format evaluasi ketersediaan obat terhadap formularium kriteria 8.2.1.7

7/25/2019 Format Evaluasi Ketersediaan Obat Terhadap Formularium Kriteria 8.2.1.7

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LAPORAN EV

BULAN : APRIL 2015

NO NAMA OBAT SA STOK PENERI- PERSE-

TUAN AWAL MAAN DIAAN

OBAT ORAL

1 Alopurinol tablet 100 mg Tablet 483 483

2 Ambroxol tablet 30 mg Tablet 0 0

3 Aminofillin 200 mg Tablet 1260 1260

4 Amitriptilin HCl tablet salut 25 mg Tablet 325 325

5 Amlodipin tablet 5 mg Tablet 2794 3000 5794

6 Amoksisilin kaplet 500 mg Tablet 7182 7182

7 Amoksisilin kaplet 250 mg Kapsul 2624 2624

8 Amoksisilin sirup kering 125 mg/5ml Botol 146 50 196

9 Tablet 4810 3000 7810

10 Antimigren !rgotamin Tartrat 1 mg " Kofein 50 mg Tablet 330 330

11 Asam Askorbat #$it C% tablet 50 mg Tablet 4232 3000 7232

12 Asam Askorbat#$it &% tablet 250 mg Tablet 360 36013 Asam 'olat 1 mg Tablet 1740 1740

14 Asam mefenamat kaplet 500 mg Tablet 2644 2000 4644

15 Asam Asetilsalisilat #asetosal% tablet 100 mg Tablet 1574 1000 2574

16 Asam Asetilsalisilat #asetosal% tablet 500 mg Tablet 173 173

17 Asiklo(ir tab )00 mg Tablet 1973 1973

18 Atenolol tablet 50 mg Tablet 0 0

19 Attapulgit tablet *00 mg Tablet 852 800 1652

20 A+itromisin Tablet 30 30

21 A+itromisin 1000 mg " Cefixime )00 mg Amplop 0 0

Antasida ! tab-kombinasi4gHidroksida 200 mg " Al6 Hidroksida6 200 mg


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41 imenidrinat tablet 50 mg Tablet 1838 1000 2838

42 oksisiklin kapsul 100 mg Kapsul 174 174

43 omperidon tablet 10 mg Tablet 1142 2000 3142

44 !kstrak Belladona tablet 10 mg Tablet 0 045 !ritromisin kapsul 500 mg Kapsul 601 601

46 !tambutol tablet 500 mg Tablet 0 0

47 'enobarbital tablet 100 mg Tablet 286 286

48 'enobarbital tablet 30 mg Tablet 0 0

49 'itomenadion #$it6K1% tablet salut gula 10 mg Tablet 545 545

50 'lukona+ol tablet 150 mg Tablet 0 0

51 'urosemid tablet )0 mg Tablet 85 500 585

52 7aram ralit untuk 200 ml air Kombinasi #a Cl 0-52 g .a&&et 924 924

53 7emfibro+il kapsul 300 mg Kapsul 642 360 1002

54 7li9uidon tablet 30 mg Tablet 368 368

55 7liben&lamide tab 5 mg Tablet 1304 500 1804

56 7limepirid tablet 2 mg Tablet 1608 1000 2608

57 7lipi+id tablet Tablet 0 0

58 7liseril 7ua:akolat tablet 100 mg Tablet 7516 5000 12516

59 7riseoful(in tablet 125 mg- mi&roni+ed Tablet 246 24660 Haloperidol tablet 0-5 mg Tablet 431 431

61 Haloperidol tablet 1-5 mg Tablet 923 800 1723

62 Haloperidol tablet 5 mg Tablet 374 200 574

63 Hidrokortia+ida #HCT% tablet 25 mg Tablet 200 200

64 H:osin But:l B tablet 10 mg Tablet 0 0

65 ,buprofen tablet 200 mg Tablet 3436 3436

66 ,buprofen tablet )00 mg Tablet 0 4000 4000

67 ,sosorbid initrat tablet sublingual 5 mg Tablet 658 658

68 ,sonia+id tablet/kapsul/kaplet 300 mg Tablet 843 843


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88 4etilergometrin 4aleat #4etilergometrin% tablet salut 0 Tablet 219 219

89 4etilprednisolon tablet mg Tablet 450 500 950

90 4etoklopramide tablet 10 mg Tablet 326 326

91 4etronida+ol 500 mg Tablet 610 61092 4ulti(it Bumil Kapsul 2939 2000 4939

93 4ulti(itamin eurotropik kaplet Kaplet 428 500 928

94 4ulti(itamin s:rup Botol 22 22

95 atrium Bikarbonat tablet 500 mg Tablet 0 0

96 atrium iklofenak tablet 25 mg Tablet 2706 2800 5506

97 atrium iklofenak tablet 50 mg Tablet 0 0

98 atrium 'enitoin kapsul 100 mg Kapsul 212 212

99 atrium 'enitoin kapsul 30 mg Kapsul 230 230

100 ifedipin Tablet 640 640

101 istatin $aginal tablet 1006000 ,5 mg Kap 0 0

112 =apa(erin tablet )0 mg Tablet 324 324

113 =arasetamol sirup 120 mg/5 ml Botol 196 252 448114 =arasetamol tablet 500 mg Tablet 10658 10000 20658

