Pengumuman - LKPP

KELOMPOK KERJA KATALOG ELEKTRONIK OBAT TAHUN 2020-2022 LEMBAGA KEBIJAKAN PENGADAAN BARANG/JASA PEMERINTAH

Yth. Pimpinan Industri Farmasi di Tempat

Pengumuman

Berikut disampaikan Daftar Nama Obat yang akan diproses baik secara Tender maupun Negosiasi oleh Kelompok Kerja Pemilihan Katalog Elektronik Obat

Tahun 2020 – 2022 (Terlampir)

Demikian disampaikan, atas perhatian dan kerjasamanya diucapkan terimakasih.

Pokja Katalog Elektronik Obat Tahun 2020-2022

TTD Ketua

Tembusan Yth. : 1. Kepala LKPP

2. Sekretaris Jenderal Kementerian Kesehatan;

3. Deputi Bidang Monitoring Evaluasi dan Pengembangan Sistem Informasi LKPP;

4. Direktur Pengembangan Sistem Katalog LKPP.

Nomor : 01/POKJAOBAT2020/12/2019 30 Desember 2019 Lampiran : 3 Berkas Perihal : Pengumuman

1 Acetyl cysteine/ N-asetil sistein tablet/kapsul/kaplet 200 mg strip/ blister

2 Air untuk injeksi, cairan inj ampul/vial/botol 25 mL

3 Air untuk injeksi/ Aqua pro injeksi/ Aqua pro injection 20 ml ampul/vial/botol

4 Akarbose/Acarbose tablet/kapsul/kaplet 100 mg strip/blister

5 Akarbose/Acarbose tablet/kapsul/kaplet 50 mg strip/blister

6 Albendazol tablet/kapsul/kaplet 400 mg strip/blister

7 Alopurinol tablet/kapsul/kaplet 100 mg strip/blister

8 Alopurinol tablet/kapsul/kaplet 300 mg strip/blister

9 Alprazolam tablet/kapsul/kaplet 0,5 mg strip/blister

10 Alprazolam tablet/kapsul/kaplet 1 mg strip/blister

11 Amikasin/Amikacin/Amikacin sulfate injeksi 250 mg/ml vial/ampul

12 Aminofilin/Aminophylline inj 24 mg/ml ampul/vial 10 ml

13 Aminofilin/Aminophylline tablet/kapsul/kaplet 200 mgstrip/blister/maks botol 100

tablet

14 Amiodaron inj 50 mg/ml (150 mg/ 3 mL) ampul/vial

15Amitriptilin/Amitriptyline tablet salut selaput/kaplet salut selaput 25

mgstrip/blister

16 Amlodipin/Amlodipine tablet/kapsul/kaplet 10 mg strip/blister

17 Amlodipin/Amlodipine tablet/kapsul/kaplet 5 mg strip/blister

18 Amoksisilin/Amoxicillin sirup kering 250 mg/5 ml botol 60 ml

19 Amoksisilin/Amoxicillin tablet/kapsul/kaplet 250 mg strip/blister

20 Ampisilin/Ampicillin serbuk injeksi 1000 mg (i.v) ampul/vial

21 Anestetik lokal gigi kombinasi: lidokain 2% + epinefrin 1:80000, inj 2 mL ampul/vial

22Antasida, kombinasi: alumunium hidroksida 200 mg + magnesium

hidroksida 200 mg, susp botol 60 ml

23Antasida, kombinasi: alumunium hidroksida 200 mg + magnesium

hidroksida 200 mg, tab kunyah strip/ blister

24 Antifungi Salep, Kombinasi: Asam Benzoat 6% + Asam Salisilat 3% pot 30 g

25 Aripiprazol tab discmelt/tab cepat larut/disitegrating tablet 10 mg strip/ blister

26Asam asetilsalisilat (asetosal/acetosal) tablet sal enterik/kaplet salut

enterik 100 mg strip/ blister

27 Asam Folat/folic acid tablet/kapsul/kaplet 0,4 mg strip/ blister

28 Asam folat/folic acid tablet/kapsul/kaplet 1 mg strip/ blister

29Asam traneksamat/Tranexamic acid tablet/kapsul/kaplet salut selaput

500 mgstrip/blister

30 Asam traneksamat/Tranexamic acid injeksi 100 mg/ml ampul/vial

31 Asam traneksamat/Tranexamic acid injeksi 50 mg/ml ampul/vial

32Asam ursodeoksikolat/Ursodeoxycholic acid tablet/kapsul/kaplet 250

mg strip/ blister

33 Asiklovir/Acyclovir tablet/kapsul/kaplet 200 mg strip/ blister

34 Asiklovir/Acyclovir tablet/kapsul/kaplet 400 mg strip/ blister

35 Atorvastatin tablet/kapsul/kaplet salut selaput 10 mg strip/ blister

36 Atorvastatin tablet/kapsul/kaplet salut selaput 20 mg strip/ blister

37 Atracurium Besilate/ Atrakurium injeksi 10mg/mL (i.v) ampul/vial @ 5 mL

Lampiran 1

DAFTAR NAMA OBAT TENDER GENERIK KATALOG OBAT 2020-2022

NO NAMA ZAT AKTIF (GENERIK) KEMASAN YANG

DIPERSYARATKAN

Lampiran 1



DIPERSYARATKAN

38 Atracurium Besilate/ Atrakurium injeksi 10mg/mL (i.v) ampul/vial @2,5 mL

39Azitromisin/Azithromycin dihydrate tablet salut selaput/kaplet salut

selaput 500 mg strip/ blister

40 Azitromisin/Azithromycin serb inj 500 mg ampul/vial

41 Azitromisin/Azithromycin sir kering 200 mg/ 5 mL maks botol @60 ml

42 Bedak salisil/Bedak salicyl serbuk 2% kotak/plastik

43Betahistin/Betahistine Mesilate/Betahistine Mesylate

tablet/kapsul/kaplet 6 mg strip/ blister

44 Betametason/Betamethasone Valerate krim 0,1% tube 5 gram

45 Bisoprolol/Bisoprolol Fumarate tablet/kapsul/kaplet 2,5 mg strip/ blister

46Bisoprolol/Bisoprolol Fumarate tablet salut selaput/kaplet salut selaput

5 mg strip/ blister

47 Bupivakain heavy/Bupivakain heavy (injeksi 0.50% + glukosa 8%) vial/ampul @4 ml

48 Bupivakain inj 0,5% (P.V) ampul/vial

49Cefadroxil monohydrate/ Cefadroxil/ Sefadroksil sirup kering 125

mg/5mlbotol @ 60 mL

50Cefadroxil monohydrate/ Cefadroxil/ Sefadroksil sirup kering 250

mg/5mlbotol @ 60 mL

51Cefadroxil monohydrate/ Cefadroxil/ Sefadroksil tablet/kapsul/kaplet

250 mg strip/ blister

52Cefadroxil monohydrate/ Cefadroxil/ Sefadroksil tablet/kapsul/kaplet


53Cefalexin monohydrate/ Cefalexin/ Sefaleksin tablet/kapsul/kaplet 500

mg strip/ blister

54 Cefazolin sodium/ Sefazolin serbuk injeksi 1000 mg ampul/vial

55 Cefepime/ Sefepim serbuk injeksi 1000 mg ampul/vial

56 Cefixime trihydrate/ Cefixime/ Sefiksim sirup 100 mg/ 5 ml botol

57Cefixime trihydrate/ Cefixime/ Sefiksim tablet salut selaput/kaplet salut

selaput 200 mg strip/ blister

58 Cefoperazone sodium/Cefoperazone/ Sefoperazon serb inj 1.000 mg ampul/vial

59Cefoperazone sodium+ Sulbactam Sodium/ Cefoperazone + Sulbactam/

(Sefoperazon 500 mg + Sulbaktam 500 mg) serb inj 1.000 mgampul/vial

60 Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 1.000 mg ampul/vial

61 Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 500 mg ampul/vial

62 Cefpirome/ Sefpirom serb inj 1000 mg ampul/vial

63 Ceftazidime/ Seftazidim serb inj 1.000 mg ampul/vial

64 Ceftriaxone/Seftriakson serb inj 1.000 mg ampul/vial

65 Cefuroxime sodium/ Cefuroxime/ Sefuroksim serbuk injeksi 750 mg ampul/vial

66 Cetirizine hydrochloride(HCl)/ Cetirizine/ Setirizin sirup 5 mg/5 ml botol @ 60 mL

67Cetirizine hydrochloride(HCl)/ Cetirizine/ Setirizin tablet/kapsul/kaplet


68Chloramphenicol/ Chloramphenicol palmitate/ Kloramfenikol suspensi

125 mg/ 5 ml botol 60 ml

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DIPERSYARATKAN

69 Chloramphenicol/ Kloramfenikol salep mata 1 % tube @ 5 gram

70 Chloramphenicol/ Kloramfenikol tablet/kapsul/kaplet 250 mg strip/ blister

71Chlorpromazine Hydrochloride/ Chlorpromazine / Klorpromazin injeksi

25 mg/ml ( i.m.)ampul/vial

72Ciprofloxacin hydrochloride (HCl)/ Ciprofloxacin Lactate/ Ciprofloxacin/

Siprofloksasin tablet salut selaput/kaplet salut selaput 500 mg strip/ blister

73Ciprofloxacin hydrochloride(HCl)/ Ciprofloxacin Lactate/ Ciprofloxacin/

Siprofloksasin inf 2 mg/ml vial/ botol 100 ml

74Clindamycin hydrochloride/ Clindamycin/ Klindamisin


75Clindamycin hydrochloride/ Clindamycin/ Klindamisin


76 Clobazam/ Klobazam tablet/kapsul/kaplet 10 mg strip/ blister

77 Clomifene citrate/ Klomifen sitrat tablet/kapsul/kaplet 50 mg strip/ blister

78Clonidine hydrochloride/ Clonidine/ Klonidin tablet/kapsul/kaplet 0,15

mg strip/ blister

79Clopidogrel bisulfate/ Clopidogrel/ Clopidogrel hydrogen sulfate/

Klopidogrel tablet salut selaput/kaplet salut selaput 75 mg strip/ blister

80 Clozapine/ Klozapin tablet 100 mg strip/ blister

81 Clozapine/ Klozapin tablet 25 mg strip/ blister

82

Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (anak) kombinasi tiap 5

ml suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg (susp 240

mg)

botol 60 mL

83Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (dewasa) kombinasi:

sulfametoksazol 400 mg + trimetoprim 80 mg (tab/kaptab 480 mg) strip/ blister

84Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol forte kombinasi:

sulfametoksazol 800 mg + trimetoprim 160 mg (tab/kaptab 960 mg) strip/ blister

85Cyanocobalamin/ Cyanocobalamine/ Sianokobalamin (vitamin B12)

injeksi 500 mcg/mLampul/vial

86Cyanocobalamin/ Cyanocobalamine/ Sianokobalamin (vitamin B12)

