| No | Etalase | Produk | Harga | Jumlah | Ongkos Kirim | Total | Penyedia |
|---|---|---|---|---|---|---|---|
| 1 | Bahan Makanan dan Minuman Provinsi Jawa Timur | Paket Nasi Kotak | 30.000 | 18 | 0 | 540.000 | RASYD JAYA |
| 2 | Makanan dan Minuman Provinsi Jawa Timur | Kue Box | 20.000 | 18 | 0 | 360.000 | RASYD JAYA |
| 3 | Alat Tulis Kantor Provinsi Jawa Timur | Tinta Printer Epson 003 | 110.000 | 17 | 0 | 1.870.000 | RASYD JAYA |
| 4 | Alat Tulis Kantor Provinsi Jawa Timur | Ballpoint Standart | 4.000 | 24 | 0 | 96.000 | RASYD JAYA |
| 5 | Alat Tulis Kantor Provinsi Jawa Timur | Spidol Snowman Permanen | 14.500 | 5 | 0 | 72.500 | RASYD JAYA |
| 6 | Alat Tulis Kantor Provinsi Jawa Timur | Map Kertas | 3.000 | 30 | 0 | 90.000 | RASYD JAYA |
| 7 | Alat Tulis Kantor Provinsi Jawa Timur | Map Plastik | 6.000 | 20 | 0 | 120.000 | RASYD JAYA |
| 8 | Alat Tulis Kantor Provinsi Jawa Timur | Box File | 31.000 | 4 | 0 | 124.000 | RASYD JAYA |
| 9 | Alat Tulis Kantor Provinsi Jawa Timur | Lampu LED | 75.500 | 4 | 0 | 302.000 | RASYD JAYA |
| 10 | Alat Tulis Kantor Provinsi Jawa Timur | Kertas HVS 70 gr F4 MAXI BRITE | 68.000 | 25 | 0 | 1.700.000 | MOZAIC |
| 11 | Fasilitas Kesehatan Sektoral Kemenkes | Surgical Mask Earloop Plus, 3 ply | 17.538 | 200 | 0 | 3.507.600 | PT Jayamas Medica Industri |
| 12 | Fasilitas Kesehatan Sektoral Kemenkes | Syringe 3 cc | 73.038 | 5 | 0 | 365.190 | PT Jayamas Medica Industri |
| 13 | Fasilitas Kesehatan Sektoral Kemenkes | Plesterin Roll non woven roll 5 cm x 5 m | 24.198 | 10 | 0 | 241.980 | PT Jayamas Medica Industri |
| 14 | Obat Non Jaminan Kesehatan | Alpara Kaplet | 750 | 5.000 | 0 | 3.750.000 | PT. MOLEX AYUS |
| 15 | Obat Non Jaminan Kesehatan | Dextral Kaplet/Dextromethorphan HBr 10mg, Guaifenesin 50mg, Phenylpropanolamine HCl 12,5mg, Chlorphenamine maleate 1mg | 700 | 3.000 | 0 | 2.100.000 | PT. MOLEX AYUS |
| 16 | Obat Non Jaminan Kesehatan | Molexflu Sirup/Paracetamol 125mg + Phenylpropanolamine HCl 3,125 mg+ Chlorphenamine maleate 0,5mg | 8.500 | 100 | 0 | 850.000 | PT. MOLEX AYUS |
| 17 | Obat Non Jaminan Kesehatan | Molexflu Kaplet | 500 | 7.000 | 0 | 3.500.000 | PT. MOLEX AYUS |
| 18 | Obat Program Jaminan Kesehatan | AMLODIPINE 10 MG | 141 | 5.000 | 0 | 705.000 | PT. Harbat Farma |
| 19 | Obat Program Jaminan Kesehatan | AMLODIPINE 5 mg | 126 | 44.000 | 0 | 5.544.000 | PT. Harbat Farma |
| 20 | Obat Program Jaminan Kesehatan | DEXAMETHASONE 0.5 | 128 | 20.000 | 0 | 2.560.000 | PT. Harbat Farma |
| 21 | Obat Program Jaminan Kesehatan | MEDIARE /LOPERAMIDE HCI 2 MG | 177 | 1.000 | 0 | 177.000 | PT. Harbat Farma |
