HARGA

NO NAMA OBAT KEMASAN

SATUAN

15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial 2,295.00

1 Albendazol Tablet 400 mg Tablet 403.00

2 Alopurinol Tablet 100 mg Tablet 99.00

3 Aminofilin Inj 24 mg/ml-10 ml Ampul 2,789.00

4 Aminofilin Tablet 200 mg Tablet 89.00

5 Amitriptilina HCl Tablet salut 25 mg Tablet 167.00

6 Amlodipin Tablet 5 mg Tablet 85.00

8 Amoksisilin Sirup Kering 125 mg/5 ml Botol 1,881.00

7 Amoksisilin Kaplet 500 mg Kaplet 233.00

115 Lidokain Inj Komp : Lidokain %+ Epinefrin 1 : 8000 Ampul 1,152.00

10 Antasida II Suspensi 60 ml Botol 1,995.00
9 Antasida DOEN I Tablet Kunyah Tablet 54.00

13 Antifungi DOEN kombinasi Pot 4,323.00

11 Anti Hemmoroid DOEN Supp 3,167.00

24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet 99.00

25 Asam Askorbat (VIT C) Tablet 50 mg Tablet 105.00

26 Asam Folat Tablet 0,4 mg Tablet 55.00

27 Asam Mefenamat kaplet 500 mg Tablet 103.00

29 Asiklovir Tablet 400 mg Tablet 380.00
30 Atapulgit Tablet 600 mg Tablet 145.00

31 Atropin Sulfat Inj 0,25 mg/ml Ampul 1,595.00

194 Temporary Restorative Material Botol 143,495.00

178 Salisil Bedak 2 % Kotak 1,774.30
35 Betametason Krim 0.1 % Tube 1,340.00

41 Deksametason Inj 5 mg/ml-1 ml Ampul 1,097.00

42 Deksametason Tablet 0,5 mg Tablet 41.00
47 Diazepam Inj 5 mg/ml-2 ml Ampul 1,735.00

48 Diazepam Rectal 5 mg/2,5 ml tube 12,573.00

49 Diazepam Tablet 2 mg Tablet 86.00

294 Diethil Karbamazin 100 mg tablet 119.00

50 Difenhidramin Inj 10 mg/ml Ampul 1,095.00
51 Digoksin Tablet 0,25 mg Tablet 104.00
52 Dimenhidrinat Tablet 50 mg Tablet 99.00

53 Doksisilin Tablet 100 mg Tablet 268.00

54 Domperidon Suspensi 5mg/5ml Botol 3,000.00
55 Domperidon Tablet 10 mg Tablet 85.00
57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul 1,408.00

58 Eritromisin Kapsul 250 mg Kapsul 546.00

60 Eritromisin Sirup 200 mg/5 ml Botol 6,150.00
59 Eritromisin Kapsul 500 mg Kapsul 730.00

62 Etanol 70 %- 1000 ml Botol 26,250.00

63 Etil Klorida Spray Botol 99,000.00

64 Eugenol Cairan Botol 18,824.00

65 Fenitoin Natrium Kapsul 100 mg Kapsul 158.00

66 Fenobarbital Tablet 30 mg Tablet 165.00

67 Fenoksimetil Penisilin Tablet 500 mg Tablet 629.00

69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul 3,682.00

68 Fitomenadion (Vit K1) Tablet Salut Gula 10 mg Tablet 710.00

72 Formokresol Cair Botol 61,490.00

73 Furosemid Tablet 40 mg Tablet 77.00

74 Garam Oralit I Serbuk Sachet 260.00

77 Glass Ionomer Cement Botol 534,600.00

78 Glibenklamid Tablet 5 mg Tablet 119.00

80 Glukosa Larutan Infus 5% steril Fls 6,900.00

81 Griseofulvin Tablet 125 mg Micronized Tablet 210.00

84 Haloperidol Inj 5 mg/ml Ampul 6,250.00

85 Haloperidol Tablet 1,5 mg Tablet 59.00

82 Haloperidol 5 mg Tablet 56.00

86 Hidrokortison Krim 2,5 % Tube 2,639.00

87 Hiosina butilbromida tab 10 mg Tablet 1,100.00

88 Human Tetanus Imunoglobulin Im 250UI (Tetagam) Set 170,000.00

89 Ibuprofen Tablet 400 mg Tablet 111.00

 90 Isoniazid Tablet 100 mg Tablet 74.00
293 Isoniazid Tablet 300 mg tablet 173.00
91 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 89.00

92 Kalsium glukonat inj 100 mg/ml Ampul 9,955.00

93 Kalsium hidroksida pasta Botol 144,991.00

94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 59.00

95 Kaptropil Tablet 25 mg Tablet 75.00

96 Karbamazepin Tablet 200 mg Tablet 230.00

97 Karbogliserin Tetes Telinga 10 % Botol 2,590.00

98 Karbon aktif tab 0,5 mg Tablet 500.00
99 Ketokonazol Tablet 200 mg Tablet 270.00

103 Klindanmisin Tablet 300 mg Tablet 578.00

104 Kloramfenikol Kapsul 250 mg Kapsul 273.74

106 Kloramfenikol Salep Kulit 2% Tube 3,091.00
107 Kloramfenikol Salep Mata 1 % Tube 1,881.00
108 Kloramfenikol Sirup 125 mg/5 ml Botol 4,700.00
110 Kloramfenikol Tetes telinga 3 % Tube 6,600.00
109 Kloramfenikol Tetes Mata 0.5% Botol 7,260.00

111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet 22.00

132 Monoklorkamfer mentol cairan Botol 63,800.00

112 Klorpropmazin HCl Tablet salut 100 mg Tablet 147.00

40 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket 2,160.00

14 Antimigren DOEN Tablet 173.00

193 Tablet Tambah Darah Kombinasi Tablet 350.00

20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet 11,894.30

175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul 4,550.00

114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet 125.00

113 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 ml Botol 2,052.00

101 Kina Inj 26 % 2 ml Ampul 6,200.00
102 Kina Tablet 222 mg Tablet 670.00
116 Lidokain Jelly 2 % Tube 40,000.00

117 Lidokain Spray 10 % Botol 170,400.00

119 Loratadin Tablet 10 mg Tablet 134.00

120 Magnesium sulfat Inj (IV) 20 % Ampul 3,200.00

121 Magnesium sulfat Inj (IV) 40 % Ampul 3,650.00

124 Metformin HCl Tablet 500 mg Tablet 96.00

126 Metilergomatrin Maleat Inj 0,200 mg Ampul 2,959.00

127 Metilergometrin Maleat (Metilergometrin) Tablet Sal Tablet 210.00
128 Metilprednisolon Tablet 4 mg Tablet 134.00

129 Metronidazol Tablet 500 mg Tablet 113.00

130 Mikonazol Krim/Salep 2% Tube 3,414.00

131 Mineral Mix Sachet 2,450.00

135 N-asetil sistein kaps 200 mg Kapsul 358.00
139 Natrium Klorida Larutan Infus 0,9% Fls 6,410.00

137 Natrium Diklofenak Tablet 50 mg Tablet 115.00

138 Natrium Hipoklorit 3% Botol 78,100.00

141 Nipedipin Tablet 10 mg Tablet 99.00

142 Nistatin Tablet Salut Gula 500.000 IU/g Tablet 790.00

143 Nistatin Tablet Vaginal 100.000 IU/g Tablet 545.00

146 OAT FDC Kategori Anak paket 214,985.00

144 OAT FDC Katagori 1 Paket 389,344.00
145 OAT FDC Katagori 2 Paket 1,199,985.00
147 OAT FDC Kategori Sisipan Paket 160,000.00

148 OAT Kombipak Kat I paket 288,200.00

150 Oksitosin Inj 10 IU/ml- 1 ml Ampul 1,199.00

151 Omeprazol Kapsul 20 mg Kapsul 130.00

153 Parasetamol Sirup 120 mg / 5ml Botol 1,107.00

154 Parasetamol Tablet 500 mg Tablet 53.00

45 Devitalisasi Pasta Botol 220,000.00

56 Endometason Botol 203,500.00

157 Permetrin 5% Krim (Scabimite) Tube 11,825.00

159 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 123.00

292 Piridoksin HCl (Vit B6) Tablet 25 mg tablet 60.00

162 Povidon Iodida 10 %-30 ml Botol 3,045.00

163 Povidon Iodida 10 %-300 ml Botol 18,900.00
164 Prednison Tablet 5 mg Tablet 96.00
165 Primakuin Tablet 15 mg Tablet 224.00

166 Prokain Benzilpenisilin Serb Inj 3 juta UI/vial (i.m.) Vial 8,615.00
168 Propiltiourasil Tablet 100 mg Tablet 550.00

170 Ranitidin Tablet 150 mg Tablet 105.00

171 Retinol (Vit A) Kapsul 100.000 IU Kapsul 288.00
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul 517.00

173 Ringer Laktat Larutan Infus Steril Fls 7,150.00

174 Risperidon Tablet 2 mg Tablet 273.00

176 Salbutamol Tablet 4 mg Tablet 70.00

177 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 2,621.00
187 Serum antibisa ular Polivalen Inj 5 ml (SABU) I Vial 462,000.00

185 Serum Anti Difteri (ADS) Vial 2,200,000.00

186 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul 130,999.00

188 Setirizin Sirup 5 mg/5 ml Botol 3,150.00

190 Simvastatin Tablet 10 mg Tablet 110.00

191 Siprofloksasin (HCl) Tablet 500 mg Kaplet 265.00

21 ARV: Tenofovir 300 mg Tablet 8,100.00

195 Tetrasiklin Kapsul 500 mg Kapsul 303.00

196 Tiamin HCL (Vit B1) Tablet 50 mg Tablet 82.00

197 Triheksifenidil HCl Tablet 2 mg Tablet 85.00

198 Vaksin BCG + Pelarut Set 61,996.00

208 Vaksin Polio 10 ds bopv + Penetes Set 19,954.00
291 Vaksin Campak Vial 28,204.00
201 Vaksin Hb-0 Set 20,900.00

200 Vaksin DT Vial 17,996.00

210 Vaksin Td Vial 16,995.00
199 Vaksin DPT-Hb-Hib Vial 78,991.00
204 Vaksin Measles Rubella (MR) Vial 155,813.00
205 Vaksin Meningitis Paket -
203 Vaksin IPV 5 ds Vial 158,994.00
209 Vaksin Rabies Vero Set 165,000.00

