| No | Etalase | Produk | Harga | Jumlah | Ongkos Kirim | Total | Penyedia |
|---|---|---|---|---|---|---|---|
| 1 | Alat Tulis Kantor Provinsi Jawa Timur | MATERAI 10.000 tempel | 12.800 | 80 | 0 | 1.024.000 | Griya Boga Danastri |
| 2 | Makanan dan Minuman Provinsi Jawa Timur | SNACK BOX ALA GRIYA | 13.000 | 75 | 0 | 975.000 | Griya Boga Danastri |
| 3 | Perlengkapan Perkantoran Provinsi Jawa Timur | Barterai ABC tanggung | 16.400 | 15 | 0 | 246.000 | CV. Putra Kelud Berdikari |
| 4 | Perlengkapan Perkantoran Provinsi Jawa Timur | Baterai ABC Alkaline AA 6 Pcs | 48.200 | 10 | 0 | 482.000 | CV. Putra Kelud Berdikari |
| 5 | Perlengkapan Perkantoran Provinsi Jawa Timur | Lampu Philips 23 watt essential | 70.300 | 40 | 0 | 2.812.000 | CV. Putra Kelud Berdikari |
| 6 | Perlengkapan Perkantoran Provinsi Jawa Timur | PHILIPS LAMPU PHILIPS ESSENTIAL 55 WATT | 170.000 | 12 | 0 | 2.040.000 | CV. Putra Kelud Berdikari |
| 7 | Perlengkapan Perkantoran Provinsi Jawa Timur | Lampu senter tangan Luby | 49.900 | 4 | 0 | 199.600 | CV. Putra Kelud Berdikari |
| 8 | Alat Tulis Kantor Provinsi Jawa Timur | Bolpoint Standart Ae7 0.5mm | 2.818 | 240 | 0 | 676.320 | Griya Boga Danastri |
| 9 | Alat Tulis Kantor Provinsi Jawa Timur | Balpoint tanda tangan biru | 5.200 | 48 | 0 | 249.600 | Griya Boga Danastri |
| 10 | Alat Tulis Kantor Provinsi Jawa Timur | Spidol Marker hitam | 8.100 | 12 | 0 | 97.200 | Griya Boga Danastri |
| 11 | Alat Tulis Kantor Provinsi Jawa Timur | (Tinta Stempel 50 Cc | 31.750 | 6 | 0 | 190.500 | Griya Boga Danastri |
| 12 | Alat Tulis Kantor Provinsi Jawa Timur | Binder Klip No 300 | 56.000 | 6 | 0 | 336.000 | Griya Boga Danastri |
| 13 | Alat Tulis Kantor Provinsi Jawa Timur | Paper Clips no 3 | 4.150 | 60 | 0 | 249.000 | Griya Boga Danastri |
| 14 | Alat Tulis Kantor Provinsi Jawa Timur | Paper Clips no 5 | 7.550 | 48 | 0 | 362.400 | Griya Boga Danastri |
| 15 | Alat Tulis Kantor Provinsi Jawa Timur | Correction Biasa atau kertas | 8.150 | 24 | 0 | 195.600 | Griya Boga Danastri |
| 16 | Alat Tulis Kantor Provinsi Jawa Timur | penghapus karet stip karet putih | 6.818 | 10 | 0 | 68.180 | Griya Boga Danastri |
| 17 | Alat Tulis Kantor Provinsi Jawa Timur | Buku Tulis Isi 38 Lembar | 5.100 | 36 | 0 | 183.600 | Griya Boga Danastri |
| 18 | Alat Tulis Kantor Provinsi Jawa Timur | Nota rangkap paperline | 10.000 | 10 | 0 | 100.000 | Griya Boga Danastri |
| 19 | Alat Tulis Kantor Provinsi Jawa Timur | Map L plastik | 5.500 | 480 | 0 | 2.640.000 | Griya Boga Danastri |
| 20 | Alat Tulis Kantor Provinsi Jawa Timur | Stopmap folio jangger | 4.000 | 96 | 0 | 384.000 | Griya Boga Danastri |
| 21 | Alat Tulis Kantor Provinsi Jawa Timur | Stopmap Snelhecter Plastik | 7.000 | 384 | 0 | 2.688.000 | Griya Boga Danastri |
