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8/17/2019 Obat Bpjs Triwulan 1
1/18
No Nama Satuan Harga
1 2 3 4
1 Allopurinol 100 mg Tablet 90
2 Amitriptilin 25 mg Tablet 123
3 Amoksicilin 500 mg Tablet 279
4 Amoksicilin sirup kering 125 mg/ 5 ml otol !0 ml 25!0
5 Amoksicilin sirup kering "orte 250 mg/ 5 ml otol !0 ml 4750
! Antasi#a $%&N ' tablet kun(a) Tablet 7*
7 Antasi#a $%&N '' suspensi otol !0 ml 2300
* Anti migrain $%&N Tablet 149
9 Asam Asetilsalisilat +acetosal, 100 mg Tablet 127
10 Asam -e"enamat 500 mg Tablet 122
11 e#ak Salisil serbuk 2. $us 1350
12 etametason krim 01. Tube 155*
13 etametason Tetes -ata 1 mg/ml otol 5 ml 2510!
14 isako#il suppositoria 10 mg Supp !045
15 $eksamet)ason 05 mg Tablet !*
1! $iaepam 2 mg Tablet 4!
17 $iaepam larutan rectal 5 mg/25 ml Stesoli# 12751
1* $i"en)i#ramin in i/im 10 mg/ml +Hl, Ampul 11!0
19 $imen)i#rinat 50 mg Tablet 107
20 $inatrium etat Tetes mata 035. botol 15ml 37500
21 $omperi#on suspensi 5 mg/ 5 ml otol !0 ml 3490
22 enoterol Hr i) 100 mcg/pu6 anister 10 ml 72900
23 lusinolon asetoni# krim 0025. Tube 2700
24 entamisin salep mata 03. Tube 35 gram 27*!25 entamisin Tetes -ata otol 5 ml 3513
2! liserin larutan 5. otol 100 ml 5*!7
27 lukosa 5. larutan in"us otol 500 ml 5720
2* Hi#rokortison krim 25. Tube 5 gram 2*!*
29 Hiosin util romi# ineksi 20mg/ml Ampul 1ml 4950
30 'bupro"en sirup 100 mg/ 5 ml otol !0 ml 3*49
31 'sosorbi# $initrat sublingual 5 mg Tablet 9*
32 8aptopril 25 mg Tablet 97
33 8etokonaol krim 2. tube 10 gram 2!33
34 8o#ein 10 mg Tablet 55035 8otrimoksaol suspensi 240 mg otol !0 ml 229*
3! 8uinin 222 mg Tablet 594
37 ansopraol 30 mg 8apsul 521
3* a:a#ine &mulsi otol !0 ml 12450
39 i#okain ineksi ;.+Hl,
8/17/2019 Obat Bpjs Triwulan 1
2/18
42 -etil pre#nisolon * mg Tablet 390
43 -etilergometrin -aleat Tablet 1!9
44 -etokloprami#e sirup 5 mg/5 ml otol !0 ml 2900
45 -ometason "uroat krim 01. Tube 10 gram 2004*
4! Nacl 09. otol 500 ml 5170
47 Natrium $iklo"enak 50mg Tablet 193
4* Ni"e#ipin 10mg Tablet 110
49 Nistatin ?aginal 100000 '@/g Tablet 52*
50 %ksitosin 'neksi '@ 10ml Ampul 1900
51 %mepraol 20mg 8apsul 221
54 arasetamol 500mg Tablet **
55 arasetamol S(rup 120mg/5ml otol !0 ml 1535
5! ermetrin 8rim 5. Tube 10 gram 11475
57 olikresulen airan otol 10ml 1*!35
5* oi#on 'o#i#a arutan 10. otol 30ml 2344
59 Bamipril 5mg Tablet !35
!0 Baniti#in 150mg Tablet 132
!1 Baniti#in 'neksi 25mg/ml Ampul 2ml 1340
!2 Binger aktaT arutan 'n"us otol 500 ml 5720
!3 Salbutamol airan 'H 01. ?ial 25ml 72!0
!4 Salbutanol 4mg +sebagai Sul"at, Tablet 91
!5 Salep 2/4 ot 30gram 2200
!! Sep)a#roksil 500mg 8apsul 529
!7 Sep)a#roksil S(rup 8ering 125mg/5ml otol !0 ml 52*!
