USULAN RENCANA KEBUTUHAN OBAT DAN BAHAN MEDIS HABIS

TAHUN ANGGARAN 2017

PUSKESMAS SAMBAS :

SISA STOK PER 01 PEMAKAIAN RATA-

NO NAMA OBAT SATUAN HARGA SATUAN
JANUARI 2017 RATA PER BULAN

1 2 3 4 5 6
I OBAT-OBATAN
A OBAT
ACT (Artesunate tablet 50 mg + Amodiaquine
1 anhydrida tablet 200 mg) Tab 1,409.00 - 6.00
2 Air untuk Injeksi (Aqua Pro Injeksi) Vial 2,200.00 20 2.00
3 Akarbose Tablet/ Kaplet 100 mg Tab 990.00 - -
4 Akarbose Tablet/ Kaplet 50 mg Tab 780.00 - -
5 Alopurinol tablet 100 mg tab 90.00 1,000 758.33
6 Alopurinol tablet 300 mg tab 229.50 - 100.00
7 Alprazolam 0,5 mg tab 185.00 5 53.00
8 Ambroxol sirup 15 mg/ml btl 3,300.00 144 55.17
9 Ambroxol tablet 30 mg tab 125.07 2,800 1,425.00
10 Aminofilina injeksi 24 mg/ml - 10 ml amp 4,200.00 - -
Aminofilina tablet 200 mg
11 tab 86.00 1,300 250.00
12 Amitriptilin HCl tablet salut 25 mg tab 123.00 100 6.00
13 Amlodipin 5 mg tab 197.00 4,170 1,634.17
14 Amoksisilin kapsul 250 mg kapsul 220.00 - 41.67
15 Amoksisilin kapsul 500 mg kapsul 279.00 4,500 3,700.67
Amoksisilin sirup kering forte 250 mg/5 ml
btl 4,730.00
16 150 25.83
17 Amoksisilin sirup kering 125 mg/5 ml btl 2,560.00 300 116.67
18 Ampisilin serbuk injeksi 1000 mg Vial 5,610.00 - -
19 Antasida DOEN suspensi btl 2,300.00 300 25.00
Antasida DOEN tablet kunyah,kombinasi:

Mg-Hidroksida 200 mg + Al. Hidroksida. 200 mg tab 78.00

20 9,500 4,141.67
Anti Bakteri DOEN salep kombinasi:
Basitrasin 500 IU/g + Polimiksin 10.000 IU/g tube 2,767.00
21 - 6.25
Antifungi DOEN kombinasi :
pot 2,096.33
Asam Benzoat 6 % + Asam Salisilat 3 %
22 72 2.00
Anti Hemoroid DOEN kombinasi :
Bismuth subgalat 150 mg + Heksaklorofen supp 3,350.00
23 2,5 mg 60 12.92
Antimigren DOEN tablet kombinasi : Ergotamin
tab 149.00
Tartrat 1 mg + Kofein 50 mg
24 - -
25 Asam Askorbat (Vit C) tablet 50 mg tab 105.00 3,600 3,908.33
Asam Folat tablet/kapsul/kaplet 0,4 mg(Afolat) tab 52.00
26 - -
27 Asam Mefenamat 500 mg tab 122.00 3,500 2,791.67
28 Asam Traneksamat 500 mg tab 1,045.00 300 20.00
29 Asam Traneksamat injeksi amp 3,200.00 - -
30 Asetosal 100 mg tab 127.00 - 83.33
31 Asetosal 80 mg tab 163.00 - -
32 Asiklovir krim 5 % tube 2,997.00 100 22.75
33 Asiklovir tablet 400 mg tab 354.00 400 107.50
34 Atapulgit tablet 600 mg tab 220.00 500 108.33
35 Atenolol 100 mg tab 800.00 - -
 SISA STOK PER 01 PEMAKAIAN RATA-
NO NAMA OBAT SATUAN HARGA SATUAN
JANUARI 2017 RATA PER BULAN

