An Praha Aaaaa An

SALDO PERSEDIAAN PER 01 JANUARI - 31 JANUARI 2016
KODE PUSKESMAS : P. 1402022201

PUSKESMAS : PANGKALAN KASAI
Unit Kerja : GUDANG PUSKESMAS
Penyesuaian saldo
Jumlah
Saldo hasil Cek
SATUAN Penerimaan Pengeluaran SALDO per 31 Harga Pengeluaran (Rp) Harga Perolehan
No. Nama Obat Fisik (31 Januari Keterangan
KEMASAN Desember 2015 Satuan 01 Januari - 31 Terakhir
2016 )
Januari 2016
Januari Januari
A OBAT
1 Albendazol suspensi 200 mg/5 ml btl 60 - - 60 4,041 - 242,460
2 Albendazol tab 400 mg tablet - - 350 - -
3 Alkohol 70 % 100 ml btl 12 - 12 2,575 - 30,900
4 ALKOHOL 70 % 1000 ml btl 5 - 1 6 27,305 27,305 136,525
5 Alopurinol tab 100 mg tablet 700 - 600 1,300 88 52,800 61,600
6 Alopurinol tab 300 mg tablet 500 - - 500 215 - 107,250
7 Alprazolam 0,5 mg tab tablet - - 180 - -
8 Ambroxol sirup btl - - 2,598 - -
9 Ambroxol tablet 30 mg tablet - - 131 - -
10 Aminofilin tab 200 mg tablet 1,250 - 100 1,350 82 8,200 102,500
11 Aminofilin injeksi 24 mg/ml ampul 34 - - 34 4,013 - 136,442
12 Amitriptilin tab 25 mg tablet 600 - - 600 117 - 70,200
13 Amlodipin 5 mg tab tablet - - - - 192 - -
14 Amlodipin 10 mg tab tablet - - 90 90 341 30,690 -
15 Amobiotic Drop btl 18 - 5 23 23,100 115,500 415,800
16 Amoksisilin kapsul 250 mg kapsul 1,320 - 1,080 2,400 210 226,800 277,200
17 Amoksisilin kapsul 500 mg kapsul - - 1,500 1,500 270 405,000 -
18 Amoksisilin syrup kering 125mg/5ml botol 5 ml - - 80 80 2,500 200,000 -
19 Amoksisilin serbuk injeksi 1g vial 10 - - 10 7,766 - 77,660
20 Ampisilin 500 mg kap kapsul - - - 400 - -
21 Ampisilin serbuk injeksi 500 mg/vial vial 10 - - 10 3,150 - 31,500
22 Antalgin tablet 500 mg tablet - - 116 - -
23 Antalgin inj ampul - - 1,400 - -
24 Antasida DOEN I tablet kunyah tablet - - 1,200 1,200 74 88,800 -
25 Antasida DOEN II Suspensi Komb btl 60 ml - - - - 2,160 - -
26 Anti bakteri salep komb tube 105 - - 105 2,641 - 277,305
27 Antifungi DOEN komb salep pot 48 - - 48 2,001 - 96,050
28 Antimigren: ergotamin tartrat 1mg +kofein 50mg tablet 200 - - 200 142 - 28,400
Antihemoroid kombinasi Bismut Subgalat 150mg
29 Heksaklorofen 2,5mg Lidokain 10mg Seng Oksida 30 - 20 50 3,200 64,000 96,000
120mg
30 Antithrom Jelly tube 12 - 13 25 35,200 457,600 422,400
31 Aqua pro injeksi steril vial 50 - - 50 2,100 - 105,000
32 Artemether injeksi 80 mg/ml ampul 12 - - 12 23,100 - 277,200
33 Artesunate injeksi vial/ktk - - 38,999 - -
34 Asam askorbat ( vit c ) tablet 50 mg tablet - - 300 ### 100 30,000 -
35 Asam Folat tab 1 mg tablet - - 50 - -
36 Asam Mefenamat kaplet 250 mg kaplet - - 1,000 1,000 166 166,000 -
37 Asam Mefenamat kaplet 500 mg kaplet - - 900 ### 116 104,400 -
38 Asetosal tab 100 mg tablet - - 122 - -
39 Asetosal tab 500 mg tablet - - 100 ### 170 17,000 -
40 Asiklovir krim 5% tube - - - - 2,260 - -
41 Asiklovir tab 200 mg tablet 200 - 400 600 239 95,600 47,800
42 Asiklovir tab 400 mg tablet 200 - 100 300 345 34,500 69,000
43 Asonfen tab tablet - - 400 ### 140 56,000 -
44 Asifit tablet - - 90 90 - -
45 Asering tablet - - - - 9,000 - -
46 Atropin sulfat injeksi ampul 30 - - 30 1,300 - 39,000
47 Atropin sulfat tab 0,5 mg tablet 100 - - 100 77 - 7,700
48 Bedak Salisil Serbuk 2 % bks 332 - 20 352 1,250 25,000 415,000
49 Beneuron tablet - - 300 ### - -
50 Benzatin benzil penisilin 1,2 jt UI inj vial 10 - - 10 10,290 - 102,900
51 Benzatin benzil penisilin 2,4 jt UI inj vial 20 - - 20 14,070 - 281,400
52 Besi II Sulfat 200 mg + as.Folat 0,25 mg tablet tablet 100 - 70 170 43 3,010 4,300
53 Betahistine Mesilat Tb, 6 Mg tablet - - 970 - -
54 Betametason krim 0,1% tube 50 - 25 75 1,520 38,000 76,000
55 Bexicom tab kapsul - - 1,650 - -
56 Bisoprolol tablet 5 mg tablet 60 - - 60 669 - 40,140
57 Brochifar tablet - - 100 ### 478 47,800 -
58 Bromiphar tablet 600 - 200 800 225 45,050 135,150
59 Budenosid respules resp 4 - - 4 8,900 - 35,600
60 Captopril tablet 12,5 mg tablet 800 - 600 1,400 62 37,200 49,600
61 Captopril tablet 25 mg tablet 400 - 600 1,000 89 53,400 35,600
62 Captopril tablet 50 mg tablet 2,400 - - 2,400 141 - 338,400
63 Carbamazepin 200 mg tablet 1,000 - - 1,000 257 - 257,000
64 Caltrak btl - - 15 15 27,500 412,500 -
65 Cefadroksil kap 500 mg kapsul - - 400 ### 519 207,600 -
66 Cefadroksil syrup kering 125 mg/5ml btl 60 ml 30 - 36 66 5,064 182,304 151,920
67 Cefaleksin kap 500 mg kapsul - - 1,100 - -
68 Cefixime syrup 100 mg/5 ml btl 30 ml - - 5 5 9,000 45,000 -
69 Cefixime kap 100 mg kapsul - - 869 - -
70 Cefotaxim 0,5 gr inj vial - - 5,247 - -
71 Cefotaxim 1 gr inj vial 10 - - 10 3,150 - 31,500
72 Ceftriaxon injeksi 1 g vial - - - - 3,500 - -
73 Cetrizine tab 10 mg tablet - - 400 ### 186 74,400 -
74 Ciprofloxacin infs btl 100 ml - - - 59,800 - -
75 Ciprofloxacin 500 mg kapsul 200 - 600 800 260 156,000 52,000
76 Cimetidin 200 mg tablet 300 - - 300 120 - 36,000
77 Clindamycin 150 mg kap tablet 100 - - 100 379 - 37,900
78 Clindamycin 300 mg kap tablet 150 - - 150 570 - 85,500
79 Clobazam tab 10 mg tablet 200 - - 200 900 - 180,000
80 Chlorpheniramine maleat (CTM) 4 mg tablet 9,000 - 3,000 12,000 53 159,000 477,000
81 Cough En Plus Syrup btl - - 5 5 23,000 115,000 -
82 Dehaf sachet 18 - 6 24 9,167 55,000 165,000
83 Deksametason injeksi 5 mg/ampl ampul 80 - - 80 1,659 - 132,720
84 Deksametason tablet 0,5 mg tablet - - - - 64 - -
85 Diaform tablet 200 - 150 350 - -
86 Diazepam 2 mg tab tablet 100 - - 100 45 - 4,500
87 Diazepam injeksi ampul 28 - - 28 4,389 - 122,892
88 Difenhidramin Injeksi im, 10 mg/ml (HCl) ampul 80 - - 80 1,107 - 88,560
89 Digoksin tablet 0,25 mg tablet - - - - 100 - -
90 Diltiazem tab 30 mg tablet 500 - - 500 134 - 67,000
91 Dimenhidrinat tab tablet 500 - - 500 104 - 52,000
92 Doksisiklin 100 mg kap tablet 100 - - 100 285 - 28,500
93 Domperidone suspensi 5 mg/5 ml btl 60 ml 63 - 40 103 3,410 136,400 214,830
94 Domperidone 10 mg tab tablet 1,150 - 400 1,550 170 68,000 195,500
95 Domperidone drop 5mg / ml botol 5 - - 5 16,350 - 81,750
96 Dumin Rectal 250 mg supp - - 2 2 16,280 32,560 -
97 Dumin Rectal 125 mg supp - - - - 11,660 - -
98 Ekstrak beladon 10 mg tab tablet 500 - - 500 33 - 16,632
99 Epinefrin injeksi ampul 16 - - 16 8,505 - 136,080
100 Erytromicyn 250 mg kapsul 120 - - 120 497 - 59,640
101 Erythromisin 500 mg kap kapsul 300 - 200 500 976 195,200 292,800
102 Erytromicyn syrup 200 mg/5 ml btl 60 ml 124 - 40 164 7,893 315,720 978,732
103 Fenilbutason tab 200 mg tablet 900 - - 900 102 - 91,800
104 Ferosulfat tab tablet 2,000 - 2,000 4,000 21 41,732 41,732
105 Flukonazol tab 150 mg kapsul 50 - - 50 23,100 - 1,155,000
106 Fludane kapsul kapsul - - 200 ### 735 147,000 -
107 Fludane Plus tablet - - 200 ### 880 176,000 -
108 Flutop C Syrup btl - - - - 10,000 - -
109 Furosemid Injeksi, im/iv, 10 mg/ml ampul 30 - - 30 1,920 - 57,600
110 Furosemid tablet, 40 mg tablet 400 - - 400 94 - 37,600
111 Fucilex Krim / Natrium Fucilat tube 24 - 22 46 6,555 144,210 157,320
112 Folic Acid tablet 1,400 - 300 1,700 50 15,000 70,000
113 Garam oralit untuk 200 ml air sachet 75 - - 75 303 - 22,725
114 Geriavita kapsul 60 - 90 150 - -
115 Gentamisin salep kulit 0,1 % tube 30 - 30 60 1,469 44,070 44,070
116 Gentamisin sulfat tetes mata 0,3 % btl 40 - - 40 3,353 - 134,120
117 Gentamisin injeksi ampul 35 - - 35 3,569 - 124,915
118 Gentian Violet larutan 1 % btl 10 ml 8 - 20 28 945 18,900 7,560
119 Glibenklamida tablet 5 mg tablet 900 - - 900 58 - 52,200
120 Gliseril Gualakolat ( GG ) 100 mg tablet 1,600 - 3,200 4,800 50 160,000 80,000
121 Glukosa larutan infus 10 % steril 500 ml/btl - - - - 5,985 - -
122 Glukosa larutan infus 40 % steril amp - - 2,577 - -
123 Glukosa larutan infus 5 % steril 500 ml/btl 98 - - 98 5,460 - 535,080
124 Grafula-DHA tablet - - - - 2,200 - -
125 Griseovulvin tablet 125 mg tablet 200 - - 200 230 - 46,000
126 Haloperidol 0,5 mg tablet 800 - - 800 100 - 80,000
127 Haloperidol 1,5 mg tablet 500 - - 500 61 - 30,500
128 Haloperidol 5 mg tablet 1,000 - - 1,000 72 - 72,000
129 HB-Vit kaplet 120 - 90 210 2,167 195,000 260,000
130 Hemafort tablet - - - - - -
131 Hico Gel tube - - - - 25,000 - -
132 Hidrokortison krim 2,5% tube - - 48 48 2,798 134,304 -
133 Hufabetamin Syrup btl 29 - 21 50 5,900 123,900 171,100
134 Hustab tablet 900 - 1,200 2,100 - -
135 Hustadin Syrup btl - - - - 16,500 - -
136 Ibuprofen Suspensi 200 mg/ 5 ml btl 60 ml 25 - 75 100 4,724 354,300 118,100
137 Ibuprofen tablet 200 mg tablet - - 600 ### 116 69,600 -
138 Ibuprofen tablet 400 mg tablet - - 600 ### 153 91,800 -
139 Imunvit Plus Kap kaplet 100 - - 100 6,500 - 650,000
140 Intibrox (Ambroksol) tablet - - 500 ### 203 101,500 -
141 Intibrox (Ambroksol) Syrup botol - - 40 40 6,200 248,000 -
142 Isoniazid tab 100 mg tablet 500 - - 500 68 - 34,000
143 Isorbitdinitrat tablet sublingul, 5 mg tablet 700 - - 700 93 - 65,100
144 Jovial Sachet kaplet 120 - 20 140 1,450 29,000 174,000
145 KA EN 1 B botol 40 - - 40 9,000 - 360,000
146 KA EN 3 A botol 40 - - 40 10,000 - 400,000
147 KA EN MG 3 botol 40 - - 40 9,625 - 385,000
148 Kalium Diklofenak 50 mg tablet - - - - 743 - -
149 Kalsium Laktat 500 mg tablet 300 - 400 700 73 29,200 21,900
150 Ketokenazole krim 2 % 10 gr tube 80 - 10 90 2,569 25,690 205,520
151 Ketokenazole krim 2 % 15 gr tube - - 4,930 - -
152 Ketokonazol 200 mg tablet 450 - - 450 310 - 139,500
153 Ketorolac inj 10 mg ampul 24 - - 24 1,697 - 40,728
154 Ketorolac inj 30 mg ampul - - 2,539 - -
155 Klonidin 0,15 mg tablet 300 - - 300 214 - 64,200
156 Kloramfenikol 250mg kaplet 100 - - 100 262 - 26,200
157 Kloramfenikol suspensi 125mg / 60ml ( Mefamicetin s botol 10 - 30 40 3,865 115,950 38,650
158 Kloramfenikol tetes telinga 3% / 5ml botol - - 1,679 - -
159 Kloramfenikol salep mata 1% / 5ml tube 62 - - 62 1,600 - 99,200
160 Kloroquin 150mg tablet 1,000 - - 1,000 89 - 89,250
161 Klorpromazin tablet 100 mg tablet 300 - - 300 153 - 45,900
162 Klorpromazin tablet 25 mg tablet 700 - - 700 71 - 49,700
163 Klorpromazin inj 25mg/ml amp 60 - - 60 1,103 - 66,180
164 Kodein tablet 10 mg tablet 100 - - 100 525 - 52,500
165 Kotrimoksazol DOEN I (Dewasa) tablet 2,700 - 700 3,400 145 101,500 391,500
166 Kotrimoksazol DOEN II (Pediatrik) tablet 1,500 - 470 1,970 75 35,250 112,500
167 Kotrimoksazol suspensi 60ml botol 75 - 125 200 2,222 277,750 166,650
Kombines : Ipratropium bromida inhalasi 0,5 mg
168 vial - - - 879 - -
Salbutamol 2,5 mg ( Combivent UVB )
169 Lidokain injeksi 2% / 2ml ampul 90 - 60 150 879 52,740 79,110
170 Lidokain + Epineprin injeksi 2% / 2ml ampul - - 1,431 - -
171 Loperamid 2mg tablet 1,000 - 100 1,100 92 9,200 92,000
172 Magnesium sulfat injeksi (iv) 40% - 25ml vial 30 - - 30 3,500 - 105,000
173 Mebendazol Syrup 100mg / 5ml botol 53 - - 53 3,711 - 196,683
174 Mebendazol 100mg tablet 270 - - 270 239 - 64,530
175 Megatic Emulgel tube 2 - 18 20 11,500 207,000 23,000
176 Metilergometrin 0,125 mg tablet 1,100 - - 1,100 127 - 139,755
177 Metilergometrin injeksi ampul 80 - 20 100 2,750 55,000 220,000
178 Metilprednisolon injeksi 500 mg vial - - - - 92,990 - -
179 Metilprednisolon 4mg tablet 300 - 300 600 210 63,000 63,000
180 Metoklopramide 5mg tablet 600 - - 600 108 - 64,800
181 Metoklopramide 10mg tablet - - - - 105 - -
182 Metronidazol 250mg tablet - - - - 113 - -
183 Metronidazol 500mg tablet 1,300 - 300 1,600 164 49,200 213,200
184 Mikonazol krim 2% tube 24 - 48 72 3,000 144,000 72,000
185 Momethasone furoat krim 0,1 % tube 18 - - 18 17,820 - 320,760
186 Mulsanol Drop btl - - 10 10 18,500 185,000 -
187 Mulsanol Syrup btl - - 54 54 8,500 459,000 -
188 Nalget tablet - - 300 ### 390 117,000 -
189 Natavit Soft Caps kapsul 180 - 90 270 3,017 271,500 543,000
190 Natrium Diklofenat 25mg tablet - - - - 141 - -
191 Natrium Diklofenat 50mg tablet - - - - 185 - -
192 Natrium Klorida larutan infus 0.9% steril 500ml botol 16 - 3 19 4,935 14,805 78,960
193 Neurodial kaplet - - 100 ### 1,260 126,000 -
194 Nevirapin 200mg tablet 120 - - 120 2,940 - 352,800
195 Nifedipin 10mg tablet - - - - 110 - -
196 Nifedipin 20 mg ( Adalat Oros ) tablet 180 - - 180 2,999 - 539,820
197 Nistatin tablet salut gula 500 000 IU/gram tablet 400 - - 400 672 - 268,800
198 Nistatin vaginal tablet 100.000 IU/gram tablet 140 - 50 190 504 25,200 70,560
199 OBH sirup botol 14 - 26 40 12,500 325,000 175,000
200 Ofloxacin 400 mg tablet - - - - 680 - -
201 Oksitetrasiklin HCl salep mata 1% tube - - - - 1,600 - -
202 Oksitetrasiklin salep kulit 3% tube 37 - 5 42 1,606 8,030 59,422
203 Omeprazol kapsul 20 mg kapsul 60 - 120 180 216 25,920 12,960
204 Ondansentron 4mg tablet 180 - - 180 180 - 32,400
205 Osteor plus kaplet - - - - 6,325 - -
206 Ostine kapsul 420 - - 420 375 - 157,500
207 Otsu-KCL 7,46% ampul 28 - - 28 297 - 8,316
208 Papaverin 40mg tablet 270 - - 270 122 - 32,940
209 Parasetamol 500mg tablet - - - - 84 - -
210 Parasetamol drops botol 22 - 82 104 5,460 447,720 120,120
211 Parasetamol syrup 120mg / 5ml botol - - 118 118 1,496 176,528 -
212 Pehavral tablet - - 400 ### - -
213 Penoksimetil Penisilin 500mg tablet 500 - - 500 535 - 267,500
214 Penolgliserol tetes telinga 10% / 5ml botol 13 - - 13 1,058 - 13,754
215 Perak Sulfadiazin krim 1% (Burnazin) tube 2 - 4 6 24,150 96,600 48,300
216 Permetrin krim 5% (Scabicid) tube - - 8 8 11,475 91,800 -
217 Pethidin injeksi ampul 5 - - 5 1,523 - 7,613
218 Phenobarbital 30mg tablet - - - - 31 - -
219 Phenobarbital injeksi 50mg/ml ampul 27 - - 27 1,890 - 51,030
220 Piracetam injeksi 3g / 15ml ampul 8 - - 8 4,200 - 33,600
221 Piracetam 800mg tablet 40 - - 40 321 - 12,840
222 Pirantel Score (base ) 125mg tablet 210 - - 210 308 - 64,680
223 Pirantel syrup 125mg / 5ml botol 58 - - 58 8,728 - 506,224
224 Pitomenadion (Vit-K) 10mg tablet 1,200 - - 1,200 666 - 799,200
225 Pitomenadion inj. 2mg ampul - - 15 15 3,582 53,730 -
226 Pitomenadion inj. 10mg ampul - - 30 30 3,582 107,460 -
227 Povidon Iodida 10% 30ml botol 48 - 10 58 2,250 22,500 108,000
228 Povidon Iodida 10% 60ml botol - - - - 6,298 - -
231 Pravastatin 20mg tablet 200 - - 200 2,400 - 480,000
232 Prednison 5mg tablet - - 300 ### 119 35,700 -
233 Primakuin 15mg tablet 500 - - 500 205 - 102,500
234 Prokain Benzil Penisilin inj 3jt UI/Vial vial 2 - - 2 7,549 - 15,098
235 Propanolol HCl 10mg tablet 1,000 - - 1,000 79 - 79,000
236 Propanolol 40mg tablet 1,200 - - 1,200 110 - 132,000
237 Propiltiourasil 100mg tablet 300 - - 300 335 - 100,500
238 Quantidex tablet 600 - 100 700 837 83,700 502,200
239 Quantidex syrup botol - - 7 7 9,500 66,500 -
240 Ramipril 5mg tablet 500 - - 500 600 - 300,000
241 Ranitidin inj 25mg / 2ml ampul 40 - - 40 1,190 - 47,600
242 Ranitidin 150mg tablet 400 - 700 1,100 126 88,200 50,400
243 Reagen Golongan Darah Anti A 10ml botol - - - - 100,000 - -
244 Reagen Golongan Darah Anti B 10ml botol - - - - 100,000 - -
245 Reagen Golongan Darah Anti D 10ml botol - - - - 125,000 - -
246 Reserpin 0,10mg tablet 700 - - 700 85 - 59,500
247 Reserpin 0,25 mg tablet 700 - - 700 109 - 76,300
248 Ringer Laktat larutan infus 500ml botol 196 - 164 360 5,460 895,440 1,070,160
249 Risperidon 2mg tablet 40 - - 40 1,038 - 41,520
250 Rivanol larutan 0,1% botol 19 - 9 28 2,283 20,549 43,381
251 Salbutamol 2mg (sebagai sulfat) tablet 200 - - 200 62 - 12,400
252 Salbutamol 4mg (sebagai sulfat) tablet 500 - - 500 85 - 42,500
253 Salbutamol serbuk inh 200mcg/caps+rotahaler caps 9 - - 9 11,550 - 103,950
254 Salbutamol serb inh 200 mcg/kaps tablet 90 - 90 452 - 40,680
255 Salbutamol cairan inh 0,1% (Ventolin Nebules) botol 55 - - 55 6,930 - 381,150
256 Salep 2-4 pot 24 - - 24 2,100 - 50,400
257 Serum Anti Tetanus ampul - - 2 2 126,000 252,000 -
258 Serum Anti Bisa Ular amp 2 - 2 47,000 - 94,000
259 Sianokobalamin (vitamin B 12) injeksi ampul 90 - 15 105 1,131 16,965 101,790
260 Sianokobalamin (vitamin B 12) 50mcg tablet - - 700 ### 60 42,000 -
261 Simvastatin 10mg tablet 630 - 90 720 174 15,660 109,620
262 Spiramisin 500mg tablet 150 - - 150 1,574 - 236,100
263 Stesolid inj ampul 15 - - 15 17,604 - 264,060
264 Stesolid rectal tube supp 18 - 18 12,159 - 218,862
265 Stick Asam Urat botol - - - - 6,800 - -
266 Stick Glukosa botol - - - - 5,600 - -
267 Stik Kolesterol botol - - - - 28,000 - -
268 Streptomisin injeksi 1 g/ml vial 20 - - 20 3,832 - 76,640
269 Sulfasetamida Natrium TM 15% / 5ml botol 24 - - 24 3,387 - 81,288
270 Sulfatdoksin 500mg tablet 700 - - 700 544 - 380,800
271 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol - - - - 13,850 - -
272 Tamsulosin SR 0,4mg (Harnal OCAS) tablet 60 - - 60 30,800 - 1,848,000
273 Tetrasiklin 250mg kapsul 1,000 - - 1,000 154 - 154,000
274 Tetrasiklin 500mg kapsul 500 - - 500 312 - 156,000
275 Thiamin (Vitamin B1) injeksi 100mg / ml ampul 50 - - 50 700 - 35,000
276 Thiamin Hcl (Vitamin B1) 50mg tablet - - - - 37 - -
277 Tramadol 50mg kapsul 150 - - 150 192 - 28,835
278 Tuzalos kaplet - - - - - -
279 Vitamin B Kompleks tablet - - 400 ### 110 44,000 -
280 Vitaplex drop botol - - - - 26,400 - -
281 Zinc Disperibel tablet 900 - 100 1,000 497 49,700 447,300
282 Zink drop 10mg / 5ml botol 312 - 5 317 12,840 64,200 4,006,080
283 Zirkum Kid syrup 20mg / 5ml botol 50 - 40 90 7,770 310,800 388,500
- - - -
B. OBAT GIGI - - - -
1 Devitalisasi Pasta btl - - 390,000 - -
2 Etil klorida btl 2 - 5 7 125,000 625,000 250,000
3 Eugenol Cairan btl - - 17,500 - -
4 Glass Ionomer btl - - 395,000 - -
5 Kalsium Hidroksi Pasta 2 tube/ktk - - 242,000 - -
6 Klorfenol kamfer menthol(CHKM) btl - - 55,000 - -
7 Mummifying pasta btl - - 176,000 - -
8 Semen seng fosfat set - - 93,500 - -
9 Temporary stoping fletcher set - - 34,000 - -
SISA OBAT DALAM RUPIAH 66,687 - 31,095 97,782 13,076,478 34,669,612
C. ALKES & BAHAN HABIS PAKAI ( BHP )

