 mg DAK 2017 790.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet
170 10 mg DAK 2016 796.00
FLIXOTIDE NBULES - Flutikason
Nebules 2 ml
171 Propionat nebules 0,5 mg DAK 2016 14,500.00
Flutikason propionat (micronized) 0,5
mg/dosis (Flutikason propionat nebules Nebules 2 ml
172 0,5 mg) DAK 2017 14,500.00
173 Furosemid tablet 40 mg Tablet DAK 2015 96.00
174 Furosemid tablet 40 mg Tablet DAK 2017 111.00
175 Furosemid tablet 40 mg Tablet DAK 2016 181.73
176 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2017 2,058.00
177 Furosemid injeksi Ampul DAK 2015 2,012.00
178 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2016 -
179 Gabapentin 300 mg Kaplet DAK 2016 1,639.00
180 Gabapentin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 1,254.00
Garam oralit kombinasi : natrium klorida
0,52 g + kalium klorida 0,30 g +
Sachet 4,26 gram
trinatrium sitrat 0,58 g + glukosa
181 anhidrat 2,7 g DAK 2016 274.00
Garam Oralit I serbuk, kombinasi:
Natrium klorida 0,52 g + kalium klorida
Sachet
0,30 g + Trinatrium sitrat dihidrat 0,58 g
182 + Glukosa Anhidrat 2,70 g DAK 2017 273.00
183 Garam Oralit serbuk,kombinasi Sachet DAK 2015 317.00
184 Gemfibrozil kapsul/kaplet 300 mg Tablet DAK 2015 318.00
185 Gemfibrozil tablet/kapsul/kaplet 300 mg Tablet DAK 2016 436.00
186 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2016 1,835.16
187 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2017 7,180.00
188 Gentamicin TM 0,3 % Botol 5 ml DAK 2016 4,600.00
189 Gentamicin TM 0,3 % Botol 5 ml DAK 2015 3,513.00
190 Gentamisin tetes mata 0,3% Botol 5 ml DAK 2017 4,800.00
191 Gentian violet 1 o/o Botol 10 ml DAK 2015 2,189.00
192 Gentian violet 1 o/o Botol 10 ml DAK 2017 3,812.00
193 Gentian violet 1 o/o Botol 10 ml DAK 2016 2,925.00
194 Glass Ionomer Cement (Fuji IX) Set DAK 2016 919,300.00
195 Glass Ionomer Cement (Fuji VII) Set DAK 2016 1,225,700.00
196 Glass Ionomer Cement (Fuji VII) Set DAK 2017 617,798.00
197 Glass Ionomer Cement (GC IX) Set DAK 2015 434,460.00
198 Glibenklamid tablet 5 mg Tablet DAK 2016 108.00
199 Glibenklamid tablet 5 mg Tablet DAK 2017 90.00
200 Glibenklamid tablet 5 mg Tablet DAK 2015 61.00
Glibenklamid tablet 5 mg (keluar e-
Tablet
201 catalog) DAK 2015 60.00
202 GLICAB - Gliklazid tab 80 mg Tablet DAK 2016 245.00
203 Gliklazid tablet/kapsul/kaplet 80 mg Tablet DAK 2017 218.00
204 Glimepiride tablet/kapsul/kaplet 2 mg Tablet DAK 2017 231.00
205 Glimepiride tablet 2 mg Tablet DAK 2016 296.00
206 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2016 36.52
207 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2017 108.00
208 Glukosa larutan infus 10% Botol plastik 500 ml DAK 2016 7,500.00
209 Glukosa larutan infus 5 % steril Botol plastik 500 ml DAK 2016 6,900.00
210 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2017 6,900.00
211 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2015 5,720.00
212 Griseofulvin tablet 125 mg, micronized Tablet DAK 2016 264.00
213 Griseofulvin tablet 125 mg, micronized Tablet DAK 2015 224.00
214 Griseofulvin tablet 125 mg, micronized Tablet DAK 2017 266.00
215 Haloperidol 1.5 mg Tablet DAK 2015 76.00
216 Haloperidol 1.5 mg Tablet DAK 2014 76.00
217 Haloperidol 1.5 mg Tablet DAK 2016 74.00
HALDOL DECANOAS - Haloperidol inj
Ampul 1 ml
218 50 mg/ml DAK 2016 97,500.00
219 Haloperidol inj 50 mg/mL Ampul 1 ml DAK 2017 97,500.00
LODOMER DROPS - Haloperidol tts 2
Botol 15 ml
220 mg/mL DAK 2016 18,499.00
221 Haloperidol tts 2 mg/mL Botol 15 ml DAK 2017 18,100.00
222 Dus, 1 syringe @ 0,5 DAK 2017 1,300,000.00
Hepatitis B imunoglobullin
ml
223 Hidroklorotiazid tab 25 mg Tablet DAK 2017 171.00
224 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2016 2,712.00
225 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2017 2,838.00
226 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2015 2,868.00
227 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2017 1,760.00
228 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2016 2,745.00
229 Ibuprofen tablet 200 mg Tablet DAK 2017 108.00
230 Ibuprofen tablet/kapsul/kaplet 200 mg Tablet DAK 2016 111.00
231 Ibuprofen tablet 400 mg Tablet DAK 2016 133.00
232 Ibuprofen tablet 400 mg Tablet DAK 2017 113.00
233 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2017 2,560.00
234 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2016 2,560.00
235 Isoniazid tablet/kapsul/kaplet 100 mg Tablet DAK 2017 85.00
236 Isoniazid tablet/kapsul/kaplet 300 mg Tablet DAK 2017 182.00
237 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2015 98.00
238 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2016 93.00
239 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2017 95.00
240 KALIPAR - Kalium aspartat tab 300 mg Tablet DAK 2016 690.00
 Kalium aspartat tablet/kapsul/kaplet 300
Kaptab salut selaput
241 mg DAK 2017 682.00
Kalsium Laktat (Kalk)
Tablet
242 tablet/kapsul/kaplet 500 mg DAK 2016 69.00
Kalsium Laktat (Kalk)
Tablet
243 tablet/kapsul/kaplet 500 mg DAK 2017 57.00
Kalsium Laktat (Kalk)
Tablet
244 tablet/kapsul/kaplet 500 mg DAK 2015 76.00
245 Kaptopril 25 mg Tablet DAK 2016 72.00
246 Kaptopril tablet/kaplet scored 25 mg Tablet DAK 2017 86.00
247 Kaptopril 25 mg Tablet DAK 2015 97.00
248 Kandesartan tab 8 mg Tablet DAK 2016 4,015.00
249 Kandesartan tablet/kapsul/kaplet 8 mg Tablet DAK 2017 770.00
Karbamazepin tablet/kapsul/kaplet 200
Tablet
250 mg DAK 2016 306.00
251 Karbamazepin tablet 200 mg Tablet DAK 2015 269.00
252 Ketoprofen supositoria 100 mg Supp DAK 2017 2,640.00
253 Ketokonazol krim 2% Tube 10 gram DAK 2016 2,605.00
254 Ketokonazol krim 2% Tube 10 gram DAK 2017 2,790.00
255 Ketokonazol tablet 200 mg Tablet DAK 2016 292.00
256 Ketokonazol tablet/kapsul/kaplet 200 DAK 2017 297.00
Tablet
mg
257 Ketokonazol tablet 200 mg Tablet DAK 2015 320.00
258 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2017 1,320.00
259 Ketorolac injeksi 30 mg Ampul 1 ml DAK 2014 2,665.00
260 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2016 1,383.00
261 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2016 660.00
262 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 589.00
263 Klopidogrel tablet 75 mg Tablet DAK 2016 2,100.00
264 Klopidogrel tablet/kapsul/kaplet 75 mg Tablet salut selaput DAK 2017 1,799.00
CHLORAMEX - Kloramfenikol kapsul
Kapsul
265 500 mg DAK 2016 1,155.00
Kloramfenikol tablet/kapsul/kaplet 250
Kapsul
266 mg DAK 2017 502.29
267 Kloramfenikol kapsul 250 mg Kapsul DAK 2010 198.92
268 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2017 1,850.00
269 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2016 1,850.00
270 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2017 4,982.00
271 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2016 4,000.00
272 Kloramfenikol tetes mata 0,5 % Botol plastik 10 ml DAK 2017 3,850.00
Kloramfenikol tetes mata 0,5 % (Reco
Botol plastik 10 ml
273 TM) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml
274 TT) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml
275 TT) DAK 2017 7,370.00
276 Kloramfenikol tetes telinga 3 % Botol plastik 10 ml DAK 2015 5,060.00
Klorfeniramina Maleat (CTM)
Tablet
277 tablet/kapsul/kaplet 4 mg DAK 2016 45.00
Klorfeniramina Maleat (CTM)
Tablet
278 tablet/kapsul/kaplet 4 mg DAK 2015 53.00
279 Klorfeniramina Maleat (CTM) tablet 4 DAK 2014 100.10
Klorpromazin injeksi i.m. 25 mg/ml Tablet
mg
280 (HCl)
Klorpromazin injeksi i.m. 25 mg/ml Ampul 1 ml DAK 2016 1,425.00
281 (HCl) Ampul 1 ml DAK 2017 1,349.00
282 Klorpromazin tablet salut 25 mg (HCl) Tablet DAK 2016 170.00
283 Klorpromazin tablet salut 100 mg (HCl) Tablet DAK 2015 153.00
284 Klozapin 25 mg Tablet DAK 2016 1,550.00
285 Kodein tablet/kapsul/kaplet 10 mg Tablet DAK 2017 632.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
286 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2016 2,225.00
kotrimoksazol (anak) kombinasi tiap 5
ml suspensi: sulfametoksazol 200 mg + Botol 60 ml
287 trimetoprim 40 mg DAK 2017 2,462.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
288 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2015 2,298.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
289 200 mg + Trimetoprim 40 mg/ 5 Ml ABT 2015 2,298.00
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg + trimetoprim Kaptab
290 160 mg DAK 2017 327.00
kotrimoksazol forte
kombinasi:sulfametoksazol 800 mg + Tablet
291 trimetoprim 160 mg DAK 2015 420.00
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg trimetoprim Tablet
292 160 mg DAK 2016 344.00
293 Laktulosa sir 3,335 g/5 mL Botol DAK 2016 14,500.00
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml
294 3A injection) DAK 2017 10,285.00
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml
295 3B injection) DAK 2017 10,285.00
296 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2015 40,000.00
297 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2016 40,000.00
298 Lidokain jelli 2% syringe 10 gram DAK 2017 40,000.00
Lidokain Komp.injeksi, Kombinasi :
Lidokain HCL 12 % Ampul 2 ml
299 + Epinefrin 1 : 80.000 - 2 ml DAK 2015 1,499.00
300 Lidokain injeksi 2% (HCL) Ampul DAK 2016 875.00
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml
301 80.000 - 2 mL DAK 2016 2,122.00
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml
302 80.000 - 2 mL DAK 2017 2,227.00
303 Lisinopril tablet/kapsul/kaplet 5 mg Tablet DAK 2016 410.00
304 Loperamid Tablet DAK 2017 85.00
305 Loperamid tablet 2 mg Tablet DAK 2016 90.00
306 Loratadin tablet/kapsul/kaplet 10 mg Tablet DAK 2016 149.00
307 Loratadin tablet/kapsul/kaplet 10 mg Kaptab DAK 2017 134.00
OTSU-MGSO4 40 - Magnesium sulfat
Ampul 25 ml
308 injeksi 40% DAK 2016 3,650.00
309 Magnesium sulfat injeksi 40% Ampul 25 ml DAK 2017 3,650.00
310 Metamizol injeksi 500 mg/ml Ampul 2 ml DAK 2017 3,050.00
311 Metil prednisolon tab 4 mg Tablet DAK 2016 209.00
Metilprednisolon tablet/kapsul/kaplet 4
Tablet
312 mg DAK 2017 165.00
313 Metilprednisolon inj 125 mg/2 mL Dus DAK 2015 22,000.00
314 Metilprednisolon inj 125 mg/2 mL Dus DAK 2016 14,750.00
Metilergametrin (Maleat) tablet salut
Tablet
315 0,125 mg DAK 2016 222.20
 Metilergametrin (Maleat) tablet salut
Tablet Salut
316 0,125 mg DAK 2017 270.60
Metilergametrin Maleat inj 0,200 mg - 1
Ampul
317 ml DAK 2015 2,750.00
Metilergametrin Maleat inj 0,200 mg - 1
318 ml Ampul DAK 2014 4,917.00
Metilergametrin Maleat inj 0,200 mg - 1
319 ml Ampul DAK 2016 2,684.00
320 Metoclopramide tablet 10 mg Tablet DAK 2016 100.00
Metoklopramide tablet/kapsul/kaplet 10
321 mg Tablet DAK 2017 93.00
322 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2017 3,904.00
323 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2016 4,395.00
LEXAPRAM SIRUP - Metoklopramide
324 sirup 5 mg/ 5 ml Botol 60 ml DAK 2016 2,750.00
325 Metoklopramide sirup 5 mg/ 5 ml Botol 60 ml DAK 2017 2,950.00
326 Metformin 400 mg Tablet DAK 2016 108.00
Metformin HCl tablet/kapsul/kaplet 500
Kaptap ss
327 mg DAK 2017 103.00
328 Metronidazol infus 5 mg/ ml Botol @100 mL DAK 2017 9,680.00
329 Metronidazole infus Botol @100 mL DAK 2010 21,759.00
330 Metronidazol tablet/kapsul/kaplet 500 DAK 2017 115.00
Tablet
mg
331 Metronidazol tablet 500 mg Tablet DAK 2016 750.00
332 Metronidazole sirup 125mg/ 5ml Botol 60 ml DAK 2016 3,800.00
333 Metronidazol sirup 125 mg/5 ml Botol 60 ml DAK 2017 3,800.00
334 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2016 3,737.00
335 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2017 5,500.00
336 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2015 3,075.00
337 Natrium Bikarbonat tablet 500 mg Tablet DAK 2016 22.00
338 Natrim Diklofenak 50 mg tab Tablet DAK 2016 161.00
Natrium diklofenak tablet/kapsul/kaplet
Tablet salut enterik
339 50 mg DAK 2017 135.00
340 Natrim Diklofenak 50 mg tab Tablet DAK 2015 193.00
341 Natrium Klorida larutan infus 0,9 % DAK 2017 6,410.00
Botol plastik 500 ml
Steril
Natrium Klorida larutan infus 0,9 %
342 Botol plastik 500 ml DAK 2015 5,170.00
Steril
Natrium Klorida larutan infus 0,9 %
343 Botol plastik 500 ml DAK 2016 6,410.00
Steril
344 Nifedipin tablet/kapsul/kaplet 10 mg Tablet salut selaput DAK 2017 110.00
345 Nifedipin tablet 10 mg Tablet DAK 2015 110.00
346 Nifedipin tablet 10 mg Tablet DAK 2016 123.00
347 Nistatin vaginal tablet 100.000 IU/ g Tablet Vaginal DAK 2017 627.00
348 Nistatin vaginal tablet 100.000 IU/ g Supp DAK 2016 602.00
349 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet Salut Gula DAK 2017 881.00
350 Nistatin tablet salut 500.000 UI/g Tablet DAK 2015 704.00
351 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet DAK 2016 857.00
352 Nystatin drop Botol 12 ml DAK 2016 38,425.00
353 Nystatin drop Botol 12 ml DAK 2017 24,198.00
354 Obat Anti Tuberculosis FDC Kategori I Paket DAK 2017 430,538.00
355 OAT FDC Kategori 1 Dewasa Paket DAK 2013 395,900.00
356 OAT FDC Kategori 2 Dewasa Paket DAK 2016 1,379,984.00
357 Obat Anti Tuberculosis FDC Kategori II Paket DAK 2017 1,435,178.00
358 Obat Antituberkulosis Kategori 1 DAK 2014 317,015.00
Paket
dewasa
Obat Anti Tuberculosis FDC Kategori
Paket
359 Sisipan DAK 2016 183,984.00
 "Dus, 12 blister @ 28
Obat Anti Tuberculosis FDC Kategori tablet dispersibel Dus, 6
Anak blister @ 28 tablet
360 dispersibel" DAK 2017 257,125.00
Obat Anti Tuberculosis FDC Kategori
Paket
361 Anak DAK 2016 247,234.00
362 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2016 7,149.00
363 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2017 6,000.00
Obat batuk Antitusif sirup Kombinasi
Botol 60 ml
364 Dextromethorphan HBr DAK 2016 9,875.00
Obat batuk Antitusif tablet Kombinasi
Tablet
365 Dextromethorphan HBr DAK 2016 548.00
Obat batuk sirup Kombinasi
Botol 60 ml
366 Dextromethorphan HBr DAK 2017 11,800.00
Obat batuk tablet Kombinasi
Tablet
367 Dextromethorphan HBr DAK 2017 704.00
368 Ofloksasin tab 400 mg Tablet DAK 2010 960.00
369 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2016 1,649.36
370 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2017 1,640.00
371 Oksitetrasiklin HCI salep mata 1 % Tube 3,5 gram DAK 2017 2,772.00
372 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2015 2,772.00
373 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2016 2,772.00
374 Oksitosin injeksi 10 IU/ml(Tiacinon) Ampul DAK 2015 1,900.00
375 Oksitosin injeksi 10 IU / ml - ml Ampul DAK 2014 5,890.50
OXYTOCIN INJLQ 10 IU Oksitosin inj
Ampul
376 10 UI/ml DAK 2016 1,900.00
377 Omeprazole Injeksi 40mg / 10ml Vial DAK 2016 18,537.00
378 Omeprazol injeksi 40 mg/ 10 ml Vial DAK 2017 14,924.00
379 Omeprazole kapsul Kapsul DAK 2016 164.00
380 Omeprazole kapsul Kapsul DAK 2015 221.00
381 Omeprazol tablet/kapsul/kaplet 20 mg Kapsul DAK 2017 148.00
382 Ondansetron tablet/kapsul/kaplet 4 mg Tablet DAK 2016 542.00
383 Ondansetron tablet/kapsul/kaplet 4 mg Tablet salut selaput DAK 2017 523.00
384 Ondansetron inj 2 mg/ml (4 mg/ 2 mL) Ampul 2 ml DAK 2017 1,254.00
Ondansetron Injeksi 2 mg/ ml (4 mg/ 2
Ampul 2 ml
385 ml) DAK 2016 1,650.00
386 Ondansetron inj 4 mg/ 2 mL Ampul 2 ml DAK 2015 2,400.00
387 PANTOCAIN 0.5% Botol DAK 2016 11,500.00
388 Parasetamol infus Dus, Botol @ 1000 mg DAK 2016 27,225.00
Parasetamol drips (infus) 1000 mg/100
Dus, Botol @ 1000 mg
389 mL DAK 2017 12,939.00
390 Parasetamol sirup 120 mg / 5 ml Botol Plastik @ 60 Ml DAK 2017 1,013.00
391 Parasetamol sirup 120 mg/ 5ml Botol Plastik @ 60 Ml DAK 2016 1,119.00
392 Parasetamol drop Botol Plastik @ 60 Ml DAK 2015 5,720.00
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml
393 (60mg/0,6ml) (G) DAK 2017 6,850.00
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml
394 (60mg/0,6ml) (G) DAK 2016 5,980.00
395 Parasetamol tablet 100 mg Tablet DAK 2016 106.59
396 Parasetamol tablet 100 mg Tablet DAK 2013 34.51
397 Parasetamol tablet 500 mg Tablet DAK 2016 174.00
398 Parasetamol tablet/kapsul/kaplet 500 DAK 2017 51.00
Tablet
mg
399 Parasetamol tablet 500 mg Tablet DAK 2015 88.00
400 Perak sulfadiazin krim 1% tube 35 g DAK 2017 20,700.00
 Petidin injeksi i.m/s.k/i.v lambat 50
Ampul
401 mg/ml (HCl) DAK 2015 15,950.00
402 Piracetam 400 mg Tablet DAK 2016 541.24
403 Piracetam Inj 1 g/5 ml Ampul DAK 2016 15,840.00
404 Piracetam Inj 1 g/5 ml Ampul DAK 2017 6,600.00
405 Pirantel tablet 125 mg Tablet DAK 2014 318.00
406 Pirantel tablet score (base) 125 mg Tablet DAK 2016 318.00
407 Pirazinamid 500 mg Tablet DAK 2017 238.00
408 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2015 148.00
Piridoksin (Vitamin B6) tab/kap/kapl 10
Tablet
409 mg (HCl) DAK 2017 136.00
410 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2016 136.00
411 Piroksikam 20 mg Tablet DAK 2016 213.95
412 Piroksikam 20 mg Tablet DAK 2017 130.00
413 Piroksikam 20 mg Tablet DAK 2015 105.00
414 Povidon lodida larutan 10 % Botol 300 ml DAK 2013 14,350.00
415 Povidon lodida larutan 10 % Botol 300 ml DAK 2015 15,386.00
416 Povidon lodida larutan 10 % Botol 300 ml DAK 2014 15,386.00
417 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2016 102.00
418 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2017 85.00
419 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2015 125.00
420 Prednison tablet/kapsul/kaplet 5 mg Tablet ABT 2015 125.00
421 Primakuin tablet 15 mg Tablet DAK 2015 205.00
422 Propranolol HCI tablet 10 mg Tablet DAK 2016 69.00
423 Propranolol tablet/kapsul/kaplet 10 mg Tablet DAK 2017 59.00
424 Propranolol HCI tablet 10 mg Tablet DAK 2015 80.00
425 Proiltiourasil tablet 100 mg Tablet DAK 2014 299.27
426 Proiltiourasil tablet 100 mg Tablet DAK 2015 351.00
Propiltiourasil tablet/kapsul/kaplet 100
Tablet
427 mg DAK 2016 320.00
428 Vaksin rabies Vial DAK 2017 174,500.00
429 Ranitidin tablet 150 mg Tablet DAK 2015 128.00
430 Ranitidin tablet/kapsul/kaplet 150 mg Tablet salut selaput DAK 2017 110.00
431 Ranitidin tablet 150 mg Tablet DAK 2016 119.00
432 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2016 1,595.18
433 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2017 1,677.00
434 Ranitidin Injeksi 25 mg/ml Ampul 2 ml DAK 2015 3,960.00
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul
435 lunak DAK 2016 327.00
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul
436 lunak DAK 2015 286.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul lunak
437 lunak DAK 2017 585.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul
438 lunak ABT 2015 505.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul
439 lunak DAK 2016 536.00
440 Rifampisin tablet/kapsul/kaplet 600 mg Kaptap ss DAK 2017 1,274.00
441 Ringer laktat larutan infus Botol plastik 500 ml DAK 2015 5,720.00
442 Ringer laktat larutan infus Botol plastik 500 ml DAK 2017 7,150.00
443 Ringer Laktat Botol DAK 2016 7,150.00
444 Risperidon 2 mg Tablet DAK 2016 495.00
Salbutamol tablet/kapsul/kaplet 4 mg
Tablet
445 (sebagai Sulfat) DAK 2017 86.00
446 Salbutamol tablet 2 mg Tablet DAK 2015 65.00
447 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet DAK 2016 84.00
448 Salbutamol sirup Dus, botol @ 100 ml DAK 2016 5,463.00
449 Salbutamol sirup Dus, botol @ 100 ml DAK 2017 4,916.00
Salbutamol cairan ih 0,1%(Ventolin
Nebules
450 Nebules) DAK 2017 14,124.00
VENTOLIN NEBULES - Salbutamol
Nebules
451 cairan ih 0,1% DAK 2016 4,000.00
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
452 Belerang Endap 4 % DAK 2017 2,907.00
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
453 Belerang Endap 4 % DAK 2016 2,797.00
454 Salisil Bedak 2 % Kotak DAK 2016 1,066.00
455 Salisil Bedak 2 % Kotak DAK 2015 4,000.00
SCABIMITE CREAM 10 - Permetrin
Tube @ 10 g
456 krim 5% DAK 2016 12,155.00
457 Permetrin Krim 5% Tube @ 10 g DAK 2017 12,155.00
458 Sefiksim sirup kering 100 mg/ 5 ml Botol DAK 2015 9,400.00
459 Sefiksim sirup kering 100 mg/5 ml Botol DAK 2016 7,690.00
460 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2016 649.00
461 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2015 899.00
462 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2016 9,840.00
463 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2017 4,133.00
464 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml ABT 2015 5,286.00
465 Sefadroksil kapsul/kaplet 500 mg Kapsul DAK 2016 557.00
466 Sefadroksil tablet/kapsul/kaplet 500 mg Kapsul DAK 2017 455.00
467 Sefadroksil kapsul 500 mg Kapsul DAK 2015 525.00
468 Seftriaksone Injeksi 1 g Vial DAK 2016 27,500.00
469 Seftriaksone Injeksi 1 g Vial DAK 2017 11,650.00
470 Sefotaksim Injeksi 1 g Vial DAK 2016 5,884.00
471 Sianocobalamin (Vit.B12) tablet 50 mg Tablet DAK 2016 126.50
Sianokobalamin (vitamin B12)
Tablet
472 tablet/kapsul/kaplet 50 mcg DAK 2017 55.00
Sianokobalamin (vitamin B12)
Tablet
473 tablet/kapsul/kaplet 50 mcg DAK 2015 63.00
Sianokobalamin (vitamin B12)
Tablet
474 tablet/kapsul/kaplet 50 mcg ABT 2015 63.00
Sianokobalamin (vitamin B12) injeksi
Ampul 1 ml
II 500 mcg DAK 2017 1,117.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml
A mcg/ml - 1ml DAK 2016 1,226.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml
1 mcg/ml - 1ml DAK 2015 1,050.00
2 Simvastatin scored tablet 10 mg Tablet DAK 2016 135.00
3 Simvastatin tablet/kaplet/salut 10 mg Tablet salut selaput DAK 2017 113.00
4 Simvastatin 10 mg Tablet DAK 2015 320.00
5 Siprofloksasin tab scored 500 mg Tablet salut selaput DAK 2017 254.00
6 Siprofloksasin tab scored 500 mg Tablet DAK 2016 298.00
7 Spironolactone 25 mg Tablet DAK 2016 314.00
8 Spironolakton tablet/kapsul/kaplet 25 DAK 2017 277.00
Tablet
mg
9 Serum BioSAVE (ABU I) Dus, 1 Vial @ 5 ml DAK 2016 591,250.00
Serum anti bisa ular (A.B.U) I cairan inj
Dus, 1 Vial @ 5 ml
10 (i.m./i.v) DAK 2017 462,000.00
 Serum Anti Bisa Ular Polivalen injeksi 5
Dus, 1 Vial @ 5 ml
11 ml ( ABU I ) DAK 2015 472,000.00
12 Serum BioSAT-1.5 (ATS 1500 UI) Ampul 1 ml DAK 2016 158,125.00
Serum antitetanus (A.T.S) cairan inj
Ampul 1 ml
13 1500 IU/amp (i.m) DAK 2017 126,500.00
Serum Anti Tetanus injeksi 1.500
Ampul 1 ml
14 IU/ampul ( A.T.S ) DAK 2015 125,000.00
STREPTOMISIN SERBUK INJ IV 1000
Vial
15 mg/ml DAK 2016 5,750.00
16 Sukralfat susp 500 mg / 5 ml, 100 ml Botol 100 ml DAK 2016 10,100.00
17 Sukralfat susp 500 mg/5 mL, 100 ml Botol 100 ml DAK 2017 9,192.00
18 Sukralfat tablet/kapsul/kaplet 500 mg Tablet DAK 2017 296.00
19 ULSIDEX - Sukralfat tab 500 mg Tablet DAK 2016 368.00
SUPRAFENID Ketoprofen supositoria
Supp
20 100 mg DAK 2016 2,789.00
21 Teofilin tablet/kapsul/kaplet 150 mg Tablet DAK 2017 328.00
22 Teofilin tablet 150 mg(Bronsolvan) Tablet DAK 2016 310.00
23 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2016 329.00
24 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2015 325.00
25 Thiamphenicol 500 mg kaps Kapsul DAK 2016 984.51
26 Thiamphenicol 500 mg kaps Kapsul DAK 2017 865.00
27 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2016 21,950.00
28 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2017 6,500.00
Tiamin HCI ( Vit.B1 injeksi 100 mg/ml -
Ampul
29 1 ml ) DAK 2013 750.00
Tiamin HCI/Mononitrat (Vit.B1) tablet 50
Tablet
30 mg DAK 2015 37.00
Tiamin (Vitamin B1) tablet/kapsul/kaplet
Tablet
31 50 mg (HCl/ Nitrat) DAK 2017 87.00
Tiamin HCI/Mononitrat (Vit.B1) tablet
Tablet
32 100 mg DAK 2016 91.00
33 Tramadol tablet 50 mg Tablet DAK 2016 329.68
34 Tramadol tablet 50 mg Tablet DAK 2015 320.00
35 Tramadol tablet/ Kapsul 50 mg Tablet DAK 2017 325.00
36 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2016 1,984.00
37 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2017 1,720.00
38 Trifluoperazine 5mg Tablet DAK 2016 786.00
39 Triheksifenidil tablet/kapsul/kaplet 2 mg Tablet DAK 2017 80.00
40 Triheksifenidil tablet 2 mg Tablet DAK 2015 600.00
41 Triheksifenidil tablet 2 mg Tablet DAK 2016 498.30
42 Valproat sirup 250 mg/5 ml Dus, Botol @ 100 mL DAK 2017 26,987.00
43 Valsartan tab 80 mg Tablet DAK 2016 1,800.00
44 Vitamin B Kompleks tablet Tablet DAK 2016 132.00
45 Vitamin B Kompleks tablet Tablet DAK 2017 132.00
46 Vitamin B Kompleks tablet Tablet DAK 2015 112.00
47 Vitamin B Kompleks tablet Tablet ABT 2015 168.00
48 Zinc sir 20 mg/5 ml Dus, Botol @ 60 ml DAK 2017 4,959.00
49 Zinc sir 20 mg/5 Ml( Zircum Kid Sirup) Dus, Botol @ 60 ml DAK 2016 6,500.00
50 Zinc tablet dispersible20 mg Tablet DAK 2016 592.00
51 Zink Tablet DAK 2015 521.00
52 Zinc tablet dispersible 20 mg Tablet dispersible DAK 2017 586.00
53 Truvit sirup Dus, Botol @ 60 ml DAU 2016 10,890.00
II ALAT KESEHATAN
A BAHAN MEDIS HABIS PAKAI
1 Alat suntik sekali pakai 1 ml Piece DAK 2016 1,012.60
2 Alat suntik sekali pakai 1 ml Piece DAK 2017 1,012.60
3 Alat suntik sekali pakai 2,5 ml Piece DAK 2014 1,141.80
4 Alat suntik sekali pakai 3 ml Piece DAK 2016 1,006.50
5 Alat suntik sekali pakai 3 ml Piece DAK 2017 1,006.50
6 Alat suntik sekali pakai 5 ml Piece DAK 2016 1,132.16
7 Alat suntik sekali pakai 5 ml Piece DAK 2017 1,132.16
8 Alat suntik sekali pakai 10 ml Piece DAK 2017 1,588.44
9 Alat suntik sekali pakai 20 ml Piece DAK 2016 2,383.88
10 Alat suntik sekali pakai 50 ml Piece DAK 2016 4,892.20
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece
11 DAK 2017 1,240.00
24GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece
12 26 GX3/8" DAK 2017 1,650.00
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece
13 DAK 2016 1,240.00
23GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece
14 DAK 2016 1,650.00
27GX3/8"
15 Alkohol Swab 4-ply Piece DAK 2016 244.00
16 Bioplasenton Tulle 10 x 10 (CBPCD) Sachet DAK 2016 10,950.00
17 Blood Lancet (21,26,28 G) Piece DAK 2016 160.23
18 Blood Transfusion Set Piece DAK 2017 17,513.10
Benang Bedah SMI
Sachet
19 CATGUT PLAIN SMI 2/0 HR 26 MM DAK 2015 26,583.00
20 CATGUT CHROMIC SMI 2/0 HR 26 DAK 2016 33,785.00
Sachet
MM
21 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2016 35,285.00
22 CATGUT CHROMIC SMI 2/0 HR 26 DAK 2017 33,785.00
Sachet
MM
23 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2017 35,285.00
24 CATGUT CHROMIC SMI 3/0 HR 26 DAK 2017 33,785.00
Sachet
MM
25 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2017 35,285.00
Benang Bedah SMI
Sachet
26 CATGUT PLAIN SMI 3/0 HR 26 MM DAK 2015 26,583.00
27 CATGUT CHROMIC SMI 3/0 HR 26 DAK 2016 33,785.00
Sachet
MM
28 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2016 35,285.00
Catgut / Benang bedah No.3/0 dengan
Sachet
29 jarum bedah DAK 2012 27,041.67
30 Folley Catheter 2 Way no. 22 Piece DAK 2016 10,000.00
31 Foley Catheter No.16 Piece DAK 2013 9,300.00
32 Foley Catheter No.16 Piece DAK 2015 10,440.00
FOLEYCATH, 2 way latex foley cath,
Piece
33 no. 16 DAK 2016 13,420.00
FOLEYCATH, 2 way latex foley cath,
Piece
34 no. 18 DAK 2016 13,420.00
35 Foley Catheter No.18 Piece DAK 2014 9,344.50
36 Foley Catheter No.18 Piece DAK 2015 10,440.00
37 FEMALE CATHETER, no. 18 Piece DAK 2016 6,978.40
38 EXAMINATION GLOVES, size M Piece DAK 2017 563.64
39 EXAMINATION GLOVES, size S Piece DAK 2017 563.64
40 EXAMINATION GLOVES, size M Piece DAK 2016 563.64
41 CHIRURGIC GLOVES, size 7.5 Piece DAK 2016 9,272.00
Sarung Tangan Obgyn Steril ( Obgyn
pasang
B glove ) DAK 2017 24,200.00
1 Infusion set anak (Micro) Piece DAK 2014 4,400.00
 Infus Set Anak PEDIATRIC SET (60
Piece
2 drops/ml) DAK 2017 6,222.00
Infusion Set Pediatric (60 drops/ml)
Bbraun Intrafix Primeline with Piece
3 Microdropper DAK 2015 20,320.50
Infus Set Anak PEDIATRIC SET (60
Piece
4 drops/ml) DAK 2016 6,222.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
5 DAK 2016 5,856.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
6 DAK 2017 5,856.00
7 IV Catheter 16 G x 2" Piece DAK 2017 9,158.00
8 IV-CATH WP, with wings & port, no. 18 Piece DAK 2016 8,540.00
I.V Catheter (with port) VASOFIX IV
Piece
9 G18 X 45 MM Green DAK 2015 10,062.50
10 IV-Cath NP, pen type, no. 18 Piece DAK 2017 7,320.00
11 IV-CATH WP, with wings & port, no. 20 Piece DAK 2016 8,540.00
I.V Catheter (with port) VASOFIX IV
Piece
12 G20 X 33 MM Pink DAK 2015 10,062.50
I.V Catheter (with port) VASOFIX IV
Piece
13 G22 X 25 MM Blue DAK 2015 10,062.50
14 IV-CATH WP, with wings & port, no. 22 Piece DAK 2016 8,540.00
15 IV-Cath NP, pen type, no. 22 Piece DAK 2017 7,320.00
I.V Catheter (with port) VASOFIX IV
Piece
16 G24 X 0.75 " DAK 2015 10,062.50
17 IV-CATH WP, with wings & port, no. 24 Piece DAK 2016 8,540.00
18 IV-Cath NP, pen type, no. 24 Piece DAK 2017 7,320.00
19 IV-Cath NP, pen type, no. 26 Piece DAK 2017 9,394.00
20 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2017 28,745.25
21 Kapas pembalut / Absorben 250 gram Roll DAK 2015 28,452.86
22 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2016 28,750.00
23 Kasa 36 x 80 Roll DAK 2015 142,376.60
24 Kasa Hidrofil DRC 36m x 80cm Roll DAK 2016 141,400.00
25 Kasa 36 x 80 Roll DAK 2014 60,720.00
26 Kasa Steril DRC 16cm x 16cm (16 DAK 2016 8,650.50
Box
pads)
Kasa Steril DRC 16cm x 16cm (16
27 Box DAK 2017 8,650.36
pads)
28 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2016 7,375.00
29 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2017 9,000.00
30 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2017 2,475.75
31 kasa 4 x 10 cm Roll DAK 2015 2,439.24
32 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2016 2,475.43
33 Surgical Mask Tie On Piece DAK 2017 412.50
34 Masker Piece ABT 2015 574.20
35 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 2016 550.00
36 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 2017 550.00
NGT
Terumo SAFEED Feeding Tube 3.5 (35 Piece
37 cm) DAK 2015 8,841.00
NGT
Terumo SAFEED Feeding Tube 5 fr (40 Piece
38 cm) DAK 2015 8,841.00
 NGT
Terumo SAFEED Stomach Tube 14 fr Piece
39 (125 cm) DAK 2015 10,010.00
NGT
Terumo SAFEED Stomach Tube 16 fr Piece
40 (125 cm) DAK 2015 10,010.00
NGT
Terumo SAFEED Stomach Tube 18 fr Piece
41 (125 cm) DAK 2015 10,010.00
42 Oxyflow nasal oxygen bayi Piece DAK 2015 6,050.00
43 Oxyflow nasal oxygen anak Piece DAK 2015 6,050.00
44 NASAL OXYGEN, O2 cannula, size S Piece DAK 2016 8,052.00
45 NASAL OXYGEN, O2 cannula, size S Piece DAK 2017 8,052.00
46 NASAL OXYGEN, O2 cannula, size M Piece DAK 2016 8,052.00
47 NASAL OXYGEN, O2 cannula, size M Piece DAK 2017 8,052.00
48 NASAL OXYGEN, O2 cannula, size L Piece DAK 2016 8,052.00
49 NASAL OXYGEN, O2 cannula, size L Piece DAK 2017 8,052.00
Plester Leukoplast Hospital 7.50 cm x
Roll
50 4.5 m DAK 2016 35,532.00
51 Plester Polifix 10 cm x 5 m Roll DAK 2017 76,314.14
52 Pembalut Elastis 10 cm x 4,55 m Roll DAK 2017 45,507.00
53 Scalpel Blades Nomor 10 Piece DAK 2017 3,300.00
54 SILK BLACK 3/0 HR 26 MM Sachet DAK 2016 20,685.00
Benang Bedah SMI
Sachet
55 SILK BLACK 3/0 DS 24 MM DAK 2015 18,364.00
56 Onemed U Pad Steril 60 x 90 cm Blister DAK 2016 9,533.15
57 Onemed U Pad Steril 60 x 90 cm Blister DAK 2017 9,533.15
Onemed Umbilical Cord Klem Steril
Piece
58 Nylon DAK 2016 1,250.00
59 Urine Bag Piece DAK 2015 3,915.00
URINE DRAINAGE BAG, T valve, with
Piece
60 hanger DAK 2016 6,710.00
61 Alkohol 70% Botol 1 L DAK 2016 27,950.00
62 Alkohol 70% Botol 100 ml DAK 2017 8,300.00
63 My Jelly 82 gram Tube @ 82 gr DAK 2016 36,936.83
64 Lysol 1 liter Botol 1 L DAK 2016 53,300.00
65 Povidone Iodine 300 ml Botol @ 300 ml DAK 2016 23,400.00
66 Povidone Iodine 300 ml Botol @ 300 ml DAK 2017 23,400.00
67 Rivanol 300 cc Botol @ 300 ml DAK 2017 3,750.00
68 Rivanol 300 cc Botol @ 300 ml DAK 2016 3,315.00
Cairan Antiseptika pencuci alat
Botol 1 Liter
69 instrumen DAK 2017 141,406.33
Cairan Antiseptika pencuci tangan
Botol 500 ml
70 tanpa dibilas DAK 2017 83,027.33
Cairan Antispetika pencuci tangan
Botol 500 ml
71 dengan dibilas DAK 2017 64,769.00
B REAGENSIA
1 Total Cholesterol Test Strip 10's Strip DAK 2016 23,354.00
2 Uric Test Strip 25's Strip DAK 2016 5,154.00
3 Glucose Test Strip 50's Strip DAK 2016 3,093.34
4 Total Cholesterol Test Strip 10's Strip DAK 2017 23,566.00
5 Uric Test Strip 25's Strip DAK 2017 5,238.80
6 Glucose Test Strip 50's Strip DAK 2017 3,188.24
Anti-A Monoclonal Golongan Darah
Vial 10 ml
7 (Vial 10 ml) DAK 2016 80,825.00
 Anti-A,B Monoclonal Golongan Darah
Vial 10 ml
8 (Vial 10 ml) DAK 2016 105,135.00
Anti-B Monoclonal Golongan Darah
Vial 10 ml
9 (Vial 10 ml) DAK 2016 80,825.00
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml
10 10 ml) DAK 2016 126,695.00
Anti-A Monoclonal Golongan Darah
Vial 10 ml
11 (Vial 10 ml) DAK 2017 74,512.50
Anti-A,B Monoclonal Golongan Darah
Vial 10 ml
12 (Vial 10 ml) DAK 2017 98,822.50
Anti-B Monoclonal Golongan Darah
Vial 10 ml
13 (Vial 10 ml) DAK 2017 74,512.50
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml
14 10 ml) DAK 2017 120,382.50
15 Rapid test Vikia HIV 1/2 Kit DAK 2016 519,750.00
16 Anti HIV 1/2 Cassette each DAK 2017 15,297.00
17 Gluco Protein tes Piece DAK 2017 1,150.00
18 Gluco Protein Piece DAK 2016 1,150.00
19 Ultra One Test Hamil Piece DAK 2016 2,133.00
20 HCG Strip each DAK 2017 7,181.00
21 Malaria Pf & Pv Cassette each DAK 2017 53,180.00
22 Hb strip Dr Family test Tes DAK 2017 24,200.00
23 HBsAg Strip each DAK 2017 10,967.00
24 R.Detergent urit (urit 3000 plus) Gallon 5 L DAK 2017 278,300.00
25 R.Dilluen urit (urit 3000 plus) Gallon 20 L DAK 2017 1,012,000.00
26 R.Lytic urit (urit 3000 plus) Botol 1 L DAK 2017 1,113,200.00
27 Rapid tes Dengue (IgG-IgM) Device Tes DAK 2017 124,100.00
28 Hayem 1x100mL Botol 100 ml DAK 2017 29,450.00
29 Aquadest Botol 1 Liter DAK 2017 19,448.00
30 Asam Asetat 6 % Botol 100 ml DAK 2017 29,000.00
31 Asam Sulfosalisilat 20% 1x100mL Botol 100 ml DAK 2017 328,700.00
32 EDTA 10% 1x100mL Botol 100 ml DAK 2017 74,100.00
33 Eosin 2% 1x100mL Botol 100 ml DAK 2017 176,225.00
34 HCl 0,1N 1x100mL Botol 100 ml DAK 2017 19,950.00
35 Immersion Oil 1x100mL Botol 50 ml DAK 2017 367,650.00
36 KOH 10% 1x100mL Botol 100 ml DAK 2017 20,900.00
37 Methanol PA Botol 100 ml DAK 2017 94,000.00
38 Na Citrate 3,13% 1x100mL Botol 100 ml DAK 2017 19,475.00
39 Rees Ecker 1x100mL Botol 100 ml DAK 2017 46,550.00
40 Turk 1x100mL Botol 100 ml DAK 2017 23,750.00
41 Salmonella Typhi H Widal Test Vial 5 ml DAK 2017 72,972.50
42 Salmonella Typhi O Widal Test Vial 5 ml DAK 2017 72,972.50
43 Salmonella Paratyphi AH Widal Test Vial 5 ml DAK 2017 72,972.50
44 Salmonella Paratyphi AO Widal Test Vial 5 ml DAK 2017 72,972.50
45 Salmonella Paratyphi BH Widal Test Vial 5 ml DAK 2017 72,972.50
46 Salmonella Paratyphi BO Widal Test Vial 5 ml DAK 2017 72,972.50
47 Salmonella Paratyphi CH Widal Test Vial 5 ml DAK 2017 72,972.50
48 Salmonella Paratyphi CO Widal Test Vial 5 ml DAK 2017 72,972.50
C OBAT DAN BMPH LAIN-LAIN
1
2
3
4
5
6
7
8
9
10
AR PENERIMAAN OBAT DAN PERBEKKES
APBD II TAHUN 2017
PUSKESMAS SEMBERANG

