| No | Etalase | Produk | Harga | Jumlah | Ongkos Kirim | Total | Penyedia |
|---|---|---|---|---|---|---|---|
| 1 | Obat Program Jaminan Kesehatan | Metamizol/Antalgin Inj 500 mg/ml atau Metamizole Sodium Monohydrate/Antalgin inj 1000 mg/2ml | 3.550 | 5.000 | 0 | 17.750.000 | PT.Bernofarm |
| 2 | Makanan dan Minuman Provinsi Jawa Timur | Snack Kotak | 20.000 | 45 | 0 | 900.000 | Gloxinia Catering |
| 3 | Makanan dan Minuman Provinsi Jawa Timur | Snack box | 20.000 | 45 | 0 | 900.000 | Gloxinia Catering |
| 4 | Jasa Pengelolaan Limbah Provinsi Jawa Timur | Pengelolaan Limbah Medis Fasyankes | 9.990 | 159 | 0 | 1.588.410 | PT.PUTRA RESTU IBU ABADI |
| 5 | Service Peralatan Perkantoran Provinsi Jawa Timur | CLEANING AC 1,5 PK - 2 PK | 100.000 | 3 | 0 | 300.000 | PT ZONA MUDA INDONESIA |
| 6 | Service Peralatan Perkantoran Provinsi Jawa Timur | JASA SERVICE PERGANTIAN KABEL FLEKSIBEL AC | 130.000 | 1 | 0 | 130.000 | PT ZONA MUDA INDONESIA |
| 7 | Service Peralatan Perkantoran Provinsi Jawa Timur | Isi Freon AC 1.5PK | 195.000 | 1 | 0 | 195.000 | PT ZONA MUDA INDONESIA |
| 8 | MATERIEL KESEHATAN UO TNI AL | MERSIBION 5000 INJEKSI | 3.500 | 400 | 0 | 1.400.000 | PT. FARMAHUSADA MILLENNIA |
| 9 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Gelang Thermal Anak Biru (250pcs) | 499.999 | 5 | 0 | 2.499.995 | Yuxa Medika Indonesia |
| 10 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Gelang Thermal Anak Pink (250pcs) | 499.999 | 5 | 0 | 2.499.995 | Yuxa Medika Indonesia |
| 11 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Label Thermal Putih 5x6 cm (1000pcs) | 179.999 | 10 | 0 | 1.799.990 | Yuxa Medika Indonesia |
| 12 | Servis Kendaraan Provinsi Jawa Timur | SERVICE GANTI BAN MOBIL APV LUXURY UK 215/50/R17 | 1.805.000 | 2 | 0 | 3.610.000 | Sastra Agung Nusantara |
| 13 | Genset Provinsi Jawa Timur | GENERATOR SET 30 KVA | 145.000.000 | 1 | 0 | 145.000.000 | RIZQI JAYA ABADI |
| 14 | Perkakas Provinsi Jawa Timur | PAKET BODY REPAIR AMBULANCE ISUZU PANTHER | 24.800.000 | 1 | 0 | 24.800.000 | RIZQI JAYA ABADI |
| 15 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Gelang Thermal Dewasa Pink (175pcs) | 349.999 | 5 | 0 | 1.749.995 | Yuxa Medika Indonesia |
| 16 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Gelang Thermal Dewasa Biru (175pcs) | 349.999 | 5 | 0 | 1.749.995 | Yuxa Medika Indonesia |
| 17 | Fasilitas Kesehatan Sektoral Kemenkes | Devit- S Non Arsen 3gr | 340.000 | 2 | 0 | 680.000 | PT.REZEKI ANAK SHOLEH |
| 18 | Fasilitas Kesehatan Sektoral Kemenkes | GC FUJI IX GP 1-1 EXTRA | 1.400.000 | 2 | 0 | 2.800.000 | PT.REZEKI ANAK SHOLEH |
| 19 | Fasilitas Kesehatan Sektoral Kemenkes | Calcium Hydroxide with iodofom | 555.000 | 2 | 0 | 1.110.000 | PT.REZEKI ANAK SHOLEH |
| 20 | Fasilitas Kesehatan Sektoral Kemenkes | Paramono Clorofenoll | 150.000 | 2 | 0 | 300.000 | PT.REZEKI ANAK SHOLEH |
