Daftar Obat Formularium

RENCANA ANGGARAN BELANJA BAHAN MEDIS PAKAI HABIS
TAHUN 2015
NAMA PUSKESMAS
ALAMAT
TELEPON
UPTD PUSKESMAS CILEDUG

RADEN PATAH
e-KATALOG
NO.
NAMA OBAT
PENERIMAAN OBAT
KEMASAN
HARGA OBAT (Rp)
PABRIK
JAN
FEB
MAR
APR
MEI
10
11
500
900
OBAT
PERBEKALAN KESEHATAN
1
Alat Suntik sekali pakai 0,05 ml
Pcs
Pcs
Alat Suntik sekali pakai 1 ml
Box
65,000.00
Jayamas
100
Box
65,000.00
Jayamas
200
Pcs
Blood set
Set
Benang Bedah Catgut No. 2/0 - 3/0 dengan jarum bedah
Sach
Benang Bedah Silk No. 2/0 - 3/0 dengan jarum bedah
Sach
110,000.00
Jayamas
Benang Bedah Catgut Chromic 2/0 -100 m
Cassete
10
Benang Bedah Catgut Plain 3/0 -100 m
Cassete
11
Benang Bedah Silk Black 3/0 -100 m
Cassete
12
Dental Film Hanshin
13
Etanol 70 % - 1 L
21,500.00
Jayamas
Pcs
Botol
14
Gel USG / EKG
Botol
15
Infusion Set Anak
Pcs
16
Infusion Set Dewasa
Pcs
17
IV. Catheter No.18 G
Set
18
Set
19
Set
20
Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT
Sach
21
Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR
Sach
22
Kapas Pembalut / absorben 250 gram
23
Kassa Hidrofil Steril uk. 16 x 16
24
Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm
25
3,200.00
Jayamas
Bungkus
12,500.00
Jayamas
Kotak
5,800.00
Jayamas
Roll
105,000.00
Jayamas
Kassa pembalut hidrofil 4m x 10 cm
Roll
1,500.00
Jayamas
26
Kertas EKG
Roll
27
Kertas USG Sony 110 HG
Roll
28
Larutan Clorin 5,25% - 1 L (Desinfektan Alat)
Botol
29
Larutan Desinfectan - 1 L (Desinfektan Ruangan)
Botol
30
Larutan Antiseptik / Desinfektan hanrub mengandung chlorhexidine gluconate 0.5 %
31
Botol 500 ml
30,000.00
Lysol 1 L
Botol 1 L
41,000.00
Jayamas
32
Kassa steril mengandung obat (Framycetin) / Lomatulle
Lembar
33
Masker
16,500.00
Jayamas
34
Masker O2
Pcs
35
Masker nebulizer set dewasa
Pcs
36
Masker nebulizer set anak
Pcs
37
Plester 5 yard X 2 inch
Roll
Kotak
2
7
15
11
38
Plester non alergi 0,5 inch / Micropore
Roll
39
Pot Urin
Pcs
40
Sarung Tangan
41
Kotak
32,500.00
Jayamas
Wing needle
Pcs
3,200.00
Jayamas
42
Safety Box
Pcs
43
Surgical blade no.11 (Pisau Bedah)
Pcs
PEMERIKSAAN TB PARU
Emersi
Botol 100 ml
Eter Alkohol
Botol 100 ml
Kaca Slide / Object Glass
Pot dahak
Pcs
Reagen Zielnelsen
Set
Spiritus Bakar
Botol
Tissu Lensa
Kotak
Wadah Kaca Slide / Box Slide
Xylol
Kotak
Pcs
Botol 100 ml
EMBALAGE
Kantong Kresek obat + cetakan, ukuran 15 x 30
Lembar
Plastik Obat dg klip + cetakan, ukuran 7 x 10 cm
Pak /100lbr
Pak /100lbr
Kertas Perkamen ( ukuran 8 x 11 )
Pak /1000lbr
Sendok obat
Pcs
AKUPUNTUR
Jarum Akupuntur 13 mm
Kotak
Kotak
Kotak
Jarum telinga (press needle)
Kotak
Moxa Roll
Kotak
OBAT PONED
Apron plastik
Pcs
Asam Traneksamat Injeksi 500 mg/ 5 ml / Hemostatik
Ampul
Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg/ml / Vitka/ Vit. K Neonatal
Ampul
Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml
Ampul
Ikat Tali Pusat ( Umbilical Cord klem )
Metilergometrin maleat injeksi 0,200 mg - 1 ml
MgSO4 40 % injeksi
Misoprostol tablet 0,2 mg / Noprostol
Tablet
Natrium Bicarbonat injeksi
Ampul
10
Nasal dewasa / Maxyflow
Pcs
11
Nasal infant/ Oxyflow
Pcs
12
Oksitosin injeksi 10 IU/ml - 1 ml / Pitogin
13
Penghisap Lendir Bayi Baru Lahir
14
Sarung Tangan panjang obgyn No. 6,5
Pasang
15
Sarung Tangan panjang obgyn No. 7
Pasang
16
Pasang
17
Sarung tangan steril/Surgical gloves steril No. 6,5
Pasang
Pcs
Ampul
Vial
Ampul
Pcs
18
Sarung tangan steril/Surgical gloves steril No. 7
Pasang
19
Sarung tangan steril/Surgical gloves steril No.7,5
Pasang
20
Sungkup bayi
Set
21
Tanda Pengenal (ID Band) Bayi
Psc
22
Tanda Pengenal (ID Band) Ibu
Psc
23
Under Pad 60 x 90 cm
Psc
24
Valethamate Br 8 mg /ml injeksi / Epidosin
Ampul
TAMBAHAN
Antiseptik & kortikosteroid Tetes mata (Neomycin 3,5 mg, Polymixin B Sulfat 10.000 IU, Dexamethason 1,0
mg) - 5 ml / Cendo Xitrol
Botol
Ambroksol tablet 30mg
Tablet
Asam Mefenamat Sirup - 60 ml / Pondex
Botol
Asering infus
Botol
Asiklovir tablet 200 mg
Tablet
Bisacodyl 5 mg / Bicolax
Tablet
Buskopan injeksi
Ampul
Bur Fissure standart
Pcs
Bur Fissure panjang
Pcs
10
Deksametason injeksi 5 mg/ml-1ml
Ampul
11
Etanol 96 % - 1 L
Botol
12
Gentian Violet larutan 1 %
Botol
13
Glucose Larutan Infus 10% Steril
Botol
1,580.00
Indofarma
14
Jarum Suntik No. 27 G
Pcs
15
Klindamisin kapsul 150 mg
16
Kasa Pembalut Hidrofil 4 m x 6 cm
Roll
17
Kasa 2x80
Roll
18
Kapas 500 gram
19
Larutan H2O2
20
Metoklopramid injeksi / Primperan
21
Metoklopramid tablet 10 mg / Metolon
Tablet
22
Metronidazol tablet 250 mg
Tablet
23
Meylon injeksi
Botol
24
Obat Batuk Pilek kaplet ( Dextromethorphan HBr 10 mg, Gliseril guayakolat 50 mg, Phenylpropanolamine HCL
12,5 mg, Chlorpeniramine Maleat 1 mg ) / Dextral
Tablet
25
Obat Preparat Flebitis dan Varises ( Heparin 20.000 IU ) - 20 gr / Thrombophob
Tube
26
Obat tetes telinga kombinasi (( Polikmisin B sulfat 10.000 IU, NeomIsin sulfat 5 mg, Fludrokortison asetat 1
mg, Lidokain Hcl 40 mg ) / Otopain / Otopraf
Botol
27
Obat analgetik (Antalgin 250 mg, Amidopyrin 50 mg, Lidocain HCl 10 mg)/Etamidon injeksi
28
Polymigel tablet 400 mg/Strocain P
Tablet
29
Propanolol tablet 40 mg (HCl)
Tablet
30
Ranitidin injeksi 25 mg/ml
Ampul
31
Saccaharine tablet
Tablet
Kapsul
Bungkus
Botol
Vial
Vial
32
Salep Kulti Anti Jamur ( Klotrimazole 1 % ) / Erphamazole
Tube
33
Teofilin tablet / Bronsolvan
Tablet
34
Terbutalin tablet 2,5 mg / Astherin
Tablet
35
Tissue lensa
36
Xylene
37
38
39
40
Buku
Botol 500 ml
TOTAL HARGA OBAT HABIS PAKAI
Mengetahui/Menyetujui
Kepala UPTD Puskesmas Ciledug
drg. Iradani Yupitaningrum, M.Kes
NIP. 19650104 199403 2 002
PENERIMAAN OBAT
JUN
JUL
AGS
SEP
OKT
12
13
14
15
16
100
Total penerimaan Rata2 penerimaan

