Format Rko Provinsi Tahun 2015

8/16/2019 Format Rko Provinsi Tahun 2015

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RENCANA KEBUTUHAN OBA

SATUAN KERJA : RUMAH SAKIT JIWA PROVINSI BALI

NO NAMA OBAT

1 A.B.U. I (khusus ular dari luar Papua) inj (i.m./i.v.)

2 A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.)

3 Air untuk vial amp 25 mL

4 Al!nda"#l ta 4$$ m%

5 Al!nda"#l susp 2$$ m%/5 mL

& Al#purin#l ta 1$$ m%' Al#purin#l ta 3$$ m%

Amil#rid ta 5 m%

Amin#*ilin ta 15$ m%

1$ Amin#*ilin ta 2$$ m%

11 Amin#*ilin inj 24 m%/mL

12 Ami#dar#n ta 2$$ m%

13 Amitriptilin ta sal 25 m%

14

15

1&

1' Am#ksisilin ta 5$$ m%

1 Am#ksisilin sir *#rt! 25$ m%/5 mL

1 Ampisilin s!r inj 25$ m%/vial

2$ Ampisilin s!r inj 1$$$ m%/vial

21

22

23

24

25

2&

2'

2

2 Antimalaria k#minasi + sul*ad#ksin 5$$ m% , pirim!tamin 25 m%

3$

31 Art!m!th!r inj $ m%/mL

32 Art!sunat s!r inj &$ m%/mL (i.v./i.m.)

33 Articulating paper

34 Asam as!tilsalisilat (as!t#sal) ta 1$$ m%

35 Asam as!tilsalisilat (as!t#sal) ta $ m%

3& Asam ask#rat (vitamin -) ta 5$ m%

Aml#dipin ta sal 25 m%

Aml#dipin ta 5 m%

Aml#dipin ta 1$ m%

Anal#% insulin + rapid atin% (inj 1$$ UI/ml (k!masan vial artrid%! disp#sil!p!n*ill artrid%!)

Anal#% insulin +l#n% atin% (inj 1$$ UI/ml (k!masan vial artrid%! disp#sil!p!n*ill artrid%!)

Anal#% insulin +mi0 insulin (inj 1$$ UI/ml (k!masan vial artrid%! disp#sil!p!n*ill artrid%!)

An!st!tik l#kal %i%i k#minasi + lid#kain -l 2 , !pin!*rin 1 + $.$$$ inj 2mL

Antasida k#minasi + aluminium hidr#ksida 2$$ m% , ma%n!sium hidr#ksida2$$ m%

Antasida k#minasi +aluminium hidr#ksida 2$$ m% , ma%n!sium hidr#ksida2$$ m%

Anti*un%i sal!p k#minasi + asam !n"#at & , asam salisilat 3

Antih!m#r#id k#minasi+ ismut su%alat 15$ m% , h!ksakl#r#*!n 25 m% ,lid#kain 1$ m% , s!n% #ksida 12$ m% sup ad 2 %

Antiparkins#n k#minasi + !ns!ra"id 25 m% , l!v#d#pa 1$$ m%


2/56

3' Asam ask#rat (vitamin -) ta 25$ m%

3 Asam *#lat ta $4 m%

3 Asam *#lat ta 1 m%

4$ Asam *#lat ta 5 m%

41 Asam m!*!namat kaps 25$ m%

42 Asam m!*!namat kaps 5$$ m%

43 Asam salisilat 5

44 Asam salisilat $145 Asikl#vir ta 2$$ m%

4& Asikl#vir ta 4$$ m%

4' Atapul%it

4 At!n#l#l ta 5$ m%

4 At!n#l#l ta 1$$ m%

5$ Atr#pin ta $5 m%

51 Atr#pin inj $25 m%/mL (i.v./i.m./s.k.)

52 Bahan tumpatan s!m!ntara lar s!r

53 B!dak salisil s!r 2

54 B!n"atin p!nisilin inj 12 juta UI/mL (i.m.)

55 B!n"atin p!nisilin inj 24 juta UI/mL (i.m.)

5& B!tam!tas#n krim $5 m%/%5' B!tam!tas#n tts mata 1 m%/mL

5 Bisak#dil ta salut 5 m%

5 Bisak#dil sup 5 m%

&$ Bisak#dil sup 1$ m%

&1 Bis#pr#l#l ta 25 m%

&2 Bis#pr#l#l ta 5 m%

&3 Bud!s#nid ih 2$$ m%/d#sis

&4 Bud!s#nid s!r ih 1$$ m%/d#sis

&5

&&

&' Coal tar lar 5 %

& Copper T & aps#n ta s#r!d 1$$ m%

'$ !ksam!tas#n inj 5 m%/mL (i.v./i.m.)

'1 !ksam!tas#n ta $5 m%

'2 ia"!pam inj 5 m%/mL (i.v./i.m.)

'3 ia"!pam lar r!ktal 5 m%/25 mL

'4 ia"!pam lar r!ktal 1$ m%/25 mL

'5 ia"!pam ta 2 m%

'& ia"!pam ta 5 m%

'' i!tilkarama"in ta 1$$ m%

' i*!nhidramin inj 1$ m%/mL (i.v./i.m.)

' i%#ksin ta $25 m%

$ iltia"!m ta 3$ m%1 iltia"!m -l ta 3$ m%

2 iltia"!m kaps 1$$ m%

3 iltia"!m kaps 2$$ m%

4 im!nhidrinat ta 5$ m%

5 #ksa"#sin ta 1 m%

& #ksa"#sin ta 2 m%

' #ksisiklin kaps 1$$ m%

#mp!rid#n ta 1$ m%

6pin!*rin (adr!nalin) inj $1 (i.v./s.k./i.m.)

$ 6pin!*rin (adr!nalin) inj 1 m%/mL

1 6r%#kalsi*!r#l (vitamin 2) kaps 5$.$$$ UI

2 6r%#kalsi*!r#l (vitamin 2) susp 1$.$$$ UI/mL3 6r%#tamin ta 1 m%

4 6ritr#misin kaps 25$ m%

5 6ritr#misin sir 2$$ m%/5 mL

& 6tamut#l ta 25$ m%

' 6tamut#l ta 4$$ m%

6tamut#l ta 5$$ m%

6tan#l #t#l '$

1$$ 6til kl#rida s!mpr#t 1$$ mL

1$1 6t#n#%!str!l implan & m%

1$2 6u%!n#l

Bud!s#nid7*#rm#t!r#l (fixed combination)8 ih 1&$/45 m%

Bud!s#nid7*#rm#t!r#l (fixed combination)8 ih $/45 m%


3/56

1$3 9!nit#in :a kaps 5$ m%

1$4 9!nit#in :a kaps 1$$ m%

1$5 9!nit#in :a inj 1$$ m%/2 mL

1$& 9!nit#in :a inj 5$ m%/mL

1$' 9!n#arital ta 3$ m%

1$ 9!n#arital ta 1$$ m%

1$ 9!n#ksim!til p!nisilin (p!nisilin ;) ta 25$ m%

11$ 9!n#ksim!til p!nisilin (p!nisilin ;) ta 5$$ m%111 9!n#ksim!til p!nisilin (p!nisilin ;) s!r inj 3 juta UI/vial (i.m.)

112 9!n#t!r#l hr a!r#s#l 1$$ m%/pu**

113 9!n#t!r#l hr airan ih $1

114 9!rr# *umarat kaps lunak 3$$ m%

115 9!rr# sul*at ta salut 3$$ m%

11& 9!rr# sul*at sir. 15 m%/5 mL

11' 9it#m!nadi#n (vitamin < 1) ta sal 1$ m%

11 9it#m!nadi#n (vitamin < 1) inj 2 m%/mL (i.m.)

11 9lu#r ta $5 m%

12$ 9lu#r kapl 1 m%

121 9lu#r s!diaan t#pikal122 9lu#r!s!in tts mata 25 m%/mL

123 9#rm#kr!s#l

124 9ur#s!mid ta 4$ m%

125 9ur#s!mid inj 1$ m%/mL (i.v./i.m.)

12& Galactose microparticle200-400 mg micropart/mL

12'

12

12

13$

131 =li!nklamid ta 25 m%

132 =li!nklamid ta 5 m%

133 =likla"id tal!t > 3$ m%

134 =likla"id tal!t &$ m%

135 =likla"id tal!t $ m%

13& =lim!pirid ta 1 m%

13' =lim!pirid ta 2 m%

13 =lim!pirid ta 3 m%

13 =lim!pirid ta 4 m%

14$ =lipi"id ta 5 m%

141 =lipi"id ta 1$ m%

142 =lis!ril trinitrat kaps 25 m%143 =lis!ril trinitrat kaps 5 m%

144 =lis!ril trinitrat ta sulin%ual $5 m%

145

14&

14'

14

14

15$

151 al#p!rid#l ta $5 m%

152 al#p!rid#l ta 15 m%

153 al#p!rid#l ta 2 m%

154 al#p!rid#l ta 5 m%155 al#p!rid#l tts 2 m%/mL

15& al#p!rid#l inj 5 m%/mL (i.m.)

