RENCANA USULAN PEMBELIAN OBAT DAN CAIRAN

BERSUMBER DANA BLUD 2023

UPTD PUSKESMAS JATIWANGI TAHUN 2023

HARGA
NO NAMA BARANG SPESIFIKASI SATUAN SATUAN (+ PPn ONGKOS KIRIM
10%)

Acetylcystein 200 mg, Expire

1 ACETYLCYSTEIN 200 MG Kapsul 404 0
Maksimal 24 bulan

Air untuk injeksi/ Aqua pro

2 AQUA PRO INJEKSI injeksi/ Aqua pro injection/ water Botol Plastik 2,955 0
for injection ampul @ 25 mL

Amlodipin/ Amlodipine/
3 AMLODIPIN 10 MG Amlodipine besilate Tablet 119 0
tablet/kapsul/kaplet 10 mg

4 CALCIUM GLUCONAS INJEKSI

Cefadroxil monohydrate/
5 CEFADROXIL 500 MG Cefadroxil/ Sefadroksil Kapsul 816 0
tablet/kapsul/kaplet 500 mg
Cefixime trihydrate/ Cefixime/
6 CEFIXIME 100 MG Sefiksim tablet/kapsul/kaplet 100 Tablet 770 0
mg

7 CLINDAMYCIN 300 MG Clindamycin 300 mg Kapsul 888 0

Deksametason/ Dexamethasone
8 DEKSAMETASON TABLET Tablet 66 0
tablet/kapsul/kaplet 0,5 mg

Domperidon/ Domperidone/
9 DOMPERIDONE TAB Domperidone Maleate Tablet 153 0
tablet/kapsul/kaplet 10 mg

10 GUAIFENISIN TAB GUAIFENESIN 100 mg tablet Tablet 85 0

Ibuprofen tablet/kapsul/kaplet
11 IBUPROFEN 400 MG TAB 400 mg Tablet 190 0

12 LORATADINE 10 MG Loratadine/ Loratadin Tablet 115 0

tablet/kapsul/kaplet 10 mg

13 KARBOGLISERIN TETES TELINGA Karbogliserin tetes telinga 10% Botol 6,100 0

 HARGA
NO NAMA BARANG SPESIFIKASI SATUAN SATUAN (+ PPn ONGKOS KIRIM
10%)

Metilprednisolon/
14 METHYLPREDNISOLON 4 MG Methylprednisolone Tablet 185 0
tablet/kapsul/kaplet 16 mg

15 NACL 100 ML NaCl / Sodium Chloride 0,9%, @ Botol Plastik 7,125 0

100 mL

Diclofenac sodium/ Natrium

16 NATRIUM DICLOFENAC 50 MG diklofenak tablet salut Tablet 143 0
enterik/kaplet salut enterik 50 mg

PARASETAMOL, PSEUDOEFEDRIN,
17 NOVACOLIN TABLET CTM Tablet 360 0

18 NOVADRYL TABLET NOVADRYL tablet Tablet 335 0

(DEXTROMETORPHAN, CTM)

19 PIROXICAM 10 MG TAB PIROXICAM 10 MG_OGB Tablet 145 0

Ringer Laktat/ Ringer Lactate

20 RINGER LAKTAT Pcs 8,498 0
@500 mL

Zinc sulfate/ Zinc sulfate

21 ZINC 20 MG monohydrate/Zinc/ Zinc tablet Tablet 186 0.00
dispersible 20 mg

TOTAL

Mengetahui,
Kepala UPTD Puskesmas Jatiwangi

dr. H. Apuh Alifuchin

NIP.

