addendum Spesifikasi pengadaan obat obatan rumah sakit
PEMERINTAH KABUPATEN SUMBAWA BARAT
DINAS KESEHATAN
Jln. Bung Karno Kompleks Kemutar Telu Center (KTC) Taliwang Kabupaten Sumbawa Barat
Telp. (0372) 81833; Fax. (0372) 81833. Email : dinkes_ksb@yahoo.co.id
SPESI FI KASI TEKNI S PENGADAAN OBAT- OBATAN
DI NAS KESEHATAN KABUPATEN SUMBAWA BARAT
TAHUN ANGGARAN 2012
NO
NAMA OBAT
SATUAN
VOL
OBAT GENERIK
A. INJEKSI
1
Aminofillin Injeksi 24 mg/ ml
Ktk 30 amp @ 10 ml
2
ampisilin serbuk injeksi i.m./ i.v. 1000 mg/ vial
ktk 10 Vial
3
Aqua pro Injeksi Steril, Bebas Pirogen
ktk 10 vial @ 20 ml
2,592
4
Atropin injeksi i.m./ i.v/ s.k. 0,25 mg/ ml (Sulfat)
ktk 30 amp @ 1 ml
18
5
Deksametason injeksi i.v. 5 mg/ ml
ktk 100 amp @ 1 ml
27
6
Diazepam Injeksi 5mg/ ml
ktk 30 amp @ 2 ml
18
7
Difenhidramin injeksi i.m. 10 mg/ ml (HCl)
ktk 30 amp @ 1 ml
48
8
Efinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl)
Fenitoin Natrium Injeksi 50 mg/ ml
ktk 30 amp @ 1 ml
6
amp @ 2 ml
36
10
Fenobarbital Injeksi i.m./ i.v. 50 mg/ ml
ktk 30 amp @ 1 ml
12
11
Fitomenadion (Vitamin K1) injeksi 10 mg/ ml
ktk 30 amp @ 1 ml
30
12
Furosemid injeksi i.v/ i.m. 10 mg/ ml
Gentamicin Inj 80 mg/ ml
ktk 25 amp @ 2 ml
13
14
Gentamicin Injeksi 40 mg/ ml
ktk 5 amp
200
15
Ketorolac injeksi 10 mg
ktk 5 amp @ 1 ml
126
16
Ketorolac injeksi 30 mg
ktk 6 amp @ 1 ml
60
17
Klorpromazin injeksi 1.m. 25 mg/ ml (HCl)
ktk 30 amp @ 2 ml
18
Kuinin Dihidroklorida Injeksi 25 % - 2 ml
ktk 30 amp
19
Lidokain Injeksi 2 % (HCl) +Epinefrin 1:80.000 - 2 ml
ktk 30 amp @ 2 ml
20
M agnesium Sulfat inj (IV) 40% - 25ml
M etampiron Injeksi 250 mg
ktk 10 vial
21
22
M etilergometrin M aleat injeksi 0,200 mg-1 ml
ktk 30 amp
23
M etoklorpramid injeksi 5 mg/ ml
ktk 10 amp @ 2 ml
90
24
M orfin injeksi 10 mg/ ml
ktk 10 amp @ 1 ml
2
25
Oksitetrasiklin HCl injeksi i.m. 50 mg.ml-10 ml
ktk 10 vial
26
Oksitosin Injeksi 10IU/ ml-1ml
ktk 30 amp
27
papaverin injeksi 40 mg/ ml
ktk 100 amp @ 1 ml
9
28
Petidin injeksi 50 mg/ ml
ktk 10 amp
2
29
Piracetam injeksi 1 g/ 5 ml
ktk 10 amp
18
30
Prokain Benzil Penisilin G. injeksi 3 jt IU/ vial
ktk 30 vial @ 15 ml
31
ktk 25 amp
32
Ranitidin injeksi 25 mg/ 2 ml
Sefotaksim injeksi 1 gram per vial
ktk 1 vial
360
33
Seftriakson serbuk injeksi 750 mg/ vial
ktk 1 vial @ 10 ml
360
34
Sianokobalamin (Vitamin B12) injeksi 500 mcg
ktk 100 amp @ 1 ml
35
Tramadol injeksi 50 mg/ ml
ktk 5 amp
9
ktk 1 Vial @ 2 ml
ktk 30 amp @ 2 ml
15
180
36
1,800
3
15
300
18
3
3
9
360
2
36
2
90
B. TABLET
36
Asiklovir tablet 400 mg
ktk 5 x 10 tablet
18.0
37
Albendazol tablet/ tablet kunyah 400 mg
ktk 5 x 6 tablet
18.0
38
Alopurinol tablet 100 mg
ktk 10 x 10 tablet
18.0
39
Alprazolam tablet 0,5 mg
ktk 10 x 10 tablet
18.0
40
Ambroxol tablet 30 mg
ktk 10 x 10 tablet
180.0
41
Aminofilin tablet 200 mg
btl 100 tablet
18.0
42
Amitriptilin tablet salut 25 mg (HCl)
ktk 10 x 10 tablet
18.0
43
Amlodipin tablet 10 mg
ktk 5 x 10 tablet
180.0
NO
NAMA OBAT
SATUAN
VOL
44
Amlodipin tablet 5 mg
ktk 5 x 10 tablet
180.0
45
Amoksisilin kaplet 250 mg
ktk 10 x 10 kapsul
360.0
46
Amoksisilin kaplet 500 mg
ktk 10 x 10 kaplet
2,520.0
47
Antasida DOEN I Tablet Kunyah, kombinasi :
ktk 10 x 10 tablet
1,080.0
Alumunium Hidroksida 200 mg
48
49
M agnesium Hidroksida 200 mg
Antimigren (Ergotamin Tartrat 1 mg+Kofein 50 mg
btl 100 tablet
81.0
Asam M efenamat kapsul 500 mg
Asam Asetilsalisilat tablet 100 mg (Asetosal)
ktk 10 x 10 tablet
720.0
ktk 10 x 10 tablet
36.0
ktk 3 x 10 tablet
18.0
52
Betahistin M esilat tablet 6 mg