PENERIMAAN TAHUN 2017

JAN FEB MAR APR MEI JUN
6 7 8 9 10 11

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 72
0 0 0 0 0 0
0 0 0 0 0 0
1000 1000 0 0 0 1000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 300 0 0 300 0
0 0 0 0 0 0

0 0 0 0 0 0

0 2000 0 0 0 2000

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0

50 100 0 0 0 50
0 0 0 0 0 0
50 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

- 0 0 0 0 0

0 0 20 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 1000 1000

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1000
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 50 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 1000 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 60 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

48 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
60 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 2000 0 0 0 3000
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 100 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 200 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 50

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 24

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 24
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 300
0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 100 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 300 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 1000

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 1000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 3000 0 0 2000

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
 0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
24 48 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 1000 1000

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 100
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
 0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 1000 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
25 25 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 300
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 100
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 56 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 3000 2000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
 0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
500 500 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 2000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

50 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

300 0 0 0 150 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
20 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 60 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 1000 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 1000 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 150 0 0 600 300
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 100 0 0 0 0
0 0 0 0 0 0
0 100 0 100 500 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 1000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 1000
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 500 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 10 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 50 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
 0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
10 10 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 2
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 5 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 100 0 0 0
0 0 0 0 0 0
0 0 0 100 0 0
0 0 0 0 0 0
0 0 0 0 100 0
0 0 0 0 0 0

1 0 0 0 0 0
1 0 0 0 0 0

1 0 0 0 0 0

1 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
TOTAL
12
-
-
-
-
-
-
-
-
72.00
-
-
3,000.00
-
-
-
-
-
-
-
-
-
-
-
-
600.00
-

4,000.00

-
-
-
-

200.00
-
50.00
 -
-
-

20.00

-
-
-
-

-
2,000.00

-
-

-
-
1,000.00
-
-
 -
-
-
-

-
50.00
-
-
-
-

1,000.00
-
-
-

-
-
60.00
-
-

48.00
-

-
-

-
-
-
-
-
-
60.00
-
-
-
-
 -
-
5,000.00
-
-

-
-

-
-
100.00
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
200.00
-
-
50.00

-
-
-
-
 -
-
-
-
-
-
-
-
1.00
-
-
-
-
100.00
-
-
24.00

-
-
-
-
-
-
-
-
-

-
-
-
100.00
-
-
-
-
 -
-
-
24.00
-
-
-
-
300.00
-
-

-
100.00
-
-
100.00
-
-
-
-
-
-
300.00
-
-
-
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
500.00
-
-
-
-
-
-
-
-
-
 -

