DAFTAR HARGA (EXCL PPN) TAHUN 2021

PRODUK PT. KIMIA FARMA (REGULER & BPJS)

2021 2021
NO SAP NAMA PRODUK KEMASAN
HNA EXCL HNA EXCL
OGB & PRODUK KHUSUS REGULER BPJS
1 11000000 ACYCLOVIR 200 MG (DUS 100 TAB) DUS 55,567
2 11000002 ACYCLOVIR 400 MG (DUS 100 TAB) DUS 93,593
3 11000004 ACYCLOVIR CREAM 5%(DUS 25 TUBE @ 5 GRAM) TUB 3,162
4 11000145 ALBENDAZOL 400 MG (DUS 100 TAB KUNYAH) DUS 51,164
5 11000146 ALLOPURINOL 100 MG (DUS 100 TAB) DUS 22,683
6 11000008 ALPRAZOLAM 0,5 MG (DUS 100 TAB) DUS 35,000
7 11000009 ALPRAZOLAM 1 MG (DUS 100 TAB) DUS 55,000
8 11000147 AMBROXOL 30 MG (DUS 100 TAB) DUS 21,528
9 11000149 AMBROXOL SIRUP (BTL 60 ML) BT 4,509
10 11000150 AMLODIPINE 5 MG (DUS 50 TAB) DUS 15,000 2,409
11 11000151 AMLODIPINE 10 MG (DUS 50 TAB) DUS 25,000
12 11000011 AMOXICILLIN 500 MG (DUS 100 TAB) DUS 37,809
13 11000012 AMPICILLIN 500 MG (DUS 100 TAB) DUS 37,479
14 11000152 ANTASIDA DOEN (DUS 100 TAB) DUS 34,239
15 11000013 ANTASIDA DOEN SUSPENSI (BTL 60 ML) BTL 8,913
16 11000291 ANTIHEMOROID (DUS 10 SUPP) DUS 33,000 29,545
17 11000014 ASAM MEFENAMAT 500 MG (DUS 100 TAB) DUS 50,364
18 11001586 ATORVASTATIN TABLET 10 MG DUS 50,000 8,808
19 11001587 ATORVASTATIN TABLET 20 MG DUS 75,000 12,735
20 11001588 ATORVASTATIN TABLET 40 MG DUS 100,000
21 11000016 AZITHROMYCIN 500 MG (DUS 20 TAB) DUS 26,880 22,727
22 11000383 BETAMETASON 0,1% CR(DUS 25 TUBE@5 GRAM) TUB 2,217
23 11000385 BETASON CREAM (TUBE 5 GRAM) TUB 7,950
24 11000384 BETASON N CREAM (TUBE 5 GRAM) TUB 13,475
25 11000386 CALCIUM LACTAT 500 MG (DUS 100 TAB) DUS 18,876
26 11000161 CAPTOPRIL 12.5 MG TAB (DUS 100 TAB) DUS 15,926
27 11000424 CAPTOPRIL 25 MG (DUS 100 TAB) DUS 16,465
28 11000022 CEFADROXIL 500 MG (DUS 50 KAPS) DUS 65,905
29 11000024 CEFIXIME 100 MG (DUS 30 KAPS) DUS 35,000
30 11000025 CETIRIZINE 10 MG (DUS 30 TAB) DUS 11,000
31 11000026 CHLORAMFECORT CREAM (TUBE 10 GRAM) TUB 13,400
32 11000027 CHLORAMFECORT H CREAM (TUBE 10 GRAM) TUB 11,500
33 11000295 CHLORAMFENICOL 1 % S. MATA (TUBE 5 GRAM) TUB 4,700
34 11000388 CHLORAMPHENICOL 250 MG (DUS 100 KAPS) DUS 61,622
35 11000164 CHLORAMPHENICOL SUSPENSI (BTL 60 ML) BT 8,044
36 11000167 CHLORPROMAZIN 100 MG (DUS 100 TAB) DUS 41,407
37 11000169 CIMETIDINE 200 MG (DUS 100 TAB) DUS 33,407
38 11000029 CIPROFLOXACIN 500 MG (DUS 50 TAB) DUS 34,393
39 11000170 CLONIDINE 0.15 MG (DUS 100 TAB) DUS 16,422 13,273
40 11000171 CLOPIDOGREL 75 MG (DUS 30 TAB) DUS 50,000 15,682
41 11000033 CODEINE 10 MG (DUS 100 TAB) DUS 62,270 54,545
