PENGUMUMAN PEMENANG Nomor : KN

PENGUMUMAN PEMENANG Nomor : KN.01.01.338.2015 Kode Lelang LPSE : 8941047 Nama Paket Pekerjaan : Pengadaan Obat Umum Triwulan I Rumah Sakit Stroke Nasional Bukittinggi TA. 2015 (Lelang Itemized) Nilai Total HPS : Rp. 1.277.309.000,- (Satu Milyar Dua Ratus Tujuh Puluh Tujuh Juta Tiga Ratus Sembilan Ribu Rupiah) Website LPSE : http://lpse.depkes.go.id Metode Kualifikasi : Pascakualifikasi Metode Evaluasi : Sistem Gugur Metode Pengadaan : E-Lelang Sederhana Lokasi Pekerjaan : Rumah Sakit Stroke Nasional Bukittinggi Jl. Jenderal Sudirman, Kota Bukittinggi Sumatera Barat Berdasarkan Berita Acara Hasil Pelelangan (BAHP) Pengadaan Obat Umum Triwulan I Rumah Sakit Stroke Nasional Bukittinggi TA. 2015 dengan cara itemized Nomor : KN.01.01.280.2015 tanggal 23 Maret 2015, maka RSSN Bukittinggi TA. 2015 mengumumkan pemenang sebagai berikut : Pemenang Nama Perusahaan : PT. PUTRA KARYA SENTOSA Alamat : Jl. Pule No. 1 RT 014 RW 010 Kel. Ciracas, Kec. Ciracas Jakarta Timur Hasil Evaluasi Penawaran Terkoreksi : Rp. 840,716,000,- (Delapan Ratus Empat Puluh Juta Tujuh Ratus Enam Belas Ribu Rupiah) NPWP : 02.748.852.7-009.000 Jangka Waktu Pelaksanaan : 60 (Enam Puluh) Hari Kalender Evaluasi Administrasi : Lulus Evaluasi Teknis : Lulus Evaluasi Harga : Lulus Nama Perusahaan : PT. ANUGRAH PRADJA MANDIRI Alamat : Jl. Prof. Dr. Hamka No. 78 C - Padang Hasil Evaluasi Penawaran Terkoreksi : Rp. 356,701,000,- (Tiga Ratus Lima Puluh Enam Juta Tujuh Ratus Satu Ribu Rupiah NPWP : 02.360.764.1-201.000 Jangka Waktu Pelaksanaan : 60 (Enam Puluh) Hari Kalender Evaluasi Administrasi : Lulus Evaluasi Teknis : Lulus Evaluasi Harga : Lulus

Demikian disampaikan agar Saudara mengetahui dan atas perhatiannya diucapkan terimakasih Bukittinggi, 24 Maret 2015 Unit Layanan Pengadaan Rs. Stroke Nasional Bukittinggi TA. 2015 Ketua Dto SARI REZEKI, S.ST, M.Biomed NIP 19670228 199103 2 003

Lampiran Pengumuman Pemenang Lelang Nomor : KN.01.01.338.2015 Tanggal : 24 Maret 2015 PT. PUTRA KARYA SENTOSA NO. NAMA BARANG SATUAN JUMLAH H. SATUAN (Rp.) J. HARGA (Rp.) 1 Acitral Liquid 120 botol 200 25,268.00 5,053,600.00 2 Alviz 50 mg tab tablet 450 2,846.00 1,280,700.00 3 Analsik Tab tablet 3300 1,163.00 3,837,900.00 5 Apialis syrup botol 48 26,682.00 1,280,736.00 6 Arkine tab tablet 3000 640.00 1,920,000.00 8 ATP dankos tab tablet 500 1,334.00 667,000.00 9 Amobiotic drop botol 24 22,410.00 537,840.00 10 Avamys nasal spray botol 12 116,429.00 1,397,148.00 11 Betadin kumur 190 ml botol 200 8,218.00 1,643,600.00 12 Bio ATP tab tablet 1000 2,286.00 2,286,000.00 13 Biodiar tab tablet 600 1,319.00 791,400.00 14 Bisolvon inj ampul 600 44,870.00 26,922,000.00 15 Bisolvon syrup botol 10 27,856.00 278,560.00 16 Bisolvon kids syrup botol 10 