RENCANA ANGGARAN BIAYA (RAB) PEKERJAAN : BELANJA BAHAN OBAT - OBATAN Unit Kerja Nama Kegiatan Kode Rekening Tahun Anggaran Lokasi : PSTW Usada Mulia 5 : Pemeliharaan Kesehatan WBS : 5.2.2.02.04 : 2011 : PSTW Usada Mulia 5 No Uraian/Spesifikasi Barang Volume 1 Vitamin B Complex 60 Btl 2 Vitamin C 48 Btl 3 Sulfas Ferousus 48 Btl 4 CTM (Soho) 48 Btl 5 Calcium Lactat (KALK) 60 Btl 6 Obat Batuk GG 100 MG 48 Btl 7 Kasa Besar 48 Roll 8 Digoxin 0,25 mg 60 Box 9 Nifedipin 10 mg 72 Box 10 Diaform 48 Btl 11 Curcuma 48 Box 12 Antalgin 48 Btl 13 Paracetamol 48 Btl 14 Amoxilin 500 mg 60 Box 15 Ciprofloxacin 500 mg 60 Box 16 Piroxicam 10 mg 48 Box 17 Ibuprofen 200 mg 48 Box 18 Plester Besar 48 Roll 19 H2O2 3 % 48 Btl 20 Bethadine 48 Liter 21 Aminophillin 24 Btl 22 HCT 25 mg 48 Btl 23 Isosorbide Dinitrate 48 Btl 24 Asmasoho 48 Box 25 Enzymplex/STP 48 Btl 26 Neuralgin 60 Box 27 Tetrasicline 24 Btl 28 Chloramfenicol 250 mg 24 Btl 29 Primpran tab 36 Box 30 Adonna tab 48 Box 31 Vitamin K 48 Btl 32 Trombahop 48 Tube 33 Metformin 500 mg 48 Box 34 Phenobarbital 48 Btl 35 Chlorpromazine 48 Btl 36 Asam Mefenamat 48 Box 37 Ambroxol 48 Box 38 Sangobion 48 Box 39 Omeprazol 48 Box 40 Acyclovir Tab 400 MG 48 Tube 41 Prednison 36 Btl 42 Multivitamin 36 Btl 43 Dextrometorpan Tab 36 Btl 44 Furocemide Tab 48 Box 45 Metronidazol 36 Box 46 Cotrimoxazol 480 MG 24 Box 47 Dulcolax 1 strep (4 Tab) 36 Box 48 Merislon 36 Box 49 Alupurinol 100 MG 24 Box 50 KSR (Aspar k) 48 Box 51 Aldactone/Lectonal 25 48 Box 52 Caviplex 24 Box Harga Satuan Jumlah Harga
No Uraian/Spesifikasi Barang Volume 53 Bactidol/Betadine kumur 48 Box 54 Ventolin 48 Box 55 Obat Batuk Hitam (Combi) 48 Dus 56 Visine Tetes Mata 48 Box 57 Catarlent 5 Ml 48 Box 58 Cendoxitrol 24 Box 59 Sabun Hijau 36 Lusin 60 Bedak Salycil 24 Dus 61 Ventolin Nebulen 2 SMS 60 Kotak 62 Transamin Tab 500 MG 24 Btl 63 Transamin Inj 48 Box 64 Nueroboran Inj 24 Box 65 Vitamin B Complex Inj 96 Vial 66 Neurobion Inj 24 Box 67 Etadryl Inj @ 15 ML 48 Box 68 Etamidon Inj @ 15 ML 48 Box 69 Primpran Inj 24 Box 70 Dexa Metason Inj/Ampul 36 Box 71 Bricasma Inj 12 Box 72 Furocemide ( Lasix ) Inj 24 Box 73 Penicillin Inj 240 Vial 74 Infus Set 84 Set 75 Ringer Lactat 120 Kolf 76 Dextrose 5 % 108 Kolf 77 Abbocath 24 Box 78 Needle 21 6 x ½ 36 Box 79 Disposable ( Spuite 5 cc ) 36 Box 80 Disposable ( Spuite 3½ cc ) 36 Box 81 Hidrocortison 1 % 24 Box 82 Hidrocortison 2½ % 24 Box 83 Doen Salep Anti Fungsi 24 Box 84 Salep 24 36 Box 85 Oxytetracycline 24 Box 86 Scabicide 36 Box 87 Acyclovir Tablet 24 Box 88 Erlamicitine Salep Mata 24 Box 89 Ichtiol Salep 48 Box 90 Undecyl Salep 24 Box 91 Verband 10 cm 36 Ball 92 Antasida 48 Btl 93 Ranitidin 36 Box 94 Seretide Diskus 