1,000.00

-
1,000.00
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-

-
-

5,000.00

-
-
-
-
-
-
-
-

-
-

-
-
-
-

-
-

-
-
-
-
-
-

-
-
-
-

-
-
-

-
 -

-
-

-
-
-

-
-
-

-
-
-
-
500.00
-
-
72.00
-
-
-
2,000.00

-
-
-
-
-
-
-
100.00
-
-
-
-
-
-
-
-
-
-
-
-

-
 -

-
-
-

1,000.00

-
-
50.00
-
-
-
-
-
-

-
-
-
300.00
-
-
-
-
-

-
-
-
-

-
-
100.00
-

56.00
-
-
5,000.00
-
-
-
 -
-
-
-
-
-
-
-

-
-
1,000.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
2,000.00
-
-
-

50.00

450.00
-
-
-
20.00
-

-
 -
-
-
-

-
-
-

-
-
-
-
-
-
60.00
-
-
1,000.00
-
-
-
-
-
1,000.00

-
1,050.00
-
-
-
-
-
-
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100.00

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100.00
-
700.00
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1,000.00
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-
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 DAFTAR PENGELUARAN OBAT
APBD II TAHUN 2
PUSKESMAS ………

NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN

1 2 3 4 9
I OBAT GENERIK
1 Akarbose tablet/kaplet 50 mg Tablet DAK 2016 657.00
2 Alopurinol tablet 100 mg Tablet DAK 2016 95.00
3 Alopurinol tablet 100 mg Tablet DAK 2015 90.00
4 Alopurinol tablet 100 mg Tablet DAK 2017 117.00
5 Alprazolam 0,5 mg Tablet DAK 2015 185.00
6 Alprazolam 0,5 mg Tablet DAK 2016 144.00
7 Alprazolam 0,5 mg Tablet DAK 2014 185.00
8 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2016 3,627.00
9 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2015 3,290.00
10 Ambroxol tablet 30 mg Tablet DAK 2017 985.00
11 Ambroxol tablet 30 mg Tablet DAK 2016 143.68
12 Ambroxol tablet 30 mg Tablet DAK 2015 125.00
13 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2017 17,375.00
14 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2017 3,080.00
15 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2015 4,200.00
16 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2016 3,349.00
17 Aminofilina tablet 200 mg DAK 2016 124.94
Tablet
18 Aminofilina tablet 200 mg Tablet salut selaput DAK 2017 97.00
19 Aminofilina tablet 200 mg DAK 2015 86.00
Tablet
20 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2015 123.00
21 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2016 165.00
22 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2017 171.00
23 Amlodipin 5 mg Tablet DAK 2017 91.00
24 Amlodipin 5 mg Tablet DAK 2016 1,333.33
25 Amlodipin 5 mg Tablet DAK 2015 197.00
Amoksisilin kapsul/kaplet/tablet scored
Kaptab
26 500 mg DAK 2017 191.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet
27 500 mg DAK 2016 233.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet
28 500 mg DAK 2015 279.00
29 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2017 1,920.00
30 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2016 2,200.00
31 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2015 2,560.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
32 ml DAK 2017 3,797.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
33 ml DAK 2015 4,730.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml
34 ml DAK 2016 4,147.00
35 Antalgin injeksi 250 mg/ml - 2 ml Ampul DAK 2013 1,500.74
36 Antasida DOEN suspensi Botol 60 ml DAK 2016 2,106.00
37 Antasida DOEN suspensi Botol 60 ml ABT 2015 2,300.00
38 Antasida DOEN suspensi Botol 60 ml DAK 2015 2,300.00
39 Antasida DOEN suspensi Botol 60 ml DAK 2017 1,962.00
Antasida DOEN tablet
kunyah,kombinasi: Tablet
40 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2015 78.00
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet
41 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2017 59.00
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet kunyah
42 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2016 64.00
200 mg
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
43 IU/g DAK 2015 2,767.00
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
44 IU/g DAK 2017 3,365.00
Anti Diare Kombinasi Kaolin 986
Botol 60 ml
45 mg+Pektin 40 mg DAK 2016 8,000.00
Anti Diare Kombinasi Kaolin 986
Botol 60 ml
46 mg+Pektin 40 mg DAK 2017 6,190.00
Antifungi DOEN kombinasi :
Asam Benzoat 6 % + pot plastik 30 gram
47 DAK 2017 4,972.00
Asam Salisilat 3 %
Antifungi DOEN kombinasi :
Asam Benzoat 6 % + pot plastik 30 gram
48 DAK 2016 4,782.00
Asam Salisilat 3 %
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
49 150 mg + Heksaklorofen 2,5 mg DAK 2015 3,350.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
50 150 mg + Heksaklorofen 2,5 mg DAK 2016 3,502.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
51 150 mg + Heksaklorofen 2,5 mg DAK 2017 3,300.00
Antimigren DOEN tablet kombinasi :
Tablet
52 Ergotamin Tartrat 1 mg + Kofein 50 mg DAK 2017 204.00
Antimigren + Paracetamol 400 mg,
Tablet
53 Acetosal 250 mg, Caffeine 65 mg DAK 2016 605.00
54 Aqua pro Injeksi steril, bebas pirogen Ampul 25 ml DAK 2015 2,200.00
55 Air untuk Injeksi 25 ml Ampul 25 ml DAK 2017 2,750.00
56 OTSU SWI 25 ML - Air untuk Injeksi 25 DAK 2016 2,750.00
Ampul 25 ml
ml
ACT (Artesunate tablet 50 mg +
Tablet
57 Amodiaquine anhydrida tablet 200 mg) DAK 2015 1,409.00
58 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2016 120.00
Asam askorbat (vitamin C)
Tablet
59 tablet/kapsul/kaplet 250 mg DAK 2017 118.00
60 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2017 120.00
Asam Folat tablet/kapsul/kaplet 0,4
Tablet
61 mg(Afolat) DAK 2015 140.00
Asam Folat tablet/kapsul/kaplet 0,4
Tablet
62 mg(Afolat) DAK 2016 68.00
63 Asam Mefenamat 500 mg Kaptap Salut Selaput DAK 2017 102.00
64 Asam Mefenamat 500 mg Tablet DAK 2016 113.00
65 Asam Traneksamat 500 mg Tablet DAK 2017 1,540.00
66 Asam Traneksamat 500 mg Tablet DAK 2016 1,540.00
67 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2016 2,789.00
68 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2017 2,530.00
69 Asetosal 100 mg Tablet DAK 2015 127.00
70 Asetosal 100 mg Tablet DAK 2016 153.00
Asam asetilsalisilat (asetosal)
Tablet
71 tablet/kapsul/kaplet 100 mg DAK 2017 154.00
72 Asiklovir krim 5 % Tube 5 gram DAK 2016 2,997.00
73 Asiklovir krim 5 % Tube 5 gram DAK 2017 9,550.00
74 Asiklovir tablet 400 mg Tablet DAK 2015 354.00
75 Asiklovir tablet 400 mg Tablet DAK 2016 368.00
76 Asiklovir tablet/kapsul/kaplet 400 mg Tablet DAK 2017 415.00
NEW ANTIDES - Attapulgite 600 mg
Tablet
77 tablet DAK 2016 173.00
78 Atapulgit tablet 600 mg (Pularex) Tablet DAK 2015 220.00
79 Atropin inj 0,25 mg / ml Ampul 1 ml DAK 2016 1,672.00
80 Azitromisin tablet 500 mg Tablet DAK 2016 1,900.00
kombinasi: ferro fumarat 60 mg + as.
Folat 0,4 mg tablet salut gula (tablet Tablet Salut Gula
81 tambah darah) DAK 2017 410.00
(Tablet Tambah Darah Kombinasi) :
Ferrous Fumarate 250 mg, Manganese
Sulfate 0,2 mg, Cupric Sulfate 0,2 mg, Tablet
Folic Acid 4 mg, Cyanocobalamin 7,5
82 mg DAK 2016 660.00
Plastik-Dus-serbuk 50
Bedak salisil serbuk 2%
83 gram DAK 2017 1,071.00
BEROTEC SOLUTION - Fenoterol HBr
Botol
84 solution 0,1% DAK 2016 125,750.00
85 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2017 151.00
86 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2016 170.00
87 Bisoprolol tablet/kapsul/kaplet 5 mg Tablet salut selaput DAK 2017 298.00
88 Bisoprolol tablet 5 mg Tablet DAK 2016 399.00
Betametason krim0,1% (Sebagai
Tube 5 gram
89 Valerat) DAK 2016 1,435.00
90 Betametason krim 0,1 o/o Tube 5 gram DAK 2015 1,558.00
Betametason krim0,1% (Sebagai
Tube 5 gram
91 Valerat) DAK 2017 1,450.00
92 Bisakodil suppositoria 10mg Supp DAK 2017 5,800.00
Bisakodil suppositoria 10 mg(Stolax
Supp
93 supp) DAK 2015 6,045.00
Bisakodil suppositoria 10 mg(keluar e-
Supp
94 catalog) DAK 2015 6,040.00
DULCOLAX SUPP ADULT 10MG
Supp
95 Bisakodil suppositoria 10mg DAK 2016 5,800.00
DULCOLAX SUPP INFANT - Bisakodil
Supp
96 suppositoria 5 mg DAK 2016 5,670.00
97 Bisakodil suppositoria 5 mg Supp DAK 2017 5,800.00
98 Bisakodil tablet/kapsul/kaplet 5 mg Tablet salut enterik DAK 2017 317.00
99 Cetirizine tablet 10 mg Tablet DAK 2015 190.00
100 Cetirizine tablet 10 mg Tablet salut selaput DAK 2017 115.00
101 Cetirizine tablet 10 mg Tablet DAK 2016 154.00
102 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2016 2,950.00
103 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2015 8,799.00
104 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2017 3,300.00
105 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,745.00
106 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,822.00
107 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2014 1,544.00
108 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,544.00
109 Deksametason tablet 0,5 mg Tablet DAK 2016 120.00
110 Deksametason tablet 0,5 mg Tablet DAK 2017 149.07
111 Deksametason tablet 0,5 mg Tablet DAK 2015 68.00
Dekstrometorfan sirup 10 mg/5
Botol 60 ml
112 ml(calortusin ) DAK 2014 3,609.00
Dekstrometorfan sirup 10 mg/5
Botol 60 ml
113 ml(calortusin ) DAK 2015 3,608.00
Dektromethorphan tablet 15mg
Tablet
114 ( Ramaflu ) DAK 2015 275.00
Dektromethorphan tablet 15mg
Tablet
115 ( Ramaflu ) DAK 2014 275.00
116 DEPAKENE - Valproat sirup 250 mg/5 DAK 2016 41,800.00
Botol
ml
DEPAKOTE TAB 250 MG - Valproat
Tablet
117 tablet salut 250 mg DAK 2016 1,750.00
118 Diazepam tablet 2 mg Tablet DAK 2015 46.00
119 Diazepam tablet 2 mg Tablet DAK 2014 125.40
120 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul DAK 2017 15,600.00
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube
121 (STESOLID) DAK 2015 18,461.00
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube
122 (STESOLID) DAK 2016 18,458.00
123 Diazepam enema 10 mg/2,5 mL Allubag DAK 2017 19,378.00
Diazepam larutan rectal 5 mg/ 2,5
Tube
124 ml(STESOLID) DAK 2015 12,751.00
Diazepam larutan rectal 5 mg/ 2,5
Tube
125 ml(STESOLID) DAK 2016 12,749.00
126 Diazepam enema 5 mg/2,5 mL Allubag DAK 2017 13,384.00
127 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,222.00
128 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,156.00
129 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,354.00
130 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2013 1,056.00
131 Digoksin tablet/kapsul/kaplet 0,25 mg Tablet DAK 2017 109.00
132 Digoksin tablet 0,25 mg Tablet DAK 2016 108.00
133 Digoksin tablet 0,25 mg Tablet DAK 2015 103.00
134 Doksisiklin tablet/kapsul/kaplet 100 mg kapsul DAK 2017 299.00
135 Doksisiklin tab 100 mg Tablet DAK 2016 309.00
136 Domperidon 10 mg Tablet DAK 2015 174.00
137 Domperidon tablet/kapsul/kaplet 10 mg Tablet DAK 2014 110.00
138 Domperidon 10 mg Tablet DAK 2016 118.00
139 Domperidon suspensi/sirup 5 mg/5 ml Botol 60 ml DAK 2015 3,490.00
140 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2017 17,000.00
141 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2016 3,180.00
DOPAMET - Metildopa tablet salut 250
Tablet
142 mg DAK 2016 1,001.00
DOPAMET - Metildopa tablet salut 250
Tablet
143 mg DAK 2017 1,050.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul
144 mg/ml DAK 2015 8,910.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul
145 mg/ml DAK 2016 2,354.00
146 Eritromisin kaplet 500mg Kaplet DAK 2016 766.00
147 Eritromisin tablet/kapsul/kaplet 500 mg Kaptab DAK 2017 766.00
148 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2017 6,461.00
149 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2016 7,039.00
150 Ethambutol 500 mg Tab Tablet DAK 2016 688.00
151 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2013 2,354.22
152 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2015 3,327.75
153 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2014 3,450.00
154 Etanol 70 % Botol DAK 2014 2,625.00
155 Etil Klorida semprot Botol DAK 2017 110,000.00
156 Etil Klorida semprot Botol DAK 2015 115,000.00
157 Etil Klorida semprot Botol DAK 2016 115,500.00
158 Eugenol cairan Botol DAK 2014 18,333.00
159 FARNORMIN - Atenolol 50 mg Tablet DAK 2016 330.00
160 Fenitoin Kapsul/Kaplet 100 mg Kaplet DAK 2016 154.00
161 Fenitoin injeksi 50 mg/ml (100 mg/2 ml) DAK 2017 6,231.00
162 Fenobarbital tablet 30 mg Tablet DAK 2015 70.10
163 Fenobarbital tablet 30 mg Tablet DAK 2017 132.00
164 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2017 2,500.00
165 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2015 1,108.79
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
166 mg/ml DAK 2014 4,356.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
167 mg/ml DAK 2015 3,754.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml
168 mg/ml DAK 2016 4,083.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet Salut Gula
169 10 mg DAK 2017 790.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet
170 10 mg DAK 2016 796.00
FLIXOTIDE NBULES - Flutikason
Nebules 2 ml
171 Propionat nebules 0,5 mg DAK 2016 14,500.00
Flutikason propionat (micronized) 0,5
mg/dosis (Flutikason propionat nebules Nebules 2 ml
172 0,5 mg) DAK 2017 14,500.00
173 Furosemid tablet 40 mg Tablet DAK 2015 96.00
174 Furosemid tablet 40 mg Tablet DAK 2017 111.00
175 Furosemid tablet 40 mg Tablet DAK 2016 181.73
176 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2017 2,058.00
177 Furosemid injeksi Ampul DAK 2015 2,012.00
178 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2016 -
179 Gabapentin 300 mg Kaplet DAK 2016 1,639.00
180 Gabapentin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 1,254.00
Garam oralit kombinasi : natrium klorida
0,52 g + kalium klorida 0,30 g +
Sachet 4,26 gram
trinatrium sitrat 0,58 g + glukosa
181 anhidrat 2,7 g DAK 2016 274.00
Garam Oralit I serbuk, kombinasi:
Natrium klorida 0,52 g + kalium klorida
Sachet
0,30 g + Trinatrium sitrat dihidrat 0,58 g
182 + Glukosa Anhidrat 2,70 g DAK 2017 273.00
183 Garam Oralit serbuk,kombinasi Sachet DAK 2015 317.00
184 Gemfibrozil kapsul/kaplet 300 mg Tablet DAK 2015 318.00
185 Gemfibrozil tablet/kapsul/kaplet 300 mg Tablet DAK 2016 436.00
186 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2016 1,835.16
187 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2017 7,180.00
188 Gentamicin TM 0,3 % Botol 5 ml DAK 2016 4,600.00
189 Gentamicin TM 0,3 % Botol 5 ml DAK 2015 3,513.00
190 Gentamisin tetes mata 0,3% Botol 5 ml DAK 2017 4,800.00
191 Gentian violet 1 o/o Botol 10 ml DAK 2015 2,189.00
192 Gentian violet 1 o/o Botol 10 ml DAK 2017 3,812.00
193 Gentian violet 1 o/o Botol 10 ml DAK 2016 2,925.00
194 Glass Ionomer Cement (Fuji IX) Set DAK 2016 919,300.00
195 Glass Ionomer Cement (Fuji VII) Set DAK 2016 1,225,700.00
196 Glass Ionomer Cement (Fuji VII) Set DAK 2017 617,798.00
197 Glass Ionomer Cement (GC IX) Set DAK 2015 434,460.00
198 Glibenklamid tablet 5 mg Tablet DAK 2016 108.00
199 Glibenklamid tablet 5 mg Tablet DAK 2017 90.00
200 Glibenklamid tablet 5 mg Tablet DAK 2015 61.00
Glibenklamid tablet 5 mg (keluar e-
Tablet
201 catalog) DAK 2015 60.00
202 GLICAB - Gliklazid tab 80 mg Tablet DAK 2016 245.00
203 Gliklazid tablet/kapsul/kaplet 80 mg Tablet DAK 2017 218.00
204 Glimepiride tablet/kapsul/kaplet 2 mg Tablet DAK 2017 231.00
205 Glimepiride tablet 2 mg Tablet DAK 2016 296.00
206 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2016 36.52
207 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2017 108.00
208 Glukosa larutan infus 10% Botol plastik 500 ml DAK 2016 7,500.00
209 Glukosa larutan infus 5 % steril Botol plastik 500 ml DAK 2016 6,900.00
210 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2017 6,900.00
211 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2015 5,720.00
212 Griseofulvin tablet 125 mg, micronized Tablet DAK 2016 264.00
213 Griseofulvin tablet 125 mg, micronized Tablet DAK 2015 224.00
214 Griseofulvin tablet 125 mg, micronized Tablet DAK 2017 266.00
215 Haloperidol 1.5 mg Tablet DAK 2015 76.00
216 Haloperidol 1.5 mg Tablet DAK 2014 76.00
217 Haloperidol 1.5 mg Tablet DAK 2016 74.00
HALDOL DECANOAS - Haloperidol inj
Ampul 1 ml
218 50 mg/ml DAK 2016 97,500.00
219 Haloperidol inj 50 mg/mL Ampul 1 ml DAK 2017 97,500.00
LODOMER DROPS - Haloperidol tts 2
Botol 15 ml
220 mg/mL DAK 2016 18,499.00
221 Haloperidol tts 2 mg/mL Botol 15 ml DAK 2017 18,100.00
222 Dus, 1 syringe @ 0,5 DAK 2017 1,300,000.00
Hepatitis B imunoglobullin
ml
223 Hidroklorotiazid tab 25 mg Tablet DAK 2017 171.00
224 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2016 2,712.00
225 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2017 2,838.00
226 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2015 2,868.00
227 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2017 1,760.00
228 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2016 2,745.00
229 Ibuprofen tablet 200 mg Tablet DAK 2017 108.00
230 Ibuprofen tablet/kapsul/kaplet 200 mg Tablet DAK 2016 111.00
231 Ibuprofen tablet 400 mg Tablet DAK 2016 133.00
232 Ibuprofen tablet 400 mg Tablet DAK 2017 113.00
233 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2017 2,560.00
234 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2016 2,560.00
235 Isoniazid tablet/kapsul/kaplet 100 mg Tablet DAK 2017 85.00
236 Isoniazid tablet/kapsul/kaplet 300 mg Tablet DAK 2017 182.00
237 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2015 98.00
238 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2016 93.00
239 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2017 95.00
240 KALIPAR - Kalium aspartat tab 300 mg Tablet DAK 2016 690.00
 Kalium aspartat tablet/kapsul/kaplet 300
Kaptab salut selaput
241 mg DAK 2017 682.00
Kalsium Laktat (Kalk)
Tablet
242 tablet/kapsul/kaplet 500 mg DAK 2016 69.00
Kalsium Laktat (Kalk)
Tablet
243 tablet/kapsul/kaplet 500 mg DAK 2017 57.00
Kalsium Laktat (Kalk)
Tablet
244 tablet/kapsul/kaplet 500 mg DAK 2015 76.00
245 Kaptopril 25 mg Tablet DAK 2016 72.00
246 Kaptopril tablet/kaplet scored 25 mg Tablet DAK 2017 86.00
247 Kaptopril 25 mg Tablet DAK 2015 97.00
248 Kandesartan tab 8 mg Tablet DAK 2016 4,015.00
249 Kandesartan tablet/kapsul/kaplet 8 mg Tablet DAK 2017 770.00
Karbamazepin tablet/kapsul/kaplet 200
Tablet
250 mg DAK 2016 306.00
251 Karbamazepin tablet 200 mg Tablet DAK 2015 269.00
252 Ketoprofen supositoria 100 mg Supp DAK 2017 2,640.00
253 Ketokonazol krim 2% Tube 10 gram DAK 2016 2,605.00
254 Ketokonazol krim 2% Tube 10 gram DAK 2017 2,790.00
255 Ketokonazol tablet 200 mg Tablet DAK 2016 292.00
256 Ketokonazol tablet/kapsul/kaplet 200 DAK 2017 297.00
Tablet
mg
257 Ketokonazol tablet 200 mg Tablet DAK 2015 320.00
258 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2017 1,320.00
259 Ketorolac injeksi 30 mg Ampul 1 ml DAK 2014 2,665.00
260 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2016 1,383.00
261 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2016 660.00
262 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 589.00
263 Klopidogrel tablet 75 mg Tablet DAK 2016 2,100.00
264 Klopidogrel tablet/kapsul/kaplet 75 mg Tablet salut selaput DAK 2017 1,799.00
CHLORAMEX - Kloramfenikol kapsul
Kapsul
265 500 mg DAK 2016 1,155.00
Kloramfenikol tablet/kapsul/kaplet 250
Kapsul
266 mg DAK 2017 502.29
267 Kloramfenikol kapsul 250 mg Kapsul DAK 2010 198.92
268 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2017 1,850.00
269 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2016 1,850.00
270 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2017 4,982.00
271 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2016 4,000.00
272 Kloramfenikol tetes mata 0,5 % Botol plastik 10 ml DAK 2017 3,850.00
Kloramfenikol tetes mata 0,5 % (Reco
Botol plastik 10 ml
273 TM) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml
274 TT) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml
275 TT) DAK 2017 7,370.00
276 Kloramfenikol tetes telinga 3 % Botol plastik 10 ml DAK 2015 5,060.00
Klorfeniramina Maleat (CTM)
Tablet
277 tablet/kapsul/kaplet 4 mg DAK 2016 45.00
Klorfeniramina Maleat (CTM)
Tablet
278 tablet/kapsul/kaplet 4 mg DAK 2015 53.00
279 Klorfeniramina Maleat (CTM) tablet 4 DAK 2014 100.10
Klorpromazin injeksi i.m. 25 mg/ml Tablet
mg
280 (HCl)
Klorpromazin injeksi i.m. 25 mg/ml Ampul 1 ml DAK 2016 1,425.00
281 (HCl) Ampul 1 ml DAK 2017 1,349.00
282 Klorpromazin tablet salut 25 mg (HCl) Tablet DAK 2016 170.00
283 Klorpromazin tablet salut 100 mg (HCl) Tablet DAK 2015 153.00
284 Klozapin 25 mg Tablet DAK 2016 1,550.00
285 Kodein tablet/kapsul/kaplet 10 mg Tablet DAK 2017 632.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
286 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2016 2,225.00
kotrimoksazol (anak) kombinasi tiap 5
ml suspensi: sulfametoksazol 200 mg + Botol 60 ml
287 trimetoprim 40 mg DAK 2017 2,462.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
288 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2015 2,298.00
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
289 200 mg + Trimetoprim 40 mg/ 5 Ml ABT 2015 2,298.00
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg + trimetoprim Kaptab
290 160 mg DAK 2017 327.00
kotrimoksazol forte
kombinasi:sulfametoksazol 800 mg + Tablet
291 trimetoprim 160 mg DAK 2015 420.00
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg trimetoprim Tablet
292 160 mg DAK 2016 344.00
293 Laktulosa sir 3,335 g/5 mL Botol DAK 2016 14,500.00
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml
294 3A injection) DAK 2017 10,285.00
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml
295 3B injection) DAK 2017 10,285.00
296 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2015 40,000.00
297 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2016 40,000.00
298 Lidokain jelli 2% syringe 10 gram DAK 2017 40,000.00
Lidokain Komp.injeksi, Kombinasi :
Lidokain HCL 12 % Ampul 2 ml
299 + Epinefrin 1 : 80.000 - 2 ml DAK 2015 1,499.00
300 Lidokain injeksi 2% (HCL) Ampul DAK 2016 875.00
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml
301 80.000 - 2 mL DAK 2016 2,122.00
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml
302 80.000 - 2 mL DAK 2017 2,227.00
303 Lisinopril tablet/kapsul/kaplet 5 mg Tablet DAK 2016 410.00
304 Loperamid Tablet DAK 2017 85.00
305 Loperamid tablet 2 mg Tablet DAK 2016 90.00
306 Loratadin tablet/kapsul/kaplet 10 mg Tablet DAK 2016 149.00
307 Loratadin tablet/kapsul/kaplet 10 mg Kaptab DAK 2017 134.00
OTSU-MGSO4 40 - Magnesium sulfat
Ampul 25 ml
308 injeksi 40% DAK 2016 3,650.00
309 Magnesium sulfat injeksi 40% Ampul 25 ml DAK 2017 3,650.00
310 Metamizol injeksi 500 mg/ml Ampul 2 ml DAK 2017 3,050.00
311 Metil prednisolon tab 4 mg Tablet DAK 2016 209.00
Metilprednisolon tablet/kapsul/kaplet 4
Tablet
312 mg DAK 2017 165.00
313 Metilprednisolon inj 125 mg/2 mL Dus DAK 2015 22,000.00
314 Metilprednisolon inj 125 mg/2 mL Dus DAK 2016 14,750.00
Metilergametrin (Maleat) tablet salut
Tablet
315 0,125 mg DAK 2016 222.20
 Metilergametrin (Maleat) tablet salut
Tablet Salut
316 0,125 mg DAK 2017 270.60
Metilergametrin Maleat inj 0,200 mg - 1
Ampul
317 ml DAK 2015 2,750.00
Metilergametrin Maleat inj 0,200 mg - 1
318 ml Ampul DAK 2014 4,917.00
Metilergametrin Maleat inj 0,200 mg - 1
319 ml Ampul DAK 2016 2,684.00
320 Metoclopramide tablet 10 mg Tablet DAK 2016 100.00
Metoklopramide tablet/kapsul/kaplet 10
321 mg Tablet DAK 2017 93.00
322 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2017 3,904.00
323 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2016 4,395.00
LEXAPRAM SIRUP - Metoklopramide
324 sirup 5 mg/ 5 ml Botol 60 ml DAK 2016 2,750.00
325 Metoklopramide sirup 5 mg/ 5 ml Botol 60 ml DAK 2017 2,950.00
326 Metformin 400 mg Tablet DAK 2016 108.00
Metformin HCl tablet/kapsul/kaplet 500
Kaptap ss
327 mg DAK 2017 103.00
