Sk Standar Satuan Harga Barang & Jasa Kota Gorontalo Tahun 2017

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• BARANG DAN JASA

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K E P U T U S A N W A L I K O T A G O R O N T A L O N O M O R : 2 5 - ' / ''1 / V I I ) f 2 0 1 6 T E N T A N G S T A N D A R S A T U A N PLU^GA B A R A N G D A N J A S A P E M E R I N T A H K O T A G O R O N T A L O T A H U N A N G G A R A N 2 0 1 7 W A L I K O T / x G O R O N T A L O , M e n i m b a n g : a. b a h w a g u n a m e n d u k u n g t e r l a k s a n a n y a tertib a d m i n i s t r a s i p e r e n c a n a a n d a n p e l a k s a n a a n A n g g a r a n P e n d a p a t a n d a n B e l a n j a D a e r a h , d i l a k u k a n u p a y a - u p a y a y a n g efektif dar. efisien;

b. b a h w a untulc m e w u j u d k a n tertib a d m i n i s t r a s i p e r e n c a n a a n d a n P e l a k s a n a a n A n g g a r a n P e n d a p a t a n d a n B e l a n j a D a e r a h , p e r l u d i t e t a p k a n S t a n d a r S a t u a n H a r g a ; c. b a h w a b e r d a s a r k a n p e r t i m b a n g a n s e b a g a i m a n a d i m a k s u d d a l a m h u r u f a d a n h u r u f b p e r l u m e n e t a p k a n K e p u t u s a n W a l i k o t a Gorontalo t e n t a n g S t a n d a r S a t u a n H a r g a B a r a n g d a n J a s a P e m e r i n t a h K o t a G o r o n t a l o T a h u n A n g g a r a n 2 0 1 7 ; Wengingat : 1. U n d a n g - U n d a r g Nomor 2 9 T a h u n 1959 t e n t a n g P e m b e n t u k a n D a e r a h - d a e r a h T i n g k a t 11 di S u l a w e s i ( L e m b a r a n N f g a r a R e p u b l i k I n d o n e s i a T a h u n 1 9 5 9 Nomor 7 4 , ' " a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 1822); 2. U n d a n g - U n d a i i g Nomor 3 8 T a h u n 2 0 0 0 t e n t a n g P e m b e n t u k a n P r o v i n s i Gorontalo ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 0 0 Nomor 2 5 8 , T a m b a h a n T ^^u^,.r^r^ M*.nraT-o P*>niil-i1ili- Trjrinnpsia Nomor 40601:

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3. Undang-Undang Nomor 33 Tahun 2004 tentang

P e r i m b a n g a n K e u a n g a n a n t a r a P e m e r i n t a h P u s a t d a n P e m e r i n t a h a n D a e r a h ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u r . 2 0 0 4 Nomor 126, T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 4 4 3 8 ) ; 4. U n d a n g - U n d a n g Nomor 2 3 T a h u n 2 0 1 4 t e n t a n g P e m e r i n t a h a n D a e r a h ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 1 4 Nomor 2 4 4 , T a m b a h a n L e m b a r a n Negara R e p u b l i c I n d o n e s i a Nomor 5587) s e b a g a i m a n a telah b e b e r a p a k a l i d i u b a h t e r a k h i r d e n g a n U n d a n g - U n d a n g Nomor 9 T a h u n 2 0 1 5 ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 1 5 Nomor 5 8 , T a m b a h a n L e m b a r a n Negai a R e p u b l i k I n d o n e s i a Nomor 5 6 7 9 ) ;

5. P e r a t u r a n Pemi^rintah Nomor 5 8 T a h u n 2 0 0 5 tentang Pengelolaan K e u a n g a n D a e r a h ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 0 5 Nomor 140, T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 4 5 7 8 ) ; 6. P e r a t u r a n P e m e r i n t a h Nomor 2 7 T a h u n 2 0 1 4 tentang Pengelolaan B i i r a n g Milik N e g a r a / D a e r a h ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 1 4 Nomor 9 2 , T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 5533); 7. P e r a t u r a n P r e s i d e n Nomor 54 T a h u n 2 0 1 0 tentang P e n g a d a a n B a r a n g / J a s a P e m e r i n t a h s e b a g a i m a n a telah b e b e r a p a k a l i d i u b a h t e r a k h i r d e n g a n P e r a t u r a n P r e s i d e n Nomor 7 0 T a h u n 2 0 1 2 ;

8. P e r a t u r a n Menteri D a l a m Negeri Nomor 19 T a h u n 2 0 1 6 t e n t a n g P e d o m a n T e k n i s Pengelolaan B a r a n g Milik D a e r a h ; M E M U T U S K A N : M e n e t a p k a n : K E S A T U : S t a n d a r S a t u a n H a r g a B a r a n g d a n J a s a P e m e r i n t a h K o t a G o r o n t a l o T a h u n A n g g a r a n 2 0 1 7 s e b a g a i m a n a t e r c a n t u m d a l a m L a m p i r a i y a n g m e r u p a k a n b a g i a n y a n g t i d a k

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KEDUA

KISTIGA

K E E M P A T

Pelaksanaan Anjjgaran Pendapatan dan Belanja Daerah

K o t a Gorontalo T a h u n A n g g a r a n 2 0 1 7 b e r p e d o m a n p a d a S t a n d a r S a t u a r i H a r g a d a n J a s a P e m e r i n t a h K o t a Gorontalo T a h u r A n g g a r a n 2 0 1 7 . P a d a s a a t K e p u t u s a n i n i m u l a i b e r l a k u , K e p u t u s a n W a l i k o t a Gorontalo Nomor : 3 1 3 / l l / X l l / 2 0 1 5 t e n t a n g P e n e t a p a n S t a n d a r S a t u a n H a r g a B a r a n g d a n J a s a P e m e r i n t a h K o t a Gorontalo T a h u n A n g g a r a n 2 0 1 6 d i n y a t a k a n tidak b e r l a k u . K e p u t u s a n W a l i k o t a i n i m u l a i b e r l a k u p a d a tanggal d i t e t a p k a n . D i t e t a p k a n di Gorontalo p a d a tanggal 1 k t; u a t u e W A L U f f l T A G O R O N T A L O , 2 0 1 6 M A R T E N A. T A H A T e m b u s a n d i s a m p a i k a n k e p a d a Y t h : 1. K e t u a D e w a n P e r w a k i l a n R a k y a t D a e r a h K o t a Gorontalo. 2. I n s p e k t u r K o t a Gorontalo. 3 . K e p a l a B a d a n P e r e n c a n a a n P e m b a n g u n a n D a e r a h K o t a Gorontalo. 4. P a r a C a m a t se K o t a Gorontalo di Gorontalo.

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K E P U T U S A N W A L I K O T A G O R O N T A L O N O M O R : 2 5 . / 1 1 / v i i l / 2 0 1 6 T E N T A N G S T A N D A R S A T U A N H A R G A B A R A N G D A N J A S A P E M E R I N T A H K O T A G O R O N T A L O T A H U N A N G G A R A N 2 0 1 7 W A L I K O T A G O R O N T A L O , M e n i m b a n g : a. b a h w a guna m e n d u k u n g t e r l a k s a n a n y a tertib a d m i n i s t r a s i p e r e n c a n a a n d a n p e l a k s a n a a n A n g g a r a n P e n d a p a t a n d a n B e l a n j a D a e r a h , d i l a k u k a n u p a y a - u p a y a y a n g efektif d a n efisien; b. b a h w a u n t u k m e w u j u d k a n tertib a d m i n i s t r a s i p e r e n c a n a a n d a n P e l a k s a n a a n A n g g a r a n P e n d a p a t a n d a n B e l a n j a E ' a e r a h , p e r l u d i t e t a p k a n S t a n d a r S a t u a n H a r g a ; c. b a h w a b e r d a s a r k a n p e r t i m b a n g a n s e b a g a i m a n a d i m a k s u d d a l a m h u r u f a d a n h u r u f b p e r l u m e n e t a p k a n K e p u t u s a n W a l i k o t a Gorontalo t e n t a n g S t a n d a r S a t u a n H a r g a B a r a n g d a n J a s a P e m e r i n t a h K o t a Gorontalo T a h u n A n g g a r a n 2 0 1 7 ; Mengingat : 1. U n d a n g - U n d a n g Nomor 2 9 T a h u n 1959 t e n t a n g P e m b e n t u k a n D a e r a h - d a e r a h T i n g k a t 11 di S u l a w e s i ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 1 9 5 9 Nomor 74, T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomgr 1822); 2. U n d a n g - U n d a r g Nomor 3 8 T a h u n 2 0 0 0 t e n t a n g P e m b e n t u k a n P r o v i n s i Gorontalo ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 0 0 Nomor 2 5 8 , T a m b a h a n T 1 A T T-> l - l X l - T 1 T _ A T A r\rz r\\ .

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3. Undang-Undarg Nomor 33 Tahun 2004 tentang

P e r i m b a n g a n K e u a n g a n a n t a r a P e m e r i n t a h P u s a t d a n P e m e r i n t a h a n D a e r a h ( L e m b a r a n N e g a r a R e p u b l i k I n d o n e s i a T a h u n 2 0 0 4 Nomor 126, T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 4 4 3 8 ) ; 4. U n d a n g - U n d a n g Nomor 2 3 T a h u n 2 0 1 4 tentang P e m e r i n t a h a n D a e r a h ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 1 4 Nomor 2 4 4 , T a m b a h a n L e m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 5587) s e b a g a i m a n a telah b e b e r a p a k a l i d i u b a h t e r a k h i r d e n g a n U n d a n g - U n d a n g Nomor 9 T a h u n 2 0 1 5 ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 1 5 Nomor 5 8 , T a m b a h a n L e m b a r a n Neg£.ra R e p u b l i k I n d o n e s i a Nomor 5679); 5. P e r a t u r a n P e n e r i n t a h Nomor 5 8 T a h u n 2 0 0 5 tentang Pengelolaan K e u a n g a n D a e r a h ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 0 5 Nomor 140, T a m b a h a n L e m b a r a n Negexa R e p u b l i k I n d o n e s i a Nomor 4 5 7 8 ) ; 6. P e r a t u r a n P e r r e r i n t a h Nomor 2 7 T a h u n 2 0 1 4 tentang Pengelolaan B a r a n g Milik N e g a r a / D a e r a h ( L e m b a r a n Negara R e p u b l i k I n d o n e s i a T a h u n 2 0 1 4 Nomor 9 2 , T a m b a h a n D ^ m b a r a n Negara R e p u b l i k I n d o n e s i a Nomor 5 5 3 3 ) ; 7. P e r a t u r a n P r e s i d e n Nomor 54 T a h u n 2 0 1 0 tentang P e n g a d a a n B a r a n g / J a s a P e m e r i n t a h s e b a g a i m a n a telah b e b e r a p a k a l i c i u b a h t e r a k h i r d e n g a n P e r a t u r a n P r e s i d e n Nomor 7 0 T a h u n 2 0 1 2 ;

