DAFTAR MUTASI BARANG PAKAI HABIS

Periode Tanggal 1 Januari 2023 s/d 31 Desember 2023

No Kode Kelompok/Bidang Barang Satuan Mutasi HARGA
Bidang
ABON MULTI DRUG ONE box 80 132,190,940,000,001.00 IDR 1,652,386,750,000.01
ACCU CHECK SAFE T PRO UNO 200 pcs 40,000 266,999,990,000,001.00 IDR 6,674,999,750.00
ADVANTIME 1 15S40A ROUND 36'S pcs 360 31,679,975,124.00 IDR 87,999,930.90
ADVANTIME 1 15S40E TAPER 36'S pcs 108 9,503,990,664.00 IDR 87,999,913.56
ALKOHOL 96% 1L liter 60 179,992,350,144.00 IDR 2,999,872,502.40
ALKOHOL SWABB 0,5% OM pcs 646,000 639,436,000,000,007.00 IDR 989,839,009.29
ANGIOGRAPHIC NEEDLES 18G AD18T71W MERIT pcs 15 799,800,066.00 IDR 53,320,004.40
ARM SLING L ONEMED pcs 400 740,000,000,000,001.00 IDR 1,850,000,000,000.00
ARM SLING M ONEMED pcs 150 277,500,000,000,001.00 IDR 1,850,000,000,000.01
ASAP LP 6Fr pcs 1 83,684,899,998.00 IDR 83,684,899,998.00
BALLOON PRO HP 2.5X15 MM pcs 1 17,627,289,954.00 IDR 17,627,289,954.00
BALLOON PRO HP 2.75X15 MM pcs 3 52,881,869,954.00 IDR 17,627,289,984.67
BIOSURE pcs 53 2,863,202,580,044.00 IDR 54,022,690,189.51
BLANKET WARM CAREQUILT (FR3X) pcs 150 171,199,999,999,999.00 IDR 1,141,333,333,333.33
COLOSTOMY BAG DEWASA 4CM pcs 330 791,999,999,999,999.00 IDR 2,400,000,000,000.00
CONDOM CATHETER S pcs 10 579,999,999,999,999.00 IDR 57,999,999,999,999.90
CRE 8 STENT 2.25X16 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 2.25X20 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 2.5X16 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 2.75X16 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 2.75X20 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 2.75X25 MM pcs 2 140,539,159,969.00 IDR 70,269,579,984.50
CRE 8 STENT 2.75X31 MM pcs 2 140,539,159,969.00 IDR 70,269,579,984.50
CRE 8 STENT 3.0X16 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 3.0X20 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 3.0X25 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 3.0X31 MM pcs 2 140,539,159,969.00 IDR 70,269,579,984.50
CRE 8 STENT 3.5X16 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 3.5X20 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 3.5X25 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 3.5X31 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
CRE 8 STENT 4.0X16 MM pcs 1 70,269,580,537,999.00 IDR 70,269,580,537,999.00

Halaman 1 / 36
No Kode Kelompok/Bidang Barang Satuan Mutasi HARGA
Bidang
CRE 8 STENT 4.0X20 MM pcs 1 70,269,579,969.00 IDR 70,269,579,969.00
DERMAFIX BOX 25'S pcs 200 615,999,999,999,999.00 IDR 3,080,000,000,000.00
ELECTROSURGICAL PENCIL 2 BUTTON ERBE FR10X kali 1,200 115,145,349,999,999.00 IDR 95,954,458,333.33
ETT NO 3 UNCUFF FORCHE pcs 30 497,999,999,999,999.00 IDR 16,600,000,000,000.00
ETT NONKING 3 FORSCH+STYLET pcs 30 4,109,999,962.00 IDR 136,999,998.73
ETT NONKING 4.5 FORSCH+STYLET pcs 50 6,849,999,838.00 IDR 136,999,996.76
ETT NONKING 6.5 FORSCH+STYLET pcs 73 10,000,999,962.00 IDR 136,999,999.48
ETT NONKING 7 FORSCH+STYLET pcs 600 82,200,002,177.00 IDR 137,000,003.63
FLUYDO BALLOON 1.5X15 MM pcs 1 17,624,990,034.00 IDR 17,624,990,034.00
FLUYDO BALLOON 2.0X15 MM pcs 4 70,499,960,034.00 IDR 17,624,990,008.50
FLUYDO BALLOON 2.5X15 MM pcs 3 52,874,970,034.00 IDR 17,624,990,011.33
FOLEY CATH 2WAY 20 RUSCH pcs 200 414,865,100,000,001.00 IDR 2,074,325,500,000.01
GRIPPER PLUS 20GX75 NEDLELESS pcs 24 389,600,000,000,001.00 IDR 16,233,333,333,333.40
GRIPPER PLUS 22GX75 NEDLELESS pcs 4 595,999,999,999,999.00 IDR 149,000,000,000,000.00
GUIDELINER V3 5.5 Fr pcs 1 5,659,350,995.00 IDR 5,659,350,995.00
HANDSCHOEN DISP NITRILE S PF box 2,500 922,349,999,999,999.00 IDR 368,940,000,000.00
INQWIRE GUIDE WIRE IQ35F150J3 MERIT pcs 20 372,302,000,000,001.00 IDR 18,615,100,000,000.10
KERTAS PUYER CETAK lembar 180,000 158,358,149,999,994.00 IDR 879,767,500.00
MASKER EARLOOP pcs 354,500 862,350,989,999,996.00 IDR 2,432,583,892.81
MASKER RESERVO ANAK BESMED pcs 350 804,999,999,999,999.00 IDR 2,300,000,000,000.00
MASKER RESERVO BAYI BESMED pcs 50 675,000,000,000,002.00 IDR 13,500,000,000,000.00
MAYO NO 9 OM pcs 3,400 427,516,009,999,999.00 IDR 125,740,002,941.18
MINI SCREW pcs 42 65,384,425,064.00 IDR 1,556,772,025.33
NEEDLE NO 18 AGANI pcs 7,500 261,697,799,999,999.00 IDR 34,893,040,000.00
NEEDLE NO 23 pcs 3,000 104,697,599,999,999.00 IDR 34,899,200,000.00
OPTIME 4/0 18S15K CUTTING 36'S pcs 180 12,167,076,192.00 IDR 67,594,867.73
PEROSSAL 1X6 pcs 48 741,879,700,000,002.00 IDR 15,455,827,083,333.40
PLATE INION 6H pcs 3 827,595,599,999,999.00 IDR 275,865,200,000,000.00
PLATE MINI 4 H pcs 3 24,837,649,947.00 IDR 8,279,216,649.00
PLATE RECON S CLAVICULA 8 H pcs 2 23,209,099,945.00 IDR 11,604,549,972.50
PLATE STRAIGHT 2.0MM 10H 210032 pcs 40 624,828,799,999,999.00 IDR 15,620,720,000,000.00
PRELUDE SHEATH INTRODUCER PSI-6F-11-038 MERIT pcs 50 18,933,949,994.00 IDR 378,678,999.88
PROLENE 6/0 W523 12'S CUTTING pcs 180 1,815,992,167,548.00 IDR 10,088,845,375.27
SILK 1 HR37 SMI ROUND 12'S pcs 48 902,351,000,000,001.00 IDR 18,798,979,166,666.70
SMALL BUR HOLE PLATE pcs 10 819,800,999,999,999.00 IDR 81,980,099,999,999.90
SPINOCAN 27 pcs 150 513,719,999,999,999.00 IDR 3,424,799,999,999.99
SUCTION CATH FR 12 OM pcs 18,900 791,879,899,999,999.00 IDR 41,898,407,407.41
SUCTION CATH FR 8 OM pcs 200 868,999,999,999,999.00 IDR 4,345,000,000,000.00
TITANIUM SCREW 1.6X4MM 2111604 BP pcs 325 746,973,499,999,999.00 IDR 2,298,380,000,000.00

Halaman 2 / 36
No Kode Kelompok/Bidang Barang Satuan Mutasi HARGA
Bidang
TITANIUM SCREW 1.6X5MM 2111605 pcs 400 919,351,999,999,999.00 IDR 2,298,380,000,000.00
TITANIUM SCREW 2.0X8MM 2112008 pcs 175 402,216,499,999,999.00 IDR 2,298,379,999,999.99
VICRYL 3/0 W 9521T 24'S pcs 96 972,182,384,904.00 IDR 10,126,899,842.75
VICRYL 6/0 W9552 SPATULLA 12'S pcs 48 1,342,411,807,548.00 IDR 27,966,912,657.25
VYGON OCTOPUS 2 LUMEN BICONECTOR+CLAMPS pcs 40 460,000,000,000,002.00 IDR 11,500,000,000,000.10

Halaman 3 / 36
Provinsi : Jawa Timur
Satuan Kerja : RSUD Dr. Soedono Madiun Medis (070303) - G. FARMASI - 02
Gudang : G. FARMASI - 02
DAFTAR MUTASI BARANG PAKAI HABIS
Periode Tanggal 1 Januari 2023 s/d 31 Desember 2023
Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
3D LAPAROSCOPY CAMERA SYSTEM pcs 80 27,637,890.00 IDR 345,473.63
3WAY PANJANG HEXACARE pcs 6,300 43,470,009.00 IDR 6,900.00
3WAY PANJANG POLYMED pcs 4,500 35,353,500.00 IDR 7,856.33
3WAY PANJANG TP (50'S) pcs 200 1,614,600.00 IDR 8,073.00
3WAY PENDEK HEXACARE pcs 1,400 6,999,992.00 IDR 4,999.99
3WAY PENDEK POLYMED pcs 1,500 17,510,250.00 IDR 11,673.50
4P79.30 CC UIBC LIQUID ABBOT kit 3 4,537,125.00 IDR 1,512,375.00
6K95.30 CC MULTIGENT IRON LIQUID set 2 3,117,990.00 IDR 1,558,995.00
7ML ER BOND RTU PRIMARY unit 1 6,454,650.00 IDR 6,454,650.00
7ML PR BOND RTU PRIMARY pcs 2 7,681,200.00 IDR 3,840,600.00
7ML RTU KI67 (K2) box 2 7,337,100.00 IDR 3,668,550.00
A2FN NAIL pcs 8 61,923,275.00 IDR 7,740,409.38
ABBOCATH 14 pcs 50 406,260.00 IDR 8,125.20
ABBOCATH 16 pcs 1,800 13,112,712.00 IDR 7,284.84
ABBOCATH 20 pcs 200 1346851.9 IDR 6,734.26
ABBOCATH 22 pcs 100 794,962.00 IDR 7,949.62
ABBOT ALBUMIN BCG2 botol 18 7,042,950.00 IDR 391,275.00
ABBOT UREA NITROGEN2 set 38 64,957,200.00 IDR 1,709,400.00
ABBOTT CONSOLIDATED CHEMISTRY CALIBRATOR vial 8 3,503,160.00 IDR 437,895.00
ABON HBSAG 402 D WB/S/P box 80 23,888,080.00 IDR 298,601.00
ABON IHBSB-302 S/P D 40T unit 30 8,958,030.00 IDR 298,601.00
ABON IHBSG-402WB D 40T kit 35 9,500,961.00 IDR 271,456.03
ABON MULTI DRUG 5 DRUG SCREEN TEST (AMP, THC, MDMA, MOP, box 3 4,725,830.00
BZO)
IDR 1,575,276.67
ABON MULTI DRUG 6 DRUG SCREEN TEST (COC, AMP, MET, THC, box 5 8,577,276.00
MOP, BZO)
IDR 1,715,455.20
ABON Syphilis kit 3 4,162,500.00 IDR 1,387,500.00
ACCU CHECK GUIDE 100 TEST pcs 2,000 8,000,000.00 IDR 4,000.00
ACCU CHECK PERFOMA 100 TEST ST pcs 7,200 26,640,001.00 IDR 3,700.00
ACID CITRIC (TRICARB C-50) 5L galon 140 42,240,516.00 IDR 301,717.97

Halaman 4 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
ACID CITRIC 1 KG kg 110 10,670,000.00 IDR 97,000.00
ACID FAST BACILLUS STAIN KIT kit 1 6,105,000.00 IDR 6,105,000.00
ACID WASH botol 8 6,251,520.00 IDR 781,440.00
ACRILIC LIQUID HEAT CURE pcs 5 1,746,063.00 IDR 349,212.60
ACRILIC OIL pcs 2 698,425.00 IDR 349,212.50
ACRILIC POWDER pcs 7 2,444,488.00 IDR 349,212.57
ACTIN FSL ACTIVATED PTT REA tablet 8 11,495,160.00 IDR 1,436,895.00
AD-PLATE 0.3 ML, MWP&SEAL FILM box 1 5,799,528.00 IDR 5,799,528.00
ALANINE AMINOTRANSFERASE2 set 11 7,112,325.00 IDR 646,575.00
ALGINATE pcs 7 1,787,100.00 IDR 255,300.00
ALKALINE PHOSPATASE FS R1 5X20ML+R2 1X25ML DIASIS kit 2 1,602,840.00 IDR 801,420.00
ALKALINE WASH botol 10 7,814,400.00 IDR 781,440.00
ALKOHOL 70% 1 L liter 2,040 39,830,896.00 IDR 19,524.95
ALKOHOL PEROXIDE+PUMP 500ML fls 4,600 110,806,601.00 IDR 24,088.39
ALOCLAIR PLUS GEL tube 63 5,362,410.00 IDR 85,117.62
ALOCLAIR PLUS OBAT KUMUR fls 70 4,311,439.00 IDR 61,591.99
ALOCLAIR PLUS SPRAY fls 3 311,520.00 IDR 103,840.00
ALOCLAIR PLUS SPRAY 15ML botol 85 6,843,315.00 IDR 80,509.59
ALVEOGIL pcs 1 1,609,500.00 IDR 1,609,500.00
AMPLAS BESI NO.500 pcs 10 122,100.00 IDR 12,210.00
AMPLAS KAYU pcs 10 122,100.00 IDR 12,210.00
AMPLATZ PTFE 0.035 ''J'' kali 45 16,110,000.00 IDR 358,000.00
ANESTHESIA MASK 1 pcs 15 562,499,979.00 IDR 37,499,998.60
ANESTHESIA MASK 2 pcs 20 737,499,979.00 IDR 36,874,998.95
ANESTHESIA MASK 3 pcs 35 1,312,499,958.00 IDR 37,499,998.80
ANESTHESIA MASK 4 pcs 150 5624999.58 IDR 37,500.00
ANESTHESIA MASK 5 pcs 430 16124996.79 IDR 37,499.99
ANGIOGRAPHIC JR CATH 3.5 6F 7503-13 MERIT pcs 10 3,721,130.00 IDR 372,113.00
ANGIOGRAPHIC ULTIMATE 4 RADIAL CATH 5F MERIT pcs 35 13,023,955.00 IDR 372,113.00
ANGIOWAY HIGH PRESSURE EXT. TUBING 150 CM/1200 PSI pcs 5 499,998.00
IDR 99,999.60
ANGIOWAY MANIFOLD 500 PSI, 3 SIDE PORT TIPE OFF pcs 5 395,006.00 IDR 79,001.20
ANTIFOGGING SOLN.STERILE F.ENDOSCOPES pcs 40 2,405,768.00 IDR 60,144.20
APRON LENGAN PANJANG pcs 800 6,800,020.00 IDR 8,500.03
APRON LENGAN PANJANG OM(BIRU) pcs 23,600 108,206,001.00 IDR 4,585.00
APRON OK PENDEK pcs 3,000 12,654,000.00 IDR 4,218.00
APRON OM pcs 16,500 30,183,300.00 IDR 1,829.29