328 Metronidazol infus 5 mg/ ml Botol @100 mL DAK 2017 9,680.00
329 Metronidazole infus Botol @100 mL DAK 2010 21,759.00
330 Metronidazol tablet/kapsul/kaplet 500 DAK 2017 115.00
Tablet
mg
331 Metronidazol tablet 500 mg Tablet DAK 2016 750.00
332 Metronidazole sirup 125mg/ 5ml Botol 60 ml DAK 2016 3,800.00
333 Metronidazol sirup 125 mg/5 ml Botol 60 ml DAK 2017 3,800.00
334 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2016 3,737.00
335 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2017 5,500.00
336 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2015 3,075.00
337 Natrium Bikarbonat tablet 500 mg Tablet DAK 2016 22.00
338 Natrim Diklofenak 50 mg tab Tablet DAK 2016 161.00
Natrium diklofenak tablet/kapsul/kaplet
Tablet salut enterik
339 50 mg DAK 2017 135.00
340 Natrim Diklofenak 50 mg tab Tablet DAK 2015 193.00
341 Natrium Klorida larutan infus 0,9 % DAK 2017 6,410.00
Botol plastik 500 ml
Steril
Natrium Klorida larutan infus 0,9 %
342 Botol plastik 500 ml DAK 2015 5,170.00
Steril
Natrium Klorida larutan infus 0,9 %
343 Botol plastik 500 ml DAK 2016 6,410.00
Steril
344 Nifedipin tablet/kapsul/kaplet 10 mg Tablet salut selaput DAK 2017 110.00
345 Nifedipin tablet 10 mg Tablet DAK 2015 110.00
346 Nifedipin tablet 10 mg Tablet DAK 2016 123.00
347 Nistatin vaginal tablet 100.000 IU/ g Tablet Vaginal DAK 2017 627.00
348 Nistatin vaginal tablet 100.000 IU/ g Supp DAK 2016 602.00
349 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet Salut Gula DAK 2017 881.00
350 Nistatin tablet salut 500.000 UI/g Tablet DAK 2015 704.00
351 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet DAK 2016 857.00
352 Nystatin drop Botol 12 ml DAK 2016 38,425.00
353 Nystatin drop Botol 12 ml DAK 2017 24,198.00
354 Obat Anti Tuberculosis FDC Kategori I Paket DAK 2017 430,538.00
355 OAT FDC Kategori 1 Dewasa Paket DAK 2013 395,900.00
356 OAT FDC Kategori 2 Dewasa Paket DAK 2016 1,379,984.00
357 Obat Anti Tuberculosis FDC Kategori II Paket DAK 2017 1,435,178.00
358 Obat Antituberkulosis Kategori 1 DAK 2014 317,015.00
Paket
dewasa
Obat Anti Tuberculosis FDC Kategori
Paket
359 Sisipan DAK 2016 183,984.00
 "Dus, 12 blister @ 28
Obat Anti Tuberculosis FDC Kategori tablet dispersibel Dus, 6
Anak blister @ 28 tablet
360 dispersibel" DAK 2017 257,125.00
Obat Anti Tuberculosis FDC Kategori
Paket
361 Anak DAK 2016 247,234.00
362 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2016 7,149.00
363 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2017 6,000.00
Obat batuk Antitusif sirup Kombinasi
Botol 60 ml
364 Dextromethorphan HBr DAK 2016 9,875.00
Obat batuk Antitusif tablet Kombinasi
Tablet
365 Dextromethorphan HBr DAK 2016 548.00
Obat batuk sirup Kombinasi
Botol 60 ml
366 Dextromethorphan HBr DAK 2017 11,800.00
Obat batuk tablet Kombinasi
Tablet
367 Dextromethorphan HBr DAK 2017 704.00
368 Ofloksasin tab 400 mg Tablet DAK 2010 960.00
369 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2016 1,649.36
370 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2017 1,640.00
371 Oksitetrasiklin HCI salep mata 1 % Tube 3,5 gram DAK 2017 2,772.00
372 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2015 2,772.00
373 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2016 2,772.00
374 Oksitosin injeksi 10 IU/ml(Tiacinon) Ampul DAK 2015 1,900.00
375 Oksitosin injeksi 10 IU / ml - ml Ampul DAK 2014 5,890.50
OXYTOCIN INJLQ 10 IU Oksitosin inj
Ampul
376 10 UI/ml DAK 2016 1,900.00
377 Omeprazole Injeksi 40mg / 10ml Vial DAK 2016 18,537.00
378 Omeprazol injeksi 40 mg/ 10 ml Vial DAK 2017 14,924.00
379 Omeprazole kapsul Kapsul DAK 2016 164.00
380 Omeprazole kapsul Kapsul DAK 2015 221.00
381 Omeprazol tablet/kapsul/kaplet 20 mg Kapsul DAK 2017 148.00
382 Ondansetron tablet/kapsul/kaplet 4 mg Tablet DAK 2016 542.00
383 Ondansetron tablet/kapsul/kaplet 4 mg Tablet salut selaput DAK 2017 523.00
384 Ondansetron inj 2 mg/ml (4 mg/ 2 mL) Ampul 2 ml DAK 2017 1,254.00
Ondansetron Injeksi 2 mg/ ml (4 mg/ 2
Ampul 2 ml
385 ml) DAK 2016 1,650.00
386 Ondansetron inj 4 mg/ 2 mL Ampul 2 ml DAK 2015 2,400.00
387 PANTOCAIN 0.5% Botol DAK 2016 11,500.00
388 Parasetamol infus Dus, Botol @ 1000 mg DAK 2016 27,225.00
Parasetamol drips (infus) 1000 mg/100
Dus, Botol @ 1000 mg
389 mL DAK 2017 12,939.00
390 Parasetamol sirup 120 mg / 5 ml Botol Plastik @ 60 Ml DAK 2017 1,013.00
391 Parasetamol sirup 120 mg/ 5ml Botol Plastik @ 60 Ml DAK 2016 1,119.00
392 Parasetamol drop Botol Plastik @ 60 Ml DAK 2015 5,720.00
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml
393 (60mg/0,6ml) (G) DAK 2017 6,850.00
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml
394 (60mg/0,6ml) (G) DAK 2016 5,980.00
395 Parasetamol tablet 100 mg Tablet DAK 2016 106.59
396 Parasetamol tablet 100 mg Tablet DAK 2013 34.51
397 Parasetamol tablet 500 mg Tablet DAK 2016 174.00
398 Parasetamol tablet/kapsul/kaplet 500 DAK 2017 51.00
Tablet
mg
399 Parasetamol tablet 500 mg Tablet DAK 2015 88.00
400 Perak sulfadiazin krim 1% tube 35 g DAK 2017 20,700.00
 Petidin injeksi i.m/s.k/i.v lambat 50
Ampul
401 mg/ml (HCl) DAK 2015 15,950.00
402 Piracetam 400 mg Tablet DAK 2016 541.24
403 Piracetam Inj 1 g/5 ml Ampul DAK 2016 15,840.00
404 Piracetam Inj 1 g/5 ml Ampul DAK 2017 6,600.00
405 Pirantel tablet 125 mg Tablet DAK 2014 318.00
406 Pirantel tablet score (base) 125 mg Tablet DAK 2016 318.00
407 Pirazinamid 500 mg Tablet DAK 2017 238.00
408 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2015 148.00
Piridoksin (Vitamin B6) tab/kap/kapl 10
Tablet
409 mg (HCl) DAK 2017 136.00
410 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2016 136.00
411 Piroksikam 20 mg Tablet DAK 2016 213.95
412 Piroksikam 20 mg Tablet DAK 2017 130.00
413 Piroksikam 20 mg Tablet DAK 2015 105.00
414 Povidon lodida larutan 10 % Botol 300 ml DAK 2013 14,350.00
415 Povidon lodida larutan 10 % Botol 300 ml DAK 2015 15,386.00
416 Povidon lodida larutan 10 % Botol 300 ml DAK 2014 15,386.00
417 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2016 102.00
418 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2017 85.00
419 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2015 125.00
420 Prednison tablet/kapsul/kaplet 5 mg Tablet ABT 2015 125.00
421 Primakuin tablet 15 mg Tablet DAK 2015 205.00
422 Propranolol HCI tablet 10 mg Tablet DAK 2016 69.00
423 Propranolol tablet/kapsul/kaplet 10 mg Tablet DAK 2017 59.00
424 Propranolol HCI tablet 10 mg Tablet DAK 2015 80.00
425 Proiltiourasil tablet 100 mg Tablet DAK 2014 299.27
426 Proiltiourasil tablet 100 mg Tablet DAK 2015 351.00
Propiltiourasil tablet/kapsul/kaplet 100
Tablet
427 mg DAK 2016 320.00
428 Vaksin rabies Vial DAK 2017 174,500.00
429 Ranitidin tablet 150 mg Tablet DAK 2015 128.00
430 Ranitidin tablet/kapsul/kaplet 150 mg Tablet salut selaput DAK 2017 110.00
431 Ranitidin tablet 150 mg Tablet DAK 2016 119.00
432 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2016 1,595.18
433 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2017 1,677.00
434 Ranitidin Injeksi 25 mg/ml Ampul 2 ml DAK 2015 3,960.00
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul
435 lunak DAK 2016 327.00
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul
436 lunak DAK 2015 286.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul lunak
437 lunak DAK 2017 585.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul
438 lunak ABT 2015 505.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul
439 lunak DAK 2016 536.00
440 Rifampisin tablet/kapsul/kaplet 600 mg Kaptap ss DAK 2017 1,274.00
441 Ringer laktat larutan infus Botol plastik 500 ml DAK 2015 5,720.00
442 Ringer laktat larutan infus Botol plastik 500 ml DAK 2017 7,150.00
443 Ringer Laktat Botol DAK 2016 7,150.00
444 Risperidon 2 mg Tablet DAK 2016 495.00
Salbutamol tablet/kapsul/kaplet 4 mg
Tablet
445 (sebagai Sulfat) DAK 2017 86.00
446 Salbutamol tablet 2 mg Tablet DAK 2015 65.00
447 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet DAK 2016 84.00
448 Salbutamol sirup Dus, botol @ 100 ml DAK 2016 5,463.00
449 Salbutamol sirup Dus, botol @ 100 ml DAK 2017 4,916.00
Salbutamol cairan ih 0,1%(Ventolin
Nebules
450 Nebules) DAK 2017 14,124.00
VENTOLIN NEBULES - Salbutamol
Nebules
451 cairan ih 0,1% DAK 2016 4,000.00
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
452 Belerang Endap 4 % DAK 2017 2,907.00
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
453 Belerang Endap 4 % DAK 2016 2,797.00
454 Salisil Bedak 2 % Kotak DAK 2016 1,066.00
455 Salisil Bedak 2 % Kotak DAK 2015 4,000.00
SCABIMITE CREAM 10 - Permetrin
Tube @ 10 g
456 krim 5% DAK 2016 12,155.00
457 Permetrin Krim 5% Tube @ 10 g DAK 2017 12,155.00
458 Sefiksim sirup kering 100 mg/ 5 ml Botol DAK 2015 9,400.00
459 Sefiksim sirup kering 100 mg/5 ml Botol DAK 2016 7,690.00
460 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2016 649.00
461 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2015 899.00
462 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2016 9,840.00
463 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2017 4,133.00
464 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml ABT 2015 5,286.00
465 Sefadroksil kapsul/kaplet 500 mg Kapsul DAK 2016 557.00
466 Sefadroksil tablet/kapsul/kaplet 500 mg Kapsul DAK 2017 455.00
467 Sefadroksil kapsul 500 mg Kapsul DAK 2015 525.00
468 Seftriaksone Injeksi 1 g Vial DAK 2016 27,500.00
469 Seftriaksone Injeksi 1 g Vial DAK 2017 11,650.00
470 Sefotaksim Injeksi 1 g Vial DAK 2016 5,884.00
471 Sianocobalamin (Vit.B12) tablet 50 mg Tablet DAK 2016 126.50
Sianokobalamin (vitamin B12)
Tablet
472 tablet/kapsul/kaplet 50 mcg DAK 2017 55.00
Sianokobalamin (vitamin B12)
Tablet
473 tablet/kapsul/kaplet 50 mcg DAK 2015 63.00
Sianokobalamin (vitamin B12)
Tablet
474 tablet/kapsul/kaplet 50 mcg ABT 2015 63.00
Sianokobalamin (vitamin B12) injeksi
Ampul 1 ml
II 500 mcg DAK 2017 1,117.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml
A mcg/ml - 1ml DAK 2016 1,226.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml
1 mcg/ml - 1ml DAK 2015 1,050.00
2 Simvastatin scored tablet 10 mg Tablet DAK 2016 135.00
3 Simvastatin tablet/kaplet/salut 10 mg Tablet salut selaput DAK 2017 113.00
4 Simvastatin 10 mg Tablet DAK 2015 320.00
5 Siprofloksasin tab scored 500 mg Tablet salut selaput DAK 2017 254.00
6 Siprofloksasin tab scored 500 mg Tablet DAK 2016 298.00
7 Spironolactone 25 mg Tablet DAK 2016 314.00
8 Spironolakton tablet/kapsul/kaplet 25 DAK 2017 277.00
Tablet
mg
9 Serum BioSAVE (ABU I) Dus, 1 Vial @ 5 ml DAK 2016 591,250.00
Serum anti bisa ular (A.B.U) I cairan inj
Dus, 1 Vial @ 5 ml
10 (i.m./i.v) DAK 2017 462,000.00
 Serum Anti Bisa Ular Polivalen injeksi 5
Dus, 1 Vial @ 5 ml
11 ml ( ABU I ) DAK 2015 472,000.00
12 Serum BioSAT-1.5 (ATS 1500 UI) Ampul 1 ml DAK 2016 158,125.00
Serum antitetanus (A.T.S) cairan inj
Ampul 1 ml
13 1500 IU/amp (i.m) DAK 2017 126,500.00
Serum Anti Tetanus injeksi 1.500
Ampul 1 ml
14 IU/ampul ( A.T.S ) DAK 2015 125,000.00
STREPTOMISIN SERBUK INJ IV 1000
Vial
15 mg/ml DAK 2016 5,750.00
16 Sukralfat susp 500 mg / 5 ml, 100 ml Botol 100 ml DAK 2016 10,100.00
17 Sukralfat susp 500 mg/5 mL, 100 ml Botol 100 ml DAK 2017 9,192.00
18 Sukralfat tablet/kapsul/kaplet 500 mg Tablet DAK 2017 296.00
19 ULSIDEX - Sukralfat tab 500 mg Tablet DAK 2016 368.00
SUPRAFENID Ketoprofen supositoria
Supp
20 100 mg DAK 2016 2,789.00
21 Teofilin tablet/kapsul/kaplet 150 mg Tablet DAK 2017 328.00
22 Teofilin tablet 150 mg(Bronsolvan) Tablet DAK 2016 310.00
23 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2016 329.00
24 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2015 325.00
25 Thiamphenicol 500 mg kaps Kapsul DAK 2016 984.51
26 Thiamphenicol 500 mg kaps Kapsul DAK 2017 865.00
27 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2016 21,950.00
28 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2017 6,500.00
Tiamin HCI ( Vit.B1 injeksi 100 mg/ml -
Ampul
29 1 ml ) DAK 2013 750.00
Tiamin HCI/Mononitrat (Vit.B1) tablet 50
Tablet
30 mg DAK 2015 37.00
Tiamin (Vitamin B1) tablet/kapsul/kaplet
Tablet
31 50 mg (HCl/ Nitrat) DAK 2017 87.00
Tiamin HCI/Mononitrat (Vit.B1) tablet
Tablet
32 100 mg DAK 2016 91.00
33 Tramadol tablet 50 mg Tablet DAK 2016 329.68
34 Tramadol tablet 50 mg Tablet DAK 2015 320.00
35 Tramadol tablet/ Kapsul 50 mg Tablet DAK 2017 325.00
36 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2016 1,984.00
37 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2017 1,720.00
38 Trifluoperazine 5mg Tablet DAK 2016 786.00
39 Triheksifenidil tablet/kapsul/kaplet 2 mg Tablet DAK 2017 80.00
40 Triheksifenidil tablet 2 mg Tablet DAK 2015 600.00
41 Triheksifenidil tablet 2 mg Tablet DAK 2016 498.30
42 Valproat sirup 250 mg/5 ml Dus, Botol @ 100 mL DAK 2017 26,987.00
43 Valsartan tab 80 mg Tablet DAK 2016 1,800.00
44 Vitamin B Kompleks tablet Tablet DAK 2016 132.00
45 Vitamin B Kompleks tablet Tablet DAK 2017 132.00
46 Vitamin B Kompleks tablet Tablet DAK 2015 112.00
47 Vitamin B Kompleks tablet Tablet ABT 2015 168.00
48 Zinc sir 20 mg/5 ml Dus, Botol @ 60 ml DAK 2017 4,959.00
49 Zinc sir 20 mg/5 Ml( Zircum Kid Sirup) Dus, Botol @ 60 ml DAK 2016 6,500.00
50 Zinc tablet dispersible20 mg Tablet DAK 2016 592.00
51 Zink Tablet DAK 2015 521.00
52 Zinc tablet dispersible 20 mg Tablet dispersible DAK 2017 586.00
53 Truvit sirup Dus, Botol @ 60 ml DAU 2016 10,890.00
II ALAT KESEHATAN
A BAHAN MEDIS HABIS PAKAI
1 Alat suntik sekali pakai 1 ml Piece DAK 2016 1,012.60
2 Alat suntik sekali pakai 1 ml Piece DAK 2017 1,012.60
3 Alat suntik sekali pakai 2,5 ml Piece DAK 2014 1,141.80
4 Alat suntik sekali pakai 3 ml Piece DAK 2016 1,006.50
5 Alat suntik sekali pakai 3 ml Piece DAK 2017 1,006.50
6 Alat suntik sekali pakai 5 ml Piece DAK 2016 1,132.16
7 Alat suntik sekali pakai 5 ml Piece DAK 2017 1,132.16
8 Alat suntik sekali pakai 10 ml Piece DAK 2017 1,588.44
9 Alat suntik sekali pakai 20 ml Piece DAK 2016 2,383.88
10 Alat suntik sekali pakai 50 ml Piece DAK 2016 4,892.20
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece
11 DAK 2017 1,240.00
24GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece
12 26 GX3/8" DAK 2017 1,650.00
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece
13 DAK 2016 1,240.00
23GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece
14 DAK 2016 1,650.00
27GX3/8"
15 Alkohol Swab 4-ply Piece DAK 2016 244.00
16 Bioplasenton Tulle 10 x 10 (CBPCD) Sachet DAK 2016 10,950.00
17 Blood Lancet (21,26,28 G) Piece DAK 2016 160.23
18 Blood Transfusion Set Piece DAK 2017 17,513.10
Benang Bedah SMI
Sachet
19 CATGUT PLAIN SMI 2/0 HR 26 MM DAK 2015 26,583.00
20 CATGUT CHROMIC SMI 2/0 HR 26 DAK 2016 33,785.00
Sachet
MM
21 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2016 35,285.00
22 CATGUT CHROMIC SMI 2/0 HR 26 DAK 2017 33,785.00
Sachet
MM
23 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2017 35,285.00
24 CATGUT CHROMIC SMI 3/0 HR 26 DAK 2017 33,785.00
Sachet
MM
25 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2017 35,285.00
Benang Bedah SMI
Sachet
26 CATGUT PLAIN SMI 3/0 HR 26 MM DAK 2015 26,583.00
27 CATGUT CHROMIC SMI 3/0 HR 26 DAK 2016 33,785.00
Sachet
MM
28 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2016 35,285.00
Catgut / Benang bedah No.3/0 dengan
Sachet
29 jarum bedah DAK 2012 27,041.67
30 Folley Catheter 2 Way no. 22 Piece DAK 2016 10,000.00
31 Foley Catheter No.16 Piece DAK 2013 9,300.00
32 Foley Catheter No.16 Piece DAK 2015 10,440.00
FOLEYCATH, 2 way latex foley cath,
Piece
33 no. 16 DAK 2016 13,420.00
FOLEYCATH, 2 way latex foley cath,
Piece
34 no. 18 DAK 2016 13,420.00
35 Foley Catheter No.18 Piece DAK 2014 9,344.50
36 Foley Catheter No.18 Piece DAK 2015 10,440.00
37 FEMALE CATHETER, no. 18 Piece DAK 2016 6,978.40
38 EXAMINATION GLOVES, size M Piece DAK 2017 563.64
39 EXAMINATION GLOVES, size S Piece DAK 2017 563.64
40 EXAMINATION GLOVES, size M Piece DAK 2016 563.64
41 CHIRURGIC GLOVES, size 7.5 Piece DAK 2016 9,272.00
Sarung Tangan Obgyn Steril ( Obgyn
pasang
B glove ) DAK 2017 24,200.00
1 Infusion set anak (Micro) Piece DAK 2014 4,400.00
 Infus Set Anak PEDIATRIC SET (60
Piece
2 drops/ml) DAK 2017 6,222.00
Infusion Set Pediatric (60 drops/ml)
Bbraun Intrafix Primeline with Piece
3 Microdropper DAK 2015 20,320.50
Infus Set Anak PEDIATRIC SET (60
Piece
4 drops/ml) DAK 2016 6,222.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
5 DAK 2016 5,856.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
6 DAK 2017 5,856.00
7 IV Catheter 16 G x 2" Piece DAK 2017 9,158.00
8 IV-CATH WP, with wings & port, no. 18 Piece DAK 2016 8,540.00
I.V Catheter (with port) VASOFIX IV
Piece
9 G18 X 45 MM Green DAK 2015 10,062.50
10 IV-Cath NP, pen type, no. 18 Piece DAK 2017 7,320.00
11 IV-CATH WP, with wings & port, no. 20 Piece DAK 2016 8,540.00
I.V Catheter (with port) VASOFIX IV
Piece
12 G20 X 33 MM Pink DAK 2015 10,062.50
I.V Catheter (with port) VASOFIX IV
Piece
13 G22 X 25 MM Blue DAK 2015 10,062.50
14 IV-CATH WP, with wings & port, no. 22 Piece DAK 2016 8,540.00
15 IV-Cath NP, pen type, no. 22 Piece DAK 2017 7,320.00
I.V Catheter (with port) VASOFIX IV
Piece
16 G24 X 0.75 " DAK 2015 10,062.50
17 IV-CATH WP, with wings & port, no. 24 Piece DAK 2016 8,540.00
18 IV-Cath NP, pen type, no. 24 Piece DAK 2017 7,320.00
19 IV-Cath NP, pen type, no. 26 Piece DAK 2017 9,394.00
20 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2017 28,745.25
21 Kapas pembalut / Absorben 250 gram Roll DAK 2015 28,452.86
22 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2016 28,750.00
23 Kasa 36 x 80 Roll DAK 2015 142,376.60
24 Kasa Hidrofil DRC 36m x 80cm Roll DAK 2016 141,400.00
25 Kasa 36 x 80 Roll DAK 2014 60,720.00
26 Kasa Steril DRC 16cm x 16cm (16 DAK 2016 8,650.50
Box
pads)
Kasa Steril DRC 16cm x 16cm (16
27 Box DAK 2017 8,650.36
pads)
28 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2016 7,375.00
29 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2017 9,000.00
30 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2017 2,475.75
31 kasa 4 x 10 cm Roll DAK 2015 2,439.24
32 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2016 2,475.43
33 Surgical Mask Tie On Piece DAK 2017 412.50
34 Masker Piece ABT 2015 574.20
35 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 2016 550.00
36 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 2017 550.00
NGT
Terumo SAFEED Feeding Tube 3.5 (35 Piece
37 cm) DAK 2015 8,841.00
NGT
Terumo SAFEED Feeding Tube 5 fr (40 Piece
38 cm) DAK 2015 8,841.00
 NGT
Terumo SAFEED Stomach Tube 14 fr Piece
39 (125 cm) DAK 2015 10,010.00
NGT
Terumo SAFEED Stomach Tube 16 fr Piece
40 (125 cm) DAK 2015 10,010.00
NGT
Terumo SAFEED Stomach Tube 18 fr Piece
41 (125 cm) DAK 2015 10,010.00
42 Oxyflow nasal oxygen bayi Piece DAK 2015 6,050.00
43 Oxyflow nasal oxygen anak Piece DAK 2015 6,050.00
44 NASAL OXYGEN, O2 cannula, size S Piece DAK 2016 8,052.00
45 NASAL OXYGEN, O2 cannula, size S Piece DAK 2017 8,052.00
46 NASAL OXYGEN, O2 cannula, size M Piece DAK 2016 8,052.00
47 NASAL OXYGEN, O2 cannula, size M Piece DAK 2017 8,052.00
48 NASAL OXYGEN, O2 cannula, size L Piece DAK 2016 8,052.00
49 NASAL OXYGEN, O2 cannula, size L Piece DAK 2017 8,052.00
Plester Leukoplast Hospital 7.50 cm x
Roll
50 4.5 m DAK 2016 35,532.00
51 Plester Polifix 10 cm x 5 m Roll DAK 2017 76,314.14
52 Pembalut Elastis 10 cm x 4,55 m Roll DAK 2017 45,507.00
53 Scalpel Blades Nomor 10 Piece DAK 2017 3,300.00
54 SILK BLACK 3/0 HR 26 MM Sachet DAK 2016 20,685.00
Benang Bedah SMI
Sachet
55 SILK BLACK 3/0 DS 24 MM DAK 2015 18,364.00
56 Onemed U Pad Steril 60 x 90 cm Blister DAK 2016 9,533.15
57 Onemed U Pad Steril 60 x 90 cm Blister DAK 2017 9,533.15
Onemed Umbilical Cord Klem Steril
Piece
58 Nylon DAK 2016 1,250.00
59 Urine Bag Piece DAK 2015 3,915.00
URINE DRAINAGE BAG, T valve, with
Piece
60 hanger DAK 2016 6,710.00
61 Alkohol 70% Botol 1 L DAK 2016 27,950.00
62 Alkohol 70% Botol 100 ml DAK 2017 8,300.00
63 My Jelly 82 gram Tube @ 82 gr DAK 2016 36,936.83
64 Lysol 1 liter Botol 1 L DAK 2016 53,300.00
65 Povidone Iodine 300 ml Botol @ 300 ml DAK 2016 23,400.00
66 Povidone Iodine 300 ml Botol @ 300 ml DAK 2017 23,400.00
67 Rivanol 300 cc Botol @ 300 ml DAK 2017 3,750.00
68 Rivanol 300 cc Botol @ 300 ml DAK 2016 3,315.00
Cairan Antiseptika pencuci alat
Botol 1 Liter
69 instrumen DAK 2017 141,406.33
Cairan Antiseptika pencuci tangan
Botol 500 ml
70 tanpa dibilas DAK 2017 83,027.33
Cairan Antispetika pencuci tangan
Botol 500 ml
71 dengan dibilas DAK 2017 64,769.00
B REAGENSIA
1 Total Cholesterol Test Strip 10's Strip DAK 2016 23,354.00
2 Uric Test Strip 25's Strip DAK 2016 5,154.00
3 Glucose Test Strip 50's Strip DAK 2016 3,093.34
4 Total Cholesterol Test Strip 10's Strip DAK 2017 23,566.00
5 Uric Test Strip 25's Strip DAK 2017 5,238.80
6 Glucose Test Strip 50's Strip DAK 2017 3,188.24
Anti-A Monoclonal Golongan Darah
Vial 10 ml
7 (Vial 10 ml) DAK 2016 80,825.00
 Anti-A,B Monoclonal Golongan Darah
Vial 10 ml
8 (Vial 10 ml) DAK 2016 105,135.00
Anti-B Monoclonal Golongan Darah
Vial 10 ml
9 (Vial 10 ml) DAK 2016 80,825.00
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml
10 10 ml) DAK 2016 126,695.00
Anti-A Monoclonal Golongan Darah
Vial 10 ml
11 (Vial 10 ml) DAK 2017 74,512.50
Anti-A,B Monoclonal Golongan Darah
Vial 10 ml
12 (Vial 10 ml) DAK 2017 98,822.50
Anti-B Monoclonal Golongan Darah
Vial 10 ml
13 (Vial 10 ml) DAK 2017 74,512.50
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml
14 10 ml) DAK 2017 120,382.50
15 Rapid test Vikia HIV 1/2 Kit DAK 2016 519,750.00
16 Anti HIV 1/2 Cassette each DAK 2017 15,297.00
17 Gluco Protein tes Piece DAK 2017 1,150.00
18 Gluco Protein Piece DAK 2016 1,150.00
19 Ultra One Test Hamil Piece DAK 2016 2,133.00
20 HCG Strip each DAK 2017 7,181.00
21 Malaria Pf & Pv Cassette each DAK 2017 53,180.00
22 Hb strip Dr Family test Tes DAK 2017 24,200.00
23 HBsAg Strip each DAK 2017 10,967.00
24 R.Detergent urit (urit 3000 plus) Gallon 5 L DAK 2017 278,300.00
25 R.Dilluen urit (urit 3000 plus) Gallon 20 L DAK 2017 1,012,000.00
26 R.Lytic urit (urit 3000 plus) Botol 1 L DAK 2017 1,113,200.00
27 Rapid tes Dengue (IgG-IgM) Device Tes DAK 2017 124,100.00
28 Hayem 1x100mL Botol 100 ml DAK 2017 29,450.00
29 Aquadest Botol 1 Liter DAK 2017 19,448.00
30 Asam Asetat 6 % Botol 100 ml DAK 2017 29,000.00
31 Asam Sulfosalisilat 20% 1x100mL Botol 100 ml DAK 2017 328,700.00
32 EDTA 10% 1x100mL Botol 100 ml DAK 2017 74,100.00
33 Eosin 2% 1x100mL Botol 100 ml DAK 2017 176,225.00
34 HCl 0,1N 1x100mL Botol 100 ml DAK 2017 19,950.00
35 Immersion Oil 1x100mL Botol 50 ml DAK 2017 367,650.00
36 KOH 10% 1x100mL Botol 100 ml DAK 2017 20,900.00
37 Methanol PA Botol 100 ml DAK 2017 94,000.00
38 Na Citrate 3,13% 1x100mL Botol 100 ml DAK 2017 19,475.00
39 Rees Ecker 1x100mL Botol 100 ml DAK 2017 46,550.00
40 Turk 1x100mL Botol 100 ml DAK 2017 23,750.00
41 Salmonella Typhi H Widal Test Vial 5 ml DAK 2017 72,972.50
42 Salmonella Typhi O Widal Test Vial 5 ml DAK 2017 72,972.50
43 Salmonella Paratyphi AH Widal Test Vial 5 ml DAK 2017 72,972.50
44 Salmonella Paratyphi AO Widal Test Vial 5 ml DAK 2017 72,972.50
45 Salmonella Paratyphi BH Widal Test Vial 5 ml DAK 2017 72,972.50
46 Salmonella Paratyphi BO Widal Test Vial 5 ml DAK 2017 72,972.50
47 Salmonella Paratyphi CH Widal Test Vial 5 ml DAK 2017 72,972.50
48 Salmonella Paratyphi CO Widal Test Vial 5 ml DAK 2017 72,972.50
C OBAT DAN BMPH LAIN-LAIN
1
2
3
4
5
6
7
8
9
10
AR PENGELUARAN OBAT DAN PERBEKKES
APBD II TAHUN 2017
PUSKESMAS ………………..

