| 0534362827518000 | - | |
| 0318168341518000 | - | |
| 0751788746443000 | - | |
Anugerah Prima Medikalindo | 09*4**2****32**0 | - |
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CV Mega Surya | 00*8**7****15**0 | - |
PT Inti Kemika Sejahtera | 07*0**0****03**0 | - |
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| 0210388096543000 | - | |
| 0802358960901000 | - | |
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PT Satangkai Bungo Harapan | 05*3**5****08**0 | - |
| 0210802179432000 | - | |
PT Medika Jasa Utama | 00*3**6****31**0 | - |
| 0027488527009000 | - | |
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Acitek Digital Indonesia | 09*3**2****28**0 | - |
PT Gen Sekar Medika | 09*8**2****55**0 | - |
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Retama Multi Usaha | 08*8**8****35**0 | - |
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CV Abadi Tidar Medika | 06*3**3****17**0 | - |
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KEMENTERIAN KESEHATAN REPUBTIK INDONESIA
DI REKTORAT ENDERAL PELAYANAN KESEHATAN
J
RUMAH SAKIT dr. H. MARZOEKI MAHDI BOGOR
Jalan dr. Sumeru No. 114 Bogor Telp.025r-8324025
Bogor, 25 Mei 2023
:
Nomor KN.01.03XXV.7 t1981112023
:
Lampiran 4 (Empat) lembar
:
Perihal Perintah Pengadaan Reagen Rutin Non E-Katalog Tahun Anggaran 2023
Yth. Kepala Unit Layanan Pengadaan (ULP)
Rumah Sakit Dr. H. Mazoeki Mahdi
Di Bogor
Sehubungan dengan surat dari Dir. Medik Keperavvatan & Penunjang tentang Pengadaan
Reagen Rutin Non E-Katalog IA 2023, bersama ini kami teruskan proses pengadaan ini
kepada Unit Layanan Pengadaan dengan ketentuan :
1.
Pengadaan Reagen Rutin Non E-Katalog TA 2023;
2.
Pengadaan ini dibebankan pada Anggaran DIPA BLU Tahun 2023
o24.U.2.41 5fi5,6388.CAB.003.051.A.5251 21
i
3.
Pelaksanaan pengadaan agar mengacu kepada Perpres Nomor 12 tahun 2021 dan
ketentuan lainnya yang berlaku;
4.
Bentuk Perikatan Perjaniian adalah Kontrak Harga Satuan;
5.
Nilai Total HPS (Harga Perkiraan Sendiri) Rp 534.935.000,-
Demikian penyampaian dari kami dan agar dilaksanakan sebaik-baiknya.
PPK Medik.
Wijanarko, S.Kp
NtP 19660301 I 989031003
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA
DIREKTORAT ENDERAL PELAYANAN KESEHATAN
J
RUMAH SAKIT dr. H. MARZOEKI MAHDI BOGOR
Jalan dr. Sumeru No. 114 Bogor Telp. 0251-8324025
Lampiran
Nomor KN.0 1 .OS|XXV .7 t',t 98q12023
