| No | Etalase | Produk | Harga | Jumlah | Ongkos Kirim | Total | Penyedia |
|---|---|---|---|---|---|---|---|
| 1 | Obat Program Jaminan Kesehatan | Ringer Laktat @ 500 mL | 8.498 | 2.000 | 0 | 16.996.000 | PT. Otsuka Indonesia |
| 2 | Obat Program Jaminan Kesehatan | NaCl 0,9% / Sodium Chloride @ 500 mL | 7.673 | 600 | 0 | 4.603.800 | PT. Otsuka Indonesia |
| 3 | Konsolidasi Obat | Antasida tab kunyah | 90 | 20.000 | 0 | 1.800.000 | PT.Imfarmind Farmasi Industri |
| 4 | Konsolidasi Obat | Kalsium laktat (kalk) tab 500 mg* | 84 | 30.000 | 0 | 2.520.000 | PT.Imfarmind Farmasi Industri |
| 5 | Obat Non Jaminan Kesehatan | Guaifenesin tablet 100 mg | 95 | 100.000 | 0 | 9.500.000 | PT.Imfarmind Farmasi Industri |
| 6 | Obat Program Jaminan Kesehatan | Chloramphenamine Maleate 4 Mg (CTM Box) | 83 | 30.000 | 0 | 2.490.000 | PT.Imfarmind Farmasi Industri |
| 7 | Fasilitas Kesehatan Sektoral Kemenkes | bayMEDIKA Nasal Oxygen Cannula | 6.650 | 100 | 0 | 665.000 | PT. Likuid Pharmalab Indonesia |
| 8 | Fasilitas Kesehatan Sektoral Kemenkes | bayMEDIKA Nasal Oxygen Cannula Anak | 6.650 | 45 | 0 | 299.250 | PT. Likuid Pharmalab Indonesia |
| 9 | Fasilitas Kesehatan Sektoral Kemenkes | bayMEDIKA Oxygen Mask RebreathingSizeXL(Adult) | 12.350 | 40 | 0 | 494.000 | PT. Likuid Pharmalab Indonesia |
| 10 | Fasilitas Kesehatan Sektoral Kemenkes | bayMEDIKA Oxygen Mask Rebreathing size M (Child) | 12.350 | 20 | 0 | 247.000 | PT. Likuid Pharmalab Indonesia |
| 11 | Fasilitas Kesehatan Sektoral Kemenkes | bayMEDIKA Underpad ukuran 60 x 90 cm | 37.000 | 11 | 0 | 407.000 | PT. Likuid Pharmalab Indonesia |
| 12 | Fasilitas Kesehatan Sektoral Kemenkes | BAYMED Surgical Face Mask Hijab | 20.000 | 100 | 0 | 2.000.000 | PT. Likuid Pharmalab Indonesia |
| 13 | Fasilitas Kesehatan Sektoral Kemenkes | bayMEDIKA Urine Bag | 8.075 | 100 | 0 | 807.500 | PT. Likuid Pharmalab Indonesia |
| 14 | Fasilitas Kesehatan Sektoral Kemenkes | BAYGEL Ultrasound Transmission Gel 250 ml | 16.000 | 5 | 0 | 80.000 | PT. Likuid Pharmalab Indonesia |
| 15 | Fasilitas Kesehatan Sektoral Kemenkes | BAYMED Alkohol Swab | 13.000 | 130 | 0 | 1.690.000 | PT. Likuid Pharmalab Indonesia |
| 16 | Obat Program Jaminan Kesehatan | Amoksisilin/Amoxicillin/Amoxicillin Trihydrate sirup/suspensi kering 125 mg/ 5 ml | 5.500 | 200 | 0 | 1.100.000 | PT.Bernofarm |
| 17 | Obat Program Jaminan Kesehatan | Amoksisilin/ Amoxicillin/ Amoxicillin Trihydrate tablet/kapsul/kaplet/kaptab 500 mg | 530 | 30.000 | 0 | 15.900.000 | PT.Bernofarm |
| 18 | Obat Program Jaminan Kesehatan | Chloramphenicol/ Kloramfenikol tablet/kapsul/kaplet 250 mg | 708 | 700 | 0 | 495.600 | PT.Bernofarm |
| 19 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol tablet /kaptab (dewasa) kombinasi: sulfametoksazol 400 mg + trimetoprim 80 mg | 275 | 3.000 | 0 | 825.000 | PT.Bernofarm |
