STANDAR SATUAN HARGA TAHUN ANGGARAN 2014 PEMERINTAH KOTA JAYAPURA

STANDAR SATUAN HARGA TAHUN ANGGARAN 2014 PEMERINTAH KOTA JAYAPURA 10.OBAT NO

JENIS BARANG

MERK/TYPE/ SPESIFIKASI

SATUAN

HARGA (Rp)

1

2

3

4

5

1

OBAT Albendazol suspensi 200 mg/5 ml

2

Albendazol tablet 400 mg

ktk 5 strip x 6 tablet

tablet

531

3

Alopurinol tablet 100 mg

ktk 10 x 10 tablet

tablet

131

4


Kotak 30 tab 300 mg

tablet

335

5


Ktk 10 x 10 tablet

tablet

335

6

Alprazolam tablet 0,5 mg

Kotak, 10 strip @ 10 tablet

tablet

531

7

Ambroxol sirup 15 mg/ml

8

Ambroxol tablet 30 mg

9

Aminofilin injeksi 24 mg/ml

Dus, @ 10 Botol

btl 60 ml

btl

btl

5,282

3,303

ktk 10 X 10 tablet

tablet

119

Kotak 30 ampul @ 10 ml

ampul

4,176

10 Aminofilin tablet 150 mg

botol 100 tablet

tablet

128

11 Aminofilin tablet 200 mg

Botol 100 tablet

tablet

117

Dus, 10 Strip @ 10 Tablet

tablet

149

13 Amlodipin tablet 10 mg

Ktk 3 x 10 tablet

tablet

584

14 Amlodipin tablet 5 mg

Ktk 3 x 10 tablet

tablet

319


tablet

6,656

16 Amoksisilin kapsul/kaplet 250 mg

Kotak 12 x 10 kapsul

kapsul

279

17 Amoksisilin kapsul/kaplet 500 mg

ktk 10 x 10 kaplet

kaplet

280

12 Amitriptilin tablet salut 25 mg (HCl)

15 Amoksisilin + As. Klavulanat 625 mg tablet

18 Amoksisilin serbuk injeksi 1000 mg 19 Amoksisilin sirup kering 125 mg/ 5 ml 20 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial

ktk 10 vial

vial

10,251

Botol 60 ml

btl

3,068

Kotak 10 vial 1000 mg

vial

6,353

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

21 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial 22 Ampisilin serbuk injeksi i.m./i.v. 500 mg/vial Antasida DOEN I tablet kunyah, kombinasi : Aluminium

ktk 10 vial

vial

6,353

Kotak 10 vial 500 mg

vial

4,158

KTK 10 X 10

tablet

102

Botol, 60 ml

btl

2,514

Dus, 25 tube @ 5 g

tube

3,453

Kotak 24 pot @ 30 gr

pot

2,641

23 Hidroksida 200 mg Magnesium Hidroksida 200 mg Antasida DOEN II suspensi, kombi : Aluminium Hidroksida 24 200 mg/5 ml Magnesium Hidroksida 200 mg/5 ml

25 26 27 28

Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g + Polimiksin 10.000 IU/g Antifungi DOEN Kombinasi: Asam Benzoat 6% + Asam Salisilat 3% Antimalaria DOEN kombinasi : Pirimetamin tablet 25 mg

ktk 10 x 10 tablet

tablet

613

Btl 100 tablet

tablet

171

Sulfadoksin tablet 500 mg Antimigren tablet: Ergotamin Tartrat 1 mg + Kofein 50 mg

