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367x Tipe PDF Ukuran file 0.16 MB Source: www.cilacapkab.go.id
REK NAMA RINCIAN MERK SATUAN HARGA KET
Levofloksasin tablet 500 mg Ktk 5 x 10 57.684
tablet
Levofloksasin tablet 500 mg Ktk 3 x 10 33.200
tablet
Lidokain injeksi 2 % Ktk 100 ampul 92.500
@ 2 ml
Lidokain injeksi 2 % (HCl)+Epinefrin 1: 80.000 - 2 ml Ktk 30 ampul 31.000
@ 2 ml
Linkomisin kapsul 250 mg Ktk 10 x 10 27.778
kapsul
Linkomisin kapsul 250 mg Ktk 5 x 12 16.680
kapsul
Linkomisin kapsul 500 mg Ktk 5 x 10 32.500
kapsul
Linkomisin kapsul 500 mg Ktk 5 x 12 39.000
kapsul
Lisinopril tablet 10 mg Ktk 3 x 10 17.321
tablet
Lisinopril tablet 20 mg Ktk 3 x 10 21.917
tablet
Lisinopril tablet 5 mg Ktk 3 x 10 10.051
tablet
Loperamid tablet 2 mg Ktk 10 x 10 9.155
tablet
Loratadin tablet 10 mg Ktk 5 x 10 16.654
tablet
Magnesium Sulfat inj (IV) 20 % - 25 ml Ktk 10 vial 15.398
Magnesium Sulfat inj (IV) 40 % - 25 ml Ktk 10 vial 19.479
Magnesium Sulfat serbuk 30 gram Ktk 10 sase @ 10.266
30 gr
Mebendazol sirup 100 mg/ 5 ml Btl 30 ml 3.000
Mebendazol tablet 100 mg Ktk 5 x 6 tablet 6.300
Mebendazol tablet 500 mg Ktk 10 x 10 22.860
tablet
Meloksikam suppositoria Ktk 10 supp 66.000
Meloksikam tablet 15 mg Ktk 5 x 10 59.950
tablet
Meloksikam tablet 15 mg Ktk 2 x 10 23.980
tablet
Meloksikam tablet 7,5 mg Ktk 5 x 10 40.700
tablet
Meloksikam tablet 7,5 mg Ktk 2 x 10 16.280
tablet
Merkaptopurin tablet 50 mg Btl 25 tablet 5.495
Metampiron injeksi 250 mg Ktk 30 ampul 36.700
@ 2 ml
Metampiron tablet 500 mg Ktk 10 x 10 13.700
tablet
Metformin HCl tablet 500 mg Ktk 10 x 10 16.500
tablet
Metformin HCl tablet 850 mg Ktk 10 x 10 33.000
tablet
Metildopa tablet 250 mg Btl 100 tablet 27.229
Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Ktk 10 x 10 10.996
tablet
Metilergometrin Maleat injeksi 0,200 mg - 1 ml Ktk 30 ampul 41.000
Metilprednisolon injeksi 500 mg Ktk 1 vial 92.250
Metilprednisolon tablet 16 mg Ktk 3 x 10 39.000
tablet
Metilprednisolon tablet 16 mg Ktk 10 x 10 115.000
tablet
Metilprednisolon tablet 4 mg Ktk 10 x 10 48.950
tablet
Metilprednisolon tablet 8 mg Ktk 10 x 10 65.000
tablet
Metoklopramide injeksi 5 mg/ ml Ktk 10 amp @ 10.000
2 ml
Metoklopramide sirup 5 mg/ ml Btl 60 ml 2.100
Metoklopramide tablet 10 mg Ktk 10 x 10 9.250
tablet
Metoklopramide tablet 5 mg Ktk 10 x 10 7.317
tablet
Standar Satuan Harga Pemerintah Kabupaten Cilacap Tahun 2012 41
REK NAMA RINCIAN MERK SATUAN HARGA KET
Metronidazol infus 500 mg/ 100 ml Btl 100 ml 29.500
