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  • Data Fast Per Nama Obat

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    This document provides a monthly report of medication and supply movements in and out of the pharmacy warehouse at RSMS Sungailiat Hospital in December 2021. It lists 33 items including medications like Acetylcysteine, Acyclovir, Allopurinol that were fast moving that month, along with their code, name, supplier, price and any applicable discounts. It also lists 13 items that were considered dead stock including medications like Antalgin, Cefadroxil, and Chloroquine along with their details. The report provides key inventory and sales data on a range of medications and medical supplies handled by the pharmacy warehouse that month.

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    This document provides a monthly report of medication and supply movements in and out of the pharmacy warehouse at RSMS Sungailiat Hospital in December 2021. It lists 33 items including medications like Acetylcysteine, Acyclovir, Allopurinol that were fast moving that month, along with their code, name, supplier, price and any applicable discounts. It also lists 13 items that were considered dead stock including medications like Antalgin, Cefadroxil, and Chloroquine along with their details. The report provides key inventory and sales data on a range of medications and medical supplies handled by the pharmacy warehouse that month.

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    © All Rights Reserved
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    12 views325 pages

    Data Fast Per Nama Obat

    Uploaded by

    fennyrahma
    This document provides a monthly report of medication and supply movements in and out of the pharmacy warehouse at RSMS Sungailiat Hospital in December 2021. It lists 33 items including medications like Acetylcysteine, Acyclovir, Allopurinol that were fast moving that month, along with their code, name, supplier, price and any applicable discounts. It also lists 13 items that were considered dead stock including medications like Antalgin, Cefadroxil, and Chloroquine along with their details. The report provides key inventory and sales data on a range of medications and medical supplies handled by the pharmacy warehouse that month.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    of 325

    RUMAH SAKIT

    MEDIKA STANNIA
    SUNGAILIAT

    LAPORAN BULANAN MUTASI OBAT-OBATAN DAN SARA


    DI GUDANG FARMASI RSMS - SUNGAILIAT
    BULAN DESEMBER 2021
    #REF!
    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    OBAT GENERIK
    OBAT DEAD STOCK
    1 ANTALGIN TAB 500 MG D non fopi PC INF (G) 269.50 269.50
    2 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL CAPS. 250 MG D non fopi PC HEXPHARM ( G ) 606.07 606.07
    1 CHLOROQUIN INJ. D non fopi AMP DUTA KAISAR 1,650.00 1,650.00
    2 CHLOROQUIN TBL.150 MG D non fopi PC KF ( G ) 85.00 85.00
    3 08 ANTI-INFECTIVES SYSTEMIC CLINDAMYCIN TAB 150 MG D non fopi PC DM ( G ) 722.15 722.15
    4 208YN04E01 FYN04E001 04 CENTRAL NERVOUS SYSTEM DIVALPROEX SODIUM 250 MG D fopi PC DM ( G ) 6,088.69 49.06% 3,101.58
    5 208KF08N03 FKF08N003 08 ANTI-INFECTIVES SYSTEMIC GRISEOFULVIN TABL 500 MG D fopi PC DARYA VARIA 1,554.30 1,554.30
    6 MOXIFLOXACIN HCL INFUS 250 ML D fopi BTL DM ( G ) 259,875.00 65.00%
    7 208KF16A02 FKF16A002 08 ANTI-INFECTIVES SYSTEMIC OXYTETRACYCLIN 3% SALEP KULIT D fopi TUBE KF ( G ) 2,069.10 10.00% 2,009.70
    8 208PR08R01 FPR08R001 08 ANTI-INFECTIVES SYSTEMIC PRIMAQUIN TABL 15 MG D fopi PC PHAPROS G 341.00 0.00% 287.38
    9 PROPOFOL INJ. 10 MG/ML
    02 CARDIOVASCULAR & HAEMATOPO D non fopi AMP NOVELL ( G ) 16,500.00 20.00% 13,200.00
    10 208KF08Q02 FKF08Q002 08 ANTI-INFECTIVES SYSTEMIC PYRANTEL TABL 125 MG D fopi PC KF ( G ) 512.67 7.50% 512.67
    11 208NP10D03 FNP10D003 SILDENAFIL CITRATE 100 MG D fopi PC NOVELL ( G ) 38,500.00 38,500.00
    12 208NP10D02 FNP10D002 SILDENAFIL CITRATE 50 MG D fopi PC NOVELL ( G ) 24,640.00 24,640.00
    13 SULFADOXINE TAB. D non fopi PC KF ( G ) 1,003.14 1,003.14
    JUMLAH

    OBAT FAST MOVING


    1 208PN11B02 FPN11B002 ACARBOSE TAB. 100 MG F fopi PC FAHRENHEIT (G ) 16.00%
    2 208DM11B01 FDM11B001 11 ENDOCRINE & METABOLIC SYST ACARBOSE TAB. 100 MG F fopi PC DM ( G ) 2,007.33 56.36% -
    3 208PN11B01 FPN11B001 ACARBOSE TAB. 50 MG F fopi PC FAHRENHEIT (G ) 1,245.20 16.00%
    4 208DM11B02 FDM11B002 11 ENDOCRINE & METABOLIC SYST ACARBOSE TAB. 50 MG F fopi PC DM ( G ) 1,245.09 49.72% 626.03
    5 03 RESPIRATORY SYSTEM ACETYLCESTEINE 200 MG/ML F fopi BTL FAHRENHEIT (G ) 218,900.00 5.00% 186,065.00
    6 ACETYLCESTEINE CAPS F fopi PC MBF ( G ) 1,833.33 30.00%
    7 208PN03C03 FPN03C003 03 RESPIRATORY SYSTEM ACETYLCESTEINE CAPS F fopi PC FAHRENHEIT (G ) 1,100.00 50.00% 660.00
    8 208KF16C01 FKF16C001 16 DERMATOLOGICALS ACYCLOVIR CREAM 5 GR F fopi TUBE KF ( G ) 3,391.25 3,391.25
    9 208IF16C01 FIF16C001 16 DERMATOLOGICALS ACYCLOVIR CREAM 5 GR F fopi TUBE INF (G) 3,080.83 3,080.83
    10 208NP08P01 FNP08P001 08 ANTI-INFECTIVES SYSTEMIC ACYCLOVIR TAB. 200 MG F fopi PC NOVELL ( G ) 550.00 15.00% 605.41
    11 08 ANTI-INFECTIVES SYSTEMIC ACYCLOVIR TAB. 400 MG F non fopi PC HEXPHARM ( G ) 660.00 35.00% 628.92
    12 208IF08P02 FIF08P002 08 ANTI-INFECTIVES SYSTEMIC ACYCLOVIR TAB. 400 MG F fopi PC FAHRENHEIT (G ) 1,056.00 15.00% -
    13 ACYCLOVIR TAB. 400 MG F non fopi PC KF ( G ) 416.22 0.00% 794.40
    14 208PR08P02 FPR08P002 08 ANTI-INFECTIVES SYSTEMIC ACYCLOVIR TAB. 400 MG F fopi PC PHAPROS (G) 646.80 0.00% 397.20
    15 208KF08Q01 FKF08Q001 08 ANTI-INFECTIVES SYSTEMIC ALBENDAZOL 400 MG F fopi PC KF ( G ) 446.60 446.60
    16 208KF08Q01 FKF08Q001 08 ANTI-INFECTIVES SYSTEMIC ALBENDAZOL 400 MG F fopi PC KF ( G ) 448.25 10.43% 446.60
    17 208HJ05B04 FHJ05B004 05 MUSCULO-SKELETAL SYSTEM ALLOPURINOL TAB 100 MG F fopi PC HEXPHARM ( G ) 220.00 35.00% -
    18 05 MUSCULO-SKELETAL SYSTEM ALLOPURINOL TAB 100 MG F non fopi PC KF ( G ) 230.80 240.78

    DATA KEBUTUHAN OBAT REVISI 1 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    19 05 MUSCULO-SKELETAL SYSTEM ALLOPURINOL TAB 100 MG F non fopi PC PROMED (G) 264.00 10.00% 237.60
    20 05 MUSCULO-SKELETAL SYSTEM ALLOPURINOL TAB 300 MG F non fopi PC MERSIFARM (G) 462.00 0.00% 216.10
    21 208BE05B05 FBE05B005 05 MUSCULO-SKELETAL SYSTEM ALLOPURINOL TAB 300 MG F fopi PC BERNOFARM ( G ) 302.50 302.50
    22 208HJ05B04 FHJ05B004 05 MUSCULO-SKELETAL SYSTEM ALLOPURINOL TAB 300 MG F fopi PC HEXPHARM ( G ) 461.92 35.00% 310.20
    23 208HJ05B04 FHJ05B004 05 MUSCULO-SKELETAL SYSTEM ALLOPURINOL TAB 300 MG F fopi PC HEXPHARM ( G ) 462.00 35.00% 310.20
    24 208KF04A01 FKF04A001 04 CENTRAL NERVOUS SYSTEM ALPRAZOLAM 0.25 MG F fopi PC KF ( G ) 557.87 0.00%
    25 208KF04A01 FKF04A001 04 CENTRAL NERVOUS SYSTEM ALPRAZOLAM 0.5 MG F fopi PC KF ( G ) 704.55 0.00% 308.00
    26 208KF04A02 FKF04A002 04 CENTRAL NERVOUS SYSTEM ALPRAZOLAM 1 MG F fopi PC KF ( G ) 1,085.70 0.00% 900.00
    27 AMBROXOL SYR. 15 MG/ 5 ML F non fopi BTL PROMED (G) 20.00%
    28 03 RESPIRATORY SYSTEM AMBROXOL SYR. 15 MG/ 5 ML F non fopi BTL KF ( G ) 4,959.91 5.00% 5,500.00
    29 208BE03C03 FBE03C003 03 RESPIRATORY SYSTEM AMBROXOL SYR. 15 MG/ 5 ML F fopi BTL BERNOFARM ( G ) 4,950.00 4,950.00
    30 208PM03C07 FPM03C007 03 RESPIRATORY SYSTEM AMBROXOL TAB. F fopi PC PROMED (G) 198.00 25.00% -
    31 AMBROXOL TAB. F non fopi PC KF ( G ) 52.47% -
    32 AMBROXOL TAB. F non fopi PC INF (G) 20.00% -
    33 208PR03B01 FPR03B001 AMINOPHYLLIN INJ. F fopi AMP PHAPROS (G) 3,023.94 3,023.94
    34 208DV02A01 FDV02A001 02 CARDIOVASCULAR & HAEMATOPO AMIODARONE INJ. F fopi AMP DARYA VARYA ( G ) 8,656.58 8,700.08
    35 208DV02A01 FDV02A001 02 CARDIOVASCULAR & HAEMATOPO AMIODARONE INJ. F fopi AMP DARYA VARYA ( G ) 8,700.08 8,700.08
    36 04 CENTRAL NERVOUS SYSTEM AMITRIPTYLINE TAB. 25 MG F fopi PC INF (G) 180.00 180.00
    37 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F non fopi PC DM ( G ) 1,775.60 71.84% 500.00
    38 208HJ02E03 FHJ02E003 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F fopi PC HEXPHARM ( G ) 935.00 85.00% 935.00
    39 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F non fopi PC SCAN (G) 500.01 0.00% 94.41
    40 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F non fopi PC FAHRENHEIT (G ) 1,716.00 65.00% 312.50
    41 208KF02E02 FKF02E002 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F fopi PC KF ( G ) 216.09 0.00% 275.00
    42 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F non fopi PC INF (G) 1,691.65 60.00% -
    43 208TP02E04 FTP02E004 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F fopi PC TEMPO (G) 95.00 95.00
    44 208PR02E02 FPR02E002 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F fopi PC PHAPROS (G) 94.72 94.72
    45 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 10 MG F non fopi PC BERNOFARM ( G ) 711.20 711.20
    46 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F non fopi PC DM ( G ) 190.01 190.01
    47 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F non fopi PC DM ( G ) 1,007.96 80.15% 880.00
    48 208HJ02E04 FHJ02E004 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F fopi PC HEXPHARM ( G ) 476.84 75.00% 476.67
    49 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F non fopi PC SCAN (G) 81.00 81.00
    50 208KF02E01 FKF02E001 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F fopi PC KF ( G ) 165.00 165.00
    51 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F fopi PC KF ( G ) 53.00 0.00% 345.60
    52 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F non fopi PC FAHRENHEIT (G ) 990.00 65.00% 396.00
    53 02 CARDIOVASCULAR & HAEMATOPO AMLODIPINE 5 MG F non fopi PC FAHRENHEIT (G ) 990.17 65.00% 396.00
    54 208BE08C06 FBE08C006 08 ANTI-INFECTIVES SYSTEMIC AMOXYCILLIN CAPS 500 MG F fopi PC BERNOFARM ( G ) 423.50 423.50
    55 08 ANTI-INFECTIVES SYSTEMIC AMOXYCILLIN CAPS 500 MG F non fopi PC KF ( G ) 415.90 10.00% 415.90
    56 208HJ08C01 FHJ08C001 08 ANTI-INFECTIVES SYSTEMIC AMOXYCILLIN CAPS 500 MG F fopi PC HEXPHARM ( G ) 370.00 20.00% 350.02
    57 08 ANTI-INFECTIVES SYSTEMIC AMOXYCILLIN DROPS F non fopi BTL BERNOFARM ( G ) 15,400.00 15,400.00
    58 208HJ08C02 FHJ08C002 08 ANTI-INFECTIVES SYSTEMIC AMOXYCILLIN DRY. SYR F fopi BTL HEXPHARM ( G ) 5,500.00 7.00% 3,502.00
    59 08 ANTI-INFECTIVES SYSTEMIC AMOXYCILLIN DRY. SYR F fopi BTL BERNOFARM ( G ) 5,775.00 0.00% 4,620.00
    60 208PR08C02 FPR08C002 08 ANTI-INFECTIVES SYSTEMIC AMPICILLIN INJ. F fopi VIAL PHAPROS (G) 7,878.42 0.00% 9,733.13
    61 208KF01A02 FKF01A002 01 GASTROINTESTINAL & HEPATOBIANTASIDA DOEN SYR. F fopi BTL KF ( G ) 9,804.35 15.00% 9,804.30
    62 ANTASIDA DOEN TAB F fopi PC PROMED (G) 198.00 25.00%
    63 208KF01A03 FKF01A003 01 GASTROINTESTINAL & HEPATOBIANTASIDA DOEN TAB F fopi PC GENERIK 210.59 210.59
    64 208KF01A03 FKF01A003 01 GASTROINTESTINAL & HEPATOBIANTASIDA DOEN TAB F fopi PC KF ( G ) 376.63 7.50% 210.60
    65 AQUA PRO INJ. 50 ML F non fopi BTL BERNOFARM ( G ) 16,500.00 16,500.00
    66 208BE04L16 FBE04L016 04 CENTRAL NERVOUS SYSTEM AS. MEFENAMAT TAB 500 MG F fopi PC BERNOFARM ( G ) 297.00 46.00% 280.00
    67 04 CENTRAL NERVOUS SYSTEM AS. MEFENAMAT TAB 500 MG F non fopi PC HEXPHARM ( G ) 302.51 5.00% 189.20

    DATA KEBUTUHAN OBAT REVISI 2 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    68 208DM04L20 FDM04L020 04 CENTRAL NERVOUS SYSTEM AS. MEFENAMAT TAB 500 MG F fopi PC DM ( G ) 262.99 0.00% 262.99
    69 208HJ04L03 FHJ04L003 04 CENTRAL NERVOUS SYSTEM AS. MEFENAMAT TAB 500 MG F fopi PC HEXPHARM ( G ) 302.51 45.00% 189.20
    70 208DM02M02 FDM02M002 AS. TRANEKSAMAT INJ 250 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi AMP DM ( G ) 4,620.00 60.00% 3,003.00
    71 AS. TRANEKSAMAT INJ 250 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi AMP BERNOFARM ( G ) 5,005.00 5,005.00
    72 208NP02M01 FNP02M001 AS. TRANEKSAMAT INJ 250 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi AMP NOVELL (G) 5,060.00 30.00% 3,390.20
    73 208NP02M02 FNP02M002 AS. TRANEKSAMAT INJ 500 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi AMP NOVELL (G) 6,930.00 35.00% 4,643.10
    74 AS. TRANEKSAMAT INJ 500 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi AMP HEXPHARM ( G ) 5,775.00 40.00% 3,941.44
    75 208DM02M03 FDM02M003 AS. TRANEKSAMAT INJ 500 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi AMP DM ( G ) 6,063.75 60.00% -
    76 208BE02M04 FBE02M004 AS. TRANEKSAMAT TAB 500 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC BERNOFARM ( G ) 1,980.00 20.00% 1,485.00
    77 AS. TRANEKSAMAT TAB 500 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC DM ( G ) 1,155.00 1,155.00
    78 04 CENTRAL NERVOUS SYSTEM ASAM VALPROAT SYR 250 ML F non fopi BTL NOVELL (G) 41,580.00 41,580.00
    79 208DM04E01 FDM04E001 04 CENTRAL NERVOUS SYSTEM ASAM VALPROAT SYR 250 ML F fopi BTL DM ( G ) 48,510.00 63.00% 34,650.69
    80 04 CENTRAL NERVOUS SYSTEM ASAM VALPROAT SYR 250 ML F non fopi BTL PHAPROS (G) 34,650.00 34,650.00
    81 208HJ02L03 FHJ02L003 ATORVASTATIN 10 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC HEXPHARM ( G ) 2,750.00 50.00% 2,612.50
    82 ATORVASTATIN 20 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC YARINDO (G) 4,400.00 35.00% 1,265.00
    83 208HJ02L04 FHJ02L004 ATORVASTATIN 20 MG F fopi PC HEXPHARM ( G ) 4,400.00 80.00% -
    84 208EI01B01 FEI01B001 01 GASTROINTESTINAL & HEPATOBIATROPIN SULFAS INJ. F fopi AMP ETHICA ( G ) 2,750.00 0.50% 1,685.53
    85 208BE08F08 FBE08F008 08 ANTI-INFECTIVES SYSTEMIC AZITHROMYCIN INFUS 500 MG F fopi BTL BERNOFARM ( G ) 88,000.00 18.75% 51,975.00
    86 208BE08F09 FBE08F009 08 ANTI-INFECTIVES SYSTEMIC AZITHROMYCIN INJ. 0.5 GR F fopi VIAL BERNOFARM ( G ) 128,700.00 128,700.00
    87 208DM08F01 FDM08F001 08 ANTI-INFECTIVES SYSTEMIC AZITHROMYCIN SYR. 200 MG / 5 ML F fopi BTL DM ( G ) 51,975.00 50.00% 44,178.75
    88 208KF08F01 FKF08F001 08 ANTI-INFECTIVES SYSTEMIC AZITHROMYCIN TAB. 500 MG F fopi PC KF ( G ) 4,500.00 69.00% 4,702.50
    89 08 ANTI-INFECTIVES SYSTEMIC AZITHROMYCIN TAB. 500 MG F non fopi PC DM ( G ) 1,540.00 0.00% -
    90 208HJ08D02 FHJ08D002 08 ANTI-INFECTIVES SYSTEMIC AZITHROMYCIN TAB. 500 MG F fopi PC FAHRENHEIT (G ) 9,900.00 30.00% -
    91 208YN04I01 FYN04I001 04 CENTRAL NERVOUS SYSTEM BETAHISTINE TABLET 24 MG F fopi PC YARINDO (G) 4,180.00 4,180.00
    92 208DM04I04 FDM04I004 04 CENTRAL NERVOUS SYSTEM BETAHISTINE TABLET 6 MG F fopi PC DM ( G ) 969.25 88.65% 726.92
    93 208NP04I01 FNP04I001 04 CENTRAL NERVOUS SYSTEM BETAHISTINE TABLET 6 MG F fopi PC NOVELL (G) 396.00 0.00% 739.20
    94 208KF16E01 FKF16E001 16 DERMATOLOGICALS BETAMETASONE CREAM F fopi TUBE KF ( G ) 2,353.35 2,353.35
    95 208PR16E01 FPR16E001 16 DERMATOLOGICALS BETAMETASONE CREAM F fopi TUBE PHAPROS (G) 2,356.20 2,356.20
    96 BIC NAT 500 MG F non fopi PC GENERIK 77.00 0.00% 77.00
    97 208NP01E01 FNP01E001 01 GASTROINTESTINAL & HEPATOBIBISACODYL TAB. F fopi PC NOVELL (G) 1,020.00 1,020.00
    98 208HJ02D04 FHJ02D004 02 CARDIOVASCULAR & HAEMATOPO BISOPROLOL TAB. 2.5 MG F fopi PC HEXPHARM ( G ) 550.00 20.00% -
    99 208HJ02D04 FHJ02D004 BISOPROLOL TAB. 2.5 MG F fopi PC FAHRENHEIT (G ) 550.00 20.00% -
    100 BISOPROLOL TAB. 2.5 MG F PC DM ( G ) 693.00 20.00%
    101 208DM02D02 FDM02D002 02 CARDIOVASCULAR & HAEMATOPO BISOPROLOL TAB. 5 MG F fopi PC DM ( G ) 2,437.82 90.27% -
    102 208HJ02D03 FHJ02D003 02 CARDIOVASCULAR & HAEMATOPO BISOPROLOL TAB. 5 MG F fopi PC HEXPHARM ( G ) 1,210.00 80.00% 2,887.50
    103 208DM02D02 FDM02D002 02 CARDIOVASCULAR & HAEMATOPO BISOPROLOL TAB. 5 MG F fopi PC NOVELL (G) 550.00 237.20
    104 208HJ02D03 FHJ02D003 02 CARDIOVASCULAR & HAEMATOPO BISOPROLOL TAB. 5 MG F fopi PC HEXPHARM ( G ) 1,210.00 30.00% 2,887.50
    105 02 CARDIOVASCULAR & HAEMATOPO BISOPROLOL TAB. 5 MG F non fopi PC FAHRENHEIT (G ) 2,321.64 72.00% -
    106 02 CARDIOVASCULAR & HAEMATOPO BISOPROLOL TAB. 5 MG F non fopi PC BERNOFARM ( G ) 4,950.00 50.00% -
    107 BUPIVACAINE SPINAL INJ. F non fopi AMP BERNOFARM ( G ) 26,878.72 -
    108 208DM30D02 FDM30D002 30 VITAMINS & MINERALS CALCII GLUCONAS INJ. F fopi AMP DM ( G ) 15,092.00 20.00% -
    109 208PR30D01 FPR30D001 30 VITAMINS & MINERALS CALCIUM LACTATE TABLET 500 MG F fopi PC PHAPROS (G) 119.27 -
    110 208KF30D01 FKF30D001 30 VITAMINS & MINERALS CALCIUM LACTATE TABLET 500 MG F fopi PC KF ( G ) 207.64 15.00% -
    111 208DM02F03 FDM02F003 02 CARDIOVASCULAR & HAEMATOPO CANDESARTAN TAB. 8 MG F fopi PC DM ( G ) 5,197.52 89.51% -
    112 02 CARDIOVASCULAR & HAEMATOPO CANDESARTAN TAB. 8 MG F non fopi PC INF (G) 2,750.00 5.00% -
    113 208PN02F02 FPN02F002 02 CARDIOVASCULAR & HAEMATOPO CANDESARTAN TAB. 8 MG F fopi PC FAHRENHEIT (G ) 4,950.00 85.00% 2,722.50
    114 208BE02F04 FBE02F004 02 CARDIOVASCULAR & HAEMATOPO CANDESARTAN TAB. 8 MG F fopi PC BERNOFARM ( G ) 5,500.00 80.00% -
    115 208PN02F01 FPN02F001 02 CARDIOVASCULAR & HAEMATOPO CANDESARTAN TAB. 16 MG F fopi PC FAHRENHEIT (G ) 7,150.00 85.00% 942.94
    116 208DM02F04 FDM02F004 02 CARDIOVASCULAR & HAEMATOPO CANDESARTAN TAB. 16 MG F fopi PC DM ( G ) 7,507.48 87.44% -

    DATA KEBUTUHAN OBAT REVISI 3 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    117 02 CARDIOVASCULAR & HAEMATOPO


    CANDESARTAN TAB. 16 MG F non fopi PC NOVELL (G) 5,720.00 5,720.00
    118 CANDESARTAN TAB. 16 MG F fopi PC FAHRENHEIT (G ) 7,150.07 85.00% 942.94
    119 02 CARDIOVASCULAR & HAEMATOPO
    CANDESARTAN TAB. 16 MG F non fopi PC YARINDO (G) 4,180.00 -
    120 208BE02F03 FBE02F003 02 CARDIOVASCULAR & HAEMATOPO
    CANDESARTAN TAB. 16 MG F fopi PC BERNOFARM ( G ) 7,700.00 80.00% 3,520.00
    121 CARBAMAZEPIN TAB. 200 MG F non fopi PC INF (G) 246.20 -
    122 208DM02C17 FDM02C017 CATOPRIL 12,5 MG
    02 CARDIOVASCULAR & HAEMATOPO F PC KF ( G ) 175.19 5.00% -
    123 208PR02C01 FPR02C001 CATOPRIL 12,5 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC PHAPROS (G) 70.83 0.00% -
    124 CATOPRIL 12,5 MG F PC DM ( G ) 94.50 10.00%
    125 208KF02C01 FKF02C001 CATOPRIL 25 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC KF ( G ) 181.11 20.00% -
    126 CATOPRIL 25 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC DM ( G ) 144.64 5.00% -
    127 208KF02C01 FKF02C001 CATOPRIL 25 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC PHAPROS (G) 75.46 0.00% 144.64
    128 CATOPRIL 25 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC HEXPHARM ( G ) 94.07 -
    129 208DM02C18 FDM02C018 CATOPRIL 50 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC DM ( G ) 235.60 5.00% 200.24
    130 208DM02C18 FDM02C018 CATOPRIL 50 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC DM ( G ) 200.25 200.25
    131 208HJ08B06 FHJ08B006 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL CAPS. 500 MG F fopi PC HEXPHARM ( G ) 840.00 40.00% 672.00
    132 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL CAPS. 500 MG F fopi PC KF ( G ) 840.00 840.00
    133 208BE08B15 FBE08B015 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL CAPS. 500 MG F fopi PC BERNOFARM ( G ) 665.50 665.50
    134 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL CAPS. 500 MG F non fopi PC DM ( G ) 882.00 10.00% 793.80
    135 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL CAPS. 500 MG F non fopi PC PROMED (G) 803.00 4.00% -
    136 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL SYR F non fopi BTL PROMED (G) 9,900.00 4.00% -
    137 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL SYR F non fopi BTL KF ( G ) 6,395.67 6,395.67
    138 208HJ08B05 FHJ08B005 08 ANTI-INFECTIVES SYSTEMIC CEFADROXIL SYR F fopi BTL HEXPHARM ( G ) 8,200.50 10.00% 7,306.65
    139 08 ANTI-INFECTIVES SYSTEMIC CEFEPIME INJ F non fopi VIAL BERNOFARM ( G ) 135,850.00 135,850.00
    140 CEFIXIME CAPS. 100 MG F non fopi PC DM ( G ) 2,514.31 66.46%
    141 208HJ08B07 FHJ08B007 CEFIXIME CAPS. 100 MG F fopi PC HEXPHARM ( G ) 1,430.00 55.00% -
    142 08 ANTI-INFECTIVES SYSTEMIC CEFIXIME CAPS. 100 MG F non fopi PC DM ( G ) 2,514.37 66.46% 843.30
    143 208NP08B03 FNP08B003 08 ANTI-INFECTIVES SYSTEMIC CEFIXIME CAPS. 100 MG F fopi PC NOVELL ( G ) 1,676.21 1,676.21
    144 CEFIXIME CAPS. 200 MG F PC HEXPHARM ( G ) 2,530.00 20.00% 2,329.46
    145 208DM08B05 FDM08B005 08 ANTI-INFECTIVES SYSTEMIC CEFIXIME CAPS. 200 MG F fopi PC DM ( G ) 1,872.05 60.00% 2,329.46
    146 08 ANTI-INFECTIVES SYSTEMIC CEFIXIME SYR F fopi BTL BERNOFARM ( G ) 36,300.00 75.00% 6,395.68
    147 08 ANTI-INFECTIVES SYSTEMIC CEFIXIME SYR F non fopi BTL DM ( G ) 31,762.50 40.00% 22,233.75
    148 208NP08B05 FNP08B005 08 ANTI-INFECTIVES SYSTEMIC CEFIXIME SYR F fopi NOVELL ( G ) 13,721.40 13,721.40
    149 CEFIXIME SYR F fopi BTL HEXPHARM ( G ) 19,800.00 55.00% 13,721.40
    150 08 ANTI-INFECTIVES SYSTEMIC CEFOPERAZONE INJ 1 GR F VIAL BERNOFARM ( G ) 88,000.00 80.00% 51,425.00
    151 CEFOPERAZONE SULBACTAM INJ. F VIAL MBF ( G ) 30.00%
    152 208BE08B22 FBE08B022 08 ANTI-INFECTIVES SYSTEMIC CEFOPERAZONE SULBACTAM INJ. F fopi VIAL BERNOFARM ( G ) 92,950.00 92,950.00
    153 208NP08B06 FNP08B006 08 ANTI-INFECTIVES SYSTEMIC CEFOPERAZONE SULBACTAM INJ. F fopi VIAL NOVELL ( G ) 109,725.00 109,725.00
    154 208DM08B21 FDM08B021 08 ANTI-INFECTIVES SYSTEMIC CEFOTAXIME INJ. F fopi VIAL DM ( G ) 7,276.50 30.00% 7,667.00
    155 208DM08B21 FDM08B021 08 ANTI-INFECTIVES SYSTEMIC CEFOTAXIME INJ. F fopi VIAL DM ( G ) 7,276.50 36.00% 5,093.55
    156 208PR08B01 FPR08B001 08 ANTI-INFECTIVES SYSTEMIC CEFOTAXIME INJ. F fopi VIAL PHAPROS (G) 5,940.00 0.00% 4,519.52
    157 208HJ08B10 FHJ08B010 CEFOTAXIME INJ. F fopi VIAL HEXPHARM ( G ) 9,350.00 55.00% 5,093.55
    158 208BE08B23 FBE08B023 08 ANTI-INFECTIVES SYSTEMIC CEFOTAXIME INJ. F fopi VIAL BERNOFARM ( G ) 24,200.00 24,200.00
    159 208PR08B01 FPR08B001 08 ANTI-INFECTIVES SYSTEMIC CEFOTAXIME INJ. F fopi VIAL PHAPROS (G) 10,010.00 50.00% 4,519.52
    160 208NP08B09 FNP08B009 08 ANTI-INFECTIVES SYSTEMIC CEFTAZIDIME INJ. 1 GR F fopi VIAL NOVELL ( G ) 45,650.00 23.00% 35,150.50
    161 208BE08B26 FBE08B026 08 ANTI-INFECTIVES SYSTEMIC CEFTAZIDIME INJ. 1 GR F fopi VIAL BERNOFARM ( G ) 44,880.00 44,880.00
    162 08 ANTI-INFECTIVES SYSTEMIC CEFTAZIDIME INJ. 1 GR F non fopi VIAL DM ( G ) 35,550.90 30.00% 24,885.63
    163 208BE08B27 FBE08B027 08 ANTI-INFECTIVES SYSTEMIC CEFTIZOXIME INJ. 1 GR F fopi VIAL NOVELL ( G ) 110,000.00 33.00% -
    164 CEFTIZOXIME INJ. 1 GR F fopi VIAL NOVELL ( G ) 110,000.00 30.00% -
    165 208HJ08B12 FHJ08B012 08 ANTI-INFECTIVES SYSTEMIC CEFTRIAXONE INJ 1 GR F fopi VIAL HEXPHARM ( G ) 11,000.00 65.00% 10,041.12

    DATA KEBUTUHAN OBAT REVISI 4 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    166 208PR08B04 FPR08B004 08 ANTI-INFECTIVES SYSTEMIC CEFTRIAXONE INJ 1 GR F fopi VIAL PHAPROS (G) 11,000.00 5.00% -
    167 208DM08B22 FDM08B022 08 ANTI-INFECTIVES SYSTEMIC CEFTRIAXONE INJ 1 GR F fopi VIAL DM ( G ) 9,023.64 45.00% 6,316.54
    168 CEFTRIAXONE INJ 1 GR F fopi VIAL DM ( G ) 49.16%
    169 12 ALLERGY & IMMUNE SYSTEM CETIRIZINE 10 MG F non fopi PC FAHRENHEIT (G ) 330.00 30.00% 346.50
    170 208HJ18A01 FHJ18A001 12 ALLERGY & IMMUNE SYSTEM CETIRIZINE 10 MG F fopi PC HEXPHARM ( G ) 313.50 70.00% -
    171 208PR18A02 FPR18A002 12 ALLERGY & IMMUNE SYSTEM CETIRIZINE 10 MG F fopi PC PHAPROS (G) 403.33 15.00% 253.91
    172 12 ALLERGY & IMMUNE SYSTEM CETIRIZINE 10 MG F non fopi PC INF (G) 317.39 30.00% 281.87
    173 208IF12A03 FIF12A003 12 ALLERGY & IMMUNE SYSTEM CETIRIZINE DROPS F fopi BTL INF (G) 27,500.00 27,500.00
    174 208PN18A02 FPN18A002 CETIRIZINE SYR. F fopi BTL PROMED (G) 16,500.00 30.00% -
    175 12 ALLERGY & IMMUNE SYSTEM CETIRIZINE SYR. F non fopi BTL FAHRENHEIT (G ) 10,439.00 25.00% 7,680.75
    176 208PR18A03 FPR18A003 12 ALLERGY & IMMUNE SYSTEM CHLORPHENAMINE TAB. 4 MG F fopi PC PHAPROS (G) 115.49 0.00% 162.39
    177 CILOSTAZOL TAB. 100 MG F non fopi PC BERNOFARM ( G ) 10,450.01 33.01% 7,315.00
    178 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN INFUS F non fopi BTL NOVELL ( G ) 56,999.80 30.00% 38,189.87
    179 208HJ08G02 FHJ08G002 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN INFUS F fopi BTL HEXPHARM ( G ) 43,889.85 43,889.85
    180 208BE08G06 FBE08G006 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN TAB. 500 MG F fopi PC BERNOFARM ( G ) 385.00 385.00
    181 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN TAB. 500 MG F non fopi PC NOVELL ( G ) 666.88 666.88
    182 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN TAB. 500 MG F non fopi PC KF ( G ) 462.00 462.00
    183 208HJ08G01 FHJ08G001 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN TAB. 500 MG F fopi PC HEXPHARM ( G ) 473.00 35.00% -
    184 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN TAB. 500 MG F non fopi PC DM ( G ) 532.17 532.17
    185 CITICOLINE INJ. 125 MG / 1 ML
    02 CARDIOVASCULAR & HAEMATOPO F non fopi AMP NOVELL (G) 14,300.00 45.00% 8,580.00
    186 CITICOLINE INJ. 125 MG / 1 ML F AMP NOVELL (G) 14,300.00 30.00%
    187 208HJ02J02 FHJ02J002 02 CARDIOVASCULAR & HAEMATOPOCITICOLINE INJ. 250 MG / 2 ML F fopi AMP HEXPHARM ( G ) 11,999.89 62.00% -
    188 208HJ02J02 FHJ02J002 02 CARDIOVASCULAR & HAEMATOPOCITICOLINE INJ. 500 MG / 4 ML F fopi AMP MBF ( G ) 16,500.00 45.00% -
    189 208HJ02J03 FHJ02J003 02 CARDIOVASCULAR & HAEMATOPOCITICOLINE INJ. 500 MG / 4 ML F fopi AMP HEXPHARM ( G ) 24,000.03 60.00% 14,400.01
    190 CITICOLINE TAB 500 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC MBF ( G ) 6,600.00 30.00% -
    191 208NP02J07 FNP02J007 02 CARDIOVASCULAR & HAEMATOPOCITICOLINE TAB 500 MG F fopi PC NOVELL (G) 5,610.00 5,610.00
    192 CITICOLINE TAB 500 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC BERNOFARM ( G ) 7,333.33 30.00% 4,400.00
    193 208HJ02J01 FHJ02J001 CITICOLINE TAB 500 MG F fopi PC HEXPHARM ( G ) 5,500.00 46.00% -
    194 CITICOLINE TAB 500 MG F non fopi PC DM ( G ) 6,930.00 30.00% 4,851.00
    195 208NP08K01 FNP08K001 08 ANTI-INFECTIVES SYSTEMIC CLINDAMYCIN TAB 150 MG F fopi PC NOVELL ( G ) 736.89 736.89
    196 08 ANTI-INFECTIVES SYSTEMIC CLINDAMYCIN TAB 300 MG F non fopi PC DM ( G ) 1,361.75 0.00% 1,334.51
    197 208BE08K04 FBE08K004 08 ANTI-INFECTIVES SYSTEMIC CLINDAMYCIN TAB 300 MG F fopi PC BERNOFARM ( G ) 1,400.00 1,400.00
    198 208NP08K02 FNP08K002 08 ANTI-INFECTIVES SYSTEMIC CLINDAMYCIN TAB 300 MG F fopi PC NOVELL ( G ) 1,540.00 17.00% 1,306.67
    199 208DM04A07 FDM04A007 04 CENTRAL NERVOUS SYSTEM CLOBAZAM TABL. F fopi PC DM ( G ) 797.01 1,122.19
    200 CLOBAZAM TABL.
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC DM ( G ) 1,122.19 17.00% 246.24
    201 208IF02F01 FIF02F001 02 CARDIOVASCULAR & HAEMATOPO
    CLONIDIN TAB F fopi PC KF ( G ) 180.65 5.13% 176.13
    202 CLOPIDOGREL TAB. 75 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC FAHRENHEIT (G ) 9,480.08 75.00% 1,283.33
    203 CLOPIDOGREL TAB. 75 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC DM ( G ) 10,394.97 86.49% 1,404.36
    204 CLOPIDOGREL TAB. 75 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC HEXPHARM ( G ) 5,533.00 68.00% 1,650.00
    205 CLOPIDOGREL TAB. 75 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC SCAN (G) 462.00 1,404.23
    206 CLOPIDOGREL TAB. 75 MG F non fopi PC FAHRENHEIT (G ) 8,635.00 75.00%
    207 208PR02N03 FFPR02N003 02 CARDIOVASCULAR & HAEMATOPOCLOPIDOGREL TAB. 75 MG F fopi PC PHAPROS (G) 594.00 30.00% 972.40
    208 208KF02N02 FKF02N002 02 CARDIOVASCULAR & HAEMATOPOCLOPIDOGREL TAB. 75 MG F fopi PC KF ( G ) 1,191.67 1,466.67
    209 CLOPIDOGREL TAB. 75 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC PROMED (G) 4,400.00 40.00% 5,362.50
    210 208DM08C05 FDM08C005 08 ANTI-INFECTIVES SYSTEMIC CO AMOXICLAV TAB 625 MG F fopi PC DM ( G ) 4,620.00 10.00% 4,158.00
    211 208IF08C02 FIF08C002 08 ANTI-INFECTIVES SYSTEMIC CO AMOXICLAV TAB 625 MG F fopi PC INF (G) 5,808.18 7.50% 5,808.14
    212 208KF08J02 FKF08J002 COTRIMOXAZOLE SYR F fopi BTL KF ( G ) 6,263.73 6,263.73
    213 COTRIMOXAZOLE SYR F non fopi BTL BERNOFARM ( G ) 5,610.00 5,610.00
    214 COTRIMOXAZOLE SYR F non fopi BTL PHAPROS (G) 6,655.00 6,655.00

    DATA KEBUTUHAN OBAT REVISI 5 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    215 COTRIMOXAZOLE TAB 480 MG F non fopi PC BERNOFARM ( G ) 330.00 0.00% 242.55
    216 208BE08J02 FBE08J002 COTRIMOXAZOLE TAB 480 MG F fopi PC PROMED (G) 330.00 20.00% -
    217 208DM16E02 FDM16E002 16 DERMATOLOGICALS DESOXIMETASONE CREAM F fopi TUBE DM ( G ) 13,975.50 20.36% 11,130.09
    218 DEVALPROEX SODIUM F non fopi PC YARINDO (G) - -
    219 FPM06D003 06 HORMONES DEXA METHASON TBL 0,50 MG F fopi PC PROMED (G) 176.00 30.00% 100.10
    220 06 HORMONES DEXA METHASON TBL 0,50 MG F non fopi PC KF ( G ) 136.06 136.06
    221 06 HORMONES DEXA METHASON TBL 0,50 MG F non fopi PC YARINDO 66.55 66.55
    222 208PR06D04 FPR06D004 06 HORMONES DEXA METHASON TBL 0,50 MG F fopi PC PHAPROS (G) 117.45 117.45
    223 06 HORMONES DEXA METHASON TBL 0,50 MG F non fopi PC HARSEN 184.25 184.25
    224 208PR06D03 FPR06D003 06 HORMONES DEXA METHASONE INJ. F fopi AMP PHAPROS (G) 2,299.00 50.84% 2,306.33
    225 208BE06D06 FBE06D006 06 HORMONES DEXA METHASONE INJ. F fopi AMP BERNOFARM ( G ) 1,561.56 1,561.56
    226 208PR06D03 FPR06D003 06 HORMONES DEXA METHASONE INJ. F fopi AMP PHAPROS (G) 1,098.00 0.00% 1,130.10
    227 06 HORMONES DEXA METHASONE INJ. F non fopi AMP KF ( G ) 2,299.00 52.23% 2,306.33
    228 04 CENTRAL NERVOUS SYSTEM DEXKETOPROFEN INJ. F non fopi AMP YARINDO (G) 26,400.00 15.00% 23,760.00
    229 208NP04L03 FNP04L003 04 CENTRAL NERVOUS SYSTEM DEXKETOPROFEN INJ. F fopi AMP FAHRENHEIT (G ) 26,400.00 20.00% 20,000.00
    230 208NP04L03 FNP04L003 04 CENTRAL NERVOUS SYSTEM DEXKETOPROFEN INJ. F fopi AMP NOVELL (G) 25,300.00 45.00% 20,000.00
    231 208NP04L03 FNP04L003 04 CENTRAL NERVOUS SYSTEM DEXKETOPROFEN INJ. F fopi AMP NOVELL (G) 25,300.00 47.00% 18,975.00
    232 04 CENTRAL NERVOUS SYSTEM DEXKETOPROFEN INJ. F non fopi AMP ETHICA ( G ) 13,200.00 13,200.00
    233 04 CENTRAL NERVOUS SYSTEM DEXKETOPROFEN TAB. 25 MG F non fopi PC YARINDO (G) 3,410.00 5.00% 3,069.00
    234 208NP04L02 FNP04L002 04 CENTRAL NERVOUS SYSTEM DEXKETOPROFEN TAB. 25 MG F fopi PC NOVELL (G) 2,805.00 2,805.00
    235 208KF04A03 FKF04A003 04 CENTRAL NERVOUS SYSTEM DIAZEPAM TBL. 2 MG F fopi PC KF ( G ) 137.26 0.00% 135.91
    236 208PN02A01 FPN02A001 02 CARDIOVASCULAR & HAEMATOPO DIGOXIN TABL 0,25MG F fopi PC FAHRENHEIT (G ) 143.01 22.50% 107.25
    237 02 CARDIOVASCULAR & HAEMATOPO DIGOXIN TABL 0,25MG F non fopi PC YARINDO (G) 107.25 107.25
    238 DILTIAZEM TAB. F fopi PC DM ( G ) 183.09 5.00%
    239 208DM02B03 FDM02B003 02 CARDIOVASCULAR & HAEMATOPO DILTIAZEM TAB. F fopi PC DM ( G ) 212.61 7.50% -
    240 FPR12A006 12 ALLERGY & IMMUNE SYSTEM DIPHENHYDRAMINE INJ F fopi AMP PHAPROS (G) 1,169.44 0.00% 2,598.90
    241 208NP02A01 FNP02A001 02 CARDIOVASCULAR & HAEMATOPO DOBUTAMIN INJ. 250 MG F fopi VIAL NOVELL (G) 40,810.00 30.00% 27,342.70
    242 208DM02A02 FDM02A002 02 CARDIOVASCULAR & HAEMATOPO DOBUTAMIN INJ. 250 MG F fopi VIAL DM ( G ) 60,031.12 75.00% 28,490.77
    243 208NP02A01 FNP02A001 02 CARDIOVASCULAR & HAEMATOPO DOBUTAMIN INJ. 250 MG F fopi VIAL NOVELL (G) 40,810.00 30.00% 28,567.00
    244 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE SYR. F non fopi BTL PROMED (G) 16,500.00 27.00% 10,725.00
    245 208HJ01B03 FHJ01B003 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE SYR. F fopi BTL HEXPHARM ( G ) 12,650.00 5.00% 9,082.70
    246 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE SYR. F fopi BTL HEXPHARM ( G ) 12,650.00 28.20% 214.50
    247 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE TAB F non fopi PC PROMED (G) 484.00 20.00% -
    248 208DM01B01 FDM01B001 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE TAB F fopi PC DM ( G ) 423.80 70.00% 214.19
    249 208HJ01B03 FHJ01B003 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE TAB F fopi PC HEXPHARM ( G ) 286.00 40.00% -
    250 208NP01B01 FNP01B001 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE TAB F fopi PC NOVELL (G) 302.71 302.71
    251 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE TAB F non fopi PC INFION (G) 286.00 286.00
    252 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE TAB F non fopi PC TEMPO (G) 189.00 189.00
    253 208DM01B01 FDM01B001 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE TAB F fopi PC DM ( G ) 214.18 -
    254 DOPAMIN INJ. F non fopi AMP DM ( G ) 11,550.00 20.00% 9,240.00
    255 208DV08D02 FDV08D002 DORIPENEM INJ. 500 MG F fopi VIAL DARYA VARYA ( G ) 330,000.00 330,000.00
    256 208PN08H01 FPN08H001 08 ANTI-INFECTIVES SYSTEMIC DOXYCYCLINE CAPS. 100 MG F fopi PC FAHRENHEIT (G) 308.55 308.55
    257 DOXYCYCLINE CAPS. 100 MG F non fopi PC DM ( G ) 528.37 40.15% 1,306.67
    258 208ML05C01 FML05C001 05 MUSCULO-SKELETAL SYSTEM EPERISONE 50 MG F fopi PC MEDIKON (G) 1,694.00 50.00% 1,104.34
    259 208EI03B02 FEI03B002 03 RESPIRATORY SYSTEM EPHEDRINE HCL INJEKSI 50 mg / ml F fopi AMP ETHICA ( G ) 8,526.15 8,526.15
    3 02 CARDIOVASCULAR & HAEMATOPO EPINEPHRINE INJ. 1 mg/ml F non fopi AMP ETHICA ( G ) 6,708.17 1,408.00
    4 208EI02K01 FEI02K001 02 CARDIOVASCULAR & HAEMATOPO EPINEPHRINE INJ. 1 mg/ml F fopi AMP ETHICA ( G ) 1,408.00 1,408.00
    5 208PR02K01 FPR02K001 EPINEPHRINE INJ. 1 mg/ml F fopi AMP PHAPROS (G) 2,772.00 4.76% 5,110.13
    6 02 CARDIOVASCULAR & HAEMATOPO EPINEPHRINE INJ. 1 mg/ml F non fopi AMP PHAPROS (G) 2,772.00 0.00% -

    DATA KEBUTUHAN OBAT REVISI 6 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    7 208NP03C03 FNP03C003 03 RESPIRATORY SYSTEM ERDOSTEIN CAPS. 300 MG F PC MBF ( G ) 3,025.00 37.00% -
    8 ERDOSTEIN CAPS. 300 MG F PC PROMED (G) 2,310.00 4.00%
    9 208NP03C04 FNP03C004 03 RESPIRATORY SYSTEM ERDOSTEIN SYR F fopi BTL NOVELL (G) 27,720.00 27,720.00
    10 208KF08F02 FKF08F002 08 ANTI-INFECTIVES SYSTEMIC ERYTHROMYCIN CAPS 250 MG F fopi PC KF ( G ) 938.77 938.77
    11 208PN08F01 FPN08F001 08 ANTI-INFECTIVES SYSTEMIC ERYTHROMYCIN CAPS 500 MG F fopi PC FAHRENHEIT (G) 1,485.01 21.50% 1,168.75
    12 208KF08F03 FKF08F003 08 ANTI-INFECTIVES SYSTEMIC ERYTHROMYCIN DRY SYR F fopi BTL KF ( G ) 13,445.31 5.00% 13,721.40
    13 208KF08L03 FKF08L003 08 ANTI-INFECTIVES SYSTEMIC ETHAMBUTOL TAB 500 MG F fopi PC KF ( G ) 827.53 15.00% 786.15
    14 208MA04L06 FMA04L006 ETORICOXIB 60 MG F fopi PC YARINDO (G) 4,400.00 5.00%
    15 FAVIPIRAVIRE 200 MG F PC HEXPHARM ( G ) 15,000.00 0.00%
    16 02 CARDIOVASCULAR & HAEMATOPO FENOFIBRATE 1OO MG F non fopi PC DM ( G ) 2,309.96 79.52% -
    17 02 CARDIOVASCULAR & HAEMATOPO FENOFIBRATE 1OO MG F non fopi PC DM ( G ) 2,310.01 79.52% -
    18 208HJ02L06 FHJ02L006 02 CARDIOVASCULAR & HAEMATOPO FENOFIBRATE 3OO MG F fopi PC HEXPHARM ( G ) 4,400.00 70.00% -
    19 02 CARDIOVASCULAR & HAEMATOPO FENOFIBRATE 3OO MG F non fopi PC DM ( G ) 4,620.00 68.70% 3,520.00
    20 02 CARDIOVASCULAR & HAEMATOPO FENOFIBRATE 3OO MG F non fopi PC PROMED (G) 2,376.00 -
    21 208KF08N01 FKF08N001 08 ANTI-INFECTIVES SYSTEMIC FLUCONAZOLE CAPS. 150 MG F fopi PC KF ( G ) 18,720.02 0.00% 11,232.01
    22 04 CENTRAL NERVOUS SYSTEM FLUNARIZIN TAB. 10 MG F non fopi PC BERNOFARM ( G ) 2,625.00 2,625.00
    23 208NB04N02 FNB04N002 04 CENTRAL NERVOUS SYSTEM FLUNARIZIN TAB. 10 MG F fopi PC NULAB (G) 1,760.00 1,760.00
    24 04 CENTRAL NERVOUS SYSTEM FLUNARIZIN TAB. 5 MG F non fopi PC BERNOFARM ( G ) 1,760.00 1,760.00
    25 208PR30B03 FPR30B003 30 VITAMINS & MINERALS FOLIC ACID 1 MG F fopi PC KF ( G ) 125.65 0.00% 79.17
    26 30 VITAMINS & MINERALS FOLIC ACID 400 F PC PROMED (G) 198.00 20.00% -
    27 208IF02H01 FIF02H001 02 CARDIOVASCULAR & HAEMATOP FUROSEMIDE INJ F fopi AMP INF (G) 3,410.00 35.00% 2,160.93
    28 02 CARDIOVASCULAR & HAEMATOP FUROSEMIDE INJ F non fopi AMP DM ( G ) 3,719.10 75.18% 1,869.22
    29 208KF02H01 FKF02H001 02 CARDIOVASCULAR & HAEMATOP FUROSEMIDE TBL. 40 MG F fopi PC KF ( G ) 160.87 30.77% 223.85
    30 208KF02H01 FKF02H001 02 CARDIOVASCULAR & HAEMATOP FUROSEMIDE TBL. 40 MG F fopi PC KF ( G ) 152.83 152.83
    31 208PN02H04 FPN02H004 02 CARDIOVASCULAR & HAEMATOP FUROSEMIDE TBL. 40 MG F fopi PC FAHRENHEIT (G ) 220.00 12.50% 198.00
    32 04 CENTRAL NERVOUS SYSTEM GABAPENTIN TAB. 300 MG F non fopi PC FAHRENHEIT (G ) 5,500.00 55.00% 3,850.00
    33 208NP04M02 FNP04M002 04 CENTRAL NERVOUS SYSTEM GABAPENTIN TAB. 300 MG F fopi PC NOVELL 5,775.03 82.42% 1,015.25
    34 04 CENTRAL NERVOUS SYSTEM GABAPENTIN TAB. 300 MG F non fopi PC DM ( G ) 5,775.00 0.00% 1,015.24
    35 208PR02L01 FPR02L001 02 CARDIOVASCULAR & HAEMATOPO GEMFIBROZIL 300 MG F fopi PC PHAPROS (G) 462.00 0.00% 573.56
    36 16 DERMATOLOGICALS GENTAMYCIN CREAM 5 GRM F non fopi TUBE KF ( G ) 2,937.01 41.01% 2,206.79
    37 208KF16A01 FKF16A001 16 DERMATOLOGICALS GENTAMYCIN CREAM 5 GRM F fopi TUBE GENERIK 3,650.90 0.00% 3,377.08
    38 08 ANTI-INFECTIVES SYSTEMIC GENTAMYCIN INJ F non fopi AMP KF ( G ) 1,732.54 -
    39 208KF03C14 FKF03C014 GG / GUAIFENESIN 100 MG F fopi PC KF ( G ) 220.00 25.00% 176.00
    40 208HJ11B01 FHJ11B001 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 1 MG F fopi PC HEXPHARM ( G ) 484.00 65.00% 314.60
    41 208KF11B01 FKF11B001 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 1 MG F fopi PC KF ( G ) 297.00 297.00
    42 208DM11B21 FDM11B021 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 2 MG F fopi PC DM ( G ) 1,504.95 86.25% 206.93
    43 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 2 MG F non fopi PC BERNOFARM ( G ) 644.98 644.98
    44 208KF11B02 FKF11B002 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 2 MG F fopi PC KF ( G ) 660.02 74.24% 396.00
    45 208HJ11B02 FHJ11B002 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 2 MG F fopi PC HEXPHARM ( G ) 880.00 80.00% -
    46 208DM11B23 FDM11B023 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 3 MG F fopi PC DM ( G ) 245.03 245.03
    47 208KF11B03 FKF11B003 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 3 MG F fopi PC KF ( G ) 770.00 55.00% 462.00
    48 208HJ11B03 FHJ11B003 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 3 MG F fopi PC HEXPHARM ( G ) 1,320.00 75.00% 1,055.25
    49 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 4 MG F non fopi PC DM ( G ) 2,736.31 89.37% 290.87
    50 208KF11B04 FKF11B004 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 4 MG F fopi PC KF ( G ) 880.01 77.84% -
    51 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 4 MG F non fopi PC INFION (G) 1,430.00 1,430.00
    52 208HJ11B04 FHJ11B004 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 4 MG F fopi PC HEXPHARM ( G ) 1,760.00 80.00% 1,232.00
    53 208DM11B11 FDM11B011 11 ENDOCRINE & METABOLIC SYST GLIQUIDONE 30 MG F fopi PC DM ( G ) 1,391.13 5.00% 1,321.57
    54 208HJ05F01 FHJ05F001 05 MUSCULO-SKELETAL SYSTEM GLUCOSAMINE 250 MG F fopi PC HEXPHARM ( G ) 880.01 33.33% 586.70
    55 208HJ05F01 FHJ05F001 GLUCOSAMINE 250 MG F fopi PC HEXPHARM ( G ) 880.00 46.00% -

    DATA KEBUTUHAN OBAT REVISI 7 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    56 05 MUSCULO-SKELETAL SYSTEM GLUCOSAMINE MPL 500 MG F non fopi PC MEDIKON (G) 1,303.57 1,303.57
    57 208KF03C14 FKF03C014 GLYCERYL GUAICOLATE TAB. F fopi PC KF ( G ) 220.00 10.00% 187.00
    58 208NP01I11 FNP01I011 01 GASTROINTESTINAL & HEPATOBIGRANISETRON INJ. 1 MG F fopi AMP NOVELL (G) 9,900.00 9,900.00
    59 01 GASTROINTESTINAL & HEPATOBIGRANISETRON INJ. 3 MG F non fopi AMP FAHRENHEIT (G ) 44,000.00 44,000.00
    60 208KF02H02 FKF02H002 02 CARDIOVASCULAR & HAEMATOPO HCT TBL. 25 MG F fopi PC KF ( G ) 163.35 163.35
    61 208KF16E04 FKF16E004 16 DERMATOLOGICALS HYDROCORTISON 2,5% F fopi TUBE KF ( G ) 3,803.80 38.88% -
    62 208IF04L03 FIF04L003 04 CENTRAL NERVOUS SYSTEM IBUPROFEN SYR. F fopi BTL INDOFARMA (G) 4,955.00 4,955.00
    63 208PN04L02 FPN04L002 04 CENTRAL NERVOUS SYSTEM IBUPROFEN 200 MG F fopi PC FAHRENHEIT (G ) 192.50 13.15% 158.40
    64 FPM04L007 04 CENTRAL NERVOUS SYSTEM IBUPROFEN 400 MG F fopi PC PROMED (G) 528.00 23.00% -
    65 208PN04L03 FPN04L003 04 CENTRAL NERVOUS SYSTEM IBUPROFEN 400 MG F fopi PC FAHRENHEIT (G ) 385.00 5.00% 365.75
    66 ISONIAZID TABL 100 MG F non fopi PC KF ( G ) 179.74 0.00%
    67 ISONIAZID TABL 100 MG F non fopi PC KF ( G ) 179.74 3.50% 173.45
    68 ISONIAZID TABL 300 MG F non fopi PC KF ( G ) 262.31 3.50% 262.31
    69 208IF02B02 FIF02B002 02 CARDIOVASCULAR & HAEMATOPO ISOSORBIDE DINITRATE INJEKSI F fopi PC FAHRENHEIT (G ) 55,000.00 25.00% 148.50
    70 208PN02B04 FPN02B004 02 CARDIOVASCULAR & HAEMATOPO ISOSORBIDE DINITRATE TABLET F fopi PC FAHRENHEIT (G ) 121.00 20.00% 102.85
    71 KALIUM DIKLOPENAK 25 MG F non fopi PC DM ( G ) 369.34 369.34
    72 208HJ04L04 FHJ04L004 KALIUM DIKLOPENAK 50 MG F fopi PC HEXPHARM ( G ) 660.00 42.00% 708.03
    73 KALIUM DIKLOPENAK 50 MG F non fopi PC DM ( G ) 594.74 594.74
    74 KALIUM DIKLOPENAK 50 MG F non fopi PC HEXPHARM ( G ) 475.20 475.20
    75 17 ANAESTHETICS LOCAL & GENER KETAMIN INJ. 100 MG/ML F non fopi AMP DM ( G ) 161,700.00 40.00% 97,020.00
    76 17 ANAESTHETICS LOCAL & GENER KETAMIN INJ. 50 MG/ML F non fopi AMP DM ( G ) 80,850.00 40.00% 48,510.00
    77 208DM16B01 FDM16B001 16 DERMATOLOGICALS KETOKONAZOLE CREAM F fopi TUBE DM ( G ) 7,350.02 10.00% 6,615.02
    78 16 DERMATOLOGICALS KETOKONAZOLE CREAM F non fopi TUBE HEXPHARM ( G ) 4,666.20 5.00% -
    79 KETOKONAZOLE CREAM F fopi TUBE KF ( G ) 44.32% -
    80 208DM08N04 FDM08N004 08 ANTI-INFECTIVES SYSTEMIC KETOKONAZOLE TAB. 200 MG F fopi PC DM ( G ) 430.49 6.00% 1,063.13
    81 208HJ08N01 FHJ08N001 08 ANTI-INFECTIVES SYSTEMIC KETOKONAZOLE TAB. 200 MG F fopi PC HEXPHARM ( G ) 409.99 25.00% 408.96
    82 KETOPROFEN TAB. F PC DM ( G ) 1,417.51 30.00% 563.20
    83 04 CENTRAL NERVOUS SYSTEM KETOPROFEN TAB. 100 MG F PC BERNOFARM ( G ) 1,320.00 55.00% -
    84 208NP04L09 FNP04L009 04 CENTRAL NERVOUS SYSTEM KETOPROFEN TAB. 50 MG F fopi PC NOVELL (G) 563.20 563.20
    85 04 CENTRAL NERVOUS SYSTEM KETOROLAC INJ. 30 MG F non fopi AMP HEXPHARM ( G ) 5,000.05 0.00% 4,750.02
    86 04 CENTRAL NERVOUS SYSTEM KETOROLAC INJ. 30 MG F non fopi AMP NOVELL (G) 13,365.00 58.00% 6,682.50
    87 04 CENTRAL NERVOUS SYSTEM KETOROLAC INJ. 30 MG F non fopi AMP INF (G) 3,849.12 3,849.12
    88 208PR04L05 FPR04L005 04 CENTRAL NERVOUS SYSTEM KETOROLAC INJ. 30 MG F fopi AMP PHAPROS (G) 1,034.18 0.00% 1,083.55
    89 208EI04L02 FEI04L002 04 CENTRAL NERVOUS SYSTEM KETOROLAC INJ. 30 MG F fopi AMP ETHICA ( G ) 2,169.20 0.50% 9,355.50
    90 04 CENTRAL NERVOUS SYSTEM KETOROLAC INJ. 30 MG F non fopi AMP DM ( G ) 8,419.95 8,419.95
    91 04 CENTRAL NERVOUS SYSTEM KETOROLAC INJ. 30 MG F non fopi AMP DARYA VARYA ( G ) 3,960.00 0.00% -
    92 04 CENTRAL NERVOUS SYSTEM KETOROLAC TAB. F non fopi PC HEXPHARM ( G ) 2,525.60 2,525.60
    93 04 CENTRAL NERVOUS SYSTEM KETOROLAC TAB. F non fopi PC NOVELL (G) 1,265.00 1,265.00
    94 208NP01A01 FNP01A001 01 GASTROINTESTINAL & HEPATOBILANSOPRAZOLE 30 MG F fopi PC NOVELL (G) 1,081.08 1,081.08
    95 208HJ01A04 FHJ01A004 01 GASTROINTESTINAL & HEPATOBILANSOPRAZOLE 30 MG F fopi PC HEXPHARM ( G ) 990.00 50.00% 330.00
    96 208PN14F03 FPN14F003 01 GASTROINTESTINAL & HEPATOBILATANOPROST 2.5 ML F fopi PC FAHRENHEIT (G ) 110,000.00 42.00% 700.00
    97 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN 500 MG F non fopi PC HEXPHARM ( G ) 1,375.00 70.00% 1,072.50
    98 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN 500 MG F non fopi PC DM ( G ) 1,211.38 20.00% 1,211.38
    99 208KF08G03 FKF08G003 LEVOFLOXACIN 500 MG F fopi PC KF ( G ) 770.00 51.56%
    100 208NP08G05 FNP08G005 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN 500 MG F fopi PC NOVELL ( G ) 1,211.38 969.10
    101 208NP08G05 FNP08G005 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN INF. 500 ML F fopi BTL NOVELL ( G ) 88,000.00 58.00% 52,800.00
    102 208DM08G03 FDM08G003 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN INF. 500 ML F fopi BTL DM ( G ) 92,400.00 74.00% 64,680.00
    103 208NP08G05 FNP08G005 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN INF. 500 ML F fopi BTL NOVELL ( G ) 88,000.00 53.00% 52,800.00
    104 208YN08G04 FYN08G004 LEVOFLOXACIN INF. 500 ML F fopi BTL HEXPHARM ( G ) 88,000.00 74.10% -

    DATA KEBUTUHAN OBAT REVISI 8 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    105 208KF08G03 FKF08G003 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN INF. 750 ML F fopi PC NOVELL ( G ) 110,000.00 30.00% 770.00
    106 08 ANTI-INFECTIVES SYSTEMIC LEVOFLOXACIN INF. 750 ML F fopi BTL DM ( G ) 173,250.00 50.00% 52,800.00
    107 LEVOFLOXACIN INF. 750 ML F BTL HEXPHARM ( G ) 165,000.00 50.00%
    108 208PR17A03 FPR17A003 17 ANAESTHETICS LOCAL & GENER LIDOCAIN COMP INJ. 2% F fopi AMP PHAPROS (G) 2,310.00 0.00% 1,197.90
    109 208BE17O07 FBE17O007 17 ANAESTHETICS LOCAL & GENER LIDOCAIN INJ. 2% F fopi AMP BERNOFARM ( G ) 1,155.00 1,155.00
    110 17 ANAESTHETICS LOCAL & GENER LIDOCAIN INJ. 2% F non fopi AMP KF ( G ) 1,392.00 5.00% 1,085.74
    111 208PR17A01 FPR17A001 17 ANAESTHETICS LOCAL & GENER LIDOCAIN INJ. 2% F fopi AMP PHAPROS (G) 1,060.49 0.00% 1,197.09
    112 12 ALLERGY & IMMUNE SYSTEM LORATADIN 10 MG F fopi PC HEXPHARM ( G ) 330.01 60.31% -
    113 12 ALLERGY & IMMUNE SYSTEM LORATADIN 10 MG F non fopi PC PROMED (G) 352.00 23.00% 254.10
    114 208NP04P02 FNP04P002 04 CENTRAL NERVOUS SYSTEM MECOBALAMIN 500 MG F fopi PC NOVELL (G) 880.00 45.00% 594.00
    115 208NP04P03 FNP04P003 04 CENTRAL NERVOUS SYSTEM MECOBALAMIN INJEKSI F fopi AMP NOVELL ( G ) 8,800.00 42.00% 7,040.00
    116 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 15 MG F non fopi PC MBF ( G ) 512.60 20.00% 791.34
    117 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 15 MG F non fopi PC DM ( G ) 1,258.95 53.55% 584.78
    118 208NP04L13 FNP04L013 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 15 MG F fopi PC NOVELL (G) 959.20 959.20
    119 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 15 MG F non fopi PC HEXPHARM ( G ) 770.00 57.00% 585.45
    120 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 7.5 MG F non fopi PC DM ( G ) 726.49 25.00% 544.87
    121 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 7.5 MG F non fopi PC BERNOFARM ( G ) 332.11 332.11
    122 208HJ04L08 FHJ04L008 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 7.5 MG F fopi PC HEXPHARM ( G ) 418.00 47.00% 331.05
    123 04 CENTRAL NERVOUS SYSTEM MELOXICAM TAB 7.5 MG F non fopi PC INF (G) 337.82 337.82
    124 MEROPENEM INJ. 0.5 GR F non fopi VIAL KF ( G ) 45,650.00 0.00%
    125 208DM08D06 FDM08D006 08 ANTI-INFECTIVES SYSTEMIC MEROPENEM INJ. 0.5 GR F fopi VIAL DM ( G ) 138,600.00 83.00% -
    126 08 ANTI-INFECTIVES SYSTEMIC MEROPENEM INJ. 1 GR F fopi VIAL NOVELL ( G ) 220,000.00 55.00% 105,600.00
    127 208DM08D03 FDM08D003 08 ANTI-INFECTIVES SYSTEMIC MEROPENEM INJ. 1 GR F fopi VIAL DM ( G ) 230,997.47 88.12% 105,600.00
    128 208DM08D03 FDM08D003 08 ANTI-INFECTIVES SYSTEMIC MEROPENEM INJ. 1 GR F fopi VIAL DM ( G ) 231,000.00 88.12% 105,600.00
    129 208HJ08D01 FHJ08D001 08 ANTI-INFECTIVES SYSTEMIC MEROPENEM INJ. 1 GR F fopi VIAL HEXPHARM ( G ) 110,000.00 72.00% 33,957.00
    130 208PR11B03 FPR11B003 11 ENDOCRINE & METABOLIC SYST METFORMIN TAB 500 MG F fopi PC PHAPROS (G) 228.69 228.69
    131 11 ENDOCRINE & METABOLIC SYST METFORMIN TAB 850 MG F non fopi PC DM ( G ) 450.44 5.00% 177.00
    132 11 ENDOCRINE & METABOLIC SYST METFORMIN TAB 850 MG F non fopi PC HEXPHARM ( G ) 316.80 316.80
    133 208DM11B23 FDM11B023 11 ENDOCRINE & METABOLIC SYST METFORMIN TAB. 500 MG F fopi PC DM ( G ) 190.58 5.00% 181.05
    134 11 ENDOCRINE & METABOLIC SYST METFORMIN TAB. 500 MG F non fopi PC SCAN (G) 168.75 0.00% 143.32
    135 208HJ11B05 FHJ11B005 11 ENDOCRINE & METABOLIC SYST METFORMIN TAB. 500 MG F fopi PC HEXPHARM ( G ) 192.50 40.00% -
    136 11 ENDOCRINE & METABOLIC SYST METFORMIN XR TAB 500 MG F non fopi PC PROMED (G) 550.00 5.00% 522.50
    137 11 ENDOCRINE & METABOLIC SYST METFORMIN XR TAB 750 MG F non fopi PC PROMED (G) 737.00 5.00% -
    138 10 GENITO-URINARY SYSTEM METHYLERGOMETRINE MALEATE INJ F non fopi AMP NOVELL (G) 3,850.00 20.00% 3,465.00
    139 FKF10C002 10 GENITO-URINARY SYSTEM METHYLERGOMETRINE TABLET F fopi AMP KF ( G ) 274.38 22.01% 3,086.49
    140 06 HORMONES METHYLPREDNISOLON INJ. F non fopi AMP DM ( G ) 37,249.30 30.00% 26,074.51
    141 208PR06D05 FPR06D005 06 HORMONES METHYLPREDNISOLON INJ. F fopi AMP MBF ( G ) 23,760.00 40.00% 10,750.69
    142 208BE06D07 FBE06D007 06 HORMONES METHYLPREDNISOLON INJ. F fopi AMP BERNOFARM ( G ) 49,500.00 75.00% 29,700.00
    143 208NP06D01 FNP06D001 06 HORMONES METHYLPREDNISOLON TAB 16 MG F fopi PC DM ( G ) 1,086.75 25.00% 983.25
    144 06 HORMONES METHYLPREDNISOLON TAB 16 MG F non fopi PC HEXPHARM ( G ) 1,170.00 55.00% 815.06
    145 06 HORMONES METHYLPREDNISOLON TAB 4 MG F non fopi PC MBF ( G ) 825.00 37.00% -
    146 208HJ06D03 FHJ06D003 06 HORMONES METHYLPREDNISOLON TAB 4 MG F fopi PC HEXPHARM ( G ) 440.56 62.55% 321.75
    147 06 HORMONES METHYLPREDNISOLON TAB 4 MG F non fopi PC DM ( G ) 462.57 40.00% -
    148 06 HORMONES METHYLPREDNISOLON TAB 8 MG F non fopi PC DM ( G ) 614.26 30.00% 429.98
    149 208PM06D06 FPM06D006 06 HORMONES METHYLPREDNISOLON TAB 8 MG F PC MBF ( G ) 462.00 30.00% 693.00
    150 06 HORMONES METHYLPREDNISOLON TAB 8 MG F non fopi PC PROMED (G) 990.00 55.00% 491.40
    151 208NP06D03 FNP06D003 06 HORMONES METHYLPREDNISOLON TAB 8 MG F fopi PC NOVELL (G) 526.50 526.50
    152 208BE01B11 FBE01B011 01 GASTROINTESTINAL & HEPATOBIMETOCLOPRAMIDE INJ. F fopi AMP BERNOFARM ( G ) 7,700.00 49.00% 6,545.00
    153 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE INPUS F non fopi BTL NOVELL (G) 39,820.00 39,820.00

    DATA KEBUTUHAN OBAT REVISI 9 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    154 208DV08S01 FDV08S001 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE INPUS F fopi BTL DARYA VARIA (G) 8,250.00 0.00% 8,250.00
    155 208HJ08S01 FHJ08S001 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE INPUS F fopi BTL HEXPHARM ( G ) 22,000.00 67.00% -
    156 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE TAB. 500 MG F non fopi PC NOVELL (G) 501.56 36.00% 281.53
    157 208BE08S01 FBE08S001 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE TAB. 500 MG F fopi PC BERNOFARM ( G ) 171.60 171.60
    158 208KF08S03 FKF08S003 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE TAB. 500 MG F fopi PC KF ( G ) 281.53 281.53
    159 208KF08S03 FKF08S003 METRONIDAZOLE TAB. 500 MG F fopi PC KF ( G ) 360.95 5.00% -
    160 208KF16B03 FKF16B003 MICONAZOLE KRIM 2% F fopi PC KF ( G ) 4,125.01 53.94% 4,125.00
    161 208KF16B03 FKF16B003 16 DERMATOLOGICALS MICONAZOLE KRIM 2% F fopi PC KF ( G ) 4,113.30 4,125.00
    162 208CB04B02 FCB04B002 04 CENTRAL NERVOUS SYSTEM MIDAZOLAM INJ. 5 MG/1 ML F fopi TUBE COMBIPHAR (G) 20,328.00 20,328.00
    163 16 DERMATOLOGICALS MUPIROCIN OINTMENT 2% F fopi TUBE NOVELL (G) 19,250.00 22.00% 29,700.00
    164 04 CENTRAL NERVOUS SYSTEM N-ACETYLCESTEINE 300 MG/3ML F non fopi AMP DM ( G ) 25,987.51 5.00% -
    165 208PR04L09 FPR04L009 04 CENTRAL NERVOUS SYSTEM NATRIUM DIKLOPENAK 25 MG F fopi PC PHAPROS (G) 122.96 0.00% -
    166 04 CENTRAL NERVOUS SYSTEM NATRIUM DIKLOPENAK 25 MG F non fopi PC PHAPROS (G) 141.00 0.00% -
    167 04 CENTRAL NERVOUS SYSTEM NATRIUM DIKLOPENAK 50 MG F non fopi PC DM ( G ) 231.00 50.00% -
    168 208KF04L16 FKF04L016 04 CENTRAL NERVOUS SYSTEM NATRIUM DIKLOPENAK 50 MG F fopi PC KF ( G ) 158.08 158.08
    169 208PR04L10 FPR04L010 04 CENTRAL NERVOUS SYSTEM NATRIUM DIKLOPENAK 50 MG F fopi PC PHAPROS (G) 122.58 0.00% 126.46
    170 208IP04E05 FIP04E005 04 CENTRAL NERVOUS SYSTEM NATRIUM PHENYTOIN CAPS F fopi PC IKAPHARMINDO 605.00 0.00% 544.62
    171 208PN02E04 FPN02E004 02 CARDIOVASCULAR & HAEMATOPO NICARDIPINE INJ. F fopi AMP FAHRENHEIT (G ) 57,170.76 57,200.00
    172 208NP02E05 FNP02E005 02 CARDIOVASCULAR & HAEMATOPO NICARDIPINE INJ. F fopi AMP NOVELL (G) 88,000.00 73.13% 58,960.00
    173 02 CARDIOVASCULAR & HAEMATOPO NIFEDIPIN TAB 10 MG F fopi PC DM ( G ) 155.76 7.00% 155.76
    174 208KF02E03 FKF02E003 02 CARDIOVASCULAR & HAEMATOPO NIFEDIPIN TAB 10 MG F fopi PC KF ( G ) 220.17 2.50% 203.68
    175 208HJ02K01 FHJ02K001 02 CARDIOVASCULAR & HAEMATOPO NOREPINEPHRINE INJ. BTR. 4 mg/4 ml F fopi AMP HEXPHARM ( G ) 33,000.00 26.00% -
    176 02 CARDIOVASCULAR & HAEMATOPO NOREPINEPHRINE INJ. BTR. 4 mg/4 ml F non fopi AMP BERNOFARM ( G ) 36,300.00 36,300.00
    177 08 ANTI-INFECTIVES SYSTEMIC NYSTATIN DROPS F non fopi BTL BERNOFARM ( G ) 21,780.00 21,780.00
    178 OMEPRAZOLE CAPS. 20 MG F non fopi PC DM ( G ) 20.00%
    179 01 GASTROINTESTINAL & HEPATOBIOMEPRAZOLE CAPS. 20 MG F non fopi PC FAHRENHEIT (G ) 528.00 25.00% 445.46
    180 208HJ01A05 FHJ01A005 01 GASTROINTESTINAL & HEPATOBIOMEPRAZOLE CAPS. 20 MG F fopi PC HEXPHARM ( G ) 408.33 51.00% -
    181 01 GASTROINTESTINAL & HEPATOBIOMEPRAZOLE INJ. F non fopi VIAL NOVELL (G) 55,000.00 52.00%
    182 01 GASTROINTESTINAL & HEPATOBIOMEPRAZOLE INJ. F non fopi VIAL NOVELL (G) 55,000.00 57.00% 27,500.00
    183 01 GASTROINTESTINAL & HEPATOBIOMEPRAZOLE INJ. F non fopi VIAL QUANTUM 27,500.00 10.00% -
    184 208DM01A04 FDM01A004 01 GASTROINTESTINAL & HEPATOBIOMEPRAZOLE INJ. F fopi VIAL DM ( G ) 78,540.00 87.00% 10,673.59
    185 ONDANSENTRON INJ. 4 MG F non fopi AMP MBF ( G ) 3,190.00 20.00%
    186 ONDANSENTRON INJ. 4 MG F non fopi AMP NOVELL ( G ) 7,700.00 58.00% -
    187 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON INJ. 4 MG F non fopi AMP DM ( G ) 5,775.01 80.03% -
    188 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON INJ. 4 MG F AMP BERNOFARM ( G ) 8,000.09 55.00% 4,950.00
    189 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON INJ. 4 MG F non fopi AMP HEXPHARM ( G ) 5,500.00 35.00% -
    190 ONDANSENTRON INJ. 8 MG F AMP BERNOFARM ( G ) 8,000.09 55.00% 4,950.00
    191 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON INJ. 8 MG F non fopi AMP NOVELL (G) 18,480.00 58.00% 10,164.00
    192 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON INJ. 8 MG F non fopi AMP HEXPHARM ( G ) 7,920.00 50.00% -
    193 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON INJ. 8 MG F non fopi AMP NOVELL (G) 18,480.00 55.00% -
    194 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON TAB. 4 MG F non fopi PC PROMED (G) 1,430.00 30.00% -
    195 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON TAB. 4 MG F non fopi PC FAHRENHEIT (G ) 1,540.00 50.00% 1,131.90
    196 208NP01I03 FNP01I003 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON TAB. 4 MG F fopi PC NOVELL ( G ) 1,595.00 35.00% 1,232.00
    197 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON TAB. 4 MG F non fopi PC DM ( G ) 1,617.03 30.00% 1,859.55
    198 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON TAB. 8 MG F non fopi PC MBF ( G ) 2,816.00 30.00% -
    199 01 GASTROINTESTINAL & HEPATOBIONDANSENTRON TAB. 8 MG F non fopi PC INF (G) 2,530.00 35.00% 1,644.50
    200 13 NUTRITION ORALIT 200 CC F non fopi PC KF ( G ) 915.06 0.00% -
    201 208KF14A02 FKF14A002 08 ANTI-INFECTIVES SYSTEMIC OXYTETRACYCLIN 1% SALEP MATA F fopi TUBE KF ( G ) 3,500.20 0.00% 3,327.50
    202 10 GENITO-URINARY SYSTEM OXYTOCIN INJ. F non fopi AMP NOVELL ( G ) 2,750.00 20.00% 2,200.00

    DATA KEBUTUHAN OBAT REVISI 10 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    203 208EI10C03 FEI10C003 10 GENITO-URINARY SYSTEM OXYTOCIN INJ. F fopi AMP ETHICA ( G ) 2,475.00 2,475.00
    204 01 GASTROINTESTINAL & HEPATOBIPANTOPRAZOLE 40 MG INJ. F non fopi VIAL NOVELL (G) 64,900.00 55.00% 43,483.00
    205 01 GASTROINTESTINAL & HEPATOBIPANTOPRAZOLE 40 MG INJ. F non fopi VIAL DM ( G ) 57,750.00 65.00% -
    206 01 GASTROINTESTINAL & HEPATOBIPANTOPRAZOLE 40 MG INJ. F non fopi VIAL PHAPROS G 13,090.00 0.00% 20,570.00
    207 208IF04K03 FIF04K003 PARACETAMOL DROPS F fopi BTL INF (G) 8,250.00 22.00% -
    208 04 CENTRAL NERVOUS SYSTEM PARACETAMOL INFUS F non fopi BTL NOVELL (G) 46,750.00 35.00% -
    209 04 CENTRAL NERVOUS SYSTEM PARACETAMOL INFUS F non fopi BTL DARYA VARIA (G) 11,990.00 0.00% 32,725.00
    210 208BE04K05 FBE04K005 04 CENTRAL NERVOUS SYSTEM PARACETAMOL INFUS F fopi BTL BERNOFARM ( G ) 66,000.00 81.83% 19,800.00
    211 04 CENTRAL NERVOUS SYSTEM PARACETAMOL INFUS F non fopi BTL KF ( G ) 25,410.00 52.81% 35,018.50
    212 04 CENTRAL NERVOUS SYSTEM PARACETAMOL INFUS F non fopi BTL QUANTUM 22,000.00 0.00% -
    213 04 CENTRAL NERVOUS SYSTEM PARACETAMOL SYRUP 60 ML F non fopi BTL PROMED (G) 7,700.00 15.00% -
    214 04 CENTRAL NERVOUS SYSTEM PARACETAMOL SYRUP 60 ML F non fopi BTL INF (G) 3,850.00 3,850.00
    215 04 CENTRAL NERVOUS SYSTEM PARACETAMOL SYRUP 60 ML F non fopi BTL KF ( G ) 6,050.00 5.00% 5,596.25
    216 208TP04L02 FTP04L002 04 CENTRAL NERVOUS SYSTEM PARACETAMOL SYRUP 60 ML F fopi BTL TEMPO (G) 5,457.00 5,457.00
    217 208PM04K04 FPM04K004 04 CENTRAL NERVOUS SYSTEM PARACETAMOL TAB 500 MG F fopi PC PROMED (G) 259.13 30.00% 177.10
    218 208BE04K07 FBE04K007 04 CENTRAL NERVOUS SYSTEM PARACETAMOL TAB 500 MG F fopi PC BERNOFARM ( G ) 115.50 115.50
    219 208KF04K01 FKF04K001 04 CENTRAL NERVOUS SYSTEM PARACETAMOL TAB 500 MG F fopi PC KF ( G ) 274.48 12.50% 267.62
    220 04 CENTRAL NERVOUS SYSTEM PARACETAMOL TAB 500 MG F non fopi PC YARINDO 158.40 158.40
    221 208PM04K04 FPM04K004 04 CENTRAL NERVOUS SYSTEM PARACETAMOL TAB 500 MG F fopi PC PROMED (G) 197.34 -
    222 208KF17A03 FKF17A003 17 ANAESTHETICS LOCAL & GENER PETHIDIN INJ 50 MG/ML F fopi AMP KF ( G ) 19,481.00 19,481.00
    223 04 CENTRAL NERVOUS SYSTEM PHENOBARBITAL INJ. F fopi AMP PHAPROS G 1,740.02 1,740.02
    224 04 CENTRAL NERVOUS SYSTEM PHENOBARBITAL TBL 30 MG F fopi PC KF ( G ) 240.00 240.00
    225 208PR02M01 FPR02M001 PHYTOMENADION INJ. 10 MG (DEWASA)F fopi AMP PHAPROS (G) 5,024.80 0.00%
    226 208PR02M01 FPR02M001 02 CARDIOVASCULAR & HAEMATOPO PHYTOMENADION INJ. 10 MG (DEWASA)F fopi AMP PHAPROS (G) 4,306.50 0.00% 4,004.03
    227 PHYTOMENADION INJ. 10 MG (DEWASA)F fopi AMP PHAPROS (G) 4,306.50 10.00% 4,004.03
    228 208PR02M02 FPR02M002 PHYTOMENADION INJ. 2 MG ( ANAK ) F fopi AMP PHAPROS (G) 3,867.00 0.00%
    229 208PR02M02 FPR02M002 02 CARDIOVASCULAR & HAEMATOPO PHYTOMENADION INJ. 2 MG ( ANAK ) F fopi AMP PHAPROS (G) 3,960.00 0.00% 4,193.92
    230 208PR02M03 FPR02M003 PHYTOMENADION TABLET 10 MG F fopi PC PHAPROS (G) 781.00 0.00% 892.95
    231 208PR02M03 FPR02M003 02 CARDIOVASCULAR & HAEMATOPO PHYTOMENADION TABLET 10 MG F fopi PC PHAPROS (G) 797.01 892.95
    232 208PR02M03 FPR02M003 02 CARDIOVASCULAR & HAEMATOPO PHYTOMENADION TABLET 10 MG F fopi PC PHAPROS (G) 797.01 797.01
    233 PIOGLITAZONE 15 MG F PC YARINDO (G) 3,630.00 35.00%
    234 11 ENDOCRINE & METABOLIC SYST PIOGLITAZONE 15 MG F fopi PC MBF ( G ) 3,666.67 45.00% 2,887.50
    235 PIOGLITAZONE 15 MG F PC DM ( G ) 2,887.51 25.00% 4,950.00
    236 11 ENDOCRINE & METABOLIC SYST PIOGLITAZONE 30 MG F fopi PC DM ( G ) 4,950.00 4,950.00
    237 208NP04P07 FNP04P007 04 CENTRAL NERVOUS SYSTEM PIRACETAM INJ. 1 GR F fopi AMP NOVELL (G) 6,600.00 30.00% 4,620.00
    238 04 CENTRAL NERVOUS SYSTEM PIRACETAM INJ. 1 GR F fopi AMP BERNOFARM ( G ) 5,610.00 5,610.00
    239 04 CENTRAL NERVOUS SYSTEM PIRACETAM INJ. 3 GR F non fopi AMP NOVEL (G) 20,625.00 30.00% 7,184.10
    240 04 CENTRAL NERVOUS SYSTEM PIRACETAM INJ. 3 GR F non fopi AMP HEXPHARM ( G ) 11,000.00 10.00% 14,437.50
    241 208DM04P09 FDM04P009 04 CENTRAL NERVOUS SYSTEM PIRACETAM INJ. 3 GR F fopi AMP DM ( G ) 12,572.18 12,572.18
    242 04 CENTRAL NERVOUS SYSTEM PIRACETAM TAB. 1200 MG F non fopi PC DM ( G ) 1,358.29 30.00% 950.80
    243 208HJ04P01 FHJ04P001 04 CENTRAL NERVOUS SYSTEM PIRACETAM TAB. 1200 MG F fopi PC HEXPHARM ( G ) 1,100.00 40.00% 896.45
    244 208HJ04P02 FHJ04P002 04 CENTRAL NERVOUS SYSTEM PIRACETAM TAB. 800 MG F fopi PC HEXPHARM ( G ) 715.00 40.00% 556.42
    245 208BE04P18 FBE04P018 04 CENTRAL NERVOUS SYSTEM PIRACETAM TAB. 800 MG F fopi PC BERNOFARM ( G ) 578.16 578.16
    246 04 CENTRAL NERVOUS SYSTEM PIRACETAM TAB. 800 MG F non fopi PC DM ( G ) 843.16 30.00% 758.83
    247 04 CENTRAL NERVOUS SYSTEM PIRACETAM TAB. 800 MG F non fopi PC PROMED (G) 627.00 -
    248 PIROXICAM TABL 10 MG F non fopi PC YARINDO (G) 93.50 93.50
    249 PRAMIPEXOLE TAB. 0.125 MG F PC DM ( G ) 10.00%
    250 PREDNISON TABL 5 MG F fopi PC PHAPROS G 148.50 0.00% 173.25
    251 208PR06D11 FPR06D011 06 HORMONES PREDNISON TABL 5 MG F fopi PC GENERIK 173.25 173.25

    DATA KEBUTUHAN OBAT REVISI 11 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    252 04 CENTRAL NERVOUS SYSTEM PREGABALIN CAPS 150 MG F non fopi PC DM ( G ) 10,395.00 30.00% 7,276.50
    253 208KF04E02 FKF04E002 04 CENTRAL NERVOUS SYSTEM PREGABALIN CAPS 150 MG F fopi PC KF ( G ) 9,900.00 48.67% -
    254 208HJ04E02 FHJ04E002 04 CENTRAL NERVOUS SYSTEM PREGABALIN CAPS 75 MG F fopi PC HEXPHARM ( G ) 4,714.28 60.00% -
    255 04 CENTRAL NERVOUS SYSTEM PREGABALIN CAPS 75 MG F non fopi PC DM ( G ) 7,507.50 34.50% 5,255.25
    256 PREGABALIN CAPS 75 MG F non fopi PC YARINDO (G) 5,316.67 10.00%
    257 208DM02D04 FDM02D004 02 CARDIOVASCULAR & HAEMATOPO PROPANOLOL TABL 10 MG F fopi PC DM ( G ) 92.98 5.00% 88.34
    258 02 CARDIOVASCULAR & HAEMATOPO PROPANOLOL TABL 10 MG F non fopi PC HOLI 71.43 0.00% -
    259 11 ENDOCRINE & METABOLIC SYST PTU TAB. 100 MG F non fopi PC DM ( G ) 521.21 22.30% 521.21
    260 208IF11D01 FIF11D001 11 ENDOCRINE & METABOLIC SYST PTU TAB. 100 MG F fopi PC DM ( G ) 521.21 0.00% -
    261 208IF11D01 FIF11D001 11 ENDOCRINE & METABOLIC SYST PTU TAB. 100 MG F fopi PC INF (G) 521.21 22.30% -
    262 208KF08L04 FKF08L004 PYRAZINAMIDE TABL 500 MG F fopi PC KF ( G ) 364.97 364.97
    263 PYRAZINAMIDE TABL 500 MG F fopi PC KF ( G ) 382.83 338.70
    264 01 GASTROINTESTINAL & HEPATOBIRANITIDIN INJ. F non fopi AMP HEXPHARM ( G ) 2,570.04 0.00% -
    265 01 GASTROINTESTINAL & HEPATOBIRANITIDIN INJ. F non fopi AMP HEXPHARM ( G ) 2,570.04 15.00% 2,184.53
    266 208PR01A03 FPR01A003 01 GASTROINTESTINAL & HEPATOBIRANITIDIN INJ. F fopi AMP PHAPROS (G) 2,448.60 0.00% 2,293.74
    267 01 GASTROINTESTINAL & HEPATOBIRANITIDIN INJ. F non fopi AMP NOVELL (G) 3,465.00 25.00% -
    268 01 GASTROINTESTINAL & HEPATOBIRANITIDIN INJ. F non fopi AMP NOVELL (G) 3,465.00 23.00% 2,945.25
    269 01 GASTROINTESTINAL & HEPATOBIRANITIDIN INJ. F non fopi AMP DM ( G ) 2,428.67 2,428.67
    270 01 GASTROINTESTINAL & HEPATOBIRANITIDIN TABL 150 MG F non fopi PC PROMED (G) 308.00 10.00% 246.40
    271 208HJ01A07 FHJ01A007 01 GASTROINTESTINAL & HEPATOBIRANITIDIN TABL 150 MG F fopi PC HEXPHARM ( G ) 220.00 44.00% 165.00
    272 01 GASTROINTESTINAL & HEPATOBIRANITIDIN TABL 150 MG F non fopi PC DM ( G ) 231.00 24.00% 207.90
    273 208PR01A06 FPR01A006 01 GASTROINTESTINAL & HEPATOBIRANITIDIN TABL 150 MG F fopi PC PHAPROS (G) 202.40 0.00%
    274 01 GASTROINTESTINAL & HEPATOBIRANITIDIN TABL 150 MG F non fopi PC KF ( G ) 462.00 462.00
    275 208PR01A06 FPR01A006 01 GASTROINTESTINAL & HEPATOBIRANITIDIN TABL 150 MG F fopi PC PHAPROS (G) 202.70 202.70
    276 01 GASTROINTESTINAL & HEPATOBIRANITIDIN TABL 150 MG F non fopi PC BERNOFARM ( G ) 165.00 165.00
    277 208IF08L02 FIF08L002 08 ANTI-INFECTIVES SYSTEMIC RIFAMPICIN CAPS 300 MG F fopi PC INF (G) 884.40 884.40
    278 208KF08L05 FKF08L005 08 ANTI-INFECTIVES SYSTEMIC RIFAMPICIN CAPS 450 MG F fopi PC KF ( G ) 934.00 0.00% 2,101.73
    279 208BE08L02 FBE08L002 08 ANTI-INFECTIVES SYSTEMIC RIFAMPICIN CAPS 450 MG F fopi PC BERNOFARM ( G ) 1,815.53 1,815.53
    280 08 ANTI-INFECTIVES SYSTEMIC RIFAMPICIN CAPS 600 MG F non fopi PC KF ( G ) 2,375.08 44.63% -
    281 208IF08L02 FIF08L002 08 ANTI-INFECTIVES SYSTEMIC RIFAMPICIN CAPS 600 MG F fopi PC GENERIK 2,375.08 2,375.08
    282 04 CENTRAL NERVOUS SYSTEM RISPERIDON TAB 2 MG F fopi PC DM ( G ) 2,493.76 79.00% 2,493.77
    283 208PN03B03 FPN03B003 03 RESPIRATORY SYSTEM SALBUTAMOL TABL 2 MG F fopi PC FAHRENHEIT (G ) 88.00 10.00% 74.80
    284 03 RESPIRATORY SYSTEM SALBUTAMOL TABL 2 MG F non fopi PC YARINDO (G) 79.82 79.82
    285 208KF03B02 FKF03B002 03 RESPIRATORY SYSTEM SALBUTAMOL TABL 2 MG F fopi PC KF ( G ) 113.28 20.00% 113.28
    286 03 RESPIRATORY SYSTEM SALBUTAMOL TABL 2 MG F non fopi PC PHAPROS (G) 78.00 78.00
    287 208PN03B03 FPN03B003 03 RESPIRATORY SYSTEM SALBUTAMOL TABL 4 MG F fopi PC FAHRENHEIT (G ) 121.01 12.50% 112.80
    288 03 RESPIRATORY SYSTEM SALBUTAMOL TABL 4 MG F non fopi PC PHAPROS (G) 115.17 115.17
    289 208PR08H01 FPR08H001 03 RESPIRATORY SYSTEM SALBUTAMOL TABL 4 MG F fopi PC KF ( G ) 142.49 10.00% 118.73
    290 208FA17A07 FFA17A007 17 ANAESTHETICS LOCAL & GENER SEVOFLURANE 250 ML F fopi BTL FAHRENHEIT (G ) 1,870,000.00 30.00% 1,776,500.00
    291 208NP17A05 FNP17A005 17 ANAESTHETICS LOCAL & GENER SEVOFLURANE 250 ML F fopi BTL NOVELL ( G ) 1,716,000.00 30.00% 1,458,600.00
    292 208KB17A04 FKB17A004 17 ANAESTHETICS LOCAL & GENER SEVOFLURANE BAXTER 250 ML F fopi BTL KALBE FARMA 1,737,450.00 0.00% -
    293 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 10 MG F non fopi PC DM ( G ) 538.65 20.00% 430.92
    294 208BE02L04 FBE02L004 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 10 MG F fopi PC BERNOFARM ( G ) 307.80 307.80
    295 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 10 MG F non fopi PC HEXPHARM ( G ) 297.00 65.00% 252.45
    296 208KF02L04 FKF020L04 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 10 MG F fopi PC KF ( G ) 307.99 66.07% 200.20
    297 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 10 MG F non fopi PC SCAN (G) 88.00 0.00% -
    298 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 20 MG F non fopi PC SCAN (G) 198.00 0.00% 223.85
    299 208HJ02L08 FHJ02L008 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 20 MG F fopi PC HEXPHARM ( G ) 1,026.67 85.00% -
    300 208KF02L03 FKF02L003 02 CARDIOVASCULAR & HAEMATOPO SIMVASTATIN TAB. 20 MG F fopi PC KF ( G ) 445.50 445.50

    DATA KEBUTUHAN OBAT REVISI 12 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    301 SIMVASTATIN TAB. 20 MG


    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC INF (G) 1,100.00 35.00% 550.00
    302 208TP02L01 FTP02L001 SIMVASTATIN TAB. 20 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC TEMPO (G) 564.30 564.30
    303 208DM02H07 FDM02H007 SPIRONOLACTONE TAB. 100 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi PC DM ( G ) 1,107.71 42.00% 746.38
    304 208DM02H02 FDM02H002 SPIRONOLACTONE TAB. 25 MG F fopi PC DM ( G ) 363.68 37.55% 227.12
    305 01 GASTROINTESTINAL & HEPATOBISUCRALFATE SYR. 100 ML F non fopi BTL PROMED (G) 16,500.00 7.00% -
    306 SUCRALFATE SYR. 100 ML F non fopi BTL DM ( G ) 23,100.00 56.70%
    307 SUCRALFATE SYR. 100 ML F non fopi BTL FAHRENHEIT (G ) 42,900.00 30.00%
    308 208NP04K04 FNP04K004 04 CENTRAL NERVOUS SYSTEM TRAMADOL INJ. F fopi AMP NOVELL (G) 4,481.40 4,481.40
    309 04 CENTRAL NERVOUS SYSTEM TRAMADOL TAB. 50 MG F non fopi PC KF ( G ) 329.67 329.67
    310 02 CARDIOVASCULAR & HAEMATOPO TRIAMCINOLONE TAB. 4 MG F non fopi PC DM ( G ) 794.96 794.96
    311 208IF04H01 FIF04H001 04 CENTRAL NERVOUS SYSTEM TRIHEXYLPHENIDIL TAB 2 MG F fopi PC INF (G) 115.50 115.50
    312 04 CENTRAL NERVOUS SYSTEM TRIMETAZIDINE 35 MG F non fopi PC NOVELL ( G ) 2,310.00 2,310.00
    313 01 GASTROINTESTINAL & HEPATOBIURSODEOXYCHOLIC ASID 250 F non fopi PC DM ( G ) 6,468.00 25.00% 4,851.00
    314 01 GASTROINTESTINAL & HEPATOBIURSODEOXYCHOLIC ASID 250 F non fopi PC DM ( G ) 6,468.00 60.00%
    315 URSODEOXYCHOLIC ASID 250 F non fopi PC PROMED (G) 4.00%
    316 208NP02F15 FNP02F015 02 CARDIOVASCULAR & HAEMATOPO VALSARTAN 160 MG F fopi PC NOVELL (G) 6,077.50 6,077.50
    317 02 CARDIOVASCULAR & HAEMATOPO VALSARTAN 160 MG F non fopi PC DM ( G ) 2,700.55 2,700.55
    318 02 CARDIOVASCULAR & HAEMATOPO VALSARTAN 80 MG F non fopi PC DM ( G ) 2,200.00 2,200.00
    319 208KF30E04 FKF30E04 30 VITAMINS & MINERALS VIT. B1. 50 mg F fopi PC KF ( G ) 161.43 25.00% 40.70
    320 30 VITAMINS & MINERALS VIT. B12. IPI F non fopi PC GENERIK 73.02 73.02
    321 208ID30B01 FID30B01 VIT. B6. 10 mg F fopi PC KF ( G ) 71.01 0.00% 40.70
    322 208KF30E03 FKF30E003 30 VITAMINS & MINERALS VITAMIN B KOMPLEKS F fopi PC KF ( G ) 142.08 43.70% 113.67
    323 208NP30C01 FNP30C001 02 CARDIOVASCULAR & HAEMATOPO VITAMIN C INJEKSI 1000 MG F fopi PC NOVELL (G) 27,500.00 25.00% -
    324 VITAMIN C INJEKSI 500 MG F fopi PC NOVELL (G) 22,000.00 25.00% -
    325 30 VITAMINS & MINERALS VITAMIN C TAB. 100 MG F non fopi PC KF ( G ) 165.39 12.50% 165.40
    326 208KF30C01 FKF30C001 30 VITAMINS & MINERALS VITAMIN C TAB. 250 MG F fopi PC KF ( G ) 200.20 19.55% 200.20
    327 208KF12C02 FKF12C002 30 VITAMINS & MINERALS VITAMIN C TAB. 50 MG F fopi PC KF ( G ) 42.00 0.00% 125.84
    328 VITAMIN C TAB. 500 MG F non fopi PC PROMED (G) 550.00 10.00%
    329 02 CARDIOVASCULAR & HAEMATOPO VITAMIN K INJ. INFANT F non fopi AMP PHAPROS (G) 4,207.50 4,207.50
    330 WARFARIN TAB. 1 MG F non fopi PC EISAI ( G ) 979.00 979.00
    331 208KF01D01 FKF01D001 ZINK DISPERSIBLE TAB F fopi PC KF ( G ) 253.00 0.00% -
    332 01 GASTROINTESTINAL & HEPATOBIZINK SULPHATE SYR. F non fopi BTL SCAN (G) 3,322.00 3,322.00
    333 ZINK SULPHATE TAB F non fopi PC SCAN (G) 212.00 0.00%
    334 208PR01D02 FPR01D002 01 GASTROINTESTINAL & HEPATOBIZINK SULPHATE TAB F fopi PC PHAPROS (G) 462.00 0.00% -
    JUMLAH

    OBAT SLOW MOVING


    1 ANTIHEMOROID SUPPS S non fopi TUBE KF ( G ) 3,630.00 0.00% 2,970.00
    2 208DM02L12 FDM02L012 ATORVASTATIN 10 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC DM ( G ) 2,887.50 50.00% 1,732.50
    3 208DM02L13 FDM02L013 ATORVASTATIN 20 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC DM ( G ) 2,450.90 80.00% 834.83
    4 ATORVASTATIN 40 MG
    02 CARDIOVASCULAR & HAEMATOPO S non fopi PC YARINDO (G) 4,950.00 4,950.00
    5 ATRACURIUM BESYLATE INJ. 2.5 ML S non fopi AMP NOVELL (G) 17,820.00 17,820.00
    6 ATRACURIUM BESYLATE INJ. 5 ML S non fopi AMP NOVELL (G) 26,730.00 26,730.00
    7 BORAX GLYSERINE S non fopi AMP GENERIK 2,926.00 -
    8 208NP02M03 FNP02M003 CARBAZOCHROME INJ. S fopi AMP NOVELL (G) 13,112.00 30.00% 11,800.80
    9 208NP02M03 FNP02M003 CARBAZOCHROME INJ. S fopi AMP NOVELL (G) 13,112.00 15.00% -
    10 08 ANTI-INFECTIVES SYSTEMIC CEFOPERAZONE INJ 1 GR S non fopi VIAL DM ( G ) 61,325.00 49.16% 54,450.00
    11 208NP08B10 FNP08B010 08 ANTI-INFECTIVES SYSTEMIC CEFTIZOXIME INJ. 1 GR S fopi VIAL NOVELL ( G ) 110,000.00 30.00% 103,881.25
    12 208KF14A01 FKF14A001 14 EYE CHLORAMPHENICOL SALEP MATA S fopi TUBE KF ( G ) 1,563.10 1,563.10
    13 14 EYE CHLORAMPHENICOL SYR S non fopi BTL KF ( G ) 4,769.60 4,769.60

    DATA KEBUTUHAN OBAT REVISI 13 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    14 14 EYE CHLORAMPHENICOL TTS MATA S non fopi BTL KF ( G ) 3,000.00 3,000.00


    15 14 EYE CHLORAMPHENICOL TTS TELINGA S fopi BTL KF ( G ) 1,050.50 1,050.50
    16 208DM08G08 FDM08G008 08 ANTI-INFECTIVES SYSTEMIC CIPROFLOXACIN INFUS S fopi BTL DM ( G ) 59,849.91 78.00% 39,500.93
    17 208BE01B05 FBE01B005 01 GASTROINTESTINAL & HEPATOBIDOMPERIDONE DROPS S fopi BTL BERNOFARM ( G ) 23,100.00 23,100.00
    18 ENTECAVIR TAB. S PC HEXPHARM ( G ) 11,000.00 10.00%
    19 03 RESPIRATORY SYSTEM ESOMEPRAZOL SODIUM INJ. 40 MG S VIAL DM ( G ) 77,962.51 63.46% 2,217.60
    20 208HJ02L05 FHJ02L005 02 CARDIOVASCULAR & HAEMATOPO FENOFIBRATE 1OO MG S fopi PC HEXPHARM ( G ) 2,200.00 60.00% -
    21 11 ENDOCRINE & METABOLIC SYST GLIBENCLAMIDA TAB 5 MG S non fopi PC KF ( G ) 183.92 183.92
    22 208DM11B24 FDM11B024 11 ENDOCRINE & METABOLIC SYST GLIMEPRIDE TAB. 1 MG S fopi PC DM ( G ) 173.98 173.98
    23 01 GASTROINTESTINAL & HEPATOBIGRANISETRON INJ. 1 MG S non fopi AMP FAHRENHEIT (G ) 17,600.00 17,600.00
    24 208NP01I12 FNP01I012 01 GASTROINTESTINAL & HEPATOBIGRANISETRON INJ. 3 MG S fopi AMP NOVELL (G) 27,500.00 20.00% 24,750.00
    25 04 CENTRAL NERVOUS SYSTEM HALOPERIDOL TABL 1.5 MG S non fopi PC INF (G) 88.00 88.00
    26 208IF04D03 FIF04D003 04 CENTRAL NERVOUS SYSTEM HALOPERIDOL TABL 5 MG S fopi PC INF (G) 134.38 134.38
    27 208BE08D04 FBE08D004 08 ANTI-INFECTIVES SYSTEMIC IMIPENEM INJ. S fopi VIAL BERNOFARM ( G ) 198,000.00 198,000.00
    28 IOHEXOL INFUS 350 MG, 100 ML S non fopi BTL NOVELL ( G ) 376,200.00 376,200.00
    29 IOHEXOL INFUS 350 MG, 100 ML S non fopi BTL NOVELL ( G ) 20.00%
    30 IOHEXOL INFUS 350 MG, 50 ML S non fopi BTL NOVELL ( G ) 20.00%
    31 208NP02F07 FNP02F007 02 CARDIOVASCULAR & HAEMATOPO IRBESARTAN 150 MG S fopi PC NOVELL (G) 1,668.98 1,668.98
    32 208IF02F02 FIF02F002 02 CARDIOVASCULAR & HAEMATOPO IRBESARTAN 300 MG S fopi PC INF (G) 5,646.67 5,646.67
    33 208NP02F08 FNP02F008 02 CARDIOVASCULAR & HAEMATOPO IRBESARTAN 300 MG S fopi PC NOVELL (G) 3,336.67 3,336.67
    34 208BE08N08 FBE08N008 08 ANTI-INFECTIVES SYSTEMIC ITRACONAZOLE 100 MG S fopi PC BERNOFARM ( G ) 3,300.00 3,300.00
    335 208NP02C01 FNP020C01 02 CARDIOVASCULAR & HAEMATOPO LISINOPRIL 10 MG S fopi PC NOVELL (G) 574.75 574.75
    336 208NP02C02 FNP02C002 02 CARDIOVASCULAR & HAEMATOPO LISINOPRIL 5 MG S fopi PC NOVELL (G) 334.40 334.40
    337 208NP02F11 FNP02F011 02 CARDIOVASCULAR & HAEMATOPO LOSARTAN 50 MG S fopi PC NOVELL (G) 3,465.00 3,465.00
    338 208HJ02F03 FHJ02F003 02 CARDIOVASCULAR & HAEMATOPO LOSARTAN 50 MG S fopi PC HEXPHARM ( G ) 2,333.30 2,333.30
    339 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE INPUS S non fopi BTL NOVELL (G) 39,820.00 36.00% 26,679.40
    340 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE INPUS S non fopi BTL NOVELL (G) 39,820.00 35.00% 26,679.40
    341 08 ANTI-INFECTIVES SYSTEMIC METRONIDAZOLE INPUS S non fopi BTL DM ( G ) 68,833.11 55.00% 26,328.67
    342 MOXIFLOXACIN HCL INFUS 250 ML S fopi BTL FAHRENHIET (G ) 220,000.00 20.00% -
    343 04 CENTRAL NERVOUS SYSTEM NATRIUM PHENYTOIN INJ. S non fopi AMP NOVELL (G) 35,750.00 40.00% 23,952.50
    344 02 CARDIOVASCULAR & HAEMATOPO NICARDIPINE INJ. S non fopi AMP DM ( G ) 150,150.00 10.00% -
    345 208DM04C01 FDM04C001 NOPRESS 20 MG TABLET S fopi PC KF ( G ) 38.00%
    346 02 CARDIOVASCULAR & HAEMATOPO NOREPINEPHRINE INJ. BTR. 4 mg/4 ml S non fopi AMP NOVELL (G) 13,860.00 5.00% 9,702.00
    347 208PR08M04 FPR08M004 08 ANTI-INFECTIVES SYSTEMIC NYSTATIN TABLET 100000 IU S fopi PC PHAPROS (G) 790.91 790.91
    348 08 ANTI-INFECTIVES SYSTEMIC OFLOXACIN 400 MG S non fopi PC NOVELL ( G ) 873.00 873.00
    349 OSELTAMIVIR PHOSPHATE CAPS. 75 MG S non fopi PC INF (G) 13,000.50 0.00% 13,000.00
    350 04 CENTRAL NERVOUS SYSTEM PIRACETAM TAB. 400 MG S non fopi PC PROMED (G) 330.00 -
    351 208NP02L06 FNP02L006 PRAVASTATIN 20 MG S fopi PC NOVELL (G) 2,664.75 2,664.75
    352 PROPANOLOL TABL 40 MG S non fopi PC HOLI 146.12 5.00% -
    353 PROPOFOL INJ. 10 MG/ML S non fopi AMP NOVELL ( G ) 16,500.00 25.00% 13,200.00
    354 08 ANTI-INFECTIVES SYSTEMIC QUININE INJ 2 CC S fopi AMP KF ( G ) 4,314.24 4,314.24
    355 208NP02C06 FNP02C006 02 CARDIOVASCULAR & HAEMATOPO RAMIPRIL TAB. 10 MG S fopi PC NOVELL (G) 1,006.83 1,006.83
    356 208DM02C07 FDM02C007 02 CARDIOVASCULAR & HAEMATOPO RAMIPRIL TAB. 2.5 MG S fopi PC DM ( G ) 336.01 28.57% 295.01
    357 208DM02C08 FDM02C008 02 CARDIOVASCULAR & HAEMATOPO RAMIPRIL TAB. 5 MG S fopi PC DM ( G ) 666.67 48.00% 533.33
    358 208NP02C07 FNP02C007 02 CARDIOVASCULAR & HAEMATOPO RAMIPRIL TAB. 5 MG S fopi PC NOVELL (G) 705.76 705.76
    359 208NP01A16 FNP01A016 01 GASTROINTESTINAL & HEPATOBIREBAMIPIDE TABL 100 MG S fopi PC NOVELL (G) 2,438.33 2,438.33
    360 208BE05C01 FBE05C001 RECURONIUM BROMIDE INJEKSI S fopi AMP BERNOFARM ( G ) 65,450.00 65,450.00
    361 208NP05C07 FNP05C007 RECURONIUM BROMIDE INJEKSI S fopi AMP NOVELL (G) 71,280.00 71,280.00
    362 SPIRAMYCIN TAB. 500 MG S NOVEL (G) 2,068.00 15.00%

    DATA KEBUTUHAN OBAT REVISI 14 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    363 208BE04L02 FBE04L002 04 CENTRAL NERVOUS SYSTEM SULFASALAZINE 500 MG S fopi PC BERNOFARM ( G ) 1,980.00 1,980.00
    364 FPR12H004 04 CENTRAL NERVOUS SYSTEM TABLET TAMBAH DARAH NEO S fopi PC PHAPROS (G) 226.00 0.00% 4,801.50
    35 VIT. B1. 100 mg S fopi PC KF ( G ) 260.71 15.00% 40.70
    JUMLAH

    -
    OBAT PATEN -
    OBAT DEAD STOCK
    JUMLAH

    OBAT FAST MOVING


    1 15 EAR AKILEN EAR DROPS F non fopi BTL SANBE FARMA 66,770.00 25.00% 51,746.75
    2 212DM19O05 FDM19O005 19 INTRAVENOUS & OTHER STERIL ALBUMINAR 25% 100 ML F fopi BTL DEXA MEDICA 1,510,000.00 1,510,000.00
    3 19 INTRAVENOUS & OTHER STERIL ALBUNORM 25% 50 ML F non fopi BTL INDO FARMA 765,000.00 765,000.00
    4 03 RESPIRATORY SYSTEM ALCO DROPS 15 ML F non fopi BTL INTERBAT 68,200.00 68,200.00
    5 208SB03C02 FSB03C002 03 RESPIRATORY SYSTEM ALDISA SR CAPS. F fopi PC SANBE FARMA 4,577.92 4,577.92
    6 208FE14G01 FFE14G001 14 EYE ALEGYSAL TTS MATA F fopi BTL FERRON 98,230.00 37.00% 88,407.00
    7 04 CENTRAL NERVOUS SYSTEM ALGANAX TAB. 0.25 MG F non fopi PC GUARDIAN 1,870.00 1,870.00
    8 04 CENTRAL NERVOUS SYSTEM ALGANAX TAB. 0.5 MG F non fopi PC GUARDIAN 3,025.00 3,025.00
    9 03 RESPIRATORY SYSTEM ALLORIS TABLET F non fopi PC SANBE FARMA 3,652.00 3,652.00
    10 208AC04M02 FAC04M002 04 CENTRAL NERVOUS SYSTEM ALPENTIN 300 MG F fopi PC ACTAVIS 6,930.00 6,930.00
    11 02 CARDIOVASCULAR & HAEMATOPO AMADIAB 1 F non fopi PC LAPI 1,980.00 1,980.00
    12 02 CARDIOVASCULAR & HAEMATOPO AMADIAB 2 F non fopi PC LAPI 3,712.50 3,712.50
    13 02 CARDIOVASCULAR & HAEMATOPO AMADIAB 3 F non fopi PC LAPI 4,290.00 4,290.00
    14 02 CARDIOVASCULAR & HAEMATOPO AMADIAB 4 F non fopi PC LAPI 5,236.00 5,236.00
    15 11 ENDOCRINE & METABOLIC SYST AMARYL - M 1 F non fopi PC AVENTIS 2,991.52 2,991.52
    16 208SA11B08 FSA11B008 11 ENDOCRINE & METABOLIC SYST AMARYL - M 2 F fopi PC AVENTIS 5,301.58 5,301.58
    17 11 ENDOCRINE & METABOLIC SYST AMARYL TAB. 1 MG F non fopi PC AVENTIS 2,394.12 2,394.12
    18 208SA11B02 FSA11B002 11 ENDOCRINE & METABOLIC SYST AMARYL TAB. 2 MG F fopi PC AVENTIS 5,304.66 5,304.66
    19 11 ENDOCRINE & METABOLIC SYST AMARYL TAB. 3 MG F non fopi PC AVENTIS 6,666.15 6,666.15
    20 208DM10F01 FDM10F001 10 GENITO-URINARY SYSTEM AMINEFRON TAB. F fopi PC DEXA MEDICA 7,150.00 46.00% 6,435.00
    21 13 NUTRITION AMINOFUSIN L 600 F non fopi BTL KALBE FARMA 55,385.00 55,385.00
    22 208FR13C08 FFR13C008 13 NUTRITION AMINOSTERIL INFUS 6% F fopi BTL FRESENIUS 46,992.00 46,992.00
    23 208SB08C01 FSB08C001 08 ANTI-INFECTIVES SYSTEMIC AMOXAN DROPS F fopi BTL SANBE FARMA 24,640.00 25.00% 19,096.00
    24 03 RESPIRATORY SYSTEM ANADEX TAB. F non fopi PC INTERBAT 2,887.50 20.00% 2,612.50
    25 01 GASTROINTESTINAL & HEPATOBIANADIUM CAPS F non fopi PC GUARDIAN 8,046.50 8,046.50
    26 04 CENTRAL NERVOUS SYSTEM ANALSIK TAB F non fopi PC SANBE FARMA 1,677.51 25.00% 2,721.29
    27 04 CENTRAL NERVOUS SYSTEM ANALSPEC 500 MG F non fopi PC METISKA FARMA 1,410.75 516.33
    28 04 CENTRAL NERVOUS SYSTEM ANALTRAM CAPS F non fopi PC LAPI 5,940.00 5,500.00
    29 08 ANTI-INFECTIVES SYSTEMIC ANBACIM INJ. F non fopi VIAL SANBE FARMA 38,498.03 0.00% 38,498.00
    30 208FA04B02 FFA04B002 04 CENTRAL NERVOUS SYSTEM ANESFAR INJ. F fopi AMP FAHRENHEIT 16,500.00 16,500.00
    31 211BF12B04 FBF12B004 12 ALLERGY & IMMUNE SYSTEM ANTI BISA ULAR F fopi AMP BIO FARMA 640,530.00 640,530.00
    32 02 CARDIOVASCULAR & HAEMATOPO ANTIPLAT 50 MG F non fopi PC INMARK 6,017.00 6,017.00
    33 208DM01I10 FDM01I010 01 GASTROINTESTINAL & HEPATOBIANVOMER B6 TAB. F fopi PC DEXA MEDICA 2,376.00 2,376.00
    34 30 VITAMINS & MINERALS APIALYS DROPS F non fopi BTL LAPI 44,000.00 20.00% 35,200.00
    35 30 VITAMINS & MINERALS APIALYS SYR. F non fopi BTL LAPI 36,300.00 20.00% 29,040.00
    36 208TN02N01 FTN02N001 02 CARDIOVASCULAR & HAEMATOPO ARIXTRA INJ. 2.5 MG F fopi AMP TANABE ABADI 360,525.00 10.00% 261,300.00
    37 ARKINE SYR F fopi PC PYRIDAM -

    DATA KEBUTUHAN OBAT REVISI 15 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    38 208PY04H02 FPY04H002 04 CENTRAL NERVOUS SYSTEM ARKINE TABLET F fopi PC PYRIDAM 825.00 30.00% 762.30
    39 ARTIMAX CAPS. F non fopi PC LANDSON 8,800.00 8,800.00
    40 208DM04E01 FDM04E001 04 CENTRAL NERVOUS SYSTEM ASAM VALPROIC SYR. 250 MG F fopi BTL DEXA MEDICA 48,510.00 48,510.00
    41 02 CARDIOVASCULAR & HAEMATOPO ASCARDIA TAB 80 MG F non fopi PC PHAROS 911.63 911.63
    42 ASEDAS SYR. F non fopi BTL PYRIDAM 47,300.00 15.00%
    43 02 CARDIOVASCULAR & HAEMATOPO ASPILETS TBL. F non fopi PC MEDIFARMA 610.50 0.00% 610.50
    44 03 RESPIRATORY SYSTEM ASTHAROL SYR F non fopi BTL SANBE FARMA 12,787.50 12,787.50
    45 03 RESPIRATORY SYSTEM ASTHAROL TABLET F non fopi PC SANBE FARMA 997.43 997.43
    46 208SO31B05 FSO31B005 31 HEALTH SUPPLEMENTS & FOOD ASTHIN FORCE Kaps 6 mg F fopi PC NOVELL 5,500.00 5,500.00
    47 ASTRIA KAPSUL 4 MG F non fopi PC LANDSON 6,233.33 6,233.33
    48 08 ANTI-INFECTIVES SYSTEMIC ATEVIR TAB. 0.5 MG F non fopi PC DEXA MEDICA 40,700.00 10.00% 36,630.00
    49 208FA02L01 FFA02L001 02 CARDIOVASCULAR & HAEMATOPO ATOFAR 10 F fopi PC FAHRENHEIT 12,650.00 34.96% 9,317.00
    50 208FA02L02 FFA02L002 02 CARDIOVASCULAR & HAEMATOPO ATOFAR 20 F fopi PC FAHRENHEIT 12,650.00 34.96% 9,317.00
    51 02 CARDIOVASCULAR & HAEMATOPO ATOFAR 40 F non fopi PC FAHRENHEIT 12,650.00 34.96% 9,317.00
    52 08 ANTI-INFECTIVES SYSTEMIC AZOMAX CAPS F non fopi PC DEXA MEDICA 28,050.00 28,050.00
    53 08 ANTI-INFECTIVES SYSTEMIC AZOMAX SYR F non fopi BTL DEXA MEDICA 101,750.00 10.00% 91,575.00
    54 208OI13C09 FOI13C009 13 NUTRITION B FLUID 500 ML F fopi BTL OTSUKA 76,300.40 0.00% 76,300.40
    55 BACTRAZ INJ. F non fopi PC OTTO 27.50%
    1 BACTRIM SYR 50 ML F non fopi BTL ROCHE 80,831.70 80,831.70
    2 04 CENTRAL NERVOUS SYSTEM BAMGETOL 200 MG F non fopi PC MERSIFARMA 1,980.00 1,980.00
    3 208SB14A01 FSB14A001 14 EYE BAQUINOR 0.3% EYE DROPS F fopi BTL SANBE FARMA 37,235.00 38.00% 28,857.13
    4 30 VITAMINS & MINERALS BECEFORT SYR 60 ML F non fopi BTL PHAPROS 17,365.70 10.00% 17,365.70
    5 30 VITAMINS & MINERALS BECEFORT TAB. F non fopi PC PHAPROS 1,548.42 12.50% 1,548.43
    6 208SB30E01 FSB30E001 30 VITAMINS & MINERALS BECOM C CAPLET F fopi PC SANBE FARMA 1,732.50 25.02% 1,732.50
    7 30 VITAMINS & MINERALS BECOM ZET CAPLET F non fopi PC SANBE FARMA 2,310.00 25.00% 2,310.00
    8 BEDAK SALYCIL 100 GRM F non fopi PC KIMIA FARMA 6,426.20 6,426.20
    9 03 RESPIRATORY SYSTEM BENACOL DTM SYRUP 60 ML F non fopi BTL DANKOS 12,540.00 12,540.00
    10 03 RESPIRATORY SYSTEM BENACOL SYRUP 100 ML F non fopi BTL DANKOS 14,107.50 14,107.50
    11 03 RESPIRATORY SYSTEM BENACOL SYRUP 60 ML F non fopi BTL DANKOS 11,495.00 11,495.00
    12 208KF16E05 FKF16E005 16 DERMATOLOGICALS BETASON-N CREAM F fopi TUBE KIMIA FARMA 16,335.00 5.00% 14,822.50
    13 BIO ATP TAB. F non fopi PC BIO FARMA 2,355.98 0.00% 2,355.98
    14 208KB16D01 FKB16D001 16 DERMATOLOGICALS BIOPLACENTON YELLY 15 GR F fopi TUBE KALBE FARMA 24,200.00 22.73% 22,000.00
    15 BIOSANBE CAP. F non fopi PC SANBE FARMA 1,182.51 25.00% 916.44
    16 BIOTHICOL CAPS 500 MG F non fopi PC SANBE FARMA 3,111.63 3,111.63
    17 BIOTHICOL SYR F non fopi BTL SANBE FARMA 17,817.25 17,817.25
    18 BIOXON INJ F non fopi VIAL OTTO 231,000.00 37.00% 167,475.00
    19 03 RESPIRATORY SYSTEM BISOLVON ELIX 125 ML F non fopi BTL BOEHRINGER 52,614.80 52,614.80
    20 03 RESPIRATORY SYSTEM BISOLVON INJ. F non fopi AMP BOEHRINGER 61,145.70 0.00% 61,145.70
    21 10 GENITO-URINARY SYSTEM BLEDSTOP INJ F non fopi AMP CAPRIFARMINDO 6,274.40 6,274.40
    22 06 HORMONES BLESIFEN TAB F non fopi PC CAPRIFARMINDO 13,849.01 22.50% 10,732.97
    23 02 CARDIOVASCULAR & HAEMATOPO BLOCAND 16 MG F non fopi PC PYRIDAM 2,751.83 2,751.83
    24 02 CARDIOVASCULAR & HAEMATOPO BLOCAND 8 MG F non fopi PC PYRIDAM 1,672.00 1,672.00
    25 208TK02F02 FTK02F002 02 CARDIOVASCULAR & HAEMATOPO BLOPRES TAB. 16 MG F fopi PC TAKEDA 15,675.00 15,675.00
    26 02 CARDIOVASCULAR & HAEMATOPO BLOPRES TAB. 16 MG PLUS F non fopi PC TAKEDA 14,200.80 14,200.80
    27 02 CARDIOVASCULAR & HAEMATOPO BLOPRES TAB. 8 MG F non fopi PC TAKEDA 11,895.83 11,895.83
    28 BNS ( BREATHY NASAL SPRAY ) F non fopi BTL NOVELL 86,240.00 86,240.00
    29 208SB01C01 FSB01C001 01 GASTROINTESTINAL & HEPATOBIBRAXIDIN TABLET F fopi PC SANBE FARMA 1,221.00 24.95% 946.28
    1 03 RESPIRATORY SYSTEM BREATHY TETES HIDUNG F non fopi BTL NOVELL 16,500.00 16,500.00
    2 03 RESPIRATORY SYSTEM BRONCHOPRONT SYR. F non fopi BTL COMBIPHAR 53,240.00 53,240.00

