contoh Rka 2015 Bpjs

7/25/2019 contoh Rka 2015 Bpjs

1/27

NO NAMA OBAT SATUAN

AKARBOSE 100 MG

AKARBOSE 50 MG

ALBENDAZOL 400 MG

ALOPURINOL 100 MG

ALOPURINOL 300 MG

ALPRAZOLAM 0.25 MG

ALPRAZOLAM 1 MG

AMIKASIN 250 MG/ML

AMILORID 5 MG

AMINOFILIN 200 MG

AMINOFILIN 24 MG/ML

AMIODARON 150 MG/3 ML

AMIODARON 200 MG

AMITRIPTILIN 25 MG

AMLODIPIN 10 MG

AMLODIPIN 5 MG

AMOKSISILIN 250 MG/5 ML

AMOKSISILIN 125 MG/5 ML

AMOKSISILIN 500 MG

AMPISILLIN 1000 MG/VIAL

ANALOG INSULIN RAPID ACTING 100 UI/ML

ANALOG INSULIN LONG ACTING 100 UI/ML

ANTASIDA DOEN SUSPENSI

ANTASIDA DOEN TABLET

AIR IRIGASI 1000 ML

AQUA PRO INJ 25 ML

ARTEMETER !0 MG/ML

ASAM ASETILSALISILAT !0 MG

ASAM FOLAT 0.4 MG

ASAM MEFENAMAT 500 MG

ASAM PIPEMIDAT 400 MG

ASAM RETINOAT KRIM 0.1"

ASAM TRANEKSAMAT 100 MG/ML

ASAM TRANEKSAMAT 500 MG

ASAM URSODEOKSIKOLAT 250 MG

ASAM VALPROAT 250 MG/5 ML

ANTI EMOROID KOMBINASI # BISMUT SUBGALLAT$EKSAKLOROFEN$ LIDOKAIN$ SENG OKSID


2/27

ASAM VALPROAT 500 MG

ASAM VALPROAT SR 500 MG

ASIKLOVIR 200 MG

ASIKLOVIR 400 MG

ATENOLOL 100 MG

ATENOLOL 50 MG

ATENOLOL 50 MG

ATRAKURIUM 25 MG/2.5 ML

ATROPIN 0.25 MG/ML

ATROPIN TETES MATA 0.5"

ATROPIN TETES MATA 1"

ATTAPULGIT TAB

AZITROMISIN 500 MG

BETAMETASON KRIM 0.1"

BETAMETASON TETES MATA 1 MG/ML

BISAKODIL 10 MG SUPP

BISAKODIL 5 MG

BISAKODIL 5 MG SUPP

BISAKODIL 10 MG SUPP

BISOPROLOL 2.5 MG

BISOPROLOL 5 MG

BUDESONID CAIRAN I 0.25 MG/ML

BUDESONID I 200 MCG/DOSIS

BUVIPAKAIN 5 MG/ML EAV% & GLUKOSA !"

DEKSAMETASON 0.5 MG

DEKSAMETASON 5 MG/ML

DESOKSIMETASON KRIM 0.25"

DIAZEPAM 2 MG

DIAZEPAM 5 MG

DIAZEPAM 5 MG/ML

DIAZEPAM LAR REKTAL 10 MG/2.5 ML

DIAZEPAM LAR REKTAL 5 MG/2.5 ML

DIFENIDRAMIN 10 MG/ML

DIFLUKORTOLON VALERAT SALEP 0.1"

DIGOKSIN 0.25 MG

DIGOKSIN 0.25 MG/ML

DILTIAZEM CL 30 MG

DILTIAZEM CL SR 100

DILTIAZEM CL INFUS INJEKSI 50 MG

DILTIAZEM CL 25 MG/5 ML

DINATRIUM EDETAT TETES MATA 0.35"

DOBUTAMIN 50 MG/ML

DOKSAZOSIN MESILAT 2 MG

BUDESONID'FORMOTEROL (FI)ED COMBINATION* I !0/4.5MCG


3/27

DOKSISIKLIN 100 MG

DOMPERIDON 10 MG

DOMPERIDON SUSP 5 MG/5 ML

DOMPERIDON TTS 5 MG/ML

DOPAMIN 40 MG/ML

EFEDRIN 50 MG/ML

EPINEFRIN 0.1"

ERGOTAMIN 1 MG

ERITROMISIN 500 MG

ERITROMISIN SIR 200 MG/5 ML

ETAMBUTOL 500 MG

ETANOL +0"