29 Aqua pro Injeksi steril, bebas pirogen

Kotak 10 vial @ 20 ml

30 Artemether injeksi 80 mg/ml

ktk 6 AMP

31 Artesunate injeksi, vial 60 mg

vial

vial

6,708

ampul

30,723

vial

34,738

32 Asam Asetilsalisilat tablet 100 mg (Asetosal)

ktk 10 str x 10's

tablet

139

33 Asam Asetilsalisilat tablet 500 mg (Asetosal)

10 str x 10's

tablet

224

34 Asam Askorbat (Vitamin C) tablet 250 mg

ktk. 10X10 TAB

tablet

172

35 Asam Askorbat (Vitamin C) tablet 100 mg

ktk 10X10 TAB

tablet

70

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

36 Asam Folat tablet 1 mg

Botol 100 tablet

tablet

60

37 Asam Mefenamat kapsul/kaplet 250 mg

Dus, 12 Blister @ 10 Kapsul

kapsul

169

38 Asam Mefenamat kapsul/kaplet 500 mg

KTK 10 X 10

tablet

142

Dus, 25 tube @ 5 g

tube

2,983

40 Asiklovir tablet 200 mg

ktk 10x10 tablet

tablet

304

41 Asiklovir tablet 400 mg

ktk 10x10 tablet

tablet

431

42 Atenolol tablet 100 mg

5x 10 tablet

tablet

755

43 Atenolol tablet 50 mg

5x 10 tablet

tablet

400

Dus, 30 ampul @ 1 ml

ampul

1,705

Kotak 10 x 10

tablet

94

39 Asiklovir krim 5%

44 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) 45 Atropin Sulfat tablet 0,5 mg 46 Benzatin Benzil Penisilin 1,2 juta IU/ vial

10 vial x 1,2 Jt IU

vial

12,384

47 Benzatin Benzil Penisilin 2,4 juta IU/vial

ktk 10 vial x 2,4 Jt IU

vial

16,888

48

Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet (tablet

1 sase @30 tablet

tablet

55

strip / ktk 3 x 10 tablet

tablet

1,281

Kotak 25 tube @ 5 g

tablet

1,987

blister / ktk 10 x 10 tablet

tablet

3,211

kotak 10 x 10 tablet, Nama Dagang: Phytovon

tablet

59

tambah darah kombinasi )

49 Betahistin Mesilat tablet 6 mg 50 Betametason krim 0,1 % (sebagai Valerat) 51 Bisoprolol tablet 5 mg 52 Bromheksin tablet 8 mg 53 Cetirizin sirup 5 mg/5 ml

Dus,, Botol 60 ml

btl

54 Cetirizine tablet 10 mg

Ktk 5 x 10 tablet

tablet

249

55 Clobazam tablet 10 mg


tablet

878

56 Clobetasol krim 0,05%

kotak 25 tube 5 gr, Nama Dagang: Emetasol

tube

5,082

57 Dapson tablet 100 mg

botol 100 tablet

tablet

51

ktk 100 ampl x 1 ml

ampul

2,594

58 Deksametason injeksi i.v. 5 mg/ml

14,338

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

59 Deksametason tablet 0,5 mg 60 Dekstran 70 - larutan infus 6% steril 61 Dekstrometorfan sirup 10 mg/5 ml (HBr) 62 Dekstrometorfan tablet 15 mg (HBr)

ktk 10 x 10 tablet

tablet

89

botol 500 ml (Merek: Dekstran)

