Você está na página 1de 10

Kode Nama Awal MutD MutK Akhir

1AC06 ACILAZ CAPS 21.00 0.00 0.00 21.00


1AC07 ACITRAL TAB 320.00 0.00 0.00 320.00
1AE01 AERIUS TAB 4.00 0.00 0.00 4.00
1AL01 ALINAMIN F TAB 72.00 0.00 0.00 72.00
1AL02 AKURAT 5.00 0.00 0.00 5.00
1AL07 ALLOPURINOL 300 95.00 0.00 0.00 95.00
1AM01 AMOXICILLIN 500 79.00 0.00 0.00 79.00
1AN01 ANVOMER B6 45.00 0.00 0.00 45.00
1AN03 ANALSIK 167.00 0.00 0.00 167.00
1AR03 ARDIUM 500 TAB 68.00 0.00 0.00 68.00
1AS03 ASPILET TAB 46.00 0.00 0.00 46.00
1AS04 ASAMNEX 106.00 0.00 0.00 106.00
1AS08 ASTA PLUS 79.00 0.00 0.00 79.00
1AZ01 AZOL 200 70.00 0.00 0.00 70.00
1BE01 BECOM-C TAB 80.00 0.00 0.00 80.00
1BI01 BIO-E 200 72.00 0.00 0.00 72.00
1BI02 BIOCAL-95 168.00 0.00 0.00 168.00
1BI03 BISOPROLOL 5 MG 30.00 0.00 0.00 30.00
1BI04 BIOSAN TAB 110.00 0.00 0.00 110.00
1BR02 BRAXIDIN 152.00 0.00 0.00 152.00
1CA03 CAL-95 90.00 0.00 0.00 90.00
1CA06 CATAFLAM 25 MG 42.00 0.00 0.00 42.00
1CA07 CATAFLAM 50 MG 50.00 0.00 0.00 50.00
1CA08 CATAFLAM FAST 50 MG 32.00 0.00 0.00 32.00
1CA10 CAPTOPRIL 12,5 18.00 0.00 0.00 18.00
1CE08 CELESTAMIN TAB 2.00 0.00 0.00 2.00
1CE12 CEPTIK TAB 16.00 0.00 0.00 16.00
1CI07 CITAZ 50MG 45.00 0.00 0.00 45.00
1CL05 CLINIUM 300 81.00 0.00 0.00 81.00
1CL07 CLABAT 500 11.00 0.00 0.00 11.00
1CL08 CLAMIXIN TAB 15.00 0.00 0.00 15.00
1CO03 COBAZYM 3000 69.00 0.00 0.00 69.00
1CO07 COTEN 100 90.00 0.00 0.00 90.00
1CO10 CODIKAF 10MG 117.00 0.00 0.00 117.00
1CR02 CURCUMA TAB 70.00 0.00 0.00 70.00
1CR03 CRIPSA 30.00 0.00 0.00 30.00
1CT01 CTM 47.00 0.00 5.00 42.00
1CY03 CYSTONE 75.00 0.00 0.00 75.00
1DE04 DEXTAFEN TAB 98.00 0.00 0.00 98.00
1DE07 DEMACOLIN TAB 108.00 0.00 0.00 108.00
1DI02 DIANE 35 2.00 0.00 0.00 2.00
1DI05 DIOVAN 14.00 0.00 0.00 14.00
1DI07 DIAGIT TAB 103.00 0.00 0.00 103.00
1DI10 DIFLAM 24.00 0.00 0.00 24.00
1DO02 DOPAMET 50.00 0.00 0.00 50.00
1DU01 DULCOLAC TAB 77.00 0.00 0.00 77.00
1ER01 ERDOMEX TAB 30.00 0.00 0.00 30.00
1ES01 ESTHERO 0,625 26.00 0.00 0.00 26.00
1FE04 FERTIN 122.00 0.00 0.00 122.00
1FG01 FG TROCHES 90.00 0.00 0.00 90.00
1FI05 FITOSERIN KAPS 60.00 0.00 0.00 60.00
1FL02 FLUIMUCIL 200 60.00 0.00 0.00 60.00
1FO01 FOLDA 136.00 0.00 0.00 136.00
1FO05 FOLAVIT 1000 190.00 0.00 0.00 190.00
1FO10 FOLAMIL GENIO 90.00 0.00 0.00 90.00
1FR01 FOLAMIL GOLD 60.00 0.00 0.00 60.00
1GA03 GASTRIDIN TAB 87.00 0.00 0.00 87.00
1GA05 GG TAB 143.00 0.00 0.00 143.00
1GE01 GERDILIUM 104.00 0.00 0.00 104.00
1GE03 GENOCLOM TAB 35.00 0.00 0.00 35.00
1GI01 GITAS PLUS 37.00 0.00 0.00 37.00
