Berdasarkan hasil evaluasi tersebut diatas, maka Kelompok Kerja III ULP RSUP Dr. Hasan Sadikin Bandung sepakat :

(1)

KEMENTERIAN KESEHATAN RI

DIREKTORAT JENDERAL PELAYANAN KESEHATAN RSUP Dr. HASAN SADIKIN BANDUNG

Jalan Pasteur No. 38 , Bandung 40161 Telepon : (022) 2034953, 2034954 (hunting)

Faksimile : (022) 2032216, 2032533

Laman : www.rshs.or.id, Pos-el : rsup@rshs.web.id SMS hotline : 08112335555

PENGUMUMAN PEMENANG

PELELANGAN UMUM PASCAKUALIFIKASI PENGADAAN KEBUTUHAN AMHP KHUSUS SMF ORTHOPAEDI TA.2017

RSUP Dr. HASAN SADIKIN BANDUNG

Nomor : BN.01.02/PNBP-POKJA III/10614/XII/2016 Tanggal : 30 Desember 2016

Berdasarkan Berita Acara Hasil Pelelangan nomor : BN.01.02/PNBP-POKJA III/10612/XII/2016, tanggal 30 Desember 2016 serta surat Penetapan Pemenang Nomor : BN.01.02/PNBP-POKJA III/10613/XII/2016, tanggal 30 Desember 2016, maka Kelompok Kerja IIIULP RSUP Dr. Hasan Sadikin Bandung, mengumumkan hasil pelaksanaan Pelelangan Umum Pasca Kualifikasi Pengadaan Kebutuhan AMHP Khusus Katup Mitral Sorin dll Devisi Bedah Kardiothorasik TA.2017 RSUP Dr. Hasan Sadikin Bandung dengan secara elektronik melalui web site LPSE Kemenkes dengan alamat situs internet : http://lpse.kemenkes.go.id dengan metode sistem itemazed dengan hasil sebagai berikut :

Berdasarkan hasil evaluasi tersebut diatas, maka Kelompok Kerja III ULP RSUP Dr. Hasan Sadikin Bandung sepakat :

1. Nama Perusahaan : PT. Rajawali Nusindo

Alamat Perusahaan : Jl. Soekarno Hatta No.493 Bandung NPWP : 01.315.708-007.000

NO NAMA BMHP MERK JUMLAH

HARGA

SATUAN JUMLAH KET

TINDAKAN ARTHROPLASTY

6 THR Cementless SMALL SIZE Phapros 6

27,750,000 166,500,000 Pemenang 8 TKR CR POSTERIOR REF INSTRUMENT Phapros 6 31,000,000 186,000,000 Pemenang 9 TKR PS POSTERIOR REF INSTRUMENT Phapros 3 34,000,000 102,000,000 Pemenang 12 Bipolar Cementless small size Phapros 15

21,500,000

322,500,000 Pemenang

13 Bipolar Cemented small size Phapros 15

21,000,000

315,000,000 Pemenang 14

Total Hip Replacement (THR)

SMALL SIZE Phapros 12

27,750,000 333,000,000 Pemenang JUMLAH 1,425,000,000 PPN 10% 142,500,000 JUMLAH 1,567,500,000

(2)

2. Nama Perusahaan : PT. Mitra Fajar Selaras

Alamat Perusahaan : Pulogadung Trade Centre (Ptc) Ruko Blok 8c No.28-29, Jl. Raya Bekasi Km.21 Kel.Rawaterate Kec. Cakung Jakarta Timur

NPWP : 02.313.083.4-004.000

HARGA

SATUAN JUMLAH KET.

TINDAKAN SPINE

1

Ballon Kyphoplasty inc.bonecement with

radiopaque agent Medinaut 2

15,250,000 30,500,000 Pemenang 2 Titanium Anterior Distraction Device Plus

inc.4 locking screw Addplus 2

11,700,000

23,400,000 Pemenang

3

Cervical Modular Cage Plate inc.2 locking screw+Bonfuse

Tryptik MC

2 _18,650,000 _37,300,000 Pemenang

4

Epidural Catheter set with soft and steereable catheter

inc.Hyaluronidase 1500UI Medinaut

2 _10,800,000 _21,600,000 Pemenang

5

Titanium Occipital Plate with titanium bone screw

Ø4,5x9mm Irine 2

6,900,000

13,800,000 Pemenang

6 TLIF PEEK cage

GS Medical 2 12,750,000 25,500,000 Pemenang 7

Epidural Ballon Catheter with steereable catheter

inc.Hyaluronidase 1500UI Medinaut

10 _13,400,000 _134,000,000 Pemenang Jumlah 286,100,000 Ppn 10% 28,610,000 Total 314,710,000

3. Nama Perusahaan : PT. Transmedic Indonesia

Alamat Perusahaan : Perkantoran Menara Era Unit G-01, jl Senen Raya No 135-137, Jakarta Pusat

NPWP : 02.414.447.9-056.000

NO NAMA BMHP JUML

AH MERK HARGA JUMLAH Ket

TINDAKAN NAILING

1 Paket Standard Interlocking

Nail Femur, consist of:

10 Synthes 16,055,000 160,550,000 pemenang Expert™ A2FN, Ø 9.0 - 12.0 mm, right/left, cannulated, length 300 - 380 mm, Titanium Alloy (TAN),

light green, sterile (1 buah)

(3)

End Cap for Expert™ A2FN, cannulated, extension 0 - 10 mm, Titanium Alloy (TAN),

grey, sterile (1 buah)

Locking Screw Stardrive® Ø 4.0 - 5.0 mm, length 26 - 54 mm, for Medullary Nails, Titanium Alloy (TAN), dark blue

/light green (4 buah)

2 Paket Advance Interlocking

Nail Femur, consist of:

10 Synthes 18,145,000 181,450,000 pemenang Expert™ A2FN, Ø 9.0 - 12.0 mm, right/left, cannulated, length 300 - 380 mm, Titanium Alloy (TAN),

light green, sterile (1 buah)

End Cap for Expert™ A2FN, cannulated, extension 0 - 10 mm, Titanium Alloy (TAN),

grey, sterile (1 buah)

Hip Screw Stardrive® Ø 6.5 mm, self-tapping, length 60 - 105 mm, for Expert™ LFN,

Titanium Alloy (TAN), sterile (2

buah)

