No. Nama Obat /alkes Satuan Nusa Lima Galuh Ldalam Lindai Terantam Rokan JML Total Harga Jumlah Fisik 6 Klinik Satuan Harga

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER
PT. NUSALIMA MEDIKA

JULI 2015
Galuh Ldalam Lindai Terantam rokan JML TOTAL Harga Jumlah
No. Nama Obat /Alkes Satuan Nusa Lima
Fisik 6 klinik Satuan Harga
1 Acarbose 100 Tab 200 200 200 200 200 200 1200 7200 1,824.00 13,132,800
2 Acarbose 50 Tab 200 200 200 200 200 200 1200 7200 1,131.00 8,143,200
3 Acetosal 100 Tab 200 200 200 200 200 200 1200 7200 110.00 792,000
4 Acyclovir Tab 200 200 200 200 200 200 1200 7200 602.00 4,334,400
5 Acyclovir Cr Tube 10 10 10 10 10 10 60 360 3,007.00 1,082,520
6 Allopurinol 100 Tab 600 200 200 200 200 200 1600 9600 120.00 1,152,000
7 Allopurinol 300 Tab 600 200 200 200 200 300 1700 10200 250.00 2,550,000
8 Ambroxol Tab 200 100 100 100 100 100 700 4200 142.00 596,400
9 Ambroxol Syr Btl 30 10 10 10 10 10 80 480 3,300.00 1,584,000
10 Aminophyillin Tab 100 100 100 100 100 100 600 3600 113.00 406,800
11 Aminophyllin Inj Amp 24 24 24 24 24 24 144 864 3,580.00 3,093,120
12 Amitriptillin Tab 100 100 100 100 100 100 600 3600 3,000.00 10,800,000
13 Amlodipine 10 Tab 500 200 200 200 200 300 1600 9600 1,539.00 14,774,400
14 Amlodipine 5 Tab 500 200 200 200 200 300 1600 9600 873.00 8,380,800
15 Amoxicillin Tab 300 100 100 100 100 100 800 4800 403.00 1,934,400
16 Amoxicillin Syr Btl 30 10 10 10 10 10 80 480 3,532.00 1,695,360
17 Ampicillin Tab 100 100 100 100 100 100 600 3600 364.00 1,310,400
18 Antasida Tab 400 200 200 200 200 200 1400 8400 147.00 1,234,800
19 Antasida Syr Btl 30 10 10 10 10 10 80 480 2,591.00 1,243,680
20 Atorvastatin Tab 150 150 150 150 150 150 900 5400 4,000.00 21,600,000
21 Bedak Salicyl + Menthol Pot 10 10 10 10 10 10 60 360 3,682.00 1,325,520
22 Bedak Salicyl 2% Pot 10 10 10 10 10 10 60 360 5,682.00 2,045,520
23 Bekarbon Tab 750 750 750 750 750 750 4500 27000 105.00 2,835,000
24 Betahistin Mesylat Tab 200 200 200 200 200 200 1200 7200 881.00 6,343,200
25 Cairan D5 Fls 10 10 10 10 10 10 60 360 7,549.00 2,717,640
26 Cairan D5+1/2NS Fls 10 10 10 10 10 10 60 360 13,750.00 4,950,000
27 Cairan NS Fls 10 10 10 10 10 10 60 360 8,300.00 2,988,000
28 Cairan RL Fls 10 10 10 10 10 10 60 360 8,182.00 2,945,520
29 Captopril 12,5 Tab 200 200 200 200 200 200 1200 7200 82.00 590,400
30 Captopril 25 Tab 200 200 200 200 200 200 1200 7200 125.00 900,000
31 Cefadroxil Tab 200 200 200 200 200 200 1200 7200 764.00 5,500,800
32 Cefadroxil Syr Btl 30 10 10 10 10 10 80 480 9,310.00 4,468,800
33 Cefixime Tab 300 100 100 100 100 100 800 4800 1,715.00 8,232,000
34 Cefixime Syr Btl 30 10 10 10 10 10 80 480 28,875.00 13,860,000
35 Cefotaxime Inj Vial 20 10 10 10 10 10 70 420 5,958.00 2,502,360
36 Ceftriaxone Inj Vial 20 10 10 10 10 10 70 420 6,500.00 2,730,000
Jumlah Dipindahkan : 164,775,840
PT. NUSALIMA MEDIKA
JULI 2015
JML TOTAL Harga Jumlah
No. Nama Obat /Alkes Satuan Nusa Lima Galuh Ldalam Lindai Terantam Rokan
Jumlah Pindahan : 164,775,840
37 Cetirizine Tab 300 300 300 300 300 300 1800 10800 286.00 3,088,800
38 Chloramphenicol Tab 250 250 250 250 250 250 1500 9000 126.00 1,134,000
39 Chloramphenicol ZM Tube 5 5 5 5 5 5 30 180 1,360.00 244,800
40 Cimetidine Tab 100 100 100 100 100 100 600 3600 102.00 367,200
41 Ciprofloxacin Tab 300 200 200 200 200 200 1300 7800 440.00 3,432,000
42 Clindamycin 300mg Tab 200 100 100 100 100 100 700 4200 718.00 3,015,600
43 Co-Amoxyclav 625 Tab 90 90 90 90 90 90 540 3240 4,592.00 14,878,080
44 Codein 10 mg Tab 100 0 0 0 0 0 0 600 462.00 277,200
45 Cotrimoxazole 480 Tab 300 100 100 100 100 100 800 4800 157.00 753,600
46 Cotrimoxazole 480 Syr Btl 20 10 10 10 10 10 70 420 3,780.00 1,587,600
47 CTM Tab 432 432 432 432 432 432 2592 15552 81.00 1,259,712
48 Dexamethason Tab 300 100 100 100 100 100 800 4800 93.00 446,400
49 Dexamethason Inj Amp 20 20 20 20 20 20 120 720 2,073.00 1,492,560
50 Dexttromethorphan Tab 200 100 100 100 100 100 700 4200 106.00 445,200
51 Dexttromethorphan Syr Btl 20 10 10 10 10 10 70 420 2,964.00 1,244,880
52 Domperidone Tab 300 300 300 300 300 300 1800 10800 333.00 3,596,400
53 Doxicillin Tab 100 100 100 100 100 100 600 3600 230.00 828,000
54 Ephedrin Tab 1000 1000 1000 1000 1000 1000 6000 36000 53.00 1,908,000
55 Ephinephrin Inj Amp 10 10 10 10 10 10 60 360 2,618.00 942,480
56 Erythromicyn Tab 100 100 100 100 100 100 600 3600 1,056.00 3,801,600
57 Erythromicyn Syr Btl 5 5 5 5 5 5 30 180 7,715.00 1,388,700
58 Ethambutol Tab 300 300 300 300 300 300 1800 10800 651.00 7,030,800
59 Fenofibrate Tab 30 30 30 30 30 30 180 1080 4,000.00 4,320,000
60 Fluconazole 150mg Tab 50 50 50 50 50 50 300 1800 16,500.00 29,700,000
61 Furosemide Tab 200 200 200 200 200 200 1200 7200 92.00 662,400
62 Gentian Violet 1% Btl 10 10 10 10 10 10 60 360 2,527.00 909,720
63 Glibenclamide Tab 300 300 300 300 300 300 1800 10800 68.00 734,400
64 Glimepiride 1 Tab 100 100 100 100 100 100 600 3600 691.00 2,487,600
65 Glimepiride 2 Tab 100 100 100 100 100 100 600 3600 1,368.00 4,924,800
66 Glimepiride 3 Tab 100 100 100 100 100 100 600 3600 1,776.00 6,393,600
67 Glimepiride 4 Tab 100 100 100 100 100 100 600 3600 2,369.00 8,528,400
68 Glyceril Guaiacolat Tab 100 100 100 100 100 100 600 3600 25.00 90,000
69 Griseopulvin Tab 100 100 100 100 100 100 600 3600 1,112.00 4,003,200
70 Hidrocortison 1-2.5% Cr Tube 10 10 10 10 10 10 60 360 2,727.00 981,720

PT. NUSALIMA MEDIKA
JULI 2015
No. Nama Obat /Alkes Satuan JULI AGT SEPT OKT NOV DES
71 Ibuprofen 200 Tab 100 100 100 100 100 100 600 3600 110.00 396,000
72 Ibuprofen 400 Tab 100 100 100 100 100 100 600 3600 196.00 705,600
73 Ichtyol Salep Pot 5 5 5 5 5 5 30 180 5,460.00 982,800
74 Infus Dextrose 40% Fls 5 5 5 5 5 5 30 180 4,500.00 810,000
75 INH 100 Tab 200 200 200 200 200 200 1200 7200 4,364.00 31,420,800
76 INH 300 Tab 200 200 200 200 200 200 1200 7200 106.00 763,200
77 Irbesartan 300 Tab 60 60 60 60 60 60 360 2160 4,666.00 10,078,560
78 Itraconazole Tab 150 150 150 150 150 150 900 5400 5,000.00 27,000,000
79 Ketoconazole Tab 100 100 100 100 100 100 600 3600 404.00 1,454,400
80 Ketoconazole Cr Tube 10 10 10 10 10 10 60 360 7,391.00 2,660,760
81 Lansoprazole Tab 500 500 500 500 500 500 3000 18000 909.00 16,362,000
82 Loratadine Tab 200 200 200 200 200 200 1200 7200 146.00 1,051,200
83 Metformin Tab 500 500 500 500 500 500 3000 18000 173.00 3,114,000
84 Methylprednisolon 16 mg Tab 50 50 50 50 50 50 300 1800 940.00 1,692,000
85 Methylprednisolon 4 mg Tab 300 300 300 300 300 300 1800 10800 401.00 4,330,800
86 Metronidazole 500mg Tab 200 200 200 200 200 200 1200 7200 240.00 1,728,000
87 Mometasone Furoat Cr Tube 20 20 20 20 20 20 120 720 20,250.00 14,580,000
88 Norit Tab 80 80 80 80 80 80 480 2880 292.00 840,960
89 Omeprazole Caps 490 490 490 490 490 490 2940 17640 735.00 12,965,400
90 Paracetamol Tab 500 500 500 500 500 500 3000 18000 96.00 1,728,000
91 Paracetamol Syr Btl 20 20 20 20 20 20 120 720 2,840.00 2,044,800
92 Prednisone Tab 100 100 100 100 100 100 600 3600 57.00 205,200
93 Pyrantel Pamoat Tab 100 100 100 100 100 100 600 3600 331.00 1,191,600
94 Pyrazinamide Tab 300 300 300 300 300 300 1800 10800 268.00 2,894,400
95 Ranitidine Tab 300 300 300 300 300 300 1800 10800 200.00 2,160,000
96 Ranitidine Inj Amp 25 25 25 25 25 25 150 900 1,183.00 1,064,700
97 Rifampicin 450 Tab 200 200 200 200 200 200 1200 7200 630.00 4,536,000
98 Rifampicin 600 Tab 200 200 200 200 200 200 1200 7200 1,300.00 9,360,000
99 Salbutamol 2 mg Tab 200 200 200 200 200 200 1200 7200 41.00 295,200
100 Salbutamol 4 mg Tab 200 200 200 200 200 200 1200 7200 88.00 633,600
101 Salep 2-4 Pot 10 10 10 10 10 10 60 360 4,963.00 1,786,680
102 Simvastatin 10 Tab 300 300 300 300 300 300 1800 10800 490.00 5,292,000
103 Simvastatin 20 Tab 300 300 300 300 300 300 1800 10800 933.00 10,076,400
104 Ranitidine Inj Amp 25 100 100 100 100 100 525 3150 1,007.00 3,172,050
105 Spironolactone 100 Tab 100 100 100 100 100 100 600 3600 1,007.00 3,625,200

PT. NUSALIMA MEDIKA
SEMESTER II / 2015
106 Spironolactone 25 Tab 100 100 100 100 100 100 600 3600 413.00 1,486,800
107 Sulfas Ferosus Tab 1000 1000 1000 1000 1000 1000 6000 36000 72.00 2,592,000
108 Tetracycline Tab 1000 1000 1000 1000 1000 1000 6000 36000 173.00 6,228,000
109 Thiamphenicol Tab 200 200 200 200 200 200 1200 7200 546.00 3,931,200
110 Verban 5 cm Roll 20 20 20 20 20 20 120 720 625.00 450,000
111 Verban 15 cm Roll 20 20 20 20 20 20 120 720 1,710.00 1,231,200
112 Infus Set Macro Pcs 15 15 15 15 15 15 90 540 12,848.00 6,937,920
113 Infus Set Micro Pcs 5 5 5 5 5 5 30 180 21,488.00 3,867,840
114 Transfusi Set Pcs 10 10 10 10 10 10 60 360 259.00 93,240
115 Iv Cath 18 Pcs 20 20 20 20 20 20 120 720 27,000.00 19,440,000
116 IV Cath 20 Pcs 20 20 20 20 20 20 120 720 27,000.00 19,440,000
117 IV Cath 22 Pcs 20 20 20 20 20 20 120 720 27,000.00 19,440,000
118 IV Cath 24 Pcs 10 10 10 10 10 10 60 360 27,000.00 9,720,000
119 Spuit 1 cc Pcs 100 100 100 100 100 100 600 3600 4,000.00 14,400,000
120 Spuit 3 cc Pcs 200 200 200 200 200 200 1200 7200 2,900.00 20,880,000
121 Spuit 5 cc Pcs 100 100 100 100 100 100 600 3600 3,606.00 12,981,600
122 Spuit 10 cc Pcs 100 100 100 100 100 100 600 3600 4,650.00 16,740,000
123 Handscoon Uk. S Psg 100 100 100 100 100 100 600 3600 525.00 1,890,000
124 Handscoon Uk. M Psg 100 100 100 100 100 100 600 3600 525.00 1,890,000
125 Handscoon Uk. L Psg 100 100 100 100 100 100 600 3600 525.00 1,890,000
126 Alerfed* Tab 200 200 200 200 200 200 1200 7200 1,300.00 9,360,000
127 Alerfed Syr* Btl 10 10 10 10 10 10 60 360 2,200.00 792,000
128 Alleron* Tab 200 200 200 200 200 200 1200 7200 64.00 460,800
129 Alloris* Tab 100 100 100 100 100 100 600 3600 4,030.00 14,508,000
130 Apolar Cr* Tube 10 10 10 10 10 10 60 360 29,187.00 10,507,320
131 Aprovel 150* Tab 28 28 28 28 28 28 168 1008 13,135.00 13,240,080
132 Aprovel 300* Tab 28 28 28 28 28 28 168 1008 17,727.00 17,868,816
133 Ascardia* Tab 200 200 200 200 200 200 1200 7200 1,063.00 7,653,600
134 Benoxuric 100* Tab 300 100 100 100 100 100 800 4800 1,800.00 8,640,000
135 Benoxuric 300* Tab 300 100 100 100 100 100 800 4800 3,200.00 15,360,000
136 Benozym* Tab 300 200 200 200 200 200 1300 7800 2,000.00 15,600,000
137 Biodiar* Tab 200 100 100 100 100 100 700 4200 1,546.00 6,493,200
138 Cefarin* Vial 12 12 12 12 12 12 72 432 10,417.00 4,500,144
139 Cefarox* Tab 40 40 40 40 40 40 240 1440 17,000.00 24,480,000
779,671,362

PT. NUSALIMA MEDIKA
JULI 2015
779,671,362
140 Cefarox Syr* Btl 10 10 10 10 10 10 60 360 70,000.00 25,200,000
141 Cendo Mycetin TM* Btl 5 5 5 5 5 5 30 180 15,940.00 2,869,200
142 Cendo Mycetin ZM* Tube 5 5 5 5 5 5 30 180 15,940.00 2,869,200
143 Clinex 300* Caps 60 60 60 60 60 60 360 2160 6,000.00 12,960,000
144 Colsancetine Inj* Tab 10 10 10 10 10 10 60 360 8,995.00 3,238,200
145 Combantrin 250 mg * Tab 100 100 100 100 100 100 600 3600 5,731.00 20,631,600
146 Combantrin Syr* Btl 10 10 10 10 10 10 60 360 14,550.00 5,238,000
147 Cortidex* Tab 200 200 200 200 200 200 1200 7200 220.00 1,584,000
148 Cupanol Syr* Btl 24 24 24 24 24 24 144 864 16,500.00 14,256,000
149 Dermovel Cr* Tube 10 10 10 10 10 10 60 360 57,000.00 20,520,000
150 Dextamin* Tab 200 200 200 200 200 200 1200 7200 1,650.00 11,880,000
151 Droxefa* Tab 100 100 100 100 100 100 600 3600 7,971.00 28,695,600
152 Dumin Rectal 125 * Rectal 10 10 10 10 10 10 60 360 10,600.00 3,816,000
153 Dumin Rectal 250 * Rectal 10 10 10 10 10 10 60 360 14,800.00 5,328,000
154 Elox Cr* Tube 10 10 10 10 10 10 60 360 58,409.00 21,027,240
155 Emibion* Caps 300 200 200 200 200 200 1300 7800 1,100.00 8,580,000
156 Eraphage 500 * Tab 200 200 200 200 200 200 1200 7200 1,100.00 7,920,000
157 Erlamycetin Plus TM* Btl 5 5 5 5 5 5 30 180 11,950.00 2,151,000
158 Erysanbe Syr* Btl 5 5 5 5 5 5 30 180 17,592.00 3,166,560
159 Evothyl 100 * Tab 30 30 30 30 30 30 180 1080 3,600.00 3,888,000
160 Evothyl 300 * Tab 30 30 30 30 30 30 180 1080 9,000.00 9,720,000
161 Extropect * Tab 200 200 200 200 200 200 1200 7200 900.00 6,480,000
162 Extropect Syr* Btl 24 24 24 24 24 24 144 864 22,500.00 19,440,000
163 Farsix* Tab 200 200 200 200 200 200 1200 7200 900.00 6,480,000
164 Fladystin Vaginal* Vagtab 20 20 20 20 20 20 120 720 12,300.00 8,856,000
165 Forcanox* Caps 54 54 54 54 54 54 324 1944 18,000.00 34,992,000
166 Fosicol Syr* Btl 5 5 5 5 5 5 30 180 18,425.00 3,316,500
167 Fuladic Cr* Tube 10 10 10 10 10 10 60 360 41,000.00 14,760,000
168 Fungasol* Tab 100 100 100 100 100 100 600 3600 4,300.00 15,480,000
169 Fungasol Cr* Tube 15 15 15 15 15 15 90 540 21,000.00 11,340,000
170 Gastrolan* Caps 100 100 100 100 100 100 600 3600 11,000.00 39,600,000
171 Genicol cap* Caps 100 100 100 100 100 100 600 3600 3,100.00 11,160,000
172 Glamarol 1* Tab 30 30 30 30 30 30 180 1080 2,000.00 2,160,000
173 Glamarol 2* Tab 30 30 30 30 30 30 180 1080 3,900.00 4,212,000
Jumlah Dipindahkan : 1,173,486,462

PT. NUSALIMA MEDIKA
SEMESTER II / 2015
Jumlah pindahan : 1,173,486,462
174 Glamarol 3* Tab 30 30 30 30 30 30 180 1080 5,100.00 5,508,000
175 Glamarol 4* Tab 30 30 30 30 30 30 180 1080 5,800.00 6,264,000
176 Glidanil* Tab 100 100 100 100 100 100 600 3600 539.00 1,940,400
177 Glucobay 50* Tab 100 100 100 100 100 100 600 3600 1,542.00 5,551,200
178 Glucobay 100* Tab 100 100 100 100 100 100 600 3600 2,472.00 8,899,200
179 Glucovance 2,5/500* Tab 300 300 300 300 300 300 1800 10800 3,183.00 34,376,400
180 Glucovance 5/500* Tab 300 300 300 300 300 300 1800 10800 3,865.00 41,742,000
181 Gluvas 2* Tab 50 50 50 50 50 50 300 1800 3,900.00 7,020,000
182 Gluvas 3* Tab 50 50 50 50 50 50 300 1800 5,100.00 9,180,000
183 Govazol* Tab 30 30 30 30 30 30 180 1080 62,500.00 67,500,000
184 Gracef Inj* Vial 10 10 10 10 10 10 60 360 175,000.00 63,000,000
185 Grasivask 5* Tab 90 90 90 90 90 90 540 3240 4,750.00 15,390,000
186 Grasivask 10* Tab 90 90 90 90 90 90 540 3240 8,500.00 27,540,000
187 Gratamin* Tab 100 100 100 100 100 100 600 3600 1,200.00 4,320,000
188 Histrin* Tab 100 100 100 100 100 100 600 3600 4,234.00 15,242,400
189 Histrin Syr* Btl 10 10 10 10 10 10 60 360 43,000.00 15,480,000
190 Histrine Drops* Btl 5 5 5 5 5 5 30 180 66,273.00 11,929,140
191 INH CIBA* Tab 200 200 200 200 200 200 1200 7200 965.00 6,948,000
192 Inhipraz* Tab 100 100 100 100 100 100 600 3600 12,000.00 43,200,000
193 Ketricin Cr* Tube 10 10 10 10 10 10 60 360 37,000.00 13,320,000
194 Lantus Inj* Amp 5 5 5 5 5 5 30 180 204,640.00 36,835,200
195 Leomoxyl* Caps 100 100 100 100 100 100 600 3600 2,700.00 9,720,000
196 Lipitor 10* Tab 150 150 150 150 150 150 900 5400 15,620.00 84,348,000
197 Lipitor 20* Tab 150 150 150 150 150 150 900 5400 15,620.00 84,348,000
198 Lovask 5* Tab 90 90 90 90 90 90 540 3240 5,000.00 16,200,000
199 Lovask 10* Tab 90 90 90 90 90 90 540 3240 8,500.00 27,540,000
200 Magalat* Tab 120 120 120 120 120 120 720 4320 692.00 2,989,440
201 Magalat Syr* Btl 10 10 10 10 10 10 60 360 23,000.00 8,280,000
202 Maganol* Tab 600 600 600 600 600 600 3600 21600 380.00 8,208,000
203 Merimac 450* Tab 100 100 100 100 100 100 600 3600 3,150.00 11,340,000
204 Merimac 600* Tab 100 100 100 100 100 100 600 3600 4,400.00 15,840,000
205 Merislon 12* Tab 100 100 100 100 100 100 600 3600 5,273.00 18,982,800
206 Nerva Plus* Tab 200 200 200 200 200 200 1200 7200 2,000.00 14,400,000
207 Nindya Drops* Tab 5 5 5 5 5 5 30 180 32,000.00 5,760,000

PT. NUSALIMA MEDIKA
SEMESTER II / 2015
208 Norvask 5* Tab 150 150 150 150 150 150 900 5400 6,495.00 35,073,000
209 Norvask 10* Tab 150 150 150 150 150 150 900 5400 11,639.00 62,850,600
210 Novax F Syr* Btl 10 10 10 10 10 10 60 360 26,500.00 9,540,000
211 Novomix Inj* Amp 5 5 5 5 5 5 30 180 152,806.00 27,505,080
212 Novorafid Inj* Amp 5 5 5 5 5 5 30 180 152,806.00 27,505,080
213 Opox* Tab 120 120 120 120 120 120 720 4320 1,100.00 4,752,000
214 Otsu Dex 40%* Fls 3 3 3 3 3 3 18 108 4,500.00 486,000
215 Palentin 625* Tab 60 60 60 60 60 60 360 2160 9,660.00 20,865,600
216 Pervita* Tab 200 200 200 200 200 200 1200 7200 1,200.00 8,640,000
217 Pibaksin Oint* Tube 10 10 10 10 10 10 60 360 34,338.00 12,361,680
218 Profim* Tab 60 60 60 60 60 60 360 2160 15,500.00 33,480,000
219 Promezole* Tab 120 120 120 120 120 120 720 4320 10,250.00 44,280,000
220 Pronalges* Tab 100 100 100 100 100 100 600 3600 2,300.00 8,280,000
221 Prosinal Syr* Btl 12 12 12 12 12 12 72 432 16,500.00 7,128,000
222 Pulmicort Nebul* Fls 40 40 40 40 40 40 240 1440 18,395.00 26,488,800
223 Ratinal* Tab 90 90 90 90 90 90 540 3240 4,000.00 12,960,000
224 Retaphyl SR* Tab 100 100 100 100 100 100 600 3600 1,948.00 7,012,800
225 Rhinofed* Tab 100 100 100 100 100 100 600 3600 1,540.00 5,544,000
226 Rhinofed Syr* Btl 20 20 20 20 20 20 120 720 21,500.00 15,480,000
227 Rhinos SR* Tab 100 100 100 100 100 100 600 3600 4,500.00 16,200,000
228 Salbron 2* Tab 100 100 100 100 100 100 600 3600 270.00 972,000
229 Salbron 4* Tab 100 100 100 100 100 100 600 3600 292.00 1,051,200
230 Sanadryl DMP Syr* Btl 24 24 24 24 24 24 144 864 9,220.00 7,966,080
231 Sanmag Syr* Btl 10 10 10 10 10 10 60 360 22,040.00 7,934,400
232 sanprima* Tab 100 100 100 100 100 100 600 3600 1,618.00 5,824,800
233 Sanprima Syr* Btl 5 5 5 5 5 5 30 180 20,949.00 3,770,820
234 Scabimite Cr* Tube 5 5 5 5 5 5 30 180 72,500.00 13,050,000
235 Siclidon 100* Caps 60 60 60 60 60 60 360 2160 4,390.00 9,482,400
236 Siramid 500* Tab 300 300 300 300 300 300 1800 10800 1,150.00 12,420,000
237 Spirolactone 25* Tab 100 100 100 100 100 100 600 3600 1,203.00 4,330,800
238 Starcef 200* Caps 50 50 50 50 50 50 300 1800 26,000.00 46,800,000
239 Stesolid Rectal 5* Rectal 5 5 5 5 5 5 30 180 21,600.00 3,888,000
240 Stesolid Rectal 10* Rectal 5 5 5 5 5 5 30 180 32,400.00 5,832,000
241 Termisil Cr* Tube 15 15 15 15 15 15 90 540 46,000.00 24,840,000

PT. NUSALIMA MEDIKA
SEMESTER II / 2015
242 Tetagam PP* Amp 2 2 2 2 2 2 12 72 180,000.00 12,960,000
243 Theragran M* Tab 100 100 100 100 100 100 600 3600 4,489.00 16,160,400
244 Thrombo Aspilet* Tab 600 600 600 600 600 600 3600 21600 800.00 17,280,000
245 Tibitol* Tab 300 300 300 300 300 300 1800 10800 960.00 10,368,000
246 Trichodazole* Tab 100 100 100 100 100 100 600 3600 1,434.00 5,162,400
247 Tripanzym* Tab 100 100 100 100 100 100 600 3600 1,050.00 3,780,000
248 Tuzalos* Tab 300 300 300 300 300 300 1800 10800 640.00 6,912,000
249 Unalium 5* Tab 80 80 80 80 80 80 480 2880 4,600.00 13,248,000
250 Unalium 10* Tab 80 80 80 80 80 80 480 2880 6,300.00 18,144,000
251 Urotractin* Tab 60 60 60 60 60 60 360 2160 2,710.00 5,853,600
252 Valdimex 5* Tab 100 100 100 100 100 100 600 3600 1,100.00 3,960,000
253 Valdimex Inj* Amp 5 5 5 5 5 5 30 180 10,000.00 1,800,000
254 Valisanbe 2* Tab 100 100 100 100 100 100 600 3600 130.00 468,000
255 Ventolin Syr* Tab 10 10 10 10 10 10 60 360 53,630.00 19,306,800
256 Ventolin Exp Syr* Btl 10 10 10 10 10 10 60 360 56,380.00 20,296,800
257 Verorab Inj* Amp 5 5 5 5 5 5 30 180 147,637.00 26,574,660
258 Versilon* Tab 100 100 100 100 100 100 600 3600 1,560.00 5,616,000
259 Vioquin 500* Tab 60 60 60 60 60 60 360 2160 11,000.00 23,760,000
260 Vocefa 500* Tab 60 60 60 60 60 60 360 2160 8,500.00 18,360,000
261 Vocefa Syr* Btl 10 10 10 10 10 10 60 360 37,500.00 13,500,000
262 Vocefa F Syr* Btl 10 10 10 10 10 10 60 360 65,000.00 23,400,000
263 Vometa Syr* Btl 10 10 10 10 10 10 60 360 37,500.00 13,500,000
264 Vomistop FT* Tab 150 150 150 150 150 150 900 5400 3,300.00 17,820,000
265 Zibramax* Tab 12 12 12 12 12 12 72 432 29,019.00 12,536,208
266 Plavix 75 Tab 140 140 140 140 140 140 840 5040 32,381.00 163,200,240
267 Crestor 10 Tab 140 140 140 140 140 140 840 5040 21,096.00 106,323,840
268 Crestor 20 Tab 140 140 140 140 140 140 840 5040 23,845.00 120,178,800
269 Januvia 100 Tab 140 140 140 140 140 140 840 5040 15,993.00 80,604,720
270 Janumet Tab 140 140 140 140 140 140 840 5040 7,666.00 38,636,640
271 Truvaz 10 Tab 60 60 60 60 60 60 360 2160 15,881.00 34,302,960
272 Truvaz 20 Tab 60 60 60 60 60 60 360 2160 15,881.00 34,302,960
273 Trajenta Tab 150 150 150 150 150 150 900 5400 16,834.00 90,903,600
274 Nexium 20 Tab 140 140 140 140 140 140 840 5040 17,356.00 87,474,240
275 Nexium 40 Tab 140 140 140 140 140 140 840 5040 21,189.00 106,792,560
276 Pantozol 20 Tab 140 140 140 140 140 140 840 5040 20,429.00 102,962,160
Jumlah dipindahkan : 3,733,673,370

PT. NUSALIMA MEDIKA
SEMESTER II / 2015
275 Pantozol 40 Tab 140 140 140 140 140 140 840 5040 25929 130,682,160
276 Kasa steril kotak 24 24 24 24 24 24 144 864 6050 5,227,200
277 Sanadryl Exp syr btl 24 24 24 24 24 24 144 864 9449 8,163,936
Total : 3,877,746,666
Diminta Oleh Disetujui Oleh
( Rini Yulianti SSi ,Apt ) ( dr. Hary Andriyanto )