17
18
KET
19
20
22
200.00
100.00
12
780,000
12 bln
1,600.00
533.33
64
4,160,000
12 bln
TOTAL HARGA
Kebutuhan
2.00
24
2,640,000
5.00
1.67
20
430,000
12 bln
12 bln
3.00
115,200
12 bln
6.00
2.00
24
300,000
12 bln
9.00
4.50
54
313,200
12 bln
20.00
10.00
120
180,000
1.00
11
36
36.00
6
-
9.00
108
246,000
12 bln
6 bln
1,782,000
12 bln
5.00
60
1,950,000
12 bln
50.00
50
160,000
1 bln
13,056,400
Yang mengajukan,
Petugas Pengelola Obat
SUPRIHARTIWI, AMF
NIP. 197601172009022004
RENCANA ANGGARAN BELANJA BAHAN OBAT- OBATAN

TAHUN 2015
NAMA PUSKESMAS
ALAMAT
TELEPON

RADEN PATAH
e-KATALOG
NO.
NAMA OBAT
PENERIMAAN OBAT
KEMASAN
HARGA OBAT (Rp)
PABRIK
JAN
FEB
MAR
APR
MEI
10
11
500
1100
800
300
450
570
180
OBAT
1
Alopurinol tablet 100 mg / Merzaluric
Tablet
86.00
Pertiwi Agung
Amlodipin tablet 5 mg
Tablet
187.00
Pertiwi Agung
Tablet
330.00
Pertiwi Agung
Aminofillin tablet 200 mg
Tablet
80.00
Erela
Amoksilin kaplet 500 mg
Kaplet
261.00
Mersifarma
Amoksilin sirup kering 125 mg/ 5 ml - 60 ml
Botol
2,445.00
Novapharin
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg + Magnesium Hidroksida 200 mg
Tablet
72.00
Erela
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg /5 ml + Magnesium Hidroksida 200 mg /
5 ml - 60 ml
Botol
2,140.00
Lucas
Anti Bakteri DOEN salep kombinasi : Basitrasin 500 IU/g + Polimiksin 10.000 IU/g
Tube
10
Antibiotik Topikal Jelly ( Neomycin Sulfate 0,5% + Placenta Ekstrak 10 %) - 15 gr / Bioplacenton
Tube
11
Antidiare tablet (Kaolin 550 mg + Pectin 20 mg ) / Neo Diaform
Tablet
12
Antidiare suspensi (Kaolin 700 mg + Pectin 66 mg) - 60 ml / Kaolimec
Botol
13
Antifungi DOEN kombinasi As. Benzoat 6% + As. Salisilat 3% - 30 gr / Whitefield
Pot
30
1200
10000
5000
12600
16900
14500
6200
50
100
14
Anti Hemmoroid DOEN kombinasi : Bismut subgalat 150 mg + Heksaklorofen 2,5 mg
Supp
15
Anti Hemmoroid Kapsul : Ekstrak Graptophylli Folium 80% + Citrus Bioflavonoid 20% / Haemorogard
16
Antiinfeksi Topikal dengan Kortikosteroid krim (Kloramfenikol base 20 mg + Prednisolon 2,5 mg) - 10 gr /
Klorfeson
Tube
17
Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg
Tablet
18
Aqua pro injeksi steril, bebas pirogen 20 ml
Vial
19
Asam Asetilsalisilat tablet 80 mg / Aspimec
Tablet
20
Asam Askorbat (Vitamin C) tablet 50 mg
21
Kapsul
135.00
KF
Tablet
95.00
KF
5000
Asam Mefenamat kaplet 500 mg
Kaplet
112.00
Bernofarm
6300
22
Tube
336.00
Sampharindo
23
Atapulgit tablet 600mg
Tablet
190.00
Zenith
24
Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (sulfat) - 1 ml
Ampul
1,300.00
Ethica
25
Besi II Sulfat 200 mg + Asam Folat 0,25 mg (tablet tambah darah kombinasi)
Tablet
42.00
Erela
26
Betahistin Mesilat tablet 6 mg / Noverty
Tablet
27
Betametason Krim 0.1 % (sebagai valerat) - 5 gr
Tube
1,520.00
28
Bisoprolol tablet 5 mg
Tablet
645.00
Pratapala
29
Borax Glyserin ( GOM ) 10 % - 8 ml
Botol
30
Bromheksin tablet 8 mg / Bromifar
Tablet
31
Bromheksin larutan 2mg/ml (untuk Nebulizer) - 50 ml / Bisolvon
Botol
32
Deksametason tablet 0,5 mg / Molacort
Tablet
62.00
Promed
33
Dektrometorfan sirup 10mg/5 ml (HBr) - 60 ml
Botol
34
Dekstrometorfan tablet 15 mg (HBr)
Tablet
35
Difenhidramin injeksi 10 mg/ml / Etadryl
Ampul
KF
10000
3500
1600
400
800
2000
1500
50
20
50
3600
4400
4800
50
3700
5200
36
Digoksin tablet 0,25 mg
Tablet
37
Domperidon tablet 10 mg
Tablet
38
Doksisiklin kapsul 100 mg / Doxihat
Kapsul
39
Efedrin tablet 25 mg (HCl)
Tablet
40
Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) - 1 ml
Ampul
8,100.00
41
Eritromisin kapsul 500 mg
Kapsul
930.00
42
Eritromisin sirup 200 mg 5 /ml - 60 ml
Botol
7,700.00
Phyto kemo
43
Etakridin (Rivanol) Larutan 0,1 % - 300 ml
Botol
2,550.00
Jayamas
44
Fenol Gliserol tetes telinga 10 % - 5 ml
Botol
45
Fenitoin Kapsul 100 mg
Kapsul
133.00
Ikapharmindo
46
Fitomenadion(Vit. K1) tablet salut gula 10 mg
Tablet
634.00
Marin
47
Furosemid tablet 40 mg
Tablet
75.00
Sampharindo
48
Garam Oralit I serbuk, kombinasi : Natrium 0,52 g, Kalium klorida 0,30 g , Trinatrium sitrat dihidrat 0,58 g,
Glukosa anhidrat 2,7 g
Sach
288.00
Phapros
49
Gemfibrozil 300 mg kapsul
50
Gentamycin salep kulit 0,1% - 5 gr / Gentalex
Tube
51
Glibenklamid tablet 5 mg
Tablet
56.00
Indofarma
52
Glimepiride 2 mg
Tablet
436.00
KF
53
Gliseril Guaiakolat tablet 100 mg
Tablet
54
Glucose Larutan Infus 5% steril - 500 ml
Botol
55
Griseofulvin tablet 125 mg / Gricin
Tablet
219.00
Indofarma
56
Botol
5,200.00
57
Hidroklortiazid (HCT) tablet 25 mg
Tablet
58
Hidrokortison krim 2,5 % - 5 gr / Lexacorton
Tube
167.00
Novapharin
300
500