| 21 | Fasilitas Kesehatan Sektoral Kemenkes | Zinc Cement Fosfat | 500.000 | 2 | 0 | 1.000.000 | PT.REZEKI ANAK SHOLEH |
| 22 | Fasilitas Kesehatan Sektoral Kemenkes | Biosponge | 240.000 | 2 | 0 | 480.000 | PT.REZEKI ANAK SHOLEH |
| 23 | Fasilitas Kesehatan Sektoral Kemenkes | Orafil Plus | 185.000 | 3 | 0 | 555.000 | PT.REZEKI ANAK SHOLEH |
| 24 | Fasilitas Kesehatan Sektoral Kemenkes | Tricresol Formalina | 150.000 | 2 | 0 | 300.000 | PT.REZEKI ANAK SHOLEH |
| 25 | Fasilitas Kesehatan Sektoral Kemenkes | Bonding Dental | 515.000 | 2 | 0 | 1.030.000 | PT.REZEKI ANAK SHOLEH |
| 26 | Fasilitas Kesehatan Sektoral Kemenkes | Cresodent Liquid | 325.000 | 1 | 0 | 325.000 | PT.REZEKI ANAK SHOLEH |
| 27 | Fasilitas Kesehatan Sektoral Kemenkes | Etching Gel 37% | 410.000 | 3 | 0 | 1.230.000 | PT.REZEKI ANAK SHOLEH |
| 28 | Fasilitas Kesehatan Sektoral Kemenkes | Dental Diamond Bur BR - 41 | 160.000 | 4 | 0 | 640.000 | PT.REZEKI ANAK SHOLEH |
| 29 | Fasilitas Kesehatan Sektoral Kemenkes | Tip Scaler G1 - G5 | 540.000 | 2 | 0 | 1.080.000 | PT.REZEKI ANAK SHOLEH |
| 30 | Fasilitas Kesehatan Sektoral Kemenkes | SOLARE GC A2 | 460.000 | 2 | 0 | 920.000 | PT.REZEKI ANAK SHOLEH |
| 31 | Fasilitas Kesehatan Sektoral Kemenkes | Komposit Solare A3 | 460.000 | 2 | 0 | 920.000 | PT.REZEKI ANAK SHOLEH |
| 32 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Blood uric Acid Test Strips | 146.999 | 60 | 0 | 8.819.940 | Yuxa Medika Indonesia |
| 33 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Blood uric cholesterol Test Strips | 244.999 | 150 | 0 | 36.749.850 | Yuxa Medika Indonesia |
| 34 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Urinalisys 10P | 150.749 | 1 | 0 | 150.749 | Yuxa Medika Indonesia |
| 35 | Jasa Pemeliharaan dan Perbaikan Peralatan Fasilitas Pelayanan Kesehatan | Perbaikan USG ultrasonografi DC N3 | 18.903.300 | 1 | 0 | 18.903.300 | CV. WONG MULTI ENGINEERING |
| 36 | Obat Program Jaminan Kesehatan | Alopurinol/Allopurinol tablet/kapsul/kaplet 100 mg | 186 | 25.000 | 0 | 4.650.000 | PT NOVAPHARIN |
| 37 | Obat Program Jaminan Kesehatan | Amoksisilin/ Amoxicillin/ Amoxicillin Trihydrate tablet/kapsul/kaplet/kaptab 500 mg | 488 | 50.000 | 0 | 24.400.000 | PT NOVAPHARIN |
| 38 | Obat Program Jaminan Kesehatan | Vitamin B Kompleks/ Vitamin B complex tablet | 81 | 35.000 | 0 | 2.835.000 | PT NOVAPHARIN |
| 39 | Obat Program Jaminan Kesehatan | ZINC SULFATE MONOHYDRATE DISPERSIBLE / ZINC 20 MG | 247 | 500 | 0 | 123.500 | PT. TRIFA RAYA LABORATORIES |
| 40 | Obat Program Jaminan Kesehatan | IBUPROFEN 400 MG_OGB | 285 | 10.000 | 0 | 2.850.000 | PT. TRIFA RAYA LABORATORIES |
| 41 | Obat Program Jaminan Kesehatan | DEXAMETHASONE 0,5 MG | 88 | 50.000 | 0 | 4.400.000 | PT. TRIFA RAYA LABORATORIES |
| 42 | Konsolidasi Obat | ANTASIDA TABLET KUNYAH | 90 | 50.000 | 0 | 4.500.000 | PT. TRIFA RAYA LABORATORIES |