211 Vitamin B Kompleks Tablet Tablet 83.00

212 Zinc Tablet 20 mg Tablet 508.00

0 BAHAN HABIS PAKAI 0 -
213 ADS 0.05 ml Buah 1,395.00
214 ADS 0.5 ml Buah 1,185.00
215 ADS 5 ml Buah 1,640.00
216 Alat Suntik Sekali Pakai 1ml Set 787.00
217 Alat Suntik Sekali Pakai 3 ml Set 827.00
218 Alat Suntik Sekali Pakai 5 ml Set 928.00
219 Alkohol Swab Buah 103.00
220 Bisturi Buah 770.00
221 Blood set Buah 3,740.00
222 Catgut/Benang Bedah No.2/0 dengan jarum bedah Set 5,750.83
223 Catgut/Benang Bedah No.3/0 dengan jarum bedah Set 5,750.83
224 Folley Catheter No.18 Buah 7,787.88
225 Infusion set anak Kantong 2,308.26
226 Infusion set dewasa Kantong 5,246.83
227 IV Catheter No.18 Set 6,000.00
228 IV Catheter No.20 Set 6,000.00
229 IV Catheter No.22 Set 6,000.00
230 IV Catheter No.24 Set 6,000.00
231 Jarum kulit Buah 2,291.67
232 Jarum otot Buah 2,291.67
233 Kaca Slide Buah 296.49
234 Kantung mayat Buah 170,000.00
235 Kapas Pembalut/absorben 250 mg Roll 24,000.00
236 Kasa Hidrofil 2x80 Roll 9,400.00
237 Kasa Hidrofil Steril 16 X 16 Lembar 493.75
238 Kasa Pembalut Hidrofil 4 X 10 cm Roll 2,300.00
239 Kasa Pembalut hidrofil 4 x 5 cm Roll 1,100.00
240 Kassa Pembalut elastic 4 inchi Roll 10,450.00
241 Masker Tie on Buah 379.48
242 Masker N-95 Buah 6,670.00
243 Plester 5 yard x 2 inch Roll 35,532.00
244 Polybag Medis Lembar 300.00
245 Polybag Nonmedis Lembar 220.00
246 Polybag Ramah Lingkungan Lembar 250.00
247 Pot Dahak Buah 5,800.00
248 Safety box Buah 22,433.00
249 Sarung Tangan Non Steril Uk.S Buah 466.62
250 Sarung Tangan Non Steril Uk.M Buah 466.62
251 Sarung Tangan Non Steril Uk.L Buah 466.62
252 Sarung Tangan Steril No.6 Set -
253 Sarung Tangan Steril No.6,5 Set 6,930.00
254 Sarung Tangan Steril No.7 Set 6,930.00
255 Sendok Obat Buah 250.00
256 Silk (Benang Bedah Sutera) No.2/0 Dengan Jarum Be Set 3,147.22
257 Urin Bag Buah 4,418.70
0 REAGEN 0 -
258 Cybow 10 Reagent Strip Set 138,950.00
259 Golongan darah anti A - 10 ml Botol 68,200.00
260 Golongan darah anti A-B - 10 ml Botol 92,510.00
261 Golongan darah anti B - 10 ml Botol 68,200.00
262 Humasens Plus Set 805,950.00
263 Humasens Plus Strip Uric Acid Kotak 550,800.00
264 Humasens Strip Glucose Kotak 252,300.00
265 Humasens Strip Kolesterol Kotak 544,400.00
266 Iodin test Botol 5,675.00
267 Larutan Asam Asetat 6% 100 ml Botol -
268 Larutan Benedict 100 ml Botol 19,950.00
269 Larutan EDTA 10 % 100 ml Botol 74,100.00
270 Larutan HCl 0,1 N 100 ml Botol 19,950.00
271 Larutan Natrium Citrat 3,13 % Botol 19,475.00
272 Larutan Rees Ecker 100 ml Botol 48,802.08
273 Larutan Turk 100 ml Botol 26,387.00
274 Larutan Ziehl Neelsen Botol 276,500.00
275 Rapid HIV 1/2 Device test 35,000.00
276 Rapid HIV 2 Fokus test 14,470.00
277 Rapid HIV Biomedika Sachet 35,000.00
278 Rapid HIV Biomeriux Sachet 22,475.00
279 Rapid HIV Intec Sachet 22,358.00
280 Rapid HIV Oncoprobe Sachet 24,495.00
281 Rapid HIV SD Sachet 14,340.00
282 Rapid Malaria Sachet 27,710.00
283 Rapid Syphilis SD Sachet 26,527.00
284 Reagen CD4 kontrol test -
285 Reagen CD4 tipe 1 (Alere Pima CD4) test 103.00
286 RPR Syphilis Sachet 4,150.00
287 Salmonella Thyphi H - 5 ml Botol 66,660.00
288 Salmonella Thyphi O - 5 ml Botol 66,660.00
289 Test Kehamilan Buah 6,911.00
0 LAIN-LAIN 0 -
12 Antibakteri DOEN Tube 2,924.00
16 ARV: Efavirenz 600 mg Tablet 6,375.00
17 ARV: Lamivudine 150 mg Tablet 1,500.00
18 ARV: Lovinapir 200 mg Ronavir Tablet 6,600.00
19 ARV: Nevirapine 200 mg Tablet 2,800.00
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet 3,058.00
23 ARV: Zidovudine(300) + Lamivudine(150) Tablet 3,700.00
28 Asiklovir Krim 5%/5g Tube 3,599.20
32 Azithromisin Tablet 500 mg Tablet 4,500.00
33 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial 13,400.00
34 Betahistin Tablet 6 mg Tablet 149.00
36 Bisoprolol Tablet 5 mg Tablet 260.00
37 Bromheksin Tablet 8 mg Tablet 199.10
38 Clobazam Tablet 10 mg Tablet 760.00
39 Clozapine Tablet 25 mg Tablet 1,550.00
43 Dekstrometorfan Tablet kombinasi Tablet 682.00
 44 Dektrometorfan Sirup kombinasi Botol 11,999.90
46 Dextrose Inj 40% Vial 14,524.00
61 Etakridin Larutan 0,1 % Botol 3,150.00
290 Fenobarbital inj 50mg/ml Ampul 1,800.00
70 Fluconazol Tablet 150 mg Tablet 18,000.00
71 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul 57,500.00
75 Gentamisin Inj 40 mg/ml (Sulfat) Vial 3,509.00
76 Gentamisin Salep Kulit 0,1% Tube 2,499.20
79 Gliseril Guaiakolat Tablet 100 mg Tablet 82.50
83 Haloperidol Dekanoat Inj 50 mg/ml Ampul 97,500.00
100 Ketoprofen Supp 100 mg Supp 2,640.00
105 Kloramfenikol Kapsul 500 mg Kapsul 1,090.00
118 Lisol Botol 43,050.00
122 MB Anak Blister 20,678.00
123 MB Dewasa Blister 31,760.00
125 Metildopa Tablet 250 mg Tablet 911.00
133 Multivitamin + DHA + Lysin Sirup Botol 9,999.00
134 Multivitamin + Mineral Kaplet Kaplet 605.00
136 Natrium Bikarbonat Tablet 500 mg Tablet 66.00
140 Natrium Tiroksin Tablet 100 µg Tablet -
149 Obat Batuk Hitam (OBH) Cairan Botol 3,999.60
152 Ondansetron Inj 4 mg/2 ml Ampul 1,070.00
155 PB Anak Blister 8,891.00
156 PB Dewasa Blister 12,569.00
158 Phenolphtalein, Paraffin Liquidum, Gliserin Sirup (La botol 7,700.00
160 Pirimetamin Tablet 25 mg Tablet 1,315.00
161 Polikresulen (Albotyl) Botol 5 ml botol 22,445.50
167 Propanolol HCl Tablet 40 mg Tablet 76.00
169 Ranitidin Inj 25 mg/ml Ampul 1,155.00
179 Sefadroksil Sirup 125 mg/5 ml Botol 3,922.00
180 Sefadroxil Kapsul 500 mg Kapsul 478.00
181 Sefiksime 200 mg + Azitromisin 500 mg Paket 30,030.00
182 Sefotaksim Inj 1 g Vial 4,200.00
183 Seftriaxon Inj 1 g Vial 9,900.00
184 Semen seng fosfat serbuk cairan Botol 169,400.00
189 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul 1,035.00
192 Tablet Tambah Darah (Camabion) Buah 355.00
202 Vaksin IPV 10 ds Vial 34,815.00
206 Vaksin Papillomavirus (HPV) Vial -
207 Vaksin Pneumococcus Vial -
295 Rapid SD HBsAG test 9,870.00
296 Vaksin Hb Ig vial 1,300,000.00
297 Tuberculin test Pcs 625,900.00
298 0 0 -
299 0 0 -
300 0 0 -
301 0 0 -
302 0 0 -
303 0 0 -
304 0 0 -
305 0 0 -
306 0 0 -
307 0 0 -
308 0 0 -
309 0 0 -
310 0 0 -
311 0 0 -
312 0 0 -
313 0 0 -
314 0 0 -
315 0 0 -
316 0 0 -
317 0 0 -
318 0 0 -
319 0 0 -
320 0 0 -
321 0 0 -
322 0 0 -
323 0 0 -
324 0 0 -
325 0 0 -
326 0 0 -
327 0 0 -
328 0 0 -
329 0 0 -
 3 Air untuk injeksi amp 20 ml Ampul
Air untuk injeksi amp 25 ml Ampul
Albendazol susp 200 mg/5 ml Botol
10 Albendazol tab 400 mg Tab
300 Alopurinol tab 100 mg Tab
Alopurinol tab 300 mg Tab
- Aminofilin inj 24 mg/ml Ampul
Aminofilin tab 150 mg Tab
20 Aminofilin Tab 200 mg Tab
10 Amitriptilin tab sal 25 mg Tab sal
Amlodipin tab 10 mg Tab
700 Amlodipin tab 5 mg Tab
Amoksisilin drops 100 mg/ml Botol
Amoksisilin sir forte 250 mg/ Botol
120 Amoksisilin sir kering 125 m Botol
Amoksisilin tab 250 mg Tab
5,000 Amoksisilin tab 500 mg Tab
Ampisilin serb inj 1000 mg/vi Vial
Ampisilin serb inj 250 mg/via Vial
30 Anestetik lokal gigi kombinasiVial
15 Antasida, kombinasi : alumi Botol
3,500 Antasida, kombinasi : alumi Tab
Anti Parkinson kombinasi : Kaps
6 Antifungi salep, kombinasi : Tube
15 Antihemoroid, kombinasi: bis Botol
Artesunat serb inj 60 mg/ml (i.Vial
Articulating paper kertas war Kertas warna penanda oklusi
Asam asetat tetes telinga 2% Botol
3 Asam asetilsalisilat (asetosal Tab
Asam askorbat (vitamin C) ta Tab
600 Asam askorbat (vitamin C) ta Tab
140 Asam folat tab 0,4 mg Tab
Asam folat tab 1 mg Tab
Asam folat tab 5 mg Tab
Asam mefenamat kaps 250 m Kaps
1,000 Asam mefenamat kaps 500 m Kaps
 Asam salisilat lar 0,1% Botol
Asam salisilat salep 10% Tube
Asam salisilat salep 2% Tube
Asam salisilat salep 5% Tube
Asiklovir tab 200 mg Tab
100 Asiklovir tab 400 mg Tab
400 Atapulgit 600 mg Tab
Atapulgit tab 630 mg Tablet
Atapulgit tablet 650 mg Tab
Atapulgit tablet 750 mg Tab
Atenolol tab 100 mg Tab
Atenolol tab 50 mg Tab
- Atropin inj 0,25 mg/ml (i.m./i.Ampul
Atropin tab 0,5 mg Tab
1 Bahan tumpatan sementara lar Botol
30 Bedak salisil serb 2% Botol
60 Betametason krim 0,1% Tube
Betametason krim 0,5 mg/g Tube
Betametason salep 0,1% Tube
Betametason tts mata 1 mg/ml Botol
Bisakodil sup 10 mg Botol
Bisakodil sup 5 mg Botol
Bisakodil tab sal 5 mg Tab sal
Budesonid cairan ih 0,25mg/mrespoules
Budesonid cairan ih 0,5 mg/m respoules
Budesonid ih 200 mcg/dosis Botol
Budesonid serb ih 100 mcg/doBotol
Coal tar lar 5 % Botol
Copper T set/buah
6 Deksametason inj 5 mg/ml (i.vVial
2,200 Deksametason tab 0,5 mg Tab
- Diazepam inj 5 mg/ml (i.v./i.mVial
Diazepam lar rektal 10 mg/2, Botol
1 Diazepam lar rektal 5 mg/2,5 Botol
20 Diazepam tab 2 mg Tab
Diazepam tab 5 mg Tab
- Dietilkarbamazin tab 100 mg Tab
5 Difenhidramin inj 10 mg/ml (i.Ampul
22 Digoksin tab 0,25 mg Tab
Diltiazem hcl tab 30 mg Tab
Diltiazem kaps SR 100 mg Kaps
Diltiazem kaps SR 200 mg Kaps
Diltiazem tab 30 mg Tab
 - Dimenhidrinat tab 50 mg Tab
Doksazosin tab 1 mg Tab
Doksazosin tab 2 mg Tab
- Doksisiklin kaps 100 mg Kaps
10 Domperidon susp 5 mg/5 ml Botol
200 Domperidon tab 10 mg Tab
6 Epinefrin (adrenalin) inj 0,1% Ampul
Epinefrin (adrenalin) inj 1 mg Ampul
Ergotamin tab 1 mg Tab
- Eritromisin kaps 250 mg Kaps
- Eritromisin sir 200 mg/5 ml Botol
- Eritromisin tab 500 mg Tab
Estrogen terkonjugasi tab sal Tab sal
1 Etanol 70% cairan 70% Botol
1 Etil klorida semprot 100 ml Botol
Etonogestrel implan 68 mg Set
1 Eugenol Botol
Fenitoin Na inj 100 mg/2 ml Ampul
Fenitoin Na inj 50 mg/ml Ampul
10 Fenitoin Na kaps 100 mg Kaps
Fenitoin Na kaps 30 mg Kaps
Fenobarbital tab 100 mg Tab
10 Fenobarbital tab 30 mg Tab
Fenoksimetil penisilin (penis Tab
- Fenoksimetil penisilin (penis Tab
Ferro fumarat kaps lunak 300 Kaps lunak
Ferro sulfat sir. 150 mg/5 ml Botol
Ferro sulfat tab salut 300 mg Tab sal
10 Fitomenadion (vitamin K 1) inVial
48 Fitomenadion (vitamin K 1) t Tab sal
Fitomenadion (vitamin K1) in Ampul
Fluoksetin kaps 10 mg Kaps
Fluor kapl 1 mg Kaplet
Fluor sediaan topikal Tube
Fluoresein tts mata 2,5 mg/ml Botol
1 Formokresol Botol
Framisetin Sulfat Tulle 1% Patch
Furosemid inj 10 mg/ml (i.v./i Ampul
46 Furosemid tab 40 mg Tab
Galactose microparticle 200- Vial
300 Garam oralit kombinasi : natr Sachet
Gentamisin salep mata 0,3% Tube
Gentamisin tts mata 0,3% Botol
 Glass ionomer ART (AtraumatiSachet
- Glass ionomer ART (AtraumatiBotol
Glass ionomer ART (AtraumatiVial
Glibenklamid tab 2,5 mg Tab
200 Glibenklamid tab 5 mg Tab
Glikuidon tab 30 mg Tab
Glimepirid tab 1 mg Tab
Glimepirid tab 2 mg Tab
Glipizid tab 5 mg Tab
Gliseril trinitrat tab 0,5 mg Tab sub
Gliserin tts 100 mg/ml Botol
Glukosa Larutan Infus 10% st Botol
Glukosa Larutan Infus 10% st Botol
Glukosa Larutan Infus 10% st Botol
Glukosa Larutan Infus 5% ste Botol
Glukosa Larutan Infus 5% ste Botol
2 Glukosa Larutan Infus 5% ste Botol
27 Griseofulvin (micronized) ta Tab
Griseofulvin (micronized) ta Tab
Gutta percha dan paper point Roll
Gutta percha dan paper point Roll
- Haloperidol inj 5 mg/ml (i.m. Vial
Haloperidol tab 0,5 mg Tab
- Haloperidol tab 1,5 mg Tab
Haloperidol tab 2 mg Tab
20 Haloperidol tab 5 mg Tab
Haloperidol tts 2 mg/ml Botol
Hepatitis B imunoglobulin (h Ampul
Hidrogen peroksida cairan 3 Botol
Hidrogen peroksida lar. Kons Botol
Hidroklorotiazid tab 25 mg Tab
50 Hidrokortison krim 2,5% Tube
Hidrokortison serb inj 100 mg Vial
45 Hiosina butilbromida tab 10 Tab
- Human tetanus imunoglobulinAmpul
Human tetanus imunoglobulinAmpul
Ibuprofen sir 100 mg/5 ml Botol
Ibuprofen sir 200 mg/5 ml Botol
Ibuprofen tab 200 mg Tab
1,500 Ibuprofen tab 400 mg Tab
Ipratropium bromida aerosol Botol
Ipratropium bromida cairan i Botol
Ipratropium bromida ih 20mcgBotol
 - Isoniazid tab 100 mg Tab
- Isoniazid tab 300 mg Tab
5 Isosorbid dinitrat tab 5 mg Tab
IUD Cu T 380 A Set
IUD Levonorgestrel Set
Kalamin Tube
1 Kalsium glukonat inj 100 mg Ampul
1 Kalsium hidroksida bubuk, pa Tube
Kalsium karbonat tab 500 mg Tab
1,000 Kalsium laktat (kalk) tab 500 Tab
Kaptopril tab 12,5 mg Tab
500 Kaptopril tab 25 mg Tab
Kaptopril tab 50 mg Tab
Karbamazepin sir 100 mg/5 mBotol
Karbamazepin tab 100 mg Tab
200 Karbamazepin Tab 200 mg Tablet
Karbo adsorben tab 0,5 g Tab
4 Karbogliserin tts telinga 10 % Botol
- Karbon aktif tab 0,5 mg Tablet
20 Ketokonazol tab 200 mg Tab
Klindamisin kaps 150 mg Kaps
- Klindamisin kaps 300 mg Kaps
Klofazimin, micronized kaps Kapsul
Klofazimin, micronizedkaps kapsul
Klonidin tab 0,15 mg Tab
- Kloramfenikol kaps 250 mg Kaps
- Kloramfenikol salep kulit 2% Tube
30 Kloramfenikol salep mata 1% Tube
10 Kloramfenikol susp 125 mg/5 Botol
10 Kloramfenikol tetes telinga 3 Botol
50 Kloramfenikol tts mata 0,5% Botol
Kloramfenikol tts mata 1% Botol
2,000 Klorfeniramin tab 4 mg Tab
1 Klorfenol kamfer mentol (C Botol
Klorheksidin lar 0,2% Botol
Klorheksidin lar 15% Botol
Klorpromazin inj 25 mg/ml (i Ampul
Klorpromazin inj 5 mg/ml (i. Ampul
30 Klorpromazin tab sal 100 mg Tab sal
Klorpromazin tab sal 25 mg Tab sal
Klortalidon tab 50 mg Tab
Klozapin tab 100 mg Tab
Klozapin tab 25 mg Tab
 Kodein tab 10 mg Tab
- Kombinasi (DHP) : dihidroart Tablet
Kombinasi : artemether 20 m Kaps
Kombinasi : artesunat tab 50 Tab
Kombinasi : Desogestrel 150 Tab
23 Kombinasi : ergotamin 1 mg+ Tab
2,000 Kombinasi : Ferro fumarat 60 Tablet
Kombinasi : levonorgestrel 15 Tab
Kombinasi : Tenofovir 300 m Tab
- Kombinasi : Tenofovir 300 m Tab
5 Kombinasi: ipratropium Br 0 Botol
Kombinasi: kaolin 550 mg + Tab
Komposit resin Set
300 Kotrimoksazol (dewasa) kombTab
Kotrimoksazol (dewasa) kombTab
40 Kotrimoksazol (dewasa) kombiBotol
- Kuinin inj 25% (i.v.) Vial
- Kuinin tab 200 mg Tab
Laktulosa sir 3,335 g/5 ml Botol
Larutan mengandung ElektroliBotol
Larutan mengandung Elektro Botol
Larutan mengandung Elektro Botol
Larutan mengandung Elektrol Botol
Larutan mengandung Elektrol Botol
Larutan mengandung ElektroliBotol
Larutan mengandung Elektrol Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohi Botol
Larutan mengandung Karbohidra Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung KarbohidBotol
Larutan mengandung Karbohidra Botol
Larutan mengandung Karbohidra Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohidr Botol
Larutan mengandung KarbohidBotol
Larutan mengandung KarbohidBotol
Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohidr Botol
 Larutan mengandung Karbohidr Botol
Larutan mengandung Karbohidr Botol
Levonorgestrel implan 2 rods Set
1 Lidokain gel 2% Tube
Lidokain inj 2% (infiltr/p.v.) Ampul
1 Lidokain spray oral 10% Botol
Linestrenol tab 0,5 mg Tab
Loperamid tab 2 mg Tab
60 Loratadin tab 10 mg Tab
Lorazepam tab 0,5 mg Tab
Lorazepam tab 1 mg Tab
Lorazepam tab sal 2 mg Tab sal
Lugol Botol
2 Magnesium sulfat inj 20% Vial
5 Magnesium sulfat inj 40% Vial
Magnesium sulfat serb, ktg 30 Sachet
Mebendazol sir 100 mg/5 ml Botol
Mebendazol tab 100 mg Tan
Mebendazol tab 500 mg Tab
Medroksi progesteron asetat Vial
Metenamin mandelat (heksamiTab salut
200 Metformin tab 500 mg Tab
Metformin tab 850 mg Tab
10 Metilergometrin inj 0,2 mg/m Ampul
15 Metilergometrin tab salut 0,1 Tab sal
150 Metilprednisolon tab 4 mg Tab
Metoklopramid inj 5 mg/ml Ampul
Metoklopramid tab 10 mg Tab
Metoklopramid tab 5 mg Tab
Metronidazol lar inf 5 mg/ml Botol
Metronidazol sir 125 mg/5 Ml Botol
Metronidazol tab 250 mg Tab
300 Metronidazol tab 500 mg Tab
20 Mikonazol krim 2% Tube
Mikonazol serb 2% Tube
- Mineral Mix (Bismuth SubcitrSachet
500 N-asetil sistein kaps 200 mg Kaps
6 NaCl 0,9% Larutan Botol
Natrium diklofenak tab 25 mg Tab
1,200 Natrium diklofenak tab 50 mg Tab
Natrium Diklofenak Tetes Ma Botol
- Natrium hipoklorit cairan kon Botol
Natrium tiosulfat inj 25% (i.v. Ampul
 - Nifedipin kaps 10 mg Kaps
Nikotinamid tab 100 mg Tab
Nikotinamid tab 5 mg Tab
Nistatin susp 100.000 UI/ml Botol
5 Nistatin tab salut 500.000 UI Tab
7 Nistatin tab vaginal 100.000 Tab
Nitrofurantoin tab 50 mg Tab
Norepinefrin inj 1 mg/ml Ampul
1 Obat Anti Tuberculosis FDC Paket
3 Obat Anti Tuberculosis FDC K Paket
1 Obat Anti Tuberculosis FDC K Paket
- Obat Anti Tuberculosis FDC K Paket
Obat Anti Tuberculosis Komb Paket
- Obat Anti Tuberculosis Komb Paket
Oksigen ih, gas dlm tabung Botol
Oksimetazolin tts hidung 0,0 Botol
Oksimetazolin tts hidung 0,0 Botol
Oksitetrasiklin 1% Salep MataTube
33 Oksitosin inj 10 UI/ml Ampul
Olopatadin tts mata 0,1% Botol
Omeprazol inj 40 mg/10 ml Vial
300 Omeprazol kaps 20 mg Kaps
Paraformaldehid tab 1 g Tab
250 Parasetamol sir 120 mg/5 ml Botol
10,000 Parasetamol tab 500 mg Tab
Parasetamol tts 60 mg/0,6 ml Botol
1 Pasta devitalisasi (non arsen) Tube
1 Pasta pengisi saluran akar (pasTube
Perak nitrat lar 20% Botol
Perak sulfadiazin krim 1% Tube
25 Permetrin krim 5 % Tube
Pirantel pamoat susp 125 mg/ Botol
Pirantel pamoat tab 500 mg Tab
Pirantel pamoat tab scored 12 Tab
Pirantel pamoat tab scored 25 Tab
Piridoksin (vitamin B6) inj 1 Ampul
1,000 Piridoksin (vitamin B6) tab 1 Tab
- Piridoksin (vitamin B6) tab 2 Tab
Povidon iodin lar 100 mg/ml Botol 60 ml
Povidon iodin lar 100 mg/ml Botol 1000 ml
3 Povidon iodin lar 100 mg/ml Botol 30 ml
1 Povidon iodin lar 100 mg/ml Botol 300 ml
50 Prednison tab 5 mg Tab
 - Primakuin tab 15 mg Tab
Probenesid tab 500 mg Tab
- Prokain benzilpenisilin serb injVial
- Propiltiourasil tab 100 mg Tab
Propranolol tab 10 mg Tab
1,300 Ranitidin tab 150 mg Tab
3,100 Retinol (vitamin A) kaps luna Kaps lunak
8,600 Retinol (vitamin A) kaps luna Kaps lunak
Rifampisin kaps 300 mg Kaps
10 Ringer Laktat Larutan Botol
- Risperidon tab sal 1 mg Tab sal
Salbutamol cairan ih 0,1% Botol
Salbutamol lar ih 0,5 % Botol
Salbutamol sir 2 mg/5 ml Botol
Salbutamol tab 2 mg Tab
200 Salbutamol tab 4 mg Tab
15 Salep 2-4, kombinasi : asam s Tube
- Serum anti bisa ular : A.B.U. IVial
Serum anti bisa ular :A.B.U.II Vial
- Serum antidifteri (A.D.S) inj (Vial
Serum antidifteri (A.D.S) inj (Vial
Serum antirabies inj 100 UI/mVial
Serum antirabies inj 200 UI/mVial
Serum antitetanus (A.T.S) (i.m.Vial
1 Serum antitetanus (A.T.S) inj Ampul
Serum antitetanus (A.T.S) inj 2Vial
5 Setirizin sir 5 mg/5 ml. Botol
Sianokobalamin (vitamin B12)Tab
300 Simvastatin tab sal 10 mg Tab sal
Simvastatin tab sal 20 mg Tab sal
Simvastatin tab sal selaput 40 Tab sal
70 Siprofloksasin tab scored 500 Tab
Siprofloksasin tetes mata 3 m Botol
Spironolakton tab 25 mg Tab
Stannous pyrophosphate 27,6 Vial
Streptomisin serb inj 1.000 mgVial
Surgical ginggival pack Tube
Telmisartan tab 40 mg Tab
Telmisartan tab 80 mg Tab
- Tenofovir tab 300 mg Tab
Tetanus toxoid inj Ampul
Tetrakain tts mata 0,5% Botol
Tetrasiklin kaps 250 mg Kaps
 - Tetrasiklin kaps 500 mg Kaps
Tetrasiklin Salep Mata 1% Tube
3,500 Tiamin (vitamin B1) tab 50 m Tab
Timolol tts mata 0,25% Botol
Timolol tts mata 0,5% Botol
Tiotropium serb ih 18 mcg + hBotol
Tiotropium serb ih 18 mcg, refBotol
20 Triheksifenidil tab 2 mg Tab
Urea krim 10 % Tube
20 Vaksin BCG inj (i.k) Vial
40 Vaksin bivalen OPV (b-OPV) dVial
130 Vaksin campak inj (s.k.) Vial
50 Vaksin Hepatitis Rekombinan VialIn
Vaksin Influenza Vial
Vaksin Japanese Enchepalitis (Vial
130 Vaksin jerap difteri tetanus (D Vial
30 Vaksin jerap difteri tetanus (T Vial
40 Vaksin kombinasi DPT-HB-HiVial
20 Vaksin measless rubella (MR) Vial
- Vaksin Meningitis MeningokoVial
30 Vaksin polio IPV inj 0,5 ml Vial
- Vaksin rabies, untuk manusia se Vial
Vaksin rabies, untuk manusia sVial
Vaksin Yellow Fever Vial
Valproat sir 250 mg/5 ml Botol
Valproat tab sal 250 mg Tab sal
Valproat tab sal 500 mg Tab sal
4,000 Vitamin B kompleks Tab
Zinc drops 10 mg/ml Botol
Zinc serb 10 mg Sachet
Zinc sir 10 mg/ml Botol
Zinc sir 20 mg/5 ml Botol
300 Zinc tab disp 20 mg Tab
-
100
300
50
60
160
10
30
4
-
 -
6
1
2
6
5
7
2
2
-
-
-
-
1
5
160
7
6
2
80
-
2
-
10
10
25
2
450
200
-
-
5
-
500
5
1
-
-
-
-
-
1
1
 1
1
5
-
-
-
-
-
-
-
1
-
-
-
-
-
5
87
-
43
-
-
-
-
-
-
-
24
-
-
-
-
-
-
17
-
-
39
10
300
-
-
600
 40
-
1
-
-
-
10
42
2,000
-
8
200
1
-
-
30
30
200
400
-
100
3
-
-
1
-
1
-
4
7
300
1
-
-
1
6
-
-
-
-
2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Catatan:
1
2
3
4

