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DINAS KESEHATAN KABUPATEN PANDEGLANG UPT GUDANG FARMASI PANDEGLANG Jl. Raya Serang KM. 3 Telp. ( 0253 ) 202089 Pandeglang 42251



DAFTAR HARGA OBAT DLL TAHUN 2017 NO 1



NAMA OBAT



2 1 Albendazol Tablet 400 mg 3 Ambroxol tablet 30 mg 4 Ambroxol sirup 5 Aminofilina injeksi 24 mg/ml - 10 ml 7 Amitriptilin HCL Tablet 25 mg 8 Amoksisilin 500 mg tablet 9 Amoksisillin Sirup Kering 125 mg/5 ml 10 Amoksisilin Forte sirup kering 250mg 12 Amlodipin 5 mg 13 Amlodipin 10 mg 14 Analog insulin Long Acting 15 Analog insulin Mix Acting 18 Antasida DOEN suspensi 19 ANTASIDA DOEN Tablet 20 Antiparkinson Tablet ( Levopar ) 21 Anti Septik Hand Rub 22 Anti Septik Surgikal Hand Scrub 26 Aqua Pro Injeksi 27 Asering 28 Asam Askorbat tablet 50 mg 29 Asam Fusidat Cream 30 Asam Traneksamat Inj 5% 31 Asam Mefenamat 500 mg 32 Asam Folat 1 mg 33 Artesunate injeksi 60 mg/ml 34 Artermether injeksi 37 Asam Asetil Salicilat 100 mg tablet 39 Asiklovir tablet 200 mg 40 Asiklovir tablet 400 mg 41 Asiklovir Cream 5% 42 Atropin Sulfat tablet 0,5 mg 46 Bisakodil Suppositoria 47 Bisoprolol 2,5MG 48 Cairan Pembersih ( Protektor ) 49 Captopril Tablet 25 mg



KODE 3



SATUAN 4 Tablet Tablet Botol Ampul Tablet Tablet Botol Botol Tablet Tablet Pen Pen Botol Tablet Tablet Botol Botol Vial Botol Tablet Tube Ampul Tablet Tablet vial Vial Tablet Tablet Tablet Tube Tablet supp Tablet Botol Tablet



50 Captopril Tablet 12,5 mg 51 Carbamazepin 200 mg tablet 52 Cefadroxil Capsul 500 mg 53 Cefixime Capsul 100 mg 54 Cefixime Sirup 55 Cefotaksime 1 gr Injeksi 56 Cetirizine sirup 5 mg/5 ml 59 Clobazam 10 mg Tablet 60 Clozapine 25 mg Tablet 61 D-Artepp tablet 62 Deksametason tablet 0,5 mg 63 Deksametason injeksi 1 ml 64 Doxicyclin 500mg 67 Diazepam Rektal 0,5 mg 68 Diazepam tablet 2 mg 69 Diazepam injeksi 2 ml 71 Difenhidramin HCL injeksi 10 mg/ml - 1ml 72 Digoksin tablet 0,25 mg 73 Efedrin HCL tablet 25 mg 74 Domperidon 10mg Tablet 76 Epinefrina HCL/Bitartrat Injeksi 81 Erytromicin sirup 125 mg 83 Etil Klorida Semprot 84 Fenitoin Natrium kapsul 30 mg 85 Fenobarbital injeksi 50 mg/ml - 2 ml 86 Fenobarbital Tablet 30 mg 90 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml 91 Fitomenadion (Vit.K1) tab salut gula 10 mg 94 Glimepiride 2 mg 95 Garam Oralit 96 Glibenclamid tablet 5 mg 97 Gentamicin Salep Kulit 98 Gentamicin Salep mata 99 Glicerin Guaiacolat ( GG ) 100 mg 100 Griseofulvin tablet 500 mg, 101 Griseofulvin tablet 125 mg, 102 Hidroklorotiazid (HCT) tab. 25 mg 103 Gemfibrozil 108 Glikazid 80 mg Tablet 109 Haloperidol 5 mg Tablet 110 Haloperidol 2 mg tablet 111 Hidrokortison krim 2,5% 112 Ibuprofen tablet 200 mg 113 Isoniazid tablet 300 mg 116 Ibuprofen Suspensi 119 Imunomodulator sirup( STIMUNO) 120 Kalsium Laktat (Kalk) tablet 500 mg 122 Ketorolac inj



Tablet Tablet Capsul Capsul Botol Vial Botol Tablet Tablet Tablet Tablet Ampul capsul supp Tablet Ampul Ampul Tablet Tablet Tablet Ampul Botol Botol Kapsul Ampul Tablet Ampul Tablet Tablet Sachet Tablet Tube Tube Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tube Tablet Tablet Tablet Botol Tablet Ampul



