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Page 1 of 32
DAFTAR OBAT E-KATALOG
No Wilayah Spesifiaksi obat Pabrikan Satuan Harga
1. DKI Jakarta n/a 1 blister@24 tablet 1,375.00
2. DKI Jakarta Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera 27,500.00
3. DKI Jakarta Albendazol suspensi 200 mg/5 ml n/a 3,849.00
4. DKI Jakarta Albendazol tablet/kapsul/kaplet 400 mg n/a Dus, 5 strip @ 6 tablet 344.00
5. DKI Jakarta Alopurinol tablet/kapsul/kaplet 100 mg n/a 86.00
6. DKI Jakarta Alprazolam tablet/kapsul/kaplet 0,25 mg n/a 380.00
7. DKI Jakarta Alprazolam tablet/kapsul/kaplet 0,5 mg n/a strip 176.008. DKI Jakarta Alprazolam tablet/kapsul/kaplet 1 mg n/a Ktk 10x10 tablet 233.009. DKI Jakarta Amfoterisin B salep mata 1% Fungicide tube 3.5 gr 18,500.00
10. DKI Jakarta Amikasin injeksi 250 mg/ml Vial 2 ml 50,500.00
11. DKI Jakarta Aminofilin injeksi 24 mg/ml n/a Dus @ 30 Ampul 3,818.0012. DKI Jakarta Aminofilin tablet scored 200 mg n/a Botol @100 Tablet 80.0013. DKI Jakarta Amiodaron injeksi 150 mg/3 ml Cordarone Dus, 6 ampul @ 3 ml 12,480.00
14. DKI Jakarta Amiodaron tablet/kaplet 200 mg strip 1,200.00
15. DKI Jakarta Amitriptilin tablet salut 25 mg (HCl) n/a Dus, 10 strip @ 10 tss 112.00
16. DKI Jakarta Amlodipin tablet 10 mg n/a 330.00
17. DKI Jakarta Amlodipin tablet 5 mg n/a 187.00
18. DKI Jakarta Amoksisilin kapsul/kaplet 250 mg n/a strip 211.00
ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida tablet 200 mg) PT. Kimia Farma
PT. SmithKline Beecham PhamaceuticalsDus, 3 Blister @ 10 kapsul
PT. Indofarma Dus, 10 dus @ 1 botol @ 10 ml
PT. Holi Pharma
PT. Pertiwi Agung Box, 10 strips @ 10 tablets
PT. Dexa Medica Dus, 10 Strip @ 10 tablet
PT. Otto PharmaceuticalsPT. Kimia FarmaPT. Cendo Industri Farmasi
Glybotic 250 mg /ml PT. Sanbe Farma
PT. Phapros, TbkPT. ErelaPT. Aventis Pharma
Kendaron Tablet PT. Darya Varia
PT. Indofarma
PT. Pertiwi Agung Box, 3 strips @ 10 tablets
PT. Pertiwi Agung Box, 3 strips @ 10 tablets
PT. Novapharin
Page 2 of 32
19. DKI Jakarta Amoksisilin kapsul/kaplet/tablet scored 500 mg n/a KOTAK @ 10 x 10 TAB 261.00
20. DKI Jakarta Amoksisilin sirup kering forte 250 mg/5 ml n/a Dus, Botol 60 ml 4,070.0021. DKI Jakarta Amoksisilin sirup kering 125 mg/ 5 ml n/a btl @ 60 ml 2,445.00
22. DKI Jakarta 85,000.00
23. DKI Jakarta 106,000.00
24. DKI Jakarta Penfill cartridge 97,500.00
25. DKI Jakarta 85,345.00
26. DKI Jakarta Novorapid Vial Dus, vial 10 ml 200,000.00
27. DKI Jakarta 79,165.00
28. DKI Jakarta Humalog Penfill cartridge 79,167.00
29. DKI Jakarta Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg 32,000.00
PT. Mersifarma Tirmaku Mercusana
PT. Holi PharmaPT. Novapharin
Analog insulin long acting inj 100 UI/ml, vial/cartridge disposible/penfill cartridge (Insulin glargine 100 IU/ml)
Lantus Solostar 100IU/ml 5pens x3ml
PT. Aventis Pharma dus, 5 solostar pen @ 3ml
Analog insulin mix acting inj 100 UI/ml, Analog insulin mix acting inj 100 UI/ml (Premix 30% Insulin Aspart + 70% Protaminated Insulin Aspart (Analogue))
Novomix Flexpen PT. Ferron Par Pharmaceuticals
Injeksi 100 IU/ml, Flexpen disposible 3 ml (1 box isi 5 flexpen disposible)
Analog insulin mix insulininj 100 UI/ml, vial/cartridge disposible/penfill cartridge (25% insulin lispro, 75% insulin lispro protamine suspension, (rDNA))
Humalog Mix 25 PT. Tempo Scan Pacific
Analog insulin rapid acting inj 100 UI/ml, vial/cartridge disposible/penfill cartridge (Insulin Aspart (Analogue))
Novorapid Flexpen PT. Ferron Par Pharmaceuticals
Injeksi 100 IU/ml, Flexpen disposible 3 ml (1 box isi 5 flexpen disposible)
Analog insulin rapid acting inj 100 UI/ml, vial/cartridge disposible/penfill cartridge (Insulin Aspart (Analogue))
PT. Ferron Par Pharmaceuticals
Analog insulin rapid actinginj 100 UI/ml, vial/cartridge disposible/penfill cartridge (Insulin glulisine 100 IU/ml)
Apidra Solostar 100IU/ml 5pens x3ml
PT. Aventis Pharma dus, 5 solostar pen @ 3ml
Analog insulin rapid actinginj 100 UI/ml, vial/cartridge disposible/penfill cartridge (Insulin lispro (rDNA origin))
PT. Tempo Scan Pacific
PT. AstraZeneca indonesia Dus, 2 blister @ 14 Tablet
Page 3 of 32
30. DKI Jakarta n/a 72.00
31. DKI Jakarta n/a btl 60 ml 2,140.00
32. DKI Jakarta n/a Dus, 25 tube @ 5 g 2,516.00
33. DKI Jakarta n/a ktk 10 x 10 tablet 518.00
34. DKI Jakarta Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg n/a Btl 100 tablet 135.00
35. DKI Jakarta Levopar Tablet 1,500.00
36. DKI Jakarta Artemether injeksi 80 mg/ml Artem Dus 6 amp @ 1ml 22,000.0037. DKI Jakarta Asam Askorbat (Vitamin C) tablet 50 mg n/a Dus 10 strip x 10 tab 95.0038. DKI Jakarta Asam Folat tablet/kapsul/kaplet 1 mg n/a Botol @ 100 tablet 48.0039. DKI Jakarta Asam Ibandronat injeksi 6mg/6ml Bondronat Boks, 1 ampul 2,209,000.00
40. DKI Jakarta Asam Mefenamat kapsul/kaplet 500 mg n/a 112.00
41. DKI Jakarta Asam pipemidat kapsul 400 mg Strip 1,815.00
42. DKI Jakarta Asam traneksamat injeksi 100 mg/ml n/a Dus, 10 ampul @ 5 ml 3,334.00
43. DKI Jakarta Asiklovir salep mata 3% Tube 3,5 gram 24,750.00
44. DKI Jakarta Asiklovir tablet/kapsul/kaplet 200 mg n/a 237.00
45. DKI Jakarta Asiklovir tablet/kapsul/kaplet 400 mg n/a 355.00
46. DKI Jakarta Asparaginase serbuk injeksi 10.000 UI/vial Leunase 10.000 UI/Vial 1,039,500.00
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg Magnesium Hidroksida 200 mg
PT. Erela Dus, 10 Strip @ 10 Tablet
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml
PT. Lucas Djaja
Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g Polimiksin 10.000 IU/g PT. Indofarma
Antimalaria DOEN kombinasi : Pirimetamin 25 mg Sulfadoksin 500 mg PT. Kimia Farma
PT. Kimia Farma
Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg Levodopa 100 mg PT. Meprofarm Dus, 5 strip @ 10
tablet
PT. Kimia FarmaPT. Kimia FarmaPT. Marin Liza FarmasiPT. Boehringer Ingelheim
PT. Bernofarm Dus, 10 blister @ 10 kaptab ss
Urotractin 400 mg PT. Sanbe Farma
PT. Hexpharm Jaya Laboratories
Temiral Eye Oint PT. Sanbe Farma
PT. Indofarma Dus, 10 blister @ 10 tablet
PT. Indofarma Dus, 10 blister @ 10 tablet
PT. Widatra Bhakti
Page 4 of 32
47. DKI Jakarta Atapulgit tablet 600 mg Pularex Dus 5 strip @ 10 tablet 190.00
48. DKI Jakarta Atrakurium injeksi 25 mg/2,5 ml Tracrium Dus, 5 ampul @ 2.5 ml 20,000.00
49. DKI Jakarta Atropin Sulfat tablet 0,5 mg n/a 74.00
50. DKI Jakarta Azitromisin sir kering 200 mg/ 5 mL n/a botol @ 60 ml 34,400.0051. DKI Jakarta Azitromisin tablet 500 mg n/a ktk 2x10 tablet 4,500.0052. DKI Jakarta Azitromisin tablet 250 mg n/a Strip 3,333.00
53. DKI Jakarta Bedak salisil serbuk 2% n/a Dus @ 50 gram 1,250.00
54. DKI Jakarta Benzatin Benzil Penisilin 1,2 juta IU/ vial n/a Dus @ 10 Vial 9,800.0055. DKI Jakarta Benzatin Benzil Penisilin 2,4 juta IU/vial n/a Dus @ 10 Vial 13,400.0056. DKI Jakarta Beractant injeksi / suspensi 25 mg/mL Survanta Vial 3,200,000.00
