Berdasarkan hasil evaluasi tersebut diatas, maka Kelompok Kerja III ULP RSUP Dr. Hasan Sadikin Bandung sepakat :

KEMENTERIAN KESEHATAN RI

DIREKTORAT JENDERAL PELAYANAN KESEHATAN RSUP Dr. HASAN SADIKIN BANDUNG Jalan Pasteur No. 38 , Bandung 40161 Telepon : (022) 2034953, 2034954 (hunting) Faksimile : (022) 2032216, 2032533 Laman : www.rshs.or.id, Pos-el : [email protected] SMS hotline : 08112335555

PENGUMUMAN PEMENANG PELELANGAN UMUM PASCAKUALIFIKASI PENGADAAN KEBUTUHAN AMHP KHUSUS SMF ORTHOPAEDI TA.2017 RSUP Dr. HASAN SADIKIN BANDUNG Nomor : BN.01.02/PNBP-POKJA III/10614/XII/2016 Tanggal : 30 Desember 2016 Berdasarkan Berita Acara Hasil Pelelangan nomor : BN.01.02/PNBP-POKJA III/10612/XII/2016, tanggal 30 Desember 2016 serta surat Penetapan Pemenang Nomor : BN.01.02/PNBP-POKJA III/10613/XII/2016, tanggal 30 Desember 2016, maka Kelompok Kerja IIIULP RSUP Dr. Hasan Sadikin Bandung, mengumumkan hasil pelaksanaan Pelelangan Umum Pasca Kualifikasi Pengadaan Kebutuhan AMHP Khusus Katup Mitral Sorin dll Devisi Bedah Kardiothorasik TA.2017 RSUP Dr. Hasan Sadikin Bandung dengan secara elektronik melalui web site LPSE Kemenkes dengan alamat situs internet : http://lpse.kemenkes.go.id dengan metode sistem itemazed dengan hasil sebagai berikut : Berdasarkan hasil evaluasi tersebut diatas, maka Kelompok Kerja III ULP RSUP Dr. Hasan Sadikin Bandung sepakat : 1. Nama Perusahaan Alamat Perusahaan NPWP

: PT. Rajawali Nusindo : Jl. Soekarno Hatta No.493 Bandung : 01.315.708-007.000 MERK

JUMLAH

HARGA SATUAN

Phapros

6

27,750,000

166,500,000

Pemenang

Phapros

6

31,000,000

186,000,000

Pemenang

9

THR Cementless SMALL SIZE TKR CR POSTERIOR REF INSTRUMENT TKR PS POSTERIOR REF INSTRUMENT

Phapros

3

34,000,000

102,000,000

Pemenang

12

Bipolar Cementless small size

Phapros

15

21,500,000

322,500,000

Pemenang

13

Bipolar Cemented small size Total Hip Replacement (THR) SMALL SIZE

Phapros

15

21,000,000

315,000,000

Pemenang

Phapros

12

27,750,000

333,000,000

Pemenang

JUMLAH

1,425,000,000

PPN 10%

142,500,000

JUMLAH

1,567,500,000

NO

NAMA BMHP

JUMLAH

KET

TINDAKAN ARTHROPLASTY 6 8

14

2. Nama Perusahaan Alamat Perusahaan

: PT. Mitra Fajar Selaras : Pulogadung Trade Centre (Ptc) Ruko Blok 8c No.28-29, Jl. Raya Bekasi Km.21 Kel.Rawaterate Kec. Cakung Jakarta Timur : 02.313.083.4-004.000

NPWP NAMA BMHP NO TINDAKAN SPINE Ballon Kyphoplasty inc.bonecement with 1 radiopaque agent Titanium Anterior Distraction Device Plus 2 inc.4 locking screw Cervical Modular Cage 3 Plate inc.2 locking screw+Bonfuse Epidural Catheter set with soft and steereable catheter 4 inc.Hyaluronidase 1500UI Titanium Occipital Plate with titanium bone screw 5 Ø4,5x9mm 6 7

TLIF PEEK cage Epidural Ballon Catheter with steereable catheter inc.Hyaluronidase 1500UI

JUMLAH

2

15,250,000

30,500,000

Pemenang

Addplus

2

11,700,000

23,400,000

Pemenang

Tryptik MC

2

18,650,000

37,300,000

Pemenang

2

10,800,000

21,600,000

Pemenang

2

6,900,000

13,800,000

Pemenang

2

12,750,000

25,500,000

Pemenang

10

13,400,000

134,000,000

Pemenang

JUMLAH

Medinaut

Medinaut Irine GS Medical Medinaut

3. Nama Perusahaan Alamat Perusahaan NPWP NO

HARGA SATUAN

MERK

NAMA BMHP

Jumlah

286,100,000

Ppn 10%

28,610,000

Total

314,710,000

KET.

: PT. Transmedic Indonesia : Perkantoran Menara Era Unit G-01, jl Senen Raya No 135137, Jakarta Pusat : 02.414.447.9-056.000 JUML AH

MERK

HARGA

JUMLAH

Ket

TINDAKAN NAILING 1

Paket Standard Interlocking Nail Femur, consist of: Expert™ A2FN, Ø 9.0 12.0 mm, right/left, cannulated, length 300 380 mm, Titanium Alloy (TAN), light green, sterile (1 buah)

10

Synthes

16,055,000

160,550,000

-

pemenang

End Cap for Expert™ A2FN, cannulated, extension 0 10 mm, Titanium Alloy (TAN), grey, sterile (1 buah) Locking Screw Stardrive® Ø 4.0 - 5.0 mm, length 26 54 mm, for Medullary Nails, Titanium Alloy (TAN), dark blue /light green (4 buah)

2

Paket Advance Interlocking Nail Femur, consist of:

10

Synthes

18,145,000

181,450,000

pemenang

16,055,000

160,550,000

Pemenang

Expert™ A2FN, Ø 9.0 12.0 mm, right/left, cannulated, length 300 380 mm, Titanium Alloy (TAN), light green, sterile (1 buah) End Cap for Expert™ A2FN, cannulated, extension 0 10 mm, Titanium Alloy (TAN), grey, sterile (1 buah) Locking Screw Stardrive® Ø 4.0 - 5.0 mm, length 26 54 mm, for Medullary Nails, Titanium Alloy (TAN), dark blue /light green (2 buah) Hip Screw Stardrive® Ø 6.5 mm, self-tapping, length 60 - 105 mm, for Expert™ LFN, Titanium Alloy (TAN), sterile (2 buah) 3

