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13.4. Obat-Obatan
13.4.1. Obat Generik
NAMA OBAT
NO KEMASAN HARGA
2
1 3 4
ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida
2 blister @ 12
1 44.000
tablet 200 mg)
tablet / kotak
ACT (Artesunate tablet 50 mg + Amodiaquine anhydrida
3 blister @ 8
2 44.000
tablet 200 mg)
tablet / kotak
Ktk 10 btl @ 10
Albendasol suspensi 200 mg/5 ml
3 6.000
ml
Albendazol tablet/ tablet kunyah 400 mg
4 ktk 5 x 6 tablet 16.000
ktk 10 x 10
Alopurinol tablet 100 mg
5 16.000
tablet
ktk 10 x 10
Alopurinol tablet 300 mg
6 33.000
tablet
ktk 10 x 10
Alprazolam tablet 0,25 mg
7 64.000
tablet
ktk 10 x 10
Alprazolam tablet 0,5 mg
8 77.000
tablet
ktk 10 x 10
Alprazolam tablet 1 mg
9 118.000
tablet
Ambroxol sirup 15 mg/ml
10 btl 60 ml 5.000
ktk 10 x 10
Ambroxol sirup 30 mg
11 21.000
tablet
ktk 10 x 10
Amilorida tablet 5 mg
12 12.000
tablet
ktk 30 ampul @
Aminofilin injeksi 24 mg/ml
13 118.000
10 ml
Aminofilin tablet 150
14 botol 1000 tablet 57.000
Aminofilin tablet 200
15 botol 100 tablet 15.000
ktk 10 x 10
Amitriptilin tablet salut 25 mg (HCI)
16 16.000
tablet salut
Amlodipin tablet 5 mg
17 ktk 3 x 10 tablet 9.000
Amlodipin tablet 5 mg
18 ktk 5 x 10 tablet 63.000
Amlodipin tablet 10 mg
19 ktk 3 x 10 tablet 8.750
Amlodipin tablet 10 mg
20 ktk 5 x 10 tablet 111.000
Amoksisilin +As.Klavulanat 625 mg tablet
21 ktk 5 x 6 tablet 209.000
ktk 10 x 10
Amoksisilin kapsul 250 mg
22 38.000
kapsul
ktk 12 x 10
Amoksisilin kapsul 250 mg
23 52.000
kapsul
ktk 10 x 10
Amoksisilin Kaplet 500 mg
24 45.000
kapsul
Amoksisilin serbuk injeksi 1000 mg
25 ktk 10 vial 99.000
Amoksisilin sirup kering 125 mg/ 5 ml
26 btl 60 ml 5.000
ktk 10 x 10
Ampisilin kaplet 250 mg
27 36.000
kaplet
ktk 10 x 10
Ampisilin kaplet 500 mg
28 62.400
kaplet
Ampisilin serbuk injeksi i.m/l.v 1000 mg/vial
29 ktk 10 vial 105.600
Ampisilin serbuk injeksi i.m/l.v 500 mg/vial
30 ktk 10 vial 40.000
- 1 -
NAMA OBAT
NO KEMASAN HARGA
2
1 3 4
Ampisilin sirup kering 125 mg/5 ml
31 btl 60 ml 6.000
Antasida DOEN I tablet kunyah, kombinasi :
ktk 10 x 10
32 14.000
Aluminium Hidroksida 200 mg Magnesium
tablet kunyah
Hidroksida200 mg
Antasida DOEN II suspensi,kombinasi: Aluminium
