Download - 58 - JDIH - BATAN
- 58 -
1 Acarbose 50 mg tablet Generik Tablet, Box = 100 buah Box 209,000
2 Acitral sirup Non Generik Sirup, Botol = 120 ml Botol 57,000
3 Acitral tablet Non Generik Tablet, Box = 100 buah Box 172,000
4 Acnes Sealing Gel Non Generik Gel, Tube = 9 gram Tube 31,000
5 Actifed Plus, sirup Non Generik Sirup, Botol = 60 ml Botol 95,000
6 Acyclovir 200 mg tablet Generik Tablet, Box = 100 buah Box 93,000
7 Acyclovir 400 mg tablet Generik Tablet, Box = 100 buah Box 118,000
8 Acyclovir 5 % krim Generik Krim, Tube = 5 gram Tube 6,000
9 Acyclovir 5 % krim GenerikKrim, Tube = 5 gram, Box =
25 buahBox 122,000
10 Adrome tablet Non Generik Tablet, Box = 100 buah Box 88,000
11 Alegi tablet Non Generik Tablet, Box = 100 buah Box 200,000
12 Alletrol Salep Mata Non Generik Tube, Box = 24 buah Box 431,000
13 Allopurinol 100 mg tablet Generik Tablet, Box = 100 buah Box 30,000
14 Aloclair Gel Non Generik Gel, Tube = 8 mg Tube 162,000
15 Alpara tablet Non Generik Tablet, Box = 100 buah Box 160,000
16 Ambeven kapsul Non Generik Kapsul, Box = 100 buah Box 229,000
17 Ambroxol 15 mg sirup Generik Sirup, Botol = 60 ml Botol 7,000
18 Ambroxol 30 mg tablet Generik Tablet, box = 100 buah Box 38,000
19 Amilorida HCL 5 mg tablet Generik Tablet, Box = 100 buah Box 19,000
20 Aminofilin 150 mg tablet Generik Tablet, Box = 100 buah Box 20,000
21 Amlodipin 10 mg tablet Generik Tablet, Box = 30 buah Box 54,000
22 Amlodipin 5 mg tablet Generik Tablet, Box = 50 buah Box 122,000
23 Amlodipin 5 mg tablet Generik Tablet, Box = 30 buah Box 47,000
24 Amoksisilin + Asam Klavulanat 625
mg tabletGenerik Tablet, Box = 100 buah Box 317,000
25 Amosterra 500 mg tablet Non Generik Tablet, Box = 100 buah Box 57,000
26 Amoxicillin 500 mg Tablet Generik Tablet, Box = 100 buah Box 81,000
27 Amoxilin sirup kering Generik Sirup kering, Botol = 60 ml Botol 25,000
28 Ampisilin 250 mg kaplet Generik Kaplet, Box = 100 buah Box 57,000
29 Ampisilin 500 mg kaplet Generik Kaplet, Box = 100 buah Box 80,000
30 Ampisilin sirup kering Generik Sirup kering, Botol = 60 ml Botol 10,000
31 Antasida DOEN sirup Generik Sirup, botol = 60 mL Botol 17,000
32 Antidia tablet Non Generik Tablet, Box = 100 buah Box 58,000
33 Antimo tablet Non Generik Tablet, Strip = 2 tablet Strip 9,000
34 Antox kapsul Non Generik Tablet, box = 60 buah Box 611,000
35 Ardium HD tablet Non Generik Tablet, Box = 100 buah Box 781,000
36 Arsinal tablet Non Generik Tablet, Box = 100 buah Box 204,000
37 Asam Mefenamat tablet Generik Tablet, Box = 100 buah Box 54,000
38 Asam Traneksanat tablet Generik Tablet, Box = 100 buah Box 377,000
39 Ascardia 160 mg tablet Non Generik Tablet, Box = 100 buah Box 263,000
40 Ascardia 80 mg tablet Non Generik Tablet, Box = 100 buah Box 119,000
41 Asetazolamid 250 mg tablet Generik Tablet, Box = 100 buah Box 38,000
42 Asetosal 500 mg tablet Generik Tablet, Box = 100 buah Box 33,000
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
I. OBAT-OBATAN UMUM
- 59 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
43 Aspar K tablet Non Generik Tablet, Box = 100 buah Box 377,000
44 Aspilet 80 mg tablet Non Generik Tablet, Box = 100 buah Box 109,000
45 Atenolol 100 mg tablet Generik Tablet, Box = 100 buah Box 54,000
46 Atenolol 50 mg tablet Generik Tablet, Box = 100 buah Box 57,000
47 Atorvastatin 10 mg tablet Generik Tablet, box = 30 buah Box 134,000
48 Atorvastatin 20 mg tablet Generik Tablet, box = 30 buah Box 223,000
49 Azithromycin 500 mg tablet Generik Tablet, box = 20 buah Box 130,000
50 Balsem cap Lang 40 g Non Generik Krim, botol = 40gr Botol 27,000
51 Becom C tablet Non Generik Tablet, box = 100 buah Box 256,000
52 Benacol Sirup Non Generik Sirup, botol = 100 ml Botol 48,000
53 Beneuron tablet Non Generik Tablet, Box = 100 buah Box 88,000
54 Benoson G krim Non Generik Krim, tube = 10 gram Tube 112,000
55 Benoson M krim Non Generik Krim, tube = 5 gram Tube 102,000
56 Benovit C tablet Non Generik Tablet, Box = 100 buah Box 278,000
57 Benoxicam 20 mg tablet Non Generik Tablet, Box = 100 buah Box 124,000
58 Benoxuric 300 tablet Non Generik Tablet, Box = 100 buah Box 593,000
59 Berotek MDI inhaler Non Generik Inhaler, botol = 10 mL Botol 243,000
60 Berryvision Tablet Non Generik Tablet, Box = 100 buah Box 569,000
61 Betadine gargle kumur Non Generik Gargle kumur, botol = 100
mLBotol 24,000
62 Betahistin mesilat 6 mg tablet Non Generik Tablet, box = 30 buah Box 58,000
63 Betametason 0,5 mg tablet Non Generik Tablet, Box = 100 buah Box 15,000
64 Betasin krim Non Generik Krim, tube = 10 gram Tube 106,000
65 Betason krim Non Generik Krim, tube = 5 gram Tube 14,000
66 Betason N krim Non Generik Krim, tube = 10 gram Tube 23,000
67 Bevalex krim Non Generik Krim, tube = 5 gram Tube 18,000
68 Bevita Sirup Non Generik Sirup, botol = 120 ml Botol 79,000
69 Bicnat tablet Generik Tablet, pot = 100 buah Pot 44,000
70 Bioplacenton Gel Non Generik Gel, tube = 15 gram Tube 41,000
71 Bisolvon Extra sirup Non Generik Sirup, botol = 60 ml Botol 60,000
72 Bisolvon Inhaler Non Generik Larutan, botol = 50 ml Botol 132,000
73 Bisoprolol 5 mg tablet Generik Tablet, Box = 100 buah Box 337,000
74 Borraginol N krim Non Generik Krim, tube = 15 gram Tube 105,000
75 Borraginol N Suppositoria Non Generik Suppost, box = 10 buah Box 202,000
76 Braito Tetes Mata monodosis Non Generik Tetes Mata Strip, box = 10
stripBox 35,000
77 Braito Tetes Mata multidosis Non Generik Tetes Mata, botol = 5 ml Botol 16,000
78 Bravoderm krim Non Generik Krim, tube = 5 gram Tube 23,000
79 Bromheksin 8 mg tablet Generik Tablet, box = 100 buah Box 9,000
80 Bufacetin salep Non Generik Krim, tube = 10 gram Tube 19,000
81 Bufacomb krim Non Generik Krim, tube = 5 gram Tube 27,000
82 Bufantacid sirup Non Generik Sirup, Botol = 60 ml Botol 15,000
83 Bufect tablet Non Generik Tablet, box = 100 buah Box 105,000
84 Burnazin krim Non Generik Krim, tube = 35 g Tube 100,000
85 Buscopan plus tablet Non Generik Tablet, Box = 100 buah Box 586,000
- 60 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
86 Caladine Lotion Non Generik Bedak cair, botol = 60 ml Botol 21,000
87 Caladine Powder (Active Fresh) Non Generik Bedak tabur, botol = 100
gramBotol 16,000
88 Calcidin tablet Non Generik Tablet, Box = 100 buah Box 108,000
89 Calfera tablet Non Generik Tablet, Box = 100 buah Box 65,000
90 Callusol Larutan Non Generik Larutan, botol = 10 ml Botol 50,000
91 Cameloc 15 mg tablet Non Generik Tablet, box = 50 buah Box 116,000
92 Canderin tablet Non Generik Tablet, Box = 100 buah Box 404,000
93 Candesartan 16 mg tablet Generik Tablet, box = 30 buah Box 263,000
94 Candesartan 8 mg tablet Generik Tablet, box = 30 buah Box 134,000
95 Captopril 12,5 mg tablet Generik Tablet, box = 100 buah Box 18,000
96 Captopril 25 mg tablet Generik Tablet, Box = 100 buah Box 51,000
97 Cardio Aspirin tablet Non Generik Tablet, Box = 100 buah Box 88,000
98 Cataflam 50 mg tablet Non Generik Tablet, box = 50 buah Box 476,000
99 Cavicur DHA sirup Non Generik Sirup, botol = 60 ml Box 24,000
100 Caviplex sirup Non Generik Sirup, Botol = 60 ml Botol 13,000
101 Cavit D3 tablet Non Generik Tablet, Box = 100 buah Box 323,000
102 CDR tablet effervescent Non Generik Tablet efferv, Botol = 10
buahBotol 60,000
103 Cedocard tablet Non Generik Tablet, box = 60 buah Box 119,000
104 Cefadroxil 500 mg tablet Generik Kapsul, box = 100 buah Kapsul 120,000
105 Cefila 100 mg kapsul Non Generik Kapsul, box = 30 buah Kapsul 923,000
106 Cefixime 200 mg kapsul Generik Kapsul, box = 50 buah Kapsul 611,000
107 Cefixime sirup kering Generik Sirup kering, botol = 30 ml Sirup 34,000
108 Cendo Fenicol Tetes Mata Non Generik Larutan Tetes Mata, botol =
5 mlBotol 48,000
109 Cendo Lyteers Tetes Mata Non Generik Cairan, Botol=15ml Botol 44,000
110 Cendo Pantocain Tetes Mata Non Generik Larutan Tetes Mata, botol =
5 mlBotol 26,000
111 Cendo Xitrol Minidose Tetes Mata Non Generik Larutan Tetes Mata, Strip =