Paket Standard Interlocking Nail Tibia, consist of: Expert™ End Cap for Tibial Nails Ø 8.0 to 13.0 mm, extension 0 - 15 mm, Titanium Alloy (TAN), gold (1 buah) Expert™ Tibial Nail Ø 8.0 10.0 mm, with proximal Bend, cannulated, length 255 375 mm, Titanium Alloy (TAN), dark blue /light green, sterile (1 buah)

10

Locking Screw Stardrive® Ø 4.0 - 5.0 mm, length 26 54 mm, for Medullary Nails, Titanium Alloy (TAN), dark blue /light green (4 buah)

4

5

Paket Advance Interlocking Nail Tibia, consist of: Expert™ End Cap for Tibial Nails Ø 8.0 to 13.0 mm, extension 0 - 15 mm, Titanium Alloy (TAN), gold (1 buah) Expert™ Tibial Nail Ø 8.0 10.0 mm, with proximal Bend, cannulated, length 255 375 mm, Titanium Alloy (TAN), dark blue /light green, sterile (1 buah) Cancellous Bone Locking Screw Stardrive® Ø 5.0 mm with dual core, self-tapping, length 30 60 mm, Titanium Alloy (TAN), gold (2 buah) Locking Screw Stardrive® Ø 4.0 - 5.0 mm, length 26 54 mm, for Medullary Nails, Titanium Alloy (TAN), dark blue /light green (4 buah) Paket Short Proximal Femoral Nail, consist of: PFNA-II - Proximal Femoral Nail Ø 9.0 - 12.0 mm,extrasmall/small, 130°, length 170240 mm, Titanium Alloy (TAN), sterile ( 1 buah) PFNA-II Blade, length 75120 mm, Titanium Alloy (TAN), sterile (1 buah) PFNA-II End Cap, extension 015 mm, Titanium Alloy (TAN), sterile (1 buah) Locking Bolt Ø 4.9 mm, selftapping, length 26-68 mm, Titanium Alloy (TAN), green (1 buah)

10

Synthes

19,285,000

192,850,000

pemenang

6

Synthes

17,005,000

102,030,000

Pemenang

6

Paket Long Proximal Femoral Nail, consist of: PFNA-II - Proximal Femoral Nail Ø 9.0 - 12.0 mm, long, 130°, length 300-380 mm, Titanium Alloy (TAN), sterile ( 1 buah) PFNA-II Blade, length 75120 mm, Titanium Alloy (TAN), sterile (1 buah) PFNA-II End Cap, extension 015 mm, Titanium Alloy (TAN), sterile (1 buah) Locking Bolt Ø 4.9 mm, selftapping, length 26-68 mm, Titanium Alloy (TAN), green (2 buah)

6

Synthes

18,145,000

108,870,000

pemenang

5

Synthes

522,500

2,612,500

pemenang

10

Synthes

522,500

5,225,000

pemenang

5

Synthes

655,500

3,277,500

pemenang

20

Synthes

655,500

13,110,000

pemenang

5

Synthes

655,500

3,277,500

pemenang

117

Synthes

551,000

64,467,000

pemenang

33

Synthes

551,000

18,183,000

pemenang

10

Synthes

655,500

6,555,000

pemenang

13

Synthes

2,280,000

29,640,000

pemenang

TINDAKAN TRAUMA LCP TITANIUM

1

2

3

4

5

6

7

8

9

Cancellous Bone Screw Ø 4.0 mm, fully threaded, length 10- 60 mm, Pure Titanium Cancellous Bone Screw Ø 4.0 mm, length 12-60 mm, Pure Titanium Cancellous Bone Screw Ø 6.5 mm, fully threaded, length 30-100 mm, Pure Titanium Cancellous Bone Screw Ø 6.5 mm, length 30-100 mm, Pure Titanium Cancellous Bone Screw Ø 6.5 mm, length 45-100/32 mm, Pure Titanium Cortex Screw Ø 3.5 mm, selftapping, length 10-60 mm, Pure Titanium Cortex Screw Ø 4.5 mm, selftapping, length 14-60 mm, Pure Titanium Cortex Screw Stardrive® Ø 2.4 mm, self-tapping, length 10-22 mm, Titanium Alloy (TAN) LCP 3.5, 5 -11 holes, length 72-150 mm, Pure Titanium

10

11

12

13

14

15

16

17

18

19

20

21

22

23

LCP 4.5/5.0, broad, 7 - 11 holes, length 134-242 mm, Pure Titanium LCP MEDIAL DISTAL TIBIAL PLATE 3.5, LOW BEND, RIGHT/LEFT, 6 -12 HOLES, TITANIUM ALLOY (TAN) LCP One-third Tubular Plate 3.5, 5 -8 holes, length 64-100 mm, Pure Titanium LCP RecoPl 3.5 straight w/Combined Hole, 5-12 ho LCP Sup-Ant-Clavic-Pl3.5 67ho left/right L94-110 TAN LCP-DF 4.5/5.0, right/left, 7 13holes, Titanium Alloy (TAN) LCP-PLT 4.5/5.0, right/left, 5 13holes, Titanium Alloy (TAN) Locking Screw Ø 3.5 mm, self-tapping, length 10-55 mm, Titanium Alloy (TAN) Locking Screw Ø 5.0 mm, self-tapping, length 14-85 mm, Titanium Alloy (TAN) PHILOS - Proximal Humeral Plate 3.5, 3 - 5holes, Pure Titanium LCP T-Plate 3.5, obliqueangled, left, shaft 3-5 holes, head 3 holes, length 52-74 mm, Pure Titanium VA Locking Screw Stardrive® Ø 2.4 mm, self-tapping, length 10-24 mm, Titanium Alloy (TAN) VA-LCP Two-Column Distal Radius Plate 2.4, volar, narrow, right/left, shaft 24 holes, head 6 holes, length 42-63 mm, Pure Titanium VA-LCP Two-Column Distal Radius Plate 2.4, volar, right/left, shaft 2 -4holes, head 6 holes, length 4566 mm, Pure Titanium

