Professional Documents
Culture Documents
OBAT SYRUP
KEBUTUHAN HARGA
NO NAMA OBAT KEMASAN
SATUAN (Rp)
Jmlh (Ktk, Btl)
1 Amoxicillin 125 mg Krtn 50 btl 10 Rp 365,350.00
2 Cotrymoksazole Krtn 50 btl 5 Rp 362,700.00
3 Nocamaag Suspensi Krtn 50 btl 15 Rp 250,000.00
4 Paracetamol 120 mg Krtn 50 btl 10 Rp 220,300.00
5 Novadiar Krtn 50 btl 5 Rp 250,000.00
JUMLAH III
OBAT ZALF/TETES/KRIM
KEBUTUHAN HARGA
NO NAMA OBAT KEMASAN
SATUAN (Rp)
Jmlh (Ktk, Btl)
1 Basitrasyn Tube 50 Rp 4,477.00
2 Betametason 5 gr krim Tube 50 Rp 16,500.00
3 Chloramphenycol 1 % tetes Mata btl 5 ml 50 Rp 6,388.00
4 Gentamycin 0,1 tetes mata Ktk 24 btl 5 Rp 182,304.00
5 Oxytetrasiklin krim Salep kulit tube 5 gr 50 Rp 4,280.00
6 PK Tube 50 Rp 11,000.00
JUMLAH IV
Jumlah I Rp 187,122,665.00
Jumlah II Rp 97,061,970.00
Jumlah III Rp 12,670,000.00
Jumlah IV Rp 3,043,770.00
TOTAL Rp 299,898,405.00
TERBILANG : Dua Ratus Sembilan Puluh Sembilan Juta Delapan Ratus Se
Delapan Ribu Empat Ratus Lima Rupiah
KABUPATEN KEPULAUAN ARU
UM DAERAH CENDRAWASIH DOBO
917) Fax. (0917) - Dobo
: Tablet/ Kapsul/Bubuk
JUMLAH
HARGA (Rp)
Rp 613,220.00
Rp 15,330,400.00
Rp 750,000.00
Rp 1,250,000.00
Rp 279,000.00
Rp 1,221,000.00
Rp 5,621,400.00
Rp 708,270.00
Rp 2,900,000.00
Rp 352,000.00
Rp 452,925.00
Rp 879,900.00
Rp 2,274,240.00
Rp 46,182,710.00
Rp 801,020.00
Rp 332,160.00
Rp 1,923,310.00
Rp 2,400,000.00
Rp 1,821,080.00
Rp 227,280.00
Rp 1,063,170.00
Rp 14,625,000.00
Rp 14,195,880.00
Rp 3,417,325.00
Rp 149,030.00
Rp 608,120.00
Rp 3,200,000.00
Rp 225,000.00
Rp 7,875,000.00
Rp 285,340.00
Rp 467,840.00
Rp 438,450.00
Rp 317,300.00
Rp 1,485,450.00
Rp 2,299,560.00
Rp 6,400,000.00
Rp 1,112,500.00
Rp 861,050.00
Rp 3,471,040.00
Rp 8,431,650.00
Rp 394,545.00
Rp 16,755,000.00
Rp 689,870.00
Rp 1,966,500.00
Rp 157,500.00
Rp 523,070.00
Rp 1,136,400.00
Rp 5,255,000.00
Rp 1,134,460.00
Rp 1,350,700.00
Rp 511,000.00
Rp 187,122,665.00
OBAT INJEKSI
JUMLAH
HARGA (Rp)
Rp 625,000.00
Rp 913,280.00
Rp 2,400,000.00
Rp 10,777,500.00
Rp 10,000,000.00
Rp 12,000,000.00
Rp 550,000.00
Rp 708,840.00
Rp 264,990.00
Rp 1,500,000.00
Rp 2,768,640.00
Rp 6,400,000.00
Rp 7,500,000.00
Rp 2,325,000.00
Rp 3,679,280.00
Rp 7,500,000.00
Rp 19,699,440.00
Rp 1,875,000.00
Rp 1,600,000.00
Rp 3,975,000.00
Rp 97,061,970.00
OBAT SYRUP
JUMLAH
HARGA (Rp)
Rp 3,653,500.00
Rp 1,813,500.00
Rp 3,750,000.00
Rp 2,203,000.00
Rp 1,250,000.00
Rp 12,670,000.00
T ZALF/TETES/KRIM
JUMLAH
HARGA (Rp)
Rp 223,850.00
Rp 825,000.00
Rp 319,400.00
Rp 911,520.00
Rp 214,000.00
Rp 550,000.00
Rp 3,043,770.00
ua Ratus Sembilan Puluh Sembilan Juta Delapan Ratus Sembilan Puluh
Empat Ratus Lima Rupiah
DAFTAR ENYERAHAN BARANG
PENGADAAN BAHAN HABIS PAKAI
DANA APBD TAHUN ANGGARAN 2010
RUMAH SAKIT UMUM DAERAH CENDRAWASIH DOBO
KABUPATAN KEPULAUAN ARU
KEBUTUHAN HARGA
NO NAMA OBAT KEMASAN
Jmlh (Ktk, Btl) SATUAN (Rp)
1 Abocat 22 Bh 200 Rp 22,500
2 Abocat 26 Bh 200 Rp 22,500
3 Alkohol 70 % Btl 1000 ml 30 Rp 75,000
4 Cairan Dextrosa 5% Krtn 20 Btl 20 Rp 190,000
5 Cairan Ringer laktat Krtn 20 Btl 240 Rp 239,500
