Puskesmas Tunjung - 15

INSTALASI PERBEKALAN FARMASI KESEHATAN KABUPATEN LUMAJANG
JL. MAHAKAM NO.103 TELP. 0334 - 882981 LUMAJANG
SURAT BUKTI BARANG KELUAR

SBBK
Penerima : Tanggal : 21 Januari 2015

Puskesmas Tunjung Nomor : 028/40/427.35.28/2015
SATUAN JUMLAH HARGA PER JUMLAH

NO NAMA OBAT KET / ED
KEMASAN DIBERIKAN UNIT + PPN HARGA
1 Alupurinol Tablet 100 mg K= 100 tab 86 - DAK 14 (E)

2 Ambroxol Tablet 30 mg Box= 100 tab 123 - APBD II-14
3 Aminofilin Tablet 200 mg K= 100 tab 80 - DAK 14 (E)
4 Aminofilina injeksi 24 mg/ml-10 ml K= 30 amp 3,822 - DAK 14 (E)
5 Amitriptilin Tab. 25 mg (HCl) K = 100 tab 120 - BS Prop 13
6 Amitriptilin Tab. 25 mg (HCl) K = 100 tab 102 - DAK 13(E) / Sep-17
7 Amlodipin 10 mg Ktk=30 tab 330 - DAK 14 (E)
8 Amoksisilin Kaplet 500 mg K = 100 Kap 220 - DAK 13(E) /Okt-16
9 Amoksisilin Kapsul 500 mg K= 100 Kap 261 - DAK 14 (E)
10 Amoksisilin Syrup Kering 125 mg / 5 ml Btl = 60 ml 2,300 - DAK 13(E) / Okt-15
11 Amoksisilin Syrup Kering 125 mg / 5 ml B= 60 ml 2,445 - DAK 14 (E)
12 Amoksisilin Syrup Kering 250mg / 5 ml B= 60 ml 4,070 - DAK 14 (E)
13 Ampicilin Inj.1000 mg/ml (Viccilin) K = 10 vial - BS Prop 11 / Des-12
14 Ampicilin Inj.1000 mg/ml (Viccilin) K = 10 vial 4,000 - DAK 13(E) / Agt-17
15 Ampicilin Inj.1000 mg/ml (Viccilin) K = 10 vial 5,252 - BS Prop 14 / Jun - 16
16 Ampisilin Serbuk Injeksi iv 1000 mg/Vial K = 10 vial 5,100 - APBD II-14 (E)
17 Antasida + Simeticon suspensi Btl= 60 ml 3,773 - APBD II-14
Antasida Doen I Tablet Kunyah, Kombinasi:
18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
19 Antibakteri DOEN Salep Kombinasi K = 25 tube 2,517 - BS PROP 13/Sep-16
20 Antibakteri DOEN Salep Kombinasi K = 25 tube 2,491 - DAK 13(E) / Okt-17
21 Antidiare tab. (Attapulgite 600 mg) Box= 50 tab 190 - DAK 14 (E)
22 Antifungi DOEN Kombinasi K = 24 pot 1,719 - DAK 12/Nov-16
23 Antifungi DOEN Kombinasi K = 24 pot 1,904 - DAK 13(E) / Agt-17
24 Antifungi Salep K = 24 pot 1,563 - BS Prop 14
30 Antihaemroid (Hemorograd) kapsul Box = 30 kap 1,552 - APBD II / 12/RI
31 Antihaemroid (Hemorograd) kapsul Box = 30 kap 1,553 - DBHCHT 13 / OKT-16
25 Antimigrain DOEN Tab. Komb. B = 100 tab - BS Prop 13
26 Antimigrain DOEN Tab. Komb. B = 100 tab 123 - DAK 13(E) /
27 Antimigrain DOEN Tablet komb. B= 100 tab 123 - DAK 14 (E)
Anti spasmodik Injeksi (Hyoscine-N-
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
Metylbromide 20 mg/ml)
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
31 Aqua Pro Injeksi Steril K=10 vial 2,200 - BS Prop 13
32 Aqua Pro Injeksi Steril K=10 vial 2,201 - BS Prop 14 / jul-17
33 Asam Askorbat (Vit C) tablet 250 mg K= 100 tab 159 - DAK 14 (E)
34 Asam Askorbat (Vit C) Tablet 50 mg B = 1000 tab 28 - BS Prop 13 / Ags -14
35 Asam Askorbat (Vit. C) Tablet 250 mg B = 250 tab 30 - BS Prop 13 / Jul -15
36 Asam Folat 1 mg B= 100 tab 48 - APBD II-14 (E)
37 Asam Mefenamat 500 mg K = 100 Kap 155 - BS Prop 12 / Sep-16
38 Asam Mefenamat Kap K= 100 Kap 112 - DAK 14 (E)
39 Asam Tranexamat 100 mg Inj/ 5 ml K = 10 Amp 5,775 - ASKES 13/Ags-17
40 Asam Tranexamat 500 mg Injeksi Box= 10 3,334 - DAK 14 (E)
41 Asam Tranexamat Tablet 500 mg K = 100 tab 1,045 - DAK 13 / Agt-16
42 Asetosal Tablet 80 mg K= 100 tab 116 - APBD II-14 (E)
43 Asetosal Tab. 100 mg K= 100 tab 100 - DAK 13(E) / Mei-16
44 Asiklovir 5 % Krim K=TUB 10gr 3,139 - APBD II-14
45 Asiklovir 5% Krim K=25 tube 5gr 2,152 - DAK 13(E) / Sep-17
360793638.xls
46 Asiklovir Tab. 400 mg K= 100 tab 350 - DAK 13(E) / Sep-17
47 Asiklovir Tablet 400 mg K= 100 tab 336 - DAK 14 (E)
48 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml K = 30 amp 1,265
49 Benzatin Benzil Penisilin 1.200.000 IU Dus:10 vial 8,200 - DAK 12/Apr-16
50 Betahistin Mesylat 6 mg Box= 30 tab 924 - APBD II-14
51 Betametason krim 0,1 % K = 25 tube 1,520 - DAK 14 (E)
52 Betametason Krim 0,1% K = 25 tube 1,520 - DAK 13(E) / 1-Okt-16
53 Bisoprolol tablet 2,5mg K = 100 tab 746 -
54 Bisakodil Suppositoria Supp 6,045 - DAK 14 (E)
55 Bromheksin Tablet 8 mg Box= 100 80 - APBD II-14
56 Bromheksin Tablet 8 mg (Novaheksin) K = 100 Tab 51 - DAK 13(E) / Sep-17
57 Calcii Glukonas 100 mg/ml K = 24 Amp - BS Prop 14 / Mar-16
58 Calcii Glukonas 100 mg/ml Ampul 7,800 - APBD II-14 (E)
59 Citicolin 250 mg/2 ml Box= 5 amp 14,300 - APBD II-14
60 Dekstran 70 - Lar. Infus 6% Steril Btl = 500 ml -
61 Dekstrometorfan Syr.Kombinasi Btl= 60 ml 8,046 - APBD II-14
62 Dexametason injeksi 5 mg/ml - 1 ml K= 100 amp 1,580 - DAK 14 (E)
63 Dexametason Injeksi 5 mg/ml-1ml K = 100 amp 1,144 - BS Prop 14/Jan-16
64 Dexametason Tablet 0,5 mg B = 100 tab - BS Prop 12/Des-15
65 Dexametason tablet 0,5 mg K= 100 tab 69 - BS Prop 14
66 Dexametason Tablet 0,5 mg B =100 tab 62 - DAK 14 (E)
67 Diazepam Inj. 5 mg /ml-2 ml K= 30 Amp 873 - BS Prop 13 /Des -16
68 Diazepam Inj. 5 mg /ml-2 ml K= 30 Amp 2,344 - DAK 13(E) / Jun-18
69 Diazepam Inj. 5 mg /ml-2 ml K= 30 Amp 833 - BS Prop 14/Jul-18
70 Diazepam Rectal 5 mg/ml-2ml (Stesolit) K = 5 Tube 17,400 - APBD II-13 / Okt-15
71 Diazepam Tablet 5 mg B = 250 tab 20 - BS Prop 13
72 Difenhidramin HCl inj.10 mg/ml-1ml K= 30 amp 1,050 - DAK 14 (E)
73 Difenhidramin HCL Inj.10 mg/ml-Iml K = 30 Amp 800 - BS Prop 12 / Jul-15
74 Digoksin Tablet 0,25 mg K = 100 tab - BS Prop 13 / Sep 15
75 Digoksin Tablet 0,25 mg K = 100 tab 91 - DAK 13(E) / Mei-17
76 Dimenhidrinat tablet 50 mg B = 100 tab 95 - DAK 13(E) /Mei-18
77 Dimenhidrinat Tablet 50 mg Btl = 100 tab 104 - DAK 14 (E)
78 Domperidon Suspensi 5 mg/5ml Btl=60 ml 3,333 - DAK 14 (E)
79 Domperidon Tab 10 mg K= 50 tab 167 - DAK 14 (E)
80 Domperidon Tablet 10 mg K = 100 tab 176 - DAK 13(E) / Jul-17
81 Efedrin HCl Tablet 25 mg B = 1000 tab 35 - BS PROP 11
82 Ekstrak Beladon Tablet 10 mg B = 1000 tab 18 - BS Prop 13 / Sep 15
83 Epinefrin HCL (Adrenalin) Inj.0,1%-ml K = 30 Amp 1,127 - BS PROP 13
84 Erythromycin Kapsul 500 mg (Eryra) K = 100 caps 930 - BS Prop 13 / Peb -16
85 Erythromycin Syr. Kering 200 mg / 5 ml Btl = 60 ml 7,220 - DAK 13(E) / Jun-18
86 Erythromycin Syr. Kering 200 mg / 5 ml Btl = 60 ml 6,500 - BS Prop 13
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
88 Etanol 70 % Btl= 1 liter 21,500 - APBD II-14 (E)
89 Fenitoin Natrium Kapsul 100 mg Btl=250 kap 80 - DAK 12 / Nop-15
90 Fenitoin Natrium Kapsul 100 mg Btl= 100 kaps 133 - DAK 14 (E)
91 Fenobarbital Inj. 50 mg/ml K= 30 amp 1,418 - DAK 14 (E)
92 Fenobarbital Inj 50 mg/ml K=30 amp 1,418 - BS Prop 13 / Jul-16
93 Fenobarbital Tablet 30 mg B= 1000 tab 25 - BS Prop 13 / Sep-14
94 Fenobarbital Tablet 30 mg B= 100 tab 62 - DAK 13(E) / Sep-18
95 Fitomenadion (Vit.K1) Inj.10 mg/ml-1ml K= 30 Amp 978 - BS Prop 14/Apr-15
96 Fitomenadion (Vit.K1) Inj.10 mg/ml-1ml K= 30 Amp 1,566 - DAK 13(E) /
97 Fitomenadion (Vit.K1) tab.salut gula 10 mg B= 100 tab 630 - DAK 14 (E)
98 Fluconazole kap 150 mg Box=10cap 20,000 - BS Prop 14/May-16
99 Fluconazole Kap 150 mg Ktk=10 Kaps 22,000 - DAK 14 (E)
100 Furosemide Injeksi 40 ml B=25AMP 1,829 - DAK 14 (E)
101 Furosemide Tab. 40 mg K = 200 tab 90 - DAK 13(E) /Apr-16
102 Furosemide Tablet 40 mg K= 100 tab 85 - DAK 14 (E)
103 Garam Oralit untuk 200 ml Air K = 100 kant 305 - P2M / Mei-14
104 Garam Oralit untuk 200 ml Air K = 100 kant 305 - BS Prop 12 / Jun-13
105 Garam Oralit untuk 200 ml Air K = 100 kant 380 - DAK 12/Mei-15
106 Garam Oralit untuk 200 ml Air K = 100 kant 345 - BS Prop 13/Sep - 16
107 Garam Oralit untuk 200 ml Air K = 100 kant 292 - DAK 13(E) / Okt-17
108 Garam Oralit untuk 200 ml air K = 100 kant 288 - DAK 14 (E)
360793638.xls
109 Gentamycin Injeksi 80 mg/ml K = 5 Amp - BS PROP 13
110 Gentamycin Injeksi 80 mg/ml K = 5 Amp 7,480 - BS Prop 14 / Jun-15
111 Gentamycin Krim 1% K=10 tube@5 gr 1,350 - DAK 13(E) /Peb-17
112 Gentamycin Krim 1% Tube @ 5 g 1,850 - BS Prop 12
113 Gentamycin Krim 1 % tube@5g 1,829 - APBD II-14
114 Gentamycin Tetes Mata 0,3 % Btl=5ml 3,194 - DAK 14 (E)
115 Gentian Violet Larutan 1% Btl @ 10 ml 450 - BS Prop 13/Jul -15
116 Gentian Violet Larutan 1% Btl @ 10 ml 900 - DAK 13(E) / Nov-16
117 Glibenklamid Tablet 5 mg B= 100 tab 56 - DAK 14 (E)
118 Glimepirid 2 mg Box=50 tab 436 - APBD II-14
119 Gliseril Guaiakolat Tablet 100 mg B = 1000 tab 44 - APBD II-14
120 Gliserin Btl = 100 ml 4,180 - BS Kab 09 / Feb-13
Glukosa 25 gr + 1,125 gr Sodium Clorida
121 Softbag = 500 ml 11,385 - DBHCHT 13 /Sep-16
(D5+1/4)
Larutan mengandung Karbohidrat + Elektrolit

