LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA

Bulan JANUARI 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN
AKHIR
1 Acyclovir salep kulit Tube 3,600 2 2
2 Albothyl Botol 30,600 1 1
3 Alletrol Tetes Mata Botol 12,950 - -
4 Alupurinol Tablet 153.000 - -
5 Ambroxol Tablet 225 170 50 120
6 Ambroxol syrup Botol 4,300 - -
7 Amlodipin 5 mg Tablet 4,100 - -
8 Amoxicillin 500 mg tab Tablet 490 80 100 10 170
9 Amoxicillin sirup Botol 4,950 - -
10 Amoxicillin sirup forte Botol 8,500 - -
11 Antasida doen Tablet 125 230 20 210
12 Antasida doen syrup Botol 3,000 11 11
13 Antihemorroid supp Supp 4,400 5 5
14 Asam mefenamat tab 500 mg Tablet 231 140 30 110
15 Bedak salisil nelco Botol 5,200 1 1
16 Betametason Tube 2,600 - -
17 Bisoprolol Tablet 1,575 - -
18 Bronkis sirup Botol 4,900 - -
19 Bronkis tab Tablet 125 - -
20 C T M Tablet 30 114 114
21 Captopril 12,5 mg Tablet 110 190 190
22 Captopril 25 mg Tablet 170 150 50 100
24 Cepadroxyl sirup Botol 10,500 - -
25 Cepadroxyl 500 mg Tablet 890 - -
26 Cetericne Tablet 420 - -
27 Ciproploxasin 500 mg Tablet 465 150 150
28 Deksametason Tablet 75 158 28 130
29 Digoksin tab Tablet 195 - -
30 Donperidon sirup Botol 4,300 - -
31 DumIn 250 mg Supp 18,500 - -
32 Duramycin 500 mg Tablet 1,200 - -
33 Ebatik serbuk SASET 3,000 - -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 - -
35 Enbatik salep kulit Tube 8,500 7 7 -
36 Erlamycetine salep mata Tube 6,500 - -
37 Erlamycetine tetes telinga Botol 5,000 3 3
38 Erythromicin sirup Botol 10,500 - -
39 Ethyl klorida Botol 96,000 1 1
40 Farsicol cream Tube 3,500 - -
41 Farsipen 400 mg Tablet 352 100 100
42 Gentamycin salep mata Tube 7,100 - -
43 Gentamycin tetes mata Botol 8,400 - -
44 Gliben klamida Tablet 110 - -
45 Gliseril guayakolas Tablet 39 568 568
46 Hufaneuron Tablet 390 120 40 80
47 Hydrokortison cream Tube 6,500 1 1
48 Ketoconasol cream Tube 9,200 - -
49 Ketoconasol tab Tablet 550 - -
50 Lico calc Tablet 175 170 20 150
51 Loratadin Tablet 450 - -
52 Metformin Tablet 250 - -
53 Methyl prednisolon Tablet 470 - -
54 Metronidasol 500 mg Tablet 270 - -
55 New diatab Tablet 750 - -
56 Oxytetra salep kulit Tube 2,800 - -
57 Parasetamol 500 mg Tablet 135 140 20 120
58 Parasetamol drop Botol 8,500 - -
59 Parasetamol sirup botol 2,900 - -
60 Pehacain injeksi Ampul 4,200 3 3
61 Ranitidin Tablet 240 20 20
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
Kepala UPT. Puskesmas Kuta Utara
64 simvastatin tablet 680 PengelolaObatUPTPuskesmasKuta
Utara
-
65 Sirup indra Botol 3,500 -
66 Ventolin dr. Ni Putu Purlimaningsih S.Ampul
Ked 9,700 -
Visine NIPmata
tetes . 19791120 200604 2 006Botol NiKomangAyuTriyani
67
15,600 NIP.198801082011012016 -
68 Voltadex Tablet 385