1 2 3 4 5 6
36 Atenolol 50 mg tab 387.00 - -
37 Bedaj Salisil 2 % dus 1,350.00 30 6.75
Besi II Sulfat 200 mg + Asam Folat 0,25 mg
tab 45.00
(Tablet Tambah Darah Kombinasi)
38 8,000 1,958.33
Betahistin 6 mg tab 170.00 600 262.50
39 Betametason krim 0,1 o/o tube 1,558.00 68 18.92
40 Bisakodil suppositoria 10mg tab 6,045.00 10 6.92
41 Bisakodil suppositoria 5 mg tab 4,990.00 - 3.42
42 Bisoprolol tablet 2.5 mg tab 746.00 - -
43 Bisoprolol tablet 5 mg tab 695.00 - 43.75
44 Cetirizine tablet 10 mg tab 190.00 1,000 1,375.00
45 Cetirizin sirup 5 mg/5 ml btl 8,799.00 120 38.50
46 Deksametason injeksi 5 mg/ml - 1 ml amp 1,544.00 3.75
47 Deksametason tablet 0,5 mg tab 68.00 3,800 1,916.67
48 Dekstrometorfan sirup KOMBINASI btl 3,609.00 550 79.17
49 Dekstrometorfan tablet KOMBINASI tab 275.00 3,900 1,179.17
Diazepam larutan rectal 10 mg/ 2,5 ml
tube 18,461.00
50 (STESOLID) 15 -
Diazepam larutan rectal 5 mg/ 2,5 ml(STESOLID) tube 12,751.00
51 6 0.75
52 Diazepam tablet 2 mg tab 46.00 800 57.08
53 Difenhidramin HCl inj 10 mg/ml - 1 ml amp 1,156.00 4.17
54 Digoksin tablet 0,25 mg tab 103.00 41.67
55 Doksisiklin tab 100 mg tab 298.00 33.33
56 Domperidon 10 mg tab 174.00 400 266.67
57 Domperidon suspensi 5 mg/5 ml btl 3,490.00 - 17.08
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml amp 8,910.00
58 - -
59 Eritromisin 250 mg tab 509.00 - -
60 Eritromisin 500 mg tab 1,023.00 - 8.33
61 Eritromisin sirup 200 mg/ 5ml btl 8,090.00 - -
62 Etanol 70 % btl 100 ml 2,625.00 40 9.50
Etakridin ( Rivanol ) larutan 0,1 o/o Botol 3,327.75 10.00 3.33
63 Etil Klorida semprot btl 115,500.00 - 1.42
Botol 10
Eugenol cairan 18,333.00
64 ml - -
65 Fenobarbital tablet 30 mg tab 70.10 430 31.67
66 Fenobarbital 100 mg tab 242.00 - -
67 Fenol Gliserol tetes telinga 10% tab 1,108.79 24 8.00

68 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml amp 3,754.00

-
Fitomenodion (Vit.K1) tablet salut gula 10 mg tab 690.00
69 100 116.67
70 Furosemid tablet 40 mg tab 96.00 247 162.75
71 Furosemid injeksi amp 2,012.00 -
72 Garam Oralit serbuk,kombinasi sachet 317.00 325.00
73 Gemfibrozil kapsul/kaplet 300 mg Tab 318.00 120 5.83
74 Gentamicin TM 0,3 % btl 3,513.00 4.00
75 Gentian violet 1 o/o btl 2,189.00 24 5.50
76 Glass Ionomer Cement (GC IX) set 434,460.00 0.08
77 Glibenklamid tablet 5 mg tab 61.00 1,500 425.00
78 Gliklazid tab 80 mg tab 251.00 50 4.17
79 Glimepiride tablet 2 mg tab 447.00 25.00
80 Glukosa larutan infus 5 o/o btl 5,720.00 3.00
 SISA STOK PER 01 PEMAKAIAN RATA-
NO NAMA OBAT SATUAN HARGA SATUAN
JANUARI 2017 RATA PER BULAN

1 2 3 4 5 6

81 Griseofulvin tablet 125 mg, micronized tab 224.00

200 158.33
82 Haloperidol 1.5 mg tab 76.00 500 150.00
Haloperidol inj 50 mg/mL (Haldol Decanoas) Ampul 91,667.00
83 -
84 Hidroklorotiazid (HCT) tablet 25 mg tab 163.00 250.00
85 Hidrokortison krim 2,5 o/o tube 2,868.00 24 34.00
86 Hyosine N-Butilbromide tab 10 mg tab 1,485.00 -
87 Ibuprofen tablet 200 mg tab 121.00 1,100 200.00
88 Ibuprofen tablet 400 mg tab 157.00 708.33