| 20 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg | 4.796 | 215 | 0 | 1.031.140 | PT.Bernofarm |
| 21 | Obat Program Jaminan Kesehatan | Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 1.000 mg | 7.492 | 500 | 0 | 3.746.000 | PT.Bernofarm |
| 22 | Obat Program Jaminan Kesehatan | Dexamethason Sodium Phosphate/ Deksamethason/ Deksametason injeksi 5 mg/mL | 1.653 | 100 | 0 | 165.300 | PT.Bernofarm |
| 23 | Obat Program Jaminan Kesehatan | Difenhidramin/ Diphenhydramine injeksi 10 mg/ml ( i.v./i.m.) | 1.893 | 400 | 0 | 757.200 | PT.Bernofarm |
| 24 | Obat Program Kesehatan Lainnya | Metformin Hydrochloride/ Metformin tablet/kapsul/kaplet 500 mg | 266 | 30.000 | 0 | 7.980.000 | PT.Bernofarm |
| 25 | Konsolidasi Obat | Natrium diklofenak tab sal enterik 50 mg | 110 | 25.000 | 0 | 2.750.000 | PT.ERELA |
| 26 | Konsolidasi Obat | Ranitidin tab 150 mg | 149 | 1.700 | 0 | 253.300 | PT.ERELA |
| 27 | Obat Program Jaminan Kesehatan | Chloramphenicol/ kloramfenikol tetes telinga 3% | 8.000 | 168 | 0 | 1.344.000 | PT.ERELA |
| 28 | Obat Program Jaminan Kesehatan | AMLODIPINE 5 MG | 102 | 10.000 | 0 | 1.020.000 | PT. TRIFA RAYA LABORATORIES |
| 29 | Obat Program Jaminan Kesehatan | AMLODIPINE BESILATE 10 MG | 122 | 19.000 | 0 | 2.318.000 | PT. TRIFA RAYA LABORATORIES |
| 30 | Obat Program Jaminan Kesehatan | IBUPROFEN 400 MG_OGB | 280 | 20.000 | 0 | 5.600.000 | PT. TRIFA RAYA LABORATORIES |
| 31 | Obat Program Jaminan Kesehatan | DEXAMETHASONE 0,5 MG | 90 | 20.000 | 0 | 1.800.000 | PT. TRIFA RAYA LABORATORIES |
| 32 | Konsolidasi Obat | Parasetamol tab 500 mg | 100 | 100.000 | 0 | 10.000.000 | PT. TRIFA RAYA LABORATORIES |
| 33 | Fasilitas Kesehatan Sektoral Kemenkes | Catgut Chromic With Needle 3/0 | 119.880 | 6 | 0 | 719.280 | PT INTISUMBER HASIL SEMPURNA GLOBAL |
| 34 | Fasilitas Kesehatan Sektoral Kemenkes | Catgut Plain With Needle 3/0 | 119.880 | 7 | 0 | 839.160 | PT INTISUMBER HASIL SEMPURNA GLOBAL |
| 35 | Fasilitas Kesehatan Sektoral Kemenkes | Surgical blades | 56.388 | 10 | 0 | 563.880 | PT INTISUMBER HASIL SEMPURNA GLOBAL |
| 36 | Fasilitas Kesehatan | Medical Recording Chart Paper, Kertas ECG / EKG Paper ukuran 80MM X 25M, Roll, ECG8025 | 128.000 | 6 | 0 | 768.000 | PT. ENDO Indonesia |
| 37 | Fasilitas Kesehatan Sektoral Kemenkes | Spalk Kayu / First Aid Spalk | 52.170 | 5 | 0 | 260.850 | PT Jayamas Medica Industri |
| 38 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 5 cc | 96.800 | 12 | 0 | 1.161.600 | PT Jayamas Medica Industri |
| 39 | Fasilitas Kesehatan Sektoral Kemenkes | Uro One Foley Catheter 2 Way 16 FR | 99.900 | 5 | 0 | 499.500 | PT Jayamas Medica Industri |
| 40 | Fasilitas Kesehatan Sektoral Kemenkes | Uro One Foley Catheter 2 Way 18 FR | 99.900 | 5 | 0 | 499.500 | PT Jayamas Medica Industri |