Phapros
Indofarma
Kapsul
Widatra
96
600
1400
900
400
500
59
Hyoscine - N - Butilbromide tablet 10 mg / Scopma
Tablet
60
Ibuprofen tablet 400 mg
Tablet
61
Ichtyol salep kulit - 15 gr
Pot
62
Isosorbid dinitrat (ISDN) tablet sublingual 5 mg
63
Kalium permanganat (PK) serbuk - 5 gr
64
Kalsium laktat (Kalk) tablet 500 mg
Tablet
70.00
65
Kaptopril tablet 25 mg
Tablet
84.00
66
Ketokonazol tablet 200 mg
Tablet
67
Kapsul
68
Kloramfenikol kapsul 250 mg
Kapsul
69
Kloramfenikol salep mata 1% - 5 gr
Tube
70
Kloramfenikol suspensi 125 mg/5ml - 60 ml
Botol
71
Kloramfenikol tetes mata 0,5 % - 5 ml / Erlamycetin
Botol
72
Kloramfenikol tetes telinga 3 % - 5 ml
Botol
73
Klorfeniramin maleat (CTM) tablet 4 mg
Tablet
74
Kotimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprim 80 mg
Tablet
75
Kotimoksazol DOEN II (pedriatik) kombinasi : Sulfametoksazol 100 mg + Trimetoprim 20 mg
Tablet
76
Kotimoksazol Suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprim 40 mg/ 5 ml - 60 ml
Botol
77
Levertraan salep - 15 gr
78
Lidokain injeksi 2% - 2 ml
Ampul
79
Lidokain comp injeksi (Lidocain 2% (HCl) + Epinefrin 1 : 80.000) - 2 ml
Ampul
80
Linkomisin kapsul 500 mg
Kapsul
81
Loperamid tablet 2 mg
Tablet
Tablet
149.00
Holi
88.00
Indofarma
700
Pot
Errita
3000
1000
2600
1100
1,600.00
138.00
Promed
2,145.00
Holi
1,363.00
Indofarma
Pot
89.00
Ifars
700
250
400
82
Loratadin tablet 10 mg
Tablet
83
Mebendazol tablet 100 mg
Tablet
84
Metampiron (Antalgin) tablet 500 mg
Tablet
85
Metformin HCl tablet 500 mg
Tablet
112.50
86
Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg
Tablet
154.00
KF
87
Tablet
160.00
pyto Kemo
88
Mikonazol krim/ salep 2 % (Nitrat) - 10 gr / Moladerm
Tube
3,000.00
89
Multivit Sirup - 60 ml / Lybex
Botol
90
Multivit Tablet / Pehavral
Tablet
91
Natrium Bikarbonat tablet 500 mg
Tablet
92
Natrium Diklofenak tablet 50 mg / Kemoren
Tablet
176.00
Phapros
93
Natrium Klorida larutan infus 0,9% - 500 ml
Botol
4,700.00
Widatra
94
Natrium Klorida larutan 0,9% - 25 ml (untuk Nebulizer)
Botol
95
Nifedipin tablet 10 mg
Tablet
110.00
Dexa
96
Nistatin tablet salut 500.000 IU/g
Tablet
640.00
Phapros
97
Nistatin vaginal tablet 100.000 IU/g
Tablet
480.00
Phapros
98
Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol
Botol
99
Obat Pencernaan tablet (Diastase 200 mg, Pankreatin 100 mg)
100
Oksitetrasiklin HCl salep kulit 3 % - 5 gr
Tube
101
Oksitetrasiklin HCl salep mata 1 % - 5 gr
Tube
102
Omeprazol kapsul 20 mg
Kapsul
211.00
Novapharin
103
Papaverin tablet 40 mg
Tablet
104
Parasetamol drops
/ Librozym
154.00
Promed
300
300
3900
1800
400
1300
800
1050
1400
950
900
168
336
KF
Tablet
Btl / 15 ml
5,200.00
Indofarma
105
Parasetamol sirup 120 mg / 5ml - 60 ml
Botol
1,438.00
Afifarma
336
588
756
106
Parasetamol tablet 100 mg
Tablet
107
Tablet
79.00
Promed
11100
23700
21500
108
Piridoksin (Vitamin B6) tablet 10 mg (HCl)
Tablet
109
Piroksikam tablet 10 mg
Tablet
110
Polikresulen (kondensasi) - 10 ml / Albothyl
Botol
17,393.00
Pratapa Nirmala
111
Povidon Iodida larutan 10 % - 300 ml
Botol
14,203.00
Afifarma
112
Prednison tablet 5 mg
Tablet
113
Tablet
114
Propiltiourasil tablet 100 mg
Tablet
115
Ranitidin tablet 150 mg
Tablet
120.00
116
Ringer Laktat larutan infus - 500 ml
Botol
5,200.00
Widatra
117
Salbutamol tablet 2 mg (sebagai sulfat)
Tablet
59.00
yarindo
118
Salbutamol 2.5 mg/ ml (untuk Nebulizer) / Ventolin
Botol
119
Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang endap 4 % - 30 gr
120
2,000.00
Marin
Salisil Bedak 2 % - 50 gr
Kotak
1,250.00
Rama
121
Sefadroksil Kapsul 500 mg
Kapsul
509.00
Holi
122
Sianokobalamin (vitamin B12) tablet 50 mcg
Tablet
123
Simvastatin tablet 10 mg
Tablet
169.00
Natura Labora
124
Siprofloksasin tablet 500 mg (sebagai HCl)
Tablet
255.00
Bernofarm
125
Sulfasetamida Natrium tetes mata 15 % - 5 ml
Botol
126
Tetrasiklin kapsul 500 mg
Kapsul
148.00
Holi
127
Thiamfenikol kapsul 500 mg
Kapsul
128
Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat)
Tablet
10400
24500
Dexa
Pot
168
1600
2200
200
200
500
60
330
420
1100
2700
570
660
129
Vitamin B Kompleks tablet
Tablet
107.00
KF
130
Zinc tablet 20 mg
Tablet
474.00
Indofarma
OBAT PROGRAM TB PARU

127
Obat FDC Kategori 1
Paket
359,990.00
Indofarma
128
Obat FDC Kategori 2
Paket
1,199,900.00
Indofarma
129
Obat FDC Anak
Paket
214,990.00
Indofarma
130
Obat FDC Sisipan
Paket
859.00
Benofarm
338.00
Holi Farma
KF
OBAT PROGRAM IMS

131
Kanamisin injeksi 1 gr
Vial
132
Levofloksasin tablet 500 mg
Tablet
133
Sefiksim kapsul 100 mg
Kapsul
OBAT PROGRAM FILARIASIS