5 fls, 1 fls = 0,6 mlStrip 62,000
112 Cendo Xitrol Tetes Mata Non Generik Larutan Tetes Mata, botol =
5 mlBotol 54,000
113 Ceptik 100 mg kapsul Non Generik Kapsul, box = 30 buah Box 1,134,000
114 Ceptik sirup kering Non Generik Sirup kering, botol = 30 ml Botol 153,000
115 Cerebrofort Gold Sirup Non Generik Sirup, botol = 200 ml Botol 45,000
116 Cetirizine tablet Generik Tablet, box = 50 buah Box 30,000
117 Chloramfecort Krim Non Generik Krim, tube= 10gr Tube 24,000
118 Ciprofloxacin 500 mg tablet Generik Tablet, box = 100 buah Box 80,000
119 Clindamycin 300 kapsul Generik Kapsul, box = 50 buah Box 67,000
120 Clindamycin Novell 300 mg kapsul Generik Berlogo Kapsul, box = 50 buah Box 116,000
121 Clinium 1% Gel Non Generik Gel, tube = 15 gram Tube 64,000
122 Clobazam 10 mg tablet Generik Tablet, box = 100 buah Box 199,000
123 Clopidogrel tablet Generik Tablet, box = ... buah Box 606,000
124 Co-amoxiclav Generik Tablet, box = 30 buah Box 291,000
125 Co-amoxiclav sirup kering Generik Sirup kering, botol = 6 ml Botol 60,000
126 Colme Tetes Mata Non Generik Larutan, botol = 8 ml Botol 50,000
- 61 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
127 Colme Tetes Telinga Non Generik Larutan, botol = 8 ml Botol 60,000
128 Combantrin tablet Non Generik Tablet, box = 50 buah Box 498,000
129 Combantrin tablet Non Generik Tablet, box = 30 buah Box 297,000
130 Combivent Nebulizer Non Generik Larutan Nebulizer, Box = 10
buahBox 364,000
131 Comtusi Sirup Non Generik Sirup, botol = 100ml Botol 101,000
132 Coten 30 mg tablet Non Generik Tablet, box = 30 buah Box 47,000
133 Coten 30 mg tablet Non Generik Tablet, box = 100 buah Box 297,000
134 Cotrimoxazole 480 mg tablet Generik Tablet, box = 100 buah Box 65,000
135 Counterpain Cool krim Non Generik Krim, tube = 30 gram Tube 65,000
136 Counterpain krim Non Generik Krim, tube = 30 gram Tube 81,000
137 Crystalline air mineral Non Generik Air mineral cup, karton = 48
cup Karton 41,000
138 Curcuma tablet Non Generik Tablet, box = 100 buah Box 175,000
139 D Vit Sirup Non Generik Sirup, botol = 100 ml Botol 68,000
140 Danason tablet Non Generik Tablet, box = 200 buah Box 40,000
141 Degirol tablet Non Generik Tablet, box = 100 buah Box 142,000
142 Dexacap 12,5 mg tablet Non Generik Tablet, box = 60 buah Box 25,000
143 Dexacap 25 mg tablet Non Generik Tablet, box = 60 buah Box 38,000
144 Dexamethasone 0,5 mg tablet Generik Tablet, box = 100 buah Box 12,000
145 Dexanta tablet Non Generik Tablet, box = 100 buah Box 48,000
146 Dexazol tablet Non Generik Tablet, box = 50 buah Box 73,000
147 Dexmolex sirup Non Generik Sirup, botol = 60 ml Botol 15,000
148 Dextamine tablet Non Generik Tablet, box = 300 buah Box 901,000
149 Dexteem Plus tablet Non Generik Tablet, box = 100 buah Box 42,000
150 Dextral tablet Non Generik Tablet, box = 100 buah Box 155,000
151 Dexymox 500 mg tablet Non Generik Tablet, box = 100 buah Box 142,000
152 Dhavit Sirup Non Generik Sirup, botol = 60 ml Botol 49,000
153 Diabemin 500 mg tablet Non Generik Tablet, box = 100 buah Box 56,000
154 Diaformin XR tablet Non Generik Tablet, box = 100 buah Box 317,000
155 Diflam 50 mg tablet Non Generik Tablet, box = 50 buah Box 295,000
156 Digenta krim Non Generik Krim, tube = 10 gram Tube 141,000
157 Digoksin 0,0625 mg tablet Generik Tablet, botol = 100 buah Botol 16,000
158 Digoxin 0.25 mg tablet Generik Tablet, box = 100 buah Box 24,000
159 Dimenhidrinat 50 mg Tablet Generik Tablet, botol = 100buah Botol 57,000
160 Disflatyl tablet Non Generik Tablet, box = 100 buah Box 115,000
161 Dom tablet Non Generik Tablet, box = 30 buah Box 52,000
162 Dom tablet Non Generik Tablet, box = 100 buah Box 151,000
163 Domperidon tablet Generik Tablet, Box = 100 buah Box 41,000
164 Doxycycline 100 mg tablet Generik Tablet, box = 100 buah Box 151,000
165 Doxycycline 100 mg tablet Generik Tablet, box = 30 buah Box 52,000
166 Dramamine tablet Non Generik Tablet, Box = 100 buah Tablet 330,000
167 Dumin 500 mg tablet Non Generik Kaplet, boks = 1000 buah Box 693,000
168 Dumocalcin tablet Non Generik Tablet, Box = 100 buah Box 58,000
169 Eclide 100 mg tablet Non Generik Tablet, Box = 100 buah Box 169,000
- 62 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
170 Eflin tablet Non Generik Tablet, box = 100 buah Box 227,000
171 Emturnas forte tablet Non Generik Tablet, box = 100 buah Box 38,000
172 Enervon C tablet effervescent Non Generik Tablet effervescent, botol =
10 buahBotol 46,000
173 Enervon C tablet Non Generik Tablet, box = 100 buah Box 180,000
174 Enzyplex tablet Non Generik Tablet, Box = 100 buah Box 175,000
175 Erlamycetin Salep Mata Non Generik Salep Mata, tube = 5 g Tube 11,000
176 Erlamycetin Tetes Mata Non Generik Tetes Mata, Botol = 5 mL Botol 19,000
177 Erlamycetin Tetes Telinga Non Generik Tetes Telinga, Botol = 5 mL Botol 27,000
178 Eryra 500 mg tablet Non Generik Tablet, box = 100 buah Box 205,000
179 Erythrin 500 mg tablet Non Generik Kaplet, botol = 50 buah Botol 554,000
180 Erythromycin 500 mg tablet Generik Kaplet, box = 50 buah Box 270,000
181 Esvat 20 mg tablet Non Generik Tablet, box = 30 buah Box 65,000
182 Etabion tablet Non Generik Tablet, Box = 100 buah Box 169,000
183 Ethambutol HCL 250 mg tablet Generik Tablet, box = 200 buah Box 146,000
184 Exaflam tablet Non Generik Tablet, box = 50 buah Box 260,000
185 Farmalat tablet Non Generik Tablet,box = 100 buah Box 61,000
186 Farnormin 50 mg tablet Non Generik Tablet, box = 100 buah Box 75,000
187 Farsifen sirup Non Generik Sirup, botol = 60 ml Botol 11,000
188 Farsix tablet Non Generik Tablet, box = 100 buah Box 178,000
189 Fasidol plus tablet Non Generik Tablet, box = 100 buah Box 57,000
190 Fasolon krim Non Generik Krim, tube = 10 g Tube 37,000
191 Fasorbid 5 mg tablet Non Generik Tablet, box = 100 buah Box 38,000
192 Fenamin tablet Non Generik Tablet, box = 100 buah Box 88,000
193 Fenitoin 100 mg kapsul Generik Kapsul, box = 100 buah Box 26,000
194 Fenitoin Natrium 30 mg kapsul Generik Kapsul, box = 100 buah Box 20,000
195 Fenofibrat 100 mg tablet Generik Tablet, box = 30 buah Box 92,000
196 Fenofibrat 300 mg tablet Generik Tablet, box = 30 buah Box 154,000
197 Fenol Gliserol 10% Tetes Telinga GenerikTetes Telinga, botol = 5 mL,
box = 24 buahBox 51,000
198 Ferlin drop Non Generik Drop, botol = 30 ml Botol 68,000
199 Ferlin sirup Non Generik Sirup, botol = 100 ml Botol 75,000
200 Fexazol krim Non Generik Krim, tube = 5 gram Tube 13,000
201 FG Troches Non Generik Tablet isap, box = isi 300
buahBox 525,000
202 FG Troches Non Generik Tablet, box = 120 buah Box 236,000
203 Fitbon Non Generik Salut selaput, box = 60
buahBox 169,000
204 Fituno Non Generik Tablet, box = 300 buah Box 249,000
205 Fladex Non Generik Tablet, box = 100 buah Box 75,000
206 Flamar gel 20g Non Generik Jel, tube = 20gr Tube 48,000
207 Flamigra tablet Non Generik Tablet,box = 50 buah Box 29,000
208 Flammar 25 mg tablet Non Generik Tablet, Box = 100 buah Box 135,000
- 63 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
209 Flammar Gel Non Generik Gel, tube = ... Gr Tube 29,000
210 Flexor DS Kaplet Non Generik Kaplet, box = 60 buah Box 587,000
211 Flexor Kaplet Non Generik Kaplet, box = 30 buah Box 170,000
212 Flu Tab, tablet Non Generik Tablet, box = 120 buah Box 152,000
213 Flunarizin tablet Non Generik Tablet, Box = 100 buah Box 71,000
214 Flutrop tablet Non Generik Tablet, box = 100 buah Box 114,000
215 Folavit tablet Non Generik Tablet, box = 100 buah Box 127,000
216 Forelax tablet Non Generik Tablet, box = 50 buah Box 334,000
217 Forres 50 tablet Non Generik Tablet, box = 50 buah Box 463,000
218 ForumenTetes Telinga Non Generik Larutan, botol = 10 ml Botol 47,000
219 Frego 5 mg tablet Non Generik Tabet, box = 50 buah Box 455,000
220 Fungares krim Non Generik Krim, tube = 5 gram Tube 34,000
221 Furosemid 40 mg tablet Generik Tablet, box = 100 buah Box 22,000