3 Paket Standard Interlocking

Nail Tibia, consist of: 10

16,055,000 160,550,000 Pemenang

Expert™ End Cap for Tibial Nails Ø 8.0 to 13.0 mm, extension 0 - 15 mm,

Titanium Alloy (TAN), gold (1

buah)

Expert™ Tibial Nail Ø 8.0 - 10.0 mm, with proximal Bend, cannulated, length 255 - 375 mm, Titanium Alloy (TAN), dark blue /light green, sterile (1

(4)

4 Paket Advance Interlocking

Nail Tibia, consist of: 10 Synthes

19,285,000 192,850,000 pemenang

Expert™ End Cap for Tibial Nails Ø 8.0 to 13.0 mm, extension 0 - 15 mm,

Titanium Alloy (TAN), gold (1

buah)

Expert™ Tibial Nail Ø 8.0 - 10.0 mm, with proximal Bend, cannulated, length 255 - 375 mm, Titanium Alloy (TAN), dark blue /light green, sterile (1

buah)

Cancellous Bone Locking Screw Stardrive® Ø 5.0 mm with dual core, self-tapping, length 30 - 60 mm, Titanium Alloy (TAN),

gold (2 buah)

5 Paket Short Proximal Femoral

Nail, consist of: 6 Synthes

17,005,000 102,030,000 Pemenang

PFNA-II - Proximal Femoral Nail Ø 9.0 - 12.0

mm,extra-small/small, 130°, length 170-240 mm, Titanium Alloy (TAN),

sterile ( 1 buah)

PFNA-II Blade, length 75-120 mm, Titanium Alloy (TAN),

sterile (1 buah)

PFNA-II End Cap, extension 0-15 mm, Titanium Alloy (TAN),

sterile (1 buah)

Locking Bolt Ø 4.9 mm, self-tapping, length 26-68 mm, Titanium Alloy (TAN), green (1

buah)

(5)

6 Paket Long Proximal Femoral

Nail, consist of: 6 Synthes

18,145,000 108,870,000 pemenang

PFNA-II - Proximal Femoral Nail Ø 9.0 - 12.0 mm, long, 130°, length 300-380 mm,

Titanium Alloy (TAN), sterile ( 1

buah)

PFNA-II Blade, length 75-120 mm, Titanium Alloy (TAN),

sterile (1 buah)

PFNA-II End Cap, extension 0-15 mm, Titanium Alloy (TAN),

sterile (1 buah)

Locking Bolt Ø 4.9 mm, self-tapping, length 26-68 mm, Titanium Alloy (TAN), green (2

buah)

TINDAKAN TRAUMA LCP TITANIUM

1

Cancellous Bone Screw Ø 4.0 mm, fully threaded, length

10- 60 mm, Pure Titanium 5 Synthes

522,500 2,612,500 pemenang

2

Cancellous Bone Screw Ø 4.0 mm, length 12-60 mm, Pure

Titanium 10 Synthes

522,500 5,225,000 pemenang

3

Cancellous Bone Screw Ø 6.5 mm, fully threaded, length

30-100 mm, Pure Titanium 5 Synthes

655,500 3,277,500 pemenang

4

Cancellous Bone Screw Ø 6.5 mm, length 30-100 mm, Pure

Titanium 20 Synthes

655,500 13,110,000 pemenang

5

Cancellous Bone Screw Ø 6.5 mm, length 45-100/32 mm,

Pure Titanium 5 Synthes

655,500 3,277,500 pemenang

6

Cortex Screw Ø 3.5 mm, self-tapping, length 10-60 mm,

551,000 64,467,000 pemenang

7

Cortex Screw Ø 4.5 mm, self-tapping, length 14-60 mm,

551,000 18,183,000 pemenang

8

Cortex Screw Stardrive® Ø 2.4 mm, self-tapping, length 10-22 mm,

Titanium Alloy (TAN) 10 Synthes

655,500 6,555,000 pemenang 9 LCP 3.5, 5 -11 holes, length 72-150 mm, Pure Titanium 13 Synthes 2,280,000 29,640,000 pemenang

(6)

10

LCP 4.5/5.0, broad, 7 - 11 holes, length 134-242 mm,

6,460,000 51,680,000 pemenang

11

LCP MEDIAL DISTAL TIBIAL PLATE 3.5, LOW BEND, RIGHT/LEFT, 6 -12 HOLES,

TITANIUM ALLOY (TAN) 8 Synthes

10,450,000 83,600,000 pemenang

12

LCP One-third Tubular Plate 3.5, 5 -8 holes, length 64-100

mm, Pure Titanium 15 Synthes

2,090,000 31,350,000 pemenang 13 LCP RecoPl 3.5 straight w/Combined Hole, 5-12 ho 25 Synthes 3,610,000 90,250,000 pemenang 14 LCP Sup-Ant-Clavic-Pl3.5

6-7ho left/right L94-110 TAN

10 Synthes

7,885,000 78,850,000 pemenang

15 LCP-DF 4.5/5.0, right/left, 7 -

13holes, Titanium Alloy (TAN)

5 Synthes

10,450,000 52,250,000 pemenang

16 LCP-PLT 4.5/5.0, right/left, 5 -

13holes, Titanium Alloy (TAN)

13 Synthes 10,830,000 140,790,000 pemenang 17 Locking Screw Ø 3.5 mm, self-tapping, length 10-55

mm, Titanium Alloy (TAN) 477 Synthes

636,500 303,610,500 pemenang

18

Locking Screw Ø 5.0 mm, self-tapping, length 14-85

mm, Titanium Alloy (TAN) 320 Synthes

788,500 252,320,000 pemenang

19

PHILOS - Proximal Humeral Plate 3.5, 3 - 5holes, Pure

Titanium 13 Synthes

14,725,000 191,425,000 pemenang

20

LCP T-Plate 3.5, oblique-angled, left, shaft 3-5 holes, head 3 holes, length 52-74

mm, Pure Titanium 5 Synthes

2,660,000 13,300,000 pemenang

21

VA Locking Screw Stardrive® Ø 2.4 mm, self-tapping, length 10-24 mm,

Titanium Alloy (TAN) 45 Synthes

817,000 36,765,000 pemenang

22

VA-LCP Two-Column Distal Radius Plate 2.4, volar, narrow, right/left, shaft 2-4 holes, head 6 holes, length 42-63 mm,