| 41 | Fasilitas Kesehatan Sektoral Kemenkes | Masker KN95 Earloop | 59.718 | 10 | 0 | 597.180 | PT Jayamas Medica Industri |
| 42 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 3 cc | 78.100 | 20 | 0 | 1.562.000 | PT Jayamas Medica Industri |
| 43 | Fasilitas Kesehatan Sektoral Kemenkes | Vacuum Blood Collection Tube EDTA K3 3ml | 91.908 | 12 | 0 | 1.102.896 | PT Jayamas Medica Industri |
| 44 | Fasilitas Kesehatan Sektoral Kemenkes | Vacuum Blood Collecting Tube Plain 3ml | 88.800 | 7 | 0 | 621.600 | PT Jayamas Medica Industri |
| 45 | Fasilitas Kesehatan Sektoral Kemenkes | OneClean | 11.000 | 50 | 0 | 550.000 | PT Jayamas Medica Industri |
| 46 | Fasilitas Kesehatan Sektoral Kemenkes | Plesterin Roll non woven roll 5 cm x 5 m | 24.198 | 30 | 0 | 725.940 | PT Jayamas Medica Industri |
| 47 | Fasilitas Kesehatan Sektoral Kemenkes | Kasa Steril Kasa Kompres, 40 cm x 40 cm (Box isi 50 pcs) | 74.148 | 1 | 0 | 74.148 | PT Jayamas Medica Industri |
| 48 | Fasilitas Kesehatan Sektoral Kemenkes | Kasa Hydrofil 4 m x 15 cm | 142.080 | 1 | 0 | 142.080 | PT Jayamas Medica Industri |
| 49 | Fasilitas Kesehatan Sektoral Kemenkes | Kasa Hydrofil Super Grade 40yx16cm | 41.958 | 20 | 0 | 839.160 | PT Jayamas Medica Industri |
| 50 | Fasilitas Kesehatan Sektoral Kemenkes | Kasa Hydrofil 4 m x 5 cm | 101.898 | 2 | 0 | 203.796 | PT Jayamas Medica Industri |
| 51 | Fasilitas Kesehatan Sektoral Kemenkes | Kasa Hydrofil 4 m x 10 cm | 101.898 | 2 | 0 | 203.796 | PT Jayamas Medica Industri |
| 52 | Fasilitas Kesehatan Sektoral Kemenkes | MEDIGLOVES Surgical Sterile Gloves PP Size 7 | 241.980 | 1 | 0 | 241.980 | PT Jayamas Medica Industri |
| 53 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter with Port with Wing 22G | 7.881 | 150 | 0 | 1.182.150 | PT Jayamas Medica Industri |
| 54 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter with Port with Wing 24G | 7.881 | 300 | 0 | 2.364.300 | PT Jayamas Medica Industri |
| 55 | Fasilitas Kesehatan Sektoral Kemenkes | Latex Medical Examination Gloves XS,S,M,L Powder Free | 42.180 | 68 | 0 | 2.868.240 | PT Jayamas Medica Industri |
| 56 | Fasilitas Kesehatan Sektoral Kemenkes | I.V Cannula With Teflon Catheter 1 Way 26 G | 241.980 | 5 | 0 | 1.209.900 | PT Jayamas Medica Industri |
| 57 | Fasilitas Kesehatan Sektoral Kemenkes | Infus Set Dewasa | 6.200 | 200 | 0 | 1.240.000 | PT. Antar Mitra Persada |
| 58 | Fasilitas Kesehatan Sektoral Kemenkes | Infus Set Anak | 5.800 | 200 | 0 | 1.160.000 | PT. Antar Mitra Persada |
| 59 | Fasilitas Kesehatan Sektoral Kemenkes | Kertas Puyer/Kertas Perkamen | 18.500 | 50 | 0 | 925.000 | PT. Antar Mitra Persada |
| 60 | Fasilitas Kesehatan Sektoral Kemenkes | Hypavix 5x5m | 123.500 | 6 | 0 | 741.000 | PT. Antar Mitra Persada |
| 61 | Fasilitas Kesehatan Sektoral Kemenkes | Tensocrape 3 inch | 128.500 | 12 | 0 | 1.542.000 | PT. Antar Mitra Persada |