42 11000035 CODEINE 15 MG TAB (DUS 100 TAB) DUS 112,180 92,273
43 11000037 CODEINE 20 MG TAB (DUS 100 TAB) DUS 147,600 123,636
44 11000173 COTRIMOXAZOLE ADULT (DUS 100 TAB) DUS 33,341
45 11000175 COTRIMOXAZOLE SUSPENSI (BTL 60 ML) BT 5,994
46 11002019 D-5 GLUKOSA LARUTAN INFUS 5% BT 7,348
47 11000182 DEXAMETHASONE 0.5 MG (DUS 100 TAB) DUS 14,843
48 11000049 DIAZEPAM 2 MG (BTL 100 TAB) BT 12,478 6,364
 2021 2021
NO SAP NAMA PRODUK KEMASAN
HNA EXCL HNA EXCL
OGB & PRODUK KHUSUS REGULER BPJS
49 11000187 DILTIAZEM 30 MG (DUS 100 TAB) DUS 19,328
50 11000188 DIMENHYDRINATE 50 MG (BTL 100 TAB) BT 14,755 9,818
51 11000056 DOXYCYCLINE (DUS 100 KAPS) DUS 58,760
52 11000192 ERGOTAMINE COFFEINE (BTL 100 TAB) BT 21,363
53 11000065 ERYTHROMYCIN 250 MG (DUS 100 KAPS) DUS 85,343
54 11000067 ERYTHROMYCIN SIRUP KERING (BTL 60 ML) BT 12,223
55 11000193 ETHAMBUTOL 250 MG (DUS 200 TAB) DUS 88,383
56 11000194 ETHAMBUTOL 500 MG (DUS 100 TAB) DUS 75,230
57 11000310 EUGENOL (BTL 10 ML) BT 24,000 18,318
58 11000071 FLUCONAZOLE 150 MG (DUS 10 KAPS) DUS 170,182 170,182
59 11000200 FUROSEMIDE 40 MG (DUS 200 TAB) DUS 29,250
62 11000391 GENTAMYCIN 0,1 % (DUS 10 TUBE @ 5 GRAM) TUB 2,670
63 11000072 GLIBENCLAMIDE 5 MG (DUS 100 TAB) DUS 18,940 7,455
64 11000073 GLIMEPIRIDE 1 MG (DUS 50 TAB) DUS 18,000
65 11000074 GLIMEPIRIDE 2 MG (DUS 50 TAB) DUS 30,000
66 11000075 GLIMEPIRIDE 3 MG (DUS 50 TAB) DUS 35,000
67 11000076 GLIMEPIRIDE 4 MG (DUS 50 TAB) DUS 40,000
68 11000202 GRISEOFULVIN 125 MG(DUS 100 TAB) DUS 30,590 19,091
69 11001612 GUAIFENESIN 100 MG TAB DUS 20,000
70 11000204 HYDROCLOROTIAZID 25 MG (DUS 100 TAB) DUS 16,500 13,455
71 11000394 HYDROCORTISONE 2,5%CR(DUS 24TUBE@ 5GRAM) TUB 3,458 2,114
72 11002004 HYDROXYCHLOROQUINE 200 MG (DUS 100 TAB) DUS 874,000 225,000
73 11000302 IODINE POVIDONE LAR 10 % (BTL 1000 ML) BT 48,818
74 11000306 IODINE POVIDONE LAR 10 % (BTL 300 ML) BT 15,636
75 11000303 IODINE POVIDONE LAR 10 % (BTL 60 ML) BT 5,711 3,864
76 11000305 IODINE POVIDONE LAR 10% (BTL 30 ML) BT 5,000 2,773
77 11000208 ISONIAZID 100 MG (DUS 100 TAB) DUS 16,340 6,818
78 11000210 ISONIAZID 300 MG (DUS 100 TAB) DUS 23,846 13,636
79 11000395 KETOCONAZOLE 2 % CREAM (TUBE 10 GRAM) TUB 4,000
80 11000213 KETOCONAZOLE 200 MG (DUS 50 TAB) DUS 28,936
81 11000216 KINA (DUS 24 STRIP) STR 14,800
82 11000091 LAMIVUDINE 100 MG TAB (BTL 30 TAB) BT 70,000 44,727
83 11000217 LEVOFLOXACIN 500 MG (DUS 50 TAB) DUS 35,000 16,955