10,830,000 54,150,000 pemenang

23

VA-LCP Two-Column Distal Radius Plate 2.4, volar, right/left, shaft 2 -4holes, head 6 holes, length

45-66 mm, Pure Titanium 3 Synthes

(7)

24 Washer Ø 13.0/6.6 mm, for Screws Ø 4.5 to 7.3 mm, Pure Titanium 12 Synthes 389,500 4,674,000 pemenang 25 Washer Ø 7.0/3.6 mm, for Screws Ø 2.7 to 4.0 mm, Pure Titanium 12 Synthes 389,500 4,674,000 pemenang 26 LCP T-Plate 4.5/5.0, shaft 4-8 holes, length 84-148 mm,

4,370,000 21,850,000 pemenang

27

LCP 4.5/5.0, narrow, 5-13 holes, length 98-242 mm,

3,135,000 31,350,000 pemenang 2,528,026,000 252,802,600 2,780,828,600

4. Nama Perusahaan : PT. Parit Padang Global Cabang Bandung Alamat Perusahaan : Komp. Kopo Mas Regency Blok B. No 21-22 NPWP : 02.998.520.7-007.000

NO NAMA BMHP

Merk JUMLAH HARGA _SAT. JUMLAH KET.

BONEGRAFT

1

Nanocrystaline

hydroxypatite + Calcium

sulphate (1x50 pellet/Box) Perrosal

5 _5,344,920 _26,724,600 Pemenang

2

Nanocrystaline

55 _2,507,120 _137,891,600 Pemenang

3

Nanocrystaline

55 _1,754,985 _96,524,150 Pemenang 4 Bongros 250 mg BioAlpha 10 641,250 6,412,500 Pemenang WOUND DRESSING 1

Negative Pressure Wound

Therapy Small Curavac 10

864,000

8,640,000 Pemenang

2

Therapy Medium Curavac 15

960,000

14,400,000 Pemenang

3

Therapy Large Curavac 20

1,248,000 24,960,000 Pemenang 4 NPWT Canister 600cc Canister 45 399,000 17,955,000 Pemenang 5 Semipermeable polyurethane foam 10X10X2-5MM Easyfoam 6 66,500 399,000 Pemenang 6 Semipermeable polyurethane foam 10X20X5MM Easyfoam 6 123,500 741,000 Pemenang 7 Semipermeable polyurethane foam 20X20X5 MM Easyfoam 6 237,500 1,425,000 Pemenang

(8)

8 Semipermeable polyurethane foam 40X70 CM Easyfoam 6 1,045,000 6,270,000 Pemenang 9 Semipermeable polyurethane foam 10X60 CM Easyfoam 6 313,500 1,881,000 Pemenang Jumlah 344,223,850 PPN 10% 34,422,385 Total 378,646,235

5. Nama Perusahaan : PT. Bina Makmur Abadi

Alamat Perusahaan : Jl. Raya Pasar Jumat No. 41 E Pondok Pinang Kebayoran Lama

NPWP : 02.623.297.5-013.000

NO NAMA BMHP MERK JUMLAH HARGA _SAT. JUMLAH KET.

TINDAKAN MINI TRAUMA TITANIUM

1

Maxican Cannulated

titanium screw partial Thread

4,5mm L 26-60 mm Agomed 3 2,416,173 7,248,518 Pemenang 1 2 Maxican Cannulated titanium screw full Thread

4,5mm L 26-60 mm Agomed 3 2,802,263 8,406,788 Pemenang 1 3

Titanium Locking Screw 2.7

mm L 8-30 mm Agomed 3 916,651 2,749,953 Pemenang 1 4

Titanium Standard Screw

2.7mm L 8-30mm Agomed 3 773,425 2,320,274 Pemenang 1 5

Forefoot System 2.7-Scarf Micro Screw Canulated

TX-Lock TX6, L10-28mm Agomed 2 2,422,400 4,844,800 Pemenang 1 6

Forefoot System 2.7-Scarf Std Compress.Screw, Cann TX-Lock TX 8, L10-30mm Agomed 2 2,422,400 4,844,800 Pemenang 1 7

Forefoot System 2.7-Scarf High Compress.Screw, Cann

TX-Lock TX 8, L10-30mm Agomed 2 2,422,400 4,844,800 Pemenang 1 8

Forefoot System 2.7-Tit Universal Plate 1.4 mm, 10-30mm Agomed 2 5,803,797 11,607,595 Pemenang 1 9

Forefoot System 2.7-Tit MP Joint Fusion plate 1.2 mm,

5-6H,28-45mm Agomed 2 3,842,214 7,684,427 Pemenang 1 10 Forefoot System 2.7-Reconstruksi Plate 6 H 35-40mm Conical Agomed 2 3,842,214 7,684,427 Pemenang 1 11 Forefoot System 2.7-Standard screw 2.7 mm TX Lock, L8-30mm Agomed 3 773,425 2,320,274 Pemenang 1 12 Rearfoot System

3.5-Calcaneus plate S/M/L/XS Agomed 2

5,803,797 11,607,595 Pemenang 1 13 Rearfoot System 3.5-Locking

Screw 3.5mm,L12-20mm Agomed 3 845,661 2,536,983 Pemenang 1 14 Rearfoot System 3.5-Locking

Screw 3.5mm,L22mm Agomed 3 871,815 2,615,446 Pemenang 1

(9)

15 Rearfoot System 3.5-Locking Screw 3.5mm,L24mm Agomed 3 900,460 2,701,380 Pemenang 1 16 Rearfoot System 3.5-Locking

Screw 3.5mm,L26mm Agomed 2 916,651 1,833,302 Pemenang 1 17 Rearfoot System 3.5-Locking

Screw 3.5mm,L28mm Agomed 2 931,596 1,863,193 Pemenang 1 18 Rearfoot System 3.5-Locking

Screw 3.5mm,L30-35mm Agomed 2 955,260 1,910,520 Pemenang 1 19 Rearfoot System 3.5-Locking

Screw 3.5mm,L40-50mm Agomed 2 980,169 1,960,338 Pemenang 1 20 Rearfoot System 3.5-Standard

Screw 3.5 mm,L12-20mm Agomed 2 719,870 1,439,740 Pemenang 1 21 Rearfoot System 3.5-Standard

