FORMULIR RENCANA KEBUTUHAN BELANJA UNIT

RSUD JOHAR BARU

TAHUN ANGGARAN 2022
UNIT : FARMASI - OBAT OBATAN

URAIAN KOEFISIEN HARGA SATUAN +

NO NAMA KOMPONEN PPN 10% TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN
2 3 4 5 7 8 = ∑8 11

1,890,687,958
1 ACARBOSE 100 MG TABLET 43,000 TABLET 1,267 54,490,632
2 ACARBOSE 50 MG TABLET 10,000 TABLET 958 9,576,000
3 ACETYLCYSTEIN 200 MG TABLET 20,000 TABLET 541 10,823,782
4 ACYCLOVIR 200 MG TABLET 1,400 TABLET 331 463,638
5 ACYCLOVIR 400MG TABLET 300 TABLET 678 203,490
6 ACYCLOVIR KRIM 5 GRAM 25 TUBE 6,574 164,361
7 ACYCLOVIR SALEP MATA 3% 25 TUBE 26,467 661,675
8 ADALAT OROS 30 MG TABLET 2,000 TABLET 5,776 11,551,848
9 ADENOSIN INJ 3 MG/ML 15 VIAL 74,214 1,113,210
10 ALBENDAZOL 400 MG TAB 100 TABLET 573 57,323
11 ALLOPURINOL 100 MG TABLET 6,000 TABLET 168 1,005,480
12 ALPRAZOLAM 1 MG TABLET 200 TABLET 372 74,374
13 AMBROXOL 30 MG TABLET 5,000 TABLET 410 2,048,200
14 AMINOPHYLIN 200 MG TABLET 100 TABLET 209 20,908
15 AMINOPHYLLIN 24 MG/INJ 20 AMPUL 3,709 74,187
16 AMITRIPILIN 25 MG TABLET 1,000 TABLET 501 501,144
17 AMLODIPIN 10 MG TABLET 30,000 TABLET 158 4,740,120
18 AMLODIPIN 5 MG TABLET 2,000 TABLET 323 646,380
19 AMOXYCILLIN 500 MG KAPLET 5,000 TABLET 460 2,298,240

20 AMOXYCILLIN FORTE 240MG/5ML DRY SYRUP 200 BOTOL 5,790 1,158,058

21 AMOXYCILLIN SYRUP 125MG/5MG 400 BOTOL 4,788 1,915,200

AMPICILLIN + SULBACTAM 1,5 GRAM INJEKSI
22 ( BACTESYN INJ 1,5 GRAM ) 100 VIAL 26,613 2,661,330

23 AMPICILLIN 1 GR INJ 450 AMPUL 11,377 5,119,593

24 ANTALGIN 1000 MG/2 ML INJEKSI 50 AMPUL 4,655 232,750
25 ANTALGIN 500 MG TABLET 200 TABLET 239 47,880
26 ANTASIDA SYRUP 150 BOTOL 3,398 509,683
27 ANTIHEMOROID SUPPOSITORIA 100 SUPPOS 5,055 505,453
28 AQUA PRO INJEKSI 20 ML 3,200 KOLF 2,570 8,222,592
ARDIUM 500 MG TABLET (EKSTRAK CITRUS
SINENSIS PERICARPUM SETARA DENGAN
29 DIOSMIN 90% DAN HESPERIDIN. MIKRONISASI 800 TABLET 14,364 11,491,200
FLAVONOID)
30 ASAM FOLAT 1 MG TABLET 13,000 TABLET 120 1,556,100
31 ASAM MEFENAMAT 500 MG TABLET 13,000 TABLET 492 6,390,384
32 ASAM TRANEKSAMAT 500 MG/5 ML INJ 50 AMPUL 3,313 165,665
33 ASAM TRANEKSAMAT TABLET 7,700 TABLET 1,475 11,355,221

34 ASAM VALPROAT 250 MG/5 ML SYRUP 120 ML 10 BOTOL 35,280 352,796

35 ATORVASTATIN 20 MG TAB 3,000 TABLET 1,333 3,997,980

36 ATRACURIUM BESYLATE INJEKSI 40 AMPUL 18,346 733,841
37 ATROPIN SULFAT 0,025MG/ML INJ 220 AMPUL 2,616 575,486
38 AVAMYS NASAL SPRAY 250 TUBE 168,830 42,207,550
39 AZITHROMICYN 500 MG TABLET 6,500 TABLET 2,601 16,907,891
40 BASAGLAR KWIKPEN 900 PEN 118,370 106,533,000
BASITRASIN 500 IU/G + POLIMIKSIN 10.000
41 IU/G 20 TUBE 3,887 77,739

42 BETAHISTIN MESILAT 6 MG TABLET 200 TABLET 176 35,112

43 BETAMETASON KRIM 0,1 % 5 GRAM 100 TUBE 2,469 246,901
44 BFLUID 500 ML INFUS 70 KOLF 101,479 7,103,530
45 BISAKODIL TABLET 5 MG 800 TABLET 3,591 2,872,800
46 BISOLVON 60 ML SOLUTIO 5 BOTOL 124,238 621,190
47 BISOPROLOL 2,5 MG TABLET 2,000 TABLET 999 1,998,192
48 BORAX GLISERIN ( GOM ARAB ) 60 TUBE 7,233 433,984
49 BUPIVACAIN HCl INJEKSI 10 AMPUL 28,954 289,541
50 BURNAZIN KRIM 70 TUBE 27,531 1,927,151
51 CALCII GLUCONAS 10 MG INJ 30 AMPUL 15,144 454,305
52 CALCIUM CARBONATE 500 MG TABLET 4,500 TABLET 931 4,189,500
CALCIUM POLYSTYRENE SULFONATE SERBUK 5
53 GRAM 50 PCS 7,142 357,097

