PELAYANAN KEFARMASIAN

No NAMA OBAT / BMHP HARGA

SATUAN HARGA I HARGA II HARGA III
SATUAN
58 Jarum Jahit Uk 8* pcs 2,750 3,520
59 Jelly USG "Conax" Botol Rp 22,700 29,056
60 Kapas pembalut 250 gr Roll 13,750 17,600
61 Kasa Hidrofil 2 X 80 cm Roll 8,470 10,842
62 Kasa Hidrofill 40 m X 80 cm 138,214 176,914
63 Kasa Hidrofill streril 16 X 16 cm pcs 198 253
65 Kertas EKG rol Rp 108,800 120,768
66 Kertas USG rol Rp 431,500 552,320
67 KY Jelly 100 g Botol Rp 162,100 207,488
68 Laryngeal mask Airway No.3 Pcs 191,200 244,736
69 Laryngeal mask Airway No.5 Pcs 191,200 244,736
70 Leukomed IV / Dermavis pcs 2,361 3,022
71 Lysol Botol 60,720 77,722
72 Masker bedah Hijab box Rp 1,400 2,000
73 Masker Headloop 945 1,210
74 Masker N95 Pcs Rp 24,900 31,872
75 Masker Oksigen Anak pcs 25,030 32,038
76 Masker Oksigen Dewasa pcs 25,030 32,038
77 My Jelly 5gram Sachet 2,641 3,380
78 MyJelly 80gram Tube 43,750 62,160
My Jelly USG Gel btl 21,875 31,080.00
79 Nald hecting 11 pcs 0.00
80 Nald hecting 15 pcs 0.00
81 Nald hecting 8 pcs 0.00
82 Nasal Oksigen Anak (Cosmomed) pcs 6,060 7,757
83 Nasal Oksigen Dewasa Tube 18,090 25,702
84 Nasal Oxy Canul PEDIATRIC pcs 16,890 24,125
85 Nebulizer Mask Anak pcs 22,391 28,660
86 Nebulizer Mask INFANT PCS 22,880 32,507
87 Nebulizer Mask Dewasa 22,391 28,660 40,058
88 NGT 18 Pcs 59,100 75,648
89 NGT No 10 8,470 10,842
90 NGT No 14 8,470 10,842
91 NGT No 18 8,470 10,842
NGT NO 8 PCS 6,660 9,462
NEEDLE PEN PCS 2,497 3,548
OCTADIN GEL TUBE 44,400 63,083
92 Pen Cauter Pcs 111,600 142,848
93 Plester 10x5 "OM" rol Rp 115,500 147,840
94 Plester 2,5cm x 1m pcs 12,675 16,224
95 Plester 5 yards x 2 inch pcs 30,800 39,424
96 Plester 5cm x 5m 27,324 34,975
Pot tutup putih pcs Rp 1,250 1,776
97 Prolene 2/0 pcs Rp 150,000 192,000
98 Prolene 3/0 pcs Rp 150,000 192,000
99 Prolene 4/0 pcs Rp 150,000 192,000
100 Prolene 5/0 pcs Rp 150,000 192,000
101 Prontosan Gel 250 gr B Rp1,417,700 1,814,656
102 Prontosan Solution 250 ml botol Rp 386,600 494,848
103 Regulator Pcs 305,000 433,344
104 Sarung Tangan NS 1,663 2,129
105 Sarung Tangan NS psg 2,420 3,098
106 Sarung Tangan NS uk. L pcs 550 704
107 Sarung Tangan NS uk. M 750 1,065 852,48
108 Sarung Tangan Obgyn* No.6,5 pcs 26,447 37,575
109 Sarung Tangan Obgyne No 7,0 40,950 58,181
110 Sarung Tangan Obgyne No 7,5 43,010 61,108
111 Sarung Tangan steril no. 6.0 Psg 8,713 12,379
112 Sarung Tangan steril no. 6.5 pcs 26,447 37,575
113 Sarung Tangan steril no. 7.0 pcs 5,088 7,229
114 Sarung Tangan steril no. 7.5 26,447 37,575 12,616
115 silk 3/0 pcs 3,457 4,425
SILK 3/0 (
116 Slik (Benang Bedah Sutra) np 2/0 pcs 3,089 3,954
117 Spinocain 25 pcs Rp 40,000 51,200
118 Spinocain 26 pcs Rp 40,000 51,200
119 Spinocain 27 pcs Rp 40,000 51,200
120 Spoit 10 cc pcs 2,751 3,521
121 Stomach Tube 85cm No.16* pcs 9,086 11,630
122 Stomach Tube 85cm No.14* pcs 5,128 6,564
123 Strip GDS Benecheck Pcs 3,409 4,364