8. P e r a t u r a n Menteri D a l a m Negeri Nomor 19 T a h u n 2 0 1 6 tentang P e d o m a n T e k n i s Pengelolaan B a r a n g Milik D a e r a h ; M E M U T U S K A N : S t a n d a r S a t u a n H a r g a B a r a n g d a n J a s a P e m e r i n t a h K o t a G o r o n t a l o T a h u n A n g g a r a n 2 0 1 7 s e b a g a i m a n a t e r c a n t u m d a l a m L a m p i r a n y a n g m e r u p a k a n b a g i a n y a n g t i d a k M e n e t a p k a n K E S A T U

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R.EDUA : Pelaksanaan Anggaran Pendapatan dan Belanja Daerah

K o t a Gorontalo T a h u n A n g g a r a n 2 0 1 7 b e r p e d o m a n p a d a S t a n d a r S a t u a n H a r g a d a n J a s a P e m e r i n t a h K o t a Gorontalo T a h u n A n g g a r a n 2 0 1 7 . K E T I G A : P a d a s a a t K e p u t u s a n i n i m u l a i b e r l a k u , K e p u t u s a n W a l i k o t a Gorontalo Nomor : 3 1 3 / l l / X I I / 2 0 1 5 t e n t a n g P e n e t a p a n S t a j i d a r S a t u a n H a r g a B a r a n g d a n J a s a P e m e r i n t a h K c t a Gorontalo T a h u n A n g g a r a n 2 0 1 6 d i n y a t a k a n tida^c b e r l a k u . K E E M P A T : K e p u t u s a n W a l i k o t a i n i m u l a i b e r l a k u p a d a tanggal d i t e t a p k a n . D i t e t a p k a n di Gorontalo p a d a tanggal 1 i4.i,astas 2 0 1 6 " ^ W A L I K O T A G O R O N T A L O , T e m b u s a n d i s a m p a i k a n k e p a d a Y t h : 1. K e t u a D e w a n P e r w a k i l a n R a k y a t D a e r a h K o t a Gorontalo. 2. I n s p e k t u r K o t a Gorontalo. 3. K e p a l a B a d a n P e r e n c a n a a n P e m b a n g u n a n D a e r a h K o t a Gorontalo. 4. P a r a C a m a t se K o t a Gorontalo di Gorontalo.

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KEPUTUSAN WALIKOTA GGRONl AUG NOMOR: 2 5 » / 1 1 /VII12016

TENTANG

STANDAR SATUAN HARGA BARAMG DAN JASA PEMERINRAH KOTA GORONTALC

TAHUN ANGGARAN 2017

D A F l A R I S I

L TENGADAAN 1

A. GOLONGAN BARANG PAKAI HABIS 1

A . I . Alat Tulis Menulis Kantor 1

A.2 Barang Cetakan 4 A.3. Obat-Obatan 6 A. 4. Peralatan Listrik 36 B. GOLONGAN BARANG INVENTARIS 41

B. I . Bangunan Gedung dan Bangunan Paga- 41 B.2. Daftar Satuan Bahan Bangunan, Upah, Peralatan dan Pekerjaan 42

B.3. Suku Cadang Kendaraan Bermotor 45 B.4. Alat Kantor dan Alat Riunah Tangga 58 B.5 Projector, Camera dan Peralatan Komp jter 63

B.6 Barang - Barang Elektronik 69 B.7. Alat Berat dan Alat Bantunya 79

B.8. Alat - Alat Angkutan 80 B.9 Alat Bengkel dan Alat Ukur 87

B.IO.AIatPertanian 89

B. 11 .Alat Studio Dan Alat Komuuikasi 91

B. 12. Alat - Alat Kesehatan (PMK No. 75 Ta run 2014) 92

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. Suku Cadangau Alat Pendingiu Ruangan /A<r 110

2. Pemeliharaan dan Perawatan Alat Pendingin Ruangan /AC 112

:•. Lampiran Pemeliharaan dan Perawatan AC UT Daftar Layanan Klaim Kendaraan Bermotor 114

a. Layanan Klaim Honda 114 b. Layanan Klaim Suzuki 115 c. Layanan Klaim Yamalia 116

IK. L A I N - L A I N N Y A 117

1. Tarif Angkutan 117 1.1. Tarif Angkutan Darat 117

1.2. Tarif Angkutan Umum AKAP Dan AKDP 118

1.3. Tarif Angkutan Laut 119 2. Perlengkapan Olahraga 123 3. Pelengkapan Pegawai 124

3.1. Bahan Pakaian Dinas Pegawai Dan Jasa Jahit 125

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A . I . A L A T T U L I S MENULIS KANTOR

NO. JENIS BARANG DAN P E R A L A T A N SATUAN HARGA

Rp K E T

/ 2 3 4 5

1 B U K U

- Agenda M/K 100 Lbr Buali 26,235

- Folio 100 Lbr Buah 25,652

- Kas Folio 100 Lbr Buah 21,730

- Expedisi 100 Lbr Buah 14,109

- KasKwartolOOLbr Buah 14,109

- Kas Folio 50 Lbr Buah 15,391

- Kwarto 100 Lbr Buah 14,109

- Kwarto 50 Lbr Buah 9,620

- Kwitansi 50 Lbr Buah 5,130

2 P U L P E N

- H e r 0 2221 Buah 205,216

- Parker Standar Buah 83,369

3 B A L L P O I N T

- Pilot Super Buah 18,598

- Pilot BP - T Buah 3,207

- Castelo Buah 1,924

- Zebra B - Pen Buah 21,163

4 AM P L O P

- Mambo Kabinet Buah 24,369

- Mambo Sedang Buah 15,391

- Kasing 28 x 49 Buah 2,650

- Kaing Airmail Buah 1,924

S B A V T A L C A P

- Artline No. 1 Buah 51,304

- Artline No. 1 Kecil No. 00 Buah 32,065

- Hero Besar Cadwell Buah 10,261

- Hero Kecil Buah 7,696

6 BATTEREY

- ABC Besar Pasang 22,446

- ABC Sedang /AA Pasang 12,185

- ABC Kecil/AAA Pasang 12,185

- Alkaline Sedang /AA Pasang 15,741

- Alkaline Kecil /AAA Pasang 12,826

- Panasonic Sedang / AA Pasang 11,660

- Panasonic Kecil/ AAA Pasang 5,830

7 BLINDER CLIPS - Clips 107 Buah 3,848 - Clips 111 Buah 5,772 - Clips 200 Buah 12,826 - Clips 260 Buah 19,880 S BLOK NOTE

- Ukuran Kecil Buah 4,489

9 B I S U R K A Y U Buah 10,902

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N O . J E N I S B A R A N G D A N P E R A L A T A N S A T U A N H A R G A R p K E T 1 z J ji J 12 IS J I L K I L K - Max 2010 r>uali Ot 087 - Max 1213 Duati 7 7 8 7 / ? Z /,OJO

- Max 1215 ouan 7 7 o/?s;

- Max 1217 T^iiolv

t>uan 7 1 474

- Max 10 DUafl 4 48Q

Great Wall No. 3 13 U all 4 740

Hand 10 j3uail Z , JO J I J WOT n A TITZIT'T* ISl PARKER Diasa / oalpen 1 3 U C U i 35 777 J J , Z . / z Ti O - R. B. D udli 77 637 Z Z ,O J / 14 JANGKA

- Compas Super 13 1 1 TV tv ₁_{7 7} <:eQ

1J /,JOO

- Kayu 13iinlv 1 Q 7 7 Q

15 KA PUR TULIS

- Madya Putin 1 T3iic S 830

- Madya Wama 1 uus / ? 7/?0

16 K 4 R B U N

- Daito Double Folio Office Make Duan 117 778 1 IZjZZS

- Daito Engkel TA —t-Huah ^ 7 7 1 7 17 m _H . VTrT¥^-VTT KARTON - Manila Putih 1 T J V * M *VTV«» S 747

- Manila Wama 1 1 TVTTV TV ATI*

t 1.6111001 7 AAI I s KL K1 A s - Casing nuoti 1 0 1 7 7 ^ l U 1 ,J Z J - Stenlis CD Berlian e.f. jKjm 48 767 r-* • fl f\r\ I L -1 iP - Bergans 200 Lmbr d.f. ivirn 38 600 J o , O l 7 U - Dorslag 400 Lmbr d.f. IvIIIl 36 SS4 JO, J JM-TA 1 A A A T i. H. 47 - Dorslag 400 Lmbr e.f. ivim 36 SS4 J O, J J v - Dorslag 400 Lmbr Wama l? 1 T M Kim 7 / ? e,OA JO, J J 7

-- FIVS 400 Lbr 60 Gr. E.f. (Sinar Duma) Run A7 7 7 / ; 4Z , J Z O T T T T O T* O O X • If T\ 1 /T - HVS 500 Lbr 70 Gr d.f. Kim 4AJ , J J Z < « 7 7 - HVS 500 Lbr 70 Gr e.f. X>t-^ Kim A Z 1 7A 4 o, l / 4 T T T T/-^ A /-» (-\ T 1 ^ /"\ T O T* ¥ T T

- HVS 400 Lbr 60 Gr. e.f. Wama Kim ^ 1J i , y 4 j OA ^

T y J-T* TV TV ' • ' - KafFRRT Lembar 7 ^ A 1 Z,JU1 - Kalkir 60 / 65 KOU 1 7S Z Q I i z j , o y j T T 1 1 • /V TV / J"V f

- Kalkir 90 / 95 Koll 1 Z7 7AQ i D Z , Z 4 y

- Milimeter Roll Koll f:7 7 1 7

J / , / I /

- Shet Daito Uus no 7zrv

ys, /OU

TV 1 • V A • ^ TV TV T 1

- Stenlis Mangum 500 Lmbr Uus J< A4 , ^ 1 1 J1 1 19 L I M

- Castol Besar T»iK«i

lube

1 7 87Z

1Z,OZO

- Castol Kecil lube T n o z

- Glukol Besar T-v t

Buah 7,696

- Glukol Sedang Buan 7 OA8

- Glukol Kecil Buah 1,924

- U H U Buah 24,369

20 LA G BATANG P E L I K A N Btg 22,446

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NO IFIVIS KARA NC l i AIV PITR A ¥ A T AIV C A TTT A IVI _{S A l UAlN} HARGA Rp \C V T JV J!i 1 / 2 3 4 5 22 MISTAR SABLON - Rotring 0,6 Buali 98,760 - SegiTigaNo. 10 Buah 16,033 - SegiTigaNo. 12 Buah 22,446 23 ORDNER Buah 25,652