222 Gameksan 1% Lotion Non Generik Lotion, botol = 30 mL Botol 5,000
223 Gemfibrozil 300 kapsul Generik Kapsul, box = 100 buah Box 131,000
224 Gentalex krim Non Generik Krim, tube = 5 gram Tube 7,000
225 Gentamisin krim Generik Krim, tube = 5 gr Tube 11,000
226 Gentamisin salep Generik Salep, tube =5 gram Tube 14,000
227 Gitas Plus kapsul Non Generik Kapsul, box = 50 buah Box 535,000
228 Glemipered 1 mg tablet Non Generik Tablet, Box = 100 buah Box 189,000
229 Glemipered 2 mg tablet Non Generik Tablet, Box = 100 buah Box 256,000
230 Glibenclamid 5 mg tablet Generik Tablet, Box = 100 buah Box 60,000
231 Glikos 850 mg tablet Non Generik Tablet, box = 100 buah Box 70,000
232 Glimepiride 1 tablet Generik Tablet, box = 50 buah Box 41,000
233 Glimepiride 2 tablet Generik Tablet, box = 50 buah Box 75,000
234 Glimepiride 3 tablet Generik Tablet, box = 100 buah Box 149,000
235 Glitaven Sirup Non Generik Sirup, botol = 100 ml Botol 73,000
236 Glucophance tablet Non Generik Tablet, Box = 100 buah Box 371,000
237 Glucosamine MPL tablet Non Generik Tablet, box = 100 buah Box 438,000
238 Glukosa 40% Larutan Steril Non Generik Larutan Steril, botol = 25
mL, box = 10 buahBox 31,000
239 Glunor XR 500 tablet Non Generik Tablet, box = 30 buah Box 102,000
240 Gluvas 1 mg tablet Non Generik Tablet, box = 50 buah Box 194,000
241 Goron tablet Non Generik Tablet, box = 100 buah Box 324,000
242 Hansaplast Elastis Plester Kain Non Generik Plester, box = 100 lembar Box 43,000
243 Hansaplast Koyo (Hangat) Non Generik Koyo, box = 100 lembar Box 118,000
244 HCT tablet Generik Tablet, box = 100 buah Box 42,000
245 Hexadol sirup Non Generik Sirup, botol = 100 ml Botol 44,000
246 Hico Gel Non Generik Gel, tube = 10 gram Tube 33,000
247 Hidrocortisone 1% krim Generik Krim, tube =5 gram Tube 23,000
248 Hidrocortisone 2,5% krim Generik Krim, tube =5 gram Tube 18,000
249 Histapan tablet Non Generik Tablet, box = 100 buah Box 103,000
- 64 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
250 Hufagrip batuk pilek, sirup NPP Sirup, botol = 60 ml Botol 27,000
251 Hufanoxil sirup Non Generik Sirup, botol = 60 ml Botol 11,000
252 Hufaxol sirup Non Generik Sirup, botol = 60 ml Botol 11,000
253 Ibuprofen 400 mg tablet Generik Tablet, box = 100 buah Box 44,000
254 Ichtiol salep Non Generik Salep, box = 12 buah Box 132,000
255 Imboost kaplet Non Generik Kaplet, box = 30 buah Box 326,000
256 Imodium 2mg tablet Non Generik Tablet, strip = 10 buah Strip 135,000
257 Indexon tablet Non Generik Tablet, box = 100 buah Box 117,000
258 Inpepsa Sirup Non Generik Suspensi, botol=200ml Botol 149,000
259 Internolol tablet Non Generik Tablet, box = 30 buah Box 178,000
260 Interzinc tablet Non Generik Tablet, box = 10 buah Box 57,000
261 Intunal Forte tablet Non Generik Tablet, box = 100 buah Box 155,000
262 Intunal Sirup Non Generik Sirup, botol = 60 ml Botol 22,000
263 Iodiol Kapsul lunak Non Generik Kapsul lunak, botol = 100
buahBotol 195,000
264 Irbesartan 150 mg tablet Generik Tablet, box = 50 buah Box 139,000
265 Iremax tablet Non Generik Tablet, box = 100 buah Box 179,000
266 Ironyl kaplet Non Generik Kaplet, box = 100 buah Box 500,000
267 ISDN 5 mg tablet Generik Tablet, Box = 100 buah Box 41,000
268 Isoric 300 tablet Non Generik Tablet, box = 50 buah Box 343,000
269 Kalcinol N krim Non Generik Krim, tube = 5 g Tube 19,000
270 Kalium Diklofenac 50 mg tablet Generik Tablet, box = 50 buah Box 48,000
271 Kalium Klorida 300 mg tablet Generik Tablet, tube = 10 buah Tube 7,000
272 Kenalog in orabase, krim Non Generik Krim, tube = 5 gram Tube 90,000
273 Ketoconazole 2% krim Generik Krim, tube = 15 gram Tube 27,000
274 Ketoconazole 200 mg tablet Generik Tablet, box = 50 buah Box 40,000
275 Ketoprofen 100 mg tablet Generik Kapsul, box = 100 buah Box 283,000
276 Kloramfenikol 0,5% Tetes Mata Generik Tetes Telinga, botol = 5 mL Botol 6,000
277 Kloramfenikol 3 % Tetes Mata Generik Tetes Telinga, botol = 5 mL Botol 4,000
278 Klorfeson salep Non Generik Krim, tube = 5 gram Tube 19,000
279 Klorokuin 250 mg tablet Generik Kapsul, box = 100 buah Box 23,000
280 Kodein 30 mg tablet NPP Tablet, botol = 20 buah Botol 14,000
281 Kuinidin 200 mg tablet Generik Kapsul, box = 100 buah Box 88,000
282 L Bio granul sachet Non Generik Granul sachet, sachet = 1
gr, box = 30 buahSachet 14,000
283 L Bio kapsul Non Generik Kapsul, box = 30 buah Box 290,000
284 L Cisin tablet Non Generik Tablet, box = 30 buah Box 181,000
285 Lacto B granul sachet Non Generik Granul sachet, sachet = 1
gr, box = 40 buahBox 357,000
286 Lactrin tablet Non Generik Tablet, box = 30 buah Box 115,000
287 Laflanac 25 mg tablet Non Generik Tablet, box = 100 buah Box 23,000
288 Lambucid tablet Non Generik Tablet, box = 200 buah Box 88,000
289 Laminine tablet Non Generik Kapsul, box = 30 buah Box 1,111,000
- 65 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
290 Lanovit tablet Non Generik Tablet, box = 50 buah Box 112,000
291 Lansoprazole kapsul Generik Kapsul, box = 20 buah Box 34,000
292 Lapibroz 600 kaplet Non Generik Kaplet, box = 30 buah Box 190,000
293 Lasal 2 mg tablet Non Generik Tablet, box = 100 buah Box 161,000
294 Lasal sirup Non Generik Sirup, botol = 100 ml Botol 41,000
295 Laserin sirup Non Generik Sirup, botol = 60 ml Botol 15,000
296 Latibet tablet Non Generik Tablet, box = 100 buah Box 48,000
297 Lelap tablet Non Generik Tablet, box = 100 buah Box 442,000
298 Levemir Flexpen Non Generik Flexpen, box = 5 buah Box 1,205,000
299 Levofloxacin tablet Generik Tablet, box = 100 buah Box 122,000
300 Lexacorton krim Non Generik Krim, tube = 5 gram Tube 11,000
301 Lexcomet tablet Non Generik Tablet, box = 100 buah Box 122,000
302 Lexcomet tablet Non Generik Tablet, box = 50 buah Box 85,000
303 Lexigo tablet Non Generik Tablet, box = 30 buah Box 27,000
304 Licokalk tablet Non Generik Tablet, box = 100 buah Box 33,000
305 Lincocin 500 mg kapsul Non Generik Kapsul, box = 30 buah Box 561,000
306 Lincomycin 500 mg kapsul Generik Kapsul, box = 60 buah Box 137,000
307 Lipitor tablet Non Generik Tablet, Box = 100 buah box 667,000
308 Lisinopril 20 mg tablet Generik Kapsul, box = 100 buah Box 46,000
309 Livron B plex tablet Non Generik Tablet, Box = 100 buah box 54,000
310 Lodia tablet Non Generik Tablet, box = 60 buah Box 93,000
311 Loperamid tablet Generik Tablet, Box = 100 buah Box 59,000
312 Loratadine tablet Generik Tablet, box = 50 buah Box 34,000
313 Loric 300 mg tablet Non Generik Tablet, box = 100 buah Box 116,000
314 Lostacef 125 mg sirup Non Generik Sirup kering, botol = 60 ml Botol 19,000
315 Lostacef 250 mg sirup Non Generik Sirup kering, botol = 60 ml Botol 26,000
316 L-zink Sirup Non Generik Sirup, botol = 100ml Botol 57,000
317 Maganol tablet Non Generik Kaplet, box = 120 buah Box 100,000
318 Magtral tablet Non Generik Tablet, Box = 100 buah Box 108,000
319 Mebendazol 100 mg/mL sirup Generik Sirup, botol 30 mL Botol 8,000
320 Mebendazol 500 mg tablet Generik Kapsul, box = 100 buah Box 50,000
321 Mebo krim Non Generik Krim, tube = 20 gram Tube 162,000
322 Mecobalamin tablet Generik Tablet, Box = 100 buah Box 125,000
323 Mecolin kapsul Non Generik Kapsul, box = 50 buah Box 186,000
324 Mefinal tablet Non Generik Tablet, Box = 100 buah Box 223,000
325 Mefinter 500 mg kapsul Non Generik Kapsul, box = 50 buah Box 369,000
326 Megabal kapsul Non Generik Kapsul, box = 100 buah Box 369,000
327 Meloxicam 7,5 mg Generik Tablet, box = 100 buah Box 175,000
328 Meloxicam suppositoria Generik Suppositoria, box = 10 buah Box 138,000
329 Merislon 6 mg tablet Non Generik Tablet, box = 100 buah Box 828,000
330 Mertigo tablet Non Generik Tablet, Box = 100 buah Box 505,000
- 66 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
331 Metformin 500 mg tablet Generik Tablet, box = 100 buah Box 31,000
332 Metformin 850 mg tablet Generik Tablet, Box = 100 buah Box 81,000
333 Metil prednisolon tablet Generik Tablet, Box = 100 buah Box 81,000