| 22 | Alat Tulis Kantor Provinsi Jawa Timur | Ordner Dan Map TAS | 19.250 | 12 | 0 | 231.000 | Griya Boga Danastri |
| 23 | Alat Tulis Kantor Provinsi Jawa Timur | Isi Staples sedang | 12.000 | 60 | 0 | 720.000 | Griya Boga Danastri |
| 24 | Alat Tulis Kantor Provinsi Jawa Timur | Sheet Protector Plastik | 10.800 | 19 | 0 | 205.200 | Griya Boga Danastri |
| 25 | Alat Tulis Kantor Provinsi Jawa Timur | Sheet Protector Plastik | 10.800 | 1 | 0 | 10.800 | Griya Boga Danastri |
| 26 | Peralatan Elektronik dan Pendukungnya | AC 1 PK - CS/CU-YN9AKJ (INSTALASI 3 METER) | 6.400.000 | 1 | 0 | 6.400.000 | CV SURYA BERSINAR |
| 27 | Peralatan Elektronik dan Pendukungnya | AC 1.5 PK - CS/CU-YN12AKJ (INSTALASI 3 METER) | 8.550.000 | 1 | 0 | 8.550.000 | CV SURYA BERSINAR |
| 28 | Peralatan Elektronik dan Pendukungnya | AIR CONDITIONER 2,0PK NEUVA DELUXE PAC 18VH (PEMASANGAN 5 METER) | 8.750.000 | 1 | 0 | 8.750.000 | CV SURYA BERSINAR |
| 29 | Perlengkapan Perkantoran Provinsi Jawa Timur | Kursi Napolly | 113.000 | 15 | 0 | 1.695.000 | CV. Putra Kelud Berdikari |
| 30 | Jasa Pemeliharaan Peralatan Elektronik Pemerintah Daerah Kabupaten Sidoarjo | SERVICE DAN MAINTENANCE CCTV | 5.150.000 | 1 | 0 | 5.150.000 | CV. Bilqis Berkah Berguna |
| 31 | Alat Ukur Dan Perlengkapan Laboratorium Provinsi Jawa Timur | Bahan Tambalan GC Fuji IX GP 1-1 Extra - A3 | 1.620.000 | 2 | 0 | 3.240.000 | CV. AFSA TECH |
| 32 | Perlengkapan Perkantoran Provinsi Jawa Timur | Kipas Angin Maspion | 1.200.000 | 1 | 0 | 1.200.000 | CV. Putra Kelud Berdikari |
| 33 | Perlengkapan Perkantoran Provinsi Jawa Timur | exhaust fan Dinding | 650.000 | 1 | 0 | 650.000 | CV. Putra Kelud Berdikari |
| 34 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron inj 2 mg/mL | 1.942 | 200 | 0 | 388.400 | PT.Bernofarm |
| 35 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl)/ Ranitidin injeksi 25 mg/ml | 1.958 | 600 | 0 | 1.174.800 | PT.Bernofarm |
| 36 | Obat Program Jaminan Kesehatan | Metamizol/Antalgin Inj 500 mg/ml atau Metamizole Sodium Monohydrate/Antalgin inj 1000 mg/2ml | 3.613 | 500 | 0 | 1.806.500 | PT.Bernofarm |
| 37 | Obat Program Jaminan Kesehatan | Difenhidramin/ Diphenhydramine injeksi 10 mg/ml ( i.v./i.m.) | 1.893 | 600 | 0 | 1.135.800 | PT.Bernofarm |
| 38 | Obat Program Jaminan Kesehatan | Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 1.000 mg | 7.492 | 300 | 0 | 2.247.600 | PT.Bernofarm |
| 39 | Obat Program Jaminan Kesehatan | Mecobalamin 500 Mcg/ml Injeksi | 9.023 | 500 | 0 | 4.511.500 | PT.Bernofarm |
| 40 | Obat Program Jaminan Kesehatan | LIDOCAINE COMPOSITUM INJEKSI | 2.237 | 160 | 0 | 357.920 | PT.Bernofarm |
| 41 | Obat Program Jaminan Kesehatan | BIOSAT | 184.676 | 10 | 0 | 1.846.760 | PT. BIO FARMA |