57. DKI Jakarta Beraprost sodium tablet 20 mcg Dorner 3,600.00
58. DKI Jakarta Beraprost sodium tablet 20 mcg Dorner 20 µg 3,600.00
59. DKI Jakarta Betametason krim 0,1% (sebagai Valerat) n/a Tube 5 gr 1,520.00
60. DKI Jakarta Bikalutamid tablet salut 150 mg 72,400.00
61. DKI Jakarta Bikalutamid tablet salut 50 mg Casodex 50 mg 45,000.00
62. DKI Jakarta Bisakodil suppositoria 10 mg Stolax supp Supp 6,045.0063. DKI Jakarta Bisoprolol tablet 5 mg n/a Box 3 X 10 tab 645.0064. DKI Jakarta Bromokriptin tablet 2,5 mg Cripsa tab Box 3 x 10'S 247,089.00
65. DKI Jakarta Budesonid inhaler 200 mcg/puff, 100 dosis 93,000.00
66. DKI Jakarta Budesonid respules / cairan inhaler 0,25mg/mL 8,900.00
PT. Zenith Pharmaceuticals
PT. Glaxo Wellcome Indonesia
PT. Indofarma Dus, 10 strip @ 10 tablet
PT. Soho Industri PharmasiPT. Kimia FarmaPT. Soho Industri Pharmasi
PT. Rama Emerald Multi Sukses
PT. Phapros, TbkPT. Phapros, TbkPT. Abbott Indonesia
PT. Combiphar Box @ 3 blister @ 10 Tablet
PT. Combiphar Box/ 3 blister @ 10 Tablet
PT. Kimia Farma
Casodex 150 mg PT. AstraZeneca indonesia Dus, 2 blister @ 14
Tablet
PT. AstraZeneca indonesia Dus, 2 blister @ 14 Tablet
PT. Sanbe FarmaPT. Pratapa NirmalaPT. Caprifarmindo
Pulmicort Turbuhaler PT. AstraZeneca indonesia Dus, 1 Turbuhaler @
100 dosis
Pulmicort Respules PT. AstraZeneca indonesia Dus, 4 pak @ 5
respules @ 2 ml
Page 5 of 32
67. DKI Jakarta 117,600.00
68. DKI Jakarta 110,500.00
69. DKI Jakarta Deferasiroks tablet disp/ eff 250 mg 76,000.00
70. DKI Jakarta Deferasiroks tablet disp/ eff 500 mg 150,000.00
71. DKI Jakarta Deferoksamin Mesilat serbuk injeksi 500 mg Desferal Dus, 10 vial @ 500mg 112,000.00
72. DKI Jakarta Deksametason injeksi i.v./i.m. 5 mg/ml n/a Dus, 100 ampul @ 1 ml 1,580.00
73. DKI Jakarta Deksametason tablet 0,5 mg n/a 68.00
74. DKI Jakarta Desoksimetason krim 0,25% n/a Kotak, tube @ 15 gram 9,983.00
75. DKI Jakarta Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) n/a ampul @ 1 ml 1,054.00
76. DKI Jakarta Digoksin tablet 0,25 mg n/a Box 10 X 10 Tab 97.00
77. DKI Jakarta Diltiazem HCl tablet 30 mg n/a 134.00
78. DKI Jakarta Diltiazem infus injeksi 50 mg 10 vial @ 50mg 127,667.00
79. DKI Jakarta Diltiazem injeksi 25 mg/5 mL Vial 5 mL 46,667.00
80. DKI Jakarta Diltiazem Kapsul SR 100 mg 3 blister @ 10 kapsul 3,667.00
81. DKI Jakarta Diltiazem Kapsul SR 200 mg 3 blister @ 10 kapsul 4,015.00
Budesonid-formoterol (fixed combination) inhaler 160/4,5 mcg
Symbicort Turbuhaler 160/4.5 mcg
PT. AstraZeneca indonesia Dus, 1 Turbuhaler @ 120 dosis
Budesonid-formoterol (fixed combination) inhaler 80/4,5 mcg
Symbicort 80/4.5 mcg PT. AstraZeneca indonesia Dus, 1 Turbuhaler @
60 dosis
Exjade 250 mg Tab PT. Novartis Indonesia Dus, 4 blister @ 7
tablet
Exjade 500 mg Tab PT. Novartis Indonesia Dus, 4 blister @ 7
tablet
PT. Novartis Indonesia
PT. Indofarma
PT. Marin Liza Farmasi Dus, 10 strip @ 10 tablet
PT. Dexa Medica
PT. Lucas Djaja
PT. Yarindo Farmatama
PT. Indofarma Dus, 10 strip @ 10 tablet
Herbesser Powder Injection 50mg
PT. Tanabe Indonesia
Farmabes Injeksi 25 mg PT. Pratapa Nirmala
Herbesser CD 100 PT. Tanabe Indonesia
Herbesser CD 200 PT. Tanabe Indonesia
Page 6 of 32
82. DKI Jakarta Dimenhidrinat tablet 50 mg n/a Btl 100 tablet 104.0083. DKI Jakarta Dinatrium edetat tetes mata 0,35% E.D.T.A botol 15 ml 37,500.00
84. DKI Jakarta Doksazosin mesilat tablet 1 mg Cardura 1mg 3,480.00
85. DKI Jakarta Doksazosin mesilat tablet 2 mg Cardura 2mg 5,480.00
86. DKI Jakarta Doksorubisin serbuk injeksi i.v. 10 mg/vial vial @ 5 ml 60,000.00
87. DKI Jakarta Doksorubisin serbuk injeksi i.v. 50 mg/vial Doxorubin Vial 50mg/25ml 279,000.0088. DKI Jakarta Domperidon suspensi/sirup 5 mg/5 ml n/a btl @ 60 ml 3,333.0089. DKI Jakarta Domperidon tablet 10 mg n/a strip 167.0090. DKI Jakarta Domperidon tetes 5 mg/mL n/a Dus, botol @ 10 ml 15,600.00
91. DKI Jakarta Dosetaksel injeksi 20 mg/0,5 ml n/a 970,200.00
92. DKI Jakarta Dutasterid kaps lunak 0,5 mg Avodart 7,100.00
93. DKI Jakarta Eksemestan tablet 25 mg Aromasin 42,600.00
94. DKI Jakarta Enoksaparin sodium inj 20 mg/0,2 mL 40,740.00
95. DKI Jakarta Enoksaparin sodium inj 40 mg/0,4 mL 71,875.00
96. DKI Jakarta Enoksaparin sodium inj 60 mg/0,6 mL 100,000.00
97. DKI Jakarta Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml n/a Dus @ 30 Ampul 8,100.00
98. DKI Jakarta Epirubisin serb injeksi 50 mg/25ml Epirubisin Kalbe Vial @ 25 ml 500,000.00
99. DKI Jakarta Epirubisin serb injeksi 10 mg/5 ml n/a Dus, 1 vial @5 ml 128,000.00
100. DKI Jakarta Ergokalsiferol (vitamin D3/D2) kapsul 50.000 UI D-Vit FT 650.00
PT. Kimia FarmaPT. Cendo Industri Farmasi
PT. Pfizer Indonesia Dus, 5 blister @10's tab
PT. Pfizer Indonesia Dus, 5 blister @10's tab
Doxorubicin HCl 2 mg/ml PT. Sanbe Farma
PT. CombipharPT. NovapharinPT. NovapharinPT. Bernofarm
PT. Sanbe Farma Dus, 1 vial @0,5 ml+ 1 vial pelarut @1,5 ml
PT. SmithKline Beecham PhamaceuticalsDus, Botol Plastik @ 30 Tablet
PT. Pfizer Indonesia Dus, 2 blister @ 15 tablet
Lovenox 2000 ANTI-XA PT. Aventis Pharma dus, 2 prefilled syringe
@ 0,2 ml
Lovenox 4000 ANTI-XA PT. Aventis Pharma dus, 2 prefilled syringe
@ 0,4 ml
Lovenox 6000 ANTI-XA PT. Aventis Pharma dus, 2 prefilled syringe
@ 0,6 ml
PT. Phapros, Tbk
PT Kalbe Farma
PT. Sanbe Farma
PT. Gracia Pharmindo Dus 3 strip @ 10 Flash tablet
Page 7 of 32
101. DKI Jakarta D-Vit Syrup 8,000.00
102. DKI Jakarta Eritromisin kapsul/kaplet 250 mg n/a ktk 10 x 10 kapsul 497.00
103. DKI Jakarta Eritromisin kapsul/kaplet 500 mg n/a 930.00
104. DKI Jakarta Eritromisin sirup kering 200 mg/ 5 ml n/a Botol @60 ml 7,700.00
105. DKI Jakarta Eritropoetin-beta inj 2000 UI/0,3 mL Recormon Boks, 6 ampul 139,500.00
106. DKI Jakarta Etambutol tablet 250 mg (HCl) n/a ktk 20 x 10 tablet 314.00
107. DKI Jakarta Etambutol tablet salut 500 mg (HCl) n/a Dus, 10 strip @ 10 tss 451.00
108. DKI Jakarta Etanol 70% cairan n/a btl @ 100 ml 2,500.00
109. DKI Jakarta Etonogestrel implan 68 mcg Implanon 128,779.00
110. DKI Jakarta Etoposid injeksi 20 mg/ml Posyd Vial 100mg/5ml 100,000.00
111. DKI Jakarta Eugenol cairan n/a Botol 10 ml 16,667.00
112. DKI Jakarta Everolimus tab 0,25 mg 11,813.00
113. DKI Jakarta Everolimus tab 0,5 mg 23,250.00
114. DKI Jakarta Novoseven 9,200,000.00
115. DKI Jakarta Fenitoin injeksi 50 mg/ml n/a KOTAK @ 10 ampul 20,250.00
Ergokalsiferol (vitamin D3/D2) suspensi 10.000 UI/ml PT. Gracia Pharmindo Dus, Botol Plastik @
100 mL
PT. Kimia Farma
PT. Indofarma Dus, 10 blister @ 10 kss
PT. Phyto Kemo Agung Farma
PT. Boehringer Ingelheim
PT. Kimia Farma
PT. Indofarma
PT. Novapharin
PT. Merck Sharp Dohme Pharma TbkDus, 1 blister @ 1 subdermal implant
PT. Combiphar
PT. Kimia Farma
Certican 0,25 mg Tab PT. Novartis Indonesia Dus, 6 blister @ 10
tablet
Certican 0,5 mg Tab PT. Novartis Indonesia Dus, 6 blister @ 10
tablet
Faktor VIIa (rekombinan) serb inj 1 mg/vial + pelarut untuk injeksi PT. Ferron Par Pharmaceuticals
