58jdih.batan.go.id/unduh/jdih/20190821115745_KlmpokV.pdf · - 59 - harga satuan standar badan...

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- 58 - 1 Acarbose 50 mg tablet Generik Tablet, Box = 100 buah Box 209,000 2 Acitral sirup Non Generik Sirup, Botol = 120 ml Botol 57,000 3 Acitral tablet Non Generik Tablet, Box = 100 buah Box 172,000 4 Acnes Sealing Gel Non Generik Gel, Tube = 9 gram Tube 31,000 5 Actifed Plus, sirup Non Generik Sirup, Botol = 60 ml Botol 95,000 6 Acyclovir 200 mg tablet Generik Tablet, Box = 100 buah Box 93,000 7 Acyclovir 400 mg tablet Generik Tablet, Box = 100 buah Box 118,000 8 Acyclovir 5 % krim Generik Krim, Tube = 5 gram Tube 6,000 9 Acyclovir 5 % krim Generik Krim, Tube = 5 gram, Box = 25 buah Box 122,000 10 Adrome tablet Non Generik Tablet, Box = 100 buah Box 88,000 11 Alegi tablet Non Generik Tablet, Box = 100 buah Box 200,000 12 Alletrol Salep Mata Non Generik Tube, Box = 24 buah Box 431,000 13 Allopurinol 100 mg tablet Generik Tablet, Box = 100 buah Box 30,000 14 Aloclair Gel Non Generik Gel, Tube = 8 mg Tube 162,000 15 Alpara tablet Non Generik Tablet, Box = 100 buah Box 160,000 16 Ambeven kapsul Non Generik Kapsul, Box = 100 buah Box 229,000 17 Ambroxol 15 mg sirup Generik Sirup, Botol = 60 ml Botol 7,000 18 Ambroxol 30 mg tablet Generik Tablet, box = 100 buah Box 38,000 19 Amilorida HCL 5 mg tablet Generik Tablet, Box = 100 buah Box 19,000 20 Aminofilin 150 mg tablet Generik Tablet, Box = 100 buah Box 20,000 21 Amlodipin 10 mg tablet Generik Tablet, Box = 30 buah Box 54,000 22 Amlodipin 5 mg tablet Generik Tablet, Box = 50 buah Box 122,000 23 Amlodipin 5 mg tablet Generik Tablet, Box = 30 buah Box 47,000 24 Amoksisilin + Asam Klavulanat 625 mg tablet Generik Tablet, Box = 100 buah Box 317,000 25 Amosterra 500 mg tablet Non Generik Tablet, Box = 100 buah Box 57,000 26 Amoxicillin 500 mg Tablet Generik Tablet, Box = 100 buah Box 81,000 27 Amoxilin sirup kering Generik Sirup kering, Botol = 60 ml Botol 25,000 28 Ampisilin 250 mg kaplet Generik Kaplet, Box = 100 buah Box 57,000 29 Ampisilin 500 mg kaplet Generik Kaplet, Box = 100 buah Box 80,000 30 Ampisilin sirup kering Generik Sirup kering, Botol = 60 ml Botol 10,000 31 Antasida DOEN sirup Generik Sirup, botol = 60 mL Botol 17,000 32 Antidia tablet Non Generik Tablet, Box = 100 buah Box 58,000 33 Antimo tablet Non Generik Tablet, Strip = 2 tablet Strip 9,000 34 Antox kapsul Non Generik Tablet, box = 60 buah Box 611,000 35 Ardium HD tablet Non Generik Tablet, Box = 100 buah Box 781,000 36 Arsinal tablet Non Generik Tablet, Box = 100 buah Box 204,000 37 Asam Mefenamat tablet Generik Tablet, Box = 100 buah Box 54,000 38 Asam Traneksanat tablet Generik Tablet, Box = 100 buah Box 377,000 39 Ascardia 160 mg tablet Non Generik Tablet, Box = 100 buah Box 263,000 40 Ascardia 80 mg tablet Non Generik Tablet, Box = 100 buah Box 119,000 41 Asetazolamid 250 mg tablet Generik Tablet, Box = 100 buah Box 38,000 42 Asetosal 500 mg tablet Generik Tablet, Box = 100 buah Box 33,000 HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL TAHUN ANGGARAN 2020 KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/ KODE/ ACUAN SATUAN HARGA (dalam Rupiah) I. OBAT-OBATAN UMUM

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Transcript of 58jdih.batan.go.id/unduh/jdih/20190821115745_KlmpokV.pdf · - 59 - harga satuan standar badan...

  • - 58 -

    1 Acarbose 50 mg tablet Generik Tablet, Box = 100 buah Box 209,000

    2 Acitral sirup Non Generik Sirup, Botol = 120 ml Botol 57,000

    3 Acitral tablet Non Generik Tablet, Box = 100 buah Box 172,000

    4 Acnes Sealing Gel Non Generik Gel, Tube = 9 gram Tube 31,000

    5 Actifed Plus, sirup Non Generik Sirup, Botol = 60 ml Botol 95,000

    6 Acyclovir 200 mg tablet Generik Tablet, Box = 100 buah Box 93,000

    7 Acyclovir 400 mg tablet Generik Tablet, Box = 100 buah Box 118,000

    8 Acyclovir 5 % krim Generik Krim, Tube = 5 gram Tube 6,000

    9 Acyclovir 5 % krim GenerikKrim, Tube = 5 gram, Box =

    25 buahBox 122,000

    10 Adrome tablet Non Generik Tablet, Box = 100 buah Box 88,000

    11 Alegi tablet Non Generik Tablet, Box = 100 buah Box 200,000

    12 Alletrol Salep Mata Non Generik Tube, Box = 24 buah Box 431,000

    13 Allopurinol 100 mg tablet Generik Tablet, Box = 100 buah Box 30,000

    14 Aloclair Gel Non Generik Gel, Tube = 8 mg Tube 162,000

    15 Alpara tablet Non Generik Tablet, Box = 100 buah Box 160,000

    16 Ambeven kapsul Non Generik Kapsul, Box = 100 buah Box 229,000

    17 Ambroxol 15 mg sirup Generik Sirup, Botol = 60 ml Botol 7,000

    18 Ambroxol 30 mg tablet Generik Tablet, box = 100 buah Box 38,000

    19 Amilorida HCL 5 mg tablet Generik Tablet, Box = 100 buah Box 19,000

    20 Aminofilin 150 mg tablet Generik Tablet, Box = 100 buah Box 20,000

    21 Amlodipin 10 mg tablet Generik Tablet, Box = 30 buah Box 54,000

    22 Amlodipin 5 mg tablet Generik Tablet, Box = 50 buah Box 122,000

    23 Amlodipin 5 mg tablet Generik Tablet, Box = 30 buah Box 47,000

    24 Amoksisilin + Asam Klavulanat 625

    mg tabletGenerik Tablet, Box = 100 buah Box 317,000

    25 Amosterra 500 mg tablet Non Generik Tablet, Box = 100 buah Box 57,000

    26 Amoxicillin 500 mg Tablet Generik Tablet, Box = 100 buah Box 81,000

    27 Amoxilin sirup kering Generik Sirup kering, Botol = 60 ml Botol 25,000

    28 Ampisilin 250 mg kaplet Generik Kaplet, Box = 100 buah Box 57,000

    29 Ampisilin 500 mg kaplet Generik Kaplet, Box = 100 buah Box 80,000

    30 Ampisilin sirup kering Generik Sirup kering, Botol = 60 ml Botol 10,000

    31 Antasida DOEN sirup Generik Sirup, botol = 60 mL Botol 17,000

    32 Antidia tablet Non Generik Tablet, Box = 100 buah Box 58,000

    33 Antimo tablet Non Generik Tablet, Strip = 2 tablet Strip 9,000

    34 Antox kapsul Non Generik Tablet, box = 60 buah Box 611,000

    35 Ardium HD tablet Non Generik Tablet, Box = 100 buah Box 781,000

    36 Arsinal tablet Non Generik Tablet, Box = 100 buah Box 204,000

    37 Asam Mefenamat tablet Generik Tablet, Box = 100 buah Box 54,000

    38 Asam Traneksanat tablet Generik Tablet, Box = 100 buah Box 377,000

    39 Ascardia 160 mg tablet Non Generik Tablet, Box = 100 buah Box 263,000

    40 Ascardia 80 mg tablet Non Generik Tablet, Box = 100 buah Box 119,000

    41 Asetazolamid 250 mg tablet Generik Tablet, Box = 100 buah Box 38,000

    42 Asetosal 500 mg tablet Generik Tablet, Box = 100 buah Box 33,000

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    I. OBAT-OBATAN UMUM

  • - 59 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    43 Aspar K tablet Non Generik Tablet, Box = 100 buah Box 377,000

    44 Aspilet 80 mg tablet Non Generik Tablet, Box = 100 buah Box 109,000

    45 Atenolol 100 mg tablet Generik Tablet, Box = 100 buah Box 54,000

    46 Atenolol 50 mg tablet Generik Tablet, Box = 100 buah Box 57,000

    47 Atorvastatin 10 mg tablet Generik Tablet, box = 30 buah Box 134,000

    48 Atorvastatin 20 mg tablet Generik Tablet, box = 30 buah Box 223,000

    49 Azithromycin 500 mg tablet Generik Tablet, box = 20 buah Box 130,000

    50 Balsem cap Lang 40 g Non Generik Krim, botol = 40gr Botol 27,000

    51 Becom C tablet Non Generik Tablet, box = 100 buah Box 256,000

    52 Benacol Sirup Non Generik Sirup, botol = 100 ml Botol 48,000

    53 Beneuron tablet Non Generik Tablet, Box = 100 buah Box 88,000

    54 Benoson G krim Non Generik Krim, tube = 10 gram Tube 112,000

    55 Benoson M krim Non Generik Krim, tube = 5 gram Tube 102,000

    56 Benovit C tablet Non Generik Tablet, Box = 100 buah Box 278,000

    57 Benoxicam 20 mg tablet Non Generik Tablet, Box = 100 buah Box 124,000

    58 Benoxuric 300 tablet Non Generik Tablet, Box = 100 buah Box 593,000

    59 Berotek MDI inhaler Non Generik Inhaler, botol = 10 mL Botol 243,000

    60 Berryvision Tablet Non Generik Tablet, Box = 100 buah Box 569,000

    61 Betadine gargle kumur Non Generik Gargle kumur, botol = 100

    mLBotol 24,000

    62 Betahistin mesilat 6 mg tablet Non Generik Tablet, box = 30 buah Box 58,000

    63 Betametason 0,5 mg tablet Non Generik Tablet, Box = 100 buah Box 15,000

    64 Betasin krim Non Generik Krim, tube = 10 gram Tube 106,000

    65 Betason krim Non Generik Krim, tube = 5 gram Tube 14,000

    66 Betason N krim Non Generik Krim, tube = 10 gram Tube 23,000

    67 Bevalex krim Non Generik Krim, tube = 5 gram Tube 18,000

    68 Bevita Sirup Non Generik Sirup, botol = 120 ml Botol 79,000

    69 Bicnat tablet Generik Tablet, pot = 100 buah Pot 44,000

    70 Bioplacenton Gel Non Generik Gel, tube = 15 gram Tube 41,000

    71 Bisolvon Extra sirup Non Generik Sirup, botol = 60 ml Botol 60,000

    72 Bisolvon Inhaler Non Generik Larutan, botol = 50 ml Botol 132,000

    73 Bisoprolol 5 mg tablet Generik Tablet, Box = 100 buah Box 337,000

    74 Borraginol N krim Non Generik Krim, tube = 15 gram Tube 105,000

    75 Borraginol N Suppositoria Non Generik Suppost, box = 10 buah Box 202,000

    76 Braito Tetes Mata monodosis Non Generik Tetes Mata Strip, box = 10

    stripBox 35,000

    77 Braito Tetes Mata multidosis Non Generik Tetes Mata, botol = 5 ml Botol 16,000

    78 Bravoderm krim Non Generik Krim, tube = 5 gram Tube 23,000

    79 Bromheksin 8 mg tablet Generik Tablet, box = 100 buah Box 9,000

    80 Bufacetin salep Non Generik Krim, tube = 10 gram Tube 19,000

    81 Bufacomb krim Non Generik Krim, tube = 5 gram Tube 27,000

    82 Bufantacid sirup Non Generik Sirup, Botol = 60 ml Botol 15,000

    83 Bufect tablet Non Generik Tablet, box = 100 buah Box 105,000

    84 Burnazin krim Non Generik Krim, tube = 35 g Tube 100,000

    85 Buscopan plus tablet Non Generik Tablet, Box = 100 buah Box 586,000

  • - 60 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    86 Caladine Lotion Non Generik Bedak cair, botol = 60 ml Botol 21,000