| 43 | Konsolidasi Obat | Asam mefenamat tab 500 mg | 155 | 50.000 | 0 | 7.750.000 | PT. TRIFA RAYA LABORATORIES |
| 44 | Konsolidasi Obat | Parasetamol tab 500 mg | 100 | 100.000 | 0 | 10.000.000 | PT. TRIFA RAYA LABORATORIES |
| 45 | Fasilitas Kesehatan Sektoral Kemenkes | SPALK 20 X 5 CM | 5.000 | 500 | 0 | 2.500.000 | PT. AZKEN INDONESIA |
| 46 | Obat Non Jaminan Kesehatan | AMBROXOL HCI 30 MG | 170 | 25.000 | 0 | 4.250.000 | PT. TRIFA RAYA LABORATORIES |
| 47 | Obat Program Kesehatan Lainnya | Metformin Hydrochloride/ Metformin tablet/kapsul/kaplet 500 mg | 266 | 25.000 | 0 | 6.650.000 | PT.Bernofarm |
| 48 | Obat Program Kesehatan Lainnya | Simvastatin tablet/kapsul/kaplet 10 mg | 230 | 20.000 | 0 | 4.600.000 | PT.Bernofarm |
| 49 | Obat Program Jaminan Kesehatan | Betametason/Betamethasone Valerate krim 0,1% 5g | 1.995 | 300 | 0 | 598.500 | PT.Bernofarm |
| 50 | Obat Program Jaminan Kesehatan | Cetirizine hydrochloride(HCl)/ Cetirizine/ Setirizin tablet/kapsul/kaplet 10 mg | 444 | 10.000 | 0 | 4.440.000 | PT.Bernofarm |
| 51 | 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 |
| 52 | Obat Program Jaminan Kesehatan | Cefadroxil monohydrate/ Cefadroxil/ Sefadroksil sirup kering 125 mg/5ml | 8.001 | 500 | 0 | 4.000.500 | PT.Bernofarm |
| 53 | Obat Program Jaminan Kesehatan | Mometasone furoate/ Mometason furoat krim 0,1% | 7.215 | 50 | 0 | 360.750 | PT.Bernofarm |
| 54 | Obat Program Jaminan Kesehatan | Metamizol/Antalgin Inj 500 mg/ml atau Metamizole Sodium Monohydrate/Antalgin inj 1000 mg/2ml | 3.613 | 1.200 | 0 | 4.335.600 | PT.Bernofarm |
| 55 | Obat Program Jaminan Kesehatan | Amoksisilin/Amoxicillin/Amoxicillin Trihydrate sirup/suspensi kering 125 mg/ 5 ml | 5.500 | 300 | 0 | 1.650.000 | PT.Bernofarm |
| 56 | Obat Program Jaminan Kesehatan | Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain injeksi 2% | 1.319 | 200 | 0 | 263.800 | PT.Bernofarm |
| 57 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol tablet /kaptab (dewasa) kombinasi: sulfametoksazol 400 mg + trimetoprim 80 mg | 275 | 500 | 0 | 137.500 | PT.Bernofarm |
| 58 | Obat Program Jaminan Kesehatan | Alopurinol/Allopurinol tablet/kapsul/kaplet 100 mg | 186 | 10.000 | 0 | 1.860.000 | PT NOVAPHARIN |
| 59 | Obat Program Jaminan Kesehatan | Air untuk injeksi/ Aqua pro injeksi/ Aqua pro injection/ water for injection | 2.955 | 200 | 0 | 591.000 | PT. EMJEBE PHARMA |
| 60 | Obat Program Jaminan Kesehatan | Ringer Laktat/ Ringer Lactate, @500 mL | 7.648 | 5.000 | 0 | 38.240.000 | PT. EMJEBE PHARMA |
| 61 | Obat Program Jaminan Kesehatan | METAMIZOLE SODIUM MONOHYDRATE Injeksi | 3.449 | 1.200 | 0 | 4.138.800 | PT. MEPROFARM |
| 62 | Obat Program Jaminan Kesehatan | Betametason/Betamethasone Valerate krim 0,1% | 1.998 | 200 | 0 | 399.600 | PT. Kimia Farma Tbk |
| 63 | Obat Program Jaminan Kesehatan | ASPILETS | 538 | 1.000 | 0 | 538.000 | PT Darya Varia |
