No REQUEST DESCRIPTION ITEM NO

1 Pen Light 02-000954

2 Glucotest 02-000849
3 Blood Pressure 02-003676
4 Gloves Sterile 02-002136
5 Thermometer 02-002513
6 Stetoscope 02-001242
7 Pulse Oximetry 02-002904
8 Wooden tongue depressor 02-001472
9 Mask CPR Pocket Mask 02-003458
10 Resusitator Adult Manual (BVM) 02-001062
11 Oropharyngeal Airway Size 3 02-001786
12 Oropharyngeal Airway Size 4 02-000549
13 Nasopharyngeal Airway Size 6 02-000797
14 Nasopharyngeal Airway Size 7 02-000798
15 Magil Forceps Adult 02-002363

16 Rescue Pump/Handle Complete Ambu 02-001282

17 Laryngeal Mask (LMA) Size 3 02-003847

18 Laryngeal Mask (LMA) Size 5 02-000676
19 Laryngoscope Adult Riester 02-000683
20 ETT Disp w/o Cuff Sizxe 6 02-000318
21 ETT Disp w/o Cuff Sizxe 7 02-000318
22 ETT Disp w/o Cuff Sizxe 8 02-000320
23 Supporting devices
24 Stylet ET Tube for Adult (Size M) 02-001273
25 KY Gel 01-005537
26 ET Tube Holder 02-001669
& Bite Block NEW ITEM
27 Ambu Tube check B CAT#172002
28 Syringe 20 CC 02-001410
29 Suction Catheter 02-001277
30 Oxygen Delivery System
31 Nasal Oxygen Canulla Adult 02-000793
32 Oxygen Mask Adult 02-000915
33 Rebreathing Mask Adult 02-002532
34 Non Rebreathing Mask Adult 02-002508
35 Oxygen tubing 02-000921
36 Surgical Airway Kit
37 Sterile Scalpel with Handle No. 15 02-001134
38 Sterile Scalpel with Handle No. 21 02-001135
39 Mosquito Clamp Straight 02-000771
40 Artery Clamp 14 cm 02-000079
41 Portex Mini Trach II Seldinget Kit 02-003843
42 Sterile Swab 02-003605
43 Solution Administration Set Adult 02-003779
44 Blood Admin Set 02-000121
45 Surflo Flash 14 02-001294
46 Surflo Flash 16 02-001295
47 Surflo Flash 18 02-001296
48 Surflo Flash 20 02-001297
49 Opsite Post Opp 6.5 x 5 cm 02-000897

50 BD Sharp Disposal Container 02-002915

51 Touniquet 02-001474

52 Gelofusin 500 cc 01-004853

53 Dextrose/Glucose 5% 500 cc 01-004845

54 NaCl 0.9% 500 cc 01-006251
55 NaCl 25 cc 01-005969
56 Aqua Bidest pro Inj 25 mL 01-004616
57 Ringer Lactate 500 cc 01-005970
58 Disposables for Injection
59 Syringe 1 mL 02-001409
60 Syringe 3mL 02-001411
61 Syringe 5 mL 02-001412
62 Syringe 10 mL 02-001408
63 Syringe 20 mL 02-001410
64 Syringe 50 mL 02-001413
65 Needle Sterile 18G 02-000832
66 Needle Sterile 23 G 02-000837
67 Tranexamic acid 500 mg 01-006644
68 Dexamethasone 0.5 mg 01-001935
69 Aspirin 500 mg 01-000818
70 Plavix 75 mg 01-000806
71 ISDN SL 5 mg 01-000499
72 Ventolin Inhaler 100 mg 01-005668
73 Norit 125 mg 01-005644
74 Ranitidine 150 mg 01-006546
75 Loperamide 2 mg 01-006773

76 Dramasine 50 mg 01-001859

77 Paracetamol 500 mg 01-001330

78 Ibuprofen 200 mg 01-001584
Cafergot (ergotamin 1 mg Caffeine 100
79 mg) n/a

80 Loratadine 10 mg 01-006575

81 Tranexamic acid Ampoule 500 mg/5 cc item baru

82 Adrenalin 0.1% Ampoule 01-005234

83 Cordarone 150mg/3 mL Ampoule 01-000478

84 Atropine Sulfas 0.25mg 1 mL Ampoule 01-006353

85 Solumedrol 125 mg vial n/a

86 Dopamine Amp 200 mg 10 mL 01-006539

87 Lasix 20 mg/2 mL Amp 2 mL 01-000708
88 Xylocain 2% 20 mL 01-004334
89 Xylocain 10% Spray 50 mL 01-004330
90 Dextrose 40% sol 25 mL 01-003386
91 Primperan Ampoule 2 mL 01-000296
92 Buscopan inj Ampoule 20 mg/mL 01-000339
Phenergan Ampoule 2 mL/Promethazine
93 n/a
Imp
94 Stesolid 10 mg/2 mL 01-001695
95 Morphine HCl 10 mg Ampoule n/a
96 Dormicum 5 mg/5 mL n/a
97 Tramadol Inj Amp 50 mg n/a
98 Nokoba 0.4/2 mL Ampoule n/a
99 Micropore 1 Inch 02-002111
100 Bandages 02-003491
101 Combine dressing 10 x 20 cm 02-002432
Oval Eye Pad - Opticlude 3M Nexcare
102 1539 02-000374