-

TOTAL
MINTA TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan FEBRUARI 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN
AKHIR MINTA TERIMA
1 Acyclovir salep kulit Tube 3,600 2 2
2 Albothyl Botol 30,600 1 1
3 Alletrol Tetes Mata Botol 12,950 - -
4 Alupurinol Tablet 153.000 - -
5 Ambroxol Tablet 225 120 120
6 Ambroxol syrup Botol 4,300 - -
7 Amlodipin 5 mg Tablet 4,100 - -
8 Amoxicillin 500 mg tab Tablet 490 170 170
9 Amoxicillin sirup Botol 4,950 - -
10 Amoxicillin sirup forte Botol 8,500 - -
11 Antasida doen Tablet 125 210 210
12 Antasida doen syrup Botol 3,000 11 11
13 Antihemorroid supp Supp 4,400 5 5
14 Asam mefenamat tab 500 mg Tablet 231 110 110
15 Bedak salisil nelco Botol 5,200 1 1
16 Betametason Tube 2,600 - -
17 Bisoprolol Tablet 1,575 - -
18 Bronkis sirup Botol 4,900 - -
19 Bronkis tab Tablet 125 - -
20 C T M Tablet 30 114 114
21 Captopril 12,5 mg Tablet 110 190 190
22 Captopril 25 mg Tablet 170 100 100
24 Cepadroxyl sirup Botol 10,500 - -
25 Cepadroxyl 500 mg Tablet 890 - -
26 Cetericne Tablet 420 - -
27 Ciproploxasin 500 mg Tablet 465 150 150
28 Deksametason Tablet 75 130 130
29 Digoksin tab Tablet 195 - -
30 Donperidon sirup Botol 4,300 - -
31 DumIn 250 mg Supp 18,500 - -
32 Duramycin 500 mg Tablet 1,200 - -
33 Ebatik serbuk SASET 3,000 - -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 - -
35 Enbatik salep kulit Tube 8,500 - -
36 Erlamycetine salep mata Tube 6,500 - -
37 Erlamycetine tetes telinga Botol 5,000 3 3
38 Erythromicin sirup Botol 10,500 - -
39 Ethyl klorida Botol 96,000 1 1
40 Farsicol cream Tube 3,500 - -
41 Farsipen 400 mg Tablet 352 100 100
42 Gentamycin salep mata Tube 7,100 - -
43 Gentamycin tetes mata Botol 8,400 - -
44 Gliben klamida Tablet 110 - -
45 Gliseril guayakolas Tablet 39 568 568
46 Hufaneuron Tablet 390 80 80
47 Hydrokortison cream Tube 6,500 1 1
48 Ketoconasol cream Tube 9,200 - -
49 Ketoconasol tab Tablet 550 - -
50 Lico calc Tablet 175 150 150
51 Loratadin Tablet 450 - -
52 Metformin Tablet 250 - -
53 Methyl prednisolon Tablet 470 - -
54 Metronidasol 500 mg Tablet 270 - -
55 New diatab Tablet 750 - -
56 Oxytetra salep kulit Tube 2,800 - -
57 Parasetamol 500 mg Tablet 135 120 120
58 Parasetamol drop Botol 8,500 - -
59 Parasetamol sirup botol 2,900 - -
60 Pehacain injeksi Ampul 4,200 3 3
61 Ranitidin Tablet 240 20 20
62 Ranitidin injeksi Ampul 3,100 - -
63 Reco tm botol 8,400 - -
64 simvastatin tablet 680 - -
65 Sirup indra Botol 3,500 - -
66 Ventolin Ampul 9,700 - -
67 Visine tetes mata Botol 15,600 - -
68 Voltadex Tablet 385 - -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



 Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan MARET 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
TRIWULAN I ( JANUARI FEBRUARI MARET ) TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSKESMAS PEMBANTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA TERIM PEMA SISA STOK

