PENGUMUMAN PEMENANG Nomor : KN

UNIT LAYANAN PENGADAAN Pokja Pengeluaran Anggaran Bersumber BLU

RUMAH SAKIT STROKE NASIONAL BUKITTINGGI

Jl. JenderalSudirmanBukittinggiTelp( 0752 ) 21013 - Fax 0752 23431 PENGUMUMAN PEMENANG Nomor : KN.01.01.338.2015 Kode Lelang LPSE

:

8941047

Nama Paket Pekerjaan

:

Pengadaan Obat Umum Triwulan I Rumah Sakit Stroke Nasional Bukittinggi TA. 2015 (Lelang Itemized)

Nilai Total HPS

:

Rp. 1.277.309.000,- (Satu Milyar Dua Ratus Tujuh Puluh Tujuh Juta Tiga Ratus Sembilan Ribu Rupiah)

Website LPSE

:

http://lpse.depkes.go.id

Metode Kualifikasi

:

Pascakualifikasi

Metode Evaluasi

:

Sistem Gugur

Metode Pengadaan

:

E-Lelang Sederhana

Lokasi Pekerjaan

:

Rumah Sakit Stroke Nasional Bukittinggi Jl. Jenderal Sudirman, Kota Bukittinggi – Sumatera Barat

Berdasarkan Berita Acara Hasil Pelelangan (BAHP) Pengadaan Obat Umum Triwulan I Rumah Sakit Stroke Nasional Bukittinggi TA. 2015 dengan cara itemized Nomor : KN.01.01.280.2015 tanggal 23 Maret 2015, maka Pokja Pengeluaran Anggaran Bersumber BLU RSSN Bukittinggi TA. 2015 mengumumkan pemenang sebagai berikut : Pemenang Nama Perusahaan

:

PT. PUTRA KARYA SENTOSA

Alamat

:

Jl. Pule No. 1 RT 014 RW 010 Kel. Ciracas, Kec. Ciracas – Jakarta Timur

:

Rp. 840,716,000,- (Delapan Ratus Empat Puluh Juta Tujuh Ratus Enam Belas Ribu Rupiah)

NPWP

:

02.748.852.7-009.000

Jangka Waktu Pelaksanaan

:

60 (Enam Puluh) Hari Kalender

Evaluasi Administrasi

:

Lulus

Evaluasi Teknis

:

Lulus

Evaluasi Harga

:

Lulus

Nama Perusahaan

:

PT. ANUGRAH PRADJA MANDIRI

Alamat

:

Jl. Prof. Dr. Hamka No. 78 C - Padang

:

Rp. 356,701,000,- (Tiga Ratus Lima Puluh Enam Juta Tujuh Ratus Satu Ribu Rupiah

NPWP

:

02.360.764.1-201.000

Jangka Waktu Pelaksanaan

:

60 (Enam Puluh) Hari Kalender

Evaluasi Administrasi

:

Lulus

Evaluasi Teknis

:

Lulus

Evaluasi Harga

:

Lulus

Hasil Evaluasi Terkoreksi

Hasil Evaluasi Terkoreksi

Penawaran

Penawaran



Jl. JenderalSudirmanBukittinggiTelp( 0752 ) 21013 - Fax 0752 23431 Demikian disampaikan agar Saudara mengetahui dan atas perhatiannya diucapkan terimakasih Bukittinggi, 24 Maret 2015 Unit Layanan Pengadaan Pokja Pengeluaran Anggaran Bersumber BLU Rs. Stroke Nasional Bukittinggi TA. 2015 Ketua Dto SARI REZEKI, S.ST, M.Biomed NIP 19670228 199103 2 003



Jl. JenderalSudirmanBukittinggiTelp( 0752 ) 21013 - Fax 0752 23431 Lampiran Pengumuman Pemenang Lelang Nomor : KN.01.01.338.2015 Tanggal : 24 Maret 2015 PT. PUTRA KARYA SENTOSA NO. 1 2 3 5 6 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 25 31 32 33 35 36 37 38 39 40 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58