334 Metolon tablet Non Generik Tablet, box = 100 buah Box 104,000
335 Metrison 4 mg tablet Non Generik Tablet, box = 100 buah Box 463,000
336 Metronidazol Novell tablet Generik Berlogo Tablet, Box = 100 buah Box 91,000
337 Metronidazol tablet Generik Tablet, box = 100 buah Box 47,000
338 Miconazole 2 % krim Generik Krim, tube = 10 Gr Tube 11,000
339 Minyak Kayu Putih "Cap Lang" Non Generik Larutan, botol = 30 ml Botol 20,000
340 Minyak Kayu Putih "Cap Lang" Non Generik Larutan, botol = 60 ml Botol 32,000
341 Minyak Kayu Putih "Sidola" Non Generik Larutan, botol = 15 ml Botol 10,000
342 Minyak Kayu Putih "Sidola" Non Generik Larutan, botol = 30 ml Botol 20,000
343 Minyak Tawon DD 30 ml Non Generik Larutan, botol = 30 ml Botol 35,000
344 Minyak Telon "Konicare" Non Generik Larutan, botol = 30 ml Botol 18,000
345 Moladerm krim Non Generik Krim, tube = 10 gram Tube 11,000
346 Molafate sirup Non Generik Sirup, botol = 60 ml Botol 31,000
347 Molagit tablet Non Generik Tablet, box = 150 buah Box 107,000
348 Molakrim, krim Non Generik Krim, tube = 30 gram Tube 24,000
349 Molaneuron tablet Non Generik Tablet, box = 50 buah Box 45,000
350 Molapect sirup Non Generik Sirup, botol =60 mL Botol 21,000
351 Molavir krim Non Generik Krim, tube = 5 gram Tube 14,000
352 Molazol tablet Non Generik Tablet, box = 100 buah Box 53,000
353 Molexdryl sirup Non Generik Sirup, botol = 60 ml Botol 9,000
354 Molexflu tablet Non Generik Tablet, box = 100 buah Box 93,000
355 Mometason krim Non Generik Krim, tube = 5 gram Tube 40,000
356 Motilex tablet Non Generik Tablet, box = 100 buah Box 249,000
357 Mucera tablet Non Generik Tablet, box = 100 buah Box 155,000
358 Mucohexin sirup Non Generik Sirup, botol = 120 ml Botol 25,000
359 Mucohexin tablet Non Generik Tablet, box = 100 buah Box 79,000
360 Mucos Drop Non Generik Sirup, botol = 20ml Botol 68,000
361 Musin sirup Non Generik Sirup, botol = 120 ml Botol 81,000
362 Musin tablet Non Generik Tablet, Box = 100 buah Box 135,000
363 Nasamol tablet Non Generik Tablet, Box = 100 buah Box 48,000
364 Natrium Diclofenac 50 mg tablet Generik Tablet, box = 50 buah Box 21,000
365 Neo Kaominal sirup Non Generik Larutan, botol = 30 ml Botol 13,000
366 Neomisin 500 mg kapsul Generik Kapsul, box = 100 buah Box 67,000
367 Nephrolit Non Generik Tablet, box = 100 buah Box 92,000
368 Nerva Plus Non Generik Kaplet, box = 50 buah Box 255,000
369 Neuralgin XR 500 Non Generik Kaplet, box = 100 buah Box 126,000
370 Neurobat tablet Non Generik Tablet, box = 100 buah Box 457,000
371 Neurobion Non Generik Kaplet, box = 250 buah Box 662,000
- 67 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
372 Neurodex Non Generik Tablet, box = 100 buah Box 229,000
373 Neurohax 5000 Non Generik Tablet, box = 50 buah Box 192,000
374 Neurovit E Non Generik Tablet, box = 60 buah Box 118,000
375 Nevox XR 500 Non Generik Tablet, box = 30 buah Box 112,000
376 Nevox XR 500 Non Generik Tablet, box = 30 buah Box 112,000
377 New diatab Non Generik Tablet, Box = 100 buah Box 107,000
378 Nicoflam Non Generik Tablet, Box = 100 buah Box 162,000
379 Nifedipine 10 mg Generik Tablet, box = 100 buah Box 30,000
380 Nilapur 300 mg Non Generik Tablet, Box = 100 buah Box 159,000
381 Nodiar tablet Non Generik Tablet, box = 100 buah Box 108,000
382 Noperten Non Generik Tablet, Box = 100 buah Box 159,000
383 Norit Carbo Activatus tablet Non Generik Tablet, pot = 20 buah Pot 26,000
384 Novatrim sirup Non Generik Sirup, botol = 60 ml Botol 13,000
385 Novomix 30 Flexpen Non Generik Flexpen, box = 5 buah Box 1,209,000
386 Nucral Sirup Non Generik Sirup, botol = 100 ml Box 90,000
387 Nucral tablet Non Generik Tablet, box = 60 buah Box 189,000
388 Nufit kaplet Non Generik Kaplet, box = 20 buah Box 256,000
389 Nutradon sirup Non Generik Sirup, botol = 60 ml Botol 7,000
390 OBH Non Generik Sirup, botol = 60 mL Botol 14,000
391 OBH Combi Batuk Berdahak Non Generik Sirup, botol = 100 ml Botol 41,000
392 OBH Combi Batuk Kering Non Generik Sirup, botol = 100 ml Botol 41,000
393 OBH Combi Batuk Pilek Non Generik Sirup, botol = 100 ml Botol 34,000
394 OBH Nelco Special sirup Non Generik Sirup, botol = 100 ml Botol 56,000
395 Omega-3 Fish Oil 1000 Wellness Non Generik Softcapsul, botol = 150 buah Botol 337,000
396 Omeprazole 20 mg kapsul Generik Kapsul, box = 30 buah Box 48,000
397 Omeprazole Novell kapsul Generik Berlogo Kapsul, Box = 30 buah Box 68,000
398 Opiglit 15 mg tablet Non Generik Tablet, box = 30 buah Box 202,000
399 Opilax sirup Non Generik Sirup, botol = 60 ml Botol 77,000
400 Opimox tablet Non Generik Tablet, Box = 100 buah Box 357,000
401 Opipas tablet Non Generik Tablet, Box = 100 buah Box 525,000
402 Opistan tablet Non Generik Tablet, box = 100 buah Box 105,000
403 Opram tablet Non Generik Tablet, box = 100 buah Box 87,000
404 Orphen tablet Non Generik Tablet, box = 100 buah Box 29,000
405 Ostela Forte Non Generik Tablet, box = 30 buah Box 404,000
406 Otopain Tetes Telinga Non Generik Tetes Telinga, botol = 8 ml Botol 95,000
407 Oxytetracycline 1% Salep Mata Generik Krim, Tube = 3,5gr Tube 19,000
408 Pamol 125 mg suppositoria Non Generik Suppositoria, box = 12 buah Box 216,000
409 Pamol 250 mg suppositoria Non Generik Suppositoria, box = 12 buah Box 311,000
410 Pamol Sirup Non Generik Sirup, botol = 60 ml Botol 41,000
411 Pamol tablet Non Generik Tablet, Box = 100 buah Box 311,000
412 Panadol biru, tablet Non Generik Tablet, Box = 100 buah Box 47,000
413 Papaverin 40 mg tablet Generik Tablet, box = 100 buah Box 81,000
- 68 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
414 Paracetamol 500 tablet Generik Tablet, box = 100 buah Box 19,000
415 Paramex tablet Non Generik Tablet, Box = 100 buah Box 125,000
416 Paratusin Sirup Non Generik Sirup, botol = 60ml Botol 46,000
417 Pasaba cough & flu sirup Non Generik Sirup, botol = 60 ml Botol 11,000
418 Perilax tablet Non Generik Tablet, box = 50 buah Box 340,000
419 Pharmaton Formula kapsul Non Generik Kapsul, box = 20 buah Box 354,000
420 Pharolit sachet Non Generik Sachet, box = 60 buah Box 119,000
421 Piracetam 400 mg tablet Generik Tablet, box = 100 buah Box 95,000
422 Piroksikam 10 mg tablet Generik Tablet, box = 100 buah Box 18,000
423 Piroksikam 20 mg tablet Generik Tablet, box = 100 buah Box 22,000
424 PK serbuk, pot Non Generik Pot, Box = 12 pot Box 62,000
425 Plasminex tablet Non Generik Tablet, box = 100 buah Box 396,000
426 Polysilane tablet Non Generik Tablet, box = 40 buah Box 62,000
427 Ponflu Sirup Non Generik Sirup, botol = 60 ml Botol 33,000
428 Ponsamic 500 tablet Non Generik Tablet, box = 100 buah Box 269,000
429 Povidone Iodine Solution Non Generik Solution, botol = 60ml Botol 22,000
430 Pravastatin 10 mg tablet Generik Tablet, box = 30 buah Box 92,000
431 Praxion drop Non Generik Drop, Botol = 15 ml Botol 48,000
432 Prazikuantel 600 mg tablet Generik Tablet, box = 100 buah Box 356,000
433 Prednison tablet Generik Tablet, pot = 100 buah Pot 27,000
434 Pritacort tablet Non Generik Tablet, box = 100 buah Box 120,000
435 Pritagesic tablet Non Generik Tablet, box = 100 buah Box 83,000
436 Pritavit kaplet Non Generik Kaplet, box = 100 buah Box 149,000
437 Prodexon kaplet Non Generik Kaplet, box = 100 buah Box 65,000
438 Prometazin 25 mg tablet Generik Tablet, box = 100 buah Box 11,000
439 Pronalges tablet Non Generik Tablet, box = 50 buah Box 205,000
440 Proneuron kaplet Non Generik Kaplet, box = 200 buah Box 537,000
441 Propanolol 10 mg tablet Generik Tablet, box = 100 buah Box 14,000
442 Propil Tio Urasil 50 mg tablet Generik Tablet, box = 100 buah Box 442,000
443 Provagin ovula Non Generik Ovula, box = 10 buah Box 202,000
444 Pulmicort Respules Non Generik Respules, Box= 10 Respules Box 451,000
445 Pure Kids Inhalant Decongestan Oil Non Generik Inhalant Decongestan Oil,
botol = 10 mlBotol 82,000
446 Pyrexin 80 mg suppositoria Non Generik Supposituria, box = 10 buah Box 119,000