115 =irantel tablet .&ore #base% 125 mg Tablet 75 75


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134 .uplemen TB Kaplet 100 100

135 Tiamin HCl / 4ononitrat #$it6B1% tablet 50 mg Tablet 1464 1464

136 Tiamin HCl / 4ononitrat #$it6B1% tablet 100 mg Tablet 0 0

137 Tramadol 50 mg Kapsul 0 0138 Trifluopera+ine tablet 5 mg Tablet 251 251

139 Trieksifenidil Hidroklorida tablet 2 mg Tablet 0 1500 1500

140 $itamin B Kompleks Tablet 4580 3000 7580

141 @ink tablet Tablet 1438 500 1938

0 BAT AK!.T?A 0 0 0

142 Anti Hipertensi Herbal Kapsul 300 300

143 Anti Keputian Herbal Kapsul 0 0

144 Anti Kolesterol Herbal Kapsul 0 0

145 Anti :eri Haid Herbal Kapsul 0 0

146 Anti :eri .endi Herbal Kapsul 0 0

147 !kstrak .erat Herbal .a&&et 0 0

148 !kstrak .tandar .a =almetto 1*0 mg Kapsul 0 0

149 ,mmunomodulator Kapsul Herbal Kapsul 0 0

150 ,mmunomodulator .:rup Herbal Botol 0 0

151 =elan&ar A., Herbal Kapsul 0 0152 .alep ;uka Bakar Herbal Tube 0 0

153 .on&i/eprolit kapsul/Cal&usol kapsul Kapsul 250 250

0 BAT ;


5/66

179 7entamisin .ulfat tetes mata 0-3 Botol 0 10 10

180 7entamisin salep mata Tube 48 48

181 7entamisin salep kulit Tube 0 0

182 Hidrokortison &ream 2-5 Tube 46 48 94183 ,nfusion set anak .et 25 25

184 ,nfusion set deasa .et 150 150

185 ,ntra(ena Cateter anak no6 2) =&s 50 50 100

186 ,ntra(ena Cateter deasa no6 20 =&s 50 50 100

187 ,ntra(ena Cateter deasa no6 22 =&s 50 50 100

188 Kapas =embalut / Absorben 250 gram Bungkus 7 7

189 Kasa gulung )0 :ard x 0 &m ?oll 5 5

190 Kasa H:dropil .teril 1*/1* Box 6 10 16

191 Kasa H:dropil .teril 1/22 Box 8 10 18

192 Kasa =embalut H:dropil ) x 5 &m ?oll 0 100 100



195 Ketokona+ol krim 2 Tube 15 15

196 Kloramfenikol 0-5 Tetes 4ata Botol 0 0

197 Kloramfenikol .alep 4ata 1 Tube 0 24 24198 Kloramfenikol TT 3 Botol 20 30 50

199 Kloreksidin glukonat/ 4inosep 0-2 Botol 0 0

200 ;isol- mengandung kresol tersabun 50 Botol 0 0

201 4asker Biasa =&s 750 750

202 4asker =lus 3 =l: =lus !arloop#masker Dilbab% =&s 300 300 600

203 4asker E5 =&s 39 39

204 4etakresol sulfonat/ =oli&resulen/ Aptil Botol 8 8

205 4ikona+ol krim/salep 2 #itrat% Tube 43 43

206 ksitetrasiklin HCl salep mata 1 Tube 176 176


6/66

226 odium po(idon 10 - 30 ml Botol 22 22



0 .!,AA ,G!K.,/CA,?A/.!?


