e Catalogue

No NamaObatGenerik NamaDagang NamaPenyedia Kemasan HargaSatuanTerkecil(Rp)FORNAS

FORRS

namaobatdiforRS harga pabrikan

1.ACT(Artesunatetablet50mg+Amodiaquineanhydridatablet200mg)

n/a PT.KimiaFarma 1blister@24tablet 1,375.00 N

2. AdefovirDipivoksiltablet/kaplet10mg HepseraPT.SmithKlineBeechamPhamaceuticals

Dus,3Blister@10kapsul

27,500.00 N N

3. Albendazolsuspensi200mg/5ml n/a PT.IndofarmaDus,10dus@1botol@10ml

3,849.00 Y N

4. Albendazoltablet/kapsul/kaplet400mg n/a PT.HoliPharma Dus,5strip@6tablet 344.00 Y N

5. Alopurinoltablet/kapsul/kaplet100mg n/a PT.PertiwiAgungBox,10strips@10tablets

86.00 Y YAllopurinoltab100

mg143.00 PTIndofarma

6. Alprazolamtablet/kapsul/kaplet0,25mg n/a PT.DexaMedica Dus,10Strip@10tablet 380.00 Y Y

7. Alprazolamtablet/kapsul/kaplet0,5mg n/a PT.KimiaFarma Ktk10x10tablet 214.00 Y YAlprazolamtab0,5

mg631.00 PTOttoPharmaIndonesia

8. Alprazolamtablet/kapsul/kaplet1mg n/a PT.KimiaFarma Ktk10x10tablet 233.00 Y Y Alprazolamtab1mg 972.00 PTOttoPharmaIndonesia

9. AmfoterisinBsalepmata1% Fungicide PT.CendoIndustriFarmasi tube3.5gr 18,500.00 Y N

10. Amikasininjeksi250mg/mlGlybotic250mg/ml

PT.SanbeFarma Vial2ml 50,500.00 Y N

11. Aminofilininjeksi24mg/ml n/a PT.LucasDjaja dus30ampul@10ml 3,823.00 Y Y injAminophylin 5000.00 PTEthica

12. Aminofilintabletscored200mg n/a PT.MarinLizaFarmasiBotol@100tabletsalutselaput

90.00 Y YAminophylintab

200mg113.00 PTIndofarma

13. Amiodaroninjeksi150mg/3ml Cordarone PT.AventisPharma Dus,6ampul@3ml 12,480.00 Y Y InjKendaron 24,750.00 PTDaryaVaria

14. Amiodarontablet/kaplet200mgKendaronTablet

PT.DaryaVaria strip 1,200.00 Y Y TIARYTtab 4180.00PTFarrenheitpratapaNirmala

15. Amitriptilintabletsalut25mg(HCl) n/a PT.Indofarma Dus,10strip@10tss 112.00 Y Y Amitriptilintab 120.00 PTIndofarma

16. Amlodipintablet10mg n/a PT.PertiwiAgung Box,3strips@10tablets 330.00 Y YAmlodipinTab10

mg1749.00 PTHexapharm

17. Amlodipintablet5mg n/a PT.PertiwiAgung Box,3strips@10tablets 187.00 Y Y Amlodipintab5mg 960.00 PTOttoPharmaIndonesia

18. Amoksisilinkapsul/kaplet250mg n/a PT.Novapharin strip 211.00 Y N

19. Amoksisilinkapsul/kaplet/tabletscored500mg n/a PT.BernofarmDus,10strip@10kaptab

272.00 Y YAmoksisilintab500

mg333.00 PTPhapros

20. Amoksisilinsirupkeringforte250mg/5ml n/a PT.HoliPharma Dus,Botol60ml 4,070.00 Y N

21. Amoksisilinsirupkering125mg/5ml n/a PT.Novapharin btl@60ml 2,445.00 Y YAmoksisilinsyr125mg/5ml

3996 PTIndofarma

22.Analoginsulinlongactinginj100UI/ml,vial/cartridgedisposible/penfillcartridge(Insulinglargine100IU/ml)

LantusSolostar100IU/ml5pensx3ml

PT.AventisPharmadus,5solostarpen@3ml

85,000.00 Y Y Lantus 180.082 PTSanofiAventis

23.Analoginsulinmixactinginj100UI/ml,Analoginsulinmixactinginj100UI/ml(Premix30%InsulinAspart+70%ProtaminatedInsulinAspart(Analogue))

NovomixFlexpen

PT.FerronParPharmaceuticals

Injeksi100IU/ml,Flexpendisposible3ml(1boxisi5flexpendisposible)

106,000.00 Y N

24.Analoginsulinmixinsulininj100UI/ml,vial/cartridgedisposible/penfillcartridge(25%insulinlispro,75%insulinlisproprotaminesuspension,(rDNA))

HumalogMix25

PT.TempoScanPacific Penfillcartridge 97,500.00 Y Y injHumalogmix 150,300.00 LaboratoriesUrgo

25.Analoginsulinrapidactinginj100UI/ml,vial/cartridgedisposible/penfillcartridge(InsulinAspart(Analogue))

NovorapidFlexpen


Injeksi100IU/ml,Flexpendisposible3ml(1boxisi5flexpendisposible)

85,345.00 Y Y Novorapid 160,083.00

26.Analoginsulinrapidactinginj100UI/ml,vial/cartridgedisposible/penfillcartridge(InsulinAspart(Analogue))

NovorapidVialPT.FerronParPharmaceuticals

Dus,vial10ml 200,000.00 Y N

27.Analoginsulinrapidactinginj100UI/ml,vial/cartridgedisposible/penfillcartridge(Insulinglulisine100IU/ml)

ApidraSolostar100IU/ml5pensx3ml

PT.AventisPharmadus,5solostarpen@3ml

79,165.00 Y N

28.Analoginsulinrapidactinginj100UI/ml,vial/cartridgedisposible/penfillcartridge(Insulinlispro(rDNAorigin))

Humalog PT.TempoScanPacific Penfillcartridge 79,167.00 Y Y InjHumalog 102,000.00 LaboratoriesUrgo

29. Anastrozoltablet/kapsul/kaplet1mg Arimidex1mg PT.AstraZenecaindonesiaDus,2blister@14Tablet

32,000.00 N N

30.AntasidaDOENItabletkunyah,kombinasi:AluminiumHidroksida200mgMagnesiumHidroksida200mg

n/aPT.PromedrahardjoFarmasiIndustri

STRIP 75.00 Y Y Antasiddoentab 79.00 PTIndofarma

31.AntasidaDOENIIsuspensi,kombinasi:AluminiumHidroksida200mg/5mlMagnesiumHidroksida200mg/5ml

n/a PT.Erela Botol@60ml 2,160.00 Y Y Antasidadoensyr 3850.00 PTKimiaFarma

32.AntiBakteriDOENsalepkombinasi:Basitrasin500IU/gPolimiksin10.000IU/g

n/a PT.Indofarma Dus,25tube@5g 2,516.00 Y N

33.AntimalariaDOENkombinasi:Pirimetamin25mgSulfadoksin500mg

n/a PT.KimiaFarma ktk10x10tablet 520.00 Y N

34. Antimigren:ErgotaminTartrat1mg+Kofein50mg n/a PT.KimiaFarma Btl100tablet 135.00 Y Y Ergotaminecoffein 103.00 PTKimiaFarma

35.AntiparkinsonDOENtabletkombinasi:Benserazid25mgLevodopa100mg

LevoparTablet PT.Meprofarm Dus,5strip@10tablet 1,500.00 Y Y Levoben 4510.00 PTMersifarmaTirmaku

36. Artemetherinjeksi80mg/ml Artem PT.KimiaFarma Dus6amp@1ml 22,000.00 Y N37. AsamAskorbat(VitaminC)tablet50mg n/a PT.KimiaFarma Dus10stripx10tab 95.00 Y Y VitC50mg 32.00 PTKimiaFarma38. AsamFolattablet/kapsul/kaplet1mg n/a PT.MarinLizaFarmasi Botol@100tablet 48.00 Y Y Anemolat 205.00 PTPhapros39. AsamIbandronatinjeksi6mg/6ml Bondronat PT.BoehringerIngelheim Boks,1ampul 2,209,000.00 N N

40. AsamMefenamatkapsul/kaplet500mg n/a PT.BernofarmDus,10blister@10kaptabss

112.00 Y YAsamMefenamat

tab500mg176.00 PTIndofarma

41. Asampipemidatkapsul400mgUrotractin400mg

PT.SanbeFarma Strip 1,815.00 Y Y Urinter 3383.00 PTInterbat

42. Asamtraneksamatinjeksi100mg/ml n/aPT.HexpharmJayaLaboratories

Dus,10ampul@5ml 3,334.00 Y YInjAsam

Tranexamat500mg5775 PTHexapharm

43. Asiklovirsalepmata3%TemiralEyeOint

PT.SanbeFarma Tube3,5gram 24,750.00 Y

44. Asiklovirtablet/kapsul/kaplet200mg n/a PT.IndofarmaDus,10blister@10tablet

237.00 Y YAcyclovirtab200

mg534.00 PTNovellPharmaceutical

45. Asiklovirtablet/kapsul/kaplet400mg n/a PT.SampharindoPerdana Dus,5strip@10tablet 336.00 Y YAcyclovirtab400

mg630.00 PTNovellPharmaceutical

46. Asparaginaseserbukinjeksi10.000UI/vial Leunase PT.WidatraBhakti 10.000UI/Vial 1,039,500.00 N N

47. Atapulgittablet600mg Pularex PT.ZenithPharmaceuticals Dus5strip@10tablet 190.00 Y N

48. Atrakuriuminjeksi25mg/2,5ml TracriumPT.GlaxoWellcomeIndonesia

Dus,[email protected] 20,000.00 Y Y InjTracurium 76,340.00

49. AtropinSulfattablet0,5mg n/a PT.Indofarma Dus,10strip@10tablet 74.00 Y N

50. Azitromisinsirkering200mg/5mL n/a PT.SohoIndustriPharmasi botol@60ml 34,400.00 Y N

51. Azitromisintablet500mg n/a PT.KimiaFarma ktk2x10tablet 4,500.00 Y YAzitromycinkap500

mg11,000.00 PTSohoIndustriPharmasi

52. Azitromisintablet250mg n/a PT.SohoIndustriPharmasi Strip 3,333.00 Y N

53. Bedaksalisilserbuk2% n/aPT.RamaEmeraldMultiSukses

Dus@50gram 1,250.00 Y Y Salyciltalk 5,500.00 PTKimiaFarma

54. BenzatinBenzilPenisilin1,2jutaIU/vial n/a PT.Phapros,Tbk Dus@10Vial 9,800.00 Y N55. BenzatinBenzilPenisilin2,4jutaIU/vial n/a PT.Phapros,Tbk Dus@10Vial 13,400.00 Y N56. Beractantinjeksi/suspensi25mg/mL Survanta PT.AbbottIndonesia Vial 3,200,000.00 N N