| 42 | Obat Non Jaminan Kesehatan | Alpara Kaplet | 888 | 4.500 | 0 | 3.996.000 | PT. MOLEX AYUS |
| 43 | Obat Non Jaminan Kesehatan | Molexflu Kaplet | 555 | 6.000 | 0 | 3.330.000 | PT. MOLEX AYUS |
| 44 | Obat Non Jaminan Kesehatan | Molagit Tablet | 629 | 3.000 | 0 | 1.887.000 | PT. MOLEX AYUS |
| 45 | Obat Program Jaminan Kesehatan | Lexatrans 500 Kaplet Salut Selaput | 2.220 | 1.000 | 0 | 2.220.000 | PT. MOLEX AYUS |
| 46 | Obat Program Jaminan Kesehatan | Thiamfilex 500 Kapsul/Thiamphenicol 500 mg Kapsul | 1.665 | 1.500 | 0 | 2.497.500 | PT. MOLEX AYUS |
| 47 | Konsolidasi Obat | Metilprednisolon tab 4 mg | 160 | 6.500 | 0 | 1.040.000 | PT. MOLEX AYUS |
| 48 | Konsolidasi Obat | Betahistin tab 6 mg | 189 | 5.000 | 0 | 945.000 | PT. MOLEX AYUS |
| 49 | Konsolidasi Obat | Alopurinol tab 100 mg | 155 | 12.000 | 0 | 1.860.000 | PT.Imfarmind Farmasi Industri |
| 50 | Konsolidasi Obat | Alopurinol tab 300 mg | 360 | 2.000 | 0 | 720.000 | PT.Imfarmind Farmasi Industri |
| 51 | Konsolidasi Obat | Antasida tab kunyah | 90 | 20.000 | 0 | 1.800.000 | PT.Imfarmind Farmasi Industri |
| 52 | Konsolidasi Obat | Ibuprofen susp 100 mg/5 mL | 4.249 | 150 | 0 | 637.350 | PT.Imfarmind Farmasi Industri |
| 53 | Konsolidasi Obat | Asam folat tab 1 mg | 60 | 5.000 | 0 | 300.000 | PT.Imfarmind Farmasi Industri |
| 54 | Konsolidasi Obat | Kalsium laktat (kalk) tab 500 mg* | 84 | 3.000 | 0 | 252.000 | PT.Imfarmind Farmasi Industri |
| 55 | Konsolidasi Obat | Piridoksin (vitamin B6) tab 10 mg* | 64 | 8.000 | 0 | 512.000 | PT.Imfarmind Farmasi Industri |
| 56 | Konsolidasi Obat | Tiamin (Vitamin B1) tab 50 mg* | 78 | 2.000 | 0 | 156.000 | PT.Imfarmind Farmasi Industri |
| 57 | Obat Program Jaminan Kesehatan | Asam askorbat (vitamin C) tablet/kapsul/kaplet 50 mg | 95 | 3.000 | 0 | 285.000 | PT.Imfarmind Farmasi Industri |
| 58 | Obat Program Jaminan Kesehatan | Paracetamol/ Parasetamol sirup 120 mg / 5 ml | 3.950 | 250 | 0 | 987.500 | PT.Imfarmind Farmasi Industri |
| 59 | Obat Program Jaminan Kesehatan | Antasida Doen Suspensi 60 ml | 4.000 | 100 | 0 | 400.000 | PT.Imfarmind Farmasi Industri |
| 60 | Obat Program Jaminan Kesehatan | Domperidon/ Domperidone maleate/ Domperidone sirup/suspensi 5 mg/5 ml | 6.650 | 100 | 0 | 665.000 | PT.Imfarmind Farmasi Industri |
| 61 | Obat Program Jaminan Kesehatan | Paracetamol/ Parasetamol tablet/kaplet 500 mg | 140 | 8.000 | 0 | 1.120.000 | PT.Imfarmind Farmasi Industri |
| 62 | Obat Program Jaminan Kesehatan | Deksametason/ Dexamethasone tablet/kaplet 0,5 mg | 80 | 18.000 | 0 | 1.440.000 | PT.Imfarmind Farmasi Industri |
| 63 | Obat Program Jaminan Kesehatan | Chlorphenamine Maleate/ Klorfeniramin (CTM) tablet/kapsul/kaplet 4 mg | 83 | 15.000 | 0 | 1.245.000 | PT.Imfarmind Farmasi Industri |