89 Isosorbit Dinitrat tablet sublingual 5 mg tab 98.00

100 25.00
90 Kalsium Laktat (Kalk) tablet 500 mg tab 76.00 4,200 1,708.33
91 Kaptopril 25 mg tab 97.00 3,800 1,216.67
Kandesartan tab 8 mg tab 4,015.00 270 30.00
92 Karbamazepin tablet 200 mg tab 269.00 800 100.00
93 Ketokonazol krim 2 % tube 5 g 3,135.00 50 50.00
94 Ketokonazol tablet 200 mg tab 320.00 750 104.17
95 Ketorolac injeksi 30 mg ampul 2,665.00 -
96 Klindamisin 300 mg kapsul 580.00 -
Klopidogrel tablet 75 mg tab 2,100.00 300 5.00
97 Kloramfenikol kapsul 500 mg kapsul 935.00 383.33
98 Kloramfenikol salep mata 1 % tube 1,640.00 -
99 Kloramfenikol suspensi 125 mg/ml btl 4,050.00 7.42
100 Kloramfenikol tetes mata 0,5 % btl 20,360.00 51 31.33
101 Kloramfenikol tetes telinga 3 % btl 5,060.00 74 16.67

102 Klorfeniramina Maleat (CTM) tablet 4 mg tab 54.00

5,800 2,422.67
ampul 1,210.00
103 Klorpromazin injeksi i.m. 25 mg/ml (HCl) 5 0.50

104 Klorpromazin HCI Tablet salut 100 mg tab 153.00

400 91.67
Kotrimoksazol Suspensi , kombinasi :
Sulfametoksazol 200 mg + Trimetoprim 40 btl 2,298.00
105 mg/ 5 Ml 300 58.33
Kotrimoksazol forte kombinasi:sulfametoksazol 800
tab 420.00
mg + trimetoprim 160 mg
106 183.33
Kotrimoksazol DOEN 1 kombinasi:sulfametoksazol
tab 152.00
400 mg + trimetoprim 80 mg
107 50.00
108 Kuinin ( Kina ) tablet 200 mg tab 737.00 -
109 Laktulosa sir 3,335 g/ 5 ml botol 15,950.00 -
Lidokain Komp.injeksi, Kombinasi :
Lidokain HCL 12 % + Epinefrin 1 : 80.000 - Ampul 1,499.00
110 2 ml 30 95.83
111 Lidokain jelli 2%(Xylocaine Jelly 2%) syringe 40,000.00 10 0.33
112 Loperamid 2 mg tab 97.00 100 200.00
113 Magnesium Sulfat Inj (IV) 40%-25 ml btl 3,500.00 4 -
114 Metil prednisolon tab 4 mg tab 230.00 1,800 266.67
115 Metilprednisolon inj 125 mg/2 mL dus 22,000.00 -

116 Metilergametrin (Maleat) tablet salut 0,125 mg tab 169.00

25.00
Metilergametrin Maleat inj 0,200 mg - 1 ml
117 ampul 2,750.00 8.33
118 Metoclopramide tablet 10 mg tab 100.00 5.00
119 Metoclopramide injeksi 5 mg/ml ampul 3,300.00 -
120 Metoclopramide sirup 5 mg/ 5 ml botol 2,900.00 11.25
 SISA STOK PER 01 PEMAKAIAN RATA-
NO NAMA OBAT SATUAN HARGA SATUAN
JANUARI 2017 RATA PER BULAN