1 Alat suntik sekali pakai 1 ml set 240 - 220 460 826 181,610 198,120
2 Alat suntik sekali pakai 2,5 ml pcs 500 - 20 520 826 16,510 412,750
3 Alat suntik sekali pakai 3 ml pcs 408 - 232 640 826 191,516 336,804
4 Alat suntik sekali pakai 5 ml pcs 320 - 120 440 953 114,300 304,800
5 Alat suntik sekali pakai 10 ml pcs 155 - 155 1,175 - 182,125
6 Alkohol Swab CHG 0,5 % pcs 300 - 100 400 197 19,680 59,040
7 Blood Transfusion Set pcs 50 - 15 65 4,572 68,580 228,600
8 Catgut/benang bedah no. 3/0 pcs 14 - 6 20 22,500 135,000 315,000
9 Catgut/benang bedah no.2/0 pcs 5 - 13 18 22,500 292,500 112,500
10 Folley Catheter no 16W pcs - - 5 5 8,000 40,000 -
13 Handscoon no 7 pcs - - 40 40 1,300 52,000 -
14 Handscoon no 7,5 pcs - - 35 35 1,300 45,500 -
15 Handscoon no 8 pcs - - 40 40 1,300 52,000 -
16 I.V Catheter no.18 pcs 65 - 80 145 8,085 646,800 525,525
17 I.V Catheter no.20 pcs - - - 8,085 - -
18 I.V Catheter no.22 pcs - - 28 28 8,085 226,380 -
19 I.V Catheter no.24 pcs 165 - 165 8,085 - 1,334,025
20 Infusion set anak set 101 - 101 4,445 - 448,945
21 Infusion set dewasa set 18 - 62 80 4,064 251,968 73,152
22 Kapas berlemak 500 gram Bks 2 - 1 3 34,000 34,000 68,000
23 Kapas pembalut/absorben 250 gram Bks 2 - 1 3 24,000 24,000 48,000
24 Kasa Hidrofil 16x16 16 pcs/ktk - - 13 13 7,900 102,700 -
25 Kasa Hidrofil 40 x 40 ktk - - 4 4 1,800 7,200 -
26 Kasa Hidrofil 4 x 15 cm roll - - 3,800 - -
27 Kasa Hidrofil 4 x 3 cm roll - - 40 40 800 32,000 -
28 Kasa Hidrofil 4 x 5 cm roll - - 1,100 - -
29 Kasa Pembalut 2 x 80 cm Rol 13 - 22 35 9,400 206,800 122,200
30 Kasa Pembalut Elastis 3 Inchi Rol 13 - 13 16,000 - 208,000
31 Kasa Pembalut Elastis 4 Inchi Rol 10 - 10 25,000 - 250,000
32 Kasa hidrofil ukuran 36 x 80cm Rol 3 - 3 130,000 - 390,000
33 Lysol btl - - 439 - -
34 Masker ear lopp pcs - - 439 - -
35 Masker Tie On pcs 65 - 260 325 439 114,114 28,529
36 Oxycan btl 5 - 5 - -
37 Pembalut elastis 10 cm x 4.55m pcs 5 - 5 33,000 - 165,000
38 Pembalut elastis 7.5 cm x 4.55m pcs 5 - 5 27,830 - 139,150
39 Pembalut Gips 6 Inchi Rol 4 - 4 60,500 - 242,000
40 Plester 5 yard x 2 inch Rol - - 30,000 - -
41 Semillas Non Woven Medical Tape (5 x 100cm) roll 18 - 12 30 3,850 46,200 69,300
45 Silk ( benang bedah sutera ) no. 3/0 pcs - - 85 85 15,000 1,275,000 -
46 Silk ( benang bedah sutera ) no. 2/0 pcs - - 15,000 - -
47 Stomach Tube pcs - - 10,010 - -
48 Surgical Blades No. 10 pcs 49 - 1 50 3,000 3,000 147,000
51 Surgical Blades No. 21 ( Bisturi ) pcs 9 - 9 - -
53 Transparent IV Dressing ( anak ) 4,4 x 4,4 cm pcs 100 - 56 156 2,021 113,190 202,125
54 Transparent IV Dressing ( Dewasa) 6 x 7 cm pcs 100 - 100 200 2,224 222,390 222,390
55 Urine bag pcs 10 - 10 3,810 - 38,100
56 Umbilical Cord Klem Steril Nylon pcs 45 - 50 95 1,270 63,500 57,150
57 wing nedle No.21 pcs - - 6,059 - -
58 wing nedle No.23 pcs - - 6,059 - -
SISA ALKES DALAM RUPIAH 2,971 - 1,686 4,657 4,799,401 7,722,039

SISA OBAT DAN ALKES DALAM RUPIAH 69,658 - 32,781 102,439 17,875,879 42,391,650
Mengetahui Pangkalan Kasai, 31 Januari 2015

Kepala UPT Pusksemas Pengelola Laporan
Pangkalan Kasai UPT Puskesmas
drg. DWIYANA SYAHPUTRI NURKHADIJAH, Amd.Kep

NIP 197507232008012007 NIP. 19680118 198903 2 002
SALDO PERSEDIAAN PER 01 FEBRUARI - 29

Penyesuaian saldo
Penerimaan
SATUAN Saldo hasil Cek Fisik
No. Nama Obat
KEMASAN (29 Februari 2016 )
Februari
A Obat-Obat
1 Albendazol suspensi 200 mg/5 ml btl 50 -
2 Albendazol tab 400 mg tablet - -
3 Alkohol 70 % 100 ml btl 11 -
4 ALKOHOL 70 % 1000 ml btl 22 20

5 Alopurinol tab 100 mg tablet 500 -
7 Alprazolam 0,5 mg tab tablet - -
8 Ambroxol sirup btl - -
9 Ambroxol tablet 30 mg tablet - -
10 Aminofilin tab 200 mg tablet 1,050 -
11 Aminofilin injeksi 24 mg/ml ampul 34 -
12 Amitriptilin tab 25 mg tablet 600 -
13 Amlodipin 5 mg tab tablet - -
15 Amobiotic Drop btl 28 20
16 Amoksisilin kapsul 250 mg kapsul 1,200 2,400
18 Amoksisilin syrup kering 125mg/5ml botol 5 ml 615 700
19 Amoksisilin serbuk injeksi 1g vial 10 -
20 Ampisilin 500 mg kap kapsul - -
21 Ampisilin serbuk injeksi 500 mg/vial vial 10 -
22 Antalgin tablet 500 mg tablet - -
23 Antalgin inj ampul - -
24 Antasida DOEN I tablet kunyah tablet 2,700 5,000
25 Antasida DOEN II Suspensi Komb btl 60 ml - -
26 Anti bakteri salep komb tube 150 150
27 Antifungi DOEN komb salep pot 48 -
28 Antimigren: ergotamin tartrat 1mg +kofein 50mg tablet 200 -

29 30 50
Heksaklorofen 2,5mg Lidokain 10mg Seng Oksida 120mg
30 Antithrom Jelly tube 4 -
31 Aqua pro injeksi steril vial 19 -
32 Artemether injeksi 80 mg/ml ampul 12 -
33 Artesunate injeksi vial/ktk - -
34 Asam askorbat ( vit c ) tablet 50 mg tablet - -
35 Asam Folat tab 1 mg tablet - -
36 Asam Mefenamat kaplet 250 mg kaplet 800 2,000
37 Asam Mefenamat kaplet 500 mg kaplet 1,400 3,000
38 Asetosal tab 100 mg tablet - -
40 Asiklovir krim 5% tube - -
41 Asiklovir tab 200 mg tablet 700 500
43 Asonfen tab tablet 1,000 2,000
44 Asifit tablet 30 300
45 Asering tablet 300 300
46 Atropin sulfat injeksi ampul 30 -
47 Atropin sulfat tab 0,5 mg tablet 100 -
48 Bedak Salisil Serbuk 2 % bks 312 -
49 Beneuron tablet - -
50 Benzatin benzil penisilin 1,2 jt UI inj vial 10 -
52 Besi II Sulfat 200 mg + as.Folat 0,25 mg tablet tablet 100 -

53 Betahistine Mesilat Tb, 6 Mg tablet - -
54 Betametason krim 0,1% tube 65 150
55 Bexicom tab kapsul - -
56 Bisoprolol tablet 5 mg tablet 60 -
57 Brochifar tablet - -
58 Bromiphar tablet 300 -
59 Budenosid respules resp - -
60 Captopril tablet 12,5 mg tablet 2,100 2,000
61 Captopril tablet 25 mg tablet 2,200 2,000
62 Captopril tablet 50 mg tablet 2,300 -
63 Carbamazepin 200 mg tablet 1,000 -
64 Caltrak btl 17 30
65 Cefadroksil kap 500 mg kapsul 300 1,000
66 Cefadroksil syrup kering 125 mg/5ml btl 60 ml 140 150
67 Cefaleksin kap 500 mg kapsul - -

68 Cefixime syrup 100 mg/5 ml btl 30 ml 60 96
69 Cefixime kap 100 mg kapsul - -
70 Cefotaxim 0,5 gr inj vial - -
71 Cefotaxim 1 gr inj vial 30 20
72 Ceftriaxon injeksi 1 g vial - -
73 Cetrizine tab 10 mg tablet - -
74 Ciprofloxacin infs btl 100 ml - -
75 Ciprofloxacin 500 mg kapsul 1,000 2,000
76 Cimetidin 200 mg tablet 900 1,000
77 Clindamycin 150 mg kap tablet 300 500
78 Clindamycin 300 mg kap tablet 600 500
79 Clobazam tab 10 mg tablet 200 -
80 Chlorpheniramine maleat (CTM) 4 mg tablet 16,000 9,000
81 Cough En Plus Syrup btl 120 150
82 Dehaf sachet 18 -
83 Deksametason injeksi 5 mg/ampl ampul 80 -
84 Deksametason tablet 0,5 mg tablet 3,600 8,000
85 Diaform tablet 1,600 1,500
86 Diazepam 2 mg tab tablet 100 -
87 Diazepam injeksi ampul 28 -
88 Difenhidramin Injeksi im, 10 mg/ml (HCl) ampul 80 -
89 Digoksin tablet 0,25 mg tablet - -
90 Diltiazem tab 30 mg tablet 500 -
91 Dimenhidrinat tab tablet 500 -
92 Doksisiklin 100 mg kap tablet 100 -
93 Domperidone suspensi 5 mg/5 ml btl 60 ml 174 150
94 Domperidone 10 mg tab tablet 800 -
95 Domperidone drop 5mg / ml botol 5 -
96 Dumin Rectal 250 mg supp 15 25
97 Dumin Rectal 125 mg supp 10 25
98 Ekstrak beladon 10 mg tab tablet 400 -
99 Epinefrin injeksi ampul 76 60
100 Erytromicyn 250 mg kapsul - -
101 Erythromisin 500 mg kap kapsul 600 500
102 Erytromicyn syrup 200 mg/5 ml btl 60 ml 354 240
103 Fenilbutason tab 200 mg tablet 900 -
104 Ferosulfat tab tablet 2,000 -
105 Flukonazol tab 150 mg kapsul 50 -
106 Fludane kapsul kapsul 200 800
107 Fludane Plus tablet 700 1,000

108 Flutop C Syrup btl 46 96
109 Furosemid Injeksi, im/iv, 10 mg/ml ampul 30 -
110 Furosemid tablet, 40 mg tablet 400 -
111 Fucilex Krim / Natrium Fucilat tube 36 48
112 Folic Acid tablet 1,100 -
113 Garam oralit untuk 200 ml air sachet 75 -
114 Geriavita kapsul 120 150
115 Gentamisin salep kulit 0,1 % tube - -
116 Gentamisin sulfat tetes mata 0,3 % btl 40 -
117 Gentamisin injeksi ampul 85 50
118 Gentian Violet larutan 1 % btl 10 ml 108 100
119 Glibenklamida tablet 5 mg tablet 900 -
120 Gliseril Gualakolat ( GG ) 100 mg tablet 8,200 10,000
121 Glukosa larutan infus 10 % steril 500 ml/btl - -
122 Glukosa larutan infus 40 % steril amp - -
123 Glukosa larutan infus 5 % steril 500 ml/btl 98 -
124 Grafula-DHA tablet - -
125 Griseovulvin tablet 125 mg tablet 100 -
126 Haloperidol 0,5 mg tablet 800 -
128 Haloperidol 5 mg tablet 1,000 -
129 HB-Vit kaplet 240 300
130 Hemafort tablet - -
131 Hico Gel tube 40 50
132 Hidrokortison krim 2,5% tube 192 240
133 Hufabetamin Syrup btl 114 120
134 Hustab tablet 1,400 1,500
135 Hustadin Syrup btl - -
136 Ibuprofen Suspensi 200 mg/ 5 ml btl 60 ml 265 300
137 Ibuprofen tablet 200 mg tablet 2,100 3,000
139 Imunvit Plus Kap kaplet 200 300
140 Intibrox (Ambroksol) tablet 1,400 2,900
141 Intibrox (Ambroksol) Syrup botol 100 150
142 Isoniazid tab 100 mg tablet 500 -
143 Isorbitdinitrat tablet sublingul, 5 mg tablet 600 -
144 Jovial Sachet kaplet 120 -
145 KA EN 1 B botol 40 -
146 KA EN 3 A botol 40 -
147 KA EN MG 3 botol 40 -
148 Kalium Diklofenak 50 mg tablet - -
149 Kalsium Laktat 500 mg tablet 2,800 3,000
150 Ketokenazole krim 2 % 10 gr tube 80 -
151 Ketokenazole krim 2 % 15 gr tube 120 120
152 Ketokonazol 200 mg tablet 950 500
153 Ketorolac inj 10 mg ampul 24 -
154 Ketorolac inj 30 mg ampul - -
155 Klonidin 0,15 mg tablet 300 -
156 Kloramfenikol 250mg kaplet - -
157 Kloramfenikol suspensi 125mg / 60ml ( Mefamicetin syrup ) botol 5 -
158 Kloramfenikol tetes telinga 3% / 5ml botol - -
159 Kloramfenikol salep mata 1% / 5ml tube 216 192
160 Kloroquin 150mg tablet 1,000 -
161 Klorpromazin tablet 100 mg tablet 300 -
162 Klorpromazin tablet 25 mg tablet 700 -
163 Klorpromazin inj 25mg/ml amp 60 -
164 Kodein tablet 10 mg tablet - -
165 Kotrimoksazol DOEN I (Dewasa) tablet 4,700 2,000
166 Kotrimoksazol DOEN II (Pediatrik) tablet 1,500 -
167 Kotrimoksazol suspensi 60ml botol 320 300
Kombines : Ipratropium bromida inhalasi 0,5 mg Salbutamol

168 vial 60 60
2,5 mg ( Combivent UVB )
169 Lidokain injeksi 2% / 2ml ampul - -
170 Lidokain + Epineprin injeksi 2% / 2ml ampul 240 300
171 Loperamid 2mg tablet 600 -

172 Magnesium sulfat injeksi (iv) 40% - 25ml vial 30 -
173 Mebendazol Syrup 100mg / 5ml botol 53 -
174 Mebendazol 100mg tablet 270 -
175 Megatic Emulgel tube 40 50
176 Metilergometrin 0,125 mg tablet 4,000 3,000
177 Metilergometrin injeksi ampul 380 300
178 Metilprednisolon injeksi 500 mg vial - -
179 Metilprednisolon 4mg tablet 600 2,000
180 Metoklopramide 5mg tablet 600 -
181 Metoklopramide 10mg tablet 1,500 1,500
182 Metronidazol 250mg tablet - -
183 Metronidazol 500mg tablet 1,300 -
184 Mikonazol krim 2% tube 129 120
185 Momethasone furoat krim 0,1 % tube 162 144
186 Mulsanol Drop btl 23 48

187 Mulsanol Syrup btl 96 144
188 Nalget tablet 1,500 2,000
189 Natavit Soft Caps kapsul - 300
190 Natrium Diklofenat 25mg tablet - -
192 Natrium Klorida larutan infus 0.9% steril 500ml botol 96 80
193 Neurodial kaplet 100 500
194 Nevirapin 200mg tablet 120 -
195 Nifedipin 10mg tablet 1,700 2,000
196 Nifedipin 20 mg ( Adalat Oros ) tablet 180 -
197 Nistatin tablet salut gula 500 000 IU/gram tablet 400 -
198 Nistatin vaginal tablet 100.000 IU/gram tablet 130 -
199 OBH sirup botol 74 100
200 Ofloxacin 400 mg tablet - -
201 Oksitetrasiklin HCl salep mata 1% tube - -
202 Oksitetrasiklin salep kulit 3% tube 25 -
203 Omeprazol kapsul 20 mg kapsul - -
204 Ondansentron 4mg tablet 180 -
205 Osteor plus kaplet - -
206 Ostine kapsul 480 300
207 Otsu-KCL 7,46% ampul 28 -
208 Papaverin 40mg tablet 270 -
209 Parasetamol 500mg tablet 6,900 10,000
210 Parasetamol drops botol 153 168
211 Parasetamol syrup 120mg / 5ml botol 310 420
212 Pehavral tablet - -
213 Penoksimetil Penisilin 500mg tablet 500 -
214 Penolgliserol tetes telinga 10% / 5ml botol 13 -
215 Perak Sulfadiazin krim 1% (Burnazin) tube 11 10
216 Permetrin krim 5% (Scabicid) tube 20 20
217 Pethidin injeksi ampul 5 -
218 Phenobarbital 30mg tablet - -
219 Phenobarbital injeksi 50mg/ml ampul 27 -
220 Piracetam injeksi 3g / 15ml ampul 8 -
221 Piracetam 800mg tablet 40 -
222 Pirantel Score (base ) 125mg tablet 710 500
223 Pirantel syrup 125mg / 5ml botol 58 -
224 Pitomenadion (Vit-K) 10mg tablet 1,000 -
225 Pitomenadion inj. 2mg ampul 60 90
226 Pitomenadion inj. 10mg ampul 90 90

227 Povidon Iodida 10% 30ml botol 30 -
228 Povidon Iodida 10% 60ml botol 21 30
231 Pravastatin 20mg tablet 200 -
232 Prednison 5mg tablet 3,900 4,000
233 Primakuin 15mg tablet 500 -
234 Prokain Benzil Penisilin inj 3jt UI/Vial vial 2 -
235 Propanolol HCl 10mg tablet 1,000 -
236 Propanolol 40mg tablet 1,200 -
237 Propiltiourasil 100mg tablet 1,300 1,000
238 Quantidex tablet 2,400 2,000
239 Quantidex syrup botol - -
240 Ramipril 5mg tablet 500 -
241 Ranitidin inj 25mg / 2ml ampul 170 150
242 Ranitidin 150mg tablet 1,600 3,000
243 Reagen Golongan Darah Anti A 10ml botol - 2
244 Reagen Golongan Darah Anti B 10ml botol - 1
245 Reagen Golongan Darah Anti D 10ml botol - 3
246 Reserpin 0,10mg tablet 700 -
247 Reserpin 0,25 mg tablet 700 -
248 Ringer Laktat larutan infus 500ml botol 80 140
249 Risperidon 2mg tablet 40 -
250 Rivanol larutan 0,1% botol 42 24
251 Salbutamol 2mg (sebagai sulfat) tablet 200 -
253 Salbutamol serbuk inh 200mcg/caps+rotahaler caps 9 -
254 Salbutamol serb inh 200 mcg/kaps tablet 90 -
255 Salbutamol cairan inh 0,1% (Ventolin Nebules) botol 35 -
256 Salep 2-4 pot 86 72
257 Serum Anti Tetanus ampul - -
258 Serum Anti Bisa Ular amp 2 -
259 Sianokobalamin (vitamin B 12) injeksi ampul 390 300
260 Sianokobalamin (vitamin B 12) 50mcg tablet 200 1,000
261 Simvastatin 10mg tablet 300 -
262 Spiramisin 500mg tablet 150 -
263 Stesolid inj ampul - -
264 Stesolid rectal tube supp 5 -
265 Stick Asam Urat botol 4 4
266 Stick Glukosa botol 3 4

267 Stik Kolesterol botol 2 4
268 Streptomisin injeksi 1 g/ml vial 20 -
269 Sulfasetamida Natrium TM 15% / 5ml botol 24 -
270 Sulfatdoksin 500mg tablet 700 -
271 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol 5 50
272 Tamsulosin SR 0,4mg (Harnal OCAS) tablet 60
273 Tetrasiklin 250mg kapsul 900
275 Thiamin (Vitamin B1) injeksi 100mg / ml ampul 45 -
276 Thiamin Hcl (Vitamin B1) 50mg tablet - -
277 Tramadol 50mg kapsul 150 -
278 Tuzalos kaplet - -
279 Vitamin B Kompleks tablet 5,000 6,800
280 Vitaplex drop botol - -
281 Zinc Disperibel tablet 700 -
282 Zink drop 10mg / 5ml botol 287 -
283 Zirkum Kid syrup 20mg / 5ml botol 150 100
- -
B. OBAT GIGI - -
1 Devitalisasi Pasta btl - -
2 Etil klorida btl - -
3 Eugenol Cairan btl - -
4 Glass Ionomer btl - -
5 Kalsium Hidroksi Pasta 2 tube/ktk - -
6 Klorfenol kamfer menthol(CHKM) btl - -
7 Mummifying pasta btl - -
8 Semen seng fosfat set - -
9 Temporary stoping fletcher set - -
SISA OBAT GIGI DALAM RUPIAH 140,163 122,180
1 Alat suntik sekali pakai 1 ml set 720 500
2 Alat suntik sekali pakai 2,5 ml pcs 400
3 Alat suntik sekali pakai 3 ml pcs 600 300
5 Alat suntik sekali pakai 10 ml pcs 155
6 Alkohol Swab CHG 0,5 % pcs 700 500
7 Blood Transfusion Set pcs 35
8 Catgut/benang bedah no. 3/0 pcs 165 168

9 Catgut/benang bedah no.2/0 pcs 154 168
10 Folley Catheter no 16W pcs -
13 Handscoon no 7 pcs 120 200
14 Handscoon no 7,5 pcs 150 200
16 I.V Catheter no.18 pcs 165 100
19 I.V Catheter no.24 pcs 165
20 Infusion set anak set 101
21 Infusion set dewasa set 150 200
22 Kapas berlemak 500 gram Bks 7 5
23 Kapas pembalut/absorben 250 gram Bks 6 5
24 Kasa Hidrofil 16x16 16 pcs/ktk 26 40
25 Kasa Hidrofil 40 x 40 pcs 20 20
26 Kasa Hidrofil 4 x 15 cm roll -
28 Kasa Hidrofil 4 x 5 cm roll 200 300
29 Kasa Pembalut 2 x 80 cm Rol 10 10
30 Kasa Pembalut Elastis 3 Inchi Rol 12
32 Kasa hidrofil ukuran 36 x 80cm Rol 6 4
33 Lysol btl 8 10
34 Masker ear lopp pcs -
35 Masker Tie On pcs 365 400
36 Oxycan btl 5
37 Pembalut elastis 10 cm x 4.55m pcs 5
38 Pembalut elastis 7.5 cm x 4.55m pcs 5
39 Pembalut Gips 6 Inchi Rol 4
40 Plester 5 yard x 2 inch Rol -
41 Semillas Non Woven Medical Tape (5 x 100cm) roll 18
45 Silk ( benang bedah sutera ) no. 3/0 pcs -
47 Stomach Tube pcs -
48 Surgical Blades No. 10 pcs 49