PT PERKEBUNAN NUSAN DAFTAR PERMINTAAN OBAT-OBATAN DAN ALAT KESEHATAN
Bagian Kesehatan SEMESTER-I 2015
PAKET - I
ESTIM
JUMLAH FISIK ASI NILAI (Rp.)
HARG
KEMASA
A
NO NAMA DAGANG N/ KET
SATU
SATUAN JANFEB MARTRW-IAPRILMEI JUNI TRW-IITOTAL JAN FEB MARET TRW-I APRIL MEI JUNI TRW-II TOTAL
AN
AU-31
(Rp.)
1 Alloris 10 mg/100
Box 10 x 10's3 3 3 9 3 3 3 9 18 ### ### ### ### ### ### ### ### ### ###
2 Amoxsan Inj Box 10 vial @1
###
gr### 50 150 ###### 50 150 300 ### ### ### ### ### ### ### ### ### ###
3 Amoxsan P. drops Fls ###### 10 30 ###### 10 30 60 20,205 ### ### ### ### ### ### ### ### ###
4 Analsik film-coate BOx 7 7 7 21 7 7 7 21 42 ### ### ### ### ### ### ### ### ### ###
5 Becom-C film-coat BOX 9 9 9 27 9 9 9 27 54 ### ### ### ### ### ### ### ### ### ###
6 Biothicol dry syru Fls ###### 12 36 ###### 12 36 72 18,440 ### ### ### ### ### ### ### ### ###
7 Braxidin/100 tab BOX 8 8 8 24 8 8 8 24 48 79,000 ### ### ### ### ### ### ### ### ###
8 Cinolon - N cream Tube ###### 15 45 ###### 15 45 90 15,820 ### ### ### ### ### ### ### ### ###
9 Claneksi dry syru fls ###### 12 36 ###### 12 36 72 46,440 ### ### ### ### ### ### ### ### ###
10 Claneksi forte dry Fls ###### 17 51 ###### 17 51 102 62,200 ### ### ### ### ### ### ### ### ###
11 Claneksi tablet/30 box 3 5 5 13 5 5 5 15 28 ### ### ### ### ### ### ### ### ### ###
12 Colsancetine Inj 1 BOX ###### 56 168 ###### 56 168 336 89,950 ### ### ### ### ### ### ### ### ###
13 Cortidex tablet/10Box/100 2 2 2 6 2 2 2 6 12 22,000 44,000 44,000 44,000 ### 44,000 44,000 44,000 ### ###
BOX1
14 Docetaxel 20 mg/0 Vial@ 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ###
Elkana film- 0.5 ml
15 coated tab/100 box 6 4 4 14 6 6 6 18 32 65,000 ### ### ### ### ### ### ### ### ###
tab
16 Elkana syrup/60 m Fls ###### 46 136 ###### 46 138 274 18,860 ### ### ### ### ### ### ### ### ###
SOFTBA
17 ENERTON 500 G 500 5 5 5 15 5 5 5 15 30 66,200 ### ### ### ### ### ### ### ### ###
ML
18 Erysanbe dry syru Fls 5 5 5 15 5 5 5 15 30 19,385 96,925 96,925 96,925 ### 96,925 96,925 96,925 ### ###
19 Flamar 50 mg/100 box 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ###
20 Forumen ear drop
Botol 10 ml6 8 8 22 8 8 8 24 46 22,460 ### ### ### ### ### ### ### ### ###
SOFTBA
21 Futrolit Infus G 500 ###### 54 162 ###### 54 162 324 49,150 ### ### ### ### ### ### ### ### ###
ML
22 Herclov / 50 caple 1 ### -
Box 5 x 10's 1 ### 1 - 1 2 ### ### - - ### - ### - ### ###
SOFTBA
23 INFUSAN D5 DP G 500 ######### 552 ###### 168 528 ### 16,850 ### ### ### ### ### ### ### ### ###
SOFTBA
ML
24 INFUSAN D5+¼ N G 500 ###### 54 162 ###### 54 162 324 17,000 ### ### ### ### ### ### ### ### ###
SOFTBA
ML
25 INFUSAN D5+½ N G 500 ###### 78 258 ###### 78 234 492 17,150 ### ### ### ### ### ### ### ### ###
SOFTBA
ML
26 INFUSAN NS DP G 500 ######### ### ###### 595 ### ### 16,100 ### ### ### ### ### ### ### ### ###
SOFTBA
ML
27 INFUSAN RING-A G 500 ######### 648 ###### 216 648 ### 18,550 ### ### ### ### ### ### ### ### ###
SOFTBA
ML
28 INFUSAN RL DP G 500 ######### ### ###### ### ### ### 16,550 ### ### ### ### ### ### ### ### ###
ML
29 Mucohexin elx/12 Fls ###### 48 144 ###### 48 144 288 14,450 ### ### ### ### ### ### ### ### ###
30 Mucohexin/100Box
ta 25 x 4's
3 3 3 9 3 3 3 9 18 41,000 ### ### ### ### ### ### ### ### ###
31 Neo Kaolana SUS Fls ###### 30 90 ###### 30 90 180 11,195 ### ### ### ### ### ### ### ### ###
32 Neurosanbe plus/1 3 3
box 10 x 10's 3 9 3 3 3 9 18 91,000 ### ### ### ### ### ### ### ### ###
33 Pervita box 3 3 3 9 3 3 3 9 18 ### ### ### ### ### ### ### ### ### ###
PAKET - I
ESTIM
HARG
KEMASA
A
SATU
AN
AU-31
(Rp.)
34 Pibaksin Oint Tube ###### 15 45 ###### 15 45 90 36,145 ### ### ### ### ### ### ### ### ###
35 Pirofel 20 mg/100 1 1
Box 10 x 10's 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ###
36 Polidemisine ED Botol 5ml
###### 20 60 ###### 20 60 120 22,170 ### ### ### ### ### ### ### ### ###
37 PROANES 4 4
box 5 ampul @20ml 4 12 4 4 4 12 24 ### ### ### ### ### ### ### ### ### ###
38 Pumpitor Injeksi
Box 1vial 40###
mg### 30 90 ###### 30 90 180 ### ### ### ### ### ### ### ### ### ###
39 Sagestam cream Tube ###### 20 60 ###### 20 60 120 10,775 ### ### ### ### ### ### ### ### ###
Sagestam Inj 80
40 6 6
Box 5 vial@2ml 6 18 6 6 6 18 36 43,000 ### ### ### ### ### ### ### ### ###
mg(2ml) / 5 vial
41 Sanadryl exp/60 m Fls ###### 48 144 ###### 48 144 288 8,590 ### ### ### ### ### ### ### ### ###
42 Sanadryl plus exp Fls ###### 48 144 ###### 48 144 288 8,590 ### ### ### ### ### ### ### ### ###
43 San-B Plex P. drop Fls ###### 10 30 ###### 10 30 60 15,220 ### ### ### ### ### ### ### ### ###
SOFTBA
44 SANBE HEST 200 G 500 ###### 22 66 ###### 22 66 132 ### ### ### ### ### ### ### ### ### ###
ML
45 Sanbe tears ED Botol 8ml 5 5 5 15 5 5 5 15 30 19,375 96,875 96,875 96,875 ### 96,875 96,875 96,875 ### ###
46 Sanmag Suspensio Fls ###### 32 96 ###### 32 84 180 22,040 ### ### ### ### ### ### ### ### ###
47 Sanmag/100 tab box 3 4 4 11 4 4 4 12 23 65,000 ### ### ### ### ### ### ### ### ###
48 Sanmol P. drops Fls ###### 20 60 ###### 20 60 120 13,740 ### ### ### ### ### ### ### ### ###
49 Sanprima forte/10 box 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ###
50 Sanprima syrup/6 Fls ###### 15 45 ###### 15 45 90 22,435 ### ### ### ### ### ### ### ### ###
51 Santa E 400/ 100box 25 x 4's
1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ###
52 Santagesik Inj / 5 Box 3 3 3 9 3 3 3 9 18 40,925 ### ### ### ### ### ### ### ### ###
53 SANTOCYN Injeks
BOX @ 105 5 5 15 5 5 5 15 30 ### ### ### ### ### ### ### ### ### ###
54 Trichodazol 500 m BOX 7 7 7 21 7 7 7 21 42 ### ### ### ### ### ### ### ### ### ###
55 Trichodazol infus Softbag###### 17 45 ###### 17 51 96 78,750 ### ### ### ### ### ### ### ### ###
SOFTBA
56 TRIDEX 27 A G 500 ###### 54 162 ###### 48 144 306 18,100 ### ### ### ### ### ### ### ### ###
SOFTBA
ML
57 TRIDEX 27 B G 500 ###### 55 165 ###### 55 165 330 18,100 ### ### ### ### ### ### ### ### ###
SOFTBA
ML
58 TRIDEX PLAIN G 500 6 6 6 18 6 6 6 18 36 16,800 ### ### ### ### ### ### ### ### ###
ML
59 Tripanzym/100 cp BOX 2 2 2 6 3 3 3 9 15 ### ### ### ### ### ### ### ### ### ###
60 Tuzalos/100 cpt Box ###### 13 39 ###### 13 39 78 64,000 ### ### ### ### ### ### ### ### ###
61 Urotractin/60 cps box ###### 14 42 ###### 14 42 84 ### ### ### ### ### ### ### ### ### ###
BOTO
62 VALAMIN L 500 ###### 10 30 ###### 10 30 60 60,700 ### ### ### ### ### ### ### ### ###
ML
63 Valisanbe 2 mg/10 box 4 4 4 12 4 4 4 12 24 15,500 62,000 62,000 62,000 ### 62,000 62,000 62,000 ### ###
64 Oxaliplatine 50 mg Vial 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ###
65 Bledstop Inj Box/10 4 4 4 12 4 4 4 12 24 64,900 ### ### ### ### ### ### ### ### ###
66 Sanadryl DMP Syr Btl ###### 48 144 ###### 48 144 288 9,220 ### ### ### ### ### ### ### ### ###
JUMLAH ### ### ### ### ### ### ### ### ###
PPN 10% ### ### ### ### ### ### ### ### ###
JUMLAH KESELURU ### ### ### ### ### ### ### ### ###
PAKET - I
ESTIM
HARG
KEMASA
A
SATU
AN
AU-31
(Rp.)
Rini Yulianti, S.Si,Apt. drg. Wiwik Widiati Bambang Budi Santoso, SE dr. Heddy Lubis
Ast. Urs. Farmasi Ka. Urs. Kesehatan Ka.Urs. Admi Kepala Bagian
No. Dok. FM-AKT-AU-32.1 No. Revisi : 00 Tgl. 01-08-2000 Halaman :…………………… dari :…………………….
DAFTAR PERMINTAAN OBAT-OBATAN DAN ALAT KESEHATAN
RS TANDUN SEMESTER-I 2015
PAKET - I
ESTI
MASI
JUMLAH FISIK NILAI (Rp.)
KEM HAR
ASAN GA
KETERA
NO NO NAMA DAGANG KOMPOSISI / SATU
NGAN
SATU JANFEB
MARET
TRW-I
APRILMEIJUNI TOTAL AN
TRW-II JAN FEB MARET TRW-I APRIL MEI JUNI TRW-II TOTAL
AN AU-
31
(Rp.)
1 2 3 4 6 7=6*110%
1 1 Alloris 10 mg/100 Loratadin 10 mg box - - - ### - - - - - - - - - ###
2 Amoxsan Inj Amoksisilin inj Vial - - - ### - - - - - - - - - ###
2 3 Amoxsan P. drops Amoksisilin Drop Fls - - - ### - - - - - - - - - ###
4 Analsik film-coate Vit
Methampyron 500
B1 50 mg, vit mg +mg,
B2 25 Diazepam
vit B6 102mg,
mg vit B12 5 mcg, BOx - - - ### - - - - - - - - - ###
1 5 Becom-C film-coat vit C 500 mg, nicotinamide 100 mg, Ca pantothenate 20 BOX 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
3 6 Biothicol dry syru mg
Thiamfenikol 125 mg / 5 ml Fls - - - ### - - - - - - - - - ###
2 7 Braxidin/100 tab Chlordiazepoxide 5 mg, clidinium Br 2.5 mg BOX 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
8 Cinolon - N cream Fluosinolon asetonida + Neomycin Cream Tube - - - ### - - - - - - - - - ###
Co-amoxiclav: Amoxicillin trihydrate 125 mg, K
9 Claneksi dry syru Fls - - - ### - - - - - - - - - ###
clavulanate 31.25
Co-amoxiclav: mg
Amoxicillin trihydrate 250 mg, K
10 Claneksi forte dry Fls - - - ### - - - - - - - - - ###
clavulanate 62.5 mg
11 Claneksi/30 cpt box - - - ### - - - - - - - - - ###
clavulanate 125 mg
3 12 Colsancetine Inj 1 Kloramfenikol inj BOX 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
13 Cortidex/100 tab Deksametason tab Box/100 - - - ### - - - - - - - - - ###
14 Docetaxel 40 mg/ Docetaxel Vial - - - ### - - - - - - - - - ###
Vit A 2,400 iu, vit B1 4 mg, vit B2 1.2 mg, vit B6 1.2 mg,
15 Elkana film-coatedDibasic Ca phosphate 200 mg, Ca lactate 100 mg,
vit B12 4 mcg, vit C 60 mg, vit D 400 iu, nicotinamide vit B6 2 box - - - ### - - - - - - - - - ###
4 16 Elkana syrup/60 m16 mg, Ca pantothenate 6 mg, choline 12 mg, inositol SOF
Fls ###### 24 ################## ### ### ### ### ### ### ### ### ### ### ###
Fruktosa
12 mg, Ca60gluconate
g, Glukosa300Monohidrat 33 g setara dengan
mg, Ca hypophosphite 20 mg, TBA
17 ENERTON 500 Glukosa Anhidrat 15
Na hypophosphite 20gmg,
Xilitol 30 g,HCl
l-lysine Air untuk
200 mgInjeksi ad G - - - ### - - - - - - - - - ###
1000 ml, Osmolaritas 690 mOsm/L 500
18 Erysanbe dry syru Eritromisin 200 mg / 5 ml Fls
ML - - - ### - - - - - - - - - ###
19 Flamar 50 mg/100 Natrium diklofenak 50 box - - - ### - - - - - - - - - ###
SOF
20 Forumen ear drop NaDocusate sodiumK5mg
⁺ 100 mEq/L; ⁺ 18 mEq/L, Ca²⁺ 4 mEq/L; Mg²⁺ Botol 6 TBA 8ml - - - ### - - - - - - - - - ###
5 21 FUTROLIT mEq/L; Cl⁻90 mEq/L; Asetat 38 mEq/L; Osmolaritas: G ###### 24 ################## ### ### ### ### ### ### ### ### ### ### ###
525 mOsm/L, Sorbitol 50 g/L SOF
22 Herclov / 50 capleValaciclovir 500mg 500
BOX - - - ### - - - - - - - - - ###
TBA
SOF
ML
6 23 INFUSAN D5 DP Dekstrosa 50 g/L; Osmolaritas: 278 mOsm/L G ###### 48
TBA ################## ### ### ### ### ### ### ### ### ### ### ###
SOF
7 24 INFUSAN D5+¼ NNa⁺38,5 mEq/L; Cl⁻ 38,5 mEq/L; Dekstrosa 50 g/L; Os TBA 500
G ###### 48 ################## ### ### ### ### ### ### ### ### ### ### ###
SOF
ML
500
8 25 INFUSAN D5+½ NNa⁺77 mEq/L; Cl⁻ 77 mEq/L; Dekstrosa 50 g/L; Osmol TBA G ###### 48 ################## ### ### ### ### ### ### ### ### ### ### ###
SOF
ML
9 26 INFUSAN NS DP Na⁺154 mEq/L; CI⁻ 154 mEq/L; Osmolaritas: 308 mOs TBA 500
G ###### 48 ################## ### ### ### ### ### ### ### ### ### ### ###
Na⁺ 131 mEq/L; K⁺ 4 mEq/L; Ca²⁺ 2,7 mEq/L; Cl ⁻109 SOF ML
500
10 27 INFUSAN RING-A G ###### 48
TBA ################## ### ### ### ### ### ### ### ### ### ### ###
mEq/L;
Na⁺ 131 Asetat
mEq/L; 28KmEq/L;Osmolaritas: 273 mOsm/L
⁺4 mEq/L; Ca²⁺ 2,7 mEq/L; Cl ⁻109 500ML
11 28 INFUSAN RL DP G ###### 48 ################## ### ### ### ### ### ### ### ### ### ### ###
mEq/L; Laktat 28 mEq/L; ML
29 Mucohexin elx/12 Bromhexin syr 500
Fls - - - ### - - - - - - - - - ###
ML
30 Mucohexin/100 ta Bromhexin tab box - - - ### - - - - - - - - - ###
12 31 Neo Kaolana SUS Per 15 mL Kaolin 700 mg, pectin 66 mg Fls ###### 24 ################## ### ### ### ### ### ### ### ### ### ### ###
Metampyrone 500 mg, vit B1 50 mg, vit B6 100 mg, vit
32 Neurosanbe plus/1Vit A 10,000 iu, vit B1 20 mg, vit B2 5 mg, nicotinamide box - - - ### - - - - - - - - - ###
B12 100 mcg
50 mg, vit B6 10 mg, Ca pantothenate 11.6 mg, biotin
0.25 mg, vit B125 mcg, vit C 150 mg, vit D3 400 iu, vit E
33 Pervita 10 mg, folic acid 0.4 mg, Ca 50 mg, phosphorus 38.64 box - - - ### - - - - - - - - - ###
mg, Fe 10 mg, Mg 16.4 mg, manganese 0.379 mg, K
0.035 mg, selenium 0.061 mg, fluoride 0.045 mg, copper
34 Pibaksin Oint 0.712 mg, Zn
Mupirocin 0.343 mg, molybdenum 0.083 mg
oint Tube - - - ### - - - - - - - - - ###
35 Pirofel 20 mg/100 Piroksikam 20mg box - - - ### - - - - - - - - - ###
36 Polidemisine ED Neomycine sulphate 3.5mg, Polymixine b Sulphate 6.00
Botol 5ml - - - ### - - - - - - - - - ###
37 PROANES Propofol 10 mg/ml AMPUL 20 ML - - - ### - - - - - - - - - ###
PAKET - I
ESTI
MASI
KEM HAR
ASAN GA
KETERA
NGAN
SATU JANFEB
MARET
TRW-I
AN AU-
31
(Rp.)
1 2 3 4 6 7=6*110%
38 Pumpitor Injeksi Omeprazole 40 mg Vial - - - ### - - - - - - - - - ###
39 Sagestam cream Gentamisin Cream Tube - - - ### - - - - - - - - - ###
40 Sagestam Inj 80 mgGentamisin inj
Diphenhydramine HCl 12.5 mg, ammon Cl 100 mg, K Vial - - - ### - - - - - - - - - ###
41 Sanadryl exp/60 mguaiacolsulfonate 30 mg, Na citrate 50 mg, menthol 1 Fls - - - 8,590 - - - - - - - - - ###
Dextromethorphan
mg HBr 10 mg, diphenhydramine HCl
42 Sanadryl plus exp 12.5 mg, ammon Cl 100 mg, Na citrate 50 mg, menthol Fls - - - 8,590 - - - - - - - - - ###
1 mg
Vit A 5,000 iu, vit D 400 iu, vit B1 1 mg, vit B2 1.2 mg,
43 San-B Plex P. drop vit B6 1 mg, nicotinamide 10 mg, pantothenic acid 5 SOF
Fls - - - ### - - - - - - - - - ###
mg, vit C 50 mg TBA
13 44 SANBE HEST 200 Hydroxyethyl Starch 30 gr, Natrium Klorida 45 gr G ###### 10 ############### 60 ### ### ### ### ### ### ### ### ### ### ###
45 Sanbe tears ED Dextran 70 1mg, Hypromellose 3mg 5008ml
Botol - - - ### - - - - - - - - - ###
Mg trisilicate 325 mg, Al(OH)3 colloidal 325 mg, ML
46 Sanmag Suspensio Fls - - - ### - - - - - - - - - ###
simethicone
Mg trisilicate25
325
mgmg, Al(OH)3 colloidal 325 mg,
papaverine HCl 30 mg, chlordiazepoxide HCl 5 mg, vit
47 Sanmag/100 tab box - - - ### - - - - - - - - - ###
B1 2 mg, vit B21 mg, vit B6 500 mcg, vit B12 1 mcg,
niacinamide 5 mg, Ca pantothenate 1 mg
48 Sanmol P. drops Paracetamol Drop Fls - - - ### - - - - - - - - - ###
Co-trimoxazole: Trimethoprim 160 mg,
49 Sanprima forte/10 box - - - ### - - - - - - - - - ###
sulfamethoxazole 800 mg
50 Sanprima syrup/6 Fls - - - ### - - - - - - - - - ###
51 Santa E 400/ 100 Vitamin E 400 mg box - - - ### - - - - - - - - - ###
52 Santagesik Inj / 5 Metamizole Na 500 mg Box - - - ### - - - - - - - - - ###
14 53 SANTOCYN InjeksOxytocin 10 IU / ml BOX @ 101 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
54 Trichodazol 500 mMetronidazole 500 mg BOX - - - ### - - - - - - - - - ###
SOF
55 Trichodazol infus Metronidazole inf Softbag
TBA - - - ### - - - - - - - - - ###
Na⁺ 60 mEq/L; K⁺ 10 mEq/L; Laktat 20 mEq/L; Cl⁻50 SOF
15 56 TRIDEX 27 A G ###### 24
TBA ################## ### ### ### ### ### ### ### ### ### ### ###
mEq/L; Dekstrosa 27 g/L;Osmolaritas: 290 mOsm/L
16 57 TRIDEX 27 B 500
G ###### 24 ################## ### ### ### ### ### ### ### ### ### ### ###
mEq/L; TBA
Na⁺ 38,5Dekstrosa 27 g/L;Osmolaritas:
mEq/L; Klorida 290 mOsm/L
38,5 mEq/L; Dekstrosa ML
37,5 500
58 TRIDEX PLAIN G - - - ### - - - - - - - - - ###
g/L; Osmolaritas:
Pancreatin 170 mg,285 mOsm/L
activated ML
dimethylpolysiloxane 80 500
59 Tripanzym/100 cpParacetamol 500 mg, dextromethorphan HBr 10 mg, BOX - - - ### - - - - - - - - -
mg ML
60 Tuzalos/100 cpt phenylpropanolamine HCl 15 mg, chlorpheniramine Box - - - ### - - - - - - - - -
17 61 Urotractin/60 cps maleate 1 mg
Asam pipemidat 400 mg BO 5 5 5
box ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ###
Asam Amino 2,7 % (BCAA 27,5%); Sorbitol 5%; TOL
62 VALAMIN - - - ### - - - - - - - - - ###
Osmolaritas: 507 mOsm/L 500
63 Valisanbe 2 mg/10Diazepam 2mg box
ML - - - ### - - - - - - - - - ###
64 Oxaliplatine 50 mgOxaliplatine 50 mg Inj Vial - - - ### - - - - - - - - -
65 Bledstop Inj methylergometrin maleat 200 mcg/ml Box/5 - - - ### - - - - - - - - -
66 Sanadryl DMP Syrper 5 ml : dextromerthopan HBr 10 mg, diphenhydramin Btl - - - 9,220 - - - - - - - - -
JUMLAH ### ### ### ### ### ### ### ### ### ###
PPN 10% ### ### ### ### ### ### ### ### ###
JUMLAH KESELURUHAN ### ### ### ### ### ### ### ### ###
Ka. Unit RS Tandun
dr Muhammad Nur
No.No. Dok. FM-AKT-AU-32.1 No. Revisi : 00 Tgl. 01-08-2000 Halaman :…………………… dari :…………………….
PAKET - I
ESTI
MASI
KEM HAR
ASAN GA
KETERA
NGAN
SATU JANFEB
MARET
TRW-I
AN AU-
31
(Rp.)
1 2 3 4 6 7=6*110%
1 1 Alloris 10 mg/100 Loratadin 10 mg box 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
2 Amoxsan Inj Amoksisilin inj Vial - - - ### - - - - - - - - - ###
2 3 Amoxsan P. drops Amoksisilin Drop Fls 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
4 Analsik film-coate Vit
Methampyron 500
B1 50 mg, vit mg +mg,
B2 25 Diazepam
vit B6 102mg,
mg vit B12 5 mcg, BOx 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
1 5 Becom-C film-coat vit C 500 mg, nicotinamide 100 mg, Ca pantothenate 20 BOX 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
3 6 Biothicol dry syru mg
Thiamfenikol 125 mg / 5 ml Fls - - - ### - - - - - - - - - ###
2 7 Braxidin/100 tab Chlordiazepoxide 5 mg, clidinium Br 2.5 mg BOX 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
8 Cinolon - N cream Fluosinolon asetonida + Neomycin Cream Tube 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
9 Claneksi dry syru Fls - - - ### - - - - - - - - - ###
clavulanate 31.25
Co-amoxiclav: mg
Amoxicillin trihydrate 250 mg, K
10 Claneksi forte dry Fls 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
clavulanate 62.5 mg
11 Claneksi/30 cpt box - - - ### - - - - - - - - - ###
clavulanate 125 mg
3 12 Colsancetine Inj 1 Kloramfenikol inj BOX 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
13 Cortidex/100 tab Deksametason tab Box/1002 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
14 Docetaxel 40 mg/ Docetaxel Vial 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
Vit A 2,400 iu, vit B1 4 mg, vit B2 1.2 mg, vit B6 1.2 mg,
15 Elkana film-coatedDibasic Ca phosphate 200 mg, Ca lactate 100 mg,
vit B12 4 mcg, vit C 60 mg, vit D 400 iu, nicotinamide vit B6 2 box 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
4 16 Elkana syrup/60 m16 mg, Ca pantothenate 6 mg, choline 12 mg, inositol SOF
Fls ###### 10 ############### 60 ### ### ### ### ### ### ### ### ### ### ###
Fruktosa
12 mg, Ca60gluconate
g, Glukosa300Monohidrat 33 g setara dengan
mg, Ca hypophosphite 20 mg, TBA
17 ENERTON 500 Glukosa Anhidrat 15
Na hypophosphite 20gmg,
Xilitol 30 g,HCl
l-lysine Air untuk
200 mgInjeksi ad G 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
1000 ml, Osmolaritas 690 mOsm/L 500
18 Erysanbe dry syru Eritromisin 200 mg / 5 ml ML 5 5 5 ### 5 5 5 ### 30
Fls ### ### ### ### ### ### ### ### ### ### ###
19 Flamar 50 mg/100 Natrium diklofenak 50 box 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
SOF
20 Forumen ear drop NaDocusate sodiumK5mg
⁺ 100 mEq/L; ⁺ 18 mEq/L, Ca²⁺ 4 mEq/L; Mg²⁺ Botol 6 TBA 8ml3 3 3 9 3 3 3 9 18 ### ### ### ### ### ### ### ### ### ### ###
5 21 FUTROLIT mEq/L; Cl⁻90 mEq/L; Asetat 38 mEq/L; Osmolaritas: G ###### 24 ################## ### ### ### ### ### ### ### ### ### ### ###
525 mOsm/L, Sorbitol 50 g/L SOF
22 Herclov / 50 capleValaciclovir 500mg 500
BOX - - - ### - - - - - - - - - ###
TBA
SOF
ML
6 23 INFUSAN D5 DP Dekstrosa 50 g/L; Osmolaritas: 278 mOsm/L G
TBA ###### 48 ################## ### ### ### ### ### ### ### ### ### ### ###
SOF
7 24 INFUSAN D5+¼ NNa⁺38,5 mEq/L; Cl⁻ 38,5 mEq/L; Dekstrosa 50 g/L; Os TBA 500
G - - - ### - - - - - - - - - ###
SOF
ML
500
8 25 INFUSAN D5+½ NNa⁺77 mEq/L; Cl⁻ 77 mEq/L; Dekstrosa 50 g/L; Osmol TBA G ###### 24 ################## ### ### ### ### ### ### ### ### ### ### ###
SOF
ML
9 26 INFUSAN NS DP Na⁺154 mEq/L; CI⁻ 154 mEq/L; Osmolaritas: 308 mOs TBA 500
G ########################### ### ### ### ### ### ### ### ### ### ### ###
Na⁺ 131 mEq/L; K⁺ 4 mEq/L; Ca²⁺ 2,7 mEq/L; Cl ⁻109 SOF ML
500
10 27 INFUSAN RING-A G ###### 48 ##################
TBA ### ### ### ### ### ### ### ### ### ### ###
mEq/L;
Na⁺ 131 Asetat
mEq/L; 28KmEq/L;Osmolaritas: 273 mOsm/L
⁺4 mEq/L; Ca²⁺ 2,7 mEq/L; Cl ⁻109 500ML
11 28 INFUSAN RL DP G ########################### ### ### ### ### ### ### ### ### ### ### ###
mEq/L; Laktat 28 mEq/L; ML
29 Mucohexin elx/12 Bromhexin syr 500
Fls ###### 24 ################## ### ### ### ### ### ### ### ### ### ### ###
ML
30 Mucohexin/100 ta Bromhexin tab box 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
12 31 Neo Kaolana SUS Per 15 mL Kaolin 700 mg, pectin 66 mg Fls - - - ### - - - - - - - - - ###
Metampyrone 500 mg, vit B1 50 mg, vit B6 100 mg, vit
32 Neurosanbe plus/1Vit A 10,000 iu, vit B1 20 mg, vit B2 5 mg, nicotinamide box 3 3 3 9 3 3 3 9 18 ### ### ### ### ### ### ### ### ### ### ###
B12 100 mcg
50 mg, vit B6 10 mg, Ca pantothenate 11.6 mg, biotin
0.25 mg, vit B125 mcg, vit C 150 mg, vit D3 400 iu, vit E
33 Pervita 10 mg, folic acid 0.4 mg, Ca 50 mg, phosphorus 38.64 box 3 3 3 9 3 3 3 9 18 ### ### ### ### ### ### ### ### ### ### ###
mg, Fe 10 mg, Mg 16.4 mg, manganese 0.379 mg, K
0.035 mg, selenium 0.061 mg, fluoride 0.045 mg, copper
34 Pibaksin Oint 0.712 mg, Zn
Mupirocin 0.343 mg, molybdenum 0.083 mg
oint Tube###### 15 ############### 90 ### ### ### ### ### ### ### ### ### ### ###
35 Pirofel 20 mg/100 Piroksikam 20mg box 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
36 Polidemisine ED Neomycine sulphate 3.5mg, Polymixine b Sulphate 6.00
Botol 5ml - - - ### - - - - - - - - - ###
37 PROANES Propofol 10 mg/ml AMPUL 20 4ML4 4 ### 4 4 4 ### 24 ### ### ### ### ### ### ### ### ### ### ###
PAKET - I
ESTI
MASI
KEM HAR
ASAN GA
KETERA
NGAN
SATU JANFEB
MARET
TRW-I
AN AU-
31
(Rp.)
1 2 3 4 6 7=6*110%
38 Pumpitor Injeksi Omeprazole 40 mg Vial ###### 10 ############### 60 ### ### ### ### ### ### ### ### ### ### ###
39 Sagestam cream Gentamisin Cream Tube###### 10 ############### 60 ### ### ### ### ### ### ### ### ### ### ###
40 Sagestam Inj 80 mgGentamisin inj
Diphenhydramine HCl 12.5 mg, ammon Cl 100 mg, K Vial 6 6 6 ### 6 6 6 ### 36 ### ### ### ### ### ### ### ### ### ### ###
41 Sanadryl exp/60 mguaiacolsulfonate 30 mg, Na citrate 50 mg, menthol 1 Fls - - - 8,590 - - - - - - - - - ###
Dextromethorphan
mg HBr 10 mg, diphenhydramine HCl
42 Sanadryl plus exp 12.5 mg, ammon Cl 100 mg, Na citrate 50 mg, menthol Fls ###### 48 ################## 8,590 ### ### ### ### ### ### ### ### ### ###
1 mg
Vit A 5,000 iu, vit D 400 iu, vit B1 1 mg, vit B2 1.2 mg,
43 San-B Plex P. drop vit B6 1 mg, nicotinamide 10 mg, pantothenic acid 5 SOF
Fls ###### 10 ############### 60 ### ### ### ### ### ### ### ### ### ### ###
mg, vit C 50 mg TBA
13 44 SANBE HEST 200 Hydroxyethyl Starch 30 gr, Natrium Klorida 45 gr G ###### 12 ############### 72 ### ### ### ### ### ### ### ### ### ### ###
45 Sanbe tears ED Dextran 70 1mg, Hypromellose 3mg 5008ml
Botol - - - ### - - - - - - - - - ###
Mg trisilicate 325 mg, Al(OH)3 colloidal 325 mg, ML
46 Sanmag Suspensio Fls ###### 20 ################## ### ### ### ### ### ### ### ### ### ### ###
simethicone
Mg trisilicate25
325
mgmg, Al(OH)3 colloidal 325 mg,
papaverine HCl 30 mg, chlordiazepoxide HCl 5 mg, vit
47 Sanmag/100 tab box 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
B1 2 mg, vit B21 mg, vit B6 500 mcg, vit B12 1 mcg,
niacinamide 5 mg, Ca pantothenate 1 mg
48 Sanmol P. drops Paracetamol Drop Fls ###### 15 ############### 90 ### ### ### ### ### ### ### ### ### ### ###
49 Sanprima forte/10 box 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
50 Sanprima syrup/6 Fls ###### 15 ############### 90 ### ### ### ### ### ### ### ### ### ### ###
51 Santa E 400/ 100 Vitamin E 400 mg box 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
52 Santagesik Inj / 5 Metamizole Na 500 mg Box 3 3 3 9 3 3 3 9 18 ### ### ### ### ### ### ### ### ### ### ###
14 53 SANTOCYN InjeksOxytocin 10 IU / ml BOX @ 104 4 4 ### 4 4 4 ### 24 ### ### ### ### ### ### ### ### ### ### ###
54 Trichodazol 500 mMetronidazole 500 mg BOX 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
SOF
55 Trichodazol infus Metronidazole inf TBA 5 5 5
Softbag ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
15 56 TRIDEX 27 A G ###### 24
TBA ################## ### ### ### ### ### ### ### ### ### ### ###
mEq/L; Dekstrosa 27 g/L;Osmolaritas: 290 mOsm/L
16 57 TRIDEX 27 B 500
G ###### 25 ################## ### ### ### ### ### ### ### ### ### ### ###
mEq/L; TBA
Na⁺ 38,5Dekstrosa 27 g/L;Osmolaritas:
mEq/L; Klorida 290 mOsm/L
38,5 mEq/L; Dekstrosa ML
37,5 500
58 TRIDEX PLAIN G 6 6 6 ### 6 6 6 ### 36 ### ### ### ### ### ### ### ### ### ### ###
g/L; Osmolaritas:
Pancreatin 170 mg,285 mOsm/L
activated ML
dimethylpolysiloxane 80 500
59 Tripanzym/100 cpParacetamol 500 mg, dextromethorphan HBr 10 mg, BOX - - - ### - - - - - - - - -
mg ML
60 Tuzalos/100 cpt phenylpropanolamine HCl 15 mg, chlorpheniramine Box 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ###
17 61 Urotractin/60 cps maleate 1 mg
Asam pipemidat 400 mg BO 1 1 1
box 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ###
Asam Amino 2,7 % (BCAA 27,5%); Sorbitol 5%; TOL
62 VALAMIN ###### 10 ############### 60 ### ### ### ### ### ### ### ### ### ### ###
Osmolaritas: 507 mOsm/L 500
63 Valisanbe 2 mg/10Diazepam 2mg ML 2 2 2
box 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
64 Oxaliplatine 50 mgOxaliplatine 50 mg Inj Vial 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ###
65 Bledstop Inj methylergometrin maleat 200 mcg/ml Box/5 4 4 4 ### 4 4 4 ### 24 ### ### ### ### ### ### ### ### ### ###
66 Sanadryl DMP Syrper 5 ml : dextromerthopan HBr 10 mg, diphenhydramin Btl ###### 48 ################## 9,220 ### ### ### ### ### ### ### ### ###
JUMLAH ### ### ### ### ### ### ### ### ### ###
PPN 10% ### ### ### ### ### ### ### ### ###
###
No.No. Dok. FM-AKT-AU-32.1 No. Revisi : 00 Tgl. 01-08-2000 Halaman :…………………… dari :…………………….
PT PERKEBUNAN NUSANTARA V (PERSERO) DAFTAR PERMINTAAN OBAT-OBATAN DAN ALAT KESEHATAN
RS Sri Rokan SEMESTER-I 2015
PAKET - I
ESTI
MASI
KEM JUMLAH FISIK HARG NILAI (Rp.)
ASA A
KETER
NONO NAMA DAGANG N / SATU
ANGAN
SAT AN
Jan FebMart
TRW Aprl
I Mei Juni
TRW-II
TOTAL Jan Feb Mart TRW-I Aprl Mei Juni TRW-II TOTAL
UAN AU-
31
1 2 4 (Rp.)
6 7=6*110%
1 1 Alloris 10 mg/1box 2 2 2 6 2 2 2 6 12
### ### ### ### ### ### ### ### ### ### ###
2 2 Amoxsan Inj Vial########################### ### ### ### ### ### ### ### ### ### ### ###
3 3 Amoxsan P. dro Fls 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
4 4 Analsik film-co BOx 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
5 5 Becom-C film-co BOX 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
6 6 Biothicol dry s Fls ######################## 72 ### ### ### ### ### ### ### ### ### ### ###
7 7 Braxidin/100 taBOX 1 1 1 3 1 1 1 3 6 ### ### ### ### ### ### ### ### ### ### ###
8 8 Cinolon - N creTube######################## 60 ### ### ### ### ### ### ### ### ### ### ###
9 9 Claneksi dry sy Fls ######################## 72 ### ### ### ### ### ### ### ### ### ### ###
###
###Claneksi forte d Fls ######################## 72 ### ### ### ### ### ### ### ### ### ### ###
###
###Claneksi/30 cptbox 3 5 5 ### 5 5 5 ### 28 ### ### ### ### ### ### ### ### ### ### ###
###
###Colsancetine InjBOX########################### ### ### ### ### ### ### ### ### ### ### ###
###
###Cortidex/100Box/100
ta ### ### - ### - - - - - - - - - ###
###
###Docetaxel 40 m
Via ### ### - - - - - - - - - - ###
###
l
###
###Elkana film-coa box
SO 5 3 3 ### 5 5 5 ### 26 ### ### ### ### ### ### ### ### ### ### ###
###
###Elkana syrup/6 FlsFT ######################## 70 ### ### ### ### ### ### ### ### ### ### ###
BA
###ENERTON 500 G ### ### - ### - - - - - - - - - ###
50
###Erysanbe dry s Fls 0 ### ### - ### - - - - - - - - - ###
SO
ML
###Flamar 50 mg/1box ### ### - ### - - - - - - - - - ###
FT
###
###Forumen earBotol
dr BA8ml 3 5 5 ### 5 5 5 ### 28 ### ### ### ### ### ### ### ### ### ### ###
SO
###
###FUTROLIT G 6 6 6 ### 6 6 6 ### 36 ### ### ### ### ### ### ### ### ### ### ###
FT
SO
###
###Herclov / 50 caBOX50 1
BA 1 1 1 2 ### ### - - ### - ### - ### ### ###
FT
SO
0 ########################### ###
###
###INFUSAN D5 D BA G ### ### ### ### ### ### ### ### ### ###
FT
ML
###INFUSAN D5+¼SO
### 50
G 6 6 6 ### 6 6 6 ### 36 ###
BA ### ### ### ### ### ### ### ### ### ###
FT
0
###INFUSAN D5+½SO
### 50
G 6 6 6 ### 6 6 6 ### 36 ###
BA ### ### ### ### ### ### ### ### ### ###
ML
FT
0
###INFUSAN NS DSO
### 50
G ########################### ###
BA ### ### ### ### ### ### ### ### ### ###
ML
FT
0
###
###INFUSAN RINGBA 50
G ########################### ### ### ### ### ### ### ### ### ### ### ###
ML
0
###INFUSAN RL D 50
### G ########################### ### ### ### ### ### ### ### ### ### ### ###
ML
0
###
###Mucohexin elx/ Fls50 ########################### ### ### ### ### ### ### ### ### ### ### ###
ML
0
###
###Mucohexin/100box 2 2 2 6 2 2 2 6 12 ### ### ### ### ### ### ### ### ### ### ###
ML
###
###Neo Kaolana S Fls 6 6 6 ### 6 6 6 ### 36 ### ### ### ### ### ### ### ### ### ### ###
###Neurosanbe plubox ### ### - ### - - - - - - - - - ###
###Pervita box ### ### - ### - - - - - - - - - ###
###Pibaksin Oint Tube ### ### -

### - - - - - - - - - ###
###Pirofel 20 mg/1 box ### ### -
### - - - - - - - - - ###
###
###PolidemisineBotol
E ########################### ###
5ml ### ### ### ### ### ### ### ### ### ###
###PROANESAMPUL 20 ML ### ### - ### - - - - - - - - - ###
###
###Pumpitor InjeksVial########################### ### ### ### ### ### ### ### ### ### ### ###
###
###Sagestam creamTube######################## 60 ### ### ### ### ### ### ### ### ### ### ###
###Sagestam Inj 80 Vial ### ### - ### - - - - - - - - - ###
###
###Sanadryl exp/6 Fls ########################### ### ### ### ### ### ### ### ### ### ### ###
###Sanadryl plus e Fls ### ### - ### - - - - - - - - - ###