Screw 3.5 mm,L22mm Agomed 3 747,270 2,241,810 Pemenang 1 22 Rearfoot System 3.5-Standard

Screw 3.5 mm,L30-35mm Agomed 3 821,997 2,465,992 Pemenang 1 26 Rearfoot System 3.5-Standard

Screw 3.5 mm,L40-50mm Agomed 3 838,188 2,514,565 Pemenang 1 27

Rearfoot System 3.5-Cann Screw Partially or Full Threaded Hex-Lock 3.5 mm,L25-60mm Agomed 2 2,416,173 4,832,345 Pemenang 1 28 Rearfoot System 3.5-Titan.Washer for Screw

3.5mm Pack of 5 Pcs Agomed 2 934,087 1,868,175 Pemenang 1 29

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0

mm-2H,Short/Long Stem Agomed

3 834,452 2,503,355 Pemenang 1 30

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-4H,w/o or 6-110mm Stem Agomed 2 996,360 1,992,720 Pemenang 1 31

mm-6H,w/o Stem Agomed

2 1,114,678 2,229,356 Pemenang 1 32

mm-6H,w/ Stem Agomed 2 1,232,995 2,465,991 Pemenang 1 33

2 1,438,495 2,876,989 Pemenang 1 34

2 1,556,813 3,113,625 Pemenang 1 35

2 2,148,401 4,296,802 Pemenang 1 36

2 2,771,126 5,542,253 Pemenang 1

(10)

37

mm-24-30H,w/o Stem Agomed

2 3,294,215 6,588,431 Pemenang 1 38

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-L Plate

4H,Right/Left,w/o Stem Agomed

2 1,606,631 3,213,262 Pemenang 1 39

4H,Right/Left,6mm Stem Agomed

2 1,606,631 3,213,262 Pemenang 1 40

2 1,637,766 3,275,533 Pemenang 1 41

2 1,687,585 3,375,169 Pemenang 1 42

2 1,756,085 3,512,169 Pemenang 1 43

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-T Plate

2 1,837,039 3,674,078 Pemenang 1 44

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-T Plate

2 1,874,402 3,748,804 Pemenang 1 45

mm-T Plate 6H,w/o Stem Agomed

2 1,980,265 3,960,531 Pemenang 1 46

mm-T Plate 5H,10mm Stem Agomed

2 1,980,265 3,960,531 Pemenang 1 47

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double T Plate 6H,w/o

Stem Agomed 2 2,030,084 4,060,167 Pemenang 1 48

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Y Plate 5H,w/o & 8mm

mm-Y Plate 5H,12 mm Stem Agomed

2 2,030,084 4,060,167 Pemenang 1 50

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double Y Plate 6H,w/o

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double Y Plate 6H,8mm Stem Agomed 2 2,179,537 4,359,075 Pemenang 1

(11)

52

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double Y Plate 7H,w/o

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate 4H,cvd,6mm Stem Agomed 2 1,388,676 2,777,353 Pemenang 1 54

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate 6H,cvd,8mm Stem Agomed 2 1,974,038 3,948,076 Pemenang 1 55

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate 8H,cvd,w/o

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate

10H,cvd,w/o Stem Agomed

2 2,098,584 4,197,167 Pemenang 1 57

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Burr Hole Plate

7-14mm,Small/Medium/Big Agomed 2 2,708,854 5,417,707 Pemenang 1 58

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-2x2H,Square/Rectangular Agomed 2 1,780,994 3,561,987 Pemenang 1 59

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-6x2H,Square/Rectangular Agomed 3 7,559,882 22,679,645 Pemenang 1

62 Titanium Screws - Cross Lock

1.7x3-4mm Agomed 3 325,063 975,188 Pemenang 1 63 Titanium Screws - Cross Lock

1.7x5-6mm Agomed 3 340,008 1,020,025 Pemenang 1 64 Titanium Screws - Cross Lock

1.7x7-8mm Agomed 3 371,145 1,113,434 Pemenang 1 65 Titanium Screws - Cross Lock

1.7x9mm Agomed 3 374,880 1,124,640 Pemenang 1 66 Titanium Screws - Cross Lock

1.7x11-15mm Agomed 3 404,771 1,214,313 Pemenang 1 67

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Plate 4H-w/o,Med,Large Stem Agomed 3 828,225 2,484,674 Pemenang 1 68

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0

mm-Plate 6H-w/o,Large Stem Agomed

3 871,815 2,615,446 Pemenang 1

(12)

69

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate

4H-Right/Left,w/o Stem Agomed

3 1,351,314 4,053,941 Pemenang 1 70

4H-Right/Left,Med Stem Agomed

3 1,413,585 4,240,756 Pemenang 1 71

4H-Right/Left,Long Stem Agomed

3 1,376,222 4,128,665 Pemenang 1 72

5H-Right/Left,Long Stem Agomed

3 1,531,904 4,595,711 Pemenang 1 73

mm-T Plate 6H-w/o Stem Agomed

3 1,531,904 4,595,711 Pemenang 1 74

mm-T Plate 6H-Long Stem Agomed

2 1,681,357 3,362,715 Pemenang 1 75

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Y Plate 5H-w/o,Long

mm-Y Plate 5H-Short Stem Agomed

2 1,525,676 3,051,353 Pemenang 1 77

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 6H-Long

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 7H-w/o

mm-Orbital Plate 6 H Agomed

2 2,385,036 4,770,073 Pemenang 1 80

2 1,967,811 3,935,622 Pemenang 1 81

2 3,306,670 6,613,340 Pemenang 1 82

mm-Orbital Plate 12H Agomed

2 2,073,675 4,147,349 Pemenang 1 83

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-2x2H,Square/Rectangular Agomed 2 1,936,675 3,873,349 Pemenang 1 84

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-3x2H,Square/Rectangular Agomed 2 2,746,217 5,492,435 Pemenang 1

(13)

85 Emergency Screw 2.3 x 7-9 mm Agomed 2 307,626 615,253 Pemenang 1 86

Plate Fixation System 3.5-Malleolar Plate 1.8x72-80mm,5-6 holes Agomed 2 5,996,842 11,993,684 Pemenang 1 87

Plate Fixation System 3.5-Malleolar Plate 1.8x95mm,8 holes Agomed 2 6,382,931 12,765,862 Pemenang 1 88

Plate Fixation System 3.5-Malleolar Plate 1.8x110mm,10 holes Agomed 2 6,382,931 12,765,862 Pemenang 1 89