57. Beraprostsodiumtablet20mcg Dorner20g PT.CombipharBox/3blister@10Tablet

3,600.00 N N

58. Beraprostsodiumtablet20mcg Dorner PT.CombipharBox@3blister@10Tablet

3,600.00 N N

59. Betametasonkrim0,1%(sebagaiValerat) n/a PT.KimiaFarma Tube5gr 1,520.00 Y Y Betametasonkrim 2026.00 PTKimiaFarma

60. Bikalutamidtabletsalut150mgCasodex150mg

PT.AstraZenecaindonesiaDus,2blister@14Tablet

72,400.00 N N

61. Bikalutamidtabletsalut50mg Casodex50mg PT.AstraZenecaindonesiaDus,2blister@14Tablet

45,000.00 N N

62. Bisakodilsuppositoria10mg Stolaxsupp PT.SanbeFarma Supp 6,045.00 Y Y Dulcolaxsupp 12,822.00 PTBoehringer

63. Bisoprololtablet5mg n/a PT.PratapaNirmala Box3X10tab 645.00 Y Y Bisoprololtab5mg 2,322.00 PTNovellPharmaceutical

64. Bromokriptintablet2,5mg Cripsatab PT.Caprifarmindo Box3x10'S 247,089.00 Y N

65. Budesonidinhaler200mcg/puff,100dosisPulmicortTurbuhaler

PT.AstraZenecaindonesiaDus,1Turbuhaler@100dosis

93,000.00 Y Y Pulmicortinhaler 200,349.00 PTAztraZeneca

66. Budesonidrespules/cairaninhaler0,25mg/mLPulmicortRespules

PT.AstraZenecaindonesiaDus,4pak@5respules@2ml

8,900.00 Y Y Pulmicortrespule 16,665.00

67.Budesonidformoterol(fixedcombination)inhaler160/4,5mcg

SymbicortTurbuhaler160/4.5mcg


117,600.00 Y N

68.Budesonidformoterol(fixedcombination)inhaler80/4,5mcg

Symbicort80/4.5mcg


110,500.00 Y N

69. Dabigatraneteksilatkapsul75mg Pradaxa PT.BoehringerIngelheimDus,3blister@10kapsul

12,936.00 N N

70. Dabigatraneteksilatkapsul110mg Pradaxa PT.BoehringerIngelheimDus,3blister@10kapsul

12,936.00 N N

71. Deferasirokstabletdisp/eff250mgExjade250mgTab

PT.NovartisIndonesia Dus,4blister@7tablet 76,000.00 N N

72. Deferasirokstabletdisp/eff500mgExjade500mgTab


73. DeferoksaminMesilatserbukinjeksi500mg Desferal PT.NovartisIndonesia Dus,10vial@500mg 112,000.00 N N74. Deksametasoninjeksii.v./i.m.5mg/ml n/a PT.Indofarma Dus,100ampul@1ml 1,580.00 Y Y InjDexametason 1,550.00 PTIndofarma

75. Desoksimetasonkrim0,25% n/a PT.DexaMedica Kotak,tube@15gram 9,983.00 Y YDeoximetason0,25

%15gr12,100.00

76. Difenhidramininjeksii.v./i.m.10mg/ml(HCl) n/a PT.Phapros,Tbk Dus@30Ampul 1,050.00 Y Y InjDulladril 1,170.00

77. Digoksintablet0,25mg n/a PT.YarindoFarmatama Box10X10Tab 97.00 Y Y Digoxintab0,25mg 143.00 PTIndofarma

78. DiltiazemHCltablet30mg n/a PT.Indofarma Dus,10strip@10tablet 134.00 Y Y Diltiazemtab30mg 152.00 PTIndofarma

79. Diltiazeminfusinjeksi50mgHerbesserPowderInjection50mg

PT.TanabeIndonesia 10vial@50mg 127,667.00 Y Y InjHerbeser 249,920.00 PTTanabeIndonesia

80. Diltiazeminjeksi25mg/5mLFarmabesInjeksi25mg

PT.PratapaNirmala Vial5mL 46,667.00 Y Y InjFarmabes 108,900.00PTFarrenheitpratapaNirmala

81. DiltiazemKapsulSR100mgHerbesserCD100

PT.TanabeIndonesia 3blister@10kapsul 3,667.00 Y Y HerbeserCD100 8,888.00 PTTanabeIndonesia

82. DiltiazemKapsulSR200mgHerbesserCD200

PT.TanabeIndonesia 3blister@10kapsul 4,015.00 Y N

83. Dinatriumedetattetesmata0,35% E.D.T.A PT.CendoIndustriFarmasi botol15ml 37,500.00 Y N

84. Doksazosinmesilattablet1mg Cardura1mg PT.PfizerIndonesia Dus,5blister@10'stab 3,480.00 Y N

85. Doksazosinmesilattablet2mg Cardura2mg PT.PfizerIndonesia Dus,5blister@10'stab 5,480.00 Y N

86. Doksorubisinserbukinjeksii.v.10mg/vialDoxorubicinkalbe

PTKalbeFarma vial@5ml 59,000.00 N N

87. Doksorubisinserbukinjeksii.v.50mg/vialDoxorubicinActavis50mg

PT.ActavisIndonesia Dus,1vial@50mg 258,000.00 N N

88. Domperidonsuspensi/sirup5mg/5ml n/a PT.Novapharin btl@60ml 3,333.00 Y Y Domperidonsyr 12,650.00 PTHexapharm89. Domperidontablet10mg n/a PT.Novapharin strip 167.00 Y Y DomperidoneTab 404.00 PTHexapharm90. Domperidontetes5mg/mL n/a PT.Bernofarm Dus,botol@10ml 15,600.00 Y N

91. Dosetakselinjeksi20mg/0,5ml n/a PT.SanbeFarmaDus,1vial@0,5ml+1vialpelarut@1,5ml

970,200.00 N N

92. Dutasteridkapslunak0,5mg AvodartPT.SmithKlineBeechamPhamaceuticals

Dus,BotolPlastik@30Tablet

7,100.00 Y Y Avodartcap 9,000.00 PTGlaxoWellcomeIndonesia

93. Eksemestantablet25mg Aromasin PT.PfizerIndonesia Dus,2blister@15tablet 42,600.00 N N

94. Enoksaparinsodiuminj20mg/0,2mLLovenox2000ANTIXA

PT.AventisPharmadus,2prefilledsyringe@0,2ml

40,740.00 Y N



71,875.00 Y N



100,000.00 Y N

97. Epinefrin(Adrenalin)injeksii.v/s.k./i.m1mg/ml n/a PT.Phapros,Tbk Dus@30Ampul 8,100.00 Y Y InjEpinefrin 1,240.00 PTPhapros

98. Epirubisinserbinjeksi50mg/25mlEpirubisinKalbe

PTKalbeFarma Vial@25ml 500,000.00 N N

99. Epirubisinserbinjeksi10mg/5ml n/a PT.SanbeFarma Dus,1vial@5ml 128,000.00 N N

100. Ergokalsiferol(vitaminD3/D2)kapsul50.000UI DVitFT PT.GraciaPharmindoDus3strip@10Flashtablet

650.00 Y N

101. Ergokalsiferol(vitaminD3/D2)suspensi10.000UI/ml DVitSyrup PT.GraciaPharmindoDus,BotolPlastik@100mL

8,000.00 Y N

102. Eritromisinkapsul/kaplet500mg n/a PT.Indofarma Dus,10blister@10kss 930.00 Y YEritromisincaps250

mg504.00 PTKimiaFarma

103. Eritromisinsirupkering200mg/5ml n/aPT.PhytoKemoAgungFarma

Botol@60ml 7,700.00 Y Y Eritomisinsyr 8100.00

104. Eritropoetinalfainj3000UI/mL Hemapo3000 PTKalbeFarma PrefilledSyringe@1ml 128,000.00 Y Y INJHEMAPO3000UI 251,900.00 PTKalbeFarma

105. Eritropoetinbetainj2000UI/0,3mL Recormon PT.BoehringerIngelheim Boks,6ampul 139,500.00 Y N106. Etambutoltablet250mg(HCl) n/a PT.KimiaFarma ktk20x10tablet 314.00 Y N

107. Etambutoltabletsalut500mg(HCl) n/a PT.Indofarma Dus,10strip@10tss 451.00 Y YEtambutoltab

500mg573 PTKimiaFarma

108. Etanol70%cairan n/a PT.Novapharin btl@100ml 2,500.00 Y Y Etanol70%

109. Etonogestrelimplan68mcg ImplanonPT.MerckSharpDohmePharmaTbk

Dus,1blister@1subdermalimplant

128,779.00 Y N

110. Etoposidinjeksi20mg/ml Posyd PT.Combiphar Vial100mg/5ml 100,000.00 Y N111. Eugenolcairan n/a PT.KimiaFarma Botol10ml 16,667.00 Y N

112. Everolimustab0,25mgCertican0,25mgTab


113. Everolimustab0,5mgCertican0,5mgTab


114.FaktorVIIa(rekombinan)serbinj1mg/vial+pelarutuntukinjeksi

NovosevenPT.FerronParPharmaceuticals

KOTAK@1VIALSERBUKOBAT&INFUSIONKIT

9,200,000.00 N N

115. Fenitoininjeksi50mg/ml n/aPT.MersifarmaTirmakuMercusana

KOTAK@10ampul 20,250.00 Y Y InjPhenytoin2ml 56,005.00 PTPhapros

116. Fenitoinkapsul/kaplet100mg n/a PT.Ikapharmindo Botol@100 133.00 Y Y Phenytoincaps 605.00 PTIkapharmindoPutramas117. Fenobarbitalinjeksii.m./i.v.50mg/ml n/a PT.Phapros,Tbk Dus@30Ampul 1,800.00 Y Y InjPhental 8,250.00 PTCombipharFarma

118. Fenofibratkaps100mg n/aPT.HexpharmJayaLaboratories

Dus,3strip@10kapsul 1,075.00 Y N

119. Fenofibratkaps300mg n/aPT.HexpharmJayaLaboratories

Dus,3strip@10kapsul 1,375.00 Y N

120. Fenoksimetilpenisilin(penisilinV)tablet250mg n/a PT.Phapros,Tbk Dus@10X10's 290.00 Y N121. Fenoksimetilpenisilin(penisilinV)tab125mg Fenocin PT.ActavisIndonesia Dus45x12tab 235.00 Y N122. Fenoksimetilpenisilin(penisilinV)tablet500mg n/a PT.Phapros,Tbk Dus@10X10's 510.00 Y N