7/66

271 =ot .putum p&s 0 0

272 b:ek 7lass box 0 0

273 Box .lide box 0 0

274 Kertas .aring box 0 0275 .piritus Botol 0 0

276 ?apid Test .:pillis ?=? p&s 0 0

277 ?apid Test .:pillis . .:pillis 3-0 p&s 0 0

278 ?apid Test H,$ 1 p&s 0 0

279 ?apid Test H,$ 2 p&s 0 0

280 ?apid Test H,$ 3 p&s 0 0

Catatan :Tidak memenuhi : Jika ketersediaan obat yang masuk dala

Memenuhi : Jika ketersediaan obat yang masuk dala

Persentase item obat yang masuk dalam formularium=

= 111 ! 1001"0

= #$"#%

Mengetahui

&e'ala Puskesmas

#dr6 Tarsisius 7lor: %

()P 1*+,0#-.-00.0,100,


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JUMLAH KUNJUNGAN RESEP

BULAN

Mengetahui / Menyetuui

&e'ala inas &esehatan &abu'aten

#drg6 4a:a .intoati =6- 446%

,=6 1E5E1105 1E03 2 002


13/66

LUASI KETERSEDIAAN OBAT DENGAN FORMULARIUM PUSKESMAS BAMBANGLIPURO

PEMA- SISA STOK PERMIN-

KAIAN STOK OPT TAAN 2ata- bln sblmnya stok o'timum

74 409 234 (175) *, -""+$

0 1555 1555 .-- 1$$$

863 397 1871 +,* 1#+1-$

77 248 269 10# -.*"+$

3089 2705 6761 4056 -+0$ .+.1-$2724 4458 10630 6172 ,-$- 10."0

2138 486 3221 1-#* "--1-$

79 117 143 26 $+ 1,-$

2961 4849 8780 3931 "$1- #+#0

0 330 106 ," 10.-$

3702 3530 7579 4049 "0"- +$+*"+$

27 333 88 "$ #+$440 1300 1963 663 +#$ 1*.-$

1863 2781 5470 2689 -1## $,+0

775 1799 1829 30 +"- 1#-#+$

0 173 0 0 0

120 1853 125 $0 1-$

0 0 0 0 0

689 963 1754 791 +0- 1+$,"+$

5 25 3 1 "1-$0 0 0 0 0


14/66

1226 1612 3508 1896 1,0" "$0+$

20 154 6 " .-$

1174 1968 3788 1820 1$1$ "+#+$

0 0 0 0 0 0

120 481 263 10$ -.-$

0 0 0 0 0 0

9 277 29 1- -*"+$

0 0 20 20 # -0

54 491 269 10# -.#+$

0 0 0 0 0 0

585 0 1240 1240 ,*. 1-,0

240 684 1144 460 ,$# 11,"+$379 623 787 164 "1$ +#.#+$

0 368 0 0 0

756 1048 2098 1050 #"* -0*+$

893 1715 2746 1031 10*# -+,$.-$

0 0 0 0 0 0

6186 6330 11129 4799 ,,$- 111-#+$

100 146 125 $0 1-$190 241 286 45 11$ -#.-$

546 1177 1810 633 +-, 1#10

168 406 418 12 1.+ ,1#1-$

32 168 0 0 0

0 0 0 0 0

1275 2161 3968 1$#+ "*.#1-$

1544 2456 3438 982 1"+$ ","+$

382 276 623 347 -,* .-"1-$0 843 0 0 0


15/66

50 169 53 -1 $"1-$

310 640 1008 368 ,0" 100+$

10 316 13 $ 1-$

60 550 348 1"* ",+$

2371 2568 4851 2283 1*,0 ,#$0.-$

715 213 858 645 "," #$+$

0 22 26 4 10 -$.-$

0 0 0 0 0 0

3860 1646 6699 5053 -.#0 ..*#+$

0 0 658 658 -." .$#1-$

50 162 113 ,$ 11-$

0 230 0 0 00 640 381 1$" "#1-$

15 66 71 5 -* +1-$

0 60 19 # 1#+$

0 0 0 0 0

0 0 1 0 0.-$

0 0 0 0 0

0 0 0 0 00 0 0 0 0

0 0 0 0 0

128 163 274 111 110 -+"+$

580 507 1138 631 ,$$ 11"#1-$

0 0 0 0 0

70 254 559 305 --, $$*"+$

270 178 651 473 -.0 .$0.-$

9491 11167 26326 15159 10$"0 -."-$.-$

24 51 44 50 1# ,, "+$


16/66

0 100 106 ," 10.-$

1001 463 1848 1385 +"* 1#,+$

0 0 250 250 100 -$0

0 0 0 0 0 0

165 86 229 143 *- --#+$

681 819 2198 1379 #+* -1*#1-$

3415 4165 12361 8196 ,*,, 1-".0.-$

655 1283 1485 202 $*, 1,#$

0 0 0

0 300 0 (300) 0 0

0 0 0 0 0 0

0 0 0 0 0 00 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0

0 00 0 0 0 0 0

110 140 156 100 ." 1$.-$

0 0 0

0 0 0 0 0 0

600 700 1375 675 $$0 1"+$

0 0 0 0 0 0

4 13 4 - ,"+$

0 50 3 1 "1-$0 15 6 - $.-$


17/66

10 0 17 17 + 1.#+$

0 48 0 0 0

0 0 9 9 , #+$

45 49 101 52 ,0 100.-$

0 25 31 6 1" "1-$

50 100 225 125 "# *"+$

0 100 63 50 -$ .-$

0 100 63 50 -$ .-$

50 50 94 44 "# *"+$

0 7 5 - $

3 2 4 2 1 1#+$

4 12 7 " .#+$4 14 6 - $.-$

50 50 125 75 $0 1-$

50 50 63 13 -$ .-$

0 100 0 0 0

0 15 3 1 "1-$

0 0 0 0 0 0

22 2 45 43 0 0

5 45 19 # 1#+$

0 0 0 0 0 0

0 0 0 0 0 0

200 550 500 200 1"# ","+$

200 400 500 200 1-$ "1-$

0 39 0 0 0

0 8 6 - $.-$

32 11 90 79 ". *021 155 136 $, 1"$.-$


18/66

2 20 8 " +$

0 14 4 - ,"+$

0 10 0 0 0

0 0 0

0 10 0 0 0

0 3 0 0 0

0 0 0 0 0

0 25 4 - "+$

0 3 0 0 0

0 80 50 -0 $0

61 0 37 37 1$ ".#+$