51 Surgical Blades No. 21 ( Bisturi ) pcs 9
53 Transparent IV Dressing ( anak ) 4,4 x 4,4 cm pcs 100
54 Transparent IV Dressing ( Dewasa) 6 x 7 cm pcs 100
55 Urine bag pcs 10
56 Umbilical Cord Klem Steril Nylon pcs 45
57 wing nedle No.21 pcs -
SISA ALKES DALAM RUPIAH 5,779 3,780
SISA OBAT DAN ALKES DALAM RUPIAH 145,942 125,960
Mengetahui
Kepala UPT Pusksemas
Pangkalan Kasai
drg. DWIYANA SYAHPUTRI

NIP 197507232008012007
R 01 FEBRUARI - 29 FEBRUARI 2016
Penyesuaian saldo
Pengeluaran SALDO per Jumlah Pengeluaran

Harga Harga Perolehan
31 Januari ( Rp ) 01 Januari - 31 Keterangan
Satuan Terakhir
2016 Maret 2016
Februari
10 60 4,041 40,410 202,050
- 350 - -
1 12 2,575 2,575 28,325
3 5 27,305 81,915 600,710

200 700 88 17,600 44,000
100 500 215 21,450 85,800
- 180 - -
- 2,598 - -
- 131 - -
200 1,250 82 16,400 86,100
- 34 4,013 - 136,442
- 600 117 - 70,200
- 192 - -
- 341 - -
10 18 23,100 231,000 646,800
2,520 1,320 210 529,200 252,000
2,000 270 540,000 270,000
85 2,500 212,500 1,537,500
- 10 7,766 - 77,660
- 400 - -
- 10 3,150 - 31,500
- 116 - -
- 1,400 - -
2,300 74 170,200 199,800
- 2,160 - -
105 105 2,641 277,305 396,150
- 48 2,001 - 96,050
- 200 142 - 28,400

50 30 3,200 160,000 96,000
8 12 35,200 281,600 140,800
31 50 2,100 65,100 39,900
- 12 23,100 - 277,200
- 38,999 - -
- 100 - -
- 50 - -
1,200 166 199,200 132,800
1,600 116 185,600 162,400
- 122 - -
- 170 - -
- 2,260 - -
- 200 239 - 167,300
300 200 345 103,500 138,000
1,000 140 140,000 140,000
270 - -
- 9,000 - 2,700,000
- 30 1,300 - 39,000
- 100 77 - 7,700
20 332 1,250 25,000 390,000
- - -
- 10 10,290 - 102,900
- 20 14,070 - 281,400
- 100 43 - 4,300
- 970 - -
135 50 1,520 205,200 98,800
- 1,650 - -
- 60 669 - 40,140
- 478 - -
300 600 225 67,575 67,575
4 4 8,900 35,600 - exp. Date
700 800 62 43,400 130,200
200 400 89 17,800 195,800
100 2,400 141 14,100 324,300
- 1,000 257 - 257,000
13 27,500 357,500 467,500
700 519 363,300 155,700
40 30 5,064 202,560 708,960
- 1,100 - -
36 9,000 324,000 540,000
- 869 - -
- 5,247 - -
- 10 3,150 - 94,500
- 3,500 - -
- 186 - -
- 59,800 - -
1,200 200 260 312,000 260,000
400 300 120 48,000 108,000
300 100 379 113,700 113,700
50 150 570 28,500 342,000
- 200 900 - 180,000
2,000 9,000 53 106,000 848,000
30 23,000 690,000 2,760,000
- 18 9,167 - 165,000
- 80 1,659 - 132,720
4,400 64 281,600 230,400
100 200 - -
- 100 45 - 4,500
- 28 4,389 - 122,892
- 80 1,107 - 88,560
- 100 - -
- 500 134 - 67,000
- 500 104 - 52,000
- 100 285 - 28,500
39 63 3,410 132,990 593,340
350 1,150 170 59,500 136,000
- 5 16,350 - 81,750
10 16,280 162,800 244,200
15 11,660 174,900 116,600
100 500 33 3,326 13,306
- 16 8,505 - 646,380
120 120 497 59,640 -
200 300 976 195,200 585,600
10 124 7,893 78,930 2,794,122
- 900 102 - 91,800
- 2,000 21 - 41,732
- 50 23,100 - 1,155,000
600 735 441,000 147,000
300 880 264,000 616,000

50 10,000 500,000 460,000
- 30 1,920 - 57,600
- 400 94 - 37,600
36 24 6,555 235,980 235,980
300 1,400 50 15,000 55,000
- 75 303 - 22,725
90 60 - -
30 30 1,469 44,070 -
- 40 3,353 - 134,120
- 35 3,569 - 303,365
- 8 945 - 102,060
- 900 58 - 52,200
3,400 1,600 50 170,000 410,000
- 5,985 - -
- 2,577 - -
- 98 5,460 - 535,080
- 2,200 - -
100 200 230 23,000 23,000
- 800 100 - 80,000
- 500 61 - 30,500
- 1,000 72 - 72,000
180 120 2,167 390,000 520,000
- - -
10 25,000 250,000 1,000,000
48 2,798 134,304 537,216
35 29 5,900 206,500 672,600
1,000 900 - -
- 16,500 - -
60 25 4,724 283,440 1,251,860
900 116 104,400 243,600
1,500 153 229,500 229,500
200 100 6,500 1,300,000 1,300,000
1,500 203 304,500 284,200
50 6,200 310,000 620,000
- 500 68 - 34,000
100 700 93 9,300 55,800
- 120 1,450 - 174,000
- 40 9,000 - 360,000
- 40 10,000 - 400,000
- 40 9,625 - 385,000
- 743 - -
500 300 73 36,500 204,400
- 80 2,569 - 205,520
- 4,930 - 591,600
- 450 310 - 294,500
- 24 1,697 - 40,728
- 2,539 - -
- 300 214 - 64,200
100 100 262 26,200 -
5 10 3,865 19,325 19,325
- 1,679 - -
38 62 1,600 60,800 345,600
- 1,000 89 - 89,250
- 300 153 - 45,900
- 700 71 - 49,700
- 60 1,103 - 66,180
100 100 525 52,500 -
- 2,700 145 - 681,500
- 1,500 75 - 112,500
55 75 2,222 122,210 711,040
- 879 - 52,740
90 90 879 79,110 -
60 1,431 85,860 343,440
400 1,000 92 36,800 55,200

- 30 3,500 - 105,000
- 53 3,711 - 196,683
- 270 239 - 64,530
12 2 11,500 138,000 460,000
100 1,100 127 12,705 508,200
- 80 2,750 - 1,045,000
- 92,990 - -
1,700 300 210 357,000 126,000
- 600 108 - 64,800
- 105 - 157,500
- 113 - -
- 1,300 164 - 213,200
15 24 3,000 45,000 387,000
- 18 17,820 - 2,886,840
25 18,500 462,500 425,500

48 8,500 408,000 816,000
500 390 195,000 585,000
480 180 3,017 1,448,000 -
- 141 - -
- 185 - -
- 16 4,935 - 473,760
400 1,260 504,000 126,000
- 120 2,940 - 352,800
300 110 33,000 187,000
- 180 2,999 - 539,820
- 400 672 - 268,800
10 140 504 5,040 65,520
40 14 12,500 500,000 925,000
- 680 - -
- 1,600 - -
12 37 1,606 19,272 40,150
60 60 216 12,960 -
- 180 180 - 32,400
- 6,325 - -
240 420 375 90,000 180,000
- 28 297 - 8,316
- 270 122 - 32,940
3,100 84 260,400 579,600
37 22 5,460 202,020 835,380
110 1,496 164,560 463,760
- -
- 500 535 - 267,500
- 13 1,058 - 13,754
1 2 24,150 24,150 265,650
- 11,475 - 229,500
- 5 1,523 - 7,613
- 31 - -
- 27 1,890 - 51,030
- 8 4,200 - 33,600
- 40 321 - 12,840
- 210 308 - 218,680
- 58 8,728 - 506,224
200 1,200 666 133,200 666,000
30 3,582 107,460 214,920
- 3,582 - 322,380
18 48 2,250 40,500 67,500
9 6,298 56,682 132,258
1 6 14,771 14,771 73,855
3 7 38,594 115,782 154,376
- 200 2,400 - 480,000
100 119 11,900 464,100
- 500 205 - 102,500
- 2 7,549 - 15,098
- 1,000 79 - 79,000
- 1,200 110 - 132,000
- 300 335 - 435,500
200 600 837 167,400 2,008,800
- 9,500 - -
- 500 600 - 300,000
20 40 1,190 23,800 202,300
1,800 400 126 226,800 201,600
2 100,000 200,000 -
1 100,000 100,000 -
3 125,000 375,000 -
- 700 85 - 59,500
- 700 109 - 76,300
256 196 5,460 1,397,760 436,800
- 40 1,038 - 41,520
1 19 2,283 2,283 95,894
- 200 62 - 12,400
- 500 85 - 42,500
- 9 11,550 - 103,950
- 90 452 - 40,680
20 55 6,930 138,600 242,550
10 24 2,100 21,000 180,600
- 126,000 - -
- 2 47,000 - 94,000
- 90 1,131 - 441,090
800 60 48,000 12,000
330 630 174 57,420 52,200
- 150 1,574 - 236,100
15 15 17,604 264,060 - exp. Date
13 18 12,159 158,067 60,795
6,800 - 27,200
1 5,600 5,600 16,800

2 28,000 56,000 56,000
- 20 3,832 - 76,640
- 24 3,387 - 81,288
- 700 544 - 380,800
45 13,850 623,250 69,250
- 60 30,800 - 1,848,000
100 1,000 154 15,400 138,600
100 500 312 31,200 124,800
5 50 700 3,500 31,500
- 37 - -
- 150 192 - 28,835
- - -
1,800 110 198,000 550,000
- 26,400 - -
200 900 497 99,400 347,900
25 312 12,840 321,000 3,685,080
- 50 7,770 - 1,165,500
- - -
- - -
- 390,000 - -
2 2 125,000 250,000 -
- 17,500 - -
- 395,000 - -
- 242,000 - -
- 55,000 - -
- 176,000 - -
- 93,500 - -
- 34,000 - -
48,704 66,687 23,258,418 71,776,241
20 240 826 16,510 -
100 500 826 82,550 330,200
108 408 826 89,154 495,300
320 953 - 429,260
155 1,175 - 147,638
100 300 197 19,680 822,500
15 50 4,572 68,580 6,888
17 14 22,500 382,500 754,380

19 5 22,500 427,500 3,465,000
8,000 - -
8,000 - -
8,000 - -
80 1,300 104,000 960,000
50 1,300 65,000 195,000
50 1,300 65,000 260,000
65 8,085 - 214,500
50 8,085 404,250 404,250
50 8,085 404,250 404,250
165 8,085 - 1,334,025
101 4,445 - 816,585
68 18 4,064 276,352 666,750
2 34,000 - 28,448
1 2 24,000 24,000 204,000
14 7,900 110,600 624,000
1,800 - 158,000
3,800 - -
800 - -
100 1,100 110,000 160,000
13 13 9,400 122,200 11,000
1 13 16,000 16,000 112,800
1 10 25,000 25,000 144,000
1 3 130,000 130,000 150,000
2 439 878 1,040,000
439 - -
100 65 439 43,890 160,199
5 - 2,195
5 33,000 - -
5 27,830 - 165,000
4 60,500 - 111,320
30,000 - -
18 3,850 - 540,000
10 20 7,315 73,150 38,500
1 3 21,753 21,753 14,630
1 5 30,030 30,030 87,012
15,000 - -
15,000 - -
10,010 - -
49 3,000 - 490,490
46 3,000 - 138,000
49 3,000 - 147,000
9 - 27,000
49 3,000 - -
100 2,021 - 300,000
100 2,224 - 202,125
10 3,810 - 22,239
45 1,270 - 171,450
6,059 - -
6,059 - -
972 2,971 3,112,827 16,955,933
49,676 69,658 26,371,244 88,732,173
Pangkalan Kasai, 29 Februari 2015

Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
SALDO PERSEDIAAN PER 01 MARET -


No. Nama Obat
KEMASAN (31 Maret 2016 )
A Obat-Obat
1 Albendazol suspensi 200 mg/5 ml btl 50
2 Albendazol tab 400 mg tablet -
3 Alkohol 70 % 100 ml btl 2
4 ALKOHOL 70 % 1000 ml btl 19
5 Alopurinol tab 100 mg tablet -
6 Alopurinol tab 300 mg tablet 400
7 Alprazolam 0,5 mg tab tablet -
8 Ambroxol sirup btl -
9 Ambroxol tablet 30 mg tablet -
10 Aminofilin tab 200 mg tablet 1,050
11 Aminofilin injeksi 24 mg/ml ampul 34
12 Amitriptilin tab 25 mg tablet 600
13 Amlodipin 5 mg tab tablet -
15 Amobiotic Drop btl 8
16 Amoksisilin kapsul 250 mg kapsul 480
17 Amoksisilin kapsul 500 mg kapsul -
18 Amoksisilin syrup kering 125mg/5ml botol 5 ml 395
19 Amoksisilin serbuk injeksi 1g vial 10
20 Ampisilin 500 mg kap kapsul -
21 Ampisilin serbuk injeksi 500 mg/vial vial 10
22 Antalgin tablet 500 mg tablet -
23 Antalgin inj ampul -
24 Antasida DOEN I tablet kunyah tablet -
25 Antasida DOEN II Suspensi Komb btl 60 ml -
26 Anti bakteri salep komb tube 75
27 Antifungi DOEN komb salep pot 48
28 Antimigren: ergotamin tartrat 1mg +kofein 50mg tablet 200
Antihemoroid kombinasi Bismut Subgalat 150mg Heksaklorofen

29 -
2,5mg Lidokain 10mg Seng Oksida 120mg
30 Antithrom Jelly tube -
31 Aqua pro injeksi steril vial 19
32 Artemether injeksi 80 mg/ml ampul 12
33 Artesunate injeksi vial/ktk -
34 Asam askorbat ( vit c ) tablet 50 mg tablet -
35 Asam Folat tab 1 mg tablet -
36 Asam Mefenamat kaplet 250 mg kaplet 500
37 Asam Mefenamat kaplet 500 mg kaplet -
38 Asetosal tab 100 mg tablet -
40 Asiklovir krim 5% tube -
41 Asiklovir tab 200 mg tablet -
42 Asiklovir tab 400 mg tablet 400
43 Asonfen tab tablet -
44 Asifit tablet -
45 Asering tablet 80
46 Atropin sulfat injeksi ampul 30
47 Atropin sulfat tab 0,5 mg tablet 100
48 Bedak Salisil Serbuk 2 % bks 248
49 Beneuron tablet -
50 Benzatin benzil penisilin 1,2 jt UI inj vial 10
52 Besi II Sulfat 200 mg + as.Folat 0,25 mg tablet tablet 100
53 Betahistine Mesilat Tb, 6 Mg tablet -
54 Betametason krim 0,1% tube -
55 Bexicom tab kapsul -
56 Bisoprolol tablet 5 mg tablet 60
57 Brochifar tablet -
58 Bromiphar tablet 300
59 Budenosid resp -
60 Captopril tablet 12,5 mg tablet 1,500
61 Captopril tablet 25 mg tablet 1,700
63 Carbamazepin 200 mg tablet 1,000
64 Caltrak btl 13
65 Cefadroksil kap 500 mg kapsul -
66 Cefadroksil syrup kering 125 mg/5ml btl 60 ml 75
67 Cefaleksin kap 500 mg kapsul -
68 Cefixime syrup 100 mg/5 ml btl 30 ml 50
69 Cefixime kap 100 mg kapsul -

70 Cefotaxim 0,5 gr inj vial -
71 Cefotaxim 1 gr inj vial 30
72 Ceftriaxon injeksi 1 g vial -
73 Cetrizine tab 10 mg tablet -
74 Ciprofloxacin infs btl 100 ml -
75 Ciprofloxacin 500 mg kapsul 400
76 Cimetidin 200 mg tablet 400
77 Clindamycin 150 mg kap tablet 300
79 Clobazam tab 10 mg tablet 200
80 Chlorpheniramine maleat (CTM) 4 mg tablet 12,000
81 Cough En Plus Syrup btl 110
82 Dehaf sachet 18
83 Deksametason injeksi 5 mg/ampl ampul 60
84 Deksametason tablet 0,5 mg tablet 700
85 Diaform tablet 100
86 Diazepam 2 mg tab tablet -
87 Diazepam injeksi ampul 28
88 Difenhidramin Injeksi im, 10 mg/ml (HCl) ampul 80
89 Digoksin tablet 0,25 mg tablet -
90 Diltiazem tab 30 mg tablet 500
91 Dimenhidrinat tab tablet 500
92 Doksisiklin 100 mg kap tablet 100
93 Domperidone suspensi 5 mg/5 ml btl 60 ml 124
94 Domperidone 10 mg tab tablet 700
95 Domperidone drop 5mg / ml botol 5
96 Dumin Rectal 250 mg supp 15
98 Ekstrak beladon 10 mg tab tablet 400
99 Epinefrin injeksi ampul 76
100 Erytromicyn 250 mg kapsul -
101 Erythromisin 500 mg kap kapsul 600
102 Erytromicyn syrup 200 mg/5 ml btl 60 ml 319
103 Fenilbutason tab 200 mg tablet 900
104 Ferosulfat tab tablet 2,000
105 Flukonazol tab 150 mg kapsul 50
106 Fludane kapsul kapsul -
107 Fludane Plus tablet 500
108 Flutop C Syrup btl -
109 Furosemid Injeksi, im/iv, 10 mg/ml ampul 25

110 Furosemid tablet, 40 mg tablet 200
111 Fucilex Krim / Natrium Fucilat tube 36
112 Folic Acid tablet 400
113 Garam oralit untuk 200 ml air sachet 75
114 Geriavita kapsul -
115 Gentamisin salep kulit 0,1 % tube -
116 Gentamisin sulfat tetes mata 0,3 % btl 30
117 Gentamisin injeksi ampul 80
118 Gentian Violet larutan 1 % btl 10 ml 50
119 Glibenklamida tablet 5 mg tablet 400
120 Gliseril Gualakolat ( GG ) 100 mg tablet 7,200
121 Glukosa larutan infus 10 % steril 500 ml/btl -
122 Glukosa larutan infus 40 % steril amp -
123 Glukosa larutan infus 5 % steril 500 ml/btl 78
124 Grafula-DHA tablet -
125 Griseovulvin tablet 125 mg tablet 100
126 Haloperidol 0,5 mg tablet 800
128 Haloperidol 5 mg tablet 500
129 HB-Vit kaplet -
130 Hemafort tablet -
131 Hico Gel tube 40
132 Hidrokortison krim 2,5% tube 120
133 Hufabetamin Syrup btl 84
134 Hustab tablet 300
135 Hustadin Syrup btl -
136 Ibuprofen Suspensi 200 mg/ 5 ml btl 60 ml 225
137 Ibuprofen tablet 200 mg tablet 1,900
138 Ibuprofen tablet 400 mg tablet 200
139 Imunvit Plus Kap kaplet 120
140 Intibrox (Ambroksol) tablet 800
141 Intibrox (Ambroksol) Syrup botol 10
142 Isoniazid tab 100 mg tablet 500
143 Isorbitdinitrat tablet sublingul, 5 mg tablet 500
144 Jovial Sachet kaplet 20
145 KA EN 1 B botol 40
146 KA EN 3 A botol 40
147 KA EN MG 3 botol 40
148 Kalium Diklofenak 50 mg tablet -
149 Kalsium Laktat 500 mg tablet 2,300

150 Ketokenazole krim 2 % 10 gr tube 65
152 Ketokonazol 200 mg tablet 700
153 Ketorolac inj 10 mg ampul -
155 Klonidin 0,15 mg tablet 300
156 Kloramfenikol 250mg kaplet -
157 Kloramfenikol suspensi 125mg / 60ml ( Mefamicetin syrup ) botol -
158 Kloramfenikol tetes telinga 3% / 5ml botol -
159 Kloramfenikol salep mata 1% / 5ml tube 148
160 Kloroquin 150mg tablet 1,000
161 Klorpromazin tablet 100 mg tablet 300
162 Klorpromazin tablet 25 mg tablet 700
163 Klorpromazin inj 25mg/ml amp 60
164 Kodein tablet 10 mg tablet -
165 Kotrimoksazol DOEN I (Dewasa) tablet 4,200
166 Kotrimoksazol DOEN II (Pediatrik) tablet 1,500
167 Kotrimoksazol suspensi 60ml botol 250
Kombines : Ipratropium bromida inhalasi 0,5 mg Salbutamol 2,5

168 vial 60
mg ( Combivent UVB )
169 Lidokain injeksi 2% / 2ml ampul -
170 Lidokain + Epineprin injeksi 2% / 2ml ampul 170
171 Loperamid 2mg tablet 400
172 Magnesium sulfat injeksi (iv) 40% - 25ml vial 30
173 Mebendazol Syrup 100mg / 5ml botol 53

174 Mebendazol 100mg tablet 270
175 Megatic Emulgel tube 30
176 Metilergometrin 0,125 mg tablet 4,000
177 Metilergometrin injeksi ampul 380
178 Metilprednisolon injeksi 500 mg vial -
179 Metilprednisolon 4mg tablet 600
180 Metoklopramide 5mg tablet 600
181 Metoklopramide 10mg tablet 1,500
182 Metronidazol 250mg tablet -
183 Metronidazol 500mg tablet 500
184 Mikonazol krim 2% tube 105
185 Momethasone furoat krim 0,1 % tube 162
186 Mulsanol Drop btl -
187 Mulsanol Syrup btl 26
188 Nalget tablet 1,500

189 Natavit Soft Caps kapsul -
190 Natrium Diklofenat 25mg tablet -
192 Natrium Klorida larutan infus 0.9% steril 500ml botol 95
193 Neurodial kaplet 100
194 Nevirapin 200mg tablet 120
195 Nifedipin 10mg tablet 1,200
196 Nifedipin 20 mg ( Adalat Oros ) tablet 180
197 Nistatin tablet salut gula 500 000 IU/gram tablet 400
198 Nistatin vaginal tablet 100.000 IU/gram tablet 130
199 OBH sirup botol 64
200 Ofloxacin 400 mg tablet -
201 Oksitetrasiklin HCl salep mata 1% tube -
202 Oksitetrasiklin salep kulit 3% tube -
203 Omeprazol kapsul 20 mg kapsul -
204 Ondansentron 4mg tablet 180
205 Osteor plus kaplet -
206 Ostine kapsul 240
207 Otsu-KCL 7,46% ampul 28
208 Papaverin 40mg tablet 270
209 Parasetamol 500mg tablet 1,700
210 Parasetamol drops botol 63
211 Parasetamol syrup 120mg / 5ml botol 86
212 Pehavral tablet -
213 Penoksimetil Penisilin 500mg tablet 500

214 Penolgliserol tetes telinga 10% / 5ml botol -
215 Perak Sulfadiazin krim 1% (Burnazin) tube 3
216 Permetrin krim 5% (Scabicid) tube -
217 Pethidin injeksi ampul 3
218 Phenobarbital 30mg tablet -
219 Phenobarbital injeksi 50mg/ml ampul 27
220 Piracetam injeksi 3g / 15ml ampul 8
221 Piracetam 800mg tablet -
222 Pirantel Score (base ) 125mg tablet 710
223 Pirantel syrup 125mg / 5ml botol 50
224 Pitomenadion (Vit-K) 10mg tablet 900
225 Pitomenadion inj. 2mg ampul 60
227 Povidon Iodida 10% 30ml botol 20

231 Pravastatin 20mg tablet 200
232 Prednison 5mg tablet 3,300
233 Primakuin 15mg tablet 500
234 Prokain Benzil Penisilin inj 3jt UI/Vial vial 2
235 Propanolol HCl 10mg tablet 1,000
236 Propanolol 40mg tablet 1,200
237 Propiltiourasil 100mg tablet 800
238 Quantidex tablet 2,200
239 Quantidex syrup botol -
240 Ramipril 5mg tablet 500
241 Ranitidin inj 25mg / 2ml ampul 150
242 Ranitidin 150mg tablet -
243 Reagen Golongan Darah Anti A 10ml botol -
244 Reagen Golongan Darah Anti B 10ml botol -
245 Reagen Golongan Darah Anti D 10ml botol -
246 Reserpin 0,10mg tablet 700
247 Reserpin 0,25 mg tablet 700
248 Ringer Laktat larutan infus 500ml botol -
249 Risperidon 2mg tablet 40
250 Rivanol larutan 0,1% botol 28
251 Salbutamol 2mg (sebagai sulfat) tablet -
252 Salbutamol 4mg (sebagai sulfat) tablet 300
253 Salbutamol serbuk inh 200mcg/caps+rotahaler caps 9
254 Salbutamol serb inh 200 mcg/kaps tablet 90
255 Salbutamol cairan inh 0,1% (Ventolin Nebules) botol 35
256 Salep 2-4 pot 81
257 Serum Anti Tetanus ampul -
258 Serum Anti Bisa Ular amp 2
259 Sianokobalamin (vitamin B 12) injeksi ampul 390
260 Sianokobalamin (vitamin B 12) 50mcg tablet -
261 Simvastatin 10mg tablet -
262 Spiramisin 500mg tablet 150
263 Stesolid inj ampul -
264 Stesolid rectal tube supp -
265 Stick Asam Urat botol 3
266 Stick Glukosa botol 2
267 Stik Kolesterol botol -
268 Streptomisin injeksi 1 g/ml vial 20