| 64 | Obat Program Jaminan Kesehatan | Asiklovir/Acyclovir/Aciclovir tablet/kapsul/kaplet 400 mg | 839 | 7.000 | 0 | 5.873.000 | PT. Kimia Farma Tbk |
| 65 | Obat Program Jaminan Kesehatan | Ketokonazol/ Ketoconazole krim 2% | 3.499,83 | 100 | 0 | 349.983 | PT. Kimia Farma Tbk |
| 66 | Obat Program Jaminan Kesehatan | Miconazole nitrate/ Miconazole/ Mikonazol krim 2 %-KF | 3.917 | 300 | 0 | 1.175.100 | PT. Kimia Farma Tbk |
| 67 | Obat Program Jaminan Kesehatan | Anestetik lokal gigi, kombinasi KDT/FDC mengandung: lidokain 2% + epinefrin 1:80.000 | 1.848 | 500 | 0 | 924.000 | PT.Phapros Tbk |
| 68 | Obat Program Jaminan Kesehatan | Lidocaine Hydrochloride/ Lidocaine/ Lidocain/ Lidokain injeksi 2% | 2.331 | 100 | 0 | 233.100 | PT.Phapros Tbk |
| 69 | Obat Program Jaminan Kesehatan | Amoksisilin/Amoxicillin/Amoxicillin Trihydrate sirup/suspensi kering 125 mg/ 5 ml | 4.750 | 200 | 0 | 950.000 | PT. IFARS PHARMACEUTICAL LABORATORIES |
| 70 | Obat Program Jaminan Kesehatan | Karbogliserin tetes telinga 10% | 7.396 | 48 | 0 | 355.008 | PT. LUCAS DJAJA |
| 71 | Obat Program Jaminan Kesehatan | Ethyl Chloride | 212.270 | 50 | 0 | 10.613.500 | PT. Duta Kaisar Pharmacy |
| 72 | Konsolidasi Obat | Kombinasi KDT/FDC mengandung: a. ipratropium bromida 0,5 mg b. salbutamol 2,5 mg cairan ih | 3.663 | 300 | 0 | 1.098.900 | PT. MEPROFARM |
| 73 | Obat Program Jaminan Kesehatan | BIOSAT | 184.676 | 20 | 0 | 3.693.520 | PT. BIO FARMA |
| 74 | Obat Program Jaminan Kesehatan | Salep 2-4, salep | 3.996 | 500 | 0 | 1.998.000 | PT. MARIN LIZA FARMASI |
| 75 | Fasilitas Kesehatan Sektoral Kemenkes | Latex Medical Examination Gloves XS,S,M,L Powder Free | 44.178 | 100 | 0 | 4.417.800 | PT Jayamas Medica Industri |
| 76 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter w/o Port with Wing 20G | 7.881 | 500 | 0 | 3.940.500 | PT Jayamas Medica Industri |
| 77 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter w/o Port with Wing 22G | 7.881 | 500 | 0 | 3.940.500 | PT Jayamas Medica Industri |
| 78 | Fasilitas Kesehatan Sektoral Kemenkes | Safety IV Catheter w/o Port with Wing 24G | 7.881 | 200 | 0 | 1.576.200 | PT Jayamas Medica Industri |
| 79 | Fasilitas Kesehatan Sektoral Kemenkes | Infusion Set Air Vented LL | 4.884 | 700 | 0 | 3.418.800 | PT Jayamas Medica Industri |
| 80 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 5 cc | 96.800 | 50 | 0 | 4.840.000 | PT Jayamas Medica Industri |
| 81 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 3 cc | 78.100 | 100 | 0 | 7.810.000 | PT Jayamas Medica Industri |
| 82 | Fasilitas Kesehatan Sektoral Kemenkes | Nebulizer Mask Set Dewasa | 17.982 | 100 | 0 | 1.798.200 | PT Jayamas Medica Industri |
| 83 | Fasilitas Kesehatan Sektoral Kemenkes | Plesterin Roll non woven roll 10 cm x 5 m | 41.958 | 150 | 0 | 6.293.700 | PT Jayamas Medica Industri |
| 84 | Fasilitas Kesehatan Sektoral Kemenkes | Nebulizer Mask Set Anak | 17.982 | 100 | 0 | 1.798.200 | PT Jayamas Medica Industri |