0 20 0 0 00 30 16 + 1.-$

0 30 0 0 0

0 0 0 0 0

0 120 19 # 1#+$

0 0 0 0 0

0 20 6 " .-$

0 0 0 0 0

0 5 3 1 "1-$

0 10 0 0 0

0 5 0 0 0

0 0 9 9 , *"+$

0 0 0 10 0 0

0 0 0 0 0

0 0 0 0 0

0 200 125 $0 1-$0 60 0 0 0


19/66

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

0 0 0 0

formularium < 100 %

formularium > 100 %

Jumlah item obat yang masuk dalam ormularium dengan keters

Jumlah item obat yang masuk dalam orm

%


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31#*.4 1"1,#% memenuhi 1

1,# ++000%memenuhi 1

31#-04 1.+."% memenuhi 1

0 5)6/07 5)6/07 1

-1* ,00#"%memenuhi 1

0 5)6/07 5)6/07 1

-,# "0+++#%memenuhi 1

3-04 5)6/07 5)6/07 1

--- *0*-.%memenuhi 1

0 5)6/07 5)6/07 1

31-,04 000% tidak memenuhi 1

3,.04 -#$00% memenuhi 131.,4 1.,"#% memenuhi 1

".# 5)6/07 5)6/07 1

310$04 1"#.-% memenuhi 1

310"14 1*-0$% memenuhi 1

0 5)6/07 5)6/07 1

3,+**4 10-""% memenuhi 1

-1 1,.00%memenuhi 1

3,$4 1-.#,% memenuhi 1

3.""4 -1$$+% memenuhi 1

31-4 -,1.+% memenuhi 1

1.# $-$00%memenuhi 1

0 5)6/07 5)6/07 1

31#0+4 1.*,*% memenuhi 1

3*#-4 1$*0+% memenuhi 1

3",+4 +--$% tidak memenuhi 1#," 5)6/07 5)6/07 1


27/66

11. ""#00%memenuhi 1

3".#4 -0.,$% memenuhi 1

"0, "1.000%memenuhi 1

-0" *1..+%memenuhi 1

3--#"4 10#"1% memenuhi 1

3.,$4 -*+*% tidak memenuhi 1

3,4 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

3$0$"4 ,-.,% tidak memenuhi 1

3.$#4 5)6/07 5)6/07 1

$0 "-,00%memenuhi 1

-"0 5)6/07 5)6/07 1-$* 5)6/07 5)6/07 1

3$4 ,,000% memenuhi 1

,1 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

314 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

31114 1-+",% memenuhi 1

3."14 #+,1% tidak memenuhi 1

0 5)6/07 5)6/07 1

3"0$4 ".-#.% memenuhi 1

3,+"4 .$*"% tidak memenuhi 1

31$1$*4 11+..% memenuhi 1

+ -1- $0%memenuhi 1


28/66

3.4 5)6/07 5)6/07 1

31"#$4 ,.-$% tidak memenuhi 1

3-$04 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

31,"4 $-1-% tidak memenuhi 1

31"+*4 1-0-.% memenuhi 1

3#1*.4 1-1*.% memenuhi 1

3-0-4 1*$##% memenuhi 1

0 5)6/07 5)6/07 1

"00 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 10 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

31.4 1-+-+% memenuhi 1

0 5)6/07 5)6/07

0 5)6/07 5)6/07 1

3.+$4 11..+% memenuhi 1

0 5)6/07 5)6/07 1

* "-$00%memenuhi 1

,+ 5)6/07 5)6/07 1* 5)6/07 5)6/07 1


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31+4 000% tidak memenuhi 1

,# 5)6/07 5)6/07 1

3*4 5)6/07 5)6/07 1

3$-4 10##*% memenuhi 1

3.4 5)6/07 5)6/07 1

. -0000%memenuhi 1

"# 5)6/07 5)6/07 1

"# 5)6/07 5)6/07 1

3,,4 10000% memenuhi 1

- 5)6/07 5)6/07 1

0 ...+% tidak memenuhi 1

$ "0000%memenuhi 1# "$000%memenuhi 1

3+$4 10000% memenuhi 1

31"4 10000% memenuhi 1

100 5)6/07 5)6/07 1

1- 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

- *0*% tidak memenuhi 1

-. *0000%memenuhi 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

-0. -+$00%memenuhi 1

## -0000%memenuhi 1

"* 5)6/07 5)6/07 1

- 5)6/07 5)6/07 1

3+*4 ","#% tidak memenuhi 11* +"#10%memenuhi 1


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1" 100000%memenuhi 1

10 5)6/07 5)6/07 1

10 5)6/07 5)6/07 1

0 5)6/07 5)6/07

10 5)6/07 5)6/07 1

" 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

-1 5)6/07 5)6/07 1

" 5)6/07 5)6/07 1

"0 5)6/07 5)6/07 1

3"+4 000% tidak memenuhi 1

-0 5)6/07 5)6/07 11, 5)6/07 5)6/07 1

"0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

101 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

1, 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

- 5)6/07 5)6/07 1

10 5)6/07 5)6/07 1

$ 5)6/07 5)6/07 1

3*4 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

+$ 5)6/07 5)6/07 1.0 5)6/07 5)6/07 1


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0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