15' !patitis B imun#%l#ulin (human) inj $5 mL

15 idr#%!n p!r#ksida #t#l 3

15 idr#%!n p!r#ksida lar. k#ns!ntrat 3

1&$ idr#kl#r#tia"id ta 25 m%

1&1 idr#k#rtis#n s!r inj 1$$ m%/vial

1&2 idr#k#rtis#n krim 25

1&3 idr#ksi kl#r#kuin ta 2$$ m%

=aram #ralit k#minasi + natrium kl#rida $52 % , kalium kl#rida $3$ % ,trinatrium sitrat dihidrat $5 %, %luk#sa anhidrat 2' % s!ruk untuk 2$$ ml air

=lass i#n#m!r AT !Atraumatic estorati"e Treatment#

=lass i#n#m!r AT !Atraumatic estorati"e Treatment#

=lass i#n#m!r AT !Atraumatic estorati"e Treatment# cocoa butter 5 g

=lis!rin tts 1$ m%/mL

=lis!rin tts 1$$ m%/mL

=ris!#*ulvin (microni$ed ) ta 125 m%

=ris!#*ulvin (microni$ed ) ta s#r!d 25$ m%

Gutta perca dan paper points &5 - 40 mm

Gutta perca dan paper points 45 - '0 mm


4/56

1&4 idr#ksi kl#r#kuin ta 4$$ m%

1&5 i#sina utilr#mida ta 1$ m%

1&&

1&'

1&

1& (uman tetanus imunoglobulin in) 250 *+ !i,m,#

1'$ (uman tetanus imunoglobulin in) 500 *+ !i,m,#

1'1 Iupr#*!n ta 2$$ m%

1'2 Iupr#*!n ta 4$$ m%

1'3 Iupr#*!n sir 1$$ m%/5 mL

1'4 Iupr#*!n sir 2$$ m%/5 mL

1'5 Imidapril ta 1$ m%

1'& Imidapril ta 5 m%

1'' Ipratr#pium r#mida ih 2$m%/pu**

1' Ipratr#pium r#mida ih padat 2$ m%

1' Ipratr#pium r#mida n!uli"!r $$25

1$ Ir!sartan ta 15$ m%11 Ir!sartan ta 3$$ m%

12 Is#nia"id ta 1$$ m%

13 Is#nia"id ta 3$$ m%

14 Is#s#rid dinitrat ta 1$ m%

15 Is#s#rid dinitrat ta 5 m%

1&

2$42$5


5/56

22&

22' k#minasi (k#mipak) + art!sunat ta 5$ m% , am#diakuin ta 2$$ m%

22

2223$

231

232

233

234

235

23&

23'23

23

24$

241

242


6/56

2&5 >a%n!sium sul*at inj 4$

2&& >!!nda"#l ta 1$$ m%

2&' >!!nda"#l ta 5$$ m%

2& >!!nda"#l sir 5$ m%/mL

2& >!dr#ksi pr#%!st!r#n as!tat inj d!p# 15$ m%

2'$ >!t!namin mand!lat (h!ksamin mand!lat) ta salut !nt!rik 5$$ m%

2'1 >!t*#rmin ta 5$$ m%2'2 >!t*#rmin ta 5$ m%

2'3 >!tild#pa ta sal 25$ m%

2'4 >!til!r%#m!trin ta salut $125 m%

2'5 >!til!r%#m!trin inj $2 m%/>l

2'& >!tilpr!dnis#l#n ta 1& m%

2'' >!tilpr!dnis#l#n ta 4 m%

2' >!tilpr!dnis#l#n ta m%

2' >!t#kl#pramid ta 5 m%

2$ >!t#kl#pramid ta 1$ m%

21 >!tr#nida"#l ta 25$ m%

22 >!tr#nida"#l ta 5$$ m%

23 >!tr#nida"#l sir 125 m%/5 mL24 >!tr#nida"#l lar in* 5 m%/mL

25 >!tr#nida"#l #vula 5$$ m%

2& >ik#na"#l s!r 2

2' >ik#na"#l krim 2

2 :atrium ikar#nat ta 5$$ m%

2 :atrium dikl#*!nak ta 25 m%

2$ :atrium dikl#*!nak ta 5$ m%

21 :atrium hip#kl#rit #t#l k#ns!ntrat 5

22 :atrium ti#sul*at inj 25 (i.v.)

23 :i*!dipin kaps 1$ m%

24 :i*!dipin ta 2$ m%

25 :i*!dipin ta 3$ m%2& :ik#tinamid ta 5 m%

2' :ik#tinamid ta 2$ m%

2 :ik#tinamid ta 1$$ m%

2 :istatin ta salut 5$$.$$$ UI

3$$ :istatin susp 1$$.$$$ UI/mL

3$1 :istatin ta va%inal 1$$.$$$ UI/ta

3$2 :itr#*urant#in ta 5$ m%

3$3 :#r!pin!*rin inj 1 m%/mL

3$4 @ksi%!n ih %as dlm taun%

3$5 @ksim!ta"#lin tts hidun% $$25

3$& @ksim!ta"#lin tts hidun% $$5$

3$' @ksit#sin inj 1$ UI/mL3$ @l#patadin tts mata $1

3$ @m!pra"#l kaps 2$ m%

31$ @m!pra"#l inj 4$ m%/1$ mL

311 Para*#rmald!hid ta 1 %

312 Paras!tam#l ta 5$$ m%

313 Paras!tam#l sir 12$ m%/5 mL

314 Paras!tam#l tts &$ m%/$& mL

315 Pasta d!vitalisasi (n#n ars!n)

31& Pasta p!n%isi saluran akar

31' P!rak nitrat lar 2$

31 P!rak sul*adia"in krim 1

31 P!rind#prilar%inin ta 5 m%32$ P!rm!trin krim 5

321 Pirant!l pam#at ta s#r!d 125 m%

322 Pirant!l pam#at ta s#r!d 25$ m%

323 Pirant!l pam#at ta 5$$ m%

324 Pirant!l pam#at susp 125 m%/5 mL

325 Pira"inamid ta 5$$ m%

32& Pirid#ksin (vitamin B&) ta 1$ m%

32' Pirid#ksin (vitamin B&) ta 25 m%

32 Pirid#ksin (vitamin B&) inj 1$$ m%/mL

32 P#vid#n i#din lar 1$$ m%/mL


7/56

33$ Pra"ikuant!l ta s#r!d 3$$ m%

331 Pra"ikuant!l ta s#r!d &$$ m%

332 Pr!dnis#n 5 m%

333 Primakuin 15 m%

334 Pr#!n!sid 5$$ m%

335 Pr#kain !n"ilp!nisilin inj 1 juta UI/vial (i.m.)

33& Pr#kain !n"ilp!nisilin s!r inj 3 juta UI/vial (i.m.)

33' Pr#pilti#urasil 1$$ m%33 pr#pran#l#l 1$ m%

33 amipril ta 1$ m%

34$ amipril ta 5 m%

341 amipril ta 25 m%

342 anitidin 15$ m%

343 !tin#l (vitamin A) kaps lunak 1$$.$$$ UI

344 !tin#l (vitamin A) kaps lunak 2$$.$$$ UI

345 i*ampisin 3$$ m%

34& isp!rid#n ta 3 m%

34' isp!rid#n ta sal 1 m%

34 isp!rid#n ta sal 2 m%

34 alutam#l a!r#s#l 1$$ m%35$ alutam#l airan s!r ih 2$$ m%/kaps , r#tahal!r

351 alutam#l sir 2 m%/5 ml

352 alutam#l 2 m%

353 alutam#l 4 m%

354 alutam#l lar ih $5

355 alutam#l #t#l ih $1

35& al!p 274 k#minasi + asam salisilat 2 , !l!ran% !ndap 4

35' !rum antidi*t!ri (A..) i.m 1$.$$$ UI/vial

35 !rum antidi*t!ri (A..) i.m 2$.$$$ UI/vial

35 !rum antirai!s inj 2$$ UI/mL

3&$ !rum antirai!s inj1$$ UI/mL3&1 !rum antit!tanus (A..) inj 15$$ UI/amp (i.m.)

3&2 !rum antit!tanus (A..) inj 1$.$$$ UI/vial (i.m /i.v.)

3&3 !rum antit!tanus (A..) inj 2$.$$$ UI/vial (i.m /i.v.)

3&4 !tiri"in 5 m%/5 mL

3&5 ian#k#alamin (vitamin B12) 5$ m%

3&& ian#k#alamin (vitamin B12) 5$$ m%/mL

3&' imvastatin 1$ m%

3& imvastatin 2$ m%

3& ipr#*l#ksasin 5$$ m%

3'$ pir#n#lakt#n 25 m%

3'1 tr!pt#misin 1$$$ m%/vial

3'2 7urgical ginggi"al pac3'3 !lmisartan ta 4$ m%

3'4 !lmisartan ta $ m%

3'5 !#*ilin ta 1$$ m%

3'& !#*ilin ta 15$ m%

3'' !#*ilin ta 3$$ m%

3' !rutalin ta 25 m%

3' !tanus t#0#id

3$ !trakain $5

31 !trasiklin 25$ m%

32 !trasiklin 5$$ m%

33 iamin (vitamin B1) 5$ m%

34 i#tr#pium s!r ih 1 m% , handihall!r35 i#tr#pium s!r ih 1 m% r!*ill

3& ri*lu#p!ra"in ta sal 5 m%

3' rih!ksi*!nidil 2 m%

3

3 ;aksin B-=

3$ ;aksin ampak

31 ;aksin j!rap di*t!ri t!tanus p!rtusis (P)

32 ;aksin j!rap di*t!ri t!tanus ()

33

34 ;aksin k#minasi P , h!patitis B

u!rkulin protein purified deri"ati"e &&0 !i,,#

;aksin j!rap t!tanus (tetanus adsorbed toxoid )