134
Dietilkarbamazin Sitrat tablet 100 mg
Tablet
OBAT PROGRAM KECACINGAN

135
Albendazole tablet 400 mg
Tablet
136
Pirantel tablet score (base) 125 mg
Tablet
OBAT PROGRAM GIZI

137
Retinol (Vitamin A) 100.000 IU kapsul lunak
Kapsul
260.00
138
Kapsul
459.00
Alprazolam tablet 1 mg
Tablet
233.00
KF
Amitriptilin tablet salut 25 mg (HCl)
Tablet
112.00
Indofarma
Clobazam tablet 10 mg
Tablet
900.00
Dexa
Diazepam tablet 2 mg
Tablet
6000
600
9000
2100
Tablet
Diazepan injeksi 5 mg /ml - 2 ml
Ampul
Diazepam tube Rectal 5 mg/2.5 ml / Stesolid
Fenobarbital tablet 30 mg
Fluoxetin tablet 10 mg /
10
Tube rectal
11,525.00
Tablet
Antiprestin
Tablet
419.00
Gracia
Haloperidol tablet 1,5 mg
Tablet
69.00
Indofarma
11
Haloperidol tablet 5 mg
Tablet
96.00
Indofarma
12
Imipramin tablet 25 mg / Tofranil
Tablet
13
Karbamazepin tablet 200 mg
Tablet
245.00
Indofarma
14
Klorpromazin tablet salut 100 mg (HCl)
Tablet
149.00
KF
15
Kodein tablet 10 mg
Tablet
16
Risperidon tablet 2 mg
Tablet
17
Sertralin tablet / Nudep
Tablet
18
Triheksifenidil tablet 2 mg
Tablet
OBAT GIGI
1
Artikulating Paper
Buku
Bur High Speed
Kotak
Bur Low Speed
Kotak
Cavit / Dentorit
Pot
Celluloid strip
Set
Cresopen - 13 ml
Botol
Dentin Conditioner
Botol
Devitalisasi Pasta (Non Arsen)
Disclosing Agent
Btl / ktk
Tube
1,008.00
Mersifarma
10
Disposible saliva ejektor
11
Etil Chlorida spray - 100 ml
Botol
12
Eugenol cairan
Botol
13
Glass Ionomer Radiopak / Fuji VII
Set
14
Glass Ionomer Cement ART / Fuji IX / Ketac Molar
Set
15
Kalsium Hidroksida pasta / Calcidor / Dycal
Set
16
Macro gold + propylen + EDTA
Set
17
Oil Spray
Botol
18
Obat Anestesi Lokal Injeksi ( Lidokain HCl 20 ml + Adrenalin 12.5 mcg ) / Pehacain
Ampul
19
Pulperyl
Botol
20
Spon Gelatin Cubicels / Spongostan/ Haemospon
Pcs
21
Temporary Stopping Fletcher (Fletcher) serbuk dan cairan
Set
22
Tetric N Ceram
Paket
23
Tetric N Ceram Refill (A2, A3, A3,5) - 3,5 gr
Tube
24
Tetric Bonding - 6 gr
Botol
25
Tetric Etch Refill - 2 gr
Tube
26
Trikresol Formalin (TKF)
Botol
27
Xylestesin Adrenalin injeksi / Scandonest
Ampul
28
Xylestesin Non Adrenalin injeksi
Ampul
29
CHKM
Botol
30
Iodoform/Mumifying pasta
Botol
JUMLAH HARGA OBAT
Bungkus @ 100 pcs
16,667.00
KF
NIP. 19650104 199403 2 002
PENERIMAAN OBAT
JUN
JUL
AGS
SEP
OKT
12
13
14
15
16
2400
200
1080
660

17
18
TOTAL HARGA
KET
20
22
Kebutuhan
19
5,300.00
883.33
5,300
455,800
6 bln
2,970.00
495.00
2,969
555,203
6 bln
990.00
5,940
1,960,200
6 bln
1600
2,800.00
1,400.00
8,400
672,000
6 bln
37000
91,000.00
18,200.00
109,248
28,513,728
6 bln
24,200.00
6,050.00
36,300
2,613,600
6 bln
600.00
200.00
1,200
2,568,000
6 bln
9000
450
4000
22000
7300
37,000.00
12,333.33
74,000
7,030,000
6 bln
6300
1800
27,200.00
3,885.71
23,314
2,611,200
6 bln
700
500
2,000.00
666.67
4,000
1,344,000
6 bln
200
4,200.00
1,050.00
6,300
1,197,000
6 bln
500
3000
3,000.00
3,000.00
150
9000
48
1000
24
2600
96
3700
488.00
18,000
-
61.00
366
756,000
556,320
38,000.00
4,222.22
25,333
6 bln
1,570,667
6 bln
6 bln
1500
2,300.00
766.67
192.00
96.00
400
3000
3200
500
400
768,200
96
4,600
288
734,400
2,300.00
575.00
3,450
2,187,300
100.00
99
7,425
5,800.00
1,160.00
6,960
2,004,480
3,200.00
3 bln
6 bln
1 bln
6 bln
3,200.00
19,200
1,075,200
6 bln
3,200.00
19,200
8,371,200
6 bln
6 bln
100.00
300
65,700
3 bln
700.00
700.00
4,200
625,800
6 bln
9000
3000
16,000.00
5,333.33
32,000
2,240,000
6 bln
8000
1700
13,400.00
3,350.00
20,100
1,688,400
6 bln
50.00
300
480,000
700.00
700.00
650.00
4,200
325.00
1,950
579,600
4,182,750
90.00
540
6 bln
6 bln
736,020
6 bln
6 bln
300.00
3500
3000
1350
300.00
4 bln
8,000.00
48,000
5,400,000
6 bln
300.00
300.00
1,200
184,800
4 bln
10,900.00
2,180.00
13,080
2,092,800
6 bln
50.00
300
900,000
6 bln
9,450.00
1,575.00
9,450
1,663,200
6 bln
3.00
18
84,600
6 bln
100.00
600
288,000
1,500.00
336
184,800
1260
1,200
2,100.00
9,000
-
525.00
3,152
1,899,000
6 bln
6 bln
16,390,400
6 bln
252
88
420
2,608.00
372.57
52000
10000
12000
2500
165,200.00
20,650.00
2.00
1.00
85,218
2,100.00
12,600
-
100.00
200
9,788,100
-
600
-
6 bln
6,300.00
100
123,900
3,214,546
400
2,235
1,512,000
6 bln
6 bln
6 bln
35,400
6 bln
30.00
180
360,000
6 bln
1,600.00
266.67
1,600
2,000,000
6 bln
1920
3,960.00
660.00
3,960
669,240
6 bln
3800
7,600.00
2,533.33
15,200
3,876,000
6 bln
18000
3500
15000
200
48,000.00
12,000.00
72,000
7,704,000
6 bln
6,400.00
1,600.00
9,600
4,550,400
6 bln
6.00
1.50
150,003
141,182,700
6 bln
Yang mengajukan,
SUPRIHARTIWI, AMF
NIP. 197601172009022004
RENCANA ANGGARAN BELANJA BAHAN MEDIS PAKAI HABIS