84 11000220 MELOXICAM 15 MG (DUS 20 TAB) DUS 14,500
85 11000219 MELOXICAM 7,5 MG (DUS 20 TAB) DUS 8,000
86 11001734 MEROPENEM INJ 0,5 G DUS 415,000
87 11001733 MEROPENEM INJ 1 G DUS 550,000
88 11001386 METAMIZOLE SODIUM 500 MG TAB DUS 10X10 DUS 26,500
89 11000104 METHYLERGOMETRINE 0,125 MG (DUS 100 TAB) DUS 24,944 19,455
90 11000222 METOCLOPRAMID 10 MG (DUS 100 TAB) DUS 13,000 6,000
91 11000221 METOCLOPRAMID 5 MG (DUS 100 TAB) DUS 12,000 10,636
92 11000223 METRONIDAZOLE 250 MG (DUS 100 TAB) DUS 23,433
93 11000225 METRONIDAZOLE 500 MG (DUS 100 TAB) DUS 32,813
94 11000296 MICONAZOLE 2 % CR(DUS 24 TUBE@10 GRAM) TUB 3,750 1,727
95 11001043 MORFINA 10 MG/ML INJEKSI (IMPOR) DUS 309,545
96 11000106 MORPHINE 10 MG (BTL 30 TAB) BT 39,709 32,700
97 11002020 NACL 0,9% INFUS BT 6,840 6,182
98 11000107 NATRIUM DIKLOFENAK 25 MG (DUS 50 TAB) DUS 14,854 5,227
99 11000108 NATRIUM DIKLOFENAK 50 MG (DUS 50 TAB) DUS 18,346 4,500
100 11000227 NIFEDIPIN 10 MG (DUS 100 TAB) DUS 20,016
101 11000115 OMEPRAZOLE 20 MG (DUS 30 KAPS) DUS 17,996 3,518
 2021 2021
NO SAP NAMA PRODUK KEMASAN
HNA EXCL HNA EXCL
OGB & PRODUK KHUSUS REGULER BPJS
102 11000229 ORALIT (DUS 100 SASE) DUS 83,187
103 11000297 OXYTETRACYCLIN 1% SM(DUS 25TUBE@3,5GRAM) TUB 3,629 3,182
104 11000298 OXYTETRACYCLIN 3% SK(DUS 25 TUBE@5 GRAM) TUB 1,881
105 11000230 PAPAVERIN 40 MG (DUS 100 TAB) DUS 15,681
106 11000397 PARACETAMOL 500 MG (DUS 100 TAB) DUS 24,953
107 11000232 PARACETAMOL SIRUP (BTL 60 ML) BT 5,500
108 11001044 PETHIDIN HCL 50 MG/ML INJEKSI (IMPOR) DUS 177,100
109 11000233 PHENOBARBITAL 30 MG TAB (DUS 100 TAB) DUS 17,000 16,545
110 11000241 PIROXICAM 10 MG (DUS 100 TAB) DUS 15,968
111 11000243 PIROXICAM 20 MG (DUS 100 TAB) DUS 22,458
112 11001426 PREGABALIN CAPS 150 MG DUS 270,000
113 11001425 PREGABALIN CAPS 75 MG DUS 195,000
114 11000121 PROPRANOLOL HCL 40 MG (DUS 100 TAB) DUS 26,904
115 11000248 PYRANTEL 125 MG (DUS 100 TAB) DUS 62,918
116 11000251 PYRAZINAMIDE 500 MG (DUS 100 TAB) DUS 37,625
117 11000253 QUININE 222 MG TAB (DUS 60 TAB) DUS 40,200 34,636
118 11000122 QUININE HCL 250MG/ML INJ (DUS 100 AMP) DUS 230,000
119 11000256 RANITIDIN 150 MG (DUS 30 TAB) DUS 12,905
120 11000124 RIFAMPICIN 450 MG (DUS 100 TAB) DUS 196,974 84,909
121 11000125 RIFAMPICIN 600 MG (DUS 100 TAB) DUS 215,916 112,091
122 11002018 RINGER LAKTAT INFUS BT 7,630 6,936
123 11002084 ROSUVASTATIN 10 MG DUS 90,000 20,016
124 11002083 ROSUVASTATIN 20 MG DUS 120,000
125 11000259 SALBUTAMOL 2 MG (DUS 100 TAB) DUS 10,298