123. FenoterolHBrinhsolution0,1%BerotecSolution

PT.BoehringerIngelheim Dus,Canister200dosis 117,500.00 Y Y Berotec 118,910.00

124. Fentanilinjeksii.m/i.v0,05mg/ml,ampul10ml n/a PT.KimiaFarma Dus5ampul@10ml 128,000.00 Y125. Fentanilinjeksii.m/i.v0,05mg/ml,ampul2ml n/a PT.KimiaFarma Dus5ampul@2ml 33,914.00 Y Y InjFentanil0,05 40.697 PTKimiaFarma

126. Fentanilpatch12,5mcg/jamDurogesic12,5MUMatrix

PT.KimiaFarma Dus@5patch 80,000.00 Y N

127. Fentanilpatch25mcg/jamDurogesic25MUMatrix


128. Fentanilpatch50mcg/jamDurogesic50MUMatrix


129. Filgrastiminj300mcg/mL Leucogen PTKalbeFarma pfs@0,5ml 375,000.00 N N130. Fitomenadion(Vit.K1)tabletsalutgula10mg n/a PT.Phapros,Tbk Dus@10X10's 630.00 Y Y vitaminK 275

131. Fludarabininj50mg FludaraIVLYO PT.AventisPharma Dus,5vial@50mg 1,248,319.00 N N

132. Fludarabintab10mg FludaraOral PT.AventisPharmaDus,4blister@5tabletsalutselaput

275,000.00 N N

133. Flufenazininjeksii.m.25mg/mlSikzonoateInjeksi

PT.MersifarmaTirmakuMercusana

Dus,5ampul@1ml 55,000.00 Y N

134. Flukonazolinjeksi2mg/ml n/aPT.NaturaLaboratoriaPrima

Dus,1Botol@100mL 47,100.00 Y N

135. Flukonazoltablet/kapsul150mg n/a PT.KimiaFarma ktk1x10kapsul 22,000.00 Y YFluconazolecap150

mg22,000.00 PTKimiaFarma

136. Fluoksetintablet10mg Foransi10 PT.GraciaPharmindo strip 419.00 Y Y Kalxetintab10mg 4,510.00 PTKalbeFarma137. Fluoksetintablet20mg NOPRES PT.DexaMedica DUS,30TABLET 410.00 Y N138. Fluorourasilinj250mg/mL Curacil PTKalbeFarma vial@1ml 24,500.00 N N139. Fluorourasilinj500mg/5mL Curacil PTKalbeFarma vial@10ml 33,000.00 N N

140. Flusinolonasetonidkrim0,025% SYNARCUSPT.IfarsPharmaceuticalLaboratories

Dus,Tube5g 2,400.00 Y N

141. Flutikasonfuroatintranasalspray AvamysPT.GlaxoWellcomeIndonesia

Dus,Botol120DosisSpay

93,333.00 Y N

142. Flutikasonpropionatnebules0,5mgFlixotideNbules

PT.GlaxoWellcomeIndonesia

Dus,2flowwrap@5nebules@1dosis(2ml)

12,917.00 Y Y Flixotidenebulizer 19,140.00 PTGlaxoSmitth

143. Fondaparinuksinj2,5mg/0,5mL ArixtraPT.GlaxoWellcomeIndonesia

Dus,2pfs0.5ml 241,667.00 Y Y InjArixtra2.5mg 360,525.00 PTGlaxoSmitth

144. Furosemidinjeksii.v./i.m.10mg/ml n/a PT.Indofarma Dus,25ampul@2ml 1,829.00 Y YInjFurosemide10

mg/ml1,830.00 PTIndofarma

145. Furosemidtablet40mg n/a PT.Indofarma Dus,10strip@10tablet 85.00 Y YFurosemidetab40


146. Gansiklovirserbinj500mg(50mg/mL) Cymevene PT.BoehringerIngelheim Boks,1ampul 399,500.00 Y N

147.GaramOralitIserbuk,kombinasi:Natriumklorida0,52gkaliumklorida0,30gTrinatriumsitratdihidrat0,58gGlukosaAnhidrat2,70g

n/a PT.Phapros,Tbk Dus@100Sachet 288.00 Y Y Oralitsachet 402 PTIndofarma

148. Gefitinibtab250mg Iressa250mg PT.AstraZenecaindonesia Dus,1blister@10tablet 295,000.00 N N

149. Gemfibrozilkapsul/kaplet300mg n/a PT.IndofarmaDus,10blister@12kapsul

289.00 Y YGemfibrozilcaps

300mg293 PTPhapros

150. Gemfibroziltablet600mg n/a PT.IndofarmaDus,10blister@10kaptab

679.00 Y N

151. Gemsitabininj1000mg/vialGemzar1000mg

PT.BayerIndonesia vial 1,098,900.00 N N

152. Gemsitabininj200mg/vial n/a PT.SanbeFarma Dus,1vial@200mg 330,000.00 N N

153. Gentamisininjeksi40mg/ml n/a PT.Indofarma Dus,5ampul@2ml 3,399.00 Y YInjGentamisin40

mg3,100.00 PTIndofarma

154. Gentamisinsalepmata0,3%GenointSalepMata

PT.Erela Tube@3,5gr 2,600.00 Y Y CendogentaSM 26,675.00 PTCendoPharmaceutical

155. Gentamisintetesmata0,3% n/a PT.Indofarma Dus,botolplastik5ml 3,194.00 Y YCendogentaTM

0,3%23,925.00 PTCendoPharmaceutical

156. Glibenklamidtablet5mg n/a PT.IndofarmaDus,10blister@10kaptab

56.00 Y YGibenclamidetab5

mg72.00 PTIndofarma

157. Gliklazidtab80mg Glicab PT.TempoScanPacific Strip 242.00 Y N

158. Glikuidontab30mg n/a PT.DexaMedica Dus,10Strip@10tablet 950.00 Y Y Gliquidontab30mg 646.00 PTDexaMedica

159. Glimepiridetablet1mg n/a PT.KimiaFarma ktk5x10tablet 265.00 Y YGlimepiridetab1

mg760.00 PTHexapharm


mg1,433.00 PTHexapharm





163. GliseriltrinitratkapsSR2,5mgNitrokafRetard

PT.KimiaFarma Dus10x10 1,493.00 Y N

164. GliseriltrinitratkapsSR5mg NitrokafForte PT.KimiaFarma Dus10x10 2,171.00 Y N

165. Gliseriltrinitrattabsublingual0,5mg Nitral PT.ActavisIndonesia Btl@30tablet 1,500.00 Y N

166. Gliserinlar50%Gliserinlar50%

PT.LucasDjaja Glycerin100ml 5,333.00 Y N

167. Glukosalarutaninfus10%steril n/a PT.WidatraBhakti botol@500ml 5,700.00 Y Y InfusD10% 5,727.00 PTWidatraBhakti168. Glukosalarutaninfus5%steril n/a PT.WidatraBhakti botol@500ml 5,200.00 Y Y InfusD5% 5,060.00 PTWidatraBhakti

169. Goserelinasetatinj10,8mg/vialZoladex10,8mg

PT.AstraZenecaindonesia Dus,[email protected] 2,300,000.00 N

170. Goserelinasetatinj3,6mg Zoladex3,6mg PT.AstraZenecaindonesia Dus,[email protected] 840,000.00 N

171. Griseofulvintablet125mg n/a PT.IndofarmaDus,10blister@10tablet

219.00 Y N

172. Haloperidolinj50mg/mLHaldolDecanoas

PT.SohoIndustriPharmasi Dus5Ampul@1mL 83,333.00 Y N

173. Haloperidoltablet0,5mg n/a PT.IndofarmaDus,10blister@10tablet

59.00 Y N

174. Haloperidoltablet5mg n/a PT.IndofarmaDus,10blister@10tablet

96.00 Y YHaloperidoltab5


175. Haloperidoltablet1,5mg n/a PT.IndofarmaDus,10blister@10tablet

69.00 Y YHaloperidoltab1,5

mg83.00 PTIndofarma

176. Haloperidoltablet2mg Lodomer2PT.MersifarmaTirmakuMercusana

KOTAK@10x10TAB 126.00 Y N

177. HalotanInhalasi Halothane PT.DexaMedica Botol 641,500.00 Y N

178. HepatitisBimunoglobulin(human) HyperhepB PT.DipaPharmalab Dus,[email protected] 1,328,000.00 Y N

179. Hiosinbutilbromidinjeksi20mg/ml n/a PT.OttoPharmaceuticals box5ampul@1ml 4,500.00 Y Y InjHyosinN 8,800.00 PTOttoPharmaIndonesia

180.Humaninsulinintermediateactinginj100UI/ml,vial(HumanInsulin(IntermediateActing))

InsulatardVialPT.FerronParPharmaceuticals


181.Humaninsulinintermediateactinginj100UI/ml,vial(InsulinhumanBasal)

HumulinNVial PT.BayerIndonesia Dus,vial10ml 138,000.00 Y Y InjhumulinN10ml 235,400.00

182.Humaninsulinintermediateactinginj100UI/ml,vial/cartridgedisposible/penfillcartridge

n/a PT.AventisPharma Dus,1Vial@5ml 72,000.00 Y N

183.Humaninsulinintermediateactinginj100UI/ml,penfillcartridge(HumanInsulin(IntermediateActing))

InsulatardPenfill


Injeksi100IU/ml,penfilldisposible3ml(1boxisi5penfilldisposible)

76,125.00 Y N

184.Humaninsulinintermediateactinginj100UI/ml,penfillcartridge(InsulinhumanBasal)

HumulinNCart PT.BayerIndonesiaDusIsi5penfill/cartridge@3ml

76,125.00 Y Y InjHumulinNcat 120,000.00

185.Humaninsulinintermediateactinginj100UI/ml,penfillcartridge(InsulinhumanBasal)

SansulinN PT.SanbeFarma penfillcartridge@3ml 75,000.00 Y Y InjSansulinNcat 118,200.00 PTSanbeFarma

186.Humaninsulinmixinsulininj100UI/ml,penfillcartridge(HumanInsulin(Premix:30%Soluble+70%NPHInsulin))

MixtardPenfillPT.FerronParPharmaceuticals


76,125.00 Y N

187.Humaninsulinmixinsulininj100UI/ml,penfillcartridge(InsulinhumanComb)

Humulin30/70Cart

PT.BayerIndonesiaDusIsi5penfill/cartridge@3ml

76,125.00 Y

188.Humaninsulinmixinsulininj100UI/ml,vial(HumanInsulin(Premix:30%Soluble+70%NPHInsulin))

MixtardVialPT.FerronParPharmaceuticals


189.Humaninsulinmixinsulininj100UI/ml,vial(InsulinhumanComb)

Humulin30/70Vial

PT.BayerIndonesia Dus,vial10ml 138,000.00 Y

190.Humaninsulinmixinsulininj100UI/ml,vial/cartridgedisposible/penfillcartridge


191.Humaninsulinshortactinginj100UI/ml,penfillcartridge(HumanInsulin(ShortActing))