Unit

45,136

btl

1,812

BTL 60 ML Dus, 10 Blister @ 10 Tablet

tablet

128


ampul

3,249

64 Diazepam tablet 2 mg

Botol 100 tablet

tablet

35

65 Diazepam tablet 5 mg

Ktk 10 x 10

tablet

82


tablet

133


ampul

1,317

10 x 10 tab

tablet

142

69 Diltiazem HCl tablet 30 mg

Ktk 10X10 TAB

tablet

156

70 Dimenhidrinat tablet 50 mg

Btl 100 tablet

tablet

121

71 Doksisiklin kapsul/kaplet 100 mg

ktk 10 x 10 kapsul

kapsul

291

72 Domperidon suspensi 5 mg/5 ml

btl 60 ml

63 Diazepam injeksi 5 mg/ml

66 Dietilkarbamazin Sitrat tablet 100 mg 67 Difenhidramin injeksi i.m. 10 mg/ml (HCl) 68 Digoksin tablet 0,25 mg

73 Domperidon tablet 10 mg

btl

5,008

Dus, 10 Blister @ 10 Tablet

tablet

244

ktk 10 bls x 10's

tablet

53

ktk 30 amp x 1 ml

ampul

2,079

76 Eritromisin kapsul/kaplet 250 mg


kapsul

683

77 Eritromisin kapsul/kaplet 500 mg


tablet

1,275

btl 60 ml

btl

9,173

Btl 300 ml

btl

2,907

74 Ekstraks Belladona tablet 10 mg 75 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl)

78 Eritromisin sirup 200 mg/ 5 ml 79 Etakridin larutan 0,1% 80 Etambutol tablet 250 mg (HCl) 81 Etambutol tablet salut 500 mg (HCl) 82 Famotidine tablet 40 mg

ktk 20 x 10 tablet

tablet

388

Dus, 10 Strip @ 10 Tablet Salut Selaput

tablet

596


tablet

243

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

83 Famotidine tablet 20 mg


tablet

156

ktk 15 str x 10's

tablet

134

BOTOL 100 KAPSUL

kapsul

171

ktk 10 amp x 2 ml

ampul

67,039

BOTOL 100 KAPSUL

kapsul

127

ktk 30 amp x 1 ml

ampul

2,378

Kotak 100 (10 strip @ 10 tablet)

tablet

95

Kotak 10 x 10

tablet

199

91 Fenoksimetil Penisilin tablet 250 mg

10 str x 10's

tablet

377

92 Fenoksimetil Penisilin tablet 500 mg

ktk 10 str x 10's

tablet

644

Kotak 24 botol @ 5 ml

ampul

1,397

94 Fitomenadion (Vit.K1) tablet salut gula 10 mg

ktk 10 x 10 tablet

tablet

699

95 Fitomenadion (Vitamin K1) injeksi 10 mg/ml

ktk 30 amp x 1 ml

ampul

2,170

ktk 1 x 10 kapsul

kapsul

30,492


sachet

2,427

ktk 20x10 tablet

sachet

114

Dus, 100 Sachet

sachet

405

ktk 10 bls x 10's

kaplet

386


tablet

942

Dus, 5 ampul @ 2 ml

ampul

4,302

tube

1,697

btl

4,024

84 Fenilbutason tablet 200 mg 85 Fenitoin kapsul/kaplet 100 mg 86 Fenitoin Natrium injeksi 50 mg/ml 87 Fenitoin Natrium kapsul/kaplet 30 mg 88 Fenobarbital injeksi i.m./i.v. 50 mg/ml 89 Fenobarbital tablet 30 mg 90 Fenobarbital tablet 100 mg

93 Fenol Gliserol tetes telinga 10%

96 Flukonazol tablet 150 mg 97 Furosemid injeksi i.v./i.m. 10 mg/ml 98 Furosemid tablet 40 mg Garam Oralit I serbuk, kombinasi : Natrium 0,52 g Kalium 99 klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g Glukosa Anhidrat 2,7 g 100 Gemfibrozil kapsul/kaplet 300 mg 101 Gemfibrozil tablet 600 mg 102 Gentamisin injeksi 40 mg/ ml 103 Gentamisin salep kulit 0.1% 104 Gentamisin Sulfat tetes mata 0,3 %

Dus, 25 tube @ 5 g Kotak 10 botol @ 5 ml

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

105 Gentian Violet larutan 1 %

btl 10 ml

btl

1,236

106 Glibenklamida tablet 5 mg


tablet

74

107 Glimepiride tablet 1 mg

Kotak 30 tab 1 mg

tablet

543


Ktk 5 x 10 tablet

tablet

666


Ktk 5 x 10 tablet

tablet

909


Ktk 5 x 10 tablet

tablet

1,212

111 Gliquidon tablet 30 mg


tablet

745

112 Gliserin

Botol, 100 ml

btl

5,769

113 Glukosa larutan infus 10 % steril

Botol 500 ml

btl

7,937

114 Glukosa larutan infus 40 % steril

ampul 25 ml (Merek: Otsu D40 %)