SATUA HARGA STOK A KAIAN AKHIR
NO NAMA OBAT
N SATUAN
JML JML JML JML RP
1 Acyclovir salep kulit Tube 3,600 - -
2 Albothyl Botol 30,600.000 - -
3 Alletrol Tetes Mata Botol 12,950 - -
4 Alupurinol Tablet 153.000 - -
5 Ambroxol Tablet 225 - -
6 Ambroxol syrup Botol 4,300 - -
7 Amlodipin 5 mg Tablet 4,100 - -
8 Amoxicillin 500 mg tab Tablet 490 - -
9 Amoxicillin sirup Botol 4,950 - -
10 Amoxicillin sirup forte Botol 8,500 - -
11 Antasida doen Tablet 125 - -
12 Antasida doen syrup Botol 3,000 - -
13 Antihemorroid supp Supp 4,400 - -
14 Asam mefenamat tab 500 mg Tablet 231 - -
15 Bedak salisil nelco Botol 5,200 - -
16 Betametason Tube 2,600 - -
17 Bisoprolol Tablet 1,575 - -
18 Bronkis sirup Botol 4,900 - -
19 Bronkis tab Tablet 125 - -
20 C T M Tablet 30 - -
21 Captopril 12,5 mg Tablet 110 - -
22 Captopril 25 mg Tablet 170 - -
24 Cepadroxyl sirup Botol 10,500 - -
25 Cepadroxyl 500 mg Tablet 890 - -
26 Cetericne Tablet 420 - -
27 Ciproploxasin 500 mg Tablet 465 - -
28 Deksametason Tablet 75 - -
29 Digoksin tab Tablet 195 - -
30 Donperidon sirup Botol 4,300 - -
31 DumIn 250 mg Supp 18,500 - -
32 Duramycin 500 mg Tablet 1,200 - -
33 Ebatik serbuk SASET 3,000 - -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 - -
35 Enbatik salep kulit Tube 8,500 - -
36 Erlamycetine salep mata Tube 6,500 - -
37 Erlamycetine tetes telinga Botol 5,000 - -
38 Erythromicin sirup Botol 10,500 - -
39 Ethyl klorida Botol 96,000 - -
40 Farsicol cream Tube 3,500 - -
41 Farsipen 400 mg Tablet 352 - -
42 Gentamycin salep mata Tube 7,100 - -
43 Gentamycin tetes mata Botol 8,400 - -
44 Gliben klamida Tablet 110 - -
45 Gliseril guayakolas Tablet 39 - -
46 Hufaneuron Tablet 390 - -
47 Hydrokortison cream Tube 6,500 - -
48 Ketoconasol cream Tube 9,200 - -
49 Ketoconasol tab Tablet 550 - -
50 Lico calc Tablet 175 - -
51 Loratadin Tablet 450 - -
52 Metformin Tablet 250 - -
53 Methyl prednisolon Tablet 470 - -
54 Metronidasol 500 mg Tablet 270 - -
55 New diatab Tablet 750 - -
56 Oxytetra salep kulit Tube 2,800 - -
57 Parasetamol 500 mg Tablet 135 - -
58 Parasetamol drop Botol 8,500 - -
59 Parasetamol sirup botol 2,900 - -
60 Pehacain injeksi Ampul 4,200 - -
61 Ranitidin Tablet 240 - -
62 Ranitidin injeksi Ampul 3,100 - -
63 Reco tm botol 8,400 - -
64 simvastatin tablet 680 - -
65 Sirup indra Botol 3,500 - -
66 Ventolin Ampul 9,700 - -
67 Visine tetes mata Botol 15,600 - -
68 Voltadex Tablet 385 - -
TOTAL -

Kepala UPT. Puskesmas Kuta Utara PengelolaObatUPTPuskesmasKutaUtara

dr. Ni Putu Purlimaningsih S. Ked NiKomangAyuTriyani

NIP . 19791120 20004 2 006 NIP.198801082011012016





Kepala UPT. Puskesmas Kuta Utara PengelolaObatUPTPuskesmasKutaUtara

dr. Ni Putu Purlimaningsih S. Ked NiKomangAyuTriyani

NIP . 19791120 20004 2 006 NIP.198801082011012016





 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan APRIL 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan MEI 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan JUNI 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
TRIWULAN II ( APRIL MEI JUNI ) TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSKESMAS PEMBANTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA TERIM PEMA SISA STOK