!* Setriin 10mg 8apsul 190
!9 Setriin S(rup 5mg/5ml otol !0 ml *79970 Sianokobalamin 'neksi 500mcg Ampul 1ml 1110
71 Si"roCoksacin 500mg Tablet 2!5
72 Simastatin 20mg Tablet 4*0
73 Simastatin Score#n 10mg Tablet 177
74 Spironolakton 25mg Tablet 350
75 Sukral"at suspensi 500 mg/5 ml otol 100 ml 14450
7! Tetracain Hl tetes mata 05. otol 5 ml 11500
77 Timolol Tetes -ata 05. otol 5ml 102*!
7* Ambro:ol sirup otol !0 ml 3!27
79 Anti Hemaroi# $%&N supp 8otak 10 Suppo 22000*0 liseril uaiakolat 100 mg otol 1000 Tabl 30!90
*1 T)iamin Hl 50 mg Tablet *3
*2 Seteriin 10 mg Tablet 190
*3 T%TA
8/17/2019 Obat Bpjs Triwulan 1
3/18
erencanaan 3 bulan Harga 3 bulan abrik
5 ! 7
300 27000 T ertiDi Agung
100 12300 T 'n#o"arma
5200 1450*00T -ersi"arma Tirmacu -ercusana
100 25!000 T Noap)arin
200 950000 T Holi )arma
5000 390000 T &rela
150 345000 T ucas $aa
500 74500 T 8imia arma
100 12700 T )apros Tbk
5000 !10000 T erno"arm
50 !7500 T Bama &meral# -ulti Sukses
50 77900 T 8imia arma
5 125530 T Sanbe arma
20 120900 T Sanbe arma
7000 47!000T rome#ra)ar#o armasi 'n#ustri
200 9200 T 8imia arma
5 !3755 T Actais 'n#onesia
30 34*00 T ucas $aa
100 10700 T 8imia arma
10 375000 T en#o 'n#ustri armasi
50 174500 T Noap)arin
0 0 T oe)ringer 'ngel)eim
50 135000T '"ars )armaceutical aboratories
*0 222**0 T &rela70 245910 T 'n#o"arma
10 5*!70 T ucas $aa
40 22**00 T Ei#arta )akti
72 20!49! T 8imia arma
5 24750 T %tto )armaceuticals
200 7!9*00 T 'n#o"arma
200 19!00 T 8imia arma
*00 77!00 T )apros Tbk
50 131!50 T 8imia arma
500 275000 T 8imia arma100 229*00 T Hol( )arma
100 59400 T 8imia arma
12!0 !5!4!0 T 'n#o"arma
3 37350 T alinium )armasia aboratories
200 299*00 T 'n#o"arma
500 *5000 T rome#ra)ar#o armasi 'n#ustri
500 59000 T erno"arm
8/17/2019 Obat Bpjs Triwulan 1
4/18
1700 !!3000 T $e:a -e#ica
500 *4500 T 8imia arma
50 145000 T -ole: A(us
10 2004*0 T uar#ian )armatama
20 103400 T Ei#arta )akti
3500 !75500 T )apros Tbk
500 55000 T $e:a -e#ica
100 52*00 T )apros Tbk
90 171000 T Tunggal '#aman Ab#i
17!0 3**9!0 T Noap)arin
5200 457!00T rome#ra)ar#o armasi 'n#ustri
200 307000 T Noap)arin
* 91*00 T alinium )armasia aboratories
5 93175 T ratapa Nirmala
17 39*4* T Ai arma
350 222250 T $e:a -e#ica
1700 224400 T $e:a -e#ica
50 !7000 T Natura aboratoria rima
40 22**00 T Ei#arta )akti
17 123420 T lakso Eelcome 'n#onesia
300 27300 T 8imia arma
100 220000 T -arin ia armasi
1700 *99300 T erno )arma
150 792900 T Hol( )arma
1700 323000 T ertiDi Agung
50 439950 T 'n#o"arma200 222000 T erno )arma
1700 450500 T erno )arma