5
6

7
Catatan:
Pengisian RKO ini dilakukan oleh petugas obat dan harus melibatkan pihak penulis resep di IGD, KIA, BP, RAWAT INAP, GIZ
Petugas obat mengisi pemakaian obat perbulan selama 2018 (pada sheet "ISI DATA PEMAKAIAN") dan analisa pemakaian
Jenis obat yang terdapat pada sheet "ISI RENCANA KEBUTUHAN" sampai dengan nomor urut 413 sesuai dengan jenis oba
Pengisian jenis obat pada data RKO:
- dapat menggunakan jenis obat yang sudah BIASA digunakan
- menggunakan jenis obat baru yang TERDAPAT dalam sheet "ISI RENCANA KEBUTUHAN" nomor urut 1-413, yang sesuai d
- menggunakan jenis obat baru yang TIDAK TERDAPAT dalam sheet "ISI RENCANA KEBUTUHAN" hasil diskusi dengan tim d
dan pelayanan kesehatan PPK1 dan dituangkan dalam Formularium puskesmas yang telah disetujui
Penambahan jenis obat dapat dilakukan pada sheet "ISI DATA PEMAKAIAN" mulai nomor urut 298
Isi dengan manual kolom I pada sheet "ISI RENCANA KEBUTUHAN" dengan mempertimbangkan data hasil perhitungan di
dan juga analisa ditambah atau dikurang
Cek rasionalitas nilai rupiah total RKO tahunan nya
 HARGA
NO NAMA OBAT KEMASAN
SATUAN