447 Radin tablet Non Generik Tablet, box = 30 buah Box 30,000
448 Ramipril 2,5 mg tablet Generik Tablet, box = 100 buah Box 63,000
449 Ranitidin 150 mg tablet Generik Tablet, box = 100 buah Box 61,000
450 Redoxon tablet effervescent Non Generik Tablet efferves, botol = 10
buahBotol 56,000
451 Rhinofed sirup Non Generik Sirup, Botol = 60 ml Botol 54,000
452 Rhinos Drop Non Generik Sirup, botol = 10ml Botol 77,000
453 Rillus Tablet Non Generik Tablet, box = 30 buah Box 364,000
454 Sagestam salep Non Generik Salep, tube = 10 gram Tube 22,000
- 69 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
455 Salbutamol sirup Generik Sirup, botol = 100 ml Botol 10,000
456 Salbutamol tablet Generik Tablet, Box = 100 buah Box 41,000
457 Salonpas koyo Non Generik Lembar, box = 120 lembar Box 101,000
458 Sanadryl DMP Sirup Non Generik Sirup, botol = 60ml Botol 22,000
459 Sangobion sirup VITA TONIK Non Generik Sirup, Botol=400 ml Botol 54,000
460 Sangobion Tab Non Generik Tablet, box = 250 buah Box 471,000
461 Sanmol forte sirup Non Generik Sirup, botol = 60 ml Botol 38,000
462 Sanmol sirup Non Generik Sirup, botol = 60 ml Botol 21,000
463 Sanmol tablet Non Generik Tablet, box = 100 buah Box 48,000
464 Sanprima forte tablet Non Generik Tablet, box = 100 buah Box 295,000
465 Scabimite Salep Non Generik Salep, tube = 10 gram Tube 72,000
466 Scopma tablet Non Generik Tablet, Box = 100 buah Box 330,000
467 Sefiksim 50 mg kapsul Generik Tablet, box = 30 buah Box 63,000
468 Selespurin 100 mg tablet Non Generik Tablet, box = 100 buah Box 42,000
469 Selespurin 300 mg tablet Non Generik Tablet, box = 100 buah Box 60,000
470 Siladex sirup Non Generik Cair, Botol=100 ml Botol 34,000
471 Simvastatin 10 mg tablet Generik Tablet, box = 50 buah Box 50,000
472 Simvastatin 20 mg tablet Generik Tablet, box = 50 buah Box 101,000
473 Sofratule gauge Non Generik Gauge, lembar Lembar 41,000
474 Solaxin tablet Non Generik Tablet, Box = 100 buah Box 754,000
475 Solvinex sirup Non Generik Sirup, botol = 100 ml Botol 25,000
476 Spasminal tablet Non Generik Tablet, Box = 100 buah Box 88,000
477 Spiramycin 500 mg tablet Generik Tablet, box = 50 buah Box 191,000
478 Spiranter 500 mg tablet Non Generik Tablet, box = 100 buah Box 1,447,000
479 Starmuno Kids Sirup Non Generik Sirup, botol = 60ml Botol 122,000
480 Stator 10 mg tablet Non Generik Tablet, box = 30 buah Box 833,000
481 Stator 20 mg tablet Non Generik Tablet, box = 300 buah Box 889,000
482 Stesolid Rectal Tube 10 mg NPP Larutan rectal, tube = 2,5 ml Tube 330,000
483 Stesolid Rectal Tube 5 mg NPP Larutan rectal, tube = 2,5 ml Tube 220,000
484 Stimuno Forte kapsul Non Generik Kapsul, Box = 60 buah Box 142,000
485 Sucralfat sirup Non Generik Sirup, botol = 100 ml Botol 61,000
486 Superhoid suppositoria Non Generik Supposituria, box = 6 buah Box 54,000
487 Suprafenid suppositoria Non Generik Supposituria, box = 10 buah Box 175,000
488 Talk Salisil bedak Non Generik Bedak Talk, pot = 60 gram Pot 11,000
489 Talk Salisil KF bedak Non Generik Bedak Talk, Pot = 60 gram Pot 12,000
490 Talk Salisil IKA bedak Non Generik Bedak Talk, Botol = 80 gram Botol 23,000
491 Tensivas tablet Non Generik Tablet, Box = 100 buah Box 488,000
492 Teofilin 150 mg tablet Generik Tablet, box = 100 buah Box 12,000
493 Tera F kaplet Non Generik Kaplet, box = 100 buah Box 63,000
494 Teranol tablet Non Generik Tablet, box = 30 buah Box 247,000
- 70 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
495 Terbutalin 2,5 mg tablet Generik Tablet, box = 50 buah Box 11,000
496 Test pack kehamilan Sensitif strip Non Generik Strip, unit = 1 strip Unit 35,000
497 Thiamfilex 500 mg tablet Non Generik Tablet, box = 100 buah Box 116,000
498 Thiamphenicol 500 mg Generik Tablet, box = 100 buah Box 223,000
499 Thiamycin 500 mg tablet Generik Kapsul, box = 100 buah Box 768,000
500 Thrombo Aspilet tablet Non Generik Tablet, Box = 100 buah Box 101,000
501 Thrombogel Non Generik Gel, tube = 10 gram Tube 57,000
502 Thrombophob Gel Non Generik Gel, tube = 20 gram Tube 92,000
503 Tolak Angin sachet Non Generik Sachet, box= 12 sachet Box 46,000
504 Tranec kaplet Non Generik Kaplet, box = 50 buah Box 247,000
505 Transamin tablet Non Generik Tablet, Box = 100 buah Box 397,000
506 Tremenza Tablet NPP Tablet, box = 100 buah Box 26,000
507 Triadex sirup Non Generik Sirup, botol = 60 ml Botol 21,000
508 Triamcort tablet Non Generik Tablet, box = 100 buah Box 512,000
509 Tricela tablet Non Generik Tablet, Box = 100 buah Box 61,000
510 Trilac 4 mg tablet Non Generik Tablet, box = 30 buah Box 229,000
511 Triomin E tablet Non Generik Tablet, box = 100 buah Box 324,000
512 Tropydril sirup Non Generik Sirup, botol = 60 ml Botol 9,000
513 Ultraproct N krim Non Generik Krim, tube =10 gram Tube 182,000
514 Ultraproct N suppositoria Non Generik Suppositoria, box = 10 buah Box 155,000
515 Urineg tablet Non Generik Tablet, box = 100 buah Box 478,000
516 Urinter 400 kapsul Non Generik Kapsul, box = 100 buah Box 870,000
517 Valproat 150 mg tablet Generik Tablet, botol = 50 buah Botol 25,000
518 Valproat 250 mg tablet Generik Tablet, botol = 50 buah Botol 37,000
519 Vastigo tablet Non Generik Tablet, box = 100 buah Box 135,000
520 Ventolin inhaler Non Generik Inhaler, Box = 1 buah Box 182,000
521 Ventolin nebules Non Generik Nebules 2,5mL, box = 20
buahBox 317,000
522 Veridin tablet Non Generik Tablet, box = 30 buah Box 321,000
523 Versilon 4 mg tablet Non Generik Tablet, box = 100 buah Box 289,000
524 Versyl tablet Non Generik Tablet, box = 50 buah Box 162,000
525 Vibramox forte sirup Non Generik Sirup kering, botol = 60 ml Botol 22,000
526 Vicks Inhaler Non Generik Inhaler, tube = 0,5 ml Tube 22,000
527 Vicks Vaporub Non Generik Obat gosok, pot = 25 gram Pot 32,000
528 Visine Tetes Mata Non Generik Tetes Mata, Botol = 6 ml Botol 24,000
529 Vitamin B1 100 mg tablet Generik Tablet, box = 100 buah Box 17,000
530 Vitamin B6 tablet Generik Tablet, Botol = 100 buah Botol 27,000
531 Vitamin C 100 mg tablet Generik Tablet, box = 100 buah Box 11,000
532 Vitamin C 25 mg tablet Generik Tablet, Botol = 500 buah Botol 27,000
533 Vitamin K 10 mg tablet Generik Tablet, botol = 500 buah Botol 69,000
534 Voltadex gel Non Generik Gel, Tube = 20 gram Tube 42,000
- 71 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
535 Voltadex tablet Non Generik Tablet, Box = 50 buah Box 54,000
536 Voltaren Emulgel Non Generik Gel, tube = 10 gram Tube 74,000
537 Vometraz 4 mg tablet Non Generik Tablet, Box = 10 buah Box 25,000
538 Vometraz 4 mg tablet Non Generik Tablet, box = 100 buah Box 74,000
539 Vometraz 8 mg tablet Non Generik Tablet, Box = 10 buah Box 42,000
540 Vometraz 8 mg tablet Non Generik Tablet, box = 100 buah Botol 48,000
541 Vosedon sirup Non Generik Sirup, botol = 60 ml Box 48,000
542 Vosedon tablet Non Generik Tablet, box = 100 buah Box 361,000
543 Vosteon tablet Non Generik Tablet, box = 30 buah Pot 193,000
544 Wellmove tablet Non Generik Tablet, Box = 60 buah Box 236,000
545 Xanturic 300 tablet Non Generik Tablet, box = 50 buah Box 90,000
546 Yusimox sirup kering Non Generik Sirup kering, botol = 60 ml Botol 13,000
547 Zegren tablet Non Generik Tablet, box = 100 buah Box 196,000
548 Zenibroz kaplet Non Generik Kaplet, box = 30 buah Box 77,000
549 Zenirex sirup Non Generik Sirup, Botol = 60 mL Botol 11,000
550 Zensoderm krim Non Generik Krim, tube =10 gram Tube 106,000
551 Zentra kaplet Non Generik Kaplet, box = 100 buah Box 167,000
552 Zinc sulfate sirup Non Generik Sirup, botol = 60 ml Botol 13,000
553 Aqua pro Injeksi Non Generik Vial 25 mL, Box = 1 vial Vial 17,000
554 Benodon Injeksi Non Generik Vial 15 mL, Box = 10 vial Box 283,000
555 Decadryl Injeksi Non Generik Vial 15 mL, Box = 10 vial Box 438,000
556 Decadryl Injeksi Non Generik Vial 5 mL, Box = 10 vial Vial 37,000
557 Dexamethason Injeksi Generik Ampul, box = 10 buah Ampul 14,000
558 Gentamisin 80 mg/mL Injeksi Generik Vial, Box = 1 buah Box 8,000