1GL01 GLUCOPHAGE 500 101.00 0.00 0.00 101.00
1GL03 GLIBENCLAMIDE 5MG 50.00 0.00 0.00 50.00
1GL04 GLUCOPHAGE XR 35.00 0.00 0.00 35.00
1GL11 GLIMEPIRIDE 4MG 47.00 0.00 0.00 47.00
1GO01 GOVAZOL 150 4.00 0.00 0.00 4.00
1GR03 GRISEOVULVIN 500 55.00 0.00 0.00 55.00
1HE06 HYSTOLAN 67.00 0.00 0.00 67.00
1HI02 HI-BONE 600 37.00 0.00 0.00 37.00
1HI03 HI-BONE CHEW 165.00 0.00 0.00 165.00
1IM01 IMODIUM 93.00 0.00 0.00 93.00
1IM04 IMMU-CEA 30.00 0.00 0.00 30.00
1IM06 INTERLAC TAB 30.00 0.00 0.00 30.00
1IM07 INLACIN 100MG 60.00 0.00 0.00 60.00
1IM08 INTERLAC SACHET 17.00 0.00 0.00 17.00
1IN02 INTERHISTIN 114.00 0.00 0.00 114.00
1IN05 INVOMIT 4 MG 37.00 0.00 0.00 37.00
1IN07 INBION 382.00 0.00 0.00 382.00
1IN09 INTERMOXIL 500 147.00 0.00 0.00 147.00
1IN11 INTERDOXIN 100 90.00 0.00 0.00 90.00
1IN12 INLACTA DHA 145.00 0.00 0.00 145.00
1IN13 INDEXON TAB 67.00 0.00 0.00 67.00
1IN14 INVOMIT 8 MG 78.00 0.00 0.00 78.00
1IN15 INTERXANTHIN 122.00 0.00 0.00 122.00
1IN18 INTRIZIN TAB 55.00 0.00 0.00 55.00
1IN19 INTERKRILL 60.00 0.00 0.00 60.00
1IN21 INBUMIN 250 40.00 0.00 0.00 40.00
1IN22 INTUNAL TAB 91.00 0.00 0.00 91.00
1IS02 INTERZOL TAB 62.00 0.00 0.00 62.00
1IS03 ISORBIDE DINITRAT 104.00 0.00 0.00 104.00
1KA03 KANAMYCIN 250 MG 82.00 0.00 0.00 82.00
1KA04 KAPIKACHHU 550.00 0.00 0.00 550.00
1KE01 KSR 24.00 0.00 0.00 24.00
1LA15 LACTAMAM 23.00 0.00 0.00 23.00
1LA19 LASAL 4MG 7.00 0.00 0.00 7.00
1LBO1 L-BIO 47.00 0.00 0.00 47.00
1MA03 MALTOFER FOL 61.00 0.00 0.00 61.00
1MA05 MAXPRINOL TAB 25.00 0.00 0.00 25.00
1ME05 MERTIGO 106.00 0.00 0.00 106.00
1ME10 MELOXICAM 15 58.00 0.00 0.00 58.00
1ME11 METRONIDAZOL 500 71.00 0.00 0.00 71.00
1ME12 MEIACT 200 20.00 0.00 0.00 20.00
1ME14 METVELL TAB 63.00 0.00 0.00 63.00
1ME22 MEFINTER 500 109.00 0.00 0.00 109.00
1MO01 MONURIL CAPS 1.00 0.00 0.00 1.00
1MU02 MUCERA TAB 84.00 0.00 0.00 84.00
1MY02 MYCROGYNON 3.00 0.00 0.00 3.00
1NA03 NATURE PLUS DHEA 117.00 0.00 0.00 117.00
1NA09 NATRIUM DICLOFENAC 84.00 0.00 0.00 84.00
1NE03 NEUROSANBE 100.00 0.00 0.00 100.00
1NE07 NEUROBION 5000 157.00 0.00 0.00 157.00
1NE11 NEURALGIN RX 55.00 0.00 0.00 55.00
1NE12 NEUROBAT A 68.00 0.00 0.00 68.00
1NI03 NIFEDIPIN TAB 100.00 0.00 0.00 100.00
1OP01 OPINACEA KAP 36.00 0.00 0.00 36.00
1OP02 OPIMOX 500 72.00 0.00 0.00 72.00
1OP05 OPICEF 500 KAP 86.00 0.00 0.00 86.00
1OS04 OSSOVIT 196.00 0.00 0.00 196.00
1OV01 OVACARE 210.00 0.00 0.00 210.00
1OV02 OLIGOCARE 60.00 0.00 0.00 60.00
1PA06 PANTOPUMP 40MG 16.00 0.00 0.00 16.00
1PA09 PAPAVERIN HCL 40MG 16.00 0.00 0.00 16.00
1PH03 PHAROLIT 40.00 0.00 0.00 40.00