24 P A l i U PAYUNG WARNA Dus 2,857

25 PENA S H E E T Buah 18,550 26 PEPfSlL - Biasa Buah 5,300 - Rotring 2 B 0,5 Buah 76,315 - Steadier HB Buah 4,489 - Steadier 2B Buali 3,710

- Faber Castle 2B Buah 3,021

- Artline Buah 2,120

- Merah / Biru Buah 3,848

27 PEb GHAPUS PAPAN TULIS

- Biasa (Kayu)

„ _ _ - _ A =" i , Buah 7,696

- White Board Buah 10,600

28 PITA MESIN TIK

- Daito Cotton Roll 24,486

- Daito Nilon Roll 26,935

29 PITA COMPUTER

- LX300 Buah 47,700

- LQR180 Buah 63,600

30 REITBL

- Rotring Pencil

• •••• —_{- Rotring Bolpoint} _____ Buah 22,446

— .. . .frf. r ... . . , Buah 80,163

31 SPIDOL

- Snowman Board Market Buah 9,620

- Snowman Market G Buah 8,337

- Snowman 12 Wama Dus 15,370

- Snowman Jumbo Besar Buah 19,239

32 STA BILG BOSS Buah 10,902

33 STABILO ARTLINE Buah 5,300

34 TEISTROK - 5/8 HVS Richi Roll 4,681 - 6/8 CD Roll 6,413 35 TINTA - Cap Stempel , , r _„ A Btl 14,310 - Parker Btl 50,021 - Rotring Btl 80,163 - Stensil Tube 90,100 - WB Snowman Btl 19,239

- Tinta Komnuter tHitam + Putih)

-M- iX.*X-V* X. v.v_T»»»iV VXV. W \ i vx VU.XXX A- U. LXX A f Set

33,989

- Tinta Komputer (Suntik Canon) 100 ml Tabung 49,380

- 1 inta Komputer (Suntik Canon) 200 ml laoung 76 QS6

/o,yjo

- Tinta Epson Hitam Btl 116,600

- Tinta Epson Wama Btl 111,300

36 TIP * EX

(13)

A.2. BARANG C E T A K A N

NO J ENIS BARANG C E T A K A N SPESIFIKASI SATUAN HARGA

(Rp.) K E T

1 2 3 4 5 6

1 ArioloD C O D Dinas

X &A AL/.AXykT V . . ' V T L T A.A A ti^iVJ

Ca.sine Uk Ma 7 Pak 524,700

Ca.sine Uk Kabinet

V ^ AAVXAAA AA.A A V W * T AA AVT L Pak 291,500

Bufalow Tinis Cabinet

A A'A A A AAX-VT rv A ALxAvx vAAAxAAAVrV Lembar X—1 VTA X A AT AAA

4,489 2 Mi ID C O D Dinas

A T A.1 l-fcT VT AHT X—T *A-A.vl'A.f Beicard/Manila kartu uk Man A_T VTA VTAAA VAT X r A VAA AAA AJ AV AAA A AA AAAIV. X T A AAA.T Lembar 1 T VTA A A AT VI X 18,365 3 Bliineko C O D Snrat Dinas

1 — T C1 U A jii .A V_- VT L T VUA VA-A _1_T A A AVAVX HVS Putih 60 to- folio A A T A A A A A A A VT AT f AVTAAVHT

Rim 293,832

4 Kartu Kendali Surat Keluar

A A- A V VA A V-VTAAVA IHAAA V . VA V VA V A AVT A VA VAX

NCR 1/4 folio s^anekao 3

X 1 V - T A V A T I AV/AAVHT . V AAAA VVA-VAAAA *.T

Set 24,486

5 Kartu Kendali Surat Masuk

A 1 W A V VA A A A. . A VA VA • .• fc_x VA A VA V X A * AAV. VA V V NCR 1/4 folio X ' V—-' P V A / . AVTAAVT Set 88,150

6 Kartu Piaaam Penahareaan

A A V. V V VA A X V1 .1VA" • • A A. • • /"V VA ' JM^A¥ A#x A Bufalow tebal folio .X.X AAA AAA VT T T AVT AT AAA. A AT AA AT

Lembar

A_T VT A AA VT W A

17,490

7 Kvdtansi Rangkap Dua HVS / dorslag Buku 36,729 250 hnbr

g _{Kvdtansi Rangkap Lima} _{HVS / dorslag Wama} _Buku 97,944 250 lmbr

9 Bliuigko SPPD HVS Wama 60 er 5 rangkap

A A . VHT ' » AAA A AAA VT VT VT A VAX A^A^A VVAHAT Set 183,645

IC Daftar Penpatar Oaii HVS Wama 60 pr 3 ranpkan Blok 100,170

11

1 1

ICjirtii tCfnfoflwaifiii I fmbar 3,673

12 Riikii TCfirtii Pf*r r>a*:al

L J I J X U I X C U l t t 1 Krl L Z d O C U HVS Piirih 60 I T f o l i o Riikii 183 645 250 lmbr

13 Kartu Izin Trayek HVS / dorslag Buku 73,458 250 lmbr

Fo -mulir Izin Trayek HVS Putih 60 i j folio Lembar 307

15 Bliuigko Bend. 20 A HVS Putih 60 jx folio Lembar 307

16 BliingkoBend. 26 A HVS Putih 60 ij folio Lembar 36,040

17 Bliingko Gaji Berkala HVS Putih 60 j j folio Lembar 307

18 IS

Daftar Penerimaan dan

Peiigesahan SPJ Penetapan Sisa UUDP

HVS Putih 60 j J folio Lembar 307

18

IS Kartu B VIII Kertas Kwarto -olio Lembar 919

20 Kartu Undangan Linen 1/2 folio dan Amplop Lembar 17,490

21 Kartu Pembayaran Gaji Pegawai Brief Card df(BB) Lembar 10,653

7 7

Z /

Kulit/Jilid Buku Laporan Ken.

Anggaran dan Sejenisnya L

T TVA«*'TVT-I T 3 11-rVv 1 TVVA /X X

Kenas tjuiaiow a i T 7D U K U I I 1 T I I 4 9 8 / ?

23 Daftar Perincian Rencana UUDP HVS Putih 60 ix folio Block 32,322

24 Buku Rekap Penrm. & Pengir.

UUDP HVS Putih 60 ix folio Buku 220,374

25 Buku Persediaan

A_T AX 1V VA A VTA VXVTVAAVAAAAA HVS Putih 60A A T V T A A A A A A A VT VT P A V T A A V T ix folio

Buku 220,374

26 Buku Penerimaan per pasal/digit HVS Putih 60 ^r folio Buku 220,374

27 Buku Pengeluaran per pasal/digit HVS Putih 60 j r folio Buku 220,374

28 Recapitulasi Daftar Gaji HVS Putih 60 ix folio Lembar 307

29 Buku Penerimaan Sejenis HVS dorslag Folio Buku 67,337

(14)

N O J E N I S B A R A N G C E T A K A N S P E S I F I K A S I S A T U A N H A R G A

( K p . ) K E T

1 2 3 4 5 6

34 Diiftar RKBU HVS Putih 60 gr d f Buku 32,322

35 Diiftar RTPBU HVS Putih 60 gr df Buku 32,322

3<» Blangko Bend. 27 HVS Putih 60 gr d f 1/3 pin Lembar 613

3'' Blangko Bend. 28 HVS Putih 60 n- df 1/3 pin

A A ' .—y A UVAAA VT VT ^A vAA A ' vT ATAAA Lembar 613

38 Biiku Kas B I HVS Wama 6( gr ef Buku 220,374

39 BiJku Umum Bend. X HVS dorslag V/ama Buku 73,458 250 lmbr

4(1 Bi kuBend. X V I I HVS dorslag 1 '4 folio Buku 101,760

4: B i k u Bend. 16 HVS dorslag 1 '2 folio Buku 102,078

4:; BikuBend. 26 HVS dorslag wama 1/2 folio Buku 102,078

43 Model KIB A, B, C, D Karton Double Polio Lembar 11,660

4^- Kiitu B n Register UUDP Karton Double Polio Lembar 11,660

43 Kirtu B IV Penerimaan Karton Double Polio Lembar 11,660

4(i Kirtu B V Pengeluaran

A A.V -A VIA A-T * A VTAA>.vV-A VAAAA VAl A Karton Double Polio A vvAii VvTAA A _ T V T A A V T A V T A \J AA\^ Lembar A./VT A A A AT VAA 11,660

47 Kartu B V I Karton Double Polio Lembar 11,660

48 Karcis Retribusi Temak CD. Wama 1/4 folio Buku 10,203

49 Karcis Retiibusi Kebersihan CD. Wama 1/4 folio Buku 10,203

5(1 Karcis Retribusi Bea Pasar CD. Wama 1/4 folio Buku 10,203

5] Karcis Retribusi PJKP CD. Wama 1/4 folio Buku 10,203

5: Karcis Tagihan Kebersihan Kwarto 1/2 folio Lembar 17,490

52 Karcis Tagihan Sewa Pajak Kwarto 1/2 folio Lembar 17,490

54 Karcis Bea Pasar Kwarto 1/2 folio Lembar 17,490

5f Karcis Retribusi Parkir CD. Wama 1/8 folio Buku 19,080

(15)

A.3. O B A T - O B A T A N

NC' N A M A O B A T G E N E R I K N A M A P E N Y E D I A K E M A S A N n X U P A_{n / \ i v i j / \ o/\} 8A T I ! A N ₁_{u A i i} T E R K E C I L (Rp.)