Hidroksida 200 mg /5 ml Magnesium Hidroksida200
33 btl 60 ml 4.800
mg/5 ml
Anti Bakteri DOEN salep kombinasi Basitrasin 500
34 ktk 25 tube @ 5 g 83.000
IU/g + Polimiksin 10000 IU/g
Antifungi DOEN Kombinasi Asam Benzoat 6% + Asam
35 ktk 24 pot @ 30 g 55.000
Salisilat 3 %
Antihemoroid DOEN Kombinasi : Bismut subgalat
36 ktk 10 supp 27.000
150 mgHeksaklorofan 2,5 mg
Antimalaria DOEN kombinasi : Pirimetamin25 mg
ktk 10 x 10
37 64.000
Sulfadoksin500 mg
tablet
Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg
38 btl 1000 tablet 26.000
Antiparkinson DOEN tablet kombinasi :
167.000
ktk 10 x 10
39 Karbidopa 25 mg
tablet
Levodopa250 mg
ktk 10 vial @ 20
Aqua pro injeksi steril, bebas pirogen
40 73.000
ml
Arthemeter Injeksi 80 mg/ml
41 ktk 6 ampul 175.000
Artesunate Injeksi vial 60 gr
42 ktk 8 vial 263.000
ktk 10 x 10
Asam Asetilsalisilat tablet 100 mg (asetosal)
43 13.000
tablet
ktk 10 x 10
Asam Asetilasalisillat tablet 500 mg (asetosal)
44 21.000
tablet
Asam Askorbat (Vitamin C) tablet 250 mg
45 btl 250 tablet 42.000
Asam Askorbat (Vitamin C) tablet 50 mg
46 btl 1000 tablet 6.500
Asam Askorbat (Vitamin C) tablet 100 mg
47 btl 1000 tablet 29.000
Asam Folat tablet 1 mg
48 btl 100 tablet 6.500
Asam Folat tablet 5 mg
49 btl 1000 tablet 62.000
ktk 10 x 10
Asam Mefenamat kapsul 250 mg
50 17.000
kapsul
ktk 10 x 10
Asam Mefenamat kaplet 500 mg
51 26.800
kaplet
Asetazolamid tablet 250 mg
52 btl 100 tablet 24.000
Asiklovir krim 5%
53 tube 5 gram 3.500
ktk 25 tube @ 5
Asiklovir krim 5%
54 99.000
gram
Asiklovir tablet 200 mg
55 ktk 3 x 10 tablet 20.000
Asiklovir tablet 200 mg
56 ktk 5 x 10 tablet 36.000
ktk 10 x 10
Asiklovir tablet 200 mg
57 51.000
tablet
Asiklovir tablet 400 mg
58 ktk 3 x 10 tablet 29.000
Asiklovir tablet 400 mg
59 ktk 5 x 10 tablet 42.000
- 2 -
NAMA OBAT
NO KEMASAN HARGA
2
1 3 4
ktk 10 x 10
Asiklovir tablet 400 mg
60 68.600
tablet
ktk 10 x 10
Atenolol tablet 50 mg
61 36.000
tablet
Atenolol tablet 100 mg
62 ktk 5 x 10 tablet 34.000
ktk 30 amp @ 1
Atropin injeksi i.m./i.v./s.k./ 0,25 mg/ml (Sulfat)
63 50.000
ml
Atropin Sulfat tablet 0,5 mg.
64 btl 100 tablet 8.000
Atropin Sulfat tablet 0,5 mg.