| 22 | Obat Program Jaminan Kesehatan | GENERIK PARASETAMOL/PARACETAMOL SYRUP 120MG/5ML | 3.900 | 500 | 0 | 1.950.000 | PT. PIM Pharmaceuticals |
| 23 | Obat Program Jaminan Kesehatan | BEDAK SALICYL 2% | 7.100 | 200 | 0 | 1.420.000 | PT. PIM Pharmaceuticals |
| 24 | Obat Program Jaminan Kesehatan | CHLORPHENAMINE MALEATE 4MG STRIP (CTM) | 70 | 30.000 | 0 | 2.100.000 | PT. PIM Pharmaceuticals |
| 25 | Obat Program Jaminan Kesehatan | PARACETAMOL BLISTER | 102 | 50.000 | 0 | 5.100.000 | PT. PIM Pharmaceuticals |
| 26 | Obat Program Kesehatan Lainnya | ACICLOVIR KRIM 5 gram | 3.329 | 200 | 0 | 665.800 | PT.Bernofarm |
| 27 | Obat Program Kesehatan Lainnya | Betahistin/Betahistine Mesilate/Betahistine Mesylate tablet/kapsul/kaplet 6 mg | 355 | 1.000 | 0 | 355.000 | PT.Bernofarm |
| 28 | Obat Program Kesehatan Lainnya | Diclofenac sodium/ Natrium diklofenak tablet salut enterik/kaplet salut enterik 50 mg | 192 | 50.000 | 0 | 9.600.000 | PT.Bernofarm |
| 29 | Obat Program Kesehatan Lainnya | Salbutamol sulfate/ Salbutamol tablet/kapsul/kaplet 2 mg | 183 | 7.000 | 0 | 1.281.000 | PT.Bernofarm |
| 30 | Obat Program Kesehatan Lainnya | Simvastatin tablet/kapsul/kaplet 10 mg | 230 | 15.000 | 0 | 3.450.000 | PT.Bernofarm |
| 31 | Obat Program Kesehatan Lainnya | Clopidogrel bisulfate tablet/kapsul/kaplet 75 mg | 1.750 | 500 | 0 | 875.000 | PT.Bernofarm |
| 32 | Obat Program Jaminan Kesehatan | Chloramphenicol/ Chloramphenicol palmitate/ Kloramfenikol suspensi 125 mg/ 5 ml | 10.238 | 100 | 0 | 1.023.800 | PT NOVAPHARIN |
| 33 | Obat Program Jaminan Kesehatan | Griseofulvin tablet/kapsul/kaplet 500 mg | 1.379 | 1.000 | 0 | 1.379.000 | PT NOVAPHARIN |
| 34 | Obat Program Jaminan Kesehatan | Vitamin B Kompleks/ Vitamin B complex tablet | 81 | 40.000 | 0 | 3.240.000 | PT NOVAPHARIN |
| 35 | Obat Program Jaminan Kesehatan | Zinc sulfate/ Zinc sulfate monohydrate/Zinc/ Zinc tablet dispersible 20 mg | 205 | 1.000 | 0 | 205.000 | PT NOVAPHARIN |
| 36 | Obat Non Jaminan Kesehatan | Molagit Tablet | 500 | 10.000 | 0 | 5.000.000 | PT. MOLEX AYUS |
| 37 | Obat Program Jaminan Kesehatan | Betametason/Betamethasone Valerate krim 0,1% 5g | 1.995 | 300 | 0 | 598.500 | PT.Bernofarm |
| 38 | Obat Program Jaminan Kesehatan | Chloramphenicol/ Kloramfenikol tablet/kapsul/kaplet 250 mg | 708 | 4.000 | 0 | 2.832.000 | PT.Bernofarm |
| 39 | Obat Program Jaminan Kesehatan | Ciprofloxacin hydrochloride (HCl)/ Ciprofloxacin Lactate/ Ciprofloxacin/ Siprofloksasin tablet/kapsul/kaplet 500 mg | 475 | 7.000 | 0 | 3.325.000 | PT.Bernofarm |