103 Gauze Pad 6.5 x 7 cm 02-002733

104 Wound dressing No. 15 02-001600

105 Povidon Iodine Solution 60 mL 01-006063
106 Mitela (Triangular Bandage) - L 02-000769
107 Asherman Chest Seal 02-001855
108 Steri-Strip Skin Closure 02-001226
109 Elastic Bandage 4" 02-001435
110 Elastic Bandage 6" 02-001436
111 Scissor 14 cm 02-001149
112 Medical Waste Biohazard Plastic Bag 02-003376
113 Burnazin 01-005353
114 Burnshield Dressing 10 x 10 02-000145
115 Burnshield Dressing 20 x 20 02-000147
116 Folley Balon Cath. CH 14 02-000433
117 Folley Balon Cath. CH 16 02-000434
118 Folley Balon Cath. CH 18 02-000435
119 Syringe 20 mL 02-001410
120 Urine Bag Sterile Adult 02-001519
121 Underpad Disposable 60 x 60 02-001511
122 Stomach Tube FR 12 02-001257
123 Stomach Tube FR 14 02-001258

124 Unsterile Gloves Size M or L 02-003599

125 Syringe 5O mL 02-001413

126 Stifneck Select Adjustable Adult 02-001250
127 Splint 02-001597
128 Thermal Blanket 02-000606
Long Spine Board GEA - Tandu
129
Emergency
130 Tas Emergency
Basket Stretcher single +strapping -
129
Tandu Basket Split Emergency

129 Scoop Strecher GEA - Tandu Emergency

 MP DESCRIPTION QTY UOM CODE
PENLIGHT PCS/1 1 PCS
NESCO MULTICHECK 3in1 (GCU/N-01) BOX/1 1 UNIT
OMRON DIGITAL TENSIMETER HEM 8712 UNIT/1 1 UNIT
GLOVES STERIL ANSELL GAMMEX # 7.5 BOX/50 1 PAIR
OMRON DIGITAL PENCIL THERMOMETER MC-341 UNIT/1 1 UNIT
STETOSCOPE ABN PCS/1 1 UNIT
PULSE OXYMETER SONOSAT-F04T GC UNIT/1 1 UNIT
TONGUE BLADE WOODEN PACK/50 1 BOX
MASK POCKET BESMED PCS/1 1 PCS
RESUSCITATOR ADULT MANUAL SET/1 1 PCS
GUEDEL AIRWAYS DISPOSIBLE 3 #100-322-099 PCS/1 1 PCS
GUEDEL AIRWAYS DISPOSIBLE 4 #100-322-100 PCS/1 1 PCS
NASOPHARYNGEAL AIR WAY PORTEX 6.0 PCS/1 1 PCS
NASOPHARYNGEAL AIR WAY PORTEX 7.0 PCS/1 1 PCS
FORCEP MAGIL PCS/1 1 PCS

SUCTION MANUAL ADULT SUC-HSE UNIT/1 1 UNIT

LARYNGEAL MASK AIRWAY NO.3 #175030 PCS/1 1 PCS

LARYNGEAL MASK AIRWAY NO.5 #175050 PCS/1 1 PCS
LARYNGOSCOPE ADULT RIESTER UNIT/1 1 UNIT
E.T.T.DISP.W/CUFF SIZE 7 PCS/1 1 PCS
E.T.T.DISP.W/CUFF SIZE 7 PCS/1 1 PCS
E.T.T.DISP.W/CUFF SIZE 8 PCS/1 1 PCS
1
STYLET INTUBATION MEDIUM NO 4.2 PCS/1 1 PCS
KY JELLY 100 GR BOX/1 1 BOX
E.T.T HOLDER BOX/100 1 PCS
BITE BLOCK PCS/1 1 PCS
NOT AVAILABLE 1
SYRINGE 20 ML TERUMO BOX/50 1 PCS
SUCTION CATHETER CH 16 PCS/1 1 PCS
1
NASAL OXYGEN CANULA ADULT 1820 PCS/1 1 PCS
OXYGEN MASK ADULT PCS/1 1 PCS
REBREATHING MASK ADULT PCS/1 1 PCS
NON REBREATHING MASK ADULT PCS/1 1 PCS
OXYGEN TUBE 2 METER #1115# PCS/1 1 PCS

