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    303471424.xlsx Halaman 1

    NAMA PUSKESMAS : xxx

    ALAMAT : xxx

    TELEPON : xxx

    NO NAMA OBAT

    S

    PUSTU K

    1 2 3 4 5

    O B A T

    1 Alopurinol tablet 100 mg Tablet 86.00

    2 Amlodipin tablet 5 mg Tablet 187.00

    3 Aminofillin tablet 200 mg Tablet 80.00

    4 Amoksilin kaplet 500 mg Kaplet 261.00

    5 Amoksilin sirup kering 125 mg 5 ml ! 60 ml "otol 2#445.00

    6 Tablet 72.00

    7 "otol 2#140.00

    8 Anti "akteri $%&' salep kombinasi ( "asitrasin 500 )*g + ,olimiksin 10.000 )*g Tube 2#266.00

    SATUAN

    KEMASAN

    HARGA SATUAN

    2015 (Rp)

    Antasida $%&' ) tablet kun-a# kombinasi ( Aluminium /idroksida 200 mg + agnesium

    /idroksida 200 mg

    Antasida $%&' )) suspensi# kombinasi ( Aluminium /idroksida 200 mg 5 ml +

    agnesium /idroksida 200 mg 5 ml ! 60 ml

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    303471424.xlsx Halaman 2

    NO NAMA OBAT

    PUST

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    SATUAN

    KEMASAN

    HARGA SATUAN

    2015 (Rp)

    Tube 11#000.00

    10 Tablet 145.20

    11 Antidiare suspensi Kaolin 700 mg + ,etin 66 mg ! 60 ml '&% KA%)'A "otol 7#000.00

    12 Antifungi $%&' kombinasi As. "enoat 6 + As. alisilat 3 ! 30 gr 9/)T&:)&$ ,ot 1#708.35

    13 Anti /emmoroid $%&' kombinasi ( "ismut subgalat 150 mg + /eksaklorofen 2#5 mg upp 3#300.00

    14 Kapsul 1#333.33

    15 Tube 6#00.00

    16 Antimigren ( &rgotamin Tartrat 1 mg + Kofein 50 mg Tablet 135.00

    17 A;ua pro in Tablet 148.00

    1 Asam Askorbat =itamin > tablet 50 mg Tablet 5.00

    20 Asam efenamat kaplet 500 mg Kaplet 112.00

    21 Asiklo?ir krim 5 ! 5 gr Tube 2#300.00

    22 Asiklo?ir tablet 400 mg Tablet 336.00

    23 Atropin in

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    2015 (Rp)

    24 "esi )) ulfat 200 mg + Asam :olat 0#25 mg tablet tamba dara kombinasi Tablet 42.00

    25 "etaistin esilat tablet 6 mg Tablet 24.00

    26 "etametason Krim 0.1 sebagai ?alerat ! 5 gr %A%' Tube 1#520.00

    27 "isoprolol tablet 5 mg Tablet 746.00

    28 "oraC l-serin % 10 ! 8 ml "otol 2#750.00

    2 Tablet 75.00

    30 "romeksin larutan 2mgml untuk 'ebulier ! 50 ml ")%=%' "otol 5#125.00

    31 $eksametason tablet 0#5 mg Tablet 62.00

    32 $ektrometorfan sirup 10mg5 ml /"r ! 60 ml "otol 1#378.85

    33 $ekstrometorfan tablet 15 mg /"r Tablet 2.00

    34 $ifenidramin inl Tablet 42.60

    3 &pinefrin Adrenalin inl ! 1 ml Ampul 8#100.00

    40 &ritromisin kapsul 500 mg Kapsul 30.00

    41 &ritromisin sirup 200 mg 5 ml ! 60 ml "otol 7#700.00

    "romeksin tablet 8 mg BROMIFAR

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    303471424.xlsx Halaman 4

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    2015 (Rp)

    42 &takridin Bi?anol arutan 0#1 ! 300 ml "otol 2#550.00

    43 :enol liserol tetes telinga 10 ! 5 ml "otol 2#042.00

    44 :itomenadion=it. K1 tablet salut gula 10 mg Tablet 634.00

    45 :urosemid tablet 40 mg Tablet 75.00

    46 a 288.00

    47 emfibroil 300 mg kapsul Kapsul 265.00

    48 entam-in salep kulit 0#1 ! 5 gr Tube 1#700.00

    4 libenklamid tablet 5 mg Tablet 56.00

    50 liseril uaiakolat tablet 100 mg Tablet 24.75

    51 luose arutan )nfus 5 steril ! 500 ml "otol 5#200.00

    52 riseoful?in tablet 125 mg Tablet 21.00

    53 /idroklortiaid />T tablet 25 mg Tablet 51.00

    54 /idrokortison krim 2#5 ! 5 gr Tube 2#78.00

    55 /-osine ! ' ! "utilbromide tablet 10 mg >%,A Tablet 858.00

    56 )buprofen tablet 400 mg Tablet 14.00

    57 )t-ol salep kulit ! 15 gr ,ot 4#50.00

    58 )sosorbid dinitrat )$' tablet sublingual 5 mg Tablet 88.00

    5 Kalium permanganat ,K serbuk ! 5 gr ,ot 3#500.20

    aram %ralit ) serbuk# kombinasi ( 'atrium 0#52 g# Kalium klorida 0#30 g # Trinatrium

    sitrat diidrat 0#58 g# lukosa anidrat 2#7 g

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    303471424.xlsx Halaman 5

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    2015 (Rp)