KOTAK @ 1 VIAL SERBUK OBAT & INFUSION KIT
PT. Mersifarma Tirmaku Mercusana
Page 8 of 32
116. DKI Jakarta Fenitoin kapsul/kaplet 100 mg n/a Botol @ 100 133.00
117. DKI Jakarta Fenobarbital injeksi i.m./i.v. 50 mg/ml n/a Dus @ 30 Ampul 1,800.00
118. DKI Jakarta Fenofibrat kaps 100 mg n/a 1,075.00
119. DKI Jakarta Fenofibrat kaps 300 mg n/a 1,375.00
120. DKI Jakarta Fenoksimetil penisilin (penisilin V) tablet 250 mg n/a Dus @ 10 X 10 's 290.00
121. DKI Jakarta Fenoksimetil penisilin (penisilin V) tab 125 mg Fenocin Dus 45 x 12 tab 235.00
122. DKI Jakarta Fenoksimetil penisilin (penisilin V)tablet 500 mg n/a Dus @ 10 X 10 's 510.00
123. DKI Jakarta Fenoterol HBr inh solution 0,1% Dus, Canister 200 dosis 117,500.00
124. DKI Jakarta Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 10 ml n/a Dus 5 ampul@ 10ml 128,000.00
125. DKI Jakarta Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 2 ml n/a Dus 5 ampul@ 2ml 33,914.00
126. DKI Jakarta Fentanil patch 12,5 mcg/jam Dus @ 5 patch 80,000.00
127. DKI Jakarta Fentanil patch 25 mcg/jam Dus@ 5 patch 153,000.00
128. DKI Jakarta Fentanil patch 50 mcg/jam Dus@ 5 patch 285,000.00
129. DKI Jakarta Filgrastim inj 300 mcg/mL Leucogen pfs @ 0,5 ml 375,000.00
130. DKI Jakarta Fitomenadion (Vit.K1) tablet salut gula 10 mg n/a 634.00
PT. Ikapharmindo
PT. Phapros, Tbk
PT. Hexpharm Jaya LaboratoriesDus, 3 strip @ 10 kapsul
PT. Hexpharm Jaya LaboratoriesDus, 3 strip @ 10 kapsul
PT. Phapros, Tbk
PT. Actavis Indonesia
PT. Phapros, Tbk
Berotec Solution PT. Boehringer Ingelheim
PT. Kimia Farma
PT. Kimia Farma
Durogesic 12,5 MU Matrix PT. Kimia Farma
Durogesic 25 MU Matrix PT. Kimia Farma
Durogesic 50 MU Matrix PT. Kimia Farma
PT Kalbe Farma
PT. Marin Liza Farmasi Botol @ 100 tablet salut gula
Page 9 of 32
131. DKI Jakarta Fludarabin inj 50 mg Fludara IV LYO Dus, 5 vial @ 50 mg 1,248,319.00
132. DKI Jakarta Fludarabin tab 10 mg Fludara Oral 275,000.00
133. DKI Jakarta Flufenazin injeksi i.m. 25 mg/ml Dus, 5 ampul @ 1ml 55,000.00
134. DKI Jakarta Flukonazol injeksi 2 mg/ml n/a Dus, 1 Botol @ 100 mL 47,100.00
135. DKI Jakarta Flukonazol tablet/kapsul 150 mg n/a ktk 1 x 10 kapsul 22,000.00
136. DKI Jakarta Fluoksetin tablet 10 mg Foransi 10 strip 419.00
137. DKI Jakarta Fluoksetin tablet 20 mg NOPRES DUS, 30 TABLET 421.00
138. DKI Jakarta Fluorourasil inj 250 mg/mL Curacil vial @ 1 ml 24,500.00
139. DKI Jakarta Fluorourasil inj 500 mg/ 5 mL Curacil vial @ 10 ml 33,000.00
140. DKI Jakarta Flusinolon asetonid krim 0,025% SYNARCUS Dus, Tube 5 g 2,400.00
141. DKI Jakarta Flutikason furoat intranasal spray Avamys 93,333.00
142. DKI Jakarta Flutikason propionat nebules 0,5 mg Flixotide Nbules 12,917.00
143. DKI Jakarta Fondaparinuks inj 2,5 mg/0,5 mL Arixtra Dus, 2 pfs 0.5 ml 241,667.00
144. DKI Jakarta Furosemid injeksi i.v./i.m. 10 mg/ml n/a Dus, 25 ampul @ 2 ml 1,829.00
145. DKI Jakarta Furosemid tablet 40 mg n/a 85.00
PT. Aventis Pharma
PT. Aventis Pharma Dus, 4 blister @ 5 tablet salut selaput
Sikzonoate Injeksi PT. Mersifarma Tirmaku Mercusana
PT. Natura Laboratoria Prima
PT. Kimia Farma
PT. Gracia Pharmindo
PT. Dexa Medica
PT Kalbe Farma
PT Kalbe Farma
PT. Ifars Pharmaceutical Laboratories
PT. Glaxo Wellcome Indonesia Dus, Botol 120 Dosis Spay
PT. Glaxo Wellcome IndonesiaDus, 2 flow wrap@ 5 nebules @ 1 dosis (2ml)
PT. Glaxo Wellcome Indonesia
PT. Indofarma
PT. Indofarma Dus, 10 strip @ 10 tablet
Page 10 of 32
146. DKI Jakarta Gansiklovir serb inj 500 mg (50 mg/mL) Cymevene Boks, 1 ampul 399,500.00
147. DKI Jakarta Gefitinib tab 250 mg Iressa 250 mg 295,000.00
148. DKI Jakarta Gemfibrozil kapsul/kaplet 300 mg n/a 289.00
149. DKI Jakarta Gemfibrozil tablet 600 mg n/a 679.00
150. DKI Jakarta Gemsitabin inj 1000 mg/vial vial 1,098,900.00
151. DKI Jakarta Gemsitabin inj 200 mg/vial n/a Dus, 1 vial @200 mg 330,000.00
152. DKI Jakarta Gentamisin injeksi 40 mg/ ml n/a Dus, 5 ampul @ 2 ml 3,399.00
153. DKI Jakarta Gentamisin salep mata 0,3% Tube @ 3,5 gr 2,600.00
154. DKI Jakarta Gentamisin tetes mata 0,3% n/a Dus, botol plastik 5 ml 3,194.00
155. DKI Jakarta Glibenklamid tablet 5 mg n/a 56.00
156. DKI Jakarta Gliklazid tab 80 mg Glicab Strip 232.00
157. DKI Jakarta Glikuidon tab 30 mg n/a 950.00
158. DKI Jakarta Glimepiride tablet 1 mg n/a ktk 5x10 tablet 265.00
159. DKI Jakarta Glimepiride tablet 2 mg n/a ktk 5x10 tablet 436.00
160. DKI Jakarta Glimepiride tablet 3 mg n/a ktk 5x10 tablet 404.00
161. DKI Jakarta Glimepiride tablet 4 mg n/a ktk 5x10 tablet 430.00
PT. Boehringer Ingelheim
PT. AstraZeneca indonesia Dus, 1 blister @ 10 tablet
PT. Indofarma Dus, 10 blister @ 12 kapsul
PT. Indofarma Dus, 10 blister @ 10 kaptab
Gemzar 1000 mg PT. Bayer Indonesia
PT. Sanbe Farma
PT. Indofarma
Genoint Salep Mata PT. Erela
PT. Indofarma
PT. Indofarma Dus, 10 blister @ 10 kaptab
PT. Tempo Scan Pacific
PT. Dexa Medica Dus, 10 Strip @ 10 tablet
PT. Kimia Farma
PT. Kimia Farma
PT. Kimia Farma
PT. Kimia Farma
Page 11 of 32
162. DKI Jakarta Gliseril trinitrat kaps SR 2,5 mg Nitrokaf Retard Dus 10x10 1,493.00
163. DKI Jakarta Gliseril trinitrat kaps SR 5 mg Nitrokaf Forte Dus 10x10 2,171.00
164. DKI Jakarta Gliseril trinitrat tab sublingual 0,5 mg Nitral Btl @ 30 tablet 1,500.00
165. DKI Jakarta Gliserin lar 50% Gliserin lar 50% Glycerin 100 ml 5,333.00
166. DKI Jakarta Glukosa larutan infus 10 % steril n/a botol @ 500 ml 5,700.00
167. DKI Jakarta Glukosa larutan infus 5 % steril n/a botol @ 500 ml 5,200.00
168. DKI Jakarta Goserelin asetat inj 10,8 mg/vial 2,300,000.00
169. DKI Jakarta Goserelin asetat inj 3,6 mg Zoladex 3,6 mg 840,000.00
170. DKI Jakarta Griseofulvin tablet 125 mg n/a 219.00
171. DKI Jakarta Haloperidol inj 50 mg/mL Dus 5 Ampul@1mL 83,333.00
172. DKI Jakarta Haloperidol tablet 0,5 mg n/a 59.00
173. DKI Jakarta Haloperidol tablet 5 mg n/a 96.00
174. DKI Jakarta Haloperidol tablet 1,5 mg n/a 69.00
175. DKI Jakarta Haloperidol tablet 2 mg Lodomer 2 KOTAK @ 10 x 10 TAB 126.00
176. DKI Jakarta Hiosin butilbromid injeksi 20 mg/ml n/a box 5ampul @1 ml 4,500.00
177. DKI Jakarta Ibuprofen sirup 100 mg/5 ml n/a Dus, botol 60 ml 3,499.00
PT. Kimia Farma
PT. Kimia Farma
PT. Actavis Indonesia
PT. Lucas Djaja
PT. Widatra Bhakti
PT. Widatra Bhakti
Zoladex 10,8 mg PT. AstraZeneca indonesia Dus, 1 syringe @ 10.8
mg
PT. AstraZeneca indonesia Dus, 1 syringe @ 3.6 mg
PT. Indofarma Dus, 10 blister @ 10 tablet
Haldol Decanoas PT. Soho Industri Pharmasi
PT. Indofarma Dus, 10 blister @ 10 tablet
PT. Indofarma Dus, 10 blister @ 10 tablet
PT. Indofarma Dus, 10 blister @ 10 tablet
PT. Mersifarma Tirmaku Mercusana
PT. Otto Pharmaceuticals
PT. Indofarma
Page 12 of 32
178. DKI Jakarta Ibuprofen suspensi 200 mg/5 ml n/a Dus, botol 60 ml 4,499.00
179. DKI Jakarta Ibuprofen tablet 400 mg n/a strip 150.00
180. DKI Jakarta Imidapril tab 10 mg 3 blister @ 10 tablet 3,908.00