8

Synthes

6,460,000

51,680,000

pemenang

8

Synthes

10,450,000

83,600,000

pemenang

15

Synthes

2,090,000

31,350,000

pemenang

25

Synthes

3,610,000

90,250,000

pemenang

10

Synthes

7,885,000

78,850,000

5

Synthes

10,450,000

52,250,000

pemenang

13

Synthes

10,830,000

140,790,000

pemenang

477

Synthes

636,500

303,610,500

pemenang

320

Synthes

788,500

252,320,000

pemenang

13

Synthes

14,725,000

191,425,000

pemenang

5

Synthes

2,660,000

13,300,000

pemenang

45

Synthes

817,000

36,765,000

pemenang

5

Synthes

10,830,000

54,150,000

pemenang

3

Synthes

10,830,000

32,490,000

pemenang

pemenang

24

25

26

27

Washer Ø 13.0/6.6 mm, for Screws Ø 4.5 to 7.3 mm, Pure Titanium Washer Ø 7.0/3.6 mm, for Screws Ø 2.7 to 4.0 mm, Pure Titanium LCP T-Plate 4.5/5.0, shaft 4-8 holes, length 84-148 mm, Pure Titanium LCP 4.5/5.0, narrow, 5-13 holes, length 98-242 mm, Pure Titanium

12

Synthes

389,500

4,674,000

pemenang

12

Synthes

389,500

4,674,000

pemenang

5

Synthes

4,370,000

21,850,000

pemenang

10

Synthes

3,135,000

31,350,000

pemenang

2,528,026,000 252,802,600 2,780,828,600


NAMA BMHP

BONEGRAFT

3

Nanocrystaline hydroxypatite + Calcium sulphate (1x50 pellet/Box) Nanocrystaline hydroxypatite + Calcium sulphate (2x6 pellet/Box) Nanocrystaline hydroxypatite + Calcium sulphate (1x6 pellet/Box)

4

Bongros 250 mg

1

2

WOUND DRESSING Negative Pressure Wound 1 Therapy Small Negative Pressure Wound 2 Therapy Medium Negative Pressure Wound 3 Therapy Large 4 5 6 7

NPWT Canister 600cc Semipermeable polyurethane foam 10X10X2-5MM Semipermeable polyurethane foam 10X20X5MM Semipermeable polyurethane foam 20X20X5 MM

: PT. Parit Padang Global Cabang Bandung : Komp. Kopo Mas Regency Blok B. No 21-22 : 02.998.520.7-007.000 HARGA SAT.

JUMLAH

5

5,344,920

26,724,600

55

2,507,120

137,891,600

55

1,754,985

96,524,150

BioAlpha

10

641,250

6,412,500

Curavac

10

864,000

8,640,000

Curavac

15

960,000

14,400,000

Curavac

20

1,248,000

24,960,000

Canister

45

399,000

17,955,000

Easyfoam

6

66,500

399,000

Easyfoam

6

123,500

741,000

Merk

JUMLAH

Perrosal

Perrosal

Perrosal

KET. Pemenang

Pemenang

Pemenang Pemenang

Pemenang Pemenang Pemenang Pemenang Pemenang Pemenang Pemenang

Easyfoam

6

237,500

1,425,000

Semipermeable polyurethane foam 40X70 CM Semipermeable polyurethane foam 10X60 CM

8 9

Pemenang Easyfoam

6

1,045,000

6,270,000

Easyfoam

6

313,500

1,881,000

Pemenang Jumlah 344,223,850 PPN 10% 34,422,385 Total 378,646,235


NAMA BMHP

: PT. Bina Makmur Abadi : Jl. Raya Pasar Jumat No. 41 E Pondok Pinang Kebayoran Lama : 02.623.297.5-013.000 MERK

TINDAKAN MINI TRAUMA TITANIUM Maxican Cannulated titanium screw partial Thread 1 4,5mm L 26-60 mm Agomed Maxican Cannulated titanium screw full Thread 2 4,5mm L 26-60 mm Agomed Titanium Locking Screw 2.7 3 mm L 8-30 mm Agomed Titanium Standard Screw 4 2.7mm L 8-30mm Agomed Forefoot System 2.7-Scarf 5 Micro Screw Canulated TXLock TX6, L10-28mm Agomed Forefoot System 2.7-Scarf Std 6 Compress.Screw, Cann TXLock TX 8, L10-30mm Agomed Forefoot System 2.7-Scarf 7 High Compress.Screw, Cann TX-Lock TX 8, L10-30mm Agomed Forefoot System 2.7-Tit 8 Universal Plate 1.4 mm, 1030mm Agomed Forefoot System 2.7-Tit MP 9 Joint Fusion plate 1.2 mm, 56H,28-45mm Agomed Forefoot System 2.710 Reconstruksi Plate 6 H 3540mm Conical Agomed Forefoot System 2.711 Standard screw 2.7 mm TX Lock, L8-30mm Agomed Rearfoot System 3.512 Calcaneus plate S/M/L/XS Agomed Rearfoot System 3.5-Locking 13 Screw 3.5mm,L12-20mm Agomed Rearfoot System 3.5-Locking 14 Screw 3.5mm,L22mm Agomed

JUMLAH

3 3

HARGA SAT.

7,248,518

Pemenang 1

2,802,263

8,406,788

Pemenang 1

916,651

3

773,425

2 2

Pemenang 2,749,953 1 Pemenang 2,320,274 1

2,422,400

4,844,800

Pemenang 1

2,422,400

4,844,800

Pemenang 1

2,422,400

4,844,800

Pemenang 1

2 5,803,797

11,607,595

2 3,842,214

7,684,427

2 3,842,214

7,684,427

3 2 3 3

KET.