24,761.00 247,610.00 17 Bioplacenton cream tube 12 12,274.00 147,288.00 18 Buscopan inj ampul 50 25,092.00 1,254,600.00 19 Brainact 500 inj ampul 90 67,665.00 6,089,850.00 20 Brainact 250 inj ampul 150 43,758.00 6,563,700.00 21 Braintact odis tab tablet 3600 11,461.00 41,259,600.00 22 Brainact tab tablet 6000 11,831.00 70,986,000.00 23 Brainvit syrup 60 ml botol 12 37,355.00 448,260.00 25 Benocetam 1200 tab tablet 500 4,696.00 2,348,000.00 31 C. Asthenof 5 ml botol 200 22,413.00 4,482,600.00 32 C. Augentonic 5 ml botol 200 26,816.00 5,363,200.00 33 C. Augentonic 0,6 strip 240 23,080.00 5,539,200.00 35 C. Vitrolenta botol 40 34,953.00 1,398,120.00 36 C. Catarlent 15 ml botol 200 32,686.00 6,537,200.00 37 Cenfresh 0,6 ml strip 40 24,547.00 981,880.00 38 C. Polydex strip 40 28,283.00 1,131,320.00 39 C. Xitrol 0,6 strip 40 26,015.00 1,040,600.00 40 C. Lyter botol 100 24,014.00 2,401,400.00 43 Coten licaps 100 mg tablet 10 5,742.00 57,420.00 44 Condro PA tab tablet 750 5,870.00 4,402,500.00 45 Curcuma tab tablet 5000 427.00 2,135,000.00 46 Curvit tab tablet 1500 1,921.00 2,881,500.00 47 Curvit sirup botol 24 23,480.00 563,520.00 48 Curvit CL emulsion botol 24 48,027.00 1,152,648.00 49 Cupanol syrup botol 60 16,543.00 992,580.00 50 CO amoxiclav tablet 500 4,900.00 2,450,000.00 51 Dilmen tab tablet 7200 971.00 6,991,200.00 52 Dolo neurobion tab tablet 500 1,259.00 629,500.00 53 Dumin caplet 500 mg caplet 7000 357.00 2,499,000.00 54 Dumin rectal tube 250 mg inj tube 50 15,796.00 789,800.00 55 Dumin rectal tube 125 mg inj tube 50 11,313.00 565,650.00 56 Estazor tab tablet 60 7,471.00 448,260.00 57 Esilgan 1 mg tablet 300 3,136.00 940,800.00 58 Folas tab tablet 1000 726.00 726,000.00

59 Ferris sirup botol 24 27,215.00 653,160.00 60 Ferris drop botol 12 26,682.00 320,184.00 61 EDTA botol 20 43,781.00 875,620.00 62 Falergi tab tablet 120 2,988.00 358,560.00 63 Farmadol infus botol 120 53,364.00 6,403,680.00 64 Forneuro capsul capsul 6000 4,838.00 29,028,000.00 65 Forres tab tablet 2000 3,949.00 7,898,000.00 66 Fudan tab 100 mg capsul 600 3,202.00 1,921,200.00 67 Frego 10 mg tablet 600 7,065.00 4,239,000.00 68 Frego 5 mg tablet 300 5,272.00 1,581,600.00 69 Frimania 200 tablet 500 2,348.00 1,174,000.00 70 Friladar 2 mg tablet 150 3,826.00 573,900.00 71 Hervis cream tube 24 39,222.00 941,328.00 72 Incelin 250 mg inj ampul 600 29,537.00 17,722,200.00 73 Inpepsa syrup 100 ml botol 48 49,095.00 2,356,560.00 75 Intermoxil forte syr botol 12 20,785.00 249,420.00 76 Interpec 30 elixir 60 ml botol 48 27,349.00 1,312,752.00 77 Interpec tab tablet 3000 1,014.00 3,042,000.00 78 Intervask 5 mg tablet 450 5,171.00 2,326,950.00 79 Interzinc tab tablet 500 1,862.00 931,000.00 80 Interzinc sirup botol 24 24,723.00 593,352.00 81 Intidrol tab