6 Handscoen non steril 6 1/2 Ktk 100 pairs 3 Rp 125,000
7 Handscoen non steril 7 1/2 Ktk 100 pairs 3 Rp 125,000
8 Handscoen steril 6 1/2 gamex ktk 50 pairs 3 Rp 800,000
9 Handscoen steril 7 1/2 gamex ktk 50 pairs 3 Rp 800,000
10 Infuset Makro Ktk 50 pcs 3 Rp 800,000
11 Infuset mikro Ktk 50 pcs 3 Rp 800,000
12 Khasa Hydrofyl 40 x 80 Karton 20 rol 3 Rp 3,000,000
13 Khasa elastis Rol 15 Rp 125,000
14 Masker Ktk 50 pcs 2 Rp 150,000
15 NGT : No 12 Bh 10 Rp 35,000
16 NGT : No 14 Bh 10 Rp 35,000
17 NGT : No 18 Bh 10 Rp 35,000
18 NGT : No 6 Bh 10 Rp 35,000
19 NGT : No 8 Bh 10 Rp 35,000
20 Plester Rol Kain 5 cm x 4,5 m Bh 50 Rp 67,300
21 Elektroda Monitor ECG Box/ 100 1 Rp 780,000
JUMLAH
TERBILANG : Sembilan Puluh Sembilan Juta Sembilan Ratus Lima Puluh Ribu Rupiah
JUMLAH
HARGA (Rp)
Rp 4,500,000
Rp 4,500,000
Rp 2,250,000
Rp 3,800,000
Rp 57,480,000
Rp 375,000
Rp 375,000
Rp 2,400,000
Rp 2,400,000
Rp 2,400,000
Rp 2,400,000
Rp 9,000,000
Rp 1,875,000
Rp 300,000
Rp 350,000
Rp 350,000
Rp 350,000
Rp 350,000
Rp 350,000
Rp 3,365,000
Rp 780,000
Rp 99,950,000
uh Sembilan Juta Sembilan Ratus Lima Puluh Ribu Rupiah
DAFTAR PENGADAAN
OBAT - OBATAN
RUMAH SAKIT UMUM DAERAH CENDRAWASIH DOBO
KABUPATEN KEPULAUAN ARU
DANA ALOKASI UMUM T.A. 2010
KEBUTUHAN
NO NAMA OBAT KEMASAN
Jmlh (Ktk, Btl)
1 Aloporinol 100 mg Ktk 10 x 10 tab 20
2 Amoxicillin 500 mg Ktk 10 x 10 tab 200
3 Amilodipin 5 mg Ktk 3 x 10 tab 10
4 Amilodipin 10 mg Ktk 3 x 10 tab 10
5 Antalgin 500 mg Btl 1000 tab 3
6 Anusol HC Sup 5 mg ktk 6 supp 20
7 Asam Mefenamat Ktk 10 x 10 tab 200
8 Betahistina 6 mg Ktk 3 x 10 tab 10
9 Buscopan Dos 10 x 10 tab 8
10 Bromoheksin 8 mg Ktk 10 x 10 tab 20
11 Captopryl 12,5 mg ktk 5 x 10 tab 25
12 Captopryl 25 mg Ktk 10 x 10 tab 25
13 Cefadroxil 250 mg Ktk 5 x 10 tab 20
14 Cefadroxil 500 mg Ktk 5 x 10 tab 170
15 Cetirizine 10 mg ktk 10 x 10 tab 20
16 Chlorpheniramine 4 mg (CTM) Btl 1000 tab 20
17 Clindamisin 300 mg Box / 50 10
18 Dexemetasone 0,5 mg Btl 1000 tab 40
19 Dextromtrophan 15 mg Btl 1000 tab 20
20 Dimenhidinat 50 mg Ktk 10 x 10 tab 10
21 Domperidon 10 mg Ktk 5 x 10 tab 10
22 Dulcolax tb, Supp Dos 50 Supp 15
23 Ethambutol 500 mg Ktk 10 x 10 tab 180
24 Eritromicin 500 mg Ktk 10 x 10 Kaps 25
25 Glibenclamide 5 mg Ktk 10 x 10 tab 10
26 Griseovulvin 125 mg Ktk 10 x 10 tab 10
27 Heptamyl Dos 20 tab 10
28 Ketakonazole 200 mg dos 50 tab 5
29 Kina 200 mg ktk 288 tab 15
30 Lisinopril 5 mg Ktk 3 x 10 tab 10
31 Loperamid 2 mg Ktk 10 x 10 tab 20
32 Loratadine 10 mg Ktk 5 x 10 tab 10
33 Metformin 500 mg Dos100 tab 10
34 Metronidazole 500 mg Ktk 10 x 10 tab 50
35 Ofloxacin 400 mg Ktk 5 x 10 tab 20
36 Omeprazol 20 mg ktk 3 x 10 tab 200
37 Oralit 200 ml Ktk 100 sasht 25
38 Paracetamol 500 mg Btl 1000 tab 10
39 Pentoksifilin 100 mg Ktk 10 x 10 tab 10
40 Pirazinamide 50 mg Ktk 10 x 10 Tab 150
41 Propylthiourasil 100 mg Btl 100 tab 5
42 Rifampicin 450 mg Ktk 10 x 10 tab 150
43 Simvastatim 10 mg Box / 30 10
44 Spironolakton 25 mg Dos 10 x 10 tab 20
45 Teosal Dos 100 tab 10