0 5)6/07 5)6/07 1

5)6/07

1"0111

ediaan obat yang memenuhi! 100 %

larium

Pengelola bat

;ist:as FiDa:anti- .6'ar6- Apt()P 1*#,0,---01001-01$


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$$-+0%

mg


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43/66

Total obat yang masuk formularium

Total obat yang ketersediaannya memenuhi yang masuk dalam formularium


44/66


45/66


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27 Captopril tablet 12-5 mg Tablet -B,00 -B000 ,B,00 ,B,00 ,B000 10B000 $B.00 100%

28 Captopril tablet 25 mg Tablet ,B$00 ,B$00 1B"00 "B-00 1B#00 ,B$00 1B"00 1.#%

29 Carba+o&rom a sulfonat tablet 10 mg Tablet 0 5)6/07


50/66

30 Cefadroxil 500 mg Kapsul #00 #00 #00 #00 100%

31 Cefixim kapsul 100 mg Kapsul .00 ,B$00 $B100 .00 ,B$00 ,00 1B000 "B$00 11$%

32 Cetiri+in tablet 10 mg Tablet 1B000 1B000 1B000 "00 +$0 -$0 100%

33 Cimetidin tablet 200 mg Tablet 0 5)6/07

34 Ciprofloxa&in 500 mg Tablet +00 +00 "$0 "$0 "$0 5)6/07

35 Clonidin tablet 0-15 mg Tablet 0 5)6/07

36 eksametason tablet 0-5 mg Tablet #00 #00 "00 $00 -00 $00 0 -$0%

37 ia+epam tablet 2 mg Tablet +00 +00 +00 +00 100%

38 ia+epam tablet 5 mg Tablet 1$0 1$0 1$0 1$0 100%

39 igoksin tablet 0-25 mg Tablet 1B000 1B000 1B000 1B000 100%

40 iltia+em HCl tablet 30 mg Tablet 1B"00 1B"00 1B"00 ,00 1B000 "00 100%

41 imenidrinat tablet 50 mg Tablet .$0 .$0 $0 .00 $00 1B-$0 .$0 10*%

42 oksisiklin kapsul 100 mg Kapsul ,00 ,00 ,00 ,00 100%

43 omperidon tablet 10 mg Tablet $00 $00 $00 ,00 1B000 1B000 0%

44 !kstrak Belladona tablet 10 mg Tablet .00 .00 .00 .00 100%

45 !ritromisin kapsul 500 mg Kapsul 1B100 1B100 100 1B000 1B000 111%46 !tambutol tablet 500 mg Tablet 0 5)6/07

47 'enobarbital tablet 100 mg Tablet 100 100 100 100 100%

48 'enobarbital tablet 30 mg Tablet 0 5)6/07

49 'itomenadion #$it6K1% tablet salut gula 10 mg Tablet $00 $00 $00 $00 100%

50 'lukona+ol tablet 150 mg Tablet -00 -00 -00 -00 100%

51 'urosemid tablet )0 mg Tablet "00 +$0 +$0 5)6/07

52 .a&&et 1B"00 1B"00 ,00 *00 "00 +$0 1$0 1#0%

53 7emfibro+il kapsul 300 mg Kapsul 1B100 1B100 1B100 .0 1$0 *$0 100%54 7li9uidon tablet 30 mg Tablet "00 "00 100 -00 -00 -00%

55 7liben&lamide tab 5 mg Tablet -B$00 -B$00 -B$00 -00 $00 -B000 100%

56 7limepirid tablet 2 mg Tablet 1B0$0 -B.-$ -B.-$ 5)6/07

57 7lipi+id tablet Tablet 0 5)6/07

58 7liseril 7ua:akolat tablet 100 mg Tablet -"B000 -"B000 "B000 -0B000 +B000 1+B$00 -B$00 11#%

59 7riseoful(in tablet 125 mg- mi&roni+ed Tablet *00 *00 100 #00 100 -$0 $$0 11,%

60 Haloperidol tablet 0-5 mg Tablet $"0 $"0 $"0 $"0 100%

61 Haloperidol tablet 1-5 mg Tablet ,B000 ,B000 -+. "B+-, "B+-, 10#%

62 Haloperidol tablet 5 mg Tablet 1B,00 1B,00 1B,00 -00 $00 *00 100%

7aram ralit untuk 200 ml air Kombinasi #a Cl 0-52

g 8 KCl 0-308 tri a Citrat diidrat 0-58 7lu&osa

anidrat 2-> g%

63 Hidrokortia+ida #HCT% tablet 25 mg Tablet 0 5)6/07

64 H:osin But:l B tablet 10 mg Tablet 0 5)6/07

65 ,buprofen tablet 200 mg Tablet 100 100 100 0 0%


51/66

66 ,buprofen tablet )00 mg Tablet 0 5)6/07

67 ,sosorbid initrat tablet sublingual 5 mg Tablet "00 "00 .00 100 $00 "00 +$0 -$0 1-$%