8/56

35 ;aksin p#li#

3& ;aksin rai!s untuk manusia

3' ;alpr#at sir 25$ m%/5 mL

3 ;alpr#at ta sal 25$ m%

3 ;alpr#at ta sal 5$$ m%

4$$ ;alpr#at ta 5$$ m%

4$1 ;alpr#at ta 25$ m%

4$2 ;alsartan ta 1&$ m%4$3 ;alsartan ta $ m%

4$4 ;!rapamil ta $ m%

4$5 ;!rapamil ta 24$ m%

4$& ;itamin B k#mpl!ks

4$' 8inc &0 mg/mL

4$ 8inc 20 mg

4$ 8inc 20 mg/5 mL

41$ 8inc &0 mg


9/56

TAHUN 2015

SATUAN JUMLAH KEBUTUHAN KETERANGAN

vial

vial

ampul &$$

tal!t

#t#l

tal!t $$

tal!t

tal!t

tal!t

tal!t

vial 1$$

a

tal!t salut 25$$$

tal!t

tal!t

3$$$

tal!t

tal!t 5$$$

#t#l

vial

vial

9ial

9ial

9ial

vial

tal!t kunah

3$$$

#t#l

tu!

supp

kapsul

kapsul

vial

vial

a 1$$$

tal!t

tal!t

k!rtas ?arna p!nanda#klusi


10/56

tal!t

tal!t

tal!t

tal!t 15$$

kapsul

kapsul &$$$

sal!p

larutantal!t

tal!t 2$$

tal!t

tal!t

tal!t

tal!t

vial 25$

#t#l

s!ruk 5$

vial

vial

krim#t#l

ta salut

supp

supp

a

tal!t 5$

B#t#l

B#t#l

B#t#l

B#t#l

#t#l

s!t/uah

vial 2$$

tal!t 3$$$

vial 2$$$

lar r!ktal

lar r!ktal

tal!t &$$$$

tal!t 12$$$

tal!t

vial 15$

tal!t

atal!t


11/56

kapsul

kapsul 25$$$$

ampul

ampul 15$

tal!t 35$$$$

tal!t

tal!t

tal!tvial

B#t#l

B#t#l

kaps. Lunak

tal!t salut

#t#l

ta. alut

vial

tal!t

kapsul

tu!#t#l

#t#l

tal!t

ampul

%!l

sah!t

3$$$

sah!t

#t#l

cocoa butter

tal!t

tal!t 2$$$

tal!t

tal!t

tal!t

tal!t

tal!t

tal!t

tal!t

tal!t

tal!t


12/56

tal!t

tal!t

9ial

9ial

9ial

vial

vial

tal!t

tal!t 13$$

#t#l

#t#l

a

a

B#t#l

pu**

#t#l

aa

tal!t

tal!t

a

tal!t

#t#l

ampul

pasta

tal!t

tal!t

a

atal!t

tal!t 12$$$

tal!t

tal!t 12$$$$

#t#l

tal!t

#t#l


13/56

Pak!t

al!t

al!t salut

al!tPak!t

Pak!t

Pak!t

Pak!t

Pak!t

Pak!t

Pak!t

tal!t 3$$$#t#l

B#t#l

B#t#l

B#t#l

s!t

tal!t

#t#l

tal!t

3$$

tal!t

tal!t

tal!t

tal!t

vial

implan

ampul

ampul 1$$

%!l#t#l

tu!

#t#l

a

a

a

tal!t

#t#l

sah!t

ampul


14/56

ampul

tal!t

tal!t

#t#l

vial

tal!t salut

tal!t 3$$$tal!t

a

tal!t

ampul

a

a '$$

a

tal!t

tal!t

tal!t

tal!t

#t#l#t#l

supp

vial

krim 1$$

tal!t

tal!t

ta 5$ m% 1$$$

#t#l

vial

kapsul

a

atal!t

ta!t

tal!t

tal!t salut

#t#l

supp

tal!t

ampul

#tl

#t#l

#t#l

ampul#t#l

kapsul 3$$$

ampul

tal!t

tal!t &$$$

#t#l

#t#l

tu!

tu!

#t#l

p#t

ap#t

tal!t s#r!

tal!t s#r!

tal!t

#t#l

tal!t

tal!t 5$$$

tal!t

ampul

#t#l 1$$


15/56

tal!t s#r!

tal!t s#r!

tal!t

tal!t

tal!t

vial

vial

tal!ttal!t

a

a

a

tal!t 5$$

kapsul lunak

kaps lunak

kapsul

a

a sal

a sal 45$$$$

B#t#lB#t#l

B#t#l

tal!t

tal!t

#t#l

#t#l

tu!

vial

vial

vial

vialampul

vial

vial

#t#l

tal!t

ampul 5$$

tal!t salut

ta!t salut 2$$$

1$$$

tal!t

vial

pastaa

a

a

a

a

a

vial

#t#l

kapsul

kapsul

tal!t 5$$$

B#t#lB#t#l

a sal 35$$$$

tal!t &5$$$$

ampul

vial

vial

vial

vial

vial

vial

tal!t scored


16/56

#t#l

vial

#t#l

a sal 21$$$

a sal

a

a

aa

a

a

tal!t 3$$$

#t#l

tal!t disp

#t#l

sah!t

KEPALA SATUAN KERJA

(dr. Ni Mad !"#i$i% M.M&

NIP.1'10)10 1'))0* 2 00+


17/56

RENCANA KEBUTUHAN OBAT TAHU

SATUAN KERJA : RUMAH SAKIT JIWA PROVINSI BALI

NO NAMA OBAT

1

2 Adefovir dipivoksil tab 10 mg

3 Air untuk injeksi amp 25 ml

4 Air untuk irigasi lar inf 1000 ml

5 Akarbose tab 100 mg

6 Akarbose tab 50 mg

7 Albendazol susp 200 mg/5 ml

Albendazol tab 400 mg

! Albumin serum normal "#uman albumin$ inj 25%

10 Albumin serum normal "#uman albumin$ inj 20%

11 Albumin serum normal "#uman albumin$ inj 5%12 Alopurinol tab 100 mg

13 Alopurinol tab 300 mg

14 Alprazolam tab 0&25 mg

15 Alprazolam tab 0&5 mg

16 Alprazolam tab 1 mg

17 Alteplase serb inj 50 mg/vial

1 Amfoterisin ' inj 50 mg/10 ml "i(v($

1! Amfoterisin ' salep mata 1%

20 Amfoterisin ' salep mata 3%

21 Amidotrizoat 370 mg/)l

22 Amikasin inj 250 mg/ml

23 Amilorid tab 2&5 mg

24 Amilorid tab 5 mg

25 Aminofilin tab 150 mg

26 Aminofilin inj 24 mg/ml

27 Aminofilin tab 200 mg

2 Amiodaron inj 150 mg/3 ml

2! Amiodaron tab 200 mg

30 Amitriptilin tab sal 25 mg

31 Amlodipin tab 10 mg

32 Amlodipin tab 5 mg

33 Amoksisilin sir forte 250 mg/5 ml

34 Amoksisilin sir kering 125 mg/5 ml

35 Amoksisilin tab 250 mg

36 Amoksisilin tab 500 mg

37 Ampisilin serb inj 1000 mg/vial

3 Ampisilin serb inj 250 mg/vial

153*+m*,-.) "ethylenediamine tetramethylene phosphonic acid $ 44 mg a/a,-.)& 5*46 g samarium& dan 150 15 mb samarium 153 per ml


18/56

3!

40

41

42 Anastrozol tab 1 mg

43

44

Antasida& kombinasi aluminium #idroksida 200 mg magnesium #idroksida 200 mg

45

Antasida& kombinasi aluminium #idroksida 200 mg magnesium #idroksida 200 mg

46

Antibakteri& kombinasi basitrasin 500 8/g olimiskin ' 10(000 8/g

47

4

4! Antimalaria kombinasi sulfadoksin 500 mg primetamin 25 mg

50 Artemet#er inj 0 mg/ml

51 Artesunat serb inj 60 mg/ml "i(v(/i(m($

52 Articulating paper kertas warna penanda oklusi

53 Asam asetilsalisilat "asetosal$ tab 100 mg54 Asam asetilsalisilat "asetosal$ tab 0 mg

55 Asam askorbat "vitamin $ tab 250 mg

56 Asam askorbat "vitamin $ tab 50 mg

57 Asam folat tab 0&4 mg

5 Asam folat tab 1 mg

5! Asam folat tab 5 mg

60 Asam ibandronat inj 6 mg/6 ml

61 Asam mefenamat kaps 250 mg

62Asam mefenamat kaps 500 mg

63 Asam pipemidat kaps 400 mg

64 Asam retinoat krim 0&1%

65 Asam salisilat lar 0&1%

66 Asam salisilat salep 10%



6! Asam traneksamat inj 100 mg/ml

70 Asam traneksamat inj 50 mg/ml

71 Asam traneksamat tab 500 mg

72 Asam ursodeoksikolat kaps 250 mg

73 Asam zoledronat inj 4 mg/5 ml

74 Asetazolamid tab 250 mg

75 Asiklovir salep mata 3%

76 Asiklovir tab 200 mg

77 Asiklovir tab 400 mg

7 Asparaginase serb inj 10(000 8/vial

7! Atapulgit

0 Atenolol tab 50 mg "sbg anti angina$

Analog insulin rapid a9ting "inj 100 8/ml "kemasan vial& 9artridge disposible& penfill9artridge$

Analog insulin long a9ting "inj 100 8/ml "kemasan vial& 9artridge disposible& penfill9artridge$

