Ekatalog 2014

No.
Nama Obat Generik Nama Dagang
1 ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida n/a

tablet 200 mg)
2 Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera
3 Albendazol suspensi 200 mg/5 ml n/a
4 Albendazol tablet/kapsul/kaplet 400 mg n/a

5 Alopurinol tablet/kapsul/kaplet 100 mg n/a
6 Alprazolam tablet/kapsul/kaplet 0,25 mg n/a
8 Alprazolam tablet/kapsul/kaplet 1 mg n/a
9 Alteplase injeksi 50 mg/vial Actilyse
10 Amfoterisin B salep mata 1% Fungicide

11 Amikasin injeksi 250 mg/ml Glybotic 250 mg /ml
12 Aminofilin injeksi 24 mg/ml n/a
13 Aminofilin tablet scored 200 mg n/a
14 Amiodaron injeksi 150 mg/3 ml Cordarone

15 Amiodaron tablet/kaplet 200 mg Kendaron Tablet
16 Amitriptilin tablet salut 25 mg (HCl) n/a
17 Amlodipin tablet 10 mg n/a
19 Amoksisilin kapsul/kaplet 250 mg n/a
20 Amoksisilin kapsul/kaplet/tablet scored 500 mg n/a
21 Amoksisilin sirup kering forte 250 mg/5 ml n/a
22 Amoksisilin sirup kering 125 mg/ 5 ml n/a
23 Analog insulin long acting inj 100 UI/ml, vial/cartridge Lantus Solostar
disposible/penfill cartridge (Insulin glargine 100 IU/ml) 100IU/ml 5pens x3ml
Analog insulin mix acting inj 100 UI/ml, Analog insulin mix
24 acting inj 100 UI/ml (Premix 30% Insulin Aspart + 70% Novomix Flexpen
Protaminated Insulin Aspart (Analogue))
Analog insulin mix insulininj 100 UI/ml, vial/cartridge

25 disposible/penfill cartridge (25% insulin lispro, 75% insulin Humalog Mix 25
lispro protamine suspension, (rDNA))
26 Analog insulin rapid acting inj 100 UI/ml, vial/cartridge Novorapid Flexpen
disposible/penfill cartridge (Insulin Aspart (Analogue))
27 Analog insulin rapid acting inj 100 UI/ml, vial/cartridge Novorapid Vial
28 Analog insulin rapid actinginj 100 UI/ml, vial/cartridge Apidra Solostar

disposible/penfill cartridge (Insulin glulisine 100 IU/ml) 100IU/ml 5pens x3ml
29 Analog insulin rapid actinginj 100 UI/ml, vial/cartridge Humalog

disposible/penfill cartridge (Insulin lispro (rDNA origin))
30 Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg
31 Antasida DOEN I tablet kunyah, kombinasi : Aluminium n/a

Hidroksida 200 mg Magnesium Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium

32 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 mg/5 n/a
ml
33 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g n/a

Polimiksin 10.000 IU/g
34 Antimalaria DOEN kombinasi : Pirimetamin 25 mg n/a

Sulfadoksin 500 mg
35 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg n/a
36 Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg Levopar Tablet

Levodopa 100 mg
37 Artemether injeksi 80 mg/ml Artem
38 Asam Askorbat (Vitamin C) tablet 50 mg n/a
39 Asam Folat tablet/kapsul/kaplet 1 mg n/a
40 Asam Ibandronat injeksi 6mg/6ml Bondronat
41 Asam Mefenamat kapsul/kaplet 500 mg n/a
42 Asam pipemidat kapsul 400 mg Urotractin 400 mg
43 Asam traneksamat injeksi 100 mg/ml n/a
44 Asiklovir salep mata 3% Temiral Eye Oint

45 Asiklovir tablet/kapsul/kaplet 200 mg n/a
47 Asparaginase serbuk injeksi 10.000 UI/vial Leunase
48 Atapulgit tablet 600 mg Pularex
49 Atrakurium injeksi 25 mg/2,5 ml Tracrium
50 Atropin Sulfat tablet 0,5 mg n/a

51 Azitromisin sir kering 200 mg/ 5 mL n/a
52 Azitromisin tablet 500 mg n/a
54 Bedak salisil serbuk 2% n/a

55 Benzatin Benzil Penisilin 1,2 juta IU/ vial n/a
56 Benzatin Benzil Penisilin 2,4 juta IU/vial n/a
57 Beractant injeksi / suspensi 25 mg/mL Survanta
58 Beraprost sodium tablet 20 mcg Dorner 20 µg
59 Beraprost sodium tablet 20 mcg Dorner
60 Betametason krim 0,1% (sebagai Valerat) n/a
61 Bikalutamid tablet salut 150 mg Casodex 150 mg
63 Bisakodil suppositoria 10 mg Stolax supp
64 Bisoprolol tablet 5 mg n/a
65 Bromokriptin tablet 2,5 mg Cripsa tab
66 Budesonid inhaler 200 mcg/puff, 100 dosis Pulmicort Turbuhaler
67 Budesonid respules / cairan inhaler 0,25mg/mL Pulmicort Respules
68 Budesonid-formoterol (fixed combination) inhaler 160/4,5 Symbicort Turbuhaler

mcg 160/4.5 mcg
69 Budesonid-formoterol (fixed combination) inhaler 80/4,5 Symbicort 80/4.5 mcg

mcg
70 Dabigatran eteksilat kapsul 75 mg Pradaxa
72 Deferasiroks tablet disp/ eff 250 mg Exjade 250 mg Tab
74 Deferipron larutan oral 100 mg/mL Ferriprox Oral Solution
75 Deferipron tablet 500 mg Ferriprox tablet

76 Deferoksamin Mesilat serbuk injeksi 500 mg Desferal
77 Deksametason injeksi i.v./i.m. 5 mg/ml n/a
78 Desoksimetason krim 0,25% n/a
79 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) n/a
80 Digoksin tablet 0,25 mg n/a
81 Diltiazem HCl tablet 30 mg n/a
Herbesser Powder
82 Diltiazem infus injeksi 50 mg Injection 50mg
Farmabes Injeksi 25
83 Diltiazem injeksi 25 mg/5 mL mg
84 Diltiazem Kapsul SR 100 mg Herbesser CD 100
86 Dinatrium edetat tetes mata 0,35% E.D.T.A
87 Doksazosin mesilat tablet 1 mg Cardura 1mg
89 Doksorubisin serbuk injeksi i.v. 10 mg/vial Doxorubicin kalbe
Doxorubicin Actavis 50
90 Doksorubisin serbuk injeksi i.v. 50 mg/vial mg
91 Domperidon suspensi/sirup 5 mg/5 ml n/a
92 Domperidon tablet 10 mg n/a
93 Domperidon tetes 5 mg/mL n/a
94 Dosetaksel injeksi 20 mg/0,5 ml n/a
95 Dutasterid kaps lunak 0,5 mg Avodart
96 Efavirens tablet salut 600 mg n/a

97 Eksemestan tablet 25 mg Aromasin
98 Enoksaparin sodium inj 20 mg/0,2 mL Lovenox 2000 ANTI-XA
101 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml n/a

102 Epirubisin serb injeksi 50 mg/25ml Epirubisin Kalbe
103 Epirubisin serb injeksi 10 mg/5 ml n/a
104 Ergokalsiferol (vitamin D3/D2) kapsul 50.000 UI D-Vit FT
105 Ergokalsiferol (vitamin D3/D2) suspensi 10.000 UI/ml D-Vit Syrup
106 Eritromisin kapsul/kaplet 500 mg n/a

107 Eritromisin sirup kering 200 mg/ 5 ml n/a
108 Eritropoetin-alfa inj 3000 UI/mL Hemapo 3000
109 Eritropoetin-beta inj 2000 UI/0,3 mL Recormon
110 Etambutol tablet 250 mg (HCl) n/a
111 Etambutol tablet salut 500 mg (HCl) n/a
112 Etanol 70% cairan n/a
113 Etonogestrel implan 68 mcg Implanon
114 Etoposid injeksi 20 mg/ml Posyd

115 Eugenol cairan n/a
116 Everolimus tab 0,25 mg Certican 0,25 mg Tab
118 Faktor VIIa (rekombinan) serb inj 1 mg/vial + pelarut untuk Novoseven
injeksi
119 Fenitoin injeksi 50 mg/ml n/a
120 Fenitoin kapsul/kaplet 100 mg n/a

121 Fenobarbital injeksi i.m./i.v. 50 mg/ml n/a
122 Fenofibrat kaps 100 mg n/a

124 Fenoksimetil penisilin (penisilin V) tablet 250 mg n/a
125 Fenoksimetil penisilin (penisilin V) tab 125 mg Fenocin
126 Fenoksimetil penisilin (penisilin V)tablet 500 mg n/a
127 Fenoterol HBr inh solution 0,1% Berotec Solution
128 Fentanil injeksi i.m/i.v 0,05 mg/ml, ampul 10 ml n/a
Durogesic 12,5 MU
130 Fentanil patch 12,5 mcg/jam Matrix
Durogesic 25 MU
131 Fentanil patch 25 mcg/jam Matrix
Durogesic 50 MU
133 Filgrastim inj 300 mcg/mL Leucogen
134 Fitomenadion (Vit.K1) tablet salut gula 10 mg n/a
135 Fludarabin inj 50 mg Fludara IV LYO
136 Fludarabin tab 10 mg Fludara Oral
137 Flufenazin injeksi i.m. 25 mg/ml Sikzonoate Injeksi
138 Flukonazol injeksi 2 mg/ml n/a

139 Flukonazol tablet/kapsul 150 mg n/a
140 Fluoksetin tablet 10 mg Foransi 10
141 Fluoksetin tablet 20 mg NOPRES
142 Fluorourasil inj 250 mg/mL Curacil
143 Fluorourasil inj 500 mg/ 5 mL Curacil
144 Flusinolon asetonid krim 0,025% SYNARCUS
145 Flutikason furoat intranasal spray Avamys
146 Flutikason propionat nebules 0,5 mg Flixotide Nbules
147 Fondaparinuks inj 2,5 mg/0,5 mL Arixtra
148 Furosemid injeksi i.v./i.m. 10 mg/ml n/a

149 Furosemid tablet 40 mg n/a
150 Gansiklovir serb inj 500 mg (50 mg/mL) Cymevene
Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g
151 kalium klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g n/a
Glukosa Anhidrat 2,70 g
152 Gefitinib tab 250 mg Iressa 250 mg
153 Gemfibrozil kapsul/kaplet 300 mg n/a
154 Gemfibrozil tablet 600 mg n/a
155 Gemsitabin inj 1000 mg/vial Gemzar 1000 mg
156 Gemsitabin inj 200 mg/vial n/a
157 Gentamisin injeksi 40 mg/ ml n/a
158 Gentamisin salep mata 0,3% Genoint Salep Mata
159 Gentamisin tetes mata 0,3% n/a
160 Glibenklamid tablet 5 mg n/a
161 Gliklazid tab 80 mg Glicab
162 Gliklazid tab 30 mg Diamicron MR 30
163 Glikuidon tab 30 mg n/a

164 Glimepiride tablet 1 mg n/a
168 Gliseril trinitrat kaps SR 2,5 mg Nitrokaf Retard
169 Gliseril trinitrat kaps SR 5 mg Nitrokaf Forte
170 Gliseril trinitrat tab sublingual 0,5 mg Nitral
171 Gliserin lar 50% Gliserin lar 50%
172 Glukosa larutan infus 10 % steril n/a
174 Goserelin asetat inj 10,8 mg/vial Zoladex 10,8 mg
175 Goserelin asetat inj 3,6 mg Zoladex 3,6 mg
176 Griseofulvin tablet 125 mg n/a
177 Haloperidol inj 50 mg/mL Haldol Decanoas
178 Haloperidol tablet 0,5 mg n/a
179 Haloperidol tablet 5 mg n/a
181 Haloperidol tablet 2 mg Lodomer 2
182 Halotan Inhalasi Halothane

183 Hepatitis B imunoglobulin (human) Hyperhep B
184 Hiosin butilbromid injeksi 20 mg/ml n/a
185 Human insulin intermediate acting inj 100 UI/ml, vial Insulatard Vial
(Human Insulin (Intermediate-Acting))
186 Human insulin intermediate acting inj 100 UI/ml, vial Humulin N Vial
(Insulin human Basal)
187 Human insulin intermediate acting inj 100 UI/ml, n/a

vial/cartridge disposible/penfill cartridge
188 Human insulin intermediate acting inj 100 UI/ml,penfill Insulatard Penfill
cartridge (Human Insulin (Intermediate-Acting))
189 Human insulin intermediate acting inj 100 UI/ml,penfill Humulin N Cart
cartridge (Insulin human Basal)
190 Human insulin intermediate acting inj 100 UI/ml,penfill Sansulin N

191 Human insulin mix insulin inj 100 UI/ml, penfill cartridge
(Human Insulin (Premix: 30% Soluble + 70 % NPH Insulin)) Mixtard Penfill
192 Human insulin mix insulin inj 100 UI/ml, penfill cartridge Humulin 30/70 Cart
(Insulin human Comb)
193 Human insulin mix insulin inj 100 UI/ml, vial (Human Mixtard Vial
Insulin (Premix: 30% Soluble + 70 % NPH Insulin))
194 Human insulin mix insulin inj 100 UI/ml, vial (Insulin Humulin 30/70 Vial
human Comb)
195 Human insulin short acting inj 100 UI/ml, penfill cartridge Actrapid Penfill
(Human Insulin (Short Acting))
196 Human insulin short acting inj 100 UI/ml, penfill cartridge Humulin R Cart
(Insulin human Rapd)
197 Human insulin short acting inj 100 UI/ml, penfill cartridge Sansulin R
198 Human insulin short acting inj 100 UI/ml, vial (Human Actrapid Vial
Insulin (Short Acting))
199 Human insulin short acting inj 100 UI/ml, vial (Insulin Humulin R Vial
human Rapd)
200 Human insulin short acting inj 100 UI/ml, vial/cartridge n/a
disposible/penfill cartridge
201 Ibuprofen sirup 100 mg/5 ml n/a
202 Ibuprofen suspensi 200 mg/5 ml n/a
203 Ibuprofen tablet 400 mg n/a
204 Ifosfamid serbuk injeksi 1000 mg/vial Holoxan injeksi 1000
205 Imidapril tab 10 mg Tanapress 10mg

207 Iopamidol 200-300 mg Iodium/mL (300mg @ vial 100ml) Iopamiro
213 Iopromide 300-370 mg Iodium/mL (300 mg / 100 ml) Ultravist 300/100 mg

217 Irbesartan tab 150 mg n/a
219 Irinotekan inf 20 mg/ml n/a
220 Isosorbid Dinitrat tablet sublingual 5 mg n/a
221 Kalium aspartat tab 300 mg Kalipar
222 Kalium Klorida tablet 600 mg KSR
223 Kalsium Glukonat injeksi i.v 10% (100 mg/ml) Kalsium glukonat
224 Kandesartan tab 16 mg n/a
226 Kapesitabin tab 500 mg Xeloda
227 Kaptopril tablet 50 mg n/a
228 Kaptopril tablet scored 25 mg n/a
229 Kaptopril tablet scored12,5 mg n/a
230 Karbamazepin sirup 100 mg/5 ml Tegretol Syrup

100mg/5ml, 120ml
231 Karbamazepin tablet 200 mg n/a
232 Karbimazol tab 5 mg Neo-Mercazole
Karbogliserin tetes
233 Karbogliserin tetes telinga 10% telinga 10%
234 Ketamin injeksi i.v. 100 mg/ml KTM
235 Ketokonazol krim 2% n/a

237 Ketokonazol tablet 200 mg n/a
238 Ketorolac injeksi 30 mg/ml n/a
239 Klaritromisin tab 500 mg ORIXAL
240 Klindamisin kapsul/kaplet 150 mg n/a

242 Klobazam tab 10 mg n/a
243 Klonidin tablet 0,15 mg n/a
244 Klopidogrel tab 75 mg n/a
245 Klorpromazin injeksi i.m. 25 mg/ml (HCl) n/a

246 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) n/a
247 Klozapin 100 mg n/a
249 Kodein tablet 10 mg n/a

252 Kombinasi suspensi : Parafin + gliserin + fenolftalein Laxadine Emulsi 60 ml
253 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam n/a
folat 0,25 mg
254 Kombinasi tetes mata 2,5 mg/mL: Natrium klorida 8,664 Cendo Lyteers
mg; Kalium klorida 1,32 mg
255 Kombinasi: Artemether 20 mg; Lumefantrin 120 mg Coartem
256 Kombinasi: Levodopa 100 mg; Karbidopa 25 mg; Stalevo

Entekapon 200 mg
257 Kombinasi: Salmeterol 25 mcg; Flutikason propionat 50 Seretide Inhaler 50

mcg mcg
258 Kombinasi: Salmeterol 50 mcg; Flutikason propionat 100 Seretide Diskus 100
mcg mcg
mcg mcg
260 Kotrimoksazol DOEN I (dewasa) kombinasi : n/a

Sulfametoksazol 400 mg Trimetoprim 80 mg
261 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + n/a

Trimetoprim 40 mg / 5 ml
262 Kuinin (Kina) tablet 200 mg n/a
263 Kuinin injeksi i.v. 25% (sebagai 2 HCl) n/a
264 Kuinin tablet 222 mg (H2SO4.7H2O) n/a
265 Lamivudine tablet 150 mg n/a
266 Lansoprazol inj 30 mg/ml Prosogan Inj.
267 Lanzoprazol kapsul/kaplet 30 mg n/a
268 Lapatinib tab 250 mg Tykerb
269 Larutan mengandung Asam Amino (Asam Amino 10%) Kalbamin
270 Larutan mengandung Asam Amino (Asam Amino 100 g, Amiparen