PENNGELUARAN TAHUN 2017

JAN FEB MAR APR MEI JUN
6 7 8 9 10 11

200 100 200

10 25 10 10 10

0 400 400 200 600

0 0 0 0 80 240

700 700 300 800 700

20 32 25 35 30 20

10 10 25 10 26
800 700 700 1100 900 900

5 5

400 300 800 500 800

0 300 400
 0

100

0 400 600 800 500 0

0 0 0 24 0 0

0 200 200 200 200

10 10 10 10 20 10
 300 400

300 400 100

5 10 16 33 10 10

0 400 100

0 90

0 100

1
 1

60 100

100

100 100

10
 5

200 200 100 100

48
600 300 400 500 400

400 100

10 10

600 400 300 1100 800 400

10 12 10 10

100
 100 200 200

100 100 200

48

400 300 300 500

 0 0 0 300 0 400

25 25

60

6 36 20 30

10 10 10 16 10

1300 1000 1200 1500 900 1500

100

200

400

0
300

10 10 15 10

10

100 300

200 200

90 180 150

90 30
 100

400 400 400 400 400 800

500 400 300 400 400

100 200 100

20
 2 1

25

100 100
 1

1 1

1 1 1

20 20 20 20 20
25
50 50
3 10 16
TOTAL
12
-
-
500.00
-
-
-
-
-
65.00
-
-
1,600.00
-
-
-
-
-
-
-
-
-
-
-
-
320.00
-

3,200.00

-
-
-
-

162.00
-
81.00
 -
-
-

5,100.00

10.00

-
-
-
-

-
2,800.00

-
-

-
-
700.00
-
-
 -
-
-
-

-
-
-
-
-
-

100.00
-
-
-

2,300.00

-
-
-
-
-

24.00
-

-
-

-
-
-
800.00
-
-
70.00
-
-
-
-
 -
-
700.00
-
800.00

84.00

500.00

-
-

-
90.00
-
-

-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
100.00
-
-
1.00

-
-
-
-
 -
-
-
1.00
-
-
-
-
1.00
-
-
-
-
160.00
-
-
-

5.00

100.00

-
-
-
-
-
-
-
-
-

200.00

-
-
-
-
-
-
10.00
-
 -
-
-
5.00
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
600.00
-
-
-
-
-

-
-

-
-
-
-
48.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 -

2,200.00

-
500.00
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-

20.00

-
-

3,600.00

-
-
-
-
-
-
 -
-

42.00

100.00
-

-
-
-
-

-
-

-
-
-
-
-
-

-
-
-
-

-
-
-

-
 -

-
-

-
-
-

-
-
500.00

-
-
-
-
400.00
-
-
48.00
-
-
-
1,500.00

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
 -

-
-
-

700.00

-
-
50.00
-
-
-
-
-
-

-
-
-
60.00
-
-
-
-
-

-
-
-
-

-
-
92.00
-

56.00
-
-
7,400.00
-
-
-
 -
-
-
-
100.00
-
-
-

-
-
200.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
400.00
-
-
-
-
-

-
-
-
-
-
-

-
 -
300.00
-
-

-
45.00
-

-
-
-
-
-
-
10.00
-
-
400.00
-
-
-
-
-
-

400.00

-
420.00
-
120.00
-
-
-
-
-

-
 -
-

-
-
-
-
-

-
-
-
-
-
100.00
-
5.00
-

2,800.00
-
-
-
-
-
-
-
-
-
-
-
2,000.00
-
-
-
-
-
400.00
-
-
20.00
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-

-
-
-
-
-
-
-

-
-
-

-
-
-
-

-
-
-
-
-
-
-
-

-
-
 -

-
-
-

-
-
-

-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
3.00
-
-
25.00
-
-
200.00
-
-

-
 -

-
-
-
-
-
-
-
-
-

1.00
-
-
-
-

-
-
-

-
-

-
2.00
-
-
3.00
-
-
-
-

-
-
100.00
25.00
100.00
-
-
-

-
 -

-
-
-
-
-
29.00
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 LAPORAN STOK OPNAME OBAT DAN PERBEKALAN KESEHATAN
PER 30 JUNI TAHUN 2017 SUMBER APBD II
PUSKESMAS: SEMBERANG