SATUA HARGA STOK A KAIAN AKHIR
NO NAMA OBAT
N SATUAN
JML JML JML JML RP
1 Acyclovir salep kulit Tube 3,600 - -
2 Albothyl Botol 30,600.000 - -
3 Alletrol Tetes Mata Botol 12,950 - -
4 Alupurinol Tablet 153.000 - -
5 Ambroxol Tablet 225 - -
6 Ambroxol syrup Botol 4,300 - -
7 Amlodipin 5 mg Tablet 4,100 - -
8 Amoxicillin 500 mg tab Tablet 490 - -
9 Amoxicillin sirup Botol 4,950 - -
10 Amoxicillin sirup forte Botol 8,500 - -
11 Antasida doen Tablet 125 - -
12 Antasida doen syrup Botol 3,000 - -
13 Antihemorroid supp Supp 4,400 - -
14 Asam mefenamat tab 500 mg Tablet 231 - -
15 Bedak salisil nelco Botol 5,200 - -
16 Betametason Tube 2,600 - -
17 Bisoprolol Tablet 1,575 - -
18 Bronkis sirup Botol 4,900 - -
19 Bronkis tab Tablet 125 - -
20 CTM Tablet 30 - -
21 Captopril 12,5 mg Tablet 110 - -
22 Captopril 25 mg Tablet 170 - -
24 Cepadroxyl sirup Botol 10,500 - -
25 Cepadroxyl 500 mg Tablet 890 - -
26 Cetericne Tablet 420 - -
27 Ciproploxasin 500 mg Tablet 465 - -
28 Deksametason Tablet 75 - -
29 Digoksin tab Tablet 195 - -
30 Donperidon sirup Botol 4,300 - -
31 DumIn 250 mg Supp 18,500 - -
32 Duramycin 500 mg Tablet 1,200 - -
33 Ebatik serbuk SASET 3,000 - -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 - -
35 Enbatik salep kulit Tube 8,500 - -
36 Erlamycetine salep mata Tube 6,500 - -
37 Erlamycetine tetes telinga Botol 5,000 - -
38 Erythromicin sirup Botol 10,500 - -
39 Ethyl klorida Botol 96,000 - -
40 Farsicol cream Tube 3,500 - -
41 Farsipen 400 mg Tablet 352 - -
42 Gentamycin salep mata Tube 7,100 - -
43 Gentamycin tetes mata Botol 8,400 - -
44 Gliben klamida Tablet 110 - -
45 Gliseril guayakolas Tablet 39 - -
46 Hufaneuron Tablet 390 - -
47 Hydrokortison cream Tube 6,500 - -
48 Ketoconasol cream Tube 9,200 - -
49 Ketoconasol tab Tablet 550 - -
50 Lico calc Tablet 175 - -
51 Loratadin Tablet 450 - -
52 Metformin Tablet 250 - -
53 Methyl prednisolon Tablet 470 - -
54 Metronidasol 500 mg Tablet 270 - -
55 New diatab Tablet 750 - -
56 Oxytetra salep kulit Tube 2,800 - -
57 Parasetamol 500 mg Tablet 135 - -
58 Parasetamol drop Botol 8,500 - -
59 Parasetamol sirup botol 2,900 - -
60 Pehacain injeksi Ampul 4,200 - -
61 Ranitidin Tablet 240 - -
62 Ranitidin injeksi Ampul 3,100 - -
63 Reco tm botol 8,400 - -
64 simvastatin tablet 680 - -
65 Sirup indra Botol 3,500 - -
66 Ventolin Ampul 9,700 - -
67 Visine tetes mata Botol 15,600 - -
68 Voltadex Tablet 385 - -
TOTAL -

Kepala UPT. Puskesmas Kuta Utara PengelolaObatUPTPuskesmasKutaUtara

dr. Ni Putu Purlimaningsih S. Ked NiKomangAyuTriyani

NIP . 19791120 20004 2 006 NIP.198801082011012016





 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan JULI 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan AGUSTUS 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan SEPTEMBER TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
TRIWULAN III ( JULI AGUSTUS SEPTEMBER ) TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSKESMAS PEMBANTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA TERIM PEMA SISA STOK