124 Suction Catheter No 10 2,997 3,836
125 Suction Catheter No 16 9,086 11,630
126 Suction Catheter No 6 9,086 11,630
 PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP HARGA
SATUAN HARGA I HARGA II HARGA III
SATUAN
127 Sungkup NRL Anak Non Rebreathing uk. L Pcs 23,865 30,547
128 Sungkup NRL Anak Non Rebreathing uk. M Pcs 23,865 30,547
129 Surgimesh/Sulenemesh Pcs 401,000 513,280
130 Tensocrepe "6" rol Rp 179,500 229,760
131 Test Strip Benecheck prime glucose botol @ 25 247,530 316,838
132 Treeway Stopcock pcs 12,541 16,052
133 Ultrasonic Gel pcs 19,200 24,576
134 Umbilical Cord Klem Steril Nylon 1,495 1,914
135 UnderPad 9,164 11,730 11,127
136 Urine Bag pcs 8,660 12,455
137 Vicryl 0/Sutryl 0 Pcs 71,300 91,264
138 Vicryl 1/Sutryl 1 Pcs 71,300 91,264
139 Vicryl 2/Sutryl 2 Pcs 62,400 79,872
140 Vicryl 4/0/Sutryl 4/0 Pcs 71,300 91,264
141 Vicryl 5/0/Sutryl 5/0 Pcs 71,300 91,264
142 Wing Needle ONEMED pcs 1,610 2,061
143 Xpert MTB/RIF Assay Kit 0
144 Yodium Povidon Larutan 10% 1000 ml pcs 149,520 215,040
145 DRESSING (perban anti air) PCS 17,600 25,006
146 RAPID AG PCS 42,952 61,026
RAPID AG (HARSONS) PCS 15,010 21,326
147 THREEWAY PCS 8,000 9,126
148 BISTURI NO 11 PCS 1,500 2,131
149 BISTURI NO 15 PCS 1,500 2,131
150 SPOIT 50 CC PCS 11,100 15,770
151 NASAL CANULA DEWASA PCS 8,520 12,105
152 SAFTY BOX PCS 28,860 41,004
153 TRULENE 3-0 PCS 65,700 93,346
154 TRULENE 2-0 PCS 65,700 93,346
155 TRULENE 4-0 PCS 65,700 93,346
TRULENE 5-0 PCS 72,927 103,614
156 TRULENE 6-0 PCS 65,700 93,346
TRULENE 0 PCS 65,700 93,346
157 TRUGLYDE 1 PCS 89,600 127,303
158 TRUGLYDE 2-0 PCS 89,600 127,303
159 TRUGLYDE 0 PCS 89,600 127,303
160 TRUSYNTH 2 PCS 120,500 171,206
161 TRUSYNTH 2-0 PCS 120,500 171,206
162 TRUSYNTH 1 PCS 120,500 171,206
163 TRUSYNTH 0 PCS 120,500 171,206
164 TRUSYNTH 4-0 PCS 120,500 171,206
165 TRUSYNTH 3-0 PCS 120,500 171,206
166 TRUSILK 2-0 PCS 44,800 63,651
167 TRUSILK 3-0 PCS 44,800 63,651
168 TRUGUT 1 PCS 75,000 106,560
169 TRULEN MESH PCS 231,480 328,886
170 CUTICELL PCS 37,185 52,832
171 DARYANTUL PCS 10,878 15,455
MEPILEX (DARYANTUL) PCS 84,360 119,858
172 CUTISORB PCS 37,500 53,280
173 GUEDEL NO 70 PCS 13,562 19,268
174 GUEDEL NO 60 PCS 13,562 19,268
175 ETT 2,5 PCS 90.727 128,904
176 ETT 4,0 PCS 90,727 128,904
177 JACSON REES NEONATAL PCS 649,652 923,025
178 JARUM BD 4 MM PCS 5,550 7,885
179 JARUM BD 5 MM PCS 5,550 7,885
180 KASA PANJANG PCS 243,243 345.599
181 BREATING CIRCUIT ANAK PCS 88,800 126,167
182 BREATING CIRCUIT DEWASA PCS 88,800 126.167
183 PERFUSOR PCS 88,800 113,664
184 OXYGEN MASK NRM ANAK PCS 23,443 30,007
185 GUEDEL 80 PCS 23,605 30,214
186 GUEDEL 90 PCS 23,605 30,214
187 ELEKTRODA DEWASA PCS 2,200 3,126
188 ELEKTRODA ANAK PCS 2,200 3,126
189 ELEKTORODA BAYI PCS 2,200 3,126
190 LAMINARIA ALL SIZE PCS 174,575 248,036
191 ELEKTROSURGICAL PLATE DEWASA PCS 37,575 53,386
192 ELEKTROSURGICAL PLATE ANAK PCS 37,575 53,386