SO
FT
###San-B Plex P. d Fls ### ### - ### - - - - - - - - - ###
BA
###SANBE HEST 20 G ### ### - ### - - - - - - - - - ###
###
###Sanbe tears ED 508ml
Botol 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
0
###
###Sanmag SuspensFls ############### ###### 60 ### ### ### ### ### ### - ### ### ### ###
ML
###
###Sanmag/100 tabbox 1 2 2 5 2 2 2 6 11 ### ### ### ### ### ### ### ### ### ### ###
PT PERKEBUNAN NUSANTARA V (PERSERO) DAFTAR PERMINTAAN OBAT-OBATAN DAN ALAT KESEHATAN
RS Sri Rokan SEMESTER-I 2015
PAKET - I
ESTI
MASI
KEM JUMLAH FISIK HARG NILAI (Rp.)
ASA A
KETER
NONO NAMA DAGANG N / SATU
ANGAN
SAT AN
Jan FebMart
TRW Aprl
I Mei Juni
TRW-II
TOTAL Jan Feb Mart TRW-I Aprl Mei Juni TRW-II TOTAL
UAN AU-
31
1 2 4 (Rp.)
6 7=6*110%
###
###Sanmol P. drop Fls 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
###Sanprima forte/box ### ### - ### - - - - - - - - - ###
###Sanprima syrup Fls ### ### - ### - - - - - - - - - ###
###Santa E 400/ 1 box ### ### - ### - - - - - - - - - ###
###Santagesik Inj Box ### ### - ### - - - - - - - - - ###
###SANTOCYN Inje
Ampul ### ### - ### - - - - - - - - - ###
###
###Trichodazol 500BOX 5 5 5 ### 5 5 5 ### 30 ### ### ### ### ### ### ### ### ### ### ###
###
###Trichodazol inf Sof 6 ##################### 66
Softbag ### ### ### ### ### ### ### ### ### ### ###
###
###TRIDEX 27 A SO 6
tba 6 6 ### ### 18 ### ### ### ### ### - - - - ### ###
Sof
FT
###
###TRIDEX 27 B tba g
BA 6 6 6 ### 6 6 6 ### 36 ### ### ### ### ### ### ### ### ### ### ###
###TRIDEX PLAIN G g ### ### - ### - - - - - - - - - ###
###
###Tripanzym/100BOX 50 2 2 2 6 3 3 3 9 15 ### ### ### ### ### ### ### ### ### ###
0
###
###Tuzalos/100 cptBox
BO 8 8 8 ### 8 8 8 ### 48 ### ### ### ### ### ### ### ### ### ###
ML
### TO
###Urotractin/60 c box 8 8 8 ### 8 8 8 ### 48 ### ### ### ### ### ### ### ### ### ###
###VALAMIN
L ### ### - - - - - - - - - - ###
###
50
###
###Valisanbe 2 mg/box
0M 2 2 2 6 2 2 2 6 12 ### ### ### ### 93,000 ### ### ### 93,000 ### ###
L
Oxaliplatine 50 Vial ###
Bledstop Inj Box/5 ###
Sanadryl DMP SBtl ###
JUMLAH ### ### ### ### ### ### ### ### ### ###
PPN 10% ### ### ### ### ### ### ### ### ###
Ka. Unit RS Sri Rokan
Dr. Budhi SP
NoNo. Dok. FM-AKT-AU-32.1 No. Revisi : 00 Tgl. 01-08-2000 Halaman :…………………… dari :…………………….
PT PERKEBUNAN NUSANTARA V HARGA PERHITUNGAN SENDIRI / (OE)
PEKANBARU
BAGIAN KESEHATAN No. AU-31 : PENGADAAN
01/5.16/AU-31.4/I/2015
OBAT-OBATAN DAN ALAT Nomor : 5.16/HPS/POAL/01/I/2015
: KESEHATAN HABIS PAKAI KEBUTUHAN
OBYEK PEKERJAAN Tanggal : Januari 2015
SEMESTER - I/2015 UNTUK RS
TANDUN/RS SRI ROKAN DAN RS
NUSALIMA PT. PERKEBUNAN NUSANTARA
V
UNIT : RS TANDUN / RS SRI ROKAN / RS NUSALIMA
PERMINTAAN SUMBER DATA/INFORMASI PENETAPAN

ESTIMASI PEMBELIA
JUML HARGA N YANG HARGA HARGA HARGA JUMLAH
KEMASAN AGEN / KETERANGAN/
NO NAMA DAGANG AH SATUAN LALU PASAR SATUAN HARGA
/ SATUAN HAR ANALISA
FISIK AU-31 BUL PRICE HPS/OE (Rp.)
RS NUSALIMARS TANDUNRS SRI ROKAN GA
(Rp.) AN LIST (Rp.) (Rp.)
(Rp) (Rp.)
1 2 4 5 6 7 5 6 7 8 9 10 11 12=11*5 7=6*110%
1 Alloris 10 mg/100
Box 10 x 10's 6 0 12 18 403,000 ### 403,000 7,254,000 ###
2 Amoxsan Inj Box 10 vial @1 gr0 0 300 300 202,050 ### 202,050 60,615,000 ###
3 Amoxsan P. drops Fls 30 0 30 60 20,205 20,205 20,205 1,212,300 ###
4 Analsik film-coate BOx 12 0 30 42 109,000 ### 109,000 4,578,000 ###
5 Becom-C film-coat BOX 12 30 12 54 117,000 ### 117,000 6,318,000 ###
6 Biothicol dry syru Fls 0 0 72 72 18,440 18,440 18,440 1,327,680 ###

7 Braxidin/100 tab BOX 12 30 6 48 79,000 79,000 79,000 3,792,000 ###
8 Cinolon - N cream Tube 30 0 60 90 15,820 15,820 15,820 1,423,800 ###
9 Claneksi dry syru fls 0 0 72 72 46,440 46,440 46,440 3,343,680 ###
10 Claneksi forte dry Fls 30 0 72 102 62,200 62,200 62,200 6,344,400 ###
11 Claneksi tablet/30 box 0 0 28 28 319,350 ### 319,350 8,941,800 ###
12 Colsancetine Inj 1 BOX 6 30 300 336 89,950 89,950 89,950 30,223,200 ###
13 Cortidex tablet/10Box/100
BOX 1 12 0 0 12 22,000 22,000 22,000 264,000 ###
14 Docetaxel 20 mg/0 Vial @ 6 0 0 6 1,291,500 ### 1,291,500 7,749,000 ###
15 Elkana film-coated 0.5
boxml 6 0 26 32 65,000 65,000 65,000 2,080,000 ###
16 Elkana syrup/60 m Fls 60 144 70 274 18,860 18,860 18,860 5,167,640 ###
SOFTB
17 ENERTON 500 AG 500 30 0 0 30 66,200 66,200 66,200 1,986,000 ###
ML
18 Erysanbe dry syru Fls 30 0 0 30 19,385 19,385 19,385 581,550 ###
19 Flamar 50 mg/100 box 6 0 0 6 158,000 ### 158,000 948,000 ###
20 Forumen ear dropBotol 10 ml 18 0 28 46 22,460 22,460 22,460 1,033,160 ###
SOFTB
21 Futrolit Infus AG 500 144 144 36 324 49,150 49,150 49,150 15,924,600 ###
ML
22 Herclov / 50 caple
Box 5 x 10's
SOFTB 0 0 2 2 655,750 ### 655,750 1,311,500 ###
23 INFUSAN D5 DP AG 500
SOFTB 216 288 576 1080 16,850 16,850 16,850 18,198,000 ###
24 INFUSAN D5+¼ NAG ML500 0 288 36 324 17,000 17,000 17,000 5,508,000 ###
SOFTB
25 INFUSAN D5+½ NAG ML500 168 288 36 492 17,150 17,150 17,150 8,437,800 ###
SOFTB
26 INFUSAN NS DP AG ML500 2743 288 480 3511 16,100 16,100 16,100 56,527,100 ###
ML
SOFTB
27 INFUSAN RING-AAG 500 288 288 720 1296 18,550 18,550 18,550 24,040,800 ###
ML
SOFTB
28 INFUSAN RL DP AG 500 3064 288 720 4072 16,550 16,550 16,550 67,391,600 ###
ML
PEKANBARU
01/5.16/AU-31.4/I/2015
V

ESTIMASI PEMBELIA
(Rp) (Rp.)
1 2 4 5 6 7 5 6 7 8 9 10 11 12=11*5 7=6*110%
29 Mucohexin elx/120 Fls 144 0 144 288 14,450 14,450 14,450 4,161,600 ###
30 Mucohexin/100 Box
ta 25 x 4's 6 0 12 18 41,000 41,000 41,000 738,000 ###
31 Neo Kaolana SUS Fls 0 144 36 180 11,195 11,195 11,195 2,015,100 ###
32 Neurosanbe plus/1
box 10 x 10's 18 0 0 18 91,000 91,000 91,000 1,638,000 ###
33 Pervita box 18 0 0 18 120,000 ### 120,000 2,160,000 ###
34 Pibaksin Oint Tube 90 0 0 90 36,145 36,145 36,145 3,253,050 ###

35 Pirofel 20 mg/100
Box 10 x 10's 6 0 0 6 148,000 ### 148,000 888,000 ###
36 Polidemisine ED Botol 5ml 0 0 120 120 22,170 22,170 22,170 2,660,400 ###
37 PROANES box 5 ampul @20ml 24 0 0 24 339,250 ### 339,250 8,142,000 ###
38 Pumpitor Injeksi
Box 1vial 40 mg 60 0 120 180 132,460 ### 132,460 23,842,800 ###
39 Sagestam cream Tube 60 0 60 120 10,775 10,775 10,775 1,293,000 ###
40 Sagestam Inj 80 mg 5 vial@2ml 36
Box 0 0 36 43,000 43,000 43,000 1,548,000 ###
41 Sanadryl exp/60 m Fls 0 0 288 288 8,590 8,590 8,590 2,473,920 ###
42 Sanadryl plus exp Fls 288 0 0 288 8,590 8,590 8,590 2,473,920 ###
43 San-B Plex P. drop Fls 60 0 0 60 15,220 15,220 15,220 913,200 ###

SOFTB
44 SANBE HEST 200 AG 500 72 60 0 132 165,500 ### 165,500 21,846,000 ###
ML8ml
45 Sanbe tears ED Botol 0 0 30 30 19,375 19,375 19,375 581,250 ###
46 Sanmag Suspensio Fls 120 0 60 180 22,040 22,040 22,040 3,967,200 ###
47 Sanmag/100 tab box 12 0 11 23 65,000 65,000 65,000 1,495,000 ###
48 Sanmol P. drops Fls 90 0 30 120 13,740 13,740 13,740 1,648,800 ###

49 Sanprima forte/10 box 12 0 0 12 175,000 ### 175,000 2,100,000 ###
50 Sanprima syrup/6 Fls 90 0 0 90 22,435 22,435 22,435 2,019,150 ###
51 Santa E 400/ 100box 25 x 4's 6 0 0 6 334,500 ### 334,500 2,007,000 ###
52 Santagesik Inj / 5 Vial 18 0 0 18 40,925 40,925 40,925 736,650 ###
53 SANTOCYN Injeks BOX @ 10 24 6 0 30 101,100 ### 101,100 3,033,000 ###
54 Trichodazol 500 m BOX 12 0 30 42 143,500 ### 143,500 6,027,000 ###
55 Trichodazol infus Softbag 30 0 66 96 78,750 78,750 78,750 7,560,000 ###
SOFTB
56 TRIDEX 27 A AG 500 144 144 18 306 18,100 18,100 18,100 5,538,600 ###
ML
SOFTB
57 TRIDEX 27 B AG 500 150 144 36 330 18,100 18,100 18,100 5,973,000 ###
SOFTB
ML
58 TRIDEX PLAIN AG 500 36 0 0 36 16,800 16,800 16,800 604,800 ###
59 Tripanzym/100 cp BOXML 0 0 15 15 111,000 ### 111,000 1,665,000
60 Tuzalos/100 cpt Box 30 0 48 78 64,000 64,000 64,000 4,992,000
61 Urotractin/60 cps box 6 30 48 84 171,000 ### 171,000 14,364,000

62 VALAMIN
BOTOL 60 0 0 60 60,700 60,700 60,700 3,642,000 ###
500 ML
63 Valisanbe 2 mg/10 box 12 0 12 24 15,500 15,500 15,500 372,000 ###
64 Oxaliplatine 50 mg Vial 6 0 6 1,394,250 ### 1,394,250 8,365,500
65 Bledstop Inj Box/10 24 0 24 64,900 64,900 64,900 1,557,600
PEKANBARU
01/5.16/AU-31.4/I/2015
V

ESTIMASI PEMBELIA
(Rp) (Rp.)
1 2 4 5 6 7 5 6 7 8 9 10 11 12=11*5 7=6*110%
66 Sanadryl DMP Syr Btl 288 0 288 9,220 9,220 9,220 2,655,360
JUMLAH ### ###

PPN 10% ###
JUMLAH KESELURUHAN ###
Dibuat Oleh Diperiksa Oleh Ditetapkan oleh Disetujui oleh,

Ast. Urs. Farmasi Ka. Urs. Kesehatan Kabag Kesehatan Direktur SDM/Umum
Rini Yulianti, S.Si,Apt. drg. Wiwik Widiati dr. Heddy Lubis Syamsul Rizal Lubis
PT PERKEBUNAN NUSANTARA V LAMPIRAN BESTEK
PEKANBARU
BAGIAN KESEHATAN No. AU-31 :01/5.16/AU-31.4/I/2015 Nomor : 5.16/HPS/POAL/01/I/2015
Objek pekerj :PENGADAAN OBAT-OBATAN DAN ALAT Tanggal : Januari 2015
KESEHATAN HABIS PAKAI KEBUTUHAN
NUSALIMA PTPN- V
Unit :RS TANDUN/RS SRI ROKAN/RS NUSALIMA
JUMLAH
KEMASAN / KETERANGAN/ANAL
NO KOMPOSISI JUMLAH FISIK HARGA SATUAN (Rp.) HARGA
SATUAN ISA
(Rp.)
1 2 3 4 5 6=4*5 7
1 Loratadin 10 mg Box 10 x 10's 18 ###
2 Amoksisilin 1 gram Box 10 vial @1 gr 300 ###
3 Amoksisilin 100 mg/ml Fls 60 ###
4 Methampyron 500 mg + Diazepam 2 mg BOx 42 ###
Vit B1 50 mg, vit B2 25 mg, vit B6 10 mg, vit B12 5
5 mcg, vit C 500 mg, nicotinamide 100 mg, BOX 54 ###
panthotenic acid 16.4 mg
6 Thiamfenikol 125 mg / 5 ml Fls 72 ###
7 Chlordiazepoxide 5 mg, clidinium Br 2.5 mg BOX 48 ###
8 Fluosinolon asetonida 0.25 mg + Neomycin Cream Tube 90 ###
per 5 ml : Amoxicillin 125 mg, clavulanic acid
9 fls 72 ###
31.25 mg: Amoxicillin 250 mg, clavulanate acid
per 5 ml
10 Fls 102 ###
62.5 mg
11 Amoxicillin 500 mg, clavulanic acid 125 mg box 28 ###
12 Kloramfenikol 1 gram BOX 336 ###
13 Deksametason 0.5 mg Box/100 12 ###
BOX 1 Vial
14 Docetaxel 20 mg/0.5 ml 6 ###
Dibasic Ca phosphate @ 0.5 ml
15 Vit A 2,400 iu, vit B1 4 200
mg,mg, Ca lactate
vit B2 1.2 mg, 100 mg,
vit B6 1.2 box 32 ###
vit B6
mg, vit20B12 4
mg, vit
mcg,C vit
25 mg,
C 60vit
mg,D3vit
100D iu
400 iu,
nicotinamide 16 mg, Ca pantothenate 6 mg,
16 Fls 274 ###
choline 12 mg, inositol 12 mg, Ca gluconate 300
Fruktosa 60 g, Glukosa 20
mg, Ca hypophosphite Monohidrat 33 g setara
mg, Na hypophosphite
dengan Glukosa
20 mg, l-lysine Anhidrat
HCl 200 mg15 g Xilitol 30 g, Air SOFTBAG 500 ML
17 30 ###
untuk Injeksi ad 1000 ml, Osmolaritas 690
18 mOsm/L
Eritromisin 200 mg/5 ml Fls 30 ###
19 Natrium diklofenak 50 mg box 6 ###
20 Docusate sodium 5mg Botol 10 ml 46 ###
Na⁺ 100 mEq/L; K⁺ 18 mEq/L, Ca²⁺ 4 mEq/L;
21 Mg²⁺ 6 mEq/L; Cl⁻90 mEq/L; Asetat 38 mEq/L;SOFTBAG 500 ML 324 ###
Osmolaritas: 525 mOsm/L, Sorbitol 50 g/L
22 Valaciclovir 500mg Box 5 x 10's 2 ###
23 Dekstrosa 50 g/L; Osmolaritas: 278 mOsm/L SOFTBAG 500 ML 1080 ###
Na⁺38,5 mEq/L; Cl⁻ 38,5 mEq/L; Dekstrosa 50
24 SOFTBAG 500 ML 324 ###
g/L;
Na Osmolaritas:
⁺77 mEq/L; Cl⁻355
77 mOsm/L
mEq/L; Dekstrosa 50 g/L;
25 SOFTBAG 500 ML 492 ###
Osmolaritas: 432 mOsm/L
Na⁺154 mEq/L; CI⁻ 154 mEq/L; Osmolaritas: 308
26 SOFTBAG 500 ML 3511 ###
mOsm/L
Na⁺ 131 mEq/L; K⁺ 4 mEq/L; Ca²⁺ 2,7 mEq/L;
27 Cl⁻109 mEq/L; Asetat 28 mEq/L;Osmolaritas: 273
SOFTBAG 500 ML 1296 ###
mOsm/L
Na⁺ 131 mEq/L; K⁺4 mEq/L; Ca²⁺ 2,7 mEq/L;
28 SOFTBAG 500 ML 4072 ###
Cl⁻109 mEq/L; Laktat 28 mEq/L;
29 Bromhexin HCL 4 mg/5ml Fls 288 ###
30 Bromhexin HCL 8 mg Box 25 x 4's 18 ###
31 Per 15 mL Kaolin 700 mg, pectin 66 mg Fls 180 ###
Metampyrone 500 mg, vit B1 50 mg, vit B6 100
32 Vit A 10,000 iu, vit B1 20 mg, vit B2 5 mg, box 10 x 10's 18 ###
mg, vit B12 100
nicotinamide 50mcg
mg, vit B6 10 mg, Ca
pantothenate 11.6 mg, biotin 0.25 mg, vit B125
mcg, vit C 150 mg, vit D3 400 iu, vit E 10 mg, folic
33 box 18 ###
acid 0.4 mg, Ca 50 mg, phosphorus 38.64 mg, Fe
10 mg, Mg 16.4 mg, manganese 0.379 mg, K 0.035
mg, selenium 0.061 mg, fluoride 0.045 mg, copper
34 0.712
Mupirocin 200.343
mg, Zn mg mg, molybdenum 0.083 mg Tube 90 ###
35 Piroksikam 20mg Box 10 x 10's 6 ###
Neomycine sulphate 3.5mg, Polymixine b
36 Botol 5ml 120 ###
Sulphate 6.000 IU, Dexamethasone 1mg
37 Propofol 10 mg/ml box 5 ampul @20ml 24 ###
38 Omeprazole 40 mg Box 1vial 40 mg 180 ###
39 Gentamisin Sulphate 1 mg Tube 120 ###
40 Gentamisin Sulphate 40mg/ ml Box 5 vial@2ml 36 ###
PT PERKEBUNAN NUSANTARA V LAMPIRAN BESTEK
PEKANBARU
BAGIAN KESEHATAN No. AU-31 :01/5.16/AU-31.4/I/2015 Nomor : 5.16/HPS/POAL/01/I/2015
Objek pekerj :PENGADAAN OBAT-OBATAN DAN ALAT Tanggal : Januari 2015
KESEHATAN HABIS PAKAI KEBUTUHAN
NUSALIMA PTPN- V
Unit :RS TANDUN/RS SRI ROKAN/RS NUSALIMA
JUMLAH
KEMASAN / KETERANGAN/ANAL
NO KOMPOSISI JUMLAH FISIK HARGA SATUAN (Rp.) HARGA
SATUAN ISA
(Rp.)
1 2 3 4 5 6=4*5 7
per 5 ml : potassium guaiacolsulphonat 30 mg,
41 diphenhydramine HCl 12.5 mg, ammon Cl 100 Fls 288 ###
mg, Na citrate 50 mg, menthol 1 mg
per 5 ml : potassium guaiacolsulphonat 30 mg,
42 diphenhydramine HCl 12.5 mg, ammon Cl 100 Fls 288 ###
mg, Na citrate 50 mg, menthol 1 mg
per 0,6 ml : Vit A 5,000 iu, vit B1 1 mg, Vit B2 1,2
43 mg, vit B6 1 mg, vit C 50 mg, vit D 400 iu, Fls 60 ###
nicotinamida 10 mg, panthotenic acid 5 mg
44 Hydroxyethyl Starch 30 gr, Natrium Klorida 45 SOFTBAG
gr 500 ML 132 ###
45 Dextran 70 1mg, Hypromellose 3mg Botol 8ml 30 ###
per 5 ml : Mg. trisilicate 325 mg, Al(OH)3 colloidal
46 Mg trisilicate 325 mg, Al(OH)3 colloidal 325 mg, Fls 180 ###
325 mg, activated dimethicone 25 mg
papaverine HCl 30 mg, chlordiazepoxide HCl 5
47 mg, vit B1 2 mg, vit B21 mg, vit B6 500 mcg, vit box 23 ###
B12 1 mcg, niacinamide 5 mg, Ca pantothenate 1
48 mg
Paracetamol 60 mg/0.6ml Fls 120 ###
49 box 12 ###
50 Fls 90 ###
51 Vitamin E 400 mg box 25 x 4's 6 ###
52 Metamizole Na 500 mg Vial 18 ###
53 Oxytocin 10 IU / ml BOX @ 10 30 ###
54 Metronidazole 500 mg BOX 42 ###
55 Metronidazole 5 mg/ml Softbag 96 ###
Na⁺ 60 mEq/L; K⁺ 10 mEq/L; Laktat 20 mEq/L;
56 Cl⁻50 mEq/L; Dekstrosa 27 g/L;Osmolaritas: 290
SOFTBAG 500 ML 306 ###
mOsm/L
Na⁺ 50 mEq/L; K⁺ 20 mEq/L; Laktat 20 mEq/L;
57 Cl⁻50 mEq/L; Dekstrosa 27 g/L;Osmolaritas: 290 SOFTBAG 500 ML 330 ###
mOsm/L
Na⁺ 38,5 mEq/L; Klorida 38,5 mEq/L; Dekstrosa
58 SOFTBAG 500 ML 36 ###
37,5 g/L; Osmolaritas:
Pancreatin 285 mOsm/L
170 mg, activated
59 BOX 15
dimethylpolysiloxane 80 mg
Paracetamol 500 mg, dextromethorphan HBr 10
60 mg, phenylpropanolamine HCl 15 mg, Box 78
chlorpheniramine maleate 1 mg
61 Asam pipemidat 400 mg box 84
per 1000 ml : amino acid 2.72%, osmolarity 540
62 BOTOL 500 ML 60
mOsm/L D-sorbitol 50 g
63 Diazepam 2mg box 24
64 Oxaliplatine 50 mg Inj Vial 6 ###
65 per 5 ml : dextromerthopan
methylergometrin HBr
maleat 200 10 mg,
mcg/ml Box/10 24
diphenhydramin HCl 12.5 mg, ammonium
66 Btl 288 ###
chlorida 100 mg, sodium citrat 50 mg, menthol 1
mg JUMLAH - ###
PPN 10%
JUMLAH KESELURUHAN
Di Buat Oleh :
Bagian Kesehatan
Ast. Urs. Farmasi Ka. Urs. Kesehatan Kepala Bagian
Rini Yulianti, S.Si., Apt drg. Wiwik Widiati dr. Heddy Lubis
LAMPIRAN KOMPILASI AU-31 OBAT-OBATAN/ALKES HABIS PAKAI
RS NUSALIMA/TANDUN/ROKAN
SEMESTER- I TAHUN 2015
PAKET I (BINA SAN PRIMA)
HAR
PERMINTAAN GA
NONAMA DAGANG KEMASAN JUMLAHSATU JUMLAH
RS NUSALIMA
RS TANDUN
RS SRI ROKAN AN
1 2 3 4 5 6 7=4+5+6(RP)
8 9=7*8
1 Alloris 10 mg/ Box 10 x 10's 6 0 12 18 ### ###
2 Amoxsan InjBox 10 vial @1 gr 0 300 300 ### ###
3 Amoxsan P. d Fls 30 0 30 60 ### ###
4 Analsik film-c BOx 12 0 30 42 ### ###
5 Becom-C film- BOX 12 30 12 54 ### ###
6 Biothicol dry Fls 0 72 72 ### ###
7 Braxidin/100 t BOX 12 30 6 48 ### ###
8 Cinolon - N c Tube 30 0 60 90 ### ###
9 Claneksi dry s fls 0 72 72 ### ###
###Claneksi forte Fls 30 0 72 102 ### ###
###Claneksi table box 0 28 28 ### ###
###Colsancetine I BOX 6 30 300 336 ### ###
###Cortidex table Box/100 12 0 0 12 ### ###
###Docetaxel 20BOXm 1 Vial @ 0.5 ml 6 0 0 6 ### ###
###Elkana film-co box 6 0 26 32 ### ###
###Elkana syrup/ Fls 60 144 70 274 ### ###
###ENERTON 500 SOFTBAG 500 ML 30 0 0 30 ### ###
###Erysanbe dry Fls 30 0 0 30 ### ###
###Flamar 50 mg/ box 6 0 0 6 ### ###
###Forumen ear d Botol 10 ml 18 0 28 46 ### ###
###Futrolit InfusSOFTBAG 500 ML144 144 36 324 ### ###
###Herclov / 50 c Box 5 x 10's 0 2 2 ### ###
###INFUSAN D5SOFTBAG 500 ML216 288 576 ### ### ###
###INFUSAN D5+ SOFTBAG 500 ML 288 36 324 ### ###
###INFUSAN D5+ SOFTBAG 500 ML168 288 36 492 ### ###
###INFUSAN NSSOFTBAG 500 ML2743 288 480 ### ### ###
###INFUSAN RIN SOFTBAG 500 ML288 288 720 ### ### ###
###INFUSAN RLSOFTBAG 500 ML3064 288 720 ### ### ###
###Mucohexin elx Fls 144 0 144 288 ### ###
###Mucohexin/100Box 25 x 4's 6 0 12 18 ### ###
###Neo Kaolana Fls 144 36 180 ### ###
###Neurosanbe plbox 10 x 10's 18 0 0 18 ### ###
###Pervita box 18 0 0 18 ### ###
###Pibaksin Oint Tube 90 0 0 90 ### ###
###Pirofel 20 mg/ Box 10 x 10's 6 0 0 6 ### ###
###Polidemisine Botol 5ml 0 120 120 ### ###
###PROANES box 5 ampul @20ml24 0 0 24 ### ###
###Pumpitor Injek
Box 1vial 40 mg 60 0 120 180 ### ###
###Sagestam cre Tube 60 0 60 120 ### ###
LAMPIRAN KOMPILASI AU-31 OBAT-OBATAN/ALKES HABIS PAKAI
RS NUSALIMA/TANDUN/ROKAN
SEMESTER- I TAHUN 2015
PAKET I (BINA SAN PRIMA)
HAR
PERMINTAAN GA
NONAMA DAGANG KEMASAN JUMLAHSATU JUMLAH
RS NUSALIMA
RS TANDUN
RS SRI ROKAN AN
1 2 3 4 5 6 7=4+5+6(RP)
8 9=7*8
###Sagestam Inj Box
8 5 vial@2ml 36 0 0 36 ### ###
###Sanadryl exp/ Fls 0 288 288 8,590 ###
###Sanadryl plus Fls 288 0 0 288 8,590 ###
###San-B Plex P. Fls 60 0 0 60 ### ###
###SANBE HEST SOFTBAG 500 ML 72 60 0 132 ### ###
###Sanbe tears E Botol 8ml 0 30 30 ### ###
###Sanmag Suspe Fls 120 0 60 180 ### ###
###Sanmag/100 t box 12 0 11 23 ### ###
###Sanmol P. dro Fls 90 0 30 120 ### ###
###Sanprima forte box 12 0 0 12 ### ###
###Sanprima syru Fls 90 0 0 90 ### ###
###Santa E 400/ box 25 x 4's 6 0 0 6 ### ###
###Santagesik Inj Box 18 0 0 18 ### ###
###SANTOCYN Inj BOX @ 10 24 6 0 30 ### ###
###Trichodazol 5 BOX 12 0 30 42 ### ###
###Trichodazol in Softbag 30 0 66 96 ### ###
###TRIDEX 27 ASOFTBAG 500 ML144 144 18 306 ### ###
###TRIDEX 27 BSOFTBAG 500 ML150 144 36 330 ### ###
###TRIDEX PLAINSOFTBAG 500 ML 36 0 0 36 ### ###
###Tripanzym/100 BOX 0 15 15 ### ###
###Tuzalos/100 cp Box 30 0 48 78 ### ###
###Urotractin/60 box 6 30 48 84 ### ###
###VALAMIN BOTOL 500 ML 60 0 0 60 ### ###
###Valisanbe 2 m box 12 0 12 24 ### ###
###Oxaliplatine 5 Vial 6 6 ### ###
###Bledstop Inj Box/5 24 24 ### ###
###Sanadryl DMP Sy Btl 288 288 9,220 ###
JUMLAH ###
PPN 10% ###
JUMLAH TOTAL ###
-
Asst. Urs Farmasi Ka. Urs. Kesehatan
###
Rini Yulianti, S.Si., Apt drg. Wiwik Widiati

DAFTAR PERMINTAAN OBAT-
PT. Nusa Lima Medika OBATAN DAN ALAT KESEHATAN
SEMESTER II 2015 PAKET - I
Nusa Lima Estimasi Harga
No. Nama Obat /Alkes Satuan
Satuan Au31
AGST SEP TRW-III OKT NOV DES TRW-IV TOTAL
1 Acyclovir BOX/50 4 4 8 4 4 4 12 20 30,100
2 Acyclovir Cr TUBE 10 10 20 10 10 10 30 50 3,007
3 Allopurinol 100 BOX/100 4 4 8 4 4 4 12 20 12,000
4 Allopurinol 300 BOX/100 4 4 8 4 4 4 12 20 25,000
5 Ambroxol BOX/100 2 2 4 2 2 2 6 10 14,200
6 Amlodipine 10 BOX/30 20 20 40 20 20 20 60 100 46,170
7 Amlodipine 5 BOX/30 20 20 40 20 20 20 60 100 26,190
8 Amoxicillin BOX/100 3 3 6 3 3 3 9 15 40,300
9 Amoxicillin Syr BTL 20 20 40 20 20 20 60 100 3,532
10 Antasida BOX/100 2 2 4 2 2 2 6 10 14,700
11 Cairan NS BTL 10 10 20 10 10 10 30 50 8,300
12 Cairan RL BTL 10 10 20 10 10 10 30 50 8,182
13 Captopril 12,5 BOX/100 2 2 4 2 2 2 6 10 8,200
14 Captopril 25 BOX/100 2 2 4 2 2 2 6 10 12,500
15 Cefadroxil BOX/100 2 2 4 2 2 2 6 10 76,400
16 Cefadroxil Syr BTL 15 15 30 15 15 15 45 75 9,310
17 Cefixime BOX/50 8 8 16 8 8 8 24 40 85,750
18 Cefixime Syr BTL 20 20 40 20 20 20 60 100 28,875
19 Cefotaxime Inj VIAL 10 10 20 10 10 10 30 50 5,958
20 Cetirizine 5 strip @ 10 6 6 12 6 6 6 18 30 14,300
21 Ciprofloxacin BOX/100 2 2 4 2 2 2 6 10 44,000
22 Co-Amoxyclav 625 BOX/30 3 3 6 3 3 3 9 15 137,760
23 CTM BOX/100 4 4 8 4 4 4 12 20 8,100
24 Glibenclamide BOX/100 2 2 4 2 2 2 6 10 6800
25 Glimepiride 1 BOX/50 2 2 4 2 2 2 6 10 34,550
26 Glimepiride 2 BOX/50 2 2 4 2 2 2 6 10 68,400
27 Glimepiride 3 BOX/50 2 2 4 2 2 2 6 10 88,800
28 Glimepiride 4 BOX/50 2 2 4 2 2 2 6 10 118,450
29 Ibuprofen 400 BOX/100 1 1 2 1 1 1 3 5 19,600
30 Lansoprazole BOX/20 30 30 60 30 30 30 90 150 18,180
31 Methylprednisolon 4 m BOX/100 3 3 6 3 3 3 9 15 40100

32 Omeprazole BOX/7 100 100 200 100 100 100 300 500 5,145
33 Ranitidine BOX/100 3 3 6 3 3 3 9 15 20,000
34 Ranitidine Inj BOX/25 1 1 2 1 1 1 3 5 72,950
35 Simvastatin 10 BOX/50 6 6 12 6 6 6 18 30 24,500
36 Simvastatin 20 BOX/30 10 10 20 10 10 10 30 50 27,990
37 Thiamphenicol BOX/100 2 2 4 2 2 2 6 10 54,600
38 Infus Set Macro Pcs 10 10 20 10 10 10 30 50 12,848

No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN

PT. Nusa Lima Medika KLINIK UTAMA NUSALIMA
ALAT KESEHATAN SEMESTER I 2017 PAKET -VIII
Nusa Lima Estimasi Harga Nilai (Rp)
JAN FEB MAR TW-I APR MEI JUN TW-II TOTAL Satuan Au31 JAN FEB MAR TW-I APR MEI JUN TW-II TOTAL
1 Dialyzer Pcs 20 20 111 151 100 100 100 300 451 167,000 3,340,000 3,340,000 18,537,000 25,217,000 16,700,000 16,700,000 16,700,000 50,100,000 75,317,000
2 Bloodlines Pcs 20 20 100 140 80 80 80 240 380 103,000 2,060,000 2,060,000 10,300,000 14,420,000 8,240,000 8,240,000 8,240,000 24,720,000 39,140,000
3 AV Fistula Pcs 20 20 150 190 150 150 150 450 640 6,500 130,000 130,000 975,000 1,235,000 975,000 975,000 975,000 2,925,000 4,160,000
4 Solution Concentrate Acid 5 Lite Pcs 20 20 120 160 100 100 100 300 460 79,000 1,580,000 1,580,000 9,480,000 12,640,000 7,900,000 7,900,000 7,900,000 23,700,000 36,340,000
5 Solution Bicarbonate/ Powder Pcs 20 20 100 140 100 100 100 300 440 77,000 1,540,000 1,540,000 7,700,000 10,780,000 7,700,000 7,700,000 7,700,000 23,100,000 33,880,000
JUMLAH 8,650,000 8,650,000 46,992,000 64,292,000 41,515,000 41,515,000 41,515,000 124,545,000 188,837,000
PPN 10% 865,000 865,000 4,699,200 6,429,200 4,151,500 4,151,500 4,151,500 12,454,500 18,883,700
JUMLAH KESELURUHAN 9,515,000 9,515,000 51,691,200 70,721,200 45,666,500 45,666,500 45,666,500 136,999,500 207,720,700
JUMLAH SELURUH PBF 10,380,000 56,390,400 77,150,400 49,818,000 49,818,000 49,818,000 149,454,000 226,604,400
Diminta oleh, Diperiksa oleh, Disetujui oleh,
dr. Hary Andrianto Rini Yulianti, SSi, Apt. dr. Hary Andrianto
(Manajer Operasional) (Apoteker) (Manajer Operasional)

No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN KLINIK PRATAMA NUSALIMA

PT. Nusa Lima Medika
ALAT KESEHATAN SEMESTER I 2017 PAKET - VI
Nusa Lima Nilai (Rp)