1700 *1!000 T Natura aboratoria rima
1700 300900 T Natura aboratoria rima
200 70000 T $e:a -e#ica
50 722500 T ombip)ar
10 115000 T en#o 'n#ustri armasi
10 102*!0 T ratapa Nirmala
100 3!2700
! 132000 T 8imia arma2 !13*0
5000 415000 T Noap)arin
1700 323000
20!7*274
8/17/2019 Obat Bpjs Triwulan 1
5/18
No Nama Satuan Harga
1 2 3 4
1 AFua#est otol 1 ltr 15730
2 a(clin otol 1 ltr 27500
3 enang plan 3/0 pcs 9075
4 atgut c)romic 3/0 bo: 24 pcs 217*00
5 &til klori#a semprot botol 137500
! 8asa )i#ro=l 4:15 cm bo: 50 roll 151250
7 8asa steril 1!/1! o: 10 pcs 7*!5
* Beagen golongan #ara) A ?ial *4700
9 reagen golongan #ara) ?ial *4700
10 Stik Asam @rat bo: 110000
11 Stik gula #ara) bo: 110000
12 Stik kolesterol bo: 192500
13 Tes 8e)amilan bo: 50 **000
14 @ pa# !0:90 steril D/SA pak isi 10 !!550
15 @rinbag pcs 4901
1! '? at)eter No 20 bo: isi 24 3*9375
17 '? at)eter No 22 bo: isi 24 3*9375
1* '? at)eter No 24 bo: isi 24 3*9375
19 Alat suntik 1 ml bo: 109250
20 Alat suntik 25 ml bo: 103*00
21 Alat suntik 5 ml bo: 103*00
22 Sarung Tangan No 7 bo: isi 50 212500
23 Sarung Tangan No 75 bo: isi 50 212500
24 Sarung Tangan No * bo: isi 50 21250025 Alog(l 10 gr botol 5*3000
2! Arsen !5 gr pot 390000
27 lass 'onomer sement +ui 'G, set 395000
2* 8alsium Hi#roksi#a pasta set 242000
29 omposite A2 3* gr tube 550000
30 omposite A3 3* gr tube 550000
31 on#ing Single on# botol 1100000
32 &tc)ing botol 330000
33 8uas on#ing bo: 170500
34 ?itrebon#/ base bon#ing ktk/btl 35200035 ait +tumpa)an sementara, 30 gr pot 1!!9*0
3! resop)ate botol *3!000
37 resop)ene botol 902000
3* 'o#o"orm pasta botol 297000
39 Spongostan bo:/50 steril 525000
40 Iinc p)osp)at semen set 17!000
T%TA
8/17/2019 Obat Bpjs Triwulan 1
6/18
erencanaan 3 bulan Harga 3 bulan -erk
7
0 an )emistr
0
0 %-/&A/Seremit(
0 %-/&A/Seremit(
0 Eater Bitc)er
0 %-
0 %-
0 %neme#
0 %neme#
9 990000 &as( touc)/Nessco
9 990000 &as( touc)/Nessco
9 1732500 &as( touc)/Nessco
0 %-
0 %-
0 @rocare
0 0 %-/Sterra
0 0 %-/Sterra
0 %-/Sterra
0 %-/Sterra
0 0 %-/Sterra
0 %-/Sterra
0 Serenit(/--
0 Serenit(/--
0 Serenit(/--1 5*3000 Septo#ont rance
0 0 Septo#ont rance
0 0 Japan
0 0 $ori#ent Austria
1 550000 Toku(ama Jepang
0 0 Toku(ama Jepang
0 0 $- erman(
1 330000 -eta 8orea
0 0 -icrorus)
1 352000 -aster on# io#inamika1 1!!9*0 $ori#ent Austria
1 *3!000 Septo#ont rance
0 0 Septo#ont rance
1 297000 )imas 'tal(
1 525000 uraspon Net#erlan#
1 17!000 $ori#ent Austria
752*4*0
8/17/2019 Obat Bpjs Triwulan 1
7/18
No Nama Satuan Harga a) ermint Jumla) Harga abrik
1 2 3 4 5 ! 7
