| No | Etalase | Produk | Harga | Jumlah | Ongkos Kirim | Total | Penyedia |
|---|---|---|---|---|---|---|---|
| 1 | Obat Program Jaminan Kesehatan | Asetat Ringer / Ringer asetat, @ 500 mL | 8.000 | 300 | 0 | 2.400.000 | PT. EMJEBE PHARMA |
| 2 | Obat Program Jaminan Kesehatan | Dexamethason Sodium Phosphate/ Deksamethason/ Deksametason injeksi 5 mg/mL | 1.776 | 500 | 0 | 888.000 | PT.Phapros Tbk |
| 3 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 2.309 | 500 | 0 | 1.154.500 | PT.Phapros Tbk |
| 4 | Obat Program Jaminan Kesehatan | METAMIZOLE SODIUM MONOHYDRATE Injeksi | 3.449 | 500 | 0 | 1.724.500 | PT. MEPROFARM |
| 5 | Obat Program Jaminan Kesehatan | Ringer Laktat/ Ringer Lactate, @500 mL | 8.498 | 1.000 | 0 | 8.498.000 | PT. Kimia Farma Tbk |
| 6 | Obat Program Jaminan Kesehatan | Nacl 0,9% / Sodium Chloride 0,9% | 7.000 | 1.000 | 0 | 7.000.000 | PT. EMJEBE PHARMA |
| 7 | Obat Program Kesehatan Lainnya | AMBROXOL HCl 30 mg TABLET | 210 | 10.000 | 0 | 2.100.000 | PT.Bernofarm |
| 8 | Obat Program Kesehatan Lainnya | Diclofenac sodium/ Natrium diklofenak tablet salut enterik/kaplet salut enterik 50 mg | 192 | 10.000 | 0 | 1.920.000 | PT.Bernofarm |
| 9 | Obat Program Kesehatan Lainnya | Paracetamol/ Parasetamol tablet/kapsul/kaplet 500 mg | 189 | 20.000 | 0 | 3.780.000 | PT.Bernofarm |
| 10 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron inj 2 mg/mL | 1.942 | 1.000 | 0 | 1.942.000 | PT.Bernofarm |
| 11 | Obat Program Jaminan Kesehatan | Amoksisilin/ Amoxicillin/ Amoxicillin Trihydrate tablet/kapsul/kaplet/kaptab 500 mg | 507 | 15.000 | 0 | 7.605.000 | PT. Kimia Farma Tbk |
| 12 | Obat Program Jaminan Kesehatan | ANTASIDA DOEN - OGB TABLET KUNYAH | 132 | 20.000 | 0 | 2.640.000 | PT. SEJAHTERA LESTARI FARMA |
| 13 | Obat Program Jaminan Kesehatan | Tridexon/ Deksametason/ Dexamethasone tablet/kapsul/kaplet 0,5 mg | 136 | 20.000 | 0 | 2.720.000 | PT. TRIMAN |
| 14 | Obat Program Jaminan Kesehatan | ATTAPULGIT/ATTAPULGITE 600 MG/TABLET/KAPLET/KAPSUL | 300 | 2.000 | 0 | 600.000 | PT. TRIMAN |
| 15 | Obat Non Jaminan Kesehatan | Guaifenesin/GG/Tablet/Kapsul/Kaplet 100 mg | 100 | 20.000 | 0 | 2.000.000 | PT. TRIMAN |
| 16 | Konsolidasi Obat | Alopurinol tab 100 mg | 155 | 10.000 | 0 | 1.550.000 | PT.Imfarmind Farmasi Industri |
| 17 | Konsolidasi Obat | Vitamin B kompleks mengandung: a. Vitamin B1 b. Vitamin B6 c. Vitamin B12 tab | 60 | 10.000 | 0 | 600.000 | PT.Imfarmind Farmasi Industri |
| 18 | Konsolidasi Obat | Tiamin (Vitamin B1) tab 50 mg* | 78 | 10.000 | 0 | 780.000 | PT.Imfarmind Farmasi Industri |
| 19 | Fasilitas Kesehatan Sektoral Kemenkes | Nitrile Medical Examination Gloves XS,S,M,L | 41.070 | 40 | 0 | 1.642.800 | PT Jayamas Medica Industri |
| 20 | Fasilitas Kesehatan Sektoral Kemenkes | Kasa Steril Kasa Kompres, 40 cm x 40 cm (Box isi 50 pcs) | 74.148 | 10 | 0 | 741.480 | PT Jayamas Medica Industri |