tablet/kapsul/kaplet 50 mcg strip/ blister

87 Deferipron tab salut selaput/kaplet salut selaput 500 mg strip/ blister

88 Deksametason/ Dexamethasone tablet/kapsul/kaplet 0,5 mg strip/ blister

89 Desoksimetason/ Desoximetasone krim 0,25% tube 15 g

90Dexamethason Sodium Phosphate/ Deksamethason/ Deksametason

injeksi 5 mg/ml (i.v./i.m.)ampul/vial

91 Diazepam injeksi 5 mg/ ml (i.v. / i.m.) ampul/vial

92 Diazepam tablet/kapsul/kaplet 2 mg strip/ blister/ maks botol

100 tablet

93 Diazepam tablet/kapsul/kaplet 5 mg strip/ blister

94Diclofenac sodium/ Natrium diklofenak tablet salut enterik/kaplet salut


Lampiran 1



DIPERSYARATKAN

95Diclofenac sodium/ Natrium diklofenak tablet salut enterikl/kaplet salut


96 Dietilkarbamazin/ Diethylcarbamazine tablet/kapsul/kaplet 100 mg strip/ blister

97 Difenhidramin/ Diphenhydramine injeksi 10 mg/ml ( i.v./i.m.) ampul/vial

98 Digoksin/ Digoxin tablet/kapsul/kaplet 0,25 mg strip/ blister

99 Diltiazem/ Diltiazem HCl tablet/kapsul/kaplet 30 mg strip/ blister

100 Dimenhidrinat tablet/kapsul/kaplet 50 mg strip/ blister/ maks botol

100 tablet

101Divalproex sodium / Valproat tablet salut enterik/ kaplet salut

enterik250 mg

strip/blister/maks botol 100

tablet

102 Dobutamin/ Dobutamin HCl/ Dobutamine HCl injeksi 50 mg/mL ampul/vial

103Domperidon/ Domperidone maleate/ Domperidone sirup/suspensi 5

mg/5 ml botol @60 ml

104 Domperidon/ Domperidone tablet/kapsul/kaplet 10 mg strip/ blister

105 Donepezil/ Donepezil HCl tablet salut selaput/kaplet salut selaput 5 mg strip/ blister

106 Dopamin / Dopamine hidrochloride injeksi 40 mg/ml ampul/vial

107 Efedrin/ Ephedrine HCl Inj 50 mg/ml ampul/vial

108 Epinefrin/ Epinephrine (Adrenalin) injeksi 0,1% (i.v/s.k./i.m) ampul/vial

109Eritromisin/ Erythromycin/ Erythromycin Ethyl Succinate sirup kering

200 mg/ 5 ml strip/ blister

110Eritromisin/ Erythromycin/ Erythromycin stearate tablet/kapsul/kaplet


111Eritromisin/ Erythromycin/ Erythromycin stearate tablet/kapsul/kaplet


112 Esomeprazole Sodium/ Esomeprazol serbuk Inj. 40 mg (i.v) ampul/vial

113 Fenitoin/ Phenytoin Sodium Injeksi 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml

114 Fenitoin/ Phenytoin/ Phenytoin sodium kapsul 100 mg strip/ blister/ maks botol

100 tablet

115 Fenofibrat tablet/kapsul/kaplet 100 mg strip/ blister

116 Fenofibrat tablet/kapsul/kaplet 300 mg strip/ blister

117 Fentanil/ Fentanyl injeksi 0,05 mg/ml (i.m/i.v) ampul @ 2 mL

118 Fentanil/ Fentanyl injeksi 0,05 mg/ml (i.m/i.v) ampul/vial, @ 10 mL

119Fitomenadion/ Phytomenadion (Vit.K1) tablet salut gula/kaplet salut

gula 10 mg strip/ blister

120 Fitomenadion/ Phytomenadion (Vitamin K1) injeksi 2 mg/ml (i.m.) ampul/vial

121 Flukonazol/ Fluconazole injeksi 2 mg/ml ampul/vial/botol

122 Fluoksetin/Fluoxetine HCl tablet/kapsul/kaplet 20 mg strip/ blister

123 Furosemid/ Furosemide inj 10mg/ml (i.v./i.m) ampul/vial

124 Furosemid/ Furosemide tablet/kapsul/kaplet 40 mg strip/ blister

125 Gabapentin tablet/kapsul/kaplet 300 mg strip/ blister

126Garam Oralit kombinasi: Natrium klorida 0,52 g + kalium klorida 0,30 g +

Trinatrium sitrat dihidrat 0,58 g + Glukosa Anhidrat 2,70 g, serbsachet

127 Gemfibrozil tablet/kapsul/kaplet 300 mg strip/ blister

Lampiran 1



DIPERSYARATKAN

128 Gentamisin/ Gentamycin sulfate salep mata 0,3% (3 mg/g) tube

129 Gentamisin/ Gentamycin/ Gentamycin sulfate tetes mata 0,3% botol 5 mL

130 Glibenklamid/ Glibenclamide tablet/kapsul/kaplet 5 mg strip/ blister

131 Glimepiride tablet/kapsul/kaplet 1 mg strip/ blister




135 Griseofulvin (micronized) tablet/kapsul/kaplet 125 mg strip/ blister

136 Griseofulvin (micronized) tablet/kapsul/kaplet 500 mg strip/ blister

137 Haloperidol tablet/kapsul/kaplet 0,5 mg strip/ blister

138 Haloperidol tablet/kapsul/kaplet 1,5 mg strip/ blister

139 Haloperidol tablet/kapsul/kaplet 5 mg strip/ blister

140 Hidrokortison/ Hydrocortisone krim 1% tube @ 5 g

141 Hidrokortison/ Hydrocortisone krim 2,5 % tube @ 5 g

142Hiosin butilbromid/Hyoscine butylbromide/Hyoscine N Butylbromide inj

20 mg/ml ampul/vial

143 Ibuprofen suspensi 100 mg/5 ml maks botol @ 60 ml

144 ibuprofen suspensi 200 mg/ 5ml maks botol @ 60 ml

145 Ibuprofen tablet/kapsul/kaplet 200 mg strip/ blister

146 Ibuprofen tablet/kapsul/kaplet 400 mg strip/ blister

147 Irbesartan tablet/kapsul/kaplet 150 mg strip/ blister

148 Irbesartan tablet/kapsul/kaplet 300 mg strip/ blister

149 Isosorbid dinitrat inj 1 mg/mL ampul/vial

150 Isosorbid Dinitrat/ Isosorbide dinitrate tablet/kaplet 5 mg strip/ blister

151 Isosorbid dinitrat/ Isosorbide dinitrate tablet/kapsul/kaplet 10 mg strip/blister

152 Kalsitriol kapsul lunak 0,25 mcgstrip/ blister/maks botol 100

kaps

153 Kalsium folinat/ Calsium folinate (leukovorin, Ca) injeksi 10 mg/mL ampul/vial

154 Kalsium glukonat/ Calcium gluconate inj 10% ampul/vial

155 Kalsium Karbonat tablet/kapsul/kaplet 500 mg strip/ blister

156 Kalsium Laktat/ Calcium lactate (Kalk) tablet/kapsul/kaplet 500 mg strip/ blister

157Kandesartan/ Candesartan/ Candesartan Cilexetil tablet/kapsul/kaplet


158Kandesartan/ Candesartan/ Candesartan Cilexetil tablet/kapsul/kaplet

8 mg strip/ blister

159 Kaptopril/ Captopril tablet/kaplet 12,5 mg strip/ blister

160 Kaptopril/ Captopril tablet/kaplet 50 mg strip/ blister

161 Karbamazepin tablet/kapsul/kaplet 200 mg strip/ blister

162 Ketamin/Ketamine Hydrochloride injeksi 100 mg/ml ( i.v.) ampul/vial

163 Ketamin/Ketamine Hydrochloride injeksi 50 mg/ml ( i.v.) ampul/vial

164 Ketokonazol/ Ketoconazole krim 2% tube 10 gr

165 Ketokonazol/ Ketoconazole tablet/kapsul/kaplet 200 mg strip/ blister

166 Ketoprofen inj 25 mg/mL ampul/vial

Lampiran 1



DIPERSYARATKAN

167Ketorolak/ Ketorolac / Ketorolac trometamol/ Ketorolac Tromethamine

inj 30 mg/ml (3%)ampul/vial

168Kombinasi: ferro fumarat 60 mg + as. Folat 0,4 mg tablet salut gula

(tablet tambah darah) strip/ blister

169Kombinasi: Levonogestrel 150 mcg + etinilestradiol 30 mcg (tab salut

gula)

strip/ blister (harga per

kemasan)

170 Lactulose/ Laktulosa sir 3,335 g/5 mL (G) botol @ 60 mL

171 Lansoprazole/ Lansoprazol tablet/kapsul/kaplet 30 mg strip/ blister

172 Levofloxacin hemihydrate/ Levofloxacin/ Levofloksasin inf 5 mg/mL vial/ botol/ flexy bag @ 100

ml

173Levofloxacin hemihydrate/ Levofloxacin/Levofloksasin tablet salut

selaput/kaplet salut selaput 500 mg strip/ blister

174 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set

175 Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain injeksi 2% ampul/vial