ampul

2,264

btl

7,364

115 Glukosa larutan infus 5 % steril 116 Griseofulvin tablet 125 mg

Botol 500 ml Dus, 10 Blister @ 10 Tablet

tablet

326

117 Haloperidol tablet 0,5 mg

10 X 10 tab

tablet

80

118 Haloperidol tablet 5 mg

10 X 10 tab

tablet

140

119 Haloperidol tablet 1,5 mg

10 X 10 tab

tablet

95

120 Hidrokortison krim 1%

tube @ 5 gr

tube

3,065

ktk 24 tube @ 5 g

tube

3,048

kotak 5 x 10 tablet, Nama Dagang: Hyorex

tablet

468

121 Hidrokortison krim 2,5 % 122 Hyoscine -N-Butilbromide tablet 10 mg 123 Ibuprofen suspensi 100 mg/5 ml

Botol 60 ml

btl

4,802

124 Ibuprofen suspensi 200 mg/5 ml

Botol 60 ml

btl

6,175

125 Ibuprofen tablet 200 mg

btl 100 tablet

tablet

128

126 Ibuprofen tablet 400 mg

ktk 10 X 10 tablet

tablet

203

BTL 100 KAP

kapsul

1,289

Ktk 10X10 TAB

tablet

61

127 Iodiol kapsul lunak 128 Isoniazid tablet 100 mg

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

129 Isoniazid tablet 300 mg

botol 100 tablet

tablet

98


tablet

127

Kotak 30 kapsul/kaplet 100 mg

kapsul

1,964

132 Kalium Diklofenak tablet 50 mg

Ktk 5 x 10 tablet

tablet

565

133 Kalsium Laktat (Kalk) tablet 500 mg

ktk 10 str x 10's

tablet

65

Ktk 10 x 10 tablet

tablet

83

135 Kaptopril tablet 25 mg


tablet

122

136 Kaptopril tablet 50 mg


tablet

170


tablet

337

tube 15 gram

tube

5,146

139 Ketokonazol tablet 200 mg

Ktk 5 x 10 tablet

tablet

355

140 Ketoprofen injeksi 100 mg

ktk 5 ampul

ampul

3,376

141 Ketoprofen tablet 100 mg

Ktk 5 x 10 tablet

tablet

807

142 Ketorolac injeksi 10 mg

Dus, 5 ampul @ 1 ml

ampul

2,546

143 Ketorolac injeksi 30 mg

ktk 6 amp

ampul

3,373

144 Klindamisin kapsul/kaplet 150 mg


kapsul

530

145 Klindamisin kapsul/kaplet 300 mg


kapsul

730

Dus, 1 strip x 10 tablet, Nama Dagang: Ofertil

tablet

2,195

147 Klonidin tablet 0,15 mg

Ktk 10X10 TAB

tablet

239

148 Kloramfenikol kapsul/kaplet 250 mg

ktk 10 str x 10's

kapsul

314

130 Isosorbid Dinitrat tablet sublingual 5 mg 131 Itrakonazol kapsul/kaplet 100 mg

134 Kaptopril tablet 12,5 mg

137 Karbamazepin tablet 200 mg 138 Ketokonazol krim 2%

146 Klomifen tablet 50 mg

149 Kloramfenikol salep mata 1 % 150 Kloramfenikol suspensi 125 mg/ 5 ml 151 Kloramfenikol tetes telinga 3 % 152 Klorfeniramina Maleat (CTM) tablet 4 mg

tube 5 g

tube

1,842

btl 60 ml

btl

5,209

btl 5 ml

btl

2,216

ktk 10 str x 10's

tablet

29

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

153 Klorokuin tablet 250 mg

ktk 10x10 tablet

tablet

136

154 Klorpromazin tablet salut 100 mg (HCl)

Ktk 10X10 TAB

tablet

185

155 Klorpromazin injeksi i.m. 25 mg/ml (HCl)

30 amp x 1 ml

ampul

1,415

156 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl)