181. DKI Jakarta Imidapril tab 5 mg Tanapress 5mg 3 blister @ 10 tablet 2,120.00
182. DKI Jakarta Botol 245,000.00
183. DKI Jakarta Iopromide 300-370 mg Iodium/mL (300 mg / 50 ml) Botol 123,200.00
184. DKI Jakarta Botol 299,000.00
185. DKI Jakarta Iopromide 300-370 mg Iodium/mL (370 mg / 50 ml) Botol 150,300.00
186. DKI Jakarta Irbesartan tab 150 mg n/a Dus, 5 blister @ 10 kss 1,425.00
187. DKI Jakarta Irbesartan tab 300 mg n/a Dus, 5 blister @ 10 kss 2,470.00
188. DKI Jakarta Irinotekan inf 20 mg/ml n/a Dus, 1 vial @2 ml 510,000.00
189. DKI Jakarta Isosorbid Dinitrat tablet sublingual 5 mg n/a 88.00
190. DKI Jakarta Kalium aspartat tab 300 mg Kalipar Strip 691.00
191. DKI Jakarta Kalium Klorida tablet 600 mg KSR 1,580.00
192. DKI Jakarta Kalsium Glukonat injeksi i.v 10% (100 mg/ml) Ampul 7,800.00
193. DKI Jakarta Kandesartan tab 16 mg n/a 4,900.00
PT. Indofarma
PT. Novapharin
Tanapress 10mg PT. Tanabe Indonesia
PT. Tanabe Indonesia
Iopromide 300-370 mg Iodium/mL (300 mg / 100 ml)
Ultravist 300/100 mg PT. Bayer Indonesia
Ultravist 300/50 mg PT. Bayer Indonesia
Iopromide 300-370 mg Iodium/mL (370 mg / 100 ml)
Ultravist 370/100 mg PT. Bayer Indonesia
Ultravist 370/50 mg PT. Bayer Indonesia
PT. Indofarma
PT. Indofarma
PT. Sanbe Farma
PT. Indofarma Dus, 10 strip @ 10 tablet
PT. Tempo Scan Pacific
PT. Merck Tbk Dus, 10 strip @ 10 tablet
Kalsium glukonat PT. Ethica Industri Farmasi
PT. Dexa Medica Dus, 3 Blister @ 10 tablet
Page 13 of 32
194. DKI Jakarta Kandesartan tab 8 mg n/a 3,100.00
195. DKI Jakarta Kapesitabin tab 500 mg Xeloda Boks, 120 tablet 27,500.00
196. DKI Jakarta Kaptopril tablet 50 mg n/a 140.00
197. DKI Jakarta Kaptopril tablet scored 25 mg n/a 84.00
198. DKI Jakarta Kaptopril tablet scored12,5 mg n/a 62.00
199. DKI Jakarta Karbamazepin sirup 100 mg/5 ml Dus, botol @ 120 ml 44,770.00
200. DKI Jakarta Karbamazepin tablet 200 mg n/a 245.00
201. DKI Jakarta Karbogliserin tetes telinga 10% Fenol 100 mg / 1 ml 2,042.00
202. DKI Jakarta Ketamin injeksi i.v. 100 mg/ml KTM Vial @ 10 ml 110,000.00
203. DKI Jakarta Ketokonazol krim 2% n/a Box isi 1 Tube @ 15 g 4,700.00
204. DKI Jakarta Ketokonazol krim 2% n/a tube 10 gr 2,569.00
205. DKI Jakarta Ketokonazol tablet 200 mg n/a 300.00
206. DKI Jakarta Ketorolac injeksi 30 mg/ml n/a Dus @ 12 Ampul 2,300.00
207. DKI Jakarta Klaritromisin tab 500 mg ORIXAL 3,200.00
PT. Dexa Medica Dus, 3 Blister @ 10 tablet
PT. Boehringer Ingelheim
PT. Indofarma Dus, 10 strip @ 10 tablet
PT. Errita Pharma Dus, 10 strip @10 tablet
PT. Indofarma Dus, 10 strip @ 10 tablet
Tegretol Syrup 100mg/5ml, 120ml
PT. Novartis Indonesia
PT. Indofarma Dus, 10 blister @ 10 tablet
Karbogliserin tetes telinga 10%
PT. Lucas Djaja
PT. Guardian Pharmatama
PT. Novell Pharmaeutical Laboratories
PT. Kimia Farma
PT. Dexa Medica Dus, 5 Strip @ 10 tablet
PT. Phapros, Tbk
PT. Ifars Pharmaceutical LaboratoriesDus, 3 Strip @ 10 Kaplet salut selaput
Page 14 of 32
208. DKI Jakarta Klindamisin kapsul/kaplet 150 mg n/a 361.00
209. DKI Jakarta Klindamisin kapsul/kaplet 300 mg n/a 553.00
210. DKI Jakarta Klobazam tab 10 mg n/a 900.00
211. DKI Jakarta Klonidin tablet 0,15 mg n/a Ktk 10X10 TAB 184.00
212. DKI Jakarta Klopidogrel tab 75 mg n/a Dus, 3 strip @ 10 tab 3,400.00
213. DKI Jakarta Klorpromazin tablet salut 100 mg (HCl) n/a Dus @ 10 X 10 's 150.00
214. DKI Jakarta Klorpromazin injeksi i.m. 25 mg/ml (HCl) n/a Dus @ 30 Ampul 1,100.00
215. DKI Jakarta Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) n/a Dus @ 30 Ampul 1,050.00
216. DKI Jakarta Klozapin 100 mg n/a KOTAK @ 5 x 10 TAB 5,000.00
217. DKI Jakarta Klozapin 25 mg n/a KOTAK @ 5 x 10 TAB 1,550.00
218. DKI Jakarta Kodein tablet 10 mg n/a ktk 10x10 tablet 500.00
219. DKI Jakarta Kodein tablet 15 mg n/a ktk 10x10 tablet 850.00
220. DKI Jakarta Kodein tablet 20 mg n/a ktk 10x10 tablet 1,100.00
221. DKI Jakarta Kombinasi suspensi : Parafin + gliserin + fenolftalein Botol @ 60 ml 12,450.00
222. DKI Jakarta n/a 42.00
223. DKI Jakarta Cendo Lyteers botol 15 ml 15,750.00
PT. Indofarma Dus, 5 blister @ 10 kapsul
PT. Indofarma Dus, 5 blister @ 10 kapsul
PT. Dexa Medica Dus, 10 Strip @ 10 tablet
PT. Kimia Farma
PT. Hexpharm Jaya Laboratories
PT. Phapros, Tbk
PT. Phapros, Tbk
PT. Phapros, Tbk
PT. Mersifarma Tirmaku Mercusana
PT. Mersifarma Tirmaku Mercusana
PT. Kimia Farma
PT. Kimia Farma
PT. Kimia Farma
Laxadine Emulsi 60 ml PT. Galenium Pharmasia Laboratories
Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat 0,25 mg PT. Erela Dus, 100 Sachet @ 30
Tablet
Kombinasi tetes mata 2,5 mg/mL: Natrium klorida 8,664 mg; Kalium klorida 1,32 mg PT. Cendo Industri Farmasi
Page 15 of 32
224. DKI Jakarta Kombinasi: Artemether 20 mg; Lumefantrin 120 mg Coartem 3,220.00
225. DKI Jakarta Stalevo 8,900.00
226. DKI Jakarta Dus, Botol 120 Dosis 90,667.00
227. DKI Jakarta 100,833.00
228. DKI Jakarta 113,333.00
229. DKI Jakarta n/a STRIP 138.00
230. DKI Jakarta n/a Botol, 60 ml 2,167.00
231. DKI Jakarta Kuinin (Kina) tablet 200 mg n/a ktk 60 tablet 670.00
232. DKI Jakarta Kuinin injeksi i.v. 25% (sebagai 2 HCl) n/a ktk 100 amp @ 2 ml 6,200.00
233. DKI Jakarta Kuinin tablet 222 mg (H2SO4.7H2O) n/a ktk 10 x 10 tablet 540.00
234. DKI Jakarta Lamivudine tablet 150 mg n/a Botol 60 tablet 1,400.00
235. DKI Jakarta Lansoprazol inj 30 mg/ml Prosogan Inj. Serbuk vial 82,042.00
236. DKI Jakarta Lanzoprazol kapsul/kaplet 30 mg n/a 473.00
PT. Novartis Indonesia Dus, 4 blister @ 6 tablet
Kombinasi: Levodopa 100 mg; Karbidopa 25 mg; Entekapon 200 mg PT. Novartis Indonesia Dus, botol plastik @ 30
tablet salut selaput
Kombinasi: Salmeterol 25 mcg; Flutikason propionat 50 mcg
Seretide Inhaler 50 mcg PT. Glaxo Wellcome Indonesia
Kombinasi: Salmeterol 50 mcg; Flutikason propionat 100 mcg
Seretide Diskus 100 mcg PT. Glaxo Wellcome Indonesia Dus, foil strip @ 60
dosis
Kombinasi: Salmeterol 50 mcg; Flutikason propionat 250 mcg
Seretide Diskus 250 mcg PT. Glaxo Wellcome Indonesia Dus, foil strip @ 60
dosis
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg Trimetoprim 80 mg PT. Promedrahardjo Farmasi Industri
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 ml PT. Sampharindo Perdana
PT. Kimia Farma
PT. Kimia Farma
PT. Kimia Farma
PT. Kimia Farma
PT. Takeda Indonesia
PT. Indofarma Dus, 2 strip @ 10 kapsul
Page 16 of 32
237. DKI Jakarta Lapatinib tab 250 mg Tykerb 67,200.00
238. DKI Jakarta Kalbamin botol 500 ml 56,300.00
239. DKI Jakarta Amiparen Softbag 500 ML 67,400.00
240. DKI Jakarta Pan-amin G Softbag 500 ML 37,500.00
241. DKI Jakarta Aminofluid 61,600.00
242. DKI Jakarta botol 500 mL 75,350.00
243. DKI Jakarta Botol Gelas 100 ml 36,667.00
244. DKI Jakarta Nephrosteril Botol Gelas 250 ml 50,820.00
245. DKI Jakarta Kidmin Softbag 200 ML 46,000.00
246. DKI Jakarta Aminoleban Softbag 500 ML 65,000.00
247. DKI Jakarta Botol Gelas 500 ml 78,720.00