126 11000262 SALBUTAMOL 4 MG (DUS 100 TAB) DUS 12,953
127 11000264 SIMVASTATIN 10 MG (DUS 50 TAB) DUS 14,000
128 11000266 SIMVASTATIN 20 MG (DUS 50 TAB) DUS 27,000 6,818
129 11000268 SULFADOXINE PYRIMETHAMINE (DUS 100 TAB) DUS 97,147
130 11000793 TABLET TAMBAH DARAH NEO (TSG)(DUS100TAB) DUS 45,000 20,545
131 11000128 TETRACYCLINE 250 MG (DUS 100 KAPS) DUS 44,361
132 11000130 TETRACYCLINE 500 MG (DUS 100 KAPS) DUS 95,000
133 11000133 TRAMADOL 50 MG (DUS 50 KAPS) DUS 23,425
134 11000136 TRINOLON 4 MG (DUS 50 TAB) DUS 65,000
135 11002086 VALSARTAN 160 MG DUS 120,000
136 11002134 VALSARTAN 80 MG DUS 80,000
137 11000274 VERAPAMIL 80 MG (DUS 100 TAB) DUS 43,550
138 11000487 VITAMIN B KOMPLEKS(SUPLEMEN)(DUS100TAB) DUS 12,917
139 11000275 VITAMIN B1 100 MG TAB(SUPL)(DUS 100 TAB) DUS 23,700
140 11000488 VITAMIN B1 50 MG (SUPLEMEN)(DUS100TAB) DUS 18,343
141 11000279 VITAMIN B12 0.05 MG TAB(OLD)(DUS 100TAB) DUS 9,868
142 11000485 VITAMIN B12 50 MCG (SUPLEMEN)(DUS100TAB) DUS 7,105 3,909
143 11000486 VITAMIN B6 10 MG (SUPLEMEN)(DUS100TAB) DUS 12,800
144 11000283 VITAMIN C 100 MG TAB(SUPL)(DUS 100TAB) DUS 15,036
145 11000489 VITAMIN C 250 MG (SUPLEMEN)(DUS100TAB) DUS 18,200
146 11000288 VITAMIN C 50 MG TAB (SUPL)(DUS 100 TAB) DUS 14,291 3,818
147 11000144 ZINK DISPERSIBEL (DUS 100 TAB) DUS 43,180
148 11001447 AMBROXOL SYRUP (BTL 60 ML)-BJN BTL 4,509
149 11001452 ANTASIDA DOEN SUSPENSI-BJN (BTL60ML)-BJN BT 8,913
150 11001478 DIMENHYDRINATE 50 MG (DUS 100 TAB)-BJN DUS 14,755
151 11002085 FAVIPIRAVIR 200 MG (DUS 100 TAB) DUS 1,500,000
152 11002048 LEVOFLOXACIN HEMIHYDRATE 500 MG TSS DUS 35,000 16,955
 2021 2021
NO SAP NAMA PRODUK KEMASAN
HNA EXCL HNA EXCL
OGB & PRODUK KHUSUS REGULER BPJS
153 11000236 MIKRODIOL BLT 6,500
ALKES
154 11001993 KIFAMED SURGICAL FACE MASK EARLOOP (5) BKS 6,818
155 11001988 KIFAMED SURGICAL FACE MASK HIJAB (5) BKS 10,000
156 11001989 KIFAMED SURGICAL FACE MASK EARLOOP (50) DUS 40,909
157 11001913 KIFAMED TONGKAT KAKI SATU LIPAT PC 77,273
158 11001914 KIFAMED TONGKAT KAKI SATU STANDARD PC 81,818
159 11001915 KIFAMED TONGKAT KAKI SATU SENTER PC 170,455
160 11001916 KIFAMED TONGKAT KAKI SATU KETIAK PC 145,455
161 11001994 KIFAMED TONGKAT KAKI EMPAT CABANG PC 95,455
162 11001995 KIFAMED TONGKAT KAKI EMPAT BERODA PC 290,909
163 11001996 KIFAMED TONGKAT KAKI EMPAT WALKER PC 259,091
164 11002008 KIMIA FARMA COVID-19 TEST PC 1,636,364
 DAFTAR HARGA (EXCL PPN) TAHUN 2021
PRODUK PT. KIMIA FARMA (REGULER & BPJS)