K E T

/ 2 J 4 5 6

1 ACT (Artesunate tablet 50 mg +

Amc diaqumc anhydrida tablet 200 mg) PT. Kimia Farma 1 blister(g24 tablet 1,764 2 Adel bvir 17inivoksil tablet/kanlct 10 ma PT. SmithKline Beecham

Phamaceuticals Dus 3 Blister 47) lOkansul 35,272 3 Air I ntuk Injeksi 25 ml PT Otsuka Indonesia Dus, 120 ampul PE @ 25ML 2,565 4 Air I ntuk irigasi lar infus 1000 ml PT. Widatra Bhalcti BlKg: 1000 ml 9,620 5 Akai bose lablet/kaplet 100 mg PT. Dexa Medica Dus, 10strip(3;10tablet 1,154 6 Akai bose tablet/kaplet 50 mg PT. Dexa Medica Dus, 10 strip @10tablet 909 7 Albe idazol suspensi 200 mg/5 ml PT. Indofarma Dus, 10 dus @ 1 botol (@ 10 ml 4,937 8 Albe idazol tablet/kapsul/kaplet 400 mg PT. Holi Pharma Dus, 5 strip Ca 6 tablet 423

9 Albumin serum normal (human

albumin) injeksi 20%, 100 ml PT. Ikapharmindo Vial 100 ml 961,950

10 Albu min serum normal (human

albui lin) injeksi 20%, 50 ml PT. Ikapharmindo Vial 50 ml 442,497 11 Albu nin serum normal (human

albumin) mjeksi 20%, 100 ml PT. Graha Farma 100 ml 961,037

12 Albu nin scnim noraial (human

albumin) injeksi 25%, 100 ml PT. Dipa Pharmalab botol (g 100 ml 1,956,281

13 Albu nin scrum normal (human

albur lin) injeksi 25%, 20 ml PT. ITipa Pharmalab botol (g 20 ml 412,638

14 Albu nm senim nonnal (human

albur un) injeksi 25%, 50 ml PT. Dankos Farma botol (g 50 ml 932,800

15 Albu nm serum normal (human _{albumin) injeksi 5% 250 ml} PT. Dipa Pharmalab botol (g 250 ml 1,123,907

iO Albu nin serum normal (human _{albur un) injeksi 5% 50 ml} T>T TA;.-«

T31-11. Uipa 1 namialab Ixitoi iw. 50 ml icy csif 17 Alop irinol tablet/kapsul/kaplet 100 mg PT. Pertiwi Agung Box, 10 strips (g 10 tablets 20,522 18 Alop irinol tablet/kapsul/kaplet 300 mg PT. Bemofarm Dus, 10 blister (g 10 tablet 25,395 19 /uprtzoiaiTi laDieuKapsui/Kapici U , Z J PT. Dexa Medica Dus, 10 Strip tg: 10 tablet 61,437 20 Alpri zolam tablet/kapsul/kaplet 0,5 rag P1. Otto Pharmaceuticals 1 1 1 /\ /7» 1 / 1 /V A 1 1 A

1 box 10 Strip X 10 tablet 141,086 21 t\l\ji.CA1 Tirr tAJS<X\\\'7nlnm tanlt^l/k'nnijiil/k'flnlct 1 mo luUiCuIvatJoUl/tVuL/lkI 1 I'lK IT I KimiJi Karma Ktk 1 Ov 10 tablet 211 629 22 Alter lase injeksi 50 mg/vial PT. Boehnnger Ingelheim 1 1 C/\ I 1 " 1 1 A V c

, 1 \ial(g50mg + 1 vial pelarut rg 5 4,430,800 23 Amfcterisin B salep mata 1% PT. Cendo Industri Farmasi tube 3.5 gr 21,571

24 Amils asin injeksi 250 mg/ml PT. Sanbe Farma Vial 2 ml 58,883

25 Amirofilin injeksi 24 mg/ml FI . Lucas Djaja dus 30 ampul (glO ml 4,902

26 Amir ofilin tablet scored 200 mg PL. Erela Botol 282,172

27 Amir ofilin tablet/kapsul/kaplet 150 mg PT, Erela Botol 282,172

28 Amic (laron injeksi 150 mg/3 ml PT. Aventis Pharma Dus, 6 ampul fg 3 ml 16,511 29 Amic Jaron tablet/kaplet 200 mg PT. Novell Pharmaeutical

Ixiboratories Box, 3 blister (g 10 tablet 1,667 30 Amitj iptilin tablet salut 25 mg (HCl) PT. Indotarma Dus, 10 stop (g lOtss 35,272 •3 1 A_ l . 31_,_ +,.U1..t lO ™. TW T.—.:—a A

(16)

N A M A O B A T G E N E R I K N A M A P E N Y E D I A K E M A S A N H A R G A S A T U A N T E R K E C I L (Rp.) K E T

1 2 3 4 5 6

y Am pisilin serbuk mjeksi i.v. 1000

me/ rial PT Bemofarm Dus, 10 rial (a: 1 g 7,195

31

Ani log insulin long acting inj 100 Ul/inl, vial/cartridge disposiblc/penfill cart idge (Insulin glargine 100 llJ/ml)

PT. Aventis Pharma dus, 5 solostar pen @ 3ml 109,021

3S

Ana log insulin mix acting inj 100

KJUl til, / A l l d l U ^ l l l a U l I I l I l l l X dGlIIlU 111]

100 Ul/ml (Premix 30% Insulm Aspart + 7( % Protaminated Insulin Aspart (An iloguel)

PT Perron Par Pharmaceutii als

mjcKsi 1 uu iu/rm, r lexpen disposible 3 ml (T box isi 5 flexpen

disposible)

135,956

40 Ana log Insulin Mix Insulm Inj 100 PT. Baver Indonesia Dus, 5 Prefilled pen (2! 3 ml 120,086

41

Ana og insulin mix insulininj 100 tlT/nl \inl/efiTiridffe HisrvisiHlp/fienfill carh idge (25% insulm lispro, 75% insu in lispro protamine suspension, (rDMA))

PT. Baver Indonesia Penlill cartridge 137,559

42 _Ul/nJAna og Insulin Rapid Acting Inj 100 PT. Baver Indonesia Dus, 5 Prefilled pen (£; 3 ml 96,189

43

Anai og insulin rapid acting inj 100 Ul/n ll, rial/cartridge disposible/peiifill cartr dge (Insulin Aspart (Analogue))

PT. Perron Par PharmaceuUc ils

Injeksi 100 iU/ml, Flexpen disposible 3 ml (1 box isi 5 flexpen

disposible)

109,464

44

Anal ug insulin rapid acting inj 100 Ul/n 1 rial/cartrtdce disDosible/nenfill cartr: dge (Insulin Aspart (Analogue))

PT Perron Par Pbarmaceiitie ils

, , - 1 V l l V H I U l 1 U U l l l L U U S ' U l l w . I l u Dns Hal 10 ml 256 520

45

Anal ig insulin rapid actinginj 100 Ul/rr 1, vial/cartridge disposible/penfiU cartridge (Insulin glulisine 100 lU/ml)

PT. Aventis Phamia dus, 5 solostar pen (a) 3nil 111,689

46

47

Anal )g insulin rapid actinginj 100 Ul/m 1, rial/cartridge disposible/penfill cartri Jge (Insulin lispro (rDNA origin)) Anas rozol tablet/kapsul/kaplet 1 mg

PT. Baver Indonesia

PT. AstraZeneca indonesia

Penfill cartridge

Dus, 2 blister (g 14 Tablet

111,681

41,043

48

Anta: ida DOENI tablet kunyah, komt inasi : Aluminium Hidroksida 200 r ig Magnesium Hidroksida 200 mg

PT. Erela Stipis 10,028

49

Antai ida DOEN 11 suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml Magresium Hidroksida 200 mg/5 ml

PT. Novapharin btl @ 60 ml 6,349

50

Anti 1 iakten DOEN salep kombinasi: Basitiasin 500 lU/g Polimiksin 10.000 lU/g

PT. Indofarma Dus, 25 tube (g: 5 g 3,549

51

Antih imoroid, kombinasi: bismut subga at 150 mg heksaklorofen 2.5 mg lidokain 10 mg seng oksida 120 mg

PT Kimia Farma DUS, 10 SUPP @ 2 GRAM 3,906

52

Antirr alaria DOEN kombinasi : Piiimi tamin 25 mg Sulfadoksin 500 mg

PT. Kimia Farma Kotak 73,341

53 Antini igren: Ergotamin 'I'artrat 1 mg +

Kofeii 50 mg PT. Kimia Farma Botol 19,122

(17)

N O NAMA D r N v m i A _{Is/VIVIA r t n IJLUIA} KTMACAN H A R G A S A T U A N

T E R K E C I L (Rp.) K F T IV I? 1

/ 2 3 4 5 6

51 Asa Ti Aselilsalisilat (asetosal) tablet

100 mg PT. Phapros, Tbk DUS 16,324

58 Asa n Asetilsalisilat (asetosal) tablot/kaplet/kapsul 80 mg

PT. Mersifarma Tiimaku

Mercusana DUS 208.714

5S Asa n Askorbat (Vitamin C) tablet 250

mg PT. Kimia Farma DUS 21,454

6C Asa n Askorbat (Vitamin C) tablet 50

mg PT. Kimia Farma DUS 13,526

61 Asa n Folat tablet/kapsul/kaplet 0,4 mg PT. Rama Emerald Multi

Sukses DUS 13,292

62 Asa: n Folat teblet/kapsul/kaplet 1 mg PT. Marin Liza Farmasi Botol 6,646

63 Asa: n Ibandronat injeksi 6mg/6ml PT. Boehringer Ingelheim Boks, 1 ampul 2,575,694

64 Asa;n Mefenamal kapsul/kaplet 250 _mg PT. Afifarma DUS 22,504

65 Asai n Mefenamat kapsul/kaplet 500 mg

PT. Hexpharm Java

Laboratories DUS 13,526

66 Asai a pipemidat kapsul 400 mg PT. Sanbe Farma Strip 2,329

67 Asai n zoledronat injeksi 4mg/5mL PT. Novartis Indonesia Dus, 1 vial plastik @ 5ml 1,049,400

68 Asiflovir salep mata 3% PT. Sanbe Farma Tube 3,5 gram 28,859

69 Asili lovir tablet/kapsul/kaplet 200 mg PT. Kimia Farma ktk 10x10 tablet 32,182 70 Asili lorir tablet/kapsul/kaplet 400 mg PT. Kimia Famia ktk 10x10 tablet 46,174 71 Aspi iraginase serbuk injeksi 10.000

Uf/Yiill r 1. w loaira tondKU lu.uuu Ul/ viai 1717

C\^l

72 Atafulgit tablet 600 mg IT. Zenith Pharmaceutical i Dus 5 strip @ 10 tablet 14,109

73 Aterolol tablet/kapsul/kaplet 100 mg PTKalbe Farma strip 102,608

74 Aten olol tablet/kapsul/kaplet 50 mg PT. Pratapa Nirmala Box 49,672

75 Atra (urium injeksi 25 mg/2,5 ml PT. Novell Pharmaeutical

Laboratories ampul (2! 2,5 ml 16,857

76 Atrojin injeksi i.v./i.m./s.k. 0,25 mg/ml PT. Ethica Industri Farmas ampul @ 1 ml 1,632

77 Atro ym Sulfat tablet 0,5 mg PT. Indofarma Dus, 10 strip® 10 tablet 10,377

78 Atro lin Sulfat tetes mata 0,5% PT. Cendo Industri Farmas Botol 5ml 15,741

79 Atropin Sulfat teles mata 1% PT. Cendo Industri Farmas Botol 5ml 15,974

80 AziU omisin sir kering 200 mg/ 5 mL PT. Soho Industri Pharmas botol @ 60 ml 43,725

81 Aziti omisin tablet 500 mg PT. Kimia Farma ktk 2x10 tablet 5,509

82 Azib omisin tablet 250 mg PT. Soho Industri Pharmas Strip 4,276

83 Beda k salisi! serbuk 2% Ff. Rama Emerald Multi

(18)

N i l 11'J NAMA HRAT PPNFDflZ iiAlVlA \Jo/\l vjC/lilLKUv iNAMA P t i N Y t D i A K E M A S A N HARGA SATUAN T E R K E C I L (Rp.)

l y W T

K E T

1 2 3 4 5 6

8( Ber ictant injeksi / suspensi 25 mg/mL PT. Abbott Indonesia Vial 3,731,200 8: Ber. iprost sodium tablet 20 meg PT. Combiphar Box/3 blister® 10 Tablet 4,198

o r

8?