193
194
195
196
 HARGA OBAT
PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP
SATUAN HARGA SATUAN HARGA I HARGA II HARGA III
1 Aqua pro inj Flacon 2,662 3,036
2 Aqua pro inj (SATORIA) AMP 2,662 3,782
3 ALBENDAZOLE SUSP BTL 4,300 5,504
4 Allopurinol tablet 100 mg Tab 258 294
5 Allopurinol Tablet 300 mg Tab 465 531
6 Alprazolam 0,5 mg Tablet 1,067 1,366
7 AMBROXOL 30 MG TAB 272 348
8 AMBROXOL SYR BTL 5,538 8,951 9,107
9 Aminofillin Injeksi 24 mg/ml Amp 3,300 4,224
10 Aminofillin Tablet 150mg Tab 155 198
11 Aminofillin Tablet 200 mg TAB
12 Aminophyllin Inj Ampul 4,859 6,220
13 AMITRIPTILIN HCL 25 MG TAB 168 238
14 AMLODIPIN 10 mg Tab 76 107
15 AMLODIPIN 10 mg (HJ) TAB 400 568,32
16 AMLODIPIN 5 mg Tab 59 84
17 AMLODIPIN 5 mg (HJ) TAB 216 306,89
18 Amoksisilin kapsul 250 mg Kaps 198 253
19 Amoksisilin kapsul 500 mg Kap 265 376
20 Amoksisilin sirup kering 125 mg/5 ml ( BTL 6,750 9,590
21 Amoksisilin sirup kering 250 mg/5 ml BTL
22 Ampicillin 1 gr serbuk Amp 10,340 14,691
23 AMPICILLIN SULBACTAM 750 MG AMPL 15,750 20,161
24 VICILLIN SULBACTAM 750 MG VIAL 19,999 28,415
25 VICILLIN SULBACTAM 1500 MG VIAL 24,000 34,099
26 Antasida DOEN Sirup Btl 1,767 2,262
27 Antasida Doen Tablet kombinasi Tab 61 86.00
28 Anti Bakteri DOEN Salep Tube 3,642 4,662
29 ANTI HEMOROID SUPP Supp 4,673 4638
30 Antifungi DOEN kombinasi Pot 3,697 4,723
Antimigrain Tablet : Ergotamin tartrat 1
Tab 208
31 mg + Kofein 50 mg 266.24
32 Antiparkison (LEVOPAR) Tab 1,090 1,395
33 APIDRA SOLOSTAR INSULIN PEN 81,363 115,601.00 128,317
34 ARINIA TAB TAB 23,861 33901
35 Arkavit C TAB 1,282 1,641
36 Asam Asetil Salisilate Tab (miniaspi) Tab 705,96 904
37 Asam Askorbat (Vit C) tablet 50 mg Tab 126 161
38 ASAM FOLAT TAB 89,91 115.08
39 ASAM MEFENAMAT Tab 128 181
40 ASAM TRANEXAMAT INJ AMP 3,891 4.980
41 ASAM TRANEXAMAT INJ 10 MG AMP 4,329 6,150
ASAM TRANEXAMAT TAB TAB 1,698 2,412
42 ASIKLOVIR KRIM TUBE 6,100 7,808
43 Asiklovir Tablet 200 mg Tab 550 704
44 Asiklovir Tablet 400 mg Tab 473 605.44
45 Atapulgit Tab 600 mg (Pularex/NewantidTab 485 620.8
46 ATORVASTATIN 10 TAB 888 1,261
47 ATORVASTATIN 20 TAB 1,200 1,704
48 Atropin Inj 0,25 mg/ml Amp 3,330 4.2624
49 Azitromicin 500mg Tab 1,778 2,276
50 Betahistine Tab 6 mg Tab 93 119.04
51 Betametason krim 0,1% Tube 1,540 2,188
BIOCOMBION TAB TAB 1,786 2,537
52 Biocombion inj (MEPRO) Ampul 3,885 5,519 6,126
53 MERSIBION INJ (BIOCOMBION INJ) AMP 5,716 8,122
54 Bisakodil Suppositoria 10 mg (Dulcolax) Supp 16,700 23,727
55 Bisakodil Suppositoria 5 mg (Dulcolax) Supp 17,600 25,006
56 Bisakodil tab 5 mg (Dulcolax) Kaptab 2,171 2,779
57 BISOPROLOL 2,5 MG TAB 212,01 271.373
58 BISOPROLOL 5 MG TAB 204,24 261.427
59 BUNASCAN AMP AMP 99,456 141.307
60 CAIRAN AMINOLEBAN BTL 74,475 105,814
61 CAIRAN B-FLUID BTL 97,899 139,096
62 CAIRAN KIDMIN BTL 54,619 77,603
63 CALGAE TAB
64 Candefar 16 Tablet 11,250 14,400