68 ,sonia+id tablet/kapsul/kaplet 300 mg Tablet 0 5)6/07

69 Kalium Aspartat Kapsul #00 #00 #00 "$0 #+$ +$ 100%

70 Kalium iklofenak 25 mg Tablet 0 5)6/07

71 Kalium iklofenak 50 mg Tablet 0 5)6/07

72 Kalsium ;aktat #Kalk% tablet 500 mg Tablet ,B*00 ,B*00 ,B*00 1B*00 ,B+$0 1$0 100%

73 Karbama+epin tablet 200 mg Tablet *00 *00 *00 *00 100%

74 Ketokona+ol tablet 200 mg Tablet -$0 -$0 -$0 ,$0 1B1-$ #+$ 100%

75 Kloramfenikol kapsul 250 mg Kapsul +$0 +$0 +$0 +$0 1B#+$ 1B1-$ 100%

76 Klorfeniramin 4aleat #CT4% tablet ) mg Tablet "B000 "B000 "B000 +B000 1+B$00 1,B$00 100%

77 Klorproma+ina HCl tablet 100 mg Tablet 1B-00 1B-00 100 1B100 "00 +$0 "$0 110%

78 Klorproma+ina HCl tablet 25 mg Tablet -B#00 -B#00 "1# -B,#- 1B-00 "B000 $1# 11$%

79 Kloba+am Tablet 0 5)6/07

80 Botol ,0 ,0 $ "$ $ 1" -" 11+%

81 Tablet 1B100 1B100 1B100 1B100 100%

82 ;isinopril tablet 10 mg Tablet 1B$"0 1B$"0 1B$"0 1B$"0 100%

83 ;operamid tablet 2 mg Tablet .00 .00 .00 0 0%

84 ;e(ofloksasin tablet 500 mg Tablet "00 "00 "00 0 0%

85 ;oratadin tablet 10 mg Tablet 0 5)6/07

86 4ebenda+ol tablet 100 mg Tablet 1#0 1#0 1#0 "0 +$ +$ 0%

87 4etformin tablet 500 mg Tablet "00 "00 "00 1B000 -B$00 -B$00 0%

88 Tablet ,00 ,00 ,00 ,00 100%

89 4etilprednisolon tablet mg Tablet 1B,00 1B,00 ,00 1B000 -00 $00 $00 1.+%

90 4etoklopramide tablet 10 mg Tablet ,00 ,00 ,00 ,00 100%

91 4etronida+ol 500 mg Tablet ,00 "00 +00 +00 100 -$0 -$0 0%

92 4ulti(itamin Bumil " 'e Kapsul "B.00 1B$00 $B100 .00 ,B$00 1B"00 "B-$0 1B-$0 11$%

93 4ulti(itamin eurotropik kaplet Kaplet 1B000 1B000 -B000 +00 1B"00 1B100 -B+$0 1B,$0 -1+%

94 4ulti(itamin s:rup Botol ,0 ,0 ,0 -0 $0 $0 0%

95 atrium Bikarbonat tablet 500 mg Tablet 100 100 100 100 100%

96 atrium iklofenak tablet 25 mg Tablet $B.00 $B.00 ,B"$0 1B-$0 "B,00 #B$00 +B-$0 ,0%

Kotrimoksa+ol .uspensi komb .ulfametoksa+ol 200mg"Trimetoprim )0 mg / 5 ml

Kotrimoksa+ol tablet kombinasi .ulfametoksa+ol )00mg"Trimetoprim 0 mg

4etilergometrin 4aleat #4etilergometrin% tablet salut0-125 mg

97 atrium iklofenak tablet 50 mg Tablet 1B000 1B000 1B000 -B+00 .B+$0 .B+$0 0%

98 atrium 'enitoin kapsul 100 mg Kapsul 1B000 1B000 *$ *0$ *0$ 11-%

99 atrium 'enitoin kapsul 30 mg Kapsul .00 .00 .00 .00 100%

00 if di i T bl t $00 -00 +00 +00 $00 1 -$0 $$0 100%


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100 ifedipin Tablet $00 -00 +00 +00 $00 1B-$0 $$0 100%

101 istatin $aginal tablet 1006000 ,


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138 Trifluopera+ine tablet 5 mg Tablet ,00 ,00 1"0 -+0 -+0 1*"%

139 Trieksifenidil Hidroklorida tablet 2 mg Tablet *00 1B$00 -B,00 .00 1B#00 1B,00 "B$00 1B+00 1$0%

140 $itamin B Kompleks Tablet "B000 .B#00 *B#00 -B000 +B#00 .B000 1$B000 +B-00 1",%