Bromheksin tablet 8 mg
ktk 10 x 10 tablet
90.0
53
Cetirizine tablet 10 mg
ktk 5 x 10 tablet
72.0
54
Deksametason tablet 1,5 mg
ktk 10 x10 tablet
540.0
55
Dekstrometorfan tablet 15 mg (HBr)
ktk 10 x10 tablet
54.0
56
Diazepam tablet 2 mg
ktk 10 x10 tablet
18.0
57
Diazepam tablet 5 mg
ktk 10 x10 tablet
36.0
58
Digoksin tablet 0,25 mg
ktk 10 x10 tablet
72.0
59
Diltiazem HCl tablet 30 mg
ktk 10 x10 tablet
36.0
60
Dimenhidrinat tablet 50 mg
btl 100 tablet
36.0
61
Domperidon tablet 10 mg
ktk 10 x10 tablet
36.0
62
Ekstrak Belladona tablet 10 mg
btl 1000 tablet
1.0
63
Efedrin tablet 25 mg (HCl)
btl 250 tablet
36.0
64
Eritromisin kapsul 250 mg
ktk 10 x10 tablet
36.0
65
Famotidine tablet 20 mg
Fenitoin kapsul 100 mg
ktk 5 x 10 tablet
126.0
66
67
Furosemid tablet 40 mg
ktk 10 x10 tablet
72.0
68
Garam Oralit I Serbuk, kombinasi :
ktk 100 sachet
90.0
50
51
btl 250 kapsul
Natrium
0,52 gram
Natrium Klorida
0,30 gram
Trinatrium Sitrat Dihidrat
0,58 gram
Glukosa Anhidrat
2,70 gram
4.0
69
Gemfibrozil kapsul 300 mg
ktk 10 x10 kapsul
54.0
70
Glibenklamida tablet 5 mg
ktk 10 x10 tablet
90.0
71
Glimepiride tablet 1 mg
ktk 5 x10 tablet
180.0
72
Gliseril guaiakolat tablet 100 mg
btl 1000 tablet
36.0
73
Griseofulvin tablet 125 mg
ktk 10 x 10 tablet
9.0
74
Haloperidol tablet 1,5 mg
ktk 10 x10 tablet
36.0
75
Haloperidol tablet 5 mg
ktk 10 x 10 tablet
18.0
76
Hyoscine -N-Butilbromide tablet 10 mg
ktk 10 x10 tablet
36.0
77
Ibuprofen tablet 400 mg
Isosorbit Dinitrat tablet sublingual 5 mg
ktk 10 x10 tablet
180.0
ktk 10 x10 tablet
54.0
btl 1000 tablet
27.0
80
Kalsium Laktat (Kalk) tablet 500 mg
Kaptopril 25 mg
ktk 10 x 10 tablet
90.0
81
Karbamazepin tablet 200 g
ktk 10 x 10 tablet
82
Ketokonazol tablet 200 mg
ktk 5 x10 tablet
216.0
83
Ketoprofen tablet 100 mg
ktk 10 x10 tablet
18.0
84
Klorfeniramina M aleat (CTM ) tablet 4 mg
btl 1000 tablet
54.0
85
Klorokuin tablet 150 mg
btl 1000 tablet
1.0
86
Klorpromazin tablet salut 100 mg (HCl)
btl 250 tablet
7.2
87
Kodein tablet 10 mg
btl 250 tablet
2.0
88
Kotrimoksazol DOEN I (dew asa)
ktk 10 x 10 tablet
360.0
78
79
18.0
kombinasi :
Sulfametoksazol 400 mg
Trimetoprim 80 mg
89
Lansoprazol kapsul 30 mg
ktk 2 x 10 Kapsul
540.0
90
Levofloksasin tablet 500 mg
ktk 5 x 10 tablet
108.0
91
Loperamid Tablet 2 mg
ktk 10 x 10 tablet
36.0
92
Loratadin tablet 10 mg
ktk 5 x 10 tablet
180.0
NO
NAMA OBAT
SATUAN
VOL
93
M eloksikam tablet 15 mg
ktk 5 x 10 tablet
108.0
94
M eloksikam tablet 7,5 mg
ktk 5 x 10 tablet
72.0
95
M etampiron tablet 500 mg
ktk 10 x 10 tablet
90.0
96
M etformin HCl tablet 500 mg
ktk 10 x 10 tablet
180.0
97
M etilprednisolon tablet 4 mg
ktk 10 x 10 tablet
108.0
98
M etilprednisolon tablet 8 mg
ktk 10 x 10 tablet
18.0
99
M etoklopramide tablet 10 mg
ktk 10 x 10 tablet
54.0
100
M etronidazol tablet 500 mg
ktk 10 x 10 tablet
108.0
101
Natrium diklofenak tablet 50 mg
ktk 5 x 10 tablet
108.0
102
Nifedipin tablet 10 mg
ktk 10 x 10 tablet
36.0
103
Nistatin tab salut 500.000 IU/ g
ktk 10 x 10 tablet
18.0
104
Ofloxacin tablet 200 mg
ktk 5 x 10 tablet
108.0
105
Omeprazol kapsul 20 mg
ktk 3 x 10 kapsul
60.0
106
Parasetamol tablet 500 mg
ktk 10 x 10 tablet
2,700.0
107
Piracetam tablet 800 mg
ktk 10 x 10 tablet
36.0
108
Piridoksin (Vitamin B6) tablet 25 mg (HCL)
btl 1000 tablet
36.0
109
Piroksikam tablet 20 mg
ktk 10 x 10 tablet
36.0
110
Prednison tablet 5 mg
btl 1000 tablet
13.0
111
Primakuin tablet 15 mg
btl 1000 tablet
10.8
112
Propiltiourasil tablet 100 mg
btl 100 tablet
36.0
113