46 Tiamfenikol 500 mg Ktk 10 x 10 Kaps 5
47 Tramadol 50 mg Dos 50 kaps 25
48 Transamin 250 mg Ktk 10 x 10 tab 10
49 Vitamin B Complex Btl 1000 tab 20
50 Vitamin C 100 mg Btl 1000 tab 20
51 Vitamin B6 10 mg Btl 1000 tab 20
JUMLAH I
OBAT INJEKSI
KEBUTUHAN
NO NAMA OBAT KEMASAN
Jmlh (Ktk, Btl)
1 Adimidon 15 mg Ktk 12 Vial 10
2 Aminophyline 24 mg Ktk 24 Amp 10
3 Buscopan Ktk 10 Amp 10
4 Cairan Ringer Laktat krtn 20 btl 45
5 Cefotaxim 1g Ktk 2 Vial 400
6 Ceftriaxone 1 g Ktk 2 Vial 400
7 Dextrose 40% fls 50
8 Depoprogestin Dos 20 Vial 3
9 Epinefrine Ktk 30 Amp 10
10 Lasix 10 mg/ml Ktk 5 Amp 20
11 Lidocain 2 ml comp Ktk 10 Amp 80
12 Neurobion 3 ml Ktk 20 Amp 40
13 Novalgin Ktk 5 Amp 100
14 Oxytoksin Ktk 100 Amp 5
15 Papaverine 40 mg/ml Ktk 12 vial 40
16 Primperan Ktk 5 Amp 100
17 Ranitidine 25 mg Ktk 25 Amp 120
18 Tramadol Inj 50mg/ml Ktk 25 Amp 5
19 Transamin 250 mg/amp Ktk 10 Amp 10
20 Vit B1 Ktk 100 Amp 10
JUMLAH II
OBAT SYRUP
KEBUTUHAN
NO NAMA OBAT KEMASAN
Jmlh (Ktk, Btl)
1 Amoxicillin 125 mg Krtn 50 btl 10
2 Cotrymoksazole Krtn 50 btl 5
3 Nocamaag Suspensi Krtn 50 btl 15
4 Paracetamol 120 mg Krtn 50 btl 10
5 Novadiar Krtn 50 btl 5
JUMLAH III
OBAT ZALF/TETES/KRIM
KEBUTUHAN
NO NAMA OBAT KEMASAN
Jmlh (Ktk, Btl)
1 Basitrasyn Tube 50
2 Betametason 5 gr krim Tube 50
3 Chloramphenycol 1 % tetes Mata btl 5 ml 50
4 Gentamycin 0,1 tetes mata Ktk 24 btl 5
5 Oxytetrasiklin krim Salep kulit tube 5 gr 50
6 PK Tube 50
JUMLAH IV
Jumlah I
Jumlah II
Jumlah III
Jumlah IV
TOTAL
TERBILANG : Dua Ratus Sembilan Puluh Sembilan Juta Delapan Ratus S
Delapan Ribu Empat Ratus Lima Rupiah
RAH ABADI
PT Neg. 1,
0911) 347997
DAAN
AN
ENDRAWASIH DOBO
UAN ARU
M T.A. 2010
HARGA JUMLAH
SATUAN (Rp) HARGA (Rp)
Rp 30,661.00 Rp 613,220.00
Rp 76,652.00 Rp 15,330,400.00
Rp 75,000.00 Rp 750,000.00
Rp 125,000.00 Rp 1,250,000.00
Rp 93,000.00 Rp 279,000.00
Rp 61,050.00 Rp 1,221,000.00
Rp 28,107.00 Rp 5,621,400.00
Rp 70,827.00 Rp 708,270.00
Rp 362,500.00 Rp 2,900,000.00
Rp 17,600.00 Rp 352,000.00
Rp 18,117.00 Rp 452,925.00
Rp 35,196.00 Rp 879,900.00
Rp 113,712.00 Rp 2,274,240.00
Rp 271,663.00 Rp 46,182,710.00
Rp 40,051.00 Rp 801,020.00
Rp 16,608.00 Rp 332,160.00
Rp 192,331.00 Rp 1,923,310.00
Rp 60,000.00 Rp 2,400,000.00
Rp 91,054.00 Rp 1,821,080.00
Rp 22,728.00 Rp 227,280.00
Rp 106,317.00 Rp 1,063,170.00
Rp 975,000.00 Rp 14,625,000.00
Rp 78,866.00 Rp 14,195,880.00
Rp 136,693.00 Rp 3,417,325.00
Rp 14,903.00 Rp 149,030.00
Rp 60,812.00 Rp 608,120.00
Rp 320,000.00 Rp 3,200,000.00
Rp 45,000.00 Rp 225,000.00
Rp 525,000.00 Rp 7,875,000.00
Rp 28,534.00 Rp 285,340.00
Rp 23,392.00 Rp 467,840.00
Rp 43,845.00 Rp 438,450.00
Rp 31,730.00 Rp 317,300.00
Rp 29,709.00 Rp 1,485,450.00
Rp 114,978.00 Rp 2,299,560.00
Rp 32,000.00 Rp 6,400,000.00
Rp 44,500.00 Rp 1,112,500.00
Rp 86,105.00 Rp 861,050.00
Rp 347,104.00 Rp 3,471,040.00
Rp 56,211.00 Rp 8,431,650.00
Rp 78,909.00 Rp 394,545.00
Rp 111,700.00 Rp 16,755,000.00
Rp 68,987.00 Rp 689,870.00
Rp 98,325.00 Rp 1,966,500.00
Rp 15,750.00 Rp 157,500.00