NO SAP NAMA PRODUK KEMASAN HARGA (99) HARGA (02) BPJS

Reguler

GENERIK
1 11000000 ACYCLOVIR 200 MG (DUS 100 TAB) DUS 55,567
2 11000002 ACYCLOVIR 400 MG (DUS 100 TAB) DUS 93,593
3 11000004 ACYCLOVIR CREAM 5%(DUS 25 TUBE @ 5 GRAM) TUB 3,162
4 11000145 ALBENDAZOL 400 MG (DUS 100 TAB KUNYAH) DUS 51,164
5 11000146 ALLOPURINOL 100 MG (DUS 100 TAB) DUS 22,683
6 11000008 ALPRAZOLAM 0,5 MG (DUS 100 TAB) DUS 35,000
7 11000009 ALPRAZOLAM 1 MG (DUS 100 TAB) DUS 55,000
8 11000147 AMBROXOL 30 MG (DUS 100 TAB) DUS 21,528
9 11000149 AMBROXOL SIRUP (BTL 60 ML) BT 4,509
10 11000150 AMLODIPINE 5 MG (DUS 50 TAB) DUS 15,000 2,409
11 11000151 AMLODIPINE 10 MG (DUS 50 TAB) DUS 25,000
12 11000011 AMOXICILLIN 500 MG (DUS 100 TAB) DUS 37,809
13 11000012 AMPICILLIN 500 MG (DUS 100 TAB) DUS 37,479
14 11000152 ANTASIDA DOEN (DUS 100 TAB) DUS 34,239
15 11001452 ANTASIDA DOEN SUSPENSI-BJN (BTL60ML)-BJN BT 8,913
16 11000291 ANTIHEMOROID (DUS 10 SUPP) DUS 33,000 29,545
17 11000014 ASAM MEFENAMAT 500 MG (DUS 100 TAB) DUS 50,364
18 11001586 ATORVASTATIN TABLET 10 MG DUS 50,000
19 11001587 ATORVASTATIN TABLET 20 MG DUS 75,000
20 11001588 ATORVASTATIN TABLET 40 MG DUS 100,000
21 11000016 AZITHROMYCIN 500 MG (DUS 20 TAB) DUS 26,880 22,727
22 11000383 BETAMETASON 0,1% CR(DUS 25 TUBE@5 GRAM) TUB 2,217
23 11000385 BETASON CREAM (TUBE 5 GRAM) TUB 7,950
24 11000384 BETASON N CREAM (TUBE 5 GRAM) TUB 13,475
25 11000386 CALCIUM LACTAT 500 MG (DUS 100 TAB) DUS 18,876
26 11000161 CAPTOPRIL 12.5 MG TAB (DUS 100 TAB) DUS 15,926
27 11000424 CAPTOPRIL 25 MG (DUS 100 TAB) DUS 16,465
28 11000022 CEFADROXIL 500 MG (DUS 50 KAPS) DUS 65,905
29 11000024 CEFIXIME 100 MG (DUS 30 KAPS) DUS 35,000
30 11000025 CETIRIZINE 10 MG (DUS 30 TAB) DUS 11,000
31 11000026 CHLORAMFECORT CREAM (TUBE 10 GRAM) TUB 13,400
32 11000027 CHLORAMFECORT H CREAM (TUBE 10 GRAM) TUB 11,500
33 11000295 CHLORAMFENICOL 1 % S. MATA (TUBE 5 GRAM) TUB 4,700
34 11000388 CHLORAMPHENICOL 250 MG (DUS 100 KAPS) DUS 61,622
35 11000164 CHLORAMPHENICOL SUSPENSI (BTL 60 ML) BT 8,044
36 11000165 CHLOROQUIN 150 MG TAB (DUS 100) DUS 37,568 25,909
37 11000167 CHLORPROMAZIN 100 MG (DUS 100 TAB) DUS 41,407
38 11000169 CIMETIDINE 200 MG (DUS 100 TAB) DUS 33,407
39 11000029 CIPROFLOXACIN 500 MG (DUS 50 TAB) DUS 34,393
40 11000170 CLONIDINE 0.15 MG (DUS 100 TAB) DUS 16,422 13,273
41 11000171 CLOPIDOGREL 75 MG (DUS 30 TAB) DUS 50,000 15,682
42 11000033 CODEINE 10 MG (DUS 100 TAB) DUS 62,270 54,545