| 64 | Obat Non Jaminan Kesehatan | Guaifenesin tablet 100 mg | 95 | 5.000 | 0 | 475.000 | PT.Imfarmind Farmasi Industri |
| 65 | Obat Program Jaminan Kesehatan | Karbogliserin tetes telinga 10% | 7.396 | 200 | 0 | 1.479.200 | PT. LUCAS DJAJA |
| 66 | Konsolidasi Obat | Kombinasi KDT/FDC mengandung: a. ipratropium bromida 0,5 mg b. salbutamol 2,5 mg cairan ih | 3.663 | 200 | 0 | 732.600 | PT. MEPROFARM |
| 67 | Konsolidasi Obat | Klozapin tab 100 mg | 990 | 500 | 0 | 495.000 | PT. MEPROFARM |
| 68 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron tablet/kapsul/kaplet 8 mg | 549 | 5.400 | 0 | 2.964.600 | PT NOVAPHARIN |
| 69 | Obat Program Jaminan Kesehatan | Cetirizine hydrochloride 10 mg tablet | 108 | 20.000 | 0 | 2.160.000 | PT NOVAPHARIN |
| 70 | Obat Program Jaminan Kesehatan | SUCRALFATE Suspensi | 7.352 | 175 | 0 | 1.286.600 | PT. MEPROFARM |
| 71 | Obat Non Jaminan Kesehatan | BRONKRIS TABLET - BROMHEXINE / BROMHEKSIN 8 MG TABLET | 210 | 10.000 | 0 | 2.100.000 | PT. Graha Farma |
| 72 | Obat Program Jaminan Kesehatan | ASPILETS | 538 | 1.500 | 0 | 807.000 | PT Darya Varia |
| 73 | Obat Program Jaminan Kesehatan | Amoksisilin/ Amoxicillin/ Amoxicillin Trihydrate tablet/kapsul/kaplet/kaptab 500 mg | 530 | 20.000 | 0 | 10.600.000 | PT. Kimia Farma Tbk |
| 74 | Obat Program Jaminan Kesehatan | Nystatin/ Nistatin vaginal tablet/kaplet 100.000 IU | 1.832 | 300 | 0 | 549.600 | PT.Phapros Tbk |
| 75 | Obat Program Jaminan Kesehatan | Salep 2-4, salep | 3.996 | 48 | 0 | 191.808 | PT. MARIN LIZA FARMASI |
| 76 | Konsolidasi Obat | Hidroklorotiazid tab 25 mg | 148 | 6.000 | 0 | 888.000 | PT. Kimia Farma Tbk |
| 77 | Obat Program Jaminan Kesehatan | Ketoprofen 100 mg Suppositoria | 3.552 | 50 | 0 | 177.600 | PT. MEPROFARM |
| 78 | Obat Program Kesehatan Lainnya | Omeprazol/Omeprazole tablet/kapsul/kaplet 20 mg | 244 | 5.000 | 0 | 1.220.000 | PT NOVAPHARIN |
| 79 | Fasilitas Kesehatan Sektoral Kemenkes | Peakflow Meter | 350.000 | 1 | 30.000 | 380.000 | PT. Irza Mutira Abadi |
| 80 | Obat Program Jaminan Kesehatan | Cefotaxime sodium/ Cefotaxime/ Sefotaksim serb inj 1.000 mg | 5.500 | 100 | 0 | 550.000 | P.T. Dexa Medica |
| 81 | Obat Program Jaminan Kesehatan | Human tetanus imunoglobulin inj 250 IU (i.m.) | 215.500 | 30 | 0 | 6.465.000 | P.T. Dexa Medica |
| 82 | Obat Program Jaminan Kesehatan | Kalsium glukonat/ Calcium gluconate inj 10% | 10.900 | 24 | 0 | 261.600 | P.T. Dexa Medica |
| 83 | Obat Program Jaminan Kesehatan | Ondansetron hydrochloride (HCl)/ Ondansetron HCl dihydrate /Ondansetron inj 2 mg/mL | 1.400 | 300 | 0 | 420.000 | P.T. Dexa Medica |