Analog insulin mi: insulin "inj 100 8/ml "kemasan vial& 9artridge disposible& penfill9artridge$

Anestetik lokal gigi kombinasi lidokain #9l 2% epinefrin 1 0(000 inj 2 ml

Antifungi& kombinasi asam benzoat 65 asam salisilat 3%

Anti#emoroid& kombinasi bismut subgalat 150 mg #eksaklorofen 2&5 mg lidokainlidokain 10 mg seng oksida 120 mg sup ad 2 g


19/56

1 Atenolol tab 100 mg

2 Atenolol tab 50 mg "sbg anti #ipertensi$

3 Atrakurium inj 25 mg/2&5 ml

4 Atropin inj 0&25 mg/ml "i(m(/i(v(/s(k$

5 Atropin inj 1 mg/ml "i(m(/i(v(/s(k$

6 Atropin tab 0&5 mg

7 Atropin tts mata 0&5%

Atropin tts mata 1%

! Azatioprin tab 50 mg

!0 Azitromisin sir kering 200 mg/5 ml

!1 Azitromisin tab 250 mg

!2 Azitromisin tab 500 mg

!3 'a#an tumpatan sementara lar& serb

!4 'arium sulfat serb !2 g/100 ml

!5 'arium sulfat susp 2&2%

!6 'arium sulfat susp 55%

!7 'arium sulfat susp 65%

! 'edak salisil serb 2%

!! 'enzatin penisilin inj 2&4 juta 8/ml "i(m($

100 'enzatin penisilin inj 1&2 juta 8/ml "i(m($

101 'era9tant susp 25 mg/ml "intratekal$

102 'eraprost sodium tab 20 m9g

103 'etametason tts mata 1 mg/ml

104 'etametason krim 0&1%

105 'etametason krim 0&5 mg/g106 'etametason salep 0&1%

107 'evasizumab inj 25 mg/ml

10 'ikalutamid tab sal 150 mg

10! 'ikalutamid tab sal 50 mg

110 'isakodil sup 10 mg

111 'isakodil sup 5 mg

112 'isakodil tab sal 5 mg

113 'isoprolol tab 2&5 mg

114'isoprolol tab 5 mg

115 'leomisin serb inj 15 mg/ml

116 'romokriptin tab 2&5 mg

117 'udesonid 9airan i# 0&25mg/ml

11 'udesonid i# 200 m9g/dosis

11! 'udesonid serb i# 100 m9g/dosis

120

121

122

123 'upivakain inj 5 mg/ml "p(v($

124 'usulfan tab salut 2 mg

125 Coal tar lar 5 %

126 -abigatran eteksilat kaps 110 mg

127 -abigatran eteksilat kaps 75 mg

12 -akarbazin serb inj 100 mg/vial

12! -akarbazin serb inj 200 mg/vial

130 -aktinomisin inj 0&5 mg/vial "i(v($

131 -apson tab s9ored 100 mg

132 -aunorubisin serb inj 20 mg/vial

'udesonid*formoterol "fixed combination$; i# 160/4&5 m9g

'udesonid*formoterol "fixed combination$; i# 0/4&5 m9g

'upivakain heavy inj 5 mg/ml (hcl ! glukosa "%


20/56

133 -eferasiroks tab disp 250 mg

134 -eferasiroks tab disp 500 mg

135 -eferipron lar oral 100 mg/ml

136 -eferipron tab sal 500 mg

137 -eferoksamin mesilat serb inj 500 mg/vial

13 -eksametason tab 0&5 mg

13! -eksametason tab 4 mg

140 -eksametason inj 5 mg/ml "i(v(/i(m($

141 -esmopresin tab 0&1 mg

142 -esmopresin tab 0&2 mg

143 -esogestrel tab 75 m9g

144 -esoksimetason gel 0&05%

145 -esoksimetason krim 0&25%

146 -esoksimetason salep 0&25%

147 -ialisa peritoneal lar intraperitonial

14 -iazepam inj 5 mg/ml "i(v(/i(m($

14! -iazepam lar rektal 10 mg/2&5 ml

150 -iazepam lar rektal 5 mg/2&5 ml

151 -iazepam tab 2 mg

152 -iazepam tab 5 mg

153 -ietilkarbamazin tab 100 mg

154 -ifen#idramin inj 10 mg/ml "i(v(/i(m($

155 -iflukortolon valerat salep berlemak 0&1%

156 -igoksin inj 0&25 mg/ml

157 -igoksin tab 0&25 mg

15 -iltiazem #9l inj 5 mg/5 ml

15! -iltiazem #9l tab 30 mg

160 -iltiazem inj 25 mg/5 ml

161 -iltiazem kaps +< 100 mg

162 -iltiazem kaps +< 200 mg

163 -iltiazem serb inj 10 mg/10 ml

164 -iltiazem serb inj 50 mg/vial

165 -iltiazem tab 30 mg

166 -imen#idrinat tab 50 mg167 -inatrium edetat tts mata 0&35%

16 -inatrium klodronat infus kons 60 mg/ml

16!

170 -obutamin inj 12&5 mg/ml

171 -obutamin inj 25 mg/ml

172 -obutamin inj 50 mg/ml

173 -oksazosin mesilat tab 1 mg

174 -oksazosin mesilat tab 2 mg

175 -oksazosin tab 1 mg

176 -oksazosin tab 2 mg

177 -oksisiklin kaps 100 mg

17 -oksisiklin kaps 50 mg

17! -oksorubisin serb inj 10 mg/vial "i(v($

10 -oksorubisin serb inj 50 mg/vial

11 -omperidon susp 5 mg/5 ml

12 -omperidon tab 10 mg

-)+A "dimercapto succinic acid $ 1&1 mg meso*2& 3*dimer9aptosu99ini9 a9id/vial


21/56

13 -omperidon tts 5 mg/ml

14 -opamin inj 40 mg/ml

15 -osetaksel inj 20 mg/0&5 ml

16 -osetaksel inj 0 mg/2 ml

17

1 -utasterid kaps 0&5 mg

1! ,favirens tab sal 600 mg

1!0 ,fedrin inj 50 mg/ml

1!1 ,ksemestan tab 25 mg

1!2 ,noksaparin sodium inj 20 mg/0&2 ml



1!5 ,pinefrin "adrenalin$ inj 0&1% "i(v(/s(k(/i(m($

1!6 ,pinefrin "adrenalin$ inj 1 mg/ml

1!7 ,pirubisin serb inj 10 mg/5 ml

1! ,pirubisin serb inj 50 mg/25 ml

1!! ,rgokalsiferol "vitamin -2$ kaps 50(000 8

200 ,rgokalsiferol "vitamin -2$ susp 10(000 8/ml

201 ,rgotamin tab 1 mg

202 ,ritromisin kaps 250 mg

203 ,ritromisin sir 200 mg/5 ml

204 ,ritromisin tab 500 mg

205 ,ritropoetin*alfa inj 10(000 8/ml



20 ,ritropoetin*beta inj 2000 8/0&3 ml

20! ,strogen terkonjugasi tab sal 0&3 mg

210 ,strogen terkonjugasi tab sal 0&625 mg

211 ,tambutol tab 250 mg



214 ,tanol 70% 9airan 70%

215 ,til klorida semprot 100 ml216 ,tinilestradiol tab 0&05 mg

217 ,tinilestradiol tab 0&5 mg

21 ,toposid inj 20 mg/ml

21! ,toposid kaps 100 mg

220 ,ugenol

221 ,verolimus tab 0&25 mg

222 ,verolimus tab 0&5 mg

223 =aktor 8> kompleks serb inj 1(000 8/vial pelarut 25 ml

224 =aktor 8> kompleks serb inj 500 8/vial pelarut

225

226=aktor viia "rekombinan$ serb inj 1 mg/vial pelarut untuk injeksi

227 =aktor ?888 "konsentrat$ serb inj 230 *340 8

22 =aktor ?888 "konsentrat$ serb inj 250 8/vial pelarut 5 ml

22! =aktor ?888 "konsentrat$ serb inj 40 * 600 8

-.A "diethylene triamine pentaacetic acid $ 2&06*2&5 mg pentetate 9al9ium trisodium/ml

=aktor koagulasi 88 14*35 8& faktor koagulasi ?88 7*20 8& faktor koagulasi 8> 25 8& faktorkoagulasi > 14*35 serb inj 500 8/10 ml 8