43 11000035 CODEINE 15 MG TAB (DUS 100 TAB) DUS 112,180 92,273
44 11000037 CODEINE 20 MG TAB (DUS 100 TAB) DUS 147,600 123,636
45 11000173 COTRIMOXAZOLE ADULT (DUS 100 TAB) DUS 33,341
46 11000175 COTRIMOXAZOLE SUSPENSI (BTL 60 ML) BT 5,994
47 11002019 D-5 GLUKOSA LARUTAN INFUS 5% BT 6,680
48 11000182 DEXAMETHASONE 0.5 MG (DUS 100 TAB) DUS 14,843
49 11000049 DIAZEPAM 2 MG (BTL 100 TAB) BT 12,478 6,364
50 11000185 DIETHYLCARBAMAZINE 100 MG (DUS 100 TAB) DUS 20,000
51 11000187 DILTIAZEM 30 MG (DUS 100 TAB) DUS 19,328
52 11000188 DIMENHYDRINATE 50 MG (BTL 100 TAB) BT 14,755 9,818
53 11000056 DOXYCYCLINE (DUS 100 KAPS) DUS 58,760
54 11002063 ENTECAVIR 0,5 MG BT 174,000
55 11002064 ENTECAVIR 1 MG BT 218,182
56 11000192 ERGOTAMINE COFFEINE (BTL 100 TAB) BT 21,363
57 11000065 ERYTHROMYCIN 250 MG (DUS 100 KAPS) DUS 85,343
58 11000067 ERYTHROMYCIN SIRUP KERING (BTL 60 ML) BT 12,223
59 11000193 ETHAMBUTOL 250 MG (DUS 200 TAB) DUS 88,383
60 11000194 ETHAMBUTOL 500 MG (DUS 100 TAB) DUS 75,230
61 11000310 EUGENOL (BTL 10 ML) BT 24,000 18,318
NO SAP NAMA PRODUK KEMASAN HARGA (99) HARGA (02) BPJS
Reguler

62 11002085 FAVIPIRAVIR 200 MG (DUS 100 TAB) DUS 1,500,000

63 11000071 FLUCONAZOLE 150 MG (DUS 10 KAPS) DUS 170,182 170,182
64 11000200 FUROSEMIDE 40 MG (DUS 200 TAB) DUS 29,250
65 11000391 GENTAMYCIN 0,1 % (DUS 10 TUBE @ 5 GRAM) TUB 2,670
66 11000072 GLIBENCLAMIDE 5 MG (DUS 100 TAB) DUS 18,940 7,455
67 11000073 GLIMEPIRIDE 1 MG (DUS 50 TAB) DUS 18,000
68 11000074 GLIMEPIRIDE 2 MG (DUS 50 TAB) DUS 30,000
69 11000075 GLIMEPIRIDE 3 MG (DUS 50 TAB) DUS 35,000
70 11000076 GLIMEPIRIDE 4 MG (DUS 50 TAB) DUS 40,000
71 11000202 GRISEOFULVIN 125 MG(DUS 100 TAB) DUS 30,590 19,091
72 11001612 GUAIFENESIN 100 MG TAB DUS 20,000
73 11000204 HYDROCLOROTIAZID 25 MG (DUS 100 TAB) DUS 16,500 13,455
74 11000394 HYDROCORTISONE 2,5%CR(DUS 24TUBE@ 5GRAM) TUB 3,458 2,114
75 11002004 HYDROXYCHLOROQUINE 200 MG (DUS 100 TAB) DUS 325,104 225,000
76 11000302 IODINE POVIDONE LAR 10 % (BTL 1000 ML) BT 48,818
77 11000306 IODINE POVIDONE LAR 10 % (BTL 300 ML) BT 15,636
78 11000303 IODINE POVIDONE LAR 10 % (BTL 60 ML) BT 5,711 3,864
79 11000305 IODINE POVIDONE LAR 10% (BTL 30 ML) BT 5,000 2,773
80 11000308 IODIUM TEST (BTL 10 ML) BT 5,159
81 11000307 IODIUM TEST KIT (DUS 6 BTL) DUS 5,004
82 11000208 ISONIAZID 100 MG (DUS 100 TAB) DUS 16,340 6,818
83 11000210 ISONIAZID 300 MG (DUS 100 TAB) DUS 23,846 13,636
84 11000395 KETOCONAZOLE 2 % CREAM (TUBE 10 GRAM) TUB 4,000