30 amp x 2 ml

ampul

1,317

157 Klorpromazin tablet salut 25 mg (HCl)

ktk 10 str x 10's

tablet

62

158 Kodein tablet 10 mg

ktk 10x10 tablet

tablet

651


Ktk 10X10 TAB

tablet

1,109


Ktk 10X10 TAB

tablet

1,448


tablet

187

Strip 10 x 10 Tablet

tablet

187


tablet

99

161 162 163

Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg , Trimetoprim 80 mg Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg , Trimetoprim 80 mg Kotrimoksazol DOEN II (pediatrik) kombinasi : Sulfametoksazol 100 mg Trimetoprim 20 mg

btl

2,785

ktk 30 ampul @ 2 ml

ampul

5,371

BTL 60 Tab

tablet

1,756

Dus, 2 Strip @ 10 Kapsul

kapsul

594

168 Levofloksasin tablet 500 mg

Kotak 30 tab 500 mg

tablet

809

169 Levofloksasin tablet 500 mg


tablet

809

ktk 100 amp @ 2 ml

ampul

1,214


ampul

1,871

164

Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +

Botol, 60 ml

Trimetoprim 40 mg / 5 ml

165 Kuinin Dihidroklorida injeksi 25% - 2 ml 166 Lamivudine tablet 150 mg 167 Lanzoprazol kapsul/kaplet 30 mg

170 Lidokain injeksi 2% 171 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

172 Linkomisin kapsul/kaplet 500 mg


kapsul

766

kotak 3 x 10 tablet

tablet

774

dus 3 x 10 tablet, Nama Dagang: Inhitril

tablet

450

175 Loperamid tablet 2 mg

Dus, 10 strip @ 10 tablet

tablet

125

176 Loratadin tablet 10 mg

Ktk 5 x 10 tablet

tablet

213

173 Lisinopril tablet 10 mg 174 Lisinopril tablet 5 mg

177 Magnesium Sulfat inj (IV) 20% - 25 ml

vial 25 ml (Merek: Otsu MgSO4 20 %)

vial

2,400

178 Magnesium Sulfat inj (IV) 40% - 25 ml

vial 25 ml (Merek: Otsu MgSO4 40 %)

vial

3,036

Botol 30 ml

btl

4,898

179 Mebendazol sirup 100 mg / 5 ml 180 Mebendazol tablet 100 mg


tablet

312

181 Meloksikam suppositoria

Kotak, isi 10 suppositoria

tablet

7,623

182 Meloksikam tablet 15 mg


tablet

402

183 Meloksikam tablet 7,5 mg


tablet

270

ktk 100 amp @ 1 ml

ampul

1,588

185 Metampiron injeksi 250 mg


ampul

1,891

186 Metampiron tablet 500 mg

Kotak 10 x 10 tablet

tablet

167

187 Metformin HCl tablet 500 mg

Ktk 10 x 10 tablet

tablet

140

188 Metformin HCl tablet 850 mg

Kotak 100 tab 850 mg

tablet

404

184 Menadion (Vitamin K3) injeksi 10 mg/ml

189 Metilprednisolon injeksi 500 mg

Kotak 1 vial 8 ml

vial

109,725

190 Metilprednisolon injeksi 500 mg

ktk 1 vial @ 8 ml

av

109,725

191 Metilprednisolon tablet 16 mg

Ktk 3 x 10 tablet

tablet

824


Ktk 10 x 10 tablet

tablet

263


Kotak 100 tab 8 mg

tablet

520

194 Metoklopramide injeksi 5 mg/ml

dus 5 ampul 2 ml, Nama Dagang: Metolon

ampul

1,363

195 Metoklopramide sirup 5 mg/ 5 ml

botol 60 ml, Nama Dagang: Lexapram syr

btl

3,269

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

196 Metoklopramide tablet 10 mg

Ktk 10X10 TAB

tablet

113

197 Metoklopramide tablet 5 mg

Ktk 10 x 10 tab

tablet

133

198 Metronidazol infus 500 mg/100 ml

btl 100 ml

btl

13,714

199 Metronidazol tablet 250 mg

ktk 10 x 10 tablet

tablet

161

200 Metronidazol tablet 500 mg

Kotak 10 x 10 tablet

tablet

221

ktk 24 tube @ 10 gram

tube

4,158

sachet

3,396

201 Mikonazol krim/salep 2 % (Nitrat) Mineral Mix, kombinasi : Kalium klorida 1792 mg Trikalium 202

Dus, 40 Sachet

sitrat (1H2O) 648 mg Magnesium klorida (6H2O) 608 mg Seng asetat (2H2O) 66 mg Tembaga sulfat (5H2O) 11 mg