176 Lisinopril dihydrate/ Lisinopril/ Lisinopril tablet/kapsul/kaplet 10 mg strip/ blister

177 Lisinopril dihydrate/ Lisinopril/ Lisinopril tablet/kapsul/kaplet 5 mg strip/ blister

178 Loratadine/ Loratadin tablet/kapsul/kaplet 10 mg strip/ blister

179 Manitol inf 20% (100 mL) botol @ 100 mL



182Medroxyprogesterone Acetate/ Medroksi progesteron asetat injeksi

150 mg/3ml (50 mg/mL)ampul/vial

183Medroxyprogesterone Acetate/ Medroksi progesteron asetat injeksi

depo 150 mg/mlampul/vial

184 Meropenem serb inj 1.000 mg ampul/vial

185 Meropenem serb inj 500 mg ampul/vial

186 Metformin Hydrochloride/ Metformin tablet/kapsul/kaplet 500 mg strip/ blister

187 Metformin Hydrochloride/ Metformin tablet/kapsul/kaplet 850 mg strip/ blister

188Methylergometrine Maleate Methylergometrine/ Metilergometrin inj

0,2 mg/mlampul/vial

189Methylergometrine Maleate/ Methylergometrine/ Metilergometrin

tablet/kaplet salut selaput 0,125 mg strip/ blister

190Methylprednisolone Sodium Succinate/ Metilprednisolon/

Methylprednisolone serb inj 125 mgampul/vial

191Methylprednisolone Sodium Succinate/ Metilprednisolon/

Methylprednisolone serb inj 500 mgampul/vial

192 Metilprednisolon/Methylprednisolone tablet/kapsul/kaplet 16 mg strip/ blister



Lampiran 1



DIPERSYARATKAN

195

Metoclopramide hydrochloride (HCl)/ Metoclopramide/

Metoklopramid inj 5 mg/mL ampul/vial

196Metoclopramide hydrochloride (HCl)/ Metoclopramide/ Metoklopramid

drop 2 mg/mLbotol @ 10mL

197Metoclopramide hydrochloride (HCl)/ Metoclopramide/ Metoklopramid


198 Metronidazole/ Metronidazol infus 5 mg/ ml botol

199 Metronidazole/Metronidazol suspensi 125 mg/5 mL botol 60 mL atau 100 mL

200 Metronidazole/Metronidazol tablet/kapsul/kaplet 250 mg strip/ blister

201 Metronidazole/Metronidazol tablet/kapsul/kaplet 500 mg strip/ blister

202 Miconazole nitrate/ Miconazole/ Mikonazol krim 2 % tube

203 Mometasone furoate/ Mometason furoat krim 0,1% tube 10 gram

204Moxifloxacin hydrochloride (HCl)/ Moxifloxacin/ Moksifloksasin infus

1,6 mg/mL (400mg/250ml) vial/ampul/botol/softbag

205Moxifloxacin hydrochloride (HCl)/ Moxifloxacin/ Moksifloksasin tablet

salut selaput/kaplet salut selaput 400 mg strip/ blister

206 Nicardipine hydrochloride(HCl)/ Nicardipine/ Nikardipin inj 1 mg/mL ampul/vial

207 Nifedipine/ Nifedipin tablet/kapsul/kaplet 10 mg strip/ blister

208 Nimodipin/ Nimodipine Infus 0,2 mg/ml (0,02%) ampul/vial/botol

209 Nistatin/Nystatin suspensi 100.000 IU/mL botol

210Norepinephrine bitartate/ Norepinephrine bitartate monohydrate /

Norepinephrine/ Norepinephrine base/ Norepinefrin inj 1 mg/mlampul/vial

211 Obat Anti Tuberculosis FDC Kategori Anak paket

212 Obat Anti Tuberculosis FDC Kategori I paket

213 Obat Anti Tuberculosis FDC Kategori II paket

214 Obat Anti Tuberculosis FDC Kategori Sisipan paket

215 Obat Anti Tuberculosis Kombipak Kategori 1 paket

216 Ofloxacin/ Ofloksasin tablet/kaplet salut selaput 200 mg strip/ blister

217 Ofloxacin/ Ofloksasin tablet/kaplet salut selaput 400 mg strip/ blister

218 Oksitetrasiklin salep mata 1% tube

219 Olanzapine/ Olanzapin tablet/kaplet/salut selaput 10 mg strip/blister

220 Olanzapine/ Olanzapin tablet/kaplet/salut selaput 5 mg strip/blister

221 Omeprazol/Omeprazole serb injeksi 40 mg ampul/vial

222 Omeprazol/Omeprazole tablet/kapsul/kaplet 20 mg strip/ blister

223Ondansentron hydrochloride/ Ondansentron HCl dihydrate

/Ondansetron inj 2 mg/mlampul/vial

224 Ondansentron hydrochloride/ Ondansetron tablet/kapsul/kaplet 4 mg strip/ blister

225 Ondansentron hydrochloride/ Ondansetron tablet/kapsul/kaplet 8 mg strip/ blister

226 Oxytocin/ Oksitosin inj 10 IU/ml ampul/vial

227 Paracetamol/ Parasetamol drops 100 mg/ml (60mg/0,6ml) botol @ 15 mL

228 Paracetamol/ Parasetamol infus 10 mg/mL vial/ flexybag/botol @ 100

ml

Lampiran 1



DIPERSYARATKAN

229 Paracetamol/ Parasetamol sirup 120 mg / 5 ml botol @ 60 mL

230 Pioglitazone/ pioglitazone hydrochloride (HCl)/ pioglitazon tablet 15 mg strip/ blister

231Pioglitazone/ pioglitazone hydrochloride (HCl)/ Pioglitazon


232 Pirantel pamoat/ Pyrantel Pamoate tablet/kapsul/kaplet 125 mg strip/ blister

233 Pirazinamid/Pyrazinamide tablet/kapsul/kaplet 500 mg strip/blister

234 Povidon iodin lar 100 mg/mL botol 30 mL

235 Povidon iodin lar 100 mg/mL botol @ 60 mL

236 Povidon iodin lar 100 mg/mL botol @ 1.000 mL

237 Pravastatin sodium/ Pravastatin tablet/kapsul/kaplet 20 mg strip/ blister

238 Prednison/Prednisone tablet/kapsul/kaplet 5 mg strip/ blister

239Procainebenzylpenicillin/ Prokain Benzilpenisilin serbuk injeksi 3 juta IU

(i.m)ampul/vial

240 Propofol injeksi 1% (i.v., bolus) ampul/vial

241Propranolol hydrochloride (HCl)/ Propranolol tablet/kapsul/kaplet 10

mg strip/ blister

242Propranolol hydrochloride (HCl)/ Propranolol tablet/kapsul/kaplet 40

mg strip/ blister

243 Propylthiouracil/ Propiltiourasil tablet/kapsul/kaplet 100 mg strip/ blister

244 Pyridoxine/ Piridoksin (Vitamin B6) tab/kap/kapl 10 mg strip/ blister

245 Ramipril tablet/kapsul/kaplet 5 mg strip/ blister

246 Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml ampul/vial

247 Ranitidine hydrochloride (HCl)/Ranitidin tablet/kapsul/kaplet 150 mg strip/ blister

248 Retinol (vitamin A) kapsul lunak 100.000 IU botol

249 Retinol acetate/ Retinol (vitamin A) kaps lunak 200.000 IU botol

250 Rifampicin/ Rifampisin tablet/kapsul/kaplet 300 mg strip/ blister



253 Risperidone/ Risperidon tablet/kapsul/kaplet 3 mg strip/blister

254 Rocuronium bromide/ Rokuronium inj 10 mg/ml (i.v.) ampul/vial

255 Rosuvastatin calcium/ Rosuvastatin tablet/kapsul/kaplet 10 mg strip/ blister

256 Salbutamol cairan ih 1 mg/mL ampul/vial/botol

257 Salbutamol sulfate/ Salbutamol tablet/kapsul/kaplet 2 mg strip/ blister

258 Salbutamol sulfate/ Salbutamol tablet/kapsul/kaplet 4 mg strip/ blister

259 Salep 2-4, kombinasi: asam salisilat 2% + belerang edap 4%, salep pot 30 gram

260Sertraline hydrochloride (HCl)/ Sertraline/ Sertralin tablet salut/kaplet

salut 50 mg strip/ blister

261 Sevoflurane/ Sevofluran cairan ih botol

262 Simvastatin tablet salut selaput/kaplet salut selaput 10 mg strip/ blister

263 Simvastatin tablet salut selaput/kaplet salut selaput 20 mg strip/ blister

264 Sodium bicarbonate/ Natrium Bikarbonat tablet/kaosul/kaplet 500 mg strip/ blister/maks botol 100

tab

265 Sodium fusidate/ Natrium fusidat krim 20% (20 mg/g) tube

266 Sodium Valproate/ Valproat sirup 250 mg/5 ml maks botol @ 120 ml

Lampiran 1



DIPERSYARATKAN

267 Spiramycin/ Spiramisin tablet salut selaput/kaplet salut selaput 500 mg strip/ blister

268 Spironolactone/ Spironolakton tablet/kapsul/kaplet 100 mg strip/ blister

269 Spironolactone/ Spironolakton tablet/kapsul/kaplet 25 mg strip/ blister

270 Streptomycin sulfate/ Streptomycin/ Streptomisin serbuk inj 1000 mg ampul/vial

271 Sucralfate/ Sukralfat susp 500 mg/5 mL botol

272 Sucralfate/ Sukralfat tablet/kapsul/kaplet 500 mg strip/ blister

273 Sulfadiazine/ Sulfadiazin tablet/kapsul/kaplet 500 mg strip/ blister

274 Telmisartan tablet/kapsul/kaplet 40 mg strip/ blister

275Tetrasiklin/ Tetracycline/ Tetracycline Hydrochloride


276Tetrasiklin/ Tetracycline/ Tetracycline Hydrochloride


277 Tiamin (Vitamin B1) tablet/kapsul/kaplet 50 mg strip/ blister

278Trifluoperazinehydrochloride (HCl)/ Trifluoperazin tablet salut

selaput/kaplet salut selaput 5 mg strip/ blister

279Valaciclovir hydrochloride (HCl)/ Valasiklovir tablet/kapsul/kaplet 500

mg strip/ blister

280 Valsartan tablet salut selaput/ kaplet salut selaput80 mg strip/ blister

281 Valsartan tablet/kapsul/kaplet 160 mg strip/ blister

282 Vitamin B Kompleks tablet strip/ blister

283 Warfarin sodium/ Warfarin tablet 2 mg strip/blister

284 Zinc sulfate/ Zinc sulfate monohydrate/ Zinc/ Zink sir 20 mg/5 ml botol

285Zinc sulfate/ Zinc sulfate monohydrate/Zinc/ Zinc tablet dispersible 20

mg strip/ blister

286Chlorpromazine Hydrochloride / Chlorpromazine /Klorpromazin tablet

salut selaput/kaplet salut selaput 100 mg strip/ blister

287Doksisiklin/ Doxycycline/ Doxycycline hyclate tablet/kapsul/kaplet 100

mg strip/ blister

288 Pyridoxine/ Piridoksin (Vitamin B6) tablet/kapsul/kaplet 25 mg strip/ blister

289 Risperidone/ Risperidon tablet/kapsul/kaplet 2 mg strip/ blister

290Tenofovir Disoproxil Fumarate/ Tenofovir tablet salut selaput/kaplet

salut selaput 300 mgstrip/blister

291Trihexyphenidyl hydrochloride (HCl)/ Triheksifenidil

tablet/kapsul/kaplet 2 mgstrip/blister

Lampiran 2

1 Air untuk irigasi inf botol @ 1.000 mL

2 Anastrozol tablet salut selaput/kaplet salut selaput 1 mg strip/blister

3 Aripiprazol oral solution 1 mg/ml botol

4 Asam Asetilsalisilat (asetosal) tablet/kapsul/kaplet 80 mg strip/blister

5 Asam Mefenamat/Mefenamic acid tablet/kapsul/kaplet 250 mg strip/blister

6 Asam Pipemidat tablet/kapsul/kaplet 400 mg strip/blister

7 Asetazolamid tablet/kapsul/kaplet 250 mg strip/blister

8 Asiklovir salep mata 3% tube

9 Atapulgit tablet/kapsul/kaplet 600 mg strip/blister



12 Atenolol tablet/kapsul/kaplet 50 mg strip/blister

13 Azitromisin/Azithromycin tablet/kaplet/kapsul 250 mg strip/blister

14 Betaksolol tts mata 0,5% botol @ 5 mL

15 Betametason tetes mata 1 mg/ml botol

16 Bikalutamid tablet salut/kaplet salut 150 mg strip/blister

17 Bikalutamid tablet salut/kaplet salut 50 mg strip/blister

18 Bisakodil suppositoria 10 mg strip

19 Bisakodil suppositoria 5 mg strip

20Cefuroxime axetil/ Cefuroxime/ Sefuroksim tablet salut selaput/kaplet salut selaput


21 Chloramphenicol/ Kloramfenikol salep 2% tube 15g

22 Chloramphenicol/ Kloramfenikol serb inj 1000 mg vial/ampul

23 Ciprofloxacin Hydrochloride/ Ciprofloxacin/ Siprofloksasin tetes mata 3 mg/ml botol 5 mL

24 Deksmedetomidin Inj 100 mcg/ml ampul/vial

25 Diazepam enema 10 mg/2,5 mL tube @ 2,5 mL

26 Diazepam enema 5 mg/2,5 mL tube @ 2,5 mL

27 Diclofenac sodium/ Natrium diklofenak tetes mata 1 mg/ml botol 5 mL

28 Doksisiklin/ Doxycycline/ Doxycycline hyclate tablet/kapsul/kaplet 50 mg strip/blister

29 Dutasterid kaps lunak 0,5 mg strip/ blister

30 Erlotinib tablet salut selaput/kaplet salut selaput 100 mg strip/blister

31 Erlotinib tablet salut selaput/kaplet salut selaput 150 mg strip/blister

32 Filgrastim inj 300 mcg/mL ampul/vial

33 Finasterid tablet/kapsul/kaplet 5 mg strip/ blister

34 Flukonazol/ Fluconazole kaps 50 mg strip/ blister

35 Fluoksetin tablet/kapsul/kaplet 10 mg strip/ blister

36 Fluorometolon tetes mata 0,1% botol

37 Flusinolon asetonid krim 0,025% tube @ 5g

38 Fondaparinuks inj 2,5 mg/0,5 mL ampul/vial/prefilled syringe

39 Gabapentin tablet/kapsul/kaplet 100 mg strip/ blister

40 Gefitinib tablet/kapsul/kaplet 250 mg strip/blister

41 Haloperidol drops 2 mg/mL botol

42 Haloperidol tablet/kapsul/kaplet 2 mg strip/ blister

43 Ibandronic Sodium Monohydrate/Asam Ibandronat inj 1 mg/mL ampul/vial

44 Imatinib mesilat tablet/kapsul/kaplet 100 mg strip/blister

45 Imatinib mesilat tablet/kapsul/kaplet 400 mg strip/blister

46 Iodiksanol 320 mg Iodium/50 mL ampul/vial/botol

47 Ioheksol inj 140-350 mg iodium/ml (350mg/100ml) ampul/vial/botol






DIPERSYARATKAN

DAFTAR NAMA OBAT TENDER DAGANG KATALOG OBAT 2020-2022

Lampiran 2


DIPERSYARATKAN


52 Iopamidol 200-300 mg Iodium/mL (300mg/100ml) ampul/vial/botol

53 Iopamidol 200-300 mg Iodium/mL (300mg/50ml) ampul/vial/botol

54 Iopamidol 300-370 mg iodium/ml (370mg/100ml) ampul/vial/botol

55 Iopamidol 300-370 mg iodium/ml (370mg/50ml) ampul/vial/botol

56 Isofluran/ isoflurane cairan inhalasi botol @ 250 mL

57 Kapesitabin/ Capecitabine tab salut/kaplet salut 500 mg strip/ blister

58 Karvedilol tablet/kapsul/kaplet 25 mg strip/ blister

59 Ketokonazol scalp sol 2% botol

60 Ketoprofen supositoria 100 mg strip

61 Klaritromisin sir kering 125 mg/5 ml botol maks 60 mL

62 Kloramfenikol tts mata 0,5% botol

63 Kolkisin tablet/ kapsul/ kaplet/ 500 mcg atau colchicine tablet/kapsul/kaplet 0,5 mg strip/blister

64Kombinasi (DHP): dihidroartemisin 40 mg + Piperakuin 320 mg tablet salut

selaput/kaplet salut selaputstrip/ blister

65 Kombinasi: Ampisilin 1000 mg + Sulbaktam 500 mg serb inj 1500 mg ampul/vial

66 Kombinasi: Ampisilin 500 mg + Sulbaktam 250 mg serb inj 750 mg ampul/vial

67 Kombinasi: benserazid 25 mg + levodopa 100 mg, tablet/kapsul/kaplet strip/blister

68 Kombinasi: Salmeterol 25 mcg + Flutikason propionat 50 mcg aerosol can/canister

69 Latanoprost tts mata 0,005% botol @ 2,5 mL

70 Letrozole/ Letrozol tablet/kapsul/kaplet 2,5 mg strip/blister

71 Leuprorelin asetat serb inj 3,75 mg ampul/vial

72Levofloxacin hemihydrate/ Levofloxacin/Levofloksasin tablet salut selaput/kaplet salut

selaput 250 mgstrip/blister

73 Levofloxacin hemihydrate/ Levofloxacin/Levofloksasin tts mata 0,5% botol @ 5mL

74 Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain gel 2% syringe/syringe plastik