Total N 15,7 g, Na+ 2 mEq, Asetat 120 mEq)
271 Larutan mengandung Asam Amino (Asam Amino 27 g, Pan-amin G

Sorbitol 50 g, Cl- 52 mEq)
272 Larutan mengandung Asam Amino (Asam Amino 30 g, Aminofluid

Glukosa 7,3 % dan elektrolit) 1000 ml

Larutan mengandung Asam Amino (Asam Amino 5%
274 dengan BCAA 45%, L-Ornithine L Aspartate 8.03 gr/L, Aminofusin Hepar
Sorbitol 50 gr/L, Xylitol 50 gr/L)
275 Larutan mengandung Asam Amino (Asam Amino 6%, Aminosteril Infant 6%
mengandung Taurine 0,24 gr/l)
Larutan mengandung Asam Amino (Asam Amino 7%,
276 Komposisi: Asam Amino esensial: Asam Amino non Nephrosteril
esensial = 60 : 40)
Larutan mengandung Asam Amino (Asam Amino 72.05 g,

277 Total N 11.53 g, AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 Kidmin
mEq)
278 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Aminoleban
Total N 12.2 g, Na+ 14 mEq, Cl 94 mEq)
279 Larutan mengandung Asam Amino (Asam amino 8%) Aminosteril N-Hepa
280 Larutan mengandung Asam Amino (Asam Amino esensial Eas Pfrimer
7%+Xylitol 10 g/L)
Larutan mengandung Asam Amino (BCAA 25 gr/L, L-
281 Ornithine L Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7 Comafusin Hepar
gr/L, Piridoxin 0.12 gr/L)
Larutan mengandung Asam Amino (Kombinasi Asam

aminno 50 g/L, Sorbitol 50 g/L, Xylitol 50 g/L, Asam
282 Askorbat (Vit C) 0.4 g/L, Inositol 0.5 g/L, Nikotinamida Aminofusin L600
(Niasinamida) 0.06 g/L, Piridoksin HCl (Vit B6) 0.04 g/L,
Riboflavin Natrium Fosfat 2.5 mg/L, elektrolit)
283 Larutan mengandung Asam Amino (Kombinasi Asam Aminofusin Paed

amino 50 g/L, vitamin dan elektrolit)
284 Amino: 34gr, Glukosa: 97gr, Lipid: 51gr dan Elektrolit Kabiven 1440 ml
(Kalori = 1000 kkal, Akses peripheral))

Larutan mengandung Asam Amino (Kombinasi Glukosa Combiflex Plus (790

286 dan elektrolit 150 gr + Asam Amino 48 gr dgn akses kcal)
sentral)
287 Larutan mengandung Asam Amino (Kombinasi Glukosa Combiflex peri (480
dan elektrolit 80 gr + Asam Amino 40 gr ) kcal)
288 Larutan mengandung Elektrolit (Kalium Klorida) Otsu - KCl 7,46%
289 Larutan mengandung Elektrolit (Larutan Ringer Laktat) Wida RL
290 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Asering
Ca 3 mEq, Asetat 28 mEq)
291 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa KA EN 1B

18.75 gr)
Larutan mengandung Elektrolit (Sodium Lactate sol (50%)
292 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 Totilac
gr/L, elektrolit)
Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l, Potassium 4.0
293 mmol/l, Calcium 2.5 mmol/l, Magnesium 1.0 mmol/l, Ringerfundin 500 mL
Chloride 118 mmol/l, Acetate 24 mmol/l, Malate 5.0
mmol/l)
294 Larutan mengandung Karbohidrat (Fructose 120 g, glucose Triofusin 1000

66 g, Xylitol 60 g/ L + elektrolit)
33 g, Xylitol 30 g/ L)
296 Larutan mengandung Karbohidrat (Maltose 100 gr) Martos
Larutan mengandung Karbohidrat + Elektrolit (25.00g
297 maltose, 3.00 g sodium chloride, 0.15 g potassium Potacol inj
chloride, 0.10 g calcium chloride dihydrate dan 1.55 g
sodium lactate)
298 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, Tutofusin OPS

K, Cl, Ca, Mg, Sorbitol 50 gr/L)
299 Larutan mengandung Karbohidrat + Elektrolit (Asam amino Clinimix N9G20E

28 gr/L, Glukosa 100 gr/L, elektrolit)

301 Larutan mengandung Karbohidrat + Elektrolit (Fructose 60 Triofusin E1000

g, glucose 33 g, Xylitol 30 g/ L)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25
302 g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk Wida HSD
injeksi ad 1000 ml)
303 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 Wida D5-NS

g ; Natrium Chloride 9 g, air untuk injeksi ad 1000 ml)
304 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: WIDA 2A

25,0 g; NaCl: 4,5 g)
305 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: WIDA D5-1/4NS

55.0 g; NaCl: 2.25 g)

55.0 g; NaCl: 4.5 g)
Larutan mengandung Karbohidrat + Elektrolit (Larutan

307 nutrisi kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. Futrolit
4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g)
308 Larutan mengandung Karbohidrat + Elektrolit (Larutan Wida RD

Ringer & Glukosa 5%)
309 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KA ENMG 3

KCL 1.5g, Glukosa 100 gr)
310 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KA EN 3B

KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr)
311 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, KA EN 3A

Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr)
312 Larutan mengandung Lipid ( Infus Lipid Emulsi MCT/LCT Lipofundin MCT/LCT
20% 100 ml) 1% 100
313 Larutan mengandung Lipid (Emulsi lemak 20%) Intralipid
314 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT Lipofundin MCT/LCT
20% 250 ml) 1% 250
Larutan mengandung Lipid (Kombinasi Glukosa dan Nutriflex Lipid Special
315 elektrolit 180 gr + Asam Amino 71.8 gr + Lipid 50 gr dgn 1250
akses sentral)
316 Larutan mengandung Lipid (Kombinasi Glukosa dan Nutriflex Lipid Peri
elektrolit 80 gr + Asam Amino 40 gr + Lipid MCT/LCT 50 gr) 1250

akses sentral)
Larutan mengandung Lipid (Soybean Oil 200 g/L, Egg

318 Lecithins 12 gr/L, Glycerol Ph 25 gr/L, Sodium Oleate 0.3 Ivelip
gr/L)
319 Latanoprost tetes mata 0,01% Cendo Glaopen
320 Leuprorelin asetat inj depot 1,88 mg Tapros 1.88mg
321 Leuprorelin asetat inj depot 11,25 mg Tapros 3M
322 Levofloksasin inf 5 mg/mL n/a
323 Levofloksasin tablet 500 mg n/a
324 Lidokain injeksi 2% (HCL) n/a

325 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml n/a
326 Lidokain jeli 2% Xylocaine Jelly 2%
327 Lisinopril tablet 10 mg n/a
329 Litium karbonat tablet 200 mg Frimania 200
331 Loperamid tablet 2 mg n/a
332 Loratadin tablet 10 mg n/a
333 Lorazepam tablet 2 mg Merlopam 2
334 Manitol n/a
335 Maprotilin HCl tab 25 mg Ludios
336 Maprotilin HCl tab 50 mg Sandepril 50
337 Melfalan tablet 2 mg Alkeran
338 Meropenem inj 1 g n/a

339 Mesna inj 100 mg/mL Uromitexan injeksi.
340 Metadon sir 50mg/5ml n/a
341 Metilfenidat kapsul LA 20 mg Ritalin LA
342 Metilprednisolon tablet 16 mg n/a

345 Metoklopramide tablet 5 mg n/a
346 Metronidazol infus 500 mg/100 ml n/a
347 Metronidazol supositoria 500 mg Flagyl
348 Metronidazol tablet 250 mg n/a

350 MIBI (metoxy iso butyl iso nitril) 5-mL reaction vial Cardioscan KaeF
351 Midazolam injeksi i.v. 1 mg/ml Fortanest
352 Midazolam injeksi i.v. 5 mg/ml Dormicum
353 Mikafungin Na serb inj 50 mg Mycamine
354 Mikonazol krim/salep 2 % (Nitrat) n/a
355 Mitomisin C (crystallin) serbuk inj 10 mg/vial Mitomycin C
356 Moksifloksasin tetes mata 0,5% Vigamox
357 Mometason furoat krim 0,1% n/a
358 Morfin HCL inj 10 mg/ml n/a
359 Morfin HCL tablet SR 10 mg MST Continus 10 mg
361 Morfin injeksi i.m./s.k./i.v. 10 mg/ml n/a
362 Morfin tablet 10 mg n/a
363 Nacl 0,9% n/a
364 Nadroparin inj 9500 Axa/mL syringe 0,3 mL Fraxiparine 0.3 ml
365 Nadroparin inj 9500 Axa/mL, syringe 0,4 mL Fraxiparine 0.4 ml
367 Nalokson injeksi 0,4 mg/ml Nokoba

368 Natrium Bikarbonat injeksi i.v 8,4% Meylon
369 Natrium Diklofenak tablet 50 mg n/a

371 Natrium fosfat lar oral 45 mL Fleet Phosphosoda
372 Natrium fusidat salep 20 mg/g Fucilex Ointment
373 Nevirapin tablet 200 mg n/a
374 Nifedipin tab 20 mg, slow release; oros Adalat Oros 20 mg
375 Nifedipin tab 30 mg, oros Adalat Oros 30 mg
376 Nifedipin tablet/kapsul 10 mg n/a
377 Nistatin tablet salut 500.000 IU/ g n/a

378 Noretisteron tablet 5 mg Primolut N
379 Obat Antituberkulosis FDC Kategori 1 n/a
381 Obat Antituberkulosis FDC Kategori Anak n/a
382 Obat Antituberkulosis FDC Sisipan n/a
383 Obat Antituberkulosis Kategori 1 dewasa n/a
384 Obat Antituberkulosis Kategori anak n/a
385 Ofloxacin tablet 200 mg n/a
387 Oksimetazolin tetes hidung 0,025% Ilaidin Drops
388 Oktreotid 10 mg Sandostatin LAR
389 Olanzapin inj 10 mg/vial Zyprexa IM

390 Olanzapin kapl salut 5 mg Olandoz 5
391 Olanzapin tab 10 mg Olandoz 10
392 Omeprazol injeksi 40 mg/ 10 ml n/a
393 Omeprazol kapsul/kaplet 20 mg n/a
394 ondansetron inj 4 mg/ 2 mL n/a
395 Ondansetron tab 4 mg n/a
396 Ondansetron tablet 8 mg n/a
397 Paket CAPD Awal (Komposisi: 1 unit Transfer Set, 2 unit n/a
Ultaclam, 1 unit Tenckoff Catheter, Titanium Adaptor)
398 Paket CAPD Pergantian Transfer Set per 6 bulan n/a

Larutan Dialisa 1.5%:
Dianeal Low Calcium
with 1,5% Dextrose;
Paket CAPD Rutin 120 ( 4x ganti cairan perhari dengan Larutan Dialisa 2.5%:
399 komposisi Larutan Dialisa 1.5 %, Larutan Dialisa 2.5 %, Dianeal Low Calcium
Larutan Dialisa 4.25 %, Minicap) with 2,5% Dextrose;
Dianeal Low Calcium
with 4.25% Dextrose
400 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) n/a
401 Parasetamol sirup 120 mg / 5 ml n/a
402 Parasetamol tablet 500 mg n/a
403 Pegylated interferon alfa-2a inj 135 mcg/0,5 ml Pegasys

405 Perindoprilarginin tab 5 mg Bioprexum 5 mg
406 Permetrin krim 5% Scabimite Cream 10
407 Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml (HCl) n/a

408 Pioglitazon tab 15 mg DECULIN 15 MG
410 Pirantel suspensi 125 mg/5 ml n/a
411 Pirantel tablet score (base) 125 mg n/a
412 Pirazinamid tablet 500 mg n/a
413 Polikresulen cairan Aptil
414 Povidon Iodida larutan 10% 1000 ml n/a
417 Pramipeksol tab ER 0,375 mg Sifrol ER 0,375mg
419 Pravastatin tablet 20 mg n/a
420 Propanolol tablet 10 mg ( HCl ) n/a

421 Propranolol tablet 40 mg (HCl) n/a
422 Quetiapin tab 200 mg Seroquel XR 200 mg
425 Ramipril tablet 5 mg n/a
426 Ranitidin injeksi 25 mg/2 ml n/a
427 Ranitidin tablet 150 mg n/a
428 Retinol (Vitamin A) 100.000 IU n/a

429 Retinol (Vitamin A) 200.000 IU kapsul lunak n/a
430 Ringer Laktat larutan infus n/a
431 Risperidon tablet 1 mg n/a

434 Rivaroksaban tab 10 mg Xarelto 10 mg
Requip PD 24 Hour 2
437 Ropinirol Tablet Salut 2 mg mg
438 Ropinirol Tablet Salut 4 mg Requip PD 24 Hour 4

mg
Requip PD 24 Hour 8
440 Salbutamol inhalasi/aerosol 100 mcg/dosis Ventolin Inhaler
441 Salbutamol serb inh 200 mcg/kaps Ventolin Rotacaps
442 Salbutamol serb inh 200 mcg/kaps + rotahaler Ventolin Rotahaler
443 Sefadroksil sirup kering 125 mg/5ml n/a
444 Sefadroksil kapsul/kaplet 250 mg n/a

446 Sefadroksil sir kering 250 mg/5 mL n/a
447 Sefaleksin kapsul/kaplet 500 mg n/a
448 Sefepim inj 1 g n/a
449 Sefiksim kapsul/kaplet 100 mg n/a
450 Sefiksim sirup kering 100 mg/ 5 ml n/a
451 Sefotaksim injeksi 0,5 g n/a
452 Sefotaksim injeksi 1 g n/a

453 Sefpodoksim proksetil tab 100 mg Banadoz 100
454 Seftazidim injeksi 1 g n/a
455 Seftriakson serbuk injeksi 1 g/vial n/a
456 Sefuroksim tab 500 mg Zinnat 500

457 Setirizin tablet 10 mg n/a
458 Sianokobalamin (vitamin B12) injeksi 500 mcg n/a
459 Siklofosfamid serbuk injeksi i.v. 200 mg Cyclovid 200 mg
Sandimmun Neoral
460 Siklosporin kaps 100 mg 100mg Kap
Sandimmun Neoral
461 Siklosporin kapsul lunak 25 mg 25mg Kap
462 Simvastatin scored tablet 10 mg n/a
463 Simvastatin tablet 20 mg n/a
464 Siprofloksasin infus 2% n/a

465 Siprofloksasin tablet 500 mg (sebagai HCl) n/a
466 Spiramisin tablet 500 mg n/a
467 Spironolakton tablet 100 mg n/a
469 Streptokinase injeksi 1,5 juta UI/vial Streptase
Sufentanyl Injeksi
470 Sufentanil injeksi iv, epidural 5 mcg/ml iv.Epidural 5 mcg / ml
471 Takrolimus kaps 0.5 mg Prograf
472 Takrolimus kaps 1 mg Prograf
Harnal ® D 0.2 mg
473 Tamsulosin tab 0,2 mg Disp. Tablet
474 Tamsulosin tab 0,2 mg Harnal D
Harnal ® OCAS 0.4 mg
475 Tamsulosin tab SR 0,4 mg Tablet
476 Telbivudin tab 600 mg Sebivo 600 mg Tab
477 Telmisartan tab 40mg Micardis 40mg
478 Tenofovir tab 300 mg n/a
479 Terbutalin cairan ih 2,5 mg/mL Bricasma Respules
480 Terbutalin tablet 2,5 mg Molasma Tablet
Bricasma Turbuhaler
481 Terbutalin turbu (serbuk ih) 0,50 mg 0,5 mg
482 Tetrakain HCl tetes mata 0,5% Pantocain 0.5%
483 Tetrasiklin kapsul/kaplet 250 mg n/a
484 Tiamazol tab 10 mg Thyrozol 10
486 Timolol tetes mata 0,25% Isotic Adretor 0,25%
Spiriva 10s +
488 Tiotropium kaps 18 mcg + handihaller Handihaler
489 Tramadol injeksi 50 mg/ml n/a
490 Travoprost tetes mata 0,004% Travatan
491 Triamsinolon asetonid nasal spray 55 mcg/puff Nasacort AQ
492 Trifluoperazin tablet 5 mg n/a
493 Urea krim 10% Soft U Derm
494 Vaksin polio inj (Vaksin Poliomyelitis yang diinaktifkan) Imovax Polio
495 Valproat tab SR 250 mg Depakote ER 250 mg

497 Valsartan tab 80 mg Diovan 80mg Tab
498 Valsartan tab 160 mg DIOVAN 160 MG
499 Verapamil tab 240 mg Isoptin 240 mg
500 Verapamil tablet 80 mg (HCl) n/a
501 Vinblastin serbuk injeksi 10 mg Vinblastine
502 Vinorelbin inj. 10 mg/ml Navelbine injeksi 10
503 Vitamin B Kompleks tablet n/a
504 Zidovudin 300 mg + Lamivudine 150 mg n/a
505 Zinc drop 10 mg/mL Zincpro Drops
506 Zinc sir 20 mg/5 Ml Zircum Kid Sirup

507 Zinc tablet dispersible20 mg n/a
Harga Satuan Terkecil Tanggal Berlaku
Nama Penyedia Kemasan (Rp) Harga
PT. Kimia Farma 1 blister@24 tablet 1,375.00 4/23/2013 10:24
PT. SmithKline Beecham Phamaceuticals

Dus, 3 Blister @ 10 kapsul 27,500.00 3/18/2014 20:03
PT. Indofarma Dus, 10 dus @ 1 botol @ 10 ml 3,849.00 4/23/2013 10:24
PT. Holi Pharma Dus, 5 strip @ 6 tablet 344 3/15/2014 16:05