54 CALPOROSIS D 500 MG (KALSIUM KARBONAT) 5,000 TABLET 572 2,859,434

 URAIAN KOEFISIEN HARGA SATUAN +
NO NAMA KOMPONEN PPN 10% TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN
2 3 4 5 7 8 = ∑8 11
55 CANDESARTAN 16 MG TABLET 11,000 TABLET 1,539 16,923,984
56 CANDESARTAN 8 MG TABLET 4,000 TABLET 870 3,479,280
57 CAPTOPRIL 12,5 MG TABLET 8,000 TABLET 120 957,600
58 CAPTOPRIL 50 MG TABLET 500 TABLET 322 161,196
59 CARBAMAZEPIN 200 MG TABLET 300 TABLET 391 117,306
60 CARBOGLISERIN 10% TETES TELINGA 300 TUBE 6,232 1,869,714
61 CATHEJELL 12,5 GRAM 300 TUBE 58,520 17,556,000
62 CEFADROXIL 500 MG KAPSUL 1,500 TABLET 931 1,396,500
63 CEFAZOLIN 1 GRAM INJEKSI 30 AMPUL 17,173 515,181
64 CEFEPIME INJ 100 AMPUL 31,983 3,198,251
65 CEFIXIME 100 MG KAPSUL 2,000 TABLET 1,954 3,907,008
66 CEFIXIME 100 MG/5 ML SYRUP 350 BOTOL 16,586 5,804,971
67 CEFIXIME 200 MG KAPSUL 12,000 TABLET 3,152 37,825,730
68 CEFOTAXIME 1 GRAM INJ 100 AMPUL 9,736 973,560
69 CEFTAZIDIME 1 GRAM INJ 300 AMPUL 14,165 4,249,351
70 CEFTRIAXONE 1 GRAM INJ 1,200 AMPUL 7,514 9,016,762
71 CENDO CENFRESH DROP 5 ML 150 TUBE 45,920 6,887,987
72 CENDO GENTA DROP 0.3% 5 ML 20 TUBE 69,183 1,383,652
73 CENDO GLAOPLUS MINIDOSES 1,000 MINIDOSE 29,260 29,260,000
74 CENDO GLAUCON TABLET 3,000 TABLET 5,003 15,010,380
75 CENDO LFX EYE DROP 0.5% 20 TUBE 91,181 1,823,630
76 CENDO LYTER TETES MATA MINIDOSES 2,500 MINIDOSE 5,351 13,377,306
77 CENDO MYDRIATIL 1% 10 TUBE 49,804 498,042
78 CENDO NATACEN MINIDOSE 10 STRIP/5 PCS 60,287 602,873
79 CENDO NONCORT MINIDOSE 70 STRIP/5 MD 66,015 4,621,074
80 CENDO PANTOCAIN TETES MATA 0.5 % 20 BOTOL 15,788 315,752
81 CENDO PANTOCAIN TETES MATA 2 % 20 BOTOL 17,252 345,049
82 CENDO POLYDEX 5 ML 10 BOTOL 47,072 470,720
83 CENDO P-PRED MINIDOSE 95 STRIP/5 MD 59,765 5,677,714
84 CENDO PROTAGENTA MINIDOSE 0,6 ML 100 STRIP/5 MD 46,711 4,671,093
85 CENDO TIMOL 0,5 % ( ISOTIC ADRETOR ) 1,400 BOTOL 17,995 25,192,860
86 CENDO TOBROSON DROP 5 ML 80 TUBE 60,897 4,871,790
87 CENDO TROPIN EYE DROP 1% 60 TUBE 21,546 1,292,760
88 CENDO XITROL EYE DROP 30 TUBE 43,092 1,292,760
89 CETIRIZIN 10 MG KAP 9,500 TABLET 158 1,503,565
90 CETIRIZIN 5 MG/5 ML SYRUP 400 BOTOL 5,047 2,018,940
91 CHLORAMPHENICOL 1% SALEP MATA 120 TUBE 3,203 384,317
CHLORAMPHENICOL 2% SALEP KULIT 15 GRAM
92 (BUFACETIN) 250 TUBE 5,174 1,293,558