2,416,173

3

2

JUMLAH

773,425

2,320,274

5,803,797

11,607,595

845,661 871,815

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

Pemenang 1 Pemenang 1 2,536,983 Pemenang 1 2,615,446

15 16 17 18 19 20 21 22 23 24 25 26 27

28 29

30

31 32 33 34 35 36

Rearfoot System 3.5-Locking Screw 3.5mm,L24mm Rearfoot System 3.5-Locking Screw 3.5mm,L26mm Rearfoot System 3.5-Locking Screw 3.5mm,L28mm Rearfoot System 3.5-Locking Screw 3.5mm,L30-35mm Rearfoot System 3.5-Locking Screw 3.5mm,L40-50mm Rearfoot System 3.5-Standard Screw 3.5 mm,L12-20mm Rearfoot System 3.5-Standard Screw 3.5 mm,L22mm Rearfoot System 3.5-Standard Screw 3.5 mm,L24mm Rearfoot System 3.5-Standard Screw 3.5 mm,L26mm Rearfoot System 3.5-Standard Screw 3.5 mm,L28mm Rearfoot System 3.5-Standard Screw 3.5 mm,L30-35mm Rearfoot System 3.5-Standard Screw 3.5 mm,L40-50mm Rearfoot System 3.5-Cann Screw Partially or Full Threaded Hex-Lock 3.5 mm,L25-60mm Rearfoot System 3.5Titan.Washer for Screw 3.5mm Pack of 5 Pcs Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-2H,Short/Long Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-4H,w/o or 6-110mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-6H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-6H,w/ Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-8H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-12H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-16H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-18H,w/o Stem

Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed

3 2 2 2 2 2 3 3 3 3 3 3

900,460

2,701,380

916,651

1,833,302

931,596

1,863,193

955,260

1,910,520

980,169

1,960,338

719,870

1,439,740

747,270

2,241,810

765,952

2,297,855

778,406

2,335,219

793,352

2,380,055

821,997

2,465,992

838,188

2,514,565

2,416,173

4,832,345

2 Agomed 2 Agomed 3 Agomed 2

934,087 834,452

1,868,175 2,503,355

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

996,360

1,992,720

Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed

1,114,678 1,232,995 1,438,495 1,556,813 2,148,401 2,771,126

2,229,356 2,465,991 2,876,989 3,113,625 4,296,802 5,542,253

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

37

38

39

40

41

42

43

44

45 46

47

48

49

50

51

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-24-30H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,6mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,8mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,10mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-L Plate 5H,Right/Left,12mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-T Plate 4H,Right/Left,8mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-T Plate 4H,Right/Left,12mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-T Plate 6H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-T Plate 5H,10mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double T Plate 6H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Y Plate 5H,w/o & 8mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Y Plate 5H,12 mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double Y Plate 6H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double Y Plate 6H,8mm Stem

2 Agomed 2

3,294,215

6,588,431

Pemenang 1 Pemenang 1

1,606,631

3,213,262

Agomed 2

Pemenang 1 1,606,631

3,213,262

Agomed 2


3,275,533

Agomed 2


3,375,169

Agomed 2


3,512,169

Agomed 2


3,674,078

Agomed 2


3,748,804

Agomed 2 Agomed 2 Agomed 2

1,980,265 1,980,265

3,960,531 3,960,531

Pemenang 1 Pemenang 1 Pemenang 1

2,030,084

4,060,167

Agomed 2


3,960,531

Agomed 2 Agomed 2

2,030,084

4,060,167


2,092,356

4,184,713

Agomed 2 Agomed


4,359,075

52

53

54

55

56

57

58

59

60

61 62 63 64 65 66 67

68

Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Double Y Plate 7H,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate 4H,cvd,6mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate 6H,cvd,8mm Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate 8H,cvd,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Orbital Plate 10H,cvd,w/o Stem Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm-Burr Hole Plate 714mm,Small/Medium/Big Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm2x2H,Square/Rectangular Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm3x2H,Square/Rectangular Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm4x2H,Square/Rectangular Osteosynthesis Mid System 1.7-Titan Plate Height 1.0 mm6x2H,Square/Rectangular Titanium Screws - Cross Lock 1.7x3-4mm Titanium Screws - Cross Lock 1.7x5-6mm Titanium Screws - Cross Lock 1.7x7-8mm Titanium Screws - Cross Lock 1.7x9mm Titanium Screws - Cross Lock 1.7x11-15mm Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Plate 4H-w/o,Med,Large Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Plate 6H-w/o,Large Stem

2


4,670,438

Agomed 2


2,777,353

Agomed 2


3,948,076

Agomed 2


3,948,076

Agomed 2


4,197,167

Agomed 2


5,417,707

Agomed 2


3,561,987

Agomed 2


5,218,436

Agomed 2


6,862,429

Agomed 3


22,679,645

Agomed Agomed Agomed Agomed Agomed Agomed

3 3 3 3 3 3

325,063

975,188

340,008

1,020,025

371,145

1,113,434

374,880

1,124,640

404,771

1,214,313

828,225

2,484,674


Agomed 3 Agomed

871,815

2,615,446

Pemenang 1

69

70

71

72

73 74

75

76

77

78

79 80 81 82

83

84

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4HRight/Left,w/o Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4HRight/Left,Med Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4HRight/Left,Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 5HRight/Left,Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-T Plate 6H-w/o Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-T Plate 6H-Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Y Plate 5H-w/o,Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Y Plate 5H-Short Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 6H-Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 7H-w/o Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Orbital Plate 6 H Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Orbital Plate 8 H Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Orbital Plate 10 H Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Orbital Plate 12H Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm2x2H,Square/Rectangular Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm3x2H,Square/Rectangular

3


4,053,941

Agomed 3


4,240,756

Agomed 3


4,128,665

Agomed 3


4,595,711

Agomed 3 Agomed 2 Agomed 2

1,531,904 1,681,357

4,595,711 3,362,715


1,531,904

3,063,807

Agomed 2 Agomed 2

1,525,676

3,051,353


1,955,356

3,910,713

Agomed 2


4,558,347

Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed 2

2,385,036 1,967,811 3,306,670 2,073,675

4,770,073 3,935,622 6,613,340 4,147,349

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

1,936,675

3,873,349

Agomed 2 Agomed


5,492,435

85 86 87 88 89 90

91 92 93 94 95 96 97 98 99 100 101 102 103 104

Emergency Screw 2.3 x 7-9 mm Plate Fixation System 3.5Malleolar Plate 1.8x7280mm,5-6 holes Plate Fixation System 3.5Malleolar Plate 1.8x95mm,8 holes Plate Fixation System 3.5Malleolar Plate 1.8x110mm,10 holes Plate Fixation System 3.5Locking Screw, HEX-Lock 3.5x8-20mm Plate Fixation System 3.5Standard Screw, HEX-Lock 3.5x8-20mm Plate Fixation System 3.5Minican 3.5 screw, partial thread, HEX-Lock (pack/1),824mm Tarsalis System 2.7-Titan Plate 4-5H,Straight Tarsalis System 2.7-Titan Plate 5H,T Shaped Tarsalis System 2.7-Titan Screw, Threated Head, TX 8, 8-30mm Tarsalis System 2.7-Titan Screw, Standard, TX 8, 830mm CBS Micro Screw, Cannulated TX6, 10-34mm CBS High Compression Screw, Cannulated TX8, 10-36mm Herberth Screw-Scarf Micro Screw Canulated TX-Lock , TX6, 10-28mm Herberth Screw-Scarf Std Compress.Screw, Cann TXLock TX 8,10-30mm Neumann Wrist Arthrodesis system-Titan Screw Treaded Head 2.7x8-30mm,TX8 Micro System 1.2- Titanium Plate 0.55 mm, Plate 4 H, Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 6 H, Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 8 H, Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 12 H, Straight