1 2 3 4 5 6
121 Metformin 500 mg tab 118.50 1,600 966.67
122 Metronidazol sirup 125 mg/5 Ml btl 4,350.00 50 5.00
123 Metronidazol tablet 250 mg tab 116.00 300.00
124 Metronidazol tablet 500 mg tab 169.00 41.67
125 Miconazole krim 2% (Nitrat) tube 3,075.00 48.00
126 Natrium Bikarbonat tablet 500 mg tab 15.70 100 6.00
127 Natrim Diklofenak 50 mg tab tab 193.00 1,950 883.33
Natrium Klorida larutan infus 0,9 % Steril btl 5,170.00
128 3.75
129 Nifedipin tablet 10 mg tab 110.00 50.00
130 Nistatin vaginal tablet 100.000 IU/ g supp 528.00 300 60.83
131 Nistatin tablet salut 500.000 UI/g tab 704.00 100 8.33
132 Nystatin drop Btl 24,200.00 -
133 OAT FDC Kategori 1 Dewasa paket 395,990.00 3.00
134 OAT FDC Kategori 2 Dewasa paket 1,319,990.00 -
Obat Antituberkulosis Kategori 1 dewasa paket 317,015.00
135 -
136 OAT FDC Kategori Anak paket 236.49 0.08
137 Obat Batuk Hitam ( O.B.H ) btl 1,570.00 18.00
138 Oksitetrasiklin HCI salep kulit 3 % tube 1,650.00 150 39.42
139 Oksitetrasiklin HCI salep mata 1 % tube 2,772.00 75 14.58
140 Oksitosin injeksi 10 IU / ml - ml Ampul 1,900.00 12.33
141 Omeprazole kapsul kapsul 221.00 300 270.00
142 Omeprazole injeksi 40 mg/ 10 ml vial 42,000.00 -
143 Ondansetron inj 4 mg/ 2 mL Ampul 808.00 -
144 Parasetamol infus btl 49,500.00 -
145 Parasetamol sirup 120 mg / 5 ml btl 1,535.00 250 151.67
146 Parasetamol drop btl 5,720.00 56 9.33
147 Parasetamol tablet 500 mg tab 88.00 6,000 7,433.33
148 Piracetam Inj 1 g/5 ml amp 6,050.00 -
149 Pirantel tablet 125 mg tab 318.00 25.00
150 Piridoksin HCI (Vit. B6 ) tablet 10 mg tab 121.00 500.00
151 Piroksikam 20 mg tab 105.00 300 458.33
152 Povidon lodida larutan 10 % btl 300 ml 15,386.00 1.58
153 Prednison tablet 5 mg tab 125.00 83.33
154 Primakuin tablet 15 mg tab 205.00 -
Prokain Benzil Penisilin injeksi 3 juta IU/Vial vial 7,910.00
155 -
156 Propranolol HCI tablet 10 mg tab 80.00 300 25.00
157 Proiltiourasil tablet 100 mg tab 351.00 600 125.00
158 Ranitidin tablet 150 mg tab 128.00 7,200 1,350.00
159 Ranitidin Injeksi 25 mg/ml ampul 1,340.00 -

160 Retinol ( Vitamin A ) 100.000 IU kapsul lunak kapsul 286.00

- 300.00
Retinol ( Vitamin A ) 200.000 IU kapsul lunak kapsul 505.00
161 - 200.00
162 Ringer laktat larutan infus btl 5,720.00 21.75
163 Salbutamol tablet 2 mg tab 65.00 291.67
164 Salbutamol sirup btl 5,500.00 44 3.33

165 Salbutamol cairan ih 0,1%(Ventolin Nebules) botol 7,260.00

35 3.00
Salep 2 - 4, Kombinasi :
pot 2,200.00
Asam Salisilat 2 % + Belerang Endap 4 %
166 96 24.00
SCABIMITE CREAM 10 - Permetrin krim 5% tub 12,155.00
20 1.67
 SISA STOK PER 01 PEMAKAIAN RATA-
NO NAMA OBAT SATUAN HARGA SATUAN
JANUARI 2017 RATA PER BULAN

1 2 3 4 5 6
167 Sefadroksil sirup kering 125 mg/5ml btl 5,286.00 8.33
168 Sefadroksil kapsul 500 mg kapsul 529.00 1,300 711.25
169 Sefiksim sirup kering 100 mg/ 5 ml btl 9,400.00 30 11.00
170 Sefiksim kapsul/kaplet 100 mg kapsul 899.00 550 118.33
171 Sefotaksim Injeksi 1 g vial 3,500.00 -
172 Seftriaksone Injeksi 1 g vial 3,900.00 -