1 Albendazol Tablet 400 mg Tablet 403.00

2 Alopurinol Tablet 100 mg Tablet 99.00
3 Aminofilin Inj 24 mg/ml-10 ml Ampul 2,789.00
4 Aminofilin Tablet 200 mg Tablet 89.00
5 Amitriptilina HCl Tablet salut 25 mg Tablet 167.00
6 Amlodipin Tablet 5 mg Tablet 85.00
7 Amoksisilin Kaplet 500 mg Kaplet 233.00
8 Amoksisilin Sirup Kering 125 mg/5 ml Botol 1,881.00
9 Antasida DOEN I Tablet Kunyah Tablet 54.00
10 Antasida II Suspensi 60 ml Botol 1,995.00
11 Anti Hemmoroid DOEN Supp 3,167.00
12 Antibakteri DOEN Tube 2,924.00
13 Antifungi DOEN kombinasi Pot 4,323.00
14 Antimigren DOEN Tablet 173.00
15 Aqua Pro Inj steril bebas pirogen- 20 ml Vial 2,295.00
16 ARV: Efavirenz 600 mg Tablet 6,375.00
17 ARV: Lamivudine 150 mg Tablet 1,500.00
18 ARV: Lovinapir 200 mg Ronavir Tablet 6,600.00
19 ARV: Nevirapine 200 mg Tablet 2,800.00
20 ARV: TDF(300) + 3TC(300) + EFV(600) Tablet 11,894.30
21 ARV: Tenofovir 300 mg Tablet 8,100.00
22 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet 3,058.00
23 ARV: Zidovudine(300) + Lamivudine(150) Tablet 3,700.00
24 Asam Asetilsalisilat Tablet 80 mg (Asetosal) Tablet 99.00
25 Asam Askorbat (VIT C) Tablet 50 mg Tablet 105.00
26 Asam Folat Tablet 0,4 mg Tablet 55.00
27 Asam Mefenamat kaplet 500 mg Tablet 103.00
28 Asiklovir Krim 5%/5g Tube 3,599.20
29 Asiklovir Tablet 400 mg Tablet 380.00
30 Atapulgit Tablet 600 mg Tablet 145.00
31 Atropin Sulfat Inj 0,25 mg/ml Ampul 1,595.00
32 Azithromisin Tablet 500 mg Tablet 4,500.00
33 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial 13,400.00
34 Betahistin Tablet 6 mg Tablet 149.00
35 Betametason Krim 0.1 % Tube 1,340.00
36 Bisoprolol Tablet 5 mg Tablet 260.00
37 Bromheksin Tablet 8 mg Tablet 199.10
38 Clobazam Tablet 10 mg Tablet 760.00
39 Clozapine Tablet 25 mg Tablet 1,550.00
40 Dehidroartemisin 40 mg + Piperaquin 320 mg Paket 2,160.00
41 Deksametason Inj 5 mg/ml-1 ml Ampul 1,097.00
42 Deksametason Tablet 0,5 mg Tablet 41.00
43 Dekstrometorfan Tablet kombinasi Tablet 682.00
44 Dektrometorfan Sirup kombinasi Botol 11,999.90
45 Devitalisasi Pasta Botol 220,000.00
46 Dextrose Inj 40% Vial 14,524.00
47 Diazepam Inj 5 mg/ml-2 ml Ampul 1,735.00
48 Diazepam Rectal 5 mg/2,5 ml tube 12,573.00
49 Diazepam Tablet 2 mg Tablet 86.00
50 Difenhidramin Inj 10 mg/ml Ampul 1,095.00
51 Digoksin Tablet 0,25 mg Tablet 104.00
52 Dimenhidrinat Tablet 50 mg Tablet 99.00
53 Doksisilin Tablet 100 mg Tablet 268.00
54 Domperidon Suspensi 5mg/5ml Botol 3,000.00
55 Domperidon Tablet 10 mg Tablet 85.00
56 Endometason Botol 203,500.00
57 Epinefrina HCl/Bitartrat (Adrenalin) Inj 0,1 % Ampul 1,408.00
58 Eritromisin Kapsul 250 mg Kapsul 546.00
59 Eritromisin Kapsul 500 mg Kapsul 730.00
60 Eritromisin Sirup 200 mg/5 ml Botol 6,150.00
61 Etakridin Larutan 0,1 % Botol 3,150.00
62 Etanol 70 %- 1000 ml Botol 26,250.00
63 Etil Klorida Spray Botol 99,000.00
64 Eugenol Cairan Botol 18,824.00
65 Fenitoin Natrium Kapsul 100 mg Kapsul 158.00
66 Fenobarbital Tablet 30 mg Tablet 165.00
67 Fenoksimetil Penisilin Tablet 500 mg Tablet 629.00
68 Fitomenadion (Vit K1) Tablet Salut Gula 10 mg Tablet 710.00
69 Fitomenadion(Vit K1) Inj 2 mg/ml Ampul 3,682.00
70 Fluconazol Tablet 150 mg Tablet 18,000.00
71 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul 57,500.00
72 Formokresol Cair Botol 61,490.00
73 Furosemid Tablet 40 mg Tablet 77.00
74 Garam Oralit I Serbuk Sachet 260.00
75 Gentamisin Inj 40 mg/ml (Sulfat) Vial 3,509.00
76 Gentamisin Salep Kulit 0,1% Tube 2,499.20
77 Glass Ionomer Cement Botol 534,600.00
78 Glibenklamid Tablet 5 mg Tablet 119.00
79 Gliseril Guaiakolat Tablet 100 mg Tablet 82.50
80 Glukosa Larutan Infus 5% steril Fls 6,900.00
81 Griseofulvin Tablet 125 mg Micronized Tablet 210.00
82 Haloperidol 5 mg Tablet 56.00
83 Haloperidol Dekanoat Inj 50 mg/ml Ampul 97,500.00
 84 Haloperidol Inj 5 mg/ml Ampul 6,250.00
85 Haloperidol Tablet 1,5 mg Tablet 59.00
86 Hidrokortison Krim 2,5 % Tube 2,639.00
87 Hiosina butilbromida tab 10 mg Tablet 1,100.00
88 Human Tetanus Imunoglobulin Im 250UI (Tetagam) Set 170,000.00
89 Ibuprofen Tablet 400 mg Tablet 111.00
90 Isoniazid Tablet 100 mg Tablet 74.00
91 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 89.00
92 Kalsium glukonat inj 100 mg/ml Ampul 9,955.00
93 Kalsium hidroksida pasta Botol 144,991.00
94 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 59.00
95 Kaptropil Tablet 25 mg Tablet 75.00
96 Karbamazepin Tablet 200 mg Tablet 230.00
97 Karbogliserin Tetes Telinga 10 % Botol 2,590.00
98 Karbon aktif tab 0,5 mg Tablet 500.00
99 Ketokonazol Tablet 200 mg Tablet 270.00
100 Ketoprofen Supp 100 mg Supp 2,640.00
101 Kina Inj 26 % 2 ml Ampul 6,200.00
102 Kina Tablet 222 mg Tablet 670.00
103 Klindanmisin Tablet 300 mg Tablet 578.00
104 Kloramfenikol Kapsul 250 mg Kapsul 273.74
105 Kloramfenikol Kapsul 500 mg Kapsul 1,090.00
106 Kloramfenikol Salep Kulit 2% Tube 3,091.00
107 Kloramfenikol Salep Mata 1 % Tube 1,881.00
108 Kloramfenikol Sirup 125 mg/5 ml Botol 4,700.00
109 Kloramfenikol Tetes Mata 0.5% Botol 7,260.00
110 Kloramfenikol Tetes telinga 3 % Tube 6,600.00
111 Klorfenarimin Maleat (CTM) Tablet 4 mg Tablet 22.00
112 Klorpropmazin HCl Tablet salut 100 mg Tablet 147.00
113 Kotrimoksazol Susp:Sulf 200+Trim 40 mg/5 ml Botol 2,052.00
114 Kotrimoksazol Tab Dws:Sulf 400+Trim 80 mg Tablet 125.00
115 Lidokain Inj Komp : Lidokain %+ Epinefrin 1 : 8000 Ampul 1,152.00
116 Lidokain Jelly 2 % Tube 40,000.00
117 Lidokain Spray 10 % Botol 170,400.00
118 Lisol Botol 43,050.00
119 Loratadin Tablet 10 mg Tablet 134.00
120 Magnesium sulfat Inj (IV) 20 % Ampul 3,200.00
121 Magnesium sulfat Inj (IV) 40 % Ampul 3,650.00
122 MB Anak Blister 20,678
123 MB Dewasa Blister 31,760
124 Metformin HCl Tablet 500 mg Tablet 96.00
125 Metildopa Tablet 250 mg Tablet 911.00
126 Metilergomatrin Maleat Inj 0,200 mg Ampul 2,959.00
127 Metilergometrin Maleat (Metilergometrin) Tablet Sal Tablet 210.00
128 Metilprednisolon Tablet 4 mg Tablet 134.00
129 Metronidazol Tablet 500 mg Tablet 113.00
130 Mikonazol Krim/Salep 2% Tube 3,414.00
131 Mineral Mix Sachet 2,450.00
132 Monoklorkamfer mentol cairan Botol 63,800.00
133 Multivitamin + DHA + Lysin Sirup Botol 9,999.00
134 Multivitamin + Mineral Kaplet Kaplet 605.00
135 N-asetil sistein kaps 200 mg Kapsul 358.00
136 Natrium Bikarbonat Tablet 500 mg Tablet 66.00
137 Natrium Diklofenak Tablet 50 mg Tablet 115.00
138 Natrium Hipoklorit 3% Botol 78,100.00
139 Natrium Klorida Larutan Infus 0,9% Fls 6,410.00
140 Natrium Tiroksin Tablet 100 µg Tablet -
141 Nipedipin Tablet 10 mg Tablet 99.00
142 Nistatin Tablet Salut Gula 500.000 IU/g Tablet 790.00
143 Nistatin Tablet Vaginal 100.000 IU/g Tablet 545.00
144 OAT FDC Katagori 1 Paket 389,344.00
145 OAT FDC Katagori 2 Paket 1,199,985.00
146 OAT FDC Kategori Anak paket 214,985.00
147 OAT FDC Kategori Sisipan Paket 160,000.00
148 OAT Kombipak Kat I paket 288,200.00
149 Obat Batuk Hitam (OBH) Cairan Botol 3,999.60
150 Oksitosin Inj 10 IU/ml- 1 ml Ampul 1,199.00
151 Omeprazol Kapsul 20 mg Kapsul 130.00
152 Ondansetron Inj 4 mg/2 ml Ampul 1,070.00
153 Parasetamol Sirup 120 mg / 5ml Botol 1,107.00
154 Parasetamol Tablet 500 mg Tablet 53.00
155 PB Anak Blister 8,891
156 PB Dewasa Blister 12,569
157 Permetrin 5% Krim (Scabimite) Tube 11,825.00
158 Phenolphtalein, Paraffin Liquidum, Gliserin Sirup (Labotol 7,700.00
159 Piridoksin HCl (Vit B6) Tablet 10 mg Tablet 123.00
160 Pirimetamin Tablet 25 mg Tablet 1,315.00
161 Polikresulen (Albotyl) Botol 5 ml botol 22,445.50
162 Povidon Iodida 10 %-30 ml Botol 3,045.00
163 Povidon Iodida 10 %-300 ml Botol 18,900.00
164 Prednison Tablet 5 mg Tablet 96.00
165 Primakuin Tablet 15 mg Tablet 224.00
166 Prokain Benzilpenisilin Serb Inj 3 juta UI/vial (i.m.) Vial 8,615.00
167 Propanolol HCl Tablet 40 mg Tablet 76.00
168 Propiltiourasil Tablet 100 mg Tablet 550.00
169 Ranitidin Inj 25 mg/ml Ampul 1,155.00
170 Ranitidin Tablet 150 mg Tablet 105.00
171 Retinol (Vit A) Kapsul 100.000 IU Kapsul 288.00
172 Retinol (VIT A) Kapsul 200.000 IU Kapsul 517.00
173 Ringer Laktat Larutan Infus Steril Fls 7,150.00
174 Risperidon Tablet 2 mg Tablet 273.00
175 Salbutamol Nebu 2,5 mg/2,5 ml NaCl Ampul 4,550.00
176 Salbutamol Tablet 4 mg Tablet 70.00
177 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 2,621.00
178 Salisil Bedak 2 % Kotak 1,774.30
179 Sefadroksil Sirup 125 mg/5 ml Botol 3,922.00
180 Sefadroxil Kapsul 500 mg Kapsul 478.00
181 Sefiksime 200 mg + Azitromisin 500 mg Paket 30,030.00
182 Sefotaksim Inj 1 g Vial 4,200.00
183 Seftriaxon Inj 1 g Vial 9,900.00
184 Semen seng fosfat serbuk cairan Botol 169,400.00
185 Serum Anti Difteri (ADS) Vial 2,200,000.00
186 Serum anti tetanus Inj 1500 IU/vial (ATS) Ampul 130,999.00
187 Serum antibisa ular Polivalen Inj 5 ml (SABU) I Vial 462,000.00
188 Setirizin Sirup 5 mg/5 ml Botol 3,150.00
189 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul 1,035.00
190 Simvastatin Tablet 10 mg Tablet 110.00
191 Siprofloksasin (HCl) Tablet 500 mg Kaplet 265.00
192 Tablet Tambah Darah (Camabion) Buah 355.00
193 Tablet Tambah Darah Kombinasi Tablet 350.00
194 Temporary Restorative Material Botol 143,495.00
195 Tetrasiklin Kapsul 500 mg Kapsul 303.00
196 Tiamin HCL (Vit B1) Tablet 50 mg Tablet 82.00
197 Triheksifenidil HCl Tablet 2 mg Tablet 85.00
198 Vaksin BCG + Pelarut Set 61,996.00
199 Vaksin DPT-Hb-Hib Vial 78,991.00
200 Vaksin DT Vial 17,996.00
201 Vaksin Hb-0 Set 20,900.00
202 Vaksin IPV 10 ds Vial 34,815.00
203 Vaksin IPV 5 ds Vial 158,994.00
204 Vaksin Measles Rubella (MR) Vial 155,813.00
205 Vaksin Meningitis Paket -
206 Vaksin Papillomavirus (HPV) Vial -
207 Vaksin Pneumococcus Vial -
208 Vaksin Polio 10 ds bopv + Penetes Set 19,954.00
209 Vaksin Rabies Vero Set 165,000.00
210 Vaksin Td Vial 16,995.00
211 Vitamin B Kompleks Tablet Tablet 83.00
212 Zinc Tablet 20 mg Tablet 508.00
 0 BAHAN HABIS PAKAI 0 -
213 ADS 0.05 ml Buah 1,395.00
214 ADS 0.5 ml Buah 1,185.00
215 ADS 5 ml Buah 1,640.00
216 Alat Suntik Sekali Pakai 1ml Set 787.00
217 Alat Suntik Sekali Pakai 3 ml Set 827.00
218 Alat Suntik Sekali Pakai 5 ml Set 928.00
219 Alkohol Swab Buah 103.00
220 Bisturi Buah 770.00
221 Blood set Buah 3,740.00
222 Catgut/Benang Bedah No.2/0 dengan jarum bedah Set 5,750.83
223 Catgut/Benang Bedah No.3/0 dengan jarum bedah Set 5,750.83
224 Folley Catheter No.18 Buah 7,787.88
225 Infusion set anak Kantong 2,308.26
226 Infusion set dewasa Kantong 5,246.83
227 IV Catheter No.18 Set 6,000.00
228 IV Catheter No.20 Set 6,000.00
229 IV Catheter No.22 Set 6,000.00
230 IV Catheter No.24 Set 6,000.00
231 Jarum kulit Buah 2,291.67
232 Jarum otot Buah 2,291.67
233 Kaca Slide Buah 296.486
234 Kantung mayat Buah 170,000.00
235 Kapas Pembalut/absorben 250 mg Roll 24,000.00
236 Kasa Hidrofil 2x80 Roll 9,400.00
237 Kasa Hidrofil Steril 16 X 16 Lembar 493.75
238 Kasa Pembalut Hidrofil 4 X 10 cm Roll 2,300.00
239 Kasa Pembalut hidrofil 4 x 5 cm Roll 1,100.00
240 Kassa Pembalut elastic 4 inchi Roll 10,450.00
241 Masker Tie on Buah 379.48
242 Masker N-95 Buah 6,670.00
243 Plester 5 yard x 2 inch Roll 35,532.00
244 Polybag Medis Lembar 300.00
245 Polybag Nonmedis Lembar 220.00
246 Polybag Ramah Lingkungan Lembar 250.00
247 Pot Dahak Buah 5,800.00
248 Safety box Buah 22,433.00
249 Sarung Tangan Non Steril Uk.S Buah 466.62
250 Sarung Tangan Non Steril Uk.M Buah 466.62
251 Sarung Tangan Non Steril Uk.L Buah 466.62
252 Sarung Tangan Steril No.6 Set -
253 Sarung Tangan Steril No.6,5 Set 6,930.00
254 Sarung Tangan Steril No.7 Set 6,930.00
255 Sendok Obat Buah 250.00
Silk (Benang Bedah Sutera) No.2/0 Dengan Jarum
256 Set 3,147.22
Bedah
257 Urin Bag Buah 4,418.70
0 REAGEN 0 -
258 Cybow 10 Reagent Strip Set 138,950.00
259 Golongan darah anti A - 10 ml Botol 68,200.00
260 Golongan darah anti A-B - 10 ml Botol 92,510.00
261 Golongan darah anti B - 10 ml Botol 68,200.00
262 Humasens Plus Set 805,950.00
263 Humasens Plus Strip Uric Acid Kotak 550,800.00
264 Humasens Strip Glucose Kotak 252,300.00
265 Humasens Strip Kolesterol Kotak 544,400.00
266 Iodin test Botol 5,675.00
267 Larutan Asam Asetat 6% 100 ml Botol -
268 Larutan Benedict 100 ml Botol 19,950.00
269 Larutan EDTA 10 % 100 ml Botol 74,100.00
270 Larutan HCl 0,1 N 100 ml Botol 19,950.00
271 Larutan Natrium Citrat 3,13 % Botol 19,475.00