75 Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain spray oral 10% botol

76 Lorazepam tablet/kapsul/kaplet 0,5 mg strip/blister

77 Lorazepam tablet/kapsul/kaplet 1 mg strip/blister

78 Low molecule feri sucrose inj 20 mg/mL (100mg/5mL) ampul/vial

79 Mebendazole/ Mebendazol tablet/kapsul/kaplet 500 mg strip/blister

80Medroxyprogesterone Acetate/ Medroksi Progesteron asetat tablet/kapsul/kaplet 10

mgstrip/blister

81Medroxyprogesterone Acetate/ Medroksi Progesteron Asetat tablet/kapsul/kaplet 100

mgstrip/blister

82 Metronidazole/ Metronidazol suppositoria 500 mg strip

83 Miconazole nitrate/ Miconazole/ Mikonazol serbuk 2% botol / sachet

84 Midazolam hydrochloride/ Midazolam injeksi 1 mg/ml (i.v.) ampul/vial

85 Midazolam hydrochloride/ Midazolam injeksi 5 mg/ml (i.v.) ampul/vial

86 Mikofenolat mofetil tablet/kapsul/kaplet 500 mg strip/blister

87 Mometasone furoate/ Mometason furoat krim 0,1% tube 5 gram

88 Natamycin/ Natamisin tts mata 5% (50 mg/ml) botol @ 15 mL

89 Natamycin/ Natamisin tts mata 5% (50 mg/ml) catchcover, botol @ 0,6 mL

90 Natrium hialuronat tetes mata botol

91 Norethisterone/ Noretisteron tablet/kapsul/kaplet 5 mg strip/ blister

92 Octreotide/ Oktreotid asetat 0,05 - 6 mg/mL ampul/vial

93 Ofloxacin/ Ofloksasin tets telinga 3% Botol @ 5 mL

94 Oxymetazoline/ Oksimetazolin tetes hidung 0,025% botol @ 10 mL

95 Oxymetazoline/ Oksimetazolin tetes hidung 0,050% botol @ 10 mL

96 Permethrin/ Permetrin Krim 5% tube

97 Pirantel pamoat tablet/kapsul/kaplet 250 mg strip/ blister

98 Quetiapine fumarate/ Quetiapin tablet SR/kaplet SR 200 mg strip/ blister

99Risedronat / Risedronate Sodium Hemipentahydrate / Risedronate sodium tablet salut

selaput / kaplet salut selaput 35 mgstrip/ blister

Lampiran 2


DIPERSYARATKAN


100 Ropivacaine hydrochloride (HCl)/ Ropivakain inj 7,5 mg/ml ampul/polyamp/vial

101 Salbutamol MDI/aerosol 100mcg/dosis canister / botol

102 Siprofloksasin tts mata 3 mg/mL botol @ 5 mL

103 Sofosbuvir tablet salut selaput / kaplet salut selaput 400 mg strip/blister

104 Terbutaline sulfate/ Terbutalin injeksi 0,5 mg/ml (s.k./i.v.) ampul/vial

105 Terbutaline sulfate/ Terbutalin sir 1,5 mg/5 mL botol

106 Terbutaline sulfate/ Terbutalin tablet/kapsul/kaplet 2,5 mg strip/ blister

107 Timolol maleate/ Timolol tetes mata 0,25% botol @ 5 mL

108 Timolol maleate/ Timolol tetes mata 0,5% botol @ 5 mL

109 Tobramisin tts mata 0,3% botol @ 5 mL

110 Topiramate/ Topiramat tablet/kapsul/kaplet 25 mg strip/blister

111 Topiramate/ Topiramat tablet/kapsul/kaplet 50 mg strip/blister

112 Triamcinolone acetonide/ Triamsinolon asetonid inj 10 mg/mL ampul/vial

113 Triamcinolone acetonide/ Triamsinolon asetonid inj 40 mg/mL ampul/vial

114 Tropikamid tts mata 0,5% botol @ 5 mL

115 Urea krim 10 % pot

116 Zinc sulfate/ Zinc sulfate monohydrate/ Zink/ Zinc sirup 10 mg/mL botol

117Kombinasi: tenofovir 300 mg + lamivudin 300 mg + efavirenz 600 mg,

tablet/kapsul/kaplet

strip/blister/botol maks 100

tablet

Lampiran 3

Daftar Nama Obat Negosiasi Katalog Obat 2020-2022

1 Acetyl cysteine cairan ih/ N-asetil sistein ih 100 mg/mL (G) PT Dexa Medica

2 Adefovir Dipivoksil tablet/kapsul/kaplet 10 mg PT Smith Kline

3 Afatinib tablet salut selaput/kaplet salut selaput 20 mg PT Boehringer Ingelheim Indonesia



6 Albendazol susp 200mg/5 ml PT Indofarma

7 Alendronat tablet/kapsul/kaplet 70 mg PT Novell Pharmaceuticals

8 Alprazolam tablet/kapsul/kaplet 0,25 mg (G) PT Dexa Medica

9 Alteplase serb inj 50mg/ Alteplase 50mg/vial PT Boehringer Ingelheim Indonesia

10 Amfoterisin B salep mata 1% PT Cendo

11 Aminofilin tablet/kapsul/kaplet 150 mg PT Harsen

12 Amiodaron tablet/kapsul/kaplet 200 mg PT Novell Pharmaceutical Lab

13 Amoksisilin/Amoxicillin/Amoxicillin trihydrate 100 mg/mL drops/ sirup kering, @ 10 mL (G) PT Meprofarm

14 Ampisilin serbuk injeksi 250 mg (i.m/i.v) PT Meiji Indonesia

15 Anti Bakteri salep kombinasi: Basitrasin 500 IU/g + Polimiksin 10.000 IU/g PT Indofarma

16

Antihemoroid, kombinasi sup :

bismut subgalat

heksaklorofen

lidokain

seng oksida

PT Kimia Farma

17 Aripiprazol tab discmelt/tab cepat larut/disintegrating tablet 15 mg (G) PT Dexa Medica

18 Asam Fusidat tetes mata 1% PT Cendo

19 Asam Zoledronat/Zoledronic acid inf 4mg/100 ml PT Ferron Par

20 Atenolol tablet/kapsul/kaplet 100 mg PT Kalbe Farma

21 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) (G) PT Ethica

22 Atropine sulfate/ Atropine/ Atropin tetes mata 0,5% PT Cendo

23 Atropine sulfate/ Atropine/ Atropin tetes mata 1% PT Cendo

24 Azatioprin tablet salut selaput/kaplet salut selaput 50 mg PT Glaxo Wellcome Indonesia

25 Beraprost sodium tablet/kapsul/kaplet 20 mcg PT Combiphar

26 Betahistin tab 24 mg (G) PT Yarindo

27 Betaksolol tts mata 0,5%, catchcover, botol 0,6 mL PT Cendo

28 Betamethasone Dipropionate/ Betametason krim 0,05% (0,5mg/g) (G) PT Tempo Scan Pasifik

29 Bisakodil/Bisacodyl tablet salut/kaplet salut 5 mg PT Etercon Pharma

30 Bisoprolol tablet salut selaput/kaplet salut selaput 10 mg PT Merck

31 Bisoprolol tablet/kapsul/kaplet 1,25 mg PT Merck

32 Brinzolamid tetes mata 1% PT Tempo Scan Pasifik

33 Bromokriptin tablet/kapsul/kaplet 2,5 mg PT Sanbe Farma

34 Budesonid cairan ih 0,25 mg/mL (G) **) PT Pratapa Nirmala

35 Budesonid cairan ih 0,5 mg/mL (G) **) PT Pratapa Nirmala

36 Budesonid cairan inhalasi 0,25mg/mL, respoules 2 mL **) PT Astrazeneca

37 Budesonid cairan inhalasi 0,5 mg/mL, respoules 2 mL **) PT Astrazeneca

38 Budesonid serb ih 200 mcg/dosis, 100 dosis PT Astrazeneca

39 Budesonid serb ih 200 mcg/dosis, 200 dosis PT Otsuka

40 Cefuroxime axetil/ Cefuroxime/ Sefuroksim tablet salut selaput/kaplet salut selaput 250 mg PT Glaxo Wellcome Indonesia

41 Chloramphenicol/ Kloramfenikol tablet/kapsul/kaplet 500 mg PT Actavis

42 Chloramphenicol/ kloramfenikol tts telinga PT Erela

43 Chloramphenicol/Kloramfenikol tetes mata 1% PT Cendo

44 CHLORPROMAZINE HYDROCHLORIDE/ Chlorpromazine / Klorpromazin injeksi 5 mg/ml ( i.m.) PT Phapros

45 Ciclosporin A/ Siklosporin kaps lunak 100 mg PT Novartis

46 Ciclosporin A/ Siklosporin Kaps lunak 50 mg PT Novartis

47 Ciclosporin A/ Siklosporin kapsul lunak 25 mg PT Novartis

48 Cilostazol/ Silostazol tablet/kapsul/kaplet 100 mg (G) PT Bernofarm

49 Clonazepam/ Klonazepam tablet salut selaput/kaplet salut selaput 2 mg (G) PT Mersifarma

50 Clonidine hydrochloride/ Clonidine/ Klonidin injeksi 150 mcg/mL (i.v.) PT Boehringer Ingelheim

51Clopidogrel bisulfate/ Clopidogrel/ Clopidogrel hydrogen sulfate/ Klopidogrel tablet salut selaput/kaplet salut selaput

300 mgPT Aventis Pharma

52 CODEINE PHOSPHATE HEMIHYDRATE/ Codeine/ Kodein tablet/kapsul/kaplet 10 mg PT Kimia Farma

53 CODEINE PHOSPHATE HEMIHYDRATE/ Codeine/ Kodein tablet/kapsul/kaplet 15 mg PTKimia Farma

54 CODEINE PHOSPHATE HEMIHYDRATE/ Codeine/ Kodein tablet/kapsul/kaplet 20 mg PT Kimia Farma

55 Dabigatran etexilate mesilate/ Dabigatran etexilate/ Dabigatran eteksilat tablet/kapsul/kaplet 110 mg PT Boehringer Ingelheim Indonesia

56 Dabigatran etexilate mesilate/ Dabigatran etexilate/ Dabigatran eteksilat tablet/kapsul/kaplet 75 mg PT Boehringer Ingelheim Indonesia