173 Sianocobalamin (Vit.B12) tablet 50 mg tab 63.00

1,800 1,016.67
Sianokobalamin (Vit.B12) injeksi 500 mcg/ml - 1ml amp 1,050.00
174 -
175 Simvastatin 10 mg tab 177.00 2,190 809.17
176 Siprofloxasin 500 mg tab 265.00 672.50
177 Sukralfat tab 500 mg tab 466.00 500 616.67

178 Serum Anti Bisa Ular Polivalen injeksi 5 ml ( ABU I ) ampul 473,000.00
0.17
Serum Anti Tetanus injeksi 1.500 IU/ampul ( A.T.S ) ampul 126,500.00
179 0.17
180 Teofilin tablet 150 mg tab 300.00 200 25.00
181 Tetrasiklin HCI Kapsul 250 mg kapsul 162.00 -
182 Tetrasiklin HCI Kapsul 500 mg kapsul 325.00 -
183 Thiamphenikol 500 mg tab 677.60 300 183.33
Tiamin HCI/Mononitrat (Vit.B1) tablet 50 mg tab 37.00
184 1,500 1,091.67
185 Tramadol tablet 50 mg tab 322.00 600 78.33
186 Tramadol injeksi 50 mg/ml Ampul 2,680.00 - -
187 Trifluoferazine tab 418.00 600 -
188 Triheksifenidil tablet 2 mg tab 605.00 560 86.67
189 Vitamin B Kompleks tablet tab 112.00 7,800 2,141.67
190 Zink tablet 521.00 500 250.00
191 Zinc sir 20 mg/5 Ml btl 8,140.00 - -
B USULAN TAMBAHAN OBAT BARU
1 Albothyl 10 ml btl 1.00
2 salbutamol 4 mg tab 84.00 1,000 83.33
3 Kaolin Pectin Syrup btl 36.83
4 Bisakodil tab tab 41.67
Loratadin tab 149.00 400 116.67
5 Multivitamin (B1, B6, B12) tab 1,941.67
6 Multivitamin tab tambah darah tab 325.00
7 Multivitamin syrup btl 115.92
8 Sirup Flu anak (PCT, GG, CTM) btl 51.42
9 GG tab 1,433.33
10 Ampicilin tab 500 tab 66.67
11 Ibuprofen Suspensi 100 mg/5 ml btl 2,560.00 50 10.00
12 Thiamphenicol 125 mg/5 ml Syr btl 21,950.00 60 5.00
13
14
15
16
17
18
19
II ALAT KESEHATAN KESEHATAN
A BAHAN MEDIS HABIS PAKAI
1 Alat suntik sekali pakai 0.05 ml set 1,650.00 1,100 100.00
2 Alat suntik sekali pakai 0.5 ml set 1,240.00 3,000 250.00
 SISA STOK PER 01 PEMAKAIAN RATA-
NO NAMA OBAT SATUAN HARGA SATUAN
JANUARI 2017 RATA PER BULAN