PT. Holi Pharma Box, 10 strips @ 10 tablets 86 3/15/2014 16:05
PT. Dexa Medica Dus, 10 Strip @ 10 tablet 380 3/15/2014 16:05
PT. Kimia Farma Ktk 10x10 tablet 214 3/15/2014 16:05
Dus, 1 vial@50mg + 1 vial
PT. Boehringer Ingelheim 3,800,000.00 6/27/2014 19:33
pelarut @ 50ml
PT. Cendo Industri Farmasi tube 3.5 gr 18,500.00 4/3/2014 21:30
PT. Sanbe Farma Vial 2 ml 50,500.00 3/16/2014 18:23
PT. Lucas Djaja dus 30 ampul @10 ml 3,823.00 4/23/2013 10:24
PT. Marin Liza Farmasi Botol @ 100 tablet salut selaput 90 3/15/2014 16:05
PT. Aventis Pharma Dus, 6 ampul @ 3 ml 12,480.00 3/16/2014 18:23

PT. Darya Varia strip 1,200.00 3/16/2014 18:23
PT. Indofarma Dus, 10 strip @ 10 tss 112 4/23/2013 10:24
PT. Pertiwi Agung Box, 3 strips @ 10 tablets 330 3/15/2014 16:05
PT. Novapharin strip 211 3/15/2014 16:05
PT. Bernofarm Dus, 10 strip @ 10 kaptab 272 3/15/2014 16:05
PT. Holi Pharma Dus, Botol 60 ml 4,070.00 3/15/2014 16:05
PT. Novapharin btl @ 60 ml 2,445.00 4/23/2013 10:24
PT. Aventis Pharma dus, 5 solostar pen @ 3ml 85,000.00 4/3/2014 21:30
Injeksi 100 IU/ml, Flexpen

PT. Ferron Par Pharmaceuticals disposible 3 ml (1 box isi 5 106,000.00 4/3/2014 21:30
flexpen disposible)
PT. Tempo Scan Pacific Penfill cartridge 97,500.00 3/18/2014 20:03

flexpen disposible)
PT. Ferron Par Pharmaceuticals Dus, vial 10 ml 200,000.00 4/3/2014 21:30
PT. AstraZeneca indonesia Dus, 2 blister @ 14 Tablet 32,000.00 4/3/2014 21:30
PT. Promedrahardjo Farmasi Industri

STRIP 75 3/15/2014 16:05
PT. Erela Botol @ 60 ml 2,160.00 3/15/2014 16:05
PT. Indofarma Dus, 25 tube @ 5 g 2,516.00 3/15/2014 16:05
PT. Kimia Farma ktk 10 x 10 tablet 520 3/15/2014 16:05
PT. Kimia Farma Btl 100 tablet 135 3/15/2014 16:05
PT. Meprofarm Dus, 5 strip @ 10 tablet 1,500.00 3/16/2014 18:23
PT. Kimia Farma Dus 6 amp @ 1ml 22,000.00 3/18/2014 20:03

PT. Kimia Farma Dus 10 strip x 10 tab 95 3/18/2014 20:03
PT. Marin Liza Farmasi Botol @ 100 tablet 48 3/15/2014 16:05
PT. Boehringer Ingelheim Boks, 1 ampul 2,209,000.00 4/3/2014 21:30
PT. Bernofarm Dus, 10 blister @ 10 kaptab ss 112 4/23/2013 10:24
PT. Sanbe Farma Strip 1,815.00 3/16/2014 18:23
PT. Hexpharm Jaya Laboratories Dus, 10 ampul @ 5 ml 3,334.00 3/15/2014 16:05
PT. Sanbe Farma Tube 3,5 gram 24,750.00 3/16/2014 18:23

PT. Indofarma Dus, 10 blister @ 10 tablet 237 3/15/2014 16:05
PT. Sampharindo Perdana Dus, 5 strip @ 10 tablet 336 3/15/2014 16:05
PT. Widatra Bhakti 10.000 UI/Vial 1,039,500.00 4/3/2014 21:30
PT. Zenith Pharmaceuticals Dus 5 strip @ 10 tablet 190 3/16/2014 18:23
PT. Glaxo Wellcome Indonesia Dus, 5 ampul @ 2.5 ml 20,000.00 3/16/2014 18:23
PT. Indofarma Dus, 10 strip @ 10 tablet 74 4/23/2013 10:24

PT. Soho Industri Pharmasi botol @ 60 ml 34,400.00 3/15/2014 16:05
PT. Kimia Farma ktk 2x10 tablet 4,500.00 3/15/2014 16:05
PT. Soho Industri Pharmasi Strip 3,333.00 3/18/2014 20:03
PT. Rama Emerald Multi Sukses Dus @ 50 gram 1,250.00 3/15/2014 16:05
PT. Phapros, Tbk Dus @ 10 Vial 9,800.00 4/23/2013 10:24
PT. Abbott Indonesia Vial 3,200,000.00 3/18/2014 20:03
PT. Combiphar Box/ 3 blister @ 10 Tablet 3,600.00 3/16/2014 19:08
PT. Combiphar Box @ 3 blister @ 10 Tablet 3,600.00 3/18/2014 20:03
PT. Kimia Farma Tube 5 gr 1,520.00 3/15/2014 16:05
PT. Sanbe Farma Supp 6,045.00 3/16/2014 18:23
PT. Pratapa Nirmala Box 3 X 10 tab 645 4/23/2013 10:24
PT. Caprifarmindo Box 3 x 10'S 247,089.00 3/16/2014 19:08
PT. AstraZeneca indonesia Dus, 1 Turbuhaler @ 100 dosis 93,000.00 4/3/2014 21:30
PT. AstraZeneca indonesia Dus, 4 pak @ 5 respules @ 2 ml 8,900.00 4/3/2014 21:30
PT. Boehringer Ingelheim Dus, 3 blister @ 10 kapsul 12,936.00 5/21/2014 20:01

PT. Novartis Indonesia Dus, 4 blister @ 7 tablet 76,000.00 3/16/2014 19:08
PT. Sydna Farma Dus, Botol @ 500ml 2,600,000.00 4/3/2014 21:30
PT. Sydna Farma Dus, Botol @ 100 tablet 25,300.00 4/3/2014 21:30
PT. Novartis Indonesia Dus, 10 vial @ 500mg 112,000.00 4/3/2014 21:30
PT. Indofarma Dus, 100 ampul @ 1 ml 1,580.00 3/15/2014 16:05
PT. Dexa Medica Kotak, tube @ 15 gram 9,983.00 3/16/2014 19:30
PT. Phapros, Tbk Dus @ 30 Ampul 1,050.00 3/15/2014 16:05
PT. Yarindo Farmatama Box 10 X 10 Tab 97 4/23/2013 10:24
PT. Tanabe Indonesia 10 vial @ 50mg 127,667.00 3/18/2014 20:03
PT. Pratapa Nirmala Vial 5 mL 46,667.00 3/18/2014 20:03
PT. Tanabe Indonesia 3 blister @ 10 kapsul 3,667.00 3/18/2014 20:03

PT. Cendo Industri Farmasi botol 15 ml 37,500.00 4/3/2014 21:30
PT. Pfizer Indonesia Dus, 5 blister @10's tab 3,480.00 3/16/2014 18:23
PT Kalbe Farma vial @ 5 ml 59,000.00 3/16/2014 18:23
PT. Actavis Indonesia Dus, 1 vial @ 50 mg 258,000.00 3/16/2014 18:23

PT. Bernofarm Dus, botol @ 10 ml 15,600.00 3/15/2014 16:05
Dus, 1 vial @0,5 ml+ 1 vial
PT. Sanbe Farma 970,200.00 4/3/2014 21:30
pelarut @1,5 ml

Dus, Botol Plastik @ 30 Tablet 7,100.00 3/18/2014 20:03
PT. Kimia Farma Botol 30 tab 6,375.00 6/16/2014 19:59

PT. Pfizer Indonesia Dus, 2 blister @ 15 tablet 42,600.00 4/3/2014 21:30
PT. Aventis Pharma dus, 2 prefilled syringe @ 0,2 ml 40,740.00 3/18/2014 20:03

PT Kalbe Farma Vial @ 25 ml 500,000.00 3/16/2014 18:23
PT. Sanbe Farma Dus, 1 vial @5 ml 128,000.00 4/3/2014 21:30
PT. Gracia Pharmindo Dus 3 strip @ 10 Flash tablet 650 3/16/2014 19:08
PT. Gracia Pharmindo Dus, Botol Plastik @ 100 mL 8,000.00 4/3/2014 21:30
PT. Indofarma Dus, 10 blister @ 10 kss 930 4/23/2013 10:24

PT. Phyto Kemo Agung Farma Botol @60 ml 7,700.00 3/15/2014 16:05
PT Kalbe Farma Prefilled Syringe @ 1ml 128,000.00 5/21/2014 20:01
PT. Boehringer Ingelheim Boks, 6 ampul 139,500.00 4/3/2014 21:30
Dus, 1 blister @ 1 subdermal
PT. Merck Sharp Dohme Pharma Tbk 128,779.00 3/24/2014 14:34
implant
PT. Combiphar Vial 100mg/5ml 100,000.00 3/16/2014 18:23
PT. Kimia Farma Botol 10 ml 16,667.00 3/18/2014 20:03

KOTAK @ 1 VIAL SERBUK OBAT
PT. Ferron Par Pharmaceuticals 9,200,000.00 4/3/2014 21:30
& INFUSION KIT
PT. Mersifarma Tirmaku MercusanaKOTAK @ 10 ampul 20,250.00 3/15/2014 16:05
PT. Ikapharmindo Botol @ 100 133 4/23/2013 10:24

PT. Hexpharm Jaya Laboratories Dus, 3 strip @ 10 kapsul 1,075.00 3/18/2014 20:03
PT. Phapros, Tbk Dus @ 10 X 10 's 290 3/15/2014 16:05
PT. Actavis Indonesia Dus 45 x 12 tab 235 4/3/2014 21:30
PT. Boehringer Ingelheim Dus, Canister 200 dosis 117,500.00 4/3/2014 21:30
PT. Kimia Farma Dus 5 ampul@ 10ml 128,000.00 3/18/2014 20:03
PT. Kimia Farma Dus @ 5 patch 80,000.00 4/3/2014 21:30
PT. Kimia Farma Dus@ 5 patch 153,000.00 3/18/2014 20:03
PT Kalbe Farma pfs @ 0,5 ml 375,000.00 3/16/2014 18:23

PT. Aventis Pharma Dus, 5 vial @ 50 mg 1,248,319.00 4/3/2014 21:30
Dus, 4 blister @ 5 tablet salut
PT. Aventis Pharma 275,000.00 4/3/2014 21:30
selaput
PT. Mersifarma Tirmaku MercusanaDus, 5 ampul @ 1ml 55,000.00 3/16/2014 19:08
PT. Natura Laboratoria Prima Dus, 1 Botol @ 100 mL 47,100.00 3/15/2014 16:05
PT. Kimia Farma ktk 1 x 10 kapsul 22,000.00 3/15/2014 16:05
PT. Gracia Pharmindo strip 419 3/16/2014 18:23
PT. Dexa Medica DUS, 30 TABLET 410 3/16/2014 18:23
PT. Ifars Pharmaceutical Laboratories

Dus, Tube 5 g 2,400.00 3/16/2014 18:23
PT. Glaxo Wellcome Indonesia Dus, Botol 120 Dosis Spay 93,333.00 3/18/2014 20:03
Dus, 2 flow wrap@ 5 nebules @

PT. Glaxo Wellcome Indonesia 12,917.00 3/18/2014 20:03
1 dosis (2ml)
PT. Glaxo Wellcome Indonesia Dus, 2 pfs 0.5 ml 241,667.00 3/18/2014 20:03

PT. Phapros, Tbk Dus @ 100 Sachet 288 3/15/2014 16:05
PT. AstraZeneca indonesia Dus, 1 blister @ 10 tablet 295,000.00 4/3/2014 21:30

PT. Indofarma Dus, 10 blister @ 12 kapsul 289 4/23/2013 10:24
PT. Indofarma Dus, 10 blister @ 10 kaptab 679 4/23/2013 10:24
PT. Bayer Indonesia vial 1,098,900.00 3/16/2014 18:23
PT. Sanbe Farma Dus, 1 vial @200 mg 330,000.00 4/3/2014 21:30
PT. Erela Tube @ 3,5 gr 2,600.00 3/16/2014 18:23
PT. Indofarma Dus, botol plastik 5 ml 3,194.00 3/15/2014 16:05
PT. Tempo Scan Pacific Strip 242 3/16/2014 18:23
Dus, 6 strip @ 10 tablet lepas
PT. Pradja Pharin 638 4/3/2014 21:30
lambat
PT. Kimia Farma ktk 5x10 tablet 265 4/23/2013 10:24
PT. Kimia Farma Dus 10x10 1,493.00 4/3/2014 21:30
PT. Actavis Indonesia Btl @ 30 tablet 1,500.00 3/18/2014 20:03
PT. Lucas Djaja Glycerin 100 ml 5,333.00 3/18/2014 20:03
PT. Widatra Bhakti botol @ 500 ml 5,700.00 4/23/2013 10:24
PT. AstraZeneca indonesia Dus, 1 syringe @ 10.8 mg 2,300,000.00 4/3/2014 21:30
PT. AstraZeneca indonesia Dus, 1 syringe @ 3.6 mg 840,000.00 4/3/2014 21:30
PT. Soho Industri Pharmasi Dus 5 Ampul@1mL 83,333.00 3/18/2014 20:03
PT. Mersifarma Tirmaku MercusanaKOTAK @ 10 x 10 TAB 126 3/16/2014 18:23
PT. Dexa Medica Botol 641,500.00 3/18/2014 20:03

PT. Dipa Pharmalab Dus, 1 syringe @ 0.5 mL 1,328,000.00 5/22/2014 14:25
PT. Otto Pharmaceuticals box 5ampul @1 ml 4,500.00 3/18/2014 20:03
PT. Bayer Indonesia Dus, vial 10 ml 138,000.00 4/3/2014 21:30
PT. Aventis Pharma Dus, 1 Vial @ 5 ml 72,000.00 4/3/2014 21:30
Injeksi 100 IU/ml, penfill

penfill disposible)
PT. Bayer Indonesia Dus Isi 5 penfill/cartridge @ 3ml 76,125.00 4/3/2014 21:30
PT. Sanbe Farma penfillcartridge @ 3ml 75,000.00 4/3/2014 21:30

penfill disposible)

penfill disposible)
PT. Sanbe Farma penfill cartridge @ 3ml 75,000.00 4/3/2014 21:30
PT. Indofarma Dus, botol 60 ml 3,499.00 3/15/2014 16:05

PT. Mugi Laboratories Dus, 1 vial @ 1 g 1,329,163.00 4/3/2014 21:30
PT. Tanabe Indonesia 3 blister @ 10 tablet 3,908.00 3/18/2014 20:03

PT. Dipa Pharmalab Dus, botol @ 100 ml 350,000.00 4/3/2014 21:30
PT. Dipa Pharmalab Dus, vial @ 30 ml 122,000.00 5/21/2014 10:06
PT. Bayer Indonesia Botol 245,000.00 4/3/2014 21:30

PT. Indofarma Dus, 5 blister @ 10 kss 1,425.00 3/15/2014 16:05
PT. Merck Tbk Dus, 10 strip @ 10 tablet 1,580.00 4/3/2014 21:30
PT. Ethica Industri Farmasi Ampul 7,800.00 4/3/2014 21:30
PT. Dexa Medica Dus, 3 Blister @ 10 tablet 4,900.00 3/15/2014 16:05
PT. Boehringer Ingelheim Boks, 120 tablet 27,500.00 4/3/2014 21:30
PT. Errita Pharma Dus, 10 strip @10 tablet 84 3/15/2014 16:05
PT. Novartis Indonesia Dus, botol @ 120 ml 44,770.00 3/16/2014 19:30
PT. Nicholas Laboratories IndonesiaDus,botol 100 tablet 875 4/3/2014 21:30
PT. Lucas Djaja Fenol 100 mg / 1 ml 2,042.00 3/18/2014 20:03
PT. Guardian Pharmatama Vial @ 10 ml 110,000.00 3/16/2014 18:23
PT. Novell Pharmaeutical Laboratories

Box isi 1 Tube @ 15 g 4,700.00 4/23/2013 10:24
PT. Kimia Farma tube 10 gr 2,569.00 4/23/2013 10:24

Dus, 3 Strip @ 10 Kaplet salut
PT. Ifars Pharmaceutical Laboratories 3,200.00 3/16/2014 18:23
selaput
PT. Kimia Farma Ktk 10X10 TAB 184 4/23/2013 10:24
PT. Hexpharm Jaya Laboratories Dus, 3 strip @ 10 tab 3,400.00 3/15/2014 16:05

PT. Mersifarma Tirmaku MercusanaKOTAK @ 5 x 10 TAB 5,000.00 4/3/2014 21:30

PT. Galenium Pharmasia Laboratories

Botol @ 60 ml 12,450.00 3/16/2014 19:08
PT. Erela Dus, 100 Sachet @ 30 Tablet 42 3/15/2014 16:05


Dus, botol plastik @ 30 tablet
PT. Novartis Indonesia 8,900.00 4/3/2014 21:30
salut selaput
PT. Glaxo Wellcome Indonesia Dus, Botol 120 Dosis 90,667.00 3/18/2014 20:03
PT. Glaxo Wellcome Indonesia Dus, foil strip @ 60 dosis 100,833.00 3/18/2014 20:03
PT. Holi Pharma Dus, 10 strip @ 10 kaptab 152 3/15/2014 16:05
PT. Kimia Farma ktk 60 tablet 670 4/23/2013 10:24

PT. Kimia Farma ktk 100 amp @ 2 ml 6,200.00 4/23/2013 10:24
PT. Kimia Farma Botol 60 tablet 1,400.00 4/23/2013 10:24
PT. Takeda Indonesia Serbuk vial 82,042.00 4/3/2014 21:30
PT. Indofarma Dus, 2 strip @ 10 kapsul 473 4/23/2013 10:24

