RENCANA KERJA ANGGARAN

RENCANA KERJA ANGGARAN 2 0 2 2 RSU HAJI MEDAN

Satuan Tarif/Harga 5 5.1 62,600,000,000 5.1.01 24,500,242,000 20,092,736,000 82 Org/Bln 6,000,000 492,000,000 120 Org/Bln 6,050,000 726,000,000 216 Org/Bln 5,350,000 1,155,600,000 204 Org/Bln 5,350,000 1,091,400,000 1724 Org/Bln 1,900,000 3,275,600,000 624 Org/Bln 2,350,000 1,466,400,000 552 Org/Bln 2,690,000 1,484,880,000 792 Org/Bln 2,988,000 2,366,496,000 456 Org/Bln 3,295,000 1,502,520,000 996 Org/Bln 3,990,000 3,974,040,000 588 Org/Bln 4,350,000 2,557,800,000 1,605,928,000 10 Org/Thn 6,050,000 60,500,000 18 Org/Thn 5,350,000 96,300,000 17 Org/Thn 5,350,000 90,950,000 125 Org/Thn 1,900,000 237,500,000 52 Org/Thn 2,350,000 122,200,000 46 Org/Thn 2,690,000 123,740,000 66 Org/Thn 2,988,000 197,208,000 38 Org/Thn 3,295,000 125,210,000 83 Org/Thn 3,990,000 331,170,000 49 Org/Thn 4,350,000 213,150,000 1 Org/Thn 8,000,000 8,000,000 1,195,650,000 3 Org/Bln 2,000,000 6,000,000 30 Org/Bln 1,000,000 30,000,000 7 Org/Bln 1,250,000 8,750,000 2 Org/Bln 2,500,000 5,000,000 12 Org/Bln 1,750,000 21,000,000 10 Org/Bln 2,000,000 20,000,000 700 Org/Bln 300,000 210,000,000 110 Org/Bln 1,000,000 110,000,000 220 Org/Bln 800,000 176,000,000 247 Org/Bln 700,000 172,900,000 260 Org/Bln 600,000 156,000,000 280 Org/Bln 500,000 140,000,000 350 Org/Bln 400,000 140,000,000 1,605,928,000 10 Org/Thn 6,050,000 60,500,000 18 Org/Thn 5,350,000 96,300,000 17 Org/Thn 5,350,000 90,950,000 125 Org/Thn 1,900,000 237,500,000 52 Org/Thn 2,350,000 122,200,000 46 Org/Thn 2,690,000 123,740,000 66 Org/Thn 2,988,000 197,208,000 38 Org/Thn 3,295,000 125,210,000 83 Org/Thn 3,990,000 331,170,000 49 Org/Thn 4,350,000 213,150,000 1 Org/Thn 8,000,000 8,000,000 Insentif Kasubbag PNS BLUD Insentif Kabag/Kabid Pegawai BLUD Non PNS Insentif Kepala Ruangan/Ka.Ur Peg BLUD Non PNS Insentif Kasubbag Pegawai BLUD Non PNS Insentif Pegawai Kontrak BLUD Non PNS Insentif Pegawai Staf BLUD Non PNS Kelompok I Insentif Pegawai Staf BLUD Non PNS Kelompok II Insentif Pegawai Staf BLUD Non PNS Kelompok III Insentif Pegawai Staf BLUD Non PNS Kelompok IV Insentif Pegawai Staf BLUD Non PNS Kelompok V Insentif Pegawai Staf BLUD Non PNS Kelompok VI THR Pegawai Staf BLUD Non PNS Kelompok I THR Pegawai Staf BLUD Non PNS Kelompok II THR Pegawai Staf BLUD Non PNS Kelompok III Gaji 13 Pegawai Staf BLUD Non PNS Kelompok III Gaji 13 Pegawai Staf BLUD Non PNS Kelompok IV Gaji 13 Pegawai Staf BLUD Non PNS Kelompok V Gaji 13 Pegawai Staf BLUD Non PNS Kelompok VI Gaji 13 Wadir/Komite Medik BLUD Non PNS [#] Belanja Gaji 13 BLUD Dana yang dibutuhkan Rp 62,600,000,000 Keluaran terlaksananya Operasional RS 1 tahun THR Kasubbag Pegawai BLUD Non PNS THR Pegawai Kontrak BLUD Non PNS THR Pegawai Staf BLUD Non PNS Kelompok IV [#] Belanja Insentif BLUD [#] Belanja THR BLUD THR Kabag/Kabid Pegawai BLUD Non PNS - - jumlah Insentif Kabag/Kabid PNS BLUD Insentif Kepala Ruangan PNS BLUD Gaji Pegawai Staf BLUD Non PNS Kelompok IV Gaji Pegawai Staf BLUD Non PNS Kelompok V Gaji Pegawai Staf BLUD Non PNS Kelompok VI Gaji 13 Kabag/Kabid Pegawai BLUD Non PNS Gaji 13 Kepala Ruangan/Ka.Ur Peg BLUD Non PNS Gaji 13 Kasubbag Pegawai BLUD Non PNS Gaji 13 Pegawai Kontrak BLUD Non PNS Gaji 13 Pegawai Staf BLUD Non PNS Kelompok I Gaji 13 Pegawai Staf BLUD Non PNS Kelompok II Kode Rekening Uraian BELANJA DAERAH THR Pegawai Staf BLUD Non PNS Kelompok V THR Pegawai Staf BLUD Non PNS Kelompok VI THR Wadir/Komite Medik BLUD Non PNS Volume Rincian Perhitungan [-] Belanja Pegawai BLUD THR Kepala Ruangan/Ka.Ur Peg BLUD Non PNS BELANJA OPERASI Belanja Pegawai Gaji Dewan Pengawas BLUD Gaji Kabag/Kabid Pegawai BLUD Non PNS Gaji Kepala Ruangan/Ka.Ur Peg BLUD Non PNS Gaji Kasubbag Pegawai BLUD Non PNS Gaji Pegawai Kontrak BLUD Non PNS Gaji Pegawai Staf BLUD Non PNS Kelompok I Gaji Pegawai Staf BLUD Non PNS Kelompok II Gaji Pegawai Staf BLUD Non PNS Kelompok III Indikator Tolak Ukur Kinerja Target Kinerja Capaian Program Masukan Hasil RENCANA KERJA ANGGARAN (RKA) BLUD 2022

5.1.02 38,099,758,000 5.1.02.01 150,000,000 375 Org/Hr 400,000 150,000,000 1,770,936,528 120 Org/Bln 522,840 62,740,800 960 Org/Bln 194,560 186,777,600 636 Org/Bln 240,640 153,047,040 552 Org/Bln 275,456 152,051,712 792 Org/Bln 305,971 242,329,032 456 Org/Bln 337,408 153,858,048 936 Org/Bln 408,576 382,427,136 588 Org/Bln 445,440 261,918,720 96 Org/Bln 566,520 54,385,920 216 Org/Bln 522,840 112,933,440 12 Org/Bln 705,590 8,467,080 9,130,097,500 100 Orang/Operasi 2,700,000 270,000,000 320 Orang/Operasi 1,950,000 624,000,000 10 Orang/Operasi 4,500,000 45,000,000 160 Orang/Operasi 4,500,000 720,000,000 20 Orang/Operasi 4,500,000 90,000,000 45 Orang/Operasi 9,376,500 421,942,500 180 Orang/Operasi 3,637,000 654,660,000 550 Orang/Operasi 1,350,000 742,500,000 90 Orang/Operasi 4,200,000 378,000,000 151 Orang/Tindakan 300,000 45,300,000 400 Orang/Tindakan 168,000 67,200,000 88 Orang/Tindakan 125,000 11,000,000 2400 Orang/Tindakan 20,000 48,000,000 10000 Orang/Tindakan 40,000 400,000,000 75 Orang/Tindakan 300,000 22,500,000 2500 Orang/Visite 75,000 187,500,000 12000 Orang/Visite 60,000 720,000,000 2262 Orang/Visite 50,000 113,100,000 21000 Orang/Visite 35,000 735,000,000 126000 Orang/Tindakan 12,500 1,575,000,000 100 Orang/Tindakan 350,000 35,000,000 1000 Orang/Visite 75,000 75,000,000 6000 Orang/Tindakan 20,000 120,000,000 8850 Orang/Pasien 35,000 309,750,000 300 Orang/Visite 150,000 45,000,000 25 Orang/Tindakan 125,000 3,125,000 2152 Orang/Visite 10,000 21,520,000 1000 Orang/Tindakan 150,000 150,000,000 5000 Orang/Visite 100,000 500,000,000 50,000,000 1 Paket 50,000,000 50,000,000 1,688,000,000 40 Org/Bln 7,000,000 280,000,000 160 Org/Bln 5,000,000 800,000,000 80 Org/Bln 2,500,000 200,000,000 2040 Org/Kunjungan 200,000 408,000,000 750,000,000 12 Bln 62,500,000 750,000,000 916,968,000 12 Bln 76,414,000 916,968,000 25,000,000 1000 Set 25,000 25,000,000 Sistem Informasi Manajemen Rumah Sakit (SIMRS) [-] Belanja Jasa Transaksi Keuangan Jasa Bank Insentif Dokter BLUD PNS/NON PNS Kelompok I Insentif Dokter BLUD PNS/NON PNS Kelompok II Insentif Dokter BLUD PNS/NON PNS Kelompok III Insentif Dokter BLUD PNS/NON PNS Kelompok IV Jasa Rujukan Konsultan Appraisal/Konsultan Penilai Honor dokter GastrocopySpesifikasi : Zona 1 Honor dokter ICU Spesifikasi : Zona 1 Honor dokter Kelas I Spesifikasi : Zona 1 Honor dokter Kelas II Spesifikasi : Zona 1 Honor dokter Kelas III Spesifikasi : Zona 1 Honor Dokter LaboratoriumSpesifikasi : Zona 1 Honor dokter Patologi AnatomiSpesifikasi : Zona 1 Honor dokter PICU / NICU Spesifikasi : Zona 1 Honor dokter RadiologiSpesifikasi : Zona 1 Honor Dokter Rawat JalanSpesifikasi : Zona 1 Honor dokter Super VipSpesifikasi : Zona 1 Honor dokter TreadmillSpesifikasi : Zona 1 Honor dokter umumSpesifikasi : Zona 1 Honor dokter USG Spesifikasi : Zona 1 Honor dokter VipSpesifikasi : Zona 1 Honor Bedah MataSpesifikasi : Zona 1 Honor Bedah ObgynSpesifikasi : Zona 1 Honor Bedah OngkologiSpesifikasi : Zona 1 Honor Bedah OrthopediSpesifikasi : Zona 1 Honor Bedah PlastikSpesifikasi : Zona 1 Honor Bedah SyarafSpesifikasi : Zona 1 Honor Bedah THT Spesifikasi : Zona 1 Honor Bedah UmumSpesifikasi : Zona 1 Honor Bedah UrologiSpesifikasi : Zona 1 Honor dokter BronchoscopiSpesifikasi : Zona 1 Honor dokter Ct ScanSpesifikasi : Zona 1 Honor dokter EEG Spesifikasi : Zona 1 Honor dokter EKG Spesifikasi : Zona 1 Honor dokter FisioterapiSpesifikasi : Zona 1 Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok II Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok III Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok IV Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok V Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok VI Iuran BPJS Kesehatan setingkat Kabag/Kabid Pegawai BLUD Iuran BPJS Kesehatan setingkat Ka.Ruangan/Ka.Ur. Pegawai BLUD Iuran BPJS Kesehatan setingkat Wadir Pegawai BLUD Iuran BPJS Kesehatan Kasubag Pegawai BLUD Iuran BPJS Kesehatan Pegawai Kontrak BLUD [-] Belanja Asuransi Pegawai BLUD [-] Belanja Jasa Medis [-] Belanja Jasa Konsultan Auditor Independent [-] Belanja Insentif Dokter Belanja Barang dan Jasa Belanja Barang Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok I [-] Belanja Jasa Rujukan [-] Belanja Jasa Pemakaian SIMRS [-] Penambahan Daya Listrik Belanja Pakaian Tenaga Kesehatan Penambahan Daya Listrik [-] Belanja BHP Pakian Nakes

992,500,000 25000 Kg 38,500 962,500,000 12 Bln 2,500,000 30,000,000 35,040,000 12 Org/Bln 2,920,000 35,040,000 212,400,000 12 Org/Bln 1,720,000 20,640,000 12 Org/Bln 1,550,000 18,600,000 36 Org/Bln 570,000 20,520,000 24 Org/Bln 1,150,000 27,600,000 12 Org/Bln 2,210,000 26,520,000 12 Org/Bln 1,780,000 21,360,000 12 Org/Bln 3,010,000 36,120,000 12 Org/Bln 3,420,000 41,040,000 5.1.01.03.07.0002 39,360,000 60 Org/Paket 520,000 31,200,000 12 Org/Bln 680,000 8,160,000 5.1.02.01.01 188,023,000 375 BUNGKUS 20,000 7,500,000 540 KOTAK 32,000 17,280,000 752 BUNGKUS 5,000 3,760,000 752 BUNGKUS 25,000 18,800,000 556 BUNGKUS 15,000 8,340,000 375 KG 35,000 13,125,000 40 BUAH 25,000 1,000,000 500 BUNGKUS 15,000 7,500,000 33,850 BUAH 3,000 101,550,000 11,280 BUAH 600 6,768,000 100 KOTAK 20,000 2,000,000 10 KG 40,000 400,000 5.1.02.01.01.0010 129,500,000 148 Tabung 875,000 129,500,000 5.1.02.01.01.0043 1,841,198,435 8,766 kg 13,110 114,922,260 500 kotak 3,729 1,864,500 1,504 kg 15,952 23,991,808 735 kotak 11,495 8,448,825 30,000 butir 1,499 44,970,000 752 kotak 67,276 50,591,552 40 kotak 76,433 3,057,320 26 kotak 186,000 4,836,000 120 bungkus 261,250 31,350,000 1,000 sachet 18,295 18,295,000 6 kg 143,629 861,774 1,500 kg 14,520 21,780,000 3,000 kg 36,300 108,900,000 375 kg 36,300 13,612,500 800 kg 135,600 108,480,000 565 kg 118,650 67,037,250 7,500 kg 55,000 412,500,000 150 kg 35,000 5,250,000 150 kg 35,000 5,250,000 1,503 buah 7,910 11,888,730 940 kg 9,200 8,648,000 500 kg 43,700 21,850,000 730 kg 48,345 35,291,850 270 kg 58,520 15,800,400 470 kg 8,050 3,783,500 [-] Honorarium Pengelola Kegiatan BLUD Bendahara Penerimaan Nilai Pagu dana diatas Rp. 50 miliar s.d. 75 miliar Bendahara Pengeluaran Nilai Pagu dana diatas Rp. 50 miliar s.d. Rp. 75 miliar Bendahara Pengeluaran Pembantu Nilai Pagu dana diatas Rp. 2,5 miliar s.d. Rp. 5 miliar Bendahara Pengeluaran Pembantu/Staf/Petugas Adm Belanja Pegawai Nilai Pagu dana diatas Rp. 50 miliar s.d. Rp. 75 miliar Pejabat Pelaksana Teknis Kegiatan (PPTK-SKPD) Nilai Pagu dana diatas Rp. 2,5 miliar s.d. Rp. 5 miliar Pejabat Penatausahaan Keuangan (PPK-SKPD) Nilai Pagu dana diatas Rp. 50 miliar s.d. Rp. 75 miliar Pengguna Anggaran/Kuasa Pengguna Anggaran Nilai Pagu dana diatas Rp. 10 miliar s.d. Rp. 25 miliar Pengguna Anggaran/Kuasa Pengguna Anggaran Nilai Pagu dana diatas Rp. 25 miliar s.d. Rp. 50 miliar Belanja Honorarium Pengadaan Barang/Jasa Panitia Pemeriksa Administrasi Hasil Pekerjaan/Pengadaan Barang/Jasa Nilai pagu pengadaan diatas Rp. 200 jt s.d. 500 jt Pejabat Pengadaan untuk Pengadaan Barang/Jasa [-] Belanja Pengangkutan Sampah Jasa Pengangkutan Sampah Medis Jasa Pengangkutan Sampah Umum [#] Honorarium Pengelola Kegiatan BLUD Pejabat Pembuat Komitmen selaku Pejabat Penandatanganan Kontrak (PPK) Nilai Pagu dana diatas Rp. 10 miliar s.d. Rp. 25 miliar TISSUE MAKAN PLASTIK PULUT UKURAN KECIL SENDOK MAKAN PLASTIK [-] Belanja BHP Instalasi Gizi SUNLIGHT 400 ml (refil) PLASTIK WRAF Uk. 300 mm x 30 m Belanja Bahan-Isi Tabung Gas [#] Belanja Pengisian Tabung Gas [-] Belanja Pengisian Tabung Gas ELPIJI GAS ELPIJI 50 KG / TABUNG Belanja Bahan Makan Pokok Pasien Belanja Barang Pakai Habis GELAS CUP PLASTIK ( 1 bungkus isi 50 buah) KOTAK NASI KOMPLIT KOTAK STREOFOM SARUNG TANGAN DISPOSABLE KARET GELANG PLASTIK UKURAN 1/4 KG PEMANTIK API [-] Belanja Kebutuhan Makan Minum Pasien BERAS IR 64 MINYAK / CORN OIL TROPICANA SLIM 1 LITER/KG MINYAK GORENG KEMASAN DAGING AYAM BUBUK TEH BENDERA 50 GR GULA PUTIH TEPUNG MAIZENA 100 GR NUGGET AYAM DAGING SAPI ( HAS ) DAGING SAPI (SOP) IKAN LAUT SEGAR BAKSO AYAM TELUR AYAM SUSU BUBUK ISOCAL 400 GR SUSU BUBUK SGM GAIN 100 400 GR SUSU SKIM TROPICANA SLIM 1000 GR SUSU BUBUK BLENDERA @1,25 KG SUSU ENSURE VANILLA BAWANG PUTIH (KUPAS) DAUN SOP / PREI SOSIS AYAM KELAPA TOMAT CABE MERAH BAWANG MERAH (KUPAS)

3,200 batang 2,200 7,040,000 12,532 potong 1,243 15,577,276 600 kg 7,840 4,704,000 11,300 buah 1,130 12,769,000 200 buah 22,000 4,400,000 3,759 kg 16,950 63,715,050 750 kg 4,500 3,375,000 1,000 sisir 19,550 19,550,000 816 kg 19,550 15,952,800 750 kg 33,900 25,425,000 600 kg 19,210 11,526,000 750 kg 49,500 37,125,000 12 kg 50,000 600,000 988 kg 16,950 16,746,600 56,700 buah 3,025 171,517,500 5,840 buah 8,349 48,758,160 100 sachet 8,470 847,000 513 kg 4,600 2,359,800 260 kg 6,900 1,794,000 742 kg 14,520 10,773,840 1,150 kg 9,040 10,396,000 1,500 ikat 3,450 5,175,000 2,570 ikat 1,150 2,955,500 500 kg 8,050 4,025,000 700 kg 8,050 5,635,000 125 kg 28,250 3,531,250 520 kg 4,600 2,392,000 550 kg 9,200 5,060,000 180 kg 13,800 2,484,000 210 kg 27,120 5,695,200 180 kg 45,200 8,136,000 12 kg 22,000 264,000 290 kg 9,040 2,621,600 400 kg 9,040 3,616,000 50 kg 2,825 141,250 290 kg 9,040 2,621,600 275 kg 9,200 2,530,000 275 kg 11,300 3,107,500 275 kg 28,250 7,768,750 275 kg 9,040 2,486,000 275 kg 25,990 7,147,250 275 kg 10,350 2,846,250 275 kg 10,170 2,796,750 275 kg 16,950 4,661,250 275 kg 12,000 3,300,000 275 kg 16,950 4,661,250 8 kg 112,932 903,456 60 kg 24,200 1,452,000 75 kg 26,620 1,996,500 375 botol 20,000 7,500,000 375 bungkus 20,000 7,500,000 650 sachet 1,210 786,500 39 kg 59,840 2,333,760 123 kg 80,500 9,901,500 2,000 butir 509 1,018,000 170 kg 54,240 9,220,800 129 kg 20,700 2,670,300 30 kg 56,500 1,695,000 13 kg 155,375 2,019,875 30 kg 55,000 1,650,000 6 kg 80,000 480,000 150 kg 12,100 1,815,000 1,027 ikat 18,645 19,148,415 40 buah 9,944 397,760 200 kg 6,780 1,356,000 26 kg 27,830 723,580 8 kg 41,745 333,960 62 kg 40,250 2,495,500 3 kg 63,250 189,750 3 kg 150,000 450,000 5 kg 45,000 225,000 7 kg 80,000 560,000 2 kg 180,000 360,000 CABE RAWIT UDANG SEGAR TELUR PUYUH CUMI - CUMI CABE IJO BUBUK KETUMBAR BUBUK MERICA BUBUK KUNYIT BUBUK JINTAN TEPUNG TERIGU DAUN - DAUNAN ( SERE,D.JERUK,D.KUNYIT,D.SALAM ) WORTEL ( JUS ) TERONG BELANDA ( JUS ) TIMUN ( JUS ) BELIMBING (JUS) MELON ( JUS ) GUAVA ( JUS ) BUAH NAGA (JUS ) IKAN TERI NASI KACANG TANAH UDANG KECEPE SAOS TOMAT KECAP MANIS REFIL KECAP MANIS SACHET PALA BULAT CENGKEH BELACAN / TERASI JAGUNG MANIS ASAM POTONG ASAM JAWA KEMIRI PISANG BARANGAN SAWI PAHIT KENTANG (KUPAS) WORTEL BAYAM MAKARONI BUNGA KOL MELINJO JANTEN ERCIS LABU JIPANG LABU KUNING SEMANGKA MERAH @ 5KG/BUAH SEMANGKA KUNING@3KG TAUGE KACANG PANJANG MARKISA ( JUS ) TEMPE TAHU OYONG / GAMBAS BUAH PIR JERUK MANIS APEL FUJI SUNKIST ANGGUR KANGKUNG BUAH NAGA KUE SNACK PASIEN ( UNTUK SMUA KELAS ) KUE SNACK PASIEN ( UNTUK KELAS S.VIP / SR ) BLUEBAND SACHET SAWI PUTIH SELADA TIMUN SAWI IJO BUNCIS KOL BROKOLI TOMAT ( JUS ) JERUK PERAS ( JUS ) KAPULAGA BUNGA LAWANG KAYU MANIS

25 buah 6,215 155,375 60 kg 45,200 2,712,000 37 kg 10,000 370,000 37 kg 34,182 1,264,734 100 kg 24,860 2,486,000 100 kg 9,944 994,400 1,410 buah 1,130 1,593,300 1,000 sachet 1,243 1,243,000 1,100 bungkus 14,690 16,159,000 10 kg 18,645 186,450 37 kg 22,600 836,200 75 botol 8,000 600,000 400 bungkus 8,000 3,200,000 550 ikat 1,500 825,000 40 kg 10,000 400,000 40 kg 50,000 2,000,000 37 botol 15,000 555,000 25 bungkus 102,545 2,563,625 5.1.02.01.01.0038 8,289,917,892 8,000 TABLET 22,300 178,400,000 100,000 TABLET 130 13,000,000 40,000 KAPSUL 507 20,280,000 1,000 AMPUL 9,200 9,200,000 1 BOX 4,460,000 4,460,000 1,200 TABLET 429 514,800 120 TUBE 2,260 271,200 60,000 TABLET 3,986 239,160,000 10,000 TABLET 66 660,000 50,000 TABLET 850 42,500,000 30,000 TABLET 600 18,000,000 6,000 KAPSUL 5,500 33,000,000 100 AMPUL 12,067 1,206,700 6,000 TABLET 200 1,200,000 6,000 TABLET 400 2,400,000 60,000 TABLET 1,397 83,820,000 80,000 TABLET 643 51,440,000 15,000 TABLET 78 1,170,000 30,000 TABLET 99 2,970,000 3,000 BOTOL 3,988 11,964,000 5,000 TABLET 229 1,142,550 3,000 VIAL 29,700 89,100,000 1,000 AMPUL 2,704 2,704,000 500 BAG 69,364 34,682,000 50 BOTOL 79,500 3,975,000 50 BOTOL 51,190 2,559,500 500 BOTOL 44,100 22,050,000 300 AMPUL 9,570 2,871,000 50,000 TABLET 168 8,400,000 100,000 TABLET 131 13,100,000 50,000 TABLET 86 4,300,000 200 BOTOL 3,498 699,600 20,000 TABLET 211 4,220,000 400 VIAL 8,988 3,595,200 8,000 BOTOL 1,725 13,800,000 10,001 TABLET 60 600,060 700 SUPP 3,250 2,275,000 4,000 PEN 89,500 358,000,000 15,000 FLS 2,500 37,500,000 3,000 TABLET 6,888 20,664,000 900 SIRING 225,290 202,761,000 200 TABLET 44,800 8,960,000 80,000 TABLET 157 12,560,000 300 TUBE 6,277 1,883,100 60,000 TABLET 150 9,000,000 8,000 TABLET 1,870 14,960,000 10,000 AMPUL 1,880 18,800,000 100 BOTOL 9,680 968,000 8,000 TABLET 615 4,920,000 8,000 TABLET 400 3,200,000 8,000 TABLET 500 4,000,000 600 AMPUL 8,978 5,386,800 BAWANG BOMBAY KALDU BLOK (1 BOTOL ISI 20 BLOK) SWEETENER TROPICANA SLIM ISI 150 SACHET/BUNGKUS Belanja Obat-obatan Lainnya [-] Belanja BHP Obat ACYCLOVIR 200 MG TAB ACYCLOVIR CREAM ADALAT OROS 30 MG AFOLAT (ASAM FOLAT) TAB 0,4 MG TAUCO CUKA SAOS SACHET @ 1 BUNGKUS ISI 25 SACHET KEMANGI KUCAI KENCUR SODA KUE AMIODARONE INJ 150 MG AMITRIPTILIN TAB 25 MG AMLODIPIN 10 MG TAB AMLODIPIN 5 MG TAB AMOKSISILIN 125 MG/5 ML SYRUP AMOKSISILIN 500 MG AMPICILLIN 1 GR INJEKSI ANTASIDA DOEN SUSPENSI ANTASIDA DOEN TABLET ANTIHEMOROID SUPP APIDRA SOLOSTAR AMINOHEPAR AMINOFUSIN L 600 AMINOSTERIL INFANT 6% AKARBOSE 100 MG BAWANG GORENG MASAK KERUPUK GULA MERAH AMINOFLUID 500 ml / BFLUID ALPENTIN 100 MG ALPENTIN 300 MG / GABAPENTIN 300 MG ALPRAZOLAM 0,5 MG TAB ALPRAZOLAM TAB 1 MG AMBROXOL SYRUP AKARBOSE 50 MG ALBUMINO/CHANNA ALINAMIN INJEKSI/FURAMIN ALLOPURINOL 100 MG ALLOPURINOL 300 MG AMBROXOL TABLET AMIKASIN INJ 250 MG/ML AMINOFILIN INJ 24 MG/ML ABILIFY DISCMELT 10 MG / ARIPRIPAZOLE ACETOSAL TAB/MINIASPI 80 MG ACETYLCYSTEIN 200 MG ACETYLCYSTEIN INJEKSI ACTILYSE 50 MG LENGKUAS JERUK NIPIS ROYCO GARAM HALUS UK.500GR/BUNGKUS JAHE ATIVAN 2 MG/LORAZEPAM 2 MG ATORVASTATIN 10 MG ATORVASTATIN 20 MG ATRACURIUM/NOTRIXUM/TRAMUS ASAM FUSIDAT KRIM 20MG/FUCILEX CREAM ASAM MEFENAMAT 500 MG ASAM TRANEKSAMAT 500 MG TABLET ASAM TRANEKSAMAT INJ 100 MG/ML ASERING AQUA PRO INJEKSI 25 ML ARICEPT EVASS 10 MG ARIXTRA INJ 2,5 MG/0,5 ML AROMASIN TAB 25 MG ASAM ASKORBAT 50 MG TAB/VIT C