93 CHLORAMPHENICOL 3 % EAR DROP 100 BOTOL 17,955 1,795,500

94 CHLORETHYL WALTER HILTER SPRAY 10 BOTOL 160,930 1,609,300
95 CHLORPROMAZIN HCL 100 MG TAB 200 TABLET 209 41,762
96 CIPROFLOXACIN 200 MG INFUS 150 KOLF 16,254 2,438,050
97 CIPROFLOXACIN 500 MG TABLET 3,000 TABLET 737 2,212,056
98 CITICHOLINE 250 MG/2 ML INJ 35 AMPUL 14,264 499,249
99 CLINDAMISINE 150 MG KAP 500 TABLET 951 475,475
100 CLINDAMISINE 300 MG KAP ( MILORIN ) 4,000 TABLET 1,707 6,826,198
101 CLONIDIN 0,15 MG TABLET 15,000 TABLET 622 9,336,600
102 CLONIDIN 0.15 MG/ML INJ (CATAPRES) 10 AMPUL 45,087 450,870
103 CLOPIDOGREL 75 MG TABLET 2,500 TABLET 2,241 5,601,960
104 CODEIN 20 MG TABLET 200 TABLET 2,073 414,694
105 CTM 4 MG TABLET (BOX/200) 1,000 TABLET 49 49,210
106 CURCUMA TABLET 25,000 TABLET 1,639 40,964,000
107 DEXAMETASON 5 MG/ML I.V INJ 2,000 AMPUL 1,750 3,500,560
108 DEXAMETHASONE 0,5 MG TABLET 6,600 TABLET 118 779,486
109 DEXTROSE 10% 500 ML INFUS 50 KOLF 12,773 638,639
110 DEXTROSE 40% 25 ML INF 200 KOLF 17,574 3,514,711
111 DEXTROSE 5% + 1/2 NS 500 ML INFUS 20 KOLF 16,694 333,883
112 DEXTROSE 5% + 1/4 NS 500 ML INFUS 20 KOLF 16,606 332,128
113 DEXTROSE 5% 500 ML INFUS 100 KOLF 10,577 1,057,669
114 DIAZEPAM 10 MG RECTAL TUBE (STESOLID) 70 TUBE 34,032 2,382,224
115 DIAZEPAM 2 MG TABLET 500 TABLET 1,813 906,528
116 DIAZEPAM 5 MG RECTAL TUBE (STESOLID) 20 TUBE 23,411 468,219
117 DIAZEPAM 5 MG TABLET 200 TABLET 3,173 634,570
118 DIAZEPAM 5MG/ML INJ 30 AMPUL 2,361 70,824
119 DIGOXIN 0.25MG/ML INJEKSI (FARGOXIN) 100 AMPUL 37,014 3,701,390
120 DIPHENHIDRAMIN HCL 10 MG/ML I.M INJ 70 AMPUL 9,831 688,195
121 DOBUTAMIN INJ 30 AMPUL 18,901 567,043
122 DOMPERIDONE 10 MG TABLET 1,000 TABLET 311 311,220
123 DOPAMET 250MG TABLET ( METHYLDOPA ) 4,500 TABLET 1,618 7,282,548
 URAIAN KOEFISIEN HARGA SATUAN +
NO NAMA KOMPONEN PPN 10% TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN
2 3 4 5 7 8 = ∑8 11
124 DOPAMIN 200 MG INJ ( CETADOP ) 65 AMPUL 9,948 646,646
125 DOXYCYCLINE 100 MG KAP 1,000 TABLET 565 564,984
126 DULCOLAX SUPP 10 MG ADULT 150 SUPPOS 9,416 1,412,460
127 DULCOLAX SUPP 5 MG PEDIATRIC 120 SUPPOS 26,846 3,221,526
128 DUVADILAN TABLET 350 TABLET 7,169 2,509,045
129 EFEDRIN INJEKSI 20 AMPUL 12,537 250,732
130 ERITROMISIN 500 MG TABLET 300 TABLET 1,756 526,680
131 ETHAMBUTOL 500 MG TABLET 1,500 TABLET 825 1,237,698
132 FENOFIBRAT 100 MG TABLET 7,500 TABLET 1,901 14,254,275
133 FENOFIBRAT 300 MG TABLET 2,000 TABLET 2,308 4,615,632
134 FENTANYL 0,05 MG/ML INJEKSI 20 AMPUL 101,532 2,030,644
135 FERRIZ DROP 12 ML 300 BOTOL 48,279 14,483,700
136 FLIXOTIDE NEBULE 100 PCS 21,562 2,156,196
137 FLUCONAZOLE 100 ML INFUS 20 KOLF 23,939 478,773
138 FORUMEN (NA-DOKUSAT 5 MG) EAR DROP 120 BOTOL 47,880 5,745,600
139 FUROSEMID 10 MG /ML INJEKSI 1,200 AMPUL 2,128 2,553,600
140 FUROSEMID 40 MG TABLET 6,000 TABLET 131 785,232
141 GABAPENTIN 100 MG TABLET ( ALPENTIN ) 7,000 TABLET 1,390 9,728,950
142 GEMFIBROZIL 600 MG TABLET 2,200 TABLET 1,352 2,973,986
143 GENTAMICIN 0,1% SALEP KULIT 550 TUBE 3,173 1,745,161
144 GENTAMICIN SALEP MATA 0.3% 3.5 GRAM 25 TUBE 3,558 88,944
145 GENTAMISIN 40 MG/ML INJ 175 AMPUL 12,954 2,266,985
146 GLIBENCLAMID 5 MG TABLET 1,000 TABLET 228 228,228
147 GLIMEPIRID 1 MG TABLET 1,200 TABLET 245 293,664
148 GLIMEPIRID 2 MG TABLET 12,000 TABLET 330 3,958,080
149 GLIMEPIRID 3 MG TABLET 2,500 TABLET 391 977,550
150 GLIMEPIRID 4 MG TAB 5,000 TABLET 359 1,795,500
151 GLIQUIDONE 30 MG TABLET 8,000 TABLET 1,596 12,768,000
152 HIDROKLOROTIAZIDA 25 MG TABLET 7,000 TABLET 305 2,132,836
153 HIDROKORTISON 2,5% 5 GR KRIM 100 TUBE 3,292 329,175
154 HIOSIN BUTILBROMIDA TABLET 500 TABLET 1,463 731,500
155 HUMALOG MIX 25 300 PEN 148,960 44,688,000
156 HYOSIAMIN BROMIDA INJEKSI 90 AMPUL 62,170 5,595,317

157 IBUPROFEN 125 MG SUPPOSITORIA ( PRORIS ) 100 SUPPOS 9,568 956,802

158 IBUPROFEN 200 MG/5 ML SUSPENSI 300 BOTOL 6,574 1,972,257

159 INSULIN RAPID NON PEN INJ 15 VIAL 323,190 4,847,850
160 ISONIAZID 300 MG TABLET 1,000 TABLET 346 345,800
161 KA-EN 1B 500 ML INFUS 100 KOLF 15,142 1,514,205
162 KA-EN 3A 500 ML INFUS 100 KOLF 14,225 1,422,475
163 KA-EN 3B 500 ML INFUS 100 KOLF 16,825 1,682,450
164 KALSIUM LAKTAT 500 MG TABLET 20,000 TABLET 92 1,843,380
165 KCL 20 MEQ 25 ML KOLF 360 KOLF 5,080 1,828,633
166 KETAMIN 100 MG/ ML INJEKSI ( IVANES ) 15 AMPUL 64,638 969,574
167 KETOCONAZOLE KRIM 500 TUBE 3,349 1,674,470
168 KETOKONAZOLE 200 MG TABLET 800 TABLET 447 357,504
169 KETOPROFEN 100 MG SUPP 430 SUPPOS 2,660 1,143,800
170 KETOROLAC 30 MG INJ 500 AMPUL 1,596 797,934
171 KOLKISIN 0,5 MG TAB 2,500 TABLET 4,972 12,428,850
KOMPOLAX SYRUP 60 ML ( PARAFIN + GLISERIN
172 + FENOFTALEIN ) 200 BOTOL 7,138 1,427,622