1 Asikloir s Tube 24750 100 2475000 T Sanbe
2 Allopurino Tablet 90 1400 12!000 T ertiDi
3 Ambro:ol otol !0 m 3!27 700 253*900 T 8imia
4 Aminop)ili Tablet *! 500 43000 T &rela
5 Amitriptili Tablet 123 100 12300 T 'n#o"ar
! Amoksicili Tablet 279 24000 !!9!000 T -ersi"a
7 Amoksicili otol !0 m 25!0 500 12*0000 T Noap
* Amoksicili otol !0 m 4750 700 3325000 T Holi )
9 Amoksilin 8apsul 220 10000 2200000 T 'n#o"ar
10 Antasi#a $Tablet 7* 21000 1!3*000 T &rela
11 Antasi#a $otol !0 m 2300 700 1!10000 T ucas $
12 Anti Hema 8otak 10 S 22000 21 4!2000 T 8imia
13 Anti migra Tablet 149 2100 312900 T 8imia
14 Asam AsetiTablet 127 300 3*100 T )apro
15 Asam askoTablet 105 24000 2520000 T 8imia "
1! Asam "olatTablet 52 !00 31200 T -arlin
17 Asam -e"eTablet 122 21000 25!2000 T erno"a
1* Asam tran Ampul 3!50 24 *7!00 t He:p)a
19 Asikloir 2 Tablet 245 1200 294000 t 8imia "a
20 Asikloir Tablet 345 !000 2070000 t 8imia "a
21 Attalpugit Tablet 220 !000 1320000 t Ienit)
22 eta)istin 2400
23 e#ak Sali $us 1350 210 2*3500 T Bama &
24 etametasTube 155* 210 3271*0 T 8imia 25 etametasotol 5 ml 2510! 21 52722! T Sanbe
2! isako#il s Supp !045 105 !34725 T Sanbe
27 $eksamet Tablet !* 4*000 32!4000 T rome#
2* $e:ameta Ampul 173* 1200 20*5!00 t 'n#o"ar
29 $iaepam Tablet 4! 700 32200 T 8imia
30 $iaepam lStesoli# 12751 12 153012 T Actais
31 $i"en)i#ra Ampul 11!0 4*0 55!*00 T ucas $
32 $igoksin 0 Tablet 103 !00 !1*00 t Karin#o
33 $imen)i#riTablet 107 700 74900 T 8imia
34 $inatrium botol 15ml 37500 35 1312500 T en#o '35 $omperi# otol !0 m 3490 100 349000 T Noap)
3! &pineprin iAmpul *910 100 *91000 t )apros
37 &ritromisi Tablet 1023 5000 5115000 t 8imia "a
3* &tanol 70 otol 1 lite 2!25 3! 94500 t Noap)
39 &ugenol caotol 1*333 1 1*333 t 8imia "a
40 enoterol anister 1 72900 14 1020!00 T oe)ri
41 itomena#iAmpul 3754 !00 2252400 t )apros
8/17/2019 Obat Bpjs Triwulan 1
8/18
42 itomena#iTablet !9* 2400 1!75200 t -arlin i
43 lusinolon Tube 2700 210 5!7000 T '"ars )
44 urosemi# Tablet *4 1000 *4000 t samp)a
45 aram oralungkus 317 2000 !34000 t )apros
4! entamisi Tube 35 g 27*! 350 975100 T &rela
47 entamisi otol 5 ml 3513 2*0 9*3!40 T 'n#o"ar
4* liseril u otol 1000 30!90 24 73!5!0
49 liserin la otol 100 5*!7 35 205345 T ucas
50 lukosa 5 otol 500 5720 140 *00*00 T Ei#art
51 riseo"ul Tablet 224 1200 2!**00 t 8imia "a
52 Haloperi#oTablet !2 300 1*!00 t 'n#o"ar
53 Hi#rokortisTube 5 gra 2*!* 2*0 *03040 T 8imia
54 Hiosin utiAmpul 1ml 4950 35 173250 T %tto )
55 'bupro"en Tablet 121 1000 121000 t Karin#o