DAFTAR PENGADAAN YG GA DI COVER

AMBROXOL TAB JUMLAH SEDIKIT
AMLODIPIN 10 MG
DOMPERIDONE TAB JUMLAH SEDIKIT
METHYLPREDNISOLON JUMLAH SEDIKIT
ACETYLCYSTEINE KAPSUL
MULTIVITAMIN
AN CAIRAN
3
UN 2023

KEBUTUHAN JUMLAH DISTRIBUTOR LINK

PT INDOFARMA
6000 2,424,000.00
(PERSERO) TBK
https://e-katalog.lkpp.go.id/katalog/produk/detail/48084008?type=p

PT OTSUKA
30 88,650.00 INDONESIA- https://e-katalog.lkpp.go.id/katalog/produk/detail/49208001?type=p
RAJAWALI

RAJAWALI-
15000 1,785,000.00
NOVAPHARIN
https://e-katalog.lkpp.go.id/katalog/produk/detail/45447530?type=p

5000 4,080,000.00 PT NOVAPHARIN

1000 770,000.00 PT HEXPHARM JAYA

LABORATORIES

600 532,800.00 PT INDOFARMA

(PERSERO) TBK
https://e-katalog.lkpp.go.id/katalog/produk/detail/48731270?type=p

PT NOVAPHARIN- https://e-katalog.lkpp.go.id/katalog/produk/
6,000 396,000.00
RAJAWALI detail/47710538?
type=province&location_id=12

PT NOVAPHARIN-
4000 612,000.00
RAJAWALI
https://e-katalog.lkpp.go.id/katalog/produk/detail/47711566?type=p

12,000 1,020,000.00 PT NOVAPHARIN- https://e-katalog.lkpp.go.id/katalog/produk/detail/48138765?type=p

RAJAWALI

PT NOVAPHARIN-
12,000 2,280,000.00 RAJAWALI
https://e-katalog.lkpp.go.id/katalog/produk/detail/47713915?type=p

6000 690,000.00 PT NOVAPHARIN-

RAJAWALI
https://e-katalog.lkpp.go.id/katalog/produk/detail/47715127?type=p

100 610,000.00 PT LUCAS-RAJAWALI https://e-katalog.lkpp.go.id/katalog/produk/

detail/49432393?
type=province&location_id=12
KEBUTUHAN JUMLAH DISTRIBUTOR LINK

PT NOVAPHARIN-
6000 1,110,000.00
RAJAWALI
https://e-katalog.lkpp.go.id/katalog/produk/detail/47715127?type=p
PT OTSUKA
200 1,425,000.00 INDONESIA-
RAJAWALI
https://e-katalog.lkpp.go.id/katalog/produk/detail/49352404?type=p

PT NOVAPHARIN-
15,000 2,145,000.00 RAJAWALI
https://e-katalog.lkpp.go.id/katalog/produk/detail/47710884?lang=id

PT NOVAPHARIN-
3,000 1,080,000.00 RAJAWALI
https://e-katalog.lkpp.go.id/katalog/produk/detail/53326854?type=p

5,000 1,675,000.00 PT NOVAPHARIN-

RAJAWALI https://e-katalog.lkpp.go.id/katalog/produk/
detail/48142727?
type=province&location_id=12
PT SEJAHTERA
12,000 1,740,000.00 LESTARI FARMA
PT OTSUKA
300 2,549,400.00 INDONESIA-
RAJAWALI https://e-katalog.lkpp.go.id/katalog/produk/detail/49324119?type=p

2500 465,000.00 PT NOVAPHARIN

https://e-katalog.lkpp.go.id/katalog/produk/detail/47735003?lang=id

27,477,850.00

Bandung, 31 Januari 2023

Pengelola Barang

apt. Vitananda Tiara Maharani, S.Farm

NIP. 19960501 202203 2 022
 RENCANA USULAN PEMBELIAN BAHAN HABIS PAKAI ALAT KESEHATAN
BERSUMBER DANA JKN 2019
PUSKESMAS DTP SUMBERJAYA TAHUN 2019