203 Momethason krim 0,1 %

25 tube 5 gram, Nama Dagang: Hyorex

tube

5,198

204 Momethason krim 0,1 %

tube 10 gram, Nama Dagang: Motaderm

tube

28,760

Ktk 10 ampul @ 1ML

ampul

14,552

btl 30 tablet

tablet

1,671

207 Natrium Diklofenak tablet 50 mg

ktk 5 x 10 tablet

tablet

249

208 Natrium Diklofenak tablet 25 mg

ktk 5 x 10 tablet

tablet

188

205 Morfin injeksi 10 mg/ml 206 Morfin tablet 10 mg

209 Natrium Klorida larutan infus 0,9 %

Botol 500 ml

btl

6,791

btl 60 tablet

tablet

3,622

ktk 10 x 10 tablet

tablet

142

ktk 10 str x 10's

tablet

887

ktk 10 str x 10's vaginal

tablet

564

214 Obat Antituberkulosis FDC Kategori 1

paket

paket

498,902

215 Obat Antituberkulosis FDC Kategori 2

Paket

paket

1,663,085

216 Obat Antituberkulosis FDC Kategori Anak

paket

paket

297,932

210 Nevirapin tablet 200 mg 211 Nifedipin tablet 10 mg 212 Nistatin tablet salut 500.000 IU/ g 213 Nistatin vaginal tablet 100.000 IU/ g

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

217 Obat Antituberkulosis FDC Sisipan

PAKET

paket

221,643

218 Obat Antituberkulosis Kategori 1 dewasa

Paket

paket

399,330

219 Obat Antituberkulosis Kategori anak

Paket

paket

238,277

220 Obat Batuk Hitam ( O.B.H. ) cairan

BTL 100 ML

btl

1,654

221 Obat Batuk Hitam ( O.B.H. ) cairan

btl 200 ml

btl

3,858

222 Ofloxacin tablet 200 mg


tablet

654

223 Ofloxacin tablet 400 mg


tablet

907

224 Oksitetrasiklin HCl salep mata 1 %

ktk 25 tube @ 3,5 g

tube

2,033

225 Oksitetrasiklin salep kulit 3%

ktk 25 tube @ 3,5 g

tube

1,842

226 Oksitosin injeksi 10 IU/ml - 1 ml

kotak 30 ampul 1 ml

ampul

2,310

227 Omeprazol kapsul/kaplet 20 mg

Ktk 3 x 10 kapsul

kapsul

352

228 Oseltamivir kapsul/kaplet 75 mg


kapsul

18,018

KOTAK 100 AMPUL

ampul

1,623

ktk 10x10 tablet

tablet

155

229 Papaverin injeksi 40 mg/ml 230 Papaverin tablet 40 mg 231 Parasetamol drops 232 Parasetamol sirup 120 mg / 5 ml

Btl 15 ml

btl

7,244

BTL 60 ML

btl

1,733

233 Parasetamol tablet 100 mg

Botol 100 tablet

tablet

43

234 Parasetamol tablet 500 mg

ktk 10 x 10 tablet

tablet

102

BTL. 100 tab

tablet

76

Ktk 10 AMP @ 2ML

ampul

18,282

1 box isi 10 ampul

ampul

2,557

ktk 4 amp

ampul

7,271

239 Piracetam tablet 1200 mg

Ktk 3 x 10 tablet

tablet

654

240 Piracetam tablet 400 mg

Ktk 5 x 10 tablet

tablet

258

235 Perfenazin tablet 4 mg (HCl) 236 Petidin injeksi 50 mg/ml 237 Piracetam injeksi 1 g/5 ml 238 Piracetam injeksi 3 g/15 ml