Halaman 5 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
APRON OM (OK) pcs 7,000 21,000,000.00 IDR 3,000.00
AQUACEL AG EXTRA 10CMX10CM pcs 400 62,269,890.00 IDR 155,674.73
AQUADEST NON STERIL liter 1,700 7,225,000.00 IDR 4,250.00
AQUASONIC 250 ML botol 32 3,192,000.00 IDR 99,750.00
AQUASONIC 5L galon 22 20,962,500.00 IDR 952,840.91
ARAGAN 25MG/2.5ML INJ syringe 320 61,092,450.00 IDR 190,913.91
ARC CONC ICT DILUENT kit 1 2,193,360.00 IDR 2,193,360.00
ARCH BARR 207-0121 pcs 30 12,692,295.00 IDR 423,076.50
ARCH HBSAG QUALITATIVE II CALIBRATOR kit 12 18,652,884.00 IDR 1,554,407.00
ARCH HBSAG QUALITATIVE II CONTROL kit 3 12,340,980.00 IDR 4,113,660.00
ARCH HBSAG QUALITATIVE II REAGENT 100 T kit 12 50,129,820.00 IDR 4,177,485.00
ARCH PRE TRIGGER SOLUTION kit 4 9,312,900.00 IDR 2,328,225.00
ARCH. TRIGGER SOLUTION kit 4 2,934,840.00 IDR 733,710.00
ARM SLING S ONEMED pcs 60 1,110,000.00 IDR 18,500.00
ARTICULATING PAPER pcs 2 543,900.00 IDR 271,950.00
ASPARTATE AMINOTRANSFERASE2 set 3 2,328,669.00 IDR 776,223.00
AST - GN93 box 31 125133985.6 IDR 4,036,580.18
ASTO LATEX 100 TEST box 1 770,340.00 IDR 770,340.00
ASTO LATEX 50 TEST box 1 510,600.00 IDR 510,600.00
AUROLAC kali 12 1,498,500.00 IDR 124,875.00
BACTALERT FA PLUS box 7 80,146,927.00 IDR 11,449,561.00
BACTALERT PF PLUS unit 3 33,580,386.00 IDR 11,193,462.00
BACTERIAL FILTER HME pcs 5,850 157,949,971.00 IDR 27,000.00
BACTIGRAS 10X10CM pcs 2,300 16,100,001.00 IDR 7,000.00
BARIUM SULFAT 1 KG pot 1 710,400.00 IDR 710,400.00
BASIC COMPAC INFLATION DEVICE IN4330 pcs 8 10,683,052.00 IDR 1,335,381.50
BAYCLIN 1 LTR fls 276 7,046,280.00 IDR 25,530.00
BD FLASHBACK NEEDLE 22GX1 box 50 7,387,050.00 IDR 147,741.00
BD VACUTAINER 4.0 ML+REDTOP box 100 15,999,999.00 IDR 159,999.99
BED SHEET DISPOSIBLE pack 16 678,864.00 IDR 42,429.00
BETADIN SOL 60ML fls 7,200 183,185,868.00 IDR 25,442.48
BIL STENT CB 7FR 7CM pcs 10 15,540,000.00 IDR 1,554,000.00
BIL STENT DOUBLE 7FR 7CM pcs 5 7,770,000.00 IDR 1,554,000.00
BIL STENT DOUBLE 7FR 9CM pcs 5 7,770,000.00 IDR 1,554,000.00
BIPOLAR CUTTING THICK LOOP VRU2 (FR5X) kali 125 65000001.6 IDR 520,000.01
BIPOLAR HIP PROSTHESE 40 pcs 4 31,080,000.00 IDR 7,770,000.00
BIPOLAR HIP PROSTHESE 41 pcs 1 7,770,000.00 IDR 7,770,000.00

Halaman 6 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
BIPOLAR HIP PROSTHESE 42 pcs 7 54,390,000.00 IDR 7,770,000.00
BIPOLAR HIP PROSTHESE 43 pcs 1 7,770,000.00 IDR 7,770,000.00
BIPOLAR HIP PROSTHESE 44 pcs 6 46,620,000.00 IDR 7,770,000.00
BIPOLAR HIP PROSTHESE 45 pcs 1 7,770,000.00 IDR 7,770,000.00
BIPOLAR HIP PROSTHESE 46 pcs 1 7,770,000.00 IDR 7,770,000.00
BIPOLAR LONGSTEM CEMENLESS pcs 1 28,860,000.00 IDR 28,860,000.00
BLOOD AGAR BASE 500GR CM0055B OXOID kit 1 2,584,080.00 IDR 2,584,080.00
BLOOD SET TERUMO pcs 21,000 332,039,295.00 IDR 15,811.40
BLOOD STOP IX pcs 240 181,068,750.00 IDR 754,453.13
BLUE SENSOR ANAK AMBU T-00-S pcs 1,000 6,038,400.00 IDR 6,038.40
BLUE SENSOR BAYI AMBU pcs 1,440 11,929,924.00 IDR 8,284.67
BLUE SENSOR DWS AMBU R-00-S pcs 33,500 178,336,976.00 IDR 5,323.49
BLUE TIPS 500 box 61 4,749,199.00 IDR 77,855.72
BOND POLYMER REFINE DETECTION box 1 17,898,750.00 IDR 17,898,750.00
BOND PRINTER RIBBON LABELS CXI box 1 14,554,875.00 IDR 14,554,875.00
BONDING pcs 1 666,000.00 IDR 666,000.00
BONE CEMENT pcs 14 23,310,000.00 IDR 1,665,000.00
BONE CEMENT SYNICEN pcs 26 39,393,900.00 IDR 1,515,150.00
BONE WAX 24'S pcs 544 28,525,727.00 IDR 52,437.00
BONECEMENT ORTHOCEM 3G+GENTAMICIN pcs 24 77,256,000.00 IDR 3,219,000.00
BONEFILL ORTHO pcs 13 11,724,546.00 IDR 901,888.15
BONGROS 5CC BONE GRAFT box 78 90,128,993.00 IDR 1,155,499.91
BOTOL PIPET TETES 10ML pcs 100 499,500.00 IDR 4,995.00
BOTOL PLASTIK 100 CC pcs 300 549,450.00 IDR 1,831.50
BOTOL PLASTIK 200CC cc 300 624,375.00 IDR 2,081.25
BOTOL PLASTIK 30 CC pcs 500 499,500.00 IDR 999.00
BOTOL PLASTIK 30 CC pcs 5 44,250.00 IDR 8,850.00
BOTTLE SABORAUD DEXTROSE BROTH 500G CAT. 238230 box 1 2,436,450.00
IDR 2,436,450.00
BOUGLE DILATOR SET VDK-BO pcs 1 35,520,000.00 IDR 35,520,000.00
BOWIE DICK TEST ONEMED pcs 100 2,900,000.00 IDR 29,000.00
BREATHING CIR. ADULT AL1121 pcs 1,140 153,899,999.00 IDR 135,000.00
BREATHING CIR. PED. DOUBLE1421 pcs 20 2,899,999.00 IDR 144,999.95
BREATHING CPAP VA4233-23 (NICU) TANPA SELANG PUTIH pcs 50 53,113,500.00
IDR 1,062,270.00
BREATHING VENTILATOR VA4233-27 (NICU) pcs 20 21,245,400.00 IDR 1,062,270.00
BRUSH DISP pcs 1 177,600.00 IDR 177,600.00

Halaman 7 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
BSS 500ML fls 36 7,132,860.00 IDR 198,135.00
BUFFER PRO WRIGHT 500ML botol 4 710,400.00 IDR 177,600.00
CALCIUM CHLORIDE SOLUTION (10X15ML) box 1 1,452,990.00 IDR 1,452,990.00
CALPLUS pcs 1 532,800.00 IDR 532,800.00
CANCELLOUS SCREW 3.5MM pcs 80 20607451.33 IDR 257,593.14
CANCELLOUS SCREW 5X60 MM SYNTHES pcs 4 4,433,650.00 IDR 1,108,412.50
CANCELLOUS SCREW FULL (6.5MM) pcs 230 52255569.3 IDR 227,198.13
CANCELLOUS SCREW KECIL (4.0MM) pcs 140 31807738.5 IDR 227,198.13
CANCELLOUS SCREW LOCKING pcs 3 1,998,000.00 IDR 666,000.00
CANISTER INTOVAC WITH GEL 500 ML pcs 20 16,000,000.00 IDR 800,000.00
CANNULATED DRILL BIT pcs 1 1,831,500.00 IDR 1,831,500.00
CANNULATED SCREW pcs 5 13,320,000.00 IDR 2,664,000.00
CANULA SUCSEN pcs 1 244,200.00 IDR 244,200.00
CANULATED SCREW 3.5-1.50 SYNTHES pcs 7 9,668,671.00 IDR 1,381,238.71
CANULATED SCREW 6.5 SYNTHES pcs 9 9,096,035.00 IDR 1,010,670.56
CAT GRAM box 2 4,435,560.00 IDR 2,217,780.00
CAT NEIZZER 100ML set 1 278,610.00 IDR 278,610.00
CAT WRIGHT 500ML botol 2 2,775,000.00 IDR 1,387,500.00
CAVIT pcs 5 2,109,000.00 IDR 421,800.00
CAWAN PETRI 90X15MM pcs 1,000 4,995,000.00 IDR 4,995.00
CC ALBUMIN BCG botol 2 782,550.00 IDR 391,275.00
CC ALT set 7 5,462,310.00 IDR 780,330.00
CC AST set 7 6,557,880.00 IDR 936,840.00
CC BILIRUBIN DIRECT set 9 2,637,360.00 IDR 293,040.00
CC BILIRUBIN TOTAL set 9 4,390,605.00 IDR 487,845.00
CC CHOLESTEROL botol 21 19,603,710.00 IDR 933,510.00
CC CREATININE set 34 18,983,220.00 IDR 558,330.00
CC DETERGENT A botol 11 14,175,810.00 IDR 1,288,710.00
CC GLUCOSE, ABBOTT botol 44 32,454,180.00 IDR 737,595.00
CC H2O BATH ADD botol 2 2,031,300.00 IDR 1,015,650.00
CC HDL ULTRA REAGENT set 15 82,334,250.00 IDR 5,488,950.00
CC HEMOGLOBIN-A1C CALIBRATOR kit 4 17,955,360.00 IDR 4,488,840.00
CC HEMOGLOBIN-A1C CONTROL kit 5 17,565,750.00 IDR 3,513,150.00
CC HEMOGLOBIN-A1C REAGENT MULTIGENT kit 8 143,340,960.00 IDR 17,917,620.00
CC ICT CALIBRATOR kit 2 3,518,700.00 IDR 1,759,350.00
CC ICT CLEANING FLUID kit 1 9,967,245.00 IDR 9,967,245.00
CC ICT INT REF kit 4 9,139,740.00 IDR 2,284,935.00

Halaman 8 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
CC LDL DIRECT MULTIGENT set 17 127,655,550.00 IDR 7,509,150.00
CC LIQUID BILIRUBIN CALIBRATOR set 6 7,812,180.00 IDR 1,302,030.00
CC MCC CAL set 3 2,539,125.00 IDR 846,375.00
CC TRIGLYCERIDES, ABBOTT botol 29 31,322,979.00 IDR 1,080,102.72
CC URIC ACID2 box 43 21,502,365.00 IDR 500,055.00
CD117, C-KIT 7ML box 1 5,361,300.00 IDR 5,361,300.00
CD15, 3 ML box 1 4,229,100.00 IDR 4,229,100.00
CD20 (L26) BOND RTU PRIMARY 7ML box 1 5,180,370.00 IDR 5,180,370.00
CD3 (EP41) box 1 5,180,370.00 IDR 5,180,370.00
CD30, 3ML box 1 4,229,100.00 IDR 4,229,100.00
CD4 CARTIDGE botol 1 23,199,000.00 IDR 23,199,000.00
CD45 BOND RTU PRIMARY 7ML box 1 5,180,370.00 IDR 5,180,370.00
CELL CLEAN 50ML CL 50 botol 1 1,333,110.00 IDR 1,333,110.00
CELOLOID STREP pcs 1 543,900.00 IDR 543,900.00
CEMENT pcs 2 1,110,000.00 IDR 555,000.00
Cement Powder+Liq set 5 2,775,000.00 IDR 555,000.00
CENTRIFUGE TUBE 15ML(50PCS)pro histo box 3 657,675.00 IDR 219,225.00
CERTOFIX DUO PED. S413 pcs 10 7,430,980.00 IDR 743,098.00
CERTOFIX DUO V1220 pcs 10 9,941,600.00 IDR 994,160.00
CERTOFIX TRIO V720 pcs 230 182,568,710.00 IDR 793,777.00
CERVICAL CAGE STAND ALONE T LOCK pcs 4 36,542,311.00 IDR 9,135,577.75
CERVICAL COLLAR HARD M RESOURCES pcs 10 1,998,000.00 IDR 199,800.00
CERVICAL COLLAR PHILADELPIA L pcs 5 2,400,000.00 IDR 480,000.00
CERVICAL COLLAR PHILADELPIA M pcs 9 4,320,000.00 IDR 480,000.00
CERVICAL COLLAR PHILADELPIA S pcs 3 1,440,000.00 IDR 480,000.00
CERVICAL COLLAR SOFT L RESOURCES pcs 2 219,780.00 IDR 109,890.00
CERVICAL COLLAR SOFT M RESOURCES pcs 15 1,648,350.00 IDR 109,890.00
CERVICAL PLATE 16X26 pcs 1 6,382,500.00 IDR 6,382,500.00
CERVICAL SCREW 3 MMX14 MM pcs 4 2,886,000.00 IDR 721,500.00
CERVICAL SCREW STAND ALONE T LOCK pcs 8 10,229,760.00 IDR 1,278,720.00
CETRIDE 5 LITER galon 5 3,796,200.00 IDR 759,240.00
CHEMO MINI SPIKE V pcs 150 4,607,700.00 IDR 30,718.00
CHLOREXIDIN 2% pcs 7 1,048,950.00 IDR 149,850.00
CHLORHEXIDINE 2% pcs 5 749,250.00 IDR 149,850.00
CHROMIC 1 48G ROUND 12'S pcs 72 7,833,205.00 IDR 108,794.51
CHROMIC 1 925T ROUND 24'S pcs 96 8,536,788.00 IDR 88,924.88
CHROMIC 2 906T ROUND 24'S pcs 48 3,105,560.00 IDR 64,699.17

Halaman 9 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
CHROMIC 2 916T ROUND 24'S pcs 48 2,742,958.00 IDR 57,144.96
CHROMIC 2 HR 50 ROUND 12'S pcs 216 8,964,846.00 IDR 41,503.92
CHROMIC 2 S116 36'S pcs 324 9,739,749.00 IDR 30,060.95
CHROMIC 2/0 G127T ROUND 24'S pcs 72 5,607,221.00 IDR 77,878.07
CHROMIC 2/0 HR 37 SMI ROUND 12'S pcs 564 16,800,430.00 IDR 29,788.00
CICA-CARE 12X15CM/1X1 pcs 2 955,998.00 IDR 477,999.00
CIDEX OPA SOL 5 LTR galon 42 21,418,183.00 IDR 509,956.74
CIDEZYM 5 LTR galon 13 18,116,095.00 IDR 1,393,545.77
CLED MEDIUM 500 GR box 1 3,463,200.00 IDR 3,463,200.00
CLOSE SUCTION SYSTEM + ETT 67120 pcs 400 100,199,997.00 IDR 250,499.99
CLOSE SUCTION SYSTEM + TRACHEA 63120 pcs 160 30,559,998.00 IDR 190,999.99
CMS pcs 1 654,900.00 IDR 654,900.00
COLD KNIFE STORZ 27069K kali 30 20,588,639.00 IDR 686,287.97
COLOSTOMY BAG ANAK pcs 80 192,000.00 IDR 2,400.00
CONCENTRATED WASH BUFFER kit 3 4,800,195.00 IDR 1,600,065.00
CONDOM CATHETER L pcs 180 1,044,000.00 IDR 5,800.00
CONDOM CATHETER M pcs 40 232,000.00 IDR 5,800.00
CONDOM CATHETER XL pcs 39 226,201.00 IDR 5,800.03
CONNECTION CABLE MONOPOLAR(FR15X) kali 150 3,108,000.00 IDR 20,720.00
CONNECTION SUCT EMP 300CM pcs 4,350 91,050,417.00 IDR 20,931.13
CONSIERGE GUIDING EXC 6F SBS 3.5 pcs 2 2,656,980.00 IDR 1,328,490.00
CONSIERGE GUIDING EXC 6F SBS JL 3.5 pcs 1 1,328,490.00 IDR 1,328,490.00
CONSIERGE GUIDING EXC 6F SBS JR 3.5 pcs 2 2,656,980.00 IDR 1,328,490.00
CONSIERGE GUIDING EXC 6F SBS JR 4.0 pcs 2 2,656,980.00 IDR 1,328,490.00
CONTROL PLASMA N 10X1ML box 3 6,845,370.00 IDR 2,281,790.00
COROLENE 5/0 20S10M pcs 36 4,737,258.00 IDR 131,590.50
COROLENE 6/0 20S07D pcs 36 5,733,812.00 IDR 159,272.56
COROLENE 7/0 20S05G pcs 36 7,882,877.00 IDR 218,968.81
CORTEX SCREW SYNTHES pcs 1 335,880.00 IDR 335,880.00
CORTICAL SCREW 3.5 MM 10-30 pcs 1,330 181,178,918.00 IDR 136,224.75
CORTICAL SCREW 3.5 MM 32-40 pcs 140 19,071,465.00 IDR 136,224.75
CORTICAL SCREW 4.5 MM pcs 1,000 227198134.7 IDR 227,198.13
CORTICAL SCREW LOCKING pcs 34 18,870,000.00 IDR 555,000.00
CORTICAL SCREW SYNTHES pcs 1 335880.45 IDR 335,880.45
COTTON BUDS DEWASA pack 64 300,800.00 IDR 4,700.00
COVER GLASS 22X22 pcs 200 721,500.00 IDR 3,607.50
COVER GLASS 24 X 60 MM box 3 3,330,000.00 IDR 1,110,000.00