TAHUN 2016
NAMA PUSKESMAS
ALAMAT
TELEPON

RADEN PATAH
e-KATALOG
NO.
NAMA OBAT
PENERIMAAN OBAT
KEMASAN
HARGA OBAT (Rp)
PABRIK
JAN
FEB
MAR
APR
MEI
10
11
500
900
OBAT
PERBEKALAN KESEHATAN
1
Pcs
Pcs
Box
65,000.00
Jayamas
100
Box
65,000.00
Jayamas
200
Pcs
Blood set
Set
Benang Bedah Catgut No. 2/0 - 3/0 dengan jarum bedah
Sach
Sach
110,000.00
Jayamas
Benang Bedah Catgut Chromic 2/0 -100 m
Cassete
10
Benang Bedah Catgut Plain 3/0 -100 m
Cassete
11
Benang Bedah Silk Black 3/0 -100 m
Cassete
12
Dental Film Hanshin
13
Etanol 70 % - 1 L
Botol
21,500.00
Jayamas
14
Gel USG / EKG
Botol
15
Infusion Set Anak
Pcs
Pcs
16
Infusion Set Dewasa
Pcs
3,200.00
Jayamas
17
Set
18
Set
19
Set
20
Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT
Sach
21
Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR
Sach
22
Bungkus
12,500.00
Jayamas
23
Kotak
5,800.00
Jayamas
24
Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm
Roll
105,000.00
Jayamas
25
Roll
1,500.00
Jayamas
26
Kertas EKG
Roll
27
Kertas USG Sony 110 HG
Roll
28
Larutan Clorin 5,25% - 1 L (Desinfektan Alat)
Botol
29
Larutan Desinfectan - 1 L (Desinfektan Ruangan)
Botol
30
Larutan Antiseptik / Desinfektan hanrub mengandung chlorhexidine gluconate 0.5 %
31
Botol 500 ml
30,000.00
Lysol 1 L
Botol 1 L
41,000.00
Jayamas
32
Kassa steril mengandung obat (Framycetin) / Lomatulle
Lembar
33
Masker
16,500.00
Jayamas
34
Masker O2
Pcs
35
Masker nebulizer set dewasa
Pcs
36
Masker nebulizer set anak
Pcs
37
Plester 5 yard X 2 inch
Roll
38
Plester non alergi 0,5 inch / Micropore
Roll
39
Pot Urin
Pcs
40
Sarung Tangan
32,500.00
Jayamas
Kotak
Kotak
2
7
15
11
41
Wing needle
Pcs
42
Safety Box
Pcs
43
Surgical blade no.11 (Pisau Bedah)
Pcs
PEMERIKSAAN TB PARU
Emersi
Botol 100 ml
Eter Alkohol
Botol 100 ml
Kaca Slide / Object Glass
Pot dahak
Pcs
Reagen Zielnelsen
Set
Spiritus Bakar
Botol
Tissu Lensa
Kotak
Wadah Kaca Slide / Box Slide
Xylol
Kotak
Pcs
Botol 100 ml
EMBALAGE
Kantong Kresek obat + cetakan, ukuran 15 x 30
Lembar
Pak /100lbr
Pak /100lbr
Kertas Perkamen ( ukuran 8 x 11 )
Pak /1000lbr
Sendok obat
Pcs
AKUPUNTUR
Kotak
Kotak
Kotak
Jarum telinga (press needle)
Kotak
Moxa Roll
Kotak
OBAT PONED
1,400.00
Jayamas
Apron plastik
Pcs
Asam Traneksamat Injeksi 500 mg/ 5 ml / Hemostatik
Ampul
Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg/ml / Vitka/ Vit. K Neonatal
Ampul
Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml
Ampul
Ikat Tali Pusat ( Umbilical Cord klem )
Metilergometrin maleat injeksi 0,200 mg - 1 ml
MgSO4 40 % injeksi
Misoprostol tablet 0,2 mg / Noprostol
Tablet
Natrium Bicarbonat injeksi
Ampul
10
Nasal dewasa / Maxyflow
Pcs
11
Nasal infant/ Oxyflow
Pcs
12
Oksitosin injeksi 10 IU/ml - 1 ml / Pitogin
13
Penghisap Lendir Bayi Baru Lahir
14
Pasang
15
Sarung Tangan panjang obgyn No. 7
Pasang
16
Pasang
17
Sarung tangan steril/Surgical gloves steril No. 6,5
Pasang
18
Sarung tangan steril/Surgical gloves steril No. 7
Pasang
19
Sarung tangan steril/Surgical gloves steril No.7,5
Pasang
20
Sungkup bayi
Set
21
Tanda Pengenal (ID Band) Bayi
Psc
22
Tanda Pengenal (ID Band) Ibu
Psc
23
Under Pad 60 x 90 cm
Psc
Pcs
Ampul
Vial
Ampul
Pcs
24
Valethamate Br 8 mg /ml injeksi / Epidosin
Ampul
TAMBAHAN
Antiseptik & kortikosteroid Tetes mata (Neomycin 3,5 mg, Polymixin B Sulfat 10.000 IU, Dexamethason 1,0
mg) - 5 ml / Cendo Xitrol
Botol
Ambroksol tablet 30mg
Tablet
Asam Mefenamat Sirup - 60 ml / Pondex
Botol
Asering infus
Botol
Tablet
Bisacodyl 5 mg / Bicolax
Tablet
Buskopan injeksi
Ampul
Bur Fissure standart
Pcs
Bur Fissure panjang
Pcs
10
Deksametason injeksi 5 mg/ml-1ml
Ampul
11
Etanol 96 % - 1 L
Botol
12
Gentian Violet larutan 1 %
Botol
13
Glucose Larutan Infus 10% Steril
Botol
14
Jarum Suntik No. 27 G
15
16
Kasa Pembalut Hidrofil 4 m x 6 cm
Roll
17
Kasa 2x80
Roll
18
Kapas 500 gram
19
Larutan H2O2
20
Metoklopramid injeksi / Primperan
Pcs
Kapsul
Bungkus
Botol
Vial
1,580.00
Indofarma
21
Metoklopramid tablet 10 mg / Metolon
Tablet
22
Tablet
23
Meylon injeksi
Botol
24
Obat Batuk Pilek kaplet ( Dextromethorphan HBr 10 mg, Gliseril guayakolat 50 mg, Phenylpropanolamine HCL
12,5 mg, Chlorpeniramine Maleat 1 mg ) / Dextral
Tablet
25
Obat Preparat Flebitis dan Varises ( Heparin 20.000 IU ) - 20 gr / Thrombophob
Tube
26
Obat tetes telinga kombinasi (( Polikmisin B sulfat 10.000 IU, NeomIsin sulfat 5 mg, Fludrokortison asetat 1
mg, Lidokain Hcl 40 mg ) / Otopain / Otopraf
Botol
27
Obat analgetik (Antalgin 250 mg, Amidopyrin 50 mg, Lidocain HCl 10 mg)/Etamidon injeksi
28
Polymigel tablet 400 mg/Strocain P
Tablet
29
Tablet
30
Ranitidin injeksi 25 mg/ml
Ampul
31
Saccaharine tablet
Tablet
32
Salep Kulti Anti Jamur ( Klotrimazole 1 % ) / Erphamazole
Tube
33
Teofilin tablet / Bronsolvan
Tablet
34
Terbutalin tablet 2,5 mg / Astherin
Tablet
35
Tissue lensa
36
Xylene
37
38
39
40
JUMLAH HARGA OBAT HABIS PAKAI
Vial
Buku
Botol 500 ml
NIP. 19650104 199403 2 002
PENERIMAAN OBAT
JUN
JUL
AGS
SEP
OKT
12
13
14
15
16
100

17
18
KET
19
20
22
200.00
100.00
12
780,000
12 bln
1,600.00
533.33
64
4,160,000
12 bln
TOTAL HARGA
Kebutuhan
2.00
24
2,640,000
5.00
1.67
20
430,000
12 bln
12 bln
3.00
115,200
12 bln
6.00
2.00
24
300,000
12 bln
9.00
4.50
54
313,200
12 bln
20.00
10.00
120
180,000
1.00
11
36
36.00
6
-
9.00
108
246,000
1,782,000
5.00
60
6 bln
12 bln
1,950,000
12 bln
12 bln
50.00
50
70,000
1 bln
12,966,400
Yang mengajukan,
SUPRIHARTIWI, AMF
NIP. 197601172009022004
RENCANA ANGGARAN BELANJA BAHAN OBAT- OBATAN