    DATA KEBUTUHAN OBAT REVISI 16 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    3 BUNASCAN SPINAL 0.5% F non fopi AMP FAHRENHEIT 72,600.00 10.00% 55,902.00
    4 16 DERMATOLOGICALS BURNAZIN CREAM TUBE 35 GR F non fopi TUBE DARYA VARIA 65,823.63 58,850.00
    5 208DV16A03 FDV16A003 16 DERMATOLOGICALS BURNAZIN PLUS 25 GR F fopi TUBE DARYA VARIA 110,000.00 2.49% 93,032.50
    6 208SA01C03 FSA01C003 01 GASTROINTESTINAL & HEPATOBIBUSCOPAN TABLET F fopi PC BOEHRINGER 3,241.15 3,241.15
    7 CALGAE CAPS F non fopi PC FAHRENHEIT 5,500.00 10.00% 4,653.00
    8 CALOS CAPS F non fopi PC FAHRENHEIT 962.50 30.00% 733.33
    9 CALTRAX TABLET F non fopi PC PYRIDAM 3,300.00 15.00% 3,291.20
    10 CANDEFION TABLET 16 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC INFION 8,250.00 8,250.00
    11 CANDEFION TABLET 8 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC INFION 4,400.00 4,400.00
    12 208DM02F01 FDM02F001 CANDERIN TAB. 16 MG
    02 CARDIOVASCULAR & HAEMATOPO F fopi AMP DEXA MEDICA 8,910.00 8,910.00
    13 CANDERIN TAB. 8 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi AMP DEXA MEDICA 6,435.00 6,435.00
    14 CANDOTENS 16 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC NOVELL 8,085.00 8,085.00
    15 CANDOTENS 8 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC NOVELL 4,958.80 4,958.80
    16 CARDIO ASPIRIN F non fopi PC BAYER 1,363.63 1,363.63
    17 16 DERMATOLOGICALS CARMED 10% F non fopi TUBE SDM 31,900.00 31,900.00
    18 16 DERMATOLOGICALS CARMED 20% F non fopi TUBE SDM 41,030.00 41,030.00
    19 16 DERMATOLOGICALS CARMED CREAM 10% F non fopi TUBE SDM 31,900.00 31,900.00
    20 16 DERMATOLOGICALS CARMED CREAM 20% F non fopi TUBE SDM 41,030.00 41,030.00
    21 CARTYLO TAB. 80 MG
    02 CARDIOVASCULAR & HAEMATOPO F non fopi PC KIMIA FARMA 616.00 0.00% 616.00
    22 208NV04L01 FNV04L001 04 CENTRAL NERVOUS SYSTEM CATAFLAM TABLET 25 MG F fopi PC NOVARTIS 3,271.13 17.48% 2,699.34
    23 04 CENTRAL NERVOUS SYSTEM CATAFLAM TABLET 50 MG F non fopi PC NOVARTIS 6,430.18 19.88% 5,151.64
    24 CATHEJELL 12,5 GR F non fopi TUBE KALBE FARMA 64,900.00 0.00% 64,900.00
    25 30 VITAMINS & MINERALS CEBEX CAPS. F non fopi PC OTTO 1,980.00 27.50% 1,435.50
    26 208DV02B01 FDV02B001 CEDOCARD INJ
    02 CARDIOVASCULAR & HAEMATOPO F fopi AMP DARYA VARIA 68,953.50 68,953.50
    27 04 CENTRAL NERVOUS SYSTEM CELEBREX CAPS. 100 MG F non fopi PC PFIZER 10,450.21 10,450.21
    28 04 CENTRAL NERVOUS SYSTEM CELEBREX CAPS. 200 MG F non fopi PC PFIZER 16,412.25 17.48% 15,137.52
    29 14 EYE CENDO ASTHENOF 5 CC F non fopi BTL CENDO 23,100.00 23,100.00
    30 14 EYE CENDO AUGENTONIC 5 ML F non fopi BTL CENDO 27,361.13 27,361.13
    31 14 EYE CENDO AUGENTONIC MD. 0.6 ML F non fopi PC CENDO 4,424.48 4,424.48
    32 208CD14E01 FCD14E001 14 EYE CENDO CARPINE 1% 5 ML F fopi BTL CENDO 17,050.00 7.50% 17,050.00
    33 208CD14E01 FCD14E001 14 EYE CENDO CARPINE 2% 5 ML F fopi BTL CENDO 20,900.00 0.00% 20,900.00
    34 14 EYE CENDO CATERLENT 15 ML F fopi BTL CENDO 33,687.50 7.50% 33,687.50
    35 14 EYE CENDO CATERLENT 5 ML F non fopi BTL CENDO 24,887.50 0.00% 24,887.50
    36 14 EYE CENDO CATERLENT MD 0.6 ML F non fopi PC CENDO 4,400.00 0.00% 4,400.00
    37 14 EYE CENDO CENFRESH 5 ML F non fopi BTL CENDO 38,362.50 0.00% 31,762.50
    38 208CD14H06 FCD14H006 14 EYE CENDO CENFRESH MD 0.6 ML F fopi PC CENDO 5,060.00 0.00% 5,087.50
    39 14 EYE CENDO CITROL EYE DROPS F fopi BTL CENDO 29,975.00 0.00% 29,975.00
    40 208CD14B11 FCD14B011 14 EYE CENDO CITROL EYE OINT F fopi TUBE CENDO 39,462.50 0.00% 39,462.50
    41 208CD14B10 FCD14B010 14 EYE CENDO CITROL MD 0.6 ML F fopi PC CENDO 5,362.50 7.50% 5,362.50
    42 14 EYE CENDO EYEFRESH DROPS 0.5 ML F non fopi BTL CENDO 31,762.50 31,762.50
    43 14 EYE CENDO EYEFRESH MD. 0.6 ML F non fopi PC CENDO 5,087.50 7.50% 5,087.50
    44 14 EYE CENDO FENECOL 0.5 EYE DROPS F non fopi TUBE CENDO 33,687.50 0.00% 24,062.50
    45 CENDO FENECOL EYE OINT 3.5 GR F non fopi BTL CENDO 7.50%
    46 CENDO FLOXA ED. 5 ML F non fopi BTL CENDO 36,300.00 7.50% 33,577.50
    47 14 EYE CENDO FLOXA MINIDOSE F non fopi PC CENDO 5,885.01 7.50% 5,885.00
    48 14 EYE CENDO GENTA SALAP MATA F non fopi TUBE CENDO 40,012.50 40,012.50
    49 14 EYE CENDO HYALUB 5 ML F non fopi BTL CENDO 63,324.32 7.50% 58,575.00
    50 CENDO HYALUB MD. 0.6 ML F fopi PC CENDO 12,540.00 7.50% 12,540.00
    51 14 EYE CENDO LFX 5 ML F non fopi BTL CENDO 76,175.00 0.00% 76,175.00

    DATA KEBUTUHAN OBAT REVISI 17 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    52 CENDO LFX MINIDOSE F non fopi BTL CENDO 7.50% 15,180.00


    53 14 EYE CENDO LYTEERS 15 CC F non fopi BTL CENDO 24,750.00 0.00% 24,750.00
    54 208CD14H21 FCD14H021 14 EYE CENDO LYTEERS MD. 0,6 ML F fopi PC CENDO 4,235.01 7.50% 4,235.00
    55 CENDO MYDRIATYL MINIDOSE F non fopi BTL CENDO 5,802.50 7.50% 5,802.50
    56 14 EYE CENDO MYDRIATYL TM F non fopi BTL CENDO 31,762.50 0.00% 31,762.50
    57 208CD14G06 FCD14G006 14 EYE CENDO PANTOCAIN EYE DROPS 0.5% F fopi BTL CENDO 17,156.29 7.50% 13,337.50
    58 208CD14G07 FCD14G007 14 EYE CENDO PANTOCAIN EYE DROPS 2% F fopi BTL CENDO 14,575.00 0.00% 14,575.00
    59 208CD14G07 FCD14G007 14 EYE CENDO PANTOCAIN EYE DROPS 2% F fopi BTL CENDO 14,575.01 7.50% 14,575.00
    60 14 EYE CENDO PROTAGENTA EYE DROP F non fopi BTL CENDO 45,738.00 45,738.00
    61 208CD14H26 FCD14H026 14 EYE CENDO PROTAGENTA MD 0.6 ML F fopi PC CENDO 7,892.50 0.00% 7,892.50
    62 CENDO TIMOL 0.5% ED. 0.6 ML F non fopi BTL CENDO 5,665.01 7.50% 17,875.00
    63 14 EYE CENDO TIMOL TETES MATA 0.25% F non fopi BTL CENDO 33,550.00 0.00% 32,711.25
    64 14 EYE CENDO TIMOL TETES MATA 0.5% F non fopi BTL CENDO 52,525.00 0.00% 52,525.00
    65 14 EYE CENDO VASACON 15 ML F non fopi BTL CENDO 17,875.00 0.00% 5,060.00
    66 CENDO VASACON ED. MINIDOSE F non fopi BTL CENDO 3,052.50 0.00% 38,362.50
    67 CEPTIK 200 MG F non fopi PC INTERBAT 41,800.00 56.00% 31,900.00
    68 CEPTIK DRY. SYRUP F non fopi BTL INTERBAT 115,500.00 56.00% 88,000.00
    69 CERINI CAPS. F non fopi PC SANBE FARMA 3,773.00 25.00% 2,924.07
    70 CERINI DROP F non fopi BTL SANBE FARMA 69,300.00 25.00% 53,707.50
    71 CERINI SYR F non fopi BTL SANBE FARMA 43,780.00 25.00% 33,929.50
    72 12 ALLERGY & IMMUNE SYSTEM CETIRGI SYR. F non fopi BTL OTTO 47,300.00 27.50% 28,710.00
    73 12 ALLERGY & IMMUNE SYSTEM CETIRGI TAB. F non fopi PC OTTO 3,300.00 27.50% 1,993.75
    74 CHANNA CAPS. 500 MG F non fopi PC MYLAN 6,655.00 5.00% 6,322.25
    75 CLAMIXIN SYR F non fopi BTL OTTO 59,812.50 59,812.50
    76 CLAMIXIN FT SYR F non fopi BTL OTTO 75,762.50 75,762.50
    77 208SB08C11 FSB08C011 08 ANTI-INFECTIVES SYSTEMIC CLANEKSI TAB. F fopi PC SANBE FARMA 13,310.00 25.00% 10,315.25
    78 04 CENTRAL NERVOUS SYSTEM CLIAD TAB F non fopi PC INTERBAT 3,465.00 20.00% 2,640.00
    79 208KF03C09 FKF03C009 CODEIN 10 MG F fopi PC KIMIA FARMA 600.00 0.00% 684.97
    80 CODEIN 20 MG F fopi PC KIMIA FARMA 1,360.00 1,623.60
    81 208KF03C03 FKF03C003 03 RESPIRATORY SYSTEM CODIKAF 10 MG F fopi PC KIMIA FARMA 866.25 0.00% 866.25
    82 03 RESPIRATORY SYSTEM CODIKAF 20 MG F non fopi PC KIMIA FARMA 1,716.00 1,716.00
    83 208KF03C06 FKF03C006 03 RESPIRATORY SYSTEM CODIPRONT CUM CAPS F fopi PC KIMIA FARMA 10,502.80 10,502.80
    84 03 RESPIRATORY SYSTEM CODIPRONT SYR. F non fopi BTL KIMIA FARMA 56,265.00 0.00% 56,265.00
    85 COLERGIS SYR F non fopi BTL DEXA MEDICA 46,200.00 10.00% 41,580.00
    86 COLERGIS TAB F non fopi PC DEXA MEDICA 2,750.00 10.00% 2,475.00
    87 COLSANCETINE INJ F non fopi AMP SANBE FARMA 15,400.00 30.00% 11,165.00
    88 208BI03B05 FBI03B005 03 RESPIRATORY SYSTEM COMBIVENT NEB. F fopi PC BOEHRINGER 3,499.98 0.50% 4,550.00
    89 03 RESPIRATORY SYSTEM COMTUSI STRAWBERRY SYR 60 ML F non fopi BTL COMBIPHAR 38,416.95 38,416.95
    90 03 RESPIRATORY SYSTEM COMTUSI SYR 100 ML F non fopi BTL COMBIPHAR 57,860.00 57,860.00
    91 208CB03C04 FCB03C004 03 RESPIRATORY SYSTEM COMTUSI SYR 60 ML F fopi BTL COMBIPHAR 38,416.95 38,416.95
    92 02 CARDIOVASCULAR & HAEMATOPOCONCOR TAB. 10 MG F non fopi PC MERCK 2,950.00 2,950.00
    93 208LS02S02 FLS02S002 02 CARDIOVASCULAR & HAEMATOPOCORMEGA CAPS. F fopi PC LANDSON 13,383.34 41.36% 13,383.33
    94 CORTAMINE SYR 60 ML F non fopi BTL INTERBAT 56,650.00 20.00% 43,120.00
    95 CORTAMINE TABLET F non fopi PC INTERBAT 3,465.00 20.00% 2,640.00
    96 CORTIDEX INJEKSI F non fopi AMP SANBE FARMA 6,869.50 30.00% 4,980.39
    97 208FE02M02 FFE02M002 02 CARDIOVASCULAR & HAEMATOPOCROME INJ 50 MG F fopi AMP FERRON 22,000.00 42.00% 19,800.00
    98 CURCUMA SANBE TAB F non fopi PC SANBE FARMA 968.00 25.00% 750.20
    99 CURFOS SYR. 100 ML F non fopi BTL INTERBAT 135,300.00 20.00%
    100 208SO31A02 FSO31A002 31 HEALTH SUPPLEMENTS & FOOD CURVIT CL EMULSION SYR. F fopi BTL SOHO 46,035.00 46,035.00

    DATA KEBUTUHAN OBAT REVISI 18 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    101 31 HEALTH SUPPLEMENTS & FOOD CURVIT SYR. 120 ML F non fopi BTL SOHO 30,134.50 30,134.50
    102 31 HEALTH SUPPLEMENTS & FOOD CURVIT SYR. 60 ML F non fopi BTL SOHO 22,423.50 22,423.50
    103 DAKTARIN DIAPER F non fopi BTL YUPHARIN 51,499.80 51,499.80
    104 DEXTAFEN CAPS. F non fopi PC OTTO 2,200.00 27.50% 1,276.00
    105 DEXTAMIN SYR 60 ML F non fopi BTL PHAPROS 28,693.61 28,693.61
    106 DEXTAMIN TAB/300 PC F non fopi PC PHAPROS 1,784.24 0.00% 1,650.42
    107 212WB19O03 FWB19O003 19 INTRAVENOUS & OTHER STERIL DEXTROSE 10% 500 ML F fopi BTL OTSUKA 7,199.50 0.00% 7,499.80
    108 19 INTRAVENOUS & OTHER STERIL DEXTROSE 10% 500 ML F fopi BTL OTSUKA 8,002.50 8,002.50
    109 212OI19O14 FOI19O014 19 INTRAVENOUS & OTHER STERIL DEXTROSE 40% INJ. 25 ML F fopi BTL OTSUKA 7,000.40 0.00% 7,000.40
    110 DEXTROSE 5% 500 ML F non fopi BTL WIDATRA 6,627.50 0.00% 7,348.00
    111 212WB19O24 FWB19O024 19 INTRAVENOUS & OTHER STERIL DEXTROSE 5% 500 ML F fopi BTL OTSUKA 6,627.50 0.00% 6,627.50
    112 19 INTRAVENOUS & OTHER STERIL DEXTROSE 5% 500 ML ( GLUCOSE UNICE
    F non fopi BTL WIDATRA 7,363.40 7,363.40
    113 DEXTROSIN SYR. 120 ML F non fopi BTL OTTO 16,747.50 16,747.50
    114 DEXYCLAV FORTE CAPS. 500 MG F non fopi PC DEXA MEDIKA 10,098.00 10,098.00
    115 DEXYMOX FORTE CAPSUL F non fopi PC DEXA MEDIKA 495.00 495.00
    116 DIABION CAPSUL F non fopi PC METISKA FARMA 1,149.50 1,149.50
    117 11 ENDOCRINE & METABOLIC SYST DIAFORMIN XR F non fopi PC OTTO 2,200.00 27.50% 1,595.00
    118 11 ENDOCRINE & METABOLIC SYST DIAFORMIN XR F non fopi PC OTTO 1,430.00 1,430.00
    119 04 CENTRAL NERVOUS SYSTEM DOGESIC 500 MG F non fopi PC YARINDO 1,320.00 38.00% 847.00
    120 01 GASTROINTESTINAL & HEPATOBIDOM SYR F non fopi BTL LAPI 24,750.00 24,750.00
    121 01 GASTROINTESTINAL & HEPATOBIDOM TB F non fopi PC LAPI 1,980.00 1,980.00
    122 01 GASTROINTESTINAL & HEPATOBIDOME DROPS F non fopi BTL PROMED 18,150.00 18,150.00
    123 01 GASTROINTESTINAL & HEPATOBIDOME SYR. F non fopi BTL PROMED 21,780.00 21,780.00
    124 DOME TAB F non fopi PC PROMED 1,980.00 1,980.00
    125 DOMINAL DROPS F non fopi BTL ACTAVIS 27,500.00 27,500.00
    126 DOMINAL SYR 60 ML F non fopi BTL ACTAVIS 27,500.00 27,500.00
    127 DOMINAL TAB F non fopi PC ACTAVIS 2,566.67 2,566.67
    128 DOPACEF INJEKSI F non fopi VIAL SANBE FARMA 60,335.00 43.48% 34,101.34
    129 208AC02F01 FAC02F001 02 CARDIOVASCULAR & HAEMATOPO DOPAMET TAB F fopi PC ACTAVIS 2,057.00 20.00% 78,100.00
    130 208SA01E04 FSA01E004 01 GASTROINTESTINAL & HEPATOBIDULCOLAX SUPP 5 MG F fopi PC BOEHRINGER 15,375.67 15,375.67
    131 208SA01E03 FSA01E003 01 GASTROINTESTINAL & HEPATOBIDULCOLAX SUPP ADULT 10 MG F fopi PC BOEHRINGER 22,239.14 22,239.14
    132 208SA01E02 FSA01E002 01 GASTROINTESTINAL & HEPATOBIDULCOLAX TAB 5 MG F fopi PC BOEHRINGER 1,456.28 1,456.28
    133 04 CENTRAL NERVOUS SYSTEM DUMIN SYRUP F non fopi BTL ACTAVIS 19,432.60 19,432.60
    134 208JJ04J01 FJJ04J001 04 CENTRAL NERVOUS SYSTEM DUROGESIC MATRIX 12 ug/h F fopi PC JANNSEN 108,454.06 108,454.06
    135 208JJ04J02 FJJ04J002 04 CENTRAL NERVOUS SYSTEM DUROGESIC MATRIX 25 ug/h F fopi PC JANNSEN 237,050.00 0.00% 237,050.00
    136 208JJ04J02 FJJ04J002 04 CENTRAL NERVOUS SYSTEM DUROGESIC MATRIX 25 ug/h F fopi PC JANNSEN 99,019.80 0.00% 99,019.80
    137 212BB19O01 FBB19O001 19 INTRAVENOUS & OTHER STERIL ECOSOL GLUCOSE 10% 500 ML F fopi BTL B/BROUN 12,100.00 12,100.00
    138 19 INTRAVENOUS & OTHER STERIL ECOSOL GLUCOSE 5% 100 ML F non fopi BTL B/BROUN 8,250.00 8,250.00
    139 212BB19O03 FBB19O003 19 INTRAVENOUS & OTHER STERIL ECOSOL GLUCOSE 5% 500 ML F fopi BTL B/BROUN 9,900.00 9,900.00
    140 212BB19O05 FBB19O005 19 INTRAVENOUS & OTHER STERIL ECOSOL NACL 0,9% 100 ML F fopi BTL B/BROUN 7,920.00 7,920.00
    141 19 INTRAVENOUS & OTHER STERIL ECOSOL NACL 0,9% 1000 ML F non fopi BTL B/BROUN 17,600.00 17,600.00
    142 19 INTRAVENOUS & OTHER STERIL ECOSOL NACL 0,9% 500 ML F non fopi BTL B/BROUN 8,800.00 8,800.00
    143 19 INTRAVENOUS & OTHER STERIL ECOSOL RL 500 ML F non fopi BTL B/BROUN 9,680.00 9,680.00
    144 208FE03C01 FFE03C001 03 RESPIRATORY SYSTEM EDOTIN CAPS F fopi PC FERRON 4,125.00 48.00% 3,712.50
    145 ELKANA CL EMULSION 120 ML F non fopi BTL SANBE FARMA 56,265.00 25.00%
    146 ELKANA CL EMULSION 60 ML F non fopi BTL SANBE FARMA 25,410.01 29.55% 42,198.75
    147 30 VITAMINS & MINERALS ELKANA TAB. F non fopi PC SANBE FARMA 716.10 716.10
    148 ELPICEF INJ F non fopi VIAL FAHRENHEIT 220,000.00 25.00% 146,300.00
    149 ELSAZYM SACHET @ 5gr F non fopi PC OTTO 11,618.75 11,618.75

    DATA KEBUTUHAN OBAT REVISI 19 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    150 EPEXOL DROP 15 MG F non fopi BTL SANBE FARMA 32,054.00 32,054.00
    151 EPEXOL SYRUP 15 MG F non fopi BTL SANBE FARMA 19,030.00 25.00% 14,748.25
    152 EPEXOL TABLET 30 MG F non fopi PC SANBE FARMA 913.00 25.00% 707.58
    153 208SB01A04 FSB01A004 EPISAN SYR. 100 ML F fopi BTL SANBE FARMA 53,790.00 25.00% 40,342.50
    154 01 GASTROINTESTINAL & HEPATOBIEPISAN SYR. 200 ML F fopi BTL SANBE FARMA 65,216.25 65,216.25
    155 EPRINOC TABLET F non fopi PC SANBE FARMA 1,540.14 0.00% 1,540.14
    156 EPSONAL TAB F non fopi PC PYRIDAM 5,038.00 15.00% 4,701.40
    157 ERDOBAT CAPSUL F non fopi PC INTERBAT 20.00%
    158 208TP04N01 FTP04N001 04 CENTRAL NERVOUS SYSTEM ERICAF TAB F fopi PC ROCHE 5,907.75 5,907.75
    159 208ER14A01 FER14A001 14 EYE ERLAMYCETIN SALEP MATA F fopi TUBE ERLA 5,775.00 5,775.00
    160 14 EYE ERLAMYCETIN TTS MATA F non fopi BTL ERLA 9,770.75 9,770.75
    161 208SB08F04 FSB08F004 08 ANTI-INFECTIVES SYSTEMIC ERYSANBE CAPS. 500 MG F fopi PC SANBE FARMA 2,920.51 25.00% 2,263.38
    162 208SB08F05 FSB08F005 08 ANTI-INFECTIVES SYSTEMIC ERYSANBE SYR. F fopi BTL SANBE FARMA 24,420.00 25.00% 18,925.50
    163 ESPERSON CR 5 GR F non fopi TUBE AVENTIS 47,679.39 47,679.39
    164 208PH03B01 FPH03B001 03 RESPIRATORY SYSTEM EUPHYLIN RETARD TAB. F fopi PC PHAROS 3,352.25 37.00% 3,352.25
    165 208MI11C01 FMI11C001 11 ENDOCRINE & METABOLIC SYST EUTHYROX 100 MG F fopi PC MERCK 2,919.18 30.91% 2,521.10
    166 208MI11C02 FMI110C02 11 ENDOCRINE & METABOLIC SYST EUTHYROX 50 MG F fopi PC MERCK 1,419.03 1,419.03
    167 208NV02E01 FNV02E001 02 CARDIOVASCULAR & HAEMATOPO EXFORGE 10/160 TAB F fopi PC NOVARTIS 14,252.29 10.00% 12,827.06
    168 FALERGI TAB F non fopi PC FAHRENHEIT 3,850.00 10.00% 3,465.00
    169 FARBION INJ F non fopi AMP FAHRENHEIT 7,260.00 10.00% 6,534.00
    170 FARBION TAB F non fopi PC FAHRENHEIT 1,320.00 10.00% 1,188.00
    171 FARBIVENT F FAHRENHEIT 0.00%
    172 208PN02A02 FPN02A002 02 CARDIOVASCULAR & HAEMATOPO FARGOXIN TAB. F fopi PC FAHRENHEIT 404.25 40.00% 214.50
    173 208PN02A02 FPN02A002 FARGOXIN TAB. F fopi PC FAHRENHEIT 404.32 40.00% 214.50
    174 FARMACROL FORTE TABLET F non fopi PC FAHRENHEIT 660.00 660.00
    175 208FA04K01 FFA04K001 04 CENTRAL NERVOUS SYSTEM FARMADOL INFUS F fopi BTL FAHRENHEIT 66,000.00 36.00% 47,520.00
    176 FARMADRAL TAB. 10 MG F non fopi PC FAHRENHEIT 242.55 35.00% 231.00
    177 208FA03C02 FFA03C002 03 RESPIRATORY SYSTEM FARMAVON INJEKSI 4MG/2ML F fopi AMP FAHRENHEIT 42,900.00 28.00% 42,900.00
    178 FARMAVON SYR 100 ML F non fopi BTL FAHRENHEIT 20,900.00 20,900.00
    179 FARSIX INJ F non fopi AMP FAHRENHEIT 7,700.00 7,700.00
    180 208PN02B03 FPN02B003 02 CARDIOVASCULAR & HAEMATOPO FARSORBID 5 MG F fopi PC FAHRENHEIT 286.00 40.00% 156.31
    181 FARSORBID INJ. F non fopi AMP FAHRENHEIT 74,250.00 0.00% 74,250.00
    182 208FA03B06 FFA03B006 FARTOLIN EXP.SYR 100 ML F fopi BTL FAHRENHEIT 30.00% 7,700.00
    183 FENDEX INJEKSI F non fopi AMP FAHRENHEIT 47,300.00 47,300.00
    184 208PI04J02 FPI04J002 04 CENTRAL NERVOUS SYSTEM FENTANYL INJ. 0.05 MG F fopi AMP JANNSEN 39,600.00 0.00% 48,400.00
    185 FERIZ DROPS F non fopi BTL NICHOLAS 40,425.00 0.00% 33,000.00
    186 FEROSPAT TABLET F non fopi PC PYRIDAM 7,920.00 15.00% 6,553.80
    187 FG TROCHES LOZENGES F non fopi PC MEIJI 1,281.25 1,281.25
    188 FINPRO TAB F non fopi PC INTERBAT 14,520.00 50.00% 6,930.00
    189 FLAMAR ZALF 20 GR F non fopi TUBE SANBE FARMA 18,040.00 25.00% 13,981.00
    190 FLAMICORT INJ. 10 MG F non fopi VIAL DEXA MEDICA 137,500.00 15.00% 116,875.00
    191 208GS03B02 FGS03B002 03 RESPIRATORY SYSTEM FLIXOTIDE NEB. 0.5 MG F fopi PC GLAXO 14,738.02 0.50% 15,596.62
    192 FOLAC TAB F non fopi PC OTTO 1,100.00 27.50% 797.50
    193 FOLAVICAP 400 MG F non fopi PC CAPRIFARMINDO 724.63 724.63
    194 208SB30B01 FSB30B001 30 VITAMINS & MINERALS FOLAVIT TAB. 1000 MG F fopi PC SANBE FARMA 2,095.51 25.00% 1,571.63
    195 30 VITAMINS & MINERALS FOLAVIT TAB. 400 MG F fopi PC SANBE FARMA 984.51 25.00% 762.99
    196 FORMOM TABLET F non fopi PC PYRIDAM 2,651.00 15.00% 2,081.31
    197 FORMOM TABLET F non fopi PC PYRIDAM 2,651.00 15.00%
    198 FORMUNO CAPS F PC SANBE FARMA 7,480.00 25.00%

    DATA KEBUTUHAN OBAT REVISI 20 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    199 FOROTIC 3MG / 5ML F BTL KALBE FARMA 56,100.00 0.00%


    200 208KB05C01 FKB05C001 05 MUSCULO-SKELETAL SYSTEM FORRES TABLET 50 MG F fopi PC KALBE FARMA 2,970.00 0.00% 2,970.00
    201 FORTANES INJ. 15 MG / 3 ML F non fopi AMP KALBE FARMA 45,100.00 0.00% 45,100.00
    202 FORTANES INJ. 5 MG / 3 ML F non fopi AMP KALBE FARMA 18,700.00 0.00% 18,700.00
    203 208SB15D01 FSB15D001 15 EAR FORUMEN EYE DROPS 10 ML F fopi BTL SANBE FARMA 28,105.00 30.00% 19,673.50
    204 FUSON CREAM F non fopi TUBE PYRIDAM 50,930.00 0.00% 50,930.00
    205 208CB16A01 FCB16A001 16 DERMATOLOGICALS FUSYCOM CREAM F fopi TUBE COMBIPHAR 6,277.70 6,277.70
    206 16 DERMATOLOGICALS FUTADERM CREAM F non fopi TUBE SANBE FARMA 112,200.00 20.00% 89,760.00
    207 212SB19O03 FSB19O003 19 INTRAVENOUS & OTHER STERIL FUTROLIT INF F fopi BTL SANBE FARMA 39,602.62 0.00% 39,602.62
    208 212SB19O03 FSB19O003 19 INTRAVENOUS & OTHER STERIL FUTROLIT INF F fopi BTL SANBE FARMA 41,232.08 41,232.08
    209 208PN13C01 FPN13C001 GABAXA INFUS 100 ML F fopi BTL FAHRENHEIT 275,000.00 10.90% 9,328.00
    210 208NV11B02 FNV11B002 11 ENDOCRINE & METABOLIC SYST GALVUS MET 50/500 MG F fopi PC NOVARTIS 8,334.63 22.87% 6,428.20
    211 GALVUS MET 50/850 MG F non fopi PC NOVARTIS 8,334.62 15.00% 6,878.11
    212 211MD12B01 FMD12B001 12 ALLERGY & IMMUNE SYSTEM GARDASIL INJ. 0.5 ML F fopi AMP MSD 900,466.60 5.48% 725,304.60
    213 212DM19O01 FDM19O001 19 INTRAVENOUS & OTHER STERIL GELAFUSAL INF 500 ML F fopi BTL DEXA MEDICA 192,500.00 21.00% 163,625.00
    214 GERDILIUM DROPS F non fopi BTL OTTO 44,000.00 27.50% 31,900.00
    215 208IT01C02 FIT01C002 01 GASTROINTESTINAL & HEPATOBIGITAS INJEKSI F fopi AMP INTERBAT 31,945.23 57.00% 23,980.00
    216 GLAUCON TAB 250 MG F non fopi PC CENDO 4,180.00 7.50% 4,180.00
    217 208SB14F01 FSB14F001 14 EYE GLAUSETA TAB. F fopi PC SANBE FARMA 4,988.50 36.00% 3,866.09
    218 GLUVAS 4 MG F non fopi PC DEXA MEDICA 6,435.00 6,435.00
    219 208OT01I03 FOT01I003 01 GASTROINTESTINAL & HEPATOBIGRANOPI CAPS. 1 MG F fopi PC OTTO 22,000.00 37.00% 15,950.00
    220 GRATIZIN 10 MG F non fopi PC SANBE FARMA 5,769.68 22.50% 4,620.55
    221 GRATIZIN 5 MG F non fopi PC SANBE FARMA 4,983.00 25.00% 3,861.82
    222 208AS10E02 FAS10E002 10 GENITO-URINARY SYSTEM HARNAL OCAS F fopi PC ASTELLAS 5,198.87 5,198.87
    223 208AS10E01 FAS10E001 10 GENITO-URINARY SYSTEM HARNAL D 0,2 MG F fopi PC ASTELLAS 7,749.06 7,749.06
    224 208KB02R01 FKB02R001 02 CARDIOVASCULAR & HAEMATOPO HEMAPO INJ F fopi VIAL KALBE FARMA 93,555.00 0.00% 93,555.00
    225 HEPA - Q CAPS F non fopi PC PYRIDAM 5,830.00 20.00% 4,851.00
    226 HEPAGUSAN INJEKSI F non fopi VIAL SANBE FARMA 49,126.00 0.00% 49,126.00
    227 HI BONE E 300 F non fopi PC OTTO 4,400.00 42.00% 3,190.00
    228 HI BONE E 600 F non fopi PC OTTO 5,500.00 27.50% 3,987.50
    229 HISTIGO TAB F non fopi PC IFARS 532.99 532.99
    230 HUMAN ALBUMIN 20% 50 ML F non fopi BTL PHARMASOLINDO 444,999.50 0.00% 444,999.00
    231 HUMAN ALBUMIN 20% 50 ML F non fopi BTL DEXA MEDICA 0.00% 445,000.00
    232 208DM10C03 FDM10C003 10 GENITO-URINARY SYSTEM HYSTOLAN TABLET F fopi PC DEXA MEDICA 4,950.00 37.00% 4,455.00
    233 IMBOOST CAPS. F non fopi PC SOHO 3,239.50 3,239.50
    234 IMBOOST FORCE SYR. F non fopi BTL SOHO 56,430.00 56,430.00
    235 208SO31B18 FSO31B018 31 HEALTH SUPPLEMENTS & FOOD IMBOOST FORTE CAPS. F fopi PC SOHO 5,808.00 5,808.00
    236 IMBOOST KIDS SYR. F non fopi BTL SOHO 32,604.00 32,604.00
    237 IMBOOST SYR. F non fopi BTL SOHO 31,559.00 31,559.00
    238 IMMU-CEA SYR. F non fopi PC INTERBAT 50.00%
    239 IMUDATOR TABLET F non fopi PC PYRIDAM 8,800.00 15.00% 8,125.33
    240 INDEXON INJ F non fopi AMP INTERBAT 13,860.00 30.00% 10,560.00
    241 208PN02A03 FPN02A003 INDOP INJ F fopi VIAL FAHRENHEIT 19,057.50 22,308.00
    242 211SM12B08 FSM12B008 12 ALLERGY & IMMUNE SYSTEM INFANRIX HEXA F fopi AMP GLAXO 646,900.95 7.47% 598,577.46
    243 INFUSAN D10 500 ML SP F non fopi BTL SANBE FARMA 20,420.40 20,420.40
    244 INFUSAN D5 100 ML F non fopi BTL SANBE FARMA 12,762.75 12,762.75
    245 INFUSAN D5 500 ML SP F non fopi BTL SANBE FARMA 12,276.00 12,276.00
    246 INFUSAN M20 500 ML F non fopi BTL SANBE FARMA 93,390.00 15.00% 79,381.50
    247 INFUSAN NS 100 ML SP F non fopi BTL SANBE FARMA 18,700.00 30.00% 13,090.00

    DATA KEBUTUHAN OBAT REVISI 21 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    248 212SB19O22 FSB19O022 19 INTRAVENOUS & OTHER STERIL INFUSAN NS 1000 ML SP F fopi BTL SANBE FARMA 27,555.00 5.34% 19,288.50
    249 INFUSAN NS 500 ML SP F non fopi BTL SANBE FARMA 6,899.61 0.00% 6,899.61
    250 INFUSAN RING AS 500 ML SP F non fopi BTL SANBE FARMA 10,573.70 10,573.70
    251 INFUSAN RL 500 ML SP F non fopi BTL SANBE FARMA 7,629.47 7,629.47
    252 INFUSAN RL 500 ML SP F non fopi BTL SANBE FARMA 7,702.52 0.00% 7,702.52
    253 INFUSAN WATER FOR IRIGATION 1 LTR F non fopi BTL SANBE FARMA 14,168.00 14,168.00
    254 INTERLAC STICK PACK 0.3 GR F non fopi PC INTERBAT 11,000.00 10.00% 9,350.00
    255 INTERLAC TAB. KUNYAH STRAWBERY F non fopi PC INTERBAT 10,450.00 10.00% 8,695.50
    256 INTERMOXIL SYR F non fopi PC INTERBAT 20.00%
    257 INTERMOXIL SYR. F BTL
    258 INTERPECT SYR. 15 ML F fopi PC INTERBAT 51,700.00 20.00%
    259 INTERPECT SYR. 30 ML F fopi PC INTERBAT 55,550.00 20.00%
    260 INTERVASK 10 MG F non fopi PC INTERBAT 15,125.00 20.00% 10,208.00
    261 INTERVASK 5 MG F non fopi PC INTERBAT 6,292.00 6,292.00
    262 INTRIZIN SYR. F non fopi BTL INTERBAT 72,600.00 20.00% 88,000.00
    263 INTRIZIN TABLET F non fopi BTL INTERBAT 7,535.00 20.00%
    264 208FA02N05 FFA02N005 02 CARDIOVASCULAR & HAEMATOPO INVICLOT INJ. F fopi VIAL FAHRENHEIT 72,600.00 27.00% 65,340.00
    265 INVOMET TAB. 4 MG F non fopi PC INTERBAT 19,250.00 20.00% 14,740.00
    266 INVOMET TAB. 8 MG F non fopi PC INTERBAT 28,600.00 20.00% 21,439.69
    267 ISORIC 300 TAB F non fopi PC INTERBAT 4,565.00 10.00% 3,476.00
    268 208PN14F02 FPN14F002 14 EYE ISOTIC ADRETOR 0.5 F fopi BTL FAHRENHEIT 27,390.00 50.00% 19,173.00
    269 212OI19O04 FOI19O004 19 INTRAVENOUS & OTHER STERIL KA-EN 3A 500 ML F fopi BTL OTSUKA 11,500.50 0.00%
    270 208KB02M01 FKB02M001 02 CARDIOVASCULAR & HAEMATOPO KALNEX TABLET 250 MG F fopi PC KALBE FARMA 1,577.22 0.00% 1,577.22
    271 KALNEX TABLET 500 MG F non fopi PC KALBE FARMA 3,500.75 3,500.75
    272 KALTROFEN SUPP. F non fopi PC KALBE FARMA 14,300.00 5.00% 13,585.00
    273 208KF04L01 FKF04L001 KAMAFLAM TABLET 50 MG F fopi AMP KIMIA FARMA 6,380.00 33.50% 4,533.28
    274 KANDISTATIN DROPS F non fopi BTL METISKA FARMA 36,575.00 36,575.00
    275 KARY UNI 5 ML F non fopi AMP FERRON 41,580.00 41,580.00
    276 208TS15E01 FTS15E001 16 DERMATOLOGICALS KENALOG IN ORBASE CREAM F fopi TUBE SQIBB 55,902.00 55,902.00
    277 208FE04L02 FFE04L002 04 CENTRAL NERVOUS SYSTEM KETESSE INJ- F fopi AMP FERRON 46,530.00 46,530.00
    278 208FE04L03 FFE04L003 04 CENTRAL NERVOUS SYSTEM KETESSE TAB. F fopi PC FERRON 7,920.00 7,920.00
    279 KETOCID CAPS F non fopi PC PYRIDAM 9,020.00 58.50% 7,511.13
    280 208FR10F01 FFR10F001 10 GENITO-URINARY SYSTEM KETOSTERIL F fopi PC FRESENIUS 7,590.00 7,590.00
    281 208FE15E01 FFE15E001 16 DERMATOLOGICALS KETRICIN ORABASE 0.1% 5 GR F fopi TUBE FERRON 49,500.00 37.00% 44,550.00
    282 KETROBAT INJ F non fopi AMP INTERBAT 43,560.00 43,560.00
    283 KIDIMUN SYR. 60 ML F non fopi BTL PYRIDAM 22,000.00 15.00% 38,511.00
    284 208MI13D01 FMI13D001 10 GENITO-URINARY SYSTEM KSR 600 MG F fopi PC MERCK 3,480.47 20.91% 3,005.86
    285 L - BIO F non fopi PC LAPI 7,700.00 20.00% 6,160.00
    286 L – ZINC SYR. 100 ML F non fopi BTL LAPI 29,040.00 29,040.00
    287 LABUMIN CAPS. F non fopi PC LAPI 7,150.00 20.00%
    288 LACTAFAR F non fopi PC FAHRENHEIT 4,400.00 10.00% 3,388.00
    289 LACTO B F non fopi PC NOVELL 6,360.00 6,360.00
    290 LANAKELOID E CREAM 10 GR F non fopi TUBE LANDSON 133,100.00 20.00% 133,100.00
    291 LANAVISION CAPS. F non fopi PC LANDSON 6,050.00 6,050.00
    292 LANFIX CAPS. 100 MG F non fopi PC LANDSON 23,100.00 23,100.00
    293 LANFIX CAPS. 200 MG F non fopi PC LANDSON 44,055.00 44,055.00
    294 LANFIX SYR. F non fopi BTL LANDSON 104,500.00 104,500.00
    295 LANTULOS SYR. 60 ML F non fopi BTL LANDSON 88,000.00 20.00% 88,000.00
    296 LASAL EXP. SYR. 100 ML F non fopi BTL LAPI 41,250.00 20.00% 33,000.00

    DATA KEBUTUHAN OBAT REVISI 22 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    297 LASAL SYR. 100 ML F non fopi BTL LAPI 28,600.00 20.00% 22,880.00
    298 208SA02H02 FSA02H002 LASIX INJ.20MG/2CC
    02 CARDIOVASCULAR & HAEMATOPO F fopi AMP AVENTIS 14,587.85 14,587.85
    299 208SA02H01 FSA02H001 LASIX TAB. 40 MG F fopi PC AVENTIS 5,018.73 5,018.73
    300 LATROPIL SYR. 100 ML F non fopi BTL LAPI 52,800.00 20.00% 42,240.00
    301 LAXADIN SYR. 110 ML F non fopi BTL YUPHARIN 48,510.00 48,510.00
    302 LAXADIN SYR. 60 ML F non fopi BTL YUPHARIN 38,500.00 38,500.00
    303 LESICHOL CAPS 300 MG F fopi PC LANDSON 12,833.33 48.70%
    304 LESICHOL CAPS 600 MG F non fopi PC LANDSON 20,716.66 20.00% 20,716.67
    305 LEVAZIDE TAB F non fopi PC PYRIDAM 6,270.00 64.00% 5,197.50
    306 LEVEMIR FLEXPEN F non fopi CART NOVO NORDISK 89,000.00 0.00% 89,000.00
    307 LEVOCIN EYE DROPS F non fopi BTL SANBE FARMA 84,260.00 25.00% 58,982.00
    308 LIDODEX INJ F non fopi AMP BERNOFARM 66,000.00 0.00% 60,500.00
    309 LIDODEX INJ F non fopi AMP BERNOFARM 66,000.00 10.00% 60,500.00
    310 208PF02L02 FPF02L002 02 CARDIOVASCULAR & HAEMATOPO LIFITOR TAB 20 MG F fopi PC PFIZER 21,753.20 17.48% 20,063.62
    311 02 CARDIOVASCULAR & HAEMATOPO LIFITOR TAB 40 MG F non fopi PC PFIZER 21,043.20 21,043.20
    312 LIPROQY TAB F non fopi PC CAPRIFARMINDO 8,250.00 25.00% 6,393.75
    313 LODIA TABLET 2 MG F non fopi PC SANBE FARMA 1,100.00 25.00% 852.50
    314 LUBIRE CAPS. F non fopi PC PYRIDAM 5,940.00 20.00% 4,950.00
    315 LUBIRE SYR. 60 ML F non fopi BTL PYRIDAM 36,630.00 36,630.00
    316 LYVIT SYR 60 ML F non fopi BTL INTERBAT 40,425.00 20.00% 30,800.00
    317 MAGTRAL SYR 120 ML F non fopi BTL OTTO 40,700.00 27.50% 27,912.50
    318 FKB19O006 MANNITOL 20% 500 ML F fopi BTL KALBE FARMA 26,959.90 0.00%
    319 208SD16B03 FSD16B003 16 DERMATOLOGICALS MEDSCAB CREAM F fopi TUBE SDM 71,995.00 27.27% 71,995.00
    320 16 DERMATOLOGICALS MEDSCAB LOTION F non fopi TUBE SDM 70,125.00 70,125.00
    321 MEFINAL CAPS. 250 MG F non fopi PC SANBE FARMA 520.02 520.02
    322 208SB04L12 FSB04L012 MEFINAL CAPS. 500 MG F fopi PC SANBE FARMA 1,468.50 20.00% 1,174.80
    323 208SB04P01 FSB04P001 04 CENTRAL NERVOUS SYSTEM MEGABAL TABLET F fopi PC SANBE FARMA 824.99 824.99
    324 212OI19O10 FOI19O010 19 INTRAVENOUS & OTHER STERIL MEYLON INJ. F fopi AMP OTSUKA 6,749.60 0.00% 6,448.20
    325 212OI19O24 FOI19O024 19 INTRAVENOUS & OTHER STERIL MGSO4 40% 25 ML F fopi BTL OTSUKA 4,089.80 0.00% 4,089.80
    326 MICARDIS PLUS 40 F non fopi PC BOEHRINGER 12,566.12 12,566.12
    327 MICARDIS PLUS 80 F non fopi PC BOEHRINGER 16,291.55 16,291.55
    328 208LL06B02 FLL06B002 06 HORMONES MICROGYEST 100 MG F fopi PC LAPI 13,200.00 20.00% 10,560.00
    329 MICROGYEST 200 MG F non fopi PC LAPI 24,200.00 20.00% 19,360.00
    330 208MT02N01 FMT02N001 02 CARDIOVASCULAR & HAEMATOPO MINIASPI 80 MG F fopi BTL MERSIFARMA 473.00 0.00% 473.00
    331 MINOSEP 150 ML F non fopi BTL PROMED 38,500.00 38,500.00
    332 208PM15E02 FPM15E002 MINOSEP 60 ML F fopi BTL PROMED 20,900.00 20,900.00
    333 MUCERA DROPS F non fopi BTL OTTO 42,900.00 27.50% 29,507.50
    334 MUCERA SYR 15 MG / 60 ML F non fopi BTL OTTO 18,342.50 18,342.50
    335 MUCERA SYR 30 MG / 60 ML F non fopi BTL OTTO 30,800.00 27.50% 23,925.00
    336 MUCERA TAB F non fopi PC OTTO 1,540.00 27.50% 957.00
    337 MUCOS DROPS F non fopi BTL MEPROFARM 30,360.00 30,360.00
    338 MYOBAT TABLET F non fopi PC INTERBAT 6,050.00 10.00%
    439 MYONAL TAB. F non fopi PC EISSAI 7,463.75 7,463.75
    440 MYONEP TAB F non fopi PC LAPI 3,168.00 3,168.00
    441 NEO GYNOXA OVULA F non fopi PC KALBE FARMA 16,500.00 5.00% 15,675.00
    442 NEO KAOLANA SYR F non fopi BTL SANBE FARMA 13,970.00 25.00% 10,571.00
    443 NEO KAOLANA SYR F non fopi BTL SANBE FARMA 10,571.00 10,826.75
    444 NEO MERCAZOL TAB. F non fopi PC NICHOLAS 1,120.00 1,120.00
    445 208MC30B01 FMC30B001 30 VITAMINS & MINERALS NEUROBION 5000 TABLET SALUT F fopi PC MERCK 1,308.38 1,308.38

    DATA KEBUTUHAN OBAT REVISI 23 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    446 208MC30B03 FMC30B003 30 VITAMINS & MINERALS NEUROBION FORTE CAPS. 5.000 MG F fopi PC MERCK 2,505.60 2,505.60
    447 208MC30B02 FMC30B002 30 VITAMINS & MINERALS NEUROBION INJ. 5000 ML F fopi AMP MERCK 12,281.77 12.00% 11,696.96
    448 208DM30B02 FDM30B002 30 VITAMINS & MINERALS NEURODEX TABLET F fopi PC DEXA MEDICA 605.00 5.00% 605.00
    449 NEURODIAL TAB F non fopi PC KIMIA FARMA 1,265.00 0.00% 1,265.00
    450 NEUROMED 5000 MG F non fopi PC PROMED 2,508.00 2,508.00
    451 208SB30B03 FSB30B003 30 VITAMINS & MINERALS NEUROSANBE 5000 MG F fopi PC SANBE FARMA 2,810.49 25.01% 2,178.14
    452 208SB30B04 FSB30B004 30 VITAMINS & MINERALS NEUROSANBE INJ. F fopi AMP SANBE FARMA 6,017.00 30.00% 4,362.32
    453 NEUROSANBE TABLET F non fopi PC SANBE FARMA 1,314.51 25.00% 985.88
    454 NEUROTAM SYR. 100 ML F non fopi BTL DANKOS 66,000.00 5.00% 62,700.00
    455 208MD01D01 FMD01D001 01 GASTROINTESTINAL & HEPATOBINEW DIATABS TAB F fopi PC MEDIFARM 557.15 0.00% 557.15
    456 208KF02B03 FKF02B003 02 CARDIOVASCULAR & HAEMATOPO NITROKAF RETARD CAPS F fopi PC KIMIA FARMA 2,706.01 39.39% 2,706.00
    457 208KF02B04 FKF02B004 02 CARDIOVASCULAR & HAEMATOPO NITROKAF RETARD FORTE CAPS F fopi PC KIMIA FARMA 3,938.01 35.75% 2,530.17
    458 208KF02B04 FKF02B004 02 CARDIOVASCULAR & HAEMATOPO NITROKAF RETARD FORTE CAPS F fopi PC KIMIA FARMA 3,937.99 35.75% 2,530.17
    459 NOCID KAPLET F non fopi PC KALBE FARMA 5,543.47 5,543.47
    460 208BY07C01 FBY07C001 07 CONTRACEPTIVE AGENTS NOVA T ( 5TH ) F fopi PC BAYER 330,673.20 23.99% 317,955.00
    461 208NN11A02 FNN11A002 11 ENDOCRINE & METABOLIC SYST NOVOMIX FLEXPEN F fopi CART NOVO NORDISK 112,000.00 0.00% 110,968.00
    462 208NN11A03 FNN11A003 11 ENDOCRINE & METABOLIC SYST NOVORAPID FLEXPEN F fopi CART NOVO NORDISK 89,500.00 0.00%
    463 NYNDIA DROPS F non fopi BTL GUARDIAN 39,187.50 39,187.50
    464 NYSTIN DROPS 12 ML F non fopi BTL LAPI 41,250.00 20.00% 33,000.00
    465 OFERLOD TAB. 500 MG F non fopi PC NOVELL 16,500.00 0.00% 16,500.00
    466 OPICEF FORTE SYR 60 ML F non fopi BTL OTTO 57,420.00 57,420.00
    467 OPICEF SYR 60 ML F non fopi BTL OTTO 35,887.50 35,887.50
    468 OPICORT TAB. 4 MG F non fopi PC OTTO 3,850.00 27.50% 2,552.00
    469 OPILAX SYR. 60 ML F non fopi BTL OTTO 60,500.00 48.00% 43,862.50
    470 OPIMER INJ. 1 GR F non fopi VIAL OTTO 539,000.00 52.00% 390,775.00
    471 OPIMOX FORTE SYR 250 ML F non fopi BTL OTTO 23,925.00 23,925.00
    472 OPIMOX SYR 125 ML F non fopi BTL OTTO 17,545.00 17,545.00
    473 OPIMOX TABLET 500 MG F non fopi BTL OTTO 3,465.01 27.50% 2,512.13
    474 OPINACEA CAPS. F non fopi PC OTTO 6,380.00 6,380.00
    475 OPINEURON TAB F non fopi PC OTTO 1,196.25 1,196.25
    476 OPIVASK 10 MG F non fopi PC OTTO 12,100.00 27.50% 8,250.00
    477 ORASIC CAPS. F non fopi PC OTTO 4,400.00 27.50% 3,030.50
    478 ORINOX tab. 60 MG F PC DEXA MEDICA 7,150.00 32.50% 3,030.50
    479 OSTARIN FORTE SYR. F non fopi BTL OTTO 29,700.00 27.50% 19,937.50
    480 OSTARIN SYR. F non fopi BTL OTTO 26,400.00 27.50% 17,545.00
    481 OSTEOR C CREAM F non fopi TUBE PYRIDAM 163,900.00 15.00%
    482 OSTEOR PLUS CAPS. F non fopi PC PYRIDAM 9,386.67 15.00% 7,804.50
    483 208SB15B02 FSB15B002 15 EAR OTILON TETES TELINGA 8 ML F fopi BTL SANBE FARMA 42,405.00 30.00% 29,683.50
    484 OTTOGENTA CREAM F non fopi TUBE OTTO 16,500.00 27.50% 11,962.50
    485 OTTOGENTA INJ F non fopi AMP OTTO 13,200.00 27.50% 13,200.00
    486 OTTOPAIN EAR DROPS F non fopi BTL INTERBAT 82,500.00 47.00% 75,762.50
    487 OTTOPAN DROPS F non fopi BTL OTTO 33,000.00 27.50% 21,931.25
    488 OTTOPAN SYR F non fopi BTL OTTO 24,200.00 27.50% 15,950.00
    489 PAMOL DROPS F non fopi BTL INTERBAT 52,250.00 20.00% 39,820.00
    490 PAMOL SYR. 60 ML F non fopi BTL INTERBAT 29,700.00 50.00% 24,076.25
    491 PEINLOS 400 INJ. F non fopi AMP FAHRENHEIT 60,500.00 15.00% 55,000.00
    30 PIBAKSIN SALEP 10 GR F non fopi TUBE SANBE FARMA 45,100.00 25.00% 34,952.50
    31 PIROFEL GEL F non fopi TUBE SANBE FARMA 19,470.00 25.00%
    32 PIROTOP CREAM 10 MG F non fopi TUBE SDM 65,560.00 0.00% 58,272.50

    DATA KEBUTUHAN OBAT REVISI 24 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    33 PLASBUMIN 20% 20 ML F non fopi BTL DIPA 387,920.00 387,920.00


    34 PLASMINEX INJ. F non fopi AMP SANBE FARMA 13,667.50 30.00% 9,908.94
    35 208SB14B04 FSB14B004 14 EYE POLIDEMISIN EYE DROPS F fopi BTL SANBE FARMA 30,470.00 38.24% 22,852.50
    36 POLIDEMISIN SALEP MATA F non fopi TUBE SANBE FARMA 39,050.00 25.00% 30,263.75
    37 PREABOR TAB. F non fopi PC CAPRIFARMINDO 3,784.00 22.50% 2,932.59
    38 PREDNICORT 4 MG F non fopi PC OTTO 2,392.50 2,392.50
    39 PREDNICORT 8 MG F non fopi PC OTTO 3,588.75 3,588.75
    40 PRONALGES SUPP. F non fopi PC DEXA MEDICA 15,400.00 15.00% 13,090.00
    41 PROPEPSA SYR 100 ml F non fopi BTL GRACIA 50,682.50 50,682.50
    42 PROPEPSA SYR 200 ml F non fopi BTL GRACIA 74,250.00 74,250.00
    43 PRORIS SYR F non fopi BTL PHAPROS 19,245.60 19,245.60
    44 PRORIS SYR FORTE F non fopi BTL PHAPROS 22,096.80 22,096.80
    45 PROSINAL SYR F non fopi BTL GRACIA 26,675.00 26,675.00
    46 PROTERINE INJ F non fopi AMP NOVELL 20,900.00 15.00% 17,765.00
    47 PROTERINE TAB F non fopi PC NOVELL 4,851.00 4,851.00
    48 PROTOP CAPS F non fopi PC INTERBAT 17,902.50 38.00% 13,640.00
    49 PSIDII SYR 60 ML F non fopi BTL DEXA MEDICA 41,800.00 10.00% 37,620.00
    50 208SB01A09 FSB01A009 01 GASTROINTESTINAL & HEPATOBIPUMPITOR CAPS F fopi PC SANBE FARMA 14,883.00 25.00% 11,162.25
    51 PUMPITOR INJ. F non fopi VL SANBE FARMA 165,000.00 30.00% 119,625.00
    52 REBAL PLUS F non fopi PC FAHRENHEIT 2,310.00 10.00% 1,608.75
    53 RECO SALEP MATA F non fopi BTL GMP 5,500.00 5,500.00
    54 RECO TETES MATA F non fopi BTL GMP 7,370.00 7,370.00
    55 RECO TETES TELINGA F non fopi BTL GMP 7,370.00 7,370.00
    56 RECUSTEIN CAPS F non fopi PC LANDSON 6,875.00 20.00% 6,875.00
    57 RECUSTEIN SYR F non fopi BTL LANDSON 55,000.00 20.00% 55,000.00
    58 REGUMEN TAB F non fopi PC CAPRIFARMINDO 4,158.00 22.50% 3,222.45
    59 208FA13D01 FFA13D001 RENAPAR TABLET F fopi PC FAHRENHEIT 2,530.00 30.00% 2,277.00
    60 208SB01G01 FSB01G001 13 NUTRITION RENOSAN INFUS 500 ML F fopi BTL SANBE FARMA 277,090.00 30.00% 235,526.50
    61 208FA03C05 FFA03C005 RESFAR INFUS 25 ML F fopi BTL FAHRENHEIT 17.50%
    62 208KF03B01 FKF03B001 03 RESPIRATORY SYSTEM RETAPHYL SR. CAPL. F fopi PC KIMIA FARMA 2,142.80 45.87% 1,159.90
    63 208SB31B05 FSB31B005 RETIVIT PLUS CAPS F fopi PC SANBE FARMA 7,661.51 30.25% 5,343.90
    64 RHINOFED SYR F non fopi BTL DEXA MEDICA 30,250.00 27,500.00
    65 208DM03C05 FDM03C005 03 RESPIRATORY SYSTEM RHINOFED TAB. F fopi PC DEXA MEDICA 2,200.00 44.00% 1,870.00
    66 RHINOS NEO DROPS F non fopi BTL DEXA MEDICA 52,800.00 49,500.00
    67 208DM03C08 FDM03C008 03 RESPIRATORY SYSTEM RHINOS SR CAPS F fopi PC DEXA MEDICA 6,050.00 32.00% 6,050.00
    68 RHINOS SYR JUNIOR F non fopi BTL DEXA MEDICA 39,600.00 36,300.00
    69 RINDOBION 5000 MG F non fopi PC YARINDO 2,200.00 2,200.00
    70 212WB19O16 FWB19O016 RINGER LACTATE 500 ML F fopi BTL EMJEBE 7,805.60 0.00% 7,703.30
    71 212MH19O01 FMH19O001 RINGER LACTATE 500 ML F fopi BTL EMJEBE 7,703.30 0.00% 7,629.60
    72 212WB19O16 FWB19O016 RINGER LACTATE 500 ML F fopi BTL WIDATRA 7,703.30 0.00% 7,703.30
    73 RINGER LACTATE 500 ML F fopi BTL OTSUKA 7,629.60 0.00% 7,150.00
    74 RINGER LACTATE 500 ML F fopi BTL KIMIA FARMA 7,629.60 6.00% 7,171.82
    75 RINGER LACTATE 500 ML F non fopi BTL WIDATRA 11,235.40 11,235.40
    76 ROFIDEN SUPS F non fopi PC OTTO 14,850.00 55.00% 9,968.75
    77 RYZODEG FLEX TOUCH F non fopi CART NOVO NORDISK 0.00%
    78 RZ-20 SYR. 60 ML F non fopi BTL PYRIDAM 34,100.00 15.00% 28,116.00
    79 SAGESTAM INJ. F non fopi AMP SANBE FARMA 10,714.00 30.00% 7,767.65
    80 208DV01B05 FDV01B005 SALOFALK SOFT. CAPS.500 MG F fopi PC DARYA VARIA 14,410.00 3.50% 11,725.56
    81 SALTICIN CREAM F non fopi TUBE INTERBAT 32,450.00 20.00% 24,552.00

    DATA KEBUTUHAN OBAT REVISI 25 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    82 SALTICIN INJ. F non fopi AMP INTERBAT 26,675.00 20.00% 21,598.50


    83 SANADRYL DMP SYR. 120 ML F non fopi BTL SANBE FARMA 16,709.00 16,709.00
    84 SANADRYL DMP SYR. 60 ML F non fopi BTL SANBE FARMA 13,200.00 25.00% 10,230.00
    85 208SB03C12 FSB03C012 03 RESPIRATORY SYSTEM SANADRYL SYRUP 120 ML F fopi BTL SANBE FARMA 15,730.00 25.00% 12,190.75
    86 208SB03C07 FSB03C007 03 RESPIRATORY SYSTEM SANADRYL SYRUP 60 ML F fopi BTL SANBE FARMA 10,890.00 25.00%
    87 SANBE HEST F non fopi BTL SANBE FARMA 184,624.00 184,624.00
    88 208SB14H03 FSB14H003 14 EYE SANBE TEARS F fopi PC SANBE FARMA 24,255.00 37.00% 16,978.50
    89 SANFULIQ TABLET F non fopi PC SANBE FARMA 5,562.10 22.50% 4,454.31
    90 SANGOBION DROP F non fopi BTL MERK 50,916.14 50,916.14
    91 SANMAG SYR F non fopi BTL SANBE FARMA 11,990.00 0.00% 11,990.00
    92 SANMOL DROPS F non fopi BTL SANBE FARMA 12,702.25 12,702.25
    93 SANMOL FORTE SYR. F non fopi BTL SANBE FARMA 28,270.00 22.50% 21,909.25
    94 SANMOL FORTE TAB. F non fopi PC SANBE FARMA 374.00 25.00% 289.85
    95 SANMOL SYR F non fopi BTL SANBE FARMA 12,870.00 25.00% 9,974.25
    96 208SB04K01 FSB04K001 04 CENTRAL NERVOUS SYSTEM SANMOL TAB. F fopi PC SANBE FARMA 319.00 25.00%
    97 SANORIN HIJAU 200 ML F non fopi BTL SANBE FARMA 25,605.80 25,605.80
    98 SANORIN HIJAU 80 ML F non fopi BTL SANBE FARMA 13,482.70 13,482.70
    99 SANPICILLIN INJ F non fopi AMP SANBE FARMA 12,779.94 12,779.94
    100 208SB11A05 FSB11A005 02 CARDIOVASCULAR & HAEMATOPO SANSULIN LOG-G F fopi PC SANBE FARMA 197,997.80 55.05% 89,000.01
    101 SCABICID CREAM F non fopi TUBE KIMIA FARMA 28,499.90 28,499.90
    102 SCABIMITE CREAM F non fopi TUBE GALANIUM 44,000.00 40.00% 26,400.00
    103 SEDACUM INJ. 15 MG / 3 ML F non fopi AMP DEXA MEDICA 58,300.00 15.00% 55,000.00
    104 SEDACUM INJ. 5 MG / 5 ML F non fopi AMP DEXA MEDICA 27,500.00 15.00% 25,300.00
    105 SERETIDE DISKUS 250 MCG F non fopi PC GLAXO 125,715.70 0.50% 121,908.69
    106 208GS03B05 FGS03B005 03 RESPIRATORY SYSTEM SERETIDE DISKUS 500 MCG F fopi PC GLAXO 137,492.30 0.50% 133,327.61
    107 SERETIDE DISKUS100 MCG F non fopi PC GLAXO 111,850.20 0.50% 108,462.76
    108 208BI04H01 FBI04H001 04 CENTRAL NERVOUS SYSTEM SIFROL 0.125 MG F fopi PC BOEHRINGER 4,401.00 4,401.00
    109 SIKSTOP TABLET F non fopi PC FAHRENHEIT 7,700.00 0.00% -
    110 208PN02N02 FPN02N002 SIMARC 2 MG TAB F fopi PC FAHRENHEIT 1,616.99 45.03% 1,617.00
    111 SIRDALUT TAB. 2 MG F non fopi PC NOVARTIS 8,408.90 10.00% 8,408.91
    112 SIRPLUS RASA ANGGUR F non fopi BTL MEPROFARM 11,440.00 11,440.00
    113 SIRPLUS RASA JERUK F non fopi BTL MEPROFARM 11,440.00 11,440.00
    114 SIRPLUS RASA MELON F non fopi BTL MEPROFARM 11,440.00 11,440.00
    115 SIRPLUS RASA STROBERY F non fopi BTL MEPROFARM 10,560.00 10,560.00
    116 212OI19O33 FOI19O033 19 INTRAVENOUS & OTHER STERIL SOD. NATR. CL. 3% 500 ML F fopi BTL OTSUKA 30,334.70 20.00% 30,334.70
    117 19 INTRAVENOUS & OTHER STERIL SOD.CHLORET NATR. 100 ML F fopi BTL OTSUKA 6,763.90 0.00% 14,410.00
    118 212WB19O01 FWB19O001 SOD.CHLORET NATR. 500 ML F fopi BTL WIDATRA 6,800.20 0.00% 6,190.02
    119 SOD.CHLORET NATR. 500 ML F fopi BTL OTSUKA 9,240.00 0.00% 16,698.00
    120 212WB19O01 FWB19O001 SOD.CHLORET NATR. 500 ML F fopi BTL EMJEBE 6,839.80 0.00% 6,190.02
    121 212WB19O01 FWB19O001 SOD.CHLORET NATR. 500 ML F fopi BTL OTSUKA 0.00% 6,190.02
    122 212KF19O05 FKF19O005 SOD.CHLORET NATR. 500 ML F fopi BTL OTSUKA 0.00%
    123 SOJOURN 250 ML F non fopi BTL FAHRENHEIT 2,145,000.00 2,145,000.00
    124 SOTATIC INJEKSI F non fopi AMP FAHRENHEIT 6,160.00 40.00% 2,970.00
    125 SPASMOMEN TAB. F non fopi PC DEXA MEDICA 5,797.00 5,797.00
    126 SPORETIK KAPS. 100MG ( 30/BOX ) F non fopi PC SANBE FARMA 21,747.00 25.00% 16,853.92
    127 SPORETIK KAPS. 200 MG ( 10/BOX ) F non fopi PC SANBE FARMA 31,405.00 25.00% 24,338.87
    128 SPORETIK SYR. F non fopi BTL SANBE FARMA 91,795.00 25.00% 71,141.12
    129 208AC04A01 FAC04A001 04 CENTRAL NERVOUS SYSTEM STESOLID RECTAL 10 MG F fopi TUBE ACTAVIS 42,144.37 30.00% 39,204.00
    130 208AC04A04 FAC04A004 04 CENTRAL NERVOUS SYSTEM STESOLID RECTAL 5 MG F fopi TUBE ACTAVIS 28,096.20 30.00% 26,136.00

    DATA KEBUTUHAN OBAT REVISI 26 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    131 208SB01E01 FSB01E001 01 GASTROINTESTINAL & HEPATOBISTOLAX SUPP 10 MG F fopi PC SANBE FARMA 7,260.00 25.00% 5,445.00
    132 SULDOX TAB. F non fopi PC ACTAVIS 2,178.00 2,178.00
    133 208AZ03B08 FAZ03B008 03 RESPIRATORY SYSTEM SYMBICORT 160, 60 DOSE F fopi BTL ASTRA ZENECA 135,689.40 0.50% 133,612.18
    134 208AZ03B09 FAZ03B009 03 RESPIRATORY SYSTEM SYMBICORT 80, 60 DOSE F fopi BTL ASTRA ZENECA 135,464.99 0.50% 133,612.18
    135 TARIVID OPTH SOL ( MATA ) F non fopi BTL FERRON 64,130.00 10.00% 57,717.00
    136 208KB15A01 FKB15A001 15 EAR TARIVID OTIC 50 LOTION ( TELINGA ) F fopi BTL KALBE FARMA 57,970.00 0.00% 88,825.00
    137 TEBOKAN SPESIAL F non fopi PC PHAPROS 12,300.75 0.00% 12,300.75
    138 TEBOKAN TAB. F non fopi PC PHAPROS 6,133.05 0.00% 6,133.05
    139 208DM02E07 FDM02E007 TENSIVAKS TAB. 5 MG F fopi PC DEXA MEDICA 6,270.32 55.09% 4,576.00
    140 TENSIVAKS TAB.10 MG F non fopi PC DEXA MEDICA 11,000.00 10.00% 8,360.00
    141 208SB08B15 FSB08B015 08 ANTI-INFECTIVES SYSTEMIC TERFACEF INJ 1 GR F fopi VIAL SANBE FARMA 232,045.00 35.00% 168,232.63
    142 211DM12B01 FDM12B001 12 ALLERGY & IMMUNE SYSTEM TETAGAM INJ. F fopi VIAL DEXA MEDIKA 224,234.41 7.00% 198,000.00
    143 THYAMYCIN FORTE SYR 60 ML F non fopi BTL INTERBAT 74,332.50 74,332.50
    144 THYAMYCIN SYR 60 ML F non fopi BTL INTERBAT 43,945.00 43,945.00
    145 208MI11D01 FMI11D001 11 ENDOCRINE & METABOLIC SYST THYROZOL 10 MG F fopi PC MERCK 2,611.28 25.46% 2,255.20
    146 208MI11D02 FMI11D002 11 ENDOCRINE & METABOLIC SYST THYROZOL 5 MG F fopi PC MERCK 1,757.63 25.46% 1,517.95
    147 208PN02A04 FPN02A004 TIARYT TAB. F fopi PC FAHRENHEIT 4,735.51 50.01% 3,833.50
    148 TIM OPHTAL TTS MATA 0.25% F non fopi BTL SANBE FARMA 26,526.50 26,526.50
    149 TIM OPHTAL TTS MATA 0.5% F non fopi BTL SANBE FARMA 52,470.00 30.00% 36,729.00
    150 TISMAZOL 500 MG F non fopi PC METISKA FARMA 1,828.75 1,828.75
    151 TOBROSAN 5 CC F non fopi PC CENDO 50,801.30 50,875.00
    152 208CD14B08 FCD14B008 14 EYE TOBROSAN MD 0.6 ML F fopi PC CENDO 6,380.00 6,380.00
    153 FCD14B008 14 EYE TOBROSAN MD 0.6 ML F fopi PC CENDO 6,380.00 7.50%
    154 TORAMINE INJ 30 MG F non fopi AMP OTTO 41,800.00 27.50% 4,386.25
    155 TORAMINE TAB.10 MG F non fopi PC OTTO 4,386.25 4,386.25
    156 TORAMINE TAB.10 MG F non fopi PC OTTO 6,050.00 27.50% 4,386.25
    157 TRADOSIK CAPS. F non fopi PC SANBE FARMA 3,410.00 3,410.00
    158 208SB04J01 FSB04J001 04 CENTRAL NERVOUS SYSTEM TRADOSIK INJ. F fopi AMP SANBE FARMA 22,066.00 30.00% 17,101.15
    159 TRADYL TABLET F non fopi PC INTERBAT 4,950.00 20.00% 3,766.13
    160 208SB03C08 FSB03C008 TREMENZA SYR. F fopi BTL SANBE FARMA 22,550.00 25.00% 17,476.25
    161 TREMENZA TAB F non fopi PC SANBE FARMA 1,600.51 25.00% 1,240.39
    162 TRICHODAZOLE 500 TABLET F non fopi PC SANBE FARMA 1,415.15 1,415.15
    163 TRICHODAZOLE PLUS OVULA F non fopi PC SANBE FARMA 10,692.00 10,692.00
    164 TRIDEX 27A 500 ML F non fopi BTL SANBE FARMA 11,499.30 0.00% 15,015.00
    165 TRIFED SYR F non fopi BTL INTERBAT 35,805.00 20.00% 27,280.00
    166 TRIFED TAB. F non fopi PC INTERBAT 2,970.00 20.00% 2,288.00
    167 TRIFEDRIN SYR. F non fopi BTL OTTO 27,500.00 27.50% 19,937.50
    168 TRIFEDRIN TAB. F non fopi PC OTTO 1,435.50 1,435.50
    169 208SE02B03 FSE02B003 TRIZEDON MR F fopi PC SERVIER 3,234.00 3,234.00
    170 TROGYL INFUS 500 MG / 100 ML F non fopi BTL OTTO 93,500.00 27.50% 63,800.00
    171 TROGYL SYR F non fopi BTL OTTO 44,000.00 27.50% 30,305.00
    172 TROGYL TABLET F non fopi PC OTTO 1,980.00 27.50% 1,435.50
    173 TROGYSTATIN OVULA F non fopi PC OTTO 18,150.00 35.00% 11,962.50
    174 TROLAC INJ F non fopi AMP BERNOFARM 33,000.00 10.00% 23,911.25
    175 TROLIP TAB 100 MG F non fopi PC DEXA MEDICA 4,455.00 4,455.00
    176 TROLIP TAB 300 MG F non fopi PC DEXA MEDICA 10,890.00 10,890.00
    177 TROVENSIS INJ. 2ML F non fopi AMP SANBE FARMA 37,213.00 30.00% 26,979.43
    178 TROVENSIS INJ. 4ML F non fopi AMP SANBE FARMA 75,614.00 27.50% 54,820.15
    179 TROVENSIS TABLET 4 MG F non fopi PC SANBE FARMA 9,906.05 9,906.05

    DATA KEBUTUHAN OBAT REVISI 27 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    180 TROVENSIS TABLET 8 MG F non fopi PC SANBE FARMA 18,942.00 25.00% 14,680.05
    181 ULVICE INJ. F non fopi AMP LANDSON 29,700.00 20.00% 29,700.00
    182 UNALIUM 10 TAB F non fopi PC GUARDIAN 8,360.00 8,360.00
    183 UNALIUM 5 TAB F non fopi PC GUARDIAN 6,061.00 6,061.00
    184 URESIX INJ. F non fopi AMP SANBE FARMA 9,196.00 27.50% 3,678.40
    185 UTROGESTAN 100 MG F non fopi PC LAPI 10,956.00 10,956.00
    186 UTROGESTAN 200 MG F non fopi PC LAPI 20,086.00 20,086.00
    187 VALEPTIK SYR F non fopi BTL OTTO 96,800.00 27.50% 63,800.00
    188 208SB04A02 FSB04A002 04 CENTRAL NERVOUS SYSTEM VALISANBE 2 MG F fopi PC SANBE FARMA 258.50 28.09% 187.55
    189 208SB04A03 FSB04A003 04 CENTRAL NERVOUS SYSTEM VALISANBE 5 MG F fopi PC SANBE FARMA 428.99 24.87% 332.48
    190 VALISANBE INJ. 2 ML F non fopi AMP SANBE FARMA 19,789.00 30.00% 15,336.47
    191 VALKENE SYR. 120 ML F non fopi BTL LANDSON 110,000.00 20.00% 63,250.00
    192 VARDIPIN 5/80 F non fopi PC OTTO 19,800.00 10.00% 12,760.00
    193 VAROC TAB 500 MG F non fopi PC PYRIDAM 7,634.00 15.00% 5,722.20
    194 VASOLA INJ F PC FAHRENHEIT 275,000.00 27.00%
    195 208KB02D04 FKB02D004 01 GASTROINTESTINAL & HEPATOBIV-BLOC 6,25 F fopi PC KALBE FARMA 1,613.33 0.00% 1,748.00
    196 VECTRINE CAPS. 300 MG F non fopi PC DEXA MEDICA 3,740.00 3,740.00
    197 VECTRINE SYR. F non fopi BTL DEXA MEDICA 33,660.00 33,660.00
    198 VELTHROM 10 MG F non fopi PC NOVELL 907.50 907.50
    199 VELTHROM 5 MG F non fopi PC NOVELL 783.75 783.75
    200 208GS03B10 FGS03B010 03 RESPIRATORY SYSTEM VENTOLIN NEBULES 2.5 MG F fopi BTL GLAXO 3,979.99 0.00% 10,900.17
    201 VERTIGOSAN TABLET F non fopi PC SANBE FARMA 2,220.76 2,220.76
    202 VESTEIN CAPS.300 MG @30 F non fopi PC KALBE FARMA 4,552.02 4,552.02
    203 VESTEIN SYR. F non fopi BTL KALBE FARMA 36,575.00 36,575.00
    204 VIOXY FM TABLET F PC FAHRENHEIT 4,950.00 15.00%
    205 VITAMULTI DHA CAPS F non fopi PC OTTO 4,180.00 40.00% 2,791.25
    206 VITROLENTA EYE DROPS F non fopi BTL CENDO 36,025.00 0.00% 36,025.00
    207 VOLTAREN EMULGEL 10 GR F non fopi TUBE NOVARTIS 39,385.50 39,385.50
    208 VOLTAREN EMULGEL 20 GR F non fopi TUBE NOVARTIS 72,155.60 72,155.60
    209 VOLTAREN EMULGEL 5 GR F non fopi TUBE NOVARTIS 24,864.40 24,864.40
    210 VOLTAREN EMULGEL 50 GR F non fopi TUBE NOVARTIS 161,698.90 161,698.90
    211 VOLTAREN TAB 50 MG F non fopi PC NOVARTIS 7,075.13 15.00% 6,182.15
    212 VOMEGO INJ.4 MG/2ML F non fopi AMP OTTO 35,200.00 27.50% 23,127.50
    213 VOMEGO TAB. 4 MG F non fopi PC OTTO 14,850.00 27.50% 9,570.00
    214 208DM01B02 FDM01B002 01 GASTROINTESTINAL & HEPATOBIVOMETA DROPS F fopi BTL DEXA MEDICA 49,500.00 43.00% 44,550.00
    215 208DM01B04 FDM01B004 01 GASTROINTESTINAL & HEPATOBIVOMETA FT TAB. 10 MG F fopi PC DEXA MEDICA 4,400.00 40.00% 3,960.00
    216 208DM01B03 FDM01B003 01 GASTROINTESTINAL & HEPATOBIVOMETA SYRUP 60 ML F fopi BTL DEXA MEDICA 49,500.00 43.00% 44,550.00
    217 212OI19O34 FOI19O034 19 INTRAVENOUS & OTHER STERIL WATER FOR INJEKSI 25 ML F fopi BTL OTSUKA 3,050.30 0.00% 6,954.20
    218 WATER STERIL / AQUADEST 1 LITER F non fopi PC WIDATRA 19,724.93 19,789.00
    219 WATER STERIL / AQUADEST 1 LITER F non fopi BTL OTSUKA 23,760.00 23,760.00
    220 XEPAMOL DROPS F non fopi BTL METISKA FARMA 22,990.00 22,990.00
    221 208MK04K01 FMK04K001 XEPAMOL SYR. 250 / 5 ML F fopi BTL METISKA FARMA 24,035.00 24,035.00
    222 XEPAMOL TABLET 500 MG F non fopi PC METISKA FARMA 444.13 444.13
    223 17 ANAESTHETICS LOCAL & GENER XYLOCAINE JELLY 2% 30 GRM F fopi BTL ASTRA ZENECA 64,534.14 20.00% 44,390.50
    224 ZANIC SYR 100 ML F non fopi BTL NICHOLAS 24,200.00 24,200.00
    225 ZIBAC INJ. 1 GR F non fopi VIAL FAHRENHEIT 66,000.00 10.00% 52,800.00
    226 ZIBRAMAX 500 MG F non fopi PC GUARDIAN 34,485.00 34,485.00
    227 ZIBRAMAX DRY SYR F non fopi BTL GUARDIAN 103,455.00 103,455.00
    228 208CB01D05 FCB01D005 01 GASTROINTESTINAL & HEPATOBIZINCPRO DROPS 15 ML F fopi BTL COMBIPHAR 6,281.00 6,281.00

    DATA KEBUTUHAN OBAT REVISI 28 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    229 ZINKID SYR F non fopi BTL INDO FARMA 30,250.00 30,250.00
    230 ZISTIC SYR F non fopi PC BERNOFARM 99,000.00 0.00% 148,500.00
    492 ZYCIN TABLET 500 MG F non fopi PC INTERBAT 1,615.16 0.00% -
    JUMLAH

    OBAT SLOW MOVING


    56 08 ANTI-INFECTIVES SYSTEMIC 3TC-HBV 100 MG S non fopi PC GLAXO 17,094.00 17,094.00
    57 208AI08F03 FAI08F003 08 ANTI-INFECTIVES SYSTEMIC ABBOTIC SYR 30 ML S fopi BTL ABBOT 114,647.50 114,647.50
    58 08 ANTI-INFECTIVES SYSTEMIC ABBOTIC SYR 60 ML S fopi BTL ABBOT 181,390.00 181,390.00
    59 02 CARDIOVASCULAR & HAEMATOPO ACETENSA S non fopi PC FAHRENHEIT 9,900.00 9,900.00
    60 01 GASTROINTESTINAL & HEPATOBIACILAZ TAB S non fopi PC OTTO 12,100.00 12,100.00
    61 01 GASTROINTESTINAL & HEPATOBIACITRAL SYR 120 ML S non fopi BTL INTERBAT 43,450.00 20.00% 33,000.00
    1 01 GASTROINTESTINAL & HEPATOBIACITRAL TABLET S non fopi PC INTERBAT 1,048.16 1,048.16
    2 05 MUSCULO-SKELETAL SYSTEM ACLASTA INFUS 100 ML S non fopi BTL NOVARTIS 4,840,535.70 4,840,535.70
    3 02 CARDIOVASCULAR & HAEMATOPO ACPULSIF 5 MG S non fopi PC DEXA MEDICA 3,465.00 3,465.00
    4 208SB01A13 FSB01A013 01 GASTROINTESTINAL & HEPATOBIACRAN INJEKSI S fopi AMP SANBE FARMA 22,913.00 30.00% 16,205.20
    5 208SB01A01 FSB01A001 01 GASTROINTESTINAL & HEPATOBIACRAN TABLET S fopi PC SANBE FARMA 4,092.00 4,092.00
    6 02 CARDIOVASCULAR & HAEMATOPO ACTALIPID 10 MG S non fopi PC ACTAVIS 8,800.00 8,800.00
    7 02 CARDIOVASCULAR & HAEMATOPO ACTALIPID 20 MG S non fopi PC ACTAVIS 8,800.00 8,800.00
    8 02 CARDIOVASCULAR & HAEMATOPO ACTALIPID 40 MG S non fopi PC ACTAVIS 8,800.00 8,800.00
    9 02 CARDIOVASCULAR & HAEMATOPO ACTAPIN 10 MG S non fopi PC ACTAVIS 7,150.00 7,150.00
    10 02 CARDIOVASCULAR & HAEMATOPO ACTAPIN 5 MG S non fopi PC ACTAVIS 3,850.00 3,850.00
    11 05 MUSCULO-SKELETAL SYSTEM ACTONEL 35 MG S non fopi PC AVENTIS 126,837.70 126,837.70
    12 208TK11B02 FTK11B002 11 ENDOCRINE & METABOLIC SYST ACTOS 15 MG S fopi PC TAKEDA 7,613.57 16.00% 7,232.89
    13 11 ENDOCRINE & METABOLIC SYST ACTOS 30 MG S non fopi PC TAKEDA 10,857.55 10,857.55
    14 02 CARDIOVASCULAR & HAEMATOPO ACTOSMET TAB 15 MG S non fopi PC TAKEDA 5,680.04 5,680.04
    15 208NN11A04 FNN11A004 11 ENDOCRINE & METABOLIC SYST ACTRAPID HUMAN 100 - IU S fopi CART NOVO NORDISK 303,050.00 303,050.00
    339 12 ALLERGY & IMMUNE SYSTEM ADACEL 0.5 ML S non fopi AMP SANOFI AVENTIS 346,500.00 346,500.00
    340 208BY02E02 FBY02E002 02 CARDIOVASCULAR & HAEMATOPO ADALAT OROS TAB. S fopi PC BAYER 6,940.54 6,940.54
    341 02 CARDIOVASCULAR & HAEMATOPO ADONA AC-17 INJ. 10 MG. 2 ML S fopi AMP TANABE ABADI 8,866.00 8,866.00
    342 208TN02M03 FTN02M003 02 CARDIOVASCULAR & HAEMATOPO ADONA AC-17 INJ. 25 MG. 5 ML S fopi AMP TANABE ABADI 16,016.00 16,016.00
    343 02 CARDIOVASCULAR & HAEMATOPO ADONA AC-17 TABLET S non fopi PC TANABE ABADI 2,217.60 2,217.60
    344 208TN02M04 FTN02M004 02 CARDIOVASCULAR & HAEMATOPO ADONA FORTE AC-17 TABLET S fopi PC TANABE ABADI 3,243.90 3,243.90
    345 208KB17A01 FKB17A001 17 ANAESTHETICS LOCAL & GENER AERRANE 250 ML S fopi BTL KALBE FARMA 1,633,500.00 1,633,500.00
    346 AGULAN TAB. S non fopi PC DARYA VARIA 7,975.00 7,975.00
    347 04 CENTRAL NERVOUS SYSTEM ALAXAN FR S non fopi PC DARYA VARIA 465.85 465.85
    348 ALBOTHYL COCENTRATE S non fopi PC PHAROS 23,474.00 23,474.00
    349 03 RESPIRATORY SYSTEM ALCO PLUS SYR 100 ML S non fopi BTL INTERBAT 50,820.00 0.00% 48,400.00
    350 03 RESPIRATORY SYSTEM ALCO PLUS DMP SYR 100 ML S non fopi BTL INTERBAT 51,397.50 20.00% 39,160.00
    351 ALERTEN CAPS Q50 S non fopi PC MEGA LIFESCIENS 6,303.00 6,303.00
    352 30 VITAMINS & MINERALS ALINAMIN - F INJ. S fopi AMP TAKEDA 14,223.91 14,223.91
    353 11 ENDOCRINE & METABOLIC SYST AMARYL TAB. 4 MG S non fopi PC AVENTIS 7,601.52 7,601.52
    354 13 NUTRITION AMINOFLUID INFUS 500 ML S non fopi BTL OTSUKA 70,188.80 70,188.00
    355 208KB13C01 FKB13C001 AMINOFUSIN HEPAR S fopi BTL KALBE FARMA 184,910.00 0.00% -
    356 FKB13C001 13 NUTRITION AMINOFUSIN PAED 250 ML S fopi BTL KALBE FARMA 101,200.00 0.00% 101,200.00
    357 13 NUTRITION AMINOLEBAN INF. 500 CC S non fopi BTL OTSUKA 72,800.20 0.00% 70,969.80
    358 13 NUTRITION AMINOLEBAN ORAL POWDER S non fopi BTL OTSUKA 43,659.00 43,659.00
    359 13 NUTRITION AMINOVEL 600 S non fopi BTL OTSUKA 79,200.00 79,200.00
    360 208SB08C06 FSB08C006 08 ANTI-INFECTIVES SYSTEMIC AMOXAN CAPS 500 MG S fopi PC SANBE FARMA 3,520.00 25.00% -

    DATA KEBUTUHAN OBAT REVISI 29 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    361 08 ANTI-INFECTIVES SYSTEMIC AMOXAN DRY SYR S non fopi BTL SANBE FARMA 19,181.25 19,181.25
    362 03 RESPIRATORY SYSTEM ANADEX SYR S non fopi BTL INTERBAT 34,650.00 20.00% 26,400.00
    363 08 ANTI-INFECTIVES SYSTEMIC ANCLA 500 MG S non fopi PC MEPROFARM 10,120.00 10,120.00
    364 30 VITAMINS & MINERALS ANELAT TAB. S non fopi PC IFARS 139.15 139.15
    365 30 VITAMINS & MINERALS ANEMOLAT CAPL. 1 MG S non fopi PC PHAPROS 183.65 183.65
    366 ANGINTRIZ MR S non fopi PC NOVELL 2,310.00 2,310.00
    367 ANGIOTEN 50 MG S non fopi PC KALBE FARMA 10,659.00 10,659.00
    368 ANITID INJ S non fopi AMP BERNOFARM 14,245.00 14,245.00
    369 11 ENDOCRINE & METABOLIC SYST APIDRA SOLOSTAR 100 S non fopi CART SANOFI AVENTIS 86,564.80 86,564.80
    370 APOLAR N CREAM 10 GRAM S non fopi TUBE ACTAVIS 39,270.00 39,270.00
    371 AQUAGEL JELLY 82 GR S non fopi TUBE PHAPROS 49,500.00 49,500.00
    372 208SE04P01 FSE04P001 04 CENTRAL NERVOUS SYSTEM ARCALION 200 TAB S fopi PC SERVIER 5,763.45 5,763.45
    373 208SE01H02 FSE01H002 01 GASTROINTESTINAL & HEPATOBIARDIUM HD. 1000 MG S fopi PC SERVIER 14,666.67 14,666.67
    374 208ES04G03 FES04G003 04 CENTRAL NERVOUS SYSTEM ARICEPT 5 MG S fopi PC EISSAI 21,423.55 21,423.55
    375 08 ANTI-INFECTIVES SYSTEMIC ARTEMETER INJ S non fopi AMP BEIJING 49,170.00 0.00% 49,170.00
    376 208CB05F01 FCB05F001 ARTRODAR S fopi PC COMBIPHAR 9,753.33 9,753.33
    377 ASABIUM TAB S non fopi PC OTTO 1,540.00 1,540.00
    378 212OI19O01 FOI19O001 19 INTRAVENOUS & OTHER STERIL ASERING 500 ML S fopi BTL OTSUKA 9,680.00 0.00% 8,800.00
    379 208TN13D01 FTN13D001 13 NUTRITION ASPAR-K TBL S fopi PC TANABE ABADI 2,721.29 30.00% 2,721.29
    380 ATARAX 0.5 MG S non fopi PC MERSIFARMA 1,430.00 1,430.00
    381 02 CARDIOVASCULAR & HAEMATOPO ATORSAN 10 S non fopi PC SANDOZ 11,434.50 11,434.50
    382 02 CARDIOVASCULAR & HAEMATOPO ATORSAN 20 S non fopi PC SANDOZ 11,434.50 11,434.50
    383 ATP. KYOWA TABLET S non fopi PC DANKOS 1,379.40 1,379.40
    384 211BF12B03 FBF12B003 12 ALLERGY & IMMUNE SYSTEM ATS. INJ. 1500 E S fopi AMP BIO FARMA 170,500.00 170,500.00
    385 208GS03D01 FGS03D001 03 RESPIRATORY SYSTEM AVAMYS SPRAY S fopi BTL GLAXO 112,476.10 112,476.10
    386 12 ALLERGY & IMMUNE SYSTEM AVAXIM DEWASA S non fopi BTL SANOFI AVENTIS 377,338.50 377,338.50
    387 208BY08G01 FBY08G001 08 ANTI-INFECTIVES SYSTEMIC AVELOX 400 MG S fopi PC BAYER 53,227.70 53,227.70
    388 AVIGAN TABLET 200 MG S non fopi PC DEXA MEDICA 19,841.00 0.00% 47,000.00
    389 BACTIROM INJ. 1 GR S non fopi VIAL SANBE FARMA 326,204.97 27.50% 236,498.60
    390 BAQUINOR FORTE TABLET 500 MG S non fopi PC SANBE FARMA 14,927.01 22.50% 11,568.42
    391 BATUGIN ELIXIR SYRUP S non fopi BTL KIMIA FARMA 43,913.10 43,913.10
    392 BD GARD CAPS S non fopi PC MBF 8,433.33 8,433.33
    393 BELLENIUM INJ S non fopi AMP BERNOFARM 96,525.00 96,525.00
    394 04 CENTRAL NERVOUS SYSTEM BENOCETAM 1200 S non fopi BTL BERNOFARM 3,561.25 3,561.25
    395 04 CENTRAL NERVOUS SYSTEM BENOCETAM INFUS S non fopi BTL BERNOFARM 127,187.50 127,187.50
    396 04 CENTRAL NERVOUS SYSTEM BENOCETAM INJ 1 GR S non fopi AMP BERNOFARM 14,300.00 14,300.00
    397 04 CENTRAL NERVOUS SYSTEM BENOCETAM INJ 3 GR S non fopi AMP BERNOFARM 34,485.00 34,485.00
    398 04 CENTRAL NERVOUS SYSTEM BENODON INJ. S non fopi AMP BERNOFARM 12,540.00 12,540.00
    399 05 MUSCULO-SKELETAL SYSTEM BENOXURIC 100 MG S non fopi PC BERNOFARM 1,707.20 1,707.20
    400 05 MUSCULO-SKELETAL SYSTEM BENOXURIC 300 MG S non fopi PC BERNOFARM 3,080.00 3,080.00
    401 13 NUTRITION BENUTRION 250 ML S non fopi PC SANBE FARMA 104,720.00 104,720.00
    402 13 NUTRITION BENUTRION 250 ML S non fopi PC SANBE FARMA 123,200.00 15.00% 123,200.00
    403 208DM02M01 FDM02M001 02 CARDIOVASCULAR & HAEMATOPO BERIPLAST P INJ. 1 ML S fopi PC DEXA MEDICA 2,664,750.00 2,664,750.00
    404 BEROTEC SOLLUTION 0.1 MG S non fopi BTL BOEHRINGER 324,496.00 324,496.00
    405 BERZYMPLEX TAB. S non fopi PC BERNOFARM 1,650.00 1,650.00
    406 02 CARDIOVASCULAR & HAEMATOPO BETABLOK TAB 100 MG S non fopi PC KALBE FARMA 2,255.00 2,255.00
    407 02 CARDIOVASCULAR & HAEMATOPO BETABLOK TAB 50 MG S non fopi PC KALBE FARMA 1,391.50 1,391.50
    408 BETADINE GARGLE 100 ML S non fopi BTL MBF 11,000.00 11,000.00
    409 BETALALANS CAPS S non fopi PC MBF 11,825.00 11,825.00

    DATA KEBUTUHAN OBAT REVISI 30 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    410 BINOZYT 500 MG S non fopi PC SANDOZ 29,782.50 29,782.50


    411 208PR02S01 FPR02S001 BIO ATP TAB.
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC PHAPROS 2,355.99 25.00% 2,355.98
    412 04 CENTRAL NERVOUS SYSTEM BIOBRAN 250 MG S non fopi PC FERRON 9,900.00 9,900.00
    413 208OT08B02 FOT08B002 08 ANTI-INFECTIVES SYSTEMIC BIOCEF INJ 1 GR S fopi VIAL OTTO 176,000.00 57.00% 127,600.00
    414 BIOCURKEM CAPS S non fopi PC SOHO 11,733.33 11,733.33
    415 BIOCURLIV CAPS S non fopi PC SOHO 7,150.00 7,150.00
    416 BIODIAR TAB. S non fopi PC SANDOZ 1,221.00 1,221.00
    417 BIOSTRUM SYR S non fopi BTL LAPI 36,960.00 36,960.00
    418 BIOTHICOL CAPS 250 MG S non fopi PC SANBE FARMA 1,479.09 1,479.09
    419 BIOTHICOL FORTE SYR S non fopi BTL SANBE FARMA 49,274.50 49,274.50
    420 BIOZYM INJ S non fopi VIAL OTTO 150,150.00 150,150.00
    421 02 CARDIOVASCULAR & HAEMATOPO BIPRO TAB 30 MG S non fopi PC FAHRENHEIT 4,372.50 4,372.50
    422 02 CARDIOVASCULAR & HAEMATOPO BISCOR 5 MG S non fopi PC DEXA MEDICA 2,106.50 2,106.50
    423 208SA03C05 FSA03C005 03 RESPIRATORY SYSTEM BISOLVON SOLUTION 50 ML S fopi BTL BOEHRINGER 80,270.63 80,270.63
    424 10 GENITO-URINARY SYSTEM BLEDSTOP TAB S non fopi PC CAPRIFARMINDO 473.14 473.14
    425 01 GASTROINTESTINAL & HEPATOBIBORAGINOL N SALEP S non fopi TUBE TAKEDA 67,872.75 67,872.75
    426 208TK01H02 FTK01H002 01 GASTROINTESTINAL & HEPATOBIBORAGINOL N SUPP S fopi TUBE TAKEDA 12,320.00 14.00% 12,936.00
    427 01 GASTROINTESTINAL & HEPATOBIBORAGINOL S SALEP S non fopi TUBE TAKEDA 91,385.25 91,385.25
    428 01 GASTROINTESTINAL & HEPATOBIBORAGINOL S SUPP S non fopi TUBE TAKEDA 15,592.50 0.00% 15,592.50
    429 208KB02J02 FKB02J002 02 CARDIOVASCULAR & HAEMATOPO BRAINACT INJ. 2 ML S fopi AMP DANKOS 44,935.00 44,935.00
    430 208KB02J04 FKB02J004 02 CARDIOVASCULAR & HAEMATOPO BRAINACT TAB. S fopi PC DANKOS 12,540.00 12,540.00
    431 02 CARDIOVASCULAR & HAEMATOPO BRAINOLIN INJ. 250 MG S non fopi AMP INMARK 30,855.00 30,855.00
    432 02 CARDIOVASCULAR & HAEMATOPO BRAINOLIN TAB 500 MG S non fopi PC INMARK 8,882.50 8,882.50
    433 14 EYE BRALIFEK PLUS EYE DROPS S non fopi BTL SANBE FARMA 35,766.50 35,766.50
    434 208NP03D03 FNP03D003 03 RESPIRATORY SYSTEM BREATHY NASAL SPRAY ( BNS ) S fopi BTL NOVELL 86,240.00 86,240.00
    435 03 RESPIRATORY SYSTEM BRICASMA INJEKSI S non fopi AMP ASTRA ZENACA 12,558.04 12,558.04
    436 03 RESPIRATORY SYSTEM BRICASMA RESPULE 2.5 MG/2ML S non fopi PC ASTRA ZENACA 7,601.00 7,601.00
    437 208AZ03B02 FAZ03B002 03 RESPIRATORY SYSTEM BRICASMA RESPULE 5MG/2ML S fopi PC ASTRA ZENACA 7,124.04 7,124.04
    438 208AZ03B04 FAZ03B004 03 RESPIRATORY SYSTEM BRICASMA TURB. 100 DOSIS S fopi BTL ASTRA ZENACA 58,251.60 58,251.60
    493 208AZ02N01 FAZ02N001 02 CARDIOVASCULAR & HAEMATOPO BRILINTA 90 MG S fopi PC ASTRA ZENACA 8,322.60 8,322.60
    494 BRONCOPHYLLIN 150 ml SYR S non fopi BTL PRAFA 21,961.50 21,961.50
    495 BUDENOFALK S non fopi PC DARYA VARIA 25,856.82 25,856.82
    496 03 RESPIRATORY SYSTEM BUDESMA 0.25 ML S non fopi PC DEXA MEDICA 15,125.00 15.00% 15,125.00
    497 208DM03B05 FDM03B005 03 RESPIRATORY SYSTEM BUDESMA 0.5 ML S fopi PC DEXA MEDICA 17,600.00 15.00% 17,600.00
    498 208DV16A02 FDV16A002 16 DERMATOLOGICALS BURNAZIN CREAM 500 GR S fopi BTL DARYA VARIA 427,710.40 427,710.40
    499 01 GASTROINTESTINAL & HEPATOBIBUSCOPAN INJ 20MG S non fopi AMP BOEHRINGER 33,558.14 33,558.14
    500 208SA01C02 FSA01C002 01 GASTROINTESTINAL & HEPATOBIBUSCOPAN PLUS TABLET S fopi PC BOEHRINGER 4,148.14 4,148.14
    501 02 CARDIOVASCULAR & HAEMATOPO CADUET 10/10 MG S non fopi PC PFIZER 16,042.03 16,042.03
    502 02 CARDIOVASCULAR & HAEMATOPO CADUET 5/10 MG S non fopi PC PFIZER 8,797.80 8,797.80
    503 CAL-95 S non fopi PC LAPI 4,576.00 4,576.00
    504 02 CARDIOVASCULAR & HAEMATOPO CALSIVAS 10 MG S non fopi PC FAHRENHEIT 7,012.50 7,012.50
    505 02 CARDIOVASCULAR & HAEMATOPO CALSIVAS 5 MG S non fopi PC FAHRENHEIT 4,125.00 4,125.00
    506 CALVIT-D TALET S non fopi PC PROMED 1,306.25 1,306.25
    507 CAMIDEXON INJ S non fopi VIAL METISKA FARMA 5,599.99 5,599.99
    508 CAMIDON INJ S non fopi VIAL METISKA FARMA 10,079.96 10,079.96
    509 CAMIDRYL INJ S non fopi VIAL METISKA FARMA 8,855.00 8,855.00
    510 CAPRAZOL CAPS S non fopi PC CAPRIFARMINDO 9,132.75 9,132.75
    511 11 ENDOCRINE & METABOLIC SYST CAPRIBOSE TABLET 100 MG S non fopi PC CAPRIFARMINDO 2,003.38 2,003.38
    512 11 ENDOCRINE & METABOLIC SYST CAPRIBOSE TABLET 50 MG S non fopi PC CAPRIFARMINDO 1,236.12 1,236.12

    DATA KEBUTUHAN OBAT REVISI 31 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    513 CAPROL INJ 40 MG S non fopi AMP ETHICA 103,950.00 103,950.00


    514 CAPSINAT FORTE SYR S non fopi BTL CAPRIFARMINDO 55,585.75 55,585.75
    515 CAPSINAT SYR S non fopi BTL CAPRIFARMINDO 42,262.00 42,262.00
    516 CARDIOMIN CAPS S non fopi PC DARYA VARIA 2,524.50 2,524.50
    517 02 CARDIOVASCULAR & HAEMATOPO CARDISAN 10 MG S non fopi PC SANBE FARMA 8,763.70 8,763.70
    518 02 CARDIOVASCULAR & HAEMATOPO CARDISAN 5 MG S non fopi PC SANBE FARMA 6,380.00 22.50% 4,944.50
    519 CARDURA TAB 1 MG S non fopi PC PFIZER 8,268.67 8,268.67
    520 CARNON CAPS S non fopi PC ETHICA 5,197.50 5,197.50
    521 CARPIATON TABLET 25 MG S PC FAHRENHEIT 1,455.30 50.00% 5,197.50
    522 CARSIVE INJ. S non fopi AMP LANDSON 187,000.00 187,000.00
    523 208NV04L10 FNV04L010 04 CENTRAL NERVOUS SYSTEM CATAFLAM FAST 50 MG S fopi PC NOVARTIS 9,031.73 19.88% 7,235.84
    524 208BI02F06 FBI02F006 02 CARDIOVASCULAR & HAEMATOPO CATAPRES INJ 1ML S fopi AMP BOEHRINGER 73,662.63 73,662.63
    525 208BI02F06 FBI02F006 02 CARDIOVASCULAR & HAEMATOPO CATAPRES INJ 1ML S fopi AMP BOEHRINGER 33,900.00 33,900.00
    526 208BI02F05 FBI02F005 02 CARDIOVASCULAR & HAEMATOPO CATAPRES TAB. 150 MG S fopi PC BOEHRINGER 4,986.36 4,986.36
    527 01 GASTROINTESTINAL & HEPATOBICEDANTRON CAPS S non fopi PC SOHO 18,150.00 18,150.00
    528 01 GASTROINTESTINAL & HEPATOBICEDANTRON INJ. 4 ML S non fopi AMP SOHO 28,710.00 28,710.00
    529 208DV02B02 FDV02B002 02 CARDIOVASCULAR & HAEMATOPO CEDOCARD RETARD S fopi PC DARYA VARIA 2,667.04 2,667.04
    530 02 CARDIOVASCULAR & HAEMATOPO CEDOCARD TBL 10 MG S non fopi PC DARYA VARIA 1,686.67 1,686.67
    531 208DV02B04 FDV02B004 02 CARDIOVASCULAR & HAEMATOPO CEDOCARD TBL 5 MG S fopi PC DARYA VARIA 1,007.85 1,007.85
    532 CEFACEF KAPLET 200 MG S non fopi PC CAPRIFARMINDO 20,545.25 20,545.25
    533 208SB08B09 FSB08B009 08 ANTI-INFECTIVES SYSTEMIC CEFAT 500 MG TAB S fopi PC SANBE FARMA 11,159.51 25.00% 8,648.61
    534 208SB08B04 FSB08B004 08 ANTI-INFECTIVES SYSTEMIC CEFAT SIRUP S fopi BTL SANBE FARMA 47,190.00 25.00% 36,572.25
    535 08 ANTI-INFECTIVES SYSTEMIC CEFAT SIRUP FORTE S non fopi BTL SANBE FARMA 63,170.25 63,170.25
    536 CEFILA DRY. SYR 100 MG/5ML S non fopi BTL LAPI 91,300.00 91,300.00
    537 CEFSPAN SYR S non fopi BTL KALBE FARMA 103,455.00 103,455.00
    538 CEFSPAN 100 MG S non fopi PC KALBE FARMA 22,990.00 22,990.00
    539 CEFTIEN INJEKSI S non fopi VIAL PYRIDAM 202,554.00 202,554.00
    540 CELLCEPT TAB. 500 MG S non fopi PC ROCHE 17,654.00 17,654.00
    541 208MT04D01 FMT04D001 04 CENTRAL NERVOUS SYSTEM CEPEZET 100 MG S fopi PC MERSIFARMA 484.00 484.00
    542 208MT04D02 FMT04D002 04 CENTRAL NERVOUS SYSTEM CEPEZET INJ S fopi AMP MERSIFARMA 7,150.00 7,150.00
    543 CEPTIK 100 MG S non fopi PC INTERBAT 28,297.50 20.00% 22,907.50
    544 CERADOLAN TAB 200 MG S non fopi PC TAKEDA 15,605.15 15,605.15
    545 208KB30E01 FKB30E001 30 VITAMINS & MINERALS CERNEVIT INJ S fopi VIAL KALBE FARMA 170,280.00 0.00% 170,280.00
    546 208EI02A01 FEI02A001 02 CARDIOVASCULAR & HAEMATOPO CETADOP INJ. 200 MG S fopi AMP ETHICA 6,129.20 6,129.20
    1 CETAZUM INJ. S non fopi VIAL LANDSON 214,500.00 214,500.00
    2 CETINAL 10 MG S non fopi PC KALBE FARMA 4,766.67 4,766.67
    3 CHIROCAINE ISOBARK INJ. 5MG S non fopi AMP ABBOT 120,062.80 120,062.80
    4 CHLORAMEX INJ. S non fopi AMP ACTAVIS 12,100.00 12,100.00
    5 16 DERMATOLOGICALS CHLORAMPHECORT CREAM S fopi TUBE KIMIA FARMA 14,003.00 14,003.00
    6 CIFLOS 500 S non fopi PC GUARDIAN 13,200.00 13,200.00
    7 CIPREC 500 S non fopi PC CAPRIFARMINDO 11,082.50 11,082.50
    8 CITAZ TAB. 100 MG S non fopi PC DANKOS 10,956.00 10,956.00
    9 CITAZ TAB. 50 MG S non fopi PC DANKOS 6,050.00 6,050.00
    10 02 CARDIOVASCULAR & HAEMATOP
    CITICOLIN MPL 500 MG S non fopi PC MEDIKON 6,864.00 6,864.00
    11 04 CENTRAL NERVOUS SYSTEM CITION INJEKSI 250 MG/2ML S non fopi AMP INFION 27,500.00 27,500.00
    12 04 CENTRAL NERVOUS SYSTEM CITION TABLET 1000 MG S non fopi PC INFION 16,500.00 16,500.00
    13 04 CENTRAL NERVOUS SYSTEM CITION TABLET 500 MG S non fopi PC INFION 11,550.00 11,550.00
    14 CLACEF INJ. 1 GR S non fopi VIAL INMARK 121,000.00 121,000.00
    15 CLAMIXIN TAB. S non fopi PC OTTO 11,165.00 11,165.00

    DATA KEBUTUHAN OBAT REVISI 32 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    16 208SB08C10 FSB08C010 ` CLANEKSI SYR S fopi BTL SANBE FARMA 77,440.00 25.00% 45,182.50
    17 CLAVAMOX CAPS. 500 MG S non fopi PC KALBE FARMA 12,888.33 12,888.33
    18 CLAVAMOX DS SYR S non fopi BTL KALBE FARMA 67,925.00 67,925.00
    19 CLIDACOR GEL S non fopi TUBE PHARMACORE 16,788.75 16,788.75
    20 CLIDACOR TAB 300 MG S non fopi PC PHARMACORE 4,070.00 4,070.00
    21 CLINIUM GEL 10 MG S non fopi TUBE INTERBAT 29,700.00 29,700.00
    22 CLINJOS 300 MG S non fopi PC MEPROFARM 5,940.00 5,940.00
    23 CLOBIUM TAB. S non fopi PC FERRON 1,881.00 1,881.00
    24 208SD16E05 FSD16E005 CLODERMA OINTMENT S fopi TUBE SDM 34,787.50 34,787.50
    25 CLOFION TAB. 75 MG S non fopi PC INFION 11,000.00 11,000.00
    26 208MT04A04 FMT04A004 04 CENTRAL NERVOUS SYSTEM CLOFRITIS TAB S fopi PC MERSIFARMA 1,562.00 1,562.00
    27 CLOGIN TAB 75 MG S non fopi PC INTERBAT 15,200.63 15,200.63
    28 CLOPEDIN INJ. S non fopi AMP MERSIFARMA 27,830.00 27,830.00
    29 208MT04D04 FMT04D004 04 CENTRAL NERVOUS SYSTEM CLORILEX 25 S fopi PC MERSIFARMA 4,400.00 4,400.00
    231 CLOVERTIL TAB. S non fopi PC MEPROFARM 12,540.00 12,540.00
    232 CO ARTEM S non fopi PC NOVARTIS 4,449.52 4,449.52
    233 208IT30E03 FIT30E003 30 VITAMINS & MINERALS COBAZIM CAP. 3000 MG S fopi PC INTERBAT 9,240.00 9,240.00
    234 208KF03C05 FKF03C005 03 RESPIRATORY SYSTEM CODIPRONT CAPS S fopi PC KIMIA FARMA 7,937.60 7,937.60
    235 208KF03C07 FKF03C007 03 RESPIRATORY SYSTEM CODIPRONT CUM SYR. 60 ML S fopi BTL KIMIA FARMA 61,105.00 61,105.00
    236 03 RESPIRATORY SYSTEM CODITAM TAB S non fopi PC KIMIA FARMA 4,510.00 4,510.00
    237 COLDIZO TAB S non fopi PC SOHO 2,200.00 2,200.00
    238 208SB08E03 FSB08E003 08 ANTI-INFECTIVES SYSTEMIC COLSANCETINE KAPS. 250 MG S fopi PC SANBE FARMA 638.00 25.00% -
    239 COMBANTRIN SYR. S non fopi BTL PFIZER 14,663.00 14,663.00
    240 208MI02D01 FMI02D001 CONCOR TAB. 1.5 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC MERCK 3,260.40 3,260.40
    241 208MI02D02 FMI02D002 CONCOR TAB. 2.5 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC MERCK 748.00 748.00
    242 208MI02D03 FMI02D003 CONCOR TAB. 5 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC MERCK 9,959.17 48.57% 8,172.95
    243 CONSTIPEN 120 ML S non fopi BTL COMBIPHAR 73,810.00 73,810.00
    244 COPIDREL 75 MG
    02 CARDIOVASCULAR & HAEMATOPO S non fopi PC LANDSON 16,500.00 16,500.00
    245 CORDARONE INJ.
    02 CARDIOVASCULAR & HAEMATOPO S non fopi AMP SANOFI AVENTIS 32,714.88 32,714.88
    246 CORDARONE TAB 200 MG
    02 CARDIOVASCULAR & HAEMATOPO S non fopi PC SANOFI AVENTIS 7,193.85 7,193.85
    247 CORSEL S non fopi PC FAHRENHEIT 5,500.00 5,500.00
    248 06 HORMONES CORTIDEX TABLET S non fopi PC SANBE FARMA 319.00 25.00% 238.70
    249 COTEN TAB. 100 MG S non fopi PC INTERBAT 16,500.00 32.00% 13,557.50
    250 COTEN TAB. 30 MG S non fopi PC INTERBAT 7,975.00 10.00% 6,545.00
    251 03 RESPIRATORY SYSTEM COUGH - EN PLUS SYR. 120 Ml S non fopi BTL METISKA FARMA 20,790.00 20,790.00
    252 03 RESPIRATORY SYSTEM COUGH - EN PLUS SYR. 60 Ml S non fopi BTL METISKA FARMA 16,170.00 16,170.00
    253 COVIFOR INJ. 100 MG S non fopi VIAL KALBE FARMA 1,100,000.00 1,500,000.00
    254 COVIFOR INJ. 100 MG S non fopi VIAL KALBE FARMA 0.00%
    255 CPG 75 MG S non fopi PC KALBE FARMA 17,068.33 17,068.33
    256 208KB08G04 FKB08G004 08 ANTI-INFECTIVES SYSTEMIC CRAVIT INFUS 750 MG S fopi BTL KALBE FARMA 294,800.00 0.00% 282,150.00
    257 08 ANTI-INFECTIVES SYSTEMIC CRAVIT OPTH SOL 5 ML S non fopi BTL FERRON 121,000.00 121,000.00
    258 208KB08G07 FKB08G007 08 ANTI-INFECTIVES SYSTEMIC CRAVIT TAB 500 MG S fopi PC KALBE FARMA 38,665.00 38,665.00
    259 08 ANTI-INFECTIVES SYSTEMIC CRAVOX TAB. 500 MG S non fopi PC LAPI 26,950.00 26,950.00
    260 CRESTOR 10 MG
    02 CARDIOVASCULAR & HAEMATOPO S non fopi PC ASTRAZENECA 14,746.83 14,746.83
    261 208AZ02L06 FAZ02L006 CRESTOR 20 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC ASTRAZENECA 23,144.28 23,144.28
    262 CRESTOR 40 MG
    02 CARDIOVASCULAR & HAEMATOPO S non fopi PC ASTRAZENECA 22,632.81 22,632.81
    263 CRISPA TAB. S non fopi PC CAPRIFARMINDO 17,105.01 22.50% 13,256.38
    264 CROME TAB
    02 CARDIOVASCULAR & HAEMATOPO S non fopi PC FERRON 1,980.00 1,980.00
    265 04 CENTRAL NERVOUS SYSTEM CUPANOL SYR S non fopi BTL GUARDIAN 19,800.00 19,800.00

    DATA KEBUTUHAN OBAT REVISI 33 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    266 CURLIV CAPS S non fopi PC SOHO 1,980.00 1,980.00


    267 CURLIV PLUS CAPS S non fopi PC SOHO 2,970.00 2,970.00
    268 CURMUNOS SYR S non fopi BTL FAHRENHEIT 88,000.00 10.00% 60,775.00
    269 31 HEALTH SUPPLEMENTS & FOOD CURVIT TAB. S non fopi PC SOHO 1,782.00 1,782.00
    270 CYCLOGESTON INJ. U/ 1 BLN S non fopi AMP ANDALAN 6,500.01 6,500.01
    271 06 HORMONES CYGEST 400 S non fopi TUBE ACTAVIS 20,900.00 20,900.00
    272 CYNTOCINON INJ. S non fopi AMP NOVARTIS 13,913.35 13,913.35
    273 CYTODROX CAPSUL 500 MG S non fopi PC COMBIPHAR 11,011.00 11,011.00
    274 DAILY D3 1000 S non fopi PC INTERBAT 2,566.66 20.00% 11,011.00
    275 DALACIN C 300 MG S non fopi PC INMARK 12,923.35 12,923.35
    276 30 VITAMINS & MINERALS DALFAROL 300 MG S non fopi PC DARYA VARIA 2,732.40 2,732.40
    277 30 VITAMINS & MINERALS DALFAROL 400 MG S non fopi PC DARYA VARIA 3,762.00 3,762.00
    278 DAMABEN TAB. S non fopi PC CAPRIFARMINDO 370.84 370.84
    279 DANOCLAV S non fopi PC ACTAVIS 8,800.00 8,800.00
    280 DANSEFION INJ. S non fopi AMP INFION 20,240.00 20,240.00
    281 DANSERA TAB. S non fopi PC OTTO 5,500.00 5,500.00
    282 DARYAZINC DROPS S BTL DARYA VARIA 0.00%
    283 04 CENTRAL NERVOUS SYSTEM DATAN FORTE CAPS. S non fopi PC PYRIDAM 1,483.02 1,483.02
    284 02 CARDIOVASCULAR & HAEMATOPO DEBOSTIN 10 MG S non fopi PC OTTO 11,440.00 11,440.00
    285 02 CARDIOVASCULAR & HAEMATOPO DEBOSTIN 20 MG S non fopi PC OTTO 15,400.00 15,400.00
    286 02 CARDIOVASCULAR & HAEMATOPO DEBOSTIN 40 MG S non fopi PC OTTO 14,300.00 14,300.00
    287 DEFLAMAT 100 MG CR S non fopi TUBE ACTAVIS 8,043.75 8,043.75
    288 DEGRADE TAB. S non fopi PC FERRON 7,150.00 7,150.00
    289 DEGRIUM TAB 5 MG S non fopi PC FERRON 5,227.20 5,227.20
    290 DEHAF SATC. S non fopi PC SOHO 8,250.00 8,250.00
    291 DENUFAM 20 MG S non fopi PC CAPRIFARMINDO 2,673.00 2,673.00
    292 208AI04E01 FAI04E001 04 CENTRAL NERVOUS SYSTEM DEPAKENE SYR. 250 MG / 5ML S fopi BTL ABBOT 172,370.00 172,370.00
    293 208AI04E03 FAI04E003 04 CENTRAL NERVOUS SYSTEM DEPAKOTE ER TAB. 250 MG S fopi PC ABBOT 1,200.10 1,200.10
    294 208AI04E04 FAI04E004 04 CENTRAL NERVOUS SYSTEM DEPAKOTE ER TAB. 500 MG S fopi PC ABBOT 18,021.93 18,021.93
    295 04 CENTRAL NERVOUS SYSTEM DEPAKOTE TAB. 250 MG S non fopi PC ABBOT 10,071.60 10,071.60
    296 04 CENTRAL NERVOUS SYSTEM DEPAKOTE TAB. 500 MG S non fopi PC ABBOT 5,928.00 5,928.00
    297 208ZU06D01 06 HORMONES DEPO MEDROL INJ 40 MG S fopi AMP PFIZER 91,905.00 91,905.00
    298 DEPO PROGESTIN INJ. 3 BLN S non fopi AMP ANDALAM 5,000.22 5,000.22
    299 16 DERMATOLOGICALS DERMADES 0.05% CR 10 GR S non fopi TUBE PHARMACORE 18,823.75 18,823.75
    300 16 DERMATOLOGICALS DERMAKEL CREAM S non fopi TUBE SOHO 110,000.00 110,000.00
    301 208SD16E03 FSD16E003 16 DERMATOLOGICALS DESOLEX CREAM 10 Gr S fopi TUBE SDM 25,080.00 25,080.00
    302 DESREM INJ. S non fopi VIAL MYLAN 1,300,000.00 1,300,000.00
    303 DESREM INJ. S non fopi VIAL MYLAN 400,000.00 0.00% 384,995.00
    304 DETRUSITOL 2 MG S non fopi PC PFIZER 9,137.46 9,137.46
    305 DEXAFLOX 400 MG S non fopi PC DEXA MEDIKA 23,375.00 23,375.00
    306 16 DERMATOLOGICALS DEXOCORT CREAM S non fopi TUBE KIMIA FARMA 28,600.00 28,600.00
    307 DEXPROFEN INJ. S non fopi AMP OTTO 39,600.00 27.50% 28,710.00
    308 212OI19O17 FOI19O017 19 INTRAVENOUS & OTHER STERIL DEXTROSE 5% + NACL 500 ML S fopi BTL OTSUKA 10,459.90 0.00% 10,400.50
    309 212OI19O15 FOI19O015 19 INTRAVENOUS & OTHER STERIL DEXTROSE 5% 100 ML S fopi BTL OTSUKA 7,150.00 15,180.00
    310 DIAGIT TABLET S non fopi PC INTERBAT 1,973.81 1,973.81
    311 DIALAC VANILA S non fopi PC KALBE FARMA 5,280.00 5,280.00
    312 DIALAC VANILA STROBERY S non fopi PC KALBE FARMA 5,280.00 5,280.00
    313 11 ENDOCRINE & METABOLIC SYST DIAMICRON MR INJ. S non fopi AMP SERVIER 419,210.00 419,210.00
    314 208SE11B01 FSE11B001 11 ENDOCRINE & METABOLIC SYST DIAMICRON MR TBL. 60 MG S fopi PC SERVIER 2,992.00 2,992.00

    DATA KEBUTUHAN OBAT REVISI 34 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    315 DIANE 35 S non fopi PC BAYER 81,510.00 81,510.00