| 62 | Fasilitas Kesehatan Sektoral Kemenkes | Framicetin Sulfate | 163.500 | 5 | 0 | 817.500 | PT. Antar Mitra Persada |
| 63 | Fasilitas Kesehatan Sektoral Kemenkes | Handscoon Steril Maxter No.7 | 10.200 | 25 | 0 | 255.000 | PT. Antar Mitra Persada |
| 64 | Fasilitas Kesehatan Sektoral Kemenkes | Handscoon Steril Maxter no 7,5 | 10.200 | 25 | 0 | 255.000 | PT. Antar Mitra Persada |
| 65 | Obat Program Jaminan Kesehatan | Asam askorbat (vitamin C) tablet/kapsul/kaplet 50 mg | 95 | 20.000 | 0 | 1.900.000 | PT.Imfarmind Farmasi Industri |
| 66 | Fasilitas Kesehatan Sektoral Kemenkes | Acyclovir tablet 400mg | 920 | 2.000 | 0 | 1.840.000 | PT. Antar Mitra Persada |
| 67 | Fasilitas Kesehatan Sektoral Kemenkes | Demacolin tablet | 645 | 27.700 | 0 | 17.866.500 | PT. Antar Mitra Persada |
| 68 | Fasilitas Kesehatan Sektoral Kemenkes | Dimenhydrinat tablet | 240 | 11.800 | 0 | 2.832.000 | PT. Antar Mitra Persada |
| 69 | Fasilitas Kesehatan Sektoral Kemenkes | Phenol Glyserol Tetes Telinga | 250.000 | 4 | 0 | 1.000.000 | PT. Antar Mitra Persada |
| 70 | Fasilitas Kesehatan Sektoral Kemenkes | PHYTOMENADION 10MG | 1.490 | 300 | 0 | 447.000 | PT. Antar Mitra Persada |
| 71 | Fasilitas Kesehatan Sektoral Kemenkes | Glibencamide 5 mg tablet | 1 | 2.000 | 0 | 2.000 | PT. Antar Mitra Persada |
| 72 | Fasilitas Kesehatan Sektoral Kemenkes | Isosorbide dinitrate 5mg tablet | 280 | 400 | 0 | 112.000 | PT. Antar Mitra Persada |
| 73 | Fasilitas Kesehatan Sektoral Kemenkes | Piroxicam 20 mg tablet | 268 | 20.000 | 0 | 5.360.000 | PT. Antar Mitra Persada |
| 74 | Fasilitas Kesehatan Sektoral Kemenkes | Glimepirid 2mg isi 100 tablet | 330 | 5.500 | 0 | 1.815.000 | PT. Antar Mitra Persada |
| 75 | Konsolidasi Obat | Kodein tab 10 mg | 600 | 500 | 0 | 300.000 | PT. Kimia Farma Tbk |
| 76 | Konsolidasi Obat | Vitamin B kompleks mengandung: a. Vitamin B1 b. Vitamin B6 c. Vitamin B12 tab | 60 | 20.000 | 0 | 1.200.000 | PT.Imfarmind Farmasi Industri |
| 77 | Konsolidasi Obat | Antasida tab kunyah | 90 | 17.000 | 0 | 1.530.000 | PT.Imfarmind Farmasi Industri |
| 78 | Alat Tulis Kantor Provinsi Jawa Timur | KERTAS F4 70 GRAM | 58.000 | 120 | 0 | 6.960.000 | Griya Boga Danastri |
| 79 | Obat Program Jaminan Kesehatan | Ibuprofen tablet 200 mg | 197 | 8.000 | 0 | 1.576.000 | PT NOVAPHARIN |
| 80 | Fasilitas Kesehatan Sektoral Kemenkes | Vacuum Blood Collection Tube EDTA K3 3ml | 91.908 | 30 | 0 | 2.757.240 | PT Jayamas Medica Industri |
| 81 | Fasilitas Kesehatan Sektoral Kemenkes | ONECARE Reagen Widal S.typhi O | 121.000 | 3 | 0 | 363.000 | PT. SENTRAL MEDIKA INDONESIA |
| 82 | Fasilitas Kesehatan Sektoral Kemenkes | ONECARE Reagen Anti A Monoclonal | 99.900 | 10 | 0 | 999.000 | PT. SENTRAL MEDIKA INDONESIA |