Agomed

2 2

Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed 2

307,626 5,996,842 6,382,931 6,382,931 845,661 719,870

Pemenang 1 615,253 Pemenang 1 11,993,684 12,765,862 12,765,862 1,691,322 1,439,740


2,416,173

4,832,345

3,481,033

6,962,065

Agomed Agomed Agomed

2 2 2

Agomed 2 Agomed Agomed Agomed

2 2 2

Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed 2 Agomed

3,481,033 4,583,256

Pemenang 1 Pemenang 1 6,962,065 Pemenang 1 9,166,513

3,867,122

7,734,244

2,422,400

4,844,800

2,422,400 2,422,400 2,422,400 916,651 1,052,405 1,145,814 1,239,223 1,974,038

Pemenang 1

Pemenang 1 Pemenang 1 4,844,800 Pemenang 1 4,844,800 4,844,800 1,833,302 2,104,811 2,291,627 2,478,445 3,948,076


105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 148 149 150 151 152 153 154

Micro System 1.2- Titanium Plate 0.55 mm, Plate 16 H, Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 24 H, Straight Micro System 1.2- L Plate, 5 H, Right/Left Micro System 1.2- L Plate, 8 H, Right/Left Micro System 1.2- T Plate, 5 H, 90° Micro System 1.2- T Plate, 7 H, 90° Micro System 1.2- H Plate, 9 H Micro System 1.2- Y Plate, 6 H Micro System 1.2-Double Y Plate, 6 H Micro System 1.2-Double Y Plate, 7 H Micro System 1.2-Orbital Plate, 8 H Micro System 1.2-2 x 2 H Plate, Square/Rectangular Micro System 1.2-3 x 2 H Plate, Square/Rectangular Micro System 1.2-4 x 2 H Plate, Square/Rectangular Micro System 1.2-6 x 4 H Plate, Square/Rectangular Titanium Screws - Cross Lock1.2x3-6mm Titanium Screws - Cross Lock1.2x7-10mm Titanium Screws - Cross Lock1.2x11-13mm Minican Cannulated Tit Screw partial Thread 2.7mm L 2060mm Minican cannulated titanium screw partial or full thread 3,5mm L 25-60mm Forefoot System 2.7-Tit Open-Wedge Plate 1.1 mm, 0-8mm Radius Plate, Small or Large, Palmar, Right/Left Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Plate 16H-w/o Stem Titanium Screws - Cross Lock2.0 x 5-11 mm Forefoot System 2.7-Locking screw 2.7 mm TX Lock, L830mm

2 Agomed 2 Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed Agomed

2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3

2,422,400

4,844,800

3,331,579

6,663,158

1,643,994

3,287,987

1,861,948

3,723,896

1,774,766

3,549,533

1,992,720

3,985,440

2,447,309

4,894,618

1,974,038

3,948,076

2,304,083

4,608,165

2,422,400

4,844,800

1,743,630

3,487,260

1,780,994

3,561,987

2,609,218

5,218,436

3,431,215

6,862,429

7,559,882

15,119,764

601,553

1,203,105

638,915

1,916,746

676,279

2,028,837

3,094,944

9,284,831

3 Agomed

2,416,173

Agomed

3 4

Agomed Agomed

10 15

Agomed

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

7,248,518 Pemenang 1

3 Agomed

Pemenang 1

Pemenang 1

3 Agomed

Pemenang 1

5,156,163

15,468,488

4,502,302

13,506,905

1,531,904

6,127,615

254,072

2,540,718

916,651

13,749,764


6. Nama Perusahaan Alamat Perusahaan NPWP

3

4

600,991,899

PPN 10%

60,099,190

Total

661,091,089

: PT. Triputra Aman Makmur : Rukan Permata Senayan Blok G-15, Jl. Tentara Pelajar No. 5 , Jakarta Selatan : 31.260.216.2-013.000 MERK

JUMLAH

HARGA SAT.

Smith & Nephew

12

7,610,000

91,320,000 Pemenang

Paket ACL Knee Standard, consist of: Drill guide 2.4-2.7mm ( 1 buah) Arthroscopy tubing ( 1 buah) BUTTON ( 1 buah) Shaver ( 1 buah) BIOSURE/BIOSCREW ( 1 buah)

Smith & Nephew

19

27,420,000

520,980,000 Pemenang

Paket ACL Knee + RF, consist of: Drill guide 2.4-2.7mm ( 1 buah) Arthroscopy tubing ( 1 buah) BUTTON ( 1 buah) Shaver ( 1 buah) BIOSURE/BIOSCREW ( 1 buah) RF-S Whirlwind

Smith & Nephew

12

36,490,000


Paket ACL Knee + Fast Fix, consist of: Drill guide 2.4-2.7mm ( 1 buah) Arthroscopy tubing ( 1 buah) BUTTON ( 1 buah) Shaver (1 buah) BIOSURE/BIOSCREW ( 1 buah)

Smith & Nephew

12

34,620,000


NO NAMA BMHP TINDAKAN ARTHROSCOPY Paket ACL Knee 1 Debridement, consist of: Arthroscopy tubing ( 1 buah) Shaver ( 1 buah)

2

Jumlah

JUMLAH

KET

ULTRA FAST-FIX, Curved ( 1 buah) Paket Meniscus Repair, consist of: Arthroscopy tubing (1 buah) Shaver ( 1 buah) ULTRA FAST-FIX, Curved (1 buah)