| 40 | Obat Program Jaminan Kesehatan | Hidrokortison/ Hydrocortisone/ Hydrocortisone acetate krim 2,5 % | 4.662 | 200 | 0 | 932.400 | PT.Bernofarm |
| 41 | Obat Program Jaminan Kesehatan | Asam traneksamat/Tranexamic acid tablet/kapsul/kaplet salut selaput 500 mg | 1.688 | 1.000 | 0 | 1.688.000 | PT.Bernofarm |
| 42 | Obat Program Jaminan Kesehatan | Amoksisilin/Amoxicillin/Amoxicillin Trihydrate sirup/suspensi kering 125 mg/ 5 ml | 5.500 | 300 | 0 | 1.650.000 | PT.Bernofarm |
| 43 | Obat Program Jaminan Kesehatan | Miconazole nitrate/ Miconazole/ Mikonazol krim 2 % | 3.900 | 400 | 0 | 1.560.000 | PT.Bernofarm |
| 44 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg | 4.796 | 100 | 0 | 479.600 | PT.Bernofarm |
| 45 | Obat Program Jaminan Kesehatan | LORATADINE 10 mg kaplett | 182 | 1.800 | 0 | 327.600 | PT.Bernofarm |
| 46 | Obat Program Jaminan Kesehatan | LIDOCAINE COMPOSITUM INJEKSI | 2.237 | 400 | 0 | 894.800 | PT.Bernofarm |
| 47 | Obat Program Jaminan Kesehatan | Ibuprofen suspensi 100 mg per 5 ml | 6.660 | 50 | 0 | 333.000 | PT.Bernofarm |
| 48 | Obat Program Jaminan Kesehatan | DILATAMOL Salbutamol/ Salbutamol Sulfate cairan ih 1 mg/mL | 6.700 | 20 | 0 | 134.000 | PT.Bernofarm |
| 49 | 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 |
| 50 | Obat Program Jaminan Kesehatan | GENTAMICIN SULFATE 01 % KRIM 5 gram | 3.325 | 200 | 0 | 665.000 | PT.Bernofarm |
| 51 | Obat Program Jaminan Kesehatan | THIAMPHENICOL 500 mg KAPS | 1.349 | 2.000 | 0 | 2.698.000 | PT.Bernofarm |
| 52 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl) 150 mg TSS | 300 | 10.000 | 0 | 3.000.000 | PT.Bernofarm |
| 53 | Obat Program Jaminan Kesehatan | Metformin Hydrochloride tablet/kapsul/kaplet 500 mg | 266 | 14.000 | 0 | 3.724.000 | PT.Bernofarm |
| 54 | Obat Program Jaminan Kesehatan | Fitomenadion/ Phytomenadion (Vitamin K1) tablet/kapsul/kaplet 10 mg | 836 | 500 | 0 | 418.000 | PT. MARIN LIZA FARMASI |
| 55 | Obat Program Jaminan Kesehatan | Salep 2-4, salep | 3.996 | 300 | 0 | 1.198.800 | PT. MARIN LIZA FARMASI |
| 56 | Obat Program Jaminan Kesehatan | Metronidazole/Metronidazol tablet/kapsul/kaplet 500 mg | 266 | 2.500 | 0 | 665.000 | PT. TRIMAN |
| 57 | Obat Program Jaminan Kesehatan | Domperidon/ Domperidone tablet/kapsul/kaplet 10 mg | 108 | 3.000 | 0 | 324.000 | PT. TRIMAN |
| 58 | Obat Program Jaminan Kesehatan | LIVTEZIN/CETIRIZINE HYDROCHLORIDE 10 MG/TABLET/KAPLET | 136 | 10.000 | 0 | 1.360.000 | PT. TRIMAN |
| 59 | Obat Program Jaminan Kesehatan | Antasida Doen kemasan box | 127 | 25.000 | 0 | 3.175.000 | PT. TRIMAN |