Rp 104,614.00 Rp 523,070.00
Rp 45,456.00 Rp 1,136,400.00
Rp 525,500.00 Rp 5,255,000.00
Rp 56,723.00 Rp 1,134,460.00
Rp 67,535.00 Rp 1,350,700.00
Rp 25,550.00 Rp 511,000.00
Rp 187,122,665.00
SI
HARGA JUMLAH
SATUAN (Rp) HARGA (Rp)
Rp 62,500.00 Rp 625,000.00
Rp 91,328.00 Rp 913,280.00
Rp 240,000.00 Rp 2,400,000.00
Rp 239,500.00 Rp 10,777,500.00
Rp 25,000.00 Rp 10,000,000.00
Rp 30,000.00 Rp 12,000,000.00
Rp 11,000.00 Rp 550,000.00
Rp 236,280.00 Rp 708,840.00
Rp 26,499.00 Rp 264,990.00
Rp 75,000.00 Rp 1,500,000.00
Rp 34,608.00 Rp 2,768,640.00
Rp 160,000.00 Rp 6,400,000.00
Rp 75,000.00 Rp 7,500,000.00
Rp 465,000.00 Rp 2,325,000.00
Rp 91,982.00 Rp 3,679,280.00
Rp 75,000.00 Rp 7,500,000.00
Rp 164,162.00 Rp 19,699,440.00
Rp 375,000.00 Rp 1,875,000.00
Rp 160,000.00 Rp 1,600,000.00
Rp 397,500.00 Rp 3,975,000.00
Rp 97,061,970.00
P
HARGA JUMLAH
SATUAN (Rp) HARGA (Rp)
Rp 365,350.00 Rp 3,653,500.00
Rp 362,700.00 Rp 1,813,500.00
Rp 250,000.00 Rp 3,750,000.00
Rp 220,300.00 Rp 2,203,000.00
Rp 250,000.00 Rp 1,250,000.00
Rp 12,670,000.00
S/KRIM
HARGA JUMLAH
SATUAN (Rp) HARGA (Rp)
Rp 4,477.00 Rp 223,850.00
Rp 16,500.00 Rp 825,000.00
Rp 6,388.00 Rp 319,400.00
Rp 182,304.00 Rp 911,520.00
Rp 4,280.00 Rp 214,000.00
Rp 11,000.00 Rp 550,000.00
Rp 3,043,770.00
Rp 187,122,665.00
Rp 97,061,970.00
Rp 12,670,000.00
Rp 3,043,770.00
Rp 299,898,405.00
an Puluh Sembilan Juta Delapan Ratus Sembilan Puluh
ma Rupiah
CV. SANJAYA ABADI
BERGERAK DALAM PERDAGANGAN, LEVERANSRI PERALATAN KANTOR,
BAHAN PANGAN DAN KONTRAKTOR
JALAN : KARANG PANJANG SLTP NEG. I AMBON
TELEPON : (0917) 347260 – FAX (0911) 347997
TERBILANG : Seratus Dua Puluh Empat Juta Sembilan Ratus Dua Puluh Lima Ribu Rupiah
TORIUM
10
SIH DOBO
325,000 650,000
325,000 650,000
325,000 650,000
325,000 650,000
325,000 650,000
325,000 650,000
325,000 650,000
800,000 1,600,000
1,350,000 2,700,000
1,350,000 2,700,000
1,350,000 2,700,000
2,100,000 4,200,000
1,100,000 2,200,000
1,600,000 3,200,000
2,700,000 2,700,000
2,700,000 2,700,000
2,800,000 2,800,000
5,800,000 5,800,000
2,500,000 2,500,000
1,945,000 1,945,000
2,525,000 2,525,000
2,400,000 2,400,000
2,515,000 2,515,000
124,925,000
ibu Rupiah
Yang Menyerahkan
Pihak Pertama
KTUR RSUD CENDRAWASIH DOBO
Sebagai Pengguna Anggaran
TOTAL
TERBILANG : Dua Ratus Lima Puluh Empat Juta Enam Ratus Enam Puluh Ribu Rupiah
1,800,000
4,500,000
4,500,000
4,500,000
35,200,000
8,800,000
254,660,000
CV. SANJAYA ABADI
BERGERAK DALAM PERDAGANGAN, LEVERANSRI PERALATAN KANTOR,
BAHAN PANGAN DAN KONTRAKTOR
JALAN : KARANG PANJANG SLTP NEG. I AMBON
TELEPON : (0917) 347260 – FAX (0911) 347997
TERBILANG : Sembilan Puluh Sembilan Juta Sembilan Ratus Lima Puluh Ribu Rupiah
Dobo, 13 Oktober 2010
Yang Menyerahkan Yang Menyerahkan
Pihak Kedua Pihak Pertama
CV. ICHIGO ENTERPRISE DIREKTUR RSUD CENDRAWASIH DOBO
Sebagai Pengguna Anggaran
JUMLAH HARGA
58,000,000
7,000,000
7,200,000
9,000,000
9,600,000
4,950,000
1,800,000
2,400,000
99,950,000
NGA
103 1 008
NO TENUN KEMASAN KEBUTUHAN HARGA SATUAN
( Rp )