    60 Kalsium laktat Kalk tablet 500 mg Tablet 70.00

    61 Kaptopril tablet 25 mg Tablet 84.00

    62 Ketokonaol Tablet 200 mg Tablet 267.00

    63 Klindamisin kapsul 300 mg Kapsul 527.00

    64 Kloramfenikol kapsul 250 mg Kapsul 550.00

    65 Kloramfenikol salep mata 1 ! 5 gr Tube 1#600.00

    66 Kloramfenikol suspensi 125 mg5ml ! 60 ml "otol 3#800.00

    67 Kloramfenikol tetes mata 0#5 ! 5 ml B&>% "otol 6#600.00

    68 Kloramfenikol tetes telinga 3 ! 5 ml "otol 1#5.00

    6 Klorfeniramin maleat >T tablet 4 mg Tablet 51.00

    70 Tablet 138.00

    71 Tablet 70.00

    72 "otol 2#145.00

    73 e?ertran salep ! 15 gr ,ot 2#836.0

    74 idokain in

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    2015 (Rp)

    77 operamid tablet 2 mg Tablet 8.00

    78 oratadin tablet 10 mg Tablet 154.00

    7 ebendaol tablet 100 mg Tablet 141.02

    80 etampiron Antalgin tablet 500 mg Tablet 158.00

    81 etformin />l tablet 500 mg Tablet 113.00

    82 etilergometrin aleat etilergometrin tablet salut 0#125 mg Tablet 154.00

    83 etronidaol tablet 500 mg Tablet 160.00

    84 ikonaol krim salep 2 'itrat ! 10 gr Tube 3#000.00

    85 "otol 1#800.00

    86 ulti?it Tablet ,&/A=BA Tablet 707.85

    87 'atrium "ikarbonat tablet 500 mg Tablet 14.30

    88 'atrium $iklofenak tablet 50 mg Tablet 176.00

    8 'atrium Klorida larutan infus 0# ! 500 ml "otol 4#700.00

    0 'atrium Klorida larutan 0## 25 ml untuk 'ebulier "otol 2#530.00

    1 'ifedipin tablet 10 mg Tablet 110.00

    2 'istatin tablet salut 500.000 )*g Tablet 640.00

    3 'istatin ?aginal tablet 100.000 )*g Tablet 480.00

    4 %bat batuk /itam %"/ >airan !100 ml non Alkool "otol 5#500.00

    5 %bat ,enernaan tablet $iastase 200 mg# ,ankreatin 100 mg D"B%FD Tablet 500.01

    ulti?it irup ! 60 ml LYSMIN

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    303471424.xlsx Halaman 7

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    2015 (Rp)

    6 %ksitetrasiklin />l salep kulit 3 ! 5 gr Tube 1#700.00

    7 %ksitetrasiklin />l salep mata 1 ! 5 gr Tube 1#1.8

    8 %mepraol kapsul 20 mg Kapsul 211.00

    ,apa?erin tablet 40 mg Tablet 2.

    100 ,arasetamol $rops "tl 15 ml 5#200.00

    101 ,arasetamol sirup 120 mg 5ml ! 60 ml "otol 1#318.0

    102 ,arasetamol tablet 100 mg Tablet 32.23

    103 ,arasetamol tablet 500 mg Tablet 7.00

    104 ,iridoksin =itamin "6 tablet 10 mg />l Tablet 17.05

    105 ,iroksikam tablet 10 mg Tablet 64.86

    106 "otol 17#33.00

    107 ,o?idon )odida larutan 10 ! 300 ml "otol 14#203.00

    108 ,rednison tablet 5 mg Tablet 114.00

    10 ,ropanolol tablet 10 mg />l Tablet 60.50

    110 ,ropiltiourasil tablet 100 mg Tablet 26.00

    111 Banitidin tablet 150 mg Tablet 120.00

    112 Binger aktat larutan infus ! 500 ml "otol 5#200.00

    113 albutamol tablet 2 mg sebagai sulfat Tablet 5.00

    114 albutamol 2.5 mg ml untuk 'ebulier =&'T%)' "otol 6#600.00

    ,olikresulen kondensasi 10 ml APTIL

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    303471424.xlsx Halaman 8

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    2015 (Rp)

    115 alep 2!4 kombinasi ( Asam alisilat 2 + "elerang endap 4 ! 30 gr ,ot 2#000.00

    116 alisil "edak 2 ! 50 gr Kotak 1#250.00

    117 efadroksil Kapsul 500 mg Kapsul 50.00

    118 ianokobalamin ?itamin "12 tablet 50 mg Tablet 57.00

    11 im?astatin tablet 10 mg Tablet 16.00

    120 iprofloksasin tablet 500 mg sebagai />l Tablet 255.00

    121 ulfasetamida 'atrium tetes mata 15 ! 5 ml "otol 3#445.20

    122 Tetrasiklin kapsul 500 mg Kapsul 541.75

    123 Tiamfenikol kapsul 500 mg Kapsul 1#650.00

    124 Tiamin =itamin "1 tablet 50 mg />l 'itrat Tablet 30.80

    125 =itamin " Kompleks tablet Tablet 107.00

    126 Fin tablet 20 mg Tablet 474.00

    !

    OBAT PROGRAM TB PARU !

    127 %bat :$> Kategori 1 ,aket 327#264.00

    128 %bat :$> Kategori 2 ,aket 1#1#00.00

    12 %bat :$> Anak ,aket 214#0.00

    130 %bat :$> isipan ,aket 160#000.00

    131 )soniaid )'/ ,rofilaksis 100 mg Tablet 125.00

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    303471424.xlsx Halaman 9

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    2015 (Rp)

    OBAT PROGRAM IMS !

    132 Kanamisin inl Tablet 112.00

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    303471424.xlsx Halaman 10

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    2015 (Rp)

    3 >lobaam tablet 10 mg Tablet 00.00

    4 $iaepam tablet 2 mg Tab