5

6

7

Smith & Nephew

8

14,810,000


Paket Shoulder Standard, consist of: Arthroscopy tubing (1 buah) Shaver (1 buah) Cannula Threaded (2 buah)

Smith & Nephew

5

10,310,000

51,550,000 Pemenang

Paket Shoulder + RF, consist of: Arthroscopy tubing (1 buah) Shaver (1 buah) Cannula Threaded (2 buah) RF-S Whirlwind (1 buah)

Smith & Nephew

5

19,380,000

96,900,000 Pemenang

9

11,340,000

102,060,000

9

9,070,000

81,630,000

8

Twinfix Ti with needle

9

Twinfix Ti without needle

Smith & Nephew Smith & Nephew

Pemenang Pemenang Jumlah 1,916,240,000 PPN 10% 191,624,000 Total 2,107,864,000

7. Nama Perusahaan Alamat Perusahaan NPWP NO 30 31 32

NAMA BMHP Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm4H,w/o or 6-110mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm6H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm6H,w/ Stem

: PT. Eka Gemilang Medika : Ruko bukit rivaria blok a8 jl. Raya Muchtar RT 003 RW 001 sawangan Depok : 21.051.943.5-412.000 MERK JUMLAH Stema

2

Stema

2

Stema

2

HARGA SAT.

JUMLAH

2,247,700

4,495,400

2,247,700

4,495,400

3,573,500

7,147,000

KET.


33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51

Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm8H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm12H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm16H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm18H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-2430H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,6mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,8mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-L Plate 4H,Right/Left,10mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-L Plate 5H,Right/Left,12mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-T Plate 4H,Right/Left,8mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-T Plate 4H,Right/Left,12mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-T Plate 6H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-T Plate 5H,10mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmDouble T Plate 6H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-Y Plate 5H,w/o & 8mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-Y Plate 5H,12 mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmDouble Y Plate 6H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmDouble Y Plate 6H,8mm Stem

Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema Stema

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

3,920,000 5,187,700 5,349,400 6,690,600 10,500,000 2,365,300 3,418,800 3,529,400 3,654,700 3,757,600 2,785,300 2,947,700 3,787,700 3,787,700 3,293,500 3,920,000 3,993,500 3,293,500 3,529,400

7,840,000 10,375,400 10,698,800 13,381,200 21,000,000 4,730,600 6,837,600 7,058,800 7,309,400 7,515,200 5,570,600 5,895,400 7,575,400 7,575,400 6,587,000 7,840,000 7,987,000 6,587,000 7,058,800

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

52 53 54 55 56

57 58 59 60 61 62 63 64 65 66

67 68 69

70

Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmDouble Y Plate 7H,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmOrbital Plate 4H,cvd,6mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmOrbital Plate 6H,cvd,8mm Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmOrbital Plate 8H,cvd,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mmOrbital Plate 10H,cvd,w/o Stem Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm-Burr Hole Plate 714mm,Small/Medium/Big Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm2x2H,Square/Rectangular Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm3x2H,Square/Rectangular Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm4x2H,Square/Rectangular Osteosynthesis Mid System 1.7Titan Plate Height 1.0 mm6x2H,Square/Rectangular Titanium Screws - Cross Lock 1.7x3-4mm Titanium Screws - Cross Lock 1.7x5-6mm Titanium Screws - Cross Lock 1.7x7-8mm Titanium Screws - Cross Lock 1.7x9mm Titanium Screws - Cross Lock 1.7x11-15mm Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Plate 4H-w/o,Med,Large Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Plate 6H-w/o,Large Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4H-Right/Left,w/o Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-L Plate 4H-Right/Left,Med Stem

Stema Stema Stema Stema Stema

2 2 2 2 2

3,529,400 2,991,800 3,669,400 4,302,900 5,378,800

7,058,800 5,983,600 7,338,800 8,605,800 10,757,600


7,737,100 Stema Stema Stema Stema

15,474,200

2 2 2 2

4,029,200 5,062,400 6,093,500

8,058,400 10,124,800 12,187,000

13,469,400

40,408,200

3

3,610,600

10,831,800

Stema

3

3,610,600

10,831,800

Stema

3

3,610,600

10,831,800

Stema

3

3,610,600

10,831,800

Stema

3

3,610,600

10,831,800

2,902,900

8,708,700

Stema

3

Stema

3

Stema

Stema

3 3

3,698,800

11,096,400

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

3,448,200

10,344,600

Stema 3 Stema


10,787,700

Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 71 mm-L Plate 4H-Right/Left,Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 72 mm-L Plate 5H-Right/Left,Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 73 mm-T Plate 6H-w/o Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 74 mm-T Plate 6H-Long Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 75 mm-Y Plate 5H-w/o,Long Stem Osteosynthesis Mini System 76 2.0-Titanium Plate Height 1.0 mm-Y Plate 5H-Short Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 6H-Long 77 Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 mm-Double Y Plate 7H-w/o 78 Stem Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 79 mm-Orbital Plate 6 H Osteosynthesis Mini System 80 2.0-Titanium Plate Height 1.0 mm-Orbital Plate 8 H Osteosynthesis Mini System 81 2.0-Titanium Plate Height 1.0 mm-Orbital Plate 10 H Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 82 mm-Orbital Plate 12H Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 83 mm-2x2H,Square/Rectangular Osteosynthesis Mini System 2.0-Titanium Plate Height 1.0 84 mm-3x2H,Square/Rectangular Emergency Screw 2.3 x 7-9 85 mm Micro System 1.2- Titanium Plate 0.55 mm, Plate 4 H, 101 Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 6 H, 102 Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 8 H, 103 Straight

3


11,272,800

Stema 3


11,384,100

4,031,300

12,093,900

Stema 3 Stema Stema Stema

2 2 2

Stema 2

3,993,500

7,987,000


3,846,500

7,693,000

4,052,300

Pemenang 8,104,600 1

3,846,500

7,693,000

Pemenang 1

Stema Pemenang 1 Stema Stema Stema

2 2 2 2

Stema Stema Stema

2 2

4,052,300 4,302,900

8,104,600 8,605,800

4,582,900

9,165,800

5,658,800

11,317,600

6,572,300 921,600

13,144,600 1,843,200

Stema

2

11,798,400

23,596,800

Stema

2

3,389,400

6,778,800

Stema Stema Stema

2 2 2

2,210,600 2,792,300 3,735,900

4,421,200 5,584,600 7,471,800

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

104 105 106 107 108 109 110

Micro System 1.2- Titanium Plate 0.55 mm, Plate 12 H, Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 16 H, Straight Micro System 1.2- Titanium Plate 0.55 mm, Plate 24 H, Straight Micro System 1.2- L Plate, 5 H, Right/Left Micro System 1.2- L Plate, 8 H, Right/Left Micro System 1.2- T Plate, 5 H, 90° Micro System 1.2- T Plate, 7 H, 90°