TAHUN 2016
NAMA PUSKESMAS
ALAMAT
TELEPON

RADEN PATAH
e-KATALOG
NO.
NAMA OBAT
PENERIMAAN OBAT
KEMASAN
HARGA OBAT (Rp)
PABRIK
JAN
FEB
MAR
APR
MEI
10
11
500
1100
800
300
450
570
180
OBAT
1
Tablet
86.00
Pertiwi Agung
Tablet
187.00
Pertiwi Agung
Tablet
330.00
Pertiwi Agung
Tablet
80.00
Erela
Kaplet
261.00
Mersifarma
Botol
2,445.00
Novapharin
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg + Magnesium Hidroksida 200 mg
Tablet
72.00
Erela
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg /5 ml + Magnesium Hidroksida 200 mg /
5 ml - 60 ml
Botol
2,140.00
Lucas
Anti Bakteri DOEN salep kombinasi : Basitrasin 500 IU/g + Polimiksin 10.000 IU/g
Tube
10
Antibiotik Topikal Jelly ( Neomycin Sulfate 0,5% + Placenta Ekstrak 10 %) - 15 gr / Bioplacenton
Tube
11
Antidiare tablet (Kaolin 550 mg + Pectin 20 mg ) / Neo Diaform
Tablet
12
Antidiare suspensi (Kaolin 700 mg + Pectin 66 mg) - 60 ml / Kaolimec
Botol
13
Antifungi DOEN kombinasi As. Benzoat 6% + As. Salisilat 3% - 30 gr / Whitefield
Pot
30
1200
10000
5000
12600
16900
14500
6200
50
100
14
Anti Hemmoroid DOEN kombinasi : Bismut subgalat 150 mg + Heksaklorofen 2,5 mg
Supp
15
Anti Hemmoroid Kapsul : Ekstrak Graptophylli Folium 80% + Citrus Bioflavonoid 20% / Haemorogard
16
Antiinfeksi Topikal dengan Kortikosteroid krim (Kloramfenikol base 20 mg + Prednisolon 2,5 mg) - 10 gr /
Klorfeson
Tube
17
Antimigren : Ergotamin Tartrat 1 mg + Kofein 50 mg
Tablet
18
Aqua pro injeksi steril, bebas pirogen 20 ml
Vial
19
Asam Asetilsalisilat tablet 80 mg / Aspimec
Tablet
20
21
Kapsul
135.00
KF
Tablet
95.00
KF
5000
Kaplet
112.00
Bernofarm
6300
22
Tube
336.00
Sampharindo
23
Tablet
190.00
Zenith
24
Ampul
1,300.00
Ethica
25
Tablet
42.00
Erela
26
Betahistin Mesilat tablet 6 mg / Noverty
Tablet
27
Tube
1,520.00
28
Bisoprolol tablet 5 mg
Tablet
645.00
Pratapala
29
Borax Glyserin ( GOM ) 10 % - 8 ml
Botol
30
Bromheksin tablet 8 mg / Bromifar
Tablet
31
Bromheksin larutan 2mg/ml (untuk Nebulizer) - 50 ml / Bisolvon
Botol
32
Tablet
62.00
Promed
33
Dektrometorfan sirup 10mg/5 ml (HBr) - 60 ml
Botol
34
Dekstrometorfan tablet 15 mg (HBr)
Tablet
35
Difenhidramin injeksi 10 mg/ml / Etadryl
Ampul
KF
10000
3500
1600
400
800
2000
1500
50
20
50
3600
4400
4800
50
3700
5200
36
Digoksin tablet 0,25 mg
Tablet
37
Tablet
38
Doksisiklin kapsul 100 mg / Doxihat
Kapsul
39
Efedrin tablet 25 mg (HCl)
Tablet
40
Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) - 1 ml
Ampul
8,100.00
41
Eritromisin kapsul 500 mg
Kapsul
930.00
42
Eritromisin sirup 200 mg 5 /ml - 60 ml
Botol
7,700.00
Phyto kemo
43
Botol
2,550.00
Jayamas
44
Fenol Gliserol tetes telinga 10 % - 5 ml
Botol
45
Fenitoin Kapsul 100 mg
Kapsul
133.00
Ikapharmindo
46
Tablet
634.00
Marin
47
Furosemid tablet 40 mg
Tablet
75.00
Sampharindo
48
Glukosa anhidrat 2,7 g
Sach
288.00
Phapros
49
Gemfibrozil 300 mg kapsul
50
Gentamycin salep kulit 0,1% - 5 gr / Gentalex
Tube
51
Tablet
56.00
Indofarma
52
Glimepiride 2 mg
Tablet
436.00
KF
53
Gliseril Guaiakolat tablet 100 mg
Tablet
54
Botol
55
Tablet
219.00
Indofarma
56
Botol
5,200.00
57
Hidroklortiazid (HCT) tablet 25 mg
Tablet
58
Hidrokortison krim 2,5 % - 5 gr / Lexacorton
Tube
167.00
Novapharin
300
500
Phapros
Indofarma
Kapsul
Widatra
96
600
1400
900
400
500
59
Hyoscine - N - Butilbromide tablet 10 mg / Scopma
Tablet
60
Tablet
61
Ichtyol salep kulit - 15 gr
Pot
62
Isosorbid dinitrat (ISDN) tablet sublingual 5 mg
63
Kalium permanganat (PK) serbuk - 5 gr
64
Tablet
70.00
65
Tablet
84.00
66
Ketokonazol tablet 200 mg
Tablet
67
Kapsul
68
Kloramfenikol kapsul 250 mg
Kapsul
69
Kloramfenikol salep mata 1% - 5 gr
Tube
70
Kloramfenikol suspensi 125 mg/5ml - 60 ml
Botol
71
Kloramfenikol tetes mata 0,5 % - 5 ml / Erlamycetin
Botol
72
Kloramfenikol tetes telinga 3 % - 5 ml
Botol
73
Tablet
51.00
Rama
22100
74
Tablet
138.00
Promed
700
75
Kotimoksazol DOEN II (pedriatik) kombinasi : Sulfametoksazol 100 mg + Trimetoprim 20 mg
Tablet
76
Botol
77
Levertraan salep - 15 gr
78
Lidokain injeksi 2% - 2 ml
Ampul
79
Ampul
80
Linkomisin kapsul 500 mg
Kapsul
81
Loperamid tablet 2 mg
Tablet
Tablet
149.00
Holi
88.00
Indofarma
700
Pot
Errita
3000
1000
2600
1100
11600
14900
1,600.00
2,145.00
Holi
1,363.00
Indofarma
Pot
89.00
Ifars
250
400
82
Tablet
83
Mebendazol tablet 100 mg
Tablet
84
Metampiron (Antalgin) tablet 500 mg
Tablet
85
Metformin HCl tablet 500 mg
Tablet
112.50
86
Tablet
154.00
KF
87
Tablet
160.00
pyto Kemo
88
Mikonazol krim/ salep 2 % (Nitrat) - 10 gr / Moladerm
Tube
3,000.00
89
Multivit Sirup - 60 ml / Lybex
Botol
90
Multivit Tablet / Pehavral
Tablet
91
Natrium Bikarbonat tablet 500 mg
Tablet
92
Tablet
176.00
Phapros
93
Natrium Klorida larutan infus 0,9% - 500 ml
Botol
4,700.00
Widatra
94
Natrium Klorida larutan 0,9% - 25 ml (untuk Nebulizer)
Botol
95
Nifedipin tablet 10 mg
Tablet
110.00
Dexa
96
Nistatin tablet salut 500.000 IU/g
Tablet
640.00
Phapros
97
Tablet
480.00
Phapros
98
Obat batuk Hitam (OBH) Cairan -100 ml non Alkohol
Botol
99
Obat Pencernaan tablet (Diastase 200 mg, Pankreatin 100 mg)
100
Oksitetrasiklin HCl salep kulit 3 % - 5 gr
Tube
101
Oksitetrasiklin HCl salep mata 1 % - 5 gr
Tube
102
Kapsul
211.00
Novapharin
103
Papaverin tablet 40 mg
Tablet
104
Parasetamol drops
/ Librozym
154.00
Promed
300
300
3900
1800
400
1300
800
1050
1400
950
900
168
336
KF
Tablet
Btl / 15 ml
5,200.00
Indofarma
105
Botol
1,438.00
Afifarma
336
588
756
106
Tablet
107
Tablet
79.00
Promed
11100
23700
21500
108
Piridoksin (Vitamin B6) tablet 10 mg (HCl)
Tablet
109
Piroksikam tablet 10 mg
Tablet
110
Polikresulen (kondensasi) - 10 ml / Albothyl
Botol
17,393.00
Pratapa Nirmala
111
Botol
14,203.00
Afifarma
112
Prednison tablet 5 mg
Tablet
113
Tablet
114
Propiltiourasil tablet 100 mg
Tablet
115
Tablet
120.00
116
Ringer Laktat larutan infus - 500 ml
Botol
5,200.00
Widatra
117
Tablet
59.00
yarindo
118
Salbutamol 2.5 mg/ ml (untuk Nebulizer) / Ventolin
Botol
119
Salep 2-4 kombinasi : Asam Salisilat 2 % + Belerang endap 4 % - 30 gr
120
2,000.00
Marin
Kotak
1,250.00
Rama
121
Sefadroksil Kapsul 500 mg
Kapsul
509.00
Holi
122
Sianokobalamin (vitamin B12) tablet 50 mcg
Tablet
123
Tablet
169.00
Natura Labora
124
Tablet
255.00
Bernofarm
125
Sulfasetamida Natrium tetes mata 15 % - 5 ml
Botol
126
Tetrasiklin kapsul 500 mg
Kapsul
148.00
Holi
127
Thiamfenikol kapsul 500 mg
Kapsul
128
Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat)
Tablet
10400
24500
Dexa
Pot
168
1600
2200
200
200
500
60
330
420
1100
2700
570
660
129
Tablet
107.00
KF
130
Zinc tablet 20 mg
Tablet
474.00
Indofarma
OBAT PROGRAM TB PARU