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

241 Piracetam tablet 800 mg 242 Pirantel sirup 125 mg/5 ml

Ktk 5 x 10 tablet

tablet

426

BOTOL 60 ML

btl

ktk 7x4 tablet

tablet

348

ktk 10 x 10 tablet

tablet

263

245 Piroksikam kapsul/kaplet/tablet 10 mg

KTK 10 X 10

kapsul

91

246 Piroksikam kapsul/kaplet/tablet 20 mg

ktk 10 x 10 tablet

kapsul

112

243 Pirantel tablet score (base) 125 mg 244 Pirazinamid tablet 500 mg

11,557

247 Povidon Iodida larutan 10%

Btl 1000 ml

btl

40,961


btl 60 ml

btl

4,447


btl 300 ml

btl

17,787


BTL. 30 ML

btl

2,541

kotak 5 x 10 tablet

tablet

3,350

252 Prednison tablet 5 mg

ktk 10 str x 10's

tablet

72

253 Primakuin tablet 15 mg

ktk 10 str x 10's

tablet

158

251 Pravastatin tablet 20 mg

254 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial

Kotak 30 vial 15 ml

vial

8,559

255 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial

ktk 30 vial x 3 Jt IU

vial

8,559

256 Propanolol tablet 40 mg (HCl)

Botol 100 Tablet

tablet

150

ktk 10 strip x 10 tab

tablet

105

Botol plastik @ 100 tablet

tablet

374

259 Ramipril tablet 2,5 mg


tablet

347

260 Ramipril tablet 5 mg


tablet

612

261 Ranitidin injeksi 25 mg/2 ml

1 box isi 10 ampul

ampul

1,537

262 Ranitidin tablet 150 mg

Ktk 10 x 10 tablet

tablet

158

263 Reserpin tablet 0,10 mg

Kotak 10 x 10

tablet

112

264 Reserpin tablet 0,25 mg

Ktk 10 x 10

tablet

143

257 Propanolol tablet 10 mg ( HCl ) 258 Propiltiourasil tablet 100 mg

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

265 Retinol (Vitamin A) 100.000 IU kapsul lunak

btl 50 kapsul lunak

kapsul

307

266 Retinol (Vitamin A) 200.000 IU kapsul lunak

btl 50 kapsul lunak

kapsul

498

267 Rifampisin kapsul/kaplet 300 mg


kapsul

554

268 Rifampisin kapsul/kaplet 600 mg


tablet

1,087

Ktk 10 x 10 Kaplet

kapsul

789

269 Rifampisin tablet salut 450 mg 270 Ringer Laktat larutan infus

Botol 500 ml

btl

7,207

271 Risperidon tablet 1 mg

2 X 10 Tablet, Nama Dagang: Persidal

tablet

1,617

272 Risperidon tablet 2 mg

strip

tablet

2,468

273 Salbutamol tablet 2 mg (sebagai Sulfat)

ktk 10 x 10 tablet

tablet

85

274 Salbutamol tablet 4 mg (sebagai Sulfat)

ktk 10 x 10 tablet

tablet

109

POT @ 30 GR

pot

2,495

276 Salisil Bedak 2 %

ktk 50 gram

ktk

1,444

277 Salisil Bedak 2 %

Kotak 50 gram

ktk

1,444

Btl 60 ml

btl

6,970

275

Salep 2-4 , Kombinasi: Asam Salisilat 2% + Belerang endap 4%

278 Sefadroksil sirup kering 125 mg/5ml 279 Sefadroksil kapsul/kaplet 250 mg

KTK 5x10 Kapsul

kapsul

623

280 Sefadroksil kapsul/kaplet 500 mg

ktk 10 x 10 kapsul

kapsul

692

281 Sefaleksin kapsul/kaplet 250 mg

kotak 10 x 10 tablet, Nama Dagang: Kemolexin

kapsul

422

282 Sefaleksin kapsul/kaplet 500 mg