Stema Stema Stema

2 2 2

4,951,800 6,115,900 8,842,400

9,903,600 12,231,800 17,684,800

Stema

2

3,757,600

7,515,200

Stema

2

5,231,800

10,463,600

Stema

2

3,721,200

7,442,400

Stema

2

3,721,200

7,442,400

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

Pemenang 24,315,200 1

111 Micro System 1.2- H Plate, 9 H

Stema

2

12,157,600

112 Micro System 1.2- Y Plate, 6 H Micro System 1.2-Double Y 113 Plate, 6 H

Stema

2

3,242,400

Stema

2

3,537,100

Pemenang 1 Pemenang 7,074,200 1

Stema

2

3,537,100

7,074,200

Stema

2

4,266,500

8,533,000

Stema

2

4,421,200

8,842,400

Stema

2

6,631,800

13,263,600

Stema

2

8,842,400

17,684,800

Stema

2

17,684,100

35,368,200


Stema

2

3,396,400

6,792,800

Pemenang 1

Stema

3

3,396,400

10,189,200

Stema

3

3,396,000

Pemenang 1 Pemenang 1 10,188,000

5,349,400

21,397,600

Micro System 1.2-Double Y 114 Plate, 7 H Micro System 1.2-Orbital Plate, 115 8 H Micro System 1.2-2 x 2 H Plate, 116 Square/Rectangular Micro System 1.2-3 x 2 H Plate, 117 Square/Rectangular Micro System 1.2-4 x 2 H Plate, 118 Square/Rectangular Micro System 1.2-6 x 4 H Plate, 119 Square/Rectangular Titanium Screws - Cross Lock120 1.2x3-6mm Titanium Screws - Cross Lock121 1.2x7-10mm Titanium Screws - Cross Lock122 1.2x11-13mm Osteosynthesis Mini System 152 2.0-Titanium Plate Height 1.0 mm-Plate 16H-w/o Stem Titanium Screws - Cross Lock153 2.0 x 5-11 mm

4 Stema Stema

10

3,389,400

6,484,800

Pemenang 1 Pemenang 33,894,000 1

Jumlah 846,704,000 Ppn 10%

84,670,400

Total 931,374,400


NAMA BMHP

Cortex Screw, Fully Threaded, 123 1.5 x 6-14 Straight Plate, 3-6H, 0.85mm 124 Thick w/1.5 Screws Straight Plate, 20H, 0.85mm 125 Thick w/1.5 Screws L - Plate, 4H, 0.85mm Thick 126 w/1.5 Screws L/R Angled L Plate, 4H, 0.85mm 127 Thick w/1.5 Screws L/R Short T Plate, 4H, 0.85mm 128 Thick w/1.5 Screws Long T Plate, 3-4H, 0.85mm 129 Thick w/1.5 Screws H - Plate, 4H, 0.85mm Thick 130 w/1.5 Screws Cortex Screw, Fully Threaded, 131 2.0 x 6-20 Straight Plate, 2-6H, 1mm 132 Thick w/2.0 Screws H - Plate, 4-6H, 1mm Thick 133 w/2.0 Screws Straight L-Plate, 4H, 1mm 134 Thick w/2.0 Screws L/R Straight L-Plate, 5H, 1mm 135 Thick w/2.0 Screws L/R Angled L Plate, 4-5H, 1mm 136 Thick w/2.0 Screws L Angled L Plate, 4-5H, 1mm 137 Thick w/2.0 Screws R Short T Plate, 4H, 1mm Thick 138 w/2.0 Screws Long T Plate, 4H, 1mm Thick 139 w/2.0 Screws T Plate, 5-6H, 1mm Thick 140 w/2.0 Screws Hex Cortex Screw, Fully 141 Threaded, 2.7 x 6-20 Hex Cortex Screw, Partially 142 Threaded, 2.7 x 10-24 Straight Plate, 2-6H, 2mm 143 Thick w/2.7 Screws Straight L - Plate, 5H, 1.2mm 144 Thick w/2.7 Screws L/R Angled L - Plate, 5H, 1.2mm 145 Thick w/2.7 Screws L/R

: PT. Bintang Biocare Indonesia : Graha Malaka Lt 1 Jl Malaka Merah Iii Blok D /17 Pd Kopi Jakarta Timur : 03.313.000.6-008.000 HARGA SAT.

MERK

JUMLAH

JUMLAH

Kanghui

3

180,000

540,000

Kanghui

2

960,300

1,920,600

Kanghui

2

2,160,000 4,320,000

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

3

180,000

540,000

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

3

180,000

540,000

Kanghui

3

180,000

540,000

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

Kanghui

2

960,300

1,920,600

KET Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

Mini T-Plate, 5H, 1.2mm Thick 146 w/2.7 Screws W-Plate, 7H, 1.2mm Thick 147 w/2.7 Screws

Kanghui

2

960,300

1,920,600

Kanghui

2

2,160,000 4,320,000


TINDAKAN TRAUMA DCP STAINLESS 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

DCP 4.5, broad, 6-9 Holes, Stainless Steel DCP 4.5, broad, 10-18 Holes, Stainless Steel DCP 4.5, narrow, 4-9 Holes, Stainless Steel DCP 4.5, narrow, 10-16 Holes, Stainless Steel Semi tubular Plate, 3-7 Holes, Stainless Steel Semi Tubular Plate,8-10 Holes, Stainless Steel T-Plate 4,5, shaft 3-8 Holes, Stainless Steel Cortex Screw Ø4,5mm, length 14-50 mm, Stainless Steel Cortex Screw Ø4,5mm, length 52-60 mm, Stainless Steel Cancellous Screw Ø6,5mm ,length 25-80/16 mm, Stainless Steel Cancellous Screw Ø6,5mm ,length 85-120/16 mm, Stainless Steel Cancellous Screw Ø6,5mm ,length 25-80/32 mm, Stainless Steel Cancellous Screw Ø6,5mm ,length 85-120/32 mm, Stainless Steel Cancellous Screw Ø6,5mm, Fully Threaded ,length 25-80 mm, Stainless Steel Cancellous Screw Ø6,5mm, Fully Threaded ,length 85-120 mm, Stainless Steel Malleolar Screw Ø4,5mm,length 25-70 mm,Stainless Steel DCP 3.5 , 4-8 Holes, Stainless Steel DCP 3.5 , 9-10 Holes, Stainless Steel One-Third tubular plate 3,5 , 2-8 Holes , Stainless Steel Reconstruction plate 3,5, 6-14 Holes, Stainless Steel T-Plate ,right-angled/obliqueangled, shaft 3-5 Holes, stainless steel