| 60 | Obat Program Jaminan Kesehatan | STUNIC/AMBROXOL 30/AMB/ T4BLET/KAPLET | 192 | 10.000 | 0 | 1.920.000 | PT. TRIMAN |
| 61 | Obat Program Jaminan Kesehatan | SEVOS 4/METILPREDNISOLONE 4MG/METHYLPREDNISOLONE 4MG /T4BLET/KAPLET | 272 | 2.000 | 0 | 544.000 | PT. TRIMAN |
| 62 | Obat Program Jaminan Kesehatan | Amoksisilin/Amoxicillin kapsul/kaplet/tablet 500 mg | 590 | 20.000 | 0 | 11.800.000 | PT. TRIMAN |
| 63 | Obat Program Jaminan Kesehatan | ALLOPURIN0L 100 MG | 209 | 15.000 | 0 | 3.135.000 | PT. TRIMAN |
| 64 | Obat Program Jaminan Kesehatan | Sefadroksil / Cefadroxil kaps/tab 500 mg | 950 | 5.000 | 0 | 4.750.000 | PT. TRIMAN |
| 65 | Obat Non Jaminan Kesehatan | Guaifenesin/GG/Tablet/Kapsul/Kaplet 100 mg | 100 | 30.000 | 0 | 3.000.000 | PT. TRIMAN |
| 66 | Obat Non Jaminan Kesehatan | VITAMIN C / Asam Askorbat/ Ascorbic Acid 50 MG | 155 | 15.000 | 0 | 2.325.000 | PT. TRIMAN |
| 67 | Konsolidasi Obat | Asam mefenamat tab 500 mg | 155 | 33.000 | 0 | 5.115.000 | PT. TRIMAN |
| 68 | Konsolidasi Obat | Ibuprofen tab 400 mg | 189 | 30.000 | 0 | 5.670.000 | PT. TRIMAN |
| 69 | Fasilitas Kesehatan Sektoral Kemenkes | Isosorbide dinitrate 5mg tablet | 285 | 300 | 0 | 85.500 | PT. Antar Mitra Persada |
| 70 | Fasilitas Kesehatan Sektoral Kemenkes | Piroxicam 10 mg tablet | 150 | 14.000 | 0 | 2.100.000 | PT. Antar Mitra Persada |
| 71 | Fasilitas Kesehatan Sektoral Kemenkes | Borax Gliserin/GOM | 104.000 | 4 | 0 | 416.000 | PT. Antar Mitra Persada |
| 72 | Fasilitas Kesehatan Sektoral Kemenkes | Glimepirid 2mg isi 100 tablet | 325 | 50.000 | 0 | 16.250.000 | PT. Antar Mitra Persada |
| 73 | Fasilitas Kesehatan Sektoral Kemenkes | Bioplacenton cr | 35.000 | 50 | 0 | 1.750.000 | PT. Antar Mitra Persada |
| 74 | Fasilitas Kesehatan Sektoral Kemenkes | Acyclovir tablet 400mg | 930 | 1.000 | 0 | 930.000 | PT. Antar Mitra Persada |
| 75 | Fasilitas Kesehatan Sektoral Kemenkes | Microlax isi 1 tube 5mL | 29.000 | 10 | 0 | 290.000 | PT. Antar Mitra Persada |
| 76 | Fasilitas Kesehatan Sektoral Kemenkes | Omeprazole isi 100 kapsul | 400 | 10.000 | 0 | 4.000.000 | PT. Antar Mitra Persada |
| 77 | Fasilitas Kesehatan Sektoral Kemenkes | Vitamin B1 tablet | 200 | 30.000 | 0 | 6.000.000 | PT. Antar Mitra Persada |
| 78 | Fasilitas Kesehatan Sektoral Kemenkes | Ketoconazole tablet 200mg | 535 | 1.500 | 0 | 802.500 | PT. Antar Mitra Persada |
| 79 | Fasilitas Kesehatan Sektoral Kemenkes | Scopma Tablet | 1.310 | 1.000 | 0 | 1.310.000 | PT. Antar Mitra Persada |
| 80 | Fasilitas Kesehatan Sektoral Kemenkes | OBH Itrasal syrup | 8.000 | 200 | 0 | 1.600.000 | PT. Antar Mitra Persada |