4,000 AMPUL 1,718 6,872,000 400 AMPUL 170,500 68,200,000 100 FLS 115,400 11,540,000 6,000 TABLET 11,330 67,980,000 15,000 TABLET 1,300 19,500,000 200 TUBE 1,540 308,000 100 FLS 86,930 8,693,000 100 TUBE 43,318 4,331,800 20,000 TABLET 121 2,420,000 10,001 TABLET 72 720,072 5,000 TABLET 500 2,500,000 80,000 TABLET 200 16,000,000 20 VIAL 382,875 7,657,500 4,800 TABLET 8,404 40,339,200 1,000 AMPUL 30,000 30,000,000 300 TUBE 18,557 5,567,100 2,000 TABLET 1,050 2,100,000 100 AMPUL 5,778 577,800 500 AMPUL 5,987 2,993,500 10,000 TABLET 100 1,000,000 20,000 TABLET 200 4,000,000 84 TABLET 11,100 932,400 30,000 KAPSUL 388 11,640,000 300 BOTOL 3,914 1,174,200 50 VIAL 6,323 316,150 15,000 TABLET 387 5,805,000 30,000 TABLET 749 22,470,000 700 BOTOL 4,947 3,462,900 400 VIAL 7,888 3,155,200 200 VIAL 8,313 1,662,600 6,000 VIAL 3,188 19,128,000 2,000 VIAL 6,597 13,194,000 30,000 VIAL 2,850 85,500,000 400 TABLET 7,915 3,166,000 500 BOTOL 2,702 1,351,000 30,000 TABLET 188 5,640,000 50 STRIP 31,128 1,556,400 100 STRIP 22,506 2,250,600 100 STRIP 18,030 1,803,000 50 STRIP 17,500 875,000 50 STRIP 18,080 904,000 500 STRIP 18,080 9,040,000 100 STRIP 36,361 3,636,100 100 STRIP 40,595 4,059,500 300 STRIP 24,936 7,480,800 300 AMPUL 3,397 1,019,100 500 KAPSUL 1,174 587,000 30 TUBE 3,431 102,930 2,000 TABLET 190 380,000 30,000 TABLET 250 7,500,000 2,000 BOTOL 7,715 15,430,000 6,000 AMPUL 5,455 32,730,000 6,000 TABLET 2,500 15,000,000 8,000 TABLET 473 3,784,000 30,000 TABLET 600 18,000,000 500 TABLET 649 324,500 2,000 FLS 5,005 10,010,000 45,000 TABLET 569 25,605,000 15,000 TABLET 3,097 46,455,000 6,000 TABLET 652 3,912,000 300 BOTOL 2,100 630,000 8,000 TABLET 240 1,920,000 600 TABLET 15,550 9,330,000 5,000 TABLET 100 500,000 4,000 BOTOL 9,500 38,000,000 30,000 TABLET 575 17,250,000 600 FLS 10,460 6,276,000 1,200 FLS 10,405 12,486,000 30,000 TABLET 136 4,080,000 9,000 AMPUL 968 8,712,000 800 BOTOL 12,123 9,698,400 15,000 TABLET 2,950 44,250,000 30,000 TABLET 1,421 42,630,000 DEPAKENE SYRUP/SODIUM VALPROATE 250 DEPAKOTE ER 250 MG SR DEPAKOTE ER 500 MG SR D5 1/2 NS D5 1/4NS DEKSAMETASON 0,5 MG TAB DEKSAMETASON INJ 5 MG/ML ATS (BIOSAT 1,5 IU ) AVAMYS AVODART/DUTASTERIDE 0,5 MG AZITROMYCIN 500 MG BETAMETASONE 0,1% CREAM ATROPIN SULFAT INJ CASODEX 50 MG CEFADROKSIL 500 MG TABLET CEFADROKSIL SIRUP 125 MG/ML CEFAZOLIN INJ 1 G CEFIKSIM 100 MG TABLET BUSCOVAN/HYOCIN N-BUTIL BROMID 10 MG/SCOPMA TABLET BUSCOVAN/HYOCIN N-BUTIL BROMID 20 MG /SCOPAMIN INJEKSI CA GLUCONAS INJ CAPTOPRIL 25 MG CARBAMAZEPIN 200 MG BISOPROLOL 5 MG BLEOCIN 15 MG/ML BRILINTA 90 MG BUPIVACAIN SPINAL HEAVY BURNAZIN/SULFADIAZINE SILVER BEROTEC MDI BETADINE SALEP 20 GR BETAHISTIN MESYLATE 6 MG BICNAT BISAKODIL TABLET 5 MG CENDO LYTEERS CENDO MYDRIATIL 1% CENDO TIMOL 0,5% CENDO XYTROL CETADOP 200 MG (DOPAMIN INJ) CENDO AUGENTONIC CENDO CATARLENT CENDO CARPINE CENDO FENICOL CENDO FLOXA CEFTAZIDIM 1000 MG CEFTRIAXON 1000 MG CELLCEPT/KAMYFET TABLET CETIRIZIN SIRUP 5 MG/5 ML CETIRIZIN TABLET 10 MG CEFIKSIM 200 MG TABLET CEFIKSIM 100 MG/5 ML SIRUP CEFOPERAZONE 1 GR CEFOPERAZONE SULBACTAM CEFOTAKSIM 1000 MG CITICOLIN INJEKSI CHLORAMEX 500 MG (KLORAMFENIKOL KAP) CHLORAMFENICOL 1% SALEP MATA CHLORPROMAZINE 100 MG (CPZ) CIPROFLOXACIN 500 MG CIPROFLOXACIN INFUS CITICOLIN TABLET/PUSPALIN CLOZAPINE 25 MG CODEIN TAB 10 MG COLCHICINE TABLET COMBIVENT 2,5 MG NEBULLES CONCOR 2.5 MG / BISOPROLOL 2,5 MG CONCOR 10 MG CORSANEURON TABLET COTRIMOXAZOLE SYRUP COTRIMOXAZOLE TABLET CRIPSA (BROMOKRIPTIN) CTM TAB 4 MG CURCUMA SIRUP CURCUMA TABLET

800 TUBE 9,000 7,200,000 2,000 FLS 7,000 14,000,000 600 AMPUL 1,545 927,000 8,000 TABLET 100 800,000 4,000 TABLET 150 600,000 100 AMPUL 825 82,500 100 TABLET 18,800 1,880,000 5,000 TABLET 95 475,000 30,000 TABLET 135 4,050,000 200 BOTOL 245,000 49,000,000 500 VIAL 8,497 4,248,500 2,000 TABLET 289 578,000 50,000 TABLET 75 3,750,000 500 BOTOL 9,756 4,878,000 2,000 TABLET 4,900 9,800,000 300 SUPP 5,085 1,525,500 800 SUPP 4,325 3,460,000 300 BOTOL 49,790 14,937,000 1,000 AMPUL 6,486 6,486,000 20,000 TABLET 922 18,440,000 1,000 AMPUL 1,590 1,590,000 100 BOTOL 6,786 678,600 3,000 TABLET 862 2,586,000 8,000 TABLET 684 5,472,000 3,000 TABLET 975 2,925,000 80 AMPUL 23,000 1,840,000 10 VIAL 163,700 1,637,000 8,000 TABLET 300 2,400,000 35,000 KAPSUL 923 32,305,000 1,200 AMPUL 3,567 4,280,400 3,000 TABLET 473 1,419,000 3,000 TABLET 573 1,719,000 2,501 AMPUL 37,000 92,537,000 1,000 SUPP 1,998 1,998,000 300 FLS 14,738 4,421,400 500 FLS 14,126 7,063,000 2,500 TABLET 2,400 6,000,000 5,000 TABLET 3,072 15,360,000 4,000 TABLET 1,500 6,000,000 1,000 TABLET 1,210 1,210,000 2,000 AMPUL 14,520 29,040,000 500 AMPUL 36,300 18,150,000 1,200 AMPUL 9,889 11,866,800 100 TABLET 1,345 134,500 10,000 AMPUL 923 9,230,000 70,000 TABLET 224 15,680,000 4,500 TABLET 1,647 7,411,500 100 SACCET 6,050 605,000 2,000 SACCET 280 560,000 1,000 TABLET 388 388,000 1,000 TABLET 847 847,000 1,500 TUBE 2,670 4,005,000 6,000 AMPUL 3,355 20,130,000 200 TUBE 2,800 560,000 100 FLS 4,720 472,000 5,000 TABLET 2,082 10,410,000 50,000 TABLET 199 9,950,000 10,000 TABLET 1,000 10,000,000 30,000 TABLET 93 2,790,000 20,000 TABLET 228 4,560,000 40,000 TABLET 143 5,720,000 5,000 TABLET 297 1,485,000 3,000 BOTOL 7,200 21,600,000 3,000 BOTOL 6,627 19,881,000 100 BOTOL 50,407 5,040,700 3,000 TABLET 49 147,000 2,000 TABLET 54 108,000 2,000 TABLET 7,860 15,720,000 10,000 TABLET 4,356 43,560,000 10,000 TABLET 148 1,480,000 3,000 AMPUL 80,000 240,000,000 20 TUBE 2,750 55,000 50 TUBE 2,325 116,250 HALOPERIDOL 0,5 MG HALOPERIDOL 5 MG HARNAL D 0,2 MG HARNAL OCAS 0,4 MG TABLET HCT TAB 25 MG HEMAPO 3000-ERITROPOETIN 3000 UI/ML HIDROKORTISON 1% KRIM HIDROKORTISON 2,5% KRIM GARAM ORALIT GEMFIBROZIL 300 MG TAB GEMFIBROZIL 600 MG TAB GENTAMISIN 0,1 % SK GENTAMISIN 40 MG/ML INJ GENTAMISIN SALEP MATA/GENOIN 0,3 % GENTAMISIN TETES MATA 0,3% GERMISEP 2,5 GR GLIKLAZID 80 MG/GLUCODEX GLIKUIDON 30 MG TAB GLIMEPIRIDE 1MG GLIMEPIRIDE 2 MG GLIMEPIRIDE 3 MG GLIMEPIRIDE 4 MG GLUKOSA 10 % GLUKOSA 5% H2O2 50 % DEXOCORT/DESOXIMETASON 0,25 KRIM EUTHYROX 100 MCG FARGOXIN 0,25 MG INJ FARMABES 25 MG (DILTIAZEM INJ) FARSORBID 10 MG (ISDN 10 MG) FORMALIN TAB FORTANEST 5 MG/ 1ML FORTANEST 15 MG/ 3ML FRESOFOL 1% FRIDEP 50 MG (SERTRALIN TAB) FUROSEMID 10 MG INJEKSI FUROSEMID 40 MG TAB GALVUS TABLET GARAM INGGRIS DILTIAZEM TAB 30 MG DIPEPTIVEN INFUS DOBUTAMIN INJ/INOTROP DOKSISIKLIN 100 MG DOMPERIDON 10 MG TAB DOMPERIDON SYRUP DORNER / BERAPROST DULCOLAX SUPP 5 MG INFANT FENITOIN 100 MG KAPSUL/KUTOIN KAPSUL FENITOIN 50 MG/ML INJ FENOFIBRAT 100 MG FENOFIBRAT 300 MG FENTANIL INJ 2 ML FETIK SUP/ KETOPROFEN SUP/SUPRAFENID FLIXOTIDE NEBULES FLUCONAZOLE INFUS FLUOKSETIN 10 MG / KALXETIN FLUOKSETIN 20 MG / KALXETIN FLUNARIZIN DEXTROSE 40% 25 ML DIAZEPAM 10 MG/2 ML DIAZEPAM TAB 2 MG DIAZEPAM TAB 5 MG DIFENHIDRAMIN INJ 10 MG/ML DIFLUCAN 50 MG DIGOKSIN 0,25 MG DULCOLAX SUPP ADULT 10 MG EAS PFRIMER / RENXAMIN EFEDRIN INJ 50MG/ML EPERISON/MYONEP TABLET EPINEFRIN INJ 1 MG/ML ERITROMISIN SIRUP ERITROMISIN TABLET 500 MG ETHAMBUTOL TABLET 500 MG

1,000 PEN 112,000 112,000,000 2,000 PEN 112,000 224,000,000 500 BOTOL 8,925 4,462,500 1,000 TABLET 580 580,000 2,000 TABLET 980 1,960,000 30 TUBE 151,200 4,536,000 500 BOTOL 3,296 1,648,000 8,000 TABLET 346 2,768,000 2,000 TABLET 250 500,000 40 BOTOL 69,600 2,784,000 200 BOTOL 38,819 7,763,800 20,000 TABLET 75 1,500,000 20,000 TABLET 150 3,000,000 50 BOTOL 78,600 3,930,000 3,000 AMPUL 46,635 139,905,000 1,200 TABLET 424 508,800 1,200 TABLET 749 898,800 100,000 TABLET 150 15,000,000 100 BOTOL 12,700 1,270,000 50 BOTOL 10,250 512,500 100 FLS 10,350 1,035,000 600 FLS 11,500 6,900,000 400 BAG 256,000 102,400,000 7,000 TABLET 208 1,453,410 50,000 TABLET 319 15,950,000 100,000 TABLET 212 21,200,000 3,000 TABLET 1,235 3,705,000 100 VIAL 14,788 1,478,800 600 TUBE 2,289 1,373,400 3,000 TABLET 260 780,000 5,000 TABLET 2,176 10,880,000 30,000 AMPUL 880 26,400,000 5,000 TABLET 761 3,805,000 10,000 TABLET 522 5,220,000 8,000 TABLET 384 3,072,000 30,000 TABLET 1,182 35,460,000 4,000 TABLET 1,842 7,368,000 1,000 SACCET 3,593 3,593,000 1,000 BOTOL 5,190 5,190,000 50,000 KAPSUL 278 13,900,000 2,000 PEN 89,000 178,000,000 100 BOTOL 8,470 847,000 1,000 PEN 89,000 89,000,000 10,000 BOTOL 8,713 87,130,000 10,000 TABLET 373 3,730,000 30,000 TABLET 904 27,120,000 3,000 AMPUL 891 2,673,000 3,000 AMPUL 847 2,541,000 5,000 TABLET 77 385,000 5,000 TABLET 121 605,000 400 SYRINGE 90,660 36,264,000 400 SYRINGE 125,325 50,130,000 600 BOTOL 26,960 16,176,000 50 VIAL 965,594 48,279,700 10,000 TABLET 520 5,200,000 300 AMPUL 1,916 574,800 20,000 TABLET 351 7,020,000 1,000 TABLET 460 460,000 500 FLS 6,245 3,122,500 500 VIAL 16,359 8,179,500 3,000 VIAL 27,435 82,305,000 2,600 TABLET 7,850 20,410,000 10,000 AMPUL 2,960 29,600,000 100,000 TABLET 77 7,700,000 20,000 TABLET 159 3,180,000 1,000 AMPUL 1,023 1,023,000 3,000 TABLET 214 642,000 6,000 VIAL 10,912 65,472,000 60,000 TABLET 102 6,120,000 10,000 TABLET 413 4,130,000 5,000 TABLET 117 585,000 1,200 TABLET 943 1,131,600 6,000 BOTOL 5,885 35,310,000 MEROPENEM SERB INJ 1000 MG MESTINONE METAMIZOLE SODIUM INJEKSI/NOVALGIN METFORMIN HCL 500 MG METFORMIN HCL 850 MG METILERGOMETRIN INJEKSI METILERGOMETRIN TABLET METILPREDNISOLON INJ 125 MG INJEKSI METILPREDNISOLON TAB 4 MG METILPREDNISOLON TAB 8 MG METOKLOPRAMID 10 MG METOTREKSAT /RHEU-TREX 2,5 MG METRONIDAZOL INFUS LEVOFLOKSASIN 5 MG/ML INFUS LEVOFLOKSASIN TAB 500 MG LEVOPAR TABLET/LEPARSON TAB LIDOKAIN INJ 2% LIDOKAIN INJ 2% + EPINEFRIN LOPERAMID TAB 2 MG LORATADIN TAB 10 MG LOVENOX 0,4 SYRINGE LOVENOX 0,6 SYRINGE MANNITOL 20% 500 ML MANTOUX TEST/ TUBERCULIN PPDRT MECOBALAMIN 500 MG/ OXICOBAL MECOBALAMIN INJEKSI MELOXICAM 15 MG MELOXICAM 7,5 MG MEPTIN INHALATION INJ MEROPENEM SER INJ 500 MG KENDARON TAB KETAMIN 100 MG/ML / IVANES KETOKONAZOL KRIM 2% KETOKONAZOL TABLET 200 MG KETOROLAC TABLET KETOROLAK INJ 30 MG/ML KLINDAMISIN 150 MG KLINDAMISIN 300 MG KLOBAZAM TAB 10 MG KLOPIDOGREL TAB 75 MG KSR LACTO B/ L BIO LAKTULOSA SIRUP/EXTRALAC SIRUP LANSOPRAZOL KAP 30 MG LANTUS SOLOSTAR LAXADINE SYRUP LEVEMIR FLEXPEN ILIADIN DROPS 0,025% ILIADIN SPRAY 0,05% INH 100 MG TAB/ISONIAZID INH 300 MG TAB/ISONIAZID INTRALIPID 20% 100 ML INVICLOT/HEPARIN 5000 UI/ML IRBESARTAN 150 MG IRBESARTAN 300 MG ISDN 5 MG/ISOSORBIDE DINITTAT ISOTIC ADRETOR 0,25% ISOTIC ADRETOR 0,5% KA EN 1B INFUS KA EN 3B INFUS KABIVEN FERIPHERAL INF KALSIUM LAKTAT 500 MG KANDESARTAN TAB 16 MG KANDESARTAN TAB 8 MG HUMALOG MIX 25 KWIKPEN HUMALOG MIX 50 KWIKPEN HUSTAB SYRUP HYTROZ 1 MG HYTROZ 2 MG IALUSET PLUS IBUPROFEN 100 MG/5 ML SUSPENSI IBUPROFEN 400 MG TAB IBUPROFEN TAB 200 MG

10,000 TABLET 267 2,670,000 500 BOTOL 3,765 1,882,500 500 AMPUL 6,750 3,375,000 500 AMPUL 4,444 2,222,000 300 TUBE 1,900 570,000 500 TABLET 5,143 2,571,500 500 AMPUL 29,900 14,950,000 700 TABLET 16,000 11,200,000 1,000 VIAL 44,597 44,597,000 10 TUBE 30,000 300,000 20,000 TABLET 115 2,300,000 30,000 TABLET 108 3,240,000 1,000 BOTOL 6,906 6,906,000 1,000 FLS 6,764 6,764,000 40,000 BOTOL 6,900 276,000,000 300 AMPUL 87,731 26,319,300 200 BOTOL 112,710 22,542,000 250 BOTOL 47,498 11,874,500 1,000 AMPUL 12,276 12,276,000 10,000 TABLET 675 6,750,000 1,000 TABLET 118 118,000 500 AMPUL 7,872 3,936,000 10,000 TABLET 1,415 14,150,000 20,000 TABLET 2,530 50,600,000 100,000 TABLET 1,640 164,000,000 1,000 AMPUL 6,298 6,298,000 500 TABLET 1,499 749,500 5,000 TABLET 1,077 5,385,000 1,000 PEN 112,000 112,000,000 1,000 PEN 89,500 89,500,000 2,000 AMPUL 70,785 141,570,000 500 BOTOL 11,750 5,875,000 10 FLS 131,250 1,312,500 1,000 BOTOL 3,812 3,812,000 500 TABLET 567 283,500 6,000 VIAL 5,346 32,076,000 60,000 KAPSUL 129 7,740,000 5,000 TABLET 270 1,350,000 500 TABLET 275 137,500 40,000 AMPUL 873 34,920,000 2,000 TABLET 4,000 8,000,000 2,000 TABLET 713 1,426,000 30 BOTOL 19,000 570,000 30 TABLET 3,569 107,070 6,000 TABLET 2,600 15,600,000 60 FLS 40,575 2,434,500 600 AMPUL 3,760 2,256,000 600 AMPUL 4,290 2,574,000 1,000 FLS 30,335 30,335,000 1,000 FLS 3,472 3,472,000 2,000 AMPUL 1,126 2,252,000 20 BOTOL 35,200 704,000 100 BOTOL 5,113 511,300 6,000 BOTOL 11,263 67,578,000 1,200 BOTOL 1,160 1,392,000 120,000 TABLET 254 30,480,000 500 AMPUL 13,300 6,650,000 30,000 TABLET 182 5,460,000 8,000 TABLET 243 1,944,000 250 BOTOL 445,000 111,250,000 100 BOTOL 905,000 90,500,000 105 BOTOL 1,590,000 166,950,000 50 BOTOL 794,000 39,700,000 35 BOTOL 940,000 32,900,000 600 TABLET 5,900 3,540,000 10,000 TABLET 71 710,000 5,000 TABLET 59 295,000 1,000 TABLET 82 82,000 3,000 AMPUL 7,050 21,150,000 2,000 TABLET 405 810,000 250 FLS 10,478 2,619,500 500 TABLET 317 158,500 RAMIPRIL 10 MG TAB 8,000 TABLET 710 5,680,000 PARACETAMOL 500 MG TABLET PETHIDINE HCL INJEKSI 50 MG/2 ML PHENOBARBITAL 20 MG TAB PIRAZINAMID 500 MG TABLET PLASBUMIN 20% 50 ML PLASBUMIN 20% 100 ML PLASBUMIN 25 % 100 ML PLASBUMIN 25 % 50 ML PLASBUMIN 5 % 50 ML PLETAAL XR 100 MG/ CILOSTAZOLE PREDNISON KAP 5 MG PROPANOLOL TAB 10 MG PROPANOLOL TAB 40 MG PROSTIGMIN INJ 0,5 MG PTU 100 MG PULMICORT RESPULES 0,25 MG/ML PYRANTEL 125 TABLET ONDANSENTRON TAB 8 MG ONDANSETRON 4 MG/2ML ONZAPIN 10 MG ONZAPIN 5 MG OPTIFLOX 0,5 %/LEVOFLOXASIN TM ORIXAL 500 MG / KLARITROMISIN 500 MG OSCAL 0,5 MG TABLET / CALCITROL OTOPAIN EAR DROP OTSU MGSO4 20% OTSU MGSO4 40% OTSU SALIN 3 % OTSU-KCL 7,46%/KLARIUM CLORIDA 25 ML OXYTOCIN INJ 10 IU/100,S PANTOCAIN 0,5 % PARACETAMOL DROP PARACETAMOL INFUS PARACETAMOL SYRUP NIKARDIPIN INJ 10 MG NITRAL-GLISERIL TRINITRAT 0,5 MG NITROKAF FORTE 5 MG NITROKAF RETARD 2,5 MG NOREPINEPHRINE INJ NOSTHYRA 5 MG/NORELUT NOTISIL 2 MG/SIMARC NOVOMIX FLEXPEN 100 UI/ML NOVORAPID FLEXPEN 100 UI/ML NTG /DBL GLICERYL TRINITRATE 50 MG/10 ML NYSTATIN DROP/CANDISTATIN/ENYSTIN OBUCORT SWINGHALER OBH SYRUP OFLOXACIN 400 MG OMEPRAZOL INJ 40MG/10ML OMEPRAZOL KAP 20 MG ONDANSENTRON TAB 4 MG MIKONAZOL KRIM 2% MISOPROSTOL TABLET MORFIN INJEKSI MORFIN TAB 10 MG / MST CONTINUS 10 MOXIFLOXACIN 400 MG INFUS MUPIROCIN CREAM NA DIKLOFENAK TAB 25 MG NA DIKLOFENAK TAB 50 MG NaCl 0,9% 1000 ML NaCl 0,9% 100 ML NaCl 0,9% 500 ML NAROPIN 7,5 MG/ML NASACORT AQ 55 MCG/PUFF NEPHOSTERIL 250 ML NEO K INJEKSI NEW ANTIDES 600 MG NIFEDIPIN 10 MG METRONIDAZOL KAPTAB 500 MG METRONIDAZOL SYRUP MEYLON 25 ML MIDAZOLAM INJEKSI

20,000 TABLET 146 2,920,000 80,000 TABLET 85 6,800,000 60,000 AMPUL 858 51,480,000 1,500 SYRINGE 80,000 120,000,000 15,000 TABLET 1,170 17,550,000 2,000 TABLET 837 1,674,200 6,000 TABLET 934 5,604,000 1,000 TABLET 1,233 1,233,000 5,000 TABLET 123 615,000 10,000 TABLET 123 1,230,000 5,000 TABLET 259 1,295,000 45,000 BOTOL 7,703 346,635,000 1,000 PEN 112,000 112,000,000 2,000 AMPUL 27,998 55,996,000 200 BOTOL 4,069 813,800 10,000 TABLET 50 500,000 7,000 TABLET 65 455,000 8,000 TABLET 3,750 30,000,000 50 AMPUL 58,000 2,900,000 1,200 TABLET 13,400 16,080,000 3,000 TABLET 6,814 20,442,000 1,500 TABLET 7,787 11,680,500 200 BOTOL 59,000 11,800,000 350 BOTOL 111,850 39,147,500 300 BOTOL 137,492 41,247,600 100 BOTOL 965,250 96,525,000 5,000 TABLET 78 390,000 1,000 AMPUL 1,700 1,700,000 4,500 TABLET 5,406 24,327,000 6,000 TABLET 68 408,000 20,000 TABLET 150 3,000,000 200 BOTOL 39,600 7,920,000 500 TUBE 6,190 3,095,000 300 AMPUL 1,762 528,600 100 BOX 445,000 44,500,000 16,000 TABLET 530 8,480,000 50,000 TABLET 200 10,000,000 100 BOTOL 47,495 4,749,500 600 SUPP 17,488 10,492,800 600 SUPP 12,001 7,200,600 200 VIAL 5,808 1,161,600 6,000 BOTOL 5,970 35,820,000 6,000 TABLET 222 1,332,000 300 BOTOL 135,577 40,673,100 5,000 TABLET 238 1,190,000 500 BOTOL 35,000 17,500,000 100 BOTOL 400,000 40,000,000 100 BOX 195,500 19,550,000 10,000 TABLET 1,169 11,690,000 6,000 TABLET 143 858,000 30,000 TABLET 163 4,890,000 2,000 TABLET 13,500 27,000,000 1,400 TABLET 1,634 2,287,600 10,000 TABLET 1,679 16,790,000 5,000 TABLET 748 3,740,000 5,000 TABLET 397 1,985,000 50 VIAL 140,290 7,014,500 8,000 FLS 3,636 29,088,000 500 AMPUL 1,452 726,000 1,000 TABLET 781 781,000 25,000 TABLET 112 2,800,000 700 BOTOL 18,000 12,600,000 600 BOTOL 16,100 9,660,000 5,000 FLS/1 L 10,220 51,100,000 800 TABLET 24,330 19,464,000 100 AMPUL 73,040 7,304,000 5 BOTOL 95,660 478,300 15,000 TABLET 253 3,795,000 500 BOTOL 5,308 2,654,000 3,883,722,463 900 PCS 11,605 10,444,500 6,000 PCS 1,950 11,700,000 ZINC 20 MG ZINC SULFAT SYRUP/60 ML [-] Belanja BHP Alat Kesehatan 3 WAY ANAK 3 WAY DEWASA TRIHEKSIFENIDIL 2 MG TABLET ULTIBRO TABLET URINTER 400 MG URSODEOXYCHOLIC ACID 250 MG VALSARTAN 160 MG/VALESCO 160 MG VALSARTAN 80 MG / VALESCO 80 MG VANCOMYCIN INJEKSI VENTOLIN NEBULES VIT K INJ VIT K TAB 10 MG VITAMIN B KOMPLEKS VOLUVEN INFUS/VOLULYTE WIDA RS 500 ML WIDA WI 1000 ML/AQUA 1L XARELTO 20 MG XYLOCAIN 2% PDF INJEKSI XYLOCAIN 10% SPRAY SOTATIC/METOCLOPRAMIDE INJEKSI SPIRIVA RESPIMAT 2,5 MCG SPIRONOLAKTON 100 MG SPIRONOLAKTON 25 MG STESOLID SYRUP STESOLID SUPP 10 MG STESOLID SUPP 5 MG STREPTOMISIN 1000 MG/ML SUKRALFAT SYRUP SUKRALFAT TABLET/ULSIDEX SYMBBICORT TURBUHALER 160/4,5 MCG TABLET TAMBAH DARAH / SF TARIVID OTIC 3%/ ALKILEN TERRELL 250 ML/ISOFLURAN TETAGAM INJEKSI THYROZOL 10 MG TIAMIN (VIT B1) 50 MG SALBUTAMOL TAB 4 MG SANDEPRIL 50 MG SANDOSTATIN / OCTREOTIDE INJEKSI SEREQUEL XR 200 MG SEREQUEL XR 300 MG SEREQUEL XR 400 MG SERETIDE 50 MCG SERETIDE 250 MCG SERETIDE 500 MCG SEVORANE 250 ML SIANOKOBALAMIN (VIT B12) 500 MCG SIBITAL INJ SIFROL ER 0,375 TABLET SIMVASTATIN 10 MG SIMVASTATIN 20 MG SMOFLIPID 20% 100 ML SOFT U DERM- UREA CREAM 10 % RAMIPRIL 5 MG TAB RANITIDIN TAB 150 MG RANITIDINE INJ 50 MG/ML RENOGEN 3000 IU RETAPHYL SR STRIP RIFAMPISIN TAB 300 MG RIFAMPISIN TAB 450 MG RIFAMPISIN TAB 600 MG RISPERIDON 1 MG RISPERIDON 2 MG RISPERIDON 3 MG RL INFUS RYZODEG INSULIN ROCURONIUM INJ 5 ML/ ROCULAX SALBUTAMOL SIRUP SALBUTAMOL TAB 2 MG