57 Deferasiroks tablet dispersible/kaplet dispersible 250 mg PT Dankos

58 Deferasiroks tablet dispersible/kaplet dispersible 500 mg PT Dankos

59 Deferipron sir 100 mg/mL PT Sydna Farma

60 Deferoksamin Mesilat serbuk injeksi 500 mg PT Novartis

61 Delamanid tablet salut selaput 50 mg PT Otsuka

62 Desogestrel tablet/kapsul/kaplet 75 mcg PT Nufarindo

NO NAMA GENERIK INDUSTRI FARMASI

Lampiran 3



63 Desoksimetason/ Desoximetasone salep 0,25% (G) PT Etercon Pharma

64 Dienogest tablet/kapsul/kaplet 2 mg PT Bayer Indonesia

65 Digoksin injeksi 0,25 mg/ml (G) PT Pratapa Nirmala

66 Diltiazem injeksi inj 5mg/mL (G) PT Pratapa Nirmala

67 Diltiazem Kapsul lepas lambat 100 mg PT Mitsubishi Tanabe Pharma Indonesia

68 Diltiazem Kapsul lepas lambat 200 mg PT Mitsubishi Tanabe Pharma Indonesia

69 Diltiazem serbuk injeksi 50 mg PT Mitsubishi Tanabe Pharma Indonesia

70 Dinatrium klodronat inj/inf 60 mg/mL PT Novell

71 Divalproex sodium / Valproat tabet lepas lambat/kaplet lepas lambat 250 mg (G) PT Dexa Medica

72 Divalproex sodium / Valproat tablet lepas lambat/kapsul lepas lambat 500 mg PT Abbott Indonesia

73 Dobutamin Injeksi 12,5 mg/ml PT Combiphar

74 DOBUTAMINE HYDROCHLORIDE/ Dobutamine/ Dobutamin Injeksi 25 mg/ml PT Pratapa Nirmala

75 Doksazosin/Doksazosin Mesilat tablet/kapsul/kaplet 1 mg (G) PT Harsen

76 Doksazosin/Doksazosin Mesilat tablet/kapsul/kaplet 2 mg PT Harsen

77 Domperidon/ Domperidone maleate/ Domperidone drops 5 mg/mL (G) PT Bernofarm

78 Donepezil tablet dispersible /kaplet dispersible 10 mg PT Eisai Indonesia

79DTPA 2,06-2,5 mg pantetate calsium trisodium/ mL / DTPA- Pentasodium diethylene triamine pentaacetate 10 mg;

SnCl2 2 H2O 0,8 mgPT Kimia Farma

80 Eksemestan tablet salut gula 25 mg PT Pfizer Indonesia

81 Enoksaparin sodium inj 20 mg/0,2 mL PT Aventis Pharma



84 Entekavir tab sal selaput 0,5 mg (G) PT Hexpharm

85 Entekavir tablet salut selaput/kaplet salut selaput 1 mg PT Taisho

86 Estrogen terkonjugasi tablet salut gula/kaplet salut gula 0,625 mg PT Sunthi Sepuri

87 Etonogestrel implan 68 mg PT Merck Sharp Dohme

88 Everolimus tablet/kapsul/kaplet 0,25 mg PT Novartis

89 Everolimus tablet/kapsul/kaplet 0,5 mg PT Novartis

90 Fenitoin/ Phenytoin sodium tablet/kapsul/kaplet 30 mg PT Harsen

91 Fenobarbital/ Phenobarbital injeksi 50 mg/ml (G) PT Phapros

92 Fenobarbital/ Phenobarbital tablet/kapsul/kaplet 30 mg (G) PT Kimia Farma

93 Fenoksimetil penisilin/ Phenoxymethyl Penicillin (penisilin V) tab 250 mg (G) PT Phapros

94 Fenoksimetil penisilin/ Phenoxymethyl Penicillin (penisilin V) tab 500 mg (G) PT Phapros

95 Fenoterol Hydromide/ Fenoterol HBr aerosol 100 mcg/puff PT Boehringer Ingelheim Indonesia

96 Fenoterol Hydromide/ Fenoterol HBr cairan ih 0,1% PT Boehringer Ingelheim Indonesia

97 Fentanil patch 12,5 mcg/jam PT Kimia Farma

98 Fentanil patch 25 mcg/jam PT Kimia Farma

99 Fentanil patch 50 mcg/jam PT Kimia Farma

100 Fludarabin tablet salut/kaplet salut 10 mg PT Aventis Pharma

101 Flukonazol/ Fluconazole tablet/kapsul/kaplet 150 mg (G) PT Kimia Farma

102 Fluorescein Sodium Natrium Fluoresein tetes mata 2% (G) PT Cendo

103 Flusinolon Asetonid salep 0,025% PT Ikapharmindo Putramas

104 Flutikason furoat susp 27,5 mcg/spray PT Glaxo Wellcome Indonesia

105 Flutikason propionat cairan ih 0,5 mg/dosis PT Glaxo Wellcome Indonesia

106 Framisetin sulfat tulle 1% (G) PT Darya Varia

107 Gadobutrol inj 1 mmol/mL, @ 5 mL PT Bayer Indonesia

108 Gadobutrol inj 1 mmol/mL, @ 7,5 mL PT Bayer Indonesia

109 Gadoksetat disodium 0,25 mmol gadoxetate disodium/mL PT Bayer Indonesia

110 Gansiklovir serb inj 500 mg PT Boehringer Ingelheim

111 Gemfibrozil tablet/kapsul/kaplet 600 mg (G) PT Indofarma

112 Gentamisin/ Gentamycin injeksi 40 mg/ ml (G) PT Indofarma

113 Glibenklamid/ Glibenclamide tablet/kapsul/kaplet 2,5 mg PT Harsen

114 Gliklazid tablet lepas lambat/kaplet lepas lambat 60 mg PT Darya Varia Laboratoria

115 Gliklazid tablet/kapsul/kaplet 80 mg (G) PT Tempo Scan Pasifik

116 Glikuidon/ Gliquidone tablet/kapsul/kaplet 30 mg (G) PT Dexa Medica

117 Glipizid tablet/kapsul/kaplet 10 mg PT Pfizer Indonesia

118 Glipizid tablet/kapsul/kaplet 5 mg PT Pfizer Indonesia

119 Gliseril trinitrat kapsul lepas lambat 2,5 mg PT Kimia Farma

120 Gliseril trinitrat kapsul lepas lambat 5 mg PT Kimia Farma

121 Gliseril trinitrat tablet/kapsul/kaplet 0,5 mg PT Actavis Indonesia

122 Gliseril Trinitrat/ Glyceryl trinitrate inj 5 mg/ml PT Tempo Scan Pasifik

123 Gliserin lar 50% PT Lucas Djaja

124 Goserelin asetat serb inj 10,8 mg PT AstraZeneca

125 Goserelin asetat serb inj 3,6 mg PT AstraZeneca

126 Griseofulvin (micronized) tablet/kapsul/kaplet 250 mg PT Galenium

127 Haloperidol inj 50 mg/mL PT Soho Industri Pharmasi

128 Halotan cairan inhalasi PT Dexa Medica

Lampiran 3



129 Heparin, Na injeksi 5000 IU/ml (i.v./s.k.) PT Pratapa Nirmala

130 Hidroklorotiazid/ Hydrochlorothiazide tablet/kapsul/kaplet 25 mg PT Kimia Farma

131 Hidrokortison serb inj 100 mg PT Pratapa Nirmala

132 Hidroksi Urea/ Hydroxy urea tablet/kapsul/kaplet 500 mg PT Dipa Pharmalab

133 Hidromorfon tablet lepas lambat/kaplet lepas lambat 16 mg PT Kimia Farma

134 Hidromorfon tablet lepas lambat/kaplet lepas lambat 8 mg PT Kimia Farma

135 Hiosin butilbromid/Hiosin butilbromida tablet/kapsul/kaplet 10 mg PT Rama Emerald Multi Sukses

136 Homatropin tts mata 2% PT Cendo

137 Imidapril tablet/kapsul/kaplet 10 mg PT Mitsubishi Tanabe Pharma Indonesia

138 Imidapril tablet/kapsul/kaplet 5 mg PT Mitsubishi Tanabe Pharma Indonesia

139 Indakaterol serbuk ih 150 mcg PT Novartis Indonesia

140 Indakaterol serbuk ih 300 mcg PT Novartis Indonesia

141 Iopromid 300 -370 mg Iodium/mL (300 mg / 100 ml) PT Bayer Indonesia




145 Ipratropium Bromida Anhidrous/ Ipratropium bromida aerosol 20 mcg/semprot PT Boehringer Ingelheim

146 Ipratropium Bromide/ Ipratropium bromida cairan ih 0,025% (G) PT Pratapa Nirmala

147 Isofluran/ isoflurane cairan inhalasi botol 100 ml PT Pratapa Nirmala

148 Itrakonazol tablet/kapsul/kaplet 100 mg (G) PT Bernofarm

149 Ivabradin tablet /kapsul/kaplet 5 mg PT Darya Varia Laboratoria

150 Kalium aspartat tablet salut selaput/kaplet salut selaput 300 mg PT Tempo Scan Pasifik

151 Kalium Klorida tablet lepas lambat/kaplet lepas lambat 600 mg PT Merck

152 Kalsitriol kapsul lunak 0,5 mcg PT Phapros

153 Kalsium polistirena sulfonat / Calcium Polystyrene Sulfonate serb 5 g (G) PT Etercon

154 Karbimazol/Carbimazole tablet/kapsul/kaplet 5 mg PT Nicholas Lab Indonesia

155 Karbogliserin tetes telinga 10% PT Lucas Djaja

156 Karvedilol tablet/kapsul/kaplet 6,25 mg PT Kalbe Farma

157 Klaritromisin sir kering 250 mg/5 ml PT Abbott Indonesia

158 Klaritromisin tablet salut selaput/kaplet salut selaput 500 mg (G) PT Etercon Pharma

159

Kombinasi (LPV/r), tablet salut selaput:

Lopinavir 200 mg

Ritonavir 50 mg

PT Abbott Indonesia

160 Kombinasi (LPV/r): lopinavir 100 mg + ritonavir 25 mg tab sal selaput PT Abbott

161

Kombinasi :

Benserazid 25 mg

Levodopa 100 mg

tablet dispersible/kaplet dispersible

PT Boehringer Ingelheim

162

Kombinasi :

Salmeterol 50 mcg

Flutikason propionat 100 mcg

ih 100mcg/puff

PT Glaxo Wellcome Indonesia

163 Kombinasi tab: Zidovudin 300 mg + Lamivudin 150 mg (G) PT Kimia Farma

164

Kombinasi tab:

Levodopa 100 mg

Karbidopa 25 mg

Entekapon 200 mg

tablet/kapsul/kaplet

PT Novartis

165

kombinasi, setiap dosis mengandung :

Budesonid 160 mcg

Formoterol 4,5 mcg

(inhalasi), 120 dosis

PT AstraZeneca Indonesia

166


Budesonid 160 mcg

Formoterol 4,5 mcg

(inhalasi), 60 dosis


167


Budesonid 80 mcg

Formoterol 4,5 mcg

(inhalasi)


168 Kombinasi, setiap mL mengandung: brinzolamid 1% + timolol 0,5%, tts mata PT Tempo Scan Pasifik

169 Kombinasi, setiap mL mengandung: natrium klorida 4,40 mg + kalium klorida 0,80 mg, tts mata PT Cendo

170 Kombinasi: artemether 20 mg + lumefantrin 120 mg tablet/kapsul/kaplet PT Novartis

171 Kombinasi: ergotamin 1 mg + kafein 50 mg, tablet/kapsul/kaplet PT Kimia Farma

172 Kombinasi: ipratropium bromida 0,5 mg + salbutamol 2,5 mg, cairan ih (G) PT Pratapa Nirmala

173 Kombinasi: medroksi progesteron asetat + estradiol sipionat, inj depot 25 mg + 5 mg (G) PT Triyasa Nagamas Farma

174 Kombinasi: parafin + gliserin + fenolftalein Susp PT Ifars

Lampiran 3



175 Kombinasi: Sefiksim 400 mg + Azitromisin 1000 mg PT Kimia Farma

176 Kombinasi: setiap mL mengandung: travoprost 0,004% + timolol 0,5%, tts mata PT Tempo Scan Pasifik

177

Kombinasi:

Salmeterol 50 mcg


ih 250 mcg/puff


178

Kombinasi:

Salmeterol 50 mcg


ih 500 mcg/puff


179 Lamivudine/ Lamivudin tablet/kapsul/kaplet 100 mg (G) PT Kimia Farma

180 Lamivudine/ Lamivudin tablet/kapsul/kaplet 150 mg (G) PT Kimia Farma

181 Lamotrigine/ Lamotrigin tablet dispersible/kaplet dispersible 25 mg PT Glaxo Wellcome Indonesia

182 Lamotrigine/ Lamotrigin tablet/kapsul/kaplet 50 mg PT Glaxo Wellcome Indonesia

183 Lansoprazole/ Lansoprazol serbuk inj 30 mg/ml (G) PT Pratapa Nirmala

184 Lapatinib tosilate/ Lapatinib tablet/kapsul/kaplet 250 mg PT Novartis

185 Leflunomide/ Leflunamid tablet salut selaput/kaplet salut selaput 20 mg PT Aventis Pharma

186 Lenograstim/ Lenogastrim inj 263 mcg PT Aventis Pharma

187 Leuprorelin asetat serbuk injeksi 1,88 mg PT Takeda Indonesia

188 Leuprorelin asetat serbuk injeksi 11,25 mg PT Takeda Indonesia

189 Levetiracetam/ Levetirasetam tablet/kapsul/kaplet 250 mg (G) PT Actavis

190 Levetiracetam/ Levetirasetam tablet/kapsul/kaplet 500 mg (G) PT Actavis

191 Levothyroxine Sodium/ Levothyroxine/ Levotiroksin tablet/kaplet/kapsul 100 mcg (G) PT Novell

192 Levothyroxine Sodium/ Levothyroxine/ Levotiroksin tablet/kapsul/kaplet 50 mcg PT Merck

193 Linestrenol tablet/kapsul/kaplet 0.5 mg (G) PT Harsen

194 Litium karbonat tablet/kapsul/kaplet 200 mg PT Mersifarma Tirmaku Mercusana

195 Litium karbonat tablet/kapsul/kaplet 400 mg PT Mersifarma Tirmaku Mercusana

196 Lorazepam tablet/kapsul/kaplet 2 mg (G) PT Mersifarma

197 Magnesium sulfate/ Magnesium sulfate heptahydrate/ Magnesium sulfat injeksi 20%v (i.v.) PT Otsuka

198 Magnesium sulfate/ Magnesium sulfate heptahydrate/ Magnesium sulfat injeksi 40%v (i.v.) PT Otsuka

199 Maprotilin/Maprotiline HCl tablet salut selaput/kaplet salut selaput 50 mg (G) PT Mersifarma Tirmaku Mercusana

200 MDP- Acidum methylene diphosphonicum 10 mg; SnCl2 2 H2O 0,238 mg; Acidum ascorbicum 2 mg PT Kimia Farma

201 Melfalan/Melphalan tablet/kapsul/kaplet2 mg PT Glaxo Wellcome Indonesia

202 Mesalazine/ Mesalazin tablet salut enterik/kaplet salut enterik 250 mg PT Darya Varia Laboratoria

203 Mesna inj 100 mg/mL PT Menarini

204 Metadon sir 50 mg/5 mL (G) PT Kimia Farma

205 Metamizol/Antalgin Inj 500 mg/ml atau Metamizole Sodium Monohydrate/Antalgin inj 1000 mg/2ml (G) PT Bernofarm

206 Methyldopa/Metildopa tablet/kapsul/kaplet 250 mg PT Actavis Indonesia

207 Metilfenidat/Methylfenidat Hydrochloride tablet/kapsul/kaplet 10 mg (G) PT Mersifarma Tirmaku Mercusana

208 Metoclopramide hydrochloride (HCl)/ Metoclopramide/ Metoklopramid tablet/kapsul/kaplet 5 mg (G) PT Kimia Farma

209 Metoclopramide hydrochloride (HCl)/ Metoclopramide/ Metoklopramide sirup 5 mg/ 5 ml (G) PT First Medifarma

210 Metoprolol tartrate/ Metoprolol tartat inj 1 mg/ml PT Pratapa Nirmala

211 Metronidazole/ Metronidazol ovula 500 mg PT Kimia Farma

212MIBI 5 ml, reaction vial / MIBI- Tetra (2-methoxyisobutyl isonitrile) Copper (1) tetrafluoroborate 1 mg; SnCl2 2 H2O 0,1

mg; Sodium Citrate dihydrate 2,6 mg; L-Cystein 1 mgPT Kimia Farma

213 Mikafungin serb inj 50 mg / Micafungin serbuk injeksi/serbuk infus 50 mg PT Combiphar

214 Mikofenolat sodium tablet salut/kaplet salut 180 mg PT Novartis

215 Mikofenolat sodium tablet salut/kaplet salut 360 mg PT Novartis

216 Milrinone inj 1 mg/mL PT Pratapa Nirmala

217Mineral Mix (Bismuth Subcitrate Tripottasium, Copper sulfate, Magnesium Chloride Anhydrous, Pottasium Chloride,

Zinc Acetate)PT Indofarma

218 Morfin Injeksi 10 mg/ml (i.m/s.k/ i.v) (G) PT Kimia Farma

219 Morphine hydrochloride(HCl)/ Morphine/ Morfin tablet/kapsul/kaplet 10 mg (G) PT Kimia Farma

220 Morphine sulfate/ Morphine/ Morfin tablet lepas lambat/kaplet lepas lambat 10 mg PT Mahakam Beta Farma

221 Morphine sulfate/ Morphine/ Morfin tablet lepas lambat/kaplet lepas lambat 15 mg PT Mahakam Beta Farma

222 Moxifloxacin hydrochloride (HCl)/ Moxifloxacin/ Moksifloksasin tts mata 0,5% PT Tempo Scan Pasifik

223 Naloxone hydrochloride/ Naloxone/ Nalokson injeksi 0,4 mg/ml (G) PT Ethica

224 Natrium fosfat btl, 133 mL PT Combiphar

225 Natrium fosfat lar oral 45 mL PT Combiphar

226 Neostigmin injeksi 0,5 mg/ml (i.v.) (G) PT Ethica

227 Nevirapine/ Nevirapin tablet/kapsul/kaplet 200 mg (G) PT Kimia Farma

228 Nifedipine/ Nifedipin tablet lepas lambat/kaplet lepas lambat 20 mg PT Bayer Indonesia

229 Nifedipine/ Nifedipin tablet lepas lambat/kaplet lepas lambat 30 mg PT Bayer Indonesia

230 Nilotinib hydrochloride (HCl)/ Nilotinib tablet/kapsul/kaplet 150 mg PT Novartis

231 Nilotinib hydrochloride (HCl)/ Nilotinib tablet/kapsul/kaplet 200 mg PT Novartis

232 Nimodipine/Nimodipin tablet salut selaput/kaplet salut selaput 30 mg PT Bayer Indonesia

233 Nomegestrol asetat tablet/kapsul/kaplet 5 mg PT Merck

Lampiran 3



234 Nystatin/ Nistatin tablet salut gula/kaplet salut gula 500.000 IU (G) PT Phapros

235 Nystatin/ Nistatin vaginal tablet/kaplet 100.000 IU (G) PT Phapros

236 Olanzapine/ Olanzapin inj 10 mg/2 mL (10 mg/vial) PT Bayer Indonesia

237 Olopatadine hydrochloride (HCl)/ Olopatadine/ Olopatadin tts mata 0,1% PT Tempo Scan Pasifik

238 Oxytetracycline Hydrochloride/ Oxytetracycline/ Oksitetrasiklin inj 50 mg/mL (i.m.) (G) PT Bernofarm

239 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml PT Boehringer Ingelheim

240 Pegylated interferon alfa-2a inj 180 mcg/0,5 ml PT Boehringer Ingelheim

241 Perindopril arginine tablet/kapsul/kaplet 5 mg PT Darya Varia Laboratoria

242 Pethidine hydrochloride/ Petidin inj 50 mg/mL (i.m./s.k./i.v.) PT Kimia Farma

243 Pilocarpine/ Pilocarpine hydrochloride/ Pilokarpin tetes mata 2%, kemasan catchcover, botol 0,6 mL PT Cendo

244 Pilocarpine/ Pilocarpine hydrochloride/ Pilokarpin tetes mata 2%, kemasan botol 5 mL PT Cendo

245 Pirantel pamoat susp 125 mg/5 ml (G) PT Holi Farma

246 Polietilen Glikol serb PT Meiji Indonesia

247Pramipexole dihydrochloride monohydrate/ Pramipexole hydrochloride monohydrate/ Pramipeksol tablet/kapsul/kaplet

0,125mg (G)PT Dexa Medica

248 Pramipexole dihydrochloride monohydrate/Pramipexole/ Pramipeksol tablet lepas lambat/kaplet lepas lambat 0,375mg PT Boehringer Ingelheim

249 Pramipexole dihydrochloride monohydrate/Pramipexole/ Pramipeksol tablet lepas lambat/kaplet lepas lambat 0,750mg PT Boehringer Ingelheim

250 Probenesid tablet/kapsul/kaplet 500 mg PT Dexa Medica

251 Procaterol hydrochloride (HCl)/ Prokaterol cairan inh 30 mcg PT Otsuka Indonesia

252 Procaterol hydrochloride (HCl)/ Prokaterol cairan inh 50 mcg PT Otsuka Indonesia

253 Procaterol hydrochloride (HCl)/ Prokaterol serb inh 10 mcg/Procaterol hydrochloride (HCl) serbuk inh 10 mcg/dosis PT Otsuka Indonesia