| 83 | Belanja Obat, Peralatan, Perlengkapan Kesehatan dan Pemeliharaan Alkes Provinsi Sumatera Selatan | Glibenclamide Tablet 5 Mg FM | 244,2 | 2.500 | 0 | 610.500 | GATRA PERSADA |
| 84 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | M-30D DILUENT | 1.660.000 | 6 | 0 | 9.960.000 | PT.RUKUN PUTERA BERSAMA |
| 85 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | LYSE M-30CFL 3 DIFF | 1.670.000 | 5 | 0 | 8.350.000 | PT.RUKUN PUTERA BERSAMA |
| 86 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | EZ-CLEANSER M30E 100ML | 992.000 | 6 | 0 | 5.952.000 | PT.RUKUN PUTERA BERSAMA |
| 87 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | BLOOD URIC ACID TEST STRIP | 130.000 | 20 | 0 | 2.600.000 | PT.RUKUN PUTERA BERSAMA |
| 88 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | ON CALL BLOOD GLUCOSE TEST STRIPS 2X25 | 235.000 | 30 | 0 | 7.050.000 | PT.RUKUN PUTERA BERSAMA |
| 89 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | MISSION HB HEMOGLOBIN TEST STRIPS | 525.000 | 10 | 0 | 5.250.000 | PT.RUKUN PUTERA BERSAMA |
| 90 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | URINALYSIS REAGENT STRIP 10 PARAMETER | 285.000 | 8 | 0 | 2.280.000 | PT.RUKUN PUTERA BERSAMA |
| 91 | Alat Tulis Kantor Provinsi Jawa Timur | spidol permanent hitam snowman | 13.500 | 45 | 0 | 607.500 | Griya Boga Danastri |
| 92 | Alat Tulis Kantor Provinsi Jawa Timur | BINDER CLIP 300 | 60.000 | 25 | 0 | 1.500.000 | Griya Boga Danastri |
| 93 | Alat Tulis Kantor Provinsi Jawa Timur | Klip Kertas Kecil | 4.000 | 75 | 0 | 300.000 | Griya Boga Danastri |
| 94 | Alat Tulis Kantor Provinsi Jawa Timur | Klip Kertas Besar | 7.500 | 75 | 0 | 562.500 | Griya Boga Danastri |
| 95 | Alat Tulis Kantor Provinsi Jawa Timur | Map Kertas tebal | 39.500 | 13 | 0 | 513.500 | Griya Boga Danastri |
| 96 | Alat Tulis Kantor Provinsi Jawa Timur | Map Kancing Plastik | 29.500 | 13 | 0 | 383.500 | Griya Boga Danastri |
| 97 | Alat Tulis Kantor Provinsi Jawa Timur | Ordner Dan Map (Stopmap Snelhecter Plastik) | 7.000 | 371 | 0 | 2.597.000 | Griya Boga Danastri |
| 98 | Alat Tulis Kantor Provinsi Jawa Timur | odner TK 403 | 29.000 | 35 | 0 | 1.015.000 | Griya Boga Danastri |
| 99 | Alat Tulis Kantor Provinsi Jawa Timur | gunting SC 848 merk joyko | 9.500 | 10 | 0 | 95.000 | Griya Boga Danastri |
| 100 | Alat Tulis Kantor Provinsi Jawa Timur | ISI STAPLES KECIL | 6.500 | 100 | 0 | 650.000 | Griya Boga Danastri |
| 101 | Alat Tulis Kantor Provinsi Jawa Timur | staples merk joyko | 18.500 | 15 | 0 | 277.500 | Griya Boga Danastri |
| 102 | Alat Tulis Kantor Provinsi Jawa Timur | Alat Tulis (Bolpoint Standart Ae7 0.5mm) | 2.800 | 480 | 0 | 1.344.000 | Griya Boga Danastri |
| 103 | Alat Tulis Kantor Provinsi Jawa Timur | TINTA Stempel botol | 20.500 | 5 | 0 | 102.500 | Griya Boga Danastri |
| 104 | Alat Tulis Kantor Provinsi Jawa Timur | Pervorator Plong kertas sedang | 44.500 | 3 | 0 | 133.500 | Griya Boga Danastri |