Plate Fixation System 3.5-Locking Screw, HEX-Lock

Plate Fixation System 3.5-Standard Screw, HEX-Lock

Plate Fixation System 3.5-Minican 3.5 screw, partial thread, HEX-Lock

(pack/1),8-24mm Agomed 2 2,416,173 4,832,345 Pemenang 1

92 Tarsalis System 2.7-Titan Plate

4-5H,Straight Agomed 2 3,481,033 6,962,065 Pemenang 1 93 Tarsalis System 2.7-Titan Plate

5H,T Shaped Agomed 2 3,481,033 6,962,065 Pemenang 1 94

Tarsalis System 2.7-Titan Screw, Threated Head, TX 8,

8-30mm Agomed 2 4,583,256 9,166,513 Pemenang 1 95

Tarsalis System 2.7-Titan Screw, Standard, TX 8, 8-30mm Agomed 2 3,867,122 7,734,244 Pemenang 1

96 CBS Micro Screw, Cannulated

TX6, 10-34mm Agomed 2 2,422,400 4,844,800 Pemenang 1 97 CBS High Compression Screw,

Cannulated TX8, 10-36mm Agomed 2 2,422,400 4,844,800 Pemenang 1 98

Herberth Screw-Scarf Micro Screw Canulated TX-Lock ,

TX6, 10-28mm Agomed 2 2,422,400 4,844,800 Pemenang 1 99 Herberth Screw-Scarf Std Compress.Screw, Cann TX-Lock TX 8,10-30mm Agomed 2 2,422,400 4,844,800 Pemenang 1 100

Neumann Wrist Arthrodesis system-Titan Screw Treaded

Head 2.7x8-30mm,TX8 Agomed 2 916,651 1,833,302 Pemenang 1 101

Micro System 1.2- Titanium Plate 0.55 mm, Plate 4 H, Straight Agomed 2 1,052,405 2,104,811 Pemenang 1 102

Micro System 1.2- Titanium Plate 0.55 mm, Plate 12 H, Straight Agomed 2 1,974,038 3,948,076 Pemenang 1

(14)

105

Micro System 1.2- Titanium Plate 0.55 mm, Plate 24 H, Straight Agomed 2 3,331,579 6,663,158 Pemenang 1

107 Micro System 1.2- L Plate, 5

H, Right/Left Agomed 2 1,643,994 3,287,987 Pemenang 1 108 Micro System 1.2- L Plate, 8

H, Right/Left Agomed 2 1,861,948 3,723,896 Pemenang 1 109 Micro System 1.2- T Plate, 5

H, 90° Agomed 2 1,774,766 3,549,533 Pemenang 1 110 Micro System 1.2- T Plate, 7

H, 90° Agomed 2 1,992,720 3,985,440 Pemenang 1 111 Micro System 1.2- H Plate, 9

H Agomed 2 2,447,309 4,894,618 Pemenang 1 112 Micro System 1.2- Y Plate, 6

H Agomed 2 1,974,038 3,948,076 Pemenang 1 113 Micro System 1.2-Double Y

Plate, 6 H Agomed 2 2,304,083 4,608,165 Pemenang 1 114 Micro System 1.2-Double Y

Plate, 7 H Agomed 2 2,422,400 4,844,800 Pemenang 1 115 Micro System 1.2-Orbital

Plate, 8 H Agomed 2 1,743,630 3,487,260 Pemenang 1 116 Micro System 1.2-2 x 2 H

Plate, Square/Rectangular Agomed 2

1,780,994 3,561,987 Pemenang 1 117 Micro System 1.2-3 x 2 H

7,559,882 15,119,764 Pemenang 1 120 Titanium Screws - Cross

Lock-1.2x3-6mm Agomed 2 601,553 1,203,105 Pemenang 1 121 Titanium Screws - Cross

Lock-1.2x7-10mm Agomed 3 638,915 1,916,746 Pemenang 1 122 Titanium Screws - Cross

Lock-1.2x11-13mm Agomed 3 676,279 2,028,837 Pemenang 1 148

Minican Cannulated Tit Screw partial Thread 2.7mm L 20-60mm Agomed 3 3,094,944 9,284,831 Pemenang 1 149

Minican cannulated titanium screw partial or full thread

3,5mm L 25-60mm Agomed 3 2,416,173 7,248,518 Pemenang 1 150

Forefoot System 2.7-Tit Open-Wedge Plate 1.1 mm, 0-8mm Agomed 3 5,156,163 15,468,488 Pemenang 1

151 Radius Plate, Small or Large,

Palmar, Right/Left Agomed 3

4,502,302 13,506,905 Pemenang 1 152

mm-Plate 16H-w/o Stem Agomed

4 1,531,904 6,127,615 Pemenang 1

153 Titanium Screws - Cross

Lock-2.0 x 5-11 mm Agomed 10 254,072 2,540,718 Pemenang 1 154

Forefoot System 2.7-Locking screw 2.7 mm TX Lock, L8-30mm Agomed 15 916,651 13,749,764 Pemenang 1

(15)

Jumlah 600,991,899 PPN 10% 60,099,190 Total 661,091,089 6. Nama Perusahaan : PT. Triputra Aman Makmur

Alamat Perusahaan : Rukan Permata Senayan Blok G-15, Jl. Tentara Pelajar No. 5 , Jakarta Selatan

NPWP : 31.260.216.2-013.000

HARGA

SAT. JUMLAH KET TINDAKAN ARTHROSCOPY

1

Paket ACL Knee

Debridement, consist of:

Smith & Nephew 12 7,610,000 91,320,000 Pemenang Arthroscopy tubing ( 1 buah) Shaver ( 1 buah) 2

Paket ACL Knee Standard, consist of: Smith & Nephew 19 27,420,000 520,980,000 Pemenang Drill guide 2.4-2.7mm ( 1 buah) Arthroscopy tubing ( 1 buah) BUTTON ( 1 buah) Shaver ( 1 buah) BIOSURE/BIOSCREW ( 1 buah) 3

Paket ACL Knee + RF, consist of: Smith & Nephew 12 36,490,000 437,880,000 Pemenang Drill guide 2.4-2.7mm ( 1 buah) Arthroscopy tubing ( 1 buah) BUTTON ( 1 buah) Shaver ( 1 buah) BIOSURE/BIOSCREW ( 1 buah) RF-S Whirlwind 4