| 21 | Fasilitas Kesehatan Sektoral Kemenkes | Infusion Set Anak | 3.500 | 300 | 0 | 1.050.000 | PT Jayamas Medica Industri |
| 22 | Fasilitas Kesehatan Sektoral Kemenkes | Disposable Syringe 1 ml | 57.750 | 5 | 0 | 288.750 | PT Jayamas Medica Industri |
| 23 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 5 cc | 96.800 | 10 | 0 | 968.000 | PT Jayamas Medica Industri |
| 24 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 3 cc | 78.100 | 30 | 0 | 2.343.000 | PT Jayamas Medica Industri |
| 25 | Fasilitas Kesehatan Sektoral Kemenkes | I.V Cannula With Teflon Catheter 1 Way 24 G | 195.138 | 2 | 0 | 390.276 | PT Jayamas Medica Industri |
| 26 | Fasilitas Kesehatan Sektoral Kemenkes | I.V Cannula With Teflon Catheter 1 Way 22 G | 195.138 | 6 | 0 | 1.170.828 | PT Jayamas Medica Industri |
| 27 | Fasilitas Kesehatan Sektoral Kemenkes | I.V Cannula With Teflon Catheter 1 Way 20 G | 195.138 | 6 | 0 | 1.170.828 | PT Jayamas Medica Industri |
| 28 | Fasilitas Kesehatan Sektoral Kemenkes | Infusion Set Air Vented LL | 4.884 | 600 | 0 | 2.930.400 | PT Jayamas Medica Industri |
| 29 | Fasilitas Kesehatan Sektoral Kemenkes | Dermafix S IV | 49.728 | 50 | 0 | 2.486.400 | PT Jayamas Medica Industri |
| 30 | Fasilitas Kesehatan Sektoral Kemenkes | Plesterin Roll non woven roll 10 cm x 5 m | 41.958 | 50 | 0 | 2.097.900 | PT Jayamas Medica Industri |
| 31 | Fasilitas Kesehatan Sektoral Kemenkes | Surgical blades | 56.388 | 6 | 0 | 338.328 | PT INTISUMBER HASIL SEMPURNA GLOBAL |
| 32 | Obat Program Jaminan Kesehatan | Air untuk injeksi/ Aqua pro injeksi/ Aqua pro injection/ water for injection | 2.500 | 960 | 0 | 2.400.000 | PT. EMJEBE PHARMA |
| 33 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | SPALK FIRST AID 20X5 | 11.500 | 50 | 0 | 575.000 | PT.RUKUN PUTERA BERSAMA |
| 34 | MATERIEL KESEHATAN UO TNI AL | Diazepam enema 5 mg/2,5 mL | 18.000 | 40 | 0 | 720.000 | PT. FARMAHUSADA MILLENNIA |
| 35 | MATERIEL KESEHATAN UO TNI AL | MERSIBION 5000 INJEKSI | 3.500 | 500 | 0 | 1.750.000 | PT. FARMAHUSADA MILLENNIA |
| 36 | MATERIEL KESEHATAN UO TNI AL | CHLORPHENAMINE MALEATE CTM 4 MG | 92 | 10.000 | 0 | 920.000 | PT. FARMAHUSADA MILLENNIA |
| 37 | Jasa Kebersihan Pemerintah Provinsi Jawa Timur | Jasa Cleaning Service | 2.500.000 | 2 | 0 | 5.000.000 | BINTANG JAYA SENTOSA |
| 38 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | TABUNG EDTA VACULAB 3ML | 195.000 | 10 | 0 | 1.950.000 | PT.RUKUN PUTERA BERSAMA |
| 39 | Jasa Pengelolaan Limbah Provinsi Jawa Timur | Pengelolaan Limbah Medis Fasyankes | 9.990 | 240 | 0 | 2.397.600 | PT.PUTRA RESTU IBU ABADI |
| 40 | Makanan dan Minuman Provinsi Jawa Timur | Nasi ayam bakar | 29.000 | 20 | 0 | 580.000 | Gloxinia Catering |
| 41 | Makanan dan Minuman Provinsi Jawa Timur | Snack box | 19.000 | 20 | 0 | 380.000 | Gloxinia Catering |