173 KSR 600 MG TABLET 5,000 TABLET 2,695 13,474,230

174 LACTO B SACHET 2,000 PCS 7,337 14,673,890
175 LAKTULOSA SYRUP 60 ML 200 BOTOL 34,198 6,839,525

176 LANSOPRAZOLE 30 MG INJ ( PROSOGAN INJ ) 550 AMPUL 134,655 74,059,986

177 LANSOPRAZOLE KAP 8,000 TABLET 899 7,189,235

178 LEVOFLOXACIN 0,5% TETES MATA ( OPTIFLOX ) 50 TUBE 23,940 1,197,000

179 LEVOFLOXACIN 500 MG TABLET 600 TABLET 601 360,776

180 LEVOFLOXACIN 500 MG/100 ML INFUS 250 KOLF 23,408 5,852,000
181 LIDOCAIN 2% INJ 600 AMPUL 1,631 978,348
182 LISINOPRIL 10 MG TABLET 1,000 TABLET 414 413,630
183 LISINOPRIL 5 MG TABLET 1,000 TABLET 351 351,120
184 LOPERAMID 2 MG TABLET 700 TABLET 233 162,925
185 LORATADIN 10 MG TABLET 5,000 TABLET 418 2,090,760
186 LYSSIN SYRUP 100 ML (UNIVIT+LYSSIN) 700 BOTOL 7,980 5,586,000
187 MAGNESIUM SULFAT 40% 25 ML I.V INJ 80 KOLF 6,528 522,211
188 MANITOL INFUS 20 KOLF 43,028 860,563
189 MECOBALAMIN 500 MG TABLET 4,000 TABLET 839 3,356,920
 URAIAN KOEFISIEN HARGA SATUAN +
NO NAMA KOMPONEN PPN 10% TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN
2 3 4 5 7 8 = ∑8 11
190 MELOXICAM 15 MG TABLET 3,000 TABLET 958 2,872,800
191 MEPROVENT 2.5 ML NEBU 300 PCS 4,658 1,397,298
192 METFORMIN 500 MG TABLET 25,000 TABLET 163 4,069,800
193 METFORMIN 850 MG TABLET 7,000 TABLET 239 1,675,800
194 METHYLERGOMETRIN INJ 400 AMPUL 3,935 1,574,188
195 METHYLERGOMETRIN TABLET 3,000 TABLET 344 1,033,410
196 METHYLPREDNISOLON 125MG INJ 125 AMPUL 16,737 2,092,090
197 METHYLPREDNISOLON 4 MG TABLET 8,000 TABLET 190 1,521,520
198 METHYLPREDNISOLON 8 MG TABLET 8,000 TABLET 680 5,439,168
199 METOCLOPRAMID 5 MG/ML INJ 40 AMPUL 5,325 213,013
200 METRONIDAZOL INFUS 250 KOLF 10,786 2,696,575
201 METRONIDAZOLE 500 MG TABLET 8,000 TABLET 702 5,617,920
METRONIDAZOLE TABLET VAGINAL OVULA
202 (VAGIZOL) 150 SUPPOS 5,453 817,950

203 MEYLON 8,4% 25 ML 50 KOLF 10,773 538,650

204 MICONAZOLE 15 GRAM KRIM 150 TUBE 4,541 681,173
205 MIDAZOLAM INJ 5 MG / ML ( MILOZ ) 30 AMPUL 7,093 212,779
206 MISOPROSTOL 200 MCG TAB 2,100 TABLET 5,852 12,289,200
207 MOMETASON FUROATE SALEP 200 TUBE 9,975 1,995,000
208 NACL 0.9 % 500 ML INFUS 7,000 KOLF 11,558 80,903,900
209 NACL 3% 500 ML ( SALIN 3 % ) 200 KOLF 42,149 8,429,806
210 NACL PULVIS 1 KG 5 BOTOL 383,040 1,915,200
NATRIUM BICARBONAT 500 MG TABLET
211 (BICNAT) 9,000 TABLET 399 3,591,000

212 NATRIUM DICLOFENAC 25 MG TABLET 5,000 TABLET 203 1,013,460

213 NATRIUM DICLOFENAC 50 MG TABLET 1,500 TABLET 184 275,310
214 NATRIUM PHENITOIN 50 MG/ML 120 AMPUL 12,736 1,528,330
NEOMYCIN SULFAT PLACENTA EKSTRAK 10%
215 KRIM 25 TUBE 31,400 784,999

216 NEOSTIGMINE METILSULFATE INJ 50 AMPUL 9,377 468,825

217 NEW DIATAB TABLET 2,600 TABLET 741 1,926,625
218 NICARDIPINE INJEKSI 80 AMPUL 31,453 2,516,254
219 NIFEDIPIN 10 MG TABLET 8,000 TABLET 326 2,604,672

220 NISTATIN 100.000 IU VAGINA TABLET (OVULA) 30 OVULA 7,182 215,460

221 NITROKAF RETARD FORTE KAP 5 MG 100 TABLET 4,102 410,172

222 NITROKAF RETARD KAP 2.5 MG 400 TABLET 2,429 971,432
223 NOKOBA INJ (NALOKSON INJEKSI) 10 AMPUL 96,558 965,580
224 NOREPHINEFRIN 1 MG/ML INJEKSI 100 AMPUL 54,863 5,486,250
225 NORETHISTERON 5 MG TABLET 5,300 TABLET 1,994 10,566,240
226 NOVORAPID FLEXPEN 1,500 PEN 130,939 196,407,750
227 NYSTATIN DROP 100.000 IU GENERIK 50 BOTOL 15,294 764,710
228 OBH SYRUP 500 BOTOL 6,650 3,325,000
229 OFLOXACIN 3% TETES TELINGA (AKILEN) 350 TUBE 49,669 17,384,098
230 OFLOXACIN 400 MG TABLET 500 TABLET 883 441,281
231 OMEPRAZOLE 20 MG KAP 10,000 TABLET 530 5,300,050
232 OMEPRAZOLE INJ 3,500 AMPUL 13,823 48,379,415
233 ONDANCENTRON 4 MG/2 ML INJ 4,000 AMPUL 1,794 7,175,616
234 ONDANCENTRON 8 MG TABLET 1,000 TABLET 496 495,957
235 ORALIT SACHET 100'S 2,100 PCS 682 1,432,809
236 OTILON TETES TELINGA 8 ML 300 BOTOL 73,150 21,945,000
OXYMETAZOLIN HCL 0,05% (ILIADIN NASAL
237 SPRAY) 150 BOTOL 62,244 9,336,600

