Spesialis Penyakit Dalam

FORNAS HARGA PBF

No Nama/Merk Obat Kebutuhan PBF
Harga Isi per box Harga Isi per box

1 Amlodipin 5 mg 20 LIMA JAYA Rp 15,900 300 Rp 4,700 30

2 Amlodipin 10 mg 20 LIMA JAYA Rp 3,600 50 Rp 11,900 30
3 Candesartan 8 mg 8 AAM Rp 6,360 30 Rp 141,751 30
4 Candesartan 16 mg 10 AAM Rp 9,570 30 Rp 204,750 30
5 Bisoprolol 2,5 mg 5 AMS Rp 12,900 100 Rp 50,000 100
6 Bisoprolol 5 mg 10 AAM Rp 4,110 30 Rp 66,485 100
7 Furosemid 5 LIMA JAYA Rp - 100 Rp 32,200 200
8 Spironolakton 25 mg 5 AAM Rp 20,000 100 Rp 35,000 100
9 Spironolakton 100 mg 5 AAM Rp 53,000 100 Rp 210,000 100
10 Glimepirid 1 mg 10 AAM Rp 9,300 100 Rp 50,015 50
11 Glimepirid 2 mg 5 LIMA JAYA Rp 12,300 100 Rp 88,000 100
12 Glimepirid 3 mg 10 AMS Rp 14,300 100 Rp 88,400 100
13 Glimepirid 4 mg 5 AAM Rp 18,300 100 Rp 61,200 100
14 Metformin 500 mg 5 LIMA JAYA Rp 15,400 200 Rp 38,500 200
15 Acarbose 50 mg 10 AAM Rp 60,000 100 Rp 144,500 100
16 Acarbose 100 mg 10 AAM Rp 85,000 100 Rp 229,500 100
17 Meloxicam 15 mg 10 LIMA JAYA Rp - Rp 18,700 50
18 Meloxicam 7,5 mg 20 LIMA JAYA Rp - Rp 23,600 50
19 Eperison 50 mg 5 AMS Rp - Rp 154,000 100
20 Osteocal 5 AMS Rp - Rp 115,000 72
21 Na Diklofenak 50 mg 20 LIMA JAYA Rp 10,800 100 Rp 17,900 50
22 Cefixime 100 mg 14 LIMA JAYA Rp 19,350 50 Rp 57,700 50
23 Levofloxacin 500 mg 20 LIMA JAYA Rp 18,650 50 Rp 52,900 50
24 Ciprofloxacin 500 mg 10 LIMA JAYA Rp 25,000 100 Rp 51,500 100
25 Urispas 10 MBS Rp - Rp 152,500 30
26 Ambroxol 5 LIMA JAYA Rp - Rp 13,300 100
27 Cetrizine 10 mg 15 KIMIA FARMA Rp 18,350 50 Rp 11,000 30
28 Alprazolam 1 mg 5 KIMIA FARMA Rp 9,900 100 Rp 47,563 100
29 Alprazolam 0,5 mg 5 KIMIA FARMA Rp 7,800 100 Rp 32,322 100
30 Diazepam 2 mg 5 AMS Rp 7,000 100 Rp 60,000 100
31 Metilprednisolon 16 mg 5 MBS Rp 44,300 100 Rp 36,065 30
32 Metilprednisolon 8 mg 3 LIMA JAYA Rp 11,650 50 Rp 32,100 50
33 Metilprednisolon 4 mg 15 LIMA JAYA Rp 10,200 100 Rp 30,800 100
34 CTM 5 LIMA JAYA Rp 4,800 100 Rp 6,500 100
35 KSR 5 INDOFARMA Rp 184,200 100 Rp 486,200 100
38 Novomix 1 AAM Rp 112,000 1 Rp 406,818 1
39 Aspilet 2 LIMA JAYA Rp 15,000 100 Rp 72,875 100
40 Retaphyl 5 KIMIA FARMA Rp 117,000 100 Rp 95,727 100
41 Salbutamol 2 mg 5 RAJAWALI Rp 5,000 100 Rp 8,463 100
42 Salbutamol 4 mg 10 LIMA JAYA Rp 6,500 100 Rp 14,300 100
Harga + PPN Total PRINCIPLE