| 84 | Obat Program Jaminan Kesehatan | Paracetamol/ Parasetamol tablet/kaplet 500 mg | 140 | 10.500 | 0 | 1.470.000 | PT.Imfarmind Farmasi Industri |
| 85 | Obat Program Kesehatan Lainnya | ACICLOVIR KRIM 5 gram | 3.329 | 100 | 0 | 332.900 | PT.Bernofarm |
| 86 | 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 |
| 87 | Obat Program Kesehatan Lainnya | Salbutamol sulfate/ Salbutamol tablet/kapsul/kaplet 2 mg | 183 | 5.000 | 0 | 915.000 | PT.Bernofarm |
| 88 | Obat Program Kesehatan Lainnya | Simvastatin tablet/kapsul/kaplet 10 mg | 230 | 4.000 | 0 | 920.000 | PT.Bernofarm |
| 89 | Obat Program Kesehatan Lainnya | Amlodipine besilate tablet/kapsul/kaplet 10 mg | 472 | 12.000 | 0 | 5.664.000 | PT.Bernofarm |
| 90 | Obat Program Kesehatan Lainnya | Amlodipine besilate tablet/kapsul/kaplet 5 mg | 291 | 10.000 | 0 | 2.910.000 | PT.Bernofarm |
| 91 | Obat Program Jaminan Kesehatan | Betametason/Betamethasone Valerate krim 0,1% 5g | 1.995 | 100 | 0 | 199.500 | PT.Bernofarm |
| 92 | Obat Program Jaminan Kesehatan | Ciprofloxacin hydrochloride (HCl)/ Ciprofloxacin Lactate/ Ciprofloxacin/ Siprofloksasin tablet/kapsul/kaplet 500 mg | 475 | 1.200 | 0 | 570.000 | PT.Bernofarm |
| 93 | Obat Program Jaminan Kesehatan | Clindamycin hydrochloride (HCl)/ Clindamycin/ Klindamisin tablet/kapsul/kaplet 300 mg | 1.211 | 1.200 | 0 | 1.453.200 | PT.Bernofarm |
| 94 | Obat Program Jaminan Kesehatan | Metronidazole/Metronidazol tablet/kapsul/kaplet 500 mg | 297 | 1.500 | 0 | 445.500 | PT.Bernofarm |
| 95 | Obat Program Jaminan Kesehatan | Amoksisilin/Amoxicillin/Amoxicillin Trihydrate sirup/suspensi kering 125 mg/ 5 ml | 5.500 | 250 | 0 | 1.375.000 | PT.Bernofarm |
| 96 | Obat Program Jaminan Kesehatan | Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg | 4.796 | 200 | 0 | 959.200 | PT.Bernofarm |
| 97 | Obat Program Jaminan Kesehatan | LORATADINE 10 mg kaplett | 182 | 8.000 | 0 | 1.456.000 | PT.Bernofarm |
| 98 | Obat Program Jaminan Kesehatan | GENTAMICIN SULFATE 01 % KRIM 5 gram | 3.325 | 200 | 0 | 665.000 | PT.Bernofarm |
| 99 | Obat Program Jaminan Kesehatan | Glimepiride tablet/kapsul/kaplet 2 mg | 549 | 23.000 | 0 | 12.627.000 | PT.Bernofarm |
| 100 | Obat Program Jaminan Kesehatan | Ranitidine hydrochloride (HCl) 150 mg TSS | 300 | 8.500 | 0 | 2.550.000 | PT.Bernofarm |
| 101 | Obat Program Jaminan Kesehatan | Glimepiridetablet/kapsul/kaplet 1 mg | 323 | 5.000 | 0 | 1.615.000 | PT.Bernofarm |
| 102 | Obat Program Jaminan Kesehatan | Metformin Hydrochloride tablet/kapsul/kaplet 500 mg | 266 | 14.500 | 0 | 3.857.000 | PT.Bernofarm |
| 103 | Obat Non Jaminan Kesehatan | OBH MOLEX Sirup | 5.750 | 150 | 0 | 862.500 | PT. MOLEX AYUS |
| 104 | Obat Program Jaminan Kesehatan | Vitamin B Kompleks/ Vitamin B complex tablet | 81 | 28.000 | 0 | 2.268.000 | PT NOVAPHARIN |