1PH04 PHENOBARBITAL 30 270.00 0.00 0.00 270.00
1PI07 PIRACETAM 800 85.00 0.00 0.00 85.00
1PO05 PROGESIC 500 134.00 0.00 5.00 129.00
1PR03 PREDNISON 81.00 0.00 0.00 81.00
1PR06 PROMEDEX TAB 50.00 0.00 0.00 50.00
1PR15 PROMAVIT KAPS 101.00 0.00 0.00 101.00
1PR24 PROTEXIN TAB 38.00 0.00 0.00 38.00
1PR26 PREDNICORT 4 143.00 0.00 0.00 143.00
1PR33 PROMENO TAB 30.00 0.00 0.00 30.00
1RA02 RANITIDIN TAB 64.00 0.00 0.00 64.00
1RE01 REGUMEN 112.00 0.00 0.00 112.00
1RE03 RHINOS SR 47.00 0.00 0.00 47.00
1RH01 RHINOFED TAB 73.00 0.00 0.00 73.00
1RO03 ROCER TAB 8.00 0.00 0.00 8.00
1SA01 SANGOBION 65.00 0.00 0.00 65.00
1SA05 SANTESAR 50 20.00 0.00 0.00 20.00
1SA07 SANMOL TAB 500 100.00 0.00 0.00 100.00
1SA08 SALBUTAMOL 4 MG 7.00 0.00 5.00 2.00
1SA09 SANMAG TAB 255.00 0.00 0.00 255.00
1SE01 SUMAGESIC TAB 111.00 0.00 0.00 111.00
1SI02 SIMVASTATIN 10 MG 182.00 0.00 0.00 182.00
1SI03 SIMVASTATIN 20 50.00 0.00 0.00 50.00
1SI07 SIMPROFEN 30 23.00 0.00 0.00 23.00
1SI08 SIMLEV 33.00 0.00 0.00 33.00
1SP03 SPORACID 100 13.00 0.00 0.00 13.00
1ST01 STILESCO TAB 26.00 0.00 0.00 26.00
1ST03 STIMUNO CAP 78.00 0.00 0.00 78.00
1TA03 TAMOFEN 10MG 75.00 0.00 0.00 75.00
1TB01 TETRIN 500 23.00 0.00 0.00 23.00
1TE02 TENSIVASK 10 30.00 0.00 0.00 30.00
1TE03 TEQUINOL 500 75.00 0.00 0.00 75.00
1TH02 THERMOLYTE 60.00 0.00 0.00 60.00
1TI01 THIAMYCIN 500 111.00 0.00 0.00 111.00
1TO01 TONICARD TAB 71.00 0.00 0.00 71.00
1TR08 TRIFED 4.00 0.00 0.00 4.00
1TR10 TRIAMCORT 82.00 0.00 0.00 82.00
1TR11 TROGYL TAB 12.00 0.00 0.00 12.00
1UL01 ULTRA D3 120.00 0.00 0.00 120.00
1UR01 URINTER 100 50.00 0.00 0.00 50.00
1UR04 URDAFALK 5.00 0.00 0.00 5.00
1UT01 UTROGESTAN 200 MG 47.00 0.00 0.00 47.00
1UT02 UTROGESTAN 100 MG 136.00 0.00 0.00 136.00
1VA02 VALISANBE 5 MG 141.00 0.00 0.00 141.00
1VI02 VITACIMIN 27.00 0.00 0.00 27.00
1VI09 VITAN 60.00 0.00 0.00 60.00
1VI10 VITAMULTI DHA 16.00 0.00 0.00 16.00
1VO05 VOLOX 500 16.00 0.00 0.00 16.00
1XE03 XEPATHRITIS 50 1.00 0.00 0.00 1.00
1YA01 YASMIN 1.00 0.00 0.00 1.00
1YA02 YAZ 2.00 0.00 0.00 2.00
1ZI02 ZITROLIN 22.00 0.00 0.00 22.00
1ZO02 ZOTER 400 43.00 0.00 0.00 43.00
1ZY02 ZYCIN 500 6.00 0.00 0.00 6.00
2AL01 ALCO PLUS SYR 5.00 0.00 0.00 5.00
2AL02 ALCO PLUS DMP SYR 5.00 0.00 0.00 5.00
2AL04 ALCO DROP 3.00 0.00 0.00 3.00
2AM03 AMOXSAN DROP 1.00 0.00 0.00 1.00
2AP01 APIALYS DROP 1.00 0.00 0.00 1.00
2AP02 APIALYS SYR 3.00 0.00 0.00 3.00
2CL03 CLAMIXIN SYR 2.00 0.00 0.00 2.00
2CL04 CLAMIXIN F SYR 3.00 0.00 0.00 3.00
2CL05 CLABAT SYR 1.00 0.00 0.00 1.00