Paket ACL Knee + Fast Fix, consist of: Smith & Nephew 12 34,620,000 415,440,000 Pemenang Drill guide 2.4-2.7mm ( 1 buah) Arthroscopy tubing ( 1 buah) BUTTON ( 1 buah) Shaver (1 buah) BIOSURE/BIOSCREW ( 1 buah)

(16)

ULTRA FAST-FIX, Curved (

1 buah)

5

Paket Meniscus Repair, consist of: Smith & Nephew 8 14,810,000 118,480,000 Pemenang Arthroscopy tubing (1 buah) Shaver ( 1 buah)

ULTRA FAST-FIX, Curved

(1 buah)

6

Paket Shoulder Standard, consist of: Smith & Nephew 5 10,310,000 51,550,000 Pemenang Arthroscopy tubing (1 buah) Shaver (1 buah) Cannula Threaded (2 buah) 7 Paket Shoulder + RF, consist of: Smith & Nephew 5 19,380,000 96,900,000 Pemenang Arthroscopy tubing (1 buah) Shaver (1 buah) Cannula Threaded (2 buah) RF-S Whirlwind (1 buah)

8 Twinfix Ti with needle

Smith & Nephew 9 11,340,000 102,060,000 Pemenang

9 Twinfix Ti without needle

Smith & Nephew 9 9,070,000 81,630,000 Pemenang Jumlah 1,916,240,000 PPN 10% 191,624,000 Total 2,107,864,000

7. Nama Perusahaan : PT. Eka Gemilang Medika

Alamat Perusahaan : Ruko bukit rivaria blok a8 jl. Raya Muchtar RT 003 RW 001 sawangan Depok

NPWP : 21.051.943.5-412.000

NO NAMA BMHP MERK JUMLAH HARGA SAT. JUMLAH KET.

30

mm-4H,w/o or 6-110mm Stem Stema 2

2,247,700 4,495,400 Pemenang 1 31

mm-6H,w/o Stem Stema 2

2,247,700 4,495,400 Pemenang 1 32

mm-6H,w/ Stem Stema 2 3,573,500 7,147,000 Pemenang 1

(17)

33

3,920,000 7,840,000 Pemenang 1 34

5,187,700 10,375,400 Pemenang 1 35

5,349,400 10,698,800 Pemenang 1 36

6,690,600 13,381,200 Pemenang 1 37

mm-24-30H,w/o Stem Stema 2

10,500,000 21,000,000 Pemenang 1 38

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-L

Plate 4H,Right/Left,w/o Stem Stema 2

2,365,300 4,730,600 Pemenang 1 39

Plate 4H,Right/Left,6mm Stem Stema 2

3,418,800 6,837,600 Pemenang 1 40

3,529,400 7,058,800 Pemenang 1 41

3,654,700 7,309,400 Pemenang 1 42

3,757,600 7,515,200 Pemenang 1 43

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-T

2,785,300 5,570,600 Pemenang 1 44

2,947,700 5,895,400 Pemenang 1 45

Plate 6H,w/o Stem Stema 2

3,787,700 7,575,400 Pemenang 1 46

Plate 5H,10mm Stem Stema 2

3,787,700 7,575,400 Pemenang 1 47

mm-Double T Plate 6H,w/o Stem Stema 2

3,293,500 6,587,000 Pemenang 1 48

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Y

Plate 5H,w/o & 8mm Stem Stema 2

3,920,000 7,840,000 Pemenang 1 49

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Y

Plate 5H,12 mm Stem Stema 2

3,993,500 7,987,000 Pemenang 1 50

mm-Double Y Plate 6H,w/o Stem Stema 2

3,293,500 6,587,000 Pemenang 1 51

mm-Double Y Plate 6H,8mm Stem Stema 2

3,529,400 7,058,800 Pemenang 1

(18)

52

mm-Double Y Plate 7H,w/o Stem Stema 2

3,529,400 7,058,800 Pemenang 1 53

mm-Orbital Plate 4H,cvd,6mm Stem Stema 2

2,991,800 5,983,600 Pemenang 1 54

mm-Orbital Plate 6H,cvd,8mm Stem Stema 2

3,669,400 7,338,800 Pemenang 1 55

mm-Orbital Plate 8H,cvd,w/o Stem Stema 2

4,302,900 8,605,800 Pemenang 1 56

mm-Orbital Plate 10H,cvd,w/o Stem Stema 2

5,378,800 10,757,600 Pemenang 1 57

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Burr Hole Plate 7-14mm,Small/Medium/Big Stema 2 7,737,100 15,474,200 Pemenang 1 58

mm-2x2H,Square/Rectangular Stema 2 4,029,200 8,058,400 Pemenang 1 59

Titanium Screws - Cross Lock

1.7x3-4mm Stema 3 3,610,600 10,831,800 Pemenang 1 63

1.7x9mm Stema 3 3,610,600 10,831,800 Pemenang 1 66

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Plate 4H-w/o,Med,Large Stem Stema 3 2,902,900 8,708,700 Pemenang 1 68

mm-Plate 6H-w/o,Large Stem Stema 3

3,698,800 11,096,400 Pemenang 1 69

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4H-Right/Left,w/o Stem Stema 3 3,448,200 10,344,600 Pemenang 1 70

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4H-Right/Left,Med Stem Stema 3 3,595,900 10,787,700 Pemenang 1

(19)

71

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4H-Right/Left,Long Stem Stema 3 3,757,600 11,272,800 Pemenang 1 72

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 5H-Right/Left,Long Stem Stema 3 3,794,700 11,384,100 Pemenang 1 73

mm-T Plate 6H-w/o Stem Stema

3 4,031,300 12,093,900 Pemenang 1 74

mm-T Plate 6H-Long Stem Stema 2

3,993,500 7,987,000 Pemenang 1 75

mm-Y Plate 5H-w/o,Long Stem Stema 2

3,846,500 7,693,000 Pemenang 1 76

mm-Y Plate 5H-Short Stem Stema

2 4,052,300 8,104,600 Pemenang 1 77

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 6H-Long

Stem Stema 2 3,846,500 7,693,000 Pemenang 1 78

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 7H-w/o

Stem Stema 2 4,052,300 8,104,600 Pemenang 1 79

mm-Orbital Plate 6 H Stema 2

4,302,900 8,605,800 Pemenang 1 80

mm-Orbital Plate 8 H Stema 2

4,582,900 9,165,800 Pemenang 1 81

mm-Orbital Plate 10 H Stema

2 5,658,800 11,317,600 Pemenang 1 82

mm-Orbital Plate 12H Stema 2

6,572,300 13,144,600 Pemenang 1 83

mm-2x2H,Square/Rectangular Stema 2 921,600 1,843,200 Pemenang 1 84

mm-3x2H,Square/Rectangular Stema 2 11,798,400 23,596,800 Pemenang 1 85 Emergency Screw 2.3 x 7-9 mm Stema 2 3,389,400 6,778,800 Pemenang 1 101