5! 'bupro"en Tablet 157 3000 471000 t Noap)
57 'bupro"en otol !0 m 3*49 700 2!94300 T 'n#o"ar
5* 'sosorbi# Tablet 9* 700 !*!00 T 8imia
59 8aptopril Tablet !9 1000 !9000 t 'n#o"ar
!0 8aptopril Tablet 97 3500 339500 T )apro
!1 8arbama Tablet 2!9 300 *0700 t 'n#o"ar
!2 8etokona Tablet 320 !00 192000 t Noap)
!3 8etokona tube 10 gr 2!33 210 552930 T 8imia
!4 8lorampen8apsul 275 1200 330000 t )apros
!5 8lorampenTube 1!40 50 *2000 t 8imia "a
!! 8o#ein 10 Tablet 550 2100 1155000 T 8imia
!7 8otrimoksaotol !0 m 229* 350 *04300 T Hol( )!* 8otrimoksaTablet 152 !000 912000 t rome#
!9 8uinin 222 Tablet 594 300 17*200 T 8imia
70 ansopra 8apsul 521 5000 2!05000 T 'n#o"ar
71 a:a#ine &otol !0 m 12450 14 174300 T aliniu
72 i#ocain eTube 40000 50 2000000 t Astra
73 i#okain inAmpul 2ml 1499 700 1049300 T 'n#o"ar
74 lisinopril Tablet !!0 !00 39!000 t Noell
75 isinopril Tablet 3*5 !00 231000 t Noell
7! operami#Tablet 97 1000 97000 t '"ars
77 orata#in Tablet 170 2100 357000 T rome#7* -et"ormin Tablet 11* 2100 247*00 T erno"
79 -etil pre# Tablet 390 7000 2730000 T $e:a -
*0 -etilergo Tablet 1!9 2100 354900 T 8imia
*1 -etoklopr Tablet 100 1000 100000 t )apros
*2 -etoklopr otol 5*30 100 5*3000 t -empro
*3 -etoklopr otol !0 m 2900 200 5*0000 T -ole:
*4 -etroni#a Tablet 11! 1000 11!000 t p)(to
8/17/2019 Obat Bpjs Triwulan 1
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*5 -etroni#a Tablet 1!9 !000 1014000 t )(to
*! -ikonaol Tube 3075 !00 1*45000 t 8imia "a
*7 -ometaso Tube 10 gr 2004* !0 1202**0 T uar#i
** Nacl 09. otol 500 5170 140 723*00 T Ei#art
*9 Natrium $iTablet 193 14000 2702000 T )apro
90 Ni"e#ipin Tablet 110 2100 231000 T $e:a -
91 Nistatin 50Tablet 704 1000 704000 t p)apros
92 Nistatin ?aTablet 52* !00 31!*00 T )apro
93 %bat Tuberaket 395900 15 593*500 t )apros
94 %bat Tuberaket 1319990 0 t 'n#o"ar
95 %ksitosin ' Ampul 1900 350 !!5000 T Tunggal
9! %mepraol8apsul 221 7000 1547000 T Noap
97 %n#ansetr Tablet *0* 2100 1!9!*00 T Karin#o
9* %n#ansetr Ampul 2400 35 *4000 T 'n#o"ar
99 arasetam Tablet ** 21000 1*4*000 T rome#
100 arasetam otol 5720 100 572000 t 'n#o"ar
101 arasetam otol !0 m 1535 1200 1*42000 T Noap
102 ermetrin Tube 10 gr 11475 35 401!25 T aliniu
103 olikresuleotol 10ml 1*!35 3! !70*!0 T ratapa
104 oi#on io otol 300 153*! 10 153*!0 T A= ar
105 oi#on 'o otol 30ml 2344 70 1!40*0 T A= ar
10! ropanolol Tablet *0 300 24000 t )oli "ar
107 ro=lT)io Tablet 351 300 105300 t 'n#o"ar
10* (rantel Tablet 31* 0 0 t )oli "ar
109 Bamipril 5 Tablet !35 1400 **9000 T $e:a -