272 Larutan Rees Ecker 100 ml Botol 48,802.08
273 Larutan Turk 100 ml Botol 26,387.00
274 Larutan Ziehl Neelsen Botol 276,500.00
275 Rapid HIV 1/2 Device test 35,000.00
276 Rapid HIV 2 Fokus test 14,470.00
277 Rapid HIV Biomedika Sachet 35,000.00
278 Rapid HIV Biomeriux Sachet 22,475.00
279 Rapid HIV Intec Sachet 22,358.00
280 Rapid HIV Oncoprobe Sachet 24,495.00
281 Rapid HIV SD Sachet 14,340.00
282 Rapid Malaria Sachet 27,710.00
283 Rapid Syphilis SD Sachet 26,527.00
284 Reagen CD4 kontrol test -
285 Reagen CD4 tipe 1 (Alere Pima CD4) test 103.00
286 RPR Syphilis Sachet 4,150.00
287 Salmonella Thyphi H - 5 ml Botol 66,660.00
288 Salmonella Thyphi O - 5 ml Botol 66,660.00
289 Test Kehamilan Buah 6,911.00
LAIN-LAIN
290 Fenobarbital inj 50mg/ml Ampul 1,800.00
291 Vaksin Campak Vial 28,204.00
292 Piridoksin HCl (Vit B6) Tablet 25 mg tablet 60.00
293 Isoniazid Tablet 300 mg tablet 173.00
294 Diethil Karbamazin 100 mg tablet 119.00
295 Rapid SD HBsAG test 9,870.00
296 Vaksin Hb Ig vial 1,300,000.00
297 Tuberculin test Pcs 625,900.00
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
 PEMAKAIAN TAHUN 2018
JAN FEB MAR APR MEI JUN JUL AGS
10 9,000 3 15 - - 15 13
460 226 164 150 303 96 120 348
- - - - 2 - - -
5 11 1 - 20 8 51 20
10 317 - - - - - -
311 373 327 589 433 460 572 690
5,729 5,016 5,721 4,808 5,285 3,405 5,457 2,282
101 100 128 153 89 119 80 107
4,338 3,640 4,200 3,026 3,039 2,528 3,531 3,754
20 20 22 23 13 7 12 26
23 9 23 21 30 24 30 5
- 1 23 10 30 28 84 22
3 - 8 3 3 5 3 24
35 - - - 15 16 5 57
- 1 4 4 - - 1 -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
937 575 502 547 453 530 425 547
- - - - - - - 10
872 784 714 1,160 380 908 693 1,030
16 9 8 7 7 10 10 18
17 78 113 90 142 50 145 115
264 296 330 225 305 213 428 290
- - - - - - - -
- - - - - - - -
- - - - - - - -
- 35 45 15 55 30 40 80
56 65 70 38 59 36 64 72
- - 5 25 10 - 60 -
399 191 321 443 295 240 322 275
- - - - - - - -
- - - - - - - -
- - - - - - - -
 - - 1 5 11 5 11 7
1,420 2,449 2,239 2,079 2,358 1,993 2,704 2,124
360 416 324 575 385 320 580 335
56 29 51 35 53 28 42 29
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
33 10 11 13 - 3 20 46
- - 80 - 3 - - 1
- - - 5 40 10 15 40
- - - - 10 210 - -
- - - - - - - -
2 3 5 11 12 10 15 10
119 99 120 108 138 224 116 79
- - - - - - - -
- - 8 9 8 - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - 1 - - 1
1 1 1 - - 1 1 -
1 - 1 - - - - -
- - - - - - - -
- - 10 - - - - -
20 - 6 - - - - -
- 20 - 380 - - - -
- 10 39 35 40 68 62 61
- - - 31 10 - 1 -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - 13 65 15 56 89
377 176 191 239 231 239 292 408
- - - - - - - -
76 61 30 67 38 43 - 35
- - - - - - - -
170 121 124 80 135 115 153 67
1,924 2,350 2,707 1,878 1,986 1,309 2,100 847
- - - 3 1 - - -
3 22 55 35 20 10 10 10
20 - - 20 50 20 15 10
- - - - - - - -
 - - - - - - - -
- - - - - - - -
67 44 36 41 42 49 20 37
68 25 36 25 41 5 70 90
- - - - - - - -
2,156 1,909 2,442 2,293 1,280 420 - -
- - - - - - - -
5 10 - 20 20 - - -
- - - - - - - -
- - - - - - - -
1,011 695 1,179 826 575 429 696 349
456 455 559 473 529 426 400 385
90 90 115 150 180 185 180 150
- 4 3 2 2 6 2 -
- - - - - - - -
- 10 5 - 10 - - 10
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
191 139 35 105 189 69 106 182
8 19 18 4 24 273 - 13
42 49 1 21 27 32 28 14
3 1 4 4 2 2 - -
43 34 48 36 45 46 21 54
7 13 14 1 19 7 9 11
1,726 1,609 2,251 1,564 1,632 876 1,482 945
1,300 - - - 25 10 15 -
3 32 28 24 26 17 25 31
164 256 282 270 446 190 499 182
40 41 46 47 46 22 18 38
- - - - - - 1 -
- - - - - 1 - -
- - - - 1 - - 1
29 101 83 70 12 13 29 10
1 - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
100 150 100 225 - - - 200
3 3 8 - 30 - 9 2
- 9 - - - - 1 -
 - - - - - 20 20 10
- - - - - - - 151
255 244 237 180 224 364 248 275
17 27 14 21 11 5 9 18
- - - - - - - -
- - - - - - - -
42 36 30 36 39 29 29 41
69 162 133 137 175 165 188 83
- - - - - - - 769
165 289 360 236 81 364 476 197
1,070 678 817 1,011 674 1,015 1,155 1,543
- - - - - - - -
8 4 8 7 2 2 - 5
- - - - - - - -
- - - - - - - -
- - - - - 10 - -
7 3 - - - 8 7 7
3 1 1 3 3 - - 1
- - - - 2 - - -
- - 1 - - - - 1
- - - - - - - -
- - - - - - - -
56 75 84 46 56 52 81 52
- 12 - 4 - - 2 -
194 127 206 250 120 136 207 250
- - - 5 4 - 1 1
80 292 234 242 229 201 246 309
12,222 7,172 10,585 8,619 9,604 7,639 10,151 5,932
- - - - - - - -
- - - - - - - -
21 12 26 24 31 18 23 23
- 2 1 1 - - - -
1,387 866 1,203 545 830 630 819 579
- - - - - - - -
- - - 2 - - - -
- - - 1 7 - 2 4
- - - 2 - - - -
115 40 87 98 37 9 41 -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - 5 - - 1 5 -
1,606 1,328 1,345 1,534 1,729 1,163 1,218 997
- 750 - - - - 1,350 -
- 3,400 - - - - 3,600 -
7 7 18 21 4 - 20 1
- - - - - - - -
- - - - - - - -
239 196 130 197 143 110 176 167
6 18 21 13 5 14 11 18
27 20 11 24 23 23 30 24
- - - 3 2 5 7 5
306 434 - - - 90 184 326
1 1 - 2 - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - 1 - 1
- - - - - - - -
- 5 10 1 1 3 5 6
1 6 3 3 33 2 2 1
261 438 97 285 153 150 227 200
76 53 44 70 20 90 80 30
- - - - - - - -
1,625 26,445 1,260 1,510 295 839 21,580 1,310
- - - - - - - -
- - - - - - - -
3,184 2,173 3,046 2,602 2,232 2,321 2,991 3,016
- - - 20 50 20 - 10
10 8 12 29 9 12 16 10
40 666 49 84 46 35 38 477
- 82 40 40 - - - -
27 15 35 40 32 38 55 60
16 - - - - - - -
3 7 8 16 13 5 8 6
13 15 13 5 8 10 7 10
- - - - - - - -
- - - - - - - -
- - - - - - - -
40 19 26 29 20 20 30 40
- - - - - - - -
30 2,040 250 11 9 8 22 940
4,211 4,523 4,376 3,731 3,610 2,758 4,411 2,296
156 140 239 320 250 189 321 173
 - - - - - - - -
90 72 30 85 81 95 128 -
440 29,236 2,682 988 389 297 415 -
23 20 20 35 20 22 25 -
- - - 100 - 50 75 75
- - 100 200 154 146 200 200
- - - - - - 7 13
- 91 6 3 - - - -
7 3 - 1 4 - 6 5
- - - - - - - -
- - - - - - - -
- - 3 10 10 1 7 2
- - - - - - - -
2 - - - 11 - - 5
- 6 7 6 9 3 5 3
1 - 2 1 5 2 1 1
- 7 2 5 4 5 4 -
- 1 4 3 3 2 4 1
- 2 4 - 5 - 1 -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- 2 - 1 - - - 1
- 2 4 1 5 7 4 3
128 128 96 160 16 32 176 112
8 3 12 3 8 1 - -
10 10 3 - 2 7 4 4
- - 1 1 2 - 2 1
60 150 - 50 50 50 - 50
- - - - - - - -
1 1 - - 1 1 2 2
- - - - - - - -
10 10 - - - 20 10 10
10 10 - - - 10 10 10
- - - 10 34 7 8 -
3 120 15 - - 2 2 28
- 800 300 300 400 300 100 500
100 100 - - - - - -
- - - - - - - -
- - - - - - - -
- 2 2 3 6 - - -
- - - - - - - -
400 400 200 400 200 300 300 400
4 4 5 8 3 1 2 4
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
2 - - 15 - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - 25 - 25 - -
68 450 40 35 - 55 22 -
- - - - - - - -
- - - - - 43 - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
- - - - - - - -
8 PEMAKAIAN RATA-
JUMLAH RATA MENURUT
SEPT OKT NOP DES RUMUS
1,784 1,623 7,017 - 19,480 1,623.33
324 339 465 380 3,375 281.25
- 6 - - 8 0.67
29 15 - 30 190 15.83
- - - - 327 27.25
545 667 734 873 6,574 547.83
5,152 5,465 5,119 4,959 58,398 4,866.50
165 165 130 99 1,436 119.67
1,380 4,000 2,785 3,876 40,097 3,341.42
4 14 13 16 190 15.83
- 3 2 3 173 14.42
25 11 27 3 264 22.00
- - 1 - 50 4.17
- - 25 6 159 13.25
4 1 - - 15 1.25
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
10 20 5 - 35 2.92
632 464 414 599 6,625 552.08
220 300 80 330 940 78.33
828 1,160 940 1,421 10,890 907.50
15 17 21 17 155 12.92
60 110 140 108 1,168 97.33
161 328 246 454 3,540 295.00
- - - - - -
- - - - - -
- - - - - -
5 70 15 - 390 32.50
53 78 52 56 699 58.25
- - - - 100 8.33
246 461 291 80 3,564 297.00
- - - - - -
- - - - - -
- - - - - -
 9 5 9 1 64 5.33
2,336 2,383 2,185 2,042 26,312 2,192.67
585 540 665 906 5,991 499.25
40 28 45 20 456 38.00
- - 1 1 2 0.17
- - - - - -
- - - - - -
- - 5 - 5 0.42
- 38 6 180 15.00
- 2 2 - 88 7.33
- 10 - 35 155 12.92
- - - - 220 18.33
- - - - - -
8 11 11 8 106 8.83
138 99 97 113 1,450 120.83
- - 1 1 2 0.17
- 10 1 1 37 3.08
- - - - - -
- - - - - -
- - - - - -
- - - - 2 0.17
1 - - - 6 0.50
- - - - 2 0.17
- - 1 - 1 0.08
- - - - 10 0.83
- - - - 26 2.17
- - - - 400 33.33
65 50 59 41 530 44.17
11 - 5 - 58 4.83
- - - - - -
- - - - - -
- - 1 - 1 0.08
55 75 22 25 415 34.58
188 335 254 323 3,253 271.08
- - - 10 10 0.83
12 27 32 40 461 38.42
- - - - - -
86 119 125 160 1,455 121.25
1,805 1,615 693 607 19,821 1,651.75
- 2 2 1 9 0.75
- - 50 53 268 22.33
- 10 15 20 180 15.00
- - - - - -
 - - - - - -
- - - - - -
13 42 31 58 480 40.00
33 45 52 - 490 40.83
- - - - - -
- - 370 430 11,300 941.67
- - - - - -
- - - 1 56 4.67
- - - 2 2 0.17
- - 1 1 2 0.17
889 1,034 723 1,040 9,446 787.17
473 653 494 522 5,825 485.42
195 193 242 200 1,970 164.17
13 2 2 3 39 3.25
- - - - - -
125 20 20 10 210 17.50
- - 10 6 16 1.33
- - - - - -
- - - - - -
- - - - - -
- - - - - -
66 213 204 71 1,570 130.83
4 2 5 - 370 30.83
25 30 39 21 329 27.42
3 10 8 9 46 3.83
45 63 27 37 499 41.58
13 14 9 11 128 10.67
1,115 1,760 1,668 1,807 18,435 1,536.25
- 10 15 10 1,385 115.42
35 38 32 56 347 28.92
325 193 187 312 3,306 275.50
43 59 30 41 471 39.25
- - - - 1 0.08
- 1 - - 2 0.17
- - 2 - 4 0.33
68 67 73 155 710 59.17
- - - 1 0.08
- - 59 - 59 4.92
- - - - - -
- - - - - -
100 94 163 202 1,334 111.17
316 30 - - 401 33.42
- 84 - 25 119 9.92
 20 - - 10 80 6.67
- 160 131 - 442 36.83
323 200 245 347 3,142 261.83
7 18 17 18 182 15.17
- - - - - -
- - 1 - 1 0.08
27 26 30 20 385 32.08
220 202 152 221 1,907 158.92
- 720 1,255 1,196 3,940 328.33
387 500 424 452 3,931 327.58
1,086 1,628 1,493 1,391 13,561 1,130.08
- - - - - -
9 4 5 7 61 5.08
- - - - - -
- - - - - -
30 - - 6 46 3.83
3 - 7 13 55 4.58
3 5 3 2 25 2.08
- 1 - - 3 0.25
1 - - - 3 0.25
- - - - - -
- - - - - -
65 107 76 83 833 69.42
70 76 - 32 196 16.33
196 241 194 335 2,456 204.67
4 4 3 1 23 1.92
123 319 234 228 2,737 228.08
9,230 7,478 10,465 10,016 109,113 9,092.75
- - - - - -
- - - - - -
14 13 17 23 245 20.42
- 1 1 1 7 0.58
846 1,021 894 1,278 10,898 908.17
- - - - - -
- - - - 2 0.17
- 3 1 8 26 2.17
2 - - - 4 0.33
13 - 16 - 456 38.00
- - - - - -
- - - - - -
- - - - - -
- - - - - -
4 3 1 5 24 2.00
1,032 1,322 1,079 1,089 15,442 1,286.83
- - - - 2,100 175.00
- - - - 7,000 583.33
11 9 9 6 113 9.42
- - - - - -
- - - 5 5 0.42
122 195 177 191 2,043 170.25
- 7 14 28 155 12.92
31 32 39 31 315 26.25
10 10 12 8 62 5.17
310 450 160 400 2,660 221.67
- - - - 4 0.33
- - - - - -
- - - - - -
- - - 1 1 0.08
- - - - - -
- - 1 - 3 0.25
- - - - - -
- 5 - - 36 3.00
1 - - 2 54 4.50
340 240 330 95 2,816 234.67
80 17 70 23 653 54.42
- - - - - -
1,770 255,222 1,962 2,572 316,390 26,365.83
- - - 1 1 0.08
- - - - - -
3,873 3,787 3,737 3,696 36,658 3,054.83
20 10 15 10 155 12.92
15 12 12 15 160 13.33
10 70 80 90 1,685 140.42
5 130 150 - 447 37.25
50 - 30 40 422 35.17
- - - - 16 1.33
9 5 17 18 115 9.58
10 12 11 13 127 10.58
- - - - - -
- - - - - -
- - - - - -
20 24 35 30 333 27.75
- - - - - -
1,432 122 140 18 5,022 418.50
2,939 4,024 1,701 3,603 42,183 3,515.25
157 335 330 340 2,950 245.83
 - - - - - -
96 - - - 677 56.42
24,068 2,679 2,314 488 63,996 5,333.00
44 35 12 28 284 23.67
- - 100 - 400 33.33
- 100 100 200 1,400 116.67
- - - - 20 1.67
- - 18 - 118 9.83
4 4 2 3 39 3.25
- - - - - -
- - - - - -
1 5 4 9 52 4.33
1 3 3 - 7 0.58
- - - 1 19 1.58
9 6 8 3 65 5.42
6 3 6 1 29 2.42
2 3 4 5 41 3.42
- - - 1 19 1.58
- - 2 - 14 1.17
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - 1 5 0.42
5 4 5 10 50 4.17
192 96 208 112 1,456 121.33
8 10 9 2 64 5.33
3 6 - 3 52 4.33
2 1 - 1 11 0.92
200 50 50 50 760 63.33
- - - - - -
1 - 1 2 12 1.00
- - - - - -
10 - - - 70 5.83
- - - - 50 4.17
20 18 20 56 173 14.42
15 20 10 3 218 18.17
800 - - - 3,500 291.67
- 300 400 500 1,400 116.67
- - - - - -
- - - - - -
7 4 5 5 34 2.83
- - - - - -
400 500 300 500 4,300 358.33
- 12 3 5 51 4.25
1 3 3 - 7 0.58
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1 - - - 1 0.08
1 8 - 9 0.75
1 11 2 14 1.17
1 22 - 23 1.92
- 3 - - 3 0.25
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
5 - - - 22 1.83
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - 50 4.17
50 23 - 40 783 65.25
- - - - - -
- - - - 43 3.58
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
115 - - - 115 9.58
- - - - - -
- - - - - -
- - - - - -
- - - 2 2 0.17
- - - - - -
- - - - - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
PEMAKAIAN
RATA-RATA
DIANALISA
10.00
300.00
-
20.00
10.00
700.00
5,000.00
120.00
3,500.00
15.00
15.00
24.00
6.00
23.00
3.00