Propanolol tablet 10 mg (HCl)
ktk 10 x 10 tablet
36.0
114
Propanolol tablet 40 mg (HCl)
btl 100 tablet
18.0
115
Ranitidin tablet 150 mg
ktk 10 x 10 tablet
63.0
116
Salbutamol tablet 2 mg (Sebagai Sulfat)
ktk 10 x 10 tablet
270.0
117
Salbutamol tablet 4 mg (Sebagai Sulfat)
ktk 10 x 10 tablet
18.0
118
Sefadroksil kapsul 500 mg
ktk 10 x 10 kapsul
90.0
119
Sefiksim kapsul 100 mg
ktk 3x 10 kapsul
5.4
120
Simetidin tablet 200 mg
ktk 10 x 10 tablet
54.0
121
Simvastatin tablet 10 mg
ktk 5 x 10 tablet
180.0
122
Siprofloksasin tablet 500 mg (Sebagai HCl)
ktk 10 x 10 tablet
180.0
123
Spironolakton tablet 100 mg
ktk 10 x 10 tablet
36.0
124
Besi (II) Sulfat 200 mg+Asam Folat 0,25 mg tablet
1 sase @ 30 tablet
600.0
(tablet tambah darah kombinasi)
125
Terbutalin tablet 2,5 mg
ktk 5 x 10 tablet
36.0
126
Tiamfenikol kapsul 500 mg
ktk 10 x 10 tablet
360.0
127
Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat)
btl 1000 tablet
18.0
128
Tramadol tablet 50 mg
ktk 5 x 10 tablet
90.0
129
Triheksilfenidil tablet 2 mg
ktk 10 x 10 tablet
9.0
130
Verapamil tablet 80 mg (HCl)
ktk 10 x 10 tablet
131
Vitamin B Kompleks tablet
btl 1000 tablet
18.0
132
Zinc tablet 20 mg
ktk 10 x 10 tablet
90.0
9.0
C. SYRUP
133
Amoksisillin sirup kering 125 mg/ 5 ml
btl 60 ml
2,700.0
134
Antasida DOEN II suspensi, kombinasi :
btl 60 ml
900.0
Aluminium Hidroksida 200 mg/ 5 ml
M agnesium Hidroksida 200 mg/ 5 ml
135
Dekstrometorfan sirup 10 mg/ 5 ml (HBr)
btl 60 ml
540.0
136
Domperidon suspensi 5 mg / 5 ml
btl 60 ml
540.0
137
Ibuprofen suspensi 100 mg / 5 ml
btl 60 ml
450.0
138
Kotrimoksazol suspensi komb :
btl 60 ml
3,600.0
540.0
Sulfametoksazol 200 mg+Trimetoprim 40 mg/ 5ml
139
M etoklopramide sirup 5 mg / 5 ml
btl 60 ml
140
Parasetamol drops
btl 15 ml
900.0
141
Parasetamol sirup 120 mg / 5 ml
btl 60 ml
9,000.0
142
Pirantel sirup 125 mg / 5 ml
btl 60 ml
180.0
143
Sefadroksil Sirup kering 125 mg/ 5 ml
btl 60 ml
900.0
144
Sefiksim sirup kering 100 mg / 5 ml
btl 30 ml
900.0
NO
NAMA OBAT
SATUAN
VOL
D. SUPPOSITORIA
145
Antihemoroid DOEN kombinasi:
ktk 10 suppo
18.0
Bismut subgalat 150 mg
Heksaklorofen 2,5 mg
E.
INFUS
146
Dekstran 70-larutan infus 6 % steril
btl 500 ml
540.0
147
Glukosa larutan infus 10 % steril
btl 500 ml
360.0
148
Glukosa larutan infus 40 % steril
ktk 10 amp @ 25 ml
149
Glukosa larutan infus 5 % steril
btl 500 ml
5,400.0
150
M etronidazol infus 500 mg/ 100 ml
btl 100 ml
270.0
151
Natrium Klorida larutan infus 0,9%
btl 500 ml
9,000.0
152
Ringer Laktat larutan infus
btl 500 ml
18,000.0
F.
CAIRAN / GELLY
153 Povidon Iodida larutan 10%
G.
18.0
btl 60 ml
720.0
TETES / SALEP / POW DER
154 Asiklovir krim 5 %
ktk 25 tube @ 5 gram
21.6
155 Betametason krim 0,1% (sebagai Valerat)
ktk 25 tube @ 5 gram
216.0
156 Kloramfenikol salep mata 1 %
tube 5 g
900.0
157 Kloramfenikol Tetes M ata 0,5 %
btl 5 ml
900.0
158 Kloramfenikol Tetes Telinga 3%
btl 5 ml
900.0
159 Gentamisin Salep Kulit 0,1 %
ktk 25 tube @ 5 gram
160 Hidrokortison krim 2,5 %
tube 5 g
161 Ketokonazol krim 2%
tube 15 gram
450.0
162 M ikonazol krim/ salep 2% (Nitrat)
tube
450.0
163 Oksitetrasiklin HCl salep mata 1%
ktk 25 tube @ 3,5 gr
164 Oksitetrasiklin salep kulit 3%
ktk 25 tube @ 5 gram
165 Salisil bedak 2%
ktk 50 gram
166 Tetrakain HCl tetes mata 0,5%
ktk 24 btl @ 5 ml
14.4
5,400.0
36.0
144.0
2,700.0
3.8
OBAT NON GENERIK
A. INJEKSI
167
Asam Traneksamat Inj 250 mg/ 5 ml
box @ 10 amp
40
168
Asam Traneksamat Inj 500 mg/ 5 ml
box @ 10 amp
40
169
Atracium 50 mg
ktk @ 5 amp
15
170