SATUA HARGA STOK A KAIAN AKHIR
NO NAMA OBAT
N SATUAN JML JML JML JML RP
1 Acyclovir salep kulit Tube 3,600 - -
2 Albothyl Botol 30,600.000 - -
3 Alletrol Tetes Mata Botol 12,950 - -
4 Alupurinol Tablet 153.000 - -
5 Ambroxol Tablet 225 - -
6 Ambroxol syrup Botol 4,300 - -
7 Amlodipin 5 mg Tablet 4,100 - -
8 Amoxicillin 500 mg tab Tablet 490 - -
9 Amoxicillin sirup Botol 4,950 - -
10 Amoxicillin sirup forte Botol 8,500 - -
11 Antasida doen Tablet 125 - -
12 Antasida doen syrup Botol 3,000 - -
13 Antihemorroid supp Supp 4,400 - -
14 Asam mefenamat tab 500 mg Tablet 231 - -
15 Bedak salisil nelco Botol 5,200 - -
16 Betametason Tube 2,600 - -
17 Bisoprolol Tablet 1,575 - -
18 Bronkis sirup Botol 4,900 - -
19 Bronkis tab Tablet 125 - -
20 CTM Tablet 30 - -
21 Captopril 12,5 mg Tablet 110 - -
22 Captopril 25 mg Tablet 170 - -
24 Cepadroxyl sirup Botol 10,500 - -
25 Cepadroxyl 500 mg Tablet 890 - -
26 Cetericne Tablet 420 - -
27 Ciproploxasin 500 mg Tablet 465 - -
28 Deksametason Tablet 75 - -
29 Digoksin tab Tablet 195 - -
30 Donperidon sirup Botol 4,300 - -
31 DumIn 250 mg Supp 18,500 - -
32 Duramycin 500 mg Tablet 1,200 - -
33 Ebatik serbuk SASET 3,000 - -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 - -
35 Enbatik salep kulit Tube 8,500 - -
36 Erlamycetine salep mata Tube 6,500 - -
37 Erlamycetine tetes telinga Botol 5,000 - -
38 Erythromicin sirup Botol 10,500 - -
39 Ethyl klorida Botol 96,000 - -
40 Farsicol cream Tube 3,500 - -
41 Farsipen 400 mg Tablet 352 - -
42 Gentamycin salep mata Tube 7,100 - -
43 Gentamycin tetes mata Botol 8,400 - -
44 Gliben klamida Tablet 110 - -
45 Gliseril guayakolas Tablet 39 - -
46 Hufaneuron Tablet 390 - -
47 Hydrokortison cream Tube 6,500 - -
48 Ketoconasol cream Tube 9,200 - -
49 Ketoconasol tab Tablet 550 - -
50 Lico calc Tablet 175 - -
51 Loratadin Tablet 450 - -
52 Metformin Tablet 250 - -
53 Methyl prednisolon Tablet 470 - -
54 Metronidasol 500 mg Tablet 270 - -
55 New diatab Tablet 750 - -
56 Oxytetra salep kulit Tube 2,800 - -
57 Parasetamol 500 mg Tablet 135 - -
58 Parasetamol drop Botol 8,500 - -
59 Parasetamol sirup botol 2,900 - -
60 Pehacain injeksi Ampul 4,200 - -
61 Ranitidin Tablet 240 - -
62 Ranitidin injeksi Ampul 3,100 - -
63 Reco tm botol 8,400 - -
64 simvastatin tablet 680 - -
65 Sirup indra Botol 3,500 - -
66 Ventolin Ampul 9,700 - -
67 Visine tetes mata Botol 15,600 - -
68 Voltadex Tablet 385 - -
TOTAL -