Metronidazol tablet 250 mg Ktk 10 x 10 13.000
tablet
Metronidazol tablet 500 mg Ktk 10 x 10 19.000
tablet
Mikonazol krem/ salep 2 % ( Nitrat ) Tube 10 gr 3.000
Mineral Mix kombinasi : Ktk 40 sachet 99.000
Kalium Klorida 1.792 mg
Trikalium sitrat (1H2O) 648 mg
Magnesium Klorida (6H2O) 608 mg
Seng Asetat (2H2O) 66 mg
Tembaga Sulfat (5H2o) 11 mg
Momethason krim 0,1 % Tube 5 gram 14.108
Momethason krim 0,1 % Tube 10 gram 22.275
Morfin injeksi 10 mg/ ml Ktk 10 amp @ 102.085
1 ml
Morfin tablet 10 mg Btl 30 tab 36.179
Natrium Bikarbonat tablet 500 mg Btl 1000 tablet 14.300
Natrium Diklofenak tablet 50 mg Ktk 5 x 10 10.884
tablet
Natrium Diklofenak tablet 25 mg Ktk 5 x 10 8.384
tablet
Natrium Fluoresin tetes mata 2 % Ktk 24 btl @ 5 94.216
ml
Natrium Klorida larutan infus 0,9 % Btl 500 ml 4.900
Natrium Thiosulfat I v 25 % Ktk 10 amp @ 27.000
10 ml
Neomisin kapsul 500 mg Ktk 10 x 10 31.650
kapsul
Nevirapin tablet 200 mg Btl 60 tablet 156.750
Nifedipin tablet 10 mg Ktk 10 x 10 10.785
kapsul
Nistatin tablet salut 500.000 IU/g Ktk 10 x 10 55.000
tablet salut
Nistatin vaginal tablet 100.000 IU/g Ktk 10 x 10 34.500
tablet vaginal
Nitrofurantoin tablet 100 mg Btl 100 tablet 6.180
Obat Antituberkulosis Kategori I Dewasa Paket/ dos 288.200
Obat Antituberkulosis Kategori anak Paket/ dos 172.000
Obat Batuk Hitam (OBH) cairan Btl 100 ml 1.500
Obat Batuk Hitam (OBH) cairan Btl 200 ml 3.000
Obat FDC Anak Paket 215.000
Obat FDC Kategori I Paket 360.000
Obat FDC Kategori II Paket 1.200.000
Obat FDC Sisipan Paket 160.000
Ofloxacin tablet 200 mg Ktk 5 x 10 29.505
tablet
Ofloxacin tablet 400 mg Ktk 5 x 10 43.650
tablet
Oksitetrasiklin salep mata 1 % (HCl) Tube 3,5 gram 2.100
Oksitetrasiklin salep mata 1 % (HCl) Ktk 25 tube @ 48.000
3,5 gr
Oksitetrasiklin (HCl) injeksi i.m 50 mg/ ml - 10 ml Ktk 10 vial 31.000
Oksitetrasiklin salep kulit 3 % Tube 5 gr 1.675
Oksitetrasiklin salep kulit 3 % Ktk 25 tube @ 41.875
5 g
Oksitosin injeksi 10 IU/ ml - 1 ml Ktk 30 ampul 53.550
Omeprazol kapsul 20 mg Btl 7 kapsul 5.386
Omeprazol kapsul 20 mg Ktk 3 x 10 12.250
kapsul
Oseltamivir 75 mg Ktk 10 130.000
Papaverin injeksi 40 mg/ ml Ktk 100 amp 53.000
@ 1 ml
Papaverin tablet 40 mg Btl 1000 tablet 93.000
Parasetamol drop Btl 15 ml 4.800
Parasetamol sirup 120 mg/ 5 ml Btl 60 ml 2.300
Parasetamol tablet 100 mg Btl 100 tablet 3.800
Parasetamol tablet 500 mg Ktk 10 x 10 10.500
tablet
Standar Satuan Harga Pemerintah Kabupaten Cilacap Tahun 2012 42