100 mcg 24 Set 95 Seretide Diskus 250mcg 24 Set 96 Alkohol 70% 24 Btl 97 Spasminal Tablet 24 Box 98 Aspilet 24 Box 99 Tripanzym 24 Box 100 Glibenclamide 24 Box Harga Satuan Jumlah Harga Sub total PPN 10% Total 218,574,000 Terbilang : Dua ratus delapan belas juta lima ratus tujuh puluh empat ribu rupiah Jakarta, 12 Mei 2011 KEPALA PANTI SOSIAL TRESNA WERDHA USADA MULIA 5 PEJABAT PENGADAAN BARANG/JASA PSTW USADA MULIA 5 MASYUDI, SST, M.Si NIP.19660202 198902 1 002 ERI SIMARMATA, AKS, M.Si NIP. 195910121985031010
No Uraian / Spesifikasi / Jenis Barang / Harga Satuan Jumlah Harga Volume Bahan Permakanan 1 Vitamin B Complex 60 Btl 35,000 2,100,000 2 Vitamin C 48 Btl 35,000 1,680,000 3 Sulfas Ferousus 48 Btl 93,000 4,464,000 4 CTM (Soho) 48 Btl 30,000 1,440,000 5 Calcium Lactat (KALK) 60 Btl 63,000 3,780,000 6 Obat Batuk GG 100 MG 48 Btl 62,000 2,976,000 7 Kasa Besar 48 Roll 80,000 3,840,000 8 Digoxin 0,25 mg 60 Box 25,000 1,500,000 9 Nifedipin 10 mg 72 Box 25,500 1,836,000 10 Diaform 48 Btl 45,000 2,160,000 11 Curcuma 48 Box 60,000 2,880,000 12 Antalgin 48 Btl 62,000 2,976,000 13 Paracetamol 48 Btl 62,000 2,976,000 14 Amoxilin 500 mg 60 Box 62,000 3,720,000 15 Ciprofloxacin 500 mg 60 Box 42,000 2,520,000 16 Piroxicam 10 mg 48 Box 35,000 1,680,000 17 Ibuprofen 200 mg 48 Box 32,000 1,536,000 18 Plester Besar 48 Roll 75,000 3,600,000 19 H2O2 3 % 48 Btl 35,000 1,680,000 20 Bethadine 48 Liter 75,000 3,600,000 21 Aminophillin 24 Btl 125,000 3,000,000 22 HCT 25 mg 48 Btl 48,000 2,304,000 23 Isosorbide Dinitrate 48 Btl 48,000 2,304,000 24 Asmasoho 48 Box 32,000 1,536,000 25 Enzymplex/STP 48 Btl 55,000 2,640,000 26 Neuralgin 60 Box 25,000 1,500,000 27 Tetrasicline 24 Btl 75,000 1,800,000 28 Chloramfenicol 250 mg 24 Btl 80,000 1,920,000 29 Primpran tab 36 Box 42,000 1,512,000 30 Adonna tab 48 Box 39,000 1,872,000 31 Vitamin K 48 Btl 32,000 1,536,000 32 Trombahop 48 Tube 59,000 2,832,000 33 Metformin 500 mg 48 Box 55,000 2,640,000 34 Phenobarbital 48 Btl 75,000 3,600,000 35 Chlorpromazine 48 Btl 60,000 2,880,000 36 Asam Mefenamat 48 Box 35,000 1,680,000 37 Ambroxol 48 Box 20,000 960,000 38 Sangobion 48 Box 34,000 1,632,000 39 Omeprazol 48 Box 65,000 3,120,000 40 Acyclovir Tab 400 MG 48 Tube 40,000 1,920,000 41 Prednison 36 Btl 75,000 2,700,000 42 Multivitamin 36 Btl 40,000 1,440,000 43 Dextrometorpan Tab 36 Btl 35,000 1,260,000 44 Furocemide Tab 48 Box 62,000 2,976,000 45 Metronidazol 36 Box 21,000 756,000 46 Cotrimoxazol 480 MG 24 Box 25,000 600,000 47 Dulcolax 1 strep (4 Tab) 36 Box 28,000 1,008,000 48 Merislon 36 Box 42,000 1,512,000 49 Alupurinol 100 MG 24 Box 25,000 600,000 50 KSR (Aspar k) 48 Box 68,000 3,264,000 51 Aldactone/Lectonal 25 48 Box 30,000 1,440,000 52 Caviplex 24 Box 60,000 1,440,000