ATS Inj 1500 IU
Ampul
90
171
ATS Inj 20000 IU/ amp 4 ml
Ampul
18
172
SITICOLIN INJ 250 M G/ 2 M L)
ktk @ 5 amp
80
173
Combivent
Ampul
72
174
Dobutamin Giullini Injeksi
ampul
49
175
Dopamin Giullini Injeksi
Ktk @ 5 Ampul
49
176
DIGOXIN
Ktk @ 5 Ampul
40
177
ISOSORBID
Ktk @ 2 Ampul
178
TRIAM SINOLON ASETONID
Amp
179
Fluxum 0,6 cc
Ktk @ 6 Ampul
180
Fulmicort
Ampul
181
HIOSINA-N-BUTILBROM IDA
Ktk @ 5 Amp
182
Heparin Inj
Vial
180
183
Kalsium glukonat Inj 100 mg/ ml
Ampul
180
184
LIDOCAIN HCL
ktk @ 5 amp
185
VIT B1 100 M G, VIT B6 100 M G
Amp
186
Nicardipin
Ktk @ 10 Ampul
187
Nimodipin
Ampul
37
188
Norefpinefrin Inj (Levosol 8mg)
ktk 5 amp
15
189
Omeprazole Inj
vial
190
Ondansetron 8 mg/ 2ml
ktk 5 amp
18
191
SABU Inj
vial
18
192
AM IODARON HIDROKLORIDA
Ktk @ 5 Ampul
14
42
170
10
180
54
37
900
6
260
NO
NAMA OBAT
SATUAN
193
Warfarin Inj
Ktk @ 100 Ampul
194
Xilomidon Inj
Vial
VOL
2
100
B. TABLET
195
Antalgin 500 mg
ktk 10 x 10 tablet
50
196
Asam Tranexamat 500 mg
ktk 10 x 10 tablet
80
197
Aspar K
ktk 10 x 10 tablet
10
198
Curcuma 200 mg
btl 500 tablet
30
199
Kalsium monohidrogen fosfat 200 mg, kalsium laktat ktk 10 x 10 tablet
54
100 mg, vit B6 20 mg, vit C, 25 mg, vit D3 100 Iu
200
Fe Glukonat 250 mg, M n Sulfat 0,2 mg, Cu Sulfat 0,2
ktk 10 x 10 tablet
20
mg, Vit C 50 mg, Asam Folat 1 mg, Vit B 12 7,5 M cg
201
ASAM TRANEXAM AT
ktk 10 x 10 tablet
30
202
ASAM TRANEXAM AT
ktk 10 x 10 tablet
30
203
M etionin 100 mg, Kolin Bitartrat 100 mg, Vit B1
btl 30 tablet
60
M ononitrat 2 mg, Vit B2 2 mg, Nikotinamid, 6 mg, vit
B6 hidroklorida 2 mg, Ca pantotenat, 3 mg, biotin 0,1
mg, Asam folat 0,4 mg, vit B 12, 0,67 mcg, vit E 3 mg
204
VIT B1 M ONONITRAT 100 M G, B6 200 M G, Vit B-12
ktk 10 x 20 tablet
180
250 M cg
C. SYRUP
205
AM OXICILLIN
drops 15 ml
206
Vit B1 5 mg, Vit B2 2 mg, Vit B6 2,5 mg, Vit B 12 3
btl
500
1,300
mcg, Niasinamid 20 mg, L-Lisin Hcl 200 mg,
207
Dekspantenolol 3 mg/ 5 ml
Bromheksin Hcl
btl @ 60 ml
208
KAOLIN 700 M G, PECTIN 66 M G/ 15 M L
btl 60 ml
1,700
209
Tyamfenicol syr
btl
1,510
400
D. SUPPOSITORIA
210
BISAKODIL
box @ 50 suppo
2
211
BISAKODIL
box @ 6 suppo
20
212
Kaltropen Supp 100 mg (Protoffen Supp 100mg)
ktk @ 20 supp
9
213
Na Lauril sulfoasetat 45 mg, Na sitrat 450 mg,Asam
tube
121
sorbat 5 mg, PEG 400 625 mg, Sorbitol 4,465 mg
214
PARASETAM OL
box @ 12 suppo
15
215
PARASETAM OL
box @ 12 suppo
15
216
M ETRONIDAZOL 500 M G, NISTATIN 100.000 IU
supp
80
217
DIAZEPAM
ktk @ 5 tube
54
E.
INFUS
218
Aminofluid
btl/ 500 ml
36
219
Asam Amino 5 % dan 7 %
BTL
20
220
As. Amini 50 g, sorbitol mg, Xylitol 50 g, vit, elektrolit BTL
20
221
per L
Asam Amino 50 g, Vit, Elektrolit
BTL 250 M L
20
222
Aqua 1 L
btl 1 L
20
223
Ca ++ 3 mEq+ 4meq, Na meq, cl-109 meq, asetat 28
fls 500 ml
450
224
meq
Combivent nebules 100 mcg
Ktk @ 20 Vial
350
225
Na 38,5 meq, cl 38,5 meq, glukosa 37,5 g
fls 500 ml
450
226
Na 60 meq, K10 M eq, cl 50 meq, laktat 20 meq
fls 500 ml
450
glukosa 27 g
NO
NAMA OBAT
SATUAN
VOL
227
Na 50 mEq, K 20 meq, cl 50 meq, laktat 20 meq
fls 500 ml
450
228
glukosa 27 g
asam aminio esensial dan non esensial
btl
100
229
M anitol inf 20% 500 ml
btl
100
230 Alkohol 70% 1 L
231 Formalin Cair 1 L
Botol
800
fls
5
232 Jelly ECG
233 Jelly USG
fls
40
gallon( 5 Liter )
36
234 KY Jelly
fls(82 gr )
40
F.
CAIRAN / GELLY
235 Lisol
236 Pehidrol 3% 1 L
36
Btl ( 800 ml )
90
237 Albothyl Concentrate 10 ml
btl
54
238 Daryantul
Ktk @ 10 lembar
52
239 Neomicin sulfat 5 mg, Basitrasin 500 iu
btl
18
240 Pantocain 0,5% TM
Tube
58
G.