269 Sulfasetamida Natrium TM 15% / 5ml botol 24
270 Sulfatdoksin 500mg tablet 700
271 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol -
275 Thiamin (Vitamin B1) injeksi 100mg / ml ampul 45
276 Thiamin Hcl (Vitamin B1) 50mg tablet -
277 Tramadol 50mg kapsul 150
278 Tuzalos kaplet -
279 Vitamin B Kompleks tablet 1,100
280 Vitaplex drop botol -
281 Zinc Disperibel tablet 600
282 Zink drop 10mg / 5ml botol 257
283 Zirkum Kid syrup 20mg / 5ml botol 150
B. OBAT GIGI -
1 Devitalisasi Pasta btl -
2 Etil klorida btl -
3 Eugenol Cairan btl -
4 Glass Ionomer btl -
5 Kalsium Hidroksi Pasta 2 tube/ktk -
6 Klorfenol kamfer menthol(CHKM) btl -
7 Mummifying pasta btl -
8 Semen seng fosfat set -
9 Temporary stoping fletcher set -
SISA OBAT GIGI DALAM RUPIAH 95,088
1 Alat suntik sekali pakai 1 ml set 580
6 Alkohol Swab CHG 0,5 % pcs 600
8 Catgut/benang bedah no. 3/0 pcs 156
9 Catgut/benang bedah no.2/0 pcs 149

13 Handscoon no 7 pcs -
14 Handscoon no 7,5 pcs 79
15 Handscoon no 8 pcs 50
17 I.V Catheter no.20 pcs -
18 I.V Catheter no.22 pcs -
21 Infusion set dewasa set -
22 Kapas berlemak 500 gram Bks 5
23 Kapas pembalut/absorben 250 gram Bks 5
24 Kasa Hidrofil 16x16 16 pcs/ktk 17
25 Kasa Hidrofil 40 x 40 pcs 20
28 Kasa Hidrofil 4 x 5 cm roll 200
29 Kasa Pembalut 2 x 80 cm Rol 5
32 Kasa hidrofil ukuran 36 x 80cm Rol 3
33 Lysol btl 6
35 Masker Tie On pcs 175
36 Oxycan btl 5
42 Semillas Non Woven Medical Tape (10 x 100cm) roll -

51 Surgical Blades No. 21 ( Bisturi ) pcs -
55 Urine bag pcs 10
SISA ALKES DALAM RUPIAH 4,392
SISA OBAT DAN ALKES DALAM RUPIAH 99,480
Mengetahui
Pangkalan Kasai

NIP 197507232008012007
PERSEDIAAN PER 01 MARET - 31 MARET 2016
Penyesuaian saldo
Jumlah Pengeluaran (
Penerimaan Pengeluaran SALDO per 29 Harga Harga Perolehan
Rp ) 01 Januari - 31
Februari 2016 Satuan Terakhir
Maret 2016
Maret Maret
50 4,041 - 202,050
350 - -
9 11 2,575 23,175 5,150
3 22 27,305 81,915 518,795
500 500 88 44,000 -
400 215 - 85,800
180 - -
2,598 - -
131 - -
1,050 82 - 86,100
34 4,013 - 136,442
600 117 - 70,200
192 - -
341 - -
20 28 23,100 462,000 184,800
720 1,200 210 151,200 100,800
1,000 1,000 270 270,000 -
220 615 2,500 550,000 987,500
10 7,766 - 77,660
400 - -
10 3,150 - 31,500
116 - -
1,400 - -
2,700 2,700 74 199,800 -
2,160 - -
75 150 2,641 198,075 198,075
48 2,001 - 96,050
200 142 - 28,400
30 30 3,200 96,000 -
4 4 35,200 140,800 -
19 2,100 - 39,900
12 23,100 - 277,200
38,999 - -
100 - -
50 - -
300 800 166 49,800 83,000
1,400 1,400 116 162,400 -
122 - -
170 - -
2,260 - -
700 700 239 167,300 -
400 345 - 138,000
1,000 1,000 140 140,000 -
30 30 - -
220 300 9,000 1,980,000 720,000
30 1,300 - 39,000
100 77 - 7,700
64 312 1,250 80,000 310,000
- -
10 10,290 - 102,900
20 14,070 - 281,400
100 43 - 4,300
970 - -
65 65 1,520 98,800 -
1,650 - -
60 669 - 40,140
478 - -
300 225 - 67,575
8,900 - -
600 2,100 62 37,200 93,000
500 2,200 89 44,500 151,300
100 2,300 141 14,100 310,200
1,000 257 - 257,000
4 17 27,500 110,000 357,500
300 300 519 155,700 -
65 140 5,064 329,160 379,800
1,100 - -
10 60 9,000 90,000 450,000
869 - -
5,247 - -
30 3,150 - 94,500
3,500 - -
186 - -
59,800 - -
600 1,000 260 156,000 104,000
500 900 120 60,000 48,000
300 379 - 113,700
600 570 - 342,000
200 900 - 180,000
4,000 16,000 53 212,000 636,000
10 120 23,000 230,000 2,530,000
18 9,167 - 165,000
20 80 1,659 33,180 99,540
2,900 3,600 64 185,600 44,800
1,500 1,600 - -
100 100 45 4,500 -
28 4,389 - 122,892
80 1,107 - 88,560
100 - -
500 134 - 67,000
500 104 - 52,000
100 285 - 28,500
50 174 3,410 170,500 422,840
100 800 170 17,000 119,000
5 16,350 - 81,750
15 16,280 - 244,200
10 11,660 - 116,600
400 33 - 13,306
76 8,505 - 646,380
497 - -
600 976 - 585,600
35 354 7,893 276,255 2,517,867
900 102 - 91,800
2,000 21 - 41,732
50 23,100 - 1,155,000
200 200 735 147,000 -
200 700 880 176,000 440,000
46 46 10,000 460,000 -
5 30 1,920 9,600 48,000

200 400 94 18,800 18,800
36 6,555 - 235,980
700 1,100 50 35,000 20,000
75 303 - 22,725
120 120 - -
1,469 - -
10 40 3,353 33,530 100,590
5 85 3,569 17,845 285,520
58 108 945 54,810 47,250
500 900 58 29,000 23,200
1,000 8,200 50 50,000 360,000
5,985 - -
2,577 - -
20 98 5,460 109,200 425,880
2,200 - -
100 230 - 23,000
800 100 - 80,000
500 61 - 30,500
500 1,000 72 36,000 36,000
240 240 2,167 520,000 -
- -
40 25,000 - 1,000,000
72 192 2,798 201,456 335,760
30 114 5,900 177,000 495,600
1,100 1,400 - -
16,500 - -
40 265 4,724 188,960 1,062,900
200 2,100 116 23,200 220,400
1,300 1,500 153 198,900 30,600
80 200 6,500 520,000 780,000
600 1,400 203 121,800 162,400
90 100 6,200 558,000 62,000
500 68 - 34,000
100 600 93 9,300 46,500
100 120 1,450 145,000 29,000
40 9,000 - 360,000
40 10,000 - 400,000
40 9,625 - 385,000
743 - -
500 2,800 73 36,500 167,900

15 80 2,569 38,535 166,985
120 4,930 - 591,600
250 950 310 77,500 217,000
24 24 1,697 40,728 -
2,539 - -
300 214 - 64,200
262 - -
5 5 3,865 19,325 -
1,679 - -
68 216 1,600 108,800 236,800
1,000 89 - 89,250
300 153 - 45,900
700 71 - 49,700
60 1,103 - 66,180
525 - -
500 4,700 145 72,500 609,000
1,500 75 - 112,500
70 320 2,222 155,540 555,500
60 879 - 52,740
879 - -
70 240 1,431 100,170 243,270
200 600 92 18,400 36,800
30 3,500 - 105,000
53 3,711 - 196,683
270 239 - 64,530
10 40 11,500 115,000 345,000
4,000 127 - 508,200
380 2,750 - 1,045,000
92,990 - -
600 210 - 126,000
600 108 - 64,800
1,500 105 - 157,500
113 - -
800 1,300 164 131,200 82,000
24 129 3,000 72,000 315,000
162 17,820 - 2,886,840
23 23 18,500 425,500 -
70 96 8,500 595,000 221,000
1,500 390 - 585,000

3,017 - -
141 - -
185 - -
1 96 4,935 4,935 468,825
100 1,260 - 126,000
120 2,940 - 352,800
500 1,700 110 55,000 132,000
180 2,999 - 539,820
400 672 - 268,800
130 504 - 65,520
10 74 12,500 125,000 800,000
680 - -
1,600 - -
25 25 1,606 40,150 -
216 - -
180 ### - 32,400
6,325 - -
240 480 375 90,000 90,000
28 297 - 8,316
270 122 - 32,940
5,200 6,900 84 436,800 142,800
90 153 5,460 491,400 343,980
224 310 1,496 335,104 128,656
- - -
500 535 - 267,500

13 13 1,058 13,754 -
8 11 24,150 193,200 72,450
20 20 11,475 229,500 -
2 5 1,523 3,045 4,568
31 - -
27 1,890 - 51,030
8 4,200 - 33,600
40 40 321 12,840 -
710 308 - 218,680
8 58 8,728 69,824 436,400
100 1,000 666 66,600 599,400
60 3,582 - 214,920
15 90 3,582 53,730 268,650
10 30 2,250 22,500 45,000
5 21 6,298 31,490 100,768

5 14,771 - 73,855
2 4 38,594 77,188 77,188
200 2,400 - 480,000
600 3,900 119 71,400 392,700
500 205 - 102,500
2 7,549 - 15,098
1,000 79 - 79,000
1,200 110 - 132,000
500 1,300 335 167,500 268,000
200 2,400 837 167,400 1,841,400
9,500 - -
500 600 - 300,000
20 170 1,190 23,800 178,500
1,600 1,600 126 201,600 -
100,000 - -
100,000 - -
125,000 - -
700 85 - 59,500
700 109 - 76,300
80 80 5,460 436,800 -
40 1,038 - 41,520
14 42 2,283 31,965 63,929
200 200 62 12,400 -
200 500 85 17,000 25,500
9 11,550 - 103,950
90 452 - 40,680
35 6,930 - 242,550
5 86 2,100 10,500 170,100
126,000 - -
2 47,000 - 94,000
390 1,131 - 441,090
200 200 60 12,000 -
300 300 174 52,200 -
150 1,574 - 236,100
17,604 - -
5 5 12,159 60,795 -
1 4 6,800 6,800 20,400
1 3 5,600 5,600 11,200
2 2 28,000 56,000 -
20 3,832 - 76,640
24 3,387 - 81,288
700 544 - 380,800
5 5 13,850 69,250 -
60 30,800 - 1,848,000
900 154 - 138,600
400 312 - 124,800
45 700 - 31,500
37 - -
150 192 - 28,835
- -
3,900 5,000 110 429,000 121,000
26,400 - -
100 700 497 49,700 298,200
30 287 12,840 385,200 3,299,880
150 7,770 - 1,165,500
- -
- -
390,000 - -
125,000 - -
17,500 - -
395,000 - -
242,000 - -
55,000 - -
176,000 - -
93,500 - -
34,000 - -
- 45,075 140,163 17,487,029 54,289,212
140 720 826 115,570 478,790
220 400 826 181,610 148,590
60 600 826 49,530 445,770
520 953 - 495,300
155 1,175 - 182,125
100 700 197 19,680 118,080
35 4,572 - 160,020
9 165 22,500 202,500 3,510,000
5 154 22,500 112,500 3,352,500
8,000 - -
8,000 - -
8,000 - -
120 120 1,300 156,000 -
71 150 1,300 92,300 102,700
150 200 1,300 195,000 65,000
5 165 8,085 40,425 1,293,600
50 50 8,085 404,250 -
50 50 8,085 404,250 -
165 8,085 - 1,334,025
101 4,445 - 448,945
150 150 4,064 609,600 -
2 7 34,000 68,000 170,000
1 6 24,000 24,000 120,000
9 26 7,900 71,100 134,300
20 1,800 - 36,000
3,800 - -
800 - -
200 1,100 - 220,000
5 10 9,400 47,000 47,000
12 16,000 - 192,000
2 9 25,000 50,000 175,000
3 6 130,000 390,000 390,000
2 8 439 878 2,633
439 - -
190 365 439 83,391 76,808
5 - -
5 33,000 - 165,000
5 27,830 - 139,150
4 60,500 - 242,000
30,000 - -
18 3,850 - 69,300
10 10 7,315 73,150 -
2 21,753 - 43,506
2 4 30,030 60,060 60,060
15,000 - -
15,000 - -
10,010 - -
1 49 3,000 3,000 144,000
46 3,000 - 138,000
49 3,000 - 147,000
9 9 - -
21 49 3,000 63,000 84,000
100 2,021 - 202,125
100 2,224 - 222,390
10 3,810 - 38,100
45 1,270 - 57,150
6,059 - -
6,059 - -
- 1,387 5,779 3,516,794 15,450,967
- 46,462 145,942 21,003,822 69,740,179
Pangkalan Kasai, 31 Maret 2015

Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
Keterangan
exp. Date
exp. Date 100
esxp. Date
esxp. Date
exp. Date
SALDO PERSEDIAAN PER 01 APRIL - 30 A

No. Nama Obat
KEMASAN (30 April 2016 )
A Obat-Obat
6 Alopurinol tab 300 mg tablet 1,300
8 Alprazolam 1 mg tab tablet 300
11 Aminofilin tab 200 mg tablet 1,050

17 Amoksisilin kapsul 250 mg kapsul 1,440
25 Antasida DOEN I tablet kunyah tablet 400
26 Antasida DOEN II Suspensi Komb btl 60 ml 175

30 10
35 Asam askorbat ( vit c ) tablet 50 mg tablet -
45 Asifit tablet 240
46 Asering tablet -
51 Benzatin benzil penisilin 1,2 jt UI inj vial -
55 Betametason krim 0,1% tube 75
57 Bisoprolol tablet 5 mg tablet 60
59 Bromiphar tablet -
60 Budenosid resp -
64 Carbamazepin 200 mg tablet 1,000
65 Caltrak btl 21
69 Cefixime syrup 100 mg/5 ml btl 30 ml 40

73 Ceftriaxon injeksi 1 g vial 4
76 Ciprofloxacin 500 mg kapsul 438
77 Cimetidin 200 mg tablet -
82 Chloramfenikol 250 mg kaplet -
83 Chloramfenikol suspensi 125mg / 60ml ( Mefamicetin syrup ) botol 85
84 Chloramfenikol tetes telinga 3% / 5ml botol -
85 Chloramfenikol salep mata 1% / 5ml tube 268
86 Chloroquin 150 mg tablet 1,000
87 Chlorpromazin tablet 100 mg tablet 300
89 Chlorpromazin inj 25mg/ml amp 60
90 Cotrimoksazol DOEN I (Dewasa) tablet 3,500
91 Cotrimoksazol DOEN II (Pediatrik) tablet 1,500
92 Cotrimoksazol suspensi 60ml botol 425
94 Dehaf sachet 306
96 Deksametason tablet 0,5 mg tablet 3,400
97 Diaform tablet 1,430

118 Fludane kapsul kapsul 748
119 Fludane Plus tablet 1,296
125 Garam oralit untuk 200 ml air sachet 1,275
126 Geriavita kapsul 210
141 HB-Vit kaplet 120
142 Hemafort tablet 500
146 Hustab tablet 1,400
149 Ibuprofen tablet 200 mg tablet 2,553

151 Imunvit Plus Kap kaplet 120
152 Intibrox (Ambroksol) tablet 400
153 Intibrox (Ambroksol) Syrup botol -
161 Kalsium Laktat 500 mg tablet 1,900
168 Kodein tablet 10 mg tablet 400

Kombines : Ipratropium bromida inhalasi 0,5 mg Salbutamol 2,5
169 vial 60
mg ( Combivent UVB )
172 Levofloksasin 500 mg 150
173 Loratidin 10 mg 300
182 Metilprednisolon 4mg tablet 2,600
184 Metoklopramide 10mg tablet 1,400
186 Metronidazol 500mg tablet 400
187 Mikonazol krim 2% tube 81
189 Mulsanol Drop btl 20
190 Mulsanol Syrup btl 72

192 Natavit Soft Caps kapsul 180
198 Nifedipin 10mg tablet 600
218 Perak Sulfadiazin krim 1% (Burnazin) tube -
225 Pirantel Score (base ) 125mg tablet 710

234 Pravastatin 20mg tablet 200
235 Prednison 5mg tablet 2,300
238 Propanolol HCl 10mg tablet 1,000
243 Quinine tablet 120
246 Ranitidin 150mg tablet 1,960
247 Reagen Golongan Darah Anti A 10ml botol 2
248 Reagen Golongan Darah Anti B 10ml botol 2
249 Reagen Golongan Darah Anti D 10ml botol 2
262 Serum Anti Bisa Ular amp 2
265 Simvastatin 10mg tablet 1,350
268 Stesolid rectal tube supp 10

273 Sulfasetamida Natrium TM 15% / 5ml botol 24
275 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol 100
B. OBAT GIGI -

12 Folley Catheter no 20W pcs 5
21 Infusion set dewasa set 200
33 Lysol btl 6
34 Masker ear lopp pcs 7
35 Masker Tie On pcs -
36 Oxycan btl 400
40 Plester 5 yard x 2 inch Rol 4
45 Silk ( benang bedah sutera ) no. 3/0 pcs 4
47 Stomach Tube pcs 81
48 Surgical Blades No. 10 pcs -

51 Surgical Blades No. 21 ( Bisturi ) pcs 48
52 Surgical Blades No. 23 pcs -
55 Urine bag pcs 100
57 wing nedle No.21 pcs 195
Mengetahui
Pangkalan Kasai
NIP 197507232008012007
SALDO PERSEDIAAN PER 01 APRIL - 30 APRIL 2016
Penyesuaian saldo
Penerimaan Pengeluaran Jumlah Pengeluaran (

SALDO per 31 Harga Perolehan
Harga Satuan Rp ) 01April - 30
Maret 2016 Terakhir
April 2016
April April
- - 50 4,041 - 202,050
- - - 350 - -
24 1 2 2,575 2,575 64,375
- 3 19 27,305 81,915 436,880
100 - - 88 - 8,800
1,000 100 400 215 21,450 278,850
- - - 180 - -
500 200 - 233 46,600 69,900
- - - 2,598 - -
- - - 131 - -
- - 1,050 82 - 86,100
- - 34 4,013 - 136,442
- 100 600 117 11,700 58,500
- - - 192 - -
- - - 341 - -
50 33 8 23,100 762,300 577,500
2,400 1,440 480 210 302,400 302,400
2,000 1,000 - 270 270,000 270,000
200 160 395 2,500 400,000 1,087,500
- - 10 7,766 - 77,660
- - - 400 - -
- - 10 3,150 - 31,500
- - - 116 - -
- - - 1,400 - -
3,000 2,600 - 74 192,400 29,600
300 125 - 2,160 270,000 378,000
100 100 75 2,641 264,100 198,075
- - 48 2,001 - 96,050
- - 200 142 - 28,400
20 10 - 3,200 32,000 32,000

- - - 35,200 - -
100 - 19 2,100 - 249,900
- - 12 23,100 - 277,200
- - - 38,999 - -
1,000 1,000 - 100 100,000 -
- - - 50 - -
200 700 500 166 116,200 -
1,000 1,000 - 116 116,000 -
- - - 122 - -
- - - 170 - -
- - - 2,260 - -
200 - - 239 - 47,800
- 200 400 345 69,000 69,000
- - - 140 - -
300 60 - - -
100 180 80 9,000 1,620,000 -
- - 30 1,300 - 39,000
- - 100 77 - 7,700
- 10 248 1,250 12,500 297,500
- - - - -
- 10 10 10,290 102,900 -
- - 20 14,070 - 281,400
- - 100 43 - 4,300
- - - 970 - -
100 25 - 1,520 38,000 114,000
- - - 1,650 - -
- - 60 669 - 40,140
- - - 478 - -
- 300 300 225 67,575 -
- - - 8,900 - -
2,000 700 1,500 62 43,400 173,600
2,000 800 1,700 89 71,200 258,100
- 100 2,200 141 14,100 296,100
- - 1,000 257 - 257,000
30 22 13 27,500 605,000 577,500
- - - 519 - -
100 60 75 5,064 303,840 582,360
- - - 1,100 - -
- 10 50 9,000 90,000 360,000
- - - 869 - -
- - - 5,247 - -
10 10 30 3,150 31,500 94,500
10 6 - 3,500 21,000 14,000
- - - 186 - -
- - - 59,800 - -
1,000 962 400 260 250,120 113,880
- 400 400 120 48,000 -
- - 300 379 - 113,700
- - 600 570 - 342,000
- - 200 900 - 180,000
15,000 2,500 12,000 53 132,500 1,298,500
- - - 262 - -
100 15 - 3,865 57,975 328,525
- - - 1,679 - -
120 - 148 1,600 - 428,800
- - 1,000 89 - 89,250
- - 300 153 - 45,900
- - 700 71 - 49,700
- - 60 1,103 - 66,180
- 700 4,200 145 101,500 507,500
- - 1,500 75 - 112,500
200 25 250 2,222 55,550 944,350
50 19 110 23,000 437,000 3,243,000
288 - 18 9,167 - 2,805,000
100 - 60 1,659 - 265,440
5,000 2,300 700 64 147,200 217,600
1,500 170 100 - -
- - - 45 - -
- - 28 4,389 - 122,892
- - 80 1,107 - 88,560
- - - 100 - -
- - 500 134 - 67,000
- - 500 104 - 52,000
- - 100 285 - 28,500
150 50 124 3,410 170,500 763,840
300 400 700 170 68,000 102,000
20 5 5 16,350 81,750 327,000
20 - 15 16,280 - 569,800
20 - - 11,660 - 233,200
- 10 400 33 333 12,973

- 5 76 8,505 42,525 603,855
- - - 497 - -
- - 600 976 - 585,600
- 10 319 7,893 78,930 2,438,937
- - 900 102 - 91,800
4,000 1,010 2,000 21 21,075 104,121
- - 50 23,100 - 1,155,000
1,000 252 - 735 185,220 549,780
1,000 204 500 880 179,520 1,140,480
- - - 10,000 - -
- - 25 1,920 - 48,000
400 - 200 94 - 56,400
48 - 36 6,555 - 550,620
- - 400 50 - 20,000
1,200 - 75 303 - 386,325
300 90 - - -
- - - 1,469 - -
- - 30 3,353 - 100,590
- - 80 3,569 - 285,520
50 - 50 945 - 94,500
300 - 400 58 - 40,600
5,000 300 7,200 50 15,000 595,000
- - - 5,985 - -
- - - 2,577 - -
- - 78 5,460 - 425,880
- - - 2,200 - -
- - 100 230 - 23,000
- - 800 100 - 80,000
- - 500 61 - 30,500
- - 500 72 - 36,000
300 180 - 2,167 390,000 260,000
1,000 500 - - -
- - 40 25,000 - 1,000,000
48 24 120 2,798 67,152 402,912
60 24 84 5,900 141,600 708,000
1,200 100 300 - -
- - - 16,500 - -
200 22 225 4,724 103,928 1,903,772
2,000 1,347 1,900 116 156,252 296,148
2,000 1,400 200 153 214,200 122,400

200 200 120 6,500 1,300,000 780,000
- 400 800 203 81,200 81,200
- 10 10 6,200 62,000 -
- - 500 68 - 34,000
- - 500 93 - 46,500
200 - 20 1,450 - 319,000
- - 40 9,000 - 360,000
- - 40 10,000 - 400,000
- - 40 9,625 - 385,000
- - - 743 - -
- 400 2,300 73 29,200 138,700
- 25 65 2,569 64,225 102,760
- 24 120 4,930 118,320 473,280
300 150 700 310 46,500 263,500
- - - 1,697 - -
- - - 2,539 - -
- - 300 214 - 64,200
400 - - 525 - 210,000
- - 60 879 - 52,740
- - - 879 - -
150 60 170 1,431 85,860 372,060
300 150 - 554 83,100 83,100
300 - - 162 - 48,600
500 - 400 92 - 82,800
- - 30 3,500 - 105,000
- - 53 3,711 - 196,683
- - 270 239 - 64,530
20 - 30 11,500 - 575,000
- 100 4,000 127 12,705 495,495
- - 380 2,750 - 1,045,000
- - - 92,990 - -
2,000 - 600 210 - 546,000
- - 600 108 - 64,800
- 100 1,500 105 10,500 147,000
- - - 113 - -
- 100 500 164 16,400 65,600
- 24 105 3,000 72,000 243,000
- - 162 17,820 - 2,886,840
50 30 - 18,500 555,000 370,000
96 50 26 8,500 425,000 612,000