3.00
600.00
140.00
1,000.00
17.00
100.00
400.00

39.00
60.00
10.00
300.00
 6.00
2,200.00
600.00
40.00
1.00

1.00
20.00
5.00
22.00
-

10.00
200.00
1.00
6.00

1.00
1.00
1.00
1.00
10.00
10.00
-
48.00
10.00

1.00
46.00
300.00
10.00
42.00

200.00
2,000.00
2.00
27.00
20.00
 50.00
45.00

1,500.00

5.00
1.00
1.00
1,000.00
500.00
200.00
4.00

20.00
8.00

200.00
-
30.00
10.00
50.00
10.00
2,000.00
30.00
40.00
300.00
30.00
1.00
1.00
1.00
60.00
2.00
5.00

200.00
30.00
10.00
 15.00
150.00
300.00
20.00

1.00
30.00
200.00
500.00
400.00
1,200.00

6.00

5.00
7.00
3.00
1.00
1.00

100.00
33.00
300.00
3.00
250.00
10,000.00

25.00
1.00
1,000.00

1.00
3.00
1.00
50.00

4.00
1,300.00
3,100.00
8,600.00
10.00

5.00
200.00
15.00
30.00
7.00
300.00
1.00

1.00

1.00

5.00
6.00
300.00
70.00

2,000.00
1.00

3,500.00
20.00
20.00
40.00
130.00
50.00

30.00
20.00

40.00

30.00
4,000.00
300.00
100.00
300.00
50.00
60.00
160.00
10.00
30.00
4.00

6.00
1.00
2.00
6.00
5.00
7.00
2.00
2.00

1.00
5.00
160.00
7.00
6.00
2.00
80.00

2.00

10.00
10.00
25.00
2.00
450.00
200.00

5.00
500.00
5.00
1.00

1.00
1.00
1.00
1.00
5.00

1.00

5.00
87.00

43.00

130.00
2.00
 RENCANA KEBUTUHAN OBAT DAN PERBEKALAN KESEHATAN
PUSKESMAS : HAURPANGGUNG
TAHUN 2020

PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA

METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
1 Air untuk injeksi amp 20 ml Ampul 2,295.00 3 36 4 40 50 114,750.00
2 Air untuk injeksi amp 25 ml Ampul 2,500.00 - - - -
3 Albendazol susp 200 mg/5 ml Botol 3,849.00 - - - -
4 Albendazol tab 400 mg Tab 403.00 10 120 12 132 12,700 5,118,100.00 12584 Program obat cacing
5 Alopurinol tab 100 mg Tab 99.00 300 3,600 360 3,960 5,000 495,000.00
6 Alopurinol tab 300 mg Tab 120.00 - - - -
7 Aminofilin inj 24 mg/ml Ampul 2,789.00 - - - - -
8 Aminofilin tab 150 mg Tab 90.00 - - - -
9 Aminofilin Tab 200 mg Tab 89.00 20 240 24 264 500 44,500.00
10 Amitriptilin tab sal 25 mg Tab sal 167.00 10 120 12 132 500 83,500.00
11 Amlodipin tab 10 mg Tab 100.00 - - - 5,000 500,000.00 permintaan baru
12 Amlodipin tab 5 mg Tab 85.00 700 8,400 840 9,240 9,500 807,500.00
13 Amoksisilin drops 100 mg/ml Botol 26,620.00 - - - 500 13,310,000.00 permintaan baru
14 Amoksisilin sir forte 250 mg/5 ml Botol 3,984.00 - - - -
15 Amoksisilin sir kering 125 mg/5 ml Botol 1,881.00 120 1,440 144 1,584 1,700 3,197,700.00
16 Amoksisilin tab 250 mg Tab 195.00 - - - 10,000 1,950,000.00 permntaan baru
17 Amoksisilin tab 500 mg Tab 233.00 5,000 60,000 6,000 66,000 66,000 15,378,000.00
18 Ampisilin serb inj 1000 mg/vial Vial 7,247.00 - - - -
19 Ampisilin serb inj 250 mg/vial Vial 4,100.00 - - - -
20 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : Vial 1,152.00 30 360 36 396 400 460,800.00
21 80.000 injkombinasi
Antasida, 2 ml : aluminium hidroksida 200 mg + magnesium Botol 1,995.00 15 180 18 198 200 399,000.00
22 hidroksidakombinasi
Antasida, 200 mg : aluminium hidroksida 200 mg + magnesium Tab 54.00 3,500 42,000 4,200 46,200 47,000 2,538,000.00
23 hidroksida 200 mg
Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps 1,298.00 - - - -
24 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% Tube 4,323.00 6 72 7 79 100 432,300.00
25 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen Botol 3,167.00 15 180 18 198 200 633,400.00
26 2,5 mg + lidokain
Artesunat serb inj lidokain
60 mg/ml10(i.v./i.m.)
mg+ seng oksida 120 mg + sup ad 2 g Vial 3,167.00 - - - -
27 Articulating paper kertas warna penanda oklusi Kertas warna 38,999.00 - - - -
28 Asam asetat tetes telinga 2% Botol 80,000.00 - - - -
29 Asam asetilsalisilat (asetosal) tab 80 mg Tab 99.00 3 36 4 40 100 9,900.00
30 Asam askorbat (vitamin C) tab 250 mg Tab 99.00 - - - -
31 Asam askorbat (vitamin C) tab 50 mg Tab 105.00 600 7,200 720 7,920 8,000 840,000.00
32 Asam folat tab 0,4 mg Tab 55.00 140 1,680 168 1,848 3,500 192,500.00
33 Asam folat tab 1 mg Tab 52.00 - - - -
34 Asam folat tab 5 mg Tab 92.00 - - - -
35 Asam mefenamat kaps 250 mg Kaps 64.00 - - - 1,000 64,000.00 permintaan baru
36 Asam mefenamat kaps 500 mg Kaps 103.00 1,000 12,000 1,200 13,200 13,200 1,359,600.00
37 Asam salisilat lar 0,1% Botol 103.00 - - - -
38 Asam salisilat salep 10% Tube 5,000.00 - - - -
39 Asam salisilat salep 2% Tube 3,000.00 - - - -
40 Asam salisilat salep 5% Tube 1,500.00 - - - -
41 Asiklovir tab 200 mg Tab 2,000.00 - - - -
42 Asiklovir tab 400 mg Tab 380.00 100 1,200 120 1,320 2,000 760,000.00
43 Atapulgit 600 mg Tab 145.00 400 4,800 480 5,280 7,000 1,015,000.00
44 Atapulgit tab 630 mg Tablet 136.00 - - - -
45 Atapulgit tablet 650 mg Tab 350.00 - - - -
46 Atapulgit tablet 750 mg Tab 400.00 - - - -
47 Atenolol tab 100 mg Tab 529.00 - - - -
48 Atenolol tab 50 mg Tab 748.00 - - - -
49 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,595.00 - - - - -
50 Atropin tab 0,5 mg Tab 1,595.00 - - - -
51 Bahan tumpatan sementara lar, serb Botol 143,495.00 1 12 1 13 1 143,495.00
52 Bedak salisil serb 2% Botol 1,774.30 30 360 36 396 500 887,150.00
53 Betametason krim 0,1% Tube 1,340.00 60 720 72 792 800 1,072,000.00
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
54 Betametason krim 0,5 mg/g Tube 1,340.00 - - - -
55 Betametason salep 0,1% Tube 1,380.00 - - - -
56 Betametason tts mata 1 mg/ml Botol 2,500.00 - - - -
57 Bisakodil sup 10 mg Botol 2,000.00 - - - -
58 Bisakodil sup 5 mg Botol 5,800.00 - - - -
59 Bisakodil tab sal 5 mg Tab sal 5,670.00 - - - -
60 Budesonid cairan ih 0,25mg/ml respoules 907.00 - - - -
61 Budesonid cairan ih 0,5 mg/ml respoules 9,725.00 - - - -
62 Budesonid ih 200 mcg/dosis Botol 101,000.00 - - - -
63 Budesonid serb ih 100 mcg/dosis Botol 197,485.00 - - - -
64 Coal tar lar 5 % Botol 141,600.00 - - - -
65 Copper T set/buah 500,000.00 - - - -
66 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,097.00 6 72 7 79 150 164,550.00
67 Deksametason tab 0,5 mg Tab 41.00 2,200 26,400 2,640 29,040 30,000 1,230,000.00
68 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 1,735.00 - - - - 50 86,750.00
69 Diazepam lar rektal 10 mg/2,5 ml Botol 16,742.00 - - - -
70 Diazepam lar rektal 5 mg/2,5 ml Botol 12,573.00 1 12 1 13 12 150,876.00
71 Diazepam tab 2 mg Tab 86.00 20 240 24 264 300 25,800.00
72 Diazepam tab 5 mg Tab 117.00 - - - -
73 Dietilkarbamazin tab 100 mg Tab 119.00 - - - - -
74 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,095.00 5 60 6 66 70 76,650.00
75 Digoksin tab 0,25 mg Tab 104.00 22 264 26 290 300 31,200.00
76 Diltiazem hcl tab 30 mg Tab 127.00 - - - -
77 Diltiazem kaps SR 100 mg Kaps 4,290.00 - - - -
78 Diltiazem kaps SR 200 mg Kaps 4,650.00 - - - -
79 Diltiazem tab 30 mg Tab 127.00 - - - -
80 Dimenhidrinat tab 50 mg Tab 99.00 - - - - -
81 Doksazosin tab 1 mg Tab 3,480.00 - - - -
82 Doksazosin tab 2 mg Tab 5,480.00 - - - -
83 Doksisiklin kaps 100 mg Kaps 268.00 - - - - -
84 Domperidon susp 5 mg/5 ml Botol 3,000.00 10 120 12 132 200 600,000.00
85 Domperidon tab 10 mg Tab 85.00 200 2,400 240 2,640 3,000 255,000.00
86 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 1,408.00 6 72 7 79 100 140,800.00
87 Epinefrin (adrenalin) inj 1 mg/ml Ampul 2,200.00 - - - -
88 Ergotamin tab 1 mg Tab 135.00 - - - -
89 Eritromisin kaps 250 mg Kaps 546.00 - - - - -
90 Eritromisin sir 200 mg/5 ml Botol 6,150.00 - - - - -
91 Eritromisin tab 500 mg Tab 730.00 - - - - -
92 Estrogen terkonjugasi tab sal 0,625 mg Tab sal 92,100.00 - - - -
93 Etanol 70% cairan 70% Botol 26,250.00 1 12 1 13 20 525,000.00
94 Etil klorida semprot 100 ml Botol 99,000.00 1 12 1 13 20 1,980,000.00
95 Etonogestrel implan 68 mg Set 230,000.00 - - - -
96 Eugenol Botol 18,824.00 1 12 1 13 1 18,824.00
97 Fenitoin Na inj 100 mg/2 ml Ampul 7,980.00 - - - -
98 Fenitoin Na inj 50 mg/ml Ampul 7,980.00 - - - -
99 Fenitoin Na kaps 100 mg Kaps 158.00 10 120 12 132 200 31,600.00
100 Fenitoin Na kaps 30 mg Kaps 126.00 - - - -
101 Fenobarbital tab 100 mg Tab 195.00 - - - -
102 Fenobarbital tab 30 mg Tab 165.00 10 120 12 132 200 33,000.00
103 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 350.00 - - - -
104 Fenoksimetil penisilin (penisilin V) tab 500 mg Tab 629.00 - - - - -
105 Ferro fumarat kaps lunak 300 mg Kaps lunak 50.00 - - - -
106 Ferro sulfat sir. 150 mg/5 ml Botol 2,000.00 - - - -
107 Ferro sulfat tab salut 300 mg Tab sal 50.00 - - - -
108 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 3,682.00 10 120 12 132 200 736,400.00
109 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 710.00 48 576 58 634 700 497,000.00
110 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul 2,349.00 - - - -
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
111 Fluoksetin kaps 10 mg Kaps 150.00 - - - -
112 Fluor kapl 1 mg Kaplet 2,000.00 - - - -
113 Fluor sediaan topikal Tube 150.00 - - - -
114 Fluoresein tts mata 2,5 mg/ml Botol 2,500.00 - - - -
115 Formokresol Botol 61,490.00 1 12 1 13 1 61,490.00
116 Framisetin Sulfat Tulle 1% Patch 10,000.00 - - - -
117 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 2,500.00 - - - -
118 Furosemid tab 40 mg Tab 77.00 46 552 55 607 600 46,200.00
119 Galactose microparticle 200-400 mg micropart/ml Vial 5,000.00 - - - -
120 Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida Sachet 260.00 300 3,600 360 3,960 4,000 1,040,000.00
121 0,30 g + trinatrium
Gentamisin sitrat0,3%
salep mata 0,58 g + glukosa anhidrat 2,7 g Tube 5,000.00 - - - -
122 Gentamisin tts mata 0,3% Botol 6,000.00 - - - -
123 Glass ionomer ART (Atraumatic Restorative Treatment) cocoa butter Sachet 521,235.00 - - - -
124 5 g ionomer ART (Atraumatic Restorative Treatment) lar
Glass Botol 534,600.00 - - - - -
125 Glass ionomer ART (Atraumatic Restorative Treatment) serb Vial 521,235.00 - - - -
126 Glibenklamid tab 2,5 mg Tab 75.00 - - - -
127 Glibenklamid tab 5 mg Tab 119.00 200 2,400 240 2,640 3,000 357,000.00
128 Glikuidon tab 30 mg Tab 1,000.00 - - - -
129 Glimepirid tab 1 mg Tab 218.00 - - - -
130 Glimepirid tab 2 mg Tab 289.00 - - - -
131 Glipizid tab 5 mg Tab 300.00 - - - -
132 Gliseril trinitrat tab 0,5 mg Tab sub 1,500.00 - - - -
133 Gliserin tts 100 mg/ml Botol 4,000.00 - - - -
134 Glukosa Larutan Infus 10% steril 100 ml Botol 4,000.00 - - - -
135 Glukosa Larutan Infus 10% steril 250 ml Botol 5,000.00 - - - -
136 Glukosa Larutan Infus 10% steril 500 ml Botol 7,500.00 - - - -
137 Glukosa Larutan Infus 5% steril 100 ml Botol 4,000.00 - - - -
138 Glukosa Larutan Infus 5% steril 250 ml Botol 5,000.00 - - - -
139 Glukosa Larutan Infus 5% steril 500 ml Botol 6,900.00 2 24 2 26 40 276,000.00
140 Griseofulvin (micronized) tab 125 mg Tab 210.00 27 324 32 356 700 147,000.00
141 Griseofulvin (micronized) tab scored 250 mg Tab 300.00 - - - -
142 Gutta percha dan paper points 15 - 40 mm Roll 400,000.00 - - - -
143 Gutta percha dan paper points 45 - 80 mm Roll 400,000.00 - - - -
144 Haloperidol inj 5 mg/ml (i.m.) Vial 6,250.00 - - - - 13 81,250.00
145 Haloperidol tab 0,5 mg Tab 60.00 - - - -
146 Haloperidol tab 1,5 mg Tab 59.00 - - - - -
147 Haloperidol tab 2 mg Tab 110.00 - - - -
148 Haloperidol tab 5 mg Tab 56.00 20 240 24 264 300 16,800.00
149 Haloperidol tts 2 mg/ml Botol 17,099.00 - - - -
150 Hepatitis B imunoglobulin (human) inj 0,5 ml Ampul 1,300,000.00 - - - -
151 Hidrogen peroksida cairan 3% Botol 15,000.00 - - - -
152 Hidrogen peroksida lar. Konsentrat 3% Botol 15,000.00 - - - -
153 Hidroklorotiazid tab 25 mg Tab 149.00 - - - -
154 Hidrokortison krim 2,5% Tube 2,639.00 50 600 60 660 700 1,847,300.00
155 Hidrokortison serb inj 100 mg Vial 2,000.00 - - - -
156 Hiosina butilbromida tab 10 mg Tab 1,100.00 45 540 54 594 700 770,000.00
157 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul 170,000.00 - - - - -
158 Human tetanus imunoglobulin inj 500 UI (i.m.) Ampul 200,000.00 - - - -
159 Ibuprofen sir 100 mg/5 ml Botol 2,475.00 - - - -
160 Ibuprofen sir 200 mg/5 ml Botol 3,000.00 - - - -
161 Ibuprofen tab 200 mg Tab 105.00 - - - -
162 Ibuprofen tab 400 mg Tab 111.00 1,500 18,000 1,800 19,800 30,000 3,330,000.00
163 Ipratropium bromida aerosol 20 mcg/semprot Botol 83,500.00 - - - -
164 Ipratropium bromida cairan ih 0,025% Botol 98,000.00 - - - -
165 Ipratropium bromida ih 20mcg/puff Botol 90,000.00 - - - -
166 Isoniazid tab 100 mg Tab 74.00 - - - - -
167 Isoniazid tab 300 mg Tab 173.00 - - - - -
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
168 Isosorbid dinitrat tab 5 mg Tab 89.00 5 60 6 66 100 8,900.00
169 IUD Cu T 380 A Set 500,000.00 - - - -
170 IUD Levonorgestrel Set 350,000.00 - - - -
171 Kalamin Tube 11,000.00 - - - -
172 Kalsium glukonat inj 100 mg/ml Ampul 9,955.00 1 12 1 13 15 149,325.00
173 Kalsium hidroksida bubuk, pasta Tube 144,991.00 1 12 1 13 1 144,991.00
174 Kalsium karbonat tab 500 mg Tab 400.00 - - - -
175 Kalsium laktat (kalk) tab 500 mg Tab 59.00 1,000 12,000 1,200 13,200 15,000 885,000.00
176 Kaptopril tab 12,5 mg Tab 50.00 - - - -
177 Kaptopril tab 25 mg Tab 75.00 500 6,000 600 6,600 7,000 525,000.00
178 Kaptopril tab 50 mg Tab 75.00 - - - -
179 Karbamazepin sir 100 mg/5 ml Botol 3,500.00 - - - -
180 Karbamazepin tab 100 mg Tab 200.00 - - - -
181 Karbamazepin Tab 200 mg Tablet 230.00 200 2,400 240 2,640 3,000 690,000.00
182 Karbo adsorben tab 0,5 g Tab 300.00 - - - -
183 Karbogliserin tts telinga 10 % Botol 2,590.00 4 48 5 53 100 259,000.00
184 Karbon aktif tab 0,5 mg Tablet 500.00 - - - - -
185 Ketokonazol tab 200 mg Tab 270.00 20 240 24 264 300 81,000.00
186 Klindamisin kaps 150 mg Kaps 578.00 - - - -
187 Klindamisin kaps 300 mg Kaps 578.00 - - - - -
188 Klofazimin, micronized kaps 50 mg Kapsul 300.00 - - - -
189 Klofazimin, micronizedkaps 100 mg kapsul 350.00 - - - -