REK NAMA RINCIAN MERK SATUAN HARGA KET
Pentoksifilin injeksi 300 mg/ 15 ml Ktk 10 vial 166.250
Pentoksifilin tablet 400 mg Ktk 10 x 10 135.850
tablet
Perfenazin tablet 4 mg (HCl) Btl 100 tablet 4.241
Perfenazin tablet 2 mg Ktk 15 x 10 6.296
tablet
Perfenazin tablet 8 mg Ktk 15 x 10 9.345
tablet
Petidin injeksi 50 mg/ ml Ktk 10 ampul 119.922
Pilokarpin tetes mata 2 % (HCl/ Nitrat) Btl 5 ml 5.214
Piracetam injeksi 1 g/ 5 ml ktk 10 ampul 55.000
Piracetam injeksi 3 g/ 15 ml Ktk 4 ampul 68.420
Piracetam tablet 1200 mg Ktk 10 x 10 132.000
tablet
Piracetam tablet 1200 mg Ktk 5 x 10 66.000
tablet
Piracetam tablet 400 mg Ktk 10 x 10 50.160
tablet
Piracetam tablet 800 mg Ktk 10 x 10 88.000
tablet
Pirantel sirup 125 mg/ 5 ml Btl 60 ml 3.500
Pirantel tab score ( base) 125 mg Ktk 25 x 4 29.000
tablet score
Pirantel tab score ( base) 125 mg Ktk 30 x 2 18.600
tablet score
Pirazinamid tablet 500 mg Ktk 10 x 10 22.000
tablet
Piridoksin (Vitamin B6) tablet 10 mg (HCl) Btl 1000 tablet 14.300
Piridoksin (Vitamin B6) tablet 25 mg (HCl) Btl 1000 tablet 25.000
Piroksikam tablet 10 mg Ktk 10 x 10 7.500
tablet
Piroksikam tablet 10 mg Ktk 12 x 10 9.000
tablet
Piroksikam tablet 20 mg Ktk 10 x 10 10.500
tablet
Piroksikam tablet 20 mg Ktk 12 x 10 12.600
kaplet
Povidon Iodida larutan 10 % Btl 30 ml 2.000
Povidon Iodida larutan 10 % Btl 60 ml 3.300
Povidon Iodida larutan 10 % Btl 300 ml 14.500
Povidon Iodida larutan 10 % Btl 1000 ml 42.000
Pravastatin tablet 10 mg Ktk 3 x 10 49.005
tablet
Pravastatin tablet 20 mg Ktk 3 x 10 81.675
tablet
Pravastatin tablet 20 mg Ktk 5 x 10 136.125
tablet
Prazikuantel tablet 300 mg Btl 1000 tablet 768.390
Prazikuantel tablet 600 mg Btl 100 tablet 160.000
Prednison tablet 5 mg Btl 1000 tablet 57.500
Primkuin tablet 15 mg Btl 1000 tablet 101.800
Prokain Benzil Penisillin G injeksi 3 jt IU/ vial Ktk 30 vial @ 168.000
15 ml
Prometazin tablet 25 mg Ktk 100 tablet 5.015
Propanolol tablet 40 mg (HCl) Btl 100 tablet 12.100
Propanolol tablet 10 mg (HCl) Btl 10 x 10 7.700
tablet
Propiltiourasil tablet 100 mg Btl 100 tablet 29.957
Propiltiourasil tablet 50 mg Btl 1000 tablet 211.200
Ramipril tablet 2,5 mg Ktk 10 x 10 29.537
tablet
Ramipril tablet 5 mg Ktk 10 x 10 50.666
tablet
Ranitidin injeksi 25 mg/ 2 ml Ktk 25 amp 64.250
Ranitidin tablet 150 mg Ktk 3 x 10 6.300
tablet
Ranitidin tablet 150 mg Ktk 10 x 10 21.000
tablet
Reserpin tablet 0,10 mg Btl 250 tablet 18.800
Reserpin tablet 0,25 mg Btl 1000 tablet 88.000
Standar Satuan Harga Pemerintah Kabupaten Cilacap Tahun 2012 43