254 Pyridostigmin bromide/ Pyridostigmin/ Piridostigmin tablet/kapsul/kaplet 60 mg PT Menarini Indria Laboratories

255 Quetiapine fumarate/ Quetiapin tab SR 300 mg PT Astrazeneca

256 Quetiapine fumarate/ Quetiapin tablet SR/kapsul SR 400 mg PT AstraZeneca

257 Quinine/ Quinine sulfate/ Kuinin tablet/kapsul/kaplet 200 mg (G) PT Kimia Farma

258 Ramipril tablet/kapsul/kaplet 10 mg PT Novell Pharmaceutical Lab

259 Ramipril tablet/kapsul/kaplet 2,5 mg PT Dexa Medica

260 Ribavirin tab sal selaput 200 mg PT Boehringer Ingelheim Indonesia

261 Rifapentin tablet 150 mg PT Aventis Farma

262 Rilpivirin tablet 25 mg PT Soho Industri Pharmasi

263 Risperidone/ Risperidon tablet/kapsul/kaplet 1 mg (G) PT Dexa Medica

264 Rivaroxaban/ Rivaroksaban tablet salut/kaplet salut 10 mg PT Bayer Indonesia



267 Ropinirole hydrochloride (HCl)/ Ropinirol tablet lepas lambat/kaplet lepas lambat 2 mg PT Glaxo Wellcome Indonesia



270 Salbutamol sulfate/ Salbutamol sir 2 mg/5 mL (G) PT Indofarma

271 Simeprevir tablet/kapsul/kaplet 150 mg PT Soho

272 Sodium bicarbonate/ Natrium Bikarbonat inj 8,4% (i.v.) PT Otsuka

273 Streptokinase serb inj 1,5 juta IU PT Dexa Medica

274 Sufentanil citrate/Sufentanil injeksi 5 mcg/ml (i.v) PT Kimia Farma

275 sugammadex+ORG488302/ sugammadeks inj 100 mg/mL PT Merck Sharp Dohme

276 Sulfadiazine silver/ Perak sulfadiazin krim 1% (tube 35 g) (G) PT Darya Varia Laboratoria

277 Sulfasalazine/ Sulfasalazin tablet salut enterik/kaplet salut enterik 500 mg (G) PT Bernofarm

278 Surfaktan susp 25 mg/mL (intratekal) PT Abbott Indonesia

279 Tacrolimus/ Takrolimus tablet/kapsul/kaplet 0.5 mg PT Combiphar

280 Tacrolimus/ Takrolimus tablet/kapsul/kaplet 1 mg PT Combiphar

281 Takrolimus/ Tacrolimus kapsul lepas lambat 0,5 mg PT Combiphar

282 Takrolimus/ Tacrolimus kapsul lepas lambat 1 mg PT Combiphar

283 Tamoxifen citrate/ Tamoksifen tab 10 mg PT Kalbe Farma

284 Tamsulosin tab lepas lambat / kaplet lepas lambat 0,4 mg (G) PT Novell

285 Tamsulosin tablet/kapsul/kaplet 0,2 mg PT Combiphar

286 Telbivudin tablet/kapsul/kaplet 600 mg PT Novartis

287 Telmisartan tablet/kapsul/kaplet 80 mg (G) PT Dexa Medica

288 Temozolomide/ Temozolamid tablet/kapsul/kaplet 100 mg PT Merck Sharp Dohme

289 Temozolomide/ Temozolamid tablet/kapsul/kaplet 20 mg PT Merck Sharp Dohme

290 Terazosin HCl tablet/kapsul/kaplet 1 mg (G) PT Dexa Medica

291 Terazosin HCl tablet/kapsul/kaplet 2 mg (G) PT Dexa Medica

292 Terbinafine hydrochloride (HCl) / Terbinafin tablet/kapsul/kaplet 250 mg PT Interbat

293 Terbutaline sulfate/ Terbutalin cairan ih 2,5 mg/mL PT AstraZeneca Indonesia

294 Terbutaline sulfate/ Terbutalin serbuk ih 0,50 mg/dosis PT AstraZeneca Indonesia

295 Testosteron Inj 250 mg/ml (vial 4 ml) PT Bayer Indonesia

296 Testosterone undecylate/ Testosteron kapsul lunak 40 mg PT Merck Sharp Dohme

Lampiran 3



297 Tetanus toxoid inj PT Biofarma

298 Tetracaine/ Tetrakain tetes mata 0,5% (G) PT Cendo

299 Theophylline/ Teofilin tablet lepas lambat/kaplet lepas lambat 300 mg PT Kimia Farma

300 Theophylline/ Teofilin tablet/kapsul/kaplet 150 mg PT Kalbe Farma

301 Thiamazole/ Tiamazol tablet salut selaput/kaplet salut selaput 10 mg PT Merck

302 Thiamazole/ Tiamazol tablet salut selaput/kaplet salut selaput 5 mg PT Merck

303 Thiopental Sodium with sodium carbonate/ Thiopental sodium/ Tiopental serb inj 1.000 mg (i.v. bolus) (G) PT Bernofarm

304 Thiopental Sodium with sodium carbonate/ Thiopental sodium/ Tiopental serb inj 500 mg (i.v. bolus) (G) PT Bernofarm

305 Ticagrelor/ Tikagrelor tablet/kapsul/kaplet 90 mg PT AstraZeneca

306 Tiotropium Bromide/ Tiotropium serb ih 18mcg + handihaller PT Boehringer Ingelheim

307 Tiotropium Bromide/ Tiotropium serb ih 18mcg, refill PT Boehringer Ingelheim

308 Tiotropium respimat ih 5 mcg/semprot PT Boehringer Ingelheim

309 Tobramisin tts mata 0,3%, catchcover, botol 0,6 mL PT Cendo

310 Topiramate/ Topiramat tablet/kapsul/kaplet 100 mg PT Soho Industri Pharmasi

311 Travoprost tetes mata 0,004%/ Travoprost cairan mata 0,004% PT Tempo Scan Pasifik

312 Tretinoin/ Asam Retinoat krim 0,1 % PT Immortal Pharmaceutical Lab

313 Triamsinolon asetonid/Triamcinolone acetonide nasal spray/semprot hidung 55 mcg/puff PT Aventis Pharma

314 Tropikamid tts mata 0,5%, catchcover, botol 0,6 mL PT Cendo

315 Tuberkulin protein purified derivative serb inj 2 TU/0,1 mL PT Bio Farma

316 Valganciclovir hydrochloride (HCl)/ Valgansiklovir tablet salut/kaplet salut 450 mg PT Boehringer Ingelheim Ingelheim

317 Vancomycin hydrochloride (HCl)/ Vankomisin serbuk injeksi 500 mg (G) PT Pratapa Nirmala

318 Vasopressin injection/ Vasopresin injeksi 20 IU/ml (i.m/s.k.) PT Pratapa Nirmala

319 Verapamil hydrochloride (HCL)/ Verapamil tablet lepas lambat/kaplet lepas lambat 240 mg PT Abbott Indonesia

320 Verapamil hydrochloride (HCL)/ Verapamil tablet/kapsul/kaplet 80 mg (G) PT Kimia Farma

321 Warfarin potassium/ Warfarin tablet/kapsul/kaplet 1 mg (G) PT Eisai Indonesia

322 Zidovudine/ Zidofudin tablet/kapsul/kaplet 100 mg (G) PT Kimia Farma

323 Aminofluid 1000 mL - Larutan mengandung asam amino PT Otsuka Indonesia

324 Aminofluid 500 mL - Larutan mengandung asam amino PT Otsuka Indonesia

325 Aminofusin Hepar - Larutan mengandung asam amino **) PT Kalbe Farma

326 Aminofusin Paed - Larutan mengandung asam amino PT Kalbe Farma

327 Aminofusn L 600 - Larutan mengandung asam amino PT Kalbe

328 Aminoleban - Larutan mengandung asam amino **) PT Otsuka Indonesia

329 Aminosteril infant 10% - Larutan mengandung asam amino **) PT Fresenius Kabi Combiphar

330 Aminosteril Infant 6% - Larutan mengandung asam amino PT Fresenius Kabi Combiphar

331 Aminosteril N-Hepa 8% - Larutan mengandung Asam Amino PT Fresenius Kabi Combiphar

332 Amiparen - Larutan mengandung asam amino PT Otsuka Indonesia

333 Benutrion VE - Larutan mengandung Asam Amino PT Sanbe

334 Clinimic N9G15E - Larutan mengandung asam amino PT Kalbe Farma

335 Clinimic N9G20E - Larutan mengandung asam amino PT Kalbe Farma

336 Clinoleic 20% 100 mL - Larutan mengandung lipid **) PT Kalbe Farma

337 Clinoleic 20% 250 mL - Larutan mengandung lipid **) PT Kalbe Farma

338 Comafusin Hepar - Larutan mengandung asam amino **) PT Finusolprima Farma Internasional

339 Combiflex Peri - Larutan mengandung asam amino PT Phapros

340 DIPEPTIVEN - Larutan mengandung Asam Amino PT Fresenius Kabi Combiphar

341 EAS PFRIMMER - Larutan mengandung Asam Amino PT Finusolprima Farma Internasional

342 Futrolit - Larutan mengandung karbohidrat+elektrolit PT Sanbe Farma

343 HYDROMAL - Larutan mengandung Karbohidrat+Elektrolit PT Sanbe Farma

344 Infumal - Larutan mengandung karbohidrat **) PT Sanbe Farma

345 INFUSAN D5 (100 ML) - Larutan mengandung karbohidrat **) PT Sanbe

346 INFUSAN D5 (250 ML) - Larutan mengandung karbohidrat PT Sanbe

347 Infusan D5+1/2NS SP - Larutan mengandung Karbohidrat+Elektrolit PT Sanbe

348 Infusan D5+1/4NS SP - Larutan mengandung Karbohidrat+Elektrolit PT Sanbe

349 Infusan D5+NS - Larutan mengandung karbohidrat+elektrolit **) PT Sanbe Farma

350 Infusan RD SP - Larutan Mengandung Karbohidrat+Elektrolit **) PT Sanbe

351 INTRALIPID - Larutan mengandung Lipid PT Fresenius Kabi Combiphar

352 Kabiven Peripheral 1440 mL - Larutan mengandung asam amino PT Fresenius Kabi Combiphar

353 Kabiven Peripheral 1920 mL - Larutan mengandung asam amino PT Fresenius Kabi Combiphar

354 KA-EN 1B - Larutan mengandung elektrolit **) PT Otsuka Indonesia

355 KA-EN 3A - Larutan mengandung elektrolik **) PT Otsuka

356 KA-EN 3B botol plastik - Larutan mengandung elektrolik **) PT Otsuka

357 KA-EN 3B softbag - Larutan mengandung elektrolik **) PT Otsuka

358 KA-EN MG3 - Larutan mengandung karbohidrat+elektrolit **) PT Otsuka

359 Kalbamin - Larutan mengandung asam amino **) PT Finusolprima Farma Internasional

360 KIDMIN - Larutan mengandung asam amino PT Otsuka Indonesia

361 Lipofundin MCT/LCT 20% 100 mL - Larutan mengandung lipid **) PT Phapros

362 Lipofundin MCT/LCT 20% 250 mL - Larutan mengandung lipid **) PT Phapros

363 Lipomed MCT/LCT 20% 100 mL - Larutan mengandung lipid **) PT Sanbe Farma

Lampiran 3



364 Lipomed MCT/LCT 20% 250 mL - Larutan mengandung lipid **) PT Sanbe

365 Martos 10 - Larutan mengandung karbohidrat **) PT Otsuka Indonesia

366 Nephrosteril - Larutan mengandung Asam Amino PT Fresenius Kabi Combiphar

367 Nutriflex Lipid Peri 1250 - Larutan mengandung asam amino PT Phapros

368 Nutriflex Lipid Special 1250 - Larutan mengandung asam amino PT Phapros

369 Nutriflex Lipid Special 625 - Larutan mengandung asam amino **) PT Phapros

370 Omegaven - Larutan mengandung lipid PT Fresenius Kabi Combiphar

371 PAN-AMIN G - Larutan mengandung Asam Amino **) PT Otsuka Indonesia

372 Precopar - Larutan mengandung asam amino **) PT Sanbe Farma

373 Renosan - Larutan mengandung asam amino **) PT Sanbe Farma

374 Ringerfundin - Larutan mengandung elektrolit PT Phapros

375 Smofkabiven - Larutan mengandung Karbohidrat+Elektrolit **) PT Fresenius Kabi Combiphar

376 Smoflipid 20% 100 mL - Larutan mengandung lipid **) PT Fresenius Kabi Combiphar

377 Totilac - Larutan mengandung elektrolit PT Kalbe Farma

378 Tridex 100 - Larutan mengandung karbohidrat+elektrolit **) PT Sanbe

379 Tridex 27A - Larutan mengandung elektrolit **) PT Sanbe

380 Tridex 27B - Larutan mengandung elektrolit **) PT Sanbe

381 Tridex Plain - Larutan mengandung elektrolit **) PT Sanbe Farma

382 Triofusin 1000 - Larutan mengandung karbohidrat **) PT Kalbe

383 Triofusin 1600 - Larutan mengandung karbohidrat **) PT Kalbe Farma

384 Triomix 1600 - Larutan mengandung karbohidrat **) PT Finusolprima Farma Internasional

385 Triofusin 500 - Larutan mengandung karbohidrat **) PT Kalbe Farma

386 Triomix 500 - Larutan mengandung karbohidrat **) PT Finusolprima Farma Internasional

387 Triofusin E 1000 - Larutan mengandung karbohidrat+elektrolit **) PT Kalbe Farma

388 Triomix 1000 - Larutan mengandung karbohidrat+elektrolit **) PT Finusolprima Farma Internasional

389 Tutofusin OPS - Larutan mengandung karbohidrat+elektrolit PT Kalbe Farma

390 Valamin - Larutan mengandung asam amino **) PT Sanbe Farma

391 WIDA 2A - Larutan mengandung karbohidrat+elektrolit PT Widatra Bhakti

392 WIDA D5-1/2NS - Larutan mengandung karbohidrat+elektrolit PT Widatra Bhakti

393 WIDA D5-1/4NS - Larutan mengandung karbohidrat+elektrolit PT Widatra Bhakti

394 WIDA D5NS - Larutan mengandung karbohidrat+elektrolit **) PT Widatra Bhakti

395 WIDA HSD - Larutan Mengandung Karbohidrat+Elektrolit PT Widatra

396 WIDA KDN1 - Larutan mengandung karbohidrat+elektrolit 500 ml PT Widatra

397 WIDA KDN2 - Larutan mengandung karbohidrat+elektrolit 500 ml PT Widatra

398 WIDA KN1 - Larutan mengandung elektrolit 500 ml PT Widatra

399 WIDA KN2 - Larutan mengandung elektrolit 500 ml PT Widatra

400 WIDA RD - Larutan Mengandung Karbohidrat+Elektrolit **) PT Widatra

401Albumin serum normal (human

Albumin) inj 20% 100 mLSeluruh industri farmasi





404 Albumin serum normal (human Albumin) inj 25% 20 mL Seluruh industri farmasi







408 Analog insulin long acting inj 100 IU/mL, vial/cartridge disposible/penfill cartridge Seluruh industri farmasi

409 Analog insulin mix insulin inj 100 IU/mL (kemasan vial, cartridge disposible, penfill cartridge) Seluruh industri farmasi