    87 Caladine Powder (Active Fresh) Non Generik Bedak tabur, botol = 100

    gramBotol 16,000

    88 Calcidin tablet Non Generik Tablet, Box = 100 buah Box 108,000

    89 Calfera tablet Non Generik Tablet, Box = 100 buah Box 65,000

    90 Callusol Larutan Non Generik Larutan, botol = 10 ml Botol 50,000

    91 Cameloc 15 mg tablet Non Generik Tablet, box = 50 buah Box 116,000

    92 Canderin tablet Non Generik Tablet, Box = 100 buah Box 404,000

    93 Candesartan 16 mg tablet Generik Tablet, box = 30 buah Box 263,000

    94 Candesartan 8 mg tablet Generik Tablet, box = 30 buah Box 134,000

    95 Captopril 12,5 mg tablet Generik Tablet, box = 100 buah Box 18,000

    96 Captopril 25 mg tablet Generik Tablet, Box = 100 buah Box 51,000

    97 Cardio Aspirin tablet Non Generik Tablet, Box = 100 buah Box 88,000

    98 Cataflam 50 mg tablet Non Generik Tablet, box = 50 buah Box 476,000

    99 Cavicur DHA sirup Non Generik Sirup, botol = 60 ml Box 24,000

    100 Caviplex sirup Non Generik Sirup, Botol = 60 ml Botol 13,000

    101 Cavit D3 tablet Non Generik Tablet, Box = 100 buah Box 323,000

    102 CDR tablet effervescent Non Generik Tablet efferv, Botol = 10

    buahBotol 60,000

    103 Cedocard tablet Non Generik Tablet, box = 60 buah Box 119,000

    104 Cefadroxil 500 mg tablet Generik Kapsul, box = 100 buah Kapsul 120,000

    105 Cefila 100 mg kapsul Non Generik Kapsul, box = 30 buah Kapsul 923,000

    106 Cefixime 200 mg kapsul Generik Kapsul, box = 50 buah Kapsul 611,000

    107 Cefixime sirup kering Generik Sirup kering, botol = 30 ml Sirup 34,000

    108 Cendo Fenicol Tetes Mata Non Generik Larutan Tetes Mata, botol =

    5 mlBotol 48,000

    109 Cendo Lyteers Tetes Mata Non Generik Cairan, Botol=15ml Botol 44,000

    110 Cendo Pantocain Tetes Mata Non Generik Larutan Tetes Mata, botol =

    5 mlBotol 26,000

    111 Cendo Xitrol Minidose Tetes Mata Non Generik Larutan Tetes Mata, Strip =

    5 fls, 1 fls = 0,6 mlStrip 62,000

    112 Cendo Xitrol Tetes Mata Non Generik Larutan Tetes Mata, botol =

    5 mlBotol 54,000

    113 Ceptik 100 mg kapsul Non Generik Kapsul, box = 30 buah Box 1,134,000

    114 Ceptik sirup kering Non Generik Sirup kering, botol = 30 ml Botol 153,000

    115 Cerebrofort Gold Sirup Non Generik Sirup, botol = 200 ml Botol 45,000

    116 Cetirizine tablet Generik Tablet, box = 50 buah Box 30,000

    117 Chloramfecort Krim Non Generik Krim, tube= 10gr Tube 24,000

    118 Ciprofloxacin 500 mg tablet Generik Tablet, box = 100 buah Box 80,000

    119 Clindamycin 300 kapsul Generik Kapsul, box = 50 buah Box 67,000

    120 Clindamycin Novell 300 mg kapsul Generik Berlogo Kapsul, box = 50 buah Box 116,000

    121 Clinium 1% Gel Non Generik Gel, tube = 15 gram Tube 64,000

    122 Clobazam 10 mg tablet Generik Tablet, box = 100 buah Box 199,000

    123 Clopidogrel tablet Generik Tablet, box = ... buah Box 606,000

    124 Co-amoxiclav Generik Tablet, box = 30 buah Box 291,000

    125 Co-amoxiclav sirup kering Generik Sirup kering, botol = 6 ml Botol 60,000

    126 Colme Tetes Mata Non Generik Larutan, botol = 8 ml Botol 50,000

  • - 61 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    127 Colme Tetes Telinga Non Generik Larutan, botol = 8 ml Botol 60,000

    128 Combantrin tablet Non Generik Tablet, box = 50 buah Box 498,000

    129 Combantrin tablet Non Generik Tablet, box = 30 buah Box 297,000

    130 Combivent Nebulizer Non Generik Larutan Nebulizer, Box = 10

    buahBox 364,000

    131 Comtusi Sirup Non Generik Sirup, botol = 100ml Botol 101,000

    132 Coten 30 mg tablet Non Generik Tablet, box = 30 buah Box 47,000

    133 Coten 30 mg tablet Non Generik Tablet, box = 100 buah Box 297,000

    134 Cotrimoxazole 480 mg tablet Generik Tablet, box = 100 buah Box 65,000

    135 Counterpain Cool krim Non Generik Krim, tube = 30 gram Tube 65,000

    136 Counterpain krim Non Generik Krim, tube = 30 gram Tube 81,000

    137 Crystalline air mineral Non Generik Air mineral cup, karton = 48

    cup Karton 41,000

    138 Curcuma tablet Non Generik Tablet, box = 100 buah Box 175,000

    139 D Vit Sirup Non Generik Sirup, botol = 100 ml Botol 68,000

    140 Danason tablet Non Generik Tablet, box = 200 buah Box 40,000

    141 Degirol tablet Non Generik Tablet, box = 100 buah Box 142,000

    142 Dexacap 12,5 mg tablet Non Generik Tablet, box = 60 buah Box 25,000

    143 Dexacap 25 mg tablet Non Generik Tablet, box = 60 buah Box 38,000

    144 Dexamethasone 0,5 mg tablet Generik Tablet, box = 100 buah Box 12,000

    145 Dexanta tablet Non Generik Tablet, box = 100 buah Box 48,000

    146 Dexazol tablet Non Generik Tablet, box = 50 buah Box 73,000

    147 Dexmolex sirup Non Generik Sirup, botol = 60 ml Botol 15,000

    148 Dextamine tablet Non Generik Tablet, box = 300 buah Box 901,000

    149 Dexteem Plus tablet Non Generik Tablet, box = 100 buah Box 42,000

    150 Dextral tablet Non Generik Tablet, box = 100 buah Box 155,000

    151 Dexymox 500 mg tablet Non Generik Tablet, box = 100 buah Box 142,000

    152 Dhavit Sirup Non Generik Sirup, botol = 60 ml Botol 49,000

    153 Diabemin 500 mg tablet Non Generik Tablet, box = 100 buah Box 56,000

    154 Diaformin XR tablet Non Generik Tablet, box = 100 buah Box 317,000

    155 Diflam 50 mg tablet Non Generik Tablet, box = 50 buah Box 295,000

    156 Digenta krim Non Generik Krim, tube = 10 gram Tube 141,000

    157 Digoksin 0,0625 mg tablet Generik Tablet, botol = 100 buah Botol 16,000

    158 Digoxin 0.25 mg tablet Generik Tablet, box = 100 buah Box 24,000

    159 Dimenhidrinat 50 mg Tablet Generik Tablet, botol = 100buah Botol 57,000

    160 Disflatyl tablet Non Generik Tablet, box = 100 buah Box 115,000

    161 Dom tablet Non Generik Tablet, box = 30 buah Box 52,000

    162 Dom tablet Non Generik Tablet, box = 100 buah Box 151,000

    163 Domperidon tablet Generik Tablet, Box = 100 buah Box 41,000

    164 Doxycycline 100 mg tablet Generik Tablet, box = 100 buah Box 151,000

    165 Doxycycline 100 mg tablet Generik Tablet, box = 30 buah Box 52,000

    166 Dramamine tablet Non Generik Tablet, Box = 100 buah Tablet 330,000

    167 Dumin 500 mg tablet Non Generik Kaplet, boks = 1000 buah Box 693,000

    168 Dumocalcin tablet Non Generik Tablet, Box = 100 buah Box 58,000

    169 Eclide 100 mg tablet Non Generik Tablet, Box = 100 buah Box 169,000

  • - 62 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    170 Eflin tablet Non Generik Tablet, box = 100 buah Box 227,000