Tanggal 25Mei2O23
Perihal Perintah Pengadaan Reagen Rutin Non E-Katalog Tahun Anggaran 2023
No Nama Barang Volume Satuan Keterangan
Calsium Chloride ,| Box
1
2 ControlPlasma N 6 Box
3 Thrombin reagent 4 Box
4 Owren's Veronal Buffer 6 Box
5 Pathromtin SL 7 Box
6 Reaction Tube SU40 4 Pack
7 Sample Cup Conical 10 Pack
8 CA Clean I CL I 6 Pack
9 CA Clean ll 6 Pack
10 lnnovin 10 Box
Thermal Paper DPT 20 Rolls
11
12 Aquabides 62 Botol
13 Asto Fokus 2 Kit
14 Barbiturate Oncoprobe 2 Kit
15 Dispet 3 Box
'16 Eosin 2 Botol
17 Anti Hbs SD 2 Kit
18 Holder Lancet 12 Buah
19 Kertas Lensa 2 Pak
20 Heparin 3 mlGreiner 10 Box
21 Heparin 0,5 mlGreiner 10 Box
22 K3 EDTA 1 mlGreiner 100 Box
23 K2EDTA 2 ml Greiner 400 Box
24 Serum with Ca 3 mlGreiner 500 Box
25 Na Sitrat 3,8 o/o 2 Botol
26 SY URINE 9OO 4 Box
27 Microscope Slide Frosted Bioglass 30 box
28 Deck Glass / cover glass 24x24 Bioglass 2 box
29 Plat test WidalAlM 3 Buah
30 Pregnansi Test SD 7 Kit
31 Rhematoid Faclor Fokus 2 Kit
32 Stopwatch 3 Buah
33 ThermalPaper 19 Roll
34 Timer Digital 10 Buah
35 Tissue RollPutih 600 Roll
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA
DIREKTORAT ENDERAL PELAYANAN KESEHATAN
J
RUMAH SAKIT dT. H. MARZOEKI MAHDI BOGOR
Jalan dr. Sumeru No. 114 Bogor Telp. 0251-8324025
36 Troponin ISD 2 Kit
37 Goldar Tulip 12 Box
38 Wright Merck 6 Botol
39 Buffer Cair (pH 6,4) 3 Botol
40 Giemsa 1 Botol
41 Asam asetat glacial I Botol
42 Nonne Botol
1
43 Pandy 1 Botol
44 WidalAlM 10 Set
45 Liquicheck Urinalysis control lewl 1 2 Box
Wondfo Multi Drug 3 Panel
46 (AMP/MOP/THC) 60 Box
47 MDMA Wondfo 6 Box
48 Auction Stik Arkray Urine 12 Tube
49 LED Micro 4 Box
50 NaCL 0,9 o/o 4 Botol
51 Wing Needle Vacuette Greiner 10 Box
PPK Medik,
rko, S.Kp
9660301 989031003
1 1
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA
DIREKTORAT ENDERAL PELAYANAN KESEHATAN
J
RUMAH SAKIT dT. H. MARZOEKI MAHDI BOGOR
Jalan dr. Sumeru No. 114 Bogor Telp.0251-8324025
HARGA PERK]RAAN SEND]RI (HPS)
PA/ KPA Direktur Utama Rumah Sakit Jiwa Dr. H. Mazoeki Mahdi Bogor
KJLDN Kementrian Kesehatan Rl
Satker/ SKPD Rumah Sakit Dr. H. Marzoeki Mahdi Bogor
PPK Rudi Wijanarko, S.Kp
Pekerjaan Pengadaan Reagen Rutin Non E-Katalog Tahun AnggaEn 2023
Lokasi Kota Bogor
Tahun Anggaran 2023
Nomor HPS KN.01.o3rfiV.7/1 98q/2O23HPS
Tanggal 25Mei2A23
Harya S.tuan