Dus, 7 Blister @ 10 tablet 67,200.00 3/18/2014 20:03
PT. Finusolprima Farma Internasional

botol 500 ml 56,300.00 4/3/2014 21:30
PT Otsuka Indonesia Softbag 500 ML 56,300.00 3/18/2014 20:03
Double Chamber Softbag 1000

PT Otsuka Indonesia 115,500.00 5/28/2014 19:25
ML
ML
PT Kalbe Farma botol 500 mL 75,350.00 4/3/2014 21:30
PT. Fresenius Kabi Combiphar Botol Gelas 100 ml 36,667.00 4/14/2014 9:16


botol 250 ml 51,260.00 4/3/2014 21:30

botol 500 ml 64,900.00 4/3/2014 21:30
PT. Fresenius Kabi Combiphar Bag (3 Chamber) 1440 ml 295,240.00 4/14/2014 9:16
Bag Double chamber (Dua

PT. Phapros, Tbk 322,000.00 4/3/2014 21:30
compartement), 1000 mL

PT. Phapros, Tbk 218,700.00 4/3/2014 21:30
PT Otsuka Indonesia Ampoel 25 ML 2,050.00 3/18/2014 20:03
PT. Widatra Bhakti Botol 1000 ml 8,000.00 4/3/2014 21:30
PT Otsuka Indonesia Plastic Bottle 500 ML 9,000.00 4/3/2014 21:30
PT Kalbe Farma flexybag 250 mL 87,000.00 4/3/2014 21:30
LDPE (Low Density Poly

PT. Phapros, Tbk 12,650.00 4/3/2014 21:30
Ethilene), botol plastik

PT Kalbe Farma Flexy bag 500 mL 42,350.00 4/3/2014 21:30
PT Kalbe Farma Botol Plastik 1000 mL 210,000.00 5/21/2014 20:01
PT. Sanbe Farma softbag 500ml 35,750.00 4/3/2014 21:30
20%, Botol Kaca @100 ml, single

PT. Phapros, Tbk 105,500.00 4/3/2014 21:30
bottle

PT. Phapros, Tbk 210,000.00 4/3/2014 21:30
bottle
Bag, 3 chamber ( 3
PT. Phapros, Tbk 591,000.00 4/3/2014 21:30
kompartemen), 1250 ml
Bag, 3 chamber ( 3
PT. Phapros, Tbk 511,000.00 4/3/2014 21:30
Bag, 3 chamber ( 3
PT. Phapros, Tbk 358,000.00 4/3/2014 21:30
PT. Cendo Industri Farmasi strip 5 x 0.6 ml 72,000.00 4/3/2014 21:30

PT. Takeda Indonesia Vial 700,000.00 4/3/2014 21:30
PT. Takeda Indonesia Vial 2,700,000.00 4/3/2014 21:30
PT. Infion Pharmaceutical Box, 1 Botol @ 100 ml 40,000.00 3/15/2014 16:05

STRIP 528 4/23/2013 10:24
PT. Bernofarm Dus, 100 ampul @ 2 ml 839 3/15/2014 16:05

PT. AstraZeneca indonesia Dus, 10 syringe @ 10 g 40,000.00 4/3/2014 21:30

Box ,3 Strip @ 10 tablet 600 4/23/2013 10:24

Box ,3 Strip @ 10 tablet 350 4/23/2013 10:24

Dus, 10 Strip @ 10 Tablet 89 4/23/2013 10:24

STRIP 154 4/23/2013 10:24

botol 500 ml 62,000.00 6/16/2014 19:59
PT. Glaxo Wellcome Indonesia Box, Tablet 2 mg/25's 12,210.00 4/3/2014 21:30
PT. Bernofarm Dus, 1 vial @ 1 g 54,000.00 3/15/2014 16:05

PT. Mugi Laboratories Dus, 15 Ampul 74,998.00 4/3/2014 21:30
Dus, botol plastik @ 30 kapsul
pelepasan lambat
PT. Mahakam Beta Farma Strip 635 4/23/2013 10:24
PT. Natura Laboratoria Prima Dus, 10 Blister @ 10 Tablet 205 4/23/2013 10:24
PT. Dexa Medica Dus, 10 Blister @ 10 tablet 300 4/23/2013 10:24
PT. Natura Laboratoria Prima Dus, 1 Botol @ 100 ml 9,950.00 4/23/2013 10:24
PT. Aventis Pharma Dus, 2 blister @ 5 suppositoria 3,220.00 3/16/2014 18:23
PT. Phyto Kemo Agung Farma 10 strip @ 10 tab 110 4/23/2013 10:24
PT. Kimia Farma Dus @ 5 vial 1,237,500.00 5/21/2014 20:01
PT Kalbe Farma Box isi 5 ampul 5,600.00 3/16/2014 18:23
PT. Boehringer Ingelheim Boks 5 amp 12,060.00 3/16/2014 18:23
PT. Combiphar Dus,1 vial@50mg 260,000.00 4/3/2014 21:30
PT. Kimia Farma Tube 10 gram 3,000.00 4/23/2013 10:24
PT. Widatra Bhakti 10 mg /Vial 697,000.00 4/3/2014 21:30
PT. Tempo Scan Pacific botol, tetes mata 3 ml 77,000.00 4/3/2014 21:30
PT. Guardian Pharmatama tube 10 gram 17,820.00 3/15/2014 16:05
PT. Kimia Farma Dus 10 amp @ 1 ml 8,400.00 3/18/2014 20:03
PT. Mahakam Beta Farma Dus, 6 strip @ 10 tablet 15,620.00 4/3/2014 21:30
PT. Kimia Farma Ktk 10 ampul @ 1ML 10,499.00 3/15/2014 16:05
PT. Glaxo Wellcome Indonesia Dus, 5 blister @ 2 pfs 0.3 ml 54,144.00 3/18/2014 20:03
PT. Pratapa Nirmala Dus, 5 Ampul @ 2ml 61,600.00 3/16/2014 18:23


Box ,5 Blister @ 10 tablet 200 4/23/2013 10:24

PT. Combiphar Botol, 45 ml 33,900.00 5/21/2014 20:01
PT. Molex Ayus Tube 5 gr 6,490.00 3/16/2014 18:23
PT. Kimia Farma btl 60 tablet 2,800.00 4/23/2013 10:24
PT. Bayer Indonesia blister 2,999.00 3/16/2014 18:23
Dus, 10 Strip @ 10 tablet salut
PT. Dexa Medica 100 3/15/2014 16:05
selaput
PT. Phapros, Tbk Paket 359,900.00 4/23/2013 10:24
PT. Kimia Farma Paket 1,199,990.00 4/23/2013 10:24
PT. Kimia Farma Paket 214,990.00 4/23/2013 10:24
Dus, 1 dus @ 60 blister @ 8

tablet tahap intensif kategori 1 +
PT. Indofarma 288,199.00 4/23/2013 10:24
1 Dus @ 54 blister @ 3 tablet
tahap lanjutan kategori 1
Dus, 60 sachet tahap intensif @

(1 tablet Isoniazid, 2 kapsul
Rifampicin, 2 tablet
PT. Indofarma 171,195.00 4/23/2013 10:24
Pyrazinamide) + 120 sachet
tahap lanjutan @ (1 tablet
Isoniazid, 2 kapsul Rifampicin)

Box ,5 Strip @ 10 tablet 400 4/23/2013 10:24

Box ,5 Strip @ 10 tablet 650 4/23/2013 10:24
PT. Merck Tbk botol @ 10 ml 27,550.00 3/16/2014 18:23

Dus, vial @ 355m + 1 prefilled
PT. Novartis Indonesia syringe pelarut @ 2,5 ml + 2 2,950,000.00 4/3/2014 21:30
jarum suntik
PT. Bayer Indonesia Vial 120,000.00 5/21/2014 20:01
PT. Sandoz Indonesia 3 X 10 fcc 6,450.00 3/16/2014 18:23
PT. Natura Laboratoria Prima Dus, 1 Vial @ 40 mg 36,000.00 3/15/2014 16:05
PT. Indofarma Dus, 5 Ampul @ 2ml 2,400.00 3/15/2014 16:05
PT. Yarindo Farmatama Box 3 X 10 Tab 1,189.00 3/15/2014 16:05
Transfer Set: Set; Ultaclam:
Kantong Plastik; Tenckoff
PT Kalbe Farma 1,902,240.00 3/15/2014 16:14
Catheter: Box; Titanium
Adaptor: Kantong Plastik
PT Kalbe Farma Set 219,540.00 3/15/2014 16:14
Larutan Dialisa 1.5 %: 2.000 ml;
PT Kalbe Farma 5,522,580.00 3/16/2014 19:49
Larutan Dialisa 4.25 %: 2.000
ml; Minicap: Kantong Plastik
PT. Indofarma Dus, 15 botol 5,200.00
PT. Afifarma botol 60 ml 1,438.00 4/23/2013 10:24
PT. Imfarmind Farmasi industri Dus, 10 strip @ 10 kaptab 89 4/23/2013 10:24
PT. Boehringer Ingelheim Boks, 1 pfs 1,077,815.00 3/16/2014 19:08

PT. Pradja Pharin 2,420.00 4/3/2014 21:30
salut selaput

Tube @ 10 g 11,475.00 3/16/2014 19:08
PT. Kimia Farma Ktk 10 ampx2ml 14,500.00 3/15/2014 16:05

PT. Dexa Medica 30 TAB/BOX 3,120.00 3/16/2014 18:23
PT. Holi Pharma Botol 60 ml 8,360.00 3/15/2014 16:05
PT. Holi Pharma Dus, 25 Blister @ 4 tablet 298 3/15/2014 16:05
PT. Holi Pharma Dus 10 strip @ 10 tablet 208 4/23/2013 10:24
PT. Pratapa Nirmala Dus, Botol @ 10ml 17,393.00 3/16/2014 18:23
PT. Afifarma botol @ 1000 ml 37,109.00 3/15/2014 16:05
PT. Boehringer Ingelheim Dus, 3 alu blister @ 10 tablet 7,200.00 3/16/2014 19:08

Box ,5 Strip @ 10 tablet 2,300.00 4/23/2013 10:24

PT. Dexa Medica Dus, 10 Strip @ 10 kaptab 580 4/23/2013 10:24
PT. Natura Laboratoria Prima Dus, 10 Ampul @ 2 ml 1,140.00 4/23/2013 10:24
PT. Dexa Medica 120 4/23/2013 10:24
selaput
PT. Kimia Farma Botol 50 kapsul lunak 260 3/18/2014 20:03
PT. Lucas Djaja Botol 50 Kapsul 459 7/10/2014 15:53
PT. Widatra Bhakti botol 500 ml 5,200.00 4/23/2013 10:24

PT. Bayer Indonesia Blister 23,500.00 5/21/2014 20:01
Dus, 7 blister @ 4 Tablet lepas
Lambat
PT. Glaxo Wellcome Indonesia Dus, 7 blister @ 4 Tablet lepas 6,275.00 3/18/2014 20:03
Lambat
Lambat
PT. Glaxo Wellcome Indonesia Dus, botol 200 dosis 63,750.00 3/18/2014 20:03
PT. Glaxo Wellcome Indonesia Dus, 10 Blister @ 10 Kapsul 431 3/18/2014 20:03
PT. Glaxo Wellcome Indonesia Dus, 1 Rotahaler 5,867.00 3/18/2014 20:03
PT. Hexpharm Jaya Laboratories Dus, 5 strip @ 10 kapsul 513 4/23/2013 10:24
PT. Bernofarm Dus, 10 strip @ 10 kapsul 509 4/23/2013 10:24


Dus, 5 Strip @ 10 Kapsul 1,000.00 4/23/2013 10:24

vial 43,000.00 3/15/2014 16:05
PT. Dexa Medica Dus, 5 Strip @ 10 kapsul 850 4/23/2013 10:24

Dus, Botol 30 ml 8,800.00 4/23/2013 10:24
PT. Hexpharm Jaya Laboratories Dus, 2 vial @ 500 mg 4,997.00 4/23/2013 10:24
PT. Natura Laboratoria Prima Dus, 10 Vial @ 1 g 2,950.00 4/23/2013 10:24

PT. Sandoz Indonesia Dus, 3 blister @ 10 tablet 3,700.00 3/16/2014 19:08
PT. Hexpharm Jaya Laboratories Dus, 2 vial @ 1 g 17,060.00 4/23/2013 10:24

Dus, 1 Blister @ 10 Tablet salut
selaput
PT. Pertiwi Agung Box, 10 strips @ 10 capsules 181 3/15/2014 16:05
PT. Lucas Djaja 100 ampul @ 1 ml 1,077.00 4/23/2013 10:24

vial 82,000.00 3/16/2014 18:23
PT. Novartis Indonesia Dus, 10 blister @ 5 kapsul lunak 43,000.00 3/16/2014 19:08

PT. Natura Laboratoria Prima 169 3/15/2014 16:05
selaput
selaput
PT. Dexa Medica Vial 200 ml 13,000.00 4/23/2013 10:24
PT. Bernofarm Dus, 10 blister @ 10 tab ss 255 4/23/2013 10:24
PT. Indofarma Dus, 5 strip @ 10 tablet 1,499.00 4/23/2013 10:24
PT. Dexa Medica Vial 3,290,000.00 5/21/2014 20:01
PT. Kimia Farma dus 5 amp @ dus 10 127,000.00 3/18/2014 20:03
Pounch @ 5 blister @ 10
PT. Combiphar 11,167.00 3/18/2014 20:03
capsule
Dus, 1 pouch @5 blister@10
PT. Combiphar 21,500.00 4/3/2014 21:30
kaps
PT. Combiphar Box/ 2 blister @ 14 tablet 5,800.00 3/16/2014 19:08
PT. Combiphar Box @ 2 blister @ 14 tablet 5,800.00 3/18/2014 20:03

PT. Boehringer Ingelheim Dus, 2 alu-blister @10 tablet 3,900.00 6/27/2014 19:33
PT. AstraZeneca indonesia Dus, 2 pak @ 5 respules 6,250.00 4/3/2014 21:30
PT. Molex Ayus Box 50's 99 3/16/2014 18:23

PT. Holi Pharma Dus, 10 strip @ 10 kapsul 149 4/23/2013 10:24
PT. Merck Tbk Dus, 10 blister @ 10 tablet 1,135.00 4/3/2014 21:30
PT. Merck Tbk Dus, 10 blister @ 10 tablet 563 3/18/2014 20:03
PT. Pratapa Nirmala Dus, Botol Plastik @ 5ml 9,128.00 3/16/2014 18:23
Dus, 1 blister @10 kapsul +
PT. Boehringer Ingelheim 152,543.00 3/16/2014 19:08
handihaler
PT. Tempo Scan Pacific botol, tetes mata 2,5 ml 115,000.00 4/3/2014 21:30
PT. Aventis Pharma Dus, botol plastik 120 dosis 90,000.00 4/3/2014 21:30
PT. Darya Varia strip 405 4/23/2013 10:24

tube 6,400.00 3/16/2014 18:23
PT. Aventis Pharma 1 vial of 10ml (10 d's) 285,000.00 4/3/2014 21:30
PT. Abbott Indonesia Tablet 2,793.00 3/16/2014 19:08

PT. Mugi Laboratories Dus, 1 vial @ 1 ml 1,229,998.00 5/21/2014 14:16
PT. Combiphar Drops 10 mg/ml, Botol @15 ml 12,840.00 3/16/2014 18:23
PT. Meprofarm Dus, botol 60 ml 7,400.00 3/16/2014 18:23

Harga Satuan
No. Nama Obat Generik Nama Dagang Nama Penyedia Kemasan Terkecil (Rp)
Vial @ 10
1 Ketamin injeksi i.v. 100 mg/ml KTM PT. Guardian Pharmatama 110,000.00
ml
Dus, Botol
2 Dutasterid kaps lunak 0,5 mg Avodart PT. SmithKline BeechamPlastik
Phamaceuticals
@ 7,100.00
30 Tablet
Tanggal Berlaku Keterangan
Harga
3/16/2014 18:23 Harga Ekatolog blm bisa untuk RS swasta/ RS swasta diharga dengan harga reguler
3/18/2014 20:03 Harga Ekatolog blm bisa untuk RS swasta/ RS swasta diharga dengan harga DPHO 2013
Tgl Case
5-Aug-14
5-Aug-14
Nama Obat Generik Nama Dagang
ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida

1 n/a
tablet 200 mg)
2 Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera
3 Albendazol suspensi 200 mg/5 ml n/a
4 Albendazol tablet/kapsul/kaplet 400 mg n/a

Albumin serum normal (human albumin) injeksi 20%, 100 Zenalb
5 ml
Albumin serum normal (human albumin) injeksi 20%, 50
6 Zenalb
ml
11 Alprazolam tablet/kapsul/kaplet 1 mg n/a
12 Alteplase injeksi 50 mg/vial Actilyse
13 Amfoterisin B salep mata 1% Fungicide

14 Amikasin injeksi 250 mg/ml Glybotic 250 mg /ml
15 Aminofilin injeksi 24 mg/ml n/a
16 Aminofilin tablet scored 200 mg n/a
17 Amiodaron injeksi 150 mg/3 ml Cordarone