    171 Emturnas forte tablet Non Generik Tablet, box = 100 buah Box 38,000

    172 Enervon C tablet effervescent Non Generik Tablet effervescent, botol =

    10 buahBotol 46,000

    173 Enervon C tablet Non Generik Tablet, box = 100 buah Box 180,000

    174 Enzyplex tablet Non Generik Tablet, Box = 100 buah Box 175,000

    175 Erlamycetin Salep Mata Non Generik Salep Mata, tube = 5 g Tube 11,000

    176 Erlamycetin Tetes Mata Non Generik Tetes Mata, Botol = 5 mL Botol 19,000

    177 Erlamycetin Tetes Telinga Non Generik Tetes Telinga, Botol = 5 mL Botol 27,000

    178 Eryra 500 mg tablet Non Generik Tablet, box = 100 buah Box 205,000

    179 Erythrin 500 mg tablet Non Generik Kaplet, botol = 50 buah Botol 554,000

    180 Erythromycin 500 mg tablet Generik Kaplet, box = 50 buah Box 270,000

    181 Esvat 20 mg tablet Non Generik Tablet, box = 30 buah Box 65,000

    182 Etabion tablet Non Generik Tablet, Box = 100 buah Box 169,000

    183 Ethambutol HCL 250 mg tablet Generik Tablet, box = 200 buah Box 146,000

    184 Exaflam tablet Non Generik Tablet, box = 50 buah Box 260,000

    185 Farmalat tablet Non Generik Tablet,box = 100 buah Box 61,000

    186 Farnormin 50 mg tablet Non Generik Tablet, box = 100 buah Box 75,000

    187 Farsifen sirup Non Generik Sirup, botol = 60 ml Botol 11,000

    188 Farsix tablet Non Generik Tablet, box = 100 buah Box 178,000

    189 Fasidol plus tablet Non Generik Tablet, box = 100 buah Box 57,000

    190 Fasolon krim Non Generik Krim, tube = 10 g Tube 37,000

    191 Fasorbid 5 mg tablet Non Generik Tablet, box = 100 buah Box 38,000

    192 Fenamin tablet Non Generik Tablet, box = 100 buah Box 88,000

    193 Fenitoin 100 mg kapsul Generik Kapsul, box = 100 buah Box 26,000

    194 Fenitoin Natrium 30 mg kapsul Generik Kapsul, box = 100 buah Box 20,000

    195 Fenofibrat 100 mg tablet Generik Tablet, box = 30 buah Box 92,000

    196 Fenofibrat 300 mg tablet Generik Tablet, box = 30 buah Box 154,000

    197 Fenol Gliserol 10% Tetes Telinga GenerikTetes Telinga, botol = 5 mL,

    box = 24 buahBox 51,000

    198 Ferlin drop Non Generik Drop, botol = 30 ml Botol 68,000

    199 Ferlin sirup Non Generik Sirup, botol = 100 ml Botol 75,000

    200 Fexazol krim Non Generik Krim, tube = 5 gram Tube 13,000

    201 FG Troches Non Generik Tablet isap, box = isi 300

    buahBox 525,000

    202 FG Troches Non Generik Tablet, box = 120 buah Box 236,000

    203 Fitbon Non Generik Salut selaput, box = 60

    buahBox 169,000

    204 Fituno Non Generik Tablet, box = 300 buah Box 249,000

    205 Fladex Non Generik Tablet, box = 100 buah Box 75,000

    206 Flamar gel 20g Non Generik Jel, tube = 20gr Tube 48,000

    207 Flamigra tablet Non Generik Tablet,box = 50 buah Box 29,000

    208 Flammar 25 mg tablet Non Generik Tablet, Box = 100 buah Box 135,000

  • - 63 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    209 Flammar Gel Non Generik Gel, tube = ... Gr Tube 29,000

    210 Flexor DS Kaplet Non Generik Kaplet, box = 60 buah Box 587,000

    211 Flexor Kaplet Non Generik Kaplet, box = 30 buah Box 170,000

    212 Flu Tab, tablet Non Generik Tablet, box = 120 buah Box 152,000

    213 Flunarizin tablet Non Generik Tablet, Box = 100 buah Box 71,000

    214 Flutrop tablet Non Generik Tablet, box = 100 buah Box 114,000

    215 Folavit tablet Non Generik Tablet, box = 100 buah Box 127,000

    216 Forelax tablet Non Generik Tablet, box = 50 buah Box 334,000

    217 Forres 50 tablet Non Generik Tablet, box = 50 buah Box 463,000

    218 ForumenTetes Telinga Non Generik Larutan, botol = 10 ml Botol 47,000

    219 Frego 5 mg tablet Non Generik Tabet, box = 50 buah Box 455,000

    220 Fungares krim Non Generik Krim, tube = 5 gram Tube 34,000

    221 Furosemid 40 mg tablet Generik Tablet, box = 100 buah Box 22,000

    222 Gameksan 1% Lotion Non Generik Lotion, botol = 30 mL Botol 5,000

    223 Gemfibrozil 300 kapsul Generik Kapsul, box = 100 buah Box 131,000

    224 Gentalex krim Non Generik Krim, tube = 5 gram Tube 7,000

    225 Gentamisin krim Generik Krim, tube = 5 gr Tube 11,000

    226 Gentamisin salep Generik Salep, tube =5 gram Tube 14,000

    227 Gitas Plus kapsul Non Generik Kapsul, box = 50 buah Box 535,000

    228 Glemipered 1 mg tablet Non Generik Tablet, Box = 100 buah Box 189,000

    229 Glemipered 2 mg tablet Non Generik Tablet, Box = 100 buah Box 256,000

    230 Glibenclamid 5 mg tablet Generik Tablet, Box = 100 buah Box 60,000

    231 Glikos 850 mg tablet Non Generik Tablet, box = 100 buah Box 70,000

    232 Glimepiride 1 tablet Generik Tablet, box = 50 buah Box 41,000

    233 Glimepiride 2 tablet Generik Tablet, box = 50 buah Box 75,000

    234 Glimepiride 3 tablet Generik Tablet, box = 100 buah Box 149,000

    235 Glitaven Sirup Non Generik Sirup, botol = 100 ml Botol 73,000

    236 Glucophance tablet Non Generik Tablet, Box = 100 buah Box 371,000

    237 Glucosamine MPL tablet Non Generik Tablet, box = 100 buah Box 438,000

    238 Glukosa 40% Larutan Steril Non Generik Larutan Steril, botol = 25

    mL, box = 10 buahBox 31,000

    239 Glunor XR 500 tablet Non Generik Tablet, box = 30 buah Box 102,000

    240 Gluvas 1 mg tablet Non Generik Tablet, box = 50 buah Box 194,000

    241 Goron tablet Non Generik Tablet, box = 100 buah Box 324,000

    242 Hansaplast Elastis Plester Kain Non Generik Plester, box = 100 lembar Box 43,000

    243 Hansaplast Koyo (Hangat) Non Generik Koyo, box = 100 lembar Box 118,000

    244 HCT tablet Generik Tablet, box = 100 buah Box 42,000

    245 Hexadol sirup Non Generik Sirup, botol = 100 ml Botol 44,000

    246 Hico Gel Non Generik Gel, tube = 10 gram Tube 33,000

    247 Hidrocortisone 1% krim Generik Krim, tube =5 gram Tube 23,000

    248 Hidrocortisone 2,5% krim Generik Krim, tube =5 gram Tube 18,000

    249 Histapan tablet Non Generik Tablet, box = 100 buah Box 103,000

  • - 64 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    250 Hufagrip batuk pilek, sirup NPP Sirup, botol = 60 ml Botol 27,000

    251 Hufanoxil sirup Non Generik Sirup, botol = 60 ml Botol 11,000

    252 Hufaxol sirup Non Generik Sirup, botol = 60 ml Botol 11,000

    253 Ibuprofen 400 mg tablet Generik Tablet, box = 100 buah Box 44,000

    254 Ichtiol salep Non Generik Salep, box = 12 buah Box 132,000

    255 Imboost kaplet Non Generik Kaplet, box = 30 buah Box 326,000

    256 Imodium 2mg tablet Non Generik Tablet, strip = 10 buah Strip 135,000

    257 Indexon tablet Non Generik Tablet, box = 100 buah Box 117,000

    258 Inpepsa Sirup Non Generik Suspensi, botol=200ml Botol 149,000

    259 Internolol tablet Non Generik Tablet, box = 30 buah Box 178,000

    260 Interzinc tablet Non Generik Tablet, box = 10 buah Box 57,000

    261 Intunal Forte tablet Non Generik Tablet, box = 100 buah Box 155,000

    262 Intunal Sirup Non Generik Sirup, botol = 60 ml Botol 22,000

    263 Iodiol Kapsul lunak Non Generik Kapsul lunak, botol = 100

    buahBotol 195,000

    264 Irbesartan 150 mg tablet Generik Tablet, box = 50 buah Box 139,000

    265 Iremax tablet Non Generik Tablet, box = 100 buah Box 179,000

    266 Ironyl kaplet Non Generik Kaplet, box = 100 buah Box 500,000

    267 ISDN 5 mg tablet Generik Tablet, Box = 100 buah Box 41,000

    268 Isoric 300 tablet Non Generik Tablet, box = 50 buah Box 343,000

    269 Kalcinol N krim Non Generik Krim, tube = 5 g Tube 19,000

    270 Kalium Diklofenac 50 mg tablet Generik Tablet, box = 50 buah Box 48,000

    271 Kalium Klorida 300 mg tablet Generik Tablet, tube = 10 buah Tube 7,000

    272 Kenalog in orabase, krim Non Generik Krim, tube = 5 gram Tube 90,000

    273 Ketoconazole 2% krim Generik Krim, tube = 15 gram Tube 27,000

    274 Ketoconazole 200 mg tablet Generik Tablet, box = 50 buah Box 40,000

    275 Ketoprofen 100 mg tablet Generik Kapsul, box = 100 buah Box 283,000

    276 Kloramfenikol 0,5% Tetes Mata Generik Tetes Telinga, botol = 5 mL Botol 6,000

    277 Kloramfenikol 3 % Tetes Mata Generik Tetes Telinga, botol = 5 mL Botol 4,000

    278 Klorfeson salep Non Generik Krim, tube = 5 gram Tube 19,000

    279 Klorokuin 250 mg tablet Generik Kapsul, box = 100 buah Box 23,000

    280 Kodein 30 mg tablet NPP Tablet, botol = 20 buah Botol 14,000

    281 Kuinidin 200 mg tablet Generik Kapsul, box = 100 buah Box 88,000

    282 L Bio granul sachet Non Generik Granul sachet, sachet = 1

    gr, box = 30 buahSachet 14,000

    283 L Bio kapsul Non Generik Kapsul, box = 30 buah Box 290,000

    284 L Cisin tablet Non Generik Tablet, box = 30 buah Box 181,000

    285 Lacto B granul sachet Non Generik Granul sachet, sachet = 1

    gr, box = 40 buahBox 357,000

    286 Lactrin tablet Non Generik Tablet, box = 30 buah Box 115,000

    287 Laflanac 25 mg tablet Non Generik Tablet, box = 100 buah Box 23,000

    288 Lambucid tablet Non Generik Tablet, box = 200 buah Box 88,000

    289 Laminine tablet Non Generik Kapsul, box = 30 buah Box 1,111,000

  • - 65 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    290 Lanovit tablet Non Generik Tablet, box = 50 buah Box 112,000

