HARGA BPJS( 02) TAHUN 2023.xlsx

	A	B	C	D	E	F	G	H	I	J
1	PRICE LIST OGB KIMIA FARMA (BPJS 02)
2	TAHUN 2023
3	NO	SAP	NAMA PRODUK	ISI KEMASAN	BENTUK KEMASAN	ISI / KARTON	BPJS KODE 02
4

5			SBU MARKETING & SALES FARMA				PER KEMASAN		SATUAN TERKECIL
6			OGB & PRODUK KHUSUS				HNA	HNA +PPN	HNA	HNA +PPN
7	1	11002397	ACARBOSE 100 MG (DUS 100 TAB)	100	DUS	0	294.414	326.800	2.944	3.268
8	2	11002396	ACARBOSE 50 MG (DUS 100 TAB)	100	DUS	0	152.162	168.900	1.522	1.689
9	3	11002238	ACETYLCYSTEINE 200 MG TAB@100	100	DUS	0	64.505	71.600	645	716
10	4	11000002	ACICLOVIR 400 MG (DUS 100 TAB)	100	DUS	0	77.928	86.500	779	865
11	5	11001445	ALLOPURINOL 100 MG (DUS 100 TAB)-BJN	100	DUS	0	16.847	18.700	168	187
12	6	11000008	ALPRAZOLAM 0.5 MG (DUS 100 TAB)	100	DUS	0	15.586	17.300	156	173
13	7	11000009	ALPRAZOLAM 1 MG (DUS 100 TAB)	100	DUS	0	17.748	19.700	177	197
14	8	11001449	AMLODIPINE 10 MG (DUS 50 TAB)-BJN	50	DUS	0	5.946	6.600	119	132
15	9	11001448	AMLODIPINE 5 MG (DUS 50 TAB)-BJN	50	DUS	0	5.631	6.250	113	125
16	10	11000011	AMOXICILLIN 500 MG (DUS 100 TAB)	100	DUS	0	48.108	53.400	481	534
17	11	11001451	ANTASIDA DOEN (DUS 100 TAB)-BJN	100	DUS	0	30.360	33.700	304	337
18	12	11001452	ANTASIDA DOEN SUSPENSI-BJN (BTL60ML)-BJN	1	BT	0	5.818	6.458	5.818	6.458
19	13	11000291	ANTIHEMOROID (DUS 10 SUPP)	10	DUS	0	29.279	32.500	2.928	3.250
20	14	11001586	ATORVASTATIN 10 MG	30	DUS	0	8.730	9.690	291	323
21	15	11001587	ATORVASTATIN 20 MG	30	DUS	0	19.108	21.210	637	707
22	16	11000016	AZITHROMYCIN 500 MG (DUS 20 TAB)	20	DUS	0	32.486	36.060	1.624	1.803
23	17	11000383	BETAMETASON 0.1% CR(DUS 25 TUBE@5 GRAM)	1	TUB	0	1.802	2.000	1.802	2.000
24	18	11002298	BISOPROLOL 2.5 MG TSS	100	DUS	0	12.973	14.400	130	144
25	19	11002299	BISOPROLOL 5 MG TSS	100	DUS	0	14.685	16.300	147	163
26	20	11001459	CALCIUM LACTAT 500 MG (DUS 100 TAB)-BJN	100	DUS	0	14.865	16.500	149	165
27	21	11000161	CAPTOPRIL 12.5 MG TAB (DUS 100 TAB)	100	DUS	0	13.423	14.900	134	149
28	22	11001461	CAPTOPRIL 25 MG (DUS 100 TAB)-BJN	100	DUS	0	10.721	11.900	107	119
29	23	11000021	CEFADROXIL 125 MG/5 ML S.K. (BTL 60 ML)	1	BT	0	7.936	8.809	7.936	8.809
30	24	11000022	CEFADROXIL 500 MG (DUS 50 KAPS)	50	DUS	0	40.360	44.800	807	896
31	25	11000024	CEFIXIME 100 MG (DUS 30 KAPS)	30	DUS	0	16.081	17.850	536	595
32	26	11000025	CETIRIZINE 10 MG (DUS 30 TAB)	30	DUS	0	7.324	8.130	244	271
33	27	11001864	CETIRIZINE DIHYDROCHLORIDE SYR 5MG/ML	1	BT	0	6.122	6.795	6.122	6.795
34	28	11000295	CHLORAMFENICOL 1 % S. MATA (TUBE 5 GRAM)	1	TUB	0	3.423	3.800	3.423	3.800
35	29	11001463	CHLORAMPHENICOL 250 MG (DUS 100KAPS)-BJN	100	DUS	0	52.703	58.500	527	585
36	30	11000164	CHLORAMPHENICOL SUSPENSI (BTL 60 ML)	1	BT	0	8.300	9.213	8.300	9.213