STOK AWAL PER 01 PENERIMAAN JAN PENGELUARAN JAN SISA STOK 3O JUNI 2017
NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN
JAN 2017 S/D JUNI 2017 S/D JUNI 2017 TOTAL HARGA
GUDANG APOTEK TOTAL
1 2 3 4 9 6 7 8 9=(6+7-8) 10 11=(9+10) 12(9X11)
I OBAT GENERIK
1 Akarbose tablet/kaplet 50 mg Tablet DAK 2016 657.00 - - - - - -
2 Alopurinol tablet 100 mg Tablet DAK 2016 95.00 500 - 500 - 130 130 12,350.00
3 Alopurinol tablet 100 mg Tablet DAK 2015 90.00 - - - - - -
4 Alopurinol tablet 100 mg Tablet DAK 2017 117.00 - - - - - -
5 Alprazolam 0,5 mg Tablet DAK 2015 185.00 170 - - 170 170 31,450.00
6 Alprazolam 0,5 mg Tablet DAK 2016 144.00 - - - - - -
7 Alprazolam 0,5 mg Tablet DAK 2014 185.00 - - - - - -
8 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2016 3,627.00 121 72 65 128 12 140 507,780.00
9 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2015 3,290.00 - - - - - -
10 Ambroxol tablet 30 mg Tablet DAK 2017 985.00 - - - - - -
11 Ambroxol tablet 30 mg Tablet DAK 2016 143.68 200 3,000 1,600 1,600 415 2,015 289,515.20
12 Ambroxol tablet 30 mg Tablet DAK 2015 125.00 - - - - - -
13 Ambroxol sirup 15 mg/ml Botol 60 ml DAK 2017 17,375.00 - - - - - -
14 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2017 3,080.00 - - - - - -
15 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2015 4,200.00 - - - - - -
16 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 10 ml DAK 2016 3,349.00 - - - - - -
Aminofilina tablet 200 mg
17 Tablet DAK 2016 124.94 - - - - - -
Aminofilina tablet 200 mg
18 Tablet salut selaput DAK 2017 97.00 - - - - - -
Aminofilina tablet 200 mg
19 Tablet DAK 2015 86.00 - - - - - -
20 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2015 123.00 - - - - - -
21 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2016 165.00 - - - - - -
22 Amitriptilin HCl tablet salut 25 mg Tablet DAK 2017 171.00 - - - - - -
23 Amlodipin 5 mg Tablet DAK 2017 91.00 - - - - - -
24 Amlodipin 5 mg Tablet DAK 2016 1,333.33 - 600 320 280 120 400 533,333.33
25 Amlodipin 5 mg Tablet DAK 2015 197.00 - - - - - -
Amoksisilin kapsul/kaplet/tablet scored
Kaptab - - - - - -
26 500 mg DAK 2017 191.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet 3,700 4,000 3,200 4,500 250 4,750 1,106,750.00
27 500 mg DAK 2016 233.00
Amoksisilin kapsul/kaplet/tablet scored
Kaplet - - - - - -
28 500 mg DAK 2015 279.00
29 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2017 1,920.00 - - - - - -
30 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2016 2,200.00 48 - - 48 6 54 118,800.00
31 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2015 2,560.00 - - - - - -
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml - - - - - -
32 ml DAK 2017 3,797.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml - - - - - -
33 ml DAK 2015 4,730.00
Amoksisilin sirup kering forte 250 mg/5
Botol 60 ml - 200 162 38 38 157,586.00
34 ml DAK 2016 4,147.00
35 Antalgin injeksi 250 mg/ml - 2 ml Ampul DAK 2013 1,500.74 - - - - - -
36 Antasida DOEN suspensi Botol 60 ml DAK 2016 2,106.00 35 50 81 4 4 8,424.00
37 Antasida DOEN suspensi Botol 60 ml ABT 2015 2,300.00 - - - - - -
38 Antasida DOEN suspensi Botol 60 ml DAK 2015 2,300.00 - - - - - -
39 Antasida DOEN suspensi Botol 60 ml DAK 2017 1,962.00 - - - - - -
Antasida DOEN tablet
kunyah,kombinasi: Tablet
40 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2015 78.00 - - - - - -
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet
41 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2017 59.00 - - - - - -
200 mg
Antasida DOEN tablet
kunyah,kombinasi: Tablet kunyah
42 Mg-Hidroksida 200 mg + Al. Hidroksida. DAK 2016 64.00 6,000 - 5,100 900 216 1,116 71,424.00
200 mg
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
43 IU/g DAK 2015 2,767.00 - - - - - -
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 Tube 5 gram
44 IU/g DAK 2017 3,365.00 - - - - - -
Anti Diare Kombinasi Kaolin 986
Botol 60 ml 20 - - 20 20 160,000.00
45 mg+Pektin 40 mg DAK 2016 8,000.00
Anti Diare Kombinasi Kaolin 986
Botol 60 ml - - - - - -
46 mg+Pektin 40 mg DAK 2017 6,190.00
Antifungi DOEN kombinasi :
Asam Benzoat 6 % + pot plastik 30 gram - - - - - -
47 DAK 2017 4,972.00
Asam Salisilat
Antifungi DOEN3 kombinasi
% :
Asam Benzoat 6 % + pot plastik 30 gram - - - - - -
48 DAK 2016 4,782.00
Asam Salisilat 3 %
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
49 150 mg + Heksaklorofen 2,5 mg DAK 2015 3,350.00 10 - 10 - - -
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
50 150 mg + Heksaklorofen 2,5 mg DAK 2016 3,502.00 - 20 - 20 20 70,040.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat supp
51 150 mg + Heksaklorofen 2,5 mg DAK 2017 3,300.00 - - - - - -
Antimigren DOEN tablet kombinasi :
Tablet - - - - - -
52 Ergotamin Tartrat 1 mg + Kofein 50 mg DAK 2017 204.00
Antimigren + Paracetamol 400 mg,
Tablet - - - - - -
53 Acetosal 250 mg, Caffeine 65 mg DAK 2016 605.00
54 Aqua pro Injeksi steril, bebas pirogen Ampul 25 ml DAK 2015 2,200.00 5 - - 5 5 11,000.00
55 Air untuk Injeksi 25 ml Ampul 25 ml DAK 2017 2,750.00 - - - - - -
OTSU SWI 25 ML - Air untuk Injeksi 25
56 ml
Ampul 25 ml DAK 2016 2,750.00 - - - - - -
ACT (Artesunate tablet 50 mg +
Tablet - - - - - -
57 Amodiaquine anhydrida tablet 200 mg) DAK 2015 1,409.00
58 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2016 120.00 1,800 2,000 2,800 1,000 230 1,230 147,600.00
Asam askorbat (vitamin C)
Tablet - - - - - -
59 tablet/kapsul/kaplet 250 mg DAK 2017 118.00
60 Asam Askorbat (Vit C) tablet 50 mg Tablet DAK 2017 120.00 - - - - - -
Asam Folat tablet/kapsul/kaplet 0,4
Tablet - - - - - -
61 mg(Afolat) DAK 2015 140.00
Asam Folat tablet/kapsul/kaplet 0,4
Tablet - - - - - -
62 mg(Afolat) DAK 2016 68.00
63 Asam Mefenamat 500 mg Kaptap Salut Selaput DAK 2017 102.00 - - - - - -
64 Asam Mefenamat 500 mg Tablet DAK 2016 113.00 2,300 1,000 700 2,600 370 2,970 335,610.00
65 Asam Traneksamat 500 mg Tablet DAK 2017 1,540.00 - - - - - -
66 Asam Traneksamat 500 mg Tablet DAK 2016 1,540.00 - - - - - -
67 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2016 2,789.00 - - - - - -
68 Asam traneksamat injeksi 100 mg/ml Ampul 5 ml DAK 2017 2,530.00 - - - - - -
69 Asetosal 100 mg Tablet DAK 2015 127.00 - - - - - -
70 Asetosal 100 mg Tablet DAK 2016 153.00 - - - - - -
Asam asetilsalisilat (asetosal)
Tablet - - - - - -
71 tablet/kapsul/kaplet 100 mg DAK 2017 154.00
72 Asiklovir krim 5 % Tube 5 gram DAK 2016 2,997.00 - 50 - 50 50 149,850.00
73 Asiklovir krim 5 % Tube 5 gram DAK 2017 9,550.00 - - - - - -
74 Asiklovir tablet 400 mg Tablet DAK 2015 354.00 100 - - 100 10 110 38,940.00
75 Asiklovir tablet 400 mg Tablet DAK 2016 368.00 - - - - - -
76 Asiklovir tablet/kapsul/kaplet 400 mg Tablet DAK 2017 415.00 - - - - - -
NEW ANTIDES - Attapulgite 600 mg
Tablet - 1,000 100 900 900 155,700.00
77 tablet DAK 2016 173.00
78 Atapulgit tablet 600 mg (Pularex) Tablet DAK 2015 220.00 50 - 50 - - -
79 Atropin inj 0,25 mg / ml Ampul 1 ml DAK 2016 1,672.00 - - - - - -
80 Azitromisin tablet 500 mg Tablet DAK 2016 1,900.00 - - - - - -
kombinasi: ferro fumarat 60 mg + as.
Folat 0,4 mg tablet salut gula (tablet Tablet Salut Gula
81 tambah darah) DAK 2017 410.00 - - - - - -
(Tablet Tambah Darah Kombinasi) :
Ferrous Fumarate 250 mg, Manganese
Sulfate 0,2 mg, Cupric Sulfate 0,2 mg, Tablet
Folic Acid 4 mg, Cyanocobalamin 7,5
82 mg DAK 2016 660.00 2,700 - 2,300 400 440 840 554,400.00
Plastik-Dus-serbuk 50
Bedak salisil serbuk 2% - - - - - -
83 gram DAK 2017 1,071.00
BEROTEC SOLUTION - Fenoterol HBr
Botol - - - - - -
84 solution 0,1% DAK 2016 125,750.00
85 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2017 151.00 - - - - - -
86 Betahistin tablet/kapsul/kaplet 6 mg Tablet DAK 2016 170.00 300 60 - 360 40 400 68,000.00
87 Bisoprolol tablet/kapsul/kaplet 5 mg Tablet salut selaput DAK 2017 298.00 - - - - - -
88 Bisoprolol tablet 5 mg Tablet DAK 2016 399.00 - - - - - -
Betametason krim0,1% (Sebagai
Tube 5 gram - 48 24 24 24 34,440.00
89 Valerat) DAK 2016 1,435.00
90 Betametason krim 0,1 o/o Tube 5 gram DAK 2015 1,558.00 - - - - - -
Betametason krim0,1% (Sebagai
Tube 5 gram - - - - - -
91 Valerat) DAK 2017 1,450.00
92 Bisakodil suppositoria 10mg Supp DAK 2017 5,800.00 - - - - - -
Bisakodil suppositoria 10 mg(Stolax
Supp - - - - - -
93 supp) DAK 2015 6,045.00
Bisakodil suppositoria 10 mg(keluar e-
Supp - - - - - -
94 catalog) DAK 2015 6,040.00
DULCOLAX SUPP ADULT 10MG
Supp - - - - - -
95 Bisakodil suppositoria 10mg DAK 2016 5,800.00
DULCOLAX SUPP INFANT - Bisakodil
Supp - - - - - -
96 suppositoria 5 mg DAK 2016 5,670.00
97 Bisakodil suppositoria 5 mg Supp DAK 2017 5,800.00 - - - - - -
98 Bisakodil tablet/kapsul/kaplet 5 mg Tablet salut enterik DAK 2017 317.00 - - - - - -
99 Cetirizine tablet 10 mg Tablet DAK 2015 190.00 800 - 800 - - -
100 Cetirizine tablet 10 mg Tablet salut selaput DAK 2017 115.00 - - - - - -
101 Cetirizine tablet 10 mg Tablet DAK 2016 154.00 - - - - - -
102 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2016 2,950.00 29 60 70 19 - 19 56,050.00
103 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2015 8,799.00 - - - - - -
104 Cetirizin sirup 5 mg/5 ml Botol 60 ml DAK 2017 3,300.00 - - - - - -
105 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,745.00 - - - - - -
106 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,822.00 - - - - - -
107 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2014 1,544.00 - - - - - -
 STOK AWAL PER 01 PENERIMAAN JAN PENGELUARAN JAN SISA STOK 3O JUNI 2017
NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN
JAN 2017 - S/D JUNI 2017 - S/D JUNI 2017 - TOTAL HARGA
108 Deksametason injeksi 5 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,544.00 - - -
109 Deksametason tablet 0,5 mg Tablet DAK 2016 120.00 - 5,000 700 4,300 490 4,790 574,800.00
110 Deksametason tablet 0,5 mg Tablet DAK 2017 149.07 - - - - - -
111 Deksametason tablet 0,5 mg Tablet DAK 2015 68.00 800 - 800 - - -
Dekstrometorfan sirup 10 mg/5
Botol 60 ml - - - - - -
112 ml(calortusin ) DAK 2014 3,609.00
Dekstrometorfan sirup 10 mg/5
Botol 60 ml 100 - 84 16 - 16 57,728.00
113 ml(calortusin ) DAK 2015 3,608.00
Dektromethorphan tablet 15mg
Tablet 500 - 500 - - -
114 ( Ramaflu ) DAK 2015 275.00
Dektromethorphan tablet 15mg
Tablet - - - - - -
115 ( Ramaflu ) DAK 2014 275.00
DEPAKENE - Valproat sirup 250 mg/5
116 ml
Botol DAK 2016 41,800.00 - - - - - -
DEPAKOTE TAB 250 MG - Valproat
Tablet - - - - - -
117 tablet salut 250 mg DAK 2016 1,750.00
118 Diazepam tablet 2 mg Tablet DAK 2015 46.00 90 - 90 - - -
119 Diazepam tablet 2 mg Tablet DAK 2014 125.40 - 100 - 100 100 12,540.00
120 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul DAK 2017 15,600.00 - - - - - -
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube - - - - - -
121 (STESOLID) DAK 2015 18,461.00
Diazepam larutan rectal 10 mg/ 2,5 ml
Tube - - - - - -
122 (STESOLID) DAK 2016 18,458.00
123 Diazepam enema 10 mg/2,5 mL Allubag DAK 2017 19,378.00 - - - - - -
Diazepam larutan rectal 5 mg/ 2,5
Tube - - - - - -
124 ml(STESOLID) DAK 2015 12,751.00
Diazepam larutan rectal 5 mg/ 2,5
Tube - - - - - -
125 ml(STESOLID) DAK 2016 12,749.00
126 Diazepam enema 5 mg/2,5 mL Allubag DAK 2017 13,384.00 - - - - - -
127 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2017 1,222.00 - - - - - -
128 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2015 1,156.00 - - - - - -
129 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2016 1,354.00 - - - - - -
130 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 1 ml DAK 2013 1,056.00 - - - - - -
131 Digoksin tablet/kapsul/kaplet 0,25 mg Tablet DAK 2017 109.00 - - - - - -
132 Digoksin tablet 0,25 mg Tablet DAK 2016 108.00 - - - - - -
133 Digoksin tablet 0,25 mg Tablet DAK 2015 103.00 - - - - - -
134 Doksisiklin tablet/kapsul/kaplet 100 mg kapsul DAK 2017 299.00 - - - - - -
135 Doksisiklin tab 100 mg Tablet DAK 2016 309.00 - - - - - -
136 Domperidon 10 mg Tablet DAK 2015 174.00 - - - - - -
137 Domperidon tablet/kapsul/kaplet 10 mg Tablet DAK 2014 110.00 - - - - - -
138 Domperidon 10 mg Tablet DAK 2016 118.00 100 200 100 200 160 360 42,480.00
139 Domperidon suspensi/sirup 5 mg/5 ml Botol 60 ml DAK 2015 3,490.00 - - - - - -
140 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2017 17,000.00 - - - - - -
141 Domperidon suspensi 5 mg/5 ml Botol 60 ml DAK 2016 3,180.00 - 50 1 49 6 55 174,900.00
DOPAMET - Metildopa tablet salut 250
Tablet - - - - - -
142 mg DAK 2016 1,001.00
DOPAMET - Metildopa tablet salut 250
Tablet - - - - - -
143 mg DAK 2017 1,050.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul - - - - - -
144 mg/ml DAK 2015 8,910.00
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
Ampul - - - - - -
145 mg/ml DAK 2016 2,354.00
146 Eritromisin kaplet 500mg Kaplet DAK 2016 766.00 - - - - - -
147 Eritromisin tablet/kapsul/kaplet 500 mg Kaptab DAK 2017 766.00 - - - - - -
148 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2017 6,461.00 - - - - - -
149 Eritromisin sirup kering 200 mg/ 5 ml Botol 60 ml DAK 2016 7,039.00 - - - - - -
150 Ethambutol 500 mg Tab Tablet DAK 2016 688.00 - - - - - -
151 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2013 2,354.22 - - - - - -
152 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2015 3,327.75 5 - 1 4 4 13,311.00
153 Etakridin ( Rivanol ) larutan 0,1 o/o Botol DAK 2014 3,450.00 - - - - - -
154 Etanol 70 % Botol DAK 2014 2,625.00 2 - - 2 2 5,250.00
155 Etil Klorida semprot Botol DAK 2017 110,000.00 - - - - - -
156 Etil Klorida semprot Botol DAK 2015 115,000.00 - - - - - -
157 Etil Klorida semprot Botol DAK 2016 115,500.00 1 1 1 1 1 115,500.00
158 Eugenol cairan Botol DAK 2014 18,333.00 1 - 1 - - -
159 FARNORMIN - Atenolol 50 mg Tablet DAK 2016 330.00 - - - - - -
160 Fenitoin Kapsul/Kaplet 100 mg Kaplet DAK 2016 154.00 - - - - - -
161 Fenitoin injeksi 50 mg/ml (100 mg/2 ml) DAK 2017 6,231.00 - - - - - -
162 Fenobarbital tablet 30 mg Tablet DAK 2015 70.10 60 100 160 - - -
163 Fenobarbital tablet 30 mg Tablet DAK 2017 132.00 - - - - - -
164 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2017 2,500.00 - - - - - -
165 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2015 1,108.79 - 24 - 24 24 26,610.96
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml - - - - - -
166 mg/ml DAK 2014 4,356.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml - - - - - -
167 mg/ml DAK 2015 3,754.00
Fitomenadion (Vitamin K1) injeksi i.m. 2
Ampul 1 ml 20 - 5 15 15 61,245.00
168 mg/ml DAK 2016 4,083.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet Salut Gula - - - - - -
169 10 mg DAK 2017 790.00
Fitomenodion (Vit.K1) tablet salut gula
Tablet 200 - 100 100 40 140 111,440.00
170 10 mg DAK 2016 796.00
FLIXOTIDE NBULES - Flutikason
Nebules 2 ml - - - - - -
171 Propionat nebules 0,5 mg DAK 2016 14,500.00
Flutikason propionat (micronized) 0,5
mg/dosis (Flutikason propionat nebules Nebules 2 ml
172 0,5 mg) DAK 2017 14,500.00 - - - - - -
173 Furosemid tablet 40 mg Tablet DAK 2015 96.00 - - - - - -
174 Furosemid tablet 40 mg Tablet DAK 2017 111.00 - - - - - -
175 Furosemid tablet 40 mg Tablet DAK 2016 181.73 - - - - - -
176 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2017 2,058.00 - - - - - -
177 Furosemid injeksi Ampul DAK 2015 2,012.00 - - - - - -
178 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul DAK 2016 - - - - - - -
179 Gabapentin 300 mg Kaplet DAK 2016 1,639.00 - - - - - -
180 Gabapentin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 1,254.00 - - - - - -
Garam oralit kombinasi : natrium klorida
0,52 g + kalium klorida 0,30 g +
Sachet 4,26 gram
trinatrium sitrat 0,58 g + glukosa
181 anhidrat 2,7 g DAK 2016 274.00 500 - 200 300 - 300 82,200.00
Garam Oralit I serbuk, kombinasi:
Natrium klorida 0,52 g + kalium klorida
Sachet
0,30 g + Trinatrium sitrat dihidrat 0,58 g
182 + Glukosa Anhidrat 2,70 g DAK 2017 273.00 - - - - - -
183 Garam Oralit serbuk,kombinasi Sachet DAK 2015 317.00 - - - - - -
184 Gemfibrozil kapsul/kaplet 300 mg Tablet DAK 2015 318.00 - - - - - -
185 Gemfibrozil tablet/kapsul/kaplet 300 mg Tablet DAK 2016 436.00 - 100 - 100 100 43,600.00
186 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2016 1,835.16 - - - - - -
187 Gentamicin 0,1 % Salep Kulit Tube 5 gram DAK 2017 7,180.00 - - - - - -
188 Gentamicin TM 0,3 % Botol 5 ml DAK 2016 4,600.00 37 - 10 27 1 28 128,800.00
189 Gentamicin TM 0,3 % Botol 5 ml DAK 2015 3,513.00 - - - - - -
190 Gentamisin tetes mata 0,3% Botol 5 ml DAK 2017 4,800.00 - - - - - -
191 Gentian violet 1 o/o Botol 10 ml DAK 2015 2,189.00 - - - - - -
192 Gentian violet 1 o/o Botol 10 ml DAK 2017 3,812.00 - - - - - -
193 Gentian violet 1 o/o Botol 10 ml DAK 2016 2,925.00 24 24 5 43 43 125,775.00
194 Glass Ionomer Cement (Fuji IX) Set DAK 2016 919,300.00 - - - - - -
195 Glass Ionomer Cement (Fuji VII) Set DAK 2016 1,225,700.00 - - - - - -
196 Glass Ionomer Cement (Fuji VII) Set DAK 2017 617,798.00 - - - - - -
197 Glass Ionomer Cement (GC IX) Set DAK 2015 434,460.00 - - - - - -
198 Glibenklamid tablet 5 mg Tablet DAK 2016 108.00 - 300 - 300 300 32,400.00
199 Glibenklamid tablet 5 mg Tablet DAK 2017 90.00 - - - - - -
200 Glibenklamid tablet 5 mg Tablet DAK 2015 61.00 - - - - - -
Glibenklamid tablet 5 mg (keluar e-
Tablet - - - - - -
201 catalog) DAK 2015 60.00
202 GLICAB - Gliklazid tab 80 mg Tablet DAK 2016 245.00 - 100 - 100 100 24,500.00
203 Gliklazid tablet/kapsul/kaplet 80 mg Tablet DAK 2017 218.00 - - - - - -
204 Glimepiride tablet/kapsul/kaplet 2 mg Tablet DAK 2017 231.00 - - - - - -
205 Glimepiride tablet 2 mg Tablet DAK 2016 296.00 - 100 - 100 100 29,600.00
206 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2016 36.52 1,000 - - 1,000 1,000 36,520.00
207 Gliseril Guaiakolat tablet 100 mg Tablet DAK 2017 108.00 - - - - - -
208 Glukosa larutan infus 10% Botol plastik 500 ml DAK 2016 7,500.00 - - - - - -
209 Glukosa larutan infus 5 % steril Botol plastik 500 ml DAK 2016 6,900.00 - - - - - -
210 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2017 6,900.00 - - - - - -
211 Glukosa larutan infus 5 o/o Botol plastik 500 ml DAK 2015 5,720.00 - - - - - -
212 Griseofulvin tablet 125 mg, micronized Tablet DAK 2016 264.00 400 300 600 100 100 26,400.00
213 Griseofulvin tablet 125 mg, micronized Tablet DAK 2015 224.00 - - - - - -
214 Griseofulvin tablet 125 mg, micronized Tablet DAK 2017 266.00 - - - - - -
215 Haloperidol 1.5 mg Tablet DAK 2015 76.00 - - - - - -
216 Haloperidol 1.5 mg Tablet DAK 2014 76.00 - - - - - -
217 Haloperidol 1.5 mg Tablet DAK 2016 74.00 - - - - - -
HALDOL DECANOAS - Haloperidol inj
Ampul 1 ml - - - - - -
218 50 mg/ml DAK 2016 97,500.00
219 Haloperidol inj 50 mg/mL Ampul 1 ml DAK 2017 97,500.00 - - - - - -
LODOMER DROPS - Haloperidol tts 2
Botol 15 ml - - - - - -
220 mg/mL DAK 2016 18,499.00
221 Haloperidol tts 2 mg/mL Botol 15 ml DAK 2017 18,100.00 - - - - - -
Dus, 1 syringe @ 0,5
222 Hepatitis B imunoglobullin
ml
DAK 2017 1,300,000.00 - - - - - -
223 Hidroklorotiazid tab 25 mg Tablet DAK 2017 171.00 - - - - - -
224 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2016 2,712.00 48 - 48 - 8 8 21,696.00
225 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2017 2,838.00 - - - - - -
226 Hidrokortison krim 2,5 o/o Tube 5 gram DAK 2015 2,868.00 - - - - - -
227 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2017 1,760.00 - - - - - -
228 Hyosine N-Butilbromide tab 10 mg Tablet DAK 2016 2,745.00 - - - - - -
229 Ibuprofen tablet 200 mg Tablet DAK 2017 108.00 - - - - - -