Kepala UPT. Puskesmas Kuta Utara PengelolaObatUPTPuskesmasKutaUtara

dr. Ni Putu Purlimaningsih S. Ked NiKomangAyuTriyani

NIP . 19791120 20004 2 006 NIP.198801082011012016





 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan OKTOBER TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan NOVEMBER TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
Bulan DESEMBER TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
SATU HARGA SISA PENERI PEMA
NO NAMA OBAT STOK
AN SATUAN STOK MAAN KAIAN MINTA
AKHIR
1 Acyclovir salep kulit Tube 3,600 -
2 Albothyl Botol 30,600 -
3 Alletrol Tetes Mata Botol 12,950 -
4 Alupurinol Tablet 153.000 -
5 Ambroxol Tablet 225 -
6 Ambroxol syrup Botol 4,300 -
7 Amlodipin 5 mg Tablet 4,100 -
8 Amoxicillin 500 mg tab Tablet 490 -
9 Amoxicillin sirup Botol 4,950 -
10 Amoxicillin sirup forte Botol 8,500 -
11 Antasida doen Tablet 125 -
12 Antasida doen syrup Botol 3,000 -
13 Antihemorroid supp Supp 4,400 -
14 Asam mefenamat tab 500 mg Tablet 231 -
15 Bedak salisil nelco Botol 5,200 -
16 Betametason Tube 2,600 -
17 Bisoprolol Tablet 1,575 -
18 Bronkis sirup Botol 4,900 -
19 Bronkis tab Tablet 125 -
20 CTM Tablet 30 -
21 Captopril 12,5 mg Tablet 110 -
22 Captopril 25 mg Tablet 170 -
24 Cepadroxyl sirup Botol 10,500 -
25 Cepadroxyl 500 mg Tablet 890 -
26 Cetericne Tablet 420 -
27 Ciproploxasin 500 mg Tablet 465 -
28 Deksametason Tablet 75 -
29 Digoksin tab Tablet 195 -
30 Donperidon sirup Botol 4,300 -
31 DumIn 250 mg Supp 18,500 -
32 Duramycin 500 mg Tablet 1,200 -
33 Ebatik serbuk SASET 3,000 -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 -
35 Enbatik salep kulit Tube 8,500 -
36 Erlamycetine salep mata Tube 6,500 -
37 Erlamycetine tetes telinga Botol 5,000 -
38 Erythromicin sirup Botol 10,500 -
39 Ethyl klorida Botol 96,000 -
40 Farsicol cream Tube 3,500 -
41 Farsipen 400 mg Tablet 352 -
42 Gentamycin salep mata Tube 7,100 -
43 Gentamycin tetes mata Botol 8,400 -
44 Gliben klamida Tablet 110 -
45 Gliseril guayakolas Tablet 39 -
46 Hufaneuron Tablet 390 -
47 Hydrokortison cream Tube 6,500 -
48 Ketoconasol cream Tube 9,200 -
49 Ketoconasol tab Tablet 550 -
50 Lico calc Tablet 175 -
51 Loratadin Tablet 450 -
52 Metformin Tablet 250 -
53 Methyl prednisolon Tablet 470 -
54 Metronidasol 500 mg Tablet 270 -
55 New diatab Tablet 750 -
56 Oxytetra salep kulit Tube 2,800 -
57 Parasetamol 500 mg Tablet 135 -
58 Parasetamol drop Botol 8,500 -
59 Parasetamol sirup botol 2,900 -
60 Pehacain injeksi Ampul 4,200 -
61 Ranitidin Tablet 240 -
62 Ranitidin injeksi Ampul 3,100 -
63 Reco tm botol 8,400 -
64 simvastatin tablet 680 -
65 Sirup indra Botol 3,500 -
66 Ventolin Ampul 9,700 -
67 Visine tetes mata Botol 15,600 -
68 Voltadex Tablet 385 -
TOTAL

Kepala UPT. Puskesmas Kuta Utara
PengelolaObatUPTPuskesmasKuta
Utara

dr. Ni Putu Purlimaningsih S. Ked

NIP . 19791120 200604 2 006 NiKomangAyuTriyani
NIP.198801082011012016



TERIMA
 LAPORAN KETERSEDIAAN OBAT JKN UPT PUSKESMAS KUTA UTARA
TRIWULAN IV ( OKTOBER NOVEMBER DESEMBER ) TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSKESMAS PEMBANTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA TERIM PEMA SISA STOK