Micro System 1.2- Titanium Plate 0.55 mm, Plate 4 H, Straight Stema 2 2,210,600 4,421,200 Pemenang 1 102

Micro System 1.2- Titanium Plate 0.55 mm, Plate 8 H, Straight Stema 2 3,735,900 7,471,800 Pemenang 1

(20)

104

Micro System 1.2- L Plate, 5 H,

Right/Left Stema 2 3,757,600 7,515,200 Pemenang 1 108

Micro System 1.2- L Plate, 8 H,

Right/Left Stema 2 5,231,800 10,463,600 Pemenang 1 109

Micro System 1.2- T Plate, 5 H,

90° Stema 2 3,721,200 7,442,400 Pemenang 1 110

Micro System 1.2- T Plate, 7 H,

90° Stema 2 3,721,200 7,442,400 Pemenang 1

111 Micro System 1.2- H Plate, 9 H Stema 2

12,157,600 24,315,200 Pemenang 1

112 Micro System 1.2- Y Plate, 6 H Stema 2

3,242,400 6,484,800 Pemenang 1 113

Micro System 1.2-Double Y

Plate, 6 H Stema 2 3,537,100 7,074,200 Pemenang 1 114

Micro System 1.2-Double Y

Plate, 7 H Stema 2 3,537,100 7,074,200 Pemenang 1 115

Micro System 1.2-Orbital Plate,

8 H Stema 2 4,266,500 8,533,000 Pemenang 1 116

Micro System 1.2-2 x 2 H Plate,

Square/Rectangular Stema 2 4,421,200 8,842,400 Pemenang 1 117

Titanium Screws - Cross

Lock-1.2x3-6mm Stema 2 3,396,400 6,792,800 Pemenang 1 121

mm-Plate 16H-w/o Stem Stema

4 5,349,400 21,397,600 Pemenang 1 153

Lock-2.0 x 5-11 mm Stema 10 3,389,400 33,894,000 Pemenang 1 Jumlah 846,704,000 Ppn 10% 84,670,400 Total 931,374,400

(21)

8. Nama Perusahaan : PT. Bintang Biocare Indonesia

Alamat Perusahaan : Graha Malaka Lt 1 Jl Malaka Merah Iii Blok D /17 Pd Kopi Jakarta Timur

NPWP : 03.313.000.6-008.000

NO NAMA BMHP MERK JUMLAH HARGA

SAT. JUMLAH KET

123

Cortex Screw, Fully Threaded,

1.5 x 6-14 Kanghui 3 180,000 540,000 Pemenang 1 124 Straight Plate, 3-6H, 0.85mm

Thick w/1.5 Screws Kanghui 2

960,300 1,920,600 Pemenang 1 125 Straight Plate, 20H, 0.85mm

2,160,000 4,320,000 Pemenang 1 126 L - Plate, 4H, 0.85mm Thick w/1.5 Screws L/R Kanghui 2 960,300 1,920,600 Pemenang 1 127 Angled L Plate, 4H, 0.85mm

Thick w/1.5 Screws L/R Kanghui 2

960,300 1,920,600 Pemenang 1 128 Short T Plate, 4H, 0.85mm

960,300 1,920,600 Pemenang 1 129 Long T Plate, 3-4H, 0.85mm

960,300 1,920,600 Pemenang 1 130 H - Plate, 4H, 0.85mm Thick w/1.5 Screws Kanghui 2 960,300 1,920,600 Pemenang 1 131

Cortex Screw, Fully Threaded,

2.0 x 6-20 Kanghui 3 180,000 540,000 Pemenang 1 132 Straight Plate, 2-6H, 1mm

960,300 1,920,600 Pemenang 1 133 H - Plate, 4-6H, 1mm Thick w/2.0 Screws Kanghui 2 960,300 1,920,600 Pemenang 1 134 Straight L-Plate, 4H, 1mm

960,300 1,920,600 Pemenang 1 135 Straight L-Plate, 5H, 1mm

960,300 1,920,600 Pemenang 1 136 Angled L Plate, 4-5H, 1mm

Thick w/2.0 Screws L Kanghui 2

960,300 1,920,600 Pemenang 1 137 Angled L Plate, 4-5H, 1mm

Thick w/2.0 Screws R Kanghui 2

960,300 1,920,600 Pemenang 1 138

Short T Plate, 4H, 1mm Thick

w/2.0 Screws Kanghui 2 960,300 1,920,600 Pemenang 1 139

Long T Plate, 4H, 1mm Thick

w/2.0 Screws Kanghui 2 960,300 1,920,600 Pemenang 1 140 T Plate, 5-6H, 1mm Thick w/2.0 Screws Kanghui 2 960,300 1,920,600 Pemenang 1 141

Hex Cortex Screw, Fully

Threaded, 2.7 x 6-20 Kanghui 3 180,000 540,000 Pemenang 1 142

Hex Cortex Screw, Partially

Threaded, 2.7 x 10-24 Kanghui 3 180,000 540,000 Pemenang 1 143 Straight Plate, 2-6H, 2mm

960,300 1,920,600 Pemenang 1 144 Straight L - Plate, 5H, 1.2mm

960,300 1,920,600 Pemenang 1 145 Angled L - Plate, 5H, 1.2mm

960,300 1,920,600 Pemenang 1

(22)

146

Mini T-Plate, 5H, 1.2mm Thick

w/2.7 Screws Kanghui 2 960,300 1,920,600 Pemenang 1 147 W-Plate, 7H, 1.2mm Thick w/2.7 Screws Kanghui 2 2,160,000 4,320,000 Pemenang 1 TINDAKAN TRAUMA DCP STAINLESS