600 - 1,500 390 - 819,000
300 120 - 3,017 362,000 543,000
- - - 141 - -
- - - 185 - -
- 2 95 4,935 9,870 458,955
500 300 100 1,260 378,000 378,000
- - 120 2,940 - 352,800
- 600 1,200 110 66,000 66,000
- - 180 2,999 - 539,820
- - 400 672 - 268,800
- - 130 504 - 65,520
- 11 64 12,500 137,500 662,500
- - - 680 - -
- - - 1,600 - -
- - - 1,606 - -
- - - 216 - -
- - 180 ### - 32,400
- - - 6,325 - -
- - 240 375 - 90,000
- - 28 297 - 8,316
- - 270 122 - 32,940
10,000 3,600 1,700 84 302,400 680,400
224 87 63 5,460 475,020 1,092,000
336 208 86 1,496 311,168 320,144
500 500 - - -
- - 500 535 - 267,500
- - - 1,058 - -
- 3 3 24,150 72,450 -
- - - 11,475 - -
- - 3 1,523 - 4,568
- - - 31 - -
- - 27 1,890 - 51,030
- - 8 4,200 - 33,600
- - - 321 - -
- - 710 308 - 218,680
- - 50 8,728 - 436,400
- - 900 666 - 599,400
- - 60 3,582 - 214,920
- - 75 3,582 - 268,650
100 4 20 2,250 9,000 261,000

14 7 16 6,298 44,086 144,854
5 - 5 14,771 - 147,710
5 - 2 38,594 - 270,158
- - 200 2,400 - 480,000
- 1,000 3,300 119 119,000 273,700
- - 500 205 - 102,500
- - 2 7,549 - 15,098
- - 1,000 79 - 79,000
- - 1,200 110 - 132,000
- - 800 335 - 268,000
1,000 - 2,200 837 - 2,678,400
- - - 9,500 - -
- - 120 704 - 84,480
- - 500 600 - 300,000
- 40 150 1,190 47,600 130,900
3,000 1,040 - 126 131,040 246,960
2 - - 100,000 - 200,000
2 - - 100,000 - 200,000
2 - - 125,000 - 250,000
- - 700 85 - 59,500
- - 700 109 - 76,300
- - - 5,460 - -
- - 40 1,038 - 41,520
24 - 28 2,283 - 118,726
400 100 - 62 6,200 18,600
- 10 300 85 850 24,650
20 - 9 11,550 - 334,950
200 90 90 452 40,680 90,400
- 20 35 6,930 138,600 103,950
- 1 81 2,100 2,100 168,000
- - - 126,000 - -
- - 2 47,000 - 94,000
- - 390 1,131 - 441,090
- - - 60 - -
1,500 150 - 174 26,100 234,900
- - 150 1,574 - 236,100
- - - 17,604 - -
10 - - 12,159 - 121,590
3 4 3 6,800 27,200 13,600
4 4 2 5,600 22,400 11,200

4 4 - 28,000 112,000 -
- - 20 3,832 - 76,640
- - 24 3,387 - 81,288
- 100 700 544 54,400 326,400
100 - - 13,850 - 1,385,000
- - 60 30,800 - 1,848,000
- - 900 154 - 138,600
- - 400 312 - 124,800
- - 45 700 - 31,500
- - - 37 - -
- - 150 192 - 28,835
- - - - -
6,800 3,100 1,100 110 341,000 528,000
- - 26,400 - -
- 100 600 497 49,700 248,500
- 10 257 12,840 128,400 3,171,480
- 20 150 7,770 155,400 1,010,100
- - - - -
- - - - -
- - - 390,000 - -
- - - 125,000 - -
- - - 17,500 - -
- - - 395,000 - -
- - - 242,000 - -
- - - 55,000 - -
- - - 176,000 - -
- - - 93,500 - -
- - - 34,000 - -
90,989 37,147 95,198 15,757,658 73,819,721
- - 580 826 - 478,790
- - 180 826 - 148,590
- 120 540 826 99,060 346,710
- 15 520 953 14,288 481,013
- - 155 1,175 - 182,125
- 200 600 197 39,360 78,720
100 35 35 4,572 160,020 457,200
- 24 156 22,500 540,000 2,970,000

- 24 149 22,500 540,000 2,812,500
- - - 8,000 - -
- - - 8,000 - -
5 - - 8,000 - 40,000
150 - - 1,300 - 195,000
200 229 79 1,300 297,700 65,000
250 100 50 1,300 130,000 260,000
- 60 160 8,085 485,100 808,500
200 50 - 8,085 404,250 1,212,750
200 50 - 8,085 404,250 1,212,750
- - 165 8,085 - 1,334,025
- 10 101 4,445 44,450 404,495
200 - - 4,064 - 812,800
6 - - 34,000 - 204,000
- - 5 24,000 - 120,000
6 1 5 7,900 7,900 79,000
40 6 17 1,800 10,800 91,800
10 - 20 3,800 - 114,000
- - - 800 - -
100 - - 1,100 - 110,000
50 - 200 9,400 - 2,350,000
8 - 5 16,000 - 208,000
- - 12 25,000 - 300,000
- - 7 130,000 - 910,000
4 1 3 439 439 2,633
5 4 6 439 1,756 3,072
- - - 439 - -
500 275 175 - -
- - 5 33,000 - 165,000
- - 5 27,830 - 139,150
- - 5 60,500 - 302,500
- - 4 30,000 - 120,000
- - - 3,850 - -
- 8 18 7,315 58,520 73,150
50 - - 21,753 - 1,087,650
5 - 2 30,030 - 210,210
5 3 2 15,000 45,000 60,000
144 36 - 15,000 540,000 1,620,000
96 15 - 10,010 150,150 810,810
- - - 3,000 - -
- - 48 3,000 - 144,000
- - 46 3,000 - 138,000
- 1 49 - -
- - - 3,000 - -
100 - 28 2,021 - 258,720
- - 100 2,224 - 222,390
- - 100 3,810 - 381,000
- - 10 1,270 - 12,700
150 - 45 6,059 - 1,181,505
- - - 6,059 - -
- - -
2,584 1,267 4,392 3,973,042 25,720,258
93,573 38,414 99,590 19,730,700 99,539,979
Pangkalan Kasai, 30 April 2016
Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
Keterangan
Exp. Date
SALDO PERSEDIAAN PER 01 MEI - 31
Penyesuaian saldo
SATUAN Saldo hasil Cek Fisik Penerimaan

No. Nama Obat
KEMASAN (31 Mei 2016 )
Mei
A Obat-Obat
1 Albendazol suspensi 200 mg/5 ml btl 350 300

4 ALKOHOL 70 % 1000 ml btl 16 -
6 Alopurinol tab 300 mg tablet 1,300 -
8 Alprazolam 1 mg tab tablet 600 500
11 Aminofilin tab 200 mg tablet 1,000 -
16 Amobiotic Drop btl 45 50
18 Amoksisilin kapsul 500 mg kapsul - -
19 Amoksisilin syrup kering 125mg/5ml botol 5 ml 400 300
22 Ampisilin serbuk injeksi 500 mg/vial vial 10 -
25 Antasida DOEN I tablet kunyah tablet - -
26 Antasida DOEN II Suspensi Komb btl 60 ml 130 300
27 Anti bakteri salep komb tube 125 150
30 supp -
-
31 Antithrom Jelly tube - -
35 Asam askorbat ( vit c ) tablet 50 mg tablet 3,000 5,000
37 Asam Mefenamat kaplet 250 mg kaplet - -
42 Asiklovir tab 200 mg tablet - -
44 Asonfen tab tablet - -
45 Asifit tablet 210 -
46 Asering tablet - -
51 Benzatin benzil penisilin 1,2 jt UI inj vial - -
55 Betametason krim 0,1% tube 90 100
57 Bisoprolol tablet 5 mg tablet - -
59 Bromiphar tablet - -
60 Bronsolvan 150 mg tablet 500 500
61 Budenosid resp - -
62 Captopril tablet 12,5 mg tablet 1,400 -
65 Carbamazepin 200 mg tablet 600 -
66 Caltrak btl - -
67 Cefadroksil kap 500 mg kapsul - -
68 Cefadroksil syrup kering 125 mg/5ml btl 60 ml 75 -
70 Cefixime syrup 100 mg/5 ml btl 30 ml 10 -
73 Cefotaxim 1 gr inj vial 30 -
77 Ciprofloxacin 500 mg kapsul - -
78 Cimetidin 200 mg tablet - -
79 Clindamycin 150 mg kap tablet 200 -
82 Chlorpheniramine maleat (CTM) 4 mg tablet 16,500 -
83 Chloramfenikol 250 mg kaplet - -
84 Chloramfenikol suspensi 125mg / 60ml ( Mefamicetin syrup ) botol 85 -
85 Chloramfenikol tetes telinga 3% / 5ml botol - -
86 Chloramfenikol salep mata 1% / 5ml tube 248 -
87 Chloroquin 150 mg tablet 1,000 -
88 Chlorpromazin tablet 100 mg tablet 300 -
90 Chlorpromazin inj 25mg/ml amp 60 -
91 Cotrimoksazol DOEN I (Dewasa) tablet 3,400 -
92 Cotrimoksazol DOEN II (Pediatrik) tablet 1,500 -
93 Cotrimoksazol suspensi 60ml botol 295 -
94 Cough En Plus Syrup btl 91 -
97 Deksametason tablet 0,5 mg tablet 7,000 10,000
98 Diaform tablet 930 -
99 Diazepam 2 mg tab tablet - -
106 Domperidone suspensi 5 mg/5 ml btl 60 ml 134 -
107 Domperidone 10 mg tab tablet 1,500 1,000
108 Domperidone drop 5mg / ml botol 30 20
109 Dumin Rectal 250 mg supp 30 -
112 Epinefrin injeksi ampul 71 -
114 Erythromisin 500 mg kap kapsul 400 -
115 Erytromicyn syrup 200 mg/5 ml btl 60 ml 259 -
117 Ferosulfat tab tablet 13,000 10,000
119 Fludane kapsul kapsul 1,500 1,000
120 Fludane Plus tablet 1,296 -
121 Flutop C Syrup btl - -
124 Fucilex Krim / Natrium Fucilat tube 60 -
125 Folic Acid tablet 400 -
126 Garam oralit untuk 200 ml air sachet 1,200 -
127 Geriavita kapsul 90 -
130 Gentamisin injeksi ampul 80 -
131 Gentian Violet larutan 1 % btl 10 ml 100 -
132 Glibenklamida tablet 5 mg tablet 800 500
133 Gliseril Gualakolat ( GG ) 100 mg tablet 5,000 -
141 Haloperidol 5 mg tablet 500 -
142 HB-Vit kaplet 120 -
143 Hemafort tablet 500 -
144 Hico Gel tube 40 -
146 Hufabetamin Syrup btl 95 -
147 Hustab tablet 1,000 -
149 Ibuprofen Suspensi 200 mg/ 5 ml btl 60 ml 303 -
150 Ibuprofen tablet 200 mg tablet 1,200 -
152 Imunvit Plus Kap kaplet 40 -
153 Intibrox (Ambroksol) tablet - -
154 Intibrox (Ambroksol) Syrup botol - -
158 KA EN 1 B botol 20 -
159 KA EN 3 A botol 20 -
162 Kalsium Laktat 500 mg tablet 1,100 -
165 Ketokonazol 200 mg tablet 750 -
169 Kodein tablet 10 mg tablet 400 -
Kombines : Ipratropium bromida inhalasi 0,5 mg Salbutamol 2,5 mg (

170 vial 60
Combivent UVB )
-
172 Lidokain + Epineprin injeksi 2% / 2ml ampul 210 -
173 Levofloksasin 500 mg tablet 150 -
174 Loratidin 10 mg tablet 600 500
179 Megatic Emulgel tube 40 -
180 Metilergometrin 0,125 mg tablet 3,700 -
181 Metilergometrin injeksi ampul 380 -
183 Metilprednisolon 4mg tablet 1,000 -
185 Metoklopramide 10mg tablet 1,000 -
187 Metronidazol 500mg tablet 200 -
188 Mikonazol krim 2% tube 24 -
189 Momethasone furoat krim 0,1 % tube 162 -
190 Mulsanol Drop btl 50 30
191 Mulsanol Syrup btl 27 -
192 Nalget tablet 2,100 -
193 Natavit Soft Caps kapsul - -
196 Natrium Klorida larutan infus 0.9% steril 500ml botol - -
197 Neurodial kaplet 600 500
199 Nifedipin 10mg tablet 300 -
200 Nifedipin 20 mg ( Adalat Oros ) tablet 180 -
203 OBH sirup botol 23 -
206 Oksitetrasiklin salep kulit 3% tube - -
208 Ondansentron 4mg tablet 90 -
210 Ostine kapsul 120 -
218 Penolgliserol tetes telinga 10% / 5ml botol - -
219 Perak Sulfadiazin krim 1% (Burnazin) tube - -
220 Permetrin krim 5% (Scabicid) tube - -
221 Pethidin injeksi ampul 3 -
224 Piracetam injeksi 3g / 15ml ampul 8 -
225 Piracetam 800mg tablet - -
226 Pirantel Score (base ) 125mg tablet 1,610 900
228 Pitomenadion (Vit-K) 10mg tablet 900 -
229 Pitomenadion inj. 2mg ampul 60 -
235 Pravastatin 20mg tablet - -
236 Prednison 5mg tablet 500 -
237 Primakuin 15mg tablet 500 -
239 Propanolol HCl 10mg tablet 700 -
241 Propiltiourasil 100mg tablet 800 -
242 Quantidex tablet 3,200 -
244 Quinine tablet 120 -
245 Ramipril 5mg tablet 500 -
246 Ranitidin inj 25mg / 2ml ampul 90 -
247 Ranitidin 150mg tablet 1,500 2,000
248 Reagen Golongan Darah Anti A 10ml botol 2 -
249 Reagen Golongan Darah Anti B 10ml botol 2 -
250 Reagen Golongan Darah Anti D 10ml botol 2 -
253 Ringer Laktat larutan infus 500ml botol - -
255 Rivanol larutan 0,1% botol 48 -
260 Salbutamol cairan inh 0,1% (Ventolin Nebules) botol 15 -
261 Salep 2-4 pot 80 -
263 Serum Anti Bisa Ular amp - -
264 Sianokobalamin (vitamin B 12) injeksi ampul 380 -
265 Sianokobalamin (vitamin B 12) 50mcg tablet - -
266 Simvastatin 10mg tablet 1,260 -
271 Stick Glukosa botol 5 4
272 Stik Kolesterol botol - 4
273 Streptomisin injeksi 1 g/ml vial 20 -
274 Sulfasetamida Natrium TM 15% / 5ml botol - -
276 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol 100 -
277 Tamsulosin SR 0,4mg (Harnal OCAS) tablet 60 -
278 Tetrasiklin 250mg kapsul 900 -
280 Thiamin (Vitamin B1) injeksi 100mg / ml ampul 45 -
287 Zink drop 10mg / 5ml botol 323 176
288 Zirkum Kid syrup 20mg / 5ml botol 95 -
- -
B. OBAT GIGI - -
1 Alat suntik sekali pakai 1 ml set 530 -

2 Alat suntik sekali pakai 2,5 ml pcs 40 -
3 Alat suntik sekali pakai 3 ml pcs 50 -
6 Alkohol Swab CHG 0,5 % pcs 200 -
7 Blood Transfusion Set pcs 70 -
8 Catgut/benang bedah no. 3/0 pcs 110 -
9 Catgut/benang bedah no.2/0 pcs 117 -
10 Folley Catheter no 16W pcs 5 5
13 Handscoon no 7 pcs - 200
14 Handscoon no 7,5 pcs 140 200
16 I.V Catheter no.18 pcs 90 -
20 Infusion set anak set 81 -
21 Infusion set dewasa set 200 -
22 kapas pembalut berlemak 500 mg Bks 5 -
23 Kapas berlemak 500 gram Bks 3 -
24 Kapas pembalut/absorben 250 gram Bks 10 -
25 Kasa Hidrofil 16x16 16 pcs/ktk 34 -
26 Kasa Hidrofil 40 x 40 pcs 30 -
27 Kasa Hidrofil 4 x 15 cm roll - -
29 Kasa Hidrofil 4 x 5 cm roll 250 -
30 Kasa Pembalut 2 x 80 cm Rol 12 -
31 Kasa Pembalut Elastis 3 Inchi Rol 12 -
33 Kasa hidrofil ukuran 36 x 80cm Rol 4 -
34 Lysol btl 5 -
35 Masker ear lopp pcs - -
36 Masker Tie On pcs 300 -
37 Oxycan btl 2 -
38 Pembalut elastis 10 cm x 4.55m pcs 5 -
39 Pembalut elastis 7.5 cm x 4.55m pcs 5 -
40 Pembalut Gips 6 Inchi Rol 4 -
41 Plester 5 yard x 2 inch Rol - -
42 Semillas Non Woven Medical Tape (5 x 100cm) roll 10 -
46 Silk ( benang bedah sutera ) no. 3/0 pcs 36 -
48 Stomach Tube pcs - -
49 Surgical Blades No. 10 pcs 48 -
52 Surgical Blades No. 21 ( Bisturi ) pcs - -
54 Transparent IV Dressing ( anak ) 4,4 x 4,4 cm pcs 100 -
55 Transparent IV Dressing ( Dewasa) 6 x 7 cm pcs 100 -
56 Urine bag pcs 10 -
57 Umbilical Cord Klem Steril Nylon pcs 150 -
58 wing nedle No.21 pcs - -
-
SISA ALKES DALAM RUPIAH 4,332 815
Mengetahui
Pangkalan Kasai
NIP 197507232008012007
IAAN PER 01 MEI - 31 MEI 2016
Penyesuaian saldo
Pengeluaran Jumlah Pengeluaran (

Harga Satuan Rp ) 01 Mei - 31 Mei Keterangan
April 2016 Terakhir
2016
Mei
- 50 4,041 - 1,414,350
- - 350 - -
- 25 2,575 - 64,375
- 16 27,305 - 436,880
- 100 88 - 8,800
- 1,300 215 - 278,850
- - 180 - -
200 300 233 46,600 139,800
- - 2,598 - -
- - 131 - -
50 1,050 82 4,100 82,000
- 34 4,013 - 136,442
- 500 117 - 58,500
- - 192 - -
- - 341 - -
30 25 23,100 693,000 1,039,500
1,800 1,440 210 378,000 428,400
1,000 1,000 270 270,000 -
335 435 2,500 837,500 1,000,000
- 10 7,766 - 77,660
- - 400 - -
- 10 3,150 - 31,500
- - 116 - -
- - 1,400 - -
400 400 74 29,600 -
345 175 2,160 745,200 280,800
100 75 2,641 264,100 330,125
- 48 2,001 - 96,050
- 200 142 - 28,400
10 3,200 32,000 -
10
- - 35,200 - -
- 119 2,100 - 249,900

- 12 23,100 - 277,200
- - 38,999 - -
2,000 - 100 200,000 300,000
- - 50 - -
- - 166 - -
- - 116 - -
- - 122 - -
- - 170 - -
- - 2,260 - -
200 200 239 47,800 -
200 200 345 69,000 -
- - 140 - -
30 240 - -
- - 9,000 - -
- 30 1,300 - 39,000
- 100 77 - 7,700
48 238 1,250 60,000 237,500
- - - -
- - 10,290 - -
- 20 14,070 - 281,400
- 100 43 - 4,300
- - 970 - -
85 75 1,520 129,200 136,800
- - 1,650 - -
60 60 669 40,140 - Exp. Date
- - 478 - -
- - 225 - -
- - 250 - 125,000
- - 8,900 - -
1,400 2,800 62 86,800 86,800
1,400 2,900 89 124,600 133,500
400 2,100 141 56,400 239,700
400 1,000 257 102,800 154,200
21 21 27,500 577,500 -
- - 519 - -
40 115 5,064 202,560 379,800
- - 1,100 - -
30 40 9,000 270,000 90,000
- - 869 - -
- - 5,247 - -
- 30 3,150 - 94,500
4 4 3,500 14,000 -
- - 186 - -
- - 59,800 - -
438 438 260 113,880 -
- - 120 - -
100 300 379 37,900 75,800
- 600 570 - 342,000
- 200 900 - 180,000
8,000 24,500 53 424,000 874,500
- - 262 - -
- 85 3,865 - 328,525
- - 1,679 - -
20 268 1,600 32,000 396,800
- 1,000 89 - 89,250
- 300 153 - 45,900
- 700 71 - 49,700
- 60 1,103 - 66,180
100 3,500 145 14,500 493,000
- 1,500 75 - 112,500
130 425 2,222 288,860 655,490
50 141 23,000 1,150,000 2,093,000
66 306 9,167 605,000 2,200,000
10 160 1,659 16,590 248,850
6,400 3,400 64 409,600 448,000
500 1,430 - -
- - 45 - -
- 28 4,389 - 122,892
- 80 1,107 - 88,560
- - 100 - -
- 500 134 - 67,000
- 500 104 - 52,000
- 100 285 - 28,500
90 224 3,410 306,900 456,940
100 600 170 17,000 255,000
10 20 16,350 163,500 490,500
5 35 16,280 81,400 488,400
10 20 11,660 116,600 116,600
- 390 33 - 12,973
- 71 8,505 - 603,855
- - 497 - -
200 600 976 195,200 390,400
50 309 7,893 394,650 2,044,287
- 900 102 - 91,800

1,990 4,990 21 41,523 271,258
- 50 23,100 - 1,155,000
248 748 735 182,280 1,102,500
- 1,296 880 - 1,140,480
- - 10,000 - -
- 25 1,920 - 48,000
200 600 94 18,800 37,600
24 84 6,555 157,320 393,300
- 400 50 - 20,000
75 1,275 303 22,725 363,600
120 210 - -
- - 1,469 - -
- 30 3,353 - 100,590
- 80 3,569 - 285,520
- 100 945 - 94,500
400 700 58 23,200 46,400
6,900 11,900 50 345,000 250,000
- - 5,985 - -
- - 2,577 - -
- 78 5,460 - 425,880
- - 2,200 - -
- 100 230 - 23,000
200 800 100 20,000 60,000
- 500 61 - 30,500
- 500 72 - 36,000
- 120 2,167 - 260,000
- 500 - -
- 40 25,000 - 1,000,000
92 144 2,798 257,416 414,104
25 120 5,900 147,500 560,500
400 1,400 - -
- - 16,500 - -
100 403 4,724 472,400 1,431,372
1,353 2,553 116 156,948 139,200
1,600 800 153 244,800 336,600
80 120 6,500 520,000 260,000
400 400 203 81,200 -
- - 6,200 - -
- 500 68 - 34,000
- 500 93 - 46,500
60 220 1,450 87,000 232,000
20 40 9,000 180,000 180,000

20 40 10,000 200,000 200,000
- 40 9,625 - 385,000
- - 743 - -
800 1,900 73 58,400 80,300
10 40 2,569 25,690 77,070
24 96 4,930 118,320 354,960
100 850 310 31,000 232,500
- - 1,697 - -
- - 2,539 - -
- 300 214 - 64,200
- 400 525 - 210,000
60 879 - 52,740
-
- - 879 - -
50 260 1,431 71,550 300,510
- 150 554 - 83,100
200 300 162 32,400 97,200
- 900 92 - 82,800
- 30 3,500 - 105,000
- 53 3,711 - 196,683
- 270 239 - 64,530
10 50 11,500 115,000 460,000
200 3,900 127 25,410 470,085
- 380 2,750 - 1,045,000
- - 92,990 - -
1,600 2,600 210 336,000 210,000
- 600 108 - 64,800
400 1,400 105 42,000 105,000
- - 113 - -
200 400 164 32,800 32,800
57 81 3,000 171,000 72,000
- 162 17,820 - 2,886,840
- 20 18,500 - 925,000
45 72 8,500 382,500 229,500
- 2,100 390 - 819,000
180 180 3,017 543,000 -
- - 141 - -
- - 185 - -
93 93 4,935 458,955 -
200 300 1,260 252,000 756,000
- 120 2,940 - 352,800
300 600 110 33,000 33,000