I
btl
TETES / SALEP / POW DER
GIGI
241 Cresophen
242 Caviton
Botol
25
Botol
12
243 Aquades Steril
244 H2O2
Botol
18
Botol
18
245 Etil cloride
246 CHKM
Botol
54
Botol
5
247 Eugenol
248 Glass Ionomer
Botol
5
249 Devitalisasi pasta
Botol
pak
10
5
Taliwang, 26 Juni 2012
Pejabat Pembuat Komitmen
Dinas Kesehatan Kab. Sumbawa Barat
ttd
Ns. KAMALUDDIN, S.Kep., MM
NIP. 19670505 198803 1 016
DINAS KESEHATAN
Jln. Bung Karno Kompleks Kemutar Telu Center (KTC) Taliwang Kabupaten Sumbawa Barat
Telp. (0372) 81833; Fax. (0372) 81833. Email : dinkes_ksb@yahoo.co.id
SPESI FI KASI TEKNI S PENGADAAN OBAT- OBATAN
DI NAS KESEHATAN KABUPATEN SUMBAWA BARAT
TAHUN ANGGARAN 2012
NO
NAMA OBAT
SATUAN
VOL
OBAT GENERIK
A. INJEKSI
1
Aminofillin Injeksi 24 mg/ ml
Ktk 30 amp @ 10 ml
2
ampisilin serbuk injeksi i.m./ i.v. 1000 mg/ vial
ktk 10 Vial
3
Aqua pro Injeksi Steril, Bebas Pirogen
ktk 10 vial @ 20 ml
2,592
4
Atropin injeksi i.m./ i.v/ s.k. 0,25 mg/ ml (Sulfat)
ktk 30 amp @ 1 ml
18
5
Deksametason injeksi i.v. 5 mg/ ml
ktk 100 amp @ 1 ml
27
6
Diazepam Injeksi 5mg/ ml
ktk 30 amp @ 2 ml
18
7
Difenhidramin injeksi i.m. 10 mg/ ml (HCl)
ktk 30 amp @ 1 ml
48
8
Efinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl)
Fenitoin Natrium Injeksi 50 mg/ ml
ktk 30 amp @ 1 ml
6
amp @ 2 ml
36
10
Fenobarbital Injeksi i.m./ i.v. 50 mg/ ml
ktk 30 amp @ 1 ml
12
11
Fitomenadion (Vitamin K1) injeksi 10 mg/ ml
ktk 30 amp @ 1 ml
30
12
Furosemid injeksi i.v/ i.m. 10 mg/ ml
Gentamicin Inj 80 mg/ ml
ktk 25 amp @ 2 ml
13
14
Gentamicin Injeksi 40 mg/ ml
ktk 5 amp
200
15
Ketorolac injeksi 10 mg
ktk 5 amp @ 1 ml
126
16
Ketorolac injeksi 30 mg
ktk 6 amp @ 1 ml
60
17
Klorpromazin injeksi 1.m. 25 mg/ ml (HCl)
ktk 30 amp @ 2 ml
18
Kuinin Dihidroklorida Injeksi 25 % - 2 ml
ktk 30 amp
19
Lidokain Injeksi 2 % (HCl) +Epinefrin 1:80.000 - 2 ml
ktk 30 amp @ 2 ml
20
M agnesium Sulfat inj (IV) 40% - 25ml
M etampiron Injeksi 250 mg
ktk 10 vial
21
22
M etilergometrin M aleat injeksi 0,200 mg-1 ml
ktk 30 amp
23
M etoklorpramid injeksi 5 mg/ ml
ktk 10 amp @ 2 ml
90
24
M orfin injeksi 10 mg/ ml
ktk 10 amp @ 1 ml
2
25
Oksitetrasiklin HCl injeksi i.m. 50 mg.ml-10 ml
ktk 10 vial
26
Oksitosin Injeksi 10IU/ ml-1ml
ktk 30 amp
27
papaverin injeksi 40 mg/ ml
ktk 100 amp @ 1 ml
9
28
Petidin injeksi 50 mg/ ml
ktk 10 amp
2
29
Piracetam injeksi 1 g/ 5 ml
ktk 10 amp
18
30
Prokain Benzil Penisilin G. injeksi 3 jt IU/ vial
ktk 30 vial @ 15 ml
31
ktk 25 amp
32
Ranitidin injeksi 25 mg/ 2 ml
Sefotaksim injeksi 1 gram per vial
ktk 1 vial
360
33
Seftriakson serbuk injeksi 750 mg/ vial
ktk 1 vial @ 10 ml
360
34
Sianokobalamin (Vitamin B12) injeksi 500 mcg
ktk 100 amp @ 1 ml
35
Tramadol injeksi 50 mg/ ml
ktk 5 amp
9
ktk 1 Vial @ 2 ml
ktk 30 amp @ 2 ml
15
180
36
1,800
3
15
300
18
3
3
9
360
2
36
2
90
B. TABLET
36
Asiklovir tablet 400 mg
ktk 5 x 10 tablet
18.0
37
Albendazol tablet/ tablet kunyah 400 mg
ktk 5 x 6 tablet
18.0
38
Alopurinol tablet 100 mg
ktk 10 x 10 tablet
18.0
39
Alprazolam tablet 0,5 mg
ktk 10 x 10 tablet
18.0
40
Ambroxol tablet 30 mg
ktk 10 x 10 tablet
180.0
41
Aminofilin tablet 200 mg
btl 100 tablet
18.0
42
Amitriptilin tablet salut 25 mg (HCl)
ktk 10 x 10 tablet
18.0
43
Amlodipin tablet 10 mg
ktk 5 x 10 tablet
180.0
NO
NAMA OBAT
SATUAN
VOL
44
Amlodipin tablet 5 mg
ktk 5 x 10 tablet
180.0
45
Amoksisilin kaplet 250 mg
ktk 10 x 10 kapsul
360.0
46
Amoksisilin kaplet 500 mg
ktk 10 x 10 kaplet
2,520.0
47
Antasida DOEN I Tablet Kunyah, kombinasi :
ktk 10 x 10 tablet
1,080.0
Alumunium Hidroksida 200 mg
48
49
M agnesium Hidroksida 200 mg
Antimigren (Ergotamin Tartrat 1 mg+Kofein 50 mg
btl 100 tablet
81.0
Asam M efenamat kapsul 500 mg