SCALPEL #15 BOX/10 1 BOX

SCALPEL #21 BOX/10 1 BOX
MOSQUITO CLAMP STR PCS/1 1 PCS
ARTERY FORCEP STR PCS/1 1 PCS
CRICOTHYROIDOTOMY SET THE QUICK FIX SET/1 1 PCS
ALCOHOL SWAB SENSI CARTON/12 1 BOX
INFUS SET SOL ADMIN ADULT TERUMO BOX/100 1 PCS
BLOOD ADMIN SET PCS/1 1 PCS
SURFLO FLASH 14 SR*FS1451 BOX / 50 PCS 1 PCS
SURFLO FLASH 16 SR*FR1651 BOX / 50 PCS 1 PCS
SURFLO FLASH 18 SR*FR1832 BOX / 50 PCS 1 PCS
SURFLO FLASH 20 SR*FS2032 BOX / 50 PCS 1 PCS
OPSITE POST -OP 6,5 CM X 5 CM PCS/1 1 PCS
SAFETY BOX/NEEDLE SHARP BOX CONTAINER 8 L BD YELLOW
1 PCS
PCS/1
TORNIQUET IDEAL PCS/1 1 PCS

GELAFUSAL INFUSION 500ML BTL/1 1 PCS

OTSU DS 5% 500 ML BTL/1 1 BTL

OTSU NACL 0,9 % 500 ML KOLF/1 1 KOLF
OTSU NS INJ AMP 25 ML AMP/1 1 AMP
OTSU WATER FOR INJ.25 ML BTL/1 1 BTL
OTSU RL 500 ML KOLF/1 1 KOLF
1
SYRINGE 1ML TUBERCULIN TERUMO BOX/100 1 PCS
SYRINGE 3 ML TERUMO BOX/100 1 PCS
SYRINGE 5 ML TERUMO BOX/100 1 PCS
SYRINGE 10 ML TERUMO BOX/100 1 PCS
SYRINGE 20 ML TERUMO BOX/50 1 PCS
SYRINGE 50ML TERUMO BOX/20 1 PCS
NEEDLE STERILE 18G PCS BOX / 100 1 PCS
NEEDLE STERILE 23G PCS BOX / 100 1 PCS
ASAM TRANEKSAMAT 500 MG TAB BOX/100 1 Box
DEXAMETHASON TAB 0,5 MG BOX/100 1 Box
CARDIO ASPIRIN TAB BOX/30 1 Box
PLAVIX TAB BOX/28 1 Box
ISOSORBIDE DINITRATE TAB 5 MG BOX/100 1 Box
VENTOLIN INHALER BOX/1 1 Box
NORIT TABLET BOX/1 1 Box
RANITIDIN TAB 150 MG BOX/100 1 Box
LODIA TAB BOX/100 1 Box

ANTIMO TAB BOX/720 1 Box

PARACETAMOL TAB 500 MG BOX/100 1 Box

IBUPROFEN TAB 200 MG BOX/100 1 Box

NOT AVAILABLE 1 Box

LORATADIN TAB BOX/100 1 Box

ASAM TRANEKSAMAT 500 MG/5 ML AMP BOX/10 1 Box

EPINEPRIN INJ AMP BOX/100 1 Box

CORDARONE AMP 150 MG INJ 3ML BOX/6 1 Box

ATROPIN SULFAS INJ AMP 0.25 MG/ML BOX/100 1 Box

NOT AVAILABLE 1

DOPAMINE HCL INJ 200 MG / 5 ML BOX/10 1 Box

LASIX INJ AMP 20MG 2ML BOX/5 1 Box
XYLOCAIN INJ AMP 2% 2ML BOX/50 1 box
XYLOCAIN SPRAY 10% BOX/1 1 Box
OTSU DS 40% INJ AMP 25 ML AMP/1 1 AMP
PRIMPERAN INJ AMP BOX/6 1 Box
BUSCOPAN INJ AMP 20MG/ML BOX/10 1 Box

NOT AVAILABLE 1

STESOLID INJ AMP BOX/5 1 Box

NOT AVAILABLE 1
NOT AVAILABLE 1
NOT AVAILABLE 1
NOT AVAILABLE 1
MICROPORE 1 INCH BOX/12 1 ROLL
HANSAPLAST 1.25CM X 4.5 M BOX/10 1 ROLL
COMBINE DRESSING 10x20CM#S0415 UNIT/1 1 UNIT