248. DKI Jakarta Eas Pfrimer botol 250 ml 51,260.00
PT. SmithKline Beecham PhamaceuticalsDus, 7 Blister @ 10 tablet
Larutan mengandung Asam Amino (Asam Amino 10%) PT. Finusolprima Farma Internasional
Larutan mengandung Asam Amino (Asam Amino 100 g, Total N 15,7 g, Na+ 2 mEq, Asetat 120 mEq) PT Otsuka Indonesia
Larutan mengandung Asam Amino (Asam Amino 27 g, Sorbitol 50 g, Cl- 52 mEq) PT Otsuka Indonesia
Larutan mengandung Asam Amino (Asam Amino 30 g, Glukosa 7,3 % dan elektrolit) PT Otsuka Indonesia Double Chamber
Softbag 500 ML
Larutan mengandung Asam Amino (Asam Amino 5% dengan BCAA 45%, L-Ornithine L Aspartate 8.03 gr/L, Sorbitol 50 gr/L, Xylitol 50 gr/L)
Aminofusin Hepar PT Kalbe Farma
Larutan mengandung Asam Amino (Asam Amino 6%, mengandung Taurine 0,24 gr/l)
Aminosteril Infant 6% PT. Fresenius Kabi Combiphar
Larutan mengandung Asam Amino (Asam Amino 7%, Komposisi: Asam Amino esensial: Asam Amino non esensial = 60 : 40)
PT. Fresenius Kabi Combiphar
Larutan mengandung Asam Amino (Asam Amino 72.05 g, Total N 11.53 g, AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 mEq)
PT Otsuka Indonesia
Larutan mengandung Asam Amino (Asam Amino 79.9 g, Total N 12.2 g, Na+ 14 mEq, Cl 94 mEq) PT Otsuka Indonesia
Larutan mengandung Asam Amino (Asam amino 8%)
Aminosteril N-Hepa PT. Fresenius Kabi Combiphar
Larutan mengandung Asam Amino (Asam Amino esensial 7%+Xylitol 10 g/L) PT. Finusolprima Farma Internasional
Page 17 of 32
249. DKI Jakarta botol 500 ml 64,900.00
250. DKI Jakarta botol 500 mL 42,000.00
251. DKI Jakarta botol 250 mL 46,000.00
252. DKI Jakarta 295,240.00
253. DKI Jakarta 343,842.00
254. DKI Jakarta 322,000.00
255. DKI Jakarta 218,700.00
256. DKI Jakarta Larutan mengandung Elektrolit (Kalium Klorida) Ampoel 25 ML 2,050.00
Larutan mengandung Asam Amino (BCAA 25 gr/L, L-Ornithine L Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7 gr/L, Piridoxin 0.12 gr/L)
Comafusin Hepar PT. Finusolprima Farma Internasional
Larutan mengandung Asam Amino (Kombinasi Asam aminno 50 g/L, Sorbitol 50 g/L, Xylitol 50 g/L, Asam Askorbat (Vit C) 0.4 g/L, Inositol 0.5 g/L, Nikotinamida (Niasinamida) 0.06 g/L, Piridoksin HCl (Vit B6) 0.04 g/L, Riboflavin Natrium Fosfat 2.5 mg/L, elektrolit)
Aminofusin L600 PT Kalbe Farma
Larutan mengandung Asam Amino (Kombinasi Asam amino 50 g/L, vitamin dan elektrolit)
Aminofusin Paed PT Kalbe Farma
Larutan mengandung Asam Amino (Kombinasi Asam Amino: 34gr, Glukosa: 97gr, Lipid: 51gr dan Elektrolit (Kalori = 1000 kkal, Akses peripheral))
Kabiven 1440 ml PT. Fresenius Kabi Combiphar Bag (3 Chamber) 1440
ml
Larutan mengandung Asam Amino (Kombinasi Asam Amino: 45gr, Glukosa: 130gr, Lipid: 68gr dan Elektrolit (Kalori = 1400 kkal, Akses peripheral))
Kabiven 1920 ml PT. Fresenius Kabi Combiphar Bag (3 Chamber) 1920
ml
Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 150 gr + Asam Amino 48 gr dgn akses sentral)
Combiflex Plus (790 kcal) PT. Phapros, Tbk
Bag Double chamber (Dua compartement), 1000 mL
Larutan mengandung Asam Amino (Kombinasi Glukosa dan elektrolit 80 gr + Asam Amino 40 gr )
Combiflex peri (480 kcal) PT. Phapros, Tbk
Bag Double chamber (Dua compartement), 1000 mL
Otsu - KCl 7,46% PT Otsuka Indonesia
Page 18 of 32
257. DKI Jakarta Wida RL Botol 1000 ml 8,000.00
258. DKI Jakarta Asering Plastic Bottle 500 ML 9,000.00
259. DKI Jakarta KA EN 1B Plastic Bottle 500 ML 9,000.00
260. DKI Jakarta Totilac flexybag 250 mL 87,000.00
261. DKI Jakarta 12,650.00
262. DKI Jakarta Triofusin 1000 botol 500 mL 50,500.00
263. DKI Jakarta Triofusin 500 Flexy bag 500 mL 42,350.00
264. DKI Jakarta Larutan mengandung Karbohidrat (Maltose 100 gr) Martos Plastic Bottle 500 ML 29,167.00
265. DKI Jakarta Potacol inj Plastic Bottle 500 ML 55,500.00
266. DKI Jakarta Tutofusin OPS botol 500 mL 37,500.00
267. DKI Jakarta Botol Plastik 1000 mL 199,000.00
268. DKI Jakarta Triofusin E1000 botol 500 mL 56,000.00
Larutan mengandung Elektrolit (Larutan Ringer Laktat) PT. Widatra Bhakti
Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) PT Otsuka Indonesia
Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa 18.75 gr) PT Otsuka Indonesia
Larutan mengandung Elektrolit (Sodium Lactate sol (50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 gr/L, elektrolit)
PT Kalbe Farma
Larutan mengandung Elektrolit (Tiap 1000 ml mengandung electrolit: Sodium 145 mmol/l, Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Magnesium 1.0 mmol/l, Chloride 118 mmol/l, Acetate 24 mmol/l, Malate 5.0 mmol/l)
Ringerfundin 500 mL PT. Phapros, Tbk LDPE (Low Density Poly
Ethilene), botol plastik
Larutan mengandung Karbohidrat (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L + elektrolit) PT Kalbe Farma
Larutan mengandung Karbohidrat (Fructose 60 g, glucose 33 g, Xylitol 30 g/ L) PT Kalbe Farma
PT Otsuka Indonesia
Larutan mengandung Karbohidrat + Elektrolit (25.00g maltose, 3.00 g sodium chloride, 0.15 g potassium chloride, 0.10 g calcium chloride dihydrate dan 1.55 g sodium lactate)
PT Otsuka Indonesia
Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L) PT Kalbe Farma
Larutan mengandung Karbohidrat + Elektrolit (Asam amino 28 gr/L, Glukosa 75 gr/L, elektrolit)
Clinimix N9G15E PT Kalbe Farma
Larutan mengandung Karbohidrat + Elektrolit (Fructose 60 g, glucose 33 g, Xylitol 30 g/ L) PT Kalbe Farma
Page 19 of 32
269. DKI Jakarta Wida HSD Botol 500 ml 9,500.00
270. DKI Jakarta Wida D5-NS Botol 500 ml 6,800.00
271. DKI Jakarta WIDA 2A Botol 500 ml 6,917.00
272. DKI Jakarta WIDA D5-1/4NS Botol 500 ml 7,700.00
273. DKI Jakarta WIDA D5-1/2NS Botol 500 ml 7,700.00
274. DKI Jakarta Futrolit softbag 500ml 35,750.00
275. DKI Jakarta Wida RD Botol 500 ml 6,930.00
276. DKI Jakarta KA ENMG 3 Plastic Bottle 500 ML 9,167.00
277. DKI Jakarta KA EN 3B Plastic Bottle 500 ML 10,000.00
278. DKI Jakarta KA EN 3A Plastic Bottle 500 ML 10,000.00
279. DKI Jakarta 105,500.00
280. DKI Jakarta Larutan mengandung Lipid (Emulsi lemak 20%) Intralipid Botol Gelas 100 ml 60,500.00
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk injeksi ad 1000 ml)
PT. Widatra Bhakti
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 g ; Natrium Chloride 9 g, air untuk injeksi ad 1000 ml)
PT. Widatra Bhakti
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 25,0 g; NaCl: 4,5 g) PT. Widatra Bhakti
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 2.25 g) PT. Widatra Bhakti
Larutan mengandung Karbohidrat + Elektrolit (Glukosa: 55.0 g; NaCl: 4.5 g) PT. Widatra Bhakti
Larutan mengandung Karbohidrat + Elektrolit (Larutan nutrisi kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g)
PT. Sanbe Farma
Larutan mengandung Karbohidrat + Elektrolit (Larutan Ringer & Glukosa 5%) PT. Widatra Bhakti
Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr) PT Otsuka Indonesia
Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr)
PT Otsuka Indonesia
Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr)
PT Otsuka Indonesia
Larutan mengandung Lipid ( Infus Lipid Emulsi MCT/LCT 20% 100 ml)
Lipofundin MCT/LCT 1% 100
PT. Phapros, Tbk 20%, Botol Kaca @100 ml, single bottle
PT. Fresenius Kabi Combiphar
Page 20 of 32
281. DKI Jakarta 210,000.00
282. DKI Jakarta 591,000.00
283. DKI Jakarta 511,000.00
284. DKI Jakarta 358,000.00
285. DKI Jakarta Ivelip Flexy bag 100 mL 89,800.00
286. DKI Jakarta Latanoprost tetes mata 0,01% Cendo Glaopen strip 5 x 0.6 ml 72,000.00
287. DKI Jakarta Leuprorelin asetat inj depot 1,88 mg Tapros 1.88mg Vial 700,000.00
288. DKI Jakarta Leuprorelin asetat inj depot 11,25 mg Tapros 3M Vial 2,700,000.00
289. DKI Jakarta Levofloksasin inf 5 mg/mL n/a Box, 1 Botol @ 100 ml 40,000.00
290. DKI Jakarta Levofloksasin tablet 500 mg n/a STRIP 528.00
291. DKI Jakarta Lidokain injeksi 2% (HCL) n/a Dus, 100 ampul @ 2 ml 839.00
292. DKI Jakarta Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml n/a Dus, 30 ampul @ 2 ml 1,363.00
293. DKI Jakarta Lidokain jeli 2% Dus, 10 syringe @ 10 g 40,000.00
Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT 20% 250 ml)
Lipofundin MCT/LCT 1% 250
PT. Phapros, Tbk 20%, Botol Kaca @250 ml, single bottle
Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 180 gr + Asam Amino 71.8 gr + Lipid 50 gr dgn akses sentral)
Nutriflex Lipid Special 1250 PT. Phapros, Tbk
Bag, 3 chamber ( 3 kompartemen), 1250 ml
Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 80 gr + Asam Amino 40 gr + Lipid MCT/LCT 50 gr)
Nutriflex Lipid Peri 1250 PT. Phapros, Tbk
Bag, 3 chamber ( 3 kompartemen), 1250 ml
Larutan mengandung Lipid (Kombinasi Glukosa dan elektrolit 90 gr + Asam Amino 35.9 gr + Lipid 25 gr dgn akses sentral)
Nutriflex Lipid Special 625 PT. Phapros, Tbk Bag, 3 chamber ( 3
kompartemen), 625 ml
Larutan mengandung Lipid (Soybean Oil 200 g/L, Egg Lecithins 12 gr/L, Glycerol Ph 25 gr/L, Sodium Oleate 0.3 gr/L)
PT Kalbe Farma
PT. Cendo Industri Farmasi
PT. Takeda Indonesia
PT. Takeda Indonesia
PT. Infion Pharmaceutical
PT. Promedrahardjo Farmasi Industri
PT. Bernofarm
PT. Indofarma
Xylocaine Jelly 2% PT. AstraZeneca indonesia
Page 21 of 32
294. DKI Jakarta Lisinopril tablet 10 mg n/a 600.00
295. DKI Jakarta Lisinopril tablet 5 mg n/a 350.00
296. DKI Jakarta Litium karbonat tablet 200 mg Frimania 200 KOTAK @ 10 x 10 TAB 1,050.00
297. DKI Jakarta Litium karbonat tablet 400 mg Frimania 400 KOTAK @ 10 x 10 TAB 1,850.00
298. DKI Jakarta Loperamid tablet 2 mg n/a 89.00
299. DKI Jakarta Loratadin tablet 10 mg n/a STRIP 154.00
300. DKI Jakarta Lorazepam tablet 2 mg Merlopam 2 KOTAK @ 10 x 10 TAB 1,341.00
301. DKI Jakarta Maprotilin HCl tab 25 mg Ludios Strip 1,200.00
302. DKI Jakarta Maprotilin HCl tab 50 mg Sandepril 50 KOTAK @ 5 x 10 TAB 3,276.00
303. DKI Jakarta Melfalan tablet 2 mg Alkeran Box, Tablet 2 mg/25's 12,210.00
304. DKI Jakarta Meropenem inj 1 g n/a Dus, 1 vial @ 1 g 54,000.00
305. DKI Jakarta Metadon sir 50mg/5ml n/a Botol 1000 ml 254,100.00
306. DKI Jakarta n/a ktk 10 x 10 tablet salut 154.00
307. DKI Jakarta Metilfenidat kapsul LA 20 mg Ritalin LA 6,537.00
308. DKI Jakarta Metilprednisolon tablet 16 mg n/a Strip 635.00
PT. Novell Pharmaeutical LaboratoriesBox ,3 Strip @ 10 tablet
PT. Novell Pharmaeutical LaboratoriesBox ,3 Strip @ 10 tablet
PT. Mersifarma Tirmaku Mercusana
PT. Mersifarma Tirmaku Mercusana
PT. Ifars Pharmaceutical LaboratoriesDus, 10 Strip @ 10 Tablet
PT. Promedrahardjo Farmasi Industri
PT. Mersifarma Tirmaku Mercusana
PT. Soho Industri Pharmasi
PT. Mersifarma Tirmaku Mercusana
PT. Glaxo Wellcome Indonesia
PT. Bernofarm
PT. Kimia Farma
Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg PT. Kimia Farma
PT. Novartis IndonesiaDus, botol plastik @ 30 kapsul pelepasan lambat
PT. Mahakam Beta Farma
Page 22 of 32
309. DKI Jakarta Metilprednisolon tablet 4 mg n/a 205.00
310. DKI Jakarta Metilprednisolon tablet 8 mg n/a 300.00
311. DKI Jakarta Metoklopramide tablet 5 mg n/a ktk 10 x 10 tablet 108.00
312. DKI Jakarta Metronidazol infus 500 mg/100 ml n/a Dus, 1 Botol @ 100 ml 9,950.00
313. DKI Jakarta Metronidazol supositoria 500 mg Flagyl 3,220.00
314. DKI Jakarta Metronidazol tablet 250 mg n/a 10 strip @ 10 tab 110.00
315. DKI Jakarta Metronidazol tablet 500 mg n/a 10 strip @ 10 tab 160.00
316. DKI Jakarta Midazolam injeksi i.v. 1 mg/ml Fortanest Box isi 5 ampul 5,300.00
317. DKI Jakarta Midazolam injeksi i.v. 5 mg/ml Fortanest Box isi 5 ampul 12,000.00
318. DKI Jakarta Mikafungin Na serb inj 50 mg Mycamine Dus,1 vial@50mg 260,000.00
319. DKI Jakarta Mikonazol krim/salep 2 % (Nitrat) n/a Tube 10 gram 3,000.00
320. DKI Jakarta Mitomisin C (crystallin) serbuk inj 10 mg/vial Mitomycin C 10 mg /Vial 697,000.00
321. DKI Jakarta Moksifloksasin tetes mata 0,5% Vigamox botol, tetes mata 3 ml 77,000.00
322. DKI Jakarta Mometason furoat krim 0,1% n/a tube 10 gram 17,820.00
323. DKI Jakarta Morfin HCL inj 10 mg/ml n/a Dus 10 amp @ 1 ml 8,400.00
324. DKI Jakarta Morfin HCL tablet SR 10 mg 15,620.00
PT. Natura Laboratoria Prima Dus, 10 Blister @ 10 Tablet
PT. Dexa Medica Dus, 10 Blister @ 10 tablet
PT. Kimia Farma
PT. Natura Laboratoria Prima
PT. Aventis Pharma Dus, 2 blister @ 5 suppositoria
PT. Phyto Kemo Agung Farma
PT. Phyto Kemo Agung Farma
PT Kalbe Farma
PT Kalbe Farma
PT. Combiphar
PT. Kimia Farma
PT. Widatra Bhakti
PT. Tempo Scan Pacific
PT. Guardian Pharmatama
PT. Kimia Farma
MST Continus 10 mg PT. Mahakam Beta Farma Dus, 6 strip @ 10
tablet
Page 23 of 32
325. DKI Jakarta Morfin HCL tablet SR 15 mg 22,990.00
326. DKI Jakarta Morfin injeksi i.m./s.k./i.v. 10 mg/ml n/a Ktk 10 ampul @ 1ML 10,499.00
327. DKI Jakarta Morfin tablet 10 mg n/a Botol 30 tablet 1,300.00
328. DKI Jakarta Nacl 0,9% n/a Botol 500 ml 4,700.00
329. DKI Jakarta Nadroparin inj 9500 Axa/mL syringe 0,3 mL 54,144.00
330. DKI Jakarta Nadroparin inj 9500 Axa/mL, syringe 0,4 mL 66,640.00
331. DKI Jakarta Nadroparin inj 9500 Axa/mL, syringe 0,6 mL 94,962.00
332. DKI Jakarta Nalokson injeksi 0,4 mg/ml Nokoba Dus, 5 Ampul @ 2ml 61,600.00
333. DKI Jakarta Natrium Bikarbonat injeksi i.v 8,4% Meylon Ampoel 25 ML 6,200.00
334. DKI Jakarta Natrium Diklofenak tablet 50 mg n/a Dus @ 5 X 10 's 176.00
335. DKI Jakarta Natrium fusidat salep 20 mg/g Tube 5 gr 6,490.00
336. DKI Jakarta Nevirapin tablet 200 mg n/a btl 60 tablet 2,800.00
337. DKI Jakarta Nifedipin tab 20 mg, slow release; oros blister 2,999.00
338. DKI Jakarta Nifedipin tab 30 mg, oros blister 3,500.00
339. DKI Jakarta Nifedipin tablet/kapsul 10 mg n/a 95.00
340. DKI Jakarta Nistatin tablet salut 500.000 IU/ g n/a Dus @ 10 X 10 's 640.00
MST Continus 15 mg PT. Mahakam Beta Farma Dus, 6 strip @ 10
tablet
PT. Kimia Farma
PT. Kimia Farma
PT. Widatra Bhakti
Fraxiparine 0.3 ml PT. Glaxo Wellcome Indonesia Dus, 5 blister @ 2 pfs
0.3 ml
Fraxiparine 0.4 ml PT. Glaxo Wellcome Indonesia Dus, 5 blister @ 2 pfs