122 Btl=500ml 7,700 - DAK 14 (E)
(Glukosa 55,0 g + NaCl 2,25 g (D5+1/4NS)

123 Btl=500ml 7,700 - DAK 14 (E)
124 Glukosa Larutan Infus 40% Steril Amp@ 25 cc 2,300 -

125 Glukosa Larutan Infus 10% Steril Btl = 500 ml 5,727 -
126 Glukosa larutan infus 5 % steril B = 500 ml 5,200 - DAK 14 (E)
127 Glukosa Larutan Infus 5% Steril Btl = 500 ml 5,313 - BS Prop 14 / Sep-17
128 Griseofulvin Tablet 125 mg, Micronizet B = 100 tab 200 - DAK 11 / Ags-16
129 Haloperidol Tablet 0,5 mg K= 100 tab 59 - DAK 14 (E)
130 Hidroklorotiazid (HCT) Tablet 25 mg B = 1000 tab 24 - BS Kab 09 / Feb-14
131 Hidrokortison Krim 2,5% K = 24 tube 2,979 - DAK 12/Sep-15
132 Hidrokortison Krim 2,5% K = 24 tube@5gr 2,541 - DAK 13(E) / Sep-16
133 Hidrokortison Krim 2,5 % Tube 5 gr 2,798 - APBD II-14
134 Ibuprofen Suspensi 200 mg/5ml Btl@60 ml 4,499 - DAK 14 (E)
135 Ibuprofen Tablet 400 mg K = 100 tab 74 - BS Prop 12 / Sep-16
136 Ibuprofen Tablet 400 mg K = 100 tab 144 - DAK 13(E) / Jul-17
137 Ibuprofen Tablet 400 mg K= 100 tab 150 - DAK 14 (E)
138 Isosorbid Dinitrat Sublingual Tablet 5 mg Ktk= 100 tab 88 - DAK 14 (E)
139 Kalsium Laktat (Kalk) Tablet 500 mg B = 1000 tab 39 - BS Prop 11 / Sep-13
140 Kaptopril tablet 25 mg K = 100 tab 88 - DAK 13(E) / Okt-17
141 Kaptopril tablet 25 mg K = 100 tab 88 - BS Prop 14 / Okt-17
142 Kaptopril Tablet 25 mg Ktk= 100 tab 84 - DAK 14 (E)
143 Karbamazepin Tablet 200 mg K= 100 tab 245 - DAK 14 (E)
144 Karbamazepin Tablet 200 mg K = 100 tab -
145 Karbamazepin Tablet 200 mg K = 100 tab 243 - DAK 13(E) / Okt-17
146 Ketokonazol Krim 2 % Tube@10 gr 2,569 - DAK 14 (E)
147 Ketokonazol Tab. 200 mg K = 50 tab 267 - DAK 13(E) / Agt-16
148 Ketokonazol Tablet 200 mg K = 50 tab 300 - DAK 14 (E)
149 Ketorolac Inj. 30 mg/ml Box=12 Ampl 2,300 - DAK 14 (E)
150 Klindamycin Kapsul 150 mg Box= 50 kap 361 - DAK 14 (E)
151 Kloramfenikol Salep Mata 1% Tube 5 g 1,562 - DAK 13(E) / Mar-17
152 Kloramfenikol Salep Mata 1 % Tube 5 gr 2,600 - DAK 14 (E)
153 Kloramfenikol Tetes Telinga 3% Btl = 5 ml 1,599 - DAK 13(E) / Peb-15
154 Klorampenikol injeksi 1 gr/ml Box= 10 Vial 9,644 - APBD II-14
155 Klorampenikol Kapsul 250 mg K=100 Kaps 249 - DAK 14 (E)
156 Klorfenaramin Maleat (CTM) Tab. 4 mg B = 100 tab 26 - DAK 13(E) / okt-16
157 Klorpromazin HCl Inj. 25/ml K=30 amp 733 - BS Prop 13
158 Klorpromazin HCL Tab. Salut 100 mg B = 1000 tab 29 - DAK 11 / Sep-16
159 Klorpromazin HCl Tablet Salut 25 mg B = 1000 tab -
Kotrimoksasol Tab Dewasa Komb :
160 B = 100 tab 50 - P2M / Nov-14
(Sulfametoks.400 mg + Trimetropim 80 mg)
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
162 Kotrimoksazol Susp. Komb Btl = 60 ml 2,574 - DAK 13(E) / Okt-16
163 Kotrimoksazol Susp. Komb B= 60 ml 2,167 - DAK 14 (E)
Krim Jelly untuk Luka Bakar (Komb. Ekstrak
164 Tube = 15 g 15,054 -
placenta10%,Neomycin sulfat)
165 Lactobacillus Sporogenes Tablet (LACBON) K=100 tab 1,265 - DAK 13 / Mar-16
360793638.xls
Larutan mengandung Elektrolit ( Na130 mEq, Cl
166 Btl@500 ml 9,000 - APBD II-14 (E)
109 mEq, Ca 3 mEq, Asetat 28 mEq (Asering)

(NaCl 1,75 g, Na Laktat 2,24 g, KCl 1,5 g,
167 Btl= 500 ml 10,000 - APBD II-14 (E)
Glukosa Anhydrat 13,5 g, Laktat 1,120 g (KA-EN
3B)
168 Lidokain Inj. 2% + Epinefrin 1:80.000-2ml K = 30 Amp 1,136 - DAK 12 / Des-15

169 Lidokain Inj. 2% + Epinefrin 1:80.000-2ml K = 30 Amp 1,355 - BS Prop 13/Des 14
170 Lidokain Inj. 2% + Epinefrin 1:80.000-2ml K = 30 Amp 1,295 - DAK 13(E) / Agt-16
171 Lidokain Inj. 2% + Epinefrin 1:80.000-2ml K = 30 Amp 1,033 - BS Prop 14/Sep-15
172 Lidokain Comp. Injeksi Box=30 Ampl@2ml 1,363 - DAK 14 (E)
173 Lidokain Jeli 2 % Syringe=10g 40,000 - DAK 14 (E)
174 Loratadin Tablet 10 mg K = 50 Tab 154 - DAK 14 (E)
175 Magnesium Sulfat Inj.(IV) 20%-25ml K = 10 vial 1,540 - DAK 10 / Jun-15
176 Magnesium Sulfat Inj.(IV) 20%-25ml K = 10 vial 1,540 -
177 Magnesium Sulfat Inj.(IV) 40%-25ml K = 10 vial 1,529 - APBD II 10 / Sep-15
178 Magnesium Sulfat Inj.(IV) 40%-25ml K = 10 vial -
179 Metformin 500 mg K = 100 tab 182 - DAK 12 / Sep-17
180 Metformin 500 mg K = 100 tab 105 - DAK 13(E) / Sep-16
181 Methoklopramid Injeksi 5mg/ml K= 5 amp 4,000 - APBD II-14
182 Methoklopramid Tablet 10 mg K= 100 tab 99 - DAK 14 (E)
183 Methoklopramid Tablet 10 mg K= 100 tab 110 - APBD II-14
184 Methylprednisolon Tablet 8 mg B= 100 tab 300 - DAK 14 (E)
185 Metilergometrin Maleat Tab Sal.0,125 mg B = 100 tab 110 - BS Prop 13 /Agt-17
186 Metilergometrin Maleat Inj. 0,200 mg-1ml K = 30 Amp 367 - BS Prop 13
187 Metilergometrin Maleat inj.0,200 mg-1 ml K=30 amp 2,300 - APBD II-14
188 Metronidasol Infus 500mg/100ml Btl= 100 ml 9,950 - DAK 14 (E)
189 Metronidazol tab 500 mg K = 100 Tab 164 - BS Prop 13/Okt-15
190 Mikonazol Krim 2% K=24 tube@10gr 3,000 - DAK 13(E) /Mar-17

191 Multivit.+ Lysin Curcumin Syr (Lytacur) Btl = 60 ml 11,000 - APBD II-13 / Okt-15
Multivitamin Syrup (Curcuminoid 2mg, P, Vit B1 3

192 mg, B2 2 mg, B6 5 mg, B12 5 mcg, -Caroten 10 % Btl= 60 ml 9,350 - APBD II-14
4 mg, Dexpantenol 3 mg + Lysine HCl 200 mg
NaCl 0,875 g ,KCl 0,75 g, Glukosa Anhydrat 13,5

193 Softbag = 500 ml 13,868 - DAK 13 / Mei-16
g, Laktat 1,120 g /Tridex 27 B/KA-EN 3B
194 Natrium Diclofenak Tab.50 mg K= 50 Tab 210 - DAK 13(E) / Ags-16

195 Natrium Diclofenak tab 50 mg K=50 tab 176 - DAK 14 (E)
196 Natrium Klorida Larutan infus 0,9 % Steril Btl = 500 ml 4,900 - DAK 13/ Jul-18
197 Natrium Klorida Larutan infus 0,9 % Steril B= 500 ml 4,700 - DAK 14 (E)
198 Nifedipin tablet 10 mg K= 100 tab 110 - DAK 14 (E)
199 Nifedipin tablet 10 mg K = 100 Tab 108 - BS PROP 13/Jul - 14
200 Nistatin Tablet Vagina 100.000 IU/g K = 100 tab 407 - DAK 13(E) / Apr-17
201 Nistatin Tablet Vagina 100.000 IU/g K = 100 tab 345 - BS Prop 13
202 Obat Batuk berdahak Kombinasi B = 300 tab 312 - DBHCHT 13 / 28-Jan-17
203 Obat Batuk Hitam (OBH) cairan B= 100 ml 2,035 - APBD II-14
204 OBH Kombinasi Batuk + Flu Btl = 100 ml 6,050 - DBHCHT 13 / Nov-16
205 Oksitetrasiklin HCl 1% Salep Mata tube=3,5 gr 1,600 - DAK 13(E) / Jul-15
206 Oksitosin Inj.10 IU/-1ml K = 100 Amp 1,820 - DAK 13(E) / Apr-16
207 Oksitosin injeksi 10 IU/- 1 ml K= 100 amp 2,200 - APBD II-14
208 Omeprazol Kapsul 20 mg Box = 30 kap 211 - DAK 14 (E)
209 Ondansetron Injeksi 4 mg/2 ml Box=5 amp 2,400 - APBD II-14
210 Ondansetron Injeksi 4 mg/2ml Box=5 amp 2,400 - DAK 14 (E)
211 Paracetamol tablet 500 mg Box= 100 tab 79 - APBD II-14 (E)
212 Parasetamol sirup 120 mg/5 ml B = 60 ml 1,438 - DAK 14 (E)
213 Parasetamol Tablet 500 mg B = 1000 tab - P2M / Mar-12
214 Parasetamol Tablet 500 mg Ktk = 100 tab 105 - BS Prop P2M
215 Parasetamol Tablet 500 mg B = 1000 tab 50 - DAK 12/Jun-16
216 Parasetamol Tablet 500 mg B = 1000 tab 46 - DBHCHT 13 / Sep-16
217 Permetrin Krim 5 % (Scabimite Cr 10 gram) Tube 10 g 11,475 - APBD II-14 (E)
360793638.xls
218 Piracetam 800 mg K = 100 tab 400 - DAK 13(E) / Ags-18
219 Piracetam Inj. 1 g / 5 ml K = 10 Amp 1,925 - DAK 13(E) / Apr-16
220 Pirantel Pamoat Tablet 125 mg K =30tab 311 - DAK 13(E) / Des-16
221 Pirantel Pamoat Tablet 125 mg K =25X4tab 169 - BS Prop 13 / Okt-15
222 Piridoksin HCl (Vit.B6) Tablet 10 mg B = 1000 tab 16 - BS Prop 14 / Ags-16
223 Piridoksin HCl (Vit.B6)Tablet 10 mg B= 1000 tab 17 - APBD II-14
224 Piroxicam 10 mg Kaplet B = 100 kap 75 - DAK 10 / Mar-15
225 Piroxicam 20 mg Kaplet B = 100 kap 126 - BS Prop 10 / Des-14
226 Polikresulen Concentrat 10 ml Btl = 10 ml 28,600 - DAK 13 / Jun-18
227 Povidon Iodida 10% Btl = 30 ml 2,400 - DAK 12 / Agt-15
228 Povidon iodida 10 % B= 30 ml 2,163 - DAK 14 (E)
229 Povidon Iodida 10% Btl = 300 ml 14,600 - BS Prop 10 / Mar-12
230 Povidon Iodida 10% Btl = 300 ml 14,000 - DAK 13(E) / Agt-16
231 Povidon Iodida 10% B=300 ml 13,182 - BS Prop 14
233 Prednison 5 mg B=1000 tab 57 - BS Prop 14
234 Prokain Benzil Penisillin 3 Juta IU / Vial Inj K = 30 Vial 3,750 - BS Prop 11 / Mei-12
235 Prokain Benzil Penisillin 3 Juta IU / Vial Inj K = 30 Vial 6,017 - DAK 12/Ar-16
236 Propanolol HCl Tablet 40 mg K = 100 Tab -
237 Propanolol HCl Tablet 40 mg K = 100 Tab 77 - DAK 13(E) / Apr-16
238 Propanolol HCl tablet 40 mg B = 100 tab 65 - DAK 14 (E)
239 Ranitidin Injeksi 25 mg / ml k= 25 amp 1,928 - DAK 13(E) / Jun-15
240 Ranitidin injeksi 25 mg/ml Box=10 amp 1,140 - DAK 14 (E)
241 Ranitidin Tablet 150 mg B= 100 tab 120 - DAK 14 (E)
242 Reserpin Tablet 0,25 mg B = 1000 tab 88 - DAK 12 / Peb-15
243 Retinol (Vit. A) Kapsul 100.000 IU:196 B = 50 tab 255 - BS Prop 13/Jul - 14
244 Retinol (Vit. A) Kapsul 100.000 IU:197 B = 50 tab 300 242 72,600 DAK 13(E) / Jun-15
245 Retinol (Vit. A) Kapsul 200.000 IU:1569 B = 50 tab 420 - BS Prop 13/Apr - 15
246 Retinol (Vit. A) Kapsul 200.000 IU:1570 B = 50 tab 1,400 432 604,800 DAK 13(E) /
247 Ringer Laktat Larutan infus steril B= 500 ml 5,200 - DAK 14 (E)
248 Salbutamol tablet 4 mg K = 100 Tab 89 - DAK 14 (E)
249 Salep 2-4 K = 24 pot 1,229 - BS Prop 14
250 Salep 2-4 K=24 pot@30 g 2,000 - APBD II-14 (E)
251 Salisil bedak 2 % K= 50 gram 1,250 - DAK 14 (E)
252 Salisil Bedak 2% K = 50 gr 1,120 - DAK 13(E) / Agt-16
253 Sefadroksil 500 mg K= 100 cap 464 - BS Prop 14
254 Sefadroksil 500 mg Ktk= 100 cap 509 - DAK 14 (E)
255 Sefotaxim injeksi 1 gr Box= 10 vial 2,950 - DAK 14 (E)
256 Setirizin tablet 10 mg B = 100 tab 181 - DAK 14 (E)
257 Simvastatin Tablet 10 mg K= 30 tab 164 - BS Prop 14 / Mei-16
258 Simvastatin tablet 10 mg K= 100 Tab 169 - DAK 14 (E)
259 Siprofloksasin tablet 500 mg K= 100 Tab 255 - DAK 14 (E)
260 Spironolakton tablet 25 mg Ktk= 100 tab 315 - DAK 14 (E)
261 Sulfacetamide TM btl 3,745 - BS Prop 14 / Mei-16
262 Tablet Tambah Darah Kombinasi Sachet = 30 tab 67 - BS Prop 13
263 Tablet Tambah Darah Kombinasi Sachet = 30 tab 30,000 44 1,320,000 DAK 13(E) /Sep-17
264 Tetrasiklin HCl Kapsul 500 mg K = 100 kap 257 - DAK 12/Des-14
265 Tetrasiklin HCl Kapsul 500 mg K = 100 kap 206 - DAK 13(E) / Sep-16
266 Tetrasiklin HCl Kapsul 500 mg K = 100 kap 234 - BS Prop 13
267 Thiamphenicol susp.125mg/5ml (Phenobiotic) Btl = 60 ml 6,500 - APBD II-13 / Okt-17
268 Thiamphenikol Kap. 500 mg B = 100 kap 431 - DAK 13(E) / Nop-17
269 Tiamin HCl (Vit.B1) Tablet 50 mg B = 1000 tab 34 - BS Prop 13
270 Tiamin HCl (Vit.B1) Tablet 50 mg B = 100 tab 81 - DAK 13(E) /
271 Tramadol Inj. Box=5amp 3,558 - BS Prop 14/Sep-15
272 Triheksifenidil Hidroklorida Tablet 2 mg K = 100 tab 40 - DAK 13(E) / Okt-18
273 Vit.B1 (Fursultia.HCL)+B2(Rib.)/Alinamin inj. K= 5 Amp 14,973 - DBHCHT 13 / Jun-15
274 Vitamin B Compleks B= 1000 tab 22 - APBD II-14

275 Vitamin B Komplek B = 1000 tab 20 - BS Prop 13/Sep-14
Vitamin E 400 IU Vegicap (d- Tocopherol Acetat 400 Box /30
276 3,410 - APBD II-14
IU Cap
277 Zinc Tablet 20 mg B = 100 tab 475 - BS Prop P2M/ Mei-14
278 Zinc Tablet 20 mg B = 100 tab 440 - DAK 13(E) / Nop-16
360793638.xls
279 Zinc Tablet 20 mg K=100 tab 474 - DAK 14 (E)
ALKES / PERBEKES PAKAI HABIS