| 42 | Obat Program Kesehatan Lainnya | GENTAMICIN SULFATE 01 % KRIM 5 g | 3.325 | 300 | 0 | 997.500 | PT.Bernofarm |
| 43 | Jasa Kebersihan Pemerintah Provinsi Jawa Timur | Jasa Cleaning Service | 2.500.000 | 2 | 0 | 5.000.000 | BINTANG JAYA SENTOSA |
| 44 | Perlengkapan Perkantoran Provinsi Jawa Timur | Tisu Nice | 12.000 | 300 | 0 | 3.600.000 | CV. Putra Kelud Berdikari |
| 45 | Perlengkapan Perkantoran Provinsi Jawa Timur | Tempat sampah injak | 100.000 | 10 | 0 | 1.000.000 | CV. Putra Kelud Berdikari |
| 46 | Perlengkapan Perkantoran Provinsi Jawa Timur | Sabun cuci tangan | 20.000 | 50 | 0 | 1.000.000 | CV. Putra Kelud Berdikari |
| 47 | Perlengkapan Perkantoran Provinsi Jawa Timur | Kantong sampah Trash bag | 40.000 | 150 | 0 | 6.000.000 | CV. Putra Kelud Berdikari |
| 48 | Perlengkapan Perkantoran Provinsi Jawa Timur | Plastik sampah Kuning Medis | 39.000 | 10 | 0 | 390.000 | CV. Putra Kelud Berdikari |
| 49 | Perlengkapan Perkantoran Provinsi Jawa Timur | Pengharum ruangan Glade | 15.000 | 25 | 0 | 375.000 | CV. Putra Kelud Berdikari |
| 50 | Perlengkapan Perkantoran Provinsi Jawa Timur | Timba air | 60.000 | 5 | 0 | 300.000 | CV. Putra Kelud Berdikari |
| 51 | Perlengkapan Perkantoran Provinsi Jawa Timur | Gayung casual pastel | 14.000 | 5 | 0 | 70.000 | CV. Putra Kelud Berdikari |
| 52 | Perlengkapan Perkantoran Provinsi Jawa Timur | Sapu lantai | 30.000 | 5 | 0 | 150.000 | CV. Putra Kelud Berdikari |
| 53 | Perlengkapan Perkantoran Provinsi Jawa Timur | Rinso bubuk | 30.000 | 20 | 0 | 600.000 | CV. Putra Kelud Berdikari |
| 54 | Perlengkapan Perkantoran Provinsi Jawa Timur | Plastik 1 kg | 10.000 | 140 | 0 | 1.400.000 | CV. Putra Kelud Berdikari |
| 55 | Perlengkapan Perkantoran Provinsi Jawa Timur | Plastik klip Uk 8x12 | 7.000 | 110 | 0 | 770.000 | CV. Putra Kelud Berdikari |
| 56 | Konsolidasi Obat | Asam mefenamat tab 500 mg | 155 | 30.000 | 0 | 4.650.000 | PT. TRIMAN |
| 57 | Obat Program Jaminan Kesehatan | Chloramphenicol/ Kloramfenikol tablet/kapsul/kaplet 250 mg | 616 | 5.000 | 0 | 3.080.000 | PT NOVAPHARIN |
| 58 | Obat Program Jaminan Kesehatan | Griseofulvin tablet/kapsul/kaplet 125 mg | 357 | 500 | 0 | 178.500 | PT NOVAPHARIN |
| 59 | Obat Program Jaminan Kesehatan | Ibuprofen tablet/kapsul/kaplet 400 mg | 209 | 10.000 | 0 | 2.090.000 | PT NOVAPHARIN |
| 60 | Obat Program Jaminan Kesehatan | Ketokonazol/ Ketoconazole tablet/kapsul/kaplet 200 mg | 430 | 1.000 | 0 | 430.000 | PT NOVAPHARIN |
| 61 | Obat Program Jaminan Kesehatan | Acetylcysteine/ N-asetilsistein tablet/kapsul/kaplet 200 mg | 465 | 2.000 | 0 | 930.000 | PT NOVAPHARIN |
| 62 | Obat Program Jaminan Kesehatan | Ibuprofen tablet 200 mg | 197 | 10.000 | 0 | 1.970.000 | PT NOVAPHARIN |