Halaman 10 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
COVER GLASS 24X40 box 5 360,750.00 IDR 72,150.00
COVERGLASS 24X50 MM pcs 1,000 1,110,000.00 IDR 1,110.00
CRANIOTOM HANDPIECE BUR MEDIUM kali 140 46,477,199.00 IDR 331,979.99
CRANIOTOME AESCULAB (FR10) F/GB265R kali 70 12,191,130.00 IDR 174,159.00
CRE 8 STENT 2.75X38 MM pcs 2 14,053,916.00 IDR 7,026,958.00
CRE 8 STENT 3.0X38 MM pcs 2 14,053,916.00 IDR 7,026,958.00
CRESENT KNIFE 2.6(FR4X)** pcs 40 1,948,050.00 IDR 48,701.25
Cresophin fls 1 1,093,350.00 IDR 1,093,350.00
CROSSLINK FOR PEDICLE SCREW pcs 2 6,596,660.00 IDR 3,298,330.00
CROSSLINK FOR SKY 40MM pcs 1 4,218,000.00 IDR 4,218,000.00
CROSSLINK TITANIUM pcs 39 116,883,000.00 IDR 2,997,000.00
CULTURE SWAB PLUS AMIES W/O CHARC SINGLE box 10 6,256,400.00 IDR 625,640.00
CUTIMED GEL 15 GR tube 220 17,729,098.00 IDR 80,586.81
CUTIMED SILTEC 10X10CM pcs 1,140 70,184,603.00 IDR 61,565.44
CUTIMED SILTEC 10X20CM pcs 369 34,028,920.00 IDR 92,219.30
CUTIMED SORBACT 7X9 CM pcs 1,680 92,559,998.00 IDR 55,095.24
CUTIMED SORBACT TUPFER 3 CM pcs 29 4,681,069.00 IDR 161,416.17
CUTTING LOOP 24/26FR 27050G MTP (FR2X) kali 12 12,382,651.00 IDR 1,031,887.58
CUTTING LOOP BALL ELECTRODE 3MM ARK kali 12 6811348.5 IDR 567,612.38
CUTTING LOOP STORZ 24FR ARK(FR4X) kali 60 32225242.5 IDR 537,087.38
CVC 2LUMEN 14.5FRX19CM HEMOSTAR pcs 5 11,238,750.00 IDR 2,247,750.00
CVC SET 2LUMEN 12FR ARROW pcs 5 5,250,000.00 IDR 1,050,000.00
CVC SET 2LUMEN 12FRX16CM ARROW pcs 30 32,460,000.00 IDR 1,082,000.00
CVC SET 3LUMEN 7FR ARROW pcs 130 84,180,000.00 IDR 647,538.46
CYTOKERATIN 20 box 1 5,361,300.00 IDR 5,361,300.00
CYTOKERATIN 7, 3 ML box 1 4,229,100.00 IDR 4,229,100.00
DADE INNOVIN (10X4ML) box 7 8,233,980.00 IDR 1,176,282.86
DARAH DOMBA ampul 6 6,515,700.00 IDR 1,085,950.00
DECONEX 34GR botol 5 3,774,000.00 IDR 754,800.00
DECONEX FOAM ACTIVE SPRAY botol 50 17,293,800.00 IDR 345,876.00
DEHIDROL ABSOLUT 2.5 L BIO OPTICA botol 15 20,167,312.00 IDR 1,344,487.47
DELTA DRY 4" roll 27 2,715,001.00 IDR 100,555.59
DELTA LITE 3" roll 15 1,871,999.00 IDR 124,799.93
DELTA LITE 4" roll 25 3,730,000.00 IDR 149,200.00
DENGUE Ig G/IgM CARD 25'' box 5 19,008,750.00 IDR 3,801,750.00
DENGUE IGG/IGM CARD 50 box 1 1,499,273.00 IDR 1,499,273.00
DESINFECTAN-C 100% 1LT fls 300 6,996,000.00 IDR 23,320.00

Halaman 11 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
DEVIT pcs 1 832,500.00 IDR 832,500.00
DEWAX SOLUTION liter 2 7,770,000.00 IDR 3,885,000.00
DIAMOND BUR LONG 2.0 MM kali 100 14,788,200.00 IDR 147,882.00
DIAMOND BUR LONG 3.0 MM kali 100 14,788,200.00 IDR 147,882.00
DIAMOND BUR LONG 4.0 MM kali 100 14,788,200.00 IDR 147,882.00
DILATION BALLOON CATHETER VDK-BD-40-80-90 kali 25 36,979,250.00 IDR 1,479,170.00
DILATION BALLOON CATHETER VDK-TBD 10/12 kali 25 26,562,500.00 IDR 1,062,500.00
DISK SINGLE DIAMOND pcs 1 310,800.00 IDR 310,800.00
DISPOSABLE ENDOSCOPIC HEMOCLIP pcs 20 25,290,000.00 IDR 1,264,500.00
DISPOSABLE GRASPING FORCEPS VDK-FG-120-A4 kali 30 3,000,000.00 IDR 100,000.00
DISPOSABLE INJECTION NEEDLE kali 10 7,136,000.00 IDR 713,600.00
DISPOSABLE NASAL BILLIARY DRAINAGE TUBE pcs 4 7,104,000.00 IDR 1,776,000.00
DISPOSABLE POLYP SNARES/VDK-SD-23-230-10-AIR pcs 2 2,974,800.00 IDR 1,487,400.00
DISPOSABLE POLYP SNARES/VDK-SD-23-230-20-AIR pcs 2 2,974,800.00 IDR 1,487,400.00
DISPOSABLE POLYP SNARES/VDK-SD-23-230-30-AIR kali 50 11,552,000.00 IDR 231,040.00
DISPOSABLE POLYP SNARES/VDK-SD-23-230-30-AIR pcs 2 2,974,800.00 IDR 1,487,400.00
DISPOSABLE ROTATABLE GRASPING FORCEPS WITH NET VDK-FG- kali 30 4,178,400.00
120-C2R
IDR 139,280.00
DISPOSABLE SPHINCTEROTOME VDK-KE-0725190A kali 12 17,649,000.00 IDR 1,470,750.00
DISPOSABLE SPHINCTEROTOME VDK-KE-0725190A pcs 4 14,936,160.00 IDR 3,734,040.00
Disposible Dissecting Blade no.100 (5pcs) box 5 6,854,250.00 IDR 1,370,850.00
Dissecting knife Handle F-100 feather box 2 2,442,000.00 IDR 1,221,000.00
DJ STENT 5 FR ARK pcs 45 16,264,269.00 IDR 361,428.20
DJ STENT PERCULEX PLUS 4.8FX26 CM pcs 70 36,890,000.00 IDR 527,000.00
DJ STENT PLASTIMED 5FR ENDS OPEN pcs 20 8,286,000.00 IDR 414,300.00
DJ STENT PLASTIMED 6FR ENDS OPEN pcs 10 4,140,000.00 IDR 414,000.00
DOUBLE ARM NEEDLE pcs 1 4,884,000.00 IDR 4,884,000.00
DRAGERSORB 800 galon 36 21,791,075.00 IDR 605,307.64
DRILL BIT 3.2 X 130 pcs 200 8,325,000.00 IDR 41,625.00
DRILL BIT 4.2MM pcs 1 1,665,000.00 IDR 1,665,000.00
DRILL BIT TEN 121MM pcs 1 1,887,000.00 IDR 1,887,000.00
DUODERM EXTRATHIN (BOX=10') pcs 100 4,491,060.00 IDR 44,910.60
DUROLANE INJ ampul 9 26,834,250.00 IDR 2,981,583.33
DYNACAST 4 INC (50CM) pcs 63 17,070,218.00 IDR 270,955.84
DYNACAST 5 INC (50CM) pcs 72 21,472,502.00 IDR 298,229.19
EBD PUSHER VDK-EBD-7 kali 10 4,440,000.00 IDR 444,000.00
EBD PUSHER VDK-EBD-8.5 kali 10 4,440,000.00 IDR 444,000.00

Halaman 12 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
ECG GEL 80ML OM tube 70 1,305,360.00 IDR 18,648.00
ECOFLAC pcs 625 4,217,431.00 IDR 6,747.89
ELASTOMULL 10CM X1MTR (FR4X) meter 2,840 36,210,002.00 IDR 12,750.00
ELASTOMULL 8CM X 1MTR (FR4X) meter 6,400 74,493,297.00 IDR 11,639.58
ELECTRODE NEONATE INNOQ PATIENT MONITOR pcs 100 130,000.00 IDR 1,300.00
ELECTROSURGICAL PENCIL ANARA FR10X kali 1,200 6,660,000.00 IDR 5,550.00
EMBEDDING CASETE PUTIH TANPA TUTUP pcs 2 1,942,500.00 IDR 971,250.00
EMBOLECTOMY TRAY 3FR EL3380 pcs 5 4,600,000.00 IDR 920,000.00
EMBOLECTOMY TRAY 4FR EL1480 pcs 5 4,600,000.00 IDR 920,000.00
EMBOLECTOMY TRAY 5FR EL1580 pcs 5 4,600,000.00 IDR 920,000.00
END CAP A2FN pcs 5 5,474,887.00 IDR 1,094,977.40
ENDCAPE 5MM pcs 3 1,863,502.00 IDR 621,167.33
ENDO BUTTON ACL biji 46 746,752,501.00 IDR 16,233,750.02
EQAS CLINICAL CHEMISTRY (MONTHLY) BIORAD BC50 kit 1 20,468,400.00 IDR 20,468,400.00
ERBE NESSY (20193.082) kali 4,550 17,034,998.00 IDR 3,743.96
ESTROGEN RECEPTOR Ab RTU PRIMARY 7ML box 1 10,000,000.00 IDR 10,000,000.00
ESTROGEN RECEPTOR AB RTU PRIMARY 7ML pcs 2 7,758,900.00 IDR 3,879,450.00
ETHIBOND GRN 4X75CM MB66G 12'S pcs 12 3,874,354.00 IDR 322,862.83
ETHILON 10/0 W1718 SPATULLA 12'S pcs 24 5,749,312.00 IDR 239,554.67
ETHYL CHLORIDE SPRAY fls 120 16,627,100.00 IDR 138,559.17
ETT NO 2 UNCUFF FORSCH pcs 20 332,001.00 IDR 16,600.05
ETT NO 2.5 UNCUFF pcs 30 467,000,945.00 IDR 15,566,698.17
ETT NO 3 WITH CUFF FORSCHE pcs 10 166,000.00 IDR 16,600.00
ETT NO 3.5 UNCUFF BICAKCILAR pcs 20 270,000.00 IDR 13,500.00
ETT NO 3.5 WITH CUFF FORSCHE pcs 10 166,001.00 IDR 16,600.10
ETT NO 4 WITH CUFF FORSCHE pcs 50 829,999,835.00 IDR 16,599,996.70
ETT NO 4,5 UNCUFF pcs 20 300999.5 IDR 15,049.98
ETT NO 4.5 WITH CUFF FORSCHE pcs 60 995,999,725.00 IDR 16,599,995.42
ETT NO 5 WITH CUFF FORSCHE pcs 50 829,999,835.00 IDR 16,599,996.70
ETT NO 5.5 WITH CUFF FORSCHE pcs 30 497,999,835.00 IDR 16,599,994.50
ETT NO 6 WITH CUFF FORSCHE pcs 60 996,000,335.00 IDR 16,600,005.58
ETT NO 6.5 WITH CUFF FORSCHE pcs 60 995,999,835.00 IDR 16,599,997.25
ETT NO 7 WITH CUFF FORSCHE pcs 1,000 17439993.7 IDR 17,439.99
ETT NO 7.5 WITH CUFF FORSCHE pcs 900 15779997.25 IDR 17,533.33
ETT NONKING 2.5 pcs 15 2,054,999.00 IDR 136,999.93
ETT NONKING 3.5 FORSCH+STYLET pcs 10 1,370,000.00 IDR 137,000.00
ETT NONKING 4 FORSCH+STYLET pcs 35 4,794,999.00 IDR 136,999.97

Halaman 13 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
ETT NONKING 5 FORSCH+STYLET pcs 60 8219999.81 IDR 137,000.00
ETT NONKING 5.5 FORSCH+STYLET pcs 20 2,740,007.00 IDR 137,000.35
ETT NONKING 6 FORSCH+STYLET pcs 20 2,740,000.00 IDR 137,000.00
ETT NONKING 7.5 FORSCH+STYLET pcs 800 109599998.48 IDR 137,000.00
ETZA pcs 1 721,500.00 IDR 721,500.00
Eugenol fls 2 777,000.00 IDR 388,500.00
EVA BAG NUTRIMIX 0.5/0 500ML pcs 100 7,889,800.00 IDR 78,898.00
EXTENSION SET 150CM HOSPITECH pcs 5,500 62,881,500.00 IDR 11,433.00
EXTENTION 75 CM 2.5ml pcs 200 1,567,177.00 IDR 7,835.89
EXTERNAL VENTRICULAR DRAIN 10FR (EVD SET) pcs 302 1,039,349,610.00 IDR 3,441,555.00
EYE DRAPE pcs 270 18,328,599.00 IDR 67,883.70
EYE SHIELD pcs 220 3,066,929.00 IDR 13,940.59
FECAL OCCULT BLOOD (FOB) tes 225 5,500,791.00 IDR 24,447.96
FECAL OCCULT BLOOD CARD 25'' box 1 1,449,937.00 IDR 1,449,937.00
FEEDING TUBE FR 10 JMS pcs 100 3,374,400.00 IDR 33,744.00
FEEDING TUBE FR 5/ 100 CM pcs 350 5341233.7 IDR 15,260.67
FEEDING TUBE FR 5/ 40 CM pcs 300 4,578,200.00 IDR 15,260.67
FEEDING TUBE FR 8/ 100 CM pcs 600 9156401.55 IDR 15,260.67
FEMALE CATH NO 12 OM pcs 550 2,686,200.00 IDR 4,884.00
FEMALE CATH NO 14 OM pcs 100 488,400.00 IDR 4,884.00
FEMALE CATH NO 16 OM pcs 100 488,400.00 IDR 4,884.00
FILAPEAU 2/0 7499E CUTTING 36'S pcs 288 14,414,657.00 IDR 50,050.89
FILM 20X25 DI-HL (150) box 107 213,875,910.00 IDR 1,998,840.28
FILM 20X25 KODAK (125) box 172 315619940.8 IDR 1,834,999.66
FILM 26X36 DI-HL (150) box 112 350,412,759.00 IDR 3,128,685.35
FILM 28X35 KODAK (125) box 120 402079953.4 IDR 3,350,666.28
FILM 35X43 DI-HL (100) box 82 264,993,391.00 IDR 3,231,626.72
FILM 35x43 KODAK (125) box 112 580559962.8 IDR 5,183,571.10
FIXOMUL 15CM (FR20X) pcs 42,000 311,099,988.00 IDR 7,407.14
FLET CONE BESAR pcs 5 893,550.00 IDR 178,710.00
FLOWABLE pcs 1 1,110,000.00 IDR 1,110,000.00
FLUYDO BALLOON NC 2.0X15 MM pcs 3 5,761,541.00 IDR 1,920,513.67
FLUYDO BALLOON NC 2.5X15 MM pcs 1 1,920,514.00 IDR 1,920,514.00
FOCUZ BAND LIGATOR pcs 100 6,105,000.00 IDR 61,050.00
FOLEY CATH 2WAY 10 RUSCH pcs 90 4,612,897.00 IDR 51,254.41
FOLEY CATH 2WAY 12 RUSCH pcs 150 2,819,100.00 IDR 18,794.00
FOLEY CATH 2WAY 14 RUSCH pcs 200 3,609,998.00 IDR 18,049.99