18 Amiodaron tablet/kaplet 200 mg Kendaron Tablet
19 Amitriptilin tablet salut 25 mg (HCl) n/a
22 Amoksisilin kapsul/kaplet 250 mg n/a
23 Amoksisilin kapsul/kaplet/tablet scored 500 mg n/a
24 Amoksisilin sirup kering forte 250 mg/5 ml n/a
25 Amoksisilin sirup kering 125 mg/ 5 ml n/a
26 Ampisilin serbuk injeksi i.v. 1000 mg/vial n/a
Analog insulin long acting inj 100 UI/ml, vial/cartridge Lantus Solostar
27 disposible/penfill cartridge (Insulin glargine 100 IU/ml) 100IU/ml 5pens x3ml
Analog insulin mix acting inj 100 UI/ml, Analog insulin mix
28 acting inj 100 UI/ml (Premix 30% Insulin Aspart + 70% Novomix Flexpen
Protaminated Insulin Aspart (Analogue))
Analog insulin mix insulininj 100 UI/ml, vial/cartridge

29 disposible/penfill cartridge (25% insulin lispro, 75% insulin Humalog Mix 25
lispro protamine suspension, (rDNA))
Analog insulin rapid acting inj 100 UI/ml, vial/cartridge
30 Novorapid Flexpen
Analog insulin rapid acting inj 100 UI/ml, vial/cartridge

31 Novorapid Vial
Analog insulin rapid actinginj 100 UI/ml, vial/cartridge Apidra Solostar

32 disposible/penfill cartridge (Insulin glulisine 100 IU/ml) 100IU/ml 5pens x3ml
Analog insulin rapid actinginj 100 UI/ml, vial/cartridge

33 Humalog
disposible/penfill cartridge (Insulin lispro (rDNA origin))
34 Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg
Antasida DOEN I tablet kunyah, kombinasi : Aluminium

35 n/a
Hidroksida 200 mg Magnesium Hidroksida 200 mg
Antasida DOEN II suspensi, kombinasi : Aluminium

36 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 mg/5 n/a
ml
Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g
37 n/a
Polimiksin 10.000 IU/g
Antimalaria DOEN kombinasi : Pirimetamin 25 mg
38 n/a
Sulfadoksin 500 mg
39 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg n/a
Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg
40 Levopar Tablet
Levodopa 100 mg
41 Artemether injeksi 80 mg/ml Artem
42 Asam Asetilsalisilat (asetosal) tablet 100 mg n/a
45 Asam Folat tablet/kapsul/kaplet 0,4 mg Starfolat
46 Asam Folat tablet/kapsul/kaplet 1 mg n/a
47 Asam Ibandronat injeksi 6mg/6ml Bondronat
48 Asam Mefenamat kapsul/kaplet 500 mg n/a
49 Asam pipemidat kapsul 400 mg Urotractin 400 mg

52 Asiklovir salep mata 3% Temiral Eye Oint
55 Asparaginase serbuk injeksi 10.000 UI/vial Leunase
56 Atapulgit tablet 600 mg Pularex
57 Atrakurium injeksi 25 mg/2,5 ml Tracrium
58 Atropin Sulfat tablet 0,5 mg n/a
59 Azitromisin sir kering 200 mg/ 5 mL n/a
62 Bedak salisil serbuk 2% n/a
63 Benzatin Benzil Penisilin 1,2 juta IU/ vial n/a
64 Benzatin Benzil Penisilin 2,4 juta IU/vial n/a
65 Beractant injeksi / suspensi 25 mg/mL Survanta
66 Beraprost sodium tablet 20 mcg Dorner 20 µg
67 Beraprost sodium tablet 20 mcg Dorner
68 Betametason krim 0,1% (sebagai Valerat) n/a
71 Bisakodil suppositoria 10 mg Stolax supp
72 Bisoprolol tablet 2,5 mg Concor 2.5
73 Bisoprolol tablet 5 mg n/a
74 Bleomisin serbuk injeksi 15 mg/ampul BLEOCIN
75 Bromokriptin tablet 2,5 mg Cripsa tab
76 Budesonid inhaler 200 mcg/puff, 100 dosis Pulmicort Turbuhaler
77 Budesonid respules / cairan inhaler 0,25mg/mL Pulmicort Respules
Budesonid-formoterol (fixed combination) inhaler 160/4,5 Symbicort Turbuhaler

78 mcg 160/4.5 mcg
Budesonid-formoterol (fixed combination) inhaler 80/4,5

79 Symbicort 80/4.5 mcg
mcg
80 Bupivakain injeksi 0,50% (HCl) + glukosa 8% n/a
81 Bupivakain injeksi 0,50% (P.V) Bunascan
84 Dakarbazin serbuk injeksi 200 mg/vial DBL Dacarbazine
85 Daunorubisin serbuk injeksi 20 mg/vial DAUNOCIN
88 Deferipron larutan oral 100 mg/mL Ferriprox Oral Solution
89 Deferipron tablet 500 mg Ferriprox tablet

90 Deferoksamin Mesilat serbuk injeksi 500 mg Desferal
91 Deksametason injeksi i.v./i.m. 5 mg/ml n/a
92 Deksametason tablet 0,5 mg n/a
93 Desogestrel tablet 75 mcg Cerazette
94 Desoksimetason krim 0,25% n/a
95 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) n/a
96 Digoksin tablet 0,25 mg n/a
97 Diltiazem HCl tablet 30 mg n/a
Herbesser Powder
98 Diltiazem infus injeksi 50 mg Injection 50mg
Farmabes Injeksi 25
99 Diltiazem injeksi 25 mg/5 mL mg
102 Dinatrium edetat tetes mata 0,35% E.D.T.A
103 Dobutamin injeksi 50 mg/mL DOBURAN
106 Doksorubisin serbuk injeksi i.v. 10 mg/vial Doxorubicin kalbe
107 Doksorubisin serbuk injeksi i.v. 50 mg/vial Doxorubicin Actavis 50

mg
108 Domperidon suspensi/sirup 5 mg/5 ml n/a
109 Domperidon tablet 10 mg n/a
110 Domperidon tetes 5 mg/mL n/a
111 Dopamin injeksi 40 mg/ml UDOPA
112 Dosetaksel injeksi 20 mg/0,5 ml n/a
113 DTPA (diethylene triamine pentaacetic acid) 2,06-2,5 mg Renalscan KaeF

pentetate calcium trisodium/mL
114 Dutasterid kaps lunak 0,5 mg Avodart
115 Efavirens tablet salut 600 mg n/a

116 Eksemestan tablet 25 mg Aromasin
120 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml n/a

121 Epirubisin serb injeksi 50 mg/25ml Epirubisin Kalbe
122 Epirubisin serb injeksi 10 mg/5 ml n/a
123 Ergokalsiferol (vitamin D3/D2) kapsul 50.000 UI D-Vit FT
124 Ergokalsiferol (vitamin D3/D2) suspensi 10.000 UI/ml D-Vit Syrup

127 Eritromisin sirup kering 200 mg/ 5 ml n/a
128 Eritropoetin-alfa inj 3000 UI/mL Hemapo 3000
129 Eritropoetin-beta inj 2000 UI/0,3 mL Recormon
130 Etambutol tablet 250 mg (HCl) n/a
131 Etambutol tablet salut 500 mg (HCl) n/a
132 Etanol 70% cairan n/a
133 Etinilestradiol tablet 0,05 mg Lynoral
134 Etonogestrel implan 68 mcg Implanon
135 Etoposid injeksi 20 mg/ml Posyd

136 Eugenol cairan n/a
139 Faktor VIIa (rekombinan) serb inj 1 mg/vial + pelarut untuk Novoseven
injeksi
140 Fenitoin injeksi 50 mg/ml n/a
141 Fenitoin kapsul/kaplet 100 mg n/a
142 Fenitoin Na Inj 100 mg/2 ml n/a
143 Fenobarbital injeksi i.m./i.v. 50 mg/ml n/a
146 Fenoksimetil penisilin (penisilin V) tablet 250 mg n/a
147 Fenoksimetil penisilin (penisilin V) tab 125 mg Fenocin
148 Fenoksimetil penisilin (penisilin V)tablet 500 mg n/a
149 Fenoterol HBr ih 100 mcg/puff Berotec MDI
150 Fenoterol HBr inh solution 0,1% Berotec Solution
Durogesic 12,5 MU
153 Fentanil patch 12,5 mcg/jam Matrix
Durogesic 25 MU
Durogesic 50 MU
156 Filgrastim inj 300 mcg/mL Leucogen
157 Fitomenadion (Vit.K1) tablet salut gula 10 mg n/a
158 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml n/a
159 Fludarabin inj 50 mg Fludara IV LYO
160 Fludarabin tab 10 mg Fludara Oral
161 Flufenazin injeksi i.m. 25 mg/ml Sikzonoate Injeksi

162 Flukonazol injeksi 2 mg/ml n/a
163 Flukonazol tablet/kapsul 150 mg n/a
164 Fluoksetin tablet 10 mg Foransi 10
165 Fluoksetin tablet 20 mg NOPRES
166 Fluorourasil inj 250 mg/mL Curacil
167 Fluorourasil inj 500 mg/ 5 mL Curacil
168 Flusinolon asetonid krim 0,025% SYNARCUS
169 Flutikason furoat intranasal spray Avamys
170 Flutikason propionat nebules 0,5 mg Flixotide Nbules
171 Fondaparinuks inj 2,5 mg/0,5 mL Arixtra

172 Fraksi protein plasma lar inf 5% Plasmanate
173 Furosemid injeksi i.v./i.m. 10 mg/ml n/a
174 Furosemid tablet 40 mg n/a
175 Gadobutrol macrocyclic 5 mg Gadovist 5 mg
176 Gadobutrol macrocyclic 7,5 mg Gadovist 7,5 mg
177 Gadoksetat disodium 0,25 mmol gadoxetate disodium/mL Primovist
178 Gansiklovir serb inj 500 mg (50 mg/mL) Cymevene

Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g
179 kalium klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g n/a
Glukosa Anhidrat 2,70 g
180 Gefitinib tab 250 mg Iressa 250 mg
181 Gemfibrozil kapsul/kaplet 300 mg n/a
182 Gemfibrozil tablet 600 mg n/a
183 Gemsitabin inj 1000 mg/vial Gemzar 1000 mg
184 Gemsitabin inj 200 mg/vial n/a
185 Gentamisin injeksi 40 mg/ ml n/a
186 Gentamisin salep mata 0,3% Genoint Salep Mata
187 Gentamisin tetes mata 0,3% n/a
188 Glibenklamid tablet 5 mg n/a
189 Gliklazid tab 80 mg Glicab
190 Gliklazid tab 30 mg Diamicron MR 30
191 Glikuidon tab 30 mg n/a

196 Gliseril trinitrat kaps SR 2,5 mg Nitrokaf Retard
197 Gliseril trinitrat kaps SR 5 mg Nitrokaf Forte
198 Gliseril trinitrat tab sublingual 0,5 mg Nitral
199 Gliserin lar 50% Gliserin lar 50%
202 Goserelin asetat inj 10,8 mg/vial Zoladex 10,8 mg
203 Goserelin asetat inj 3,6 mg Zoladex 3,6 mg
204 Griseofulvin tablet 125 mg n/a
205 Haloperidol inj 50 mg/mL Haldol Decanoas
207 Haloperidol tablet 5 mg n/a
209 Haloperidol tablet 2 mg Lodomer 2
210 Halotan Inhalasi Halothane
211 Heparin injeksi i.v./s.k. 5000 UI/ml Inviclot
212 Hepatitis B imunoglobulin (human) Hyperhep B
213 Hidrokortison krim 2,5 % n/a
214 Hiosin butilbromid injeksi 20 mg/ml n/a
215 Human insulin intermediate acting inj 100 UI/ml, vial Insulatard Vial
(Human Insulin (Intermediate-Acting))
216 Human insulin intermediate acting inj 100 UI/ml, vial Humulin N Vial
(Insulin human Basal)
217 Human insulin intermediate acting inj 100 UI/ml, n/a

vial/cartridge disposible/penfill cartridge
218 Human insulin intermediate acting inj 100 UI/ml,penfill Insulatard Penfill
cartridge (Human Insulin (Intermediate-Acting))
219 Human insulin intermediate acting inj 100 UI/ml,penfill Sansulin N

220 Human insulin intermediate acting inj 100 UI/ml,penfill Humulin N Cart
221 Human insulin mix insulin inj 100 UI/ml, penfill cartridge
(Human Insulin (Premix: 30% Soluble + 70 % NPH Insulin)) Mixtard Penfill
222 Human insulin mix insulin inj 100 UI/ml, penfill cartridge Humulin 30/70 Cart
(Insulin human Comb)
223 Human insulin mix insulin inj 100 UI/ml, vial (Human Mixtard Vial
Insulin (Premix: 30% Soluble + 70 % NPH Insulin))
224 Human insulin mix insulin inj 100 UI/ml, vial (Insulin Humulin 30/70 Vial
human Comb)
225 Human insulin short acting inj 100 UI/ml, penfill cartridge Actrapid Penfill
(Human Insulin (Short Acting))
226 Human insulin short acting inj 100 UI/ml, penfill cartridge Humulin R Cart
227 Human insulin short acting inj 100 UI/ml, penfill cartridge Sansulin R
228 Human insulin short acting inj 100 UI/ml, vial (Human Actrapid Vial
Insulin (Short Acting))
229 Human insulin short acting inj 100 UI/ml, vial (Insulin Humulin R Vial
human Rapd)
230 Human insulin short acting inj 100 UI/ml, vial/cartridge n/a
disposible/penfill cartridge
231 Human tetanus imunoglobulinn injeksi i.m. 250 UI Tetagam
232 Ibuprofen sirup 100 mg/5 ml n/a
233 Ibuprofen suspensi 200 mg/5 ml n/a
236 Ifosfamid serbuk injeksi 1000 mg/vial Holoxan injeksi 1000


249 Ipratropium bromida inhalasi 20 mcg/semprot Atrovent HFA
252 Irinotekan inf 20 mg/ml n/a
253 Isosorbid Dinitrat injeksi i.v 10 mg/10 ml Farsorbid inj
254 Isosorbid Dinitrat tablet sublingual 5 mg n/a
255 Kalium aspartat tab 300 mg Kalipar
256 Kalium Klorida tablet 600 mg KSR
257 Kalsium Folinat (Leukovorin Ca) inj 50 mg/ml DBL Leucovorin
258 Kalsium Glukonat injeksi i.v 10% (100 mg/ml) Kalsium glukonat
261 Kapesitabin tab 500 mg Xeloda
262 Kaptopril tablet 50 mg n/a
263 Kaptopril tablet scored 25 mg n/a
264 Kaptopril tablet scored12,5 mg n/a
Tegretol Syrup
265 Karbamazepin sirup 100 mg/5 ml 100mg/5ml, 120ml
266 Karbamazepin tablet 200 mg n/a
267 Karbimazol tab 5 mg Neo-Mercazole
Karbogliserin tetes
268 Karbogliserin tetes telinga 10% telinga 10%
DBL Carboplatin 150
269 Karboplatin 150 mg / 15 ml mg
DBL Carboplatin 450
270 Karboplatin 450 mg / 45 ml mg
271 Ketamin injeksi i.v. 100 mg/ml KTM
274 Ketokonazol tablet 200 mg n/a
275 Ketoprofen supositoria 100 mg Protofen Supp
276 Ketorolac injeksi 30 mg/ml n/a
277 Klaritromisin tab 500 mg ORIXAL

280 Klobazam tab 10 mg n/a
281 Klonidin injeksi i.v 0,15 mg/ml (HCL) (150) Catapres Injeksi
282 Klonidin tablet 0,15 mg n/a
283 Klopidogrel tab 75 mg n/a
284 Kloramfenikol salep mata 1 % n/a
285 Kloramfenikol suspensi 125 mg/ 5 ml n/a
286 Klorpromazin injeksi i.m. 25 mg/ml (HCl) n/a
287 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) n/a
293 Koloid HES BM 130 000 lar inf 6% Voluven
294 Kombinasi suspensi : Parafin + gliserin + fenolftalein Laxadine Emulsi 60 ml
295 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam n/a
folat 0,25 mg
296 Kombinasi tetes mata 2,5 mg/mL: Natrium klorida 8,664 Cendo Lyteers
mg; Kalium klorida 1,32 mg
297 Kombinasi: Artemether 20 mg; Lumefantrin 120 mg Coartem
298 Kombinasi: Levodopa 100 mg; Karbidopa 25 mg; Stalevo

Entekapon 200 mg
299 Kombinasi: Lopinavir 200 mg; Ritonavir (LPV/r) 50 mg Aluvia
300 Kombinasi: Salmeterol 25 mcg; Flutikason propionat 50 Seretide Inhaler 50

mcg mcg
mcg mcg
mcg mcg
303 Kotrimoksazol DOEN I (dewasa) kombinasi : n/a

Sulfametoksazol 400 mg Trimetoprim 80 mg
304 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + n/a
Trimetoprim 40 mg / 5 ml
305 Kuinin (Kina) tablet 200 mg n/a
306 Kuinin injeksi i.v. 25% (sebagai 2 HCl) n/a
307 Kuinin tablet 222 mg (H2SO4.7H2O) n/a
308 Lamivudine tablet 150 mg n/a
309 Lansoprazol inj 30 mg/ml Prosogan Inj.
310 Lanzoprazol kapsul/kaplet 30 mg n/a
311 Lapatinib tab 250 mg Tykerb
312 Larutan mengandung Asam Amino (Asam Amino 10%) Kalbamin
313 Larutan mengandung Asam Amino (Asam Amino 100 g, Amiparen

Total N 15,7 g, Na+ 2 mEq, Asetat 120 mEq)
314 Larutan mengandung Asam Amino (Asam Amino 27 g, Pan-amin G

Sorbitol 50 g, Cl- 52 mEq)


Larutan mengandung Asam Amino (Asam Amino 5%
317 dengan BCAA 45%, L-Ornithine L Aspartate 8.03 gr/L, Aminofusin Hepar
Sorbitol 50 gr/L, Xylitol 50 gr/L)
318 Larutan mengandung Asam Amino (Asam Amino 6%, Aminosteril Infant 6%
mengandung Taurine 0,24 gr/l)
Larutan mengandung Asam Amino (Asam Amino 7%,
319 Komposisi: Asam Amino esensial: Asam Amino non Nephrosteril
esensial = 60 : 40)
Larutan mengandung Asam Amino (Asam Amino 72.05 g,