ETIL KLORIDA SEMPROT 100 ML

ETINILESTRADIOL 0.5 MG

FENITOIN 100 MG/2 ML

FENITOIN NA 100 MG

FENOBARBITAL 100 MG

FENOBARBITAL 150 MG/ML

FENOBARBITAL 30 MG

FENOFIBRAT 100 MG

FENOFIBRAT 300 MG

FENOTEROL BR AEROSOL 10 MCG/PUFF

FENOTEROL BR CAIRAN I 0.1 "

1 FENTANIL 0.05 MG/ML (IV* 10 ML

FENTANIL 12.5 MCG/JAM

FENTANIL 25 MCG/JAM

FERRO SULFAT SIR. 15 MG/5 ML

FERRO SULFAT TAB SALUT 300 MG

FITOMENADION (VIT. K1* 2 MG/ML

FITOMENADION (VITAMIN K1* 10 MG

FLUKONAZOL 150 MG

FLUKONAZOL 2 MG/ML

FLUKONAZOL 50 MG

FLUOKSETIN 20 MG

FLUORESEIN INJ 10"

FLUORESEIN TETES MATA 2.5 MG/ML

FLUOROMETOLON TETES MATA 0.1"

FLUSINOLON ASETONID KRIM 0.025"

FLUTIKASON PROPIONAT INTRANASAL SPRA%

FONDAPARINUKS 2.5 MG/0.5 ML

FUROSEMID 10 MG/ML

FUROSEMID 40 MG

GAS NITROGEN

GAS OKSIGEN

GEMFIBROZIL 300 MG


4/27

GEMFIBROZIL ,00 MG

GENTAMISIN 40 MG/ML

GENTAMISIN SALEP MATA 0.3"

GLIKLAZID !0 MG

GLIKUIDON 30 MG

GLIMEPIRID 1 MG

GLIMEPIRID 2 MG

GLISERIL TRINITRAT 50 MG/ML

GLISERIL TRINITRAT SUBLINGUAL 0.5 MG

GRISEOFULVIN 125 MG

GRISEOFULVIN 500 MG

ALOPERIDOL 1.5 MG

ALOPERIDOL 5 MG

ALOPERIDOL INJ 5 MG/ML

EPARIN NA 5000 UI/ML

IDROGEN PEROKSIDA 3 "

IDROKLOROTIAZID 25 MG

IDROKORTISON 2.5"

IOSINA BUTILBROMIDA 10 MG

IOSINA BUTILBROMIDA INJ 20 MG/ML

OMATROPIN TETES MATA 2"

UMAN ALBUMIN 25 "

UMAN INSULIN SORT ACTING 100 UI/ML

UMAN INSULIN INTERMEDIATE ACTING 100 UI

UMAN TETANUS IMUNOGLOBULIN

%DRO)%L ET%L STARC LAR ,"

IBUPROFEN 200 MG

IBUPROFEN 400 MG

IBUPROFEN SIR 100 MG/5 ML

IPRATROPIUM BROMIDA NEBULIZER 0.025"

IRBESARTAN 150 MG

IRBESARTAN 300 MG

ISOFLURAN 100 ML

ISONIAZID 100 MG

ISONIAZID 300 MG

ISOSORBID DINITRAT 10 MG/10 ML

ISOSORBID DINITRAT 5 MG

KALAMIN LOTION

KALIUM ASPARTAT 300 MG

KALIUM KLORIDA 300 MG

KALSIUM GLUKONAT 100 MG/ML

KALSIUM LAKTAT 500 MG

KANAMISIN 1 G

KANDESARTAN 1, MG

KANDESARTAN ! MG


5/27

KAPTOPRIL 12.5 MG

KAPTOPRIL 25 MG

KAPTOPRIL 50 MG

KARBAMAZEPIN 100 MG/5 ML

KARBAMAZEPIN 200 MG

KARBIMAZOL 5 MG

KETAMIN 100 MG/ML

KETOKONAZOL 200 MG

KETOKONAZOL KRIM 2"

KETOPROFEN SUPP 10 MG

KETOROLAK 30 MG/ML

KLINDAMISIN 150 MG

KLINDAMISIN 300 MG

KLOBAZAM 10 MG

KLOMIFEN SITRAT 50 MG

KLONIDIN 0.15 MG

KLOPIDOGREL +5 MG

KLORAMFENIKOL 250 MG

KLORFENIRAMIN MALEAT 4 MG

KLORPROMAZIN 100 MG

KLORPROMAZIN INJ 5 MG/ML

KLOZAPIN 25 MG

KODEIN 10 MG

KOLKISIN 500 MCG

KOLOID ES BM 130.000 LAR ,"