100 PCS 7,744 774,400 100 PCS 7,744 774,400 3,000 PCS 7,744 23,232,000 7,000 PCS 7,744 54,208,000 5,000 PCS 7,744 38,720,000 4,000 PCS 7,744 30,976,000 500 BOTOL 27,373 13,686,500 50 GLN 500,532 25,026,600 1,000 BOX 13,900 13,900,000 10,000 PCS 2,625 26,250,000 300 TUBE 29,550 8,865,000 600 BOTOL 31,000 18,600,000 50 PCS 18,500 925,000 50 PCS 18,500 925,000 50 PCS 18,500 925,000 300 SET 72,558 21,767,400 250 PCS 67,000 16,750,000 150 PCS 67,000 10,050,000 150 PCS 67,000 10,050,000 1,500 PCS 3,600 5,400,000 100 PCS 45,187 4,518,700 5 BOX 1,043,000 5,215,000 50 PCS 1,519,674 75,983,700 100 PCS 375,000 37,500,000 30 PCS 1,667,000 50,010,000 400 PCS 7,440 2,976,000 72 PCS 71,610 5,155,920 72 PCS 68,750 4,950,000 24 PCS 98,450 2,362,800 144 PCS 67,320 9,694,080 720 PCS 64,240 46,252,800 144 PCS 62,040 8,933,760 240 PCS 59,290 14,229,600 300 PCS 44,000 13,200,000 30 PCS 212,395 6,371,850 30 PCS 212,395 6,371,850 400 PCS 24,000 9,600,000 200 PCS 5,800 1,160,000 200 PCS 5,800 1,160,000 200 PCS 5,800 1,160,000 5,000 PCS 7,700 38,500,000 1 PCS 3,245,000 3,245,000 150 PCS 730,162 109,524,300 50 PCS 935,072 46,753,600 20 PCS 426,112 8,522,240 20 PCS 660,018 13,200,360 100 PCS 597,883 59,788,300 20 PCS 708,070 14,161,400 48 PCS 325,429 15,620,592 300 PCS 13,200 3,960,000 80 PCS 478,049 38,243,920 24 BOX/10 400,000 9,600,000 500 PCS 6,875 3,437,500 5 BOX 5,738,000 28,690,000 50 PCS 213,790 10,689,500 2 BOX 2,613,278 5,226,556 2 BOX 1,228,983 2,457,966 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 400 PCS 23,100 9,240,000 400 PCS 23,100 9,240,000 100 PCS 23,100 2,310,000 30 PCS 86,240 2,587,200 30 PCS 86,240 2,587,200 30 PCS 86,240 2,587,200 5 PCS 2,256,000 11,280,000 ETT NONKINGKING 7,5 EVD ECOPLAC MIX ELEFIX / PASTA EEG EPIDURAL CATETER/ PERIFIX 400 ETHIBOND W 4843 ETHILON 10/0 U-7003 ETT 2,5 ETT 3 ETT 3,5 ETT 4 ETT 4,5 ETT 5 ETT 5,5 ETT 6 ETT 6,5 ETT 7 ETT 7,5 ETT 8 ETT NONKINGKING 6,5 ETT NONKINGKING 7 CATGUT CROMIC 2 CUTTING CATGUT PLAIN 2/0 CUTTING CATGUT PLAIN 2/0 TAPER CATGUT PLAIN 3/0 CUTTING CATGUT PLAIN 3/0 TAPER CATHEJELL/ AQUATOUCH LUBRICANT CLOSED SUCTION NO 12 CLOSED SUCTION NO 14 COLOSTOMY BAG CONDOM CATH S CONDOM CATH M CONDOM CATH L CUTICEL 10x10 CUTTING LOOP CVC 2LUMEN NO 12/CERTOFIX CVC 3LUMEN NO 12 CVC NO 4 CVC NO 5 CVC NO 7 CVC TRIO V720/CERTOFIX DAFILON 10/0 2XDLM 6S DERMAFIX DJ STENT SET ECG PAPER AQUA PACK/HYDROX ARM SLING S ARM SLING M ARM SLING L BACTERI FILTER/TERMOVEN HEPA BAJU OPERASI STERIL UKURAN L BAJU OPERASI STERIL UKURAN LL BAJU OPERASI STERIL UKURAN XL BLOOD TRANSFUSION SET BONE WAX BONGROS 5CC BREATHING CIRCUIT WITH CHAMBER BREATING CIRCUIT VENTILATOR BREATHING CIRCUIT CPAP BROS SIKAT OPERASI (SCRUBBRUSH) CATGUT CROMIC 1 TAPER CATGUT CROMIC 2 TAPER ABOCAT NO 14 ABOCAT NO 16 ABOCAT NO 18 ABOCAT NO 20 ABOCAT NO 22 ABOCAT NO 24 ALKOHOL 70% @ 1 LITER ALKOHOL 96% @ 20 LITER ALKOHOL SWAB APRON PLASTIK AQUA GEL 82/ MY JELLY

100 BOX/100 161,665 16,166,500 800 ROLL 102,500 82,000,000 600 ROLL 148,000 88,800,000 200 ROLL 15,730 3,146,000 200 ROLL 19,910 3,982,000 200 ROLL 29,810 5,962,000 30 PCS 54,450 1,633,500 20 PCS 54,450 1,089,000 100 PCS 54,450 5,445,000 100 PCS 60,000 6,000,000 100 PCS 56,000 5,600,000 100 PCS 55,500 5,550,000 100 PCS 16,800 1,680,000 100 PCS 16,800 1,680,000 1,500 PCS 16,800 25,200,000 1,500 PCS 16,800 25,200,000 30 PCS 19,690 590,700 20 PCS 19,690 393,800 100 PCS 1,210 121,000 100 PCS 1,210 121,000 50 BOX/250 27,500 1,375,000 90 PCS 14,000 1,260,000 10 PCS 14,000 140,000 50 GALON 869,700 43,485,000 200 FLS 82,900 16,580,000 3,000 BOX 94,500 283,500,000 2,000 PCS 48,000 96,000,000 50 PCS 420,000 21,000,000 300 PCS 42,900 12,870,000 12,000 PCS 3,500 42,000,000 1,200 PCS 3,500 4,200,000 1,200 PCS 21,264 25,516,800 200 BUNGKUS 27,280 5,456,000 1,500 LEMBAR 1,860 2,790,000 10 ROLL 400,000 4,000,000 100 PCS 71,827 7,182,700 200 ROLL 43,400 8,680,000 60 BOX/6 233,906 14,034,360 2,500 BOX 40,000 100,000,000 100 PCS 18,788 1,878,800 800 PCS 18,788 15,030,400 1,500 PCS 18,788 28,182,000 10 PCS 205,462 2,054,620 240 PCS 108,900 26,136,000 96 PCS 143,947 13,818,912 5,000 PCS 1,695 8,475,000 300 PCS 358 107,400 300 PCS 358 107,400 100 PCS 358 35,800 500 PCS 358 179,000 3,000 PCS 358 1,074,000 100 PCS 358 35,800 30 PCS 370,000 11,100,000 20 PCS 197,281 3,945,620 61 PCS 7,656 467,016 60 PCS 7,656 459,360 60 PCS 7,656 459,360 60 PCS 7,656 459,360 100 PCS 7,656 765,600 300 PCS 7,744 2,323,200 300 PCS 7,744 2,323,200 200 PCS 7,744 1,548,800 150 PCS 7,744 1,161,600 500 PCS 7,744 3,872,000 1,200 PCS 7,744 9,292,800 1,200 PCS 7,744 9,292,800 120 PCS 55,330 6,639,600 420 PCS 47,960 20,143,200 360 PCS 47,960 17,265,600 80 GLN/5L 420,000 33,600,000 30 PCS 90,032 2,700,960 30 PCS 130,310 3,909,300 1 BOX 2,683,233 2,683,233 MASKER BEDAH HANDSCOON/ SARUNG TANGAN NONSTERIL HARUM PEN / ELECROSURGICAL PEN HARUM PLATE CABLE MONOPOLAR HARUM PLATE NON CABLE INFUS SET ADULT STERA INFUS SET PAED STERA (ANAK) INTRAFIX SAFESET (INFUSET PUMP) KERTAS USG SONY LAMINARIA LEUKOPLAST 7,5 CM x 4,5 LYOSTYPT 5X6CM KAPAS 500 GR KERTAS EKG GELANG PASIEN ISI 250 PCS GUDEL 100 MM ADULT GUDEL 60 MM ANAK H2O2 50% HAND RUB 500 CC FOLY CATH 3WAY NO 24 FOLY CATH NO 6 FOLY CATH NO 8 FOLY CATH NO 10 FOLY CATH NO 12 FOLY CATH NO 14 FOLY CATH NO 16 FOLY CATH NO 18 FOLY CATH NO 20 FOLY CATH NO 24 GELANG BAYI BIRU GELANG BAYI PINK FILM IV DRESS 67P FIXOMUL 5X10 FIXOMUL 5X15 FM CREPE 3 INC FM CREPE 4 INC FM CREPE 6 INC FOLY CATH 3WAY NO 20 FOLY CATH 3WAY NO 22 NGT NO 14 NGT NO 16 NALD NO 24 NALD NO 25 NALD NO 26 NGT NO 6 NGT NO 8 40 CM NGT NO 8 100 CM NGT NO 10 NGT NO 12 NEONATAL REM POLYHESIVE NGT NO 3,5 NGT NO 4 NGT NO 5 40 CM NGT NO 5 100 CM NALD NO 27 NC PAP BREATHING CIRCUIT NGT NO 18 NYLON 2/0 TS 19 NYLON 3/0 TS 19 NYLON 4/0 TS 19 MASKER NON REBREATHING BAYI MASKER NON REBREATHING ANAK MASKER NON REBREATHING DEWASA MEDIFIX MANOMETER MONOCRYL 4/0 MPC 426 MONOSYN 4/0 DS 19 NALD BD NO 31X5 NALD NO 18 NALD NO 23 ONE SCRUB OPSITE 45X28 OPSITE 55X45 PDS II 5/0 - Z1013H

1 BOX 3,678,687 3,678,687 2,000 ROLL/400 1,898 3,796,000 2,000 ROLL/400 1,898 3,796,000 800 PCS 20,160 16,128,000 1,500 PCS 37,843 56,764,500 100 PCS 3,125 312,500 6 BOX/100 250,113 1,500,678 6 BOX/100 250,113 1,500,678 12 BOX/100 250,113 3,001,356 6 BOX/100 250,113 1,500,678 12 BOX/100 250,113 3,001,356 120 ROLL 11,700 1,404,000 150 ROLL 15,100 2,265,000 100 ROLL 20,300 2,030,000 100 ROLL 15,400 1,540,000 150 ROLL 22,100 3,315,000 150 ROLL 28,900 4,335,000 48 PCS 82,170 3,944,160 48 PCS 76,540 3,673,920 48 PCS 80,190 3,849,120 48 PCS 76,450 3,669,600 48 PCS 190,850 9,160,800 600 LITER 80,000 48,000,000 1,200 PCS 2,200 2,640,000 1,200 PCS 2,200 2,640,000 30 PCS 224,070 6,722,100 2 BOX/36 2,042,731 4,085,462 4 BOX/36 1,472,358 5,889,432 4 BOX/36 1,270,551 5,082,203 2 BOX/36 6,384,235 12,768,470 100 PCS 6,490 649,000 100 PCS 6,491 649,100 100 PCS 6,490 649,000 100 PCS 6,490 649,000 2 PCS 403,520 807,040 800 PCS 88,660 70,928,000 400 PCS 84,150 33,660,000 400 PCS 86,350 34,540,000 60 PCS 80,960 4,857,600 100 PSG 34,694 3,469,400 300 PSG 34,694 10,408,200 200 PSG 34,694 6,938,800 100 PSG 34,694 3,469,400 100 PCS 19,470 1,947,000 200 PCS 19,470 3,894,000 300 PCS 5,500 1,650,000 200 PCS 5,500 1,100,000 2,000 PCS 5,500 11,000,000 1,500 PCS 21,798 32,697,000 600 PCS 40,370 24,222,000 900 PCS 46,200 41,580,000 780 PCS 46,750 36,465,000 720 PCS 43,120 31,046,400 60 PCS 45,210 2,712,600 10 PCS 2,085,500 20,855,000 500 PCS 16,000 8,000,000 5 BOX 3,789,000 18,945,000 1,000 PCS 1,905 1,905,000 6,000 PCS 3,217 19,302,000 10 BOX 667,000 6,670,000 300 PCS 29,549 8,864,700 1,500 PCS 30,550 45,825,000 500 PCS 30,550 15,275,000 5,000 PCS 650 3,250,000 60,000 PCS 779 46,740,000 25,000 PCS 968 24,200,000 15,000 PCS 1,200 18,000,000 4,000 PCS 1,500 6,000,000 1,000 PCS 4,049 4,049,000 1,000 PCS 3,400 3,400,000 2,000 PCS 6,702 13,404,000 500 PCS 17,589 8,794,500 10 BOTOL 561,042 5,610,420 PDS II 6/0 - Z-432H PERBAN 5 CM PERBAN 10 CM PERPUSOR SYRINGE WHITE PERPUSOR TUBING WHITE PIPET TETES KACA PISAU OPERASI NO 10 PISAU OPERASI NO 11 PISAU OPERASI NO 15 PISAU OPERASI NO 20 PISAU OPERASI NO 22 POLIBAN 3 INC POLIBAN 4 INC POLIBAN 6 INC POLIGYP 3 INC POLIGYP 4 INC POLIGYP 6 INC PROLENE 2/0 8685 H PROLENE 5/0 W 8006T PROLENE 6/0 8606 G PROLENE 7/0 EP 8735 H RECTAL TUBE NO 20 RECTAL TUBE NO 22 RECTAL TUBE NO 28 RECTAL TUBE NO 32 RING PERSARIUM NO 7,5 POLYPROPYLANE 2/0 TS 27 POLYPROPYLANE 4/0 TS 19 POLYPROPYLANE 3/0 TS 19 POLYPROPYLANE 5/0 CUTTING POLYPROPYLANE 7/0 TAPPER POPIDONE IODINE 1000CC/ECODIN POT PLASTIK 100CC POT PLASTIK 50CC PREMILEN MESH 5X10 SELANG NEBULIZER DEWASA SELANG NASAL O2 ANAK SELANG NASAL O2 BAYI SELANG NASAL O2 DEWASA SELANG SUCTION / MASS SUCTION SILK BLACK 2/0 CUTTING SILK BLACK 2/0 TAPPER SILK BLACK 3/0 TAPPER SILK BLACK 3/0 CUTTING SAFIL 1 HR / T-VIO / PGA 1 SAFIL 2/0 HR / T-VIO / PGA 2/0 SAFIL 3/0 HR / T-VIO / PGA 3/0 SAFIL 4/0 HR / T-VIO / PGA 4/0 SARUNG TANGAN PANJANG NO 6,5 SARUNG TANGAN PANJANG NO 7 SARUNG TANGAN PANJANG NO 7,5 SARUNG TANGAN PANJANG NO 8 SELANG NEBULIZER ANAK SPINOCAN NO 27 SPUIT 1 CC SPUIT 3 CC SPUIT 5 CC SPUIT 10 CC SPUIT 20 CC ECCENTRIC SPUIT 30 CC SPUIT 50 CC ECCENTRIC SPUIT 50 CC CATHIP SILK BLACK 4/0 TAPPER SIRCUIT NCPAP SLE SKIN MARKER REGULAR TIP SKIN PREPARATION GEL/SKINPURE SKINTEK FOAM/ELEKTRODA ANAK SKINTEK FOAM/ELEKTRODA DEWASA SODA LIME SPINOCAN NO 23 SPINOCAN NO 25 SPUIT 100 CC STABIMET

50 BOX/100 360,000 18,000,000 60 PCS 39,455 2,367,300 60 PCS 39,455 2,367,300 60 PCS 39,455 2,367,300 300 BAG/10 41,624 12,487,200 50 PCS 4,345 217,250 100 PCS 4,345 434,500 100 PCS 4,345 434,500 200 PCS 4,345 869,000 300 PCS 4,345 1,303,500 200 PCS 4,345 869,000 300 PSG 5,332 1,599,600 5,000 PSG 5,332 26,660,000 8,000 PSG 5,332 42,656,000 12,000 PSG 5,332 63,984,000 1,200 PSG 5,332 6,398,400 80 PCS 55,500 4,440,000 100 BOX/10 60,500 6,050,000 12 BOX/10 3,490,174 41,882,088 200 ROLL 152,637 30,527,400 200 ROLL 197,329 39,465,800 10 PCS 302,500 3,025,000 10 PCS 302,500 3,025,000 5 BOX 127,600 638,000 5 BOX 112,640 563,200 100 BOX/100 70,400 7,040,000 100 BOX/100 39,500 3,950,000 5 PCS 3,369,786 16,848,930 5 PCS 142,500 712,500 5 PCS 142,500 712,500 5 PCS 142,500 712,500 5 PCS 142,500 712,500 500 PCS 149,490 74,745,000 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 50 PCS 37,000 1,850,000 50 PCS 37,000 1,850,000 8 PCS 5,120,000 40,960,000 50 PCS 36,872 1,843,600 50 PCS 36,872 1,843,600 50 PCS 31,716 1,585,800 50 PCS 32,090 1,604,500 30 PCS 44,801 1,344,030 80 PCS 112,695 9,015,600 4,000 PCS 7,626 30,504,000 5,000 PCS 4,700 23,500,000 10 GLN/5L 322,000 3,220,000 2 BOX/36 3,296,375 6,592,750 2 BOX/36 4,004,215 8,008,430 10 BOX/36 3,378,477 33,784,770 10 BOX/36 3,860,651 38,606,510 10 BOX/36 2,945,315 29,453,150 6 PCS 2,900,000 17,400,000 6 PCS 2,900,000 17,400,000 10 PCS 82,000 820,000 10 PCS 82,000 820,000 5.1.02.01.01 5.1.02.01.01.0026 467,655,593 100 Kotak 52,202 5,220,200 50 Bungkus 45,938 2,296,900 2,000 Lembar 4,802 9,604,000 2,000 Lembar 4,802 9,604,000 700 Lembar 4,802 3,361,400 100 Blok 49,592 4,959,200 10 Bks 2,610 26,100 1,000 Lembar 2,000 2,000,000 10 Blok 55,000 550,000 1,000 Lembar 1,096 1,096,000 100 Blok 7,000 700,000 SUCTION CATH NO 10 SUCTION CATH NO 12 SUCTION CATH NO 14 SUCTION CATH NO 16 SURGI GLOVE STERIL 6 SURGI GLOVE STERIL 6,5 SURGI GLOVE STERIL 7 SURGI GLOVE STERIL 7,5 SURGI GLOVE STERIL 8 STIK KGD STYLET TRACH TUBE BAYI STYLET TRACH TUBE ANAK STYLET TRACH TUBE DEWASA SOFTPAD SUCTION CATH NO 6 SUCTION CATH NO 8 TOPI DOKTER TOPI PERAWAT TOPI WILAMED NEONATAL BONNET TRACHEOSTOMY NO 6 TRACHEOSTOMY NO 7 TRACHEOSTOMY 7,5 TRACHEOSTOMY 8 TRIPLE LUMEN OCTOPUS THORARIC TROCAT NO 16 SUREFIT/GROUNDING CABLE SURGICAL MASKER VISOR B24 SURGICEL FIBLIAR 5X10 SYNCERA ELECTOFIX 10X10 SYNCERA ELECTOFIX 15X10 T.TUBE / T. DRINE NO 3 T.TUBE / T. DRINE NO 5 TENSOPLAST STK ADULT TENSOPLAST STK PAED UMBLICAL CATH NO 5 UMBLICAL CATH NO 8 UMBLICAL CORD UNDER PAD URINE BAG USG GEL ONEMED VICRYL 1/0 VCP 359 VICRYL 2/0 VCP 602 H VICRYL 3/0 VCP 316 THORARIC TROCAT NO 24 THORARIC TROCAT NO 28 THORARIC TROCAT NO 32 TUTUP MATA BAYI GEA SIZE M TUTUP MATA BAYI GEA SIZE S ULTRA FAST FIX UMBLICAL CATH NO 2,5 UMBLICAL CATH NO 3,5 UMBLICAL CATH NO 4 AMPLOP DINAS AMPLOP RADIOLOGI UK 24X30 AMPLOP RADIOLOGI UK 37X47 AMPLOP SCANNING BIRU UK 37X57 ASESMEN PRA OPERASI AMPLOP COKLAT EEG BLANKO ECHO KERTAS BC WARNA HIJAU DOUBLE BLANGKO EEG BLANGKO EKG VICRYL 4/0 VCP 392 H VICRYL 4/0 VCP 310 VP SHUNT MED PRESSURE ANAK VP SHUNT MED PRESSURE DEWASA WOUND DRAIN 200 ML NO 10 WOUND DRAIN 200 ML NO 12 Belanja Alat/Bahan untuk Kegiatan Kantor- Bahan Cetak [-] Barang Cetakan AMPLOP BERKOP BLANGKO FOTO Belanja Barang Habis Pakai

200 Blok 53,768 10,753,600 20 Blok 26,883 537,660 50 Blok 22,000 1,100,000 20 Blok 125,000 2,500,000 40 Blok 49,070 1,962,800 40 Blok 37,324 1,492,960 20 Blok 41,761 835,220 400 Blok 23,751 9,500,400 50 Blok 22,000 1,100,000 31 Blok 50,000 1,550,000 10 Blok 41,761 417,610 10 Blok 26,000 260,000 20 Blok 49,592 991,840 60 Blok 49,592 2,975,520 70 Kotak 275,000 19,250,000 50 Kotak 275,000 13,750,000 50 Kotak 275,000 13,750,000 60 Blok 112,000 6,720,000 3,000 Rim 156 468,000 4,000 Lbr 3,000 12,000,000 300 Lbr 1,500 450,000 500 Lbr 1,500 750,000 200 Lbr 1,000 200,000 200 Lbr 2,000 400,000 200 Lbr 2,000 400,000 14 Rim 350,000 4,830,000 5 Rim 620,000 3,100,000 4 Rim 350,000 1,400,000 5 Rim 137,814 689,070 50 Blok 26,883 1,344,150 50 Blok 26,883 1,344,150 50 Blok 47,504 2,375,200 12,000 Lbr 2,088 25,056,000 300 Blok 49,592 14,877,600 50 Lbr 292 14,600 2,000 Lbr 573 1,146,000 500 Lbr 1,566 783,000 600 Lbr 4,000 2,400,000 600 Lbr 4,000 2,400,000 150 Blok 47,504 7,125,600 20 Blok 47,504 950,080 30 Blok 47,504 1,425,120 20 Blok 47,504 950,080 60 Blok 10,440 626,400 30 Blok 24,535 736,050 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 50 Blok 49,592 2,479,600 20 Blok 49,592 991,840 100 Blok 49,592 4,959,200 60 Blok 49,592 2,975,520 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 100 Blok 49,592 4,959,200 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 10 Blok 49,592 495,920 10 Blok 49,592 495,920 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 20 Blok 49,592 991,840 20 Blok 49,592 991,840 30 Blok 49,592 1,487,760 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 1/6 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 3/6 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 5/6 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 1/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 3/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 5/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 7/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 9/10 PENGKAJIAN KEPERAWATAN PASIEN TAHAP TERMINAL RM 5 E HAL 1/2 PENGKAJIAN KEPERAWATAN PASIEN HEMODIALISA RM 5 F HAL 1/4 DAFTAR TINDAKAN HD TRAVELLING DIALISIS DAFTAR PEMAKAIAN OKSIGEN BUKU CETAK DISPOSISI SURAT FORMULIR PELAYANAN INFORMASI OBAT FORMULIR SELESAI KEPANITERAAN KLINIK GELANG PASIEN ANAK-ANAK GELANG PASIEN DEWASA LAKI-LAKI GELANG PASIEN DEWASA WANITA BLANGKO LABORATORIUM FORMULIR PERMINTAAN PEMERIKSAAN PATOLOGI BLANGKO PA BLANGKO PMI FAAL HATI BLANGKO PEMERIKSAAN LABORATORIUM BLANGKO SP (SURAT PESANAN) BON CATATAN LINEN BON PERBAIKAN BARANG BUKTI PELAYANAN RAJAL BPJS SURAT KETERANGAN KELAHIRAN LK SURAT KETERANGAN KELAHIRAN PR SURAT KETERANGAN PROTOKOL TERAPI SURAT KETERANGAN MENINGGAL SURAT KETERANGAN SAKIT SURAT KETERANGAN DOKTER SURAT PENGANTAR PEMANTAUAN ICU/ CETAK OBSERVASI ICU PEMANTAUAN ICU/KERTAS PICU NICU LAPORAN ANASTESI LAPORAN HARIAN RAJAL PRIBADI LAPORAN PELAYANAN RAWAT JALAN POLI BPJS LAPORAN KEGIATAN PELAYANAN DI POLIKLINIK RSHM MAP STATUS RESEP STELLING CARD HVS BERKOP WARNA KARTU BEROBAT KECIL KARTU IGD KARTU PEMERIKSAAN USG OBGYN REPORT KARTU PEMELIHARAAN ALAT KESEHATAN KARTU STOK BIRU KARTU STOK HIJAU KARTU STOK MERAH KERTAS MERAH PENGKAJIAN AWAL MEDIS THT RANAP RM 4 G HAL 3/3 PENGKAJIAN MEDIS THT RAJAL RM 3 F HAL 1/4 PENGKAJIAN MEDIS THT RAJAL RM 3 F HAL 3/4 PENGKAJIAN MEDIS IGD RM 4 A HAL 1/4 PENGKAJIAN MEDIS IGD RM 4 A HAL 3/4 PENGKAJIAN AWAL MEDIS RANAP RM 4 B HAL1/2 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 1/6 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 3/6 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 5/6 PENGKAJIAN AWAL MEDIS THT RANAP RM 4 G HAL 1/3 SURAT REKOMENDASI DPJP RESUME KLINIS RAJAL RM 2 A RESUME MEDIS RANAP RM 2 B HAL 1/2 (RM 002) RESUME KEPERAWATAN PASIEN PULANG RANAP RM 2+E RENCANA PEMULANGAN PASIEN 2 F HAL 1/2 PENGKAJIAN AWAL MEDIS RAJAL RM 3A HAL 1/2 PENGKAJIAN AWAL KEPERAWATAN RAJAL RM 3 B HAL 1/2 PENGKAJIAN AWAL MEDIS NEUROLOGI RAJAL RM 3 E HAL 1/3 PENGKAJIAN AWAL MEDIS NEUROLOGI RAJAL RM 3 E HAL 3/3 STELLING CARD GUDANG FARMASI STIKER OBAT LASA SEDANG