1 Matras Latex Untuk 3 Crank Buah 3 3,885,000
2 Matras Latex Untuk 1 Crank Standar Set 12 3,800,000
3 Bantal Dacron 40 X 60 Buah 30 150,000
4 Sarung Bantal uk 50 x 70 cm Buah 40 75,000
5 Seprey Fitted 90 x 200 cm x 15 cm Buah 15 275,000
6 Seprey Anak 80 x 170 x 15 cm Buah 15 250,000
7 Isolasi Gown Buah 5 465,000
JUMLAH
TERBILANG : Tujuh Puluh Empat Juta Sembilan Ratus Lima Puluh Lima Ribu Rupiah
JUMLAH
HARGA
11,655,000
45,600,000
4,500,000
3,000,000
4,125,000
3,750,000
2,325,000
74,955,000
1
2 3 4 5
Harga
SATUAN JUMLAH
6 7
98,957,500.00 98,957,500.00
34,780,000.00 34,780,000.00
14,405,000.00 28,810,000.00
18,385,000.00 36,770,000.00
1,470,000.00 2,940,000.00
3,460,000.00 6,920,000.00
425,250.00 850,500.00
11,895,000.00 11,895,000.00
72,092,500.00 72,092,500.00
59,655,000.00 59,655,000.00
11,189,500.00 11,189,500.00
4,308,125.00 4,308,125.00
4,308,125.00 4,308,125.00
47,217,500.00 47,217,500.00
360,642,500.00 360,642,500.00
452,500.00 452,500.00
452,500.00 452,500.00
452,500.00 452,500.00
635,500.00 2,542,000.00
107,437.50 1,074,375.00
82,562.50 825,625.00
79,562.50 477,375.00
129,312.50 775,875.00
144,750.00 1,447,500.00
524,750.00 1,049,500.00
4,952,500.00 9,905,000.00
107,437.50 1,074,375.00
599,375.00 1,198,750.00
26,062.50 104,250.00
2,962,500.00 5,925,000.00
1,843,125.00 3,686,250.00
131,742,750.00 131,742,750.00
161,558.93 56,545,625.50
111,808.93 39,133,125.50
1,983,571.43 13,885,000.01
2,233,750.00 20,103,750.00
1,486,071.43 10,402,500.01
2,233,750.00 20,103,750.00
16,161,250.00 96,967,500.00
2,233,125.00 17,865,000.00
1,486,875.00 11,895,000.00
740,625.00 5,925,000.00
1,113,750.00 8,910,000.00
865,000.00 6,920,000.00
2,691,250.00 2,691,250.00
3,211,250.00 6,422,500.00
17,865,000.00 17,865,000.00
19,357,500.00 19,357,500.00
4,930,000.00 4,930,000.00
185,796,125.00 185,796,125.00
1,490,241,001.02
1,490,241,000.00
SEMBILAN PULUH JUTA DUA RATUS
YENNY DARWATI
Direktris
DAFTAR PENYERAHAN
PENGADAAN ALAT UTDRS
RUMAH SAKIT UMUM DAERAH CENDRAWASIH DOBO
KABUPATEN KEPULAUAN ARU
DANA ALOKASI KHUSUS T. A. 2010
1 2 3 4 5
1 2 3 4 5
- Klem Lab Lokal Wooden Indonesia 4 Bh
16 Distribusi Cool Box
- Untuk mobile unit (25-50 ktg) Doveline 8,6 ltr Indonesia 2 Unit
- Untuk ruangan (2-5 Ktg) Doveline 6,7ltr Indonesia 2 Unit
17 Penyimpan Reagent dan Darah
- Medical Refrigerator Sibir KV 110 GE Sweden 1 Unit
18 Kantong Darah
- Single Bag 250 ml / 350 ml jms JMS 250 ml RRC 350 Bh
- Transfer bag jms JMS 150ml RRC 350 Bh
19 Reagent
- Anti HCV Acon USA 7 Box
- HBs AG Acon USA 9 Box
- Gol Darah ABD Rhesus, Uji silang
serasis albumin 22 % dan coombs serum Plasmatec UK 7 Set
- Sypillis Acon USA 9 Box
NO. NAMA BARANG Merk / Type / Negara Asal Negara Jumlah
1 2 3 4 5
Reagen untuk pemeriksaan uji saring
- metode Gel
tes/microplate Girl forst Spain 6 Set
- HIV / AIDS Acon USA 8 Box
- Larutan CuSO4 Dengan BJ 1, 053 Merk 250 mg Germany 8 btl
- Nacl 0,9 %, 500 ml Lokal 500 ml Indonesia 8 Box
- Cairan Desinfectant Lokal 1000 ml Indonesia 8 btl