238 OXYTETRACYCLIN EYE OINT 25 TUBE 3,325 83,125

239 OXYTOCIN INJ 2,000 AMPUL 1,595 3,189,340
240 PARACETAMOL 1 GRAM INFUS 600 KOLF 16,477 9,886,422
241 PARACETAMOL 500 MG TABLET 45,000 TABLET 168 7,541,100
242 PARACETAMOL DROP 648 BOTOL 8,843 5,730,379
243 PARACETAMOL SUPP 160 MG ( PROPYRETIC) 300 SUPPOS 10,363 3,109,008
PENGGANTI PLASMA GOLONGAN GELATIN
244 (GELAFUSAL/GELOFUSINE) INFUS 50 BOTOL 179,550 8,977,500

245 PHENOBARBITAL 50 MG/ML I.M/I.V INJ 30 AMPUL 2,396 71,893

246 PHYTOMENADION 10 MG/ML INJ (VITADION) 250 AMPUL 7,618 1,904,560

247 PHYTOMENADION 2 MG/ML INJ 400 AMPUL 4,897 1,958,824

248 PHYTOMENADION TABLET ( VIT K ) 800 TABLET 1,495 1,195,936
249 PIOGLITAZON 30 MG TABLET 300 TABLET 5,706 1,711,710
250 PROGESTERON 200 MG ( MICROGEST ) 1,000 TABLET 28,967 28,967,400
251 PROPANOLOL 10 MG TABLET 1,000 TABLET 150 150,024
252 PROPANOLOL 40 MG TABLET 500 TABLET 101 50,540
 URAIAN KOEFISIEN HARGA SATUAN +
NO NAMA KOMPONEN PPN 10% TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN
2 3 4 5 7 8 = ∑8 11
253 PROPOFOL 1% INJEKSI ( FRESOPOL) 50 AMPUL 14,308 715,407
254 PTU 100 MG TABLET 1,200 TABLET 1,007 1,208,607
255 PULMICORT RESP 0,25MG 150 PCS 13,936 2,090,361
256 PYRAZINAMID 500 MG TABLET 1,000 TABLET 838 837,900
257 RAMIPRIL 10 MG TABLET (BOX/30) 17,000 TABLET 1,133 19,263,720
258 RAMIPRIL 5 MG TABLET (BOX/100) 9,000 TABLET 391 3,519,180
259 RANITIDIN 50 MG INJ 1,000 AMPUL 1,580 1,580,040
260 RHINOFED TABLET 50'S 2,500 TABLET 4,190 10,473,750
261 RIFAMPICIN 450 MG KAPSUL 1,000 TABLET 1,866 1,865,990
262 RIFAMPICIN 600 MG TABLET 1,000 TABLET 1,572 1,572,067
263 RINGER LACTAT 500 ML INFUS 4,500 KOLF 12,081 54,366,543

264 ROCURONIUM BROMIDE 50 MG/5 ML INJEKSI 10 VIAL 66,500 665,000

265 SABU INJ (ANTI BISA ULAR) 3 VIAL 598,500 1,795,500

266 SACHARIN TABLET (BOX/200) 6,000 TABLET 330 1,979,040
267 SALBUTAMOL 2 MG TABLET 1,700 TABLET 84 142,443
268 SALBUTAMOL 4 MG TABLET 5,000 TABLET 93 465,500
269 SALBUTAMOL INHALER ( SALBULIN ) 350 BOTOL 50,319 17,611,727
270 SALBUTAMOL SOL 1MG/ML 300 TUBE 6,384 1,915,200
271 SANGOBION DROP BABY 160 BOTOL 53,865 8,618,400
272 SANGOBION SYRUP KIDS 100 BOTOL 42,720 4,271,960
273 SEVOFLURANE 250 ML ( SOJOURN ) 8 BOTOL 1,323,206 10,585,651
274 SIMVASTATIN 10 MG TABLET 1,500 TABLET 187 280,098
275 SIMVASTATIN 20 MG TABLET 7,000 TABLET 327 2,290,260
276 SPIRONOLACTONE 100 MG TABLET 2,000 TABLET 918 1,835,400
277 SPIRONOLACTONE 25 MG TABLET 2,000 TABLET 332 663,936
278 SUCRALFATE 100 ML SUSPENSI 500 BOTOL 10,914 5,456,990

279 SULFAS FEROSUS TABLET ( TAMBAH DARAH ) 24,000 TABLET 471 11,299,744

280 SYMBICORT 160 MG/4,5 MCG 300 BOTOL 200,436 60,130,896

281 TAMSULOSIN 0,4 MG TABLET 1,500 TABLET 5,793 8,690,220
282 TRAMADOL 100 MG/2 ML INJ 150 AMPUL 2,559 383,911
283 TRAMADOL 50 MG TABLET 1,000 TABLET 480 480,303
284 TRIAMCINOLON 4 MG TABLET 4,000 TABLET 742 2,968,560
TRIAMCINOLON ACETONIDE 10 MG /ML
285 INJEKSI ( TRILAC ) 10 AMPUL 46,549 465,487