kapsul

1,647

283 Sefiksim 400 mg + Azitromisin 1000 mg

PAKET/AMPLOP

paket

45,738

284 Sefiksim kapsul/kaplet 100 mg

Ktk 5 x 10 kapsul

kapsul

1,273

btl 30 ml

btl

14,063

KTK 2 Vial

vial

8,085

ktk 2 vial

vial

3,222

285 Sefiksim sirup kering 100 mg/ 5 ml 286 Sefotaksim injeksi 0,5 g 287 Sefotaksim injeksi 1 g

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

288 Seftazidim injeksi 1 g

ktk 2 vial

vial

16,639

289 Seftriakson injeksi 1 g

ktk 2 vial

vial

3,425


ampul

1,344

291 Sianokobalamin (vitamin B12) tablet 50 mcg

ktk 10x10 tablet

tablet

17

292 Simetidin tablet 200 mg

ktk 10 str x 10's

tablet

148

293 Simetidin tablet 200 mg

Strip 10 x 10 Tablet

tablet

148

294 Simvastatin tablet 10 mg

Ktk 3 x 10 tablet

tablet

239


DS. 50 TAB

tablet

632


kotak 3 x 10 tablet, Nama Dagang: Rendapid

tablet

347

297 Siprofloksasin infus 2%

btl 100 ml

290 Sianokobalamin (vitamin B12) injeksi 500 mcg

btl

19,685

298 Siprofloksasin tablet 500 mg (sebagai HCl)

Ktk 10 x 10 tablet

tablet

320

299 Siprofloksasin tablet 250 mg (sebagai HCl)


tablet

329


tablet

1,922

BTL 60 Tab

tablet

1,169 5,105

300 Spiramisin tablet 500 mg 301 Stavudin tablet 30 mg 302 Streptomisin serbuk injeksi i.v 1000 mg/ml

Dus 56 vial @ 1 gram

vial

303 Sulfasalazin tablet 500 mg

Kotak 100 tab 500 mg

tablet

304 Sulfasetamida Natrium tetes mata 15 %

btl

4,471

box 30 tablet (merek: Tamofen)

tablet

1,964

306 Tetrasiklin kapsul/kaplet 250 mg

ktk 10x10 kapsul

kapsul

178

307 Tetrasiklin kapsul/kaplet 500 mg

KTK 10 X 10

kapsul

336

308 Tiamfenikol kapsul/kaplet 250 mg

Dus,10 strip@10 kapsul

kapsul

368

309 Tiamfenikol kapsul/kaplet 500 mg


kapsul

554

ktk 10x10 tablet

tablet

103

Kotak 30 ampul 1 ml

ampul

1,040

305 Tamoksifen tablet 20 mg

310 Tiamin (Vitamin B1) 100 mg tablet 311 Tiamin (Vitamin B1) injeksi 100 mg/ml

btl @ 5 ml

578

10.OBAT NO

JENIS BARANG


SATUAN

HARGA (Rp)

1

2

3

4

5

312 Tiamin (Vitamin B1) injeksi 100 mg/ml

ktk 30 amp x 1 ml

ampul

1,040

Kotak 5 ampul 1 ml

ampul

8,085

314 Tramadol kapsul/kaplet/tablet 50 mg


kapsul

261

315 Tramadol kapsul/kaplet/tablet 50 mg

ktk 5 X10 kapsul

kapsul

261

316 Trifluoperazin tablet 5 mg

(Dus, 10 strip @ 10 tablet salut gula)

tablet

505

317 Triheksifenidil tablet 2 mg


tablet

55

Ktk 10X10 TAB

tablet

274

319 Zidovudin tablet 100 mg

BTL 60 KAP

kapsul

1,316

320 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg

btl 60 tablet

tablet

4,320

ktk 10 x 10 tablet

tablet

647

313 Tramadol injeksi 50 mg/ml

318 Verapamil tablet 80 mg (HCl)

321 Zinc tablet 20 mg

-

STANDAR SATUAN HARGA TAHUN ANGGARAN 2014 PEMERINTAH KOTA JAYAPURA

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