No Jenis Pengadaan Volume Satuan TKDN Jumlah (Rp)
(Rp) + PPN 'llYo
Rp Rp
Calsium Chloride 1,562,000 Box 0 1,562,000
1 1
Rp Rp
2 Control Plasrna N o 2,493,750 Box 0 14,962,500
Rp Rp
Thrombin reagenl 4 2,375,000 Box 0 9,500,000
Rp Rp
4 Owren's Veronal Buffer 6 768,750 Box 0 4,612,500
Rp Rp
5 Pathrorntin SL 7 3,7,t3,750 Box 0 26,206,250
Rp Rp
6 Reaction Tube SU-40 4 3,362,500 Pack 0 13,450,000
Rp Rp
7 Sample Cup Conical 10 675,000 Pack 0 6,750,000
Rp Rp
CA C|ean I CL I b 1,293,750 Pack 0 7,762,500
Rp Rp
o CA Clean ll t) 1,062,500 Pack 0 6,375,000
Rp
Rp
'10 lnnovin '10 1,247 soo Box 0 12,475,000
Rp Rp
11 Thermal Paper DPT 20 40,625 Rolls 0 812,500
Rp Rp
12 Aquabides 62 37,500 Botol 0 2,325,000
Rp Rp
IJ Asto Fokus 2 622,500 Kit 0 1,245,000
Rp Rp
14 Barbiturate Oncoprobe 2 1,250,000 Kir 0 2,500,000
Rp Rp
15 Dispet 3 1,987,500 Box 0 s,962,500
Rp Rp
'16
Eosin 2 1 ,/150,000 Botol 0 2,900,000
Rp Rp
17 Anti Hbs SD 2 1,250,000 Kit 0 2,500,000
Rp Rp
18 Holder Lancet 91,250 Buah 0 1,095,000
to Rp Rp
Kertas Lensa 2 66,250 Pak 0 132,500
Rp Rp
20 Heparin 3 ml Greiner 10 218,750 Box 0 2,187,500
Rp Rp
Heparin 0,5 ml Greiner 10 293,750 Box 0 2,937,500
))
Rp Rp
K3 EDTA 1 rfl Greiner 100 200,000 Box 0 20,000,000
Rp Rp
K2EDTA 2 ml Greiner /100 200,000 Box 0 80,000,000
Rp
Rp
24 Serum with Ca 3 ml Greiner 500 200,000 Box 0 100,000,000
Rp Rp
25 Na Sitrat 3,8 o/o 2 268,750 Botol 0 537,500
Rp Rp
26 SY URINE 9OO 4 5,925,000 Box 0 23,700,000
lllicroscope Slide Frosted
Rp Rp
27 Bioglass 30 35,000 box 0 1,050,000
Deck Glass / cover glass 21n1
Rp Rp
28 Bioglass 2 225,000 box 0 450,000
Rp Rp
29 Plat test Widal AIM 3 73.750 Buah 0 22'l,250
KEMENTERIAN KESEHATAN REPUBTIK INDONESIA
DIREKTORAT JENDERAL PELAYANAN KESEHATAN
RUMAH SAKIT dr. H. MARZOEKI MAHDI BOGOR
.lalan dr. Sumeru No. 114 Bogor Telp. 0251-8324025
Harga Satuan
No Jonis Pcngadern Volurna Satua n TKDN Jumlah (Rp)
(Rp) + PPN l1%
Rp Rp
30 Pregnansi Test SD 7 500,000 Kit 0 3,500,000
Rp Rp
31 Rhernatoid Factor Fokus 2 687,500 Kir 0 1,375,000
Rp Rp
StopMlatch 3 437,500 Buah 0 1,312,500
Rp Rp
Thermal Paper '19 56,250 Roll 0 1,068,750
Rp Rp
34 Timer Digilal 10 212,il0 Buah 0 2j25,000
Rp
35 Tissue Roll Putih 600 Rp 6,125 Roll 0 3,675,000
Ro Rp
36 Troponin ISD 2 1,562,500 Kit 0 3,125,000
Rp Rp
Goldar Tulip 12 1,100,000 Box 0 13,200,000
Rp Rp
38 Wright Merck 6 1,500,000 Botol 0 9,000,000
Rp Rp
