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



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

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TAHUN ANGGARAN 2020




(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

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(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

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(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 -


TAHUN ANGGARAN 2020




(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

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TAHUN ANGGARAN 2020




(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



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

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TAHUN ANGGARAN 2020




(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

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TAHUN ANGGARAN 2020




(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

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(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

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(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

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(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

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TAHUN ANGGARAN 2020




(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 -


TAHUN ANGGARAN 2020




(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 -


TAHUN ANGGARAN 2020




(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 -


TAHUN ANGGARAN 2020




(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 -


TAHUN ANGGARAN 2020




(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



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 -


TAHUN ANGGARAN 2020




(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 -


TAHUN ANGGARAN 2020




(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


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

- 76 -


TAHUN ANGGARAN 2020




(dalam Rupiah)



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 -


TAHUN ANGGARAN 2020




(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



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 -


TAHUN ANGGARAN 2020




(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 -


TAHUN ANGGARAN 2020




(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



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

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