286 TUBERKULIN PPD MANTOUX 5 VIAL 1,064,000 5,320,000

287 URSODEOXYXHOLIC ACID 250 MG TABLET 360 TABLET 3,337 1,201,353
288 UTROGESTAN 200 MG 950 TABLET 32,186 30,576,700
289 VAGISTIN OVULA 400 SUPPOS 20,775 8,309,840
290 VAKSIN HEPATITIS B 110 VIAL 47,880 5,266,800
291 VAKSIN ROTAVIRUS 5 STRAIN 30 VIAL 418,950 12,568,500
292 VAKSIN TETAGAM SYRINGE 1 ML 10 AMPUL 195,244 1,952,440
293 VALSARTAN 80 MG TABLET 1,000 TABLET 4,213 4,213,440
294 VASELIN ALBUM 5 BOTOL 418,950 2,094,750
295 VITAMIN A 100.000 IU TABLET ( RETINOL ) 1,200 TABLET 407 488,376
296 VITAMIN A 200.000 IU TABLET ( RETINOL ) 500 TABLET 735 367,745
297 VITAMIN B 12 TABLET 4,000 TABLET 65 260,680
298 VITAMIN B 6 TABLET ( PYRIDOXIN ) 7,000 TABLET 295 2,066,820
299 VITAMIN C 500 MG TABLET 10,000 TABLET 263 2,633,400
300 VITAMIN D3 1000 IU 1,500 TABLET 3,591 5,386,500
301 VOLUVEN 6% 500 ML INFUS 20 KOLF 31,920 638,400
302 XYLOCAIN SPRAY 5 BOTOL 251,512 1,257,562
303 ZINC SULFATE SYRUP 60 ML (BOX/36) 1,300 BOTOL 4,348 5,652,101
304 ZINK PULVIS 5 BOTOL 418,950 2,094,750
305 PETHIDIN HCL 50 MG/ML INJEKSI 80 AMPUL 17,600 1,408,000

Pemohon Ka.Sie Penunjang Medis

(...........................................) Ns. Wiji Saraswati, S.Kep., MAP

Nip.197710151998032001
 FORMULIR RENCANA KEBUTUHAN BELANJA UNIT
RSUD JOHAR BARU
TAHUN ANGGARAN 2022
UNIT : FARMASI - ALKES, BHP DAN GAS MEDIK

URAIAN KOEFISIEN HARGA SATUAN +

NO NAMA KOMPONEN TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN PPN 10%

2 3 4 5 7 8 = ∑8 11

1,135,382,349
1 ALKACID 1 LITER 1 BOTOL 2,702,700 2,702,700
2 ALKAZYM SACHET 30 PAK/25 PCS 801,000 24,030,000
3 ALKOHOL SWABS 100 LBR 700 BOX 12,300 8,609,994
4 APRON ONE NEW 350 PCS 2,526 883,960
5 AQUA BIDEST STERIL 1 LITER 190 BOTOL 15,000 2,850,000
6 ASKINA CALGITROL AG 10 X 10 5 PCS 132,000 660,000
7 ASKINA CALGITROL PASTE 15 GR 5 PCS 82,000 410,000
8 ASKINA FOAM 10 X 10 5 PCS 67,440 337,200
9 ASKINA GEL 15 GR 5 PCS 80,876 404,380
AUTOCLAVE INDIKATOR TAPE 19
10 10 PCS 39,734 397,342
MM X 50 M
BENANG CATGUT CHROMIC 2-0
11 400 PCS 46,769 18,707,600
HRG 38 TAPER
BENANG CATGUT CHROMIC 3/0
12 12 PCS 5,583 67,000
CUTTING 75 CM
BENANG CATGUT CHROMIC 3/0 TS
13 24 PCS 3,360 80,640
24 75 CM CUTTING
BENANG CATGUT PLAIN 3/0 HR-27
14 24 PCS 37,203 892,872
75 CM TAPER
15 BENANG MONOSYN 3/0 CUTTING 60 PCS 105,000 6,300,000
BENANG SILK 2/0 TS-27 75 CM
16 24 PCS 35,077 841,848
CUTTING
17 BENANG SILK 3/0 75 CM TAPER 24 PCS 41,361 992,664
BENANG SILK 3/0 HR35 75 CM 36S
18 60 PCS 3,056 183,333
CUTTING
BENANG SILK 4/0 TS-19 75 CM
19 12 PCS 35,077 420,924
CUTTING
20 BETADINE 10% 1 LITER (NEODIN) 5 BOTOL 45,000 225,000
21 BIOSANITIZER AHP P 1000 ML 80 BOTOL 996,875 79,750,000
22 BIOSANITIZER STRECH WIPES 100 PAK 363,000 36,300,000
23 BISTURI BLADE NO.10 200 PCS 2,790 558,000
24 BISTURI BLADE NO.15 200 PCS 2,790 558,000
25 BISTURI BLADE NO.20 100 PCS 2,790 279,000
26 BLOOD SET 50 PCS 8,250 412,500
27 DARYAN TULLE 50 PCS 24,750 1,237,500
28 DEPPER SEDANG 200 PCS 371 74,250
29 DERMAFIX 7 X 9 CM 300 PCS 3,175 952,560
DERMANIOS SCRUB
30 1 BOTOL 720,000 720,000
CHLORHEXIDINE 4% 5 LITER
31 DISCOFIX 3 WAY EKOR 200 PCS 30,058 6,011,500
DISPOSABLE PATIENT PLATE
32 25 PCS 16,000 400,000
MONOPOLAR ADULT
33 ELECTRODA EKG DEWASA 900 PCS 2,198 1,978,200
34 ELECTROSURGERY PENCIL BIRU 50 PCS 25,000 1,250,000
35 ETT NO.2 UNCUFFED 10 PCS 17,008 170,080
36 ETT NO.2,5 UNCUFFED 10 PCS 17,008 170,080
37 ETT NO.3 UNCUFFED 10 PCS 17,008 170,080
38 ETT NO.3,5 UNCUFFED 10 PCS 17,008 170,080
39 ETT WITH CUFF NO 2.5 20 PCS 27,899 557,980
40 ETT WITH CUFF NO 3 20 PCS 27,900 558,000
41 ETT WITH CUFF NO 3,5 20 PCS 27,900 558,000
42 ETT WITH CUFF NO 4 30 PCS 27,900 837,000
43 ETT WITH CUFF NO 4,5 20 PCS 27,900 558,000
44 ETT WITH CUFF NO 5 30 PCS 27,900 837,000
45 ETT WITH CUFF NO 5,5 20 PCS 27,900 558,000
46 ETT WITH CUFF NO 6 30 PCS 27,900 837,000
47 ETT WITH CUFF NO 6,5 30 PCS 27,900 837,000
48 ETT WITH CUFF NO 7 30 PCS 27,900 837,000
49 ETT WITH CUFF NO 7,5 20 PCS 27,900 558,000
50 ETT WITH CUFF NO 8 20 PCS 27,900 558,000
51 EXTENTION TUBE 75 CM 200 PCS 7,041 1,408,176
 URAIAN KOEFISIEN HARGA SATUAN +
NO NAMA KOMPONEN TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN PPN 10%