Kanghui

25

990,000

Kanghui

9

1,125,000 10,125,000

Kanghui

23

900,000

Kanghui

5

1,049,940 4,724,730

Kanghui

5

675,000

3,375,000

Kanghui

5

712,530

3,562,650

Kanghui

9

945,000

8,505,000

Kanghui

610

108,000

65,853,000

Kanghui

61

117,000

7,107,750

Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1 Pemenang 1

Kanghui

16

173,250

2,728,688

Pemenang 1

Kanghui

7

187,470

1,265,423

Pemenang 1

Kanghui

9

173,250

1,559,250

Pemenang 1

24,502,500

20,250,000

Kanghui

9

187,470

1,687,230

Pemenang 1

Kanghui

41

173,250

7,016,625

Pemenang 1

Kanghui

10

187,470

1,874,700

Pemenang 1

Kanghui

9

150,030

1,350,270

Kanghui

9

824,940

7,424,460

Kanghui

5

900,000

4,050,000

Kanghui

52

712,530

36,873,428

Kanghui

33

1,649,970 54,449,010


Kanghui

2

824,940

Pemenang 1

1,856,115

22 23 24 25 26 27 28 29

Reconstruction Y Plate 3,5, 3-7 Holes, Stainless Steel S-Reconstruction plate 3,5, 6-9 Holes, Right/Left, stainless steel Cortex Screw Ø3,5mm, length 12-30 mm, Stainless Steel Cortex Screw Ø3,5mm, length 32-40 mm, Stainless Steel Cancellous Screw Ø4,0mm, Partially Threaded,length 1450 mm, Stainless Steel Cancellous Screw Ø4,0mm, Fully Threaded ,length 14-50 mm, Stainless Steel K-Wire Dia : 0,6 ; 0,8 ; 1,0 ; 1,2 ; 1,4 ; 1,6 ; 1,8 ; 2,0 ;2,4 ;2,8; 3,0m SS. Wire Dia. 0,6 0,8 1,0 1,2 1,4 1,6 1,8 2,0 2,2 2,4 2,6 2,8 , 3,0

9. Nama Perusahaan Alamat Perusahaan NPWP NO NAMA BMHP TINDAKAN ARTHROPLASTY 6 7 8 9 10 12 13

THR Cementless SMALL SIZE THR Cemented With 22,28,32mm Head TKR CR POSTERIOR REF INSTRUMENT TKR PS POSTERIOR REF INSTRUMENT THR Hybrid Multihole Cup Bipolar Cementless small size Bipolar Cemented small size

Kanghui

5

1,800,000 9,000,000

Kanghui

5

1,800,000 9,000,000

Kanghui

580

108,000

62,640,000

Kanghui

80

117,720

9,417,600


Kanghui

5

155,250

776,250

Pemenang 1

Kanghui

27

155,250

4,191,750

Pemenang 1

Kanghui

45

247,500

11,137,500

Pemenang 1

Kanghui

10

2,430,000 24,300,000

Pemenang 1

Jumlah

447,895,328

Ppn 10%

44,789,533

Total

492,684,860

: PT Meditech Indonesia : Ruko Harco Elektronik Mangga Dua, Komp Agung Sedayu Blok I No.5B Lt.2 : 02.355.699.6-026.000 MERK

JUMLAH HARGA SAT.

JUMLAH

KET

Pemenang 1

Biomet

6

42,750,000

256,500,000

Biomet

6

26,220,000

Biomet

6

34,105,000

Biomet

3

38,285,000

157,320,000 Pemenang Pemenang 204,630,000 1 Pemenang 114,855,000 1

Biomet

6

39,900,000


Biomet

15

28,547,500

428,212,500

Pemenang 1

Biomet

15

25,697,500

385,462,500

Pemenang 1

14

Total Hip Replacement (THR) SMALL SIZE

Biomet

12

29,545,000 Jumlah Ppn 10% Total


NAMA BMHP

354,540,000

Pemenang 1

2,140,920,000 214,092,000 2,355,012,000

: PT. Utama Sarana Medika : Jl. Tebet Barat Raya No. 3 : 02.179.093.6-062.000 MERK

JUMLAH

HARGA SAT.

JUMLAH

KET

BONECEMENT 1 2 3 4

Bonecement Low Viscosity 40gr Bonecement Low Viscosity+Gentamicin 40gr Bonecement High Viscosity 40gr Bonecement High Viscosity+Gentamicin 40gr

Heraeus Medical Heraeus Medical Heraeus Medical Heraeus Medical

70

Pemenang 1 Pemenang 1 1,750,000 122,500,000

10

1,200,000 12,000,000

10

1,800,000 18,000,000

10

1,150,000 11,500,000

Pemenang Pemenang

Jumlah 164,000,000 Ppn 10% 16,400,000 Total 180,400,000

Kepada peserta yang memasukandokumenpenawarandiberikan masa sanggah selama 5 (lima) hari kalender terhitung setelah tanggal pengumuman ini. Surat sanggahan disampaikan pada : Alamat Situs Internet: http://lpse.kemenkes.go.id: atau secara tertulis ditujukan kepada: KelompokKerjaIIIULP RSUP Dr. HasanSadikin Bandung. Demikian untuk diketahui, atas perhatian serta partisipasinya, kami ucapkan terima kasih. Pokja III ULP RSUP Dr. Hasan Sadikin Bandung

Berdasarkan hasil evaluasi tersebut diatas, maka Kelompok Kerja III ULP RSUP Dr. Hasan Sadikin Bandung sepakat :

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