| 85 | Fasilitas Kesehatan Sektoral Kemenkes | Kasa Hydrofil 40 yard x 80 cm | 158.180 | 30 | 0 | 4.745.400 | PT Jayamas Medica Industri |
| 86 | Fasilitas Kesehatan Sektoral Kemenkes | Oxyflow Oxygen Nasal Cannula Anak | 5.550 | 100 | 0 | 555.000 | PT Jayamas Medica Industri |
| 87 | Fasilitas Kesehatan Sektoral Kemenkes | Infusion Set Anak Y Type | 266.400 | 6 | 0 | 1.598.400 | PT Jayamas Medica Industri |
| 88 | Fasilitas Kesehatan Sektoral Kemenkes | Catgut Chromic With Needle 3/0 | 119.880 | 10 | 0 | 1.198.800 | PT INTISUMBER HASIL SEMPURNA GLOBAL |
| 89 | Fasilitas Kesehatan Sektoral Kemenkes | Catgut Plain With Needle 3/0 | 119.880 | 5 | 0 | 599.400 | PT INTISUMBER HASIL SEMPURNA GLOBAL |
| 90 | Obat Non Jaminan Kesehatan | Guaifenesin 100 mg + Paracetamol 500 mg + Chlorpheniramine Maleate 2 mg + Pseudoephedrine HCl 30 mg | 450 | 40.000 | 0 | 18.000.000 | PT.Bernofarm |
| 91 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg, susp | 7.200 | 500 | 0 | 3.600.000 | PT.Bernofarm |
| 92 | Obat Program Jaminan Kesehatan | Cetirizine hydrochloride 10 mg tablet. | 508 | 10.000 | 0 | 5.080.000 | PT.Bernofarm |
| 93 | Obat Program Jaminan Kesehatan | Nacl 0,9% / Sodium Chloride 0,9% | 7.673 | 200 | 0 | 1.534.600 | PT. EMJEBE PHARMA |
| 94 | Obat Program Jaminan Kesehatan | CHLORPHENAMINE MALEATE _CTM 4 MG | 70 | 50.000 | 0 | 3.500.000 | PT. TRIFA RAYA LABORATORIES |
| 95 | Obat Program Jaminan Kesehatan | CETIRIZINE 10 MG | 90 | 10.000 | 0 | 900.000 | PT. TRIFA RAYA LABORATORIES |
| 96 | Obat Program Jaminan Kesehatan | PREDNISONE 5MG | 152 | 10.000 | 0 | 1.520.000 | PT. TRIFA RAYA LABORATORIES |
| 97 | Obat Program Jaminan Kesehatan | METRONIDAZOLE 500 MG | 286 | 5.000 | 0 | 1.430.000 | PT. TRIFA RAYA LABORATORIES |
| 98 | Obat Program Jaminan Kesehatan | METHYLPREDNISOLONE 4 MG_OGB | 240 | 20.000 | 0 | 4.800.000 | PT. TRIFA RAYA LABORATORIES |
| 99 | Obat Non Jaminan Kesehatan | FORNERO TABLET | 430 | 1.000 | 0 | 430.000 | PT. TRIFA RAYA LABORATORIES |
| 100 | Obat Non Jaminan Kesehatan | Guaifenesin 100 mg | 100 | 35.000 | 0 | 3.500.000 | PT. TRIFA RAYA LABORATORIES |
| 101 | Obat Program Jaminan Kesehatan | Cefadroxil monohydrate/ Cefadroxil/ Sefadroksil tablet/kapsul/kaplet 500 mg | 1.035 | 10.000 | 0 | 10.350.000 | PT NOVAPHARIN |
| 102 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (dewasa) kombinasi: sulfametoksazol 400 mg + trimetoprim 80 mg (tab/kaptab 480 mg) | 266 | 5.000 | 0 | 1.330.000 | PT NOVAPHARIN |
| 103 | Obat Program Jaminan Kesehatan | Domperidon/ Domperidone/ Domperidone Maleate tablet/kapsul/kaplet 10 mg | 163 | 10.000 | 0 | 1.630.000 | PT NOVAPHARIN |
| 104 | Obat Program Jaminan Kesehatan | Paracetamol/ Parasetamol sirup 120 mg / 5 ml | 4.186 | 500 | 0 | 2.093.000 | PT NOVAPHARIN |
| Total | 566.172.380 | ||||||
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