123 Kalsium Glukonas Injeksi 124 Kloramphenicol 500 mg 125 Kaen 3 B cairan infus 128 Klorfeniramin Maleat (CTM) tablet 4 mg 131 Ketokonazol Kream 133 Klorpromazin HCL tablet salut 25 mg 134 Klorpromazin HCL tablet salut 100 mg 139 Kotrimoksazol Dewasa Tablet 480 MG 140 Kuinin Dihidroklorida injeksi 25% - 2 ml 141 Lactobacilus serbuk 142 Lidocain injeksi 2 ml 143 Lidocain 2%+efinefrin injeksi 144 Lisinopril 5 mg tablet 145 Lisinopril 10 mg tablet 146 Loperamid 2 mg tablet 148 Magnesium Sulfat injeksi 25 ml 150 MDT MB Anak Tablet 151 MDT MB Dewasa Tablet 152 MDT PB Dewasa Tablet 154 Metampiron tablet 500 mg 155 Metformin 500 mg Tablet 156 Metilergometrin Maleat (Metilergometrin) injeksi 1 ml 157 Metilergometrin tablet 160 Metronidazol 500 mg 161 Metronidazol suspensi 162 Methilprednisolon tablet 8 mg 163 Metoklopramid Suspensi 164 Metoklopramid tablet 165 Mikonazol kream 166 Multivitamin Anak ( Sanbe Kids ) 167 Multivitamin Dewasa Antioksidan ( Becom c ) 168 Multivitamin Dewasa ( Panviton ) 169 Natrium Klorida Cairan Infus ( NaCl ) 171 Natrium Diklofenak 25 mg 174 Nifedipine Tablet 10 mg 176 Obat Anti Diare Tablet (Akita / Molagit ) 177 Obat Antituberkulosis kategori 2 178 Obat Antituberkulosis kategori 1 179 Obat Antituberkulosis Kategori Anak 180 Obat Batuk Flu Kapsul 182 Obat Batuk Sirup Herbal ( Herbacop ) 183 Ofloxsacin Tetes Telinga 184 Oksitosin injeksi 10 IU/ml - 1 ml 186 Omeprazol injeksi 187 Omeprazol Kapsul 20 mg 188 Ondancentron Tablet 4 mg 189 Ondancentron injeksi 4 mg 190 Parafin Dresing ( Bioplacenton Tull )



Ampul capsul Botol Tablet Tube Tablet Tablet Tablet Botol Sachet Ampul Ampul Tablet Tablet Tablet Blister Blister Tablet Tablet Tablet Tablet Ampul Tablet Tablet Botol Tablet Botol Tablet Tube Botol Tablet Tablet Botol Tablet Tablet Tablet Paket Paket Paket Kapsul Botol Tube Ampul Ampul capsul Tablet Ampul pcs



192 Parasetamol tablet 500 mg 193 Paracetamol Sirup 120 mg/5 ml 194 Paracetamol Drop 195 Permetrin Krim 5 % 196 Pirantel Sirup 197 Pirantel tablet 25 mg 200 piridoksin HCL (VIT B6) tablet 10mg 201 Piroksikam tablet 10 mg 203 povidon lodida 10% 300 ml 204 povidon lodida 10% 60 ml 205 POT Dahak Steril 206 Prednison Tablet 5 mg 207 POT Dahak Non Steril 208 Primakuin 209 Propanolol HCL tablet 10 mg 210 Probenesid 500 mg tablet 211 Resperidone 2 mg tablet 213 Ranitidin injeksi 214 Ranitidin tablet 215 Reagen Ziehl Neelsen 216 Retinol (Vitamin A) kapsul 200.000 IU 217 Retinol (Vitamin A) kapsul 100.000 IU 218 Ringer Laktat cairan infus 219 Salbutamol tablet 4mg 220 Salbutamol Tablet 2 mg 221 Salbutamol Nebulizer ( Ventolin ) 223 Salep kombinasi cream ( Berloson ) 224 Setirizin Tablet 10 mg 225 Salep 2-4 226 Serum Anti Bisa Ular Inj. 5ml 227 Serum Anti Tetanus inj 1500 IU 228 Sukralfat tablet 500 mg 230 Tablet Penambah Darah 231 Simvastatin 20 mg tablet 232 Sianokobalamin Injeksi 234 Tablet Tambah Darah 237 Tetrasiklin 250 mg capsul 238 Tetrasiklin 500 mg capsul 239 Triheksilfenidil Hcl 2 mg tablet 240 Underpad 241 Urine Bag 242 Vitamin B komplek 243 Zink sirup