Halaman 14 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
FOLEY CATH 2WAY 16 RUSCH pcs 5,500 100,835,006.00 IDR 18,333.64
FOLEY CATH 2WAY 18 RUSCH pcs 310 5,532,002.00 IDR 17,845.17
FOLEY CATH 2WAY 22 RUSCH pcs 50 1,090,050.00 IDR 21,801.00
FOLEY CATH 2WAY 24 RUSCH pcs 10 274,731.00 IDR 27,473.10
FOLEY CATH 2WAY 6 RUSCH pcs 40 6,916,138.00 IDR 172,903.45
FOLEY CATH 2WAY 8 RUSCH pcs 130 7,152,475.00 IDR 55,019.04
FOLEY CATH 3WAY 20 RUSCH pcs 180 14,179,999.00 IDR 78,777.77
FOLEY CATH 3WAY 24 RUSCH pcs 120 9,440,001.00 IDR 78,666.68
FORMALIN 10% 1L liter 180 26,293,680.00 IDR 146,076.00
FREE T4 CALIBRATOR kit 1 2,614,050.00 IDR 2,614,050.00
FREE T4 REAGENT 100T kit 3 16,300,350.00 IDR 5,433,450.00
FRESSER pcs 5 1,110,000.00 IDR 222,000.00
Fuji I set 2 1,998,000.00 IDR 999,000.00
Fuji II set 7 9,720,270.00 IDR 1,388,610.00
Fuji IX set 2 3,185,700.00 IDR 1,592,850.00
FUJI IX HIJAU set 5 7,964,250.00 IDR 1,592,850.00
GARAM GROSOK kg 900 7,992,000.00 IDR 8,880.00
GELAS UKUR 10ML pcs 5 832,500.00 IDR 166,500.00
GENERATOR INTERFACE (NICU) pcs 40 31,080,000.00 IDR 777,000.00
Gergaji besi biji 5 144,300.00 IDR 28,860.00
GIGASEPT galon 16 42,320,000.00 IDR 2,645,000.00
GIGI FULL SET pcs 20 3,996,000.00 IDR 199,800.00
GIGI FULL Set A-3 pcs 15 2,997,000.00 IDR 199,800.00
GIGI FULL Set A-3,5 pcs 5 999,000.00 IDR 199,800.00
GIPS BIRU pcs 5 482,850.00 IDR 96,570.00
GIPS PUTIH pcs 30 1,065,600.00 IDR 35,520.00
GN TET VKT2 20 CARDS box 26 99694694.4 IDR 3,834,411.32
GN TET VTK 20 CARDS unit 5 20,211,324.00 IDR 4,042,264.80
GOLONGAN DARAH ANTI A vial 1 168,720.00 IDR 168,720.00
GOLONGAN DARAH ANTI AB vial 1 157,601.00 IDR 157,601.00
GOLONGAN DARAH ANTI B vial 1 157,600.00 IDR 157,600.00
GOLONGAN DARAH ANTI D vial 2 518,999.00 IDR 259,499.50
GOWN TOWEL SMS15K pcs 3,615 314,331,120.00 IDR 86,951.90
GP TET VKT2 20 CARDS box 7 27094922.4 IDR 3,870,703.20
GRANUFOAM DRESSING MEDIUM pcs 10 10,500,000.00 IDR 1,050,000.00
GUIDEWIRE CANNULATED pcs 1 610,500.00 IDR 610,500.00

Halaman 15 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
GUIDEWIRE HYDROPHILIC COATING 0.025X260 CM GWO-25-260A pcs 4 4,617,600.00
IDR 1,154,400.00
GUIDEWIRE HYDROPHILIC COATING 0.035X260 CM GWO-35-260A pcs 8 9,235,200.00
IDR 1,154,400.00
GUIDEWIRE HYDROPHILIC COATING GWO-25-260A pcs 2 4,145,184.00 IDR 2,072,592.00
GUIDEWIRE HYDROPHILLIC VDK-ZGW-450-A kali 10 9,813,250.00 IDR 981,325.00
GUIDEWIRE SENSOR 0,035 X 150 CM pcs 55 16,192,001.00 IDR 294,400.02
GUIDEWIRE SENSOR 0,038 X 150 CM pcs 25 7,699,999.00 IDR 307,999.96
GUTAP POINT NO. 15-40 pcs 16 2,575,200.00 IDR 160,950.00
GUTTAP POINT No. 40 - 80 pcs 2 344,100.00 IDR 172,050.00
H2O2 FOR PLASMA pcs 43 365,425,320.00 IDR 8,498,263.26
H2O2 STERICOOL 240ML pcs 8 40,600,000.00 IDR 5,075,000.00
HANDSCHOEN DISP NADI M box 3,500 127,662,500.00 IDR 36,475.00
HANDSCHOEN DISP NITRILE L PF box 1,100 40,700,000.00 IDR 37,000.00
HANDSCHOEN DISP NITRILE M PF box 8,500 314,500,000.00 IDR 37,000.00
HANDSCHOEN DISP SPMED L PF box 300 15,000,000.00 IDR 50,000.00
HANSAPLAST KECIL pcs 4,600 1,165,761.00 IDR 253.43
HBS ANTIBODY CARD 25 box 1 940,725.00 IDR 940,725.00
HBSAG CARD 25 box 12 4,349,992.00 IDR 362,499.33
HCG CARD 25 box 5 3,954,375.00 IDR 790,875.00
HCV ANTIBODY CARD 25' box 45 15,072,762.00 IDR 334,950.27
HCV ANTIBODY CARD 50'' box 125 252,026,277.00 IDR 2,016,210.22
HEAD STRAP SILICON pcs 520 56,507,853.00 IDR 108,668.95
HEMODIALISA SET LENGKAP set 10 5,472,300.00 IDR 547,230.00
HER 2/C-ERB-2 RTU kit 1 18,559,200.00 IDR 18,559,200.00
HER2 (RTU) box 2 37,118,400.00 IDR 18,559,200.00
HISTOACRIL pcs 10 7,992,000.00 IDR 799,200.00
HIV DEVICE 25T box 6 9,657,000.00 IDR 1,609,500.00
HIV I & II ANTIBODY CARD 50'' box 140 309,205,307.00 IDR 2,208,609.34
HOOK PLATE pcs 1 2,913,750.00 IDR 2,913,750.00
HS GAMEX NO. 6.5 PF BIRU pasang 2,650 26,473,500.00 IDR 9,990.00
HS GAMEX NO. 7 PF BIRU pasang 3,200 31,968,000.00 IDR 9,990.00
HS GAMEX NO. 7 PF UNGU pasang 500 10,878,000.00 IDR 21,756.00
HS GAMEX NO. 7.5 PF BIRU pasang 12,500 124,875,000.00 IDR 9,990.00
HS GAMEX NO. 8 PF BIRU pasang 2,200 21,978,000.00 IDR 9,990.00
HS ORTHO 7.5 PF TRO-ORTHOSURGE pasang 250 4,374,830.00 IDR 17,499.32
HS ORTHOPEDI 7 PF pasang 120 2,400,423.00 IDR 20,003.53

Halaman 16 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
HS ORTHOPEDI 7.5 PF pasang 1,120 22,403,955.00 IDR 20,003.53
HS ORTHOPEDI 8 PF pasang 360 7,201,271.00 IDR 20,003.53
HS STERIL EXAM L LONG / 7.5 pasang 2,770 9,473,850.00 IDR 3,420.16
HS STERIL EXAM M LONG / 7 pasang 2,500 6,315,900.00 IDR 2,526.36
HS STERIL EXAM S LONG / 6.5 pasang 1,000 2,526,360.00 IDR 2,526.36
HS STERIL MAS PF 7.5 pasang 400 3,552,000.00 IDR 8,880.00
HS STERIL SPMED 6.5 PF pasang 2,600 13,399,932.00 IDR 5,153.82
HS STERIL SPMED 7 PF pasang 15,500 80,400,024.00 IDR 5,187.10
HS STERIL SPMED 7,5 PF pasang 15,000 78,400,024.00 IDR 5,226.67
HUBI CRP BOX/25 box 30 78,671,250.00 IDR 2,622,375.00
HYDROCEPHALUS SHUNT ADULT BURHOLE MEDIUM pcs 23 137,862,000.00 IDR 5,994,000.00
HYDROCEPHALUS SHUNT ADULT HIGH pcs 10 53,280,000.00 IDR 5,328,000.00
HYDROCEPHALUS SHUNT ADULT LOW pcs 10 53,280,000.00 IDR 5,328,000.00
HYDROCEPHALUS SHUNT ADULT MEDIUM pcs 65 368,750,880.00 IDR 5,673,090.46
HYDROCEPHALUS SHUNT ANAK BURHOLE MEDIUM pcs 5 29,970,000.00 IDR 5,994,000.00
HYDROCEPHALUS SHUNT ANAK MEDIUM pcs 10 59,940,000.00 IDR 5,994,000.00
HYDROCEPHALUS SHUNT BAYI MEDIUM pcs 1 5,914,080.00 IDR 5,914,080.00
ICE BAG COMPRESS OM pcs 5 107,800.00 IDR 21,560.00
ID BAND ANAK PINK pcs 200 143,856.00 IDR 719.28
ID BAND DEWASA BLUE OM pcs 9,000 6,473,520.00 IDR 719.28
ID BAND DEWASA PINK OM pcs 7,000 5,034,960.00 IDR 719.28
IMMUNOHISTOCHEMICAL ANTIGEN RETRIEVAL BUFFER I botol 2 7,770,000.00 IDR 3,885,000.00
IMMUNOHISTOCHEMICAL ANTIGEN RETRIEVAL BUFFER II botol 2 8,624,700.00 IDR 4,312,350.00
INDIKATOR BIOLOGI BT96 BIONOVA pcs 150 14,985,000.00 IDR 99,900.00
INDIKATOR DALAM 1250** box 36 12,587,400.00 IDR 349,650.00
INDIKATOR LABEL BARCODE GKE roll 20 25,285,800.00 IDR 1,264,290.00
INDIKATOR PLASMA STRIP LOWTEM pack 5 22,893,750.00 IDR 4,578,750.00
INDIKATOR RECORD BLUE LABEL box 3 18,881,100.00 IDR 6,293,700.00
INDIKATOR STEAM CLAS 4 DUAL STRIP STERISTAR pack 20 1,585,420.00 IDR 79,271.00
INFLOW TUBE ACL pcs 22 94780128.5 IDR 4,308,187.66
INFUSET NIPRO pcs 28,000 201,388,161.00 IDR 7,192.43
INFUSET PEDIATRIC pcs 200 2268029.85 IDR 11,340.15
INSTANT HAEMOTOXYLIN box 2 10,955,700.00 IDR 5,477,850.00
INT FINETHROUGH GUIDEWIRE pcs 13 18,725,656.00 IDR 1,440,435.08
INTRASITE GEL 15G/1X10 pcs 30 3,846,150.00 IDR 128,205.00
INTUBATION STYLET 2.5-4.5 pcs 10 570,000.00 IDR 57,000.00
IODOSORB POWDER 1 SACHET @ 3 G pcs 105 6,614,998.00 IDR 62,999.98

Halaman 17 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
ISOFIX 1.25 CM X 9.2 CM roll 336 2,427,264.00 IDR 7,224.00
IV DRESING 67P E CARE pcs 44,000 71,128,157.00 IDR 1,616.55
JACKSON REEVER ADULT 2LT FLEXICARE pcs 50 15,000,000.00 IDR 300,000.00
JACKSON REEVER ADULT AL0410/0120 pcs 548 137,000,000.00 IDR 250,000.00
JACKSON REEVER PED 0.5LT AL0420 pcs 40 10,000,001.00 IDR 250,000.03
JACKSON REEVER PED 1LT AL0420 pcs 20 4,999,999.00 IDR 249,999.95
JARUM AKUPUNTUR 0.25X25 HWATO pack 20 661,560.00 IDR 33,078.00
JARUM AKUPUNTUR 0.3X25 HWATO pack 20 661,560.00 IDR 33,078.00
JARUM AKUPUNTUR 0.5'(0.20X15)DONGBANG pack 30 1,653,900.00 IDR 55,130.00
JARUM AKUPUNTUR 1" (0.25 X 25) pack 50 2,997,000.00 IDR 59,940.00
JARUM AKUPUNTUR 1'(0.25X25)DONGBANG pack 20 1,054,500.00 IDR 52,725.00
JARUM AKUPUNTUR 1.5" (0.25X40) pack 80 4,795,200.00 IDR 59,940.00
JARUM CYTOJECT pcs 5 1,698,300.00 IDR 339,660.00
Jarum Exterpatie set 3 1,098,900.00 IDR 366,300.00
JARUM FILE SENDOLIN set 4 1,420,800.00 IDR 355,200.00
JARUM IRIGASI pcs 14 3,885,000.00 IDR 277,500.00
K WIRE pcs 550 256,089,487.00 IDR 465,617.25
KACAMATA BAYI (POSEY) pcs 132 11,648,340.00 IDR 88,245.00
KAPAS 1 KG roll 180 19,678,301.00 IDR 109,323.89
KAPAS 500GR roll 220 11,890,764.00 IDR 54,048.93
KARBONDIOKSIDA 4 KG MR tabung 1 111,000.00 IDR 111,000.00
KARTRID XPERT SARS-COV 2 10 PCS PER BOX box 30 106,560,000.00 IDR 3,552,000.00
KASA HYDROFIL 42X110 AV SHUNT roll 2 704576.94 IDR 352,288.47
KASA HYDROFIL DRC 36MX80 CM roll 950 139,223,136.00 IDR 146,550.67
KASA STERIL 16X16 NARITA box 1,800 6,993,000.00 IDR 3,885.00
KASA STERIL 16X16 OM box 430 2,881,000.00 IDR 6,700.00
KASET CENTURION ABS INTREPID(FR3X) kali 66 36,893,736.00 IDR 558,996.00
KERTAS SARING pcs 100 8,325,000.00 IDR 83,250.00
KHB HIV ANTIBODY (1+2) DEVICE RAPID 50 TEST box 307 13,193,400.00 IDR 42,975.24
KILLBAC WOUND IRRIGATION pcs 120 6,119,998.00 IDR 50,999.98
KNIFE STRAIGHT MST15 (FR4X)(6') pcs 408 28,460,112.00 IDR 69,755.18
KOH 10% 100ML botol 1 61,050.00 IDR 61,050.00
KWIK DIFF KIT 125ML REAGENT box 12 25,974,000.00 IDR 2,164,500.00
LACTOPHENOL BLUE SOLUTION 100ML botol 1 960,150.00 IDR 960,150.00
LAMINARIA " L " pcs 20 3,576,420.00 IDR 178,821.00
LARGE BUR HOLE PLATE pcs 10 10,716,600.00 IDR 1,071,660.00
LATERAL MASS SCREW TT pcs 6 17,316,000.00 IDR 2,886,000.00