22/56

230 =aktor ?888 "konsentrat$ serb inj 500 8/vial pelarut 5 ml

231 =enitoin a inj 100 mg/2 ml

232 =enitoin a inj 50 mg/ml

233 =enitoin a kaps 100 mg

234 =enitoin a kaps 50 mg

235 =enobarbital inj 50 mg/ml

236 =enobarbital tab 100 mg

237 =enobarbital tab 30 mg

23 =enofibrat kaps 100 mg

23! =enofibrat kaps 300 mg

240 =enoksimetil penisilin "penisilin ?$ tab 125 mg



243 =enoterol #br aerosol 100 m9g/puff

244 =enoterol #br 9airan i# 0&1%

245 =entanil inj 0&05 mg/ml "i(v($

246 =entanil pat9# 12&5 m9g/jam

247 =entanil pat9# 25 m9g/jam

24 =entanil pat9# 50 m9g/jam

24! =erro fumarat kaps lunak 300 mg

250 =erro sulfat sir( 15 mg/5 ml

251 =erro sulfat tab salut 300 mg

252 =ilgrastim inj 300 m9g/ml

253 =inasterid tab 5 mg

254 =itomenadion "vitamin @ 1$ inj 2 mg/ml "i(m($

255 =itomenadion "vitamin @ 1$ tab sal 10 mg

256 =ludarabin inj 50 mg/vial

257 =ludarabin tab sal 10 mg

25 =lufenazin inj 25 mg/ml "i(m($

25! =lukonazol inj 2 mg/ml

260 =lukonazol kaps 150 mg

261 =lukonazol kaps 50 mg

262 =luoksetin kaps 10 mg

263 =luoksetin kaps 20 mg264 =luor sediaan topikal

265 =luor tab 0&5 mg

266 =luor kapl 1 mg

267 =luoresein tts mata 2&5 mg/ml

26

26! =luorometolon tts mata 0&1%

270 =luorourasil inj 250 mg/ml

271 =luorourasil inj 50 mg/ml "i(v($

272 =luorourasil serb inj 250 mg

273 =lusinolon asetonid krim 0&025%

274 =lusinolon asetonid salep 0&025%

275 =lutikason furoat intranasal spra

276 =lutikason propionat 9airan i# 0&5 mg/dosis

277 =ondaparinuks inj 2&5 mg/0&5 ml

27 =ormalde#id serb lar buffer 10%

27! =ormalde#id serb tab 1 g

20 =ormokresol

#luoro deoxy glucose "=-B$


23/56

21 =raksi protein plasma lar inf 5%

22 =urosemid inj 10 mg/ml "i(v(/i(m($

23 =urosemid tab 40 mg

24 Badobutrol ma9ro99li9

25 Badodiamid inj 27 mg/10 ml

26 Badoksetat disodium 0&25 mmol gadoksetat disodium/ml

27 $alactose microparticle &&'&& mg micropart/ml

2 Bansiklovir serb inj 500 mg/vial

2!

2!0 Befitinib tab 250 mg

2!1 Bemfibrozil kaps 300 mg

2!2 Bemfibrozil kaps 600 mg

2!3 Bemsitabin inj 1000 mg/vial

2!4 Bemsitabin inj 200 mg/vial

2!5 Bentamisin inj 10 mg/ml



2! Bentamisin salep mata 0&3%

2!! Bentamisin tts mata 0&3%

300

301

302

303 Blibenklamid tab 2&5 mg

304 Blibenklamid tab 5 mg

305 Bliklazid tab 0 mg

306 Bliklazid tab )< 30 mg

307 Bliklazid tab +< 60 mg

30 Blikuidon tab 30 mg

30! Blimepirid tab 1 mg

310 Blimepirid tab 2 mg

311 Blimepirid tab 3 mg

312 Blimepirid tab 4 mg313 Blipizid tab 10 mg

314 Blipizid tab 5 mg

315 Bliseril trinitrat inj 10 mg/ml

316 Bliseril trinitrat inj 50 mg/ml

317 Bliseril trinitrat kaps +< 2&5 mg

31 Bliseril trinitrat kaps +< 5 mg

31! Bliseril trinitrat tab sublingual 0&5 mg

320 Bliserin lar 50%

321

322

323 Boserelin asetat inj 10& mg/vial

324 Boserelin asetat inj 3&6 mg/vial

325

326

327

32

32!

Baram oralit kombinasi natrium klorida 0&52 g kalium klorida 0&30 g trinatrium sitrat0&5 g glukosa an#idrat 2&7 g

Blass ionomer A)* (Atraumatic )estorative *reatment cocoa butter 5 g

Blass ionomer A)* (Atraumatic )estorative *reatment lar

Blass ionomer A)* (Atraumatic )estorative *reatment serb

Bliserin tts 10 mg/ml

Bliserin tts 100 mg/ml

Briseofulvin "microni+ed $ tab 125 mg

Briseofulvin "microni+ed $ tab 500 mg

Briseofulvin "microni+ed $ tab s9ored 250 mg

$utta percha dan paper points ,5 ' & mm

$utta percha dan paper points 5 ' "& mm


24/56

330 Caloperidol inj 5 mg/ml "i(m($

331 Caloperidol inj 50 mg/ml

332 Caloperidol tab 0&5 mg

333 Caloperidol tab 1&5 mg

334 Caloperidol tab 2 mg

335 Caloperidol tab 5 mg

336 Caloperidol tts 2 mg/ml

337 Calotan i#

33 Cemodialisa lar konsentrat basis asetat

33! Cemodialisa lar konsentrat basis natrium bikarbonat

340 Ceparin& a inj 5(000 8/ml "i(v(/s(k($

341 Cepatitis ' imunoglobulin "#uman$ inj 0&5 ml

342 Cidro klorokuin tab 150 mg

343 Cidro klorokuin tab 250 mg

344 Cidrogen peroksida 9airan 3%

345 Cidrogen peroksida lar( @onsentrat 3%

346 Cidroklorotiazid tab 12&5 mg

347 Cidroklorotiazid tab 25 mg

34 Cidrokortison inj 100 mg/vial

34! Cidrokortison krim 1%

350 Cidrokortison krim 2&5%

351 Cidrokortison serb inj 100 mg/vial

352 Cidrokortison tab 10 mg

353 Cidroksi progesteron inj 125 mg/ml

354 Cidroksi urea tab 500 mg

355 -idroxyl ethyl starch lar inf .%

356 Ciosina butilbromida inj 20 mg/ml

357 Ciosina butilbromida tab 10 mg

35 Comatropin tts mata 2%

35!

360

361

362 -uman tetanus imunoglobulin inj 5& 0 (i1m1

363 -uman tetanus imunoglobulin inj 5&& 0 (i1m1

364 8buprofen sir 100 mg/5 ml

365 8buprofen sir 200 mg/5 ml

366 8buprofen tab 200 mg

367 8buprofen tab 400 mg

36 8fosfamid serb inj 1000 mg/vial

36! 8fosfamid serb inj 500 mg/vial

370 8matinib mesilat tab 100 mg

371 8midapril tab 10 mg

372 8midapril tab 5 mg

373 8nterferon alfa inj 1 miu

374 8odiksanol vial 320 mg 8odium/50 ml

375 8odium 131

376

377 8o#eksol 10*300 mg 8odium/ml

37 8o#eksol 240*350 mg 8odium/ml

Cuman insulin intermediate a9ting inj 100 8/ml "kemasan vial/ 9artridge disposible&penfill 9artridge$

Cuman insulin mi: insulin inj 100 8/ml "kemasan vial& 9artridge disposible& penfill9artridge$

Cuman insulin s#ort a9ting inj 100 8/ml "kemasan vial& 9artridge disposible& penfill9artridge$