| 105 | Alat Tulis Kantor Provinsi Jawa Timur | Stike Note endbook | 8.000 | 30 | 0 | 240.000 | Griya Boga Danastri |
| 106 | Alat Tulis Kantor Provinsi Jawa Timur | Ordner Dan Map (Stopmap folio jangger) | 4.500 | 200 | 0 | 900.000 | Griya Boga Danastri |
| 107 | Perlengkapan Perkantoran Provinsi Jawa Timur | Service AC | 600.000 | 7 | 0 | 4.200.000 | CV. MUTIARA JINGGA |
| 108 | Perlengkapan Perkantoran Provinsi Jawa Timur | Service printer | 590.000 | 2 | 0 | 1.180.000 | CV. MUTIARA JINGGA |
| 109 | Fasilitas Kesehatan Sektoral Kemenkes | Spalk Kids uk 5cm X 15cm | 185.000 | 6 | 0 | 1.110.000 | PT.REZEKI ANAK SHOLEH |
| 110 | Fasilitas Kesehatan Sektoral Kemenkes | Cotton Bud Dewasa | 25.000 | 20 | 0 | 500.000 | PT.REZEKI ANAK SHOLEH |
| 111 | Fasilitas Kesehatan Sektoral Kemenkes | Duk Polos Disposable 40cm x 40cm | 50.000 | 10 | 0 | 500.000 | PT.REZEKI ANAK SHOLEH |
| 112 | Fasilitas Kesehatan Sektoral Kemenkes | ONECARE Reagen Anti D igG/igM Monoclonal | 122.100 | 5 | 0 | 610.500 | PT. SENTRAL MEDIKA INDONESIA |
| 113 | Fasilitas Kesehatan Sektoral Kemenkes | ONECARE Reagen Widal S.typhi H | 121.000 | 3 | 0 | 363.000 | PT. SENTRAL MEDIKA INDONESIA |
| 114 | Fasilitas Kesehatan Sektoral Kemenkes | Hidrogen Peroxide 3 | 27.528 | 30 | 0 | 825.840 | PT Jayamas Medica Industri |
| 115 | Konsolidasi Obat | Salbutamol tab 2 mg | 62 | 10.000 | 0 | 620.000 | PT.Imfarmind Farmasi Industri |
| 116 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 1.958 | 300 | 0 | 587.400 | PT.Bernofarm |
| 117 | Obat Program Jaminan Kesehatan | Fitomenadion/ Phytomenadione/ Phytomenadion (Vitamin K1) injeksi 2 mg/ml (i.m.) | 5.589 | 50 | 0 | 279.450 | PT.Bernofarm |
| 118 | Obat Program Jaminan Kesehatan | Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 1.000 mg | 7.492 | 300 | 0 | 2.247.600 | PT.Bernofarm |
| 119 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron inj 2 mg/mL | 1.942 | 100 | 0 | 194.200 | PT.Bernofarm |
| 120 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron inj 2 mg/mL | 1.942 | 100 | 0 | 194.200 | PT.Bernofarm |
| 121 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 1.958 | 100 | 0 | 195.800 | PT.Bernofarm |
| 122 | Obat Program Jaminan Kesehatan | Difenhidramin/ Diphenhydramine injeksi 10 mg/ml ( i.v./i.m.) | 1.893 | 100 | 0 | 189.300 | PT.Bernofarm |
| 123 | Obat Program Jaminan Kesehatan | Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 1.000 mg | 7.492 | 100 | 0 | 749.200 | PT.Bernofarm |
| 124 | Obat Program Jaminan Kesehatan | Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain injeksi 2% | 1.319 | 300 | 0 | 395.700 | PT.Bernofarm |
| 125 | Obat Program Jaminan Kesehatan | Dexamethason Sodium Phosphate/ Deksamethason/ Deksametason injeksi 5 mg/mL | 1.653 | 800 | 0 | 1.322.400 | PT.Bernofarm |