2DE02 DEXTROSIN SYR 5.00 0.00 0.00 5.00
2DE03 DEXTROSIN SYR ANAK 2.00 0.00 0.00 2.00
2ER02 ERYTHRIN SYR 3.00 0.00 0.00 3.00
2ER03 ERDOMEX SYR 4.00 0.00 0.00 4.00
2FE04 FENRIS SYR 3.00 0.00 0.00 3.00
2IM06 IMMU-CEA SYR 2.00 0.00 0.00 2.00
2IN03 INTERLAC DROP 2.00 0.00 0.00 2.00
2IN05 INTRIZIN DROP 5.00 0.00 0.00 5.00
2IN06 INTRIZIN SYR 3.00 0.00 0.00 3.00
2IN07 INTERMOXIL F SYR 1.00 0.00 0.00 1.00
2IN08 INTERZINC SYR 3.00 0.00 0.00 3.00
2LA03 LADERMA CR 2.00 0.00 0.00 2.00
2LA05 LAXOBERON DROP 3.00 0.00 0.00 3.00
2LA06 LASAL EXP SYR 2.00 0.00 0.00 2.00
2LA13 LAPIFED EXP SYR 3.00 0.00 0.00 3.00
2LA14 LASAL SYR 3.00 0.00 1.00 2.00
2MA01 MAGTRAL SYR 120 1.00 0.00 0.00 1.00
2MA03 MAXPRINOL SYR 2.00 0.00 0.00 2.00
2ME01 MALTOFER DROP 1.00 0.00 0.00 1.00
2MU03 MUCERA DROP 10.00 0.00 0.00 10.00
2MU04 MUCERA SYR 5.00 0.00 0.00 5.00
2MU05 MUCERA FORTE SYR 9.00 0.00 0.00 9.00
2NA02 NARFOZ SYR 30 2.00 0.00 0.00 2.00
2NE01 NEO KAOLANA SYR 2.00 0.00 0.00 2.00
2OP04 OPIXIME SYR 4.00 0.00 0.00 4.00
2OP07 OPIMOX F SYR 2.00 0.00 0.00 2.00
2OP08 OPIMOX SYR 5.00 0.00 0.00 5.00
2OP10 OPTALVIT SYR 5.00 0.00 0.00 5.00
2OP11 OPICEF SYR 6.00 0.00 0.00 6.00
2OT01 OTTOPAN SYR 5.00 0.00 0.00 5.00
2PA03 PAMOL SYR 4.00 0.00 0.00 4.00
2PA04 PAMOL DROP 3.00 0.00 0.00 3.00
2PR04 PROGESIC SYR 2.00 0.00 0.00 2.00
2RE01 RESPIMER BABY 115ML 1.00 0.00 0.00 1.00
2RH01 RHINOS JUNIOR SYR 4.00 0.00 0.00 4.00
2RH02 RHINOFED SYR 3.00 0.00 0.00 3.00
2RH03 RHINOS DROP 3.00 0.00 0.00 3.00
2SA14 SIRPLUS SYR 1.00 0.00 0.00 1.00
2SI03 SILEX SYR 2.00 0.00 0.00 2.00
2SU02 SUCRALFATE SYR 3.00 0.00 0.00 3.00
2TE02 TILIDON SYR 1.00 0.00 0.00 1.00
2TR06 TROGYL SYR 1.00 0.00 0.00 1.00
2TR10 TRIMOXSUL SYR 2.00 0.00 0.00 2.00
2VI05 VISANNE 63.00 0.00 0.00 63.00
2XA05 XEPAFEN F SYR 2.00 0.00 0.00 2.00
2XE01 ZINCPRO DROPS 2.00 0.00 0.00 2.00
2ZI01 ZIBRAMAX SYR 5.00 0.00 0.00 5.00
3AC01 ACYCLOVIR CR 26.00 0.00 0.00 26.00
3AN01 ANTRAIN INJ 5.00 0.00 0.00 5.00
3BA02 BACTROBANT OINT 5 GR 4.00 0.00 0.00 4.00
3BA03 BAYCUTEN N CR 3.00 0.00 0.00 3.00
3BE06 BETASON N CR 5 GR 4.00 0.00 0.00 4.00
3BR02 BREATHY NASAL DROP 3.00 0.00 0.00 3.00
3BU01 BURNAZIN CR 2.00 0.00 0.00 2.00
3CA03 CANESTEN SD VAG 0,5GR 1.00 0.00 0.00 1.00
3CE06 CENDO STATROL md 3.00 0.00 0.00 3.00
3CE15 CENDO CENFRESH MD 5.00 0.00 0.00 5.00
3CE17 CENDO TOBROSON MD 6.00 0.00 0.00 6.00
3CE27 CENDO CENFRESH 5 ML 1.00 0.00 0.00 1.00
3CE40 CENDO XITROL md 1.00 0.00 0.00 1.00
3CE52 CENDO LFX md 1.00 0.00 0.00 1.00
3CE53 CENDO GENTAMYCIN 0.3 md 3.00 0.00 0.00 3.00