| 81 | Fasilitas Kesehatan Sektoral Kemenkes | Captopril 25 mg | 170 | 3.000 | 0 | 510.000 | PT. Antar Mitra Persada |
| 82 | Fasilitas Kesehatan Sektoral Kemenkes | Laxana tablet | 390 | 300 | 0 | 117.000 | PT. Antar Mitra Persada |
| 83 | Fasilitas Kesehatan Sektoral Kemenkes | Dimenhydrinat tablet | 240 | 7.000 | 0 | 1.680.000 | PT. Antar Mitra Persada |
| 84 | Fasilitas Kesehatan Sektoral Kemenkes | Calcium Laktat tab | 250 | 30.000 | 0 | 7.500.000 | PT. Antar Mitra Persada |
| 85 | Fasilitas Kesehatan Sektoral Kemenkes | Gentian Violet | 127.000 | 4 | 0 | 508.000 | PT. Antar Mitra Persada |
| 86 | Fasilitas Kesehatan Sektoral Kemenkes | Bromifar tablet | 230 | 10.000 | 0 | 2.300.000 | PT. Antar Mitra Persada |
| 87 | Fasilitas Kesehatan Sektoral Kemenkes | Farsifen 200 mg tab | 330 | 5.000 | 0 | 1.650.000 | PT. Antar Mitra Persada |
| 88 | Fasilitas Kesehatan Sektoral Kemenkes | Vitamin b12 tab | 200 | 3.000 | 0 | 600.000 | PT. Antar Mitra Persada |
| 89 | Fasilitas Kesehatan Sektoral Kemenkes | Digoxin tablet | 465 | 200 | 0 | 93.000 | PT. Antar Mitra Persada |
| 90 | Obat Program Jaminan Kesehatan | Furosemid/ Furosemide tablet/kapsul/kaplet 40 mg | 222 | 500 | 0 | 111.000 | PT. Kimia Farma Tbk |
| 91 | Obat Program Jaminan Kesehatan | Permethrin/ Permetrin Krim 5% | 6.325 | 100 | 0 | 632.500 | PT. Kimia Farma Tbk |
| 92 | Fasilitas Kesehatan Sektoral Kemenkes | Aspilet Tablet | 97.000 | 20 | 0 | 1.940.000 | PT. Antar Mitra Persada |
| 93 | Fasilitas Kesehatan Sektoral Kemenkes | Enbatic salep/cream | 12.700 | 500 | 0 | 6.350.000 | PT. Antar Mitra Persada |
| 94 | Fasilitas Kesehatan Sektoral Kemenkes | Fimediab tab | 338 | 5.000 | 0 | 1.690.000 | PT. Antar Mitra Persada |
| 95 | Fasilitas Kesehatan Sektoral Kemenkes | Superhoid supo | 73.500 | 15 | 0 | 1.102.500 | PT. Antar Mitra Persada |
| 96 | Obat Program Jaminan Kesehatan | Gentamycin / Gentamicin Sulfate Salep Mata | 6.740 | 96 | 0 | 647.040 | PT.ERELA |
| 97 | Obat Program Jaminan Kesehatan | Gentamisin/ Gentamycin / Gentamycin sulfate tetes mata 0,3% | 9.402 | 288 | 0 | 2.707.776 | PT.ERELA |
| 98 | Obat Program Jaminan Kesehatan | Chloramphenicol/ kloramfenikol tetes telinga 3% | 8.000 | 288 | 0 | 2.304.000 | PT.ERELA |
| 99 | Obat Program Jaminan Kesehatan | Antasida susp | 3.719 | 300 | 0 | 1.115.700 | PT.ERELA |
| 100 | Obat Program Jaminan Kesehatan | Chloramphenicol/ Kloramfenikol salep mata 1 % | 7.936 | 192 | 0 | 1.523.712 | PT.ERELA |
| Total | 207.902.798 | ||||||
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