| 63 | Obat Program Kesehatan Lainnya | Metformin Hydrochloride/ Metformin tablet/kapsul/kaplet 500 mg | 266 | 10.000 | 0 | 2.660.000 | PT.Bernofarm |
| 64 | Obat Program Kesehatan Lainnya | Amlodipine besilate tablet/kapsul/kaplet 5 mg | 291 | 10.000 | 0 | 2.910.000 | PT.Bernofarm |
| 65 | Obat Program Kesehatan Lainnya | Ranitidine hydrochloride (HCl)/Ranitidin tablet/kapsul/kaplet 150 mg | 300 | 10.000 | 0 | 3.000.000 | PT.Bernofarm |
| 66 | Obat Program Jaminan Kesehatan | Amoksisilin/Amoxicillin/Amoxicillin Trihydrate sirup/suspensi kering 125 mg/ 5 ml | 5.500 | 500 | 0 | 2.750.000 | PT.Bernofarm |
| 67 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg | 4.796 | 500 | 0 | 2.398.000 | PT.Bernofarm |
| 68 | Obat Program Jaminan Kesehatan | Domperidon/ Domperidone/ Domperidone Maleate tablet/kapsul/kaplet 10 mg | 283 | 15.000 | 0 | 4.245.000 | PT.Bernofarm |
| 69 | Obat Program Jaminan Kesehatan | Hidrokortison/ Hydrocortisone/ Hydrocortisone acetate krim 2,5 % | 4.662 | 200 | 0 | 932.400 | PT.Bernofarm |
| 70 | Obat Program Jaminan Kesehatan | Paracetamol/ Parasetamol sirup 120 mg / 5 ml | 4.460 | 500 | 0 | 2.230.000 | PT.Bernofarm |
| 71 | Obat Program Jaminan Kesehatan | Betametason/Betamethasone Valerate krim 0,1% 5g | 1.995 | 200 | 0 | 399.000 | PT.Bernofarm |
| 72 | Peralatan dan Perlengkapan Kantor Kabupaten Mojokerto | Kursi Susun | 290.000 | 50 | 0 | 14.500.000 | PT. KARYA ULTIMA MANDIRI |
| 73 | Makanan dan Minuman Provinsi Jawa Timur | Snack Box Buah dan Cumcum | 20.000 | 60 | 0 | 1.200.000 | soulmate catering |
| 74 | Peralatan atau Perlengkapan Kantor dan Rumah Tangga | Sprei Rumah Sakit | 165.000 | 16 | 0 | 2.640.000 | RO'ISUL FELIATI |
| 75 | Peralatan atau Perlengkapan Kantor dan Rumah Tangga | Bantal Tidur Oscar | 135.000 | 16 | 0 | 2.160.000 | RO'ISUL FELIATI |
| 76 | Peralatan atau Perlengkapan Kantor dan Rumah Tangga | Selimut Rumah Sakit | 74.000 | 2 | 0 | 148.000 | RO'ISUL FELIATI |
| 77 | Peralatan atau Perlengkapan Kantor dan Rumah Tangga | Sarung Bantal Cover | 24.000 | 15 | 0 | 360.000 | RO'ISUL FELIATI |
| 78 | Jasa Kebersihan Pemerintah Provinsi Jawa Timur | Jasa Cleaning Service | 2.500.000 | 2 | 0 | 5.000.000 | BINTANG JAYA SENTOSA |
| 79 | BAHAN KIMIA REAGEN PROVINSI JAWA TIMUR | HYDROGEN PEROXIDE 3% (H2O2) 800ml | 57.000 | 4 | 0 | 228.000 | PT.RUKUN PUTERA BERSAMA |
| 80 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | KASA STERIL VASELINE SWAB 10 X 10 CM | 98.000 | 10 | 0 | 980.000 | PT.RUKUN PUTERA BERSAMA |
| 81 | Obat Program Jaminan Kesehatan | Fitomenadion/ Phytomenadion (Vitamin K1) tablet/kapsul/kaplet 10 mg | 1.055 | 500 | 0 | 527.500 | PT.Phapros Tbk |
| 82 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 2.309 | 1.000 | 0 | 2.309.000 | PT.Phapros Tbk |
| 83 | Obat Program Jaminan Kesehatan | Asiklovir/Acyclovir/Aciclovir tablet/kapsul/kaplet 400 mg | 848 | 3.000 | 0 | 2.544.000 | PT. Kimia Farma Tbk |