Estimasi Harga
1 Bedak Salicyl 2% Pot 10 5 10 25 10 10 10 30 55 5,625 56,250 28,125 56,250 140,625 56,250 56,250 56,250 168,750 309,375
2 Bekarbon Tab - - 0 0 - - - - - - - - -
3 Gentian Violet 1% Btl 5 5 5 5 10 2,995 14,975 - - 14,975 14,975 - - 14,975 29,950
4 Ichtyol Salep Pot 5 5 5 5 10 5,650 28,250 - - 28,250 28,250 - - 28,250 56,500
5 Norit Tab 80 80 80 240 80 80 80 240 480 277 22,130 22,130 22,130 66,390 22,130 22,130 22,130 66,390 132,780
6 Salep 2-4 Pot 5 5 5 5 10 3,685 18,425 - - 18,425 18,425 - - 18,425 36,850
7 Aprovel 150* Tab 28 28 28 84 28 28 28 84 168 355,830 9,963,240 9,963,240 9,963,240 29,889,720 9,963,240 9,963,240 9,963,240 29,889,720 59,779,440
8 Aprovel 300* Tab 28 28 28 84 28 28 28 84 168 480,250 13,447,000 13,447,000 13,447,000 40,341,000 13,447,000 13,447,000 13,447,000 40,341,000 80,682,000
9 Ascardia* Tab 100 100 100 300 100 100 100 300 600 956 95,600 95,600 95,600 286,800 95,600 95,600 95,600 286,800 573,600
10 Biodiar* Tab - 0 - - - - - 0 0 - - - - - - - - - -
11 Cendo Mycetin TM* Btl - 0 - - - - - 0 0 - - - - - - - - -
12 Cendo Mycetin ZM* Tube 6 5 5 16 5 5 5 15 31 14,350 86,100 71,750 71,750 229,600 71,750 71,750 71,750 215,250 444,850
13 Cortidex* Tab - 0 - - - - - 0 0 281 - - - - - - - - -
14 Dermovel Cr* Tube 5 5 5 15 5 5 5 15 30 67,500 337,500 337,500 337,500 1,012,500 337,500 337,500 337,500 1,012,500 2,025,000
15 Dumin Rectal 125 * Tube 5 5 5 15 5 5 5 15 30 13,118 65,590 65,590 65,590 196,770 65,590 65,590 65,590 196,770 393,540
17 Erlamycetin Plus TM* Btl 5 5 5 15 5 5 5 15 30 13,030 65,150 65,150 65,150 195,450 65,150 65,150 65,150 195,450 390,900
18 Fladystin Vaginal* Vagtab 10 10 10 30 10 10 10 30 60 14,625 146,250 146,250 146,250 438,750 146,250 146,250 146,250 438,750 877,500
19 Glucobay 50* Tab 50 50 50 150 50 50 50 150 300 2,009 100,470 100,470 100,470 301,410 100,470 100,470 100,470 301,410 602,820
20 Glucobay 100* Tab 50 50 50 150 50 50 50 150 300 3365 168,250 168,250 168,250 504,750 168,250 168,250 168,250 504,750 1,009,500
21 Glucovance 2,5/500* Tab 100 100 100 300 100 100 100 300 600 3,795 379,500 379,500 379,500 1,138,500 379,500 379,500 379,500 1,138,500 2,277,000
22 Glucovance 5/500* Tab 100 100 100 300 100 100 100 300 600 4,608 460,800 460,800 460,800 1,382,400 460,800 460,800 460,800 1,382,400 2,764,800
23 Gluvas 2* Tab - 0 - - - - - 0 0 - - - - - - - - - -
24 Gluvas 3* Tab - 0 - - - - - 0 0 - - - - - - - - - -
25 Ketricin Cr* Tube 5 5 5 15 5 5 5 15 30 45,000 225,000 225,000 225,000 675,000 225,000 225,000 225,000 675,000 1,350,000
26 Lantus Inj* Amp 5 5 5 15 5 5 5 15 30 193,384 966,920 966,920 966,920 2,900,760 966,920 966,920 966,920 2,900,760 5,801,520
27 Lipitor 10* Tab 30 30 30 90 30 30 30 90 180 18,641 559,230 559,230 559,230 1,677,690 559,230 559,230 559,230 1,677,690 3,355,380
28 Lipitor 20* Tab 30 30 30 90 30 30 30 90 180 19,007 570,210 570,210 570,210 1,710,630 570,210 570,210 570,210 1,710,630 3,421,260
29 Norvask 5* Tab 30 30 30 90 30 30 30 90 180 7,826 234,790 234,790 234,790 704,370 234,790 234,790 234,790 704,370 1,408,740
30 Norvask 10* tab 30 30 30 90 30 30 30 90 180 14,026 420,780 420,780 420,780 1,262,340 420,780 420,780 420,780 1,262,340 2,524,680
31 Novomix Inj* Amp 5 5 5 15 5 5 5 15 30 171,908 859,540 859,540 859,540 2,578,620 859,540 859,540 859,540 2,578,620 5,157,240
32 Novorafid Inj* Amp 5 5 5 15 5 5 5 15 30 171,908 859,540 859,540 859,540 2,578,620 859,540 859,540 859,540 2,578,620 5,157,240
33 Pibaksin Oint* Tube 2 2 2 6 2 2 2 6 12 41,690 83,380 83,380 83,380 250,140 83,380 83,380 83,380 250,140 500,280
34 Pronalges* tab 50 50 50 150 50 50 50 150 300 2812.6 140,630 140,630 140,630 421,890 140,630 140,630 140,630 421,890 843,780
35 Pulmicort Nebul* Fls 20 20 20 60 20 20 20 60 120 17,384 347,670 347,670 347,670 1,043,010 347,670 347,670 347,670 1,043,010 2,086,020
36 Retaphyl SR* Tab 100 100 0 100 2,191 219,100 - - 219,100 - - - - 219,100
37 Rhinofed* Tab 0 0 0 - 0 0 0 0 0 - - - - - - - - -
38 Rhinofed Syr* Btl 0 0 0 - 0 0 0 0 0 - - - - - - - - -
39 Rhinos SR* Tab 0 0 0 - 0 0 0 0 0 - - - - - - - - -
40 sanprima*Forte Tab - 0 - - - - - 0 0 2,025 - - - - - - - - -
41 Scabimite Cr* Tube 2 2 2 6 2 2 2 6 12 41,070 82,140 82,140 82,140 246,420 82,140 82,140 82,140 246,420 492,840
42 Siclidon 100* Caps - 0 - - - - - 0 0 5,192 - - - - - - - - -
43 Starcef 200* Caps - 0 - - - - - 0 0 30,938 - - - - - - - - -
44 Termisil Cr* Tube 5 5 5 15 5 5 5 15 30 54,340 271,700 271,700 271,700 815,100 271,700 271,700 271,700 815,100 1,630,200
45 Tetagam PP* Amp 1 0 - 1 1 - - 1 2 211,500 211,500 - - 211,500 211,500 - - 211,500 423,000
46 Theragran M* Tab 100 100 100 300 100 100 100 300 600 4,241 424,100 424,100 424,100 1,272,300 424,100 424,100 424,100 1,272,300 2,544,600
47 Thrombo Aspilet* Tab 100 100 100 300 100 100 100 300 600 759 75,940 75,940 75,940 227,820 75,940 75,940 75,940 227,820 455,640
48 Trichodazole* Tab - 0 - - - - - 0 0 1,687 - - - - - - - - -
49 Tripanzym* Tab - 0 - - - 0 - 0 0 - - - - - - - - -
50 Tuzalos* Tab - 0 - - - - - 0 0 - - - - - - - - -
51 Ventolin Syr* Tab 5 5 5 15 5 5 5 15 30 50,680 253,400 253,400 253,400 760,200 253,400 253,400 253,400 760,200 1,520,400
52 Ventolin Exp Syr* Btl 5 5 5 15 5 5 5 15 30 53,280 266,400 266,400 266,400 799,200 266,400 266,400 266,400 799,200 1,598,400
53 Verorab Inj* Amp 1 0 - 1 1 - - 1 2 178,470 178,470 - - 178,470 178,470 - - 178,470 356,940
54 Plavix 75* Tab 70 70 70 210 70 70 70 210 420 26,494 1,854,563 1,854,563 1,854,563 5,563,688 1,854,563 1,854,563 1,854,563 5,563,688 11,127,375
55 Crestor 10* Tab 28 28 28 84 28 28 28 84 168 17,779 497,800 497,800 497,800 1,493,400 497,800 497,800 497,800 1,493,400 2,986,800
56 Crestor 20* Tab 28 28 28 84 28 28 28 84 168 20,844 583,640 583,640 583,640 1,750,920 583,640 583,640 583,640 1,750,920 3,501,840
57 Januvia 100* Tab 28 28 28 84 28 28 28 84 168 15,803 442,484 442,484 442,484 1,327,452 442,484 442,484 442,484 1,327,452 2,654,904
58 Janumet* Tab 28 28 28 84 28 28 28 84 168 8,485 237,580 237,580 237,580 712,740 237,580 237,580 237,580 712,740 1,425,480
59 Truvaz 10* Tab 30 30 30 90 30 30 30 90 180 14,438 433,125 433,125 433,125 1,299,375 433,125 433,125 433,125 1,299,375 2,598,750
60 Truvaz 20* Tab 30 30 30 90 30 30 30 90 180 14,438 433,125 433,125 433,125 1,299,375 433,125 433,125 433,125 1,299,375 2,598,750
61 Trajenta* Tab 150 150 150 450 150 150 150 450 900 14,875 2,231,300 2,231,300 2,231,300 6,693,900 2,231,300 2,231,300 2,231,300 6,693,900 13,387,800
62 Nexium 20* Tab 140 140 140 420 140 140 140 420 840 16,089 2,252,460 2,252,460 2,252,460 6,757,380 2,252,460 2,252,460 2,252,460 6,757,380 13,514,760
63 Nexium 40* Tab 140 140 140 420 140 140 140 420 840 19,642 2,749,880 2,749,880 2,749,880 8,249,640 2,749,880 2,749,880 2,749,880 8,249,640 16,499,280
64 Pantozol 20* Tab 140 140 140 420 140 140 140 420 840 16,714 2,340,000 2,340,000 2,340,000 7,020,000 2,340,000 2,340,000 2,340,000 7,020,000 14,040,000
65 Pantozol 40* Tab 140 140 140 420 140 140 140 420 840 21,214 2,970,000 2,970,000 2,970,000 8,910,000 2,970,000 2,970,000 2,970,000 8,910,000 17,820,000
66 OBH Nelco spec 100* btl 12 12 12 36 12 12 12 36 72 23,740 284,880 284,880 284,880 854,640 284,880 284,880 284,880 854,640 1,709,280
67 MAGALAT SUSP 100ML ( btl 15 15 15 45 20 20 20 60 105 28,130 421,950 421,950 421,950 1,265,850 562,600 562,600 562,600 1,687,800 2,953,650
68 MAGALAT TAB @60 (FPP BOX60 3 3 3 9 3 3 3 9 18 50,630 151,890 151,890 151,890 455,670 151,890 151,890 151,890 455,670 911,340
69 Blopress 8 tab 140 140 140 420 140 140 140 420 840 12,807 1,792,980 1,792,980 1,792,980 5,378,940 1,792,980 1,792,980 1,792,980 5,378,940 10,757,880
70 Blopress 16 tab 140 140 140 420 140 140 140 420 840 16,052 2,247,280 2,247,280 2,247,280 6,741,840 2,247,280 2,247,280 2,247,280 6,741,840 13,483,680
71 Blopress Plus tab 140 140 140 420 140 140 140 420 840 16,052 2,247,280 2,247,280 2,247,280 6,741,840 2,247,280 2,247,280 2,247,280 6,741,840 13,483,680
72 KASA BIRU 42 Y rol 1 1 1 3 1 1 1 3 6 732,040 732,040 732,040 732,040 2,196,120 732,040 732,040 732,040 2,196,120 4,392,240
73 HYPAFIX 10 CM X 5 M ( ktk 0 0 0 - 0 0 0 0 0 59,910 - - - - - - - - -
74 HYPAFIX 5 CM X 5 M (N ktk 0 0 0 - 0 0 0 0 0 59,910 - - - - - - - - -
75 LEUKOPLAST 1562 (1x1) rol 2 1 2 5 2 2 2 6 11 5,100 10,200 5,100 10,200 25,500 10,200 10,200 10,200 30,600 56,100
76 OPTIMAX (Box/30) box 1 1 1 3 1 1 2 4 7 198,000 198,000 198,000 198,000 594,000 198,000 198,000 396,000 792,000 1,386,000
77 Amaryl M2 Box/30 2 2 2 6 2 2 2 6 12 163,940 327,880 327,880 327,880 983,640 327,880 327,880 327,880 983,640 1,967,280
78 Batugin Exlixir 120 ml Btl 10 10 10 30 10 10 10 30 60 20,820 208,200 208,200 208,200 624,600 208,200 208,200 208,200 624,600 1,249,200
79 Co Diovan 80 mg @28 Tab 84 84 84 252 84 84 84 252 504 13,350 1,121,430 1,121,430 1,121,430 3,364,290 1,121,430 1,121,430 1,121,430 3,364,290 6,728,580
80 Co Diovan 160 mg @28 Tab 84 84 84 252 84 84 84 252 504 16,737 1,405,875 1,405,875 1,405,875 4,217,625 1,405,875 1,405,875 1,405,875 4,217,625 8,435,250
81 Canderin 16 mg @30 Tab 60 60 60 180 60 60 60 180 360 9,563 573,760 573,760 573,760 1,721,280 573,760 573,760 573,760 1,721,280 3,442,560
82 Canderin 8 mg @30 Tab 60 60 60 180 60 60 60 180 360 6,750 405,000 405,000 405,000 1,215,000 405,000 405,000 405,000 1,215,000 2,430,000
83 Celebrex 100 mg@30 Tab 60 60 60 180 60 60 60 180 360 9,457 567,420 567,420 567,420 1,702,260 567,420 567,420 567,420 1,702,260 3,404,520
84 Celebrex 200 mg@30 Tab 60 60 60 180 60 60 60 180 360 14,203 852,200 852,200 852,200 2,556,600 852,200 852,200 852,200 2,556,600 5,113,200
85 Concor 5 mg @100 Tab 100 100 100 300 100 100 100 300 600 8,799 879,870 879,870 879,870 2,639,610 879,870 879,870 879,870 2,639,610 5,279,220
86 Concor 2,5 mg @100 Tab 200 200 200 600 200 200 200 600 1200 6,076 1,215,240 1,215,240 1,215,240 3,645,720 1,215,240 1,215,240 1,215,240 3,645,720 7,291,440
87 Diovan 160 mg @28 Tab 84 56 56 196 56 56 56 168 364 15,940 1,338,930 892,620 892,620 3,124,170 892,620 892,620 892,620 2,677,860 5,802,030
88 Diovan 80 mg @28 Box 84 56 56 196 56 56 56 168 364 12,715 1,068,030 712,020 712,020 2,492,070 712,020 712,020 712,020 2,136,060 4,628,130
89 Digenta Cr Tube 0 0 0 - 0 0 0 0 0 - - - - - - - - -
90 Exforge 5/80 mg @28 tab 28 28 28 84 28 28 56 112 196 14,963 418,950 418,950 418,950 1,256,850 418,950 418,950 837,900 1,675,800 2,932,650
91 Exforge 10/160 mg @28 Box 28 28 28 84 28 28 28 84 168 18,731 524,480 524,480 524,480 1,573,440 524,480 524,480 524,480 1,573,440 3,146,880
92 Cinogenta Cream Tube 5 5 5 15 5 5 5 15 30 43,320 216,600 216,600 216,600 649,800 216,600 216,600 216,600 649,800 1,299,600
93 Galvusmet 5/500 @30 tab 90 90 90 270 90 90 90 270 540 7,031 632,820 632,820 632,820 1,898,460 632,820 632,820 632,820 1,898,460 3,796,920
94 Hyperil 5 mg @60 Box 60 60 60 180 60 60 60 180 360 8,438 506,250 506,250 506,250 1,518,750 506,250 506,250 506,250 1,518,750 3,037,500
95 Hyperil 2,5 mg @ 60 Box 60 60 60 180 60 60 60 180 360 5,344 320,630 320,630 320,630 961,890 320,630 320,630 320,630 961,890 1,923,780
96 Hysterin Syr Btl 5 5 5 15 5 5 5 15 30 48,380 241,900 241,900 241,900 725,700 241,900 241,900 241,900 725,700 1,451,400
97 Herbesser 100 mg tab/30 60 60 60 180 60 60 60 180 360 8,370 502,200 502,200 502,200 1,506,600 502,200 502,200 502,200 1,506,600 3,013,200
98 HP Pro @120 tab 120 120 120 360 120 120 120 360 720 4,736 568,330 568,330 568,330 1,704,990 568,330 568,330 568,330 1,704,990 3,409,980
99 Harnal 0,2 @28 tab 28 28 28 84 28 28 28 84 168 14,392 402,975 402,975 402,975 1,208,925 402,975 402,975 402,975 1,208,925 2,417,850
100 Harnal Ocas @28 tab/28 28 28 28 84 56 28 28 112 196 14,891 416,957 416,957 416,957 1,250,872 833,915 416,957 416,957 1,667,829 2,918,701
101 Lyrica 50 @14 tab 28 28 28 84 28 28 28 84 168 8,903 249,280 249,280 249,280 747,840 249,280 249,280 249,280 747,840 1,495,680
102 Lyrica 75 @14 tab 28 28 28 84 28 28 28 84 168 12,856 359,980 359,980 359,980 1,079,940 359,980 359,980 359,980 1,079,940 2,159,880
103 Lyrica 150 @14 tab 28 28 28 84 28 28 28 84 168 21,212 593,940 593,940 593,940 1,781,820 593,940 593,940 593,940 1,781,820 3,563,640
104 Neuralgin@100 tab 0 0 0 - 0 0 0 0 0 - - - - - - - - -
105 Symbicort Inhaler Btl 10 10 10 30 10 10 10 30 60 297,820 2,978,200 2,978,200 2,978,200 8,934,600 2,978,200 2,978,200 2,978,200 8,934,600 17,869,200
106 Trileptal 300 @50 Box 50 50 50 150 50 50 50 150 300 9,184 459,200 459,200 459,200 1,377,600 459,200 459,200 459,200 1,377,600 2,755,200
107 Tegretol 200 @50 Box 50 50 50 150 50 50 50 150 300 4,240 212,020 212,020 212,020 636,060 212,020 212,020 212,020 636,060 1,272,120
108 Thrombophob gel Tube 5 5 5 15 5 5 5 15 30 53,160 265,800 265,800 265,800 797,400 265,800 265,800 265,800 797,400 1,594,800
109 Trizedon MR @60 tab 180 180 180 540 180 180 180 540 1080 3,675 661,500 661,500 661,500 1,984,500 661,500 661,500 661,500 1,984,500 3,969,000
110 Twynsta 5/40 @28 tab 28 28 28 84 28 28 28 84 168 15,688 439,260 439,260 439,260 1,317,780 439,260 439,260 439,260 1,317,780 2,635,560
111 Twynsta 5/80 @28 tab 28 28 28 84 56 56 56 168 252 20,381 570,680 570,680 570,680 1,712,040 1,141,360 1,141,360 1,141,360 3,424,080 5,136,120
112 Twynsta 10/80 @28 tab 28 28 28 84 28 28 28 84 168 20,381 570,680 570,680 570,680 1,712,040 570,680 570,680 570,680 1,712,040 3,424,080
113 Tantum Verde 60 ml Btl 5 5 5 15 5 5 5 15 30 23,630 118,150 118,150 118,150 354,450 118,150 118,150 118,150 354,450 708,900
114 Ultrapoct N Supp @10 Supp 10 10 10 30 10 10 10 30 60 16,223 162,233 162,233 162,233 486,700 162,233 162,233 162,233 486,700 973,400
115 Ventolin Inhaler Btl 5 5 5 15 5 5 5 15 30 101,120 505,600 505,600 505,600 1,516,800 505,600 505,600 505,600 1,516,800 3,033,600
116 Ventolin Nebul @ 20 box 3 3 3 9 3 3 3 9 18 202,230 606,690 606,690 606,690 1,820,070 606,690 606,690 606,690 1,820,070 3,640,140
117 Cholespar 20 mg @30 tab 30 30 30 90 30 60 60 150 240 18,750 562,500 562,500 562,500 1,687,500 562,500 1,125,000 1,125,000 2,812,500 4,500,000
118 Cholespar 10 mg @30 tab 30 30 30 90 30 30 30 90 180 14,063 421,875 421,875 421,875 1,265,625 421,875 421,875 421,875 1,265,625 2,531,250
119 Voltaren Gel 20g Tube 5 5 5 15 5 5 5 15 30 64,020 320,100 320,100 320,100 960,300 320,100 320,100 320,100 960,300 1,920,600
120 Glurenorm @ 100 Tab 100 0 0 100 0 0 0 0 100 3,658 365,810 - - 365,810 - - - - 365,810
121 Dulcolax Tab 50 50 50 150 50 50 50 150 300 1,265 63,250 63,250 63,250 189,750 63,250 63,250 63,250 189,750 379,500
122 Dulcolax Supp @6 Supp 6 6 6 18 6 6 6 18 36 16,400 98,400 98,400 98,400 295,200 98,400 98,400 98,400 295,200 590,400
123 Diamicron MR tab 90 90 90 270 90 90 90 270 540 6,379 574,110 574,110 574,110 1,722,330 574,110 574,110 574,110 1,722,330 3,444,660
124 Clanexi F Syr Btl 0 0 0 - 0 0 0 0 0 - - - - - - - - -
125 Cendo Polydex TM Btl 5 5 5 15 5 5 5 15 30 40,220 201,100 201,100 201,100 603,300 201,100 201,100 201,100 603,300 1,206,600
126 Rivanol 100 ml Btl 10 10 10 30 10 10 10 30 60 2,770 27,700 27,700 27,700 83,100 27,700 27,700 27,700 83,100 166,200
127 Cataflam D @50 tab 50 50 50 150 50 50 50 150 300 5,966 298,300 298,300 298,300 894,900 298,300 298,300 298,300 894,900 1,789,800
128 Micardis 40 mg @20 tab 20 20 20 60 20 20 20 60 120 14,915 298,300 298,300 298,300 894,900 298,300 298,300 298,300 894,900 1,789,800
129 Micardis 80 mg @ 20 tab 20 20 20 60 20 20 20 60 120 19,337 386,730 386,730 386,730 1,160,190 386,730 386,730 386,730 1,160,190 2,320,380
130 Leukocrep "6" Roll 2 2 2 6 2 2 2 6 12 97,710 195,420 195,420 195,420 586,260 195,420 195,420 195,420 586,260 1,172,520
131 Leukocrep "4 " Roll 2 2 2 6 2 2 2 6 12 76,000 152,000 152,000 152,000 456,000 152,000 152,000 152,000 456,000 912,000
132 Inviclot Inj Amp - 0 0 0 0 0 67,500 - - - - - - - - -
133 Madecasol Oint Tube 5 5 5 15 5 5 5 15 30 135,850 679,250 679,250 679,250 2,037,750 679,250 679,250 679,250 2,037,750 4,075,500
134 Apolar Cr Tube 5 5 5 15 5 5 5 15 30 35,440 177,200 177,200 177,200 531,600 177,200 177,200 177,200 531,600 1,063,200
135 Apolar N Cr Tube 3 5 6 14 5 5 5 15 29 40,170 120,510 200,850 241,020 562,380 200,850 200,850 200,850 602,550 1,164,930
136 Aspar K Tab 100 0 0 100 100 0 0 100 200 2,299 229,910 - - 229,910 229,910 - - 229,910 459,820
137 Ultrapoct N Cr Tube 3 3 3 9 3 3 3 9 18 110,670 332,010 332,010 332,010 996,030 332,010 332,010 332,010 996,030 1,992,060
138 Nifural Syr Btl 0 0 0 - 0 0 0 0 0 55,635 - - - - - - - - -
139 Tarivid TT Btl 2 2 2 6 2 2 2 6 12 86,630 173,260 173,260 173,260 519,780 173,260 173,260 173,260 519,780 1,039,560
140 Betadine Sol 30 Ml Btl 12 12 12 36 12 12 12 36 72 18,060 216,720 216,720 216,720 650,160 216,720 216,720 216,720 650,160 1,300,320
141 Betadine OInt 10 Gr Tube 5 5 5 15 5 5 5 15 30 15,080 75,400 75,400 75,400 226,200 75,400 75,400 75,400 226,200 452,400
142 Betadine Oint 5 Gr Tube - 0 0 9,280 - - - - - - - - -
143 Betadine Sol 5 Ml Btl 12 12 12 36 12 12 12 36 72 3,040 36,480 36,480 36,480 109,440 36,480 36,480 36,480 109,440 218,880
144 Bioplacenton Gel Tube 5 5 5 15 5 5 5 15 30 15,190 75,950 75,950 75,950 227,850 75,950 75,950 75,950 227,850 455,700
145 Claneksi Syr Btl - 0 0 53,550 - - - - - - - - -
146 Combantyrin Syr Btl 5 5 5 15 5 5 5 15 30 14,330 71,650 71,650 71,650 214,950 71,650 71,650 71,650 214,950 429,900
147 Depakene Syr Btl 2 2 2 6 2 2 2 6 12 176,290 352,580 352,580 352,580 1,057,740 352,580 352,580 352,580 1,057,740 2,115,480
148 Exforge 5/160 Mg Tab @ 28 Tab 28 28 28 84 28 28 28 84 168 17,438 488,260 488,260 488,260 1,464,780 488,260 488,260 488,260 1,464,780 2,929,560
149 Leukoplast 1621 Rol - 0 0 7,360 - - - - - - - - -
150 Nonflamin Cap @60 Tab 60 0 0 60 60 0 0 60 120 4,374 262,430 - - 262,430 262,430 - - 262,430 524,860
151 Pronalges Supp @ 10 Box 1 1 1 3 1 1 1 3 6 133,880 133,880 133,880 133,880 401,640 133,880 133,880 133,880 401,640 803,280
152 Spasmomen Tab @30 Tab 30 30 30 90 30 30 30 90 180 6,975 209,250 209,250 209,250 627,750 209,250 209,250 209,250 627,750 1,255,500
153 Verban Uk. 5 cm Rol 30 30 30 90 30 30 32 92 182 565 16,950 16,950 16,950 50,850 16,950 16,950 18,080 51,980 102,830
154 Verban Uk. 15 cm Rol 30 30 30 90 30 30 29 89 179 1,540 46,200 46,200 46,200 138,600 46,200 46,200 44,660 137,060 275,660
155 COMBANTRIN TAB TAB 50 50 0 0 50 5,910 295,500 - - 295,500 - - - - 295,500
156 HERBESSER 200 BOX 1 0 0 1 1 0 0 1 2 381,720 381,720 - - 381,720 381,720 - - 381,720 763,440
157 Authocheck Cholesterol str btl 4 4 4 12 4 4 4 12 24 185,630 742,520 742,520 742,520 2,227,560 742,520 742,520 742,520 2,227,560 4,455,120
158 Authocheck Gluco DR stri btl 2 2 2 6 2 2 2 6 12 106,880 213,760 213,760 213,760 641,280 213,760 213,760 213,760 641,280 1,282,560
159 Authocheck Uric Acid stri btl 2 2 2 6 2 2 2 6 12 123,750 247,500 247,500 247,500 742,500 247,500 247,500 247,500 742,500 1,485,000
160 Leukopor Besar Pcs - 0 0 20,000 - - - - - - - - -
161 Leukopor Kecil Pcs - 0 0 15,000 - - - - - - - - -
162 Renxamin Btl - 0 0 110,000 - - - - - - - - -
JUMLAH 90,923,582 87,947,937 88,021,332 266,892,852 90,435,130 89,254,992 89,871,532 269,561,654 536,454,505
PPN 10% 9,092,358 8,794,794 8,802,133 26,689,285 9,043,513 8,925,499 8,987,153 26,956,165 53,645,451

No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN KLINIK SEI. LINDAI

PT. Nusa Lima Medika ALAT KESEHATAN SEMESTER I 2017 PAKET -
VI

Estimasi Harga
1 Bedak Salicyl 2% Pot - 0 - - - - - - 0 5,625 - - - - - - - - -

2 Bekarbon Tab - 0 - - - - - - 0 - - - - - - - - -
3 Gentian Violet 1% Btl 3 0 0 3 3 0 0 3 6 2,995 8,985 - - 8,985 8,985 - - 8,985 17,970
4 Ichtyol Salep Pot 3 0 - 3 3 - - 3 6 5,650 16,950 - - 16,950 16,950 - - 16,950 33,900
5 Norit Tab 40 0 - 40 40 - - 40 80 277 11,065 - - 11,065 11,065 - - 11,065 22,130
6 Salep 2-4 Pot 3 3 3 9 3 3 3 9 18 3,685 11,055 11,055 11,055 33,165 11,055 11,055 11,055 33,165 66,330
7 Aprovel 150* Tab - - 0 355,830 - - - - - - - - -
8 Aprovel 300* Tab - - 0 480,250 - - - - - - - - -
9 Ascardia* Tab - - 0 956 - - - - - - - - -
10 Biodiar* Tab - 0 - - - - - - 0 - - - - - - - - - -
11 Cendo Mycetin TM* Btl - 0 - - - - - - 0 - - - - - - - - -
12 Cendo Mycetin ZM* Tube 2 0 - 2 2 - - 2 4 14,350 28,700 - - 28,700 28,700 - - 28,700 57,400
13 Cortidex* Tab - 0 - - - - - - 0 281 - - - - - - - - -
14 Dermovel Cr* Tube 1 0 - 1 1 - - 1 2 67,500 67,500 - - 67,500 67,500 - - 67,500 135,000
15 Dumin Rectal 125 * Tube 1 0 - 1 - - - - 1 13,118 13,118 - - 13,118 - - - - 13,118
16 Dumin Rectal 250 * Tube 1 0 - 1 - - - - 1 18,316 18,316 - - 18,316 - - - - 18,316
17 Erlamycetin Plus TM* Btl 2 0 - 2 - - - - 2 13,030 26,060 - - 26,060 - - - - 26,060
18 Fladystin Vaginal* Vagtab 10 0 - 10 - - - - 10 14,625 146,250 - - 146,250 - - - - 146,250
19 Glucobay 50* Tab - - 0 2,009 - - - - - - - - -
20 Glucobay 100* Tab - - 0 3365 - - - - - - - - -
21 Glucovance 2,5/500* Tab - - 0 3,795 - - - - - - - - -
22 Glucovance 5/500* Tab - - 0 4,608 - - - - - - - - -
23 Gluvas 2* Tab - - 0 - - - - - - - - - -
24 Gluvas 3* Tab - - 0 - - - - - - - - - -
25 Ketricin Cr* Tube 1 0 - 1 - - - - 1 45,000 45,000 - - 45,000 - - - - 45,000
26 Lantus Inj* Amp - - 0 193,384 - - - - - - - - -
27 Lipitor 10* Tab - - 0 18,641 - - - - - - - - -
28 Lipitor 20* Tab - - 0 19,007 - - - - - - - - -
29 Norvask 5* Tab - - 0 7,826 - - - - - - - - -
30 Norvask 10* tab - - 0 14,026 - - - - - - - - -
31 Novomix Inj* Amp - - 0 171,908 - - - - - - - - -
32 Novorafid Inj* Amp - - 0 171,908 - - - - - - - - -
33 Pibaksin Oint* Tube 1 0 - 1 1 - - 1 2 41,690 41,690 - - 41,690 41,690 - - 41,690 83,380
34 Pronalges* tab - - 0 2812.6 - - - - - - - - -
35 Pulmicort Nebul* Fls 5 0 - 5 5 - - 5 10 17,384 86,918 - - 86,918 86,918 - - 86,918 173,835
36 Retaphyl SR* Tab - - 0 2,191 - - - - - - - - -
37 Rhinofed* Tab 0 0 0 - 0 0 0 - 0 - - - - - - - - -
38 Rhinofed Syr* Btl 0 0 0 - 0 0 0 - 0 - - - - - - - - -
39 Rhinos SR* Tab 0 0 0 - 0 0 0 - 0 - - - - - - - - -
40 sanprima*Forte Tab - 0 - - - - - - 0 2,025 - - - - - - - - -
41 Scabimite Cr* Tube 1 0 - 1 - - - - 1 41,070 41,070 - - 41,070 - - - - 41,070
42 Siclidon 100* Caps - - 0 5,192 - - - - - - - - -
43 Starcef 200* Caps - - 0 30,938 - - - - - - - - -
44 Termisil Cr* Tube - - 0 54,340 - - - - - - - - -
45 Tetagam PP* Amp 1 0 - 1 - - - - 1 211,500 211,500 - - 211,500 - - - - 211,500
46 Theragran M* Tab - - 0 4,241 - - - - - - - - -
47 Thrombo Aspilet* Tab - - 0 759 - - - - - - - - -
48 Trichodazole* Tab - - 0 1,687 - - - - - - - - -
49 Tripanzym* Tab - 0 - - - 0 - - 0 - - - - - - - - -
50 Tuzalos* Tab - 0 - - - - - - 0 - - - - - - - - -
51 Ventolin Syr* Tab 2 0 - 2 - - - - 2 50,680 101,360 - - 101,360 - - - - 101,360
52 Ventolin Exp Syr* Btl 1 1 - 2 - - - - 2 53,280 53,280 53,280 - 106,560 - - - - 106,560
53 Verorab Inj* Amp 1 0 - 1 - - - - 1 178,470 178,470 - - 178,470 - - - - 178,470
54 Plavix 75* Tab - - 0 26,494 - - - - - - - - -
55 Crestor 10* Tab - - 0 17,779 - - - - - - - - -
56 Crestor 20* Tab - - 0 20,844 - - - - - - - - -
57 Januvia 100* Tab - - 0 15,803 - - - - - - - - -
58 Janumet* Tab - - 0 8,485 - - - - - - - - -
59 Truvaz 10* Tab - - 0 14,438 - - - - - - - - -
60 Truvaz 20* Tab - - 0 14,438 - - - - - - - - -
61 Trajenta* Tab - - 0 14,875 - - - - - - - - -
62 Nexium 20* Tab - - 0 16,089 - - - - - - - - -
63 Nexium 40* Tab - - 0 19,642 - - - - - - - - -
64 Pantozol 20* Tab - - 0 16,714 - - - - - - - - -
65 Pantozol 40* Tab - - 0 21,214 - - - - - - - - -
66 OBH Nelco spec 100* btl 3 3 3 9 5 2 2 9 18 23,740 71,220 71,220 71,220 213,660 118,700 47,480 47,480 213,660 427,320
67 MAGALAT SUSP 100ML ( btl - 0 - - - - - - 0 28,130 - - - - - - - - -
68 MAGALAT TAB @60 (FPP BOX60 1 0 0 1 0 0 0 - 1 50,630 50,630 - - 50,630 - - - - 50,630
69 Blopress 8 tab - - 0 12,807 - - - - - - - - -
70 Blopress 16 tab - - 0 16,052 - - - - - - - - -
71 Blopress Plus tab - - 0 16,052 - - - - - - - - -
72 KASA BIRU 42 Y rol 1 0 0 1 1 0 0 1 2 732,040 732,040 - - 732,040 732,040 - - 732,040 1,464,080
73 HYPAFIX 10 CM X 5 M ( ktk 0 0 0 - 0 0 0 - 0 59,910 - - - - - - - - -
74 HYPAFIX 5 CM X 5 M (N ktk 0 0 0 - 0 0 0 - 0 59,910 - - - - - - - - -
75 LEUKOPLAST 1562 (1x1) rol 0 0 0 - 0 0 0 - 0 5,100 - - - - - - - - -
76 OPTIMAX (Box/30) box 0 0 0 - 0 0 0 - 0 198,000 - - - - - - - - -
77 Amaryl M2 Box/30 - - 0 163,940 - - - - - - - - -
78 Batugin Exlixir 120 ml Btl - - 0 20,820 - - - - - - - - -
79 Co Diovan 80 mg @28 Tab - - 0 13,350 - - - - - - - - -
80 Co Diovan 160 mg @28 Tab - - 0 16,737 - - - - - - - - -
81 Canderin 16 mg @30 Tab - - 0 9,563 - - - - - - - - -
82 Canderin 8 mg @30 Tab - - 0 6,750 - - - - - - - - -
83 Celebrex 100 mg@30 Tab - - 0 9,457 - - - - - - - - -
84 Celebrex 200 mg@30 Tab - - 0 14,203 - - - - - - - - -
85 Concor 5 mg @100 Tab - - 0 8,799 - - - - - - - - -
86 Concor 2,5 mg @100 Tab - - 0 6,076 - - - - - - - - -
87 Diovan 160 mg @28 Tab - - 0 15,940 - - - - - - - - -
88 Diovan 80 mg @28 Box - - 0 12,715 - - - - - - - - -
89 Digenta Cr Tube 0 0 0 - 0 0 0 - 0 - - - - - - - - -
90 Exforge 5/80 mg @28 tab - - 0 14,963 - - - - - - - - -
91 Exforge 10/160 mg @28 Box - - 0 18,731 - - - - - - - - -
92 Cinogenta Cream Tube 3 3 3 9 3 3 3 9 18 43,320 129,960 129,960 129,960 389,880 129,960 129,960 129,960 389,880 779,760
93 Galvusmet 5/500 @30 tab - - 0 7,031 - - - - - - - - -
94 Hyperil 5 mg @60 Box - - 0 8,438 - - - - - - - - -
95 Hyperil 2,5 mg @ 60 Box - - 0 5,344 - - - - - - - - -
96 Hysterin Syr Btl - - 0 48,380 - - - - - - - - -
97 Herbesser 100 mg tab/30 - - 0 8,370 - - - - - - - - -
98 HP Pro @120 tab - - 0 4,736 - - - - - - - - -
99 Harnal 0,2 @28 tab - - 0 14,392 - - - - - - - - -
100 Harnal Ocas @28 tab/28 - - 0 14,891 - - - - - - - - -
101 Lyrica 50 @14 tab - - 0 8,903 - - - - - - - - -
102 Lyrica 75 @14 tab - - 0 12,856 - - - - - - - - -
103 Lyrica 150 @14 tab - - 0 21,212 - - - - - - - - -
104 Neuralgin@100 tab 0 0 0 - 0 0 0 - 0 - - - - - - - - -
105 Symbicort Inhaler Btl 2 2 2 6 1 0 1 2 8 297,820 595,640 595,640 595,640 1,786,920 297,820 - 297,820 595,640 2,382,560
106 Trileptal 300 @50 Box - - 0 9,184 - - - - - - - - -
107 Tegretol 200 @50 Box - - 0 4,240 - - - - - - - - -
108 Thrombophob gel Tube 2 2 2 6 2 2 2 6 12 53,160 106,320 106,320 106,320 318,960 106,320 106,320 106,320 318,960 637,920
109 Trizedon MR @60 tab - - 0 3,675 - - - - - - - - -
110 Twynsta 5/40 @28 tab - - 0 15,688 - - - - - - - - -
111 Twynsta 5/80 @28 tab - - 0 20,381 - - - - - - - - -
112 Twynsta 10/80 @28 tab - - 0 20,381 - - - - - - - - -
114 Ultrapoct N Supp @10 Supp 10 0 0 10 10 0 0 10 20 16,223 162,233 - - 162,233 162,233 - - 162,233 324,467
115 Ventolin Inhaler Btl 3 3 3 9 5 2 2 9 18 101,120 303,360 303,360 303,360 910,080 505,600 202,240 202,240 910,080 1,820,160
116 Ventolin Nebul @ 20 box 1 0 0 1 1 0 0 1 2 202,230 202,230 - - 202,230 202,230 - - 202,230 404,460
117 Cholespar 20 mg @30 tab - - 0 18,750 - - - - - - - - -
118 Cholespar 10 mg @30 tab - - 0 14,063 - - - - - - - - -
119 Voltaren Gel 20g Tube - - 0 64,020 - - - - - - - - -
120 Glurenorm @ 100 Tab - - 0 3,658 - - - - - - - - -
121 Dulcolax Tab - - 0 1,265 - - - - - - - - -
122 Dulcolax Supp @6 Supp - - 0 16,400 - - - - - - - - -
123 Diamicron MR tab - - 0 6,379 - - - - - - - - -
124 Clanexi F Syr Btl - - 0 - - - - - - - - -
125 Cendo Polydex TM Btl 1 1 1 3 1 1 1 3 6 40,220 40,220 40,220 40,220 120,660 40,220 40,220 40,220 120,660 241,320
126 Rivanol 100 ml Btl 1 1 1 3 1 1 0 2 5 2,770 2,770 2,770 2,770 8,310 2,770 2,770 - 5,540 13,850
127 Cataflam D @50 tab 50 50 0 100 0 0 0 - 100 5,966 298,300 298,300 - 596,600 - - - - 596,600
128 Micardis 40 mg @20 tab - - 0 14,915 - - - - - - - - -
129 Micardis 80 mg @ 20 tab - - 0 19,337 - - - - - - - - -
130 Leukocrep "6" Roll - - 0 97,710 - - - - - - - - -
131 Leukocrep "4 " Roll 2 2 2 6 2 2 2 6 12 76,000 152,000 152,000 152,000 456,000 152,000 152,000 152,000 456,000 912,000
132 Inviclot Inj Amp - - 0 67,500 - - - - - - - - -
133 Madecasol Oint Tube - - 0 135,850 - - - - - - - - -
134 Apolar Cr Tube - - 0 35,440 - - - - - - - - -
135 Apolar N Cr Tube - - 0 40,170 - - - - - - - - -
136 Aspar K Tab - - 0 2,299 - - - - - - - - -
137 Ultrapoct N Cr Tube - - 0 110,670 - - - - - - - - -
138 Nifural Syr Btl - - 0 55,635 - - - - - - - - -
139 Tarivid TT Btl - - 0 86,630 - - - - - - - - -
141 Betadine OInt 10 Gr Tube - - 0 15,080 - - - - - - - - -
142 Betadine Oint 5 Gr Tube - - 0 9,280 - - - - - - - - -
145 Claneksi Syr Btl - - 0 53,550 - - - - - - - - -
147 Depakene Syr Btl - - 0 176,290 - - - - - - - - -
148 Exforge 5/160 Mg Tab @ 28 Tab - - 0 17,438 - - - - - - - - -
149 Leukoplast 1621 Rol 1 1 1 3 1 1 1 3 6 7,360 7,360 7,360 7,360 22,080 7,360 7,360 7,360 22,080 44,160
150 Nonflamin Cap @60 Tab - - 0 4,374 - - - - - - - - -
151 Pronalges Supp @ 10 Box - - 0 133,880 - - - - - - - - -
152 Spasmomen Tab @30 Tab - - 0 6,975 - - - - - - - - -
153 Verban Uk. 5 cm Rol 10 10 10 30 10 10 10 30 60 565 5,650 5,650 5,650 16,950 5,650 5,650 5,650 16,950 33,900
154 Verban Uk. 15 cm Rol 10 10 5 25 5 5 5 15 40 1,540 15,400 15,400 7,700 38,500 7,700 7,700 7,700 23,100 61,600
155 COMBANTRIN TAB TAB 0 - 0 0 0 - 0 5,910 - - - - - - - - -
156 HERBESSER 200 Caps 0 0 0 - 0 0 0 - 0 381,720 - - - - - - - - -
157 Authocheck Cholesterol st btl 0 0 0 - 0 0 0 - 0 185,630 - - - - - - - - -
158 Authocheck Gluco DR stri btl 0 0 0 - 0 0 0 - 0 106,880 - - - - - - - - -
159 Authocheck Uric Acid stri btl 0 0 0 - 0 0 0 - 0 123,750 - - - - - - - - -
160 Leukopor Besar Pcs - - 0 20,000 - - - - - - - - -
161 Leukopor Kecil Pcs - - 0 15,000 - - - - - - - - -
162 Renxamin Btl - - 0 110,000 - - - - - - - - -
JUMLAH 4,306,610 2,116,525 1,757,245 8,180,380 3,067,456 1,036,745 1,301,415 5,405,616 13,585,996
PPN 10% 430,661 211,653 175,725 818,038 306,746 103,675 130,142 540,562 1,358,600
No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN KLINIK SEI. GALUH