65 Candefar 8 Tablet 8,750 11,200
 PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP
SATUAN HARGA SATUAN HARGA I HARGA II HARGA III
66 CANDESARTAN 16 MG (DEXA) TAB 634 900,78
67 CANDESARTAN 16 MG (HJ) TAB 722 1,025
68 Candesartan 8 mg Tablet 4,900 6393.0 1,135
69 CARBAZOCRHOM INJ AMP 27,000 38,361
70 Catapres inj Ampul 43,392 61,651
71 Caviplex Tablet
72 Cefadroxil 500 mg kapsul 708 1,361
73 CEFADROXIL SYR Tab 4,360 6,194
74 CEFIXIM 200 mg Tab 968 1,375 2,841
75 CEFIXIME 200 MG (HJ) TAB 1,550 2,202
76 CEFIXIM SYRUP Botol 13,035 18,520
77 CEFIXIME 100 MG TAB 1,609 2,286
78 Ceftriaxone inj (BERNO) VIAL 14,041 17,972
79 CEFTRIAXINE INJ (HJ) VIAL 11,399 16,196
CEFTRIAXOne inj (PHAPROS) VIAL 9,435 13,405
80 CETERIZIN 10 mg Tab 264 389
81 CETERIZIN SYR Botol 6,500 8,320 6,156
82 CIPFLAXACIN INF BOTOL 10,461 14.862
83 CIPROFLOXACIN Tab 600 768
CLINDAMYCIN TAB 1,154 1,659
84 CLONIDIN TAB TAB 188 267
85 Clopidogrel Tablet 853 1,211
86 Combivent BTL 12,705 16,262
87 Curcuma Tablet 1,240 1,587
88 COTRIMOXAZOLE SYR BTL 3,078 4,373
89 DAYLAX 22,956 29,384
90 Deksametason inj 5 mg/ml 1ml Amp 2,184 3,103
91 Deksametason tablet 0,5mg Tab 140 198
92 Desrem (Remdesivir) Vial 564,190 722,163
93 DHP Tab 2,030 2,598
94 Diasepam Injeksi 5 mg/ml Amp 11,440 14,643
95 DIAZEPAM 2 MG TAB 1,545 1,978
96 Diazepam enema (Stesolid) RT 10 mg TTube 21,935 28,077
97 Diazepam enema (Stesolid) RT 5 mg TuTube 15,088 19,313
98 Difenhidramin Injeksi 10 mg/ml Amp 3,000 4,262
99 Digoksin tablet 0,25mg Tab 124 158.72
100 Dimenhidrinat 50mg Tab 159 226
101 DOBUTAMIN INJ AMP 11,525 16,374
102 Doksisiklin 100 mg Kaps 303 387.84
103 DOMPERIDON SYR BTL 15,685 22,285
104 DOMPERIDON TABLET Tab 172 196
105 DOPAMET TAB TAB 1,308 1,858
106 DOPAMIN INJ AMP 5,655 7,238
107 Dosivec KAP 5,500 6274
108 EPINEFRIN INJ AMP 2,575 3,296
EPERIZON TAB TAB 2,081 2,957
109 Eritromisin kap 250 mg Kaps 1,100 1,408
110 Eritromisin kap 500 mg Kaps 781 999.68
111 Eritromisin Sirup kering 250 mg/5ml Btl 7,761 9,934
112 Eritromisin Sirup kering 500 mg/5ml Btl 15,779 20,197
113 Etabion Tablet 1,700 2,176
114 Farelax inj Ampul 98,000 139,238
115 FARGOXIN INJ (DIGOXIN INJ) AMP 27,750 39,427
116 Favipiravir Tablet
117 FERBIVENT INJ AMP 11,655 16,559
118 Fenitoin Tablet 100 mg Tap 550 704
119 FENOL GLISEROL TTS TELINGA BTL 3,300 4,224
120 FENTANYL CITRATE 2 ML Ampul 26,255 37,760 41,844
121 FENTANYL CITRATE 10 ML AMP 118,899 169,074
122 PHYTOMENADION (Vit.K) tablet salut 1 Tab 847 1,203
123 FLUOXETIN TAB TAB 606 775.68
124 FOCYN INJ (MEJI) VIAL 56,610 80,431
FOCYN INJ (FAHRENHEIT) VIAL 58,608 83,270
125 FORUSEMIDE TAB TAB 242 309.76
126 FRIDEF 50 MG TAB 2,263 2,897
127 Furosemid injeksi 10 mg/ml (BERNO) Amp 7,000 9,945
128 Furosemid injeksi 10 mg/ml (QUANTUM)AMP 4,662 6,623
129 Gentamisin Inj 40mg/ml Amp
130 Gentamisin Salep Kulit Tube 2,300 3,267
131 Gentamisin SM Tube
132 Gentamisin Tetes Mata 0,3 % Btl