    316 DIFLOXIN INFUS S non fopi BTL OTTO 228,800.00 228,800.00
    317 DIFLOXIN TAB. S non fopi PC OTTO 29,040.00 29,040.00
    318 08 ANTI-INFECTIVES SYSTEMIC DIFLUCAN I.V 2 MG/ML X 100 ML S non fopi BTL PFIZER 305,890.20 305,890.20
    319 DIGENTA CREAM S non fopi TUBE INTERBAT 96,800.00 10.00% 69,300.00
    320 DILANTIN CAPS. 100 MG S non fopi PC INMARK 4,505.52 4,505.52
    321 DIONICOL SYR. S non fopi BTL IFARS 5,940.00 5,940.00
    322 02 CARDIOVASCULAR & HAEMATOPO DIOVAN 160 MG CAPSUL S non fopi PC NOVARTIS 1,017.89 1,017.89
    323 02 CARDIOVASCULAR & HAEMATOPO DIOVAN 40 MG CAPSUL S non fopi PC NOVARTIS 8,856.49 8,856.49
    324 208SO02F06 FSO02F006 02 CARDIOVASCULAR & HAEMATOPO DIOVAN 80 MG CAPSUL S fopi PC NOVARTIS 698.93 698.93
    325 DISMENO CAPS. 100 MG S non fopi PC DEXA MEDICA 4,455.00 4,455.00
    326 DISOLF CAPS. S non fopi PC DEXA MEDICA 6,792.50 6,792.50
    327 02 CARDIOVASCULAR & HAEMATOPO DIUVAR INJ S non fopi AMP GRACIA 13,062.50 13,062.50
    328 02 CARDIOVASCULAR & HAEMATOPO DIVASK 10 S non fopi PC KALBE FARMA 10,972.50 10,972.50
    329 02 CARDIOVASCULAR & HAEMATOPO DIVASK 5 S non fopi PC KALBE FARMA 6,270.00 6,270.00
    330 DIVENS PLUS CAPS S non fopi PC DEXA MEDICA 3,085.50 3,085.50
    331 DIVENS PLUS SYR. S non fopi BTL DEXA MEDICA 30,855.00 30,855.00
    332 02 CARDIOVASCULAR & HAEMATOPO DIVITI INJEKSI S non fopi AMP DEXA MEDICA 324,500.00 31.00% 259,600.00
    333 208DM02A01 FDM02A001 02 CARDIOVASCULAR & HAEMATOPO DOBUJECT INJ. S fopi VIAL DEXA MEDICA 126,225.00 126,225.00
    334 02 CARDIOVASCULAR & HAEMATOPO DOBURAN INJ. S non fopi AMP DIPA 18,631.47 18,631.47
    335 04 CENTRAL NERVOUS SYSTEM DOLOFENAC TAB S non fopi PC MERCK 3,082.75 3,082.75
    336 16 DERMATOLOGICALS DOLONES CREAM S non fopi TUBE SANBE FARMA 47,355.00 47,355.00
    337 208AC02F01 FAC02F001 02 CARDIOVASCULAR & HAEMATOPO DOPAMET TAB S fopi PC ACTAVIS 2,818.06 2,057.00
    338 DORMICUM INJ. 3 ML / 15 MG S non fopi AMP ROCHE 70,441.00 70,441.00
    339 DORMICUM INJ. 5 ML / 5 MG S non fopi AMP ROCHE 23,984.71 23,984.71
    340 208AS02N01 FAS02N001 02 CARDIOVASCULAR & HAEMATOPO DORNER 20 MCB TAB. S fopi PC ASTELAS 4,873.00 4,873.00
    341 DOTRIM FORTE CAPS S non fopi PC YARINDO 1,320.00 1,320.00
    342 208AC04K01 FAC04K001 04 CENTRAL NERVOUS SYSTEM DUMIN SUPP 125 MG S fopi PC ACTAVIS 17,914.16 22.08% 12,826.00
    343 208AC04K02 FAC04K002 04 CENTRAL NERVOUS SYSTEM DUMIN SUPP 250 MG S fopi PC ACTAVIS 25,028.95 22.08% 14,960.00
    344 DUMOZOL INFUS S non fopi BTL ACTAVIS 66,000.00 66,000.00
    345 DUROLANE INJEKSI S non fopi AMP KALBE FARMA 2,420,000.00 2,420,000.00
    346 208KF10C03 FKF10C003 10 GENITO-URINARY SYSTEM DUVADILAN INJ. S fopi AMP KIMIA FARMA 32,816.67 89.44% 30,800.00
    347 208KF10C01 FKF10C001 10 GENITO-URINARY SYSTEM DUVADILAN TABLET S fopi PC KIMIA FARMA 5,500.00 30.00% 5,500.00
    348 DYNACEF INJ 1 GR S non fopi VIAL DEXA MEDIKA 82,500.00 82,500.00
    349 E NAT 400 IU S non fopi PC MEGA LIFESCIENS 3,064.71 3,064.71
    350 ECLID 100 MG S non fopi PC DEXA MEDICA 2,376.00 2,376.00
    351 ECLID 50 MG S non fopi PC DEXA MEDICA 1,485.00 1,485.00
    352 208PH17B03 FPH17B003 17 ANAESTHETICS LOCAL & GENER ECRON INJ. 4 MG S fopi AMP PHAROS 75,971.50 75,971.50
    353 208SB03C03 FSB03C003 03 RESPIRATORY SYSTEM EDORISAN DROPS S fopi BTL SANBE FARMA 54,560.00 25.00% 42,284.00
    354 ELOPRO CREAM 10 GR S non fopi TUBE PHARMACORE 23,402.50 23,402.50
    355 EMEGRAN INJ. 3 MG S non fopi AMP KALBE FARMA 110,000.00 110,000.00
    356 EMINETON TABLET S non fopi AMP DANKOS 1,567.50 1,567.50
    357 ENATIN CAPS. S non fopi PC NOVELL 1,499.52 1,499.52
    358 04 CENTRAL NERVOUS SYSTEM ENCEPHABOL SYR. S non fopi BTL MERCK 53,295.00 53,295.00
    359 04 CENTRAL NERVOUS SYSTEM ENCEPHABOL TAB 100 MG S non fopi PC MERCK 2,787.02 2,787.02
    360 ENDROLIN INJ. 3.75 MG S non fopi PC KALBE FARMA 569,800.00 0.00% 548,999.99
    361 ENERCORE S non fopi PC SOHO 19,800.00 19,800.00
    362 211SM12B04 FSM12B004 12 ALLERGY & IMMUNE SYSTEM ENGERIX B INJ 20 MCG(DEWASA) S fopi AMP GLAXO 88,000.00 88,000.00

    DATA KEBUTUHAN OBAT REVISI 35 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    363 211SM12B03 FSM12B003 12 ALLERGY & IMMUNE SYSTEM ENGERIX B 0.5 ML (ANAK) S fopi AMP GLAXO 68,207.15 68,207.15
    364 ENTROCARE 35 MG S non fopi PC KALBE FARMA 8,882.50 8,882.50
    365 ENZYMFORT TABLET S non fopi PC KIMIA FARMA 1,650.00 1,650.00
    366 ENZYPLEX TAB. S non fopi PC MEDIFARMA 948.67 948.67
    367 EPREX PROTEX 2000 IU S non fopi CART JANNSEN 294,525.00 294,525.00
    368 EPREX PROTEX 4000 IU S non fopi CART JANNSEN 583,275.00 583,275.00
    369 ERPHAFILLIN TAB S non fopi PC ERLLIMPEX 146.30 146.30
    370 ERYTHRINE SYR. 60 ML S non fopi BTL INTERBAT 46,750.00 46,750.00
    371 208TK04B01 FTK04B001 04 CENTRAL NERVOUS SYSTEM ESILGAN TAB 1 MG S fopi PC TAKEDA 3,546.00 3,546.00
    372 208TK04B02 FTK04B002 04 CENTRAL NERVOUS SYSTEM ESILGAN TAB 2 MG S fopi PC TAKEDA 5,427.99 5,427.99
    373 ESOMAX INJ. S non fopi VIAL OTTO 181,500.00 27.50% 119,625.00
    374 ESPERSON CR 15 GR S non fopi TUBE AVENTIS 117,985.23 117,985.23
    375 01 GASTROINTESTINAL & HEPATOBIESTOZAR CAPS. 250 MG S non fopi PC FAHRENHEIT 9,900.00 40.00% -
    376 ESVAT 10 S non fopi PC DEXA MEDICA 1,155.00 1,155.00
    377 ESVAT 20 S non fopi PC DEXA MEDICA 2,117.50 2,117.50
    378 ETACIN 500 MG S non fopi PC ETHICA 9,900.00 9,900.00
    379 ETHIDOL INJ 1 GR S non fopi BTL ETHICA 95,040.00 95,040.00
    380 ETOFION INJEKSI S non fopi AMP INFION 26,400.00 26,400.00
    381 211SA12B05 FSA12B005 12 ALLERGY & IMMUNE SYSTEM EUVAX B 0.5 ML S fopi VIAL SANOFI AVENTIS 58,443.00 58,443.00
    382 211SA12B06 FSA12B006 12 ALLERGY & IMMUNE SYSTEM EUVAX B 1 ML S fopi VIAL SANOFI AVENTIS 74,669.10 74,669.10
    383 EVALEN GEL 10 GR S TUBE DEXA MEDICA 37.00%
    384 EVIPROSTAT TAB. S non fopi PC PHAROS 1,518.00 1,518.00
    385 EVOFION INFUS 500MG/100 ML S non fopi BTL INFION 135,850.00 135,850.00
    386 EVOTHYL 100 MG S non fopi PC GUARDIAN 4,807.00 4,807.00
    387 EVOTHYL 300 MG S non fopi PC GUARDIAN 12,435.50 12,435.50
    388 208NV02E02 FNV02E002 02 CARDIOVASCULAR & HAEMATOPO EXFORGE 5/160 TAB S fopi PC NOVARTIS 12,827.06 12,827.06
    389 208NV02E03 FNV02E003 02 CARDIOVASCULAR & HAEMATOPO EXFORGE 5/80 TAB S fopi PC NOVARTIS 12,137.68 12,137.68
    390 16 DERMATOLOGICALS EXODERIL CREAM 5 GRM S non fopi TUBE SANDOZ 33,495.00 33,495.00
    391 208EI30C03 FEI30C003 30 VITAMINS & MINERALS EXTRACE INJ 2 ML S fopi AMP ETHICA 12,100.00 0.00% 12,100.00
    392 208KB11A01 FKB11A001 11 ENDOCRINE & METABOLIC SYST EZELIN INSULIN S fopi AMP KALBE FARMA 137,500.00 137,500.00
    393 EZYGARD SYR. S non fopi BTL PROMED 66,000.00 66,000.00
    394 208PH01H01 FPH01H001 01 GASTROINTESTINAL & HEPATOBIFAKTU SUPP. S fopi PC PHAROS 7,837.50 7,837.50
    395 FAMOCID 20 MG S non fopi PC SANBE FARMA 2,893.00 2,893.00
    396 FAMOCID 40 MG S non fopi PC SANBE FARMA 4,394.50 4,394.50
    397 FANSIDAR TAB. S non fopi PC ROCHE 7,215.25 7,215.25
    398 FARAPON TAB S non fopi PC FAHRENHEIT 440.00 440.00
    399 208FA02A01 FFA02A001 02 CARDIOVASCULAR & HAEMATOPO FARGOXIN INJ S fopi AMP FAHRENHEIT 33,880.00 33,880.00
    400 FARLEV TAB. 500 MG S non fopi PC FAHRENHEIT 27,500.00 27,500.00
    401 FARLEV TAB. 750 MG S non fopi PC FAHRENHEIT 26,950.00 26,950.00
    402 208FA02B01 FFA02B001 02 CARDIOVASCULAR & HAEMATOPO FARMABES INJ. 5 ML S fopi VIAL FAHRENHEIT 121,000.00 30.00% 121,000.00
    403 FARMABION TAB. S non fopi PC GRAHA PHARMA 228.85 228.85
    404 FARMACROL SYR. 100 ML S non fopi BTL FAHRENHEIT 47,300.00 10.00% 34,727.00
    405 FARMACROL SYR. 200 ML S non fopi BTL FAHRENHEIT 58,300.00 10.00% 42,350.00
    406 FARNAT INFUS S non fopi BTL FAHRENHEIT 69,300.00 69,300.00
    407 FARSIX TABLET 40 MG S non fopi PC FAHRENHEIT 1,210.00 25.00% 1,100.00
    408 FARTISON INJEKSI S fopi VIAL FAHRENHEIT 104,500.00 15.00% -
    409 FAVIKAL 200 MG S non fopi PC KALBE FARMA - 0.00% 74,250.00
    410 FEBOGREL TAB. S non fopi PC OTTO 13,200.00 13,200.00
    411 FELDEN CAPS 10 MG S non fopi PC INMARK 4,990.04 4,990.04

    DATA KEBUTUHAN OBAT REVISI 36 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    412 FELDEN GEL 0.5% 15 GR S non fopi TUBE INMARK 74,816.78 74,816.78
    413 FELOSMA 300 MG S non fopi PC BERNOFARM 10,450.00 10,450.00
    414 FENDEX TAB. 25 MG S non fopi PC FAHRENHEIT 6,600.00 10.00% 5,082.00
    415 FENOLIP 100 MG S non fopi PC MEPROFARM 3,520.00 3,520.00
    416 FENOLIP 300 MG S non fopi PC MEPROFARM 8,800.00 8,800.00
    417 FENOPI TAB. 160 MG S non fopi PC OTTO 6,435.00 6,435.00
    418 FENRIS SYR. JERUK S non fopi BTL INTERBAT 27,225.00 27,225.00
    419 FEPIRAM 1200 S non fopi PC FERRON 4,840.00 4,840.00
    420 FERITRIN TABLET S non fopi PC DEXA MEDICA 2,475.00 2,475.00
    421 FERIZ SYR. S non fopi BTL NICHOLAS 33,000.00 33,000.00
    422 FEROFORT FR CAPS. S non fopi PC KALBE FARMA 1,724.25 1,724.25
    423 FERRIPROX TAB. S non fopi PC TAKEDA 32,999.97 32,999.97
    424 FETIK SUPPOSITORIA 100 MG S non fopi PC INTERBAT 18,150.00 30.00% 13,860.00
    425 208DM02N04 FDM02N004 FIBRION INJ. 1500000 IU S fopi VIAL DEXA MEDICA 4,180,000.00 7.50% 3,866,500.00
    426 FIBUMIN CAPS. 500 MG S non fopi PC INFION 4,400.00 4,400.00
    427 FIOCILAS INJEKSI 1 GR S non fopi VIAL INFION 258,500.00 258,500.00
    428 FIONTIC INJEKSI 1000 MG S non fopi VIAL INFION 242,000.00 242,000.00
    429 FIONVASK 10 MG S non fopi PC INFION 6,600.00 6,600.00
    430 FIONVASK 5 MG S non fopi PC INFION 4,106.67 4,106.67
    431 FIORAMOL INFUS S non fopi BTL INFION 44,000.00 44,000.00
    432 FITAJOINT ROLLER S non fopi PC COMBIPHAR 82,500.00 82,500.00
    433 FIXACEP 100 SIRUP KERING S non fopi BTL FAHRENHEIT 82,500.00 10.00% 74,250.00
    434 208FA08B06 FFA08B006 FIXACEP DROPS S fopi BTL FAHRENHEIT 71,500.00 30.00% 64,350.00
    435 FIXACEP TAB 200 MG S non fopi PC FAHRENHEIT 27,500.00 10.00% 23,760.00
    436 FLADEX INFUS S non fopi BTL DEXA MEDICA 63,580.00 63,580.00
    437 FLADYSTIN OVULA S non fopi SUPP DEXA MEDICA 13,662.00 13,662.00
    438 FLAGYL SYR S non fopi BTL AVENTIS 37,807.11 37,807.11
    439 FLAMIC TAB S non fopi PC GRACIA 1,776.50 1,776.50
    440 FLAMICORT INJ. 40 MG S non fopi VIAL DEXA MEDICA 84,150.00 84,150.00
    441 FLAVIN TAB S non fopi PC LANDSON 2,183.50 2,183.50
    442 208CB01E03 FCB01E003 01 GASTROINTESTINAL & HEPATOBIFLEET ENEMA 133 ML S fopi BTL COMBIPHAR 39,325.01 0.50% 106,713.75
    443 FLEXOR DS S non fopi PC DEXA MEDICA 5,445.00 5,445.00
    444 208LL31B01 FLL31B001 FLORAGYN CAPS S fopi PC LAPI 13,200.00 20.00% 10,560.00
    445 FLOXACAP TAB S non fopi PC CAPRIFARMINDO 27,398.25 27,398.25
    446 FLOXARIS INFUS S non fopi BTL OTTO 330,000.00 27.50% 239,250.00
    447 211BF12B08 FBF12B008 12 ALLERGY & IMMUNE SYSTEM FLUBIO VAKSIN 0.5 ML S fopi VIAL BIO FARMA 82,335.00 82,335.00
    448 FLUCADEX SYR S non fopi BTL GRAHA PHARMA 8,800.00 8,800.00
    449 FLUCADEX TAB. S non fopi PC GRAHA PHARMA 475.20 475.20
    450 FLUCORAL 150 MG S non fopi PC KALBE FARMA 71,060.00 71,060.00
    451 FLUDEXIN SYR S non fopi BTL DEXA MEDICA 23,375.00 23,375.00
    452 FLUDEXIN TAB. S non fopi PC DEXA MEDICA 572.00 572.00
    453 FLUMETHHOLON TETES MATA S non fopi BTL FERRON 87,318.00 87,318.00
    454 FLUOMICIN TABLET S non fopi PC MEDINOVA 32,003.13 32,003.13
    455 FLUQUADRI ADULT SH 0.5 S non fopi AMP SANOFI AVENTIS 219,450.00 219,450.00
    456 FLUQUADRI PED SH 0.25 S non fopi AMP SANOFI AVENTIS 174,900.00 174,900.00
    457 FLURIN DMP CAPS S non fopi PC YARINDO 726.00 726.00
    458 FLUTAMOL SYR. 60 ML S non fopi BTL PYRIDAM 7,260.00 7,260.00
    459 FLUTAMOL TABLET S non fopi PC PYRIDAM - -
    460 FLUTIAS INHALER 125 S non fopi BTL KALBE FARMA 120,175.00 120,175.00

    DATA KEBUTUHAN OBAT REVISI 37 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    461 FLUXUM 4250 IU AXA S non fopi CART FAHRENHEIT 112,200.00 112,200.00
    462 FLUXUM 6400 IU AXA S non fopi CART FAHRENHEIT 163,625.00 163,625.00
    463 FLUZEP CAPS. S non fopi PC OTTO 797.50 797.50
    464 FOLAMIL GENIO S non fopi PC DEXA MEDICA 4,180.00 38.00% 3,762.00
    465 FOLAMIL GOLD S non fopi PC DEXA MEDICA 3,960.00 3,960.00
    466 FOLAMIL TAB. S non fopi PC DEXA MEDICA 1,122.00 1,122.00
    467 FOLAS TABLET S non fopi PC LANDSON 1,760.00 1,760.00
    468 FORDIN INJ S non fopi AMP PROMED 14,850.00 14,850.00
    469 FORGESIC CAPS 50 MG S non fopi PC BERNOFARM 2,543.75 2,543.75
    470 FORIFEK 500 S non fopi PC CAPRIFARMINDO 16,780.50 16,780.50
    471 FORIFEK DRY SYR S non fopi BTL CAPRIFARMINDO 67,592.25 67,592.25
    472 FKB30B001 FORNEURO CAPS. S fopi PC KALBE FARMA 4,051.67 0.00% 5,797.00
    473 FORTAGYL INFUS 100 ML S non fopi BTL PRAFA 62,370.00 62,370.00
    474 FOSICOL TAB S non fopi PC GRACIA 3,521.10 3,521.10
    475 208MJ08K02 FMJ08K002 08 ANTI-INFECTIVES SYSTEMIC FOSMICIN INJ. 2 GR S fopi BTL MEIJI 182,875.00 182,875.00
    476 208FR17A01 FFR17A001 17 ANAESTHETICS LOCAL & GENER FRESOFOL INJ. 1% S fopi AMP ETHICA 10,758.00 10,758.00
    477 FRIDEP 50 MG S non fopi PC MERSIFARMA 9,075.00 9,075.00
    478 FRIMANIA 200 S non fopi PC MERSIFARMA 2,200.00 2,200.00
    479 FRIZIN TABLET S non fopi PC INFION 4,400.00 4,400.00
    480 FUDAN SYR S non fopi BTL PYRIDAM 69,300.00 69,300.00
    481 FULMICORT NEBU 0.25 mg S non fopi PC ASTRA ZENECA 10,377.40 10,377.40
    482 FULMICORT NEBU 0.5 mg S non fopi PC ASTRA ZENECA 14,130.60 14,130.60
    483 208MM30B01 FMM30B001 FURAMIN INJ S fopi AMP MEPROFARM 9,680.00 9,680.00
    484 FUZIDE SYR S non fopi BTL OTTO 29,507.50 29,507.50
    485 GABAFION TABLET S non fopi PC INFION 7,920.00 7,920.00
    486 GABASANT 300 MG S non fopi PC PYRIDAM 10,018.80 10,018.80
    487 GALFLUX TAB S non fopi PC GUARDIAN 3,960.00 3,960.00
    488 GALVUS TAB. 50 MG S non fopi PC NOVARTIS 7,084.43 5,348.23
    489 208CB12B01 FCB12B001 12 ALLERGY & IMMUNE SYSTEM GAMMARAAS INJ. 5% S fopi AMP COMBIPHAR 3,025,000.00 3,025,000.00
    490 GARENA INFUS S non fopi BTL FAHRENHEIT 220,000.00 220,000.00
    491 GASTRIDIN INJ. S non fopi AMP INTERBAT 21,417.00 21,417.00
    492 GASTRIDIN TABLET S non fopi PC INTERBAT 4,877.81 4,877.81
    493 GASTRINAL SYR 120 ML S non fopi BTL MEPROFARM 19,360.00 19,360.00
    494 208DM01A02 FDM01A002 GASTROFER INJ. S fopi AMP DEXA MEDICA 107,525.00 107,525.00
    495 GASTROLAN CAPS S non fopi PC GRACIA 12,540.00 12,540.00
    496 208FA01A04 FFA01A004 01 GASTROINTESTINAL & HEPATOBIGASTRUL TAB S fopi PC FAHRENHEIT 12,650.00 33.04% 9,740.50
    497 GERAC POWDER S non fopi PC LANDSON 14,850.00 14,850.00
    498 GERDILIUM SYR. S non fopi BTL OTTO 33,495.00 33,495.00
    499 GERDILIUM TAB. S non fopi PC OTTO 4,620.00 27.50% 3,190.00
    500 GERIAVITA CAPS. S non fopi PC PHAPROS 2,174.26 2,174.26
    501 GETIDINE INJ S non fopi AMP GUARDIAN 20,900.00 20,900.00
    502 GITAS PLUS CAPS S non fopi PC INTERBAT 6,710.00 20.00% 5,368.00
    503 GLAMAROL 1 MG S non fopi BTL GUARDIAN 12,762.75 2,310.00
    504 GLAMAROL 2 MG S non fopi PC GUARDIAN 4,180.00 4,180.00
    505 GLAMAROL 3 MG S non fopi PC GUARDIAN 5,538.50 5,538.50
    506 GLAMAROL 4 MG S non fopi PC GUARDIAN 6,792.50 6,792.50
    507 GLANCER TAB S non fopi PC MEPROFARM 2,481.88 2,481.88
    508 GLIARIDE TAB. 2 MG S non fopi PC OTTO 4,070.00 4,070.00
    509 GLIARIDE TAB. 3 MG S non fopi PC OTTO 5,830.00 5,830.00

    DATA KEBUTUHAN OBAT REVISI 38 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    510 GLIMEFION TAB. 2 MG S non fopi PC INFION 4,216.67 4,216.67


    511 GLIMEFION TAB. 4 MG S non fopi PC INFION 5,720.00 5,720.00
    512 GLISODIN CAPS S non fopi PC KALBE FARMA 4,766.67 4,766.67
    513 GLOCEF INJ 1 GR S non fopi VIAL METISKA FARMA 120,175.00 120,175.00
    514 GLUCOBAY TAB. 100 MG S non fopi PC BAYER 2,719.20 2,719.20
    515 208BY11B02 FBY11B002 11 ENDOCRINE & METABOLIC SYST GLUCOBAY TAB. 50 MG S fopi PC BAYER 2,052.60 2,052.60
    516 GLUCOBION TAB S non fopi PC - -
    517 208MI11B01 FMI11B001 11 ENDOCRINE & METABOLIC SYST GLUCOPHAGE TAB. 500 MG S fopi PC MERCK 2,061.34 5.00% 1,498.52
    518 GLUCOPHAGE TAB. 850 MG S non fopi PC MERCK 1,942.51 1,942.51
    519 GLUCOPHAGE XR 500 S non fopi PC MERCK 2,328.47 2,328.47
    520 GLUCOPHAGE XR 750 S non fopi PC MERCK 2,561.35 2,561.35
    521 GLUFOR 500 MG S non fopi PC PYRIDAM 687.50 687.50
    522 GLUMIN TAB. 500 MG S non fopi PC FERRON 1,009.80 1,009.80
    523 GLUMIN XR 500 MG S non fopi PC FERRON 1,815.00 1,815.00
    524 GLUMIN XR 750 MG S non fopi PC FERRON 2,227.50 2,227.50
    525 GLURENORM 30 MG S non fopi PC BOEHRINGER 3,567.80 3,567.80
    526 GLUTROP TAB S non fopi PC TROPICA MAS 15,147.00 15,147.00
    527 GLUVAS 1 MG S non fopi PC DEXA MEDICA 2,057.00 2,057.00
    528 GLUVAS 2 MG S non fopi PC DEXA MEDICA 4,257.00 4,257.00
    529 GLUVAS 3 MG S non fopi PC DEXA MEDICA 4,955.50 4,955.50
    530 GOFORON INJ S non fopi VIAL GUARDIAN 137,500.00 137,500.00
    531 GOOTROPIL 1200 MG TAB S non fopi PC GUARDIAN 4,730.00 4,730.00
    532 GOOTROPIL INJ 1 GR S non fopi AMP GUARDIAN 16,500.00 16,500.00
    533 GOOTROPIL INJ 3 GR S non fopi AMP GUARDIAN 49,500.00 49,500.00
    534 GOVAZOL 150 MG S non fopi PC GUARDIAN 78,375.00 78,375.00
    535 GRACEF INJ. 1 GR S non fopi VIAL GRACIA 182,875.00 182,875.00
    536 GRAFIX TAB. S non fopi PC GRACIA 1,440.45 1,440.45
    537 208DM01I05 FDM01I005 01 GASTROINTESTINAL & HEPATOBIGRANON INJ. 1GR S fopi AMP DEXA MEDICA 47,685.00 47,685.00
    538 GRANON INJ. 3GR S non fopi AMP DEXA MEDICA 100,980.00 100,980.00
    539 GUANISTREP SYR. 60 ML S non fopi BTL ITRASAL 4,749.80 4,749.80
    540 HAEMACCEL INPUS S non fopi BTL DEXA MEDICA 187,000.00 187,000.00
    541 211SM12B06 FSM12B006 12 ALLERGY & IMMUNE SYSTEM HAVRIX 720 junior S fopi PC GLAXO 245,993.00 245,993.00
    542 HEDIX TAB. S non fopi PC SANDOZ 962.50 962.50
    543 208DM16K01 FDM16K001 11 ENDOCRINE & METABOLIC SYST HEMOLOK FERACRYLUM 1%100ML S fopi BTL DEXA MEDICA 99,550.00 99,550.00
    544 HEPA - Q CAPS S non fopi PC PYRIDAM 5,830.00 15.00%
    545 HEPAMAX TAB. S non fopi PC KALBE FARMA 9,240.00 9,240.00
    546 HEPTASAN 4 MG S non fopi PC CAPRIFARMINDO 187.21 187.21
    547 208TN02B02 FTN02B002 02 CARDIOVASCULAR & HAEMATOPO HERBESER CD 100 MG S fopi PC TANABE ABADI 9,925.15 31.82% 8,184.00
    548 HERBESER CD 200 MG S non fopi PC TANABE ABADI 12,441.00 12,441.00
    549 208TN02B04 FTN02B004 02 CARDIOVASCULAR & HAEMATOPO HERBESER INJ 50 MG S fopi AMP TANABE ABADI 297,000.00 297,000.00
    550 HEXADOL SOLUTION 120 MG S non fopi PC OTTO 13,956.25 13,956.25
    551 208OT15E01 FOT15E001 HEXADOL SOLUTION 60 MG S fopi PC OTTO 16,500.00 37.00% 9,968.75
    552 HEXAXIM INJ S non fopi AMP SANOFI AVENTIS 613,800.00 613,800.00
    553 208MT04H01 FMT04H001 04 CENTRAL NERVOUS SYSTEM HEXYMER 2 MG S fopi PC MERSIFARMA 385.00 385.00
    554 HI BONE ACTIVE CHEW S non fopi PC OTTO 2,153.25 2,153.25
    555 HIALID 5 ML S non fopi PC FERRON 83,160.00 83,160.00
    556 HIBERIX INJ S non fopi AMP GLAXO 174,900.00 174,900.00
    557 208EL11A03 FEL11A003 11 ENDOCRINE & METABOLIC SYST HUMALOG MIX CART 100 IU/ML S fopi CART ELI LILLY 150,040.00 150,040.00
    558 HYALOPH EYE DROP S non fopi BTL SANBE FARMA 70,950.00 30.00% 49,665.00

    DATA KEBUTUHAN OBAT REVISI 39 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    559 HYPERIL 10 MG S non fopi PC FERRON 12,375.00 12,375.00


    560 HYPERIL 2.5 MG S non fopi PC FERRON 4,702.50 4,702.50
    561 208FE02C03 FFE02C003 HYPERIL 5 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC FERRON 7,920.00 7,920.00
    562 HYRIC CAPS S non fopi PC INTERBAT 6,072.00 6,072.00
    563 IBUFENZ SYR. S non fopi BTL KALBE FARMA 14,107.50 14,107.50
    564 IGASTRUM DROPS S non fopi BTL PHAROS 24,200.00 24,200.00
    565 IGASTRUM SYR. 100 ml S non fopi BTL PHAROS 23,650.00 23,650.00
    566 IGASTRUM SYR. 60 ml S non fopi BTL PHAROS 14,850.00 14,850.00
    567 208IP12A02 FIP12A002 03 RESPIRATORY SYSTEM IKADRYL SYR. 100 CC S fopi BTL IKAPHARMINDO 17,820.00 17,820.00
    568 208MC03D03 FMC03D003 ILIADIN SPRAY dewasa S fopi BTL MERCK 48,411.00 48,411.00
    569 208MC03D01 FMC03D001 ILIADIN SPRAY DROPS S fopi BTL MERCK 34,177.00 34,177.00
    570 ILLIADIN MOIST S non fopi BTL MERCK 20,237.85 20,237.85
    571 IMATROL DROP S non fopi BTL INTERBAT 36,080.00 36,080.00
    572 IMDUR 60 MG S non fopi PC ASTRA ZENECA 6,302.71 6,302.71
    573 IMMU-CEA TABLET S non fopi PC INTERBAT 10,780.00 50.00%
    574 IMODIAR TABLET S non fopi PC ERLIMPEX 456.80 456.80
    575 IMODIUM TAB. 2 MG S non fopi PC JANNSEN 7,623.90 7,623.90
    576 IMUNDO SYR 60 ML S PC FAHRENHEIT 71,500.00 5.00% 7,680.75
    577 IMUNOS CAPS S non fopi PC LAPI 7,680.75 7,680.75
    578 IMUNOS PLUS CAP. S non fopi PC LAPI 9,927.50 9,927.50
    579 IMUNOS PLUS SYR S non fopi BTL LAPI 80,960.00 80,960.00
    580 IMUNOS SYR S non fopi BTL LAPI 55,440.00 55,440.00
    581 IMUNVIT PLUS SYR. S non fopi BTL SIMEX 67,925.00 67,925.00
    582 IMUNVIT PLUS TAB S non fopi PC SIMEX 6,270.00 6,270.00
    583 INADRYL SYR 100 ML S non fopi BTL INTERBAT 29,205.00 29,205.00
    584 INADRYL SYR 50 ML S non fopi BTL INTERBAT 19,800.00 19,800.00
    585 INBACEF TABLET S non fopi PC INFION 20,240.00 -
    586 INBION CAPSUL S non fopi PC INTERBAT 1,672.00 1,672.00
    587 INBUMIN FC TAB 250 MG S non fopi PC DEXA MEDICA 5,775.00 5,775.00
    588 INCELIN INJ 250 MG S non fopi AMP INTERBAT 22,990.00 22,990.00
    589 INCELIN TAB 500 MG S non fopi AMP INTERBAT 9,056.67 9,056.67
    590 INDUXIN INJ. S non fopi AMP KALBE FARMA 9,405.00 9,405.00
    591 INERSON SALEP 15 GR S non fopi TUBE INTERBAT 87,422.51 15.00% 67,553.75
    592 INFANRIX S non fopi AMP GLAXO 242,000.00 242,000.00
    593 211SM12B09 FSM12B009 12 ALLERGY & IMMUNE SYSTEM INFANRIX IPV-HIB S fopi AMP GLAXO 346,500.00 346,500.00
    594 INFANRIX-HIB S non fopi AMP GLAXO 343,200.00 343,200.00
    595 INFIMYCIN INJ. 0.5 GR S non fopi VIAL INFION 81,250.00 137,500.00
    596 INFIMYCIN SYR S non fopi BTL INFION 58,080.00 88,000.00
    597 INHIPRAZ CAPS 30 MG S non fopi PC BERNOFARM 10,683.75 10,683.75
    598 INKURIN TAB S non fopi PC INTERBAT 7,700.00 7,700.00
    599 INLACIN CAPS 100 MG S non fopi PC DEXA MEDICA 4,950.00 4,950.00
    600 INLACIN CAPS 50 MG S non fopi PC DEXA MEDICA 3,960.00 3,960.00
    601 INMATROL TETES MATA S non fopi PC INTERBAT 36,080.00 36,080.00
    602 INOTROP INJ S non fopi VIAL FAHRENHEIT 81,675.00 81,675.00
    603 208FA02A03 FFA02A003 INOVAD INJ. S fopi VIAL FAHRENHEIT 242,000.00 242,000.00
    604 INPEPSA SYR. 100 ML S non fopi BTL FAHRENHEIT 66,000.00 10.00% 46,585.00
    605 INPEPSA SYR. 200 ML S non fopi BTL FAHRENHEIT 93,500.00 10.00% 66,066.00
    606 INSAAR TAB. S non fopi PC INTERBAT 11,434.50 11,434.50
    607 INSTO EYE DROPS S non fopi PC COMBIPHAR 11,660.00 0.00% 11,434.50

    DATA KEBUTUHAN OBAT REVISI 40 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    608 INTERCO TABLET S non fopi PC INTERBAT 3,465.00 20.00%


    609 INTERKRILL CAPS S non fopi PC INTERBAT 8,415.00 8,415.00
    610 INTERLAC PROBIOTIC ORAL S non fopi PC INTERBAT 196,350.00 196,350.00
    611 INTERLAC TAB. KUNYAH LEMON S non fopi PC INTERBAT 8,695.50 8,695.50
    612 INTERZINC SYR. 60 ML S non fopi BTL INTERBAT 46,200.00 20.00% 34,031.25
    613 INTIDROL INJ. 125 MG S non fopi AMP INTERBAT 138,600.00 20.00% 103,950.00
    614 INTIDROL TAB. S non fopi PC INTERBAT 3,300.00 3,300.00
    615 INTORVASK CAPS. 40 MG S non fopi PC INFION 11,000.00 11,000.00
    616 INTRIZIN DROPS 15 ML S non fopi BTL INTERBAT 101,200.00 20.00% 77,440.00
    617 INTRUM SYR 100 ML S non fopi BTL INTERBAT 43,854.25 43,854.25
    618 INTUNAL SYR 60 ML S non fopi BTL MEPROFARM 11,550.00 11,550.00
    619 INVITIC TAB S non fopi PC KALBE FARMA 11,104.17 11,104.17
    620 INVOMET INJ. 4 MG S non fopi AMP INTERBAT 42,350.00 20.00% 33,880.00
    621 IRETENSA 150 MG S non fopi PC FAHRENHEIT 6,600.00 6,600.00
    622 208FA02F03 FFA02F003 02 CARDIOVASCULAR & HAEMATOPO IRETENSA 300 MG S fopi PC FAHRENHEIT 9,075.00 9,075.00
    623 ISOFLURAN 250 ML S non fopi BTL DEXA MEDICA 1,519,375.00 1,519,375.00
    624 ISORIC 100 TAB S non fopi PC INTERBAT 2,420.00 10.00% 1,870.00
    625 ISOTIC ADRETOR 0.25 S fopi BTL FAHRENHEIT 24,090.00 50.00%
    626 JANUMET 50 / 1000 MG S non fopi PC MSD 8,296.16 8,296.16
    627 JANUMET 50 / 500 MG S non fopi PC MSD 8,296.16 8,296.16
    628 11 ENDOCRINE & METABOLIC SYST JANUVIA 100 MG S fopi PC MSD 15,452.05 15,452.05
    629 JANUVIA 50 MG S non fopi PC MSD 15,452.05 15,452.05
    630 JUBI - R INJ. 100 MG S VIAL DEXA MEDICA 417,273.00 0.00%
    631 K PAIN INJ S non fopi AMP DARYA VARIA 19,800.00 19,800.00
    632 KABIROC INJ. 50 MG S non fopi AMP ETHICA 39,600.00 39,600.00
    633 KABIVEN PERIPHERAL 1440 ML S non fopi VIAL FRESENIUS 335,995.00 335,995.00
    634 KADIFLAM 50 MG S non fopi PC METISKA FARMA 3,135.00 3,135.00
    635 212OI19O03 FOI19O003 19 INTRAVENOUS & OTHER STERIL KA-EN 1B 500 ML S fopi BTL OTSUKA 10,349.90 0.00% 10,125.50
    636 212OI19O03 FOI19O003 19 INTRAVENOUS & OTHER STERIL KA-EN 1B 500 ML S fopi BTL OTSUKA 11,500.50 0.00% 10,125.50
    637 212OI19O05 FOI19O005 19 INTRAVENOUS & OTHER STERIL KA-EN 3B 500 ML S fopi BTL OTSUKA 11,500.50 11,231.00
    638 212OI19O08 FOI19O008 19 INTRAVENOUS & OTHER STERIL KA-EN MG3 SOL. 500 ML S fopi BTL OTSUKA 17,084.10 17,084.10
    639 KAFLAM 25 MG S non fopi PC KALBE FARMA 1,741.66 1,741.66
    640 KAFLAM 50 MG S non fopi PC KALBE FARMA 3,666.67 3,666.67
    641 KALITAKE S non fopi PC DIPA 14,241.70 14,241.70
    642 KALKURENAL DROPS S non fopi BTL DARYA VARIA 114,950.00 114,950.00
    643 KALMECO TAB. 500 MG S non fopi PC DANKOS 2,508.00 2,508.00
    644 208KB02M04 FKB02M004 02 CARDIOVASCULAR & HAEMATOPO KALNEX INJ 500 MG S fopi AMP KALBE FARMA 9,599.70 0.00% 9,599.70
    645 KALXETIN 10 MG S non fopi PC KALBE FARMA 4,400.00 5.00% 4,180.00
    646 KALXETIN 20 MG S non fopi PC KALBE FARMA 7,333.34 5.00% 6,966.67
    647 KAMADOL INJ S non fopi AMP KALBE FARMA 4,533.28 4,533.28
    648 08 ANTI-INFECTIVES SYSTEMIC KANAMYCIN 250 MG S non fopi PC MEIJI 1,485.00 1,485.00
    649 212OI19O20 FOI19O020 19 INTRAVENOUS & OTHER STERIL KCL INJ. 7.46 25 ML S fopi AMP OTSUKA 3,223.00 3,223.00
    650 KENACORT A,I.M 40MG/ 1ml S non fopi VIAL TAISHO PHARMA 88,220.00 88,220.00
    651 208TS16E01 FTS16E001 16 DERMATOLOGICALS KENACORT SALEP KULIT S fopi TUBE TAISHO PHARMA 65,890.00 65,890.00
    652 208DV02A02 FDV02A002 02 CARDIOVASCULAR & HAEMATOPO KENDARON TABLET 200 MG S fopi PC DARYA VARIA 1,027.00 0.00% 1,027.00
    653 KETALAR INJ. S non fopi AMP PFIZER 289,613.50 289,613.50
    654 KETAMIN INJ. S non fopi AMP COMBIPHAR 62,649.00 62,649.00
    655 KETRICIN TAB S non fopi PC FERRON 2,970.00 2,970.00
    656 KIDMIN 7,2% S non fopi BTL OTSUKA 104,500.00 104,500.00

    DATA KEBUTUHAN OBAT REVISI 41 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    657 208KF08P09 FKF08P009 KIFOVIR TAB. 300 MG S fopi PC KIMIA FARMA 12,833.33 4.00%
    658 KLIDIBRAX TAB. S non fopi PC SANDOZ 1,210.00 1,210.00
    659 KLODERMA CREAM 0.5 GR S non fopi TUBE SDM 22,385.00 0.00% 22,385.00
    660 208SD16E05 FSD16E005 16 DERMATOLOGICALS KLODERMA CREAM 10 GR S fopi TUBE SDM 34,787.50 22.50% 34,787.50
    661 FKF04L005 KLOTAREN TABLET 25 MG S fopi PC KIMIA FARMA 1,040.61 39.96% 4,400.00
    662 KOLEFION TABLET 20 MG S non fopi PC INFION 4,400.00 4,400.00
    663 KOLKATRIOL 0.25 MCG S non fopi PC PHAPROS 6,580.31 6,580.31
    664 208GU17A01 FGU17A001 17 ANAESTHETICS LOCAL & GENER KTM INJ. S fopi VIAL GUARDIAN 200,200.00 200,200.00
    665 L - CORE S non fopi PC LAPI 20,900.00 20,900.00
    666 208KF01B02 FKF01B002 LACBON GRANUL SACHET S fopi SACH KALBE FARMA 3,630.00 15.00% 3,085.50
    667 LACEDIM INJ. 1 GR S non fopi VIAL LAPI 242,000.00 242,000.00
    668 LACIDOFIL S non fopi PC DEXA MEDICA 3,599.75 3,599.75
    669 LACTAMOR CAPS S non fopi PC KALBE FARMA 2,475.00 5.00% 2,351.25
    670 LACTRIN TABLET S non fopi PC LAPI 4,675.00 4,675.00
    671 LADERMA CREAM S non fopi TUBE INTERBAT 67,320.00 67,320.00
    672 LAKTAFIT TAB. S non fopi PC DEXA MEDICA 2,673.00 2,673.00
    673 LAMBUCID SYR. S non fopi BTL KALBE FARMA 11,000.00 11,000.00
    674 LAMESON TAB. 4 MG S non fopi PC LAPI 3,740.00 3,740.00
    675 LAMESON TAB. 8 MG S non fopi PC LAPI 4,372.50 4,372.50
    676 LAMETIC INJ. 4 MG S non fopi AMP LANDSON 29,700.00 29,700.00
    677 LAMETIC SYR. S non fopi BTL LANDSON 96,800.00 96,800.00
    678 LAMETIC TAB. 4 MG S non fopi PC LANDSON 27,500.00 27,500.00
    679 LAMETIC TAB. 8 MG S non fopi PC LANDSON 28,600.00 28,600.00
    680 LANABAL INJEKSI S non fopi AMP LANDSON 22,000.00 22,000.00
    681 LANABAL KAPSUL 500 MG S non fopi PC LANDSON 2,695.00 2,695.00
    682 LANAGINKOLA CAPS. S non fopi PC LANDSON 9,240.00 0.00% 9,240.00
    683 LANCEF INJ 1 GR S non fopi VIAL LANDSON 138,600.00 138,600.00
    684 LANCID CAPS S non fopi PC KALBE FARMA 11,275.00 11,275.00
    685 208LS02J03 FLS02J003 04 CENTRAL NERVOUS SYSTEM LANCOLIN INJ. S fopi AMP LANDSON 70,400.00 70,400.00
    686 208LS02J01 FLS02J001 LANCOLIN TAB. S fopi PC LANDSON 17,050.01 59.37% 17,050.00
    687 LANOVIT CAPS S non fopi PC OTTO 2,420.00 27.50% 1,595.00
    688 LANTIPAIN INJ. S non fopi AMP LANDSON 38,500.00 38,500.00
    689 208LS30E02 FLS30E002 30 VITAMINS & MINERALS LANTUROL 400 MG S fopi PC LANDSON 6,050.00 45.50% 6,050.00
    690 208SA11A02 FSA11A002 LANTUS SOLOSTAR INJ S fopi CART AVENTIS 83,530.20 83,530.20
    691 208SA11A05 FSA11A005 LANTUS XR S fopi PC SANOFI 280,792.71 280,792.71
    692 LAPIBAL INJ S non fopi AMP LAPI 22,000.00 22,000.00
    693 LAPIBAL TAB. 500 MG S non fopi PC LAPI 1,856.25 1,856.25
    694 LAPIXIME INJ 1 GR S non fopi VIAL LAPI 107,250.00 107,250.00
    695 LASAL KAPSUL4 MG S non fopi PC LAPI 1,237.50 1,237.50
    696 LASAL NEBU S non fopi PC LAPI 8,800.00 20.00% 7,040.00
    697 ` ` LATANOPROST TTS. MATA S non fopi BTL FAHRENHEIT 110,000.00 110,000.00
    698 LAXOBEROM DROPS 7.5 MG/ML S non fopi PC BOEHRINGER 48,801.50 48,801.50
    699 LAZ TAB. S non fopi PC DEXA MEDICA 11,781.00 11,781.00
    700 LEKUICIN 500 S non fopi PC INMARK 24,502.50 24,502.50
    701 LEORESAL TAB. 10 MG S PC NOVARTIS 7,856.93 5.00%
    702 LEPSIO SYR. S non fopi BTL DEXA MEDICA 70,125.00 70,125.00
    703 LERZIN SYR. 60 ML S non fopi BTL IFARS 5,335.00 5,335.00
    704 LESCOL CAPS. 40 MG S non fopi PC NOVARTIS 12,037.94 12,037.94
    705 LESCOL CAPS. XL 80 MG S non fopi PC NOVARTIS 15,089.65 15,089.65

    DATA KEBUTUHAN OBAT REVISI 42 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    706 LESIFIT TAB. S non fopi PC SANDOZ 5,214.55 5,214.55


    707 LETONAL TAB. 100 MG S non fopi PC OTTO 3,696.00 3,696.00
    708 LETONAL TAB. 25 MG S non fopi PC OTTO 1,320.00 1,320.00
    709 208DM17A07 FDM17A007 17 ANAESTHETICS LOCAL & GENER LEVICA INJEKSI S fopi AMP DEXA MEDICA 60,500.00 25.00% 54,450.00
    710 LEVIN INFUS S non fopi BTL OTTO 231,275.00 231,275.00
    711 208SB08G07 FSB08G007 08 ANTI-INFECTIVES SYSTEMIC LEVOCIN INFUS S fopi BTL SANBE FARMA 332,090.00 30.00% 240,765.25
    712 08 ANTI-INFECTIVES SYSTEMIC LEVOCIN TAB. 500 MG S non fopi PC SANBE FARMA 31,457.25 31,457.25
    713 LEVOZOL INJ. 8 MG S non fopi AMP KIMIA FARMA 62,843.00 62,843.00
    714 LEXA INFUS 500 MG / 100 ML S non fopi BTL LANDSON 242,000.00 242,000.00
    715 LEXA INFUS 750 MG / 150 ML S non fopi BTL LANDSON 330,000.00 330,000.00
    716 LIBRAX TAB. S non fopi PC COMBIPHAR 2,330.30 2,330.30
    717 LIFEZAR 100 MG S non fopi PC PRAFA 8,566.80 8,566.80
    718 208DV02F02 FDV02F002 LIFEZAR 50 MG S fopi PC PRAFA 6,062.10 6,062.10
    719 208PF02L01 FPF02L001 LIFITOR TAB 10 MG S fopi PC PFIZER 19,486.74 19,486.74
    720 LIKOKALK TAB. S non fopi PC BERLICO 162.00 162.00
    721 LIPROLAC VAN. S non fopi PC KALBE FARMA 6,966.67 6,966.67
    722 208DV31B01 FDV31B001 31 HEALTH SUPPLEMENTS & FOOD LIVERPRIME CAPS S fopi PC DARYA VARIA 7,276.50 7,276.50
    723 LIVOLIN FORTE S non fopi PC MEGA LIFESCIENS 4,096.40 4,096.40
    724 208DM11B17 FDM11B017 11 ENDOCRINE & METABOLIC SYST LODEM TAB. S fopi PC DEXA MEDICA 1,881.00 1,881.00
    725 208MT04D07 FMT04D007 04 CENTRAL NERVOUS SYSTEM LODOMER 2 MG S fopi PC MERSIFARMA 1,089.00 1,089.00
    726 04 CENTRAL NERVOUS SYSTEM LODOMER 5 MG S non fopi PC MERSIFARMA 1,875.50 1,875.50
    727 208MT04D18 FMT04D018 04 CENTRAL NERVOUS SYSTEM LODOMER INJ 5 MG S fopi AMP MERSIFARMA 12,523.50 12,523.50
    728 208MI02D04 FMI02D004 02 CARDIOVASCULAR & HAEMATOPO LODOZ TAB. 2.5 MG S fopi PC MERCK 6,444.17 6,444.17
    729 208MI02D05 FMI02D005 02 CARDIOVASCULAR & HAEMATOPO LODOZ TAB. 5 MG S fopi PC MERCK 9,230.83 9,230.83
    730 LOFACOL TAB S non fopi PC FERRON 8,580.00 8,580.00
    731 LOLANIN INJ S non fopi AMP FERRON 74,250.00 74,250.00
    732 LONENE 200 MG S non fopi PC SUNTHI 5,005.00 5,005.00
    733 LONGATIN 25 MG S non fopi PC ACTAVIS 2,662.00 2,662.00
    734 LONGATIN 50 MG S non fopi PC ACTAVIS 4,126.10 4,126.10
    735 LOPITEN 10 MG S non fopi PC GUARDIAN 10,120.00 10,120.00
    736 LOPITEN 5 MG S non fopi PC GUARDIAN 5,720.00 5,720.00
    737 208KF01A01 FKF01A001 01 GASTROINTESTINAL & HEPATOBILOPREZOL CAPS. 30 MG S fopi PC KIMIA FARMA 12,726.67 41.66% 799.99
    738 LORACOR TAB S non fopi PC PHARMACORE 2,543.75 2,543.75
    739 LORAN TAB S non fopi PC GUARDIAN 3,850.00 3,850.00
    740 LOSTACEF 250 DS S non fopi BTL IFARS 10,780.00 10,780.00
    741 LOVATROL TAB S non fopi PC FAHRENHEIT 6,875.00 6,875.00
    742 208SA02N01 FSA02N001 02 CARDIOVASCULAR & HAEMATOPO LOVENOX INJ. 0,4 MG S fopi CART AVENTIS 90,703.80 90,703.80
    743 208SA02N03 FSA02N003 02 CARDIOVASCULAR & HAEMATOPO LOVENOX INJ. 0,6 MG S fopi CART AVENTIS 125,384.05 125,384.05
    744 LUDIOMIL 25 S non fopi PC NOVARTIS 7,611.43 7,611.43
    745 LUPRED TAB. 5 MG S non fopi PC FAHRENHEIT 2,750.00 2,750.00
    746 208DM30E02 FDM30E002 LYCOXY CAPS. S fopi PC DEXA MEDICA 4,675.00 4,675.00
    747 LYRICA 50 MG S non fopi PC PFIZER 8,269.23 8,269.23
    748 LYRICA 75 MG S non fopi PC PFIZER 11,941.66 11,941.66
    749 LYSMIN SYR 125 ML S non fopi BTL CONMED 23,100.00 23,100.00
    750 MADOPAR TAB S non fopi PC ROCHE 4,956.10 4,956.10
    751 MAGALAT SYR 100 ML S non fopi BTL FERRON 24,750.00 24,750.00
    752 MAGALAT TABL. S non fopi PC FERRON 742.50 742.50
    753 MAGARD FA TAB S non fopi PC SOHO 4,400.00 4,400.00
    754 MAINTATE 2.5 MG S non fopi PC TANABE ABADI 5,379.00 5,379.00

    DATA KEBUTUHAN OBAT REVISI 43 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    755 MAINTATE 5 MG S non fopi PC TANABE ABADI 7,810.00 7,810.00


    756 MALTIRON PLUS SYR. S non fopi BTL MEPROFARM 33,440.00 33,440.00
    757 MALTIRON PLUS TAB. S non fopi PC MEPROFARM 1,320.00 1,320.00
    758 208CB30H01 FCB30H001 MALTOFER TAB S fopi PC COMBIPHAR 2,823.33 2,823.33
    759 212OI19O22 FOI19O022 MANITOL INFUS 500 ML S fopi BTL OTSUKA 43,499.50 0.00% 39,499.90
    760 MARTOS 10 500 ML S non fopi BTL OTSUKA 34,500.40 0.00% 31,100.30
    761 MATOFLAM TAB. S non fopi PC SOHO 6,600.00 6,600.00
    762 208SO31B24 FSO31B024 31 HEALTH SUPPLEMENTS & FOOD MATOVIT AX S fopi PC SOHO 7,150.00 7,150.00
    763 MAXIFLON S non fopi PC NULAB 44,000.00 44,000.00
    764 MAXPRO TAB. 100 MG S non fopi PC MEPROFARM 15,840.00 15,840.00
    765 208CB16M03 FCB16M003 16 DERMATOLOGICALS MEBO OINTMENT S fopi TUBE OTSUKA 84,700.00 84,700.00
    766 MECOLA TAB S non fopi PC LAPI 3,520.00 3,520.00
    767 MECOX 15 MG S non fopi PC FERRON 8,415.00 8,415.00
    768 MECOX 7,5 MG S non fopi PC FERRON 4,257.00 4,257.00
    769 MEDERMA TOPIKAL 20 GR S non fopi TUBE COMBIPHAR 166,375.00 166,375.00
    770 208DV01I01 FDV01I001 MEDIAMER B6 TBL. S fopi PC DARYA VARIA 2,970.00 2,970.00
    771 MEDICLORE 5 ML S non fopi BTL DEXA MEDICA 1,072,500.00 1,072,500.00
    772 FKB05F006 MEDIFLEX CREAM 75 MG S fopi BTL KALBE FARMA 0.00%
    773 208SD16A01 FSD16A001 16 DERMATOLOGICALS MEDIKLIN GEL 15 GR S fopi TUBE SDM 20,790.00 20,790.00
    774 208SD16M02 FSD16M002 16 DERMATOLOGICALS MEDIQUIN CREAM S fopi TUBE SDM 21,780.00 21,780.00
    775 MEDISTEIN 300 MG S non fopi PC PROMED 2,805.00 2,805.00
    776 208FE06D03 FFE06D003 06 HORMONES MEDIXON INJ. 125 MG S fopi AMP FERRON 93,500.00 47.00% 74,250.00
    777 06 HORMONES MEDIXON TAB.4 MG S non fopi PC FERRON 2,277.00 2,277.00
    778 MEDROL 4 MG S non fopi PC INMARK 2,946.01 2,946.01
    779 MEFINTER TAB. 500 MG S non fopi PC INTERBAT 40.00%
    780 MEFLOXIN TAB S non fopi PC METISKA FARMA 13,167.00 13,167.00
    781 08 ANTI-INFECTIVES SYSTEMIC MEIACT 200 MG S non fopi PC MEIJI 25,080.00 25,080.00
    782 08 ANTI-INFECTIVES SYSTEMIC MEIACT MS GRANULES 10 % S non fopi PC MEIJI 14,300.00 14,300.00
    783 MELFION TABLET 15 MG S non fopi PC INFION 5,720.00 5,720.00
    784 MELIDOX TAB. S non fopi PC MEPROFARMA 1,100.00 1,100.00
    785 MELOXIN 15 MG S non fopi PC INTERBAT 9,460.00 9,460.00
    786 MELOXIN 7,5 MG S non fopi PC INTERBAT 5,720.00 5,720.00
    787 MEPROBAL 500 MG S non fopi PC MEPROFARM 1,980.00 1,980.00
    788 MEPROTRIN SYR. S non fopi BTL MEPROFARM 18,287.50 18,287.50
    789 208OI03B01 FOI03B001 MEPTIN INHALATION SOL 0.3 M S fopi PC OTSUKA 8,883.60 8,883.60
    790 MEPTIN INHALATION SOL 0.5 M S non fopi PC OTSUKA 8,883.60 8,883.60
    791 MEPTIN SWINGHALER S non fopi BTL OTSUKA 149,338.20 149,338.20
    792 MEPTIN SYRUP S non fopi BTL OTSUKA 52,030.00 52,030.00
    793 208OI03B03 FOI03B003 MEPTIN TAB. 0,025 MG S fopi PC OTSUKA 2,696.10 2,696.10
    794 MEPTIN TAB. 0,050 MG S non fopi PC OTSUKA 4,165.70 4,165.70
    795 MEREM INJ S non fopi VIAL GUARDIAN 434,500.00 434,500.00
    796 MERISLON TAB S non fopi PC EISSAI 6,955.15 6,955.15
    797 MERLOPAM 0.5 MG S non fopi PC MERSIFARMA 1,045.00 1,045.00
    798 MEROTIK INJ 0.5 MG S non fopi VIAL LAPI 173,250.00 173,250.00
    799 MERTIGO SR TABLET S non fopi PC DEXA MEDICA 6,270.00 52.50% 5,643.00
    800 MERTIGO TABLET S non fopi PC DEXA MEDICA 3,740.00 10.00% 3,366.00
    801 MESONE CR 10 GR S non fopi TUBE PHARMACORE 56,980.00 56,980.00
    802 MESTAMOX CAPS 500 MG S non fopi PC METISKA FARMA 3,300.00 3,300.00
    803 METANEURON TABLET S non fopi PC PHAPROS 1,142.00 1,142.00

    DATA KEBUTUHAN OBAT REVISI 44 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    804 METHAM CAPS. S non fopi PC PROMED 3,553.00 3,553.00


    805 METHERGIN INJ. 0,2 MG S non fopi AMP NOVARTIS 8,094.00 8,094.00
    806 METHERGIN TABL S non fopi PC NOVARTIS 3,207.33 3,207.33
    807 METHOPI SYR S non fopi BTL OTTO 51,837.50 51,837.50
    808 METHOPI TABLET S non fopi PC OTTO 9,680.00 30.00% 6,380.00
    809 208ES04P01 FES04P001 04 CENTRAL NERVOUS SYSTEM METHYCOBAL CAPS. 500 MG S fopi PC EISSAI 3,853.05 3,853.05
    810 208ES04P02 FES04P002 04 CENTRAL NERVOUS SYSTEM METHYCOBAL INJ S fopi AMP EISSAI 21,967.68 21,967.68
    811 METOLONE INJ. S non fopi AMP BERNOFARM 8,910.00 8,910.00
    812 METRIX 2 MG S non fopi PC KALBE FARMA 4,702.50 4,702.50
    813 METRIX 3 MG S non fopi PC KALBE FARMA 5,886.83 5,886.83
    814 METRIX 4 MG S non fopi PC KALBE FARMA 7,053.75 7,053.75
    815 MEVILOX 15 MG S non fopi PC BERNOFARM 6,792.50 6,792.50
    816 MEVILOX 7,5 MG S non fopi PC BERNOFARM 3,918.75 3,918.75
    817 MEXPHARM TAB 15 MG S non fopi PC DANKOS 7,480.00 7,480.00
    818 212OI19O23 FOI19O023 19 INTRAVENOUS & OTHER STERIL MGSO4 20% 25 ML S fopi BTL OTSUKA 3,580.50 0.00% 3,327.50
    819 208BI02F02 FBI02F002 02 CARDIOVASCULAR & HAEMATOPO MICARDIS 40 MG S fopi PC BOEHRINGER 3,045.00 3,045.00
    820 208BI02F03 FBI02F003 02 CARDIOVASCULAR & HAEMATOPO MICARDIS 80 MG S fopi PC BOEHRINGER 5,409.00
    821 MICODERM CREAM S non fopi TUBE OTTO 11,962.50 11,962.50
    822 MICROGYNON LIBI S non fopi AMP SCHERING 9,196.00 9,196.00
    823 208PH01E01 FPH01E001 01 GASTROINTESTINAL & HEPATOBIMICROLAX SUPP. S fopi TUBE PHAROS 20,625.00 25.00% 17,325.00
    824 MICTONORM TAB S non fopi PC PHAROS 10,648.00 10,648.00
    825 MILOZ INJEKSI S non fopi AMP NOVELL 17,600.00 17,600.00
    826 MIOMERGIN INJ. S non fopi AMP ETHICA 5,500.00 5,500.00
    827 MISOTAB TAB. S non fopi PC MBF 6,160.00 6,160.00
    828 211MD12B05 FMD12B005 12 ALLERGY & IMMUNE SYSTEM MMR VACCINE 0.5 ML S fopi VL MSD 79,625.70 79,625.70
    829 208SD16E08 FSD16E008 16 DERMATOLOGICALS MOFACORT CREAM 10 GR S fopi TUBE SDM 73,205.00 73,205.00
    830 208MA06D04 FMA06D004 16 DERMATOLOGICALS MOFACORT CREAM 5 GR S fopi TUBE SDM 38,390.00 38,390.00
    831 208MA01D02 FMA01D002 01 GASTROINTESTINAL & HEPATOBIMOLAGIT TAB. S fopi PC HARSEN 481.07 481.07
    832 MOLINFA CAPS. S non fopi PC LANDSON 4,253.33 4,253.33
    833 208DV31B02 FDV31B002 MOLOCO B12 TAB. S fopi PC PRAFA 3,017.85 3,017.85
    834 MOMEFION CREAM 10 GR S non fopi PC INFION 52,800.00 52,800.00
    835 208FA02B04 FFA02B004 02 CARDIOVASCULAR & HAEMATOPO MONECTO TAB. 20 MG S fopi PC FAHRENHEIT 2,970.00 2,970.00
    836 208KF04J01 FKF04J001 04 CENTRAL NERVOUS SYSTEM MORPHIN HCL INJ S fopi AMP KIMIA FARMA 29,899.98 0.00% 34,049.95
    837 MOVICOX 15 MG S non fopi PC BOEHRINGER 12,543.48 12,543.48
    838 MOVICOX INJ S non fopi AMP BOEHRINGER 28,883.80 28,883.80
    839 208OT04L01 FOT04L001 04 CENTRAL NERVOUS SYSTEM MOXIC TABLET S fopi PC OTTO 6,050.00 6,050.00
    840 MOZUKU TAB S non fopi PC TROPICA MAS 7,887.00 7,887.00
    841 MST CONTINUS 10 MG S non fopi PC MBF 15,620.00 15,620.00
    842 MUCIFAT SYR S non fopi BTL MEPROFARM 39,600.00 39,600.00
    843 MUCOHEXIN SYR S non fopi BTL SANBE FARMA 18,040.00 22.50% 13,981.00
    844 MUCOHEXIN TABLET S non fopi PC SANBE FARMA 430.51 430.51
    845 208SA03C10 FSA03C010 03 RESPIRATORY SYSTEM MUCOPECT 15 MG SYR 60 ML ( ANAK ) S fopi BTL BOEHRINGER 46,637.31 46,637.31
    846 MUCOPECT 30 MG SYR 60 ML ( DEWASAS non fopi BTL BOEHRINGER 60,260.20 60,260.20
    847 MUCOPECT DROPS 15 MG 20 ML S non fopi BTL BOEHRINGER 55,520.85 55,520.85
    848 MUCOSOLVAN TBL. 8 MG S non fopi PC KALBE FARMA 275.00 275.00
    849 208OI01A01 FOI01A001 03 RESPIRATORY SYSTEM MUCOSTA TAB. 100 MG S fopi PC OTSUKA 4,711.30 4,711.30
    850 MUCYLIN TABLET 200 MG S non fopi BTL YARINDO 2,420.00 5.00% 30,360.00
    851 MULTI GYN ACTIGEL S non fopi BTL INFION 198,000.00 198,000.00
    852 MUSIN SYR. S non fopi BTL OTTO 27,500.00 27,500.00

    DATA KEBUTUHAN OBAT REVISI 45 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    853 MUSIN TAB. S non fopi PC OTTO 1,375.00 1,375.00


    854 MUSTELA STELA EMOL CR 200 ML S non fopi BTL INTERBAT 298,870.00 298,870.00
    855 MYCILIN S PC YARINDO 2,420.00 5.00%
    856 MYORES TAB S non fopi PC MEPROFARM 3,960.00 3,960.00
    857 MYOTONIC INJ. S non fopi AMP MEPROFARM 7,425.00 7,425.00
    858 N ACE INJ. S non fopi AMP FAHRENHEIT 33,000.00 33,000.00
    859 208OT03B02 FOT03B002 03 RESPIRATORY SYSTEM NAIRET INJ. S fopi AMP OTTO 24,200.00 24,200.00
    860 NAIRET SYR 60 ML S non fopi BTL OTTO 24,200.00 24,200.00
    861 NAIRET TAB S non fopi PC OTTO 1,196.25 1,196.25
    862 208GU02N02 FGU02N002 NALETAL 100 TAB S fopi PC GUARDIAN 10,241.00 10,241.00
    863 NALETAL 50 TAB S non fopi PC GUARDIAN 7,315.00 7,315.00
    864 208SA03D01 FSA03D001 NASACORT AQ SPRAY S non fopi BTL AVENTIS 111,999.80 111,999.80
    865 NASAFLAM 100 S non fopi PC FAHRENHEIT 3,366.00 3,366.00
    866 NASAFLAM INJ S non fopi AMP FAHRENHEIT 20,152.00 20,152.00
    867 NASEA INJ. 0.3 MG S non fopi AMP ASTELAS 222,585.00 222,585.00
    868 NASEA TAB. 0.1 MG S non fopi AMP ASTELAS 104,500.00 104,500.00
    869 NAT C 1000 S non fopi PC MEGA LIFESCIENS 4,106.67 4,106.67
    870 208CB02M01 FCB02M001 NEO K 2 MG INJ
    02 CARDIOVASCULAR & HAEMATOPO S fopi AMP COMBIPHAR 13,640.00 13,640.00
    871 NEOCORTIC 5 MG S non fopi PC FERRON 27,500.00 27,500.00
    872 208EI05C02 FEI05C002 05 MUSCULO-SKELETAL SYSTEM NEOSTIGMINE HAMELAN 0.5 MG S fopi AMP COMBIPHAR 11,000.00 28.00% 7,623.00
    873 NEPATIC CAPS S non fopi PC KALBE FARMA 10,241.00 10,241.00
    874 NERFECO INJ S non fopi VL FERRON 15,488.00 15,488.00
    875 NERVA PLUS S non fopi PC GRACIA 2,667.50 2,667.50
    876 NEUCITI INJ. 250 S non fopi AMP LAPI 29,920.00 29,920.00
    877 NEUCITI INJ. 500 MG ( 4 ML ) S non fopi AMP LAPI 46,200.00 46,200.00
    878 NEUCITI TABLET 500 MG S non fopi PC LAPI 7,837.50 7,837.50
    879 NEULIN INJ. 250 MG S non fopi AMP FERRON 37,620.00 37,620.00
    880 208FE02J05 FFE02J005 NEULIN PS
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC FERRON 13,200.00 28.00% 11,880.00
    881 NEURAXON 500 MG S non fopi PC PYRIDAM 2,580.93 2,580.93
    882 NEURINDO TAB S non fopi PC YARINDO 1,485.00 1,485.00
    883 NEURO BESTON TAB. S non fopi PC TANABE ABADI 1,272.70 1,272.70
    884 NEUROBAT FORTE INJ S non fopi AMP INTERBAT 5,596.25 5,596.25
    885 NEUROBION INJ 3 ML S non fopi AMP MERCK 3,678.40 3,678.40
    886 NEUROFENAC PLUS TAB S non fopi PC MERCK 4,896.90 4,896.90
    887 NEUROGEN TAB S non fopi PC BERNOFARM 1,925.00 1,925.00
    888 NEUROLIN INJ 250 MG S non fopi AMP FAHRENHEIT 25,300.00 25,300.00
    889 NEUROLIN INJ 500 MG S non fopi AMP FAHRENHEIT 55,000.00 55,000.00
    890 NEUROLIN TAB 500 MG S non fopi PC FAHRENHEIT 10,395.00 10,395.00
    891 NEURONTIN 300 MG S non fopi PC PFIZER 13,076.99 13,076.99
    892 208SB30B03 FSB30B003 30 VITAMINS & MINERALS NEUROSANBE 5000 MG S fopi PC SANBE FARMA 1,314.51 25.00%
    893 208SB30B06 FSB30B006 30 VITAMINS & MINERALS NEUROSANBE PLUS CAPS. S fopi PC SANBE FARMA 1,243.67 25.00% 932.25
    894 NEUROSANTIN 300 MG S non fopi PC SANBE FARMA 5,285.50 5,285.50
    895 NEUROTAM INJ 1 GR S non fopi AMP DANKOS 16,720.00 16,720.00
    896 NEUROTAM INJ 3 GR S non fopi AMP DANKOS 57,475.00 57,475.00
    897 NEUROTAM TAB. 1.200 MG S non fopi PC KALBE FARMA 2,798.40 0.00% 5,538.50
    898 NEUROTAM TAB. 400 MG S non fopi PC DANKOS 2,048.20 2,048.20
    899 NEUROTAM TAB. 800 MG S non fopi PC DANKOS 3,971.00 3,971.00

    DATA KEBUTUHAN OBAT REVISI 46 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    900 NEUROVIT-E TABLET S non fopi PC KIMIA FARMA 877.80 877.80


    901 NEUVAR 75 MG S non fopi PC FAHRENHEIT 8,250.00 8,250.00
    902 NEVODIO TAB. S non fopi PC DEXA MEDICA 4,455.00 4,455.00
    903 NEVOX XR S non fopi PC KALBE FARMA 2,090.00 2,090.00
    904 NEVRADIN E. TAB. S non fopi PC BERNOFARM 2,391.13 2,391.13
    905 NEVRAMIN TAB S non fopi PC TAKEDA 980.01 980.01
    906 NEW SKELAN CAPS. S non fopi PC MEDIFARM 1,876.88 1,876.88
    907 208AZ01A01 FAZ01A001 01 GASTROINTESTINAL & HEPATOBINEXIUM 20 MG S fopi PC ASTRA ZENECA 13,746.01 13,746.01
    908 208AZ01A02 FAZ01A002 01 GASTROINTESTINAL & HEPATOBINEXIUM 40 MG S fopi PC ASTRA ZENECA 16,781.42 16,781.42
    909 NIASPAN 375 MG S non fopi PC ABBOTT 4,051.93 4,051.93
    910 NICARFION INJEKSI S non fopi AMP INFION 132,000.00 132,000.00
    911 NICHOLIN INJ 250 MG S non fopi BTL INMARK 42,198.14 42,198.14
    912 NIFUDIAR SYR 60 ML S non fopi BTL MEPROFARM 31,680.00 31,680.00
    913 NIFURAL SYRUP S non fopi BTL DARYA VARIA 63,250.00 63,250.00
    914 208BY04P02 FBY04P002 04 CENTRAL NERVOUS SYSTEM NIMOTOP TAB S fopi PC BAYER 9,005.66 9,005.66
    915 208FA18B02 FFA18B002 18 ANTIDOTES & DETOXIFYING AGENOKOBA INJ S fopi AMP FAHRENHEIT 110,000.00 30.00% 110,000.00
    916 NONFLAMIN TAB/60 PC S non fopi PC TAKEDA 4,062.77 4,062.77
    917 NOOCEPHAL SYR. 100 ML S non fopi BTL NOVELL 46,750.00 46,750.00
    918 NOOTROPYL INJ. 1 GR S non fopi AMP INMARK 18,810.00 18,810.00
    919 NOOTROPYL INJ. 3 GR S non fopi AMP INMARK 62,562.50 62,562.50
    920 NOOTROPYL TAB. 1200 MG S non fopi PC INMARK 5,768.40 5,768.40
    921 NOOTROPYL TAB. 400 MG S non fopi PC INMARK 2,319.16 2,319.16
    922 NOOTROPYL TAB. 800 MG S non fopi PC INMARK 4,244.16 4,244.16
    923 NORELUT TAB. S non fopi PC DEXA MEDICA 4,257.00 4,257.00
    924 NORFION INJEKSI 4 MG/ 4ML S non fopi AMP INFION 88,000.00 88,000.00
    925 NORPHAGEN INJ. 20 ML S non fopi AMP FAHRENHEIT 20.00%
    926 NORSEC CAPS S non fopi PC GUARDIAN 13,090.00 13,090.00
    927 NORSEC INJ. S non fopi AMP GUARDIAN 130,900.00 130,900.00
    928 NORVASK TAB. 10 MG S non fopi PC PFIZER 11,983.19 11,983.19
    929 NORVASK TAB. 5 MG S non fopi PC PFIZER 6,686.60 6,686.60
    930 NOSIRAX CAPS S non fopi PC METISKA FARMA 2,600.00 2,600.00
    931 NOSTROK 10 MG S non fopi PC FAHRENHEIT 10.00%
    932 NOTISIL 2 MG S non fopi PC NOVELL 759.00 759.00
    933 NOZA TAB. S non fopi PC PHAPROS 717.75 717.75
    934 NUCEF CAPS S non fopi PC GUARDIAN 20,350.00 20,350.00
    935 NUCEF SYR S non fopi BTL GUARDIAN 80,850.00 80,850.00
    936 NUCOLIN INJ. 250 MG S non fopi AMP GUARDIAN 35,750.00 35,750.00
    937 01 GASTROINTESTINAL & HEPATOBINUCRAL SYR 100 ML S fopi BTL GUARDIAN 48,400.00 48,400.00
    938 208GU01A06 FGU01A006 01 GASTROINTESTINAL & HEPATOBINUCRAL SYR 200 ML S fopi BTL GUARDIAN 79,750.00 79,750.00
    939 NUFIROM INJ S non fopi VIAL GUARDIAN 275,000.00 275,000.00
    940 NULAGYL INFUS S non fopi BTL GUARDIAN 72,600.00 72,600.00
    941 NUREST TAB. S non fopi PC NULAB 3,448.50 3,448.50
    942 NUTRIBREAST TAB. S non fopi PC NUTRINDO 8,036.05 8,036.05
    943 NUTRIFLAM S non fopi PC TROPICA MAS 8,910.00 8,910.00
    944 NUTRIFLEX LIPID PERI 1250 ML S non fopi BTL B/BRAUN 554,400.00 554,400.00
    945 NUVINO S non fopi PC NUTRINDO 6,008.75 6,008.75
    946 NUVOGIN S non fopi PC NUTRINDO 2,962.58 2,962.58
    947 NUZOLE CAPS S non fopi PC NULAB 11,550.00 11,550.00
    948 NUZYM CAPS S non fopi PC GUARDIAN 6,792.50 6,792.50

    DATA KEBUTUHAN OBAT REVISI 47 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    949 OBUCORT SWINGHALER S non fopi BTL OTSUKA 158,122.80 158,122.80


    950 OCTALBIN INF. 25% 100 ML S non fopi BTL KALBE FARMA 1,499,999.60 1,499,999.60
    951 OCUFLAN EYE DROPS S non fopi BTL SANBE FARMA 51,243.50 51,243.50
    952 ODR SYR. 60 ML S non fopi BTL LAPI 101,200.00 101,200.00
    953 OKAVAX INJ S non fopi AMP SANOFI 302,500.00 302,500.00
    954 208PF02F01 FPF02F001 01 GASTROINTESTINAL & HEPATOBIOLMETEC TAB 20 MG S fopi PC PFIZER 11,170.43 11,170.43
    955 OLMETEC TAB 40 MG S non fopi PC PFIZER 13,669.76 13,669.76
    956 OLMETEC TAB PLUS 20 MG S non fopi PC PFIZER 10,234.95 10,234.95
    957 OMZ CAPS. S non fopi PC FERRON 11,550.00 11,550.00
    958 OMZ INJ. S non fopi VL FERRON 117,810.00 117,810.00
    959 ONDANE INJ. 4 MG / 2 ML S non fopi AMP GUARDIAN 30,580.00 30,580.00
    960 ONDANE INJ. 8 MG / 4 ML S non fopi AMP GUARDIAN 45,100.00 45,100.00
    961 ONETIC INJ. 4 MG S non fopi PC FAHRENHEIT 20,625.00 20,625.00
    962 ONETIC INJ. 8 MG S non fopi PC FAHRENHEIT 34,650.00 34,650.00
    963 ONETIC TAB 4 MG S non fopi PC FAHRENHEIT 12,809.50 12,809.50
    964 OPICEF CAPS. 500 MG S non fopi PC OTTO 11,000.00 30.00% 7,975.00
    965 OPIDIAR SYR. S non fopi BTL OTTO 22,000.00 22,000.00
    966 OPIGLIT TABLET 15 MG S non fopi PC OTTO 3,987.50 3,987.50
    967 OPIGRAN INJ. 3 GR S non fopi AMP OTTO 95,040.00 95,040.00
    968 OPIPENTIN KAPS. 300 MG S non fopi PC OTTO 6,635.75 6,635.75
    969 OPIPHEN 500 MG S non fopi PC OTTO 3,080.00 3,080.00
    970 OPIPHEN SYR. S non fopi BTL OTTO 17,600.00 17,600.00
    971 OPIPROL TABLET 2.5 MG S non fopi PC OTTO 1,754.50 1,754.50
    972 OPIPROL TABLET 5 MG S non fopi PC OTTO 4,400.00 27.50% 2,791.25
    973 OPISAR 150 MG S non fopi PC OTTO 7,744.00 7,744.00
    974 OPISAR 300 MG S non fopi PC OTTO 11,000.00 11,000.00
    975 OPITHRCIN SYR. S non fopi BTL OTTO 22,000.00 22,000.00
    976 OPITHRCIN TAB. S non fopi PC OTTO 1,430.00 1,430.00
    977 OPIVASK 5 MG S non fopi PC OTTO 4,466.00 4,466.00
    978 OPIXIME CAPS. S non fopi PC OTTO 15,840.00 15,840.00
    979 OPIXIME SYR S non fopi BTL OTTO 66,000.00 66,000.00
    980 OPIZOLAM TAB 0.5 MG S non fopi PC OTTO 1,993.75 1,993.75
    981 OPIZOLAM TAB 0.5 MG S non fopi PC OTTO 27.50% 4,466.00
    982 OPIZOLAM TAB 1 MG S non fopi PC OTTO 4,620.00 27.50% 3,030.50
    983 OPTALVIT SYR 60 ML S non fopi BTL LAPI 62,700.00 62,700.00
    984 OPTALVIT PLUS TAB S non fopi PC LAPI 6,050.00 6,050.00
    985 OPTIMAX PLUS SYR S non fopi BTL FERRON 63,360.00 63,360.00
    986 ORASIC INJ S non fopi AMP OTTO 20,900.00 27.50% 15,152.50
    987 OSFIT DHA CAPS. S non fopi PC KALBE FARMA 4,083.00 4,083.00
    988 OSSOVIT CAPS S non fopi PC INTERBAT 5,555.00 20.00% 4,268.00
    989 OSSOVIT SYR 100 ML S non fopi BTL INTERBAT 62,040.00 62,040.00
    990 OSTE CAPS. S non fopi PC SOHO 3,630.00 3,630.00
    991 208SB04L08 FSB04L008 OSTELOX 15 MG S fopi PC SANBE FARMA 10,087.00 24.99% 7,565.25
    992 OSTENIL INJ. S non fopi AMP MEPROFARM 522,500.00 522,500.00
    993 OSTEOCAL S non fopi PC NICHOLAS 560.00 560.00
    994 OSTEOFORTIS CAPS. S non fopi PC INFION 3,080.00 3,080.00
    995 OSTEOR C CREAM S non fopi TUBE PYRIDAM 163,900.00 15.00% 137,214.00
    996 OTTOPRIM SYR. 60 ML S non fopi BTL OTTO 5,500.00 5,500.00
    997 OTTOZOL INJ. S non fopi VL OTTO 90,750.00 90,750.00

    DATA KEBUTUHAN OBAT REVISI 48 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    998 OXFEZIN SYR. 100 ML S non fopi BTL PROMED 31,680.00 31,680.00
    999 OXFEZIN SYR. 60 ML S non fopi BTL PROMED 19,800.00 19,800.00
    1000 OXOFERIN S non fopi BTL PHAROS 77,000.00 35.00% 75,075.00
    1001 OXOPECT SYR S non fopi BTL MBF 33,000.00 33,000.00
    1002 OXYLA INJ S non fopi AMP NOVELL 12,397.00 12,397.00
    1003 OZID CAPS S non fopi PC DARYA VARIA 12,186.43 12,186.43
    1004 OZID INJ. S non fopi VL DARYA VARIA 36,025.00 36,025.00
    1005 PALOVIR CREAM 10 GR S non fopi TUBE PHARMACORE 26,963.75 26,963.75
    1006 PALOVIR TAB S non fopi PC PHARMACORE 7,631.25 7,631.25
    1007 PAMOL SUPP 125 MG S non fopi PC INTERBAT 14,850.00 10.00% 11,264.00
    1008 PAMOL SUPP 250 MG S non fopi PC INTERBAT 22,000.00 10.00% 16,720.00
    1009 PAMOL SYR. 60 ML S non fopi BTL INTERBAT 29,700.00 40.00%
    1010 PAMOL TABLET 500 MG S non fopi PC INTERBAT 770.00 40.00% 602.80
    1011 PANLOC INJ. S non fopi VL LANDSON 165,000.00 165,000.00
    1012 PANSO 40 MG VIAL S non fopi VL SOHO 132,000.00 132,000.00
    1013 PANTOPUMP INJ S non fopi VL INTERBAT 199,237.50 56.00% 151,800.00
    1014 PANTOPUMP KAPSU 40 MG S non fopi VL INTERBAT 23,925.00 32.00%
    1015 PARAMIDON INJ 15 ML S non fopi AMP PRAFA 6,756.75 6,756.75
    1016 PARATUSIN TABLET S non fopi PC DARYA VARIA 1,003.75 1,003.75
    1017 PEDIACEL VAKSIN S non fopi AMP AVENTIS 693,000.00 693,000.00
    1018 PEDITOK 50 ML S non fopi AMP ASTRA ZENECA 0.50%
    1019 208PR17A02 FPR17A002 17 ANAESTHETICS LOCAL & GENER PEHACAIN INJEKSI S fopi AMP PHAPROS 3,113.06 0.00% 3,113.06
    1020 FPR08L005 PEHADOXIN FORTE TABLET S fopi PC PHAPROS 660.00 10.00%
    1021 208PR02E03 FPR02E003 PEHAVASK TABLET 10 MG S fopi PC PHAPROS 440.00 0.00%
    1022 208PR02E03 FPR02E003 PEHAVASK TABLET 10 MG S fopi PC PHAPROS 440.00 15.00%
    1023 208PR02E04 FPR02E004 PEHAVASK TABLET 5 MG S fopi PC PHAPROS 330.00 0.00%
    1024 PEINLOS 400 INJ. S non fopi AMP FAHRENHEIT 72,600.00 10.00% 55,000.00
    1025 PELASTIN INJ S non fopi BTL SANBE FARMA 254,100.00 254,100.00
    1026 PELASTIN INJ. S non fopi AMP SANBE FARMA 260,623.00 260,623.00
    1027 PENTABIO INJ. 0.5 ML S non fopi AMP BIO FARMA 106,029.00 106,029.00
    1028 PEPZOL INJ 40 MG S non fopi AMP MBF 132,000.00 132,000.00
    1029 PERMYO TAB S non fopi PC FERRON 4,675.00 4,675.00
    1030 PERSIDAL 1 S non fopi PC MERSIFARMA 4,290.00 4,290.00
    1031 PERSIDAL 2 S non fopi PC MERSIFARMA 7,150.00 7,150.00
    1032 PHADILON INJ. 125 MG S non fopi AMP PHAPROS 33,000.00 33,000.00
    1033 PHALSY SYR. S non fopi BTL PHAPROS 46,200.00 46,200.00
    1034 PHARMATON FORMULA CAPS S non fopi PC BOEHRINGER 4,204.77 4,204.77
    1035 PHARMATON VIT TAB S non fopi PC BOEHRINGER 4,093.66 4,093.66
    1036 PHYFION INJ. 2 MG/ML S non fopi AMP INFION 11,000.00 11,000.00
    1037 PHYLLOCONTIN S non fopi PC MBF 2,090.00 2,090.00
    1038 PIL KINA 222 MG S non fopi PC KIMIA FARMA 1,166.64 1,166.64
    1039 PILOPIL S non fopi PC GUARDIAN 3,300.00 3,300.00
    1040 PIO LN 15 MG S non fopi PC LANDSON 6,050.00 0.00% 6,050.00
    1041 PIPTAL DROPS S non fopi BTL NICHOLAS 110,000.00 110,000.00
    1042 PITOGIN S INJ. S non fopi AMP ETHICA 7,700.00 7,700.00
    1043 PLACTA 75 MG S non fopi PC ACTAVIS 10,890.00 10,890.00
    1044 PLADOGREL TABLET 75 MG S non fopi PC FAHRENHEIT 10,164.00 10,164.00
    1045 212DP19O05 FDP19O005 19 INTRAVENOUS & OTHER STERIL PLASBUMIN 20% 100 ML S fopi BTL DIPA 1,510,000.00 1,510,000.00
    1046 PLASMINEX TABLET S non fopi PC SANBE FARMA 2,981.00 25.00% 2,310.28

    DATA KEBUTUHAN OBAT REVISI 49 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1047 208SA02N04 FSA02N004 PLATOGRIX TAB.


    02 CARDIOVASCULAR & HAEMATOPO S fopi PC AVENTIS 12,335.68 12,335.68
    1048 PLAVIX TAB. 300 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC SANOFI 16,392.97 16,392.97
    1049 208SA02N05 FSA02N005 PLAVIX TAB. 75 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC SANOFI 16,311.00 16,311.00
    1050 PLETAAL 20% POWDER S non fopi PC OTSUKA 12,219.90 12,219.90
    1051 PLETAAL TAB. 100 MG S non fopi PC OTSUKA 13,442.00 13,442.00
    1052 PLETAAL TAB. 50 MG S non fopi PC OTSUKA 8,467.80 8,467.80
    1053 PNEUMO 23 S non fopi PC SANOFI 293,485.50 293,485.50
    1054 POLYCROL FORTE SYR 100 ML S non fopi BTL NICHOLAS 27,500.00 27,500.00
    1055 POLYCROL FORTE SYR 400 ML S non fopi BTL NICHOLAS 55,000.00 55,000.00
    1056 PONDEX SYR S non fopi BTL DEXA MEDICA 11,275.01 17.50% 11,275.00
    1057 POSPARGIN INJ S non fopi AMP KALBE FARMA 5,747.50 5,747.50
    1058 POSPARGIN 0,125 MG+C1958 S non fopi AMP KALBE FARMA 522.50 522.50
    1059 PPD2TU ( MANTUK TEST ) S non fopi PC MMR 772,475.00 772,475.00
    1060 PRAVINAT TAB 10 MG S non fopi PC INTERBAT 12,705.00 12,705.00
    1061 PRAVINAT TAB 20 MG S non fopi PC INTERBAT 15,427.50 15,427.50
    1062 PRAXION SYR 120 MG S non fopi BTL PHAROS 24,035.00 24,035.00
    1063 PRAXION SYR 250 MG S non fopi BTL PHAROS 28,215.00 28,215.00
    1064 PRAZOTEC CAPS S non fopi PC FAHRENHEIT 12,870.00 12,870.00
    1065 PREDNICORT INJ. 125 MG S non fopi VL OTTO 99,000.00 27.50% 71,775.00
    1066 PREDNICORT INJ. 125 MG S non fopi VL OTTO 104,500.00 53.00%
    1067 PREMASTON 5 MG S non fopi PC KALBE FARMA 4,005.83 4,005.83
    1068 PRESTENOL TANLET S non fopi VL INTERBAT 5,024.25 56.00% 71,775.00
    1069 211PF12B01 FPF12B001 12 ALLERGY & IMMUNE SYSTEM PREVENAR 13 INJ. S fopi AMP PFIZER 714,001.00 714,001.00
    1070 06 HORMONES PRIMOLUT-N TABLET S fopi PC SCHERING 5,753.47 0.00% 5,753.47
    1071 PRIMPERAN TAB 5 MG S non fopi PC SOHO 752.40 752.40
    1072 PRIMPERAN TAB. 10 MG S non fopi PC SOHO 1,331.00 1,331.00
    1073 PRO TB2 S non fopi PC PHAPROS 7,228.57 10.00% 7,246.25
    1074 208PR08L08 FPR08L008 08 ANTI-INFECTIVES SYSTEMIC PRO TB4 S fopi PC PHAPROS 5,426.65 0.00% 5,426.65
    1075 PROANES 1% 200 MG/ 20 ML S AMP SANBE FARMA 88,935.00 35.00%
    1076 PROBIOKID SACHETS @ 1.5 G S non fopi PC SANBE FARMA 10,613.63 10,613.63
    1077 PROBIOSTIM CAPS. S non fopi PC SANBE FARMA 8,141.38 8,141.38
    1078 PROCALMA LICAPS S non fopi PC MEPROFARM 3,971.00 3,971.00
    1079 PROCEFA INJ. 1 GR S non fopi VIAL PROMED 145,200.00 145,200.00
    1080 PROCEPIM INJ 1 GR S non fopi VIAL MEPROFARM 253,000.00 253,000.00
    1081 PROCETAM 1200 MG S non fopi PC MEPROFARM 3,740.00 3,740.00
    1082 PROCETAM INJ 3 GR S non fopi AMP MEPROFARM 44,000.00 44,000.00
    1083 PROCLOZAM 10 MG S non fopi PC PROMED 1,463.00 1,463.00
    1084 PROFECOM SUPP S non fopi PC COMBIPHAR 13,420.00 13,420.00
    1085 PROFENAL CAPS. S non fopi PC YARINDO 1,320.00 1,320.00
    1086 PROFERRO TAB. S non fopi PC FAHRENHEIT 5,500.00 5,500.00
    1087 208KB06E02 FKB06E002 06 HORMONES PROFERTIL 50 MG S fopi PC KALBE FARMA 13,689.50 13,689.50
    1088 PROGESIC SYR. S non fopi BTL METISKA FARMA 22,990.00 22,990.00
    1089 PROGESIC TAB. S non fopi PC METISKA FARMA 467.50 467.50
    1090 PROGESTON TAB S non fopi PC MEPROFARM 3,553.00 3,553.00
    1091 PROGYL 500 MG S non fopi PC PROMED 770.00 770.00
    1092 PROHELIC TAB S non fopi PC PROMED 5,434.00 5,434.00
    1093 PROHEM INJ. S non fopi AMP FAHRENHEIT 10,890.00 10,890.00
    1094 PROINFARK INJEKSI S non fopi AMP PHAPROS 13,200.00 13,200.00
    1095 PROKIDS DROPS S non fopi BTL MBF 29,700.00 29,700.00

    DATA KEBUTUHAN OBAT REVISI 50 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1096 208SB08K02 FSB08K002 08 ANTI-INFECTIVES SYSTEMIC PROLIC 300 MG CAPS S fopi PC SANBE FARMA 7,903.51 25.00% 5,927.63
    1097 PROLYSIN SYRUP 120 ML S non fopi BTL PROMED 30,305.00 30,305.00
    1098 PROLYSIN PLUS SYRUP 100 ML S non fopi BTL PROMED 24,420.00 24,420.00
    1099 PROMAVIT CAPS. S non fopi PC LAPI 3,630.00 20.00% 2,904.00
    1100 PROMEZOL CAPS S non fopi PC PROMED 9,927.50 9,927.50
    1101 PROMUBA SYR 60 ML S non fopi BTL MEPROFARM 39,187.50 39,187.50
    1102 PRONALGES TAB. 100 MG S non fopi PC DEXA MEDICA 4,207.50 4,207.50
    1103 PRONALGES TAB. 50 MG S non fopi PC DEXA MEDICA 2,337.50 2,337.50
    1104 PRONALGES CR TAB. 200 MG S non fopi PC DEXA MEDICA 7,480.00 7,480.00
    1105 PRONALGES INJ. S non fopi AMP DEXA MEDICA 25,740.00 25,740.00
    1106 PRONEURON CAPS S non fopi PC MEPROFARM 1,210.00 1,210.00
    1107 PRORENAL TABLET S non fopi PC NOVELL 4,290.00 4,290.00
    1108 208TK01A05 FTK01A005 PROSOGAN FD CAPS. 30 MG S fopi PC TAKEDA 19,057.25 19,057.25
    1109 208TK01A06 FTK01A006 PROSOGAN INJ. 30 MG S fopi AMP TAKEDA 88,490.20 88,490.20
    1110 PROSTACOM TAB. S non fopi PC COMBIPHAR 2,950.20 2,950.20
    1111 PROSTIGMIN INJ. S non fopi AMP TRANSFARMA 23,958.00 23,958.00
    1112 PROTEN RASA VANILA S non fopi PC OTSUKA 4,199.80 4,199.80
    1113 PROTOFEN SUPP. S non fopi PC KIMIA FARMA 10,436.25 32.64% 2,379.96
    1114 PROVAGIN OVULA S non fopi PC MEPROFARM 11,880.00 11,880.00
    1115 PROVAMED TAB S non fopi PC PROMED 4,963.75 4,963.75
    1116 PROVELYN 150 MG S non fopi PC KALBE FARMA 14,928.57 14,928.57
    1117 PROVELYN 75 MG S non fopi PC KALBE FARMA 10,845.61 10,845.61
    1118 PROVITAL PLUS TBL S non fopi PC LANDSON 6,380.00 6,380.00
    1119 PROVITAL TBL S non fopi PC LANDSON 4,070.00 4,070.00
    1120 PROVULA 50 MG S non fopi PC DEXA MEDICA 14,355.00 14,355.00
    1121 PROZA TAB. S non fopi PC LANDSON 12,650.00 12,650.00
    1122 PSIDII KAPSUL S PC DEXA MEDICA 5,500.00 10.00%
    1123 208AZ03B18 FAZ03B018 PULMICORT INHALER S fopi BTL ASTRA ZENECA 111,527.36 111,527.36
    1124 208AZ03B06 FAZ03B006 PULMICORT RESPULES 0.5 MG S fopi BTL ASTRA ZENECA 14,300.00 0.50% 14,060.33
    1125 208AZ03B05 FAZ03B005 PULMICORT RESPULES 0.25 MG S fopi BTL ASTRA ZENECA 10,444.99 0.50% 10,326.11
    1126 PUMPICEL INJ. S non fopi AMP SANBE FARMA 162,855.01 27.50% 118,069.88
    1127 PYDERMA KRIM S non fopi TUBE PYRIDAM 28,611.00 28,611.00
    1128 PYRICIN TABLET S non fopi PC PYRIDAM 4,400.00 4,400.00
    1129 PYSOLAN 30 MG @ 20 capsul S non fopi PC PYRIDAM 14,899.50 14,899.50
    1130 Q 10 PLUS S non fopi PC NUTRINDO 13,741.75 13,741.75
    1131 Q CEF SYR 60 ML S non fopi BTL GUARDIAN 46,200.00 46,200.00
    1132 Q CEF TAB 500 MG S non fopi PC GUARDIAN 10,340.00 10,340.00
    1133 RADIBLOCK CAPS S non fopi PC SANDOZ 6,050.00 6,050.00
    1134 RADIN INJ S non fopi AMP DEXA MEDICA 18,700.00 18,700.00
    1135 RAIVAS INJ. S non fopi AMP DEXA MEDICA 84,150.00 84,150.00
    1136 RAMOLIT S non fopi PC IFARS 1,100.00 1,100.00
    1137 208NI01A01 FNI01A001 RANICHO SYR. 60 ML S fopi BTL NICHOLAS 52,250.00 52,250.00
    1138 RANIFIN INJEKSI S non fopi AMP INFION 14,080.00 14,080.00
    1139 RANIVELL SYR S non fopi BTL NOVELL 56,595.00 56,595.00
    1140 RANTIN INJ S non fopi AMP KALBE FARMA 16,500.00 16,500.00
    1141 RASILEZ 150 MG S non fopi PC NOVARTIS 10,816.79 10,816.79
    1142 RASILEZ 300 MG S non fopi PC NOVARTIS 13,559.92 13,559.92
    1143 RATIVOL INJEKSI S non fopi AMP SANBE FARMA 40,238.00 27.50% 29,172.55
    1144 REBOZET TABLET 25 MG S non fopi PC GLAXO 226,470.59 226,470.59

    DATA KEBUTUHAN OBAT REVISI 51 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1145 RECOFOL N INJ. S non fopi AMP DEXA MEDICA 104,500.00 15.00% 88,825.00
    1146 208FA05B01 FFA05B001 04 CENTRAL NERVOUS SYSTEM RECOLPAR TAB. S fopi PC FAHRENHEIT 5,500.00 30.00% 4,950.00
    1147 RECORMON 2000 IU INJ.
    02 CARDIOVASCULAR & HAEMATOPO S fopi CART ROCHE 115,650.00 115,650.00
    1148 REDACID TAB. S non fopi PC DEXA MEDICA 8,910.00 8,910.00
    1149 REGIT DROPS S non fopi BTL LANDSON 33,000.00 33,000.00
    1150 REGIT SYR 60 ML S non fopi BTL LANDSON 35,200.00 35,200.00
    1151 REMATOF TAB. 100 MG S non fopi PC BERNOFARM 2,640.00 2,640.00
    1152 REMCOR INJ. 100G/ 20ML S non fopi PC ADVANCED 0.00%
    1153 208DM04L14 FDM04L014 04 CENTRAL NERVOUS SYSTEM REMOPAIN 3 % INJ S fopi AMP DEXA MEDICA 36,465.00 36,465.00
    1154 REMOPAIN PREFILLED SYRINGE S non fopi AMP DEXA MEDICA 36,465.00 36,465.00
    1155 RENAGAS S non fopi PC FAHRENHEIT 770.00 770.00
    1156 RENALYTE 200 ML S non fopi BTL FAHRENHEIT 15,400.00 15,400.00
    1157 RENAMID TAB. S non fopi PC FAHRENHEIT 247.50 247.50
    1158 208FA08B11 FFA08B011 08 ANTI-INFECTIVES SYSTEMIC RENASISTIN OD S fopi BTL FAHRENHEIT 41,250.00 41,250.00
    1159 08 ANTI-INFECTIVES SYSTEMIC RENASISTIN TAB 500 MG S non fopi PC FAHRENHEIT 8,910.00 8,910.00
    1160 RENATOR TAB S non fopi PC FAHRENHEIT 9,075.00 9,075.00
    1161 RENAX CAP. S non fopi PC INTERBAT 7,078.50 7,078.50
    1162 RENOGEN 3000 IU S non fopi CART DARYA VARIA 99,000.00 99,000.00
    1163 RENOSTERIL CAPS. S non fopi PC LANDSON 7,150.00 7,150.00
    1164 RENXON INJ 1 GR S non fopi VIAL METISKA FARMA 172,425.00 172,425.00
    1165 208FA03C05 FFA03C005 03 RESPIRATORY SYSTEM RESFAR INFUS 25 ML S fopi BTL FAHRENHEIT 218,900.00 16.00% 186,065.00
    1166 RESPIMER BABY DECONGEST 60 ML S non fopi BTL INTERBAT 120,175.00 120,175.00
    1167 RHODIUM TABLET S PC FAHRENHEIT 7,150.00 0.00%
    1168 RICOVIR TAB. 300 MG S non fopi PC MYLAN 18,205.00 18,205.00
    1169 RIHEST SYR. S non fopi BTL OTTO 25,168.00 25,168.00
    1170 RIHEST TAB. S non fopi PC OTTO 3,960.00 3,960.00
    1171 RIMACTANE SYR 100 ML S non fopi BTL SANDOZ 72,583.61 72,583.61
    1172 RIMACTAZID 450/300 MG S non fopi PC SANDOZ 8,088.30 8,088.30
    1173 RIMACTAZID PAED 75/50 MG S non fopi PC SANDOZ 1,641.75 1,641.75
    1174 RIMCURE 3 S non fopi PC SANDOZ 5,016.00 5,016.00
    1175 RIMCURE PAED S non fopi PC SANDOZ 2,508.00 2,508.00
    1176 RIMSTAR 4FDC S non fopi PC SANDOZ 5,561.33 5,561.33
    1177 RINCOBAL TAB. 500 MG S PC YARINDO 1,650.00 15.00%
    1178 RINDOPUMP CAPS S non fopi PC YARINDO 12,100.00 12,100.00
    1179 RINDOPUMP INJ. S non fopi AMP YARINDO 99,000.00 99,000.00
    1180 RINDOVECT CAPS. S non fopi YARINDO 2,849.00 2,849.00
    1181 RINDOVECT SYR. S non fopi BTL YARINDO 60,500.00 5.00% 28,875.00
    1182 RINOCET DROPS S non fopi BTL MEPROFARM 52,250.00 52,250.00
    1183 RINOCET SYR 60 ML S non fopi BTL MEPROFARM 46,200.00 46,200.00
    1184 RINOFER INJ. S non fopi AMP YARINDO 88,000.00 88,000.00
    1185 RINVOX INFUS 150 ML S non fopi BTL YARINDO 188,100.00 188,100.00
    1186 RINVOX TAB. 500 MG S non fopi PC YARINDO 22,000.00 22,000.00
    1187 RISTEON CAPS S non fopi PC YARINDO 6,600.00 6,600.00
    1188 RISTONAT TAB. 35 mg S non fopi PC BIO FARMA 19,745.00 0.00% 35,545.95
    1189 RITEZ FT S non fopi PC DEXA MEDICA 4,950.00 4,950.00
    1190 RIZONAX 50 MG S non fopi PC NOVELL 4,312.00 4,312.00
    1191 ROCER CAPS S non fopi PC OTTO 9,900.00 9,900.00
    1192 ROCER INJ S non fopi VL OTTO 110,000.00 110,000.00
    1193 208KB17B01 FKB17B001 ROCULAX INJ. 5 ML S fopi AMP KALBE FARMA 107,184.00 0.00% 107,184.00

    DATA KEBUTUHAN OBAT REVISI 52 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1194 ROCUM INJEKSI S non fopi AMP DEXA MEDICA 102,850.00 102,850.00
    1195 RONEM INJ 1 GR S non fopi VIAL FAHRENHEIT 440,000.00 440,000.00
    1196 ROSAGEN TAB. S non fopi PC INTERBAT 27,500.00 10.00% 21,780.00
    1197 ROTARIX S non fopi PC GLAXO 257,174.50 257,174.50
    1198 ROVASTAR 10 MG S non fopi PC INTERBAT 11,000.00 10.00%
    1199 ROVASTAR 20 MG S non fopi PC INTERBAT 12,650.00 10.00%
    1200 ROZEREM TAB S non fopi PC TAKEDA 9,776.49 9,776.49
    1201 RUBYSTA S non fopi PC MEIJI 23,947.92 23,947.92
    1202 RYVEL DROPS S BTL NOVELL 55,000.00 15.00%
    1203 RYZEN S non fopi PC INMARK 5,756.67 5,756.67
    1204 RYZICOR 10 MG S non fopi PC PHARMACORE 2,543.75 2,543.75
    1205 SAGALON CREAM S non fopi TUBE SDM 36,630.00 36,630.00
    1206 SAGESTAM TETES MATA S non fopi AMP SANBE FARMA 31,680.00 30.00% 7,767.65
    1207 SALOFALK SOFT. CAPS.250 MG S non fopi PC DARYA VARIA 6,672.60 6,672.60
    1208 SAN-B-PLEX DROPS S non fopi BTL SANBE FARMA 14,080.00 14,080.00
    1209 SANEXON INJEKSI 125 MG S non fopi AMP SANBE FARMA 73,011.13 73,011.13
    1210 SANGOBION BABY 30 ML S non fopi BTL MERK 53,729.50 0.50% 28,670.40
    1211 SANGOBION VITA TONIK S non fopi BTL MERK 27,227.88 24,626.25
    1212 SANKORBIN INJ. S non fopi AMP SANBE FARMA 23,637.90 23,637.90
    1213 SANMOL INFUS S non fopi BTL SANBE FARMA 67,210.00 22.50% 52,087.75
    1214 SANOSKIN MELLADERM PLUS S non fopi BTL INTERBAT 219,450.00 10.00% 177,650.00
    1215 SANOSKIN OXY S non fopi BTL INTERBAT 383,350.00 10.00% 274,890.00
    1216 SANPRIMA SYR S SANBE FARMA 28,160.00 25.00%
    1217 SANSULIN PEN S non fopi PC SANBE FARMA - -
    1218 SANTA E 200 tablet S non fopi PC SANBE FARMA 1,773.20 1,773.20
    1219 SANTA E 400 tablet S non fopi PC SANBE FARMA 3,552.08 3,552.08
    1220 SANTOCYN INJ. S non fopi AMP SANBE FARMA 12,639.01 27.50% 9,163.28
    1221 SCANTENSIN 12.5 MG S non fopi PC TEMPO 632.50 632.50
    1222 SCANTENSIN 25 MG S non fopi PC TEMPO 1,056.00 1,056.00
    1223 SEBIVO 600 MG S non fopi PC NOVARTIS 28,300.01 28,300.01
    1224 SEFANEM INJ 0,5 GR S non fopi VIAL MEPROFARM 195,525.00 195,525.00
    1225 SEFANEM INJ 1 GR S non fopi VIAL MEPROFARM 396,000.00 396,000.00
    1226 SELOXY TAB. S non fopi PC FERRON 3,448.50 3,448.50
    1227 SEMINAC CONTINUS S non fopi PC MBF 6,600.00 6,600.00
    1228 208NP02L11 FNP02L011 02 CARDIOVASCULAR & HAEMATOPO
    SEQUEST S fopi PC NOVELL 20,625.00 15.00% 20,212.50
    1229 208GS03B06 208GS03B06 03 RESPIRATORY SYSTEM SERETIDE INHALER 125 / can S fopi PC GLAXO 138,600.00 138,600.00
    1230 SERETIDE INHALER 50 / can S non fopi PC GLAXO 57,461.25 57,461.25
    1231 208TN01C01 FTN01C001 SESDEN S fopi PC TANABE ABADI 2,225.20 25.00% 2,022.90
    1232 SEVODEK 250 ML S non fopi BTL DEXA MEDICA 2,376,000.00 2,376,000.00
    1233 SHAROX 500 MG S non fopi PC FAHRENHEIT 22,000.00 22,000.00
    1234 SIBERIT 5 MG S non fopi PC PYRIDAM 4,675.00 4,675.00
    1235 SIBITAL INJ. S non fopi AMP MERSIFARMA 9,900.00 9,900.00
    1236 SIBRO 20 GR S fopi TUBE COMBIPHAR 84,700.00 84,700.00
    1237 SIDIADRYL INJ. S non fopi AMP BERNOFARM 8,800.00 8,800.00
    1238 SIFROL 0.375 MG S non fopi PC BOEHRINGER 8,300.00 8,300.00
    1239 SILEX SYR. 100 ML S non fopi BTL DARYA VARIA 55,440.00 55,440.00
    1240 SILUM TAB. 5 MG S non fopi PC DARYA VARIA 3,080.00 3,080.00
    1241 SIM-DHA SYR. S non fopi BTL SIMEX 41,800.00 41,800.00

    DATA KEBUTUHAN OBAT REVISI 53 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1242 SINCRONIK CAPS. S non fopi PC KALBE FARMA 7,837.50 7,837.50


    1243 SIRPLUS SERBUK ORIGINAL S non fopi BTL MEPROFARM 172.43 172.43
    1244 SISTENOL TAB S non fopi PC DEXA MEDICA 1,980.00 1,980.00
    1245 212OI19O27 FOI19O027 19 INTRAVENOUS & OTHER STERIL SOD.CHLORET NATR. 1000 ML S fopi BTL OTSUKA 30,690.00 15.00% 7,150.00
    1246 SODERMIX KRIM 15 GR S non fopi TUBE MEPROFARM 74,800.00 74,800.00
    1247 SOFRADEX EAR/EYE DROPS. S non fopi BTL AVENTIS 52,104.69 52,104.69
    1248 SOLFION TAB. 4 MG S non fopi PC INFION 3,300.00 3,300.00
    1249 SOLVINEX INJ S non fopi AMP MEPROFARM 41,800.00 41,800.00
    1250 SOMATOSTATIN INJ 250 MG S non fopi VL INMARK 277,200.00 277,200.00
    1251 SOMATOSTATIN INJ 30 MG S non fopi VL INMARK 1,190,970.00 1,190,970.00
    1252 SOTATIC TABLET S non fopi PC FAHRENHEIT 495.00 40.00%
    1253 SPASMIUM TABLET S non fopi PC SOHO 1,595.00 1,595.00
    1254 SPIROLACTONE TAB. 100 MG S non fopi PC PHAPROS 880.00 0.00% 880.00
    1255 208PR02H02 FPR02H002 02 CARDIOVASCULAR & HAEMATOPO SPIROLACTONE TAB. 25 MG S fopi PC PHAPROS (G) 991.96 991.96
    1256 SPORACID TAB. S non fopi PC FERRON 21,670.00 21,670.00
    1257 STABACTAM INJ. S non fopi VIAL FAHRENHEIT 159,500.00 159,500.00
    1258 08 ANTI-INFECTIVES SYSTEMIC STARCEF CAPS. 100 MG S non fopi PC DEXA MEDIKA 16,362.50 16,362.50
    1259 STARCEF CAPS. 200 MG S non fopi PC DEXA MEDIKA 46.00%
    1260 208DM08B15 FDM08B015 08 ANTI-INFECTIVES SYSTEMIC STARCEF SYR. S fopi BTL DEXA MEDIKA 70,125.00 70,125.00
    1261 STARXON INJ 1 GR S non fopi VIAL INTERBAT 274,450.00 46.00% 203,733.75
    1262 STATOR 10 MG S non fopi PC DEXA MEDICA 14,850.00 14,850.00
    1263 STATOR 20 MG S non fopi PC DEXA MEDICA 15,840.00 15,840.00
    1264 STESOLID INJ 10 MG S non fopi AMP ACTAVIS 13,527.80 0.00% 16,500.00
    1265 STESOLID SYR 60 ML S non fopi BTL ACTAVIS 41,261.00 41,261.00
    1266 STROVAC CAPS. S non fopi PC PYRIDAM 18,956.67 15.00% -
    1267 SULCOLON TAB. S non fopi PC BERNOFARM 7,315.00 7,315.00
    1268 SULFADIAZINE SILVER S non fopi PC DARYA VARIA 20,699.80 20,699.80
    1269 SULPEFION INJ. 1 GR S non fopi VL INFION 140,800.00 140,800.00
    1270 SULPERAZONE INJ S non fopi VIAL PFIZER 203,830.00 203,830.00
    1271 SUPRAFENID SUPPS. 100 MG S non fopi PC MEPROFARM 12,100.00 12,100.00
    1272 208DM03B03 FDM03B003 SUPRASMA HFA INHALER S fopi PC DEXA MEDICA 77,000.00 16.00% 77,000.00
    1273 SUPRASMA SOL. FOR INHALER S non fopi PC DEXA MEDICA 7,700.00 7,700.00
    1274 SUSU APTA+GLUKOFIT VANILA S non fopi KTK COMBIPHAR 36,932.50 36,932.50
    1275 SUSU APTA+KOLESFIT GREENTEA S non fopi KTK COMBIPHAR 39,176.50 39,176.50
    1276 SUSU APTA+KOLESFIT MIX. BERRY S non fopi KTK COMBIPHAR 39,176.50 39,176.50
    1277 SUSU APTA+KOLESFIT ORIGINAL S non fopi KTK COMBIPHAR 39,176.50 39,176.50
    1278 SUSU DIABETASOL COKLAT S non fopi KTK KALBE FARMA 37,411.00 37,411.00
    1279 SUSU DIABETASOL SWEET O CAL 1 GR S non fopi KTK KALBE FARMA 346.64 346.64
    1280 SUSU DIABETASOL VANILA S non fopi KTK KALBE FARMA 37,411.00 37,411.00
    1281 SUSU ENSURE VAN 400 GR S non fopi KTK KALBE FARMA 103,291.65 103,291.65
    1282 SUSU ENTRAKID VANILA 185 GR S non fopi KTK KALBE FARMA 44,830.50 44,830.50
    1283 SUSU ENTRASOL GOLD VAN. 185 GR S non fopi KTK KALBE FARMA 28,600.00 28,600.00
    1284 SUSU ENTRASOL SENIOR VAN. 400 GR S non fopi KTK KALBE FARMA 93,379.00 93,379.00
    1285 SUSU GOLD LBW S-26 100 ML S non fopi BTL KALBE FARMA 51,561.40 51,561.40
    1286 SUSU LOVAMIL IBU MENYUSUI COKLAT S non fopi KTK KALBE FARMA 20,620.60 20,620.60
    1287 SUSU LOVAMIL IBU MENYUSUI VANILA S non fopi KTK KALBE FARMA 20,620.60 20,620.60
    1288 SUSU NEPHRISOL D S non fopi KTK KALBE FARMA 60,310.00 60,310.00
    1289 SUSU NEPHRISOL VAN. S non fopi KTK KALBE FARMA 52,919.00 52,919.00
    1290 SUSU PEPTIBREN VANILA 210 GR S non fopi KTK KALBE FARMA 65,178.00 65,178.00

    DATA KEBUTUHAN OBAT REVISI 54 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1291 SUSU PROMIL S-26 400 GR S non fopi KTK KALBE FARMA 103,878.94 103,878.94
    1292 208AZ03B07 FAZ03B007 SYMBICORT 160, 120 DOSE S fopi BTL ASTRA ZENECA 276,640.76 276,640.76
    1293 SYNCORA S non fopi PC LANDSON 33,000.00 33,000.00
    1294 SYNFLORIX INJEKSI S non fopi AMP GLAXO 433,675.00 433,675.00
    1295 TAMOLIV INFUS 1000 MG S non fopi BTL KALBE FARMA 49,005.00 49,005.00
    1296 208TN02C01 FTN02C001 TANAPRESS 10 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC TANABE ABADI 13,953.50 13,953.50
    1297 TANAPRESS 5 MG S non fopi PC TANABE ABADI 10,298.20 10,298.20
    1298 208TK06E02 FTK06E002 06 HORMONES TAPROS INJ. 3.75 MG S fopi AMP TAKEDA 569,866.73 569,866.73
    1299 TAXECAP INJ 1 GR S non fopi VIAL CAPRIFARMINDO 89,958.00 89,958.00
    1300 TAXEGRAM INJ 1 GR S non fopi VIAL SANBE FARMA 113,803.25 113,803.25
    1301 TEKASOL OINTMENT S non fopi TUBE SDM 38,115.00 38,115.00
    1302 208SA12A04 FSA12A004 TELFAST OD KAPSUL S fopi PC AVENTIS 6,752.08 6,752.08
    1303 TELSAT 40 MG S PC FERRON 9,350.00 37.50%
    1304 TELSAT 80 MG S PC FERRON 12,375.01 37.50%
    1305 TENSICAP 12.5 MG S non fopi PC SANBE FARMA 1,826.00 1,826.00
    1306 TENSICAP 25 MG S non fopi PC SANBE FARMA 3,586.00 3,586.00
    1307 TENSILO INJ. S non fopi AMP FAHRENHEIT 176,000.00 176,000.00
    1308 TEQUINOL 500 MG S non fopi PC OTTO 9,968.75 9,968.75
    1309 TEQUINOL 500 MG S non fopi PC OTTO 27.50%
    1310 TERANOL INJ 30MG S non fopi AMP GUARDIAN 35,750.00 35,750.00
    1311 TERANOL TAB S non fopi PC GUARDIAN 4,950.00 4,950.00
    1312 TERMISIL CREAM 10 GR S fopi TUBE DEXA MEDICA 37.50%
    1313 TERMOFEN SYR. S non fopi BTL INFION 27,500.00 27,500.00
    1314 TERRACORTRIL TOP OIN S non fopi VIAL PFIZER 15,592.50 15,592.50
    1315 THERAVASK 10 MG S non fopi PC DARYA VARIA 5,789.85 5,789.85
    1316 THERAVASK 5 MG S non fopi PC DARYA VARIA 3,974.85 3,974.85
    1317 THERODEL TAB. S non fopi PC SANBE FARMA 6,600.20 6,600.20
    1318 THIAMYCIN CAPS 500 MG S non fopi PC INTERBAT 3,831.30 3,831.30
    1319 THISLACOL 500 MG S non fopi PC METISKA FARMA 3,448.50 3,448.50
    1320 208DV02N01 FDV02N001 THROMBO ASPILET
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC MEDIFARM 904.93 904.93
    1321 THROMBOPHOB GEL. 20 GR S non fopi TUBE NORDMARK 54,450.00 54,450.00
    1322 THYRAX S non fopi PC ORGANON 2,097.34 2,097.34
    1323 208FA02A04 FFA02A004 TIARYT INJ. S fopi AMP FAHRENHEIT 20,625.00 20,625.00
    1324 TICURING S non fopi PC LAPI 7,425.00 7,425.00
    1325 TILFLAM S non fopi PC DEXA MEDICA 8,415.00 8,415.00
    1326 TIMIPEN INJ. 1 GR S non fopi VIAL INTERBAT 277,365.00 277,365.00
    1327 TIRDICEF INJ 1 GR S non fopi VIAL BERNOFARM 94,627.50 94,627.50
    1328 TISACEF SYR 125 MG/60 ML S non fopi BTL METISKA FARMA 41,800.00 41,800.00
    1329 TISACEF SYR 250 MG/60 ML S non fopi BTL METISKA FARMA 67,925.00 67,925.00
    1330 TIZOS INJ 1 GR S non fopi VIAL DEXA MEDIKA 185,130.00 185,130.00
    1331 208KB08P01 FKB08P001 TKV TABLET S fopi PC KALBE FARMA 0.00% 27,866.66
    1332 208KB08P01 FKB08P001 08 ANTI-INFECTIVES SYSTEMIC TKV TABLET S fopi PC KALBE FARMA 29,333.33 5.00% 27,866.66
    1333 TOFEDEX TABLET 25 MG S non fopi PC LAPI 5,808.00 10,340.00
    1334 TOMIT INJ. 5 AMP/KTK S non fopi AMP INTERBAT 10,340.00 5,516.50
    1335 TONAR TAB. S non fopi PC SANDOZ 5,516.50 30,305.00
    1336 TORDEX INJEKSI S non fopi PC INTERBAT 45,100.00 35.00% 42,845.00
    1337 TORDEX TABLET S non fopi PC INTERBAT 6,600.00 30.00% 5,808.00
    1338 208FA09B02 FFA09B002 TRACETATE INFUS 200 ML S fopi BTL FAHRENHEIT 429,000.00 17.18% -
    1339 TRADYL INJ S non fopi PC INTERBAT - 40.00% -

    DATA KEBUTUHAN OBAT REVISI 55 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1340 TRAMIFEN CAPS S non fopi PC OTTO 6,160.00 6,160.00


    1341 TRAMSET TABLET S non fopi PC FAHRENHEIT 7,480.00 7,480.00
    1342 208DM05C04 FDM05C004 05 MUSCULO-SKELETAL SYSTEM TRAMUS 1% 5 ML S fopi AMP DEXA MEDICA 70,125.00 70,125.00
    1343 TRAMUS 1% 2.5 ML S non fopi AMP DEXA MEDICA 44,880.00 44,880.00
    1344 TRANEC 500 MG S non fopi AMP GRACIA 2,987.60 2,987.60
    1345 TRANEC INJ S non fopi AMP GRACIA 17,242.50 17,242.50
    1346 TRANEXID INJ 5% S non fopi AMP INMARK 9,900.00 9,900.00
    1347 208TM03C08 FTM03C008 03 RESPIRATORY SYSTEM TRANSPULMIN SYR. 60 ML S fopi BTL TRANSFARMA 64,680.00 64,680.00
    1348 TRAZEP SUPPS 2 MG S non fopi PC FAHRENHEIT 19,800.00 19,800.00
    1349 TRIACTEC TAB. 5 MG S non fopi PC AVENTIS 10,200.17 10,200.17
    1350 TRICEFIN INJ. S non fopi VIAL DEXA MEDIKA 163,625.00 163,625.00
    1351 TRICHODAZOLE INFUS 100 ML S non fopi BTL SANBE FARMA 98,230.00 30.00% 72,820.00
    1352 TRICKER INJ. S non fopi AMP MEPROFARM 16,500.00 16,500.00
    1353 TRICKER TAB S non fopi PC MEPROFARM 3,960.00 3,960.00
    1354 TRIDEX 27B 500 ML S non fopi BTL SANBE FARMA 15,408.25 15,408.25
    1355 TRIDEX PLAIN 500 ML S non fopi BTL SANBE FARMA 22,000.00 22,000.00
    1356 TRIJEC INJ. 1 GR S non fopi VIAL LANDSON 220,000.00 220,000.00
    1357 TRIMOVAX INJ S non fopi VIAL AVENTIS 101,062.50 101,062.50
    1358 TRIPENEM INJ. 1 GR S non fopi VIAL DEXA MEDIKA 425,700.00 425,700.00
    1359 TRIXIM CAPS 100 MG S non fopi PC FERRON 15,400.00 15,400.00
    1360 TRIXIM SYR S non fopi BTL FERRON 71,500.00 71,500.00
    1361 TROLIP TAB 160 MG S non fopi PC DEXA MEDICA 9,405.00 9,405.00
    1362 TROLIT S non fopi PC KALBE FARMA 11,320.83 11,320.83
    1363 TROMBIKAF TAB S non fopi PC KALBE FARMA 13,200.00 13,200.00
    1364 TROMECON 20 GR S non fopi TUBE ERTECON 22,772.76 22,772.76
    1365 TUTOFUSIN OPS S non fopi BTL KALBE FARMA 38,600.00 38,600.00
    1366 TWYNSTA 40 / 10 MG S non fopi PC BERNOFARM 12,435.43 12,435.43
    1367 TWYNSTA 80 / 10 MG S non fopi PC BERNOFARM 17,210.91 17,210.91
    1368 TYPHERIX S non fopi VIAL GLAXO 93,333.90 93,333.90
    1369 TYPHIM VI 0.5 ML S non fopi VIAL SANOFI 166,563.10 166,563.10
    1370 208TN02S01 FTN02S001 UBI-Q CAPS 100 MG
    02 CARDIOVASCULAR & HAEMATOPO S fopi PC EISAI 13,952.60 13,952.60
    1371 UBI-Q CAPS 30 MG S non fopi PC EISAI 6,044.49 6,044.49
    1372 UDOPA INJ S non fopi AMP DIPA 7,808.24 7,808.24
    1373 ULCERANIN INJ S non fopi AMP OTTO 16,280.00 16,280.00
    1374 ULCETRA CAPS. S non fopi PC U 8,250.00 8,250.00
    1375 208JJ04K01 FJJ04K001 04 CENTRAL NERVOUS SYSTEM ULTRACET TABLET 37.5 MG S fopi PC JANNSEN 7,828.88 7,828.88
    1376 UMARONE INJEKSI S non fopi AMP FAHRENHEIT 173,250.00 173,250.00
    1377 UNIGEN S non fopi PC NUTRINDO 8,652.60 8,652.60
    1378 UNISIA TAB S non fopi PC TAKEDA 13,750.00 13,750.00
    1379 UNIVOXY TAB S non fopi PC TROPICA MAS 6,435.00 6,435.00
    1380 UPERIO 50 MG S fopi PC NOVARTIS 10.89%
    1381 URDAFALK TAB. 250 S non fopi PC DARYA VARIA 10,426.17 10,426.17
    1382 URDEX CAPS. S non fopi PC DEXA MEDICA 8,800.00 10.00% 6,545.00
    1383 URESIX CAPS. S non fopi PC CAPRIFARMINDO 767.25 767.25
    1384 URIEF TAB. 4 MG S non fopi PC EISAI 6,894.76 6,894.76
    1385 URISPAS 200 MG TAB. S non fopi PC INDOFARMA 5,591.66 5,591.66
    1386 208TM10B01 FTM10B001 10 GENITO-URINARY SYSTEM UROGETIK 100 MG S fopi PC TRANSFARMA 5,465.90 5,465.90
    1387 UROTRACTIN CAPS. S non fopi PC SANBE FARMA 3,586.00 25.00% 2,779.15
    1388 URSOLIC 250 MG S non fopi PC GUARDIAN 7,260.00 7,260.00

    DATA KEBUTUHAN OBAT REVISI 56 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1389 VACLO TAB S non fopi PC DEXA MEDICA 11,687.50 11,687.50