VI

Estimasi Harga
1 Bedak Salicyl 2% Pot - - - - - - - 0 0 5,625 - - - - - - - - -

2 Bekarbon Tab - 0 - - - - - 0 0 - - - - - - - - -
3 Gentian Violet 1% Btl - - - - - - - 0 0 2,995 - - - - - - - - -
4 Ichtyol Salep Pot 3 3 3 9 3 3 3 9 18 5,650 16,950 16,950 16,950 50,850 16,950 16,950 16,950 50,850 101,700
5 Norit Tab 40 40 40 120 40 40 - 80 200 277 11,065 11,065 11,065 33,195 11,065 11,065 - 22,130 55,325
6 Salep 2-4 Pot - - - - - - - 0 0 3,685 - - - - - - - - -
7 Aprovel 150* Tab - 0 0 355,830 - - - - - - - - -
8 Aprovel 300* Tab - 0 0 480,250 - - - - - - - - -
9 Ascardia* Tab - 0 0 956 - - - - - - - - -
10 Biodiar* Tab - - - - - - - 0 0 - - - - - - - - - -
11 Cendo Mycetin TM* Btl - 0 - - - - - 0 0 - - - - - - - - -
13 Cortidex* Tab - - - - - - - 0 0 281 - - - - - - - - -
14 Dermovel Cr* Tube 1 - - 1 1 - - 1 2 67,500 67,500 - - 67,500 67,500 - - 67,500 135,000
15 Dumin Rectal 125 * Tube 1 - - 1 1 - - 1 2 13,118 13,118 - - 13,118 13,118 - - 13,118 26,236
16 Dumin Rectal 250 * Tube 1 - - 1 1 - - 1 2 18,316 18,316 - - 18,316 18,316 - - 18,316 36,632
17 Erlamycetin Plus TM* Btl 1 0 - 1 1 0 - 1 2 13,030 13,030 - - 13,030 13,030 - - 13,030 26,060
18 Fladystin Vaginal* Vagtab 10 - - 10 - - - 0 10 14,625 146,250 - - 146,250 - - - - 146,250
19 Glucobay 50* Tab - 0 0 2,009 - - - - - - - - -
20 Glucobay 100* Tab - 0 0 3365 - - - - - - - - -
21 Glucovance 2,5/500* Tab - 0 0 3,795 - - - - - - - - -
22 Glucovance 5/500* Tab - 0 0 4,608 - - - - - - - - -
23 Gluvas 2* Tab - 0 0 - - - - - - - - - -
24 Gluvas 3* Tab - 0 0 - - - - - - - - - -
25 Ketricin Cr* Tube 1 1 1 3 2 1 1 4 7 45,000 45,000 45,000 45,000 135,000 90,000 45,000 45,000 180,000 315,000
26 Lantus Inj* Amp - 0 0 193,384 - - - - - - - - -
27 Lipitor 10* Tab - 0 0 18,641 - - - - - - - - -
28 Lipitor 20* Tab - 0 0 19,007 - - - - - - - - -
29 Norvask 5* Tab - 0 0 7,826 - - - - - - - - -
30 Norvask 10* tab - 0 0 14,026 - - - - - - - - -
31 Novomix Inj* Amp - 0 0 171,908 - - - - - - - - -
32 Novorafid Inj* Amp - 0 0 171,908 - - - - - - - - -
33 Pibaksin Oint* Tube - - - - - - - 0 0 41,690 - - - - - - - - -
34 Pronalges* tab - 0 0 2812.6 - - - - - - - - -
35 Pulmicort Nebul* Fls 5 0 - 5 - - - 0 5 17,384 86,918 - - 86,918 - - - - 86,918
36 Retaphyl SR* Tab - 0 0 2,191 - - - - - - - - -
37 Rhinofed* Tab - 0 0 - - - - - - - - -
38 Rhinofed Syr* Btl - 0 0 - - - - - - - - -
39 Rhinos SR* Tab - 0 0 - - - - - - - - -
40 sanprima*Forte Tab - - - - - - - 0 0 2,025 - - - - - - - - -
41 Scabimite Cr* Tube 1 0 - 1 1 - - 1 2 41,070 41,070 - - 41,070 41,070 - - 41,070 82,140
42 Siclidon 100* Caps - 0 0 5,192 - - - - - - - - -
43 Starcef 200* Caps - 0 0 30,938 - - - - - - - - -
44 Termisil Cr* Tube - 0 0 54,340 - - - - - - - - -
45 Tetagam PP* Amp 1 0 - 1 - - - 0 1 211,500 211,500 - - 211,500 - - - - 211,500
46 Theragran M* Tab - 0 0 4,241 - - - - - - - - -
47 Thrombo Aspilet* Tab - 0 0 759 - - - - - - - - -
48 Trichodazole* Tab - 0 0 1,687 - - - - - - - - -
49 Tripanzym* Tab - 0 - - - 0 - 0 0 - - - - - - - - -
50 Tuzalos* Tab - 0 - - - - - 0 0 - - - - - - - - -
51 Ventolin Syr* Tab - - - - - - - 0 0 50,680 - - - - - - - - -
52 Ventolin Exp Syr* Btl 1 1 - 2 - 0 - 0 2 53,280 53,280 53,280 - 106,560 - - - - 106,560
53 Verorab Inj* Amp 1 0 - 1 - - - 0 1 178,470 178,470 - - 178,470 - - - - 178,470
54 Plavix 75* Tab - 0 0 26,494 - - - - - - - - -
55 Crestor 10* Tab - 0 0 17,779 - - - - - - - - -
56 Crestor 20* Tab - 0 0 20,844 - - - - - - - - -
57 Januvia 100* Tab - 0 0 15,803 - - - - - - - - -
58 Janumet* Tab - 0 0 8,485 - - - - - - - - -
59 Truvaz 10* Tab - 0 0 14,438 - - - - - - - - -
60 Truvaz 20* Tab - 0 0 14,438 - - - - - - - - -
61 Trajenta* Tab - 0 0 14,875 - - - - - - - - -
62 Nexium 20* Tab - 0 0 16,089 - - - - - - - - -
63 Nexium 40* Tab - 0 0 19,642 - - - - - - - - -
64 Pantozol 20* Tab - 0 0 16,714 - - - - - - - - -
65 Pantozol 40* Tab - 0 0 21,214 - - - - - - - - -
67 MAGALAT SUSP 100ML ( btl 0 0 0 - 0 0 0 0 0 28,130 - - - - - - - - -
68 MAGALAT TAB @60 (FPP BOX60 0 0 0 - 0 0 0 0 0 50,630 - - - - - - - - -
69 Blopress 8 tab - 0 0 12,807 - - - - - - - - -
70 Blopress 16 tab - 0 0 16,052 - - - - - - - - -
71 Blopress Plus tab - 0 0 16,052 - - - - - - - - -
72 KASA BIRU 42 Y rol 1 0 0 1 0 0 0 0 1 732,040 732,040 - - 732,040 - - - - 732,040
73 HYPAFIX 10 CM X 5 M ( ktk - - - - - - - 0 0 59,910 - - - - - - - - -
74 HYPAFIX 5 CM X 5 M (N ktk - - - - - - - 0 0 59,910 - - - - - - - - -
75 LEUKOPLAST 1562 (1x1) rol 1 1 0 2 1 1 1 3 5 5,100 5,100 5,100 - 10,200 5,100 5,100 5,100 15,300 25,500
76 OPTIMAX (Box/30) box - - - - - - - 0 0 198,000 - - - - - - - - -
77 Amaryl M2 Box/30 - 0 0 163,940 - - - - - - - - -
78 Batugin Exlixir 120 ml Btl - 0 0 20,820 - - - - - - - - -
79 Co Diovan 80 mg @28 Tab - 0 0 13,350 - - - - - - - - -
80 Co Diovan 160 mg @28 Tab - 0 0 16,737 - - - - - - - - -
81 Canderin 16 mg @30 Tab - 0 0 9,563 - - - - - - - - -
82 Canderin 8 mg @30 Tab - 0 0 6,750 - - - - - - - - -
83 Celebrex 100 mg@30 Tab - 0 0 9,457 - - - - - - - - -
84 Celebrex 200 mg@30 Tab - 0 0 14,203 - - - - - - - - -
85 Concor 5 mg @100 Tab - 0 0 8,799 - - - - - - - - -
86 Concor 2,5 mg @100 Tab - 0 0 6,076 - - - - - - - - -
87 Diovan 160 mg @28 Tab - 0 0 15,940 - - - - - - - - -
88 Diovan 80 mg @28 Box - 0 0 12,715 - - - - - - - - -
89 Digenta Cr Tube 0 0 0 - 0 0 0 0 0 - - - - - - - - -
90 Exforge 5/80 mg @28 tab - 0 0 14,963 - - - - - - - - -
91 Exforge 10/160 mg @28 Box - 0 0 18,731 - - - - - - - - -
92 Cinogenta Cream Tube 1 0 0 1 1 0 0 1 2 43,320 43,320 - - 43,320 43,320 - - 43,320 86,640
93 Galvusmet 5/500 @30 tab - 0 0 7,031 - - - - - - - - -
94 Hyperil 5 mg @60 Box - 0 0 8,438 - - - - - - - - -
95 Hyperil 2,5 mg @ 60 Box - 0 0 5,344 - - - - - - - - -
96 Hysterin Syr Btl - 0 0 48,380 - - - - - - - - -
97 Herbesser 100 mg tab/30 - 0 0 8,370 - - - - - - - - -
98 HP Pro @120 tab - 0 0 4,736 - - - - - - - - -
99 Harnal 0,2 @28 tab - 0 0 14,392 - - - - - - - - -
100 Harnal Ocas @28 tab/28 - 0 0 14,891 - - - - - - - - -
101 Lyrica 50 @14 tab - 0 0 8,903 - - - - - - - - -
102 Lyrica 75 @14 tab - 0 0 12,856 - - - - - - - - -
103 Lyrica 150 @14 tab - 0 0 21,212 - - - - - - - - -
104 Neuralgin@100 tab - 0 0 - - - - - - - - -
105 Symbicort Inhaler Btl 0 0 0 - 0 0 0 0 0 297,820 - - - - - - - - -
106 Trileptal 300 @50 Box 0 0 0 - 0 0 0 0 0 9,184 - - - - - - - - -
107 Tegretol 200 @50 Box - 0 0 4,240 - - - - - - - - -
108 Thrombophob gel Tube 1 0 0 1 1 0 0 1 2 53,160 53,160 - - 53,160 53,160 - - 53,160 106,320
109 Trizedon MR @60 tab - 0 0 3,675 - - - - - - - - -
110 Twynsta 5/40 @28 tab - 0 0 15,688 - - - - - - - - -
111 Twynsta 5/80 @28 tab - 0 0 20,381 - - - - - - - - -
112 Twynsta 10/80 @28 tab - 0 0 20,381 - - - - - - - - -
114 Ultrapoct N Supp @10 Supp 6 0 0 6 0 0 0 0 6 16,223 97,340 - - 97,340 - - - - 97,340
115 Ventolin Inhaler Btl 1 0 0 1 0 0 1 1 2 101,120 101,120 - - 101,120 - - 101,120 101,120 202,240
116 Ventolin Nebul @ 20 box 1 0 0 1 0 0 0 0 1 202,230 202,230 - - 202,230 - - - - 202,230
117 Cholespar 20 mg @30 tab - 0 0 18,750 - - - - - - - - -
118 Cholespar 10 mg @30 tab - 0 0 14,063 - - - - - - - - -
119 Voltaren Gel 20g Tube - 0 0 64,020 - - - - - - - - -
120 Glurenorm @ 100 Tab - 0 0 3,658 - - - - - - - - -
121 Dulcolax Tab - 0 0 1,265 - - - - - - - - -
122 Dulcolax Supp @6 Supp - 0 0 16,400 - - - - - - - - -
123 Diamicron MR tab - 0 0 6,379 - - - - - - - - -
124 Clanexi F Syr Btl - 0 0 - - - - - - - - -
125 Cendo Polydex TM Btl 3 0 0 3 0 0 0 0 3 40,220 120,660 - - 120,660 - - - - 120,660
126 Rivanol 100 ml Btl 2 1 2 5 2 2 1 5 10 2,770 5,540 2,770 5,540 13,850 5,540 5,540 2,770 13,850 27,700
127 Cataflam D @50 tab 50 0 0 50 0 0 0 0 50 5,966 298,300 - - 298,300 - - - - 298,300
128 Micardis 40 mg @20 tab - 0 0 14,915 - - - - - - - - -
129 Micardis 80 mg @ 20 tab - 0 0 19,337 - - - - - - - - -
130 Leukocrep "6" Roll - 0 0 97,710 - - - - - - - - -
131 Leukocrep "4 " Roll 1 0 0 1 1 0 0 1 2 76,000 76,000 - - 76,000 76,000 - - 76,000 152,000
132 Inviclot Inj Amp - 0 0 67,500 - - - - - - - - -
133 Madecasol Oint Tube - 0 0 135,850 - - - - - - - - -
134 Apolar Cr Tube - 0 0 35,440 - - - - - - - - -
135 Apolar N Cr Tube - 0 0 40,170 - - - - - - - - -
136 Aspar K Tab - 0 0 2,299 - - - - - - - - -
137 Ultrapoct N Cr Tube - 0 0 110,670 - - - - - - - - -
138 Nifural Syr Btl - 0 0 55,635 - - - - - - - - -
139 Tarivid TT Btl - 0 0 86,630 - - - - - - - - -
140 Betadine Sol 30 Ml Btl - 0 0 18,060 - - - - - - - - -
141 Betadine OInt 10 Gr Tube - 0 0 15,080 - - - - - - - - -
142 Betadine Oint 5 Gr Tube - 0 0 9,280 - - - - - - - - -
143 Betadine Sol 5 Ml Btl - 0 0 3,040 - - - - - - - - -
144 Bioplacenton Gel Tube - 0 0 15,190 - - - - - - - - -
145 Claneksi Syr Btl - 0 0 53,550 - - - - - - - - -
146 Combantyrin Syr Btl - 0 0 14,330 - - - - - - - - -
147 Depakene Syr Btl - 0 0 176,290 - - - - - - - - -
148 Exforge 5/160 Mg Tab @ 28 Tab - 0 0 17,438 - - - - - - - - -
149 Leukoplast 1621 Rol - 0 0 7,360 - - - - - - - - -
150 Nonflamin Cap @60 Tab - 0 0 4,374 - - - - - - - - -
151 Pronalges Supp @ 10 Box - 0 0 133,880 - - - - - - - - -
152 Spasmomen Tab @30 Tab - 0 0 6,975 - - - - - - - - -
153 Verban Uk. 5 cm Rol - 0 0 565 - - - - - - - - -
154 Verban Uk. 15 cm Rol - 0 0 1,540 - - - - - - - - -
155 COMBANTRIN TAB TAB 0 - 0 0 0 5,910 - - - - - - - - -
156 HERBESSER 200 Caps 0 0 0 - 0 0 0 0 0 381,720 - - - - - - - - -
157 Authocheck Cholesterol st btl 1 0 0 1 1 0 0 1 2 185,630 185,630 - - 185,630 185,630 - - 185,630 371,260
158 Authocheck Gluco DR stri btl 1 0 0 1 1 0 0 1 2 106,880 106,880 - - 106,880 106,880 - - 106,880 213,760
159 Authocheck Uric Acid stri btl 1 0 0 1 1 0 0 1 2 123,750 123,750 - - 123,750 123,750 - - 123,750 247,500
160 Leukopor Besar Pcs - 0 0 20,000 - - - - - - - - -
161 Leukopor Kecil Pcs - 0 0 15,000 - - - - - - - - -
162 Renxamin Btl - 0 0 110,000 - - - - - - - - -
JUMLAH 3,162,627 205,275 149,665 3,517,567 955,889 154,765 242,050 1,352,704 4,870,271
PPN 10% 316,263 20,528 14,967 351,757 95,589 15,477 24,205 135,270 487,027
JUMLAH KESELURUHAN 3,478,889 225,803 164,632 3,869,323 1,051,478 170,242 266,255 1,487,974 5,357,298
No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN

PT. Nusa Lima Medika KLINIK TERANTAM
ALAT KESEHATAN SEMESTER I 2017 PAKET - I
Estimasi Harga
JAN FEB MAR TW-I APR MEI JUN TW-II Satuan Au31 JAN FEB MAR TW-I APR MEI JUN TW-II
TOTAL TOTAL
1 Acyclovir BOX/50 2 2 2 6 2 2 2 6 12 36,110 72,220 72,220 72,220 216,660 72,220 72,220 72,220 216,660 433,320
2 Acyclovir Cr TUBE 5 5 5 15 5 5 5 15 30 3,303 16,515 16,515 16,515 49,545 16,515 16,515 16,515 49,545 99,090
3 Allopurinol 100 BOX/100 2 2 2 6 2 2 2 6 12 13,000 26,000 26,000 26,000 78,000 26,000 26,000 26,000 78,000 156,000
4 Allopurinol 300 BOX/100 2 2 2 6 2 2 2 6 12 25,000 50,000 50,000 50,000 150,000 50,000 50,000 50,000 150,000 300,000
5 Ambroxol BOX/100 2 2 2 6 2 2 2 6 12 19,362 38,724 38,724 38,724 116,172 38,724 38,724 38,724 116,172 232,344
6 Amlodipine 10 BOX/30 5 10 10 25 10 10 10 30 55 46,182 230,910 461,820 461,820 1,154,550 461,820 461,820 461,820 1,385,460 2,540,010
7 Amlodipine 5 BOX/30 5 5 5 15 5 5 5 15 30 26,182 130,910 130,910 130,910 392,730 130,910 130,910 130,910 392,730 785,460
8 Amoxicillin BOX/100 2 2 2 6 2 2 2 6 12 48,342 96,684 96,684 96,684 290,052 96,684 96,684 96,684 290,052 580,104
9 Amoxicillin Syr BTL 20 20 20 60 20 20 20 60 120 4,242 84,840 84,840 84,840 254,520 84,840 84,840 84,840 254,520 509,040
10 Antasida BOX/100 2 2 2 6 2 2 2 6 12 26,400 52,800 52,800 52,800 158,400 52,800 52,800 52,800 158,400 316,800
11 Otsu NS BTL 5 5 5 15 5 5 5 15 30 13,200 66,000 66,000 66,000 198,000 66,000 66,000 66,000 198,000 396,000
12 Otsu RL BTL 5 5 5 15 5 5 5 15 30 13,200 66,000 66,000 66,000 198,000 66,000 66,000 66,000 198,000 396,000
13 Captopril 12,5 BOX/100 2 2 2 6 2 2 2 6 12 8,591 17,182 17,182 17,182 51,546 17,182 17,182 17,182 51,546 103,092
14 Captopril 25 BOX/100 2 2 2 6 2 2 2 6 12 13,149 26,298 26,298 26,298 78,894 26,298 26,298 26,298 78,894 157,788
15 Cefadroxil BOX/100 3 2 2 7 2 2 2 6 13 76,364 229,092 152,728 152,728 534,548 152,728 152,728 152,728 458,184 992,732
16 Cefadroxil Syr BTL 20 20 20 60 20 20 20 60 120 7,455 149,100 149,100 149,100 447,300 149,100 149,100 149,100 447,300 894,600
17 Cefixime 100 mg BOX/50 4 4 4 12 4 4 4 12 24 108,845 435,380 435,380 435,380 1,306,140 435,380 435,380 435,380 1,306,140 2,612,280
18 Cefixime Syr BTL 10 10 10 30 10 10 10 30 60 27,500 275,000 275,000 275,000 825,000 275,000 275,000 275,000 825,000 1,650,000
19 Cefotaxime Inj VIAL 10 18 10 38 10 10 10 30 68 21,021 210,210 378,378 210,210 798,798 210,210 210,210 210,210 630,630 1,429,428
20 Cetirizine 5 strip @ 10 6 6 6 18 6 6 6 18 36 14,250 85,500 85,500 85,500 256,500 85,500 85,500 85,500 256,500 513,000
21 Ciprofloxacin 500 mg BOX/50 2 2 2 6 2 2 2 6 12 26,376 52,752 52,752 52,752 158,256 52,752 52,752 52,752 158,256 316,512
22 Co-Amoxyclav 625 BOX/30 1 1 1 3 1 1 1 3 6 158,404 158,404 158,404 158,404 475,212 158,404 158,404 158,404 475,212 950,424
23 CTM BOX/100 1 - - 1 1 - - 1 2 16,128 16,128 - - 16,128 16,128 - - 16,128 32,256
24 Glibenclamide BOX/100 4 4 4 12 4 4 4 12 24 9,618 38,472 38,472 38,472 115,416 38,472 38,472 38,472 115,416 230,832
25 Glimepiride 1 BOX/50 2 2 2 6 2 2 2 6 12 22,000 44,000 44,000 44,000 132,000 44,000 44,000 44,000 132,000 264,000
26 Glimepiride 2 BOX/50 2 2 2 6 2 2 2 6 12 40,000 80,000 80,000 80,000 240,000 80,000 80,000 80,000 240,000 480,000
27 Glimepiride 3 BOX/50 2 2 2 6 2 2 2 6 12 60,000 120,000 120,000 120,000 360,000 120,000 120,000 120,000 360,000 720,000
28 Glimepiride 4 BOX/50 1 1 1 3 1 1 1 3 6 80,000 80,000 80,000 80,000 240,000 80,000 80,000 80,000 240,000 480,000
29 Ibuprofen 400 BOX/100 1 1 1 3 1 1 1 3 6 19,572 19,572 19,572 19,572 58,716 19,572 19,572 19,572 58,716 117,432
30 Lansoprazole BOX/20 5 5 5 15 5 5 5 15 30 24,570 122,850 122,850 122,850 368,550 122,850 122,850 122,850 368,550 737,100
31 Methylprednisolon 4 mg BOX/100 3 3 3 9 3 3 3 9 18 42,053 126,159 126,159 126,159 378,477 126,159 126,159 126,159 378,477 756,954
32 Omeprazole BOX/30 5 5 5 15 5 5 5 15 30 11,136 55,680 55,680 55,680 167,040 55,680 55,680 55,680 167,040 334,080
33 Ranitidine BOX/100 3 3 3 9 3 3 3 9 18 20,475 61,425 61,425 61,425 184,275 61,425 61,425 61,425 184,275 368,550
34 Ranitidine Inj BOX/25 1 1 1 3 1 1 1 3 6 55,692 55,692 55,692 55,692 167,076 55,692 55,692 55,692 167,076 334,152
35 Simvastatin 10 BOX/30 6 6 6 18 6 6 6 18 36 13,991 83,946 83,946 83,946 251,838 83,946 83,946 83,946 251,838 503,676
36 Simvastatin 20 BOX/30 6 6 6 18 6 6 6 18 36 28,000 168,000 168,000 168,000 504,000 168,000 168,000 168,000 504,000 1,008,000
37 Thiamphenicol BOX/100 1 - - 1 1 - - 1 2 89,510 89,510 - - 89,510 89,510 - - 89,510 179,020
38 Infus Set Macro Pcs 2 2 2 6 2 2 2 6 12 13,400 26,800 26,800 26,800 80,400 26,800 26,800 26,800 80,400 160,800
39 Infus Set Micro Pcs 2 2 2 6 2 2 2 6 12 19,000 38,000 38,000 38,000 114,000 38,000 38,000 38,000 114,000 228,000
40 Iv Cath 18 Pcs 1 1 1 3 1 1 1 3 6 27,000 27,000 27,000 27,000 81,000 27,000 27,000 27,000 81,000 162,000
41 IV Cath 20 Pcs 1 1 1 3 1 1 1 3 6 27,000 27,000 27,000 27,000 81,000 27,000 27,000 27,000 81,000 162,000
42 IV Cath 22 Pcs 1 1 1 3 1 1 1 3 6 27,000 27,000 27,000 27,000 81,000 27,000 27,000 27,000 81,000 162,000
43 IV Cath 24 Pcs 1 1 1 3 1 1 1 3 6 27,000 27,000 27,000 27,000 81,000 27,000 27,000 27,000 81,000 162,000
44 Spuit 1 cc Pcs 10 10 10 30 10 10 11 31 61 6,400 64,000 64,000 64,000 192,000 64,000 64,000 70,400 198,400 390,400
45 Spuit 3 cc Pcs 20 20 20 60 20 20 20 60 120 4,600 92,000 92,000 92,000 276,000 92,000 92,000 92,000 276,000 552,000
46 Spuit 5 cc Pcs 20 20 20 60 20 20 20 60 120 5,600 112,000 112,000 112,000 336,000 112,000 112,000 112,000 336,000 672,000
47 Spuit 10 cc Pcs 10 10 10 30 10 10 10 30 60 7,300 73,000 73,000 73,000 219,000 73,000 73,000 73,000 219,000 438,000
48 Spuit 20 cc Pcs - 0 0 12,700 - - - - - - - - -
49 Benoxuric 100* BOX/100 1 1 1 3 1 1 1 3 6 180,000 180,000 180,000 180,000 540,000 180,000 180,000 180,000 540,000 1,080,000
50 Benoxuric 300* BOX/100 1 1 1 3 1 1 1 3 6 320,000 320,000 320,000 320,000 960,000 320,000 320,000 320,000 960,000 1,920,000
51 Benozym* BOX/100 1 1 1 3 1 1 1 3 6 200,000 200,000 200,000 200,000 600,000 200,000 200,000 200,000 600,000 1,200,000
52 Dextamin* BOX/100 1 1 1 3 1 1 1 3 6 165,000 165,000 165,000 165,000 495,000 165,000 165,000 165,000 495,000 990,000
53 Droxefa* BOX/50 - - - - - - - 0 0 - - - - - - - - - -
54 Inhipraz* BOX/10 5 5 5 15 5 5 5 15 30 120,000 600,000 600,000 600,000 1,800,000 600,000 600,000 600,000 1,800,000 3,600,000
55 Lovask 5* BOX/30 1 1 1 3 1 1 1 3 6 150,000 150,000 150,000 150,000 450,000 150,000 150,000 150,000 450,000 900,000
56 Lovask 10* BOX/30 1 1 1 3 1 1 1 3 6 255,000 255,000 255,000 255,000 765,000 255,000 255,000 255,000 765,000 1,530,000
57 Oralit BOX/100 1 1 1 3 1 1 1 3 6 36,278 36,278 36,278 36,278 108,834 36,278 36,278 36,278 108,834 217,668
58 Merislon 12* BOX/100 1 1 1 3 1 1 1 3 6 637,356 637,356 637,356 637,356 1,912,068 637,356 637,356 637,356 1,912,068 3,824,136
59 Clopidogrel* BOX/30 2 2 2 6 2 2 2 6 12 283,500 567,000 567,000 567,000 1,701,000 567,000 567,000 567,000 1,701,000 3,402,000
60 Alkohol 96% LTR 2 2 2 6 2 2 2 6 12 30,600 61,200 61,200 61,200 183,600 61,200 61,200 61,200 183,600 367,200
61 ATS Inj 1500 iu Amp 1 - - 1 1 - - 1 2 115,000 115,000 - - 115,000 115,000 - - 115,000 230,000
62 Myonal Box/100 1 1 1 3 1 1 1 3 6 683,964 683,964 683,964 683,964 2,051,892 683,964 683,964 683,964 2,051,892 4,103,784
63 Atorvastatin 20 mg Box/30 5 5 5 15 5 5 5 15 30 120,000 600,000 600,000 600,000 1,800,000 600,000 600,000 600,000 1,800,000 3,600,000
64 Betahistin Mesylat Box/100 1 1 1 3 1 1 1 3 6 25,200 25,200 25,200 25,200 75,600 25,200 25,200 25,200 75,600 151,200
65 Cairan D5 Btl 2 2 2 6 2 2 2 6 12 13,200 26,400 26,400 26,400 79,200 26,400 26,400 26,400 79,200 158,400
66 Cairan D5+1/2NS Btl 2 2 2 6 2 2 2 6 12 14,000 28,000 28,000 28,000 84,000 28,000 28,000 28,000 84,000 168,000
67 Spirolacton 25 Box/100 - 0 0 120,238 - - - - - - - - -
68 Povidone Iodine Btl/1000 2 2 2 6 2 2 2 6 12 75,000 150,000 150,000 150,000 450,000 150,000 150,000 150,000 450,000 900,000
69 Natrium Diklofenac 25 5 str x 10's 2 2 2 6 2 2 2 6 12 8,892 17,784 17,784 17,784 53,352 17,784 17,784 17,784 53,352 106,704
70 Natrium Diklofenac 50 5 str x 10's 2 2 2 6 2 2 2 6 12 12,369 24,738 24,738 24,738 74,214 24,738 24,738 24,738 74,214 148,428
71 Pariet 10 Box/14 0 - 0 - 0 0 0 0 0 236,997 - - - - - - - - -
72 Pariet 20 Box/14 0 - 0 - 0 0 0 0 0 267,311 - - - - - - - - -
73 VERTIZINE tablet Box 100 Tab. 1 1 1 3 1 1 1 3 6 220,000 220,000 220,000 220,000 660,000 220,000 220,000 220,000 660,000 1,320,000
74 Piracetam 400 mg / 50 tab 5 strip @ 10 2 2 1 5 1 1 1 3 8 20,500 41,000 41,000 20,500 102,500 20,500 20,500 20,500 61,500 164,000
75 Piracetam 800 mg / 50 kap 5 strip @ 10 2 2 1 5 1 1 1 3 8 36,500 73,000 73,000 36,500 182,500 36,500 36,500 36,500 109,500 292,000
76 Aesculab/pisau bisturi pcs 5 5 6 16 6 6 6 18 34 3,300 16,500 16,500 19,800 52,800 19,800 19,800 19,800 59,400 112,200
77 Antalgin 500 mg Box 100 Tab. 3 3 3 9 3 3 3 9 18 21,190 63,570 63,570 63,570 190,710 63,570 63,570 63,570 190,710 381,420
78 Dios Tss/3 x 10's Box/30 1 1 1 3 1 1 1 3 6 115,000 115,000 115,000 115,000 345,000 115,000 115,000 115,000 345,000 690,000
79 Cotrimoxazol 480 mg 10 str x 10s 1 1 1 3 1 1 1 3 6 18,000 18,000 18,000 18,000 54,000 18,000 18,000 18,000 54,000 108,000
80 Cotrimoxazole Susp/60 ml Btl 60 ml 5 5 5 15 5 5 5 15 30 4,945 24,725 24,725 24,725 74,175 24,725 24,725 24,725 74,175 148,350
81 Daryant-tulle 10x10 Box/10 1 1 1 3 1 1 1 3 6 165,000 165,000 165,000 165,000 495,000 165,000 165,000 165,000 495,000 990,000
Digoxin 0,25 mg Tab