- Aquadest Lokal 1000 ml Indonesia 8 Box
20 Peralatan kantor
- Meja kantor + Kursi Lokal Indonesia 1 Bh
- Meja Komputer / Labtob + Kursi Lokal Indonesia 2 Bh
- Komputer + Printer HP Compac Presario USA 1 Set
- Laptob DELL Inspiren USA 1 Bh
-Peralatan
AC 1/2Pengganti
PK Listrik (Genset) 20 KVA LG Termination Japan 1 Bh
21 + Roda Yanmar Japan 1 Pkt
JUMLAH
DIBULATKAN
TERBILANG : SATU MILYAR EMPAT RATUS SEMBILAN PU
*) Harga Sudah Termasuk Pajak
PULUH SATU RIBU RUPIAH
Dobo, 16 Oktobe
NY. YENNY DA
Direktris
O
6 7
98,957,500.00 98,957,500.00
34,780,000.00 34,780,000.00
14,405,000.00 28,810,000.00
18,385,000.00 36,770,000.00
1,470,000.00 2,940,000.00
3,460,000.00 6,920,000.00
425,250.00 850,500.00
11,895,000.00 11,895,000.00
72,092,500.00 72,092,500.00
59,655,000.00 59,655,000.00
11,189,500.00 11,189,500.00
4,308,125.00 4,308,125.00
4,308,125.00 4,308,125.00
47,217,500.00 47,217,500.00
360,642,500.00 360,642,500.00
452,500.00 452,500.00
452,500.00 452,500.00
452,500.00 452,500.00
635,500.00 2,542,000.00
107,437.50 1,074,375.00
82,562.50 825,625.00
79,562.50 477,375.00
129,312.50 775,875.00
144,750.00 1,447,500.00
524,750.00 1,049,500.00
4,952,500.00 9,905,000.00
107,437.50 1,074,375.00
599,375.00 1,198,750.00
Harga Satuan JUMLAH HARGA
6 7
26,062.50 104,250.00
2,962,500.00 5,925,000.00
1,843,125.00 3,686,250.00
131,742,750.00 131,742,750.00
161,558.93 56,545,625.50
111,808.93 39,133,125.50
1,983,571.43 13,885,000.01
2,233,750.00 20,103,750.00
1,486,071.43 10,402,500.01
2,233,750.00 20,103,750.00
Harga Satuan JUMLAH HARGA
6 7
16,161,250.00 96,967,500.00
2,233,125.00 17,865,000.00
1,486,875.00 11,895,000.00
740,625.00 5,925,000.00
1,113,750.00 8,910,000.00
865,000.00 6,920,000.00
2,691,250.00 2,691,250.00
3,211,250.00 6,422,500.00
17,865,000.00 17,865,000.00
19,357,500.00 19,357,500.00
4,930,000.00 4,930,000.00
185,796,125.00 185,796,125.00
1,490,241,001.02
1,490,241,000.00
MBILAN PULUH JUTA DUA RATUS EMPAT
16 Oktober 2010
YENNY DARWATI
Direktris
DAFTAR ENYERAHAN BARANG
PENGADAAN PERBEKALAN
DANA APBD TAHUN ANGGARAN 2010
RUMAH SAKIT UMUM DAERAH CENDRAWASIH DOBO
KABUPATEN KEPULAUAN ARU
2010
kan
a
WASIH DOBO
nggaran
GA
03 1 008
PT. KASIH ANUGERAH ABADI
KAA Jln. Karang Panjang SLPT Neg. 1,
Telp : (0917) 347260 – FAX (0911) 347997
Ambon
KEBUTUHAN HARGA
NO NAMA OBAT KEMASAN
Jmlh (Ktk, Btl) SATUAN (Rp)
1 Aloporinol 100 mg Ktk 10 x 10 tab 20 Rp 30,661.00
2 Amoxicillin 500 mg Ktk 10 x 10 tab 200 Rp 76,652.00
3 Amilodipin 5 mg Ktk 3 x 10 tab 10 Rp 75,000.00
4 Amilodipin 10 mg Ktk 3 x 10 tab 10 Rp 125,000.00
5 Antalgin 500 mg Btl 1000 tab 3 Rp 93,000.00
6 Anusol HC Sup 5 mg ktk 6 supp 20 Rp 61,050.00
7 Asam Mefenamat Ktk 10 x 10 tab 200 Rp 28,107.00
8 Betahistina 6 mg Ktk 3 x 10 tab 10 Rp 70,827.00
9 Buscopan Dos 10 x 10 tab 8 Rp 362,500.00
10 Bromoheksin 8 mg Ktk 10 x 10 tab 20 Rp 17,600.00
11 Captopryl 12,5 mg ktk 5 x 10 tab 25 Rp 18,117.00
12 Captopryl 25 mg Ktk 10 x 10 tab 25 Rp 35,196.00
13 Cefadroxil 250 mg Ktk 5 x 10 tab 20 Rp 113,712.00