0odohippurate sodium 8 132 37*74 mb/ multiple*dose


25/56

37! 8o#eksol inj 140*350 mg 8odium/ml

30 8opamidol 200*300 mg 8odium/ml

31 8opamidol 300*370 mg 8odium/ml

32 8opamidol inj 200*370 mg 8odium/ml

33 8opromid 240 *370 mg 8odium/ml

34 8opromid 300*370 mg 8odium/ml

35 8pratropium bromida i# 20m9g/puff

36 8pratropium bromida i# padat 20 m9g

37 8pratropium bromida nebulizer 0&025%

3 8rbesartan tab 150 mg

3! 8rbesartan tab 300 mg

3!0 8rinotekan inf 20 mg/ml

3!1 8rinotekan inj 20 mg/ml

3!2 8sofluran i#

3!3 8soniazid tab 100 mg

3!4 8soniazid tab 300 mg

3!5 8sosorbid dinitrat inj 10 mg/10 ml

3!6 8sosorbid dinitrat tab 10 mg

3!7 8sosorbid dinitrat tab 5 mg

3! @alamin

3!! @alium aspartat tab 300 mg

400 @alium klorida tab siap larut 300 mg

401 @alium klorida tab +< 600 mg

402 @alsium folinat "leukovorin& a$ inj 3 mg/ml

403 @alsium folinat "leukovorin& a$ inj 50 mg/ml

404 @alsium folinat "leukovorin& a$ tab 15 mg

405 @alsium glukonat inj 100 mg/ml "Dbat untuk .C.$

406

@alsium glukonat inj 100 mg/ml "Antidot k#usus dan obat untuk kera9unan$

407 @alsium #idroksida bubuk& pasta

40 @alsium karbonat tab 500 mg

40! @alsium laktat "kalk$ tab 500 mg

410 @alsium polistirena sulfonat ktg 5 g

411 @anamisin inj 1(000 mg/ vial412 @andesartan tab 16 mg

413 @andesartan tab mg

414 @apesitabin tab sal 500 mg

415 @aptopril tab 12&5 mg

416 @aptopril tab 25 mg

417 @aptopril tab 50 mg

41 @arbamazepin sir 100 mg/5 ml

41! @arbamazepin tab 200 mg

420 @arbimazol tab 5 mg

421 @arbo adsorben tab 0&5 g

422 @arbogliserin tts telinga 10 %

423 @arboksimetilselulosa tts mata

424 @arboplatin inj 150 mg/15 ml



427 @arvediol kaps 6&25 mg

42 @etamin iinj 100 mg/ml "i(v($


26/56

42! @etamin inj 50 mg/ml "i(v($

430 @etokonazol tab 200 mg

431 @etokonazol krim 2%

432 @etokonazol s9alp sol 2%

433 @etoprofen sup 100 mg

434 @etorolak inj 30 mg/ml

435 @laritromisin tab 500 mg

436 @lindamisin kaps 150 mg

437 @lindamisin kaps 300 mg

43 @lobazam tab 10 mg

43! @lomifen sitrat tab 50 mg

440 @lomipramin tab 25

441 @lonidin inj 150 m9g/ml

442 @lonidin tab 0&15 mg

443 @lopidogrel tab 75 mg

444 @loral #idrat lar

445 @lorambusil tab 2 mg

446 @loramfenikol tts mata 0&5%

447 @loramfenikol tts mata 1%

44 @loramfenikol kaps 250 mg

44! @loramfenikol kaps 500 mg

450 @loramfenikol salep kulit 2%

451 @loramfenikol salep mata 1%

452 @loramfenikol serb inj 1(000 mg/ml

453 @loramfenikol susp 125 mg/5 ml

454 @lorfeniramin tab 4 mg

455 @lorfenol kamfer mentol "C@)$

456 @lor#eksidin lar 0&2%

457 @lor#eksidin lar 15%

45 @lorpromazin inj 25 mg/ml "i(m($

45! @lorpromazin inj 5 mg/ml "i(m($

460 @lorpromazin tab 25 mg "sbg anti emetik$

461 @lorpromazin tab sal 100 mg

462 @lorpromazin tab sal 25 mg "sbg antipsikosis$463 @lortalidon tab 50 mg

464 @lotrimazol tab vagina 100 mg

465 @lozapin tab 100 mg

466 @lozapin tab 25 mg

467 @odein tab 10 mg

46 @odein tab 15 mg

46! @odein tab 20 mg

470 @olekalsiferol "vitamin -3$ kaps lunak 0&25 m9g

471 @olekalsiferol "vitamin -3$ kaps lunak 0&5 m9g

472 @olestiramin serb& 4 g

473 @olkisin tab 500 m9g

474 @oloid C,+ ') 130 000 lar inf 6%

475

476

2ombinasi untuk anak 3 4aduan dalam bentuk dosis tetap (2*/#C rifampisin kapl 65! isonia+id tab 5& mg

.ombinasi untu ana aduan dalam bentu dosis tetap !.1T/1C#ifampisin aplet 35 mg isonia$id tablet 50 mg pira$inamid tablet &50 mg


27/56

477

47

47!

@ombinasi "kombipak$ artesunat tab 50 mg amodiakuin tab 200

40

@ombinasi levodopa 100 mg@arbidopa 25 mg entekapon 200 mg

41

42 @ombinasi zidovudin 300 mg lamivudin 150 mg

43

44 @ombinasi ergotamin 1 mg kafein 50 mg

45

46

47

@ombinasi ipratropium bromida 0&5 mg salbutamol 2&5 mg nebul

4

@ombinasi ipratropium bromida 0&5 mg salbutamol 2&5 mg solution 0&025%

4!

@ombinasi medroksi progesteron asetat estradiol sipionat inj depot 25 mg 5 mg

4!0

4!1

4!2

4!3

4!4

4!5

4!6

4!7 @ombinasi parafin gliserin fenolftalein

4!

4!! @omposit resin

500

501

502

503 @uinin inj 25% "i(v($

504 @uinin tab 200 mg



507 Eaktulosa sir 3&335 g/5 ml

50 Eamivudin tab 100 mg

50! Eamivudin "3.$ tab 150 mg

2ombinasi untuk dewasa3 4aduan dalam bentuk dosis tetap (2*/#C rifamisin kapls,5& mg ! isonia+id tab ,5& mg

2ombinasi untuk dewasa3 4aduan dalam bentuk dosis tetap (2*/#C rifamisin kapl,5& mg ! isonia+id tab 65 mg ! pira+inamid tab && mg! etambutol tab 65 mg