1 2 3 4 5 6
3 Alat suntik sekali pakai 1 ml set 1,540.00 41.67
4 Alat suntik sekali pakai 3 ml set 957.00 300 242.33
5 Alat suntik sekali pakai 5 ml set 1,348.00 300 45.75
6 Alat suntik sekali pakai 10 ml set 1,790.00 -
7 Alkohol Swab pcs 10,000.00 100.00
Catgut / Benang bedah No. 2/0 dengan jarum
set 26,583.00
8 bedah 12 4.67
Catgut / Benang bedah No.3/0 dengan jarum bedah set 26,583.00
9 12 5.58
10 Etakridin ( Rivanol ) larutan 0,1 o/o btl 300 ml 3,327.75 3.33
11 Etanol 70 % btl 1 Liter 21,500.00 9.50
12 Foley Catheter No.16 set 10,440.00 -
13 Foley Catheter No.18 set 10,440.00 -
14 Foley Catheter No.22 set 10,440.00 -
Handschoon ( Sarung Tangan ) pendek set 424.13
15 1,200 258.33
Handschoon ( Sarung Tangan ) ginekolog set
16 2.00
17 Infusion set anak (Micro) set 20,320.50 -
18 Infusion set dewasa (Macro) set 19,999.65 4.50
19 IV Catheter G 20 set 10,062.50 4.00
20 IV Catheter G 22 set 10,062.50 4.00
21 IV Catheter G 24 set 10,062.50 4.00
Kapas pembalut / Absorben 250 gram bungkus 28,452.86
22 2.92
23 Kasa 36 x 80 rol 142,376.60 1.67
24 Kasa 16 m x 16 cm kotak 8,495.28 4.00
25 kasa 4 x 10 cm rol 2,439.24 20.83
26 Lisol Botol 1 L 41,000.00 0.58
27 Masker pcs 574.20 183.33
28 Plester 5 yards x 2 inch rol 25,980.00 10 1.83
Botol 500
Sabun Non Mikrobial 58,539.00
29 ml -
Silk (Benang Bedah Sutera) No.3/0 dgn jarum
set 18,364.00
30 bedah 5.50
31 Underpad Piece -
32 Urine Bag Piece 3,915.00 -
USULAN TAMBAHAN BAHAN MEDIS HABIS
B PAKAI BARU
1 Bioplasenton Tulle 10 x 10 (CBPCD) pcs 10,950.00 2.00
2 Blood Lancet pcs 160.23 300.00
3 Total Cholesterol Test Strip 10's pcs 23,354.00 100.00
4 Uric Test Strip 25's pcs 5,154.00 100.00
5 Glucose Test Strip 50's pcs 3,093.34 100.00
6 Needle 23 G pcs 400.00 100.00
7
8
9
10
11
12
13
14
15
16
17
 SISA STOK PER 01 PEMAKAIAN RATA-
NO NAMA OBAT SATUAN HARGA SATUAN
JANUARI 2017 RATA PER BULAN

1 2 3 4 5 6
18
19
20
21
22
23
24
25
26
27
28
29
30
31
C REAGENSIA
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

Mengetahui
Kepala Puskesmas

SIMTITI Ro
NIP. 19630604 198603 1 022
DIS HABIS PAKAI

KEBUTUHAN TAHUN USULAN

TOTAL HARGA
2017 KEBUTUHAN 2017

7=KOLOM 6 X 18 BULAN 8= KOLOM 7-5 9= KOLOM 4 X 8

108.00 108.00 152,172.00

36.00 16.00 35,200.00
- - -
- - -
13,650.00 12,650.00 1,138,500.00
1,800.00 1,800.00 413,100.00
954.00 949.00 175,565.00
993.00 849.00 2,801,700.00
25,650.00 22,850.00 2,857,849.50
- - -
4,500.00 3,200.00 275,200.00
108.00 8.00 984.00
29,415.00 25,245.00 4,973,265.00
750.00 750.00 165,000.00
66,612.00 62,112.00 17,329,247.98

465.00 315.00 1,489,950.00

2,100.00 1,800.00 4,608,000.00
- - -
450.00 150.00 345,000.00

74,550.00 65,050.00 5,073,900.00

112.50 112.50 311,287.50

36.00 (36.00) (75,467.88)

232.50 172.50 577,875.00

- - -
70,350.00 66,750.00 7,008,750.00

- - -
50,250.00 46,750.00 5,703,500.00
360.00 60.00 62,700.00
- - -
1,500.00 1,500.00 190,500.00
- - -
409.50 309.50 927,571.50
1,935.00 1,535.00 543,390.00
1,950.00 1,450.00 319,000.00
- - -
 KEBUTUHAN TAHUN USULAN
TOTAL HARGA
2017 KEBUTUHAN 2017

7=KOLOM 6 X 18 BULAN 8= KOLOM 7-5 9= KOLOM 4 X 8

- - -
121.50 91.50 123,525.00

35,250.00 27,250.00 1,226,250.00

4,725.00 4,125.00 701,250.00
340.50 272.50 424,555.00
124.50 114.50 692,152.50
61.50 61.50 306,885.00
- - -
787.50 787.50 547,312.50
24,750.00 23,750.00 4,512,500.00
693.00 573.00 5,041,827.00
67.50 67.50 104,220.00
34,500.00 30,700.00 2,087,600.00
1,425.00 875.00 3,157,875.00
21,225.00 17,325.00 4,764,375.00