82 Kotak 100 ( 10 Strip @ 10 Kotak 100 0 - 0 0 0 0 12,987
Tablet ) - 0 0 - - - - - - - - -
83 FARBIVENT Box/10 Amp 0 - 0 - 0 0 0 0 0 - - - - - - - - - -
84 Farsix Box/100 0 - 0 - 0 0 0 0 0 108,900 - - - - - - - - -
85 Fask Mask Lbr 100 100 100 300 100 100 100 300 600 860 86,000 86,000 86,000 258,000 86,000 86,000 86,000 258,000 516,000
86 Gammex 7 (Sarung Tangan Box/pairs 5 5 5 15 5 5 5 15 30 16,000 80,000 80,000 80,000 240,000 80,000 80,000 80,000 240,000 480,000
87 Gammex 7,5 (Sarung Tanga Box/ pairs 5 5 5 15 5 5 5 15 30 16,000 80,000 80,000 80,000 240,000 80,000 80,000 80,000 240,000 480,000
88 Gammex 8 (Sarung Tangan Box/ pairs 5 5 5 15 5 5 5 15 30 16,000 80,000 80,000 80,000 240,000 80,000 80,000 80,000 240,000 480,000
89 Kapas 1 kg roll 0 - 0 - 0 0 0 0 0 49,500 - - - - - - - - -
90 Kapsul No. 0 Sak 0 - 0 - 0 0 0 0 0 45,000 - - - - - - - - -
91 Kapsul No. 00 Sak 0 - 0 - 0 0 0 0 0 75,000 - - - - - - - - -
92 Kapsul No. 1 Sak 0 - 0 - 0 0 0 0 0 42,000 - - - - - - - - -
93 Kapsul No. 2 Sak 0 - 0 - 0 0 0 0 0 40,000 - - - - - - - - -
94 Lidocain 2% Inj/100 100 amp x 2 ml 1 - 0 1 1 0 0 1 2 104,580 104,580 - - 104,580 104,580 - - 104,580 209,160
95 Lyncomycin 500 mg/5x10 5 x 10 1 1 1 3 1 1 1 3 6 77,318 77,318 77,318 77,318 231,954 77,318 77,318 77,318 231,954 463,908
96 Mucosta Tablet Box/100 - 0 0 417,900 - - - - - - - - -
97 Needle 23 box/100 1 - 0 1 1 0 0 1 2 170,000 170,000 - - 170,000 170,000 - - 170,000 340,000
98 Ondansetron 8 mg tab - Kt Kotak 12 - 0 0 27,600 - - - - - - - - -
99 Pehacain Inj/20 Dos. 20 amp 1 1 1 3 1 1 1 3 6 56,601 56,601 56,601 56,601 169,803 56,601 56,601 56,601 169,803 339,606
100 Pletaal 50 mg Box 100 Tab. 0 0 0 - 0 0 0 0 0 733,100 - - - - - - - - -
101 Ristonate Box/4 0 0 0 - 0 0 0 0 0 290,000 - - - - - - - - -
102 Salofalk 500 mg Box / 100 0 0 0 - 0 0 0 0 0 1,128,000 - - - - - - - - -
103 Simarc Box/100 1 0 0 1 1 0 0 1 2 136,500 136,500 - - 136,500 136,500 - - 136,500 273,000
104 Tramadol 50 mg 5 strip @ 10 0 - 0 - 0 0 0 0 0 15,368 - - - - - - - - -
105 Dexamethazon 0.5 mg Inj/ Box 1 1 1 3 1 1 1 3 6 191,100 191,100 191,100 191,100 573,300 191,100 191,100 191,100 573,300 1,146,600
106 Salbutamol 2mg Box 4 4 4 12 4 4 4 12 24 8,453 33,812 33,812 33,812 101,436 33,812 33,812 33,812 101,436 202,872
107 Salbutamol 4mg Box 4 4 4 12 4 4 4 12 24 10,605 42,420 42,420 42,420 127,260 42,420 42,420 42,420 127,260 254,520
108 Asam Mefenamat 500 mg Box/100 2 2 2 6 2 2 2 6 12 20,160 40,320 40,320 40,320 120,960 40,320 40,320 40,320 120,960 241,920
109 Meloxicam 7,5 mg Box/50 2 2 2 6 2 2 2 6 12 33,023 66,046 66,046 66,046 198,138 66,046 66,046 66,046 198,138 396,276
110 Meloxicam 15 mg Box/50 2 2 2 6 2 2 2 6 12 57,225 114,450 114,450 114,450 343,350 114,450 114,450 114,450 343,350 686,700
111 Dexamethazon 0.5 mg Box/100 - - - - - - - 0 0 - - - - - - - - - -
112 Furosemide 40 mg Box/100 2 2 2 6 2 2 2 6 12 16,521 33,042 33,042 33,042 99,126 33,042 33,042 33,042 99,126 198,252
113 Metformin 500 mg Box/100 6 6 6 18 6 6 6 18 36 31,450 188,700 188,700 188,700 566,100 188,700 188,700 188,700 566,100 1,132,200
114 Metronidazole 500 mg Box/100 2 2 2 6 2 2 2 6 12 28,275 56,550 56,550 56,550 169,650 56,550 56,550 56,550 169,650 339,300
115 Cotrimoxazole Box/100 - - - - - - - 0 0 - - - - - - - - - -
116 Cotrimoxazole Susp/60 ml Btl - - - - - - - 0 0 - - - - - - - - - -
117 Burnazin Cr 35 g Tube 2 2 2 6 2 2 2 6 12 48,950 97,900 97,900 97,900 293,700 97,900 97,900 97,900 293,700 587,400
118 Trihexypenidil 2 mg Box/100 - - - - - - - 0 0 10,500 - - - - - - - - -
119 Amitriphilin 25 Box/100 - - - - - - - 0 0 15,585 - - - - - - - - -
120 Urdafalk Box/30 - - - - - - - 0 0 312,785 - - - - - - - - -
121 ISDN 5 mg Box/100 4 3 3 10 4 4 4 12 22 11,184 44,736 33,552 33,552 111,840 44,736 44,736 44,736 134,208 246,048
122 Asam Tranexamat inj Box/10 - - - - - - - 0 0 100,000 - - - - - - - - -
123 Kasa Steril Ktk 4 4 3 11 4 4 4 12 23 5,500 22,000 22,000 16,500 60,500 22,000 22,000 22,000 66,000 126,500
124 Face mask Bok/50 - - - - - - - 0 0 28,650 - - - - - - - - -
125 Silk Braided 2/0 DS 24 Pcs 2 2 2 6 2 2 2 6 12 50,000 100,000 100,000 100,000 300,000 100,000 100,000 100,000 300,000 600,000
126 Silk 0 DS 24 @ 12 Pcs 2 2 2 6 2 2 2 6 12 50,000 100,000 100,000 100,000 300,000 100,000 100,000 100,000 300,000 600,000
127 Irbesartan 300 Box/50 - - - - - - - 0 0 140,000 - - - - - - - - -
128 Irbesartan 150 Box/50 - - - - - - - 0 0 90,000 - - - - - - - - -
129 Piroxicam 20 mg Box/120 3 3 3 9 3 3 3 9 18 23,340 70,020 70,020 70,020 210,060 70,020 70,020 70,020 210,060 420,120
130 Gentamycin salep kulit Tube 10 10 10 30 10 10 10 30 60 1,668 16,683 16,683 16,683 50,050 16,683 16,683 16,683 50,050 100,099
131 Levofloxacim 500 mg Box/50 2 2 2 6 2 2 2 6 12 52,440 104,880 104,880 104,880 314,640 104,880 104,880 104,880 314,640 629,280
132 Fenofibrate 100 mg Box/30 - - - - - - - 0 0 60,000 - - - - - - - - -
133 Fenofibrate 300 mg Box/30 - - - - - - - 0 0 120,000 - - - - - - - - -
134 Domperidon Syr Btl 5 5 5 15 5 5 5 15 30 11,500 57,500 57,500 57,500 172,500 57,500 57,500 57,500 172,500 345,000
135 Bisoprolol 5 mg Box/100 5 5 5 15 5 5 5 15 30 60,500 302,500 302,500 302,500 907,500 302,500 302,500 302,500 907,500 1,815,000
136 Salbutamol 2 mg Syr Btl - - - - - - - 0 0 - - - - - - - - - -
137 Keterolac Inj 1% Box/12 1 - - 1 1 1 1 3 4 26,775 26,775 - - 26,775 26,775 26,775 26,775 80,325 107,100
138 Keterolac Inj 3% Box/12 1 - - 1 1 1 1 3 4 28,980 28,980 - - 28,980 28,980 28,980 28,980 86,940 115,920
139 Ibuprofen 200 @100 Btl 2 2 2 6 2 2 2 6 12 18,900 37,800 37,800 37,800 113,400 37,800 37,800 37,800 113,400 226,800
140 EPREX 4000 Inj Amp - - - - - - - 0 0 530,250 - - - - - - - - -
141 AvF 16 Gx25 mm Set - - - - - - - 0 0 18,300 - - - - - - - - -
142 Bi bag,GB/D/F/NL 650 G Set - - - - - - - 0 0 138,800 - - - - - - - - -
143 Blood Line A/V Set 22 m Set - - - - - - - 0 0 164,400 - - - - - - - - -
144 F-Hemosol Patr A Set - - - - - - - 0 0 150,000 - - - - - - - - -
145 Fistula needle 16G Ven F Set - - - - - - - 0 0 18,300 - - - - - - - - -
146 Hemoflow fresenius F7 Hp Set - - - - - - - 0 0 332,200 - - - - - - - - -
147 Aricept Evess 10 mg Box/28 - - - - - - - 0 0 738,970 - - - - - - - - -
148 Abu/Biosave Box/Vial 1 - - 1 1 - - 1 2 430,000 430,000 - - 430,000 430,000 - - 430,000 860,000
149 Acetosal 100 mg Box/100 - 0 0 18,552 - - - - - - - - -
150 Alkohol 70% btl 1 1 1 3 0 3 27,000 27,000 27,000 27,000 81,000 - - - - 81,000
151 Betametason Cr 0,1 % Tube/5 gr 10 10 10 30 10 11 13 34 64 2,520 25,200 25,200 25,200 75,600 25,200 27,720 32,760 85,680 161,280
152 Citicolin 500 mg Box/30 - 0 0 180,000 - - - - - - - - -
153 Clindamicin 150 mg Box/50 - 0 0 36,200 - - - - - - - - -
154 Clindamicin 300 mg Box/50 - 0 0 62,520 - - - - - - - - -
155 Eperisone HCl 50 mg Box/100 - 0 0 140,000 - - - - - - - - -
156 Hydrocortisone Cr 2,5% Tube/5 gr 10 10 10 30 10 10 10 30 60 4,967 49,670 49,670 49,670 149,010 49,670 49,670 49,670 149,010 298,020
157 Kasa Steril Kamsa Ktk - 0 0 5,500 - - - - - - - - -
158 Losartan 10 mg Box/50 - 0 0 90,909 - - - - - - - - -
159 Losartan 50 mg Box/30 - 0 0 126,000 - - - - - - - - -
160 Mecobalamin 500 mg Box/100 - 0 0 70,000 - - - - - - - - -
161 Otsu D5 Btl - 0 0 13,200 - - - - - - - - -
162 Paracetamol Syrup Btl/60 ml 30 30 30 90 30 30 30 90 180 4,441 133,230 133,230 133,230 399,690 133,230 133,230 133,230 399,690 799,380
163 Ramipril 10 Mg Box/30 - 0 0 30,510 - - - - - - - - -
164 Ramipril 5 zmg Box/100 - 0 0 57,727 - - - - - - - - -
165 Sucralfate Syr 500 mg Btl/200 ml - 0 0 66,000 - - - - - - - - -
166 Triamsinolone 4 mg Box/100 - 0 0 72,450 - - - - - - - - -
167 Ursodeoxycholic 250 MG Box/30 - 0 0 126,000 - - - - - - - - -
168 Nifural syr Btl 5 5 5 15 5 5 5 15 30 51,923 259,615 259,615 259,615 778,845 259,615 259,615 259,615 778,845 1,557,690
169 Kasa Hidrofil DRC roll 1 1 1 3 1 1 1 3 6 210,210 210,210 210,210 210,210 630,630 210,210 210,210 210,210 630,630 1,261,260
170 Enzyplex Tab 200 200 200 600 400 200 200 800 1400 821 164,200 164,200 164,200 492,600 328,400 164,200 164,200 656,800 1,149,400
171 Candesartan 8mg Tab - - - - - - - 0 0 4,500 - - - - - - - - -
172 Candesartan 16mg Tab - - - - - - - 0 0 6,500 - - - - - - - - -
173 Surgicryl 2/0 HR 26 Pcs 1 1 1 3 1 1 1 3 6 87,000 87,000 87,000 87,000 261,000 87,000 87,000 87,000 261,000 522,000
174 Catgut Chromic 3/0 DS 24 Pcs 1 1 1 3 1 1 1 3 6 62,500 62,500 62,500 62,500 187,500 62,500 62,500 62,500 187,500 375,000
175 Catgut Chromic 2-0 100 M Roll 1 1 1 1 2 2,427,000 2,427,000 - - 2,427,000 2,427,000 - - 2,427,000 4,854,000
176 Silk Black 1 DS 24 Pcs - - - - - - - 0 0 50,000 - - - - - - - - -
177 Valsartan 160 mg Tab - - - - - - - 0 0 7,150 - - - - - - - - -
178 Valsartan 80 mg Tab - - - - - - - 0 0 4,400 - - - - - - - - -
179 Tranfusi Set Pcs - 0 0 25,500 - - - - - - - - -
180 Nacl 1000ml Btl 0 0 0 - 0 0 0 0 0 16,000 - - - - - - - - -
181 Ambroxol Syr Btl - 0 0 3,297 - - - - - - - - -
JUMLAH 16,348,308 13,115,365 12,887,997 42,351,671 16,586,354 12,935,956 12,947,396 42,469,707 84,821,377
PPN 10% 1,634,831 1,311,537 1,288,800 4,235,167 1,658,635 1,293,596 1,294,740 4,246,971 8,482,138
No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN KLINIK LUBUK DALAM

VI

Estimasi Harga
1 Bedak Salicyl 2% Pot - 0 - - - - - - 0 5,625 - - - - - - - - -

2 Bekarbon Tab - 0 - - - - - - 0 - - - - - - - - -
3 Gentian Violet 1% Btl 3 3 3 9 3 3 4 10 19 2,995 8,985 8,985 8,985 26,955 8,985 8,985 11,980 29,950 56,905
5 Norit Tab 40 40 40 120 40 40 39 119 239 277 11,065 11,065 11,065 33,195 11,065 11,065 10,788 32,918 66,113
6 Salep 2-4 Pot 3 3 3 9 3 3 3 9 18 3,685 11,055 11,055 11,055 33,165 11,055 11,055 11,055 33,165 66,330
7 Aprovel 150* Tab - - 0 355,830 - - - - - - - - -
8 Aprovel 300* Tab - - 0 480,250 - - - - - - - - -
9 Ascardia* Tab - - 0 956 - - - - - - - - -
10 Biodiar* Tab - 0 - - - - - - 0 - - - - - - - - - -
11 Cendo Mycetin TM* Btl - 0 - - - - - - 0 - - - - - - - - -
13 Cortidex* Tab - 0 - - - - - - 0 281 - - - - - - - - -
14 Dermovel Cr* Tube 3 3 3 9 3 3 3 9 18 67,500 202,500 202,500 202,500 607,500 202,500 202,500 202,500 607,500 1,215,000
15 Dumin Rectal 125 * Tube 1 0 - 1 1 - - 1 2 13,118 13,118 - - 13,118 13,118 - - 13,118 26,236
16 Dumin Rectal 250 * Tube 1 0 - 1 1 - - 1 2 18,316 18,316 - - 18,316 18,316 - - 18,316 36,632
17 Erlamycetin Plus TM* Btl - 0 5 5 - - - - 5 13,030 - - 65,150 65,150 - - - - 65,150
19 Glucobay 50* Tab - - 0 2,009 - - - - - - - - -
20 Glucobay 100* Tab - - 0 3365 - - - - - - - - -
21 Glucovance 2,5/500* Tab - - 0 3,795 - - - - - - - - -
22 Glucovance 5/500* Tab - - 0 4,608 - - - - - - - - -
23 Gluvas 2* Tab - - 0 - - - - - - - - - -
24 Gluvas 3* Tab - - 0 - - - - - - - - - -
25 Ketricin Cr* Tube 1 1 1 3 1 1 1 3 6 45,000 45,000 45,000 45,000 135,000 45,000 45,000 45,000 135,000 270,000
26 Lantus Inj* Amp - - 0 193,384 - - - - - - - - -
27 Lipitor 10* Tab - - 0 18,641 - - - - - - - - -
28 Lipitor 20* Tab - - 0 19,007 - - - - - - - - -
29 Norvask 5* Tab - - 0 7,826 - - - - - - - - -
30 Norvask 10* tab - - 0 14,026 - - - - - - - - -
31 Novomix Inj* Amp - - 0 171,908 - - - - - - - - -
32 Novorafid Inj* Amp - - 0 171,908 - - - - - - - - -
33 Pibaksin Oint* Tube - 0 - - - - - - 0 41,690 - - - - - - - - -
34 Pronalges* tab - - 0 2812.6 - - - - - - - - -
35 Pulmicort Nebul* Fls 5 5 5 15 5 5 5 15 30 17,384 86,918 86,918 86,918 260,753 86,918 86,918 86,918 260,753 521,505
36 Retaphyl SR* Tab - - 0 2,191 - - - - - - - - -
37 Rhinofed* Tab 0 0 0 - 0 0 0 - 0 - - - - - - - - -
38 Rhinofed Syr* Btl 0 0 0 - 0 0 0 - 0 - - - - - - - - -
39 Rhinos SR* Tab 0 0 0 - 0 0 0 - 0 - - - - - - - - -
40 sanprima*Forte Tab - 0 - - - - - - 0 2,025 - - - - - - - - -
42 Siclidon 100* Caps - - 0 5,192 - - - - - - - - -
43 Starcef 200* Caps - - 0 30,938 - - - - - - - - -
44 Termisil Cr* Tube - - 0 54,340 - - - - - - - - -
45 Tetagam PP* Amp 1 0 - 1 - - - - 1 211,500 211,500 - - 211,500 - - - - 211,500
46 Theragran M* Tab - - 0 4,241 - - - - - - - - -
47 Thrombo Aspilet* Tab - - 0 759 - - - - - - - - -
48 Trichodazole* Tab - - 0 1,687 - - - - - - - - -
49 Tripanzym* Tab - 0 - - - 0 - - 0 - - - - - - - - -
50 Tuzalos* Tab - 0 - - - - - - 0 - - - - - - - - -
51 Ventolin Syr* Btl 2 2 2 6 2 2 3 7 13 50,680 101,360 101,360 101,360 304,080 101,360 101,360 152,040 354,760 658,840
52 Ventolin Exp Syr* Btl 2 2 2 6 2 2 2 6 12 53,280 106,560 106,560 106,560 319,680 106,560 106,560 106,560 319,680 639,360
53 Verorab Inj* Amp 1 0 - 1 1 - - 1 2 178,470 178,470 - - 178,470 178,470 - - 178,470 356,940
54 Plavix 75* Tab - - 0 26,494 - - - - - - - - -
55 Crestor 10* Tab - - 0 17,779 - - - - - - - - -
56 Crestor 20* Tab - - 0 20,844 - - - - - - - - -
57 Januvia 100* Tab - - 0 15,803 - - - - - - - - -
58 Janumet* Tab - - 0 8,485 - - - - - - - - -
59 Truvaz 10* Tab - - 0 14,438 - - - - - - - - -
60 Truvaz 20* Tab - - 0 14,438 - - - - - - - - -
61 Trajenta* Tab - - 0 14,875 - - - - - - - - -
62 Nexium 20* Tab - - 0 16,089 - - - - - - - - -
63 Nexium 40* Tab - - 0 19,642 - - - - - - - - -
64 Pantozol 20* Tab - - 0 16,714 - - - - - - - - -
65 Pantozol 40* Tab - - 0 21,214 - - - - - - - - -
67 MAGALAT SUSP 100ML ( btl 0 0 0 - 0 0 0 - 0 28,130 - - - - - - - - -
68 MAGALAT TAB @60 (FPP BOX60 0 0 0 - 0 0 0 - 0 50,630 - - - - - - - - -
69 Blopress 8 tab - - 0 12,807 - - - - - - - - -
70 Blopress 16 tab - - 0 16,052 - - - - - - - - -
71 Blopress Plus tab - - 0 16,052 - - - - - - - - -
72 KASA BIRU 42 Y rol 1 0 0 1 0 0 0 - 1 732,040 732,040 - - 732,040 - - - - 732,040
73 HYPAFIX 10 CM X 5 M ( ktk 0 0 0 - 0 0 0 - 0 59,910 - - - - - - - - -
74 HYPAFIX 5 CM X 5 M (N ktk 0 0 0 - 0 0 0 - 0 59,910 - - - - - - - - -
75 LEUKOPLAST 1562 (1x1) rol 0 0 0 - 0 0 0 - 0 5,100 - - - - - - - - -
76 OPTIMAX (Box/30) box 0 0 0 - 0 0 0 - 0 198,000 - - - - - - - - -
77 Amaryl M2 Box/30 - - 0 163,940 - - - - - - - - -
78 Batugin Exlixir 120 ml Btl - - 0 20,820 - - - - - - - - -
79 Co Diovan 80 mg @28 Tab - - 0 13,350 - - - - - - - - -
80 Co Diovan 160 mg @28 Tab - - 0 16,737 - - - - - - - - -
81 Canderin 16 mg @30 Tab - - 0 9,563 - - - - - - - - -
82 Canderin 8 mg @30 Tab - - 0 6,750 - - - - - - - - -
83 Celebrex 100 mg@30 Tab - - 0 9,457 - - - - - - - - -
84 Celebrex 200 mg@30 Tab - - 0 14,203 - - - - - - - - -
85 Concor 5 mg @100 Tab - - 0 8,799 - - - - - - - - -
86 Concor 2,5 mg @100 Tab - - 0 6,076 - - - - - - - - -
87 Diovan 160 mg @28 Tab - - 0 15,940 - - - - - - - - -
88 Diovan 80 mg @28 Box - - 0 12,715 - - - - - - - - -
89 Digenta Cr Tube 0 0 0 - 0 0 0 - 0 - - - - - - - - -
90 Exforge 5/80 mg @28 tab - - 0 14,963 - - - - - - - - -
91 Exforge 10/160 mg @28 Box - - 0 18,731 - - - - - - - - -
93 Galvusmet 5/500 @30 tab - - 0 7,031 - - - - - - - - -
94 Hyperil 5 mg @60 Box - - 0 8,438 - - - - - - - - -
95 Hyperil 2,5 mg @ 60 Box - - 0 5,344 - - - - - - - - -
96 Hysterin Syr Btl - - 0 48,380 - - - - - - - - -
97 Herbesser 100 mg tab/30 - - 0 8,370 - - - - - - - - -
98 HP Pro @120 tab - - 0 4,736 - - - - - - - - -
99 Harnal 0,2 @28 tab - - 0 14,392 - - - - - - - - -
100 Harnal Ocas @28 tab/28 - - 0 14,891 - - - - - - - - -
101 Lyrica 50 @14 tab - - 0 8,903 - - - - - - - - -
102 Lyrica 75 @14 tab - - 0 12,856 - - - - - - - - -
103 Lyrica 150 @14 tab - - 0 21,212 - - - - - - - - -
104 Neuralgin@100 tab 0 0 0 - 0 0 0 - 0 - - - - - - - - -
105 Symbicort Inhaler Btl 0 0 0 - 0 0 0 - 0 297,820 - - - - - - - - -
106 Trileptal 300 @50 Box - - 0 9,184 - - - - - - - - -
107 Tegretol 200 @50 Box - - 0 4,240 - - - - - - - - -
109 Trizedon MR @60 tab - - 0 3,675 - - - - - - - - -
110 Twynsta 5/40 @28 tab - - 0 15,688 - - - - - - - - -
111 Twynsta 5/80 @28 tab - - 0 20,381 - - - - - - - - -
112 Twynsta 10/80 @28 tab - - 0 20,381 - - - - - - - - -
115 Ventolin Inhaler Btl 1 1 1 3 1 1 1 3 6 101,120 101,120 101,120 101,120 303,360 101,120 101,120 101,120 303,360 606,720
116 Ventolin Nebul @ 20 box 1 0 0 1 1 0 0 1 2 202,230 202,230 - - 202,230 202,230 - - 202,230 404,460
117 Cholespar 20 mg @30 tab - - 0 18,750 - - - - - - - - -
118 Cholespar 10 mg @30 tab - - 0 14,063 - - - - - - - - -
119 Voltaren Gel 20g Tube - - 0 64,020 - - - - - - - - -
120 Glurenorm @ 100 Tab - - 0 3,658 - - - - - - - - -
121 Dulcolax Tab - - 0 1,265 - - - - - - - - -
122 Dulcolax Supp @6 Supp - - 0 16,400 - - - - - - - - -
123 Diamicron MR tab - - 0 6,379 - - - - - - - - -
124 Clanexi F Syr Btl - - 0 - - - - - - - - -
126 Rivanol 100 ml Btl 4 4 4 12 3 3 3 9 21 2,770 11,080 11,080 11,080 33,240 8,310 8,310 8,310 24,930 58,170
127 Cataflam D @50 tab 1 0 0 1 0 0 0 - 1 5,966 5,966 - - 5,966 - - - - 5,966
128 Micardis 40 mg @20 tab - - 0 14,915 - - - - - - - - -
129 Micardis 80 mg @ 20 tab - - 0 19,337 - - - - - - - - -
130 Leukocrep "6" Roll - - 0 97,710 - - - - - - - - -
131 Leukocrep "4 " Roll 1 0 0 1 1 0 0 1 2 76,000 76,000 - - 76,000 76,000 - - 76,000 152,000
132 Inviclot Inj Amp - - 0 67,500 - - - - - - - - -
133 Madecasol Oint Tube - - 0 135,850 - - - - - - - - -
134 Apolar Cr Tube - - 0 35,440 - - - - - - - - -
135 Apolar N Cr Tube - - 0 40,170 - - - - - - - - -
136 Aspar K Tab - - 0 2,299 - - - - - - - - -
137 Ultrapoct N Cr Tube - - 0 110,670 - - - - - - - - -
138 Nifural Syr Btl - - 0 55,635 - - - - - - - - -
139 Tarivid TT Btl - - 0 86,630 - - - - - - - - -
140 Betadine Sol 30 Ml Btl - - 0 18,060 - - - - - - - - -
141 Betadine OInt 10 Gr Tube - - 0 15,080 - - - - - - - - -
142 Betadine Oint 5 Gr Tube - - 0 9,280 - - - - - - - - -
143 Betadine Sol 5 Ml Btl - - 0 3,040 - - - - - - - - -
144 Bioplacenton Gel Tube - - 0 15,190 - - - - - - - - -
145 Claneksi Syr Btl - - 0 53,550 - - - - - - - - -
146 Combantyrin Syr Btl - - 0 14,330 - - - - - - - - -
147 Depakene Syr Btl - - 0 176,290 - - - - - - - - -
148 Exforge 5/160 Mg Tab @ 28 Tab - - 0 17,438 - - - - - - - - -
149 Leukoplast 1621 Rol - - 0 7,360 - - - - - - - - -
150 Nonflamin Cap @60 Tab - - 0 4,374 - - - - - - - - -
151 Pronalges Supp @ 10 Box - - 0 133,880 - - - - - - - - -
152 Spasmomen Tab @30 Tab - - 0 6,975 - - - - - - - - -
153 Verban Uk. 5 cm Rol - - 0 565 - - - - - - - - -
154 Verban Uk. 15 cm Rol - - 0 1,540 - - - - - - - - -
155 COMBANTRIN TAB TAB 0 0 0 - 0 0 0 - 0 5,910 - - - - - - - - -
156 HERBESSER 200 Caps 0 0 0 - 0 0 0 - 0 381,720 - - - - - - - - -
157 Authocheck Cholesterol st btl 1 1 1 3 1 1 1 3 6 185,630 185,630 185,630 185,630 556,890 185,630 185,630 185,630 556,890 1,113,780
158 Authocheck Gluco DR stri btl 1 1 1 3 1 1 1 3 6 106,880 106,880 106,880 106,880 320,640 106,880 106,880 106,880 320,640 641,280
159 Authocheck Uric Acid stri btl 1 1 1 3 1 1 1 3 6 123,750 123,750 123,750 123,750 371,250 123,750 123,750 123,750 371,250 742,500
160 Leukopor Besar Pcs - - 0 20,000 - - - - - - - - -
161 Leukopor Kecil Pcs - - 0 15,000 - - - - - - - - -
162 Renxamin Btl - - 0 110,000 - - - - - - - - -
JUMLAH 3,366,603 1,867,133 1,979,763 7,213,498 2,467,487 1,911,843 1,965,241 6,344,570 13,558,067
PPN 10% 336,660 186,713 197,976 721,350 246,749 191,184 196,524 634,457 1,355,807