| 105 | Obat Non Jaminan Kesehatan | MECOBALAMIN / MEKOBALAMIN 500 MCG | 450 | 3.500 | 0 | 1.575.000 | PT. Graha Farma |
| 106 | Obat Program Jaminan Kesehatan | OZELA/LOPERAMIDE HYDROCHLORIDE 2 MG/TABLET/LAPLET | 247 | 4.000 | 0 | 988.000 | PT. TRIMAN |
| 107 | Obat Program Jaminan Kesehatan | Prednison/Prednisone tablet/kapsul/kapl 5 mg | 127 | 4.000 | 0 | 508.000 | PT. TRIMAN |
| 108 | Obat Program Jaminan Kesehatan | Asam mefenamat t4b 500 mg | 260 | 18.500 | 0 | 4.810.000 | PT. TRIMAN |
| 109 | Obat Non Jaminan Kesehatan | Trimabion | 455 | 3.000 | 0 | 1.365.000 | PT. TRIMAN |
| 110 | Konsolidasi Obat | Ibuprofen tab 400 mg | 189 | 2.000 | 0 | 378.000 | PT. TRIMAN |
| 111 | Obat Program Jaminan Kesehatan | Piroxicam tab 20 mg | 132 | 4.000 | 0 | 528.000 | PT.Imfarmind Farmasi Industri |
| 112 | Fasilitas Kesehatan Sektoral Kemenkes | Genoint Tetes Mata 0.3% | 14.985 | 100 | 0 | 1.498.500 | GATRA PERSADA |
| 113 | Fasilitas Kesehatan Sektoral Kemenkes | Reco Tetes Mata 0.5% 5mg | 11.655 | 100 | 0 | 1.165.500 | GATRA PERSADA |
| 114 | Fasilitas Kesehatan Sektoral Kemenkes | Reco Tetes Telina 3% 5 Ml | 11.655 | 100 | 0 | 1.165.500 | GATRA PERSADA |
| 115 | Fasilitas Kesehatan Sektoral Kemenkes | Hidrokortison / Hydrocortisone Cream 2,5% | 130.536 | 5 | 0 | 652.680 | GATRA PERSADA |
| 116 | Fasilitas Kesehatan Sektoral Kemenkes | Furosemide Tablet 40mg | 32.190 | 15 | 0 | 482.850 | GATRA PERSADA |
| 117 | Fasilitas Kesehatan Sektoral Kemenkes | Isosorbid Dinitrat / Isosorbide Dinitrade / ISDN 5mg | 21.090 | 6 | 0 | 126.540 | GATRA PERSADA |
| 118 | Fasilitas Kesehatan Sektoral Kemenkes | Ketoconazole Tablet 200 mg | 33.300 | 15 | 0 | 499.500 | GATRA PERSADA |
| 119 | Obat Program Jaminan Kesehatan | Antifungi Salep, Kombinasi: Asam Benzoat 6% + Asam Salisilat 3% / Salep Whitfield | 7.000 | 24 | 0 | 168.000 | PT. Holi Pharma |
| 120 | Fasilitas Kesehatan Sektoral Kemenkes | Pehacain Injeksi | 6.700 | 100 | 0 | 670.000 | PT. Antar Mitra Persada |
| 121 | Fasilitas Kesehatan Sektoral Kemenkes | ZINC SULFATE TABLET | 350 | 5.800 | 0 | 2.030.000 | PT. Antar Mitra Persada |
| 122 | Fasilitas Kesehatan Sektoral Kemenkes | Ambroxol 30 mg tablet | 138 | 10.000 | 0 | 1.380.000 | PT. Antar Mitra Persada |
| 123 | Fasilitas Kesehatan Sektoral Kemenkes | Cefadroxil 500mg tablet | 1.450 | 4.500 | 0 | 6.525.000 | PT. Antar Mitra Persada |
| 124 | Fasilitas Kesehatan Sektoral Kemenkes | Domperidone 10mg tablet | 220 | 7.000 | 0 | 1.540.000 | PT. Antar Mitra Persada |
| 125 | Fasilitas Kesehatan Sektoral Kemenkes | Borax Gliserin/GOM | 103.000 | 7 | 0 | 721.000 | PT. Antar Mitra Persada |
| 126 | Fasilitas Kesehatan Sektoral Kemenkes | Bioplacenton cr | 35.000 | 12 | 0 | 420.000 | PT. Antar Mitra Persada |