ActrapidPenfillPT.FerronParPharmaceuticals


76,125.00 Y N

192.Humaninsulinshortactinginj100UI/ml,penfillcartridge(InsulinhumanRapd)

SansulinR PT.SanbeFarma penfillcartridge@3ml 75,000.00 Y Y InjSansulinRampul 121,200.00 PTSanbeFarma

193.Humaninsulinshortactinginj100UI/ml,penfillcartridge(InsulinhumanRapd)

HumulinRCart PT.BayerIndonesiaDusIsi5penfill/cartridge@3ml

76,125.00 Y Y InjHumulinRampul 120,000.00 PTCombipharFarma

194.Humaninsulinshortactinginj100UI/ml,vial(HumanInsulin(ShortActing))

ActrapidVialPT.FerronParPharmaceuticals


195.Humaninsulinshortactinginj100UI/ml,vial(InsulinhumanRapd)

HumulinRVial PT.BayerIndonesia Dus,vial10ml 138,000.00 Y Y InjHumulinRvial 235,540.00

196.Humaninsulinshortactinginj100UI/ml,vial/cartridgedisposible/penfillcartridge


197. Ibuprofensirup100mg/5ml n/a PT.Indofarma Dus,botol60ml 3,499.00 Y Y Ibuprofensyr 3,497.00 PTIndofarma198. Ibuprofensuspensi200mg/5ml n/a PT.Indofarma Dus,botol60ml 4,499.00 Y N

199. Ibuprofentablet400mg n/a PT.Novapharin strip 150.00 Y YIbuprofentab400


200. Ifosfamidserbukinjeksi1000mg/vialHoloxaninjeksi1000

PT.MugiLaboratories Dus,1vial@1g 1,329,163.00 N N

201. Imidapriltab10mgTanapress10mg

PT.TanabeIndonesia 3blister@10tablet 3,908.00 Y N Tanapres10mg 17,204.00

202. Imidapriltab5mg Tanapress5mg PT.TanabeIndonesia 3blister@10tablet 2,120.00 Y N Tanapres5mg 10,893.00

203. Iopamidol200300mgIodium/mL(300mg@vial100ml) Iopamiro PT.DipaPharmalab Dus,botol@100ml 350,000.00 Y

204. Iopamidol200300mgIodium/mL(300mg@vial30ml) Iopamiro PT.DipaPharmalab Dus,vial@30ml 122,000.00 Y

205. Iopamidol200300mgIodium/mL(300mg@vial50ml) Iopamiro PT.DipaPharmalab Dus,vial@50ml 166,000.00 Y YIopamiro300mg/50ml

209,000.00

206. Iopamidol300370mgIodium/mL(370mg@vial100ml) Iopamiro PT.DipaPharmalab Dus,botol@100ml 369,000.00 Y



209. Iopromide300370mgIodium/mL(300mg/100ml)Ultravist300/100mg

PT.BayerIndonesia Botol 245,000.00 Y


PT.BayerIndonesia Botol 123,200.00





213. Irbesartantab150mg n/a PT.Indofarma Dus,5blister@10kss 1,425.00 Y Y Irvelltab150mg 7.59 PTNovellPharmaceutical214. Irbesartantab300mg n/a PT.Indofarma Dus,5blister@10kss 2,470.00 Y Y Irbesartan300mg 3,801.00 PTIndofarma215. Irinotekaninf20mg/ml n/a PT.SanbeFarma Dus,1vial@2ml 510,000.00 N N

216. IsosorbidDinitrattabletsublingual5mg n/a PT.Indofarma Dus,10strip@10tablet 88.00 Y YIsosorbidDinitratSL

5mg98

217. Kaliumaspartattab300mg Kalipar PT.TempoScanPacific Strip 700.00 Y Y AsparKtab300mg 2,248.00 PTTanabeIndonesia

218. KaliumKloridatablet600mg KSR PT.MerckTbk Dus,10strip@10tablet 1,580.00 Y Y KCLtab10mg 8 PTPhapros

219. KalsiumGlukonatinjeksii.v10%(100mg/ml)Kalsiumglukonat

PT.EthicaIndustriFarmasi Ampul 7,800.00 Y Y InjKalsiumGluconat 10.437 PTEthica

220. Kandesartantab16mg n/a PT.DexaMedica Dus,3Blister@10tablet 4,900.00 Y YCandesartantab16

mg7,150.00 PTDexaMedica

221. Kandesartantab8mg n/a PT.DexaMedica Dus,3Blister@10tablet 3,100.00 Y N

222. Kapesitabintab500mg Xeloda PT.BoehringerIngelheim Boks,120tablet 27,500.00 N N

223. Kaptopriltablet50mg n/a PT.Indofarma Dus,10strip@10tablet 140.00 Y N

224. Kaptopriltabletscored25mg n/a PT.ErritaPharma Dus,10strip@10tablet 84.00 Y Y Captopril25mg 138.00 PTHexapharm

225. Kaptopriltabletscored12,5mg n/a PT.Indofarma Dus,10strip@10tablet 62.00 Y Y Captopril12,5mg 90.00 PTHexapharm

226. Karbamazepinsirup100mg/5mlTegretolSyrup100mg/5ml,120ml

PT.NovartisIndonesia Dus,botol@120ml 44,770.00 Y N

227. Karbamazepintablet200mg n/a PT.IndofarmaDus,10blister@10tablet

245.00 Y N

228. Karbogliserintetestelinga10%Karbogliserintetestelinga10%

PT.LucasDjaja Fenol100mg/1ml 2,042.00 Y N

229. Ketamininjeksii.v.100mg/ml KTM PT.GuardianPharmatama Vial@10ml 110,000.00 Y Y InjKTM100mg 165,000.00 PTLapiLaboratories

230. Ketokonazolkrim2% n/a PT.KimiaFarma tube10gr 2,569.00 Y Y Ketokonazolecream 2,569.00 PTKimiaFarma

231. Ketokonazolkrim2% n/aPT.NovellPharmaeuticalLaboratories

Boxisi1Tube@15g 4,700.00 Y N

232. Ketokonazoltablet200mg n/a PT.DexaMedica Dus,5Strip@10tablet 300.00 Y YKetokonazoletab

200mg380.00 PTKimiaFarma

233. Ketorolacinjeksi30mg/ml n/a PT.Phapros,Tbk Dus@12Ampul 2,300.00 Y Y InjKetorolac 5,500.00 PTPhapros

234. Klaritromisintab500mg ORIXALPT.IfarsPharmaceuticalLaboratories

Dus,3Strip@10Kapletsalutselaput

3,200.00 Y N

235. Klindamisinkapsul/kaplet150mg n/a PT.IndofarmaDus,5blister@10kapsul

361.00 Y YClindamycincaps


236. Klindamisinkapsul/kaplet300mg n/a PT.IndofarmaDus,5blister@10kapsul

553.00 Y YClindamycincaps

300mg752.00 PTNovellPharmaceutical

237. Klobazamtab10mg n/a PT.DexaMedica Dus,10Strip@10tablet 900.00 Y Y Clobazamtab10mg 950.00 PTDexaMedica

238. Klonidintablet0,15mg n/a PT.KimiaFarma Ktk10X10TAB 184.00 Y N

239. Klopidogreltab75mg n/aPT.HexpharmJayaLaboratories

Dus,3strip@10tab 3,400.00 Y Y Clopidogreltab 7,700.00

240. Klorpromazininjeksii.m.25mg/ml(HCl) n/a PT.Phapros,Tbk Dus@30Ampul 1,100.00 Y N241. Klorpromazininjeksii.m5mg/ml2ml(HCl) n/a PT.Phapros,Tbk Dus@30Ampul 1,050.00 Y N

242. Klozapin100mg n/aPT.MersifarmaTirmakuMercusana

KOTAK@5x10TAB 5,000.00 Y N

243. Klozapin25mg n/aPT.MersifarmaTirmakuMercusana


244. Kodeintablet10mg n/a PT.KimiaFarma ktk10x10tablet 500.00 Y Y Codeintab10mg 427.00 PTKimiaFarma245. Kodeintablet15mg n/a PT.KimiaFarma ktk10x10tablet 850.00 Y Y Codeintab15mg 728.00 PTKimiaFarma246. Kodeintablet20mg n/a PT.KimiaFarma ktk10x10tablet 1,100.00 Y Y Codeintab20mg 950.00 PTKimiaFarma

247. Kombinasisuspensi:Parafin+gliserin+fenolftaleinLaxadineEmulsi60ml

PT.GaleniumPharmasiaLaboratories

Botol@60ml 12,450.00 Y Y Laxadinesyr 30,250.00 PTGaleniumPharmasia

248.Kombinasitabletsalut:Besi(II)sulfat7H2O200mgAsamfolat0,25mg

n/a PT.ErelaDus,100Sachet@30Tablet

42.00 Y N

249.Kombinasitetesmata2,5mg/mL:Natriumklorida8,664mg;Kaliumklorida1,32mg

CendoLyteers PT.CendoIndustriFarmasi botol15ml 15,750.00 Y Y CendoLyters 24,750.00 PTCendoPharmaceutical

250. Kombinasi:Artemether20mg;Lumefantrin120mg Coartem PT.NovartisIndonesia Dus,4blister@6tablet 3,220.00 Y N

251.Kombinasi:Levodopa100mg;Karbidopa25mg;Entekapon200mg

Stalevo PT.NovartisIndonesiaDus,botolplastik@30tabletsalutselaput

8,900.00 Y N

252.Kombinasi:Salmeterol25mcg;Flutikasonpropionat50mcg

SeretideInhaler50mcg


Dus,Botol120Dosis 90,667.00 Y N


SeretideDiskus100mcg


Dus,foilstrip@60dosis 100,833.00 Y N


SeretideDiskus250mcg


Dus,foilstrip@60dosis 113,333.00 Y N

255.KotrimoksazolDOENI(dewasa)kombinasi:Sulfametoksazol400mgTrimetoprim80mg

n/a PT.HoliPharmaDus,10strip@10kaptab

152.00 Y Y Cotrimoxazole 165.00 PTIndofarma

256.KotrimoksazolSuspensikomb:Sulfametoksazol200mg+Trimetoprim40mg/5ml

n/a PT.Novapharin btl@60ml 2,350.00 Y Y Cotrimoxazolesyr 3,960.00 PTKimiaFarma

257. Kuinin(Kina)tablet200mg n/a PT.KimiaFarma ktk60tablet 670.00 Y N258. Kuinininjeksii.v.25%(sebagai2HCl) n/a PT.KimiaFarma ktk100amp@2ml 6,200.00 Y N259. Kuinintablet222mg(H2SO4.7H2O) n/a PT.KimiaFarma ktk10x10tablet 540.00 Y N260. Lamivudinetablet150mg n/a PT.KimiaFarma Botol60tablet 1,400.00 Y N261. Lansoprazolinj30mg/ml ProsoganInj. PT.TakedaIndonesia Serbukvial 82,042.00 Y N