- (15.00) (276,915.00)

13.50 7.50 95,632.50

1,027.50 227.50 10,465.00
75.00 75.00 86,700.00
750.00 750.00 77,250.00
600.00 600.00 178,800.00
4,800.00 4,400.00 765,600.00
307.50 307.50 1,073,175.00

- - -
- - -
150.00 150.00 153,450.00
- - -
171.00 131.00 343,875.00
60.00 50.00 166,387.50
25.50 25.50 2,945,250.00

- - -
570.00 140.00 9,814.00
- - -
144.00 120.00 133,054.80

- - -

2,100.00 2,000.00 1,380,000.00

2,929.50 2,682.50 257,520.00
- - -
5,850.00 5,850.00 1,854,450.00
105.00 (15.00) (4,770.00)
72.00 72.00 252,936.00
99.00 75.00 164,175.00
1.50 1.50 651,690.00
7,650.00 6,150.00 375,150.00
75.00 25.00 6,275.00
450.00 450.00 201,150.00
54.00 54.00 308,880.00
 KEBUTUHAN TAHUN USULAN
TOTAL HARGA
2017 KEBUTUHAN 2017

7=KOLOM 6 X 18 BULAN 8= KOLOM 7-5 9= KOLOM 4 X 8

2,850.00 2,650.00 593,600.00

2,700.00 2,200.00 167,200.00

- - -
4,500.00 4,500.00 733,500.00
612.00 588.00 1,686,384.00
- - -
3,600.00 2,500.00 302,500.00
12,750.00 12,750.00 2,001,750.00

450.00 350.00 34,300.00

30,750.00 26,550.00 2,017,800.00
21,900.00 18,100.00 1,755,700.00
540.00 270.00 1,084,050.00
1,800.00 1,000.00 269,000.00
900.00 850.00 2,664,750.00
1,875.00 1,125.00 360,000.00
- - -
- - -
90.00 (210.00) (441,000.00)
6,900.00 6,900.00 6,451,500.00
- - -
133.50 133.50 540,675.00
564.00 513.00 10,444,680.00
300.00 226.00 1,143,560.00

43,608.00 37,808.00 2,041,632.00

9.00 4.00 4,840.00

1,650.00 1,250.00 191,250.00

1,050.00 750.00 1,723,500.00

3,300.00 3,300.00 1,386,000.00

900.00 900.00 136,800.00

- - -
- - -

1,725.00 1,695.00 2,540,805.00

6.00 (4.00) (160,000.00)
3,600.00 3,500.00 339,500.00
- (4.00) (14,000.00)
4,800.00 3,000.00 690,000.00
- - -

450.00 450.00 76,050.00

150.00 150.00 412,500.00

90.00 90.00 9,000.00
- - -
202.50 202.50 587,250.00
 KEBUTUHAN TAHUN USULAN
TOTAL HARGA
2017 KEBUTUHAN 2017

7=KOLOM 6 X 18 BULAN 8= KOLOM 7-5 9= KOLOM 4 X 8

17,400.00 15,800.00 1,872,300.00
90.00 40.00 174,000.00
5,400.00 5,400.00 626,400.00
750.00 750.00 126,750.00
864.00 864.00 2,656,800.00
108.00 8.00 125.60
15,900.00 13,950.00 2,692,350.00

67.50 67.50 348,975.00

900.00 900.00 99,000.00
1,095.00 795.00 419,760.00
149.94 49.94 35,157.76
- - -
54.00 54.00 21,383,460.00
- - -

- - -
1.50 1.50 354.74
324.00 324.00 508,680.00
709.50 559.50 923,175.00
262.50 187.50 519,750.00
222.00 222.00 421,800.00
4,860.00 4,560.00 1,007,760.00
- - -
- - -
- - -
2,730.00 2,480.00 3,806,800.00
168.00 112.00 640,640.00
133,800.00 127,800.00 11,246,400.00
- - -
450.00 450.00 143,100.00
9,000.00 9,000.00 1,089,000.00
8,250.00 7,950.00 834,750.00
28.50 28.50 438,501.00
1,500.00 1,500.00 187,500.00
- - -