2 3 4 5 7 8 = ∑8 11
52 EYE PROTECTOR BAYI 150 PCS 38,720 5,808,000
53 FACESHIELD 300 PCS 11,000 3,300,000
54 FOLLEY CATHETER NO.10 30 PCS 11,800 353,991
55 FOLLEY CATHETER NO.14 70 PCS 12,000 840,000
56 FOLLEY CATHETER NO.16 450 PCS 12,000 5,400,000
57 FOLLEY CATHETER NO.18 40 PCS 12,500 500,000
58 FOLLEY CATHETER NO.24 120 PCS 13,000 1,560,000
59 FOLLEY CATHETER NO.6 20 PCS 10,400 208,000
60 FOLLEY CATHETER NO.8 20 PCS 11,800 236,000
61 GUDEL NO.0 (UK.60 MM BLACK) 20 PCS 12,574 251,480
GUDEL NO.00 NEONATAL (UK.50
62 20 PCS 14,199 283,980
MM BLUE)
GUDEL NO.000 NEONATAL (UK.40
63 20 PCS 14,199 283,980
MM PINK)
GUDEL NO.2 ADULT (UK.80 MM
64 20 PCS 14,200 284,000
GREEN)
GUDEL NO.3 ADULT (UK.90 MM
65 50 PCS 12,499 624,965
YELLOW)
GUDEL NO.4 ADULT (UK.100 MM
66 10 PCS 12,500 125,000
RED)
GUDEL NO.5 ADULT (UK.110 MM
67 20 PCS 12,574 251,480
ORANGE)
HANDRUB + CHLORHEXIDINE 0,5 %
68 350 BOTOL 42,427 14,849,450
500 ML
69 HANDSCOEN GYNECOLOG NO.7,5 350 PSG 38,830 13,590,500
70 HANDSCOEN LATEX UK L 250 BOX 101,574 25,393,500
71 HANDSCOEN LATEX UK M 720 BOX 101,574 73,133,280
72 HANDSCOEN LATEX UK S 650 BOX 184,800 120,120,000
HANDSCOEN STERIL LATEX POWDER
73 300 PSG 18,400 5,520,000
FREE UK 7
74 HANDSCOEN STERIL UK. 6,5 250 PSG 7,865 1,966,250
75 HANDSCOEN STERIL UK. 7,5 200 PSG 12,925 2,585,000
76 HYPAFIX 10 CM X 500 CM 20 BOX 30,000 600,000
77 HYPAFIX 15 CM X 500 CM 20 PCS 156,420 3,128,400
78 HYPAFIX 5 CM X 500 CM 20 PCS 16,500 330,000
79 INFUS SET ANAK 300 PCS 7,920 2,376,000
80 INFUS SET DEWASA OTSU Y 3,000 PCS 8,400 25,198,800
81 IV CATHETER NO.18 500 PCS 15,785 7,892,500
82 IV CATHETER NO.20 2,000 PCS 15,785 31,570,000
83 IV CATHETER NO.22 2,500 PCS 12,100 30,250,000
84 IV CATHETER NO.24 400 PCS 15,785 6,314,000
85 IV CATHETER NO.26 500 PCS 18,755 9,377,500

86 JELLY USG 250 ML ULTRASONIC GEL 60 BOTOL 22,000 1,320,000

87 KANULA ANAK 50 PCS 10,000 500,000

88 KANULA BAYI 50 PCS 13,300 665,000
89 KANULA DEWASA 600 PCS 6,000 3,600,000
90 KASA STERIL 16 X 16 50 BOX 7,899 394,955
91 KERTAS CTG 50 PCS 130,900 6,545,000
92 KERTAS ECG 20 ROLL 89,348 1,786,950
93 KERTAS USG 40 ROLL 237,600 9,504,000
94 KONDOM SUTRA 500 PCS 1,700 850,000
95 MANDRAIN / STYLET BAYI NO.2,2 3 PCS 91,850 275,550
96 MASKER ANESTESI UK 3 10 PCS 31,900 319,000
97 MASKER KARET 1,300 BOX 50,000 65,000,000
98 MASKER N 95 4,200 PCS 60,000 252,000,000

99 MASKER NON REBREATHING ANAK 50 PCS 44,275 2,213,750

MASKER NON REBREATHING

100 150 PCS 24,640 3,696,000
DEWASA
101 MICROPORE 1 INCH ( SEDANG ) 252 PCS 18,086 4,557,586
102 MICROPORE 2 INCH ( BESAR ) 150 PCS 32,934 4,940,150
103 NASAL PRONG UK L 3 PCS 91,143 273,430
104 NASAL PRONG UK M 3 PCS 91,143 273,430
105 NASAL PRONG UK S 3 PCS 91,143 273,430
106 NEEDLE 18 G X 38 MM 400 PCS 1,794 717,600
107 NEEDLE 21 G X 28 MM 200 PCS 1,650 330,000
108 NEEDLE 23 G X 28 MM 2,000 PCS 1,794 3,588,000
 URAIAN KOEFISIEN HARGA SATUAN +
NO NAMA KOMPONEN TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN PPN 10%