Asam Asetilsalisilat tablet 100 mg (Asetosal)
ktk 10 x 10 tablet
720.0
ktk 10 x 10 tablet
36.0
ktk 3 x 10 tablet
18.0
52
Betahistin M esilat tablet 6 mg
Bromheksin tablet 8 mg
ktk 10 x 10 tablet
90.0
53
Cetirizine tablet 10 mg
ktk 5 x 10 tablet
72.0
54
Deksametason tablet 1,5 mg
ktk 10 x10 tablet
540.0
55
Dekstrometorfan tablet 15 mg (HBr)
ktk 10 x10 tablet
54.0
56
Diazepam tablet 2 mg
ktk 10 x10 tablet
18.0
57
Diazepam tablet 5 mg
ktk 10 x10 tablet
36.0
58
Digoksin tablet 0,25 mg
ktk 10 x10 tablet
72.0
59
Diltiazem HCl tablet 30 mg
ktk 10 x10 tablet
36.0
60
Dimenhidrinat tablet 50 mg
btl 100 tablet
36.0
61
Domperidon tablet 10 mg
ktk 10 x10 tablet
36.0
62
Ekstrak Belladona tablet 10 mg
btl 1000 tablet
1.0
63
Efedrin tablet 25 mg (HCl)
btl 250 tablet
36.0
64
Eritromisin kapsul 250 mg
ktk 10 x10 tablet
36.0
65
Famotidine tablet 20 mg
Fenitoin kapsul 100 mg
ktk 5 x 10 tablet
126.0
66
67
Furosemid tablet 40 mg
ktk 10 x10 tablet
72.0
68
Garam Oralit I Serbuk, kombinasi :
ktk 100 sachet
90.0
50
51
btl 250 kapsul
Natrium
0,52 gram
Natrium Klorida
0,30 gram
Trinatrium Sitrat Dihidrat
0,58 gram
Glukosa Anhidrat
2,70 gram
4.0
69
Gemfibrozil kapsul 300 mg
ktk 10 x10 kapsul
54.0
70
Glibenklamida tablet 5 mg
ktk 10 x10 tablet
90.0
71
Glimepiride tablet 1 mg
ktk 5 x10 tablet
180.0
72
Gliseril guaiakolat tablet 100 mg
btl 1000 tablet
36.0
73
Griseofulvin tablet 125 mg
ktk 10 x 10 tablet
9.0
74
Haloperidol tablet 1,5 mg
ktk 10 x10 tablet
36.0
75
Haloperidol tablet 5 mg
ktk 10 x 10 tablet
18.0
76
Hyoscine -N-Butilbromide tablet 10 mg
ktk 10 x10 tablet
36.0
77
Ibuprofen tablet 400 mg
Isosorbit Dinitrat tablet sublingual 5 mg
ktk 10 x10 tablet
180.0
ktk 10 x10 tablet
54.0
btl 1000 tablet
27.0
80
Kalsium Laktat (Kalk) tablet 500 mg
Kaptopril 25 mg
ktk 10 x 10 tablet
90.0
81
Karbamazepin tablet 200 g
ktk 10 x 10 tablet
82
Ketokonazol tablet 200 mg
ktk 5 x10 tablet
216.0
83
Ketoprofen tablet 100 mg
ktk 10 x10 tablet
18.0
84
Klorfeniramina M aleat (CTM ) tablet 4 mg
btl 1000 tablet
54.0
85
Klorokuin tablet 150 mg
btl 1000 tablet
1.0
86
Klorpromazin tablet salut 100 mg (HCl)
btl 250 tablet
7.2
87
Kodein tablet 10 mg
btl 250 tablet
2.0
88
Kotrimoksazol DOEN I (dew asa)
ktk 10 x 10 tablet
360.0
78
79
18.0
kombinasi :
Sulfametoksazol 400 mg
Trimetoprim 80 mg
89
Lansoprazol kapsul 30 mg
ktk 2 x 10 Kapsul
540.0
90
Levofloksasin tablet 500 mg
ktk 5 x 10 tablet
108.0
91
Loperamid Tablet 2 mg
ktk 10 x 10 tablet
36.0
92
Loratadin tablet 10 mg
ktk 5 x 10 tablet
180.0
NO
NAMA OBAT
SATUAN
VOL
93
M eloksikam tablet 15 mg
ktk 5 x 10 tablet
108.0
94
M eloksikam tablet 7,5 mg
ktk 5 x 10 tablet
72.0
95
M etampiron tablet 500 mg
ktk 10 x 10 tablet
90.0
96
M etformin HCl tablet 500 mg
ktk 10 x 10 tablet
180.0
97
M etilprednisolon tablet 4 mg
ktk 10 x 10 tablet
108.0
98
M etilprednisolon tablet 8 mg
ktk 10 x 10 tablet
18.0
99
M etoklopramide tablet 10 mg
ktk 10 x 10 tablet
54.0
100
M etronidazol tablet 500 mg
ktk 10 x 10 tablet
108.0
101
Natrium diklofenak tablet 50 mg
ktk 5 x 10 tablet
108.0
102
Nifedipin tablet 10 mg
ktk 10 x 10 tablet
36.0
103
Nistatin tab salut 500.000 IU/ g
ktk 10 x 10 tablet
18.0
104
Ofloxacin tablet 200 mg
ktk 5 x 10 tablet
108.0
105
Omeprazol kapsul 20 mg
ktk 3 x 10 kapsul
60.0
106
Parasetamol tablet 500 mg
ktk 10 x 10 tablet
2,700.0
107
Piracetam tablet 800 mg
ktk 10 x 10 tablet
36.0
108
Piridoksin (Vitamin B6) tablet 25 mg (HCL)
btl 1000 tablet
36.0
109
Piroksikam tablet 20 mg
ktk 10 x 10 tablet
36.0
110
Prednison tablet 5 mg
btl 1000 tablet
13.0
111
Primakuin tablet 15 mg
btl 1000 tablet
10.8
112
Propiltiourasil tablet 100 mg
btl 100 tablet
36.0
113
Propanolol tablet 10 mg (HCl)
ktk 10 x 10 tablet