280 Alat Suntik ADS Soloshot 0,05 ml K = 100 set 1,800 - BS PROP IMUN
281 Alat Suntik ADS Soloshot 0,05 ml Box =100 set 1,800 - APBD II-14
284 Alat Suntik Sekali Pakai 1 ml K = 100 set 1,092 - DAK 13
285 Alat suntik sekali pakai 1 ml B=100 set 1,093 - BS Prop 14
286 Alat Suntik sekali pakai 1 ml K= 100 set 1,092 - APBD II-14
287 Alat Suntik Sekali Pakai 3 ml K = 100 set 790 - BS Prop 11
288 Alat Suntik Sekali Pakai 3 ml K = 100 set 979 - DAK 13
289 Alat Suntik sekali Pakai 3 ml K= 100 set 860 - APBD II-14
290 Alat Suntik sekali Pakai 5 ml K = 100 set 735 - BS PROP IMUN
291 Alat Suntik sekali Pakai 5 ml K = 100 set 1,037 - DAK 13
292 Alat Suntik sekali Pakai 5 ml K= 100 set 1,038 - APBD II-14
294 Aquadest Pro Analisa Btl = 20 Liter 85,800 - DAK 13
295 Blood Glucose Test (One Call) Box = 25 tip 85,010 - APBD II / 12/RI
296 Blood Glucose Test (Terumo) Box = 30 tip 220,000 - APBD II / 12/RI
297 Blood Glucose Test (Easytouch) Box = 25 tip 90,000 - APBD II-13
298 Cat Gut Chromic K = 24x70 cm 24,958 - BS Prop 12 / Des-13
299 Cat Gut Chromic 12x75 cm No.2/0 - 3/0 K = 12x75 cm 24,499 - DAK 13
301 Cat gut Chromic No. 3/0 + Jarum 1/2 GT 35 mm Box/24 5,583 - APBD II-14 (E)
302 Cat gut Plain No. 3/0 + Jarum 1/2 GT 35 mm Box/24 5,583 - APBD II-14 (E)
303 Foley Catheter Rush No.16-18 K = 10 set 12,299 - DAK 13
304 Foley Catheter No.16-18 B= 10 set 14,300 - APBD II-14
305 Handschoen Steril B = 50 set 4,250 - BS Prop 12
306 Handschoen Steril K=100 pasang 11,500 - APBD II-14
307 Handschoen Non Steril K = 50 Set 2,124 - BS prop 13
308 Handschoen Non Steril K = 100 pieces 849 - DAK 13
309 Handscoen Non Steril K=50 psc 849 - APBD II-14
310 Handschoen Ginec Steril K=50 pasang 15,000 - DAK 13
311 Handscoen Ginec (Obstetri) K=50 set 15,000 - APBD II-14
312 I.V Catheter No. 18 s/d 24 K = 50 set 7,788 - DAK 13 / Ags-15
313 I.V Cateter No. 18 - 24 K= 50 Biji 7,788 - APBD II-14
314 Infusion Set Anak Set 4,000 - DAK 13
315 Infusion set Anak set 4,500 - APBD II-14
316 Infusion set Dewasa set 3,499 - APBD II-14
317 Infusion Set Y type Set 3,499 - DAK 13
318 Jarum Jahit (Bedah) No. 9 - 14 K = 12 Biji 2,083 - DAK 11
319 Kapas Pembalut / Absorben 250 gr Bungkus 15,000 - BS Prop 13
320 Kapas Pembalut / Absorben 250 gr Bungkus 12,075 - DAK 13
321 Kapas Pembalut / Absorben 250 gram Roll 12,500 - APBD II-14 (E)
322 Kasa pembalut 30 m x 80 cm Rol 108,950 - DAK 13
323 Kasa Pembalut Hidrofil 30 x 80 cm Rol 108,950 - APBD II-14
324 Kasa Pembalut Hidrofil 4 Yard x 10 cm Rol 2,399 - DAK 13
325 Kasa Pembalut Hidrofil 4 m x 10cm Rol 1,500 - APBD II-14
326 Kasa Steril 16 x 16 K = 16 lb 5,200 - DAK 12
327 Kasa Steril 16 x 16 cm Dos 5,800 - APBD II-14
328 Lanset for Fine Touch Box = 100 pcs 24,200 - APBD II-13
329 Lisol (Desinfectan C 100% Citroen) Btl = 1000 ml 15,400 - DAK 12
331 Masker B = 20 bj 1,122 - Buffer Stok Prop 13
332 Masker Box= 50 biji 500 - APBD II/2012
333 Masker N95 Disposibel Box= 20 bj 17,500 - APBD II-14
334 Masker N95 Disposible B = 20 bj 17,500 - DAK 13
335 Mucus Extractor Set 11,000 - DAK 12 /Jun-16
336 Nelaton Cateter Set 9,900 - DAK 12
337 Plester 5 yard x 2 Inch Rol 23,625 - DAK 13
338 Plester Hypo alergenik 5m x 2 Inch Box = 10lbr 3,740 - DAK 13
339 Silk (Benang Bedah Sutera) No. 3/0 K=12x500cm 6,983 - DAK 13
360793638.xls
340 Silk (Benang Bedah Sutera) No. 3/1 K = 12x5m 5,744 - BS Prop 13
341 Skalpel (Mess) B = 100 420 - DAK 11 / Okt-16
342 Skalpel (Mess) B = 100 275 - DAK 12 / Jun-17
343 Transfusion Set Set 12,000 - DAK 12 / Mar-14
344 Ultrasound Transmision Gel 0,25 ltr (Ul-Trans) Btl = 0,25 ltr 18,700 - DAK 13
345 Urine Bag Standart Steril 2 lt. (T valne) Bag/10 3,000 - APBD II-14 (E)
OBAT GIGI
346 Bahan Tumpatan Sementara (grey) /Cavit G (A2 ,A3) Tube = 25 gr 75,400 - DBHCHT 13 / Des-16
347 Bahan u/ sterilisasi saluran akar (Rockles) Btl 562,650 - DBHCHT 13
348 Devitalisasi pasta non arsen (Devitex) Btl 429,000 - DBHCHT 13
Diamon Boor High Speed / Sharp Cut (Long
349 Pcs 18,150 - DBHCHT 13
Shank, Toppered, Round, Fissure Bur)
350 Enching Set 138,600 - DBHCHT 12
351 Etil Klorida Semprot Btl = 100 ml 104,999 - DAK 13 / Mei-16
352 Eugenol Cairan K = 12 btl@10ml 45,832 - DAK 13 / Sep-15
353 Matrix band Set 60,500 - DBHCHT 13
354 Metronidazol Gel Syringe Syringe = 1 gr 125,000 - DAK 12/Des-14
355 Oil Pelumas Handpiece W&H 400 ml Btl = 400ml 314,600 - DBHCHT 13 / '9-Sep-15
356 Semen Seng (GC / Display) B = set 175,450 - DAK 13 / Mar-16
REAGEN
357 3 GPH Strip Test (Gula, Protein, PH) B = 100 Sachet 95,999 - DAK 13
358 Anti A Monoklonal (Reagen Gol Darah) Btl = 10 ml 99,000 - DAK 13
359 Anti B Monoklonal (Reagen Gol Darah) Btl = 10 ml 99,000 - DAK 13
360 EDTA Powder Btl = 25 gr 70,000 - DAK 12 / Sep-15
361 Larutan Anisol Btl = 100 ml 144,000 - DAK 12 / Sep-15
362 Larutan Asam Chlorida 0,1 Btl =100 ml 8,470 - DAK 13
363 Larutan EDTA 10% Btl = 500 ml 99,900 - APBD 11/ RI
364 Larutan Eter Alkohol Btl = 250 ml 96,800 - DAK 12 / Sep-15
365 Larutan Giemsa Btl = 100 ml 181,500 - DAK 13
366 Larutan Metanol Btl = 2500 ml 242,000 - APBD 11/ RI
367 Larutan Metanol Btl = 100 ml 61,600 - DAK 12 / Sep-15
368 Larutan Turk Btl = 100 ml 54,450 - DAK 12 / Sep-15
369 Safety (Imunisasi) Box 22,000 - Buffer Prop Imunisasi
370 Safety Box 5lt unit 22,000 - DAK 13
OBAT TB PARU
371 Box Slide Box - P2M
372 Box Slide Unit 121,000 - DAK 13
373 FDC TB PARU KIT KAT I/III KIT 359,990 - DPHCHT 11
374 FDC TB PARU KIT KAT I/III KIT 359,990 - P2M
375 FDC KOMBIPAK KAT I KIT -
376 FDC TB PARU KIT KATEGORI II KIT 1,199,990 - P2M
377 FDC TB PARU KIT KATEGORI II Paket 1,199,990 - DAK 14 (E)
378 INH 300 mg B = 1000 tab 97 - APBD II 09 / Okt-14
379 OAT Anak (KOMBIPAK) paket 215,000 - P2M / Des-14
380 OAT (KOMBIPAK) paket - P2M / Des-15
381 Pot Sputum K = 250 set 900 - APBD II 09
382 Pot Sputum K = 250 set 1,238 - DAK 10
383 Pot Sputum K = 250 set 250 1,238 309,500 BS Prop P2M
384 Reagen Zeil Nelseen@100 cc Paket=3jenis 100,000 - P2M
385 Slide / Objeck Glass K = 72 pcs 20,900 - DAK 10
386 Slide / Objeck Glass K = 72 pcs 20,900 - APBD II / 10
387 STREPTOMYCIN INJ 1 GRAM Vial 1,828 -
OBAT KUSTA
388 MDT MB ANAK KIT - P2M
389 MDT MB DEWASA KIT - P2M
390 MDT PB ANAK KIT - P2M
391 MDT PB DEWASA KIT - P2M
OBAT KB
360793638.xls
392 Susuk KB II (Implan isi 2) Set 190,300 - DAK 10 / Okt-14
393 Antasida + Simeticon Tablet (Dexanta) Box= 100 tab 162 - JKN 14
Botol @1000
394 Antasida Doen Tablet Tablet 44 - Askes 14 / Mei-17
Box = 10
395 Anti Tetanus (ATS) 1500 IU amp 126,500 - Askes 14 / mar-16
396 Aqua Pro Injeksi Steril K= 10 Vial 5,000 - JKN 14

397 Asam Folat 400 g tab. Box =100 tab 84 - JKN 14 (E)
398 Asam Traneksamat Inj. 100 mg/ml Ampul@5ml 3,334 - JKN 14 (E)
Balutan Tulle Grass 10x10, ( Zat aktif : Kalsium
399 BOX=10 Sachet 15,593 - JKN 14
Alginat)
400 Betametason Krim 1 % Ds=25 tube 1,520 - JKN 14 (E)
401 Cefotaksim Injeksi 1 g B=10 Vial @1 g - JKN 14 (E)
402 Cefotaxim Injeksi 1 Gram (Dexa Medica) Box = 10 Vial 2,950 - Askes 14 / Apr-16
403 Diazepam Rectal 5 mg/2.5 ml Ktk= 5 tube 11,525 - JKN 14 (E)

404 Dimenhidrinat Box=720 Tab 104 - JKN 14 (E)
405 Fitomenadion (Vit. K1) inj.2 mg/ml-1 ml K= 10 ampul 3,417 - JKN 14 (E)
Gel : Placenta Extract 100 mg+ Neomycin Tube= 20 g
406 15,054 - JKN 14
Sulphate 5 mg
407 Kalsium Laktat (Kalk) Tablet 500 mg B= 1000 tab 70 - JKN 14 (E)
408 Karbamazepin tab. 200 mg Box=100 tab. 1,980 - JKN 14
Dus = 5 amp
409 Ketorolac Injeksi 10 mg/ml @ 1 mL 1,616 - Askes 14 / Okt-16
410 Kloramfenikol Salep Mata 1 % Tube 5 gram 2,600 - JKN 14

411 Kloramfenikol Tetes Telinga 3 % K = 24 btl 1,599 - JKN 14
412 Klorpheniramin Maleat (CTM) 4 mg B= 1000 tab 26 - JKN 14
413 Kotrimoksasol Forte Tablet 960 mg K= 100 tab 500 - JKN 14
Lacto Bacillus Powder ( L Lacidophilus , B. Box=40 Sach
414 3,300 - JKN 14
Longum, S. Thermophilus)
415 Loperamid Tablet 2 mg K= 100 tab 89 - JKN 14 (E)
Ktk = 10 amp
416 Metamizol 500 mg Injeksi (Progesol Injeksi) @ 2 mL 7,500 - Askes 14 / Jun - 17
417 Metamizol sodium Injeksi 500mg/ml Box @ 5 Ampul 7,660 - JKN 14

418 Metronidazol Suspensi Btl @ 60 ml 4,447 - JKN 14
Botol = 100
419 Metronidazole Infus 500 mg/100 mL mL 9,950 - Askes 14 / Feb - 17
Multivitamin Tab. Tambah Darah ( Fe

Glukonat 250 mg, Vit C 50 mg, As. Folat 1 mg,
420 Box=100 kaps 197 - JKN 14
CuSO4 0,2 mg, MgSO4 0,2 mg , Vit B12 7,5
mcg, Sorbitol 25 mg
Multivitamin (Neurotropic) injeksi Thiamine

421 HCl 100 mg, Pyridoxine 100,Cyanocobalamin Box= 10 ampul 5,010 - JKN 14
5000 mcg
Multivitamin (Neurotropic) Tablet +B1 100, B6

422 Box=200 kaps 297 - JKN 14
200, B12 200 mcg (Neurotropic Tab)
423 Mikonazol Krim Tube=10 gram 3,000 - JKN 14
Neurotropik Injeksi (Vit. B1 100 mg, B6 100 mg, Box = 10

424 4,653 - Askes 14 / Jan - 16
B12 5000 mcg) Biocombin 5000 Injeksi amp @ 3 mL

425 - Askes 14 / Feb - 17
B12 5000 mcg) Mersibion 5000 Injeksi amp @ 3 mL
426 Nifedipin tablet 30 mg K =100 tab 3,500

427 Obat Kumur Btl = 200 ml 23,694 - JKN 14
428 OBH Batuk Pilek Syrup Btl = 60 ml 8,250 - JKN 14
429 Oksigen Tabung 1 m3 Tabung 1m3 55,000 - JKN 14
431 Oksitetrasiklin HCl 1% Salep Mata K = 25 tube 2,772 - JKN 14
432 Omeprazol Kapsul 20 mg Box = 30 kap 211 - JKN 14 (E)
360793638.xls
Dus = 5 amp
433 Ondansetron Injeksi 4mg/ 2 mL @ 1 mL 2,400 - Askes 14 / Apr - 17
Parasetamol Kombinasi Tablet Batuk

434 Berdahak (Parasetamol 400 mg, Bromheksin 8 Box= 300 Caplet 312 - JKN 14
mg, Difenhidramin HCl 25 mg)
Parasetamol Kombinasi Tablet Antitusif

435 (Parasetamol 500 mg,Dekstromethorphan 15 Box= 150 Caplet 390 - JKN 14
mg, PPA 12.5 mg, CTM 2 mg)
Parasetamol Kombinasi Tablet Flu
436 (Parasetamol 500 mg,Tripolidin 2,5 mg, Box= 100 tab 363 - JKN 14
Pseudoefedrin 30 mg
437 Piracetam 800 mg Box= 100 tab 803 - JKN 14
438 Piracetam Inj. 1 gr / 5 ml Box=10 Amp 5,500 - JKN 14
439 Plester 5 yards X 2 inch Rol 26,843 - JKN 14
440 Prednison tablet 5 mg Box= 100 tab 140 - JKN 14
441 Propiliteorasil ( PTU ) tablet 100 mg B = 100 tab 319 - JKN 14 (E)
Salbutamol SO4 3,01mg +Ipratonium Brom Ktk = 20
442 8,100 - JKN 14
0,52mg Nebulizer
443 Salbutamol Tablet 4 mg Box = 100 Tab 93 - JKN 14
444 Salbutamol Tablet 2,5 mg Box = 20 Amp 93 - JKN 15
Serum Anti Bisa Ular (SABU) I Polivalen Inj K= 10 vial
445 473,000 - JKN 14
5ml
446 Serum Anti Tetanus (ATS) Inj.1.500 IU/amp K= 10 amp 126,500 - JKN 14
447 Streptomycin Inj. Vial - JKN 14 (E)