14 Cefadroxil 500 mg Ktk 5 x 10 tab 170 Rp 271,663.00
15 Cetirizine 10 mg ktk 10 x 10 tab 20 Rp 40,051.00
16 Chlorpheniramine 4 mg (CTM) Btl 1000 tab 20 Rp 16,608.00
17 Clindamisin 300 mg Box / 50 10 Rp 192,331.00
18 Dexemetasone 0,5 mg Btl 1000 tab 40 Rp 60,000.00
19 Dextromtrophan 15 mg Btl 1000 tab 20 Rp 91,054.00
20 Dimenhidinat 50 mg Ktk 10 x 10 tab 10 Rp 22,728.00
21 Domperidon 10 mg Ktk 5 x 10 tab 10 Rp 106,317.00
22 Dulcolax tb, Supp Dos 50 Supp 15 Rp 975,000.00
23 Ethambutol 500 mg Ktk 10 x 10 tab 180 Rp 78,866.00
24 Eritromicin 500 mg Ktk 10 x 10 Kaps 25 Rp 136,693.00
25 Glibenclamide 5 mg Ktk 10 x 10 tab 10 Rp 14,903.00
26 Griseovulvin 125 mg Ktk 10 x 10 tab 10 Rp 60,812.00
27 Heptamyl Dos 20 tab 10 Rp 320,000.00
28 Ketakonazole 200 mg dos 50 tab 5 Rp 45,000.00
29 Kina 200 mg ktk 288 tab 15 Rp 525,000.00
30 Lisinopril 5 mg Ktk 3 x 10 tab 10 Rp 28,534.00
31 Loperamid 2 mg Ktk 10 x 10 tab 20 Rp 23,392.00
32 Loratadine 10 mg Ktk 5 x 10 tab 10 Rp 43,845.00
33 Metformin 500 mg Dos100 tab 10 Rp 31,730.00
34 Metronidazole 500 mg Ktk 10 x 10 tab 50 Rp 29,709.00
35 Ofloxacin 400 mg Ktk 5 x 10 tab 20 Rp 114,978.00
36 Omeprazol 20 mg ktk 3 x 10 tab 200 Rp 32,000.00
37 Oralit 200 ml Ktk 100 sasht 25 Rp 44,500.00
38 Paracetamol 500 mg Btl 1000 tab 10 Rp 86,105.00
39 Pentoksifilin 100 mg Ktk 10 x 10 tab 10 Rp 347,104.00
40 Pirazinamide 50 mg Ktk 10 x 10 Tab 150 Rp 56,211.00
41 Propylthiourasil 100 mg Btl 100 tab 5 Rp 78,909.00
42 Rifampicin 450 mg Ktk 10 x 10 tab 150 Rp 111,700.00
43 Simvastatim 10 mg Box / 30 10 Rp 68,987.00
44 Spironolakton 25 mg Dos 10 x 10 tab 20 Rp 98,325.00
45 Teosal Dos 100 tab 10 Rp 15,750.00
46 Tiamfenikol 500 mg Ktk 10 x 10 Kaps 5 Rp 104,614.00
47 Tramadol 50 mg Dos 50 kaps 25 Rp 45,456.00
48 Transamin 250 mg Ktk 10 x 10 tab 10 Rp 525,500.00
49 Vitamin B Complex Btl 1000 tab 20 Rp 56,723.00
50 Vitamin C 100 mg Btl 1000 tab 20 Rp 67,535.00
51 Vitamin B6 10 mg Btl 1000 tab 20 Rp 25,550.00
JUMLAH I
OBAT INJEKSI
KEBUTUHAN HARGA
NO NAMA OBAT KEMASAN
SATUAN (Rp)
Jmlh (Ktk, Btl)
1 Adimidon 15 mg Ktk 12 Vial 10 Rp 62,500.00
2 Aminophyline 24 mg Ktk 24 Amp 10 Rp 91,328.00
3 Buscopan Ktk 10 Amp 10 Rp 240,000.00
4 Cairan Ringer Laktat krtn 20 btl 45 Rp 239,500.00
5 Cefotaxim 1g Ktk 2 Vial 400 Rp 25,000.00
6 Ceftriaxone 1 g Ktk 2 Vial 400 Rp 30,000.00
7 Dextrose 40% fls 50 Rp 11,000.00
8 Depoprogestin Dos 20 Vial 3 Rp 236,280.00
9 Epinefrine Ktk 30 Amp 10 Rp 26,499.00
10 Lasix 10 mg/ml Ktk 5 Amp 20 Rp 75,000.00
11 Lidocain 2 ml comp Ktk 10 Amp 80 Rp 34,608.00
12 Neurobion 3 ml Ktk 20 Amp 40 Rp 160,000.00
13 Novalgin Ktk 5 Amp 100 Rp 75,000.00
14 Oxytoksin Ktk 100 Amp 5 Rp 465,000.00
15 Papaverine 40 mg/ml Ktk 12 vial 40 Rp 91,982.00
16 Primperan Ktk 5 Amp 100 Rp 75,000.00
17 Ranitidine 25 mg Ktk 25 Amp 120 Rp 164,162.00
18 Tramadol Inj 50mg/ml Ktk 25 Amp 5 Rp 375,000.00
19 Transamin 250 mg/amp Ktk 10 Amp 10 Rp 160,000.00
20 Vit B1 Ktk 100 Amp 10 Rp 397,500.00
JUMLAH II
OBAT SYRUP
KEBUTUHAN HARGA
NO NAMA OBAT KEMASAN
SATUAN (Rp)
Jmlh (Ktk, Btl)