110 Baniti#in Tablet 132 7000 924000 T $e:a -111 Baniti#in ' Ampul 2ml 1340 210 2*1400 T Natura
112 Binger akotol 500 5720 140 *00*00 T Ei#art
113 SalbutamoTablet !5 3!00 234000 t Karin#o
114 Salbutamo?ial 25ml 72!0 70 50*200 T lakso
115 Salbutanol Tablet 91 3!00 327!00 T 8imia
11! Salep 2/4 ot 30gra 2200 3!0 792000 T -arin
117 Se"ota:im ?ial 3500 5 17500 t Natura
11* Se"tria:on ?ial 3700 5 1*500 t #e:a m
119 Sep)a#rok8apsul 529 7000 3703000 T erno
120 Sep)a#rokotol !0 m 52*! 700 3700200 T Hol( )121 Setriin 108apsul 190 7000 1330000 T ertiDi
122 Setriin S otol !0 m *799 140 1231*!0 T 'n#o"ar
123 SianokobalAmpul 1ml 1110 700 777000 T erno
124 SiproCoks Tablet 2!5 7000 1*55000 T erno
125 Simastati Tablet 4*0 7000 33!0000 T Natura
12! Simastati Tablet 177 7000 1239000 T Natura
127 Spironolak Tablet 350 700 245000 T $e:a -
8/17/2019 Obat Bpjs Triwulan 1
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12* Sukral"at otol 100 14450 210 3034500 T ombi
129 Tablet Tamungkus ;30 2400 T 8imia
130 Tetracain otol 5 ml 11500 50 575000 T en#o '
131 Tetrasiklin 8apsul 325 !00 195000 t A="arma
132 T)iamin H Tablet *3 21000 1743000 T Noap
133 Timolol Te otol 5ml 102*! 14 144004 T ratapa
134 ?itamin b Tablet 112 !000 !72000 t 8imia "a
135 inc #rop otol 141!0 50 70*000 t combip
13! Iinc sirup otol *140 !0 4**400 t mepro"a
137 Iinc 10 m Tablet 521 1200 !25200 t 'n#o"ar
1331!5110
8/17/2019 Obat Bpjs Triwulan 1
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arma
Agung
rma
a
ma Tirmacu -ercusana
arin
rma
a
aa
arma
arma
Tbk
rma
ia
rm
m
rma
rma
meral# -ulti Sukses
rmaarma
arma
ra)ar#o armasi 'n#ustri
a
rma
'n#onesia
aa
rma
'n#ustri armasiarin
rma
rin
rma
ger 'ngel)eim
8/17/2019 Obat Bpjs Triwulan 1
12/18
a
rmaceutical aboratories
rin#o
a
aa
)akti
rma
a
arma
armaceuticals
rin
a
arma
a
Tbk
a
rin
arma
rma
arma
armaar#o
arma
a
)armasia aboratories
a
ra)ar#o armasi 'n#ustrirm
e#ica
arma
parm
(us
8/17/2019 Obat Bpjs Triwulan 1
13/18
rma
n )armatama
)akti
Tbk
e#ica
Tbk
a
l '#aman Ab#i
arin
)arma Tama
a
ra)ar#o armasi 'n#ustri
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Nirmala
a
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e#ica
e#icaaboratoria rima
)akti
Eelcome 'n#onesia
arma
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#ica
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)arma
aboratoria rima
aboratoria rima
e#ica
8/17/2019 Obat Bpjs Triwulan 1
14/18
)ar
rma
'n#ustri armasi
arin
Nirmala
rma
ar
rm
a
8/17/2019 Obat Bpjs Triwulan 1
15/18
No Nama Satuan Harga a) ermint Jumla) Harga
1 2 3 4 5 !