448 Tetrasiklin HCl kapsul 500 mg K= 100 kaps 300 - JKN 14 (E)
449 Thiamphenicol Kapsul 500 mg K = 100 kap 550 - JKN 14
450 Thiamphenicol suspensi 125 mg/5 ml Btl= 60 ml 6,500 - JKN 14
451 Tiamin Hcl (Vit B1) tablet 50 mg B= 1000 tab 36 - JKN 14
452 Triheksifenidil Hidroklorida tablet 2 mg K= 250 tab 352 - JKN 14
453 Vitamin B Compleks Plus Ekstrak Hati Box= 100 tab 220 - JKN 14
Vitamin E 400 mg Licap (d- Tocopherol 400 Box /30 Cap
454 3,410 - JKN 14
Mg)
ALKES / PERBEKES PAKAI HABIS -

455 Alat suntik sekali pakai 0,5 cc Box = 100 2,158 - Askes 14 / Jun-18
456 Hand Scrub Btl= 500 ml 104,500 - JKN 14
Kasa Elastic ( Self Adhesive Elastic Bandage) Box=60 Roll
457 12,650 - JKN 14
2,5 cm x 4,5 m
458 Masker (ear Loop, Tie On) Box= 50 bj 770 - JKN 14
459 Rapid Test Anti HIV 2 Card Box=50Card 37,400 - JKN 14
OBAT GIGI - JKN 14

460 Bahan Adhesive / Bonding BTL @ 5 ml 242,000 - JKN 14
461 Bahan Tumpatan Sementara (Grey) Tub= 28 gr 171,600 - JKN 14
462 Bahan Tumpatan Sementara (Pink) Tub= 28 gr 165,000 - JKN 14
463 Bahan u/Sterilisasi saluran akar (Cresofen) Btl= 13 ml 566,500 - JKN 14
464 Celluloid strip Ktk=100 pcs 115,500 - JKN 14
465 Devitalisasi Pasta non Arsen / Pulperil Btl 429,000 - JKN 14
466 Enching / Phosporic Acid BTL@9 ml 138,600 - JKN 14
467 Etil Klorida Semprot Klg = 100 ml 95,000 - JKN 14
468 Eugenol Btl=15,ml 29,000 - JKN 14
469 Formokresol / TKF B= 10 ml 49,500 - JKN 14
470 Glass Ionomer Cement (Powder & Lig) set (Pwd=15g) 869,000 - JKN 14
471 Glass Ionomer Cement (Powder & Lig) set (Pwd=12,5g) 493,300 - JKN 14
472 Hydrogen Piroxida 3 % Btl=1 l 20,570 - JKN 14
473 Kalsium Hidroksida pasta Set 137,500 - JKN 14
Komposit Light Cure (Bahan tumpatan tetap Tube= 4 g
474 289,300 - JKN 14
dgn sinar) A2
360793638.xls
475 289,300 - JKN 14
dgn sinar) A3
Mata Boor Diamon High Speed/Sharp Cut, set= 6 pcs
476 22,733 - JKN 14
Denteply
477 Mata Skaler / Tip Scaller Psc 88,000 - JKN 14
478 Micro Brush Pack 71,500 - JKN 14
479 Monoklor kanfer Mentol Cairan (CHKM) B=10 ml 49,500 - JKN 14
480 Mummifying Pasta Botol 176,000 - JKN 14
481 Oil Pelumas Boor Botol 88,000 - JKN 14
482 Semen Seng Fosfat Set@ 100 g pwd,100 ml Liq
649,000 - JKN 14
483 Spons Gelatin Cubicles 1x1x1 cm Kotak 132,000 - JKN 14
484 Yodoform (+Creosote/Ca-Hidoxida) pack 605,000 - JKN 14
Obat P3K Mobile -

485 Balsem / Krim analgetik anti inflasi Tube =30gram 10,450 - JKN 14
486 Minyak Kayu Putih 50 ml Btl=50 ml 12,375 - JKN 14
487 Plaster (Sachet) Box = 100 sachet 225 - JKN 14
Jumlah Harga 2,306,900

2,306,900


SBBK


1 Retinol (Vit. A) Kapsul 100.000 IU:197 B = 50 tab 300 242 72,600 DAK 13(E) / Jun-15
2 Retinol (Vit. A) Kapsul 200.000 IU:1570 B = 50 tab 1,400 432 604,800 DAK 13(E) /
3 Tablet Tambah Darah Kombinasi Sachet = 30 tab 30,000 44 1,320,000 DAK 13(E) /Sep-17
Yang Menyerahkan,
KEPALA INSTALASI PERBEKALAN
FARMASI KESEHATAN PENERIMA
Dra. TRI MUSYAROFAH, Apt RISMA YANSA F.

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009


SBBK


360793638.xls
Jumlah Harga 309,500
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009
360793638.xls
360793638.xls

SBBK
Penerima : Tanggal : 4 Pebruari 2015



18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -

166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)





244 Retinol (Vit. A) Kapsul 100.000 IU:197 B = 50 tab 242 - DAK 13(E) / Jun-15
246 Retinol (Vit. A) Kapsul 200.000 IU:1570 B = 50 tab 432 - DAK 13(E) /
263 Tablet Tambah Darah Kombinasi Sachet = 30 tab 44 - DAK 13(E) /Sep-17

276 3,410 - APBD II-14
IU Cap

280 Alat Suntik ADS Soloshot 0,05 ml K = 100 set 500 1,800 900,000 BS PROP IMUN
283 Alat Suntik ADS Soloshot 0,5 ml Box =100 set 1,500 2,158 3,237,000 APBD II-14
291 Alat Suntik sekali Pakai 5 ml K = 100 set 500 1,037 518,500 DAK 13
OBAT GIGI
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
374 FDC TB PARU KIT KAT I/III KIT 6 359,990 2,159,940 P2M
383 Pot Sputum K = 250 set 1,238 - BS Prop P2M
OBAT KUSTA
OBAT KB
Botol @1000
Box = 10

399 BOX=10 Sachet 15,593 - JKN 14
Alginat)

406 15,054 - JKN 14
Sulphate 5 mg
Dus = 5 amp

414 3,300 - JKN 14
Ktk = 10 amp

Botol = 100

420 Box=100 kaps 197 - JKN 14
mcg, Sorbitol 25 mg

5000 mcg

422 Box=200 kaps 297 - JKN 14

424 4,653 - Askes 14 / Jan - 16
425 - Askes 14 / Feb - 17

Dus = 5 amp


Pseudoefedrin 30 mg
442 8,100 - JKN 14
0,52mg Nebulizer
444 Salbutamol Nebulez 2,5 mg Box = 20 Amp 93 - JKN 15
445 473,000 - JKN 14
5ml

454 3,410 - JKN 14
Mg)

457 12,650 - JKN 14
2,5 cm x 4,5 m
OBAT GIGI - JKN 14

474 289,300 - JKN 14
dgn sinar) A2
475 289,300 - JKN 14
dgn sinar) A3
476 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


6,815,440


SBBK


1 Alat Suntik ADS Soloshot 0,05 ml K = 100 set 500 1,800 900,000 BS PROP IMUN
2 Alat Suntik ADS Soloshot 0,5 ml Box =100 set 1,500 2,158 3,237,000 APBD II-14
3 Alat Suntik sekali Pakai 5 ml K = 100 set 500 1,037 518,500 DAK 13
Yang Menyerahkan,
Dra. TRI MUSYAROFAH, Apt N.G.AYU T

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008


SBBK


Yang Menyerahkan,
Dra. TRI MUSYAROFAH, Apt JOKO WAHYU U.
NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK



18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -

166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)





276 3,410 - APBD II-14
IU Cap

OBAT GIGI
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
OBAT KUSTA
OBAT KB
Botol @1000
Box = 10

399 BOX=10 Sachet 15,593 - JKN 14
Alginat)

406 15,054 - JKN 14
Sulphate 5 mg
Dus = 5 amp

414 3,300 - JKN 14
Ktk = 10 amp

Botol = 100

420 Box=100 kaps 197 - JKN 14
mcg, Sorbitol 25 mg

5000 mcg

422 Box=200 kaps 297 - JKN 14

424 4,653 - Askes 14 / Jan - 16

425 - Askes 14 / Feb - 17

Dus = 5 amp


Pseudoefedrin 30 mg
442 8,100 - JKN 14
0,52mg Nebulizer
444 Salbutamol Tablet 2,5 mg Box = 20 Amp 93 - JKN 15
445 473,000 - JKN 14
5ml

454 3,410 - JKN 14
Mg)

457 12,650 - JKN 14
2,5 cm x 4,5 m
OBAT GIGI - JKN 14

474 289,300 - JKN 14
dgn sinar) A2
475 289,300 - JKN 14
dgn sinar) A3
476 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -

488 Oil Emersi BS PROP

489 Gliseril Guaiakolat Tablet 100 mg B = 100 tab 2,000 26 52,000 BS PROP
490 Paracetamol tablet 500 mg Box= 100 tab 1,000 110 110,000 BS PROP
491 Vitamin B Compleks B= 1000 tab 6,000 30 180,000 BS PROP
492 Paracetamol tablet 500 mg Box= 100 tab 79 - DAK 15
493 Diazepam Tablet 2 mg B = 100 tab 27 - BS PROP
494 Haloperidol Tablet 5 mg K= 100 tab 88 - BS PROP
495 Haloperidol 5mg/ml inj. K= 12 amp. 12,155 - BS PROP
496 Salbutamol tab. 4 mg K= 100 tab 89 - DAK 15
497 Betametason krim 0,1 % K = 25 tube 1,520 - DAK 15
498 Dimenhidrinat tab. 50 mg Btl = 100 tab 104 - DAK 15
499 Diazepam 2 mg Btl = 100 tab 45 - DAK 15
500 Ketokonazol Krim 2 % Tube@10 gr 2,569 - DAK 15
501 Ampisilin Serbuk Injeksi iv 1000 mg/Vial K = 10 vial 5,100 - DAK 15
502 Ranitidin injeksi 25 mg/ml Box=10 amp 1,140 - DAK 15
2,141,950


SBBK
Penerima : Tanggal : 17 April 2015

Puskesmas Tunjung Nomor : 028/ /427.35.28/2015

1 Gliseril Guaiakolat Tablet 100 mg B = 1000 tab 2,000 26 52,000 BS Prop

2 Parasetamol Tablet 500 mg Ktk = 100 tab 1,000 110 110,000 BS Prop
3 Vitamin B Komplek B = 1000 tab 6,000 30 180,000 BS Prop
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009


SBBK
Penerima : Tanggal : 28 April 2015


OBAT TB PARU
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009

SBBK
Penerima : Tanggal : 11 Juni 2015



2 Ambroxol Tablet 30 mg Box= 100 tab 3,000 123 369,000 APBD II-14
3 Aminofilin Tablet 200 mg K= 100 tab 1,000 80 80,000 DAK 14 (E)
4 Aminofilina injeksi 24 mg/ml-10 ml K= 30 amp 30 3,822 114,660 DAK 14 (E)
7 Amlodipin 10 mg Ktk=30 tab 900 330 297,000 DAK 14 (E)
9 Amoksisilin Kapsul 500 mg K= 100 Kap 10,000 261 2,610,000 DAK 14 (E)
11 Amoksisilin Syrup Kering 125 mg / 5 ml B= 60 ml 120 2,445 293,400 DAK 14 (E)
16 Ampisilin Serbuk Injeksi iv 1000 mg/Vial K = 10 vial 100 5,100 510,000 APBD II-14 (E)
18 K= 100 tab 3,000 72 216,000 DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
20 Antibakteri DOEN Salep Kombinasi K = 25 tube 25 2,491 62,275 DAK 13(E) / Okt-17
21 Antidiare tab. (Attapulgite 600 mg) Box= 50 tab 1,000 190 190,000 DAK 14 (E)
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
33 Asam Askorbat (Vit C) tablet 250 mg K= 100 tab 1,000 159 159,000 DAK 14 (E)
42 Asetosal Tablet 100 mg K= 100 tab 2,000 116 232,000 APBD II-14 (E)
45 Asiklovir 5% Krim K=25 tube 5gr 50 2,152 107,600 DAK 13(E) / Sep-17
50 Betahistin Mesylat 6 mg Box= 30 tab 150 924 138,600 APBD II-14
52 Betametason Krim 0,1% K = 25 tube 96 1,520 145,920 DAK 13(E) / 1-Okt-16
59 Citicolin 250 mg/2 ml Box= 5 amp 30 14,300 429,000 APBD II-14
61 Dekstrometorfan Syr.Kombinasi Btl= 60 ml 72 8,046 579,312 APBD II-14
62 Dexametason injeksi 5 mg/ml - 1 ml K= 100 amp 100 1,580 158,000 DAK 14 (E)
66 Dexametason Tablet 0,5 mg B =100 tab 1,000 62 62,000 DAK 14 (E)
72 Difenhidramin HCl inj.10 mg/ml-1ml K= 30 amp 300 1,050 315,000 DAK 14 (E)
75 Digoksin Tablet 0,25 mg K = 100 tab 500 91 45,500 DAK 13(E) / Mei-17
78 Domperidon Suspensi 5 mg/5ml Btl=60 ml 30 3,333 99,990 DAK 14 (E)
79 Domperidon Tab 10 mg K= 50 tab 500 167 83,500 DAK 14 (E)
85 Erythromycin Syr. Kering 200 mg / 5 ml Btl = 60 ml 24 7,220 173,280 DAK 13(E) / Jun-18
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
88 Etanol 70 % Btl= 1 liter 12 21,500 258,000 APBD II-14 (E)
95 Fitomenadion (Vit.K1) Inj.10 mg/ml-1ml K= 30 Amp 150 978 146,700 BS Prop 14/Apr-15
97 Fitomenadion (Vit.K1) tab.salut gula 10 mg B= 100 tab 500 630 315,000 DAK 14 (E)
108 Garam Oralit untuk 200 ml air K = 100 kant 3,000 288 864,000 DAK 14 (E)
111 Gentamycin Krim 1% K=10 tube@5 gr 50 1,350 67,500 DAK 13(E) /Peb-17
114 Gentamycin Tetes Mata 0,3 % Btl=5ml 70 3,194 223,580 DAK 14 (E)
116 Gentian Violet Larutan 1% Btl @ 10 ml 50 900 45,000 DAK 13(E) / Nov-16
117 Glibenklamid Tablet 5 mg B= 100 tab 3,000 56 168,000 DAK 14 (E)
119 Gliseril Guaiakolat Tablet 100 mg B = 1000 tab 2,000 44 87,000 APBD II-14
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

132 Hidrokortison Krim 2,5% K = 24 tube@5gr 48 2,541 121,968 DAK 13(E) / Sep-16
137 Ibuprofen Tablet 400 mg K= 100 tab 10,000 150 1,500,000 DAK 14 (E)
142 Kaptopril Tablet 25 mg Ktk= 100 tab 2,000 84 168,000 DAK 14 (E)
150 Klindamycin Kapsul 150 mg Box= 50 kap 300 361 108,300 DAK 14 (E)
151 Kloramfenikol Salep Mata 1% Tube 5 g 72 1,562 112,464 DAK 13(E) / Mar-17
156 Klorfenaramin Maleat (CTM) Tab. 4 mg B = 100 tab 500 26 13,000 DAK 13(E) / okt-16
160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
162 Kotrimoksazol Susp. Komb Btl = 60 ml 100 2,574 257,400 DAK 13(E) / Okt-16
164 Tube = 15 g 15,054 -