133 Gentian violet 1% Larutan Btl 6,050 7,744
134 Glibenklamid tablet 5 mg Tab 304 389.12
 PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP
SATUAN HARGA SATUAN HARGA I HARGA II HARGA III
135 Glimepirid 1 mg Tablet 830,4 1,179
136 Glimepirid 2mg Tablet 1,650 2,344
137 GLIMEPIRID 3 mg Tab 2,131 3,028
138 GLIMEPIRID 4 mg Tab 2,892 4,039
 PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP
SATUAN HARGA SATUAN HARGA I HARGA II HARGA III
139 Gliserilis Guaiakolat tab 100mg Tab 109 139.52
140 Glukosa larutan infus 10 % steril Btl 7,200 9,216
141 Glukosa larutan infus 5 % steril (SATOR Btl 6,627 8,483
142 Griseofulvin tablet 125 mg Tab
143 HALOPERIDOL 5 MG TAB 57 72,96
144 HALOPERIDO 5 INJ (LODOMER INJ) INJ 17,417 22,294
145 HARNAL TAB 5,626 7,201
HEXYMER TAB 2 MG (HALOPERIDOL 2 TAB 607
146 MG) 776.96
147 Hidroklorotiazid (HCT) tablet 25 mg Tab 2,556 3,272
148 Hidrokortisonkrim 2,5% Tube 2,556 3,272
149 Histapan Tablet 725 1,030
150 Hyosine Butil Bromida Injeksi 20mg/ml Ampul 7,200 9,216
151 Hyosine Butil Bromida Tablet (SpasmolitTab 1,050 1,344
152 Ibuprofen 100 mg/5 ml Suspensi Btl 2,400 3,072
153 IBUPROFEN 200 MG TAB 160 204.8
154 IBUPROFEN 400 MG TAB 223 285.44
155 Ibuprofen 80mg suppositoria (PYREXIN)Supp 8,800 11,264
156 Ipratorium br spray/ Atroven Btl 12,705 16,262
157 Ipratorium br spray/Farbivent inj Inj 11,000 14,080
158 Isorane (Isoflurane) botol 2,000,000 2,560,000
159 SEVOFLURANE BOTOL 877,166 1261543.00
160 ISOSORBIT DINITRAT 5 MG TAB 163 208.86
161 Kalsium Glukonat Inj 10 % Amp 6,199 7,935
162 Kalsium laktat tab TAB 60 76.8
163 Kaptopril Tab 12.5 mg Tab
164 Kaptopril Tab 25 mg Tab
165 Kaptopril Tab 50 mg Tab
166 Karbamazepin 200 mg Kaplet 252 322.56
167 Ketamine inj Vial 43,000 61,094
168 Ketokonazole 200 mg Tab 270 345.6
169 Ketokonazole Krim Tube 2,694 3,448
170 Ketokonazole Scalp Solution Btl 84,186 107,758
171 Ketorolak 1% Injeksi Amp
172 KETOROLAK 3 % INJ (BERNO) AMP 14,580 20,715
173 KETOROLAK 3 % INJ (OGB DEXA) AMP
174 KETOROLAK 3% INJ (MEPRO) AMP 11,468 16,293
175 Kloramfenikol kapsul 250 mg Kap 341 436.48
176 Kloramfenikol kapsul 500 mg Kap 1,185 1,517
177 Kloramfenikol S.Kulit 2% (BUFACETIN) Tube 3,925 5,024
178 Kloramfenikol Salep Mata 1% Tube 2,148 2,749
179 Kloramfenikol suspensi Botol 3,416 4,853
180 Kloramfenikol Tetes Telinga Botol 9,102 11,651
181 Klorfeniramin maleat (ctm) tablet 4 mg Tab 78 99.84
182 Klorpromazin HCl Tablet Salut 100 mg Tab 605 774.4
183 Kodein Tab 10 mg Tab 621 883
184 Kodein Tab 20 mg Tab 0
185 Kotrimoksazol suspensi Btl 2,100 2,688
186 Kotrimokzasol Tablet (480 mg) Tab 1,957 2,199
187 LACTULOSE SYR BTL 45,341 58,036
188 Lantus Solostar Pen 80,909 114,955 127,586
189 Lanzoprazole Tablet 1,850 2,368
LANZOPRAZOLE KAPS
KAPS 618,82
190 (NUFARINDO)@20 KAP 879,23
191 LANZOPRAZOLE KAPS (HJ) @50 KAPS 1,332 1,892
Larutan Mengandung Elektrolit
Btl 9,968
192 (Asering) (MJB) 11,200