30 Blok 49,592 1,487,760 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 5 Blok 49,592 247,960 20 Blok 49,592 991,840 5 Rim 49,592 247,960 300 Blok 49,592 14,877,600 20 Blok 49,592 991,840 50 Blok 49,592 2,479,600 10 Blok 49,592 495,920 30 Blok 49,592 1,487,760 60 Blok 49,592 2,975,520 30 Blok 49,592 1,487,760 30 Blok 49,592 1,492,719 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 60 Blok 49,592 2,975,520 20 Blok 49,592 991,840 50 Blok 49,592 2,479,600 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 20 Blok 49,592 991,840 20 Blok 49,592 991,840 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 49,592 495,920 4 Blok 49,592 198,368 2 Blok 49,592 99,184 4 Blok 49,592 198,368 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 49,592 495,920 2,500 Blok 49,592 123,980,000 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 26,101 261,010 50 Blok 31,500 1,575,000 2 Blok 49,592 99,184 50 Blok 132,000 6,600,000 30 Blok 47,504 1,425,120 30 Blok 26,883 806,490 287,669,000.00 200 Buah 1,000 200,000 1,000 Buah 1,300 1,300,000 100 Botol 60,000 6,000,000 500 Botol 60,000 30,000,000 100 Botol 45,000 4,500,000 30 Buah 11,000 330,000 50 Botol 42,988 2,149,400 20 Buah 14,300 286,000 100 Buah 100,000 10,000,000 20 Helai 80,000 1,600,000 400 Botol 60,000 24,000,000 6 Kg 30,000 180,000 400 Helai 57,500 23,000,000 7 Botol 21,000 147,000 10 Buah 50,000 500,000 25 Buah 16,250 406,250 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 1/6 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 3/6 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 5/6 PENGKAJIAN AWAL KEBIDANAN BAYI BARU LAHIR RM 5 I HAL 1/2 SITE MARKING (PENANDAAN OPERASI) RM 6 B GANGGUAN ELIMINASI KONSTIPASI FORM RM 009 1 09 GANGGUAN ELIMINASI URINE FORM RM 009 1 10 GANGGUAN INTEGRITAS KULIT HIPER TERMIA FORM RM 09 1 20 HIPOTERMI FORM RM 009 1 21 INTOLERANSI AKTIFITAS FORM 009 1 23 MUAL FORM RM 009 1 30 NYERI AKUT FORM RM 009 1 32 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 1/10 PENGKAJIAN KEPERAWATAN PASIEN HEMODIALISA RM 5 F HAL 3/4 PENGKAJIAN KEPERAWATAN PASIEN RANAP USIA 14 TAHUN RM 5 G HAL 1/4 PENGKAJIAN KEPERAWATAN PASIEN RANAP USIA 14 TAHUN RM 5 G HAL 3/4 NYERI KRONIS FORM RM 009 1 33 LAPORAN PEMBEDAHAN / LAPORAN OPERASI RM 6 A HAL 1/2 PELAKSANAAN PENCEGAHAN PASIEN JATUH RM 11 B CATATAN PERKEMBANGAN PASIEN TERINTEGRASI RM 7 A HAL 1/2 KOMUNIKASI S BAR RM 7 C KOMUNIKASI EDUKASI HARIAN RM 7 D EDUKASI PASIEN DAN KELUARGA TERINTEGRASI RM 7 E HAL 1/4 EDUKASI PASIEN DAN KELUARGA TERINTEGRASI RM 7 E HAL 3/4 CATATAN INTAKE DAN OUT PUT RM 8 D (RM 025) ASESMEN ULANG TANDA - TANDA & ULANG NYERI RM 8 F HAL 1/2 ASSESEMEN AWAL MEDIS HEMODIALISIS PERMINTAAN KONSUL JAWABAN KONSUL RM 12 A (RM 059-PAGE I) TRANSFER PASIEN DARI IGD ANTAR RUANGAN RM 12 B HAL 1/2 CATATAN VITAL SIGN RM 025.1 HAL 1/2 PINDAH ANTAR RUANGAN RM 035 HAL 1/3 PINDAH ANTAR RUANGAN RM 035 HAL 3/3 BERSIHAN JALAN NAFAS TIDAK EFEKTIF FORM RM 009.1.03 CEMAS FORM RM 009. 1. 04 GANGGUAN ELIMINASI DIARE FORM RM 009 1 08 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 3/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 5/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 7/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 9/10 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 1/10 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 3/10 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 9/10 ASUHAN KEBIDANAN RM 9 C DAFTAR PEMBERIAN TERAFI RM 10 B HAL 1/2 RM 9 E HAL 5/10 TIKET JASA DOKTER [-] BARANG RUMAH TANGGA BOTOL POT OBAT BOTOL TETES TELINGA BAYGON SEMPROT BAYCLIN BAYFRES BRUS HITAM FORCE MAGIC PEMBUNUH SERANGGA PERUBAHAN NUTRISI LEBIH DARI KEBUTUHAN RM 009 1 41 POLA NAFAS TIDAK EFEKTIF FORM RM 009 1 42 RESIKO ASPIKSIA FORM RM 009 1 43 RESIKO CEDERA JATUH FORM RM 009 1 46 RESIKO TIDAK STABIL KADAR GULA DARAH CETAK AMPRAHAN FARMASI NCR R3 FOLIO KERTAS PICU - PICU PERINCIAN BIAYA SURAT MASUK PERAWATAN GUNTING BESAR JAM DINDING KANEBO UNTUK MOBIL KARBOL KARET GELANG KESET KAKI HANDUK KIT BLACK SEMPROT MAGIC BESAR KIT BLACK SEMIR PEWANGI GANTUNG UNTUK MOBIL PINGWIN

24 Buah 17,000 408,000 120 Buah 13,000 1,560,000 400 Bungkus 40,150 16,060,000 700 Kg 20,800 14,560,000 700 Kg 28,600 20,020,000 100 Kg 46,200 4,620,000 100 Kg 31,110 3,111,000 100 Kg 16,500 1,650,000 100 Kg 7,800 780,000 100 Kg 6,500 650,000 100 Kg 9,100 910,000 800 Saset 25,740 20,592,000 350 Batang 1,000 350,000 100 Botol 140,000 14,000,000 250 Buah 7,000 1,750,000 12 Buah 33,800 405,600 45 Pasang 40,000 1,800,000 100 Buah 62,500 6,250,000 30 Buah 60,000 1,800,000 50 Pasang 18,750 937,500 25 Pasang 12,650 316,250 7 Pasang 220,000 1,540,000 200 Buah 60,000 12,000,000 300 Bungkus 25,000 7,500,000 1,000 Kotak 19,500 19,500,000 500 Botol 60,000 30,000,000 475,905,050.00 1,000 Kotak 26,000 26,000,000 200 Kotak 85,000 17,000,000 140 Kotak 44,000 6,160,000 140 Kotak 32,800 4,592,000 120 Bungkus 2,610 313,200 50 Buah 36,000 1,800,000 50 Buah 30,500 1,525,000 144 Buah 258,000 37,152,000 61 Buah 21,300 1,299,300 750 Buah 13,900 10,425,000 1,000 Buah 16,500 16,500,000 80 Buah 16,500 1,320,000 80 Buah 40,000 3,200,000 120 Kotak 7,800 936,000 120 Kotak 3,900 468,000 500 Buah 31,000 15,500,000 300 Buah 80,600 24,180,000 50 Buah 16,500 825,000 150 Buah 42,000 6,300,000 30 Buah 175,000 5,250,000 250 Buah 20,250 5,062,500 50 Buah 60,000 3,000,000 1,100 Rim 49,270 54,197,000 1,000 Rim 43,000 43,000,000 3 Bungkus 575,000 1,725,000 2 Rol 4,687,500 9,375,000 500 Buah 750 375,000 1 Bungkus 90,000 90,000 100 Kotak 21,792 2,179,200 20 Buah 500,000 10,000,000 70 Kotak 9,100 637,000 200 Kotak 5,200 1,040,000 10 Kotak 400,000 4,000,000 25 Kotak 442,600 11,065,000 75 Buah 35,000 2,625,000 100 Buah 19,500 1,950,000 150 Buah 46,150 6,922,500 2,000 Buah 2,500 5,000,000 300 Buah 63,000 18,900,000 30 Buah 350,000 10,500,000 24 Buah 3,600 86,400 240 Buah 20,000 4,800,000 30 Kotak 45,500 1,365,000 5 Rol 40,000 200,000 300 Lembar 1,650 495,000 STELLA GANTUNG/PEWANGI GANTUNG PISAU SILET CUKUR GAGANG PLASTIK ASOY PUTIH PLASTIK HITAM 90X100 PLASTIK KUNING 90X100 PLASTIK 1/4 /KG PLASTIK 1/2 KG PLASTIK 1 KG PLASTIK OBAT KLIP UK 12X8 SAPU KECIL U MOBIL SARUNG TANGAN KARET SARUNG TANGAN KAIN SEPATU BOAT SERBET KAIN KOTAK SUNLIGHT / MAMA LEMON TISSU KOTAK WIPOL [-] BARANG ALAT TULIS KANTOR (ATK) PLASTIK OBAT KLIP UK 15X10 PLASTIK OBAT KLIP UK17X11 RINSO / DAIA SABUN BATANGAN SABUN DETTOL CAIR SABUN MANDI LIFEBUOY SAMPO MOBIL SANDAL SAPU PLASTIK BATRAI REMOT BATRAI JAM BATRAI SEDANG BATRE PETAK 9 VOLT BINDER KLIP BESAR BINDER KLIP KECIL BUKU BESAR FOLIO BUKU EXPEDISI DOKUMEN PAPER ISI 100 ANAK HEKTER KECIL ANAK HEKTER BESAR AMPLOP BESAR PUTIH AMPLOP KECIL PUTIH AMPLOP COKLAT UK HVS BALPOINT HITAM BALPOINT BIRU BALPOINT CAIR BALPOINT MERAH KERTAS FILM GLOSSY KERTAS PRINT THERMAL 80X80 KEYBOARD COMPUTER WAYAR LES KLIP ATOM BESAR KLIP ATOM SEDANG KERTAS CF 9 1/2 X 11 R3 KERTAS CF 9 1/2 X 11 R3 F LEM POVINAL LETTER FILE 401 FILE BOX FLASDISK 32 GB HEKTER SEDANG HEKTER BESAR HVS F4 HVS A4 JEK IRJ KABEL JARIGAN KABEL JARINGAN KERTAS PRINT ETIKET FARMASI LETTER FILE 403 MAP KERTAS MAP TULANG PLASTIK MOUSE COMPUTER WAYAR LES PINSIL 2 B PISAU CUTTER PITA PRINTER LX 310 PITA TIK KALKULATOR PLASTIK KARTU INVENTARIS

45 Buah 35,100 1,579,500 150 Buah 11,500 1,725,000 150 Buah 30,500 4,575,000 150 Buah 23,000 3,450,000 900 Buah 13,000 11,700,000 450 Buah 15,600 7,020,000 40 Buah 3,900 156,000 2 Buah 153,400 306,800 300 Buah 7,500 2,250,000 250 Botol 105,447 26,361,750 100 Botol 105,447 10,544,700 100 Botol 105,447 10,544,700 100 Botol 105,447 10,544,700 10 Botol 300,000 3,000,000 100 Botol 14,059 1,405,900 100 Buah 14,059 1,405,900 2,537,925,036.00 5 Box 2,068,000 10,340,000 39 Set 187,220 7,301,580 320 Ktk 64,890 20,764,800 190 Box 40,556 7,705,640 10 Btl 2,250,000 22,500,000 10 Btl 901,250 9,012,500 1 Btl 1,350,000 1,350,000 38 Btl 170,000 6,460,000 2 Kit 294,000 588,000 2 Kit 205,000 410,000 2 Kit 482,000 964,000 38 Kit 1,089,900 41,416,200 38 Kit 1,965,755 74,698,690 38 Kit 1,487,062 56,508,356 38 Kit 1,534,429 58,308,302 38 Kit 1,201,200 45,645,600 38 Kit 596,112 22,652,256 38 Kit 973,350 36,987,300 50 Kit 2,500,000 125,000,000 50 Kit 1,622,250 81,112,500 50 Kit 4,537,665 226,883,250 1 Btl 11,855 11,855 26 Ktk 302,880 7,874,880 13 Ktk 1,364,275 17,735,575 11 Ktk 3,090,000 33,990,000 17 Bok 50,000 850,000 7 Kit 2,879,800 20,158,600 7 Kit 771,920 5,403,440 13 Kit 1,841,125 23,934,625 77 Ktk 446,188 34,356,476 38 Ktk 4,184,620 159,015,560 21 Kit 1,705,011 35,805,231 21 Kit 6,231,500 130,861,500 21 Kit 1,934,533 40,625,193 3 Ktk 9,042,000 27,126,000 3 Ktk 402,500 1,207,500 3 Ktk 4,136,000 12,408,000 3 Ktk 4,088,700 12,266,100 43 Kit 3,626,000 155,918,000 13 Kit 1,336,500 17,374,500 25 Kit 850,000 21,250,000 25 Kit 1,746,189 43,654,725 38 Kit 215,000 8,170,000 6 Kit 2,240,315 13,441,890 16 Kit 1,430,000 22,880,000 38 Kit 612,700 23,282,600 128 Box 88,000 11,264,000 128 Box 52,300 6,694,400 128 Ktk 30,000 3,840,000 321 Box 425,500 136,585,500 385 Box 400,000 154,000,000 25 Bks 321,875 8,046,875 25 Bks 500,000 12,500,000 42 Bks 1,008,150 42,342,300 7 Bks 1,008,150 7,057,050 Procalcitonin D.Dimer HS. CRP Blue Tive Cup Sample Terbuka Cup Sample Tertutup Plesterin Alkohol Swab Vacutainer Serum Vacutainer EDTA Yellow Tive HBAIC NSI Troponin IgG / IgM Dengue Blood Lancet ROL BESI SLASIBAN BENING BESAR SLASIBAN HITAM BESAR SLASIBAN COKLAT SPIDOL PERMANENT SPIDOL WHITE BOARD STIP PINSIL 2B STEMPEL TANGGAL TINTA PRINT LABEL FARMASI Malaria Rapid Tes Golongan Darah ABO Object Glass Deck Glass Giemsa Methanol Eosin 1 % Stik Urine PT (Prothrombine Time) TINTA PRINTER HITAM EPSON TINTA PRINTER KUNING EPOSN TINTA PRINTER MERAH EPSON TINTA PRINTER BIRU EPSON TINTA PRINTER CANNON TINTA STEMPEL OTOMATIS BIRU TINTA STEMPEL OTOMATIS HIJAU [-] Barang BHP Laboratorium FT4/TSH Ureum Creatin Uric Acid Timol - Catrige BG 3 - Calibrant CP 100 - Control Level - Spuit Heparin Ck NAC APTT (Masa Tromboplastin Parsial) TT (Trhombine Time) Glucosa Blirubin Total SGOT SGPT Alkali Phospate Total Protein Albumin T3T4 Ca 125 Tubex LDH Asto HBs Ag Anti HBS Cholesterol Triglesirida HDL-Cholesterol CEA

385 Ktk 219,600 84,546,000 21 Glng 21,792 457,632 16 Glng 21,792 348,672 1,285 Pcs 20,000 25,700,000 1 Btl 2,376,725 2,376,725 39 Box 245,000 9,555,000 30 Pcs 246,600 7,398,000 25 Ktk 185,000 4,625,000 25 Ktk 185,000 4,625,000 25 Ktk 185,000 4,625,000 25 Ktk 185,000 4,625,000 16 Ktk 294,000 4,704,000 2 Btl 1,183,730 2,367,460 16 Galon 749,196 11,987,136 16 Btl 1,006,647 16,106,352 16 Btl 1,183,730 18,939,680 24 Kg 300,000 7,200,000 10 Btl 295,592 2,955,920 10 Btl 749,196 7,491,960 10 Btl 384,133 3,841,330 3 Btl 5,816,487 17,449,461 3 Btl 6,919,849 20,759,547 54 Ktk 30,000 1,620,000 54 Ktk 30,000 1,620,000 1 Buah 85,000 85,000 5 Btl 2,456,001 12,280,005 5 Btl 5,816,487 29,082,435 5 Btl 5,170,816 25,854,080 2 Ktk 27,141,337 54,282,674 3 Btl 13,958,206 41,874,618 - 1,075,101,077 20 Box 5,236,000 104,720,000 13 Box 6,599,999 85,799,987 2 Box 8,563,000 17,126,000 - 38 Box 4,760,000 180,880,000 10 Box 6,000,000 60,000,000 - 40 Box 8,563,000 342,520,000 70 Roll 2,750,000 192,500,000 30 Box 400,000 12,000,000 10 Box 400,000 4,000,000 30 Liter 40,000 1,200,000 70 Box 209,775 14,684,250 20 Ampul 997 19,940 15 Ampul 27,600 414,000 200 Set 121,000 24,200,000 20 Set 397,260 7,945,200 60 Set 40,000 2,400,000 300 Set 33,000 9,900,000 12 Set 24,200 290,400 10 Set 12,500 125,000 12 Kit 482,000 5,784,000 20 Fls 15,000 300,000 10 Gulung 129,780 1,297,800 10 Set 52,300 523,000 20 Set 162,500 3,250,000 1 Box 71,500 71,500 35 Botol 90,000 3,150,000 7 Galon 92,615 648,305 - 2,224,364,158 1,200 Galon 79,000 94,800,000 24 Liter 150,000 3,600,000 144 Box 10,000 1,440,000 336 Box 200,000 67,200,000 192 Box 325,000 62,400,000 192 Box 325,000 62,400,000 756 Liter 60,000 45,360,000 200 Box 651,475 130,295,000 110 Box 651,475 71,662,250 Bayclin (Desinfectan Mesin) Blood Tubing Set Menjangan Blood Tubing Set Sinar Roda -14 x 17 cm Film USG Iopamiro 50/370 mg Parafin Ecomount/ Canada Balsem Haematocylin Eosin Alkohol Esrtrogen Reseptor Bond Primary Solution Bond Epitope Retrieval Solution Bond Polimer Refine Detection Calretini CD 20 Objek Glass Ciover Glass Comeco / Alat Aspirator Dewax Solution - Amphetamin - THC Thermal Paper Kecil - 8 x 10 cm -11 x 14 cm Film CT Scan DT2B Film Carestrem - 8 x 10 cm -11 x 14 cm -14 x 17 cm Film Codonic - Cocain [-] Barang BHP Radiologi - Morphin INR Xylol Buffer Formalin Alkohol Absulute Xylol/Xylen Kertas Gol Darah Emercy Oil Rhesus Tabung Runcing Stik Glucosa Thermal Paper Besar Spuit 3 CC Spuit 30 CC Spuit 100 CC Spuit 50 CC TI (Trhombine Time) Nacl 0,9 % Kapas 250 mg Plaster Merah Tree Way Wing Nald No 21 Hand Drub Jelly 5 Kg [-] Barang BHP Hemodialisa Acid (AK-1) Sinar Roda Alkohol 70 % Alkohol Sweb Apron Plastik Av Fistula Menjagan Av Fistula Sinar Roda Iopamiro 100/370 mg Aquadest Steril Handsconn No 8 Dexametashon Buscopan Cateter No 18 Cateter No 8

2,209 Liter 557,700 1,231,959,300 2,400 Galon 50,000 120,000,000 144 Ampul 16,000 2,304,000 80 Box 200,000 16,000,000 40 Box 200,000 8,000,000 144 Liter 440,000 63,360,000 144 Liter 50,407 7,258,608 48 Liter 550,000 26,400,000 1,500 Sering 139,950 209,925,000 224,174,268 12 LITER 50,000 600,000 24 DRIGEN 669,000 16,056,000 60 KOTAK 55,000 3,300,000 12 BTL 85,000 1,020,000 3 KTK 997,700 2,993,100 6 POT 189,200 1,135,200 3 KTK 6,510,000 19,530,000 60 ROL 30,000 1,800,000 12 LITER 533,400 6,400,800 6 ROL 2,730,000 16,380,000 11 ROL 1,248,000 13,728,000 12 ROL 510,000 6,120,000 16 BOX 1,730,000 27,680,000 16 ROL 60,913 974,608 180 PSG 71,662 12,899,160 180 PSG 75,000 13,500,000 2 BOTOL 11,000,000 22,000,000 1 KTK 11,530,000 11,530,000 5 BUNGKUS 519,480 2,597,400 10 BTL 682,000 6,820,000 5 ROL 1,248,000 6,240,000 5 ROL 1,473,000 7,365,000 24 KTK 225,000 5,400,000 36 BUNGKUS 200,000 7,200,000 100 PSC 55,000 5,500,000 100 PSC 46,800 4,680,000 29 KTK 25,000 725,000 200,000,000 1 Thn 200,000,000 200,000,000 500,000,000 1 Thn 500,000,000 500,000,000 14,300,000 2 box 500,000 1,000,000 4 box 250,000 1,000,000 2 botol 500,000 1,000,000 3 syringe 1,000,000 3,000,000 3 syringe 333,333 1,000,000 2 syringe 250,000 500,000 1 syringe 1,000,000 1,000,000 1 box 200,000 200,000 3 box 66,667 200,000 2 set 100,000 200,000 2 gulung 100,000 200,000 1 box 200,000 200,000 2 botol 100,000 200,000 2 botol 100,000 200,000 2 box 100,000 200,000 2 box 150,000 300,000 2 box 250,000 500,000 2 box 250,000 500,000 24 syringe 8,333 200,000 1 botol 200,000 200,000 1 200,000 200,000 2 botol 100,000 200,000 1 botol 100,000 100,000 2 box 100,000 200,000 3 botol 66,667 200,000 3 box 33,333 100,000 2 botol 50,000 100,000 Gutaperca ProTaper Gutaperca Protaper Next Bonding Resin komposit bulk-fill Resin komposit flowable Semen Resin Jarum irigasi Cotton roll Bur diamond high speed FACE SHIELD TOPI PERAWAT [#] Belanja Penambahan Pipa Gas Medis [-] Belanja Penambahan Pipa Gas Medis [#] Belanja Pemeliharaan Gedung [-] Belanja Pemeliharaan Gedung Resin komposit anterior Glass ionomer cement restorasi Etsa gel Dentin Conditioner Varnish Microbrush Bubuk pumice Pasta profilaksis Chlor ethyl spray Tambalan sementara Eugenol [#] BELANJA BAHAN SPESIALIS KONSERVASI GIGI POLI GIGI DAN MULUT Benang retraksi Blade scalpel Hemostat EDTA cairan EDTA pasta Sealer Glass ionomer cement lining ALKOHOL ANIOSYME DLT PLUS HANSCUN NON STERIL HANS CRUB (SANITIZER) INDIKATOR EDSEPHES GERMISEP INDIKATOR BOWDICK KAIN KASA 40 YEARS x 80 ONE SCRAB SABLON PAUCES 40x200 (FLAT) PAUCES 20x200 (FLAT) PAUCES 7,5x200 (FLAT) WROPING PAPER 100x100 LEOKOPLAST 7,5M x 4,5M SARUNG TANGAN NO 7,5 SARUNG TANGAN NO 8 H2O2 59% INDIKATOR STEAM 1250 INDIKATOR STEAM 1234 A STABIMET POUCES LOW 20 x 200 (FLAT) POUCES LOW 10 x 100 (FLAT) MASKER APRON GOEGLE [-] Barang BHP CSSD Citric Acid (Desinfectan Mesin HD) Hemapo 3000 iu/ml Citric Acid Menjangan Dexametashon Inj 5 mg/ml Dializer 16 S Menjangan Dializer 16 Sinar Roda Formalin 37 5 H2O2 50 % Hand sanitizer

2 botol 50,000 100,000 2 box 100,000 200,000 2 box 100,000 200,000 1 box 100,000 100,000 1 box 100,000 100,000 1 box 100,000 100,000 1 box 100,000 100,000 4 box 50,000 200,000 4 box 50,000 200,000 Spreader 2 box 50,000 100,000 CHKM Kalsium hidroksida medikamen intrakanal Kalsium hidroksida Pasta Articulating paper Seluloid strips Wooden wedge Polishing strips Paper point Gutaperca