3CE56 CERADAN DIAPER CR 1.00 0.00 0.00 1.00
3CE57 CERADAN WASH 1.00 0.00 0.00 1.00
3DA01 DAKTARIN CR 5 GR 1.00 0.00 0.00 1.00
3DE10 DESOLEX CR 2.00 0.00 0.00 2.00
3DI03 DIGENTA CR 2.00 0.00 0.00 2.00
3DU02 DULCOLAX SUPP DWS 5.00 0.00 0.00 5.00
3DU03 DUMIN RECTAL 125 4.00 0.00 0.00 4.00
3DU04 DUMIN RECTAL 250 7.00 0.00 0.00 7.00
3EL01 ELOCON CR 5 GR 2.00 0.00 0.00 2.00
3EN01 ENKASARI 120 2.00 0.00 0.00 2.00
3ES01 ESPERSON CR 5 GR 3.00 0.00 0.00 3.00
3FE01 FETIK SUPP 8.00 0.00 0.00 8.00
3FL02 FLADYSTIN OVULA 10.00 0.00 0.00 10.00
3FU02 FUTADERM CR 2.00 0.00 0.00 2.00
3GA03 GENTAMYCIN SLP 8.00 0.00 0.00 8.00
3HY02 HYDROCORTISON 2.5% 1.00 0.00 0.00 1.00
3IL01 ILLIADYN 0.025% 4.00 0.00 0.00 4.00
3IN02 INTERZOL CR 2.00 0.00 0.00 2.00
3IN04 INERSON OINT 1.00 0.00 0.00 1.00
3KE01 KENALOG IN ORABASE 2.00 0.00 0.00 2.00
3KE03 KENACORT A CR 3.00 0.00 0.00 3.00
3KE06 KALCINOL N CR 5.00 0.00 0.00 5.00
3KL01 KLODERMA CR 3.00 0.00 0.00 3.00
3LA01 LACTACYD PINK 60 3.00 0.00 0.00 3.00
3LA02 LACTACYD BIRU 60 4.00 0.00 0.00 4.00
3MI01 MICROLAX 5 ML 8.00 0.00 0.00 8.00
3MI02 MICONAZOLE CR 2.00 0.00 0.00 2.00
3MO04 MOMILEN NURSING CR 1.00 0.00 0.00 1.00
3MY02 MYCO Z CR 3.00 0.00 0.00 3.00
3MY07 MYK TELON KONICARE 30 4.00 0.00 0.00 4.00
3MY23 MYK TELON PLUS 30 2.00 0.00 0.00 2.00
3OT02 OTOPAIN EAR DROP 4.00 0.00 0.00 4.00
3PR02 PRORIS SUPP 12.00 0.00 0.00 12.00
3SA02 SAGALON CR 2.00 0.00 0.00 2.00
3SA04 SALTICIN CR 5.00 0.00 0.00 5.00
3SO02 SCABIMITE CR 30 2.00 0.00 0.00 2.00
3ST01 STESOLID SUPP 3.00 0.00 0.00 3.00
3ST03 STESOLID INJ 7.00 0.00 0.00 7.00
3TA01 TARIVID OTIC 3.00 0.00 0.00 3.00
3TA02 TERMISIL CR 1.00 0.00 0.00 1.00
3TA05 TANTUM VERDE 60 2.00 0.00 0.00 2.00
3TH01 THROMBOPHOB GEL 1.00 0.00 0.00 1.00
3TR02 TRANSPULMIN BB 10 3.00 0.00 0.00 3.00
3VA01 VAPORIN SOFTGEL 70.00 0.00 0.00 70.00
3VO03 VOLTAREN GEL 50 1.00 0.00 0.00 1.00
3ZO01 ZOTER CR 2.00 0.00 0.00 2.00
4AM01 AMINOPHYLLIN INJ 6.00 0.00 0.00 6.00
4AQ01 AQ pi OTSU 25 ML 7.00 0.00 0.00 7.00
4AT01 ATROPIN SULFAS INJ 10.00 0.00 0.00 10.00
4BA01 BIOSAT 1,5 3.00 0.00 0.00 3.00
4CA02 CA GLUCONAST 4.00 0.00 0.00 4.00
4CE07 CETROTIDE INJ 5.00 0.00 0.00 5.00
4CO02 COMBIVENT NEBUL 25.00 0.00 0.00 25.00
4CY01 CYCLOFEM INJ 33.00 0.00 0.00 33.00
4DE01 DEPO PROGESTIN INJ 25.00 0.00 0.00 25.00
4DO01 DOPAC INJ 1.00 0.00 0.00 1.00
4DO03 DOPAMIN INJ 1.00 0.00 0.00 1.00
4DY01 DYPHENHIDRAMIN INJ 16.00 0.00 0.00 16.00
4EN04 ENGERIX B 0,5 3.00 0.00 0.00 3.00
4EU01 EUVAX 20mcg 3.00 0.00 0.00 3.00
4FL01 FLIXOTIDE NEBUL 31.00 0.00 0.00 31.00