Rp 5,170 Rp 103,400 TEMPO

Rp 13,090 Rp 261,800 SAMPHARINDO
Rp 155,926 Rp 1,247,409 DEXA
Rp 225,225 Rp 2,252,250 DEXA
Rp 55,000 Rp 275,000 DEXA
Rp 73,134 Rp 731,335 DEXA
Rp 35,420 Rp 177,100 KIMIA FARMA
Rp 38,500 Rp 192,500 DEXA
Rp 231,000 Rp 1,155,000 DEXA
Rp 55,017 Rp 550,165 DEXA
Rp 96,800 Rp 484,000 HEXPHARM
Rp 97,240 Rp 972,400 DEXA
Rp 67,320 Rp 336,600 DEXA
Rp 42,350 Rp 211,750 HEXPHARM
Rp 158,950 Rp 1,589,500 DEXA
Rp 252,450 Rp 2,524,500 DEXA
Rp 20,570 Rp 205,700 DEXA
Rp 25,960 Rp 519,200 DEXA
Rp 169,400 Rp 847,000 ETERCON
Rp 126,500 Rp 632,500 NICHOLAS
Rp 19,690 Rp 393,800 DEXA
Rp 63,470 Rp 888,580 HEXPHARM
Rp 58,190 Rp 1,163,800 KIMIA FARMA
Rp 56,650 Rp 566,500 HEXPHARM
Rp 167,750 Rp 1,677,500 INDOFARMA
Rp 14,630 Rp 73,150 -
Rp 12,100 Rp 181,500 SAMPHARINDO
Rp 52,319 Rp 261,597 MERSI
Rp 35,554 Rp 177,771 MERSI
Rp 66,000 Rp 330,000 YARINDO FARMATAMA
Rp 39,672 Rp 198,358 NOVAPHARIN
Rp 35,310 Rp 105,930 PROMEDRAHARDJO
Rp 33,880 Rp 508,200 HEXPHARM
Rp 7,150 Rp 35,750 IMFARMIND
Rp 534,820 Rp 2,674,100 MERCK
Rp 447,500 Rp 447,500 BETA PHARMACON
Rp 80,163 Rp 160,325 DARYA VARYA
Rp 105,300 Rp 526,499 KIMIA FARMA
Rp 9,309 Rp 46,547 IMFARMIND
Rp 15,730 Rp 157,300 IMFARMIND
Rp 25,843,814
Spesialis Jantung