559 Getidin Injeksi Non Generik Ampul mL, Box = 5 ampul Box 155,000
560 Indexon Injeksi Non Generik Ampul mL, Box = 5 ampul Box 88,000
561 Kalnex Injeksi Non Generik Ampul 5 mL, Box = 10 ampul Box 245,000
562 Kanamycin Injeksi Generik Vial 1 g, Box = 10 vial Box 207,000
563 Ketoprofen Injeksi Generik Ampul, box = 6 buah Box 71,000
564 Ketorolac Injeksi Generik Ampul, box = 10 buah Ampul 27,000
565 Lignocain Injeksi Non Generik Ampul, box = 10 ampul ampul 1,481,000
566 Metoklopramide 5mg/mL Injeksi Generik Ampul, box = 10 buah Box 21,000
567 Nairet Injeksi Non Generik Ampul, box = 5 ampul Box 186,000
568 Neurobion 5000 Injeksi Non Generik Ampul, box = 10 pasang Box 297,000
569 Neuroboran Injeksi Non Generik Vial 9 mL, Box = 10 vial Box 218,000
570 Ondane 4 mg Injeksi Non Generik Ampul, box = 5 buah Box 227,000
571 Ondane 8 mg Injeksi Non Generik Ampul, box = 5 buah Box 401,000
572 Primperan Injeksi Non Generik Ampul 2 mL, Box = 6 ampul Box 68,000
573 Ratinal Injeksi Non Generik Vial 2 mL, Box = 5 vial Box 186,000
574 Scopamin Injeksi Non Generik Ampul 1 mL, Box = 5 ampul Box 159,000
II. OBAT-OBATAN INJEKSI
- 72 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
575 Teranol Injeksi Non Generik Ampul, box = 6 buah Box 350,000
576 Tomit Injeksi Non Generik Ampul 2 mL, Box = 5 ampul Box 101,000
577 Trilac Injeksi Non Generik Vial 5 mL, Box = 10 vial Box 186,000
578 Vitamin B1 100 mg/mL njeksi Generik Ampul, box = 30 buah Box 49,000
579 Vitamin K Injeksi Generik Ampul, Box = 30 buah Box 110,000
580 Vitamin K Injeksi Generik Ampul, Box = 100 buah Box 303,000
581 Alkohol 70 % Non Generik Cairan, botol = 60 ml Botol 7,000
582 Alkohol 70 % Non Generik Cairan, botol = 100 ml Botol 17,000
583 Alkohol 70 % Non Generik Cairan, botol = 1 liter Botol 88,000
584 Dispossible Needle Nomor 24 G
"Terumo"Non Generik Box = 100 buah Box 256,000
585 Dispossible Syringe 1 ml "Terumo"
InsulinNon Generik Box = 100 buah Box 471,000
586 Dispossible Syringe 2,5 mL "Terumo" Non Generik Box = 100 buah Box 471,000
587 Dispossible Syringe 3 ml "Terumo" Non Generik Box = 100 buah Box 471,000
588 Dissposible Syringe 5 ml "Terumo" Non Generik Box = 100 buah Box 438,000
589 Dispossible Syringe 10 ml "Terumo" Non Generik Box = 100 buah Box 438,000
590 Abbocath Intravena Venisystems Non Generik Ukuran 20G Buah 19,000
591 Adrenalin Injeksi / Epinefrin Injeksi Generik Ampul, box = 10 ampul Ampul 18,000
592 Alcohol Swab "Onemed" Non Generik Box = 100 buah Box 41,000
593 Atropin 0,25 mg/mL Injeksi Generik Ampul, box = 100 ampul Box 875,000
594 Betadine solution Non Generik Cairan, botol = 30 ml Botol 31,000
595 Betadine solution Non Generik Cairan, botol = 15 ml Botol 17,000
596 Braided Silk Suture "Ethicon-Mersilk" Non Generik Sachet Sachet 213,000
597 Buscopan 20 mg/ml Non Generik Cairan, boks = 10 ampul Boks 60,000
598 Catgut Silk with Needle "OneMed" Non Generik Sachet Sachet 30,000
599 Cortison Asetat Injeksi Non Generik Vial 10 mL, Box = 10 vial Box 371,000
600 Cotton bud Non Generik Pak Pak 11,000
601Cum stainless, pinset, gunting, needle
holder (bahan bedah minor)Non Generik Unit = 1 unit Unit 54,000
602 Daryant-Tulle Non Generik Lembar, boks = 5 lembar Box 350,000
603 Decamidon Injeksi Non Generik Vial 15 mL Vial 34,000
604 Deksametason 5 mg/mL Injeksi Generik Ampul = 1ml Ampul 4,000
605 Diazepam 5 mg/mL Injeksi NPP Ampul, box = 30 ampul Box 162,000
606 Epinefrin Injeksi / Adrenalin Injeksi Generik Ampul, box = 10 buah Ampul 18,000
607 EpiPen / Epinefrin in Auto Injector Non Generik Pen Auto Injector, box = 2 buah Box 6,728,000
608 Glukosa 10 % larutan infus Non Generik Larutan Infus, botol = 500 mL Botol 11,000
609 Glukosa 40 % larutan infus Non Generik Ampul, box = 10 ampul Ampul 27,000
610 Glukosa 5 % larutan infus Non Generik Larutan Infus, botol = 500 mL Botol 10,000
611 Gunting Non Generik Stainless, gagang plastik Buah 48,000
612 H2O2 solution 100 mL Non Generik Larutan 3%, Botol Botol 13,000
III. OBAT/ BAHAN/ ALAT P3K DAN KEDARURATAN
- 73 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
613 Hansaplast Non Generik Box Box 68,000
614 Hansaplast Plester Kain Elastis Non Generik Lembar, boks = 100 lembar Box 48,000
615Hansaplast Plester Roll Kain 1,25 cm
x 1 m Non Generik Roll, box = 10 roll Box 59,000
616 Hypafix Plester Rol 5cm x 1 m Non Generik Plester Rol 5cm x 1 m Rol 88,000
617 Hypafix Plester Rol 10cm x 1 m Non Generik Plester Rol 10cm x 1 m Rol 162,000
618 Hypafix Plester Rol 20cm x 1 m Non Generik Plester Rol 20cm x 1 m Rol 404,000
619 Infus Set Terumo Non Generik Ukuran 1 ml 20 tetes Buah 14,000
620 ISDN 10 mg tablet Generik Tablet, box = 100 buah Box 41,000
621 ISDN 5 mg tablet Generik Tablet, box = 100 buah Box 21,000
622 Kanul Oksigen Nasal Bmed Non Generik Ukuran dewasa Buah 10,000
623 Kapas Lestari Non Generik Pack = 250 g Pack 38,000
624Kasa Pembalut Hidrofil 4 yrd x 10 cm
"Kasa Husada"Non Generik Roll, Pack = 5 roll Pack 64,000
625Kasa Pembalut Hidrofil 4 yrd x 6 cm
"Kasa Husada"Non Generik Roll, Pack = 5 roll Pack 64,000
626 Kasa Steril Hidrofil "Husada" Non Generik Box = 10 buah Box 16,000
627 Kasa Steril Hidrofil Lestari Non Generik Box = 16 buah Box 9,000
628 Kasa Perban Gulung 10 cm Lestari Non Generik Pack = 5 roll Pack 18,000
629 Kasa Perban Gulung 5 cm Lestari Non Generik Pack = 10 roll Pack 17,000
630 Kasa Perban Elastis Policrepe 6 inch Non Generik Roll = 1 buah Roll 162,000
631 Kasa Perban Elastis Policrepe 3 inch Non Generik Roll = 1 buah Roll 108,000
632 Kateter urine/Folley Catheter Silikon Non Generik Ukuran 16 Buah 14,000
633 Ketoprofen 100 mg suppositoria Generik Suppositoria, box = 10 buah Box 122,000
634 Klorpromazin 25 mg/mL Injeksi Generik Ampul 2ml, box = 30 ampul Box 50,000
635 Klorpromazin 5 mg/mL Injeksi Generik Ampul 2ml, box = 30 ampul Box 45,000
636 Lidocaine 2% Generik Cairan, ampul = 2 ml Ampul 14,000
637 Minyak Angin Roll Fresh Care Strong Non Generik Cairan, botol = 10 ml Botol 23,000
638 Minyak Kayu Putih "Cap Lang" Non Generik Cairan, botol = 15 ml Botol 10,000
639 Minyak Kayu Putih Cap Lang Non Generik Cairan, botol = 30 ml Botol 17,000
640 NaCl 0,9% larutan infus Non Generik Larutan, vial = 25 mL Vial 14,000
641 NaCl 0,9% larutan infus Non Generik Larutan Infus, Botol = 500 mL Botol 10,000
642 NaCl 0.9% larutan infus Non Generik Larutan Infus, Botol = 1000 mL Botol 21,000
643 Oksigen Refill Non Generik Tabung kecil Tabung 68,000
644 Oxycan Green Non Generik Can Aerosol Can 75,000
645 Pembalut Siku Mitela Non Generik Buah Buah 17,000
646 Povidone Iodine Generik Cairan, botol = 1 liter Botol 95,000
647 Primperan 5 mg/ml Non Generik Cairan, boks = 6 ampul Boks 87,000
648 Ranitidin 25 mg/ml Generik Cairan, ampul = 2 ml Ampul 4,000
649 Recodryl Non Generik Cairan, vial = 15 ml Vial 11,000
650 Rivanol Larutan Kompres Non GenerikLarutan kompres, botol = 100
mlBotol 9,000
651 RL larutan infus Non Generik Larutan Infus, Kolf = 500 mL Kolf 10,000
- 74 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
652 Safety box 5 L Non Generik Box Box 34,000
653 Salbutamol 1 mg/ml larutan inhaler Non Generik Larutan inhaler, botol = 5 ml Botol 34,000
654 Selang oksigen set Non Generik Selang set set 14,000
655 Sofratulle Gauge Non Generik Gause, box = 10 lembar Box 235,000
656 Tensocrepe 10 cm Non Generik Roll = 1 unit Roll 105,000
657 Tensocrepe 15 cm Non Generik Roll = 1 unit Roll 142,000
658 Urine Bag Steril Non Generik Urine Bag, buah Buah 8,000
659 Ventolin nebules, larutan Non Generik Ampul, box = 20 ampul Box 377,000
660 Accutrend Cholesterol Non Generik Strip, pot = 25 buah Pot 688,000
661 Accutrend Glucose Non Generik Strip, pot = 25 buah Pot 403,000
662 Accutrend Trigliserida Non Generik Strip, pot = 25 buah Pot 803,000
663 Lancet Accu Chek Softclik Non Generik Lancet, box = 100 buah Box 211,000
664 Strip Asam Urat Easytouch Non Generik Strip, Box = 25 buah Box 249,000