No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN KLINIK SEI ROKAN

VI

Estimasi Harga
2 Bekarbon Tab - 0 - - - - - - - - - - - - - - - -
5 Norit Tab 40 40 40 120 40 40 40 120 240 277 11,065 11,065 11,065 33,195 11,065 11,065 11,065 33,195 66,390
6 Salep 2-4 Pot 3 3 3 9 3 3 3 9 18 3,685 11,055 11,055 11,055 33,165 11,055 11,055 11,055 33,165 66,330
7 Aprovel 150* Tab - - - 355,830 - - - - - - - - -
8 Aprovel 300* Tab - - - 480,250 - - - - - - - - -
9 Ascardia* Tab - - - 956 - - - - - - - - -
10 Biodiar* Tab - 0 - - - - - - - - - - - - - - - - -
11 Cendo Mycetin TM* Btl - 0 - - - - - - - - - - - - - - - -
13 Cortidex* Tab - 0 - - - - - - - 281 - - - - - - - - -
14 Dermovel Cr* Tube 5 5 5 15 5 5 5 15 30 67,500 337,500 337,500 337,500 1,012,500 337,500 337,500 337,500 1,012,500 2,025,000
19 Glucobay 50* Tab - - - 2,009 - - - - - - - - -
20 Glucobay 100* Tab - - - 3365 - - - - - - - - -
21 Glucovance 2,5/500* Tab - - - 3,795 - - - - - - - - -
22 Glucovance 5/500* Tab - - - 4,608 - - - - - - - - -
23 Gluvas 2* Tab - - - - - - - - - - - - -
24 Gluvas 3* Tab - - - - - - - - - - - - -
25 Ketricin Cr* Tube 3 3 3 9 3 3 3 9 18 45,000 135,000 135,000 135,000 405,000 135,000 135,000 135,000 405,000 810,000
26 Lantus Inj* Amp - - - 193,384 - - - - - - - - -
27 Lipitor 10* Tab - - - 18,641 - - - - - - - - -
28 Lipitor 20* Tab - - - 19,007 - - - - - - - - -
29 Norvask 5* Tab - - - 7,826 - - - - - - - - -
30 Norvask 10* tab - - - 14,026 - - - - - - - - -
31 Novomix Inj* Amp - - - 171,908 - - - - - - - - -
32 Novorafid Inj* Amp - - - 171,908 - - - - - - - - -
33 Pibaksin Oint* Tube 2 0 - 2 - - - - 2 41,690 83,380 - - 83,380 - - - - 83,380
34 Pronalges* tab - - - 2812.6 - - - - - - - - -
35 Pulmicort Nebul* Fls 5 5 5 15 5 5 5 15 30 17,384 86,918 86,918 86,918 260,753 86,918 86,918 86,918 260,753 521,505
36 Retaphyl SR* Tab - - - 2,191 - - - - - - - - -
37 Rhinofed* Tab 0 0 0 - 0 0 0 - - - - - - - - - - -
38 Rhinofed Syr* Btl 0 0 0 - 0 0 0 - - - - - - - - - - -
39 Rhinos SR* Tab 0 0 0 - 0 0 0 - - - - - - - - - - -
40 sanprima*Forte Tab - 0 - - - - - - - 2,025 - - - - - - - - -
42 Siclidon 100* Caps - - - 5,192 - - - - - - - - -
43 Starcef 200* Caps - - - 30,938 - - - - - - - - -
44 Termisil Cr* Tube - - - 54,340 - - - - - - - - -
45 Tetagam PP* Amp 1 0 - 1 1 - - 1 2 211,500 211,500 - - 211,500 211,500 - - 211,500 423,000
46 Theragran M* Tab - - - 4,241 - - - - - - - - -
47 Thrombo Aspilet* Tab - - - 759 - - - - - - - - -
48 Trichodazole* Tab - - - 1,687 - - - - - - - - -
49 Tripanzym* Tab - 0 - - - 0 - - - - - - - - - - - -
50 Tuzalos* Tab - 0 - - - - - - - - - - - - - - - -
51 Ventolin Syr* Tab 5 5 5 15 5 5 5 15 30 50,680 253,400 253,400 253,400 760,200 253,400 253,400 253,400 760,200 1,520,400
52 Ventolin Exp Syr* Btl 5 5 5 15 5 5 5 15 30 53,280 266,400 266,400 266,400 799,200 266,400 266,400 266,400 799,200 1,598,400
53 Verorab Inj* Amp 1 1 1 3 1 1 1 3 6 178,470 178,470 178,470 178,470 535,410 178,470 178,470 178,470 535,410 1,070,820
54 Plavix 75* Tab - - - 26,494 - - - - - - - - -
55 Crestor 10* Tab - - - 17,779 - - - - - - - - -
56 Crestor 20* Tab - - - 20,844 - - - - - - - - -
57 Januvia 100* Tab - - - 15,803 - - - - - - - - -
58 Janumet* Tab - - - 8,485 - - - - - - - - -
59 Truvaz 10* Tab - - - 14,438 - - - - - - - - -
60 Truvaz 20* Tab - - - 14,438 - - - - - - - - -
61 Trajenta* Tab - - - 14,875 - - - - - - - - -
62 Nexium 20* Tab - - - 16,089 - - - - - - - - -
63 Nexium 40* Tab - - - 19,642 - - - - - - - - -
64 Pantozol 20* Tab - - - 16,714 - - - - - - - - -
65 Pantozol 40* Tab - - - 21,214 - - - - - - - - -
67 MAGALAT SUSP 100ML ( btl 5 0 - 5 5 - - 5 10 28,130 140,650 - - 140,650 140,650 - - 140,650 281,300
68 MAGALAT TAB @60 (FPP BOX60 1 0 0 1 1 0 0 1 2 50,630 50,630 - - 50,630 50,630 - - 50,630 101,260
69 Blopress 8 tab - - - 12,807 - - - - - - - - -
70 Blopress 16 tab - - - 16,052 - - - - - - - - -
71 Blopress Plus tab - - - 16,052 - - - - - - - - -
72 KASA BIRU 42 Y rol 1 1 1 3 1 1 1 3 6 732,040 732,040 732,040 732,040 2,196,120 732,040 732,040 732,040 2,196,120 4,392,240
73 HYPAFIX 10 CM X 5 M ( ktk 0 0 0 - 0 0 0 - - 59,910 - - - - - - - - -
74 HYPAFIX 5 CM X 5 M (N ktk 0 0 0 - 0 0 0 - - 59,910 - - - - - - - - -
75 LEUKOPLAST 1562 (1x1) rol 1 1 1 3 1 1 1 3 6 5,100 5,100 5,100 5,100 15,300 5,100 5,100 5,100 15,300 30,600
76 OPTIMAX (Box/30) box 0 0 0 - 0 0 0 - - 198,000 - - - - - - - - -
77 Amaryl M2 Box/30 - - - 163,940 - - - - - - - - -
78 Batugin Exlixir 120 ml Btl - - - 20,820 - - - - - - - - -
79 Co Diovan 80 mg @28 Tab - - - 13,350 - - - - - - - - -
80 Co Diovan 160 mg @28 Tab - - - 16,737 - - - - - - - - -
81 Canderin 16 mg @30 Tab - - - 9,563 - - - - - - - - -
82 Canderin 8 mg @30 Tab - - - 6,750 - - - - - - - - -
83 Celebrex 100 mg@30 Tab - - - 9,457 - - - - - - - - -
84 Celebrex 200 mg@30 Tab - - - 14,203 - - - - - - - - -
85 Concor 5 mg @100 Tab - - - 8,799 - - - - - - - - -
86 Concor 2,5 mg @100 Tab - - - 6,076 - - - - - - - - -
87 Diovan 160 mg @28 Tab - - - 15,940 - - - - - - - - -
88 Diovan 80 mg @28 Box - - - 12,715 - - - - - - - - -
89 Digenta Cr Tube 0 0 0 - 0 0 0 - - - - - - - - - - -
90 Exforge 5/80 mg @28 tab - - - 14,963 - - - - - - - - -
91 Exforge 10/160 mg @28 Box - - - 18,731 - - - - - - - - -
93 Galvusmet 5/500 @30 tab - - - 7,031 - - - - - - - - -
94 Hyperil 5 mg @60 Box - - - 8,438 - - - - - - - - -
95 Hyperil 2,5 mg @ 60 Box - - - 5,344 - - - - - - - - -
96 Hysterin Syr Btl - - - 48,380 - - - - - - - - -
97 Herbesser 100 mg tab/30 - - - 8,370 - - - - - - - - -
98 HP Pro @120 tab - - - 4,736 - - - - - - - - -
99 Harnal 0,2 @28 tab - - - 14,392 - - - - - - - - -
100 Harnal Ocas @28 tab/28 - - - 14,891 - - - - - - - - -
101 Lyrica 50 @14 tab - - - 8,903 - - - - - - - - -
102 Lyrica 75 @14 tab - - - 12,856 - - - - - - - - -
103 Lyrica 150 @14 tab - - - 21,212 - - - - - - - - -
104 Neuralgin@100 tab 0 0 0 - 0 0 0 - - - - - - - - - - -
105 Symbicort Inhaler Btl 0 0 0 - 0 0 0 - - 297,820 - - - - - - - - -
106 Trileptal 300 @50 Box - - - 9,184 - - - - - - - - -
107 Tegretol 200 @50 Box - - - 4,240 - - - - - - - - -
109 Trizedon MR @60 tab - - - 3,675 - - - - - - - - -
110 Twynsta 5/40 @28 tab - - - 15,688 - - - - - - - - -
111 Twynsta 5/80 @28 tab - - - 20,381 - - - - - - - - -
112 Twynsta 10/80 @28 tab - - - 20,381 - - - - - - - - -
115 Ventolin Inhaler Btl 2 2 2 6 2 2 2 6 12 101,120 202,240 202,240 202,240 606,720 202,240 202,240 202,240 606,720 1,213,440
116 Ventolin Nebul @ 20 box 1 1 1 3 1 1 1 3 6 202,230 202,230 202,230 202,230 606,690 202,230 202,230 202,230 606,690 1,213,380
117 Cholespar 20 mg @30 tab - - - 18,750 - - - - - - - - -
118 Cholespar 10 mg @30 tab - - - 14,063 - - - - - - - - -
119 Voltaren Gel 20g Tube - - - 64,020 - - - - - - - - -
120 Glurenorm @ 100 Tab - - - 3,658 - - - - - - - - -
121 Dulcolax Tab - - - 1,265 - - - - - - - - -
122 Dulcolax Supp @6 Supp - - - 16,400 - - - - - - - - -
123 Diamicron MR tab - - - 6,379 - - - - - - - - -
124 Clanexi F Syr Btl - - - - - - - - - - - -
126 Rivanol 100 ml Btl 5 5 5 15 5 5 5 15 30 2,770 13,850 13,850 13,850 41,550 13,850 13,850 13,850 41,550 83,100
127 Cataflam D @50 tab 50 0 0 50 50 0 0 50 100 5,966 298,300 - - 298,300 298,300 - - 298,300 596,600
128 Micardis 40 mg @20 tab - - - 14,915 - - - - - - - - -
129 Micardis 80 mg @ 20 tab - - - 19,337 - - - - - - - - -
130 Leukocrep "6" Roll - - - 97,710 - - - - - - - - -
131 Leukocrep "4 " Roll 2 2 2 6 2 2 2 6 12 76,000 152,000 152,000 152,000 456,000 152,000 152,000 152,000 456,000 912,000
132 Inviclot Inj Amp - - - 67,500 - - - - - - - - -
133 Madecasol Oint Tube - - - 135,850 - - - - - - - - -
134 Apolar Cr Tube - - - 35,440 - - - - - - - - -
135 Apolar N Cr Tube - - - 40,170 - - - - - - - - -
136 Aspar K Tab - - - 2,299 - - - - - - - - -
137 Ultrapoct N Cr Tube - - - 110,670 - - - - - - - - -
138 Nifural Syr Btl - - - 55,635 - - - - - - - - -
139 Tarivid TT Btl - - - 86,630 - - - - - - - - -
140 Betadine Sol 30 Ml Btl - - - 18,060 - - - - - - - - -
141 Betadine OInt 10 Gr Tube - - - 15,080 - - - - - - - - -
142 Betadine Oint 5 Gr Tube - - - 9,280 - - - - - - - - -
143 Betadine Sol 5 Ml Btl - - - 3,040 - - - - - - - - -
144 Bioplacenton Gel Tube - - - 15,190 - - - - - - - - -
145 Claneksi Syr Btl - - - 53,550 - - - - - - - - -
146 Combantyrin Syr Btl - - - 14,330 - - - - - - - - -
147 Depakene Syr Btl - - - 176,290 - - - - - - - - -
148 Exforge 5/160 Mg Tab @ 28 Tab - - - 17,438 - - - - - - - - -
149 Leukoplast 1621 Rol - - - 7,360 - - - - - - - - -
150 Nonflamin Cap @60 Tab - - - 4,374 - - - - - - - - -
151 Pronalges Supp @ 10 Box - - - 133,880 - - - - - - - - -
152 Spasmomen Tab @30 Tab - - - 6,975 - - - - - - - - -
153 Verban Uk. 5 cm Rol - - - 565 - - - - - - - - -
154 Verban Uk. 15 cm Rol - - - 1,540 - - - - - - - - -
155 COMBANTRIN TAB TAB 0 - 0 - - 5,910 - - - - - - - - -
156 HERBESSER 200 Caps 0 0 0 - 0 0 0 - - 381,720 - - - - - - - - -
157 Authocheck Cholesterol st btl - - - 185,630 - - - - - - - - -
158 Authocheck Gluco DR stri btl - - - 106,880 - - - - - - - - -
159 Authocheck Uric Acid stri btl - - - 123,750 - - - - - - - - -
160 Leukopor Besar Pcs - - - 20,000 - - - - - - - - -
161 Leukopor Kecil Pcs - - - 15,000 - - - - - - - - -
162 Renxamin Btl - - - 110,000 - - - - - - - - -
JUMLAH 4,423,674 3,639,214 3,639,214 11,702,102 4,340,294 3,639,214 3,598,144 11,577,652 23,279,753
PPN 10% 442,367 363,921 363,921 1,170,210 434,029 363,921 359,814 1,157,765 2,327,975
No :
DAFTAR PERMINTAAN OBAT-OBATAN DAN 7 KLINIK

PT. Nusa Lima Medika
ALAT KESEHATAN SEMESTER I 2017 PAKET - VI

Estimasi Harga
2 Bekarbon Tab - - - - - - - - - - - - - - - - - - -
5 Norit Tab 320 280 280 880 320 280 199 799 1,679 277 88,520 77,455 77,455 243,430 88,520 77,455 55,048 221,023 464,453
6 Salep 2-4 Pot 17 12 12 41 17 12 12 41 82 3,685 62,645 44,220 44,220 151,085 62,645 44,220 44,220 151,085 302,170
7 Aprovel 150* Tab 28 28 28 84 28 28 28 84 168 355,830 9,963,240 9,963,240 9,963,240 29,889,720 9,963,240 9,963,240 9,963,240 29,889,720 59,779,440
8 Aprovel 300* Tab 28 28 28 84 28 28 28 84 168 480,250 13,447,000 13,447,000 13,447,000 40,341,000 13,447,000 13,447,000 13,447,000 40,341,000 80,682,000
9 Ascardia* Tab 300 300 300 900 300 300 300 900 1,800 956 286,800 286,800 286,800 860,400 286,800 286,800 286,800 860,400 1,720,800
10 Biodiar* Tab - - - - - - - - - - - - - - - - - - -
11 Cendo Mycetin TM* Btl - - - - - - - - - - - - - - - - - - -
13 Cortidex* Tab - - - - - - - - - 281 - - - - - - - - -
14 Dermovel Cr* Tube 17 15 15 47 20 15 15 50 97 67,500 1,147,500 1,012,500 1,012,500 3,172,500 1,350,000 1,012,500 1,012,500 3,375,000 6,547,500
18 Fladystin Vaginal* Vagtab 52 32 32 116 32 32 32 96 212 14,625 760,500 468,000 468,000 1,696,500 468,000 468,000 468,000 1,404,000 3,100,500
19 Glucobay 50* Tab 100 100 100 300 100 100 100 300 600 2,009 200,940 200,940 200,940 602,820 200,940 200,940 200,940 602,820 1,205,640
20 Glucobay 100* Tab 100 100 100 300 100 100 100 300 600 3,365 336,500 336,500 336,500 1,009,500 336,500 336,500 336,500 1,009,500 2,019,000
21 Glucovance 2,5/500* Tab 200 200 200 600 200 200 200 600 1,200 3,795 759,000 759,000 759,000 2,277,000 759,000 759,000 759,000 2,277,000 4,554,000
22 Glucovance 5/500* Tab 200 200 200 600 200 200 200 600 1,200 4,608 921,600 921,600 921,600 2,764,800 921,600 921,600 921,600 2,764,800 5,529,600
23 Gluvas 2* Tab - - - - - - - - - - - - - - - - - - -
24 Gluvas 3* Tab - - - - - - - - - - - - - - - - - - -
25 Ketricin Cr* Tube 14 13 13 40 14 13 13 40 80 45,000 630,000 585,000 585,000 1,800,000 630,000 585,000 585,000 1,800,000 3,600,000
26 Lantus Inj* Amp 15 15 15 45 15 15 15 45 90 193,384 2,900,760 2,900,760 2,900,760 8,702,280 2,900,760 2,900,760 2,900,760 8,702,280 17,404,560
27 Lipitor 10* Tab 60 60 60 180 60 60 60 180 360 18,641 1,118,460 1,118,460 1,118,460 3,355,380 1,118,460 1,118,460 1,118,460 3,355,380 6,710,760
28 Lipitor 20* Tab 60 60 60 180 60 60 60 180 360 19,007 1,140,420 1,140,420 1,140,420 3,421,260 1,140,420 1,140,420 1,140,420 3,421,260 6,842,520
29 Norvask 5* Tab 60 60 60 180 60 60 60 180 360 7,826 469,580 469,580 469,580 1,408,740 469,580 469,580 469,580 1,408,740 2,817,480
30 Norvask 10* tab 60 60 60 180 60 60 60 180 360 14,026 841,560 841,560 841,560 2,524,680 841,560 841,560 841,560 2,524,680 5,049,360
31 Novomix Inj* Amp 10 10 10 30 10 10 10 30 60 171,908 1,719,080 1,719,080 1,719,080 5,157,240 1,719,080 1,719,080 1,719,080 5,157,240 10,314,480
32 Novorafid Inj* Amp 10 10 10 30 10 10 10 30 60 171,908 1,719,080 1,719,080 1,719,080 5,157,240 1,719,080 1,719,080 1,719,080 5,157,240 10,314,480
33 Pibaksin Oint* Tube 5 2 2 9 3 2 2 7 16 41,690 208,450 83,380 83,380 375,210 125,070 83,380 83,380 291,830 667,040
34 Pronalges* tab 100 100 100 300 100 100 100 300 600 2,813 281,260 281,260 281,260 843,780 281,260 281,260 281,260 843,780 1,687,560
35 Pulmicort Nebul* Fls 65 55 50 170 60 55 50 165 335 17,384 1,129,928 956,093 869,175 2,955,195 1,043,010 956,093 869,175 2,868,278 5,823,473
36 Retaphyl SR* Tab 200 - - 200 - - - - 200 2,191 438,200 - - 438,200 - - - - 438,200
37 Rhinofed* Tab - - - - - - - - - - - - - - - - - - -
38 Rhinofed Syr* Btl - - - - - - - - - - - - - - - - - - -
39 Rhinos SR* Tab - - - - - - - - - - - - - - - - - - -
40 sanprima*Forte Tab - - - - - - - - - 2,025 - - - - - - - - -
41 Scabimite Cr* Tube 11 9 9 29 10 9 8 27 56 41,070 451,770 369,630 369,630 1,191,030 410,700 369,630 328,560 1,108,890 2,299,920
42 Siclidon 100* Caps - - - - - - - - - 5,192 - - - - - - - - -
43 Starcef 200* Caps - - - - - - - - - 30,938 - - - - - - - - -
44 Termisil Cr* Tube 10 10 10 30 10 10 10 30 60 54,340 543,400 543,400 543,400 1,630,200 543,400 543,400 543,400 1,630,200 3,260,400
45 Tetagam PP* Amp 7 - - 7 4 - - 4 11 211,500 1,480,500 - - 1,480,500 846,000 - - 846,000 2,326,500
46 Theragran M* Tab 200 200 200 600 200 200 200 600 1,200 4,241 848,200 848,200 848,200 2,544,600 848,200 848,200 848,200 2,544,600 5,089,200
47 Thrombo Aspilet* Tab 200 200 200 600 200 200 200 600 1,200 759 151,880 151,880 151,880 455,640 151,880 151,880 151,880 455,640 911,280
48 Trichodazole* Tab 100 100 100 300 100 100 100 300 600 1,687 168,700 168,700 168,700 506,100 168,700 168,700 168,700 506,100 1,012,200
49 Tripanzym* Tab - - - - - - - - - - - - - - - - - - -
50 Tuzalos* Tab - - - - - - - - - - - - - - - - - - -
51 Ventolin Syr* Tab 19 17 17 53 17 17 18 52 105 50,680 962,920 861,560 861,560 2,686,040 861,560 861,560 912,240 2,635,360 5,321,400
52 Ventolin Exp Syr* Btl 19 19 17 55 17 17 17 51 106 53,280 1,012,320 1,012,320 905,760 2,930,400 905,760 905,760 905,760 2,717,280 5,647,680
53 Verorab Inj* Amp 7 2 2 11 5 2 2 9 20 178,470 1,249,290 356,940 356,940 1,963,170 892,350 356,940 356,940 1,606,230 3,569,400
54 Plavix 75* Tab 98 98 98 294 98 98 98 294 588 26,494 2,596,388 2,596,388 2,596,388 7,789,163 2,596,388 2,596,388 2,596,388 7,789,163 15,578,325
55 Crestor 10* Tab 56 56 56 168 56 56 56 168 336 17,779 995,600 995,600 995,600 2,986,800 995,600 995,600 995,600 2,986,800 5,973,600
56 Crestor 20* Tab 56 56 56 168 56 56 56 168 336 20,844 1,167,280 1,167,280 1,167,280 3,501,840 1,167,280 1,167,280 1,167,280 3,501,840 7,003,680
57 Januvia 100* Tab 98 98 98 294 98 98 98 294 588 15,803 1,548,694 1,548,694 1,548,694 4,646,082 1,548,694 1,548,694 1,548,694 4,646,082 9,292,164
58 Janumet* Tab 98 98 98 294 98 98 98 294 588 8,485 831,530 831,530 831,530 2,494,590 831,530 831,530 831,530 2,494,590 4,989,180
59 Truvaz 10* Tab 60 60 60 180 60 60 60 180 360 14,438 866,250 866,250 866,250 2,598,750 866,250 866,250 866,250 2,598,750 5,197,500
60 Truvaz 20* Tab 60 60 60 180 60 60 60 180 360 14,438 866,250 866,250 866,250 2,598,750 866,250 866,250 866,250 2,598,750 5,197,500
61 Trajenta* Tab 210 210 210 630 210 210 210 630 1,260 14,875 3,123,820 3,123,820 3,123,820 9,371,460 3,123,820 3,123,820 3,123,820 9,371,460 18,742,920
62 Nexium 20* Tab 210 210 210 630 210 210 210 630 1,260 16,089 3,378,690 3,378,690 3,378,690 10,136,070 3,378,690 3,378,690 3,378,690 10,136,070 20,272,140
63 Nexium 40* Tab 210 210 210 630 210 210 210 630 1,260 19,642 4,124,820 4,124,820 4,124,820 12,374,460 4,124,820 4,124,820 4,124,820 12,374,460 24,748,920
64 Pantozol 20* Tab 210 210 210 630 210 210 210 630 1,260 16,714 3,510,000 3,510,000 3,510,000 10,530,000 3,510,000 3,510,000 3,510,000 10,530,000 21,060,000
65 Pantozol 40* Tab 210 210 210 630 210 210 210 630 1,260 21,214 4,455,000 4,455,000 4,455,000 13,365,000 4,455,000 4,455,000 4,455,000 13,365,000 26,730,000
66 OBH Nelco spec 100* btl 42 40 42 124 44 41 40 125 249 23,740 997,080 949,600 997,080 2,943,760 1,044,560 973,340 949,600 2,967,500 5,911,260
67 MAGALAT SUSP 100ML ( btl 22 17 17 56 27 22 22 71 127 28,130 618,860 478,210 478,210 1,575,280 759,510 618,860 618,860 1,997,230 3,572,510
68 MAGALAT TAB @60 (FPP BOX60 5 3 3 11 4 3 3 10 21 50,630 253,150 151,890 151,890 556,930 202,520 151,890 151,890 506,300 1,063,230
69 Blopress 8 tab 210 210 210 630 210 210 210 630 1,260 12,807 2,689,470 2,689,470 2,689,470 8,068,410 2,689,470 2,689,470 2,689,470 8,068,410 16,136,820
70 Blopress 16 tab 210 210 210 630 210 210 210 630 1,260 16,052 3,370,920 3,370,920 3,370,920 10,112,760 3,370,920 3,370,920 3,370,920 10,112,760 20,225,520
71 Blopress Plus tab 175 175 175 525 175 175 175 525 1,050 16,052 2,809,100 2,809,100 2,809,100 8,427,300 2,809,100 2,809,100 2,809,100 8,427,300 16,854,600
72 KASA BIRU 42 Y rol 7 3 3 13 4 3 3 10 23 732,040 5,124,280 2,196,120 2,196,120 9,516,520 2,928,160 2,196,120 2,196,120 7,320,400 16,836,920
73 HYPAFIX 10 CM X 5 M ( ktk - - - - - - - - - 59,910 - - - - - - - - -
74 HYPAFIX 5 CM X 5 M (N ktk - - - - - - - - - 59,910 - - - - - - - - -
75 LEUKOPLAST 1562 (1x1) rol 7 4 5 16 6 6 6 18 34 5,100 35,700 20,400 25,500 81,600 30,600 30,600 30,600 91,800 173,400
76 OPTIMAX (Box/30) box 1 1 1 3 1 1 2 4 7 198,000 198,000 198,000 198,000 594,000 198,000 198,000 396,000 792,000 1,386,000
77 Amaryl M2 Box/30 7 7 7 21 7 7 7 21 42 163,940 1,147,580 1,147,580 1,147,580 3,442,740 1,147,580 1,147,580 1,147,580 3,442,740 6,885,480
78 Batugin Exlixir 120 ml Btl 20 20 20 60 20 20 20 60 120 20,820 416,400 416,400 416,400 1,249,200 416,400 416,400 416,400 1,249,200 2,498,400
79 Co Diovan 80 mg @28 Tab 168 168 168 504 168 168 168 504 1,008 13,350 2,242,860 2,242,860 2,242,860 6,728,580 2,242,860 2,242,860 2,242,860 6,728,580 13,457,160
80 Co Diovan 160 mg @28 Tab 168 168 168 504 168 168 168 504 1,008 16,737 2,811,750 2,811,750 2,811,750 8,435,250 2,811,750 2,811,750 2,811,750 8,435,250 16,870,500
81 Canderin 16 mg @30 Tab 60 60 60 180 60 60 60 180 360 9,563 573,760 573,760 573,760 1,721,280 573,760 573,760 573,760 1,721,280 3,442,560
82 Canderin 8 mg @30 Tab 60 60 60 180 60 60 60 180 360 6,750 405,000 405,000 405,000 1,215,000 405,000 405,000 405,000 1,215,000 2,430,000
83 Celebrex 100 mg@30 Tab 90 90 90 270 90 90 90 270 540 9,457 851,130 851,130 851,130 2,553,390 851,130 851,130 851,130 2,553,390 5,106,780
84 Celebrex 200 mg@30 Tab 90 90 90 270 90 90 90 270 540 14,203 1,278,300 1,278,300 1,278,300 3,834,900 1,278,300 1,278,300 1,278,300 3,834,900 7,669,800
85 Concor 5 mg @100 Tab 200 200 200 600 200 200 200 600 1,200 8,799 1,759,740 1,759,740 1,759,740 5,279,220 1,759,740 1,759,740 1,759,740 5,279,220 10,558,440
86 Concor 2,5 mg @100 Tab 300 300 300 900 300 300 300 900 1,800 6,076 1,822,860 1,822,860 1,822,860 5,468,580 1,822,860 1,822,860 1,822,860 5,468,580 10,937,160
87 Diovan 160 mg @28 Tab 140 112 112 364 112 112 112 336 700 15,940 2,231,550 1,785,240 1,785,240 5,802,030 1,785,240 1,785,240 1,785,240 5,355,720 11,157,750
88 Diovan 80 mg @28 Box 140 112 112 364 112 112 112 336 700 12,715 1,780,050 1,424,040 1,424,040 4,628,130 1,424,040 1,424,040 1,424,040 4,272,120 8,900,250
89 Digenta Cr Tube - - - - - - - - - - - - - - - - - - -
90 Exforge 5/80 mg @28 tab 84 84 84 252 84 84 112 280 532 14,963 1,256,850 1,256,850 1,256,850 3,770,550 1,256,850 1,256,850 1,675,800 4,189,500 7,960,050
91 Exforge 10/160 mg @28 Box 84 84 84 252 84 84 84 252 504 18,731 1,573,440 1,573,440 1,573,440 4,720,320 1,573,440 1,573,440 1,573,440 4,720,320 9,440,640
92 Cinogenta Cream Tube 20 19 19 58 20 19 19 58 116 43,320 866,400 823,080 823,080 2,512,560 866,400 823,080 823,080 2,512,560 5,025,120
93 Galvusmet 5/500 @30 tab 120 120 120 360 120 120 120 360 720 7,031 843,760 843,760 843,760 2,531,280 843,760 843,760 843,760 2,531,280 5,062,560
94 Hyperil 5 mg @60 Box 120 120 120 360 120 120 120 360 720 8,438 1,012,500 1,012,500 1,012,500 3,037,500 1,012,500 1,012,500 1,012,500 3,037,500 6,075,000
95 Hyperil 2,5 mg @ 60 Box 120 120 120 360 120 120 120 360 720 5,344 641,260 641,260 641,260 1,923,780 641,260 641,260 641,260 1,923,780 3,847,560
96 Hysterin Syr Btl 5 5 5 15 5 5 5 15 30 48,380 241,900 241,900 241,900 725,700 241,900 241,900 241,900 725,700 1,451,400
97 Herbesser 100 mg tab/30 160 160 160 480 160 160 160 480 960 8,370 1,339,200 1,339,200 1,339,200 4,017,600 1,339,200 1,339,200 1,339,200 4,017,600 8,035,200
98 HP Pro @120 tab 240 240 240 720 240 240 240 720 1,440 4,736 1,136,660 1,136,660 1,136,660 3,409,980 1,136,660 1,136,660 1,136,660 3,409,980 6,819,960
99 Harnal 0,2 @28 tab 56 56 56 168 56 56 56 168 336 14,392 805,950 805,950 805,950 2,417,850 805,950 805,950 805,950 2,417,850 4,835,700
100 Harnal Ocas @28 tab/28 56 56 56 168 112 56 56 224 392 14,891 833,915 833,915 833,915 2,501,744 1,667,829 833,915 833,915 3,335,659 5,837,403
101 Lyrica 50 @14 tab 70 70 70 210 70 70 70 210 420 8,903 623,200 623,200 623,200 1,869,600 623,200 623,200 623,200 1,869,600 3,739,200
102 Lyrica 75 @14 tab 70 70 70 210 70 70 70 210 420 12,856 899,950 899,950 899,950 2,699,850 899,950 899,950 899,950 2,699,850 5,399,700
103 Lyrica 150 @14 tab 70 70 70 210 70 70 70 210 420 21,212 1,484,850 1,484,850 1,484,850 4,454,550 1,484,850 1,484,850 1,484,850 4,454,550 8,909,100
104 Neuralgin@100 tab - - - - - - - - - - - - - - - - - - -
105 Symbicort Inhaler Btl 12 12 12 36 11 10 11 32 68 297,820 3,573,840 3,573,840 3,573,840 10,721,520 3,276,020 2,978,200 3,276,020 9,530,240 20,251,760
106 Trileptal 300 @50 Box 50 50 50 150 50 50 50 150 300 9,184 459,200 459,200 459,200 1,377,600 459,200 459,200 459,200 1,377,600 2,755,200
107 Tegretol 200 @50 Box 50 50 50 150 50 50 50 150 300 4,240 212,020 212,020 212,020 636,060 212,020 212,020 212,020 636,060 1,272,120
108 Thrombophob gel Tube 18 17 17 52 20 18 17 55 107 53,160 956,880 903,720 903,720 2,764,320 1,063,200 956,880 903,720 2,923,800 5,688,120
109 Trizedon MR @60 tab 360 360 360 1,080 360 360 360 1,080 2,160 3,675 1,323,000 1,323,000 1,323,000 3,969,000 1,323,000 1,323,000 1,323,000 3,969,000 7,938,000
110 Twynsta 5/40 @28 tab 84 84 84 252 84 84 84 252 504 15,688 1,317,780 1,317,780 1,317,780 3,953,340 1,317,780 1,317,780 1,317,780 3,953,340 7,906,680
111 Twynsta 5/80 @28 tab 84 84 84 252 112 112 112 336 588 20,381 1,712,040 1,712,040 1,712,040 5,136,120 2,282,720 2,282,720 2,282,720 6,848,160 11,984,280
112 Twynsta 10/80 @28 tab 84 84 84 252 84 84 84 252 504 20,381 1,712,040 1,712,040 1,712,040 5,136,120 1,712,040 1,712,040 1,712,040 5,136,120 10,272,240
113 Tantum Verde 60 ml Btl 25 24 24 73 24 24 24 72 145 23,630 590,750 567,120 567,120 1,724,990 567,120 567,120 567,120 1,701,360 3,426,350
114 Ultrapoct N Supp @10 Supp 58 42 42 142 52 42 42 136 278 16,223 940,953 681,380 681,380 2,303,713 843,613 681,380 681,380 2,206,373 4,510,087
115 Ventolin Inhaler Btl 14 13 13 40 15 12 13 40 80 101,120 1,415,680 1,314,560 1,314,560 4,044,800 1,516,800 1,213,440 1,314,560 4,044,800 8,089,600
116 Ventolin Nebul @ 20 box 9 5 5 19 7 5 5 17 36 202,230 1,820,070 1,011,150 1,011,150 3,842,370 1,415,610 1,011,150 1,011,150 3,437,910 7,280,280
117 Cholespar 20 mg @30 tab 60 60 60 180 60 90 90 240 420 18,750 1,125,000 1,125,000 1,125,000 3,375,000 1,125,000 1,687,500 1,687,500 4,500,000 7,875,000
118 Cholespar 10 mg @30 tab 60 60 60 180 60 60 60 180 360 14,063 843,750 843,750 843,750 2,531,250 843,750 843,750 843,750 2,531,250 5,062,500
119 Voltaren Gel 20g Tube 15 15 15 45 15 15 15 45 90 64,020 960,300 960,300 960,300 2,880,900 960,300 960,300 960,300 2,880,900 5,761,800
120 Glurenorm @ 100 Tab 200 100 100 400 100 100 100 300 700 3,658 731,620 365,810 365,810 1,463,240 365,810 365,810 365,810 1,097,430 2,560,670
121 Dulcolax Tab 100 100 100 300 100 100 100 300 600 1,265 126,500 126,500 126,500 379,500 126,500 126,500 126,500 379,500 759,000
122 Dulcolax Supp @6 Supp 12 12 12 36 12 12 12 36 72 16,400 196,800 196,800 196,800 590,400 196,800 196,800 196,800 590,400 1,180,800
123 Diamicron MR tab 210 210 210 630 210 210 210 630 1,260 6,379 1,339,590 1,339,590 1,339,590 4,018,770 1,339,590 1,339,590 1,339,590 4,018,770 8,037,540
124 Clanexi F Syr Btl - - - - - - - - - - - - - - - - - - -
125 Cendo Polydex TM Btl 15 12 12 39 12 12 12 36 75 40,220 603,300 482,640 482,640 1,568,580 482,640 482,640 482,640 1,447,920 3,016,500
126 Rivanol 100 ml Btl 35 34 35 104 35 35 33 103 207 2,770 96,950 94,180 96,950 288,080 96,950 96,950 91,410 285,310 573,390
127 Cataflam D @50 tab 351 200 150 701 200 150 150 500 1,201 5,966 2,094,066 1,193,200 894,900 4,182,166 1,193,200 894,900 894,900 2,983,000 7,165,166
128 Micardis 40 mg @20 tab 50 50 50 150 50 50 50 150 300 14,915 745,750 745,750 745,750 2,237,250 745,750 745,750 745,750 2,237,250 4,474,500
129 Micardis 80 mg @ 20 tab 50 50 50 150 50 50 50 150 300 19,337 966,825 966,825 966,825 2,900,475 966,825 966,825 966,825 2,900,475 5,800,950
130 Leukocrep "6" Roll 4 4 4 12 4 4 4 12 24 97,710 390,840 390,840 390,840 1,172,520 390,840 390,840 390,840 1,172,520 2,345,040
131 Leukocrep "4 " Roll 12 10 10 32 12 10 10 32 64 76,000 912,000 760,000 760,000 2,432,000 912,000 760,000 760,000 2,432,000 4,864,000
132 Inviclot Inj Amp 20 20 20 60 20 20 20 60 120 67,500 1,350,000 1,350,000 1,350,000 4,050,000 1,350,000 1,350,000 1,350,000 4,050,000 8,100,000
133 Madecasol Oint Tube 5 5 5 15 5 5 5 15 30 135,850 679,250 679,250 679,250 2,037,750 679,250 679,250 679,250 2,037,750 4,075,500
134 Apolar Cr Tube 7 7 7 21 7 7 7 21 42 35,440 248,080 248,080 248,080 744,240 248,080 248,080 248,080 744,240 1,488,480
135 Apolar N Cr Tube 5 7 8 20 7 7 7 21 41 40,170 200,850 281,190 321,360 803,400 281,190 281,190 281,190 843,570 1,646,970
136 Aspar K Tab 200 - - 200 200 - - 200 400 2,299 459,820 - - 459,820 459,820 - - 459,820 919,640
137 Ultrapoct N Cr Tube 5 5 5 15 5 5 5 15 30 110,670 553,350 553,350 553,350 1,660,050 553,350 553,350 553,350 1,660,050 3,320,100
138 Nifural Syr Btl - - - - - - - - - 55,635 - - - - - - - - -
139 Tarivid TT Btl 2 2 2 6 2 2 2 6 12 86,630 173,260 173,260 173,260 519,780 173,260 173,260 173,260 519,780 1,039,560
140 Betadine Sol 30 Ml Btl 17 17 17 51 17 17 17 51 102 18,060 307,020 307,020 307,020 921,060 307,020 307,020 307,020 921,060 1,842,120
141 Betadine OInt 10 Gr Tube 5 5 5 15 5 5 5 15 30 15,080 75,400 75,400 75,400 226,200 75,400 75,400 75,400 226,200 452,400
142 Betadine Oint 5 Gr Tube - - - - - - - - - 9,280 - - - - - - - - -
145 Claneksi Syr Btl - - - - - - - - - 53,550 - - - - - - - - -
147 Depakene Syr Btl 2 2 2 6 2 2 2 6 12 176,290 352,580 352,580 352,580 1,057,740 352,580 352,580 352,580 1,057,740 2,115,480
148 Exforge 5/160 Mg Tab @ Tab 84 84 84 252 84 84 84 252 504 17,438 1,464,780 1,464,780 1,464,780 4,394,340 1,464,780 1,464,780 1,464,780 4,394,340 8,788,680
149 Leukoplast 1621 Rol 1 1 1 3 1 1 1 3 6 7,360 7,360 7,360 7,360 22,080 7,360 7,360 7,360 22,080 44,160
150 Nonflamin Cap @60 Tab 60 - - 60 60 - - 60 120 4,374 262,430 - - 262,430 262,430 - - 262,430 524,860
151 Pronalges Supp @ 10 Box 3 3 2 8 2 2 2 6 14 133,880 401,640 401,640 267,760 1,071,040 267,760 267,760 267,760 803,280 1,874,320
152 Spasmomen Tab @30 Tab 90 90 90 270 90 90 90 270 540 6,975 627,750 627,750 627,750 1,883,250 627,750 627,750 627,750 1,883,250 3,766,500
153 Verban Uk. 5 cm Rol 40 40 40 120 40 40 42 122 242 565 22,600 22,600 22,600 67,800 22,600 22,600 23,730 68,930 136,730
154 Verban Uk. 15 cm Rol 40 40 35 115 35 35 34 104 219 1,540 61,600 61,600 53,900 177,100 53,900 53,900 52,360 160,160 337,260
155 COMBANTRIN TAB TAB 100 - - 100 - - - - 100 5,910 591,000 - - 591,000 - - - - 591,000
156 HERBESSER 200 box 2 1 1 4 2 1 1 4 8 381,720 763,440 381,720 381,720 1,526,880 763,440 381,720 381,720 1,526,880 3,053,760
157 Authocheck Cholesterol st btl 14 13 13 40 14 13 13 40 80 185,630 2,598,820 2,413,190 2,413,190 7,425,200 2,598,820 2,413,190 2,413,190 7,425,200 14,850,400
158 Authocheck Gluco DR stri btl 10 9 9 28 10 9 9 28 56 106,880 1,068,800 961,920 961,920 2,992,640 1,068,800 961,920 961,920 2,992,640 5,985,280
159 Authocheck Uric Acid stri btl 10 9 9 28 10 9 9 28 56 123,750 1,237,500 1,113,750 1,113,750 3,465,000 1,237,500 1,113,750 1,113,750 3,465,000 6,930,000
160 Leukopor Besar Pcs 20 20 20 60 20 20 20 60 120 20,000 400,000 400,000 400,000 1,200,000 400,000 400,000 400,000 1,200,000 2,400,000
161 Leukopor Kecil Pcs 20 20 20 60 20 20 20 60 120 15,000 300,000 300,000 300,000 900,000 300,000 300,000 300,000 900,000 1,800,000
162 Renxamin Btl 5 5 5 15 5 5 5 15 30 110,000 550,000 550,000 550,000 1,650,000 550,000 550,000 550,000 1,650,000 3,300,000
JUMLAH 165,106,842 152,098,051 151,653,488 468,858,381 158,966,209 152,246,676 153,052,617 464,265,501 933,123,882
PPN 10% 16,510,684 15,209,805 15,165,349 46,885,838 15,896,621 15,224,668 15,305,262 46,426,550 93,312,388
JUMLAH KESELURUHAN 181,617,526 167,307,856 166,818,837 515,744,219 174,862,830 167,471,343 168,357,878 510,692,052 1,026,436,270
PT. NUSA LIMA MEDIKA LAMPIRAN BESTEK
No. AU-31 /PTNLM/AU-31.4/I/2017 Nomor : PTNLM/BESTEK/ /I /2017