320 Total N 11.53 g, AAE/AANE ratio 2.6, Na+ 2 mEq, Asetat 46 Kidmin
mEq)
321 Larutan mengandung Asam Amino (Asam Amino 79.9 g, Aminoleban

Total N 12.2 g, Na+ 14 mEq, Cl 94 mEq)
322 Larutan mengandung Asam Amino (Asam amino 8%) Aminosteril N-Hepa
323 Larutan mengandung Asam Amino (Asam Amino esensial Eas Pfrimer
7%+Xylitol 10 g/L)
Larutan mengandung Asam Amino (BCAA 25 gr/L, L-
324 Ornithine L Aspartate 10 gr/L, Xylitol 50 gr/L, Malic Acid 7 Comafusin Hepar
gr/L, Piridoxin 0.12 gr/L)

aminno 50 g/L, Sorbitol 50 g/L, Xylitol 50 g/L, Asam
325 Askorbat (Vit C) 0.4 g/L, Inositol 0.5 g/L, Nikotinamida Aminofusin L600
(Niasinamida) 0.06 g/L, Piridoksin HCl (Vit B6) 0.04 g/L,
Riboflavin Natrium Fosfat 2.5 mg/L, elektrolit)
326 Larutan mengandung Asam Amino (Kombinasi Asam Aminofusin Paed
amino 50 g/L, vitamin dan elektrolit)

Larutan mengandung Asam Amino (Kombinasi Glukosa Combiflex Plus (790

329 dan elektrolit 150 gr + Asam Amino 48 gr dgn akses kcal)
sentral)
330 Larutan mengandung Asam Amino (Kombinasi Glukosa Combiflex peri (480
dan elektrolit 80 gr + Asam Amino 40 gr ) kcal)
331 Larutan mengandung Elektrolit (Kalium Klorida) Otsu - KCl 7,46%
332 Larutan mengandung Elektrolit (Larutan Ringer Laktat) Wida RL
333 Larutan mengandung Elektrolit (Na 130 mEq, Cl 109 mEq, Asering
Ca 3 mEq, Asetat 28 mEq)
334 Larutan mengandung Elektrolit (NaCl 1.125 gr, Dekstrosa KA EN 1B

18.75 gr)
Larutan mengandung Elektrolit (Sodium Lactate sol (50%)
335 113 gr/L, Potassium Chloride 0.3 gr/L, Calcium Chloride 0.2 Totilac
gr/L, elektrolit)
Larutan mengandung Elektrolit (Tiap 1000 ml

mengandung electrolit: Sodium 145 mmol/l, Potassium 4.0
336 mmol/l, Calcium 2.5 mmol/l, Magnesium 1.0 mmol/l, Ringerfundin 500 mL
Chloride 118 mmol/l, Acetate 24 mmol/l, Malate 5.0
mmol/l)

66 g, Xylitol 60 g/ L + elektrolit)

33 g, Xylitol 30 g/ L)
339 Larutan mengandung Karbohidrat (Maltose 100 gr) Martos
Larutan mengandung Karbohidrat + Elektrolit (25.00g
340 maltose, 3.00 g sodium chloride, 0.15 g potassium Potacol inj
chloride, 0.10 g calcium chloride dihydrate dan 1.55 g
sodium lactate)
341 Larutan mengandung Karbohidrat + Elektrolit (Acetate, Na, Tutofusin OPS

K, Cl, Ca, Mg, Sorbitol 50 gr/L)


344 Larutan mengandung Karbohidrat + Elektrolit (Fructose 60 Triofusin E1000

g, glucose 33 g, Xylitol 30 g/ L)
Larutan mengandung Karbohidrat + Elektrolit (Glukosa 25
345 g, NaCl 2,0 g, KCl 1,3 g, Natrium Laktat 3,1 g, air untuk Wida HSD
injeksi ad 1000 ml)
346 Larutan mengandung Karbohidrat + Elektrolit (Glukosa 55 Wida D5-NS

g ; Natrium Chloride 9 g, air untuk injeksi ad 1000 ml)
347 Larutan mengandung Karbohidrat + Elektrolit (Glukosa: WIDA 2A

25,0 g; NaCl: 4,5 g)

55.0 g; NaCl: 2.25 g)

55.0 g; NaCl: 4.5 g)
Larutan mengandung Karbohidrat + Elektrolit (Larutan

350 nutrisi kombinasi infus per L: Na. 100mEQ, K 18mEQ, Ca. Futrolit
4mEQ, Mg 6mEQ, Cl 90mEQ, Asetat 38mEQ, Sorbitol 50g)
351 Larutan mengandung Karbohidrat + Elektrolit (Larutan Wida RD

Ringer & Glukosa 5%)
352 Larutan mengandung Karbohidrat + Elektrolit (NaCl 1.75 g, KA ENMG 3

KCL 1.5g, Glukosa 100 gr)
353 Larutan mengandung Karbohidrat + Elektrolit (Nacl 1.75 gr, KA EN 3B

KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27 gr)
354 Larutan mengandung Karbohidrat + Elektrolit (Nacl 2.34 gr, KA EN 3A

Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27 gr)
355 Larutan mengandung Lipid ( Infus Lipid Emulsi MCT/LCT Lipofundin MCT/LCT
20% 100 ml) 1% 100
356 Larutan mengandung Lipid (Emulsi lemak 20%) Intralipid
357 Larutan mengandung Lipid (Infus Lipid Emulsi MCT/LCT Lipofundin MCT/LCT
20% 250 ml) 1% 250
akses sentral)
359 Larutan mengandung Lipid (Kombinasi Glukosa dan Nutriflex Lipid Peri
elektrolit 80 gr + Asam Amino 40 gr + Lipid MCT/LCT 50 gr) 1250

akses sentral)
Larutan mengandung Lipid (Soybean Oil 200 g/L, Egg

361 Lecithins 12 gr/L, Glycerol Ph 25 gr/L, Sodium Oleate 0.3 Ivelip
gr/L)
362 Latanoprost tetes mata 0,01% Cendo Glaopen
363 Latanoprost tts mata 0,005% btl@2,5ml Xalatan 0,005%
Granocyte 34 1vl HSA
364 Lenograstim inj 263 mcg/mL Free
365 Leuprorelin asetat inj depot 1,88 mg Tapros 1.88mg

366 Leuprorelin asetat inj depot 11,25 mg Tapros 3M
367 Levofloksasin inf 5 mg/mL n/a
368 Levofloksasin tablet 500 mg n/a
369 Lidokain injeksi 2% (HCL) n/a
370 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml n/a
371 Lidokain jeli 2% Xylocaine Jelly 2%
376 Loperamid tablet 2 mg n/a
377 Loratadin tablet 10 mg n/a
378 Lorazepam tablet 2 mg Merlopam 2
379 Low molecule feri sucrose inj amp 100 mg/5 mL DIALIFER
380 Manitol n/a
381 Maprotilin HCl tab 25 mg Ludios
382 Maprotilin HCl tab 50 mg Sandepril 50
383 MDP (methylene diphosphonate) 1 mg methylene Bonescan KaeF

diphosphonic acid/mL
384 Mebendazol tablet 500 mg Vermox 500
385 Melfalan tablet 2 mg Alkeran
386 Meropenem inj 1 g n/a
387 Meropenem serb inj 500 mg/vial n/a
388 Mesna inj 100 mg/mL Uromitexan injeksi.
389 Metadon sir 50mg/5ml n/a
390 Metformin HCl tablet 500 mg n/a
391 Metilergometrin Maleat (Metilergometrin) tablet salut n/a

0,125 mg
392 Metilfenidat kapsul LA 20 mg Ritalin LA
393 Metilprednisolon inj 125 mg/2 mL n/a
394 Metilprednisolon inj 500 mg/8 mL n/a

398 Metoklopramide tablet 5 mg n/a
399 Metronidazol infus 500 mg/100 ml n/a
400 Metronidazol supositoria 500 mg Flagyl

403 MIBI (metoxy iso butyl iso nitril) 5-mL reaction vial Cardioscan KaeF
404 Midazolam injeksi i.v. 1 mg/ml Fortanest
405 Midazolam injeksi i.v. 5 mg/ml Dormicum
406 Mikafungin Na serb inj 50 mg Mycamine
407 Mikofenolat Mofetil 500 mg Cellcept
408 Mikonazol krim/salep 2 % (Nitrat) n/a
409 Mitomisin C (crystallin) serbuk inj 10 mg/vial Mitomycin C
410 Moksifloksasin tetes mata 0,5% Vigamox
411 Mometason furoat krim 0,1% n/a
412 Morfin HCL inj 10 mg/ml n/a
415 Morfin injeksi i.m./s.k./i.v. 10 mg/ml n/a
416 Morfin tablet 10 mg n/a
417 Nacl 0,9% n/a
418 Nadroparin inj 9500 Axa/mL syringe 0,3 mL Fraxiparine 0.3 ml
421 Nalokson injeksi 0,4 mg/ml Nokoba
422 Natrium Bikarbonat injeksi i.v 8,4% Meylon
425 Natrium fosfat lar oral 45 mL Fleet Phosphosoda
426 Natrium fusidat salep 20 mg/g Fucilex Ointment
427 Neostigmin injeksi 0,5 mg/ml Neostigmin Hameln inj
428 Nevirapin tablet 200 mg n/a

429 Nifedipin tab 20 mg, slow release; oros Adalat Oros 20 mg
430 Nifedipin tab 30 mg, oros Adalat Oros 30 mg
431 Nifedipin tablet/kapsul 10 mg n/a
432 Nistatin tablet salut 500.000 IU/ g n/a

433 Nistatin vaginal tablet 100.000 IU/ g n/a
434 Norepinefrin injeksi 1 mg/ml Levosol
435 Noretisteron tablet 5 mg Primolut N
438 Obat Antituberkulosis FDC Kategori Anak n/a
439 Obat Antituberkulosis FDC Sisipan n/a
440 Obat Antituberkulosis Kategori 1 dewasa n/a

441 Obat Antituberkulosis Kategori anak n/a

444 Oksaliplatin serbuk injeksi 100 mg / vial ELOXATIN
445 Oksaliplatin serbuk injeksi 50 mg / vial ELOXATIN
446 Oksimetazolin tetes hidung 0,025% Ilaidin Drops
447 Oktreotid 10 mg Sandostatin LAR
448 Olanzapin inj 10 mg/vial Zyprexa IM

449 Olanzapin kapl salut 5 mg Olandoz 5
450 Olanzapin tab 10 mg Olandoz 10
451 Olopatadin tts mata 0,1% Patanol
452 Omeprazol injeksi 40 mg/ 10 ml n/a
453 Omeprazol kapsul/kaplet 20 mg n/a
454 ondansetron inj 4 mg/ 2 mL n/a
455 Ondansetron tab 4 mg n/a
456 Ondansetron tablet 8 mg n/a
457 Paket CAPD Awal (Komposisi: 1 unit Transfer Set, 2 unit n/a
Ultaclam, 1 unit Tenckoff Catheter, Titanium Adaptor)
458 Paket CAPD Pergantian Transfer Set per 6 bulan n/a

Dianeal Low Calcium
with 1,5% Dextrose;
Paket CAPD Rutin 120 ( 4x ganti cairan perhari dengan Larutan Dialisa 2.5%:
459 komposisi Larutan Dialisa 1.5 %, Larutan Dialisa 2.5 %, Dianeal Low Calcium
Larutan Dialisa 4.25 %, Minicap) with 2,5% Dextrose;
Dianeal Low Calcium
with 4.25% Dextrose
SINDAXEL 100
460 Paklitaksel inj 100 mg/vial MG/16,67 ML
SINDAXEL
461 Paklitaksel inj 300 mg/vial 260mg/43.33 ML
SINDAXEL 30 MG/5
462 Paklitaksel injeksi 30 mg/vial ML
463 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) n/a
464 Parasetamol sirup 120 mg / 5 ml n/a

465 Parasetamol tablet 500 mg n/a
466 Parasetamol tetes 60 mg/0,6 mL FASIDOL
Pegintron Vial 100

469 Pegylated Interferon alfa-2b serb inj 100 mcg Mcg
Pegintron Pen 120

470 Pegylated Interferon alfa-2b serb inj 120 mcg Mcg
471 Pegylated Interferon alfa-2b serb inj 50 mcg Pegintron
472 Pegylated Interferon alfa-2b serb inj 80 mcg Pegintron Vial 80 Mcg
473 Perak sulfadiazin krim 1% BURNAZIN 35 GR
474 Perindoprilarginin tab 5 mg Bioprexum 5 mg
475 Permetrin krim 5% Scabimite Cream 10

476 Petidin injeksi i.m/s.k/i.v lambat 50 mg/ml (HCl) n/a
479 Pirantel suspensi 125 mg/5 ml n/a
480 Pirantel tablet score (base) 125 mg n/a
481 Pirazinamid tablet 500 mg n/a
482 Polikresulen cairan Aptil
488 Pravastatin tablet 20 mg n/a
489 Propanolol tablet 10 mg ( HCl ) n/a
490 Propofol injeksi i.v., bolus 1% Fresofol 1% MCT/LCT
491 Propranolol tablet 40 mg (HCl) n/a

Cardace 2.5mg 6x10 s
495 Ramipril tablet 2,5 mg tablet
496 Ramipril tablet 5 mg n/a
497 Ranitidin injeksi 25 mg/ml n/a
498 Ranitidin tablet 150 mg n/a
499 Retinol (Vitamin A) 100.000 IU n/a

500 Retinol (Vitamin A) 200.000 IU kapsul lunak n/a
501 Ringer Laktat larutan infus n/a
Requip PD 24 Hour 2
Requip PD 24 Hour 4
Requip PD 24 Hour 8
511 Salbutamol inhalasi/aerosol 100 mcg/dosis Ventolin Inhaler
512 Salbutamol serb inh 200 mcg/kaps Ventolin Rotacaps
513 Salbutamol serb inh 200 mcg/kaps + rotahaler Ventolin Rotahaler
514 Salbutamol tablet 2 mg (sebagai Sulfat) n/a
515 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap n/a

4%
516 Sefadroksil sirup kering 125 mg/5ml n/a
519 Sefadroksil sir kering 250 mg/5 mL n/a
520 Sefaleksin kapsul/kaplet 500 mg n/a
521 Sefazolin serbuk injeksi 1 g/vial n/a
522 Sefepim inj 1 g n/a
523 Sefiksim kapsul/kaplet 100 mg n/a
524 Sefiksim sirup kering 100 mg/ 5 ml n/a
525 Sefoperazon inj 1 g n/a
526 Sefotaksim injeksi 0,5 g n/a
527 Sefotaksim injeksi 1 g n/a
528 Sefpodoksim proksetil tab 100 mg Banadoz 100
529 Seftazidim injeksi 1 g n/a
530 Seftriakson serbuk injeksi 1 g/vial n/a
531 Sefuroksim tab 500 mg Zinnat 500
532 Sertralin tab 50 mg Fatral

533 Setirizin tablet 10 mg n/a
534 Sevofluran ih, btl Sojourn
535 Sianokobalamin (vitamin B12) injeksi 500 mcg n/a
536 Siklofosfamid serbuk injeksi i.v. 200 mg Cyclovid 200 mg
Sandimmun Neoral
537 Siklosporin kaps 100 mg 100mg Kap
Sandimmun Neoral
538 Siklosporin kapsul lunak 25 mg 25mg Kap
539 Simvastatin scored tablet 10 mg n/a
540 Simvastatin tablet 20 mg n/a
541 Siprofloksasin infus 2% n/a

542 Siprofloksasin tablet 500 mg (sebagai HCl) n/a
543 Sisplatin serbuk injeksi 10 mg Cisplatin
544 Sisplatin serbuk injeksi 50 mg Cisplatin
545 Sitarabin serbuk injeksi i.m./i.v./s.k. 1gr/10ml DBL Cytarabun
546 Spiramisin tablet 500 mg n/a
549 Streptokinase injeksi 1,5 juta UI/vial Streptase
550 Streptomisin serbuk injeksi i.v 1000 mg/ml n/a
Sufentanyl Injeksi
551 Sufentanil injeksi iv, epidural 5 mcg/ml iv.Epidural 5 mcg / ml
552 Sukralfat susp 500 mg/5 mL Ulsafate
553 Takrolimus kaps 0.5 mg Prograf
554 Takrolimus kaps 1 mg Prograf
555 Tamsulosin tab 0,2 mg Harnal D

Harnal ® D 0.2 mg
556 Tamsulosin tab 0,2 mg Disp. Tablet
Harnal ® OCAS 0.4 mg
557 Tamsulosin tab SR 0,4 mg Tablet
558 Telbivudin tab 600 mg Sebivo 600 mg Tab
559 Telmisartan tab 40mg Micardis 40mg
560 Telmisartan tab 80 mg Micardis 80mg
561 Temozolamid kaps 100 mg Temodal
562 Temozolamid kaps 20 mg Temodal
563 Tenofovir tab 300 mg n/a
564 Terbutalin cairan ih 2,5 mg/mL Bricasma Respules
565 Terbutalin tablet 2,5 mg Molasma Tablet
Bricasma Turbuhaler
566 Terbutalin turbu (serbuk ih) 0,50 mg 0,5 mg
567 Testoteron soft capsul 40 mg Andriol Testocaps
568 Tetrakain HCl tetes mata 0,5% Pantocain 0.5%