Satuan Tarif/Harga 5 5.1 5.1.01 24,500,242,000 20,092,736,000 82 Org/Bln 6,000,000 492,000,000 120 Org/Bln 6,050,000 726,000,000 216 Org/Bln 5,350,000 1,155,600,000 204 Org/Bln 5,350,000 1,091,400,000 1724 Org/Bln 1,900,000 3,275,600,000 624 Org/Bln 2,350,000 1,466,400,000 552 Org/Bln 2,690,000 1,484,880,000 792 Org/Bln 2,988,000 2,366,496,000 456 Org/Bln 3,295,000 1,502,520,000 996 Org/Bln 3,990,000 3,974,040,000 588 Org/Bln 4,350,000 2,557,800,000 1,605,928,000 10 Org/Thn 6,050,000 60,500,000 18 Org/Thn 5,350,000 96,300,000 17 Org/Thn 5,350,000 90,950,000 125 Org/Thn 1,900,000 237,500,000 52 Org/Thn 2,350,000 122,200,000 46 Org/Thn 2,690,000 123,740,000 66 Org/Thn 2,988,000 197,208,000 38 Org/Thn 3,295,000 125,210,000 83 Org/Thn 3,990,000 331,170,000 49 Org/Thn 4,350,000 213,150,000 1 Org/Thn 8,000,000 8,000,000 1,195,650,000 3 Org/Bln 2,000,000 6,000,000 30 Org/Bln 1,000,000 30,000,000 7 Org/Bln 1,250,000 8,750,000 2 Org/Bln 2,500,000 5,000,000 12 Org/Bln 1,750,000 21,000,000 10 Org/Bln 2,000,000 20,000,000 700 Org/Bln 300,000 210,000,000 110 Org/Bln 1,000,000 110,000,000 220 Org/Bln 800,000 176,000,000 247 Org/Bln 700,000 172,900,000 260 Org/Bln 600,000 156,000,000 280 Org/Bln 500,000 140,000,000 350 Org/Bln 400,000 140,000,000 1,605,928,000 10 Org/Thn 6,050,000 60,500,000 18 Org/Thn 5,350,000 96,300,000 17 Org/Thn 5,350,000 90,950,000 125 Org/Thn 1,900,000 237,500,000 52 Org/Thn 2,350,000 122,200,000 46 Org/Thn 2,690,000 123,740,000 66 Org/Thn 2,988,000 197,208,000 38 Org/Thn 3,295,000 125,210,000 83 Org/Thn 3,990,000 331,170,000 49 Org/Thn 4,350,000 213,150,000 1 Org/Thn 8,000,000 8,000,000 THR Pegawai Staf BLUD Non PNS Kelompok VI THR Wadir/Komite Medik BLUD Non PNS THR Pegawai Staf BLUD Non PNS Kelompok II THR Pegawai Staf BLUD Non PNS Kelompok III THR Pegawai Staf BLUD Non PNS Kelompok IV THR Pegawai Staf BLUD Non PNS Kelompok V THR Pegawai Kontrak BLUD Non PNS THR Pegawai Staf BLUD Non PNS Kelompok I Insentif Pegawai Staf BLUD Non PNS Kelompok VI [#] Belanja THR BLUD THR Kabag/Kabid Pegawai BLUD Non PNS THR Kepala Ruangan/Ka.Ur Peg BLUD Non PNS THR Kasubbag Pegawai BLUD Non PNS Insentif Pegawai Staf BLUD Non PNS Kelompok V Insentif Kabag/Kabid PNS BLUD Insentif Kepala Ruangan PNS BLUD Insentif Kasubbag PNS BLUD Insentif Kabag/Kabid Pegawai BLUD Non PNS Insentif Kepala Ruangan/Ka.Ur Peg BLUD Non PNS Insentif Kasubbag Pegawai BLUD Non PNS Insentif Pegawai Kontrak BLUD Non PNS Insentif Pegawai Staf BLUD Non PNS Kelompok I Insentif Pegawai Staf BLUD Non PNS Kelompok II Insentif Pegawai Staf BLUD Non PNS Kelompok III Insentif Pegawai Staf BLUD Non PNS Kelompok IV [#] Belanja Insentif BLUD Gaji 13 Kepala Ruangan/Ka.Ur Peg BLUD Non PNS Gaji 13 Kasubbag Pegawai BLUD Non PNS Gaji 13 Pegawai Kontrak BLUD Non PNS Gaji 13 Pegawai Staf BLUD Non PNS Kelompok I Gaji 13 Pegawai Staf BLUD Non PNS Kelompok II Gaji 13 Pegawai Staf BLUD Non PNS Kelompok III Gaji 13 Pegawai Staf BLUD Non PNS Kelompok IV Gaji 13 Pegawai Staf BLUD Non PNS Kelompok V Gaji 13 Pegawai Staf BLUD Non PNS Kelompok VI Gaji 13 Wadir/Komite Medik BLUD Non PNS Gaji 13 Kabag/Kabid Pegawai BLUD Non PNS Gaji Kepala Ruangan/Ka.Ur Peg BLUD Non PNS Gaji Kasubbag Pegawai BLUD Non PNS Gaji Pegawai Kontrak BLUD Non PNS Gaji Pegawai Staf BLUD Non PNS Kelompok I Gaji Pegawai Staf BLUD Non PNS Kelompok II Gaji Pegawai Staf BLUD Non PNS Kelompok III Gaji Pegawai Staf BLUD Non PNS Kelompok IV Gaji Pegawai Staf BLUD Non PNS Kelompok V Gaji Pegawai Staf BLUD Non PNS Kelompok VI [#] Belanja Gaji 13 BLUD Gaji Kabag/Kabid Pegawai BLUD Non PNS Hasil - - Kode Rekening Uraian Rincian Perhitungan jumlah Volume BELANJA DAERAH BELANJA OPERASI Belanja Pegawai [-] Belanja Pegawai BLUD Gaji Dewan Pengawas BLUD Masukan Dana yang dibutuhkan Rp 65,000,000,000 Keluaran terlaksananya Operasional RS 1 tahun RENCANA KERJA ANGGARAN (RKA) BLUD 2022 Indikator Tolak Ukur Kinerja Target Kinerja Capaian Program

65,000,000,000 19,600,736,000

Satuan Tarif/Harga 5 5.1 5.1.02 39,076,133,330 5.1.02.01 120,000,000 1 Paket 120,000,000 120,000,000 150,000,000 375 Org/Hr 400,000 150,000,000 1,770,936,528 120 Org/Bln 522,840 62,740,800 960 Org/Bln 194,560 186,777,600 636 Org/Bln 240,640 153,047,040 552 Org/Bln 275,456 152,051,712 792 Org/Bln 305,971 242,329,032 456 Org/Bln 337,408 153,858,048 936 Org/Bln 408,576 382,427,136 588 Org/Bln 445,440 261,918,720 96 Org/Bln 566,520 54,385,920 216 Org/Bln 522,840 112,933,440 12 Org/Bln 705,590 8,467,080 9,130,097,500 100 Orang/Operasi 2,700,000 270,000,000 320 Orang/Operasi 1,950,000 624,000,000 10 Orang/Operasi 4,500,000 45,000,000 160 Orang/Operasi 4,500,000 720,000,000 20 Orang/Operasi 4,500,000 90,000,000 45 Orang/Operasi 9,376,500 421,942,500 180 Orang/Operasi 3,637,000 654,660,000 550 Orang/Operasi 1,350,000 742,500,000 90 Orang/Operasi 4,200,000 378,000,000 151 Orang/Tindakan 300,000 45,300,000 400 Orang/Tindakan 168,000 67,200,000 88 Orang/Tindakan 125,000 11,000,000 2400 Orang/Tindakan 20,000 48,000,000 10000 Orang/Tindakan 40,000 400,000,000 75 Orang/Tindakan 300,000 22,500,000 2500 Orang/Visite 75,000 187,500,000 12000 Orang/Visite 60,000 720,000,000 2262 Orang/Visite 50,000 113,100,000 21000 Orang/Visite 35,000 735,000,000 126000 Orang/Tindakan 12,500 1,575,000,000 100 Orang/Tindakan 350,000 35,000,000 1000 Orang/Visite 75,000 75,000,000 6000 Orang/Tindakan 20,000 120,000,000 8850 Orang/Pasien 35,000 309,750,000 300 Orang/Visite 150,000 45,000,000 25 Orang/Tindakan 125,000 3,125,000 2152 Orang/Visite 10,000 21,520,000 1000 Orang/Tindakan 150,000 150,000,000 5000 Orang/Visite 100,000 500,000,000 50,000,000 1 Paket 50,000,000 50,000,000 1,688,000,000 40 Org/Bln 7,000,000 280,000,000 160 Org/Bln 5,000,000 800,000,000 80 Org/Bln 2,500,000 200,000,000 Insentif Dokter BLUD PNS/NON PNS Kelompok II Insentif Dokter BLUD PNS/NON PNS Kelompok III Konsultan Appraisal/Konsultan Penilai [-] Belanja Insentif Dokter Insentif Dokter BLUD PNS/NON PNS Kelompok I Honor dokter USG Spesifikasi : Zona 1 Honor dokter VipSpesifikasi : Zona 1 [-] Belanja Jasa Konsultan Auditor Independent Honor dokter Super VipSpesifikasi : Zona 1 Honor dokter TreadmillSpesifikasi : Zona 1 Honor dokter umumSpesifikasi : Zona 1 Honor dokter PICU / NICU Spesifikasi : Zona 1 Honor dokter RadiologiSpesifikasi : Zona 1 Honor Dokter Rawat JalanSpesifikasi : Zona 1 Honor dokter Kelas III Spesifikasi : Zona 1 Honor Dokter LaboratoriumSpesifikasi : Zona 1 Honor dokter Patologi AnatomiSpesifikasi : Zona 1 Honor dokter ICU Spesifikasi : Zona 1 Honor dokter Kelas I Spesifikasi : Zona 1 Honor dokter Kelas II Spesifikasi : Zona 1 Honor dokter EKG Spesifikasi : Zona 1 Honor dokter FisioterapiSpesifikasi : Zona 1 Honor dokter GastrocopySpesifikasi : Zona 1 Honor dokter BronchoscopiSpesifikasi : Zona 1 Honor dokter Ct ScanSpesifikasi : Zona 1 Honor dokter EEG Spesifikasi : Zona 1 Honor Bedah THT Spesifikasi : Zona 1 Honor Bedah UmumSpesifikasi : Zona 1 Honor Bedah UrologiSpesifikasi : Zona 1 Honor Bedah OrthopediSpesifikasi : Zona 1 Honor Bedah PlastikSpesifikasi : Zona 1 Honor Bedah SyarafSpesifikasi : Zona 1 Honor Bedah MataSpesifikasi : Zona 1 Honor Bedah ObgynSpesifikasi : Zona 1 Honor Bedah OngkologiSpesifikasi : Zona 1 Iuran BPJS Kesehatan setingkat Ka.Ruangan/Ka.Ur. Pegawai BLUD Iuran BPJS Kesehatan setingkat Wadir Pegawai BLUD [-] Belanja Jasa Medis Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok VI Iuran BPJS Kesehatan setingkat Kabag/Kabid Pegawai BLUD Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok IV Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok V Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok II Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok III Iuran BPJS Kesehatan Pegawai Kontrak BLUD Iuran BPJS Kesehatan Pegawai Staf Pegawai BLUD Kelompok I [-] Belanja Asuransi Pegawai BLUD Iuran BPJS Kesehatan Kasubag Pegawai BLUD [-] Penambahan Daya Listrik Penambahan Daya Listrik [-] Belanja BHP Pakian Nakes Belanja Pakaian Tenaga Kesehatan Belanja Barang dan Jasa Belanja Barang BELANJA DAERAH BELANJA OPERASI Hasil - - Kode Rekening Uraian Rincian Perhitungan jumlah Volume Masukan Dana yang dibutuhkan Rp 65,000,000,000 Keluaran terlaksananya Operasional RS 1 tahun RENCANA KERJA ANGGARAN (RKA) BLUD 2022 Indikator Tolak Ukur Kinerja Target Kinerja Capaian Program

2040 Org/Kunjungan 200,000 408,000,000 750,000,000 12 Bln 62,500,000 750,000,000 916,968,000 12 Bln 76,414,000 916,968,000 25,000,000 1000 Set 25,000 25,000,000 992,500,000 25000 Kg 38,500 962,500,000 12 Bln 2,500,000 30,000,000 35,040,000 12 Org/Bln 2,920,000 35,040,000 212,400,000 12 Org/Bln 1,720,000 20,640,000 12 Org/Bln 1,550,000 18,600,000 36 Org/Bln 570,000 20,520,000 24 Org/Bln 1,150,000 27,600,000 12 Org/Bln 2,210,000 26,520,000 12 Org/Bln 1,780,000 21,360,000 12 Org/Bln 3,010,000 36,120,000 12 Org/Bln 3,420,000 41,040,000 5.1.01.03.07.0002 39,360,000 60 Org/Paket 520,000 31,200,000 12 Org/Bln 680,000 8,160,000 5.1.02.01.01 188,023,000 375 BUNGKUS 20,000 7,500,000 540 KOTAK 32,000 17,280,000 752 BUNGKUS 5,000 3,760,000 752 BUNGKUS 25,000 18,800,000 556 BUNGKUS 15,000 8,340,000 375 KG 35,000 13,125,000 40 BUAH 25,000 1,000,000 500 BUNGKUS 15,000 7,500,000 33,850 BUAH 3,000 101,550,000 11,280 BUAH 600 6,768,000 100 KOTAK 20,000 2,000,000 10 KG 40,000 400,000 5.1.02.01.01.0010 129,500,000 148 Tabung 875,000 129,500,000 5.1.02.01.01.0043 1,841,198,435 8,766 kg 13,110 114,922,260 500 kotak 3,729 1,864,500 1,504 kg 15,952 23,991,808 735 kotak 11,495 8,448,825 30,000 butir 1,499 44,970,000 752 kotak 67,276 50,591,552 40 kotak 76,433 3,057,320 26 kotak 186,000 4,836,000 120 bungkus 261,250 31,350,000 1,000 sachet 18,295 18,295,000 6 kg 143,629 861,774 1,500 kg 14,520 21,780,000 3,000 kg 36,300 108,900,000 375 kg 36,300 13,612,500 MINYAK GORENG KEMASAN DAGING AYAM NUGGET AYAM SUSU BUBUK BLENDERA @1,25 KG SUSU ENSURE VANILLA MINYAK / CORN OIL TROPICANA SLIM 1 LITER/KG SUSU BUBUK ISOCAL 400 GR SUSU BUBUK SGM GAIN 100 400 GR SUSU SKIM TROPICANA SLIM 1000 GR GULA PUTIH TEPUNG MAIZENA 100 GR TELUR AYAM Belanja Bahan Makan Pokok Pasien [-] Belanja Kebutuhan Makan Minum Pasien BERAS IR 64 BUBUK TEH BENDERA 50 GR Belanja Bahan-Isi Tabung Gas [#] Belanja Pengisian Tabung Gas [-] Belanja Pengisian Tabung Gas ELPIJI GAS ELPIJI 50 KG / TABUNG PEMANTIK API GELAS CUP PLASTIK ( 1 bungkus isi 50 buah) KOTAK NASI KOMPLIT KOTAK STREOFOM SARUNG TANGAN DISPOSABLE KARET GELANG SUNLIGHT 400 ml (refil) PLASTIK WRAF Uk. 300 mm x 30 m TISSUE MAKAN PLASTIK PULUT UKURAN KECIL SENDOK MAKAN PLASTIK PLASTIK UKURAN 1/4 KG Panitia Pemeriksa Administrasi Hasil Pekerjaan/Pengadaan Barang/Jasa Nilai pagu pengadaan diatas Rp. 200 jt s.d. 500 jt Pejabat Pengadaan untuk Pengadaan Barang/Jasa Belanja Barang Pakai Habis [-] Belanja BHP Instalasi Gizi Pejabat Pelaksana Teknis Kegiatan (PPTK-SKPD) Nilai Pagu dana diatas Rp. 2,5 miliar s.d. Rp. 5 miliar Pejabat Penatausahaan Keuangan (PPK-SKPD) Nilai Pagu dana diatas Rp. 50 miliar s.d. Rp. 75 miliar Pengguna Anggaran/Kuasa Pengguna Anggaran Nilai Pagu dana diatas Rp. 10 miliar s.d. Rp. 25 miliar Pengguna Anggaran/Kuasa Pengguna Anggaran Nilai Pagu dana diatas Rp. 25 miliar s.d. Rp. 50 miliar Belanja Honorarium Pengadaan Barang/Jasa [-] Honorarium Pengelola Kegiatan BLUD Bendahara Penerimaan Nilai Pagu dana diatas Rp. 50 miliar s.d. 75 miliar Bendahara Pengeluaran Nilai Pagu dana diatas Rp. 50 miliar s.d. Rp. 75 miliar Bendahara Pengeluaran Pembantu Nilai Pagu dana diatas Rp. 2,5 miliar s.d. Rp. 5 miliar Bendahara Pengeluaran Pembantu/Staf/Petugas Adm Belanja Pegawai Nilai Pagu dana diatas Rp. 50 miliar s.d. Rp. 75 miliar [-] Belanja Pengangkutan Sampah Jasa Pengangkutan Sampah Medis Jasa Pengangkutan Sampah Umum [#] Honorarium Pengelola Kegiatan BLUD Pejabat Pembuat Komitmen selaku Pejabat Penandatanganan Kontrak (PPK) Nilai Pagu dana diatas Rp. 10 miliar s.d. Rp. 25 miliar [-] Belanja Jasa Pemakaian SIMRS Sistem Informasi Manajemen Rumah Sakit (SIMRS) [-] Belanja Jasa Transaksi Keuangan Jasa Bank Insentif Dokter BLUD PNS/NON PNS Kelompok IV [-] Belanja Jasa Rujukan Jasa Rujukan

800 kg 135,600 108,480,000 565 kg 118,650 67,037,250 7,500 kg 55,000 412,500,000 150 kg 35,000 5,250,000 150 kg 35,000 5,250,000 1,503 buah 7,910 11,888,730 940 kg 9,200 8,648,000 500 kg 43,700 21,850,000 730 kg 48,345 35,291,850 270 kg 58,520 15,800,400 470 kg 8,050 3,783,500 3,200 batang 2,200 7,040,000 12,532 potong 1,243 15,577,276 600 kg 7,840 4,704,000 11,300 buah 1,130 12,769,000 200 buah 22,000 4,400,000 3,759 kg 16,950 63,715,050 750 kg 4,500 3,375,000 1,000 sisir 19,550 19,550,000 816 kg 19,550 15,952,800 750 kg 33,900 25,425,000 600 kg 19,210 11,526,000 750 kg 49,500 37,125,000 12 kg 50,000 600,000 988 kg 16,950 16,746,600 56,700 buah 3,025 171,517,500 5,840 buah 8,349 48,758,160 100 sachet 8,470 847,000 513 kg 4,600 2,359,800 260 kg 6,900 1,794,000 742 kg 14,520 10,773,840 1,150 kg 9,040 10,396,000 1,500 ikat 3,450 5,175,000 2,570 ikat 1,150 2,955,500 500 kg 8,050 4,025,000 700 kg 8,050 5,635,000 125 kg 28,250 3,531,250 520 kg 4,600 2,392,000 550 kg 9,200 5,060,000 180 kg 13,800 2,484,000 210 kg 27,120 5,695,200 180 kg 45,200 8,136,000 12 kg 22,000 264,000 290 kg 9,040 2,621,600 400 kg 9,040 3,616,000 50 kg 2,825 141,250 290 kg 9,040 2,621,600 275 kg 9,200 2,530,000 275 kg 11,300 3,107,500 275 kg 28,250 7,768,750 275 kg 9,040 2,486,000 275 kg 25,990 7,147,250 275 kg 10,350 2,846,250 275 kg 10,170 2,796,750 275 kg 16,950 4,661,250 275 kg 12,000 3,300,000 275 kg 16,950 4,661,250 8 kg 112,932 903,456 60 kg 24,200 1,452,000 75 kg 26,620 1,996,500 375 botol 20,000 7,500,000 375 bungkus 20,000 7,500,000 650 sachet 1,210 786,500 39 kg 59,840 2,333,760 123 kg 80,500 9,901,500 2,000 butir 509 1,018,000 170 kg 54,240 9,220,800 129 kg 20,700 2,670,300 30 kg 56,500 1,695,000 13 kg 155,375 2,019,875 30 kg 55,000 1,650,000 6 kg 80,000 480,000 150 kg 12,100 1,815,000 1,027 ikat 18,645 19,148,415 TEPUNG TERIGU DAUN - DAUNAN ( SERE,D.JERUK,D.KUNYIT,D.SALAM ) BUBUK MERICA BUBUK KUNYIT BUBUK JINTAN CUMI - CUMI CABE IJO BUBUK KETUMBAR CABE RAWIT UDANG SEGAR TELUR PUYUH SAOS TOMAT KECAP MANIS REFIL KECAP MANIS SACHET IKAN TERI NASI KACANG TANAH UDANG KECEPE MELON ( JUS ) GUAVA ( JUS ) BUAH NAGA (JUS ) TERONG BELANDA ( JUS ) TIMUN ( JUS ) BELIMBING (JUS) JERUK PERAS ( JUS ) MARKISA ( JUS ) WORTEL ( JUS ) KOL BROKOLI TOMAT ( JUS ) MAKARONI BUNGA KOL BUNCIS MELINJO JANTEN ERCIS SELADA TIMUN SAWI IJO KANGKUNG TAUGE KACANG PANJANG KENTANG (KUPAS) WORTEL BAYAM BLUEBAND SACHET SAWI PUTIH SAWI PAHIT BUAH NAGA KUE SNACK PASIEN ( UNTUK SMUA KELAS ) KUE SNACK PASIEN ( UNTUK KELAS S.VIP / SR ) APEL FUJI SUNKIST ANGGUR PISANG BARANGAN BUAH PIR JERUK MANIS LABU KUNING SEMANGKA MERAH @ 5KG/BUAH SEMANGKA KUNING@3KG TAHU OYONG / GAMBAS LABU JIPANG BAWANG PUTIH (KUPAS) DAUN SOP / PREI TEMPE TOMAT CABE MERAH BAWANG MERAH (KUPAS) BAKSO AYAM SOSIS AYAM KELAPA DAGING SAPI ( HAS ) DAGING SAPI (SOP) IKAN LAUT SEGAR

40 buah 9,944 397,760 200 kg 6,780 1,356,000 26 kg 27,830 723,580 8 kg 41,745 333,960 62 kg 40,250 2,495,500 3 kg 63,250 189,750 3 kg 150,000 450,000 5 kg 45,000 225,000 7 kg 80,000 560,000 2 kg 180,000 360,000 25 buah 6,215 155,375 60 kg 45,200 2,712,000 37 kg 10,000 370,000 37 kg 34,182 1,264,734 100 kg 24,860 2,486,000 100 kg 9,944 994,400 1,410 buah 1,130 1,593,300 1,000 sachet 1,243 1,243,000 1,100 bungkus 14,690 16,159,000 10 kg 18,645 186,450 37 kg 22,600 836,200 75 botol 8,000 600,000 400 bungkus 8,000 3,200,000 550 ikat 1,500 825,000 40 kg 10,000 400,000 40 kg 50,000 2,000,000 37 botol 15,000 555,000 25 bungkus 102,545 2,563,625 5.1.02.01.01.0038 8,898,277,878 8,000 TABLET 22,300 178,400,000 100,000 TABLET 130 13,000,000 40,000 KAPSUL 507 20,280,000 1,000 AMPUL 9,200 9,200,000 1 BOX 4,460,000 4,460,000 1,200 TABLET 429 514,800 120 TUBE 2,260 271,200 60,001 TABLET 3,986 239,163,986 10,000 TABLET 66 660,000 50,000 TABLET 850 42,500,000 30,000 TABLET 600 18,000,000 6,000 KAPSUL 5,500 33,000,000 100 AMPUL 12,067 1,206,700 6,000 TABLET 200 1,200,000 6,000 TABLET 400 2,400,000 60,000 TABLET 1,397 83,820,000 80,000 TABLET 643 51,440,000 15,000 TABLET 78 1,170,000 30,000 TABLET 99 2,970,000 3,000 BOTOL 3,988 11,964,000 5,000 TABLET 229 1,142,550 3,000 VIAL 29,700 89,100,000 1,000 AMPUL 2,704 2,704,000 500 BAG 69,364 34,682,000 50 BOTOL 79,500 3,975,000 50 BOTOL 51,190 2,559,500 500 BOTOL 44,100 22,050,000 300 AMPUL 9,570 2,871,000 50,000 TABLET 168 8,400,000 100,000 TABLET 131 13,100,000 50,000 TABLET 86 4,300,000 200 BOTOL 3,498 699,600 20,000 TABLET 211 4,220,000 400 VIAL 8,988 3,595,200 8,000 BOTOL 1,725 13,800,000 10,001 TABLET 60 600,060 700 SUPP 3,250 2,275,000 5,000 PEN 89,500 447,500,000 15,000 FLS 2,500 37,500,000 3,000 TABLET 6,888 20,664,000 1,800 SIRING 225,290 405,522,000 200 TABLET 44,800 8,960,000 80,000 TABLET 157 12,560,000 ARIXTRA INJ 2,5 MG/0,5 ML AROMASIN TAB 25 MG ASAM ASKORBAT 50 MG TAB/VIT C ANTASIDA DOEN SUSPENSI ANTASIDA DOEN TABLET ANTIHEMOROID SUPP APIDRA SOLOSTAR AQUA PRO INJEKSI 25 ML ARICEPT EVASS 10 MG AMITRIPTILIN TAB 25 MG AMLODIPIN 10 MG TAB AMLODIPIN 5 MG TAB AMOKSISILIN 125 MG/5 ML SYRUP AMOKSISILIN 500 MG AMPICILLIN 1 GR INJEKSI AMINOFILIN INJ 24 MG/ML AMINOFLUID 500 ml / BFLUID AMINOHEPAR AMINOFUSIN L 600 AMINOSTERIL INFANT 6% AMIODARONE INJ 150 MG ALPENTIN 300 MG / GABAPENTIN 300 MG ALPRAZOLAM 0,5 MG TAB ALPRAZOLAM TAB 1 MG AMBROXOL SYRUP AMBROXOL TABLET AMIKASIN INJ 250 MG/ML AKARBOSE 50 MG ALBUMINO/CHANNA ALINAMIN INJEKSI/FURAMIN ALLOPURINOL 100 MG ALLOPURINOL 300 MG ALPENTIN 100 MG ACTILYSE 50 MG ACYCLOVIR 200 MG TAB ACYCLOVIR CREAM ADALAT OROS 30 MG AFOLAT (ASAM FOLAT) TAB 0,4 MG AKARBOSE 100 MG Belanja Obat-obatan Lainnya [-] Belanja BHP Obat ABILIFY DISCMELT 10 MG / ARIPRIPAZOLE ACETOSAL TAB/MINIASPI 80 MG ACETYLCYSTEIN 200 MG ACETYLCYSTEIN INJEKSI BAWANG BOMBAY KALDU BLOK (1 BOTOL ISI 20 BLOK) SWEETENER TROPICANA SLIM ISI 150 SACHET/BUNGKUS SAOS SACHET @ 1 BUNGKUS ISI 25 SACHET KEMANGI KUCAI KENCUR TAUCO CUKA JERUK NIPIS ROYCO GARAM HALUS UK.500GR/BUNGKUS GULA MERAH JAHE LENGKUAS SODA KUE BAWANG GORENG MASAK KERUPUK KAYU MANIS PALA BULAT CENGKEH KEMIRI KAPULAGA BUNGA LAWANG JAGUNG MANIS ASAM POTONG ASAM JAWA BELACAN / TERASI