HARGA
NO NAMA BARANG SPESIFIKASI SATUAN SATUAN (+ PPn ONGKOS KIRIM
10%)
1 Cellulose Matrix Strip Svenska Dentorama Cellulose Box 151,000 44,000
Matrix Strip
2 Bur Carbide Highspeed Round Meisinger Bur Carbide Highspeed Box 200,000 11,000
Round
3 Composit Finishing Kit Edenta Composit Finishing Kit Box 799,000 44,000

4 Cresotin Liquid No. 2 Tehnodent Cresotin Liquid No. 2 Botol 160,500 10,893.75

5 Gutta Percha Point Ukuran #45/80 Dentplus Gutta Percha Point Box 45,000 22,000
Ukuran #45/80
6 Dental Cotton Roll 12x50 (Kapas Wellness Dental Cotton Roll 12x50 Piece 34,400 580
Gigi) isi 600 pcs (Kapas Gigi)
7 1470A3 Z250 XT Rest Syr 3G 3M 1470A3 Z250 XT Rest Syr 3G Dus 187,725 0
LA/APAC/MEA LA/APAC/MEA
8 44130 Cavit W 3M 44130 Cavit W Dus 109,714 0

9 61104 Ketac Universal HM Intro Kit 3M 61104 Ketac Universal HM Dus 437,547 0
A3 Intro Kit A3
10 7423 Etchant Gel Vial 9 ml 3M 7423 Etchant Gel Vial 9 ml Botol 120,227 0

11 Bisturi Serenity Carbon Steel Surgical Box 52,313 0

Blade (Box 100) Size No. 10-24
12 Cannula 22G Polymed MMP Polywin IV. Piece 11,000 550
Cannula 22G
13 Cannula 24G Polymed MMP Polywin IV. Piece 12,210 550
Cannula 24G
14 Cannula 26G Polymed MMP Polywin IV. Piece 13,090 660
Cannula 26G
15 Infusion Set for Adult Onionex Infusion Set for Adult Piece 3,190 287.10

16 Infusion Set for Pediatric Onionex Infusion Set for Pediatric Piece 3,290 296.10

17 Masker Imaske Surgical Face Mask Tie On Box 20,570 0

18 Remedi Apron 25 Micron Remedi Apron 25 Micron Piece 2,100 189

TOTAL

Mengetahui,
Kepala Puskesmas DTP Sumberjaya
 HARGA
NO NAMA BARANG SPESIFIKASI SATUAN SATUAN (+ PPn ONGKOS KIRIM
10%)

dr. Hj. Nina Nurainy Syarief

NIP. 19711110 200212 2 003
AN BAHAN HABIS PAKAI ALAT KESEHATAN
MBER DANA JKN 2019
TP SUMBERJAYA TAHUN 2019

KEBUTUHAN JUMLAH DISTRIBUTOR

2 390,000.00 PT. Cobra Dental

Indonesia
2 422,000.00 PT. Cobra Dental
Indonesia
4 3,372,000.00 PT. Cobra Dental
Indonesia
1 171,393.75 PT. Cobra Dental
Indonesia
3 201,000.00 PT. Cobra Dental
Indonesia
17 594,660.00 PT. Cottonindo Ariesta

4 750,900.00 3M Indonesia Importama

4 438,856.00 3M Indonesia Importama

2 875,094.00 3M Indonesia Importama

2 240,454.00 3M Indonesia Importama

10 523,130.00 PT. Serenity Indonesia

10 115,500.00 PT. Megah Medika

Pharma
10 127,600.00 PT. Megah Medika
Pharma
10 137,500.00 PT. Megah Medika
Pharma
50 173,855.00 PT. Prima Alkesindo
Nusantara
50 179,305.00 PT. Prima Alkesindo
Nusantara
10 205,700.00 PT. Industri Masker
Kreatif Teknologi
50 114,450.00 PT. Anugrah Mitra
Selaras
9,033,397.75

Sumberjaya, 31 Januari 2019

Pengelola Barang
KEBUTUHAN JUMLAH DISTRIBUTOR

Luzy Raudho Meilani, SKM

NIP. 19770530 200604 2 008