Beti metason krim 0,1% (sebagai

Valorat) PT. Kimia Farma Tube 5 gr 1,861

8? Beti metason tetes mata 1 mg/ml PT. Sanbe Farma botol (2: 5 ml 29,274 9C

Bevisizumab injeksi 25 mg/ml (Skema Risl Sharing sesuai Kepmenkes RI Non lor HK,02.02/Menkes/223/2014)

PT. Boehringer Ingelhem Dus, 1 vial ® 4 ml 5,601,111

91 Rikf liitfliTiiH taVilct saint I Sf) mcF \ry A cf f¥ 7 *»n w d ir»/4/-»n*>e;i'

r t. /\siraz.enecd muonesi. UiicU U S , _ unsier (tx, 14 laoiei 7 Vili«tr*r <7h Id TnKlf.! gd dig o 4 , 4 1 o

92 Rika iiitamiH talilt*t saint SO mo uus, L uiisici 14 laoici S7 d70 7 4 , 4 / O

93 Risa C(v1tl siinnositnna 10 mo Ri vjinrv*X 1 . O U I I L T C C d J I I I d K n t r a n t i Supp 7 Adg

94 Risa rtviil snnrxisitcina S mo X X . U v / C l U l l l K d liltiC'lllCilii 1 Rov fti) 6'c 1 OOA \Ui O S

3 gig

7 , 0 IO

95 R i R / n w r \ I r \ i tni-ilf^t / *i m o X J I O V Z ZlVZivZl L a U i d , ^-^'K PT Mprflf ThV rill« in IsltClpT f?7> 10 Iflhlpt

U U S lo uiisiei lu UiUtei o/u a7A

96 Biso] irolol tablet 5 mg PT. Pratapa Nirmala Box 3 X 10 tab 810

97 Bleoiaisin serbuk injeksi 15 mg/ampul PT Kalbe Farma Vial 389,444 98 Bronr okriptin tablet 2,5 mg Ff. Capritarmindo Box 3 X lO'S 288,106

OQ Bude ionid mhaler 200 meg/puff, 100

dosis r>iic_{L/us, 1 1 ufDunaier} I TiirKiiViilcrt- / J ? ,_(o^ 1_luoaosis OR Ji-vciio log dig 100 Bude ;omd inhaler 200 mcg/pulT 200

dosis PT Otsuka Indonesia Unit, 200 dosis 123,596

101 Bude: onid respules / cairan inhaler

0,25nig/mL PT. AstraZeneca indonesia Dus, 4 pak ®! 5 respules @ 2 ml 10,377 102 Bude: onid-formoterol (fixed

comb: nation) inhaler 160/4,5 meg PT. AstraZeneca indonesia ITus, 1 Turbuhaler @ 120 dosis 137,122 103 Budes onid-formoterol (fixed

combiaation) mhaler 80/4,5 meg PT. AstraZeneca indonesia Dus, 1 Turbulialer @ 60 dosis 128,843 ina

l U 4

Bupiv ikain injeksi 0,50% (HCl)

-i-gluko: a 8% rj'P rYc^u-n \/fre.4?nr. F l . Dexa Medica UUS, J ampul (aj 4 mi J Z , O J _ ) ins tJUplviKain injeKSl U , J U / O yr, v ) PT. AstraZeneca Indonesia Lms, -> poijamp auoiu(a! zu mi 11 IM

1 irarvi/T l i i - z m xstol/'cs 1'1 ¥ L-ssTvcjiil /N mn

UdLHU,. l l l d l l L t c K d l i d l K d U a U l / J m^ I ^ J . D u C l l I l I l g c l U l g c U l c U U U U b , J U l l a l c l (U.I l U JVdpaUi

111/ Ttfslvi/T> i F m w •.vtaKxsi I ' l 4 L - a n o i i T 1 111 rw/v

L/aoigiiuau eieKsuui Kapsui j lu mg r 1, ooennntier inaeineim L/US, .7 Diisier (a; lu Kapsui I A « 1 lo L-'iT-l \ n * * v t7£s#'r\nL'' it-sixsl/'tii 7 j l i i t T 7 n / \ n o i

udKdri wzm seiDUK inicKsi zuu mg/\7di

XYi ' 1 xiAw-rv/v xl/*o*7 vJorviT*/^

r 1. lempo .scan raciiic v l d l \w L\J mi j O Z , O Z O

109 T V 1 ' ' S 1 • ' 1 ' l\/\ 1 1

Daimo Tibism serbuk injeksi 20 mg/vial

PT. Novell Pharmaeutical

Laboratories vial 352,715

n o Defera ;iroks tablet disp/ eff 250 mg PT. Novartis Indonesia Dus, 4 blister @ 7 tablet 93,280

i n ITefera: liroks tablet disp/ eff 500 mg PT. Novartis Indonesia Dus, 4 blister @ 1 tablet 180,730 1 17

(19)

NAMA OBAT G E N E R I K NAMA PENYEDIA KEMASAN HARGA SATUAN T E R K E C I L (Rp.) K E T

1 2 3 4 5 6

114 Defe 'oksainin Mesilat serbuk injeksi

500 ;ng PT. Novartis Indonesia Dus, iOvialf/i?500mg 130,592

115 Dekiametason mjeksi i.v /i.m. 5 mg/ml PT. Phapros, Tbk Dus@ 100 Ampul 1,800 116 Deks ametason tablet 0,5 mg PT. Promedrahardio Farma; i

Industri DiLS 10 Strint'fl^! 0 Tablet 8,745 117 Deso ij^estrel tablet 75 meg PT. Merck Sharp Dohme

Pharma Tbk Dns 1 Rlistpr fn) 78 tablet 81,620 118 Deso isimetason krim 0,25% PT. Ifars Pharmaceutical

Laboratories Dus tub** (o, 5 Q 7,579

119 Deso ;simetason krim 0,25% PT Dexa Medica Kotak tube (a) J S tzrain 1W WX V , XXXI-^4 \\ky, X -7 IXXXXXXX

11,640 120 Desol :simetason salep 0,25% PT Kimia Farma Dus Tube 10 eram

X-7 VO X XX X7V 1 V XXi XX 12,593 121 Diazepam larutan rektal 5 mg/2,5 mL PT Actavis Indonesia Dus 5 aliibae (a) 1 tube (S) 7 5ml 14 868

122 _X^l<i/!.vTiifl'ZP'"unn_Lnlill niipl'ci i_{I i l | v J v & l I . v . / I . I l l} i / / i m S_{-t lilgjnil} T n f T / i T i i _{r i . muojarmd} _{U l i b ,}TTilo TR_{j \ }}_dllipui Q m r\ i i l f7i\ 1_{l U /}_L r t i l _{i l l l} _{7,JO 1} 123 riiii_{i^iiXJLKi jalli}"7P-viim_{I d l U l a l i I C K l d l} Inriitnn rplrtnl IR_l\J_{l U g / Z . D I l L L .} mciH ^ tnt _{Jr 1 . /YCldVlS muoiicsid} _uus,_J_aiuDag_i_{.tii 1 luue}_\w,_z,jmi 7 1

Z 1,740 124 Diaze lam tablet 2 mo PT Kimia Farma L 1 . i N J i i i i a A g u i l d Btl 100 6 063 125 Diaze lam tablet/kaDsul/kaolet 5 mo

k^ kk\t-n^ 7UUX VUVLV^W XW4L7tJ4.XU 1VUL7XW4 U PT Indofarma A X . XX XVXXJXXXX IX XXX DiLS 10 strin fS; 10 tablet 22,970

126 Dietill nrbamazin tablet scored 100 mg PT Hnli Pharma Fhis 10 blister 1^7)10 tablet 19 239 127 Ditenl idramin injeksi i. v./i.m. 10

mg/ml (HCl) PT Lucas Diaia amnul_UXiXvXXX (o)₁_IHX_{7 1} 1 ml _XXll 1,353 128 Digok lin injeksi 0,25 mg/ml T 1 . 1 I d l a L z d i i l i l l i d i d PT Pratar\n hJiTmnisi PrtvD O A (U7 //T) -J S n m n i i l d l l l U U l 7 A. WW , t n l 28 334 129 Digok iin tablet 0,25 mg PT YarinHo Farmatama

1 1 . 1 d i iiikiVf 1 d i i i i d i d i i i d Box 10 X 10 Tab O V A I V J\. I V 1x111 13,176 130 Dilbazsm HCl tablet 30 mg PT Kimia Farma

I 1 . P v l l l i l d 1 d l l i l d Ktk 10X10 TAR P v l A i V / A l V I r\lCi 18,073

131 Diltiaz 3m infus mjeksi 50 mg PT Tnnnrvr 1 . 1 d i i d c c i i i c i v j i i c & t d i n n n r i P Q i a 10 vial (a) SOma

I V V I d l (Ml d v l l l l t 163 745 132 Diltiazjm mjeksi 25 mg/5 mL PTI 1 . d d u I l A l I N d l l i d l d P r R t Q r\!i Ml r m n i n Vial 5 ml V i d i fj nil./ 59 854

133 Diltiaz rm Kapsul SR 100 mg r i . 1 anaoe muonesia 7v riMct**!" / / I ) I ' l l S l C I 'W; I V In k n n c i ' i l ivflL'SllJ. 4 702

134 Diltiaz- an Kapsul SR 200 mg PT Tanahe Indonesia

L X . X XXXXXXXZv XXXXXWIXvOXXX 3 blister f2) 10 kansul u v i x o x w i \yAft I V xvxx^uux 5,150 135 Dimenl lidrinat tablet 50 mg PT Kimia Farma