300 TUBE 6,277 1,883,100 60,000 TABLET 150 9,000,000 8,000 TABLET 1,870 14,960,000 10,000 AMPUL 1,880 18,800,000 100 BOTOL 9,680 968,000 8,000 TABLET 615 4,920,000 8,000 TABLET 400 3,200,000 8,000 TABLET 500 4,000,000 600 AMPUL 8,978 5,386,800 4,000 AMPUL 1,718 6,872,000 400 AMPUL 170,500 68,200,000 100 FLS 115,400 11,540,000 6,000 TABLET 11,330 67,980,000 15,000 TABLET 1,300 19,500,000 200 TUBE 1,540 308,000 100 FLS 86,930 8,693,000 100 TUBE 43,318 4,331,800 20,000 TABLET 121 2,420,000 10,001 TABLET 72 720,072 5,000 TABLET 500 2,500,000 80,000 TABLET 200 16,000,000 20 VIAL 382,875 7,657,500 4,800 TABLET 8,404 40,339,200 1,000 AMPUL 30,000 30,000,000 300 TUBE 18,557 5,567,100 2,000 TABLET 1,050 2,100,000 100 AMPUL 5,778 577,800 500 AMPUL 5,987 2,993,500 10,000 TABLET 100 1,000,000 20,000 TABLET 200 4,000,000 84 TABLET 11,100 932,400 30,000 KAPSUL 388 11,640,000 300 BOTOL 3,914 1,174,200 50 VIAL 6,323 316,150 15,000 TABLET 387 5,805,000 30,000 TABLET 749 22,470,000 700 BOTOL 4,947 3,462,900 400 VIAL 7,888 3,155,200 200 VIAL 8,313 1,662,600 6,000 VIAL 3,188 19,128,000 2,000 VIAL 6,597 13,194,000 30,000 VIAL 2,850 85,500,000 400 TABLET 7,915 3,166,000 500 BOTOL 2,702 1,351,000 30,000 TABLET 188 5,640,000 50 STRIP 31,128 1,556,400 100 STRIP 22,506 2,250,600 100 STRIP 18,030 1,803,000 50 STRIP 17,500 875,000 50 STRIP 18,080 904,000 500 STRIP 18,080 9,040,000 100 STRIP 36,361 3,636,100 100 STRIP 40,595 4,059,500 300 STRIP 24,936 7,480,800 300 AMPUL 3,397 1,019,100 500 KAPSUL 1,174 587,000 30 TUBE 3,431 102,930 2,000 TABLET 190 380,000 30,000 TABLET 250 7,500,000 2,000 BOTOL 7,715 15,430,000 6,000 AMPUL 5,455 32,730,000 6,000 TABLET 2,500 15,000,000 8,000 TABLET 473 3,784,000 30,000 TABLET 600 18,000,000 500 TABLET 649 324,500 2,000 FLS 5,005 10,010,000 45,000 TABLET 569 25,605,000 15,000 TABLET 3,097 46,455,000 6,000 TABLET 652 3,912,000 300 BOTOL 2,100 630,000 8,000 TABLET 240 1,920,000 600 TABLET 15,550 9,330,000 5,000 TABLET 100 500,000 4,000 BOTOL 9,500 38,000,000 COTRIMOXAZOLE SYRUP COTRIMOXAZOLE TABLET CRIPSA (BROMOKRIPTIN) CTM TAB 4 MG CURCUMA SIRUP CODEIN TAB 10 MG COLCHICINE TABLET COMBIVENT 2,5 MG NEBULLES CONCOR 2.5 MG / BISOPROLOL 2,5 MG CONCOR 10 MG CORSANEURON TABLET CHLORPROMAZINE 100 MG (CPZ) CIPROFLOXACIN 500 MG CIPROFLOXACIN INFUS CITICOLIN INJEKSI CITICOLIN TABLET/PUSPALIN CLOZAPINE 25 MG CENDO MYDRIATIL 1% CENDO TIMOL 0,5% CENDO XYTROL CETADOP 200 MG (DOPAMIN INJ) CHLORAMEX 500 MG (KLORAMFENIKOL KAP) CHLORAMFENICOL 1% SALEP MATA CENDO AUGENTONIC CENDO CATARLENT CENDO CARPINE CENDO FENICOL CENDO FLOXA CENDO LYTEERS CEFOTAKSIM 1000 MG CEFTAZIDIM 1000 MG CEFTRIAXON 1000 MG CELLCEPT/KAMYFET TABLET CETIRIZIN SIRUP 5 MG/5 ML CETIRIZIN TABLET 10 MG CEFAZOLIN INJ 1 G CEFIKSIM 100 MG TABLET CEFIKSIM 200 MG TABLET CEFIKSIM 100 MG/5 ML SIRUP CEFOPERAZONE 1 GR CEFOPERAZONE SULBACTAM CA GLUCONAS INJ CAPTOPRIL 25 MG CARBAMAZEPIN 200 MG CASODEX 50 MG CEFADROKSIL 500 MG TABLET CEFADROKSIL SIRUP 125 MG/ML BLEOCIN 15 MG/ML BRILINTA 90 MG BUPIVACAIN SPINAL HEAVY BURNAZIN/SULFADIAZINE SILVER BUSCOVAN/HYOCIN N-BUTIL BROMID 10 MG/SCOPMA TABLET BUSCOVAN/HYOCIN N-BUTIL BROMID 20 MG /SCOPAMIN INJEKSI BEROTEC MDI BETADINE SALEP 20 GR BETAHISTIN MESYLATE 6 MG BICNAT BISAKODIL TABLET 5 MG BISOPROLOL 5 MG ATROPIN SULFAT INJ ATS (BIOSAT 1,5 IU ) AVAMYS AVODART/DUTASTERIDE 0,5 MG AZITROMYCIN 500 MG BETAMETASONE 0,1% CREAM ASAM TRANEKSAMAT INJ 100 MG/ML ASERING ATIVAN 2 MG/LORAZEPAM 2 MG ATORVASTATIN 10 MG ATORVASTATIN 20 MG ATRACURIUM/NOTRIXUM/TRAMUS ASAM FUSIDAT KRIM 20MG/FUCILEX CREAM ASAM MEFENAMAT 500 MG ASAM TRANEKSAMAT 500 MG TABLET

30,000 TABLET 575 17,250,000 600 FLS 10,460 6,276,000 1,200 FLS 10,405 12,486,000 30,000 TABLET 136 4,080,000 9,000 AMPUL 968 8,712,000 800 BOTOL 12,123 9,698,400 15,000 TABLET 2,950 44,250,000 30,000 TABLET 1,421 42,630,000 800 TUBE 9,000 7,200,000 2,000 FLS 7,000 14,000,000 600 AMPUL 1,545 927,000 8,000 TABLET 100 800,000 4,000 TABLET 150 600,000 100 AMPUL 825 82,500 100 TABLET 18,800 1,880,000 5,000 TABLET 95 475,000 30,000 TABLET 135 4,050,000 200 BOTOL 245,000 49,000,000 500 VIAL 8,497 4,248,500 2,000 TABLET 289 578,000 50,000 TABLET 75 3,750,000 500 BOTOL 9,756 4,878,000 2,000 TABLET 4,900 9,800,000 300 SUPP 5,085 1,525,500 800 SUPP 4,325 3,460,000 300 BOTOL 49,790 14,937,000 1,000 AMPUL 6,486 6,486,000 20,000 TABLET 922 18,440,000 1,000 AMPUL 1,590 1,590,000 100 BOTOL 6,786 678,600 3,000 TABLET 862 2,586,000 8,000 TABLET 684 5,472,000 3,000 TABLET 975 2,925,000 80 AMPUL 23,000 1,840,000 10 VIAL 163,700 1,637,000 8,000 TABLET 300 2,400,000 35,000 KAPSUL 923 32,305,000 1,200 AMPUL 3,567 4,280,400 3,000 TABLET 473 1,419,000 3,000 TABLET 573 1,719,000 2,501 AMPUL 37,000 92,537,000 1,000 SUPP 1,998 1,998,000 300 FLS 14,738 4,421,400 500 FLS 14,126 7,063,000 2,500 TABLET 2,400 6,000,000 5,000 TABLET 3,072 15,360,000 4,000 TABLET 1,500 6,000,000 1,000 TABLET 1,210 1,210,000 2,000 AMPUL 14,520 29,040,000 500 AMPUL 36,300 18,150,000 1,200 AMPUL 9,889 11,866,800 100 TABLET 1,345 134,500 10,000 AMPUL 923 9,230,000 70,000 TABLET 224 15,680,000 4,500 TABLET 1,647 7,411,500 100 SACCET 6,050 605,000 2,000 SACCET 280 560,000 1,000 TABLET 388 388,000 1,000 TABLET 847 847,000 1,500 TUBE 2,670 4,005,000 6,000 AMPUL 3,355 20,130,000 200 TUBE 2,800 560,000 100 FLS 4,720 472,000 5,000 TABLET 2,082 10,410,000 50,000 TABLET 199 9,950,000 10,000 TABLET 1,000 10,000,000 30,000 TABLET 93 2,790,000 20,000 TABLET 228 4,560,000 40,000 TABLET 143 5,720,000 5,000 TABLET 297 1,485,000 3,000 BOTOL 7,200 21,600,000 3,000 BOTOL 6,627 19,881,000 100 BOTOL 50,407 5,040,700 HALOPERIDOL 0,5 MG 3,000 TABLET 49 147,000 GLIMEPIRIDE 2 MG GLIMEPIRIDE 3 MG GLIMEPIRIDE 4 MG GLUKOSA 10 % GLUKOSA 5% H2O2 50 % GENTAMISIN SALEP MATA/GENOIN 0,3 % GENTAMISIN TETES MATA 0,3% GERMISEP 2,5 GR GLIKLAZID 80 MG/GLUCODEX GLIKUIDON 30 MG TAB GLIMEPIRIDE 1MG GARAM INGGRIS GARAM ORALIT GEMFIBROZIL 300 MG TAB GEMFIBROZIL 600 MG TAB GENTAMISIN 0,1 % SK GENTAMISIN 40 MG/ML INJ FORTANEST 15 MG/ 3ML FRESOFOL 1% FRIDEP 50 MG (SERTRALIN TAB) FUROSEMID 10 MG INJEKSI FUROSEMID 40 MG TAB GALVUS TABLET FLUCONAZOLE INFUS FLUOKSETIN 10 MG / KALXETIN FLUOKSETIN 20 MG / KALXETIN FLUNARIZIN FORMALIN TAB FORTANEST 5 MG/ 1ML FENITOIN 50 MG/ML INJ FENOFIBRAT 100 MG FENOFIBRAT 300 MG FENTANIL INJ 2 ML FETIK SUP/ KETOPROFEN SUP/SUPRAFENID FLIXOTIDE NEBULES ETHAMBUTOL TABLET 500 MG EUTHYROX 100 MCG FARGOXIN 0,25 MG INJ FARMABES 25 MG (DILTIAZEM INJ) FARSORBID 10 MG (ISDN 10 MG) FENITOIN 100 MG KAPSUL/KUTOIN KAPSUL EAS PFRIMER / RENXAMIN EFEDRIN INJ 50MG/ML EPERISON/MYONEP TABLET EPINEFRIN INJ 1 MG/ML ERITROMISIN SIRUP ERITROMISIN TABLET 500 MG DOKSISIKLIN 100 MG DOMPERIDON 10 MG TAB DOMPERIDON SYRUP DORNER / BERAPROST DULCOLAX SUPP 5 MG INFANT DULCOLAX SUPP ADULT 10 MG DIFENHIDRAMIN INJ 10 MG/ML DIFLUCAN 50 MG DIGOKSIN 0,25 MG DILTIAZEM TAB 30 MG DIPEPTIVEN INFUS DOBUTAMIN INJ/INOTROP DEPAKOTE ER 500 MG SR DEXOCORT/DESOXIMETASON 0,25 KRIM DEXTROSE 40% 25 ML DIAZEPAM 10 MG/2 ML DIAZEPAM TAB 2 MG DIAZEPAM TAB 5 MG D5 1/2 NS D5 1/4NS DEKSAMETASON 0,5 MG TAB DEKSAMETASON INJ 5 MG/ML DEPAKENE SYRUP/SODIUM VALPROATE 250 DEPAKOTE ER 250 MG SR CURCUMA TABLET

2,000 TABLET 54 108,000 2,000 TABLET 7,860 15,720,000 10,000 TABLET 4,356 43,560,000 10,000 TABLET 148 1,480,000 3,000 AMPUL 80,000 240,000,000 20 TUBE 2,750 55,000 50 TUBE 2,325 116,250 1,000 PEN 112,000 112,000,000 2,000 PEN 112,000 224,000,000 500 BOTOL 8,925 4,462,500 1,000 TABLET 580 580,000 2,000 TABLET 980 1,960,000 30 TUBE 151,200 4,536,000 500 BOTOL 3,296 1,648,000 8,000 TABLET 346 2,768,000 2,000 TABLET 250 500,000 40 BOTOL 69,600 2,784,000 200 BOTOL 38,819 7,763,800 20,000 TABLET 75 1,500,000 20,000 TABLET 150 3,000,000 50 BOTOL 78,600 3,930,000 3,000 AMPUL 46,635 139,905,000 1,200 TABLET 424 508,800 1,200 TABLET 749 898,800 100,000 TABLET 150 15,000,000 100 BOTOL 12,700 1,270,000 50 BOTOL 10,250 512,500 100 FLS 10,350 1,035,000 600 FLS 11,500 6,900,000 400 BAG 256,000 102,400,000 7,000 TABLET 208 1,453,410 50,000 TABLET 319 15,950,000 100,000 TABLET 212 21,200,000 3,000 TABLET 1,235 3,705,000 100 VIAL 14,788 1,478,800 600 TUBE 2,289 1,373,400 3,000 TABLET 260 780,000 5,000 TABLET 2,176 10,880,000 30,000 AMPUL 880 26,400,000 5,000 TABLET 761 3,805,000 10,000 TABLET 522 5,220,000 8,000 TABLET 384 3,072,000 30,000 TABLET 1,182 35,460,000 4,000 TABLET 1,842 7,368,000 1,000 SACCET 3,593 3,593,000 1,000 BOTOL 5,190 5,190,000 50,000 KAPSUL 278 13,900,000 3,000 PEN 89,000 267,000,000 100 BOTOL 8,470 847,000 1,000 PEN 89,000 89,000,000 10,000 BOTOL 8,713 87,130,000 10,000 TABLET 373 3,730,000 30,000 TABLET 904 27,120,000 3,000 AMPUL 891 2,673,000 3,000 AMPUL 847 2,541,000 5,000 TABLET 77 385,000 5,000 TABLET 121 605,000 400 SYRINGE 90,660 36,264,000 400 SYRINGE 125,325 50,130,000 600 BOTOL 26,960 16,176,000 50 VIAL 965,594 48,279,700 10,000 TABLET 520 5,200,000 300 AMPUL 1,916 574,800 20,000 TABLET 351 7,020,000 1,000 TABLET 460 460,000 500 FLS 6,245 3,122,500 500 VIAL 16,359 8,179,500 3,000 VIAL 27,435 82,305,000 2,600 TABLET 7,850 20,410,000 10,000 AMPUL 2,960 29,600,000 100,000 TABLET 77 7,700,000 20,000 TABLET 159 3,180,000 1,000 AMPUL 1,023 1,023,000 3,000 TABLET 214 642,000 METFORMIN HCL 850 MG METILERGOMETRIN INJEKSI METILERGOMETRIN TABLET MEPTIN INHALATION INJ MEROPENEM SER INJ 500 MG MEROPENEM SERB INJ 1000 MG MESTINONE METAMIZOLE SODIUM INJEKSI/NOVALGIN METFORMIN HCL 500 MG MANNITOL 20% 500 ML MANTOUX TEST/ TUBERCULIN PPDRT MECOBALAMIN 500 MG/ OXICOBAL MECOBALAMIN INJEKSI MELOXICAM 15 MG MELOXICAM 7,5 MG LIDOKAIN INJ 2% LIDOKAIN INJ 2% + EPINEFRIN LOPERAMID TAB 2 MG LORATADIN TAB 10 MG LOVENOX 0,4 SYRINGE LOVENOX 0,6 SYRINGE LANTUS SOLOSTAR LAXADINE SYRUP LEVEMIR FLEXPEN LEVOFLOKSASIN 5 MG/ML INFUS LEVOFLOKSASIN TAB 500 MG LEVOPAR TABLET/LEPARSON TAB KLOBAZAM TAB 10 MG KLOPIDOGREL TAB 75 MG KSR LACTO B/ L BIO LAKTULOSA SIRUP/EXTRALAC SIRUP LANSOPRAZOL KAP 30 MG KETOKONAZOL KRIM 2% KETOKONAZOL TABLET 200 MG KETOROLAC TABLET KETOROLAK INJ 30 MG/ML KLINDAMISIN 150 MG KLINDAMISIN 300 MG KABIVEN FERIPHERAL INF KALSIUM LAKTAT 500 MG KANDESARTAN TAB 16 MG KANDESARTAN TAB 8 MG KENDARON TAB KETAMIN 100 MG/ML / IVANES IRBESARTAN 300 MG ISDN 5 MG/ISOSORBIDE DINITTAT ISOTIC ADRETOR 0,25% ISOTIC ADRETOR 0,5% KA EN 1B INFUS KA EN 3B INFUS ILIADIN SPRAY 0,05% INH 100 MG TAB/ISONIAZID INH 300 MG TAB/ISONIAZID INTRALIPID 20% 100 ML INVICLOT/HEPARIN 5000 UI/ML IRBESARTAN 150 MG HYTROZ 2 MG IALUSET PLUS IBUPROFEN 100 MG/5 ML SUSPENSI IBUPROFEN 400 MG TAB IBUPROFEN TAB 200 MG ILIADIN DROPS 0,025% HIDROKORTISON 1% KRIM HIDROKORTISON 2,5% KRIM HUMALOG MIX 25 KWIKPEN HUMALOG MIX 50 KWIKPEN HUSTAB SYRUP HYTROZ 1 MG HALOPERIDOL 5 MG HARNAL D 0,2 MG HARNAL OCAS 0,4 MG TABLET HCT TAB 25 MG HEMAPO 3000-ERITROPOETIN 3000 UI/ML

6,000 VIAL 10,912 65,472,000 60,000 TABLET 102 6,120,000 10,000 TABLET 413 4,130,000 5,000 TABLET 117 585,000 1,200 TABLET 943 1,131,600 6,000 BOTOL 5,885 35,310,000 10,000 TABLET 267 2,670,000 500 BOTOL 3,765 1,882,500 500 AMPUL 6,750 3,375,000 500 AMPUL 4,444 2,222,000 300 TUBE 1,900 570,000 500 TABLET 5,143 2,571,500 500 AMPUL 29,900 14,950,000 700 TABLET 16,000 11,200,000 1,000 VIAL 44,597 44,597,000 10 TUBE 30,000 300,000 20,000 TABLET 115 2,300,000 30,000 TABLET 108 3,240,000 1,000 BOTOL 6,906 6,906,000 1,000 FLS 6,764 6,764,000 40,000 BOTOL 6,900 276,000,000 300 AMPUL 87,731 26,319,300 200 BOTOL 112,710 22,542,000 250 BOTOL 47,498 11,874,500 1,000 AMPUL 12,276 12,276,000 10,000 TABLET 675 6,750,000 1,000 TABLET 118 118,000 500 AMPUL 7,872 3,936,000 10,000 TABLET 1,415 14,150,000 20,000 TABLET 2,530 50,600,000 100,000 TABLET 1,640 164,000,000 1,000 AMPUL 6,298 6,298,000 500 TABLET 1,499 749,500 5,000 TABLET 1,077 5,385,000 1,000 PEN 112,000 112,000,000 1,000 PEN 89,500 89,500,000 2,000 AMPUL 70,785 141,570,000 500 BOTOL 11,750 5,875,000 10 FLS 131,250 1,312,500 1,000 BOTOL 3,812 3,812,000 500 TABLET 567 283,500 6,000 VIAL 5,346 32,076,000 60,000 KAPSUL 129 7,740,000 5,000 TABLET 270 1,350,000 500 TABLET 275 137,500 40,000 AMPUL 873 34,920,000 2,000 TABLET 4,000 8,000,000 2,000 TABLET 713 1,426,000 30 BOTOL 19,000 570,000 30 TABLET 3,569 107,070 6,000 TABLET 2,600 15,600,000 60 FLS 40,575 2,434,500 600 AMPUL 3,760 2,256,000 600 AMPUL 4,290 2,574,000 1,000 FLS 30,335 30,335,000 1,000 FLS 3,472 3,472,000 2,000 AMPUL 1,126 2,252,000 20 BOTOL 35,200 704,000 100 BOTOL 5,113 511,300 6,000 BOTOL 11,263 67,578,000 1,200 BOTOL 1,160 1,392,000 120,000 TABLET 254 30,480,000 500 AMPUL 13,300 6,650,000 30,000 TABLET 182 5,460,000 8,000 TABLET 243 1,944,000 250 BOTOL 445,000 111,250,000 100 BOTOL 905,000 90,500,000 150 BOTOL 1,590,000 238,500,000 50 BOTOL 794,000 39,700,000 35 BOTOL 940,000 32,900,000 600 TABLET 5,900 3,540,000 10,000 TABLET 71 710,000 5,000 TABLET 59 295,000 1,000 TABLET 82 82,000 PLASBUMIN 5 % 50 ML PLETAAL XR 100 MG/ CILOSTAZOLE PREDNISON KAP 5 MG PROPANOLOL TAB 10 MG PROPANOLOL TAB 40 MG PHENOBARBITAL 20 MG TAB PIRAZINAMID 500 MG TABLET PLASBUMIN 20% 50 ML PLASBUMIN 20% 100 ML PLASBUMIN 25 % 100 ML PLASBUMIN 25 % 50 ML PANTOCAIN 0,5 % PARACETAMOL DROP PARACETAMOL INFUS PARACETAMOL SYRUP PARACETAMOL 500 MG TABLET PETHIDINE HCL INJEKSI 50 MG/2 ML OTOPAIN EAR DROP OTSU MGSO4 20% OTSU MGSO4 40% OTSU SALIN 3 % OTSU-KCL 7,46%/KLARIUM CLORIDA 25 ML OXYTOCIN INJ 10 IU/100,S ONDANSETRON 4 MG/2ML ONZAPIN 10 MG ONZAPIN 5 MG OPTIFLOX 0,5 %/LEVOFLOXASIN TM ORIXAL 500 MG / KLARITROMISIN 500 MG OSCAL 0,5 MG TABLET / CALCITROL OBH SYRUP OFLOXACIN 400 MG OMEPRAZOL INJ 40MG/10ML OMEPRAZOL KAP 20 MG ONDANSENTRON TAB 4 MG ONDANSENTRON TAB 8 MG NOTISIL 2 MG/SIMARC NOVOMIX FLEXPEN 100 UI/ML NOVORAPID FLEXPEN 100 UI/ML NTG /DBL GLICERYL TRINITRATE 50 MG/10 ML NYSTATIN DROP/CANDISTATIN/ENYSTIN OBUCORT SWINGHALER NIKARDIPIN INJ 10 MG NITRAL-GLISERIL TRINITRAT 0,5 MG NITROKAF FORTE 5 MG NITROKAF RETARD 2,5 MG NOREPINEPHRINE INJ NOSTHYRA 5 MG/NORELUT NAROPIN 7,5 MG/ML NASACORT AQ 55 MCG/PUFF NEPHOSTERIL 250 ML NEO K INJEKSI NEW ANTIDES 600 MG NIFEDIPIN 10 MG MUPIROCIN CREAM NA DIKLOFENAK TAB 25 MG NA DIKLOFENAK TAB 50 MG NaCl 0,9% 1000 ML NaCl 0,9% 100 ML NaCl 0,9% 500 ML MIDAZOLAM INJEKSI MIKONAZOL KRIM 2% MISOPROSTOL TABLET MORFIN INJEKSI MORFIN TAB 10 MG / MST CONTINUS 10 MOXIFLOXACIN 400 MG INFUS METOKLOPRAMID 10 MG METOTREKSAT /RHEU-TREX 2,5 MG METRONIDAZOL INFUS METRONIDAZOL KAPTAB 500 MG METRONIDAZOL SYRUP MEYLON 25 ML METILPREDNISOLON INJ 125 MG INJEKSI METILPREDNISOLON TAB 4 MG METILPREDNISOLON TAB 8 MG

3,000 AMPUL 7,050 21,150,000 2,000 TABLET 405 810,000 250 FLS 10,478 2,619,500 500 TABLET 317 158,500 8,000 TABLET 710 5,680,000 20,000 TABLET 146 2,920,000 80,000 TABLET 85 6,800,000 60,000 AMPUL 858 51,480,000 2,000 SYRINGE 80,000 160,000,000 15,000 TABLET 1,170 17,550,000 2,000 TABLET 837 1,674,200 6,000 TABLET 934 5,604,000 1,000 TABLET 1,233 1,233,000 5,000 TABLET 123 615,000 10,000 TABLET 123 1,230,000 5,000 TABLET 259 1,295,000 60,000 BOTOL 7,703 462,180,000 1,000 PEN 112,000 112,000,000 2,000 AMPUL 27,998 55,996,000 200 BOTOL 4,069 813,800 10,000 TABLET 50 500,000 7,000 TABLET 65 455,000 8,000 TABLET 3,750 30,000,000 50 AMPUL 58,000 2,900,000 1,200 TABLET 13,400 16,080,000 3,000 TABLET 6,814 20,442,000 1,500 TABLET 7,787 11,680,500 200 BOTOL 59,000 11,800,000 350 BOTOL 111,850 39,147,500 300 BOTOL 137,492 41,247,600 100 BOTOL 965,250 96,525,000 5,000 TABLET 78 390,000 1,000 AMPUL 1,700 1,700,000 4,500 TABLET 5,406 24,327,000 6,000 TABLET 68 408,000 20,000 TABLET 150 3,000,000 200 BOTOL 39,600 7,920,000 500 TUBE 6,190 3,095,000 300 AMPUL 1,762 528,600 100 BOX 445,000 44,500,000 16,000 TABLET 530 8,480,000 50,000 TABLET 200 10,000,000 100 BOTOL 47,495 4,749,500 600 SUPP 17,488 10,492,800 600 SUPP 12,001 7,200,600 200 VIAL 5,808 1,161,600 6,000 BOTOL 5,970 35,820,000 6,000 TABLET 222 1,332,000 300 BOTOL 135,577 40,673,100 5,000 TABLET 238 1,190,000 500 BOTOL 35,000 17,500,000 100 BOTOL 400,000 40,000,000 100 BOX 195,500 19,550,000 10,000 TABLET 1,169 11,690,000 6,000 TABLET 143 858,000 30,000 TABLET 163 4,890,000 2,000 TABLET 13,500 27,000,000 1,400 TABLET 1,634 2,287,600 10,000 TABLET 1,679 16,790,000 5,000 TABLET 748 3,740,000 5,000 TABLET 397 1,985,000 50 VIAL 140,290 7,014,500 8,000 FLS 3,636 29,088,000 500 AMPUL 1,452 726,000 1,000 TABLET 781 781,000 25,000 TABLET 112 2,800,000 700 BOTOL 18,000 12,600,000 600 BOTOL 16,100 9,660,000 5,000 FLS/1 L 10,220 51,100,000 800 TABLET 24,330 19,464,000 100 AMPUL 73,040 7,304,000 5 BOTOL 95,660 478,300 15,000 TABLET 253 3,795,000 ZINC SULFAT SYRUP/60 ML 500 BOTOL 5,308 2,654,000 WIDA RS 500 ML WIDA WI 1000 ML/AQUA 1L XARELTO 20 MG XYLOCAIN 2% PDF INJEKSI XYLOCAIN 10% SPRAY ZINC 20 MG VANCOMYCIN INJEKSI VENTOLIN NEBULES VIT K INJ VIT K TAB 10 MG VITAMIN B KOMPLEKS VOLUVEN INFUS/VOLULYTE TRIHEKSIFENIDIL 2 MG TABLET ULTIBRO TABLET URINTER 400 MG URSODEOXYCHOLIC ACID 250 MG VALSARTAN 160 MG/VALESCO 160 MG VALSARTAN 80 MG / VALESCO 80 MG TABLET TAMBAH DARAH / SF TARIVID OTIC 3%/ ALKILEN TERRELL 250 ML/ISOFLURAN TETAGAM INJEKSI THYROZOL 10 MG TIAMIN (VIT B1) 50 MG STESOLID SUPP 10 MG STESOLID SUPP 5 MG STREPTOMISIN 1000 MG/ML SUKRALFAT SYRUP SUKRALFAT TABLET/ULSIDEX SYMBBICORT TURBUHALER 160/4,5 MCG SOFT U DERM- UREA CREAM 10 % SOTATIC/METOCLOPRAMIDE INJEKSI SPIRIVA RESPIMAT 2,5 MCG SPIRONOLAKTON 100 MG SPIRONOLAKTON 25 MG STESOLID SYRUP SIANOKOBALAMIN (VIT B12) 500 MCG SIBITAL INJ SIFROL ER 0,375 TABLET SIMVASTATIN 10 MG SIMVASTATIN 20 MG SMOFLIPID 20% 100 ML SEREQUEL XR 300 MG SEREQUEL XR 400 MG SERETIDE 50 MCG SERETIDE 250 MCG SERETIDE 500 MCG SEVORANE 250 ML SALBUTAMOL SIRUP SALBUTAMOL TAB 2 MG SALBUTAMOL TAB 4 MG SANDEPRIL 50 MG SANDOSTATIN / OCTREOTIDE INJEKSI SEREQUEL XR 200 MG RISPERIDON 1 MG RISPERIDON 2 MG RISPERIDON 3 MG RL INFUS RYZODEG INSULIN ROCURONIUM INJ 5 ML/ ROCULAX RANITIDINE INJ 50 MG/ML RENOGEN 3000 IU RETAPHYL SR STRIP RIFAMPISIN TAB 300 MG RIFAMPISIN TAB 450 MG RIFAMPISIN TAB 600 MG PTU 100 MG PULMICORT RESPULES 0,25 MG/ML PYRANTEL 125 TABLET RAMIPRIL 10 MG TAB RAMIPRIL 5 MG TAB RANITIDIN TAB 150 MG PROSTIGMIN INJ 0,5 MG