190 Klonidin tab 0,15 mg Tab 200.00 - - - -
191 Kloramfenikol kaps 250 mg Kaps 273.74 - - - - 500 136,871.67 permintaan baru
192 Kloramfenikol salep kulit 2% Tube 3,091.00 - - - - -
193 Kloramfenikol salep mata 1% Tube 1,881.00 30 360 36 396 400 752,400.00
194 Kloramfenikol susp 125 mg/5 ml Botol 4,700.00 10 120 12 132 150 705,000.00
195 Kloramfenikol tetes telinga 3% Botol 6,600.00 10 120 12 132 100 660,000.00
196 Kloramfenikol tts mata 0,5% Botol 7,260.00 50 600 60 660 700 5,082,000.00
197 Kloramfenikol tts mata 1% Botol 6,500.00 - - - -
198 Klorfeniramin tab 4 mg Tab 22.00 2,000 24,000 2,400 26,400 27,000 594,000.00
199 Klorfenol kamfer mentol (CHKM) Botol 63,800.00 1 12 1 13 1 63,800.00
200 Klorheksidin lar 0,2% Botol 5,000.00 - - - -
201 Klorheksidin lar 15% Botol 5,000.00 - - - -
202 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,500.00 - - - -
203 Klorpromazin inj 5 mg/ml (i.m.) Ampul 1,000.00 - - - -
204 Klorpromazin tab sal 100 mg Tab sal 147.00 30 360 36 396 400 58,800.00
205 Klorpromazin tab sal 25 mg Tab sal 150.00 - - - -
206 Klortalidon tab 50 mg Tab 300.00 - - - -
207 Klozapin tab 100 mg Tab 2,000.00 - - - -
208 Klozapin tab 25 mg Tab 1,550.00 - - - -
209 Kodein tab 10 mg Tab 100.00 - - - -
210 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg tab Tablet 2,160.00 - - - - -
211 sal selaput : artemether 20 mg + lumefantrin 120 mg
Kombinasi Kaps 3,498.00 - - - -
212 Kombinasi : artesunat tab 50 mg + amodiakuin tab 200 Tab 1,000.00 - - - -
213 Kombinasi : Desogestrel 150 mcg Etinilestradiol 30 mcg Tab 5,000.00 - - - -
214 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 173.00 23 276 28 304 400 69,200.00
215 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut Tablet 350.00 2,000 24,000 2,400 26,400 493,000 172,550,000.00 Rematri 466080
216 Kombinasi : levonorgestrel 150 mcg + etinilestradiol 30 mcg Tab 9,000.00 - - - -
217 Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 mg Tab 10,000.00 - - - -
218 Kombinasi : Tenofovir 300 mg + Lamivudin 300 mg + Efavirenz 600 Tab 11,894.30 - - - - -
219 mg
Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules Botol 4,550.00 5 60 6 66 70 318,500.00
220 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 200.00 - - - -
221 Komposit resin Set 100,000.00 - - - -
222 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ Tab 125.00 300 3,600 360 3,960 4,000 500,000.00
223 trimetoprim 80 (dewasa)
Kotrimoksazol mg kombinasi : sulfametoksazol 800 mg+ Tab 300.00 - - - -
224 trimetoprim 160(dewasa)
Kotrimoksazol mg kombinasi tiap 5 ml suspensi : Botol 2,052.00 40 480 48 528 600 1,231,200.00
sulfametoksazol 200 mg + trimetoprim 40 mg
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
225 Kuinin inj 25% (i.v.) Vial 6,200.00 - - - - -
226 Kuinin tab 200 mg Tab 670.00 - - - - -
227 Laktulosa sir 3,335 g/5 ml Botol 10,000.00 - - - -
228 Larutan mengandung Elektrolit (Kalium Klorida) Botol 7,000.00 - - - -
229 Larutan mengandung Elektrolit (KCl 0,15%, NaCL 0,9%) (KN1) Botol 10,000.00 - - - -
230 Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0,9%) (KN2) Botol 10,000.00 - - - -
231 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 Botol 10,000.00 - - - -
232 mEq, Asetat
Larutan 28 mEq) Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr)
mengandung Botol 10,000.00 - - - -
233 (KA EN mengandung
Larutan 1B) Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Botol 57,750.00 - - - -
234 Potassium
Larutan Chloride 0.3
mengandung gr/L, Calcium
Elektrolit Chloride
(Tiap 1000 0.2 gr/L, elektrolit)
ml mengandung electrolit: Botol 60,000.00 - - - -
235 Sodium 145 mmol/l, Potassium
Larutan mengandung Karbohidrat 4.0(Fructose
mmol/l, Calcium 2.5 mmol/l,
120 g, glucose 66 g, Botol 50,000.00 - - - -
236 Magnesium
Xylitol 60
Larutan g/1.0
L) mmol/l,
mengandung Chloride 118
Karbohidrat mmol/l,
(Fructose Acetate
200 24 mmol/l,
g, glucose 110 g, Botol 50,000.00 - - - -
237 Malate
Xylitol 5.0
Larutan 100 mmol/l)
g/ L)
mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Botol 50,000.00 - - - -
238 Xylitol
Larutan30 g/ L)
mengandung Karbohidrat (Maltose 10%) Botol 47,000.00 - - - -
239 Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 Botol 50,000.00 - - - -
240 g sodiummengandung
Larutan chloride, 0.15 g potassium
Karbohidrat chloride, 0.10
+ Elektrolit g calcium
(Acetate, Na, K,chloride
Cl, Botol 8,025.00 - - - -
241 dihydrate
Ca, dan 1.5550ggr/L)
Mg, mengandung
Larutan Sorbitol sodium lactate)
Karbohidrat + Elektrolit (Dextrose 5%, NaCL Botol 50,000.00 - - - -
242 0,45%, KCl)
Larutan (HSD) Karbohidrat + Elektrolit (Fructose 120 g,
mengandung Botol 50,000.00 - - - -
243 glucose 66
Larutan g, Xylitol 60
mengandung g/ L + elektrolit)
Karbohidrat + Elektrolit (Glukosa 25 g, NaCl Botol 50,000.00 - - - -
244 2,0 g, KCl
Larutan 1,3 g, Natrium
mengandung Laktat 3,1
Karbohidrat g, air untuk
+ Elektrolit injeksi ad
(Glukosa 55 1000
g ; ml) Botol 50,000.00 - - - -
245 Natriummengandung
Larutan Chloride 9 g,Karbohidrat
air untuk injeksi ad 1000(Glukosa:
+ Elektrolit ml) (D5-NS)25,0 g; Botol 50,000.00 - - - -
246 NaCl:
Larutan4,5 g)
mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; Botol 50,000.00 - - - -
247 NaCl: 2.25
Larutan g) (D5-1/4NS)
mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; Botol 9,350.00 - - - -
248 NaCl: 4.5
Larutan g) (D5-1/2NS)
mengandung Karbohidrat + Elektrolit (Larutan nutrisi Botol 9,400.00 - - - -
249 kombinasi infus per L:Karbohidrat
Larutan mengandung Na. 100mEQ, K 18mEQ,
+ Elektrolit Ca. 4mEQ,
(Larutan Mg&
Ringer Botol 39,325.00 - - - -
250 6mEQ,
GlukosaCl
Larutan 5%)90mEQ, Asetat
mengandung 38mEQ,+Sorbitol
Karbohidrat 50g)
Elektrolit (NaCl 1.75 g, KCL Botol 50,000.00 - - - -
251 1.5g, Glukosa
Larutan 100 gr)Karbohidrat + Elektrolit (NaCl 1.75 g, KCL
mengandung Botol 50,000.00 - - - -
252 1.5g, Namengandung
Larutan Lactate 2.24 Karbohidrat
g, Glukosa 100 gr)
+ Elektrolit (Nacl 1.75 gr, KCl 1.5 Botol 10,050.00 - - - -
253 gr, Na Lactat
Larutan 2.24 gr, Dekstrosa
mengandung Karbohidrat 27+gr) (KA EN(Nacl
Elektrolit 3B) 2.34 gr, Na Botol 10,050.00 - - - -
254 Laktat 2.24 gr, KCL
Levonorgestrel 0.75
implan gr Dekstrosa
2 rods, 27 gr)
75 mg (3-4 (KA EN 3A)
tahun) Set 50,000.00 - - - -
255 Lidokain gel 2% Tube 40,000.00 1 12 1 13 5 200,000.00
256 Lidokain inj 2% (infiltr/p.v.) Ampul 2,000.00 - - - -
257 Lidokain spray oral 10% Botol 170,400.00 1 12 1 13 5 852,000.00
258 Linestrenol tab 0,5 mg Tab 500.00 - - - -
259 Loperamid tab 2 mg Tab 85.00 - - - 1,000 85,000.00 permintaan baru
260 Loratadin tab 10 mg Tab 134.00 60 720 72 792 800 107,200.00
261 Lorazepam tab 0,5 mg Tab 200.00 - - - -
262 Lorazepam tab 1 mg Tab 250.00 - - - -
263 Lorazepam tab sal 2 mg Tab sal 300.00 - - - -
264 Lugol Botol 50,000.00 - - - -
265 Magnesium sulfat inj 20% Vial 3,200.00 2 24 2 26 30 96,000.00
266 Magnesium sulfat inj 40% Vial 3,650.00 5 60 6 66 100 365,000.00
267 Magnesium sulfat serb, ktg 30 g Sachet 2,000.00 - - - -
268 Mebendazol sir 100 mg/5 ml Botol 10,000.00 - - - -
269 Mebendazol tab 100 mg Tan 5,000.00 - - - -
270 Mebendazol tab 500 mg Tab 8,800.00 - - - -
271 Medroksi progesteron asetat inj 150 mg/ml Vial 6,100.00 - - - -
272 Metenamin mandelat (heksamin mandelat) tab salut enterik 500 mg Tab salut 10,000.00 - - - -
273 Metformin tab 500 mg Tab 96.00 200 2,400 240 2,640 3,000 288,000.00
274 Metformin tab 850 mg Tab 185.00 - - - -
275 Metilergometrin inj 0,2 mg/ml Ampul 2,959.00 10 120 12 132 150 443,850.00
276 Metilergometrin tab salut 0,125 mg Tab sal 210.00 15 180 18 198 200 42,000.00
277 Metilprednisolon tab 4 mg Tab 134.00 150 1,800 180 1,980 2,000 268,000.00
278 Metoklopramid inj 5 mg/ml Ampul 3,960.00 - - - -
279 Metoklopramid tab 10 mg Tab 90.00 - - - -
280 Metoklopramid tab 5 mg Tab 115.00 - - - -
281 Metronidazol lar inf 5 mg/ml Botol 7,000.00 - - - -
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
282 Metronidazol sir 125 mg/5 Ml Botol 3,800.00 - - - -
283 Metronidazol tab 250 mg Tab 94.00 - - - -
284 Metronidazol tab 500 mg Tab 113.00 300 3,600 360 3,960 4,500 508,500.00
285 Mikonazol krim 2% Tube 3,414.00 20 240 24 264 300 1,024,200.00
286 Mikonazol serb 2% Tube 25,500.00 - - - -
287 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, Sachet 2,450.00 - - - - -
288 Magnesium Chloride
N-asetil sistein Anhydrous,
kaps 200 mg Potassium Chloride, Zinc Acetate) Kaps 358.00 500 6,000 600 6,600 7,000 2,506,000.00
289 NaCl 0,9% Larutan Botol 6,410.00 6 72 7 79 200 1,282,000.00
290 Natrium diklofenak tab 25 mg Tab 145.00 - - - -
291 Natrium diklofenak tab 50 mg Tab 115.00 1,200 14,400 1,440 15,840 16,000 1,840,000.00
292 Natrium Diklofenak Tetes Mata 1 mg/ml Botol 3,000.00 - - - -
293 Natrium hipoklorit cairan konsentrat 5% Botol 78,100.00 - - - - -
294 Natrium tiosulfat inj 25% (i.v.) Ampul 2,000.00 - - - -
295 Nifedipin kaps 10 mg Kaps 99.00 - - - - -
296 Nikotinamid tab 100 mg Tab 500.00 - - - -
297 Nikotinamid tab 5 mg Tab 400.00 - - - -
298 Nistatin susp 100.000 UI/ml Botol 5,000.00 - - - -
299 Nistatin tab salut 500.000 UI Tab 790.00 5 60 6 66 100 79,000.00
300 Nistatin tab vaginal 100.000 UI Tab 545.00 7 84 8 92 100 54,500.00
301 Nitrofurantoin tab 50 mg Tab 300.00 - - - -
302 Norepinefrin inj 1 mg/ml Ampul 2,000.00 - - - -
303 Obat Anti Tuberculosis FDC Kategori Anak Paket 214,985.00 1 12 1 13 13 2,794,805.00
304 Obat Anti Tuberculosis FDC Kategori I Paket 389,344.00 3 36 4 40 40 15,573,760.00
305 Obat Anti Tuberculosis FDC Kategori II Paket 1,199,985.00 1 12 1 13 1 1,199,985.00
306 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 160,000.00 - - - - -
307 Obat Anti Tuberculosis Kombipak Anak Paket 232,200.00 - - - -
308 Obat Anti Tuberculosis Kombipak Dewasa Paket 288,200.00 - - - - -
309 Oksigen ih, gas dlm tabung Botol 25,000.00 - - - -
310 Oksimetazolin tts hidung 0,025% Botol 30,000.00 - - - -
311 Oksimetazolin tts hidung 0,050% Botol 31,000.00 - - - -
312 Oksitetrasiklin 1% Salep Mata Tube 1,199.00 - - - -
313 Oksitosin inj 10 UI/ml Ampul 1,199.00 33 396 40 436 200 239,800.00
314 Olopatadin tts mata 0,1% Botol 16,997.00 - - - -
315 Omeprazol inj 40 mg/10 ml Vial 130.00 - - - -
316 Omeprazol kaps 20 mg Kaps 130.00 300 3,600 360 3,960 4,000 520,000.00
317 Paraformaldehid tab 1 g Tab 1,107.00 - - - -
318 Parasetamol sir 120 mg/5 ml Botol 1,107.00 250 3,000 300 3,300 4,000 4,428,000.00
319 Parasetamol tab 500 mg Tab 53.00 10,000 120,000 12,000 132,000 135,000 7,155,000.00
320 Parasetamol tts 60 mg/0,6 ml Botol 246,400.00 - - - -
321 Pasta devitalisasi (non arsen) Tube 220,000.00 1 12 1 13 1 220,000.00
322 Pasta pengisi saluran akar (pasta) Tube 203,500.00 1 12 1 13 1 203,500.00
323 Perak nitrat lar 20% Botol 50,000.00 - - - -
324 Perak sulfadiazin krim 1% Tube 12,155.00 - - - -
325 Permetrin krim 5 % Tube 11,825.00 25 300 30 330 400 4,730,000.00
326 Pirantel pamoat susp 125 mg/5 ml Botol 2,500.00 - - - -
327 Pirantel pamoat tab 500 mg Tab 500.00 - - - -
328 Pirantel pamoat tab scored 125 mg Tab 291.00 - - - -
329 Pirantel pamoat tab scored 250 mg Tab 350.00 - - - -
330 Piridoksin (vitamin B6) inj 100 mg/ml Ampul 3,000.00 - - - -
331 Piridoksin (vitamin B6) tab 10 mg Tab 123.00 1,000 12,000 1,200 13,200 13,500 1,660,500.00
332 Piridoksin (vitamin B6) tab 25 mg Tab 60.00 - - - - -
333 Povidon iodin lar 100 mg/ml Botol 60 ml 3,045.00 - - - -
334 Povidon iodin lar 100 mg/ml Botol 1000 ml 6,550.00 - - - -
335 Povidon iodin lar 100 mg/ml Botol 30 ml 3,045.00 3 36 4 40 30 91,350.00
336 Povidon iodin lar 100 mg/ml Botol 300 ml 18,900.00 1 12 1 13 20 378,000.00
337 Prednison tab 5 mg Tab 96.00 50 600 60 660 700 67,200.00
338 Primakuin tab 15 mg Tab 224.00 - - - - -
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
339 Probenesid tab 500 mg Tab 1,780.00 - - - -
340 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) Vial 8,615.00 - - - - -
341 Propiltiourasil tab 100 mg Tab 550.00 - - - - -
342 Propranolol tab 10 mg Tab 76.00 - - - -
343 Ranitidin tab 150 mg Tab 105.00 1,300 15,600 1,560 17,160 17,500 1,837,500.00
344 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak 288.00 3,100 37,200 3,720 40,920 3,100 892,800.00
345 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 517.00 8,600 103,200 10,320 113,520 8,600 4,446,200.00
346 Rifampisin kaps 300 mg Kaps 683.00 - - - -
347 Ringer Laktat Larutan Botol 7,150.00 10 120 12 132 200 1,430,000.00
348 Risperidon tab sal 1 mg Tab sal 273.00 - - - - -
349 Salbutamol cairan ih 0,1% Botol 3,999.60 - - - -
350 Salbutamol lar ih 0,5 % Botol 3,000.00 - - - -
351 Salbutamol sir 2 mg/5 ml Botol 4,750.00 - - - -
352 Salbutamol tab 2 mg Tab 66.00 - - - -
353 Salbutamol tab 4 mg Tab 70.00 200 2,400 240 2,640 3,000 210,000.00
354 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % Tube 2,621.00 15 180 18 198 200 524,200.00
355 Serum anti bisa ular : A.B.U. I (khusus ular dari luar ) inj (i.m./i.v.) Vial 462,000.00 - - - - -
356 Papua
Serum anti bisa ular :A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) Vial 500,000.00 - - - -
357 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 10.000 UI/ Vial 2,200,000.00 - - - - -
358 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 20.000 UI/ Vial 200,000.00 - - - -
359 Serum antirabies inj 100 UI/ml Vial 150,000.00 - - - -
360 Serum antirabies inj 200 UI/ml Vial 200,000.00 - - - -
361 Serum antitetanus (A.T.S) (i.m.) Inj 10.000 UI/vial (i.m /i.v.) Vial 250,000.00 - - - -
362 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul 130,999.00 1 12 1 13 13 1,702,987.00
363 Serum antitetanus (A.T.S) inj 20.000 UI/vial (i.m /i.v.) Vial 400,000.00 - - - -