FORNAS HARGA PBF

No Nama/Merk Obat Kebutuhan PBF
Harga Isi per box Harga

1 Amiodaron 200 mg 30 KIMIA FARMA Rp 6,118 30 Rp 26,048

2 Verapamil 80 mg 30 KIMIA FARMA Rp 7,150 50 Rp 44,100
3 Digoxin 0,25 mg 30 LIMA JAYA Rp 12,400 100 Rp 16,500
4 Furosemid 5 LIMA JAYA Rp - Rp 32,200
5 Spironolakton 25 mg 5 AAM Rp 20,000 100 Rp 35,000
6 Spironolakton 100 mg 5 AAM Rp 53,000 100 Rp 210,000
7 HCT 25 mg 30 KIMIA FARMA Rp 14,800 100 Rp 16,500
8 Amlodipin 5 mg 20 LIMA JAYA Rp 15,900 300 Rp 4,700
9 Amlodipin 10 mg 20 LIMA JAYA Rp 3,600 50 Rp 11,900
10 Kolkisin 0,5 mg 20 LIMA JAYA Rp 19,470 30 Rp 137,500
11 Allopurinol 300 mg 10 LIMA JAYA Rp 20,000 100 Rp 74,000
13 Notisil 2 mg 5 AMS Rp - Rp 115,000
14 Codein 10 mg 2 KIMIA FARMA Rp 1,300 100 Rp 55,000
15 Lansoprazole 30 mg 50 LIMA JAYA Rp 13,900 50 Rp 16,900
16 Sucralfate 500 mg/ 5 ml 15 AMS Rp 5,970 1 Rp 66,000
17 Ranitidin 150 mg 8 LIMA JAYA Rp 8,500 100 Rp 18,850
18 Nitral 500 mcg 5 MBS Rp 42,450 30 Rp 120,567
19 Nitrokaf 2,5 mg 5 KIMIA FARMA Rp 164,000 100 Rp 313,250
20 ISDN 10 mg 10 AMS Rp 15,000 100 Rp 15,000
21 Carvedilol 6,25 mg 20 KIMIA FARMA Rp 52,440 30 Rp 110,670
22 Bisoprolol 10 mg (Concor) 3 AAM Rp 92,910 30 Rp 153,700
23 Candesartan 8 mg 8 AAM Rp 6,360 30 Rp 141,751
24 Candesartan 16 mg 10 AAM Rp 9,570 30 Rp 204,750
25 Bisoprolol 2,5 mg 5 AMS Rp 12,900 100 Rp 50,000
26 Ramipril 10 mg 20 AMS Rp 21,300 30 Rp 30,150
27 Ramipril 5 mg 10 AMS Rp 14,600 100 Rp 57,727
28 Captopril 25 mg 10 INDOFARMA Rp 20,600 100 Rp 25,540
29 Gemfibrozil 300 mg 10 KIMIA FARMA Rp 31,500 100 Rp 60,700
30 Atorvastatin 20 mg 7 AMS Rp 14,010 30 Rp 120,000
31 Simvastatin 20 mg 20 AAM Rp 7,500 50 Rp 38,450
32 Clopidogrel 75 mg 10 AMS Rp 17,250 30 Rp 38,301
33 PCT 10 LIMA JAYA Rp 1,700 100 Rp 18,000
34 Azitromicin 500 mg 4 KIMIA FARMA Rp 26,000 20 Rp 34,000
35 N-Asetil Sistein 200 mg 5 MBS Rp 18,420 60 Rp 60,000
36 Cefixime 200 mg 7 AMS Rp 74,900 100 Rp 183,333
37 Seretide Diskus 1 AAM Rp 59,000 1 Rp 137,492
38 Inhaler Berotec 1 AAM (IMEDCO) Rp 86,930 1 Rp 32,120
39 Aminofilin 100 mg 5 MBS Rp - Rp 30,800
40 Salbutamol 2 mg 5 RAJAWALI Rp 5,000 100 Rp 8,463
41 Gliquidon 15 mg 10 AAM Rp 100,000 100 Rp 177,100
42 Metformin 500 mg 5 LIMA JAYA Rp 15,400 200 Rp 38,500
43 Glimepirid 4 mg 5 AAM Rp 18,300 100 Rp 61,200
44 Glimepirid 2 mg 5 LIMA JAYA Rp 12,300 100 Rp 88,000
45 Diazepam 5 mg 50 MBS Rp 10,800 100 Rp 4,950
46 B Complex 10 LIMA JAYA Rp 5,900 100 Rp 11,050
47 Natrium Bicarbonat 10 LIMA JAYA Rp - Rp 40,900
48 Asam Folat 1 mg 10 LIMA JAYA Rp 5,800 100 Rp 8,600
HARGA PBF
Harga + PPN Total PRINCIPLE
Isi per box

30 Rp 28,653 Rp 859,584 ETHICA

30 Rp 48,510 Rp 1,455,300 ABBOTT 240 MG
30 Rp 18,150 Rp 544,500 YARINDO FARMATAMA
200 Rp 35,420 Rp 177,100 KIMIA FARMA
100 Rp 38,500 Rp 192,500 DEXA
100 Rp 231,000 Rp 1,155,000 DEXA
30 Rp 18,150 Rp 544,500 KIMIA FARMA
30 Rp 5,170 Rp 103,400 TEMPO
30 Rp 13,090 Rp 261,800 SAMPHARINDO
50 Rp 151,250 Rp 3,025,000 COMBINED
100 Rp 81,400 Rp 814,000 HEXPHARM
Rp 126,500 Rp 632,500 NOVELL
100 Rp 60,500 Rp 121,000 KIMIA FARMA
20 Rp 18,590 Rp 929,500 HEXPHARM
1 Rp 72,600 Rp 1,089,000 PROMEDRAHARDJO DEXA(TABLET), HARGA 222
100 Rp 20,735 Rp 165,880 DEXA
30 Rp 132,624 Rp 663,119 ACTAVIS
100 Rp 344,575 Rp 1,722,875 KIMIA FARMA
100 Rp 16,500 Rp 165,000 YARINDO FARMATAMA 5 MG
50 Rp 121,737 Rp 2,434,740 KALBE
100 Rp 169,070 Rp 507,210 MERCK
30 Rp 155,926 Rp 1,247,409 DEXA
30 Rp 225,225 Rp 2,252,250 DEXA
100 Rp 55,000 Rp 275,000 DEXA
50 Rp 33,165 Rp 663,300 NOVELL
100 Rp 60,606 Rp 606,060 DEXA
100 Rp 28,094 Rp 280,940 RAMA EMERALD
100 Rp 66,770 Rp 667,700 PHAPROS
100 Rp 132,000 Rp 924,000 DEXA
50 Rp 42,295 Rp 845,900 KIMIA FARMA
100 Rp 42,131 Rp 421,311 KIMIA FARMA
100 Rp 19,800 Rp 198,000 AFIFARMA
20 Rp 37,400 Rp 149,600 KIMIA FARMA
100 Rp 66,000 Rp 330,000 INDOFARMA
100 Rp 201,666 Rp 1,411,664 DEXA
Rp 151,241 Rp 151,241 GSK (GLAXOSMITHKLINE)
50 Rp 35,332 Rp 35,332 IMEDCO BOEHRINGER INGELHEIM
100 Rp 33,880 Rp 169,400
100 Rp 9,309 Rp 46,547 IMFARMIND
100 Rp 194,810 Rp 1,948,100 DEXA 30 MG
200 Rp 42,350 Rp 211,750 HEXPHARM
100 Rp 67,320 Rp 336,600 DEXA
100 Rp 96,800 Rp 484,000 HEXPHARM
 10 Rp 5,445 Rp 272,250 MERSI
100 Rp 12,155 Rp 121,550 NOVAPHARIN
100 Rp 44,990 Rp 449,900 MERCK
100 Rp 9,460 Rp 94,600 NOVAPHARIN
Rp 32,157,911
Spesialis Kejiwaan