NAMA BARANG Acitral Liquid 120 Alviz 50 mg tab Analsik Tab Apialis syrup Arkine tab ATP dankos tab Amobiotic drop Avamys nasal spray Betadin kumur 190 ml Bio ATP tab Biodiar tab Bisolvon inj Bisolvon syrup Bisolvon kids syrup Bioplacenton cream Buscopan inj Brainact 500 inj Brainact 250 inj Braintact odis tab Brainact tab Brainvit syrup 60 ml Benocetam 1200 tab C. Asthenof 5 ml C. Augentonic 5 ml C. Augentonic 0,6 C. Vitrolenta C. Catarlent 15 ml Cenfresh 0,6 ml C. Polydex C. Xitrol 0,6 C. Lyter Coten licaps 100 mg Condro PA tab Curcuma tab Curvit tab Curvit sirup Curvit CL emulsion Cupanol syrup CO amoxiclav Dilmen tab Dolo neurobion tab Dumin caplet 500 mg Dumin rectal tube 250 mg inj Dumin rectal tube 125 mg inj Estazor tab Esilgan 1 mg Folas tab

SATUAN

JUMLAH

botol tablet tablet botol tablet tablet botol botol botol tablet tablet ampul botol botol tube ampul ampul ampul tablet tablet botol tablet botol botol strip botol botol strip strip strip botol tablet tablet tablet tablet botol botol botol tablet tablet tablet caplet tube tube tablet tablet tablet

200 450 3300 48 3000 500 24 12 200 1000 600 600 10 10 12 50 90 150 3600 6000 12 500 200 200 240 40 200 40 40 40 100 10 750 5000 1500 24 24 60 500 7200 500 7000 50 50 60 300 1000

H. SATUAN (Rp.) 25,268.00 2,846.00 1,163.00 26,682.00 640.00 1,334.00 22,410.00 116,429.00 8,218.00 2,286.00 1,319.00 44,870.00 27,856.00 24,761.00 12,274.00 25,092.00 67,665.00 43,758.00 11,461.00 11,831.00 37,355.00 4,696.00 22,413.00 26,816.00 23,080.00 34,953.00 32,686.00 24,547.00 28,283.00 26,015.00 24,014.00 5,742.00 5,870.00 427.00 1,921.00 23,480.00 48,027.00 16,543.00 4,900.00 971.00 1,259.00 357.00 15,796.00 11,313.00 7,471.00 3,136.00 726.00

J. HARGA (Rp.) 5,053,600.00 1,280,700.00 3,837,900.00 1,280,736.00 1,920,000.00 667,000.00 537,840.00 1,397,148.00 1,643,600.00 2,286,000.00 791,400.00 26,922,000.00 278,560.00 247,610.00 147,288.00 1,254,600.00 6,089,850.00 6,563,700.00 41,259,600.00 70,986,000.00 448,260.00 2,348,000.00 4,482,600.00 5,363,200.00 5,539,200.00 1,398,120.00 6,537,200.00 981,880.00 1,131,320.00 1,040,600.00 2,401,400.00 57,420.00 4,402,500.00 2,135,000.00 2,881,500.00 563,520.00 1,152,648.00 992,580.00 2,450,000.00 6,991,200.00 629,500.00 2,499,000.00 789,800.00 565,650.00 448,260.00 940,800.00 726,000.00



Jl. JenderalSudirmanBukittinggiTelp( 0752 ) 21013 - Fax 0752 23431

59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 99 100 101 102 103 105 106 108 109 111 113 114 115 116 117 118 119 121

Ferris sirup Ferris drop EDTA Falergi tab Farmadol infus Forneuro capsul Forres tab Fudan tab 100 mg Frego 10 mg Frego 5 mg Frimania 200 Friladar 2 mg Hervis cream Incelin 250 mg inj Inpepsa syrup 100 ml Intermoxil forte syr Interpec 30 elixir 60 ml Interpec tab Intervask 5 mg Interzinc tab Interzinc sirup Intidrol tab Isoric 300 Iliadin tetes hidung Kalmeco inj Kalmeco 500 tab Ka En 1 B KCL Infus Lancolin 500 mg inj Lankolin inj Lantulos syrup Lasix inj Lodia tab L F X monodos Matovit tab Matovit sirup Meloxin 15 mg Merislon tab 12 mg Moxam 15 mg tab Mucera drop Myonep tab Myobat tab Neurochol tab New diatab Neurotam 1200 mg tab Neurotam 3 gr inj Notrotam 1200 Ocu-V tab Oste forte tab Otsu salin 3 % 500 ml Ottopan syrup Ottopan drop Ottoprim tab Ottopain tetes telinga Oxoferin solution 30

botol botol botol tablet botol capsul tablet capsul tablet tablet tablet tablet tube ampul botol botol botol tablet tablet tablet botol tablet tablet botol ampul tablet botol botol ampul ampul botol ampul tablet minidose tablet botol tablet tablet tablet botol tablet tablet tablet tablet tablet ampul tablet tablet capsul botol botol botol tablet botol botol