- 180 2,999 - 539,820
- 400 672 - 268,800
30 130 504 15,120 50,400
30 53 12,500 375,000 287,500
- - 680 - -
- - 1,600 - -
- - 1,606 - -
- - 216 - -
90 180 ### 16,200 16,200
- - 6,325 - -
120 240 375 45,000 45,000
- 28 297 - 8,316
- 270 122 - 32,940
6,400 8,100 84 537,600 982,800
132 200 5,460 720,720 982,800
159 214 1,496 237,864 584,936
- - - -
- 500 535 - 267,500
- - 1,058 - -
- - 24,150 - -
- - 11,475 - -
- 3 1,523 - 4,568
- - 31 - -
- 27 1,890 - 51,030
- 8 4,200 - 33,600
- - 321 - -
- 710 308 - 495,880
- 50 8,728 - 436,400
- 900 666 - 599,400
- 60 3,582 - 214,920
25 75 3,582 89,550 179,100
10 116 2,250 22,500 238,500
1 23 6,298 6,298 138,556
- 10 14,771 - 147,710
1 7 38,594 38,594 231,564
200 200 2,400 480,000 -
1,800 2,300 119 214,200 59,500
- 500 205 - 102,500
- 2 7,549 - 15,098
300 1,000 79 23,700 55,300
- 1,200 110 - 132,000
- 800 335 - 268,000

- 3,200 837 - 2,678,400
- - 9,500 - -
- 120 704 - 84,480
- 500 600 - 300,000
20 110 1,190 23,800 107,100
2,460 1,960 126 309,960 189,000
- 2 100,000 - 200,000
- 2 100,000 - 200,000
- 2 125,000 - 250,000
- 700 85 - 59,500
- 700 109 - 76,300
- - 5,460 - -
- 40 1,038 - 41,520
4 52 2,283 9,133 109,593
- 300 62 - 18,600
- 290 85 - 24,650
- 29 11,550 - 334,950
- 200 452 - 90,400
- 15 6,930 - 103,950
- 80 2,100 - 168,000
- - 126,000 - -
2 2 47,000 94,000 - Exp. Date
10 390 1,131 11,310 429,780
- - 60 - -
90 1,350 174 15,660 219,240
- 150 1,574 - 236,100
- - 17,604 - -
- 10 12,159 - 121,590
1 2 6,800 6,800 34,000
1 2 5,600 5,600 28,000
4 - 28,000 112,000 -
- 20 3,832 - 76,640
24 24 3,387 81,288 - Exp. Date
100 600 544 54,400 272,000
- 100 13,850 - 1,385,000
- 60 30,800 - 1,848,000
- 900 154 - 138,600
- 400 312 - 124,800
- 45 700 - 31,500
- - 37 - -
- 150 192 - 28,835
- - - -
5,800 4,800 110 638,000 638,000
- - 26,400 - -
200 500 497 99,400 149,100
100 247 12,840 1,284,000 4,147,320
35 130 7,770 271,950 738,150
- - - -
- - - -
- - 390,000 - -
- - 125,000 - -
- - 17,500 - -
- - 395,000 - -
- - 242,000 - -
- - 55,000 - -
- - 176,000 - -
- - 93,500 - -
- - 34,000 - -
63,792 149,040 21,375,264 67,759,491
50 580 826 41,275 437,515
140 180 826 115,570 33,020
370 420 826 305,435 41,275
10 505 953 9,525 471,488
- 155 1,175 - 182,125
200 400 197 39,360 39,360
30 100 4,572 137,160 320,040
22 132 22,500 495,000 2,475,000
8 125 22,500 180,000 2,632,500
- ### 8,000 - 40,000
- ### 8,000 - 40,000
5 ### 8,000 40,000 40,000
350 150 1,300 455,000 -
110 50 1,300 143,000 182,000
170 200 1,300 221,000 299,000
10 100 8,085 80,850 727,650
100 150 8,085 808,500 1,212,750
50 150 8,085 404,250 1,617,000
50 165 8,085 404,250 929,775
10 91 4,445 44,450 360,045
- 200 4,064 - 812,800
1 6 - -
2 5 34,000 68,000 102,000
- 10 24,000 - 240,000
17 51 7,900 134,300 268,600
- 30 1,800 - 54,000
- ### 3,800 - -
100 100 800 80,000 -
- 250 1,100 - 275,000
1 13 9,400 9,400 112,800
- 12 16,000 - 192,000
- 7 25,000 - 175,000
2 6 130,000 260,000 520,000
2 7 439 878 2,195
- ### 439 - -
100 400 439 43,890 131,670
3 5 - -
- 5 33,000 - 165,000
- 5 27,830 - 139,150
- 4 60,500 - 242,000
- ### 30,000 - -
- 10 3,850 - 38,500
10 50 7,315 73,150 292,600
4 7 21,753 87,012 65,259
- 4 30,030 - 120,120
72 108 15,000 1,080,000 540,000
19 81 15,000 285,000 930,000
- ### 10,010 - -
- 48 3,000 - 144,000
23 46 3,000 69,000 69,000
3 48 3,000 9,000 135,000
- ### - -
103 128 3,000 309,000 75,000
- 100 2,021 - 202,125
- 100 2,224 - 222,390
- 10 3,810 - 38,100
45 195 1,270 57,150 190,500
- ### 6,059 - -
- ### 6,059 - -
- ###
2,192 5,709 6,490,405 18,575,351
65,984 154,749 27,865,669 86,334,842
Pangkalan Kasai, 31 Mei 2016

Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
SALDO PERSEDIAAN OBAT BUFFER STOCK PROVIN
Penyesuaian saldo
SATUAN Saldo hasil Cek Fisik Penerimaan

No. Nama Obat
KEMASAN (31 Mei 2016 )
Mei
A Obat-Obat
1 Amoksisilin kapsul 500 mg kapsul - 300

2 Antalgin inj ampul 90 90
3 Antasida DOEN I tablet kunyah tablet - 300
4 supp 20
30
5 Asam Mefenamat kaplet 500 mg kaplet - 200
6 Asiklovir krim 5% tube - 25
9 Arimed / Meloxicam 15 mg tablet 20 40
10 Becefort tablet - 100
11 Bisolvon Extra Syrup btl - 3
12 Captopril tablet 12,5 mg tablet 300 300
13 Cefadroksil kap 500 mg kapsul 100 300
14 Cefadroksil syrup kering 125 mg/5ml btl 60 ml 5 5
15 Ciprofloxacin 500 mg kapsul 50 150
16 Chlorpheniramine maleat (CTM) 4 mg tablet 7,500 7,500
17 Cotrimoksazol DOEN I (Dewasa) tablet 300 300
18 Dasabion (Anti Anemic + Vitamin ) tablet 200 200
19 Diaform tablet 500 500
20 Dimenhidrinat tab tablet 500 500
21 Eryra Porte ( Erytromisin 500 mg ) kapsul 300 300
22 Erlamycetin Ear Drop Tetes Telinga btl 2 4
23 Flukonazol tab 150 mg kapsul 20 20
24 Fituno tablet - 30
25 Griseovulvin tablet 125 mg tablet 300 300
27 Holicos ( Ambroxol ) syrup btl 3 3
28 Hustab tablet 300 300
29 Ibuprofen tablet 400 mg tablet 500 500
30 Isotic Neolyson Tetes Mata btl - 3
31 Isotic Clearens Tetes Mata btl - 3
32 Livron B Plek tablet 300 300
33 Loperamid 2mg tablet 300 300
34 Metaneuron tablet 600 900
35 Metilprednisolon 4mg tablet 200 200
36 Mucohexin tablet 200 200
37 Natrium Diklofenat 25mg tablet 50 150
38 Natrium Klorida larutan infus 0.9% steril 500ml botol 40 60
39 Neurovit - E kaplet - 60
40 Nodiar tablet 300 300
41 Noza tablet 100 200
42 OBH Indo Plus syrup botol - 3
43 Oxfezin syrup botol - 3
44 Oksitetrasiklin salep kulit 3% tube 25 25
45 Oksitetrasiklin inj ampul 10 10
46 Omeprazol kapsul 20 mg kapsul 60 150
48 Pehavral tablet 100 200
49 Piroxicam 20 mg tablet 200 300
50 Pehacort / Prednison 5mg tablet 1,000 1,000
51 Propanolol 40mg tablet 500 500
52 Prolysin Plus syrup botol - 3
53 Pularex Attalpugit 600 mg tablet 100 100
54 Ranitidin 150mg tablet 300 300
55 Ringer Laktat larutan infus 500ml botol - 40
56 Salbutamol 4mg (sebagai sulfat) tablet 300 300
57 Sanbe Kids syrup botol - 3
58 Sagestam Cream tube 3 3
59 Scabimite Cream tube - 3
60 Tryhexilpenidil tablet 200 500
61 Zinc Disperibel tablet 100 100
62 Oxycan btl 5 5
SISA OBAT DALAM RUPIAH 16,735 19,251
Mengetahui
Pangkalan Kasai
NIP 197507232008012007
FER STOCK PROVINSI PER 01 MEI - 31 MEI 2016
Penyesuaian saldo
Pengeluaran Jumlah Pengeluaran (

Harga Satuan Rp ) 01 Mei - 31 Mei Keterangan
April 2016 Terakhir
2016
Mei
300 - 270 81,000 -
- - 1,393 - 125,400
300 - 74 22,200 -
- 3,685 36,850 73,700

10
200 - 209 41,800 -
25 - 2,260 56,500 -
- - 239 - 71,700
- - 345 - 103,500
20 - 8,085 161,700 161,700
100 - 1,500 150,000 -
3 - 32,625 97,875 -
- - 62 - 18,600
200 - 519 103,800 51,900
- - 5,064 - 25,320
100 - 513 51,260 25,630
- - 77 - 575,000
- - 145 - 43,500
- - 979 - 195,800
- - 140 - 70,000
- - 95 - 47,500
- - 2,970 - 891,000
2 - 4,840 9,680 9,680
- - 23,100 - 462,000
30 - 4,033 121,000 -
- - 230 - 69,000
- - 2,399 - 115,152
- - 23,100 - 69,300
- - 300 - 90,000
- - 153 - 76,500
3 - 28,750 86,250 -
3 - 10,750 32,250 -
- - 250 - 75,000
- - 92 - 27,600
300 - 1,283 385,000 770,000
- - 210 - 42,000
- - 506 - 101,200
100 - 141 14,100 7,050
20 - 4,935 98,700 197,400
60 - 1,027 61,600 -
- - 1,210 - 363,000
100 - 891 89,100 89,100
3 - 12,100 36,300 -
3 - 56,100 168,300 -
- - 2,200 - 55,000
- - 5,500 - 55,000
90 - 216 19,440 12,960
- - 1,496 - 125,664
100 - 693 69,300 69,300
100 - 119 11,900 23,800
- - 145 - 145,000
- - 114 - 57,000
3 - 30,800 92,400 -
- - 210 - 21,000
- - 108 - 32,445
40 - 5,460 218,400 -
- - 85 - 25,500
3 - 38,500 115,500 -
- - 13,090 - 39,270
3 - 77,000 231,000 -
300 - 44 13,200 8,800
- - 497 - 49,700
- - - -
2,521 - 2,676,405 5,764,671
Pangkalan Kasai, 31 Mei 2016
Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm

No. Nama Obat
KEMASAN ( 28 Juni 2016 )
A Obat-Obat
2 Antalgin inj ampul 90

4 supp 20
9 Arimed / Meloxicam 15 mg tablet 20
10 Becefort tablet -
11 Bisolvon Extra Syrup btl -
12 Captopril tablet 12,5 mg tablet -
15 Ciprofloxacin 500 mg kapsul -
17 Cotrimoksazol DOEN I (Dewasa) tablet -
18 Dasabion (Anti Anemic + Vitamin ) tablet 100
21 Eryra Porte ( Erytromisin 500 mg ) kapsul -
22 Erlamycetin Ear Drop Tetes Telinga btl -
24 Fituno tablet -
27 Holicos ( Ambroxol ) syrup btl -
29 Ibuprofen tablet 400 mg tablet -

30 Isotic Neolyson Tetes Mata btl -
31 Isotic Clearens Tetes Mata btl -
32 Livron B Plek tablet 300
34 Metaneuron tablet 600
35 Metilprednisolon 4mg tablet -
36 Mucohexin tablet 100
37 Natrium Diklofenat 25mg tablet 50
38 Natrium Klorida larutan infus 0.9% steril 500ml botol -
39 Neurovit - E kaplet -
40 Nodiar tablet 300
41 Noza tablet 100
42 OBH Indo Plus syrup botol -
43 Oxfezin syrup botol -
45 Oksitetrasiklin inj ampul 10
47 Parasetamol syrup 120mg / 5ml botol -
48 Pehavral tablet 100
49 Piroxicam 20 mg tablet -
50 Pehacort / Prednison 5mg tablet 1,000
51 Propanolol 40mg tablet 500
52 Prolysin Plus syrup botol -
53 Pularex Attalpugit 600 mg tablet 100
57 Sanbe Kids syrup botol -
58 Sagestam Cream tube 3
59 Scabimite Cream tube -
60 Tryhexilpenidil tablet 200
62 Oxycan btl 5
SISA OBAT DALAM RUPIAH 12,571
Mengetahui
Pangkalan Kasai
NIP 197507232008012007
OBAT BUFFER STOCK PROVINSI PER 01 JUNI - 28 JUNI 2016
Penyesuaian saldo
SALDO per 31 Mei Harga Perolehan
Penerimaan Pengeluaran Harga Satuan Rp ) 01 Juni - 28 Juni
2016 Terakhir
2016
Juni Juni
- - - 270 - -
- - 90 1,393 - 125,400
- - - 74 - -
20 3,685 - 73,700
- -
- - - 209 - -
- - - 2,260 - -
- - 300 239 - 71,700
- - 300 345 - 103,500
- - 20 8,085 - 161,700
- - - 1,500 - -
- - - 32,625 - -
- 300 300 62 18,600 -
- 100 100 519 51,900 -
- - 5 5,064 - 25,320
- 50 50 513 25,630 -
- 1,500 7,500 77 115,000 460,000
- 300 300 145 43,500 -
- 100 200 979 97,900 97,900
- - 500 140 - 70,000
- - 500 95 - 47,500
- 300 300 2,970 891,000 -
- 2 2 4,840 9,680 -
- - 20 23,100 - 462,000
- - - 4,033 - -
- - 300 230 - 69,000
- - 48 2,399 - 115,152
- 3 3 23,100 69,300 -
- - 300 300 - 90,000
- 500 500 153 76,500 -

- - - 28,750 - -
- - - 10,750 - -
- - 300 250 - 75,000
- - 300 92 - 27,600
- - 600 1,283 - 770,000
- 200 200 210 42,000 -
- 100 200 506 50,600 50,600
- - 50 141 - 7,050
- 40 40 4,935 197,400 -
- - - 1,027 - -
- - 300 1,210 - 363,000
- - 100 891 - 89,100
- - - 12,100 - -
- - - 56,100 - -
- 25 25 2,200 55,000 -
- - 10 5,500 - 55,000
- 60 60 216 12,960 -
- 84 84 1,496 125,664 -
- 100 693 - 69,300
- 200 200 119 23,800 -
- 1,000 145 - 145,000
- 500 114 - 57,000
- - 30,800 - -
- 100 210 - 21,000
- 300 300 108 32,445 -
- - 5,460 - -
- 300 85 - 25,500
- - 38,500 - -
- 3 13,090 - 39,270
- - 77,000 - -
- 200 44 - 8,800
- 100 497 - 49,700
- 5 - -
- 4,164 16,735 1,938,879 3,825,792
Pangkalan Kasai, 28 Juni 2016
Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
Keterangan
SALDO PERSEDIAAN PER

No. Nama Obat
KEMASAN ( 28 juni 2016 )
A Obat-Obat
6 Alopurinol tab 300 mg tablet 1,300
8 Alprazolam 1 mg tab tablet 500
11 Aminofilin tab 200 mg tablet 900
26 Antasida DOEN II Suspensi Komb btl 60 ml -

30 supp -
35 Asam askorbat ( vit c ) tablet 50 mg tablet 1,400
45 Asifit tablet 150
46 Asering tablet -
51 Benzatin benzil penisilin 1,2 jt UI inj vial -
55 Betametason krim 0,1% tube 25
57 Bisoprolol tablet 5 mg tablet -
59 Bromiphar tablet -
60 Bronsolvan 150 mg tablet 400
61 Budenosid resp -
63 Captopril tablet 25 mg tablet 300
65 Carbamazepin 200 mg tablet 600
66 Caltrak btl -

70 Cefixime syrup 100 mg/5 ml btl 30 ml -
74 Ceftriaxon injeksi 1 g vial -
78 Cimetidin 200 mg tablet -
83 Chloramfenikol 250 mg kaplet -
84 Chloramfenikol suspensi 125mg / 60ml ( Mefamicetin syrup ) botol 85
85 Chloramfenikol tetes telinga 3% / 5ml botol -
86 Chloramfenikol salep mata 1% / 5ml tube 144
87 Chloroquin 150 mg tablet 1,000
90 Chlorpromazin inj 25mg/ml amp -
91 Cotrimoksazol DOEN I (Dewasa) tablet 3,400
92 Cotrimoksazol DOEN II (Pediatrik) tablet 1,500
93 Cotrimoksazol suspensi 60ml botol 230
95 Dehaf sachet 228
97 Deksametason tablet 0,5 mg tablet 4,400

110 Dumin Rectal 125 mg supp -
119 Fludane kapsul kapsul 1,200
120 Fludane Plus tablet 1,296
126 Garam oralit untuk 200 ml air sachet 1,200
127 Geriavita kapsul 30
138 Griseovulvin tablet 125 mg tablet -
142 HB-Vit kaplet -
143 Hemafort tablet 500

152 Imunvit Plus Kap kaplet -
153 Intibrox (Ambroksol) tablet -
154 Intibrox (Ambroksol) Syrup botol -
162 Kalsium Laktat 500 mg tablet 700
169 Kodein tablet 10 mg tablet 400

170 vial 60
Combivent UVB )
173 Levofloksasin 500 mg tablet -
174 Loratidin 10 mg tablet 600
183 Metilprednisolon 4mg tablet 800

188 Mikonazol krim 2% tube -
190 Mulsanol Drop btl 25
191 Mulsanol Syrup btl -
193 Natavit Soft Caps kapsul -
199 Nifedipin 10mg tablet -

226 Pirantel Score (base ) 125mg tablet 1,610
235 Pravastatin 20mg tablet -
236 Prednison 5mg tablet 300
239 Propanolol HCl 10mg tablet 700
250 Reagen Golongan Darah Anti D 10ml botol 2

263 Serum Anti Bisa Ular amp -
274 Sulfasetamida Natrium TM 15% / 5ml botol -
276 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol -
286 Zinc Disperibel tablet -
B. OBAT GIGI -

2 Alat suntik sekali pakai 2,5 ml pcs -
3 Alat suntik sekali pakai 3 ml pcs -
21 Infusion set dewasa set 100
22 kapas pembalut berlemak 500 mg Bks 5
34 Lysol btl 5
36 Masker Tie On pcs -

37 Oxycan btl 2
56 Urine bag pcs 9
Mengetahui
Pangkalan Kasai
NIP 197507232008012007
SALDO PERSEDIAAN PER 01 JUNI - 28 JUNI 2016
Penyesuaian saldo
SALDO per 31 Jumlah Pengeluaran ( Rp )
Penerimaan Pengeluaran Harga Satuan
Mei 2016 01 Juni - 28 Juni 2016
Juni Juni
- - 350 4,041 -
- - - 350 -
- 1 25 2,575 2,575
- 2 16 27,305 54,610
- - 100 88 -
- - 1,300 215 -
- - - 180 -
- 100 600 233 23,300
- - - 2,598 -
- - - 131 -
- 100 1,000 82 8,200
- - 34 4,013 -
- 200 500 117 23,400
- - - 192 -
- - - 341 -
- 20 45 23,100 462,000
2,400 2,640 2,040 210 554,400
- - - 270 -
- 140 400 2,500 350,000
- - 10 7,766 -
- - - 400 -
- - 10 3,150 -
- - - 116 -
- - - 1,400 -
- - - 74 -
100 230 130 2,160 496,800
- 100 125 2,641 264,100
- - 48 2,001 -
- 100 200 142 14,200

- 3,200 -
- -
- - - 35,200 -
- 10 119 2,100 21,000
- - 12 23,100 -
- - - 38,999 -
- 1,600 3,000 100 160,000
- - - 50 -
- - - 166 -
- - - 116 -
- - - 122 -
- - - 170 -
- - - 2,260 -
- - - 239 -
- - - 345 -
- - - 140 -
- 60 210 -
- - - 9,000 -
- - 30 1,300 -
- - 100 77 -
- 40 190 1,250 50,000
- - - -
- - - 10,290 -
- - 20 14,070 -
- 25 100 43 1,075
- - - 970 -
- 65 90 1,520 98,800
- - - 1,650 -
- - - 669 -
- - - 478 -
- - - 225 -
- 100 500 250 25,000
- - - 8,900 -
- 300 1,400 62 18,600
- 1,200 1,500 89 106,800
- 200 1,700 141 28,200
- - 600 257 -
- - - 27,500 -
- - - 519 -
- 45 75 5,064 227,880
- - - 1,100 -
- 10 10 9,000 90,000
- - - 869 -
- - - 5,247 -
- - 30 3,150 -
- - - 3,500 -
- - - 186 -
- - - 59,800 -
- - - 260 -
- - - 120 -
- - 200 379 -
- - 600 570 -
- 100 200 900 90,000
- 1,500 16,500 53 79,500
- - - 262 -
- - 85 3,865 -
- - - 1,679 -
- 104 248 1,600 166,400
- - 1,000 89 -
- - 300 153 -
- 400 700 71 28,400
- 60 60 1,103 66,180
- - 3,400 145 -
- - 1,500 75 -
- 65 295 2,222 144,430
- 40 91 23,000 920,000
- 12 240 9,167 110,000
- - 150 1,659 -
- 2,600 7,000 64 166,400
- 200 930 -
- - - 45 -
- - 28 4,389 -
- - 80 1,107 -
- - - 100 -
- - 500 134 -
- 100 500 104 10,400
- - 100 285 -
- 5 134 3,410 17,050

- 600 1,500 170 102,000
- - 30 16,350 -
- 5 30 16,280 81,400
- 10 10 11,660 116,600
- - 390 33 -
- - 71 8,505 -
- - - 497 -
- 200 400 976 195,200
- 15 259 7,893 118,395
- - 900 102 -
- - 13,000 21 -
- - 50 23,100 -
- 300 1,500 735 220,500
- - 1,296 880 -
- - - 10,000 -
- - 25 1,920 -
- - 400 94 -
- 6 60 6,555 39,330
- 200 400 50 10,000
- - 1,200 303 -
- 60 90 -
- - - 1,469 -
- 10 30 3,353 33,530
- - 80 3,569 -
- 10 100 945 9,450
- 300 800 58 17,400
- 4,000 5,000 50 200,000
- - - 5,985 -
- - - 2,577 -
- - 78 5,460 -
- - - 2,200 -
- 100 100 230 23,000
- - 600 100 -
- - 500 61 -
- - 500 72 -
- 120 120 2,167 260,000
- - 500 -
- - 40 25,000 -
- 76 148 2,798 212,648

- 25 95 5,900 147,500
- 700 1,000 -
- - - 16,500 -
- 20 303 4,724 94,480
- 600 1,200 116 69,600
- 1,700 2,200 153 260,100
- 40 40 6,500 260,000
- - - 203 -
- - - 6,200 -
- - 500 68 -
- - 500 93 -
- - 160 1,450 -
- - 20 9,000 -
- - 20 10,000 -
- - 40 9,625 -
- - - 743 -
- 400 1,100 73 29,200
- 5 30 2,569 12,845
- 12 72 4,930 59,160
- 150 750 310 46,500
- - - 1,697 -
- - - 2,539 -
- - 300 214 -
- - 400 525 -
60 879 -
- -
- - - 879 -
- 120 210 1,431 171,720
- 150 150 554 83,100
- - 600 162 -
- - 900 92 -
- - 30 3,500 -
- - 53 3,711 -
- - 270 239 -
- 10 40 11,500 115,000
- 400 3,700 127 50,820
- 20 380 2,750 55,000
- - - 92,990 -
- 200 1,000 210 42,000