37	31	11000029	CIPROFLOXACIN 500 MG (DUS 50 TAB)	50	DUS	0	31.036	34.450	621	689
38	32	11001469	CLONIDINE 0.15 MG (DUS 100 TAB)-BJN	100	DUS	0	13.153	14.600	132	146
39	33	11001470	CLOPIDOGREL 75 MG (DUS 30 TAB)-BJN	30	DUS	0	19.730	21.900	658	730
40	34	11000033	CODEINE 10 MG (DUS 100 TAB)	100	DUS	0	54.054	60.000	541	600
41	35	11000035	CODEINE 15 MG TAB (DUS 100 TAB)	100	DUS	0	91.441	101.500	914	1.015
42	36	11000037	CODEINE 20 MG TAB (DUS 100 TAB)	100	DUS	0	122.523	136.000	1.225	1.360
43	37	11001472	COTRIMOXAZOLE SUSPENSI (BTL 60 ML)-BJN	1	BT	0	14.816	16.446	14.816	16.446
44	38	11001476	DIETHYLCARBAMAZINE 100 MG(DUS100TAB)-BJN	100	DUS	0	40.360	44.800	404	448
45	39	11001478	DIMENHYDRINATE 50 MG (DUS 100 TAB)-BJN	100	DUS	0	13.604	15.100	136	151
46	40	11002210	DOBUTAMINE 250 MG/ 5 ML INJEKSI	5	DUS	0	36.482	40.495	7.296	8.099
47	41	11000056	DOXYCYCLINE (DUS 100 KAPS)	100	DUS	0	51.171	56.800	512	568
48	42	11000067	ERYTHROMYCIN SIRUP KERING (BTL 60 ML)	1	BT	0	12.043	13.368	12.043	13.368
49	43	11000071	FLUCONAZOLE 150 MG (DUS 10 KAPS)	10	DUS	0	162.162	180.000	16.216	18.000
50	44	11000200	FUROSEMIDE 40 MG (DUS 200 TAB)	200	DUS	0	17.658	19.600	88	98
51	45	11002137	GABAPENTIN 100 MG (DUS 100 KPS)	100	DUS	0	80.901	89.800	809	898
52	46	11002060	GABAPENTIN 300 MG	100	DUS	0	67.568	75.000	676	750
53	47	11000072	GLIBENCLAMIDE 5 MG (DUS 100 TAB)	100	DUS	0	15.315	17.000	153	170
54	48	11000073	GLIMEPIRIDE 1 MG (DUS 50 TAB)	50	DUS	0	8.604	9.550	172	191
55	49	11000074	GLIMEPIRIDE 2 MG (DUS 50 TAB)	50	DUS	0	13.604	15.100	272	302
56	50	11000075	GLIMEPIRIDE 3 MG (DUS 50 TAB)	50	DUS	0	14.414	16.000	288	320
57	51	11000076	GLIMEPIRIDE 4 MG (DUS 50 TAB)	50	DUS	0	15.360	17.050	307	341
58	52	11000204	HYDROCLOROTIAZID 25 MG (DUS 100 TAB)	100	DUS	0	13.333	14.800	133	148
59	53	11000394	HYDROCORTISONE 2.5%CR(DUS 24TUBE@ 5GRAM)	1	TUB	0	2.523	2.800	2.523	2.800
60	54	11000302	IODINE POVIDONE LAR 10 % (BTL 1000 ML)	1	BT	0	79.690	88.456	79.690	88.456
61	55	11000303	IODINE POVIDONE LAR 10 % (BTL 60 ML)	1	BT	0	6.068	6.736	6.068	6.736
62	56	11000305	IODINE POVIDONE LAR 10% (BTL 30 ML)	1	BT	0	3.371	3.742	3.371	3.742
63	57	11000395	KETOCONAZOLE 2 % CREAM (TUBE 10 GRAM)	1	TUB	0	2.116	2.349	2.116	2.349
64	58	11000088	KOMBIPAK AZITHROMYCIN-CEFIXIME (PAKET)	1	DUS	0	281.360	312.310	281.360	312.310
65	59	11000090	LAMIVUDIN150MG+ZIDOVUDIN300MG (BTL60TAB)	60	BT	0	208.000	230.880	3.467	3.848
66	60	11000091	LAMIVUDINE 100 MG TAB (BTL 30 TAB)	30	BT	0	44.324	49.200	1.477	1.640
67	61	11000092	LAMIVUDINE 150 MG TAB (BTL 60 TAB)	60	BT	0	88.649	98.400	1.477	1.640
68	62	11001733	MEROPENEM 1 GR SERBUK INJEKSI	10	DUS	0	365.595	405.810	36.559	40.581