@ombinasi levonorgestrel 150 m9g etinilestradiol 30 m9g

@ombinasi artemet#er 20 mg lumefantrin 120 mg

@ombinasi ferro sulfat 200 mg asam folat 0&25 mg

@ombinasi ferro sulfat 200 mg as( =olat 0&25 mg

@ombinasi ipratropium 'r 0&5 mg salbutamol 2&5 mg nebules

@ombinasi salmeterol 25 m9g flutikason propionat 50 m9g i# 50 m9g/puff



@ombinasi kaolin 550 mg pektin 20 mg

@ombinasi lopinavir 200 mg ritonavir "E?$ 50 mg& tab 250 mg

@ombinasi natrium klorida &664 mg kalium klorida 1&32 mg

@ombinasi spironolakton 25 mg tiabutazin 2&5 mg

@otrimoksazol "deFasa$ kombinasi sulfametoksazol 400 mg trimetoprim 0 mg

@otrimoksazol "deFasa$ kombinasi sulfametoksazol 00 mg trimetoprim 160 mg

@otrimoksazol "deFasa$ kombinasi tiap 5 ml suspensi sulfametoksazol 200 mg

trimetoprim 40 mg


28/56

510 Eansoprazol inj 30 mg/ml

511 Eansoprazol kaps 30 mg

512 Eapatinib tab 250 mg

513


29/56

560

561 )agnesium sulfat inj 20%

562 )agnesium sulfat inj 40%

563 )agnesium sulfat serb& ktg 30 g

564 )anitol lar inf 20% "sbg diuretik$

565 )anitol lar infus 20% "sbg terapi parenteral$

566 )aprotilin #9l tab sal 25 mg

567 )aprotilin #9l tab sal 50 mg

56

56! )ebendazol sir 50 mg/ml

570 )ebendazol tab 100 mg

571 )ebendazol tab 500 mg

572 )edroksi progesteron asetat inj 200 mg/ml

573 )edroksi progesteron asetat inj depo 150 mg

574 )edroksi progesteron asetat tab 10 mg





57! )elfalan tab 2 mg

50 )erkaptopurin tab 50 mg

51 )eropenem serb inj 1000 mg/vial

52 )eropenem serb inj 500 mg/vial

53 )esalazin tab sal 250 mg

54 )esna inj 100 mg/ml

55 )etadon sir 50 mg/5 ml

56

)etenamin mandelat "#eksamin mandelat$ tab salut enterik 500 mg

57 )etformin tab 500 mg

5 )etformin tab 50 mg

5! )etildopa tab sal 250 mg

5!0 )etilergometrin inj 0&2 mg/ml

5!1 )etilergometrin tab salut 0&125 mg5!2 )etilfenidat tab +< 10 mg

5!3 )etilfenidat tab +< 20 mg

5!4 )etilprednisolon inj 125 mg/2 ml "sbg kortikosteroid$

5!5

)etilprednisolon inj 125 mg/vial "obat untuk saluran napas antiasma$

5!6 )etilprednisolon inj 500 mg/ ml

5!7 )etilprednisolon tab 16 mg

5! )etilprednisolon tab 4 mg

5!! )etilprednisolon tab mg

600 )etoklopramid tab 5 mg

601 )etoklopramid drop botol 10 ml

602 )etoklopramid inj 5 mg/ml

603 )etoklopramid sir 5 mg/5 ml

604 )etoklopramid tab 10 mg

605 )etotreksat serb inj 5 mg/vial

606 )etotreksat serb inj 50 mg/2 ml

607 )etotreksat tab 2&5 mg

)AB3 "mercapto acetyl tri glysine$ 1 mg betiatide/vial

)- "methylene diphosphonate$ 1 mg met#lene dip#osp#oni9 a9id/ml


30/56

60 )etronidazol lar inf 5 mg/ml "sbg antibakteri$

60!)etronidazol lar infus 5 mg/ml "sbg anti amuba dan anti gardiasis$

610 )etronidazol ovula 500 mg

611 )etronidazol sir 125 mg/5 )l

612 )etronidazol sup 500 mg

613 )etronidazol tab 250 mg

614 )etronidazol tab 500 mg

615

616

617 )idazolam inj 1 mg/ml "i(v($

61 )idazolam inj 5 mg/ml "i(v($

61! )ikafungin a serb inj 50 mg/vial

620 )ikofenolat mofetil tab 500 mg

621 )ikonazol krim 2%

622 )ikonazol serb 2%

623

624

625

626 )oksifloksasin tts mata 0&5%

627 )ometason furoat krim 0&1%

62 )orfin C9l inj 10 mg/ml "i(m(/s(k(/i(v($

62! )orfin C9l tab 10 mg

630 )orfin C9l tab +< 10 mg



633 adroparin inj 10 mg/ml

634 adroparin inj !(500 A:a/ml sringe 0&3 )l

635 adroparin inj !(500 A:a/ml& sringe 0&4 ml

636 adroparin inj !(500 A:a/ml& sringe 0&6 ml

637 alokson inj 0&4 mg/ml

63 *asetil sistein i# 100 mg/ml

63! *asetil sistein kaps 200 mg640 atamisin tts mata 5%

641 atamisin tts mata 50 mg/ml

642 atrium amino#ipurat inj 200 mg/ml "i(v($

643 atrium bikarbonat Cig# alert medi9ine(

644 atrium bikarbonat inj &4% "i(v($

645 atrium bikarbonat tab 500 mg

646 atrium diklofenak tab 25 mg

647 atrium diklofenak tab 50 mg

64 atrium fluoresein tts mata 2%

64! atrium fosfat btl& 133 ml

650 atrium fosfat lar oral 45 ml

651 atrium fusidat krim 20 mg/g

652 atrium fusidat salep 20 mg/g

653 atrium #ipoklorit 9airan konsentrat 5%

654 atrium tiosulfat inj 25% "i(v($

655 eostigmin inj 0&5 mg/ml

656 evirapin tab 200 g

)8'B "meta'iodoben+ylguanidine$ o9treotide a9etate 0&05 * 6 mg/ml

)8'8 "metoxy iso butyl isonitril $ 5*ml rea9tion vial

)itomisin "crystallin$ inj 2 mg/ml

)itomisin "crystallin$ serb inj 10 mg/vial

8odified fluid gelatine ') 30 000 lar inf 4%


31/56

657 ifedipin kaps 10 mg

65 ifedipin tab +< 20 mg

65! ifedipin tab +< 30 mg

660 ikardipin inj 10 mg/vial

661 ikotinamid tab 100 mg



664 ilotinib tab 200 mg

665 istatin susp 100(000 8/ml

666 istatin tab salut 500(000 8

667 istatin tab vaginal 100(000 8

66 itrofurantoin tab 50 mg

66! itrogen oksida i#& gas dlm tabung

670 orepinefrin inj 1 mg/ml

671 oretisteron tab 5 mg

672 Dfloksasin tab 200 mg

673 Dfloksasin tab 400 mg

674 Dfloksasin tts telinga 3%

675 Dksaliplatin serb inj 100 mg/vial

676 Dksaliplatin serb inj 50 mg/vial

677 Dksigen i#& gas dlm tabung

67 Dksimetazolin tts #idung 0&025%

67! Dksimetazolin tts #idung 0&050%

60 Dksitetrasiklin #9l inj 250 mg/3 ml "i(m($

61 Dksitetrasiklin #9l inj 50 mg/ml "i(m($

62 Dksitetrasiklin #9l inj 500 mg/ml

63 Dksitosin inj 10 8/ml

64 Dktreotid inj 10 mg/ml

65 Dlanzapin inj 10 mg/2 ml

66 Dlanzapin tab sal 10 mg

67 Dlanzapin tab sal 5 mg

6 Dlopatadin tts mata 0&1%

6! Dmeprazol inj 40 mg/10 ml

6!0 Dmeprazol kaps 20 mg6!1 Dndansetron inj 2 mg/ml

6!2 Dndansetron tab 4 mg

6!3 Dndansetron tab mg

6!4 aklitaksel inj 100 mg/vial



6!7 arasetamol drips "infus$ 1000 mg/100 ml

6! arasetamol sir 120 mg/5 ml

6!! arasetamol tab 500 mg

700 arasetamol tts 60 mg/0&6 ml

701 asta devitalisasi "non arsen$

702 asta pengisi saluran akar "pasta$

703 eglated interferon alfa*2a inj 135 m9g/0&5 ml

704 eglated interferon alfa*2a inj 10 m9g/0&5 ml

705 eglated interferon alfa*2b serb inj 100 m9g/ml




32/56


70!

710 erak nitrat lar 20%

711 erak sulfadiazin krim 2 %

712 erak sulfadiazin krim 1%

713 erindoprilarginin tab 5 mg

714 ermetrin krim 5 %

715 etidin inj 50 mg/ml "i(m(/s(k(/i(v($

716 ilokarpin tts mata 2%

717 ioglitazon tab 15 mg

71 ioglitazon tab 30 mg

71! irantel pamoat susp 125 mg/5 ml

720 irantel pamoat tab 500 mg

721 irantel pamoat tab s9ored 125 mg

722 irantel pamoat tab s9ored 250 mg

723 irazinamid tab 500 mg

724 iridoksin "vitamin '6$ inj 100 mg/ml

725 iridoksin "vitamin '6$ tab 10 mg

726 iridoksin "vitamin '6$ tab 25 mg

727 iridostigmin tab sal 60 mg

72 odofilin tingtur 25 %

72! olietilen glikol

730 olikresulen

731 ovidon iodin lar 100 mg/ml

732 ramipeksol tab ,< 0&375 mg

733 ramipeksol tab ,< 0&750 mg

734 ravastatin tab 10 mg

735 ravastatin tab 20 mg

736

737 razikuantel tab s9ored 300 mg73 razikuantel tab s9ored 600 mg "sbg Antelmintik intestinal$

73! rednisolon tts mata 10 mg/ml

740 rednison tab 5 mg

741 rimakuin tab 15 mg

742 robenesid tab 500 mg

743 rokain benzilpenisilin serb inj 1 juta 8/vial "i(m($

744 rokain benzilpenisilin serb inj 3 juta 8/vial "i(m($

745 ropiltiourasil tab 100 mg

746 ropofol inj 1% "i(v( 'olus$

747 ropranolol inj 1 mg/ml "i(v($

74 ropranolol tab 10 mg

74! ropranolol tab 40 mg

750 rotamin sulfat inj 10 mg/ml "i(m($

751 Guetiapin tab +< 200 mg



754


33/56

755


34/56

05 +efuroksim tab sal 500 mg

06 +ertralin tab sal 50 mg

07+erum anti bisa ular A('(( 8 "k#usus ular dari luar $ inj "i(m(/i(v($ apua

0+erum anti bisa ular A('((88 "k#usus ular dari apua$ inj "i(m(/i(v($

0! +erum antidifteri "A(-(+$ inj " i(m(/i(v($ 8nj i(m 10(000 8/

10 +erum antidifteri "A(-(+$ inj " i(m(/i(v($ 8nj i(m 20(000 8/

11 +erum antirabies inj 100 8/ml

12 +erum antirabies inj 200 8/ml

13 +erum antitetanus "A(.(+$ "i(m($ 8nj 10(000 8/vial "i(m /i(v($

14 +erum antitetanus "A(.(+$ inj 1500 8/amp "i(m($

15 +erum antitetanus "A(.(+$ inj 20(000 8/vial "i(m /i(v($

16 +etirizin sir 5 mg/5 ml1(

17 +etirizin tab 10 mg

1 +etuksimab inj 5 mg/ml

1! +evofluran 9airan i# 250 ml

20 +ianokobalamin "vitamin '12$ inj 500 m9g/ml

21 +ianokobalamin "vitamin '12$ tab 50 m9g

22 +iklofosfamid serb inj 1000 mg/vial "i(v($



25 +iklofosfamid tab sal 50 mg

26 +iklosporin inj 50 mg/ml

27 +iklosporin kaps 100 mg2 +iklosporin kaps lunak 25 mg

2! +ilostazol tab 100 mg

30 +imvastatin tab sal 10 mg

31 +imvastatin tab sal 20 mg

32 +iprofloksasin inf 2 mg/ml

33 +iprofloksasin tab s9ored 500 mg

34 +isplatin serb inj 10 mg

35 +isplatin serb inj 50 mg

36+itarabin serb inj 100 mg "i(m(/i(v(/s(k($

37 +itarabin serb inj 500 mg/10 ml

3 +piramisin tab 250 mg

3! +piramisin tab 500 mg

40 +pironolakton tab 100 mg

41 +pironolakton tab 25 mg

42 9tannous pyrophosphate 6:. mg sodium pyrophosphate/vial

43 +tavudin tab 30 mg

44 +treptokinase serb inj 1&5 juta 8/vial

45 +treptomisin serb inj 1(000 mg/vial

46 +ufentanil inj 5 m9g/ml "i(v($

47 +ukralfat susp 500 mg/5 ml

4 +ukralfat tab 500 mg

4! +uksinilkolin inj 20 mg/ml "i(v(/i(m($

50 +uksinilkolin inj 50 mg/ml "i(v(/i(m($

51 +uksinilkolin serb inj 100 mg/vial "i(v(/i(m($

52 +ulfasalazin kapl sal enterik 500 mg

53 9ulfur colloid :5 mg gelatin/reaction vial

54 9urgical ginggival pack


35/56

55 .akrolimus kaps 0&5 mg

56 .akrolimus kaps 1 mg

57 .amoksifen tab 20 mg

5 .amsulosin tab 0&2 mg

5! .amsulosin tab +< 0&4 mg

60 .e9#netium !!m 740 mb * 3&7 gb "20 to 100 milli9uries$/ml

61 .elbivudin tab 600 mg

62 .elmisartan tab 40 mg

63 .elmisartan tab 0 mg

64 .emozolamid kaps 100 mg

65 .emozolamid kaps 20 mg

66 .enofovir tab 300 mg

67 .eofilin tab 100 mg

6 .eofilin tab 150 mg

6! .eofilin tab +< 300 mg

70 .erazosin #9l tab 1 mg

71 .erazosin #9l tab 2 mg

72 .erbutalin 9airan i# 2&5 mg/ml

73 .erbutalin inj 0&5 mg/ml

74 .erbutalin serb i# 0&50 mg/dose

75 .erbutalin sir 1&5 mg/5 ml

76 .erbutalin tab 2&5 mg

77 .estosteron inj 250 mg/ml

7 .estosteron kaps lunak 40 mg

7!