Halaman 18 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
LENSA CLAW LENS IOL NO 17.5 pcs 1 666,000.00 IDR 666,000.00
LENSA CLAW LENS IOL NO 19.5 pcs 1 666,000.00 IDR 666,000.00
LENSA FOLDABLE OPTIMA 11.0 pcs 1 399,600.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 12.0 pcs 1 399,600.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 13.0 pcs 1 399,600.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 14.0 pcs 1 399,600.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 15.0 pcs 2 799,200.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 15.5 pcs 3 1,198,800.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 16.0 pcs 3 1,198,800.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 16.5 pcs 4 1,598,400.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 17.0 pcs 5 1,998,000.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 17.5 pcs 10 3,996,000.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 18.0 pcs 7 2,797,200.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 18.5 pcs 7 2,797,200.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 19.0 pcs 16 6,393,600.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 19.5 pcs 13 5,194,800.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 2.5 pcs 2 799,200.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 20.0 pcs 16 6,393,600.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 20.5 pcs 20 7,992,000.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 21.0 pcs 9 3,596,400.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 21.5 pcs 10 3,996,000.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 22.0 pcs 14 5,594,400.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 22.5 pcs 9 3,596,400.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 23.0 pcs 14 5,594,400.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 23.5 pcs 11 4,395,600.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 24.0 pcs 7 2,797,200.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 24.5 pcs 8 3,196,800.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 25.0 pcs 7 2,797,200.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 25.5 pcs 2 799,200.00 IDR 399,600.00
LENSA FOLDABLE OPTIMA 9.0 pcs 1 399,600.00 IDR 399,600.00
LEUKOPLAST 3" X5M (1625) roll 100 4,379,998.00 IDR 43,799.98
LEUKOTAPE K 5X5 meter 25 1,044,432.00 IDR 41,777.28
LIGHT CURING pcs 3 2,497,500.00 IDR 832,500.00
LIGHT CURING Z 350 pcs 2 2,086,800.00 IDR 1,043,400.00
LIPID MULTICONSTITUEN CALIBRATOR vial 6 3,359,970.00 IDR 559,995.00
LIPIODOL cc 10 6,049,500.00 IDR 604,950.00
LOCKING SCREW 4.0 MM pcs 12 7268882.26 IDR 605,740.19

Halaman 19 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
LOCKING SCREW A2FN pcs 58 36,884,623.00 IDR 635,941.78
LOCKING SCREW PFNA 5.0 MM pcs 64 38350229.28 IDR 599,222.33
LOCKING SCREW SYNTHES pcs 23 11,916,621.00 IDR 518,113.96
LOCKING SCREW VA pcs 7 3,526,763.00 IDR 503,823.29
LONG 2 HL PLATE pcs 111 48,528,867.00 IDR 437,197.00
LS PRAXIS KEEPER pcs 12 673,200.00 IDR 56,100.00
LS SEALWARE D pcs 12 238,600.00 IDR 19,883.33
LUBRAGEL 11 ML pcs 1,100 26,251,500.00 IDR 23,865.00
LUGOL 1% 100ML botol 1 138,750.00 IDR 138,750.00
LYOSTIP 5X8CM 6'S pcs 960 84,715,186.00 IDR 88,244.99
M1 VARNISH pcs 5 499,500.00 IDR 99,900.00
MAC CONKEY AGAR NO 3 CAT CM0115B kit 2 3,675,210.00 IDR 1,837,605.00
MAGNA PURE 96 OUTPUT PLATE unit 1 1,731,600.00 IDR 1,731,600.00
MAGNA PURE 96 PROCESSING CARTRIDGE unit 4 5,594,400.00 IDR 1,398,600.00
MAGNA PURE SEALING FOIL unit 2 2,730,600.00 IDR 1,365,300.00
MALARIA COMBO ANTI GEN CARD 25" box 1 2,358,750.00 IDR 2,358,750.00
MAMIFIX box 1,400 101,999,998.00 IDR 72,857.14
MANIFOLD 500 PSI 503HF-R 3 PORT MERIT (FR2X) pcs 60 3,400,800.00 IDR 56,680.00
MASKER N95 OM pcs 11,200 74,592,000.00 IDR 6,660.00
MASKER NEBULIZER DWS ALTECH 33210 pcs 120 2,940,000.00 IDR 24,500.00
MASKER RESERVO BAYI HEXACARE pcs 100 1,639,999.00 IDR 16,399.99
MASKER RESERVO DWS BESMED pcs 3,250 74,750,000.00 IDR 23,000.00
MASKER RESERVO DWS HEXACARE pcs 2,000 32,800,000.00 IDR 16,400.00
MASKER TIES ON pcs 72,000 19,028,800.00 IDR 264.29
MATA BOR OPERASI PENDEK pcs 6 1,931,400.00 IDR 321,900.00
MAYO NO 10 OM pcs 306 3,941,758.00 IDR 12,881.56
MAYO NO 4 OM pcs 10 122,100.00 IDR 12,210.00
MAYO NO 5 OM pcs 40 488,400.00 IDR 12,210.00
MAYO NO 6 OM pcs 120 1,508,882.00 IDR 12,574.02
MAYO NO 7 OM pcs 240 3,017,760.00 IDR 12,574.00
MAYO NO 8 OM pcs 320 4,023,679.00 IDR 12,574.00
MCREPE 4'' roll 288 9,590,400.00 IDR 33,300.00
MEDICLORE 5ML vial 27 44,505,663.00 IDR 1,648,357.89
MEDISAFE TEST STRIP BOX 50'S pcs 20,000 64,847,562.00 IDR 3,242.38
MEDITAPE UC-11A botol 70 60,384,000.00 IDR 862,628.57
MEDIUM 2 HOLE PLATE 218-0024 pcs 205 91,882,435.00 IDR 448,207.00
MEDRAD BROSMED 190ML DUAL SYRINGE set 120 57,942,000.00 IDR 482,850.00

Halaman 20 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
MELOLIN 10X10 CM pcs 2,000 9,999,989.00 IDR 4,999.99
MERSILK 2/0 W213 12'S pcs 96 7,227,964.00 IDR 75,291.29
MERSILK 3/0 W212 pcs 48 3,147,516.00 IDR 65,573.25
MESS NO 10 pcs 2,500 7,164,551.00 IDR 2,865.82
MESS NO 11 pcs 1,700 4,871,894.00 IDR 2,865.82
MESS NO 15 pcs 1,700 4,871,893.00 IDR 2,865.82
MESS NO 21 pcs 1,300 3,725,566.00 IDR 2,865.82
MICROMIST JET NEBULIZER DWS BROSMED pcs 1,110 21,908,500.00 IDR 19,737.39
MICROSMOOTH MICROTIP(ALCON) kali 20 2,708,400.00 IDR 135,420.00
MICROTAINER box 5 1,587,300.00 IDR 317,460.00
MICROTOME BLADE DISP LOW PROFILE pcs 100 4,440,000.00 IDR 44,400.00
MIOSTAT (CARBACHOL)(FR4X) kali 600 26,379,843.00 IDR 43,966.41
MIXI INFUSION BAGS 500P pcs 240 18,120,160.00 IDR 75,500.67
MONOCRIL 3/0 Y427H CUTTING pcs 72 10,279,096.00 IDR 142,765.22
MONOSYN 6/0 HRT17 (36'S) TAPER pcs 108 15,895,871.00 IDR 147,183.99
MUCCUS EXTRACTOR GENERAL pcs 428 3,440,304.00 IDR 8,038.09
MUCCUS EXTRACTOR JMS pcs 780 22,311,000.00 IDR 28,603.85
MULTIDRUG ONE STEP MULTI GREEN TEST PANEL box 225 11,279,619.00 IDR 50,131.64
MY JELLY 80 GR tube 672 19,857,602.00 IDR 29,550.00
NASAL OKSIGEN ANAK pcs 100 680,000.00 IDR 6,800.00
NASAL OKSIGEN ANAK HOSPITECH pcs 100 1,221,000.00 IDR 12,210.00
NASAL OKSIGEN BAYI HOSPITECH pcs 300 4,961,700.00 IDR 16,539.00
NASAL OKSIGEN DWS JAM pcs 1,000 6,700,000.00 IDR 6,700.00
NASAL OKSIGEN DWS MAS pcs 1,650 11,355,300.00 IDR 6,882.00
NASAL OKSIGEN DWS SPMED pcs 8,100 54480066.25 IDR 6,725.93
NASAL PRONG M NICU pcs 20 8,880,000.00 IDR 444,000.00
NASAL PRONG XS NICU pcs 30 13,320,000.00 IDR 444,000.00
NATRIUM HIPOKLORIT I LTR fls 10 250,000.00 IDR 25,000.00
NATURA POUCH UROSTOMI 45CM pcs 40 3,933,396.00 IDR 98,334.90
NAVIFLEX 10F pcs 2 4,218,000.00 IDR 2,109,000.00
NAVIFLEX 8.5F pcs 2 4,218,000.00 IDR 2,109,000.00
NAVIFLEX RX 7F pcs 2 4,218,000.00 IDR 2,109,000.00
NAVIPRO 0.025 ANGLED pcs 5 12,210,000.00 IDR 2,442,000.00
NAVIPRO 0.025 STRAIGHT pcs 5 12,210,000.00 IDR 2,442,000.00
NEEDLE FLASHBACK 22X1 pcs 13,000 25,999,997.00 IDR 2,000.00
NEEDLE INSULIN NANOPAS 32,5G pcs 13,000 25,972,676.00 IDR 1,997.90
NEEDLE NO 25 AGANI pcs 2,400 837,568.00 IDR 348.99

Halaman 21 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
NELATON CATH 12 RUSCH pcs 10 199,800.00 IDR 19,980.00
NELATON CATH 14 RUSCH pcs 32 675,519.00 IDR 21,109.97
NELATON CATH 16 RUSCH pcs 10 237,760.00 IDR 23,776.00
NEO-CLEAR (XYLENE SUBSTITUTE) box 3 9,657,000.00 IDR 3,219,000.00
NEULEN PLATE pcs 32 131,487,000.00 IDR 4,108,968.75
NEULEN PLATE SCREW pcs 127 77,533,500.00 IDR 610,500.00
N-METHASON pcs 1 1,221,000.00 IDR 1,221,000.00
NON VASCULAR GUIDEWIRE VDK-ZGW-63-450A pcs 2 4,466,640.00 IDR 2,233,320.00
NON VASCULAR GUIDEWIRE VDK-ZGW-88-450A pcs 2 4,466,640.00 IDR 2,233,320.00
NON-GYN THINPREP TESTS PACKAGE CONTAINS (HOLOGIC) kit 1 26,399,130.00
IDR 26,399,130.00
NOVOSYN 0 HR40 36'S pcs 72 5,720,255.00 IDR 79,447.99
NOVOSYN 0 HS40 36'S pcs 212 17,625,891.00 IDR 83,141.00
NOVOSYN 1 HR40 36'S pcs 180 14,311,429.00 IDR 79,507.94
NOVOSYN 1 HS40 36'S pcs 216 14,074,127.00 IDR 65,158.00
NOVOSYN 2/0 HR26 36'S pcs 180 14,104,939.00 IDR 78,360.77
NOVOSYN 2/0 HS26 36'S pcs 236 17,191,655.00 IDR 72,846.00
NOVOSYN 3/0 DS24 36'S pcs 252 18,456,222.00 IDR 73,238.98
NOVOSYN 3/0 HR 26 36'S pcs 144 11,323,007.00 IDR 78,631.99
NOVOSYN 4/0 HR17 36'S pcs 72 5,264,497.00 IDR 73,118.01
NOVOSYS BONE GRAFT pcs 8 34,404,999.00 IDR 4,300,624.88
NUCLEASE FREE WATER 500ML CAT NO. P 1197 box 1 3,163,500.00 IDR 3,163,500.00
NUPREP tube 5 1,898,100.00 IDR 379,620.00
NUT FOR PEDICLE SCREW pcs 66 22,603,406.00 IDR 342,475.85
NUT FOR SKY POLIAXIAL SCREW pcs 48 18,648,000.00 IDR 388,500.00
OBJECT GLASS FROSTED 7105 SAIL pcs 2,520 1,359,750.00 IDR 539.58
OBJECT GLASS RED box 45 4,995,000.00 IDR 111,000.00
OCTENIC HAIR WASH pack 5 635,000.00 IDR 127,000.00
OKSIGEN BESAR pcs 20 1,487,400.00 IDR 74,370.00
OKSIGEN KECIL pcs 906 35,798,055.00 IDR 39,512.20
OKSIGEN LIQUID m3 400,000 2,743,999,929.00 IDR 6,860.00
OMNIFIX 50ML LS pcs 950 16,514,626.00 IDR 17,383.82
ONE SCRUB 4% 5 LTR fls 130 50,216,400.00 IDR 386,280.00
OPERATING TABLE COVER pcs 280 12,208,920.00 IDR 43,603.29
OPSITE 10X25 pcs 460 11,499,997.00 IDR 24,999.99
OPSITE 56X84 pcs 100 23,900,001.00 IDR 239,000.01
OPSITE POST OP 15.5 X 8.5CM pcs 50 1,081,391.00 IDR 21,627.82

Halaman 22 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
OPSITE POST OP 9.5X8.5 pcs 60 1,012,646.00 IDR 16,877.43
OPTICELLE SILICONE FOAM DRESSING BORDER 15X15CM pcs 40 3,263,400.00
IDR 81,585.00
OPTILENE 2/0 DS 24 CUTTING 36'S pcs 1,656 74,772,928.00 IDR 45,152.73
OPTILENE 3/0 DS 24 CUTTING 36'S pcs 1,872 85,863,024.00 IDR 45,867.00
OPTILENE 4/0 DS 19 CUTTING 36'S pcs 72 3,257,568.00 IDR 45,244.00
OPTILENE 5/0 DS 16 CUTTING 36' pcs 180 9,625,405.00 IDR 53,474.47
OPTIME 1 18S40G 36'S pcs 384 33,303,848.00 IDR 86,728.77
OPTIME 2/0 18S30J CUTTING 36'S pcs 540 42,129,171.00 IDR 78,016.98
OPTIME RAPIDE 2/0 CUTTING 36'S pcs 36 2,397,483.00 IDR 66,596.75
ORAL SPONGE ONEMED pcs 18,000 22,414,501.00 IDR 1,245.25
ORTHOPAEDIC SET (SHOULDER)HOGY ORS-2137 pcs 47 44,507,082.00 IDR 946,959.19
ORTHOPAEDIC SET (TKR) HOGY ORS-2138 pcs 53 29,670,065.00 IDR 559,812.55
PAKET DARM GAS ISI 2 (IBS) pack 1,500 32,883,750.00 IDR 21,922.50
PAKET DEPPERS ISI 10 pack 6,500 94,155,750.00 IDR 14,485.50
PAKET DRESSING ISI 10 pack 10,000 146,575,500.00 IDR 14,657.55
PAKET GANGGREN BESAR pack 3,000 49,950,000.00 IDR 16,650.00
PAKET HEMODIALISA NEW pack 13,740 302,280,000.00 IDR 22,000.00
PAPER ECG MAC 1200(210x295x150) pack 136 37,943,968.00 IDR 278,999.76
PAPER ECG MAC I(80x90x280) pcs 40 5,119,986.00 IDR 127,999.65
PAPER ECG MACHINE 12 ROLL(210MMX30M) roll 4 620,001.00 IDR 155,000.25
PAPER ECG PHILIPS (210X300X200) pack 30 11,190,023.00 IDR 373,000.77
PAPER ECG UTAS/MACHINE 3(80MMX25M) roll 18 2,304,006.00 IDR 128,000.33
Paper point 15-40 box 13 2,092,350.00 IDR 160,950.00
PAPER SELPHY CP 100 pack 8 6,060,600.00 IDR 757,575.00
PAPER UPC 21L box 6 14,580,000.00 IDR 2,430,000.00
PAPER USG 110X18 HG roll 210 44,400,860.00 IDR 211,432.67
PATHFAST cTnl box 3 18,056,073.00 IDR 6,018,691.00
PCR KIT MBIOCOV 10 TES PERBOX box 5 27,417,000.00 IDR 5,483,400.00
PDS 6/0 W9096H ROUND 36'S pcs 108 17,086,741.00 IDR 158,210.56
PDT KIT 8 SINGLE STAGE set 2 8,350,000.00 IDR 4,175,000.00
PEDICLE SCREW MONOAXIAL TT pcs 308 854,700,000.00 IDR 2,775,000.00
PEDICLE SCREW POLIAXIAL TT pcs 23 68,931,000.00 IDR 2,997,000.00
PERFUSOR TUBING pcs 1,422 59,264,825.00 IDR 41,677.09
PERIFIX 18G pcs 6 1,615,127.00 IDR 269,187.83
PERIFIX 400/20 G pcs 3 1,019,769.00 IDR 339,923.00
PERIODIC ACID SCHIFF 100 TEST kit 1 11,988,000.00 IDR 11,988,000.00