1 Amoxicillin 125 mg Krtn 50 btl 10 Rp 365,350.00
2 Cotrymoksazole Krtn 50 btl 5 Rp 362,700.00
3 Nocamaag Suspensi Krtn 50 btl 15 Rp 250,000.00
4 Paracetamol 120 mg Krtn 50 btl 10 Rp 220,300.00
5 Novadiar Krtn 50 btl 5 Rp 250,000.00
JUMLAH III
OBAT ZALF/TETES/KRIM
KEBUTUHAN HARGA
NO NAMA OBAT KEMASAN
SATUAN (Rp)
Jmlh (Ktk, Btl)
1 Basitrasyn Tube 50 Rp 4,477.00
2 Betametason 5 gr krim Tube 50 Rp 16,500.00
3 Chloramphenycol 1 % tetes Mata btl 5 ml 50 Rp 6,388.00
4 Gentamycin 0,1 tetes mata Ktk 24 btl 5 Rp 182,304.00
5 Oxytetrasiklin krim Salep kulit tube 5 gr 50 Rp 4,280.00
6 PK Tube 50 Rp 11,000.00
JUMLAH IV
Jumlah I Rp 187,122,665.00
Jumlah II Rp 97,061,970.00
Jumlah III Rp 12,670,000.00
Jumlah IV Rp 3,043,770.00
TOTAL Rp 299,898,405.00
DIBULATKAN Rp299,898,000.00
TERBILANG : Dua Ratus Sembilan Puluh Sembilan Juta Delapan Ratus Sembilan Puluh Delapan Ribu
R PENYERAHAN BARANG
ADAAN OBAT - OBATAN
UM DAERAH CENDRAWASIH DOBO
PATEN KEPULAUAN ARU
ALOKASI UMUM T.A. 2010
JUMLAH
HARGA (Rp)
Rp 613,220.00
Rp 15,330,400.00
Rp 750,000.00
Rp 1,250,000.00
Rp 279,000.00
Rp 1,221,000.00
Rp 5,621,400.00
Rp 708,270.00
Rp 2,900,000.00
Rp 352,000.00
Rp 452,925.00
Rp 879,900.00
Rp 2,274,240.00
Rp 46,182,710.00
Rp 801,020.00
Rp 332,160.00
Rp 1,923,310.00
Rp 2,400,000.00
Rp 1,821,080.00
Rp 227,280.00
Rp 1,063,170.00
Rp 14,625,000.00
Rp 14,195,880.00
Rp 3,417,325.00
Rp 149,030.00
Rp 608,120.00
Rp 3,200,000.00
Rp 225,000.00
Rp 7,875,000.00
Rp 285,340.00
Rp 467,840.00
Rp 438,450.00
Rp 317,300.00
Rp 1,485,450.00
Rp 2,299,560.00
Rp 6,400,000.00
Rp 1,112,500.00
Rp 861,050.00
Rp 3,471,040.00
Rp 8,431,650.00
Rp 394,545.00
Rp 16,755,000.00
Rp 689,870.00
Rp 1,966,500.00
Rp 157,500.00
Rp 523,070.00
Rp 1,136,400.00
Rp 5,255,000.00
Rp 1,134,460.00
Rp 1,350,700.00
Rp 511,000.00
Rp 187,122,665.00
OBAT INJEKSI
JUMLAH
HARGA (Rp)
Rp 625,000.00
Rp 913,280.00
Rp 2,400,000.00
Rp 10,777,500.00
Rp 10,000,000.00
Rp 12,000,000.00
Rp 550,000.00
Rp 708,840.00
Rp 264,990.00
Rp 1,500,000.00
Rp 2,768,640.00
Rp 6,400,000.00
Rp 7,500,000.00
Rp 2,325,000.00
Rp 3,679,280.00
Rp 7,500,000.00
Rp 19,699,440.00
Rp 1,875,000.00
Rp 1,600,000.00
Rp 3,975,000.00
Rp 97,061,970.00
OBAT SYRUP
JUMLAH
HARGA (Rp)
Rp 3,653,500.00
Rp 1,813,500.00
Rp 3,750,000.00
Rp 2,203,000.00
Rp 1,250,000.00
Rp 12,670,000.00
AT ZALF/TETES/KRIM
JUMLAH
HARGA (Rp)
Rp 223,850.00
Rp 825,000.00
Rp 319,400.00
Rp 911,520.00
Rp 214,000.00
Rp 550,000.00
Rp 3,043,770.00
HARGA
NO TENUN UKURAN / JENIS KEBUTUHAN SATUAN
( Rp )
1 Film Rontgen 24 x 30 cm 2 1,576,000
2 Film Rontgen 30 x 40 cm 4 1,950,000
3 Film Rontgen 35 x 35 cm 3 2,100,000
4 Film Rontgen 35 x 43 cm 1 2,200,000
5 Cairan Pencuci Film Developer Liquid 12 975,000
6 Cairan Pencuci Film Fixer Liquid 12 975,000
7 Film Dental Gigi Hansein 3 716,000
JUMLAH
TERBILANG : EMPAT PULUH LIMA JUTA RUPIAH
JUMLAH
HARGA
3,152,000
7,800,000
6,300,000
2,200,000
11,700,000
11,700,000
2,148,000
45,000,000
NG : EMPAT PULUH LIMA JUTA RUPIAH
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