1

DCP 4.5, broad, 6-9 Holes,

Stainless Steel Kanghui 25

990,000 24,502,500 Pemenang 1 2 DCP 4.5, broad, 10-18 Holes,

1,125,000 10,125,000 Pemenang 1 3 DCP 4.5, narrow, 4-9 Holes,

900,000 20,250,000 Pemenang 1 4 DCP 4.5, narrow, 10-16 Holes,

1,049,940 4,724,730 Pemenang 1 5

Semi tubular Plate, 3-7 Holes,

675,000 3,375,000 Pemenang 1 6

Semi Tubular Plate,8-10 Holes,

712,530 3,562,650 Pemenang 1 7

T-Plate 4,5, shaft 3-8 Holes,

945,000 8,505,000 Pemenang 1 8

Cortex Screw Ø4,5mm, length

14-50 mm, Stainless Steel Kanghui 610

108,000 65,853,000 Pemenang 1 9

117,000 7,107,750 Pemenang 1 10 Cancellous Screw Ø6,5mm ,length 25-80/16 mm,

187,470 1,687,230 Pemenang 1 14 Cancellous Screw Ø6,5mm, Fully Threaded ,length 25-80

mm, Stainless Steel Kanghui 41

173,250 7,016,625 Pemenang 1 15 Cancellous Screw Ø6,5mm, Fully Threaded ,length 85-120

187,470 1,874,700 Pemenang 1 16 Malleolar Screw Ø4,5mm,length 25-70

mm,Stainless Steel Kanghui 9

150,030 1,350,270 Pemenang 1 17 DCP 3.5 , 4-8 Holes, Stainless Steel Kanghui 9 824,940 7,424,460 Pemenang 1 18 DCP 3.5 , 9-10 Holes, Stainless Steel Kanghui 5 900,000 4,050,000 Pemenang 1 19

One-Third tubular plate 3,5 ,

2-8 Holes , Stainless Steel Kanghui 52

712,530 36,873,428 Pemenang 1 20 Reconstruction plate 3,5, 6-14

Holes, Stainless Steel Kanghui 33

1,649,970 54,449,010 Pemenang 1 21 T-Plate ,right-angled/oblique-angled, shaft 3-5 Holes,

stainless steel Kanghui 2

824,940 1,856,115 Pemenang 1

(23)

22

Reconstruction Y Plate 3,5, 3-7

Holes, Stainless Steel Kanghui 5

1,800,000 9,000,000 Pemenang 1 23 S-Reconstruction plate 3,5, 6-9

Holes, Right/Left, stainless steel Kanghui 5

1,800,000 9,000,000 Pemenang 1 24

108,000 62,640,000 Pemenang 1 25

117,720 9,417,600 Pemenang 1 26 Cancellous Screw Ø4,0mm, Partially Threaded,length

155,250 776,250 Pemenang 1 27 Cancellous Screw Ø4,0mm, Fully Threaded ,length 14-50

155,250 4,191,750 Pemenang 1 28 K-Wire Dia : 0,6 ; 0,8 ; 1,0 ; 1,2 ; 1,4 ; 1,6 ; 1,8 ; 2,0 ;2,4 ;2,8; 3,0m Kanghui 45 247,500 11,137,500 Pemenang 1 29 SS. Wire Dia. 0,6 0,8 1,0 1,2 1,4 1,6 1,8 2,0 2,2 2,4 2,6 2,8 , 3,0 Kanghui 10 2,430,000 24,300,000 Pemenang 1 Jumlah 447,895,328 Ppn 10% 44,789,533 Total 492,684,860

9. Nama Perusahaan : PT Meditech Indonesia

Alamat Perusahaan : Ruko Harco Elektronik Mangga Dua, Komp Agung Sedayu Blok I No.5B Lt.2

NPWP : 02.355.699.6-026.000

NO NAMA BMHP MERK JUMLAH HARGA SAT. JUMLAH KET

TINDAKAN ARTHROPLASTY 6 THR Cementless SMALL SIZE Biomet 6 42,750,000 256,500,000 Pemenang 1 7 THR Cemented With 22,28,32mm Head Biomet 6 26,220,000 157,320,000 Pemenang 8 TKR CR POSTERIOR REF INSTRUMENT Biomet 6 34,105,000 204,630,000 Pemenang 1 9 TKR PS POSTERIOR REF INSTRUMENT Biomet 3 38,285,000 114,855,000 Pemenang 1

10 THR Hybrid Multihole Cup Biomet 6

39,900,000

239,400,000 Pemenang

12

Bipolar Cementless small size Biomet 15 28,547,500 428,212,500 Pemenang 1 13

Bipolar Cemented small size Biomet 15 25,697,500 385,462,500 Pemenang 1

(24)

14

Total Hip Replacement (THR) SMALL SIZE Biomet 12 29,545,000 354,540,000 Pemenang 1 Jumlah 2,140,920,000 Ppn 10% 214,092,000 Total 2,355,012,000 10.Nama Perusahaan : PT. Utama Sarana Medika

Alamat Perusahaan : Jl. Tebet Barat Raya No. 3 NPWP : 02.179.093.6-062.000

NO NAMA BMHP MERK JUMLAH HARGA

SAT. JUMLAH KET

BONECEMENT

1

Bonecement Low Viscosity 40gr Heraeus Medical 10 1,150,000 11,500,000 Pemenang 1 2 Bonecement Low Viscosity+Gentamicin 40gr Heraeus Medical 70 1,750,000 122,500,000 Pemenang 1 3

Bonecement High Viscosity 40gr Heraeus Medical 10 1,200,000 12,000,000 Pemenang 4 Bonecement High Viscosity+Gentamicin 40gr Heraeus Medical 10 1,800,000 18,000,000 Pemenang Jumlah 164,000,000 Ppn 10% 16,400,000 Total 180,400,000

Kepada peserta yang memasukandokumenpenawarandiberikan masa sanggah selama 5 (lima) hari kalender terhitung setelah tanggal pengumuman ini.

Surat sanggahan disampaikan pada :

Alamat Situs Internet: http://lpse.kemenkes.go.id: atau secara tertulis ditujukan kepada: KelompokKerjaIIIULP RSUP Dr. HasanSadikin Bandung.

Demikian untuk diketahui, atas perhatian serta partisipasinya, kami ucapkan terima kasih.

Pokja III