36.0
114
Propanolol tablet 40 mg (HCl)
btl 100 tablet
18.0
115
Ranitidin tablet 150 mg
ktk 10 x 10 tablet
63.0
116
Salbutamol tablet 2 mg (Sebagai Sulfat)
ktk 10 x 10 tablet
270.0
117
Salbutamol tablet 4 mg (Sebagai Sulfat)
ktk 10 x 10 tablet
18.0
118
Sefadroksil kapsul 500 mg
ktk 10 x 10 kapsul
90.0
119
Sefiksim kapsul 100 mg
ktk 3x 10 kapsul
5.4
120
Simetidin tablet 200 mg
ktk 10 x 10 tablet
54.0
121
Simvastatin tablet 10 mg
ktk 5 x 10 tablet
180.0
122
Siprofloksasin tablet 500 mg (Sebagai HCl)
ktk 10 x 10 tablet
180.0
123
Spironolakton tablet 100 mg
ktk 10 x 10 tablet
36.0
124
Besi (II) Sulfat 200 mg+Asam Folat 0,25 mg tablet
1 sase @ 30 tablet
600.0
(tablet tambah darah kombinasi)
125
Terbutalin tablet 2,5 mg
ktk 5 x 10 tablet
36.0
126
Tiamfenikol kapsul 500 mg
ktk 10 x 10 tablet
360.0
127
Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat)
btl 1000 tablet
18.0
128
Tramadol tablet 50 mg
ktk 5 x 10 tablet
90.0
129
Triheksilfenidil tablet 2 mg
ktk 10 x 10 tablet
9.0
130
Verapamil tablet 80 mg (HCl)
ktk 10 x 10 tablet
131
Vitamin B Kompleks tablet
btl 1000 tablet
18.0
132
Zinc tablet 20 mg
ktk 10 x 10 tablet
90.0
9.0
C. SYRUP
133
Amoksisillin sirup kering 125 mg/ 5 ml
btl 60 ml
2,700.0
134
Antasida DOEN II suspensi, kombinasi :
btl 60 ml
900.0
Aluminium Hidroksida 200 mg/ 5 ml
M agnesium Hidroksida 200 mg/ 5 ml
135
Dekstrometorfan sirup 10 mg/ 5 ml (HBr)
btl 60 ml
540.0
136
Domperidon suspensi 5 mg / 5 ml
btl 60 ml
540.0
137
Ibuprofen suspensi 100 mg / 5 ml
btl 60 ml
450.0
138
Kotrimoksazol suspensi komb :
btl 60 ml
3,600.0
540.0
Sulfametoksazol 200 mg+Trimetoprim 40 mg/ 5ml
139
M etoklopramide sirup 5 mg / 5 ml
btl 60 ml
140
Parasetamol drops
btl 15 ml
900.0
141
Parasetamol sirup 120 mg / 5 ml
btl 60 ml
9,000.0
142
Pirantel sirup 125 mg / 5 ml
btl 60 ml
180.0
143
Sefadroksil Sirup kering 125 mg/ 5 ml
btl 60 ml
900.0
144
Sefiksim sirup kering 100 mg / 5 ml
btl 30 ml
900.0
NO
NAMA OBAT
SATUAN
VOL
D. SUPPOSITORIA
145
Antihemoroid DOEN kombinasi:
ktk 10 suppo
18.0
Bismut subgalat 150 mg
Heksaklorofen 2,5 mg
E.
INFUS
146
Dekstran 70-larutan infus 6 % steril
btl 500 ml
540.0
147
Glukosa larutan infus 10 % steril
btl 500 ml
360.0
148
Glukosa larutan infus 40 % steril
ktk 10 amp @ 25 ml
149
Glukosa larutan infus 5 % steril
btl 500 ml
5,400.0
150
M etronidazol infus 500 mg/ 100 ml
btl 100 ml
270.0
151
Natrium Klorida larutan infus 0,9%
btl 500 ml
9,000.0
152
Ringer Laktat larutan infus
btl 500 ml
18,000.0
F.
CAIRAN / GELLY
153 Povidon Iodida larutan 10%
G.
18.0
btl 60 ml
720.0
TETES / SALEP / POW DER
154 Asiklovir krim 5 %
ktk 25 tube @ 5 gram
21.6
155 Betametason krim 0,1% (sebagai Valerat)
ktk 25 tube @ 5 gram
216.0
156 Kloramfenikol salep mata 1 %
tube 5 g
900.0
157 Kloramfenikol Tetes M ata 0,5 %
btl 5 ml
900.0
158 Kloramfenikol Tetes Telinga 3%
btl 5 ml
900.0
159 Gentamisin Salep Kulit 0,1 %
ktk 25 tube @ 5 gram
160 Hidrokortison krim 2,5 %
tube 5 g
161 Ketokonazol krim 2%
tube 15 gram
450.0
162 M ikonazol krim/ salep 2% (Nitrat)
tube
450.0
163 Oksitetrasiklin HCl salep mata 1%
ktk 25 tube @ 3,5 gr
164 Oksitetrasiklin salep kulit 3%
ktk 25 tube @ 5 gram
165 Salisil bedak 2%
ktk 50 gram
166 Tetrakain HCl tetes mata 0,5%
ktk 24 btl @ 5 ml
14.4
5,400.0
36.0
144.0
2,700.0
3.8
OBAT NON GENERIK
A. INJEKSI
167
Asam Traneksamat Inj 250 mg/ 5 ml
box @ 10 amp
40
168
Asam Traneksamat Inj 500 mg/ 5 ml
box @ 10 amp
40
169
Atracium 50 mg
ktk @ 5 amp
15
170
ATS Inj 1500 IU
Ampul
90
171
ATS Inj 20000 IU/ amp 4 ml
Ampul
18
172
SITICOLIN INJ 250 M G/ 2 M L)
ktk @ 5 amp
80
173
Combivent
Ampul
72
174
Dobutamin Giullini Injeksi
ampul
49
175
Dopamin Giullini Injeksi
Ktk @ 5 Ampul