262. Lanzoprazolkapsul/kaplet30mg n/a PT.Indofarma Dus,2strip@10kapsul 473.00 Y YLanzoprazolecaps

30mg1,352.00 PTNovellPharmaceutical

263. Lapatinibtab250mg TykerbPT.SmithKlineBeechamPhamaceuticals

Dus,7Blister@10tablet 67,200.00 Y N

264. LarutanmengandungAsamAmino(AsamAmino10%) KalbaminPT.FinusolprimaFarmaInternasional

botol500ml 56,300.00 Y Y InfusKalbamin 96,800.00 PTKalbeFarma

265.LarutanmengandungAsamAmino(AsamAmino100g,TotalN15,7g,Na+2mEq,Asetat120mEq)

Amiparen PTOtsukaIndonesia Softbag500ML 67,400.00 Y N

266.LarutanmengandungAsamAmino(AsamAmino27g,Sorbitol50g,Cl52mEq)

PanaminG PTOtsukaIndonesia Softbag500ML 37,500.00 Y N

267.LarutanmengandungAsamAmino(AsamAmino30g,Glukosa7,3%danelektrolit)

Aminofluid PTOtsukaIndonesiaDoubleChamberSoftbag1000ML

115,500.00 Y N

268.LarutanmengandungAsamAmino(AsamAmino5%denganBCAA45%,LOrnithineLAspartate8.03gr/L,Sorbitol50gr/L,Xylitol50gr/L)

AminofusinHepar

PTKalbeFarma botol500mL 75,350.00 Y YInfusAminofusin

Hepar195,250.00 PTKalbeFarma

269.LarutanmengandungAsamAmino(AsamAmino6%,mengandungTaurine0,24gr/l)

AminosterilInfant6%

PT.FreseniusKabiCombiphar

BotolGelas100ml 36,667.00 Y N

270.LarutanmengandungAsamAmino(AsamAmino7%,Komposisi:AsamAminoesensial:AsamAminononesensial=60:40)

NephrosterilPT.FreseniusKabiCombiphar


271.LarutanmengandungAsamAmino(AsamAmino72.05g,TotalN11.53g,AAE/AANEratio2.6,Na+2mEq,Asetat46mEq)

Kidmin PTOtsukaIndonesia Softbag200ML 46,000.00 Y N

272.LarutanmengandungAsamAmino(AsamAmino79.9g,TotalN12.2g,Na+14mEq,Cl94mEq)

Aminoleban PTOtsukaIndonesia Softbag500ML 65,000.00 Y N

273. LarutanmengandungAsamAmino(Asamamino8%)AminosterilNHepa



274.LarutanmengandungAsamAmino(AsamAminoesensial7%+Xylitol10g/L)

EasPfrimerPT.FinusolprimaFarmaInternasional

botol250ml 51,260.00 Y Y InfusEAS7%250ml 57,200.00 PTFinusolprimaFarmaInt

275.LarutanmengandungAsamAmino(BCAA25gr/L,LOrnithineLAspartate10gr/L,Xylitol50gr/L,MalicAcid7gr/L,Piridoxin0.12gr/L)

ComafusinHepar

PT.FinusolprimaFarmaInternasional

botol500ml 64,900.00 Y YInfusComafusin

Hepar189,200.00 PTKalbeFarma

276.

LarutanmengandungAsamAmino(KombinasiAsamaminno50g/L,Sorbitol50g/L,Xylitol50g/L,AsamAskorbat(VitC)0.4g/L,Inositol0.5g/L,Nikotinamida(Niasinamida)0.06g/L,PiridoksinHCl(VitB6)0.04g/L,RiboflavinNatriumFosfat2.5mg/L,elektrolit)

AminofusinL600

PTKalbeFarma botol500mL 42,000.00 Y YInfusaminofusin

L60075,350.00 PTKalbeFarma

277.LarutanmengandungAsamAmino(KombinasiAsamamino50g/L,vitamindanelektrolit)

AminofusinPaed

PTKalbeFarma botol250mL 46,000.00 Y N

278.LarutanmengandungAsamAmino(KombinasiAsamAmino:34gr,Glukosa:97gr,Lipid:51grdanElektrolit(Kalori=1000kkal,Aksesperipheral))

Kabiven1440ml


Bag(3Chamber)1440ml

295,240.00 Y N

279.LarutanmengandungAsamAmino(KombinasiAsamAmino:45gr,Glukosa:130gr,Lipid:68grdanElektrolit(Kalori=1400kkal,Aksesperipheral))

Kabiven1920ml


Bag(3Chamber)1920ml

343,842.00 Y N

280.LarutanmengandungAsamAmino(KombinasiGlukosadanelektrolit150gr+AsamAmino48grdgnaksessentral)

CombiflexPlus(790kcal)

PT.Phapros,TbkBagDoublechamber(Duacompartement),1000mL

322,000.00 Y N

281.LarutanmengandungAsamAmino(KombinasiGlukosadanelektrolit80gr+AsamAmino40gr)

Combiflexperi(480kcal)

PT.Phapros,TbkBagDoublechamber(Duacompartement),1000mL

218,700.00 Y N

282. LarutanmengandungElektrolit(KaliumKlorida)OtsuKCl7,46%

PTOtsukaIndonesia Ampoel25ML 2,050.00 Y Y InjKCL7.46 2,400.00 PTOtsukaIndonesia

283. LarutanmengandungElektrolit(LarutanRingerLaktat) WidaRL PT.WidatraBhakti Botol1000ml 8,000.00 Y Y InfusRL(wida) 5,200.00 PTWidatraBhakti

284.LarutanmengandungElektrolit(Na130mEq,Cl109mEq,Ca3mEq,Asetat28mEq)

Asering PTOtsukaIndonesia PlasticBottle500ML 9,000.00 Y Y InfusAsering500cc 15,901.00 PTOtsukaIndonesia

285.LarutanmengandungElektrolit(NaCl1.125gr,Dekstrosa18.75gr)

KAEN1B PTOtsukaIndonesia PlasticBottle500ML 9,000.00 Y N

286.LarutanmengandungElektrolit(SodiumLactatesol(50%)113gr/L,PotassiumChloride0.3gr/L,CalciumChloride0.2gr/L,elektrolit)

Totilac PTKalbeFarma flexybag250mL 87,000.00 Y N

287.

LarutanmengandungElektrolit(Tiap1000mlmengandungelectrolit:Sodium145mmol/l,Potassium4.0mmol/l,Calcium2.5mmol/l,Magnesium1.0mmol/l,Chloride118mmol/l,Acetate24mmol/l,Malate5.0mmol/l)

Ringerfundin500mL

PT.Phapros,TbkLDPE(LowDensityPolyEthilene),botolplastik

12,650.00 Y Y InfusRingerfundin 14,850.00 PTBibraunAesculap

288.LarutanmengandungKarbohidrat(Fructose120g,glucose66g,Xylitol60g/L+elektrolit)

Triofusin1000 PTKalbeFarma botol500mL 50,500.00 Y N

289.LarutanmengandungKarbohidrat(Fructose60g,glucose33g,Xylitol30g/L)

Triofusin500 PTKalbeFarma Flexybag500mL 42,350.00 Y N

290. LarutanmengandungKarbohidrat(Maltose100gr) Martos PTOtsukaIndonesia PlasticBottle500ML 29,167.00 Y Y InfusMartos 74,048.00 PTOtsukaIndonesia

291.

LarutanmengandungKarbohidrat+Elektrolit(25.00gmaltose,3.00gsodiumchloride,0.15gpotassiumchloride,0.10gcalciumchloridedihydratedan1.55gsodiumlactate)

Potacolinj PTOtsukaIndonesia PlasticBottle500ML 55,500.00 Y N

292.LarutanmengandungKarbohidrat+Elektrolit(Acetate,Na,K,Cl,Ca,Mg,Sorbitol50gr/L)

TutofusinOPS PTKalbeFarma botol500mL 37,500.00 Y Y InfusTutofusinOPS 51,700.00 PTFinusolprimaFarmaInt

293.LarutanmengandungKarbohidrat+Elektrolit(Asamamino28gr/L,Glukosa100gr/L,elektrolit)

ClinimixN9G20E

PTKalbeFarma BotolPlastik1000mL 210,000.00 Y N

294.LarutanmengandungKarbohidrat+Elektrolit(Asamamino28gr/L,Glukosa75gr/L,elektrolit)

ClinimixN9G15E

PTKalbeFarma BotolPlastik1000mL 199,000.00 Y N

295.LarutanmengandungKarbohidrat+Elektrolit(Fructose60g,glucose33g,Xylitol30g/L)

TriofusinE1000

PTKalbeFarma botol500mL 56,000.00 Y N

296.LarutanmengandungKarbohidrat+Elektrolit(Glukosa25g,NaCl2,0g,KCl1,3g,NatriumLaktat3,1g,airuntukinjeksiad1000ml)

WidaHSD PT.WidatraBhakti Botol500ml 9,500.00 Y N

297.LarutanmengandungKarbohidrat+Elektrolit(Glukosa55g;NatriumChloride9g,airuntukinjeksiad1000ml)

WidaD5NS PT.WidatraBhakti Botol500ml 6,800.00 Y Y InfusD5NS 10,340.00 PTWidatraBhakti

298.LarutanmengandungKarbohidrat+Elektrolit(Glukosa:25,0g;NaCl:4,5g)

WIDA2A PT.WidatraBhakti Botol500ml 6,917.00 Y N

299.LarutanmengandungKarbohidrat+Elektrolit(Glukosa:55.0g;NaCl:2.25g)

WIDAD51/4NS

PT.WidatraBhakti Botol500ml 7,700.00 Y Y InfusD51/4 7,560.00 PTWidatraBhakti

300.LarutanmengandungKarbohidrat+Elektrolit(Glukosa:55.0g;NaCl:4.5g)

WIDAD51/2NS

PT.WidatraBhakti Botol500ml 7,700.00 Y Y InfusD51/2 10,340.00 PTWidatraBhakti

301.LarutanmengandungKarbohidrat+Elektrolit(LarutannutrisikombinasiinfusperL:Na.100mEQ,K18mEQ,Ca.4mEQ,Mg6mEQ,Cl90mEQ,Asetat38mEQ,Sorbitol50g)

Futrolit PT.SanbeFarma softbag500ml 35,750.00 Y Y InfusFutrolit 52,729.00 PTSanbeFarma

302.LarutanmengandungKarbohidrat+Elektrolit(LarutanRinger&Glukosa5%)