SATUA HARGA STOK A KAIAN AKHIR
NO NAMA OBAT
N SATUAN
JML JML JML JML RP
1 Acyclovir salep kulit Tube 3,600 - -
2 Albothyl Botol 30,600.000 - -
3 Alletrol Tetes Mata Botol 12,950 - -
4 Alupurinol Tablet 153.000 - -
5 Ambroxol Tablet 225 - -
6 Ambroxol syrup Botol 4,300 - -
7 Amlodipin 5 mg Tablet 4,100 - -
8 Amoxicillin 500 mg tab Tablet 490 - -
9 Amoxicillin sirup Botol 4,950 - -
10 Amoxicillin sirup forte Botol 8,500 - -
11 Antasida doen Tablet 125 - -
12 Antasida doen syrup Botol 3,000 - -
13 Antihemorroid supp Supp 4,400 - -
14 Asam mefenamat tab 500 mg Tablet 231 - -
15 Bedak salisil nelco Botol 5,200 - -
16 Betametason Tube 2,600 - -
17 Bisoprolol Tablet 1,575 - -
18 Bronkis sirup Botol 4,900 - -
19 Bronkis tab Tablet 125 - -
20 CTM Tablet 30 - -
21 Captopril 12,5 mg Tablet 110 - -
22 Captopril 25 mg Tablet 170 - -
24 Cepadroxyl sirup Botol 10,500 - -
25 Cepadroxyl 500 mg Tablet 890 - -
26 Cetericne Tablet 420 - -
27 Ciproploxasin 500 mg Tablet 465 - -
28 Deksametason Tablet 75 - -
29 Digoksin tab Tablet 195 - -
30 Donperidon sirup Botol 4,300 - -
31 DumIn 250 mg Supp 18,500 - -
32 Duramycin 500 mg Tablet 1,200 - -
33 Ebatik serbuk SASET 3,000 - -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 - -
35 Enbatik salep kulit Tube 8,500 - -
36 Erlamycetine salep mata Tube 6,500 - -
37 Erlamycetine tetes telinga Botol 5,000 - -
38 Erythromicin sirup Botol 10,500 - -
39 Ethyl klorida Botol 96,000 - -
40 Farsicol cream Tube 3,500 - -
41 Farsipen 400 mg Tablet 352 - -
42 Gentamycin salep mata Tube 7,100 - -
43 Gentamycin tetes mata Botol 8,400 - -
44 Gliben klamida Tablet 110 - -
45 Gliseril guayakolas Tablet 39 - -
46 Hufaneuron Tablet 390 - -
47 Hydrokortison cream Tube 6,500 - -
48 Ketoconasol cream Tube 9,200 - -
49 Ketoconasol tab Tablet 550 - -
50 Lico calc Tablet 175 - -
51 Loratadin Tablet 450 - -
52 Metformin Tablet 250 - -
53 Methyl prednisolon Tablet 470 - -
54 Metronidasol 500 mg Tablet 270 - -
55 New diatab Tablet 750 - -
56 Oxytetra salep kulit Tube 2,800 - -
57 Parasetamol 500 mg Tablet 135 - -
58 Parasetamol drop Botol 8,500 - -
59 Parasetamol sirup botol 2,900 - -
60 Pehacain injeksi Ampul 4,200 - -
61 Ranitidin Tablet 240 - -
62 Ranitidin injeksi Ampul 3,100 - -
63 Reco tm botol 8,400 - -
64 simvastatin tablet 680 - -
65 Sirup indra Botol 3,500 - -
66 Ventolin Ampul 9,700 - -
67 Visine tetes mata Botol 15,600 - -
68 Voltadex Tablet 385 - -
TOTAL -

Kepala UPT. Puskesmas Kuta Utara PengelolaObatUPTPuskesmasKutaUtara

dr. Ni Putu Purlimaningsih S. Ked NiKomangAyuTriyani

NIP . 19791120 20004 2 006 NIP.198801082011012016





 LAPORAN KETERSEDIAAN OBAT JKN TAHUNAN UPT PUSKESMAS KUTA UTARA
TAHUN 2017

UPT PUSKESMAS : KUTA UTARA

PUSKESMAS PEMBANTU YANG ADA : 5
PROVINSI : Bali
PUSTU CANGGU

SISA
STOK PEMA
TERIM SISA STOK
PER KAIAN
SATUA HARGA A THN AKHIR PER 31
NO NAMA OBAT 31 THN
N SATUAN 2017 DES 2017
DES 2017
2016