364 Setirizin sir 5 mg/5 ml. Botol 3,150.00 5 60 6 66 100 315,000.00
365 Sianokobalamin (vitamin B12) tab 50 mcg Tab 1,035.00 - - - -
366 Simvastatin tab sal 10 mg Tab sal 110.00 300 3,600 360 3,960 4,000 440,000.00
367 Simvastatin tab sal 20 mg Tab sal 252.00 - - - -
368 Simvastatin tab sal selaput 40 mg Tab sal 500.00 - - - -
369 Siprofloksasin tab scored 500 mg Tab 265.00 70 840 84 924 1,000 265,000.00
370 Siprofloksasin tetes mata 3 mg/ml Botol 5,000.00 - - - -
371 Spironolakton tab 25 mg Tab 294.00 - - - -
372 Stannous pyrophosphate 27,6 mg sodium pyrophosphate/vial Vial 20,000.00 - - - -
373 Streptomisin serb inj 1.000 mg/vial Vial 5,000.00 - - - -
374 Surgical ginggival pack Tube 228,800.00 - - - -
375 Telmisartan tab 40 mg Tab 2,000.00 - - - -
376 Telmisartan tab 80 mg Tab 3,000.00 - - - -
377 Tenofovir tab 300 mg Tab 8,100.00 - - - - -
378 Tetanus toxoid inj Ampul 170,000.00 - - - -
379 Tetrakain tts mata 0,5% Botol 5,000.00 - - - -
380 Tetrasiklin kaps 250 mg Kaps 163.00 - - - -
381 Tetrasiklin kaps 500 mg Kaps 303.00 - - - - -
382 Tetrasiklin Salep Mata 1% Tube 3,000.00 - - - -
383 Tiamin (vitamin B1) tab 50 mg Tab 82.00 3,500 42,000 4,200 46,200 46,500 3,813,000.00
384 Timolol tts mata 0,25% Botol 3,000.00 - - - -
385 Timolol tts mata 0,5% Botol 4,000.00 - - - -
386 Tiotropium serb ih 18 mcg + handihaller Botol 162,000.00 - - - -
387 Tiotropium serb ih 18 mcg, refill Botol 14,750.00 - - - -
388 Triheksifenidil tab 2 mg Tab 85.00 20 240 24 264 300 25,500.00
389 Urea krim 10 % Tube 5,000.00 - - - -
390 Vaksin BCG inj (i.k) Vial 61,996.00 20 240 24 264 270 16,738,920.00
391 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial 19,954.00 40 480 48 528 530 10,575,620.00
392 Vaksin campak inj (s.k.) Vial 28,204.00 130 1,560 156 1,716 130 3,666,520.00
393 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device (Uniject) Vial 20,900.00 50 600 60 660 660 13,794,000.00
394 Vaksin Influenza Vial 82,005.00 - - - -
395 Vaksin Japanese Enchepalitis (J.E) Vial 100,000.00 - - - -
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
396 Vaksin jerap difteri tetanus (DT) Vial 17,996.00 130 1,560 156 1,716 130 2,339,480.00
397 Vaksin jerap difteri tetanus (Td) Vial 16,995.00 30 360 36 396 550 9,347,250.00 ditambah BIAS
398 Vaksin kombinasi DPT-HB-Hib Vial 78,991.00 40 480 48 528 530 41,865,230.00
399 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial 155,813.00 20 240 24 264 400 62,325,200.00 ditambah BIAS
400 Vaksin Meningitis Meningokokus Vial 135,000.00 - - - - -
401 Vaksin polio IPV inj 0,5 ml Vial 158,994.00 30 360 36 396 400 63,597,600.00
402 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial 165,000.00 - - - - -
403 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 78,500.00 - - - -
404 Vaksin Yellow Fever Vial 296,000.00 - - - -
405 Valproat sir 250 mg/5 ml Botol 189,607.00 - - - -
406 Valproat tab sal 250 mg Tab sal 1,750.00 - - - -
407 Valproat tab sal 500 mg Tab sal 6,000.00 - - - -
408 Vitamin B kompleks Tab 83.00 4,000 48,000 4,800 52,800 53,000 4,399,000.00
409 Zinc drops 10 mg/ml Botol 20,000.00 - - - -
410 Zinc serb 10 mg Sachet 500.00 - - - -
411 Zinc sir 10 mg/ml Botol 14,980.00 - - - 500 7,490,000.00 permintaan baru
412 Zinc sir 20 mg/5 ml Botol 6,290.00 - - - -
413 Zinc tab disp 20 mg Tab 508.00 300 3,600 360 3,960 4,000 2,032,000.00
ALKES HABIS PAKAI - - - -
414 ADS 0.05 ml Buah 1,395.00 100 1,200 120 1,320 1,320 1,841,400.00
415 ADS 0.5 ml Buah 1,185.00 300 3,600 360 3,960 7,468 8,849,580.00 ditambah BIAS
416 ADS 5 ml Buah 1,640.00 50 600 60 660 790 1,295,600.00 ditambah BIAS
417 Alat Suntik Sekali Pakai 1ml Set 787.00 60 720 72 792 1,000 787,000.00
418 Alat Suntik Sekali Pakai 3 ml Set 827.00 160 1,920 192 2,112 2,500 2,067,500.00
419 Alat Suntik Sekali Pakai 5 ml Set 928.00 10 120 12 132 100 92,800.00
420 Alkohol Swab Buah 103.00 30 360 36 396 400 41,200.00
421 Bisturi Buah 770.00 4 48 5 53 100 77,000.00
422 Blood set Buah 3,740.00 - - - - -
423 Catgut/Benang Bedah No.2/0 dengan jarum bedah Set 5,750.83 - - - - -
424 Catgut/Benang Bedah No.3/0 dengan jarum bedah Set 5,750.83 6 72 7 79 100 575,083.33
425 Folley Catheter No.18 Buah 7,787.88 1 12 1 13 20 155,757.50
426 Infusion set anak Kantong 2,308.26 2 24 2 26 30 69,247.86
427 Infusion set dewasa Kantong 5,246.83 6 72 7 79 100 524,683.33
428 IV Catheter No.18 Set 6,000.00 5 60 6 66 100 600,000.00
429 IV Catheter No.20 Set 6,000.00 7 84 8 92 100 600,000.00
430 IV Catheter No.22 Set 6,000.00 2 24 2 26 50 300,000.00
431 IV Catheter No.24 Set 6,000.00 2 24 2 26 50 300,000.00
432 Jarum kulit Buah 2,291.67 - - - - -
433 Jarum otot Buah 2,291.67 - - - - -
434 Kaca Slide Buah 296.49 - - - - -
435 Kantung mayat Buah 170,000.00 - - - - -
436 Kapas Pembalut/absorben 250 mg Roll 24,000.00 1 12 1 13 20 480,000.00
437 Kasa Hidrofil 2x80 Roll 9,400.00 5 60 6 66 150 1,410,000.00
438 Kasa Hidrofil Steril 16 X 16 Lembar 493.75 160 1,920 192 2,112 2,160 1,066,500.00
439 Kasa Pembalut Hidrofil 4 X 10 cm Roll 2,300.00 7 84 8 92 150 345,000.00
440 Kasa Pembalut hidrofil 4 x 5 cm Roll 1,100.00 6 72 7 79 150 165,000.00
441 Kassa Pembalut elastic 4 inchi Roll 10,450.00 2 24 2 26 50 522,500.00
442 Masker Tie on Buah 379.48 80 960 96 1,056 1,300 493,324.00
443 Masker N-95 Buah 6,670.00 - - - - -
444 Plester 5 yard x 2 inch Roll 35,532.00 2 24 2 26 30 1,065,960.00
445 Polybag Medis Lembar 300.00 - - - - -
446 Polybag Nonmedis Lembar 220.00 10 120 12 132 100 22,000.00
447 Polybag Ramah Lingkungan Lembar 250.00 10 120 12 132 100 25,000.00
448 Pot Dahak Buah 5,800.00 25 300 30 330 350 2,030,000.00
449 Safety box Buah 22,433.00 2 24 2 26 300 6,729,900.00
450 Sarung Tangan Non Steril Uk.S Buah 466.62 450 5,400 540 5,940 -
451 Sarung Tangan Non Steril Uk.M Buah 466.62 200 2,400 240 2,640 6,000 2,799,720.00
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
452 Sarung Tangan Non Steril Uk.L Buah 466.62 - - - - -
453 Sarung Tangan Steril No.6 Set - - - - - -
454 Sarung Tangan Steril No.6,5 Set 6,930.00 5 60 6 66 100 693,000.00
455 Sarung Tangan Steril No.7 Set 6,930.00 - - - - -
456 Sendok Obat Buah 250.00 500 6,000 600 6,600 7,000 1,750,000.00
457 Silk (Benang Bedah Sutera) No.2/0 Dengan Jarum Bedah Set 3,147.22 5 60 6 66 70 220,305.56
458 Urin Bag Buah 4,418.70 1 12 1 13 20 88,374.07
REAGEN - - - -
459 Cybow 10 Reagent Strip Set 138,950.00 - - - - -
460 Golongan darah anti A - 10 ml Botol 68,200.00 - - - - -
461 Golongan darah anti A-B - 10 ml Botol 92,510.00 - - - - -
462 Golongan darah anti B - 10 ml Botol 68,200.00 - - - - -
463 Humasens Plus Set 805,950.00 1 12 1 13 1 805,950.00
464 Humasens Plus Strip Uric Acid Kotak 550,800.00 1 12 1 13 12 6,609,600.00
465 Humasens Strip Glucose Kotak 252,300.00 1 12 1 13 12 3,027,600.00
466 Humasens Strip Kolesterol Kotak 544,400.00 1 12 1 13 15 8,166,000.00
467 Iodin test Botol 5,675.00 5 60 6 66 5 28,375.00 Ditambah desa Tarogong jadi 5
468 Larutan Asam Asetat 6% 100 ml Botol - - - - - -
469 Larutan Benedict 100 ml Botol 19,950.00 - - - - -
470 Larutan EDTA 10 % 100 ml Botol 74,100.00 - - - - -
471 Larutan HCl 0,1 N 100 ml Botol 19,950.00 - - - - -
472 Larutan Natrium Citrat 3,13 % Botol 19,475.00 - - - - -
473 Larutan Rees Ecker 100 ml Botol 48,802.08 - - - - -
474 Larutan Turk 100 ml Botol 26,387.00 - - - - -
475 Larutan Ziehl Neelsen Botol 276,500.00 1 12 1 13 20 5,530,000.00
476 Rapid HIV 1/2 Device test 35,000.00 - - - - -
477 Rapid HIV 2 Fokus test 14,470.00 - - - - -
478 Rapid HIV Biomedika Sachet 35,000.00 - - - - -
479 Rapid HIV Biomeriux Sachet 22,475.00 - - - - -
480 Rapid HIV Intec Sachet 22,358.00 - - - - -
481 Rapid HIV Oncoprobe Sachet 24,495.00 5 60 6 66 100 2,449,500.00
482 Rapid HIV SD Sachet 14,340.00 87 1,044 104 1,148 500 7,170,000.00
483 Rapid Malaria Sachet 27,710.00 - - - - -
484 Rapid Syphilis SD Sachet 26,527.00 43 516 52 568 100 2,652,700.00
485 Reagen CD4 kontrol test - - - - - -
486 Reagen CD4 tipe 1 (Alere Pima CD4) test 103.00 - - - - -
487 RPR Syphilis Sachet 4,150.00 - - - - -
488 Salmonella Thyphi H - 5 ml Botol 66,660.00 - - - - -
489 Salmonella Thyphi O - 5 ml Botol 66,660.00 - - - - -
490 Test Kehamilan Buah 6,911.00 - - - -
LAIN-LAIN - - - -
491 Antibakteri DOEN Tube 2,924.00 24 288 29 317 300 877,200.00
492 ARV: Efavirenz 600 mg Tablet 6,375.00 - - - - -
493 ARV: Lamivudine 150 mg Tablet 1,500.00 - - - - -
494 ARV: Lovinapir 200 mg Ronavir Tablet 6,600.00 - - - - -
495 ARV: Nevirapine 200 mg Tablet 2,800.00 - - - - -
496 ARV: Zdvdn(60) + Lmvdn(30) + Nvrpn(50) Tablet 3,058.00 - - - - -
497 ARV: Zidovudine(300) + Lamivudine(150) Tablet 3,700.00 - - - - -
498 Asiklovir Krim 5%/5g Tube 3,599.20 17 204 20 224 300 1,079,760.00
499 Azithromisin Tablet 500 mg Tablet 4,500.00 - - - - -
500 Benzatin Benzil Penisilin Inj 2,4 juta IU/vial Vial 13,400.00 - - - - -
501 Betahistin Tablet 6 mg Tablet 149.00 39 468 47 515 500 74,500.00
502 Bisoprolol Tablet 5 mg Tablet 260.00 10 120 12 132 100 26,000.00
503 Bromheksin Tablet 8 mg Tablet 199.10 300 3,600 360 3,960 5,000 995,500.00
504 Clobazam Tablet 10 mg Tablet 760.00 - - - - -
505 Clozapine Tablet 25 mg Tablet 1,550.00 - - - - -
506 Dekstrometorfan Tablet kombinasi Tablet 682.00 600 7,200 720 7,920 8,000 5,456,000.00
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
507 Dektrometorfan Sirup kombinasi Botol 11,999.90 40 480 48 528 600 7,199,940.00
508 Dextrose Inj 40% Vial 14,524.00 - - - - -
509 Etakridin Larutan 0,1 % Botol 3,150.00 1 12 1 13 5 15,750.00
510 Fenobarbital inj 50mg/ml Ampul 1,800.00 - - - - -
511 Fluconazol Tablet 150 mg Tablet 18,000.00 - - - - -
512 Flufenazin Inj im 25 mg/ml (Sikzonoate) Ampul 57,500.00 - - - - -
513 Gentamisin Inj 40 mg/ml (Sulfat) Vial 3,509.00 10 120 12 132 150 526,350.00
514 Gentamisin Salep Kulit 0,1% Tube 2,499.20 42 504 50 554 600 1,499,520.00
515 Gliseril Guaiakolat Tablet 100 mg Tablet 82.50 2,000 24,000 2,400 26,400 27,000 2,227,500.00
516 Haloperidol Dekanoat Inj 50 mg/ml Ampul 97,500.00 - - - - -
517 Ketoprofen Supp 100 mg Supp 2,640.00 8 96 10 106 150 396,000.00
518 Kloramfenikol Kapsul 500 mg Kapsul 1,090.00 200 2,400 240 2,640 2,700 2,943,000.00
519 Lisol Botol 43,050.00 1 12 1 13 13 559,650.00
520 MB Anak Blister 20,678.00 - - - - -
521 MB Dewasa Blister 31,760.00 - - - - -
522 Metildopa Tablet 250 mg Tablet 911.00 30 360 36 396 400 364,400.00
523 Multivitamin + DHA + Lysin Sirup Botol 9,999.00 30 360 36 396 400 3,999,600.00
524 Multivitamin + Mineral Kaplet Kaplet 605.00 200 2,400 240 2,640 2,700 1,633,500.00
525 Natrium Bikarbonat Tablet 500 mg Tablet 66.00 400 4,800 480 5,280 5,300 349,800.00
526 Natrium Tiroksin Tablet 100 µg Tablet - - - - - -
527 Obat Batuk Hitam (OBH) Cairan Botol 3,999.60 100 1,200 120 1,320 1,400 5,599,440.00
528 Ondansetron Inj 4 mg/2 ml Ampul 1,070.00 3 36 4 40 50 53,500.00
529 PB Anak Blister 8,891.00 - - - - -
530 PB Dewasa Blister 12,569.00 - - - - -
531 Phenolphtalein, Paraffin Liquidum, Gliserin Sirup (Laxadin syr) botol 7,700.00 1 12 1 13 13 100,100.00
532 Pirimetamin Tablet 25 mg Tablet 1,315.00 - - - - -
533 Polikresulen (Albotyl) Botol 5 ml botol 22,445.50 1 12 1 13 -
534 Propanolol HCl Tablet 40 mg Tablet 76.00 - - - - -
535 Ranitidin Inj 25 mg/ml Ampul 1,155.00 4 48 5 53 100 115,500.00
536 Sefadroksil Sirup 125 mg/5 ml Botol 3,922.00 7 84 8 92 100 392,200.00
537 Sefadroxil Kapsul 500 mg Kapsul 478.00 300 3,600 360 3,960 4,000 1,912,000.00
538 Sefiksime 200 mg + Azitromisin 500 mg Paket 30,030.00 1 12 1 13 1 30,030.00
539 Sefotaksim Inj 1 g Vial 4,200.00 - - - - -
540 Seftriaxon Inj 1 g Vial 9,900.00 - - - - -
541 Semen seng fosfat serbuk cairan Botol 169,400.00 1 12 1 13 1 169,400.00
542 Sianokobalamin (Vit B12 ) Inj 500 mcg/ml Ampul 1,035.00 6 72 7 79 100 103,500.00
543 Tablet Tambah Darah (Camabion) Buah 355.00 - - - - -
544 Vaksin IPV 10 ds Vial 34,815.00 - - - - -
545 Vaksin Papillomavirus (HPV) Vial - - - - - -
546 Vaksin Pneumococcus Vial - - - - - -
547 Rapid SD HBsAG test 9,870 2 24 2 26 50 493,500.00
548 Vaksin Hb Ig vial 1,300,000 - - - - -
549 Tuberculin test Pcs 625,900 - - - - -
550 - - - - - - - -
551 - - - - - - - -
552 - - - - - - - -
553 - - - - - - - -
554 - - - - - - - -
555 - - - - - - - -
556 - - - - - - - -
557 - - - - - - - -
558 - - - - - - - -
559 - - - - - - - -
560 - - - - - - - -
561 - - - - - - - -
562 - - - - - - - -
563 - - - - - - - -
 PERKIRAAN PEMAKAIAN KEBUTUHAN OBAT 1 TAHUN DENGAN RENCANA
METODA KONSUMSI JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA RATA-RATA KEBUTUHAN KETERANGAN
(Rp)
SATUAN (Rp) PER BULAN 12 BULAN BUFFER 10% JUMLAH TAHUN 2020
(1) (2) (3) (4) (5) (6) = (5) x 12 (7) = (6) x 10% (8) = (6) + (7) (9) (10) (11)
564 - - - - - - - -
565 - - - - - - - -
566 - - - - - - - -
567 - - - - - - - -
568 - - - - - - - -
569 - - - - - - - -
570 - - - - - - - -
571 - - - - - - - -
572 - - - - - - - -
573 - - - - - - - -
574 - - - - - - - -
575 - - - - - - - -
576 - - - - - - - -
577 - - - - - - - -
578 - - - - - - - -
579 - - - - - - - -
580 - - - - - - - -
581 - - - - - - - -
582 - - - - - - - -
583 - - - - - - - -
584 - - - - - - - -
585 - - - - - - - -
586 - - - - - - - -
587 - - - - - - - -
588 - - - - - - - -
589 - - - - - - - -
590 - - - - - - - -
591 - - - - - - - -
592 - - - - - - - -
593 - - - - - - - -
594 - - - - - - - -
595 - - - - - - - -
596 - - - - - - - -
JUMLAH HARGA 668,920,130.32

Mengetahui, Garut, Maret 2019

Kepala Puskesmas Haurpanggung Petugas Obat,

Rohmahalia M Noor,SKM.MKM Armia Noviani,S.Farm.,Apt

NIP 19670101 198901 2 003