| 126 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron inj 2 mg/mL | 1.942 | 500 | 0 | 971.000 | PT.Bernofarm |
| 127 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 1.958 | 700 | 0 | 1.370.600 | PT.Bernofarm |
| 128 | Obat Program Jaminan Kesehatan | Difenhidramin/ Diphenhydramine injeksi 10 mg/ml ( i.v./i.m.) | 1.893 | 800 | 0 | 1.514.400 | PT.Bernofarm |
| 129 | Obat Program Jaminan Kesehatan | Ampisilin/Ampicillin injeksi 1000 mg (i.v) | 10.417 | 100 | 0 | 1.041.700 | PT.Bernofarm |
| 130 | Obat Program Jaminan Kesehatan | Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 1.000 mg | 7.492 | 1.000 | 0 | 7.492.000 | PT.Bernofarm |
| 131 | Obat Program Jaminan Kesehatan | Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain injeksi 2% | 1.319 | 2.000 | 0 | 2.638.000 | PT.Bernofarm |
| 132 | Konsolidasi Obat | Alopurinol tab 100 mg | 155 | 10.000 | 0 | 1.550.000 | PT.Imfarmind Farmasi Industri |
| 133 | Konsolidasi Obat | Prednison tab 5 mg | 92 | 20.000 | 0 | 1.840.000 | PT.Imfarmind Farmasi Industri |
| 134 | Konsolidasi Obat | Piridoksin (vitamin B6) tab 10 mg* | 64 | 10.000 | 0 | 640.000 | PT.Imfarmind Farmasi Industri |
| 135 | Konsolidasi Obat | Tiamin (Vitamin B1) tab 50 mg* | 78 | 5.000 | 0 | 390.000 | PT.Imfarmind Farmasi Industri |
| 136 | Obat Program Jaminan Kesehatan | Asam askorbat (vitamin C) tablet/kapsul/kaplet 50 mg | 95 | 30.000 | 0 | 2.850.000 | PT.Imfarmind Farmasi Industri |
| 137 | Obat Program Jaminan Kesehatan | Paracetamol/ Parasetamol tablet/kaplet 500 mg | 140 | 30.000 | 0 | 4.200.000 | PT.Imfarmind Farmasi Industri |
| 138 | Obat Program Jaminan Kesehatan | Epinefrin/ Epinephrine (Adrenalin) injeksi 1 mg/mL | 5.828 | 60 | 0 | 349.680 | PT.Phapros Tbk |
| 139 | Obat Program Jaminan Kesehatan | Asiklovir/Acyclovir/Aciclovir tablet/kapsul/kaplet 400 mg | 932 | 2.000 | 0 | 1.864.000 | PT.Phapros Tbk |
| 140 | Obat Program Jaminan Kesehatan | Nystatin/ Nistatin vaginal tablet/kaplet 100.000 IU | 1.832 | 700 | 0 | 1.282.400 | PT.Phapros Tbk |
| 141 | Obat Program Kesehatan Lainnya | ACICLOVIR KRIM 5 gram | 3.329 | 300 | 0 | 998.700 | PT.Bernofarm |
| 142 | Obat Program Kesehatan Lainnya | Simvastatin tablet/kapsul/kaplet 10 mg | 230 | 12.000 | 0 | 2.760.000 | PT.Bernofarm |
| 143 | Obat Program Kesehatan Lainnya | Diclofenac sodium/ Natrium diklofenak tablet salut enterik/kaplet salut enterik 50 mg | 192 | 30.000 | 0 | 5.760.000 | PT.Bernofarm |
| 144 | Obat Program Kesehatan Lainnya | Deksametason/ Dexamethasone tablet/kapsul/kaplet 0,5 mg | 106 | 20.000 | 0 | 2.120.000 | PT.Bernofarm |
| 145 | Obat Program Kesehatan Lainnya | Betahistin/Betahistine Mesilate/Betahistine Mesylate tablet/kapsul/kaplet 6 mg | 355 | 5.000 | 0 | 1.775.000 | PT.Bernofarm |