127
Obat FDC Kategori 1
Paket
359,990.00
Indofarma
128
Obat FDC Kategori 2
Paket
1,199,900.00
Indofarma
129
Obat FDC Anak
Paket
214,990.00
Indofarma
130
Obat FDC Sisipan
Paket
859.00
Benofarm
338.00
Holi Farma
KF
OBAT PROGRAM IMS

131
Kanamisin injeksi 1 gr
Vial
132
Levofloksasin tablet 500 mg
Tablet
133
Sefiksim kapsul 100 mg
Kapsul
OBAT PROGRAM FILARIASIS

134
Dietilkarbamazin Sitrat tablet 100 mg
Tablet
OBAT PROGRAM KECACINGAN

135
Albendazole tablet 400 mg
Tablet
136
Pirantel tablet score (base) 125 mg
Tablet
OBAT PROGRAM GIZI

137
Kapsul
260.00
138
Kapsul
459.00
Alprazolam tablet 1 mg
Tablet
233.00
KF
Amitriptilin tablet salut 25 mg (HCl)
Tablet
112.00
Indofarma
Clobazam tablet 10 mg
Tablet
900.00
Dexa
Tablet
6000
600
9000
2100
Tablet
Diazepan injeksi 5 mg /ml - 2 ml
Ampul
Diazepam tube Rectal 5 mg/2.5 ml / Stesolid
Fenobarbital tablet 30 mg
Fluoxetin tablet 10 mg /
10
Tube rectal
11,525.00
Tablet
Antiprestin
Tablet
419.00
Gracia
Haloperidol tablet 1,5 mg
Tablet
69.00
Indofarma
11
Haloperidol tablet 5 mg
Tablet
96.00
Indofarma
12
Imipramin tablet 25 mg / Tofranil
Tablet
13
Karbamazepin tablet 200 mg
Tablet
245.00
Indofarma
14
Klorpromazin tablet salut 100 mg (HCl)
Tablet
149.00
KF
15
Kodein tablet 10 mg
Tablet
16
Risperidon tablet 2 mg
Tablet
17
Sertralin tablet / Nudep
Tablet
18
Triheksifenidil tablet 2 mg
Tablet
OBAT GIGI
1
Artikulating Paper
Buku
Bur High Speed
Kotak
Bur Low Speed
Kotak
Cavit / Dentorit
Pot
Celluloid strip
Set
Cresopen - 13 ml
Botol
Dentin Conditioner
Botol
Devitalisasi Pasta (Non Arsen)
Disclosing Agent
Btl / ktk
Tube
1,008.00
Mersifarma
10
Disposible saliva ejektor
11
Etil Chlorida spray - 100 ml
Botol
12
Eugenol cairan
Botol
13
Glass Ionomer Radiopak / Fuji VII
Set
14
Glass Ionomer Cement ART / Fuji IX / Ketac Molar
Set
15
Kalsium Hidroksida pasta / Calcidor / Dycal
Set
16
Macro gold + propylen + EDTA
Set
17
Oil Spray
Botol
18
Obat Anestesi Lokal Injeksi ( Lidokain HCl 20 ml + Adrenalin 12.5 mcg ) / Pehacain
Ampul
19
Pulperyl
Botol
20
Spon Gelatin Cubicels / Spongostan/ Haemospon
Pcs
21
Temporary Stopping Fletcher (Fletcher) serbuk dan cairan
Set
22
Tetric N Ceram
Paket
23
Tetric N Ceram Refill (A2, A3, A3,5) - 3,5 gr
Tube
24
Tetric Bonding - 6 gr
Botol
25
Tetric Etch Refill - 2 gr
Tube
26
Trikresol Formalin (TKF)
Botol
27
Xylestesin Adrenalin injeksi / Scandonest
Ampul
28
Xylestesin Non Adrenalin injeksi
Ampul
29
CHKM
Botol
30
Iodoform/Mumifying pasta
Botol
JUMLAH HARGA OBAT
Bungkus @ 100 pcs
16,667.00
KF
NIP. 19650104 199403 2 002
PENERIMAAN OBAT
JUN
JUL
AGS
SEP
OKT
12
13
14
15
16
2400
200
1080
660