| 84 | Obat Program Jaminan Kesehatan | Dimenhidrinat/ Dimenhydrinate tablet/kapsul/kaplet 50 mg | 143 | 9.000 | 0 | 1.287.000 | PT. Kimia Farma Tbk |
| 85 | Obat Program Jaminan Kesehatan | Antasida Doen susp | 2.743 | 1.000 | 0 | 2.743.000 | PT. LUCAS DJAJA |
| 86 | Konsolidasi Obat | Omeprazol kaps 20 mg | 215 | 9.000 | 0 | 1.935.000 | PT. IFARS PHARMACEUTICAL LABORATORIES |
| 87 | Konsolidasi Obat | Prednison tab 5 mg | 92 | 10.000 | 0 | 920.000 | PT. IFARS PHARMACEUTICAL LABORATORIES |
| 88 | MATERIEL KESEHATAN UO TNI AL | CALORTUSIN | 570 | 10.000 | 0 | 5.700.000 | PT. FARMAHUSADA MILLENNIA |
| 89 | MATERIEL KESEHATAN UO TNI AL | LAXANA TABLET / BISACODYL 5 MG | 390 | 500 | 0 | 195.000 | PT. FARMAHUSADA MILLENNIA |
| 90 | Obat Program Jaminan Kesehatan | Karbogliserin tetes telinga 10% | 7.396 | 144 | 0 | 1.065.024 | PT. LUCAS DJAJA |
| 91 | Fasilitas Kesehatan Sektoral Kemenkes | Latex Medical Examination Gloves XS,S,M,L Powder Free | 42.180 | 100 | 0 | 4.218.000 | PT Jayamas Medica Industri |
| 92 | Fasilitas Kesehatan Sektoral Kemenkes | Nebulizer Mask Set Dewasa | 17.982 | 200 | 0 | 3.596.400 | PT Jayamas Medica Industri |
| 93 | Fasilitas Kesehatan Sektoral Kemenkes | Nebulizer Mask Set Anak | 17.982 | 100 | 0 | 1.798.200 | PT Jayamas Medica Industri |
| 94 | Fasilitas Kesehatan Sektoral Kemenkes | Maxiflow Anak | 10.323 | 100 | 0 | 1.032.300 | PT Jayamas Medica Industri |
| 95 | Fasilitas Kesehatan Sektoral Kemenkes | Oxyflow Oxygen Nasal Cannula Dewasa | 5.550 | 400 | 0 | 2.220.000 | PT Jayamas Medica Industri |
| 96 | Fasilitas Kesehatan Sektoral Kemenkes | Oxyflow Oxygen Nasal Cannula Anak | 5.550 | 200 | 0 | 1.110.000 | PT Jayamas Medica Industri |
| 97 | MATERIEL KESEHATAN UO TNI AL | CHLORPHENAMINE MALEATE CTM 4 MG | 92 | 20.000 | 0 | 1.840.000 | PT. FARMAHUSADA MILLENNIA |
| 98 | MATERIEL KESEHATAN UO TNI AL | RECO TETES MATA 10 ML | 12.735 | 300 | 0 | 3.820.500 | PT. FARMAHUSADA MILLENNIA |
| 99 | Alat Tulis Kantor Provinsi Jawa Timur | KERTAS HVS PUTIH SIDU F4 80GR | 63.000 | 30 | 0 | 1.890.000 | soulmate catering |
| 100 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | ISI ULANG TABUNG OKSIGEN MEDIS 6 M3 | 300.000 | 8 | 0 | 2.400.000 | PT.RUKUN PUTERA BERSAMA |
| 101 | Obat Program Jaminan Kesehatan | METAMIZOLE SODIUM MONOHYDRATE Injeksi | 3.449 | 1.000 | 0 | 3.449.000 | PT. MEPROFARM |
| 102 | Obat Program Kesehatan Lainnya | Paracetamol/ Parasetamol tablet/kapsul/kaplet 500 mg | 189 | 30.000 | 0 | 5.670.000 | PT.Bernofarm |
| 103 | Obat Program Jaminan Kesehatan | Amoksisilin/ Amoxicillin/ Amoxicillin Trihydrate tablet/kapsul/kaplet/kaptab 500 mg | 530 | 15.000 | 0 | 7.950.000 | PT.Bernofarm |
| 104 | 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 |
| 105 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 2.309 | 1.000 | 0 | 2.309.000 | PT.Phapros Tbk |