- - 600 108 -
- 200 1,000 105 21,000
- - - 113 -
- 200 200 164 32,800
- 24 24 3,000 72,000
- - 162 17,820 -
- 25 50 18,500 462,500
- 27 27 8,500 229,500
- 200 2,100 390 78,000
- - - 3,017 -
- - - 141 -
- - - 185 -
100 40 - 4,935 197,400
- - 600 1,260 -
- - 120 2,940 -
- 300 300 110 33,000
- - 180 2,999 -
- - 400 672 -
- - 100 504 -
- 6 23 12,500 75,000
- - - 680 -
- - - 1,600 -
- - - 1,606 -
- - - 216 -
- - 90 180 -
- - - 6,325 -
- 60 120 375 22,500
- - 28 297 -
- - 270 122 -
- 5,600 11,700 84 470,400
- 35 180 5,460 191,100
- 164 391 1,496 245,344
- - - -
- - 500 535 -
- - - 1,058 -
- - - 24,150 -
- - - 11,475 -
- - 3 1,523 -
- - - 31 -
- - 27 1,890 -
- - 8 4,200 -
- - - 321 -
- - 1,610 308 -
- - 50 8,728 -
- - 900 666 -
- 30 60 3,582 107,460
- 20 50 3,582 71,640
- 26 106 2,250 58,500
- 17 22 6,298 107,066
- - 10 14,771 -
- 2 6 38,594 77,188
- - - 2,400 -
- 200 500 119 23,800
- - 500 205 -
- - 2 7,549 -
- - 700 79 -
- - 1,200 110 -
- - 800 335 -
- - 3,200 837 -
- - - 9,500 -
- - 120 704 -
- - 500 600 -
- 20 90 1,190 23,800
- 1,500 1,500 126 189,000
- - 2 100,000 -
- - 2 100,000 -
- - 2 125,000 -
- - 700 85 -
- - 700 109 -
- - - 5,460 -
- - 40 1,038 -
- 17 48 2,283 38,814
- 100 300 62 6,200
- - 290 85 -
- - 29 11,550 -
- - 200 452 -
- - 15 6,930 -
- 8 80 2,100 16,800
- - - 126,000 -
- - - 47,000 -
- 10 380 1,131 11,310
- - - 60 -
- 1,260 1,260 174 219,240
- - 150 1,574 -
- - - 17,604 -
- 5 10 12,159 60,795
- - 5 6,800 -
- 2 5 5,600 11,200
- - - 28,000 -
- - 20 3,832 -
- - - 3,387 -
- 100 500 544 54,400
- 100 100 13,850 1,385,000
- - 60 30,800 -
- 100 900 154 15,400
- 100 400 312 31,200
- - 45 700 -
- - - 37 -
- - 150 192 -
- - - -
- 1,600 5,800 110 176,000
- - - 26,400 -
- 300 300 497 149,100
- 40 323 12,840 513,600
- 46 95 7,770 357,420
- - - -
- - - -
- - - 390,000 -
- - - 125,000 -
- - - 17,500 -
- - - 395,000 -
- - - 242,000 -
- - - 55,000 -
- - - 176,000 -
- - - 93,500 -
- - - 34,000 -
2,600 35,522 141,830 13,851,655
- 160 530 826 132,080
- 40 40 826 33,020
- 50 50 826 41,275
- 130 495 953 123,825
- 10 155 1,175 11,750
- 100 200 197 19,680
- 8 70 4,572 36,576
- 2 110 22,500 45,000
- 21 117 22,500 472,500
- 3 5 8,000 24,000
- 2 5 8,000 16,000
- 2 5 8,000 16,000
- - - 1,300 -
- 62 140 1,300 80,600
- 100 230 1,300 130,000
- 10 90 8,085 80,850
- 50 150 8,085 404,250
- 50 200 8,085 404,250
- - 115 8,085 -
- - 81 4,445 -
- 100 200 4,064 406,400
- - 5 -
- - 3 34,000 -
- 4 10 24,000 96,000
- 29 34 7,900 229,100
- 16 30 1,800 28,800
- - - 3,800 -
- - - 800 -
- - 250 1,100 -
- 3 12 9,400 28,200
- - 12 16,000 -
- - 7 25,000 -
- 1 4 130,000 130,000
- - 5 439 -
- - - 439 -
- 300 300 439 131,670

- - 2 -
- - 5 33,000 -
- - 5 27,830 -
- - 4 60,500 -
- - - 30,000 -
- 10 10 3,850 38,500
- 20 40 7,315 146,300
- 3 3 21,753 65,259
- 2 4 30,030 60,060
- 36 36 15,000 540,000
- 18 62 15,000 270,000
- - - 10,010 -
- - 48 3,000 -
- - 23 3,000 -
- - 45 3,000 -
- - - -
- - 25 3,000 -
- - 100 2,021 -
- - 100 2,224 -
- 1 10 3,810 3,810
- 5 150 1,270 6,350
- - - 6,059 -
- - - 6,059 -
- 1,348 4,332 4,252,105
2,600 36,870 146,162 18,103,760
Pangkalan Kasai, 28 Juni 2016
Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
Harga Perolehan Terakhir Keterangan
1,414,350
61,800
382,270
8,800
278,850
116,500
73,800
136,442
35,100
577,500
378,000
650,000
77,660
31,500
66,025
96,050
14,200
-
228,900
277,200
140,000
39,000
7,700
187,500
281,400
3,225
38,000
100,000
68,200
26,700
211,500
154,200
-
151,920
94,500
75,800
342,000
90,000
795,000
328,525
230,400
89,250
45,900
21,300
- Exp. Date
493,000
112,500
511,060
1,173,000
2,090,000
248,850
281,600
122,892
88,560
67,000
41,600
28,500
439,890
153,000
490,500
407,000
12,973
603,855
195,200
1,925,892
91,800
271,258
1,155,000
882,000
1,140,480
48,000
37,600
353,970
10,000
363,600
67,060
285,520
85,050
29,000
50,000
425,880
60,000
30,500
36,000
1,000,000
201,456
413,000
1,336,892
69,600
76,500
34,000
46,500
232,000
180,000
200,000
385,000
51,100
64,225
295,800
186,000
64,200
210,000
52,740
128,790
97,200
82,800
105,000
196,683
64,530
345,000
419,265
990,000
168,000
64,800
84,000
2,886,840
462,500
741,000
296,100
756,000
352,800
539,820
268,800
50,400
212,500
16,200
22,500
8,316
32,940
512,400
791,700
339,592
267,500
4,568
-
51,030
33,600
495,880
436,400
599,400
107,460
107,460
180,000
31,490
147,710
154,376
35,700
102,500
15,098
55,300
132,000
268,000
2,678,400
84,480
300,000
83,300
200,000
200,000
250,000
59,500
76,300
41,520
70,779
12,400
24,650
334,950
90,400
103,950
151,200
-
418,470
236,100
60,795
34,000
16,800
76,640
- Exp. Date
217,600
1,848,000
123,200
93,600
31,500
28,835
462,000
3,633,720
380,730
-
55,121,336
305,435
347,663
170,375
19,680
283,464
2,430,000
2,160,000
16,000
24,000
24,000
101,400
169,000
646,800
808,500
1,212,750
929,775
360,045
406,400
102,000
144,000
39,500
25,200
275,000
84,600
192,000
175,000
390,000
2,195
-
-
165,000
139,150
242,000
146,300
60,060
660,000
144,000
69,000
135,000
75,000
202,125
222,390
34,290
184,150
14,323,246
69,444,582
SALDO PERSEDIAAN PER 29 JUNI - 3
Penyesuaian saldo
Saldo hasil Cek
SATUAN
No. Nama Obat Fisik ( 31 Juli Penerimaan
KEMASAN
2016 )
Juli
A Obat-Obat
1 Albendazol suspensi 200 mg/5 ml btl 350 -

4 ALKOHOL 70 % 1000 ml btl 14 -
6 Alopurinol tab 300 mg tablet 1,200 -
8 Alprazolam 1 mg tab tablet 500 -
11 Aminofilin tab 200 mg tablet 700 -
16 Amobiotic Drop btl - -
19 Amoksisilin syrup kering 125mg/5ml botol 5 ml 150 -
22 Ampisilin serbuk injeksi 500 mg/vial vial - -
26 Antasida DOEN II Suspensi Komb btl 60 ml - -
27 Anti bakteri salep komb tube - -

30 supp -
-
31 Antithrom Jelly tube - -
35 Asam askorbat ( vit c ) tablet 50 mg tablet - -
44 Asonfen tab tablet - -
45 Asifit tablet 90 -
46 Asering tablet - -
51 Benzatin benzil penisilin 1,2 jt UI inj vial - -
55 Betametason krim 0,1% tube - -
57 Bisoprolol tablet 5 mg tablet - -
59 Bromiphar tablet - -
60 Bronsolvan 150 mg tablet 400 -
61 Budenosid resp - -
62 Captopril tablet 12,5 mg tablet 500 -
63 Captopril tablet 25 mg tablet 300 -
65 Carbamazepin 200 mg tablet 300 -
66 Caltrak btl - -
70 Cefixime syrup 100 mg/5 ml btl 30 ml - -
73 Cefotaxim 1 gr inj vial 30 -
78 Cimetidin 200 mg tablet - -
83 Chloramfenikol 250 mg kaplet - -
84 Chloramfenikol suspensi 125mg / 60ml ( Mefamicetin syrup ) botol 85 -
85 Chloramfenikol tetes telinga 3% / 5ml botol - -
86 Chloramfenikol salep mata 1% / 5ml tube 144 -
87 Chloroquin 150 mg tablet 1,000 -
90 Chlorpromazin inj 25mg/ml amp - -
91 Cotrimoksazol DOEN I (Dewasa) tablet 2,900 -
92 Cotrimoksazol DOEN II (Pediatrik) tablet 1,500 -
93 Cotrimoksazol suspensi 60ml botol 180 -
94 Cough En Plus Syrup btl 51 -
97 Deksametason tablet 0,5 mg tablet 1,800 -
99 Diazepam 2 mg tab tablet - -
106 Domperidone suspensi 5 mg/5 ml btl 60 ml 79 -
107 Domperidone 10 mg tab tablet 100 -
108 Domperidone drop 5mg / ml botol 30 -
110 Dumin Rectal 125 mg supp - -
112 Epinefrin injeksi ampul 69 -
114 Erythromisin 500 mg kap kapsul - -
115 Erytromicyn syrup 200 mg/5 ml btl 60 ml 224 -
117 Ferosulfat tab tablet - -
119 Fludane kapsul kapsul 1,000 -
120 Fludane Plus tablet 1,096 -
121 Flutop C Syrup btl - -
124 Fucilex Krim / Natrium Fucilat tube 54 -
125 Folic Acid tablet 200 -
126 Garam oralit untuk 200 ml air sachet 1,200 -
127 Geriavita kapsul 30 -
130 Gentamisin injeksi ampul 80 -
131 Gentian Violet larutan 1 % btl 10 ml 90 -
132 Glibenklamida tablet 5 mg tablet 200 -
133 Gliseril Gualakolat ( GG ) 100 mg tablet - -
138 Griseovulvin tablet 125 mg tablet - -
141 Haloperidol 5 mg tablet 500 -
142 HB-Vit kaplet - -
143 Hemafort tablet 500 -
144 Hico Gel tube 40 -
145 Hidrokortison krim 2,5% tube 24 -
146 Hufabetamin Syrup btl 60 -
147 Hustab tablet - -
149 Ibuprofen Suspensi 200 mg/ 5 ml btl 60 ml 273 -
150 Ibuprofen tablet 200 mg tablet - -
152 Imunvit Plus Kap kaplet - -
153 Intibrox (Ambroksol) tablet - -
154 Intibrox (Ambroksol) Syrup botol - -
158 KA EN 1 B botol - -
159 KA EN 3 A botol - -
162 Kalsium Laktat 500 mg tablet 200 -
165 Ketokonazol 200 mg tablet 350 -
169 Kodein tablet 10 mg tablet 400 -
170 vial 60 -
Combivent UVB )
172 Lidokain + Epineprin injeksi 2% / 2ml ampul 14 -
173 Levofloksasin 500 mg tablet - -
174 Loratidin 10 mg tablet 350 -
179 Megatic Emulgel tube 30 -
180 Metilergometrin 0,125 mg tablet 3,300 -
181 Metilergometrin injeksi ampul 360 -
183 Metilprednisolon 4mg tablet 200 -
188 Mikonazol krim 2% tube - -
189 Momethasone furoat krim 0,1 % tube 144 -
190 Mulsanol Drop btl - -
191 Mulsanol Syrup btl - -
192 Nalget tablet 1,800 -
193 Natavit Soft Caps kapsul - -
197 Neurodial kaplet 500 -
199 Nifedipin 10mg tablet - -
200 Nifedipin 20 mg ( Adalat Oros ) tablet - -
203 OBH sirup botol - -
208 Ondansentron 4mg tablet - -
210 Ostine kapsul 60 -
213 Parasetamol 500mg tablet 2,900 -
214 Parasetamol drops botol 145 -
215 Parasetamol syrup 120mg / 5ml botol 133 -
218 Penolgliserol tetes telinga 10% / 5ml botol - -
219 Perak Sulfadiazin krim 1% (Burnazin) tube - -
220 Permetrin krim 5% (Scabicid) tube - -
221 Pethidin injeksi ampul - -
224 Piracetam injeksi 3g / 15ml ampul - -
225 Piracetam 800mg tablet - -
226 Pirantel Score (base ) 125mg tablet 1,610 -
228 Pitomenadion (Vit-K) 10mg tablet 600 -
235 Pravastatin 20mg tablet - -
236 Prednison 5mg tablet 300 -
237 Primakuin 15mg tablet - -
239 Propanolol HCl 10mg tablet 700 -
241 Propiltiourasil 100mg tablet 800 -
242 Quantidex tablet 3,200 -
244 Quinine tablet 120 -
245 Ramipril 5mg tablet - -
246 Ranitidin inj 25mg / 2ml ampul 70 -
247 Ranitidin 150mg tablet - -
248 Reagen Golongan Darah Anti A 10ml botol 1 -
249 Reagen Golongan Darah Anti B 10ml botol 1 -
250 Reagen Golongan Darah Anti D 10ml botol 1 -
255 Rivanol larutan 0,1% botol 31 -
256 Salbutamol 2mg (sebagai sulfat) tablet - -
260 Salbutamol cairan inh 0,1% (Ventolin Nebules) botol - -
261 Salep 2-4 pot 48 -
263 Serum Anti Bisa Ular amp - -
264 Sianokobalamin (vitamin B 12) injeksi ampul 360 -
265 Sianokobalamin (vitamin B 12) 50mcg tablet - -
266 Simvastatin 10mg tablet - -
270 Stick Asam Urat botol 3 -
271 Stick Glukosa botol 1 -
272 Stik Kolesterol botol - -
273 Streptomisin injeksi 1 g/ml vial - -
274 Sulfasetamida Natrium TM 15% / 5ml botol - -
276 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol - -
277 Tamsulosin SR 0,4mg (Harnal OCAS) tablet 60 -
280 Thiamin (Vitamin B1) injeksi 100mg / ml ampul - -
284 Vitamin B Kompleks tablet 1,600 -
286 Zinc Disperibel tablet - -
287 Zink drop 10mg / 5ml botol 283 -
288 Zirkum Kid syrup 20mg / 5ml botol 9 -
- -
B. OBAT GIGI - -
SISA OBAT GIGI DALAM RUPIAH 73,081 -
1 Alat suntik sekali pakai 1 ml set 370 -

2 Alat suntik sekali pakai 2,5 ml pcs - -
3 Alat suntik sekali pakai 3 ml pcs - -
6 Alkohol Swab CHG 0,5 % pcs - -
7 Blood Transfusion Set pcs 50 -
8 Catgut/benang bedah no. 3/0 pcs 90 -
9 Catgut/benang bedah no.2/0 pcs 96 -
10 Folley Catheter no 16W pcs 2 -
13 Handscoon no 7 pcs - -
14 Handscoon no 7,5 pcs 5 -
15 Handscoon no 8 pcs - -
20 Infusion set anak set 71 -
21 Infusion set dewasa set 50 -
22 kapas pembalut berlemak 500 mg Bks 2 -
23 Kapas berlemak 500 gram Bks 2 -
24 Kapas pembalut/absorben 250 gram Bks 6 -
25 Kasa Hidrofil 16x16 16 pcs/ktk 4 -
26 Kasa Hidrofil 40 x 40 pcs 14 -
29 Kasa Hidrofil 4 x 5 cm roll 150 -
30 Kasa Pembalut 2 x 80 cm Rol 5 -
33 Kasa hidrofil ukuran 36 x 80cm Rol 1 -
34 Lysol btl 4 -
35 Masker ear lopp pcs - -
36 Masker Tie On pcs - -
37 Oxycan btl 2 -
38 Pembalut elastis 10 cm x 4.55m pcs 5 -
39 Pembalut elastis 7.5 cm x 4.55m pcs 5 -
40 Pembalut Gips 6 Inchi Rol 4 -
41 Plester 5 yard x 2 inch Rol - -
42 Semillas Non Woven Medical Tape (5 x 100cm) roll - -
46 Silk ( benang bedah sutera ) no. 3/0 pcs - -
48 Stomach Tube pcs - -
52 Surgical Blades No. 21 ( Bisturi ) pcs - -
54 Transparent IV Dressing ( anak ) 4,4 x 4,4 cm pcs 100 -
55 Transparent IV Dressing ( Dewasa) 6 x 7 cm pcs 100 -
56 Urine bag pcs 9 -
57 Umbilical Cord Klem Steril Nylon pcs 145 -
SISA ALKES DALAM RUPIAH 2,314 -
SISA OBAT DAN ALKES DALAM RUPIAH 75,395 -
Mengetahui
Pangkalan Kasai
NIP 197507232008012007
DIAAN PER 29 JUNI - 31 JULI 2016
Penyesuaian saldo
Jumlah Pengeluaran
Pengeluaran Harga Satuan ( Rp ) 29 Juni - 31 Keterangan
Juni 2016 Terakhir
Juli 2016
Juli
- 350 4,041 - 1,414,350
- - 350 - -
- 24 2,575 - 61,800
- 14 27,305 - 382,270
- 100 88 - 8,800
100 1,300 215 21,450 257,400
- - 180 - -
- 500 233 - 116,500
- - 2,598 - -
- - 131 - -
200 900 82 16,400 57,400
- 34 4,013 - 136,442
- 300 117 - 35,100
- - 192 - -
- - 341 - -
25 25 23,100 577,500 -
1,800 1,800 210 378,000 -
- - 270 - -
110 260 2,500 275,000 375,000
- 10 7,766 - 77,660
- - 400 - -
10 10 3,150 31,500 - Exp. Date
- - 116 - -
- ### 1,400 - -
- - 74 - -
- - 2,160 - -
25 25 2,641 66,025 -
- 48 2,001 - 96,050
- 100 142 - 14,200
3,200 - -
- ###
- - 35,200 - -
2 109 2,100 4,200 224,700
- 12 23,100 - 277,200
- - 38,999 - -
1,400 1,400 100 140,000 -
- - 50 - -
- - 166 - -
- - 116 - -
- - 122 - -
- - 170 - -
- - 2,260 - -
- - 239 - -
- - 345 - -
- ### 140 - -
60 150 - -
- ### 9,000 - -
- 30 1,300 - 39,000
- 100 77 - 7,700
- 150 1,250 - 187,500
- ### - -
- ### 10,290 - -
- 20 14,070 - 281,400
10 75 43 430 2,795
- ### 970 - -
25 ### 1,520 38,000 -
- ### 1,650 - -
- ### 669 - -
- ### 478 - -
- ### 225 - -
- 400 250 - 100,000
- ### 8,900 - -
600 1,100 62 37,200 31,000
- 300 89 - 26,700
- 1,500 141 - 211,500
300 600 257 77,100 77,100
- ### 27,500 - -
- ### 519 - -
- 30 5,064 - 151,920
- ### 1,100 - -
- ### 9,000 - -
- ### 869 - -
- ### 5,247 - -
- 30 3,150 - 94,500
- ### 3,500 - -
- ### 186 - -
- ### 59,800 - -
- ### 260 - -
- ### 120 - -
150 200 379 56,850 18,950
300 600 570 171,000 171,000
- 100 900 - 90,000
- 15,000 53 - 795,000
- ### 262 - -
- 85 3,865 - 328,525
- ### 1,679 - -
- 144 1,600 - 230,400
- 1,000 89 - 89,250
- 300 153 - 45,900
- 300 71 - 21,300
- ### 1,103 - - Exp. Date
500 3,400 145 72,500 420,500
- 1,500 75 - 112,500
50 230 2,222 111,100 399,960
- 51 23,000 - 1,173,000
- 228 9,167 - 2,090,000
10 150 1,659 16,590 232,260
2,600 4,400 64 166,400 115,200
230 730 - -
- ### 45 - -
- 28 4,389 - 122,892
50 80 1,107 55,350 33,210 Exp. Date ( 40 amp)
- ### 100 - -
- 500 134 - 67,000
- 400 104 - 41,600
- 100 285 - 28,500
50 129 3,410 170,500 269,390
800 900 170 136,000 17,000
- 30 16,350 - 490,500
5 25 16,280 81,400 325,600
- - 11,660 - -
- 390 33 - 12,973
2 71 8,505 17,010 586,845
- - 497 - -
200 200 976 195,200 -
20 244 7,893 157,860 1,768,032
50 900 102 5,100 86,700
13,000 ### 21 271,258 - Exp. Date
- 50 23,100 - 1,155,000
200 1,200 735 147,000 735,000

200 1,296 880 176,000 964,480
- ### 10,000 - -
- 25 1,920 - 48,000
- 400 94 - 37,600
- 54 6,555 - 353,970
- 200 50 - 10,000
- 1,200 303 - 363,600
- 30 - -
- ### 1,469 - -
- 20 3,353 - 67,060
- 80 3,569 - 285,520
- 90 945 - 85,050
300 500 58 17,400 11,600
1,000 1,000 50 50,000 -
- ### 5,985 - -
- ### 2,577 - -
- 78 5,460 - 425,880
- ### 2,200 - -
- ### 230 - -
- 600 100 - 60,000
- 500 61 - 30,500
- 500 72 - 36,000
- ### 2,167 - -
- 500 - -
- 40 25,000 - 1,000,000
48 72 2,798 134,304 67,152
10 70 5,900 59,000 354,000
300 ### - -
- ### 16,500 - -
10 283 4,724 47,240 1,289,652
600 ### 116 69,600 -
500 ### 153 76,500 -
- ### 6,500 - -
- ### 203 - -
- ### 6,200 - -
- 500 68 - 34,000
- 500 93 - 46,500
100 160 1,450 145,000 87,000
20 ### 9,000 180,000 -
20 ### 10,000 200,000 -
- 40 9,625 - 385,000
- ### 743 - -
500 700 73 36,500 14,600

- 25 2,569 - 64,225
- 60 4,930 - 295,800
250 600 310 77,500 108,500 Exp. Date
- ### 1,697 - -
- ### 2,539 - -
- 300 214 - 64,200
- 400 525 - 210,000
- 60 879 - 52,740
- ### 879 - -
76 90 1,431 108,756 20,034
- ### 554 - -
250 600 162 40,500 56,700
- 900 92 - 82,800
- 30 3,500 - 105,000
- 53 3,711 - 196,683
- 270 239 - 64,530
- 30 11,500 - 345,000
- 3,300 127 - 419,265
- 360 2,750 - 990,000
- - 92,990 - -
600 800 210 126,000 42,000
- 600 108 - 64,800
- 800 105 - 84,000
- ### 113 - -
- ### 164 - -
- ### 3,000 - -
18 162 17,820 320,760 2,566,080
25 ### 18,500 462,500 -
- ### 8,500 - -
100 1,900 390 39,000 702,000
- ### 3,017 - -
- ### 141 - -
- ### 185 - -
60 ### 4,935 296,100 -
100 600 1,260 126,000 630,000
- 120 2,940 - 352,800
- ### 110 - -
180 180 2,999 539,820 -
- 400 672 - 268,800
- 100 504 - 50,400
17 ### 12,500 212,500 -
- ### 680 - -
- ### 1,600 - -
- ### 1,606 - -
- ### 216 - -
90 ### 180 16,200 -
- ### 6,325 - -
- 60 375 - 22,500
- 28 297 - 8,316
- 270 122 - 32,940
3,200 6,100 84 268,800 243,600
- 145 5,460 - 791,700
94 227 1,496 140,624 198,968
- ### - -
- 500 535 - 267,500
- ### 1,058 - -
- ### 24,150 - -
- ### 11,475 - -
3 ### 1,523 4,568 - Exp. Date
- ### 31 - -
- 27 1,890 - 51,030
8 ### 4,200 33,600 - Exp. Date
- ### 321 - -
- 1,610 308 - 495,880
- 50 8,728 - 436,400
300 900 666 199,800 399,600
- 30 3,582 - 107,460
- 30 3,582 - 107,460
- 80 2,250 - 180,000
3 5 6,298 18,894 12,596
- 10 14,771 - 147,710
- 4 38,594 - 154,376
- ### 2,400 - -
- 300 119 - 35,700
500 500 205 102,500 - Exp. Date
- 2 7,549 - 15,098
- 700 79 - 55,300
- 1,200 110 - 132,000
- 800 335 - 268,000
- 3,200 837 - 2,678,400
- ### 9,500 - -
- 120 704 - 84,480
500 ### 600 300,000 - Exp. Date
- 70 1,190 - 83,300
- ### 126 - -
1 2 100,000 100,000 100,000