569 Tetrasiklin kapsul/kaplet 250 mg n/a
Spiriva 10s +
574 Tiotropium kaps 18 mcg + handihaller Handihaler
575 Tramadol injeksi 50 mg/ml n/a
576 Travoprost tetes mata 0,004% Travatan
577 Triamsinolon asetonid nasal spray 55 mcg/puff Nasacort AQ
578 Trifluoperazin tablet 5 mg n/a
579 Urea krim 10% Soft U Derm
580 Vaksin polio inj (Vaksin Poliomyelitis yang diinaktifkan) Imovax Polio
581 Valgansiklovir tab 450 mg Valcyte

582 Valproat sirup 250 mg/5 ml Ikalep
585 Valsartan tab 80 mg Diovan 80mg Tab
586 Valsartan tab 160 mg DIOVAN 160 MG
587 Verapamil tab 240 mg Isoptin 240 mg
588 Verapamil tablet 80 mg (HCl) n/a
589 Vinblastin serbuk injeksi 10 mg Vinblastine
590 Vinkristin serb inj i.v 2 mg/vial Vincristine Kalbe
591 Vinkristin serbuk injeksi i.v. 1 mg Vincristine Kalbe
592 Vinorelbin inj. 10 mg/ml Navelbine injeksi 10
593 Vitamin B Kompleks tablet n/a
594 Zidovudin 300 mg + Lamivudine 150 mg n/a
595 Zinc drop 10 mg/mL Zincpro Drops
596 Zinc sir 20 mg/5 Ml Zircum Kid Sirup

597 Zinc tablet dispersible20 mg n/a
Harga Satuan Terkecil Tanggal Berlaku
Nama Penyedia Kemasan (Rp) Harga
PT. Kimia Farma 1 blister@24 tablet 1,375.00 4/23/2013 10:24

Dus, 3 Blister @ 10 kapsul 27,500.00 3/18/2014 20:03
PT. Indofarma Dus, 10 dus @ 1 botol @ 10 ml 3,849.00 4/23/2013 10:24
PT. Ikapharmindo Vial 100 ml 750,000.00 7/21/2014 21:09
PT. Ikapharmindo Vial 50 ml 345,000.00 7/21/2014 21:09

PT. Bernofarm Dus, 10 blister @ 10 tablet 199.5 3/15/2014 16:05
Dus, 1 vial@50mg + 1 vial
PT. Boehringer Ingelheim 3,800,000.00 6/27/2014 19:33
pelarut @ 50ml
PT. Cendo Industri Farmasi tube 3.5 gr 18,500.00 4/3/2014 21:30
PT. Sanbe Farma Vial 2 ml 50,500.00 3/16/2014 18:23
PT. Lucas Djaja dus 30 ampul @10 ml 3,823.00 4/23/2013 10:24
PT. Marin Liza Farmasi Botol @ 100 tablet salut selaput 90 3/15/2014 16:05
PT. Aventis Pharma Dus, 6 ampul @ 3 ml 12,480.00 3/16/2014 18:23

PT. Darya Varia strip 1,200.00 3/16/2014 18:23
PT. Novapharin dus 10 X 10'S 211 3/15/2014 16:05
PT. Bernofarm Dus, 10 strip @ 10 kaptab 272 3/15/2014 16:05

flexpen disposible)

flexpen disposible)

Dus, 10 Strip@10 Tablet 75 3/15/2014 16:05
PT. Erela Botol @ 60 ml 2,160.00 3/15/2014 16:05
PT. Indofarma Dus, 25 tube @ 5 g 2,516.00 3/15/2014 16:05
PT. Kimia Farma Btl 100 tablet 135 3/15/2014 16:05
PT. Meprofarm Dus, 5 strip @ 10 tablet 1,500.00 3/16/2014 18:23
PT. Kimia Farma Dus 6 amp @ 1ml 22,000.00 3/18/2014 20:03

PT. Dexa Medica Dus, 10 strip @10 tablet 84 7/21/2014 21:09
PT. Marin Liza Farmasi Botol @ 100 tablet 48 3/15/2014 16:05
PT. Boehringer Ingelheim Boks, 1 ampul 2,209,000.00 4/3/2014 21:30
PT. Bernofarm Dus, 10 blister @ 10 kaptab ss 112 4/23/2013 10:24
PT. Sanbe Farma Strip 1,815.00 3/16/2014 18:23

PT. Hexpharm Jaya Laboratories Dus, 10 ampul @ 5 ml 3,334.00 3/15/2014 16:05
PT. Bernofarm Dus, 10 ampul @ 5 ml 2,950.00 3/15/2014 16:05
PT. Sanbe Farma Tube 3,5 gram 24,750.00 3/16/2014 18:23
PT. Sampharindo Perdana Dus, 5 strip @ 10 tablet 336 3/15/2014 16:05
PT. Widatra Bhakti 10.000 UI/Vial 1,039,500.00 4/3/2014 21:30
PT. Zenith Pharmaceuticals Dus 5 strip @ 10 tablet 190 3/16/2014 18:23
PT. Glaxo Wellcome Indonesia Dus, 5 ampul @ 2.5 ml 20,000.00 3/16/2014 18:23
PT. Soho Industri Pharmasi botol @ 60 ml 34,400.00 3/15/2014 16:05
PT. Rama Emerald Multi Sukses Dus @ 50 gram 1,250.00 3/15/2014 16:05
PT. Abbott Indonesia Vial 3,200,000.00 3/18/2014 20:03
PT. Combiphar Box @ 3 blister @ 10 Tablet 3,600.00 3/18/2014 20:03
PT. Sanbe Farma Supp 6,045.00 3/16/2014 18:23
PT. Merck Tbk Dus 10 blister @ 10 tablet 746 7/21/2014 21:09
PT. Pratapa Nirmala Box 3 X 10 tab 645 4/23/2013 10:24
PT Kalbe Farma Vial 304,000.00 7/21/2014 21:09
PT. Caprifarmindo Box 3 x 10'S 247,089.00 3/16/2014 19:08
PT. AstraZeneca indonesia Dus, 4 pak @ 5 respules @ 2 ml 8,900.00 4/3/2014 21:30
PT. Dexa Medica Dus, 5 ampul @ 4 ml 25,600.00 7/21/2014 21:08

PT. Pratapa Nirmala ampul 30,800.00 7/21/2014 21:09
PT. Tempo Scan Pacific vial @ 20 ml 305,000.00 9/5/2014 23:17
vial 275,000.00 7/21/2014 21:09
PT. Sydna Farma Dus, Botol @ 500ml 2,600,000.00 4/3/2014 21:30
PT. Sydna Farma Dus, Botol @ 100 tablet 25,300.00 4/3/2014 21:30
PT. Novartis Indonesia Dus, 10 vial @ 500mg 112,000.00 4/3/2014 21:30
PT. Merck Sharp Dohme Pharma Tbk
PT. Dexa Medica Kotak, tube @ 15 gram 9,983.00 3/16/2014 19:30
PT. Tanabe Indonesia 10 vial @ 50mg 127,667.00 3/18/2014 20:03
PT. Pratapa Nirmala Vial 5 mL 46,667.00 3/18/2014 20:03

PT. Dipa Pharmalab ampul @ 5 ml 26,700.00 7/21/2014 21:09
PT. Actavis Indonesia Dus, 1 vial @ 50 mg 258,000.00 3/16/2014 18:23

PT. Bernofarm Dus, botol @ 10 ml 15,600.00 3/15/2014 16:05
PT. Dipa Pharmalab ampul @ 5 ml 9,840.00 7/21/2014 21:09
Dus, 1 vial @0,5 ml+ 1 vial
PT. Sanbe Farma 970,200.00 4/3/2014 21:30
pelarut @1,5 ml
PT. Kimia Farma Dus @ 5 vial 455,000.00 8/6/2014 18:35

Dus, Botol Plastik @ 30 Tablet 7,100.00 3/18/2014 20:03

PT. Pfizer Indonesia Dus, 2 blister @ 15 tablet 42,600.00 4/3/2014 21:30

PT Kalbe Farma Vial @ 25 ml 500,000.00 3/16/2014 18:23
PT. Gracia Pharmindo Dus 3 strip @ 10 Flash tablet 650 3/16/2014 19:08
PT. Gracia Pharmindo Dus, Botol Plastik @ 100 mL 8,000.00 4/3/2014 21:30
PT. Kimia Farma ktk 10 x 10 kapsul 497 4/23/2013 10:24

PT. Indofarma Dus, 10 blister @ 10 kss 930 4/23/2013 10:24
PT. Phyto Kemo Agung Farma Botol @60 ml 7,700.00 3/15/2014 16:05
PT Kalbe Farma Prefilled Syringe @ 1ml 128,000.00 5/21/2014 20:01
Dus, botol @ 100 tablet 1,360.00 8/6/2014 18:35
Dus, 1 blister @ 1 subdermal
PT. Merck Sharp Dohme Pharma Tbk 128,779.00 3/24/2014 14:34
implant

KOTAK @ 1 VIAL SERBUK OBAT
PT. Ferron Par Pharmaceuticals 9,200,000.00 4/3/2014 21:30
& INFUSION KIT
PT. Ikapharmindo Botol @ 100 133 4/23/2013 10:24
PT. Actavis Indonesia Dus 45 x 12 tab 235 4/3/2014 21:30
PT. Boehringer Ingelheim Box, canister 10mL 72,900.00 8/6/2014 18:35
PT. Boehringer Ingelheim Dus, Canister 200 dosis 117,500.00 4/3/2014 21:30
PT. Kimia Farma Dus @ 5 patch 80,000.00 4/3/2014 21:30
PT Kalbe Farma pfs @ 0,5 ml 375,000.00 3/16/2014 18:23

PT. Phapros, Tbk dus @ 30 ampul 3,417.00 8/6/2014 18:35
PT. Aventis Pharma Dus, 5 vial @ 50 mg 1,248,319.00 4/3/2014 21:30
Dus, 4 blister @ 5 tablet salut
selaput
PT. Mersifarma Tirmaku MercusanaDus, 5 ampul @ 1ml 55,000.00 3/16/2014 19:08
PT. Natura Laboratoria Prima Dus, 1 Botol @ 100 mL 47,100.00 3/15/2014 16:05
PT. Kimia Farma ktk 1 x 10 kapsul 22,000.00 3/15/2014 16:05
PT. Gracia Pharmindo strip 419 3/16/2014 18:23
PT. Dexa Medica DUS, 30 TABLET 410 3/16/2014 18:23
Dus, Tube 5 g 2,400.00 3/16/2014 18:23
PT. Glaxo Wellcome Indonesia Dus, Botol 120 Dosis Spay 93,333.00 3/18/2014 20:03
Dus, 2 flow wrap@ 5 nebules @
1 dosis (2ml)
PT. Glaxo Wellcome Indonesia Dus, 2 pfs 0.5 ml 241,667.00 3/18/2014 20:03
PT. Dipa Pharmalab dus, vial @ 250 ml 972,000.00 8/6/2014 18:35
PT. Bayer Indonesia Prefilled Syringe 275,000.00 8/6/2014 18:35
PT. Bayer Indonesia Prefilled Syringe 412,500.00 8/6/2014 18:35
PT. Bayer Indonesia Prefilled Syringe 2,570,000.00 8/6/2014 18:35
PT. Phapros, Tbk Dus @ 100 Sachet 288 3/15/2014 16:05

PT. Bayer Indonesia vial 1,098,900.00 3/16/2014 18:23
PT. Sanbe Farma Dus, 1 vial @200 mg 330,000.00 4/3/2014 21:30
PT. Erela Tube @ 3,5 gr 2,600.00 3/16/2014 18:23
PT. Indofarma Dus, botol plastik 5 ml 3,194.00 3/15/2014 16:05
Dus, 6 strip @ 10 tablet lepas
PT. Pradja Pharin 638 4/3/2014 21:30
lambat
PT. Actavis Indonesia Btl @ 30 tablet 1,500.00 3/18/2014 20:03
PT. Lucas Djaja Glycerin 100 ml 5,333.00 3/18/2014 20:03
PT. AstraZeneca indonesia Dus, 1 syringe @ 10.8 mg 2,300,000.00 4/3/2014 21:30
PT. AstraZeneca indonesia Dus, 1 syringe @ 3.6 mg 840,000.00 4/3/2014 21:30
PT. Soho Industri Pharmasi Dus 5 Ampul@1mL 83,333.00 3/18/2014 20:03
PT. Mersifarma Tirmaku MercusanaKOTAK @ 10 x 10 TAB 126 3/16/2014 18:23
PT. Dexa Medica Botol 641,500.00 3/18/2014 20:03
PT. Pratapa Nirmala vial 42,900.00 7/21/2014 21:09
PT. Dipa Pharmalab Dus, 1 syringe @ 0.5 mL 1,328,000.00 5/22/2014 14:25
PT. Otto Pharmaceuticals box 5ampul @1 ml 4,500.00 3/18/2014 20:03

penfill disposible)
PT. Sanbe Farma penfillcartridge @ 3ml 75,000.00 4/3/2014 21:30

penfill disposible)

penfill disposible)
PT. Sanbe Farma penfill cartridge @ 3ml 75,000.00 4/3/2014 21:30
PT. Dexa Medica Prefilled syringe 170,000.00 8/6/2014 18:35

PT. Yarindo Farmatama botol @ 100 tablet 110 4/23/2013 10:24
PT. Mugi Laboratories Dus, 1 vial @ 1 g 1,329,163.00 4/3/2014 21:30


PT. Boehringer Ingelheim Box, canister 10mL 80,000.00 8/6/2014 18:35
PT. Pratapa Nirmala vial 33,000.00 7/21/2014 21:09
PT. Merck Tbk Dus, 10 strip @ 10 tablet 1,580.00 4/3/2014 21:30
PT. Tempo Scan Pacific Vial 50 mg/5 ml 82,000.00 7/21/2014 21:09
PT. Ethica Industri Farmasi Ampul 7,800.00 4/3/2014 21:30
PT. Errita Pharma Dus, 10 strip @10 tablet 84 3/15/2014 16:05
PT. Novartis Indonesia Dus, botol @ 120 ml 44,770.00 3/16/2014 19:30

PT. Nicholas Laboratories IndonesiaDus,botol 100 tablet 875 4/3/2014 21:30
PT. Lucas Djaja Fenol 100 mg / 1 ml 2,042.00 3/18/2014 20:03

PT. Guardian Pharmatama Vial @ 10 ml 110,000.00 3/16/2014 18:23

Box isi 1 Tube @ 15 g 4,700.00 4/23/2013 10:24
PT. Kimia Farma tube 10 gr 2,569.00 4/23/2013 10:24
PT. Kimia Farma dus 2 's @ 10 supp 2,722.00 7/21/2014 21:09
PT. Ifars Pharmaceutical Laboratories 3,200.00 3/16/2014 18:23
selaput
PT. Boehringer Ingelheim Box, 10 ampoules @ 1mL 30,600.00 8/6/2014 18:35
PT. Hexpharm Jaya Laboratories Dus, 3 strip @ 10 tab 3,400.00 3/15/2014 16:05
PT. Bernofarm Botol @ 60 ml 3,680.00 4/23/2013 10:24
PT. Fresenius Kabi Combiphar Botol Plastik @ 500 ml 33,000.00 7/21/2014 21:09

Botol @ 60 ml 12,450.00 3/16/2014 19:08
PT. Erela Dus, 100 Sachet @ 30 Tablet 42 3/15/2014 16:05

salut selaput
PT. Abbott Indonesia botol @ 120 tablet 6,100.00 8/6/2014 18:35
PT. Glaxo Wellcome Indonesia Dus, Botol 120 Dosis 90,667.00 3/18/2014 20:03
PT. Holi Pharma Dus, 10 strip @ 10 kaptab 152 3/15/2014 16:05

PT. Kimia Farma ktk 60 tablet 670 4/23/2013 10:24

PT. Kimia Farma ktk 100 amp @ 2 ml 6,200.00 4/23/2013 10:24
PT. Takeda Indonesia Serbuk vial 82,042.00 4/3/2014 21:30
PT. Indofarma Dus, 2 strip @ 10 kapsul 473 4/23/2013 10:24

botol 500 ml 56,300.00 4/3/2014 21:30

ML
ML

botol 250 ml 51,260.00 4/3/2014 21:30

botol 500 ml 64,900.00 4/3/2014 21:30


PT. Phapros, Tbk 322,000.00 4/3/2014 21:30
PT. Phapros, Tbk Bag Double chamber (Dua 218,700.00 4/3/2014 21:30
PT Kalbe Farma flexybag 250 mL 87,000.00 4/3/2014 21:30
LDPE (Low Density Poly

PT. Phapros, Tbk 12,650.00 4/3/2014 21:30
Ethilene), botol plastik

PT. Sanbe Farma softbag 500ml 35,750.00 4/3/2014 21:30

PT. Phapros, Tbk 105,500.00 4/3/2014 21:30
bottle
PT. Phapros, Tbk 210,000.00 4/3/2014 21:30
bottle
Bag, 3 chamber ( 3
PT. Phapros, Tbk 591,000.00 4/3/2014 21:30
Bag, 3 chamber ( 3
PT. Phapros, Tbk 511,000.00 4/3/2014 21:30
Bag, 3 chamber ( 3
PT. Phapros, Tbk 358,000.00 4/3/2014 21:30
PT. Cendo Industri Farmasi strip 5 x 0.6 ml 72,000.00 4/3/2014 21:30

PT. Pfizer Indonesia dus, Botol @ 2,5 ml 127,000.00 8/6/2014 18:35
Dus, 1 vial @ 263 mcg + 1
prefilled syringe pelarut @ 1 ml
PT. Takeda Indonesia Vial 700,000.00 4/3/2014 21:30