ASERING (OTSUKA) BTL 8,750 12,432
Larutan Mengandung Karbohidrat
Btl 11,500
193 +Elektrolit (KAEN) 3B (OTSUKA) 14,720
194 Levica inj 50 mg/10 ml Ampul 82,500 105,600
195 LIDOCAIN INJ 2% (PHAPROS) AMP 1,277 1,635 2,996
196 Lidokain Komp. Amp 924 1,183
197 LODIA TAB 2,759 3,532
198 LOPERAMIDE HCL 2 MG TAB 93 119.04
LORATADINE TAB TAB 302,19 430
199 Magnesium Sulfat inj 20 % Amp
200 Magnesium Sulfat inj 40 % Amp 12,044 17,112
201 MECOBALAMIN500 MCG/ML INJ AMP 8,235 11,828
202 Meloxicam 15 tablet 644 914,9
203 MELOXICAM 15 (HJ) TAB 488 69,335
 PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP
SATUAN HARGA SATUAN HARGA I HARGA II HARGA III
204 MELOXICAM 7,5 MG TAB 491 574.00
205 MELOXICAM 7,5 MG (HJ) TAB 325 461,76
206 Meprovent Ampul 14,233 18,218
207 Meropenem 1 gr Vial 69,575 89,056
208 Metformin HCL tab. 500 mg Tab 86 110.08
209 Metformin HCL tab. 850 mg Tab 475 674,8
210 METILERGOMETRIN MALEAT 0,125 MG TAB 253 323.84
211 Metilergometrin Maleat Injeksi 0,200 mg Amp 1,096 1402.88
212 Metilprednisolon Tab 4 mg Tab 115 147.2
METHYLPREDNISOLON TAB 4 MG
TAB 250
213 (QUANTUM) 355.2
214 Metilprednisolon Tab 8 mg Tab 638,18 906,7
215 METHYLPREDNISOLON INJ (PHAPROS AMP 16,000 22,732
216 Metoclopramide Inj (INTERBAT) Ampul 6,050 7,744 3,544
217 Metoklopramid sirup BTL 0
218 Metoklopramide drop (GAVISTAL) Btl 4,065 5,203
219 Metoklopramide Tablet 10mg Tab 93 119.04
220 Metronidazol Infus 500 mg/100 ml Btl 6,061 7,758
221 Metronidazol Infus 500 mg/100 ml (FIMABtl 14,041 19,950
222 Metronidazol Suspensi Btl 3,950 5,056
223 Metronidazol Tablet 500 mg Tab 299 382.72
224 Midanest 15 Ampul 27,830 35,622
225 Midanest 5 Ampul 57,051 73,025
226 Mikonazol Krim/Salep 2 % Tube 2,090 5,264
227 MISOPROSTOL TAB TAB 4,973 7,014
228 MORPIN (MST CONTINUS) 15 MG TAB 16,000 22,732
229 Multivitamin D 1000 IU tab 429 549.12
230 Na.klorida larutan infus 0,9% steril (NaC Btl 6,900 9,821
231 Nacl (SATORIA) BTL 6,913 9,821
232 N-ASETIL SISTEIN TAB TAB 852,48 1,211
233 Natrium Bicarbonat Inj (Meylon) Amp 6,448 9,821
234 Natrium Diclofenak Tablet 25 mg Tab 250 320
235 Natrium Diclofenak Tablet 50 mg Tab 450 576
236 Neomicin Bacitrasin Salepp Pot 17,204 22,021
237 New diatabs Tablet 750 960
238 NIFEDIPIN TAB TAB 339 433.34
239 NISTATIN 100.000 IU/ML BTL 14,250 18,240
240 Nistatin 500.000 iu/g Tab Vaginal Tab 957 1,225
241 NITROKAF RETARD TAB 1,902 2,703 2,435
242 Norelut Tab 6,200 8,808
243 NORELUT DEXA TAB 4,259 6,038
244 NOVAKAL Tab 400 512
245 Oksitetrasiklin hcl salep kulit 3 % TUBE
246 Oksitetrasiklin hcl salep mata 1 % Tube
247 Oksitosin inj 10 IU/ml Amp 1,498 1,917
248 OLANZAPIN TAB 10 MG TAB 6,251 8,001
249 Omeprazol Caps 20 mg KAPS 527,25 750
250 OMEPRAZOLE 40 MG INJ (BERNO) AMP 11,799 16,970
251 OMEPRAZOLE 40 MG INJ (PHAPROS) AMP 6,500 9,235
252 ondancetron Tablet 2,220 2,841.60
253 Ondancetron Ampul 4,885 7,026
254 ORALIT SST 293 375.04