166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)
168 Lidokain Inj. 2% + Epinefrin 1:80.000-2ml K = 30 Amp 150 1,136 170,400 DAK 12 / Des-15
174 Loratadin Tablet 10 mg K = 50 Tab 300 154 46,200 DAK 14 (E)
177 Magnesium Sulfat Inj.(IV) 40%-25ml K = 10 vial 10 1,529 15,290 APBD II 10 / Sep-15
179 Metformin 500 mg K = 100 tab 700 182 127,400 DAK 12 / Sep-17
180 Metformin 500 mg K = 100 tab 4,300 105 451,500 DAK 13(E) / Sep-16
183 Methoklopramid Tablet 10 mg K= 100 tab 500 110 55,000 APBD II-14
187 Metilergometrin Maleat inj.0,200 mg-1 ml K=30 amp 100 2,300 230,000 APBD II-14
189 Metronidazol tab 500 mg K = 100 Tab 2,000 164 328,000 BS Prop 13/Okt-15
190 Mikonazol Krim 2% K=24 tube@10gr 24 3,000 72,000 DAK 13(E) /Mar-17
191 Multivit.+ Lysin Curcumin Syr Btl = 60 ml 50 11,000 550,000 APBD II-13 / Okt-15



195 Natrium Diclofenak tab 50 mg K=50 tab 300 176 52,800 DAK 14 (E)
198 Nifedipin tablet 10 mg K= 100 tab 1,000 110 110,000 DAK 14 (E)
200 Nistatin Tablet Vagina 100.000 IU/g K = 100 tab 100 407 40,700 DAK 13(E) / Apr-17
205 Oksitetrasiklin HCl 1% Salep Mata tube=3,5 gr 50 1,600 80,000 DAK 13(E) / Jul-15
207 Oksitosin injeksi 10 IU/- 1 ml K= 100 amp 100 2,200 220,000 APBD II-14
208 Omeprazol Kapsul 20 mg Box = 30 300 211 63,300 DAK 14 (E)
210 Ondansetron Injeksi 4 mg/2ml Box=5 amp 200 2,400 480,000 DAK 14 (E)
212 Parasetamol sirup 120 mg/5 ml B = 60 ml 240 1,438 345,120 DAK 14 (E)
214 Parasetamol Tablet 500 mg Ktk = 100 tab 1,000 105 105,000 BS Prop P2M
217 Permetrin Krim 5 % (Scabimite Cr 10 gram) Tube 10 g 24 11,475 275,400 APBD II-14 (E)
223 Piridoksin HCl (Vit.B6)Tablet 10 mg B= 1000 tab 3,000 17 51,000 APBD II-14
226 Polikresulen Concentrat 10 ml Btl = 10 ml 5 28,600 143,000 DAK 13 / Jun-18
241 Ranitidin Tablet 150 mg B= 100 tab 300 120 36,000 DAK 14 (E)
250 Salep 2-4 K=24 pot@30 g 48 2,000 96,000 APBD II-14 (E)
251 Salisil bedak 2 % K= 50 gram 50 1,250 62,500 DAK 14 (E)
254 Sefadroksil 500 mg Ktk= 100 cap 1,000 509 509,000 DAK 14 (E)
256 Setirizin tablet 10 mg B = 100 tab 200 181 36,200 DAK 14 (E)
258 Simvastatin tablet 10 mg K= 100 Tab 100 169 16,900 DAK 14 (E)
259 Siprofloksasin tablet 500 mg K= 100 Tab 2,000 255 510,000 DAK 14 (E)
269 Tiamin HCl (Vit.B1) Tablet 50 mg B = 1000 tab 3,000 34 102,000 BS Prop 13

276 300 3,410 1,023,000 APBD II-14
IU Cap
279 Zinc Tablet 20 mg K=100 tab 1,000 474 474,000 DAK 14 (E)
Prednison tablet 5 mg Box= 100 tab 1,000 140 140,000 DAK 14 (E)
302 Cat gut Plain No. 3/0 + Jarum 1/2 GT 35 mm Box/24 72 5,583 401,976 APBD II-14 (E)
311 Handscoen Ginec (Obstetri) K=50 set 100 15,000 1,500,000 APBD II-14
313 I.V Cateter No. 18 - 24 K= 50 Biji 300 7,788 2,336,400 APBD II-14
315 Infusion set Anak set 100 4,500 450,000 APBD II-14
316 Infusion set Dewasa set 100 3,499 349,900 APBD II-14
318 Jarum Jahit (Bedah) No. 9 - 14 K = 12 Biji 12 2,083 24,996 DAK 11
322 Kasa pembalut 30 m x 80 cm Rol 10 108,950 1,089,500 DAK 13
324 Kasa Pembalut Hidrofil 4 Yard x 10 cm Rol 300 2,399 719,700 DAK 13
326 Kasa Steril 16 x 16 K = 16 lb 300 5,200 1,560,000 DAK 12
328 Lanset for Fine Touch Box = 100 pcs 100 24,200 24,200 APBD II-13
331 Masker B = 20 bj 300 1,122 336,735 Buffer Stok Prop 13
342 Skalpel (Mess) B = 100 100 275 27,500 DAK 12 / Jun-17
345 Urine Bag Standart Steril 2 lt. (T valne) Bag/10 20 3,000 60,000 APBD II-14 (E)
OBAT GIGI
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
386 Slide / Objeck Glass K = 72 pcs 5 20,900 104,500 APBD II / 10
OBAT KUSTA
OBAT KB
393 Antasida + Simeticon Tablet (Dexanta) Box= 100 tab 3,000 162 486,000 JKN 14
Botol @1000
Box = 10
396 Aqua Pro Injeksi Steril K= 10 Vial 120 5,000 600,000 JKN 14
397 Asam Folat 400 g tab. Box =100 tab 4,000 84 336,000 JKN 14 (E)
399 BOX=10 Sachet 15,593 - JKN 14
Alginat)

406 20 15,054 301,080 JKN 14
Sulphate 5 mg
407 Kalsium Laktat (Kalk) Tablet 500 mg B= 1000 tab 3,000 70 210,000 JKN 14 (E)
Dus = 5 amp

412 Klorpheniramin Maleat (CTM) 4 mg B= 1000 tab 10,000 26 260,000 JKN 14
413 Kotrimoksasol Forte Tablet 960 mg K= 100 tab 500 500 250,000 JKN 14
414 3,300 - JKN 14
415 Loperamid Tablet 2 mg K= 100 tab 200 89 17,800 JKN 14 (E)
Ktk = 10 amp
417 Metamizol sodium Injeksi 500mg/ml Box @ 5 Ampul 500 7,660 3,830,000 JKN 14
Botol = 100

420 Box=100 kaps 197 - JKN 14
mcg, Sorbitol 25 mg

421 HCl 100 mg, Pyridoxine 100,Cyanocobalamin Box= 10 ampul 100 5,010 501,000 JKN 14
5000 mcg

422 Box=200 kaps 2,000 297 594,000 JKN 14

424 4,653 - Askes 14 / Jan - 16

425 - Askes 14 / Feb - 17

427 Obat Kumur Btl = 200 ml 5 23,694 118,470 JKN 14
428 OBH Batuk Pilek Syrup Btl = 60 ml 48 8,250 396,000 JKN 14
Dus = 5 amp


435 (Parasetamol 500 mg,Dekstromethorphan 15 Box= 150 Caplet 1,500 390 585,000 JKN 14
Pseudoefedrin 30 mg
439 Plester 5 yards X 2 inch Rol 30 26,843 805,290 JKN 14
442 40 8,100 324,000 JKN 14
0,52mg Nebulizer
444 Salbutamol Tablet 2,5 mg Box = 20 Amp 40 6,600 264,000 JKN 15
445 2 473,000 946,000 JKN 14
5ml
446 Serum Anti Tetanus (ATS) Inj.1.500 IU/amp K= 10 amp 20 126,500 2,530,000 JKN 14

449 Thiamphenicol Kapsul 500 mg K = 100 kap 300 550 165,000 JKN 14
450 Thiamphenicol suspensi 125 mg/5 ml Btl= 60 ml 50 6,500 325,000 JKN 14
453 Vitamin B Compleks Plus Ekstrak Hati Box= 100 tab 2,000 220 440,000 JKN 14
454 3,410 - JKN 14
Mg)

457 12,650 - JKN 14
2,5 cm x 4,5 m
OBAT GIGI - JKN 14

466 Enching / Phosporic Acid BTL@9 ml 1 138,600 138,600 JKN 14
467 Etil Klorida Semprot Klg = 100 ml 3 95,000 285,000 JKN 14
472 Hydrogen Piroxida 3 % Btl=1 l 2 20,570 41,140 JKN 14
474 289,300 - JKN 14
dgn sinar) A2
475 289,300 - JKN 14
dgn sinar) A3
476 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


489 Gliseril Guaiakolat Tablet 100 mg B = 100 tab 26 - BS PROP
490 Paracetamol tablet 500 mg Box= 100 tab 110 - BS PROP
492 Paracetamol tablet 500 mg Box= 100 tab 20,000 79 1,580,000 DAK 15
496 Salbutamol tab. 4 mg K= 100 tab 300 89 26,700 DAK 15
498 Dimenhidrinat tab. 50 mg Btl = 100 tab 1,000 104 104,000 DAK 15
499 Diazepam 2 mg Btl = 100 tab 300 45 13,500 DAK 15

45,202,646
-


SBBK



1 2 473,000 946,000 JKN 14
5ml
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009

SBBK


8 K= 100 tab 3,000 72 216,000 DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
62 Prednison tablet 5 mg Box= 100 tab 1,000 140 140,000 DAK 14 (E)
71 300 3,410 1,023,000 APBD II-14
IU Cap

OBAT TB PARU
91 20 15,054 301,080 JKN 14
Sulphate 5 mg

5000 mcg

98 Box=200 kaps 2,000 297 594,000 JKN 14

103 40 8,100 324,000 JKN 14
0,52mg Nebulizer
104 Salbutamol Tablet 4 mg Box = 100 Tab 300 89 26,700 DAK 15
105 Salbutamol Tablet 2,5 mg Box = 20 Amp 40 6,600 264,000 JKN 14
OBAT GIGI JKN 14



42,564,566
259,080
Yang Menyerahkan,
Dra. TRI MUSYAROFAH, Apt DEBBY AISHATUL HIKMAH

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008
Mengetahui Yang Menyerahkan,

KEPALA DINAS KESEHATAN KEPALA INSTALASI PERBEKALAN
KABUPATEN LUMAJANG FARMASI KESEHATAN PENERIMA
Dr.TRIWORO SETYOWATI Dra. TRI MUSYAROFAH, Apt DEBBY AISHATUL HIKMAH

NIP. 19590824 198701 2 002 NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008


SBBK



Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK
Penerima : Tanggal : 09 Juli 2015



18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
(D5+1/4)
122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -

166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)


191 Multivit.+ Lysin Curcumin Syr Btl = 60 ml 11,000 - APBD II-13 / Okt-15



243 Retinol (Vit. A) Kapsul 100.000 IU:196 B = 50 tab 100 255 25,500 BS Prop 13/Jul - 14
246 Retinol (Vit. A) Kapsul 200.000 IU:1570 B = 50 tab 500 432 216,000 DAK 13(E) /
Sachet = 30
262 Tablet Tambah Darah Kombinasi tab 45,000 67 3,015,000 BS Prop 13

276 3,410 - APBD II-14
IU Cap
Prednison tablet 5 mg Box= 100 tab 140 - DAK 14 (E)
OBAT GIGI
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
OBAT KUSTA
OBAT KB
Botol @1000
Box = 10

399 BOX=10 Sachet 15,593 - JKN 14
Alginat)

406 15,054 - JKN 14
Sulphate 5 mg
Dus = 5 amp

414 3,300 - JKN 14
Ktk = 10 amp

Botol = 100

420 Box=100 kaps 197 - JKN 14
mcg, Sorbitol 25 mg

5000 mcg

422 Box=200 kaps 297 - JKN 14

424 4,653 - Askes 14 / Jan - 16

425 - Askes 14 / Feb - 17

Dus = 5 amp


Pseudoefedrin 30 mg
442 8,100 - JKN 14
0,52mg Nebulizer
444 Salbutamol Tablet 2,5 mg Box = 20 Amp 6,600 - JKN 15
445 473,000 - JKN 14
5ml

454 3,410 - JKN 14
Mg)

457 12,650 - JKN 14
2,5 cm x 4,5 m
OBAT GIGI - JKN 14

474 289,300 - JKN 14
dgn sinar) A2
475 289,300 - JKN 14
dgn sinar) A3
476 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


491 Vitamin B Compleks B= 1000 tab 30 - BS PROP

3,256,500


SBBK
Penerima : Tanggal : 09 Juli 2015


2 Retinol (Vit. A) Kapsul 200.000 IU:1570 B = 50 tab 500 432 216,000 DAK 13(E) /
Sachet = 30
3 Tablet Tambah Darah Kombinasi tab 45,000 67 3,015,000 BS Prop 13
Yang Menyerahkan,
Dra. TRI MUSYAROFAH, Apt NI. G. AYU T

NIP. 19630411 199203 2 005 NIP. 19640424 198703 2 008
/ Sep 15

SBBK
Penerima : Tanggal : 3 Agustus 2015



18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
53 Bisoprolol tablet 2,5mg K = 100 tab 746 - DAK 14 (E)
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -

166 Btl@500 ml 9,000 - APBD II-14 (E)
167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)

212 Metronidazol tab 500 mg K = 100 Tab 220 - DAK 12 / Okt-16
213 Metronidazol tab 500 mg K = 100 Tab 164 - DAK 13(E) / Okt-16



245 Retinol (Vit. A) Kapsul 200.000 IU:1569 B = 50 tab 1,000 420 420,000 BS Prop 13/Apr - 15
246 Retinol (Vit. A) Kapsul 200.000 IU:1570 B = 50 tab 432 - DAK 13(E)

276 3,410 - APBD II-14
IU Cap
Prednison Tablet 5 mg K = 100 Tab 64 - DAK 13(E) / Des-18
OBAT GIGI
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
OBAT KUSTA
OBAT KB
394 Antasida Doen Tablet Botol @1000 Tablet 44 - Askes 14 / Mei-17
395 Anti Tetanus (ATS) 1500 IU Box = 10 amp 126,500 - Askes 14 / mar-16
399 BOX=10 Sachet 15,593 - JKN 14
Alginat)
Gel : Placenta Extract 100 mg+ Neomycin
406 Tube= 20 g 15,054 - JKN 14
Sulphate 5 mg
409 Ketorolac Injeksi 10 mg/ml Dus = 5 amp @ 1 mL 1,616 - Askes 14 / Okt-16
Lacto Bacillus Powder ( L Lacidophilus , B.
414 Box=40 Sach 3,300 - JKN 14
416 Metamizol 500 mg Injeksi (Progesol Injeksi) Ktk = 10 amp @ 2 mL 7,500 - Askes 14 / Jun - 17
419 Metronidazole Infus 500 mg/100 mL Botol = 100 mL 9,950 - Askes 14 / Feb - 17
Multivitamin Tab. Tambah Darah ( Fe Glukonat
250 mg, Vit C 50 mg, As. Folat 1 mg, CuSO4 0,2
420 Box=100 kaps 197 - JKN 14
mg, MgSO4 0,2 mg , Vit B12 7,5 mcg, Sorbitol
25 mg
Multivitamin (Neurotropic) injeksi Thiamine HCl

421 100 mg, Pyridoxine 100,Cyanocobalamin 5000 Box= 10 ampul 5,010 - JKN 14
mcg
422 Box=200 kaps 297 - JKN 14
Neurotropik Injeksi (Vit. B1 100 mg, B6 100 mg,