| 127 | Fasilitas Kesehatan Sektoral Kemenkes | Cairan D40% Flacon | 14.000 | 20 | 0 | 280.000 | PT. Antar Mitra Persada |
| 128 | Fasilitas Kesehatan Sektoral Kemenkes | Acyclovir tablet 400mg | 930 | 2.000 | 0 | 1.860.000 | PT. Antar Mitra Persada |
| 129 | Fasilitas Kesehatan Sektoral Kemenkes | Nifedipin tablet | 260 | 4.000 | 0 | 1.040.000 | PT. Antar Mitra Persada |
| 130 | Fasilitas Kesehatan Sektoral Kemenkes | Oxytetracicline cr Salep Kulit | 1 | 100 | 0 | 100 | PT. Antar Mitra Persada |
| 131 | Fasilitas Kesehatan Sektoral Kemenkes | Caviplex tablet | 950 | 4.000 | 0 | 3.800.000 | PT. Antar Mitra Persada |
| 132 | Fasilitas Kesehatan Sektoral Kemenkes | Dionicol syr | 11.200 | 100 | 0 | 1.120.000 | PT. Antar Mitra Persada |
| 133 | Fasilitas Kesehatan Sektoral Kemenkes | Dulcolax supo dewasa | 210.000 | 2 | 0 | 420.000 | PT. Antar Mitra Persada |
| 134 | Fasilitas Kesehatan Sektoral Kemenkes | Enbatic salep/cream | 12.600 | 100 | 0 | 1.260.000 | PT. Antar Mitra Persada |
| 135 | Fasilitas Kesehatan Sektoral Kemenkes | Cairan Infus RL 500 mL | 11.800 | 100 | 0 | 1.180.000 | PT. Antar Mitra Persada |
| 136 | Fasilitas Kesehatan Sektoral Kemenkes | Scopma Tablet | 1.320 | 1.000 | 0 | 1.320.000 | PT. Antar Mitra Persada |
| 137 | Fasilitas Kesehatan Sektoral Kemenkes | Captopril 25 mg | 200 | 8.000 | 0 | 1.600.000 | PT. Antar Mitra Persada |
| 138 | Fasilitas Kesehatan Sektoral Kemenkes | Amitriptilin 25mg | 1 | 400 | 0 | 400 | PT. Antar Mitra Persada |
| 139 | Fasilitas Kesehatan Sektoral Kemenkes | Dimenhydrinat tablet | 240 | 4.000 | 0 | 960.000 | PT. Antar Mitra Persada |
| 140 | Fasilitas Kesehatan Sektoral Kemenkes | CEPEZET Tab | 1 | 40 | 0 | 40 | PT. Antar Mitra Persada |
| 141 | Obat Non Jaminan Kesehatan | Alpara Kaplet | 800 | 2.500 | 0 | 2.000.000 | PT. MOLEX AYUS |
| 142 | Obat Non Jaminan Kesehatan | Molagit Tablet | 500 | 1.000 | 0 | 500.000 | PT. MOLEX AYUS |
| 143 | Fasilitas Kesehatan Sektoral Kemenkes | MOLEX ALKOHOL 70% 1L | 45.000 | 18 | 0 | 810.000 | PT. MOLEX AYUS |
| 144 | Obat Program Jaminan Kesehatan | Infatrim Suspensi/Cotrimoxazole/ Cotrimoksazole/ Kotrimoksazol (anak) kombinasi tiap 5 ml suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg (susp 240 mg) | 6.500 | 200 | 0 | 1.300.000 | PT. MOLEX AYUS |
| 145 | Konsolidasi Obat | Metilprednisolon tab 4 mg | 160 | 2.800 | 0 | 448.000 | PT. MOLEX AYUS |
| 146 | Fasilitas Kesehatan Sektoral Kemenkes | YUWELL INFRARED THERMOMETER tipe YHW-1 | 197.580 | 4 | 0 | 790.320 | PT INTISUMBER HASILSEMPURNA |
| 147 | Fasilitas Kesehatan Sektoral Kemenkes | Snellen Chart | 12.138 | 5 | 0 | 60.690 | PT Jayamas Medica Industri |
| Total | 227.790.658 | ||||||
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