    1390 VAKSIN HEPATITIS B RECOM S non fopi VIAL BIO FARMA 82,764.00 82,764.00
    1391 VAKSIN HEPATITIS B RECOM S non fopi VIAL BIO FARMA 87,120.00 87,120.00
    1392 VALAMIN 500 ML S non fopi BTL SANBE FARMA 68,420.00 68,420.00
    1393 VALESCO 160 MG S non fopi PC DIPA 2,688.40 2,688.40
    1394 VALESCO 80 MG S non fopi PC DIPA 1,795.20 1,795.20
    1395 VALIUM INJ 10 MG S non fopi AMP ROCHE 26,474.20 26,474.20
    1396 VANCEP INJ S non fopi VIAL FAHRENHEIT 198,000.00 198,000.00
    1397 VAPORUB 10 GR S non fopi AMP VICKS 6,821.00 0.00% 26,474.20
    1398 VAPORUB 25 GR S non fopi AMP VICKS 16,109.00 0.00% 26,474.20
    1399 VARDIPIN 5/160 S non fopi PC OTTO 17,545.00 17,545.00
    1400 211SM12B13 FSM12B013 12 ALLERGY & IMMUNE SYSTEM VARILRIX INJEKSI S fopi VIAL GLAXO 391,875.00 391,875.00
    1401 211MD12B03 FMD12B003 12 ALLERGY & IMMUNE SYSTEM VARIVAX S fopi VIAL MSD 442,121.00 442,121.00
    1402 208FA02K01 FFA02K001 01 GASTROINTESTINAL & HEPATOBIVASCON INJ S fopi AMP FAHRENHEIT 104,500.00 23.00% 78,375.00
    1403 VAXIGRIP 0,25 ml S non fopi VIAL SANOFI 107,525.00 107,525.00
    1404 VAXIGRIP 0,5 ml S non fopi VIAL SANOFI 146,800.50 146,800.50
    1405 208KB02D03 FKB02D003 01 GASTROINTESTINAL & HEPATOBIV-BLOC 25 S fopi PC KALBE FARMA 3,514.50 0.00% 7,419.50
    1406 VENARON CAPS S non fopi PC METISKA FARMA 3,201.00 3,201.00
    1407 VENODENOL INJ. S non fopi AMP FAHRENHEIT 148,500.00 148,500.00
    1408 208KB02N05 FKB02N005 VENOSMIL CAP. S fopi PC KALBE FARMA 5,052.30 0.00% 5,052.30
    1409 VENOVER INJ S non fopi AMP COMBIPHAR 179,300.00 179,300.00
    1410 208GS03B09 FGS03B009 03 RESPIRATORY SYSTEM VENTOLIN INHALER S fopi BTL GLAXO 59,699.50 0.00% 59,699.50
    1411 VERDIF INJ. 1 MG S non fopi AMP OTTO 119,625.00 119,625.00
    1412 VERIDIN TAB. S non fopi PC MEPROFARM 5,940.00 5,940.00
    1413 VERSILON TAB. 6 MG S non fopi PC MERSIFARMA 1,716.00 1,716.00
    1414 VERTIKAF TABLET 8 MG S non fopi PC KIMIA FARMA 3,540.46 3,540.46
    1415 208AS10E03 FAS10E003 10 GENITO-URINARY SYSTEM VESICARE 5 MG S fopi PC ASTELAS 16,101.33 16,101.33
    1416 10 GENITO-URINARY SYSTEM VESICARE 10 MG S non fopi PC ASTELAS 17,843.10 17,843.10
    1417 VESPERUM SYR S non fopi BTL NICHOLAS 4,643.10 4,643.10
    1418 VIAJOY CAPS. S non fopi PC OTTO 35,200.00 35,200.00
    1419 208MJ08C05 FMJ08C005 08 ANTI-INFECTIVES SYSTEMIC VICCILLIN - SX 1500 INJ. 1.5 G S fopi BTL MEIJI 90,200.00 54.55% 39,002.48
    1420 VIOQUIN 500 MG S non fopi PC GRACIA 12,540.00 12,540.00
    1421 208BY06B05 FBY06B005 06 HORMONES VISANNE TAB. S fopi PC BAYER 13,781.43 13,781.43
    1422 VISEBAD DROP S non fopi BTL OTTO 18,700.00 18,700.00
    1423 VISEBAD PLUS SYR. S non fopi BTL OTTO 27,500.00 27,500.00
    1424 VISEBAD SYR. S non fopi BTL OTTO 23,100.00 23,100.00
    1425 VITACID CR 0.025% 15 GR S non fopi TUBE SDM 22,990.00 22,990.00
    1426 208SD16F08 FSD16F008 16 DERMATOLOGICALS VITACID CR 0.05% 20 GR S fopi TUBE SDM 27,830.00 27,830.00
    1427 VITAMIN K TAB S non fopi PC KIMIA FARMA 65.34 65.34
    1428 VITAZET KAPLET S non fopi PC INTERBAT 8,305.00 50.00% 1,870.04
    1429 VIVACE 2.5 MG S non fopi PC ACTAVIS 4,620.00 4,620.00
    1430 VOLEQUIN INF. S non fopi BTL DEXA MEDIKA 243,100.00 243,100.00
    1431 VOLEQUIN TAB. 500 MG S non fopi PC DEXA MEDIKA 28,050.00 28,050.00
    1432 VOLOX 500 MG S non fopi PC INTERBAT 38,115.00 38,115.00
    1433 VOLTADEX GEL 20 GR S non fopi TUBE DEXA MEDICA 22,099.00 22,099.00
    1434 VOLTADEX TAB. 50 MG S non fopi PC DEXA MEDICA 495.00 495.00
    1435 VOLTAREN INJ. S non fopi AMP NOVARTIS 47,084.77 47,084.77
    1436 VOLTAREN TAB 25 MG S non fopi PC NOVARTIS 4,061.22 15.00% 3,548.63
    1437 VOMIPER SYR. S non fopi BTL INFION 33,000.00 33,000.00

    DATA KEBUTUHAN OBAT REVISI 57 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    1438 VOMIPER TABLET S non fopi PC INFION 2,933.33 2,933.33


    1439 VOMITAS SYR S non fopi BTL KALBE FARMA 37,400.00 37,400.00
    1440 VOSEDON SYR S non fopi BTL SANBE FARMA 24,807.75 24,807.75
    1441 VOSEDON TAB. S non fopi PC SANBE FARMA 1,982.06 1,982.06
    1442 VOSTEM CAPS. S non fopi PC SANBE FARMA 3,520.00 3,520.00
    1443 VROXIL 500 MG S non fopi PC INTERBAT 9,900.00 9,900.00
    1444 WATER & ADPT HUMID 325 ML S non fopi BTL RESPIFLO 82,500.00 82,500.00
    1445 WIAFLOX 500 MG S non fopi PC LANDSON 12,650.00 12,650.00
    1446 WIDROX CAPS S non fopi PC LANDSON 9,009.00 9,009.00
    1447 X CAM 15 MG S non fopi PC MEPROFARM 6,930.00 6,930.00
    1448 X CAM 7.5 MG S non fopi PC MEPROFARM 4,356.00 4,356.00
    1449 XANAX TAB. 0,25 MG S non fopi PC PFIZER 1,844.98 1,844.98
    1450 208PF04A02 FPF04A002 04 CENTRAL NERVOUS SYSTEM XANAX TAB. 0,5 MG S fopi PC PFIZER 3,286.13 3,286.13
    1451 XANAX XR S non fopi PC PFIZER 3,654.38 3,654.38
    1452 XANDA SYR 120 ML S non fopi BTL METISKA FARMA 55,000.00 55,000.00
    1453 XANDA SYR 60 ML S non fopi BTL METISKA FARMA 31,350.00 31,350.00
    1454 XENOPROM INJ 1 GR S non fopi VIAL NOVELL 228,800.00 228,800.00
    1455 XEPAFEN FORTE SYR. S non fopi BTL METISKA FARMA 20,900.00 20,900.00
    1456 XEPAGEL LOTION S non fopi BTL METISKA FARMA 146,300.00 146,300.00
    1457 XEPANEURON TAB. S non fopi PC METISKA FARMA 1,018.88 1,018.88
    1458 XEPAPRIM FORTE CAPS S non fopi PC METISKA FARMA 1,828.75 1,828.75
    1459 XEPAPRIM SYR 60 ML S non fopi BTL METISKA FARMA 23,100.00 23,100.00
    1460 208MK01F01 FMK01F001 01 GASTROINTESTINAL & HEPATOBIXEPAZYM TAB S fopi PC METISKA FARMA 2,612.50 2,612.50
    1461 208TN17A01 FTN17A001 17 ANAESTHETICS LOCAL & GENER XYLOCAINE 10% SPRAY S fopi BTL ASTRA ZENECA 307,307.00 307,307.00
    1462 208GS12A01 FGS12A001 17 ANAESTHETICS LOCAL & GENER XYZAL CAPS S fopi PC INMARK 7,927.92 7,927.92
    1463 YAFIX TAB. S non fopi PC YARINDO 12,210.00 12,210.00
    1464 YARIDON TAB. S non fopi PC YARINDO 2,420.00 2,420.00
    1465 YAZ S non fopi PC BAYER 148,181.00 148,181.00
    1466 YUVIT D S PC YARINDO 2,530.00 5.00%
    1467 ZAMEL SYR. S BTL NOVELL 15.00%
    1468 ZANTADIN INJ 2 ML S non fopi AMP SOHO 18,700.00 18,700.00
    1469 208KB30E05 FKB30E005 30 VITAMINS & MINERALS ZEGAVIT TAB. S fopi PC KALBE FARMA 2,257.20 0.00% 2,257.20
    1470 ZINCARE 20 MG S non fopi PC KALBE FARMA 1,985.50 1,985.50
    1471 ZINCPRO SYR. 60 ML S fopi BTL COMBIPHAR 7,089.50 7,089.50
    1472 ZINFION SYR. S non fopi BTL INFION 26,400.00 26,400.00
    1473 ZISTIC INFUS 500 MG S non fopi PC BERNOFARM 85,000.00 0.00% 148,500.00
    1474 ZISTIC TABLET 500 MG S non fopi PC BERNOFARM 34,485.00 34,485.00
    1475 08 ANTI-INFECTIVES SYSTEMIC ZITHROMAX IV S non fopi VIAL PFIZER 163,311.50 163,311.50
    1476 ZITROLIN TAB. S non fopi PC OTTO 27,912.50 27,912.50
    1477 ZOLAGEL CREAM S non fopi TUBE NICHOLAS 5,500.00 5,500.00
    1478 ZOLLOCID CAPS S non fopi PC LANDSON 9,900.00 9,900.00
    1479 ZOLLOCID INJ. S non fopi VIAL LANDSON 149,600.00 67.50% 63,580.00
    1480 ZOLMIA TAB S non fopi PC FAHRENHEIT 4,950.00 4,950.00
    1481 ZOLOFT TAB. S non fopi PC PFIZER 15,353.48 15,353.48
    1482 ZOSTAVAX INJ. S non fopi VIAL SANOFI 1,702,462.80 1,702,462.80
    1483 ZOTER 400 MG S non fopi PC INTERBAT 9,157.50 9,157.50
    1484 ZOTER CREAM S non fopi TUBE INTERBAT 44,000.00 44,000.00

    DATA KEBUTUHAN OBAT REVISI 58 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    BAHAN PELENGKAP -
    DEAD STOCK
    1 CLIP PENJEPIT COLOSTOMY BAG D PC HOLLISTER 42,075.00 42,075.00
    2 COLLACURE 120 X 40 X 3 MM D PC NUFARINDO 519,750.00 519,750.00
    3 COLLACURE 50 X 50 X 5 MM D PC NUFARINDO 273,003.88 273,003.88
    4 217OD17U70 DOD17U070 COLOSTOMY BAG D fopi PC ONE MED 10,384.00 10,384.00
    5 217OD17U70 DOD17U070 COLOSTOMY BAG D fopi PC ONE MED 46,200.00 46,200.00
    6 DECK GLASS D PC XXX 77,000.00 77,000.00
    7 PAPER PRINTER COLOR CK-900S D ROL MITSUBISHI 2,145,000.00 2,145,000.00
    8 PILA HEMORROID INTERNA D PC FAHRENHEIT 365,750.00 365,750.00
    9 RING PESARIUM NO. 7 D PC RUSCH 138,600.00 138,600.00
    10 RING PESARIUM NO. 7 D PC RUSCH 154,000.00 154,000.00
    11 RING PESARIUM NO. 7.5 D PC RUSCH 138,600.00 138,600.00
    12 RING PESARIUM NO. 7.5 D PC RUSCH 127,050.00 127,050.00
    13 SAFIL 0 HR 48 D PC B/BROUND 102,050.30 102,050.30
    14 SAFIL 1 HR 48 D PC B/BROUND 122,650.00 122,650.00
    15 SAFIL 2/0 HR 26 VIOLET D PC B/BROUND 92,230.60 92,230.60
    16 SAFIL 3/0 DS 24 D PC B/BROUND 87,258.60 87,258.60
    17 SAFIL 3/0 HR 26 D PC B/BROUND 92,364.80 92,364.80
    18 SAFIL 4/0 HR 17 D PC B/BROUND 97,202.60 97,202.60
    19 SOFFBAN 72011.13 6" 15 X 2.7 D ROL BSN 27,288.58 27,288.58
    20 SOFFBAN 72011.13 6" 15 X 2.7 D ROL BSN 39,655.00 39,655.00
    21 SOFFBAN 72011.14 3" 7.5 X 2.7 D ROL BSN 20,847.20 20,847.20
    22 SOFFBAN 72011.15 4" 10 X 2.7 D ROL BSN 26,059.00 26,059.00
    23 SOFFBAN 72011.15 4" 10 X 2.7 D ROL BSN 28,325.00 28,325.00
    24 SURGICAL N 3/8 1204 NO,12 D PC GSCT 5,999.40 5,999.40
    25 SURGICAL N 3/8 1204 NO,13 D PC GSCT 5,999.40 5,999.40
    26 SURGICAL NEEDLE ME-18 D PC MANI 22,385.00 22,385.00
    27 SURGICAL NEEDLE ME-21 D PC MANI 22,385.00 22,385.00
    28 SURGICAL NEEDLE ME-24 D PC MANI 22,385.00 22,385.00
    29 SURGICAL NEEDLE ME-32 D PC MANI 22,385.00 22,385.00
    30 SURGICAL NEEDLE ME-36 D PC MANI 15,467.83 15,467.83
    31 SURGICAL NEEDLE ME-40 D PC MANI 11,550.00 11,550.00
    32 SURGICAL NEEDLE ME-41 D PC MANI 22,385.00 22,385.00
    33 SURGICAL NEEDLE ME-55 D PC MANI 11,550.00 11,550.00
    34 SURGICAL NEEDLE MH-18 D PC MANI 22,385.00 22,385.00
    35 SURGICAL NEEDLE MH-21 D PC MANI 15,467.83 15,467.83
    36 SURGICAL NEEDLE MH-21 D PC MANI 22,385.00 22,385.00
    37 SURGICAL NEEDLE MH-24 D PC MANI 22,385.00 22,385.00
    38 SURGICAL NEEDLE MH-28 D PC MANI 15,467.83 15,467.83
    39 SURGICAL NEEDLE MH-32 D PC MANI 15,467.83 15,467.83
    40 SURGICAL NEEDLE MH-32 D PC MANI 22,385.00 22,385.00
    41 SURGICAL NEEDLE MH-36 D PC MANI 15,467.83 15,467.83
    42 SURGICAL NEEDLE MH-36 D PC MANI 22,385.00 22,385.00
    43 SURGICAL NEEDLE MH-40 D PC MANI 22,385.00 22,385.00
    44 SURGICAL NEEDLE MH-41 D PC MANI 22,385.00 22,385.00
    45 SURGICAL NEEDLE MH-41 D PC MANI 15,467.83 15,467.83
    46 SURGICAL NEEDLE MH-45 D PC MANI 22,385.00 22,385.00

    DATA KEBUTUHAN OBAT REVISI 59 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    47 SURGICAL NEEDLE MH-50 D PC MANI 19,250.00 19,250.00


    48 SURGICAL NEEDLE TE-21 D PC MANI 22,385.00 22,385.00
    49 SURGICAL NEEDLE TH-18 D PC MANI 15,467.83 15,467.83
    50 SURGICAL NEEDLE TH-18 D PC MANI 22,385.00 22,385.00
    51 SURGICAL NEEDLE TH-21 D PC MANI 22,385.00 22,385.00
    52 SURGICAL NEEDLE TH-24 D PC MANI 22,385.00 22,385.00
    53 SURGICAL NEEDLE TH-28 D PC MANI 22,385.00 22,385.00
    54 SURGICAL NEEDLE TH-32 D PC MANI 22,385.00 22,385.00
    55 SURGICAL NEEDLE TH-36 D PC MANI 22,385.00 22,385.00
    56 SURGICAL NEEDLE TH-40 D PC MANI 19,250.00 19,250.00
    57 SURGICAL NEEDLE TH-41 D PC MANI 22,385.00 22,385.00
    58 SURGICAL NEEDLE TH-45 D PC MANI 22,385.00 22,385.00
    59 SURGICAL NEEDLE TH-50 D PC MANI 22,385.00 22,385.00
    60 SURGICAL NEEDLE TH-55 D PC MANI 15,467.83 15,467.83
    61 SURGICAL NEEDLE TH-55 D PC MANI 22,385.00 22,385.00
    62 URINAL UTK. LAKI-LAKI PLASTIK D PC XXX 15,840.00 15,840.00

    FAST MOVING
    63 AGTIFA- IOL POSTERIOR CHAMBER 19 F PC AGTIFA 275,412.50 275,412.50
    64 AGTIFA- IOL POSTERIOR CHAMBER 19.50 F PC AGTIFA 275,412.50 0.00% 275,412.50
    65 AGTIFA- IOL POSTERIOR CHAMBER 20.00 F PC AGTIFA 275,412.50 0.00% 275,412.50
    66 AGTIFA- IOL POSTERIOR CHAMBER 20.50 F PC AGTIFA 275,412.50 275,412.50
    67 AGTIFA- SAFETY CREASENT KNIFE F PC AGTIFA 266,750.00 266,750.00
    68 AGTIFA- SAFETY SLIT KNIFE F PC AGTIFA 266,750.00 266,750.00
    69 AGTIFA- SAFETY STAB KNIFE F PC AGTIFA 266,750.00 266,750.00
    70 AGTIFA- TRYPAN BLUE F PC AGTIFA 96,470.00 0.00% 96,470.00
    71 AGTIFA- VISCO F PC AGTIFA 1,030,975.00 0.00% 1,030,975.00
    951 214LP14I01 DLP14I001 ALCOHOL SWABS F fopi PC REMEDI 165.00 0.00% 495.00
    72 214OD14I45 DOD14I045 ALCOHOL SWABS F fopi PC ONE MED 198.00 0.00% 126.00
    73 ALCOHOL SWABS F fopi PC AXIMED 158.39 24.24%
    74 DJI14I001 ALCOHOL SWABS F fopi PC ALTAMED 155.00 45.16%
    75 APRON F SET ONEMED 4,100.00 0.00% 3,150.00
    76 BAJU OPERASI ( KIT CESAREAN ) F SET MAESINDO 770,000.00 0.00%
    77 BAJU OPERASI ( KIT CESAREAN ) F SET SMI 1,039,500.00 0.00% 308,000.00
    78 BAJU OPERASI ( UNIVERSAL SET ) F SET SOLIDA 418,990.00 0.00% 455,840.00
    79 217OD17N57 DOD17N057 BANDANA CAP GREEN F fopi PC ONEMED 557.00 0.00% 6,950.24
    80 217OD17N57 DOD17N057 BANDANA CAP GREEN F fopi PC SOLIDA 522.50 0.00% 1,045.00
    81 217OD17N57 DOD17N057 BANDANA CAP GREEN F fopi PC ONEMED 319.77 0.00% 319.77
    82 217OD17N57 DOD17N057 BANDANA CAP GREEN F fopi PC ONEMED 682.00 0.00% 375.00
    83 217OD17N57 DOD17N057 BANDANA CAP F fopi PC ONEMED 1,100.00 0.00% 1,018.26
    84 217OD17N57 DOD17N057 BANDANA CAP GREEN @ 100 F fopi PC SINAR OGAN 462.85 0.00% 462.85
    85 BLOOD TRANFUSION SET F fopi PC GEA 10,500.00 0.00% 8,580.00
    86 213NO13D10 DNO13D010 BLOOD TRANFUSION SET F fopi PC NIPRO 28,050.00 0.00% 13,761.00
    87 213TO13D61 DTO13D061 BLOOD TRANFUSION SET F fopi PC TERUMO 16,500.00 0.00% 4,537.50
    88 BLOOD TRANFUSION SET F fopi PC STERRA 5,197.00 0.00% 4,537.50
    89 CATGUT CHROMIC 0 HR 37 F PC B/BROUND 69,938.00 69,938.00
    90 CATGUT CHROMIC 2/0 HR 37 MM F PC SMI 68,750.00 0.00% 32,799.98

    DATA KEBUTUHAN OBAT REVISI 60 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    91 CATGUT CHROMIC 2/0 TP 37 MM 90 CM F PC ATRAMAT 79,750.00 79,750.00


    92 CATGUT PLAIN NO. 0 HR 37 F PC B/BROUND 67,034.00 67,034.00
    93 CATGUT PLAIN NO. 2/0 HR 37 F PC SMI 74,250.00 0.00% 34,300.02
    94 COMBO KATETERISASI 16 F PC PRO DIVICE 37,400.00 37,400.00
    95 COMBO KATETERISASI 18 F PC PRO DIVICE 37,400.00 37,400.00
    96 COMBO PACK 24+SPALK (makro) F PC PRO DIVICE 37,400.00 37,400.00
    97 COMBO PACK BS 18 F PC PRO DIVICE 32,725.00 32,725.00
    98 COMBO PACK BS 20 F PC PRO DIVICE 32,725.00 32,725.00
    99 COMBO PACK NPNW 20 GSTC F PC PRO DIVICE 23,375.00 23,375.00
    100 COMBO PACK NPNW 22 GSTC F PC PRO DIVICE 23,375.00 23,375.00
    101 CORE ELECTRODE 2670 F PC ONEMED 1,694.00 25.00% 1,072.50
    102 CORE ELECTRODE 2670 F PC ONEMED 2,420.00 0.00% -
    103 CORE ELECTRODE 2670 F PC ONEMED 1,760.00 0.00% -
    104 CUP SAMPLE @ 1000 F BOK HUMAN 580,800.00 0.00% 580,800.00
    105 CURVED HAEMODIALYSIS CATH. KIT F SET APPROVED 990,000.00 0.00% 990,000.00
    106 DARYANTULLE F PC DARYA VARYA 20,592.00 20,592.00
    107 214OD14E38 DOD14E038 DERMAFIX 10 X 25 CM F fopi PC ONEMED 17,800.00 0.00% 25,960.00
    108 214OD14E38 DOD14E038 DERMAFIX 10 X 25 CM F fopi PC ONEMED 20,570.00 0.00% 12,622.50
    109 217BB17Q53 DBB17Q053 DISCOFIX 3 WAY LUER LOCK 10 CM F fopi PC B/BRAUN 38,500.00 38,500.00
    110 217BB17Q54 DBB17Q054 DISCOFIX 3 WAY STOPCOCK BLUE F fopi PC B/BRAUN 30,250.00 30,250.00
    111 DISPOSIBLE / NEEDLE 25 G F PC ONEMED 165.00 165.00
    112 213BD13B19 DBD13B019 DISPOSIBLE / NEEDLE 25 G F fopi PC BD 350.00 0.00% 1,089.00
    113 213BD13B19 DBD13B019 DISPOSIBLE / NEEDLE 25 G F fopi PC BD 1,023.00 1,023.00
    114 DISPOSIBLE / NEEDLE 26 G F PC ONE MED 350.00 0.00% 1,149.50
    115 213BD13B20 DBD13B020 DISPOSIBLE / NEEDLE 26 G 1/21 TAN F fopi PC BD 792.00 792.00
    116 213BD13A04 DBD13A004 DISPOSIBLE SYRINGE UK. 1 CC F fopi PC BD 770.00 0.00% 2,200.00
    117 213TO13A01 DTO13A001 DISPOSIBLE SYRINGE UK. 1 CC F fopi PC TERUMO 4,796.00 70.00% 1,395.90
    118 213S513A01 DS513A001 DISPOSIBLE SYRINGE UK. 1 CC F fopi PC STERRA 1,430.00 0.00% 561.00
    119 213NO13A01 DNO13A001 DISPOSIBLE SYRINGE UK. 1 CC F fopi PC NIPRO 1,100.00 0.00% 2,530.00
    120 213SY13A01 DSY13A001 DISPOSIBLE SYRINGE UK. 1 CC F fopi PC ONE MED 877.80 25.00% -
    121 DISPOSIBLE SYRINGE UK. 1 CC F PC AXIMED 1,161.60 24.24%
    122 213NO13A02 DNO13A002 DISPOSIBLE SYRINGE UK. 10 F fopi PC NIPRO 1,650.00 0.00% 1,597.20
    123 213BD13A05 DBD13A005 DISPOSIBLE SYRINGE UK. 10 F fopi PC BD 5,489.00 70.00% 971.25
    124 213S513A02 DS513A002 DISPOSIBLE SYRINGE UK. 10 F fopi PC STERRA 1,430.00 0.00% -
    125 213TO13A02 DTO13A002 DISPOSIBLE SYRINGE UK. 10 F fopi PC ONEMED 1,298.00 25.00% 2,376.00
    126 DISPOSIBLE SYRINGE UK. 10 F PC AXIMED 1,764.18 24.24% 891.00
    127 DISPOSIBLE SYRINGE UK. 10 F PC ONEMED 1,430.00 0.00%
    128 213OD13A04 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) F fopi PC ONE MED 1,653.30 0.00% 1,420.36
    129 213OD13A04 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) F fopi PC ONE MED 1,894.20 10.00% 1,420.32
    130 213BB13F21 DBB13F021 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) F PC ONE MED 1,892.00 25.00% 1,420.30
    131 213TO13A05 DTO13A005 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) F fopi PC TERUMO 2,035.00 0.00% 3,575.00
    132 213OD13A04 DOD13A004 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) F fopi PC ONEMED 6,500.00 0.00% 16,500.00
    133 213OD13A04 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) F PC AXIMED 2,323.20 24.24% -
    134 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) F PC TERUMO 27,500.00 27,500.00
    135 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) F PC NIPRO 1,653.30 0.00% 2,090.00
    136 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) F PC ONEMED 3,900.00 0.00% 3,080.00
    137 213BD13A08 DBD13A008 DISPOSIBLE SYRINGE UK. 3 F fopi PC BD 3,553.00 70.00% 1,032.90
    138 DISPOSIBLE SYRINGE UK. 3 F fopi PC STERRA 1,430.00 0.00%
    139 213NO13A03 DNO13A003 DISPOSIBLE SYRINGE UK. 3 F fopi PC ONEMED 1,210.00 0.00% 792.00

    DATA KEBUTUHAN OBAT REVISI 61 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    140 213S513A04 DISPOSIBLE SYRINGE UK. 3 F fopi PC ONEMED 781.00 25.00% -


    141 213OD13A05 DOD13A005 DISPOSIBLE SYRINGE UK. 3 F fopi PC ONEMED 833.80 25.00% 561.00
    142 213OD13A05 DOD13A005 DISPOSIBLE SYRINGE UK. 3 F fopi PC KIMSMED 750.20 0.00% -
    143 213OD13A05 DOD13A005 DISPOSIBLE SYRINGE UK. 3 F fopi PC ONEMED 803.00 25.00% 682.50
    144 DSY13A005 DISPOSIBLE SYRINGE UK. 5 F fopi PC NIPRO 1,430.00 0.00% 787.50
    145 213S513A05 DS513A005 DISPOSIBLE SYRINGE UK. 5 F fopi PC STERRA 1,320.00 0.00% -
    146 213BD13A09 DBD13A009 DISPOSIBLE SYRINGE UK. 5 F fopi PC BD 1,300.00 0.00% 1,260.60
    147 213TO13A08 DTO13A008 DISPOSIBLE SYRINGE UK. 5 F fopi PC TERUMO 853.96 0.00% -
    148 213BD13A09 DBD13A009 DISPOSIBLE SYRINGE UK. 5 F fopi PC ONEMED 877.80 25.00% 1,980.00
    149 DISPOSIBLE SYRINGE UK. 5 F PC AXIMED 1,212.42 24.24%
    150 DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) F PC B/BROUND 27,500.00 27,500.00
    151 213TO13A10 DTO13A010 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) F fopi PC ONEMED 6,820.00 25.00% -
    152 213S513A06 DOD13A006 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) F PC ONE MED 6,900.00 0.00% -
    153 DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) F PC ONEMED 6,200.00 0.00% 7,672.50
    154 213S513A06 DS513A006 DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) F PC AXIMED 4,839.99 24.24% 3,588.75
    155 213S513A06 DOD13A006 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) F fopi PC ONE MED 8,600.00 0.00% 27,500.00
    156 213NO13A05 DNO13A005 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) F fopi PC NIPRO 37,700.00 0.00% 3,588.75
    157 ENDOTRACHELA TUBE CUFFED 2.5 F PC RUSCH 143,000.00 0.00% 38,709.00
    158 ENDOTRACHELA TUBE CUFFED 3.0 F PC REMEDI 45,760.00 45,760.00
    159 ENDOTRACHELA TUBE CUFFED 3.0 F PC BICAKCILAR 32,725.00 -
    160 ENDOTRACHELA TUBE CUFFED 3.5 F PC AXIMED 30,201.60 24.24% 25,300.00
    161 ENDOTRACHELA TUBE CUFFED 3.5 F PC BICAKCILAR 42,200.00 0.00% 32,725.00
    162 ENDOTRACHELA TUBE CUFFED 3.5 F PC REMEDI 45,760.00 45,760.00
    163 ENDOTRACHELA TUBE CUFFED 4.0 F PC BICAKCILAR 42,200.00 0.00% 32,725.00
    164 ENDOTRACHELA TUBE CUFFED 4.0 F PC RUSCH 45,760.00 45,760.00
    165 ENDOTRACHELA TUBE CUFFED 4.5 F PC AXIMED 25,300.00 25,300.00
    166 ENDOTRACHELA TUBE CUFFED 4.5 F PC REMEDI 45,760.00 45,760.00
    167 ENDOTRACHELA TUBE CUFFED 5.0 F PC BICAKCILAR 32,725.00 32,725.00
    168 ENDOTRACHELA TUBE CUFFED 5.5 F PC RUSCH 45,760.00 45,760.00
    169 ENDOTRACHELA TUBE CUFFED 5.5 F PC BICAKCILAR 32,725.00 32,725.00
    170 ENDOTRACHELA TUBE CUFFED 6.0 F PC REMEDI 22,379.50 45,760.00
    171 ENDOTRACHELA TUBE CUFFED 6.0 F PC SMI 16,140.30 32,725.00
    172 ENDOTRACHELA TUBE CUFFED 6.0 F PC RESOURCES 0.00%
    173 ENDOTRACHELA TUBE CUFFED 6.5 F PC BICAKCILAR 25,297.80 32,725.00
    174 ENDOTRACHELA TUBE CUFFED 6.5 F PC AXIMED 30,201.60 24.24% 45,760.00
    175 ENDOTRACHELA TUBE CUFFED 7.0 F PC BICAKCILAR 42,200.00 0.00% -
    176 ENDOTRACHELA TUBE CUFFED 7.0 F PC AXIMED 30,201.60 24.24% 32,725.00
    177 ENDOTRACHELA TUBE CUFFED 7.5 F PC BICAKCILAR 42,200.00 0.00% 22,379.50
    178 ENDOTRACHELA TUBE CUFFED 7.5 F PC AXIMED 30,201.60 24.24% 22,379.50
    179 ENDOTRACHELA TUBE CUFFED 8.0 F PC RUSCH 75,900.00 75,900.00
    180 ENDOTRACHELA TUBE CUFFED 8.0 F PC RUSCH 75,240.00 75,240.00
    181 ENDOTRACHELA TUBE CUFFED 8.0 F PC RUSCH 72,050.00 72,050.00
    182 ENDOTRACHELA UNCUF 2.5 F PC IDEALCARE 62,920.00 0.00% 75,240.00
    183 ENDOTRACHELA UNCUF 2.5 F PC BICAKCILAR 57,200.00 0.00% 18,700.00
    184 ENDOTRACHELA UNCUF 3.0 F PC BICAKCILAR 57,200.00 0.00% -
    185 ENDOTRACHELA UNCUF 3.0 F PC IDEALCARE 62,920.00 0.00% 75,240.00
    186 ENDOTRACHELA UNCUF 3,5 F PC IDEALCARE 62,920.00 0.00% 75,240.00
    187 ENDOTRACHELA UNCUF 4,0 F PC IDEALCARE 62,920.00 0.00% 75,240.00
    188 ENDOTRACHELA UNCUF 4,0 F PC SMI 16,140.30 0.00% -

    DATA KEBUTUHAN OBAT REVISI 62 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    189 ENDOTRACHELA WIRE 5 REINFOR F PC SMI 156,200.00 156,200.00


    190 ENDOTRACHELA WIRE 5 REINFOR F PC BICAKCILAR 208,500.00 0.00% 162,222.50
    191 ENDOTRACHELA WIRE 6 REINFOR F PC SMI 171,820.00 247,711.20
    192 ENDOTRACHELA WIRE 6 REINFOR F PC BICAKCILAR 162,222.50 162,222.50
    193 ENDOTRACHELA WIRE 6.5 REINFOR F PC SMI 184,550.30 184,550.30
    194 ENDOTRACHELA WIRE 6.5 REINFOR F PC BICAKCILAR 144,882.00 162,222.50
    195 EXTENDED UFE PH TRANSFER F PC XXX 264,000.00 264,000.00
    196 FACE MASK F PC SENSI 2,200.00 2,200.00
    197 FACE MASK TALI PREMIUM F PC SINAR OGAN 1,199.99 -
    198 FACE MASK TALI HIJAP PREMIUM F PC SINAR OGAN 1,199.99 -
    199 217S217C01 DS217C001 FACE MASK EARLOOP F PC SOLMED 800.01 0.00% -
    200 2173M17C17 D3M17C017 FACE MASK F PC 3M 1,920.00 0.00% 1,116.00
    201 FACE MASK F PC ONEMED 456.00 0.00% -
    202 FACE MASK F PC BAYMED 800.01 33.20% -
    203 217OD17C48 DOD17C048 FACE MASK F PC ONEMED 1,200.00 0.00% -
    204 FACE MASK F PC SEVEN 960.00 0.00% -
    205 217OD17D51 DOD17D051 FEEDING TUBE FR. 5 . 100 CM F fopi PC ONEMED 8,039.00 0.00% -
    206 217TO17D74 DTO17D074 FEEDING TUBE FR. 5 . 100 CM F fopi PC AXIMED 10,018.80 24.24% 39,710.00
    207 FEEDING TUBE FR. 5 . 100 CM F fopi PC TERUMO 42,350.00 0.00% -
    208 217OD17D51 DOD17D051 FEEDING TUBE FR. 5 . 100 CM F fopi PC ONEMED 13,000.00 0.00% -
    209 217TO17D75 DTO17D075 FEEDING TUBE FR. 5 . 40 CM F fopi PC TERUMO 23,100.00 0.00% 31,768.00
    210 217WL17D20 DWL17D020 FEEDING TUBE FR. 5 . 40 CM F fopi PC TERUMO 42,350.00 0.00% 8,039.00
    211 217OD17D53 DOD17D053 FEEDING TUBE FR. 5 . 40 CM F fopi PC ONEMED 13,000.00 0.00% 8,039.00
    212 217TO17D73 DTO17D073 FEEDING TUBE NO. 3,5 35 CM F fopi PC TERUMO 92,872.81 54.40% 33,880.00
    213 217TO17D76 DTO17D076 FEEDING TUBE NO. 8 100 CM F fopi PC TERUMO 32,857.00 0.00% 39,710.00
    214 217WL17D23 DWL17D023 FEEDING TUBE NO. 8 100 CM F fopi PC TERUMO 42,350.00 54.40% 10,588.05
    215 217OD17D54 DOD17D054 FEEDING TUBE NO. 8 100 CM F fopi PC ONEMED 13,000.00 0.00% 8,039.00
    216 FEEDING TUBE NO. 8 100 CM F PC AXIMED 10,164.00 24.24%
    217 DOD17D052 FEEDING TUBE NO. 8 40 CM F fopi PC ONEMED 13,000.00 0.00% 8,039.00
    218 217TO17D77 DTO17D077 FEEDING TUBE NO. 8 40 CM F fopi PC TERUMO 42,350.00 54.40% 33,880.00
    219 FEEDING TUBE NO. 8 40 CM F PC COSMOMRD 23,100.00 0.00% -
    220 FILM ISLAND DRESSING 10X25CM ( dermafik ) F PC WINNER 17,088.67 0.00% -
    221 FILM X RAY 24 X 30 F PC FUJI 14,410.00 0.00% 7,425.00
    222 FILM X RAY 30 X 40 F PC FUJI 21,120.00 0.00% 21,120.00
    223 FILM X RAY 30 X 40 F PC FUJI 12,100.00 0.00%
    224 FILM X RAY 35 X 35 F PC FUJI 22,990.00 0.00% 32,257.50
    225 FILM X RAY 35 X 35 F PC FUJI 12,650.00 0.00%
    226 FILM X RAY 35 X 43 F PC FUJI 27,610.00 0.00% 27,610.00
    227 FILM X RAY 35 X 43 F PC FUJI 12,925.00 0.00%
    228 214EH14D20 DEH14D020 FIXOMULL 76992-01 (10 CM X 5M) F fopi ROL BSN 52,624.00 52,624.00
    229 214EH14D21 DEH14D021 FIXOMULL 76993-01 ( 5 CM X 5M) F fopi ROL BSN 103,143.04 103,143.04
    230 217WL17E27 DWL17E027 FOLLEY CATHETER NO. 14 F PC WELL LEAD 10,164.00 0.00% -
    231 217EH17E45 DEH17E045 FOLLEY CATHETER NO. 14 F PC NORTA 15,180.00 0.00% -
    232 217RU17E02 DRU17E002 FOLLEY CATHETER NO. 14 F PC RUSCH 20,900.00 0.00% -
    233 217OD17E56 DOD17E056 FOLLEY CATHETER NO. 16 F fopi PC ONEMED 16,500.00 0.00% -
    234 217RU17E03 DRU17E003 FOLLEY CATHETER NO. 16 F PC RUSCH 20,900.00 0.00% -
    235 217OD17E58 DOD17E058 Uro One Foley catheter no. 18 FOLLEY CATHETER NO. 18 F PC ONEMED 9,240.00 0.00% 10,164.00
    236 217RU17E04 DRU17E004 FOLLEY CATHETER NO. 18 F fopi PC RUSCH 27,300.00 0.00% 19,360.00
    237 217OD17E58 DOD17E058 FOLLEY CATHETER NO. 18 F fopi PC NORTA 16,500.00 0.00% 15,125.40

    DATA KEBUTUHAN OBAT REVISI 63 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    238 217WL17E29 DWL17E029 FOLLEY CATHETER NO. 18 F fopi PC AXIMED 17,424.00 24.24% -
    239 217OD17E58 DOD17E058 FOLLEY CATHETER NO. 18 F PC ONEMED 12,100.00 0.00% 16,500.00
    240 217RU17E05 DRU17E005 FOLLEY CATHETER NO. 20 F PC RUSCH 20,900.00 20,900.00
    241 FOLLEY CATHETER THREE WAY 18 F PC REMEDI 114,950.00 114,950.00
    242 FOLLEY CATHETER THREE WAY 20 F PC RUSCH 86,020.00 86,020.00
    243 217EH17E52 DEH17E052 FOLLEY CATHETER THREE WAY 22 F PC NORTA 114,950.00 114,950.00
    244 217EH17E53 DEH17E053 FOLLEY CATHETER THREE WAY 24 F PC REMEDI 86,020.00 86,020.00
    245 FRAMYCETIN SULFATE F PC DARYA VARYA 11,220.00 0.00% 10,124.12
    246 225AI28A01 DAI28A001 FREESTYLE LANCET KIT @ 100 F fopi PC ABBOT 444.12 0.00% 654.31
    247 225AI28A01 DAI28A001 FREESTYLE LANCET KIT @ 100 F fopi PC ABBOT 387.20 0.00% 401.71
    248 FREESTYLE OPTIUM BG STRIP @ 25 F PC ABBOT - -
    249 FREESTYLE OPTIUM NEO BG ( ALAT ) F BOK ABBOT 275,000.00 275,000.00
    250 225AI28A02 DAI28A002 FREESTYLE OPTIUM NEO H BG @ 100 F fopi PC ABBOT 4,276.75 0.00% 4,045.82
    251 225AI28A02 DAI28A002 FREESTYLE OPTIUM NEO H BG @ 100 F PC ABBOT 4,291.10 0.00% 4,045.82
    252 GELANG Adult ( PINK ) WRITE ON F PC ONEMED 1,300.00 0.00% 668.25
    253 GELANG Adult ( PINK ) WRITE ON F PC ONEMED 1,320.00 0.00% -
    254 GELANG Adult ( PINK ) WRITE ON F PC COSMOMED 2,000.00 0.00% 1,584.00
    255 GELANG Adult BLUE (Write On) F PC ONEMED 990.00 0.00% 1,584.00
    256 GELANG Adult BLUE (Write On) F PC REMEDI 1,760.00 25.00% 668.25
    257 GELANG Adult RED (Insert Card) F PC REMEDI 891.07 25.00% 2,090.00
    258 GELANG Adult UNGGU (Insert Card) F PC REMEDI 891.07 25.00% 1,980.00
    259 GELANG Adult YELLOW (Insert Card) F PC ONEMED 1,760.00 25.00% -
    260 GELANG Adult YELLOW (Insert Card) F PC REMEDI 792.00 0.00% 1,584.00
    261 GELANG BAYI / ANAK BIRU F PC ONEMED 891.00 25.00% 701.25
    262 GELANG BAYI / ANAK BIRU F PC COSMMOMED 957.00 0.00% 668.25
    263 GELANG BAYI / ANAK BIRU F PC ONEMED 891.00 25.00% -
    264 GELANG BAYI / ANAK BIRU F PC GC 1,320.00 0.00% -
    265 GELANG BAYI / ANAK PINK F PC COSMOMED 957.00 0.00% 891.00
    266 GELANG BAYI / ANAK PINK F PC ONEMED 891.00 25.00% 668.25
    267 GELANG BAYI / ANAK PINK F PC GC 1,320.00 0.00% 668.25
    268 GLYCO 1 HRS 48 USP, 100 CM F PC BIOMED 110,000.00 0.00% 110,000.00
    269 GLYCO 2 HRS 48 USP, 100 CM F PC BIOMED 110,000.00 0.00% 110,000.00
    270 GLYCO 2-0 HR 26 USP. 70 CM F PC BIOMED 85,250.00 85,250.00
    271 GLYCO 3-0 HR 26 USP, 70 CM F PC BIOMED 79,750.00 0.00% 79,750.00
    272 GLYCO USP 3-0 DS 24 MM, 70 CM VIOLA F PC BIOMED 85,250.00 0.00% -
    273 GLYCO 4-0 HR 26 USP. 70 CM F PC BIOMED 90,200.00 0.00% 90,200.00
    274 217BS17F02 DBS17F002 GUEDEL AIRWAY 1 ( 70 MM ) F PC BESMED 13,203.00 13,203.00
    275 GUEDEL AIRWAY 2 ( 70 MM ) F PC BESMED 12,155.00 -
    276 GUEDEL AIRWAY 3 ( 90 MM ) F PC FORSCH 12,100.00 0.00% -
    277 217BS17F04 DBS17F004 GUEDEL AIRWAY 3 ( 90 MM ) F PC BESMED 13,203.00 0.00% 13,203.00
    278 GUEDEL AIRWAY 4 ( 100 MM ) F PC BESMED 13,203.00 0.00% 13,203.00
    279 217BS17F05 DBS17F005 GUEDEL AIRWAY 4 ( 100 MM ) F PC BESMED 20,300.00 0.00% -
    280 GUEDEL AIRWAY 4 ( 100 MM ) F PC FORSCH 12,100.00 0.00%
    281 GUEDEL AIRWAY 5 ( 100 MM ) F PC BESMED 18,700.00 0.00% 13,203.00
    282 217BS17F06 DBS17F006 GUEDEL AIRWAY 5 ( 110 MM ) F PC BESMED 13,203.00 0.00% -
    283 GUEDEL AIRWAY 5 ( 110 MM ) F PC FORSCH 12,100.00 0.00% 13,203.00
    284 217BS17F01 DBS17F001 GUEDEL AIRWAY 0 ( 60 MM ) F PC BESMED 13,203.00 0.00% -
    285 GUEDEL AIRWAY CLEAR NO. 1 F PC RUSCH 187,000.00 187,000.00
    286 GUEDEL AIRWAY CLEAR NO. 3 F PC RUSCH 187,000.00 187,000.00

    DATA KEBUTUHAN OBAT REVISI 64 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    287 GUEDEL AIRWAY CLEAR NO. 3 F PC AXIMED 7,199.50 7,199.50


    288 GUEDEL AIRWAY CLEAR NO. 4 F PC RUSCH 187,000.00 187,000.00
    289 GUEDEL AIRWAY CLEAR NO. 4 F PC ONEMED 24,200.00 24,200.00
    290 GUEDEL AIRWAY CLEAR NO. 5 F PC ONEMED 24,200.00 24,200.00
    291 GUEDEL AIRWAY CLEAR NO. 6 F PC RUSCH 187,000.00 187,000.00
    292 GUEDEL NO. 00 F PC SHILEY 41,580.00 41,580.00
    293 GUEDEL RED NO. 0 F PC RUSCH 235,950.00 235,950.00
    294 GUEDEL RED NO. 1 F PC RUSCH 235,950.00 235,950.00
    295 GUEDEL RED NO. 3 F PC RUSCH 235,950.00 235,950.00
    296 GUEDEL RED NO. 4 F PC RUSCH 235,950.00 235,950.00
    297 GUEDEL RED NO. 5 F PC RUSCH 235,950.00 235,950.00
    298 GYNECOLOGY SET GNS-2109 F PC HOGY 607,552.00 607,552.00
    299 HD ~ DIACAN ARTERIAL G16. 30 MM F PC B/BRAUN 10,890.00 25.00% 8,167.50
    300 HD ~ DIACAN ARTERIAL G16. 30 MM F PC B/BRAUN 11,550.00 29.28% 12,100.00
    301 HD ~ DIACAP LOPS 15 PS DIALYSATC F PC B/BRAUN 269,500.00 25.00% 202,125.00
    302 HD ~ DIACAP LOPS 15 PS DIALYSATC F PC B/BRAUN 297,000.00 297,000.00
    303 HD ~ DIALOG BLOODLINE ARTERIAL F PC B/BRAUN 134,200.00 25.00% 100,650.00
    304 HD ~ DIALOG BLOODLINE ARTERIAL F PC B/BRAUN 147,620.00 147,620.00
    305 HD ~ HD. CONC. ACIDIC HDM 303 10 LTRF GLN B/BRAUN 187,000.00 25.00% 140,250.00
    306 HD ~ HD. CONC. ACIDIC HDM 303 10 LTRF GLN B/BRAUN 190,300.00 26.30% 224,400.00
    307 HD ~ SOL CART B F PC B/BRAUN 129,800.00 25.00% 97,350.00
    308 HD ~ SOL CART B F PC B/BRAUN 142,780.00 142,780.00
    309 HOGI ~ SHOE COVER SR-SC-41E F PC HOGY 35,200.00 35,200.00
    310 HOGI ~ SURG. GOWN ( L ) SG-SMS13K F PC HOGY 104,280.00 104,280.00
    311 HOGI ~ SURG. GOWN ( XL ) SG-SMS15K F PC HOGY 113,190.00 113,190.00
    312 HOGI ~ UNIVERSAL SET USP-2101 F PC HOGY 744,920.00 744,920.00
    313 HYPAFIX 10 CM X 5 CM F ROL BSN 130,900.00 8.00% 115,772.80
    314 213BB13C01 DBB13C001 INFUSION NEEDLE 18 INTROCAN SAFETF PC B BRAUN 3,850.00 20.00% 3,135.00
    315 INFUSION NEEDLE 18 ABBOCATH F PC ABBOT 19,069.05 19,069.05
    316 INFUSION NEEDLE 18 INFLO F PC ONEMED 5,000.00 0.00% 2,887.50
    317 INFUSION NEEDLE 18 AXIMED F fopi PC AXIMED 9,147.60 24.24%
    318 213BB13C04 DBB13C004 INFUSION NEEDLE 18 INTROCAN SAFETF PC B BRAUN 30,250.00 30,250.00
    319 213NO13C09 DNO13C009 INFUSION NEEDLE 18 NIPRO F PC NIPRO 7,499.80 7,499.80
    320 INFUSION NEEDLE 18 OPTIVA F PC JOHNSON 19,360.00 19,360.00
    321 213S5113C07 DS5113C007 INFUSION NEEDLE 18 STERACATH F fopi PC STERRA 3,990.00 0.00% 3,990.00
    322 213S5113C07 DS5113C007 INFUSION NEEDLE 18 STERACATH F fopi PC STERRA 4,400.00 0.00%
    323 213TO13C44 DTO13C044 INFUSION NEEDLE 18 SURFLO F fopi PC TERUMO 29,700.00 71.87% 8,354.61
    324 INFUSION NEEDLE 18 CATHPRO F PC CATH PRO 8,518.40 0.00% 8,325.90
    325 INFUSION NEEDLE 2 22G OPTIVA F PC JOHNSON 24,200.00 24,200.00
    326 INFUSION NEEDLE 20 ABBOCATH F PC ABBOT 19,069.05 19,069.05
    327 INFUSION NEEDLE 20 INFLO F PC GEA 7,000.00 0.00% 2,887.50
    328 INFUSION NEEDLE 20 INFLO F PC ONEMED 5,000.00 0.00%
    329 INFUSION NEEDLE 20 INFLO F PC ONEMED 3,850.00 0.00% 2,887.50
    330 INFUSION NEEDLE 20 INFLO F PC ONEMED 3,990.00 0.00%
    331 213BB13C06 DBB13C006 INFUSION NEEDLE 20 INTROCAN SAFETF fopi PC B BRAUN 36,300.00 36,300.00
    332 213NO13C10 DNO13C010 INFUSION NEEDLE 20 NIPRO F fopi PC NIPRO 5,500.00 5,500.00
    333 INFUSION NEEDLE 20 OPTIVA F PC JOHNSON 24,200.00 20.00% 19,360.00
    334 INFUSION NEEDLE 20 GEA F PC GEA 6,985.00 19,360.00
    335 213OI13C02 DOI13C002 INFUSION NEEDLE 20 OTCUCATH F fopi PC OTSUKA 21,450.00 21,450.00

    DATA KEBUTUHAN OBAT REVISI 65 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    336 DS5113C008 INFUSION NEEDLE 20 STERACATH F fopi PC STERRA 3,990.00 0.00% 3,990.00
    337 DS5113C008 INFUSION NEEDLE 20 STERACATH F fopi PC GEA 8,800.00 0.00%
    338 213S5113C08 DS5113008 INFUSION NEEDLE 20 SURFLO F fopi PC TERUMO 29,700.00 71.87% 8,354.61
    339 INFUSION NEEDLE 20 CATHPRO F PC CATH PRO 8,518.40 0.00% 8,325.90
    340 INFUSION NEEDLE 22 ABBOCATH F PC ABBOT 19,069.05 19,069.05
    341 213ZK13C05 DZK13C005 INFUSION NEEDLE 22 AXIMED F fopi PC AXIMED 5,500.00 5,500.00
    342 INFUSION NEEDLE 22 INFLO F fopi PC ONEMED 3,850.00 25.00% 2,887.50
    343 213BB13C08 DBB13C008 INFUSION NEEDLE 22 INTROCAN SAFETF fopi PC B BRAUN 36,300.00 36,300.00
    344 213NO13C11 DNO13C011 INFUSION NEEDLE 22 NIPRO F fopi PC NIPRO 5,500.00 5,500.00
    345 INFUSION NEEDLE 22 OPTIVA F PC JOHNSON 19,360.00 19,360.00
    346 213OI13C03 DOI13C003 INFUSION NEEDLE 22 OTCUCATH F fopi PC OTSUKA 16,280.00 16,280.00
    347 213S5113C09 DS5113C009 INFUSION NEEDLE 22 STERACATH F fopi PC STERRA 3,990.00 0.00% 3,850.00
    348 213TO13C52 DTO13C052 INFUSION NEEDLE 22 SURFLO F fopi PC TERUMO 29,700.00 71.87% 8,354.61
    349 INFUSION NEEDLE 22 GEA F PC GEA 8,800.00 0.00% 8,354.61
    350 INFUSION NEEDLE 22 AXIMED F PC AXIMED 9,147.60 24.24% 8,354.61
    351 INFUSION NEEDLE 22 CATHPRO F PC CATH PRO 8,518.40 0.00% 8,325.90
    352 INFUSION NEEDLE 24 ABBOCATH F PC ABBOT 29,337.00 35.00% 29,337.00
    353 INFUSION NEEDLE 24 AXIMED F PC AXIMED 7,499.80 7,499.80
    354 INFUSION NEEDLE 24 INFLO F PC ONEMED 3,850.00 25.00% 2,887.50
    355 INFUSION NEEDLE 24 INFLO F PC ONEMED 3,850.00 20.00% 3,135.00
    356 213BB13C10 DBB13C010 INFUSION NEEDLE 24 INTROCAN SAFETF PC B BRAUN 33,000.00 33,000.00
    357 213NO13C12 DNO13C012 INFUSION NEEDLE 24 NIPRO F fopi PC NIPRO 5,500.00 5,500.00
    358 INFUSION NEEDLE 24 GEA F PC GEA 8,800.00 0.00% 19,360.00
    359 INFUSION NEEDLE 24 OPTIVA F PC JOHNSON 19,360.00 19,360.00
    360 213OI13C04 DOI13C004 INFUSION NEEDLE 24 OTCUCATH F fopi PC OTSUKA 17,226.00 17,226.00
    361 213S5113C10 DS5113C010 INFUSION NEEDLE 24 STERACATH F fopi PC STERRA 3,990.00 0.00% 3,990.00
    362 213TO13C56 DTO13C056 INFUSION NEEDLE 24 SURFLO F fopi PC TERUMO 29,700.00 71.87% 8,354.61
    363 INFUSION NEEDLE 24 CATHPRO F fopi PC CATH PRO 8,325.90 0.00% 8,325.90
    364 213IC13C03 DIC13C003 INFUSION NEEDLE 26 ABBOCATH F fopi PC ABBOT 25,675.65 25,675.65
    365 INFUSION NEEDLE 26 AXIMED F PC GEA 8,055.00 9,625.00
    366 INFUSION NEEDLE 26 INFLO F PC ONEMED 6,050.00 25.00%
    367 INFUSION NEEDLE 26 NIPRO F PC STERRA 6,930.00 0.00% 10,608.10
    368 213S5113C11 DS5113C011 INFUSION NEEDLE 26 STERACATH F fopi PC STERRA 8,450.00 0.00% 4,305.00
    369 213TO13C60 DTO13C060 INFUSION NEEDLE 26 SURFLO F PC TERUMO 46,365.00 54.00% 41,679.00
    370 213TO13E64 DTO13E064 INFUSION SET ANAK ( Mikrodrip ) F fopi PC TERUMO 7,700.00 0.00% 7,524.00
    371 213SY13E08 DSY13E008 INFUSION SET ANAK ( Mikrodrip ) F fopi PC AXIMED 7,920.00 24.24% 5,956.80
    372 213OI13E09 DOI13E009 INFUSION SET ANAK ( Mikrodrip ) F PC AML-MEDDIS 6,050.00 0.00%
    373 213S513E10 INFUSION SET ANAK ( Mikrodrip ) F fopi PC STERA 11,000.00 0.00% 3,675.00
    374 INFUSION SET ANAK ( Mikrodrip ) F PC ONEMED 5,500.00 0.00% 4,620.00
    375 213S513E08 DS513E008 INFUSION SET DEWASA F PC STERA 4,180.00 25.00% 2,970.00
    376 213TO13E63 DTO13E063 INFUSION SET DEWASA F PC ONEMED 7,000.00 0.00% 7,524.00
    377 INFUSION SET DEWASA F PC ONEMED 4,290.00 25.00% 15,466.00
    378 213ID13E01 DID13E001 INFUSION SET INFUSION SET DEWASA F PC AML-MEDDIS 6,050.00 0.00%
    379 213SY13E09 DSY13E009 INFUSION SET DEWASA F fopi PC AXIMED 10,500.00 0.00% 8,140.00
    380 213OI13E07 DOI13E007 INFUSION SET DEWASA F fopi PC OTSUKA 26,620.00 0.00%
    381 INJECTIONN PAD 36 MM F PC NICHIBAN 1,265.00 1,265.00
    382 KAPSUL KOSONG NO.0 F PC LOKAL 60.00 0.00% 104.50

    DATA KEBUTUHAN OBAT REVISI 66 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    383 KAPSUL KOSONG NO.00 F PC BRATACO 93.50 0.00% 104.50


    384 KAPSUL KOSONG NO.00 F PC LOKAL 126.90 0.00%
    385 KAPSUL KOSONG NO.1 F PC BRATACO 63.80 0.00% 104.50
    386 KAPSUL KOSONG NO.2 F PC LOKAL 76.23 0.00% 104.50
    387 KAPSUL KOSONG NO.2 F PC LOKAL 44.00 0.00%
    388 KAPSUL KOSONG NO.3 F PC LOKAL 74.69 0.00%
    389 KAPSUL KOSONG NO.3 F PC BRATACO 60.50 0.00% 104.50
    390 KARTU GOLONGAN DARAH F PC DALF 583.00 0.00% 583.00
    391 KARTU GOLONGAN DARAH FREE F PC DALF -
    392 214OD14A24 DOD14A024 KASA HYDROPHYL 40 Yard X 80 CM F ROL ONEMED 141,750.00 0.00% 135,299.90
    393 214DA14A01 DDA14A001 KASA HYDROPHYL 40 Yard X 80 CM F ROL DRC 148,500.00 0.00%
    394 KASA HYDROPHYL 40 Yard X 80 CM F ROL CIPTA NIAGA 143,000.00 0.00% 156,200.00
    395 214KH14A03 DKH14A003 KASA HYDROPHYL 40 Yard X 80 CM F ROL HEXA HUSADA 132,000.00 0.00%
    396 214OD14A23 DKH14A004 KASA KOMPRES STERIL 16 X16 F fopi BOK ONEMED 5,500.00 0.00% 141,750.00
    397 214KH14A01 DKH14A001 KASA KOMPRES STERIL 16 X16 F BOK HEXA HUSADA 2,500.00 0.00%
    398 214EH14D17 DEH14D017 LEUKOMED T PLUS 10 X 25 CM F fopi PC BSN 28,600.00 0.00% 10,120.00
    399 LEUKOMED T PLUS 10 X 25 CM F PC BSN 33,330.00 8.00% 32,032.00
    400 LEUKOMED T PLUS 8 X 15 CM F PC BSN 33,880.00 33,880.00
    401 LEUKOMED-IV 72389-00 F PC BSN 2,327.60 2,327.60
    402 LEUKOPLAST UK. 2,5 x 5 (1624H) F ROL BSN 13,682.24 13,682.24
    403 LEUKOPLAST UK. 4,5 x 5 (1624H) F ROL BSN 56,430.00 56,430.00
    404 LINA PEN ( PENSIL WHOLSTER ) F SET COVIDEN 88,000.00 0.00% 125,400.00
    405 LINA PEN SINGLE USE 516 F SET PRO DIVICE 112,200.00 112,200.00
    406 LOMATULE F PC PRO DIVICE 12,155.00 12,155.00
    407 MEDICRAPE 10 X 4.5 F ROL ONEMED 12,760.00 10.00% 11,484.00
    408 MEDICRAPE 10 X 4.5 F ROL ONEMED 12,375.00 0.00% 11,484.00
    409 MEDICRAPE 15 X 4.5 F ROL ONEMED 18,700.00 10.00% 18,700.00
    410 MEDICRAPE 15 X 4.5 F ROL ONEMED 46,200.00 0.00% 18,700.00
    411 MEDICRAPE 7.5 X 4.5 F ROL ONEMED 9,735.00 0.00% 9,702.00
    412 MEDICRAPE 7.5 X 4.5 F ROL ONEMED 20,570.00 0.00% 9,702.00
    413 213BD13B23 DBD13B023 MICRO FINE 0.25mm (31G) x 5mm F fopi PC ONEMED 9,735.00 0.00%
    414 MICRO FINE 8 MM F PC BD 2,323.48 2,323.48
    415 MICROBURET ( MICRODRIP FOR ST503 )F PC TERUMO 83,776.00 83,776.00
    416 MICROPORE 1/2 " / ISOPORE 1/2 " F fopi ROL ONEMED 8,700.00 0.00% 5,197.50
    417 2143M14D09 D3M14D009 MICROPORE 1/2 " / ISOPORE 1/2 " F fopi ROL 3M 12,350.00 0.00%
    418 2143M14D09 D3M14D009 MICROPORE 1/2 " / ISOPORE 1/2 " F fopi ROL 3M 12,632.86 28.00% 8,564.28
    419 2143M14D11 D3M14D011 MICROPORE / PAPER TAPE DISP. 1" F ROL 3M 17,128.56 17,128.56
    420 2143M14D11 D3M14D011 MICROPORE 1 " / ISOPORE 1 " F fopi ROL 3M 64,350.00
    421 2143M14D14 D3M14D014 MICROPORE 2 " / ISOPORE 2 " F fopi ROL 3M 37,216.67 0.00% 35,200.00
    422 2143M14D15 D3M14D015 MICROPORE 2 " / ISOPORE 2 " F fopi ROL ONEMED 25,391.67 25.00% -
    423 213TO13B34 DTO13B034 NANOPASS 32. 5G F fopi PC TERUMO 3,960.00 3,960.00
    424 NEBULIZER MASK ADULT WITH CHAMBER F PC ONEMED 38,500.00 0.00% 35,200.00
    425 NEBULIZER MASK ADULT WITH CHAMBER F PC GEA 35,200.00 35,200.00
    426 NEBULIZER MASK CHILD WITH CHAMBER F PC AXIMED 17,900.30 17,900.30
    427 NEBULIZER MASK CHILD F PC GEA 20,444.00 0.00% 17,900.30
    428 NEBULIZER MASK ADULT WITH CHAMBER F PC AXIMED 20,444.00 0.00% 17,900.30
    429 NON WOVEN FIXATION 10 X 10 F PC AXIMED 85,377.60 24.24%

    DATA KEBUTUHAN OBAT REVISI 67 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    430 NON WOVEN FIXATION 15 X 10 F PC AXIMED 115,579.20 24.24%


    431 NOVOTWIST 32 G F PC NOVONORDISK 2,310.00 0.00% 2,310.00
    432 NOVOTWIST 32 G F PC NOVONORDISK 4,300.00 0.00%
    433 PARAFILM 4" 125 FTM F ROL CUP WOOD 578,182.00 578,182.00
    434 PAPER USG 110 HG TYPE V F ROL SONY 275,000.00 0.00% 247,500.00
    435 PAPER USG 110 HG TYPE V F ROL SONY 247,500.00 0.00% 25,300.00
    436 213BB13F20 DBB13F020 PERFUSOR TUB. WHITE 150 CM F fopi PC B/BRAUN 49,500.00 20.00% 49,500.00
    437 213BB13F20 DBB13F020 PERFUSOR TUB. WHITE 150 CM F fopi PC B/BRAUN 136,500.00 0.00% 49,500.00
    438 PHARMAFIX 5 CM X 5 MTR F PC PHARMAPLAST 15.00%
    439 214OD14E34 DOD14E034 PLESTERAN BULAT @ 200 F fopi PC ONEMED 183.75 0.00% 534.60
    440 214OD14E34 DOD14E034 PLESTERAN BULAT SOFT @ 200 F fopi PC ONEMED 192.50 192.50
    441 POT ZALF 100 GR F PC LOKAL 2,464.00 0.00% 3,300.00
    442 POT ZALF 20 GR F PC LOKAL 1,061.50 0.00%
    443 POT ZALF 20 GR F PC LOKAL 968.00 0.00% 1,078.00
    444 POT ZALF 30 GR F PC LOKAL 1,320.00 0.00%
    445 POT ZALF 50 GR F PC LOKAL 2,200.00 0.00% 1,158.30
    446 POT ZALF 50 GR F PC LOKAL 1,040.00 0.00%
    447 POT ZALF 50 GR F PC LOKAL 1,039.00 0.00% 1,408.00
    448 PPH STAPLER 33 F PC ATRAMAT 4,400,000.00 4,400,000.00
    449 PRECISION INFANT THERMAL BLUE F PC MEXICO 3,080.00 3,080.00
    450 PRECISION INFANT THERMAL PINK F PC MEXICO 3,080.00 3,080.00
    451 RUBBER HAND GLOVE NO. 6,0 F PC TROGE 11,990.00 30.00% -
    452 RUBBER HAND GLOVE NO. 6,5 F PC TROGE 11,990.00 30.00% -
    453 RUBBER HAND GLOVE NO. 6,5 F PC B/BRAUN 19,500.00 0.00% 11,220.00
    454 217AP17G08 DAP17G008 RUBBER HAND GLOVE NO. 6,5 F fopi PC MAXTER 9,130.00 0.00% 10,560.00
    455 217SK17G011 DSK17G011 RUBBER HAND GLOVE NO. 6,5 F fopi PC SHAMROCK 9,500.00 0.00% -
    456 RUBBER HAND GLOVE NO. 6,5 F PC REMEDI 13,200.00 0.00% 17,600.00
    457 RUBBER HAND GLOVE NO. 7 F PC WRP 15,400.00 15.00% 10,560.00
    458 217SK17G04 DSK17G004 RUBBER HAND GLOVE NO. 7 F fopi PC SHAMROCK 9,130.00 0.00% -
    459 217AP17G13 DAP17G013 RUBBER HAND GLOVE NO. 7 F fopi PC TROGE 8,393.00 0.00% 18,700.00
    460 RUBBER HAND GLOVE NO. 7 F PC MAXTER 6,196.00 25.00%
    461 RUBBER HAND GLOVE NO. 7 F PC ANSELL 22,000.00 25.00% -
    462 RUBBER HAND GLOVE NO. 7,5 F PC TROGE 11,990.00 30.00% 12,810.00
    463 217AP17G20 DAP17G020 RUBBER HAND GLOVE NO. 7,5 F fopi PC MAXTER 14,850.00 0.00% 21,780.00
    464 RUBBER HAND GLOVE NO. 7,5 F PC REMEDI 11,000.00 0.00% -
    465 217SK17G05 DSK17G005 RUBBER HAND GLOVE NO. 7,5 F fopi PC SHAMROCK 9,500.00 0.00% -
    466 RUBBER HAND GLOVE NO. 7,5 F PC MAXTER 6,196.00 25.00% -
    467 RUBBER HAND GLOVE NO. 8 F PC TROGE 8,393.00 0.00% 21,780.00
    468 217AP17G22 DAP17G022 RUBBER HAND GLOVE NO. 8 F fopi PC MAXTER 14,850.00 0.00%
    469 RUBBER HAND GLOVE NO. 8 F PC GAMMEX 11,000.00 0.00% -
    470 RUBBER HAND GLOVE NO. 8 F PC WRP 25,619.00 50.00% 10,560.00
    471 RUBBER HAND GLOVE NO. 8 F PC ANSELL 22,000.00 25.00% 11,220.00
    472 217SK17G06 DSK17G006 RUBBER HAND GLOVE NO. 8 F fopi PC SHAMROCK 9,500.00 0.00% -
    473 SCALPEL BLADE BB- 510 F PC AESCULAP 2,783.00 0.00% 3,905.99
    474 SCALPEL BLADE BB- 510 F PC GEA 2,800.00 0.00% 3,905.99
    475 SCALPEL BLADE BB- 510 F PC B/BRAUN 4,950.00 0.00% 3,905.99
    476 SCALPEL BLADE BB- 511 F PC AESCULAP 2,783.00 0.00% 6,083.00
    477 SCALPEL BLADE BB- 511 F PC GEA 2,800.00 0.00% 6,083.00
    478 SCALPEL BLADE BB- 511 F PC B/BRAUN 4,950.00 0.00% 6,083.00

    DATA KEBUTUHAN OBAT REVISI 68 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    479 SCALPEL BLADE BB- 515 F PC AESCULAP 2,783.00 0.00% 3,905.99


    480 SCALPEL BLADE BB- 515 F PC GEA 2,800.00 0.00% 3,905.99
    481 SCALPEL BLADE BB- 515 F PC B/BRAUN 4,950.00 0.00% 3,905.99
    482 SCALPEL BLADE BB- 520 F PC AESCULAP 2,783.00 0.00% 6,083.00
    483 SCALPEL BLADE BB- 520 F PC GEA 2,800.00 0.00% 6,083.00
    484 SCALPEL BLADE BB- 520 F PC B/BRAUN 4,950.00 0.00% 6,083.00
    485 SCALPEL BLADE BB- 522 F PC GEA 2,800.00 0.00% 6,083.00
    486 SCALPEL BLADE BB- 522 F PC B/BRAUN 4,950.00 0.00% 6,083.00
    487 SELANG O2 ANAK F PC ONEMED 10,800.00 0.00% -
    488 SELANG O2 ANAK F PC ONEMED 5,500.00 0.00% 6,930.00
    489 SELANG O2 ANAK F PC ONEMED 8,800.00 0.00% 5,775.00
    490 SELANG O2 ANAK F PC RHEMEDY 6,600.00 15,840.00
    491 SELANG O2 ANAK F fopi PC AXIMED 8,857.19 24.24% 6,930.00
    492 SELANG O2 ANAK F PC ONEMED 6,600.00 0.00% -
    493 SELANG O2 BAYI F PC ONEMED 5,775.00 0.00% -
    494 SELANG O2 BAYI F PC GEA 9,900.00 0.00% -
    495 217BS17J03 DBS17J003 SELANG O2 DEWASA F fopi PC BESMED 7,150.00 0.00% -
    496 SELANG O2 DEWASA F PC BURBLE 9,900.00 0.00% 5,775.00
    497 SELANG O2 DEWASA F PC ONEMED 4,150.00 0.00% -
    498 217XU17J01 DXU17J001 SELANG O2 DEWASA UK. L F fopi PC AXIMED 8,857.19 24.24% 6,930.00
    499 217XU17J02 DXU17J002 SELANG O2 DEWASA UK. M F fopi PC AXIMED 8,857.19 24.24% 6,930.00
    500 SELANG O2 DEWASA UK. XS F fopi PC AXIMED 8,857.19 24.24% 6,930.00
    501 SENSIPED ALAS POPOK L F PC SENSI 39,050.00 39,050.00
    502 SHOES COVER NON WOVEN F PC ONEMED 798.00 0.00% -
    503 SHOES COVER NON WOVEN F PC ONEMED 1,427.80 0.00% -
    504 SHOES COVER NON WOVEN F PC ONEMED 1,500.00 0.00% -
    505 SHOES COVER GREEN F PC REMEDI 1,084.60 0.00% -
    506 SIMP. MASK NON REBR. M ( DEWASA ) F PC BESMED 36,200.00 0.00% 24,150.00
    507 SIMP. MASK NON REBR. M ( DEWASA ) F PC GEA 38,500.00 0.00% 44,000.00
    508 SIMP. MASK NON REBR. M ( DEWASA ) F PC ONEMED 24,150.00 0.00% 44,000.00
    509 SIMP. MASK NON REBR. S ( ANAK ) F PC REMEDI 55,000.00 0.00% -
    510 SIMP. MASK NON REBR. S ( ANAK ) F PC ONEMED 36,200.00 0.00% 44,000.00
    511 SOFRATULLE F PC AVENTIS 24,781.10 24,781.10
    512 SOFTCLIX LANCET UNO 200 F PC ROCHE 1,452.00 1,452.00
    513 SOFTCLIX STANDART ACCUCHEK F PC BOEHRINGER 176,000.00 176,000.00
    514 SPINOCAN 25G X 3 1/2 " F fopi PC EGEMEN 26,950.00 15.00% 22,907.50
    515 215BB15C24 DBB15C024 SPINOCAN 25G X 3 1/2 " F fopi PC B/BRAUN 30,550.00 0.00% 67,925.00
    516 SPINOCAN 26G X 3 1/2 " F PC EGEMEN 26,950.00 15.00% 22,907.50
    517 215BB15C23 DBB15C023 SPINOCAN 26G X 3 1/2 " F fopi PC B/BRAUN 30,550.00 0.00% 67,925.00
    518 215BB15C28 DBB15C028 SPINOCAN 27G X 3 1/2 " F fopi PC B/BRAUN 51,700.00 51,700.00
    519 SPINOCAN / SPINAL 25G X 3 1/2 " F PC EGEMEN 20,295.00 20,295.00
    520 SPINOCAN / SPINAL 26G X 3 1/2 " F PC EGEMEN 20,295.00 20,295.00
    521 217OD17O62 DOD17O062 STOMACH TUBE NO.16 F fopi PC ONEMED 13,200.00 0.00% -
    522 DTO17O080 STOMACH TUBE NO.16 F fopi PC TERUMO 33,550.00 0.00% 35,112.00
    523 STOMACH TUBE NO.16 F PC ONE MED 8,131.00 0.00%
    524 217TO17O81 DTO17O081 STOMACH TUBE NO.18 F fopi PC TERUMO 29,250.00 0.00% 35,112.00
    525 217WL17O40 DWL17O040 STOMACH TUBE NO.18 F fopi PC TERUMO 36,960.00 54.40% 11,000.00
    526 217TO17O81 DOD17O063 STOMACH TUBE NO.18 F fopi PC ONEMED 8,131.00 0.00% 8,131.00
    527 217TO17O81 DTO17O081 STOMACH TUBE NO.18 F fopi PC ONEMED 19,800.00 0.00% 11,000.00

    DATA KEBUTUHAN OBAT REVISI 69 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    528 217WL17P44 DWL17P044 SUCTION CATHETER NO. 12 F fopi PC COSMOMED 3,410.00 0.00% -
    529 217WL17P44 DWL17P044 SUCTION CATHETER NO. 12 F fopi PC AXIMED 11,000.00 11,000.00
    530 DOD17O059 SUCTION CATHETER NO. 12 F fopi PC REMEDI 13,750.00 0.00% 4,562.00
    531 SUCTION CATHETER NO. 12 F PC COSMOMED 3,565.10 0.00% 9,900.00
    532 SUCTION CATHETER NO. 12 F PC ONE MED 4,562.00 0.00% 4,562.00
    533 SUCTION CATHETER NO. 14 F PC REMEDI 6,380.00 0.00% 6,380.00
    534 217WL17P45 DWL17P045 SUCTION CATHETER NO. 14 F fopi PC AXIMED 13,750.00 10,133.70
    535 SUCTION CATHETER NO. 16 F PC ONE MED 4,562.00 0.00% 4,562.00
    536 SUCTION CATHETER NO. 16 F PC COSMOMED 3,410.00 0.00% 3,410.00
    537 217WL17P46 DWL17P046 SUCTION CATHETER NO. 16 F fopi PC REMEDI 13,750.00 0.00% 10,133.70
    538 SUCTION CATHETER NO. 8 F PC STERRA 13,750.00 13,750.00
    539 SUCTION CATHETER NO. 8 F PC ONE MED 3,410.00 0.00% 3,410.00
    540 SUCTION CATHETER NO. 8 F PC ONE MED 4,562.00 0.00% 4,562.00
    541 217WL17P48 DWL17P048 SUCTION CATHETER NO. 8 F fopi PC AXIMED 9,212.50 9,212.50
    542 SUCTION CATHETER NO. 8 F PC RHEMEDY 13,750.00 0.00% 11,000.00
    543 SUNGKUP OXYGEN ANAK F PC ONE MED 33,000.00 33,000.00
    544 SUNGKUP OXYGEN ANAK F PC RHEMEDY 31,944.00 31,944.00
    545 SUNGKUP OXYGEN ANAK F PC RHEMEDY 35,200.00 35,200.00
    546 217BS17J04 DBS17J004 SUNGKUP OXYGEN BAYI F fopi PC BESMED 14,520.00 0.00% 14,520.00
    547 SUNGKUP OXYGEN BAYI F PC ONEMED 17,600.00 0.00% 16,380.00
    548 SUNGKUP OXYGEN DEWASA F PC ONEMED 16,830.00 0.00% 16,380.00
    549 SUNGKUP OXYGEN DEWASA F PC COSMOMED 11,550.00 0.00% 11,550.00
    550 SUNGKUP OXYGEN DEWASA F PC ONE MED 14,175.00 0.00% 14,175.00
    551 SURGICAL GLOVE UK. L F PC ONE MED 681.82 0.00% 2,068.00
    552 SURGICAL GLOVE UK. L F PC PUREGLOVE 1,750.00 0.00% 1,750.00
    553 SURGICAL GLOVE UK. L F PC ALTAMED 2,000.00 57.49% 2,000.00
    554 SURGICAL GLOVE UK. L F PC AXIMED 1,750.00 0.00% 2,050.00
    555 SURGICAL GLOVE UK. L F PC PUREGLOVE 1,782.00 0.00% 1,750.00
    556 217SJ17G07 DSJ17G007 SURGICAL GLOVE UK. L F fopi PC HAND SEAL 1,750.00 0.00% 1,741.67
    557 SURGICAL GLOVE UK. M F PC ALTAMED 2,000.00 57.49% 1,411.67
    558 SURGICAL GLOVE UK. M F PC SHAMROCK 2,050.00 0.00% 2,050.00
    559 SURGICAL GLOVE UK. M F PC HAND SEAL 1,750.00 0.00% 1,782.00
    560 SURGICAL GLOVE UK. M F PC SAFEGLOVE 681.82 0.00% 1,863.63
    561 217SJ17G06 DSJ17G006 SURGICAL GLOVE UK. M F fopi PC PUREGLOVE 1,750.00 0.00% 1,750.00
    562 217SJ17G06 DSJ17G006 SURGICAL GLOVE UK. M F fopi PC AXIMED 1,750.00 0.00% 1,741.67
    563 SURGICAL GLOVE UK. S F PC SAFEGLOVE 681.82 0.00% 935.00
    564 SURGICAL GLOVE UK. S F PC PUREGLOVE 1,210.00 0.00% 1,782.00
    565 SURGICAL GLOVE UK. S F PC ALTAMED 2,000.00 57.49% 1,411.67
    566 SURGICAL GLOVE UK. S F PC AXIMED 1,090.91 0.00% 1,863.63
    567 SURGICAL GLOVE UK. S F PC REMEDI 1,750.00 0.00% 1,750.00
    568 SURGICAL GLOVE UK. XS F PC ALTAMED 2,000.00 57.49% 1,411.67
    569 SURGICRYL 910 1 HR 48 MM F PC SMI 76,322.00 0.00% 102,066.80
    570 SURGICRYL 910 2 HR 45 MM F PC SMI 151,800.00 151,800.00
    571 SURGICRYL 910 2 HR 48 MM F PC SMI 102,066.98 0.00% 102,066.98
    572 SURGICRYL 910 3/0 HR 26 MM F PC SMI 62,957.03 0.00% 62,957.03
    573 SURGICRYL 910 2/0 HR 40 MM F PC SMI 82,500.00 0.00% 95,700.00
    574 SURGICRYL 910 3/0 DS 24 MM F PC SMI 87,934.00 0.00% 87,934.00
    575 SURGICRYL 910 2/0 HR 26 MM F PC SMI 62,957.03 62,957.03
    576 SURGICRYL 910 4/0 HR 17 MM F PC SMI 90,200.00 90,200.00

    DATA KEBUTUHAN OBAT REVISI 70 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    577 SURGICRYL 910 5/0 HR 17 MM F PC SMI 76,107.99 76,107.99


    578 SURGI-FIX 10 CM X 10 MTR F ROL YAFHO 179,740.00 179,740.00
    579 SURGI-FIX 5 CM X 10 MTR F ROL YAFHO 100,320.00 100,320.00
    580 TABUNG VTM F PC SIGPRO 0.00%
    581 TABUNG VTM F PC ALTAMED 82.66%
    582 TERMAL PAPER UTK. ECG 215 MM X 25 M F ROL ONE MED 58,800.00 0.00% 58,800.00
    583 TERMAL PAPER UTK. ECG 215 MM X 25 M F ROL SONOMED 143,000.00 0.00%
    585 THERASORB 10 X10 CM X 0.5 CM F PC WONBIOGEN 82,500.00 82,500.00
    586 214DV14E03 DDV14E003 THERASORB C 10 X10 CM X 0.5 CM F fopi PC WONBIOGEN 77,000.00 77,000.00
    587 217TO17Q82 DTO17Q082 THREE WAY STOPCOCK F fopi PC ONE MED 4,950.00 0.00% 26,334.00
    588 217OD17Q61 DOD17Q061 THREE WAY STOPCOCK F fopi PC ONE MED 2,047.50 0.00% 2,354.00
    589 217OD17Q61 THREE WAY STOPCOCK F PC AXIMED 7,695.60 24.24% 2,145.00
    590 TRACHEOSTOMY CUFFED 6.5 F PC SURGIKA 236,500.00 236,500.00
    591 TRANSFIX HF 10 CM X 10 MTR F ROL YAFHO 313,500.00 313,500.00
    592 TRANSFIX HF 5 CM X 10 MTR F ROL YAFHO 167,200.00 167,200.00
    596 ULTRA~FINE 0.23 mm ( 32G ) X 4 mm F PC BD 3,988.60 3,988.60
    597 ULTRAFIC 10 CM X 500 CM F ROL ONE MED 38,500.00 0.00% 30,800.00
    598 ULTRAFIC 10X1000 CM( NON WOVEN FI F ROL AXIMED 60,244.80 60,244.80
    599 ULTRAFIC 15 CM X 500 CM F ROL ONE MED 44,704.00 0.00% 44,704.00
    600 ULTRAFIC 5 CM X 500 CM F ROL ONE MED 17,930.00 0.00% 17,930.00
    601 UMBILICAL KLAMP F PC ONE MED 2,090.00 0.00% 3,410.00
    602 UMBILICAL KLAMP F PC ONE MED 5,646.67 25.00% 2,090.00
    603 UMBILICAL KLAMP F PC ONE MED 1,650.00 0.00% 2,640.00
    604 217OD17T63 URINE BAG F PC AXIMED 8,712.00 24.24% 6,098.00
    605 217ID17T02 DID17T002 URINE BAG F fopi PC TROGE 8,855.00 0.00% -
    606 217OD17T63 DOD17T063 URINE BAG F fopi PC ONE MED 5,544.00 0.00% -
    607 URINE BAG F fopi PC GETINGE 7,700.00 0.00% -
    608 UROGARD PLUS F PC TERUMO 44,770.00 44,770.00
    609 VASELIN SWAB 10 X 10 F PC SMI 8,800.00 8,800.00
    610 VICRYL RAP UND 90 CM 2/0 F PC ETHICON 73,810.00 73,810.00

    SLOW MOVING
    611 ACTIMOVE ACTERBRACE L S SET BSN 637,450.00 637,450.00
    612 ACTIMOVE ACTERBRACE M S SET BSN 637,367.50 637,367.50
    613 ACTIMOVE ACTERBRACE S S SET BSN 637,450.00 637,450.00
    614 AGTIFA- BRILON 10/0 S PC AGTIFA 275,000.00 275,000.00
    615 AGTIFA- CANNULA TUBING 23G S PC AGTIFA 962,500.00 962,500.00
    616 AGTIFA- CARBACHOL S PC AGTIFA 96,470.00 0.00% 96,470.00
    617 AGTIFA- DOP MATA S PC AGTIFA 13,750.00 13,750.00
    618 AGTIFA- EYE DRAPE PLAIN D700P S PC AGTIFA 105,050.00 105,050.00
    619 AGTIFA- IOL POSTERIOR CHAMBER 16.00 S PC AGTIFA 297,440.00 0.00% 297,440.00
    620 AGTIFA- IOL POSTERIOR CHAMBER 16.5 S PC AGTIFA 297,440.00 0.00% 297,440.00
    621 AGTIFA- OPTEN COUTER S PC AGTIFA 390,500.00 390,500.00
    622 AGTIFA- POLYGLYCOLIC ACID 8/0 S PC AGTIFA 335,500.00 335,500.00
    623 AGTIFA- POLYSORB 6/0 S PC AGTIFA 148,500.00 148,500.00
    624 ANGISPONG DENTAL CUBE 10X10X10 S PC BIOMED 13,750.00 13,750.00
    625 ANGISPONG STANDART S PC BIOMED 13,750.00 13,750.00
    626 ARM SLING UK. L ( DEWASA ) S SET MITRACO 173,250.00 173,250.00

    DATA KEBUTUHAN OBAT REVISI 71 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    627 ARM SLING UK. M ( DEWASA ) S SET COMPOFT 19,425.00 19,425.00


    628 ARM SLING UK. S ( ANAK ) S SET COMPOFT 19,425.00 19,425.00
    629 ARM SLING UK. S ( ANAK ) S SET MITRACO 173,250.00 173,250.00
    630 AURA – 1 NO. 1 S PC AMBU 630,000.36 630,000.36
    631 AURA – 1 NO. 1 1/2 S PC AMBU 630,000.36 630,000.36
    632 AURA – 1 NO. 2 S PC AMBU 630,000.36 630,000.36
    633 AURA – 1 NO. 2 ½ S PC AMBU 630,000.36 630,000.36
    634 AURA – 1 NO. 3 S PC AMBU 630,000.36 630,000.36
    635 AURA – 1 NO. 4 S PC AMBU 629,999.37 629,999.37
    636 BALON TENSIMETER S PC BATEDA 19,250.00 19,250.00
    637 BALON TENSIMETER S PC LOKAL 52,800.00 52,800.00
    638 BIOCRYL 1 HRS 40, 100 CM S PC BIOMED 110,000.00 0.00% 110,000.00
    639 BIOCRYL 2.0 HR 36, 90 CM S PC BIOMED 99,000.00 99,000.00
    640 BIOCRYL 3/0 DS 24, 90 CM S PC BIOMED 99,000.00 0.00% 99,000.00
    641 BIOLENE HR 26 USP 2-0, 75 CM S PC BIOMED 88,000.00 0.00% 88,000.00
    642 BIOLENE HR 10 USP 7-0, 75 CM S PC BIOMED 203,500.00 0.00% 203,500.00
    643 BIOLENE HR 26 USP 0, 75 CM S PC BIOMED 82,500.00 0.00% 82,500.00
    644 BIOPOLAR GROUNDING PAD S PC HC MEDICAL 55,000.00 55,000.00
    645 BIOSHORT DSM 24 USP 3-0, 70 CM S PC BIOMED 110,000.00 0.00% 110,000.00
    646 BIOSILK 1 HRS 40 MM, 75 CM S PC BIOMED 55,000.00 55,000.00
    647 BIOSILK 2/0 HR 26, 75 CM S PC BIOMED 46,750.00 0.00% 55,000.00
    648 BIOSILK 3/0 HR 26, 75 CM S PC BIOMED 46,750.00 0.00% 55,000.00
    649 BIOSILK 4/0 HR 40, 75 CM S PC BIOMED 55,000.00 55,000.00
    650 BRACKET BHS S PC ONE MED 26,125.00 26,125.00
    651 BYE-BYE FEVER FOR BABIES S PC HISAMITSU 6,381.10 6,381.10
    652 BYE-BYE FEVER FOR CHILDREN S PC HISAMITSU 9,084.90 9,084.90
    653 CATGUT CHROMIC 1 S ROL BIOSM 2,103,750.00 2,103,750.00
    654 CATGUT CHROMIC 1 @ 75 M S ROL SMI 1,485,000.00 1,485,000.00
    655 CATGUT CHROMIC 1 HR 30 S PC B/BROUND 82,764.00 82,764.00
    656 CATGUT CHROMIC 1. 100 M S ROL SMI 1,996,720.00 1,996,720.00
    657 CATGUT CHROMIC 2 . 50 M ( 2060 ) S ROL SMI 2,684,990.00 2,684,990.00
    658 CATGUT CHROMIC 2 HR 40 MM S PC SMI 45,700.00 45,700.00
    659 CATGUT CHROMIC 2 HR 48 MM S PC SMI 82,500.00 0.00% 46,744.96
    660 CATGUT CHROMIC 2 HR 45 MM S PC SMI 68,970.00 68,970.00
    661 CATGUT CHROMIC 2 HR 50 MM S PC SMI 45,699.96 0.00% 45,699.96
    662 CATGUT CHROMIC 2/0 @ 100 M S ROL SMI 2,135,760.00 2,135,760.00
    663 CATGUT CHROMIC 2/0 HR 40 MM S PC SMI 55,000.00 0.00% 34,170.00
    664 CATGUT CHROMIC 2/0, 100 M S ROL BIOSM 2,103,750.00 2,103,750.00
    665 CATGUT CHROMIC 3/0 S ROL B/BROUND 1,600,203.00 1,600,203.00
    666 CATGUT CHROMIC 3/0 100 M S ROL SMI 2,091,760.00 2,091,760.00
    667 CATGUT CHROMIC 3/0 HR 26 MM S PC SMI 58,300.00 58,300.00
    668 CATGUT CHROMIC USP 2, 90 CM S PC ATRAMAT 82,500.00 82,500.00
    669 CATGUT CHROMIC W/O 0 S PC SMI 32,032.00 32,032.00
    670 CATGUT CHROMIC W/O 2 S PC SMI 59,125.00 59,125.00
    671 CATGUT CROMIC 1 HR 43 S PC B/BROUND 73,568.00 73,568.00
    672 CATGUT PLAIN NO. 0 @ 100 M S ROL SMI 1,584,000.00 1,584,000.00
    673 CATGUT PLAIN NO. 1 @ 75 M S ROL SMI 1,996,720.00 1,996,720.00
    674 CATGUT PLAIN NO. 1 HR 48 S PC B/BROUND 91,850.00 91,850.00
    675 CATGUT PLAIN NO. 2/0 HR 20 MM S PC SMI 34,300.00 34,300.00

    DATA KEBUTUHAN OBAT REVISI 72 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    676 CATGUT PLAIN NO. 2/0 @ 100 M S ROL SMI 2,936,670.00 2,936,670.00
    677 CATGUT PLAIN NO. 3/0 S PC ONE MED 14,300.00 14,300.00
    678 CATGUT PLAIN NO. 3/0 @ 100 M S ROL SMI 1,485,000.00 1,485,000.00
    679 CATGUT PLAIN NO. 3/0 HR 20 MM S PC SMI 55,000.00 55,000.00
    680 CATGUT PLAIN NO. 3/0 HR 37 MM S PC SMI 35,066.90 35,066.90
    681 CATGUT PLAIN NO. 3/0 HR 37 MM S PC SMI 68,750.00 35,066.99
    682 CATGUT PLAIN NO. 4/0 HR 20 MM S PC SMI 32,870.00 32,870.00
    683 CATGUT PLAIN NO. 4/0 HR 26 MM S PC SMI 50,600.00 0.00% 55,000.00
    684 CDL CURVED MMCVCBJ2-115-16 S PC FARCATH 846,450.00 846,450.00
    685 222AR22A03 DAR22A003 CVC TRIPLE LUMEN 7FR S fopi PC APPROVED 880,000.00 0.00% 638,000.00
    686 222AR22A01 DAR22A001 CVC 2 LUMEN 12FR / CDL S fopi PC ARROW 1,870,000.00 0.00% 1,870,000.00
    687 CERTOFIX DUO V 1220 HF S SET B/BRAUN 1,155,000.00 1,155,000.00
    688 CERTOFIX DUO V 1220 HF S SET B/BRAUN 1,426,425.00 1,426,425.00
    689 215BB15C46 DBB15C046 CERTOFIX DUO V 720 S fopi SET B/BRAUN 852,500.00 852,500.00
    690 215BB15C51 DBB15C051 CERTOFIX TRIO V 1220 HF S fopi SET B/BRAUN 1,155,000.00 1,155,000.00
    691 215BB15C50 DBB15C050 CERTOFIX TRIO V 720 S fopi SET B/BRAUN 990,000.00 990,000.00
    692 DAT15AA65 CHROMIC 0 TP. 40 MM, 90 CM S PC ATRAMAT 79,750.00 50.00% 71,500.00
    693 DAT15AA75 CHROMIC 2 TP. 40 MM, 90 CM S PC ATRAMAT 82,500.00 50.00% 100,100.00
    694 CHROMIC 2 HR 48, 90 CM S PC BIOMED 82,500.00 0.00% 82,500.00
    695 CHROMIC 2, 48 MM, 90 CM S PC BIOMED 82,500.00 0.00% 82,500.00
    696 CHROMIC 2/0 + ½ GT 35 MM S PC ONE MED 11,607.75 11,607.75
    697 CHROMIC 2/0 TP 40, 90 CM S PC ATRAMAT 79,750.00 95,700.00
    698 DAT15AA64 CHROMIC 2-0, G37 MM, 90 CM S PC ATRAMAT 79,750.00 50.00% 79,750.00
    699 CHROMIC 2-0, 37 MM, 75 CM S PC ATRAMAT 74,250.00 50.00%
    700 CHROMIC 2-0, 37 MM, 90 CM S PC ATRAMAT 79,750.00 0.00% 79,750.00
    701 CHROMIC USP 2, 40 MM, 75 CM S PC ATRAMAT 100,100.00 100,100.00
    702 CHROGUT 2/0 S PC - 100,100.00
    703 CHUSHAVAN 27 X 27 MM S PC NICHIBAN 880.00 880.00
    704 CONDOM CATHETER M S PC ONE MED 4,620.00 4,620.00
    705 CORRUGATE DEWASA 160 CM S PC SURGIKA 84,700.00 15.00% 71,995.00
    706 DACLON 1 DS 24 S PC SMI 21,326.98 -
    707 DACLON 10/0 2X6.4 S PC SMI 196,174.00 196,174.00
    708 DACLON 2/0 DS 24 S PC SMI 21,326.98 21,326.98
    709 DACLON 2/0 DS 30 S PC SMI 21,896.97 21,896.97
    710 DACLON 2/0 HR 24 S PC SMI 21,326.98 21,326.98
    711 DACLON 3/0 DS 19 S PC SMI 55,000.00 55,000.00
    712 DACLON 3/0 DS 24 S PC SMI 21,326.98 21,326.98
    713 DACLON 3/0 DS 30 S PC SMI 21,326.80 21,326.80
    714 DACLON 4/0 DS 19 S PC SMI 21,896.97 21,896.97
    715 DACLON 5/0 DS 16 S PC SMI 21,896.60 21,896.60
    716 DAFILON 3/0 DS 24 BLUE S PC B/BRAUN 69,168.00 69,168.00
    717 DAFILON 6/0 DS 12 BLUE S PC B/BRAUN 37,294.03 37,294.03
    718 DELTA CAST PRINT PAW 72273-21 S PC BSN 190,271.40 190,271.40
    719 DELTA DRY 3" ( 5 X 2.4 m ) S PC BSN 57,890.45 57,890.45
    720 DELTA DRY 4" ( 7.5 X 2.4 M ) S PC BSN 67,538.86 67,538.86
    721 DELTA DRY 6" ( 10 X 2.4 M ) S PC BSN 74,775.67 74,775.67
    722 DELTA LITE CONF. 10 X 3.6 M S PC BSN 165,310.20 165,310.20
    723 DENTAL 10 X 10 X 10 MM S PC EUCARE 9,350.00 9,350.00
    724 DBD13B012 DISPOSIBLE / NEEDLE 18 G S fopi PC BD 1,600.00 0.00% 223.41

    DATA KEBUTUHAN OBAT REVISI 73 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    725 DISPOSIBLE / NEEDLE 21 G S PC ONEMED 165.00 165.00


    726 DISPOSIBLE / NEEDLE 23 G S PC ONEMED 223.41 -
    727 DISPOSIBLE / NEEDLE 23 G S PC ONEMED 165.00 -
    728 DISPOSIBLE / NEEDLE 24 G S PC ONEMED 165.00 165.00
    729 213BD13B23 DBD13B023 DISPOSIBLE / NEEDLE 31 G X 5 MM S fopi PC BD 3,018.40 3,018.40
    730 213BD13B24 DBD13B024 DISPOSIBLE / NEEDLE 32 G X 4 MM S fopi PC BD 2,750.00 -
    731 213BD13B24 DBD13B024 DISPOSIBLE NOVOFINE 32 G S PC NOVONORDISK 3,500.00 0.00% 2,750.00
    732 DRAGER CIRCUIT VENTILATOR DEWASAS PC DRAGER 341,000.00 0.00% 880,000.00
    733 DRAGER CIRCUIT VENTILATOR DEWASAS PC DRAGER 341,220.00 0.00% 880,000.00
    734 DYNACAST PRELUDE 3" S ROL BSN 2,519,286.00 2,519,286.00
    735 DYNACAST PRELUDE 4" S ROL BSN 2,446,400.00 2,446,400.00
    736 DYNACAST PRELUDE 5" S ROL BSN 2,964,500.00 2,964,500.00
    737 ELASTOMUL 8 CM X 4 M S PC BSN 37,444.00 37,444.00
    738 214EH14B01 DEH14B001 ELASTOMUL 10 CM X 4 M S PC BSN 53,515.00 8.00% -
    739 214EH14B02 DEH14B002 ELASTOMUL 12 CM X 4 M S PC BSN 59,510.00 8.00% -
    740 217RU17E06 DRU17E006 FOLLEY CATHETER NO. 06 S fopi PC RUSCH 19,360.00 19,360.00
    741 217OD17D52 DOD17D052 FOLLEY CATHETER NO. 08 S PC ONEMED 32,340.00 0.00% -
    742 217RU17E07 DRU17E007 FOLLEY CATHETER NO. 08 S PC COSMOMED 17,111.11 10.00% 72,600.00
    743 217RU17E01 DRU17E001 FOLLEY CATHETER NO. 10 S PC RUSCH 15,840.00 15,840.00
    744 217WL17E26 DWL17E026 FOLLEY CATHETER NO. 12 S PC REMEDI 23,496.00 23,496.00
    745 FOLLEY CATHETER NO. 12 S PC GEA 16,500.00 0.00% 75,900.00
    746 FOLLEY CATHETER NO. 12 S PC COSMOMED 15,180.00 0.00% -
    747 GELANG BAYI / ANAK KUNING S PC REMEDI 1,584.00 1,584.00
    748 GELANG BAYI / ANAK RED S PC REMEDI 1,540.00 1,540.00
    749 GYPSONE 3" 3.5 X 7.5 S PC BSN 25,059.14 25,059.14
    750 GYPSONE 4" 3.5 X 10 S PC BSN 35,083.00 35,083.00
    751 GYPSONE 6" 3.5 X 15 S PC BSN 46,005.52 46,005.52
    752 HERNIAMESH 6 X 10 S PC ALFA 220,000.00 0.00% 187,000.00
    753 HIPERSKIN TR 10 CM X 10 Mtr S ROL WONBIOGEN 435,600.00 435,600.00
    754 HME FILTER WITH PAPER SOFT S PC SURGIKA 42,350.00 15.00% 42,350.00
    755 BACTERIAL FILTER VENTILATOR S PC VENTIPRO 61,750.00 0.00%
    756 HOT WATER CAP S PC LOKAL 34,650.00 34,650.00
    757 IBS~ LINA PEN SINGLE USE 516 S PC PRO DIVICE 112,200.00 112,200.00
    758 INFUSION NEEDLE 14 ABBOCATH S PC ABBOT 19,305.00 19,305.00
    759 INFUSION NEEDLE 14 INFLO S PC ONEMED 4,180.00 25.00% 3,135.00
    760 INFUSION NEEDLE 14 INFLO S PC ONEMED 5,500.00 0.00% 3,135.00
    761 INFUSION NEEDLE 14 STERACATH S PC STERRA 23,760.00 23,760.00
    762 213TO13C37 DTO13C037 INFUSION NEEDLE 14 SURFLO S fopi PC TERUMO 8,354.61 8,354.61
    763 INJ ~ FLAT ROLL 10 CM X 200 M S PC GETINGE 852,500.00 852,500.00
    764 INJ ~ FLAT ROLL 25 CM X 200 M S PC GETINGE 937,750.00 937,750.00
    765 INJ ~ LABELER INDICATOR FOR STEAM S PC GETINGE 6,237,000.00 10.00% 7,799,000.00
    766 INTRAFIX AIR PEDIATRI ( ANAK ) S PC B BROUND 18,150.00 18,150.00
    767 213BB13E12 DBB13E012 INTRAFIX SAFE SET ( DEWASA ) S PC B BROUND 33,000.00 33,000.00
    768 KAPAS PEMBALUT 25 GR S PC ONEMED 5,500.00 5,500.00
    769 KAPAS PEMBALUT 50 GR S PC ONEMED 7,700.00 7,700.00
    770 KAPAS PUTIH @ 1 KG S KG SUMBERMED 57,288.00 0.00% 44,550.00
    771 214OD14H43 DOD14H043 KAPAS PUTIH @ 1 KG S fopi KG ONEMED 66,000.00 0.00% 66,000.00
    772 KAPAS PUTIH @ 500 GR S KG ONEMED 36,300.00 36,300.00
    773 KAPAS PUTIH BERLEMAK @ 1 KG S KG RAJAWALI 56,650.00 56,650.00

    DATA KEBUTUHAN OBAT REVISI 74 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    774 KAPAS PUTIH BERLEMAK @ 500 GR S KG ONEMED 46,200.00 46,200.00


    775 217FO17I05 DFO17I005 LARYNGEAL MASK AIRWAY 2.5 S fopi PC FORSCH 180,895.00
    776 217FO17I06 DFO17I006 LARYNGEAL MASK AIRWAY 3 S fopi PC FORSCH 180,895.00
    777 217FO17I08 DFO17I008 LARYNGEAL MASK AIRWAY 4 S fopi PC FORSCH 180,895.00
    778 LEUKOTAPE 5 cm X 5 meter S ROL BSN 210,210.00 210,210.00
    779 LIGA CLIP EXTRA TITANIUM S SET ETHICON 3,432,000.00 3,432,000.00
    780 LIGA CLIP LT-300 S SET ENDO 567,600.46 0.00% 480,000.00
    781 LOGICATH SET 12 FR 20 CM S SET RNI 1,039,500.00 1,039,500.00
    782 LOGICATH SET 2 12 FR 20 CM S SET RNI 1,039,500.00 1,039,500.00
    783 MANSET TENSIMETER DEWASA S PC DOMESTIK 23,400.00 0.00% 53,460.00
    784 MANSET TENSIMETER DEWASA S PC LOKAL 97,500.00 0.00% 53,460.00
    785 MANSET TENSIMETER ANAK S PC LOKAL 97,500.00 0.00% 53,460.00
    786 MASKER KN95 S PC ONEMED 2,500.00 0.00% 7,000.00
    787 217OD17C49 DOD17C049 MASKER N95-8210 S fopi PC ONEMED 14,872.00 0.00% -
    788 217OD17C49 DOD17C049 MASKER N95-8820 @20 S fopi PC ONEMED 11,931.80 0.00%
    789 217OD17C49 DOD17C049 MASKER N95-8210 S fopi PC ONEMED 14,872.00 0.00% -
    790 217OD17C49 DOD17C049 MASKER N95-8210 S fopi PC ONEMED 34,500.00 0.00% -
    791 217OD17C49 DOD17C049 MASKER N95-8511 S fopi PC 3M 47,500.00 0.00% 75,000.00
    792 217OD17C49 DOD17C049 MASKER N95-1860 S fopi PC ONEMED 34,500.00 0.00% -
    793 MASKER N95-1860 S PC 3M 43,065.00 0.00% -
    794 NYLON 10-0 SPATULA 6 MM, 30CM S PC ATRAMAT 181,500.00 0.00% 181,500.00
    795 NYLON 10-0 SPATULA 6 MM, 30CM S PC ATRAMAT 181,500.00 50.00% 181,500.00
    796 NYLON 2 - 0 RC 24 ( CE2442 - 75N ) S PC ATRAMAT 60,500.00 60,500.00
    797 NYLON 3 - 0 RC ( CE2443 - 75 ) S PC ATRAMAT 55,000.00 55,000.00
    798 NYLON 4 - 0 RC ( CE2444 - 75N ) S PC ATRAMAT 55,000.00 55,000.00
    799 NYLON 5 - 0 Reverse Cutting 12 MM, 45 C S PC ATRAMAT 60,500.00 50.00% 60,500.00
    800 NYLON DS 16 USP 2-0, 75 CM S PC BIOMED 57,750.00 57,750.00
    801 NYLON 1 DS 24 S PC SMI 21,326.98 0.00%
    802 NYLON 2/0 DS 24 S PC SMI 21,326.98 0.00%
    803 NYLON DS 24 USP 2-0, 75 CM S PC BIOMED 57,750.00 0.00%
    804 NYLON DS 24 USP 3-0, 75 CM S PC BIOMED 57,750.00 0.00%
    805 NYLON DS 24 USP 4-0, 75 CM S PC BIOMED 57,750.00 0.00%
    806 NYLON DS 16 USP 5-0, 75 CM S PC ATRAMAT 57,750.00 0.00%
    807 NYLON NEGRO 3 - 0 RC ( CE2443 - 75 ) S PC ATRAMAT 46,750.00
    808 OBJECT GLASS/SLIDE @ 72 S BOK SAIL BRAND 58,850.00 0.00% 58,850.00
    809 OPTITORQUE STRAIGHT PIGTAIL S PC TERUMO 679,250.00 679,250.00
    810 217OD17U97 DOD17U097 PAP'S MEAR KID SIZE L S fopi PC ONEMED 29,700.00 29,700.00
    811 217OD17U96 DOD17U096 PAP'S MEAR KID SIZE M S fopi PC ONEMED 34,650.00 344,650.00
    812 217OD17U93 DOD17U093 PAP'S MEAR KID SIZE S S fopi PC ONEMED 34,650.00 34,650.00
    813 PD. CABLE C1 S PC 201,025.00 201,025.00
    814 PD. PLATE M2 ( BIOPOLAR ) S PC CHINA 55,000.00 0.00% 35,062.50
    815 PD. UNDERPAD 60 X 90 S PC PRO DIVICE 6,545.00 6,545.00
    816 PENSIL COUTER S PC HC MEDICAL 88,000.00 88,000.00
    817 PENUTUP MATA BAYI S PC METDBAR 138,600.00 138,600.00
    818 215BB15C43 PERIFIK 400 G18 X 3 S fopi SET B/BRAUN 396,000.00 396,000.00
    819 215BB15C43 PERIFIK 400 G18 X 3 S fopi SET B/BRAUN 435,600.00 435,600.00
    820 DAT15AA17 PGA 1 TP 48, 100 CM S PC ATRAMAT 110,000.00 50.00% 110,000.00
    821 DAT15AA18 PGA 2 TP 48 MM, 90 CM S PC ATRAMAT 121,000.00 50.00% 104,500.00
    822 PGA 2 - 0 TP. 37 MM, 90 CM S PC ATRAMAT 90,750.00 50.00%

    DATA KEBUTUHAN OBAT REVISI 75 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    823 PGA 2 - 0 R. 26 MM, 75 CM S PC ATRAMAT 88,000.00 50.00%


    824 PGA 3 - 0 RC. 19 MM, 75 CM S PC ATRAMAT 88,000.00 50.00%
    825 DAT15AA06 PGA 3 - 0 R 26 MM, 75 CM S PC ATRAMAT 82,500.00 50.00% 82,500.00
    826 DAT15AA05 PGA 4 - 0 TP ( R2094 - 75 ) S PC ATRAMAT 82,500.00 82,500.00
    827 DAT15AA02 PGA 5 - 0 TP 17 MM, 75 CM S PC ATRAMAT 93,500.00 50.00% 91,300.00
    828 DAT15AA56 PGC 25 3 - 0 PRC 24 MM, 75 CM S PC ATRAMAT 115,500.00 50.00% 115,500.00
    829 DAT15AA90 PLAIN 1 TP ( G3728 ) S PC ATRAMAT 60,500.00 60,500.00
    830 DAT15AA88 PLAIN 2 - 0 HR 37 USP, 76 CM S PC ATRAMAT 77,000.00 0.00% 74,250.00
    831 DAT15AA88 PLAIN 2 - 0 TP 37 MM, 75 CM S PC ATRAMAT 74,250.00 50.00% 74,250.00
    832 DAT15AA86 PLAIN 3 - 0 TP 26 MM, 75 CM S PC ATRAMAT 74,250.00 50.00% 74,250.00
    833 PLAIN 4 - 0 TP 17 MM, 75 CM S PC ATRAMAT 77,000.00 50.00% 74,250.00
    834 DAT15AA85 PLAIN 4 - 0 HR 26 USP, 76 CM S PC ATRAMAT 74,250.00 0.00% 77,000.00
    835 PLAIN USP 2/0, 75 CM S PC SMI 93,500.00 93,500.00
    836 PLAN 0 TP 37 MM, 75 CM S PC ATRAMAT 79,750.00 50.00% 95,700.00
    837 PLAN 2/0 HR 35, 0.76 CM S PC BIOMED 93,500.00 93,500.00
    838 214S114G16 DS114G016 POLIBAN 15 X 2.7 S fopi ROL SNA 23,650.00 23,650.00
    839 214S114G21 DS114G021 POLICREPE 10 X 4.55 S fopi ROL SNA 41,360.00 41,360.00
    840 214S114G22 DS114G022 POLICREPE 15 X 4.55 S fopi ROL SNA 52,360.00 52,360.00
    841 214S114G19 DS114G019 POLICREPE 7.5 X 4.55 S fopi ROL SNA 34,760.00 34,760.00
    842 POLIFIX 20 X 5 S ROL SNA Medika 124,960.00 124,960.00
    843 POLYMEM MAX NON ADHESIF 11 X 11 S PC MEPROFARMA 162,800.00 162,800.00
    844 POLYMEM NON ADHESIF 10 x 10 S PC MEPROFARMA 82,500.00 82,500.00
    845 POLYMEM SILVER 10,8 X 10,8 CM S PC MEPROFARMA 207,350.00 207,350.00
    846 POLYPRO HERNIA MESSH S PC SMI 164,370.00 164,370.00
    847 POLYPROPYLENE 0 HR 40 MM S PC SMI 66,000.00 66,000.00
    848 POLYPROPYLENE 1 HR 40 MM, 75CM S PC ATRAMAT 99,000.00 0.00% 99,000.00
    849 POLYPROPYLENE 1 HR 40 MM, 75CM S PC BIOMED 99,000.00 0.00% 99,000.00
    850 POLYPROPYLENE 1 TP 40 MM, 75CM S PC ATRAMAT 99,000.00 50.00%
    851 POLYPROPYLENE 2/0 HR 25 MM S PC SMI 27,030.30 27,030.00
    852 POLYPROPYLENE 4/0 HR 15 S PC SMI 87,010.00 87,010.00
    853 POLYPROPYLENE 7/0 HR 10 S PC SMI 91,608.00 91,608.00
    854 POLYPROPYLENE USP 7.0, 75 CM S PC ATRAMAT 203,500.00 203,500.00
    855 PREMILENE 1 HR 40 S PC B/BRAUN 103,983.00 103,983.00
    856 PREMILENE 2/0 HR 26 BLUE S PC B/BRAUN 110,000.00 110,000.00
    857 PREMILENE 7/ 0 2X DRC S PC B/BRAUN 226,050.00 226,050.00
    858 PREMILENE MESH 5 X 10 S PC B/BRAUN 332,640.00 332,640.00
    859 PREMILENE MESH 7.5 X 15 S PC B/BRAUN 431,420.00 431,420.00
    860 PROXIMATE PPH PROCEDURE 33 MM S SET ETHICON 4,752,000.00 4,752,000.00
    861 RECTAL TUBE 20 S PC RUSCH 32,670.00 32,670.00
    862 RECTAL TUBE 22 S PC TAIWAN 32,670.00 32,670.00
    863 RECTAL TUBE 24 S PC TAIWAN 32,670.00 32,670.00
    864 RECTAL TUBE 28 S PC TAIWAN 32,670.00 32,670.00
    865 RECTAL TUBE 30 S PC TAIWAN 32,670.00 32,670.00
    866 RECTAL TUBE 32 S PC TAIWAN 16,500.00 16,500.00
    867 RENODERM 10 CM X 10 CM S PC WONBIOGEN 44,000.00 44,000.00
    868 SANOSKIN PLUS TULE S PC INTERBAT 41,800.00 41,800.00
    869 SANRUNG TANGAN PANJANG M S PC ONEMED 28,000.00 25.00% 66,000.00
    870 SANRUNG TANGAN PANJANG NO. 7.5 S PC REMEDI 37,400.00 37,400.00

    DATA KEBUTUHAN OBAT REVISI 76 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    871 SD WASH GLOVES S PC SENSI 3,093.75 3,093.75


    872 AGTIFA- ECOSORB 4/0 S PC AGTIFA 95,700.00 95,700.00
    873 SILK 2/0 HR 26 MM S PC BIOMED 46,750.00 0.00% 20,300.04
    874 SILK 2/0 w/o S PC SMI 44,000.00 44,000.00
    875 SILK 4-0 HR 26 USP, 75 CM S PC BIOMED 46,750.00 0.00% 46,750.00
    876 SILK 1 HR 40 USP, 75 CM S PC BIOMED 55,000.00 0.00% 55,000.00
    877 SILK 1 ROLL 100 M S ROL SMI 1,257,190.00 1,257,190.00
    878 SILK 2/0 + ½ GT 35 MM S PC ONE MED 7,763.80 7,763.80
    879 SILK 2/0 ROLL 100 M S ROL SMI 850,080.00 850,080.00
    880 SILK 2-0 TP 26 MM USP, 75 CM S PC ATRAMAT 52,250.00 0.00% 52,250.00
    881 SILK 3 ROLL 100 M S ROL SMI 1,069,640.00 1,069,640.00
    882 SILK 3-0 TP 26 USP, 75 CM S PC ATRAMAT 52,250.00 50.00% 46,750.00
    883 SILK 4-0 TP 26 USP, 75 CM S PC ATRAMAT 52,250.00 50.00% 46,750.00
    884 SILK 4 ROLL 100 M S ROL SMI 777,920.00 777,920.00
    885 SILK BLACK 2 ( 5080 ) @100 M S ROL B/BRAUN 643,500.00 643,500.00
    886 SILK BLACK 2/0 @100 M S ROL B/BRAUN 1,402,500.00 1,402,500.00
    887 SILK BLACK 2/0 HR 20 MM S PC SMI 20,610.00 20,610.00
    888 SILK BLACK 2/0 HR 26 MM S PC SMI 44,000.00 44,000.00
    889 SILK BLACK 2/0 HR 37 MM S PC SMI 20,757.00 20,757.00
    890 SILK BLACK 3/0 HR 26 MM S PC SMI 19,699.90 19,699.90
    891 SILK BLACK 3/0 HR 30 MM S PC SMI 20,186.01 20,186.01
    892 SILK BLACK 4/0 HR 20 MM S PC SMI 20,300.00 20,300.00
    893 SILK BLACK W/O 0 S PC SMI 18,700.00 18,700.00
    894 SILK BLACK W/O 1 S PC SMI 18,920.00 18,920.00
    895 SILK BLACK W/O 2/0 S PC SMI 17,600.00 17,600.00
    896 SILK BLACK W/O 3/0 S PC SMI 15,400.00 15,400.00
    897 SILK BRAIDED S PC ONE MED - -
    898 SILKAM 0 DS 30 BLACK S PC B/BROUND 83,853.00 83,853.00
    899 SILKAM 1 13X60 CM BLACK S PC B/BROUND 71,060.00 71,060.00
    900 SILKAM 1 HR 48 S PC B/BROUND 70,070.00 70,070.00
    901 SILKAM 2/0 BLACK S PC B/BROUND 58,201.00 58,201.00
    902 SILKAM 3/0 HR 17 S PC B/BROUND 55,781.00 55,781.00
    903 SILKAM 3/0 HR 22 BLACK 75 CM S PC B/BROUND 68,970.00 68,970.00
    904 217TO17O78 DTO17O078 STOMACH TUBE NO.12 S fopi PC TERUMO 36,960.00 54.40% 29,568.00
    905 217WL17O37 DWL17O037 STOMACH TUBE NO.12 S fopi PC ONE MED 8,131.00 0.00% 4,346.10
    906 STOMACH TUBE NO.12 S fopi PC ONE MED 33,550.00 0.00%
    907 STOMACH TUBE NO.12 S PC AXIMED 10,018.80 24.24%
    908 217TO17O79 DTO17O079 STOMACH TUBE NO.14 S fopi PC TERUMO 36,960.00 54.40% 8,131.20
    909 217WL17O38 DWL17O038 STOMACH TUBE NO.14 S fopi PC ONEMED 10,732.58 24.24% 4,346.00
    910 STOMACH TUBE NO.14 S fopi PC TERUMO 73,574.56 54.40% 8,131.20
    911 213BB13F15 DBB13F015 STOPPER LL S fopi PC B/BRAUN 6,600.00 19.00% 6,600.00
    912 SURGICRYL MONOFAST 3/0 DS 24 MM S PC SMI 104,940.00 104,940.00
    913 SUTURE NEEDLE "B" FRG 12 S PC ZEPT 29,997.91 29,997.91
    914 SUTURE NEEDLE "B" FRG 15 S PC ZEPT 29,997.91 29,997.91
    915 SUTURE NEEDLE "G" FRG 6 S PC ZEPT 29,997.91 29,997.91
    916 TABUNG REAKSI 10 X 75 S PC PYREX 8,965.00 0.00% 8,800.00
    917 TABUNG REAKSI 12 X 75 S PC PYREX 10,120.00 0.00% 8,800.00
    918 214EH14G40 DEH14G040 TENSOCREPE FL ( 3" ) 7,5 X 4,5 S fopi PC BSN 53,205.90 53,205.90
    919 214EH14G41 DEH14G041 TENSOCREPE FL ( 4" ) 10,5 X 4,5 S fopi PC BSN 64,046.44 64,046.44

    DATA KEBUTUHAN OBAT REVISI 77 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    920 214EH14G39 DEH14G039 TENSOCREPE FL ( 6" ) 15,5 X 4,5 S fopi PC BSN 84,116.42 84,116.42
    921 TERMAL PAPER COMBOSTIK S ROL SYSMEX 33,000.00 0.00%
    922 TERMAL PAPER UTK. ECG 50X30 S ROL FUKUDA 33,660.00 0.00% -
    923 TERMAL PAPER UTK. ECG 80X25 S ROL ENDO 138,600.00 -
    924 TERMAL PAPER UTK. ECG OP - 119TE S ROL FUKUDA 88,000.00 88,000.00
    925 TERMAL. PAPER UTK. ECG 110 MM S ROL SONOMED 297,000.00 297,000.00
    926 TERMAL. PAPER UTK. ECG 80 MM S ROL SONOMED 158,400.00 158,400.00
    927 THERMOMETER MEDIS S PC SAFETY 23,100.00 23,100.00
    928 THERMOMETER MEDIS DIGITAL S PC ALPHA 18,150.00 28,875.00
    929 THORAC CATETER NO. 20 S PC SURGIKA 83,600.00 83,600.00
    930 THORAC CATETER NO. 24 S PC SURGIKA 83,600.00 83,600.00
    931 THORASIC TROCAR 20 S PC HOSPITECH 235,004.00 235,004.00
    932 THORASIC TROCAR 24 S PC HOSPITECH 271,700.00 271,700.00
    933 THORASIC TROCAR 28 S PC HOSPITECH 271,700.00 271,700.00
    934 TORNIQUITE S PC ONE MED 14,135.00 25.00% 12,100.00
    935 TORNIQUITE S PC ONE MED 16,500.00 0.00% 12,100.00
    936 213BB13F16 DBB13F016 TRANSOFIX S fopi PC B/BROUND 7,590.00 0.00% 7,590.00
    937 UNDERPADS 60 X 90 @10 S PC ONE MED 20,856.00 0.00% 2,802.80
    938 DOD14F042 UNDERPADS 60 X 90 @10 S fopi PC ONE MED 6,500.00 0.00% 8,690.00
    939 URINAL UTK. WANITA PLASTIK S PC XXX 5,148.00 5,148.00
    940 URINAL UTK. WANITA PLASTIK S PC XXX 15,840.00 15,480.00
    941 URINAL UTK. WANITA PLASTIK S PC XXX 22,000.00 22,000.00
    942 VAGINAL TAMPON S PC SNA 3,861.00 3,861.00
    943 VAGIONS M S PC ONE MED 7,920.00 7,920.00
    944 DOD13B016 WING INFUS 23G S fopi PC ONE MED 2,400.00 0.00% 12,375.00
    945 DOD13B018 WING INFUS 27G S fopi PC ONE MED 2,400.00 0.00% 12,375.00
    946 WING INFUS 25G 3/4 S PC TERUMO 12,375.00 12,375.00
    947 WING INFUS 27G 1/2 S PC TERUMO 17,857.40 17,857.40
    948 WIPAK 10 CM X 200 MTR R41 S ROL GETINGE 683,100.00 10.00% 852,800.00
    949 WIPAK 25 CM X 200 MTR R43 S ROL GETINGE 1,188,000.00 0.00% 1,650,000.00
    950 WIPAK 25 CM X 200 MTR R44 S ROL GETINGE 1,590,600.00 10.00% 1,991,000.00
    952 ALAT PENGISAP LENDIR BAYI S PC ONEMED 35,200.00 35,200.00
    953 ALCOHOL METER S PC XXX 71,500.00 71,500.00
    954 BAJU APD ( HAZMAT ) S PC HAZMAT 704,000.00 704,000.00
    955 BALON ECG S PC FUKUDA 165,000.00 165,000.00
    956 BLOODSTOP BS-IX-15 S PC METIKA FARMA 665,500.00 665,500.00
    957 BONE WAX S PC ATRAMAT 77,000.00 77,000.00
    958 BOTOL ASPIRATOR 10 LITER S BTL XXX 671,000.00 671,000.00
    959 CABLE FOR GROUNDING PAD S PC HD MEDICAL 330,000.00 330,000.00
    960 CANULA DUBLE TUB. 23G S PC - -
    961 CARPUS ALLENIUM S PC XXX 15,000.00 15,000.00
    962 CATGUT CHROMIC S PC ONE MED - -
    963 CERPLAST AEROFIL 100 MM S PC GRACIA 56,925.00 56,925.00
    964 CERPLAST AEROFIL 150 MM S PC GRACIA 88,000.00 88,000.00
    965 CERPLAST AEROFIL 200 MM S PC GRACIA 84,150.00 84,150.00
    966 CERPLAST AEROFIL 50 MM S PC GRACIA 47,025.00 47,025.00
    967 CERPLAST CAVITY 100 X 200 MM S PC GRACIA 93,500.00 93,500.00
    968 CERVICAL MC HARD L S PC MASIDA 302,500.00 302,500.00
    969 CERVICAL MC HARD M (nekcolaar) S PC MASIDA 302,500.00 302,500.00

    DATA KEBUTUHAN OBAT REVISI 78 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    970 CERVICAL MC S HARD S PC MASIDA 220,000.00 220,000.00