X X . XV.XXXXIU X XXIXXLCX

Btl 100 tablet 13,992

136 Dinatri un edetat tetes mata 0,35% PI. Cenao inaustn rarmasi (xitol 10 ml d 7 77_4.1,/47 s 137 Dinatri un klodronat infus kons 60

ng/ml. PT. Baver Indonesia ampul Ids ZQS 143,070

138 \ Dobuta nin injeksi 50 mg/mL PT. Ferron Par Pharmaceuticals Dus, 5 ampul % 5 ml 33,814 139 IToksaz )sin mesilat tablet I mg PT. Ptizer Indonesia Dus. 5 blister (aTO's tab 4,058 1 7lA 1

(20)

Net

ll»7 fNAMA PtINYtUlA

IZr M A C A N HARGA SATUAN

T E R K E C I L (Rp.) 17 17 T R t. 1

I 2 J c

J

14! Dolsorubisin serbuk injeksi i.v. 50

mg,'rial PT. Kimia Farma Dus 1 vial @ 50 mg 366,824

141 Dor iperidon suspensi/sirup 5 mg/5 ml PT. Novapharin btl @ 60 ml 4,069

14) Doriperidon tablet 10 mg PT. Novanharin dus 10 X lO'S 203

14) Dof amin injeksi 40 mg/ml PT. Kimia Farma Dus 5 amp (3) 10 ml 11,998

14' Dosjtaksel injeksi 20 mg/0,5 ml PT. Sanbe Farma Dus, 1 vial @0,5 ml+ 1 vial

pelarut @1,5 ml 1,131,253

14i! DTI A (diethylene triamine pentaacetic _{acid) 2,06-2,5 mg pentetate calcium}

txiczdium/ml

PT. Kimia Farma Dus @ 5 vial 530,530

14" Dutiisterid kaps lunak 0,5 mg PT. SmithKline Beecham

Phamaceuticals Dus, Botol Plastik @ 30 Tablet 9,106

150 Efar irens tablet salut 600 mg PT Kimia Farma Botol 30 tab 7,433

15 Efec rin Inj 50 mg/ml PT. Bemofarm Ampul @ 1 ml 17,082

15; Eksf mestan tablet 25 mg PT. Pfizer Indonesia Dus, 2 blister® 15 tablet 49,672 15/ End :saparin sodium inj 20 mg/0,2 ml. PT. Aventis Pharma Dus, 2 prefilled syringe @ 0,2 ml 52,237 15/ End aapaiin sodium inj 40 mg/0,4 mL PT. AvenUs Pharma Dus, 2 prefilled syringe @ 0,4 ml 92,184 151 End saparin sodium inj 60 mg/0,6 mL PT. Aventis Pharma Du.s, 2 prefilled syringe @ 0,6 ml 128,260 15f Epin ifrin (Adrenalin) injeksi

i.v/s. k./i.m 1 mg/ml PT. Phapros, Tbk Dus @ 30 Ampul 10,389

157

Epiribisin serb injeksi 50 mg/25ml (Proiluk Kosong s/d awal Agustus 2015)

PT Kalbe Farma Vial (ffi 25 ml 699,600

158 Epinibisin serb mjeksi 10 mg/5 ml PT. Sanbe Farma Dus, 1 vial @5 ml 149,248

159 Ergo calsil'erol (vitamin D3/D2) kapsul C A A / I A I TT 50.0110 Ul

PT. Gracia Pharmindo Dus 3 strip @ 10 Flash tablet 793 160 Ergo calsifcrol (vitamin D3/D2) _ . _ T A A A A T I T / 1

suspnsi 10.000 Ul/ml

PT. Gracia Phaimindo Ehis, Botol Plastik @ 100 mL 9,328

161 Eritn imisin kapsul/kaplet 250 mg PT. Kimia Farma k-tk 10 X 10 kapsul 609

162 Eritromisin kapsul/kaplet 500 mg PT. Indofarma Dus, 10 blister @ 10 kss 1,193 163 Eritn imisin simp kering 200 mg/ 5 ml PT. Phvto Kemo Agung Fam la Botol @60 ml 9,433 164 Eritn poetin-alfa inj 10000 UI/mL PT Kalbe Farma \ial/ampul (Prefilled Syringe) 327,646 165 Eritn poetin-alfa inj 2000 UI/mL PT. Soho Industri Phamiasi Dus, 6 prefilled syrenge ®. 0.5 ml 171,707 166 Eritrc poetin-alfa raj 3000 UI/mL PT Kalbe Farma Prefilled Syringe @ 1ml 149,248 167 Eritrcpoetin-beta inj 2000 Ul/0,3 mL Ff. Boehringer Ingelheim Boks, 6 ampul 162,657 168 Estro 'en terkonjugasi tablet salut 0,625

mg PT SUNTHI SEPURl

Dus, 1 blister @ 28 kaptab salut

gula 105,412

169 Etam lutol tablet 250 mg (UCl) PT. Kimia Farma ktk 20 X 10 tablet 42,326

(21)

NO NAMA OBAT G E N E R I K NAMA PENYEDIA KEMASAN HARGA SATUAN

T E R K E C I L (Rp.) K E T

/ 2 J 4 5

173 Eto logestrel implan 68 meg PT. Merck Sharp Dohmi Pharma Tbk

Dus, 1 blister @ 1 subdermal

implant 150,156

171 Eto xjsid injeksi 20 mg/ml PT. Novell Pharmaeutica 1

Laboratories ampul @ 5ml 117,649

175 nug Clio] call ill] Rofol 1 A ml

DOioi J o mi Zl,.l /o

175 Evemlimus tab 0,25 mg P"!. Novartis indonesia Dus, 6 blister (a>. 10 tablet 13,774 171 Eve -oliraus tab 0,5 mg PT. Novartis Indonesia Dus, 6 blister @ 10 tablet 27,110 17! Fak or IX kompleks serbuk injeksi

1.010 UIAial + pelarut 10 ml FF. Graha Farma

Dus, 1 vial (5) 1000 lU-l- 1 vial

pelarut (w, 10ml 9,911,000

17) Fak or IX kompleks serbuk injeksi 500

Ul/i ial + pelarut 5 ml PT. Graha Farma

Uus, 1 viai [W J U U 1 U + 1 vial

pelarut @ 5 ml 5,1.57,801

180

Fak or Koagulasi 11 14-35 Ul, Faktor Koagulasi VUl 7-20 Ul, Faktor Koagulasi IX 25 Ul, Faktor Koagulasi X 14-35 UI (250 lU/lOml)

PT. Graha Farma Dus vial1_7 CX^, » XUl XV ' X 4 XU X J^ (a) 250 111+ I vial nelarut TVXXXX UL

@10 mL+ transfer needle-l-swab 2,442,770

18 Fak or Vila (rekombinan) serb inj 1

mg/ rial + pelarut untuk injeksi PT. Ferron Par Pharmaceutii als

KOTAK @ 1 VIAI, SERBUK

OBAT & INFUSION KIT 10,727,200 18:; Fakior VIII (konsentrat) serb inj 230

-340 UI PT. Kimia Farma vial 1,453,186

18' Fakior VIII (konsentrat) serb mj 250

Ul/\ lal 4 pelarut 5 mL PT. Ikapharmindo Vial 10 mil 1,280,035

18: FakI or Vlll (konsentrat) serb inj 480 -_{600 Ul} PT. Dipa Pharmalab vial 2,757,590

18( Fakior VIII (konsentrat) serb mj 500

Ul/\ ial + pelamt 5 ml. PT. Ikapharmindo Vial 10 mil 1,862,335

is: Fakt or VIII (konsentrat) serb mj 500 _{UlA ial + pelarut 5 ml} PT. Graha Farma 500 lU 2,496,568

181 Feni ;oin injeksi 50 mg/ml PT. Mersifarma Tirmaku _Mercusana KOTAK (gl 10 ampul 24,319

185 Feni oin kapsul/kaplet 100 mg PT. Ikapharmindo Botol @ 100 18,773

19C Feni oin Na Inj 100 mg/2 ml PT. Mersifarma Tirmaku

Mercusana KOTAK® 10 ampul 24,319

191 Fenc barbital injeksi i.m./i.v. 50 mg/ml PT. Phapros. Tbk Dus ®; 30 Ampul 2,309 192 Fenc barbital tablct/kapsul/kaplct 100

mg PT. Indofarma Dus, 10 strip® 10 tablet 28,684

193 Fenc barbital tablet/kapsul/kaplet 30 mg PT. Indofarma Dus, 10 strip® 10 tablet 19,122 19'! Fenc fibrat kaps 100 mg PT. Hexpharm Java _{I .aboratones} Dus, 3 strip @ 10 kapsul 1,253 195 Feno fibrat kaps 300 mg PT. Hexpharm Java _Ua

LXJI tx lones Dus, 3 strip @ 10 kapsul 1,603

1% Feno icsimetil penisilin (penisilin V) _{InVilp OSO mo}_{UlUIC. 400 lug} PT. Phapros. Tbk Dus @ 10 X 10's 40,927 197 Feno csimetil penisilin (penisilin V) tab _{125 mg} PT. Actavis Indonesia Dus 45x12 tab 30,199 198 Feno csimetil penisilin (penisilin

V)ta1ilet500 mg PT. Phapros. Tbk Dus 10 X 10's 71,942

(22)

NO NAMA OBAT G E N E R I K NAMA PENYEDIA X IX AX* AX A A A4X * A Mm* mr AX A

KEMASAN HARGA SATUAN

T E R K E C I L (Rp.) K E T

/ 2 3 4 5 6

20:; Feni anil injeksi i.m/i.v 0,05 mg/nil,

amp ul 2 ml T T | K i T T i i n h n i T T i R V I • J V i l l l l x x I / u l l x u l I jLAN J alliUUkl^UZ A.xill 43,499

20:. Feni anil patch 12,5 meg/jam PT. Kimia Farma Dus fo; 5 patch 99,402 7 A Feni anil patch 25 meg/jam Fl. Kimia Farma Y\*IYI4/^*N C

rtnty-*!-Dusftt 5 paten

20:. Feni anil patch 50 meg/jam PT. Kimia Farma ^ Dus® 5 patch 365,541 20(. Filg astim inj 300 mcg/mL PT Kalbe Farma pfs ® 0,5 ml 466,400

2()" Fina sterid tab 5 mg PT. Combiphar Box, isi 3 Strip ® 10 tab 3,760

201; Fito nenadion (Vit.Kl) tablet salut gula _{10 no}

1 0 11 i g PT. Marin Liza Farmasi Botol ® 100 tablet salut gula

89,549 200 Fito: nenadion (Vitamin KI) injeksi i m.