PT. Takeda Indonesia Vial 2,700,000.00 4/3/2014 21:30
PT. Infion Pharmaceutical Box, 1 Botol @ 100 ml 40,000.00 3/15/2014 16:05
PT. Promedrahardjo Farmasi IndustriDus, 5 Strip@10 Tablet 528 4/23/2013 10:24
PT. Bernofarm Dus, 100 ampul @ 2 ml 839 3/15/2014 16:05
PT. AstraZeneca indonesia Dus, 10 syringe @ 10 g 40,000.00 4/3/2014 21:30
Box ,3 Strip @ 10 tablet 600 4/23/2013 10:24
Box ,3 Strip @ 10 tablet 350 4/23/2013 10:24
Dus, 10 Strip @ 10 Tablet 89 4/23/2013 10:24
PT. Promedrahardjo Farmasi IndustriDus, 5 Strip@10 Tablet 154 4/23/2013 10:24
ampul 52,000.00 7/21/2014 21:09
botol 500 ml 62,000.00 6/16/2014 19:59
PT. Kimia Farma Dus @ 5 vial 473,000.00 8/6/2014 18:35
PT. Taisho Pharmaceutical Indonesia

Dus,24
Tbk Catch @ 1 tablet 7,140.00 3/18/2014 20:03
PT. Glaxo Wellcome Indonesia Box, Tablet 2 mg/25's 12,210.00 4/3/2014 21:30
PT. Bernofarm Dus, 1 vial @ 0,5 g 44,960.00 7/21/2014 21:08
PT. Mugi Laboratories Dus, 15 Ampul 74,998.00 4/3/2014 21:30
PT. Kimia Farma ktk 10 x 10 tablet salut 154 4/23/2013 10:24
Dus, botol plastik @ 30 kapsul

PT. Novartis Indonesia pelepasan lambat 6,537.00 4/3/2014 21:30
Dus, 1 Vial @125mg + 1 ampul

PT. Dexa Medica 19,200.00 7/21/2014 21:08
pelarut @ 2ml
PT. Phapros, Tbk Dus @ 1 vial 93,393.00 7/21/2014 21:08
PT. Mahakam Beta Farma Strip 635 4/23/2013 10:24
PT. Natura Laboratoria Prima Dus, 10 Blister @ 10 Tablet 205 4/23/2013 10:24
PT. Dexa Medica Dus, 10 Blister @ 10 tablet 300 4/23/2013 10:24
PT. Natura Laboratoria Prima Dus, 1 Botol @ 100 ml 9,950.00 4/23/2013 10:24
PT. Aventis Pharma Dus, 2 blister @ 5 suppositoria 3,220.00 3/16/2014 18:23
PT. Kimia Farma Dus @ 5 vial 1,237,500.00 5/21/2014 20:01
PT Kalbe Farma Box isi 5 ampul 5,600.00 3/16/2014 18:23
PT. Boehringer Ingelheim Boks 5 amp 12,060.00 3/16/2014 18:23
PT. Combiphar Dus,1 vial@50mg 260,000.00 4/3/2014 21:30
PT. Kimia Farma Tube 10 gram 3,000.00 4/23/2013 10:24
PT. Widatra Bhakti 10 mg /Vial 697,000.00 4/3/2014 21:30
PT. Guardian Pharmatama tube 10 gram 17,820.00 3/15/2014 16:05
PT. Kimia Farma Ktk 10 ampul @ 1ML 10,499.00 3/15/2014 16:05
PT. Pratapa Nirmala Dus, 5 Ampul @ 2ml 61,600.00 3/16/2014 18:23
Box ,5 Blister @ 10 tablet 200 4/23/2013 10:24
PT. Molex Ayus Tube 5 gr 6,490.00 3/16/2014 18:23
PT. Pharma Health Care Box, isi 5 ampul @ 1 ml 9,500.00 7/21/2014 21:09
PT. Kimia Farma btl 60 tablet 2,800.00 4/23/2013 10:24

PT. Dexa Medica 100 3/15/2014 16:05
selaput
PT. Phapros, Tbk Paket 359,900.00 4/23/2013 10:24
PT. Kimia Farma Paket 1,199,990.00 4/23/2013 10:24
PT. Kimia Farma Paket 214,990.00 4/23/2013 10:24
Dus, 1 dus @ 60 blister @ 8

tablet tahap intensif kategori 1 +
PT. Indofarma 288,199.00 4/23/2013 10:24
1 Dus @ 54 blister @ 3 tablet
tahap lanjutan kategori 1
Dus, 60 sachet tahap intensif @
(1 tablet Isoniazid, 2 kapsul
Rifampicin, 2 tablet
PT. Indofarma 171,195.00 4/23/2013 10:24
Pyrazinamide) + 120 sachet
tahap lanjutan @ (1 tablet
Isoniazid, 2 kapsul Rifampicin)

Box ,5 Strip @ 10 tablet 400 4/23/2013 10:24
Box ,5 Strip @ 10 tablet 650 4/23/2013 10:24
PT. Aventis Pharma Dus, 1 vial @ 20 ml 1,100,000.00 9/5/2014 23:17
PT. Aventis Pharma Dus, 1 vial @ 10 ml 550,000.00 9/5/2014 23:17
PT. Merck Tbk botol @ 10 ml 27,550.00 3/16/2014 18:23
Dus, vial @ 355m + 1 prefilled
PT. Novartis Indonesia syringe pelarut @ 2,5 ml + 2 2,950,000.00 4/3/2014 21:30
jarum suntik
PT. Bayer Indonesia Vial 120,000.00 5/21/2014 20:01
PT. Natura Laboratoria Prima Dus, 1 Vial @ 40 mg 36,000.00 3/15/2014 16:05
PT. Indofarma Dus, 5 Ampul @ 2ml 2,400.00 3/15/2014 16:05
PT. Yarindo Farmatama Box 3 X 10 Tab 1,189.00 3/15/2014 16:05
Transfer Set: Set; Ultaclam:
Kantong Plastik; Tenckoff
PT Kalbe Farma 1,902,240.00 3/15/2014 16:14
Catheter: Box; Titanium
Adaptor: Kantong Plastik
PT Kalbe Farma Set 219,540.00 3/15/2014 16:14

PT Kalbe Farma 5,522,580.00 3/16/2014 19:49
Larutan Dialisa 4.25 %: 2.000
ml; Minicap: Kantong Plastik
PT. Actavis Indonesia Vial 6mg/ml (100mg/16.67ml) 984,000.00 9/5/2014 23:17
PT. Actavis Indonesia Vial 6mg/ml (260mg/43.33ml) 3,000,000.00 9/5/2014 23:17

PT. Actavis Indonesia Vial 6mg/ml (30mg/5ml) 274,560.00 9/5/2014 23:17
PT. Indofarma Dus, 15 botol 5,200.00 5/20/2014 18:46
PT. Afifarma botol 60 ml 1,438.00 4/23/2013 10:24

PT. Imfarmind Farmasi industri Dus, 10 strip @ 10 kaptab 89 4/23/2013 10:24
Dus, botol @ 15 ml 6,450.00 7/21/2014 21:09
Dus, 1 vial 100 mcg + 1 ampul
pelarut 0,7 ml + 1 syringe + 2 973,500.00 4/3/2014 21:30
jarum
Dus, 1 prefilled syringe (serbuk

injeksi 120mcg + pelarut 0.5 ml) 1,135,000.00 4/3/2014 21:30
+ 1 jarum

jarum

jarum
PT. Darya Varia tube @ 35 gram 23,000.00 7/21/2014 21:09
PT. Pradja Pharin 2,420.00 4/3/2014 21:30
salut selaput
Tube @ 10 g 11,475.00 3/16/2014 19:08
PT. Kimia Farma Ktk 10 ampx2ml 14,500.00 3/15/2014 16:05
PT. Holi Pharma Botol 60 ml 8,360.00 3/15/2014 16:05
PT. Holi Pharma Dus, 25 Blister @ 4 tablet 298 3/15/2014 16:05
PT. Holi Pharma Dus 10 strip @ 10 tablet 208 4/23/2013 10:24
PT. Pratapa Nirmala Dus, Botol @ 10ml 17,393.00 3/16/2014 18:23
Box ,5 Strip @ 10 tablet 2,300.00 4/23/2013 10:24
PT. Fresenius Kabi Combiphar Ampul 16,236.00 7/21/2014 21:09

PT. Pharma Health Care Dus, 6 blister @ 10 tablet 995 7/21/2014 21:09
PT. Dexa Medica Dus, 10 Strip @ 10 kaptab 580 4/23/2013 10:24

PT. Dexa Medica 120 4/23/2013 10:24
selaput
PT. Kimia Farma Botol 50 kapsul lunak 260 3/18/2014 20:03
PT. Lucas Djaja Botol 50 Kapsul 459 7/10/2014 15:53
PT. Widatra Bhakti botol 500 ml 5,200.00 4/23/2013 10:24
Lambat
Lambat
Lambat
PT. Glaxo Wellcome Indonesia Dus, botol 200 dosis 63,750.00 3/18/2014 20:03
PT. Glaxo Wellcome Indonesia Dus, 10 Blister @ 10 Kapsul 431 3/18/2014 20:03
PT. Glaxo Wellcome Indonesia Dus, 1 Rotahaler 5,867.00 3/18/2014 20:03
PT. Yarindo Farmatama strip @ 10 tablet 59 4/23/2013 10:24
PT. Marin Liza Farmasi Pot @ 30 gram 2,000.00 3/15/2014 16:05

PT. Hexpharm Jaya Laboratories strip 513 4/23/2013 10:24
PT. Bernofarm Dus, 10 strip @ 10 kapsul 509 4/23/2013 10:24
Dus, 5 Strip @ 10 Kapsul 1,000.00 4/23/2013 10:24
PT. Dexa Medica Dus, 2 Vial @ 1 gram 16,500.00 3/15/2014 16:05
vial 43,000.00 3/15/2014 16:05
PT. Dexa Medica Dus, 5 Strip @ 10 kapsul 850 4/23/2013 10:24
Dus, Botol 30 ml 8,800.00 4/23/2013 10:24
PT. Holi Pharma Dus, 2 vial @ 1 g 12,775.00 7/21/2014 21:08
PT. Hexpharm Jaya Laboratories vial 4,997.00 4/23/2013 10:24
PT. Sandoz Indonesia Dus, 3 blister @ 10 tablet 3,700.00 3/16/2014 19:08
PT. Hexpharm Jaya Laboratories Dus, 2 vial @ 1 g 17,060.00 4/23/2013 10:24
Dus, 1 Blister @ 10 Tablet salut
selaput
PT. Pratapa Nirmala strip @ 10 tab 3,300.00 7/21/2014 21:09
PT. Pertiwi Agung Box, 10 strips @ 10 capsules 181 3/15/2014 16:05
PT. Pratapa Nirmala tabung/botol 1,320,000.00 7/21/2014 21:09
PT. Lucas Djaja 100 ampul @ 1 ml 1,077.00 4/23/2013 10:24
vial 82,000.00 3/16/2014 18:23

selaput
selaput
PT. Dexa Medica Vial 200 ml 13,000.00 4/23/2013 10:24
PT. Bernofarm Dus, 10 blister @ 10 tab ss 255 4/23/2013 10:24
PT Kalbe Farma vial 22,000.00 9/5/2014 23:17
PT Kalbe Farma vial 93,000.00 9/5/2014 23:17
PT. Tempo Scan Pacific dus, 1 vial @ 10 ml 575,000.00 8/6/2014 18:35
PT. Indofarma Dus, 5 strip @ 10 tablet 1,499.00 4/23/2013 10:24
PT. Dexa Medica Vial 3,290,000.00 5/21/2014 20:01
PT. Kimia Farma dus 5 amp @ dus 10 127,000.00 3/18/2014 20:03

Pounch @ 5 blister @ 10
PT. Combiphar 11,167.00 3/18/2014 20:03
capsule
Dus, 1 pouch @5 blister@10
PT. Combiphar 21,500.00 4/3/2014 21:30
kaps
PT. Combiphar Box @ 2 blister @ 14 tablet 5,800.00 3/18/2014 20:03
PT. Combiphar Box/ 2 blister @ 14 tablet 5,800.00 3/16/2014 19:08

PT. Boehringer Ingelheim Dus, 2 alu-blister @10 tablet 3,900.00 6/27/2014 19:33
PT. Boehringer Ingelheim Box, 2 blisters @10 tablets 6,500.00 8/6/2014 18:35
Dus, 5 sachet @ 1 kapsul 1,120,000.00 8/6/2014 18:35
Dus, 5 sachet @ 1 kapsul 223,000.00 8/6/2014 18:35
PT. AstraZeneca indonesia Dus, 2 pak @ 5 respules 6,250.00 4/3/2014 21:30
PT. Molex Ayus Box 50's 99 3/16/2014 18:23
Dus, 6 blister @ 10 kapsul lunak 6,200.00 8/6/2014 18:35

PT. Holi Pharma Dus, 10 strip @ 10 kapsul 149 4/23/2013 10:24
PT. Merck Tbk Dus, 10 blister @ 10 tablet 1,135.00 4/3/2014 21:30
PT. Merck Tbk Dus, 10 blister @ 10 tablet 563 3/18/2014 20:03
Dus, 1 blister @10 kapsul +
PT. Boehringer Ingelheim 152,543.00 3/16/2014 19:08
handihaler
PT. Tempo Scan Pacific botol, tetes mata 2,5 ml 115,000.00 4/3/2014 21:30
PT. Aventis Pharma Dus, botol plastik 120 dosis 90,000.00 4/3/2014 21:30
PT. Darya Varia strip 405 4/23/2013 10:24
tube 6,400.00 3/16/2014 18:23
PT. Aventis Pharma 1 vial of 10ml (10 d's) 285,000.00 4/3/2014 21:30

PT. Ikapharmindo Botol 120 ml 40,000.00 7/21/2014 21:09
PT. Mugi Laboratories Dus, 1 vial @ 1 ml 1,229,998.00 5/21/2014 14:16
PT. Combiphar Drops 10 mg/ml, Botol @15 ml 12,840.00 3/16/2014 18:23
PT. Meprofarm Dus, botol 60 ml 7,400.00 3/16/2014 18:23


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Nama Obat Generik Nama Dagang

1 ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida n/a

2 Adefovir Dipivoksil tablet/kaplet 10 mg Hepsera

3 Albendazol suspensi 200 mg/5 ml n/a

4 Albendazol tablet/kapsul/kaplet 400 mg n/a

9 Alteplase injeksi 50 mg/vial Actilyse

10 Amfoterisin B salep mata 1% Fungicide

13 Aminofilin tablet scored 200 mg n/a

14 Amiodaron injeksi 150 mg/3 ml Cordarone

Analog insulin mix insulininj 100 UI/ml, vial/cartridge

28 Analog insulin rapid actinginj 100 UI/ml, vial/cartridge Apidra Solostar

29 Analog insulin rapid actinginj 100 UI/ml, vial/cartridge Humalog

30 Anastrozol tablet/kapsul/kaplet 1 mg Arimidex 1 mg

31 Antasida DOEN I tablet kunyah, kombinasi : Aluminium n/a

Antasida DOEN II suspensi, kombinasi : Aluminium

33 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g n/a

34 Antimalaria DOEN kombinasi : Pirimetamin 25 mg n/a

36 Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg Levopar Tablet

41 Asam Mefenamat kapsul/kaplet 500 mg n/a

42 Asam pipemidat kapsul 400 mg Urotractin 400 mg

43 Asam traneksamat injeksi 100 mg/ml n/a

44 Asiklovir salep mata 3% Temiral Eye Oint

49 Atrakurium injeksi 25 mg/2,5 ml Tracrium

50 Atropin Sulfat tablet 0,5 mg n/a

54 Bedak salisil serbuk 2% n/a

66 Budesonid inhaler 200 mcg/puff, 100 dosis Pulmicort Turbuhaler

67 Budesonid respules / cairan inhaler 0,25mg/mL Pulmicort Respules

68 Budesonid-formoterol (fixed combination) inhaler 160/4,5 Symbicort Turbuhaler

69 Budesonid-formoterol (fixed combination) inhaler 80/4,5 Symbicort 80/4.5 mcg

74 Deferipron larutan oral 100 mg/mL Ferriprox Oral Solution

75 Deferipron tablet 500 mg Ferriprox tablet

94 Dosetaksel injeksi 20 mg/0,5 ml n/a

95 Dutasterid kaps lunak 0,5 mg Avodart

96 Efavirens tablet salut 600 mg n/a

98 Enoksaparin sodium inj 20 mg/0,2 mL Lovenox 2000 ANTI-XA

99 Enoksaparin sodium inj 40 mg/0,4 mL Lovenox 4000 ANTI-XA

100 Enoksaparin sodium inj 60 mg/0,6 mL Lovenox 6000 ANTI-XA

101 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml n/a

105 Ergokalsiferol (vitamin D3/D2) suspensi 10.000 UI/ml D-Vit Syrup

106 Eritromisin kapsul/kaplet 500 mg n/a

113 Etonogestrel implan 68 mcg Implanon

114 Etoposid injeksi 20 mg/ml Posyd

116 Everolimus tab 0,25 mg Certican 0,25 mg Tab

117 Everolimus tab 0,5 mg Certican 0,5 mg Tab

119 Fenitoin injeksi 50 mg/ml n/a

120 Fenitoin kapsul/kaplet 100 mg n/a

122 Fenofibrat kaps 100 mg n/a

123 Fenofibrat kaps 300 mg n/a

136 Fludarabin tab 10 mg Fludara Oral

137 Flufenazin injeksi i.m. 25 mg/ml Sikzonoate Injeksi

138 Flukonazol injeksi 2 mg/ml n/a

144 Flusinolon asetonid krim 0,025% SYNARCUS

145 Flutikason furoat intranasal spray Avamys

146 Flutikason propionat nebules 0,5 mg Flixotide Nbules

147 Fondaparinuks inj 2,5 mg/0,5 mL Arixtra

148 Furosemid injeksi i.v./i.m. 10 mg/ml n/a

162 Gliklazid tab 30 mg Diamicron MR 30

163 Glikuidon tab 30 mg n/a