85 11000213 KETOCONAZOLE 200 MG (DUS 50 TAB) DUS 28,936
86 11000216 KINA (STRIP) STR 14,800
87 11000088 KOMBIPAK AZITHROMYCIN-CEFIXIME (PAKET) PET 50,000 28,392
88 11000090 LAMIVUDIN150MG+ZIDOVUDIN300MG (BTL60TAB) BT 300,000
89 11000091 LAMIVUDINE 100 MG TAB (BTL 30 TAB) BT 70,000 44,727
90 11000092 LAMIVUDINE 150 MG TAB (BTL 60 TAB) BT 120,000 89,455
91 11001644 LEVOFLOXACIN 250 MG DUS 36,818
92 11000217 LEVOFLOXACIN 500 MG (DUS 50 TAB) DUS 35,000 16,955
93 11002048 LEVOFLOXACIN HEMIHYDRATE 500 MG TSS DUS 35,000 16,955
94 11000220 MELOXICAM 15 MG (DUS 20 TAB) DUS 14,500
95 11000219 MELOXICAM 7,5 MG (DUS 20 TAB) DUS 8,000
96 11001734 MEROPENEM INJ 0,5 G DUS 415,000
97 11001733 MEROPENEM INJ 1 G DUS 550,000
98 11001386 METAMIZOLE SODIUM 500 MG TAB DUS 10X10 DUS 26,500
99 11000103 METHADONE SIRUP (BTL 1000 ML) BT 285,000
100 11000104 METHYLERGOMETRINE 0,125 MG (DUS 100 TAB) DUS 24,944 19,455
101 11000222 METOCLOPRAMID 10 MG (DUS 100 TAB) DUS 13,000 6,000
102 11000221 METOCLOPRAMID 5 MG (DUS 100 TAB) DUS 12,000 10,636
103 11000223 METRONIDAZOLE 250 MG (DUS 100 TAB) DUS 23,433
104 11000225 METRONIDAZOLE 500 MG (DUS 100 TAB) DUS 32,813
105 11000296 MICONAZOLE 2 % CR(DUS 24 TUBE@10 GRAM) TUB 3,750 1,727
106 11000236 MIKRODIOL 30 LIMAS-BLISS 28 TAB BLT 6,500
107 11000105 MORFINA 10 MG/ ML INJ (DUS 10 AMP) DUS - 271,818
108 11001043 MORFINA 10 MG/ML INJEKSI (IMPOR) DUS 309,545
109 11000106 MORPHINE 10 MG (BTL 30 TAB) BT 39,709 32,700
110 11002020 NACL 0,9% INFUS BT 6,218 6,182
111 11000107 NATRIUM DIKLOFENAK 25 MG (DUS 50 TAB) DUS 14,854 5,227
112 11000108 NATRIUM DIKLOFENAK 50 MG (DUS 50 TAB) DUS 18,346 4,500
113 11000111 NEVIRAPINE 200 MG (BTL 60 TAB) BT 180,000
114 11000227 NIFEDIPIN 10 MG (DUS 100 TAB) DUS 20,016
115 11000115 OMEPRAZOLE 20 MG (DUS 30 KAPS) DUS 17,996 3,518
116 11000229 ORALIT (DUS 100 SASE) DUS 83,187
117 11000297 OXYTETRACYCLIN 1% SM(DUS 25TUBE@3,5GRAM) TUB 3,629 3,182
118 11000298 OXYTETRACYCLIN 3% SK(DUS 25 TUBE@5 GRAM) TUB 1,881
119 11000117 PAKET OAT ANAK - FDC (KDT) (PAKET) PET 266,060 225,464
120 11000118 PAKET OAT KATEGORI I FDC (KDT) (PAKET) PET 460,000 380,883
121 11000230 PAPAVERIN 40 MG (DUS 100 TAB) DUS 15,681
122 11000397 PARACETAMOL 500 MG (DUS 100 TAB) DUS 24,953
123 11000232 PARACETAMOL SIRUP (BTL 60 ML) BT 5,500
124 11000120 PETHIDIN HCL 50 MG/ML INJ (DUS 10 AMP) DUS - 120,909
125 11001044 PETHIDIN HCL 50 MG/ML INJEKSI (IMPOR) DUS 177,100
126 11000233 PHENOBARBITAL 30 MG TAB (DUS 100 TAB) DUS 17,000 16,545
