PT.
BANGUN NUSANTARA PERKASA
SURAT JALAN
No. 013-SJ/BNP/X/2025
Alamat Tujuan: Jakarta, 02 Oktober 2025
Kepala Rumah Sakit Penyedia:
Rumah Sakit Tk. IV Palangkaraya PT. Bangun Nusantara Perkasa
Jl. Diponegoro No.55, Pahandut,
Kec. Pahandut, Kota Palangka Raya,
Kalimantan Tengah 73112
Dengan Hormat,
Bersama Surat ini kami mengirimkan barang dengan perincian sebagai berikut:
Qty
No. Nama Alat Merk Type Koli
Vol Sat
1 Pasien Monitor Philips MX450 3 Unit 5
2 Mesin X-Ray Medien Garosu 1 Unit 4
3 Ventilator Siare Falco 202 5 Unit 5
4 Incubator Phoenix INC-200 5 Unit 5
5 Treadmil Welch Allyn TMX 428 1 Unit 2
Point 800S HD 3D Plus 1 Unit 2
6 Digital Panoramic CBCT Point Impant
(Pano+Ceph+CBCT)
7 Syringe Pump Medcaptain SYS-50 3 Unit
1
8 Infusion Pump Medcaptain SYS-70 3 Unit
9 Video Laryngoscope Verathon Verathon glidescope core 10" 1 Unit 1
10 Infant Warmer Phoenix NWS 101 2 Unit 1
11 Emergency Trolley Paramount Bed PY-40QR 1 Unit 3
12 Manual Book Alat 1 Set 1
Demikian kami sampaikan dan agar bisa diterima dengan baik. Atas perhatiannya kami ucapkan terima
kasih.
Hormat Kami,
Penerima Mengetahui Pengirim
PT. Bangun Nusantara Perkasa
Tan Yukie
( ) ( ) Direktur
Jl. Pluit Karang Manis No.2 Blok A.6 Sel, Lantai 4 Jakarta Utara 14450
Telp : (+62) 21 39702633 E-mail : [email protected]
PT. BANGUN NUSANTARA PERKASA
SURAT JALAN
No. 013-SJ/BNP/X/2025
Alamat Tujuan: Jakarta, 02 Oktober 2025
Kepala Rumah Sakit Penyedia:
Rumah Sakit Tk. IV Palangkaraya PT. Bangun Nusantara Perkasa
Jl. Diponegoro No.55, Pahandut,
Kec. Pahandut, Kota Palangka Raya,
Kalimantan Tengah 73112
Dengan Hormat,
Bersama Surat ini kami mengirimkan barang dengan perincian sebagai berikut:
Qty
No. Nama Alat Merk Type Koli
Vol Sat
1 Pasien Monitor Philips MX450 3 Unit 5
2 Mesin X-Ray Medien Garosu 1 Unit 4
3 Ventilator Siare Falco 202 5 Unit 5
4 Incubator Phoenix INC-200 5 Unit 5
5 Treadmil Welch Allyn TMX 428 1 Unit 2
Point 800S HD 3D Plus 1 Unit 2
6 Digital Panoramic CBCT Point Impant
(Pano+Ceph+CBCT)
7 Syringe Pump Medcaptain SYS-50 3 Unit
1
8 Infusion Pump Medcaptain SYS-70 3 Unit
9 Video Laryngoscope Verathon Verathon glidescope core 10" 1 Unit 1
10 Infant Warmer Phoenix NWS 101 2 Unit 1
11 Emergency Trolley Paramount Bed PY-40QR 1 Unit 3
12 Manual Book Alat 1 Set 1
Demikian kami sampaikan dan agar bisa diterima dengan baik. Atas perhatiannya kami ucapkan terima
kasih.
Hormat Kami,
Penerima Mengetahui Pengirim
PT. Bangun Nusantara Perkasa
Tan Yukie
( ) ( ) Direktur
Jl. Pluit Karang Manis No.2 Blok A.6 Sel, Lantai 4 Jakarta Utara 14450
Telp : (+62) 21 39702633 E-mail : [email protected]
PT. BANGUN NUSANTARA PERKASA
LAMPIRAN
No Item Item Deskripsi Qty Serial Number
1 Pasien Monitor
866062 IntelliVue MX450 Patient Monitor 3 DE671V9790;DE671V9795;
DE671W0038
866062_A06 A06 6-waves capability 3
866062_H12 H12 Intensive Care Software 3
866062_J40 J40 Advanced System Interface 3
866062_E05 E05 Integrated Recorder 3
866062_E22 E22 Quick Release Mount 3
866062_E24 E24 One Lithium Ion Battery 3
867030_H72 H72 Critical Care Transport SW 3
867030_B06 B06 Dual Press and Temp 3
867036_B06 B06 Dual Press and Temp 3
867030_SP1 SP1 FAST SpO2 3
M1668A CBL 5 Lead ECG Trunk, AAMI/IEC 2.7m 3 4B [3]
M1971A 5 lead limb cable - Grabber - IEC – ICU 3 10-20 [3]
M1191BL Reusable Adult SpO2 Sensor 3 2428G17986 ; 2431G21964 ;
2431G21961
M1599B Adult NIBP Air Hose 3.0m 3 2131 [3]
M1574A Comfort Care Cuff, Adult 3 0324 [3]
M1575A Comfort Care Cuff, Large Adult 3 2921 [3]
989803203581 Skin Temperature Probe, Reusable 3 0227492785 [1] ; 0227492741
[1] ; 0227121132 [1]
867036 Intellivue MMX 3 DE69551550;DE69543957;
DE69543931 ;
TLKLMX450 Trolley for MX450
M4816A Thermal Array Paper 9 928812