    971 CERVICAL NC SOFT CHOLER L S PC MASIDA 275,000.00 275,000.00
    972 CERVICAL NC SOFT CHOLER M S PC MASIDA 302,500.00 302,500.00
    973 CERVICAL NC SOFT CHOLER S S PC MASIDA JAPAN 302,500.00 302,500.00
    974 HALOGEN LAMP. 554871 S PC RNI 343,200.00 343,200.00
    975 HOGI ~ DUEL SHEET OB SS S PC HOGY 144,100.00 144,100.00
    976 HOGI ~ EQUIPMENT TABLE COVER RP- S PC HOGY 122,100.00 122,100.00
    977 HOGI ~ MEDICAL CAP L-MCS-0101 S PC HOGY 100,870.00 100,870.00
    978 HOLDER ( free ) S PC LOKAL -
    979 IBS~ TIP CLEANER FOR ELEC. DISP. S PC PRO DIVICE 32,725.00 32,725.00
    980 ICE CAP S PC LOKAL 66,000.00 66,000.00
    981 INJ ~ CHECK BOWIE DICK MINI S PC GETINGE 3,245,000.00 3,245,000.00
    982 INJ ~ INTERNAL INDIKATOR FOR STEAMS PC GETINGE 605,000.00 605,000.00
    983 INJ ~ RINSE AID 5 LTR S PC GETINGE 1,952,500.00 1,952,500.00
    984 INJ ~ UNIVERSAL DETERGENT 5 LTR S PC GETINGE 1,870,000.00 1,870,000.00
    985 INTEST. NEEDLE PB ROUND FRG 4 S PC ZEPT 24,811.41 24,811.41
    986 INTEST. NEEDLE PB ROUND FRG 5 S PC ZEPT 24,811.41 24,811.41
    987 INTEST. NEEDLE PB ROUND FRG 00 S PC ZEPT 28,482.66 28,482.66
    988 INTRODUCER 7F 10 CM NEEDLE 3.8 S PC TERUMO 496,375.00 496,375.00
    989 INTTROCAN W 20 IN STOPER S PC B BRAUN 10,725.00 10,725.00
    990 INTTROCAN W 22 IN STOPER S PC B BRAUN 10,725.00 10,725.00
    991 INTTROCAN W 24 IN STOPER S PC B BRAUN 10,725.00 10,725.00
    992 KACA MATA GOOGLE S PC CHINA 44,000.00 44,000.00
    993 POSPACK SIMPLE S PC ALCARE 28,050.00 28,050.00
    994 RAK WESTEGREEN 10 HOLE S PC NESCO 278,300.00 278,300.00
    995 RAUCODRAPE SMART C-SECTION SET S SET SURGIKA 470,250.00 470,250.00
    996 RAUCODRAPE SMART UNIVERSAL SET S SET SURGIKA 396,000.00 396,000.00
    997 RELIANT DISP. PENCIL WHOLSTER S PC BIOMED 88,000.00 88,000.00
    998 SANGOFIX S PC B BRAUN 24,200.00 24,200.00
    999 SURGILACTION 50 MM 1/2 CR S PC SUTURE 103,950.00 103,950.00
    1000 SURGIQUICK 37 MM 1/2 CR S PC SUTURE 110,000.00 110,000.00
    1001 SX PRO Gown SPEC SMMS WL,XL Long 170 S PC SURGIKA 123,750.00 123,750.00
    1002 SX PRO OP-M SPESIAL SMMSmEL 103 S PC SURGIKA 110,880.00 110,880.00
    1003 TRACHEOSTOMY CUFFED 5 S PC SURGIKA 319,660.00 319,660.00
    1004 TRICOFIX 2189 S PC BSN 53,083.80 53,083.80
    1005 UNIVERSAL TAP 2" X 5 M S PC 3M 19,167.50 19,167.50
    1006 VASOFIX SAFETY 18 S PC B/ BRAUN 35,200.00 35,200.00
    1007 VISOR FACE SHIELD S PC KRISBOW 302,500.00 302,500.00
    1008 WASKOM STAINLESS STEEL S PC XXX 104,500.00 104,500.00
    1009 ZYDE STERIL NO. 2/0 100 METER S ROL BIO DINAMIC 583,440.00 583,440.00
    1010 ALAT PASANG IMPLANT PC 0 55,000.00 55,000.00
    -

    BAHAN KIMIA -
    FAST MOVING
    1 A/C PERFORMA LA/ APAC 50 F PC ROCHE 10,340.00
    2 ACCUCHECK ACTIVE ( HIJAU ) F PC ROCHE 343,200.00
    3 ALCOHOL 70% 1 LITER F BTL MEDIKA 37,638.71 45.00%
    4 ALCOHOL 95% 1 LITER F BTL MEDIKA 55,800.00 0.00%

    DATA KEBUTUHAN OBAT REVISI 79 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    5 ANTI HBS F PC ACON 34,375.00


    6 ANTI HCV F PC MONOTES 15,268.00
    7 ASAM SULFOSALICYLATE 20 % F BTL INDOREAGEN 690,250.00
    8 ASEPTAN ( anti septik ) @ 5000 ML F BTL ONE MED 388,000.00 25.00%
    9 ASEPTAN ( anti septik ) @ 500 ML F BTL ONE MED 51,800.00 25.00%
    10 ASEPTIC GEL @ 500 ML F BTL ONE MED 41,000.00 25.00%
    11 ASEPTIC GEL @ 500 ML F BTL ONE MED 38,948.67 25.00%
    12 ASEPTIC GEL @ 5000 ML F BTL ONE MED 288,000.00 25.00%
    13 HANDSANITIZER 500 ML F PC COSMOMED 66,000.00 0.00%
    14 BIOSONIC ULTRASONIC GEL F BTL SELLA 30,000.30
    15 BLUE TIP @ 1000 F KTK GILSON 348,150.00 0.00%
    16 CHOLESTEROL 10028 F BTL HUMAN 2,631,200.00 0.00%
    17 CHOLESTEROL STIK F BTL AUTO CHECK 187,000.00
    18 CIDEX OPA SOLUTION 5 LITER F BTL ETHICON 702,768.00
    19 CIDEZYME 5 LITER F BTL ETHICON 830,544.00
    20 CITRIC ACID MONOHYDRATE @ 25 KG F KRG BRATACO 1,650,000.00 0.00%
    21 CHLORHEXIDINE 4% F GLN BAYMED 825,000.00 0.00%
    22 COMBINA 11's F BTL HUMAN 1,733,600.00 0.00%
    23 CREATININE 10051 F BTL HUMAN 644,600.00 0.00%
    24 DENTAL X - RAY FILM F BTL HANSIN 24,640.00
    25 DEVELOPER F GLN FUJI 1,111,000.00 0.00%
    26 DEVELOPER F GLN FUJI 770,000.00 0.00%
    27 DENGUE DUO CASSETE (igG&IgM) F BOK SIGPRO 3,031,600.00 15.00%
    28 DENGUE DUO CASSETE (igG&IgM) F BOK ORIENT GENE 1,430,000.00 0.00%
    29 DENGUE DUO CASSETE (igG&IgM) F BOK GLY 2,024,000.00 0.00%
    30 DENGUE EARLY RAFID (NS1) F BTL ORIENT GENE 1,364,000.00 10.00%
    31 DENGUE EARLY RAFID (NS1) F KIT SIGPRO 4,263,187.51 15.00%
    32 DENGUE EARLY RAFID (NS1) F KIT WF 1,771,000.00 0.00%
    33 DENGUE EARLY RAFID (NS1) F KIT GLY 2,846,800.00 0.00%
    34 DETRO OPA F BTL ENDO 847,000.00
    35 DETRO ENZYM F BTL ENDO 900,900.00
    36 DILUENT (10) F BTL DIRUI BCC-300 3,850,000.00
    37 DISPOSIBLE VIRUS SAMLING (VTM) F KIT LOKAL 42,900.00 0.00%
    38 DRUG TESTCARD @ 20 F BTL INTEC 2,597,870.00
    39 EOSIN 2% 100 ML F BTL INDOREAGEN 422,675.00
    40 EOSIN 2% 500 ML F BTL HUMAN 1,586,200.00
    41 ETHYLCHLORET SPRY F BTL CHLOREEHYL 126,500.00
    42 EXTRAN 2.5 L F BTL E MERCK 1,563,100.00 0.00%
    43 FIRST AID 1 LTR F BTL BSN 283,360.00
    44 FIXER F SET FUJI 753,500.00 0.00%
    45 GEL UNTUK ECG 250 ML F BTL ONE MED 31,900.00 0.00%
    46 GEL UNTUK ECG 5000 ML F BTL ONE MED 170,500.00 0.00%
    47 GIEMSA 250 ML F BTL INDOREAGEN 731,500.00
    48 GIEMSA 500 ML F BTL MERCK 1,518,550.00
    49 GLUCOSE 10260 F BTL HUMAN 1,523,500.00
    50 GLYCERINE 1000 ML F BTL BRATACO 70,000.00
    51 GLYCERINE 500 ML F BTL BRATACO 143,000.00
    52 HbA 1C TEST NYCOCARD F PC NYCOCARD 109,663.12
    53 HbA 1C TEST NYCOCARD @ 24 TEST F KTK NYCOCARD 2,751,999.80

    DATA KEBUTUHAN OBAT REVISI 80 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    54 HBs AB / ANTI HBS F KTK ANSWER 399,300.00


    55 HBs AB @ 40 TEST F KTK ACON 341,550.00
    56 HBs Ab @ 25 TEST F KTK INT 577,500.00
    57 HBs AG CARD @ 30 F KTK STAR 338,800.00 0.00%
    58 HBs AG CARD @ 25 F KTK onsite 314,600.00 0.00%
    59 HBs AG START PLUS F PC STAR D PLUS 27,500.00
    60 HBs Ag STRIPS F KTK MONO 344,850.00
    61 HBs Ag STRIPS F KTK GLRY 341,550.00 0.00%
    62 HBs Ag @ 30 TEST F KTK INT 451,550.00
    63 HCG TEST F KTK ANSWER 254,100.00 0.00%
    64 HCG strip F KTK ANSWER 113,300.00 0.00%
    65 HCV DIVICE F KTK ANSWER 845,350.00
    66 HCV TEST @ 40 F KTK MONO 544,500.00
    67 HDL CHOLESTEROL 10018 F BTL HUMAN 2,110,900.00
    68 HIV @ 40 TEST F KTK INTEC 1,755,600.00
    69 HIV CARD @ 25 F PC ANSWER 50,193.00 15.00%
    70 HIV CARD @ 25 F KTK STAR 1,254,824.71 15.00%
    71 HIV CARD F KTK onsite 617,100.00 0.00%
    72 HUMATROL N 13511 F BTL HUMAN 1,642,300.00
    73 HYDREX SUG. SCRUB 5 LITER F BTL SMI 1,221,000.00
    74 IMMERSION OIL 100 ML F BTL E MERCK 788,700.00
    75 IMMERSION OIL 500 ML F BTL E MERCK 2,216,500.00
    76 208KF16K03 IODINE POVIDONE 1000 ML F fopi BTL KF ( G ) 36,720.20 0.00%
    77 IODINE POVIDONE 60 ML F BTL KF ( G ) 6,600.00 0.00%
    78 IODINE POVIDONE 60 ML F BTL KF ( G ) 4,250.40 0.00%
    79 IODINE POVIDONE 30 ML F BTL KF ( G ) 3,658.60 0.00%
    80 K3 EDTA ( PC ) MINI UNGU 0.5 ML F PC VACUETTE 5,016.00 0.00%
    81 K2 EDTA ( PC ) UNGU 3 ml F PC VCB 2,475.00 0.00%
    82 K3 EDTA ( PC ) UNGU 3 ml F PC ITM 2,508.00 0.00%
    83 LITHIUM HEPARIN 3 ML @ 100 F PC GREINERBIO 2,662.00 0.00%
    84 LQ SUPRA @ 4 X 5 LTR F BTL EPRO STEWART 1,100,000.00
    85 METHANOL 500 ML F BTL INDOREAGEN 462,000.00 0.00%
    86 NATRIUM CITRATE 3,8 F BTL MBF 41,800.00
    87 NATRIUM CITRATE 500 ML F BTL GD 308,000.00 0.00%
    88 MULTIDRUG 6 PARAMETER F KTK ANSWER 2,323,200.00
    89 ODEX 5 LITER F GLN ONE MED 880,000.00 25.00%
    90 209OD26A96 DOD26A096 ONESCRUB 5 LTR F GLN ONE MED 420,000.00 0.00%
    91 PERHYDROL 3% (800 Ml) H2O2 F BTL ONE MED 35,000.00 25.00%
    92 POLI AID ASL 1 LTR F BTL SNA 154,000.00
    93 POLI AID ASL 5 LITER F BTL SNA 794,816.00
    94 POLIWASH 5 LITER F BTL SNA 668,272.00
    95 PP TEST F KTK ACON 330,000.00
    96 RAPID TEST COVID-19 F PC SYSMEX 60,000.00
    97 RAPID TEST COVID-19 F PC FEMOMETER 75,000.00
    98 RAPID TEST ANTI BODY F PC CLUNGENE 47,000.00 0.00%
    99 SAR-COV-2 ANTIGEN F PC CLUNGENE 40,000.00 0.00%
    100 RAPID TEST COVID-19 F PC CLUNGENE 49,000.00 0.00%
    101 RAPID TEST COVID-19 F PC ABBOT 104,500.00 0.00%
    102 SAR-COV-2 ANTIGEN F PC BIOSENSOR 92,000.00 0.00%

    DATA KEBUTUHAN OBAT REVISI 81 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    103 SAR-COV-2 ANTIGEN F PC ROCHE 115,000.00 24.43%


    104 SAR-COV-2 ANTIGEN F PC CLUNGENE 26,000.00 0.00%
    105 SAR-COV-2 ANTIGEN F PC CLUNGENE 24,400.00 0.00%
    106 SAR-COV-2 ANTIGEN F PC BIOSENSOR 80,000.00 0.00%
    107 SAR-COV-2 ANTIGEN F PC CLUNGENE 25,000.00 0.00%
    108 SAR-COV-2 ANTIGEN F PC ALTAMED 150,000.00 83.03%
    109 REAGENT HEMATOLOGI F BTL GENIO 3,630,000.00
    110 REAGENT PACK K-LYTE F BTL DIRUI BCC-300 8,360,000.00
    111 PD SCRUB 5 LITER F BTL PRO DIVICE 766,700.00
    112 SALMONELLA PARATYPHI A - O F BTL BIOTECH 174,499.60
    113 SALMONELLA PARATYPHI A - O F BTL FORTRESS 180,000.00
    114 SALMONELLA PARATYPHI A - O F BTL DALF 121,000.00 0.00%
    115 SALMONELLA PARATYPHI B - O F BTL DALF 121,000.00 0.00%
    116 SALMONELLA PARATYPHI C - O F BTL DALF 121,000.00 0.00%
    117 SALMONELLA TYPHI - B - O F BTL DALF 148,500.00
    118 SALMONELLA TYPHI - H F BTL DALF 121,000.00 0.00%
    119 SALMONELLA TYPHI - H F BTL HUMAN 148,500.00
    120 SALMONELLA TYPHI - O F BTL DALF 121,000.00 0.00%
    121 SALMONELLA TYPHI - O F BTL HUMAN 306,625.00
    122 SALMONELLA TYPHI - O F BTL BIOTECH 174,499.60
    123 SALMONELLA TYPHI A - H F BTL DALF 121,000.00 0.00%
    124 SALMONELLA TYPHI A - H F BTL HUMAN 148,500.00
    125 SALMONELLA TYPHI B - H F BTL DALF 121,000.00 0.00%
    126 SALMONELLA TYPHI C - H F BTL DALF 121,000.00
    127 SERUM GOL. DARAH 1 SET ( A,B,AB & D F BTL HUMAN 450,450.00
    128 SERUM GOL. DARAH ANTI A F BTL DALF 105,600.00 0.00%
    129 SERUM GOL. DARAH ANTI A F BTL XXX 289,474.90
    130 SERUM GOL. DARAH ANTI A F BTL GLORY 92,400.00 0.00%
    131 SERUM GOL. DARAH ANTI AB F BTL DALF 105,600.00 0.00%
    132 SERUM GOL. DARAH ANTI AB F BTL GLORY 105,600.00 0.00%
    133 SERUM GOL. DARAH ANTI B F BTL DALF 135,134.12 15.00%
    134 SERUM GOL. DARAH ANTI B F BTL GLORY 92,400.00 0.00%
    135 SERUM GOL. DARAH ANTI B F BTL DALF 105,600.00 0.00%
    136 SERUM GOL. DARAH ANTI D F BTL DALF 105,600.00 0.00%
    137 SERUM GOL. DARAH ANTI D F BTL GLORY 132,000.00 0.00%
    138 SERUM GOL. DARAH ANTI D F BTL DALF 193,050.00 15.00%
    139 SGOT 12011 F BTL HUMAN 903,100.00 0.00%
    140 SGPT 12012 F BTL HUMAN 903,100.00 0.00%
    141 SMX ~ ACTIN FS ACTAVATED F BTL SYSMEX 926,640.00
    142 SMX ~ ALAT ( GPT ) FS ( IFCC MOD ) F BTL SYSMEX 1,602,370.00 0.00%
    143 SMX ~ ALAT ( GPT ) FS ( IFCC MOD ) R1 F BTL SYSMEX 721,050.00
    144 SMX ~ ALAT ( GPT ) FS ( IFCC MOD ) R2 F BTL SYSMEX 721,050.00
    145 SMX ~ ALBUMIN FS R1 F BTL SYSMEX 1,280,180.00
    146 SMX ~ ASAT ( GOT ) FS ( IFCC MOD ) F BTL SYSMEX 1,602,370.00 0.00%
    147 SMX ~ ASAT ( GOT ) FS ( IFCC MOD ) R1 F BTL SYSMEX 721,050.00
    148 SMX ~ ASAT ( GOT ) FS ( IFCC MOD ) R2 F BTL SYSMEX 721,050.00
    149 SMX ~ BI-LEVEL QC KIT, MEDICA F BTL SYSMEX 2,016,300.00
    150 SMX ~ BILIRUBIN AUTO DIREC FS F BTL SYSMEX 705,375.00
    151 SMX ~ BILIRUBIN AUTO DIREC FS R1 F BTL SYSMEX 352,687.50

    DATA KEBUTUHAN OBAT REVISI 82 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    152 SMX ~ BILIRUBIN AUTO DIREC FS R2 F BTL SYSMEX 352,687.50


    153 SMX ~ BILIRUBIN AUTO TOTAL FS F BTL SYSMEX 1,645,967.40
    154 SMX ~ BILIRUBIN AUTO TOTAL FS R1 F BTL SYSMEX 822,983.70
    155 SMX ~ BILIRUBIN AUTO TOTAL FS R2 F BTL SYSMEX 822,983.70
    156 SMX ~ CALCIUM CHLORIDE SOLUTION F BTL SYSMEX 1,143,450.00
    157 SMX ~ CALIBRATION STRIP F BTL SYSMEX 114,400.00
    158 SMX ~ CELL CLEAN 50 ML ( CL - 50 ) F BTL SYSMEX 1,258,400.00
    159 SMX ~ CELL PACK ( PK- 30 L ) F BTL SYSMEX 3,944,160.00 0.00%
    160 SMX ~ CHOLESTEROL FS F BTL SYSMEX 3,692,700.00 0.00%
    161 SMX ~ COMBO STICK 10 M ( 100T ) F BTL SYSMEX 446,160.00 0.00%
    162 SMX ~ COMBO STICK 10 M ( 100T ) F BTL SYSMEX 385,000.00 0.00%
    163 SMX ~ CONTROL PLASMA F BTL SYSMEX 1,853,280.00
    164 SMX ~ CREATININE PAP FS F BTL SYSMEX 5,308,050.00 0.00%
    165 SMX ~ CREATININE PAP FS R1 F BTL SYSMEX 2,388,595.00
    166 SMX ~ CREATININE PAP FS R2 F BTL SYSMEX 2,508,000.00
    167 SMX ~ DADE INNOVIN F BTL SYSMEX 944,460.00
    168 SMX ~ DAILY CLEANING SOL. F BTL SYSMEX 1,540,000.00 0.00%
    169 SMX ~ E- CHECK LEVEL 1 ( LOW ) F BTL SYSMEX 925,100.00 0.00%
    170 SMX ~ E- CHECK LEVEL 2 ( NORMAL ) F BTL SYSMEX 925,100.00 0.00%
    171 SMX ~ E- CHECK LEVEL 3 ( HIGH ) F BTL SYSMEX 925,100.00 0.00%
    172 SMX ~ E- CHECK 3WP (NORMAL) 1.5 ML F BTL SYSMEX 412,500.00
    173 SMX ~ E- CHECK 3WP (LOW) 1.5 ML F BTL SYSMEX 412,500.00
    174 SMX ~ E- CHECK 3WP (HIGH) 1.5 ML F BTL SYSMEX 412,500.00
    175 SMX ~ EBG QC KIT LEVEL 1 ( LOW ) F BTL SYSMEX 532,400.00
    176 SMX ~ EBG QC KIT LEVEL 2 ( NORMAL ) F BTL SYSMEX 532,400.00
    177 SMX ~ EBG QC KIT LEVEL 3 ( HIGH ) F BTL SYSMEX 532,400.00
    178 SMX ~ EBG REAGENT MODULE F BTL SYSMEX 9,084,900.00
    179 SMX ~ EBG REAGENT PACK SOLUTION F BTL SYSMEX 6,201,800.00
    180 SMX ~ GAMMA FT FS F BTL SYSMEX 3,403,840.00
    181 SMX ~ GLUCOSE HEXOKINASE F BTL SYSMEX 3,782,460.00 0.00%
    182 SMX ~ GLUCOSE HEXOKINASE FS R1 F BTL SYSMEX 1,702,085.00
    183 SMX ~ GLUCOSE HEXOKINASE FS R2 F BTL SYSMEX 1,854,286.50
    184 SMX ~ HDL-C INMMUNO FS R1 F BTL SYSMEX 3,291,750.00
    185 SMX ~ HDL-C INMMUNO FS R2 F BTL SYSMEX 3,291,750.00
    186 SMX ~ HDL-C INMMUNO FS F BTL SYSMEX 8,127,790.00 0.00%
    187 SMX ~ LEVEL QC F BTL SYSMEX 2,016,300.00
    188 SMX ~ LDL - C SELECT FS R1 F BTL SYSMEX 1,959,375.00
    189 SMX ~ LDL - C SELECT FS R2 F BTL SYSMEX 1,959,375.00
    190 SMX ~ LIQUICHECK URINALYSIS CONTROL F BTL SYSMEX 1,694,000.00
    191 SMX ~ MULTI DRUG ONE STEP 6 TEST F KIT SYSMEX 0.00%
    192 SMX ~ SAMPLIX 4 ML F PACK SYSMEX 0.00%
    193 SMX ~ SAMPLE CUP @ 500 PC F PACK SYSMEX 0.00%
    194 SMX ~ SOLUTION PACK NA/KCL 400 MG F BTL SYSMEX 6,201,800.00 0.00%
    195 SMX ~ STROMATOLYZER 4DL (FFD-220 F BTL SYSMEX 6,195,860.00 0.00%
    196 SMX ~ STROMATOLYZER 4DS F BTL SYSMEX 5,796,120.00 0.00%
    197 SMX ~ STROMATOLYZER WH 500 ML F BTL SYSMEX 2,770,020.00
    198 SMX ~ STROMATOLYZER WH 500 ML F BTL SYSMEX 3,077,800.00
    199 SMX ~ SULFOLYSER 500 ML SLS-210A F BTL SYSMEX 1,515,800.00 0.00%
    200 SMX ~ TABUNG SODIUM CITRAT F BTL SYSMEX 220,000.00

    DATA KEBUTUHAN OBAT REVISI 83 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    201 SMX ~ THERMAL PAPER DPT 282-EL KX F BTL SYSMEX 39,600.00


    202 SMX ~ THERMAL PAPER COMBOSTIK R300 F BTL SYSMEX 33,000.00
    203 SMX ~ THERMAL PAPER FOR EASYLITE F BTL SYSMEX 35,200.00
    204 SMX ~ TOTAL PROTEN F BTL SYSMEX 1,316,700.00
    205 SMX ~ TOTAL PROTEN FS R1 F BTL SYSMEX 658,350.00
    206 SMX ~ TOTAL PROTEN FS R2 F BTL SYSMEX 658,350.00
    207 SMX ~ TRIGLYCERIDES FS 10 F BTL SYSMEX 4,444,330.00 0.00%
    208 SMX ~ TRU CAL U F BTL SYSMEX -
    209 SMX ~ TRU LAB N F BTL SYSMEX -
    210 SMX ~ TRU LAB P F BTL SYSMEX -
    211 SMX ~ UREA FS F BTL SYSMEX 4,538,380.00 0.00%
    212 SMX ~ UREA FS R1 F BTL SYSMEX 2,269,190.00
    213 SMX ~ UREA FS R2 F BTL SYSMEX 2,472,171.90
    214 SMX ~ URIC ACID FS TOOS F BTL SYSMEX 1,828,860.00 0.00%
    215 SMX ~ URIC ACID FS TOOS R1 F BTL SYSMEX 740,667.40
    216 SMX ~ URIC ACID FS TOOS R2 F BTL SYSMEX 740,667.40
    217 SMX ~ WASH SOLUTION NO. 3 F BTL SYSMEX 740,667.40
    218 SMX ~ VAC 3.5 ML Z SER SEP C/A NR F BOK SYSMEX 0.00%
    219 SODA LIME ( INTERSORB GRAN MOLECUF BTL XXX 979,000.00
    220 SODIUM CITRATE 3,2% 500 ML F BTL HUMAN 117,700.00
    221 SODIUM CITRATE 3,8 F BTL INDOREAGEN 96,900.10
    222 SOFNOLIME F GLN SOFNOLIME 1,210,000.00
    223 STIK URINE ANALYZER BA600 F KIT HUMAN 308,550.00
    224 TABUNG CENTRIFUGE 10 ML F KTK PYREX 533,500.00
    225 TABUNG CLOT ACTIVATOR 3 ML F PC SYSMEX 1,980.00 0.00%
    226 TABUNG GEL CLOT ACTIVATOR 3 ML F PC VACUETTE 2,508.00 0.00%
    227 TABUNG GEL CLOT ACTIVATOR 3 ML F PC VDL 2,002.00 0.00%
    228 TABUNG NATRIUM CITRAT F PC VDL 234,300.00 0.00%
    229 TEST MALARIA F KTK J. MITRA 1,443,750.00
    230 TES NARKOBA @ 25 F BOK -
    238 TRICARB C 50 F KTK B/BRAUN 247,500.00
    239 TRIGLYCERIDES 10724 F BTL HUMAN 5,012,700.00 0.00%
    240 TUBEX TF @ 36 TEST IDL F BTL BIOTECH 4,443,000.10
    241 UREA 10505 F BTL HUMAN 869,000.00 0.00%
    242 URIC ACID 10691 F BTL HUMAN 5,047,900.00 0.00%
    243 URINE 10 PARAMETER DUS F BTL HUMAN 319,000.00
    244 VENTY UNNALYSIS F PC BIOCOMMA 0.00%
    245 VIRUS TRANSPORT MEDIA @50 F KIT BIOCOMMA 46,500.00 0.00%
    246 WHITE TIP ( SOCOREX ) @ 1000 F KTK SOCOREX 968,000.00 0.00%
    247 X RAY FILM DENTAL F BTL HATELA 616,000.00
    248 X-TRAGENE @ 5 LTR F GLN GRAHA FARMA 600,875.00
    249 YELLOW TIP @ 1000 F KTK SOCOREX 348,150.00 0.00%

    SLOW MOVING
    250 ALKALINE PHOSPHAT 107092 S BTL MPR 931,700.00
    251 ASAM ACETAT 500 ML S BTL HUMAN 137,500.00
    252 ASAM ACETAT 6 % S BTL ASAM 49,500.00

    DATA KEBUTUHAN OBAT REVISI 84 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    253 BENEDICTS 100 ML S BTL INDO REAGEN 90,249.50


    254 BILLIRUBIN 10740 S BTL HUMAN 1,135,200.00 0.00%
    255 VASELIN PUTIH 1 KG S BTL BRATACO 100,000.00

    SUB JUMLAH

    JUMLAH

    OBAT RETUR DARI UNIT

    SUB JUMLAH

    JUMLAH SETELAH RETUR

    Kesimpulan :
    Month Stock (Stock Akhir Bulan)

    Nilai ideal
    Turn Over Ratio

    Nilai ideal minimal

    DATA KEBUTUHAN OBAT REVISI 85 / 325


    KETERANGAN HNA+PPN DISKON HARGA
    NO. KODE PBM KODE OSS KODE ITEM PBM NAMA OBAT / BAHAN KEL. OBAT STN PABRIK
    FOPI / NON FOPI NETTO % 2020
    1 3 3

    RETUR / AFKIR :
    NO NAMA OBAT
    RETUR ke PBF
    1 BIOXON INJ non fopi VIAL OTTO 231,000.00 37.00% 16747500.00%
    2 NEO KAOLANA SYR non fopi BTL SANBE FARMA 10,571.00 1082675.00%
    3 BLEDSTOP TAB non fopi PC CAPRIFARMINDO 473.14 47314.00%
    4 SPORETIK KAPS. 100MG ( 30/BOX ) non fopi PC SANBE FARMA 21,747.00 25.00% 1685392.00%

    JUMLAH RETUR KE PBF

    APKIR GUDANG

    JUMLAH AFKIR GUDANG

    TOTAL

    Nilai Pengeluaran Gudang


    Nilai Barang Afkir Gudang / Retur Ke FBF
    Nilai Pengeluaran Gudang

    DIKETAHUI OLEH,
    KA. GUDANG FARMASI

    MORALISA S. Farm.

    DATA KEBUTUHAN OBAT REVISI 86 / 325


    OBATAN DAN SARANA PELENGKAP
    SI RSMS - SUNGAILIAT
    EMBER 2021
    #REF! #REF! #REF! #REF! #REF! #REF!
    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    269.50 - - - - - - - -
    606.07 - - - - - - - -
    1,650.00 - - - - - - - -
    85.00 - - - - - - - -
    722.15 200 144,430.00 - - 200 144,430.00 - -
    3,101.58 - - 100 310,158.00 100 310,158.00 - -
    1,554.30 - - - - - - - -
    90,956.25 - - 10 909,562.50 10 909,562.50 - -
    1,862.19 - - - - - - - -
    341.00 - - - - - - - -
    13,200.00 98 1,293,600.00 10 132,000.00 48 633,600.00 60 792,000.00
    474.22 100 47,422.00 - - - - 100 47,422.00
    38,500.00 - - - - - - - -
    24,640.00 28 689,920.00 - - - - 28 689,920.00
    1,003.14 - - - - - - - -
    1,529,342

    1,766.38 1,290 2,278,630.20 - - - - 1,290 2,278,630.20


    876.00 350 306,600.00 - - - - 350 306,600.00
    1,045.97 - - - - - - - -
    626.03 600 375,618.00 - - - - 600 375,618.00
    207,955.00 - - - - - - - -
    1,283.33 - - 1,500 1,924,995.00 420 538,998.60 1,080 1,385,996.40
    550.00 - - - - - - - -
    3,391.25 - - - - - - - -
    3,080.83 - - - - - - - -
    467.50 - - - - - - - -
    429.00 400 171,600.00 - - 200 85,800.00 200 85,800.00
    897.60 200 179,520.00 - - 200 179,520.00 - -
    416.22 100 41,622.00 - - 100 41,622.00 - -
    646.80 - - - - - - - -
    446.60 100 44,660.00 - - - - 100 44,660.00
    401.50 - - - - - - - -
    143.00 300 42,900.00 - - - - 300 42,900.00
    230.80 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 87 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    237.60 100 23,760.00 - - - - 100 23,760.00


    462.00 - - - - - - - -
    302.50 - - - - - - - -
    300.25 300 90,075.00 - - - - 300 90,075.00
    300.30 - - - - - - - -
    557.87 500 278,935.00 200 111,574.00 - - 700 390,509.00
    704.55 200 140,910.00 200 140,910.00 - - 400 281,820.00
    1,085.70 200 217,140.00 - - - - 200 217,140.00
    7,040.00 - - 98 689,920.00 98 689,920.00 - -
    4,711.91 - - - - - - - -
    4,950.00 - - - - - - - -
    148.50 - - 5,000 742,500.00 2,700 400,950.00 2,300 341,550.00
    101.43 - - - - - - - -
    246.40 - - - - - - - -
    3,023.94 - - - - - - - -
    8,656.58 - - - - - - - -
    8,700.08 - - - - - - - -
    180.00 - - - - - - - -
    500.01 840 420,008.40 9,000 4,500,090.00 5,140 2,570,051.40 4,700 2,350,047.00
    140.25 14,400 2,019,600.00 - - 7,200 1,009,800.00 7,200 1,009,800.00
    500.01 60 30,000.60 - - 60 30,000.60 - -
    600.60 - - 9,000 5,405,400.00 3,960 2,378,376.00 5,040 3,027,024.00
    216.09 - - - - - - - -
    676.66 - - - - - - - -
    95.00 - - - - - - - -
    94.72 - - - - - - - -
    711.20 - - - - - - - -
    190.01 900 171,009.00 - - 900 171,009.00 - -
    200.08 6,700 1,340,536.00 - - 600 120,048.00 6,100 1,220,488.00
    119.21 10,000 1,192,100.00 - - - - 10,000 1,192,100.00
    81.00 5,000 405,000.00 - - - - 5,000 405,000.00
    165.00 200 33,000.00 - - - - 200 33,000.00
    53.00 10,000 530,000.00 - - - - 10,000 530,000.00
    346.50 3,680 1,275,120.00 - - - - 3,680 1,275,120.00
    346.56 - - - - - - - -
    423.50 - - - - - - - -
    374.31 - - - - - - - -
    296.00 - - - - - - - -
    15,400.00 - - - - - - - -
    5,115.00 - - - - - - - -
    5,775.00 - - - - - - - -
    7,878.42 - - - - - - - -
    8,333.70 - - - - - - - -
    148.50 - - 1,600 237,600.00 1,500 222,750.00 100 14,850.00
    210.59 - - - - - - - -
    348.38 - - - - - - - -
    16,500.00 - - - - - - - -
    160.38 9,600 1,539,648.00 - - 2,000 320,760.00 7,600 1,218,888.00
    287.38 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 88 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    262.99 - - - - - - - -
    166.38 - - - - - - - -
    1,848.00 400 739,200.00 - - - - 400 739,200.00
    5,005.00 - - - - - - - -
    3,542.00 395 1,399,090.00 - - - - 395 1,399,090.00
    4,504.50 350 1,576,575.00 350 1,576,575.00 575 2,590,087.50 125 563,062.50
    3,465.00 - - - - - - - -
    2,425.50 - - - - - - - -
    1,584.00 - - - - - - - -
    1,155.00 - - - - - - - -
    41,580.00 - - - - - - - -
    17,948.70 - - - - - - - -
    34,650.00 - - - - - - - -
    1,375.00 - - - - - - - -
    2,860.00 - - - - - - - -
    880.00 - - - - - - - -
    2,736.25 - - - - - - - -
    71,500.00 - - - - - - - -
    128,700.00 - - - - - - - -
    25,987.50 - - - - - - - -
    1,395.00 1,300 1,813,500.00 - - - - 1,300 1,813,500.00
    1,540.00 - - - - - - - -
    6,930.00 - - - - - - - -
    4,180.00 - - - - - - - -
    110.01 - - 4,500 495,045.00 600 66,006.00 3,900 429,039.00
    396.00 - - - - - - - -
    2,353.35 - - - - - - - -
    2,356.20 - - - - - - - -
    77.00 - - - - - - - -
    1,020.00 - - - - - - - -
    440.00 3,500 1,540,000.00 - - 3,500 1,540,000.00 - -
    440.00 - - - - - - - -
    554.40 5,000 2,772,000.00 - - - - 5,000 2,772,000.00
    237.20 11,100 2,632,920.00 - - 10,200 2,419,440.00 900 213,480.00
    242.00 - - - - - - - -
    550.00 - - - - - - - -
    847.00 - - - - - - - -
    650.06 - - 5,760 3,744,345.60 - - 5,760 3,744,345.60
    2,475.00 - - - - - - - -
    26,878.72 - - - - - - - -
    12,073.60 - - - - - - - -
    119.27 - - - - - - - -
    176.49 - - - - - - - -
    545.22 - - 13,500 7,360,470.00 7,950 4,334,499.00 5,550 3,025,971.00
    2,612.50 - - 210 548,625.00 210 548,625.00 - -
    742.50 - - 13,500 10,023,750.00 - - 13,500 10,023,750.00
    1,100.00 - - - - - - - -
    1,072.50 - - 16,650 17,857,125.00 3,180 3,410,550.00 13,470 14,446,575.00
    942.94 - - 21,000 19,801,740.00 11,820 11,145,550.80 9,180 8,656,189.20

    DATA KEBUTUHAN OBAT REVISI 89 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    5,720.00 - - - - - - - -
    1,072.51 - - - - - - - -
    4,180.00 - - 150 627,000.00 - - 150 627,000.00
    1,540.00 - - - - - - - -
    246.20 - - - - - - - -
    166.43 400 66,572.00 - - - - 400 66,572.00
    70.83 400 28,332.00 - - - - 400 28,332.00
    85.05 800 68,040.00 - - - - 800 68,040.00
    144.89 800 115,912.00 - - 700 101,423.00 100 14,489.00
    137.41 1,500 206,115.00 500 68,705.00 500 68,705.00 1,500 206,115.00
    75.46 400 30,184.00 - - - - 400 30,184.00
    94.07 - - - - - - - -
    223.82 - - - - - - - -
    200.25 - - - - - - - -
    504.00 3,600 1,814,400.00 - - 2,500 1,260,000.00 1,100 554,400.00
    840.00 - - - - - - - -
    665.50 - - - - - - - -
    793.80 - - - - - - - -
    770.88 - - - - - - - -
    9,504.00 - - 20 190,080.00 20 190,080.00 - -
    6,395.67 - - - - - - - -
    7,380.45 - - - - - - - -
    135,850.00 - - - - - - - -
    843.30 600 505,980.00 1,800 1,517,940.00 1,400 1,180,620.00 1,000 843,300.00
    643.50 1,100 707,850.00 - - 100 64,350.00 1,000 643,500.00
    843.32 - - - - - - - -
    1,676.21 - - - - - - - -
    2,024.00 600 1,214,400.00 - - 200 404,800.00 400 809,600.00
    748.82 1,200 898,584.00 - - - - 1,200 898,584.00
    9,075.00 100 907,500.00 - - 50 453,750.00 50 453,750.00
    19,057.50 - - 300 5,717,250.00 100 1,905,750.00 200 3,811,500.00
    13,721.40 - - - - - - - -
    8,910.00 - - - - - - - -
    17,600.00 10 176,000.00 - - - - 10 176,000.00
    38,500.00 - - 3 115,500.00 - - 3 115,500.00
    92,950.00 - - - - - - - -
    109,725.00 - - - - - - - -
    5,093.55 300 1,528,065.00 - - 156 794,593.80 144 733,471.20
    4,656.96 70 325,987.20 - - - - 70 325,987.20
    5,940.00 - - - - - - - -
    4,207.50 - - - - - - - -
    24,200.00 - - - - - - - -
    5,005.00 232 1,161,160.00 - - - - 232 1,161,160.00
    35,150.50 30 1,054,515.00 - - - - 30 1,054,515.00
    44,880.00 - - - - - - - -
    24,885.63 - - - - - - - -
    73,700.00 - - - - - - - -
    77,000.00 - - - - - - - -
    3,850.00 2,498 9,617,300.00 - - 676 2,602,600.00 1,822 7,014,700.00

    DATA KEBUTUHAN OBAT REVISI 90 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    10,450.00 - - - - - - - -
    4,963.00 - - - - - - - -
    4,700.41 - - - - - - - -
    231.00 - - 600 138,600.00 600 138,600.00 - -
    94.05 420 39,501.00 - - 420 39,501.00 - -
    342.83 - - - - - - - -
    222.17 - - - - - - - -
    27,500.00 - - - - - - - -
    11,550.00 - - 27 311,850.00 27 311,850.00 - -
    7,829.25 - - 100 782,925.00 91 712,461.75 9 70,463.25
    115.49 - - - - - - - -
    7,000.46 - - - - - - - -
    39,899.86 3 119,699.58 - - - - 3 119,699.58
    43,889.85 - - - - - - - -
    385.00 10,300 3,965,500.00 - - 1,100 423,500.00 9,200 3,542,000.00
    666.88 - - - - - - - -
    462.00 - - - - - - - -
    307.45 - - - - - - - -
    532.17 - - - - - - - -
    7,865.00 610 4,797,650.00 - - 350 2,752,750.00 260 2,044,900.00
    10,010.00 - - 100 1,001,000.00 100 1,001,000.00 - -
    4,559.96 - - - - - - - -
    9,075.00 - - - - - - - -
    9,600.01 - - - - - - - -
    4,620.00 - - 1,380 6,375,600.00 90 415,800.00 1,290 5,959,800.00
    5,610.00 - - - - - - - -
    5,133.33 - - - - - - - -
    2,970.00 - - - - - - - -
    4,851.00 - - 2,700 13,097,700.00 - - 2,700 13,097,700.00
    736.89 - - - - - - - -
    1,361.75 300 408,525.00 - - 200 272,350.00 100 136,175.00
    1,400.00 - - - - - - - -
    1,278.20 - - - - - - - -
    797.01 800 637,608.00 - - - - 800 637,608.00
    931.42 - - 500 465,710.00 - - 500 465,710.00
    171.38 - - - - - - - -
    2,370.02 4,320 10,238,486.40 - - 4,200 9,954,084.00 120 284,402.40
    1,404.36 1,890 2,654,240.40 7,500 10,532,700.00 4,110 5,771,919.60 5,280 7,415,020.80
    1,770.56 1,160 2,053,849.60 - - 1,160 2,053,849.60 - -
    462.00 - - - - - - - -
    2,158.75 - - 2,730 5,893,387.50 - - 2,730 5,893,387.50
    415.80 1,740 723,492.00 - - - - 1,740 723,492.00
    1,191.67 - - - - - - - -
    2,640.00 - - - - - - - -
    4,158.00 - - 150 623,700.00 90 374,220.00 60 249,480.00
    5,372.57 - - - - - - - -
    6,263.73 - - - - - - - -
    5,610.00 - - - - - - - -
    6,655.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 91 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    330.00 - - 200 66,000.00 200 66,000.00 - -


    264.00 - - 1,000 264,000.00 400 105,600.00 600 158,400.00
    11,130.09 - - - - - - - -
    0.00 - - - - - - - -
    123.20 - - 1,500 184,800.00 1,200 147,840.00 300 36,960.00
    136.06 - - - - - - - -
    66.55 - - - - - - - -
    117.45 - - - - - - - -
    184.25 - - - - - - - -
    1,130.19 - - - - - - - -
    1,561.56 - - - - - - - -
    1,098.00 - - - - - - - -
    1,098.23 - - - - - - - -
    22,440.00 125 2,805,000.00 - - 100 2,244,000.00 25 561,000.00
    21,120.00 - - - - - - - -
    13,915.00 - - - - - - - -
    13,409.00 250 3,352,250.00 - - - - 250 3,352,250.00
    13,200.00 - - - - - - - -
    3,239.50 - - - - - - - -
    2,805.00 - - - - - - - -
    137.26 - - - - - - - -
    110.83 1,100 121,913.00 - - 1,100 121,913.00 - -
    107.25 - - - - - - - -
    173.94 - - 100 17,394.00 - - 100 17,394.00
    196.66 - - - - - - - -
    1,169.44 - - - - - - - -
    28,567.00 100 2,856,700.00 - - 72 2,056,824.00 28 799,876.00
    15,007.78 - - - - - - - -
    28,567.00 - - - - - - - -
    12,045.00 - - 100 1,204,500.00 100 1,204,500.00 - -
    12,017.50 - - - - - - - -
    9,082.70 - - - - - - - -
    387.20 - - 1,700 658,240.00 1,700 658,240.00 - -
    127.14 - - 3,800 483,132.00 1,000 127,140.00 2,800 355,992.00
    171.60 - - - - - - - -
    302.71 - - - - - - - -
    286.00 - - - - - - - -
    189.00 - - - - - - - -
    214.18 - - - - - - - -
    9,240.00 - - 40 369,600.00 2 18,480.00 38 351,120.00
    330,000.00 - - - - - - - -
    308.55 - - - - - - - -
    316.23 - - - - - - - -
    847.00 - - - - - - - -
    8,526.15 - - - - - - - -
    6,708.17 - - 60 402,490.20 36 241,494.12 24 160,996.08
    1,408.00 300 422,400.00 - - - - 300 422,400.00
    2,640.05 - - - - - - - -
    2,772.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 92 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    1,905.75 - - 500 952,875.00 500 952,875.00 - -


    2,217.60 - - 1,000 2,217,600.00 400 887,040.00 600 1,330,560.00
    27,720.00 - - - - - - - -
    938.77 - - - - - - - -
    1,165.73 - - - - - - - -
    12,773.04 - - - - - - - -
    703.40 1,400 984,760.00 - - 400 281,360.00 1,000 703,400.00
    4,180.00 - - - - - - - -
    15,000.00 2,500 37,500,000.00 - - - - 2,500 37,500,000.00
    473.08 600 283,848.00 - - - - 600 283,848.00
    473.09 120 56,770.80 1,500 709,635.00 - - 1,620 766,405.80
    1,320.00 1,830 2,415,600.00 - - 1,280 1,689,600.00 550 726,000.00
    1,446.06 2,400 3,470,544.00 - - 2,400 3,470,544.00 - -
    2,376.00 - - - - - - - -
    18,720.02 40 748,800.80 - - - - 40 748,800.80
    2,625.00 - - - - - - - -
    1,760.00 - - - - - - - -
    1,760.00 - - - - - - - -
    125.65 3,300 414,645.00 - - - - 3,300 414,645.00
    158.40 - - 2,000 316,800.00 500 79,200.00 1,500 237,600.00
    2,216.50 - - - - - - - -
    923.08 - - - - - - - -
    111.37 500 55,685.00 - - 500 55,685.00 - -
    152.83 - - - - - - - -
    192.50 - - - - - - - -
    2,475.00 - - 2,100 5,197,500.00 1,800 4,455,000.00 300 742,500.00
    1,015.25 - - - - - - - -
    5,775.00 - - 2,100 12,127,500.00 - - 2,100 12,127,500.00
    462.00 2,100 970,200.00 - - - - 2,100 970,200.00
    1,732.54 - - - - - - - -
    3,650.90 - - - - - - - -
    1,732.54 - - - - - - - -
    165.00 800 132,000.00 - - - - 800 132,000.00
    169.40 - - - - - - - -
    297.00 - - - - - - - -
    206.93 200 41,386.00 3,500 724,255.00 1,200 248,316.00 2,500 517,325.00
    644.98 - - - - - - - -
    170.02 - - - - - - - -
    176.00 - - - - - - - -
    245.03 2,100 514,563.00 - - 1,500 367,545.00 600 147,018.00
    346.50 500 173,250.00 - - 500 173,250.00 - -
    330.00 - - - - - - - -
    290.87 550 159,978.50 21,000 6,108,270.00 5,050 1,468,893.50 16,500 4,799,355.00
    195.01 1,000 195,010.00 - - 1,000 195,010.00 - -
    1,430.00 - - - - - - - -
    352.00 - - - - - - - -
    1,321.57 - - 4,000 5,286,280.00 - - 4,000 5,286,280.00
    586.70 - - - - - - - -
    475.20 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 93 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    1,303.57 - - - - - - - -
    198.00 - - - - - - - -
    9,900.00 - - - - - - - -
    44,000.00 - - - - - - - -
    163.35 - - - - - - - -
    2,324.88 - - - - - - - -
    4,955.00 - - - - - - - -
    167.19 - - - - - - - -
    406.56 - - 400 162,624.00 400 162,624.00 - -
    365.75 - - - - - - - -
    179.74 - - - - - - - -
    173.45 - - - - - - - -
    253.13 - - - - - - - -
    41,250.00 40 1,650,000.00 24 990,000.00 32 1,320,000.00 32 1,320,000.00
    96.80 - - - - - - - -
    369.34 - - - - - - - -
    382.80 - - - - - - - -
    594.74 - - - - - - - -
    475.20 - - - - - - - -
    97,020.00 - - - - - - - -
    48,510.00 5 242,550.00 - - - - 5 242,550.00
    6,615.02 24 158,760.48 - - 24 158,760.48 - -
    4,432.89 - - - - - - - -
    2,449.92 - - - - - - - -
    404.66 - - 600 242,796.00 300 121,398.00 300 121,398.00
    307.49 - - - - - - - -
    992.26 - - - - - - - -
    594.00 1,400 831,600.00 - - 300 178,200.00 1,100 653,400.00
    563.20 - - - - - - - -
    5,000.05 600 3,000,030.00 - - 600 3,000,030.00 - -
    5,613.30 600 3,367,980.00 - - 438 2,458,625.40 162 909,354.60
    3,849.12 - - - - - - - -
    1,034.18 540 558,457.20 - - - - 540 558,457.20
    2,158.35 - - - - - - - -
    8,419.95 - - - - - - - -
    3,960.00 - - - - - - - -
    2,525.60 - - - - - - - -
    1,265.00 - - - - - - - -
    1,081.08 - - - - - - - -
    495.00 - - - - - - - -
    63,800.00 - - 20 1,276,000.00 20 1,276,000.00 - -
    412.50 300 123,750.00 - - 300 123,750.00 - -
    969.10 - - - - - - - -
    372.99 1,100 410,289.00 - - - - 1,100 410,289.00
    1,211.38 - - - - - - - -
    36,960.00 267 9,868,320.00 - - 60 2,217,600.00 207 7,650,720.00
    24,024.00 - - - - - - - -
    41,360.00 70 2,895,200.00 - - - - 70 2,895,200.00
    22,792.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 94 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    77,000.00 23 1,771,000.00 - - - - 23 1,771,000.00


    86,625.00 30 2,598,750.00 - - - - 30 2,598,750.00
    82,500.00 25 2,062,500.00 - - - - 25 2,062,500.00
    2,310.00 - - 30 69,300.00 30 69,300.00 - -
    1,155.00 - - - - - - - -
    1,322.40 - - - - - - - -
    1,060.49 - - - - - - - -
    130.98 900 117,882.00 - - 900 117,882.00 - -
    271.04 - - - - - - - -
    484.00 - - - - - - - -
    5,104.00 - - 10 51,040.00 10 51,040.00 - -
    410.08 - - 3,000 1,230,240.00 500 205,040.00 2,500 1,025,200.00
    584.78 1,600 935,648.00 - - - - 1,600 935,648.00
    959.20 - - - - - - - -
    331.10 2,000 662,200.00 - - - - 2,000 662,200.00
    544.87 2,000 1,089,740.00 - - - - 2,000 1,089,740.00
    332.11 - - - - - - - -
    221.54 - - - - - - - -
    337.82 - - - - - - - -
    45,650.00 - - - - - - - -
    23,562.00 - - 20 471,240.00 - - 20 471,240.00
    99,000.00 149 14,751,000.00 5 495,000.00 71 7,029,000.00 83 8,217,000.00
    27,442.50 100 2,744,250.00 - - - - 100 2,744,250.00
    27,442.80 40 1,097,712.00 - - - - 40 1,097,712.00
    30,800.00 - - - - - - - -
    228.69 - - - - - - - -
    427.92 - - - - - - - -
    316.80 - - - - - - - -
    181.05 15,000 2,715,750.00 - - 15,000 2,715,750.00 - -
    168.75 2,500 421,875.00 - - 2,500 421,875.00 - -
    115.50 - - - - - - - -
    522.50 - - - - - - - -
    700.15 - - - - - - - -
    3,080.00 60 184,800.00 - - 50 154,000.00 10 30,800.00
    213.99 - - - - - - - -
    26,074.51 340 8,865,333.40 139 3,624,356.89 208 5,423,498.08 271 7,066,192.21
    14,256.00 - - 100 1,425,600.00 - - 100 1,425,600.00
    12,375.00 2 24,750.00 - - - - 2 24,750.00
    815.06 300 244,518.00 400 326,024.00 100 81,506.00 600 489,036.00
    526.50 100 52,650.00 - - 100 52,650.00 - -
    519.75 - - 400 207,900.00 400 207,900.00 - -
    164.99 4,900 808,451.00 - - 1,300 214,487.00 3,600 593,964.00
    277.54 - - - - - - - -
    429.98 - - 1,000 429,980.00 600 257,988.00 400 171,992.00
    323.40 - - 1,000 323,400.00 700 226,380.00 300 97,020.00
    445.50 - - 200 89,100.00 - - 200 89,100.00
    526.50 - - - - - - - -
    3,927.00 - - - - - - - -
    39,820.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 95 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    8,250.00 - - - - - - - -
    7,260.00 39 283,140.00 - - - - 39 283,140.00
    321.00 - - - - - - - -
    171.60 - - - - - - - -
    281.53 - - - - - - - -
    342.90 - - - - - - - -
    1,899.98 72 136,798.56 - - 24 45,599.52 48 91,199.04
    4,113.30 - - - - - - - -
    20,328.00 - - - - - - - -
    15,015.00 - - - - - - - -
    24,688.13 - - - - - - - -
    122.96 - - - - - - - -
    141.00 - - - - - - - -
    115.50 - - 2,500 288,750.00 1,000 115,500.00 1,500 173,250.00
    158.08 - - - - - - - -
    122.58 - - - - - - - -
    605.00 - - - - - - - -
    57,170.76 20 1,143,415.20 - - - - 20 1,143,415.20
    23,645.60 90 2,128,104.00 - - - - 90 2,128,104.00
    144.86 - - 500 72,430.00 500 72,430.00 - -
    214.67 - - - - - - - -
    24,420.00 - - - - - - - -
    36,300.00 - - - - - - - -
    21,780.00 - - - - - - - -
    445.46 3,600 1,603,656.00 - - 3,600 1,603,656.00 - -
    396.00 - - - - - - - -
    200.08 - - - - - - - -
    26,400.00 650 17,160,000.00 - - 650 17,160,000.00 - -
    23,650.00 - - - - - - - -
    24,750.00 - - - - - - - -
    10,210.20 - - - - - - - -
    2,552.00 - - 500 1,276,000.00 250 638,000.00 250 638,000.00
    3,234.00 365 1,180,410.00 500 1,617,000.00 780 2,522,520.00 85 274,890.00
    1,153.27 - - - - - - - -
    3,600.04 - - - - - - - -
    3,575.00 - - - - - - - -
    3,600.04 180 648,007.20 - - 100 360,004.00 80 288,003.20
    7,761.60 - - 300 2,328,480.00 - - 300 2,328,480.00
    3,960.00 - - - - - - - -
    8,316.00 - - - - - - - -
    1,001.00 - - 1,800 1,801,800.00 1,800 1,801,800.00 - -
    770.00 - - - - - - - -
    1,036.75 - - - - - - - -
    1,131.92 - - - - - - - -
    1,971.20 - - 300 591,360.00 150 295,680.00 150 295,680.00
    1,644.50 - - - - - - - -
    915.06 - - - - - - - -
    3,500.20 - - - - - - - -
    2,200.00 2,330 5,126,000.00 - - 450 990,000.00 1,880 4,136,000.00

    DATA KEBUTUHAN OBAT REVISI 96 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    2,475.00 - - - - - - - -
    29,205.00 60 1,752,300.00 - - 53 1,547,865.00 7 204,435.00
    20,212.50 - - - - - - - -
    13,090.00 - - - - - - - -
    6,435.00 - - - - - - - -
    30,387.50 38 1,154,725.00 - - 38 1,154,725.00 - -
    11,990.00 9 107,910.00 - - 9 107,910.00 - -
    11,992.20 100 1,199,220.00 - - 100 1,199,220.00 - -
    11,990.98 - - - - - - - -
    22,000.00 - - - - - - - -
    6,545.00 - - 140 916,300.00 140 916,300.00 - -
    3,850.00 - - - - - - - -
    5,747.50 - - - - - - - -
    5,457.00 - - - - - - - -
    181.39 - - 20,000 3,627,800.00 1,000 181,390.00 19,000 3,446,410.00
    115.50 - - - - - - - -
    240.17 5,000 1,200,850.00 - - - - 5,000 1,200,850.00
    158.40 - - - - - - - -
    197.34 - - - - - - - -
    19,481.00 50 974,050.00 - - - - 50 974,050.00
    1,740.02 - - - - - - - -
    240.00 1,200 288,000.00 - - 200 48,000.00 1,000 240,000.00
    5,024.80 240 1,205,952.00 - - 120 602,976.00 120 602,976.00
    4,306.50 300 1,291,950.00 - - - - 300 1,291,950.00
    3,875.85 60 232,551.00 - - - - 60 232,551.00
    3,867.00 120 464,040.00 - - 120 464,040.00 - -
    3,960.00 - - - - - - - -
    781.00 100 78,100.00 - - - - 100 78,100.00
    797.01 100 79,701.00 - - - - 100 79,701.00
    797.01 400 318,804.00 - - - - 400 318,804.00
    2,359.50 810 1,911,195.00 - - 810 1,911,195.00 - -
    2,016.67 - - - - - - - -
    2,165.63 - - - - - - - -
    4,950.00 - - - - - - - -
    4,620.00 132 609,840.00 - - 24 110,880.00 108 498,960.00
    5,610.00 - - - - - - - -
    14,437.50 80 1,155,000.00 - - 8 115,500.00 72 1,039,500.00
    9,900.00 16 158,400.00 - - 16 158,400.00 - -
    12,572.18 - - - - - - - -
    950.80 300 285,240.00 - - 300 285,240.00 - -
    660.00 900 594,000.00 - - 100 66,000.00 800 528,000.00
    429.00 800 343,200.00 - - 300 128,700.00 500 214,500.00
    578.16 - - - - - - - -
    590.21 - - - - - - - -
    627.00 - - - - - - - -
    93.50 - - - - - - - -
    1,767.15 - - 150 265,072.50 - - 150 265,072.50
    148.50 - - - - - - - -
    173.25 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 97 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    7,276.50 - - 600 4,365,900.00 300 2,182,950.00 300 2,182,950.00


    5,081.67 - - - - - - - -
    1,885.71 294 554,398.74 - - 294 554,398.74 - -
    4,917.41 - - 2,100 10,326,561.00 2,100 10,326,561.00 - -
    4,785.00 - - - - - - - -
    88.33 500 44,165.00 700 61,831.00 1,000 88,330.00 200 17,666.00
    71.43 - - - - - - - -
    404.98 300 121,494.00 - - 300 121,494.00 - -
    521.21 - - 1,200 625,452.00 200 104,242.00 1,000 521,210.00
    404.98 - - - - - - - -
    364.97 700 255,479.00 - - - - 700 255,479.00
    382.83 500 191,415.00 - - - - 500 191,415.00
    2,570.04 2,010 5,165,780.40 - - 870 2,235,934.80 1,140 2,929,845.60
    2,184.53 - - - - - - - -
    2,448.60 - - - - - - - -
    2,598.75 - - - - - - - -
    2,668.05 - - - - - - - -
    2,428.67 - - - - - - - -
    277.20 - - 1,500 415,800.00 1,500 415,800.00 - -
    123.20 3,700 455,840.00 - - 2,300 283,360.00 1,400 172,480.00
    175.56 - - - - - - - -
    202.40 - - - - - - - -
    462.00 - - - - - - - -
    202.70 15,000 3,040,500.00 - - - - 15,000 3,040,500.00
    165.00 - - - - - - - -
    884.40 - - - - - - - -
    934.00 - - - - - - - -
    1,815.53 - - - - - - - -
    1,315.08 100 131,508.00 - - 100 131,508.00 - -
    2,375.08 - - - - - - - -
    523.69 - - 500 261,845.00 500 261,845.00 - -
    79.20 2,500 198,000.00 - - - - 2,500 198,000.00
    79.82 - - - - - - - -
    90.62 1,300 117,806.00 - - - - 1,300 117,806.00
    78.00 - - - - - - - -
    105.88 2,700 285,876.00 - - - - 2,700 285,876.00
    115.17 - - - - - - - -
    128.24 300 38,472.00 - - - - 300 38,472.00
    1,309,000.00 8 10,472,000.00 22 28,798,000.00 6 7,854,000.00 24 31,416,000.00
    1,201,200.00 6 7,207,200.00 12 14,414,400.00 - - 18 21,621,600.00
    1,737,450.00 1 1,737,450.00 - - - - 1 1,737,450.00
    430.92 11,500 4,955,580.00 - - 800 344,736.00 10,700 4,610,844.00
    307.80 - - - - - - - -
    103.95 6,000 623,700.00 - - - - 6,000 623,700.00
    104.50 6,000 627,000.00 - - - - 6,000 627,000.00
    88.00 - - - - - - - -
    198.00 1,000 198,000.00 - - 1,000 198,000.00 - -
    154.00 9,800 1,509,200.00 - - 9,800 1,509,200.00 - -
    445.50 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 98 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    715.00 - - - - - - - -
    564.30 - - - - - - - -
    642.47 200 128,494.00 2,800 1,798,916.00 600 385,482.00 2,400 1,541,928.00
    227.12 - - 3,300 749,496.00 3,300 749,496.00 - -
    15,345.00 - - 300 4,603,500.00 300 4,603,500.00 - -
    10,002.30 - - 300 3,000,690.00 188 1,880,432.40 112 1,120,257.60
    30,030.00 - - 55 1,651,650.00 - - 55 1,651,650.00
    4,481.40 - - - - - - - -
    329.67 - - - - - - - -
    794.96 - - - - - - - -
    115.50 - - - - - - - -
    2,310.00 - - - - - - - -
    4,851.00 150 727,650.00 - - 150 727,650.00 - -
    2,587.20 - - 600 1,552,320.00 150 388,080.00 450 1,164,240.00
    3,801.60 - - 600 2,280,960.00 - - 600 2,280,960.00
    6,077.50 - - - - - - - -
    2,700.55 - - - - - - - -
    2,200.00 - - - - - - - -
    121.07 200 24,214.00 - - - - 200 24,214.00
    73.02 - - - - - - - -
    71.01 - - - - - - - -
    79.99 200 15,998.00 - - - - 200 15,998.00
    20,625.00 50 1,031,250.00 - - - - 50 1,031,250.00
    16,500.00 120 1,980,000.00 - - - - 120 1,980,000.00
    144.72 200 28,944.00 - - - - 200 28,944.00
    161.06 200 32,212.00 - - - - 200 32,212.00
    42.00 - - - - - - - -
    495.00 - - 2,000 990,000.00 1,000 495,000.00 1,000 495,000.00
    4,207.50 - - - - - - - -
    979.00 - - - - - - - -
    253.00 1,000 253,000.00 - - - - 1,000 253,000.00
    3,322.00 - - - - - - - -
    212.00 300 63,600.00 - - 300 63,600.00 - -
    462.00 - - - - - - - -
    352,522,972.66

    3,630.00 130 471,900.00 - - - - 130 471,900.00


    1,443.75 - - 1,200 1,732,500.00 300 433,125.00 900 1,299,375.00
    490.18 - - 1,500 735,270.00 600 294,108.00 900 441,162.00
    4,950.00 - - - - - - - -
    17,820.00 - - - - - - - -
    26,730.00 - - - - - - - -
    2,926.00 - - - - - - - -
    9,178.40 90 826,056.00 - - 20 183,568.00 70 642,488.00
    11,145.20 - - - - - - - -
    31,177.63 20 623,552.60 40 1,247,105.20 - - 60 1,870,657.80
    77,000.00 10 770,000.00 - - 6 462,000.00 4 308,000.00
    1,563.10 - - - - - - - -
    4,769.60 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 99 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    3,000.00 - - - - - - - -
    1,050.50 - - - - - - - -
    13,166.98 8 105,335.84 6 79,001.88 - - 14 184,337.72
    23,100.00 - - - - - - - -
    9,900.00 - - - - - - - -
    28,487.50 - - 20 569,750.00 20 569,750.00 - -
    880.00 600 528,000.00 - - 150 132,000.00 450 396,000.00
    183.92 900 165,528.00 - - 100 18,392.00 800 147,136.00
    173.98 1,150 200,077.00 - - 1,000 173,980.00 150 26,097.00
    17,600.00 - - - - - - - -
    22,000.00 - - 45 990,000.00 - - 45 990,000.00
    88.00 - - - - - - - -
    134.38 - - - - - - - -
    198,000.00 - - - - - - - -
    376,200.00 4 1,504,800.00 - - - - 4 1,504,800.00
    334,400.00 - - - - - - - -
    171,600.00 5 858,000.00 - - - - 5 858,000.00
    1,668.98 - - - - - - - -
    5,646.67 - - - - - - - -
    3,336.67 - - - - - - - -
    3,300.00 - - - - - - - -
    574.75 - - - - - - - -
    334.40 - - - - - - - -
    3,465.00 - - - - - - - -
    2,333.30 - - - - - - - -
    25,484.80 26 662,604.80 - - 26 662,604.80 - -
    25,883.00 43 1,112,969.00 - - 27 698,841.00 16 414,128.00
    30,974.90 25 774,372.50 - - 25 774,372.50 - -
    176,000.00 - - - - - - - -
    21,450.00 216 4,633,200.00 - - 96 2,059,200.00 120 2,574,000.00
    135,135.00 - - 50 6,756,750.00 - - 50 6,756,750.00
    558.90 - - - - - - - -
    13,167.00 200 2,633,400.00 - - 52 684,684.00 148 1,948,716.00
    790.91 300 237,273.00 - - - - 300 237,273.00
    873.00 - - - - - - - -
    13,000.50 2,200 28,601,100.00 - - - - 2,200 28,601,100.00
    330.00 - - - - - - - -
    2,664.75 - - - - - - - -
    138.81 - - - - - - - -
    12,375.00 - - - - - - - -
    4,314.24 - - - - - - - -
    1,006.83 - - - - - - - -
    240.01 - - 500 120,005.00 500 120,005.00 - -
    346.67 - - 500 173,335.00 - - 500 173,335.00
    705.76 - - - - - - - -
    2,438.33 - - - - - - - -
    65,450.00 - - - - - - - -
    71,280.00 - - - - - - - -
    1,757.80 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 100 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    1,980.00 - - - - - - - -
    226.00 - - - - - - - -
    221.60 200 44,320.00 - - - - 200 44,320.00
    49,889,575.52

    - -

    50,077.50 - - - - - - - -
    1,510,000.00 - - - - - - - -
    765,000.00 - - - - - - - -
    68,200.00 - - - - - - - -
    4,577.92 - - - - - - - -
    61,884.90 - - 10 618,849.00 10 618,849.00 - -
    1,870.00 - - - - - - - -
    3,025.00 - - - - - - - -
    3,652.00 - - - - - - - -
    6,930.00 - - - - - - - -
    1,980.00 - - - - - - - -
    3,712.50 - - - - - - - -
    4,290.00 - - - - - - - -
    5,236.00 - - - - - - - -
    2,991.52 - - - - - - - -
    5,301.58 - - - - - - - -
    2,394.12 - - - - - - - -
    5,304.66 - - - - - - - -
    6,666.15 - - - - - - - -
    3,861.00 - - - - - - - -
    55,385.00 - - - - - - - -
    46,992.00 - - - - - - - -
    18,480.00 - - 20 369,600.00 10 184,800.00 10 184,800.00
    2,310.00 - - - - - - - -
    8,046.50 - - - - - - - -
    1,258.13 - - 2,000 2,516,260.00 1,000 1,258,130.00 1,000 1,258,130.00
    1,410.75 - - - - - - - -
    5,940.00 - - - - - - - -
    38,498.03 122 4,696,759.66 - - 122 4,696,759.66 - -
    16,500.00 - - - - - - - -
    640,530.00 1 640,530.00 - - - - 1 640,530.00
    6,017.00 - - - - - - - -
    2,376.00 - - - - - - - -
    35,200.00 - - - - - - - -
    29,040.00 - - - - - - - -
    324,472.50 30 9,734,175.00 - - - - 30 9,734,175.00
    0.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 101 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    577.50 - - - - - - - -
    8,800.00 - - - - - - - -
    48,510.00 - - - - - - - -
    911.63 - - - - - - - -
    40,205.00 - - 96 3,859,680.00 96 3,859,680.00 - -
    610.50 - - - - - - - -
    12,787.50 - - - - - - - -
    997.43 - - - - - - - -
    5,500.00 - - - - - - - -
    6,233.33 - - - - - - - -
    36,630.00 - - 150 5,494,500.00 - - 150 5,494,500.00
    8,227.56 - - 150 1,234,134.00 150 1,234,134.00 - -
    8,227.56 - - 210 1,727,787.60 210 1,727,787.60 - -
    8,227.56 - - 60 493,653.60 60 493,653.60 - -
    28,050.00 - - - - - - - -
    91,575.00 - - - - - - - -
    76,300.40 - - - - - - - -
    156,310.00 - - - - - - - -
    80,831.70 - - - - - - - -
    1,980.00 - - - - - - - -
    23,085.70 - - - - - - - -
    15,629.13 - - - - - - - -
    1,354.87 - - - - - - - -
    1,299.03 - - 3,000 3,897,090.00 1,000 1,299,030.00 2,000 2,598,060.00
    1,732.50 - - - - - - - -
    6,426.20 - - - - - - - -
    12,540.00 - - - - - - - -
    14,107.50 - - - - - - - -
    11,495.00 - - - - - - - -
    15,518.25 - - - - - - - -
    2,355.98 - - - - - - - -
    18,699.34 12 224,392.08 - - - - 12 224,392.08
    886.88 - - 500 443,440.00 500 443,440.00 - -
    3,111.63 - - - - - - - -
    17,817.25 - - - - - - - -
    145,530.00 16 2,328,480.00 - - 16 2,328,480.00 - -
    52,614.80 - - - - - - - -
    61,145.70 - - - - - - - -
    6,274.40 - - - - - - - -
    10,732.98 - - 600 6,439,788.00 - - 600 6,439,788.00
    2,751.83 - - - - - - - -
    1,672.00 - - - - - - - -
    15,675.00 - - - - - - - -
    14,200.80 - - - - - - - -
    11,895.83 - - - - - - - -
    86,240.00 - - - - - - - -
    916.36 - - - - - - - -
    16,500.00 - - - - - - - -
    53,240.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 102 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    65,340.00 65 4,247,100.00 100 6,534,000.00 20 1,306,800.00 145 9,474,300.00


    65,823.63 - - - - - - - -
    107,261.00 - - - - - - - -
    3,241.15 - - - - - - - -
    4,950.00 - - - - - - - -
    673.75 - - 900 606,375.00 900 606,375.00 - -
    2,805.00 310 869,550.00 1,300 3,646,500.00 1,610 4,516,050.00 - -
    8,250.00 - - - - - - - -
    4,400.00 - - - - - - - -
    8,910.00 - - - - - - - -
    6,435.00 - - - - - - - -
    8,085.00 - - - - - - - -
    4,958.80 - - - - - - - -
    1,363.63 90 122,726.70 - - - - 90 122,726.70
    31,900.00 - - - - - - - -
    41,030.00 - - - - - - - -
    31,900.00 - - - - - - - -
    41,030.00 - - - - - - - -
    616.00 - - - - - - - -
    2,699.34 - - - - - - - -
    5,151.86 - - - - - - - -
    64,900.00 2 129,800.00 - - 2 129,800.00 - -
    1,435.50 - - - - - - - -
    68,953.50 - - - - - - - -
    10,450.21 - - - - - - - -
    13,543.39 - - 30 406,301.70 30 406,301.70 - -
    23,100.00 - - - - - - - -
    27,361.13 - - - - - - - -
    4,424.48 - - - - - - - -
    15,771.25 5 78,856.25 - - 5 78,856.25 - -
    20,900.00 - - - - - - - -
    31,160.94 - - - - - - - -
    24,887.50 40 995,500.00 - - 40 995,500.00 - -
    4,400.00 - - - - - - - -
    38,362.50 - - - - - - - -
    5,060.00 - - - - - - - -
    29,975.00 - - - - - - - -
    39,462.50 - - - - - - - -
    4,960.31 - - - - - - - -
    31,762.50 - - - - - - - -
    4,705.94 - - - - - - - -
    33,687.50 - - - - - - - -
    36,502.81 - - - - - - - -
    33,577.50 - - - - - - - -
    5,443.63 - - - - - - - -
    40,012.50 - - - - - - - -
    58,575.00 - - - - - - - -
    11,599.50 - - - - - - - -
    76,175.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 103 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    14,041.50 - - - - - - - -
    24,750.00 - - - - - - - -
    3,917.38 - - - - - - - -
    5,367.31 - - - - - - - -
    31,762.50 - - - - - - - -
    15,869.57 1 15,869.57 - - - - 1 15,869.57
    14,575.00 - - - - - - - -
    13,481.88 2 26,963.76 - - - - 2 26,963.76
    45,738.00 - - - - - - - -
    7,892.50 - - - - - - - -
    5,240.13 - - - - - - - -
    33,550.00 - - - - - - - -
    52,525.00 - - - - - - - -
    17,875.00 - - - - - - - -
    3,052.50 - - - - - - - -
    18,392.00 - - 310 5,701,520.00 220 4,046,240.00 90 1,655,280.00
    50,820.00 - - - - - - - -
    2,829.75 - - 80 226,380.00 80 226,380.00 - -
    51,975.00 - - 15 779,625.00 15 779,625.00 - -
    32,835.00 - - 24 788,040.00 24 788,040.00 - -
    34,292.50 - - 24 823,020.00 24 823,020.00 - -
    2,392.50 - - - - - - - -
    6,322.25 - - - - - - - -
    59,812.50 - - - - - - - -
    75,762.50 - - - - - - - -
    9,982.50 - - - - - - - -
    2,772.00 - - - - - - - -
    600.00 - - - - - - - -
    1,360.00 300 408,000.00 - - - - 300 408,000.00
    866.25 300 259,875.00 - - - - 300 259,875.00
    1,716.00 300 514,800.00 - - - - 300 514,800.00
    10,502.80 200 2,100,560.00 - - - - 200 2,100,560.00
    56,265.00 - - - - - - - -
    41,580.00 - - 5 207,900.00 5 207,900.00 - -
    2,475.00 - - 200 495,000.00 200 495,000.00 - -
    10,780.00 10 107,800.00 10 107,800.00 10 107,800.00 10 107,800.00
    3,482.48 - - - - - - - -
    38,416.95 - - - - - - - -
    57,860.00 - - - - - - - -
    38,416.95 - - - - - - - -
    2,950.00 - - - - - - - -
    7,847.99 - - - - - - - -
    45,320.00 - - 13 589,160.00 13 589,160.00 - -
    2,772.00 - - 150 415,800.00 150 415,800.00 - -
    4,808.65 - - 100 480,865.00 100 480,865.00 - -
    12,760.00 20 255,200.00 - - - - 20 255,200.00
    726.00 - - 1,000 726,000.00 1,000 726,000.00 - -
    108,240.00 - - - - - - - -
    46,035.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 104 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    30,134.50 - - - - - - - -
    22,423.50 - - - - - - - -
    51,499.80 - - - - - - - -
    1,595.00 - - - - - - - -
    28,693.61 - - - - - - - -
    1,784.24 - - - - - - - -
    7,199.50 55 395,972.50 - - 40 287,980.00 15 107,992.50
    8,002.50 - - - - - - - -
    7,000.40 78 546,031.20 - - 78 546,031.20 - -
    6,627.50 - - - - - - - -
    6,627.50 - - - - - - - -
    7,363.40 - - - - - - - -
    16,747.50 - - - - - - - -
    10,098.00 - - - - - - - -
    495.00 - - - - - - - -
    1,149.50 - - - - - - - -
    1,595.00 - - - - - - - -
    1,430.00 - - - - - - - -
    818.40 - - - - - - - -
    24,750.00 - - - - - - - -
    1,980.00 - - - - - - - -
    18,150.00 - - - - - - - -
    21,780.00 - - - - - - - -
    1,980.00 - - - - - - - -
    27,500.00 - - - - - - - -
    27,500.00 - - - - - - - -
    2,566.67 - - - - - - - -
    34,101.34 57 1,943,776.38 - - 57 1,943,776.38 - -
    1,645.60 - - 100 164,560.00 - - 100 164,560.00
    15,375.67 - - - - - - - -
    22,239.14 - - - - - - - -
    1,456.28 - - - - - - - -
    19,432.60 - - - - - - - -
    108,454.06 - - - - - - - -
    237,050.00 - - - - - - - -
    99,019.80 - - - - - - - -
    12,100.00 - - - - - - - -
    8,250.00 - - - - - - - -
    9,900.00 - - - - - - - -
    7,920.00 - - - - - - - -
    17,600.00 - - - - - - - -
    8,800.00 - - - - - - - -
    9,680.00 - - - - - - - -
    2,145.00 - - - - - - - -
    42,198.75 - - 10 421,987.50 10 421,987.50 - -
    17,901.35 - - 24 429,632.40 24 429,632.40 - -
    716.10 - - - - - - - -
    165,000.00 - - - - - - - -
    11,618.75 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 105 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    32,054.00 - - - - - - - -
    14,272.50 - - 48 685,080.00 46 656,535.00 2 28,545.00
    684.75 - - 400 273,900.00 400 273,900.00 - -
    40,342.50 - - 18 726,165.00 18 726,165.00 - -
    65,216.25 - - - - - - - -
    1,540.14 - - - - - - - -
    4,282.30 - - 1,000 4,282,300.00 1,000 4,282,300.00 - -
    6,116.00 - - - - - - - -
    5,907.75 - - - - - - - -
    5,775.00 - - - - - - - -
    9,770.75 - - - - - - - -
    2,190.38 - - - - - - - -
    18,315.00 - - 3 54,945.00 3 54,945.00 - -
    47,679.39 - - - - - - - -
    2,111.92 - - - - - - - -
    2,016.86 - - - - - - - -
    1,419.03 - - - - - - - -
    12,827.06 - - 56 718,315.36 56 718,315.36 - -
    3,465.00 - - 240 831,600.00 240 831,600.00 - -
    6,534.00 - - 200 1,306,800.00 60 392,040.00 140 914,760.00
    1,188.00 - - 500 594,000.00 500 594,000.00 - -
    12,100.00 670 8,107,000.00 - - 320 3,872,000.00 350 4,235,000.00
    242.55 1,200 291,060.00 - - - - 1,200 291,060.00
    242.59 700 169,813.00 - - - - 700 169,813.00
    660.00 - - - - - - - -
    42,240.00 96 4,055,040.00 - - 96 4,055,040.00 - -
    157.66 - - - - - - - -
    30,888.00 50 1,544,400.00 150 4,633,200.00 200 6,177,600.00 - -
    20,900.00 - - - - - - - -
    7,700.00 - - - - - - - -
    171.60 - - - - - - - -
    74,250.00 60 4,455,000.00 - - 20 1,485,000.00 40 2,970,000.00
    30,800.00 - - 39 1,201,200.00 39 1,201,200.00 - -
    47,300.00 - - - - - - - -
    39,600.00 100 3,960,000.00 - - 50 1,980,000.00 50 1,980,000.00
    40,425.00 - - 10 404,250.00 10 404,250.00 - -
    6,732.00 950 6,395,400.00 4,000 26,928,000.00 850 5,722,200.00 4,100 27,601,200.00
    1,281.25 - - - - - - - -
    7,260.00 - - 900 6,534,000.00 600 4,356,000.00 300 2,178,000.00
    13,530.00 - - 30 405,900.00 30 405,900.00 - -
    116,875.00 - - - - - - - -
    14,664.33 20 293,286.60 - - 20 293,286.60 - -
    797.50 5,500 4,386,250.00 - - 2,000 1,595,000.00 3,500 2,791,250.00
    724.63 - - - - - - - -
    1,571.63 - - 4,500 7,072,335.00 - - 4,500 7,072,335.00
    738.38 - - - - - - - -
    2,253.35 800 1,802,680.00 - - 800 1,802,680.00 - -
    2,253.35 - - 8,000 18,026,800.00 2,500 5,633,375.00 5,500 12,393,425.00
    5,610.00 - - 300 1,683,000.00 300 1,683,000.00 - -

    DATA KEBUTUHAN OBAT REVISI 106 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    56,100.00 - - 20 1,122,000.00 15 841,500.00 5 280,500.00


    2,970.00 - - 1,000 2,970,000.00 800 2,376,000.00 200 594,000.00
    45,100.00 - - - - - - - -
    18,700.00 - - - - - - - -
    19,673.50 - - 10 196,735.00 5 98,367.50 5 98,367.50
    50,930.00 - - - - - - - -
    6,277.70 - - - - - - - -
    89,760.00 - - - - - - - -
    39,602.62 48 1,900,925.76 - - - - 48 1,900,925.76
    41,232.08 48 1,979,139.84 - - - - 48 1,979,139.84
    245,025.00 - - 20 4,900,500.00 20 4,900,500.00 - -
    6,428.50 - - 300 1,928,550.00 300 1,928,550.00 - -
    7,084.43 - - 450 3,187,993.50 120 850,131.60 330 2,337,861.90
    851,166.05 5 4,255,830.25 - - 2 1,702,332.10 3 2,553,498.15
    152,075.00 21 3,193,575.00 - - 12 1,824,900.00 9 1,368,675.00
    31,900.00 - - - - - - - -
    13,736.45 55 755,504.75 - - - - 55 755,504.75
    3,866.50 - - - - - - - -
    3,192.64 - - - - - - - -
    6,435.00 - - - - - - - -
    13,860.00 - - 200 2,772,000.00 200 2,772,000.00 - -
    4,471.50 - - 500 2,235,750.00 500 2,235,750.00 - -
    3,737.25 - - 500 1,868,625.00 500 1,868,625.00 - -
    5,198.87 - - - - - - - -
    7,749.06 - - - - - - - -
    93,555.00 - - 60 5,613,300.00 40 3,742,200.00 20 1,871,100.00
    4,664.00 - - 300 1,399,200.00 300 1,399,200.00 - -
    49,126.00 - - - - - - - -
    2,552.00 - - 600 1,531,200.00 450 1,148,400.00 150 382,800.00
    3,987.50 3,780 15,072,750.00 - - - - 3,780 15,072,750.00
    532.99 - - - - - - - -
    444,999.50 5 2,224,997.50 - - 5 2,224,997.50 - -
    445,000.00 10 4,450,000.00 - - 2 890,000.00 8 3,560,000.00
    3,118.50 - - 1,300 4,054,050.00 - - 1,300 4,054,050.00
    3,239.50 - - - - - - - -
    56,430.00 - - - - - - - -
    5,808.00 - - - - - - - -
    32,604.00 - - - - - - - -
    31,559.00 - - - - - - - -
    52,250.00 - - - - - - - -
    7,480.00 - - 450 3,366,000.00 450 3,366,000.00 - -
    9,702.00 - - - - - - - -
    19,057.50 - - - - - - - -
    598,577.45 - - 20 11,971,549.00 20 11,971,549.00 - -
    20,420.40 - - - - - - - -
    12,762.75 - - - - - - - -
    12,276.00 - - - - - - - -
    79,381.50 - - - - - - - -
    13,090.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 107 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    26,083.56 - - 300 7,825,068.00 - - 300 7,825,068.00


    6,899.61 - - - - - - - -
    10,573.70 - - - - - - - -
    7,629.47 - - - - - - - -
    7,702.52 - - - - - - - -
    14,168.00 - - - - - - - -
    9,900.00 - - 270 2,673,000.00 90 891,000.00 180 1,782,000.00
    9,405.00 - - 120 1,128,600.00 - - 120 1,128,600.00
    41,580.00 - - - - - - - -
    0.00 - - - - - - - -
    41,360.00 - - - - - - - -
    44,440.00 - - - - - - - -
    12,100.00 - - - - - - - -
    6,292.00 - - - - - - - -
    58,080.00 - - - - - - - -
    6,028.00 - - - - - - - -
    52,998.00 110 5,829,780.00 200 10,599,600.00 100 5,299,800.00 210 11,129,580.00
    15,400.00 - - - - - - - -
    22,880.00 - - - - - - - -
    4,108.50 50 205,425.00 - - - - 50 205,425.00
    13,695.00 - - 15 205,425.00 15 205,425.00 - -
    11,500.50 - - - - - - - -
    1,577.22 300 473,166.00 - - - - 300 473,166.00
    3,500.75 - - - - - - - -
    13,585.00 - - - - - - - -
    4,242.70 - - - - - - - -
    36,575.00 - - - - - - - -
    41,580.00 - - - - - - - -
    55,902.00 - - - - - - - -
    46,530.00 - - - - - - - -
    7,920.00 - - - - - - - -
    3,743.30 - - 1,000 3,743,300.00 1,000 3,743,300.00 - -
    7,590.00 - - - - - - - -
    31,185.00 - - 10 311,850.00 10 311,850.00 - -
    43,560.00 - - - - - - - -
    18,700.00 - - 96 1,795,200.00 96 1,795,200.00 - -
    2,752.70 - - - - - - - -
    6,160.00 - - - - - - - -
    29,040.00 - - - - - - - -
    5,720.00 - - 300 1,716,000.00 300 1,716,000.00 - -
    3,960.00 - - 450 1,782,000.00 450 1,782,000.00 - -
    6,360.00 - - - - - - - -
    106,480.00 - - - - - - - -
    6,050.00 - - - - - - - -
    23,100.00 - - - - - - - -
    44,055.00 - - - - - - - -
    104,500.00 - - - - - - - -
    70,400.00 - - - - - - - -
    33,000.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 108 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    22,880.00 - - - - - - - -
    14,587.85 - - - - - - - -
    5,018.73 - - - - - - - -
    42,240.00 - - - - - - - -
    48,510.00 - - - - - - - -
    38,500.00 - - - - - - - -
    6,583.50 - - 720 4,740,120.00 720 4,740,120.00 - -
    16,573.33 - - 270 4,474,799.10 270 4,474,799.10 - -
    2,257.20 - - 300 677,160.00 300 677,160.00 - -
    89,000.00 - - 50 4,450,000.00 50 4,450,000.00 - -
    63,195.00 - - - - - - - -
    66,000.00 - - - - - - - -
    59,400.00 - - - - - - - -
    17,950.74 - - 120 2,154,088.80 - - 120 2,154,088.80
    21,043.20 - - - - - - - -
    6,187.50 300 1,856,250.00 450 2,784,375.00 - - 750 4,640,625.00
    825.00 - - 180 148,500.00 180 148,500.00 - -
    4,752.00 - - 150 712,800.00 150 712,800.00 - -
    36,630.00 - - - - - - - -
    32,340.00 - - 30 970,200.00 15 485,100.00 15 485,100.00
    29,507.50 - - - - - - - -
    26,959.90 20 539,198.00 - - 20 539,198.00 - -
    52,361.96 - - - - - - - -
    70,125.00 - - - - - - - -
    520.02 - - - - - - - -
    1,174.80 - - 1,000 1,174,800.00 1,000 1,174,800.00 - -
    824.99 - - 5,000 4,124,950.00 - - 5,000 4,124,950.00
    6,749.60 113 762,704.80 - - - - 113 762,704.80
    4,089.80 180 736,164.00 - - 38 155,412.40 142 580,751.60
    12,566.12 - - - - - - - -
    16,291.55 - - - - - - - -
    10,560.00 - - 450 4,752,000.00 360 3,801,600.00 90 950,400.00
    19,360.00 - - - - - - - -
    473.00 - - - - - - - -
    38,500.00 - - - - - - - -
    20,900.00 - - - - - - - -
    31,102.50 - - - - - - - -
    18,342.50 - - - - - - - -
    22,330.00 - - 48 1,071,840.00 48 1,071,840.00 - -
    1,116.50 - - 500 558,250.00 500 558,250.00 - -
    30,360.00 - - - - - - - -
    5,445.00 - - - - - - - -
    7,463.75 200 1,492,750.00 - - - - 200 1,492,750.00
    3,168.00 - - - - - - - -
    15,675.00 - - 50 783,750.00 - - 50 783,750.00
    10,477.50 - - 5 52,387.50 5 52,387.50 - -
    10,571.00 2 21,142.00 - - 2 21,142.00 - -
    1,120.00 - - - - - - - -
    1,308.38 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 109 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    2,505.60 - - - - - - - -
    10,807.96 - - - - - - - -
    574.75 - - - - - - - -
    1,265.00 2,000 2,530,000.00 - - - - 2,000 2,530,000.00
    2,508.00 - - - - - - - -
    2,107.59 - - 1,000 2,107,590.00 1,000 2,107,590.00 - -
    4,211.90 - - 200 842,380.00 200 842,380.00 - -
    985.88 - - - - - - - -
    62,700.00 - - - - - - - -
    557.15 - - - - - - - -
    1,640.11 - - - - - - - -
    2,530.17 - - - - - - - -
    2,530.16 - - - - - - - -
    5,543.47 - - - - - - - -
    251,344.70 - - - - - - - -
    112,000.00 - - 150 16,800,000.00 - - 150 16,800,000.00
    89,500.00 30 2,685,000.00 - - 30 2,685,000.00 - -
    39,187.50 - - - - - - - -
    33,000.00 - - - - - - - -
    16,500.00 - - - - - - - -
    57,420.00 - - - - - - - -
    35,887.50 - - - - - - - -
    2,791.25 - - 180 502,425.00 180 502,425.00 - -
    31,460.00 - - 36 1,132,560.00 36 1,132,560.00 - -
    258,720.00 - - - - - - - -
    23,925.00 - - - - - - - -
    17,545.00 - - - - - - - -
    2,512.13 - - - - - - - -
    6,380.00 - - - - - - - -
    1,196.25 - - - - - - - -
    8,772.50 - - - - - - - -
    3,190.00 1,500 4,785,000.00 - - 600 1,914,000.00 900 2,871,000.00
    4,826.25 - - - - - - - -
    21,532.50 - - 8 172,260.00 8 172,260.00 - -
    19,140.00 - - - - - - - -
    139,315.00 - - 5 696,575.00 5 696,575.00 - -
    7,978.67 - - 150 1,196,800.50 150 1,196,800.50 - -
    29,683.50 - - 20 593,670.00 20 593,670.00 - -
    11,962.50 5 59,812.50 50 598,125.00 55 657,937.50 - -
    9,570.00 50 478,500.00 - - 50 478,500.00 - -
    43,725.00 - - 10 437,250.00 - - 10 437,250.00
    23,925.00 - - - - - - - -
    17,545.00 - - - - - - - -
    41,800.00 - - 48 2,006,400.00 48 2,006,400.00 - -
    14,850.00 - - 96 1,425,600.00 58 861,300.00 38 564,300.00
    51,425.00 - - 20 1,028,500.00 20 1,028,500.00 - -
    33,825.00 - - 10 338,250.00 10 338,250.00 - -
    14,602.50 - - - - - - - -
    65,560.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 110 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    387,920.00 - - - - - - - -
    9,567.25 200 1,913,450.00 - - 30 287,017.50 170 1,626,432.50
    18,818.27 - - 20 376,365.40 20 376,365.40 - -
    29,287.50 - - 10 292,875.00 10 292,875.00 - -
    2,932.60 - - 900 2,639,340.00 150 439,890.00 750 2,199,450.00
    2,392.50 - - - - - - - -
    3,588.75 - - - - - - - -
    13,090.00 300 3,927,000.00 - - - - 300 3,927,000.00
    50,682.50 - - - - - - - -
    74,250.00 - - - - - - - -
    19,245.60 - - - - - - - -
    22,096.80 - - - - - - - -
    26,675.00 - - - - - - - -
    17,765.00 - - - - - - - -
    4,851.00 - - - - - - - -
    11,099.55 - - - - - - - -
    37,620.00 - - - - - - - -
    11,162.25 - - 1,000 11,162,250.00 1,000 11,162,250.00 - -
    115,500.00 - - 25 2,887,500.00 25 2,887,500.00 - -
    2,079.00 - - 300 623,700.00 300 623,700.00 - -
    5,500.00 - - - - - - - -
    7,370.00 - - - - - - - -
    7,370.00 - - - - - - - -
    5,500.00 - - - - - - - -
    44,000.00 - - - - - - - -
    3,222.45 - - 1,200 3,866,940.00 - - 1,200 3,866,940.00
    1,771.00 700 1,239,700.00 - - 100 177,100.00 600 1,062,600.00
    193,963.00 - - 12 2,327,556.00 10 1,939,630.00 2 387,926.00
    180,592.50 28 5,056,590.00 150 27,088,875.00 28 5,056,590.00 150 27,088,875.00
    1,159.90 - - - - - - - -
    5,343.90 - - 300 1,603,170.00 300 1,603,170.00 - -
    30,250.00 - - 48 1,452,000.00 24 726,000.00 24 726,000.00
    1,232.00 - - 1,500 1,848,000.00 250 308,000.00 1,250 1,540,000.00
    52,800.00 - - 24 1,267,200.00 24 1,267,200.00 - -
    4,114.00 - - 1,000 4,114,000.00 500 2,057,000.00 500 2,057,000.00
    39,600.00 - - 24 950,400.00 12 475,200.00 12 475,200.00
    2,200.00 - - - - - - - -
    7,805.60 - - 3,500 27,319,600.00 3,500 27,319,600.00 - -
    7,703.30 - - - - - - - -
    7,703.30 - - - - - - - -
    7,629.60 - - - - - - - -
    7,171.82 - - - - - - - -
    11,235.40 - - - - - - - -
    6,682.50 - - - - - - - -
    112,000.00 - - 425 47,600,000.00 - - 425 47,600,000.00
    28,985.00 - - 96 2,782,560.00 96 2,782,560.00 - -
    7,499.80 25 187,495.00 - - 25 187,495.00 - -
    13,905.65 - - - - - - - -
    25,960.00 25 649,000.00 50 1,298,000.00 45 1,168,200.00 30 778,800.00

    DATA KEBUTUHAN OBAT REVISI 111 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    21,340.00 33 704,220.00 - - - - 33 704,220.00


    16,709.00 - - - - - - - -
    9,900.00 - - - - - - - -
    11,797.50 - - 48 566,280.00 24 283,140.00 24 283,140.00
    8,167.50 - - 48 392,040.00 24 196,020.00 24 196,020.00
    184,624.00 - - - - - - - -
    15,280.65 - - 50 764,032.50 50 764,032.50 - -
    4,310.63 - - - - - - - -
    50,916.14 - - - - - - - -
    11,990.00 6 71,940.00 72 863,280.00 72 863,280.00 6 71,940.00
    12,702.25 150 1,905,337.50 - - - - 150 1,905,337.50
    21,909.25 - - - - - - - -
    280.50 - - - - - - - -
    9,652.50 - - 72 694,980.00 24 231,660.00 48 463,320.00
    239.25 - - - - - - - -
    25,605.80 - - - - - - - -
    13,482.70 - - 10 134,827.00 10 134,827.00 - -
    12,779.94 - - - - - - - -
    89,000.01 175 15,575,001.75 100 8,900,001.00 95 8,455,000.95 180 16,020,001.80
    28,499.90 - - - - - - - -
    26,400.00 - - - - - - - -
    49,555.00 - - 50 2,477,750.00 50 2,477,750.00 - -
    23,375.00 - - 100 2,337,500.00 100 2,337,500.00 - -
    125,087.12 - - - - - - - -
    136,804.84 - - - - - - - -
    111,290.95 - - - - - - - -
    4,401.00 - - - - - - - -
    7,700.00 - - 90 693,000.00 90 693,000.00 - -
    888.86 2,000 1,777,720.00 - - - - 2,000 1,777,720.00
    7,568.01 - - - - - - - -
    11,440.00 - - - - - - - -
    11,440.00 - - - - - - - -
    11,440.00 - - - - - - - -
    10,560.00 - - - - - - - -
    24,267.76 29 703,765.04 - - - - 29 703,765.04
    6,763.90 100 676,390.00 - - 100 676,390.00 - -
    6,800.20 703 4,780,540.60 - - 703 4,780,540.60 - -
    9,240.00 - - - - - - - -
    6,839.80 - - - - - - - -
    7,810.00 - - - - - - - -
    9,240.00 - - - - - - - -
    2,145,000.00 - - - - - - - -
    3,696.00 - - 30 110,880.00 30 110,880.00 - -
    5,797.00 - - - - - - - -
    16,310.25 - - 450 7,339,612.50 450 7,339,612.50 - -
    23,553.75 - - 650 15,309,937.50 650 15,309,937.50 - -
    68,846.25 - - 10 688,462.50 10 688,462.50 - -
    29,501.06 65 1,917,568.90 - - 10 295,010.60 55 1,622,558.30
    19,667.34 62 1,219,375.08 - - 10 196,673.40 52 1,022,701.68

    DATA KEBUTUHAN OBAT REVISI 112 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    5,445.00 - - 60 326,700.00 - - 60 326,700.00


    2,178.00 - - - - - - - -
    135,010.95 90 12,150,985.50 - - 10 1,350,109.50 80 10,800,876.00
    134,787.67 90 12,130,890.30 - - 40 5,391,506.80 50 6,739,383.50
    57,717.00 - - 20 1,154,340.00 20 1,154,340.00 - -
    57,970.00 - - - - - - - -
    12,300.75 - - - - - - - -
    6,133.05 - - - - - - - -
    2,816.00 - - - - - - - -
    9,900.00 - - - - - - - -
    150,829.25 - - 80 12,066,340.00 80 12,066,340.00 - -
    208,538.00 15 3,128,070.00 - - 6 1,251,228.00 9 1,876,842.00
    74,332.50 - - - - - - - -
    43,945.00 - - - - - - - -
    1,946.45 - - - - - - - -
    1,310.14 - - - - - - - -
    2,367.28 - - 60 142,036.80 60 142,036.80 - -
    26,526.50 - - - - - - - -
    36,729.00 - - - - - - - -
    1,828.75 - - - - - - - -
    50,801.30 - - - - - - - -
    6,380.00 - - - - - - - -
    5,901.50 - - - - - - - -
    30,305.00 - - - - - - - -
    4,386.25 200 877,250.00 - - - - 200 877,250.00
    4,386.25 - - - - - - - -
    3,410.00 - - - - - - - -
    15,446.20 - - 200 3,089,240.00 200 3,089,240.00 - -
    3,960.00 - - - - - - - -
    16,912.50 - - 72 1,217,700.00 - - 72 1,217,700.00
    1,200.38 - - 3,000 3,601,140.00 1,500 1,800,570.00 1,500 1,800,570.00
    1,415.15 - - - - - - - -
    10,692.00 - - - - - - - -
    11,499.30 480 5,519,664.00 - - 24 275,983.20 456 5,243,680.80
    28,644.00 - - - - - - - -
    2,376.00 - - - - - - - -
    19,937.50 - - - - - - - -
    1,435.50 - - - - - - - -
    3,234.00 - - - - - - - -
    67,787.50 - - - - - - - -
    31,900.00 - - - - - - - -
    1,435.50 - - - - - - - -
    11,797.50 50 589,875.00 100 1,179,750.00 110 1,297,725.00 40 471,900.00
    29,700.00 75 2,227,500.00 - - 25 742,500.00 50 1,485,000.00
    4,455.00 - - - - - - - -
    10,890.00 - - - - - - - -
    26,049.10 - - 30 781,473.00 30 781,473.00 - -
    54,820.15 - - - - - - - -
    9,906.05 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 113 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    14,206.50 - - 50 710,325.00 50 710,325.00 - -


    23,760.00 10 237,600.00 - - - - 10 237,600.00
    8,360.00 - - - - - - - -
    6,061.00 - - - - - - - -
    6,667.10 - - 100 666,710.00 100 666,710.00 - -
    10,956.00 - - - - - - - -
    20,086.00 - - - - - - - -
    70,180.00 - - 72 5,052,960.00 72 5,052,960.00 - -
    185.89 - - - - - - - -
    322.30 - - - - - - - -
    13,852.30 - - 50 692,615.00 40 554,092.00 10 138,523.00
    88,000.00 - - - - - - - -
    17,820.00 - - - - - - - -
    6,488.90 - - 150 973,335.00 150 973,335.00 - -
    200,750.00 - - - - - - - -
    1,613.33 60 96,799.80 150 241,999.50 - - 210 338,799.30
    3,740.00 - - - - - - - -
    33,660.00 - - - - - - - -
    907.50 - - - - - - - -
    783.75 - - - - - - - -
    3,979.99 - - - - - - - -
    2,220.76 - - - - - - - -
    4,552.02 - - - - - - - -
    36,575.00 - - - - - - - -
    4,207.50 - - 300 1,262,250.00 - - 300 1,262,250.00
    2,508.00 300 752,400.00 - - - - 300 752,400.00
    36,025.00 - - - - - - - -
    39,385.50 - - - - - - - -
    72,155.60 - - - - - - - -
    24,864.40 - - - - - - - -
    161,698.90 - - - - - - - -
    6,013.86 - - 100 601,386.00 50 300,693.00 50 300,693.00
    25,520.00 - - - - - - - -
    10,766.25 - - - - - - - -
    28,215.00 - - 5 141,075.00 5 141,075.00 - -
    2,640.00 - - 300 792,000.00 100 264,000.00 200 528,000.00
    28,215.00 - - - - - - - -
    3,050.30 - - - - - - - -
    19,724.93 - - - - - - - -
    23,760.00 - - - - - - - -
    22,990.00 - - - - - - - -
    24,035.00 - - - - - - - -
    444.13 - - - - - - - -
    51,627.31 - - - - - - - -
    24,200.00 - - - - - - - -
    59,400.00 - - - - - - - -
    34,485.00 - - - - - - - -
    103,455.00 - - - - - - - -
    6,281.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 114 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    30,250.00 - - - - - - - -
    99,000.00 1 99,000.00 - - 1 99,000.00 - -
    1,615.16 1,038 1,676,536.08 - - - - 1,038 1,676,536.08
    357,126,024.21

    17,094.00 - - - - - - - -
    114,647.50 - - - - - - - -
    181,390.00 - - - - - - - -
    9,900.00 - - - - - - - -
    12,100.00 - - - - - - - -
    34,760.00 - - 48 1,668,480.00 48 1,668,480.00 - -
    1,048.16 - - - - - - - -
    4,840,535.70 - - - - - - - -
    3,465.00 - - - - - - - -
    16,039.10 - - 20 320,782.00 20 320,782.00 - -
    4,092.00 - - - - - - - -
    8,800.00 - - - - - - - -
    8,800.00 - - - - - - - -
    8,800.00 - - - - - - - -
    7,150.00 - - - - - - - -
    3,850.00 - - - - - - - -
    126,837.70 - - - - - - - -
    6,395.40 28 179,071.20 - - - - 28 179,071.20
    10,857.55 - - - - - - - -
    5,680.04 - - - - - - - -
    303,050.00 - - - - - - - -
    346,500.00 - - - - - - - -
    6,940.54 - - - - - - - -
    8,866.00 - - - - - - - -
    16,016.00 - - - - - - - -
    2,217.60 - - - - - - - -
    3,243.90 - - - - - - - -
    1,633,500.00 - - - - - - - -
    7,975.00 - - - - - - - -
    465.85 - - - - - - - -
    23,474.00 - - - - - - - -
    50,820.00 - - - - - - - -
    41,118.00 - - - - - - - -
    6,303.00 - - - - - - - -
    14,223.91 - - - - - - - -
    7,601.52 - - - - - - - -
    70,188.80 - - - - - - - -
    184,910.00 - - - - - - - -
    101,200.00 - - - - - - - -
    72,800.20 - - - - - - - -
    43,659.00 - - - - - - - -
    79,200.00 - - - - - - - -
    2,640.00 - - 300 792,000.00 300 792,000.00 - -

    DATA KEBUTUHAN OBAT REVISI 115 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    19,181.25 - - - - - - - -
    27,720.00 - - - - - - - -
    10,120.00 30 303,600.00 - - - - 30 303,600.00
    139.15 - - - - - - - -
    183.65 - - - - - - - -
    2,310.00 - - - - - - - -
    10,659.00 - - - - - - - -
    14,245.00 - - - - - - - -
    86,564.80 - - - - - - - -
    39,270.00 - - - - - - - -
    49,500.00 - - - - - - - -
    5,763.45 - - - - - - - -
    14,666.67 - - - - - - - -
    21,423.55 - - - - - - - -
    49,170.00 18 885,060.00 - - - - 18 885,060.00
    9,753.33 - - - - - - - -
    1,540.00 - - - - - - - -
    9,680.00 - - - - - - - -
    1,904.90 - - - - - - - -
    1,430.00 - - - - - - - -
    11,434.50 - - - - - - - -
    11,434.50 - - - - - - - -
    1,379.40 - - - - - - - -
    170,500.00 - - - - - - - -
    112,476.10 - - - - - - - -
    377,338.50 - - - - - - - -
    53,227.70 - - - - - - - -
    19,841.00 - - - - - - - -
    236,498.60 - - - - - - - -
    11,568.43 - - - - - - - -
    43,913.10 - - - - - - - -
    8,433.33 - - - - - - - -
    96,525.00 - - - - - - - -
    3,561.25 - - - - - - - -
    127,187.50 - - - - - - - -
    14,300.00 - - - - - - - -
    34,485.00 - - - - - - - -
    12,540.00 - - - - - - - -
    1,707.20 - - - - - - - -
    3,080.00 - - - - - - - -
    104,720.00 2 209,440.00 - - - - 2 209,440.00
    104,720.00 20 2,094,400.00 - - - - 20 2,094,400.00
    2,664,750.00 - - - - - - - -
    324,496.00 - - - - - - - -
    1,650.00 - - - - - - - -
    2,255.00 - - - - - - - -
    1,391.50 - - - - - - - -
    11,000.00 - - - - - - - -
    11,825.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 116 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    29,782.50 - - - - - - - -
    1,766.99 - - - - - - - -
    9,900.00 - - - - - - - -
    75,680.00 16 1,210,880.00 35 2,648,800.00 28 2,119,040.00 23 1,740,640.00
    11,733.33 - - - - - - - -
    7,150.00 - - - - - - - -
    1,221.00 - - - - - - - -
    36,960.00 - - - - - - - -
    1,479.09 - - - - - - - -
    49,274.50 - - - - - - - -
    150,150.00 - - - - - - - -
    4,372.50 - - - - - - - -
    2,106.50 - - - - - - - -
    80,270.63 - - - - - - - -
    473.14 300 141,942.00 - - 300 141,942.00 - -
    67,872.75 - - - - - - - -
    10,595.20 - - - - - - - -
    91,385.25 - - - - - - - -
    15,592.50 - - - - - - - -
    44,935.00 - - - - - - - -
    12,540.00 - - - - - - - -
    30,855.00 - - - - - - - -
    8,882.50 - - - - - - - -
    35,766.50 - - - - - - - -
    86,240.00 - - - - - - - -
    12,558.04 - - - - - - - -
    7,601.00 - - - - - - - -
    7,124.04 - - - - - - - -
    58,251.60 - - - - - - - -
    8,322.60 56 466,065.60 - - - - 56 466,065.60
    21,961.50 - - - - - - - -
    25,856.82 - - - - - - - -
    12,856.25 - - - - - - - -
    14,960.00 - - - - - - - -
    427,710.40 - - - - - - - -
    33,558.14 - - - - - - - -
    4,148.14 - - - - - - - -
    16,042.03 - - - - - - - -
    8,797.80 - - - - - - - -
    4,576.00 - - - - - - - -
    7,012.50 - - - - - - - -
    4,125.00 - - - - - - - -
    1,306.25 - - - - - - - -
    5,599.99 - - - - - - - -
    10,079.96 - - - - - - - -
    8,855.00 - - - - - - - -
    9,132.75 - - - - - - - -
    2,003.38 - - - - - - - -
    1,236.12 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 117 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    103,950.00 - - - - - - - -
    55,585.75 - - - - - - - -
    42,262.00 - - - - - - - -
    2,524.50 - - - - - - - -
    8,763.70 - - - - - - - -
    4,944.50 - - - - - - - -
    8,268.67 - - - - - - - -
    5,197.50 - - - - - - - -
    727.65 - - - - - - - -
    187,000.00 - - - - - - - -
    7,236.22 - - 27 195,377.94 27 195,377.94 - -
    73,662.63 - - - - - - - -
    33,900.00 10 339,000.00 - - - - 10 339,000.00
    4,986.36 - - - - - - - -
    18,150.00 - - - - - - - -
    28,710.00 - - - - - - - -
    2,667.04 - - - - - - - -
    1,686.67 - - - - - - - -
    1,007.85 - - - - - - - -
    20,545.25 - - - - - - - -
    8,369.63 - - 100 836,963.00 100 836,963.00 - -
    35,392.50 - - - - - - - -
    63,170.25 - - - - - - - -
    91,300.00 - - - - - - - -
    103,455.00 - - - - - - - -
    22,990.00 - - - - - - - -
    202,554.00 - - - - - - - -
    17,654.00 100 1,765,400.00 - - - - 100 1,765,400.00
    484.00 - - - - - - - -
    7,150.00 - - - - - - - -
    22,638.00 - - 210 4,753,980.00 210 4,753,980.00 - -
    15,605.15 - - - - - - - -
    170,280.00 10 1,702,800.00 - - - - 10 1,702,800.00
    6,129.20 - - - - - - - -
    214,500.00 - - - - - - - -
    4,766.67 - - - - - - - -
    120,062.80 - - - - - - - -
    12,100.00 - - - - - - - -
    14,003.00 - - - - - - - -
    13,200.00 - - - - - - - -
    11,082.50 - - - - - - - -
    10,956.00 - - - - - - - -
    6,050.00 - - - - - - - -
    6,864.00 - - - - - - - -
    27,500.00 - - - - - - - -
    16,500.00 - - - - - - - -
    11,550.00 - - - - - - - -
    121,000.00 - - - - - - - -
    11,165.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 118 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    58,080.00 - - - - - - - -
    12,888.33 - - - - - - - -
    67,925.00 - - - - - - - -
    16,788.75 - - - - - - - -
    4,070.00 - - - - - - - -
    29,700.00 - - - - - - - -
    5,940.00 - - - - - - - -
    1,881.00 - - - - - - - -
    34,787.50 - - - - - - - -
    11,000.00 - - - - - - - -
    1,562.00 - - - - - - - -
    15,200.63 - - - - - - - -
    27,830.00 - - - - - - - -
    4,400.00 - - - - - - - -
    12,540.00 - - - - - - - -
    4,449.52 - - - - - - - -
    9,240.00 - - - - - - - -
    7,937.60 - - - - - - - -
    61,105.00 8 488,840.00 - - 8 488,840.00 - -
    4,510.00 500 2,255,000.00 - - - - 500 2,255,000.00
    2,200.00 - - - - - - - -
    478.50 - - - - - - - -
    14,663.00 - - - - - - - -
    3,260.40 - - - - - - - -
    748.00 - - - - - - - -
    5,122.00 - - - - - - - -
    73,810.00 - - - - - - - -
    16,500.00 30 495,000.00 - - - - 30 495,000.00
    32,714.88 - - - - - - - -
    7,193.85 - - - - - - - -
    5,500.00 - - - - - - - -
    239.25 - - 2,000 478,500.00 800 191,400.00 1,200 287,100.00
    11,220.00 - - - - - - - -
    7,177.50 - - 30 215,325.00 - - 30 215,325.00
    20,790.00 - - - - - - - -
    16,170.00 - - - - - - - -
    1,100,000.00 - - - - - - - -
    425,000.00 - - - - - - - -
    17,068.33 - - - - - - - -
    294,800.00 - - - - - - - -
    121,000.00 - - - - - - - -
    38,665.00 - - - - - - - -
    26,950.00 - - - - - - - -
    14,746.83 - - - - - - - -
    23,144.28 - - - - - - - -
    22,632.81 - - - - - - - -
    13,256.38 - - 90 1,193,074.20 60 795,382.80 30 397,691.40
    1,980.00 - - - - - - - -
    19,800.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 119 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    1,980.00 - - - - - - - -
    2,970.00 - - - - - - - -
    79,200.00 - - 5 396,000.00 5 396,000.00 - -
    1,782.00 - - - - - - - -
    6,500.01 - - - - - - - -
    20,900.00 - - - - - - - -
    13,913.35 - - - - - - - -
    11,011.00 - - - - - - - -
    2,053.33 - - - - - - - -
    12,923.35 - - - - - - - -
    2,732.40 - - - - - - - -
    3,762.00 - - - - - - - -
    370.84 - - - - - - - -
    8,800.00 - - - - - - - -
    20,240.00 - - - - - - - -
    5,500.00 - - - - - - - -
    37,950.00 - - - - - - - -
    1,483.02 - - - - - - - -
    11,440.00 - - - - - - - -
    15,400.00 - - - - - - - -
    14,300.00 - - - - - - - -
    8,043.75 - - - - - - - -
    7,150.00 - - - - - - - -
    5,227.20 - - - - - - - -
    8,250.00 - - - - - - - -
    2,673.00 - - - - - - - -
    172,370.00 - - - - - - - -
    1,200.10 - - - - - - - -
    18,021.93 - - - - - - - -
    10,071.60 - - - - - - - -
    5,928.00 - - - - - - - -
    91,905.00 - - - - - - - -
    5,000.22 - - - - - - - -
    18,823.75 - - - - - - - -
    110,000.00 - - - - - - - -
    25,080.00 - - - - - - - -
    1,300,000.00 - - - - - - - -
    400,000.00 - - - - - - - -
    9,137.46 - - - - - - - -
    23,375.00 - - - - - - - -
    28,600.00 - - - - - - - -
    28,710.00 - - - - - - - -
    10,459.90 100 1,045,990.00 - - 20 209,198.00 80 836,792.00
    7,150.00 160 1,144,000.00 - - 40 286,000.00 120 858,000.00
    1,973.81 - - - - - - - -
    5,280.00 - - - - - - - -
    5,280.00 - - - - - - - -
    419,210.00 - - - - - - - -
    2,992.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 120 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    81,510.00 - - - - - - - -
    228,800.00 - - - - - - - -
    29,040.00 - - - - - - - -
    305,890.20 - - - - - - - -
    87,120.00 - - - - - - - -
    4,505.52 - - - - - - - -
    5,940.00 - - - - - - - -
    1,017.89 - - - - - - - -
    8,856.49 - - - - - - - -
    698.93 - - - - - - - -
    4,455.00 - - - - - - - -
    6,792.50 - - - - - - - -
    13,062.50 - - - - - - - -
    10,972.50 - - - - - - - -
    6,270.00 - - - - - - - -
    3,085.50 - - - - - - - -
    30,855.00 - - - - - - - -
    223,905.00 50 11,195,250.00 - - 20 4,478,100.00 30 6,717,150.00
    126,225.00 - - - - - - - -
    18,631.47 - - - - - - - -
    3,082.75 - - - - - - - -
    47,355.00 - - - - - - - -
    2,818.06 100 281,806.00 - - - - 100 281,806.00
    70,441.00 - - - - - - - -
    23,984.71 - - - - - - - -
    4,873.00 - - - - - - - -
    1,320.00 - - - - - - - -
    13,958.71 25 348,967.75 - - 20 279,174.20 5 69,793.55
    19,502.56 25 487,564.00 - - 20 390,051.20 5 97,512.80
    66,000.00 - - - - - - - -
    2,420,000.00 - - - - - - - -
    3,465.44 - - - - - - - -
    3,850.00 - - - - - - - -
    82,500.00 - - - - - - - -
    3,064.71 - - - - - - - -
    2,376.00 - - - - - - - -
    1,485.00 - - - - - - - -
    75,971.50 - - - - - - - -
    40,920.00 - - - - - - - -
    23,402.50 - - - - - - - -
    110,000.00 - - - - - - - -
    1,567.50 - - - - - - - -
    1,499.52 - - - - - - - -
    53,295.00 - - - - - - - -
    2,787.02 - - - - - - - -
    569,800.00 - - 5 2,849,000.00 5 2,849,000.00 - -
    19,800.00 - - - - - - - -
    88,000.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 121 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    68,207.15 - - - - - - - -
    8,882.50 - - - - - - - -
    1,650.00 - - - - - - - -
    948.67 - - - - - - - -
    294,525.00 - - - - - - - -
    583,275.00 - - - - - - - -
    146.30 - - - - - - - -
    46,750.00 - - - - - - - -
    3,546.00 - - - - - - - -
    5,427.99 - - - - - - - -
    131,587.50 - - - - - - - -
    117,985.23 - - - - - - - -
    5,940.00 - - - - - - - -
    1,155.00 - - - - - - - -
    2,117.50 - - - - - - - -
    9,900.00 - - - - - - - -
    95,040.00 - - - - - - - -
    26,400.00 - - - - - - - -
    58,443.00 - - - - - - - -
    74,669.10 - - - - - - - -
    27,720.00 - - 5 138,600.00 - - 5 138,600.00
    1,518.00 - - - - - - - -
    135,850.00 - - - - - - - -
    4,807.00 - - - - - - - -
    12,435.50 - - - - - - - -
    12,827.06 - - - - - - - -
    12,137.68 - - - - - - - -
    33,495.00 - - - - - - - -
    12,100.00 - - - - - - - -
    137,500.00 - - - - - - - -
    66,000.00 - - - - - - - -
    7,837.50 - - - - - - - -
    2,893.00 - - - - - - - -
    4,394.50 - - - - - - - -
    7,215.25 - - - - - - - -
    440.00 - - - - - - - -
    33,880.00 20 677,600.00 - - - - 20 677,600.00
    27,500.00 - - - - - - - -
    26,950.00 - - - - - - - -
    84,700.00 18 1,524,600.00 - - - - 18 1,524,600.00
    228.85 - - - - - - - -
    42,570.00 54 2,298,780.00 - - 1 42,570.00 53 2,256,210.00
    52,470.00 - - - - - - - -
    69,300.00 - - - - - - - -
    907.50 1,400 1,270,500.00 - - 1,400 1,270,500.00 - -
    88,825.00 10 888,250.00 - - - - 10 888,250.00
    17,000.00 - - - - - - - -
    13,200.00 - - - - - - - -
    4,990.04 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 122 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    74,816.78 - - - - - - - -
    10,450.00 - - - - - - - -
    5,940.00 - - - - - - - -
    3,520.00 - - - - - - - -
    8,800.00 - - - - - - - -
    6,435.00 - - - - - - - -
    27,225.00 - - - - - - - -
    4,840.00 - - - - - - - -
    2,475.00 - - - - - - - -
    33,000.00 - - - - - - - -
    1,724.25 - - - - - - - -
    32,999.97 - - - - - - - -
    12,705.00 - - 120 1,524,600.00 - - 120 1,524,600.00
    3,866,500.00 2 7,733,000.00 - - - - 2 7,733,000.00
    4,400.00 - - - - - - - -
    258,500.00 - - - - - - - -
    242,000.00 - - - - - - - -
    6,600.00 - - - - - - - -
    4,106.67 - - - - - - - -
    44,000.00 - - - - - - - -
    82,500.00 - - - - - - - -
    74,250.00 - - - - - - - -
    50,050.00 - - 10 500,500.00 7 350,350.00 3 150,150.00
    24,750.00 - - - - - - - -
    63,580.00 - - - - - - - -
    13,662.00 - - - - - - - -
    37,807.11 - - - - - - - -
    1,776.50 - - - - - - - -
    84,150.00 - - - - - - - -
    2,183.50 - - - - - - - -
    39,128.38 - - - - - - - -
    5,445.00 - - - - - - - -
    10,560.00 - - - - - - - -
    27,398.25 - - - - - - - -
    239,250.00 - - - - - - - -
    82,335.00 - - - - - - - -
    8,800.00 - - - - - - - -
    475.20 - - - - - - - -
    71,060.00 - - - - - - - -
    23,375.00 - - - - - - - -
    572.00 - - - - - - - -
    87,318.00 - - - - - - - -
    32,003.13 - - - - - - - -
    219,450.00 - - - - - - - -
    174,900.00 - - - - - - - -
    726.00 - - - - - - - -
    7,260.00 - - - - - - - -
    0.00 - - - - - - - -
    120,175.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 123 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    112,200.00 - - - - - - - -
    163,625.00 - - - - - - - -
    797.50 - - - - - - - -
    2,591.60 - - - - - - - -
    3,960.00 - - - - - - - -
    1,122.00 - - - - - - - -
    1,760.00 - - - - - - - -
    14,850.00 - - - - - - - -
    2,543.75 - - - - - - - -
    16,780.50 - - - - - - - -
    67,592.25 - - - - - - - -
    4,051.67 - - - - - - - -
    62,370.00 - - - - - - - -
    3,521.10 - - - - - - - -
    182,875.00 - - - - - - - -
    10,758.00 - - - - - - - -
    9,075.00 - - - - - - - -
    2,200.00 - - - - - - - -
    4,400.00 - - - - - - - -
    69,300.00 - - - - - - - -
    10,377.40 - - - - - - - -
    14,130.60 - - - - - - - -
    9,680.00 - - - - - - - -
    29,507.50 - - - - - - - -
    7,920.00 - - - - - - - -
    10,018.80 - - - - - - - -
    3,960.00 - - - - - - - -
    7,084.43 - - 56 396,728.08 - - 56 396,728.08
    3,025,000.00 - - - - - - - -
    220,000.00 - - - - - - - -
    21,417.00 - - - - - - - -
    4,877.81 - - - - - - - -
    19,360.00 - - - - - - - -
    107,525.00 - - - - - - - -
    12,540.00 - - - - - - - -
    8,470.44 300 2,541,132.00 - - - - 300 2,541,132.00
    14,850.00 - - - - - - - -
    33,495.00 48 1,607,760.00 - - 24 803,880.00 24 803,880.00
    3,349.50 - - - - - - - -
    2,174.26 - - - - - - - -
    20,900.00 - - - - - - - -
    5,368.00 - - - - - - - -
    12,762.75 - - - - - - - -
    4,180.00 - - - - - - - -
    5,538.50 - - - - - - - -
    6,792.50 - - - - - - - -
    2,481.88 200 496,376.00 - - - - 200 496,376.00
    4,070.00 - - - - - - - -
    5,830.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 124 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    4,216.67 - - - - - - - -
    5,720.00 - - - - - - - -
    4,766.67 - - - - - - - -
    120,175.00 - - - - - - - -
    2,719.20 - - - - - - - -
    2,052.60 - - - - - - - -
    0.00 - - - - - - - -
    1,958.27 - - - - - - - -
    1,942.51 - - - - - - - -
    2,328.47 - - - - - - - -
    2,561.35 - - - - - - - -
    687.50 - - - - - - - -
    1,009.80 - - - - - - - -
    1,815.00 - - - - - - - -
    2,227.50 - - - - - - - -
    3,567.80 - - - - - - - -
    15,147.00 - - - - - - - -
    2,057.00 - - - - - - - -
    4,257.00 - - - - - - - -
    4,955.50 - - - - - - - -
    137,500.00 - - - - - - - -
    4,730.00 - - - - - - - -
    16,500.00 - - - - - - - -
    49,500.00 - - - - - - - -
    78,375.00 - - - - - - - -
    182,875.00 - - - - - - - -
    1,440.45 - - - - - - - -
    47,685.00 - - - - - - - -
    100,980.00 - - - - - - - -
    4,749.80 - - - - - - - -
    187,000.00 - - - - - - - -
    245,993.00 - - - - - - - -
    962.50 - - - - - - - -
    99,550.00 - - - - - - - -
    4,955.50 - - - - - - - -
    9,240.00 - - - - - - - -
    187.21 - - - - - - - -
    6,766.97 - - - - - - - -
    12,441.00 - - - - - - - -
    297,000.00 - - - - - - - -
    13,956.25 - - - - - - - -
    10,395.00 - - 20 207,900.00 20 207,900.00 - -
    613,800.00 - - - - - - - -
    385.00 - - - - - - - -
    2,153.25 - - - - - - - -
    83,160.00 - - - - - - - -
    174,900.00 - - - - - - - -
    150,040.00 - - - - - - - -
    49,665.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 125 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    12,375.00 - - - - - - - -
    4,702.50 - - - - - - - -
    7,920.00 - - - - - - - -
    6,072.00 - - - - - - - -
    14,107.50 - - - - - - - -
    24,200.00 - - - - - - - -
    23,650.00 - - - - - - - -
    14,850.00 - - - - - - - -
    17,820.00 - - - - - - - -
    48,411.00 - - - - - - - -
    34,177.00 - - - - - - - -
    20,237.85 - - - - - - - -
    36,080.00 - - - - - - - -
    6,302.71 - - - - - - - -
    5,390.00 - - - - - - - -
    456.80 - - - - - - - -
    7,623.90 - - - - - - - -
    67,925.00 - - - - - - - -
    7,680.75 - - - - - - - -
    9,927.50 - - - - - - - -
    80,960.00 - - - - - - - -
    55,440.00 - - - - - - - -
    67,925.00 - - - - - - - -
    6,270.00 - - - - - - - -
    29,205.00 - - - - - - - -
    19,800.00 - - - - - - - -
    20,240.00 - - - - - - - -
    1,672.00 - - - - - - - -
    5,775.00 - - - - - - - -
    22,990.00 - - - - - - - -
    9,056.67 - - - - - - - -
    9,405.00 - - - - - - - -
    74,309.13 - - - - - - - -
    242,000.00 - - - - - - - -
    346,500.00 - - - - - - - -
    343,200.00 - - - - - - - -
    81,250.00 - - - - - - - -
    58,080.00 - - - - - - - -
    10,683.75 - - - - - - - -
    7,700.00 - - - - - - - -
    4,950.00 - - - - - - - -
    3,960.00 - - - - - - - -
    36,080.00 - - - - - - - -
    81,675.00 - - - - - - - -
    242,000.00 - - - - - - - -
    59,400.00 - - - - - - - -
    84,150.00 - - 12 1,009,800.00 - - 12 1,009,800.00
    11,434.50 - - - - - - - -
    11,660.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 126 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    2,772.00 - - - - - - - -
    8,415.00 - - - - - - - -
    196,350.00 - - - - - - - -
    8,695.50 - - - - - - - -
    36,960.00 - - - - - - - -
    110,880.00 - - - - - - - -
    3,300.00 - - - - - - - -
    11,000.00 - - - - - - - -
    80,960.00 - - 20 1,619,200.00 10 809,600.00 10 809,600.00
    43,854.25 - - - - - - - -
    11,550.00 - - - - - - - -
    11,104.17 - - - - - - - -
    33,880.00 - - - - - - - -
    6,600.00 - - - - - - - -
    9,075.00 - - - - - - - -
    1,519,375.00 - - - - - - - -
    2,178.00 - - - - - - - -
    12,045.00 - - - - - - - -
    8,296.16 - - - - - - - -
    8,296.16 - - - - - - - -
    15,452.05 - - - - - - - -
    15,452.05 - - - - - - - -
    417,273.00 - - - - - - - -
    19,800.00 - - - - - - - -
    39,600.00 - - - - - - - -
    335,995.00 - - - - - - - -
    3,135.00 - - - - - - - -
    10,349.90 - - - - - - - -
    11,500.50 - - - - - - - -
    11,500.50 - - - - - - - -
    17,084.10 - - - - - - - -
    1,741.66 - - - - - - - -
    3,666.67 - - - - - - - -
    14,241.70 - - - - - - - -
    114,950.00 - - - - - - - -
    2,508.00 - - - - - - - -
    9,599.70 - - 30 287,991.00 - - 30 287,991.00
    4,180.00 - - 90 376,200.00 60 250,800.00 30 125,400.00
    6,966.67 - - - - - - - -
    4,533.28 - - - - - - - -
    1,485.00 - - - - - - - -
    3,223.00 174 560,802.00 - - 62 199,826.00 112 360,976.00
    88,220.00 - - - - - - - -
    65,890.00 - - - - - - - -
    1,027.00 - - - - - - - -
    289,613.50 - - - - - - - -
    62,649.00 - - - - - - - -
    2,970.00 - - - - - - - -
    104,500.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 127 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    12,320.00 - - - - - - - -
    1,210.00 - - - - - - - -
    22,385.00 - - - - - - - -
    26,960.31 - - - - - - - -
    624.78 - - - - - - - -
    4,400.00 - - - - - - - -
    6,580.31 - - - - - - - -
    200,200.00 - - - - - - - -
    20,900.00 - - - - - - - -
    3,085.50 - - - - - - - -
    242,000.00 - - - - - - - -
    3,599.75 - - - - - - - -
    2,351.25 - - - - - - - -
    4,675.00 - - - - - - - -
    67,320.00 - - - - - - - -
    2,673.00 - - - - - - - -
    11,000.00 - - - - - - - -
    3,740.00 - - - - - - - -
    4,372.50 - - - - - - - -
    29,700.00 - - - - - - - -
    96,800.00 - - - - - - - -
    27,500.00 - - - - - - - -
    28,600.00 - - - - - - - -
    22,000.00 - - - - - - - -
    2,695.00 - - - - - - - -
    9,240.00 - - - - - - - -
    138,600.00 - - - - - - - -
    11,275.00 - - - - - - - -
    70,400.00 - - - - - - - -
    6,927.42 - - - - - - - -
    1,754.50 - - - - - - - -
    38,500.00 - - - - - - - -
    3,297.25 - - - - - - - -
    83,530.20 - - - - - - - -
    280,792.71 - - - - - - - -
    22,000.00 - - - - - - - -
    1,856.25 - - - - - - - -
    107,250.00 - - - - - - - -
    1,237.50 - - - - - - - -
    7,040.00 - - - - - - - -
    110,000.00 - - - - - - - -
    48,801.50 - - - - - - - -
    11,781.00 - - - - - - - -
    24,502.50 - - - - - - - -
    7,464.08 - - - - - - - -
    70,125.00 - - - - - - - -
    5,335.00 - - - - - - - -
    12,037.94 - - - - - - - -
    15,089.65 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 128 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    5,214.55 - - - - - - - -
    3,696.00 - - - - - - - -
    1,320.00 - - - - - - - -
    45,375.00 - - 10 453,750.00 - - 10 453,750.00
    231,275.00 - - - - - - - -
    232,463.00 - - - - - - - -
    31,457.25 - - - - - - - -
    62,843.00 - - - - - - - -
    242,000.00 - - - - - - - -
    330,000.00 - - - - - - - -
    2,330.30 - - - - - - - -
    8,566.80 - - - - - - - -
    6,062.10 - - - - - - - -
    19,486.74 - - - - - - - -
    162.00 - - - - - - - -
    6,966.67 - - - - - - - -
    7,276.50 - - - - - - - -
    4,096.40 - - - - - - - -
    1,881.00 - - - - - - - -
    1,089.00 - - - - - - - -
    1,875.50 - - - - - - - -
    12,523.50 - - - - - - - -
    6,444.17 30 193,325.10 - - - - 30 193,325.10
    9,230.83 - - - - - - - -
    8,580.00 - - - - - - - -
    74,250.00 - - - - - - - -
    5,005.00 - - - - - - - -
    2,662.00 - - - - - - - -
    4,126.10 - - - - - - - -
    10,120.00 - - - - - - - -
    5,720.00 - - - - - - - -
    7,424.74 - - - - - - - -
    2,543.75 - - - - - - - -
    3,850.00 - - - - - - - -
    10,780.00 - - - - - - - -
    6,875.00 - - - - - - - -
    90,703.80 - - - - - - - -
    125,384.05 - - - - - - - -
    7,611.43 - - - - - - - -
    2,750.00 - - - - - - - -
    4,675.00 - - - - - - - -
    8,269.23 - - - - - - - -
    11,941.66 - - - - - - - -
    23,100.00 - - - - - - - -
    4,956.10 - - - - - - - -
    24,750.00 - - - - - - - -
    742.50 - - - - - - - -
    4,400.00 - - - - - - - -
    5,379.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 129 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    7,810.00 - - - - - - - -
    33,440.00 - - - - - - - -
    1,320.00 - - - - - - - -
    2,823.33 - - - - - - - -
    43,499.50 - - - - - - - -
    34,500.40 20 690,008.00 - - - - 20 690,008.00
    6,600.00 - - - - - - - -
    7,150.00 - - - - - - - -
    44,000.00 - - - - - - - -
    15,840.00 - - - - - - - -
    84,700.00 - - - - - - - -
    3,520.00 - - - - - - - -
    8,415.00 - - - - - - - -
    4,257.00 - - - - - - - -
    166,375.00 - - - - - - - -
    2,970.00 - - - - - - - -
    1,072,500.00 - - - - - - - -
    148,225.00 - - - - - - - -
    20,790.00 - - - - - - - -
    21,780.00 - - - - - - - -
    2,805.00 - - - - - - - -
    49,555.00 10 495,550.00 - - - - 10 495,550.00
    2,277.00 - - - - - - - -
    2,946.01 - - - - - - - -
    1,452.00 - - - - - - - -
    13,167.00 - - - - - - - -
    25,080.00 - - - - - - - -
    14,300.00 15 214,500.00 - - - - 15 214,500.00
    5,720.00 - - - - - - - -
    1,100.00 - - - - - - - -
    9,460.00 - - - - - - - -
    5,720.00 - - - - - - - -
    1,980.00 - - - - - - - -
    18,287.50 - - - - - - - -
    8,883.60 - - - - - - - -
    8,883.60 - - - - - - - -
    149,338.20 - - - - - - - -
    52,030.00 - - - - - - - -
    2,696.10 - - - - - - - -
    4,165.70 - - - - - - - -
    434,500.00 - - - - - - - -
    6,955.15 - - - - - - - -
    1,045.00 - - - - - - - -
    173,250.00 - - - - - - - -
    2,978.25 - - - - - - - -
    3,366.00 - - 300 1,009,800.00 200 673,200.00 100 336,600.00
    56,980.00 - - - - - - - -
    3,300.00 - - - - - - - -
    1,142.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 130 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    3,553.00 250 888,250.00 - - - - 250 888,250.00