39 Buffer Cair (pH 6,4) 3 1,500,000 Botol 0 4,500,000
Rp Rp
40 Giemsa 1 1 ,5@,000 Bolol 0 1,500,000
Rp Rp
41 Asam asetat glacial 1 625,000 Botol 0 625,000
Rp Rp
42 Nonne 1,000,000 Bolol 0 1,000,000
1
Rp Rp
43 Pandy 218,750 Botol 0 218,750
1
Rp Rp
44 Widal AIM 10 1,500,000 Set 0 15,000,000
Liquicheck Urinalysis control
Rp Rp
45 level 2 6,250,000 Box 0 12,500,000
1
Wondfo Multi Drug 3 Panel
RD Rp
46 (AMP/MOP/THC) 60 1.377.500 Box 0 82,650,000
Rp Rp
47 MDMA Wondfo 6 1.000.000 Box 0 6,000,000
Rp Rp
48 Auction Stik Arkray Urine 12 743,750 Tube 0 8,925,000
Rp Rp
49 LED Micro 4 1,750,000 Box 0 7,000,000
Rp Rp
50 NaCL 0,9 % 4 200,000 Bolol 0 800,000
Rp Rp
51 Wing Needle Vacuetle Greiner 10 162,300 Box 0 1,623,000
TOTAL Rp 534,935,000
PPK Medik,
dirVizjanarto, S.Kp
NtP 19660301 1989031003
g
KEMENTERIAN KESEHATAN REPUBLIK INDONESIA
2
a
DIREKTORAT JENDERAL PEI.AYANAN KESEHATAN
)
RUMAH SAKITJIWA DR. H. MARZOEKI MAHDI BOGOR a
5
) ,",","i"131,T$;T:!'i$?;)i1,Y';J,l?:ll#i",?:I'i'i,,00,,
Laman .. '\i. ,,r.i,,r.. , , ,, Surat Elektronik rsmm.bgr@gmail.com
NOTA DINAS
NOMOR : FO.O3.O4t1t t2023
Yrh. : PPK Medik
Dari :Direktur Medik, Keperawatan dan Penuniang
Hal : Ajuan Pengadaan Reagen Rutin Non E-Katalog Tahun 2023 'gBt\
Tanggal :25Mei2O23
Sehubungan dengan pengajuan dari lnstalasi Laboratorium No. No. 016/LABflll/2023 tentang Ajuan
Pengadaan Reagen Rutin Non E-Katalog Tahun 2023 senilai Rp.534.935.000,- (Lima Ratus Tiga Puluh
Empat Juta Sembilan Ratus Tiga Puluh Lima Ribu Rupiah), maka bersama ini kami ajukan permohonan
tersebut dengan perincian terlampir
Demikian disampaikan dengan ucapan terimakasih.
dr. Rahmi Handayani, Sp.KJ,MARS
Lempiran Ajuan Reagen Rutin Non E-Katalog Tahun 2023
Harga Satuan (Rp)
t{o Jenis Pengadarn Volume Satuan TKOt{ Jumlah (Rp)
+ PPN ,1%
Rp Rp
Calsium Chloride 1,562,000 Bor 0 1,562,000
1 1
Rp Rp
2 Conkol Plasma N 6 2,493,750 Box 0 14,962,500
Rp Rp
3 Throrntin reagent 4 2,375,000 Box 0 9,500,000
Rp Rp
4 Owren's Veronal Buffer 6 768,750 Box 0 4,612,500
Rp Rp
5 Pathrorntin SL 7 3,743,750 Box 0 26,246,250
I Rp Rp
6 Reaction Tube SU-40 3,362,500 Pack 0 13,450,000
lRp Rp
7 Sample Cup Conical 10 675,000 Pack 0 6,750,000
Rp Rp
8 I CA Clean I CL I 6 Rp 1,293,750 Pack 0 Rp 7,762,500
CA Clean ll 6 1,m2,500 Pack 0 6,375,000
Rp Rp
10 lnnovin '10 'l,247 ,500 Box 0 12,475,000
Rp Rp