| 146 | Obat Program Jaminan Kesehatan | Amoksisilin/ Amoxicillin/ Amoxicillin Trihydrate tablet/kapsul/kaplet/kaptab 500 mg | 530 | 20.000 | 0 | 10.600.000 | PT.Bernofarm |
| 147 | Obat Program Jaminan Kesehatan | Betametason/Betamethasone Valerate krim 0,1% 5g | 1.995 | 500 | 0 | 997.500 | PT.Bernofarm |
| 148 | Obat Program Jaminan Kesehatan | Ciprofloxacin hydrochloride (HCl)/ Ciprofloxacin Lactate/ Ciprofloxacin/ Siprofloksasin tablet/kapsul/kaplet 500 mg | 475 | 10.000 | 0 | 4.750.000 | PT.Bernofarm |
| 149 | Obat Program Jaminan Kesehatan | Miconazole nitrate/ Miconazole/ Mikonazol krim 2 % | 3.900 | 400 | 0 | 1.560.000 | PT.Bernofarm |
| 150 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol tablet /kaptab (dewasa) kombinasi: sulfametoksazol 400 mg + trimetoprim 80 mg | 275 | 10.000 | 0 | 2.750.000 | PT.Bernofarm |
| 151 | Obat Program Jaminan Kesehatan | GENTAMICIN SULFATE 01 % KRIM 5 gram | 3.325 | 300 | 0 | 997.500 | PT.Bernofarm |
| 152 | Obat Program Jaminan Kesehatan | Mefenamic acid tablet/kapsul/kaplet/kaptab 500 mg | 279 | 30.000 | 0 | 8.370.000 | PT.Bernofarm |
| 153 | Fasilitas Kesehatan Sektoral Kemenkes | ROEKO Endo-Frost | 399.550 | 24 | 50.000 | 9.639.200 | CIPTA MEDIKA SEMPURNA |
| 154 | Fasilitas Kesehatan Sektoral Kemenkes | IMICRYL Nova Compo C Composite Set | 2.713.900 | 1 | 50.000 | 2.763.900 | CIPTA MEDIKA SEMPURNA |
| 155 | Fasilitas Kesehatan Sektoral Kemenkes | CUPLIK Kasa Hidrofil 16 x 16 | 5.700 | 100 | 0 | 570.000 | PT. Likuid Pharmalab Indonesia |
| 156 | Fasilitas Kesehatan Sektoral Kemenkes | Medika Povidine 10% ukuran 300 ml | 31.029 | 50 | 0 | 1.551.450 | PT. Likuid Pharmalab Indonesia |
| 157 | Fasilitas Kesehatan Sektoral Kemenkes | Bi-Dcare Disposable Syringe With Needle 1 ml | 1.159 | 1.300 | 0 | 1.506.700 | PT. Sri Tita Medika |
| 158 | Fasilitas Kesehatan Sektoral Kemenkes | NO-PAIN Spray Skin Refrigerant | 95.238 | 90 | 0 | 8.571.420 | PT Jayamas Medica Industri |
| 159 | Fasilitas Kesehatan Sektoral Kemenkes | Nebulizer Mask Set Dewasa | 17.982 | 50 | 0 | 899.100 | PT Jayamas Medica Industri |
| 160 | Fasilitas Kesehatan Sektoral Kemenkes | Nebulizer Mask Set Anak | 17.982 | 25 | 0 | 449.550 | PT Jayamas Medica Industri |
| 161 | Fasilitas Kesehatan Sektoral Kemenkes | Infusion Set Dewasa ST01 | 3.200 | 200 | 0 | 640.000 | PT Jayamas Medica Industri |
| 162 | Obat Program Jaminan Kesehatan | Air untuk injeksi/ Aqua pro injeksi/ Aqua pro injection/ water for injection | 2.659 | 600 | 0 | 1.595.400 | PT. EMJEBE PHARMA |
| 163 | Obat Program Jaminan Kesehatan | Vitamin B Kompleks tablet / Vitamin B Complex tablet | 81 | 22.200 | 0 | 1.798.200 | PT.Imfarmind Farmasi Industri |
| 164 | Konsolidasi Obat | Salbutamol tab 2 mg | 62 | 20.000 | 0 | 1.240.000 | PT.Imfarmind Farmasi Industri |
| Total | 351.477.256 | ||||||
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