    8,094.00 - - - - - - - -
    3,207.33 - - - - - - - -
    51,837.50 - - - - - - - -
    6,776.00 - - - - - - - -
    3,853.05 - - - - - - - -
    21,967.68 - - - - - - - -
    8,910.00 - - - - - - - -
    4,702.50 - - - - - - - -
    5,886.83 - - - - - - - -
    7,053.75 - - - - - - - -
    6,792.50 - - - - - - - -
    3,918.75 - - - - - - - -
    7,480.00 - - - - - - - -
    3,580.50 228 816,354.00 - - - - 228 816,354.00
    3,045.00 - - - - - - - -
    5,409.00 - - - - - - - -
    11,962.50 - - - - - - - -
    9,196.00 - - - - - - - -
    15,468.75 - - - - - - - -
    10,648.00 - - - - - - - -
    17,600.00 - - - - - - - -
    5,500.00 - - - - - - - -
    6,160.00 - - - - - - - -
    79,625.70 - - - - - - - -
    73,205.00 - - - - - - - -
    38,390.00 - - - - - - - -
    481.07 - - - - - - - -
    4,253.33 - - - - - - - -
    3,017.85 - - - - - - - -
    52,800.00 - - - - - - - -
    2,970.00 - - - - - - - -
    29,899.98 - - - - - - - -
    12,543.48 - - - - - - - -
    28,883.80 - - - - - - - -
    6,050.00 - - - - - - - -
    7,887.00 - - - - - - - -
    15,620.00 120 1,874,400.00 - - 60 937,200.00 60 937,200.00
    39,600.00 - - - - - - - -
    13,981.00 - - - - - - - -
    430.51 - - - - - - - -
    46,637.31 - - - - - - - -
    60,260.20 - - - - - - - -
    55,520.85 - - - - - - - -
    275.00 - - - - - - - -
    4,711.30 - - - - - - - -
    2,299.00 - - - - - - - -
    198,000.00 - - - - - - - -
    27,500.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 131 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    1,375.00 - - - - - - - -
    298,870.00 - - - - - - - -
    2,299.00 - - - - - - - -
    3,960.00 - - - - - - - -
    7,425.00 - - - - - - - -
    33,000.00 - - - - - - - -
    24,200.00 - - - - - - - -
    24,200.00 - - - - - - - -
    1,196.25 - - - - - - - -
    10,241.00 - - - - - - - -
    7,315.00 - - - - - - - -
    111,999.80 - - - - - - - -
    3,366.00 - - - - - - - -
    20,152.00 - - - - - - - -
    222,585.00 - - - - - - - -
    104,500.00 - - - - - - - -
    4,106.67 - - - - - - - -
    13,640.00 - - - - - - - -
    27,500.00 - - - - - - - -
    7,920.00 15 118,800.00 - - - - 15 118,800.00
    10,241.00 - - - - - - - -
    15,488.00 - - - - - - - -
    2,667.50 - - - - - - - -
    29,920.00 - - - - - - - -
    46,200.00 - - - - - - - -
    7,837.50 - - - - - - - -
    37,620.00 - - - - - - - -
    9,504.00 - - - - - - - -
    2,580.93 - - - - - - - -
    1,485.00 - - - - - - - -
    1,272.70 - - - - - - - -
    5,596.25 - - - - - - - -
    3,678.40 - - - - - - - -
    4,896.90 - - - - - - - -
    1,925.00 - - - - - - - -
    25,300.00 - - - - - - - -
    55,000.00 - - - - - - - -
    10,395.00 - - - - - - - -
    13,076.99 - - - - - - - -
    985.88 - - - - - - - -
    932.75 - - 300 279,825.00 300 279,825.00 - -
    5,285.50 - - - - - - - -
    16,720.00 - - - - - - - -
    57,475.00 - - - - - - - -
    2,798.40 - - - - - - - -
    2,048.20 - - - - - - - -
    3,971.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 132 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    877.80 - - - - - - - -
    8,250.00 - - - - - - - -
    4,455.00 - - - - - - - -
    2,090.00 - - - - - - - -
    2,391.13 - - - - - - - -
    980.01 - - - - - - - -
    1,876.88 - - - - - - - -
    13,746.01 - - - - - - - -
    16,781.42 - - - - - - - -
    4,051.93 - - - - - - - -
    132,000.00 - - - - - - - -
    42,198.14 - - - - - - - -
    31,680.00 - - - - - - - -
    63,250.00 - - - - - - - -
    9,005.66 - - - - - - - -
    77,000.00 - - - - - - - -
    4,062.77 - - - - - - - -
    46,750.00 - - - - - - - -
    18,810.00 - - - - - - - -
    62,562.50 - - - - - - - -
    5,768.40 - - - - - - - -
    2,319.16 - - - - - - - -
    4,244.16 - - - - - - - -
    4,257.00 - - - - - - - -
    88,000.00 - - - - - - - -
    79,200.00 20 1,584,000.00 - - - - 20 1,584,000.00
    13,090.00 - - - - - - - -
    130,900.00 - - - - - - - -
    11,983.19 - - - - - - - -
    6,686.60 - - - - - - - -
    2,600.00 - - - - - - - -
    20,790.00 - - 60 1,247,400.00 60 1,247,400.00 - -
    759.00 - - - - - - - -
    717.75 - - - - - - - -
    20,350.00 - - - - - - - -
    80,850.00 - - - - - - - -
    35,750.00 - - - - - - - -
    48,400.00 - - - - - - - -
    79,750.00 - - - - - - - -
    275,000.00 - - - - - - - -
    72,600.00 - - - - - - - -
    3,448.50 - - - - - - - -
    8,036.05 - - - - - - - -
    8,910.00 - - - - - - - -
    554,400.00 - - - - - - - -
    6,008.75 - - - - - - - -
    2,962.58 - - - - - - - -
    11,550.00 - - - - - - - -
    6,792.50 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 133 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    158,122.80 - - - - - - - -
    1,499,999.60 - - - - - - - -
    51,243.50 - - - - - - - -
    101,200.00 - - - - - - - -
    302,500.00 - - - - - - - -
    11,170.43 - - - - - - - -
    13,669.76 - - - - - - - -
    10,234.95 - - - - - - - -
    11,550.00 - - - - - - - -
    117,810.00 - - - - - - - -
    30,580.00 - - - - - - - -
    45,100.00 - - - - - - - -
    20,625.00 - - - - - - - -
    34,650.00 - - - - - - - -
    12,809.50 - - - - - - - -
    7,700.00 - - - - - - - -
    22,000.00 - - - - - - - -
    3,987.50 120 478,500.00 - - - - 120 478,500.00
    95,040.00 - - - - - - - -
    6,635.75 - - - - - - - -
    3,080.00 - - - - - - - -
    17,600.00 - - - - - - - -
    1,754.50 - - - - - - - -
    3,190.00 - - - - - - - -
    7,744.00 - - - - - - - -
    11,000.00 180 1,980,000.00 - - - - 180 1,980,000.00
    22,000.00 - - - - - - - -
    1,430.00 - - - - - - - -
    4,466.00 - - - - - - - -
    15,840.00 - - - - - - - -
    66,000.00 - - - - - - - -
    1,993.75 250 498,437.50 - - - - 250 498,437.50
    2,233.00 500 1,116,500.00 - - - - 500 1,116,500.00
    3,349.50 150 502,425.00 - - - - 150 502,425.00
    62,700.00 - - - - - - - -
    6,050.00 - - - - - - - -
    63,360.00 2 126,720.00 - - - - 2 126,720.00
    15,152.50 - - - - - - - -
    4,083.00 - - - - - - - -
    4,444.00 - - - - - - - -
    62,040.00 - - - - - - - -
    3,630.00 - - - - - - - -
    7,566.26 - - 40 302,650.40 40 302,650.40 - -
    522,500.00 - - - - - - - -
    560.00 - - - - - - - -
    3,080.00 - - - - - - - -
    139,315.00 - - - - - - - -
    5,500.00 - - - - - - - -
    90,750.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 134 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    31,680.00 - - - - - - - -
    19,800.00 - - - - - - - -
    50,050.00 - - - - - - - -
    33,000.00 - - - - - - - -
    12,397.00 - - - - - - - -
    12,186.43 - - - - - - - -
    36,025.00 - - - - - - - -
    26,963.75 - - - - - - - -
    7,631.25 - - - - - - - -
    13,365.00 12 160,380.00 - - 12 160,380.00 - -
    19,800.00 12 237,600.00 - - 12 237,600.00 - -
    17,820.00 - - - - - - - -
    462.00 3,700 1,709,400.00 - - - - 3,700 1,709,400.00
    165,000.00 - - - - - - - -
    132,000.00 - - - - - - - -
    87,664.50 - - - - - - - -
    16,269.00 - - - - - - - -
    6,756.75 - - - - - - - -
    1,003.75 - - - - - - - -
    693,000.00 - - - - - - - -
    7,661.50 1 7,661.50 - - - - 1 7,661.50
    3,113.06 - - - - - - - -
    594.00 200 118,800.00 - - - - 200 118,800.00
    440.00 - - - - - - - -
    374.00 - - - - - - - -
    330.00 30 9,900.00 - - - - 30 9,900.00
    65,340.00 - - - - - - - -
    254,100.00 - - - - - - - -
    260,623.00 - - - - - - - -
    106,029.00 - - - - - - - -
    132,000.00 - - - - - - - -
    4,675.00 - - - - - - - -
    4,290.00 - - - - - - - -
    7,150.00 - - - - - - - -
    33,000.00 - - - - - - - -
    46,200.00 - - - - - - - -
    4,204.77 - - - - - - - -
    4,093.66 - - - - - - - -
    11,000.00 - - - - - - - -
    2,090.00 - - - - - - - -
    1,166.64 - - - - - - - -
    3,300.00 - - - - - - - -
    6,050.00 - - - - - - - -
    110,000.00 - - - - - - - -
    7,700.00 - - - - - - - -
    10,890.00 - - - - - - - -
    10,164.00 - - - - - - - -
    1,510,000.00 - - - - - - - -
    2,235.75 400 894,300.00 - - 400 894,300.00 - -

    DATA KEBUTUHAN OBAT REVISI 135 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    12,335.68 - - - - - - - -
    16,392.97 - - - - - - - -
    16,311.00 - - - - - - - -
    12,219.90 - - - - - - - -
    13,442.00 - - - - - - - -
    8,467.80 - - - - - - - -
    293,485.50 - - - - - - - -
    27,500.00 - - - - - - - -
    55,000.00 - - - - - - - -
    9,301.88 - - - - - - - -
    5,747.50 - - - - - - - -
    522.50 - - - - - - - -
    772,475.00 - - - - - - - -
    12,705.00 - - - - - - - -
    15,427.50 - - - - - - - -
    24,035.00 - - - - - - - -
    28,215.00 - - - - - - - -
    12,870.00 - - - - - - - -
    71,775.00 28 2,009,700.00 - - - - 28 2,009,700.00
    49,115.00 - - - - - - - -
    4,005.83 - - - - - - - -
    2,210.67 - - - - - - - -
    714,001.00 - - - - - - - -
    5,753.47 - - - - - - - -
    752.40 - - - - - - - -
    1,331.00 - - - - - - - -
    6,505.71 700 4,553,997.00 - - - - 700 4,553,997.00
    5,426.65 56 303,892.40 - - 56 303,892.40 - -
    57,807.75 - - - - - - - -
    10,613.63 - - - - - - - -
    8,141.38 - - - - - - - -
    3,971.00 - - - - - - - -
    145,200.00 - - - - - - - -
    253,000.00 - - - - - - - -
    3,740.00 - - - - - - - -
    44,000.00 - - - - - - - -
    1,463.00 - - - - - - - -
    13,420.00 - - - - - - - -
    1,320.00 - - - - - - - -
    5,500.00 - - - - - - - -
    13,689.50 - - - - - - - -
    22,990.00 - - - - - - - -
    467.50 - - - - - - - -
    3,553.00 - - - - - - - -
    770.00 - - - - - - - -
    5,434.00 - - - - - - - -
    10,890.00 - - - - - - - -
    13,200.00 - - - - - - - -
    29,700.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 136 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    5,927.63 - - - - - - - -
    30,305.00 - - - - - - - -
    24,420.00 - - - - - - - -
    2,904.00 - - - - - - - -
    9,927.50 - - - - - - - -
    39,187.50 - - - - - - - -
    4,207.50 - - - - - - - -
    2,337.50 - - - - - - - -
    7,480.00 - - - - - - - -
    25,740.00 - - - - - - - -
    1,210.00 - - - - - - - -
    4,290.00 - - - - - - - -
    19,057.25 - - - - - - - -
    88,490.20 - - - - - - - -
    2,950.20 - - - - - - - -
    23,958.00 - - - - - - - -
    4,199.80 - - - - - - - -
    7,029.86 - - - - - - - -
    11,880.00 - - - - - - - -
    4,963.75 - - - - - - - -
    14,928.57 - - - - - - - -
    10,845.61 - - - - - - - -
    6,380.00 - - - - - - - -
    4,070.00 - - - - - - - -
    14,355.00 - - - - - - - -
    12,650.00 - - - - - - - -
    4,950.00 - - 250 1,237,500.00 150 742,500.00 100 495,000.00
    111,527.36 - - - - - - - -
    14,228.50 120 1,707,420.00 - - 40 569,140.00 80 1,138,280.00
    10,392.77 180 1,870,698.60 - - 20 207,855.40 160 1,662,843.20
    118,069.88 - - - - - - - -
    28,611.00 - - - - - - - -
    4,400.00 - - - - - - - -
    14,899.50 - - - - - - - -
    13,741.75 - - - - - - - -
    46,200.00 - - - - - - - -
    10,340.00 - - - - - - - -
    6,050.00 - - - - - - - -
    18,700.00 - - - - - - - -
    84,150.00 - - - - - - - -
    1,100.00 - - - - - - - -
    52,250.00 - - - - - - - -
    14,080.00 - - - - - - - -
    56,595.00 - - - - - - - -
    16,500.00 - - - - - - - -
    10,816.79 - - - - - - - -
    13,559.92 - - - - - - - -
    29,172.55 - - - - - - - -
    226,470.59 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 137 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    88,825.00 145 12,879,625.00 - - - - 145 12,879,625.00


    3,850.00 150 577,500.00 - - - - 150 577,500.00
    115,650.00 - - - - - - - -
    8,910.00 - - - - - - - -
    33,000.00 - - - - - - - -
    35,200.00 - - - - - - - -
    2,640.00 - - - - - - - -
    290,000.00 120 34,800,000.00 - - - - 120 34,800,000.00
    36,465.00 - - - - - - - -
    36,465.00 - - - - - - - -
    770.00 - - - - - - - -
    15,400.00 - - - - - - - -
    247.50 - - - - - - - -
    41,250.00 - - - - - - - -
    8,910.00 - - - - - - - -
    9,075.00 - - - - - - - -
    7,078.50 - - - - - - - -
    99,000.00 - - - - - - - -
    7,150.00 - - - - - - - -
    172,425.00 - - - - - - - -
    183,876.00 - - - - - - - -
    120,175.00 1 120,175.00 - - - - 1 120,175.00
    7,150.00 - - - - - - - -
    18,205.00 - - - - - - - -
    25,168.00 - - - - - - - -
    3,960.00 - - - - - - - -
    72,583.61 - - - - - - - -
    8,088.30 - - - - - - - -
    1,641.75 - - - - - - - -
    5,016.00 - - - - - - - -
    2,508.00 - - - - - - - -
    5,561.33 - - - - - - - -
    1,402.50 - - - - - - - -
    12,100.00 - - - - - - - -
    99,000.00 - - - - - - - -
    2,849.00 - - - - - - - -
    57,475.00 - - - - - - - -
    52,250.00 - - - - - - - -
    46,200.00 - - - - - - - -
    88,000.00 - - - - - - - -
    188,100.00 - - - - - - - -
    22,000.00 - - - - - - - -
    6,600.00 - - - - - - - -
    19,745.00 - - - - - - - -
    4,950.00 - - - - - - - -
    4,312.00 - - - - - - - -
    9,900.00 - - - - - - - -
    110,000.00 - - - - - - - -
    107,184.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 138 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    102,850.00 - - - - - - - -
    440,000.00 - - - - - - - -
    24,750.00 - - 30 742,500.00 - - 30 742,500.00
    257,174.50 - - - - - - - -
    9,900.00 - - - - - - - -
    11,385.00 - - - - - - - -
    9,776.49 - - - - - - - -
    23,947.92 - - - - - - - -
    46,750.00 - - - - - - - -
    5,756.67 - - - - - - - -
    2,543.75 - - - - - - - -
    36,630.00 - - - - - - - -
    22,176.00 - - - - - - - -
    6,672.60 - - - - - - - -
    14,080.00 - - - - - - - -
    73,011.13 - - - - - - - -
    53,460.85 - - - - - - - -
    27,227.88 - - - - - - - -
    23,637.90 - - - - - - - -
    52,087.75 - - - - - - - -
    197,505.00 5 987,525.00 - - - - 5 987,525.00
    345,015.00 - - 3 1,035,045.00 - - 3 1,035,045.00
    21,120.00 - - 15 316,800.00 15 316,800.00 - -
    0.00 - - - - - - - -
    1,773.20 - - - - - - - -
    3,552.08 - - - - - - - -
    9,163.28 - - 50 458,164.00 - - 50 458,164.00
    632.50 - - - - - - - -
    1,056.00 - - - - - - - -
    28,300.01 - - - - - - - -
    195,525.00 - - - - - - - -
    396,000.00 - - - - - - - -
    3,448.50 - - - - - - - -
    6,600.00 - - - - - - - -
    17,531.25 - - - - - - - -
    138,600.00 - - - - - - - -
    57,461.25 - - - - - - - -
    1,668.90 - - - - - - - -
    2,376,000.00 - - - - - - - -
    22,000.00 - - - - - - - -
    4,675.00 - - - - - - - -
    9,900.00 - - - - - - - -
    84,700.00 - - - - - - - -
    8,800.00 - - - - - - - -
    8,300.00 - - - - - - - -
    55,440.00 - - - - - - - -
    3,080.00 - - - - - - - -
    41,800.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 139 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    7,837.50 - - - - - - - -
    172.43 - - - - - - - -
    1,980.00 - - - - - - - -
    26,086.50 - - - - - - - -
    74,800.00 - - - - - - - -
    52,104.69 - - - - - - - -
    3,300.00 - - - - - - - -
    41,800.00 - - - - - - - -
    277,200.00 - - - - - - - -
    1,190,970.00 - - - - - - - -
    297.00 - - - - - - - -
    1,595.00 - - - - - - - -
    880.00 - - - - - - - -
    991.96 - - - - - - - -
    21,670.00 - - - - - - - -
    159,500.00 - - - - - - - -
    16,362.50 - - - - - - - -
    17,820.00 - - 50 891,000.00 - - 50 891,000.00
    70,125.00 - - - - - - - -
    148,203.00 - - - - - - - -
    14,850.00 - - - - - - - -
    15,840.00 - - - - - - - -
    13,527.80 5 67,639.00 - - - - 5 67,639.00
    41,261.00 - - - - - - - -
    16,113.17 - - - - - - - -
    7,315.00 - - - - - - - -
    20,699.80 - - - - - - - -
    140,800.00 - - - - - - - -
    203,830.00 - - - - - - - -
    12,100.00 - - - - - - - -
    64,680.00 - - - - - - - -
    7,700.00 - - - - - - - -
    36,932.50 - - - - - - - -
    39,176.50 - - - - - - - -
    39,176.50 - - - - - - - -
    39,176.50 - - - - - - - -
    37,411.00 - - - - - - - -
    346.64 - - - - - - - -
    37,411.00 - - - - - - - -
    103,291.65 - - - - - - - -
    44,830.50 - - - - - - - -
    28,600.00 - - - - - - - -
    93,379.00 - - - - - - - -
    51,561.40 - - - - - - - -
    20,620.60 - - - - - - - -
    20,620.60 - - - - - - - -
    60,310.00 - - - - - - - -
    52,919.00 - - - - - - - -
    65,178.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 140 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    103,878.94 - - - - - - - -
    276,640.76 - - - - - - - -
    33,000.00 - - - - - - - -
    433,675.00 - - - - - - - -
    49,005.00 - - - - - - - -
    13,953.50 - - - - - - - -
    10,298.20 - - - - - - - -
    569,866.73 - - - - - - - -
    89,958.00 - - - - - - - -
    113,803.25 - - - - - - - -
    38,115.00 - - - - - - - -
    6,752.08 - - - - - - - -
    5,843.75 - - 40 233,750.00 - - 40 233,750.00
    7,734.38 - - 40 309,375.20 - - 40 309,375.20
    1,826.00 - - - - - - - -
    3,586.00 - - - - - - - -
    176,000.00 - - - - - - - -
    9,968.75 120 1,196,250.00 - - - - 120 1,196,250.00
    10,367.50 - - - - - - - -
    35,750.00 - - - - - - - -
    4,950.00 - - - - - - - -
    33,206.25 - - 10 332,062.50 - - 10 332,062.50
    27,500.00 - - - - - - - -
    15,592.50 - - - - - - - -
    5,789.85 - - - - - - - -
    3,974.85 - - - - - - - -
    6,600.20 - - - - - - - -
    3,831.30 - - - - - - - -
    3,448.50 - - - - - - - -
    904.93 - - - - - - - -
    54,450.00 - - - - - - - -
    2,097.34 - - - - - - - -
    20,625.00 - - - - - - - -
    7,425.00 - - - - - - - -
    8,415.00 - - - - - - - -
    277,365.00 - - - - - - - -
    94,627.50 - - - - - - - -
    41,800.00 - - - - - - - -
    67,925.00 - - - - - - - -
    185,130.00 - - - - - - - -
    22,880.00 90 2,059,200.00 - - - - 90 2,059,200.00
    27,866.66 - - - - - - - -
    5,808.00 - - - - - - - -
    10,340.00 - - - - - - - -
    5,516.50 - - - - - - - -
    29,315.00 - - - - - - - -
    4,620.00 - - - - - - - -
    355,297.80 3 1,065,893.40 - - - - 3 1,065,893.40
    15,180.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 141 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    6,160.00 - - - - - - - -
    7,480.00 - - - - - - - -
    70,125.00 - - - - - - - -
    44,880.00 - - - - - - - -
    2,987.60 - - - - - - - -
    17,242.50 - - - - - - - -
    9,900.00 - - - - - - - -
    64,680.00 - - - - - - - -
    19,800.00 - - - - - - - -
    10,200.17 - - - - - - - -
    163,625.00 - - - - - - - -
    68,761.00 5 343,805.00 - - - - 5 343,805.00
    16,500.00 - - - - - - - -
    3,960.00 - - - - - - - -
    15,408.25 - - - - - - - -
    22,000.00 33 726,000.00 - - - - 33 726,000.00
    220,000.00 - - - - - - - -
    101,062.50 - - - - - - - -
    425,700.00 - - - - - - - -
    15,400.00 - - - - - - - -
    71,500.00 - - - - - - - -
    9,405.00 - - - - - - - -
    11,320.83 - - - - - - - -
    13,200.00 - - - - - - - -
    22,772.76 - - - - - - - -
    38,600.00 - - - - - - - -
    12,435.43 - - - - - - - -
    17,210.91 - - - - - - - -
    93,333.90 - - - - - - - -
    166,563.10 - - - - - - - -
    13,952.60 - - - - - - - -
    6,044.49 - - - - - - - -
    7,808.24 - - - - - - - -
    16,280.00 - - - - - - - -
    8,250.00 - - - - - - - -
    7,828.88 - - - - - - - -
    173,250.00 - - - - - - - -
    8,652.60 - - - - - - - -
    13,750.00 - - - - - - - -
    6,435.00 - - - - - - - -
    15,674.29 - - 56 877,760.24 - - 56 877,760.24
    10,426.17 - - - - - - - -
    7,920.00 - - - - - - - -
    767.25 - - - - - - - -
    6,894.76 - - - - - - - -
    5,591.66 - - - - - - - -
    5,465.90 - - - - - - - -
    2,689.50 - - 60 161,370.00 - - 60 161,370.00
    7,260.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 142 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    11,687.50 - - - - - - - -
    82,764.00 30 2,482,920.00 - - - - 30 2,482,920.00
    87,120.00 - - - - - - - -
    68,420.00 - - - - - - - -
    2,688.40 - - - - - - - -
    1,795.20 - - - - - - - -
    26,474.20 - - - - - - - -
    198,000.00 - - - - - - - -
    6,821.00 2 13,642.00 - - - - 2 13,642.00
    16,109.00 1 16,109.00 - - - - 1 16,109.00
    17,545.00 - - - - - - - -
    391,875.00 - - - - - - - -
    442,121.00 - - - - - - - -
    80,465.00 - - - - - - - -
    107,525.00 - - - - - - - -
    146,800.50 - - - - - - - -
    3,514.50 240 843,480.00 - - - - 240 843,480.00
    3,201.00 - - - - - - - -
    148,500.00 - - 5 742,500.00 - - 5 742,500.00
    5,052.30 - - - - - - - -
    179,300.00 - - - - - - - -
    59,699.50 - - - - - - - -
    119,625.00 - - - - - - - -
    5,940.00 - - - - - - - -
    1,716.00 - - - - - - - -
    3,540.46 - - - - - - - -
    16,101.33 - - - - - - - -
    17,843.10 - - - - - - - -
    4,643.10 - - - - - - - -
    35,200.00 - - - - - - - -
    40,995.90 - - - - - - - -
    12,540.00 - - - - - - - -
    13,781.43 - - - - - - - -
    18,700.00 - - - - - - - -
    27,500.00 - - - - - - - -
    23,100.00 - - - - - - - -
    22,990.00 - - - - - - - -
    27,830.00 - - - - - - - -
    65.34 - - - - - - - -
    4,152.50 - - - - - - - -
    4,620.00 - - - - - - - -
    243,100.00 - - - - - - - -
    28,050.00 - - - - - - - -
    38,115.00 - - - - - - - -
    22,099.00 - - - - - - - -
    495.00 - - - - - - - -
    47,084.77 - - - - - - - -
    3,452.04 - - 100 345,204.00 - - 100 345,204.00
    33,000.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 143 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    2,933.33 - - - - - - - -
    37,400.00 - - - - - - - -
    24,807.75 - - - - - - - -
    1,982.06 - - - - - - - -
    3,520.00 - - - - - - - -
    9,900.00 - - - - - - - -
    82,500.00 - - - - - - - -
    12,650.00 - - - - - - - -
    9,009.00 - - - - - - - -
    6,930.00 - - - - - - - -
    4,356.00 - - - - - - - -
    1,844.98 - - - - - - - -
    3,286.13 - - - - - - - -
    3,654.38 - - - - - - - -
    55,000.00 - - - - - - - -
    31,350.00 - - - - - - - -
    228,800.00 - - - - - - - -
    20,900.00 - - - - - - - -
    146,300.00 - - - - - - - -
    1,018.88 - - - - - - - -
    1,828.75 - - - - - - - -
    23,100.00 - - - - - - - -
    2,612.50 - - - - - - - -
    307,307.00 - - - - - - - -
    7,927.92 - - - - - - - -
    12,210.00 - - - - - - - -
    2,420.00 - - - - - - - -
    148,181.00 - - - - - - - -
    2,403.50 - - - - - - - -
    35,062.50 - - - - - - - -
    18,700.00 - - - - - - - -
    2,257.20 - - - - - - - -
    1,985.50 - - - - - - - -
    7,089.50 - - - - - - - -
    26,400.00 - - - - - - - -
    85,000.00 50 4,250,000.00 - - - - 50 4,250,000.00
    34,485.00 - - - - - - - -
    163,311.50 - - - - - - - -
    27,912.50 - - - - - - - -
    5,500.00 - - - - - - - -
    9,900.00 - - - - - - - -
    48,620.00 - - - - - - - -
    4,950.00 - - - - - - - -
    15,353.48 90 1,381,813.20 - - - - 90 1,381,813.20
    1,702,462.80 - - - - - - - -
    9,157.50 48 439,560.00 - - - - 48 439,560.00
    44,000.00 - - - - - - - -
    137,437,909

    DATA KEBUTUHAN OBAT REVISI 144 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    42,075.00 103 4,333,725.00 - - - - 103 4,333,725.00


    519,750.00 - - - - - - - -
    273,003.88 4 1,092,015.52 - - - - 4 1,092,015.52
    10,384.00 11 114,224.00 - - - - 11 114,224.00
    46,200.00 31 1,432,200.00 - - - - 31 1,432,200.00
    77,000.00 - - - - - - - -
    2,145,000.00 - - - - - - - -
    365,750.00 3 1,097,250.00 - - - - 3 1,097,250.00
    138,600.00 3 415,800.00 - - - - 3 415,800.00
    154,000.00 - - - - - - - -
    138,600.00 2 277,200.00 - - - - 2 277,200.00
    127,050.00 1 127,050.00 - - 1 127,050.00 - -
    102,050.30 - - - - - - - -
    122,650.00 - - - - - - - -
    92,230.60 - - - - - - - -
    87,258.60 - - - - - - - -
    92,364.80 - - - - - - - -
    97,202.60 - - - - - - - -
    27,288.58 6 163,731.48 - - - - 6 163,731.48
    39,655.00 7 277,585.00 - - - - 7 277,585.00
    20,847.20 - - - - - - - -
    26,059.00 - - - - - - - -
    28,325.00 8 226,600.00 - - - - 8 226,600.00
    5,999.40 12 71,992.80 - - - - 12 71,992.80
    5,999.40 36 215,978.40 - - - - 36 215,978.40
    22,385.00 12 268,620.00 - - - - 12 268,620.00
    22,385.00 36 805,860.00 - - - - 36 805,860.00
    22,385.00 36 805,860.00 - - - - 36 805,860.00
    22,385.00 24 537,240.00 - - - - 24 537,240.00
    15,467.83 - - - - - - - -
    11,550.00 - - - - - - - -
    22,385.00 48 1,074,480.00 - - - - 48 1,074,480.00
    11,550.00 12 138,600.00 - - - - 12 138,600.00
    22,385.00 12 268,620.00 - - - - 12 268,620.00
    15,467.83 24 371,227.92 - - - - 24 371,227.92
    22,385.00 24 537,240.00 - - - - 24 537,240.00
    22,385.00 48 1,074,480.00 - - - - 48 1,074,480.00
    15,467.83 12 185,613.96 - - - - 12 185,613.96
    15,467.83 - - - - - - - -
    22,385.00 36 805,860.00 - - - - 36 805,860.00
    15,467.83 12 185,613.96 - - - - 12 185,613.96
    22,385.00 12 268,620.00 - - - - 12 268,620.00
    22,385.00 - - - - - - - -
    22,385.00 48 1,074,480.00 - - - - 48 1,074,480.00
    15,467.83 12 185,613.96 - - - - 12 185,613.96
    22,385.00 36 805,860.00 - - - - 36 805,860.00

    DATA KEBUTUHAN OBAT REVISI 145 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    19,250.00 - - - - - - - -
    22,385.00 36 805,860.00 - - - - 36 805,860.00
    15,467.83 24 371,227.92 - - - - 24 371,227.92
    22,385.00 12 268,620.00 - - - - 12 268,620.00
    22,385.00 48 1,074,480.00 - - - - 48 1,074,480.00
    22,385.00 84 1,880,340.00 - - - - 84 1,880,340.00
    22,385.00 96 2,148,960.00 - - - - 96 2,148,960.00
    22,385.00 12 268,620.00 - - - - 12 268,620.00
    22,385.00 36 805,860.00 - - - - 36 805,860.00
    19,250.00 - - - - - - - -
    22,385.00 - - - - - - - -
    22,385.00 60 1,343,100.00 - - - - 60 1,343,100.00
    22,385.00 12 268,620.00 - - - - 12 268,620.00
    15,467.83 48 742,455.84 - - - - 48 742,455.84
    22,385.00 48 1,074,480.00 - - - - 48 1,074,480.00
    15,840.00 - - - - - - - -
    30,164,815.76

    275,412.50 - - - - - - - -
    275,412.50 - - - - - - - -
    275,412.50 - - - - - - - -
    275,412.50 - - - - - - - -
    266,750.00 - - - - - - - -
    266,750.00 - - - - - - - -
    266,750.00 - - - - - - - -
    96,470.00 20 1,929,400.00 - - - - 20 1,929,400.00
    1,030,975.00 5 5,154,875.00 - - - - 5 5,154,875.00
    165.00 - - - - - - - -
    198.00 - - 1,000 198,000.00 700 138,600.00 300 59,400.00
    120.00 - - - - - - - -
    85.00 7,100 603,500.00 - - 5,800 493,000.00 1,300 110,500.00
    4,100.00 80 328,000.00 - - - - 80 328,000.00
    770,000.00 - - - - - - - -
    1,039,500.00 3 3,118,500.00 1 1,039,500.00 4 4,158,000.00 - -
    418,990.00 10 4,189,900.00 - - 2 837,980.00 8 3,351,920.00
    557.00 - - - - - - - -
    522.50 - - - - - - - -
    319.77 - - 1,000 319,770.00 - - 1,000 319,770.00
    682.00 - - - - - - - -
    1,100.00 255 280,500.00 - - 235 258,500.00 20 22,000.00
    462.85 - - - - - - - -
    10,500.00 - - - - - - - -
    28,050.00 - - - - - - - -
    16,500.00 - - - - - - - -
    5,197.00 - - 500 2,598,500.00 500 2,598,500.00 - -
    69,938.00 - - - - - - - -
    68,750.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 146 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    79,750.00 - - - - - - - -
    67,034.00 - - - - - - - -
    74,250.00 - - 60 4,455,000.00 - - 60 4,455,000.00
    37,400.00 - - - - - - - -
    37,400.00 - - - - - - - -
    37,400.00 - - - - - - - -
    32,725.00 - - - - - - - -
    32,725.00 - - - - - - - -
    23,375.00 - - - - - - - -
    23,375.00 - - - - - - - -
    1,270.50 - - 1,000 1,270,500.00 1,000 1,270,500.00 - -
    2,420.00 - - 100 242,000.00 100 242,000.00 - -
    1,760.00 - - 150 264,000.00 150 264,000.00 - -
    580,800.00 - - 6 3,484,800.00 6 3,484,800.00 - -
    990,000.00 4 3,960,000.00 - - 4 3,960,000.00 - -
    20,592.00 - - - - - - - -
    17,800.00 75 1,335,000.00 - - 75 1,335,000.00 - -
    20,570.00 38 781,660.00 - - 38 781,660.00 - -
    38,500.00 - - - - - - - -
    30,250.00 - - - - - - - -
    165.00 - - - - - - - -
    350.00 - - - - - - - -
    1,023.00 - - - - - - - -
    350.00 - - - - - - - -
    792.00 - - - - - - - -
    770.00 - - - - - - - -
    1,438.80 - - - - - - - -
    1,430.00 - - - - - - - -
    1,100.00 - - 1,000 1,100,000.00 - - 1,000 1,100,000.00
    658.35 - - 3,000 1,975,050.00 3,000 1,975,050.00 - -
    880.03 - - - - - - - -
    1,650.00 - - - - - - - -
    1,646.70 - - - - - - - -
    1,430.00 - - 1,500 2,145,000.00 1,500 2,145,000.00 - -
    973.50 - - 2,000 1,947,000.00 1,800 1,752,300.00 200 194,700.00
    1,336.54 3,280 4,383,851.20 - - 3,182 4,252,870.28 98 130,980.92
    1,430.00 - - - - - - - -
    1,653.30 - - - - - - - -
    1,704.78 - - - - - - - -
    1,419.00 - - 300 425,700.00 220 312,180.00 80 113,520.00
    2,035.00 - - - - - - - -
    6,500.00 - - - - - - - -
    1,760.06 100 176,006.00 - - 100 176,006.00 - -
    27,500.00 - - - - - - - -
    1,653.30 - - - - - - - -
    3,900.00 25 97,500.00 - - 25 97,500.00 - -
    1,065.90 - - - - - - - -
    1,430.00 - - - - - - - -
    1,210.00 - - 2,400 2,904,000.00 2,400 2,904,000.00 - -

    DATA KEBUTUHAN OBAT REVISI 147 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    585.75 - - 9,000 5,271,750.00 1,900 1,112,925.00 7,100 4,158,825.00


    625.35 - - 5,000 3,126,750.00 5,000 3,126,750.00 - -
    750.20 - - 3,000 2,250,600.00 2,300 1,725,460.00 700 525,140.00
    602.25 - - - - - - - -
    1,430.00 - - - - - - - -
    1,320.00 - - 1,500 1,980,000.00 1,300 1,716,000.00 200 264,000.00
    1,300.00 - - - - - - - -
    853.96 - - - - - - - -
    658.35 - - 5,500 3,620,925.00 3,900 2,567,565.00 1,600 1,053,360.00
    918.53 - - - - - - - -
    27,500.00 - - - - - - - -
    5,115.00 - - - - - - - -
    6,900.00 135 931,500.00 - - 24 165,600.00 111 765,900.00
    6,200.00 140 868,000.00 - - 70 434,000.00 70 434,000.00
    3,666.78 30 110,003.40 - - - - 30 110,003.40
    8,600.00 - - - - - - - -
    37,700.00 - - - - - - - -
    143,000.00 - - - - - - - -
    45,760.00 - - - - - - - -
    32,725.00 - - - - - - - -
    22,880.73 - - - - - - - -
    42,200.00 1 42,200.00 - - - - 1 42,200.00
    45,760.00 - - - - - - - -
    42,200.00 - - - - - - - -
    45,760.00 - - - - - - - -
    25,300.00 5 126,500.00 - - - - 5 126,500.00
    45,760.00 7 320,320.00 - - - - 7 320,320.00
    32,725.00 5 163,625.00 - - 5 163,625.00 - -
    45,760.00 - - - - - - - -
    32,725.00 10 327,250.00 - - - - 10 327,250.00
    22,379.50 2 44,759.00 - - - - 2 44,759.00
    16,140.30 7 112,982.10 - - 4 64,561.20 3 48,420.90
    25,750.00 5 128,750.00 - - - - 5 128,750.00
    25,297.80 10 252,978.00 - - - - 10 252,978.00
    22,880.73 - - - - - - - -
    42,200.00 - - - - - - - -
    22,880.73 5 114,403.65 - - - - 5 114,403.65
    42,200.00 - - - - - - - -
    22,880.73 5 114,403.65 - - - - 5 114,403.65
    75,900.00 5 379,500.00 - - - - 5 379,500.00
    75,240.00 5 376,200.00 - - - - 5 376,200.00
    72,050.00 15 1,080,750.00 - - - - 15 1,080,750.00
    62,920.00 - - 5 314,600.00 3 188,760.00 2 125,840.00
    57,200.00 3 171,600.00 - - - - 3 171,600.00
    57,200.00 3 171,600.00 - - - - 3 171,600.00
    62,920.00 - - 5 314,600.00 4 251,680.00 1 62,920.00
    62,920.00 - - 5 314,600.00 4 251,680.00 1 62,920.00
    62,920.00 - - 5 314,600.00 5 314,600.00 - -
    16,140.30 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 148 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    156,200.00 - - - - - - - -
    208,500.00 3 625,500.00 - - - - 3 625,500.00
    171,820.00 - - - - - - - -
    162,222.50 - - - - - - - -
    184,550.30 - - - - - - - -
    144,882.00 - - - - - - - -
    264,000.00 2 528,000.00 - - - - 2 528,000.00
    2,200.00 - - - - - - - -
    1,199.99 2,350 2,819,976.50 - - 2,350 2,819,976.50 - -
    1,199.99 - - - - - - - -
    800.01 4,000 3,200,040.00 - - 2,848 2,278,428.48 1,152 921,611.52
    1,920.00 - - - - - - - -
    456.00 - - 3,000 1,368,000.00 - - 3,000 1,368,000.00
    534.41 - - - - - - - -
    1,200.00 590 708,000.00 - - 590 708,000.00 - -
    960.00 - - - - - - - -
    8,039.00 1 8,039.00 - - 1 8,039.00 - -
    7,590.24 - - - - - - - -
    42,350.00 - - 5 211,750.00 5 211,750.00 - -
    13,000.00 5 65,000.00 - - 2 26,000.00 3 39,000.00
    23,100.00 - - - - - - - -
    42,350.00 - - 5 211,750.00 5 211,750.00 - -
    13,000.00 - - - - - - - -
    42,350.00 - - 3 127,050.00 - - 3 127,050.00
    32,857.00 - - - - - - - -
    19,311.60 - - - - - - - -
    13,000.00 - - - - - - - -
    7,700.25 5 38,501.25 - - 5 38,501.25 - -
    13,000.00 8 104,000.00 - - 3 39,000.00 5 65,000.00
    19,311.60 2 38,623.20 - - 2 38,623.20 - -
    23,100.00 - - - - - - - -
    17,088.67 - - - - - - - -
    14,410.00 - - - - - - - -
    21,120.00 - - - - - - - -
    12,100.00 - - - - - - - -
    22,990.00 - - - - - - - -
    12,650.00 - - - - - - - -
    27,610.00 - - - - - - - -
    12,925.00 - - - - - - - -
    52,624.00 - - - - - - - -
    103,143.04 - - - - - - - -
    10,164.00 10 101,640.00 - - - - 10 101,640.00
    15,180.00 10 151,800.00 - - 5 75,900.00 5 75,900.00
    20,900.00 - - - - - - - -
    16,500.00 - - 60 990,000.00 14 231,000.00 46 759,000.00
    20,900.00 - - - - - - - -
    9,240.00 - - 40 369,600.00 40 369,600.00 - -
    27,300.00 - - - - - - - -
    16,500.00 - - 60 990,000.00 60 990,000.00 - -

    DATA KEBUTUHAN OBAT REVISI 149 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    13,200.42 - - - - - - - -
    12,100.00 - - - - - - - -
    20,900.00 - - - - - - - -
    114,950.00 2 229,900.00 - - 2 229,900.00 - -
    86,020.00 - - - - - - - -
    114,950.00 4 459,800.00 - - - - 4 459,800.00
    86,020.00 3 258,060.00 - - 1 86,020.00 2 172,040.00
    11,220.00 - - 100 1,122,000.00 100 1,122,000.00 - -
    444.12 - - - - - - - -
    387.20 6,000 2,323,200.00 - - 1,200 464,640.00 4,800 1,858,560.00
    0.00 - - - - - - - -
    275,000.00 14 3,850,000.00 - - - - 14 3,850,000.00
    4,276.75 3,500 14,968,625.00 - - 1,600 6,842,800.00 1,900 8,125,825.00
    4,291.10 - - - - - - - -
    1,300.00 - - - - - - - -
    1,320.00 - - 200 264,000.00 200 264,000.00 - -
    2,000.00 - - - - - - - -
    990.00 - - 300 297,000.00 230 227,700.00 70 69,300.00
    1,320.00 - - 200 264,000.00 100 132,000.00 100 132,000.00
    668.30 20 13,366.00 - - 20 13,366.00 - -
    668.30 100 66,830.00 - - 10 6,683.00 90 60,147.00
    1,320.00 - - 200 264,000.00 200 264,000.00 - -
    792.00 - - - - - - - -
    668.25 - - 200 133,650.00 200 133,650.00 - -
    957.00 - - 300 287,100.00 120 114,840.00 180 172,260.00
    668.25 - - 200 133,650.00 - - 200 133,650.00
    1,320.00 - - - - - - - -
    957.00 - - 300 287,100.00 100 95,700.00 200 191,400.00
    668.25 - - 500 334,125.00 400 267,300.00 100 66,825.00
    1,320.00 - - 200 264,000.00 200 264,000.00 - -
    110,000.00 - - - - - - - -
    110,000.00 - - - - - - - -
    85,250.00 - - - - - - - -
    79,750.00 - - - - - - - -
    85,250.00 - - - - - - - -
    90,200.00 - - - - - - - -
    13,203.00 - - - - - - - -
    12,155.00 - - - - - - - -
    12,100.00 - - 10 121,000.00 10 121,000.00 - -
    13,203.00 - - 10 132,030.00 10 132,030.00 - -
    13,203.00 - - 50 660,150.00 50 660,150.00 - -
    20,300.00 1 20,300.00 - - 1 20,300.00 - -
    12,100.00 - - 10 121,000.00 10 121,000.00 - -
    18,700.00 - - - - - - - -
    13,203.00 - - 9 118,827.00 9 118,827.00 - -
    12,100.00 - - 10 121,000.00 10 121,000.00 - -
    13,203.00 - - - - - - - -
    187,000.00 - - - - - - - -
    187,000.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 150 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    7,199.50 - - - - - - - -
    187,000.00 - - - - - - - -
    24,200.00 - - - - - - - -
    24,200.00 - - - - - - - -
    187,000.00 - - - - - - - -
    41,580.00 - - - - - - - -
    235,950.00 - - - - - - - -
    235,950.00 - - - - - - - -
    235,950.00 - - - - - - - -
    235,950.00 - - - - - - - -
    235,950.00 - - - - - - - -
    607,552.00 - - - - - - - -
    8,167.50 - - - - - - - -
    8,168.16 81 661,620.96 500 4,084,080.00 500 4,084,080.00 81 661,620.96
    202,125.00 30 6,063,750.00 370 74,786,250.00 390 78,828,750.00 10 2,021,250.00
    297,000.00 - - - - - - - -
    100,650.00 38 3,824,700.00 370 37,240,500.00 408 41,065,200.00 - -
    147,620.00 - - - - - - - -
    140,250.00 - - - - - - - -
    140,251.10 - - 170 23,842,687.00 170 23,842,687.00 - -
    97,350.00 - - 370 36,019,500.00 370 36,019,500.00 - -
    142,780.00 - - - - - - - -
    35,200.00 - - - - - - - -
    104,280.00 - - - - - - - -
    113,190.00 - - - - - - - -
    744,920.00 - - - - - - - -
    120,428.00 - - - - - - - -
    3,080.00 - - - - - - - -
    19,069.05 - - - - - - - -
    5,000.00 - - - - - - - -
    6,930.22 - - - - - - - -
    30,250.00 - - - - - - - -
    7,499.80 - - - - - - - -
    19,360.00 - - - - - - - -
    3,990.00 - - 240 957,600.00 240 957,600.00 - -
    4,400.00 - - - - - - - -
    8,354.61 - - - - - - - -
    8,518.40 - - 50 425,920.00 50 425,920.00 - -
    24,200.00 - - - - - - - -
    19,069.05 - - - - - - - -
    7,000.00 - - - - - - - -
    5,000.00 - - - - - - - -
    3,850.00 - - - - - - - -
    3,990.00 - - - - - - - -
    36,300.00 - - - - - - - -
    5,500.00 - - - - - - - -
    19,360.00 - - - - - - - -
    6,985.00 - - - - - - - -
    21,450.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 151 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    3,990.00 - - 250 997,500.00 250 997,500.00 - -


    8,800.00 - - 100 880,000.00 100 880,000.00 - -
    8,354.61 - - - - - - - -
    8,518.40 - - 100 851,840.00 100 851,840.00 - -
    19,069.05 - - - - - - - -
    5,500.00 - - - - - - - -
    2,887.50 - - 250 721,875.00 250 721,875.00 - -
    36,300.00 - - - - - - - -
    5,500.00 - - - - - - - -
    19,360.00 - - - - - - - -
    16,280.00 - - - - - - - -
    3,990.00 - - 105 418,950.00 105 418,950.00 - -
    8,354.61 - - - - - - - -
    8,800.00 - - 150 1,320,000.00 150 1,320,000.00 - -
    6,930.22 - - - - - - - -
    8,518.40 - - 150 1,277,760.00 150 1,277,760.00 - -
    19,069.05 - - 61 1,163,212.05 61 1,163,212.05 - -
    7,499.80 - - - - - - - -
    2,887.50 - - 100 288,750.00 100 288,750.00 - -
    3,080.00 - - - - - - - -
    33,000.00 - - - - - - - -
    5,500.00 - - - - - - - -
    8,800.00 - - 100 880,000.00 100 880,000.00 - -
    19,360.00 - - - - - - - -
    17,226.00 - - - - - - - -
    3,990.00 - - - - - - - -
    8,354.61 - - - - - - - -
    8,325.90 - - - - - - - -
    25,675.65 - - - - - - - -
    8,055.00 - - - - - - - -
    4,537.50 - - 50 226,875.00 50 226,875.00 - -
    6,930.00 - - - - - - - -
    8,450.00 - - - - - - - -
    21,327.90 - - - - - - - -
    7,700.00 20 154,000.00 - - 20 154,000.00 - -
    6,000.19 85 510,016.15 - - 85 510,016.15 - -
    6,050.00 - - 300 1,815,000.00 215 1,300,750.00 85 514,250.00
    11,000.00 23 253,000.00 - - 23 253,000.00 - -
    5,500.00 25 137,500.00 50 275,000.00 75 412,500.00 - -
    3,135.00 - - - - - - - -
    7,000.00 - - - - - - - -
    3,217.50 - - 1,000 3,217,500.00 485 1,560,487.50 515 1,657,012.50
    6,050.00 - - - - - - - -
    10,500.00 - - - - - - - -
    26,620.00 - - - - - - - -
    1,265.00 - - - - - - - -
    60.00 2,000 120,000.00 - - 1,000 60,000.00 1,000 60,000.00

    DATA KEBUTUHAN OBAT REVISI 152 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    93.50 2,000 187,000.00 - - 1,000 93,500.00 1,000 93,500.00


    126.90 - - - - - - - -
    63.80 1,000 63,800.00 - - - - 1,000 63,800.00
    76.23 - - - - - - - -
    44.00 - - - - - - - -
    74.69 - - - - - - - -
    60.50 1,000 60,500.00 - - - - 1,000 60,500.00
    583.00 - - 500 291,500.00 500 291,500.00 - -
    0.00 - - - - - - - -
    141,750.00 - - 50 7,087,500.00 20 2,835,000.00 30 4,252,500.00
    148,500.00 - - 20 2,970,000.00 - - 20 2,970,000.00
    143,000.00 - - - - - - - -
    132,000.00 - - - - - - - -
    5,500.00 - - - - - - - -
    2,500.00 - - - - - - - -
    28,600.00 - - - - - - - -
    30,663.60 - - - - - - - -
    33,880.00 - - - - - - - -
    2,327.60 - - - - - - - -
    13,682.24 - - - - - - - -
    56,430.00 - - - - - - - -
    88,000.00 - - - - - - - -
    112,200.00 - - - - - - - -
    12,155.00 - - - - - - - -
    11,484.00 2 22,968.00 - - 2 22,968.00 - -
    12,375.00 - - 3 37,125.00 - - 3 37,125.00
    16,830.00 2 33,660.00 - - 2 33,660.00 - -
    46,200.00 - - - - - - - -
    9,735.00 - - 3 29,205.00 - - 3 29,205.00
    20,570.00 2 41,140.00 - - 2 41,140.00 - -
    9,735.00 - - - - - - - -
    2,323.48 - - - - - - - -
    83,776.00 - - - - - - - -
    8,700.00 36 313,200.00 - - 8 69,600.00 28 243,600.00
    12,350.00 15 185,250.00 - - 15 185,250.00 - -
    9,095.66 18 163,721.88 - - 18 163,721.88 - -
    17,128.56 - - - - - - - -
    64,350.00 - - - - - - - -
    37,216.67 - - 48 1,786,400.16 48 1,786,400.16 - -
    19,043.75 - - 30 571,312.50 30 571,312.50 - -
    3,960.00 - - - - - - - -
    38,500.00 - - - - - - - -
    35,200.00 8 281,600.00 - - 1 35,200.00 7 246,400.00
    17,900.30 5 89,501.50 - - - - 5 89,501.50
    20,444.00 5 102,220.00 - - 1 20,444.00 4 81,776.00
    20,444.00 5 102,220.00 - - - - 5 102,220.00
    64,682.07 7 452,774.49 - - 7 452,774.49 - -

    DATA KEBUTUHAN OBAT REVISI 153 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    87,562.80 8 700,502.40 - - 8 700,502.40 - -


    2,310.00 - - - - - - - -
    4,300.00 - - - - - - - -
    578,182.00 - - - - - - - -
    275,000.00 10 2,750,000.00 - - 10 2,750,000.00 - -
    247,500.00 4 990,000.00 - - 2 495,000.00 2 495,000.00
    39,600.00 50 1,980,000.00 - - 50 1,980,000.00 - -
    136,500.00 - - - - - - - -
    34,595.00 - - 20 691,900.00 20 691,900.00 - -
    183.75 600 110,250.00 - - - - 600 110,250.00
    192.50 - - - - - - - -
    2,464.00 - - - - - - - -
    1,061.50 - - - - - - - -
    968.00 - - - - - - - -
    1,320.00 - - - - - - - -
    2,200.00 - - 51 112,200.00 51 112,200.00 - -
    1,040.00 - - 31 32,240.00 31 32,240.00 - -
    1,039.00 - - 19 19,741.00 19 19,741.00 - -
    4,400,000.00 - - - - - - - -
    3,080.00 2,000 6,160,000.00 - - - - 2,000 6,160,000.00
    3,080.00 1,200 3,696,000.00 - - - - 1,200 3,696,000.00
    8,393.00 47 394,471.00 - - - - 47 394,471.00
    8,393.00 - - 400 3,357,200.00 150 1,258,950.00 250 2,098,250.00
    19,500.00 - - - - - - - -
    9,130.00 - - 50 456,500.00 50 456,500.00 - -
    9,500.00 - - - - - - - -
    13,200.00 - - - - - - - -
    13,090.00 - - - - - - - -
    9,130.00 - - 50 456,500.00 50 456,500.00 - -
    8,393.00 - - 500 4,196,500.00 300 2,517,900.00 200 1,678,600.00
    4,647.00 - - 800 3,717,600.00 400 1,858,800.00 400 1,858,800.00
    16,500.00 - - - - - - - -
    8,393.00 - - 400 3,357,200.00 150 1,258,950.00 250 2,098,250.00
    14,850.00 - - - - - - - -
    11,000.00 - - - - - - - -
    9,500.00 - - - - - - - -
    4,647.00 - - 100 464,700.00 100 464,700.00 - -
    8,393.00 - - 150 1,258,950.00 50 419,650.00 100 839,300.00
    14,850.00 - - - - - - - -
    11,000.00 - - - - - - - -
    12,809.50 - - - - - - - -
    16,500.00 - - - - - - - -
    9,500.00 - - - - - - - -
    2,783.00 - - - - - - - -
    2,800.00 200 560,000.00 - - - - 200 560,000.00
    4,950.00 100 495,000.00 - - 100 495,000.00 - -
    2,783.00 - - - - - - - -
    2,800.00 200 560,000.00 - - - - 200 560,000.00
    4,950.00 100 495,000.00 - - - - 100 495,000.00

    DATA KEBUTUHAN OBAT REVISI 154 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    2,783.00 - - - - - - - -
    2,800.00 200 560,000.00 - - - - 200 560,000.00
    4,950.00 100 495,000.00 - - - - 100 495,000.00
    2,783.00 200 556,600.00 - - - - 200 556,600.00
    2,800.00 100 280,000.00 - - - - 100 280,000.00
    4,950.00 100 495,000.00 - - 100 495,000.00 - -
    2,800.00 100 280,000.00 - - - - 100 280,000.00
    4,950.00 100 495,000.00 - - - - 100 495,000.00
    10,800.00 15 162,000.00 - - - - 15 162,000.00
    5,500.00 35 192,500.00 - - - - 35 192,500.00
    8,800.00 30 264,000.00 - - 10 88,000.00 20 176,000.00
    6,600.00 10 66,000.00 - - 10 66,000.00 - -
    6,710.21 9 60,391.89 - - 9 60,391.89 - -
    6,600.00 20 132,000.00 - - - - 20 132,000.00
    5,775.00 - - 10 57,750.00 - - 10 57,750.00
    9,900.00 - - 10 99,000.00 - - 10 99,000.00
    7,150.00 - - 5 35,750.00 5 35,750.00 - -
    9,900.00 - - 100 990,000.00 100 990,000.00 - -
    4,150.00 - - - - - - - -
    6,710.21 - - - - - - - -
    6,710.21 40 268,408.40 - - 40 268,408.40 - -
    6,710.21 10 67,102.10 - - - - 10 67,102.10
    39,050.00 - - - - - - - -
    798.00 - - 300 239,400.00 - - 300 239,400.00
    1,427.80 - - - - - - - -
    1,500.00 - - - - - - - -
    1,084.60 - - 300 325,380.00 - - 300 325,380.00
    36,200.00 - - - - - - - -
    38,500.00 - - 20 770,000.00 - - 20 770,000.00
    24,150.00 - - 50 1,207,500.00 36 869,400.00 14 338,100.00
    55,000.00 68 3,740,000.00 - - 5 275,000.00 63 3,465,000.00
    36,200.00 50 1,810,000.00 - - - - 50 1,810,000.00
    24,781.10 - - - - - - - -
    1,452.00 - - - - - - - -
    176,000.00 - - - - - - - -
    22,907.50 - - - - - - - -
    30,550.00 - - - - - - - -
    22,907.50 - - - - - - - -
    30,550.00 - - - - - - - -
    51,700.00 - - - - - - - -
    20,295.00 - - - - - - - -
    20,295.00 10 202,950.00 - - - - 10 202,950.00
    13,200.00 5 66,000.00 - - 5 66,000.00 - -
    33,550.00 - - 10 335,500.00 10 335,500.00 - -
    8,131.00 - - 30 243,930.00 29 235,799.00 1 8,131.00
    29,250.00 - - - - - - - -
    16,853.76 - - - - - - - -
    8,131.00 - - 15 121,965.00 1 8,131.00 14 113,834.00
    19,800.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 155 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    3,410.00 - - - - - - - -
    11,000.00 - - - - - - - -
    13,750.00 - - - - - - - -
    3,565.10 - - 20 71,302.00 - - 20 71,302.00
    4,562.00 - - 40 182,480.00 - - 40 182,480.00
    6,380.00 - - - - - - - -
    13,750.00 80 1,100,000.00 - - 22 302,500.00 58 797,500.00
    4,562.00 15 68,430.00 - - - - 15 68,430.00
    3,410.00 - - - - - - - -
    13,750.00 100 1,375,000.00 - - - - 100 1,375,000.00
    13,750.00 - - - - - - - -
    3,410.00 - - - - - - - -
    4,562.00 - - - - - - - -
    9,212.50 - - - - - - - -
    13,750.00 90 1,237,500.00 - - 40 550,000.00 50 687,500.00
    33,000.00 - - - - - - - -
    31,944.00 2 63,888.00 - - - - 2 63,888.00
    35,200.00 30 1,056,000.00 - - 3 105,600.00 27 950,400.00
    14,520.00 - - 10 145,200.00 - - 10 145,200.00
    17,600.00 10 176,000.00 - - 3 52,800.00 7 123,200.00
    16,830.00 - - - - - - - -
    11,550.00 - - - - - - - -
    14,175.00 19 269,325.00 50 708,750.00 7 99,225.00 62 878,850.00
    681.82 - - 5,000 3,409,100.00 - - 5,000 3,409,100.00
    1,750.00 - - - - - - - -
    850.20 3,300 2,805,660.00 - - 1,400 1,190,280.00 1,900 1,615,380.00
    1,750.00 - - - - - - - -
    1,782.00 - - - - - - - -
    1,750.00 - - - - - - - -
    850.20 11,500 9,777,300.00 - - 8,900 7,566,780.00 2,600 2,210,520.00
    2,050.00 - - - - - - - -
    1,750.00 - - - - - - - -
    681.82 - - 20,000 13,636,400.00 11,100 7,568,202.00 8,900 6,068,198.00
    1,750.00 - - - - - - - -
    1,750.00 - - - - - - - -
    681.82 - - 20,000 13,636,400.00 12,800 8,727,296.00 7,200 4,909,104.00
    1,210.00 - - 5,000 6,050,000.00 1,600 1,936,000.00 3,400 4,114,000.00
    850.20 3,900 3,315,780.00 - - 3,900 3,315,780.00 - -
    1,090.91 - - - - - - - -
    1,750.00 - - - - - - - -
    850.20 - - - - - - - -
    76,322.00 - - 12 915,864.00 12 915,864.00 - -
    151,800.00 - - - - - - - -
    102,066.98 - - - - - - - -
    62,957.03 - - - - - - - -
    82,500.00 12 990,000.00 - - 12 990,000.00 - -
    87,934.00 - - - - - - - -
    62,957.03 - - - - - - - -
    90,200.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 156 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    76,107.99 - - - - - - - -
    179,740.00 - - - - - - - -
    100,320.00 - - - - - - - -
    24,200.00 - - 500 12,100,000.00 100 2,420,000.00 400 9,680,000.00
    13,005.01 - - 340 4,421,703.40 - - 340 4,421,703.40
    58,800.00 - - 10 588,000.00 3 176,400.00 7 411,600.00
    143,000.00 - - 10 1,430,000.00 10 1,430,000.00 - -
    82,500.00 - - - - - - - -
    77,000.00 - - - - - - - -
    4,950.00 - - 100 495,000.00 100 495,000.00 - -
    2,047.50 - - 500 1,023,750.00 250 511,875.00 250 511,875.00
    5,830.19 - - - - - - - -
    236,500.00 - - - - - - - -
    313,500.00 - - - - - - - -
    167,200.00 2 334,400.00 - - - - 2 334,400.00
    3,988.60 - - - - - - - -
    38,500.00 - - 5 192,500.00 5 192,500.00 - -
    60,244.80 - - - - - - - -
    44,704.00 - - - - - - - -
    17,930.00 - - - - - - - -
    2,090.00 - - 50 104,500.00 50 104,500.00 - -
    4,235.00 50 211,750.00 - - 50 211,750.00 - -
    1,650.00 - - 200 330,000.00 150 247,500.00 50 82,500.00
    6,600.21 10 66,002.10 - - 10 66,002.10 - -
    8,855.00 - - 200 1,771,000.00 90 796,950.00 110 974,050.00
    5,544.00 - - 135 748,440.00 83 460,152.00 52 288,288.00
    7,700.00 - - 40 308,000.00 - - 40 308,000.00
    44,770.00 - - - - - - - -
    8,800.00 - - - - - - - -
    73,810.00 - - - - - - - -
    138,570,375.50

    637,450.00 - - - - - - - -
    637,367.50 - - - - - - - -
    637,450.00 - - - - - - - -
    275,000.00 - - - - - - - -
    962,500.00 - - - - - - - -
    96,470.00 10 964,700.00 - - - - 10 964,700.00
    13,750.00 - - - - - - - -
    105,050.00 - - - - - - - -
    297,440.00 6 1,784,640.00 - - - - 6 1,784,640.00
    297,440.00 3 892,320.00 - - - - 3 892,320.00
    390,500.00 - - - - - - - -
    335,500.00 - - - - - - - -
    148,500.00 - - - - - - - -
    13,750.00 - - - - - - - -
    13,750.00 10 137,500.00 - - - - 10 137,500.00
    173,250.00 4 693,000.00 - - - - 4 693,000.00

    DATA KEBUTUHAN OBAT REVISI 157 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    19,425.00 3 58,275.00 - - - - 3 58,275.00


    19,425.00 4 77,700.00 - - - - 4 77,700.00
    173,250.00 - - - - - - - -
    630,000.36 - - - - - - - -
    630,000.36 - - - - - - - -
    630,000.36 - - - - - - - -
    630,000.36 - - - - - - - -
    630,000.36 - - - - - - - -
    629,999.37 - - - - - - - -
    19,250.00 2 38,500.00 - - - - 2 38,500.00
    52,800.00 2 105,600.00 - - - - 2 105,600.00
    110,000.00 - - - - - - - -
    99,000.00 - - - - - - - -
    99,000.00 - - - - - - - -
    88,000.00 36 3,168,000.00 - - 12 1,056,000.00 24 2,112,000.00
    203,500.00 60 12,210,000.00 - - - - 60 12,210,000.00
    82,500.00 - - - - - - - -
    55,000.00 - - - - - - - -
    110,000.00 - - - - - - - -
    55,000.00 - - - - - - - -
    46,750.00 - - - - - - - -
    46,750.00 - - - - - - - -
    55,000.00 - - - - - - - -
    26,125.00 32 836,000.00 - - - - 32 836,000.00
    6,381.10 - - - - - - - -
    9,084.90 - - - - - - - -
    2,103,750.00 - - - - - - - -
    1,485,000.00 - - - - - - - -
    82,764.00 - - - - - - - -
    1,996,720.00 - - - - - - - -
    2,684,990.00 - - - - - - - -
    45,700.00 - - - - - - - -
    82,500.00 - - - - - - - -
    68,970.00 - - - - - - - -
    45,699.96 - - - - - - - -
    2,135,760.00 - - - - - - - -
    55,000.00 - - - - - - - -
    2,103,750.00 - - - - - - - -
    1,600,203.00 - - - - - - - -
    2,091,760.00 - - - - - - - -
    58,300.00 - - - - - - - -
    82,500.00 - - - - - - - -
    32,032.00 - - - - - - - -
    59,125.00 - - - - - - - -
    73,568.00 - - - - - - - -
    1,584,000.00 - - - - - - - -
    1,996,720.00 - - - - - - - -
    91,850.00 - - - - - - - -
    34,300.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 158 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    2,936,670.00 - - - - - - - -
    14,300.00 - - - - - - - -
    1,485,000.00 - - - - - - - -
    55,000.00 - - - - - - - -
    35,066.90 - - - - - - - -
    68,750.00 - - - - - - - -
    32,870.00 - - - - - - - -
    50,600.00 12 607,200.00 - - - - 12 607,200.00
    846,450.00 - - - - - - - -
    880,000.00 1 880,000.00 - - - - 1 880,000.00
    1,870,000.00 - - - - - - - -
    1,155,000.00 - - - - - - - -
    1,426,425.00 - - - - - - - -
    852,500.00 - - - - - - - -
    1,155,000.00 - - - - - - - -
    990,000.00 - - - - - - - -
    39,875.00 48 1,914,000.00 - - - - 48 1,914,000.00
    41,250.00 36 1,485,000.00 - - - - 36 1,485,000.00
    82,500.00 - - - - - - - -
    82,500.00 - - - - - - - -
    11,607.75 - - - - - - - -
    79,750.00 - - - - - - - -
    39,875.00 48 1,914,000.00 - - - - 48 1,914,000.00
    37,125.00 - - 48 1,782,000.00 - - 48 1,782,000.00
    79,750.00 - - - - - - - -
    100,100.00 - - - - - - - -
    0.00 - - - - - - - -
    880.00 - - - - - - - -
    4,620.00 - - - - - - - -
    71,995.00 - - - - - - - -
    21,326.98 - - - - - - - -
    196,174.00 - - - - - - - -
    21,326.98 - - - - - - - -
    21,896.97 - - - - - - - -
    21,326.98 - - - - - - - -
    55,000.00 - - - - - - - -
    21,326.98 - - - - - - - -
    21,326.80 - - - - - - - -
    21,896.97 - - - - - - - -
    21,896.60 - - - - - - - -
    69,168.00 - - - - - - - -
    37,294.03 - - - - - - - -
    190,271.40 - - - - - - - -
    57,890.45 - - - - - - - -
    67,538.86 - - - - - - - -
    74,775.67 - - - - - - - -
    165,310.20 - - - - - - - -
    9,350.00 - - - - - - - -
    1,600.00 100 160,000.00 - - - - 100 160,000.00

    DATA KEBUTUHAN OBAT REVISI 159 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    165.00 - - - - - - - -
    223.41 - - - - - - - -
    165.00 200 33,000.00 - - - - 200 33,000.00
    165.00 - - - - - - - -
    3,018.40 - - - - - - - -
    2,750.00 - - - - - - - -
    3,500.00 250 875,000.00 - - - - 250 875,000.00
    341,000.00 - - - - - - - -
    341,220.00 - - - - - - - -
    2,519,286.00 - - - - - - - -
    2,446,400.00 - - - - - - - -
    2,964,500.00 - - - - - - - -
    37,444.00 - - - - - - - -
    49,233.80 3 147,701.40 - - - - 3 147,701.40
    54,749.20 2 109,498.40 - - - - 2 109,498.40
    19,360.00 - - - - - - - -
    32,340.00 - - 30 970,200.00 - - 30 970,200.00
    15,400.00 - - 20 308,000.00 - - 20 308,000.00
    15,840.00 - - - - - - - -
    23,496.00 - - - - - - - -
    16,500.00 - - 3 49,500.00 3 49,500.00 - -
    15,180.00 - - - - - - - -
    1,584.00 - - - - - - - -
    1,540.00 180 277,200.00 - - 5 7,700.00 175 269,500.00
    25,059.14 - - - - - - - -
    35,083.00 - - - - - - - -
    46,005.52 - - - - - - - -
    220,000.00 30 6,600,000.00 - - - - 30 6,600,000.00
    435,600.00 - - - - - - - -
    35,997.50 - - - - - - - -
    61,750.00 - - - - - - - -
    34,650.00 - - - - - - - -
    112,200.00 - - - - - - - -
    19,305.00 - - - - - - - -
    3,135.00 35 109,725.00 - - 4 12,540.00 31 97,185.00
    5,500.00 10 55,000.00 - - 10 55,000.00 - -
    23,760.00 - - - - - - - -
    8,354.61 - - - - - - - -
    852,500.00 - - - - - - - -
    937,750.00 - - - - - - - -
    5,613,300.00 - - - - - - - -
    18,150.00 - - - - - - - -
    33,000.00 - - - - - - - -
    5,500.00 - - - - - - - -
    7,700.00 22 169,400.00 - - - - 22 169,400.00
    57,288.00 - - - - - - - -
    66,000.00 5 330,000.00 - - 1 66,000.00 4 264,000.00
    36,300.00 - - - - - - - -
    56,650.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 160 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    46,200.00 1 46,200.00 - - - - 1 46,200.00


    180,895.00 2 361,790.00 - - - - 2 361,790.00
    180,895.00 - - - - - - - -
    180,895.00 - - - - - - - -
    210,210.00 - - - - - - - -
    3,432,000.00 - - - - - - - -
    567,600.46 - - - - - - - -
    1,039,500.00 - - - - - - - -
    1,039,500.00 - - - - - - - -
    23,400.00 - - - - - - - -
    97,500.00 - - - - - - - -
    97,500.00 1 97,500.00 - - - - 1 97,500.00
    2,500.00 2,125 5,312,500.00 - - 90 225,000.00 2,035 5,087,500.00
    14,872.00 - - - - - - - -
    11,931.80 - - - - - - - -
    14,872.00 - - - - - - - -
    34,500.00 2,000 69,000,000.00 - - - - 2,000 69,000,000.00
    47,500.00 - - - - - - - -
    34,500.00 1,102 38,019,000.00 - - 15 517,500.00 1,087 37,501,500.00
    43,065.00 - - - - - - - -
    181,500.00 12 2,178,000.00 - - 12 2,178,000.00 - -
    90,750.00 24 2,178,000.00 - - - - 24 2,178,000.00
    60,500.00 - - - - - - - -
    55,000.00 - - - - - - - -
    55,000.00 - - - - - - - -
    30,250.00 12 363,000.00 - - - - 12 363,000.00
    57,750.00 - - - - - - - -
    21,326.98 - - - - - - - -
    21,326.98 - - - - - - - -
    57,750.00 - - - - - - - -
    57,750.00 60 3,465,000.00 - - - - 60 3,465,000.00
    57,750.00 48 2,772,000.00 - - - - 48 2,772,000.00
    57,750.00 12 693,000.00 - - - - 12 693,000.00
    46,750.00 - - - - - - - -
    58,850.00 - - - - - - - -
    679,250.00 - - - - - - - -
    29,700.00 - - - - - - - -
    34,650.00 20 693,000.00 - - - - 20 693,000.00
    34,650.00 - - - - - - - -
    201,025.00 - - - - - - - -
    55,000.00 100 5,500,000.00 - - - - 100 5,500,000.00
    6,545.00 - - - - - - - -
    88,000.00 - - - - - - - -
    138,600.00 20 2,772,000.00 - - - - 20 2,772,000.00
    396,000.00 2 792,000.00 - - - - 2 792,000.00
    435,600.00 2 871,200.00 - - - - 2 871,200.00
    55,000.00 - - 24 1,320,000.00 24 1,320,000.00 - -
    60,500.00 - - 48 2,904,000.00 48 2,904,000.00 - -
    45,375.00 48 2,178,000.00 - - 24 1,089,000.00 24 1,089,000.00

    DATA KEBUTUHAN OBAT REVISI 161 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    44,000.00 24 1,056,000.00 - - - - 24 1,056,000.00


    44,000.00 - - - - - - - -
    41,250.00 24 990,000.00 - - 24 990,000.00 - -
    82,500.00 - - - - - - - -
    46,750.00 12 561,000.00 - - - - 12 561,000.00
    57,750.00 - - - - - - - -
    60,500.00 - - - - - - - -
    77,000.00 - - - - - - - -
    37,125.00 - - 96 3,564,000.00 36 1,336,500.00 60 2,227,500.00
    37,125.00 48 1,782,000.00 - - - - 48 1,782,000.00
    38,500.00 12 462,000.00 - - - - 12 462,000.00
    74,250.00 12 891,000.00 - - - - 12 891,000.00
    93,500.00 - - - - - - - -
    39,875.00 - - - - - - - -
    93,500.00 - - - - - - - -
    23,650.00 - - - - - - - -
    41,360.00 - - - - - - - -
    52,360.00 - - - - - - - -
    34,760.00 - - - - - - - -
    124,960.00 - - - - - - - -
    162,800.00 - - - - - - - -
    82,500.00 - - - - - - - -
    207,350.00 - - - - - - - -
    164,370.00 - - - - - - - -
    66,000.00 - - - - - - - -
    99,000.00 - - - - - - - -
    99,000.00 - - - - - - - -
    49,500.00 12 594,000.00 - - - - 12 594,000.00
    27,030.30 - - - - - - - -
    87,010.00 - - - - - - - -
    91,608.00 - - - - - - - -
    203,500.00 - - - - - - - -
    103,983.00 - - - - - - - -
    110,000.00 - - - - - - - -
    226,050.00 - - - - - - - -
    332,640.00 - - - - - - - -
    431,420.00 - - - - - - - -
    4,752,000.00 - - - - - - - -
    32,670.00 - - - - - - - -
    32,670.00 - - - - - - - -
    32,670.00 - - - - - - - -
    32,670.00 - - - - - - - -
    32,670.00 - - - - - - - -
    16,500.00 - - - - - - - -
    44,000.00 - - - - - - - -
    41,800.00 - - - - - - - -
    21,000.00 - - 5 105,000.00 - - 5 105,000.00
    37,400.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 162 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    3,093.75 4 12,375.00 - - - - 4 12,375.00


    95,700.00 - - - - - - - -
    46,750.00 - - - - - - - -
    44,000.00 - - - - - - - -
    46,750.00 12 561,000.00 - - 12 561,000.00 - -
    55,000.00 72 3,960,000.00 - - - - 72 3,960,000.00
    1,257,190.00 - - - - - - - -
    7,763.80 - - - - - - - -
    850,080.00 - - - - - - - -
    52,250.00 - - - - - - - -
    1,069,640.00 - - - - - - - -
    26,125.00 36 940,500.00 - - 36 940,500.00 - -
    26,125.00 12 313,500.00 - - 12 313,500.00 - -
    777,920.00 - - - - - - - -
    643,500.00 - - - - - - - -
    1,402,500.00 - - - - - - - -
    20,610.00 - - - - - - - -
    44,000.00 - - - - - - - -
    20,757.00 - - - - - - - -
    19,699.90 - - - - - - - -
    20,186.01 - - - - - - - -
    20,300.00 - - - - - - - -
    18,700.00 - - - - - - - -
    18,920.00 - - - - - - - -
    17,600.00 - - - - - - - -
    15,400.00 - - - - - - - -
    0.00 - - - - - - - -
    83,853.00 - - - - - - - -
    71,060.00 - - - - - - - -
    70,070.00 - - - - - - - -
    58,201.00 - - - - - - - -
    55,781.00 - - - - - - - -
    68,970.00 - - - - - - - -
    16,853.76 - - - - - - - -
    8,131.00 - - 2 16,262.00 - - 2 16,262.00
    33,550.00 - - 5 167,750.00 - - 5 167,750.00
    7,590.24 8 60,721.92 - - - - 8 60,721.92
    16,853.76 5 84,268.80 - - 5 84,268.80 - -
    8,131.00 - - 10 81,310.00 10 81,310.00 - -
    33,550.00 - - 3 100,650.00 - - 3 100,650.00
    5,346.00 50 267,300.00 - - 20 106,920.00 30 160,380.00
    104,940.00 - - - - - - - -
    29,997.91 - - - - - - - -
    29,997.91 - - - - - - - -
    29,997.91 - - - - - - - -
    8,965.00 - - 200 1,793,000.00 200 1,793,000.00 - -
    10,120.00 - - 200 2,024,000.00 200 2,024,000.00 - -
    53,205.90 - - - - - - - -
    64,046.44 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 163 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    84,116.42 - - - - - - - -
    33,000.00 10 330,000.00 - - - - 10 330,000.00
    33,660.00 50 1,683,000.00 - - - - 50 1,683,000.00
    138,600.00 - - - - - - - -
    88,000.00 2 176,000.00 - - - - 2 176,000.00
    297,000.00 9 2,673,000.00 - - - - 9 2,673,000.00
    158,400.00 - - - - - - - -
    23,100.00 - - - - - - - -
    18,150.00 - - 5 90,750.00 - - 5 90,750.00
    83,600.00 - - - - - - - -
    83,600.00 - - - - - - - -
    235,004.00 - - - - - - - -
    271,700.00 1 271,700.00 - - - - 1 271,700.00
    271,700.00 - - - - - - - -
    10,601.25 - - 10 106,012.50 2 21,202.50 8 84,810.00
    16,500.00 - - 3 49,500.00 3 49,500.00 - -
    7,590.00 - - - - - - - -
    20,856.00 40 834,240.00 - - 40 834,240.00 - -
    6,500.00 100 650,000.00 - - - - 100 650,000.00
    5,148.00 3 15,444.00 - - - - 3 15,444.00
    15,840.00 5 79,200.00 - - - - 5 79,200.00
    22,000.00 2 44,000.00 - - - - 2 44,000.00
    3,861.00 - - - - - - - -
    7,920.00 - - - - - - - -
    2,400.00 10 24,000.00 - - - - 10 24,000.00
    2,400.00 10 24,000.00 - - - - 10 24,000.00
    12,375.00 - - - - - - - -
    17,857.40 - - - - - - - -
    614,790.00 - - - - - - - -
    1,188,000.00 - - - - - - - -
    1,431,540.00 - - - - - - - -
    35,200.00 - - - - - - - -
    71,500.00 1 71,500.00 - - - - 1 71,500.00
    704,000.00 - - - - - - - -
    165,000.00 - - - - - - - -
    665,500.00 - - - - - - - -
    77,000.00 22 1,694,000.00 - - - - 22 1,694,000.00
    671,000.00 - - - - - - - -
    330,000.00 - - - - - - - -
    0.00 - - - - - - - -
    15,000.00 - - - - - - - -
    0.00 - - - - - - - -
    56,925.00 - - - - - - - -
    88,000.00 - - - - - - - -
    84,150.00 - - - - - - - -
    47,025.00 - - - - - - - -
    93,500.00 - - - - - - - -
    302,500.00 - - - - - - - -
    302,500.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 164 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    220,000.00 - - - - - - - -
    275,000.00 - - - - - - - -
    302,500.00 - - - - - - - -
    302,500.00 - - - - - - - -
    343,200.00 - - - - - - - -
    144,100.00 - - - - - - - -
    122,100.00 - - - - - - - -
    100,870.00 - - - - - - - -
    0.00 - - - - - - - -
    32,725.00 - - - - - - - -
    66,000.00 1 66,000.00 - - - - 1 66,000.00
    3,245,000.00 - - - - - - - -
    605,000.00 - - - - - - - -
    1,952,500.00 - - - - - - - -
    1,870,000.00 - - - - - - - -
    24,811.41 - - - - - - - -
    24,811.41 - - - - - - - -
    28,482.66 - - - - - - - -
    496,375.00 - - - - - - - -
    10,725.00 - - - - - - - -
    10,725.00 - - - - - - - -
    10,725.00 - - - - - - - -
    44,000.00 - - - - - - - -
    28,050.00 4 112,200.00 - - - - 4 112,200.00
    278,300.00 - - - - - - - -
    470,250.00 - - - - - - - -
    396,000.00 - - - - - - - -
    88,000.00 - - - - - - - -
    24,200.00 - - - - - - - -
    103,950.00 - - - - - - - -
    110,000.00 - - - - - - - -
    123,750.00 - - - - - - - -
    110,880.00 - - - - - - - -
    319,660.00 2 639,320.00 - - - - 2 639,320.00
    53,083.80 - - - - - - - -
    19,167.50 - - - - - - - -
    35,200.00 - - - - - - - -
    302,500.00 - - - - - - - -
    104,500.00 - - - - - - - -
    583,440.00 - - - - - - - -
    55,000.00 - - - - - - - -
    192,664,173

    10,340.00 - - - - - - - -
    343,200.00 - - - - - - - -
    20,701.29 8 165,610.32 - - 6 124,207.74 2 41,402.58
    55,800.00 47 2,622,600.00 - - - - 47 2,622,600.00

    DATA KEBUTUHAN OBAT REVISI 165 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    34,375.00 - - - - - - - -
    15,268.00 - - - - - - - -
    690,250.00 - - - - - - - -
    291,000.00 4 1,164,000.00 - - - - 4 1,164,000.00
    38,850.00 42 1,631,700.00 - - 20 777,000.00 22 854,700.00
    30,750.00 51 1,568,250.00 - - 38 1,168,500.00 13 399,750.00
    29,211.50 - - - - - - - -
    216,000.00 - - 6 1,296,000.00 2 432,000.00 4 864,000.00
    66,000.00 - - - - - - - -
    30,000.30 - - - - - - - -
    348,150.00 - - 5 1,740,750.00 5 1,740,750.00 - -
    2,631,200.00 - - 1 2,631,200.00 1 2,631,200.00 - -
    187,000.00 - - - - - - - -
    702,768.00 - - - - - - - -
    830,544.00 - - - - - - - -
    1,650,000.00 - - - - - - - -
    825,000.00 1 825,000.00 - - - - 1 825,000.00
    1,733,600.00 - - - - - - - -
    644,600.00 - - 2 1,289,200.00 2 1,289,200.00 - -
    24,640.00 - - - - - - - -
    1,111,000.00 - - - - - - - -
    770,000.00 - - - - - - - -
    2,576,860.00 - - 8 20,614,880.00 8 20,614,880.00 - -
    1,430,000.00 - - 2 2,860,000.00 2 2,860,000.00 - -
    2,024,000.00 - - 3 6,072,000.00 3 6,072,000.00 - -
    1,227,600.00 - - 2 2,455,200.00 2 2,455,200.00 - -
    3,623,709.38 - - 6 21,742,256.28 6 21,742,256.28 - -
    1,771,000.00 - - 5 8,855,000.00 5 8,855,000.00 - -
    2,846,800.00 - - 2 5,693,600.00 2 5,693,600.00 - -
    847,000.00 - - - - - - - -
    900,900.00 - - - - - - - -
    3,850,000.00 - - - - - - - -
    42,900.00 - - - - - - - -
    2,597,870.00 - - - - - - - -
    422,675.00 - - - - - - - -
    1,586,200.00 - - - - - - - -
    126,500.00 - - - - - - - -
    1,563,100.00 - - - - - - - -
    283,360.00 - - - - - - - -
    753,500.00 - - - - - - - -
    31,900.00 - - - - - - - -
    170,500.00 - - 2 341,000.00 1 170,500.00 1 170,500.00
    731,500.00 - - - - - - - -
    1,518,550.00 - - - - - - - -
    1,523,500.00 - - - - - - - -
    70,000.00 1 70,000.00 - - 1 70,000.00 - -
    143,000.00 - - - - - - - -
    109,663.12 - - - - - - - -
    2,751,999.80 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 166 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    399,300.00 - - - - - - - -
    341,550.00 - - - - - - - -
    577,500.00 - - - - - - - -
    338,800.00 - - 22 7,453,600.00 22 7,453,600.00 - -
    314,600.00 - - 3 943,800.00 3 943,800.00 - -
    27,500.00 - - - - - - - -
    344,850.00 - - - - - - - -
    341,550.00 - - - - - - - -
    451,550.00 - - - - - - - -
    254,100.00 - - - - - - - -
    113,300.00 - - - - - - - -
    845,350.00 - - - - - - - -
    544,500.00 - - - - - - - -
    2,110,900.00 - - - - - - - -
    1,755,600.00 - - - - - - - -
    42,664.05 - - - - - - - -
    1,066,601.00 - - - - - - - -
    617,100.00 - - 25 15,427,500.00 25 15,427,500.00 - -
    1,642,300.00 - - - - - - - -
    1,221,000.00 - - - - - - - -
    788,700.00 - - - - - - - -
    2,216,500.00 - - - - - - - -
    36,720.20 22 807,844.40 - - 12 440,642.40 10 367,202.00
    6,600.00 3 19,800.00 - - - - 3 19,800.00
    4,250.40 3 12,751.20 - - 3 12,751.20 - -
    3,658.60 - - - - - - - -
    5,016.00 - - 300 1,504,800.00 300 1,504,800.00 - -
    2,475.00 - - 1,000 2,475,000.00 1,000 2,475,000.00 - -
    2,508.00 - - 1,500 3,762,000.00 1,500 3,762,000.00 - -
    2,662.00 - - 200 532,400.00 200 532,400.00 - -
    1,100,000.00 - - - - - - - -
    462,000.00 - - - - - - - -
    41,800.00 - - - - - - - -
    308,000.00 - - - - - - - -
    2,323,200.00 - - - - - - - -
    660,000.00 - - 2 1,320,000.00 2 1,320,000.00 - -
    420,000.00 - - 2 840,000.00 - - 2 840,000.00
    26,250.00 2 52,500.00 - - - - 2 52,500.00
    154,000.00 - - - - - - - -
    794,816.00 - - - - - - - -
    668,272.00 - - - - - - - -
    330,000.00 - - - - - - - -
    60,000.00 - - - - - - - -
    75,000.00 - - - - - - - -
    47,000.00 - - 500 23,500,000.00 500 23,500,000.00 - -
    40,000.00 - - - - - - - -
    49,000.00 - - - - - - - -
    104,500.00 - - - - - - - -
    92,000.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 167 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    86,905.50 - - - - - - - -
    26,000.00 - - 1,000 26,000,000.00 1,000 26,000,000.00 - -
    24,400.00 - - 75 1,830,000.00 75 1,830,000.00 - -
    80,000.00 - - - - - - - -
    25,000.00 - - 250 6,250,000.00 250 6,250,000.00 - -
    25,455.00 - - 2,250 57,273,750.00 2,250 57,273,750.00 - -
    3,630,000.00 - - - - - - - -
    8,360,000.00 - - - - - - - -
    766,700.00 - - - - - - - -
    174,499.60 - - - - - - - -
    180,000.00 - - - - - - - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    148,500.00 - - - - - - - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    148,500.00 - - - - - - - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    306,625.00 - - - - - - - -
    174,499.60 - - - - - - - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    148,500.00 - - - - - - - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    121,000.00 - - 2 242,000.00 2 242,000.00 - -
    450,450.00 - - - - - - - -
    105,600.00 - - 3 316,800.00 3 316,800.00 - -
    289,474.90 - - - - - - - -
    92,400.00 - - - - - - - -
    105,600.00 - - 3 316,800.00 3 316,800.00 - -
    105,600.00 - - - - - - - -
    114,864.00 - - - - - - - -
    92,400.00 - - - - - - - -
    105,600.00 - - 3 316,800.00 3 316,800.00 - -
    105,600.00 - - 3 316,800.00 3 316,800.00 - -
    132,000.00 - - - - - - - -
    164,092.50 - - - - - - - -
    903,100.00 - - 2 1,806,200.00 2 1,806,200.00 - -
    903,100.00 - - 2 1,806,200.00 2 1,806,200.00 - -
    926,640.00 - - - - - - - -
    1,602,370.00 - - - - - - - -
    721,050.00 - - - - - - - -
    721,050.00 - - - - - - - -
    1,280,180.00 - - - - - - - -
    1,602,370.00 - - - - - - - -
    721,050.00 - - - - - - - -
    721,050.00 - - - - - - - -
    2,016,300.00 - - - - - - - -
    705,375.00 - - - - - - - -
    352,687.50 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 168 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    352,687.50 - - - - - - - -
    1,645,967.40 - - - - - - - -
    822,983.70 - - - - - - - -
    822,983.70 - - - - - - - -
    1,143,450.00 - - - - - - - -
    114,400.00 - - - - - - - -
    1,258,400.00 - - - - - - - -
    3,944,160.00 - - - - - - - -
    3,692,700.00 - - - - - - - -
    446,160.00 - - - - - - - -
    385,000.00 - - - - - - - -
    1,853,280.00 - - - - - - - -
    5,308,050.00 - - - - - - - -
    2,388,595.00 - - - - - - - -
    2,508,000.00 - - - - - - - -
    944,460.00 - - - - - - - -
    1,540,000.00 - - - - - - - -
    925,100.00 - - - - - - - -
    925,100.00 - - - - - - - -
    925,100.00 - - - - - - - -
    412,500.00 - - - - - - - -
    412,500.00 - - - - - - - -
    412,500.00 - - - - - - - -
    532,400.00 - - - - - - - -
    532,400.00 - - - - - - - -
    532,400.00 - - - - - - - -
    9,084,900.00 - - - - - - - -
    6,201,800.00 - - - - - - - -
    3,403,840.00 - - - - - - - -
    3,782,460.00 - - - - - - - -
    1,702,085.00 - - - - - - - -
    1,854,286.50 - - - - - - - -
    3,291,750.00 - - - - - - - -
    3,291,750.00 - - - - - - - -
    8,127,790.00 - - - - - - - -
    2,016,300.00 - - - - - - - -
    1,959,375.00 - - - - - - - -
    1,959,375.00 - - - - - - - -
    1,694,000.00 - - - - - - - -
    1,443,750.00 - - - - - - - -
    243,100.00 - - 20 4,862,000.00 20 4,862,000.00 - -
    1,238,600.00 - - - - - - - -
    6,201,800.00 - - - - - - - -
    6,195,860.00 - - - - - - - -
    5,796,120.00 - - - - - - - -
    2,770,020.00 - - - - - - - -
    3,077,800.00 - - - - - - - -
    1,515,800.00 - - 2 3,031,600.00 2 3,031,600.00 - -
    220,000.00 - - - - - - - -

    DATA KEBUTUHAN OBAT REVISI 169 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    39,600.00 - - - - - - - -
    33,000.00 - - - - - - - -
    35,200.00 - - - - - - - -
    1,316,700.00 - - - - - - - -
    658,350.00 - - - - - - - -
    658,350.00 - - - - - - - -
    4,444,330.00 - - - - - - - -
    0.00 - - - - - - - -
    0.00 - - - - - - - -
    0.00 - - - - - - - -
    4,538,380.00 - - - - - - - -
    2,269,190.00 - - - - - - - -
    2,472,171.90 - - - - - - - -
    1,828,860.00 - - - - - - - -
    740,667.40 - - - - - - - -
    740,667.40 - - - - - - - -
    740,667.40 - - - - - - - -
    99,000.00 - - - - - - - -
    979,000.00 - - - - - - - -
    117,700.00 - - - - - - - -
    96,900.10 - - - - - - - -
    1,210,000.00 - - - - - - - -
    308,550.00 - - - - - - - -
    533,500.00 - - - - - - - -
    1,980.00 - - - - - - - -
    2,508.00 - - 2,000 5,016,000.00 2,000 5,016,000.00 - -
    2,002.00 - - 500 1,001,000.00 500 1,001,000.00 - -
    234,300.00 - - - - - - - -
    1,443,750.00 - - - - - - - -
    0.00 - - - - - - - -
    247,500.00 - - - - - - - -
    5,012,700.00 - - 1 5,012,700.00 1 5,012,700.00 - -
    4,443,000.10 - - - - - - - -
    869,000.00 - - 2 1,738,000.00 2 1,738,000.00 - -
    5,047,900.00 - - 1 5,047,900.00 1 5,047,900.00 - -
    319,000.00 - - - - - - - -
    209,000.00 - - - - - - - -
    46,500.00 - - - - - - - -
    968,000.00 - - 2 1,936,000.00 2 1,936,000.00 - -
    616,000.00 - - - - - - - -
    600,875.00 - - - - - - - -
    348,150.00 - - 5 1,740,750.00 5 1,740,750.00 - -
    8,221,454.58

    931,700.00 - - - - - - - -
    137,500.00 - - - - - - - -
    49,500.00 5 247,500.00 - - - - 5 247,500.00

    DATA KEBUTUHAN OBAT REVISI 170 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    90,249.50 - - - - - - - -
    1,135,200.00 - - 2 2,270,400.00 2 2,270,400.00 - -
    100,000.00 1 100,000.00 - - - - 1 100,000.00
    347,500.00

    190 9,287,556 9,740 263,175,886 9,813 263,894,488 117 17,137,909

    #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

    381,044 1,032,147,154.32 410,327 1,414,986,507.98 325,876 1,178,659,519.88 #REF! #REF!


    #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

    RETUR DARI ~
    #REF! #REF! #REF! #REF!
    - #REF! #REF! #REF! #REF!

    - - - 0.00 #REF! #REF! #REF! #REF!

    #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!


    381,044 1,032,147,154.32 410,327 1,414,986,507.98 325,876 1,178,659,519.88 465,495 1,268,474,142.42
    #REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

    MS = #REF!
    #REF!
    = #REF!
    = 0.5 - 1

    TOR = #REF!
    #REF!
    = #REF!
    = 1.2

    DATA KEBUTUHAN OBAT REVISI 171 / 325


    SALDO AWAL PENERIMAAN TOTAL PENGELUARAN SALDO AKHIR
    HAR - SAT
    JML NILAI JML NILAI JML NILAI JML NILAI
    4 5 6 7 8 9 10 11 12

    HARGA JMLH NILAI KET

    145,530.00 16 2,328,480.00 PT. MBS


    10,571.00 2 21,142.00 PT. BSP
    473.14 300 141,942.00 PT. BSP
    16,310.25 150 2,446,537.50 PT. BSP

    468.00 4,938,101.50

    - -

    468 4,938,101.50

    #REF! Nilai obat jadi #REF! #REF!


    4,938,101.50 Nilai bmhp & bahan kimia #REF! #REF!
    #REF! Nilai stok depo #REF! #REF!

    SUNGAILIAT, 31 DESEMBER 2021


    PETUGAS GUDANG FARMASI

    ZAINUL ARIVIN

    MENGETAHUI,
    KA. INSTALASI FARMASI

    ELFIRA RATNA PRADIPTA S.Far, Apt

    DATA KEBUTUHAN OBAT REVISI 172 / 325


    NO JUMLAH (Rp) KETERANGAN GOLONGAN
    1 1,529,342 DEATHSTOCK OBAT GENERIK
    2 352,522,973 FAST MOVING OBAT GENERIK
    3 49,889,576 SLOW MOVING OBAT GENERIK
    4 357,126,024 FAST MOVING OBAT PATEN
    5 137,437,909 SLOW MOVING OBAT PATEN
    6 30,164,816 DEATHSTOCK BAHAN PELENGKAP
    7 138,570,376 FAST MOVING BAHAN PELENGKAP
    8 192,664,173 SLOW MOVING BAHAN PELENGKAP
    9 8,221,455 FAST MOVING BAHAN KIMIA
    10 347,500 SLOW MOVING BAHAN KIMIA

    1,268,474,142
    OBAT FAST MOVING
    1 ALLOPURINOL TAB 300 MG F BERNOFARM ( G )
    2 AMBROXOL SYR. 15 MG/ 5 MLF BERNOFARM ( G )
    3 AMLODIPINE 10 MG F BERNOFARM ( G ) AMLODIPINE 10 MG
    4 AMOXYCILLIN CAPS 500 MG F BERNOFARM ( G )
    5 AMOXYCILLIN DROPS F BERNOFARM ( G )
    6 AMOXYCILLIN DRY. SYR F BERNOFARM ( G )
    7 AQUA PRO INJ. 50 ML F BERNOFARM ( G )
    8 AS. MEFENAMAT TAB 500 MGF BERNOFARM ( G ) AS. MEFENAMAT TAB 500
    9 AS. TRANEKSAMAT INJ 250 MF BERNOFARM ( G ) AS. TRANEKSAMAT INJ 250
    10 AS. TRANEKSAMAT TAB 500 F BERNOFARM ( G ) AS. TRANEKSAMAT TAB 50
    11 AZITHROMYCIN INFUS 500 M F BERNOFARM ( G )
    12 AZITHROMYCIN INJ. 0.5 GR F BERNOFARM ( G )
    13 BISOPROLOL TAB. 5 MG F BERNOFARM ( G ) BISOPROLOL TAB. 5 MG
    14 BUPIVACAINE SPINAL INJ. F BERNOFARM ( G )
    15 CANDESARTAN TAB. 8 MG F BERNOFARM ( G ) CANDESARTAN TAB. 8 MG
    16 CANDESARTAN TAB. 16 MG F BERNOFARM ( G ) CANDESARTAN TAB. 16 MG
    17 CEFADROXIL CAPS. 500 MG F BERNOFARM ( G ) CEFADROXIL CAPS. 500 MG
    18 CEFEPIME INJ F BERNOFARM ( G )
    19 CEFIXIME SYR F BERNOFARM ( G ) CEFIXIME SYR
    20 CEFOPERAZONE INJ 1 GR F BERNOFARM ( G )
    21 CEFOPERAZONE SULBACTAMF BERNOFARM ( G )
    22 CEFOTAXIME INJ. F BERNOFARM ( G ) CEFOTAXIME INJ.
    23 CEFTAZIDIME INJ. 1 GR F BERNOFARM ( G ) CEFTAZIDIME INJ. 1 GR
    24 CILOSTAZOL TAB. 100 MG F BERNOFARM ( G )
    25 CIPROFLOXACIN TAB. 500 MGF BERNOFARM ( G ) CIPROFLOXACIN TAB. 500
    26 CITICOLINE TAB 500 MG F BERNOFARM ( G ) CITICOLINE TAB 500 MG
    27 CLINDAMYCIN TAB 300 MG F BERNOFARM ( G ) CLINDAMYCIN TAB 300 MG
    28 COTRIMOXAZOLE SYR F BERNOFARM ( G )
    29 COTRIMOXAZOLE TAB 480 M F BERNOFARM ( G )
    30 DEXA METHASONE INJ. F BERNOFARM ( G )
    31 FLUNARIZIN TAB. 10 MG F BERNOFARM ( G )
    32 FLUNARIZIN TAB. 5 MG F BERNOFARM ( G )
    33 GLIMEPRIDE TAB. 2 MG F BERNOFARM ( G ) GLIMEPRIDE TAB. 2 MG
    34 KETOPROFEN TAB. 100 MG F BERNOFARM ( G ) KETOPROFEN TAB.
    35 LIDOCAIN INJ. 2% F BERNOFARM ( G )
    36 MELOXICAM TAB 7.5 MG F BERNOFARM ( G ) MELOXICAM TAB 7.5 MG
    37 METHYLPREDNISOLON INJ. F BERNOFARM ( G ) METHYLPREDNISOLON INJ.
    38 METOCLOPRAMIDE INJ. F BERNOFARM ( G )
    39 METRONIDAZOLE TAB. 500 M F BERNOFARM ( G )
    40 NOREPINEPHRINE INJ. BTR. 4F BERNOFARM ( G )
    41 NYSTATIN DROPS F BERNOFARM ( G )
    42 ONDANSENTRON INJ. 4 MG F BERNOFARM ( G ) ONDANSENTRON INJ. 4 MG
    43 ONDANSENTRON INJ. 8 MG F BERNOFARM ( G )
    44 PARACETAMOL INFUS F BERNOFARM ( G )
    45 PARACETAMOL TAB 500 MG F BERNOFARM ( G )
    46 PIRACETAM INJ. 1 GR F BERNOFARM ( G )
    47 PIRACETAM TAB. 800 MG F BERNOFARM ( G )
    48 RANITIDIN TABL 150 MG F BERNOFARM ( G ) RANITIDIN TABL 150 MG
    49 RIFAMPICIN CAPS 450 MG F BERNOFARM ( G )
    50 SIMVASTATIN TAB. 10 MG F BERNOFARM ( G ) SIMVASTATIN TAB. 10 MG
    1 MIDAZOLAM INJ. 5 MG/1 ML F COMBIPHAR (G)

    1 AMIODARONE INJ. F DARYA VARYA ( G )


    2 AMIODARONE INJ. F DARYA VARYA ( G )
    3 DORIPENEM INJ. 500 MG F DARYA VARYA ( G )
    4 KETOROLAC INJ. 30 MG F DARYA VARYA ( G )
    5 METRONIDAZOLE INPUS F DARYA VARIA (G)
    6 PARACETAMOL INFUS F DARYA VARIA (G)

    1 ACARBOSE TAB. 100 MG F DM ( G )


    2 ACARBOSE TAB. 50 MG F DM ( G )
    3 AMLODIPINE 10 MG F DM ( G )
    4 AMLODIPINE 5 MG F DM ( G )
    5 AMLODIPINE 5 MG F DM ( G )
    6 AS. MEFENAMAT TAB 500 MGF DM ( G )
    7 AS. TRANEKSAMAT INJ 250 MF DM ( G )
    8 AS. TRANEKSAMAT INJ 500 MF DM ( G )
    9 AS. TRANEKSAMAT TAB 500 F DM ( G )
    10 ASAM VALPROAT SYR 250 MLF DM ( G )
    11 AZITHROMYCIN SYR. 200 MG F/ DM ( G )
    12 AZITHROMYCIN TAB. 500 MG F DM ( G )
    13 BETAHISTINE TABLET 6 MG F DM ( G )
    14 BISOPROLOL TAB. 2.5 MG F DM ( G )
    15 BISOPROLOL TAB. 5 MG F DM ( G )
    16 CALCII GLUCONAS INJ. F DM ( G )
    17 CANDESARTAN TAB. 8 MG F DM ( G )
    18 CANDESARTAN TAB. 16 MG F DM ( G )
    19 CATOPRIL 12,5 MG F DM ( G )
    20 CATOPRIL 25 MG F DM ( G )
    21 CATOPRIL 50 MG F DM ( G )
    22 CATOPRIL 50 MG F DM ( G )
    23 CEFADROXIL CAPS. 500 MG F DM ( G )
    24 CEFIXIME CAPS. 100 MG F DM ( G )
    25 CEFIXIME CAPS. 100 MG F DM ( G )
    26 CEFIXIME CAPS. 200 MG F DM ( G )
    27 CEFIXIME SYR F DM ( G )
    28 CEFOTAXIME INJ. F DM ( G )
    29 CEFOTAXIME INJ. F DM ( G )
    30 CEFTAZIDIME INJ. 1 GR F DM ( G )
    31 CEFTRIAXONE INJ 1 GR F DM ( G )
    32 CEFTRIAXONE INJ 1 GR F DM ( G )
    33 CIPROFLOXACIN TAB. 500 MGF DM ( G )
    34 CITICOLINE TAB 500 MG F DM ( G )
    35 CLINDAMYCIN TAB 300 MG F DM ( G )
    36 CLOBAZAM TABL. F DM ( G )
    37 CLOBAZAM TABL. F DM ( G )
    38 CLOPIDOGREL TAB. 75 MG F DM ( G )
    39 CO AMOXICLAV TAB 625 MG F DM ( G )
    40 DESOXIMETASONE CREAM F DM ( G )
    41 DILTIAZEM TAB. F DM ( G )
    42 DILTIAZEM TAB. F DM ( G )
    43 DOBUTAMIN INJ. 250 MG F DM ( G )
    44 DOMPERIDONE TAB F DM ( G )
    45 DOMPERIDONE TAB F DM ( G )
    46 DOPAMIN INJ. F DM ( G )
    47 DOXYCYCLINE CAPS. 100 MGF DM ( G )
    48 FENOFIBRATE 1OO MG F DM ( G )
    49 FENOFIBRATE 1OO MG F DM ( G )
    50 FENOFIBRATE 3OO MG F DM ( G )
    51 FUROSEMIDE INJ F DM ( G )
    52 GABAPENTIN TAB. 300 MG F DM ( G )
    53 GLIMEPRIDE TAB. 2 MG F DM ( G )
    54 GLIMEPRIDE TAB. 3 MG F DM ( G )
    55 GLIMEPRIDE TAB. 4 MG F DM ( G )
    56 GLIQUIDONE 30 MG F DM ( G )
    57 KALIUM DIKLOPENAK 25 MG F DM ( G )
    58 KALIUM DIKLOPENAK 50 MG F DM ( G )
    59 KETAMIN INJ. 100 MG/ML F DM ( G )
    60 KETAMIN INJ. 50 MG/ML F DM ( G )
    61 KETOKONAZOLE CREAM F DM ( G )
    62 KETOKONAZOLE TAB. 200 MGF DM ( G )
    63 KETOPROFEN TAB. F DM ( G )
    64 KETOROLAC INJ. 30 MG F DM ( G )
    65 LEVOFLOXACIN 500 MG F DM ( G )
    66 LEVOFLOXACIN INF. 500 ML F DM ( G )
    67 LEVOFLOXACIN INF. 750 ML F DM ( G )
    68 MELOXICAM TAB 15 MG F DM ( G )
    69 MELOXICAM TAB 7.5 MG F DM ( G )
    70 MEROPENEM INJ. 0.5 GR F DM ( G )
    71 MEROPENEM INJ. 1 GR F DM ( G )
    72 MEROPENEM INJ. 1 GR F DM ( G )
    73 METFORMIN TAB 850 MG F DM ( G )
    74 METFORMIN TAB. 500 MG F DM ( G )
    75 METHYLPREDNISOLON INJ. F DM ( G )
    76 METHYLPREDNISOLON TAB 16 MF DM ( G )
    77 METHYLPREDNISOLON TAB 4 M F DM ( G )
    78 METHYLPREDNISOLON TAB 8 M F DM ( G )
    79 N-ACETYLCESTEINE 300 MG/ F DM ( G )
    80 NATRIUM DIKLOPENAK 50 MGF DM ( G )
    81 NIFEDIPIN TAB 10 MG F DM ( G )
    82 OMEPRAZOLE CAPS. 20 MG F DM ( G )
    83 OMEPRAZOLE INJ. F DM ( G )
    84 ONDANSENTRON INJ. 4 MG F DM ( G )
    85 ONDANSENTRON TAB. 4 MG F DM ( G )
    86 PANTOPRAZOLE 40 MG INJ. F DM ( G )
    87 PIOGLITAZONE 15 MG F DM ( G )
    88 PIOGLITAZONE 30 MG F DM ( G )
    89 PIRACETAM INJ. 3 GR F DM ( G )
    90 PIRACETAM TAB. 1200 MG F DM ( G )
    91 PIRACETAM TAB. 800 MG F DM ( G )
    92 PRAMIPEXOLE TAB. 0.125 MGF DM ( G )
    93 PREGABALIN CAPS 150 MG F DM ( G )
    94 PREGABALIN CAPS 75 MG F DM ( G )
    95 PROPANOLOL TABL 10 MG F DM ( G )
    96 PTU TAB. 100 MG F DM ( G )
    97 PTU TAB. 100 MG F DM ( G )
    98 RANITIDIN INJ. F DM ( G )
    99 RANITIDIN TABL 150 MG F DM ( G )
    100 RISPERIDON TAB 2 MG F DM ( G )
    101 SIMVASTATIN TAB. 10 MG F DM ( G )
    102 SPIRONOLACTONE TAB. 100 F DM ( G )
    103 SPIRONOLACTONE TAB. 25 MF DM ( G )
    104 SUCRALFATE SYR. 100 ML F DM ( G )
    105 TRIAMCINOLONE TAB. 4 MG F DM ( G )
    106 URSODEOXYCHOLIC ASID 25 F DM ( G )
    107 URSODEOXYCHOLIC ASID 25 F DM ( G )
    108 VALSARTAN 160 MG F DM ( G )
    109 VALSARTAN 80 MG F DM ( G )

    1 WARFARIN TAB. 1 MG F EISAI ( G )

    1 ATROPIN SULFAS INJ. F ETHICA ( G )


    2 DEXKETOPROFEN INJ. F ETHICA ( G )
    3 EPHEDRINE HCL INJEKSI 50 mg
    F ETHICA ( G )
    4 EPINEPHRINE INJ. 1 mg/ml F ETHICA ( G )
    5 EPINEPHRINE INJ. 1 mg/ml F ETHICA ( G )
    6 KETOROLAC INJ. 30 MG F ETHICA ( G )
    7 OXYTOCIN INJ. F ETHICA ( G )

    1 ACARBOSE TAB. 100 MG F FAHRENHEIT (G )


    2 ACARBOSE TAB. 50 MG F FAHRENHEIT (G )
    3 ACETYLCESTEINE 200 MG/MLF FAHRENHEIT (G )
    4 ACETYLCESTEINE CAPS F FAHRENHEIT (G )
    5 ACYCLOVIR TAB. 400 MG F FAHRENHEIT (G )
    6 AMLODIPINE 10 MG F FAHRENHEIT (G )
    7 AMLODIPINE 5 MG F FAHRENHEIT (G )
    8 AMLODIPINE 5 MG F FAHRENHEIT (G )
    9 AZITHROMYCIN TAB. 500 MG F FAHRENHEIT (G )
    10 BISOPROLOL TAB. 2.5 MG F FAHRENHEIT (G )
    11 BISOPROLOL TAB. 5 MG F FAHRENHEIT (G )
    12 CANDESARTAN TAB. 8 MG F FAHRENHEIT (G )
    13 CANDESARTAN TAB. 16 MG F FAHRENHEIT (G )
    14 CANDESARTAN TAB. 16 MG F FAHRENHEIT (G )
    15 CETIRIZINE 10 MG F FAHRENHEIT (G )
    16 CETIRIZINE SYR. F FAHRENHEIT (G )
    17 CLOPIDOGREL TAB. 75 MG F FAHRENHEIT (G )
    18 CLOPIDOGREL TAB. 75 MG F FAHRENHEIT (G )
    19 DEXKETOPROFEN INJ. F FAHRENHEIT (G )
    20 DIGOXIN TABL 0,25MG F FAHRENHEIT (G )
    21 DOXYCYCLINE CAPS. 100 MGF FAHRENHEIT (G)
    22 ERYTHROMYCIN CAPS 500 M F FAHRENHEIT (G)
    23 FUROSEMIDE TBL. 40 MG F FAHRENHEIT (G )
    24 GABAPENTIN TAB. 300 MG F FAHRENHEIT (G )
    25 GRANISETRON INJ. 3 MG F FAHRENHEIT (G )
    26 IBUPROFEN 200 MG F FAHRENHEIT (G )
    27 IBUPROFEN 400 MG F FAHRENHEIT (G )
    28 ISOSORBIDE DINITRATE INJE F FAHRENHEIT (G )
    29 ISOSORBIDE DINITRATE TAB F FAHRENHEIT (G )
    30 LATANOPROST 2.5 ML F FAHRENHEIT (G )
    31 NICARDIPINE INJ. F FAHRENHEIT (G )
    32 OMEPRAZOLE CAPS. 20 MG F FAHRENHEIT (G )
    33 ONDANSENTRON TAB. 4 MG F FAHRENHEIT (G )
    34 SALBUTAMOL TABL 2 MG F FAHRENHEIT (G )
    35 SALBUTAMOL TABL 4 MG F FAHRENHEIT (G )
    36 SEVOFLURANE 250 ML F FAHRENHEIT (G )
    37 SUCRALFATE SYR. 100 ML F FAHRENHEIT (G )

    1 ANTASIDA DOEN TAB F GENERIK


    2 BIC NAT 500 MG F GENERIK
    3 GENTAMYCIN CREAM 5 GRM F GENERIK
    4 PREDNISON TABL 5 MG F GENERIK
    5 RIFAMPICIN CAPS 600 MG F GENERIK
    6 VIT. B12. IPI F GENERIK