0 .etanus to:oid inj

1 .etrakain tts mata 0&5%

2 .etrasiklin kaps 250 mg

3 .etrasiklin kaps 500 mg

4

5 .iamazol tab 10 mg

6 .iamazol tab 5 mg7 .iamin "vitamin '1$ tab 50 mg

.imolol tts mata 0&25%

! .imolol tts mata 0&5%

!0 .iopental serb inj 500 mg/amp "i(v( 'olus$

!1 .iopental serb serb inj 1(000 mg/amp "i(v($

!2 .iotropium serb i# 1 m9g #andi#aller

!3 .iotropium serb i# 1 m9g& refill

!4 .ramadol inj 50 mg/ml

!5 .rastuzumab serb inj 440 mg/vial

!6 .ravoprost tts mata 0&004%

!7 .riamsinolon inj 10 mg/ml

! .riamsinolon asetonid nasal spra 55 m9g/puff

!! .rifluoperazin tab sal 5 mg

!00 .ri#eksifenidil tab 2 mg

!01 .ropikamid tts mata 1%

!02 rea krim 10 %

!03 ?aksin 'B inj "i(k$

!04 ?aksin 9ampak

.estoteron kombinasi benserazin 25 mg levodopa 100 mg

*hallous Chloride .l*202 1 mg met#lene dip#osp#oni9 a9id/ml


36/56

!05 ?aksin 9ampak inj "s(k($

!06 ?aksin jerap difteri tetanus pertusis "-.$ inj "i(m($

!07 ?aksin jerap difteri tetanus "-.$

!0 ?aksin jerap tetanus "tetanus adsorbed to:oid$ inj "i(m($

!0! ?aksin kombinasi -. #epatitis ' inj "i(m($

!10 ?aksin polio 9airan steril 10 dosis

!11 ?aksin polio drops 10 dosis

!12 ?aksin rabies& untuk manusia serb inj "s(k(/i(k$ booster

!13 ?alasiklovir tab 500 mg

!14 ?algansiklovir tab sal 450 mg

!15 ?alproat sir 250 mg/5 ml

!16 ?alproat tab sal 250 mg

!17 ?alproat tab sal 500 mg

!1 ?alproat tab sal enterik 200 mg

!1! ?alproat tab +< 500 mg

!20 ?alproat tab +< 250 mg

!21 ?alsartan tab 160 mg

!22 ?alsartan tab 0 mg

!23 ?ankomisin serb inj 500 mg/vial

!24 ?asopresin inj 20 8/ml "i(m(/s(k($

!25 ?erapamil inj 2&5 mg/ml

!26 ?erapamil tab 0 mg

!27 ?erapamil tab 240 mg

!2 ?inblastin serb inj 10 mg/ml

!2! ?inkristin serb inj 1 mg "i(v($

!30 ?inkristin serb inj 2 mg/2 ml "i(v($

!31 ?inorelbin inj 10 mg/ml

!32 Iarfarin tab 2 mg

!33 Iarfarin tab 1 mg

!34 Jidovudin kaps 300 mg

!35 ;inc sir ,& mg/ml

!36 ;inc tab disp & mg

!37 ;inc serb ,& mg

!3 ;inc sir & mg/5 ml !3! ?itamin ' kompleks


37/56

2015

SATUAN JUMLAH KEBUTUHAN KETERANGAN

.ab

.abAmpul 600

'otol

.ab

.ab

'otol

.ab

?ial

?ial

?ial.ab 00

.ab

.ab

.ab 13&000

.ab 7&000

?ial

Ampul

.ube

.ube

?ial

?ial

.ab

.ab

.ab

Ampul 100

.ab

Ampul

.ab

.ab sal 25&000

.ab

.ab 3&000

'otol

'otol

.ab

.ab 5&000

?ial

?ial


38/56


39/56

.ab

.ab

?ial

Ampul 250

Ampul

.ab

'otol

'otol

.ab

'otol

.ab

.ab

'otol

'otol

'otol

'otol

'otol

'otol 50

?ial

?ial

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.ab

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.ube 50

.ube

.ube

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.ab

.ab

'otol

'otol

.ab sal 50

.ab

.ab

?ial

.ab

'otol

'otol

'otol

'otol

'otol

Ampul

Ampul

.ab

'otol

@aps

@aps

?ial

?ial

?ial

.ab

?ial


40/56

.ab

.ab

'otol

'otol

?ial

.ab 3&000

.ab

?ial 200

.ab

.ab

.ab

.ube

.ube

.ube

'otol

?ial 2&000

'otol

'otol

.ab 60&000

.ab 12&000

.ab

Ampul 150

.ube

?ial

.abAmpul

.ab

Ampul

@aps

@aps

Ampul

?ial

.ab

.ab'otol

'otol

?ial

?ial

?ial

?ial

.ab

.ab

.ab

.ab

@aps

@aps

?ial

?ial

'otol

.ab


41/56

'otol

?ial

Ampul

Ampul

?ial

@aps

.ab sal

Ampul

.ab

Ampul

Ampul

Ampul

Ampul 500

Ampul

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?ial

@aps

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.ab

@aps

'otol

.ab

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?ial?ial

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.ab sal

.ab sal

.ab

.ab

.ab

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'otol.ab

.ab

?ial

@aps

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.ab

.ab

?ial

?ial

?ial

?ial

?ial

?ial

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42/56

?ial

Ampul

Ampul 150

@aps 250&000

@aps

Ampul

.ab

.ab 350&000

@aps

@aps

.ab

.ab

.ab

'otol

'otol

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a9k

a9k

a9k

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'otol

.ab sal

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.ab

?ial.ab sal

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?ial 1&000

Ampul

@aps

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.ab

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?ial

'otol

Ampul

Ampul

Ampul

.ube

.ube

'otol

'otol

?ial

'otol

.ab

'otol


43/56

'otol

Ampul

.ab

8acrocyclic

?ial

?ial


44/56

?ial 4&000

?ial

.ab

.ab !6&000

.ab

.ab 170&000

'otol

'otol

'otol

'otol

?ial

Ampul

.ab

.ab

'otol

'otol

.ab

.ab

?ial

.ube

.ube 50

?ial

.ab

?ial

.ab=otol

Ampul

.ab

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45/56

?ial

?ial

?ial

?ial

?ial

?ial

'otol

uff

'otol

.ab

.ab

Ampul

Ampul

'otol

.ab

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?ial.ab

.ab

.ab sal

.ab

.ab 12&000

.ab

'otol

.ab 120&000

.ab

.ab

'otol

'otol

?ial

?ial

?ial

@aps

Ampul


46/56

Ampul

.ab 500

.ube 100

.ube

'otol

Ampul

.ab

@aps 00

@aps

.ab 100&000

.ab

.ab

?ial

.ab

.ab

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.ab

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'otol

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Ampul 100

Ampul

.ab

.ab sal 250&000

.ab sal.ab

.ab

.ab 250&000

.ab 120&000

.ab

.ab

.ab

@aps lunak

@aps lunak

Ampul

.ab

'otol

4aket

4aket


47/56

4aket

4aket

.ab

.ab

.ab

.ab

@aps

.ab

.ab

.ab sal

'otol

100

'otol

?ial

'otol

'otol

'otol

'otol

.ab 3&000

.ab

'otol

'otol

.ab

+et

.ab

300

.ab

'otol

?ial

.ab

.ab

.ab

'otol

.ab

.ab


48/56

?ial

@aps

.ab

'otol 500

'otol 200

'otol 20

'otol 500

'otol

'otol

'otol

'otol

'otol

'otol

'otol

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.ube

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Ampul

Ampul

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.ab

.ab

.ab

.ab

.ab

.ab

.ab 500

.ab

.ab

.ab

.ab sal 25&000

Ampul

Ampul

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?ial


49/56

?ial

?ial

?ial

+a9#et

'otol

'otol

.ab sal

.ab sal 11&000

?ial

'otol

.an

.ab

?ial

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.ab

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.ab

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.ab

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.ab salut

.ab 3&000

.ab

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Ampul

.ab sal.ab

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.ab

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.ab

.ab

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.ab

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50/56

'otol

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+upp

'otol

'otol

.ab

.ab

?ial

?ial

?ial

?ial

?ial

.ab

.ube 100

.ube

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Ampul

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.ab

.ab

.ab 1&000

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.ube

.ube

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Ampul

?ial

.ab


51/56

@aps

.ab

.ab

?ial

.ab

.ab

.ab

.ab

'otol

.ab

.ab

.ab

'otol

Ampul

.ab

.ab

.ab

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'otol

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'otol

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Ampul

Ampul

Ampul 600

.ab sal 21&100

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@aps 3&000?ial

.ab

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'otol

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.ab 6&000

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.ube

.ube

?ial

?ial

?ial

?ial

?ial


52/56

?ial

'otol

'otol

.ube

.ube

.ab

.ube

?ial

'otol

.ab

.ab

'otol

.ab

.ab

.ab

.ab

Ampul

.ab 5&000

.ab

.ab sal

'otol

'otol

'otol'otol 100

.ab

.ab

.ab

.ab

.ab

.ab

.ab

'otol

.ab

.ab

.ab

.ab

?ial

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Ampul

Ampul

.ab

.ab

Ampul

.ab 400

.ab

.ab

.ab


53/56

.ab

.ab

Ampul 50

.ab 500

@aps lunak

@aps lunak

.ab

@aps

.ab

.ab

.ab

.ab sal

.ab sal 450&000

Ampul

Ampul

.ab sal

.ab sal

.ab sal

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.ab sal

.ab sal

.ab sal

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.ab

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?ial 100

?ial

.ab


54/56

.ab

.ab sal 31&000

?ial

?ial

?ial

?ial

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Ampul

?ial

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.ab

?ial

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Ampul

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.ab sal

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55/56

@aps

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.ab

.ab

@aps

@aps

.ab

.ab

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.ab

.ab

.ab

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.ab

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.ab

.ab

.ab 5&000

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'otol

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Ampul

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'otol

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?ial

'otol

Ampul

'otol

.ab sal 350&000

.ab 650&000

'otol

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56/56

?ial

?ial

?ial

?ial

?ial

?ial

?ial

?ial

.ab

.ab sal

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.ab sal 21&000

.ab sal

.ab

.ab

.ab

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?ial

.ab

.ab

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?ial

.ab

.ab

@aps

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'otol.ab 3000

KEPALA SATUAN KERJA

(dr. Ni Mad !"#i$i% M.M&

NIP.1'10)10 1'))0* 2 00+

Format Rko Provinsi Tahun 2015

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