65 btl 500 tablet 47.000
ktk 24 btl @ 5 ml @
Atropin Sulfat tetes mata 0,5 %
66 89.000
5 ml@
Atropin tetes mata 0,5 % (Sulfat)
67 btl 5 ml 4.000
ktk 10 x 10
Azatioprin tablet 50 mg
68 28.000
tablet
ktk 10 vial @ 20
Benzatin Benzil Penisilin 1,2 Juta IU/ vial
69 108.000
ml
ktk 10 vial @ 20
Benzatin Benzil Penisilin 2,4 Juta IU/ vial
70 150.000
ml
btl 1000 tablet
Besi (ll) Sulfat 7 H2O tablet salut 300 mg
71 35.000
salut
Besi II Sulfat 200 mg + asam folat 0,25 mg tablet (tablet
1 bungkus @ 30
72 3.000
tambah darah kombinasi)
tablet
Betahistin Mesilat tablet 6 mg
73 ktk 3 x 10 tablet 34.000
Betametason krim 0,1 % (sebagai valerat)
74 tube 5 gram 2.400
Betametason krim 0,1 % (sebagai valerat)
75 ktk 25 tube @ 5 g 62.000
ktk 10 x 10
Betametason tablet 0,5 mg
76 10.000
tablet
Bisoprolol tablet 5 mg
77 ktk 3 x 10 tablet 44.000
ktk 10 x 10
Bromheksin tablet 8 mg
78 6.000
tablet
Cetirizine sirup 5 mg/5 ml
79 btl 60 ml 12.600
Cetirizine tablet 10 mg
80 ktk 3 x 10 tablet 12.000
Cetirizine tablet 10 mg
81 ktk 5 x 10 tablet 19.000
ktk 10 x 10
Cisapride tablet 10 mg
82 178.000
tablet
ktk 10 x 10
Cisapride tablet 5 mg
83 103.000
tablet
ktk 10 x 10
Clobazam tablet 10 mg
84 125.000
tablet
Clobetasol krim 0,05 %
85 tube 10 gram 16.000
Dapson tablet 100 mg
86 btl 1000 tablet 42.000
ktk 100 amp @ 1
Deksametason injeksi I.v.5 mg/ml
87 263.000
ml
ktk 10 x 10
Deksametason tablet 0,5 mg
88 29.000
tablet
- 3 -
NAMA OBAT
NO KEMASAN HARGA
2
1 3 4
Dekstran 70 - larutan infus 6 % steril
89 btl 500 ml 47.000
Dekstrometorfan sirup 10 mg/5 ml (HBr)
90 btl 60 ml 4.000
ktk 10 x 10
Dekstrometorfan tablet 15 mg (HBr)
91 15.000
tablet
ktk 30 amp @ 2
Diazepam Injeksi 5 mg/ml
92 94.000
ml
Diazepam tablet 2 mg
93 btl 100 tablet 5.000
ktk 10 x 10
Diazepam tablet 2 mg
94 6.000
tablet
Diazepam tablet 5 mg
95 btl 250 tablet 16.000
Diazepam tablet 5 mg
96 btl 100 tablet 7.000
ktk 10 x 10
Diazepam tablet 5 mg
97 9.000
tablet
ktk 10 x 10
Dietilkarbamezin sitrat tablet 100 mg
98 13.000
tablet
ktk 30 amp @ 1
Difenhidramin injeksi i.m 10 mg/ml/(HCI)
99 36.000
ml
ktk 10 x 10
Digoksin tablet 0,25 mg
100 19.000
tablet
Digoksin tablet 0,0625 mg
101 btl 100 tablet 10.000
Dikloksasilin kapsul 125 mg
102 ktk 100 kapsul 30.000
Dikloksasilin kapsul 250 mg
103 ktk 25 x 4 kapsul 42.000
Dikloksasilin kapsul 500 mg
104 ktk 25 x 4 kapsul 56.000
ktk 10 x 10
Diltiazem HCI tablet 30 mg
105 20.000
tablet
Dimenhidrinat tablet 50 mg
106 btl 100 tablet 18.000
Disopiramid kapsul 100 mg
107 btl 100 kapsul 31.000
ktk 10 x 10
Doksisiklin kapsul 100 mg
108 36.000
kapsul
Domperidon Suspensi 5 mg/5 ml
109 btl 60 ml 15.200
ktk 10 x 10
Domperidon tablet 10 mg
110 34.200
tablet
Efedrin tablet 25 mg (HCI)
111 botol 250 tablet 17.000
Ekstraks Belladona tablet 10 mg
112 botol 1000 tablet 78.000
ktk 30 amp @ 1
Epinefrin (adrenalin) injeksi 0,1 % (sebagai HCL)
113 49.000
ml
ktk 10 x 10
Eritromisin kapsul 250 mg
114 67.000
kapsul
ktk 12 x 10
Entromisin kapsul 250 mg
115 72.000
kapsul
ktk 10 x 10
Entromisin kaplet 500 mg
116 111.500
kaplet
Entromisin sirup 200 mg/5 mg
117 btl 60 ml 11.000
- 4 -
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