    291 Lansoprazole kapsul Generik Kapsul, box = 20 buah Box 34,000

    292 Lapibroz 600 kaplet Non Generik Kaplet, box = 30 buah Box 190,000

    293 Lasal 2 mg tablet Non Generik Tablet, box = 100 buah Box 161,000

    294 Lasal sirup Non Generik Sirup, botol = 100 ml Botol 41,000

    295 Laserin sirup Non Generik Sirup, botol = 60 ml Botol 15,000

    296 Latibet tablet Non Generik Tablet, box = 100 buah Box 48,000

    297 Lelap tablet Non Generik Tablet, box = 100 buah Box 442,000

    298 Levemir Flexpen Non Generik Flexpen, box = 5 buah Box 1,205,000

    299 Levofloxacin tablet Generik Tablet, box = 100 buah Box 122,000

    300 Lexacorton krim Non Generik Krim, tube = 5 gram Tube 11,000

    301 Lexcomet tablet Non Generik Tablet, box = 100 buah Box 122,000

    302 Lexcomet tablet Non Generik Tablet, box = 50 buah Box 85,000

    303 Lexigo tablet Non Generik Tablet, box = 30 buah Box 27,000

    304 Licokalk tablet Non Generik Tablet, box = 100 buah Box 33,000

    305 Lincocin 500 mg kapsul Non Generik Kapsul, box = 30 buah Box 561,000

    306 Lincomycin 500 mg kapsul Generik Kapsul, box = 60 buah Box 137,000

    307 Lipitor tablet Non Generik Tablet, Box = 100 buah box 667,000

    308 Lisinopril 20 mg tablet Generik Kapsul, box = 100 buah Box 46,000

    309 Livron B plex tablet Non Generik Tablet, Box = 100 buah box 54,000

    310 Lodia tablet Non Generik Tablet, box = 60 buah Box 93,000

    311 Loperamid tablet Generik Tablet, Box = 100 buah Box 59,000

    312 Loratadine tablet Generik Tablet, box = 50 buah Box 34,000

    313 Loric 300 mg tablet Non Generik Tablet, box = 100 buah Box 116,000

    314 Lostacef 125 mg sirup Non Generik Sirup kering, botol = 60 ml Botol 19,000

    315 Lostacef 250 mg sirup Non Generik Sirup kering, botol = 60 ml Botol 26,000

    316 L-zink Sirup Non Generik Sirup, botol = 100ml Botol 57,000

    317 Maganol tablet Non Generik Kaplet, box = 120 buah Box 100,000

    318 Magtral tablet Non Generik Tablet, Box = 100 buah Box 108,000

    319 Mebendazol 100 mg/mL sirup Generik Sirup, botol 30 mL Botol 8,000

    320 Mebendazol 500 mg tablet Generik Kapsul, box = 100 buah Box 50,000

    321 Mebo krim Non Generik Krim, tube = 20 gram Tube 162,000

    322 Mecobalamin tablet Generik Tablet, Box = 100 buah Box 125,000

    323 Mecolin kapsul Non Generik Kapsul, box = 50 buah Box 186,000

    324 Mefinal tablet Non Generik Tablet, Box = 100 buah Box 223,000

    325 Mefinter 500 mg kapsul Non Generik Kapsul, box = 50 buah Box 369,000

    326 Megabal kapsul Non Generik Kapsul, box = 100 buah Box 369,000

    327 Meloxicam 7,5 mg Generik Tablet, box = 100 buah Box 175,000

    328 Meloxicam suppositoria Generik Suppositoria, box = 10 buah Box 138,000

    329 Merislon 6 mg tablet Non Generik Tablet, box = 100 buah Box 828,000

    330 Mertigo tablet Non Generik Tablet, Box = 100 buah Box 505,000

  • - 66 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    331 Metformin 500 mg tablet Generik Tablet, box = 100 buah Box 31,000

    332 Metformin 850 mg tablet Generik Tablet, Box = 100 buah Box 81,000

    333 Metil prednisolon tablet Generik Tablet, Box = 100 buah Box 81,000

    334 Metolon tablet Non Generik Tablet, box = 100 buah Box 104,000

    335 Metrison 4 mg tablet Non Generik Tablet, box = 100 buah Box 463,000

    336 Metronidazol Novell tablet Generik Berlogo Tablet, Box = 100 buah Box 91,000

    337 Metronidazol tablet Generik Tablet, box = 100 buah Box 47,000

    338 Miconazole 2 % krim Generik Krim, tube = 10 Gr Tube 11,000

    339 Minyak Kayu Putih "Cap Lang" Non Generik Larutan, botol = 30 ml Botol 20,000

    340 Minyak Kayu Putih "Cap Lang" Non Generik Larutan, botol = 60 ml Botol 32,000

    341 Minyak Kayu Putih "Sidola" Non Generik Larutan, botol = 15 ml Botol 10,000

    342 Minyak Kayu Putih "Sidola" Non Generik Larutan, botol = 30 ml Botol 20,000

    343 Minyak Tawon DD 30 ml Non Generik Larutan, botol = 30 ml Botol 35,000

    344 Minyak Telon "Konicare" Non Generik Larutan, botol = 30 ml Botol 18,000

    345 Moladerm krim Non Generik Krim, tube = 10 gram Tube 11,000

    346 Molafate sirup Non Generik Sirup, botol = 60 ml Botol 31,000

    347 Molagit tablet Non Generik Tablet, box = 150 buah Box 107,000

    348 Molakrim, krim Non Generik Krim, tube = 30 gram Tube 24,000

    349 Molaneuron tablet Non Generik Tablet, box = 50 buah Box 45,000

    350 Molapect sirup Non Generik Sirup, botol =60 mL Botol 21,000

    351 Molavir krim Non Generik Krim, tube = 5 gram Tube 14,000

    352 Molazol tablet Non Generik Tablet, box = 100 buah Box 53,000

    353 Molexdryl sirup Non Generik Sirup, botol = 60 ml Botol 9,000

    354 Molexflu tablet Non Generik Tablet, box = 100 buah Box 93,000

    355 Mometason krim Non Generik Krim, tube = 5 gram Tube 40,000

    356 Motilex tablet Non Generik Tablet, box = 100 buah Box 249,000

    357 Mucera tablet Non Generik Tablet, box = 100 buah Box 155,000

    358 Mucohexin sirup Non Generik Sirup, botol = 120 ml Botol 25,000

    359 Mucohexin tablet Non Generik Tablet, box = 100 buah Box 79,000

    360 Mucos Drop Non Generik Sirup, botol = 20ml Botol 68,000

    361 Musin sirup Non Generik Sirup, botol = 120 ml Botol 81,000

    362 Musin tablet Non Generik Tablet, Box = 100 buah Box 135,000

    363 Nasamol tablet Non Generik Tablet, Box = 100 buah Box 48,000

    364 Natrium Diclofenac 50 mg tablet Generik Tablet, box = 50 buah Box 21,000

    365 Neo Kaominal sirup Non Generik Larutan, botol = 30 ml Botol 13,000

    366 Neomisin 500 mg kapsul Generik Kapsul, box = 100 buah Box 67,000

    367 Nephrolit Non Generik Tablet, box = 100 buah Box 92,000

    368 Nerva Plus Non Generik Kaplet, box = 50 buah Box 255,000

    369 Neuralgin XR 500 Non Generik Kaplet, box = 100 buah Box 126,000

    370 Neurobat tablet Non Generik Tablet, box = 100 buah Box 457,000

    371 Neurobion Non Generik Kaplet, box = 250 buah Box 662,000

  • - 67 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    372 Neurodex Non Generik Tablet, box = 100 buah Box 229,000

    373 Neurohax 5000 Non Generik Tablet, box = 50 buah Box 192,000

    374 Neurovit E Non Generik Tablet, box = 60 buah Box 118,000

    375 Nevox XR 500 Non Generik Tablet, box = 30 buah Box 112,000

    376 Nevox XR 500 Non Generik Tablet, box = 30 buah Box 112,000

    377 New diatab Non Generik Tablet, Box = 100 buah Box 107,000

    378 Nicoflam Non Generik Tablet, Box = 100 buah Box 162,000

    379 Nifedipine 10 mg Generik Tablet, box = 100 buah Box 30,000

    380 Nilapur 300 mg Non Generik Tablet, Box = 100 buah Box 159,000

    381 Nodiar tablet Non Generik Tablet, box = 100 buah Box 108,000

    382 Noperten Non Generik Tablet, Box = 100 buah Box 159,000

    383 Norit Carbo Activatus tablet Non Generik Tablet, pot = 20 buah Pot 26,000

    384 Novatrim sirup Non Generik Sirup, botol = 60 ml Botol 13,000

    385 Novomix 30 Flexpen Non Generik Flexpen, box = 5 buah Box 1,209,000

    386 Nucral Sirup Non Generik Sirup, botol = 100 ml Box 90,000

    387 Nucral tablet Non Generik Tablet, box = 60 buah Box 189,000

    388 Nufit kaplet Non Generik Kaplet, box = 20 buah Box 256,000

    389 Nutradon sirup Non Generik Sirup, botol = 60 ml Botol 7,000

    390 OBH Non Generik Sirup, botol = 60 mL Botol 14,000

    391 OBH Combi Batuk Berdahak Non Generik Sirup, botol = 100 ml Botol 41,000

    392 OBH Combi Batuk Kering Non Generik Sirup, botol = 100 ml Botol 41,000

    393 OBH Combi Batuk Pilek Non Generik Sirup, botol = 100 ml Botol 34,000

    394 OBH Nelco Special sirup Non Generik Sirup, botol = 100 ml Botol 56,000

    395 Omega-3 Fish Oil 1000 Wellness Non Generik Softcapsul, botol = 150 buah Botol 337,000

    396 Omeprazole 20 mg kapsul Generik Kapsul, box = 30 buah Box 48,000

    397 Omeprazole Novell kapsul Generik Berlogo Kapsul, Box = 30 buah Box 68,000

    398 Opiglit 15 mg tablet Non Generik Tablet, box = 30 buah Box 202,000

    399 Opilax sirup Non Generik Sirup, botol = 60 ml Botol 77,000

    400 Opimox tablet Non Generik Tablet, Box = 100 buah Box 357,000

    401 Opipas tablet Non Generik Tablet, Box = 100 buah Box 525,000

    402 Opistan tablet Non Generik Tablet, box = 100 buah Box 105,000

    403 Opram tablet Non Generik Tablet, box = 100 buah Box 87,000

    404 Orphen tablet Non Generik Tablet, box = 100 buah Box 29,000

    405 Ostela Forte Non Generik Tablet, box = 30 buah Box 404,000

    406 Otopain Tetes Telinga Non Generik Tetes Telinga, botol = 8 ml Botol 95,000

    407 Oxytetracycline 1% Salep Mata Generik Krim, Tube = 3,5gr Tube 19,000

    408 Pamol 125 mg suppositoria Non Generik Suppositoria, box = 12 buah Box 216,000

    409 Pamol 250 mg suppositoria Non Generik Suppositoria, box = 12 buah Box 311,000

    410 Pamol Sirup Non Generik Sirup, botol = 60 ml Botol 41,000

    411 Pamol tablet Non Generik Tablet, Box = 100 buah Box 311,000

    412 Panadol biru, tablet Non Generik Tablet, Box = 100 buah Box 47,000

    413 Papaverin 40 mg tablet Generik Tablet, box = 100 buah Box 81,000

  • - 68 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    414 Paracetamol 500 tablet Generik Tablet, box = 100 buah Box 19,000