WidaRD PT.WidatraBhakti Botol500ml 6,930.00 Y N

303.LarutanmengandungKarbohidrat+Elektrolit(NaCl1.75g,KCL1.5g,Glukosa100gr)

KAENMG3 PTOtsukaIndonesia PlasticBottle500ML 9,167.00 Y N

304.LarutanmengandungKarbohidrat+Elektrolit(Nacl1.75gr,KCl1.5gr,NaLactat2.24gr,Dekstrosa27gr)

KAEN3B PTOtsukaIndonesia PlasticBottle500ML 10,000.00 Y Y InfusKAEN3B 15,661.00 PTOtsukaIndonesia

305.LarutanmengandungKarbohidrat+Elektrolit(Nacl2.34gr,NaLaktat2.24gr,KCL0.75grDekstrosa27gr)

KAEN3A PTOtsukaIndonesia PlasticBottle500ML 10,000.00 Y Y InfusKAEN3A 15,661.00 PTOtsukaIndonesia

306.LarutanmengandungLipid(InfusLipidEmulsiMCT/LCT20%100ml)

LipofundinMCT/LCT1%100

PT.Phapros,Tbk20%,BotolKaca@100ml,singlebottle

105,500.00 Y N

307. LarutanmengandungLipid(Emulsilemak20%) IntralipidPT.FreseniusKabiCombiphar


308.LarutanmengandungLipid(InfusLipidEmulsiMCT/LCT20%250ml)

LipofundinMCT/LCT1%250

PT.Phapros,Tbk20%,BotolKaca@250ml,singlebottle

210,000.00 Y N

309.LarutanmengandungLipid(KombinasiGlukosadanelektrolit180gr+AsamAmino71.8gr+Lipid50grdgnaksessentral)

NutriflexLipidSpecial1250

PT.Phapros,TbkBag,3chamber(3kompartemen),1250ml

591,000.00 Y N

310.LarutanmengandungLipid(KombinasiGlukosadanelektrolit80gr+AsamAmino40gr+LipidMCT/LCT50gr)

NutriflexLipidPeri1250


511,000.00 Y N

311.LarutanmengandungLipid(KombinasiGlukosadanelektrolit90gr+AsamAmino35.9gr+Lipid25grdgnaksessentral)

NutriflexLipidSpecial625


358,000.00 Y N

312.LarutanmengandungLipid(SoybeanOil200g/L,EggLecithins12gr/L,GlycerolPh25gr/L,SodiumOleate0.3gr/L)

Ivelip PTKalbeFarma Flexybag100mL 89,800.00 Y N

313. Latanoprosttetesmata0,01% CendoGlaopen PT.CendoIndustriFarmasi strip5x0.6ml 72,000.00 Y N

314. Leuprorelinasetatinjdepot1,88mg Tapros1.88mg PT.TakedaIndonesia Vial 700,000.00 N N

315. Leuprorelinasetatinjdepot11,25mg Tapros3M PT.TakedaIndonesia Vial 2,700,000.00 N N

316. Levofloksasininf5mg/mL n/a PT.InfionPharmaceutical Box,1Botol@100ml 40,000.00 Y YInfusLevofloxaxin

500mg90,750.00 Encefall

317. Levofloksasintablet500mg n/aPT.PromedrahardjoFarmasiIndustri

STRIP 528.00 Y YLevofloxaxintab500

mg1,154.00 PTNovellPharmaceutical

318. Lidokaininjeksi2%(HCL) n/a PT.Bernofarm Dus,100ampul@2ml 839.00 Y Y InjLidocain2% 1,010.00 PTPhapros319. Lidokaininjeksi2%(HCl)+Epinefrin1:80.0002ml n/a PT.Indofarma Dus,30ampul@2ml 1,363.00 Y Y InjPehacain 3,113.00 PTPhapros

320. Lidokainjeli2%XylocaineJelly2%

PT.AstraZenecaindonesia Dus,10syringe@10g 40,000.00 Y N

321. Lisinopriltablet10mg n/aPT.NovellPharmaeuticalLaboratories

Box,3Strip@10tablet 600.00 Y Y Lisinopriltab10mg 605 PTNovellPharmaceutical

322. Lisinopriltablet5mg n/aPT.NovellPharmaeuticalLaboratories

Box,3Strip@10tablet 350.00 Y Y Lisinopriltab5mg 352.00 PTNovellPharmaceutical

323. Litiumkarbonattablet200mg Frimania200PT.MersifarmaTirmakuMercusana


324. Litiumkarbonattablet400mg Frimania400PT.MersifarmaTirmakuMercusana


325. Loperamidtablet2mg n/aPT.IfarsPharmaceuticalLaboratories

Dus,10Strip@10Tablet 89.00 Y Y Lopamidtab 242.00 PTHarsen

326. Loratadintablet10mg n/aPT.PromedrahardjoFarmasiIndustri

STRIP 154.00 Y Y Loratadintab10mg 333.00 PTIndofarma

327. Lorazepamtablet2mg Merlopam2PT.MersifarmaTirmakuMercusana

KOTAK@10x10TAB 1,341.00 Y Y merlopamtab2mg 2,860.00 PTMersifarmaTirmaku

328. MaprotilinHCltab25mg Ludios PT.SohoIndustriPharmasi Strip 1,200.00 Y N

329. MaprotilinHCltab50mg Sandepril50PT.MersifarmaTirmakuMercusana


330. Melfalantablet2mg AlkeranPT.GlaxoWellcomeIndonesia

Box,Tablet2mg/25's 12,210.00 N Y Alkerantab2mg 13,200.00 AAM

331. Meropeneminj1g n/a PT.Bernofarm Dus,1vial@1g 54,000.00 Y Y InjMeropenem1g 220,000.00 AAM

332. Mesnainj100mg/mLUromitexaninjeksi.

PT.MugiLaboratories Dus,15Ampul 74,998.00 N N

333. Metadonsir50mg/5ml n/a PT.KimiaFarma Botol1000ml 254,100.00 N N

334. MetilfenidatkapsulLA20mg RitalinLA PT.NovartisIndonesiaDus,botolplastik@30kapsulpelepasanlambat

6,537.00 Y N

335. Metilprednisolontablet16mg n/a PT.MahakamBetaFarma Strip 635.00 Y YMethylprednisolon

16mg1,035.00 PTIndofarma

336. Metilprednisolontablet4mg n/aPT.NaturaLaboratoriaPrima

Dus,10Blister@10Tablet

205.00 Y YMethylprednisolon


337. Metilprednisolontablet8mg n/a PT.DexaMedicaDus,10Blister@10tablet

300.00 Y YMethylprednisolon


338. Metoklopramidetablet5mg n/a PT.KimiaFarma ktk10x10tablet 108.00 Y YMetochlorpramid

tab10mg110.00 PTKimiaFarma

339. Metronidazolinfus500mg/100ml n/aPT.NaturaLaboratoriaPrima

Dus,1Botol@100ml 9,950.00 Y Y InfusMetronidazole 23,100.00 PTIkapharmindoPutramas

340. Metronidazolsupositoria500mg Flagyl PT.AventisPharmaDus,2blister@5suppositoria

3,220.00 Y Y Neogynoxasupp 13,200.00 PTDurafarmaJaya

341. Metronidazoltablet250mg n/aPT.PhytoKemoAgungFarma

10strip@10tab 110.00 Y N

342. Metronidazoltablet500mg n/aPT.PhytoKemoAgungFarma

10strip@10tab 160.00 Y YMetronidazoletab

500mg220.00 PTBernofarmaGen

343. MIBI(metoxyisobutylisonitril)5mLreactionvialCardioscanKaeF

PT.KimiaFarma Dus@5vial 1,237,500.00 N N

344. Midazolaminjeksii.v.1mg/ml Fortanest PTKalbeFarma Boxisi5ampul 5,600.00 Y Y InjSedacum 19,250.00 PTDexaMedica345. Midazolaminjeksii.v.5mg/ml Dormicum PT.BoehringerIngelheim Boks5amp 12,060.00 Y Y InjSedacum 46,200.00 PTDexaMedica346. MikafunginNaserbinj50mg Mycamine PT.Combiphar Dus,1vial@50mg 260,000.00 N N347. Mikonazolkrim/salep2%(Nitrat) n/a PT.KimiaFarma Tube10gram 3,000.00 Y Y Miconazolecr 3,000.00 PTKimiaFarma348. MitomisinC(crystallin)serbukinj10mg/vial MitomycinC PT.WidatraBhakti 10mg/Vial 697,000.00 N N

349. Moksifloksasintetesmata0,5% Vigamox PT.TempoScanPacific botol,tetesmata3ml 77,000.00 Y Y Vigamox 122,100.00 PTTempo

350. Mometasonfuroatkrim0,1% n/a PT.GuardianPharmatama tube10gram 17,820.00 Y YMometasonefuroat

0,1%14,108.00 PTGuardianPharmatama

351. MorfinHCLinj10mg/ml n/a PT.KimiaFarma Dus10amp@1ml 8,400.00 Y Y InjMorfin 10,500.00 PTKimiaFarma

352. MorfinHCLtabletSR10mgMSTContinus10mg

PT.MahakamBetaFarma Dus,6strip@10tablet 15,620.00 N Y MSTCont10mg 15,620.00 PTKimiaFarma

353. MorfinHCLtabletSR15mgMSTContinus15mg

PT.MahakamBetaFarma Dus,6strip@10tablet 22,990.00 N N

354. Morfininjeksii.m./s.k./i.v.10mg/ml n/a PT.KimiaFarma Ktk10ampul@1ML 10,499.00 N N355. Morfintablet10mg n/a PT.KimiaFarma Botol30tablet 1,300.00 N N356. Nacl0,9% n/a PT.WidatraBhakti Botol500ml 4,700.00 Y Y InfusNacl0,9% 8,690.00 PTBibraunAesculap

357. Nadroparininj9500Axa/mLsyringe0,3mLFraxiparine0.3ml


Dus,[email protected]

54,144.00 Y N

358. Nadroparininj9500Axa/mL,syringe0,4mLFraxiparine0.4ml



66,640.00 Y YInjFraxiparine0,4

ml84,000.00 PTGlaxoWellcomeIndonesia

359. Nadroparininj9500Axa/mL,syringe0,6mLFraxiparine0.6ml



94,962.00 Y N

360. Naloksoninjeksi0,4mg/ml Nokoba PT.PratapaNirmala Dus,5Ampul@2ml 61,600.00 Y Y InjNokoba 93,625.00PTFarrenheitpratapaNirmala

361. NatriumBikarbonatinjeksii.v8,4% Meylon PTOtsukaIndonesia Ampoel25ML 6,200.00 Y Y InjMeylon 6,200.00 PTOtsukaIndonesia