ANTIMIGREN KOMBINASI # ERGOTAMIN 1 MG$ KAFEIN 50 MG

KOMBINASI # FERRO SULFAT 200 MG$ ASAM FOLAT 0.25 MG

KOMBINASI # KAOLIN 550 MG$ PEKTIN 20 MG

LIDOKAIN CL 2" & EPINEFRIN 1 # !0.000 INJ 2 ML

KOMBINASI # PARAFIN$ GLISERIN$ FENOLFTALEIN SUSPENSI

KOTRIMOKSAZOL 4!0 MG

KOTRIMOKSAZOL -,0 MG

KOTRIMOKSAZOL SUSP 240 MG

KUININ 25"

ANTIMALARIA KOMBINASI # ARTEMETER 20 MG$LUMEFANTRIN 120 MG

KOMBINASI # IPRATROPIUM BR 0.5 MG$ SALBUTAMOL 2.5 MGNEBULES

KOMBINASI # IPRATROPIUM BR 0.5 MG$ SALBUTAMOL 2.5 MGSOLUTION 0.025"

KOMBINASI # IPRATROPRIUM BR 0.5 MG. SALBUTAMOL 2.5MG NEBULIZER 0.025"

KOMBINASI # NATRIUM KLORIDA$ KALIUM KLORIDA TETESMATA

KOMBINASI # SALMETEROL 25 MCG$ FLUTIKASON 50 MCG I50 MCG/PUFF


6/27

KUININ (KINA* 200 MG

LAKTULOSA SIR 3.3335 G/5 ML

LANSOPRAZOLE 30 MG

LEVOFLOKSASIN 500 MG

LEVOFLOKSASIN INF 5 MG/ML

LEVOFLOKSASIN TETES MATA 0.5"

LEVOTIROKSIN 50 MCG

LIDOKAIN 2"

LIDOKAIN GEL 2"

LIDOKAIN SEMPROT 10"

LISINOPRIL 10 MG

LISINOPRIL 5 MG

LOPERAMID 2 MG

LORATADIN 10 MG

MAGNESIUM SULFAT 20 "

MAGNESIUM SULFAT 40 "

MANITOL LAR INFUS 20"

MEROPENEM 1 G

METFORMIN 500 MG

METFORMIN !50 MG

METILDOPA 250 MG

METILERGOMETRIN 0.125 MG

METILERGOMETRIN 0.2 MG/ML

METILPREDNISOLON 125 MG/2 ML

METILPREDNISOLON 1, MG

METILPREDNISOLON 4 MG

METILPREDNISOLON ! MG

METRONIDAZOL 500 MG

METRONIDAZOL SIR 125 MG/5 ML

METRONIDAZOLE LAR INFUS 5 MG/ML

MIDAZOLAM 1 MG/ML

MIKONAZOL KRIM 2"

MODIFIED FLUID GELATIN BM 30.000 LAR 4"

MORFIN CL 10 MG/ML

NALOKSON 0.4 MG/ML

N'ASETILSISTEIN 200 MG

NATRIUM BIKARBONAT !.4 " IV

NATRIUM DIKLOFENAK 25 MG

NATRIUM DIKLOFENAK 50 MG

NATRIUM FLUORESEIN TETES MATA 2"

NATRIUM FUSIDAT KRIM 20 MG/G

NEOSTIGMIN 0.5 MG/ML

NIFEDIPIN 10 MG

NIFEDIPIN SR 30 MG

NIKARDIPIN 10 MG/VIAL


7/27

NISTATIN 100.000 UI/ML

NOREPINEFRIN 1 MG/ML

NORETISTERON 5 MG

OFLOKSASIN 200 MG

OFLOKSASIN 400 MG

OKSITOSIN 10 UI/ML

OMEPRAZOL 20 MG

OMEPRAZOL 40 MG/10 ML

ONDANSENTRON INJ 2 MG/ML

ONDANSENTRON 4 MG

ONDANSENTRON ! MG

ORALIT

PARAFORMALDEID LAR BUFFER 10"

PARASETAMOL 1000 MG/100 ML

PARASETAMOL 120 MG/5 ML

PARASETAMOL 500 MG

PARASETAMOL ,0 MG/0., ML

PERAK SULFADIAZIN KRIM 1"