tablet 2600 2,519.00 6,549,400.00 82 Isoric 300 tablet 180 3,063.00 551,340.00 83 Iliadin tetes hidung botol 12 22,413.00 268,956.00 84 Kalmeco inj ampul 100 93,920.00 9,392,000.00 85 Kalmeco 500 tab tablet 6000 1,985.00 11,910,000.00 86 Ka En 1 B botol 40 17,930.00 717,200.00 87 KCL Infus botol 140 7,044.00 986,160.00 88 Lancolin 500 mg inj ampul 450 68,305.00 30,737,250.00 89 Lankolin inj ampul 240 32,018.00 7,684,320.00 90 Lantulos syrup botol 10 42,691.00 426,910.00 91 Lasix inj ampul 300 12,725.00 3,817,500.00 92 Lodia tab tablet 1800 945.00 1,701,000.00 93 L F X monodos minidose 120 73,642.00 8,837,040.00 94 Matovit tab tablet 300 3,380.00 1,014,000.00 95 Matovit sirup botol 6 32,020.00 192,120.00 96 Meloxin 15 mg tablet 500 8,426.00 4,213,000.00 99 Merislon tab 12 mg tablet 1800 5,758.00 10,364,400.00 100 Moxam 15 mg tab tablet 1800 9,534.00 17,161,200.00 101 Mucera drop botol 24 34,153.00 819,672.00 102 Myonep tab tablet 3000 3,629.00 10,887,000.00 103 Myobat tab tablet 600 3,447.00 2,068,200.00 105 Neurochol tab tablet 3600 10,673.00 38,422,800.00 106 New diatab tablet 1500 517.00 775,500.00 108 Neurotam 1200 mg tab tablet 3000 5,507.00 16,521,000.00 109 Neurotam 3 gr inj ampul 150 55,498.00 8,324,700.00 111 Notrotam 1200 tablet 3000 4,162.00 12,486,000.00 113 Ocu-V tab tablet 1080 4,269.00 4,610,520.00 114 Oste forte tab capsul 300 3,522.00 1,056,600.00 115 Otsu salin 3 % 500 ml botol 300 14,942.00 4,482,600.00 116 Ottopan syrup botol 60 11,740.00 704,400.00 117 Ottopan drop botol 60 19,211.00 1,152,660.00 118 Ottoprim tab tablet 1000 374.00 374,000.00 119 Ottopain tetes telinga botol 24 34,953.00 838,872.00 121 Oxoferin solution 30 botol 90 69,373.00 6,243,570.00

122 Phardex tab tablet 4000 4,269.00 17,076,000.00 124 Plasmin tab tablet 2160 9,072.00 19,595,520.00 125 Proxime tab tablet 7500 1,094.00 8,205,000.00 126 Properetic 80 supp 120 6,075.00 729,000.00 127 Properetic 160 supp 30 6,457.00 193,710.00 129 Rebal plus tab tablet 1500 1,921.00 2,881,500.00 130 Recolfar tab tablet 600 4,269.00 2,561,400.00 131 Recustein dry syr botol 24 35,220.00 845,280.00 132 Regit drop botol 12 34,150.00 409,800.00 133 Regit syrup botol 24 34,153.00 819,672.00 134 Retivit tab tablet 1000 3,570.00 3,570,000.00 135 Rhodium tab tablet 500 5,070.00 2,535,000.00 138 Sanmol syrup botol 60 10,854.00 651,240.00 139 Serlof tab tablet 300 10,886.00 3,265,800.00 140 Sedrofen syrup 60 ml botol 24 40,476.00 971,424.00 144 Sterimar tetes hidung botol 12 121,135.00 1,453,620.00 145 Tilidon tab tablet 2400 3,293.00 7,903,200.00 146 Tensipar 10 mg tab tablet 2250 3,202.00 7,204,500.00 147 Tensipar 5 mg tab tablet 2250 2,206.00 4,963,500.00 148 Tebokan forte tablet 1620 16,614.00 26,914,680.00 150 Thiamycin syrup 60 ml botol 24 