4FL05 FLUQUADRI 0.25ML 2.00 0.00 0.00 2.00
4FL06 FLUQUADRI 0.5ML 1.00 0.00 0.00 1.00
4GA01 GARDASIL INJ 5.00 0.00 0.00 5.00
4GA02 GASTRIDIN INJ 4.00 0.00 0.00 4.00
4GI01 GITAS INJ 6.00 0.00 0.00 6.00
4GO02 GONAL 75IU INJ 5.00 0.00 0.00 5.00
4GO03 GONAL F PEN 300IU 1.00 0.00 0.00 1.00
4GO04 GONAL F PEN 900IU 3.00 0.00 0.00 3.00
4HI01 HEXAXIM 5.00 0.00 0.00 5.00
4IN04 INDEXON INJ 19.00 0.00 0.00 19.00
4IN06 INVOMIT 4 MG INJ 4.00 0.00 0.00 4.00
4IN07 INVOMIT 8 MG INJ 3.00 0.00 0.00 3.00
4IN08 INTERMIC INJ 5.00 0.00 0.00 5.00
4IN10 INFANRIX HEXA 8.00 0.00 0.00 8.00
4LA05 LIDOCAIN 20% INJ 5.00 0.00 0.00 5.00
4NE01 NEUROBION INJ 19.00 0.00 0.00 19.00
4NS02 NS OTSU 25 2.00 0.00 0.00 2.00
4OV01 OVIDREL INJ 3.00 0.00 0.00 3.00
4PE01 PEHACAIN INJ 19.00 0.00 0.00 19.00
4PL02 PERGOVERIS 3.00 0.00 0.00 3.00
4PR02 PREVENAR 9.00 0.00 0.00 9.00
4PU01 PULMICORT 9.00 0.00 0.00 9.00
4RE02 RECOFOL N INJ 5.00 0.00 0.00 5.00
4RO01 ROTARIX 6.00 0.00 0.00 6.00
4RO04 ROTATEQ 10.00 0.00 0.00 10.00
4SY01 SYNFLORIX 3.00 0.00 0.00 3.00
4TA02 TAPROS 3.75 INJ 2.00 0.00 0.00 2.00
4TA03 TAPROS INJ 1.88 3.00 0.00 0.00 3.00
4TA04 TAPROS 11.25MG INJ 1.00 0.00 0.00 1.00
4TY01 TYPHIM VI 0.5 5.00 0.00 0.00 5.00
4VE01 VENTOLIN NEBUL 6.00 0.00 0.00 6.00
5AC01 NOVO RAPID 6.00 0.00 0.00 6.00
5AL03 ALKOHOL SWABS 53.00 0.00 0.00 53.00
5AN06 TABIND EDTA 2.00 0.00 0.00 2.00
5BA01 BABY TEST 2.00 0.00 0.00 2.00
5BL01 BLOOD SET 5.00 0.00 0.00 5.00
5CA01 CAESAREAN SET 3.00 0.00 0.00 3.00
5CA02 CANNUL NASAL DWS 5.00 0.00 0.00 5.00
5CA03 CATHETER HSG 1.00 0.00 0.00 1.00
5CA04 CANNUL NASAL ANAK 5.00 0.00 0.00 5.00
5CA06 CANNUL INSEMINASI 5.00 0.00 0.00 5.00
5CH02 CHROMIC 1 J803H ETHICON 32.00 0.00 0.00 32.00
5CU02 CUTICELL 10X10CM 11.00 0.00 0.00 11.00
5DO01 DILUENT DIFF 20L MINDRAY 1.00 0.00 0.00 1.00
5HC01 HCV DEVICE 40.00 0.00 0.00 40.00
5HI01 HIV DEVIVE 40.00 0.00 0.00 40.00
5HY03 HYPAFIX 5 X 5 1.00 0.00 0.00 1.00
5HY04 HYPAFIX 5 X 1 2.00 0.00 0.00 2.00
5IN01 IN STOPPER 10.00 0.00 0.00 10.00
5IN02 INFUSET 6.00 0.00 0.00 6.00
5JA01 JARUM 23 TERUMO 100.00 0.00 0.00 100.00
5JA02 JARUM 26 TERUMO 97.00 0.00 0.00 97.00
5JA03 JARUM NOVOLET 31GX5 67.00 0.00 0.00 67.00
5JA06 JARUM 25 TERUMO 46.00 0.00 0.00 46.00
5JA08 JARUM 20 TERUMO 10.00 0.00 0.00 10.00
5JA09 JARUM 18 TERUMO 9.00 0.00 0.00 9.00
5KA01 KASSA STERIL 10.00 0.00 0.00 10.00
5KA02 KASA 40 * 80 HUSADA 1.00 0.00 0.00 1.00
5LA02 LANTUS SOLOSTAR 2.00 0.00 0.00 2.00
5LE03 LEUKOMED IV 4.00 0.00 0.00 4.00
5MA02 MASKER NEBULAIZER ANAK 3.00 0.00 0.00 3.00
5MA05 MASKER NEBULAIZER DWS 25.00 0.00 0.00 25.00