PERMETRIN KRIM 5"

PETIDIN CL 50 MG/ML

PILOKARPIN TETES MATA 2"

PIOGLITAZON 15 MG

PIRANTEL PAMOAT 125 MG/5 ML

PIRANTEL PAMOAT SCORE 125 MG

PIRAZINAMID 500 MG

POLIKRESULEN LAR

POVIDON IODIN LAR 100 MG/ML

PREDNISOLON TETES MATA 10 MG/ML

PREDNISON 5 MG

PRIMAKUIN 15 MG

PROPILTIOURASIL 100 MG

PROPOFOL 1 " (IV BOLUS*

PROPRANOLOL 10 MG

PROPRANOLOL 40 MG

PROTAMIN SULFAT 10 MG/ML

RAMIPRIL 5 MG

RANITIDIN 150 MG

RANITIDIN 25 MG/ML

RIFAMPISIN 300 MG

RIFAMPISIN 450 MG

RIFAMPISIN ,00 MG

RISPERIDON 2 MG

ROKURONIUM 50 MG/5 ML

SALBUTAMOL 2 MG

SALBUTAMOL 4 MG


8/27

SALBUTAMOL AEROSOL 100 MCG

SALBUTAMOL NEBULES VIAL 2.5 MG

SEFADROKSIL 125 MG/5 ML

SEFADROKSIL 500 MG

SEFALEKSIN 500 MG

SEFAZOLIN 1 G

SEFEPIM 1 G

SEFIKSIM 100 MG

SEFIKSIM 100 MG/5 ML

SEFOPERAZON 1 G

SEFOTAKSIM 1000 MG

SEFTAZIDIM 1 G

SEFTRIAKSON 1 G

SEFUROKSIM +50 MG/VIAL

SERUM ANTI BISA ULAR

SERUM ANTI DIFTERI

SETIRIZIN 10 MG

SETIRIZIN 5 MG/5 ML

SEVOFLURAN 250 ML

SILOSTAZOL 100 MG

SIMVASTATIN 10 MG

SIPROFLOKSASIN 2 MG/ML

SIPROFLOKSASIN 500 MG

SPIRONOLAKTON 25 MG

SPIRONOLAKTON 50 MG

STREPTOKINASE 1.5 JUTA UI/VIAL

STREPTOMISIN 1 G

SUKRALFAT 500 MG

SUKRALFAT 500 MG/5 ML

SUKSINILKOLIN 50 MG/ML

SULFASALAZIN 500 MG

TERAZOSIN CL 2 MG

TETRAKAIN TETES MATA 0.5"

TIMOLOL TETES MATA 0.25"

TIMOLOL TETES MATA 0.5"

TRAMADOL 50 MG/ML

TRIAMSINOLON 10 MG/ML

TRIAMSINOLON ASETONID NASAL SPRA% 55 MCG/PUFF

TRIEKSIFENIDIL 2 MG

TROPIKAMID TETES MATA 1 "

UREA KRIM 10"

VAKSIN RABIES

VALPROAT SIRUP 250 MG/5 ML

VITAMIN B1 50 MG

VITAMIN B12 50 MCG


9/27

VITAMIN B, 10 MG

VITAMIN BKOMPLEKS

VITAMIN C 50 MG

ARFARIN 2 MG

ZINC SIR 10 MG/ML

ZINC TAB 20 MG

TELBIVUDIN ,00 MG

ZINC DROP 10 MG/ML

ERITROPOETIN'ALFA 10.000 UI

BEDAK SALISIL SERBUK 2 "

BERAPROST NA 20 MCG

DE)TROSE 10"

DE)TROSE 5"

EPARIN INJEKSI 5000 UI

N'ASETILSISTEIN NEBULES 100 MG

NACL 0.-"

RINGER LAKTAT

UMAN ALBUMIN 20 " 100 ML

E'1-

E'1-


10/27

RENCANA KEBUTUHAN OBAT TAHUN 2015 SESUAI DENGAN FORMULARIUM NASIONAL

DI INSTALASI FARMASI RSUD

NAMA DAGANG (MERK) NAMA PENYEDIA


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AMINOFLUID PT. OTSUKA

AMINOFUSIN EPAR PT. KALBE


19/27

HARGA SATUAN JUMLAH KEBUTUHAN JUMLAH HARGA


20/27


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360


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3600

3600


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115$500.00

+5$350.00

contoh Rka 2015 Bpjs

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