0.4 ml
Fraxiparine 0.6 ml PT. Glaxo Wellcome Indonesia Dus, 5 blister @ 2 pfs
0.6 ml
PT. Pratapa Nirmala
PT Otsuka Indonesia
PT. Phapros, Tbk
Fucilex Ointment PT. Molex Ayus
PT. Kimia Farma
Adalat Oros 20 mg PT. Bayer Indonesia
Adalat Oros 30 mg PT. Bayer Indonesia
PT. Dexa Medica Dus, 10 Strip @ 10 tablet salut selaput
PT. Phapros, Tbk
Page 24 of 32
341. DKI Jakarta Noretisteron tablet 5 mg Primolut N blister 2,618.00
342. DKI Jakarta Obat Antituberkulosis FDC Kategori 1 n/a Paket 359,990.00
343. DKI Jakarta Obat Antituberkulosis FDC Kategori 2 n/a Paket 1,199,900.00
344. DKI Jakarta Obat Antituberkulosis FDC Kategori Anak n/a Paket 214,990.00
345. DKI Jakarta Obat Antituberkulosis FDC Sisipan n/a Dus, 3 blister @ 28 kss 159,990.00
346. DKI Jakarta Ofloxacin tablet 200 mg n/a 400.00
347. DKI Jakarta Ofloxacin tablet 400 mg n/a 650.00
348. DKI Jakarta Oksimetazolin tetes hidung 0,025% Ilaidin Drops botol @ 10 ml 27,550.00
349. DKI Jakarta Oktreotid 10 mg 2,950,000.00
350. DKI Jakarta Olanzapin kapl salut 5 mg Olandoz 5 3 X 10 fcc 6,450.00
351. DKI Jakarta Olanzapin tab 10 mg Olandoz 10 3 X 10 fcc 11,200.00
352. DKI Jakarta Omeprazol injeksi 40 mg/ 10 ml n/a Dus, 1 Vial @ 40 mg 36,000.00
353. DKI Jakarta Omeprazol kapsul/kaplet 20 mg n/a strip 211.00
354. DKI Jakarta ondansetron inj 4 mg/ 2 mL n/a Dus, 5 Ampul @ 2ml 2,400.00
355. DKI Jakarta Ondansetron tab 4 mg n/a Box 3 X 10 Tab 716.00
PT. Bayer Indonesia
PT. Kimia Farma
PT. Phapros, Tbk
PT. Indofarma
PT. Indofarma
PT. Novell Pharmaeutical LaboratoriesBox ,5 Strip @ 10 tablet
PT. Novell Pharmaeutical LaboratoriesBox ,5 Strip @ 10 tablet
PT. Merck Tbk
Sandostatin LAR PT. Novartis Indonesia
Dus, vial @ 355m + 1 prefilled syringe pelarut @ 2,5 ml + 2 jarum suntik
PT. Sandoz Indonesia
PT. Sandoz Indonesia
PT. Natura Laboratoria Prima
PT. Novapharin
PT. Indofarma
PT. Yarindo Farmatama
Page 25 of 32
356. DKI Jakarta Ondansetron tablet 8 mg n/a Box 3 X 10 Tab 1,189.00
357. DKI Jakarta n/a 1,902,240.00
358. DKI Jakarta Paket CAPD Pergantian Transfer Set per 6 bulan n/a Set 219,540.00
359. DKI Jakarta 5,522,580.00
360. DKI Jakarta Parasetamol sirup 120 mg / 5 ml n/a botol 60 ml 1,438.00
361. DKI Jakarta Parasetamol tablet 500 mg n/a 87.00
PT. Yarindo Farmatama
Paket CAPD Awal (Komposisi: 1 unit Transfer Set, 2 unit Ultaclam, 1 unit Tenckoff Catheter, Titanium Adaptor)
PT Kalbe Farma
Transfer Set: Set; Ultaclam: Kantong Plastik; Tenckoff Catheter: Box; Titanium Adaptor: Kantong Plastik
PT Kalbe Farma
Paket CAPD Rutin 120 ( 4x ganti cairan perhari dengan komposisi Larutan Dialisa 1.5 %, Larutan Dialisa 2.5 %, Larutan Dialisa 4.25 %, Minicap)
Larutan Dialisa 1.5%: Dianeal Low Calcium with 1,5% Dextrose; Larutan Dialisa 2.5%: Dianeal Low Calcium with 2,5% Dextrose; Larutan Dialisa 4.25%: Dianeal Low Calcium with 4.25% Dextrose
PT Kalbe Farma
Larutan Dialisa 1.5 %: 2.000 ml; Larutan Dialisa 2.5 %: 2.000 ml; Larutan Dialisa 4.25 %: 2.000 ml; Minicap: Kantong Plastik
PT. Afifarma
PT. Afifarma Dus, 10 strip @10tablet
Page 26 of 32
362. DKI Jakarta Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Pegasys Boks, 1 pfs 1,077,815.00
363. DKI Jakarta Pegylated interferon alfa-2a inj 180 mcg/0,5 ml Pegasys Boks, 1 pfs 1,248,220.00
364. DKI Jakarta Permetrin krim 5% Tube @ 10 g 11,475.00
365. DKI Jakarta Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml (HCl) n/a Ktk 10 ampx2ml 14,500.00
366. DKI Jakarta Pioglitazon tab 15 mg DECULIN 15 MG 30 TAB/BOX 3,120.00
367. DKI Jakarta Pioglitazon tab 30 mg DECULIN 30 MG 30 TAB/BOX 4,525.00
368. DKI Jakarta Pirantel suspensi 125 mg/5 ml n/a Botol 60 ml 8,360.00
369. DKI Jakarta Pirantel tablet score (base) 125 mg n/a 298.00
370. DKI Jakarta Pirazinamid tablet 500 mg n/a 208.00
371. DKI Jakarta Polikresulen cairan Aptil Dus, Botol @ 10ml 17,393.00
372. DKI Jakarta Povidon Iodida larutan 10% 1000 ml n/a botol @ 1000 ml 37,109.00
373. DKI Jakarta Povidon Iodida larutan 10% 30 ml n/a botol @ 30 ml 2,163.00
374. DKI Jakarta Povidon Iodida larutan 10% 300 ml n/a botol @ 300 ml 14,203.00
375. DKI Jakarta Pramipeksol tab ER 0,375 mg 7,200.00
376. DKI Jakarta Pramipeksol tab ER 0,750 mg 11,268.00
377. DKI Jakarta Pravastatin tablet 20 mg n/a 2,300.00
PT. Boehringer Ingelheim
PT. Boehringer Ingelheim
Scabimite Cream 10 PT. Galenium Pharmasia Laboratories
PT. Kimia Farma
PT. Dexa Medica
PT. Dexa Medica
PT. Holi Pharma
PT. Holi Pharma Dus, 25 Blister @ 4 tablet
PT. Holi Pharma Dus 10 strip @ 10 tablet
PT. Pratapa Nirmala
PT. Afifarma
PT. Afifarma
PT. Afifarma
Sifrol ER 0,375mg PT. Boehringer Ingelheim Dus, 3 alu blister @ 10
tablet
Sifrol ER 0,750mg PT. Boehringer Ingelheim Dus, 3 alu blister @ 10
tablet
PT. Novell Pharmaeutical LaboratoriesBox ,5 Strip @ 10 tablet
Page 27 of 32
378. DKI Jakarta Propanolol tablet 10 mg ( HCl ) n/a 65.00
379. DKI Jakarta Propranolol tablet 40 mg (HCl) n/a 107.00
380. DKI Jakarta Quetiapin tab 200 mg 17,391.00
381. DKI Jakarta Quetiapin tab 300 mg 19,500.00
382. DKI Jakarta Quetiapin tab 400 mg 23,185.00
383. DKI Jakarta Ramipril tablet 5 mg n/a 580.00
384. DKI Jakarta Ranitidin injeksi 25 mg/2 ml n/a Dus, 10 Ampul @ 2 ml 1,140.00
385. DKI Jakarta Ranitidin tablet 150 mg n/a 120.00
386. DKI Jakarta Retinol (Vitamin A) 100.000 IU n/a Botol 50 kapsul lunak 260.00
387. DKI Jakarta Ringer Laktat larutan infus n/a botol 500 ml 5,200.00
388. DKI Jakarta Risperidon tablet 1 mg n/a 1,000.00
389. DKI Jakarta Risperidon tablet 2 mg n/a KOTAK @ 5 x 10 TAB 1,008.00
390. DKI Jakarta Risperidon tablet 3 mg n/a 2,000.00
391. DKI Jakarta Ropinirol Tablet Salut 2 mg 5,248.00
392. DKI Jakarta Ropinirol Tablet Salut 4 mg 6,275.00
393. DKI Jakarta Ropinirol Tablet Salut 8 mg 7,383.00
PT. Dexa Medica Dus, 10 Strip @ 10 tablet
PT. Holi Pharma Dus, 10 strip @ 10 tablet
Seroquel XR 200 mg PT. AstraZeneca indonesia Dus, 1 blister @ 10
tablet
Seroquel XR 300 mg PT. AstraZeneca indonesia Dus, 1 blister @ 10
tablet
Seroquel XR 400 mg PT. AstraZeneca indonesia Dus, 1 blister @ 10
tablet
PT. Dexa Medica Dus, 10 Strip @ 10 kaptab
PT. Natura Laboratoria Prima
PT. Dexa Medica Dus, 10 Strip @ 10 tablet salut selaput
PT. Kimia Farma
PT. Widatra Bhakti
PT. Dexa Medica Dus, 5 Blister @ 10 tablet
PT. Mersifarma Tirmaku Mercusana
PT. Dexa Medica Dus, 5 Blister @ 10 tablet
Requip PD 24 Hour 2 mg PT. Glaxo Wellcome Indonesia Dus, 7 blister @ 4
Tablet lepas Lambat
Requip PD 24 Hour 4 mg PT. Glaxo Wellcome Indonesia Dus, 7 blister @ 4
Tablet lepas Lambat
Requip PD 24 Hour 8 mg PT. Glaxo Wellcome Indonesia Dus, 7 blister @ 4
Tablet lepas Lambat
Page 28 of 32
394. DKI Jakarta Salbutamol inhalasi/aerosol 100 mcg/dosis Ventolin Inhaler Dus, botol 200 dosis 63,750.00
395. DKI Jakarta Salbutamol serb inh 200 mcg/kaps 431.00
396. DKI Jakarta Salbutamol serb inh 200 mcg/kaps + rotahaler Dus, 1 Rotahaler 5,867.00