7 TYii r / r n l PT. Phapros. Tbk dus @ 30 ampul 4,377

21(1 Flue arabin inj 50 mg PT. Aventis Pharma Dus, 5 vial (gj 50 mg 1,455,540

21: Flue arabin tab 10 mg PT. Avenbs Pharma Dus, 4 blister @ 5 tablet salut

c t C I a U l i l 320,650

21: Fluf inazin injeksi i.m. 25 mg/ml PT. Mersifarma Tirmaku _Mercusana Dus, 5 ampul ® 1ml 64,130

21: Flukanazol injeksi 2 mg/ml PT. Novell Pharmaeutical _{T .rfiboratones} X—IX XZVZl XXXVX 1W k7

Botol 48,528

21/ Fluk onazol tablet/kaplet/kapsu! 50 mg PT. Pfizer Indonesia Blister 5,669

211 Fluk onazol tablet/kapsul 150 mg PT. Kimia Farma ktk 1 x 10 kapsul 28,217

2U Fluoisetin tablet 10 mg PT. Gracia Pharmindo strip 59,233

21'; Flue esetin tablet 20 mg PT. Dexa Medica DUS, 30 TABLET 60,982 218 Fluo ometolon tetes mata 0,1 % PT. Sanbe Farma botol ® 5 ml 35,555

21s Fluo -ourasil inj 250 mg/mL PT Kalbe Farma vial @ 1 ml 31,424

22c Fluo ourasil inj 500 mg/ 5 ml. PT Kalbe Farma rial @ 10 ml 41,393

221 Plus; nolon asetonid krim 0,025% PT. Ifars Pharmaceutical

1 atT/iT*'it/'»n—0

i.aooiaLoiies

Dus, Tube 5 g 3,148

222 flusi; lolon asetonid salep 0,025% PT. Ikapharmindo Dus, tube @ 10 g 6,400 223 Fluti cason furoat intranasal spray PT. Glaxo Wellcome Indone; ia Dus, Botol 120 Dosis Spay 119,704 224 Flutieason propionat iiebules 0,5 mg PT. Glaxo Wellcome hidone: ia Dus, 2 flow wrap® 5 nebules (ffi 1 16,567 225 Fonc aparinuks inj 2,5 mg/0,5 niL PT. Glaxo Wellcome Indone: la Dus, 2 pfs 0.5 ml 309,961 226 Frak ;i protein plasma lar inf 5% PT. Dipa Pharmalab dus, rial @ 250 ml 1,133,352 227 Euro lemid injeksi i.v./i.m. 10 mg/ml PT. Indofarma Dus, 25 ampul fg) 2 ml 2,346 228 Furo lemid tablet 40 mg PT. Sampharindo Perdana Dus, 10 strip @ 10 tablet 10,727 229 Gadc butrol macrocyclic 5 mg PT. Bayer Indonesia Prefilled Syringe 320,650 230 Gadc butrol macrocyclic 7,5 mg PT. Baver Indonesia Prefilled Syringe 480,975 231 Gadc ksetat disodium_{gado cetate disodium/mL} 0,25 mmol PT. Baver Indonesia Prefilled Syringe 2,996,620

(23)

NO NAMA OBAT G E N E R I K NAMA PENYEDIA KEMASAN HAKGA sA 1UAIN T E R K E C I L (Rp.) K E T

/ 2 3 4 5 6

23 5 Ger ifibrozil kapsul/kaplet 300 mg PT. Indofarma Dus, 10 blister (ff 12 kapsul 4,081 233 Get ifibrozil tablet 600 mg PT. Indofarma Dus, 10 blister (ff 10 kaptab 95,845

23 7 Ger isitabin inj lOOOmg/rial PT. Baver Indonesia vial 1,359,323

23! Ger isitabin inj 200 mg/vial PT. Sanbe Farma Dus, 1 vial (ff200 mg 384,780

23) Ger tamisin injeksi 40 mg/ ml PT. Indofarma Dus, 5 ampul ® 2 ml 4,360

24) Geiitamisin salep mata 0,3% PT. Erela Tube (ff 3,5 gr 3,248

241 Gen tamisin tetes mata 0,3% PT. Indofarma Dus, botol plastik 5 ml 4,096

241! Glilenklamid tablet 5 mg PT. Indofarma Dus, 10 blister @ 10 kaptab 7,812

24:: Glii lazid tab 80 mg PT. Dexa Medica DUS, 100 TABLET 39,411

24.- Glik lazid tab 30 mg PT. Pradia Pharin Dus, 6 strip @ 10 tablet lepas _lambat 81,853

24;: Glik lazid tablet lepas lambat 60 Mg PT. Darva Varia Box, 30 Tablet 6,413

24(. Glik uidon tab 30 mg PT. Dexa Medica Dus, 10 Strip @ 10 tablet 1,218

24" Glin lepiride tablet 1 mg PT. Kimia Farma ktk 5x10 tablet 17,840

24} Glimepiride tablet 2 mg PT. Kimia Farma ktk 5x10 tablet 29,383

24} Glin lepiride tablet 3 mg PT. Kimia Farma ktk 5x10 tablet 27,168

25( Glin epiride tablet 4 mg PT. Kimia Farma ktk 5x10 tablet 289,751

251 Glip zid tablet/kaplet/kapsul 10 mg PT. Pfizer Indonesia Dus, botol(2!TAB lOMG 30 3,739 252 Glip Zid tablet/kaplet/kapsul 5 mg PT. Pfizer Indonesia Dus, botolfffTAB 10MG31 3,498 253 Glisi ril trinitrat inj 50 mg/10 mL PT. Tempo Scan Pacific 1 box isi 5 ampul 10 ml 139,803

254 Glist ril trinitrat kaps SR 2,5 mg PT. Kimia Farma Dus 10x10 1,741

255 Glisi ril trinitrat kaps SR 5 mg PT. Kimia Farma Dus 10x10 2,531

256 Gliscril trinitrat tab sublingual 0,5 mg PT. Actavis Indonesia Btl (ff 30 tablet 1,924

257 Glist tin lar 50% PT. Lucas Diaia Glycerin 100 ml 6,841

258 Glukisa lamtan inllis 10 % steril PT. Widatra Bhakti botol @ 500 ml 7,311

259 Gluk isa larutan infus 5 % steril PT. Widatra Bhakti botol (ff 500 ml 6,670

260 Gose 'elin asetat mj 10,8 mg/\ial PT. AstraZeneca Indonesia fXis, 1 syringe ® 10.8 mg 2,681,800 261 Gose elin asetat inj 3,6 mg PT. AstraZeneca indonesia Dus, 1 syringe @ 3.6 mg 979,440

262 Grise oflilvin tablet 125 mg Ff. Kimia Farma ktk 10x10 tablet 29,500

(24)

NC' SAMA OBAT G E N E R I K NAMA PENYEDIA KEMASAN A A /A0k r M-i A X * T V X n v-* A Ay A m v T x A T' HARGA SATUAN T E R K E C I L (Rp.) K E T I 2 _J C J X u

269 Halo leiidol tts 2 mg/mL PT. Mersifarma Tirmaku

Mercusana BOTOL @ 15 ML 20,411

270 Halo an Inhalasi PT. Dexa Medica Botol 822,613

271 Heps rm mjeksi i.v./s.k. 5000 IJT/ml PT. Pratapa Nirmala vial 56,434 272 Hepatitis B imunoglobulin (human) PT. Dipa Pharmalab Dus, 1 syringe ( g 0.5 ml. 1,548,448 273 hidro clorotiazid tab 25 mg PT. Kimia Farma dus, 10 strip® 10 tablet 20,871

274 Hidrc kortison krim 1% PT. Marin Liza Farmasi tube® 5 ml 3,296

275 Hidro kortison krim 2,5 % PT. Kimia Farma Tube5gr 3,426

276 Hidrotsi Urea tablet/kaplet/kapsul 500

mg PT. Dipa Pharmalab vial 6,926

277 Hiosii 1 butilbromid injeksi 20 mg/ml PT. Otto Pharmaceubcals box 5ampul @1 ml 5,772 278 Homa ropin tetes mata 2% PT. Cendo Indastri Fannasi Botol 5ml 20,988 279 Huma 1 Insulin Intermediate Acting Inj

100 Ul/ml PT. Baver Indonesia Dus, 5 Prefilled pen ® 3 ml 88,762

280

Huma 1 insulin intermediate acting inj 100 U /ml, vial (Human Insulin (Interr lediate-Acting))

PT. Ferron Par Pharmaceutical > Dus. rial 10 ml 160,908

2^ 1 Humai 1 insulin intermediate acting mj

100 LT /ml, vial (Insulin human Basal) PT. Baver Indonesia E>us, vial 10 ml 160,908

282

Humai 1 insulin intermediate acting inj 100 U]/ml,penfill cartridge (Human Insulin (Intermediate-Acting))

PT Ferron Par Pharmaceutical

L L . L \mL 1\J1L 1 U l 1 I I I U I l l U l i - U U U U U l . > nenfill disnosihle 3 ml (1 box isi 5 88.762

283

Humat insulin intermediate acting inj 100 Ul'ml,penlill cartridge (Insubn human Basal)

PT Sanbe Farma

1 1 . ' . l U l l W U 1 U l l l l U nenfillcartndQe iff 3ml 87,450

284

Huraar insulin intermediate acting inj 100 UI 'ml.penfiU cartridge (Insulin luman Basal)

PT. Baver Indonesia Dus Isi 5 penfill/eartiidge @ 3ml 88,762

285 duman insulin intermediate acting inj _{lOOiu/ril, vial (Insulin Human Basal)} PT. Aventis Pharma Dus, 1 Vial (ff 5 ml 83,952

286 ; Juman insulin mix inj lOOiu/ml, nal

1 Insulit Human Comb 25) PT. Aventis Pharma I3us, 1 Vial (ff 5 ml 83,952

287 ] luman Insulin Mix Insulm Irij 100 _Ul

/ml PT. Baver Indonesia Dus, 5 Prefilled pen fd! 3 ml 88,762

288

1 luman insulin mix insulin inj 100 Ul/ml, jienfill cartridge (Human Insulin (Premix: 30% Soluble + 70 % NPH lasplm)!