27,340.00 656,160.00 151 Thiamycin forte syrup botol 24 49,220.00 1,181,280.00 152 Thiamicin tab tablet 3000 2,135.00 6,405,000.00 153 Trimoxsul syrup botol 24 22,810.00 547,440.00 154 Trifed tab tablet 3000 1,366.00 4,098,000.00 155 Trombopop gel tube 24 48,030.00 1,152,720.00 156 Trombopop ointment tube 24 37,355.00 896,520.00 157 Truvas 20 tab tablet 300 12,327.00 3,698,100.00 158 Tarivid otic botol 12 72,575.00 870,900.00 159 Vitacur syrup botol 120 32,018.00 3,842,160.00 160 Vitaplex drop botol 12 37,355.00 448,260.00 161 Vitaplex syrup botol 12 37,352.00 448,224.00 165 Wiacid tab tablet 600 4,483.00 2,689,800.00 166 Zerlin tab tablet 1500 12,679.00 19,018,500.00 167 Zeufor tab tablet 1800 11,916.00 21,448,800.00 168 Zypraz 0,5 mg tab tablet 3000 2,327.00 6,981,000.00 169 Cercul inj 250 mg ampul 2000 16,009.00 32,018,000.00 JUMLAH (Rp.) 764,287,356.00 PPN 10% (Rp.) 76,428,735.60 JUMLAH SUBTOTAL (Rp.) 840,716,091.60 PEMBULATAN (Rp.) 840,716,000.00

PT. ANUGRAH PRADJA MANDIRI NO. NAMA BARANG SATUAN VOLUME H. SATUAN (Rp.) J. HARGA (Rp.) 4 Aminefron tab tablet 900 6,125.00 5,512,500.00 7 Asppilets thrombo tab tablet 25000 642.00 16,050,000.00 24 Brainnolin 250 mg/ml inj ampul 1000 29,400.00 29,400,000.00 26 Candesartan 8 tablet 3000 4,341.00 13,023,000.00 27 Candesartan 16 tablet 10800 6,270.00 67,716,000.00 28 Cefixime 200 mg tab tablet 1000 3,144.00 3,144,000.00 29 Carbogliserin tetes telinga botol 48 1,837.00 88,176.00 30 Cefixime 100 mg tab tablet 1000 1,202.00 1,202,000.00 34 C. Conver strip 100 18,370.00 1,837,000.00 41 Citicolin inj 250 ampul 2200 8,686.00 19,109,200.00 42 Citicolin tab 500 mg tablet 6000 5,512.00 33,072,000.00 74 Intermoxil syrup 60 ml botol 60 21,190.00 1,271,400.00 97 Mertigo tablet 500 2,714.00 1,357,000.00 98 Mertigo SR tab tablet 6000 4,522.00 27,132,000.00 104 Myonal tab tablet 3000 5,987.00 17,961,000.00 107 Neurobat tab tablet 1500 1,019.00 1,528,500.00 110 Nicholin 250 inj pcs 300 46,993.00 14,097,900.00 112 Nonflamin kapsul kapsul 500 4,113.00 2,056,500.00 120 Ottopraf tetes telinga botol 24 28,665.00 687,960.00 123 Pharolit sachet 300 1,019.00 305,700.00 128 PSIDII tablet 1000 3,528.00 3,528,000.00 136 Rhinofed tab tablet 1000 1,509.00 1,509,000.00 137 Rhinos junior sirup botol 24 24,990.00 599,760.00 141 Soholin inj ampul 300 34,300.00 10,290,000.00 142 Spasmomen tab tablet 3000 6,076.00 18,228,000.00 143 Sumagesic tab tablet 2000 407.00 814,000.00 149 Theravask 10 mg tab tablet 5000 5,731.00 28,655,000.00 162 Vistrum syrup botol 48 30,257.00 1,452,336.00 163 Vometa syrup botol 48 36,750.00 1,764,000.00 164 Vometa drop botol 24 36,750.00 882,000.00 JUMLAH (Rp.) 324,273,932.00 PPN 10% (Rp.) 32,427,393.20 JUMLAH SUBTOTAL (Rp.) 356,701,325.20 PEMBULATAN (Rp.) 356,701,000.00