410 Analog insulin rapid acting inj 100 IU/mL (cartridge disposible, penfill cartridge) Seluruh industri farmasi

411 Asparaginase serb inj 10.000 IU Seluruh industri farmasi

412 Bleomisin serb inj 15 mg Seluruh industri farmasi

413 Cisplatin/ Sisplatin serb inj 10 mg Seluruh industri farmasi

414 Cisplatin/ Sisplatin serb inj 50 mg Seluruh industri farmasi

415 CODEINE PHOSPHATE HEMIHYDRATE/ Codeine/ Kodein tablet/kapsul/kaplet 20 mg Seluruh industri farmasi

416 Cyclophosphamide monohydrate/ Cyclophosphamide/ siklofosfamid serb inj 1.000 mg (i.v.) Seluruh industri farmasi

417 Cyclophosphamide monohydrate/ Cyclophosphamide/ siklofosfamid serb inj 200 mg (i.v.) Seluruh industri farmasi

418 Cyclophosphamide monohydrate/ Cyclophosphamide/ siklofosfamid serb inj 500 mg (i.v.) Seluruh industri farmasi

419 Cytarabine/ Sitarabin inj 100 mg/ml (i.m./i.v/s.k.) **) Seluruh industri farmasi

420 Dakarbazin/Dacarbazine serb inj 200 mg Seluruh industri farmasi

421 Daunorubisin serb inj 20 mg Seluruh industri farmasi

422 Dialisa peritoneal, lar intraperitoneal dengan dekstrose 1,5% Seluruh industri farmasi

423 Dialisa peritoneal, lar intraperitoneal dengan dekstrose 2,5% Seluruh industri farmasi

424 Doksorubisin /Doxorubicin HCl serbuk inj 50 mg Seluruh industri farmasi

Lampiran 3



425 Doksorubisin/ Doxorubicin HCl serb inj 10 mg (i.v.) Seluruh industri farmasi

426 Epirubisin/Epirubicin Hydrochloride injeksi 2 mg/mL, vial 5 mL Seluruh industri farmasi

427 Epirubisin/Epirubicin Hydrochloride injeksi 2 mg/mL, vial 25 mL Seluruh industri farmasi

428 Epirubisin/Epirubicin Hydrochloride serb injeksi 50 mg / inj 50 mg/25 mL Seluruh industri farmasi

429 Eritropoetin-alfa inj 10000 IU Seluruh industri farmasi



432 Etoposid inj 20 mg/mL Seluruh industri farmasi

433 Faktor IX kompleks serb inj 1.000 IU + pelarut 10 mL Seluruh industri farmasi

434 Faktor IX kompleks serb inj 500 IU + pelarut 5 mL Seluruh industri farmasi

435Faktor koagulasi II, faktor

koagulasi VII, faktor koagulasi, faktor IX, faktor koagulasi X, serb inj 500 IU/10 mLSeluruh industri farmasi

436 Faktor VIIA serb inj + pelarut untuk injeksi Seluruh industri farmasi

437 Faktor VIII serb inj 1.000 IU Seluruh industri farmasi

438 Faktor VIII serb inj 230-340 IU Seluruh industri farmasi

439 Faktor VIII serb inj 250 IU + pelarut 10 mL Seluruh industri farmasi

440 Faktor VIII serb inj 480-600 IU Seluruh industri farmasi

441 Faktor VIII serb inj 500 IU + pelarut 5 mL Seluruh industri farmasi

442 Faktor IX kompleks inj 50 IU/mL Seluruh industri farmasi

443 Fludarabin serb inj 50 mg Seluruh industri farmasi

444 fluorourasil inj 50 mg/mL (@ 10 mL) Seluruh industri farmasi

445 Fraksi Protein Plasma inf 5% Seluruh industri farmasi

446 Gemsitabin/ Gemcitabine / Gemcitabine HCl serb inj / lar inj 1000 mg Seluruh industri farmasi

447 Gemsitabin/ Gemcitabine / Gemcitabine HCl serb inj / lar inj 200 mg Seluruh industri farmasi

448 Human Insulin intermediate acting inj 100 IU/ml, cartridge disposible/penfill cartridge Seluruh industri farmasi

449 Human insulin intermediate acting inj 100 IU/mL, vial 10 mL Seluruh industri farmasi

450 Human insulin mix insulin inj 100 IU/mL (kemasan vial, cartridge disposible, penfill cartridge) Seluruh industri farmasi

451 Human insulin mix insulin inj 100 IU/mL, vial 10 mL Seluruh industri farmasi

452 Human insulin short acting inj 100 IU/ml, cartridge disposible/penfill cartridge Seluruh industri farmasi

453 Human insulin short acting inj 100 IU/ml, vial 10 mL Seluruh industri farmasi

454 ifosfamid serb inj 1.000 mg Seluruh industri farmasi

455 Ifosfamid serb inj 2000 mg Seluruh industri farmasi

456 Ifosfamid serb inj 500 mg Seluruh industri farmasi

457 Imunoglobullin Intravena inj 250 mg/50 ml Seluruh industri farmasi

458 Irinotekan/ Irininotecan HCl/ Irinotecan HCl trihydrate inf 20 mg/mL Seluruh industri farmasi

459 Irinotekan/ Irininotecan HCl/ Irinotecan HCl trihydrate inj 20 mg/mL Seluruh industri farmasi

460 karboplatin/ carboplatin inj/inf 10 mg/mL (vial 15mL) Seluruh industri farmasi

461 karboplatin/ carboplatin inj/inf 10 mg/mL (vial 45mL) Seluruh industri farmasi

462 Methotrexate/ metotreksat inj 25 mg/mL Seluruh industri farmasi

463 Octreotide/ Oktreotid LAR serb inj 20 mg Seluruh industri farmasi

464 Octreotide/ Oktreotid LAR serb inj 30 mg Seluruh industri farmasi

465 Oxaliplatin/ oksaliplatin serb inj 100 mg Seluruh industri farmasi

466 Oxaliplatin/ oksaliplatin serb inj 50 mg Seluruh industri farmasi

467 Paclitaxel/ paklitaksel inj 6 mg/mL, vial @ 16,7 mL(inj 100 mg) Seluruh industri farmasi

468 Paclitaxel/ paklitaksel inj 6 mg/mL, vial @ 5 mL (inj 30 mg) Seluruh industri farmasi

469 Paclitaxel/ paklitaksel inj 6 mg/mL, vial @ 50 mL (inj 300 mg) Seluruh industri farmasi

470 Pemetreksed serb injeksi 500 mg Seluruh industri farmasi

471 Pengganti plasma golongan gelatin inf Seluruh industri farmasi

472 Ranibizumab inj 10 mg/mL Seluruh industri farmasi

473 Rituximab/ Rituksimab infus 10 mg/ml (vial @ 10 ml) Seluruh industri farmasi

474 Rituximab/ Rituksimab infus 10 mg/ml (vial @ 50 ml) Seluruh industri farmasi

475 Serum anti bisa ular A.B.U. I inj (i.m./i.v) Seluruh industri farmasi

476 Serum antidifteri (A.D.S) inj i.m 20.000 IU/mL (i.m.) Seluruh industri farmasi

477 Serum antitetanus (A.T.S) inj 1500 IU/mL (i.m) Seluruh industri farmasi

478 Setuksimab injeksi 5 mg/mL Seluruh industri farmasi

479 Trastuzumab serb inj 440 mg Seluruh industri farmasi

480 Vaksin Campak inj s.k + pelarut Seluruh industri farmasi

481 Vaksin Hepatitis B Rekombinan Prefilledsyringe (Uniject) @ 0,5 Ml Seluruh industri farmasi

482 Vaksin Polio 10 dosis (b-opv) Seluruh industri farmasi

483 Vaksin Yellow Fever Seluruh industri farmasi

484 Vinblastin inj 1 mg/mL Seluruh industri farmasi

485 Vincristine sulfate/ Vinkristin inj 1 mg/ml (vial 1 mL) (i.v.) Seluruh industri farmasi

486 Vincristine sulfate/ Vinkristin inj 1 mg/ml (vial 2 mL) (i.v.) Seluruh industri farmasi

487 Vinorelbine tartrate/ vinorelbin inj 50 mg/ 5 mL (10 mg/mL) Seluruh industri farmasi

488 Vinorelbine tartrate/ vinorelbin inj 50 mg/ 5 mL (10 mg/mL), kemasan 1 mL Seluruh industri farmasi

Lampiran 3



489 Hepatitis B imunoglobulin (human) inj 220 IU/mL Seluruh industri farmasi

490 Human tetanus imunoglobulin inj 250 IU (i.m.) Seluruh industri farmasi

491 Vaksin influenza Seluruh industri farmasi

492 Vaksin Meningitis Seluruh industri farmasi

493 Amoksisilin/Amoxicillintablet/kapsul/kaplet 500 mg Seluruh industri farmasi

494 Asam askorbat (vitamin C) tablet/kapsul/kaplet 50 mg Seluruh industri farmasi

495 Asam Mefenamat/Mefenamic acid tablet/kapsul/kaplet 500 mg Seluruh industri farmasi

496 Kaptopril/ Captopril tablet/kaplet 25 mg Seluruh industri farmasi

497 CHLORPHENAMINE MALEATE/Klorfeniramin tablet/kapsul/kaplet 4 mg Seluruh industri farmasi

498 Paracetamol/ Parasetamol tablet/kapsul/kaplet 500 mg Seluruh industri farmasi

499 Asetat Ringer (softbag, flexy bag, plabot) Seluruh industri farmasi

500 Glukosa larutan infus 10% 500 mL Seluruh industri farmasi

501 Glukosa larutan infus 5 % 500 mL Seluruh industri farmasi

502 Glukosa Larutan Infus 5% steril 100 ml Seluruh industri farmasi

503 Glukosa Larutan Infus 5% steril 250 ml Seluruh industri farmasi

504 Kalium klorida / Potasium klorida injeksi 25 mg 7,46% 25 mL Seluruh industri farmasi

505 Nacl 0,9% / Sodium Chloride 0,9%, 500 mL Seluruh industri farmasi

506 Ringer Laktat/ Ringer Lactate, @1000 ml Seluruh industri farmasi

507 Ringer Laktat/ Ringer Lactate, @500 mL Seluruh industri farmasi

508 Artesunate injeksi 60 mg/mL (i.v./i.m.) PT Pharma Laboratories

509 Bedaquiline/Bedaquiline fumarate tablet 100 mg PT Soho

510 Efavirens tablet salut selaput/kaplet salut selaput 600 mg (G) PT Kimia Farma

511 Flufenazin injeksi 25 mg/mL (i.m ) PT Mersifarma Tirmaku Mercusana

512 Kanamisin/ Kanamycin serb inj 1000 mg PT Harsen

513 Kombinasi: Elbasvir 50 mg dan Grazoprevir 100 mg Tablet/Kapsul/Kaplet PT MSD

514 Quinine Dihydrochloride/ kuinin inj 25% (i.v) (G) PT Kimia Farma

515 Vaksin DPT-HB-Hib Seluruh industri farmasi

516 Vaksin Jerap difteri tetanus (DT) cairan inj i.m 40/15 If per mL Seluruh industri farmasi

517 Vaksin Jerap difteri tetanus (Td) cairan inj i.m 15/4 If per mL Seluruh industri farmasi

518 Vaksin MR (Measles and Rubella Vaccine), 10 dosis Seluruh industri farmasi

519 Vaksin Pneumococcus 13 (PCV13), Prefilled syringe 1 dosis @0,5 mL Seluruh industri farmasi

520 Vaksin Pneumococcus 13 (PCV13), vial 1 dosis @0,5 mL Seluruh industri farmasi

521 Vaksin Rabies untuk manusia, serb inj 2,5 IU (s.k.) Seluruh industri farmasi

Pengumuman - LKPP

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