Halaman 23 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
PESSARIUM NO. 6 pcs 1 111,000.00 IDR 111,000.00
PESSARIUM NO. 6,5 pcs 11 1,136,640.00 IDR 103,330.91
PESSARIUM NO. 7 pcs 19 1,974,024.00 IDR 103,896.00
PEWARNA ZIEHL NELSEN SET 3X100ML set 1 316,350.00 IDR 316,350.00
PHYTO STEMCELL TREATMENT KIT tube 20 11,699,400.00 IDR 584,970.00
PILOT DRILL 16MM 1,3MM 220-0362 pcs 50 11,292,340.00 IDR 225,846.80
PIPET PLASTIK 3ML 500'S pack 3 915,750.00 IDR 305,250.00
PIPET TIPS PATHFAST box 5 17,718,980.00 IDR 3,543,796.00
PLAIN 3/0 HR 26 12'S pcs 60 1,869,037.00 IDR 31,150.62
PLAIN 4/0 H 819 CUTTING 24'S pcs 144 12448538.5 IDR 86,448.18
PLATE 1/3 TUBULAR TEBAL 6 H pcs 8 4606499.5 IDR 575,812.44
PLATE 1/3 TUBULAR TEBAL 7 H pcs 2 1,151,625.00 IDR 575,812.50
PLATE 1/3 TUBULAR TEBAL 8 H pcs 2 1,151,625.00 IDR 575,812.50
PLATE 1/3 TUBULAR TIPIS 10 H pcs 1 575812.5 IDR 575,812.50
PLATE 1/3 TUBULAR TIPIS 11 H pcs 1 575812.5 IDR 575,812.50
PLATE 1/3 TUBULAR TIPIS 5 H pcs 20 11516249.5 IDR 575,812.48
PLATE 1/3 TUBULAR TIPIS 6 H pcs 20 11516249.5 IDR 575,812.48
PLATE 1/3 TUBULAR TIPIS 7 H pcs 8 4606499.5 IDR 575,812.44
PLATE 1/3 TUBULAR TIPIS 8 H pcs 3 1727437.5 IDR 575,812.50
PLATE 1/3 TUBULAR TIPIS 9 H pcs 1 575812.5 IDR 575,812.50
PLATE 2 HOLE CRANIOTOMY pcs 49 18,964,388.00 IDR 387,028.33
PLATE BIPOLAR CEMENTED pcs 1 23,876,100.00 IDR 23,876,100.00
PLATE BROAD 10 H pcs 6 8,325,000.00 IDR 1,387,500.00
PLATE BROAD 8 H pcs 6 8,325,000.00 IDR 1,387,500.00
PLATE BROAD 9 H pcs 10 13,875,000.00 IDR 1,387,500.00
PLATE BROAD LOCKING pcs 1 5,550,000.00 IDR 5,550,000.00
PLATE CLAVICULA / S 3 H KI pcs 1 1,160,455.00 IDR 1,160,455.00
PLATE CLAVICULA / S 5 H KA pcs 1 1,160,455.00 IDR 1,160,455.00
PLATE CLAVICULA / S 7 H KI pcs 3 3,481,364.00 IDR 1,160,454.67
PLATE CLAVICULA / S 9 H KA pcs 1 1,160,455.00 IDR 1,160,455.00
PLATE CLOVER LEAF pcs 2 1,665,000.00 IDR 832,500.00
PLATE CONDYLAIR RIGHT 5 H pcs 2 4,329,000.00 IDR 2,164,500.00
PLATE CONDYLAR BUTTERS LOCKING pcs 2 8,325,000.00 IDR 4,162,500.00
PLATE CONDYLAR LEFT 10 H pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE CONDYLAR LEFT 11 H pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE CONDYLAR LEFT 12 H pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE CONDYLAR LEFT 5 H pcs 2 4,329,000.00 IDR 2,164,500.00

Halaman 24 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
PLATE CONDYLAR LEFT 6 H pcs 3 6,493,500.00 IDR 2,164,500.00
PLATE CONDYLAR LEFT 7 H pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE CONDYLAR LEFT 8 H pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE CONDYLAR LEFT 9 H pcs 2 4,329,000.00 IDR 2,164,500.00
PLATE CONDYLAR RIGHT 10 H pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE CONDYLAR RIGHT 6 H pcs 2 4,329,000.00 IDR 2,164,500.00
PLATE CONDYLAR RIGHT 7 H pcs 3 6,493,500.00 IDR 2,164,500.00
PLATE CONDYLAR RIGHT 9 H pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE DISTAL FEMORAL LOCKING 5 HOLE pcs 1 6,662,217.00 IDR 6,662,217.00
PLATE DISTAL FEMORAL LOCKING 7 HOLE pcs 2 13324433.67 IDR 6,662,216.84
PLATE END CAP TEN 2.5MM pcs 6 6,049,971.00 IDR 1,008,328.50
PLATE EXPERT END CAP SYNTHES pcs 5 3105833.1 IDR 621,166.62
PLATE EXPERT TIBIAL NAIL SYNTHES pcs 8 55,084,732.00 IDR 6,885,591.50
PLATE HOOK LOCKING pcs 2 5,827,500.00 IDR 2,913,750.00
PLATE INION 1016 pcs 3 13,433,433.00 IDR 4,477,811.00
PLATE INION 20H pcs 4 20,789,836.00 IDR 5,197,459.00
PLATE L 4 H LEFT pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE L 5 H LEFT pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE L BUTTERS 3 H pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE L BUTTERS 4 H RIGHT pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE L BUTTERS 5 H RIGHT pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE L BUTTERS 6 H LEFT pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE L BUTTERS 6 H RIGHT pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE L BUTTERS 7 H RIGHT pcs 1 1,831,500.00 IDR 1,831,500.00
PLATE L BUTTERS 8 H RIGHT pcs 1 1,831,500.00 IDR 1,831,500.00
PLATE LATERAL TIBIA 3 H RIGHT pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE LATERAL TIBIA 4 H RIGHT pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE LATERAL TIBIA 5 H LEFT pcs 2 4,329,000.00 IDR 2,164,500.00
PLATE LATERAL TIBIA 5 H RIGHT pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE LATERAL TIBIA 6 H LEFT pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE LATERAL TIBIA 8 H LEFT pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE LATERAL TIBIA 8 H RIGHT pcs 1 2,164,500.00 IDR 2,164,500.00
PLATE MINI 2 H pcs 2 1,655,842.00 IDR 827,921.00
PLATE MINI 5 H pcs 1 827,921.00 IDR 827,921.00
PLATE MINI T 2H pcs 3 2,483,763.00 IDR 827,921.00
PLATE MINI T 3H pcs 1 827,921.00 IDR 827,921.00
PLATE NARROW 10 H pcs 6 8,325,000.00 IDR 1,387,500.00

Halaman 25 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
PLATE NARROW 6 H pcs 19 26,362,500.00 IDR 1,387,500.00
PLATE NARROW 7 H pcs 17 23,587,500.00 IDR 1,387,500.00
PLATE NARROW 8 H pcs 13 18,037,500.00 IDR 1,387,500.00
PLATE NARROW 9 H pcs 6 8,325,000.00 IDR 1,387,500.00
PLATE NARROW LOCKING pcs 2 9,990,000.00 IDR 4,995,000.00
PLATE NEOGEN FEMUR pcs 4 57,720,000.00 IDR 14,430,000.00
PLATE PFNA NAIL pcs 61 426884870.88 IDR 6,998,112.64
PLATE PFNA-II BLADE pcs 61 235,928,790.00 IDR 3,867,685.08
PLATE PFNA-II END CAP EXTENS pcs 61 79906466.36 IDR 1,309,942.07
PLATE PROXIMAL HUMERUS HOLES 3 pcs 2 4,329,000.00 IDR 2,164,500.00
PLATE PROXIMAL HUMERUS HOLES 4 pcs 5 10,822,500.00 IDR 2,164,500.00
PLATE PROXIMAL HUMERUS HOLES 5 pcs 5 10,822,500.00 IDR 2,164,500.00
PLATE PROXIMAL HUMERUS HOLES 6 pcs 2 4,329,000.00 IDR 2,164,500.00
PLATE RECON S CLAVICULA KANAN 7 H pcs 2 2,320,910.00 IDR 1,160,455.00
PLATE RECON S CLAVICULA KIRI 5 H pcs 1 1,160,455.00 IDR 1,160,455.00
PLATE RECON S CLAVICULA KIRI 7 H pcs 1 1,160,455.00 IDR 1,160,455.00
PLATE RECONSTRUCTION 13 H pcs 1 2,775,000.00 IDR 2,775,000.00
PLATE RECONSTRUCTION 14 H pcs 1 2,775,000.00 IDR 2,775,000.00
PLATE RECONSTRUCTION 16 H pcs 1 2,775,000.00 IDR 2,775,000.00
PLATE RECONSTRUCTION 18 H pcs 2 4,856,250.00 IDR 2,428,125.00
PLATE RECONSTRUCTION 20 H pcs 2 4,856,250.00 IDR 2,428,125.00
PLATE RECONSTRUCTION 5 H pcs 1 1,160,455.00 IDR 1,160,455.00
PLATE RECONSTRUCTION 8 H pcs 1 1,160,455.00 IDR 1,160,455.00
PLATE SMALL BONE 5 H pcs 4 2303249.5 IDR 575,812.38
PLATE SMALL BONE 6 H pcs 12 6909750.5 IDR 575,812.54
PLATE SMALL BONE 7 H pcs 5 2879062.5 IDR 575,812.50
PLATE SMALL BONE 8 H pcs 9 5182312.5 IDR 575,812.50
PLATE SMALL DCP 10 H pcs 5 2,879,062.00 IDR 575,812.40
PLATE SMALL DCP 11 H pcs 2 1,151,625.00 IDR 575,812.50
PLATE SMALL DCP 5 H pcs 12 6909750.5 IDR 575,812.54
PLATE SMALL DCP 6 H pcs 36 20729249.5 IDR 575,812.49
PLATE SMALL DCP 7 H pcs 16 9212999.5 IDR 575,812.47
PLATE SMALL DCP 8 H pcs 3 1,727,438.00 IDR 575,812.67
PLATE SMALL DCP 9 H pcs 5 2,879,063.00 IDR 575,812.60
PLATE STRAIGHT 1.6MM 10H 2180038 pcs 140 85,507,100.00 IDR 610,765.00
PLATE STRAIGHT 10H 2.0MM 210-0032 pcs 70 109,345,040.00 IDR 1,562,072.00
PLATE STRAIGHT 40 H(MDBL 210-0050) kali 28 23,898,560.00 IDR 853,520.00

Halaman 26 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
PLATE STRAIGHT MINI 8H 1.0MM 210-1032 pcs 80 112,047,120.00 IDR 1,400,589.00
PLATE STRAIGHT RECONSTRUCTION 18H 214-0208 pcs 5 31,684,150.00 IDR 6,336,830.00
PLATE T 10 H pcs 2 3,663,000.00 IDR 1,831,500.00
PLATE T 11 H pcs 1 1,831,500.00 IDR 1,831,500.00
PLATE T 4 H pcs 6 10,989,000.00 IDR 1,831,500.00
PLATE T 5 H pcs 6 10,989,000.00 IDR 1,831,500.00
PLATE T 6 H pcs 3 5,494,500.00 IDR 1,831,500.00
PLATE T 7 H pcs 6 10,989,000.00 IDR 1,831,500.00
PLATE T 8 H pcs 4 7,326,000.00 IDR 1,831,500.00
PLATE T 9 H pcs 3 5,494,500.00 IDR 1,831,500.00
PLATE TEN 2.0MM L440MM pcs 6 12,432,368.00 IDR 2,072,061.33
PLATE THR CEMENTED pcs 1 21,369,165.00 IDR 21,369,165.00
PLATE THR CEMENTLESS pcs 1 33,784,314.00 IDR 33,784,314.00
PLATE THR CR LEFT set 1 29,847,900.00 IDR 29,847,900.00
PLATE THR CR RIGHT set 4 119,391,600.00 IDR 29,847,900.00
PLATE THR HYBRID RESERVE pcs 2 50,500,560.00 IDR 25,250,280.00
PLATE THR REVERSE HYBRID CEMENTLESS STEM pcs 5 132,747,120.00 IDR 26,549,424.00
PLATE TKR CR LEFT set 1 29,847,900.00 IDR 29,847,900.00
PLATE TKR CR RIGHT set 7 208,935,300.00 IDR 29,847,900.00
PLATE TKR PS LEFT pcs 4 119,391,600.00 IDR 29,847,900.00
PLATE TKR PS RIGHT pcs 12 358,174,800.00 IDR 29,847,900.00
PLATE TKR PS RIGHT set 1 29,847,900.00 IDR 29,847,900.00
PLATE VA LCP DISTAL pcs 2 13,043,987.00 IDR 6,521,993.50
PLATE VOLAR / T MINI 3 H pcs 12 6909750.5 IDR 575,812.54
PLATE VOLAR / T MINI 4 H pcs 12 6909750.5 IDR 575,812.54
PLATE VOLAR / T MINI 5 H pcs 11 6333937.5 IDR 575,812.50
PLATE VOLAR / T MINI 6 H pcs 8 4,606,500.00 IDR 575,812.50
PLATE VOLAR / T MINI 7 H pcs 7 4,030,687.00 IDR 575,812.43
PLATE VOLAR / T MINI 8 H pcs 3 1727437.5 IDR 575,812.50
PLESTERIN BULAT SOFT box 30 1,025,640.00 IDR 34,188.00
POLIAXIAL PEDICLE SCREW pcs 76 238,720,031.00 IDR 3,141,053.04
POLIBAN NATURAL 4''(VELBAN) roll 96 1,886,400.00 IDR 19,650.00
POLICREPE 4" (10CM) roll 1,920 73,637,999.00 IDR 38,353.12
POLICREPE 6'' (15CM) roll 1,860 88,325,995.00 IDR 47,487.09
POLIGYP 3 (7.5) roll 192 3,333,600.00 IDR 17,362.50
POLIGYP 4" (10) roll 672 16,223,999.00 IDR 24,142.86
POLIGYP 6" (15) roll 288 9,215,999.00 IDR 32,000.00