    1 DEXA METHASON TBL 0,50 M F HARSEN

    1 ACYCLOVIR TAB. 400 MG F HEXPHARM ( G )


    2 ALLOPURINOL TAB 100 MG F HEXPHARM ( G )
    3 ALLOPURINOL TAB 300 MG F HEXPHARM ( G )
    4 ALLOPURINOL TAB 300 MG F HEXPHARM ( G )
    5 AMLODIPINE 10 MG F HEXPHARM ( G )
    6 AMLODIPINE 5 MG F HEXPHARM ( G )
    7 AMOXYCILLIN CAPS 500 MG F HEXPHARM ( G )
    8 AMOXYCILLIN DRY. SYR F HEXPHARM ( G )
    9 AS. MEFENAMAT TAB 500 MGF HEXPHARM ( G )
    10 AS. MEFENAMAT TAB 500 MGF HEXPHARM ( G )
    11 AS. TRANEKSAMAT INJ 500 MF HEXPHARM ( G )
    12 ATORVASTATIN 10 MG F HEXPHARM ( G )
    13 ATORVASTATIN 20 MG F HEXPHARM ( G )
    14 BISOPROLOL TAB. 2.5 MG F HEXPHARM ( G )
    15 BISOPROLOL TAB. 5 MG F HEXPHARM ( G )
    16 BISOPROLOL TAB. 5 MG F HEXPHARM ( G )
    17 CATOPRIL 25 MG F HEXPHARM ( G )
    18 CEFADROXIL CAPS. 500 MG F HEXPHARM ( G )
    19 CEFADROXIL SYR F HEXPHARM ( G )
    20 CEFIXIME CAPS. 100 MG F HEXPHARM ( G )
    21 CEFIXIME CAPS. 200 MG F HEXPHARM ( G )
    22 CEFIXIME SYR F HEXPHARM ( G )
    23 CEFOTAXIME INJ. F HEXPHARM ( G )
    24 CEFTRIAXONE INJ 1 GR F HEXPHARM ( G )
    25 CETIRIZINE 10 MG F HEXPHARM ( G )
    26 CIPROFLOXACIN INFUS F HEXPHARM ( G )
    27 CIPROFLOXACIN TAB. 500 MGF HEXPHARM ( G )
    28 CITICOLINE INJ. 250 MG / 2 M F HEXPHARM ( G )
    29 CITICOLINE INJ. 500 MG / 4 M F HEXPHARM ( G )
    30 CITICOLINE TAB 500 MG F HEXPHARM ( G )
    31 CLOPIDOGREL TAB. 75 MG F HEXPHARM ( G )
    32 DOMPERIDONE SYR. F HEXPHARM ( G )
    33 DOMPERIDONE SYR. F HEXPHARM ( G )
    34 DOMPERIDONE TAB F HEXPHARM ( G )
    35 FAVIPIRAVIRE 200 MG F HEXPHARM ( G )
    36 FENOFIBRATE 3OO MG F HEXPHARM ( G )
    37 GLIMEPRIDE TAB. 1 MG F HEXPHARM ( G )
    38 GLIMEPRIDE TAB. 2 MG F HEXPHARM ( G )
    39 GLIMEPRIDE TAB. 3 MG F HEXPHARM ( G )
    40 GLIMEPRIDE TAB. 4 MG F HEXPHARM ( G )
    41 GLUCOSAMINE 250 MG F HEXPHARM ( G )
    42 GLUCOSAMINE 250 MG F HEXPHARM ( G )
    43 KALIUM DIKLOPENAK 50 MG F HEXPHARM ( G )
    44 KALIUM DIKLOPENAK 50 MG F HEXPHARM ( G )
    45 KETOKONAZOLE CREAM F HEXPHARM ( G )
    46 KETOKONAZOLE TAB. 200 MGF HEXPHARM ( G )
    47 KETOROLAC INJ. 30 MG F HEXPHARM ( G )
    48 KETOROLAC TAB. F HEXPHARM ( G )
    49 LANSOPRAZOLE 30 MG F HEXPHARM ( G )
    50 LEVOFLOXACIN 500 MG F HEXPHARM ( G )
    51 LEVOFLOXACIN INF. 500 ML F HEXPHARM ( G )
    52 LEVOFLOXACIN INF. 750 ML F HEXPHARM ( G )
    53 LORATADIN 10 MG F HEXPHARM ( G )
    54 MELOXICAM TAB 15 MG F HEXPHARM ( G )
    55 MELOXICAM TAB 7.5 MG F HEXPHARM ( G )
    56 MEROPENEM INJ. 1 GR F HEXPHARM ( G )
    57 METFORMIN TAB 850 MG F HEXPHARM ( G )
    58 METFORMIN TAB. 500 MG F HEXPHARM ( G )
    59 METHYLPREDNISOLON TAB 16 MF HEXPHARM ( G )
    60 METHYLPREDNISOLON TAB 4 M F HEXPHARM ( G )
    61 METRONIDAZOLE INPUS F HEXPHARM ( G )
    62 NOREPINEPHRINE INJ. BTR. 4F HEXPHARM ( G )
    63 OMEPRAZOLE CAPS. 20 MG F HEXPHARM ( G )
    64 ONDANSENTRON INJ. 4 MG F HEXPHARM ( G )
    65 ONDANSENTRON INJ. 8 MG F HEXPHARM ( G )
    66 PIRACETAM INJ. 3 GR F HEXPHARM ( G )
    67 PIRACETAM TAB. 1200 MG F HEXPHARM ( G )
    68 PIRACETAM TAB. 800 MG F HEXPHARM ( G )
    69 PREGABALIN CAPS 75 MG F HEXPHARM ( G )
    70 RANITIDIN INJ. F HEXPHARM ( G )
    71 RANITIDIN INJ. F HEXPHARM ( G )
    72 RANITIDIN TABL 150 MG F HEXPHARM ( G )
    73 SIMVASTATIN TAB. 10 MG F HEXPHARM ( G )
    74 SIMVASTATIN TAB. 20 MG F HEXPHARM ( G )

    1 PROPANOLOL TABL 10 MG F HOLI


    1 NATRIUM PHENYTOIN CAPS F IKAPHARMINDO

    1 IBUPROFEN SYR. F INDOFARMA (G)

    1 ACYCLOVIR CREAM 5 GR F INF (G)


    2 AMBROXOL TAB. F INF (G)
    3 AMITRIPTYLINE TAB. 25 MG F INF (G)
    4 AMLODIPINE 10 MG F INF (G)
    5 CANDESARTAN TAB. 8 MG F INF (G)
    6 CARBAMAZEPIN TAB. 200 MGF INF (G)
    7 CETIRIZINE 10 MG F INF (G)
    8 CETIRIZINE DROPS F INF (G)
    9 CO AMOXICLAV TAB 625 MG F INF (G)
    10 FUROSEMIDE INJ F INF (G)
    11 KETOROLAC INJ. 30 MG F INF (G)
    12 MELOXICAM TAB 7.5 MG F INF (G)
    13 ONDANSENTRON TAB. 8 MG F INF (G)
    14 PARACETAMOL DROPS F INF (G)
    15 PARACETAMOL SYRUP 60 MLF INF (G)
    16 PTU TAB. 100 MG F INF (G)
    17 RIFAMPICIN CAPS 300 MG F INF (G)
    18 SIMVASTATIN TAB. 20 MG F INF (G)
    19 TRIHEXYLPHENIDIL TAB 2 MGF INF (G)

    1 DOMPERIDONE TAB F INFION (G)


    2 GLIMEPRIDE TAB. 4 MG F INFION (G)

    1 SEVOFLURANE BAXTER 250 F KALBE FARMA

    1 ACYCLOVIR CREAM 5 GR F KF ( G )
    2 ACYCLOVIR TAB. 400 MG F KF ( G )
    3 ALBENDAZOL 400 MG F KF ( G )
    4 ALBENDAZOL 400 MG F KF ( G )
    5 ALLOPURINOL TAB 100 MG F KF ( G )
    6 ALPRAZOLAM 0.25 MG F KF ( G )
    7 ALPRAZOLAM 0.5 MG F KF ( G )
    8 ALPRAZOLAM 1 MG F KF ( G )
    9 AMBROXOL SYR. 15 MG/ 5 MLF KF ( G )
    10 AMBROXOL TAB. F KF ( G )
    11 AMLODIPINE 10 MG F KF ( G )
    12 AMLODIPINE 5 MG F KF ( G )
    13 AMLODIPINE 5 MG F KF ( G )
    14 AMOXYCILLIN CAPS 500 MG F KF ( G )
    15 ANTASIDA DOEN SYR. F KF ( G )
    16 ANTASIDA DOEN TAB F KF ( G )
    17 AZITHROMYCIN TAB. 500 MG F KF ( G )
    18 BETAMETASONE CREAM F KF ( G )
    19 CALCIUM LACTATE TABLET 5 F KF ( G )
    20 CATOPRIL 12,5 MG F KF ( G )
    21 CATOPRIL 25 MG F KF ( G )
    22 CEFADROXIL CAPS. 500 MG F KF ( G )
    23 CEFADROXIL SYR F KF ( G )
    24 CIPROFLOXACIN TAB. 500 MGF KF ( G )
    25 CLONIDIN TAB F KF ( G )
    26 CLOPIDOGREL TAB. 75 MG F KF ( G )
    27 COTRIMOXAZOLE SYR F KF ( G )
    28 DEXA METHASON TBL 0,50 M F KF ( G )
    29 DEXA METHASONE INJ. F KF ( G )
    30 DIAZEPAM TBL. 2 MG F KF ( G )
    31 ERYTHROMYCIN CAPS 250 M F KF ( G )
    32 ERYTHROMYCIN DRY SYR F KF ( G )
    33 ETHAMBUTOL TAB 500 MG F KF ( G )
    34 FLUCONAZOLE CAPS. 150 MGF KF ( G )
    35 FOLIC ACID 1 MG F KF ( G )
    36 FUROSEMIDE TBL. 40 MG F KF ( G )
    37 FUROSEMIDE TBL. 40 MG F KF ( G )
    38 GENTAMYCIN CREAM 5 GRM F KF ( G )
    39 GENTAMYCIN INJ F KF ( G )
    40 GG / GUAIFENESIN 100 MG F KF ( G )
    41 GLIMEPRIDE TAB. 1 MG F KF ( G )
    42 GLIMEPRIDE TAB. 2 MG F KF ( G )
    43 GLIMEPRIDE TAB. 3 MG F KF ( G )
    44 GLIMEPRIDE TAB. 4 MG F KF ( G )
    45 GLYCERYL GUAICOLATE TAB.F KF ( G )
    46 HCT TBL. 25 MG F KF ( G )
    47 HYDROCORTISON 2,5% F KF ( G )
    48 ISONIAZID TABL 100 MG F KF ( G )
    49 ISONIAZID TABL 100 MG F KF ( G )
    50 ISONIAZID TABL 300 MG F KF ( G )
    51 KETOKONAZOLE CREAM F KF ( G )
    52 LEVOFLOXACIN 500 MG F KF ( G )
    53 LIDOCAIN INJ. 2% F KF ( G )
    54 MEROPENEM INJ. 0.5 GR F KF ( G )
    55 METHYLERGOMETRINE TABLF KF ( G )
    56 METRONIDAZOLE TAB. 500 M F KF ( G )
    57 METRONIDAZOLE TAB. 500 M F KF ( G )
    58 MICONAZOLE KRIM 2% F KF ( G )
    59 MICONAZOLE KRIM 2% F KF ( G )
    60 NATRIUM DIKLOPENAK 50 MGF KF ( G )
    61 NIFEDIPIN TAB 10 MG F KF ( G )
    62 ORALIT 200 CC F KF ( G )
    63 OXYTETRACYCLIN 1% SALEPF KF ( G )
    64 PARACETAMOL INFUS F KF ( G )
    65 PARACETAMOL SYRUP 60 MLF KF ( G )
    66 PARACETAMOL TAB 500 MG F KF ( G )
    67 PETHIDIN INJ 50 MG/ML F KF ( G )
    68 PHENOBARBITAL TBL 30 MG F KF ( G )
    69 PREGABALIN CAPS 150 MG F KF ( G )
    70 PYRAZINAMIDE TABL 500 MG F KF ( G )
    71 PYRAZINAMIDE TABL 500 MG F KF ( G )
    72 RANITIDIN TABL 150 MG F KF ( G )
    73 RIFAMPICIN CAPS 450 MG F KF ( G )
    74 RIFAMPICIN CAPS 600 MG F KF ( G )
    75 SALBUTAMOL TABL 2 MG F KF ( G )
    76 SALBUTAMOL TABL 4 MG F KF ( G )
    77 SIMVASTATIN TAB. 10 MG F KF ( G )
    78 SIMVASTATIN TAB. 20 MG F KF ( G )
    79 TRAMADOL TAB. 50 MG F KF ( G )
    80 VIT. B1. 50 mg F KF ( G )
    81 VIT. B6. 10 mg F KF ( G )
    82 VITAMIN B KOMPLEKS F KF ( G )
    83 VITAMIN C TAB. 100 MG F KF ( G )
    84 VITAMIN C TAB. 250 MG F KF ( G )
    85 VITAMIN C TAB. 50 MG F KF ( G )
    86 ZINK DISPERSIBLE TAB F KF ( G )

    1 ACETYLCESTEINE CAPS F MBF ( G )


    2 CEFOPERAZONE SULBACTAMF MBF ( G )
    3 CITICOLINE INJ. 500 MG / 4 M F MBF ( G )
    4 CITICOLINE TAB 500 MG F MBF ( G )
    5 ERDOSTEIN CAPS. 300 MG F MBF ( G )
    6 MELOXICAM TAB 15 MG F MBF ( G )
    7 METHYLPREDNISOLON INJ. F MBF ( G )
    8 METHYLPREDNISOLON TAB 4 M F MBF ( G )
    9 METHYLPREDNISOLON TAB 8 M F MBF ( G )
    10 ONDANSENTRON INJ. 4 MG F MBF ( G )
    11 ONDANSENTRON TAB. 8 MG F MBF ( G )
    12 PIOGLITAZONE 15 MG F MBF ( G )

    1 EPERISONE 50 MG F MEDIKON (G)


    2 GLUCOSAMINE MPL 500 MG F MEDIKON (G)

    1 ALLOPURINOL TAB 300 MG F MERSIFARM (G)

    1 ACYCLOVIR TAB. 200 MG F NOVELL ( G )


    2 AS. TRANEKSAMAT INJ 250 MF NOVELL (G)
    3 AS. TRANEKSAMAT INJ 500 MF NOVELL (G)
    4 ASAM VALPROAT SYR 250 MLF NOVELL (G)
    5 BETAHISTINE TABLET 6 MG F NOVELL (G)
    6 BISACODYL TAB. F NOVELL (G)
    7 BISOPROLOL TAB. 5 MG F NOVELL (G)
    8 CANDESARTAN TAB. 16 MG F NOVELL (G)
    9 CEFIXIME CAPS. 100 MG F NOVELL ( G )
    10 CEFIXIME SYR F NOVELL ( G )
    11 CEFOPERAZONE SULBACTAMF NOVELL ( G )
    12 CEFTAZIDIME INJ. 1 GR F NOVELL ( G )
    13 CEFTIZOXIME INJ. 1 GR F NOVELL ( G )
    14 CEFTIZOXIME INJ. 1 GR F NOVELL ( G )
    15 CIPROFLOXACIN INFUS F NOVELL ( G )
    16 CIPROFLOXACIN TAB. 500 MGF NOVELL ( G )
    17 CITICOLINE INJ. 125 MG / 1 M F NOVELL (G)
    18 CITICOLINE INJ. 125 MG / 1 M F NOVELL (G)
    19 CITICOLINE TAB 500 MG F NOVELL (G)
    20 CLINDAMYCIN TAB 150 MG F NOVELL ( G )
    21 CLINDAMYCIN TAB 300 MG F NOVELL ( G )
    22 DEXKETOPROFEN INJ. F NOVELL (G)
    23 DEXKETOPROFEN INJ. F NOVELL (G)
    24 DEXKETOPROFEN TAB. 25 M F NOVELL (G)
    25 DOBUTAMIN INJ. 250 MG F NOVELL (G)
    26 DOBUTAMIN INJ. 250 MG F NOVELL (G)
    27 DOMPERIDONE TAB F NOVELL (G)
    28 ERDOSTEIN SYR F NOVELL (G)
    29 GABAPENTIN TAB. 300 MG F NOVELL
    30 GRANISETRON INJ. 1 MG F NOVELL (G)
    31 KETOPROFEN TAB. 50 MG F NOVELL (G)
    32 KETOROLAC INJ. 30 MG F NOVELL (G)
    33 KETOROLAC TAB. F NOVELL (G)
    34 LANSOPRAZOLE 30 MG F NOVELL (G)
    35 LEVOFLOXACIN 500 MG F NOVELL ( G )
    36 LEVOFLOXACIN INF. 500 ML F NOVELL ( G )
    37 LEVOFLOXACIN INF. 500 ML F NOVELL ( G )
    38 LEVOFLOXACIN INF. 750 ML F NOVELL ( G )
    39 MECOBALAMIN 500 MG F NOVELL (G)
    40 MECOBALAMIN INJEKSI F NOVELL ( G )
    41 MELOXICAM TAB 15 MG F NOVELL (G)
    42 MEROPENEM INJ. 1 GR F NOVELL ( G )
    43 METHYLERGOMETRINE MALEA F NOVELL (G)
    44 METHYLPREDNISOLON TAB 8 M F NOVELL (G)
    45 METRONIDAZOLE INPUS F NOVELL (G)
    46 METRONIDAZOLE TAB. 500 M F NOVELL (G)
    47 MUPIROCIN OINTMENT 2% F NOVELL (G)
    48 NICARDIPINE INJ. F NOVELL (G)
    49 OMEPRAZOLE INJ. F NOVELL (G)
    50 OMEPRAZOLE INJ. F NOVELL (G)
    51 ONDANSENTRON INJ. 4 MG F NOVELL ( G )
    52 ONDANSENTRON INJ. 8 MG F NOVELL (G)
    53 ONDANSENTRON INJ. 8 MG F NOVELL (G)
    54 ONDANSENTRON TAB. 4 MG F NOVELL ( G )
    55 OXYTOCIN INJ. F NOVELL ( G )
    56 PANTOPRAZOLE 40 MG INJ. F NOVELL (G)
    57 PARACETAMOL INFUS F NOVELL (G)
    58 PIRACETAM INJ. 1 GR F NOVELL (G)
    59 PIRACETAM INJ. 3 GR F NOVEL (G)
    60 RANITIDIN INJ. F NOVELL (G)
    61 RANITIDIN INJ. F NOVELL (G)
    62 SEVOFLURANE 250 ML F NOVELL ( G )
    63 TRAMADOL INJ. F NOVELL (G)
    64 TRIMETAZIDINE 35 MG F NOVELL ( G )
    65 VALSARTAN 160 MG F NOVELL (G)
    66 VITAMIN C INJEKSI 1000 MG F NOVELL (G)
    67 VITAMIN C INJEKSI 500 MG F NOVELL (G)
    1 FLUNARIZIN TAB. 10 MG F NULAB (G)

    1 ACYCLOVIR TAB. 400 MG F PHAPROS (G)


    2 AMINOPHYLLIN INJ. F PHAPROS (G)
    3 AMLODIPINE 10 MG F PHAPROS (G)
    4 AMPICILLIN INJ. F PHAPROS (G)
    5 ASAM VALPROAT SYR 250 MLF PHAPROS (G)
    6 BETAMETASONE CREAM F PHAPROS (G)
    7 CALCIUM LACTATE TABLET 5 F PHAPROS (G)
    8 CATOPRIL 12,5 MG F PHAPROS (G)
    9 CATOPRIL 25 MG F PHAPROS (G)
    10 CEFOTAXIME INJ. F PHAPROS (G)
    11 CEFOTAXIME INJ. F PHAPROS (G)
    12 CEFTRIAXONE INJ 1 GR F PHAPROS (G)
    13 CETIRIZINE 10 MG F PHAPROS (G)
    14 CHLORPHENAMINE TAB. 4 M F PHAPROS (G)
    15 CLOPIDOGREL TAB. 75 MG F PHAPROS (G)
    16 COTRIMOXAZOLE SYR F PHAPROS (G)
    17 DEXA METHASON TBL 0,50 M F PHAPROS (G)
    18 DEXA METHASONE INJ. F PHAPROS (G)
    19 DEXA METHASONE INJ. F PHAPROS (G)
    20 DIPHENHYDRAMINE INJ F PHAPROS (G)
    21 EPINEPHRINE INJ. 1 mg/ml F PHAPROS (G)
    22 EPINEPHRINE INJ. 1 mg/ml F PHAPROS (G)
    23 GEMFIBROZIL 300 MG F PHAPROS (G)
    24 KETOROLAC INJ. 30 MG F PHAPROS (G)
    25 LIDOCAIN COMP INJ. 2% F PHAPROS (G)
    26 LIDOCAIN INJ. 2% F PHAPROS (G)
    27 METFORMIN TAB 500 MG F PHAPROS (G)
    28 NATRIUM DIKLOPENAK 25 MGF PHAPROS (G)
    29 NATRIUM DIKLOPENAK 25 MGF PHAPROS (G)
    30 NATRIUM DIKLOPENAK 50 MGF PHAPROS (G)
    31 PANTOPRAZOLE 40 MG INJ. F PHAPROS G
    32 PHENOBARBITAL INJ. F PHAPROS G
    33 PHYTOMENADION INJ. 10 MG F PHAPROS (G)
    34 PHYTOMENADION INJ. 10 MG F PHAPROS (G)
    35 PHYTOMENADION INJ. 10 MG F PHAPROS (G)
    36 PHYTOMENADION INJ. 2 MG ( F PHAPROS (G)
    37 PHYTOMENADION INJ. 2 MG ( F PHAPROS (G)
    38 PHYTOMENADION TABLET 10F PHAPROS (G)
    39 PHYTOMENADION TABLET 10F PHAPROS (G)
    40 PHYTOMENADION TABLET 10F PHAPROS (G)
    41 PREDNISON TABL 5 MG F PHAPROS G
    42 RANITIDIN INJ. F PHAPROS (G)
    43 RANITIDIN TABL 150 MG F PHAPROS (G)
    44 RANITIDIN TABL 150 MG F PHAPROS (G)
    45 SALBUTAMOL TABL 2 MG F PHAPROS (G)
    46 SALBUTAMOL TABL 4 MG F PHAPROS (G)
    47 VITAMIN K INJ. INFANT F PHAPROS (G)
    48 ZINK SULPHATE TAB F PHAPROS (G)

    1 ALLOPURINOL TAB 100 MG F PROMED (G)


    2 AMBROXOL SYR. 15 MG/ 5 MLF PROMED (G)
    3 AMBROXOL TAB. F PROMED (G)
    4 ANTASIDA DOEN TAB F PROMED (G)
    5 CEFADROXIL CAPS. 500 MG F PROMED (G)
    6 CEFADROXIL SYR F PROMED (G)
    7 CETIRIZINE SYR. F PROMED (G)
    8 CLOPIDOGREL TAB. 75 MG F PROMED (G)
    9 COTRIMOXAZOLE TAB 480 M F PROMED (G)
    10 DEXA METHASON TBL 0,50 M F PROMED (G)
    11 DOMPERIDONE SYR. F PROMED (G)
    12 DOMPERIDONE TAB F PROMED (G)
    13 ERDOSTEIN CAPS. 300 MG F PROMED (G)
    14 FENOFIBRATE 3OO MG F PROMED (G)
    15 FOLIC ACID 400 F PROMED (G)
    16 IBUPROFEN 400 MG F PROMED (G)
    17 LORATADIN 10 MG F PROMED (G)
    18 METFORMIN XR TAB 500 MG F PROMED (G)
    19 METFORMIN XR TAB 750 MG F PROMED (G)
    20 METHYLPREDNISOLON TAB 8 M F PROMED (G)
    21 ONDANSENTRON TAB. 4 MG F PROMED (G)
    22 PARACETAMOL SYRUP 60 MLF PROMED (G)
    23 PARACETAMOL TAB 500 MG F PROMED (G)
    24 PARACETAMOL TAB 500 MG F PROMED (G)
    25 PIRACETAM TAB. 800 MG F PROMED (G)
    26 RANITIDIN TABL 150 MG F PROMED (G)
    27 SUCRALFATE SYR. 100 ML F PROMED (G)
    28 URSODEOXYCHOLIC ASID 25 F PROMED (G)
    29 VITAMIN C TAB. 500 MG F PROMED (G)

    1 OMEPRAZOLE INJ. F QUANTUM


    2 PARACETAMOL INFUS F QUANTUM

    1 AMLODIPINE 10 MG F SCAN (G)


    2 AMLODIPINE 5 MG F SCAN (G)
    3 CLOPIDOGREL TAB. 75 MG F SCAN (G)
    4 METFORMIN TAB. 500 MG F SCAN (G)
    5 SIMVASTATIN TAB. 10 MG F SCAN (G)
    6 SIMVASTATIN TAB. 20 MG F SCAN (G)
    7 ZINK SULPHATE SYR. F SCAN (G)
    8 ZINK SULPHATE TAB F SCAN (G)

    1 AMLODIPINE 10 MG F TEMPO (G)


    2 DOMPERIDONE TAB F TEMPO (G)
    3 PARACETAMOL SYRUP 60 MLF TEMPO (G)
    4 SIMVASTATIN TAB. 20 MG F TEMPO (G)

    1 ATORVASTATIN 20 MG F YARINDO (G)


    2 BETAHISTINE TABLET 24 MG F YARINDO (G)
    3 CANDESARTAN TAB. 16 MG F YARINDO (G)
    4 DEVALPROEX SODIUM F YARINDO (G)
    5 DEXA METHASON TBL 0,50 M F YARINDO
    6 DEXKETOPROFEN INJ. F YARINDO (G)
    7 DEXKETOPROFEN TAB. 25 M F YARINDO (G)
    8 DIGOXIN TABL 0,25MG F YARINDO (G)
    9 ETORICOXIB 60 MG F YARINDO (G)
    10 PARACETAMOL TAB 500 MG F YARINDO
    11 PIOGLITAZONE 15 MG F YARINDO (G)
    12 PIROXICAM TABL 10 MG F YARINDO (G)
    13 PREGABALIN CAPS 75 MG F YARINDO (G)
    14 SALBUTAMOL TABL 2 MG F YARINDO (G)
    DM ( G ) 65,292,706
    NOVELL (G) 43,912,417
    FAHRENHEIT (G ) 31,800,505
    F DM ( G ) HEXPHARM ( G ) 19,195,093
    PROMED (G) 13,474,384
    YARINDO (G) 4,155,195
    MBF ( G ) 3,480,674
    BERNOFARM ( G ) 3,001,434
    F DM ( G ) PHAPROS (G) 1,136,316
    F DM ( G ) KF ( G ) 1,073,458
    F DM ( G ) SCAN (G) 713,476
    INF (G) 548,625
    ETHICA ( G ) 241,494
    F DM ( G ) DARYA VARIA (G) 107,910
    DM ( G )
    F DM ( G )
    F DM ( G )
    F DM ( G )

    F DM ( G )

    F DM ( G )
    F DM ( G )

    F DM ( G )
    F DM ( G )
    F DM ( G )

    F DM ( G )
    F DM ( G )

    F DM ( G )
    F DM ( G )

    F DM ( G )

    F DM ( G )

    F DM ( G )
    1 ALPENTIN 300 MG ACTAVIS -
    2 DOMINAL DROPS ACTAVIS -
    3 DOMINAL SYR 60 ML ACTAVIS -
    4 DOMINAL TAB ACTAVIS -
    5 DOPAMET TAB ACTAVIS -
    6 DUMIN SYRUP ACTAVIS -
    7 STESOLID RECTAL 10 MG ACTAVIS 295,010.60
    8 STESOLID RECTAL 5 MG ACTAVIS 196,673.40
    9 SULDOX TAB. ACTAVIS -
    491,684.00

    1 HARNAL OCAS ASTELLAS -


    2 HARNAL D 0,2 MG ASTELLAS -

    1 SYMBICORT 160, 60 DOSE ASTRA ZENECA 1,350,109.50


    2 SYMBICORT 80, 60 DOSE ASTRA ZENECA 5,391,506.80
    3 XYLOCAINE JELLY 2% 30 GRM ASTRA ZENECA -
    6,741,616.30

    1 AMARYL - M 1 AVENTIS -
    2 AMARYL - M 2 AVENTIS -
    3 AMARYL TAB. 1 MG AVENTIS -
    4 AMARYL TAB. 2 MG AVENTIS -
    5 AMARYL TAB. 3 MG AVENTIS -
    6 ESPERSON CR 5 GR AVENTIS -
    7 LASIX INJ.20MG/2CC AVENTIS -
    8 LASIX TAB. 40 MG AVENTIS -

    1 ECOSOL GLUCOSE 10% 500 ML B/BROUN -


    2 ECOSOL GLUCOSE 5% 100 ML B/BROUN -
    3 ECOSOL GLUCOSE 5% 500 ML B/BROUN -
    4 ECOSOL NACL 0,9% 100 ML B/BROUN -
    5 ECOSOL NACL 0,9% 1000 ML B/BROUN -
    6 ECOSOL NACL 0,9% 500 ML B/BROUN -
    7 ECOSOL RL 500 ML B/BROUN -

    1 CARDIO ASPIRIN BAYER -


    2 NOVA T ( 5TH ) BAYER -

    1 LIDODEX INJ BERNOFARM -


    2 LIDODEX INJ BERNOFARM -
    3 TROLAC INJ BERNOFARM 742,500.00
    4 ZISTIC SYR BERNOFARM 99,000.00
    841,500.00

    1 ANTI BISA ULAR BIO FARMA -


    2 BIO ATP TAB. BIO FARMA -
    1 BISOLVON ELIX 125 ML BOEHRINGER -
    2 BISOLVON INJ. BOEHRINGER -
    3 BUSCOPAN TABLET BOEHRINGER -
    4 COMBIVENT NEB. BOEHRINGER -
    5 DULCOLAX SUPP 5 MG BOEHRINGER -
    6 DULCOLAX SUPP ADULT 10 MG BOEHRINGER -
    7 DULCOLAX TAB 5 MG BOEHRINGER -
    8 MICARDIS PLUS 40 BOEHRINGER -
    9 MICARDIS PLUS 80 BOEHRINGER -
    10 SIFROL 0.125 MG BOEHRINGER -

    1 BLEDSTOP INJ CAPRIFARMINDO -


    2 BLESIFEN TAB CAPRIFARMINDO -
    3 FOLAVICAP 400 MG CAPRIFARMINDO -
    4 LIPROQY TAB CAPRIFARMINDO -
    5 PREABOR TAB. CAPRIFARMINDO 439,890.00
    6 REGUMEN TAB CAPRIFARMINDO -
    439,890.00

    1 CENDO ASTHENOF 5 CC CENDO -


    2 CENDO AUGENTONIC 5 ML CENDO -
    3 CENDO AUGENTONIC MD. 0.6 ML CENDO -
    4 CENDO CARPINE 1% 5 ML CENDO 78,856.25
    5 CENDO CARPINE 2% 5 ML CENDO -
    6 CENDO CATERLENT 15 ML CENDO -
    7 CENDO CATERLENT 5 ML CENDO 995,500.00
    8 CENDO CATERLENT MD 0.6 ML CENDO -
    9 CENDO CENFRESH 5 ML CENDO -
    10 CENDO CENFRESH MD 0.6 ML CENDO -
    11 CENDO CITROL EYE DROPS CENDO -
    12 CENDO CITROL EYE OINT CENDO -
    13 CENDO CITROL MD 0.6 ML CENDO -
    14 CENDO EYEFRESH DROPS 0.5 MCENDO -
    15 CENDO EYEFRESH MD. 0.6 ML CENDO -
    16 CENDO FENECOL 0.5 EYE DROPS CENDO -
    17 CENDO FENECOL EYE OINT 3.5 GR CENDO -
    18 CENDO FLOXA ED. 5 ML CENDO -
    19 CENDO FLOXA MINIDOSE CENDO -
    20 CENDO GENTA SALAP MATA CENDO -
    21 CENDO HYALUB 5 ML CENDO -
    22 CENDO HYALUB MD. 0.6 ML CENDO -
    23 CENDO LFX 5 ML CENDO -
    24 CENDO LFX MINIDOSE CENDO -
    25 CENDO LYTEERS 15 CC CENDO -
    26 CENDO LYTEERS MD. 0,6 ML CENDO -
    27 CENDO MYDRIATYL MINIDOSE CENDO -
    28 CENDO MYDRIATYL TM CENDO -
    29 CENDO PANTOCAIN EYE DROPS 0. CENDO -
    30 CENDO PANTOCAIN EYE DROPS 2%CENDO -
    31 CENDO PANTOCAIN EYE DROPS 2%CENDO -
    32 CENDO PROTAGENTA EYE DROP CENDO -
    33 CENDO PROTAGENTA MD 0.6 ML CENDO -
    34 CENDO TIMOL 0.5% ED. 0.6 ML CENDO -
    35 CENDO TIMOL TETES MATA 0.25% CENDO -
    36 CENDO TIMOL TETES MATA 0.5% CENDO -
    37 CENDO VASACON 15 ML CENDO -
    38 CENDO VASACON ED. MINIDOS CENDO -
    39 GLAUCON TAB 250 MG CENDO -
    40 TOBROSAN 5 CC CENDO -
    41 TOBROSAN MD 0.6 ML CENDO -
    42 TOBROSAN MD 0.6 ML CENDO -
    43 VITROLENTA EYE DROPS CENDO -
    1,074,356.25

    1 BRONCHOPRONT SYR. COMBIPHAR -


    2 COMTUSI STRAWBERRY SYR 60COMBIPHAR -
    3 COMTUSI SYR 100 ML COMBIPHAR -
    4 COMTUSI SYR 60 ML COMBIPHAR -
    5 FUSYCOM CREAM COMBIPHAR -
    6 ZINCPRO DROPS 15 ML COMBIPHAR -

    1 BENACOL DTM SYRUP 60 ML DANKOS -


    2 BENACOL SYRUP 100 ML DANKOS -
    3 BENACOL SYRUP 60 ML DANKOS -
    4 NEUROTAM SYR. 100 ML DANKOS -

    1 BURNAZIN CREAM TUBE 35 GR DARYA VARIA -


    2 BURNAZIN PLUS 25 GR DARYA VARIA -
    3 CEDOCARD INJ DARYA VARIA -
    4 SALOFALK SOFT. CAPS.500 MG DARYA VARIA -

    1 ALBUMINAR 25% 100 ML DEXA MEDICA -


    2 AMINEFRON TAB. DEXA MEDICA -
    3 ANVOMER B6 TAB. DEXA MEDICA -
    4 ASAM VALPROIC SYR. 250 MG DEXA MEDICA -
    5 ATEVIR TAB. 0.5 MG DEXA MEDICA -
    6 AZOMAX CAPS DEXA MEDICA -
    7 AZOMAX SYR DEXA MEDICA -
    8 CANDERIN TAB. 16 MG DEXA MEDICA -
    9 CANDERIN TAB. 8 MG DEXA MEDICA -
    10 COLERGIS SYR DEXA MEDICA 207,900.00
    11 COLERGIS TAB DEXA MEDICA 495,000.00
    12 FLAMICORT INJ. 10 MG DEXA MEDICA -
    13 GELAFUSAL INF 500 ML DEXA MEDICA 1,824,900.00
    14 GLUVAS 4 MG DEXA MEDICA -
    15 HUMAN ALBUMIN 20% 50 ML DEXA MEDICA 890,000.00
    16 HYSTOLAN TABLET DEXA MEDICA -
    17 NEURODEX TABLET DEXA MEDICA -
    18 ORINOX tab. 60 MG DEXA MEDICA -
    19 PRONALGES SUPP. DEXA MEDICA -
    20 PSIDII SYR 60 ML DEXA MEDICA -
    21 RHINOFED SYR DEXA MEDICA 726,000.00
    22 RHINOFED TAB. DEXA MEDICA 308,000.00
    23 RHINOS NEO DROPS DEXA MEDICA 1,267,200.00
    24 RHINOS SR CAPS DEXA MEDICA 2,057,000.00
    25 RHINOS SYR JUNIOR DEXA MEDICA 475,200.00
    26 SEDACUM INJ. 15 MG / 3 ML DEXA MEDICA 2,477,750.00
    27 SEDACUM INJ. 5 MG / 5 ML DEXA MEDICA 2,337,500.00
    28 SPASMOMEN TAB. DEXA MEDICA -
    29 TENSIVAKS TAB. 5 MG DEXA MEDICA -
    30 TENSIVAKS TAB.10 MG DEXA MEDICA -
    31 TROLIP TAB 100 MG DEXA MEDICA -
    32 TROLIP TAB 300 MG DEXA MEDICA -
    33 VECTRINE CAPS. 300 MG DEXA MEDICA -
    34 VECTRINE SYR. DEXA MEDICA -
    35 VOMETA DROPS DEXA MEDICA 141,075.00
    36 VOMETA FT TAB. 10 MG DEXA MEDICA 264,000.00
    37 VOMETA SYRUP 60 ML DEXA MEDICA -
    38 DEXYCLAV FORTE CAPS. 500 M DEXA MEDIKA -
    39 DEXYMOX FORTE CAPSUL DEXA MEDIKA -
    40 TETAGAM INJ. DEXA MEDIKA 1,251,228.00
    14,722,753.00

    1 PLASBUMIN 20% 20 ML DIPA -

    1 MYONAL TAB. EISSAI -

    1 RINGER LACTATE 500 ML EMJEBE 27,319,600.00


    2 RINGER LACTATE 500 ML EMJEBE -
    3 SOD.CHLORET NATR. 500 ML EMJEBE -
    27,319,600.00

    1 ERLAMYCETIN SALEP MATA ERLA -


    2 ERLAMYCETIN TTS MATA ERLA -

    1 ANESFAR INJ. FAHRENHEIT -


    2 ATOFAR 10 FAHRENHEIT 1,234,134.00
    3 ATOFAR 20 FAHRENHEIT 1,727,787.60
    4 ATOFAR 40 FAHRENHEIT 493,653.60
    5 BUNASCAN SPINAL 0.5% FAHRENHEIT 1,306,800.00
    6 CALGAE CAPS FAHRENHEIT -
    7 CALOS CAPS FAHRENHEIT 606,375.00
    8 ELPICEF INJ FAHRENHEIT -
    9 FALERGI TAB FAHRENHEIT 831,600.00
    10 FARBION INJ FAHRENHEIT 392,040.00
    11 FARBION TAB FAHRENHEIT 594,000.00
    12 FARBIVENT FAHRENHEIT 3,872,000.00
    13 FARGOXIN TAB. FAHRENHEIT -
    14 FARGOXIN TAB. FAHRENHEIT -
    15 FARMACROL FORTE TABLET FAHRENHEIT -
    16 FARMADOL INFUS FAHRENHEIT 4,055,040.00
    17 FARMADRAL TAB. 10 MG FAHRENHEIT -
    18 FARMAVON INJEKSI 4MG/2ML FAHRENHEIT 6,177,600.00
    19 FARMAVON SYR 100 ML FAHRENHEIT -
    20 FARSIX INJ FAHRENHEIT -
    21 FARSORBID 5 MG FAHRENHEIT -
    22 FARSORBID INJ. FAHRENHEIT 1,485,000.00
    23 FARTOLIN EXP.SYR 100 ML FAHRENHEIT 1,201,200.00
    24 FENDEX INJEKSI FAHRENHEIT -
    25 GABAXA INFUS 100 ML FAHRENHEIT 4,900,500.00
    26 INDOP INJ FAHRENHEIT -
    27 INVICLOT INJ. FAHRENHEIT 5,299,800.00
    28 ISOTIC ADRETOR 0.5 FAHRENHEIT 205,425.00
    29 LACTAFAR FAHRENHEIT 1,782,000.00
    30 PEINLOS 400 INJ. FAHRENHEIT 1,028,500.00
    31 REBAL PLUS FAHRENHEIT 623,700.00
    32 RENAPAR TABLET FAHRENHEIT 177,100.00
    33 RESFAR INFUS 25 ML FAHRENHEIT 5,056,590.00
    34 SIKSTOP TABLET FAHRENHEIT 693,000.00
    35 SIMARC 2 MG TAB FAHRENHEIT -
    36 SOJOURN 250 ML FAHRENHEIT -
    37 SOTATIC INJEKSI FAHRENHEIT 110,880.00
    38 TIARYT TAB. FAHRENHEIT 142,036.80
    39 VASOLA INJ FAHRENHEIT -
    40 VIOXY FM TABLET FAHRENHEIT -
    41 ZIBAC INJ. 1 GR FAHRENHEIT -
    43,996,762.00

    1 ALEGYSAL TTS MATA FERRON 618,849.00


    2 CROME INJ 50 MG FERRON -
    3 EDOTIN CAPS FERRON -
    4 KARY UNI 5 ML FERRON -
    5 KETESSE INJ- FERRON -
    6 KETESSE TAB. FERRON -
    7 KETRICIN ORABASE 0.1% 5 GR FERRON 311,850.00
    8 TARIVID OPTH SOL ( MATA ) FERRON 1,154,340.00
    2,085,039.00

    1 AMINOSTERIL INFUS 6% FRESENIUS -


    2 KETOSTERIL FRESENIUS -

    1 SCABIMITE CREAM GALANIUM -

    1 FLIXOTIDE NEB. 0.5 MG GLAXO 293,286.60


    2 INFANRIX HEXA GLAXO 11,971,549.00
    3 SERETIDE DISKUS 250 MCG GLAXO -
    4 SERETIDE DISKUS 500 MCG GLAXO -
    5 SERETIDE DISKUS100 MCG GLAXO -
    6 VENTOLIN NEBULES 2.5 MG GLAXO -
    12,264,835.60

    1 RECO SALEP MATA GMP -


    2 RECO TETES MATA GMP -
    3 RECO TETES TELINGA GMP -

    1 PROPEPSA SYR 100 ml GRACIA -


    2 PROPEPSA SYR 200 ml GRACIA -
    3 PROSINAL SYR GRACIA -

    1 ALGANAX TAB. 0.25 MG GUARDIAN -


    2 ALGANAX TAB. 0.5 MG GUARDIAN -
    3 ANADIUM CAPS GUARDIAN -
    4 NYNDIA DROPS GUARDIAN -
    5 UNALIUM 10 TAB GUARDIAN -
    6 UNALIUM 5 TAB GUARDIAN -
    7 ZIBRAMAX 500 MG GUARDIAN -
    8 ZIBRAMAX DRY SYR GUARDIAN -

    1 HISTIGO TAB IFARS -

    1 ALBUNORM 25% 50 ML INDO FARMA -


    2 ZINKID SYR INDO FARMA -

    1 CANDEFION TABLET 16 MG INFION -


    2 CANDEFION TABLET 8 MG INFION -

    1 ANTIPLAT 50 MG INMARK -

    1 ALCO DROPS 15 ML INTERBAT -


    2 ANADEX TAB. INTERBAT -
    3 CEPTIK 200 MG INTERBAT 4,046,240.00
    4 CEPTIK DRY. SYRUP INTERBAT -
    5 CLIAD TAB INTERBAT -
    6 CORTAMINE SYR 60 ML INTERBAT 589,160.00
    7 CORTAMINE TABLET INTERBAT 415,800.00
    8 CURFOS SYR. 100 ML INTERBAT -
    9 ERDOBAT CAPSUL INTERBAT -
    10 FINPRO TAB INTERBAT 4,356,000.00
    11 GITAS INJEKSI INTERBAT -
    12 IMMU-CEA SYR. INTERBAT -
    13 INDEXON INJ INTERBAT -
    14 INTERLAC STICK PACK 0.3 GR INTERBAT 891,000.00
    15 INTERLAC TAB. KUNYAH STRA INTERBAT -
    16 INTERMOXIL SYR INTERBAT -
    17 INTERPECT SYR. 15 ML INTERBAT -
    18 INTERPECT SYR. 30 ML INTERBAT -
    19 INTERVASK 10 MG INTERBAT -
    20 INTERVASK 5 MG INTERBAT -
    21 INTRIZIN SYR. INTERBAT -
    22 INTRIZIN TABLET INTERBAT -
    23 INVOMET TAB. 4 MG INTERBAT -
    24 INVOMET TAB. 8 MG INTERBAT -
    25 ISORIC 300 TAB INTERBAT -
    26 KETROBAT INJ INTERBAT -
    27 LYVIT SYR 60 ML INTERBAT 485,100.00
    28 MYOBAT TABLET INTERBAT -
    29 OTTOPAIN EAR DROPS INTERBAT -
    30 PAMOL DROPS INTERBAT 2,006,400.00
    31 PAMOL SYR. 60 ML INTERBAT 861,300.00
    32 PROTOP CAPS INTERBAT -
    33 SALTICIN CREAM INTERBAT 1,168,200.00
    34 SALTICIN INJ. INTERBAT -
    35 THYAMYCIN FORTE SYR 60 ML INTERBAT -
    36 THYAMYCIN SYR 60 ML INTERBAT -
    37 TRADYL TABLET INTERBAT -
    38 TRIFED SYR INTERBAT -
    39 TRIFED TAB. INTERBAT -
    40 ZYCIN TABLET 500 MG INTERBAT -
    14,819,200.00

    1 DUROGESIC MATRIX 12 ug/h JANNSEN -


    2 DUROGESIC MATRIX 25 ug/h JANNSEN -
    3 DUROGESIC MATRIX 25 ug/h JANNSEN -
    4 FENTANYL INJ. 0.05 MG JANNSEN 1,980,000.00
    1,980,000.00

    1 AMINOFUSIN L 600 KALBE FARMA -


    2 BIOPLACENTON YELLY 15 GR KALBE FARMA -
    3 CATHEJELL 12,5 GR KALBE FARMA 129,800.00
    4 FOROTIC 3MG / 5ML KALBE FARMA 841,500.00
    5 FORRES TABLET 50 MG KALBE FARMA 2,376,000.00
    6 FORTANES INJ. 15 MG / 3 ML KALBE FARMA -
    7 FORTANES INJ. 5 MG / 3 ML KALBE FARMA -
    8 HEMAPO INJ KALBE FARMA 3,742,200.00
    9 KALNEX TABLET 250 MG KALBE FARMA -
    10 KALNEX TABLET 500 MG KALBE FARMA -
    11 KALTROFEN SUPP. KALBE FARMA -
    12 MANNITOL 20% 500 ML KALBE FARMA 539,198.00
    13 NEO GYNOXA OVULA KALBE FARMA -
    14 NOCID KAPLET KALBE FARMA -
    15 TARIVID OTIC 50 LOTION ( TELINKALBE FARMA -
    16 V-BLOC 6,25 KALBE FARMA -
    17 VESTEIN CAPS.300 MG @30 KALBE FARMA -
    18 VESTEIN SYR. KALBE FARMA -
    7,628,698.00

    1 BEDAK SALYCIL 100 GRM KIMIA FARMA -


    2 BETASON-N CREAM KIMIA FARMA -
    3 CARTYLO TAB. 80 MG KIMIA FARMA -
    4 CODEIN 10 MG KIMIA FARMA -
    5 CODEIN 20 MG KIMIA FARMA -
    6 CODIKAF 10 MG KIMIA FARMA -
    7 CODIKAF 20 MG KIMIA FARMA -
    8 CODIPRONT CUM CAPS KIMIA FARMA -
    9 CODIPRONT SYR. KIMIA FARMA -
    10 KAMAFLAM TABLET 50 MG KIMIA FARMA -
    11 NEURODIAL TAB KIMIA FARMA -
    12 NITROKAF RETARD CAPS KIMIA FARMA -
    13 NITROKAF RETARD FORTE CAP KIMIA FARMA -
    14 NITROKAF RETARD FORTE CAP KIMIA FARMA -
    15 RETAPHYL SR. CAPL. KIMIA FARMA -
    16 RINGER LACTATE 500 ML KIMIA FARMA -
    17 SCABICID CREAM KIMIA FARMA -

    1 ARTIMAX CAPS. LANDSON -


    2 ASTRIA KAPSUL 4 MG LANDSON -
    3 CORMEGA CAPS. LANDSON -
    4 LANAKELOID E CREAM 10 GR LANDSON -
    5 LANAVISION CAPS. LANDSON -
    6 LANFIX CAPS. 100 MG LANDSON -
    7 LANFIX CAPS. 200 MG LANDSON -
    8 LANFIX SYR. LANDSON -
    9 LANTULOS SYR. 60 ML LANDSON -
    10 LESICHOL CAPS 300 MG LANDSON 4,740,120.00
    11 LESICHOL CAPS 600 MG LANDSON 4,474,799.10
    12 RECUSTEIN CAPS LANDSON -
    13 RECUSTEIN SYR LANDSON -
    14 ULVICE INJ. LANDSON -
    15 VALKENE SYR. 120 ML LANDSON -
    9,214,919.10

    1 AMADIAB 1 LAPI -
    2 AMADIAB 2 LAPI -
    3 AMADIAB 3 LAPI -
    4 AMADIAB 4 LAPI -
    5 ANALTRAM CAPS LAPI -
    6 APIALYS DROPS LAPI -
    7 APIALYS SYR. LAPI -
    8 DOM SYR LAPI -
    9 DOM TB LAPI -
    10 L - BIO LAPI -
    11 L – ZINC SYR. 100 ML LAPI -
    12 LABUMIN CAPS. LAPI 1,716,000.00
    13 LASAL EXP. SYR. 100 ML LAPI -
    14 LASAL SYR. 100 ML LAPI -
    15 LATROPIL SYR. 100 ML LAPI -
    16 MICROGYEST 100 MG LAPI 3,801,600.00
    17 MICROGYEST 200 MG LAPI -
    18 MYONEP TAB LAPI -
    19 NYSTIN DROPS 12 ML LAPI -
    20 UTROGESTAN 100 MG LAPI -
    21 UTROGESTAN 200 MG LAPI -
    5,517,600.00
    1 NEW DIATABS TAB MEDIFARM -
    2 ASPILETS TBL. MEDIFARMA -

    1 FG TROCHES LOZENGES MEIJI -

    1 MUCOS DROPS MEPROFARM -


    2 SIRPLUS RASA ANGGUR MEPROFARM -
    3 SIRPLUS RASA JERUK MEPROFARM -
    4 SIRPLUS RASA MELON MEPROFARM -
    5 SIRPLUS RASA STROBERY MEPROFARM -

    1 CONCOR TAB. 10 MG MERCK -


    2 EUTHYROX 100 MG MERCK -
    3 EUTHYROX 50 MG MERCK -
    4 KSR 600 MG MERCK -
    5 NEUROBION 5000 TABLET SALUMERCK -
    6 NEUROBION FORTE CAPS. 5.000MERCK -
    7 NEUROBION INJ. 5000 ML MERCK -
    8 THYROZOL 10 MG MERCK -
    9 THYROZOL 5 MG MERCK -
    10 SANGOBION DROP MERK -

    1 BAMGETOL 200 MG MERSIFARMA -


    2 MINIASPI 80 MG MERSIFARMA -

    1 ANALSPEC 500 MG METISKA FARMA -


    2 DIABION CAPSUL METISKA FARMA -
    3 KANDISTATIN DROPS METISKA FARMA -
    4 TISMAZOL 500 MG METISKA FARMA -
    5 XEPAMOL DROPS METISKA FARMA -
    6 XEPAMOL SYR. 250 / 5 ML METISKA FARMA -
    7 XEPAMOL TABLET 500 MG METISKA FARMA -

    1 GARDASIL INJ. 0.5 ML MSD 1,702,332.10

    1 CHANNA CAPS. 500 MG MYLAN -

    1 FERIZ DROPS NICHOLAS 404,250.00


    2 NEO MERCAZOL TAB. NICHOLAS -
    3 ZANIC SYR 100 ML NICHOLAS -
    404,250.00

    1 CATAFLAM TABLET 25 MG NOVARTIS -


    2 CATAFLAM TABLET 50 MG NOVARTIS -
    3 EXFORGE 10/160 TAB NOVARTIS 718,315.36
    4 GALVUS MET 50/500 MG NOVARTIS 1,928,550.00
    5 GALVUS MET 50/850 MG NOVARTIS 850,131.60
    6 SIRDALUT TAB. 2 MG NOVARTIS -
    7 VOLTAREN EMULGEL 10 GR NOVARTIS -
    8 VOLTAREN EMULGEL 20 GR NOVARTIS -
    9 VOLTAREN EMULGEL 5 GR NOVARTIS -
    10 VOLTAREN EMULGEL 50 GR NOVARTIS -
    11 VOLTAREN TAB 50 MG NOVARTIS 300,693.00
    3,797,689.96

    1 ASTHIN FORCE Kaps 6 mg NOVELL -


    2 BNS ( BREATHY NASAL SPRAY )NOVELL -
    1 BREATHY TETES HIDUNG NOVELL -
    2 CANDOTENS 16 MG NOVELL -
    3 CANDOTENS 8 MG NOVELL -
    4 LACTO B NOVELL -
    5 OFERLOD TAB. 500 MG NOVELL -
    6 PROTERINE INJ NOVELL -
    7 PROTERINE TAB NOVELL -
    8 VELTHROM 10 MG NOVELL -
    9 VELTHROM 5 MG NOVELL -

    1 LEVEMIR FLEXPEN NOVO NORDISK 4,450,000.00


    2 NOVOMIX FLEXPEN NOVO NORDISK -
    3 NOVORAPID FLEXPEN NOVO NORDISK 2,685,000.00
    4 RYZODEG FLEX TOUCH NOVO NORDISK -
    7,135,000.00

    1 B FLUID 500 ML OTSUKA -


    2 DEXTROSE 10% 500 ML OTSUKA 287,980.00
    3 DEXTROSE 10% 500 ML OTSUKA -
    4 DEXTROSE 40% INJ. 25 ML OTSUKA 546,031.20
    5 DEXTROSE 5% 500 ML OTSUKA -
    6 KA-EN 3A 500 ML OTSUKA -
    7 MEYLON INJ. OTSUKA -
    8 MGSO4 40% 25 ML OTSUKA 155,412.40
    9 SOD. NATR. CL. 3% 500 ML OTSUKA -
    10 SOD.CHLORET NATR. 100 ML OTSUKA 676,390.00
    11 SOD.CHLORET NATR. 500 ML OTSUKA -
    12 SOD.CHLORET NATR. 500 ML OTSUKA -
    13 SOD.CHLORET NATR. 500 ML OTSUKA -
    14 WATER FOR INJEKSI 25 ML OTSUKA -
    15 WATER STERIL / AQUADEST 1 L OTSUKA -
    16 RINGER LACTATE 500 ML OTSUKA -
    1,665,813.60

    1 BACTRAZ INJ. OTTO -


    2 BIOXON INJ OTTO 2,328,480.00
    3 CEBEX CAPS. OTTO -
    4 CETIRGI SYR. OTTO 823,020.00
    5 CETIRGI TAB. OTTO -
    6 CLAMIXIN SYR OTTO -
    7 CLAMIXIN FT SYR OTTO -
    8 DEXTAFEN CAPS. OTTO -
    9 DEXTROSIN SYR. 120 ML OTTO -
    10 DIAFORMIN XR OTTO -
    11 DIAFORMIN XR OTTO -
    12 ELSAZYM SACHET @ 5gr OTTO -
    13 FOLAC TAB OTTO 1,595,000.00
    14 GERDILIUM DROPS OTTO -
    15 GRANOPI CAPS. 1 MG OTTO 2,772,000.00
    16 HI BONE E 300 OTTO 1,148,400.00
    17 HI BONE E 600 OTTO -
    18 MAGTRAL SYR 120 ML OTTO -
    19 MUCERA DROPS OTTO -
    20 MUCERA SYR 15 MG / 60 ML OTTO -
    21 MUCERA SYR 30 MG / 60 ML OTTO 1,071,840.00
    22 MUCERA TAB OTTO 558,250.00
    23 OPICEF FORTE SYR 60 ML OTTO -
    24 OPICEF SYR 60 ML OTTO -
    25 OPICORT TAB. 4 MG OTTO 502,425.00
    26 OPILAX SYR. 60 ML OTTO 1,132,560.00
    27 OPIMER INJ. 1 GR OTTO -
    28 OPIMOX FORTE SYR 250 ML OTTO -
    29 OPIMOX SYR 125 ML OTTO -
    30 OPIMOX TABLET 500 MG OTTO -
    31 OPINACEA CAPS. OTTO -
    32 OPINEURON TAB OTTO -
    33 OPIVASK 10 MG OTTO -
    34 ORASIC CAPS. OTTO 1,914,000.00
    35 OSTARIN FORTE SYR. OTTO 172,260.00
    36 OSTARIN SYR. OTTO -
    37 OTTOGENTA CREAM OTTO 657,937.50
    38 OTTOGENTA INJ OTTO 478,500.00
    39 OTTOPAN DROPS OTTO -
    40 OTTOPAN SYR OTTO -
    41 PREDNICORT 4 MG OTTO -
    42 PREDNICORT 8 MG OTTO -
    43 ROFIDEN SUPS OTTO -
    44 TORAMINE INJ 30 MG OTTO -
    45 TORAMINE TAB.10 MG OTTO -
    46 TORAMINE TAB.10 MG OTTO -
    47 TRIFEDRIN SYR. OTTO -
    48 TRIFEDRIN TAB. OTTO -
    49 TROGYL INFUS 500 MG / 100 ML OTTO -
    50 TROGYL SYR OTTO -
    51 TROGYL TABLET OTTO -
    52 TROGYSTATIN OVULA OTTO 1,297,725.00
    53 VALEPTIK SYR OTTO 5,052,960.00
    54 VARDIPIN 5/80 OTTO -
    55 VITAMULTI DHA CAPS OTTO -
    56 VOMEGO INJ.4 MG/2ML OTTO -
    57 VOMEGO TAB. 4 MG OTTO -
    21,505,357.50

    1 CELEBREX CAPS. 100 MG PFIZER -


    2 CELEBREX CAPS. 200 MG PFIZER 406,301.70
    3 LIFITOR TAB 20 MG PFIZER -
    4 LIFITOR TAB 40 MG PFIZER -
    406,301.70

    1 BECEFORT SYR 60 ML PHAPROS -


    2 BECEFORT TAB. PHAPROS -
    3 DEXTAMIN SYR 60 ML PHAPROS -
    4 DEXTAMIN TAB/300 PC PHAPROS -
    5 PRORIS SYR PHAPROS -
    6 PRORIS SYR FORTE PHAPROS -
    7 TEBOKAN SPESIAL PHAPROS -
    8 TEBOKAN TAB. PHAPROS -
    9 ASCARDIA TAB 80 MG PHAROS -
    10 EUPHYLIN RETARD TAB. PHAROS -

    1 DOME DROPS PROMED -


    2 DOME SYR. PROMED -
    3 DOME TAB PROMED -
    4 MINOSEP 150 ML PROMED -
    5 MINOSEP 60 ML PROMED -
    6 NEUROMED 5000 MG PROMED -

    1 ARKINE SYR PYRIDAM -


    2 ARKINE TABLET PYRIDAM -
    3 ASEDAS SYR. PYRIDAM 3,859,680.00
    4 BLOCAND 16 MG PYRIDAM -
    5 BLOCAND 8 MG PYRIDAM -
    6 CALTRAX TABLET PYRIDAM 4,516,050.00
    7 EPSONAL TAB PYRIDAM 4,282,300.00
    8 FEROSPAT TABLET PYRIDAM 5,722,200.00
    9 FORMOM TABLET PYRIDAM 1,802,680.00
    10 FORMOM TABLET PYRIDAM 5,633,375.00
    11 FUSON CREAM PYRIDAM -
    12 HEPA - Q CAPS PYRIDAM 1,399,200.00
    13 IMUDATOR TABLET PYRIDAM 3,366,000.00
    14 KETOCID CAPS PYRIDAM 3,743,300.00
    15 KIDIMUN SYR. 60 ML PYRIDAM 1,795,200.00
    16 LEVAZIDE TAB PYRIDAM 677,160.00
    17 LUBIRE CAPS. PYRIDAM 712,800.00
    18 LUBIRE SYR. 60 ML PYRIDAM -
    19 OSTEOR C CREAM PYRIDAM 696,575.00
    20 OSTEOR PLUS CAPS. PYRIDAM 1,196,800.50
    21 RZ-20 SYR. 60 ML PYRIDAM 2,782,560.00
    22 VAROC TAB 500 MG PYRIDAM 973,335.00
    43,159,215.50

    1 BACTRIM SYR 50 ML ROCHE -


    2 ERICAF TAB ROCHE -

    1 AKILEN EAR DROPS SANBE FARMA -


    2 ALDISA SR CAPS. SANBE FARMA -
    3 ALLORIS TABLET SANBE FARMA -
    4 AMOXAN DROPS SANBE FARMA 184,800.00
    5 ANALSIK TAB SANBE FARMA 1,258,130.00
    6 ANBACIM INJ. SANBE FARMA 4,696,759.66
    7 ASTHAROL SYR SANBE FARMA -
    8 ASTHAROL TABLET SANBE FARMA -
    9 BAQUINOR 0.3% EYE DROPS SANBE FARMA -
    10 BECOM C CAPLET SANBE FARMA 1,299,030.00
    11 BECOM ZET CAPLET SANBE FARMA -
    12 BIOSANBE CAP. SANBE FARMA 443,440.00
    13 BIOTHICOL CAPS 500 MG SANBE FARMA -
    14 BIOTHICOL SYR SANBE FARMA -
    15 BRAXIDIN TABLET SANBE FARMA -
    16 CERINI CAPS. SANBE FARMA 226,380.00
    17 CERINI DROP SANBE FARMA 779,625.00
    18 CERINI SYR SANBE FARMA 788,040.00
    19 CLANEKSI TAB. SANBE FARMA -
    20 COLSANCETINE INJ SANBE FARMA 107,800.00
    21 CORTIDEX INJEKSI SANBE FARMA 480,865.00
    22 CURCUMA SANBE TAB SANBE FARMA 726,000.00
    23 DOPACEF INJEKSI SANBE FARMA 1,943,776.38
    24 ELKANA CL EMULSION 120 ML SANBE FARMA 421,987.50
    25 ELKANA CL EMULSION 60 ML SANBE FARMA 429,632.40
    26 ELKANA TAB. SANBE FARMA -
    27 EPEXOL DROP 15 MG SANBE FARMA -
    28 EPEXOL SYRUP 15 MG SANBE FARMA 656,535.00
    29 EPEXOL TABLET 30 MG SANBE FARMA 273,900.00
    30 EPISAN SYR. 100 ML SANBE FARMA 726,165.00
    31 EPISAN SYR. 200 ML SANBE FARMA -
    32 EPRINOC TABLET SANBE FARMA -
    33 ERYSANBE CAPS. 500 MG SANBE FARMA -
    34 ERYSANBE SYR. SANBE FARMA 54,945.00
    35 FLAMAR ZALF 20 GR SANBE FARMA 405,900.00
    36 FOLAVIT TAB. 1000 MG SANBE FARMA -
    37 FOLAVIT TAB. 400 MG SANBE FARMA -
    38 FORMUNO CAPS SANBE FARMA 1,683,000.00
    39 FORUMEN EYE DROPS 10 ML SANBE FARMA 98,367.50
    40 FUTADERM CREAM SANBE FARMA -
    41 FUTROLIT INF SANBE FARMA -
    42 FUTROLIT INF SANBE FARMA -
    43 GLAUSETA TAB. SANBE FARMA -
    44 GRATIZIN 10 MG SANBE FARMA 2,235,750.00
    45 GRATIZIN 5 MG SANBE FARMA 1,868,625.00
    46 HEPAGUSAN INJEKSI SANBE FARMA -
    47 INFUSAN D10 500 ML SP SANBE FARMA -
    48 INFUSAN D5 100 ML SANBE FARMA -
    49 INFUSAN D5 500 ML SP SANBE FARMA -
    50 INFUSAN M20 500 ML SANBE FARMA -
    51 INFUSAN NS 100 ML SP SANBE FARMA -
    52 INFUSAN NS 1000 ML SP SANBE FARMA -
    53 INFUSAN NS 500 ML SP SANBE FARMA -
    54 INFUSAN RING AS 500 ML SP SANBE FARMA -
    55 INFUSAN RL 500 ML SP SANBE FARMA -
    56 INFUSAN RL 500 ML SP SANBE FARMA -
    57 INFUSAN WATER FOR IRIGATION SANBE FARMA -
    58 LEVOCIN EYE DROPS SANBE FARMA -
    59 LODIA TABLET 2 MG SANBE FARMA 148,500.00
    60 MEFINAL CAPS. 250 MG SANBE FARMA -
    61 MEFINAL CAPS. 500 MG SANBE FARMA 1,174,800.00
    62 MEGABAL TABLET SANBE FARMA -
    63 NEO KAOLANA SYR SANBE FARMA 52,387.50
    64 NEO KAOLANA SYR SANBE FARMA 21,142.00
    65 NEUROSANBE 5000 MG SANBE FARMA 2,107,590.00
    66 NEUROSANBE INJ. SANBE FARMA 842,380.00
    67 NEUROSANBE TABLET SANBE FARMA -
    68 OTILON TETES TELINGA 8 ML SANBE FARMA 593,670.00
    69 PIBAKSIN SALEP 10 GR SANBE FARMA 338,250.00
    70 PIROFEL GEL SANBE FARMA -
    71 PLASMINEX INJ. SANBE FARMA 287,017.50
    72 POLIDEMISIN EYE DROPS SANBE FARMA 376,365.40
    73 POLIDEMISIN SALEP MATA SANBE FARMA 292,875.00
    74 PUMPITOR CAPS SANBE FARMA 11,162,250.00
    75 PUMPITOR INJ. SANBE FARMA 2,887,500.00
    76 RENOSAN INFUS 500 ML SANBE FARMA 1,939,630.00
    77 RETIVIT PLUS CAPS SANBE FARMA 1,603,170.00
    78 SAGESTAM INJ. SANBE FARMA 187,495.00
    79 SANADRYL DMP SYR. 120 ML SANBE FARMA -
    80 SANADRYL DMP SYR. 60 ML SANBE FARMA -
    81 SANADRYL SYRUP 120 ML SANBE FARMA 283,140.00
    82 SANADRYL SYRUP 60 ML SANBE FARMA 196,020.00
    83 SANBE HEST SANBE FARMA -
    84 SANBE TEARS SANBE FARMA 764,032.50
    85 SANFULIQ TABLET SANBE FARMA -
    86 SANMAG SYR SANBE FARMA 863,280.00
    87 SANMOL DROPS SANBE FARMA -
    88 SANMOL FORTE SYR. SANBE FARMA -
    89 SANMOL FORTE TAB. SANBE FARMA -
    90 SANMOL SYR SANBE FARMA 231,660.00
    91 SANMOL TAB. SANBE FARMA -
    92 SANORIN HIJAU 200 ML SANBE FARMA -
    93 SANORIN HIJAU 80 ML SANBE FARMA 134,827.00
    94 SANPICILLIN INJ SANBE FARMA -
    95 SANSULIN LOG-G SANBE FARMA 8,455,000.95
    96 SPORETIK KAPS. 100MG ( 30/BOXSANBE FARMA 7,339,612.50
    97 SPORETIK KAPS. 200 MG ( 10/BOSANBE FARMA 15,309,937.50
    98 SPORETIK SYR. SANBE FARMA 688,462.50
    99 STOLAX SUPP 10 MG SANBE FARMA -
    100 TERFACEF INJ 1 GR SANBE FARMA 12,066,340.00
    101 TIM OPHTAL TTS MATA 0.25% SANBE FARMA -
    102 TIM OPHTAL TTS MATA 0.5% SANBE FARMA -
    103 TRADOSIK CAPS. SANBE FARMA -
    104 TRADOSIK INJ. SANBE FARMA 3,089,240.00
    105 TREMENZA SYR. SANBE FARMA -
    106 TREMENZA TAB SANBE FARMA 1,800,570.00
    107 TRICHODAZOLE 500 TABLET SANBE FARMA -
    108 TRICHODAZOLE PLUS OVULA SANBE FARMA -
    109 TRIDEX 27A 500 ML SANBE FARMA 275,983.20
    110 TROVENSIS INJ. 2ML SANBE FARMA 781,473.00
    111 TROVENSIS INJ. 4ML SANBE FARMA -
    112 TROVENSIS TABLET 4 MG SANBE FARMA -
    113 TROVENSIS TABLET 8 MG SANBE FARMA 710,325.00
    114 URESIX INJ. SANBE FARMA 666,710.00
    115 VALISANBE 2 MG SANBE FARMA -
    116 VALISANBE 5 MG SANBE FARMA -
    117 VALISANBE INJ. 2 ML SANBE FARMA 554,092.00
    118 VERTIGOSAN TABLET SANBE FARMA -
    100,015,181.99

    1 CARMED 10% SDM -


    2 CARMED 20% SDM -
    3 CARMED CREAM 10% SDM -
    4 CARMED CREAM 20% SDM -
    5 MEDSCAB CREAM SDM -
    6 MEDSCAB LOTION SDM -
    7 PIROTOP CREAM 10 MG SDM -

    1 TRIZEDON MR SERVIER -

    1 CURVIT CL EMULSION SYR. SOHO -


    2 CURVIT SYR. 120 ML SOHO -
    3 CURVIT SYR. 60 ML SOHO -
    4 IMBOOST CAPS. SOHO -
    5 IMBOOST FORCE SYR. SOHO -
    6 IMBOOST FORTE CAPS. SOHO -
    7 IMBOOST KIDS SYR. SOHO -
    8 IMBOOST SYR. SOHO -

    1 KENALOG IN ORBASE CREAM SQIBB -

    1 BLOPRES TAB. 16 MG TAKEDA -


    2 BLOPRES TAB. 16 MG PLUS TAKEDA -
    3 BLOPRES TAB. 8 MG TAKEDA -

    1 ARIXTRA INJ. 2.5 MG TANABE ABADI -

    1 DEXTROSE 5% 500 ML WIDATRA -


    2 DEXTROSE 5% 500 ML ( GLUCOSWIDATRA -
    3 RINGER LACTATE 500 ML WIDATRA -
    4 RINGER LACTATE 500 ML WIDATRA -
    5 SOD.CHLORET NATR. 500 ML WIDATRA 4,780,540.60
    6 WATER STERIL / AQUADEST 1 L WIDATRA -
    4,780,540.60

    1 DOGESIC 500 MG YARINDO -


    2 RINDOBION 5000 MG YARINDO -
    1 DAKTARIN DIAPER YUPHARIN -
    2 LAXADIN SYR. 110 ML YUPHARIN -
    3 LAXADIN SYR. 60 ML YUPHARIN -
    SANBE FARMA 100,015,182
    FAHRENHEIT 43,996,762
    PYRIDAM 43,159,216
    EMJEBE 27,319,600
    OTTO 21,505,358
    INTERBAT 14,819,200
    DEXA MEDIKA 14,722,753
    GLAXO 12,264,836
    LANDSON 9,214,919
    KALBE FARMA 7,628,698
    NOVO NORDISK 7,135,000
    ASTRA ZENECA 6,741,616
    LAPI 5,517,600
    WIDATRA 4,780,541
    NOVARTIS 3,797,690
    FERRON 2,085,039
    JANNSEN 1,980,000
    MSD 1,702,332
    OTSUKA 1,665,814
    CENDO 1,074,356
    BERNOFARM 841,500
    ACTAVIS 491,684
    CAPRIFARMINDO 439,890
    PFIZER 406,302
    NICHOLAS 404,250
    1 FACE MASK 3M -
    2 MICROPORE 1/2 " / ISOPORE 1/2 " 3M 185,250.00
    3 MICROPORE 1/2 " / ISOPORE 1/2 " 3M 163,721.88
    4 MICROPORE / PAPER TAPE DISP. 1" 3M -
    5 MICROPORE 1 " / ISOPORE 1 " 3M -
    6 MICROPORE 2 " / ISOPORE 2 " 3M 1,786,400.16
    2,135,372.04

    1 FREESTYLE LANCET KIT @ 100 ABBOT -


    2 FREESTYLE LANCET KIT @ 100 ABBOT 464,640.00
    3 FREESTYLE OPTIUM BG STRIP @ 25 ABBOT -
    1 FREESTYLE OPTIUM NEO BG ( ALAT ) ABBOT -
    4 FREESTYLE OPTIUM NEO H BG @ 100 ABBOT 6,842,800.00
    5 FREESTYLE OPTIUM NEO H BG @ 100 ABBOT -
    6 INFUSION NEEDLE 18 ABBOCATH ABBOT -
    7 INFUSION NEEDLE 20 ABBOCATH ABBOT -
    8 INFUSION NEEDLE 22 ABBOCATH ABBOT -
    9 INFUSION NEEDLE 24 ABBOCATH ABBOT 1,163,212.05
    10 INFUSION NEEDLE 26 ABBOCATH ABBOT -
    8,470,652.05

    1 SCALPEL BLADE BB- 510 AESCULAP -


    2 SCALPEL BLADE BB- 511 AESCULAP -
    3 SCALPEL BLADE BB- 515 AESCULAP -
    4 SCALPEL BLADE BB- 520 AESCULAP -

    1 AGTIFA- IOL POSTERIOR CHAMBER 19 AGTIFA -


    2 AGTIFA- IOL POSTERIOR CHAMBER 19.50 AGTIFA -
    3 AGTIFA- IOL POSTERIOR CHAMBER 20.00 AGTIFA -
    4 AGTIFA- IOL POSTERIOR CHAMBER 20.50 AGTIFA -
    5 AGTIFA- SAFETY CREASENT KNIFE AGTIFA -
    6 AGTIFA- SAFETY SLIT KNIFE AGTIFA -
    7 AGTIFA- SAFETY STAB KNIFE AGTIFA -
    8 AGTIFA- TRYPAN BLUE AGTIFA -
    9 AGTIFA- VISCO AGTIFA -

    1 ALCOHOL SWABS ALTAMED 493,000.00


    2 SURGICAL GLOVE UK. L ALTAMED 1,190,280.00
    3 SURGICAL GLOVE UK. M ALTAMED 7,566,780.00
    4 SURGICAL GLOVE UK. S ALTAMED 3,315,780.00
    5 SURGICAL GLOVE UK. XS ALTAMED -
    6 TABUNG VTM ALTAMED -
    12,565,840.00

    1 INFUSION SET ANAK ( Mikrodrip ) AML-MEDDIS 1,300,750.00


    2 INFUSION SET DEWASA AML-MEDDIS -
    1,300,750.00

    1 RUBBER HAND GLOVE NO. 7 ANSELL -


    2 RUBBER HAND GLOVE NO. 8 ANSELL -
    1 CURVED HAEMODIALYSIS CATH. KIT APPROVED 3,960,000.00

    1 CATGUT CHROMIC 2/0 TP 37 MM 90 CM ATRAMAT -


    2 PPH STAPLER 33 ATRAMAT -

    1 SOFRATULLE AVENTIS -

    1 ALCOHOL SWABS AXIMED -


    2 DISPOSIBLE SYRINGE UK. 1 CC AXIMED -
    3 DISPOSIBLE SYRINGE UK. 10 AXIMED 4,252,870.28
    4 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) AXIMED 176,006.00
    5 DISPOSIBLE SYRINGE UK. 5 AXIMED -
    6 DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) AXIMED -
    7 ENDOTRACHELA TUBE CUFFED 3.5 AXIMED -
    8 ENDOTRACHELA TUBE CUFFED 4.5 AXIMED -
    9 ENDOTRACHELA TUBE CUFFED 6.5 AXIMED -
    10 ENDOTRACHELA TUBE CUFFED 7.0 AXIMED -
    11 ENDOTRACHELA TUBE CUFFED 7.5 AXIMED -
    12 FEEDING TUBE FR. 5 . 100 CM AXIMED -
    13 FEEDING TUBE NO. 8 100 CM AXIMED 38,501.25
    14 FOLLEY CATHETER NO. 18 AXIMED -
    15 GUEDEL AIRWAY CLEAR NO. 3 AXIMED -
    16 INFUSION NEEDLE 18 AXIMED AXIMED -
    17 INFUSION NEEDLE 22 AXIMED AXIMED -
    18 INFUSION NEEDLE 22 AXIMED AXIMED -
    19 INFUSION NEEDLE 24 AXIMED AXIMED -
    20 INFUSION SET ANAK ( Mikrodrip ) AXIMED 510,016.15
    21 INFUSION SET DEWASA AXIMED -
    22 NEBULIZER MASK CHILD WITH CHAMBER AXIMED -
    23 NEBULIZER MASK ADULT WITH CHAMBER AXIMED -
    24 NON WOVEN FIXATION 10 X 10 AXIMED 452,774.49
    25 NON WOVEN FIXATION 15 X 10 AXIMED 700,502.40
    26 SELANG O2 ANAK AXIMED 60,391.89
    27 SELANG O2 DEWASA UK. L AXIMED -
    28 SELANG O2 DEWASA UK. M AXIMED 268,408.40
    29 SELANG O2 DEWASA UK. XS AXIMED -
    30 SUCTION CATHETER NO. 12 AXIMED -
    31 SUCTION CATHETER NO. 14 AXIMED 302,500.00
    32 SUCTION CATHETER NO. 8 AXIMED -
    33 SURGICAL GLOVE UK. L AXIMED -
    34 SURGICAL GLOVE UK. M AXIMED -
    35 SURGICAL GLOVE UK. S AXIMED -
    36 THREE WAY STOPCOCK AXIMED -
    37 ULTRAFIC 10X1000 CM( NON WOVEN FIXATION AXIMED -
    38 URINE BAG AXIMED 66,002.10
    6,827,972.96

    1 INFUSION NEEDLE 18 INTROCAN SAFETY B BRAUN -


    2 INFUSION NEEDLE 18 INTROCAN SAFETY B BRAUN -
    3 INFUSION NEEDLE 20 INTROCAN SAFETY B BRAUN -
    4 INFUSION NEEDLE 22 INTROCAN SAFETY B BRAUN -
    5 INFUSION NEEDLE 24 INTROCAN SAFETY B BRAUN -
    6 DISCOFIX 3 WAY LUER LOCK 10 CM B/BRAUN -
    7 DISCOFIX 3 WAY STOPCOCK BLUE B/BRAUN -
    8 HD ~ DIACAN ARTERIAL G16. 30 MM B/BRAUN -
    9 HD ~ DIACAN ARTERIAL G16. 30 MM B/BRAUN 4,084,080.00
    10 HD ~ DIACAP LOPS 15 PS DIALYSATC B/BRAUN 78,828,750.00
    11 HD ~ DIACAP LOPS 15 PS DIALYSATC B/BRAUN -
    12 HD ~ DIALOG BLOODLINE ARTERIAL B/BRAUN 41,065,200.00
    13 HD ~ DIALOG BLOODLINE ARTERIAL B/BRAUN -
    14 HD ~ HD. CONC. ACIDIC HDM 303 10 LTR. B/BRAUN -
    15 HD ~ HD. CONC. ACIDIC HDM 303 10 LTR. B/BRAUN 23,842,687.00
    16 HD ~ SOL CART B B/BRAUN 36,019,500.00
    17 HD ~ SOL CART B B/BRAUN -
    18 PERFUSOR TUB. WHITE 150 CM B/BRAUN 1,980,000.00
    19 PERFUSOR TUB. WHITE 150 CM B/BRAUN -
    20 RUBBER HAND GLOVE NO. 6,5 B/BRAUN -
    21 SCALPEL BLADE BB- 510 B/BRAUN 495,000.00
    22 SCALPEL BLADE BB- 511 B/BRAUN -
    23 SCALPEL BLADE BB- 515 B/BRAUN -
    24 SCALPEL BLADE BB- 520 B/BRAUN 495,000.00
    25 SCALPEL BLADE BB- 522 B/BRAUN -
    26 SPINOCAN 25G X 3 1/2 " B/BRAUN -
    27 SPINOCAN 26G X 3 1/2 " B/BRAUN -
    28 SPINOCAN 27G X 3 1/2 " B/BRAUN -
    29 CATGUT CHROMIC 0 HR 37 B/BROUND -
    30 CATGUT PLAIN NO. 0 HR 37 B/BROUND -
    31 DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) B/BROUND -
    186,810,217.00

    1 FACE MASK BAYMED -

    1 DISPOSIBLE / NEEDLE 25 G BD -
    2 DISPOSIBLE / NEEDLE 25 G BD -
    3 DISPOSIBLE / NEEDLE 26 G 1/21 TAN BD -
    4 DISPOSIBLE SYRINGE UK. 1 CC BD -
    5 DISPOSIBLE SYRINGE UK. 10 BD -
    6 DISPOSIBLE SYRINGE UK. 3 BD -
    7 DISPOSIBLE SYRINGE UK. 5 BD -
    8 MICRO FINE 8 MM BD -
    9 MICRO FINE 4 MM BD -
    10 MIROTAINER K2 EDTA BD -
    11 MULTIPLE NEEDLE FLASHBACK 22G BD -
    12 ULTRA~FINE 0.23 mm ( 32G ) X 4 mm BD -

    1 GUEDEL AIRWAY 1 ( 70 MM ) BESMED -


    2 GUEDEL AIRWAY 2 ( 70 MM ) BESMED -
    3 GUEDEL AIRWAY 3 ( 90 MM ) BESMED 132,030.00
    4 GUEDEL AIRWAY 4 ( 100 MM ) BESMED 660,150.00
    5 GUEDEL AIRWAY 4 ( 100 MM ) BESMED 20,300.00
    6 GUEDEL AIRWAY 5 ( 100 MM ) BESMED -
    7 GUEDEL AIRWAY 5 ( 110 MM ) BESMED 118,827.00
    8 GUEDEL AIRWAY 0 ( 60 MM ) BESMED -
    9 SELANG O2 DEWASA BESMED 35,750.00
    10 SIMP. MASK NON REBR. M ( DEWASA ) BESMED -
    11 SUNGKUP OXYGEN BAYI BESMED -
    967,057.00

    1 ENDOTRACHELA TUBE CUFFED 3.0 BICAKCILAR -


    2 ENDOTRACHELA TUBE CUFFED 3.5 BICAKCILAR -
    3 ENDOTRACHELA TUBE CUFFED 4.0 BICAKCILAR -
    4 ENDOTRACHELA TUBE CUFFED 5.0 BICAKCILAR 163,625.00
    5 ENDOTRACHELA TUBE CUFFED 5.5 BICAKCILAR -
    6 ENDOTRACHELA TUBE CUFFED 6.5 BICAKCILAR -
    7 ENDOTRACHELA TUBE CUFFED 7.0 BICAKCILAR -
    8 ENDOTRACHELA TUBE CUFFED 7.5 BICAKCILAR -
    9 ENDOTRACHELA UNCUF 2.5 BICAKCILAR -
    10 ENDOTRACHELA UNCUF 3.0 BICAKCILAR -
    11 ENDOTRACHELA WIRE 5 REINFOR BICAKCILAR -
    12 ENDOTRACHELA WIRE 6 REINFOR BICAKCILAR -
    13 ENDOTRACHELA WIRE 6.5 REINFOR BICAKCILAR -
    163,625.00

    1 GLYCO 1 HRS 48 USP, 100 CM BIOMED -


    2 GLYCO 2 HRS 48 USP, 100 CM BIOMED -
    3 GLYCO 2-0 HR 26 USP. 70 CM BIOMED -
    4 GLYCO 3-0 HR 26 USP, 70 CM BIOMED -
    5 GLYCO USP 3-0 DS 24 MM, 70 CM VIOLA BIOMED -
    6 GLYCO 4-0 HR 26 USP. 70 CM BIOMED -

    1 SOFTCLIX STANDART ACCUCHEK BOEHRINGER -

    1 KAPSUL KOSONG NO.00 BRATACO 93,500.00


    2 KAPSUL KOSONG NO.1 BRATACO -
    3 KAPSUL KOSONG NO.3 BRATACO -
    93,500.00

    1 FIXOMULL 76992-01 (10 CM X 5M) BSN -


    2 FIXOMULL 76993-01 ( 5 CM X 5M) BSN -
    3 HYPAFIX 10 CM X 5 CM BSN -
    4 LEUKOMED T PLUS 10 X 25 CM BSN -
    5 LEUKOMED T PLUS 10 X 25 CM BSN -
    6 LEUKOMED T PLUS 8 X 15 CM BSN -
    7 LEUKOMED-IV 72389-00 BSN -
    8 LEUKOPLAST UK. 2,5 x 5 (1624H) BSN -
    9 LEUKOPLAST UK. 4,5 x 5 (1624H) BSN -
    -

    1 SELANG O2 DEWASA BURBLE 990,000.00


    2 INFUSION NEEDLE 18 CATHPRO CATH PRO 425,920.00
    3 INFUSION NEEDLE 20 CATHPRO CATH PRO 851,840.00
    4 INFUSION NEEDLE 22 CATHPRO CATH PRO 1,277,760.00
    5 INFUSION NEEDLE 24 CATHPRO CATH PRO -
    3,545,520.00

    1 KASA HYDROPHYL 40 Yard X 80 CM CIPTA NIAGA -

    1 GELANG BAYI / ANAK BIRU COSMMOMED 114,840.00


    2 GELANG Adult ( PINK ) WRITE ON COSMOMED -
    3 GELANG BAYI / ANAK PINK COSMOMED 95,700.00
    4 SUCTION CATHETER NO. 12 COSMOMED -
    5 SUCTION CATHETER NO. 12 COSMOMED -
    6 SUCTION CATHETER NO. 16 COSMOMED -
    7 SUNGKUP OXYGEN DEWASA COSMOMED -
    8 FEEDING TUBE NO. 8 40 CM COSMOMRD -
    210,540.00

    1 LINA PEN ( PENSIL WHOLSTER ) COVIDEN -

    1 PARAFILM 4" 125 FTM CUP WOOD -

    1 KARTU GOLONGAN DARAH DALF 291,500.00


    2 KARTU GOLONGAN DARAH FREE DALF -
    291,500.00

    1 DARYANTULLE DARYA VARYA -


    2 FRAMYCETIN SULFATE DARYA VARYA 1,122,000.00
    1,122,000.00

    1 KASA HYDROPHYL 40 Yard X 80 CM DRC -

    1 SPINOCAN 25G X 3 1/2 " EGEMEN -


    2 SPINOCAN 26G X 3 1/2 " EGEMEN -
    3 SPINOCAN / SPINAL 25G X 3 1/2 " EGEMEN -
    4 SPINOCAN / SPINAL 26G X 3 1/2 " EGEMEN -

    1 VICRYL RAP UND 90 CM 2/0 ETHICON -

    1 GUEDEL AIRWAY 3 ( 90 MM ) FORSCH 121,000.00


    2 GUEDEL AIRWAY 4 ( 100 MM ) FORSCH 121,000.00
    3 GUEDEL AIRWAY 5 ( 110 MM ) FORSCH 121,000.00
    363,000.00

    1 FILM X RAY 24 X 30 FUJI -


    2 FILM X RAY 30 X 40 FUJI -
    3 FILM X RAY 30 X 40 FUJI -
    4 FILM X RAY 35 X 35 FUJI -
    5 FILM X RAY 35 X 35 FUJI -
    6 FILM X RAY 35 X 43 FUJI -
    7 FILM X RAY 35 X 43 FUJI -

    1 RUBBER HAND GLOVE NO. 8 GAMMEX -

    1 GELANG BAYI / ANAK BIRU GC -


    2 GELANG BAYI / ANAK PINK GC 264,000.00
    264,000.00

    1 BLOOD TRANFUSION SET GEA -


    2 INFUSION NEEDLE 20 INFLO GEA -
    3 INFUSION NEEDLE 20 GEA GEA -
    4 INFUSION NEEDLE 20 STERACATH GEA 880,000.00
    5 INFUSION NEEDLE 22 GEA GEA 1,320,000.00
    6 INFUSION NEEDLE 24 GEA GEA 880,000.00
    7 INFUSION NEEDLE 26 AXIMED GEA -
    8 NEBULIZER MASK ADULT WITH CHAMBER GEA 35,200.00
    9 NEBULIZER MASK CHILD GEA 20,444.00
    10 SCALPEL BLADE BB- 510 GEA -
    11 SCALPEL BLADE BB- 511 GEA -
    12 SCALPEL BLADE BB- 515 GEA -
    13 SCALPEL BLADE BB- 520 GEA -
    14 SCALPEL BLADE BB- 522 GEA -
    15 SELANG O2 BAYI GEA -
    16 SIMP. MASK NON REBR. M ( DEWASA ) GEA -
    3,135,644.00

    1 URINE BAG GETINGE -

    1 SURGICAL GLOVE UK. L HAND SEAL -


    2 SURGICAL GLOVE UK. M HAND SEAL -

    1 KASA HYDROPHYL 40 Yard X 80 CM HEXA HUSADA -


    2 KASA KOMPRES STERIL 16 X16 HEXA HUSADA -

    1 GYNECOLOGY SET GNS-2109 HOGY -


    2 HOGI ~ SHOE COVER SR-SC-41E HOGY -
    3 HOGI ~ SURG. GOWN ( L ) SG-SMS13K HOGY -
    4 HOGI ~ SURG. GOWN ( XL ) SG-SMS15K HOGY -
    5 HOGI ~ UNIVERSAL SET USP-2101 HOGY -

    1 CUP SAMPLE @ 1000 HUMAN 3,484,800.00

    1 ENDOTRACHELA UNCUF 2.5 IDEALCARE 188,760.00


    2 ENDOTRACHELA UNCUF 3.0 IDEALCARE 251,680.00
    3 ENDOTRACHELA UNCUF 3,5 IDEALCARE 251,680.00
    4 ENDOTRACHELA UNCUF 4,0 IDEALCARE 314,600.00
    1,006,720.00

    1 INFUSION NEEDLE 18 OPTIVA JOHNSON -


    2 INFUSION NEEDLE 2 22G OPTIVA JOHNSON -
    3 INFUSION NEEDLE 20 OPTIVA JOHNSON -
    4 INFUSION NEEDLE 22 OPTIVA JOHNSON -
    5 INFUSION NEEDLE 24 OPTIVA JOHNSON -

    1 DISPOSIBLE SYRINGE UK. 3 KIMSMED 1,725,460.00

    1 KAPSUL KOSONG NO.0 LOKAL 60,000.00


    2 KAPSUL KOSONG NO.00 LOKAL -
    3 KAPSUL KOSONG NO.2 LOKAL -
    4 KAPSUL KOSONG NO.2 LOKAL -
    5 KAPSUL KOSONG NO.3 LOKAL -
    6 POT ZALF 100 GR LOKAL -
    7 POT ZALF 20 GR LOKAL -
    8 POT ZALF 20 GR LOKAL -
    9 POT ZALF 30 GR LOKAL -
    10 POT ZALF 50 GR LOKAL 112,200.00
    11 POT ZALF 50 GR LOKAL 32,240.00
    12 POT ZALF 50 GR LOKAL 19,741.00
    13 MOUTH PIECE 2.5 CM LOKAL -
    224,181.00

    1 BAJU OPERASI ( KIT CESAREAN ) MAESINDO -

    1 RUBBER HAND GLOVE NO. 6,5 MAXTER 456,500.00


    2 RUBBER HAND GLOVE NO. 7 MAXTER 1,858,800.00
    3 RUBBER HAND GLOVE NO. 7,5 MAXTER -
    4 RUBBER HAND GLOVE NO. 7,5 MAXTER 464,700.00
    5 RUBBER HAND GLOVE NO. 8 MAXTER -
    2,780,000.00

    1 PRECISION INFANT THERMAL BLUE MEXICO -


    2 PRECISION INFANT THERMAL PINK MEXICO -

    1 INJECTIONN PAD 36 MM NICHIBAN -

    1 BLOOD TRANFUSION SET NIPRO -


    2 DISPOSIBLE SYRINGE UK. 1 CC NIPRO -
    3 DISPOSIBLE SYRINGE UK. 10 NIPRO -
    4 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) NIPRO -
    5 DISPOSIBLE SYRINGE UK. 5 NIPRO -
    6 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) NIPRO -
    7 INFUSION NEEDLE 18 NIPRO NIPRO -
    8 INFUSION NEEDLE 20 NIPRO NIPRO -
    9 INFUSION NEEDLE 22 NIPRO NIPRO -
    10 INFUSION NEEDLE 24 NIPRO NIPRO -

    1 FOLLEY CATHETER NO. 14 NORTA 75,900.00


    2 FOLLEY CATHETER NO. 18 NORTA 990,000.00
    3 FOLLEY CATHETER THREE WAY 22 NORTA 1,065,900.00
    2,131,800.00

    1 NOVOTWIST 32 G NOVONORDISK -
    2 NOVOTWIST 32 G NOVONORDISK -

    1 ALCOHOL SWABS ONE MED 138,600.00


    2 DISPOSIBLE / NEEDLE 26 G ONE MED -
    3 DISPOSIBLE SYRINGE UK. 1 CC ONE MED 1,975,050.00
    4 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONE MED -
    5 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONE MED -
    6 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONE MED 312,180.00
    7 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) ONE MED 165,600.00
    8 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) ONE MED -
    9 STOMACH TUBE NO.16 ONE MED 235,799.00
    10 SUCTION CATHETER NO. 12 ONE MED -
    11 SUCTION CATHETER NO. 16 ONE MED -
    12 SUCTION CATHETER NO. 8 ONE MED -
    13 SUCTION CATHETER NO. 8 ONE MED -
    14 SUNGKUP OXYGEN ANAK ONE MED -
    15 SUNGKUP OXYGEN DEWASA ONE MED 99,225.00
    16 SURGICAL GLOVE UK. L ONE MED -
    17 TERMAL PAPER UTK. ECG 215 MM X 25 M ONE MED 176,400.00
    18 THREE WAY STOPCOCK ONE MED 495,000.00
    19 THREE WAY STOPCOCK ONE MED 511,875.00
    20 ULTRAFIC 10 CM X 500 CM ONE MED 192,500.00
    21 ULTRAFIC 15 CM X 500 CM ONE MED -
    22 ULTRAFIC 5 CM X 500 CM ONE MED -
    23 UMBILICAL KLAMP ONE MED 104,500.00
    24 UMBILICAL KLAMP ONE MED 211,750.00
    25 UMBILICAL KLAMP ONE MED 247,500.00
    26 URINE BAG ONE MED 460,152.00
    27 APRON ONEMED -
    28 BANDANA CAP GREEN ONEMED -
    29 BANDANA CAP GREEN ONEMED -
    30 BANDANA CAP GREEN ONEMED -
    31 BANDANA CAP ONEMED 258,500.00
    32 CORE ELECTRODE 2670 ONEMED 1,270,500.00
    33 CORE ELECTRODE 2670 ONEMED 242,000.00
    34 CORE ELECTRODE 2670 ONEMED 264,000.00
    35 DERMAFIX 10 X 25 CM ONEMED 1,335,000.00
    36 DERMAFIX 10 X 25 CM ONEMED 781,660.00
    37 DISPOSIBLE / NEEDLE 25 G ONEMED -
    38 DISPOSIBLE SYRINGE UK. 10 ONEMED 1,752,300.00
    39 DISPOSIBLE SYRINGE UK. 10 ONEMED -
    40 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONEMED -
    41 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) ONEMED 97,500.00
    42 DISPOSIBLE SYRINGE UK. 3 ONEMED 2,904,000.00
    43 DISPOSIBLE SYRINGE UK. 3 ONEMED 1,112,925.00
    44 DISPOSIBLE SYRINGE UK. 3 ONEMED 3,126,750.00
    45 DISPOSIBLE SYRINGE UK. 3 ONEMED -
    46 DISPOSIBLE SYRINGE UK. 5 ONEMED 2,567,565.00
    47 DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) ONEMED -
    48 DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) ONEMED 434,000.00
    49 FACE MASK ONEMED -
    50 FACE MASK ONEMED 708,000.00
    51 FEEDING TUBE FR. 5 . 100 CM ONEMED 8,039.00
    52 FEEDING TUBE FR. 5 . 100 CM ONEMED 26,000.00
    53 FEEDING TUBE FR. 5 . 40 CM ONEMED -
    54 FEEDING TUBE NO. 8 100 CM ONEMED -
    55 FEEDING TUBE NO. 8 40 CM ONEMED 39,000.00
    56 FOLLEY CATHETER NO. 16 ONEMED 231,000.00
    57 FOLLEY CATHETER NO. 18 ONEMED 369,600.00
    58 FOLLEY CATHETER NO. 18 ONEMED -
    59 GELANG Adult ( PINK ) WRITE ON ONEMED -
    60 GELANG Adult ( PINK ) WRITE ON ONEMED 264,000.00
    61 GELANG Adult BLUE (Write On) ONEMED 227,700.00
    62 GELANG Adult YELLOW (Insert Card) ONEMED 264,000.00
    63 GELANG BAYI / ANAK BIRU ONEMED 133,650.00
    64 GELANG BAYI / ANAK BIRU ONEMED -
    65 GELANG BAYI / ANAK PINK ONEMED 267,300.00
    66 GUEDEL AIRWAY CLEAR NO. 4 ONEMED -
    67 GUEDEL AIRWAY CLEAR NO. 5 ONEMED -
    68 INFUSION NEEDLE 18 INFLO ONEMED -
    69 INFUSION NEEDLE 20 INFLO ONEMED -
    70 INFUSION NEEDLE 20 INFLO ONEMED -
    71 INFUSION NEEDLE 20 INFLO ONEMED -
    72 INFUSION NEEDLE 22 INFLO ONEMED 721,875.00
    73 INFUSION NEEDLE 24 INFLO ONEMED 288,750.00
    74 INFUSION NEEDLE 24 INFLO ONEMED -
    75 INFUSION NEEDLE 26 INFLO ONEMED 226,875.00
    76 INFUSION SET ANAK ( Mikrodrip ) ONEMED 412,500.00
    77 INFUSION SET DEWASA ONEMED -
    78 INFUSION SET DEWASA ONEMED 1,560,487.50
    79 KASA HYDROPHYL 40 Yard X 80 CM ONEMED 2,835,000.00
    80 KASA KOMPRES STERIL 16 X16 ONEMED -
    81 MEDICRAPE 10 X 4.5 ONEMED 22,968.00
    82 MEDICRAPE 10 X 4.5 ONEMED -
    83 MEDICRAPE 15 X 4.5 ONEMED 33,660.00
    84 MEDICRAPE 15 X 4.5 ONEMED -
    85 MEDICRAPE 7.5 X 4.5 ONEMED -
    86 MEDICRAPE 7.5 X 4.5 ONEMED 41,140.00
    87 MICRO FINE 0.25mm (31G) x 5mm ONEMED -
    88 MICROPORE 1/2 " / ISOPORE 1/2 " ONEMED 69,600.00
    89 MICROPORE 2 " / ISOPORE 2 " ONEMED 571,312.50
    90 NEBULIZER MASK ADULT WITH CHAMBER ONEMED -
    91 PLESTERAN BULAT @ 200 ONEMED -
    92 PLESTERAN BULAT SOFT @ 200 ONEMED -
    93 SELANG O2 ANAK ONEMED -
    94 SELANG O2 ANAK ONEMED -
    95 SELANG O2 ANAK ONEMED 88,000.00
    96 SELANG O2 ANAK ONEMED -
    97 SELANG O2 BAYI ONEMED -
    98 SELANG O2 DEWASA ONEMED -
    99 SHOES COVER NON WOVEN ONEMED -
    100 SHOES COVER NON WOVEN ONEMED -
    101 SHOES COVER NON WOVEN ONEMED -
    102 SIMP. MASK NON REBR. M ( DEWASA ) ONEMED 869,400.00
    103 SIMP. MASK NON REBR. S ( ANAK ) ONEMED -
    104 STOMACH TUBE NO.16 ONEMED 66,000.00
    105 STOMACH TUBE NO.18 ONEMED 8,131.00
    106 STOMACH TUBE NO.18 ONEMED -
    107 SUNGKUP OXYGEN BAYI ONEMED 52,800.00
    108 SUNGKUP OXYGEN DEWASA ONEMED -
    31,879,619.00

    1 INFUSION NEEDLE 20 OTCUCATH OTSUKA -


    2 INFUSION NEEDLE 22 OTCUCATH OTSUKA -
    3 INFUSION NEEDLE 24 OTCUCATH OTSUKA -
    4 INFUSION SET DEWASA OTSUKA -

    1 PHARMAFIX 5 CM X 5 MTR PHARMAPLAST 691,900.00

    1 COMBO KATETERISASI 16 PRO DIVICE -


    2 COMBO KATETERISASI 18 PRO DIVICE -
    3 COMBO PACK 24+SPALK (makro) PRO DIVICE -
    4 COMBO PACK BS 18 PRO DIVICE -
    5 COMBO PACK BS 20 PRO DIVICE -
    6 COMBO PACK NPNW 20 GSTC PRO DIVICE -
    7 COMBO PACK NPNW 22 GSTC PRO DIVICE -
    8 LINA PEN SINGLE USE 516 PRO DIVICE -
    9 LOMATULE PRO DIVICE -

    1 SURGICAL GLOVE UK. L PUREGLOVE -


    2 SURGICAL GLOVE UK. L PUREGLOVE -
    3 SURGICAL GLOVE UK. M PUREGLOVE -
    4 SURGICAL GLOVE UK. S PUREGLOVE 1,936,000.00

    1 ALCOHOL SWABS REMEDI -


    2 ENDOTRACHELA TUBE CUFFED 3.0 REMEDI -
    3 ENDOTRACHELA TUBE CUFFED 3.5 REMEDI -
    4 ENDOTRACHELA TUBE CUFFED 4.5 REMEDI -
    5 ENDOTRACHELA TUBE CUFFED 6.0 REMEDI -
    6 FOLLEY CATHETER THREE WAY 18 REMEDI 229,900.00
    7 FOLLEY CATHETER THREE WAY 24 REMEDI 86,020.00
    8 GELANG Adult BLUE (Write On) REMEDI 132,000.00
    9 GELANG Adult RED (Insert Card) REMEDI 13,366.00
    10 GELANG Adult UNGGU (Insert Card) REMEDI 6,683.00
    11 GELANG Adult YELLOW (Insert Card) REMEDI -
    12 RUBBER HAND GLOVE NO. 6,5 REMEDI -
    13 RUBBER HAND GLOVE NO. 7,5 REMEDI -
    14 SHOES COVER GREEN REMEDI -
    15 SIMP. MASK NON REBR. S ( ANAK ) REMEDI 275,000.00
    16 SUCTION CATHETER NO. 12 REMEDI -
    17 SUCTION CATHETER NO. 14 REMEDI -
    18 SUCTION CATHETER NO. 16 REMEDI -
    19 SURGICAL GLOVE UK. S REMEDI -
    2 SELANG O2 ANAK RHEMEDY 66,000.00
    3 SUCTION CATHETER NO. 8 RHEMEDY 550,000.00
    4 SUNGKUP OXYGEN ANAK RHEMEDY -
    5 SUNGKUP OXYGEN ANAK RHEMEDY 105,600.00
    1,464,569.00

    1 ENDOTRACHELA TUBE CUFFED 6.0 RESOURCES -

    1 SOFTCLIX LANCET UNO 200 ROCHE -

    1 ENDOTRACHELA TUBE CUFFED 2.5 RUSCH -


    2 ENDOTRACHELA TUBE CUFFED 4.0 RUSCH -
    3 ENDOTRACHELA TUBE CUFFED 5.5 RUSCH -
    4 ENDOTRACHELA TUBE CUFFED 8.0 RUSCH -
    5 ENDOTRACHELA TUBE CUFFED 8.0 RUSCH -
    6 ENDOTRACHELA TUBE CUFFED 8.0 RUSCH -
    7 FOLLEY CATHETER NO. 14 RUSCH -
    8 FOLLEY CATHETER NO. 16 RUSCH -
    9 FOLLEY CATHETER NO. 18 RUSCH -
    10 FOLLEY CATHETER NO. 20 RUSCH -
    11 FOLLEY CATHETER THREE WAY 20 RUSCH -
    12 GUEDEL AIRWAY CLEAR NO. 1 RUSCH -
    13 GUEDEL AIRWAY CLEAR NO. 3 RUSCH -
    14 GUEDEL AIRWAY CLEAR NO. 4 RUSCH -
    15 GUEDEL AIRWAY CLEAR NO. 6 RUSCH -
    16 GUEDEL RED NO. 0 RUSCH -
    17 GUEDEL RED NO. 1 RUSCH -
    18 GUEDEL RED NO. 3 RUSCH -
    19 GUEDEL RED NO. 4 RUSCH -
    20 GUEDEL RED NO. 5 RUSCH -

    1 SURGICAL GLOVE UK. M SAFEGLOVE 7,568,202.00


    2 SURGICAL GLOVE UK. S SAFEGLOVE 8,727,296.00
    16,295,498.00

    1 FACE MASK SENSI -


    2 SENSIPED ALAS POPOK L SENSI -

    1 FACE MASK SEVEN -


    1 RUBBER HAND GLOVE NO. 6,5 SHAMROCK -
    2 RUBBER HAND GLOVE NO. 7 SHAMROCK 456,500.00
    3 RUBBER HAND GLOVE NO. 7,5 SHAMROCK -
    4 RUBBER HAND GLOVE NO. 8 SHAMROCK -
    5 SURGICAL GLOVE UK. M SHAMROCK -
    456,500.00

    1 GUEDEL NO. 00 SHILEY -

    1 TABUNG VTM SIGPRO 2,420,000.00

    1 BANDANA CAP GREEN @ 100 SINAR OGAN -


    2 FACE MASK TALI PREMIUM SINAR OGAN 2,819,976.50
    3 FACE MASK TALI HIJAP PREMIUM SINAR OGAN -

    1 BAJU OPERASI ( KIT CESAREAN ) SMI 4,158,000.00


    2 CATGUT CHROMIC 2/0 HR 37 MM SMI -
    3 CATGUT PLAIN NO. 2/0 HR 37 SMI -
    4 ENDOTRACHELA TUBE CUFFED 6.0 SMI 64,561.20
    5 ENDOTRACHELA UNCUF 4,0 SMI -
    6 ENDOTRACHELA WIRE 5 REINFOR SMI -
    7 ENDOTRACHELA WIRE 6 REINFOR SMI -
    8 ENDOTRACHELA WIRE 6.5 REINFOR SMI -
    9 SURGICRYL 910 1 HR 48 MM SMI 915,864.00
    10 SURGICRYL 910 2 HR 45 MM SMI -
    11 SURGICRYL 910 2 HR 48 MM SMI -
    12 SURGICRYL 910 3/0 HR 26 MM SMI -
    13 SURGICRYL 910 2/0 HR 40 MM SMI 990,000.00
    14 SURGICRYL 910 3/0 DS 24 MM SMI -
    15 SURGICRYL 910 2/0 HR 26 MM SMI -
    16 SURGICRYL 910 4/0 HR 17 MM SMI -
    17 SURGICRYL 910 5/0 HR 17 MM SMI -
    18 VASELIN SWAB 10 X 10 SMI -
    6,128,425.20

    1 BAJU OPERASI ( UNIVERSAL SET ) SOLIDA 837,980.00


    2 BANDANA CAP GREEN SOLIDA -

    1 FACE MASK EARLOOP SOLMED 2,278,428.48

    1 TERMAL PAPER UTK. ECG 215 MM X 25 M SONOMED 1,430,000.00

    1 PAPER USG 110 HG TYPE V SONY 2,750,000.00


    2 PAPER USG 110 HG TYPE V SONY 495,000.00
    3,245,000.00

    1 INFUSION SET ANAK ( Mikrodrip ) STERA 253,000.00


    2 INFUSION SET DEWASA STERA -
    3 BLOOD TRANFUSION SET STERRA 2,598,500.00
    4 DISPOSIBLE SYRINGE UK. 1 CC STERRA -
    5 DISPOSIBLE SYRINGE UK. 10 STERRA 2,145,000.00
    6 DISPOSIBLE SYRINGE UK. 3 STERRA -
    7 DISPOSIBLE SYRINGE UK. 5 STERRA 1,716,000.00
    8 INFUSION NEEDLE 18 STERACATH STERRA 957,600.00
    9 INFUSION NEEDLE 18 STERACATH STERRA -
    10 INFUSION NEEDLE 20 STERACATH STERRA 997,500.00
    11 INFUSION NEEDLE 22 STERACATH STERRA 418,950.00
    12 INFUSION NEEDLE 24 STERACATH STERRA -
    13 INFUSION NEEDLE 26 NIPRO STERRA -
    14 INFUSION NEEDLE 26 STERACATH STERRA -
    15 SUCTION CATHETER NO. 8 STERRA -
    9,086,550.00

    1 TRACHEOSTOMY CUFFED 6.5 SURGIKA -

    1 BLOOD TRANFUSION SET TERUMO -


    2 DISPOSIBLE SYRINGE UK. 1 CC TERUMO -
    3 DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) TERUMO -
    4 DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) TERUMO -
    5 DISPOSIBLE SYRINGE UK. 5 TERUMO -
    6 FEEDING TUBE FR. 5 . 100 CM TERUMO 211,750.00
    7 FEEDING TUBE FR. 5 . 40 CM TERUMO -
    8 FEEDING TUBE FR. 5 . 40 CM TERUMO 211,750.00
    9 FEEDING TUBE NO. 3,5 35 CM TERUMO -
    10 FEEDING TUBE NO. 8 100 CM TERUMO -
    11 FEEDING TUBE NO. 8 100 CM TERUMO -
    12 FEEDING TUBE NO. 8 40 CM TERUMO 38,623.20
    13 INFUSION NEEDLE 18 SURFLO TERUMO -
    14 INFUSION NEEDLE 20 SURFLO TERUMO -
    15 INFUSION NEEDLE 22 SURFLO TERUMO -
    16 INFUSION NEEDLE 24 SURFLO TERUMO -
    17 INFUSION NEEDLE 26 SURFLO TERUMO -
    18 INFUSION SET ANAK ( Mikrodrip ) TERUMO 154,000.00
    19 MICROBURET ( MICRODRIP FOR ST503 ) TERUMO -
    20 NANOPASS 32. 5G TERUMO -
    21 STOMACH TUBE NO.16 TERUMO 335,500.00
    22 STOMACH TUBE NO.18 TERUMO -
    23 STOMACH TUBE NO.18 TERUMO -
    24 UROGARD PLUS TERUMO -
    951,623.20

    1 RUBBER HAND GLOVE NO. 6,0 TROGE -


    2 RUBBER HAND GLOVE NO. 6,5 TROGE 1,258,950.00
    3 RUBBER HAND GLOVE NO. 7 TROGE 2,517,900.00
    4 RUBBER HAND GLOVE NO. 7,5 TROGE 1,258,950.00
    5 RUBBER HAND GLOVE NO. 8 TROGE 419,650.00
    6 URINE BAG TROGE 796,950.00
    6,252,400.00
    1 FOLLEY CATHETER NO. 14 WELL LEAD -

    1 FILM ISLAND DRESSING 10X25CM ( dermafik ) WINNER -

    1 THERASORB 10 X10 CM X 0.5 CM WONBIOGEN -


    2 THERASORB C 10 X10 CM X 0.5 CM WONBIOGEN -

    1 RUBBER HAND GLOVE NO. 7 WRP -


    2 RUBBER HAND GLOVE NO. 8 WRP -

    1 EXTENDED UFE PH TRANSFER XXX -

    1 SURGI-FIX 10 CM X 10 MTR YAFHO -


    2 SURGI-FIX 5 CM X 10 MTR YAFHO -
    3 TRANSFIX HF 10 CM X 10 MTR YAFHO -
    4 TRANSFIX HF 5 CM X 10 MTR YAFHO -
    B/BROUND 186,810,217
    ONEMED 31,879,619
    SAFEGLOVE 16,295,498
    ALTAMED 12,565,840
    STERRA 9,086,550
    ABBOT 8,470,652
    AXIMED 6,827,973
    TROGE 6,252,400
    SMI 6,128,425
    APPROVED 3,960,000
    CATH PRO 3,545,520
    HUMAN 3,484,800
    SONY 3,245,000
    GEA 3,135,644
    SINAR OGAN 2,819,977
    MAXTER 2,780,000
    SIGPRO 2,420,000
    SOLMED 2,278,428
    3M 2,135,372
    NORTA 2,131,800
    PUREGLOVE 1,936,000
    KIMSMED 1,725,460
    REMEDI 1,464,569
    SONOMED 1,430,000
    AML-MEDDIS 1,300,750
    DARYA VARYA 1,122,000
    IDEALCARE 1,006,720
    BESMED 967,057
    TERUMO 951,623
    SOLIDA 837,980
    PHARMAPLAST 691,900
    SHAMROCK 456,500
    FORSCH 363,000
    DALF 291,500
    GC 264,000
    LOKAL 224,181
    COSMOMED 210,540
    BICAKCILAR 163,625
    BRATACO 93,500
    RAPID TEST COVID-19 ABBOT -

    ANTI HBS ACON -


    HBs AB @ 40 TEST ACON -
    PP TEST ACON -

    SAR-COV-2 ANTIGEN ALTAMED 57,273,750.00

    HBs AB / ANTI HBS ANSWER -


    HCG TEST ANSWER -
    HCG strip ANSWER -
    HCV DIVICE ANSWER -
    HIV CARD @ 25 ANSWER -
    MULTIDRUG 6 PARAMETER ANSWER -

    CHOLESTEROL STIK AUTO CHECK -

    TRICARB C 50 B/BRAUN -

    CHLORHEXIDINE 4% BAYMED -

    VENTY UNNALYSIS BIOCOMMA -


    VIRUS TRANSPORT MEDIA @50 BIOCOMMA -

    SAR-COV-2 ANTIGEN BIOSENSOR -


    SAR-COV-2 ANTIGEN BIOSENSOR -

    SALMONELLA PARATYPHI A - O BIOTECH -


    SALMONELLA TYPHI - O BIOTECH -
    TUBEX TF @ 36 TEST IDL BIOTECH -

    CITRIC ACID MONOHYDRATE @ 25 KG BRATACO -


    GLYCERINE 1000 ML BRATACO 70,000.00
    GLYCERINE 500 ML BRATACO -
    70,000.00

    FIRST AID 1 LTR BSN -

    ETHYLCHLORET SPRY CHLOREEHYL -

    RAPID TEST ANTI BODY CLUNGENE 23,500,000.00


    SAR-COV-2 ANTIGEN CLUNGENE -
    RAPID TEST COVID-19 CLUNGENE -
    SAR-COV-2 ANTIGEN CLUNGENE 26,000,000.00
    SAR-COV-2 ANTIGEN CLUNGENE 1,830,000.00
    SAR-COV-2 ANTIGEN CLUNGENE 6,250,000.00
    57,580,000.00

    HANDSANITIZER 500 ML COSMOMED -

    SALMONELLA PARATYPHI A - O DALF 242,000.00


    SALMONELLA PARATYPHI B - O DALF 242,000.00
    SALMONELLA PARATYPHI C - O DALF 242,000.00
    SALMONELLA TYPHI - B - O DALF -
    SALMONELLA TYPHI - H DALF 242,000.00
    SALMONELLA TYPHI - O DALF 242,000.00
    SALMONELLA TYPHI A - H DALF 242,000.00
    SALMONELLA TYPHI B - H DALF 242,000.00
    SALMONELLA TYPHI C - H DALF 242,000.00
    SERUM GOL. DARAH ANTI A DALF 316,800.00
    SERUM GOL. DARAH ANTI AB DALF 316,800.00
    SERUM GOL. DARAH ANTI B DALF -
    SERUM GOL. DARAH ANTI B DALF 316,800.00
    SERUM GOL. DARAH ANTI D DALF 316,800.00
    SERUM GOL. DARAH ANTI D DALF -
    3,203,200.00

    DILUENT (10) DIRUI BCC-300 -


    REAGENT PACK K-LYTE DIRUI BCC-300 -

    EXTRAN 2.5 L E MERCK -


    IMMERSION OIL 100 ML E MERCK -
    IMMERSION OIL 500 ML E MERCK -

    DETRO OPA ENDO -


    DETRO ENZYM ENDO -

    LQ SUPRA @ 4 X 5 LTR EPRO STEWART -

    CIDEX OPA SOLUTION 5 LITER ETHICON -


    CIDEZYME 5 LITER ETHICON -

    RAPID TEST COVID-19 FEMOMETER -

    SALMONELLA PARATYPHI A - O FORTRESS -

    DEVELOPER FUJI -
    DEVELOPER FUJI -
    FIXER FUJI -

    NATRIUM CITRATE 500 ML GD -

    REAGENT HEMATOLOGI GENIO -

    BLUE TIP @ 1000 GILSON 1,740,750.00

    SERUM GOL. DARAH ANTI A GLORY -


    SERUM GOL. DARAH ANTI AB GLORY -
    SERUM GOL. DARAH ANTI B GLORY -
    SERUM GOL. DARAH ANTI D GLORY -
    HBs Ag STRIPS GLRY -
    DENGUE DUO CASSETE (igG&IgM) GLY 6,072,000.00
    DENGUE EARLY RAFID (NS1) GLY 5,693,600.00
    11,765,600.00

    X-TRAGENE @ 5 LTR GRAHA FARMA -

    LITHIUM HEPARIN 3 ML @ 100 GREINERBIO 532,400.00

    DENTAL X - RAY FILM HANSIN -

    X RAY FILM DENTAL HATELA -

    CHOLESTEROL 10028 HUMAN 2,631,200.00


    COMBINA 11's HUMAN -
    CREATININE 10051 HUMAN 1,289,200.00
    EOSIN 2% 500 ML HUMAN -
    GLUCOSE 10260 HUMAN -
    HDL CHOLESTEROL 10018 HUMAN -
    HUMATROL N 13511 HUMAN -
    SALMONELLA TYPHI - H HUMAN -
    SALMONELLA TYPHI - O HUMAN -
    SALMONELLA TYPHI A - H HUMAN -
    SGOT 12011 HUMAN 1,806,200.00
    SGPT 12012 HUMAN 1,806,200.00
    SODIUM CITRATE 3,2% 500 ML HUMAN -
    STIK URINE ANALYZER BA600 HUMAN -
    TOTAL PROTEIN 157004 HUMAN -
    TRIGLYCERIDES 10724 HUMAN 5,012,700.00
    UREA 10505 HUMAN 1,738,000.00
    URIC ACID 10691 HUMAN 5,047,900.00
    URINE 10 PARAMETER DUS HUMAN -
    SERUM GOL. DARAH 1 SET ( A,B,AB & D HUMAN -
    19,331,400.00

    ASAM SULFOSALICYLATE 20 % INDOREAGEN -


    EOSIN 2% 100 ML INDOREAGEN -
    GIEMSA 250 ML INDOREAGEN -
    METHANOL 500 ML INDOREAGEN -
    SODIUM CITRATE 3,8 INDOREAGEN -

    HBs Ab @ 25 TEST INT -


    HBs Ag @ 30 TEST INT -
    DRUG TESTCARD @ 20 INTEC -
    HIV @ 40 TEST INTEC -

    K3 EDTA ( PC ) UNGU 3 ml ITM 3,762,000.00

    TEST MALARIA J. MITRA -

    1 IODINE POVIDONE 1000 ML KF ( G ) 440,642.40


    2 IODINE POVIDONE 60 ML KF ( G ) -
    3 IODINE POVIDONE 60 ML KF ( G ) 12,751.20
    4 IODINE POVIDONE 30 ML KF ( G ) -
    453,393.60

    DISPOSIBLE VIRUS SAMLING (VTM) LOKAL -

    NATRIUM CITRATE 3,8 MBF -

    1 ALCOHOL 70% 1 LITER MEDIKA 124,207.74


    2 ALCOHOL 95% 1 LITER MEDIKA -
    124,207.74

    GIEMSA 500 ML MERCK -

    HBs Ag STRIPS MONO -


    HCV TEST @ 40 MONO -
    TEST NARKOBA ( 3 PARAMETER ) MONO -
    ANTI HCV MONOTES -

    HbA 1C TEST NYCOCARD NYCOCARD -


    HbA 1C TEST NYCOCARD @ 24 TEST NYCOCARD -

    1 ASEPTAN ( anti septik ) @ 5000 ML ONE MED -


    2 ASEPTAN ( anti septik ) @ 500 ML ONE MED 777,000.00
    3 ASEPTIC GEL @ 500 ML ONE MED 1,168,500.00
    4 ASEPTIC GEL @ 500 ML ONE MED -
    5 ASEPTIC GEL @ 5000 ML ONE MED 432,000.00
    6 GEL UNTUK ECG 250 ML ONE MED -
    7 GEL UNTUK ECG 5000 ML ONE MED 170,500.00
    8 ODEX 5 LITER ONE MED 1,320,000.00
    9 ONESCRUB 5 LTR ONE MED -
    10 PERHYDROL 3% (800 Ml) H2O2 ONE MED -
    3,868,000.00

    HBs AG CARD @ 25 onsite 943,800.00


    HIV CARD onsite 15,427,500.00
    16,371,300.00

    DENGUE DUO CASSETE (igG&IgM) ORIENT GENE 2,860,000.00


    DENGUE EARLY RAFID (NS1) ORIENT GENE 2,455,200.00
    5,315,200.00

    PD SCRUB 5 LITER PRO DIVICE -


    TABUNG CENTRIFUGE 10 ML PYREX -
    TABUNG REAKSI 12 X 75 PYREX -
    A/C PERFORMA LA/ APAC 50 ROCHE -
    ACCUCHECK ACTIVE ( HIJAU ) ROCHE -
    SAR-COV-2 ANTIGEN ROCHE -
    BIOSONIC ULTRASONIC GEL SELLA -

    DENGUE DUO CASSETE (igG&IgM) SIGPRO 20,614,880.00


    DENGUE EARLY RAFID (NS1) SIGPRO 21,742,256.28
    42,357,136.28

    HYDREX SUG. SCRUB 5 LITER SMI -


    POLI AID ASL 1 LTR SNA -
    POLI AID ASL 5 LITER SNA -
    POLIWASH 5 LITER SNA -

    WHITE TIP ( SOCOREX ) @ 1000 SOCOREX 1,936,000.00


    YELLOW TIP @ 1000 SOCOREX 1,740,750.00
    3,676,750.00

    SOFNOLIME SOFNOLIME -
    HBs AG CARD @ 30 STAR 7,453,600.00
    HIV CARD @ 25 STAR -
    HBs AG START PLUS STAR D PLUS -

    RAPID TEST COVID-19 SYSMEX -


    SMX ~ ACTIN FS ACTAVATED SYSMEX -
    SMX ~ ALAT ( GPT ) FS ( IFCC MOD ) SYSMEX -
    SMX ~ ALAT ( GPT ) FS ( IFCC MOD ) R1 SYSMEX -
    SMX ~ ALAT ( GPT ) FS ( IFCC MOD ) R2 SYSMEX -
    SMX ~ ALBUMIN FS R1 SYSMEX -
    SMX ~ ASAT ( GOT ) FS ( IFCC MOD ) SYSMEX -
    SMX ~ ASAT ( GOT ) FS ( IFCC MOD ) R1 SYSMEX -
    SMX ~ ASAT ( GOT ) FS ( IFCC MOD ) R2 SYSMEX -
    SMX ~ BI-LEVEL QC KIT, MEDICA SYSMEX -
    SMX ~ BILIRUBIN AUTO DIREC FS SYSMEX -
    SMX ~ BILIRUBIN AUTO DIREC FS R1 SYSMEX -
    SMX ~ BILIRUBIN AUTO DIREC FS R2 SYSMEX -
    SMX ~ BILIRUBIN AUTO TOTAL FS SYSMEX -
    SMX ~ BILIRUBIN AUTO TOTAL FS R1 SYSMEX -
    SMX ~ BILIRUBIN AUTO TOTAL FS R2 SYSMEX -
    SMX ~ CALCIUM CHLORIDE SOLUTION SYSMEX -
    SMX ~ CALIBRATION STRIP SYSMEX -
    SMX ~ CELL CLEAN 50 ML ( CL - 50 ) SYSMEX -
    SMX ~ CELL PACK ( PK- 30 L ) SYSMEX -
    SMX ~ CHOLESTEROL FS SYSMEX -
    SMX ~ COMBO STICK 10 M ( 100T ) SYSMEX -
    SMX ~ COMBO STICK 10 M ( 100T ) SYSMEX -
    SMX ~ CONTROL PLASMA SYSMEX -
    SMX ~ CREATININE PAP FS SYSMEX -
    SMX ~ CREATININE PAP FS R1 SYSMEX -
    SMX ~ CREATININE PAP FS R2 SYSMEX -
    SMX ~ DADE INNOVIN SYSMEX -
    SMX ~ DAILY CLEANING SOL. SYSMEX -
    SMX ~ E- CHECK LEVEL 1 ( LOW ) SYSMEX -
    SMX ~ E- CHECK LEVEL 2 ( NORMAL ) SYSMEX -
    SMX ~ E- CHECK LEVEL 3 ( HIGH ) SYSMEX -
    SMX ~ E- CHECK 3WP (NORMAL) 1.5 ML SYSMEX -
    SMX ~ E- CHECK 3WP (LOW) 1.5 ML SYSMEX -
    SMX ~ E- CHECK 3WP (HIGH) 1.5 ML SYSMEX -
    SMX ~ EBG QC KIT LEVEL 1 ( LOW ) SYSMEX -
    SMX ~ EBG QC KIT LEVEL 2 ( NORMAL ) SYSMEX -
    SMX ~ EBG QC KIT LEVEL 3 ( HIGH ) SYSMEX -
    SMX ~ EBG REAGENT MODULE SYSMEX -
    SMX ~ EBG REAGENT PACK SOLUTION SYSMEX -
    SMX ~ GAMMA FT FS SYSMEX -
    SMX ~ GLUCOSE HEXOKINASE SYSMEX -
    SMX ~ GLUCOSE HEXOKINASE FS R1 SYSMEX -
    SMX ~ GLUCOSE HEXOKINASE FS R2 SYSMEX -
    SMX ~ HDL-C INMMUNO FS R1 SYSMEX -
    SMX ~ HDL-C INMMUNO FS R2 SYSMEX -
    SMX ~ HDL-C INMMUNO FS SYSMEX -
    SMX ~ LEVEL QC SYSMEX -
    SMX ~ LDL - C SELECT FS R1 SYSMEX -
    SMX ~ LDL - C SELECT FS R2 SYSMEX -
    SMX ~ LIQUICHECK URINALYSIS CONTROL SYSMEX -
    SMX ~ MULTI DRUG ONE STEP 6 TEST SYSMEX -
    SMX ~ SAMPLIX 4 ML SYSMEX 4,862,000.00
    SMX ~ SAMPLE CUP @ 500 PC SYSMEX -
    SMX ~ SOLUTION PACK NA/KCL 400 MG SYSMEX -
    SMX ~ STROMATOLYZER 4DL (FFD-220 SYSMEX -
    SMX ~ STROMATOLYZER 4DS SYSMEX -
    SMX ~ STROMATOLYZER WH 500 ML SYSMEX -
    SMX ~ STROMATOLYZER WH 500 ML SYSMEX -
    SMX ~ SULFOLYSER 500 ML SLS-210A SYSMEX 3,031,600.00
    SMX ~ TABUNG SODIUM CITRAT SYSMEX -
    SMX ~ THERMAL PAPER DPT 282-EL KX SYSMEX -
    SMX ~ THERMAL PAPER COMBOSTIK R300 SYSMEX -
    SMX ~ THERMAL PAPER FOR EASYLITE SYSMEX -
    SMX ~ TOTAL PROTEN SYSMEX -
    SMX ~ TOTAL PROTEN FS R1 SYSMEX -
    SMX ~ TOTAL PROTEN FS R2 SYSMEX -
    SMX ~ TRIGLYCERIDES FS 10 SYSMEX -
    SMX ~ TRU CAL U SYSMEX -
    SMX ~ TRU LAB N SYSMEX -
    SMX ~ TRU LAB P SYSMEX -
    SMX ~ UREA FS SYSMEX -
    SMX ~ UREA FS R1 SYSMEX -
    SMX ~ UREA FS R2 SYSMEX -
    SMX ~ URIC ACID FS TOOS SYSMEX -
    SMX ~ URIC ACID FS TOOS R1 SYSMEX -
    SMX ~ URIC ACID FS TOOS R2 SYSMEX -
    SMX ~ WASH SOLUTION NO. 3 SYSMEX -
    SMX ~ VAC 3.5 ML Z SER SEP C/A NR SYSMEX -
    TABUNG CLOT ACTIVATOR 3 ML SYSMEX -
    7,893,600.00

    K3 EDTA ( PC ) MINI UNGU 0.5 ML VACUETTE 1,504,800.00


    TABUNG GEL CLOT ACTIVATOR 3 ML VACUETTE 5,016,000.00
    TABUNG COAGULATION ( BIRU ) VACUETTE -
    6,520,800.00

    K2 EDTA ( PC ) UNGU 3 ml VCB 2,475,000.00

    TABUNG GEL CLOT ACTIVATOR 3 ML VDL 1,001,000.00


    TABUNG NATRIUM CITRAT VDL -

    DENGUE EARLY RAFID (NS1) WF 8,855,000.00


    SERUM GOL. DARAH ANTI A XXX -
    SODA LIME ( INTERSORB GRAN MOLECUXXX -
    TISSUE LENSA XXX -
    TES NARKOBA @ 25 -
    TEST KEHAMILAN -
    CLUNGENE 57,580,000
    ALTAMED 57,273,750
    SIGPRO 42,357,136
    HUMAN 19,331,400
    onsite 16,371,300
    GLORY 11,765,600
    WF 8,855,000
    SYSMEX 7,893,600
    STAR 7,453,600
    VACUETTE 6,520,800
    ORIENT GENE 5,315,200
    ONE MED 3,868,000
    ITM 3,762,000
    SOCOREX 3,676,750
    DALF 3,203,200
    VCB 2,475,000
    GILSON 1,740,750
    VDL 1,001,000
    GREINERBIO 532,400
    KF ( G ) 453,394
    MEDIKA 124,208
    BRATACO 70,000
    GENERIK PATEN BAHAN PELENG
    NO NAMA PABRIK NILAI STOK NO NAMA PABRIK NILAI STOK NO
    1 DM ( G ) 65,292,706 1 SANBE FARMA 100,015,182 1
    2 NOVELL (G) 43,912,417 2 FAHRENHEIT 43,996,762 2
    3 FAHRENHEIT (G ) 31,800,505 3 PYRIDAM 43,159,216 3
    4 HEXPHARM ( G ) 19,195,093 4 EMJEBE 27,319,600 4
    5 PROMED (G) 13,474,384 5 OTTO 21,505,358 5
    6 YARINDO (G) 4,155,195 6 INTERBAT 14,819,200 6
    7 MBF ( G ) 3,480,674 7 DEXA MEDIKA 14,722,753 7
    8 BERNOFARM ( G ) 3,001,434 8 GLAXO 12,264,836 8
    9 PHAPROS (G) 1,136,316 9 LANDSON 9,214,919 9
    10 KF ( G ) 1,073,458 10 KALBE FARMA 7,628,698 10
    11 SCAN (G) 713,476 11 NOVO NORDISK 7,135,000 11
    12 INF (G) 548,625 12 ASTRA ZENECA 6,741,616 12
    13 ETHICA ( G ) 241,494 13 LAPI 5,517,600 13
    14 DARYA VARIA (G) 107,910 14 WIDATRA 4,780,541 14
    15 NOVARTIS 3,797,690 15
    TOTAL 188,133,686 16 FERRON 2,085,039 16
    17 JANNSEN 1,980,000 17
    18 MSD 1,702,332 18
    19 OTSUKA 1,665,814 19
    20 CENDO 1,074,356 20
    21 BERNOFARM 841,500 21
    22 ACTAVIS 491,684 22
    23 CAPRIFARMINDO 439,890 23
    24 PFIZER 406,302 24
    25 NICHOLAS 404,250 25
    26
    27
    TOTAL 333,710,136 28
    29
    30
    31
    32
    33
    34
    35
    36
    37
    38
    39

    TOTAL
    BAHAN PELENGKAP BAHAN KIMIA
    NAMA PABRIK NILAI STOK NO NAMA PABRIK NILAI STOK
    B/BROUND 186,810,217 1 CLUNGENE 57,580,000
    ONEMED 31,879,619 2 ALTAMED 57,273,750
    SAFEGLOVE 16,295,498 3 SIGPRO 42,357,136
    ALTAMED 12,565,840 4 HUMAN 19,331,400
    STERRA 9,086,550 5 onsite 16,371,300
    ABBOT 8,470,652 6 GLORY 11,765,600
    AXIMED 6,827,973 7 WF 8,855,000
    TROGE 6,252,400 8 SYSMEX 7,893,600
    SMI 6,128,425 9 STAR 7,453,600
    APPROVED 3,960,000 10 VACUETTE 6,520,800
    CATH PRO 3,545,520 11 ORIENT GENE 5,315,200
    HUMAN 3,484,800 12 ONE MED 3,868,000
    SONY 3,245,000 13 ITM 3,762,000
    GEA 3,135,644 14 SOCOREX 3,676,750
    SINAR OGAN 2,819,977 15 DALF 3,203,200
    MAXTER 2,780,000 16 VCB 2,475,000
    SIGPRO 2,420,000 17 GILSON 1,740,750
    SOLMED 2,278,428 18 VDL 1,001,000
    3M 2,135,372 19 GREINERBIO 532,400
    NORTA 2,131,800 20 KF ( G ) 453,394
    PUREGLOVE 1,936,000 21 MEDIKA 124,208
    KIMSMED 1,725,460 22 BRATACO 70,000
    REMEDI 1,464,569
    SONOMED 1,430,000 TOTAL 261,624,087.62
    AML-MEDDIS 1,300,750
    DARYA VARYA 1,122,000
    IDEALCARE 1,006,720
    BESMED 967,057
    TERUMO 951,623
    SOLIDA 837,980
    PHARMAPLAST 691,900
    SHAMROCK 456,500
    FORSCH 363,000
    DALF 291,500
    GC 264,000
    LOKAL 224,181
    COSMOMED 210,540
    BICAKCILAR 163,625
    BRATACO 93,500

    TOTAL 331,754,620
    ACARBOSE TAB. 100 MG FAHRENHEIT (G ) ACARBOSE TAB. 100 MG

    ACARBOSE TAB. 50 MG FAHRENHEIT (G ) 1,245.20 ACARBOSE TAB. 50 MG

    ACETYLCESTEINE 200 MG/ML FAHRENHEIT (G ) 218,900.00


    ACETYLCESTEINE CAPS MBF ( G ) 1,833.33 ACETYLCESTEINE CAPS

    ACYCLOVIR CREAM 5 GR KF ( G ) 3,391.25 ACYCLOVIR CREAM 5 GR

    ACYCLOVIR TAB. 200 MG NOVELL ( G ) 550.00


    ACYCLOVIR TAB. 400 MG HEXPHARM ( G ) 660.00 ACYCLOVIR TAB. 400 MG
    ACYCLOVIR TAB. 400 MG
    ACYCLOVIR TAB. 400 MG

    ALBENDAZOL 400 MG KF ( G ) 446.60


    ALBENDAZOL 400 MG KF ( G ) 448.25
    ALLOPURINOL TAB 100 MG HEXPHARM ( G ) 220.00 ALLOPURINOL TAB 100 MG
    ALLOPURINOL TAB 100 MG

    ALLOPURINOL TAB 300 MG MERSIFARM (G) 462.00 ALLOPURINOL TAB 300 MG


    ALLOPURINOL TAB 300 MG

    ALPRAZOLAM 0.25 MG KF ( G ) 557.87


    ALPRAZOLAM 0.5 MG KF ( G ) 704.55
    ALPRAZOLAM 1 MG KF ( G ) 1,085.70
    AMBROXOL SYR. 15 MG/ 5 ML PROMED (G) AMBROXOL SYR. 15 MG/ 5 ML
    AMBROXOL SYR. 15 MG/ 5 ML

    AMBROXOL TAB. PROMED (G) 198.00 AMBROXOL TAB.