    415 Paramex tablet Non Generik Tablet, Box = 100 buah Box 125,000

    416 Paratusin Sirup Non Generik Sirup, botol = 60ml Botol 46,000

    417 Pasaba cough & flu sirup Non Generik Sirup, botol = 60 ml Botol 11,000

    418 Perilax tablet Non Generik Tablet, box = 50 buah Box 340,000

    419 Pharmaton Formula kapsul Non Generik Kapsul, box = 20 buah Box 354,000

    420 Pharolit sachet Non Generik Sachet, box = 60 buah Box 119,000

    421 Piracetam 400 mg tablet Generik Tablet, box = 100 buah Box 95,000

    422 Piroksikam 10 mg tablet Generik Tablet, box = 100 buah Box 18,000

    423 Piroksikam 20 mg tablet Generik Tablet, box = 100 buah Box 22,000

    424 PK serbuk, pot Non Generik Pot, Box = 12 pot Box 62,000

    425 Plasminex tablet Non Generik Tablet, box = 100 buah Box 396,000

    426 Polysilane tablet Non Generik Tablet, box = 40 buah Box 62,000

    427 Ponflu Sirup Non Generik Sirup, botol = 60 ml Botol 33,000

    428 Ponsamic 500 tablet Non Generik Tablet, box = 100 buah Box 269,000

    429 Povidone Iodine Solution Non Generik Solution, botol = 60ml Botol 22,000

    430 Pravastatin 10 mg tablet Generik Tablet, box = 30 buah Box 92,000

    431 Praxion drop Non Generik Drop, Botol = 15 ml Botol 48,000

    432 Prazikuantel 600 mg tablet Generik Tablet, box = 100 buah Box 356,000

    433 Prednison tablet Generik Tablet, pot = 100 buah Pot 27,000

    434 Pritacort tablet Non Generik Tablet, box = 100 buah Box 120,000

    435 Pritagesic tablet Non Generik Tablet, box = 100 buah Box 83,000

    436 Pritavit kaplet Non Generik Kaplet, box = 100 buah Box 149,000

    437 Prodexon kaplet Non Generik Kaplet, box = 100 buah Box 65,000

    438 Prometazin 25 mg tablet Generik Tablet, box = 100 buah Box 11,000

    439 Pronalges tablet Non Generik Tablet, box = 50 buah Box 205,000

    440 Proneuron kaplet Non Generik Kaplet, box = 200 buah Box 537,000

    441 Propanolol 10 mg tablet Generik Tablet, box = 100 buah Box 14,000

    442 Propil Tio Urasil 50 mg tablet Generik Tablet, box = 100 buah Box 442,000

    443 Provagin ovula Non Generik Ovula, box = 10 buah Box 202,000

    444 Pulmicort Respules Non Generik Respules, Box= 10 Respules Box 451,000

    445 Pure Kids Inhalant Decongestan Oil Non Generik Inhalant Decongestan Oil,

    botol = 10 mlBotol 82,000

    446 Pyrexin 80 mg suppositoria Non Generik Supposituria, box = 10 buah Box 119,000

    447 Radin tablet Non Generik Tablet, box = 30 buah Box 30,000

    448 Ramipril 2,5 mg tablet Generik Tablet, box = 100 buah Box 63,000

    449 Ranitidin 150 mg tablet Generik Tablet, box = 100 buah Box 61,000

    450 Redoxon tablet effervescent Non Generik Tablet efferves, botol = 10

    buahBotol 56,000

    451 Rhinofed sirup Non Generik Sirup, Botol = 60 ml Botol 54,000

    452 Rhinos Drop Non Generik Sirup, botol = 10ml Botol 77,000

    453 Rillus Tablet Non Generik Tablet, box = 30 buah Box 364,000

    454 Sagestam salep Non Generik Salep, tube = 10 gram Tube 22,000

  • - 69 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    455 Salbutamol sirup Generik Sirup, botol = 100 ml Botol 10,000

    456 Salbutamol tablet Generik Tablet, Box = 100 buah Box 41,000

    457 Salonpas koyo Non Generik Lembar, box = 120 lembar Box 101,000

    458 Sanadryl DMP Sirup Non Generik Sirup, botol = 60ml Botol 22,000

    459 Sangobion sirup VITA TONIK Non Generik Sirup, Botol=400 ml Botol 54,000

    460 Sangobion Tab Non Generik Tablet, box = 250 buah Box 471,000

    461 Sanmol forte sirup Non Generik Sirup, botol = 60 ml Botol 38,000

    462 Sanmol sirup Non Generik Sirup, botol = 60 ml Botol 21,000

    463 Sanmol tablet Non Generik Tablet, box = 100 buah Box 48,000

    464 Sanprima forte tablet Non Generik Tablet, box = 100 buah Box 295,000

    465 Scabimite Salep Non Generik Salep, tube = 10 gram Tube 72,000

    466 Scopma tablet Non Generik Tablet, Box = 100 buah Box 330,000

    467 Sefiksim 50 mg kapsul Generik Tablet, box = 30 buah Box 63,000

    468 Selespurin 100 mg tablet Non Generik Tablet, box = 100 buah Box 42,000

    469 Selespurin 300 mg tablet Non Generik Tablet, box = 100 buah Box 60,000

    470 Siladex sirup Non Generik Cair, Botol=100 ml Botol 34,000

    471 Simvastatin 10 mg tablet Generik Tablet, box = 50 buah Box 50,000

    472 Simvastatin 20 mg tablet Generik Tablet, box = 50 buah Box 101,000

    473 Sofratule gauge Non Generik Gauge, lembar Lembar 41,000

    474 Solaxin tablet Non Generik Tablet, Box = 100 buah Box 754,000

    475 Solvinex sirup Non Generik Sirup, botol = 100 ml Botol 25,000

    476 Spasminal tablet Non Generik Tablet, Box = 100 buah Box 88,000

    477 Spiramycin 500 mg tablet Generik Tablet, box = 50 buah Box 191,000

    478 Spiranter 500 mg tablet Non Generik Tablet, box = 100 buah Box 1,447,000

    479 Starmuno Kids Sirup Non Generik Sirup, botol = 60ml Botol 122,000

    480 Stator 10 mg tablet Non Generik Tablet, box = 30 buah Box 833,000

    481 Stator 20 mg tablet Non Generik Tablet, box = 300 buah Box 889,000

    482 Stesolid Rectal Tube 10 mg NPP Larutan rectal, tube = 2,5 ml Tube 330,000

    483 Stesolid Rectal Tube 5 mg NPP Larutan rectal, tube = 2,5 ml Tube 220,000

    484 Stimuno Forte kapsul Non Generik Kapsul, Box = 60 buah Box 142,000

    485 Sucralfat sirup Non Generik Sirup, botol = 100 ml Botol 61,000

    486 Superhoid suppositoria Non Generik Supposituria, box = 6 buah Box 54,000

    487 Suprafenid suppositoria Non Generik Supposituria, box = 10 buah Box 175,000

    488 Talk Salisil bedak Non Generik Bedak Talk, pot = 60 gram Pot 11,000

    489 Talk Salisil KF bedak Non Generik Bedak Talk, Pot = 60 gram Pot 12,000

    490 Talk Salisil IKA bedak Non Generik Bedak Talk, Botol = 80 gram Botol 23,000

    491 Tensivas tablet Non Generik Tablet, Box = 100 buah Box 488,000

    492 Teofilin 150 mg tablet Generik Tablet, box = 100 buah Box 12,000

    493 Tera F kaplet Non Generik Kaplet, box = 100 buah Box 63,000

    494 Teranol tablet Non Generik Tablet, box = 30 buah Box 247,000

  • - 70 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    495 Terbutalin 2,5 mg tablet Generik Tablet, box = 50 buah Box 11,000

    496 Test pack kehamilan Sensitif strip Non Generik Strip, unit = 1 strip Unit 35,000

    497 Thiamfilex 500 mg tablet Non Generik Tablet, box = 100 buah Box 116,000

    498 Thiamphenicol 500 mg Generik Tablet, box = 100 buah Box 223,000

    499 Thiamycin 500 mg tablet Generik Kapsul, box = 100 buah Box 768,000

    500 Thrombo Aspilet tablet Non Generik Tablet, Box = 100 buah Box 101,000

    501 Thrombogel Non Generik Gel, tube = 10 gram Tube 57,000

    502 Thrombophob Gel Non Generik Gel, tube = 20 gram Tube 92,000

    503 Tolak Angin sachet Non Generik Sachet, box= 12 sachet Box 46,000

    504 Tranec kaplet Non Generik Kaplet, box = 50 buah Box 247,000

    505 Transamin tablet Non Generik Tablet, Box = 100 buah Box 397,000

    506 Tremenza Tablet NPP Tablet, box = 100 buah Box 26,000

    507 Triadex sirup Non Generik Sirup, botol = 60 ml Botol 21,000

    508 Triamcort tablet Non Generik Tablet, box = 100 buah Box 512,000

    509 Tricela tablet Non Generik Tablet, Box = 100 buah Box 61,000

    510 Trilac 4 mg tablet Non Generik Tablet, box = 30 buah Box 229,000

    511 Triomin E tablet Non Generik Tablet, box = 100 buah Box 324,000

    512 Tropydril sirup Non Generik Sirup, botol = 60 ml Botol 9,000

    513 Ultraproct N krim Non Generik Krim, tube =10 gram Tube 182,000

    514 Ultraproct N suppositoria Non Generik Suppositoria, box = 10 buah Box 155,000

    515 Urineg tablet Non Generik Tablet, box = 100 buah Box 478,000

    516 Urinter 400 kapsul Non Generik Kapsul, box = 100 buah Box 870,000

    517 Valproat 150 mg tablet Generik Tablet, botol = 50 buah Botol 25,000

    518 Valproat 250 mg tablet Generik Tablet, botol = 50 buah Botol 37,000

    519 Vastigo tablet Non Generik Tablet, box = 100 buah Box 135,000

    520 Ventolin inhaler Non Generik Inhaler, Box = 1 buah Box 182,000

    521 Ventolin nebules Non Generik Nebules 2,5mL, box = 20

    buahBox 317,000

    522 Veridin tablet Non Generik Tablet, box = 30 buah Box 321,000

    523 Versilon 4 mg tablet Non Generik Tablet, box = 100 buah Box 289,000

    524 Versyl tablet Non Generik Tablet, box = 50 buah Box 162,000

    525 Vibramox forte sirup Non Generik Sirup kering, botol = 60 ml Botol 22,000

    526 Vicks Inhaler Non Generik Inhaler, tube = 0,5 ml Tube 22,000

    527 Vicks Vaporub Non Generik Obat gosok, pot = 25 gram Pot 32,000

    528 Visine Tetes Mata Non Generik Tetes Mata, Botol = 6 ml Botol 24,000

    529 Vitamin B1 100 mg tablet Generik Tablet, box = 100 buah Box 17,000

    530 Vitamin B6 tablet Generik Tablet, Botol = 100 buah Botol 27,000

    531 Vitamin C 100 mg tablet Generik Tablet, box = 100 buah Box 11,000

    532 Vitamin C 25 mg tablet Generik Tablet, Botol = 500 buah Botol 27,000

    533 Vitamin K 10 mg tablet Generik Tablet, botol = 500 buah Botol 69,000

    534 Voltadex gel Non Generik Gel, Tube = 20 gram Tube 42,000

  • - 71 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    535 Voltadex tablet Non Generik Tablet, Box = 50 buah Box 54,000