No Uraian / Spesifikasi / Jenis Barang / Harga Satuan Jumlah Harga Volume Bahan Permakanan 53 Bactidol/Betadine kumur 48 Box 40,000 1,920,000 54 Ventolin 48 Box 55,000 2,640,000 55 Obat Batuk Hitam (Combi) 48 Dus 150,000 7,200,000 56 Visine Tetes Mata 48 Box 55,000 2,640,000 57 Catarlent 5 Ml 48 Box 58,000 2,784,000 58 Cendoxitrol 24 Box 78,000 1,872,000 59 Sabun Hijau 36 Lusin 75,000 2,700,000 60 Bedak Salycil 24 Dus 150,000 3,600,000 61 Ventolin Nebulen 2 SMS 60 Kotak 50,000 3,000,000 62 Transamin Tab 500 MG 24 Btl 42,000 1,008,000 63 Transamin Inj 48 Box 58,000 2,784,000 64 Nueroboran Inj 24 Box 115,000 2,760,000 65 Vitamin B Complex Inj 96 Vial 9,000 864,000 66 Neurobion Inj 24 Box 315,000 7,560,000 67 Etadryl Inj @ 15 ML 48 Box 9,000 432,000 68 Etamidon Inj @ 15 ML 48 Box 10,000 480,000 69 Primpran Inj 24 Box 30,000 720,000 70 Dexa Metason Inj/Ampul 36 Box 25,000 900,000 71 Bricasma Inj 12 Box 42,000 504,000 72 Furocemide ( Lasix ) Inj 24 Box 55,000 1,320,000 73 Penicillin Inj 240 Vial 12,500 3,000,000 74 Infus Set 84 Set 25,000 2,100,000 75 Ringer Lactat 120 Kolf 9,000 1,080,000 76 Dextrose 5 % 108 Kolf 12,500 1,350,000 77 Abbocath 24 Box 140,000 3,360,000 78 Needle 21 6 x ½ 36 Box 35,000 1,260,000 79 Disposable ( Spuite 5 cc ) 36 Box 65,000 2,340,000 80 Disposable ( Spuite 3½ cc ) 36 Box 65,000 2,340,000 81 Hidrocortison 1 % 24 Box 55,000 1,320,000 82 Hidrocortison 2½ % 24 Box 72,000 1,728,000 83 Doen Salep Anti Fungsi 24 Box 49,000 1,176,000 84 Salep 24 36 Box 49,000 1,764,000 85 Oxytetracycline 24 Box 62,000 1,488,000 86 Scabicide 36 Box 62,000 2,232,000 87 Acyclovir Tablet 24 Box 70,000 1,680,000 88 Erlamicitine Salep Mata 24 Box 45,000 1,080,000 89 Ichtiol Salep 48 Box 28,000 1,344,000 90 Undecyl Salep 24 Box 42,000 1,008,000 91 Verband 10 cm 36 Ball 60,000 2,160,000 92 Antasida 48 Btl 60,000 2,880,000 93 Ranitidin 36 Box 35,000 1,260,000 94 Seretide Diskus 100 mcg 24 Set 192,000 4,608,000 95 Seretide Diskus 250mcg 24 Set 242,000 5,808,000 96 Alkohol 70% 24 Btl 70,000 1,680,000 97 Spasminal Tablet 24 Box 32,000 768,000 98 Aspilet 24 Box 65,000 1,560,000 99 Tripanzym 24 Box 55,000 1,320,000 100 Glibenclamide 24 Box 86,000 2,064,000
84,545.45 27,272.73 57,272.73 72,727.27 23,181.82 40,909.09 113,636.36 43,636.36 43,636.36 72,727.27 35,454.55 53,636.36 18,181.82 30,909.09 36,363.64 36,363.64 19,090.91 25,454.55 61,818.18 27,272.73
36,363.64 136,363.64 52,727.27 70,909.09 136,363.64 45,454.55 52,727.27 104,545.45 8,181.82 286,363.64 8,181.82 9,090.91 27,272.73 11,363.64 8,181.82 11,363.64 127,272.73 65,454.55 44,545.45 44,545.45 63,636.36 40,909.09 25,454.55 174,545.45 220,000.00 63,636.36 78,181.82