REK NAMA RINCIAN MERK SATUAN HARGA KET
Retinol (Vitamin A) 100.000 IU kapsul lunak Btl 50 kapsul 13.000
lunak
Retinol (Vitamin A) 100.000 IU kapsul lunak Btl 50 kapsul 21.000
lunak
Retinol (Vitamin A) tablet 50.000 IU Btl 1000 tablet 160.000
Rifampisin kapsul 600 mg Ktk 10 x 10 77.500
kapsul
Rifampisin kapsul 300 mg Ktk 10 x 10 40.000
kapsul
Rifampisin kapsul 300 mg Ktk 12 x 10 46.200
kapsul
Rifampisin tablet salut 450 mg Ktk 10 x 10 tab 55.000
salut
Ringer Laktat larutan infus Btl 500 ml 5.200
Risperidon tablet 1 mg Ktk 2 x 10 37.620
tablet
Risperidon tablet 1 mg Ktk 5 x 10 94.050
tablet
Risperidon tablet 2 mg Ktk 5 x 10 118.750
tablet
Risperidon tablet 3 mg Ktk 2 x 10 57.000
tablet
Risperidon tablet 3 mg Ktk 5 x 10 142.500
tablet
Salbutamol tablet 2 mg (sebagai sulfat) Ktk 10 x 10 8.403
tablet
Salbutamol tablet 4 mg (sebagai sulfat) Ktk 10 x 10 9.749
tablet
Salep 2-4, Kombinasi : Asam Salisat 2% + Belerang endap 4 %Ktk 24 pot @ 29.500
30 gr
Salisil Bedak 2% Ktk 50 gram 1.100
Sefadroksil sirup kering 125 mg / 5 ml Btl 60 ml 7.230
Sefadroksil kapsul 250 mg Ktk 3 x 10 13.352
kapsul
Sefadroksil kapsul 250 mg Ktk 10 x 10 44.505
kapsul
Sefadroksil kapsul 500 mg Ktk 5 x 10 35.000
kapsul
Sefadroksil kapsul 500 mg Ktk 10 x 10 70.000
kapsul
Sefaklor kapsul 250 mg Ktk 3 x 10 35.739
kapsul
Sefaklor kapsul 500 mg Ktk 3 x 10 6 5.522
kapsul
Sefaleksin kapsul 250 mg Ktk 5 x 10 3 2.485
kapsul
Sefaleksin kapsul 500 mg Ktk 5 x 10 6 0.000
kapsul
Sefazolin injeksi 1 g Ktk 2 vial 4 5.568
Sefiksim kapsul 100 mg Ktk 5 x 10 1 19.730
kapsul
Sefiksim kapsul 100 mg Ktk 3 x 10 7 1.838
kapsul
Sefiksim kapsul 50 mg Ktk 3 x 10 3 0.000
kapsul
Sefiksim sirup kering 100 mg / 5 ml Btl 30 ml 3 0.250
Sefiksim 400 mg + Azitromisin 1000 mg Paket 3 3.000
Sefotaksim injeksi 0,5 g Ktk 2 vial 8 .679
Sefotaksim injeksi 1 g Ktk 2 vial 1 5.400
Sefotaksim injeksi 1 g Ktk 10 vial 7 7.000
Sefotaksim injeksi 1 g per vial Ktk 1 vial 7 .700
Seftazidim injeksi 1 g Ktk 2 vial 7 5.240
Seftriakson injeksi 1 g Ktk 2 vial 1 9.098
Seftriakson serbuk injeksi 1 g/ vial Ktk 1 vial @ 10 9 .549
ml
Sefuroksim serbuk injeksi 750 mg / vial Ktk 2 vial @ 10 2 1.318
ml
Sianokobalamin (vitamin B12) injeksi 500 mcg Ktk 100 amp 9 7.000
@ 1 ml
Sianokobalamin (vitamin B12) injeksi 50 mcg Btl 1000 tablet 1 2.360
Siklofosfamid tablet 50 mg Btl 50 tablet 8 4.384
Standar Satuan Harga Pemerintah Kabupaten Cilacap Tahun 2012 44
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