1 2 100,000 100,000 100,000
1 2 125,000 125,000 125,000
- 700 85 - 59,500
- 700 109 - 76,300
- ### 5,460 - -
- 40 1,038 - 41,520
- 31 2,283 - 70,779
200 ### 62 12,400 -
- 290 85 - 24,650
- 29 11,550 - 334,950
- 200 452 - 90,400
15 ### 6,930 103,950 -
24 72 2,100 50,400 100,800
- ### 126,000 - -
- ### 47,000 - -
10 370 1,131 11,310 407,160
- ### 60 - -
- ### 174 - -
- 150 1,574 - 236,100
- ### 17,604 - -
- 5 12,159 - 60,795
2 5 6,800 13,600 20,400
2 3 5,600 11,200 5,600
- ### 28,000 - -
20 ### 3,832 76,640 - Exp. Date
- ### 3,387 - -
- 400 544 - 217,600
- ### 13,850 - -
- 60 30,800 - 1,848,000
- 800 154 - 123,200
- 300 312 - 93,600
45 ### 700 31,500 - Exp. Date
- ### 37 - -
- 150 192 - 28,835
- ### - -
2,600 4,200 110 286,000 176,000
- ### 26,400 - -
- ### 497 - -
- 283 12,840 - 3,633,720
40 49 7,770 310,800 69,930
- ### - -
- ### - -
- ### 390,000 - -
- ### 125,000 - -
- ### 17,500 - -
- ### 395,000 - -
- ### 242,000 - -
- ### 55,000 - -
- ### 176,000 - -
- ### 93,500 - -
- ### 34,000 - -
35,827 108,908 9,352,689 45,768,647
- 370 826 - 305,435
- ### 826 - -
- ### 826 - -
5 365 953 4,763 342,900
- 145 1,175 - 170,375
100 ### 197 19,680 -
12 62 4,572 54,864 228,600
18 108 22,500 405,000 2,025,000
- 96 22,500 - 2,160,000
- 2 8,000 - 16,000
- 3 8,000 - 24,000
- 3 8,000 - 24,000
- ### 1,300 - -
73 78 1,300 94,900 6,500
130 ### 1,300 169,000 -
30 80 8,085 242,550 404,250
50 100 8,085 404,250 404,250
50 150 8,085 404,250 808,500
- 115 8,085 - 929,775
10 81 4,445 44,450 315,595
50 100 4,064 203,200 203,200
3 5 - -
1 3 34,000 34,000 68,000
- 6 24,000 - 144,000
1 5 7,900 7,900 31,600
- 14 1,800 - 25,200
- ### 3,800 - -
- ### 800 - -
100 250 1,100 110,000 165,000
4 9 9,400 37,600 47,000
- 12 16,000 - 192,000
- 7 25,000 - 175,000
2 3 130,000 260,000 130,000
1 5 439 439 1,756
- ### 439 - -
- ### 439 - -
- 2 - -
- 5 33,000 - 165,000
- 5 27,830 - 139,150
- 4 60,500 - 242,000
- ### 30,000 - -
- ### 3,850 - -
- 20 7,315 - 146,300
- ### 21,753 - -
2 ### 30,030 60,060 -
- ### 15,000 - -
6 44 15,000 90,000 570,000
- ### 10,010 - -
- 48 3,000 - 144,000
- 23 3,000 - 69,000
4 45 3,000 12,000 123,000
- ### - -
18 25 3,000 54,000 21,000
- 100 2,021 - 202,125
- 100 2,224 - 222,390
- 9 3,810 - 34,290
- 145 1,270 - 184,150
- ### 6,059 - -
- ### 6,059 - -
670 2,984 2,712,905 11,610,341
36,497 111,892 12,065,594 57,378,988
Pangkalan Kasai, 31 Juli 2016
Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm

Penyesuaian saldo
No. Nama Obat Penerimaan
KEMASAN ( 31 Juli 2016 )
Juli
A Obat-Obat
2 Antalgin inj ampul 85 -

4 supp - -

7 Asiklovir tab 200 mg tablet 300 -
8 Asiklovir tab 400 mg tablet 100 -
9 Arimed / Meloxicam 15 mg tablet 20 -
10 Becefort tablet - -
11 Bisolvon Extra Syrup btl - -
12 Captopril tablet 12,5 mg tablet - -
17 Cotrimoksazol DOEN I (Dewasa) tablet - -
18 Dasabion (Anti Anemic + Vitamin ) tablet - -
21 Eryra Porte ( Erytromisin 500 mg ) kapsul - -
22 Erlamycetin Ear Drop Tetes Telinga btl - -
24 Fituno tablet - -
26 Hidrokortison krim 2,5% tube - -
27 Holicos ( Ambroxol ) syrup btl - -
28 Hustab tablet - -
30 Isotic Neolyson Tetes Mata btl - -
31 Isotic Clearens Tetes Mata btl - -
32 Livron B Plek tablet 100 -
34 Metaneuron tablet 600 -
35 Metilprednisolon 4mg tablet - -
36 Mucohexin tablet 100 -
39 Neurovit - E kaplet - -
40 Nodiar tablet 300 -
41 Noza tablet - -
42 OBH Indo Plus syrup botol - -
43 Oxfezin syrup botol - -
45 Oksitetrasiklin inj ampul 10 -
47 Parasetamol syrup 120mg / 5ml botol - -
48 Pehavral tablet 100 -
49 Piroxicam 20 mg tablet - -
50 Pehacort / Prednison 5mg tablet 1,000 -
51 Propanolol 40mg tablet 500 -
52 Prolysin Plus syrup botol - -
53 Pularex Attalpugit 600 mg tablet 100 -
54 Ranitidin 150mg tablet - -
57 Sanbe Kids syrup botol - -
58 Sagestam Cream tube 3 -
59 Scabimite Cream tube - -
60 Tryhexilpenidil tablet 200 -
62 Oxycan btl 5 -
SISA OBAT DALAM RUPIAH 10,048 -
Mengetahui
Pangkalan Kasai

NIP 197507232008012007
FER STOCK PROVINSI PER 29 JULI - 31 JULI 2016
Penyesuaian saldo
Pengeluaran Harga Satuan Rp ) 29 Juni - 31 Juli Keterangan
Juni 2016 Terakhir
2016
Juli
- - 270 - -
5 90 1,393 6,967 118,433
- - 74 - -
20 20 3,685 73,700 -
- - 209 - -
- - 2,260 - -
- 300 239 - 71,700
200 300 345 69,000 34,500
- 20 8,085 - 161,700
- - 1,500 - -
- - 32,625 - -
- - 62 - -
- - 519 - -
- 5 5,064 - 25,320
- - 513 - -
1,500 6,000 77 115,000 345,000
- - 145 - -
100 100 979 97,900 -
- 500 140 - 70,000
- 500 95 - 47,500
- - 2,970 - -
- - 4,840 - -
- 20 23,100 - 462,000
- - 4,033 - -
- 300 230 - 69,000
48 48 2,399 115,152 -
- - 23,100 - -
300 300 300 90,000 -
- - 153 - -
- - 28,750 - -
- - 10,750 - -
200 300 250 50,000 25,000
- 300 92 - 27,600
- 600 1,283 - 770,000
- - 210 - -
- 100 506 - 50,600
50 50 141 7,050 -
- - 4,935 - -
- - 1,027 - -
- 300 1,210 - 363,000
100 100 891 89,100 -
- - 12,100 - -
- - 56,100 - -
- - 2,200 - -
- 10 5,500 - 55,000
- - 216 - -
- - 1,496 - -
- 100 693 - 69,300
- - 119 - -
- 1,000 145 - 145,000
- 500 114 - 57,000
- - 30,800 - -
- 100 210 - 21,000
- - 108 - -
- - 5,460 - -
- 300 85 - 25,500
- - 38,500 - -
- 3 13,090 - 39,270
- - 77,000 - -
- 200 44 - 8,800
- 100 497 - 49,700
- 5 - -
2,523 12,571 713,869 3,111,923
Pangkalan Kasai, 31 Juli 2016

Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
1 203 Nistatin vaginal tablet 100.000 IU/gram tablet 20
204 OBH sirup botol -
209 Ondansentron 4mg tablet -
211 Ostine kapsul -
218 Penoksimetil Penisilin 500mg tablet -
222 Pethidin injeksi ampul -
225 Piracetam injeksi 3g / 15ml ampul -
227 Pirantel Score (base ) 125mg tablet 1,490
230 Pitomenadion inj. 2mg ampul -
231 Pitomenadion inj. 10mg ampul -
233 Povidon Iodida 10% 60ml botol -
236 Pravastatin 20mg tablet 350 500
237 Prednison 5mg tablet 900 2,000
238 Primakuin 15mg tablet -
240 Propanolol HCl 10mg tablet 700
246 Ramipril 5mg tablet -
251 Reagen Golongan Darah Anti D 10ml botol -
252 Reserpin 0,10mg tablet -
257 Salbutamol 2mg (sebagai sulfat) tablet -
261 Salbutamol cairan inh 0,1% (Ventolin Nebules) botol 40 40
264 Serum Anti Bisa Ular amp -
1 266 Sianokobalamin (vitamin B 12) 50mcg tablet -
272 Stick Glukosa botol -
274 Streptomisin injeksi 1 g/ml vial -
275 Sulfasetamida Natrium TM 15% / 5ml botol -
277 Sukralfat suspensi 500mg / 5ml (Ulsafate Syrup) botol 250 300
281 Thiamin (Vitamin B1) injeksi 100mg / ml ampul -
287 Zinc Disperibel tablet -
289 Zirkum Kid syrup 20mg / 5ml botol 74 100
-
B. OBAT GIGI -

2 Alat suntik sekali pakai 2,5 ml pcs 370 500
6 Alkohol Swab CHG 0,5 % pcs 700 1,000
7 Blood Transfusion Set pcs 180 150
14 Handscoon no 7,5 pcs - 250
15 Handscoon no 8 pcs - 250
21 Infusion set dewasa set 195 200
22 kapas pembalut berlemak 500 mg Bks -
23 Kapas pembalut 500 gram Bks 1
1 25 Kasa Hidrofil 16x16 16 pcs/ktk 19 50
27 Kasa Hidrofil 4 x 15 cm roll 80 100
30 Kasa Pembalut 2 x 80 cm Rol 3 20
33 Kasa hidrofil ukuran 36 x 80cm Rol 7 10
34 Lysol btl 6 5
36 Masker Tie On pcs 1,550 2,000
37 Oxycan btl 2
43 Semillas Non Woven Medical Tape (10 x 100cm) roll 48 50
46 Silk ( benang bedah sutera ) no. 3/0 pcs 48 72
56 Urine bag pcs 9
SISA ALKES DALAM RUPIAH 5,368 5,327

Mengetahui
Pangkalan Kasai

NIP 197507232008012007
200 400 672 134,400 134,400
1 80 100 504 40,320 10,080
12,500 - -
680 - -
1,600 - -
1,606 - -
216 - -
180 - -
6,325 - -
60 60 375 22,500 -
28 297 - 8,316
270 122 - 32,940
8,800 2,900 84 739,200 344,400
8 145 5,460 43,680 1,359,540
311 133 1,496 465,256 236,368
- -
500 500 535 267,500 - exp. Date 500 tab
1,058 - -
24,150 - -
11,475 - -
1,523 - -
31 - -
27 1,890 - 51,030
4,200 - -
321 - -
120 1,610 308 36,960 458,920
40 50 8,728 349,120 87,280
100 600 666 66,600 333,000
30 30 3,582 107,460 -
30 30 3,582 107,460 - exp. Date 25 ampul
20 80 2,250 45,000 135,000
2 2 6,298 12,596 -
5 10 14,771 73,855 73,855
4 38,594 - 154,376
150 2,400 360,000 840,000
1,400 300 119 166,600 107,100
205 - -
2 7,549 - 15,098
700 79 - 55,300
1,200 110 - 132,000
100 800 335 33,500 234,500
300 3,200 837 251,100 2,427,300
9,500 - -
120 704 - 84,480
600 - -
45 70 1,190 53,550 29,750
126 - -
1 100,000 - 100,000
1 100,000 - 100,000
1 1 125,000 125,000 -
700 700 85 59,500 - exp date 700 tab
700 109 - 76,300
- 5,460 - -
40 1,038 - 41,520
5 31 2,283 11,416 59,363
62 - -
100 290 85 8,500 16,150
29 11,550 - 334,950
200 452 - 90,400
6,930 - 277,200
13 48 2,100 27,300 73,500
126,000 - -
47,000 - -
5 360 1,131 5,655 401,505
1 60 - -
174 - -
150 1,574 - 236,100
17,604 - -
3 5 12,159 36,477 24,318
3 6,800 - 34,000
1 1 5,600 5,600 -
28,000 - -
3,832 - -
3,387 - -
400 544 - 217,600
50 13,850 692,500 3,462,500
60 30,800 - 1,848,000
100 800 154 15,400 107,800
300 312 - 93,600
700 - -
37 - -
50 150 192 9,612 19,223
- -
4,000 1,600 110 440,000 484,000
26,400 - -
497 - -
10 283 12,840 128,400 3,505,320
35 9 7,770 271,950 574,980
- -
- -
- 390,000 - -
- 125,000 - -
- 17,500 - -
- 395,000 - -
- 242,000 - -
- 55,000 - -
- 176,000 - -
- 93,500 - -
- 34,000 - -
42,356 73,066 15,941,013 52,266,372
190 370 826 156,845 148,590

130 826 107,315 305,435
195 826 160,973 251,778
15 360 953 14,288 328,613
10 145 1,175 11,750 158,625
300 197 59,040 137,760
20 50 4,572 91,440 822,960
15 90 22,500 337,500 1,687,500
24 96 22,500 540,000 1,620,000
2 8,000 - 16,000
3 8,000 - 24,000
3 8,000 - 24,000
1,300 - -
255 5 1,300 331,500 -
250 1,300 325,000 -
34 50 8,085 274,890 533,610
59 50 8,085 477,015 735,735
3 100 8,085 24,255 784,245
3 115 8,085 24,255 905,520
71 4,445 - 315,595
55 50 4,064 223,520 792,480
2 2 - -
1 2 34,000 34,000 34,000
2 6 24,000 48,000 96,000
1 35 4 7,900 276,500 150,100
2 14 1,800 3,600 21,600
20 3,800 76,000 304,000
800 - -
30 150 1,100 33,000 132,000
22 5 9,400 206,800 28,200
3 12 16,000 48,000 144,000
1 7 25,000 25,000 150,000
4 1 130,000 520,000 910,000
3 4 439 1,317 2,633
439 - -
450 439 197,505 680,295
2 - -
5 33,000 - 165,000
5 27,830 - 139,150
4 60,500 - 242,000
30,000 - -
3,850 - -
22 20 7,315 160,930 351,120
3 21,753 65,259 152,271
4 30,030 120,120 180,180
24 15,000 360,000 720,000
17 38 15,000 255,000 315,000
10,010 - -
24 48 3,000 72,000 72,000
3 23 3,000 9,000 60,000
3 41 3,000 9,000 114,000
- -
3 7 3,000 9,000 12,000
100 2,021 - 202,125
100 2,224 - 222,390
9 3,810 - 34,290
37 145 1,270 46,990 137,160
6,059 - -
6,059 - -
2,273 2,314 5,736,606 15,363,959

44,629 75,380 21,677,619 67,630,332
Pangkalan Kasai, 31 Agustus 2016

Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm
SALDO PERSEDIAAN OBAT BUFFER STOCK PROVINS

Penyesuaian saldo
Saldo hasil Cek
SATUAN
No. Nama Obat Fisik ( 31 Agustus Penerimaan
KEMASAN
2016 )
Agustus
A Obat-Obat
1 Amoksisilin kapsul 500 mg kapsul - 1,000
2 Antalgin inj ampul 85
3 Antasida DOEN I tablet kunyah tablet - 1,000
4 supp 20 50
Heksaklorofen 2,5mg Lidokain 10mg Seng Oksida 120mg
6 Asiklovir krim 5% tube 25 75
7 Asiklovir tab 200 mg tablet 1,200 1,000
8 Asiklovir tab 400 mg tablet 1,000 1,000
9 Arimed / Meloxicam 15 mg tablet 20
10 Becefort tablet 100 300
11 Bisolvon Extra Syrup btl -
12 Captopril tablet 12,5 mg tablet -
13 Cefadroksil kap 500 mg kapsul 100 500
14 Cefadroksil syrup kering 125 mg/5ml btl 60 ml -
17 Cotrimoksazol DOEN I (Dewasa) tablet -
18 Dasabion (Anti Anemic + Vitamin ) tablet 300 500
19 Diaform tablet -
21 Eryra Porte ( Erytromisin 500 mg ) kapsul -
22 Erlamycetin Ear Drop Tetes Telinga btl 5 10
24 Fituno tablet -
26 Hidrokortison krim 2,5% tube -
27 Holicos ( Ambroxol ) syrup btl -
28 Hustab tablet - 600
29 Ibuprofen tablet 400 mg tablet -
30 Isotic Neolyson Tetes Mata btl -
31 Isotic Clearens Tetes Mata btl -
32 Livron B Plek tablet 100
34 Metaneuron tablet 600
35 Metilprednisolon 4mg tablet 100 500
36 Mucohexin tablet 100
37 Natrium Diklofenat 25mg tablet - 250
38 Natrium Klorida larutan infus 0.9% steril 500ml botol -
39 Neurovit - E kaplet -
40 Nodiar tablet 300
41 Noza tablet -
42 OBH Indo Plus syrup botol -
43 Oxfezin syrup botol -
44 Oksitetrasiklin salep kulit 3% tube 75 100
45 Oksitetrasiklin inj ampul 10
46 Omeprazol kapsul 20 mg kapsul 30 180
47 Parasetamol syrup 120mg / 5ml botol -
48 Pehavral tablet 300 500
49 Piroxicam 20 mg tablet 200 400
50 Pehacort / Prednison 5mg tablet 1,000
51 Propanolol 40mg tablet 500
52 Prolysin Plus syrup botol -
53 Pularex Attalpugit 600 mg tablet 100
54 Ranitidin 150mg tablet - 500
55 Ringer Laktat larutan infus 500ml botol - 40
57 Sanbe Kids syrup botol -
58 Sagestam Cream tube 3
59 Scabimite Cream tube -
60 Tryhexilpenidil tablet 1,200 1,000
61 Zinc Disperibel tablet 600 500
62 Oxycan btl 2
SISA OBAT DALAM RUPIAH 12,495 10,005
Mengetahui
Pangkalan Kasai

ER STOCK PROVINSI PER 29 JULI - 31 Agustus 2016
Penyesuaian saldo Jumlah

SALDO per 31 Pengeluaran ( Rp ) Harga Perolehan
Pengeluaran Harga Satuan Keterangan
Juli 2016 31 Juli - 31 Agustus Terakhir
Agustus 2016
1,000 - 270 270,000 -

85 1,393 - 118,433
1,000 74 74,000 -
30 3,685 110,550 73,700
209 - -
50 2,260 113,000 56,500
100 300 239 23,900 286,800
100 100 345 34,500 345,000
20 8,085 - 161,700
200 1,500 300,000 150,000
32,625 - -
62 - -
400 519 207,600 51,900
5 5 5,064 25,320 -
513 - -
1,500 4500 77 115,000 230,000
145 - -
200 979 195,800 293,700
500 500 140 70,000 -
500 95 - 47,500
2,970 - -
5 4,840 24,200 24,200
20 23,100 - 462,000
4,033 - -
300 230 - 69,000
2,399 - -
23,100 - -
600 300 180,000 -
153 - -
28,750 - -
10,750 - -
100 250 - 25,000
300 92 - 27,600
600 1,283 - 770,000
400 210 84,000 21,000
100 506 - 50,600
250 141 35,250 -
4,935 - -
1,027 - -
300 1,210 - 363,000
891 - -
12,100 - -
56,100 - -
25 2,200 55,000 165,000
10 5,500 - 55,000
150 216 32,400 6,480
1,496 - -
300 100 693 207,900 207,900
200 119 23,800 23,800
1000 145 - 145,000
500 114 - 57,000
30,800 - -
100 210 - 21,000
500 108 54,075 -
40 5,460 218,400 -
300 85 - 25,500
38,500 - -
3 13,090 - 39,270
77,000 - -
200 44 - 52,800
100 497 - 298,200
3 5 - -
7,558 10,048 2,454,695 4,724,583
Pangkalan Kasai, 31 Agustus 2016

Pengelola Laporan
UPT Puskesmas
SINTICE, Amd.Farm

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SALDO PERSEDIAAN PER 01 JANUARI - 31 JANUARI 2016

KODE PUSKESMAS : P. 1402022201

SISA OBAT DALAM RUPIAH 66,687 - 31,095 97,782 13,076,478 34,669,612

C. ALKES & BAHAN HABIS PAKAI ( BHP )

SISA ALKES DALAM RUPIAH 2,971 - 1,686 4,657 4,799,401 7,722,039

Mengetahui Pangkalan Kasai, 31 Januari 2015

drg. DWIYANA SYAHPUTRI NURKHADIJAH, Amd.Kep

KODE PUSKESMAS : P. 1402022201

1 Albendazol suspensi 200 mg/5 ml btl 50 -

2 Albendazol tab 400 mg tablet - -

3 Alkohol 70 % 100 ml btl 11 -

4 ALKOHOL 70 % 1000 ml btl 22 20

6 Alopurinol tab 300 mg tablet 400 -

7 Alprazolam 0,5 mg tab tablet - -

8 Ambroxol sirup btl - -

9 Ambroxol tablet 30 mg tablet - -

10 Aminofilin tab 200 mg tablet 1,050 -

11 Aminofilin injeksi 24 mg/ml ampul 34 -

12 Amitriptilin tab 25 mg tablet 600 -

13 Amlodipin 5 mg tab tablet - -

14 Amlodipin 10 mg tab tablet - -

15 Amobiotic Drop btl 28 20

16 Amoksisilin kapsul 250 mg kapsul 1,200 2,400

17 Amoksisilin kapsul 500 mg kapsul 1,000 3,000

18 Amoksisilin syrup kering 125mg/5ml botol 5 ml 615 700

19 Amoksisilin serbuk injeksi 1g vial 10 -

20 Ampisilin 500 mg kap kapsul - -

21 Ampisilin serbuk injeksi 500 mg/vial vial 10 -

22 Antalgin tablet 500 mg tablet - -

23 Antalgin inj ampul - -

24 Antasida DOEN I tablet kunyah tablet 2,700 5,000

25 Antasida DOEN II Suspensi Komb btl 60 ml - -

26 Anti bakteri salep komb tube 150 150

27 Antifungi DOEN komb salep pot 48 -

28 Antimigren: ergotamin tartrat 1mg +kofein 50mg tablet 200 -

30 Antithrom Jelly tube 4 -

31 Aqua pro injeksi steril vial 19 -

32 Artemether injeksi 80 mg/ml ampul 12 -

33 Artesunate injeksi vial/ktk - -

34 Asam askorbat ( vit c ) tablet 50 mg tablet - -

35 Asam Folat tab 1 mg tablet - -

36 Asam Mefenamat kaplet 250 mg kaplet 800 2,000

37 Asam Mefenamat kaplet 500 mg kaplet 1,400 3,000

38 Asetosal tab 100 mg tablet - -

39 Asetosal tab 500 mg tablet - -

40 Asiklovir krim 5% tube - -

41 Asiklovir tab 200 mg tablet 700 500

42 Asiklovir tab 400 mg tablet 400 500

43 Asonfen tab tablet 1,000 2,000

44 Asifit tablet 30 300

45 Asering tablet 300 300

46 Atropin sulfat injeksi ampul 30 -

47 Atropin sulfat tab 0,5 mg tablet 100 -

48 Bedak Salisil Serbuk 2 % bks 312 -

50 Benzatin benzil penisilin 1,2 jt UI inj vial 10 -

51 Benzatin benzil penisilin 2,4 jt UI inj vial 20 -

52 Besi II Sulfat 200 mg + as.Folat 0,25 mg tablet tablet 100 -

54 Betametason krim 0,1% tube 65 150

55 Bexicom tab kapsul - -

56 Bisoprolol tablet 5 mg tablet 60 -

58 Bromiphar tablet 300 -

59 Budenosid respules resp - -

60 Captopril tablet 12,5 mg tablet 2,100 2,000

61 Captopril tablet 25 mg tablet 2,200 2,000