    536 Voltaren Emulgel Non Generik Gel, tube = 10 gram Tube 74,000

    537 Vometraz 4 mg tablet Non Generik Tablet, Box = 10 buah Box 25,000

    538 Vometraz 4 mg tablet Non Generik Tablet, box = 100 buah Box 74,000

    539 Vometraz 8 mg tablet Non Generik Tablet, Box = 10 buah Box 42,000

    540 Vometraz 8 mg tablet Non Generik Tablet, box = 100 buah Botol 48,000

    541 Vosedon sirup Non Generik Sirup, botol = 60 ml Box 48,000

    542 Vosedon tablet Non Generik Tablet, box = 100 buah Box 361,000

    543 Vosteon tablet Non Generik Tablet, box = 30 buah Pot 193,000

    544 Wellmove tablet Non Generik Tablet, Box = 60 buah Box 236,000

    545 Xanturic 300 tablet Non Generik Tablet, box = 50 buah Box 90,000

    546 Yusimox sirup kering Non Generik Sirup kering, botol = 60 ml Botol 13,000

    547 Zegren tablet Non Generik Tablet, box = 100 buah Box 196,000

    548 Zenibroz kaplet Non Generik Kaplet, box = 30 buah Box 77,000

    549 Zenirex sirup Non Generik Sirup, Botol = 60 mL Botol 11,000

    550 Zensoderm krim Non Generik Krim, tube =10 gram Tube 106,000

    551 Zentra kaplet Non Generik Kaplet, box = 100 buah Box 167,000

    552 Zinc sulfate sirup Non Generik Sirup, botol = 60 ml Botol 13,000

    553 Aqua pro Injeksi Non Generik Vial 25 mL, Box = 1 vial Vial 17,000

    554 Benodon Injeksi Non Generik Vial 15 mL, Box = 10 vial Box 283,000

    555 Decadryl Injeksi Non Generik Vial 15 mL, Box = 10 vial Box 438,000

    556 Decadryl Injeksi Non Generik Vial 5 mL, Box = 10 vial Vial 37,000

    557 Dexamethason Injeksi Generik Ampul, box = 10 buah Ampul 14,000

    558 Gentamisin 80 mg/mL Injeksi Generik Vial, Box = 1 buah Box 8,000

    559 Getidin Injeksi Non Generik Ampul mL, Box = 5 ampul Box 155,000

    560 Indexon Injeksi Non Generik Ampul mL, Box = 5 ampul Box 88,000

    561 Kalnex Injeksi Non Generik Ampul 5 mL, Box = 10 ampul Box 245,000

    562 Kanamycin Injeksi Generik Vial 1 g, Box = 10 vial Box 207,000

    563 Ketoprofen Injeksi Generik Ampul, box = 6 buah Box 71,000

    564 Ketorolac Injeksi Generik Ampul, box = 10 buah Ampul 27,000

    565 Lignocain Injeksi Non Generik Ampul, box = 10 ampul ampul 1,481,000

    566 Metoklopramide 5mg/mL Injeksi Generik Ampul, box = 10 buah Box 21,000

    567 Nairet Injeksi Non Generik Ampul, box = 5 ampul Box 186,000

    568 Neurobion 5000 Injeksi Non Generik Ampul, box = 10 pasang Box 297,000

    569 Neuroboran Injeksi Non Generik Vial 9 mL, Box = 10 vial Box 218,000

    570 Ondane 4 mg Injeksi Non Generik Ampul, box = 5 buah Box 227,000

    571 Ondane 8 mg Injeksi Non Generik Ampul, box = 5 buah Box 401,000

    572 Primperan Injeksi Non Generik Ampul 2 mL, Box = 6 ampul Box 68,000

    573 Ratinal Injeksi Non Generik Vial 2 mL, Box = 5 vial Box 186,000

    574 Scopamin Injeksi Non Generik Ampul 1 mL, Box = 5 ampul Box 159,000

    II. OBAT-OBATAN INJEKSI

  • - 72 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    575 Teranol Injeksi Non Generik Ampul, box = 6 buah Box 350,000

    576 Tomit Injeksi Non Generik Ampul 2 mL, Box = 5 ampul Box 101,000

    577 Trilac Injeksi Non Generik Vial 5 mL, Box = 10 vial Box 186,000

    578 Vitamin B1 100 mg/mL njeksi Generik Ampul, box = 30 buah Box 49,000

    579 Vitamin K Injeksi Generik Ampul, Box = 30 buah Box 110,000

    580 Vitamin K Injeksi Generik Ampul, Box = 100 buah Box 303,000

    581 Alkohol 70 % Non Generik Cairan, botol = 60 ml Botol 7,000

    582 Alkohol 70 % Non Generik Cairan, botol = 100 ml Botol 17,000

    583 Alkohol 70 % Non Generik Cairan, botol = 1 liter Botol 88,000

    584 Dispossible Needle Nomor 24 G

    "Terumo"Non Generik Box = 100 buah Box 256,000

    585 Dispossible Syringe 1 ml "Terumo"

    InsulinNon Generik Box = 100 buah Box 471,000

    586 Dispossible Syringe 2,5 mL "Terumo" Non Generik Box = 100 buah Box 471,000

    587 Dispossible Syringe 3 ml "Terumo" Non Generik Box = 100 buah Box 471,000

    588 Dissposible Syringe 5 ml "Terumo" Non Generik Box = 100 buah Box 438,000

    589 Dispossible Syringe 10 ml "Terumo" Non Generik Box = 100 buah Box 438,000

    590 Abbocath Intravena Venisystems Non Generik Ukuran 20G Buah 19,000

    591 Adrenalin Injeksi / Epinefrin Injeksi Generik Ampul, box = 10 ampul Ampul 18,000

    592 Alcohol Swab "Onemed" Non Generik Box = 100 buah Box 41,000

    593 Atropin 0,25 mg/mL Injeksi Generik Ampul, box = 100 ampul Box 875,000

    594 Betadine solution Non Generik Cairan, botol = 30 ml Botol 31,000

    595 Betadine solution Non Generik Cairan, botol = 15 ml Botol 17,000

    596 Braided Silk Suture "Ethicon-Mersilk" Non Generik Sachet Sachet 213,000

    597 Buscopan 20 mg/ml Non Generik Cairan, boks = 10 ampul Boks 60,000

    598 Catgut Silk with Needle "OneMed" Non Generik Sachet Sachet 30,000

    599 Cortison Asetat Injeksi Non Generik Vial 10 mL, Box = 10 vial Box 371,000

    600 Cotton bud Non Generik Pak Pak 11,000

    601Cum stainless, pinset, gunting, needle

    holder (bahan bedah minor)Non Generik Unit = 1 unit Unit 54,000

    602 Daryant-Tulle Non Generik Lembar, boks = 5 lembar Box 350,000

    603 Decamidon Injeksi Non Generik Vial 15 mL Vial 34,000

    604 Deksametason 5 mg/mL Injeksi Generik Ampul = 1ml Ampul 4,000

    605 Diazepam 5 mg/mL Injeksi NPP Ampul, box = 30 ampul Box 162,000

    606 Epinefrin Injeksi / Adrenalin Injeksi Generik Ampul, box = 10 buah Ampul 18,000

    607 EpiPen / Epinefrin in Auto Injector Non Generik Pen Auto Injector, box = 2 buah Box 6,728,000

    608 Glukosa 10 % larutan infus Non Generik Larutan Infus, botol = 500 mL Botol 11,000

    609 Glukosa 40 % larutan infus Non Generik Ampul, box = 10 ampul Ampul 27,000

    610 Glukosa 5 % larutan infus Non Generik Larutan Infus, botol = 500 mL Botol 10,000

    611 Gunting Non Generik Stainless, gagang plastik Buah 48,000

    612 H2O2 solution 100 mL Non Generik Larutan 3%, Botol Botol 13,000

    III. OBAT/ BAHAN/ ALAT P3K DAN KEDARURATAN

  • - 73 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    613 Hansaplast Non Generik Box Box 68,000

    614 Hansaplast Plester Kain Elastis Non Generik Lembar, boks = 100 lembar Box 48,000

    615Hansaplast Plester Roll Kain 1,25 cm

    x 1 m Non Generik Roll, box = 10 roll Box 59,000

    616 Hypafix Plester Rol 5cm x 1 m Non Generik Plester Rol 5cm x 1 m Rol 88,000

    617 Hypafix Plester Rol 10cm x 1 m Non Generik Plester Rol 10cm x 1 m Rol 162,000

    618 Hypafix Plester Rol 20cm x 1 m Non Generik Plester Rol 20cm x 1 m Rol 404,000

    619 Infus Set Terumo Non Generik Ukuran 1 ml 20 tetes Buah 14,000

    620 ISDN 10 mg tablet Generik Tablet, box = 100 buah Box 41,000

    621 ISDN 5 mg tablet Generik Tablet, box = 100 buah Box 21,000

    622 Kanul Oksigen Nasal Bmed Non Generik Ukuran dewasa Buah 10,000

    623 Kapas Lestari Non Generik Pack = 250 g Pack 38,000

    624Kasa Pembalut Hidrofil 4 yrd x 10 cm

    "Kasa Husada"Non Generik Roll, Pack = 5 roll Pack 64,000

    625Kasa Pembalut Hidrofil 4 yrd x 6 cm

    "Kasa Husada"Non Generik Roll, Pack = 5 roll Pack 64,000

    626 Kasa Steril Hidrofil "Husada" Non Generik Box = 10 buah Box 16,000

    627 Kasa Steril Hidrofil Lestari Non Generik Box = 16 buah Box 9,000

    628 Kasa Perban Gulung 10 cm Lestari Non Generik Pack = 5 roll Pack 18,000

    629 Kasa Perban Gulung 5 cm Lestari Non Generik Pack = 10 roll Pack 17,000

    630 Kasa Perban Elastis Policrepe 6 inch Non Generik Roll = 1 buah Roll 162,000

    631 Kasa Perban Elastis Policrepe 3 inch Non Generik Roll = 1 buah Roll 108,000

    632 Kateter urine/Folley Catheter Silikon Non Generik Ukuran 16 Buah 14,000

    633 Ketoprofen 100 mg suppositoria Generik Suppositoria, box = 10 buah Box 122,000

    634 Klorpromazin 25 mg/mL Injeksi Generik Ampul 2ml, box = 30 ampul Box 50,000

    635 Klorpromazin 5 mg/mL Injeksi Generik Ampul 2ml, box = 30 ampul Box 45,000

    636 Lidocaine 2% Generik Cairan, ampul = 2 ml Ampul 14,000

    637 Minyak Angin Roll Fresh Care Strong Non Generik Cairan, botol = 10 ml Botol 23,000

    638 Minyak Kayu Putih "Cap Lang" Non Generik Cairan, botol = 15 ml Botol 10,000

    639 Minyak Kayu Putih Cap Lang Non Generik Cairan, botol = 30 ml Botol 17,000

    640 NaCl 0,9% larutan infus Non Generik Larutan, vial = 25 mL Vial 14,000

    641 NaCl 0,9% larutan infus Non Generik Larutan Infus, Botol = 500 mL Botol 10,000

    642 NaCl 0.9% larutan infus Non Generik Larutan Infus, Botol = 1000 mL Botol 21,000

    643 Oksigen Refill Non Generik Tabung kecil Tabung 68,000

    644 Oxycan Green Non Generik Can Aerosol Can 75,000

    645 Pembalut Siku Mitela Non Generik Buah Buah 17,000

    646 Povidone Iodine Generik Cairan, botol = 1 liter Botol 95,000

    647 Primperan 5 mg/ml Non Generik Cairan, boks = 6 ampul Boks 87,000

    648 Ranitidin 25 mg/ml Generik Cairan, ampul = 2 ml Ampul 4,000

    649 Recodryl Non Generik Cairan, vial = 15 ml Vial 11,000

    650 Rivanol Larutan Kompres Non GenerikLarutan kompres, botol = 100

    mlBotol 9,000

    651 RL larutan infus Non Generik Larutan Infus, Kolf = 500 mL Kolf 10,000

  • - 74 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    652 Safety box 5 L Non Generik Box Box 34,000