| 106 | Obat Program Jaminan Kesehatan | METAMIZOLE SODIUM MONOHYDRATE Injeksi | 3.449 | 1.000 | 0 | 3.449.000 | PT. MEPROFARM |
| 107 | Obat Non Jaminan Kesehatan | MEFFU DMP | 415 | 10.000 | 0 | 4.150.000 | PT. TRIMAN |
| 108 | Konsolidasi Obat | Asam mefenamat tab 500 mg | 155 | 20.000 | 0 | 3.100.000 | PT. TRIMAN |
| 109 | Obat Program Jaminan Kesehatan | Antasida Doen kemasan box | 127 | 15.000 | 0 | 1.905.000 | PT. TRIMAN |
| 110 | Obat Program Kesehatan Lainnya | Deksametason/ Dexamethasone tablet/kapsul/kaplet 0,5 mg | 106 | 20.000 | 0 | 2.120.000 | PT.Bernofarm |
| 111 | Fasilitas Kesehatan Sektoral Kemenkes | Urine Container 60 ml non steril | 999 | 500 | 0 | 499.500 | PT Jayamas Medica Industri |
| 112 | Fasilitas Kesehatan Sektoral Kemenkes | Plesterin Bulat non woven | 34.188 | 10 | 0 | 341.880 | PT Jayamas Medica Industri |
| 113 | Fasilitas Kesehatan Sektoral Kemenkes | Tongue Depressor Steril | 18.648 | 25 | 0 | 466.200 | PT Jayamas Medica Industri |
| 114 | Fasilitas Kesehatan Sektoral Kemenkes | Medical Chart Paper 80 mm x 20 m | 31.080 | 20 | 0 | 621.600 | PT Jayamas Medica Industri |
| 115 | Fasilitas Kesehatan Sektoral Kemenkes | Nebulizer Mask Set Dewasa | 17.982 | 50 | 0 | 899.100 | PT Jayamas Medica Industri |
| 116 | Fasilitas Kesehatan Sektoral Kemenkes | Stomach Tube FR16, 125cm | 7.992 | 25 | 0 | 199.800 | PT Jayamas Medica Industri |
| 117 | Fasilitas Kesehatan Sektoral Kemenkes | CAVITIMI | 140.900 | 4 | 30.000 | 593.600 | CIPTA MEDIKA SEMPURNA |
| 118 | Fasilitas Kesehatan Sektoral Kemenkes | IMICRYL Nova Compo C Composite Set | 2.713.900 | 1 | 30.000 | 2.743.900 | CIPTA MEDIKA SEMPURNA |
| 119 | Fasilitas Kesehatan Sektoral Kemenkes | IMICRYL NOVA COMPO HS | 298.500 | 1 | 0 | 298.500 | CIPTA MEDIKA SEMPURNA |
| 120 | Fasilitas Kesehatan Sektoral Kemenkes | IMICRYL Imipomza | 79.900 | 1 | 0 | 79.900 | CIPTA MEDIKA SEMPURNA |
| 121 | Obat Program Jaminan Kesehatan | Chlorphenamine Maleate/ Klorfeniramin tablet/kapsul/kaplet 4 mg | 73 | 20.000 | 0 | 1.460.000 | PT NOVAPHARIN |
| 122 | Obat Program Jaminan Kesehatan | Vitamin B Kompleks/ Vitamin B complex tablet | 81 | 10.000 | 0 | 810.000 | PT NOVAPHARIN |
| 123 | Obat Program Jaminan Kesehatan | Cetirizine hydrochloride 10 mg tablet | 108 | 10.000 | 0 | 1.080.000 | PT NOVAPHARIN |
| 124 | Obat Program Jaminan Kesehatan | METAMIZOLE SODIUM MONOHYDRATE Injeksi | 3.449 | 1.000 | 0 | 3.449.000 | PT. MEPROFARM |
| 125 | Obat Program Kesehatan Lainnya | Diclofenac sodium tablet salut enterik 50 mg | 142 | 15.000 | 0 | 2.130.000 | PT NOVAPHARIN |
| 126 | Obat Program Kesehatan Lainnya | Simvastatin tablet 10 mg | 131 | 8.000 | 0 | 1.048.000 | PT NOVAPHARIN |
| 127 | Obat Program Kesehatan Lainnya | Vitamin B1 tablet 50 mg | 145 | 15.000 | 0 | 2.175.000 | PT NOVAPHARIN |