665 Strip Glukosa Easytouch Non Generik Strip, Box = 25 buah Box 249,000
666 Strip Hb Family Dr Non Generik Strip, Box = 10 buah Box 42,000
667 Strip Kolesterol Easytouch Non Generik Strip, Box = 10 buah Box 249,000
668 UA Sure Non Generik Strip, Pot = 25 buah Pot 379,000
669 Vaksin Difteri Non Generik Injeksi Ampul 88,000
670 Vaksin Hepatitis B Non Generik Injeksi Ampul 95,000
671 Vaksin Hepatitis B "Engerix B" Non Generik Injeksi Ampul 108,000
672 Vaksin HPV "Gardasil" Non Generik Injeksi Ampul 1,211,000
673 Vaksin Influenza "Fluquadri" Non Generik Injeksi Ampul 358,000
674 Water-based Fogging Agent Non Generik Cairan, botol = 1 liter Botol 76,000
675 Hi-Cook Butane Gas Cartridge Non Generik Kaleng 230 g Kaleng 30,000
676Pestisida Smash 100 EC Cypermetrin
100 g/LNon Generik Cairan, botol = 500 ml Botol 88,000
-
677 Aseptic Gel OneMed Non Generik Cairan, jerigen = 5 liter Jerigen 303,000
678 Blood Lancet Non Generik Lancet, box = 100 buah Box 40,000
679 Botol plastik 60 ml Non Generik Volume 60 ml Buah 3,000
680Charm Fragrance Extra Comfort Maxi
Non Wing Non Generik Pack, pack = 18 buah Pack 34,000
681Charm Fragrance Extra Comfort Maxi
Wing Non Generik Pack, pack = 18 buah Pack 34,000
682 Jelly USG Non Generik Cairan, jerigen = 5 liter Jerigen 337,000
683 Kantong Obat Kertas 10 x 15 cm Non Generik Lembar, pack = 100 lembar Pack 23,000
684 Kantong plastik putih kecil Non Generik Lembar, pack = 100 lembar Pack 26,000
685 Kantong Plastik Putih No.15 Non Generik Lembar, pack = 100 lembar Pack 30,000
IV. VAKSIN, KIT / STRIP DIAGNOSTIK SEDERHANA
V. OBAT DAN BAHAN KEGIATAN LAPANGAN/ PELATIHAN/ PENYULUHAN/ AMBULANCE
VI. BAHAN MEDIS HABIS PAKAI (BMHP) PELAYANAN UMUM
- 75 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
686 Kertas printer USG Non Generik Roll Roll 270,000
687Laurier Active Day Maxi Pembalut
WanitaNon Generik Pakc, pack = 30 buah Pack 25,000
688 Masker Disposible Earloop Surgi-Care Non Generik Box = 50 buah Box 64,000
689 Masker Disposible Tie-on OneMed Non Generik Box= 50 buah Box 64,000
690 Micropore besar Non Generik Roll Roll 52,000
691 Micropore kecil Non Generik Roll Roll 21,000
692 Pipet obat 1 ml Non Generik Pipet, unit = 1 unit Unit 7,000
693 Pipet obat 5 ml Non Generik Pipet, unit = 1 unit Unit 23,000
694 Plastik kresek kecil Non Generik Lembar, pack = 100 lembar Pack 21,000
695 Plastik Obat Klip 8.7 x 13 cm Non Generik Lembar, pack = 100 lembar Pack 12,000
696 Plastik Obat Klip Besar Non Generik Lembar, pack = 100 lembar Pack 15,000
697 Plastik Obat Klip Kecil (10 x 7) Non Generik Lembar, pack = 100 lembar Pack 7,000
698 Plastik Obat Klip Kecil (10 x 7) Non Generik Lembar, pack = 100 lembar Pack 7,000
699 Plastik Obat Klip Sedang Non Generik Lembar, pack = 100 lembar Pack 10,000
700 Sarung Tangan Lateks Remedi Non Generik Box = 50 pasang Box 75,000
701 Sarung Tangan Nitril Remedi Non Generik Box = 50 pasang Box 108,000
702 Spatel Lidah Kayu Non Generik Pack = 50 buah Pack 34,000
703 Tissue Facial 900 gram Non Generik Lembar, pack = 900 gram Pack 56,000
704 Tissue Rol Tessa Non Generik Rol Rol 11,000
705 Absorbent paper points 15-40 Non Generik Box = 200 buah Box 146,000
706 Alginat, Fast Set, merk GC Non Generik Pak = 500 gram Pack 155,000
707 Alkohol 70% Non Generik Cairan, botol = 1 liter Botol 68,000
708 Alloclair plus gel Non Generik Gel, tube= 8 mL Tube 142,000
709 Alveogyl Non Generik Pasta, botol = 10 gram Botol 702,000
710 Aquabidestilata 500 ml Generik Cairan, botol = 500 ml Botol 41,000
711 Arkansas Stone Silinder Hijau Non Generik Buah Buah 23,000
712 Arkansas Stone Silinder Merah Non Generik Buah Buah 23,000
713 Articulating Paper double check Non Generik Lembar, pak = 12 x 12 lembar Pack 162,000
714 Articulating paper horseshoe Non Generik Lembar, pak = 6 x 12 lembar Pack 337,000
715 Baju Operator Disposible Non Generik Buah Buah 75,000
716Benang jahit silk 2/0 dengan jarum
"OneMed"Non Generik Buah Buah 13,000
717Benang jahit silk 3/0 dengan jarum
"OneMed"Non Generik Buah Buah 15,000
718 Betadine, Sol Antiseptik Non Generik Cairan, botol = 1 liter Botol 84,000
719 Bond Force Tokuyama Non Generik Cairan, Botol = 5 ml Botol 913,000
720 Bonding 3M Universal Non Generik Cairan, botol = 5 ml Botol 1,615,000
721 Brush CA Kecil Non Generik Sikat, buah Buah 14,000
722 Brush CA Kecil point Non Generik Sikat, buah Buah 14,000
723 Bur Diamond Meisinger A 801 016 Non Generik Buah Buah 49,000
724 Bur Diamond Meisinger A 805 012 Non Generik Buah Buah 49,000
VII. OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP) PELAYANAN GIGI
- 76 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
725 Bur Diamond Meisinger A 805 018 Non Generik Buah Buah 49,000
726 Bur Diamond Meisinger A 808 012 Non Generik Buah Buah 49,000
727 Bur Diamond Meisinger B 389 012 Non Generik Buah Buah 52,000
728 Bur Diamond Meisinger B 833C 018 Non Generik Buah Buah 60,000
729 Bur Diamond Meisinger B 837L 014 Non Generik Buah Buah 64,000
730 Bur Diamond Meisinger B 858 016 Non Generik Buah Buah 64,000
731 Bur Diamond Meisinger B 858C 014 Non Generik Buah Buah 64,000
732 Bur Diamond Meisinger C 802LG 012 Non Generik Buah Buah 51,000
733 Bur Diamond Meisinger C 802LG 016 Non Generik Buah Buah 64,000
734 Cairan Saline Non Generik Cairan, botol = 500 ml Botol 135,000
735 Cal LC Non Generik Pasta, syringe = 2 gram Syringe 347,000
736 Cal LC Denpro Non Generik Pasta, syringe = 2 gram Syringe 274,000
737 Calcetin Cavity Liner paste 7g Non Generik Pasta, syringe = 7 gram Syringe 619,000
738 Carpule Non Generik Box = 100 buah Box 263,000
739 Caustinerf forte Non Generik Pasta, pot = 4,5 gram Pot 2,691,000
740 Cavit G merk 3M Non Generik Pasta, pot = 28 gram Pot 270,000
741 Cavit/ Calasept Non Generik Pasta, pot = 30 gram Pot 162,000
742 Caviton merk GC Non Generik Pasta, pot = 30 gram Pot 269,000
743 Caviton Pink Non Generik Pasta, pot = 30 gram Pot 213,000
744 Caviton White Non Generik Pasta, pot = 30 gram Pot 213,000
745 Celluloid strip Non Generik Strip, Pack = 100 lembar Box 290,000
746 Celluloid strip "Dentamedica" Non Generik Strip, Pack = 100 lembar Pack 162,000
747 Celluloid Strip Svenska Non Generik Strip, Pack = 100 lembar Pack 223,000
748 Ceram X Sphere TEC One Non Generik Pasta, syringe, 3 gram Syringe 848,000
749 Cheeck Retraktor Non Generik Buah Buah 115,000
750 ChKm Non Generik Cairan, botol = 10 ml Botol 225,000
751 ChKm "Biodinamica" Non Generik Cairan, botol = 20 ml Botol 115,000
752 Chloraethyl Spray Non Generik Cairan, botol = 100 ml Botol 162,000
753 Chloraethyl Spray Botol Kaca Non Generik Cairan, botol = 100 ml Botol 424,000
754 Cito Ject Needle, uk. 0,3 x 33mm Non Generik Box = 100 buah Box 229,000
755 Clip dental chain Non Generik Buah Buah 34,000
756 Cocoa butter merk GC Non Generik Pasta, tube = 10 gram Tube 163,000
757 Composite estelite quick Non Generik Pasta, syringe = 3,6 gram Syringe 963,000
758 Composite flowable quick Non Generik Pasta, syringe = 3,6 gram syringe 640,000
759 Cotton pelet Non Generik Pot Pot 61,000
760 Cotton roll Non Generik Pack = 600 buah Pack 101,000
761 Creshopate merk Septodont Non Generik Pasta, Pot = 7,5 gram Pot 1,010,000
762 Cresophate Non Generik Pasta, Pot = 25 gram Pot 633,000
763 Cresophene Non Generik Cairan, botol = 15 ml Botol 1,346,000
764 Cresophene Non Generik Cairan, botol = 5 ml Botol 263,000
765 Cresotin Paste Tehnodent Non Generik Pasta, pot = 25 g Pot 438,000
766 Curaspon Non Generik Box Box 828,000
767 Dental bib + kantong hijau Non Generik Pack = 100 buah Pack 106,000
- 77 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
768 Dental cotton 8 mm Non Generik Pack = 20 buah Pack 104,000
769 Dental floss Non Generik Pack = 50 floss Pack 54,000
770 Dental floss pick Non Generik Pack = 100 buah Pack 135,000
771 Dental microbrush applicator Non Generik Pack = 100 buah Pack 88,000
772 Dental poli bib Non Generik Pack = 500 buah Pack 393,000