141 @ink tablet Tablet 100 .00 +00 +00 $00 1B-$0 1B-$0 0%

OBAT YANKESTRAD 0 5)6/07

142 Anti Hipertensi Herbal Kapsul 0 5)6/07

143 Anti Keputian Herbal Kapsul 0 5)6/07

144 Anti Kolesterol Herbal Kapsul 0 5)6/07

145 Anti :eri Haid Herbal Kapsul 0 5)6/07

146 Anti :eri .endi Herbal Kapsul 0 5)6/07

147 !kstrak .erat Herbal .a&&et 0 5)6/07

148 !kstrak .tandar .a =almetto 1*0 mg Kapsul 0 5)6/07

149 ,mmunomodulator Kapsul Herbal Kapsul 0 5)6/07

150 ,mmunomodulator .:rup Herbal Botol 0 5)6/07

151 =elan&ar A., Herbal Kapsul 0 5)6/07

152 .alep ;uka Bakar Herbal Tube 0 5)6/07153 .on&i/eprolit kapsul/Cal&usol kapsul Kapsul 0 5)6/07

OBAT LUAR dan ALAT KESEHATAN 0 5)6/07

154 Alat .untik .ekali =akai 1 && =&s ,00 ,00 ,00 0 0%

155 Alat .untik .ekali =akai 3 && =&s "B.00 "B.00 .00 "B000 1B,00 "B$00 $00 1-$%

156 Alat .untik .ekali =akai 5 && =&s 1# ,$ ,$ 5)6/07

157 Alkool .ab Box 11 10 -1 1 -0 * -" " 10$%

158 =ot +$ +$ -$ $0 $0 -00%

159Antifungi ! salep

=ot -, .0 .0 5)6/07160 Anti Hemoroid ! .uppositoria .upp 0 5)6/07

161 Botol 10 10 10 $ 1" 1" 0%

162 Asam .alisilat 2"belerang endap )#2) salep% =ot ,# ,# ,# -, .0 1- 100%

163 Asiklo(ir krim 5 Tube 1-0 1-0 -0 100 100 1-$%

164 Betametason krim 0-1 Tube $0 $0 $0 $0 1-$ 1-$ 0%

165 Betametason (alerat " neomisin sulfat &ream Tube 10 10 10 10 -$ -$ 0%

166 Catgut Cromi& 2/0 =&s 0 5)6/07

167 Catgut Cromi& 3/0 =&s 0 5)6/07

Anti Bakteri ! saleb kombinasi Basitrasin 500

,0 1000 ml Botol 11 11 - * , 10 1 1-*%

171 !til Klorida semprot Botol . 1$ 1$ 5)6/07


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171 !til Klorida semprot Botol . 1$ 1$ 5)6/07

172 !xtrak =la&enta 10 Tube -0 -0 -0 -0 100%

173 'enol 7liserol TT 10 Botol -, -, -, -, .0 ". 100%

174 'lusinolon asetonid krim 0-025 Tube 0 5)6/07

175 'lusinolon " eomisin &ream Tube "0 "0 "0 "0 100%

176 'ole: Cateter no61* =&s 0 5)6/07

177 'ole: Cateter o61 =&s 0 5)6/07

178 7entian $iolet Botol -* -* -* -* 100%

179 7entamisin .ulfat tetes mata 0-3 Botol 0 5)6/07

180 7entamisin salep mata Tube -, -, -, -, .0 .0 0%

181 7entamisin salep kulit Tube 0 5)6/07

182 Hidrokortison &ream 2-5 Tube -, -, ,# ,# -, .0 .0 0%

183 ,nfusion set anak .et "# "# -" 1$ 1$ 1##%

184 ,nfusion set deasa .et "$ $0 #$ +0 1$ 1* ,# "" -+%

185 ,ntra(ena Cateter anak no6 2) =&s 100 100 100 100 100%

186 ,ntra(ena Cateter deasa no6 20 =&s $0 $0 $0 $0 100%

187 ,ntra(ena Cateter deasa no6 22 =&s -$0 -$0 -$0 -$0 100%

188 Kapas =embalut / Absorben 250 gram Bungkus " 10 1" 1 1- " # $ 10*%

189 Kasa gulung )0 :ard x 0 &m ?oll -+ -+ - -$ -$ 10*%

190 Kasa H:dropil .teril 1*/1* Box , 10 10 5)6/07

191 Kasa H:dropil .teril 1/22 Box " # # 5)6/07

192 Kasa =embalut H:dropil ) x 5 &m ?oll 0 5)6/07



195 Ketokona+ol krim 2 Tube -, -, -, 1- "0 . 100%

196 Kloramfenikol 0-5 Tetes 4ata Botol 0 5)6/07197 Kloramfenikol .alep 4ata 1 Tube -, .0 .0 5)6/07

198 Kloramfenikol TT 3 Botol "" "" "" "" 100%

199 Kloreksidin glukonat/ 4inosep 0-2 Botol 0 5)6/07

200 ;isol- mengandung kresol tersabun 50 Botol 0 5)6/07

201 4asker Biasa =&s 1B000 1B000 -00 #00 #00 1""%

2024asker =lus 3 =l: =lus !arloop#masker Dilbab%

=&s 1B000 1B000 #00 -00 1B$00 "B+$0 "B$$0 ""%

203 4asker E5 =&s 0 5)6/07

204 4etakresol sulfonat/ =oli&resulen/ Aptil Botol -$ -$ -$ " # # 0%

205 4ikona+ol krim/salep 2 #itrat% Tube -, -, 1* $ -, .0 $$ ".%

206 ksitetrasiklin HCl salep mata 1 Tube 1-$ 1-$ $0 +$ +$ "00%

207 ksitetrasiklin HCl salep kulit 3 Tube *. *. -, +- -, .0 1- 1$0%


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208=embalut !lastis ukuran 10 &m x )-22m roll