5MA07 MASKER OKSIGEN 18.00 0.00 0.00 18.00
5ME01 MESS 15.00 0.00 0.00 15.00
5MI06 MICROSET BB 5.00 0.00 0.00 5.00
5MI07 MIRENA IUD 1.00 0.00 0.00 1.00
5MO07 M-18 EZ CLEANSER 100ML 1.00 0.00 0.00 1.00
5PE03 PESARIUM RUSH 5.00 0.00 0.00 5.00
5PE05 PESARIUM SIMACLUS 1.00 0.00 0.00 1.00
5PE06 PERILAX 42.00 0.00 0.00 42.00
5PL08 PLESTERIN WP 100.00 0.00 0.00 100.00
5PO03 POT KECANTIKAN 10.00 0.00 0.00 10.00
5SP01 SPUIT 1CC 95.00 0.00 0.00 95.00
5SP02 SPUIT 3CC TERUMO 23.00 0.00 0.00 23.00
5SP06 SPUIT 20CC 5.00 0.00 0.00 5.00
5SP07 SPUIT 50CC BBRAUN 5.00 0.00 0.00 5.00
5SP10 SPUIT 5 CC TERUMO 21.00 0.00 0.00 21.00
5SP11 SPUIT 10CC TERUMO 20.00 0.00 0.00 20.00
5SP12 SPALK 10X5 23.00 0.00 0.00 23.00
5SP13 SPALK 15X5 10.00 0.00 0.00 10.00
5SP14 SPONS KECANTIKAN 21.00 0.00 0.00 21.00
5SP15 SPUIT 3CC GIDCARE 43.00 0.00 0.00 43.00
5SU10 SUPERCATH 18 29.00 0.00 0.00 29.00
5SU11 SUPERCATH 20 20.00 0.00 0.00 20.00
5SU12 SUPERCATH 22 16.00 0.00 0.00 16.00
5SU13 SUPERCATH 24 15.00 0.00 0.00 15.00
5TE03 TEGADERM 9 X 25 5.00 0.00 0.00 5.00
5TE04 TENSOCREPE 7.5 2.00 0.00 0.00 2.00
5TR01 TRANSOFIX 10.00 0.00 0.00 10.00

5TT02 THREE WAY EKOR STOPCOCK 5.00 0.00 0.00 5.00


5TW01 THREE WAY BIASA BB 4.00 0.00 0.00 4.00
5UN02 URINE COLECTOR 5.00 0.00 0.00 5.00
5UN03 UNDER PAD STERIL 5.00 0.00 0.00 5.00
5VE03 VERBAND 10' 5.00 0.00 0.00 5.00
5VI01 VERBAND 5" 5.00 0.00 0.00 5.00
6GE01 GELOFUSINE 500 3.00 0.00 0.00 3.00
6IN03 INFUSAN RD sp 2.00 0.00 0.00 2.00
6IN06 INFUSAN D5 + 1/2 NS 2.00 0.00 0.00 2.00
6IN08 INFUSAN D5 1/4 NS 6.00 0.00 0.00 6.00
6INO4 INFUSAN RING AS sp 10.00 0.00 0.00 10.00
6KA03 KAEN 3A 2.00 0.00 0.00 2.00
6TR01 TRIDEX 27b 2.00 0.00 0.00 2.00
7AN02 ANTANGIN CAIR 3.00 0.00 0.00 3.00
7BY01 BYE BYE FEVER PAED 7.00 0.00 0.00 7.00
7BY02 BYE BYE FEVER BABY 1.00 0.00 0.00 1.00
7CH02 CHIL GO 104.00 0.00 0.00 104.00
7HA01 HANSAPLAST 18.00 0.00 0.00 18.00
7IN01 INFANTRINI 125ML 5.00 0.00 0.00 5.00
7NU10 NUTRINI 200ML 5.00 0.00 0.00 5.00
7ON01 ONE MED 1.00 0.00 0.00 1.00
7OT01 OK PLAST 149.00 0.00 0.00 149.00
7PR07 PRENAGEN JUZ 10.00 0.00 0.00 10.00
7PR08 PRENAGEN UHT 9.00 0.00 0.00 9.00
7SA02 SALONPAS KOYO 9.00 0.00 0.00 9.00
7SA03 SALONPAS KOYO HOT 7.00 0.00 0.00 7.00
7SE01 SENSITIF 5.00 0.00 0.00 5.00
7TE02 TERMOMETER DIGITAL 3.00 0.00 0.00 3.00
7ZA01 DIVA COLAGEN 80ML 4.00 0.00 0.00 4.00
8AC01 ACYCLOVIR 200 JKN 85.00 0.00 0.00 85.00
8AC02 ACYCLOVIR 400 JKN 49.00 0.00 0.00 49.00
8AL01 ALLOPURINOL 300 JKN 21.00 0.00 0.00 21.00
8AL02 ALLOPURINOL 100 JKN 190.00 0.00 0.00 190.00