255 Otsu ns 25 ml (gm) ampul 6,954 8,901
256 Otsu ns piggi back 100 ml (gm) ampul 15,180 19,430
257 PANTOPRAZOLE INJ (BERNO) AMP 19,980 28,387
258 Paracetamol Tablet 217 308
259 PARACETAMOL INF (SANMOL INF) BTL 21,997 31,253 34,691
260 PARACETAMOL INF (BERNO) BTL 18,000 25,574
261 PARACETAMOL SYR BTL 5,520 7,066 9,050
262 Parasetamol DROPS 100 mg/ml Btl 12,000 15,360
263 Parasetamol ENEMA SUPP 9,990 14,200
264 Permetrin Krim 5 % (Scabimite Krim) Tube 6,641 9,500
265 PHENYTOIN INJ AMP 18,503 26,289
266 PHENOBARBITAL INJ AMP
267 Phenobarbital Tablet 30 mg Tab 205 262.4
268 PHYTOMENADION 2 MG INJ 3,818 5,425
269 PIRACETAM INJ 3 GR (BERNO) AMP 13,242 16,950
270 Pirantel Pamoat Tablet 125 mg Tab 869 1,112
271 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 76 97.28
272 Prednison Tablet 78 110
 PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP
SATUAN HARGA SATUAN HARGA I HARGA II HARGA III
273 ProPofol Inj Vial 28,083 35,946
274 PROMAVIT TAB TAB 3,996 5,677
275 Propanolol HCL tab 10 mg Tab 66 84.48
276 Propanolol HCL tab 40 mg Tab 94 120.32
277 PROPILTIOURASIL 10 MG TAB 695 987.00
ranitIDIN TAB TAB 237 303.36
278 RANITIDIN (HJ) AMP 2,775 3,942
REBAMIPIDE 100 MG TAB 2,109 2,996
FOMYCIN TAB 1,128 1,700
REMIPRIL 5 MG TAB 641 911
279 RHODIUM TAB TAB 7,770 11,039 9,935
280 RL (SANBE) BTL 8,324 11,827
RL (OTSUKA) BTL 8,498 12,073
281 SALBUTAMOL 4 MG TAB 219,78 281.32
282 Salep 2-4 kombinasi Tube 2,539 3,250
283 Salisil bedak 2% Pot 6,438 8,241
284 SALISIL BEDak 2% KF POT 5,800 8,240
285 SANTAGESIK INJ (SANBE) AMP 4,773 6,781 11,179
286 SEFADROKSIL 500 MG TAB 708 906.24
287 Sefadroksil Syr Kering Btl 4,360 5,581
288 SETERIZIN 10 MG TAB 264 375
289 Setirizin Sirup 5mg/5ml Btl 2,278 2,916
290 Sevodex botol 3,240,000 4,147,200
291 Sevoflurane botol 2,170,740 2,778,547
292 Sianokobalamin (vit B 12) tab 50 mcg Tab 50 64
293 Sikstop Tablet 7,500 9,600
294 SIMVASTATIN 10 MG TAB 73 93.44
295 SIMVASTATIN 20 MG TAB 407,37 521.43 442
296 Siprofloksasin 500 mg Tab 270 345.6
297 Sodium Bicarbonat 8,4% inj (MEYLON®)Ampul 0
298 Solvinex vial 32,634 46,336
299 Solvita Tablet 1,709 2,188
300 SOLVITIS (SULFASALAZINE Tab) TAB 5,365 7,622
301 SPIRONOLACTON 25 MG TAB 316,35 405
302 SUKRALFAT SYR BTL
303 Sulfadizine silver Tube 0
304 Tablet tambah darah tab 260 332.8
305 TEGRETOL TAB TAB 1,409 1,804
306 TETAGAM AMP TAB 210,470 269.402
307 THYARID INJ AMP 11,088 14.193
308 Tiamin (Vit B 1) 100 mg tab. Tab 98 125.44
309 Tiopol Inj Vial 114,000 161,971
310 Tranexamat Acid 500 mg Tab 1,210 1,549
311 Triheksifenidil tab. 2 mg Tab
312 Valproat (Depakene) Syr Btl
313 Valproat (Depakote) Tab 250mg Tab 0
314 VASOLA INJ AMP 301,920 428.968
315 Vastral Tablet
316 Vit. B kompleks tablet Tab 141 180.48
317 Vitamin (SUPRALYSIN) Multivitamin SyrBtl 28,050 35,904
318 Vitamin (VIOXY FM) Multivitamin Tablet Tab 18,750 24,000
319 VOPICAIN INJ AMP 78,065 99,923