24 12 20 120 120 6000 2000 600 600 300 500 150 24 600 48 12 48 3000 450 500 24 2600 180 12 100 6000 40 140 450 240 10 300 1800 120 300 6 500 1800 1800 24 3000 600 3600 1500 3000 150 3000 1080 300 300 60 60 1000 24 90

27,215.00 26,682.00 43,781.00 2,988.00 53,364.00 4,838.00 3,949.00 3,202.00 7,065.00 5,272.00 2,348.00 3,826.00 39,222.00 29,537.00 49,095.00 20,785.00 27,349.00 1,014.00 5,171.00 1,862.00 24,723.00 2,519.00 3,063.00 22,413.00 93,920.00 1,985.00 17,930.00 7,044.00 68,305.00 32,018.00 42,691.00 12,725.00 945.00 73,642.00 3,380.00 32,020.00 8,426.00 5,758.00 9,534.00 34,153.00 3,629.00 3,447.00 10,673.00 517.00 5,507.00 55,498.00 4,162.00 4,269.00 3,522.00 14,942.00 11,740.00 19,211.00 374.00 34,953.00 69,373.00

653,160.00 320,184.00 875,620.00 358,560.00 6,403,680.00 29,028,000.00 7,898,000.00 1,921,200.00 4,239,000.00 1,581,600.00 1,174,000.00 573,900.00 941,328.00 17,722,200.00 2,356,560.00 249,420.00 1,312,752.00 3,042,000.00 2,326,950.00 931,000.00 593,352.00 6,549,400.00 551,340.00 268,956.00 9,392,000.00 11,910,000.00 717,200.00 986,160.00 30,737,250.00 7,684,320.00 426,910.00 3,817,500.00 1,701,000.00 8,837,040.00 1,014,000.00 192,120.00 4,213,000.00 10,364,400.00 17,161,200.00 819,672.00 10,887,000.00 2,068,200.00 38,422,800.00 775,500.00 16,521,000.00 8,324,700.00 12,486,000.00 4,610,520.00 1,056,600.00 4,482,600.00 704,400.00 1,152,660.00 374,000.00 838,872.00 6,243,570.00



Jl. JenderalSudirmanBukittinggiTelp( 0752 ) 21013 - Fax 0752 23431

122 124 125 126 127 129 130 131 132 133 134 135 138 139 140 144 145 146 147 148 150 151 152 153 154 155 156 157 158 159 160 161 165 166 167 168 169

Phardex tab Plasmin tab Proxime tab Properetic 80 Properetic 160 Rebal plus tab Recolfar tab Recustein dry syr Regit drop Regit syrup Retivit tab Rhodium tab Sanmol syrup Serlof tab Sedrofen syrup 60 ml Sterimar tetes hidung Tilidon tab Tensipar 10 mg tab Tensipar 5 mg tab Tebokan forte Thiamycin syrup 60 ml Thiamycin forte syrup Thiamicin tab Trimoxsul syrup Trifed tab Trombopop gel Trombopop ointment Truvas 20 tab Tarivid otic Vitacur syrup Vitaplex drop Vitaplex syrup Wiacid tab Zerlin tab Zeufor tab Zypraz 0,5 mg tab Cercul inj 250 mg

tablet tablet tablet supp supp tablet tablet botol botol botol tablet tablet botol tablet botol botol tablet tablet tablet tablet botol botol tablet botol tablet tube tube tablet botol botol botol botol tablet tablet tablet tablet ampul

4000 2160 7500 120 30 1500 600 24 12 24 1000 500 60 300 24 12 2400 2250 2250 1620 24 24 3000 24 3000 24 24 300 12 120 12 12 600 1500 1800 3000 2000