JML JML JML JML RP

1 Acyclovir salep kulit Tube 3,600 - -
2 Albothyl Botol 30,600.000 - -
3 Alletrol Tetes Mata Botol 12,950 - -
4 Alupurinol Tablet 153.000 - -
5 Ambroxol Tablet 225 - -
6 Ambroxol syrup Botol 4,300 - -
7 Amlodipin 5 mg Tablet 4,100 - -
8 Amoxicillin 500 mg tab Tablet 490 - -
9 Amoxicillin sirup Botol 4,950 - -
10 Amoxicillin sirup forte Botol 8,500 - -
11 Antasida doen Tablet 125 - -
12 Antasida doen syrup Botol 3,000 - -
13 Antihemorroid supp Supp 4,400 - -
14 Asam mefenamat tab 500 mg Tablet 231 - -
15 Bedak salisil nelco Botol 5,200 - -
16 Betametason Tube 2,600 - -
17 Bisoprolol Tablet 1,575 - -
18 Bronkis sirup Botol 4,900 - -
19 Bronkis tab Tablet 125 - -
20 CTM Tablet 30 - -
21 Captopril 12,5 mg Tablet 110 - -
22 Captopril 25 mg Tablet 170 - -
24 Cepadroxyl sirup Botol 10,500 - -
25 Cepadroxyl 500 mg Tablet 890 - -
26 Cetericne Tablet 420 - -
27 Ciproploxasin 500 mg Tablet 465 - -
28 Deksametason Tablet 75 - -
29 Digoksin tab Tablet 195 - -
30 Donperidon sirup Botol 4,300 - -
31 DumIn 250 mg Supp 18,500 - -
32 Duramycin 500 mg Tablet 1,200 - -
33 Ebatik serbuk SASET 3,000 - -
34 Efinefrine[adrenalin] injeksi Ampul 12,900 - -
35 Enbatik salep kulit Tube 8,500 - -
36 Erlamycetine salep mata Tube 6,500 - -
37 Erlamycetine tetes telinga Botol 5,000 - -
38 Erythromicin sirup Botol 10,500 - -
39 Ethyl klorida Botol 96,000 - -
40 Farsicol cream Tube 3,500 - -
41 Farsipen 400 mg Tablet 352 - -
42 Gentamycin salep mata Tube 7,100 - -
43 Gentamycin tetes mata Botol 8,400 - -
44 Gliben klamida Tablet 110 - -
45 Gliseril guayakolas Tablet 39 - -
46 Hufaneuron Tablet 390 - -
47 Hydrokortison cream Tube 6,500 - -
48 Ketoconasol cream Tube 9,200 - -
49 Ketoconasol tab Tablet 550 - -
50 Lico calc Tablet 175 - -
51 Loratadin Tablet 450 - -
52 Metformin Tablet 250 - -
53 Methyl prednisolon Tablet 470 - -
54 Metronidasol 500 mg Tablet 270 - -
55 New diatab Tablet 750 - -
56 Oxytetra salep kulit Tube 2,800 - -
57 Parasetamol 500 mg Tablet 135 - -
58 Parasetamol drop Botol 8,500 - -
59 Parasetamol sirup botol 2,900 - -
60 Pehacain injeksi Ampul 4,200 - -
61 Ranitidin Tablet 240 - -
62 Ranitidin injeksi Ampul 3,100 - -
63 Reco tm botol 8,400 - -
64 simvastatin tablet 680 - -
65 Sirup indra Botol 3,500 - -
66 Ventolin Ampul 9,700 - -
67 Visine tetes mata Botol 15,600 - -
68 Voltadex Tablet 385 - -
TOTAL -

Kepala UPT. Puskesmas Kuta Utara PengelolaObatUPTPuskesmasKutaUtara

dr. Ni Putu Purlimaningsih S. Ked NiKomangAyuTriyani

NIP . 19791120 20004 2 006 NIP.198801082011012016