    653 Salbutamol 1 mg/ml larutan inhaler Non Generik Larutan inhaler, botol = 5 ml Botol 34,000

    654 Selang oksigen set Non Generik Selang set set 14,000

    655 Sofratulle Gauge Non Generik Gause, box = 10 lembar Box 235,000

    656 Tensocrepe 10 cm Non Generik Roll = 1 unit Roll 105,000

    657 Tensocrepe 15 cm Non Generik Roll = 1 unit Roll 142,000

    658 Urine Bag Steril Non Generik Urine Bag, buah Buah 8,000

    659 Ventolin nebules, larutan Non Generik Ampul, box = 20 ampul Box 377,000

    660 Accutrend Cholesterol Non Generik Strip, pot = 25 buah Pot 688,000

    661 Accutrend Glucose Non Generik Strip, pot = 25 buah Pot 403,000

    662 Accutrend Trigliserida Non Generik Strip, pot = 25 buah Pot 803,000

    663 Lancet Accu Chek Softclik Non Generik Lancet, box = 100 buah Box 211,000

    664 Strip Asam Urat Easytouch Non Generik Strip, Box = 25 buah Box 249,000

    665 Strip Glukosa Easytouch Non Generik Strip, Box = 25 buah Box 249,000

    666 Strip Hb Family Dr Non Generik Strip, Box = 10 buah Box 42,000

    667 Strip Kolesterol Easytouch Non Generik Strip, Box = 10 buah Box 249,000

    668 UA Sure Non Generik Strip, Pot = 25 buah Pot 379,000

    669 Vaksin Difteri Non Generik Injeksi Ampul 88,000

    670 Vaksin Hepatitis B Non Generik Injeksi Ampul 95,000

    671 Vaksin Hepatitis B "Engerix B" Non Generik Injeksi Ampul 108,000

    672 Vaksin HPV "Gardasil" Non Generik Injeksi Ampul 1,211,000

    673 Vaksin Influenza "Fluquadri" Non Generik Injeksi Ampul 358,000

    674 Water-based Fogging Agent Non Generik Cairan, botol = 1 liter Botol 76,000

    675 Hi-Cook Butane Gas Cartridge Non Generik Kaleng 230 g Kaleng 30,000

    676Pestisida Smash 100 EC Cypermetrin

    100 g/LNon Generik Cairan, botol = 500 ml Botol 88,000

    -

    677 Aseptic Gel OneMed Non Generik Cairan, jerigen = 5 liter Jerigen 303,000

    678 Blood Lancet Non Generik Lancet, box = 100 buah Box 40,000

    679 Botol plastik 60 ml Non Generik Volume 60 ml Buah 3,000

    680Charm Fragrance Extra Comfort Maxi

    Non Wing Non Generik Pack, pack = 18 buah Pack 34,000

    681Charm Fragrance Extra Comfort Maxi

    Wing Non Generik Pack, pack = 18 buah Pack 34,000

    682 Jelly USG Non Generik Cairan, jerigen = 5 liter Jerigen 337,000

    683 Kantong Obat Kertas 10 x 15 cm Non Generik Lembar, pack = 100 lembar Pack 23,000

    684 Kantong plastik putih kecil Non Generik Lembar, pack = 100 lembar Pack 26,000

    685 Kantong Plastik Putih No.15 Non Generik Lembar, pack = 100 lembar Pack 30,000

    IV. VAKSIN, KIT / STRIP DIAGNOSTIK SEDERHANA

    V. OBAT DAN BAHAN KEGIATAN LAPANGAN/ PELATIHAN/ PENYULUHAN/ AMBULANCE

    VI. BAHAN MEDIS HABIS PAKAI (BMHP) PELAYANAN UMUM

  • - 75 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    686 Kertas printer USG Non Generik Roll Roll 270,000

    687Laurier Active Day Maxi Pembalut

    WanitaNon Generik Pakc, pack = 30 buah Pack 25,000

    688 Masker Disposible Earloop Surgi-Care Non Generik Box = 50 buah Box 64,000

    689 Masker Disposible Tie-on OneMed Non Generik Box= 50 buah Box 64,000

    690 Micropore besar Non Generik Roll Roll 52,000

    691 Micropore kecil Non Generik Roll Roll 21,000

    692 Pipet obat 1 ml Non Generik Pipet, unit = 1 unit Unit 7,000

    693 Pipet obat 5 ml Non Generik Pipet, unit = 1 unit Unit 23,000

    694 Plastik kresek kecil Non Generik Lembar, pack = 100 lembar Pack 21,000

    695 Plastik Obat Klip 8.7 x 13 cm Non Generik Lembar, pack = 100 lembar Pack 12,000

    696 Plastik Obat Klip Besar Non Generik Lembar, pack = 100 lembar Pack 15,000

    697 Plastik Obat Klip Kecil (10 x 7) Non Generik Lembar, pack = 100 lembar Pack 7,000

    698 Plastik Obat Klip Kecil (10 x 7) Non Generik Lembar, pack = 100 lembar Pack 7,000

    699 Plastik Obat Klip Sedang Non Generik Lembar, pack = 100 lembar Pack 10,000

    700 Sarung Tangan Lateks Remedi Non Generik Box = 50 pasang Box 75,000

    701 Sarung Tangan Nitril Remedi Non Generik Box = 50 pasang Box 108,000

    702 Spatel Lidah Kayu Non Generik Pack = 50 buah Pack 34,000

    703 Tissue Facial 900 gram Non Generik Lembar, pack = 900 gram Pack 56,000

    704 Tissue Rol Tessa Non Generik Rol Rol 11,000

    705 Absorbent paper points 15-40 Non Generik Box = 200 buah Box 146,000

    706 Alginat, Fast Set, merk GC Non Generik Pak = 500 gram Pack 155,000

    707 Alkohol 70% Non Generik Cairan, botol = 1 liter Botol 68,000

    708 Alloclair plus gel Non Generik Gel, tube= 8 mL Tube 142,000

    709 Alveogyl Non Generik Pasta, botol = 10 gram Botol 702,000

    710 Aquabidestilata 500 ml Generik Cairan, botol = 500 ml Botol 41,000

    711 Arkansas Stone Silinder Hijau Non Generik Buah Buah 23,000

    712 Arkansas Stone Silinder Merah Non Generik Buah Buah 23,000

    713 Articulating Paper double check Non Generik Lembar, pak = 12 x 12 lembar Pack 162,000

    714 Articulating paper horseshoe Non Generik Lembar, pak = 6 x 12 lembar Pack 337,000

    715 Baju Operator Disposible Non Generik Buah Buah 75,000

    716Benang jahit silk 2/0 dengan jarum

    "OneMed"Non Generik Buah Buah 13,000

    717Benang jahit silk 3/0 dengan jarum

    "OneMed"Non Generik Buah Buah 15,000

    718 Betadine, Sol Antiseptik Non Generik Cairan, botol = 1 liter Botol 84,000

    719 Bond Force Tokuyama Non Generik Cairan, Botol = 5 ml Botol 913,000

    720 Bonding 3M Universal Non Generik Cairan, botol = 5 ml Botol 1,615,000

    721 Brush CA Kecil Non Generik Sikat, buah Buah 14,000

    722 Brush CA Kecil point Non Generik Sikat, buah Buah 14,000

    723 Bur Diamond Meisinger A 801 016 Non Generik Buah Buah 49,000

    724 Bur Diamond Meisinger A 805 012 Non Generik Buah Buah 49,000

    VII. OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) PELAYANAN GIGI

  • - 76 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    725 Bur Diamond Meisinger A 805 018 Non Generik Buah Buah 49,000

    726 Bur Diamond Meisinger A 808 012 Non Generik Buah Buah 49,000

    727 Bur Diamond Meisinger B 389 012 Non Generik Buah Buah 52,000

    728 Bur Diamond Meisinger B 833C 018 Non Generik Buah Buah 60,000

    729 Bur Diamond Meisinger B 837L 014 Non Generik Buah Buah 64,000

    730 Bur Diamond Meisinger B 858 016 Non Generik Buah Buah 64,000

    731 Bur Diamond Meisinger B 858C 014 Non Generik Buah Buah 64,000

    732 Bur Diamond Meisinger C 802LG 012 Non Generik Buah Buah 51,000

    733 Bur Diamond Meisinger C 802LG 016 Non Generik Buah Buah 64,000

    734 Cairan Saline Non Generik Cairan, botol = 500 ml Botol 135,000

    735 Cal LC Non Generik Pasta, syringe = 2 gram Syringe 347,000

    736 Cal LC Denpro Non Generik Pasta, syringe = 2 gram Syringe 274,000

    737 Calcetin Cavity Liner paste 7g Non Generik Pasta, syringe = 7 gram Syringe 619,000

    738 Carpule Non Generik Box = 100 buah Box 263,000

    739 Caustinerf forte Non Generik Pasta, pot = 4,5 gram Pot 2,691,000

    740 Cavit G merk 3M Non Generik Pasta, pot = 28 gram Pot 270,000

    741 Cavit/ Calasept Non Generik Pasta, pot = 30 gram Pot 162,000

    742 Caviton merk GC Non Generik Pasta, pot = 30 gram Pot 269,000

    743 Caviton Pink Non Generik Pasta, pot = 30 gram Pot 213,000

    744 Caviton White Non Generik Pasta, pot = 30 gram Pot 213,000

    745 Celluloid strip Non Generik Strip, Pack = 100 lembar Box 290,000

    746 Celluloid strip "Dentamedica" Non Generik Strip, Pack = 100 lembar Pack 162,000

    747 Celluloid Strip Svenska Non Generik Strip, Pack = 100 lembar Pack 223,000

    748 Ceram X Sphere TEC One Non Generik Pasta, syringe, 3 gram Syringe 848,000

    749 Cheeck Retraktor Non Generik Buah Buah 115,000

    750 ChKm Non Generik Cairan, botol = 10 ml Botol 225,000

    751 ChKm "Biodinamica" Non Generik Cairan, botol = 20 ml Botol 115,000

    752 Chloraethyl Spray Non Generik Cairan, botol = 100 ml Botol 162,000

    753 Chloraethyl Spray Botol Kaca Non Generik Cairan, botol = 100 ml Botol 424,000

    754 Cito Ject Needle, uk. 0,3 x 33mm Non Generik Box = 100 buah Box 229,000

    755 Clip dental chain Non Generik Buah Buah 34,000

    756 Cocoa butter merk GC Non Generik Pasta, tube = 10 gram Tube 163,000

    757 Composite estelite quick Non Generik Pasta, syringe = 3,6 gram Syringe 963,000

    758 Composite flowable quick Non Generik Pasta, syringe = 3,6 gram syringe 640,000

    759 Cotton pelet Non Generik Pot Pot 61,000

    760 Cotton roll Non Generik Pack = 600 buah Pack 101,000

    761 Creshopate merk Septodont Non Generik Pasta, Pot = 7,5 gram Pot 1,010,000

    762 Cresophate Non Generik Pasta, Pot = 25 gram Pot 633,000

    763 Cresophene Non Generik Cairan, botol = 15 ml Botol 1,346,000

    764 Cresophene Non Generik Cairan, botol = 5 ml Botol 263,000

    765 Cresotin Paste Tehnodent Non Generik Pasta, pot = 25 g Pot 438,000

    766 Curaspon Non Generik Box Box 828,000

    767 Dental bib + kantong hijau Non Generik Pack = 100 buah Pack 106,000

  • - 77 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    768 Dental cotton 8 mm Non Generik Pack = 20 buah Pack 104,000