| 128 | Obat Program Kesehatan Lainnya | Deksametason/ Dexamethasone tablet/kapsul/kaplet 0,5 mg | 106 | 20.000 | 0 | 2.120.000 | PT.Bernofarm |
| 129 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron inj 2 mg/mL | 1.942 | 500 | 0 | 971.000 | PT.Bernofarm |
| 130 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 1.958 | 1.000 | 0 | 1.958.000 | PT.Bernofarm |
| 131 | Obat Program Jaminan Kesehatan | GENTAMICIN SULFATE 01 % KRIM 5 gram | 3.325 | 500 | 0 | 1.662.500 | PT.Bernofarm |
| 132 | Obat Program Jaminan Kesehatan | Glimepiride tablet/kapsul/kaplet 2 mg | 549 | 10.000 | 0 | 5.490.000 | PT.Bernofarm |
| 133 | Obat Program Jaminan Kesehatan | Domperidon/ Domperidone tablet/kapsul/kaplet 10 mg | 108 | 15.000 | 0 | 1.620.000 | PT. TRIMAN |
| 134 | Obat Program Jaminan Kesehatan | ATTAPULGIT/ATTAPULGITE 600 MG/TABLET/KAPLET/KAPSUL | 300 | 15.000 | 0 | 4.500.000 | PT. TRIMAN |
| 135 | Konsolidasi Obat | Alopurinol tab 100 mg | 155 | 10.000 | 0 | 1.550.000 | PT.Imfarmind Farmasi Industri |
| 136 | Konsolidasi Obat | Piridoksin (vitamin B6) tab 25 mg* | 222 | 10.000 | 0 | 2.220.000 | PT.Imfarmind Farmasi Industri |
| 137 | Konsolidasi Obat | Antasida tab kunyah | 90 | 15.000 | 0 | 1.350.000 | PT.Imfarmind Farmasi Industri |
| 138 | Konsolidasi Obat | Asam mefenamat tab 500 mg | 155 | 20.000 | 0 | 3.100.000 | PT. TRIMAN |
| 139 | Fasilitas Kesehatan Sektoral Kemenkes | Vacuum Blood Collection Tube EDTA K3 3ml | 91.908 | 10 | 0 | 919.080 | PT Jayamas Medica Industri |
| 140 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter w/o Port w/o Wing 24G | 7.881 | 100 | 0 | 788.100 | PT Jayamas Medica Industri |
| 141 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter w/o Port w/o Wing 22G | 7.881 | 200 | 0 | 1.576.200 | PT Jayamas Medica Industri |
| 142 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter w/o Port with Wing 18G | 7.881 | 100 | 0 | 788.100 | PT Jayamas Medica Industri |
| 143 | Fasilitas Kesehatan Sektoral Kemenkes | Uro One Foley Catheter 2 Way 16 FR | 99.900 | 3 | 0 | 299.700 | PT Jayamas Medica Industri |
| 144 | Fasilitas Kesehatan Sektoral Kemenkes | Uro One Foley Catheter 2 Way 18 FR | 99.900 | 3 | 0 | 299.700 | PT Jayamas Medica Industri |
| 145 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 5 cc | 86.580 | 30 | 0 | 2.597.400 | PT Jayamas Medica Industri |
| 146 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 3 cc | 73.038 | 50 | 0 | 3.651.900 | PT Jayamas Medica Industri |
| 147 | Fasilitas Kesehatan Sektoral Kemenkes | I.V Cannula With Teflon Catheter 1 Way 20 G | 3.885 | 500 | 0 | 1.942.500 | PT Jayamas Medica Industri |
| 148 | Fasilitas Kesehatan | Tiang/Stand Infus SS Deluxe | 463.980 | 5 | 0 | 2.319.900 | PT. KARYA INDAH MEDIKA |
| Total | 310.537.974 | ||||||
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