230 Ibuprofen tablet/kapsul/kaplet 200 mg Tablet DAK 2016 111.00 - - - - - -
231 Ibuprofen tablet 400 mg Tablet DAK 2016 133.00 400 500 - 900 100 1,000 133,000.00
232 Ibuprofen tablet 400 mg Tablet DAK 2017 113.00 - - - - - -
 STOK AWAL PER 01 PENERIMAAN JAN PENGELUARAN JAN SISA STOK 3O JUNI 2017
NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN
JAN 2017 - S/D JUNI 2017 - S/D JUNI 2017 - TOTAL HARGA
233 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2017 2,560.00 - - -
234 Ibuprofen Suspensi 100 mg/5 ml Botol 60 ml DAK 2016 2,560.00 50 - - 50 50 128,000.00
235 Isoniazid tablet/kapsul/kaplet 100 mg Tablet DAK 2017 85.00 - - - - - -
236 Isoniazid tablet/kapsul/kaplet 300 mg Tablet DAK 2017 182.00 - - - - - -
237 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2015 98.00 - - - - - -
238 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2016 93.00 - - - - - -
239 Isosorbit Dinitrat tablet sublingual 5 mg Tablet DAK 2017 95.00 - - - - - -
240 KALIPAR - Kalium aspartat tab 300 mg Tablet DAK 2016 690.00 - - - - - -
Kalium aspartat tablet/kapsul/kaplet 300
Kaptab salut selaput - - - - - -
241 mg DAK 2017 682.00
Kalsium Laktat (Kalk)
Tablet 4,800 1,000 2,200 3,600 170 3,770 260,130.00
242 tablet/kapsul/kaplet 500 mg DAK 2016 69.00
Kalsium Laktat (Kalk)
Tablet - - - - - -
243 tablet/kapsul/kaplet 500 mg DAK 2017 57.00
Kalsium Laktat (Kalk)
Tablet - - - - - -
244 tablet/kapsul/kaplet 500 mg DAK 2015 76.00
245 Kaptopril 25 mg Tablet DAK 2016 72.00 3,200 1,000 500 3,700 100 3,800 273,600.00
246 Kaptopril tablet/kaplet scored 25 mg Tablet DAK 2017 86.00 - - - - - -
247 Kaptopril 25 mg Tablet DAK 2015 97.00 - - - - - -
248 Kandesartan tab 8 mg Tablet DAK 2016 4,015.00 - - - - - -
249 Kandesartan tablet/kapsul/kaplet 8 mg Tablet DAK 2017 770.00 - - - - - -
Karbamazepin tablet/kapsul/kaplet 200
Tablet - - - - - -
250 mg DAK 2016 306.00
251 Karbamazepin tablet 200 mg Tablet DAK 2015 269.00 - - - - - -
252 Ketoprofen supositoria 100 mg Supp DAK 2017 2,640.00 - - - - - -
253 Ketokonazol krim 2% Tube 10 gram DAK 2016 2,605.00 - - - - - -
254 Ketokonazol krim 2% Tube 10 gram DAK 2017 2,790.00 - - - - - -
255 Ketokonazol tablet 200 mg Tablet DAK 2016 292.00 - - - - - -
Ketokonazol tablet/kapsul/kaplet 200
256
mg
Tablet DAK 2017 297.00 - - - - - -
257 Ketokonazol tablet 200 mg Tablet DAK 2015 320.00 - - - - - -
258 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2017 1,320.00 - - - - - -
259 Ketorolac injeksi 30 mg Ampul 1 ml DAK 2014 2,665.00 - - - - - -
260 Ketorolak inj 30 mg/ml Ampul 1 ml DAK 2016 1,383.00 - - - - - -
261 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2016 660.00 - - - - - -
262 Klindamisin tablet/kapsul/kaplet 300 mg kapsul DAK 2017 589.00 - - - - - -
263 Klopidogrel tablet 75 mg Tablet DAK 2016 2,100.00 - - - - - -
264 Klopidogrel tablet/kapsul/kaplet 75 mg Tablet salut selaput DAK 2017 1,799.00 - - - - - -
CHLORAMEX - Kloramfenikol kapsul
Kapsul - - - - - -
265 500 mg DAK 2016 1,155.00
Kloramfenikol tablet/kapsul/kaplet 250
Kapsul - - - - - -
266 mg DAK 2017 502.29
267 Kloramfenikol kapsul 250 mg Kapsul DAK 2010 198.92 - - - - - -
268 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2017 1,850.00 - - - - - -
269 Kloramfenikol salep mata 1 % Tube 5 gram DAK 2016 1,850.00 - - - - - -
270 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2017 4,982.00 - - - - - -
271 Kloramfenikol suspensi 125 mg/ml Botol 60 ml DAK 2016 4,000.00 - - - - - -
272 Kloramfenikol tetes mata 0,5 % Botol plastik 10 ml DAK 2017 3,850.00 - - - - - -
Kloramfenikol tetes mata 0,5 % (Reco
Botol plastik 10 ml - - - - - -
273 TM) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml 25 - 20 5 9 14 99,750.00
274 TT) DAK 2016 7,125.00
Kloramfenikol tetes telinga 3 % (Reco
Botol plastik 10 ml - - - - - -
275 TT) DAK 2017 7,370.00
276 Kloramfenikol tetes telinga 3 % Botol plastik 10 ml DAK 2015 5,060.00 - - - - - -
Klorfeniramina Maleat (CTM)
Tablet 1,400 5,000 3,600 2,800 380 3,180 143,100.00
277 tablet/kapsul/kaplet 4 mg DAK 2016 45.00
Klorfeniramina Maleat (CTM)
Tablet - - - - - -
278 tablet/kapsul/kaplet 4 mg DAK 2015 53.00
Klorfeniramina Maleat (CTM) tablet 4
279
mg
Tablet DAK 2014 100.10 - - - - - -
Klorpromazin injeksi i.m. 25 mg/ml
280 (HCl) Ampul 1 ml DAK 2016 1,425.00 - - - - - -
Klorpromazin injeksi i.m. 25 mg/ml
281 (HCl) Ampul 1 ml DAK 2017 1,349.00 - - - - - -
282 Klorpromazin tablet salut 25 mg (HCl) Tablet DAK 2016 170.00 - - - - - -
283 Klorpromazin tablet salut 100 mg (HCl) Tablet DAK 2015 153.00 - - - - - -
284 Klozapin 25 mg Tablet DAK 2016 1,550.00 470 - - 470 470 728,500.00
285 Kodein tablet/kapsul/kaplet 10 mg Tablet DAK 2017 632.00 - - - - - -
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
286 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2016 2,225.00 100 - 42 58 8 66 146,850.00
kotrimoksazol (anak) kombinasi tiap 5
ml suspensi: sulfametoksazol 200 mg + Botol 60 ml
287 trimetoprim 40 mg DAK 2017 2,462.00 - - - - - -
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
288 200 mg + Trimetoprim 40 mg/ 5 Ml DAK 2015 2,298.00 - - - - - -
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol Botol 60 ml
289 200 mg + Trimetoprim 40 mg/ 5 Ml ABT 2015 2,298.00 - - - - - -
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg + trimetoprim Kaptab
290 160 mg DAK 2017 327.00 - - - - - -
kotrimoksazol forte
kombinasi:sulfametoksazol 800 mg + Tablet
291 trimetoprim 160 mg DAK 2015 420.00 - - - - - -
Kotrimoksazol forte kombinasi:
sulfametoksazol 800 mg trimetoprim Tablet
292 160 mg DAK 2016 344.00 500 - 100 400 120 520 178,880.00
293 Laktulosa sir 3,335 g/5 mL Botol DAK 2016 14,500.00 - - - - - -
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml - - - - - -
294 3A injection) DAK 2017 10,285.00
Larutan mengandung Elektrolit (KA-EN
Plabott, 500 ml - - - - - -
295 3B injection) DAK 2017 10,285.00
296 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2015 40,000.00 - - - - - -
297 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe DAK 2016 40,000.00 - - - - - -
298 Lidokain jelli 2% syringe 10 gram DAK 2017 40,000.00 - - - - - -
Lidokain Komp.injeksi, Kombinasi :
Lidokain HCL 12 % Ampul 2 ml
299 + Epinefrin 1 : 80.000 - 2 ml DAK 2015 1,499.00 30 - - 30 30 44,970.00
300 Lidokain injeksi 2% (HCL) Ampul DAK 2016 875.00 - - - - - -
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml - - - - - -
301 80.000 - 2 mL DAK 2016 2,122.00
Lidokain injeksi 2% (HCl) + Epinefrin 1:
Ampul 2 ml - - - - - -
302 80.000 - 2 mL DAK 2017 2,227.00
303 Lisinopril tablet/kapsul/kaplet 5 mg Tablet DAK 2016 410.00 - - - - - -
304 Loperamid Tablet DAK 2017 85.00 - - - - - -
305 Loperamid tablet 2 mg Tablet DAK 2016 90.00 - - - - - -
306 Loratadin tablet/kapsul/kaplet 10 mg Tablet DAK 2016 149.00 500 - - 500 500 74,500.00
307 Loratadin tablet/kapsul/kaplet 10 mg Kaptab DAK 2017 134.00 - - - - - -
OTSU-MGSO4 40 - Magnesium sulfat
Ampul 25 ml - - - - - -
308 injeksi 40% DAK 2016 3,650.00
309 Magnesium sulfat injeksi 40% Ampul 25 ml DAK 2017 3,650.00 - - - - - -
310 Metamizol injeksi 500 mg/ml Ampul 2 ml DAK 2017 3,050.00 - - - - - -
311 Metil prednisolon tab 4 mg Tablet DAK 2016 209.00 - - - - - -
Metilprednisolon tablet/kapsul/kaplet 4
Tablet - - - - - -
312 mg DAK 2017 165.00
313 Metilprednisolon inj 125 mg/2 mL Dus DAK 2015 22,000.00 - - - - - -
314 Metilprednisolon inj 125 mg/2 mL Dus DAK 2016 14,750.00 - - - - - -
Metilergametrin (Maleat) tablet salut
Tablet - - - - - -
315 0,125 mg DAK 2016 222.20
Metilergametrin (Maleat) tablet salut
Tablet Salut - - - - - -
316 0,125 mg DAK 2017 270.60
Metilergametrin Maleat inj 0,200 mg - 1
Ampul - - - - - -
317 ml DAK 2015 2,750.00
Metilergametrin Maleat inj 0,200 mg - 1
318 ml Ampul DAK 2014 4,917.00 - - - - - -
Metilergametrin Maleat inj 0,200 mg - 1
319 ml Ampul DAK 2016 2,684.00 90 - - 90 90 241,560.00
320 Metoclopramide tablet 10 mg Tablet DAK 2016 100.00 - - - - - -
Metoklopramide tablet/kapsul/kaplet 10
321 mg Tablet DAK 2017 93.00 - - - - - -
322 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2017 3,904.00 - - - - - -
323 Metoclopramide injeksi 5 mg/ml Ampul 2 ml DAK 2016 4,395.00 - - - - - -
LEXAPRAM SIRUP - Metoklopramide
324 sirup 5 mg/ 5 ml Botol 60 ml DAK 2016 2,750.00 - - - - - -
325 Metoklopramide sirup 5 mg/ 5 ml Botol 60 ml DAK 2017 2,950.00 - - - - - -
326 Metformin 400 mg Tablet DAK 2016 108.00 500 - 500 - - -
Metformin HCl tablet/kapsul/kaplet 500
Kaptap ss - - - - - -
327 mg DAK 2017 103.00
328 Metronidazol infus 5 mg/ ml Botol @100 mL DAK 2017 9,680.00 - - - - - -
329 Metronidazole infus Botol @100 mL DAK 2010 21,759.00 - - - - - -
Metronidazol tablet/kapsul/kaplet 500
330
mg
Tablet DAK 2017 115.00 - - - - - -
331 Metronidazol tablet 500 mg Tablet DAK 2016 750.00 - 500 400 100 80 180 135,000.00
332 Metronidazole sirup 125mg/ 5ml Botol 60 ml DAK 2016 3,800.00 - - - - - -
333 Metronidazol sirup 125 mg/5 ml Botol 60 ml DAK 2017 3,800.00 - - - - - -
334 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2016 3,737.00 - 72 48 24 24 89,688.00
335 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2017 5,500.00 - - - - - -
336 Miconazole krim 2% (Nitrat) Tube 10 gram DAK 2015 3,075.00 - - - - - -
337 Natrium Bikarbonat tablet 500 mg Tablet DAK 2016 22.00 100 - - 100 100 2,200.00
338 Natrim Diklofenak 50 mg tab Tablet DAK 2016 161.00 1,100 2,000 1,500 1,600 200 1,800 289,800.00
Natrium diklofenak tablet/kapsul/kaplet
Tablet salut enterik - - - - - -
339 50 mg DAK 2017 135.00
340 Natrim Diklofenak 50 mg tab Tablet DAK 2015 193.00 - - - - - -
Natrium Klorida larutan infus 0,9 %
341
Steril
Botol plastik 500 ml DAK 2017 6,410.00 - - - - - -
Natrium Klorida larutan infus 0,9 %
342
Steril
Botol plastik 500 ml DAK 2015 5,170.00 - - - - - -
Natrium Klorida larutan infus 0,9 %
343
Steril
Botol plastik 500 ml DAK 2016 6,410.00 10 - - 10 10 64,100.00
344 Nifedipin tablet/kapsul/kaplet 10 mg Tablet salut selaput DAK 2017 110.00 - - - - - -
345 Nifedipin tablet 10 mg Tablet DAK 2015 110.00 - - - - - -
346 Nifedipin tablet 10 mg Tablet DAK 2016 123.00 - 100 - 100 100 12,300.00
347 Nistatin vaginal tablet 100.000 IU/ g Tablet Vaginal DAK 2017 627.00 - - - - - -
348 Nistatin vaginal tablet 100.000 IU/ g Supp DAK 2016 602.00 - - - - - -
349 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet Salut Gula DAK 2017 881.00 - - - - - -
 STOK AWAL PER 01 PENERIMAAN JAN PENGELUARAN JAN SISA STOK 3O JUNI 2017
NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN
JAN 2017 - S/D JUNI 2017 - S/D JUNI 2017 - TOTAL HARGA
350 Nistatin tablet salut 500.000 UI/g Tablet DAK 2015 704.00 - - -
351 Nistatin tablet/kaplet salut 500.000 IU/ g Tablet DAK 2016 857.00 - - - - - -
352 Nystatin drop Botol 12 ml DAK 2016 38,425.00 - - - - - -
353 Nystatin drop Botol 12 ml DAK 2017 24,198.00 - - - - - -
354 Obat Anti Tuberculosis FDC Kategori I Paket DAK 2017 430,538.00 - - - - - -
355 OAT FDC Kategori 1 Dewasa Paket DAK 2013 395,900.00 - - - - - -
356 OAT FDC Kategori 2 Dewasa Paket DAK 2016 1,379,984.00 - - - - - -
357 Obat Anti Tuberculosis FDC Kategori II Paket DAK 2017 1,435,178.00 - - - - - -
Obat Antituberkulosis Kategori 1
358
dewasa
Paket DAK 2014 317,015.00 - - - - - -
Obat Anti Tuberculosis FDC Kategori
Paket - - - - - -
359 Sisipan DAK 2016 183,984.00
"Dus, 12 blister @ 28
Obat Anti Tuberculosis FDC Kategori tablet dispersibel Dus, 6
Anak blister @ 28 tablet
360 dispersibel" DAK 2017 257,125.00 - - - - - -
Obat Anti Tuberculosis FDC Kategori
Paket - - - - - -
361 Anak DAK 2016 247,234.00
362 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2016 7,149.00 - - - - - -
363 Obat Batuk Hitam ( O.B.H ) sirup Botol 100 ml DAK 2017 6,000.00 - - - - - -
Obat batuk Antitusif sirup Kombinasi
Botol 60 ml - - - - - -
364 Dextromethorphan HBr DAK 2016 9,875.00
Obat batuk Antitusif tablet Kombinasi
Tablet - 1,000 700 300 120 420 230,160.00
365 Dextromethorphan HBr DAK 2016 548.00
Obat batuk sirup Kombinasi
Botol 60 ml - - - - - -
366 Dextromethorphan HBr DAK 2017 11,800.00
Obat batuk tablet Kombinasi
Tablet - - - - - -
367 Dextromethorphan HBr DAK 2017 704.00
368 Ofloksasin tab 400 mg Tablet DAK 2010 960.00 - - - - - -
369 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2016 1,649.36 50 50 50 50 12 62 102,260.32
370 Oksitetrasiklin HCI salep kulit 3 % Tube 5 gram DAK 2017 1,640.00 - - - - - -
371 Oksitetrasiklin HCI salep mata 1 % Tube 3,5 gram DAK 2017 2,772.00 - - - - - -
372 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2015 2,772.00 - - - - - -
373 Oksitetrasiklin HCI salep mata 1 % Tube DAK 2016 2,772.00 - - - - - -
374 Oksitosin injeksi 10 IU/ml(Tiacinon) Ampul DAK 2015 1,900.00 - - - - - -
375 Oksitosin injeksi 10 IU / ml - ml Ampul DAK 2014 5,890.50 - - - - - -
OXYTOCIN INJLQ 10 IU Oksitosin inj
Ampul - - - - - -
376 10 UI/ml DAK 2016 1,900.00
377 Omeprazole Injeksi 40mg / 10ml Vial DAK 2016 18,537.00 - - - - - -
378 Omeprazol injeksi 40 mg/ 10 ml Vial DAK 2017 14,924.00 - - - - - -
379 Omeprazole kapsul Kapsul DAK 2016 164.00 - 300 60 240 120 360 59,040.00
380 Omeprazole kapsul Kapsul DAK 2015 221.00 - - - - - -
381 Omeprazol tablet/kapsul/kaplet 20 mg Kapsul DAK 2017 148.00 - - - - - -
382 Ondansetron tablet/kapsul/kaplet 4 mg Tablet DAK 2016 542.00 - - - - - -
383 Ondansetron tablet/kapsul/kaplet 4 mg Tablet salut selaput DAK 2017 523.00 - - - - - -
384 Ondansetron inj 2 mg/ml (4 mg/ 2 mL) Ampul 2 ml DAK 2017 1,254.00 - - - - - -
Ondansetron Injeksi 2 mg/ ml (4 mg/ 2
Ampul 2 ml - - - - - -
385 ml) DAK 2016 1,650.00
386 Ondansetron inj 4 mg/ 2 mL Ampul 2 ml DAK 2015 2,400.00 - - - - - -
387 PANTOCAIN 0.5% Botol DAK 2016 11,500.00 - - - - - -
388 Parasetamol infus Dus, Botol @ 1000 mg DAK 2016 27,225.00 - - - - - -
Parasetamol drips (infus) 1000 mg/100
Dus, Botol @ 1000 mg - - - - - -
389 mL DAK 2017 12,939.00
390 Parasetamol sirup 120 mg / 5 ml Botol Plastik @ 60 Ml DAK 2017 1,013.00 - - - - - -
391 Parasetamol sirup 120 mg/ 5ml Botol Plastik @ 60 Ml DAK 2016 1,119.00 54 100 92 62 8 70 78,330.00
392 Parasetamol drop Botol Plastik @ 60 Ml DAK 2015 5,720.00 - - - - - -
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml - - - - - -
393 (60mg/0,6ml) (G) DAK 2017 6,850.00
Parasetamol drop 100 mg/ml btl @15ml
Botol 15 ml 56 56 56 56 8 64 382,720.00
394 (60mg/0,6ml) (G) DAK 2016 5,980.00
395 Parasetamol tablet 100 mg Tablet DAK 2016 106.59 - - - - - -
396 Parasetamol tablet 100 mg Tablet DAK 2013 34.51 - - - - - -
397 Parasetamol tablet 500 mg Tablet DAK 2016 174.00 5,600 5,000 7,400 3,200 460 3,660 636,840.00
Parasetamol tablet/kapsul/kaplet 500
398
mg
Tablet DAK 2017 51.00 - - - - - -
399 Parasetamol tablet 500 mg Tablet DAK 2015 88.00 - - - - - -
400 Perak sulfadiazin krim 1% tube 35 g DAK 2017 20,700.00 - - - - - -
Petidin injeksi i.m/s.k/i.v lambat 50
Ampul - - - - - -
401 mg/ml (HCl) DAK 2015 15,950.00
402 Piracetam 400 mg Tablet DAK 2016 541.24 - - - - - -
403 Piracetam Inj 1 g/5 ml Ampul DAK 2016 15,840.00 - - - - - -
404 Piracetam Inj 1 g/5 ml Ampul DAK 2017 6,600.00 - - - - - -
405 Pirantel tablet 125 mg Tablet DAK 2014 318.00 100 - 100 - - -
406 Pirantel tablet score (base) 125 mg Tablet DAK 2016 318.00 - - - - - -
407 Pirazinamid 500 mg Tablet DAK 2017 238.00 - - - - - -
408 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2015 148.00 - - - - - -
Piridoksin (Vitamin B6) tab/kap/kapl 10
Tablet - - - - - -
409 mg (HCl) DAK 2017 136.00
410 Piridoksin HCI (Vit. B6 ) tablet 10 mg Tablet DAK 2016 136.00 - - - - - -
411 Piroksikam 20 mg Tablet DAK 2016 213.95 400 1,000 200 1,200 120 1,320 282,414.00
412 Piroksikam 20 mg Tablet DAK 2017 130.00 - - - - - -
413 Piroksikam 20 mg Tablet DAK 2015 105.00 1,000 - - 1,000 1,000 105,000.00
414 Povidon lodida larutan 10 % Botol 300 ml DAK 2013 14,350.00 - - - - - -
415 Povidon lodida larutan 10 % Botol 300 ml DAK 2015 15,386.00 4 - - 4 4 61,544.00
416 Povidon lodida larutan 10 % Botol 300 ml DAK 2014 15,386.00 - - - - - -
417 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2016 102.00 - - - - - -
418 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2017 85.00 - - - - - -
419 Prednison tablet/kapsul/kaplet 5 mg Tablet DAK 2015 125.00 - - - - - -
420 Prednison tablet/kapsul/kaplet 5 mg Tablet ABT 2015 125.00 - - - - - -
421 Primakuin tablet 15 mg Tablet DAK 2015 205.00 - - - - - -
422 Propranolol HCI tablet 10 mg Tablet DAK 2016 69.00 - - - - - -
423 Propranolol tablet/kapsul/kaplet 10 mg Tablet DAK 2017 59.00 - - - - - -
424 Propranolol HCI tablet 10 mg Tablet DAK 2015 80.00 - - - - - -
425 Proiltiourasil tablet 100 mg Tablet DAK 2014 299.27 - - - - - -
426 Proiltiourasil tablet 100 mg Tablet DAK 2015 351.00 - - - - - -
Propiltiourasil tablet/kapsul/kaplet 100
Tablet - - - - - -
427 mg DAK 2016 320.00
428 Vaksin rabies Vial DAK 2017 174,500.00 - - - - - -
429 Ranitidin tablet 150 mg Tablet DAK 2015 128.00 1,000 - 400 600 200 800 102,400.00
430 Ranitidin tablet/kapsul/kaplet 150 mg Tablet salut selaput DAK 2017 110.00 - - - - - -
431 Ranitidin tablet 150 mg Tablet DAK 2016 119.00 - 2,000 - 2,000 2,000 238,000.00
432 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2016 1,595.18 - - - - - -
433 Ranitidin injeksi 25 mg/ml Ampul 2 ml DAK 2017 1,677.00 - - - - - -
434 Ranitidin Injeksi 25 mg/ml Ampul 2 ml DAK 2015 3,960.00 - - - - - -
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul - 50 - 50 50 16,350.00
435 lunak DAK 2016 327.00
Retinol ( Vitamin A ) 100.000 IU kapsul
Kapsul - - - - - -
436 lunak DAK 2015 286.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul lunak - - - - - -
437 lunak DAK 2017 585.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul - - - - - -
438 lunak ABT 2015 505.00
Retinol ( Vitamin A ) 200.000 IU kapsul
Kapsul - 450 - 450 450 241,200.00
439 lunak DAK 2016 536.00
440 Rifampisin tablet/kapsul/kaplet 600 mg Kaptap ss DAK 2017 1,274.00 - - - - - -
441 Ringer laktat larutan infus Botol plastik 500 ml DAK 2015 5,720.00 5 - - 5 5 28,600.00
442 Ringer laktat larutan infus Botol plastik 500 ml DAK 2017 7,150.00 - - - - - -
443 Ringer Laktat Botol DAK 2016 7,150.00 - 20 - 20 20 143,000.00
444 Risperidon 2 mg Tablet DAK 2016 495.00 - - - - - -
Salbutamol tablet/kapsul/kaplet 4 mg
Tablet - - - - - -
445 (sebagai Sulfat) DAK 2017 86.00
446 Salbutamol tablet 2 mg Tablet DAK 2015 65.00 - - - - - -
447 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet DAK 2016 84.00 900 - 300 600 140 740 62,160.00
448 Salbutamol sirup Dus, botol @ 100 ml DAK 2016 5,463.00 - - - - - -
449 Salbutamol sirup Dus, botol @ 100 ml DAK 2017 4,916.00 - - - - - -
Salbutamol cairan ih 0,1%(Ventolin
Nebules - - - - - -
450 Nebules) DAK 2017 14,124.00
VENTOLIN NEBULES - Salbutamol
Nebules - - - - - -
451 cairan ih 0,1% DAK 2016 4,000.00
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
452 Belerang Endap 4 % DAK 2017 2,907.00 - - - - - -
Salep 2 - 4, Kombinasi :
Asam Salisilat 2 % + Pot 30 gram
453 Belerang Endap 4 % DAK 2016 2,797.00 - - - - - -
454 Salisil Bedak 2 % Kotak DAK 2016 1,066.00 53 - 45 8 3 11 11,726.00
455 Salisil Bedak 2 % Kotak DAK 2015 4,000.00 - - - - - -
SCABIMITE CREAM 10 - Permetrin
Tube @ 10 g 10 - - 10 10 121,550.00
456 krim 5% DAK 2016 12,155.00
457 Permetrin Krim 5% Tube @ 10 g DAK 2017 12,155.00 - - - - - -
458 Sefiksim sirup kering 100 mg/ 5 ml Botol DAK 2015 9,400.00 - - - - - -
459 Sefiksim sirup kering 100 mg/5 ml Botol DAK 2016 7,690.00 - - - - - -
460 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2016 649.00 - - - - - -