    769 Dental floss Non Generik Pack = 50 floss Pack 54,000

    770 Dental floss pick Non Generik Pack = 100 buah Pack 135,000

    771 Dental microbrush applicator Non Generik Pack = 100 buah Pack 88,000

    772 Dental poli bib Non Generik Pack = 500 buah Pack 393,000

    773 Dental tampon Non Generik Pak Pack 38,000

    774 Dental x-ray film Non Generik Box = 25 buah Box 519,000

    775 Dentin conditioner Non Generik Cairan, botol = 25 gram Botol 210,000

    776 Dentin Conditioner Mini Pack 6 gr Non Generik Cairan, botol = 6 g Botol 168,000

    777 Dentsply XP Bond Non Generik Cairan, botol = 4,5 ml Botol 1,427,000

    778 Desensitizer Non Generik Cairan, botol = 5 ml Botol 202,000

    779 Diamond bur jrt 12's Non Generik Set Set 1,010,000

    780 Diamond Bur Set Non GenerikPack = 9 buah, (bur round,

    inverted bur, fisure bur)Pack 297,000

    781 Dissposible Syringe 1 cc "Terumo" Non Generik Box = 100 buah Box 471,000

    782 Dissposible Syringe 10 cc "Terumo" Non Generik Box = 100 buah Box 471,000

    783 Dissposible Syringe 3 cc "Terumo" Non Generik Box = 100 buah Box 438,000

    784 Dycal Non Generik Pasta, set Set 640,000

    785 Endometason,merk 'N-Metasone' Non Generik Powder, botol, 14 gram Botol 808,000

    786 Endomethason Non Generik Cairan, botol = 10 ml Botol 2,355,000

    787 Endoseal Non GenerikBox = 20gr powder & 10ml

    liquidBox 470,000

    788 Endoseptone Non Generik Cairan, botol = 15 ml Botol 607,000

    789 Etchant Non Generik Cairan, botol = 9 ml Botol 258,000

    790 Etching Non Generik Pasta, syringe = 2 ml Syringe 371,000

    791 Ethylchloride spray Non Generik Cairan, botol = 100 ml Spray 337,000

    792 Eugenol Camex Non Generik Cairan, botol = 15 ml Botol 101,000

    793 Eugenol Zhermack Non Generik Cairan, botol = 15 ml Botol 75,000

    794 Exterpatie / Barbed Broach Svenska Non Generik Set = 10 buah Set 171,000

    795 Fiber Splint Set Non Generik Set Set 2,624,000

    796 Filtek Z350 XT Flowable (3M) Non Generik Cairan, syringe = 2 gram Syringe 828,000

    797 Fletcher powder Non Generik Powder, Pot = 100 gr Pot 68,000

    798 Fuji 9 Gold Label Non Generik Powder + Liquid, pack Pack 1,144,000

    799 Fuji I merk GC Non Generik Powder + Liquid, pack Pack 1,353,000

    800 Fuji I minipack Non Generik Powder + Liquid, pack Pack 537,000

    801 Fuji IX GP Non Generik Powder + Liquid, pack Pack 1,178,000

    802 Fuji IX GP minipack Non Generik Powder + Liquid, pack Pack 551,000

    803 Fuji IX universal Non Generik Powder + Liquid, pack Pack 2,221,000

    804 G-aenial Anterior & Posterior Non Generik Pasta, syringe = 2,7 ml Syringe 1,076,000

    805 G-Aenial Bond Bottle Refill GC Non Generik Liquid, botol = 5 ml Botol 1,317,000

    806 G-aenial Bond merk GC Non Generik Liquid, botol = 5 ml Botol 1,343,000

    807 G-aenial Posterior A3.5 Non Generik Pasta, syringe = 2,7 ml Syringe 850,000

  • - 78 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    808 G-aenial Universal Flow Non Generik Pasta, syringe = 3,4 ml Syringe 1,354,000

    809 Gengigel Sachet Non Generik Sachet, box = 100 sachet Box 1,200,000

    810 Gengigel Spray Non Generik Cairan, botol = 20 ml Botol 233,000

    811 Gengigel tube Non Generik Jel, tube = 20 ml Tube 572,000

    812 Grinding Strip Non Generik Lembar, pack = 12 lembar Pack 34,000

    813 Gutta percha 15-40 Non Generik Point, pack = 120 points Pack 108,000

    814Gutta percha points 45-80 Sure-endo

    KoreaNon Generik Point, pack = 120 points Pack 169,000

    815 Hexidin 2% OneMed Non Generik Cairan, botol = 100 ml Botol 69,000

    816 Hidrogen peroksida (H2O2) 3% Non Generik Cairan, botol = 800 ml Botol 38,000

    817 Jarum K-file 15-40 Non Generik Set = 6 buah Set 317,000

    818 Jarum Irigasi Nomor 28G Non Generik Box = 50 buah Box 209,000

    819 Jarum K-file 45-80 Non Generik Set = 6 buah Set 317,000

    820 Jarum lentulo no 25-40 Non Generik Set = 4 buah Set 252,000

    821 Kaca Mulut Non Generik Buah Buah 171,000

    822 Kapas Gulung Non Generik Pack = 1000 gram Pack 54,000

    823 Kassa steril "Husada" 16 x 16 Non Generik Lembar , box = 16 lembar Box 21,000

    824 Kassa steril gulung Non Generik Gulung = 1000 gram Gulung 135,000

    825 Kenalog Non Generik Tube Tube 135,000

    826 Kin mouth wash Non Generik Cairan, botol = 250 ml Botol 223,000

    827 Larutan desinfektan ODEX - OneMed Non Generik Cairan, botol = 500 ml Botol 128,000

    828 Lem fiber splint Non Generik Liquid, botol Botol 2,624,000

    829 Masker 3 ply earloop Non Generik Lembar, box = 50 lembar Box 62,000

    830 Masker Hijab Non Generik Lembar, box = 50 lembar Box 62,000

    831 Masker tali Non Generik Lembar, box = 50 lembar Box 48,000

    832 Matrix band Non Generik Set Set 2,624,000

    833 Micro Applicator Brush Non Generik Pack = 50 buah Pack 270,000

    834 Minosep Gargle Non Generik Cairan, botol = 60 ml Botol 39,000

    835 Moldano biru Non Generik Bubuk, pack = 1000 gram Kg 109,000

    836 NaOCL Non Generik Cairan, botol = 1000 ml Botol 155,000

    837 NaOCl 2.5% OneMed Non Generik Cairan, botol = 500 ml Botol 52,000

    838 Oli Pelumas handpiece MD400 W&H Non Generik Cairan, botol Botol 933,000

    839Oral Surgery - Carbide 151 016

    MeisingerNon Generik Buah Buah 252,000

    840 Paper mixing pad Non Generik Lembar, buku Buku 34,000

    841 Paper point no.15-40 Non Generik Set = 120 buah Set 115,000

    842 Pehacain Injeksi Non Generik Cairan, box = 20 ampule Box 86,000

    843 Perio Kin Non Generik Jel, tube = 30 ml Tube 216,000

    844 Periodontal dressing "COE Pack" Non Generik Box Box 875,000

    845 Polibib tali Non Generik Lembar, pak = 50 lembar Pack 108,000

    846 Polibib tanpa tali Non Generik Lembar, box = 125 lembar Box 202,000

    847 Poliren Polishing Pasta No 1 Non Generik Pasta, pot = 45 gram Pot 243,000

  • - 79 -

    HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL

    TAHUN ANGGARAN 2020

    KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN

    NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/

    KODE/ ACUAN SATUAN HARGA

    (dalam Rupiah)

    848 Prophy Brush OneMed Non Generik Buah Buah 8,000

    849 Pulp X Devitalisasi Non Generik Pasta, pot = 6 gram Pot 404,000

    850 Rockle's Non Generik Cairan, botol = 13 ml Botol 781,000

    851 Saliva Ejector Non Generik Pack Pack 171,000

    852 Sarung Tangan Nitrile Size S Non Generik Lembar, box = 100 lembar Box 202,000

    853 Sarung Tangan Nitrile Size XS Non Generik Lembar, box = 100 lembar Box 84,000

    854 Scandonest 2 % Non Generik Cartridge, box = 50 Box 1,615,000

    855 Self etching dentex Non Generik Liquid, botol = 5 ml Botol 529,000

    856 Septocaine Injeksi Non Generik Cartridge, box = 50 Box 1,211,000

    857 Septoject 0,3 x 12 mm Non Generik Box = 100 buah Box 263,000

    858 Septoject 0,3 x 16 mm Non Generik Box = 100 buah Box 263,000

    859 Septoject 0,3 x 25 mm Non Generik Box = 100 buah Box 263,000

    860 Slaber Disposible Non Generik Pack = 100 buah Pack 96,000

    861 Sof-Lex 3M Mini Kit Non Generik Set Set 563,000

    862 Sof-Lex 3M Spiral Mini Kit Non Generik Set Set 434,000

    863 Solare Flo A2 GC Non Generik Pasta, syringe = 0,56 ml Syringe 297,000

    864 Solare Flo A3 GC Non Generik Pasta, syringe = 0,56 ml Syringe 297,000

    865 Solare Komposit, Anterior merk GC Non Generik Pasta, syringe = 2 ml Syringe 471,000

    866Solare Sculpt Syringe A2 1.9g (1ml)

    GCNon Generik Pasta, syringe = 1 ml Syringe 474,000

    867 Solare X Komposit, Posterior merk GC Non Generik Pasta, syringe = 1 ml Syringe 471,000

    868 Spet one pro classic (liquid) Non Generik Cairan, botol Botol 808,000

    869 Spet one pro spray Non Generik Botol Botol 808,000

    870 ST. House Hold (S,M,L) Non Generik Pack Pack 169,000

    871 Stain Remover OCO Non Generik Cairan, botol = 15 ml Botol 256,000

    872 Steri One Plus OneMed Non Generik Cairan, botol = 500 ml Botol 91,000

    873 Sterile Pouch 7 x 200 cm OneMed Non Generik Gulung Gulung 485,000

    874 Sterile Pouch 9 x 200 cm OneMed Non Generik Gulung Gulung 976,000

    875 Suture needle dengan benang Non Generik Buah Buah 108,000

    876 Ti Es Hitam Non Generik Pasta, syringe = 2,5 ml Syringe 377,000

    877 Ti Es Kuning Non Generik Pasta, syringe = 2,5 ml Syringe 270,000

    878 TKF Non Generik Cairan, botol = 10 ml Botol 169,000

    879 Topical anaesthesi Gel Non Generik Pasta, pot = 30 gram Pot 263,000

    880 TSR Non Generik Botol Botol 115,000

    881 Tutup Oly W&H 400 ml Non Generik Buah Buah 149,000

    882 Wedges Dentamerica Transparan Non Generik Pack Pack 97,000

    883 Xylonor Non Generik Cairan, botol = 36 gram Botol 808,000

    884 Zinc Posfat cement Non Generik Set Set 327,000