PT, Ferron Par Pharmaceuticals

Injeksi 100 IU/ml, penfill disposible 3 ml (1 box isi 5 penfill

disposible)

88,762

289

1 luman insulin mix insulin inj 100 1 n/ml, I enfiU cartridge (Insulin humim

Uonib)

PT. Baver Indonesia Dus Isi 5 penfiU/cartridge @ 3ml 88,762

290

Human nsulin mix insulm mj 100 I d/nil, \ ial (Human [nsulin (Premix: 3 3% Soi uble + 70 % NPH Insulm))

PT. Ferron Par Pharmaceuticals Dus, vial 10 ml 160,908

(25)

NO NAMA OBAT G E N E R I K NAMA PENYEDIA KEMASAN HARGA SATUAN T E R K E C I L (Rp.) K E T

1 2 3 4 5 6

291 _{Ul/iril, penfill cartridge (Human Insulin}Hur lan insulin short acting inj 100 /StKaa-Acliuiiii

PT. Ferron Par Pharmaceutii als _disposibleInjeksi 100 IU/ml, penfill ₃_{ml (1 box isi 5 penfill} rtii-nnrihlaV

88,762 294

T T _ . _ _ _ _ ' _ul" L L, X' ' ' A

Hur tan insulm snort acting mj 100 UI/i rl, penfill cartridge (Insulin human Rani)

PT. Baver Indonesia Dus Isi 5 penfill/cartridge @ 3ml 88,762

29. i

Hur lan insulin short acting inj 100 Ul/i l l , penfill cartridge (Insulin hiunan Rapi)

PT. Sanbe Farma penfill cartridge (3! 3ml 87,450

29()

Hur lan insulin short acting mj 100 UI/i l l , vial (Human Insulin (Short Acting))

PT. Ferron Par Pharmaceutii als Dus, vial 10 ml 160,908

29' Hun lan insulm short acting inj 100

Ul/r ll, vial (Insulin human Rapd) PT. Baver Indonesia Dus, vial 10 ml 160,908

291; Hun lan insulin short acting mj

100: u/nJ, vial (Insulin Hiunan Rapid) PT. Aventis Pharma Dus, 1 Vial @ 5 ml 83,952

29" Hun lan tetanus iraunoglobulinn injeksi

i.m. 250 UI PT. Dexa Medica Prefilled syringe 198,220

30(1 Ibuf rofen sirup 100 mg/5 ml PT. Indofarma Dus, botol 60 ml 4,488

30 Ibuf rofen suspensi 200 mg/5 ml PT. Indofarma Dus, botol 60 ml 5,771

3o:; Ibuf rofen tablet 200 mg PT. Yarindo Farmatama botol @ 100 tablet 141

302 Ibuf rofen tablet 400 mg Ff. Novapharin dus 10 X ICS 183

30' Ifosiamid serbuk injeksi 1000 mg/vial PT. Mugi Laboratories Dus, 1 vial {ff 1 g 1,549,804

3o;

Imai litib Mesilat tablet salut selaput 100 mg (Skema Risk Sharing sesuai

*C *iV^ WXA-rtL'tAC U 1 KiX\tW/\T

xs-cp ncnKcb rs.i iNomor HK.12.02/Menkes/223/2014)

PT. Novartis Indonesia Dus, 6 blister @ 10 tablet salut

ISCldpUl 246,026

30(- Imicapriltab 10 mg PT. Tanabe Indonesia 3 blister (ff 10 tablet 5,013

30" Imic april tab 5 mg PT. Tanabe Indonesia 3 blister® 10tablet 2,720

30i. lopa tnidol 200-300 mg lodiiun/mL _{(30Cmg@ vial 100ml)} PT. Dipa Pharmalab Dus, botol @ 100 ml 408,100

30} TonaTiidol 200-^00 me Todium/mT AV/|rZU .XiXViV* X*UY —' VY «XX^ XV/VXXVUXJU A 1XL>

(30Cmg@ vial 30ml) PT. Dipa Pharmalab Dus, vial fff 30 ml 142,252

3K' Tona nido) 200-^00 me lodiiirn/mT XVZXZU .XlXu-V'L X* Y Y Y Y Y XJ-JibX A\J\mkL\*tHl kxlX-J

(30Cmg(ffvial 50ml) PT. Dipa Pharmalab Dus, vial (ff 50 ml 193,556

311 looa tiidol 300-370 mc lodium/mL XYXyC* .XXXAAYl Y Y Y ^ 1 \J AlLfA X V.X\.XJ. Xl 11U LXJl-J (37Cmg@vial 100ml)

PT. Dipa Pharmalab Dus, botol (ff 100 ml 430,254

3i; lopa nidol 300-370 mg lodium/mL

(37Cmg(oi vial 30ml) PT, Dipa Pharmalab Dus, vial @ 30 ml 171,402

31} lopa nidol 300-370 mg lodium/ml,

(370tng@ vial 50ml) PT. Dipa Pharmalab Dus, vial @ 50 ml 232.034

31/ lopn >mide 300-370 mg lodium/mL

(26)

1 2 3 4 5 6

3 1 ' lopr Dinide 300-370 mg lodium/ml^

(37( mg / 50 ml) PT. Baver Indonesia Botol 175,250

311! Ipra ropium bromida inhalasi 20

meg 'semprot PT. Boehringer Ingelhem Box, canister lOmL 93,280

31" Ipra ropium bromida nebulizer 0,025% PT. Boehrinaer Inaelhein Box, bottle 20mL 104,940

320 Irbe saltan tab 150 mg Ff Indofarma Dus, 5 bhster (w. 10 kss 1,827

32 Irbe saltan tab 300 mg PT. Indofarma Dus, 5 blister @ 10 kss 3,168

322 Irini tekan inf 20 mg/ml PT. Sanbe Farma Dus, 1 vial @2 ml 594,660

322 Isofl uran inhalasi PT. Pratapa Nirmala Botol 100 ml- 314,820

32'. Isomazid tablet/kapsul/kaplet 100 mg PT. Phvto Kemo Agimg Far na Botol 100 tablet 9,211 322 Isoniazid tabletAapsul/kaplet 300 mg PT. Phvto Kemo Agtmg Far na Botol 100 tablet 22,271

320 _mlIsoS'irbid Dinitrat injeksi i.v 10 mg/10 PT. Pratapa Nirmala vial 43,095

32" Isosi irbid Dinitiat tablet sublingual 5 _mg PT. Indofarma Dus, 10 strip @ 10 tablet 12,593

322 Isosi irbid dinitrat tablet/kaplet/kapsul

10 mg PT. Kimia Farma Dus, 5 strip @ 10 tablet 13,001

32} • Kali jm aspartat tab 300 mg PT. Tempo Scan Pacific Strip 100,393

33(' Kali rm Klorida tablet 600 mg PT. Merck Tbk Dus, 10 strip (ff 10 tablet 1,842

33: Kals ium Folinat (Leukovorin Ca) inj 50

mg/inl PT. Combiphar Vial 50mg/5ml 163,240

33: Kals ium Glukonat injeksi i.v 10% (100

mg/ml) PT. Ethica Industri Farmas i Ampul 9,095

33: Kals ium Karbonat tablet/kapsul/kaplet 500 Bg

PT. Mersifarma Tirmakn

Mercusana Dus, 3 blister @10kaplet 171,985

33/ Kals ium Inktat (Kalk)

tabk t/kapsul/kaplet 500 mg PT. Afifarma Dus, 10 Strip® 10 tablet 9,794

33; Kals ium polistirena sulfonat ktg 5 g PT. Novell Pharmaeutical

Laboratories kantong 5 g 10,544

33( Kan: imisin inj 1000 mg/ vial PT. Hexpharm Java

Laboratories vial 5,947

33: Kan lesartan tab 16 mg PT. Dexa Medica Dus, 3 Blister @ 10 tablet 6,285

33f Kan lesartan tab 8 mg PT. Dexa Medica Dus, 3 Blister @ 10 tablet 3,976

33} Kap isitabin tab 500 mg PT. Boehringer Inaelheim Boks, 120 tablet 32,065

(27)

1 2 3 4 5 6

34! Kaplopril tablet scored 12,5 rag PT. Indofarma Dus, 10 strip @ 10 tablet 88,616 341 Kar taniazepm sirup 100 mg/5 ml PT. Novartis Indonesia Dus, botol @ 120 ml 52,202

344 Kar tamazepin tablet 200 mg PT. Indofarma Dus, 10 blister® 10 tablet 34,514

34 i Kar timazol tab 5 mg PT. Nicholas 1 aboratorie

Indonesia Dus,botol 100 tablet 112,286

34i) Kar Ktgliserin tetes telinga 10% PT. Lucas Djaja Fenol 100 mg / 1 ml 2,619

34" Karl toplatin 150 mg /15 ml PT. Tempo Scan Pacific vial @. 15 ml 223,872

341! Karl toplatin 450 mg / 45 ml PT. Tempo Scan Pacific vial (ff 45 ml 481,558

34" Kar 'ediol tablet/kaplet/kapsul 6,25 mg PT Kalbe Farma strip 1,744

350 Keti min injeksi i.v. 100 mg/ml PT. Guardian Pharmatami Vial @ 10 ml 128,260

35 Ketf min injeksi i.v. 50 mg/ml PT. Combiphar Box, isi 1 vial @ 10 ml 73,924

35:: Ket( .konazol krim 2% PT. Kimia Fanna tube 10 gr 3,145

35:1 Ket( .konazol krim 2% PT. Hexpharm Java _Laboratories tube 5 gr 3,655

352 Kelt .konazol krim 2% PT. Novell Pharmaeutica

Laboratories Box isi 1 Tube® 15 g 6.005

35:. Keti 'konazol scalp sol 2% PT. Ikapharmindo Botol 80 ml 35,913

35" Ket< konazol tablet 200 mg PT. Novapharin dus 10X5'S 20,522

35" Ketoprofen supositoria 100 mg PT. Kimia Farma dus 2's (ff 10 supp 3,332

35!i Ket( Tolac injeksi 30 mg/ml Ff. Indofarma Dus, 6 ampul (ff 1 ml 3,107

35" Klai itromisin tab 500 mg PT. Ifars Phamiaceutical

T n n n m f / A n p ' ; I j t l U v / J . tllxjk 1C&

Dus, 3 Strip @ 10 Kaplet salut

d C l d L z u l 4,198

360 Kliii damisin kapstil/kaplet 150 mg PT. Indofarma Dus, 5 blister @ 10 kapsul 26,002 36 Kliiidamism kapsul/kaplet 300 mg PT. Indofarma Dus, 5 blister (ff 10 kapsul 39,702

36:; Klol Kizam tab 10 mg PT. Dexa Medica Dus, 10 Strip @ 10 tablet 121,847

36: Kloi tiifen sitrat tablet/kapsul/kaplet 150 _mc PT SUNTHI SEPURl dus, 2 strip (ff 10 tablet 2,089 36" Kloiiidininjeksi i.v0,15 mg/ml (HCL) _{n sr V}

(tot) PT. Boehringer Ingelheiti Box, 10 ampoules @ ImL 35,680

36:. Kloiiidin tablet 0,15 mg PT. Kimia Farma Ktk 10X10 TAB 24,719

36<. Klo] ndogrel tab 75 mg PT. Hexpharm Java

Laboratories Dus, 3 strip ® 10 tab 4,163