397. DKI Jakarta Salbutamol tablet 4 mg (sebagai Sulfat) n/a ktk 10 x 10 tablet 89.00
398. DKI Jakarta Sefadroksil sirup kering 125 mg/5ml n/a Dus, Botol 60 ml 4,896.00
399. DKI Jakarta Sefadroksil kapsul/kaplet 250 mg n/a 513.00
400. DKI Jakarta Sefadroksil kapsul/kaplet 500 mg n/a 509.00
401. DKI Jakarta Sefadroksil sir kering 250 mg/5 mL n/a Dus, Botol 60 ml 5,940.00
402. DKI Jakarta Sefaleksin kapsul/kaplet 500 mg n/a 1,000.00
403. DKI Jakarta Sefepim inj 1 g n/a Box 2 Vial @ 1000mg 48,060.00
404. DKI Jakarta Sefiksim kapsul/kaplet 100 mg n/a 850.00
405. DKI Jakarta Sefiksim sirup kering 100 mg/ 5 ml n/a Dus, Botol 30 ml 8,800.00
406. DKI Jakarta Sefotaksim injeksi 0,5 g n/a Dus, 2 vial @ 500 mg 4,997.00
407. DKI Jakarta Sefotaksim injeksi 1 g n/a Dus, 10 Vial @ 1 g 2,950.00
408. DKI Jakarta Sefpodoksim proksetil tab 100 mg Banadoz 100 3,700.00
409. DKI Jakarta Seftazidim injeksi 1 g n/a Dus, 2 vial @ 1 g 17,060.00
PT. Glaxo Wellcome Indonesia
Ventolin Rotacaps PT. Glaxo Wellcome Indonesia Dus, 10 Blister @ 10
Kapsul
Ventolin Rotahaler PT. Glaxo Wellcome Indonesia
PT. Kimia Farma
PT. Holi Pharma
PT. Hexpharm Jaya LaboratoriesDus, 5 strip @ 10 kapsul
PT. Bernofarm Dus, 10 strip @ 10 kapsul
PT. Holi Pharma
PT. Ifars Pharmaceutical LaboratoriesDus, 5 Strip @ 10 Kapsul
PT. Yarindo Farmatama
PT. Dexa Medica Dus, 5 Strip @ 10 kapsul
PT. Ifars Pharmaceutical Laboratories
PT. Hexpharm Jaya Laboratories
PT. Natura Laboratoria Prima
PT. Sandoz Indonesia Dus, 3 blister @ 10 tablet
PT. Hexpharm Jaya Laboratories
Page 29 of 32
410. DKI Jakarta Seftriakson serbuk injeksi 1 g/vial n/a Dus, 10 Vial @ 1 g 3,300.00
411. DKI Jakarta Sefuroksim tab 500 mg Zinnat 500 7,200.00
412. DKI Jakarta Setirizin tablet 10 mg n/a 181.00
413. DKI Jakarta Sianokobalamin (vitamin B12) injeksi 500 mcg n/a 100 ampul @ 1 ml 1,077.00
414. DKI Jakarta Siklosporin kaps 100 mg 43,000.00
415. DKI Jakarta Siklosporin kapsul lunak 25 mg 12,000.00
416. DKI Jakarta Simvastatin scored tablet 10 mg n/a 169.00
417. DKI Jakarta Simvastatin tablet 20 mg n/a 485.00
418. DKI Jakarta Siprofloksasin infus 2% n/a Vial 200 ml 15,000.00
419. DKI Jakarta Siprofloksasin tablet 500 mg (sebagai HCl) n/a 255.00
420. DKI Jakarta Spiramisin tablet 500 mg n/a 1,499.00
421. DKI Jakarta Spironolakton tablet 100 mg n/a 900.00
422. DKI Jakarta Spironolakton tablet 25 mg n/a 315.00
423. DKI Jakarta Sufentanil injeksi iv, epidural 5 mcg/ml dus 5 amp @ dus 10 127,000.00
PT. Natura Laboratoria Prima
PT. Glaxo Wellcome Indonesia Dus, 1 Blister @ 10 Tablet salut selaput
PT. Pertiwi Agung Box, 10 strips @ 10 capsules
PT. Lucas Djaja
Sandimmun Neoral 100mg Kap
PT. Novartis Indonesia Dus, 10 blister @ 5 kapsul lunak
Sandimmun Neoral 25mg Kap
PT. Novartis Indonesia Dus, 10 blister @ 5 kapsul lunak
PT. Natura Laboratoria Prima Dus, 3 Strip @ 10 Kaplet salut selaput
PT. Bernofarm Dus, 3 strip @ 10 kaptab ss
PT. Dexa Medica
PT. Bernofarm Dus, 10 blister @ 10 tab ss
PT. Indofarma Dus, 5 strip @ 10 tablet
PT. Dexa Medica Dus, 10 Strip @ 10 tablet
PT. Dexa Medica Dus, 10 Strip @ 10 tablet
Sufentanyl Injeksi iv.Epidural 5 mcg / ml
PT. Kimia Farma
Page 30 of 32
424. DKI Jakarta Takrolimus kaps 0.5 mg Prograf 11,167.00
425. DKI Jakarta Takrolimus kaps 1 mg Prograf 21,500.00
426. DKI Jakarta Tamsulosin tab 0,2 mg Harnal D 5,800.00
427. DKI Jakarta Tamsulosin tab 0,2 mg 5,800.00
428. DKI Jakarta Tamsulosin tab SR 0,4 mg 6,800.00
429. DKI Jakarta Telbivudin tab 600 mg 28,500.00
430. DKI Jakarta Terbutalin cairan ih 2,5 mg/mL 6,250.00
431. DKI Jakarta Terbutalin tablet 2,5 mg Molasma Tablet Box 50's 99.00
432. DKI Jakarta Terbutalin turbu (serbuk ih) 0,50 mg 71,100.00
433. DKI Jakarta Tetrakain HCl tetes mata 0,5% Pantocain 0.5% botol 5 ml 11,500.00
434. DKI Jakarta Tetrasiklin kapsul/kaplet 250 mg n/a 149.00
435. DKI Jakarta Tiamazol tab 10 mg Thyrozol 10 1,135.00
436. DKI Jakarta Tiamazol tab 5 mg Thyrozol 5 563.00
437. DKI Jakarta Timolol tetes mata 0,25% 9,128.00
PT. Combiphar Pounch @ 5 blister @ 10 capsule
PT. Combiphar Dus, 1 pouch @5 blister@10 kaps
PT. Combiphar Box @ 2 blister @ 14 tablet
Harnal ® D 0.2 mg Disp. Tablet PT. Combiphar Box/ 2 blister @ 14
tablet
Harnal ® OCAS 0.4 mg Tablet PT. Combiphar Box/ 3 blister @ 10
Tablet
Sebivo 600 mg Tab PT. Novartis Indonesia Dus, 2 blister @ 14
tablet
Bricasma Respules PT. AstraZeneca indonesia Dus, 2 pak @ 5
respules
PT. Molex Ayus
Bricasma Turbuhaler 0,5 mg
PT. AstraZeneca indonesia Dus, 1 Turbuhaler @ 200 dosis
PT. Cendo Industri Farmasi
PT. Holi Pharma Dus, 10 strip @ 10 kapsul
PT. Merck Tbk Dus, 10 blister @ 10 tablet
PT. Merck Tbk Dus, 10 blister @ 10 tablet
Isotic Adretor 0,25% PT. Pratapa Nirmala Dus, Botol Plastik @
5ml
Page 31 of 32
438. DKI Jakarta Timolol tetes mata 0,5% 9,722.00
439. DKI Jakarta Tiotropium kaps 18 mcg + handihaller 152,543.00
440. DKI Jakarta Tramadol injeksi 50 mg/ml n/a Dus, 10 Ampul @ 2 ml 2,395.00
441. DKI Jakarta Travoprost tetes mata 0,004% Travatan 115,000.00
442. DKI Jakarta Triamsinolon asetonid nasal spray 55 mcg/puff Nasacort AQ 90,000.00
443. DKI Jakarta Trifluoperazin tablet 5 mg n/a strip 405.00
444. DKI Jakarta Urea krim 10% Soft U Derm tube 6,400.00
445. DKI Jakarta Imovax Polio 1 vial of 10ml (10 d's) 285,000.00
446. DKI Jakarta Valproat tab SR 250 mg Tablet 2,793.00
447. DKI Jakarta Valproat tab SR 500 mg Tablet 5,450.00
448. DKI Jakarta Valsartan tab 80 mg 3,900.00
449. DKI Jakarta Valsartan tab 160 mg 6,500.00
450. DKI Jakarta Verapamil tab 240 mg Isoptin 240 mg Tablet 6,200.00
451. DKI Jakarta Verapamil tablet 80 mg (HCl) n/a Ktk 10X10 TAB 234.00
452. DKI Jakarta Vinblastin serbuk injeksi 10 mg Vinblastine Vial 10mg/10ml 210,000.00
453. DKI Jakarta Vitamin B Kompleks tablet n/a Dus 10 strip x 10 tab 107.00
Isotic Adretor 0,5% PT. Pratapa Nirmala Dus, Botol Plastik @
5ml
Spiriva 10s + Handihaler PT. Boehringer Ingelheim Dus, 1 blister @10
kapsul + handihaler
PT. Natura Laboratoria Prima
PT. Tempo Scan Pacific botol, tetes mata 2,5 ml
PT. Aventis Pharma Dus, botol plastik 120 dosis
PT. Darya Varia
PT. Galenium Pharmasia Laboratories
Vaksin polio inj (Vaksin Poliomyelitis yang diinaktifkan) PT. Aventis Pharma
Depakote ER 250 mg PT. Abbott Indonesia
Depakote ER 500 mg PT. Abbott Indonesia
Diovan 80mg Tab PT. Novartis Indonesia Dus, 2 blister @ 14
tablet
DIOVAN 160 MG PT. Novartis Indonesia Dus, 2 blister @ 14
tablet
PT. Abbott Indonesia
PT. Kimia Farma
PT. Combiphar
PT. Kimia Farma
Page 32 of 32
454. DKI Jakarta Zidovudin 300 mg + Lamivudine 150 mg n/a Botol 60 tablet 3,429.00
455. DKI Jakarta Zinc drop 10 mg/mL Zincpro Drops 12,840.00
456. DKI Jakarta Zinc sir 20 mg/5 Ml Dus, botol 60 ml 7,400.00
457. DKI Jakarta Zinc tablet dispersible20 mg n/a 474.00
PT. Kimia Farma
PT. Combiphar Drops 10 mg/ml, Botol @15 ml
Zircum Kid Sirup PT. Meprofarm
PT. Indofarma Dus, 10 strip @ 10 tablet dispersible