4,269.00 9,072.00 1,094.00 6,075.00 6,457.00 1,921.00 4,269.00 35,220.00 34,150.00 34,153.00 3,570.00 5,070.00 10,854.00 10,886.00 40,476.00 121,135.00 3,293.00 3,202.00 2,206.00 16,614.00 27,340.00 49,220.00 2,135.00 22,810.00 1,366.00 48,030.00 37,355.00 12,327.00 72,575.00 32,018.00 37,355.00 37,352.00 4,483.00 12,679.00 11,916.00 2,327.00 16,009.00 JUMLAH (Rp.) PPN 10% (Rp.) JUMLAH SUBTOTAL (Rp.) PEMBULATAN (Rp.)

17,076,000.00 19,595,520.00 8,205,000.00 729,000.00 193,710.00 2,881,500.00 2,561,400.00 845,280.00 409,800.00 819,672.00 3,570,000.00 2,535,000.00 651,240.00 3,265,800.00 971,424.00 1,453,620.00 7,903,200.00 7,204,500.00 4,963,500.00 26,914,680.00 656,160.00 1,181,280.00 6,405,000.00 547,440.00 4,098,000.00 1,152,720.00 896,520.00 3,698,100.00 870,900.00 3,842,160.00 448,260.00 448,224.00 2,689,800.00 19,018,500.00 21,448,800.00 6,981,000.00 32,018,000.00 764,287,356.00 76,428,735.60 840,716,091.60 840,716,000.00



Jl. JenderalSudirmanBukittinggiTelp( 0752 ) 21013 - Fax 0752 23431 PT. ANUGRAH PRADJA MANDIRI NO. 4 7 24 26 27 28 29 30 34 41 42 74 97 98 104 107 110 112 120 123 128 136 137 141 142 143 149 162 163 164

NAMA BARANG Aminefron tab Asppilets thrombo tab Brainnolin 250 mg/ml inj Candesartan 8 Candesartan 16 Cefixime 200 mg tab Carbogliserin tetes telinga Cefixime 100 mg tab C. Conver Citicolin inj 250 Citicolin tab 500 mg Intermoxil syrup 60 ml Mertigo Mertigo SR tab Myonal tab Neurobat tab Nicholin 250 inj Nonflamin kapsul Ottopraf tetes telinga Pharolit PSIDII Rhinofed tab Rhinos junior sirup Soholin inj Spasmomen tab Sumagesic tab Theravask 10 mg tab Vistrum syrup Vometa syrup Vometa drop

SATUAN

VOLUME

tablet tablet ampul tablet tablet tablet botol tablet strip ampul tablet botol tablet tablet tablet tablet pcs kapsul botol sachet tablet tablet botol ampul tablet tablet tablet botol botol botol

900 25000 1000 3000 10800 1000 48 1000 100 2200 6000 60 500 6000 3000 1500 300 500 24 300 1000 1000 24 300 3000 2000 5000 48 48 24

H. SATUAN (Rp.) 6,125.00 642.00 29,400.00 4,341.00 6,270.00 3,144.00 1,837.00 1,202.00 18,370.00 8,686.00 5,512.00 21,190.00 2,714.00 4,522.00 5,987.00 1,019.00 46,993.00 4,113.00 28,665.00 1,019.00 3,528.00 1,509.00 24,990.00 34,300.00 6,076.00 407.00 5,731.00 30,257.00 36,750.00 36,750.00

J. HARGA (Rp.) 5,512,500.00 16,050,000.00 29,400,000.00 13,023,000.00 67,716,000.00 3,144,000.00 88,176.00 1,202,000.00 1,837,000.00 19,109,200.00 33,072,000.00 1,271,400.00 1,357,000.00 27,132,000.00 17,961,000.00 1,528,500.00 14,097,900.00 2,056,500.00 687,960.00 305,700.00 3,528,000.00 1,509,000.00 599,760.00 10,290,000.00 18,228,000.00 814,000.00 28,655,000.00 1,452,336.00 1,764,000.00 882,000.00

JUMLAH (Rp.)

324,273,932.00

PPN 10% (Rp.)

32,427,393.20

JUMLAH SUBTOTAL (Rp.)

356,701,325.20

PEMBULATAN (Rp.)

356,701,000.00

PENGUMUMAN PEMENANG Nomor : KN

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