2 3 4 5 7 8 = ∑8 11
109 NEEDLE 25 G X 28 MM 100 PCS 1,650 165,000
110 NEEDLE 27 G X 28 MM 50 PCS 1,650 82,500
111 NGT NO. 5 FR 100 CM 10 PCS 7,656 76,560
112 NGT NO.10 30 PCS 7,700 231,000
113 NGT NO.12 20 PCS 15,373 307,460
114 NGT NO.14 20 PCS 15,373 307,460
115 NGT NO.16 100 PCS 2,750 275,000
116 NGT NO.18 20 PCS 16,000 320,000
117 NGT NO.3,5 20 PCS 15,373 307,460
118 NGT NO.6 20 PCS 3,564 71,280
119 NGT NO.8 20 PCS 14,081 281,627
NOVO TWIST 32 G X 5 MM ( PEN
120 2,000 PCS 1,700 3,400,000
INSULIN )
121 PARAFILM 1 PCS 638,000 638,000
122 PLATELET ADMINISTRATION SET 20 PCS 13,976 279,520
POUCHES STERIL FLAT UK 10 CM X
123 3 ROLL 343,224 1,029,672
200 M
POUCHES STERIL FLAT UK 15 CM X
124 3 ROLL 494,450 1,483,350
200 M
POUCHES STERIL FLAT UK 20 CM X
125 3 ROLL 596,750 1,790,250
200 M
POUCHES STERIL FLAT UK 40 CM X
126 1 ROLL 1,307,547 1,307,547
200 M
127 PRONTOSAN LIQUID 5 PCS 151,600 757,999
128 PRONTOSAN WOUND GEL 30 ML 5 PCS 194,101 970,503
129 SAFETY BOX 12,5 LITER 250 PCS 32,861 8,215,250
130 SCRUB BRUSHES PLAIN 50 PCS 7,984 399,200
131 SENDOK OBAT 1,300 PCS 185 240,240
132 SIRKUIT CPAP 2 PCS 550,000 1,100,000
133 SOFTANOL 500 ML 700 BOTOL 55,000 38,500,000
134 SPALK INFUS 15 CM X 5 CM 200 PCS 8,910 1,782,000
135 SPINAL NEEDLE NO.27 25 PCS 9,951 248,775
136 SPUIT 1 CC 4,500 PCS 1,614 7,263,000
137 SPUIT 10 CC 5,000 PCS 3,619 18,095,000
138 SPUIT 20 CC 500 PCS 13,970 6,985,000
139 SPUIT 3 CC 8,000 PCS 1,138 9,104,000
140 SPUIT 5 CC 500 PCS 2,000 1,000,000
141 SPUIT 50 CC 100 PCS 23,320 2,332,000
142 SPUIT 50 CC CATHETER TIP 30 PCS 11,990 359,700
143 SUCTION CATHETER NO.10 40 PCS 7,370 294,800
144 SUCTION CATHETER NO.12 40 PCS 3,520 140,800
145 SUCTION CATHETER NO.6 40 PCS 3,520 140,800
146 SUCTION CATHETER NO.8 100 PCS 4,900 490,000
147 SUCTION CONNECTING TUBE 10 PCS 16,500 165,000
148 SUNGKUP O2 ANAK 50 PCS 9,500 475,000
149 SUNGKUP O2 DEWASA 30 PCS 8,000 240,000
150 TEGADERM PAD 5 X 7 CM 3582 10 PCS 5,399 53,991
151 TEGADERM PAD 9 X 25 CM 3591 10 PCS 22,302 223,018
152 TERMOMETER DIGITAL 15 PCS 46,424 696,360
153 THREE WAY STOP COCK 250 PCS 20,000 5,000,000
154 TONGUE SPATEL 14 BOX 15,180 212,520
155 TRANSOFIX 300 PCS 3,400 1,020,000
UMBILICAL CORD NYLON (KLEM
156 300 PCS 2,699 809,820
TALI PUSAR)
157 UNDERPAD 1,900 PCS 8,580 16,302,000
158 UNIFLEX 4,5 M X 15 CM 20 PCS 33,700 673,999
159 VICRYL 1 PLUS VIO 90 CM TAPER 12 PCS 115,645 1,387,738

160 VICRYL 2/0 PLUS VIO 70 CM TAPER 12 PCS 100,701 1,208,406

161 VIOREX LIQUID 2% 500 ML 15 BOTOL 67,650 1,014,750

162 WING NEEDLE NO.23 100 PCS 5,642 564,247
163 WING NEEDLE NO.25 200 PCS 5,642 1,128,494
164 BOWIEDICK TEST SHEET 2 PCS 2,197,961 4,395,922
165 KASA 10 CM X 10 CM XRAY 16 FLY 100 PAK 40,000 4,000,000
166 LOGICATH CVC 3L 7F 16 CM 5 PCS 650,000 3,250,000
167 MANSET TENSIMETER ANAK 5 PCS 500,000 2,500,000
CUFF LARGE ADULT ( MANSET
168 5 PCS 500,000 2,500,000
TENSIMETER DEWASA )
 URAIAN KOEFISIEN HARGA SATUAN +
NO NAMA KOMPONEN TOTAL GRAND TOTAL KETERANGAN
VOLUME SATUAN PPN 10%

2 3 4 5 7 8 = ∑8 11
169 SPALK INFUS 20 CM X 5 CM 300 PCS 15,000 4,500,000
170 MANOMETER CVP 5 PCS 700,000 3,500,000

Pemohon Ka.Sie Penunjang Medis

(...........................................) Ns. Wiji Saraswati, S.Kep., MAP

Nip.197710151998032001