8AM01 AMOXYCILLIN JKN 90.00 0.00 0.00 90.00
8AM02 AMLODIPINE 5MG JKN 40.00 0.00 0.00 40.00
8AM03 AMLODIPINE 10MG JKN 51.00 0.00 0.00 51.00
8AM04 AMBROXOL JKN 66.00 0.00 0.00 66.00
8AS01 ASAM MEFENAMAT JKN 36.00 0.00 0.00 36.00
8AT01 ATORVASTATIN 20 JKN 46.00 0.00 0.00 46.00
8BI01 BISOPROLOL 5 JKN 7.00 0.00 0.00 7.00
8CA01 CAPTOPRIL 25 JKN 50.00 0.00 0.00 50.00
8CA02 CAVIPLEX TAB JKN 85.00 0.00 0.00 85.00
8CE01 CETIRIZINE 10MG JKN 68.00 0.00 0.00 68.00
8CE02 CEFADROXIL JKN 4.00 0.00 0.00 4.00
8CE03 CEFIXIME JKN 48.00 0.00 0.00 48.00
8CI01 CITICOLINE 500MG JKN 30.00 0.00 0.00 30.00
8CI02 CIPROFLOXACINE JKN 44.00 0.00 0.00 44.00
8CL01 CLINDAMYCIN 150 JKN 72.00 0.00 0.00 72.00
8CL02 CLINDAMYCIN 300 JKN 110.00 0.00 0.00 110.00
8DO01 DOMPERIDONE JKN 49.00 0.00 10.00 39.00
8ER01 ERYTHROMYCIN JKN 60.00 0.00 0.00 60.00
8FU01 FUROSEMIDE 40 JKN 77.00 0.00 0.00 77.00
8GA01 GASTRUL 30 JKN 20.00 0.00 0.00 20.00
8GL01 GLIMEPIRIDE 1MG JKN 10.00 0.00 0.00 10.00
8GL05 GLIMEPIRIDE 2 JKN 95.00 0.00 0.00 95.00
8IB01 IBUPROFEN JKN 105.00 0.00 0.00 105.00
8IN01 INBESARTAN 300 JKN 30.00 0.00 0.00 30.00
8LA01 LANSOPRAZOL TAB JKN 26.00 0.00 0.00 26.00
8LO01 LORATADINE JKN 73.00 0.00 0.00 73.00
8LO02 LOPERAMIDE JKN 116.00 0.00 10.00 106.00

8ME01 METHYLPREDNISOLONE 4 JKN 151.00 0.00 0.00 151.00


8ME03 MELOXICAM 7.5MG JKN 2.00 0.00 0.00 2.00

8ME06 METHYLPREDNISOLONE 16 JKN 78.00 0.00 0.00 78.00


8NE01 NEXA TAB JKN 4.00 0.00 0.00 4.00
8OM01 OMEPRAZOLE TAB JKN 42.00 0.00 0.00 42.00
8ON01 ONDANSENTRON 4 TAB JKN 44.00 0.00 0.00 44.00
8PA01 PANTOPRAZOLE 40 JKN 10.00 0.00 0.00 10.00
8PA02 PARACETAMOL TAB JKN 93.00 0.00 0.00 93.00
8RA01 RANITIDIN TAB JKN 51.00 0.00 0.00 51.00
8SI01 SIMVASTATIN 20 JKN 7.00 0.00 0.00 7.00
8TH01 THIAMPHENICOL JKN 90.00 0.00 0.00 90.00
8VA01 VALSARTAN 80 JKN 40.00 0.00 0.00 40.00
9AM01 AMPICILLIN SYR JKN 1.00 0.00 0.00 1.00
9AM02 AMOXICILLIN SYR JKN 4.00 0.00 0.00 4.00
9AN01 ANTASIDA DOEN SYR JKN 4.00 0.00 0.00 4.00
9CA01 CAVIPLEX SYR JKN 1.00 0.00 0.00 1.00
9CE01 CEFIXIME SYR JKN 1.00 0.00 0.00 1.00
9CH01 CHLORAMPHENICOL SYR JKN 5.00 0.00 0.00 5.00
9PA01 PARACETAMOL SYR JKN 3.00 0.00 0.00 3.00
A1RA01 RANITIDINE INJ JKN 10.00 0.00 0.00 10.00
A2NS01 NS WIDA JKN 5.00 0.00 0.00 5.00
AD1 ADMIN 9,767.00 0.00 2.00 9,765.00
KA 1 KANTONG OBAT BESAR 32.00 0.00 1.00 31.00
KA 2 KANTONG 1 13.00 0.00 0.00 13.00
KA 3 KANTONG 2 43.00 0.00 1.00 42.00
KA 4 KANTONG 3 151.00 0.00 0.00 151.00
PE# PERKAMEN 9,882.00 0.00 10.00 9,872.00
37,827.00 0.00 50.00 37,777.00