424 Box = 10 amp @ 3 mL 4,653 - Askes 14 / Jan - 16
B12 5000 mcg) Biocombin 5000 Injeksi

425 Box = 10 amp @ 3 mL
- Askes 14 / Feb - 17
B12 5000 mcg) Mersibion 5000 Injeksi
426 Nifedipin tablet oros 30 mg K =30 tab 3,500 JKN 14 (E)

433 Ondansetron Injeksi 4mg/ 2 mL Dus = 5 amp @ 1 mL 2,400 - Askes 14 / Apr - 17
Parasetamol Kombinasi Tablet Batuk Berdahak

434 (Parasetamol 400 mg, Bromheksin 8 mg, Box= 300 Caplet 312 - JKN 14
Difenhidramin HCl 25 mg)

435 (Parasetamol 500 mg,Dekstromethorphan 15 mg, Box= 150 Caplet 390 - JKN 14
PPA 12.5 mg, CTM 2 mg)
Parasetamol Kombinasi Tablet Flu (Parasetamol

436 Box= 100 tab 363 - JKN 14
500 mg,Tripolidin 2,5 mg, Pseudoefedrin 30 mg

Salbutamol SO4 3,01mg +Ipratonium Brom
442 Ktk = 20 8,100 - JKN 14
0,52mg Nebulizer
444 Salbutamol Nebulez 2,5 mg Box = 20 Amp 6,600 - JKN 14
445 Serum Anti Bisa Ular (SABU) I Polivalen Inj 5ml K= 10 vial 473,000 - JKN 14

Vitamin E 400 mg Licap (d- Tocopherol 400
454 Box /30 Cap 3,410 - JKN 14
Mg)

Kasa Elastic ( Self Adhesive Elastic Bandage) 2,5
457 Box=60 Roll 12,650 - JKN 14
cm x 4,5 m
OBAT GIGI - JKN 14

Komposit Light Cure (Bahan tumpatan tetap dgn
474 Tube= 4 g 289,300 - JKN 14
sinar) A2
475 Tube= 4 g 289,300 - JKN 14
sinar) A3
Mata Boor Diamon High Speed/Sharp Cut,
476 set= 6 pcs 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


501 Ampisilin Serbuk Injeksi iv 1000 mg/Vial K = 10 vial 5,100 - DAK 15 / Mar - 18
Amitriptilin Tab. 25 mg K = 100 tab 112 - DAK 15 / Mei -19
Antibakteri DOEN Salep Kombinasi K = 25 tube 2,516 - DAK 15 / Mei -19
Aqua Pro Injeksi Steril K=10 vial 2,200 - DAK 15 / Jan - 18
Asiklovir tab 400 mg K=50 tab 336 - DAK 15 /
Bromheksin Tablet 8 mg Box= 100 99 - DAK 15 /
Dexametason Injeksi 5 mg/ml-1ml K = 100 amp 1,580 - DAK 15 / Sep - 18
Digoksin tab 0,25 mg 97 - DAK 15 / Apr - 17
Erythromycin Kapsul 500 mg (Eryra) K = 100 caps 930 - DAK 15/ Mei-17
Furosemide Injeksi 40 ml B=25AMP 1,829 - DAK 15 / Mar -19
Gemfibrozil kap 300 mg b= 120 kap 289 - DAK 15
Glibenklamid Tablet 5 mg B= 100 tab 56 - DAK 15 / Apr - 20
Griseofulvin tablet 125 mg B= 100 tab 209 - DAK 15 / Mei -19
Gliseril Guaiakolat Tablet 100 mg B = 1000 tab 40 - DAK 15
Haloperidol Tablet 5 mg K= 100 tab 96 - DAK 15 / Apr - 19
Ibuprofen susp. 200mg/5ml botol = 60 ml 4,499 - DAK 15 / Apr - 17
Isosorbid Dinitrat Sublingual Tablet 5 mg Ktk= 100 tab 88 - DAK 15 / Mei-19
Klorpromazin tab 100 mg Ktk= 100 tab 144 -
Obat Batuk berdahak Kombinasi B = 300 tab 312 - DAK 15 / Nop - 19
Ondansetron Injeksi 4 mg/2 ml Box=5 amp 2,400 - DAK 15 / Apr - 18
Parasetamol Kombinasi Tablet Flu (Parasetamol Box= 100 tab 798 - Mei - 19
Propiliteorasil ( PTU ) tablet 100 mg B = 100 tab 319 - DAK 15 / Mar - 20

Albendazole 400 mg B=200 tab 4,600 231 1,062,508 P2M

1,495,258

SBBK


1 Albendazole 400 mg B=200 tab 4,600 231 1,062,508 P2M
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008


SBBK


2 Retinol (Vit. A) Kapsul 200.000 IU:1569 B = 50 tab 1,000 420 420,000 BS Prop 13/Apr - 15
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK
Penerima : Tanggal : 10 September 2015



18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
95 Fitomenadion (Vit.K1) Inj.10 mg/ml-1ml K= 30 Amp 978 - BS Prop 14
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -
166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)





276 3,410 - APBD II-14
IU Cap
OBAT GIGI
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
379 OAT Anak (KOMBIPAK) paket 1 215,000 215,000 P2M / Des-14
385 Slide / Objeck Glass paket 20,900 - DAK 10
386 Slide / Objeck Glass paket 20,900 - APBD II / 10
OBAT KUSTA
OBAT KB
399 BOX=10 Sachet 15,593 - JKN 14
Alginat)
406 Tube= 20 g 15,054 - JKN 14
Sulphate 5 mg
414 Box=40 Sach 3,300 - JKN 14
420 Box=100 kaps 197 - JKN 14
25 mg

mcg
422 Box=200 kaps 297 - JKN 14


425 Box = 10 amp @ 3 mL - Askes 14 / Feb - 17
426 Nifedipin tablet oros 30 mg K =30 tab 3,500 - JKN 14 (E)




436 Box= 100 tab 363 - JKN 14

442 Ktk = 20 8,100 - JKN 14
0,52mg Nebulizer

454 Box /30 Cap 3,410 - JKN 14
Mg)

457 Box=60 Roll 12,650 - JKN 14
cm x 4,5 m
OBAT GIGI - JKN 14

474 Tube= 4 g 289,300 - JKN 14
sinar) A2
475 Tube= 4 g 289,300 - JKN 14
sinar) A3
476 set= 6 pcs 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


Digoksin tab 0,25 mg 97 - DAK 15 / Apr - 17
Klorpromazin tab 100 mg Ktk= 100 tab 144 -
Parasetamol Kombinasi Tablet Flu (Parasetamol Box= 100 tab 798 - Mei - 19

Albendazole 400 mg B=200 tab 231 - P2M
Human tetanus imunoglobulin (Tetagam) Injeksi Prefilled
170,000 - DAK 15 / Sep -17
i.m. 250 IU syringe
2,374,940


SBBK


Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008


SBBK


1 OAT Anak (KOMBIPAK) paket 1 215,000 215,000 P2M
Yang Menyerahkan,
NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK
Penerima : Tanggal : 17 Oktober 2015



3 Aminofilin Tablet 200 mg K= 100 tab 500 80 40,000 DAK 14 (E)

18 K= 100 tab 5,000 72 360,000 DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg

21 Antidiare tab. (Attapulgite 600 mg) Box= 50 tab 800 190 152,000 DAK 14 (E)
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
42 Asetosal Tablet 100 mg K= 100 tab 500 116 58,000 APBD II-14 (E)
47 Asiklovir Tablet 400 mg K= 100 tab 400 336 134,400 DAK 14 (E)
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
113 Gentamycin Krim 1 % tube@5g 40 1,829 73,160 APBD II-14
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

133 Hidrokortison Krim 2,5 % Tube 5 gr 120 2,798 335,760 APBD II-14
137 Ibuprofen Tablet 400 mg K= 100 tab 5,000 150 750,000 DAK 14 (E)
148 Ketokonazol Tablet 200 mg K = 50 tab 200 300 60,000 DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14

161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -
165 Lactobacillus Sporogenes Tablet (LACBON) K=100 tab 100 1,265 126,500 DAK 13 / Mar-16

166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
Glukosa Anhydrat 13,5 g, Laktat 1,120 g (KA-
EN 3B)

213 Metronidazol tab 500 mg K = 100 Tab 2,000 164 328,000 DAK 13(E) / Okt-16
191 Multivit.+ Lysin Curcumin Syr (Lytacur) Btl = 60 ml 100 11,000 1,100,000 APBD II-13 / Okt-15
Multivitamin Syrup (Curcuminoid 2mg, P, Vit B1

192 3 mg, B2 2 mg, B6 5 mg, B12 5 mcg, -Caroten 10 Btl= 60 ml 9,350 - APBD II-14
% 4 mg, Dexpantenol 3 mg + Lysine HCl 200 mg


210 Ondansetron Injeksi 4 mg/2ml Box=5 amp 500 2,400 1,200,000 DAK 14 (E)
227 Povidon Iodida 10% Btl = 30 ml 50 2,400 120,000 DAK 12 / Agt-15
230 Povidon Iodida 10% Btl = 300 ml 10 14,000 140,000 DAK 13(E) / Agt-16
241 Ranitidin Tablet 150 mg B= 100 tab 2,000 120 240,000 DAK 14 (E)
254 Sefadroksil 500 mg Ktk= 100 cap 2,000 509 1,018,000 DAK 14 (E)
265 Tetrasiklin HCl Kapsul 500 mg K = 100 kap 500 206 103,000 DAK 13(E) / Sep-16

276 3,410 - APBD II-14
IU Cap
279 Zinc Tablet 20 mg K=100 tab 5,000 474 2,370,000 DAK 14 (E)
282 Alat Suntik ADS Soloshot 0,5 ml K = 100 set 700 1,600 1,120,000 BS PROP IMUN
292 Alat Suntik sekali Pakai 5 ml K= 100 set 1,000 1,038 1,038,000 APBD II-14
293 Alat Suntik sekali Pakai 10 ml K= 100 set 300 1,199 359,700 APBD II-14
300 Cat Gut Chromic 24x75 cm No.2/0 - 3/0 K = 24x75 cm 48 24,499 1,175,952 DAK 13

309 Handscoen Non Steril K=50 psc 2,000 849 1,698,000 APBD II-14
317 Infusion Set Y type Set 300 3,499 1,049,700 DAK 13
325 Kasa Pembalut Hidrofil 4 m x 10cm Rol 100 1,500 150,000 APBD II-14
330 Lisol (Desinfectan C 100% Citroen) Btl = 900 ml 10 18,500 185,000 DAK 13
334 Masker N95 Disposible B = 20 bj 60 17,500 1,050,000 DAK 13
OBAT GIGI
Bahan Tumpatan Sementara (grey) /Cavit G
346 Tube = 25 gr 75,400 - DBHCHT 13 / Des-16
(A2 ,A3)

349 Pcs 18,150 - DBHCHT 13

REAGEN
OBAT TB PARU
OBAT KUSTA
OBAT KB
399 BOX=10 Sachet 15,593 - JKN 14
Alginat)
406 Tube= 20 g 20 15,054 301,080 JKN 14
Sulphate 5 mg
413 Kotrimoksasol Forte Tablet 960 mg K= 100 tab 1,000 500 500,000 JKN 14
414 Box=40 Sach 3,300 - JKN 14
420 Box=100 kaps 197 - JKN 14
25 mg

421 100 mg, Pyridoxine 100,Cyanocobalamin 5000 Box= 10 ampul 500 5,010 2,505,000 JKN 14
mcg
422 Box=200 kaps 3,000 297 891,000 JKN 14
423 Mikonazol Krim Tube=10 gram 96 3,000 288,000 JKN 14





436 Box= 100 tab 363 - JKN 14
437 Piracetam 800 mg Box= 100 tab 300 803 240,900 JKN 14
441 Propiliteorasil ( PTU ) tablet 100 mg B = 100 tab 300 319 95,700 JKN 14 (E)
442 Ktk = 20 40 8,100 324,000 JKN 14
0,52mg Nebulizer
444 Salbutamol Nebulez 2,5 mg Box = 20 Amp 40 6,600 264,000 JKN 14

449 Thiamphenicol Kapsul 500 mg K = 100 kap 3,000 550 1,650,000 JKN 14
454 Box /30 Cap 3,410 - JKN 14
Mg)

456 Hand Scrub Btl= 500 ml 1 104,500 104,500 JKN 14
457 Box=60 Roll 12,650 - JKN 14
cm x 4,5 m
458 Masker (ear Loop, Tie On) Box= 50 bj 300 770 231,000 JKN 14
OBAT GIGI - JKN 14

462 Bahan Tumpatan Sementara (Pink) Tub= 28 gr 5 165,000 825,000 JKN 14

474 Tube= 4 g 289,300 - JKN 14
sinar) A2
475 Tube= 4 g 289,300 - JKN 14
sinar) A3
476 set= 6 pcs 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


490 Parasetamol tablet 500 mg Box= 100 tab 110 - BS PROP
492 Parasetamol tablet 500 mg Box= 100 tab 10,000 79 790,000 DAK 15
496 Salbutamol tab. 4 mg K= 100 tab 2,000 89 178,000 DAK 15
502 Ranitidin injeksi 25 mg/ml Box=10 amp 500 1,140 570,000 DAK 15
Aqua Pro Injeksi Steril K=10 vial 120 2,200 264,000 DAK 15 / Jan - 18
Bromheksin Tablet 8 mg Box= 100 3,000 97 291,000 DAK 15
Digoksin tab 0,25 mg B= 100 tab 97 - DAK 15 / Apr - 17
Gliseril Guaiakolat Tablet 100 mg B = 1000 tab 10,000 40 400,000 DAK 15
Klorpromazin tab 100 mg Ktk= 100 tab 144 - DAK 15
Parasetamol Kombinasi Tablet Flu (Parasetamol Box= 100 tab 3,000 798 2,394,000 DAK 15 / Mei - 19

170,000 - DAK 15 / Sep -17
i.m. 250 IU syringe
* Cefotaksim Injeksi 0,5g B=2 Vial @0,5 g 2,000 - DAK 15/ Juni-17
Oksitosin Inj.10 IU/ml K = 100 Amp 2,200 - DAK 15
Klorampenikol injeksi 1 gr/ml Box= 10 Vial 7,260 - DAK 15
Bisakodil Suppositoria 10 mg Supp 60 6,045 362,700 DAK 15
Ranitidin Tablet 150 mg B= 100 tab 120 - DAK 15
Ketokonazol Tablet 200 mg K = 50 tab 300 - DAK 15
Methylprednisolon Tablet 8 mg B= 100 tab 300 - DAK 15
Kalsium Laktat (Kalk) Tablet 500 mg B= 100 tab 70 - DAK 15
Parasetamol sirup 120 mg/5 ml B = 60 ml 1,438 - DAK 15
88 Etanol 70 % Btl= 1 liter 21,500 - DAK 15
301 Cat gut Chromic No. 3/0 + Jarum 1/2 GT 35 mm 5,583 - DAK 15
302 Cat gut Plain No. 3/0 + Jarum 1/2 GT 35 mm 5,583 - DAK 15
320 Kapas Pembalut / Absorben 250 gr 12,500 - DAK 15