320 WIDAHES BTL 116,505 165,530
321 Zinc sirup 20 mg/5ml Btl 15,000 19,200
322 ZINK 20 MG TAB 275 352
323 PROMAVIT TAB TAB 4,440 5,065
324 FOMYCIN Vial 79,255 101,446
325 AMPICillin SULBACTAM 1500MG VIAL 23,999 30,179
326 CLAST TAB 2,309 2,955
327 EFEDRIN AMP 26,306 37,375
328 COLCHICINE (LAPI) TAB 1,798 2,301
329 L-CISIN TAB 5,272 6,748
330 L-CISIN TAB (LAPI) TAB 4,717 6,702
331 ATORVASTATIN 10 MG TAB 1,265 1,619
332 ATORVASTATIN 20 MG TAB 1,581 2,023
 PELAYANAN KEFARMASIAN
No NAMA OBAT / BMHP
SATUAN HARGA SATUAN HARGA I HARGA II HARGA III
333 FERVIT DROPS 49,400 53,990
334 L-BIO SACH SACH 8,491 12,064
335 APIALIS DROPS DROPS 47,452 60,733
336 APIALIS SYR SYR 48,071 51,290
337 L-BIO CAPS TAB 9,435 12,076
338 ROCORONIUM BROMIDE INJ 52,000 73,881
339 LIDODEX 5% AMP 65,000 92,532
340 Farelax inj INJ 80,000 113,664
341 RAPID AG PCS 15,010 21,326
342 RENAQUIL TAB 2,617 3,718
343 AMPICILIN SULBACTAM VIAL 23,999 30,179
344 NOREFINEFRIN AMP 19,080 27,108
345 FOSMICIN VIAL 111,000 157,708
FOSMICIN (MEJI) VIAL 56,610 80,431
346 EFEDRIN AMP 26,306 37,375
347 TOFEDEX AMP 52,250 66,880
348 NOVARAVID TAB 116,000 164,812
349 METHYLPREDNISOLONE INJ (BERNO) AMP 35,816 45,845
350 KLINDAMICIN 300 MG TAB 1,215 17,274
351 FARLOCIN TAB 2,988 4,246
352 AMBROXOL SYR BTL 6,300 8,951
353 LEVOFLOXACIN INF BTL 37,000 52,569
354 LEVOFLOXACIN INF (HJ) BTL 29,150 41,416
355 CENDO XYTROL STRIP 24,375 34,632
356 CENDO XYTROL SALEP TUBE 39,821 56,578
357 CENDO LYTER 15 CC FLS 24,975 35,484
358 SCABICID KRIM TUBE 35,000 49,728
359 GENTAMYCIN INJ INJ 15,000 21,312
360 HYOCINE INJ AMP 6,200 8,808
361 FLUNARIZINE TAB TAB 1,465 2,100
362 CITICOLIN TAB TAB 4,733 6,726
363 CITICOLIN INJ (BERNO) INJ 4,950 7,032
364 CITICOLIN INJ(MERSI) INJ 31,235 44,379
365 PANTOPRAZOLE INJ (PHPAPROS) INJ 34,000 48,307
366 CEFUROXIME INJ ((DARYA PARIA) INJ 16,350 23,230
367 PETHIDINE INJ INJ 13,779 19,577 21,731
368 MORPHINE TAB TAB 1,242 1,765
369 CEFOTAXIME INJ (DANKOS) INJ 11,220 15,941
370 CEFOTAXIME INJ (BERNO) INJ 9,324 13,247
371 SANSULIN LOG (PINK) PEN 89,802 127,590
372 SANSULIN RAPID (BIRU) PEN 89,492 127,150
373 VALSARTAN 80 MG (HJ) TAB 1,300 1,847 6,308
374 VIP ALBUMIN KAP 6,290 8,936
375 ONOIWA CAPS KAP 5,633 8,003
376 ONOIWA KAP 16,983 24,129
377 ONOIWA SACH SST 17,050 24,224
378 LAXALOSAN (LACTULOSE) BTL 36,184 46,316
379 EPISAN (SUCRALFAT) BTL 17,926 22,945 26,813
380 ANALTRAM TAB 10,338 13,232
381 HYSTOLAN TAB TAB 4,250 6,038
382 BUDESMA AMP 10,725 15,238
383 AMINEFRON TAB 5,200 7,388
384 FOLAMIL GENIO
385 FARMACROL FORTE BTL 44583 63,343
386 KETOS TAB 7,076 10,053
387 PRONOVIR SYR BTL 58,275 74,529
388 NYSTATIN VAGINAL TAB 805 1,144
389 CODICAF (CODEIN 10 MG) TAB 787 1,118
390 PLASMINEX TAB 13,400 19,039
391 Histapan TAB 1,030
392 MEGABAL TAB 1,750 2,486
393 ANBACIN AMP 35,997 56,775
394 NICARDIPINE (BERNO) INJ 21046 29,902
395 NOVORPID FLEX PEN PEN 85,879 122,017