362. NatriumDiklofenaktablet50mg n/aPT.NovellPharmaeuticalLaboratories

Box,5Blister@10tablet 200.00 Y YNatriumDiklofenac

tab50mg218.00 PTNovellPharmaceutical

363. NatriumDiklofenaktablet25mg n/a PT.Phapros,Tbk Dus@5X10's 133.00 Y N

364. Natriumfosfatlaroral45mLFleetPhosphosoda

PT.Combiphar Botol,45ml 33,900.00 Y Y Fleetenema 99,220.00 PTCombipharFarma

365. Natriumfusidatsalep20mg/gFucilexOintment

PT.MolexAyus Tube5gr 6,490.00 Y N

366. Nevirapintablet200mg n/a PT.KimiaFarma btl60tablet 2,800.00 Y N

367. Nifedipintab20mg,slowrelease;orosAdalatOros20mg

PT.BayerIndonesia blister 2,999.00 Y N

368. Nifedipintab30mg,orosAdalatOros30mg

PT.BayerIndonesia blister 3,500.00 Y N

369. Nifedipintablet/kapsul10mg n/a PT.DexaMedicaDus,10Strip@10tabletsalutselaput

100.00 Y Y Nifedipintab10mg 129.00 PTDexaMedica

370. Nistatintabletsalut500.000IU/g n/a PT.Phapros,Tbk Dus@10X10's 640.00 Y N371. Noretisterontablet5mg PrimolutN PT.BayerIndonesia blister 2,618.00 Y Y PrimolutN 4,554.00 PTBayerIndonesia372. ObatAntituberkulosisFDCKategori1 n/a PT.Phapros,Tbk Paket 359,900.00 Y Y373. ObatAntituberkulosisFDCKategori2 n/a PT.KimiaFarma Paket 1,199,990.00 Y Y374. ObatAntituberkulosisFDCKategoriAnak n/a PT.KimiaFarma Paket 214,990.00 Y N375. ObatAntituberkulosisFDCSisipan n/a PT.Indofarma Dus,3blister@28kss 160,000.00 Y N

376. ObatAntituberkulosisKategori1dewasa n/a PT.Indofarma

Dus,1dus@60blister@8tablettahapintensifkategori1+1Dus@54blister@3tablettahaplanjutankategori1

288,199.00 Y Y

377. ObatAntituberkulosisKategorianak n/a PT.Indofarma

Dus,60sachettahapintensif@(1tabletIsoniazid,2kapsulRifampicin,2tabletPyrazinamide)+120sachettahaplanjutan@(1tabletIsoniazid,2kapsulRifampicin)

171,195.00 Y N

378. Ofloxacintablet200mg n/aPT.NovellPharmaeuticalLaboratories

Box,5Strip@10tablet 400.00 Y N

379. Ofloxacintablet400mg n/aPT.NovellPharmaeuticalLaboratories

Box,5Strip@10tablet 650.00 Y YOfloxaxintab400

mg873.00 PTDexaMedica

380. Oksimetazolinteteshidung0,025% IlaidinDrops PT.MerckTbk botol@10ml 27,550.00 Y N

381. Oktreotid10mgSandostatinLAR

PT.NovartisIndonesia

Dus,vial@355m+1prefilledsyringepelarut@2,5ml+2jarumsuntik

2,950,000.00 N N

382. Olanzapininj10mg/vial ZyprexaIM PT.BayerIndonesia Vial 120,000.00 Y N383. Olanzapinkaplsalut5mg Olandoz5 PT.SandozIndonesia 3X10fcc 6,450.00 Y N384. Olanzapintab10mg Olandoz10 PT.SandozIndonesia 3X10fcc 11,200.00 Y N

385. Omeprazolinjeksi40mg/10ml n/aPT.NaturaLaboratoriaPrima

Dus,1Vial@40mg 36,000.00 Y Y InjOmeprazole 74,800.00 PTOttoPharmaIndonesia

386. Omeprazolkapsul/kaplet20mg n/a PT.Novapharin strip 211.00 Y Y Omperazolecaps 408.00 PTHexapharm387. ondansetroninj4mg/2mL n/a PT.Indofarma Dus,5Ampul@2ml 2,400.00 Y Y InjOndasentron 3,550.00 PTIndofarma

388. Ondansetrontab4mg n/a PT.YarindoFarmatama Box3X10Tab 716.00 Y YOndansentrontab4


389. Ondansetrontablet8mg n/a PT.YarindoFarmatama Box3X10Tab 1,189.00 Y N

390.PaketCAPDAwal(Komposisi:1unitTransferSet,2unitUltaclam,1unitTenckoffCatheter,TitaniumAdaptor)

n/a PTKalbeFarma

TransferSet:Set;Ultaclam:KantongPlastik;TenckoffCatheter:Box;TitaniumAdaptor:KantongPlastik

1,902,240.00 N N

391. PaketCAPDPergantianTransferSetper6bulan n/a PTKalbeFarma Set 219,540.00 N N

392.PaketCAPDRutin120(4xganticairanperharidengankomposisiLarutanDialisa1.5%,LarutanDialisa2.5%,LarutanDialisa4.25%,Minicap)

LarutanDialisa1.5%:DianealLowCalciumwith1,5%Dextrose;LarutanDialisa2.5%:DianealLowCalciumwith2,5%Dextrose;LarutanDialisa4.25%:DianealLowCalciumwith4.25%Dextrose

PTKalbeFarma

LarutanDialisa1.5%:2.000ml;LarutanDialisa2.5%:2.000ml;LarutanDialisa4.25%:2.000ml;Minicap:KantongPlastik

5,522,580.00 N N

393. Parasetamoldrop100mg/mlbtl@15ml(60mg/0,6ml) n/a PT.Indofarma Dus,15botol 5,200.00 Y Y SANMOLDROP 14,383.00 PTSanbeFarma

394. Parasetamolsirup120mg/5ml n/a PT.Afifarma botol60ml 1,438.00 Y Y sanmolsyr 10912 PTSanbeFarma

395. Parasetamoltablet500mg n/aPT.ImfarmindFarmasiindustri

Dus,10strip@10kaptab

89.00 Y Y SANMOLTAB 264 PTSanbeFarma

396. Pegylatedinterferonalfa2ainj135mcg/0,5ml Pegasys PT.BoehringerIngelheim Boks,1pfs 1,077,815.00 N N397. Pegylatedinterferonalfa2ainj180mcg/0,5ml Pegasys PT.BoehringerIngelheim Boks,1pfs 1,248,220.00 N N

398. Permetrinkrim5%ScabimiteCream10

PT.GaleniumPharmasiaLaboratories

Tube@10g 11,475.00 Y N

399. Petidininjeksii.m/s.k/i.vlambat50mg/ml(HCl) n/a PT.KimiaFarma Ktk10ampx2ml 14,500.00 Y Y INJPETHIDIN 13,191 PTKimiaFarma

400. Pioglitazontab15mgDECULIN15MG

PT.DexaMedica 30TAB/BOX 3,120.00 Y N

401. Pioglitazontab30mgDECULIN30MG

PT.DexaMedica 30TAB/BOX 4,525.00 Y N

402. Pirantelsuspensi125mg/5ml n/a PT.HoliPharma Botol60ml 8,360.00 Y N

403. Piranteltabletscore(base)125mg n/a PT.HoliPharma Dus,25Blister@4tablet 298.00 Y Y PYRANTEL125MG 319 PTKimiaFarma

404. Pirazinamidtablet500mg n/a PT.HoliPharma Dus10strip@10tablet 208.00 Y YPYRAZINAMIDE

500MG234 INDOFARMA

405. Polikresulencairan Aptil PT.PratapaNirmala Dus,Botol@10ml 17,393.00 Y Y ALBOTHYL10ML 28600 PTPhapros

406. PovidonIodidalarutan10%1000ml n/a PT.Afifarma botol@1000ml 37,109.00 Y Y POVIDONEIODINE 56.925 ONEMED

407. PovidonIodidalarutan10%30ml n/a PT.Afifarma botol@30ml 2,163.00 Y Y POVIDONIODINE 2,750 ONEMED408. PovidonIodidalarutan10%300ml n/a PT.Afifarma botol@300ml 14,203.00 Y N

409. PramipeksoltabER0,375mgSifrolER0,375mg

PT.BoehringerIngelheimDus,3alublister@10tablet

7,200.00 Y N

410. PramipeksoltabER0,750mgSifrolER0,750mg

PT.BoehringerIngelheimDus,3alublister@10tablet

11,268.00 Y N

411. Pravastatintablet20mg n/aPT.NovellPharmaeuticalLaboratories

Box,5Strip@10tablet 2,300.00 Y YPRAVASTATIN

20MG2446 PTNovellPharmaceutical

412. Propanololtablet10mg(HCl) n/a PT.DexaMedica Dus,10Strip@10tablet 65.00 Y Y PROPANOLOL 76 PTDexaMedica

413. Propranololtablet40mg(HCl) n/a PT.HoliPharma Dus,10strip@10tablet 107.00 Y Y PROPANOLOL40 121 PTDexaMedica

414. Quetiapintab200mgSeroquelXR200mg

PT.AstraZenecaindonesia Dus,1blister@10tablet 17,391.00 Y N





417. Ramipriltablet5mg n/a PT.DexaMedicaDus,10Strip@10kaptab

580.00 Y N

418. Ranitidininjeksi25mg/2ml n/aPT.NaturaLaboratoriaPrima

Dus,10Ampul@2ml 1,140.00 Y YINJRANITIDINE

25MG/ML1711 PTPhapros

419. Ranitidintablet150mg n/a PT.DexaMedicaDus,10Strip@10tabletsalutselaput

120.00 Y YRANITIDINETAB

150MG275 PTHexapharm

420. Retinol(VitaminA)100.000IU n/a PT.KimiaFarma Botol50kapsullunak 260.00 Y N421. RingerLaktatlarutaninfus n/a PT.WidatraBhakti botol500ml 5,200.00 Y Y InfusRL(wida) 5200 PTWidatraBhakti

422. Risperidontablet1mg n/a PT.DexaMedica Dus,5Blister@10tablet 1,200.00 Y N

423. Risperidontablet2mg n/aPT.MersifarmaTirmakuMercusana

KOTAK@5x10TAB 1,008.00 Y Y RISPERIDONE2MG 3454 PTDexaMedica

424. Risperidontablet3mg n/a PT.DexaMedica Dus,5Blister@10tablet 2,000.00 Y N

425. Rivaroksabantab10mg Xarelto10mg PT.BayerIndonesia Blister 23,500.00 Y N426. Rivaroksabantab15mg Xarelto15mg PT.BayerIndonesia Blister 23,500.00 Y N427. Rivaroksabantab20mg Xarelto20mg PT.BayerIndonesia Blister 23,500.00 Y N