3,883,714,807 900 PCS 11,605 10,444,500 6,000 PCS 1,950 11,700,000 100 PCS 7,744 774,400 100 PCS 7,744 774,400 3,000 PCS 7,744 23,232,000 7,000 PCS 7,744 54,208,000 5,000 PCS 7,744 38,720,000 4,000 PCS 7,744 30,976,000 500 BOTOL 27,373 13,686,500 50 GLN 500,532 25,026,600 1,000 BOX 13,900 13,900,000 10,000 PCS 2,625 26,250,000 300 TUBE 29,550 8,865,000 600 BOTOL 31,000 18,600,000 50 PCS 18,500 925,000 50 PCS 18,500 925,000 50 PCS 18,500 925,000 300 SET 72,558 21,767,400 250 PCS 67,000 16,750,000 150 PCS 67,000 10,050,000 150 PCS 67,000 10,050,000 1,500 PCS 3,600 5,400,000 100 PCS 45,187 4,518,700 5 BOX 1,043,000 5,215,000 50 PCS 1,519,674 75,983,700 100 PCS 375,000 37,500,000 30 PCS 1,667,000 50,010,000 400 PCS 7,440 2,976,000 72 PCS 71,610 5,155,920 72 PCS 68,750 4,950,000 24 PCS 98,450 2,362,800 144 PCS 67,320 9,694,080 720 PCS 64,240 46,252,800 144 PCS 62,040 8,933,760 240 PCS 59,290 14,229,600 300 PCS 44,000 13,200,000 30 PCS 212,395 6,371,850 30 PCS 212,395 6,371,850 400 PCS 24,000 9,600,000 200 PCS 5,800 1,160,000 200 PCS 5,800 1,160,000 200 PCS 5,800 1,160,000 5,000 PCS 7,700 38,500,000 1 PCS 3,245,000 3,245,000 150 PCS 730,162 109,524,300 50 PCS 935,072 46,753,600 20 PCS 426,112 8,522,240 20 PCS 660,018 13,200,360 100 PCS 597,883 59,788,300 20 PCS 708,070 14,161,400 48 PCS 325,429 15,620,592 300 PCS 13,200 3,960,000 80 PCS 478,049 38,243,920 24 BOX/10 400,000 9,600,000 500 PCS 6,875 3,437,500 5 BOX 5,738,000 28,690,000 50 PCS 213,790 10,689,500 2 BOX 2,613,278 5,226,556 2 BOX 1,228,983 2,457,966 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 100 PCS 23,100 2,310,000 400 PCS 23,100 9,240,000 400 PCS 23,100 9,240,000 100 PCS 23,100 2,310,000 30 PCS 86,240 2,587,200 ETT 7,5 ETT 8 ETT NONKINGKING 6,5 ETT 4,5 ETT 5 ETT 5,5 ETT 6 ETT 6,5 ETT 7 ETHIBOND W 4843 ETHILON 10/0 U-7003 ETT 2,5 ETT 3 ETT 3,5 ETT 4 DERMAFIX DJ STENT SET ECG PAPER ECOPLAC MIX ELEFIX / PASTA EEG EPIDURAL CATETER/ PERIFIX 400 CVC 3LUMEN NO 12 CVC NO 4 CVC NO 5 CVC NO 7 CVC TRIO V720/CERTOFIX DAFILON 10/0 2XDLM 6S CONDOM CATH S CONDOM CATH M CONDOM CATH L CUTICEL 10x10 CUTTING LOOP CVC 2LUMEN NO 12/CERTOFIX CATGUT PLAIN 3/0 CUTTING CATGUT PLAIN 3/0 TAPER CATHEJELL/ AQUATOUCH LUBRICANT CLOSED SUCTION NO 12 CLOSED SUCTION NO 14 COLOSTOMY BAG BROS SIKAT OPERASI (SCRUBBRUSH) CATGUT CROMIC 1 TAPER CATGUT CROMIC 2 TAPER CATGUT CROMIC 2 CUTTING CATGUT PLAIN 2/0 CUTTING CATGUT PLAIN 2/0 TAPER BLOOD TRANSFUSION SET BONE WAX BONGROS 5CC BREATHING CIRCUIT WITH CHAMBER BREATING CIRCUIT VENTILATOR BREATHING CIRCUIT CPAP ARM SLING M ARM SLING L BACTERI FILTER/TERMOVEN HEPA BAJU OPERASI STERIL UKURAN L BAJU OPERASI STERIL UKURAN LL BAJU OPERASI STERIL UKURAN XL ALKOHOL 96% @ 20 LITER ALKOHOL SWAB APRON PLASTIK AQUA GEL 82/ MY JELLY AQUA PACK/HYDROX ARM SLING S ABOCAT NO 16 ABOCAT NO 18 ABOCAT NO 20 ABOCAT NO 22 ABOCAT NO 24 ALKOHOL 70% @ 1 LITER [-] Belanja BHP Alat Kesehatan 3 WAY ANAK 3 WAY DEWASA ABOCAT NO 14

30 PCS 86,240 2,587,200 30 PCS 86,240 2,587,200 5 PCS 2,256,000 11,280,000 100 BOX/100 161,665 16,166,500 800 ROLL 102,500 82,000,000 600 ROLL 148,000 88,800,000 200 ROLL 15,730 3,146,000 200 ROLL 19,910 3,982,000 200 ROLL 29,810 5,962,000 30 PCS 54,450 1,633,500 20 PCS 54,450 1,089,000 100 PCS 54,450 5,445,000 100 PCS 60,000 6,000,000 100 PCS 56,000 5,600,000 100 PCS 55,500 5,550,000 100 PCS 16,800 1,680,000 100 PCS 16,800 1,680,000 1,500 PCS 16,800 25,200,000 1,500 PCS 16,800 25,200,000 30 PCS 19,690 590,700 20 PCS 19,690 393,800 100 PCS 1,210 121,000 100 PCS 1,210 121,000 50 BOX/250 27,500 1,375,000 90 PCS 14,000 1,260,000 10 PCS 14,000 140,000 50 GALON 869,700 43,485,000 200 FLS 82,900 16,580,000 3,000 BOX 94,500 283,500,000 2,000 PCS 48,000 96,000,000 50 PCS 420,000 21,000,000 300 PCS 42,900 12,870,000 12,000 PCS 3,500 42,000,000 1,200 PCS 3,500 4,200,000 1,200 PCS 21,264 25,516,800 200 BUNGKUS 27,280 5,456,000 1,500 LEMBAR 1,860 2,790,000 10 ROLL 400,000 4,000,000 100 PCS 71,827 7,182,700 200 ROLL 43,400 8,680,000 60 BOX/6 233,906 14,034,360 2,500 BOX 40,000 100,000,000 100 PCS 18,788 1,878,800 800 PCS 18,788 15,030,400 1,500 PCS 18,788 28,182,000 10 PCS 205,462 2,054,620 240 PCS 108,900 26,136,000 96 PCS 143,947 13,818,912 5,000 PCS 1,695 8,475,000 300 PCS 358 107,400 300 PCS 358 107,400 100 PCS 358 35,800 500 PCS 358 179,000 3,000 PCS 358 1,074,000 100 PCS 358 35,800 30 PCS 370,000 11,100,000 20 PCS 197,281 3,945,620 60 PCS 7,656 459,360 60 PCS 7,656 459,360 60 PCS 7,656 459,360 60 PCS 7,656 459,360 100 PCS 7,656 765,600 300 PCS 7,744 2,323,200 300 PCS 7,744 2,323,200 200 PCS 7,744 1,548,800 150 PCS 7,744 1,161,600 500 PCS 7,744 3,872,000 1,200 PCS 7,744 9,292,800 1,200 PCS 7,744 9,292,800 120 PCS 55,330 6,639,600 420 PCS 47,960 20,143,200 360 PCS 47,960 17,265,600 80 GLN/5L 420,000 33,600,000 30 PCS 90,032 2,700,960 NYLON 2/0 TS 19 NYLON 3/0 TS 19 NYLON 4/0 TS 19 ONE SCRUB OPSITE 45X28 NGT NO 8 100 CM NGT NO 10 NGT NO 12 NGT NO 14 NGT NO 16 NGT NO 18 NGT NO 3,5 NGT NO 4 NGT NO 5 40 CM NGT NO 5 100 CM NGT NO 6 NGT NO 8 40 CM NALD NO 24 NALD NO 25 NALD NO 26 NALD NO 27 NC PAP BREATHING CIRCUIT NEONATAL REM POLYHESIVE MEDIFIX MANOMETER MONOCRYL 4/0 MPC 426 MONOSYN 4/0 DS 19 NALD BD NO 31X5 NALD NO 18 NALD NO 23 LEUKOPLAST 7,5 CM x 4,5 LYOSTYPT 5X6CM MASKER BEDAH MASKER NON REBREATHING BAYI MASKER NON REBREATHING ANAK MASKER NON REBREATHING DEWASA INFUS SET PAED STERA (ANAK) INTRAFIX SAFESET (INFUSET PUMP) KAPAS 500 GR KERTAS EKG KERTAS USG SONY LAMINARIA HAND RUB 500 CC HANDSCOON/ SARUNG TANGAN NONSTERIL HARUM PEN / ELECROSURGICAL PEN HARUM PLATE CABLE MONOPOLAR HARUM PLATE NON CABLE INFUS SET ADULT STERA GELANG BAYI BIRU GELANG BAYI PINK GELANG PASIEN ISI 250 PCS GUDEL 100 MM ADULT GUDEL 60 MM ANAK H2O2 50% FOLY CATH NO 12 FOLY CATH NO 14 FOLY CATH NO 16 FOLY CATH NO 18 FOLY CATH NO 20 FOLY CATH NO 24 FOLY CATH 3WAY NO 20 FOLY CATH 3WAY NO 22 FOLY CATH 3WAY NO 24 FOLY CATH NO 6 FOLY CATH NO 8 FOLY CATH NO 10 FILM IV DRESS 67P FIXOMUL 5X10 FIXOMUL 5X15 FM CREPE 3 INC FM CREPE 4 INC FM CREPE 6 INC ETT NONKINGKING 7 ETT NONKINGKING 7,5 EVD

30 PCS 130,310 3,909,300 1 BOX 2,683,233 2,683,233 1 BOX 3,678,687 3,678,687 2,000 ROLL/400 1,898 3,796,000 2,000 ROLL/400 1,898 3,796,000 800 PCS 20,160 16,128,000 1,500 PCS 37,843 56,764,500 100 PCS 3,125 312,500 6 BOX/100 250,113 1,500,678 6 BOX/100 250,113 1,500,678 12 BOX/100 250,113 3,001,356 6 BOX/100 250,113 1,500,678 12 BOX/100 250,113 3,001,356 120 ROLL 11,700 1,404,000 150 ROLL 15,100 2,265,000 100 ROLL 20,300 2,030,000 100 ROLL 15,400 1,540,000 150 ROLL 22,100 3,315,000 150 ROLL 28,900 4,335,000 48 PCS 82,170 3,944,160 48 PCS 76,540 3,673,920 48 PCS 80,190 3,849,120 48 PCS 76,450 3,669,600 48 PCS 190,850 9,160,800 600 LITER 80,000 48,000,000 1,200 PCS 2,200 2,640,000 1,200 PCS 2,200 2,640,000 30 PCS 224,070 6,722,100 2 BOX/36 2,042,731 4,085,462 4 BOX/36 1,472,358 5,889,432 4 BOX/36 1,270,551 5,082,203 2 BOX/36 6,384,235 12,768,470 100 PCS 6,490 649,000 100 PCS 6,491 649,100 100 PCS 6,490 649,000 100 PCS 6,490 649,000 2 PCS 403,520 807,040 800 PCS 88,660 70,928,000 400 PCS 84,150 33,660,000 400 PCS 86,350 34,540,000 60 PCS 80,960 4,857,600 100 PSG 34,694 3,469,400 300 PSG 34,694 10,408,200 200 PSG 34,694 6,938,800 100 PSG 34,694 3,469,400 100 PCS 19,470 1,947,000 200 PCS 19,470 3,894,000 300 PCS 5,500 1,650,000 200 PCS 5,500 1,100,000 2,000 PCS 5,500 11,000,000 1,500 PCS 21,798 32,697,000 600 PCS 40,370 24,222,000 900 PCS 46,200 41,580,000 780 PCS 46,750 36,465,000 720 PCS 43,120 31,046,400 60 PCS 45,210 2,712,600 10 PCS 2,085,500 20,855,000 500 PCS 16,000 8,000,000 5 BOX 3,789,000 18,945,000 1,000 PCS 1,905 1,905,000 6,000 PCS 3,217 19,302,000 10 BOX 667,000 6,670,000 300 PCS 29,549 8,864,700 1,500 PCS 30,550 45,825,000 500 PCS 30,550 15,275,000 5,000 PCS 650 3,250,000 60,000 PCS 779 46,740,000 25,000 PCS 968 24,200,000 15,000 PCS 1,200 18,000,000 4,000 PCS 1,500 6,000,000 1,000 PCS 4,049 4,049,000 1,000 PCS 3,400 3,400,000 2,000 PCS 6,702 13,404,000 SPUIT 100 CC 500 PCS 17,589 8,794,500 SPUIT 5 CC SPUIT 10 CC SPUIT 20 CC ECCENTRIC SPUIT 30 CC SPUIT 50 CC ECCENTRIC SPUIT 50 CC CATHIP SODA LIME SPINOCAN NO 23 SPINOCAN NO 25 SPINOCAN NO 27 SPUIT 1 CC SPUIT 3 CC SILK BLACK 4/0 TAPPER SIRCUIT NCPAP SLE SKIN MARKER REGULAR TIP SKIN PREPARATION GEL/SKINPURE SKINTEK FOAM/ELEKTRODA ANAK SKINTEK FOAM/ELEKTRODA DEWASA SELANG NASAL O2 DEWASA SELANG SUCTION / MASS SUCTION SILK BLACK 2/0 CUTTING SILK BLACK 2/0 TAPPER SILK BLACK 3/0 TAPPER SILK BLACK 3/0 CUTTING SARUNG TANGAN PANJANG NO 7,5 SARUNG TANGAN PANJANG NO 8 SELANG NEBULIZER ANAK SELANG NEBULIZER DEWASA SELANG NASAL O2 ANAK SELANG NASAL O2 BAYI SAFIL 1 HR / T-VIO / PGA 1 SAFIL 2/0 HR / T-VIO / PGA 2/0 SAFIL 3/0 HR / T-VIO / PGA 3/0 SAFIL 4/0 HR / T-VIO / PGA 4/0 SARUNG TANGAN PANJANG NO 6,5 SARUNG TANGAN PANJANG NO 7 PROLENE 7/0 EP 8735 H RECTAL TUBE NO 20 RECTAL TUBE NO 22 RECTAL TUBE NO 28 RECTAL TUBE NO 32 RING PERSARIUM NO 7,5 POT PLASTIK 100CC POT PLASTIK 50CC PREMILEN MESH 5X10 PROLENE 2/0 8685 H PROLENE 5/0 W 8006T PROLENE 6/0 8606 G POLYPROPYLANE 2/0 TS 27 POLYPROPYLANE 4/0 TS 19 POLYPROPYLANE 3/0 TS 19 POLYPROPYLANE 5/0 CUTTING POLYPROPYLANE 7/0 TAPPER POPIDONE IODINE 1000CC/ECODIN POLIBAN 3 INC POLIBAN 4 INC POLIBAN 6 INC POLIGYP 3 INC POLIGYP 4 INC POLIGYP 6 INC PIPET TETES KACA PISAU OPERASI NO 10 PISAU OPERASI NO 11 PISAU OPERASI NO 15 PISAU OPERASI NO 20 PISAU OPERASI NO 22 PDS II 5/0 - Z1013H PDS II 6/0 - Z-432H PERBAN 5 CM PERBAN 10 CM PERPUSOR SYRINGE WHITE PERPUSOR TUBING WHITE OPSITE 55X45

10 BOTOL 561,042 5,610,420 50 BOX/100 360,000 18,000,000 60 PCS 39,455 2,367,300 60 PCS 39,455 2,367,300 60 PCS 39,455 2,367,300 300 BAG/10 41,624 12,487,200 50 PCS 4,345 217,250 100 PCS 4,345 434,500 100 PCS 4,345 434,500 200 PCS 4,345 869,000 300 PCS 4,345 1,303,500 200 PCS 4,345 869,000 300 PSG 5,332 1,599,600 5,000 PSG 5,332 26,660,000 8,000 PSG 5,332 42,656,000 12,000 PSG 5,332 63,984,000 1,200 PSG 5,332 6,398,400 80 PCS 55,500 4,440,000 100 BOX/10 60,500 6,050,000 12 BOX/10 3,490,174 41,882,088 200 ROLL 152,637 30,527,400 200 ROLL 197,329 39,465,800 10 PCS 302,500 3,025,000 10 PCS 302,500 3,025,000 5 BOX 127,600 638,000 5 BOX 112,640 563,200 100 BOX/100 70,400 7,040,000 100 BOX/100 39,500 3,950,000 5 PCS 3,369,786 16,848,930 5 PCS 142,500 712,500 5 PCS 142,500 712,500 5 PCS 142,500 712,500 5 PCS 142,500 712,500 500 PCS 149,490 74,745,000 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 20 PCS 95,260 1,905,200 50 PCS 37,000 1,850,000 50 PCS 37,000 1,850,000 8 PCS 5,120,000 40,960,000 50 PCS 36,872 1,843,600 50 PCS 36,872 1,843,600 50 PCS 31,716 1,585,800 50 PCS 32,090 1,604,500 30 PCS 44,801 1,344,030 80 PCS 112,695 9,015,600 4,000 PCS 7,626 30,504,000 5,000 PCS 4,700 23,500,000 10 GLN/5L 322,000 3,220,000 2 BOX/36 3,296,375 6,592,750 2 BOX/36 4,004,215 8,008,430 10 BOX/36 3,378,477 33,784,770 10 BOX/36 3,860,651 38,606,510 10 BOX/36 2,945,315 29,453,150 6 PCS 2,900,000 17,400,000 6 PCS 2,900,000 17,400,000 10 PCS 82,000 820,000 10 PCS 82,000 820,000 5.1.02.01.01 5.1.02.01.01.0026 467,605,593 100 Kotak 52,202 5,220,200 50 Bungkus 45,938 2,296,900 2,000 Lembar 4,802 9,604,000 2,000 Lembar 4,802 9,604,000 700 Lembar 4,802 3,361,400 100 Blok 49,592 4,959,200 10 Bks 2,610 26,100 1,000 Lembar 2,000 2,000,000 10 Blok 55,000 550,000 1,000 Lembar 1,096 1,096,000 BLANGKO FOTO 100 Blok 7,000 700,000 BLANKO ECHO KERTAS BC WARNA HIJAU DOUBLE BLANGKO EEG BLANGKO EKG AMPLOP SCANNING BIRU UK 37X57 ASESMEN PRA OPERASI AMPLOP COKLAT EEG AMPLOP DINAS AMPLOP RADIOLOGI UK 24X30 AMPLOP RADIOLOGI UK 37X47 Belanja Barang Habis Pakai Belanja Alat/Bahan untuk Kegiatan Kantor- Bahan Cetak [-] Barang Cetakan AMPLOP BERKOP VICRYL 4/0 VCP 392 H VICRYL 4/0 VCP 310 VP SHUNT MED PRESSURE ANAK VP SHUNT MED PRESSURE DEWASA WOUND DRAIN 200 ML NO 10 WOUND DRAIN 200 ML NO 12 UNDER PAD URINE BAG USG GEL ONEMED VICRYL 1/0 VCP 359 VICRYL 2/0 VCP 602 H VICRYL 3/0 VCP 316 UMBLICAL CATH NO 2,5 UMBLICAL CATH NO 3,5 UMBLICAL CATH NO 4 UMBLICAL CATH NO 5 UMBLICAL CATH NO 8 UMBLICAL CORD THORARIC TROCAT NO 24 THORARIC TROCAT NO 28 THORARIC TROCAT NO 32 TUTUP MATA BAYI GEA SIZE M TUTUP MATA BAYI GEA SIZE S ULTRA FAST FIX TRACHEOSTOMY NO 6 TRACHEOSTOMY NO 7 TRACHEOSTOMY 7,5 TRACHEOSTOMY 8 TRIPLE LUMEN OCTOPUS THORARIC TROCAT NO 16 T.TUBE / T. DRINE NO 5 TENSOPLAST STK ADULT TENSOPLAST STK PAED TOPI DOKTER TOPI PERAWAT TOPI WILAMED NEONATAL BONNET SUREFIT/GROUNDING CABLE SURGICAL MASKER VISOR B24 SURGICEL FIBLIAR 5X10 SYNCERA ELECTOFIX 10X10 SYNCERA ELECTOFIX 15X10 T.TUBE / T. DRINE NO 3 SUCTION CATH NO 16 SURGI GLOVE STERIL 6 SURGI GLOVE STERIL 6,5 SURGI GLOVE STERIL 7 SURGI GLOVE STERIL 7,5 SURGI GLOVE STERIL 8 SOFTPAD SUCTION CATH NO 6 SUCTION CATH NO 8 SUCTION CATH NO 10 SUCTION CATH NO 12 SUCTION CATH NO 14 STABIMET STIK KGD STYLET TRACH TUBE BAYI STYLET TRACH TUBE ANAK STYLET TRACH TUBE DEWASA

200 Blok 53,768 10,753,600 20 Blok 26,883 537,660 50 Blok 22,000 1,100,000 20 Blok 125,000 2,500,000 40 Blok 49,070 1,962,800 40 Blok 37,324 1,492,960 20 Blok 41,761 835,220 400 Blok 23,751 9,500,400 50 Blok 22,000 1,100,000 30 Blok 50,000 1,500,000 10 Blok 41,761 417,610 10 Blok 26,000 260,000 20 Blok 49,592 991,840 60 Blok 49,592 2,975,520 70 Kotak 275,000 19,250,000 50 Kotak 275,000 13,750,000 50 Kotak 275,000 13,750,000 60 Blok 112,000 6,720,000 3,000 Rim 156 468,000 4,000 Lbr 3,000 12,000,000 300 Lbr 1,500 450,000 500 Lbr 1,500 750,000 200 Lbr 1,000 200,000 200 Lbr 2,000 400,000 200 Lbr 2,000 400,000 14 Rim 350,000 4,830,000 5 Rim 620,000 3,100,000 4 Rim 350,000 1,400,000 5 Rim 137,814 689,070 50 Blok 26,883 1,344,150 50 Blok 26,883 1,344,150 50 Blok 47,504 2,375,200 12,000 Lbr 2,088 25,056,000 300 Blok 49,592 14,877,600 50 Lbr 292 14,600 2,000 Lbr 573 1,146,000 500 Lbr 1,566 783,000 600 Lbr 4,000 2,400,000 600 Lbr 4,000 2,400,000 150 Blok 47,504 7,125,600 20 Blok 47,504 950,080 30 Blok 47,504 1,425,120 20 Blok 47,504 950,080 60 Blok 10,440 626,400 30 Blok 24,535 736,050 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 50 Blok 49,592 2,479,600 20 Blok 49,592 991,840 100 Blok 49,592 4,959,200 60 Blok 49,592 2,975,520 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 100 Blok 49,592 4,959,200 5 Blok 49,592 247,960 5 Blok 49,592 247,960 5 Blok 49,592 247,960 10 Blok 49,592 495,920 10 Blok 49,592 495,920 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 20 Blok 49,592 991,840 20 Blok 49,592 991,840 30 Blok 49,592 1,487,760 30 Blok 49,592 1,487,760 PENGKAJIAN KEPERAWATAN PASIEN TAHAP TERMINAL RM 5 E HAL 1/2 PENGKAJIAN KEPERAWATAN PASIEN HEMODIALISA RM 5 F HAL 1/4 PENGKAJIAN KEPERAWATAN PASIEN HEMODIALISA RM 5 F HAL 3/4 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 5/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 7/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 9/10 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 5/6 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 1/10 PENGKAJIAN AWAL KEPERAWATAN RANAP RM 5 B HAL 3/10 PENGKAJIAN AWAL MEDIS THT RANAP RM 4 G HAL 3/3 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 1/6 PENGKAJIAN KEPERAWATAN IGD RM 5A HAL 3/6 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 3/6 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 5/6 PENGKAJIAN AWAL MEDIS THT RANAP RM 4 G HAL 1/3 PENGKAJIAN MEDIS IGD RM 4 A HAL 3/4 PENGKAJIAN AWAL MEDIS RANAP RM 4 B HAL1/2 PENGKAJIAN AWAL MEDIS MATA RANAP RM 4 F HAL 1/6 PENGKAJIAN MEDIS THT RAJAL RM 3 F HAL 1/4 PENGKAJIAN MEDIS THT RAJAL RM 3 F HAL 3/4 PENGKAJIAN MEDIS IGD RM 4 A HAL 1/4 PENGKAJIAN AWAL KEPERAWATAN RAJAL RM 3 B HAL 1/2 PENGKAJIAN AWAL MEDIS NEUROLOGI RAJAL RM 3 E HAL 1/3 PENGKAJIAN AWAL MEDIS NEUROLOGI RAJAL RM 3 E HAL 3/3 RESUME KEPERAWATAN PASIEN PULANG RANAP RM 2+E RENCANA PEMULANGAN PASIEN 2 F HAL 1/2 PENGKAJIAN AWAL MEDIS RAJAL RM 3A HAL 1/2 SURAT REKOMENDASI DPJP RESUME KLINIS RAJAL RM 2 A RESUME MEDIS RANAP RM 2 B HAL 1/2 (RM 002) SURAT KETERANGAN SAKIT SURAT KETERANGAN DOKTER SURAT PENGANTAR SURAT KETERANGAN KELAHIRAN PR SURAT KETERANGAN PROTOKOL TERAPI SURAT KETERANGAN MENINGGAL STELLING CARD GUDANG FARMASI STIKER OBAT LASA SEDANG SURAT KETERANGAN KELAHIRAN LK MAP STATUS RESEP STELLING CARD LAPORAN HARIAN RAJAL PRIBADI LAPORAN PELAYANAN RAWAT JALAN POLI BPJS LAPORAN KEGIATAN PELAYANAN DI POLIKLINIK RSHM PEMANTAUAN ICU/ CETAK OBSERVASI ICU PEMANTAUAN ICU/KERTAS PICU NICU LAPORAN ANASTESI KARTU STOK HIJAU KARTU STOK MERAH KERTAS MERAH KARTU PEMERIKSAAN USG OBGYN REPORT KARTU PEMELIHARAAN ALAT KESEHATAN KARTU STOK BIRU HVS BERKOP WARNA KARTU BEROBAT KECIL KARTU IGD GELANG PASIEN ANAK-ANAK GELANG PASIEN DEWASA LAKI-LAKI GELANG PASIEN DEWASA WANITA BUKU CETAK DISPOSISI SURAT FORMULIR PELAYANAN INFORMASI OBAT FORMULIR SELESAI KEPANITERAAN KLINIK DAFTAR TINDAKAN HD TRAVELLING DIALISIS DAFTAR PEMAKAIAN OKSIGEN BON CATATAN LINEN BON PERBAIKAN BARANG BUKTI PELAYANAN RAJAL BPJS BLANGKO PMI FAAL HATI BLANGKO PEMERIKSAAN LABORATORIUM BLANGKO SP (SURAT PESANAN) BLANGKO LABORATORIUM FORMULIR PERMINTAAN PEMERIKSAAN PATOLOGI BLANGKO PA