17
18
TOTAL HARGA
KET
20
22
Kebutuhan
19
5,300.00
883.33
5,300
455,800
6 bln
2,970.00
495.00
2,969
555,203
6 bln
990.00
5,940
1,960,200
6 bln
1600
2,800.00
1,400.00
8,400
672,000
6 bln
37000
91,000.00
18,200.00
109,248
28,513,728
6 bln
24,200.00
6,050.00
36,300
2,613,600
6 bln
600.00
200.00
1,200
2,568,000
6 bln
9000
450
4000
22000
7300
37,000.00
12,333.33
74,000
7,030,000
6 bln
6300
1800
27,200.00
3,885.71
23,314
2,611,200
6 bln
700
500
2,000.00
666.67
4,000
1,344,000
6 bln
200
4,200.00
1,050.00
6,300
1,197,000
6 bln
500
3000
3,000.00
3,000.00
150
9000
48
1000
24
2600
96
3700
488.00
18,000
-
61.00
366
756,000
556,320
38,000.00
4,222.22
25,333
6 bln
1,570,667
6 bln
6 bln
1500
2,300.00
766.67
192.00
96.00
400
3000
3200
500
400
768,200
96
4,600
288
734,400
2,300.00
575.00
3,450
2,187,300
100.00
99
7,425
5,800.00
1,160.00
6,960
2,004,480
3,200.00
3 bln
6 bln
1 bln
6 bln
3,200.00
19,200
1,075,200
6 bln
3,200.00
19,200
8,371,200
6 bln
6 bln
100.00
300
65,700
3 bln
700.00
700.00
4,200
625,800
6 bln
9000
3000
16,000.00
5,333.33
32,000
2,240,000
6 bln
8000
1700
13,400.00
3,350.00
20,100
1,688,400
6 bln
42000
14100
50.00
300
480,000
104,700.00
20,940.00
125,640
6,407,640
700.00
700.00
4,200
579,600
650.00
325.00
1,950
4,182,750
90.00
540
6 bln
6 bln
6 bln
736,020
6 bln
6 bln
300.00
3500
3000
1350
300.00
4 bln
8,000.00
48,000
5,400,000
6 bln
300.00
300.00
1,200
184,800
4 bln
10,900.00
2,180.00
13,080
2,092,800
6 bln
50.00
300
900,000
6 bln
9,450.00
1,575.00
9,450
1,663,200
6 bln
3.00
18
84,600
6 bln
100.00
600
288,000
1,500.00
336
184,800
1260
1,200
2,100.00
9,000
-
525.00
3,152
1,899,000
6 bln
6 bln
16,390,400
6 bln
252
88
420
2,608.00
372.57
52000
10000
12000
2500
165,200.00
20,650.00
2.00
1.00
85,218
2,100.00
12,600
-
100.00
200
9,788,100
-
600
-
6 bln
6,300.00
100
123,900
3,214,546
400
2,235
1,512,000
6 bln
6 bln
6 bln
35,400
6 bln
30.00
180
360,000
6 bln
1,600.00
266.67
1,600
2,000,000
6 bln
1920
3,960.00
660.00
3,960
669,240
6 bln
3800
7,600.00
2,533.33
15,200
3,876,000
6 bln
18000
3500
15000
200
48,000.00
12,000.00
72,000
7,704,000
6 bln
6,400.00
1,600.00
9,600
4,550,400
6 bln
6.00
1.50
150,003
147,590,340
6 bln
Yang mengajukan,
SUPRIHARTIWI, AMF
NIP. 197601172009022004
DAFTAR OBAT DAN MEDIS PAKAI PUSKESMAS C

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DAFTAR OBAT DAN MEDIS PAKAI PUSKESMAS CILED

OBAT

Antasida
kunyah,
kombinasi
: Aluminium
Hidroksida
mgml+ +Magnesium
Antasida DOEN
DOEN IIItablet
suspensi,
kombinasi
: Aluminium
Hidroksida
200200
mg /5
MagnesiumHidroksida
Hidroksida200
200m
ml
anhidrat 2,7 g
Parasetamol drops
Zinc tablet 20 mg
Eugenol cairan
BAHAN MEDIS HABIS PAKAI
Etanol 70 % - 1 L
Infusion Set Dewasa
Masker
Sarung Tangan
Wing needle

Daftar Obat Formularium

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Daftar Obat Formularium

Diunggah oleh

Hak Cipta:

Format Tersedia

RENCANA ANGGARAN BELANJA BAHAN MEDIS PAKAI HABIS

UPTD PUSKESMAS CILEDUG

HARGA OBAT (Rp)

Alat Suntik sekali pakai 0,05 ml

Alat Suntik sekali pakai 0,5 ml

Alat Suntik sekali pakai 1 ml

Alat Suntik sekali pakai 3 ml

Alat Suntik sekali pakai 5 ml

Benang Bedah Catgut No. 2/0 - 3/0 dengan jarum bedah

Benang Bedah Silk No. 2/0 - 3/0 dengan jarum bedah

Benang Bedah Catgut Chromic 2/0 -100 m

Benang Bedah Catgut Plain 3/0 -100 m

Benang Bedah Silk Black 3/0 -100 m

Dental Film Hanshin

Gel USG / EKG

Infusion Set Anak

Infusion Set Dewasa

IV. Catheter No.18 G

IV. Catheter No.20 G

IV. Catheter No.22 G

Jarum Jahit Bedah No. 9 s/d 14 (Kulit) - GT

Jarum Jahit Bedah No. 9 s/d 14 (Otot) - GR

Kapas Pembalut / absorben 250 gram

Kassa Hidrofil Steril uk. 16 x 16

Kassa Hidrofil uk. 36 m x 40 cm / 40 yard x 80 cm

Kassa pembalut hidrofil 4m x 10 cm

Kertas USG Sony 110 HG

Larutan Clorin 5,25% - 1 L (Desinfektan Alat)

Larutan Desinfectan - 1 L (Desinfektan Ruangan)

Larutan Antiseptik / Desinfektan hanrub mengandung chlorhexidine gluconate 0.5 %

Kassa steril mengandung obat (Framycetin) / Lomatulle

Masker nebulizer set dewasa

Masker nebulizer set anak

Plester 5 yard X 2 inch

Plester non alergi 0,5 inch / Micropore

Surgical blade no.11 (Pisau Bedah)

Kaca Slide / Object Glass

Wadah Kaca Slide / Box Slide

Kantong Kresek obat + cetakan, ukuran 15 x 30

Plastik Obat dg klip + cetakan, ukuran 7 x 10 cm

Plastik Obat dg klip + cetakan, ukuran 10 x 15 cm

Kertas Perkamen ( ukuran 8 x 11 )

Jarum telinga (press needle)

Asam Traneksamat Injeksi 500 mg/ 5 ml / Hemostatik

Fitomenadion (Vit. K ) Neonatal Injeksi 2 mg/ml / Vitka/ Vit. K Neonatal

Fitomenadion (Vit. K) Dewasa injeksi 10 mg/ml

Ikat Tali Pusat ( Umbilical Cord klem )

Metilergometrin maleat injeksi 0,200 mg - 1 ml

Misoprostol tablet 0,2 mg / Noprostol

Natrium Bicarbonat injeksi

Nasal dewasa / Maxyflow

Nasal infant/ Oxyflow

Oksitosin injeksi 10 IU/ml - 1 ml / Pitogin

Penghisap Lendir Bayi Baru Lahir

Sarung Tangan panjang obgyn No. 6,5

Sarung Tangan panjang obgyn No. 7

Sarung Tangan panjang obgyn No. 7,5

Sarung tangan steril/Surgical gloves steril No. 6,5

Sarung tangan steril/Surgical gloves steril No. 7

Sarung tangan steril/Surgical gloves steril No.7,5

Tanda Pengenal (ID Band) Bayi

Tanda Pengenal (ID Band) Ibu

Valethamate Br 8 mg /ml injeksi / Epidosin