FORNAS PBF
No Nama/Merk Obat Kebutuhan PBF
Isi 1 box Harga Harga
2 Risperidon 2 mg 5 AAM 100 Rp 12,300 Rp 145,000
3 Risperidon 3 mg 5 AAM 100 Rp 5,900 Rp -
4 Risperidon 1,5 mg 5 MBS 100 Rp 5,300 Rp 9,347
5 Haloperidol 0,5 mg 5 KF 100 Rp 4,900 Rp 7,038
7 Haloperidol 5 mg 5 KF 100 Rp 5,400 Rp 5,298
8 Haloperidol 2 mg (Lodomer) 5 KF 100 Rp 8,100 Rp -
9 Trifluopherazine 5 mg 5 KF 100 Rp 22,000 Rp 23,157
10 CPZ/Chlorpromazine 5 KF 100 Rp 19,000 Rp 36,548
11 Amitriptilin 5 MBS 100 Rp 17,500 Rp 20,000
12 Maprotilin 50 mg 5 INF 50 Rp 187,500 Rp 750,000
13 Aripiprazole 5 mg (Arinia) 20 KF 10 Rp 105,450 Rp 215,000
14 Fluoxetin 20 mg 20 INF 30 Rp 11,610 Rp 19,550
16 Clozapin 25 10 AAM 50 Rp 21,850 Rp 70,000
17 Quetiapin 10 AAM 30 Rp 204,420 Rp 325,444
18 Trihexyphenidyl 50 KF 100 Rp 6,300 Rp 6,472
19 Sertaline 20 INF 30 Rp 43,800 Rp 155,000

POLI JUMLAH
PENYAKIT DALAM Rp 25,843,814
JANTUNG Rp 32,157,911
JIWA Rp 18,756,078
TOTAL Rp 76,757,803

Disetujui Oleh Diperiksa Oleh

dr. Tommy Daindes, Sp.JP.,M.KM Deddy Irawan, SE

PBF
Harga + PPN Jumlah PRINCIPLE
Isi 1 box
100 Rp 159,500 Rp 797,500 DEXA
Rp - DEXA
100 Rp 10,282 Rp 51,409 HOLI PHARMA
100 Rp 7,742 Rp 38,709 HOLI PHARMA
100 Rp 5,828 Rp 29,139 MERSI
Rp - Rp - MERSI
100 Rp 25,473 Rp 127,364 MERSI
100 Rp 40,203 Rp 201,014 PHAPROS
100 Rp 22,000 Rp 110,000 YARINDO
100 Rp 825,000 Rp 4,125,000 MERSI
10 Rp 236,500 Rp 4,730,000 MEPROFARM
30 Rp 21,505 Rp 430,100 DEXA
50 Rp 77,000 Rp 770,000 DEXA
10 Rp 357,988 Rp 3,579,884 AMAROX
10 Rp 7,119 Rp 355,960 MERSI
30 Rp 170,500 Rp 3,410,000 MEPROFARM
Rp 18,756,078

Sungai Limau, Desember 2021

Diajukan Oleh

apt. Elvira Hardianti, S.Farm