69	63	11000103	METHADONE SIRUP (BTL 1000 ML)	1	BT	0	257.658	286.000	257.658	286.000
70	64	11000104	METHYLERGOMETRINE 0.125 MG (DUS 100 TAB)	100	DUS	0	26.847	29.800	268	298
71	65	11001521	METOCLOPRAMID 10 MG (DUS 100 TAB)-BJN	100	DUS	0	10.090	11.200	101	112
72	66	11001522	METOCLOPRAMIDE HCL 5 MG (DUS 100TAB)-BJN	100	DUS	0	10.541	11.700	105	117
73	67	11000296	MICONAZOLE 2 % CR(DUS 24 TUBE@10 GRAM)	1	TUB	0	3.529	3.917	3.529	3.917
74	68	11002394	MORFINA 10 MG/ML	10	DUS	0	269.369	299.000	26.937	29.900
75	69	11000106	MORPHINE 10 MG (BTL 30 TAB)	30	BT	0	32.405	35.970	1.080	1.199
76	70	11000107	NATRIUM DIKLOFENAK 25 MG (DUS 50 TAB)	50	DUS	0	13.829	15.350	277	307
77	71	11001526	NATRIUM DIKLOFENAK 50 MG (DUS 50 TAB)-BJ	50	DUS	0	19.009	21.100	380	422
78	72	11000111	NEVIRAPINE 200 MG (BTL 60 TAB)	60	BT	0	130.541	144.900	2.176	2.415
79	73	11000115	OMEPRAZOLE 20 MG (DUS 30 KAPS)	30	DUS	0	13.973	15.510	466	517
80	74	11001536	ORALIT (DUS 100 SASE)-BJN	100	DUS	0	54.955	61.000	550	610
81	75	11000297	OXYTETRACYCLIN 1% SM(DUS 25TUBE@3.5GRAM)	1	DUS	0	5.346	5.934	5.346	5.934
82	76	11000117	PAKET OAT ANAK - FDC (KDT) (PAKET)	1	PET	0	344.104	381.955	344.104	381.955
83	77	11000118	PAKET OAT KATEGORI I FDC (KDT) (PAKET)	1	PET	0	461.000	511.710	461.000	511.710
84	78	11001538	PARACETAMOL 500 MG (DUS 100 TAB)-BJN	100	DUS	0	23.153	25.700	232	257
85	79	11001539	PARACETAMOL SYRUP (BTL 60 ML)-BJN	1	BT	0	4.253	4.721	4.253	4.721
86	80	11002221	PERMETHRIN KRIM 5%	1	TUB	0	5.698	6.325	5.698	6.325
87	81	11001044	PETHIDINA 50 MG/ML INJ (IMPORT)	10	DUS	0	119.820	133.000	11.982	13.300
88	82	11001540	PHENOBARBITAL 30 MG TAB (DUS 100TAB)-BJN	30	DUS	0	16.396	18.200	547	607
89	83	11001425	PREGABALINE 75 MG	30	DUS	0	33.000	36.630	1.100	1.221
90	84	11000121	PROPRANOLOL HCL 40 MG (DUS 100 TAB)	100	DUS	0	14.595	16.200	146	162
91	85	11001547	PYRANTEL 125 MG (DUS 30 TAB)-BJN	30	DUS	0	52.342	58.100	1.745	1.937
92	86	11000251	PYRAZINAMIDE 500 MG (DUS 100 TAB)	100	DUS	0	41.441	46.000	414	460
93	87	11000309	RETINOL (VIT A 100.000 UI)(BTL 50 KAPS)	50	BT	0	22.523	25.000	450	500
94	88	11000304	RETINOL (VIT A 200.000 UI) (BTL 50 KAPS)	50	BT	0	49.550	55.000	991	1.100
95	89	11000124	RIFAMPICIN 450 MG (DUS 100 TAB)	100	DUS	0	165.045	183.200	1.650	1.832
96	90	11000125	RIFAMPICIN 600 MG (DUS 100 TAB)	100	DUS	0	215.676	239.400	2.157	2.394
97	91	11002084	ROSUVASTATIN CALCIUM 10 MG (DUS 30 TAB)	30	DUS	0	19.838	22.020	661	734
98	92	11001555	SALBUTAMOL 2 MG (DUS 100 TAB)-BJN	100	DUS	0	7.748	8.600	77	86
99	93	11000353	SALICYL BEDAK 2 % (I) 50 gr NEW (DUS)	1	DUS	0	2.662	2.955	2.662	2.955
100	94	11000793	TABLET TAMBAH DARAH NEO (TSG)(DUS100TAB)	100	DUS	0	20.270	22.500	203	225