49
176
DIGOXIN
Ktk @ 5 Ampul
40
177
ISOSORBID
Ktk @ 2 Ampul
178
TRIAM SINOLON ASETONID
Amp
179
Fluxum 0,6 cc
Ktk @ 6 Ampul
180
Fulmicort
Ampul
181
HIOSINA-N-BUTILBROM IDA
Ktk @ 5 Amp
182
Heparin Inj
Vial
180
183
Kalsium glukonat Inj 100 mg/ ml
Ampul
180
184
LIDOCAIN HCL
ktk @ 5 amp
185
VIT B1 100 M G, VIT B6 100 M G
Amp
186
Nicardipin
Ktk @ 10 Ampul
187
Nimodipin
Ampul
37
188
Norefpinefrin Inj (Levosol 8mg)
ktk 5 amp
15
189
Omeprazole Inj
vial
190
Ondansetron 8 mg/ 2ml
ktk 5 amp
18
191
SABU Inj
vial
18
192
AM IODARON HIDROKLORIDA
Ktk @ 5 Ampul
14
42
170
10
180
54
37
900
6
260
NO
NAMA OBAT
SATUAN
193
Warfarin Inj
Ktk @ 100 Ampul
194
Xilomidon Inj
Vial
VOL
2
100
B. TABLET
195
Antalgin 500 mg
ktk 10 x 10 tablet
50
196
Asam Tranexamat 500 mg
ktk 10 x 10 tablet
80
197
Aspar K
ktk 10 x 10 tablet
10
198
Curcuma 200 mg
btl 500 tablet
30
199
Kalsium monohidrogen fosfat 200 mg, kalsium laktat ktk 10 x 10 tablet
54
100 mg, vit B6 20 mg, vit C, 25 mg, vit D3 100 Iu
200
Fe Glukonat 250 mg, M n Sulfat 0,2 mg, Cu Sulfat 0,2
ktk 10 x 10 tablet
20
mg, Vit C 50 mg, Asam Folat 1 mg, Vit B 12 7,5 M cg
201
ASAM TRANEXAM AT
ktk 10 x 10 tablet
30
202
ASAM TRANEXAM AT
ktk 10 x 10 tablet
30
203
M etionin 100 mg, Kolin Bitartrat 100 mg, Vit B1
btl 30 tablet
60
M ononitrat 2 mg, Vit B2 2 mg, Nikotinamid, 6 mg, vit
B6 hidroklorida 2 mg, Ca pantotenat, 3 mg, biotin 0,1
mg, Asam folat 0,4 mg, vit B 12, 0,67 mcg, vit E 3 mg
204
VIT B1 M ONONITRAT 100 M G, B6 200 M G, Vit B-12
ktk 10 x 20 tablet
180
250 M cg
C. SYRUP
205
AM OXICILLIN
drops 15 ml
206
Vit B1 5 mg, Vit B2 2 mg, Vit B6 2,5 mg, Vit B 12 3
btl
500
1,300
mcg, Niasinamid 20 mg, L-Lisin Hcl 200 mg,
207
Dekspantenolol 3 mg/ 5 ml
Bromheksin Hcl
btl @ 60 ml
208
KAOLIN 700 M G, PECTIN 66 M G/ 15 M L
btl 60 ml
1,700
209
Tyamfenicol syr
btl
1,510
400
D. SUPPOSITORIA
210
BISAKODIL
box @ 50 suppo
2
211
BISAKODIL
box @ 6 suppo
20
212
Kaltropen Supp 100 mg (Protoffen Supp 100mg)
ktk @ 20 supp
9
213
Na Lauril sulfoasetat 45 mg, Na sitrat 450 mg,Asam
tube
121
sorbat 5 mg, PEG 400 625 mg, Sorbitol 4,465 mg
214
PARASETAM OL
box @ 12 suppo
15
215
PARASETAM OL
box @ 12 suppo
15
216
M ETRONIDAZOL 500 M G, NISTATIN 100.000 IU
supp
80
217
DIAZEPAM
ktk @ 5 tube
54
E.
INFUS
218
Aminofluid
btl/ 500 ml
36
219
Asam Amino 5 % dan 7 %
BTL
20
220
As. Amini 50 g, sorbitol mg, Xylitol 50 g, vit, elektrolit BTL
20
221
per L
Asam Amino 50 g, Vit, Elektrolit
BTL 250 M L
20
222
Aqua 1 L
btl 1 L
20
223
Ca ++ 3 mEq+ 4meq, Na meq, cl-109 meq, asetat 28
fls 500 ml
450
224
meq
Combivent nebules 100 mcg
Ktk @ 20 Vial
350
225
Na 38,5 meq, cl 38,5 meq, glukosa 37,5 g
fls 500 ml
450
226
Na 60 meq, K10 M eq, cl 50 meq, laktat 20 meq
fls 500 ml
450
glukosa 27 g
NO
NAMA OBAT
SATUAN
VOL
227
Na 50 mEq, K 20 meq, cl 50 meq, laktat 20 meq
fls 500 ml
450
228
glukosa 27 g
asam aminio esensial dan non esensial
btl
100
229
M anitol inf 20% 500 ml
btl
100
230 Alkohol 70% 1 L
231 Formalin Cair 1 L
Botol
800
fls
5
232 Jelly ECG
233 Jelly USG
fls
40
gallon( 5 Liter )
36
234 KY Jelly
fls(82 gr )
40
F.
CAIRAN / GELLY
235 Lisol
236 Pehidrol 3% 1 L
36
Btl ( 800 ml )
90
237 Albothyl Concentrate 10 ml
btl
54
238 Daryantul
Ktk @ 10 lembar
52
239 Neomicin sulfat 5 mg, Basitrasin 500 iu
btl
18
240 Pantocain 0,5% TM
Tube
58
G.
I
btl
TETES / SALEP / POW DER
GIGI
241 Cresophen
242 Caviton
Botol
25
Botol
12
243 Aquades Steril
244 H2O2
Botol
18
Botol
18
245 Etil cloride
246 CHKM
Botol
54
Botol
5
247 Eugenol
248 Glass Ionomer
Botol
5
249 Devitalisasi pasta
Botol
pak
10
5
Taliwang, 26 Juni 2012
Pejabat Pembuat Komitmen
Dinas Kesehatan Kab. Sumbawa Barat
ttd
Ns. KAMALUDDIN, S.Kep., MM
NIP. 19670505 198803 1 016