Halaman 27 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
POLYFLEX 24G pcs 3,500 34,769,496.00 IDR 9,934.14
POLYFLEX 26G pcs 2,500 24,835,500.00 IDR 9,934.20
POLYMER CHROMOGENIC DETECTION SYSTEM, 25ML box 1 26,085,000.00 IDR 26,085,000.00
POLYSAFETY 18G pcs 1,500 14,901,750.00 IDR 9,934.50
POLYSAFETY 20G pcs 24,000 238,727,753.00 IDR 9,946.99
POLYSAFETY 22G pcs 14,000 139,247,001.00 IDR 9,946.21
POLYVAC NO 12 pcs 430 35,797,500.00 IDR 83,250.00
POLYVAC NO 14 pcs 320 26,640,000.00 IDR 83,250.00
PORT A CATH II LOW PROFILE 2.6 MM TRAY pcs 1 4,350,000.00 IDR 4,350,000.00
POSTOFIX-PU 10 X 15 CM pcs 60 1731580.02 IDR 28,859.67
POSTOFIX-PU 10 X 25 CM pcs 40 1,154,388.00 IDR 28,859.70
POT KOSMETIK 60GR pcs 100 499,500.00 IDR 4,995.00
POT PLASTIK 30 CC pot 500 777,000.00 IDR 1,554.00
POT SALEP 30GR PINK pcs 50 194,250.00 IDR 3,885.00
POT SALEP 60GR UNGU pcs 50 249,750.00 IDR 4,995.00
POT TUTUP KUNING pcs 3,000 2,974,500.00 IDR 991.50
POV IODIN 10% 30 ML botol 2,000 8,147,488.00 IDR 4,073.74
POV IODIN 10% 300 ML fls 48 1,545,120.00 IDR 32,190.00
PRECUT SILK 2 PS27 12'S pcs 204 4,279,716.00 IDR 20,979.00
PRELUDE SHEATH INTRODUCER PSI-7F-23-038 MERIT pcs 2 797,358.00 IDR 398,679.00
PRELUDE+NEEDLE SHEATH INTRODUCER PSI-6F-7-025 MERIT pcs 10 5,315,090.00
IDR 531,509.00
PREMILEN MESH 30X30 pcs 60 6,111,484.00 IDR 101,858.07
PRESSURE MONITOR TUBING PM6160 152CM(FR5X) pcs 50 533,200.00 IDR 10,664.00
PRESSURE TUBE 300 CONNECTOR pcs 20 2,775,000.00 IDR 138,750.00
PRISMAFLEX M100 set 2 16,800,000.00 IDR 8,400,000.00
PRISMASOL fls 25 21,125,000.00 IDR 845,000.00
PROBE 1.0 MM LITHOMED (FR6X) kali 30 15,262,500.00 IDR 508,750.00
PROBE 3.3X403MM ULTRASOUND HANDPIECE kali 20 13,507,979.00 IDR 675,398.95
PROBE CLEANING SOLUTION box 1 19,770,654.00 IDR 19,770,654.00
PROBE CONDITIONING SOLUTION kit 2 1,607,835.00 IDR 803,917.50
PROBE STORZ 27093LL (FR4X) kali 24 25,200,000.00 IDR 1,050,000.00
PROLENE 3/0 W8025T CUTTING 24'S pcs 360 42,711,692.00 IDR 118,643.59
PROLENE 4/0 W8007 24'S pcs 96 7,718,345.00 IDR 80,399.43
PROLENE 5/0 W8006 CUTTING 24'S pcs 216 18,357,199.00 IDR 84,987.03
PROLENE 6/0 W8706 ROUND 12'S pcs 24 2796154.04 IDR 116,506.42
PROLENE 7/0 8696G CUTTING 12'S pcs 36 9,785,887.00 IDR 271,830.19

Halaman 28 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
PROLENE BLU 2/0 8833H ROUND pcs 36 2,839,501.00 IDR 78,875.03
PROLENE BLU 7/0 EP8702H ROUND 36'S pcs 108 39,599,997.00 IDR 366,666.64
PTFE FELT BARD 15.2CM X 15.2CM kali 40 8,436,000.00 IDR 210,900.00
RADIO FREQUENCY pcs 2 34,188,000.00 IDR 17,094,000.00
RADIOFREQUENCY (22GX52.6) TIP 4.0 PAJUNK 001165-10B pcs 20 2,819,998.00
IDR 140,999.90
RADIOFREQUENCY (22GX98.6) TIP 10 PAJUNK 001165-20C pcs 10 1,814,998.00
IDR 181,499.80
RADIOFREQUENCY (22GX98.6) TIP 2.5 PAJUNK 001165-20A pcs 5 705,000.00
IDR 141,000.00
RADIOFREQUENCY (22GX98.6) TIP 5.0 PAJUNK 001165-20B pcs 50 7,049,998.00
IDR 140,999.96
RAPID TEST ANTIGEN BIOQUICK tes 9,000 237,200,000.00 IDR 26,355.56
RAPID TEST ANTIGEN BIOQUICK (1000TES/BOX) tes 40 29,600,000.00 IDR 740,000.00
RECTAL TUBE NO 20 pcs 50 639,720.00 IDR 12,794.40
RECTAL TUBE NO 24 pcs 40 499,860.00 IDR 12,496.50
RECTAL TUBE NO 28 pcs 30 419,580.00 IDR 13,986.00
RECTAL TUBE NO 30 pcs 25 349,650.00 IDR 13,986.00
RECTAL TUBE NO 32 pcs 20 279,720.00 IDR 13,986.00
RENASYS CANISTER 300 ML TOUCH pcs 45 40,459,500.00 IDR 899,100.00
RENASYS F FOAM DRESSING MEDIUM pcs 9 10,718,998.00 IDR 1,190,999.78
RF FORTRESS 100T kit 1 621,600.00 IDR 621,600.00
RHA CURVE JL 3.5 6F (100 CM) pcs 15 4,842,500.00 IDR 322,833.33
RHA CURVE JL 4 6F (100CM) pcs 15 4,842,501.00 IDR 322,833.40
RHA CURVE JR 3.5 6F (100 CM) pcs 15 4,842,500.00 IDR 322,833.33
RHA CURVE JR 4 6F (100CM) pcs 10 3,233,751.00 IDR 323,375.10
RHA CURVE TIG 5F (100 CM) pcs 15 4,842,500.00 IDR 322,833.33
RIVALTA 500ML botol 1 39,960.00 IDR 39,960.00
ROD pcs 18 27,132,663.00 IDR 1,507,370.17
ROD 350 MM pcs 6 10,656,000.00 IDR 1,776,000.00
ROD 70 MM pcs 2 2,065,599.00 IDR 1,032,799.50
ROD TITANIUM pcs 105 131,118,750.00 IDR 1,248,750.00
ROD TITANIUM LONG pcs 4 11,544,000.00 IDR 2,886,000.00
ROHTO HYRON (FR4X) kali 100 12,924,563.00 IDR 129,245.63
ROHTOVISC pcs 370 95641762.5 IDR 258,491.25
ROUND FLUTED BUR, LONG 2.0 MM kali 100 12,977,400.00 IDR 129,774.00
ROUND FLUTED BUR, LONG 3.0 MM kali 20 2,595,480.00 IDR 129,774.00

Halaman 29 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
ROUND FLUTED BUR, LONG 4.0 MM kali 20 2,595,480.00 IDR 129,774.00
ROUND FLUTED BUR, MEDIUM 2.0 MM kali 40 5,190,960.00 IDR 129,774.00
ROUND FLUTED BUR, MEDIUM 3.0 MM kali 40 5,190,959.00 IDR 129,773.98
ROUND FLUTED BUR, MEDIUM 4.0 MM kali 40 5,190,959.00 IDR 129,773.98
ROUND FLUTED BUR,MEDIUN 5.0 MM kali 40 5,190,962.00 IDR 129,774.05
RRC CARBON pack 1 183,150.00 IDR 183,150.00
S WIRE 207-0120 roll 4 1,692,306.00 IDR 423,076.50
SALMONE;;A SIGELA AGAR botol 1 2,358,750.00 IDR 2,358,750.00
SALMONELLA PARATYPHI AO vial 5 1,110,000.00 IDR 222,000.00
SALMONELLA PARATYPHI BO vial 5 1,110,000.00 IDR 222,000.00
SALMONELLA THYPI H vial 4 888,000.00 IDR 222,000.00
SALMONELLA TYPHY O vial 3 666,000.00 IDR 222,000.00
SAMPLE CUP 1.5ML pack 4 2,839,380.00 IDR 709,845.00
SCREW INION 1.5X4 MM pcs 9 40,300,299.00 IDR 4,477,811.00
SCREW INION 1.5X6 MM pcs 5 22,389,055.00 IDR 4,477,811.00
SCREW INION 2.0X5 MM pcs 7 25,747,414.00 IDR 3,678,202.00
SCREW INION 2.0X7 MM pcs 5 18,391,010.00 IDR 3,678,202.00
SD BLN HIV 1/2 3.0 D 30T unit 5 1,713,780.00 IDR 342,756.00
SEQUENCE pcs 182 66,857,126.00 IDR 367,346.85
SG CALIBRATOR kit 1 846,930.00 IDR 846,930.00
SHANT SCREW 4.0 pcs 20 6,984,253.00 IDR 349,212.65
SHAVER NON AGRESIF pcs 28 157,342,500.00 IDR 5,619,375.00
SHOOCIN INTRODUCER KIT FEMORAL 6F pcs 15 3,166,247.00 IDR 211,083.13
SHOOCIN INTRODUCER KIT RADIAL 6F pcs 10 2,681,522.00 IDR 268,152.20
SILICON CATH NO 10 pcs 5 1,598,400.00 IDR 319,680.00
SILICON CATH NO 12 pcs 5 370,000.00 IDR 74,000.00
SILICON CATH NO 14 pcs 5 724,275.00 IDR 144,855.00
SILICON CATH NO 16 pcs 10 1,448,550.00 IDR 144,855.00
SILICON CATH NO 18 pcs 15 1,454,275.00 IDR 96,951.67
SILICONE TIP I/A pcs 60 24,775,200.00 IDR 412,920.00
SILK 2 HR37 SMI ROUND 12'S pcs 84 1,635,655.00 IDR 19,472.08
SILKAM 2/0 DS 24 36'S pcs 576 15,858,359.00 IDR 27,531.87
SILKAM 3/0 HR 17 36'S pcs 1,584 47,230,036.00 IDR 29,816.94
SIMPLYP VIRUS DNA/RNA EXTRACTION KIT kit 1 4,149,525.00 IDR 4,149,525.00
SKIN MARKER STERIL DUAL TIP pcs 100 1,600,001.00 IDR 16,000.01
SKIN TRACTION KIT ANAK pcs 17 4,257,638.00 IDR 250,449.29
SKIN TRACTION KIT DWS pcs 156 45,944,194.00 IDR 294,514.06

Halaman 30 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
SKY CERVICAL POLIAXIAL SCREW pcs 38 172,938,000.00 IDR 4,551,000.00
SKY CERVICAL ROD 250MM pcs 2 4,107,000.00 IDR 2,053,500.00
SKY CONT BOX OBAT box 5 490,050.00 IDR 98,010.00
SLIDE MAILER (Postal box) 100 pcs box 1 1,903,650.00 IDR 1,903,650.00
SLIDE MICROSCOPE for ihc Manual(72pcs) box 12 7,402,590.00 IDR 616,882.50
SLIT KNIFE MSL27 (FR4X)(6') pcs 296 20,647,532.00 IDR 69,755.18
SNAPPACK 9180, 9181 CAT 3112349180 box 4 9,017,640.00 IDR 2,254,410.00
SNARE 10 pcs 1 6,588,566.00 IDR 6,588,566.00
SNARE 20 pcs 1 6,588,566.00 IDR 6,588,566.00
SOFTBAN 4" roll 1,488 38,458,349.00 IDR 25,845.66
SOFTBAN 6" roll 1,584 57,969,447.00 IDR 36,596.87
SOLARE A2 pcs 2 1,332,000.00 IDR 666,000.00
SOLARE A3 pcs 1 666,000.00 IDR 666,000.00
SOLID HEAD OF RADIAL HEAD PROSTHESIS pcs 1 4,949,900.00 IDR 4,949,900.00
SPARE CUTTER F TE 562 kali 680 107,165,451.00 IDR 157,596.25
SPINAL NEEDLE 25 EGEMEN pcs 400 5,999,999.00 IDR 15,000.00
SPINOCAN 25 pcs 3,400 116,443,200.00 IDR 34,248.00
SPINOCAN 26 pcs 550 18,836,400.00 IDR 34,248.00
SPIRITUS BAKAR liter 14 560,000.00 IDR 40,000.00
SPO2 NEONATUS SINGLE USE pcs 140 59,829,000.00 IDR 427,350.00
SPROTEE CANNULA 27G X 90MM pcs 10 700,000.00 IDR 70,000.00
SPUIT 100 CC pcs 100 1,759,800.00 IDR 17,598.00
SPUIT 10CC pcs 20,800 42,473,411.00 IDR 2,041.99
SPUIT 10CC NIPRO pcs 196,000 254,489,199.00 IDR 1,298.41
SPUIT 1CC TUBERCULIN pcs 12,600 19,742,950.00 IDR 1,566.90
SPUIT 20 CC TERUMO pcs 1,400 3,412,745.00 IDR 2,437.68
SPUIT 20CC NIPRO pcs 24,000 45,288,000.00 IDR 1,887.00
SPUIT 3CC pcs 12,600 19,302,215.00 IDR 1,531.92
SPUIT 3CC NIPRO pcs 192,000 170,496,000.00 IDR 888.00
SPUIT 50CC MAS (CATETER TIP) pcs 300 1,631,700.00 IDR 5,439.00
SPUIT 50CC ONEMED (LUER LOCK) pcs 140 529,201.00 IDR 3,780.01
SPUIT 50CC TERUMO (CATETER TIP) pcs 5,880 70,992,845.00 IDR 12,073.61
SPUIT 50CC TERUMO (LUER LOCK) pcs 100 676,876.00 IDR 6,768.76
SPUIT 50CC TERUMO (TEPI) pcs 6,960 52,240,501.00 IDR 7,505.82
SPUIT 5CC pcs 12,000 20,281,237.00 IDR 1,690.10
SPUIT 5CC NIPRO pcs 195,500 190,903,200.00 IDR 976.49
SPUIT ABG PRESET 3CC BD pcs 3,200 35,520,000.00 IDR 11,100.00