461 Sefiksim kapsul/kaplet 100 mg Kapsul DAK 2015 899.00 - - - - - -
462 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2016 9,840.00 - 60 10 50 9 59 580,560.00
463 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml DAK 2017 4,133.00 - - - - - -
464 Sefadroksil sirup kering 125 mg/5ml Dus, botol @ 60 ml ABT 2015 5,286.00 - - - - - -
465 Sefadroksil kapsul/kaplet 500 mg Kapsul DAK 2016 557.00 200 1,000 400 800 120 920 512,440.00
466 Sefadroksil tablet/kapsul/kaplet 500 mg Kapsul DAK 2017 455.00 - - - - - -
467 Sefadroksil kapsul 500 mg Kapsul DAK 2015 525.00 - - - - - -
468 Seftriaksone Injeksi 1 g Vial DAK 2016 27,500.00 - - - - - -
469 Seftriaksone Injeksi 1 g Vial DAK 2017 11,650.00 - - - - - -
470 Sefotaksim Injeksi 1 g Vial DAK 2016 5,884.00 - - - - - -
471 Sianocobalamin (Vit.B12) tablet 50 mg Tablet DAK 2016 126.50 - 1,000 - 1,000 1,000 126,500.00
Sianokobalamin (vitamin B12)
Tablet - - - - - -
472 tablet/kapsul/kaplet 50 mcg DAK 2017 55.00
Sianokobalamin (vitamin B12)
Tablet - - - - - -
473 tablet/kapsul/kaplet 50 mcg DAK 2015 63.00
 STOK AWAL PER 01 PENERIMAAN JAN PENGELUARAN JAN SISA STOK 3O JUNI 2017
NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN
JAN 2017 S/D JUNI 2017 S/D JUNI 2017 TOTAL HARGA
Sianokobalamin (vitamin B12)
Tablet 500 - 400 100 80 180 11,340.00
474 tablet/kapsul/kaplet 50 mcg ABT 2015 63.00
Sianokobalamin (vitamin B12) injeksi
Ampul 1 ml - - - - - -
475 500 mcg DAK 2017 1,117.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml - - - - - -
476 mcg/ml - 1ml DAK 2016 1,226.00
Sianokobalamin (Vit.B12) injeksi 500
Ampul 1 ml - - - - - -
477 mcg/ml - 1ml DAK 2015 1,050.00
478 Simvastatin scored tablet 10 mg Tablet DAK 2016 135.00 - 1,050 420 630 80 710 95,850.00
479 Simvastatin tablet/kaplet/salut 10 mg Tablet salut selaput DAK 2017 113.00 - - - - - -
480 Simvastatin 10 mg Tablet DAK 2015 320.00 120 - 120 - - -
481 Siprofloksasin tab scored 500 mg Tablet salut selaput DAK 2017 254.00 - - - - - -
482 Siprofloksasin tab scored 500 mg Tablet DAK 2016 298.00 400 - - 400 60 460 137,080.00
483 Spironolactone 25 mg Tablet DAK 2016 314.00 - - - - - -
Spironolakton tablet/kapsul/kaplet 25
484 mg
Tablet DAK 2017 277.00 - - - - - -
485 Serum BioSAVE (ABU I) Dus, 1 Vial @ 5 ml DAK 2016 591,250.00 - - - - - -
Serum anti bisa ular (A.B.U) I cairan inj
Dus, 1 Vial @ 5 ml - - - - - -
486 (i.m./i.v) DAK 2017 462,000.00
Serum Anti Bisa Ular Polivalen injeksi 5
Dus, 1 Vial @ 5 ml - - - - - -
487 ml ( ABU I ) DAK 2015 472,000.00
488 Serum BioSAT-1.5 (ATS 1500 UI) Ampul 1 ml DAK 2016 158,125.00 - - - - - -
Serum antitetanus (A.T.S) cairan inj
Ampul 1 ml - - - - - -
489 1500 IU/amp (i.m) DAK 2017 126,500.00
Serum Anti Tetanus injeksi 1.500
Ampul 1 ml - - - - - -
490 IU/ampul ( A.T.S ) DAK 2015 125,000.00
STREPTOMISIN SERBUK INJ IV 1000
Vial - - - - - -
491 mg/ml DAK 2016 5,750.00
492 Sukralfat susp 500 mg / 5 ml, 100 ml Botol 100 ml DAK 2016 10,100.00 50 - - 50 50 505,000.00
493 Sukralfat susp 500 mg/5 mL, 100 ml Botol 100 ml DAK 2017 9,192.00 - - - - - -
494 Sukralfat tablet/kapsul/kaplet 500 mg Tablet DAK 2017 296.00 - - - - - -
495 ULSIDEX - Sukralfat tab 500 mg Tablet DAK 2016 368.00 - 100 - 100 100 36,800.00
SUPRAFENID Ketoprofen supositoria
Supp - - - - - -
496 100 mg DAK 2016 2,789.00
497 Teofilin tablet/kapsul/kaplet 150 mg Tablet DAK 2017 328.00 - - - - - -
498 Teofilin tablet 150 mg(Bronsolvan) Tablet DAK 2016 310.00 - - - - - -
499 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2016 329.00 - 100 - 100 100 32,900.00
500 Tetrasiklin tablet/kapsul/kaplet 500 mg Tablet DAK 2015 325.00 - - - - - -
501 Thiamphenicol 500 mg kaps Kapsul DAK 2016 984.51 - 700 100 600 100 700 689,157.00
502 Thiamphenicol 500 mg kaps Kapsul DAK 2017 865.00 - - - - - -
503 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2016 21,950.00 50 - 5 45 5 50 1,097,500.00
504 Thiamphenicol 125 mg/5 ml Syr Botol 60 ml DAK 2017 6,500.00 - - - - - -
Tiamin HCI ( Vit.B1 injeksi 100 mg/ml -
Ampul - - - - - -
505 1 ml ) DAK 2013 750.00
Tiamin HCI/Mononitrat (Vit.B1) tablet 50
Tablet - - - - - -
506 mg DAK 2015 37.00
Tiamin (Vitamin B1) tablet/kapsul/kaplet
Tablet - - - - - -
507 50 mg (HCl/ Nitrat) DAK 2017 87.00
Tiamin HCI/Mononitrat (Vit.B1) tablet
Tablet 3,700 1,000 2,800 1,900 200 2,100 191,100.00
508 100 mg DAK 2016 91.00
509 Tramadol tablet 50 mg Tablet DAK 2016 329.68 - - - - - -
510 Tramadol tablet 50 mg Tablet DAK 2015 320.00 - - - - - -
511 Tramadol tablet/ Kapsul 50 mg Tablet DAK 2017 325.00 - - - - - -
512 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2016 1,984.00 - - - - - -
513 Tramadol injeksi 50 mg/ml Ampul 2 ml DAK 2017 1,720.00 - - - - - -
514 Trifluoperazine 5mg Tablet DAK 2016 786.00 500 - - 500 500 393,000.00
515 Triheksifenidil tablet/kapsul/kaplet 2 mg Tablet DAK 2017 80.00 - - - - - -
516 Triheksifenidil tablet 2 mg Tablet DAK 2015 600.00 - - - - - -
517 Triheksifenidil tablet 2 mg Tablet DAK 2016 498.30 100 - - 100 100 49,830.00
518 Valproat sirup 250 mg/5 ml Dus, Botol @ 100 mL DAK 2017 26,987.00 - - - - - -
519 Valsartan tab 80 mg Tablet DAK 2016 1,800.00 - - - - - -
520 Vitamin B Kompleks tablet Tablet DAK 2016 132.00 2,800 1,000 2,000 1,800 2,120 3,920 517,440.00
521 Vitamin B Kompleks tablet Tablet DAK 2017 132.00 - - - - - -
522 Vitamin B Kompleks tablet Tablet DAK 2015 112.00 - - - - - -
523 Vitamin B Kompleks tablet Tablet ABT 2015 168.00 - - - - - -
524 Zinc sir 20 mg/5 ml Dus, Botol @ 60 ml DAK 2017 4,959.00 - - - - - -
525 Zinc sir 20 mg/5 Ml( Zircum Kid Sirup) Dus, Botol @ 60 ml DAK 2016 6,500.00 - - - - - -
526 Zinc tablet dispersible20 mg Tablet DAK 2016 592.00 300 500 400 400 200 600 355,200.00
527 Zink Tablet DAK 2015 521.00 - - - - - -
528 Zinc tablet dispersible 20 mg Tablet dispersible DAK 2017 586.00 - - - - - -
529 Truvit sirup Dus, Botol @ 60 ml DAU 2016 10,890.00 20 - 20 - - -
B ALAT KESEHATAN - - - - - -
I BAHAN MEDIS HABIS PAKAI - - - - - -
1 Alat suntik sekali pakai 1 ml Piece DAK 2016 1,012.60 - - - - - -
2 Alat suntik sekali pakai 1 ml Piece DAK 2017 1,012.60 - - - - - -
3 Alat suntik sekali pakai 2,5 ml Piece DAK 2014 1,141.80 - - - - - -
4 Alat suntik sekali pakai 3 ml Piece DAK 2016 1,006.50 100 - - 100 100 100,650.00
5 Alat suntik sekali pakai 3 ml Piece DAK 2017 1,006.50 - - - - - -
6 Alat suntik sekali pakai 5 ml Piece DAK 2016 1,132.16 100 - - 100 100 113,216.00
7 Alat suntik sekali pakai 5 ml Piece DAK 2017 1,132.16 - - - - - -
8 Alat suntik sekali pakai 10 ml Piece DAK 2017 1,588.44 - - - - - -
9 Alat suntik sekali pakai 20 ml Piece DAK 2016 2,383.88 - - - - - -
10 Alat suntik sekali pakai 50 ml Piece DAK 2016 4,892.20 - - - - - -
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece - - - - - -
11 DAK 2017 1,240.00
24GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece
12 26 GX3/8" DAK 2017 1,650.00 - - - - - -
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.5 ml Piece - - - - - -
13 DAK 2016 1,240.00
23GX1"
Auto Disable Syringe / Alat Suntik
Sekali Pakai Otomatis Rusak 0.05 ml Piece - - - - - -
14 DAK 2016 1,650.00
27GX3/8"
15 Alkohol Swab 4-ply Piece DAK 2016 244.00 100 - - 100 100 24,400.00
16 Bioplasenton Tulle 10 x 10 (CBPCD) Sachet DAK 2016 10,950.00 10 10 - 20 20 219,000.00
17 Blood Lancet (21,26,28 G) Piece DAK 2016 160.23 100 - - 100 100 16,023.00
18 Blood Transfusion Set Piece DAK 2017 17,513.10 - - - - - -
Benang Bedah SMI
Sachet - - - - - -
19 CATGUT PLAIN SMI 2/0 HR 26 MM DAK 2015 26,583.00
CATGUT CHROMIC SMI 2/0 HR 26
20
MM
Sachet DAK 2016 33,785.00 - - - - - -
21 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2016 35,285.00 - - - - - -
CATGUT CHROMIC SMI 2/0 HR 26
22
MM
Sachet DAK 2017 33,785.00 - - - - - -
23 CATGUT PLAIN SMI 2/0 HR 26 MM Sachet DAK 2017 35,285.00 - - - - - -
CATGUT CHROMIC SMI 3/0 HR 26 - - - - - -
24 Sachet DAK 2017 33,785.00
MM
25 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2017 35,285.00 - - - - - -
Benang Bedah SMI
Sachet - - - - - -
26 CATGUT PLAIN SMI 3/0 HR 26 MM DAK 2015 26,583.00
CATGUT CHROMIC SMI 3/0 HR 26
27
MM
Sachet DAK 2016 33,785.00 - - - - - -
28 CATGUT PLAIN SMI 3/0 HR 26 MM Sachet DAK 2016 35,285.00 - - - - - -
Catgut / Benang bedah No.3/0 dengan
Sachet 24 - - 24 24 649,000.00
29 jarum bedah DAK 2012 27,041.67
30 Folley Catheter 2 Way no. 22 Piece DAK 2016 10,000.00 - - - - - -
31 Foley Catheter No.16 Piece DAK 2013 9,300.00 - - - - - -
32 Foley Catheter No.16 Piece DAK 2015 10,440.00 - - - - - -
FOLEYCATH, 2 way latex foley cath,
Piece - - - - - -
33 no. 16 DAK 2016 13,420.00
FOLEYCATH, 2 way latex foley cath,
Piece 20 - - 20 20 268,400.00
34 no. 18 DAK 2016 13,420.00
35 Foley Catheter No.18 Piece DAK 2014 9,344.50 - - - - - -
36 Foley Catheter No.18 Piece DAK 2015 10,440.00 - - - - - -
37 FEMALE CATHETER, no. 18 Piece DAK 2016 6,978.40 - - - - - -
38 EXAMINATION GLOVES, size M Piece DAK 2017 563.64 - - - - - -
39 EXAMINATION GLOVES, size S Piece DAK 2017 563.64 - - - - - -
40 EXAMINATION GLOVES, size M Piece DAK 2016 563.64 - - - - - -
41 CHIRURGIC GLOVES, size 7.5 Piece DAK 2016 9,272.00 - - - - - -
Sarung Tangan Obgyn Steril ( Obgyn
pasang - - - - - -
B glove ) DAK 2017 24,200.00
1 Infusion set anak (Micro) Piece DAK 2014 4,400.00 - - - - - -
Infus Set Anak PEDIATRIC SET (60
Piece - - - - - -
2 drops/ml) DAK 2017 6,222.00
Infusion Set Pediatric (60 drops/ml)
Bbraun Intrafix Primeline with Piece
3 Microdropper DAK 2015 20,320.50 - - - - - -
Infus Set Anak PEDIATRIC SET (60
Piece - - - - - -
4 drops/ml) DAK 2016 6,222.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
5 DAK 2016 5,856.00 8 - - 8 8 46,848.00
Infus Set Dewasa INFUSET (20
drops/ml) Piece
6 DAK 2017 5,856.00 - - - - - -
7 IV Catheter 16 G x 2" Piece DAK 2017 9,158.00 - - - - - -
8 IV-CATH WP, with wings & port, no. 18 Piece DAK 2016 8,540.00 - - - - - -
I.V Catheter (with port) VASOFIX IV
Piece - - - - - -
9 G18 X 45 MM Green DAK 2015 10,062.50
10 IV-Cath NP, pen type, no. 18 Piece DAK 2017 7,320.00 - - - - - -
11 IV-CATH WP, with wings & port, no. 20 Piece DAK 2016 8,540.00 - - - - - -
I.V Catheter (with port) VASOFIX IV
Piece - - - - - -
12 G22 X 25 MM Blue DAK 2015 10,062.50
13 IV-CATH WP, with wings & port, no. 22 Piece DAK 2016 8,540.00 - - - - - -
14 IV-Cath NP, pen type, no. 22 Piece DAK 2017 7,320.00 10 - - 10 10 73,200.00
I.V Catheter (with port) VASOFIX IV
Piece - - - - - -
15 G24 X 0.75 " DAK 2015 10,062.50
16 IV-CATH WP, with wings & port, no. 24 Piece DAK 2016 8,540.00 - - - - - -
17 IV-Cath NP, pen type, no. 24 Piece DAK 2017 7,320.00 - - - - - -
18 IV-Cath NP, pen type, no. 26 Piece DAK 2017 9,394.00 - - - - - -
19 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2017 28,745.25 - - - - - -
20 Kapas pembalut / Absorben 250 gram Roll DAK 2015 28,452.86 - - - - - -
21 Kapas Pembalut Hidrofil DRC 250gr Roll DAK 2016 28,750.00 - - - - - -
22 Kasa 36 x 80 Roll DAK 2015 142,376.60 2 - - 2 2 284,753.20
 STOK AWAL PER 01 PENERIMAAN JAN PENGELUARAN JAN SISA STOK 3O JUNI 2017
NO NAMA OBAT SATUAN SUMBER HARGA PEROLEHAN
JAN 2017 - S/D JUNI 2017 - S/D JUNI 2017 - TOTAL HARGA
23 Kasa Hidrofil DRC 36m x 80cm Roll DAK 2016 141,400.00 - - -
24 Kasa 36 x 80 Roll DAK 2014 60,720.00 - - - - - -
Kasa Steril DRC 16cm x 16cm (16
25
pads)
Box DAK 2016 8,650.50 - - - - - -
Kasa Steril DRC 16cm x 16cm (16
26
pads)
Box DAK 2017 8,650.36 - - - - - -
27 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2016 7,375.00 - - - - - -
28 Kasa Hydrophil Steril Uk. 18 x 22 Kotak @ 12 pcs DAK 2017 9,000.00 - 50 3 47 47 423,000.00
29 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2017 2,475.75 - - - - - -
30 kasa 4 x 10 cm Roll DAK 2015 2,439.24 - - - - - -
31 Kasa Pembalut Hidrofil DRC 4m x 10cm Roll DAK 2016 2,475.43 50 - 25 25 25 61,885.83
32 Surgical Mask Tie On Piece DAK 2017 412.50 - - - - - -
33 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 16 412.50 - - - - - -
34 Masker Piece ABT 2015 574.20 800 - 200 600 600 344,520.00
35 Surgical Mask Plus 3 Ply Plus Earloop Piece DAK 2017 550.00 - - - - - -
NGT
Terumo SAFEED Feeding Tube 3.5 (35 Piece
36 cm) DAK 2015 8,841.00 - - - - - -
NGT
Terumo SAFEED Feeding Tube 5 fr (40 Piece
37 cm) DAK 2015 8,841.00 - - - - - -
NGT
Terumo SAFEED Stomach Tube 14 fr Piece
38 (125 cm) DAK 2015 10,010.00 - - - - - -
NGT
Terumo SAFEED Stomach Tube 16 fr Piece
39 (125 cm) DAK 2015 10,010.00 - - - - - -
NGT
Terumo SAFEED Stomach Tube 18 fr Piece
40 (125 cm) DAK 2015 10,010.00 - - - - - -
41 Oxyflow nasal oxygen bayi Piece DAK 2015 6,050.00 - - - - - -
42 Oxyflow nasal oxygen anak Piece DAK 2015 6,050.00 - - - - - -
43 NASAL OXYGEN, O2 cannula, size S Piece DAK 2016 8,052.00 - - - - - -
44 NASAL OXYGEN, O2 cannula, size S Piece DAK 2017 8,052.00 - - - - - -
45 NASAL OXYGEN, O2 cannula, size M Piece DAK 2016 8,052.00 - - - - - -
46 NASAL OXYGEN, O2 cannula, size M Piece DAK 2017 8,052.00 - - - - - -
47 NASAL OXYGEN, O2 cannula, size L Piece DAK 2016 8,052.00 - - - - - -
48 NASAL OXYGEN, O2 cannula, size L Piece DAK 2017 8,052.00 - - - - - -
Plester Leukoplast Hospital 7.50 cm x
Roll - - - - - -
49 4.5 m DAK 2016 35,532.00
50 Plester Polifix 10 cm x 5 m Roll DAK 2017 76,314.14 2 - 1 1 1 76,314.14
51 Pembalut Elastis 10 cm x 4,55 m Roll DAK 2017 45,507.00 - - - - - -
52 Scalpel Blades Nomor 10 Piece DAK 2017 3,300.00 - - - - - -
53 SILK BLACK 3/0 HR 26 MM Sachet DAK 2016 20,685.00 - - - - - -
Benang Bedah SMI
Sachet - - - - - -
54 SILK BLACK 3/0 DS 24 MM DAK 2015 18,364.00
55 Onemed U Pad Steril 60 x 90 cm Blister DAK 2016 9,533.15 - - - - - -
56 Onemed U Pad Steril 60 x 90 cm Blister DAK 2017 9,533.15 4 20 - 24 24 228,795.60
Onemed Umbilical Cord Klem Steril
Piece - - - - - -
57 Nylon DAK 2016 1,250.00
58 Urine Bag Piece DAK 2015 3,915.00 40 - - 40 40 156,600.00
URINE DRAINAGE BAG, T valve, with
Piece - - - - - -
59 hanger DAK 2016 6,710.00
60 Alkohol 70% Botol 1 L DAK 2016 27,950.00 - - - - - -
61 Alkohol 70% Botol 100 ml DAK 2017 8,300.00 - 2 2 - - -
62 My Jelly 82 gram Tube @ 82 gr DAK 2016 36,936.83 - - - - - -
63 Lysol 1 liter Botol 1 L DAK 2016 53,300.00 23 - - 23 23 1,225,900.00
64 Povidone Iodine 300 ml Botol @ 300 ml DAK 2016 23,400.00 - 5 3 2 2 46,800.00
65 Povidone Iodine 300 ml Botol @ 300 ml DAK 2017 23,400.00 - - - - - -
66 Rivanol 300 cc Botol @ 300 ml DAK 2017 3,750.00 - - - - - -
67 Rivanol 300 cc Botol @ 300 ml DAK 2016 3,315.00 - - - - - -
Cairan Antiseptika pencuci alat
Botol 1 Liter - - - - - -
68 instrumen DAK 2017 141,406.33
Cairan Antiseptika pencuci tangan
Botol 500 ml - - - - - -
69 tanpa dibilas DAK 2017 83,027.33
Cairan Antispetika pencuci tangan
Botol 500 ml - - - - - -
70 dengan dibilas DAK 2017 64,769.00
II REAGENSIA - - - - - -
1 Total Cholesterol Test Strip 10's Strip DAK 2016 23,354.00 - - - - - -
2 Uric Test Strip 25's Strip DAK 2016 5,154.00 60 100 100 60 60 309,240.00
3 Glucose Test Strip 50's Strip DAK 2016 3,093.34 50 - 25 25 25 77,333.62
4 Total Cholesterol Test Strip 10's Strip DAK 2017 23,566.00 75 100 100 75 75 1,767,450.00
5 Uric Test Strip 25's Strip DAK 2017 5,238.80 - - - - - -
6 Glucose Test Strip 50's Strip DAK 2017 3,188.24 - 100 - 100 100 318,824.00
Anti-A Monoclonal Golongan Darah
Vial 10 ml - - - - - -
7 (Vial 10 ml) DAK 2016 80,825.00
Anti-A,B Monoclonal Golongan Darah
Vial 10 ml - 1 - 1 1 105,135.00
8 (Vial 10 ml) DAK 2016 105,135.00
Anti-B Monoclonal Golongan Darah
Vial 10 ml - 1 - 1 1 80,825.00
9 (Vial 10 ml) DAK 2016 80,825.00
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml - 1 - 1 1 126,695.00
10 10 ml) DAK 2016 126,695.00
Anti-A Monoclonal Golongan Darah
Vial 10 ml - 1 - 1 1 74,512.50
11 (Vial 10 ml) DAK 2017 74,512.50
Anti-A,B Monoclonal Golongan Darah
Vial 10 ml - - - - - -
12 (Vial 10 ml) DAK 2017 98,822.50
Anti-B Monoclonal Golongan Darah
Vial 10 ml - - - - - -
13 (Vial 10 ml) DAK 2017 74,512.50
Anti-D Duoclone Golongan Darah (Vial
Vial 10 ml - - - - - -
14 10 ml) DAK 2017 120,382.50
15 Rapid test Vikia HIV 1/2 Kit DAK 2016 519,750.00 - - - - - -
16 Anti HIV 1/2 Cassette each DAK 2017 15,297.00 - - - - - -
17 Gluco Protein tes Piece DAK 2017 1,150.00 - - - - - -
18 Gluco Protein Piece DAK 2016 1,150.00 - - - - - -
19 Ultra One Test Hamil Piece DAK 2016 2,133.00 - - - - - -
20 HCG Strip each DAK 2017 7,181.00 97 - 29 68 68 488,308.00
21 Malaria Pf & Pv Cassette each DAK 2017 53,180.00 - - - - - -
22 Hb strip Dr Family test Tes DAK 2017 24,200.00 - - - - - -
23 HBsAg Strip each DAK 2017 10,967.00 - - - - - -
24 R.Detergent urit (urit 3000 plus) Gallon 5 L DAK 2017 278,300.00 - - - - - -
25 R.Dilluen urit (urit 3000 plus) Gallon 20 L DAK 2017 1,012,000.00 - - - - - -
26 R.Lytic urit (urit 3000 plus) Botol 1 L DAK 2017 1,113,200.00 - - - - - -
27 Rapid tes Dengue (IgG-IgM) Device Tes DAK 2017 124,100.00 - - - - - -
28 Hayem 1x100mL Botol 100 ml DAK 2017 29,450.00 - - - - - -
29 Aquadest Botol 1 Liter DAK 2017 19,448.00 - - - - - -
30 Asam Asetat 6 % Botol 100 ml DAK 2017 29,000.00 - - - - - -
31 Asam Sulfosalisilat 20% 1x100mL Botol 100 ml DAK 2017 328,700.00 - - - - - -
32 EDTA 10% 1x100mL Botol 100 ml DAK 2017 74,100.00 - - - - - -
33 Eosin 2% 1x100mL Botol 100 ml DAK 2017 176,225.00 - - - - - -
34 HCl 0,1N 1x100mL Botol 100 ml DAK 2017 19,950.00 - - - - - -
35 Immersion Oil 1x100mL Botol 50 ml DAK 2017 367,650.00 - - - - - -
36 KOH 10% 1x100mL Botol 100 ml DAK 2017 20,900.00 - - - - - -
37 Methanol PA Botol 100 ml DAK 2017 94,000.00 - - - - - -
38 Na Citrate 3,13% 1x100mL Botol 100 ml DAK 2017 19,475.00 - - - - - -
39 Rees Ecker 1x100mL Botol 100 ml DAK 2017 46,550.00 - - - - - -
40 Turk 1x100mL Botol 100 ml DAK 2017 23,750.00 - - - - - -
41 Salmonella Typhi H Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
42 Salmonella Typhi O Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
43 Salmonella Paratyphi AH Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
44 Salmonella Paratyphi AO Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
45 Salmonella Paratyphi BH Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
46 Salmonella Paratyphi BO Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
47 Salmonella Paratyphi CH Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
48 Salmonella Paratyphi CO Widal Test Vial 5 ml DAK 2017 72,972.50 - - - - - -
1 OBAT DAN BMPH LAIN-LAIN - -
2 Furosemid tablet 40 mg Tablet DAK 2013 92.00 800 - - 800 800 73,600.00
Aminofilina tablet 200 mg
3 Tablet DAK 2013 93.31 600 600 - - -
4 Amlodipin 5 mg Tablet DAK 2013 241.00 300 - 300 - - -
5 Amoksisilin sirup kering 125 mg/5 ml Botol 60 ml DAK 2014 4,730.00 75 - 75 - - -
Antimigren DOEN tablet kombinasi :
Tablet 200 - - 200 200 29,800.00
6 Ergotamin Tartrat 1 mg + Kofein 50 mg DAK 2015 149.00
7 Fenol Gliserol tetes telinga 10% Botol Plastik 5 ml DAK 2013 1,108.00 24 - 24 - - -
8 Gemfibrozil kap/tablet 300 mg Tablet DAK 2016 436.00 200 - - 200 200 87,200.00
9 Parasetamol sirup 120 mg/ 5ml Botol Plastik @ 60 Ml DAK 2015 1,535.00 50 - 50 - - -
10 Handschoon ( sarung tangan) Piece DAK 2015 424.00 500 - 200 300 300 127,200.00
11 IV Catheter G20 Piece DAK 2012 8,566.25 4 - 4 - - -
12 IV Catheter G22 Piece DAK 2012 8,566.20 3 - 3 - - -
13 Kapas pembalut / Absorben 250 gram Roll DAK 2014 8,250.00 6 - - 6 6 49,500.00
Plester Leukoplast Hospital 7.50 cm x
Roll 2 - 2 - - -
14 4.5 m DAK 2012 25,980.00

TOTAL RP. 25,545,486.71

Mengetahui Petugas Pengelola Obat

Plt.Kepala Puskesmas Semberang Puskesmas

YUSNIARTI,Amd.GZ FATMAWATI,Amd.KL
NIP. 19730323 199603 2 003 NIP. 19690801 199303 2 015