10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 5 Blok 49,592 247,960 20 Blok 49,592 991,840 5 Rim 49,592 247,960 300 Blok 49,592 14,877,600 20 Blok 49,592 991,840 50 Blok 49,592 2,479,600 10 Blok 49,592 495,920 30 Blok 49,592 1,487,760 60 Blok 49,592 2,975,520 30 Blok 49,592 1,487,760 30 Blok 49,592 1,492,719 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 60 Blok 49,592 2,975,520 20 Blok 49,592 991,840 50 Blok 49,592 2,479,600 60 Blok 49,592 2,975,520 60 Blok 49,592 2,975,520 20 Blok 49,592 991,840 20 Blok 49,592 991,840 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 49,592 495,920 4 Blok 49,592 198,368 2 Blok 49,592 99,184 4 Blok 49,592 198,368 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 10 Blok 49,592 495,920 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 49,592 495,920 2,500 Blok 49,592 123,980,000 20 Blok 49,592 991,840 10 Blok 49,592 495,920 10 Blok 26,101 261,010 50 Blok 31,500 1,575,000 2 Blok 49,592 99,184 50 Blok 132,000 6,600,000 30 Blok 47,504 1,425,120 30 Blok 26,883 806,490 287,669,000.00 200 Buah 1,000 200,000 1,000 Buah 1,300 1,300,000 100 Botol 60,000 6,000,000 500 Botol 60,000 30,000,000 100 Botol 45,000 4,500,000 30 Buah 11,000 330,000 50 Botol 42,988 2,149,400 20 Buah 14,300 286,000 100 Buah 100,000 10,000,000 20 Helai 80,000 1,600,000 400 Botol 60,000 24,000,000 6 Kg 30,000 180,000 400 Helai 57,500 23,000,000 7 Botol 21,000 147,000 10 Buah 50,000 500,000 25 Buah 16,250 406,250 24 Buah 17,000 408,000 PISAU SILET CUKUR GAGANG 120 Buah 13,000 1,560,000 KIT BLACK SEMIR PEWANGI GANTUNG UNTUK MOBIL PINGWIN STELLA GANTUNG/PEWANGI GANTUNG KARET GELANG KESET KAKI HANDUK KIT BLACK SEMPROT MAGIC BESAR JAM DINDING KANEBO UNTUK MOBIL KARBOL BRUS HITAM FORCE MAGIC PEMBUNUH SERANGGA GUNTING BESAR BAYGON SEMPROT BAYCLIN BAYFRES [-] BARANG RUMAH TANGGA BOTOL POT OBAT BOTOL TETES TELINGA PERINCIAN BIAYA SURAT MASUK PERAWATAN TIKET JASA DOKTER RESIKO TIDAK STABIL KADAR GULA DARAH CETAK AMPRAHAN FARMASI NCR R3 FOLIO KERTAS PICU - PICU POLA NAFAS TIDAK EFEKTIF FORM RM 009 1 42 RESIKO ASPIKSIA FORM RM 009 1 43 RESIKO CEDERA JATUH FORM RM 009 1 46 NYERI AKUT FORM RM 009 1 32 NYERI KRONIS FORM RM 009 1 33 PERUBAHAN NUTRISI LEBIH DARI KEBUTUHAN RM 009 1 41 HIPOTERMI FORM RM 009 1 21 INTOLERANSI AKTIFITAS FORM 009 1 23 MUAL FORM RM 009 1 30 GANGGUAN ELIMINASI URINE FORM RM 009 1 10 GANGGUAN INTEGRITAS KULIT HIPER TERMIA FORM RM 09 1 20 CEMAS FORM RM 009. 1. 04 GANGGUAN ELIMINASI DIARE FORM RM 009 1 08 GANGGUAN ELIMINASI KONSTIPASI FORM RM 009 1 09 PINDAH ANTAR RUANGAN RM 035 HAL 1/3 PINDAH ANTAR RUANGAN RM 035 HAL 3/3 BERSIHAN JALAN NAFAS TIDAK EFEKTIF FORM RM 009.1.03 PERMINTAAN KONSUL JAWABAN KONSUL RM 12 A (RM 059-PAGE I) TRANSFER PASIEN DARI IGD ANTAR RUANGAN RM 12 B HAL 1/2 CATATAN VITAL SIGN RM 025.1 HAL 1/2 ASUHAN KEBIDANAN RM 9 C DAFTAR PEMBERIAN TERAFI RM 10 B HAL 1/2 RM 9 E HAL 5/10 PELAKSANAAN PENCEGAHAN PASIEN JATUH RM 11 B TINDAKAN HARIAN KEBIDANAN RM 9B HAL 1/10 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 3/10 TINDAKAN HARIAN KEBIDANAN RM 9B HAL 9/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 5/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 7/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 9/10 ASSESEMEN AWAL MEDIS HEMODIALISIS TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 1/10 TINDAKAN HARIAN KEPERAWATAN RM 9 A HAL 3/10 EDUKASI PASIEN DAN KELUARGA TERINTEGRASI RM 7 E HAL 3/4 CATATAN INTAKE DAN OUT PUT RM 8 D (RM 025) ASESMEN ULANG TANDA - TANDA & ULANG NYERI RM 8 F HAL 1/2 KOMUNIKASI S BAR RM 7 C KOMUNIKASI EDUKASI HARIAN RM 7 D EDUKASI PASIEN DAN KELUARGA TERINTEGRASI RM 7 E HAL 1/4 SITE MARKING (PENANDAAN OPERASI) RM 6 B LAPORAN PEMBEDAHAN / LAPORAN OPERASI RM 6 A HAL 1/2 CATATAN PERKEMBANGAN PASIEN TERINTEGRASI RM 7 A HAL 1/2 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 3/6 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 5/6 PENGKAJIAN AWAL KEBIDANAN BAYI BARU LAHIR RM 5 I HAL 1/2 PENGKAJIAN KEPERAWATAN PASIEN RANAP USIA 14 TAHUN RM 5 G HAL 1/4 PENGKAJIAN KEPERAWATAN PASIEN RANAP USIA 14 TAHUN RM 5 G HAL 3/4 PENGKAJIAN KEPERAWATAN PERINATOLOGI RM 5 H HAL 1/6

400 Bungkus 40,150 16,060,000 700 Kg 20,800 14,560,000 700 Kg 28,600 20,020,000 100 Kg 46,200 4,620,000 100 Kg 31,110 3,111,000 100 Kg 16,500 1,650,000 100 Kg 7,800 780,000 100 Kg 6,500 650,000 100 Kg 9,100 910,000 800 Saset 25,740 20,592,000 350 Batang 1,000 350,000 100 Botol 140,000 14,000,000 250 Buah 7,000 1,750,000 12 Buah 33,800 405,600 45 Pasang 40,000 1,800,000 100 Buah 62,500 6,250,000 30 Buah 60,000 1,800,000 50 Pasang 18,750 937,500 25 Pasang 12,650 316,250 7 Pasang 220,000 1,540,000 200 Buah 60,000 12,000,000 300 Bungkus 25,000 7,500,000 1,000 Kotak 19,500 19,500,000 500 Botol 60,000 30,000,000 470,978,050.00 1,000 Kotak 26,000 26,000,000 200 Kotak 85,000 17,000,000 140 Kotak 44,000 6,160,000 140 Kotak 32,800 4,592,000 120 Bungkus 2,610 313,200 50 Buah 36,000 1,800,000 50 Buah 30,500 1,525,000 144 Buah 258,000 37,152,000 61 Buah 21,300 1,299,300 750 Buah 13,900 10,425,000 1,000 Buah 16,500 16,500,000 80 Buah 16,500 1,320,000 80 Buah 40,000 3,200,000 120 Kotak 7,800 936,000 120 Kotak 3,900 468,000 500 Buah 31,000 15,500,000 300 Buah 80,600 24,180,000 50 Buah 16,500 825,000 150 Buah 42,000 6,300,000 30 Buah 175,000 5,250,000 250 Buah 20,250 5,062,500 50 Buah 60,000 3,000,000 1,000 Rim 49,270 49,270,000 1,000 Rim 43,000 43,000,000 3 Bungkus 575,000 1,725,000 2 Rol 4,687,500 9,375,000 500 Buah 750 375,000 1 Bungkus 90,000 90,000 100 Kotak 21,792 2,179,200 20 Buah 500,000 10,000,000 70 Kotak 9,100 637,000 200 Kotak 5,200 1,040,000 10 Kotak 400,000 4,000,000 25 Kotak 442,600 11,065,000 75 Buah 35,000 2,625,000 100 Buah 19,500 1,950,000 150 Buah 46,150 6,922,500 2,000 Buah 2,500 5,000,000 300 Buah 63,000 18,900,000 30 Buah 350,000 10,500,000 24 Buah 3,600 86,400 240 Buah 20,000 4,800,000 30 Kotak 45,500 1,365,000 5 Rol 40,000 200,000 300 Lembar 1,650 495,000 45 Buah 35,100 1,579,500 150 Buah 11,500 1,725,000 150 Buah 30,500 4,575,000 SLASIBAN BENING BESAR SLASIBAN HITAM BESAR PITA TIK KALKULATOR PLASTIK KARTU INVENTARIS ROL BESI PINSIL 2 B PISAU CUTTER PITA PRINTER LX 310 MAP KERTAS MAP TULANG PLASTIK MOUSE COMPUTER WAYAR LES LEM POVINAL LETTER FILE 401 LETTER FILE 403 KLIP ATOM SEDANG KERTAS CF 9 1/2 X 11 R3 KERTAS CF 9 1/2 X 11 R3 F KERTAS PRINT THERMAL 80X80 KEYBOARD COMPUTER WAYAR LES KLIP ATOM BESAR KABEL JARINGAN KERTAS PRINT ETIKET FARMASI KERTAS FILM GLOSSY HVS F4 HVS A4 JEK IRJ KABEL JARIGAN FLASDISK 32 GB HEKTER SEDANG HEKTER BESAR BUKU EXPEDISI DOKUMEN PAPER ISI 100 FILE BOX BINDER KLIP BESAR BINDER KLIP KECIL BUKU BESAR FOLIO BATRAI JAM BATRAI SEDANG BATRE PETAK 9 VOLT BALPOINT CAIR BALPOINT MERAH BATRAI REMOT AMPLOP COKLAT UK HVS BALPOINT HITAM BALPOINT BIRU ANAK HEKTER BESAR AMPLOP BESAR PUTIH AMPLOP KECIL PUTIH WIPOL [-] BARANG ALAT TULIS KANTOR (ATK) ANAK HEKTER KECIL SERBET KAIN KOTAK SUNLIGHT / MAMA LEMON TISSU KOTAK SARUNG TANGAN KARET SARUNG TANGAN KAIN SEPATU BOAT SANDAL SAPU PLASTIK SAPU KECIL U MOBIL SABUN DETTOL CAIR SABUN MANDI LIFEBUOY SAMPO MOBIL PLASTIK OBAT KLIP UK17X11 RINSO / DAIA SABUN BATANGAN PLASTIK 1 KG PLASTIK OBAT KLIP UK 12X8 PLASTIK OBAT KLIP UK 15X10 PLASTIK KUNING 90X100 PLASTIK 1/4 /KG PLASTIK 1/2 KG PLASTIK ASOY PUTIH PLASTIK HITAM 90X100

150 Buah 23,000 3,450,000 900 Buah 13,000 11,700,000 450 Buah 15,600 7,020,000 40 Buah 3,900 156,000 2 Buah 153,400 306,800 300 Buah 7,500 2,250,000 250 Botol 105,447 26,361,750 100 Botol 105,447 10,544,700 100 Botol 105,447 10,544,700 100 Botol 105,447 10,544,700 10 Botol 300,000 3,000,000 100 Botol 14,059 1,405,900 100 Buah 14,059 1,405,900 2,537,925,036.00 5 Box 2,068,000 10,340,000 39 Set 187,220 7,301,580 320 Ktk 64,890 20,764,800 190 Box 40,556 7,705,640 10 Btl 2,250,000 22,500,000 10 Btl 901,250 9,012,500 1 Btl 1,350,000 1,350,000 38 Btl 170,000 6,460,000 2 Kit 294,000 588,000 2 Kit 205,000 410,000 2 Kit 482,000 964,000 38 Kit 1,089,900 41,416,200 38 Kit 1,965,755 74,698,690 38 Kit 1,487,062 56,508,356 38 Kit 1,534,429 58,308,302 38 Kit 1,201,200 45,645,600 38 Kit 596,112 22,652,256 38 Kit 973,350 36,987,300 50 Kit 2,500,000 125,000,000 50 Kit 1,622,250 81,112,500 50 Kit 4,537,665 226,883,250 1 Btl 11,855 11,855 26 Ktk 302,880 7,874,880 13 Ktk 1,364,275 17,735,575 11 Ktk 3,090,000 33,990,000 17 Bok 50,000 850,000 7 Kit 2,879,800 20,158,600 7 Kit 771,920 5,403,440 13 Kit 1,841,125 23,934,625 77 Ktk 446,188 34,356,476 38 Ktk 4,184,620 159,015,560 21 Kit 1,705,011 35,805,231 21 Kit 6,231,500 130,861,500 21 Kit 1,934,533 40,625,193 3 Ktk 9,042,000 27,126,000 3 Ktk 402,500 1,207,500 3 Ktk 4,136,000 12,408,000 3 Ktk 4,088,700 12,266,100 43 Kit 3,626,000 155,918,000 13 Kit 1,336,500 17,374,500 25 Kit 850,000 21,250,000 25 Kit 1,746,189 43,654,725 38 Kit 215,000 8,170,000 6 Kit 2,240,315 13,441,890 16 Kit 1,430,000 22,880,000 38 Kit 612,700 23,282,600 128 Box 88,000 11,264,000 128 Box 52,300 6,694,400 128 Ktk 30,000 3,840,000 321 Box 425,500 136,585,500 385 Box 400,000 154,000,000 25 Bks 321,875 8,046,875 25 Bks 500,000 12,500,000 42 Bks 1,008,150 42,342,300 7 Bks 1,008,150 7,057,050 385 Ktk 219,600 84,546,000 21 Glng 21,792 457,632 16 Glng 21,792 348,672 Kertas Gol Darah 1,285 Pcs 20,000 25,700,000 Blue Tive Cup Sample Terbuka Cup Sample Tertutup Stik Glucosa Thermal Paper Besar Thermal Paper Kecil Blood Lancet Plesterin Alkohol Swab Vacutainer Serum Vacutainer EDTA Yellow Tive D.Dimer HS. CRP HBAIC NSI Troponin IgG / IgM Dengue CEA FT4/TSH T3T4 Ca 125 Tubex Procalcitonin Asto HBs Ag Anti HBS Cholesterol Triglesirida HDL-Cholesterol - Catrige BG 3 - Calibrant CP 100 - Control Level - Spuit Heparin Ck NAC LDH Total Protein Albumin Ureum Creatin Uric Acid Timol TT (Trhombine Time) Glucosa Blirubin Total SGOT SGPT Alkali Phospate Giemsa Methanol Eosin 1 % Stik Urine PT (Prothrombine Time) APTT (Masa Tromboplastin Parsial) [-] Barang BHP Laboratorium Malaria Rapid Tes Golongan Darah ABO Object Glass Deck Glass TINTA PRINTER CANNON TINTA STEMPEL OTOMATIS BIRU TINTA STEMPEL OTOMATIS HIJAU TINTA PRINTER KUNING EPOSN TINTA PRINTER MERAH EPSON TINTA PRINTER BIRU EPSON STEMPEL TANGGAL TINTA PRINT LABEL FARMASI TINTA PRINTER HITAM EPSON SPIDOL PERMANENT SPIDOL WHITE BOARD STIP PINSIL 2B SLASIBAN COKLAT

1 Btl 2,376,725 2,376,725 39 Box 245,000 9,555,000 30 Pcs 246,600 7,398,000 25 Ktk 185,000 4,625,000 25 Ktk 185,000 4,625,000 25 Ktk 185,000 4,625,000 25 Ktk 185,000 4,625,000 16 Ktk 294,000 4,704,000 2 Btl 1,183,730 2,367,460 16 Galon 749,196 11,987,136 16 Btl 1,006,647 16,106,352 16 Btl 1,183,730 18,939,680 24 Kg 300,000 7,200,000 10 Btl 295,592 2,955,920 10 Btl 749,196 7,491,960 10 Btl 384,133 3,841,330 3 Btl 5,816,487 17,449,461 3 Btl 6,919,849 20,759,547 54 Ktk 30,000 1,620,000 54 Ktk 30,000 1,620,000 1 Buah 85,000 85,000 5 Btl 2,456,001 12,280,005 5 Btl 5,816,487 29,082,435 5 Btl 5,170,816 25,854,080 2 Ktk 27,141,337 54,282,674 3 Btl 13,958,206 41,874,618 - 1,075,101,077 20 Box 5,236,000 104,720,000 13 Box 6,599,999 85,799,987 2 Box 8,563,000 17,126,000 - 38 Box 4,760,000 180,880,000 10 Box 6,000,000 60,000,000 - 40 Box 8,563,000 342,520,000 70 Roll 2,750,000 192,500,000 30 Box 400,000 12,000,000 10 Box 400,000 4,000,000 30 Liter 40,000 1,200,000 70 Box 209,775 14,684,250 20 Ampul 997 19,940 15 Ampul 27,600 414,000 200 Set 121,000 24,200,000 20 Set 397,260 7,945,200 60 Set 40,000 2,400,000 300 Set 33,000 9,900,000 12 Set 24,200 290,400 10 Set 12,500 125,000 12 Kit 482,000 5,784,000 20 Fls 15,000 300,000 10 Gulung 129,780 1,297,800 10 Set 52,300 523,000 20 Set 162,500 3,250,000 1 Box 71,500 71,500 35 Botol 90,000 3,150,000 7 Galon 92,615 648,305 - 2,224,364,158 1,200 Galon 79,000 94,800,000 24 Liter 150,000 3,600,000 144 Box 10,000 1,440,000 336 Box 200,000 67,200,000 192 Box 325,000 62,400,000 192 Box 325,000 62,400,000 756 Liter 60,000 45,360,000 200 Box 651,475 130,295,000 110 Box 651,475 71,662,250 2,209 Liter 557,700 1,231,959,300 2,400 Galon 50,000 120,000,000 144 Ampul 16,000 2,304,000 80 Box 200,000 16,000,000 40 Box 200,000 8,000,000 Dexametashon Inj 5 mg/ml Dializer 16 S Menjangan Dializer 16 Sinar Roda Av Fistula Sinar Roda Bayclin (Desinfectan Mesin) Blood Tubing Set Menjangan Blood Tubing Set Sinar Roda Citric Acid (Desinfectan Mesin HD) Citric Acid Menjangan [-] Barang BHP Hemodialisa Acid (AK-1) Sinar Roda Alkohol 70 % Alkohol Sweb Apron Plastik Av Fistula Menjagan Plaster Merah Tree Way Wing Nald No 21 Hand Drub Jelly 5 Kg Spuit 30 CC Spuit 100 CC Spuit 50 CC TI (Trhombine Time) Nacl 0,9 % Kapas 250 mg Handsconn No 8 Dexametashon Buscopan Cateter No 18 Cateter No 8 Spuit 3 CC Film CT Scan DT2B -14 x 17 cm Film USG Iopamiro 50/370 mg Iopamiro 100/370 mg Aquadest Steril - 8 x 10 cm -11 x 14 cm -14 x 17 cm Film Codonic - 8 x 10 cm -11 x 14 cm Bond Epitope Retrieval Solution Bond Polimer Refine Detection Calretini [-] Barang BHP Radiologi Film Carestrem CD 20 Objek Glass Ciover Glass Comeco / Alat Aspirator Dewax Solution Bond Primary Solution Xylol/Xylen Parafin Ecomount/ Canada Balsem Haematocylin Eosin Alkohol Esrtrogen Reseptor - Cocain - Morphin INR Xylol Buffer Formalin Alkohol Absulute Emercy Oil Rhesus Tabung Runcing - Amphetamin - THC

144 Liter 440,000 63,360,000 144 Liter 50,407 7,258,608 48 Liter 550,000 26,400,000 1,500 Sering 139,950 209,925,000 224,174,268 12 LITER 50,000 600,000 24 DRIGEN 669,000 16,056,000 60 KOTAK 55,000 3,300,000 12 BTL 85,000 1,020,000 3 KTK 997,700 2,993,100 6 POT 189,200 1,135,200 3 KTK 6,510,000 19,530,000 60 ROL 30,000 1,800,000 12 LITER 533,400 6,400,800 6 ROL 2,730,000 16,380,000 11 ROL 1,248,000 13,728,000 12 ROL 510,000 6,120,000 16 BOX 1,730,000 27,680,000 16 ROL 60,913 974,608 180 PSG 71,662 12,899,160 180 PSG 75,000 13,500,000 2 BOTOL 11,000,000 22,000,000 1 KTK 11,530,000 11,530,000 5 BUNGKUS 519,480 2,597,400 10 BTL 682,000 6,820,000 5 ROL 1,248,000 6,240,000 5 ROL 1,473,000 7,365,000 24 KTK 225,000 5,400,000 36 BUNGKUS 200,000 7,200,000 100 PSC 55,000 5,500,000 100 PSC 46,800 4,680,000 29 KTK 25,000 725,000 200,000,000 1 Thn 200,000,000 200,000,000 500,000,000 1 Thn 500,000,000 500,000,000 13,300,000 2 box 500,000 1,000,000 4 box 250,000 1,000,000 2 botol 500,000 1,000,000 2 syringe 1,000,000 2,000,000 3 syringe 333,333 1,000,000 2 syringe 250,000 500,000 1 syringe 1,000,000 1,000,000 1 box 200,000 200,000 3 box 66,667 200,000 2 set 100,000 200,000 2 gulung 100,000 200,000 1 box 200,000 200,000 2 botol 100,000 200,000 2 botol 100,000 200,000 2 box 100,000 200,000 2 box 150,000 300,000 2 box 250,000 500,000 2 box 250,000 500,000 24 syringe 8,333 200,000 1 botol 200,000 200,000 1 200,000 200,000 2 botol 100,000 200,000 1 botol 100,000 100,000 2 box 100,000 200,000 3 botol 66,667 200,000 3 box 33,333 100,000 2 botol 50,000 100,000 2 botol 50,000 100,000 2 box 100,000 200,000 2 box 100,000 200,000 1 box 100,000 100,000 1 box 100,000 100,000 1 box 100,000 100,000 Kalsium hidroksida medikamen intrakanal Kalsium hidroksida Pasta Articulating paper Seluloid strips Wooden wedge Bubuk pumice Pasta profilaksis Chlor ethyl spray Tambalan sementara Eugenol CHKM Glass ionomer cement lining Glass ionomer cement restorasi Etsa gel Dentin Conditioner Varnish Microbrush Benang retraksi Blade scalpel Hemostat EDTA cairan EDTA pasta Sealer Resin komposit bulk-fill Resin komposit flowable Semen Resin Jarum irigasi Cotton roll Bur diamond high speed [#] BELANJA BAHAN SPESIALIS KONSERVASI GIGI POLI GIGI DAN MULUT Gutaperca ProTaper Gutaperca Protaper Next Bonding Resin komposit anterior [#] Belanja Penambahan Pipa Gas Medis [-] Belanja Penambahan Pipa Gas Medis [#] Belanja Pemeliharaan Gedung [-] Belanja Pemeliharaan Gedung POUCES LOW 10 x 100 (FLAT) MASKER APRON GOEGLE FACE SHIELD TOPI PERAWAT SARUNG TANGAN NO 8 H2O2 59% INDIKATOR STEAM 1250 INDIKATOR STEAM 1234 A STABIMET POUCES LOW 20 x 200 (FLAT) PAUCES 40x200 (FLAT) PAUCES 20x200 (FLAT) PAUCES 7,5x200 (FLAT) WROPING PAPER 100x100 LEOKOPLAST 7,5M x 4,5M SARUNG TANGAN NO 7,5 HANS CRUB (SANITIZER) INDIKATOR EDSEPHES GERMISEP INDIKATOR BOWDICK KAIN KASA 40 YEARS x 80 ONE SCRAB SABLON Hemapo 3000 iu/ml [-] Barang BHP CSSD ALKOHOL ANIOSYME DLT PLUS HANSCUN NON STERIL Formalin 37 5 H2O2 50 % Hand sanitizer

1 box 100,000 100,000 4 box 50,000 200,000 4 box 50,000 200,000 2 box 50,000 100,000 5.2.02.06.02 254,000,000 1 unit 46,000,000 46,000,000 1 unit 10,000,000 10,000,000 1 unit 18,000,000 18,000,000 1 unit 10,000,000 10,000,000 1 unit 30,000,000 30,000,000 1 unit 10,000,000 10,000,000 1 unit 10,000,000 10,000,000 1 set 6,000,000 6,000,000 1 unit 35,000,000 35,000,000 1 unit 12,000,000 12,000,000 1 unit 14,000,000 14,000,000 3 set 1,000,000 3,000,000 1 unit 14,000,000 14,000,000 1 set 8,000,000 8,000,000 1 pcs 1,000,000 1,000,000 5 set 1,400,000 7,000,000 2 set 2,000,000 4,000,000 2 set 1,000,000 2,000,000 2 set 250,000 500,000 2 set 250,000 500,000 5 pcs 40,000 200,000 3 pcs 166,667 500,000 2 pcs 400,000 800,000 2 pcs 600,000 1,200,000 1 set (30 pcs) 1,000,000 1,000,000 3 box 666,667 2,000,000 2 set 1,500,000 3,000,000 1 pcs 1,000,000 1,000,000 1 set 200,000 200,000 1 unit 200,000 200,000 3 buah 66,667 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 100,000 200,000 2 buah 50,000 100,000 1 unit - - 1 unit - - White stone bur Bur brush Bunsen spiritus Alat sinar bleaching UV light sterilisator Glass slab Ball instrument Rubber bowl Spatula Prob periodontal Finishing bur Pinset Ekskavator Kaca mulut Plastis instrumen Semen stopper Semen spatel Alat polis Plastis instrumen Pasak fiber Sterilisator kering (oven) Sonde lurus Sonde halfmoon Endo access bur Diamendo bur Mini endo block Endo stand Enhance finishing point Stainless steel K-file Alat obturasi Matrix sectional Ergo kit File ProTaper Next File ProTaper FHU ProGlider Alat electro surgery Rubber dam Endomotor Apex locator Endoactivator Tip endoactivator X-ray dental Sensor X-ray Suction aerosol Dental Lup Alat ultrasonik Tip ultrasonik endodontik Paper point Gutaperca Spreader Belanja Modal Alat [#] BELANJA ALAT SPESIALIS KONSERVASI GIGI POLI GIGI DAN MULUT Polishing strips