773 Dental tampon Non Generik Pak Pack 38,000
774 Dental x-ray film Non Generik Box = 25 buah Box 519,000
775 Dentin conditioner Non Generik Cairan, botol = 25 gram Botol 210,000
776 Dentin Conditioner Mini Pack 6 gr Non Generik Cairan, botol = 6 g Botol 168,000
777 Dentsply XP Bond Non Generik Cairan, botol = 4,5 ml Botol 1,427,000
778 Desensitizer Non Generik Cairan, botol = 5 ml Botol 202,000
779 Diamond bur jrt 12's Non Generik Set Set 1,010,000
780 Diamond Bur Set Non GenerikPack = 9 buah, (bur round,
inverted bur, fisure bur)Pack 297,000
781 Dissposible Syringe 1 cc "Terumo" Non Generik Box = 100 buah Box 471,000
782 Dissposible Syringe 10 cc "Terumo" Non Generik Box = 100 buah Box 471,000
783 Dissposible Syringe 3 cc "Terumo" Non Generik Box = 100 buah Box 438,000
784 Dycal Non Generik Pasta, set Set 640,000
785 Endometason,merk 'N-Metasone' Non Generik Powder, botol, 14 gram Botol 808,000
786 Endomethason Non Generik Cairan, botol = 10 ml Botol 2,355,000
787 Endoseal Non GenerikBox = 20gr powder & 10ml
liquidBox 470,000
788 Endoseptone Non Generik Cairan, botol = 15 ml Botol 607,000
789 Etchant Non Generik Cairan, botol = 9 ml Botol 258,000
790 Etching Non Generik Pasta, syringe = 2 ml Syringe 371,000
791 Ethylchloride spray Non Generik Cairan, botol = 100 ml Spray 337,000
792 Eugenol Camex Non Generik Cairan, botol = 15 ml Botol 101,000
793 Eugenol Zhermack Non Generik Cairan, botol = 15 ml Botol 75,000
794 Exterpatie / Barbed Broach Svenska Non Generik Set = 10 buah Set 171,000
795 Fiber Splint Set Non Generik Set Set 2,624,000
796 Filtek Z350 XT Flowable (3M) Non Generik Cairan, syringe = 2 gram Syringe 828,000
797 Fletcher powder Non Generik Powder, Pot = 100 gr Pot 68,000
798 Fuji 9 Gold Label Non Generik Powder + Liquid, pack Pack 1,144,000
799 Fuji I merk GC Non Generik Powder + Liquid, pack Pack 1,353,000
800 Fuji I minipack Non Generik Powder + Liquid, pack Pack 537,000
801 Fuji IX GP Non Generik Powder + Liquid, pack Pack 1,178,000
802 Fuji IX GP minipack Non Generik Powder + Liquid, pack Pack 551,000
803 Fuji IX universal Non Generik Powder + Liquid, pack Pack 2,221,000
804 G-aenial Anterior & Posterior Non Generik Pasta, syringe = 2,7 ml Syringe 1,076,000
805 G-Aenial Bond Bottle Refill GC Non Generik Liquid, botol = 5 ml Botol 1,317,000
806 G-aenial Bond merk GC Non Generik Liquid, botol = 5 ml Botol 1,343,000
807 G-aenial Posterior A3.5 Non Generik Pasta, syringe = 2,7 ml Syringe 850,000
- 78 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
808 G-aenial Universal Flow Non Generik Pasta, syringe = 3,4 ml Syringe 1,354,000
809 Gengigel Sachet Non Generik Sachet, box = 100 sachet Box 1,200,000
810 Gengigel Spray Non Generik Cairan, botol = 20 ml Botol 233,000
811 Gengigel tube Non Generik Jel, tube = 20 ml Tube 572,000
812 Grinding Strip Non Generik Lembar, pack = 12 lembar Pack 34,000
813 Gutta percha 15-40 Non Generik Point, pack = 120 points Pack 108,000
814Gutta percha points 45-80 Sure-endo
KoreaNon Generik Point, pack = 120 points Pack 169,000
815 Hexidin 2% OneMed Non Generik Cairan, botol = 100 ml Botol 69,000
816 Hidrogen peroksida (H2O2) 3% Non Generik Cairan, botol = 800 ml Botol 38,000
817 Jarum K-file 15-40 Non Generik Set = 6 buah Set 317,000
818 Jarum Irigasi Nomor 28G Non Generik Box = 50 buah Box 209,000
819 Jarum K-file 45-80 Non Generik Set = 6 buah Set 317,000
820 Jarum lentulo no 25-40 Non Generik Set = 4 buah Set 252,000
821 Kaca Mulut Non Generik Buah Buah 171,000
822 Kapas Gulung Non Generik Pack = 1000 gram Pack 54,000
823 Kassa steril "Husada" 16 x 16 Non Generik Lembar , box = 16 lembar Box 21,000
824 Kassa steril gulung Non Generik Gulung = 1000 gram Gulung 135,000
825 Kenalog Non Generik Tube Tube 135,000
826 Kin mouth wash Non Generik Cairan, botol = 250 ml Botol 223,000
827 Larutan desinfektan ODEX - OneMed Non Generik Cairan, botol = 500 ml Botol 128,000
828 Lem fiber splint Non Generik Liquid, botol Botol 2,624,000
829 Masker 3 ply earloop Non Generik Lembar, box = 50 lembar Box 62,000
830 Masker Hijab Non Generik Lembar, box = 50 lembar Box 62,000
831 Masker tali Non Generik Lembar, box = 50 lembar Box 48,000
832 Matrix band Non Generik Set Set 2,624,000
833 Micro Applicator Brush Non Generik Pack = 50 buah Pack 270,000
834 Minosep Gargle Non Generik Cairan, botol = 60 ml Botol 39,000
835 Moldano biru Non Generik Bubuk, pack = 1000 gram Kg 109,000
836 NaOCL Non Generik Cairan, botol = 1000 ml Botol 155,000
837 NaOCl 2.5% OneMed Non Generik Cairan, botol = 500 ml Botol 52,000
838 Oli Pelumas handpiece MD400 W&H Non Generik Cairan, botol Botol 933,000
839Oral Surgery - Carbide 151 016
MeisingerNon Generik Buah Buah 252,000
840 Paper mixing pad Non Generik Lembar, buku Buku 34,000
841 Paper point no.15-40 Non Generik Set = 120 buah Set 115,000
842 Pehacain Injeksi Non Generik Cairan, box = 20 ampule Box 86,000
843 Perio Kin Non Generik Jel, tube = 30 ml Tube 216,000
844 Periodontal dressing "COE Pack" Non Generik Box Box 875,000
845 Polibib tali Non Generik Lembar, pak = 50 lembar Pack 108,000
846 Polibib tanpa tali Non Generik Lembar, box = 125 lembar Box 202,000
847 Poliren Polishing Pasta No 1 Non Generik Pasta, pot = 45 gram Pot 243,000
- 79 -
HARGA SATUAN STANDAR BADAN TENAGA NUKLIR NASIONAL
TAHUN ANGGARAN 2020
KELOMPOK PEMERIKSAAN KESEHATAN DAN OBAT-OBATAN
NO NAMA BARANG/URAIAN KATEGORI SPESIFIKASI/
KODE/ ACUAN SATUAN HARGA
(dalam Rupiah)
848 Prophy Brush OneMed Non Generik Buah Buah 8,000
849 Pulp X Devitalisasi Non Generik Pasta, pot = 6 gram Pot 404,000
850 Rockle's Non Generik Cairan, botol = 13 ml Botol 781,000
851 Saliva Ejector Non Generik Pack Pack 171,000
852 Sarung Tangan Nitrile Size S Non Generik Lembar, box = 100 lembar Box 202,000
853 Sarung Tangan Nitrile Size XS Non Generik Lembar, box = 100 lembar Box 84,000
854 Scandonest 2 % Non Generik Cartridge, box = 50 Box 1,615,000
855 Self etching dentex Non Generik Liquid, botol = 5 ml Botol 529,000
856 Septocaine Injeksi Non Generik Cartridge, box = 50 Box 1,211,000
857 Septoject 0,3 x 12 mm Non Generik Box = 100 buah Box 263,000
858 Septoject 0,3 x 16 mm Non Generik Box = 100 buah Box 263,000
859 Septoject 0,3 x 25 mm Non Generik Box = 100 buah Box 263,000
860 Slaber Disposible Non Generik Pack = 100 buah Pack 96,000
861 Sof-Lex 3M Mini Kit Non Generik Set Set 563,000
862 Sof-Lex 3M Spiral Mini Kit Non Generik Set Set 434,000
863 Solare Flo A2 GC Non Generik Pasta, syringe = 0,56 ml Syringe 297,000
864 Solare Flo A3 GC Non Generik Pasta, syringe = 0,56 ml Syringe 297,000
865 Solare Komposit, Anterior merk GC Non Generik Pasta, syringe = 2 ml Syringe 471,000
866Solare Sculpt Syringe A2 1.9g (1ml)
GCNon Generik Pasta, syringe = 1 ml Syringe 474,000
867 Solare X Komposit, Posterior merk GC Non Generik Pasta, syringe = 1 ml Syringe 471,000
868 Spet one pro classic (liquid) Non Generik Cairan, botol Botol 808,000
869 Spet one pro spray Non Generik Botol Botol 808,000
870 ST. House Hold (S,M,L) Non Generik Pack Pack 169,000
871 Stain Remover OCO Non Generik Cairan, botol = 15 ml Botol 256,000
872 Steri One Plus OneMed Non Generik Cairan, botol = 500 ml Botol 91,000
873 Sterile Pouch 7 x 200 cm OneMed Non Generik Gulung Gulung 485,000
874 Sterile Pouch 9 x 200 cm OneMed Non Generik Gulung Gulung 976,000
875 Suture needle dengan benang Non Generik Buah Buah 108,000
876 Ti Es Hitam Non Generik Pasta, syringe = 2,5 ml Syringe 377,000
877 Ti Es Kuning Non Generik Pasta, syringe = 2,5 ml Syringe 270,000
878 TKF Non Generik Cairan, botol = 10 ml Botol 169,000
879 Topical anaesthesi Gel Non Generik Pasta, pot = 30 gram Pot 263,000
880 TSR Non Generik Botol Botol 115,000
881 Tutup Oly W&H 400 ml Non Generik Buah Buah 149,000
882 Wedges Dentamerica Transparan Non Generik Pack Pack 97,000
883 Xylonor Non Generik Cairan, botol = 36 gram Botol 808,000
884 Zinc Posfat cement Non Generik Set Set 327,000