1 Alat suntikbo: 109250 12 1311000
2 Alog(l 10 botol 5*3000 1 5*3000
3 Arsen !5 pot 390000 1 390000
4 enang pl pcs 9075 57! 5227200
5 on#ing Sibotol 1100000 1 1100000
! ait +tum pot 1!!9*0 1 1!!9*0
7 omposite tube 550000 1 550000
* omposite tube 550000 1 550000
9 resop)at botol *3!000 1 *3!000
10 resop)enbotol 902000 1 902000
11 &tc)ing botol 330000 1 330000
12 lass 'ono set 395000 1 395000
13 'o#o"orm pbotol 297000 1 297000
14 '? at)ete bo: isi 24 3*9375 3 11!*125
15 '? at)ete bo: isi 24 3*9375 3 11!*125
1! '? at)ete bo: isi 24 3*9375 1 3*9375
17 8alsium Hi set 242000 1 242000
1* 8asa steril o: 10 pcs 7*!5 9! 755040
19 8uas on#ibo: 170500 1 170500
20 Beagen gol?ial *4700 5 423500
21 reagen gol?ial *4700 5 423500
22 Sarung Tanbo: isi 50 212500 5 10!2500
23 Spongosta bo:/50 ste 525000 1 525000
24 Stik Asam bo: 110000 30 330000025 Stik gula #bo: 110000 30 3300000
2! Stik kolest bo: 192500 30 5775000
27 Tes 8e)amibo: 50 **000 5 440000
2* @ pa# !0: pak isi 10 !!550 30 199!500
29 @rinbag pcs 4901 20 9*020
30 ?itrebon#/ ktk/btl 352000 1 352000
31 Iinc p)ospset 17!000 1 17!000
32 '%A& : ; 10 tu 104000 5 520000
33 A@A$&STotol ;1 lit 17000 3 51000
34 AAT S@NTo: ;100 !5000 4* 312000035 AAT S@NTo: ;100 75000 3! 2700000
3! A?%K otol ;1 lit !40000 4 25!0000
37 ABS&N otol ;1 lit !15420 4 24!1!*0
3* AK'N otol ;1 lit 30000 ! 1*0000
39 ATH&J& tube 41!00 4 1!!400
40 &LAB& S@ pcs 4500 ! 27000
41 &LAB& S@ pcs 4500 ! 27000
8/17/2019 Obat Bpjs Triwulan 1
16/18
42 &T' 8%B' tol ;100 150000 12 1*00000
43 %K AT pcs 15000 3! 540000
44 %K AT pcs 15000 3! 540000
45 '&-SA otol ;1 lit 255*00 4 1023200
4! ASS '%Notol ;1 lit 430000 4 1720000
47 HKA?'G Boll 44000 24 105!000
4* 'N@S&T A pcs 3500 30 105000
49 'N@S&T $ pcs 3200 75 240000
50 8AS'@- otol ;1 lit 3!0000 4 1440000
51 8AAS AS ungkus 12500 3! 450000
52 8AB% otol ;1 lit 93*00 4 375200
53 8ASA H'$B Boll 1500 100 150000
54 8ASA H'$B Boll 590 240 141!00
55 8ASA H'$B Boll 750 240 1*0000
5! 8ASA 8%- Boll 1!00 240 3*4000
57 AN&T o: 21000 4 *4000
5* AB@TAN otol ;1 lit 247500 4 990000
59 AB@TAN otol ;1 lit 22500 4 90000
!0 AB@TAN otol ;1 lit 190000 4 7!0000
!1 AB@TAN otol ;1 lit *5500 4 342000
!2 AB@TAN otol ;1 lit 35300 4 141200
!3 AB@TAN otol ;1 lit 127500 4 510000
!4 AB@TAN otol ;1 lit 19!700 2 393400
!5 AB@TAN otol ;1 lit 27000 4 10*000
!! AB@TAN otol ;1 lit 70000 4 2*0000
!7 AB@TAN otol ;1 lit 12*00 4 51200!* AB@TAN otol ;1 lit 37200 4 14**00
!9 AB@TAN otol ;1 lit 27000 4 10*000
70 K%' AT o: ;24 7*57!1 1 7*57!1
71 K%' AT o: ;24 !7*449 1 !7*449
72 KS% 1 ' otol ;1 lit 41000 4 1!4000
73 -&TAN% otol ;1 lit 54000 4 21!000
74 -&T'&N otol ;1 lit 39*00 4 159200
75 %N&-&$ Aotol ;1 lit 21500 3! 774000
7! B'?AN% 3 tol ;300 2550 24 !1200
77 I'& N&S otol ;1 lit 3*5700 4 1542*00!4749455
8/17/2019 Obat Bpjs Triwulan 1
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