?oll $ $ 1 , , 1""%

209=embalut !lastis ukuran 15 &m x )-22m roll

?oll $ $ $ $ 100%

210=embalut !lastis ukuran >-5 &m x )-22m roll

?oll . . . . 100%

211 =er:drol 3 Botol 0 5)6/07212 =lester 5 :ards x 2 in& ?oll $ $ $ 0 0%

213 =lester on Fo(en ?oll 0 5)6/07

214 .albutamol 2-5 mg/2-5 ml ebuli+er Ampul #0 #0 ., 1. -0 $0 ", ""%

215 .alisil Bedak 2 Box "0 10 ,0 ,0 "$ ## ## 0%

216 .arung Tangan Biasa =&s 1B$00 -B000 "B$00 $00 "B000 -B000 $B000 -B000 1-0%

217 .arung tangan .teril =&s 0 5)6/07

218 .ilk #benang sutera% no6 3/0 =&s 0 5)6/07

219 .ulfa&etamid tetes mata Botol 0 5)6/07

220 Transfusion set .et 10 10 $ $ $ 5)6/07

221 =&s 0 5)6/07

226 odium po(idon 10 - 30 ml Botol 1- 1- - 10 10 1-$%

227 odium po(idon 10 - 300 ml Botol , , , , 100%

228 odium po(idon 10 - 1000 ml Botol + + + + 100%

SEDIAAN INJEKSI/AIRAN/SERUM 0 5)6/07

229 Aminofillin ,nDeksi 2) mg/ml Ampul 0 5)6/07

230 Ampi&illin serbuk ,nD i6(6 16000 mg/(ial Ampul 0 5)6/07

231 A9ua =ro ,nDeksi steril- bebas pirogen 20 ml Ampul $0 $0 -0 "0 "0 "00%

232 Atropin .ulfat inDeksi 0-25 mg/ml 1 ml Ampul + + + 0 0%

233 Ben+atin Ben+il =enisilin 2-)Duta ,< / (ial $ial 0 5)6/07

234 Ceftriaxon serbuk inD 1g/(ial $ial $0 $0 $0 $0 100%

235 eksametason inD Ampul *0 *0 *0 *0 100%

236 ia+epam inDeksi 5mg/ml 2ml Ampul . . . . 100%

237ifenidramin ,nDeksi ,646 10 mg/ml #HC;%

Ampul ,0 100 100 5)6/07

238 !pinefrine inD 0-1 Ampul 1" 1" 1 1- ", #$ +" 10*%

239 'enobarbital inDeksi 50 mg/ml2ml Ampul 0 5)6/07

240 'itomenadion #$it6K1% inD 10mg/ml Ampul "0 "0 "0 "0 100%

241 7entamisin inDeksi Ampul 0 5)6/07

242 7lukosa larutan infus 5 Botol 1- 1- 1- 0 0%


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242 7 5 Botol 1- 1- 1- 0 0%

243 Haloperidol ,nD Ampul 10 10 10 0 0%

244 @iosin butilbromid ineksi -0 mg/ml Ampul 0 5)6/07

245 Human Tetanus ,mmunoglobulin ,nDeksi Ampul $ $ $ $ 1" # 100%

246 Kalsium 7lukonas ,nDeksi $ial -, -, -, -, 100%

247 Ketoprofen inDeksi 100 mg Ampul 0 5)6/07

248 Ketorola& inDeksi 10 mg Ampul 0 5)6/07

249 Kinina iidrolotida#kinina%inDeksi 25 2 ml Ampul 0 5)6/07

250 Klorproma+in ,nD 5 mg/ml Ampul 0 5)6/07

251 ;idokain inD ;idokain HCl 2 2 ml Ampul 100 100 100 ,. 11$ 1$ 100%

252 Ampul +# +# +# +# 100%

253 4g.) inDeksi ,$ )0 25 ml Ampul # # # # 100%

254 4etilergometrin 4aleat inD 0-200 mg1 ml Ampul 10 10 10 0 0%

255 4etoklopramide inD6 5mg/ml Ampul +- +- ". ". ". 5)6/07

256 atrium Klorida larutan infus 0-E steril #=roduk lokal% Botol ,0 ,0 -0 -0 -0 $0 "0 5)6/07

257 ksitosin inD 10 ,


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p :p :p - p /

278 ?apid Test H,$ 1 p&s 0 5)6/07

279 ?apid Test H,$ 2 p&s 0 5)6/07

280 ?apid Test H,$ 3 p&s 0 5)6/07

JM8@

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