11 Therrnal Paper DPT 1n &,625 Rolls 0 812,500
Rp Rp
12 Aquabides 62 37,500 Botol 0 2,325,000
Rp Rp
13 Asto Fokus 2 622,500 Kit 0 1,245,000
Rp Rp
14 Barliturate Oncoprobe 2 1,250,000 Kit 0 2,500,000
Rp Rp
15 Dispet 3 1.987,500 Box 0 5,962,500
Rp Rp
'1,450,000
16 Eosin 2 Botol 0 2,900,000
Rp Rp
17 Anti Hbs S0 2 1,250,000 Kit 0 2,500,000
Rp Rp
18 Holder Lancet 12 91,250 Buah 0 1,09s,000
Rp Rp
19 Kertas Lensa 2 66,250 Pak 0 132,500
Rp
Rp
20 Heparin 3 rnl Greiner '10 218,750 Box 0 2,187,500
Rp Rp
21 Heparin 0,5 mlGreiner 10 293,750 Box 0 2,937,500
Rp Rp
22 K3 EDTA 1 rfl Greiner 100 200,000 Box 0 20,000,000
Rp Rp
23 KzEDTA 2 rnl Greiner 400 200,000 Bor 0 80,000,000
Rp Rp
24 Serum wilh Ca 3 rnl Greiner 500 200,000 Box 0 100,000,000
Rp Rp
25 Na Sitrat 3,8 % 2 268,750 Botol 0 537,500
Rp Rp
26 SY URINE 9OO 4 5,925,000 Bor 0 23,700,000
Microscope Slide Frosted
Rp Rp
27 Bioglass 30 35.000 bor 0 1,050,000
Deck Glass / cover glass 24x24
Rp Rp
28 Bioqlass 2 225,000 box 0 450,000
Rp Rp
29 Plat test Widal AIM 73,750 Buah 0 D1,250
Rp Rp
30 Pregnansi Test SD 7 500,000 Kit 0 3,500,000
Rp Rp
31 Rhernatoid Factor Fokus 2 687,500 Kit 0 1,375,000
Rp Rp
32 Stopwatch 3 437,500 Buah 0 1,312,500
Rp
Rp
33 Thermal Paper 19 56,250 Roll 0 1,068,750
Rp Rp
34 Timer Digital 10 212,500 Buah 0 2,125,0@
Rp Rp
35 Tissue Roll Putih 600 6,125 Roll 0 3,675,000
Rp Rp
36 Troponin I SD 2 1,562,500 Kir 0 3,125,000
Rp Rp
JI Goklar Tulip 12 1,100,000 Box 0 13,200,000
Rp Rp
38 Wright Merck 6 1,500,000 Botol 0 9,000,000
Rp Rp
39 Bufier Cair (pH 6,4) 3 1.500.000 Botol 0 4,500,000
Rp Rp
40 Giernsa ,| '1,500,000 Botol 0 1,500,000
Rp Rp
41 lAsam asetat glacial 1 625,000 B0t0l 0 625,000
Harga Satuan (Rp)
No Jgnis Pengadaan Volume Satuan TKDN Jumlah (Rp)
+ PPN II%
Rp Rp
42 Nonne 1 1,000,000 Botol 0 1.000,000
lRp Rp
Pandy 218,750 Botol 0 218,750
1
Rp Rp
44 WidalAl[, '10 I,500,000 Set 0 15,000,000
Liquicheck Urinalysis control
Rp Rp
45 level 1 2 6.250.000 Box 0 12,500,000
Wondfo Multi Drug 3 Panel
Rp Rp
46 (AMP/MOP/THC) 60 1,377,500 Box 0 82,650,000
Rp Rp
'l,000,000
47 MDMA Wondfo 6 Box 0 6,000,000
Rp Rp
48 Auction Stik Arkray Urine 12 743,750 Tube 0 8,925,000
Rp Rp
49 LED Micro 4 I,750,000 Box 0 7,000,000
Rp Rp
50 NaCL 0,9 % 4 200,000 Bolol 0 800,000
Rp Rp
51 Wing Needle Vacuette Greiner '10 162,300 Box 0 1,623,000
Rp
Jumlah 534,935,000
dr. Rahmi Handayani, Sp.KJ,MARS