428. RopinirolTabletSalut2mgRequipPD24Hour2mg


Dus,7blister@4TabletlepasLambat

5,248.00 Y N




6,275.00 Y N




7,383.00 Y N

431. Salbutamolinhalasi/aerosol100mcg/dosisVentolinInhaler


Dus,botol200dosis 63,750.00 Y N

432. Salbutamolserbinh200mcg/kapsVentolinRotacaps


Dus,10Blister@10Kapsul

431.00 Y N

433. Salbutamolserbinh200mcg/kaps+rotahalerVentolinRotahaler


Dus,1Rotahaler 5,867.00 Y N

434. Sefadroksilsirupkering125mg/5ml n/a PT.HoliPharma Dus,Botol60ml 4,896.00 Y Y CEFADROXILSYR 8192 PTIndofarma

435. Sefadroksilkapsul/kaplet250mg n/aPT.HexpharmJayaLaboratories

Dus,5strip@10kapsul 513.00 Y N

436. Sefadroksilkapsul/kaplet500mg n/a PT.Bernofarm Dus,10strip@10kapsul 509.00 Y YCEFADROXILCAPS

500840 PTHexapharm

437. Sefadroksilsirkering250mg/5mL n/a PT.HoliPharma Dus,Botol60ml 5,940.00 Y YCEFADROXILSYR

FORTE16500 PTNovellPharmaceutical

438. Sefaleksinkapsul/kaplet500mg n/aPT.IfarsPharmaceuticalLaboratories

Dus,5Strip@10Kapsul 1,000.00 Y N

439. Sefepiminj1g n/aPT.NovellPharmaeuticalLaboratories

vial 43,000.00 Y Y InjDaryacef 181,500.00 PTDaryaVaria

440. Sefiksimkapsul/kaplet100mg n/a PT.DexaMedica Dus,5Strip@10kapsul 850.00 Y YCefiximecaps100


441. Sefiksimsirupkering100mg/5ml n/aPT.IfarsPharmaceuticalLaboratories

Dus,Botol30ml 8,800.00 Y Y Cefixiemesyr 30,250.00 PTHexapharm

442. Sefotaksiminjeksi0,5g n/aPT.HexpharmJayaLaboratories

Dus,2vial@500mg 4,997.00 Y N

443. Sefotaksiminjeksi1g n/aPT.NaturaLaboratoriaPrima

Dus,10Vial@1g 2,950.00 Y Y InjCefotaxime1g 6,050.00 PTHexapharm

444. Sefpodoksimproksetiltab100mg Banadoz100 PT.SandozIndonesia Dus,3blister@10tablet 3,700.00 Y N

445. Seftazidiminjeksi1g n/aPT.HexpharmJayaLaboratories

Dus,2vial@1g 17,060.00 Y Y InjCeftazidime1g 33,858.00 PTHexapharm

446. Seftriaksonserbukinjeksi1g/vial n/aPT.NaturaLaboratoriaPrima

Dus,10Vial@1g 3,300.00 Y Y InjCeftriaxon1g 8,594.00 PTPhapros

447. Sefuroksimtab500mg Zinnat500PT.GlaxoWellcomeIndonesia

Dus,1Blister@10Tabletsalutselaput

7,200.00 Y Y InjOxtercid 71,500.00 PTInterbat

448. Setirizintablet10mg n/a PT.PertiwiAgungBox,10strips@10capsules

181.00 Y Y Cetirizinetab10mg 314.00 PTIndofarma

449. Sianokobalamin(vitaminB12)injeksi500mcg n/a PT.LucasDjaja 100ampul@1ml 1,077.00 Y N

450. Siklofosfamidserbukinjeksii.v.200mgCyclovid200mg

PT.NovellPharmaeuticalLaboratories

vial 82,000.00 N N

451. Siklosporinkaps100mgSandimmunNeoral100mgKap

PT.NovartisIndonesiaDus,10blister@5kapsullunak

43,000.00 N N

452. Siklosporinkapsullunak25mgSandimmunNeoral25mgKap

PT.NovartisIndonesiaDus,10blister@5kapsullunak

12,000.00 N N

453. Simvastatinscoredtablet10mg n/aPT.NaturaLaboratoriaPrima


169.00 Y YSimvastatintab10


454. Simvastatintablet20mg n/aPT.NaturaLaboratoriaPrima


391.00 Y YAtorvastatintab20

mg4,400.00 PTYarindoFarmatama

455. Siprofloksasininfus2% n/a PT.DexaMedica Vial200ml 13,000.00 Y Y InfusCiprofloxaxin 57,000.00 PTHexapharm

456. Siprofloksasintablet500mg(sebagaiHCl) n/a PT.BernofarmDus,10blister@10tabss

255.00 Y YCiprofloxaxintab

500mg363.00 PTHexapharm

457. Spiramisintablet500mg n/a PT.Indofarma Dus,5strip@10tablet 1,499.00 Y YSpiramycintab500


458. Spironolaktontablet100mg n/a PT.DexaMedica Dus,10Strip@10tablet 900.00 Y YSpironolactontab

100mg1,140.00 PTOttoPharmaIndonesia

459. Spironolaktontablet25mg n/a PT.DexaMedica Dus,10Strip@10tablet 315.00 Y YSpironolactontab25


460. Streptokinaseinjeksi1,5jutaUI/vial Streptase PT.DexaMedica Vial 3,290,000.00 N N

461. Sufentanilinjeksiiv,epidural5mcg/ml

SufentanylInjeksiiv.Epidural5mcg/ml

PT.KimiaFarma dus5amp@dus10 127,000.00 Y N

462. Takrolimuskaps0.5mg Prograf PT.CombipharPounch@5blister@10capsule

11,167.00 N N

463. Takrolimuskaps1mg Prograf PT.CombipharDus,1pouch@5blister@10kaps

21,500.00 N N

464. Tamsulosintab0,2mg HarnalD PT.CombipharBox@2blister@14tablet

5,800.00 N N

465. Tamsulosintab0,2mgHarnalD0.2mgDisp.Tablet

PT.CombipharBox/2blister@14tablet

5,800.00 N N

466. TamsulosintabSR0,4mgHarnalOCAS0.4mgTablet

PT.CombipharBox/3blister@10Tablet

6,800.00 N N

467. Telbivudintab600mgSebivo600mgTab


468. Terbutalincairanih2,5mg/mLBricasmaRespules

PT.AstraZenecaindonesia Dus,2pak@5respules 6,250.00 Y Y InjNairet 16,302.00 PTOttoPharmaIndonesia

469. Terbutalintablet2,5mgMolasmaTablet

PT.MolexAyus Box50's 99.00 Y Y Nairettab 880.00 PTOttoPharmaIndonesia

470. Terbutalinturbu(serbukih)0,50mgBricasmaTurbuhaler0,5mg


71,100.00 Y

471. TetrakainHCltetesmata0,5% Pantocain0.5% PT.CendoIndustriFarmasi botol5ml 11,500.00 Y YCendopantocain0,5

%13,338.00 PTCendoPharmaceutical

472. Tetrasiklinkapsul/kaplet250mg n/a PT.HoliPharma Dus,10strip@10kapsul 149.00 Y N Suprabiotic 501.00

473. Tiamazoltab10mg Thyrozol10 PT.MerckTbkDus,10blister@10tablet

1,135.00 N Y Thyrozoltab10mg 1,823.00

474. Tiamazoltab5mg Thyrozol5 PT.MerckTbkDus,10blister@10tablet

563.00 N N

475. Timololtetesmata0,25%IsoticAdretor0,25%

PT.PratapaNirmala Dus,BotolPlastik@5ml 9,128.00 Y YCendotimolo0,25%

TM33,550.00 PTCendoPharmaceutical

476. Timololtetesmata0,5%IsoticAdretor0,5%

PT.PratapaNirmala Dus,BotolPlastik@5ml 9,722.00 Y YCendotimolol),5%

TM52,525.00 PTCendoPharmaceutical

477. Tiotropiumkaps18mcg+handihallerSpiriva10s+Handihaler

PT.BoehringerIngelheimDus,1blister@10kapsul+handihaler

152,543.00 Y N

478. Tramadolinjeksi50mg/ml n/aPT.NaturaLaboratoriaPrima

Dus,10Ampul@2ml 2,395.00 Y Y InjTramadol50mg 6,395.00 PTIndofarma

479. Travoprosttetesmata0,004% Travatan PT.TempoScanPacific botol,tetesmata2,5ml 115,000.00 Y N

480. Triamsinolonasetonidnasalspray55mcg/puff NasacortAQ PT.AventisPharmaDus,botolplastik120dosis

90,000.00 Y Y NasacortAQ 189,420.00 PTSanofiAventis

481. Trifluoperazintablet5mg n/a PT.DaryaVaria strip 405.00 Y N

482. Ureakrim10% SoftUDermPT.GaleniumPharmasiaLaboratories

tube 6,400.00 Y N

483. Vaksinpolioinj(VaksinPoliomyelitisyangdiinaktifkan) ImovaxPolio PT.AventisPharma 1vialof10ml(10d's) 285,000.00 Y N

484. ValproattabSR250mgDepakoteER250mg

PT.AbbottIndonesia Tablet 2,793.00 Y Y DepakoteER250mg 2,793.00 PTAbbotIndonesia

485. ValproattabSR500mgDepakoteER500mg

PT.AbbottIndonesia Tablet 5,450.00 Y Y DepakoteER500mg 6.916 PTAbbotIndonesia

486. Valsartantab80mgDiovan80mgTab

PT.NovartisIndonesia Dus,2blister@14tablet 3,900.00 Y N

487. Valsartantab160mgDIOVAN160MG

PT.NovartisIndonesia Dus,2blister@14tablet 6,500.00 Y N

488. Verapamiltab240mg Isoptin240mg PT.AbbottIndonesia Tablet 6,200.00 Y N

489. Verapamiltablet80mg(HCl) n/a PT.KimiaFarma Ktk10X10TAB 234.00 Y N490. Vinblastinserbukinjeksi10mg Vinblastine PT.Combiphar Vial10mg/10ml 210,000.00 N N

491. Vinorelbininj.10mg/mlNavelbineinjeksi10

PT.MugiLaboratories Dus,1vial@1ml 1,229,998.00 N N

492. VitaminBKomplekstablet n/a PT.KimiaFarma Dus10stripx10tab 107.00 Y Y VitBcompleks 22 PTKimiaFarma493. Zidovudin300mg+Lamivudine150mg n/a PT.KimiaFarma Botol60tablet 3,429.00 Y N

494. Zincdrop10mg/mL ZincproDrops PT.CombipharDrops10mg/ml,Botol@15ml

12,840.00 Y N

495. Zincsir20mg/5MlZircumKidSirup

PT.Meprofarm Dus,botol60ml 7,400.00 Y Y Zincprosyr60ml 29,040.00 PTCombipharFarma

496. Zinctabletdispersible20mg n/a PT.KimiaFarma ktk10x10tablet 473.00 Y Y Zinctabgenerik 475.00 PTKimiaFarma

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