- - -
450.00 150.00 12,000.00
2,250.00 1,650.00 579,150.00
24,300.00 17,100.00 2,188,800.00
- - -

5,400.00 5,400.00 1,544,400.00

3,600.00 3,600.00 1,818,000.00

391.50 391.50 2,239,380.00
5,250.00 5,250.00 341,250.00
60.00 16.00 88,000.00

54.00 19.00 137,940.00

432.00 336.00 739,200.00

30.00 10.00 121,550.00

 KEBUTUHAN TAHUN USULAN
TOTAL HARGA
2017 KEBUTUHAN 2017

7=KOLOM 6 X 18 BULAN 8= KOLOM 7-5 9= KOLOM 4 X 8

150.00 150.00 792,900.00
12,802.50 11,502.50 6,084,822.50
198.00 168.00 1,579,200.00
2,130.00 1,580.00 1,420,420.00
- - -
- - -

18,300.00 16,500.00 1,039,500.00

- - -
14,565.00 12,375.00 2,190,375.00
12,105.00 12,105.00 3,207,825.00
11,100.00 10,600.00 4,939,600.00

3.00 3.00 1,419,000.00

3.00 3.00 379,500.00

450.00 250.00 75,000.00
- - -
- - -
3,300.00 3,000.00 2,032,800.00

19,650.00 18,150.00 671,550.00

1,410.00 810.00 260,820.00
- - -
- (600.00) (250,800.00)
1,560.00 1,000.00 605,000.00
38,550.00 30,750.00 3,444,000.00
4,500.00 4,000.00 2,084,000.00
- - -
- - -
18.00 18.00 -
1,500.00 500.00 42,000.00
663.00 663.00 -
750.00 750.00 -
2,100.00 1,700.00 253,300.00
34,950.00 34,950.00 -
5,850.00 5,850.00 -
2,086.50 2,086.50 -
925.50 925.50 -
25,800.00 25,800.00 -
1,200.00 1,200.00 -
180.00 130.00 332,800.00
90.00 30.00 658,500.00
- - -
- - -
- - -
- - -
- - -
- - -

1,800.00 700.00 1,155,000.00

4,500.00 1,500.00 1,860,000.00
 KEBUTUHAN TAHUN USULAN
TOTAL HARGA
2017 KEBUTUHAN 2017

7=KOLOM 6 X 18 BULAN 8= KOLOM 7-5 9= KOLOM 4 X 8

750.00 750.00 1,155,000.00
4,362.00 4,062.00 3,887,334.00
823.50 523.50 705,678.00
- - -
1,800.00 1,800.00 18,000,000.00

84.00 72.00 1,913,976.00

100.50 88.50 2,352,595.50

60.00 60.00 199,665.00
171.00 171.00 3,676,500.00
- - -
- - -
- - -

4,650.00 3,450.00 1,463,231.25

36.00 36.00 -
- - -
81.00 81.00 1,619,971.65
72.00 72.00 724,500.00
72.00 72.00 724,500.00
72.00 72.00 724,500.00

52.50 52.50 1,493,775.15

30.00 30.00 4,271,298.00
72.00 72.00 611,660.16
375.00 375.00 914,715.00
10.50 10.50 430,500.00
3,300.00 3,300.00 1,894,860.00
33.00 23.00 597,540.00

- - -

99.00 99.00 1,818,036.00

- - -

- - -
36.00 36.00 394,200.00
5,400.00 5,400.00 865,242.00
1,800.00 1,800.00 42,037,200.00
1,800.00 1,800.00 9,277,200.00
1,800.00 1,800.00 5,568,020.57
1,800.00 1,800.00 720,000.00
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
 KEBUTUHAN TAHUN USULAN
TOTAL HARGA
2017 KEBUTUHAN 2017

7=KOLOM 6 X 18 BULAN 8= KOLOM 7-5 9= KOLOM 4 X 8

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Sambas, Januari 2017

Petugas Pengelola Obat

Robert P. Situmorang, S. Si., Apt.

NIP. 19861118 201101 1 005