    AMBROXOL TAB.

    AMINOPHYLLIN INJ. PHAPROS (G) 3,023.94


    AMIODARONE INJ. DARYA VARYA ( G 8,656.58

    AMITRIPTYLINE TAB. 25 MG INF (G) 180.00


    AMLODIPINE 10 MG DM ( G ) 1,775.60 AMLODIPINE 10 MG
    AMLODIPINE 10 MG
    AMLODIPINE 10 MG
    AMLODIPINE 10 MG
    AMLODIPINE 10 MG
    AMLODIPINE 10 MG
    AMLODIPINE 10 MG
    AMLODIPINE 10 MG

    AMLODIPINE 5 MG DM ( G ) 190.01 AMLODIPINE 5 MG


    AMLODIPINE 5 MG
    AMLODIPINE 5 MG
    AMLODIPINE 5 MG
    AMLODIPINE 5 MG
    AMLODIPINE 5 MG
    AMLODIPINE 5 MG
    AMOXYCILLIN CAPS 500 MG BERNOFARM ( G ) 423.50 AMOXYCILLIN CAPS 500 MG
    AMOXYCILLIN CAPS 500 MG

    AMOXYCILLIN DROPS BERNOFARM ( G ) 15,400.00


    AMOXYCILLIN DRY. SYR HEXPHARM ( G ) 5,500.00 AMOXYCILLIN DRY. SYR

    AMPICILLIN INJ. PHAPROS (G) 7,878.42


    ANTASIDA DOEN SYR. KF ( G ) 9,804.35
    ANTASIDA DOEN TAB PROMED (G) 198.00 ANTASIDA DOEN TAB
    ANTASIDA DOEN TAB

    AQUA PRO INJ. 50 ML BERNOFARM ( G ) 16,500.00


    AS. MEFENAMAT TAB 500 MG BERNOFARM ( G ) 297.00 AS. MEFENAMAT TAB 500 MG
    AS. MEFENAMAT TAB 500 MG
    AS. MEFENAMAT TAB 500 MG

    AS. TRANEKSAMAT INJ 250 MG DM ( G ) 4,620.00


    AS. TRANEKSAMAT INJ 250 MG BERNOFARM ( G ) 5,005.00 AS. TRANEKSAMAT INJ 250 MG
    AS. TRANEKSAMAT INJ 500 MG

    AS. TRANEKSAMAT INJ 500 MG HEXPHARM ( G ) 5,775.00 AS. TRANEKSAMAT INJ 500 MG

    AS. TRANEKSAMAT TAB 500 MG BERNOFARM ( G ) 1,980.00 AS. TRANEKSAMAT TAB 500 M

    ASAM VALPROAT SYR 250 ML NOVELL (G) 41,580.00 ASAM VALPROAT SYR 250 ML
    ASAM VALPROAT SYR 250 ML

    ATORVASTATIN 10 MG HEXPHARM ( G ) 2,750.00


    ATORVASTATIN 20 MG YARINDO (G) 4,400.00 ATORVASTATIN 20 MG

    ATROPIN SULFAS INJ. ETHICA ( G ) 2,750.00


    AZITHROMYCIN INFUS 500 MG BERNOFARM ( G ) 88,000.00
    AZITHROMYCIN INJ. 0.5 GR BERNOFARM ( G ) 128,700.00
    AZITHROMYCIN SYR. 200 MG / 5 M DM ( G ) 51,975.00
    AZITHROMYCIN TAB. 500 MG KF ( G ) 4,500.00
    AZITHROMYCIN TAB. 500 MG
    AZITHROMYCIN TAB. 500 MG
    BETAHISTINE TABLET 24 MG YARINDO (G) 4,180.00
    BETAHISTINE TABLET 6 MG DM ( G ) 969.25 BETAHISTINE TABLET 6 MG

    BETAMETASONE CREAM KF ( G ) 2,353.35 BETAMETASONE CREAM

    BIC NAT 500 MG GENERIK 77.00


    BISACODYL TAB. NOVELL (G) 1,020.00
    BISOPROLOL TAB. 2.5 MG HEXPHARM ( G ) 550.00 BISOPROLOL TAB. 2.5 MG
    BISOPROLOL TAB. 2.5 MG

    BISOPROLOL TAB. 5 MG DM ( G ) 2,437.82 BISOPROLOL TAB. 5 MG


    BISOPROLOL TAB. 5 MG
    BISOPROLOL TAB. 5 MG
    BISOPROLOL TAB. 5 MG
    BISOPROLOL TAB. 5 MG
    BUPIVACAINE SPINAL INJ. BERNOFARM ( G ) 26,878.72
    CALCII GLUCONAS INJ. DM ( G ) 15,092.00
    CALCIUM LACTATE TABLET 500 M PHAPROS (G) 119.27 CALCIUM LACTATE TABLET 500

    CANDESARTAN TAB. 8 MG DM ( G ) 5,197.52 CANDESARTAN TAB. 8 MG


    CANDESARTAN TAB. 8 MG
    CANDESARTAN TAB. 8 MG

    CANDESARTAN TAB. 16 MG FAHRENHEIT (G ) 7,150.00 CANDESARTAN TAB. 16 MG


    CANDESARTAN TAB. 16 MG
    CANDESARTAN TAB. 16 MG
    CANDESARTAN TAB. 16 MG
    CANDESARTAN TAB. 16 MG

    CARBAMAZEPIN TAB. 200 MG INF (G) 246.20


    CATOPRIL 12,5 MG KF ( G ) 175.19 CATOPRIL 12,5 MG
    CATOPRIL 12,5 MG

    CATOPRIL 25 MG KF ( G ) 181.11 CATOPRIL 25 MG


    CATOPRIL 25 MG
    CATOPRIL 25 MG

    CATOPRIL 50 MG DM ( G ) 235.60
    CATOPRIL 50 MG DM ( G ) 200.25
    CEFADROXIL CAPS. 500 MG HEXPHARM ( G ) 840.00 CEFADROXIL CAPS. 500 MG
    CEFADROXIL CAPS. 500 MG
    CEFADROXIL CAPS. 500 MG
    CEFADROXIL CAPS. 500 MG

    CEFADROXIL SYR PROMED (G) 9,900.00 CEFADROXIL SYR


    CEFADROXIL SYR

    CEFEPIME INJ BERNOFARM ( G ) 135,850.00


    CEFIXIME CAPS. 100 MG DM ( G ) 2,514.31 CEFIXIME CAPS. 100 MG
    CEFIXIME CAPS. 100 MG
    CEFIXIME CAPS. 100 MG

    CEFIXIME CAPS. 200 MG HEXPHARM ( G ) 2,530.00 CEFIXIME CAPS. 200 MG

    CEFIXIME SYR BERNOFARM ( G ) 36,300.00 CEFIXIME SYR


    CEFIXIME SYR
    CEFIXIME SYR

    CEFOPERAZONE INJ 1 GR BERNOFARM ( G ) 88,000.00


    CEFOPERAZONE SULBACTAM INJ.MBF ( G ) CEFOPERAZONE SULBACTAM IN
    CEFOPERAZONE SULBACTAM IN

    CEFOTAXIME INJ. DM ( G ) 7,276.50


    CEFOTAXIME INJ.
    CEFOTAXIME INJ.
    CEFOTAXIME INJ.
    CEFOTAXIME INJ.
    CEFOTAXIME INJ.
    CEFTAZIDIME INJ. 1 GR NOVELL ( G ) 45,650.00 CEFTAZIDIME INJ. 1 GR
    CEFTAZIDIME INJ. 1 GR

    CEFTIZOXIME INJ. 1 GR NOVELL ( G ) 110,000.00


    CEFTIZOXIME INJ. 1 GR NOVELL ( G ) 110,000.00 CEFTRIAXONE INJ 1 GR
    CEFTRIAXONE INJ 1 GR HEXPHARM ( G ) 11,000.00 CEFTRIAXONE INJ 1 GR

    CEFTRIAXONE INJ 1 GR DM ( G )
    CETIRIZINE 10 MG FAHRENHEIT (G ) 330.00 CETIRIZINE 10 MG
    CETIRIZINE 10 MG
    CETIRIZINE 10 MG

    CETIRIZINE DROPS INF (G) 27,500.00


    CETIRIZINE SYR. PROMED (G) 16,500.00 CETIRIZINE SYR.

    CHLORPHENAMINE TAB. 4 MG PHAPROS (G) 115.49


    CILOSTAZOL TAB. 100 MG BERNOFARM ( G ) 10,450.01
    CIPROFLOXACIN INFUS NOVELL ( G ) 56,999.80 CIPROFLOXACIN INFUS

    CIPROFLOXACIN TAB. 500 MG BERNOFARM ( G ) 385.00 CIPROFLOXACIN TAB. 500 MG


    CIPROFLOXACIN TAB. 500 MG
    CIPROFLOXACIN TAB. 500 MG
    CIPROFLOXACIN TAB. 500 MG

    CITICOLINE INJ. 125 MG / 1 ML NOVELL (G) 14,300.00


    CITICOLINE INJ. 125 MG / 1 ML NOVELL (G) 14,300.00
    CITICOLINE INJ. 250 MG / 2 ML HEXPHARM ( G ) 11,999.89
    CITICOLINE INJ. 500 MG / 4 ML MBF ( G ) 16,500.00 CITICOLINE INJ. 500 MG / 4 ML

    CITICOLINE TAB 500 MG MBF ( G ) 6,600.00 CITICOLINE TAB 500 MG


    CITICOLINE TAB 500 MG
    CITICOLINE TAB 500 MG
    CITICOLINE TAB 500 MG

    CLINDAMYCIN TAB 150 MG NOVELL ( G ) 736.89


    CLINDAMYCIN TAB 300 MG DM ( G ) 1,361.75 CLINDAMYCIN TAB 300 MG
    CLINDAMYCIN TAB 300 MG

    CLOBAZAM TABL. DM ( G ) 797.01


    CLOBAZAM TABL. DM ( G ) 1,122.19
    CLONIDIN TAB KF ( G ) 180.65
    CLOPIDOGREL TAB. 75 MG FAHRENHEIT (G ) 9,480.08 CLOPIDOGREL TAB. 75 MG
    CLOPIDOGREL TAB. 75 MG
    CLOPIDOGREL TAB. 75 MG
    CLOPIDOGREL TAB. 75 MG
    CLOPIDOGREL TAB. 75 MG
    CLOPIDOGREL TAB. 75 MG
    CLOPIDOGREL TAB. 75 MG

    CO AMOXICLAV TAB 625 MG DM ( G ) 4,620.00 CO AMOXICLAV TAB 625 MG

    COTRIMOXAZOLE SYR KF ( G ) 6,263.73 COTRIMOXAZOLE SYR


    COTRIMOXAZOLE SYR

    COTRIMOXAZOLE TAB 480 MG BERNOFARM ( G ) 330.00 COTRIMOXAZOLE TAB 480 MG

    DESOXIMETASONE CREAM DM ( G ) 13,975.50


    DEVALPROEX SODIUM YARINDO (G) -
    DEXA METHASON TBL 0,50 MG PROMED (G) 176.00 DEXA METHASON TBL 0,50 MG
    DEXA METHASON TBL 0,50 MG
    DEXA METHASON TBL 0,50 MG
    DEXA METHASON TBL 0,50 MG

    DEXA METHASONE INJ. PHAPROS (G) 2,299.00 DEXA METHASONE INJ.


    DEXA METHASONE INJ.
    DEXA METHASONE INJ.

    DEXKETOPROFEN INJ. YARINDO (G) 26,400.00 DEXKETOPROFEN INJ.


    DEXKETOPROFEN INJ.
    DEXKETOPROFEN INJ.
    DEXKETOPROFEN INJ.

    DEXKETOPROFEN TAB. 25 MG YARINDO (G) 3,410.00 DEXKETOPROFEN TAB. 25 MG

    DIAZEPAM TBL. 2 MG KF ( G ) 137.26


    DIGOXIN TABL 0,25MG FAHRENHEIT (G ) 143.01 DIGOXIN TABL 0,25MG

    DILTIAZEM TAB. DM ( G ) 183.09 DILTIAZEM TAB.

    DIPHENHYDRAMINE INJ PHAPROS (G) 1,169.44


    DOBUTAMIN INJ. 250 MG NOVELL (G) 40,810.00 DOBUTAMIN INJ. 250 MG
    DOBUTAMIN INJ. 250 MG

    DOMPERIDONE SYR. PROMED (G) 16,500.00 DOMPERIDONE SYR.

    DOMPERIDONE SYR. HEXPHARM ( G ) 12,650.00 DOMPERIDONE TAB


    DOMPERIDONE TAB PROMED (G) 484.00 DOMPERIDONE TAB
    DOMPERIDONE TAB
    DOMPERIDONE TAB
    DOMPERIDONE TAB
    DOMPERIDONE TAB

    DOPAMIN INJ. DM ( G ) 11,550.00 DOXYCYCLINE CAPS. 100 MG


    DORIPENEM INJ. 500 MG DARYA VARYA ( G 330,000.00
    DOXYCYCLINE CAPS. 100 MG FAHRENHEIT (G) 308.55

    EPERISONE 50 MG MEDIKON (G) 1,694.00


    EPHEDRINE HCL INJEKSI 50 mg / mETHICA ( G ) 8,526.15
    EPINEPHRINE INJ. 1 mg/ml ETHICA ( G ) 6,708.17 EPINEPHRINE INJ. 1 mg/ml
    EPINEPHRINE INJ. 1 mg/ml ETHICA ( G ) 1,408.00

    EPINEPHRINE INJ. 1 mg/ml PHAPROS (G) 2,772.00


    ERDOSTEIN CAPS. 300 MG MBF ( G ) 3,025.00 ERDOSTEIN CAPS. 300 MG
    ERDOSTEIN SYR NOVELL (G) 27,720.00
    ERYTHROMYCIN CAPS 250 MG KF ( G ) 938.77
    ERYTHROMYCIN CAPS 500 MG FAHRENHEIT (G) 1,485.01
    ERYTHROMYCIN DRY SYR KF ( G ) 13,445.31
    ETHAMBUTOL TAB 500 MG KF ( G ) 827.53
    ETORICOXIB 60 MG YARINDO (G) 4,400.00
    FAVIPIRAVIRE 200 MG HEXPHARM ( G ) 15,000.00
    FENOFIBRATE 1OO MG DM ( G ) 2,309.96 FENOFIBRATE 1OO MG

    FENOFIBRATE 3OO MG HEXPHARM ( G ) 4,400.00 FENOFIBRATE 3OO MG


    FENOFIBRATE 3OO MG

    FLUCONAZOLE CAPS. 150 MG KF ( G ) 18,720.02


    FLUNARIZIN TAB. 10 MG BERNOFARM ( G ) 2,625.00 FLUNARIZIN TAB. 10 MG

    FLUNARIZIN TAB. 5 MG BERNOFARM ( G ) 1,760.00


    FOLIC ACID 1 MG KF ( G ) 125.65
    FOLIC ACID 400 PROMED (G) 198.00
    FUROSEMIDE INJ INF (G) 3,410.00 FUROSEMIDE INJ

    FUROSEMIDE TBL. 40 MG KF ( G ) 160.87 FUROSEMIDE TBL. 40 MG


    FUROSEMIDE TBL. 40 MG

    GABAPENTIN TAB. 300 MG FAHRENHEIT (G ) 5,500.00 GABAPENTIN TAB. 300 MG


    GABAPENTIN TAB. 300 MG

    GEMFIBROZIL 300 MG PHAPROS (G) 462.00


    GENTAMYCIN CREAM 5 GRM KF ( G ) 2,937.01 GENTAMYCIN CREAM 5 GRM

    GENTAMYCIN INJ KF ( G ) 1,732.54


    GG / GUAIFENESIN 100 MG KF ( G ) 220.00
    GLIMEPRIDE TAB. 1 MG HEXPHARM ( G ) 484.00 GLIMEPRIDE TAB. 1 MG

    GLIMEPRIDE TAB. 2 MG DM ( G ) 1,504.95 GLIMEPRIDE TAB. 2 MG


    GLIMEPRIDE TAB. 2 MG
    GLIMEPRIDE TAB. 2 MG

    GLIMEPRIDE TAB. 3 MG DM ( G ) 245.03 GLIMEPRIDE TAB. 3 MG


    GLIMEPRIDE TAB. 3 MG

    GLIMEPRIDE TAB. 4 MG DM ( G ) 2,736.31 GLIMEPRIDE TAB. 4 MG


    GLIMEPRIDE TAB. 4 MG
    GLIMEPRIDE TAB. 4 MG

    GLIQUIDONE 30 MG DM ( G ) 1,391.13
    GLUCOSAMINE 250 MG HEXPHARM ( G ) 880.01
    GLUCOSAMINE 250 MG HEXPHARM ( G ) 880.00
    GLUCOSAMINE MPL 500 MG MEDIKON (G) 1,303.57
    GLYCERYL GUAICOLATE TAB. KF ( G ) 220.00
    GRANISETRON INJ. 1 MG NOVELL (G) 9,900.00
    GRANISETRON INJ. 3 MG FAHRENHEIT (G ) 44,000.00
    HCT TBL. 25 MG KF ( G ) 163.35
    HYDROCORTISON 2,5% KF ( G ) 3,803.80
    IBUPROFEN SYR. INDOFARMA (G) 4,955.00
    IBUPROFEN 200 MG FAHRENHEIT (G ) 192.50
    IBUPROFEN 400 MG PROMED (G) 528.00 IBUPROFEN 400 MG

    ISONIAZID TABL 100 MG KF ( G ) 179.74


    ISONIAZID TABL 100 MG KF ( G ) 179.74
    ISONIAZID TABL 300 MG KF ( G ) 262.31
    ISOSORBIDE DINITRATE INJEKSI FAHRENHEIT (G ) 55,000.00
    ISOSORBIDE DINITRATE TABLET FAHRENHEIT (G ) 121.00
    KALIUM DIKLOPENAK 25 MG DM ( G ) 369.34
    KALIUM DIKLOPENAK 50 MG HEXPHARM ( G ) 660.00 KALIUM DIKLOPENAK 50 MG

    KALIUM DIKLOPENAK 50 MG HEXPHARM ( G ) 475.20


    KETAMIN INJ. 100 MG/ML DM ( G ) 161,700.00
    KETAMIN INJ. 50 MG/ML DM ( G ) 80,850.00
    KETOKONAZOLE CREAM DM ( G ) 7,350.02 KETOKONAZOLE CREAM
    KETOKONAZOLE CREAM

    KETOKONAZOLE TAB. 200 MG DM ( G ) 430.49 KETOKONAZOLE TAB. 200 MG

    KETOPROFEN TAB. DM ( G ) 1,417.51


    KETOPROFEN TAB. 100 MG BERNOFARM ( G ) 1,320.00
    KETOPROFEN TAB. 50 MG NOVELL (G) 563.20
    KETOROLAC INJ. 30 MG HEXPHARM ( G ) 5,000.05 KETOROLAC INJ. 30 MG
    KETOROLAC INJ. 30 MG
    KETOROLAC INJ. 30 MG
    KETOROLAC INJ. 30 MG
    KETOROLAC INJ. 30 MG
    KETOROLAC INJ. 30 MG

    KETOROLAC TAB. HEXPHARM ( G ) 2,525.60 KETOROLAC TAB.

    LANSOPRAZOLE 30 MG NOVELL (G) 1,081.08 LANSOPRAZOLE 30 MG

    LATANOPROST 2.5 ML FAHRENHEIT (G ) 110,000.00 LEVOFLOXACIN 500 MG


    LEVOFLOXACIN 500 MG HEXPHARM ( G ) 1,375.00 LEVOFLOXACIN 500 MG
    LEVOFLOXACIN 500 MG

    LEVOFLOXACIN INF. 500 ML NOVELL ( G ) 88,000.00 LEVOFLOXACIN INF. 500 ML


    LEVOFLOXACIN INF. 500 ML
    LEVOFLOXACIN INF. 500 ML

    LEVOFLOXACIN INF. 750 ML NOVELL ( G ) 110,000.00 LEVOFLOXACIN INF. 750 ML


    LEVOFLOXACIN INF. 750 ML

    LIDOCAIN COMP INJ. 2% PHAPROS (G) 2,310.00


    LIDOCAIN INJ. 2% BERNOFARM ( G ) 1,155.00 LIDOCAIN INJ. 2%
    LIDOCAIN INJ. 2%

    LORATADIN 10 MG HEXPHARM ( G ) 330.01


    LORATADIN 10 MG PROMED (G) 352.00
    MECOBALAMIN 500 MG NOVELL (G) 880.00
    MECOBALAMIN INJEKSI NOVELL ( G ) 8,800.00
    MELOXICAM TAB 15 MG MBF ( G ) 512.60 MELOXICAM TAB 15 MG
    MELOXICAM TAB 15 MG
    MELOXICAM TAB 15 MG

    MELOXICAM TAB 7.5 MG DM ( G ) 726.49 MELOXICAM TAB 7.5 MG


    MELOXICAM TAB 7.5 MG
    MELOXICAM TAB 7.5 MG

    MEROPENEM INJ. 0.5 GR KF ( G ) 45,650.00 MEROPENEM INJ. 0.5 GR

    MEROPENEM INJ. 1 GR NOVELL ( G ) 220,000.00 MEROPENEM INJ. 1 GR


    MEROPENEM INJ. 1 GR
    MEROPENEM INJ. 1 GR

    METFORMIN TAB 500 MG PHAPROS (G) 228.69 METFORMIN TAB. 500 MG


    METFORMIN TAB. 500 MG
    METFORMIN TAB. 500 MG
    METFORMIN TAB 850 MG DM ( G ) 450.44 METFORMIN TAB 850 MG
    METFORMIN XR TAB 500 MG PROMED (G) 550.00
    METFORMIN XR TAB 750 MG PROMED (G) 737.00
    METHYLERGOMETRINE MALEATE NOVELL (G) 3,850.00
    METHYLERGOMETRINE TABLET KF ( G ) 274.38
    METHYLPREDNISOLON INJ. DM ( G ) 37,249.30 METHYLPREDNISOLON INJ.
    METHYLPREDNISOLON INJ.

    METHYLPREDNISOLON TAB 16 MG DM ( G ) 1,086.75 METHYLPREDNISOLON TAB 16 MG

    METHYLPREDNISOLON TAB 4 MG MBF ( G ) 825.00 METHYLPREDNISOLON TAB 4 MG


    METHYLPREDNISOLON TAB 4 MG

    METHYLPREDNISOLON TAB 8 MG DM ( G ) 614.26 METHYLPREDNISOLON TAB 8 MG


    METHYLPREDNISOLON TAB 8 MG
    METHYLPREDNISOLON TAB 8 MG

    METOCLOPRAMIDE INJ. BERNOFARM ( G ) 7,700.00


    METRONIDAZOLE INPUS NOVELL (G) 39,820.00 METRONIDAZOLE INPUS
    METRONIDAZOLE INPUS

    METRONIDAZOLE TAB. 500 MG NOVELL (G) 501.56


    METRONIDAZOLE TAB. 500 MG
    METRONIDAZOLE TAB. 500 MG
    METRONIDAZOLE TAB. 500 MG
    MICONAZOLE KRIM 2% KF ( G ) 4,125.01
    MICONAZOLE KRIM 2% KF ( G ) 4,113.30
    MIDAZOLAM INJ. 5 MG/1 ML COMBIPHAR (G) 20,328.00
    MUPIROCIN OINTMENT 2% NOVELL (G) 19,250.00
    N-ACETYLCESTEINE 300 MG/3ML DM ( G ) 25,987.51
    NATRIUM DIKLOPENAK 25 MG PHAPROS (G) 122.96
    NATRIUM DIKLOPENAK 25 MG PHAPROS (G) 141.00
    NATRIUM DIKLOPENAK 50 MG DM ( G ) 231.00 NATRIUM DIKLOPENAK 50 MG
    NATRIUM DIKLOPENAK 50 MG
    NATRIUM PHENYTOIN CAPS IKAPHARMINDO 605.00
    NICARDIPINE INJ. FAHRENHEIT (G ) 57,170.76
    NICARDIPINE INJ. NOVELL (G) 88,000.00
    NIFEDIPIN TAB 10 MG DM ( G ) 155.76 NIFEDIPIN TAB 10 MG

    NOREPINEPHRINE INJ. BTR. 4 mg/4HEXPHARM ( G ) 33,000.00 NOREPINEPHRINE INJ. BTR. 4 m

    NYSTATIN DROPS BERNOFARM ( G ) 21,780.00


    OMEPRAZOLE CAPS. 20 MG DM ( G ) OMEPRAZOLE CAPS. 20 MG
    OMEPRAZOLE CAPS. 20 MG

    OMEPRAZOLE INJ. NOVELL (G) 55,000.00 OMEPRAZOLE INJ.


    OMEPRAZOLE INJ.
    OMEPRAZOLE INJ.

    ONDANSENTRON INJ. 4 MG MBF ( G ) 3,190.00 ONDANSENTRON INJ. 4 MG


    ONDANSENTRON INJ. 4 MG
    ONDANSENTRON INJ. 4 MG
    ONDANSENTRON INJ. 4 MG

    ONDANSENTRON INJ. 8 MG BERNOFARM ( G ) 8,000.09 ONDANSENTRON INJ. 8 MG


    ONDANSENTRON INJ. 8 MG
    ONDANSENTRON INJ. 8 MG

    ONDANSENTRON TAB. 4 MG PROMED (G) 1,430.00 ONDANSENTRON TAB. 4 MG


    ONDANSENTRON TAB. 4 MG
    ONDANSENTRON TAB. 4 MG

    ONDANSENTRON TAB. 8 MG MBF ( G ) 2,816.00 ONDANSENTRON TAB. 8 MG

    ORALIT 200 CC KF ( G ) 915.06


    OXYTETRACYCLIN 1% SALEP MATKF ( G ) 3,500.20
    OXYTOCIN INJ. NOVELL ( G ) 2,750.00 OXYTOCIN INJ.

    PANTOPRAZOLE 40 MG INJ. NOVELL (G) 64,900.00 PANTOPRAZOLE 40 MG INJ.


    PANTOPRAZOLE 40 MG INJ.

    PARACETAMOL DROPS INF (G) 8,250.00


    PARACETAMOL INFUS NOVELL (G) 46,750.00 PARACETAMOL INFUS
    PARACETAMOL INFUS
    PARACETAMOL INFUS
    PARACETAMOL INFUS

    PARACETAMOL SYRUP 60 ML PROMED (G) 7,700.00 PARACETAMOL SYRUP 60 ML


    PARACETAMOL SYRUP 60 ML
    PARACETAMOL SYRUP 60 ML

    PARACETAMOL TAB 500 MG PROMED (G) 259.13 PARACETAMOL TAB 500 MG


    PARACETAMOL TAB 500 MG
    PARACETAMOL TAB 500 MG
    PARACETAMOL TAB 500 MG

    PETHIDIN INJ 50 MG/ML KF ( G ) 19,481.00


    PHENOBARBITAL INJ. PHAPROS G 1,740.02
    PHENOBARBITAL TBL 30 MG KF ( G ) 240.00
    PHYTOMENADION INJ. 10 MG (DE PHAPROS (G) 5,024.80
    PHYTOMENADION INJ. 10 MG (DE PHAPROS (G) 4,306.50
    PHYTOMENADION INJ. 10 MG (DE PHAPROS (G) 4,306.50
    PHYTOMENADION INJ. 2 MG ( ANAK
    PHAPROS (G) 3,867.00
    PHYTOMENADION INJ. 2 MG ( ANAK
    PHAPROS (G) 3,960.00
    PHYTOMENADION TABLET 10 MG PHAPROS (G) 781.00
    PHYTOMENADION TABLET 10 MG PHAPROS (G) 797.01
    PHYTOMENADION TABLET 10 MG PHAPROS (G) 797.01
    PIOGLITAZONE 15 MG YARINDO (G) 3,630.00 PIOGLITAZONE 15 MG
    PIOGLITAZONE 15 MG

    PIOGLITAZONE 30 MG DM ( G ) 4,950.00
    PIRACETAM INJ. 1 GR NOVELL (G) 6,600.00 PIRACETAM INJ. 1 GR

    PIRACETAM INJ. 3 GR NOVEL (G) 20,625.00 PIRACETAM INJ. 3 GR


    PIRACETAM INJ. 3 GR

    PIRACETAM TAB. 1200 MG DM ( G ) 1,358.29 PIRACETAM TAB. 1200 MG

    PIRACETAM TAB. 800 MG HEXPHARM ( G ) 715.00 PIRACETAM TAB. 800 MG


    PIRACETAM TAB. 800 MG
    PIRACETAM TAB. 800 MG

    PIROXICAM TABL 10 MG YARINDO (G) 93.50


    PRAMIPEXOLE TAB. 0.125 MG DM ( G )
    PREDNISON TABL 5 MG PHAPROS G 148.50 PREDNISON TABL 5 MG

    PREGABALIN CAPS 150 MG DM ( G ) 10,395.00 PREGABALIN CAPS 150 MG

    PREGABALIN CAPS 75 MG HEXPHARM ( G ) 4,714.28 PREGABALIN CAPS 75 MG


    PREGABALIN CAPS 75 MG

    PROPANOLOL TABL 10 MG DM ( G ) 92.98 PROPANOLOL TABL 10 MG

    PTU TAB. 100 MG DM ( G ) 521.21 PTU TAB. 100 MG


    PTU TAB. 100 MG DM ( G ) 521.21

    PYRAZINAMIDE TABL 500 MG KF ( G ) 364.97


    PYRAZINAMIDE TABL 500 MG KF ( G ) 382.83
    RANITIDIN INJ. HEXPHARM ( G ) 2,570.04 RANITIDIN INJ.
    RANITIDIN INJ.
    RANITIDIN INJ.
    RANITIDIN INJ.

    RANITIDIN TABL 150 MG PROMED (G) 308.00 RANITIDIN TABL 150 MG


    RANITIDIN TABL 150 MG
    RANITIDIN TABL 150 MG
    RANITIDIN TABL 150 MG
    RANITIDIN TABL 150 MG
    RANITIDIN TABL 150 MG
    RIFAMPICIN CAPS 300 MG INF (G) 884.40
    RIFAMPICIN CAPS 450 MG KF ( G ) 934.00 RIFAMPICIN CAPS 450 MG

    RIFAMPICIN CAPS 600 MG KF ( G ) 2,375.08 RIFAMPICIN CAPS 600 MG

    RISPERIDON TAB 2 MG DM ( G ) 2,493.76


    SALBUTAMOL TABL 2 MG FAHRENHEIT (G ) 88.00 SALBUTAMOL TABL 2 MG
    SALBUTAMOL TABL 2 MG
    SALBUTAMOL TABL 2 MG

    SALBUTAMOL TABL 4 MG FAHRENHEIT (G ) 121.01 SALBUTAMOL TABL 4 MG


    SALBUTAMOL TABL 4 MG

    SEVOFLURANE 250 ML FAHRENHEIT (G ) 1,870,000.00 SEVOFLURANE 250 ML

    SEVOFLURANE BAXTER 250 ML KALBE FARMA 1,737,450.00


    SIMVASTATIN TAB. 10 MG DM ( G ) 538.65 SIMVASTATIN TAB. 10 MG
    SIMVASTATIN TAB. 10 MG
    SIMVASTATIN TAB. 10 MG
    SIMVASTATIN TAB. 10 MG

    SIMVASTATIN TAB. 20 MG SCAN (G) 198.00 SIMVASTATIN TAB. 20 MG


    SIMVASTATIN TAB. 20 MG
    SIMVASTATIN TAB. 20 MG
    SIMVASTATIN TAB. 20 MG

    SPIRONOLACTONE TAB. 100 MG DM ( G ) 1,107.71


    SPIRONOLACTONE TAB. 25 MG DM ( G ) 363.68
    SUCRALFATE SYR. 100 ML PROMED (G) 16,500.00 SUCRALFATE SYR. 100 ML
    SUCRALFATE SYR. 100 ML

    TRAMADOL INJ. NOVELL (G) 4,481.40


    TRAMADOL TAB. 50 MG KF ( G ) 329.67
    TRIAMCINOLONE TAB. 4 MG DM ( G ) 794.96
    TRIHEXYLPHENIDIL TAB 2 MG INF (G) 115.50
    TRIMETAZIDINE 35 MG NOVELL ( G ) 2,310.00
    URSODEOXYCHOLIC ASID 250 DM ( G ) 6,468.00 URSODEOXYCHOLIC ASID 250
    URSODEOXYCHOLIC ASID 250 DM ( G ) 6,468.00

    VALSARTAN 160 MG NOVELL (G) 6,077.50 VALSARTAN 160 MG

    VALSARTAN 80 MG DM ( G ) 2,200.00
    VIT. B1. 50 mg KF ( G ) 161.43
    VIT. B12. IPI GENERIK 73.02
    VIT. B6. 10 mg KF ( G ) 71.01
    VITAMIN B KOMPLEKS KF ( G ) 142.08
    VITAMIN C INJEKSI 1000 MG NOVELL (G) 27,500.00
    VITAMIN C INJEKSI 500 MG NOVELL (G) 22,000.00
    VITAMIN C TAB. 100 MG KF ( G ) 165.39
    VITAMIN C TAB. 250 MG KF ( G ) 200.20
    VITAMIN C TAB. 50 MG KF ( G ) 42.00
    VITAMIN C TAB. 500 MG PROMED (G) 550.00
    VITAMIN K INJ. INFANT PHAPROS (G) 4,207.50
    WARFARIN TAB. 1 MG EISAI ( G ) 979.00
    ZINK DISPERSIBLE TAB KF ( G ) 253.00
    ZINK SULPHATE SYR. SCAN (G) 3,322.00
    ZINK SULPHATE TAB SCAN (G) 212.00 ZINK SULPHATE TAB
    DM ( G ) 2,007.33

    DM ( G ) 1,245.09

    FAHRENHEIT 1,100.00

    INF (G) 3,080.83

    FAHRENHEIT 1,056.00
    KF ( G ) 416.22
    PHAPROS (G 646.80

    KF ( G ) 230.80
    PROMED (G) 264.00

    BERNOFARM 302.50
    HEXPHARM ( 461.92

    KF ( G ) 4,959.91
    BERNOFARM 4,950.00

    KF ( G )
    INF (G)

    HEXPHARM ( 935.00
    SCAN (G) 500.01
    FAHRENHEIT 1,716.00
    KF ( G ) 216.09
    INF (G) 1,691.65
    TEMPO (G) 95.00
    PHAPROS (G 94.72
    BERNOFARM 711.20

    DM ( G ) 1,007.96
    HEXPHARM ( 476.84
    SCAN (G) 81.00
    KF ( G ) 165.00
    KF ( G ) 53.00
    FAHRENHEIT 990.00
    FAHRENHEIT 990.17
    KF ( G ) 415.90
    HEXPHARM ( 370.00

    BERNOFARM 5,775.00

    GENERIK 210.59
    KF ( G ) 376.63

    HEXPHARM ( 302.51
    DM ( G ) 262.99
    HEXPHARM ( 302.51

    NOVELL (G) 5,060.00


    NOVELL (G) 6,930.00

    DM ( G ) 6,063.75

    DM ( G ) 1,155.00

    DM ( G ) 48,510.00
    PHAPROS (G 34,650.00

    HEXPHARM ( 4,400.00

    DM ( G ) 1,540.00
    FAHRENHEIT 9,900.00

    NOVELL (G) 396.00

    PHAPROS (G 2,356.20

    FAHRENHEIT 550.00
    DM ( G ) 693.00

    HEXPHARM ( 1,210.00
    NOVELL (G) 550.00
    HEXPHARM ( 1,210.00
    FAHRENHEIT 2,321.64
    BERNOFARM 4,950.00
    KF ( G ) 207.64

    INF (G) 2,750.00


    FAHRENHEIT 4,950.00
    BERNOFARM 5,500.00

    DM ( G ) 7,507.48
    NOVELL (G) 5,720.00
    FAHRENHEIT 7,150.07
    YARINDO (G) 4,180.00
    BERNOFARM 7,700.00

    PHAPROS (G 70.83
    DM ( G ) 94.50

    DM ( G ) 144.64
    PHAPROS (G 75.46
    HEXPHARM ( 94.07

    KF ( G ) 840.00
    BERNOFARM 665.50
    DM ( G ) 882.00
    PROMED (G) 803.00

    KF ( G ) 6,395.67
    HEXPHARM ( 8,200.50

    HEXPHARM ( 1,430.00
    DM ( G ) 2,514.37
    NOVELL ( G ) 1,676.21

    DM ( G ) 1,872.05

    DM ( G ) 31,762.50
    NOVELL ( G ) 13,721.40
    HEXPHARM ( 19,800.00

    BERNOFARM 92,950.00
    NOVELL ( G ) 109,725.00

    DM ( G ) 7,276.50
    PHAPROS (G 5,940.00
    HEXPHARM ( 9,350.00
    BERNOFARM 24,200.00
    PHAPROS (G 10,010.00
    BERNOFARM 44,880.00
    DM ( G ) 35,550.90

    PHAPROS (G 11,000.00
    DM ( G ) 9,023.64

    HEXPHARM ( 313.50
    PHAPROS (G 403.33
    INF (G) 317.39

    FAHRENHEIT 10,439.00

    HEXPHARM ( 43,889.85

    NOVELL ( G ) 666.88
    KF ( G ) 462.00
    HEXPHARM ( 473.00
    DM ( G ) 532.17

    HEXPHARM ( 24,000.03

    NOVELL (G) 5,610.00


    BERNOFARM 7,333.33
    HEXPHARM ( 5,500.00
    DM ( G ) 6,930.00

    BERNOFARM 1,400.00
    NOVELL ( G ) 1,540.00

    DM ( G ) 10,394.97
    HEXPHARM ( 5,533.00
    SCAN (G) 462.00
    FAHRENHEIT 8,635.00
    PHAPROS (G 594.00
    KF ( G ) 1,191.67
    PROMED (G) 4,400.00

    INF (G) 5,808.18

    BERNOFARM 5,610.00
    PHAPROS (G 6,655.00

    PROMED (G) 330.00

    KF ( G ) 136.06
    YARINDO 66.55
    PHAPROS (G 117.45
    HARSEN 184.25

    BERNOFARM 1,561.56
    PHAPROS (G 1,098.00
    KF ( G ) 2,299.00

    FAHRENHEIT 26,400.00
    NOVELL (G) 25,300.00
    NOVELL (G) 25,300.00
    ETHICA ( G ) 13,200.00

    NOVELL (G) 2,805.00

    YARINDO (G) 107.25

    DM ( G ) 212.61

    DM ( G ) 60,031.12
    NOVELL (G) 40,810.00

    HEXPHARM ( 12,650.00

    DM ( G ) 423.80
    HEXPHARM ( 286.00
    NOVELL (G) 302.71
    INFION (G) 286.00
    TEMPO (G) 189.00
    DM ( G ) 214.18

    DM ( G ) 528.37

    PHAPROS (G 2,772.00

    PROMED (G) 2,310.00


    DM ( G ) 2,310.01

    DM ( G ) 4,620.00
    PROMED (G) 2,376.00

    NULAB (G) 1,760.00

    DM ( G ) 3,719.10

    KF ( G ) 152.83
    FAHRENHEIT 220.00

    NOVELL 5,775.03
    DM ( G ) 5,775.00

    GENERIK 3,650.90

    KF ( G ) 297.00

    BERNOFARM 644.98
    KF ( G ) 660.02
    HEXPHARM ( 880.00

    KF ( G ) 770.00
    HEXPHARM ( 1,320.00

    KF ( G ) 880.01
    INFION (G) 1,430.00
    HEXPHARM ( 1,760.00
    FAHRENHEIT 385.00

    DM ( G ) 594.74

    HEXPHARM ( 4,666.20
    KF ( G )

    HEXPHARM ( 409.99

    NOVELL (G) 13,365.00


    INF (G) 3,849.12
    PHAPROS (G 1,034.18
    ETHICA ( G ) 2,169.20
    DM ( G ) 8,419.95
    DARYA VARYA 3,960.00

    NOVELL (G) 1,265.00

    HEXPHARM ( 990.00

    DM ( G ) 1,211.38
    KF ( G ) 770.00
    NOVELL ( G ) 1,211.38

    DM ( G ) 92,400.00
    NOVELL ( G ) 88,000.00
    HEXPHARM ( 88,000.00

    DM ( G ) 173,250.00
    HEXPHARM ( 165,000.00

    KF ( G ) 1,392.00
    PHAPROS (G 1,060.49
    DM ( G ) 1,258.95
    NOVELL (G) 959.20
    HEXPHARM ( 770.00

    BERNOFARM 332.11
    HEXPHARM ( 418.00
    INF (G) 337.82

    DM ( G ) 138,600.00

    DM ( G ) 230,997.47
    DM ( G ) 231,000.00
    HEXPHARM ( 110,000.00

    DM ( G ) 190.58
    SCAN (G) 168.75
    HEXPHARM ( 192.50
    HEXPHARM ( 316.80

    MBF ( G ) 23,760.00
    BERNOFARM 49,500.00

    HEXPHARM ( 1,170.00

    HEXPHARM ( 440.56
    DM ( G ) 462.57

    MBF ( G ) 462.00
    PROMED (G) 990.00
    NOVELL (G) 526.50

    DARYA VARIA 8,250.00


    HEXPHARM ( 22,000.00

    BERNOFARM 171.60
    KF ( G ) 281.53
    KF ( G ) 360.95

    KF ( G ) 158.08
    PHAPROS (G 122.58
    KF ( G ) 220.17

    BERNOFARM 36,300.00

    FAHRENHEIT 528.00
    HEXPHARM ( 408.33

    NOVELL (G) 55,000.00


    QUANTUM 27,500.00
    DM ( G ) 78,540.00

    NOVELL ( G ) 7,700.00
    DM ( G ) 5,775.01
    BERNOFARM 8,000.09
    HEXPHARM ( 5,500.00

    NOVELL (G) 18,480.00


    HEXPHARM ( 7,920.00
    NOVELL (G) 18,480.00

    FAHRENHEIT 1,540.00
    NOVELL ( G ) 1,595.00
    DM ( G ) 1,617.03

    INF (G) 2,530.00

    ETHICA ( G ) 2,475.00

    DM ( G ) 57,750.00
    PHAPROS G 13,090.00

    DARYA VARIA 11,990.00


    BERNOFARM 66,000.00
    KF ( G ) 25,410.00
    QUANTUM 22,000.00

    INF (G) 3,850.00


    KF ( G ) 6,050.00
    TEMPO (G) 5,457.00

    BERNOFARM 115.50
    KF ( G ) 274.48
    YARINDO 158.40
    PROMED (G) 197.34
    MBF ( G ) 3,666.67
    DM ( G ) 2,887.51

    BERNOFARM 5,610.00

    HEXPHARM ( 11,000.00
    DM ( G ) 12,572.18

    HEXPHARM ( 1,100.00

    BERNOFARM 578.16
    DM ( G ) 843.16
    PROMED (G) 627.00

    GENERIK 173.25

    KF ( G ) 9,900.00

    DM ( G ) 7,507.50
    YARINDO (G) 5,316.67

    HOLI 71.43

    INF (G) 521.21

    PHAPROS (G 2,448.60
    NOVELL (G) 3,465.00
    NOVELL (G) 3,465.00
    DM ( G ) 2,428.67

    HEXPHARM ( 220.00
    DM ( G ) 231.00
    PHAPROS (G 202.40
    KF ( G ) 462.00
    PHAPROS (G 202.70
    BERNOFARM 165.00
    BERNOFARM 1,815.53

    GENERIK 2,375.08

    YARINDO (G) 79.82


    KF ( G ) 113.28
    PHAPROS (G 78.00

    PHAPROS (G 115.17
    KF ( G ) 142.49

    NOVELL ( G ) 1,716,000.00

    BERNOFARM 307.80
    HEXPHARM ( 297.00
    KF ( G ) 307.99
    SCAN (G) 88.00

    HEXPHARM ( 1,026.67
    KF ( G ) 445.50
    INF (G) 1,100.00
    TEMPO (G) 564.30

    DM ( G ) 23,100.00
    FAHRENHEIT 42,900.00

    PROMED (G)

    DM ( G ) 2,700.55
    PHAPROS (G 462.00
    AKILEN EAR DROPS SANBE FARMA
    ALBUMINAR 25% 100 ML DEXA MEDICA
    ALBUNORM 25% 50 ML INDO FARMA
    ALCO DROPS 15 ML INTERBAT
    ALDISA SR CAPS. SANBE FARMA
    ALEGYSAL TTS MATA FERRON
    ALGANAX TAB. 0.25 MG GUARDIAN
    ALGANAX TAB. 0.5 MG GUARDIAN
    ALLORIS TABLET SANBE FARMA
    ALPENTIN 300 MG ACTAVIS
    AMADIAB 1 LAPI
    AMADIAB 2 LAPI
    AMADIAB 3 LAPI
    AMADIAB 4 LAPI
    AMARYL - M 1 AVENTIS
    AMARYL - M 2 AVENTIS
    AMARYL TAB. 1 MG AVENTIS
    AMARYL TAB. 2 MG AVENTIS
    AMARYL TAB. 3 MG AVENTIS
    AMINEFRON TAB. DEXA MEDICA
    AMINOFUSIN L 600 KALBE FARMA
    AMINOSTERIL INFUS 6% FRESENIUS
    AMOXAN DROPS SANBE FARMA
    ANADEX TAB. INTERBAT
    ANADIUM CAPS GUARDIAN
    ANALSIK TAB SANBE FARMA
    ANALSPEC 500 MG METISKA FARMA
    ANALTRAM CAPS LAPI
    ANBACIM INJ. SANBE FARMA
    ANESFAR INJ. FAHRENHEIT
    ANTI BISA ULAR BIO FARMA
    ANTIPLAT 50 MG INMARK
    ANVOMER B6 TAB. DEXA MEDICA
    APIALYS DROPS LAPI
    APIALYS SYR. LAPI
    ARIXTRA INJ. 2.5 MG TANABE ABADI
    ARKINE SYR PYRIDAM
    ARKINE TABLET PYRIDAM
    ARTIMAX CAPS. LANDSON
    ASAM VALPROIC SYR. 250 MG DEXA MEDICA
    ASCARDIA TAB 80 MG PHAROS
    ASEDAS SYR. PYRIDAM
    ASPILETS TBL. MEDIFARMA
    ASTHAROL SYR SANBE FARMA
    ASTHAROL TABLET SANBE FARMA
    ASTHIN FORCE Kaps 6 mg NOVELL
    ASTRIA KAPSUL 4 MG LANDSON
    ATEVIR TAB. 0.5 MG DEXA MEDICA
    ATOFAR 10 FAHRENHEIT
    ATOFAR 20 FAHRENHEIT
    ATOFAR 40 FAHRENHEIT
    AZOMAX CAPS DEXA MEDICA
    AZOMAX SYR DEXA MEDICA
    B FLUID 500 ML OTSUKA
    BACTRAZ INJ. OTTO
    BACTRIM SYR 50 ML ROCHE
    BAMGETOL 200 MG MERSIFARMA
    BAQUINOR 0.3% EYE DROPS SANBE FARMA
    BECEFORT SYR 60 ML PHAPROS
    BECEFORT TAB. PHAPROS
    BECOM C CAPLET SANBE FARMA
    BECOM ZET CAPLET SANBE FARMA
    BEDAK SALYCIL 100 GRM KIMIA FARMA
    BENACOL DTM SYRUP 60 ML DANKOS
    BENACOL SYRUP 100 ML DANKOS
    BENACOL SYRUP 60 ML DANKOS
    BETASON-N CREAM KIMIA FARMA
    BIO ATP TAB. BIO FARMA
    BIOPLACENTON YELLY 15 GR KALBE FARMA
    BIOSANBE CAP. SANBE FARMA
    BIOTHICOL CAPS 500 MG SANBE FARMA
    BIOTHICOL SYR SANBE FARMA
    BIOXON INJ OTTO
    BISOLVON ELIX 125 ML BOEHRINGER
    BISOLVON INJ. BOEHRINGER
    BLEDSTOP INJ CAPRIFARMINDO
    BLESIFEN TAB CAPRIFARMINDO
    BLOCAND 16 MG PYRIDAM
    BLOCAND 8 MG PYRIDAM
    BLOPRES TAB. 16 MG TAKEDA
    BLOPRES TAB. 16 MG PLUS TAKEDA
    BLOPRES TAB. 8 MG TAKEDA
    BNS ( BREATHY NASAL SPRAY ) NOVELL
    BRAXIDIN TABLET SANBE FARMA
    BREATHY TETES HIDUNG NOVELL
    BRONCHOPRONT SYR. COMBIPHAR
    BUNASCAN SPINAL 0.5% FAHRENHEIT
    BURNAZIN CREAM TUBE 35 GR DARYA VARIA
    BURNAZIN PLUS 25 GR DARYA VARIA
    BUSCOPAN TABLET BOEHRINGER
    CALGAE CAPS FAHRENHEIT
    CALOS CAPS FAHRENHEIT
    CALTRAX TABLET PYRIDAM
    CANDEFION TABLET 16 MG INFION
    CANDEFION TABLET 8 MG INFION
    CANDERIN TAB. 16 MG DEXA MEDICA
    CANDERIN TAB. 8 MG DEXA MEDICA
    CANDOTENS 16 MG NOVELL
    CANDOTENS 8 MG NOVELL
    CARDIO ASPIRIN BAYER
    CARMED 10% SDM
    CARMED 20% SDM
    CARMED CREAM 10% SDM
    CARMED CREAM 20% SDM
    CARTYLO TAB. 80 MG KIMIA FARMA
    CATAFLAM TABLET 25 MG NOVARTIS
    CATAFLAM TABLET 50 MG NOVARTIS
    CATHEJELL 12,5 GR KALBE FARMA
    CEBEX CAPS. OTTO
    CEDOCARD INJ DARYA VARIA
    CELEBREX CAPS. 100 MG PFIZER
    CELEBREX CAPS. 200 MG PFIZER
    CENDO ASTHENOF 5 CC CENDO
    CENDO AUGENTONIC 5 ML CENDO
    CENDO AUGENTONIC MD. 0.6 ML CENDO
    CENDO CARPINE 1% 5 ML CENDO
    CENDO CARPINE 2% 5 ML CENDO
    CENDO CATERLENT 15 ML CENDO
    CENDO CATERLENT 5 ML CENDO
    CENDO CATERLENT MD 0.6 ML CENDO
    CENDO CENFRESH 5 ML CENDO
    CENDO CENFRESH MD 0.6 ML CENDO
    CENDO CITROL EYE DROPS CENDO
    CENDO CITROL EYE OINT CENDO
    CENDO CITROL MD 0.6 ML CENDO
    CENDO EYEFRESH DROPS 0.5 ML CENDO
    CENDO EYEFRESH MD. 0.6 ML CENDO
    CENDO FENECOL 0.5 EYE DROPS CENDO
    CENDO FENECOL EYE OINT 3.5 GR CENDO
    CENDO FLOXA ED. 5 ML CENDO
    CENDO FLOXA MINIDOSE CENDO
    CENDO GENTA SALAP MATA CENDO
    CENDO HYALUB 5 ML CENDO
    CENDO HYALUB MD. 0.6 ML CENDO
    CENDO LFX 5 ML CENDO
    CENDO LFX MINIDOSE CENDO
    CENDO LYTEERS 15 CC CENDO
    CENDO LYTEERS MD. 0,6 ML CENDO
    CENDO MYDRIATYL MINIDOSE CENDO
    CENDO MYDRIATYL TM CENDO
    CENDO PANTOCAIN EYE DROPS 0.5% CENDO
    CENDO PANTOCAIN EYE DROPS 2% CENDO
    CENDO PANTOCAIN EYE DROPS 2% CENDO
    CENDO PROTAGENTA EYE DROP CENDO
    CENDO PROTAGENTA MD 0.6 ML CENDO
    CENDO TIMOL 0.5% ED. 0.6 ML CENDO
    CENDO TIMOL TETES MATA 0.25% CENDO
    CENDO TIMOL TETES MATA 0.5% CENDO
    CENDO VASACON 15 ML CENDO
    CENDO VASACON ED. MINIDOSE CENDO
    CEPTIK 200 MG INTERBAT
    CEPTIK DRY. SYRUP INTERBAT
    CERINI CAPS. SANBE FARMA
    CERINI DROP SANBE FARMA
    CERINI SYR SANBE FARMA
    CETIRGI SYR. OTTO
    CETIRGI TAB. OTTO
    CHANNA CAPS. 500 MG MYLAN
    CLAMIXIN SYR OTTO
    CLAMIXIN FT SYR OTTO
    CLANEKSI TAB. SANBE FARMA
    CLIAD TAB INTERBAT
    CODEIN 10 MG KIMIA FARMA
    CODEIN 20 MG KIMIA FARMA
    CODIKAF 10 MG KIMIA FARMA
    CODIKAF 20 MG KIMIA FARMA
    CODIPRONT CUM CAPS KIMIA FARMA
    CODIPRONT SYR. KIMIA FARMA
    COLERGIS SYR DEXA MEDICA
    COLERGIS TAB DEXA MEDICA
    COLSANCETINE INJ SANBE FARMA
    COMBIVENT NEB. BOEHRINGER
    COMTUSI STRAWBERRY SYR 60 ML COMBIPHAR
    COMTUSI SYR 100 ML COMBIPHAR
    COMTUSI SYR 60 ML COMBIPHAR
    CONCOR TAB. 10 MG MERCK
    CORMEGA CAPS. LANDSON
    CORTAMINE SYR 60 ML INTERBAT
    CORTAMINE TABLET INTERBAT
    CORTIDEX INJEKSI SANBE FARMA
    CROME INJ 50 MG FERRON
    CURCUMA SANBE TAB SANBE FARMA
    CURFOS SYR. 100 ML INTERBAT
    CURVIT CL EMULSION SYR. SOHO
    CURVIT SYR. 120 ML SOHO
    CURVIT SYR. 60 ML SOHO
    DAKTARIN DIAPER YUPHARIN
    DEXTAFEN CAPS. OTTO
    DEXTAMIN SYR 60 ML PHAPROS
    DEXTAMIN TAB/300 PC PHAPROS
    DEXTROSE 10% 500 ML OTSUKA
    DEXTROSE 10% 500 ML OTSUKA
    DEXTROSE 40% INJ. 25 ML OTSUKA
    DEXTROSE 5% 500 ML WIDATRA
    DEXTROSE 5% 500 ML OTSUKA
    DEXTROSE 5% 500 ML ( GLUCOSE UNICEFWIDATRA
    DEXTROSIN SYR. 120 ML OTTO
    DEXYCLAV FORTE CAPS. 500 MG DEXA MEDIKA
    DEXYMOX FORTE CAPSUL DEXA MEDIKA
    DIABION CAPSUL METISKA FARMA
    DIAFORMIN XR OTTO
    DIAFORMIN XR OTTO
    DOGESIC 500 MG YARINDO
    DOM SYR LAPI
    DOM TB LAPI
    DOME DROPS PROMED
    DOME SYR. PROMED
    DOME TAB PROMED
    DOMINAL DROPS ACTAVIS
    DOMINAL SYR 60 ML ACTAVIS
    DOMINAL TAB ACTAVIS
    DOPACEF INJEKSI SANBE FARMA
    DOPAMET TAB ACTAVIS
    DULCOLAX SUPP 5 MG BOEHRINGER
    DULCOLAX SUPP ADULT 10 MG BOEHRINGER
    DULCOLAX TAB 5 MG BOEHRINGER
    DUMIN SYRUP ACTAVIS
    DUROGESIC MATRIX 12 ug/h JANNSEN
    DUROGESIC MATRIX 25 ug/h JANNSEN
    DUROGESIC MATRIX 25 ug/h JANNSEN
    ECOSOL GLUCOSE 10% 500 ML B/BROUN
    ECOSOL GLUCOSE 5% 100 ML B/BROUN
    ECOSOL GLUCOSE 5% 500 ML B/BROUN
    ECOSOL NACL 0,9% 100 ML B/BROUN
    ECOSOL NACL 0,9% 1000 ML B/BROUN
    ECOSOL NACL 0,9% 500 ML B/BROUN
    ECOSOL RL 500 ML B/BROUN
    EDOTIN CAPS FERRON
    ELKANA CL EMULSION 120 ML SANBE FARMA
    ELKANA CL EMULSION 60 ML SANBE FARMA
    ELKANA TAB. SANBE FARMA
    ELPICEF INJ FAHRENHEIT
    ELSAZYM SACHET @ 5gr OTTO
    EPEXOL DROP 15 MG SANBE FARMA
    EPEXOL SYRUP 15 MG SANBE FARMA
    EPEXOL TABLET 30 MG SANBE FARMA
    EPISAN SYR. 100 ML SANBE FARMA
    EPISAN SYR. 200 ML SANBE FARMA
    EPRINOC TABLET SANBE FARMA
    EPSONAL TAB PYRIDAM
    ERDOBAT CAPSUL INTERBAT
    ERICAF TAB ROCHE
    ERLAMYCETIN SALEP MATA ERLA
    ERLAMYCETIN TTS MATA ERLA
    ERYSANBE CAPS. 500 MG SANBE FARMA
    ERYSANBE SYR. SANBE FARMA
    ESPERSON CR 5 GR AVENTIS
    EUPHYLIN RETARD TAB. PHAROS
    EUTHYROX 100 MG MERCK
    EUTHYROX 50 MG MERCK
    EXFORGE 10/160 TAB NOVARTIS
    FALERGI TAB FAHRENHEIT
    FARBION INJ FAHRENHEIT
    FARBION TAB FAHRENHEIT
    FARBIVENT FAHRENHEIT
    FARGOXIN TAB. FAHRENHEIT
    FARGOXIN TAB. FAHRENHEIT
    FARMACROL FORTE TABLET FAHRENHEIT
    FARMADOL INFUS FAHRENHEIT
    FARMADRAL TAB. 10 MG FAHRENHEIT
    FARMAVON INJEKSI 4MG/2ML FAHRENHEIT
    FARMAVON SYR 100 ML FAHRENHEIT
    FARSIX INJ FAHRENHEIT
    FARSORBID 5 MG FAHRENHEIT
    FARSORBID INJ. FAHRENHEIT
    FARTOLIN EXP.SYR 100 ML FAHRENHEIT
    FENDEX INJEKSI FAHRENHEIT
    FENTANYL INJ. 0.05 MG JANNSEN
    FERIZ DROPS NICHOLAS
    FEROSPAT TABLET PYRIDAM
    FG TROCHES LOZENGES MEIJI
    FINPRO TAB INTERBAT
    FLAMAR ZALF 20 GR SANBE FARMA
    FLAMICORT INJ. 10 MG DEXA MEDICA
    FLIXOTIDE NEB. 0.5 MG GLAXO
    FOLAC TAB OTTO
    FOLAVICAP 400 MG CAPRIFARMINDO
    FOLAVIT TAB. 1000 MG SANBE FARMA
    FOLAVIT TAB. 400 MG SANBE FARMA
    FORMOM TABLET PYRIDAM
    FORMOM TABLET PYRIDAM
    FORMUNO CAPS SANBE FARMA
    FOROTIC 3MG / 5ML KALBE FARMA
    FORRES TABLET 50 MG KALBE FARMA
    FORTANES INJ. 15 MG / 3 ML KALBE FARMA
    FORTANES INJ. 5 MG / 3 ML KALBE FARMA
    FORUMEN EYE DROPS 10 ML SANBE FARMA
    FUSON CREAM PYRIDAM
    FUSYCOM CREAM COMBIPHAR
    FUTADERM CREAM SANBE FARMA
    FUTROLIT INF SANBE FARMA
    FUTROLIT INF SANBE FARMA
    GABAXA INFUS 100 ML FAHRENHEIT
    GALVUS MET 50/500 MG NOVARTIS
    GALVUS MET 50/850 MG NOVARTIS
    GARDASIL INJ. 0.5 ML MSD
    GELAFUSAL INF 500 ML DEXA MEDICA
    GERDILIUM DROPS OTTO
    GITAS INJEKSI INTERBAT
    GLAUCON TAB 250 MG CENDO
    GLAUSETA TAB. SANBE FARMA
    GLUVAS 4 MG DEXA MEDICA
    GRANOPI CAPS. 1 MG OTTO
    GRATIZIN 10 MG SANBE FARMA
    GRATIZIN 5 MG SANBE FARMA
    HARNAL OCAS ASTELLAS
    HARNAL D 0,2 MG ASTELLAS
    HEMAPO INJ KALBE FARMA
    HEPA - Q CAPS PYRIDAM
    HEPAGUSAN INJEKSI SANBE FARMA
    HI BONE E 300 OTTO
    HI BONE E 600 OTTO
    HISTIGO TAB IFARS
    HUMAN ALBUMIN 20% 50 ML PHARMASOLINDO
    HUMAN ALBUMIN 20% 50 ML DEXA MEDICA
    HYSTOLAN TABLET DEXA MEDICA
    IMBOOST CAPS. SOHO
    IMBOOST FORCE SYR. SOHO
    IMBOOST FORTE CAPS. SOHO
    IMBOOST KIDS SYR. SOHO
    IMBOOST SYR. SOHO
    IMMU-CEA SYR. INTERBAT
    IMUDATOR TABLET PYRIDAM
    INDEXON INJ INTERBAT
    INDOP INJ FAHRENHEIT
    INFANRIX HEXA GLAXO
    INFUSAN D10 500 ML SP SANBE FARMA
    INFUSAN D5 100 ML SANBE FARMA
    INFUSAN D5 500 ML SP SANBE FARMA
    INFUSAN M20 500 ML SANBE FARMA
    INFUSAN NS 100 ML SP SANBE FARMA
    INFUSAN NS 1000 ML SP SANBE FARMA
    INFUSAN NS 500 ML SP SANBE FARMA
    INFUSAN RING AS 500 ML SP SANBE FARMA
    INFUSAN RL 500 ML SP SANBE FARMA
    INFUSAN RL 500 ML SP SANBE FARMA
    INFUSAN WATER FOR IRIGATION 1 LTR SANBE FARMA
    INTERLAC STICK PACK 0.3 GR INTERBAT
    INTERLAC TAB. KUNYAH STRAWBERY INTERBAT
    INTERMOXIL SYR INTERBAT
    INTERMOXIL SYR.
    INTERPECT SYR. 15 ML INTERBAT
    INTERPECT SYR. 30 ML INTERBAT
    INTERVASK 10 MG INTERBAT
    INTERVASK 5 MG INTERBAT
    INTRIZIN SYR. INTERBAT
    INTRIZIN TABLET INTERBAT
    INVICLOT INJ. FAHRENHEIT
    INVOMET TAB. 4 MG INTERBAT
    INVOMET TAB. 8 MG INTERBAT
    ISORIC 300 TAB INTERBAT
    ISOTIC ADRETOR 0.5 FAHRENHEIT
    KA-EN 3A 500 ML OTSUKA
    KALNEX TABLET 250 MG KALBE FARMA
    KALNEX TABLET 500 MG KALBE FARMA
    KALTROFEN SUPP. KALBE FARMA
    KAMAFLAM TABLET 50 MG KIMIA FARMA
    KANDISTATIN DROPS METISKA FARMA
    KARY UNI 5 ML FERRON
    KENALOG IN ORBASE CREAM SQIBB
    KETESSE INJ- FERRON
    KETESSE TAB. FERRON
    KETOCID CAPS PYRIDAM
    KETOSTERIL FRESENIUS
    KETRICIN ORABASE 0.1% 5 GR FERRON
    KETROBAT INJ INTERBAT
    KIDIMUN SYR. 60 ML PYRIDAM
    KSR 600 MG MERCK
    L - BIO LAPI
    L – ZINC SYR. 100 ML LAPI
    LABUMIN CAPS. LAPI
    LACTAFAR FAHRENHEIT
    LACTO B NOVELL
    LANAKELOID E CREAM 10 GR LANDSON
    LANAVISION CAPS. LANDSON
    LANFIX CAPS. 100 MG LANDSON
    LANFIX CAPS. 200 MG LANDSON
    LANFIX SYR. LANDSON
    LANTULOS SYR. 60 ML LANDSON
    LASAL EXP. SYR. 100 ML LAPI
    LASAL SYR. 100 ML LAPI
    LASIX INJ.20MG/2CC AVENTIS
    LASIX TAB. 40 MG AVENTIS
    LATROPIL SYR. 100 ML LAPI
    LAXADIN SYR. 110 ML YUPHARIN
    LAXADIN SYR. 60 ML YUPHARIN
    LESICHOL CAPS 300 MG LANDSON
    LESICHOL CAPS 600 MG LANDSON
    LEVAZIDE TAB PYRIDAM
    LEVEMIR FLEXPEN NOVO NORDISK
    LEVOCIN EYE DROPS SANBE FARMA
    LIDODEX INJ BERNOFARM
    LIDODEX INJ BERNOFARM
    LIFITOR TAB 20 MG PFIZER
    LIFITOR TAB 40 MG PFIZER
    LIPROQY TAB CAPRIFARMINDO
    LODIA TABLET 2 MG SANBE FARMA
    LUBIRE CAPS. PYRIDAM
    LUBIRE SYR. 60 ML PYRIDAM
    LYVIT SYR 60 ML INTERBAT
    MAGTRAL SYR 120 ML OTTO
    MANNITOL 20% 500 ML KALBE FARMA
    MEDSCAB CREAM SDM
    MEDSCAB LOTION SDM
    MEFINAL CAPS. 250 MG SANBE FARMA
    MEFINAL CAPS. 500 MG SANBE FARMA
    MEGABAL TABLET SANBE FARMA
    MEYLON INJ. OTSUKA
    MGSO4 40% 25 ML OTSUKA
    MICARDIS PLUS 40 BOEHRINGER
    MICARDIS PLUS 80 BOEHRINGER
    MICROGYEST 100 MG LAPI
    MICROGYEST 200 MG LAPI
    MINIASPI 80 MG MERSIFARMA
    MINOSEP 150 ML PROMED
    MINOSEP 60 ML PROMED
    MUCERA DROPS OTTO
    MUCERA SYR 15 MG / 60 ML OTTO
    MUCERA SYR 30 MG / 60 ML OTTO
    MUCERA TAB OTTO
    MUCOS DROPS MEPROFARM
    MYOBAT TABLET INTERBAT
    MYONAL TAB. EISSAI
    MYONEP TAB LAPI
    NEO GYNOXA OVULA KALBE FARMA
    NEO KAOLANA SYR SANBE FARMA
    NEO KAOLANA SYR SANBE FARMA
    NEO MERCAZOL TAB. NICHOLAS
    NEUROBION 5000 TABLET SALUT MERCK
    NEUROBION FORTE CAPS. 5.000 MG MERCK
    NEUROBION INJ. 5000 ML MERCK
    NEURODEX TABLET DEXA MEDICA
    NEURODIAL TAB KIMIA FARMA
    NEUROMED 5000 MG PROMED
    NEUROSANBE 5000 MG SANBE FARMA
    NEUROSANBE INJ. SANBE FARMA
    NEUROSANBE TABLET SANBE FARMA
    NEUROTAM SYR. 100 ML DANKOS
    NEW DIATABS TAB MEDIFARM
    NITROKAF RETARD CAPS KIMIA FARMA
    NITROKAF RETARD FORTE CAPS KIMIA FARMA
    NITROKAF RETARD FORTE CAPS KIMIA FARMA
    NOCID KAPLET KALBE FARMA
    NOVA T ( 5TH ) BAYER
    NOVOMIX FLEXPEN NOVO NORDISK
    NOVORAPID FLEXPEN NOVO NORDISK
    NYNDIA DROPS GUARDIAN
    NYSTIN DROPS 12 ML LAPI
    OFERLOD TAB. 500 MG NOVELL
    OPICEF FORTE SYR 60 ML OTTO
    OPICEF SYR 60 ML OTTO
    OPICORT TAB. 4 MG OTTO
    OPILAX SYR. 60 ML OTTO
    OPIMER INJ. 1 GR OTTO
    OPIMOX FORTE SYR 250 ML OTTO
    OPIMOX SYR 125 ML OTTO
    OPIMOX TABLET 500 MG OTTO
    OPINACEA CAPS. OTTO
    OPINEURON TAB OTTO
    OPIVASK 10 MG OTTO
    ORASIC CAPS. OTTO
    ORINOX tab. 60 MG DEXA MEDICA
    OSTARIN FORTE SYR. OTTO
    OSTARIN SYR. OTTO
    OSTEOR C CREAM PYRIDAM
    OSTEOR PLUS CAPS. PYRIDAM
    OTILON TETES TELINGA 8 ML SANBE FARMA
    OTTOGENTA CREAM OTTO
    OTTOGENTA INJ OTTO
    OTTOPAIN EAR DROPS INTERBAT
    OTTOPAN DROPS OTTO
    OTTOPAN SYR OTTO
    PAMOL DROPS INTERBAT
    PAMOL SYR. 60 ML INTERBAT
    PEINLOS 400 INJ. FAHRENHEIT
    PIBAKSIN SALEP 10 GR SANBE FARMA
    PIROFEL GEL SANBE FARMA
    PIROTOP CREAM 10 MG SDM
    PLASBUMIN 20% 20 ML DIPA
    PLASMINEX INJ. SANBE FARMA
    POLIDEMISIN EYE DROPS SANBE FARMA
    POLIDEMISIN SALEP MATA SANBE FARMA
    PREABOR TAB. CAPRIFARMINDO
    PREDNICORT 4 MG OTTO
    PREDNICORT 8 MG OTTO
    PRONALGES SUPP. DEXA MEDICA
    PROPEPSA SYR 100 ml GRACIA
    PROPEPSA SYR 200 ml GRACIA
    PRORIS SYR PHAPROS
    PRORIS SYR FORTE PHAPROS
    PROSINAL SYR GRACIA
    PROTERINE INJ NOVELL
    PROTERINE TAB NOVELL
    PROTOP CAPS INTERBAT
    PSIDII SYR 60 ML DEXA MEDICA
    PUMPITOR CAPS SANBE FARMA
    PUMPITOR INJ. SANBE FARMA
    REBAL PLUS FAHRENHEIT
    RECO SALEP MATA GMP
    RECO TETES MATA GMP
    RECO TETES TELINGA GMP
    RECUSTEIN CAPS LANDSON
    RECUSTEIN SYR LANDSON
    REGUMEN TAB CAPRIFARMINDO
    RENAPAR TABLET FAHRENHEIT
    RENOSAN INFUS 500 ML SANBE FARMA
    RESFAR INFUS 25 ML FAHRENHEIT
    RETAPHYL SR. CAPL. KIMIA FARMA
    RETIVIT PLUS CAPS SANBE FARMA
    RHINOFED SYR DEXA MEDICA
    RHINOFED TAB. DEXA MEDICA
    RHINOS NEO DROPS DEXA MEDICA
    RHINOS SR CAPS DEXA MEDICA
    RHINOS SYR JUNIOR DEXA MEDICA
    RINDOBION 5000 MG YARINDO
    RINGER LACTATE 500 ML EMJEBE

    ROFIDEN SUPS OTTO


    RYZODEG FLEX TOUCH NOVO NORDISK
    RZ-20 SYR. 60 ML PYRIDAM
    SAGESTAM INJ. SANBE FARMA
    SALOFALK SOFT. CAPS.500 MG DARYA VARIA
    SALTICIN CREAM INTERBAT
    SALTICIN INJ. INTERBAT
    SANADRYL DMP SYR. 120 ML SANBE FARMA
    SANADRYL DMP SYR. 60 ML SANBE FARMA
    SANADRYL SYRUP 120 ML SANBE FARMA
    SANADRYL SYRUP 60 ML SANBE FARMA
    SANBE HEST SANBE FARMA
    SANBE TEARS SANBE FARMA
    SANFULIQ TABLET SANBE FARMA
    SANGOBION DROP MERK
    SANMAG SYR SANBE FARMA
    SANMOL DROPS SANBE FARMA
    SANMOL FORTE SYR. SANBE FARMA
    SANMOL FORTE TAB. SANBE FARMA
    SANMOL SYR SANBE FARMA
    SANMOL TAB. SANBE FARMA
    SANORIN HIJAU 200 ML SANBE FARMA
    SANORIN HIJAU 80 ML SANBE FARMA
    SANPICILLIN INJ SANBE FARMA
    SANSULIN LOG-G SANBE FARMA
    SCABICID CREAM KIMIA FARMA
    SCABIMITE CREAM GALANIUM
    SEDACUM INJ. 15 MG / 3 ML DEXA MEDICA
    SEDACUM INJ. 5 MG / 5 ML DEXA MEDICA
    SERETIDE DISKUS 250 MCG GLAXO
    SERETIDE DISKUS 500 MCG GLAXO
    SERETIDE DISKUS100 MCG GLAXO
    SIFROL 0.125 MG BOEHRINGER
    SIKSTOP TABLET FAHRENHEIT
    SIMARC 2 MG TAB FAHRENHEIT
    SIRDALUT TAB. 2 MG NOVARTIS
    SIRPLUS RASA ANGGUR MEPROFARM
    SIRPLUS RASA JERUK MEPROFARM
    SIRPLUS RASA MELON MEPROFARM
    SIRPLUS RASA STROBERY MEPROFARM
    SOD. NATR. CL. 3% 500 ML OTSUKA
    SOD.CHLORET NATR. 100 ML OTSUKA
    SOD.CHLORET NATR. 500 ML WIDATRA

    SOJOURN 250 ML FAHRENHEIT


    SOTATIC INJEKSI FAHRENHEIT
    SPASMOMEN TAB. DEXA MEDICA
    SPORETIK KAPS. 100MG ( 30/BOX ) SANBE FARMA
    SPORETIK KAPS. 200 MG ( 10/BOX ) SANBE FARMA
    SPORETIK SYR. SANBE FARMA
    STESOLID RECTAL 10 MG ACTAVIS
    STESOLID RECTAL 5 MG ACTAVIS
    STOLAX SUPP 10 MG SANBE FARMA
    SULDOX TAB. ACTAVIS
    SYMBICORT 160, 60 DOSE ASTRA ZENECA
    SYMBICORT 80, 60 DOSE ASTRA ZENECA
    TARIVID OPTH SOL ( MATA ) FERRON
    TARIVID OTIC 50 LOTION ( TELINGA ) KALBE FARMA
    TEBOKAN SPESIAL PHAPROS
    TEBOKAN TAB. PHAPROS
    TENSIVAKS TAB. 5 MG DEXA MEDICA
    TENSIVAKS TAB.10 MG DEXA MEDICA
    TERFACEF INJ 1 GR SANBE FARMA
    TETAGAM INJ. DEXA MEDIKA
    THYAMYCIN FORTE SYR 60 ML INTERBAT
    THYAMYCIN SYR 60 ML INTERBAT
    THYROZOL 10 MG MERCK
    THYROZOL 5 MG MERCK
    TIARYT TAB. FAHRENHEIT
    TIM OPHTAL TTS MATA 0.25% SANBE FARMA
    TIM OPHTAL TTS MATA 0.5% SANBE FARMA
    TISMAZOL 500 MG METISKA FARMA
    TOBROSAN 5 CC CENDO
    TOBROSAN MD 0.6 ML CENDO
    TOBROSAN MD 0.6 ML CENDO
    TORAMINE INJ 30 MG OTTO
    TORAMINE TAB.10 MG OTTO
    TORAMINE TAB.10 MG OTTO
    TRADOSIK CAPS. SANBE FARMA
    TRADOSIK INJ. SANBE FARMA
    TRADYL TABLET INTERBAT
    TREMENZA SYR. SANBE FARMA
    TREMENZA TAB SANBE FARMA
    TRICHODAZOLE 500 TABLET SANBE FARMA
    TRICHODAZOLE PLUS OVULA SANBE FARMA
    TRIDEX 27A 500 ML SANBE FARMA
    TRIFED SYR INTERBAT
    TRIFED TAB. INTERBAT
    TRIFEDRIN SYR. OTTO
    TRIFEDRIN TAB. OTTO
    TRIZEDON MR SERVIER
    TROGYL INFUS 500 MG / 100 ML OTTO
    TROGYL SYR OTTO
    TROGYL TABLET OTTO
    TROGYSTATIN OVULA OTTO
    TROLAC INJ BERNOFARM
    TROLIP TAB 100 MG DEXA MEDICA
    TROLIP TAB 300 MG DEXA MEDICA
    TROVENSIS INJ. 2ML SANBE FARMA
    TROVENSIS INJ. 4ML SANBE FARMA
    TROVENSIS TABLET 4 MG SANBE FARMA
    TROVENSIS TABLET 8 MG SANBE FARMA
    ULVICE INJ. LANDSON
    UNALIUM 10 TAB GUARDIAN
    UNALIUM 5 TAB GUARDIAN
    URESIX INJ. SANBE FARMA
    UTROGESTAN 100 MG LAPI
    UTROGESTAN 200 MG LAPI
    VALEPTIK SYR OTTO
    VALISANBE 2 MG SANBE FARMA
    VALISANBE 5 MG SANBE FARMA
    VALISANBE INJ. 2 ML SANBE FARMA
    VALKENE SYR. 120 ML LANDSON
    VARDIPIN 5/80 OTTO
    VAROC TAB 500 MG PYRIDAM
    VASOLA INJ FAHRENHEIT
    V-BLOC 6,25 KALBE FARMA
    VECTRINE CAPS. 300 MG DEXA MEDICA
    VECTRINE SYR. DEXA MEDICA
    VELTHROM 10 MG NOVELL
    VELTHROM 5 MG NOVELL
    VENTOLIN NEBULES 2.5 MG GLAXO
    VERTIGOSAN TABLET SANBE FARMA
    VESTEIN CAPS.300 MG @30 KALBE FARMA
    VESTEIN SYR. KALBE FARMA
    VIOXY FM TABLET FAHRENHEIT
    VITAMULTI DHA CAPS OTTO
    VITROLENTA EYE DROPS CENDO
    VOLTAREN EMULGEL 10 GR NOVARTIS
    VOLTAREN EMULGEL 20 GR NOVARTIS
    VOLTAREN EMULGEL 5 GR NOVARTIS
    VOLTAREN EMULGEL 50 GR NOVARTIS
    VOLTAREN TAB 50 MG NOVARTIS
    VOMEGO INJ.4 MG/2ML OTTO
    VOMEGO TAB. 4 MG OTTO
    VOMETA DROPS DEXA MEDICA
    VOMETA FT TAB. 10 MG DEXA MEDICA
    VOMETA SYRUP 60 ML DEXA MEDICA
    WATER FOR INJEKSI 25 ML OTSUKA
    WATER STERIL / AQUADEST 1 LITER WIDATRA

    XEPAMOL DROPS METISKA FARMA


    XEPAMOL SYR. 250 / 5 ML METISKA FARMA
    XEPAMOL TABLET 500 MG METISKA FARMA
    XYLOCAINE JELLY 2% 30 GRM ASTRA ZENECA
    ZANIC SYR 100 ML NICHOLAS
    ZIBAC INJ. 1 GR FAHRENHEIT
    ZIBRAMAX 500 MG GUARDIAN
    ZIBRAMAX DRY SYR GUARDIAN
    ZINCPRO DROPS 15 ML COMBIPHAR
    ZINKID SYR INDO FARMA
    ZISTIC SYR BERNOFARM
    ZYCIN TABLET 500 MG INTERBAT
    RINGER LACTATE 500 ML WIDATRA
    RINGER LACTATE 500 ML OTSUKA
    RINGER LACTATE 500 ML KIMIA FARMA
    SOD.CHLORET NATR. 500 ML OTSUKA
    SOD.CHLORET NATR. 500 ML EMJEBE
    WATER STERIL / AQUADEST 1 LITER OTSUKA
    AGTIFA- IOL POSTERIOR CHAMBER 19 AGTIFA
    AGTIFA- IOL POSTERIOR CHAMBER 19.50 AGTIFA
    AGTIFA- IOL POSTERIOR CHAMBER 20.00 AGTIFA
    AGTIFA- IOL POSTERIOR CHAMBER 20.50 AGTIFA
    AGTIFA- SAFETY CREASENT KNIFE AGTIFA
    AGTIFA- SAFETY SLIT KNIFE AGTIFA
    AGTIFA- SAFETY STAB KNIFE AGTIFA
    AGTIFA- TRYPAN BLUE AGTIFA
    AGTIFA- VISCO AGTIFA
    ALCOHOL SWABS REMEDI

    APRON ONEMED
    BAJU OPERASI ( KIT CESAREAN ) MAESINDO

    BAJU OPERASI ( UNIVERSAL SET ) SOLIDA


    BANDANA CAP GREEN ONEMED

    BANDANA CAP ONEMED


    BANDANA CAP GREEN @ 100 SINAR OGAN
    BLOOD TRANFUSION SET GEA

    CATGUT CHROMIC 0 HR 37 B/BROUND


    CATGUT CHROMIC 2/0 HR 37 MM SMI
    CATGUT CHROMIC 2/0 TP 37 MM 90 CM ATRAMAT
    CATGUT PLAIN NO. 0 HR 37 B/BROUND
    CATGUT PLAIN NO. 2/0 HR 37 SMI
    COMBO KATETERISASI 16 PRO DIVICE
    COMBO KATETERISASI 18 PRO DIVICE
    COMBO PACK 24+SPALK (makro) PRO DIVICE
    COMBO PACK BS 18 PRO DIVICE
    COMBO PACK BS 20 PRO DIVICE
    COMBO PACK NPNW 20 GSTC PRO DIVICE
    COMBO PACK NPNW 22 GSTC PRO DIVICE
    CORE ELECTRODE 2670 ONEMED
    CORE ELECTRODE 2670 ONEMED
    CORE ELECTRODE 2670 ONEMED
    CUP SAMPLE @ 1000 HUMAN
    CURVED HAEMODIALYSIS CATH. KIT APPROVED
    DARYANTULLE DARYA VARYA
    DERMAFIX 10 X 25 CM ONEMED
    DERMAFIX 10 X 25 CM ONEMED
    DISCOFIX 3 WAY LUER LOCK 10 CM B/BRAUN
    DISCOFIX 3 WAY STOPCOCK BLUE B/BRAUN
    DISPOSIBLE / NEEDLE 25 G ONEMED

    DISPOSIBLE / NEEDLE 26 G ONE MED


    DISPOSIBLE / NEEDLE 26 G 1/21 TAN BD
    DISPOSIBLE SYRINGE UK. 1 CC BD

    DISPOSIBLE SYRINGE UK. 10 NIPRO

    DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONE MED

    DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) AXIMED

    DISPOSIBLE SYRINGE UK. 3 BD

    DISPOSIBLE SYRINGE UK. 5 NIPRO

    DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) B/BROUND

    DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) ONEMED


    ENDOTRACHELA TUBE CUFFED 2.5 RUSCH
    ENDOTRACHELA TUBE CUFFED 3.0 REMEDI

    ENDOTRACHELA TUBE CUFFED 3.5 BICAKCILAR

    ENDOTRACHELA TUBE CUFFED 4.0 BICAKCILAR

    ENDOTRACHELA TUBE CUFFED 4.5 AXIMED

    ENDOTRACHELA TUBE CUFFED 5.0 BICAKCILAR


    ENDOTRACHELA TUBE CUFFED 5.5 RUSCH

    ENDOTRACHELA TUBE CUFFED 6.0 REMEDI


    ENDOTRACHELA TUBE CUFFED 6.5 BICAKCILAR

    ENDOTRACHELA TUBE CUFFED 7.0 BICAKCILAR

    ENDOTRACHELA TUBE CUFFED 7.5 BICAKCILAR

    ENDOTRACHELA TUBE CUFFED 8.0 RUSCH


    ENDOTRACHELA UNCUF 2.5 IDEALCARE
    ENDOTRACHELA UNCUF 3.0 IDEALCARE

    ENDOTRACHELA UNCUF 3,5 IDEALCARE


    ENDOTRACHELA UNCUF 4,0 IDEALCARE

    ENDOTRACHELA WIRE 5 REINFOR SMI

    ENDOTRACHELA WIRE 6 REINFOR SMI

    ENDOTRACHELA WIRE 6.5 REINFOR SMI

    EXTENDED UFE PH TRANSFER XXX

    FACE MASK TALI PREMIUM SINAR OGAN


    FACE MASK TALI HIJAP PREMIUM SINAR OGAN
    FACE MASK EARLOOP SOLMED
    FACE MASK 3M

    FEEDING TUBE FR. 5 . 100 CM ONEMED

    FEEDING TUBE FR. 5 . 40 CM TERUMO

    FEEDING TUBE NO. 3,5 35 CM TERUMO


    FEEDING TUBE NO. 8 100 CM TERUMO

    FEEDING TUBE NO. 8 40 CM ONEMED

    FILM ISLAND DRESSING 10X25CM ( dermafik ) WINNER


    FILM X RAY 24 X 30 FUJI
    FILM X RAY 30 X 40 FUJI
    FILM X RAY 30 X 40 FUJI
    FILM X RAY 35 X 35 FUJI
    FILM X RAY 35 X 35 FUJI
    FILM X RAY 35 X 43 FUJI
    FILM X RAY 35 X 43 FUJI
    FIXOMULL 76992-01 (10 CM X 5M) BSN
    FIXOMULL 76993-01 ( 5 CM X 5M) BSN
    FOLLEY CATHETER NO. 14 WELL LEAD

    FOLLEY CATHETER NO. 16 ONEMED

    FOLLEY CATHETER NO. 18 ONEMED

    FOLLEY CATHETER NO. 20 RUSCH


    FOLLEY CATHETER THREE WAY 18 REMEDI
    FOLLEY CATHETER THREE WAY 20 RUSCH
    FOLLEY CATHETER THREE WAY 22 NORTA
    FOLLEY CATHETER THREE WAY 24 REMEDI
    FRAMYCETIN SULFATE DARYA VARYA
    FREESTYLE LANCET KIT @ 100 ABBOT
    FREESTYLE LANCET KIT @ 100 ABBOT
    FREESTYLE OPTIUM BG STRIP @ 25 ABBOT
    FREESTYLE OPTIUM NEO BG ( ALAT ) ABBOT
    FREESTYLE OPTIUM NEO H BG @ 100 ABBOT
    FREESTYLE OPTIUM NEO H BG @ 100 ABBOT
    GELANG Adult ( PINK ) WRITE ON ONEMED

    GELANG Adult BLUE (Write On) ONEMED

    GELANG Adult RED (Insert Card) REMEDI


    GELANG Adult UNGGU (Insert Card) REMEDI
    GELANG Adult YELLOW (Insert Card) ONEMED

    GELANG BAYI / ANAK BIRU ONEMED

    GELANG BAYI / ANAK PINK COSMOMED

    GLYCO 1 HRS 48 USP, 100 CM BIOMED


    GLYCO 2 HRS 48 USP, 100 CM BIOMED
    GLYCO 2-0 HR 26 USP. 70 CM BIOMED
    GLYCO 3-0 HR 26 USP, 70 CM BIOMED
    GLYCO USP 3-0 DS 24 MM, 70 CM VIOLA BIOMED
    GLYCO 4-0 HR 26 USP. 70 CM BIOMED
    GUEDEL AIRWAY 1 ( 70 MM ) BESMED
    GUEDEL AIRWAY 2 ( 70 MM ) BESMED
    GUEDEL AIRWAY 3 ( 90 MM ) FORSCH
    GUEDEL AIRWAY 3 ( 90 MM ) BESMED
    GUEDEL AIRWAY 4 ( 100 MM ) BESMED
    GUEDEL AIRWAY 5 ( 100 MM ) BESMED

    GUEDEL AIRWAY 0 ( 60 MM ) BESMED


    GUEDEL AIRWAY CLEAR NO. 1 RUSCH
    GUEDEL AIRWAY CLEAR NO. 3 RUSCH

    GUEDEL AIRWAY CLEAR NO. 4 RUSCH

    GUEDEL AIRWAY CLEAR NO. 5 ONEMED


    GUEDEL AIRWAY CLEAR NO. 6 RUSCH
    GUEDEL NO. 00 SHILEY
    GUEDEL RED NO. 0 RUSCH
    GUEDEL RED NO. 1 RUSCH
    GUEDEL RED NO. 3 RUSCH
    GUEDEL RED NO. 4 RUSCH
    GUEDEL RED NO. 5 RUSCH
    GYNECOLOGY SET GNS-2109 HOGY
    HD ~ DIACAN ARTERIAL G16. 30 MM B/BRAUN
    HD ~ DIACAN ARTERIAL G16. 30 MM B/BRAUN
    HD ~ DIACAP LOPS 15 PS DIALYSATC B/BRAUN
    HD ~ DIACAP LOPS 15 PS DIALYSATC B/BRAUN
    HD ~ DIALOG BLOODLINE ARTERIAL B/BRAUN
    HD ~ DIALOG BLOODLINE ARTERIAL B/BRAUN
    HD ~ HD. CONC. ACIDIC HDM 303 10 LTR. B/BRAUN
    HD ~ HD. CONC. ACIDIC HDM 303 10 LTR. B/BRAUN
    HD ~ SOL CART B B/BRAUN
    HD ~ SOL CART B B/BRAUN
    HOGI ~ SHOE COVER SR-SC-41E HOGY
    HOGI ~ SURG. GOWN ( L ) SG-SMS13K HOGY
    HOGI ~ SURG. GOWN ( XL ) SG-SMS15K HOGY
    HOGI ~ UNIVERSAL SET USP-2101 HOGY
    HYPAFIX 10 CM X 5 CM BSN
    INFUSION NEEDLE 18 INTROCAN SAFETY B BRAUN
    INFUSION NEEDLE 18 ABBOCATH ABBOT
    INFUSION NEEDLE 18 INFLO ONEMED
    INFUSION NEEDLE 18 AXIMED AXIMED
    INFUSION NEEDLE 18 INTROCAN SAFETY B BRAUN
    INFUSION NEEDLE 18 NIPRO NIPRO
    INFUSION NEEDLE 18 OPTIVA JOHNSON
    INFUSION NEEDLE 18 STERACATH STERRA
    INFUSION NEEDLE 18 STERACATH STERRA
    INFUSION NEEDLE 18 SURFLO TERUMO
    INFUSION NEEDLE 18 CATHPRO CATH PRO
    INFUSION NEEDLE 2 22G OPTIVA JOHNSON
    INFUSION NEEDLE 20 ABBOCATH ABBOT
    INFUSION NEEDLE 20 INFLO GEA
    INFUSION NEEDLE 20 INFLO ONEMED
    INFUSION NEEDLE 20 INFLO ONEMED
    INFUSION NEEDLE 20 INFLO ONEMED
    INFUSION NEEDLE 20 INTROCAN SAFETY B BRAUN
    INFUSION NEEDLE 20 NIPRO NIPRO
    INFUSION NEEDLE 20 OPTIVA JOHNSON
    INFUSION NEEDLE 20 GEA GEA
    INFUSION NEEDLE 20 OTCUCATH OTSUKA
    INFUSION NEEDLE 20 STERACATH STERRA
    INFUSION NEEDLE 20 STERACATH GEA
    INFUSION NEEDLE 20 SURFLO TERUMO
    INFUSION NEEDLE 20 CATHPRO CATH PRO
    INFUSION NEEDLE 22 ABBOCATH ABBOT
    INFUSION NEEDLE 22 AXIMED AXIMED
    INFUSION NEEDLE 22 INFLO ONEMED
    INFUSION NEEDLE 22 INTROCAN SAFETY B BRAUN
    INFUSION NEEDLE 22 NIPRO NIPRO
    INFUSION NEEDLE 22 OPTIVA JOHNSON
    INFUSION NEEDLE 22 OTCUCATH OTSUKA
    INFUSION NEEDLE 22 STERACATH STERRA
    INFUSION NEEDLE 22 SURFLO TERUMO
    INFUSION NEEDLE 22 GEA GEA
    INFUSION NEEDLE 22 AXIMED AXIMED
    INFUSION NEEDLE 22 CATHPRO CATH PRO
    INFUSION NEEDLE 24 ABBOCATH ABBOT
    INFUSION NEEDLE 24 AXIMED AXIMED
    INFUSION NEEDLE 24 INFLO ONEMED
    INFUSION NEEDLE 24 INFLO ONEMED
    INFUSION NEEDLE 24 INTROCAN SAFETY B BRAUN
    INFUSION NEEDLE 24 NIPRO NIPRO
    INFUSION NEEDLE 24 GEA GEA
    INFUSION NEEDLE 24 OPTIVA JOHNSON
    INFUSION NEEDLE 24 OTCUCATH OTSUKA
    INFUSION NEEDLE 24 STERACATH STERRA
    INFUSION NEEDLE 24 SURFLO TERUMO
    INFUSION NEEDLE 24 CATHPRO CATH PRO
    INFUSION NEEDLE 26 ABBOCATH ABBOT
    INFUSION NEEDLE 26 AXIMED GEA
    INFUSION NEEDLE 26 INFLO ONEMED
    INFUSION NEEDLE 26 NIPRO STERRA
    INFUSION NEEDLE 26 STERACATH STERRA
    INFUSION NEEDLE 26 SURFLO TERUMO
    INFUSION SET ANAK ( Mikrodrip ) TERUMO

    INFUSION SET DEWASA STERA

    INJECTIONN PAD 36 MM NICHIBAN


    KAPSUL KOSONG NO.0 LOKAL
    KAPSUL KOSONG NO.00 BRATACO
    KAPSUL KOSONG NO.00 LOKAL
    KAPSUL KOSONG NO.1 BRATACO
    KAPSUL KOSONG NO.2 LOKAL
    KAPSUL KOSONG NO.2 LOKAL
    KAPSUL KOSONG NO.3 LOKAL
    KAPSUL KOSONG NO.3 BRATACO
    KARTU GOLONGAN DARAH DALF
    KARTU GOLONGAN DARAH FREE DALF
    KASA HYDROPHYL 40 Yard X 80 CM ONEMED

    KASA KOMPRES STERIL 16 X16 ONEMED

    LEUKOMED T PLUS 10 X 25 CM BSN


    LEUKOMED T PLUS 10 X 25 CM BSN
    LEUKOMED T PLUS 8 X 15 CM BSN
    LEUKOMED-IV 72389-00 BSN
    LEUKOPLAST UK. 2,5 x 5 (1624H) BSN
    LEUKOPLAST UK. 4,5 x 5 (1624H) BSN
    LINA PEN ( PENSIL WHOLSTER ) COVIDEN
    LINA PEN SINGLE USE 516 PRO DIVICE
    LOMATULE PRO DIVICE
    MEDICRAPE 10 X 4.5 ONEMED
    MEDICRAPE 10 X 4.5 ONEMED
    MEDICRAPE 15 X 4.5 ONEMED
    MEDICRAPE 15 X 4.5 ONEMED
    MEDICRAPE 7.5 X 4.5 ONEMED
    MEDICRAPE 7.5 X 4.5 ONEMED
    MICRO FINE 0.25mm (31G) x 5mm ONEMED
    MICRO FINE 8 MM BD
    MICROBURET ( MICRODRIP FOR ST503 ) TERUMO
    MICROPORE 1/2 " / ISOPORE 1/2 " ONEMED
    MICROPORE 1/2 " / ISOPORE 1/2 " 3M
    MICROPORE 1/2 " / ISOPORE 1/2 " 3M
    MICROPORE / PAPER TAPE DISP. 1" 3M
    MICROPORE 1 " / ISOPORE 1 " 3M
    MICROPORE 2 " / ISOPORE 2 " 3M
    MICROPORE 2 " / ISOPORE 2 " ONEMED
    NANOPASS 32. 5G TERUMO
    NEBULIZER MASK ADULT WITH CHAMBER ONEMED
    NEBULIZER MASK ADULT WITH CHAMBER GEA
    NEBULIZER MASK CHILD WITH CHAMBER AXIMED
    NEBULIZER MASK CHILD GEA
    NEBULIZER MASK ADULT WITH CHAMBER AXIMED
    NON WOVEN FIXATION 10 X 10 AXIMED
    NON WOVEN FIXATION 15 X 10 AXIMED
    NOVOTWIST 32 G NOVONORDISK
    NOVOTWIST 32 G NOVONORDISK
    PARAFILM 4" 125 FTM CUP WOOD
    PAPER USG 110 HG TYPE V SONY
    PAPER USG 110 HG TYPE V SONY
    PERFUSOR TUB. WHITE 150 CM B/BRAUN
    PERFUSOR TUB. WHITE 150 CM B/BRAUN
    PHARMAFIX 5 CM X 5 MTR PHARMAPLAST
    PLESTERAN BULAT @ 200 ONEMED
    PLESTERAN BULAT SOFT @ 200 ONEMED
    POT ZALF 100 GR LOKAL
    POT ZALF 20 GR LOKAL
    POT ZALF 20 GR LOKAL
    POT ZALF 30 GR LOKAL
    POT ZALF 50 GR LOKAL
    POT ZALF 50 GR LOKAL
    POT ZALF 50 GR LOKAL
    PPH STAPLER 33 ATRAMAT
    PRECISION INFANT THERMAL BLUE MEXICO
    PRECISION INFANT THERMAL PINK MEXICO
    RUBBER HAND GLOVE NO. 6,0 TROGE

    RUBBER HAND GLOVE NO. 6,5 B/BRAUN

    RUBBER HAND GLOVE NO. 7 WRP

    RUBBER HAND GLOVE NO. 7,5 TROGE

    RUBBER HAND GLOVE NO. 8 TROGE

    SCALPEL BLADE BB- 510 AESCULAP

    SCALPEL BLADE BB- 511 AESCULAP

    SCALPEL BLADE BB- 515 AESCULAP

    SCALPEL BLADE BB- 520 AESCULAP

    SCALPEL BLADE BB- 522 GEA

    SELANG O2 ANAK ONEMED


    SELANG O2 BAYI ONEMED

    SELANG O2 DEWASA BESMED

    SELANG O2 DEWASA UK. L AXIMED


    SELANG O2 DEWASA UK. M AXIMED
    SELANG O2 DEWASA UK. XS AXIMED
    SENSIPED ALAS POPOK L SENSI
    SHOES COVER NON WOVEN ONEMED
    SHOES COVER NON WOVEN ONEMED
    SHOES COVER NON WOVEN ONEMED
    SHOES COVER GREEN REMEDI
    SIMP. MASK NON REBR. M ( DEWASA ) BESMED

    SIMP. MASK NON REBR. S ( ANAK ) REMEDI

    SOFRATULLE AVENTIS
    SOFTCLIX LANCET UNO 200 ROCHE
    SOFTCLIX STANDART ACCUCHEK BOEHRINGER
    SPINOCAN 25G X 3 1/2 " EGEMEN

    SPINOCAN 26G X 3 1/2 " EGEMEN

    SPINOCAN 27G X 3 1/2 " B/BRAUN


    SPINOCAN / SPINAL 25G X 3 1/2 " EGEMEN
    SPINOCAN / SPINAL 26G X 3 1/2 " EGEMEN
    STOMACH TUBE NO.16 ONEMED

    STOMACH TUBE NO.18 TERUMO

    SUCTION CATHETER NO. 12 COSMOMED

    SUCTION CATHETER NO. 14 REMEDI

    SUCTION CATHETER NO. 16 ONE MED

    SUCTION CATHETER NO. 8 STERRA

    SUNGKUP OXYGEN ANAK ONE MED

    SUNGKUP OXYGEN BAYI BESMED


    SUNGKUP OXYGEN BAYI ONEMED
    SUNGKUP OXYGEN DEWASA ONEMED
    SUNGKUP OXYGEN DEWASA COSMOMED
    SUNGKUP OXYGEN DEWASA ONE MED
    SURGICAL GLOVE UK. L ONE MED
    SURGICAL GLOVE UK. L PUREGLOVE
    SURGICAL GLOVE UK. L ALTAMED
    SURGICAL GLOVE UK. L AXIMED
    SURGICAL GLOVE UK. L PUREGLOVE
    SURGICAL GLOVE UK. L HAND SEAL
    SURGICAL GLOVE UK. M ALTAMED
    SURGICAL GLOVE UK. M SHAMROCK
    SURGICAL GLOVE UK. M HAND SEAL
    SURGICAL GLOVE UK. M SAFEGLOVE
    SURGICAL GLOVE UK. M PUREGLOVE
    SURGICAL GLOVE UK. M AXIMED
    SURGICAL GLOVE UK. S SAFEGLOVE
    SURGICAL GLOVE UK. S PUREGLOVE
    SURGICAL GLOVE UK. S ALTAMED
    SURGICAL GLOVE UK. S AXIMED
    SURGICAL GLOVE UK. S REMEDI
    SURGICAL GLOVE UK. XS ALTAMED
    SURGICRYL 910 1 HR 48 MM SMI
    SURGICRYL 910 2 HR 45 MM SMI
    SURGICRYL 910 2 HR 48 MM SMI
    SURGICRYL 910 3/0 HR 26 MM SMI
    SURGICRYL 910 2/0 HR 40 MM SMI
    SURGICRYL 910 3/0 DS 24 MM SMI
    SURGICRYL 910 2/0 HR 26 MM SMI
    SURGICRYL 910 4/0 HR 17 MM SMI
    SURGICRYL 910 5/0 HR 17 MM SMI
    SURGI-FIX 10 CM X 10 MTR YAFHO
    SURGI-FIX 5 CM X 10 MTR YAFHO
    TABUNG VTM SIGPRO
    TABUNG VTM ALTAMED
    TERMAL PAPER UTK. ECG 215 MM X 25 M ONE MED
    TERMAL PAPER UTK. ECG 215 MM X 25 M SONOMED
    MICRO FINE 4 MM BD
    THERASORB 10 X10 CM X 0.5 CM WONBIOGEN
    THERASORB C 10 X10 CM X 0.5 CM WONBIOGEN
    THREE WAY STOPCOCK ONE MED
    THREE WAY STOPCOCK ONE MED
    THREE WAY STOPCOCK AXIMED
    TRACHEOSTOMY CUFFED 6.5 SURGIKA
    TRANSFIX HF 10 CM X 10 MTR YAFHO
    TRANSFIX HF 5 CM X 10 MTR YAFHO
    MIROTAINER K2 EDTA BD
    MOUTH PIECE 2.5 CM LOKAL
    MULTIPLE NEEDLE FLASHBACK 22G BD
    ULTRA~FINE 0.23 mm ( 32G ) X 4 mm BD
    ULTRAFIC 10 CM X 500 CM ONE MED
    ULTRAFIC 10X1000 CM( NON WOVEN FIXATION AXIMED
    ULTRAFIC 15 CM X 500 CM ONE MED
    ULTRAFIC 5 CM X 500 CM ONE MED
    UMBILICAL KLAMP ONE MED
    UMBILICAL KLAMP ONE MED
    UMBILICAL KLAMP ONE MED
    URINE BAG AXIMED
    URINE BAG TROGE
    URINE BAG ONE MED
    URINE BAG GETINGE
    UROGARD PLUS TERUMO
    VASELIN SWAB 10 X 10 SMI
    VICRYL RAP UND 90 CM 2/0 ETHICON
    ALCOHOL SWABS ONE MED
    ALCOHOL SWABS AXIMED
    ALCOHOL SWABS ALTAMED

    BAJU OPERASI ( KIT CESAREAN ) SMI

    BANDANA CAP GREEN SOLIDA


    BANDANA CAP GREEN ONEMED
    BANDANA CAP GREEN ONEMED

    BLOOD TRANFUSION SET NIPRO


    BLOOD TRANFUSION SET TERUMO
    BLOOD TRANFUSION SET STERRA

    DISPOSIBLE / NEEDLE 25 G BD
    DISPOSIBLE SYRINGE UK. 1 CC TERUMO
    DISPOSIBLE SYRINGE UK. 1 CC STERRA
    DISPOSIBLE SYRINGE UK. 1 CC NIPRO
    DISPOSIBLE SYRINGE UK. 1 CC ONE MED
    DISPOSIBLE SYRINGE UK. 1 CC AXIMED

    DISPOSIBLE SYRINGE UK. 10 BD


    DISPOSIBLE SYRINGE UK. 10 STERRA
    DISPOSIBLE SYRINGE UK. 10 ONEMED
    DISPOSIBLE SYRINGE UK. 10 AXIMED
    DISPOSIBLE SYRINGE UK. 10 ONEMED

    DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONE MED


    DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONE MED
    DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) TERUMO
    DISPOSIBLE SYRINGE UK. 20 ( CENTRIC ) ONEMED

    DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) TERUMO


    DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) NIPRO
    DISPOSIBLE SYRINGE UK. 20 ( ECCENTRIC ) ONEMED

    DISPOSIBLE SYRINGE UK. 3 STERRA


    DISPOSIBLE SYRINGE UK. 3 ONEMED
    DISPOSIBLE SYRINGE UK. 3 ONEMED
    DISPOSIBLE SYRINGE UK. 3 ONEMED
    DISPOSIBLE SYRINGE UK. 3 KIMSMED
    DISPOSIBLE SYRINGE UK. 3 ONEMED

    DISPOSIBLE SYRINGE UK. 5 STERRA


    DISPOSIBLE SYRINGE UK. 5 BD
    DISPOSIBLE SYRINGE UK. 5 TERUMO
    DISPOSIBLE SYRINGE UK. 5 ONEMED
    DISPOSIBLE SYRINGE UK. 5 AXIMED

    DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) ONEMED


    DISPOSIBLE SYRINGE UK. 50 ( L.PINGGIR) AXIMED

    DISPOSIBLE SYRINGE UK. 50 ( L.TENGAH) NIPRO

    ENDOTRACHELA TUBE CUFFED 3.0 BICAKCILAR


    ENDOTRACHELA TUBE CUFFED 3.5 AXIMED

    ENDOTRACHELA TUBE CUFFED 3.5 REMEDI

    ENDOTRACHELA TUBE CUFFED 4.0 RUSCH

    ENDOTRACHELA TUBE CUFFED 4.5 REMEDI

    ENDOTRACHELA TUBE CUFFED 5.5 BICAKCILAR

    ENDOTRACHELA TUBE CUFFED 6.0 SMI


    ENDOTRACHELA TUBE CUFFED 6.0 RESOURCES
    ENDOTRACHELA TUBE CUFFED 6.5 AXIMED

    ENDOTRACHELA TUBE CUFFED 7.0 AXIMED

    ENDOTRACHELA TUBE CUFFED 7.5 AXIMED

    ENDOTRACHELA UNCUF 2.5 BICAKCILAR


    ENDOTRACHELA UNCUF 3.0 BICAKCILAR

    ENDOTRACHELA UNCUF 4,0 SMI

    ENDOTRACHELA WIRE 5 REINFOR BICAKCILAR

    ENDOTRACHELA WIRE 6 REINFOR BICAKCILAR

    ENDOTRACHELA WIRE 6.5 REINFOR BICAKCILAR

    FACE MASK ONEMED


    FACE MASK BAYMED
    FACE MASK ONEMED
    FACE MASK SEVEN
    FACE MASK SENSI
    FEEDING TUBE FR. 5 . 100 CM AXIMED
    FEEDING TUBE FR. 5 . 100 CM TERUMO

    FEEDING TUBE FR. 5 . 40 CM ONEMED

    FEEDING TUBE NO. 8 100 CM ONEMED


    FEEDING TUBE NO. 8 100 CM AXIMED

    FEEDING TUBE NO. 8 40 CM TERUMO


    FEEDING TUBE NO. 8 40 CM COSMOMRD
    FOLLEY CATHETER NO. 14 NORTA
    FOLLEY CATHETER NO. 14 RUSCH

    FOLLEY CATHETER NO. 16 RUSCH

    FOLLEY CATHETER NO. 18 RUSCH


    FOLLEY CATHETER NO. 18 NORTA
    FOLLEY CATHETER NO. 18 AXIMED
    FOLLEY CATHETER NO. 18 ONEMED

    GELANG Adult ( PINK ) WRITE ON COSMOMED

    GELANG Adult BLUE (Write On) REMEDI

    GELANG Adult YELLOW (Insert Card) REMEDI

    GELANG BAYI / ANAK BIRU COSMMOMED


    GELANG BAYI / ANAK BIRU ONEMED
    GELANG BAYI / ANAK BIRU GC

    GELANG BAYI / ANAK PINK ONEMED


    GELANG BAYI / ANAK PINK GC

    GUEDEL AIRWAY 4 ( 100 MM ) FORSCH


    GUEDEL AIRWAY 5 ( 110 MM ) FORSCH

    GUEDEL AIRWAY CLEAR NO. 3 AXIMED

    GUEDEL AIRWAY CLEAR NO. 4 ONEMED


    INFUSION SET ANAK ( Mikrodrip ) AXIMED
    INFUSION SET ANAK ( Mikrodrip ) AML-MEDDIS
    INFUSION SET ANAK ( Mikrodrip ) STERA
    INFUSION SET ANAK ( Mikrodrip ) ONEMED

    INFUSION SET DEWASA ONEMED


    INFUSION SET DEWASA ONEMED
    INFUSION SET DEWASA AML-MEDDIS
    INFUSION SET DEWASA AXIMED
    INFUSION SET DEWASA OTSUKA
    KASA HYDROPHYL 40 Yard X 80 CM DRC
    KASA HYDROPHYL 40 Yard X 80 CM CIPTA NIAGA
    KASA HYDROPHYL 40 Yard X 80 CM HEXA HUSADA

    KASA KOMPRES STERIL 16 X16 HEXA HUSADA


    RUBBER HAND GLOVE NO. 6,5 MAXTER
    RUBBER HAND GLOVE NO. 6,5 SHAMROCK
    RUBBER HAND GLOVE NO. 6,5 REMEDI

    RUBBER HAND GLOVE NO. 7 SHAMROCK


    RUBBER HAND GLOVE NO. 7 TROGE
    RUBBER HAND GLOVE NO. 7 MAXTER
    RUBBER HAND GLOVE NO. 7 ANSELL

    RUBBER HAND GLOVE NO. 7,5 MAXTER


    RUBBER HAND GLOVE NO. 7,5 REMEDI
    RUBBER HAND GLOVE NO. 7,5 SHAMROCK
    RUBBER HAND GLOVE NO. 7,5 MAXTER

    RUBBER HAND GLOVE NO. 8 MAXTER


    RUBBER HAND GLOVE NO. 8 GAMMEX
    RUBBER HAND GLOVE NO. 8 WRP
    RUBBER HAND GLOVE NO. 8 ANSELL
    RUBBER HAND GLOVE NO. 8 SHAMROCK

    SCALPEL BLADE BB- 510 GEA


    SCALPEL BLADE BB- 510 B/BRAUN

    SCALPEL BLADE BB- 511 GEA


    SCALPEL BLADE BB- 511 B/BRAUN

    SCALPEL BLADE BB- 515 GEA


    SCALPEL BLADE BB- 515 B/BRAUN

    SCALPEL BLADE BB- 520 GEA


    SCALPEL BLADE BB- 520 B/BRAUN

    SCALPEL BLADE BB- 522 B/BRAUN

    SELANG O2 ANAK RHEMEDY


    SELANG O2 ANAK AXIMED
    SELANG O2 BAYI GEA

    SELANG O2 DEWASA BURBLE


    SELANG O2 DEWASA ONEMED

    SIMP. MASK NON REBR. M ( DEWASA ) GEA


    SIMP. MASK NON REBR. M ( DEWASA ) ONEMED

    SIMP. MASK NON REBR. S ( ANAK ) ONEMED

    SPINOCAN 25G X 3 1/2 " B/BRAUN

    SPINOCAN 26G X 3 1/2 " B/BRAUN

    STOMACH TUBE NO.16 TERUMO


    STOMACH TUBE NO.16 ONE MED

    STOMACH TUBE NO.18 TERUMO


    STOMACH TUBE NO.18 ONEMED
    STOMACH TUBE NO.18 ONEMED

    SUCTION CATHETER NO. 12 AXIMED


    SUCTION CATHETER NO. 12 REMEDI
    SUCTION CATHETER NO. 12 ONE MED

    SUCTION CATHETER NO. 14 AXIMED

    SUCTION CATHETER NO. 16 COSMOMED


    SUCTION CATHETER NO. 16 REMEDI

    SUCTION CATHETER NO. 8 ONE MED


    SUCTION CATHETER NO. 8 AXIMED
    SUCTION CATHETER NO. 8 RHEMEDY

    SUNGKUP OXYGEN ANAK RHEMEDY

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