2 Mesin X-Ray
GAROSU-40KW MEDIEN Analog Radiography System - 1 GAROSU-R001
Garosu 40 kw
17HQ901G LG IT Medical DXD Oxide 1 505KCZPKA085
PC-L PC Set for LG Detector 1 GNGX34
ROUTER Wi-Fi Router 1
3 Ventilator
980104 FALCO 202 EVO - Portable lung 5 81463 ; 81465 ; 81466 ; 81467 ;
ventilator with 10,4 TOUCH SCREEN 81468
colour display and built-in turbine Patient
types: adult, paediatric and neonatal
8011.O2 Regulator for Oxygen 5
00340 Advanced Trolley for Ventilator Complete 5
with support for Cable cylinder and
humidifier
G00036000 Support for Arm 06755 on Trolley 5
G00039000 Support for Ventilator on Trolley 5
002-009-102 NUOVAtech Test Lung Reusable 1L 5 241021 [5]
(Adult)
06751 Patient Circuit Supporting Arm 5
AL1100 Breathing circuit disposable, Adult 25 7171.1710.24 [25]
19402 HUMID-VENT FILTER COMPACT 125 40Z24A1390 [125]
STRAIGHT
Jl. Pluit Karang Manis No.2 Blok A.6 Sel, Lantai 4 Jakarta Utara 14450
Telp : (+62) 21 39702633 E-mail : [email protected]
PT. BANGUN NUSANTARA PERKASA
4 Incubator
INC200 Neonatal Intensive Care Incubator - INC 200 5 2472 ; 2473 ; 2474 ; 2475 ; 2476
(Fully loaded) ,Double-walled hood,
Motorized Trendelenburg, Colour LCD
touch-screen display, Air & Skin temperature
Probe Servo-controlled humidification..
Electrically Operated Bed tilt.
5 Treadmil
9922-018-50 Treadmill TMX428 220V 1 VDC-10207
XSCRIBE-6BC-AXAAA XSCRIBE AM12 TTL KIT AHA XML 1 125110000193
TLKLTM Trolley for Treadmill 1
PCT Computer set for Treadmill (PC + 1 4CE408BM0V
Keyboard + Mouse)
ADA3-2 3 to 2 Electrical Adaptor 1
L3210 Printer Epson L3210 1 XAGKF67586
TPAPER-L P2000SFC Treadmill Paper Grid - Lokal 1
UPS Prolink 2000VA SFC Line 1 529301252800244
40493E Interactive 2000Va
Adult Foam ECG Electrode, Disposable 9 200406-0285 [9]
Digital Panoramic
6
CBCT
POINT-800S-HD POINT 800S HD 3D Plus 1 P08CS1-2540192
MONITORS1 Samsung Gaming Monitor 27" Odyssay 1 0TT3HNAY300002
G5 G55C QHD 156 Hz Curved
L3250 Printer EPSON L3250 1 X8JX157259
VDK-FB-18-105-O-O-B1 Non-electric Biopsy Force`ps 1 2024111109FB [1]
VDK-FB-18-120-O-O-A1 Non-electric Biopsy Forceps 1 022112220FB [1]
VDK-BC-18-120-C Disposible Cytology Brush 1 2025020702BC [1]
VDK-BC-18-120-B Disposible Cytology Brush 1 2024041701BC [1]
APT Apron Tyroid 4
APDL-TL Apron Double Tanpa Lengan 4
PC13-2-5 Lead Google 0.5mmpb 4
7 Syringe Pump
SYS-50 Syringe Pump 3 6132502000676;
SYS-50 6132502000677;
6132502000680
8 Infusion Pump
SYS-70 Infusion Pump 3 6122501000191 ;
SYS-70 6122501000194 ;
6122501000196
9 Video Laryngoscope
0270-0995-FHD GlideScope® Core 10"with Bflex 1 CP240511
QuickConnect Cable
(includes Core 10" Monitor,
QuickConnect Cable, Premium
Workstation)
0574-0147 Lopro T3 1 LA250146
0800-0604 GlideScope® Core Video Cable (for 1 18068-1-4.
Titanium RU Blades)
0800-0605 GlideScope® Core QuickConnect Cable 1 18350-1-7
0800-0636 GlideScope® Core Premium Workstation 1 CS2031140-2501 [1]
0570-0449 BFlex 2 Regular 5.0 SU Bronchoscope 5 KS250704 [5]
0570-0450 Bflex 2 Large 5.8 Single-Use 5 KT250704 [5]
Bronchoscope
0570-0448 BFlex 2 Slim 3.8 SU Bronchoscope 5 KR250701 [5]
Jl. Pluit Karang Manis No.2 Blok A.6 Sel, Lantai 4 Jakarta Utara 14450
Telp : (+62) 21 39702633 E-mail : [email protected]
PT. BANGUN NUSANTARA PERKASA
0270-0681 GlideRite Rigid Style 1 W98554 [1]
ADA3-2 3 to 2 Electrical Adaptor 1
10 Infant Warmer
NWS101 Infant Radiant Warmer - NWS 101 with 2 33193 ; 33194
Bed. Standard accessories: Infant Skin
Temperature probe-1, Standard Monitor
Shelf (11
11 Emergency Trolley 25F05560
Emergency Cart 1
IV Pole 1
Oxygen Stand 1
Jl. Pluit Karang Manis No.2 Blok A.6 Sel, Lantai 4 Jakarta Utara 14450
Telp : (+62) 21 39702633 E-mail : [email protected]