Objek pekerjaan PENGADAAN OBAT-OBATAN DAN ALAT KESEHATAN Tanggal : 13 DESEMBER 2016
HABIS PAKAI PAKET II KEBUTUHAN SEMESTER -
I/2017 UNTUK KLINIK PT NUSA LIMA MEDIKA
Unit KLINIK PT NUSALIMA MEDIKA ( 7 KLINIK)
JUMLAH HARGA
NO NAMA DAGANG KOMPOSISI KEMASAN / SATUAN JUMLAH FISIK HARGA SATUAN (Rp.) KETERANGAN/ANALISA
(Rp.)
1 2 2 3 4 5 6=4*5 7
1 Alerfed Syr* Tripolidin 1,25mg+pseudofedrin 30mg btl 564 24,000 13,536,000
2 Alerfed* Tripolidin 2,5mg+pseudofedrin 60mg box/50 119 70,000 8,330,000
3 ALGANAX TABLET 0,5 Alprazolam 0,5mg box/40 54 104,000 5,616,000
4 Amiclav* Amoxycilin Trihydrate, Potassium Clavlulanate box/30 44 300,000 13,200,000
5 ANALTRAM KAPLET Tramadol+Paracetamol box/30 282 225,000 63,450,000
6 Apialys Syr Vit A, Vit D, Vit B1, Vit B2 Btl 162 27,500 4,455,000
7 CALNIC PLUS SYR Calsium 400 mg, Vit B3 200 mg Btl 135 50,000 6,750,000
8 CALNIC PLUS TAB Calsium 400 mg, Vit B3 200 mg Box/30 66 105,000 6,930,000
9 Carbisol 5 mg Bisoprol Fumarate 5mg Box/100 24 325,000 7,800,000
10 Cefarin* Cefotaxime 1gr Vial 10 130,000 1,300,000
11 Cefarox* Cefixime 100mg box/20 85 340,000 28,900,000
12 Cefarox Syr* Cefixime 100mg/5ml btl 160 75,000 12,000,000
13 Clinex 300* Cindamycin 300 BOX/30 59 187,500 11,062,500
14 Cupanol Syr* Paracetamol 120mg btl 506 18,000 9,108,000
15 DISFLATYL 40 Dimetylpolisiloksan Aktif 40mg box/100 44 50,500 2,222,000
16 Domperidon 10 mg Domperidon Box/100 56 36,693 2,054,808
17 Elox Cr*10 gr Mometasone Furoate 0.1 % tube 130 65,000 8,450,000
Fe gluconat,folic acid,magan sulfat,copper sulfat,vit
18 Emibion* box/100 120,000 5,040,000
B12,Vit C,sorbitol 42
19 Eraphage 500 * Metformin Hidroklorida 500 mg box/100 53 120,000 6,360,000
20 ETHIGOBAL CAP 500 MG Mecobalamin500mg box/50 201 97,500 19,597,500
21 ETHIGOBAL Inj Mecobalamin500mc/ampulg Box/6 amp 54 116,400 6,285,600
22 Evothyl 100 * Fenofibrate100mg BOX/30 12 117,000 1,404,000
23 Evothyl 300 * Fenofibrate300mg BOX/30 12 297,000 3,564,000
24 EXAFLAM 50 MG TABLET Potassium Diclopenac50mg box/50 130 120,000 15,600,000
25 Extropect * Potassium Diclopenac50mg BOX/50 76 47,500 3,610,000
26 Extropect Syr* Ambroxol Hcl 15mg/5ml btl 378 24,000 9,072,000
27 F.G. TROCHES 300'S Fradiomycin 2,5mg+Gramicidin 1,0mg box/300 15 285,000 4,275,000
28 Flu-Tab Paracetamol300mg,Phenyl12,5,Chlor 2mg Box/120 62 78,000 4,836,000
29 Forcanox* Itraconazole 100 mg BOX/18 12 351,000 4,212,000
30 Fosicol Syr* Thiamphenicol palmitat Btl 90 27,500 2,475,000
31 Fuladic Cr* Fusidic Acid 2% Tube 125 45,000 5,625,000
32 Fungasol Cr* Ketoconazole 2 % Tube 172 23,000 3,956,000
33 Fungasol* Ketoconazole 200 mg BOX/50 40 230,000 9,200,000
34 Gabapentin 300 mg Gabapentin 300 mg Box/30 24 150,000 3,600,000
35 Gastrolan* Lansoperazole 30mg BOX/20 94 240,000 22,560,000
36 Genicol cap* Thiamfenicol500 box/100 21 330,000 6,930,000
37 Glamarol 1* Glimepiride 1mg box/50 48 105,000 5,040,000
41 Goralgin Methampiron500mg,B1,B6,B12 Box/100 40 120,000 4,800,000
42 Gracef Inj* Ceftriaxone 1gr Vial 10 180,000 1,800,000
43 Grafix 500 mg Mefenamat Acid 500mg Box/50 74 67,500 4,995,000
44 Graphalac Syr Lactulosa 3,335 g/5 ml Btl 160 42,500 6,800,000
45 Grasivask 10* Amplodipine besylate 10 mg box/30 62 255,000 15,810,000
46 Grasivask 5* Amplodipine besylate 5 mg box/30 62 142,500 8,835,000
47 Gratamin Betamethasone 0.25mg,dexachlor 2mg BOX/50 66 65,000 4,290,000
48 Hustadin Syr Chlorpheniramie2mg/Dextromethorpan 10 mg Btl 505 16,500 8,332,500
49 Ketokonazol Cr 15 gr Ketokonazol Cr tube 315 6,364 2,004,660
50 L-BIO Ricestarch,Maltodextrin,7strainBakteri box/30 28 180,000 5,040,000
51 Leomoxyl* Amoxycilin 500 mg box/100 37 285,000 10,545,000
52 Loran Loratadin 10 mg Box/30 24 132,000 3,168,000
53 Loratadine Loratadine Box/50 86 15,140 1,302,040
54 MAGANOL KAPLET Paracetamol500 box/120 110 49,200 5,412,000
55 MECOLIN Methycobalamin 500mg box/50 60 90,000 5,400,000
56 MOMETASONE FUROATE 10 gr MOMETASONE FUROATE tube 282 20,250 5,710,500
57 Moretic Drop Paracetamol 60 mg/0,5 ml Btl 110 27,500 3,025,000
58 Nerva Plus* Folid Acid 400mcg,Vitamin B1 100 mg, Vitamin B6 200 mg, BOX/50 125 112,500 14,062,500
59 Neurohax 5000 mg Vit B1 100 mg,Vit B6 200mg,Vit B12 5000mcg Box/50 119 100,000 11,900,000
60 NORESTIL Tab Noresthisteron box/30 41 120,000 4,920,000
61 Nyndia Drop Nystatin 100.000 IU / ml btl 30 35,000 1,050,000
62 Opox* Loperamide 2 mg box/60 51 72,000 3,672,000
63 Ositin Glucosamine 400 mg, chondroitin 250 mg Box/20 180 126,000 22,680,000
64 Osteokom Glucosamine 0,3 % , chondroitin 2% Box/30 - 0 -
65 Piracetam 1200 Piracetam 1200 Box/100 6 117,600 705,600
66 Profim* Cefixime 100 mg box/30 - 0 -
67 Promezole* Omeprazole 20 mg box/20 - 0 -
68 Propepsa syr 200 Sucralfate 500 mg / 5 ml btl 462 80,000 36,960,000
69 Prosinal Syr* Ibuprofen 100 mg / 5 ml btl 222 20,000 4,440,000
70 Pyrazinamide 500 mg Pyrazinamide 500 mg Box/100 - 0 -
71 Ratinal* Ranitidine 150 mg box/30 72 126,000 9,072,000
72 Rydian Cetirizine 10 mg Box/30 82 114,000 9,348,000
Aluminium hidroksida gel kering 200 mg, Magnesium
73 Stromag box/100 69,000 4,347,000
hidroksida 200 mg, Dimetikon 40 mg 63
74 Tranec 500 Asam Traneksamat Box/50 51 140,000 7,140,000
75 Triocol 0,25 Calcitriol Box/30 12 186,000 2,232,000
76 Triocol 0,5 Calcitriol Box/30 12 300,000 3,600,000
77 Unalium 10* Flunarizine 10 mg box/40 51 264,000 13,464,000
78 Unalium 5* Flunarizine 5 mg box/40 51 196,000 9,996,000
79 Vioquin 500* Ciprofloxacin 500mg box/30 26 375,000 9,750,000
80 Vocefa 500* Cefadroxil 500 mg box/30 37 277,500 10,267,500
81 Vocefa F Syr* Cefadroxil 250 mg / 5 ml btl 164 66,000 10,824,000
82 Vocefa Syr* Cefadroxil 125 mg / 5 ml btl 195 40,000 7,800,000
83 Vomistop FT* Domperidone10mg BOX/30 142 105,000 14,910,000
84 VOMISTOP SUSPENSI Domperidone5mg btl 258 30,000 7,740,000
85 Voxin Levofloxacin500 Box/20 42 650,000 27,300,000
86 ZEMINDO Syrup Oxomemazine1,65mg,guaifenesin33,3mg btl 498 32,500 16,185,000
87 Zibramax* Azithromycin 500 mg BOX/6 36 198,000 7,128,000
88 Progesic Tab Paracetamol 500 mg Box/100 18 42,500 765,000
89 Tro Urine Bag T-Type Urine Bag Pcs 24 11,500 276,000
90 Pharmafix 5 x 5 Pharmafix 5 x 5 Rol 75 37,000 2,775,000
91 Pharmafix 10 x 5 Pharmafix 10 x 5 Rol 69 70,500 4,864,500
92 Pharmafix 15 x 5 Pharmafix 15 x 5 Rol - 0 -
93 Flunarizine 5 mg Flunarizine 5 mg box/40 45 50,000 2,250,000
94 Flunarizine 10 mg Flunarizine 10 mg box/40 45 80,000 3,600,000
95 Estin syr Cetrizine HCl Btl 158 50,000 7,900,000
96 Tro Soluset G Infusion Tro Soluset G Infusion Pcs 24 9,000 216,000
97 Erdomex syr Erdostein btl 126 40,000 5,040,000
98 Lasal Syr Salbutamol Btl 186 23,000 4,278,000
Bilberry dry extract, Retinol, B-Carotene, Vit. E, Lutein,
99 Eyebright Box/30 135,000 3,240,000
Zeaxanthin, Selenium, Zinc 24
100 Simfix 200 Cefixime 200 mg Box/10 122 200,000 24,400,000
101 Alganax tab 0,25 Alprazolam 0,25mg Box/40 62 64,000 3,968,000
102 Ratinal Inj 2 ml Ranitidine Box/5 26 100,000 2,600,000
103 Solvinex Cap Bromnexina Box/100 35 44,000 1,540,000
104 Elgran 1 mg Estazolam Box/50 36 120,000 4,320,000
105 Clixid Clidinium, Chlordiazepoxida Box/100 12 80,000 960,000
JUMLAH 811,978,208
PPN 10% 81,197,821
JUMLAH KESELURUHAN 893,176,029
Dibuat oleh, Diperiksa oleh, Ditetapkan Oleh, Disetujui Oleh,

Apoteker Manager Umum/SDM/Pemasaran Manager Operasional/Pengembangan Direktur
Rini Yulianti, S.Si., Apt Erwin Maulana Lubis, SE., M.Fin dr. Hary Andriyanto dr. Heddy Lubis
PT. NUSA LIMA MEDIKA HARGA PERHITUNGAN SENDIRI / (OE)
No. AU-31 /PTNLM/AU-31.4/I/2017 Nomor : PTNLM/HPS/POAL/ /I /2017

OBYEK PEKERJAAN Tanggal : 13 DESEMBER 2016
PENGADAAN OBAT-OBATAN DAN ALAT KESEHATAN HABIS PAKAI PAKET I KEBUTUHAN
SEMESTER - I/2017 UNTUK KLINIK PT. NUSA LIMA MEDIKA
UNIT KLINIK PT NUSALIMA MEDIKA ( 7 KLINIK)
SUMBER DATA/INFORMASI
ESTIMASI HARGA PENETAPAN
PEMBELIAN YANG LALU JUMLAH HARGA
NO NAMA DAGANG KOMPOSISI KEMASAN / SATUAN JUMLAH FISIK SATUAN AU-31 HARGA AGEN HARGA PASAR HARGA SATUAN KETERANGAN/ANALISA
(Rp.)
(Rp.) /PRICE LIST (Rp.) (Rp.) HPS/OE (Rp.)
HARGA (Rp) BULAN
1 2 3 4 5 6 7 8 9 10 11 12=11*5 7=6*110%
1 Acyclovir BOX/50 71 36,110 36,110 36,110 2,563,810
2 Acyclovir Cr TUBE 254 3,303 3,303 3,303 838,962
3 Allopurinol 100 BOX/100 68 13,000 13,000 13,000 884,000
4 Allopurinol 300 BOX/100 68 25,000 25,000 25,000 1,700,000
5 Ambroxol BOX/100 45 19,362 19,362 19,362 871,290
6 Amlodipine 10 BOX/30 393 46,182 46,182 46,182 18,149,526
7 Amlodipine 5 BOX/30 368 26,182 26,182 26,182 9,634,976
8 Amoxicillin BOX/100 78 48,342 48,342 48,342 3,770,676
9 Amoxicillin Syr BTL 310 4,242 4,242 4,242 1,315,020
10 Antasida BOX/100 57 26,400 26,400 26,400 1,504,800
11 Otsu NS BTL 1343 13,200 13,200 13,200 17,727,600
12 Otsu RL BTL 216 13,200 13,200 13,200 2,851,200
13 Captopril 12,5 BOX/100 58 8,591 8,591 8,591 498,278
14 Captopril 25 BOX/100 81 13,149 13,149 13,149 1,065,069
15 Cefadroxil BOX/100 70 76,364 76,364 76,364 5,345,480
16 Cefadroxil Syr BTL 292 7,455 7,455 7,455 2,176,860
17 Cefixime 100 mg BOX/50 120 108,845 108,845 108,845 13,061,400
18 Cefixime Syr BTL 274 27,500 27,500 27,500 7,535,000
19 Cefotaxime Inj VIAL 349 21,021 21,021 21,021 7,336,329
20 Cetirizine 5 strip @ 10 120 14,250 14,250 14,250 1,710,000
21 Ciprofloxacin 500 mg BOX/50 110 26,376 26,376 26,376 2,901,360
22 Co-Amoxyclav 625 BOX/30 62 158,404 158,404 158,404 9,821,048
23 CTM BOX/100 34 16,128 16,128 16,128 548,352
24 Glibenclamide BOX/100 68 9,618 9,618 9,618 654,024
25 Glimepiride 1 BOX/50 79 22,000 22,000 22,000 1,738,000
26 Glimepiride 2 BOX/50 97 40,000 40,000 40,000 3,880,000
27 Glimepiride 3 BOX/50 73 60,000 60,000 60,000 4,380,000
28 Glimepiride 4 BOX/50 67 80,000 80,000 80,000 5,360,000
29 Ibuprofen 400 BOX/100 38 19,572 19,572 19,572 743,736
30 Lansoprazole BOX/20 442 24,570 24,570 24,570 10,859,940
31 Methylprednisolon 4 mg BOX/100 158 42,053 42,053 42,053 6,644,374
32 Omeprazole BOX/30 220 11,136 11,136 11,136 2,449,920
33 Ranitidine BOX/100 59 20,475 20,475 20,475 1,208,025
34 Ranitidine Inj BOX/25 31 55,692 55,692 55,692 1,726,452
35 Simvastatin 10 BOX/30 194 13,991 13,991 13,991 2,714,254
36 Simvastatin 20 BOX/30 194 28,000 28,000 28,000 5,432,000
37 Thiamphenicol BOX/100 20 89,510 89,510 89,510 1,790,200
38 Infus Set Macro Pcs 681 13,400 13,400 13,400 9,125,400
39 Infus Set Micro Pcs 93 19,000 19,000 19,000 1,767,000
40 Iv Cath 18 Pcs 63 27,000 27,000 27,000 1,701,000
41 IV Cath 20 Pcs 63 27,000 27,000 27,000 1,701,000
42 IV Cath 22 Pcs 63 27,000 27,000 27,000 1,701,000
43 IV Cath 24 Pcs 63 27,000 27,000 27,000 1,701,000
44 Spuit 1 cc Pcs 826 6,400 6,400 6,400 5,286,400
45 Spuit 3 cc Pcs 345 4,600 4,600 4,600 1,587,000
46 Spuit 5 cc Pcs 915 5,600 5,600 5,600 5,124,000
47 Spuit 10 cc Pcs 825 7,300 7,300 7,300 6,022,500
48 Spuit 20 cc Pcs 1200 12,700 12,700 12,700 15,240,000
49 Benoxuric 100* BOX/100 73 180,000 180,000 180,000 13,140,000
50 Benoxuric 300* BOX/100 73 320,000 320,000 320,000 23,360,000
51 Benozym* BOX/100 49 200,000 200,000 200,000 9,800,000
52 Dextamin* BOX/100 61 165,000 165,000 165,000 10,065,000
53 Droxefa* BOX/50 0 - - - -
54 Inhipraz* BOX/10 209 120,000 120,000 120,000 25,080,000
55 Lovask 5* BOX/30 73 150,000 150,000 150,000 10,950,000
56 Lovask 10* BOX/30 81 255,000 255,000 255,000 20,655,000
57 Oralit BOX/100 35 36,278 36,278 36,278 1,269,730
58 Merislon 12* BOX/100 29 637,356 637,356 637,356 18,483,324
59 Clopidogrel* BOX/30 399 283,500 283,500 283,500 113,116,500
60 Alkohol 96% LTR 54 30,600 30,600 30,600 1,652,400
61 ATS Inj 1500 iu Amp 30 115,000 115,000 115,000 3,450,000
62 Myonal Box/100 97 683,964 683,964 683,964 66,344,508
63 Atorvastatin 20 mg Box/30 439 120,000 120,000 120,000 52,680,000
64 Betahistin Mesylat Box/100 33 25,200 25,200 25,200 831,600
65 Cairan D5 Btl 114 13,200 13,200 13,200 1,504,800
66 Cairan D5+1/2NS Btl 114 14,000 14,000 14,000 1,596,000
67 Spirolacton 25 Box/100 24 120,238 120,238 120,238 2,885,712
68 Povidone Iodine Btl/1000 62 75,000 75,000 75,000 4,650,000
69 Natrium Diklofenac 25 5 str x 10's 97 8,892 8,892 8,892 862,524
70 Natrium Diklofenac 50 5 str x 10's 121 12,369 12,369 12,369 1,496,649
71 Pariet 10 Box/14 90 236,997 236,997 236,997 21,329,730
72 Pariet 20 Box/14 90 267,311 267,311 267,311 24,057,990
73 VERTIZINE tablet Box 100 Tab. 25 220,000 220,000 220,000 5,500,000
74 Piracetam 400 mg / 50 tablet 5 strip @ 10 25 20,500 20,500 20,500 512,500
75 Piracetam 800 mg / 50 kaplet 5 strip @ 10 23 36,500 36,500 36,500 839,500
76 Aesculab/pisau bisturi pcs 176 3,300 3,300 3,300 580,800
77 Antalgin 500 mg Box 100 Tab. 99 21,190 21,190 21,190 2,097,810
78 Dios Tss/3 x 10's Box/30 74 115,000 115,000 115,000 8,510,000
79 Cotrimoxazol 480 mg 10 str x 10s 66 18,000 18,000 18,000 1,188,000
80 Cotrimoxazole Susp/60 ml Btl 60 ml 228 4,945 4,945 4,945 1,127,460
81 41 165,000 165,000 165,000 6,765,000

Daryant-tulle 10x10 Box/10
82 Digoxin 0,25 mg Tab Kotak 100 ( 10 Strip @ 10 Tablet ) Kotak 100 24 12,987 12,987 12,987 311,688
83 FARBIVENT Box/10 Amp 0 - - - -
84 Farsix Box/100 24 108,900 108,900 108,900 2,613,600
85 Fask Mask Lbr 2500 860 860 860 2,150,000
86 Gammex 7 (Sarung Tangan Steril ) Box/pairs 228 16,000 16,000 16,000 3,648,000
87 Gammex 7,5 (Sarung Tangan Steril ) Box/ pairs 228 16,000 16,000 16,000 3,648,000
88 Gammex 8 (Sarung Tangan Steril ) Box/ pairs 228 16,000 16,000 16,000 3,648,000
89 Kapas 1 kg roll 12 49,500 49,500 49,500 594,000
90 Kapsul No. 0 Sak 4 45,000 45,000 45,000 180,000
91 Kapsul No. 00 Sak 2 75,000 75,000 75,000 150,000
92 Kapsul No. 1 Sak 2 42,000 42,000 42,000 84,000
93 Kapsul No. 2 Sak 6 40,000 40,000 40,000 240,000
94 Lidocain 2% Inj/100 100 amp x 2 ml 17 104,580 104,580 104,580 1,777,860
95 Lyncomycin 500 mg/5x10 5 x 10 43 77,318 77,318 77,318 3,324,674
96 Mucosta Tablet Box/100 36 417,900 417,900 417,900 15,044,400
97 Needle 23 box/100 24 170,000 170,000 170,000 4,080,000
98 Ondansetron 8 mg tab - Ktk 12 Kotak 12 48 27,600 27,600 27,600 1,324,800
99 Pehacain Inj/20 Dos. 20 amp 34 56,601 56,601 56,601 1,924,434
100 Pletaal 50 mg Box 100 Tab. 36 733,100 733,100 733,100 26,391,600
101 Ristonate Box/4 12 290,000 290,000 290,000 3,480,000
102 Salofalk 500 mg Box / 100 12 1,128,000 1,128,000 1,128,000 13,536,000
103 Simarc Box/100 38 136,500 136,500 136,500 5,187,000
104 Tramadol 50 mg 5 strip @ 10 54 15,368 15,368 15,368 829,872
105 Dexamethazon 0.5 mg Inj/ Box 53 191,100 191,100 191,100 10,128,300
106 Salbutamol 2mg Box 163 8,453 8,453 8,453 1,377,839
107 Salbutamol 4mg Box 163 10,605 10,605 10,605 1,728,615
108 Asam Mefenamat 500 mg Box/100 118 20,160 20,160 20,160 2,378,880
109 Meloxicam 7,5 mg Box/50 109 33,023 33,023 33,023 3,599,507
110 Meloxicam 15 mg Box/50 109 57,225 57,225 57,225 6,237,525
111 Dexamethazon 0.5 mg Box/100 0 - - - -
112 Furosemide 40 mg Box/100 129 16,521 16,521 16,521 2,131,209
113 Metformin 500 mg Box/100 205 31,450 31,450 31,450 6,447,250
114 Metronidazole 500 mg Box/100 91 28,275 28,275 28,275 2,573,025
115 Cotrimoxazole Box/100 0 - - - -
116 Cotrimoxazole Susp/60 ml Btl 0 - - - -
117 Burnazin Cr 35 g Tube 82 48,950 48,950 48,950 4,013,900
118 Trihexypenidil 2 mg Box/100 70 10,500 10,500 10,500 735,000
119 Amitriphilin 25 Box/100 90 15,585 15,585 15,585 1,402,650
120 Urdafalk Box/30 60 312,785 312,785 312,785 18,767,100
121 ISDN 5 mg Box/100 193 11,184 11,184 11,184 2,158,512
122 Asam Tranexamat inj Box/10 24 100,000 100,000 100,000 2,400,000
123 Kasa Steril Ktk 282 5,500 5,500 5,500 1,551,000
124 Face mask Bok/50 18 28,650 28,650 28,650 515,700
125 Silk Braided 2/0 DS 24 Pcs 62 50,000 50,000 50,000 3,100,000
126 Silk 0 DS 24 @ 12 Pcs 68 50,000 50,000 50,000 3,400,000
127 Irbesartan 300 Box/50 24 140,000 140,000 140,000 3,360,000
128 Irbesartan 150 Box/50 24 90,000 90,000 90,000 2,160,000
129 Piroxicam 20 mg Box/120 73 23,340 23,340 23,340 1,703,820
130 Gentamycin salep kulit Tube 336 1,668 1,668 1,668 560,556
131 Levofloxacim 500 mg Box/50 73 52,440 52,440 52,440 3,828,120
132 Fenofibrate 100 mg Box/30 26 60,000 60,000 60,000 1,560,000
133 Fenofibrate 300 mg Box/30 14 120,000 120,000 120,000 1,680,000
134 Domperidon Syr Btl 244 11,500 11,500 11,500 2,806,000
135 Bisoprolol 5 mg Box/100 189 60,500 60,500 60,500 11,434,500
136 Salbutamol 2 mg Syr Btl 0 - - - -
137 Keterolac Inj 1% Box/12 57 26,775 26,775 26,775 1,526,175
138 Keterolac Inj 3% Box/12 51 28,980 28,980 28,980 1,477,980
139 Ibuprofen 200 @100 Btl 66 18,900 18,900 18,900 1,247,400
140 EPREX 4000 Inj Amp 60 530,250 530,250 530,250 31,815,000
141 AvF 16 Gx25 mm Set 0 18,300 18,300 18,300 -
142 Bi bag,GB/D/F/NL 650 G Set 0 138,800 138,800 138,800 -
143 Blood Line A/V Set 22 m Set 0 164,400 164,400 164,400 -
144 F-Hemosol Patr A Set 0 150,000 150,000 150,000 -
145 Fistula needle 16G Ven FXD Set 0 18,300 18,300 18,300 -
146 Hemoflow fresenius F7 Hps Set 0 332,200 332,200 332,200 -
147 Ariccept Evess 10 mg Box/28 14 738,970 738,970 738,970 10,345,580
148 Abu/Biosave Box/Vial 24 430,000 430,000 430,000 10,320,000
149 Acetosal 100 mg Box/100 36 18,552 18,552 18,552 667,872
150 Alkohol 70% btl 37 27,000 27,000 27,000 999,000
151 Betametason Cr 0,1 % Tube/5 gr 334 2,520 2,520 2,520 841,680
152 Citicolin 500 mg Box/30 30 180,000 180,000 180,000 5,400,000
153 Clindamicin 150 mg Box/50 38 36,200 36,200 36,200 1,375,600
154 Clindamicin 300 mg Box/50 38 62,520 62,520 62,520 2,375,760
155 Eperisone HCl 50 mg Box/100 38 140,000 140,000 140,000 5,320,000
156 Hydrocortisone Cr 2,5% Tube/5 gr 400 4,967 4,967 4,967 1,986,800
157 Kasa Steril Kamsa Ktk 30 5,500 5,500 5,500 165,000
158 Losartan 10 mg Box/50 12 90,909 90,909 90,909 1,090,908
159 Losartan 50 mg Box/30 12 126,000 126,000 126,000 1,512,000
160 Mecobalamin 500 mg Box/100 86 70,000 70,000 70,000 6,020,000
161 Otsu D5 Btl 60 13,200 13,200 13,200 792,000
162 Paracetamol Syrup Btl/60 ml 750 4,441 4,441 4,441 3,330,750
163 Ramipril 10 Mg Box/30 60 30,510 30,510 30,510 1,830,600
164 Ramipril 5 zmg Box/100 24 57,727 57,727 57,727 1,385,448
165 Sucralfate Syr 500 mg j Btl/200 ml 60 66,000 66,000 66,000 3,960,000
166 Triamsinolone 4 mg Box/100 12 72,450 72,450 72,450 869,400
167 Ursodeoxycholic 250 MG Box/30 60 126,000 126,000 126,000 7,560,000
168 Nifural syr Btl 178 51,923 51,923 51,923 9,242,294
169 Kasa Hidrofil DRC roll 45 210,210 210,210 210,210 9,459,450
170 Enzyplex Tab 7000 821 821 821 5,747,000
171 Candesartan 8mg Tab 3600 4,500 4,500 4,500 16,200,000
172 Candesartan 16mg Tab 3600 6,500 6,500 6,500 23,400,000
173 Surgicryl 2/0 HR 26 Pcs 31 87,000 87,000 87,000 2,697,000
174 Catgut Chromic 3/0 DS 24 Pcs 31 62,500 62,500 62,500 1,937,500
175 Catgut Chromic 2-0 100 M Roll 6 2,427,000 2,427,000 2,427,000 14,562,000
176 Silk Black 1 DS 24 Pcs 25 50,000 50,000 50,000 1,250,000
177 Valsartan 160 mg Tab 3600 7,150 7,150 7,150 25,740,000
178 Valsartan 80 mg Tab 3600 4,400 4,400 4,400 15,840,000
179 Tranfusi Set Pcs 120 25,500 25,500 25,500 3,060,000
180 Nacl 1000ml Btl 60 16,000 16,000 16,000 960,000
181 Ambroxol Syr Btl 0 3,297 3,297 3,297 -
JUMLAH 1,102,947,931
PPN 10% 110,294,793
JUMLAH KESELURUHAN 1,213,242,724
Dibuat Oleh Diperiksa Oleh Ditetapkan oleh Disetujui oleh,

Apoteker Manajer SDM/Umum/Pemasaran Manajer Operasional/Pengembangan Direktur
Rini Yulianti, S.Si,Apt. Erwin Maulana Lubis, SE., M.Fin dr. Hary Andriyanto dr. Heddy Lubis
No. Dok. FM-AKT-AU-32.1 No. Revisi : 00 Tgl. 01-08-2000 Halaman :…………………… dari :…………………….
TOTAL PEMAKAIAN ANGGARAN OBAT-OBATAN
SEMESTER I TAHUN 2017
Total Anggaran yang
No. Uraian Anggaran Tahun 2017 Anggaran Persemester Digunakan Persemester + PPN Selisih Anggaran
(10%)
1 Klinik Utama Nusa Lima Rp 3,659,820,000 Rp 1,829,910,000 Rp 1,283,434,685 Rp 546,475,315
2 Klinik Pratama Nusa Lima Rp 3,609,473,684 Rp 1,804,736,842 Rp 1,551,346,313 Rp 253,390,529
3 Klinik Sei. Lindai Rp 103,126,316 Rp 51,563,158 Rp 47,525,234 Rp 4,037,924
4 Klinik Sei. Galuh Rp 323,431,579 Rp 161,715,789 Rp 109,641,268 Rp 52,074,522
5 Klinik Terantam Rp 422,242,105 Rp 211,121,053 Rp 211,117,161 Rp 3,891
6 Klinik Lubuk Dalam Rp 329,447,368 Rp 164,723,684 Rp 127,263,151 Rp 37,460,533
7 Klinik Sei. Rokan Rp 631,578,947 Rp 315,789,474 Rp 315,787,293 Rp 2,180
8 RS. Tandun Rp 4,063,052,632 Rp 2,031,526,316 Rp 2,026,450,975 Rp 5,075,341
TOTAL Rp 13,142,172,632 Rp 6,571,086,316 Rp 5,672,566,080 Rp 898,520,236
Diperiksa oleh, Disetujui oleh,
Rini Yulianti, SSi, Apt. dr. Hary Andrianto

(Apoteker) (Manajer Operasional)

No. Nama Obat /alkes Satuan Nusa Lima Galuh Ldalam Lindai Terantam Rokan JML Total Harga Jumlah Fisik 6 Klinik Satuan Harga

Uploaded by

Copyright:

Available Formats

No. Nama Obat /alkes Satuan Nusa Lima Galuh Ldalam Lindai Terantam Rokan JML Total Harga Jumlah Fisik 6 Klinik Satuan Harga

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

No. Nama Obat /alkes Satuan Nusa Lima Galuh Ldalam Lindai Terantam Rokan JML Total Harga Jumlah Fisik 6 Klinik Satuan Harga

Uploaded by

Copyright:

Available Formats

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

PT. NUSALIMA MEDIKA

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

KEBUTUHAN OBAT-OBATAN & ALKES KLINIK PRATAMA /FASKES PRIMER

Diminta Oleh Disetujui Oleh

( Rini Yulianti SSi ,Apt ) ( dr. Hary Andriyanto )

Ka. Unit RS Tandun

###Pervita box ### ### - ### - - - - - - - - - ###

###Pibaksin Oint Tube ### ### -

###Sanadryl plus e Fls ### ### - ### - - - - - - - - - ###

Ka. Unit RS Sri Rokan

PERMINTAAN SUMBER DATA/INFORMASI PENETAPAN

5 Becom-C film-coat BOX 12 30 12 54 117,000 ### 117,000 6,318,000 ###

6 Biothicol dry syru Fls 0 0 72 72 18,440 18,440 18,440 1,327,680 ###

PERMINTAAN SUMBER DATA/INFORMASI PENETAPAN

33 Pervita box 18 0 0 18 120,000 ### 120,000 2,160,000 ###

34 Pibaksin Oint Tube 90 0 0 90 36,145 36,145 36,145 3,253,050 ###

43 San-B Plex P. drop Fls 60 0 0 60 15,220 15,220 15,220 913,200 ###

47 Sanmag/100 tab box 12 0 11 23 65,000 65,000 65,000 1,495,000 ###

48 Sanmol P. drops Fls 90 0 30 120 13,740 13,740 13,740 1,648,800 ###

60 Tuzalos/100 cpt Box 30 0 48 78 64,000 64,000 64,000 4,992,000

61 Urotractin/60 cps box 6 30 48 84 171,000 ### 171,000 14,364,000

PERMINTAAN SUMBER DATA/INFORMASI PENETAPAN

JUMLAH ### ###

Dibuat Oleh Diperiksa Oleh Ditetapkan oleh Disetujui oleh,

Ast. Urs. Farmasi Ka. Urs. Kesehatan Kepala Bagian

Rini Yulianti, S.Si., Apt drg. Wiwik Widiati

1 Acyclovir BOX/50 4 4 8 4 4 4 12 20 30,100

2 Acyclovir Cr TUBE 10 10 20 10 10 10 30 50 3,007

3 Allopurinol 100 BOX/100 4 4 8 4 4 4 12 20 12,000

4 Allopurinol 300 BOX/100 4 4 8 4 4 4 12 20 25,000

5 Ambroxol BOX/100 2 2 4 2 2 2 6 10 14,200

6 Amlodipine 10 BOX/30 20 20 40 20 20 20 60 100 46,170

7 Amlodipine 5 BOX/30 20 20 40 20 20 20 60 100 26,190

8 Amoxicillin BOX/100 3 3 6 3 3 3 9 15 40,300

9 Amoxicillin Syr BTL 20 20 40 20 20 20 60 100 3,532

10 Antasida BOX/100 2 2 4 2 2 2 6 10 14,700

11 Cairan NS BTL 10 10 20 10 10 10 30 50 8,300

12 Cairan RL BTL 10 10 20 10 10 10 30 50 8,182

13 Captopril 12,5 BOX/100 2 2 4 2 2 2 6 10 8,200

14 Captopril 25 BOX/100 2 2 4 2 2 2 6 10 12,500

15 Cefadroxil BOX/100 2 2 4 2 2 2 6 10 76,400

16 Cefadroxil Syr BTL 15 15 30 15 15 15 45 75 9,310

17 Cefixime BOX/50 8 8 16 8 8 8 24 40 85,750

18 Cefixime Syr BTL 20 20 40 20 20 20 60 100 28,875

19 Cefotaxime Inj VIAL 10 10 20 10 10 10 30 50 5,958

20 Cetirizine 5 strip @ 10 6 6 12 6 6 6 18 30 14,300

21 Ciprofloxacin BOX/100 2 2 4 2 2 2 6 10 44,000

22 Co-Amoxyclav 625 BOX/30 3 3 6 3 3 3 9 15 137,760

23 CTM BOX/100 4 4 8 4 4 4 12 20 8,100

24 Glibenclamide BOX/100 2 2 4 2 2 2 6 10 6800

25 Glimepiride 1 BOX/50 2 2 4 2 2 2 6 10 34,550

26 Glimepiride 2 BOX/50 2 2 4 2 2 2 6 10 68,400