345 Urine Bag Standart Steril 2 lt. (T valve) 3,000 - DAK 15
Antiseptik dan desinfektan - Alkohol swab 10,000 - DAK 15
Antiseptik dan desinfektan - Aseptan gel 500
22,000 - DAK 15
cc+ Dispenser
Umbilical Cord Klem Steril Nylon 50,000 - DAK 15
258 Simvastatin tablet 10 mg K= 100 Tab 2,000 169 338,000 DAK 15
254 Sefadroksil 500 mg Ktk= 100 cap 509 - DAK 15
39 Asam Tranexamat Inj.50 mg / ml K = 10 Amp 2,950 - DAK 15
1 Alupurinol Tablet 100 mg K= 100 tab 86 - DAK 15
7 Amlodipin 10 mg Ktk=30 tab 330 - DAK 15
42 Asetosal Tablet 100 mg K= 100 tab 116 - DAK 15
83 Epinefrin HCL (Adrenalin) Inj.0,1%-ml K = 30 Amp 8,100 - DAK 15
96 Fitomenadion (Vit.K1) Inj.2 mg/ml K= 30 Amp 3,417 - DAK 15
195 Natrium Diclofenak tab 50 mg K=50 tab 176 - DAK 15
226 Polikresulen Concentrat 10 ml Btl = 10 ml 17,393 - DAK 15
4 Aminofilina injeksi 24 mg/ml K= 30 amp 3,822 - DAK 15
Kaptopril Tablet 25 mg Ktk= 100 tab 84 - DAK 15
415 Loperamid Tablet 2 mg K= 100 tab 89 - DAK 15
163 Kotrimoksazol Susp. Komb B= 60 ml 2,167 - DAK 15
412 Klorpheniramin Maleat (CTM) 4 mg K= 100 tab 51 - DAK 15
21 Antidiare tab. (Attapulgite 600 mg) Box= 50 tab 190 - DAK 15
3 Aminofilin Tablet 200 mg K= 100 tab 80 - DAK 15

18 K= 100 tab 72 - DAK 15
Al(OH)3 200 mg , Mg(OH)2 200 mg
126 Glukosa larutan infus 5 % steril B = 500 ml 5,200 - DAK 15

143 Karbamazepin Tablet 200 mg K= 100 tab 245 - DAK 15
68 Diazepam Inj. 5 mg /ml-2 ml K= 30 Amp 4,180 - DAK 15
152 Kloramfenikol Salep Mata 1 % Tube 5 gr 1,600 - DAK 15
133 Hidrokortison Krim 2,5 % Tube 5 gr 2,798 - DAK 15
90 Fenitoin Natrium Kapsul 100 mg Btl= 100 kaps 133 - DAK 15
85 Erythromycin Syr. Kering 200 mg / 5 ml Btl = 60 ml 7,700 - DAK 15
137 Ibuprofen Tablet 400 mg K= 100 tab 150 - DAK 15
432 Omeprazol Kapsul 20 mg Box = 30 kap 211 - DAK 15
88 Etanol 70 % Btl= 100 ML 2,500 - DAK 15
79 Domperidon Tab 10 mg K= 50 tab 167 - DAK 15
10 Amoksisilin Syrup Kering 125 mg / 5 ml Btl = 60 ml 2,445 - DAK 15
Kodein tab 10 mg K = 100 tab 500 - DAK 15
130 Hidroklorotiazid (HCT) Tablet 25 mg K= 100 tab 149 - DAK 15
274 Vitamin B Compleks K= 100 tab 107 - DAK 15
223 Piridoksin HCl (Vit.B6)Tablet 10 mg K= 100 tab 110 - DAK 15
423 Mikonazol Krim Tube=10 gram 3,000 - DAK 15
183 Methoklopramid Tablet 10 mg K= 100 tab 108 - DAK 15
Isoniazid tab 300 mg Btl= 100 kaps 158 - APBD II 15
208 Omeprazol Kapsul 20 mg Box = 30 kap 211 - APBD II 15
78 Domperidon Suspensi 5 mg/5ml Btl=60 ml 3,333 - APBD II 15
Trifluoperazin tab 5 mg 405 - APBD II 15
444 Salbutamol Nebulez 2,5 mg Box = 20 Amp 6,600 - APBD II 15
379 FDC ANAK paket 214,900 - APBD II 15
302 Cat gut Plain No. 3/0 23,991 - APBD II 15
312 I.V Catheter No. 18 s/d 24 K = 50 set 7,993 - APBD II 15
295 Blood Glucose Test (Accu check) Box = 100 tip 4,200 - APBD II 15
Alkohol Swab (E-Care) APBD II 15
Film IV Dressing APBD II 15
305 Handschoen Steril (E-Care no 7; 7,5) B = 50 set 500 4,500 2,250,000 APBD II 15
399 BOX=10 Sachet 10,400 - APBD II 15
Alginat)
328 Lanset for Fine Touch (Accu Check) Box = 200 pcs 635 - APBD II 15
Pembalut Elastis Polifix 5 cm X 1 m Box 7,370 APBD II 15
Pembalut Elastis Policrepe 10 cm X 4,55 m 32,892 APBD II 15
198 Nifedipin tablet 10 mg K= 100 tab 1,000 110 110,000 APBD II 15
426 Nifedipin tablet oros 30 mg K =30 tab 3,500 - APBD II 15
260 Spironolakton tablet 25 mg Ktk= 50 tab 315 - APBD II 15
306 Handschoen Steril K=100 pasang 627 - APBD II 15
307 Handschoen Non Steril K = 50 Set 4,600 - APBD II 15
88 Etanol 70 % Btl= 1 liter 21,500 - APBD II 15
308 Handschoen Non Steril K = 100 pieces 325 - APBD II 15
320 Kapas Pembalut / Absorben 250 gr Bungkus 12,500 - APBD II 15
326 Kasa Steril 16 x 16 K = 16 lb 5,800 - APBD II 15
Kasa Pembalut hydrophil 4 x 15 cm 2,100 - APBD II 15
227 Povidon Iodida 10% Btl = 30 ml 2,900 - APBD II 15
339 Silk No. 3/0 + Jarum 1/2 GT 35 mm K=12x500cm 3,056 - APBD II 15
332 Masker Box= 50 biji - APBD II 15
316 Infusion set Dewasa set 4,975 - APBD II 15
284 Alat Suntik Sekali Pakai 1 ml K = 100 set 990 - APBD II 15
290 Alat Suntik sekali Pakai 5 ml K = 100 set 979 - APBD II 15
176 Magnesium Sulfat Inj.(IV) 20%-25ml Ampul = 25ml 2,800 - APBD II 15
314 Infusion Set Anak Set 7,920 - APBD II 15
31 Aqua Pro Injeksi Steril Ampul = 25ml 2,200 - APBD II 15

166 Btl@500 ml 9,000 - APBD II 15
42 Asetosal Tablet 100 mg K= 100 tab 148 - APBD II 15

265 Tetrasiklin HCl Kapsul 500 mg K = 100 kap 300 - APBD II 15
Prednison Tablet 5 mg K = 100 Tab 114 - APBD II 15
Lisinopril 10 mg Box = 30 tab 600 - APBD II 15
179 Metformin 500 mg K = 100 tab 113 - APBD II 15
Alat Suntik ADS Soloshot 0,5 ml , 23 G Box =100 set 2,365 - APBD II 15
Ambroxol Tablet 30 mg Box= 100 tab 125 - APBD II 15
Antasida + Simeticon 50 mg tablet Box= 100 tab 180 - APBD II 15
Antasida + Simeticon suspensi Btl= 60 ml 4,650 - APBD II 15
Antihemoroid Tablet ( Hemorograd Kap) Box = 30 kap 1,552 - APBD II 15
Asam Tranexamat Tablet 500 mg Box= 100 tab 1,540 - APBD II 15
Asiklovir 5 % Krim K=TUB 10gr 3,139 - APBD II 15
Betahistin Mesylat 6 mg Box= 30 tab 924 - APBD II 15
Bromheksin Tablet 8 mg Box= 100 101 - APBD II 15
Citicolin 125 mg/ml Box= 5 amp@2ml 16,500 - APBD II 15
Gentamycin Krim 1 % SK K=10 tub@5g 1,829 - APBD II 15
Gliseril Guaiakolat Tablet 100 mg B = 1000 tab 44 - APBD II 15
Glukosa larutan infus 40 % steril K = 10 Amp. 2,300 - APBD II 15
Hidroklortiazid Tab. 25 mg Box= 100 149 - APBD II 15
Kalium Diklofenak Tablet 50 mg Box= 50 tab 455 - APBD II 15
Kloramfenikol Tetes mata Fls=10 ml 6,600 - APBD II 15
Kloramfenikol Tetes Telinga 3 % K = 24 btl 5,000 - APBD II 15
Krim Jelly Untuk Luka Bakar Tub= 15 g 15,000 - APBD II 15
Kotimoksasol Forte Tablet 960 mg K= 100 tab 495 - APBD II 15
Klindamycin Kapsul 300 mg Box= 50 kap 954 - APBD II 15
Lidokain Comp. Injeksi (Pehacain) K= 20 amp 3,113 - APBD II 15
Meloxicam Tablet 15 mg Ktk= 50 tab 528 - APBD II 15
Multivitamin+B1 100, B6 200, B12 200 mcg Box=100 kaps 330 - APBD II 15
( Tablet)
Multivitamin+ Lysin,Curcuma Syrup Btl= 60 ml 11,000 - APBD II 15
Multivitamin B1 100, B6 100, B12 5000 mcg Box= 10 amp @ 3 ml 5,011 - APBD II 15
injeksi
Multivitamin B1 100, B6 100, B12 1000mcg ,
Box= 5 amp 4,341 - APBD II 15
Lidocain HCl 15mcg injeksi
Multivitamin, mineral, Royal Jelly & Gingseng 1,500 - APBD II 15
Metamizol sodium Injeksi 500mg/ml Box= 5 Amp 7,660 - APBD II 15

OBH Batuk Pilek Syrup B = 60 ml 9,900 - APBD II 15
Piridoksin HCl (Vit.B6)Tablet 10 mg B= 1000 tab 30 - APBD II 15
Piracetam 800 mg Box= 60 tab 803 - APBD II 15
Piracetam Inj. 1 gr / 5 ml Box=10 Amp 5,500 - APBD II 15
Rapit Test HIV Oncopribe B = 100 tes 50,000 - APBD II 15
Rapit Test HIV SD B = 100 tes 45,100 - APBD II 15
Ranitidin Tablet inj 1,799 - APBD II 15
Simvastatin tablet 10 mg K= 30 Tab 222 - APBD II 15
Siprofloksasin tablet 500 mg K= 100 Tab 385 - APBD II 15
Sukralfat Susp 500 mg/5ml Btl=100 ml 13,425 - APBD II 15
Tiamin Hcl (Vit B1) tablet 50 mg B= 1000 tab 58 - APBD II 15
Thiamphenicol suspensi 125 mg/5 ml Btl= 60 ml 6,500 - APBD II 15
Thiamphenicol Kapsul 500 mg K = 100 kap 590 - APBD II 15
Triheksifenidil Hidroklorida tablet 2 mg K=250 tab 352 - APBD II 15
Dextrometorfan Kombinasi Syr
(DextrometorfanHbr 7,5 mg, Pseudoefedrine-HCl Btl= 60 ml 10,142 - APBD II 15
15 mg)
Dextromethorfan Kombinasi Tablet Antitusif

(Parasetamol 500 mg,Dekstromethorphan 15 B = 150 tab 450 - APBD II 15
Vitamin B Compleks Plus Ekstrak Hati Box= 100 tab 220 - APBD II 15
Obat kumur Aseptik 24,860 - APBD II 15
48 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml K = 100 amp 10 APBD II 15

48,154,631
2,159,940

SBBK


1 Aminofilin Tablet 200 mg K= 100 tab 500 80 40,000 DAK 14 (E)

4 K= 100 tab 5,000 72 360,000 DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
6 Antidiare tab. (Attapulgite 600 mg) Box= 50 tab 800 190 152,000 DAK 14 (E)
7 Aqua Pro Injeksi Steril K=10 vial 120 2,200 264,000 DAK 15 / Jan - 18
9 Asetosal Tablet 100 mg K= 100 tab 500 116 58,000 APBD II-14 (E)
11 Asiklovir Tablet 400 mg K= 100 tab 400 336 134,400 DAK 14 (E)
12 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml K = 100 amp 10 APBD II 15
13 Bisakodil Suppositoria 10 mg Supp 60 6,045 362,700 DAK 15
14 Bromheksin Tablet 8 mg Box= 100 3,000 97 291,000 DAK 15
19 Tube= 20 g 20 15,054 301,080 JKN 14
Sulphate 5 mg
20 Gentamycin Krim 1 % tube@5g 40 1,829 73,160 APBD II-14
24 Gliseril Guaiakolat Tablet 100 mg B = 1000 tab 10,000 40 400,000 DAK 15
25 Hidrokortison Krim 2,5 % Tube 5 gr 120 2,798 335,760 APBD II-14
26 Ibuprofen Tablet 400 mg K= 100 tab 5,000 150 750,000 DAK 14 (E)
29 Ketokonazol Tablet 200 mg K = 50 tab 200 300 60,000 DAK 14 (E)
31 Kotrimoksasol Forte Tablet 960 mg K= 100 tab 1,000 500 500,000 JKN 14
33 Lactobacillus Sporogenes Tablet (LACBON) K=100 tab 100 1,265 126,500 DAK 13 / Mar-16

38 Metronidazol tab 500 mg K = 100 Tab 2,000 164 328,000 DAK 13(E) / Okt-16
39 Mikonazol Krim Tube=10 gram 96 3,000 288,000 JKN 14
40 Multivit.+ Lysin Curcumin Syr (Lytacur) Btl = 60 ml 100 11,000 1,100,000 APBD II-13 / Okt-15
41 100 mg, Pyridoxine 100,Cyanocobalamin 5000 Box= 10 ampul 500 5,010 2,505,000 JKN 14
mcg
42 Box=200 kaps 3,000 297 891,000 JKN 14
44 Nifedipin tablet 10 mg K= 100 tab 1,000 110 110,000 APBD II 15
48 Ondansetron Injeksi 4 mg/2ml Box=5 amp 500 2,400 1,200,000 DAK 14 (E)

49 Box= 100 tab 3,000 798 2,394,000 DAK 15 / Mei - 19

51 Parasetamol tablet 500 mg Box= 100 tab 10,000 79 790,000 DAK 15
53 Piracetam 800 mg Box= 100 tab 300 803 240,900 JKN 14
55 Povidon Iodida 10% Btl = 30 ml 50 2,400 120,000 DAK 12 / Agt-15
56 Povidon Iodida 10% Btl = 300 ml 10 14,000 140,000 DAK 13(E) / Agt-16
57 Propiliteorasil ( PTU ) tablet 100 mg B = 100 tab 300 319 95,700 JKN 14 (E)
58 Ranitidin injeksi 25 mg/ml Box=10 amp 500 1,140 570,000 DAK 15
59 Ranitidin Tablet 150 mg B= 100 tab 2,000 120 240,000 DAK 14 (E)
60 Salbutamol Nebulez 2,5 mg Box = 20 Amp 40 6,600 264,000 JKN 14
61 Ktk = 20 40 8,100 324,000 JKN 14
0,52mg Nebulizer
62 Salbutamol tab. 4 mg K= 100 tab 2,000 89 178,000 DAK 15
65 Sefadroksil 500 mg Ktk= 100 cap 2,000 509 1,018,000 DAK 14 (E)
66 Simvastatin tablet 10 mg K= 100 Tab 2,000 169 338,000 DAK 15
68 Tetrasiklin HCl Kapsul 500 mg K = 100 kap 500 206 103,000 DAK 13(E) / Sep-16
69 Thiamphenicol Kapsul 500 mg K = 100 kap 3,000 550 1,650,000 JKN 14
71 Zinc Tablet 20 mg K=100 tab 5,000 474 2,370,000 DAK 14 (E)
72 Alat Suntik sekali Pakai 5 ml K= 100 set 1,000 1,038 1,038,000 APBD II-14
73 Alat Suntik sekali Pakai 10 ml K= 100 set 300 1,199 359,700 APBD II-14
74 Cat Gut Chromic 24x75 cm No.2/0 - 3/0 K = 24x75 cm 48 24,499 1,175,952 DAK 13
75 Hand Scrub Btl= 500 ml 1 104,500 104,500 JKN 14
76 Handscoen Non Steril K=50 psc 2,000 849 1,698,000 APBD II-14
77 Handschoen Steril (E-Care no 7; 7,5) B = 50 set 500 4,500 2,250,000 APBD II 15
81 Infusion Set Y type Set 300 3,499 1,049,700 DAK 13
82 Kasa Pembalut Hidrofil 4 m x 10cm Rol 100 1,500 150,000 APBD II-14
83 Lisol (Desinfectan C 100% Citroen) Btl = 900 ml 10 18,500 185,000 DAK 13
84 Masker (ear Loop, Tie On) Box= 50 bj 300 770 231,000 JKN 14
85 Masker N95 Disposible B = 20 bj 60 17,500 1,050,000 DAK 13
OBAT TB PARU
OBAT GIGI
88 Bahan Tumpatan Sementara (Pink) Tub= 28 gr 5 165,000 825,000 JKN 14
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009