127 11000241 PIROXICAM 10 MG (DUS 100 TAB) DUS 15,968
NO SAP NAMA PRODUK KEMASAN HARGA (99) HARGA (02) BPJS
Reguler

128 11000243 PIROXICAM 20 MG (DUS 100 TAB) DUS 22,458

129 11001426 PREGABALIN CAPS 150 MG DUS 270,000
130 11001425 PREGABALIN CAPS 75 MG DUS 195,000
131 11000121 PROPRANOLOL HCL 40 MG (DUS 100 TAB) DUS 26,904
132 11000248 PYRANTEL 125 MG (DUS 100 TAB) DUS 62,918
133 11000251 PYRAZINAMIDE 500 MG (DUS 100 TAB) DUS 37,625
134 11000253 QUININE 222 MG TAB (DUS 60 TAB) DUS 40,200 34,636
135 11000122 QUININE HCL 250MG/ML INJ (DUS 100 AMP) DUS 230,000
136 11000256 RANITIDIN 150 MG (DUS 30 TAB) DUS 12,905
137 11002125 REMDAC 100 MG VIAL DUS 446,687
138 11000309 RETINOL (VIT A 100.000 UI)(BTL 50 KAPS) BT 22,500 13,864
139 11000304 RETINOL (VIT A 200.000 UI) (BTL 50 KAPS) BT 37,650 25,136
140 11000124 RIFAMPICIN 450 MG (DUS 100 TAB) DUS 196,974 84,909
141 11000125 RIFAMPICIN 600 MG (DUS 100 TAB) DUS 215,916 112,091
142 11002018 RINGER LAKTAT INFUS BT 6,939 6,936
143 11002084 ROSUVASTATIN 10 MG DUS 90,000
144 11002083 ROSUVASTATIN 20 MG DUS 120,000
145 11000259 SALBUTAMOL 2 MG (DUS 100 TAB) DUS 10,298
146 11000262 SALBUTAMOL 4 MG (DUS 100 TAB) DUS 12,953
147 11000264 SIMVASTATIN 10 MG (DUS 50 TAB) DUS 14,000
148 11000266 SIMVASTATIN 20 MG (DUS 50 TAB) DUS 27,000 6,818
149 11001894 STREPTOMYCIN INJ 1 G DUS 338,878
150 11000268 SULFADOXINE PYRIMETHAMINE (DUS 100 TAB) DUS 97,147
151 11000793 TABLET TAMBAH DARAH NEO (TSG)(DUS100TAB) DUS 45,000 20,545
152 11000128 TETRACYCLINE 250 MG (DUS 100 KAPS) DUS 44,361
153 11000130 TETRACYCLINE 500 MG (DUS 100 KAPS) DUS 95,000
154 11000133 TRAMADOL 50 MG (DUS 50 KAPS) DUS 23,425
155 11000136 TRINOLON 4 MG (DUS 50 TAB) DUS 65,000
156 11002086 VALSARTAN 160 MG (DUS 30 TAB) DUS 120,000
157 11002134 VALSARTAN 80 MG (DUS 30 TAB) DUS 80,000
158 11000274 VERAPAMIL 80 MG (DUS 100 TAB) DUS 43,550
159 11000487 VITAMIN B KOMPLEKS(SUPLEMEN)(DUS100TAB) DUS 12,917
160 11000275 VITAMIN B1 100 MG TAB(SUPL)(DUS 100 TAB) DUS 23,700
161 11000488 VITAMIN B1 50 MG (SUPLEMEN)(DUS100TAB) DUS 18,343
162 11000485 VITAMIN B12 50 MCG (SUPLEMEN)(DUS100TAB) DUS 7,105 3,909
163 11000486 VITAMIN B6 10 MG (SUPLEMEN)(DUS100TAB) DUS 12,800
164 11000283 VITAMIN C 100 MG TAB(SUPL)(DUS 100TAB) DUS 15,036
165 11000489 VITAMIN C 250 MG (SUPLEMEN)(DUS100TAB) DUS 18,200
166 11000288 VITAMIN C 50 MG TAB (SUPL)(DUS 100 TAB) DUS 14,291 3,818
167 11000144 ZINK DISPERSIBEL (DUS 100 TAB) DUS 43,180