EYE PATCH ORTHOPTIC REGULAR TM1539 BOX/20 1 BOX

GAUZE PAD NON STERIL 6X6CM 16 PLY SURGILAB #1222 1 BOX

BOX/100
WOUND DRESSING #15 - HOSPAC S0042 PCS/1 1 PCS
BETADINE SOLUTION 60 ML BOX/1 1 BTL
MITELA KAIN SEGITIGA - SIZE L PCS/1 1 PCS
ASHERMAN CHEST SEAL 1 PCS
STERI STRIP 1/2X4" R1547 PACK/50 1 PCS
TENSOCREPE 4 x 4.5 M ROLL/1 1 PCS
TENSOCREPE 6 x 4.5 M ROLL/1 1 PCS
SCISSOR FINE 14 CM PCS/1 1 PCS
INFECTIOUS BAG YELLOW SIZE.90CMX120CM PCS/1 1 PCS
BURNAZIN CREAM 35 GR BOX/1 1 tube
BURN DRESSING 10x10 CM PCS/1 1 PCS
BURN DRESSING 20x20 CM PCS/1 1 PCS
FOLLEY BALON CATHETER CH14 PCS/1 1 PCS
FOLLEY BALON CATHETER CH16 PCS/1 1 PCS
FOLLEY BALON CATHETER CH18 PCS/1 1 PCS
SYRINGE 20 ML TERUMO BOX/50 1 PCS
URINE BAG STERIL PCS/1 1 PCS
UNDERPAD 60X90 BOX/10 1 BOX
STOMACH TUBE FR 12 TERUMO PCS/1 1 PCS
STOMACH TUBE FR 14 TERUMO PCS/1 1 PCS
GLOVES NON STERILE FREE POWDER LATEX SENSI SIZE L
1 BOX
CARTON/10
SYRINGE 50ML TERUMO BOX/20 1 PCS
STIFFNECK COLLAR ADJUSTABLE PCS/1 1 PCS
WOOD SPLINT SPALK ORTHOPHEDY SET / 6 PCS 1 SET
ISOTHERMIC BLANKET MIS-EBA DYNAMED PCS/1 1 PCS
PRICE / OuM TOTAL PRICE REMARK
56,250 56,250
362,500 362,500
812,500 812,500
25,000 25,000
122,500 122,500
312,500 312,500
375,000 375,000
22,500 22,500
201,875 201,875
364,375 364,375
18,750 18,750
18,750 18,750
207,813 207,813
207,813 207,813
225,000 225,000

1,512,500 1,512,500

169,455 169,455
169,455 169,455
3,915,000 3,915,000
44,531 44,531
44,531 44,531
44,531 44,531
- -
312,500 312,500
86,729 86,729
180,625 180,625
150,000 150,000
- -
6,891 6,891
11,250 11,250
- -
19,688 19,688
15,938 15,938
18,929 18,929
22,939 22,939
56,250 56,250
- -
562,500 562,500
562,500 562,500
81,250 81,250
68,750 68,750
2,250,000 2,250,000
12,375 12,375
15,225 15,225
30,375 30,375
 38,265 38,265
31,390 31,390
23,400 23,400
23,400 23,400
12,375 12,375

178,125 178,125

21,875 21,875
Gelofusin kosong (refer ke
225,000 225,000
sejenis)
21,854 21,854
21,480 21,480
9,088 9,088
9,088 9,088
21,480 21,480
- -
3,106 3,106
3,163 3,163
4,331 4,331
3,500 3,500
6,891 6,891
18,813 18,813
1,125 1,125
1,125 1,125
225,000 225,000
17,500 17,500
74,276 74,276
954,895 954,895
15,000 15,000
158,089 158,089
16,459 16,459
28,750 28,750
118,125 118,125 Refer ke Paten

Dranmasine kosong,direfer
387,000 387,000 dengan fungsi yang sama

28,750 28,750
26,250 26,250

- -

41,250 41,250

125,000 125,000

1,187,500 1,187,500
380,219 380,219

625,000 625,000
 - - stok kosong dari awal tahun

125,000 125,000
130,525 130,525
360,124 360,124
349,213 349,213
13,650 13,650
77,500 77,500
414,540 414,540

- -

85,000 85,000
- - ED Dekat
- -
- -
- -
19,500 19,500
9,479 9,479
31,250 31,250

87,500 87,500

152,000 152,000

43,750 43,750
43,315 43,315
12,500 12,500
1,250,000 1,250,000
29,688 29,688
101,808 101,808
133,975 133,975
43,750 43,750
12,500 12,500
77,416 77,416
625,000 625,000
975,000 975,000
22,500 22,500
22,501 22,501
22,503 22,503
6,891 6,891
5,938 5,938
75,000 75,000
33,600 33,600
33,600 33,600

80,000 80,000

18,813 18,813
350,000 350,000
825,000 825,000
150,000 150,000

25,636,103