SBBK


1 Alat Suntik ADS Soloshot 0,5 ml K = 100 set 700 1,600 1,120,000 BS PROP IMUN
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009
JELCO 16 7992,8
420,000 JELCO 18 7498,7
19,680 JELCO 20 7498,7
220,000 7018
4,500 vasofix 8750
10,400
127,050
62700 , 47600
32,500
110,000
16,500

SBBK
Penerima : Tanggal : 6 Nopember 2015



18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)

123 Btl=500ml 7,700 - DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -
166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)


192 mg, B2 2 mg, B6 5 mg, B12 5 mcg, -Caroten 10 Btl= 60 ml 9,350 - APBD II-14



Vitamin E 400 IU Vegicap (d- Tocopherol Acetat Box /30
276 3,410 - APBD II-14
400 IU Cap

OBAT GIGI
(A2 ,A3)
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
OBAT KUSTA
OBAT KB
399 BOX=10 Sachet 15,593 - JKN 14
Alginat)
406 Tube= 20 g 15,054 - JKN 14
Sulphate 5 mg
414 Box=40 Sach 3,300 - JKN 14

420 Box=100 kaps 197 - JKN 14
25 mg

mcg
422 Box=200 kaps 297 - JKN 14





436 Box= 100 tab 363 - JKN 14

442 Ktk = 20 8,100 - JKN 14
0,52mg Nebulizer

454 Box /30 Cap 3,410 - JKN 14
Mg)

457 Box=60 Roll 12,650 - JKN 14
cm x 4,5 m
OBAT GIGI - JKN 14

474 Tube= 4 g 289,300 - JKN 14
sinar) A2
475 Tube= 4 g 289,300 - JKN 14
sinar) A3
476 set= 6 pcs 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


492 Parasetamol tablet 500 mg Box= 100 tab 79 - DAK 15
Parasetamol Kombinasi Tablet Flu (Parasetamol Box= 100 tab 798 - DAK 15 / Mei - 19

170,000 - DAK 15 / Sep -17
i.m. 250 IU syringe
Bisakodil Suppositoria 10 mg Supp 6,045 - DAK 15

Antiseptik dan desinfektan - Aseptan gel 500 cc+
22,000 - DAK 15
Dispenser
258 Simvastatin tablet 10 mg K= 100 Tab 169 - DAK 15
18 K= 100 tab 72 - DAK 15
Al(OH)3 200 mg , Mg(OH)2 200 mg
88 Etanol 70 % Btl= 100 ML 2,500 - DAK 15
Alkohol Swab (E-Care) APBD II 15
Film IV Dressing APBD II 15
305 Handschoen Steril (E-Care no 7; 7,5) B = 50 set 4,500 - APBD II 15
Alginat)
Pembalut Elastis Polifix 5 cm X 1 m Box 7,370 APBD II 15
Pembalut Elastis Policrepe 10 cm X 4,55 m 32,892 APBD II 15
198 Nifedipin tablet 10 mg K= 100 tab 110 - APBD II 15

166 Btl@500 ml 9,000 - APBD II 15

Alat Suntik ADS Soloshot 0,5 ml , 23 G Box =100 set 2,365 - APBD II 15
( Tablet)
injeksi

15 mg)

(Parasetamol 500 mg,Dekstromethorphan 15 mg, B = 150 tab 450 - APBD II 15
Isoniazid tab 100 mg Box= 100 tab 65 - BS PROP
2,014,950


SBBK
Penerima : Tanggal : 6 Nopember 2015




Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008
JELCO 16 7992,8
420,000 JELCO 18 7498,7
19,680 JELCO 20 7498,7
220,000 7018
4,500 vasofix 8750
10,400
127,050
62700 , 47600
32,500
110,000
16,500

SBBK
Penerima : Tanggal : 7 Desember 2015



18 K= 100 tab 72 - DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
28 Box = 5 amp 8,800 - DAK 12 / Ags-15
29 Box = 5 amp 8,800 - DAK 13 / Mei-16
Box10
30 Ampl@1m 4,500 - APBD II-14
l
37 Asam Mefenamat 500 mg K = 100 Kap 112 - BS Prop / Nov 19
87 Etanol 70 % Btl = 1000 ml 25,300 - DAK 13
(D5+1/4)

122 Btl=500ml 7,700 - DAK 14 (E)
123 Btl=500ml 7,700 - DAK 14 (E)

160 B = 100 tab 50 - P2M / Nov-14
161 B = 100 tab 120 - BS Prop 13 / Mei - 15
164 Tube = 15 g 15,054 -
166 Btl@500 ml 9,000 - APBD II-14 (E)

167 Btl= 500 ml 10,000 - APBD II-14 (E)
3B)


192 mg, B2 2 mg, B6 5 mg, B12 5 mcg, -Caroten 10 Btl= 60 ml 9,350 - APBD II-14


199 Nifedipin tablet 10 mg K = 100 Tab 110 - BS PROP /Sep - 18

Vitamin E 400 IU Vegicap (d- Tocopherol Acetat Box /30
276 3,410 - APBD II-14
400 IU Cap

OBAT GIGI
(A2 ,A3)
349 Pcs 18,150 - DBHCHT 13
REAGEN
OBAT TB PARU
OBAT KUSTA
389 MDT MB DEWASA KIT 12 - P2M
OBAT KB
399 BOX=10 Sachet 15,593 - JKN 14
Alginat)
406 Tube= 20 g 15,054 - JKN 14
Sulphate 5 mg
414 Box=40 Sach 3,300 - JKN 14

420 Box=100 kaps 197 - JKN 14
25 mg

mcg
422 Box=200 kaps 297 - JKN 14


425 Box = 10 amp @ 3 mL
- Askes 14 / Feb - 17




436 Box= 100 tab 363 - JKN 14

442 Ktk = 20 8,100 - JKN 14
0,52mg Nebulizer

454 Box /30 Cap 3,410 - JKN 14
Mg)

457 Box=60 Roll 12,650 - JKN 14
cm x 4,5 m
OBAT GIGI - JKN 14

474 Tube= 4 g 289,300 - JKN 14
sinar) A2
475 Tube= 4 g 289,300 - JKN 14
sinar) A3
476 set= 6 pcs 22,733 - JKN 14
Denteply
649,000 - JKN 14
Obat P3K Mobile -


492 Parasetamol tablet 500 mg Box= 100 tab 79 - DAK 15
Parasetamol Kombinasi Tablet Flu (Parasetamol Box= 100 tab 798 - DAK 15 / Mei - 19

170,000 - DAK 15 / Sep -17
i.m. 250 IU syringe
Bisakodil Suppositoria 10 mg Supp 6,045 - DAK 15

Antiseptik dan desinfektan - Aseptan gel 500 cc+
22,000 - DAK 15
Dispenser
258 Simvastatin tablet 10 mg K= 100 Tab 169 - DAK 15
18 K= 100 tab 72 - DAK 15
Al(OH)3 200 mg , Mg(OH)2 200 mg
88 Etanol 70 % Btl= 100 ML 2,500 - DAK 15
Alkohol Swab (E-Care) - APBD II 15
Film IV Dressing - APBD II 15
305 Handschoen Steril (E-Care no 7; 7,5) B = 50 set 4,500 - APBD II 15
Alginat)
Plester hypoallergenik Polifix 5 cm X 1 m Box 7,370 - APBD II 15
Pembalut Elastis Policrepe 10 cm X 4,55 m 32,892 - APBD II 15
198 Nifedipin tablet 10 mg K= 100 tab 110 - APBD II 15

166 Btl@500 ml 9,000 - APBD II 15

Alat Suntik ADS Soloshot 0,5 ml , 23 G Box =100 set 1,000 2,365 2,365,000 APBD II 15
( Tablet)
injeksi

15 mg)

(Parasetamol 500 mg,Dekstromethorphan 15 mg, B = 150 tab 450 - APBD II 15
Isoniazid tab 100 mg Box= 100 tab 65 - BS PROP
174 Loratadin Tablet 10 mg K = 50 Tab 154 - BS PROP / Mei -18
241 Ranitidin Tablet 150 mg B= 100 tab 120 - BS PROP
Tiamin Hcl (Vit B1) tablet 50 mg B= 1000 tab 34 - BS PROP
31 Antihaemroid (Hemorograd) kapsul Box = 30 kap - APBD II 15
2,365,000


SBBK

1 MDT MB DEWASA KIT 12 - P2M
Jumlah Harga -
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009


SBBK


1 Alat Suntik ADS Soloshot 0,5 ml , 23 G Box =100 set 1,000 2,365 2,365,000 APBD II 15
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19860206 200903 2 009
JELCO 16 7992,8
420,000 JELCO 18 7498,7
19,680 JELCO 20 7498,7
220,000 7018
4,500 vasofix 8750
10,400
127,050
62700 , 47600
32,500
110,000
16,500

SBBK



OBAT TB PARU
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK



OBAT TB PARU
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK



Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK



6 K= 100 tab 3,000 72 216,000 DAK 14 (E)
Al(OH)3 200 mg , Mg(OH)2 200 mg
26 Prednison tablet 5 mg Box= 100 tab 1,000 140 140,000 DAK 14 (E)
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK


10 300 3,410 1,023,000 APBD II-14
IU Cap

Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK



Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK


4 20 15,054 301,080 JKN 14
Sulphate 5 mg

5000 mcg

11 Box=200 kaps 2,000 297 594,000 JKN 14


16 40 8,100 324,000 JKN 14
0,52mg Nebulizer
17 Salbutamol Tablet 4 mg Box = 100 Tab 300 93 27,900 JKN 14
18 Salbutamol Tablet 2,5 mg Box = 20 Amp 40 93 3,720 JKN 15

OBAT GIGI
Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

SBBK



Yang Menyerahkan,

NIP. 19630411 199203 2 005 NIP. 19640429 198703 2 008

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INSTALASI PERBEKALAN FARMASI KESEHATAN KABUPATEN LUMAJANG

JL. MAHAKAM NO.103 TELP. 0334 - 882981 LUMAJANG

SURAT BUKTI BARANG KELUAR

Penerima : Tanggal : 21 Januari 2015

SATUAN JUMLAH HARGA PER JUMLAH

1 Alupurinol Tablet 100 mg K= 100 tab 86 - DAK 14 (E)

Larutan mengandung Karbohidrat + Elektrolit

Larutan mengandung Karbohidrat + Elektrolit

124 Glukosa Larutan Infus 40% Steril Amp@ 25 cc 2,300 -

Larutan mengandung Karbohidrat + Elektrolit

168 Lidokain Inj. 2% + Epinefrin 1:80.000-2ml K = 30 Amp 1,136 - DAK 12 / Des-15

190 Mikonazol Krim 2% K=24 tube@10gr 3,000 - DAK 13(E) /Mar-17

Multivitamin Syrup (Curcuminoid 2mg, P, Vit B1 3

NaCl 0,875 g ,KCl 0,75 g, Glukosa Anhydrat 13,5

194 Natrium Diclofenak Tab.50 mg K= 50 Tab 210 - DAK 13(E) / Ags-16

273 Vit.B1 (Fursultia.HCL)+B2(Rib.)/Alinamin inj. K= 5 Amp 14,973 - DBHCHT 13 / Jun-15

274 Vitamin B Compleks B= 1000 tab 22 - APBD II-14

ALKES / PERBEKES PAKAI HABIS

396 Aqua Pro Injeksi Steril K= 10 Vial 5,000 - JKN 14

403 Diazepam Rectal 5 mg/2.5 ml Ktk= 5 tube 11,525 - JKN 14 (E)

410 Kloramfenikol Salep Mata 1 % Tube 5 gram 2,600 - JKN 14

417 Metamizol sodium Injeksi 500mg/ml Box @ 5 Ampul 7,660 - JKN 14

Multivitamin Tab. Tambah Darah ( Fe

Multivitamin (Neurotropic) injeksi Thiamine

Multivitamin (Neurotropic) Tablet +B1 100, B6

423 Mikonazol Krim Tube=10 gram 3,000 - JKN 14

Neurotropik Injeksi (Vit. B1 100 mg, B6 100 mg, Box = 10

Neurotropik Injeksi (Vit. B1 100 mg, B6 100 mg, Box = 10

426 Nifedipin tablet 30 mg K =100 tab 3,500

Parasetamol Kombinasi Tablet Batuk

Parasetamol Kombinasi Tablet Antitusif

447 Streptomycin Inj. Vial - JKN 14 (E)

ALKES / PERBEKES PAKAI HABIS -

OBAT GIGI - JKN 14

Obat P3K Mobile -

Jumlah Harga 2,306,900

INSTALASI PERBEKALAN FARMASI KESEHATAN KABUPATEN LUMAJANG

SURAT BUKTI BARANG KELUAR

Penerima : Tanggal : 21 Januari 2015

SATUAN JUMLAH HARGA PER JUMLAH

Jumlah Harga 1,997,400

Dra. TRI MUSYAROFAH, Apt RISMA YANSA F.

INSTALASI PERBEKALAN FARMASI KESEHATAN KABUPATEN LUMAJANG

SURAT BUKTI BARANG KELUAR

Penerima : Tanggal : 21 Januari 2015

SATUAN JUMLAH HARGA PER JUMLAH

Jumlah Harga 309,500

Dra. TRI MUSYAROFAH, Apt RISMA YANSA F.

SURAT BUKTI BARANG KELUAR

Penerima : Tanggal : 4 Pebruari 2015

SATUAN JUMLAH HARGA PER JUMLAH

1 Alupurinol Tablet 100 mg K= 100 tab 86 - DAK 14 (E)

Larutan mengandung Karbohidrat + Elektrolit

Larutan mengandung Karbohidrat + Elektrolit

124 Glukosa Larutan Infus 40% Steril Amp@ 25 cc 2,300 -

Larutan mengandung Elektrolit ( Na130 mEq, Cl

Larutan mengandung Karbohidrat + Elektrolit

168 Lidokain Inj. 2% + Epinefrin 1:80.000-2ml K = 30 Amp 1,136 - DAK 12 / Des-15

190 Mikonazol Krim 2% K=24 tube@10gr 3,000 - DAK 13(E) /Mar-17

Multivitamin Syrup (Curcuminoid 2mg, P, Vit B1 3

NaCl 0,875 g ,KCl 0,75 g, Glukosa Anhydrat 13,5

194 Natrium Diclofenak Tab.50 mg K= 50 Tab 210 - DAK 13(E) / Ags-16

273 Vit.B1 (Fursultia.HCL)+B2(Rib.)/Alinamin inj. K= 5 Amp 14,973 - DBHCHT 13 / Jun-15