Tablet Botol Botol Tube Botol Tablet Botol Tablet Botol Tablet Pot Tablet Pot Tablet Tablet Tablet Tablet Ampul Tablet Kit capsul capsul Botol Tablet Tablet Vial Tube Tablet Tube Vial Vial Tablet Tablet Tablet Ampul Sachet capsul capsul Tablet Lembar Biji Tablet Botol



NAMA BAHAN MEDIS HABIS PAKAI (BMHP ) 247 Alat suntik 10 ml 248 Alat suntik 20 ml 249 Alat suntik 1 ml



Pcs Pcs Pcs



250 Alat suntik 2,5 ml 251 Alat suntik 3 ml 252 Alat suntik 5 ml 253 Alkohol swab 255 Cat Gut no 2/0 256 Cat Gut no 3/0 257 Cathetter Jelly 258 Demetech Silk 3/0 259 E Care I.V Dresing 260 Folly No 14 Catether 261 Folly No 16 Catether 262 I.V Cathetter No. 20 263 I.V Cathetter No. 22 264 I.V Cathetter No. 24 265 Infuset Dewasa ( Otsuka ) 266 I.V Cathetter No. 26 267 Infuset Anak 268 Infuset Dewasa 269 Jarum Insulin 270 Kapas Berlemak 250 gr 272 Kasa 4 m x 10 cm 273 Kasa Hidrofil 36 x 80 cm 274 Kasa Steril 16 x 16 cm 275 Masker tali (E Care Surgical Mask Tie On) 276 Masker karet 278 Plester 1" 279 Sarung tangan M (Non Steril) Aximed 280 Sarung tangan no 6,5 Cosmo 281 Sarung tangan no 6,5 Steril 282 Sarung tangan no 7,0 Steril NAMA OBAT REAGEN 285 Chikungunya IgM (Reagen) 286 Dengue IgM / IgM ( Reagen ) 287 Leptospira IgM (Reagen) 288 NS1 Antigen Test (Reagen)



Pcs Pcs pcs Sachet Sachet Sachet Biji Set Lembar pcs pcs Set Set Set Set Set Set Set Tablet Bungkus Rol Rol Kotak Tube Sachet Rol Pasang Pasang Pasang Pasang Kotak Kotak Kotak Kotak Pelaksana Opname Fisik Persediaan



( Sylvianti T Maharani, MPH., Apt ) NIP. 198607062010012 010



( Yuliati ) NIP. 196109031987032 003



Mengetahui Kepala UPT Gudang Farmasi Kabupaten Pandeglang



Didiek Hendro Bawono.SKM NIP. 196604301992031 004



DEGLANG



ANG



HARGA SATUAN 5 406 169 7,499 3,345 143 232 2,445 3,984 105 330 425,000 550,000 2,140 61 1,500 60,800 74,000 2,750 9,275 95 5,506 24,449 106 63 14,250 1,000 130 237 348 6,490 1,672 5,670 650 22,000 68



62 269 516 590 7,490 5,500 2,849 969 1,548 1,000 44 1,580 269 11,516 45 4,180 1,176 105 51 118 2,204 67 132,000 154 1,969 165 3,550 695 288 380 178 2,829 2,600 51 2,200 219 149 380 235 96 126 2,650 104 97 3,499 20,680 62 1,290



9,955 1,007 10,050 42 2,545 148 149 150 6,200 12,700 860 1,845 375 448 85 3,200 21,750 30,595 9,770 380 100 2,684 154 133 3,799 309 2,345 91 3,250 35,000 1,320 1,316 6,410 145 108 450 1,199,990 359,619 160,000 366 12,210 45,989 1,900 16,997 160 471 1,650 10,400



199 1,438 5,199 12,155 8,360 291 45 143 14,203 6,550 5,890 114 1,750 224 60 1,780 1,008 1,140 105 276,600 459 284 7,150 83 66 110 11,100 143 2,429 501,050 137,500 368 400 252 1,098 1,740 163 300 88 7,956 7,036 43 6,290



1,067 2,650 777



649 825 856 197 52,000 44,953 41,600 20,833 2,200 16,610 12,036 4,794 12,342 4,794 7,920 13,464 5,100 4,182 2,083 12,250 1,440 127,600 5,500 553 740 8,167 924 1,018 4,500 4,500 2,750,000 1,584,000 2,090,000 2,200,000



e Fisik Persediaan



tahui dang Farmasi Pandeglang



Bawono.SKM 1992031 004