Halaman 31 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
STEINMAN PIN pcs 9 3218407.72 IDR 357,600.86
STEM OF RADIAL HEAD PROSTHESIS pcs 1 11,699,900.00 IDR 11,699,900.00
STERI STRIP 1/4'' X 3'' 3M pcs 200 1,244,598.00 IDR 6,222.99
STERICIDE 500ML botol 270 23,736,240.00 IDR 87,912.00
STERIJELL 12.5GR pcs 9,050 19,119,750.00 IDR 2,112.68
STERILE MICROSCOPE COVER pcs 20 13,978,438.00 IDR 698,921.90
STERILE POUCH INDIKATOR 10X200 ONEMED box 6 2,059,344.00 IDR 343,224.00
STERILIZATION INDICATOR STRIP box 4 18,315,000.00 IDR 4,578,750.00
STERILIZATION INDICATOR TAPE roll 2 5,616,600.00 IDR 2,808,300.00
STERILIZATION PLASMA 200X100 roll 14 38,652,420.00 IDR 2,760,887.14
STERILIZATION PLASMA 250X100 roll 26 72,407,520.00 IDR 2,784,904.62
STERILIZATION PLASMA 400X100 roll 10 30,475,050.00 IDR 3,047,505.00
STERIZYME 5L galon 65 66,866,399.00 IDR 1,028,713.83
STIKPAN pcs 250 5,500,484.00 IDR 22,001.94
STIMUPLEX ULTRA 360 30 20GX100mm pcs 5 1,017,430.00 IDR 203,486.00
STIMUPLEX ULTRA 360 30 22GX50mm pcs 5 1,003,230.00 IDR 200,646.00
STOMACH TUBE 12 pcs 100 1,295,663.00 IDR 12,956.63
STOMACH TUBE 14 pcs 600 8,022,369.00 IDR 13,370.62
STOMACH TUBE 16 pcs 2,000 26,410,043.00 IDR 13,205.02
STOMACH TUBE 18 pcs 250 3301254.6 IDR 13,205.02
STONE EXTRACTION BALLOON VDK-BAL-23-9/12/15B kali 15 15,338,250.00 IDR 1,022,550.00
STONE EXTRACTION BALLOON VDK-BAL-23-9/12/15B pcs 4 18,648,000.00 IDR 4,662,000.00
STONE EXTRACTION BASKET/VDK-BAS-23-230-35S4A kali 9 7,395,000.00 IDR 821,666.67
STONE EXTRACTION BASKET/VDK-BAS-23-230-35S4A pcs 2 8,524,800.00 IDR 4,262,400.00
STRATAFIX PDS PLUS 12'S pcs 48 13,199,983.00 IDR 274,999.65
SUCTION CATH FR 10 OM pcs 1,200 5,007,000.00 IDR 4,172.50
SUCTION CATH FR 14 OM pcs 800 3,407,000.00 IDR 4,258.75
SUCTION CATH FR 6 OM pcs 600 2,607,000.00 IDR 4,345.00
SUCTION CATH FR 8 BICAKCILAR pcs 600 2,699,997.00 IDR 4,500.00
SUCTION LINER 2.5L DISPOSABLE pack 50 3,450,000.00 IDR 69,000.00
SUDAN III 100ML botol 1 122,100.00 IDR 122,100.00
SURFIT NATURA DURAHESIVE 45MM pcs 60 8,497,649.00 IDR 141,627.48
SURGICEL W1913T 12'S pcs 1,080 135,906,457.00 IDR 125,839.31
SUTURES WIRES pcs 25 11640430.35 IDR 465,617.21
SWIVEL ELBOW/ AL 17300 pcs 3,750 84,374,998.00 IDR 22,500.00
TANBEAD NUCLEIC ACID EXTRACTION KIT unit 1 14,319,000.00 IDR 14,319,000.00
TECHNOPATH MULTICHEM IA PLUS kit 1 7,972,020.00 IDR 7,972,020.00

Halaman 32 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
TECHNOWOOD ANGIOGRAPHIC GUIDEWIRE HYDROPHILIC pcs 2 4,145,184.00
COATING/H502-3526A
IDR 2,072,592.00
TEGADERM 1626W(10X12) BOX 50'S pcs 500 6,581,228.00 IDR 13,162.46
TENSOCREP 3" roll 96 3,413,281.00 IDR 35,555.01
TENSOCREP 4" roll 48 3,572,447.00 IDR 74,425.98
TENSOCREP 6" roll 150 14,692,801.00 IDR 97,952.01
TEST CARTRIDGE CLOVER CLOVER box 20 22,200,000.00 IDR 1,110,000.00
THERASORB C 10X10CM pcs 80 4,662,000.00 IDR 58,275.00
T-HERNIA MESH 6X10CM LM5 12'S pcs 72 12,211,776.00 IDR 169,608.00
THORASIC CATHETER 24 pcs 10 570,000.00 IDR 57,000.00
THORASIC CATHETER 32 pcs 5 285,001.00 IDR 57,000.20
TIE DENT pcs 1 1,221,000.00 IDR 1,221,000.00
TIP CLEANER pcs 230 8,365,235.00 IDR 36,370.59
TISSU GULUNG roll 2,460 8,191,800.00 IDR 3,330.00
TISSUE FREEZING MEDIUM (JUNG) botol 2 1,054,500.00 IDR 527,250.00
TITANIUM MESH/CORPECTOMY pcs 1 6,771,000.00 IDR 6,771,000.00
TITANIUM SCREW 1.6X4MM 2111604 BS pcs 675 155,140,650.00 IDR 229,838.00
TITANIUM SCREW 2.0X10MM 2022010 pcs 150 36,746,550.00 IDR 244,977.00
TITANIUM SCREW 2.0X12MM 2022012 pcs 150 36,746,550.00 IDR 244,977.00
TITANIUM SCREW 2.0X6MM 2112006 pcs 425 96,511,125.00 IDR 227,085.00
TITANIUM SCREW 2.4MMX10MM 206-2410 pcs 50 15,735,400.00 IDR 314,708.00
TITANIUM SCREW 2.4MMX12MM 206-2412 pcs 33 10,521,621.00 IDR 318,837.00
TITANIUM SCREW 4MM CRANIOTOMY pcs 98 36,854,342.00 IDR 376,064.71
TITANIUM SCREW MMF 2.0X8 MDBL 209-2008 pcs 4 3,082,856.00 IDR 770,714.00
T-LENE 2/0 CUTTING L20 12'S pcs 312 25,315,884.00 IDR 81,140.65
TLIF PEEK CAGE pcs 5 66,600,000.00 IDR 13,320,000.00
TONG SPATEL SS POLOS 16CM pcs 2 77,700.00 IDR 38,850.00
TOPICAL ANESTHESI GEL pcs 2 1,110,000.00 IDR 555,000.00
TOTAL PROTEIN, ABBOTT botol 3 517,815.00 IDR 172,605.00
TOTAL T3 CALIBRATOR kit 1 3,281,160.00 IDR 3,281,160.00
TOTAL T3 REAGENT 100T kit 3 11,983,005.00 IDR 3,994,335.00
TOURNIQUET GREEN BH pcs 80 795,648.00 IDR 9,945.60
TOWEL WASH GLOVES PAKET pack 4,000 22,644,000.00 IDR 5,661.00
TPHA KIT 100T CAT. SYTP0100 box 4 3,463,200.00 IDR 865,800.00
T-PLAIN 2/0 P180X ROUND pcs 564 32,741,892.00 IDR 58,053.00
T-PLAIN 3/0 P121 CUTTING pcs 96 6,009,984.00 IDR 62,604.00
TRACH MASK ADULT FLEXICARE pcs 173 9,480,400.00 IDR 54,800.00

Halaman 33 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
TRACHEOSTOMY KIT 6 BLUE LINE pcs 7 8,450,000.00 IDR 1,207,142.86
TRACHEOSTOMY KIT 7 BLUE LINE pcs 120 47,100,000.00 IDR 392,500.00
TRACHEOSTOMY KIT 7.5 BLUE LINE pcs 55 21,525,000.00 IDR 391,363.64
TRACHEOSTOMY KIT 8 BLUE LINE pcs 2 770,000.00 IDR 385,000.00
TRACHEOSTOMY OXYGEN MASK ADULT pcs 50 2,719,500.00 IDR 54,390.00
TRANSABDOMINAL 20GX150MM (AMNIORAM) pcs 25 18,125,000.00 IDR 725,000.00
TRANSOFIX pcs 3,000 13,929,038.00 IDR 4,643.01
TRANSOFIX OM pcs 2,750 6,013,400.00 IDR 2,186.69
TRYPAN BLUE (FR4X) kali 300 15078656.5 IDR 50,262.19
TSH REAGENT 100T kit 3 11,356,965.00 IDR 3,785,655.00
T-SILK 2/0 ROUND S25 12'S pcs 252 11,748,240.00 IDR 46,620.00
TUBE CIT PLH 13X75 pcs 1,900 3,387,687.00 IDR 1,782.99
TUBE EDTA PLH 13X75 3.0 pcs 58,500 127,292,728.00 IDR 2,175.94
TUBE LIHEP PLH 13X75 4.0 GREEN pcs 10,000 19,999,999.00 IDR 2,000.00
TUBE PLN PLH 13X75 4.0 PLBL RD pcs 20,000 31,999,998.00 IDR 1,600.00
TUBIFAST 10.75CM X10M YELLOW meter 20 852,480.00 IDR 42,624.00
TUBIFAST 5CMX10 M GREEN meter 50 1,398,600.00 IDR 27,972.00
TUBIFAST 7.5CM X10M BLUE meter 40 1,198,800.00 IDR 29,970.00
TUNGSTEN LOOP 21191-142 NEURO kali 25 3,443,775.00 IDR 137,751.00
T-VIO 0 ROUND V12 12'S pcs 12 1,040,292.00 IDR 86,691.00
T-VIO 1 ROUND V13 pcs 276 24,692,616.00 IDR 89,466.00
T-VIO 2/0 CUTTING V40 pcs 492 45,054,900.00 IDR 91,575.00
UC-CONTROL kit 1 1,536,240.00 IDR 1,536,240.00
UF CELLPACK CR botol 1 2,344,320.00 IDR 2,344,320.00
UF CELLPACK SF botol 1 3,085,800.00 IDR 3,085,800.00
UF CELLSHEATH box 34 116,694,300.00 IDR 3,432,185.29
UF FLUOROCELL CR box 1 3,479,850.00 IDR 3,479,850.00
UF FLUOROCELL SF box 1 3,846,150.00 IDR 3,846,150.00
UF-CELLPACK CR box 8 22,016,628.00 IDR 2,752,078.50
UF-CELLPACK SF box 4 12,923,508.00 IDR 3,230,877.00
UF-CONTROL box 2 7,310,460.00 IDR 3,655,230.00
UF-FLUOROCELL CR box 6 21,868,110.00 IDR 3,644,685.00
UF-FLUOROCELL SF box 6 24,169,140.00 IDR 4,028,190.00
UIBC LIQUID set 1 1,512,375.00 IDR 1,512,375.00
ULTRASOUND CASSET LAUREAT(FR3X) kali 144 39,341,952.00 IDR 273,208.00
UMBILICAL CORD CLAMP OM pcs 1,450 2,608,110.00 IDR 1,798.70
UNDERPAD 60X90 STERIL pcs 17,500 137,917,500.00 IDR 7,881.00

Halaman 34 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
UNIVERSAL CANNULE SMITH pcs 2 2,997,000.00 IDR 1,498,500.00
UNIVERSAL HRP EXELL STAIN SYSTEM kit 1 9,768,000.00 IDR 9,768,000.00
UNIVERSAL SET USP2114 pcs 220 156,696,207.00 IDR 712,255.49
URIC ACID 2X50 ML botol 13 6,500,715.00 IDR 500,055.00
URINAL LAKI LAKI pcs 400 4,305,690.00 IDR 10,764.23
URINAL PEREMPUAN pcs 40 184,120.00 IDR 4,603.00
URINBAG T VALVE OM pcs 8,800 38,180,500.00 IDR 4,338.69
URINE CONTAINER 60ML NON STERIL pcs 10,000 9,990,000.00 IDR 999.00
VASELIN pcs 10 355,200.00 IDR 35,520.00
VDRL 5 ML botol 3 666,000.00 IDR 222,000.00
VERBAN 10 CM DRC roll 9,500 22,934,265.00 IDR 2,414.13
VERBAN 5 CM DRC roll 27,500 40,833,015.00 IDR 1,484.84
VESTEC CUVETTE pack 20 43,956,000.00 IDR 2,197,800.00
VESTEC CUVETTE 200 box 20 43,956,000.00 IDR 2,197,800.00
VESTEC CUVETTE 200 box 20 43,956,000.00 IDR 2,197,800.00
VICRYL 0 VCP 518 H CUTTING 36'S pcs 108 14416063.96 IDR 133,482.07
VICRYL 0 VCP W9141 12'S pcs 12 1,244,477.00 IDR 103,706.42
VICRYL 1 W 9431 ROUND 12'S pcs 48 2,490,840.00 IDR 51,892.50
VICRYL 2/0 RAPIDE W9962 CUTTING 12'S pcs 456 28,361,652.00 IDR 62,196.61
VICRYL 2/0 W9522T CUTTING 24'S pcs 432 43,748,208.00 IDR 101,269.00
VICRYL 3/0 W 9114 12'S pcs 12 1,373,736.00 IDR 114,478.00
VICRYL 4/0 W 9106 12'S pcs 24 2,447,438.00 IDR 101,976.58
VICRYL 4/0 W 9443 12'S pcs 180 16855627.5 IDR 93,642.38
VICRYL PLUS 0 VCP340H ROUND 36'S pcs 108 11,699,998.00 IDR 108,333.31
VICRYL PLUS 1 VCP371H ROUND 36'S pcs 36 5,909,005.00 IDR 164,139.03
VICRYL PLUS 5/0 VCP490G 12'S pcs 108 36166817.4 IDR 334,877.94
VIDAS AFP 60 TESTS botol 3 23,300,676.00 IDR 7,766,892.00
VIDAS CA 125 II box 7 38984576.4 IDR 5,569,225.20
VIDAS CEA S box 6 75227896.4 IDR 12,537,982.73
VIDAS D DIMER EXCLUSION II unit 9 152,233,614.00 IDR 16,914,846.00
VIDAS FT3 60 TESTS botol 2 16353440.8 IDR 8,176,720.40
VIDAS FT4N botol 28 311292460.5 IDR 11,117,587.88
VIDAS HBSAG ULTRA botol 3 14155541.4 IDR 4,718,513.80
VIDAS HCG 60 TESTS box 2 13,597,500.00 IDR 6,798,750.00
VIDAS HS TROPONIN I box 7 123,013,863.00 IDR 17,573,409.00
VIDAS T3 60 TESTS box 8 43921012.6 IDR 5,490,126.58
VIDAS T4 60 TESTS botol 3 16,602,003.00 IDR 5,534,001.00

Halaman 35 / 36
 Mutasi
No Kode Kelompok/Bidang Barang Satuan Bertambah (APBD) HARGA
Bidang
Jml Nilai (Rp)
VIDAS TPSA botol 4 37646582.4 IDR 9,411,645.60
VIDAS TSH 60 TESTS botol 19 96193609.5 IDR 5,062,821.55
VIDAS TSH 60 TESTS box 5 26,335,638.00 IDR 5,267,127.60
VIOREX LIQUID 4% galon 40 29,061,797.00 IDR 726,544.93
VITEK 2, AST GP67 CARDS box 9 35,266,476.00 IDR 3,918,497.33
VITEK 2,AST GP67 CARDS box 2 8084529.6 IDR 4,042,264.80
VP SHUNT CAPRA pcs 15 43,290,000.00 IDR 2,886,000.00
VYGON UMBILICAL CATHETER 5 FR 37 CM pcs 130 5,750,000.00 IDR 44,230.77
WADAH SAMPLE PA BESAR 1500ML pcs 360 3,796,200.00 IDR 10,545.00
WADAH SAMPLE PA SEDANG 200ML box 600 999,000.00 IDR 1,665.00
WARTHIN-STARY STAIN KIT, 50 TEST box 1 9,435,000.00 IDR 9,435,000.00
WASHER pcs 13 2,537,153.00 IDR 195,165.62
WASHER 4.0 (KECIL) pcs 10 1,703,983.00 IDR 170,398.30
WASHER 4.5 (BESAR) pcs 51 8649656.6 IDR 169,601.11
WASHER SYNTHES pcs 1 129,741.00 IDR 129,741.00
WHITE TIPS pack 20 4,995,000.00 IDR 249,750.00
WING NEEDLE 25 pcs 4,600 29466928.4 IDR 6,405.85
WIPAK STERIKING FLAT 15CMX200M roll 20 23,310,000.00 IDR 1,165,500.00
WIPAK STERIKING FLAT 20CMX200M roll 19 27,874,801.00 IDR 1,467,094.79
WIPAK STERIKING FLAT 25CMX200M roll 9 16,383,600.00 IDR 1,820,400.00
WIPAK STERIKING FLAT 7.5CMX200M roll 15 9,191,699.00 IDR 612,779.93
WIPAK STERIKING GUSSET 25CMX6.5CM roll 25 34,854,000.00 IDR 1,394,160.00
XILOL/XYLENE HISTOLOGYCAL GRADE 2.5 ML BIO OPTICA botol 3 3,663,000.00 IDR 1,221,000.00
YELLOW TIP pack 61 8,113,498.00 IDR 133,008.16
ZIEHL NEELSEN (ZN) 3X100 ML botol 1 316,350.00 IDR 316,350.00
ZIEHL NELSEN SET (4X100ML) set 10 4,323,450.00 IDR 432,345.00

Halaman 36 / 36