Lplpo 2016

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS : Pugaan
KECAMATAN : Pugaan PELAPORAN BULAN/PERIODE : JANUARI 2016
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : FEBRUARI 2016
PROPINSI : KALIMANTAN SELATAN
NO NAMA OBAT KEMASAN HARGA SATUAN STOK AWAL PENERIMAANPERSEDIAAN PEMAKAIAN NON SISA STOK
(Rp) PEMAKAIAN STOK OPTIMUM
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
I Alat Kesehatan
1 Alat Suntik sekali pakai 1 ml 100 set / kotak 1,540.00 104 104 4 100 9
2 Alat Suntik sekali pakai 2.5 ml 100 set / kotak 1,141.80 - - -
3 Alat Suntik sekali pakai 3 ml 100 set / kotak 957.00 75 75 25 50 58
4 Alat Suntik sekali pakai 5 ml 100 set / kotak 1,348.00 34 34 1 33 2
5 Alat Suntik sekali pakai 10 ml 100 set / kotak 1,790.00 4 4 4 - 9
6 Alkohol Swab Box 13,050.00 - - -
7 Bisturi 1 Pcs / Pcs 1,250.00 28 28 28 -
8 Catgut/Benang Bedah No 2/0 dg Jarum bedah 24 x 70 cm / ktk 7,287.00 - - -
9 Catgut PLAIN No 2/0 dg Jarum bedah 1 Saset / Saset 29,333.00 - - -
10 Catgut/Benang Bedah No 3/0 dg Jarum bedah 24 x 70 cm / ktk 7,287.00 24 24 24 -
11 Catgut PLAIN No 3/0 dg Jarum bedah 1 Saset / Saset 7,287.00 24 24 24 -
12 Catgut/Benang Bedah No 2/0 Chromic rol 1 Roll / Roll 1,100,000.00 - - -
13 Catgut/Benang Bedah No 3/0 Chromic rol 1 Roll / Roll 1,600,000.00 1 1 1 - 2
14 Ceplast Gauze aerofilm pack 99,000.00 - - -
15 Foley Catheter No 12 Pcs 12,100.00 12 12 12 - 28
16 Foley Catheter No 14 Pcs 10,440.00 3 3 3 - 7
17 Foley Catheter No 16 Pcs 10,440.00 - - -
20 Foley Catheter No 24 Pcs 9,340.00 5 5 5 -
21 Infusion set anak Set / kantong 4,568.00 28 28 28 -
22 Infusion set dewasa Set / kantong 4,176.00 4 50 54 54 -
23 Kapas Pembalut/absorben 250 mg Bungkus 28,235.00 2 5 7 2 5 5
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak 7,569.00 1 25 26 1 25 2
25 Kasa Hidrofil steril 18 cm x 22 cm ISI 12 pack 5,225.00 - - -
26 Kasa hidrofil 4 m x 10 cm Rol 2,750.00 - - -
27 Kasa hidrofil 36 m x 80 cm Rol 142,946.00 1 1 1 -
28 Kasa Kompres 40/40 steril Bungkus 1,800.00 - - -
29 Kasa Pembalut 2 m x 80 cm Rol 10,443.00 7 7 7 - 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
30 Kasa Pembalut Hidrofil 4 m x 3 cm elastic Rol 842.60 - - -
31 Kasa Pembalut Hidrofil 4 m x 15 cm elastic Rol 2,741.00 - - -
32 Kertas Puyer 1200 pcs / pack 200.00 - - -
33 Masker N 95 Pcs 15,400.00 - - -
34 Needle No 23 Pcs 429.00 - - -
35 Needle No 25 Pcs 429.00 - - -
36 Plester 5 yards x 2 inch Rol 35,532.00 19 19 19 -
37 Plester Kecil Rol 1,375.00 - - -
38 Plester Sedang Rol 8,250.00 - - -
39 Policrepe 10 cm x 4,55 M Rol 822,300.00 - - -
40 Sarung Tangan STERIL S (6) Bks 4,675.00 - - -
41 Sarung Tangan STERIL M (7) Bks 9,000.00 - - -
42 Sarung Tangan STERIL L (8) Bks 9,000.00 - - -
43 Sarung tangan Non Steril No S 50 Psg / Kotak 849.00 50 100 150 100 50 230
44 Sarung tangan Non Steril No M 50 Psg / Kotak 849.00 300 300 100 200 230
45 Sarung tangan Non Steril No L 50 Psg / Kotak 849.00 300 300 300 -
46 Silk (Benang bedah sutera) No.2/0 dg jarum bedah 1 Pcs / Pcs 3,988.00 24 24 24 -
47 Silk (Benang bedah sutera) No.3/0 dg jarum beda 12 x 3 x 75 cm/ktk 276,540.00 24 24 24 -
48 Transfusion set Set / kantong 9,396.00 - - -
49 Ultrafix 5 cm x 1 m Rol 27,000.00 1 1 1 -
50 Ultrafix 10 cm x 5 m Rol 115,800.00 1 1 1 -
51 Umbelical Klem / Tali Pusat Pcs 1,305.00 - - -
52 Underpad Ibu Nifas Pcs 7,000.00 4 4 4 -
53 Urine bag Steril 2 ltr Pcs 3,915.00 6 6 6 -
54 Jarum jahit no 9 dzn 25,000.00 2 2 2 -
55 Jarum jahit no 10 dzn 13,750.00 1 1 1 -
56 Jarum jahit no 11 dzn 25,000.00 - - -
57 IV Catheter No 18 ( Surflo ) 50 Steril / Kotak 8,355.00 46 46 3 43 7
58 IV Catheter No 20 ( Surflo ) 50 Steril / Kotak 8,355.00 39 39 7 32 16
59 IV Catheter No 22 ( Surflo ) 50 Steril / Kotak 8,355.00 43 43 43 -
60 IV Catheter No 24 ( Surflo ) 50 Steril / Kotak 8,355.00 43 43 43 -
61 Oksigen Tabung Kecil kubik 60,000.00 - - -
62 Tabung Oksigen Kecil Botol Tabung 1,920,000.00 1 1 1 -
63 Surgical Masker Ear Loop 3 Ply ( 2013 ) 50 Pcs / kotak 574.00 150 150 150 -
- - -
II Reagensia - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
64 Asam klorida 0,1 N Botol 20,000.00 - - -
65 Asam Sulfosalisilat 20 % Botol 775,000.00 - - -
66 Larutan Benedict Botol 100 ml 345,000.00 - - -
67 Larutan Eosin 2 % Botol 100 ml 40,250.00 - - -
68 Larutan Etanol Asam Botol 100 ml 35,000.00 - - -
69 Larutan Giemsa Stain Botol 100 ml 69,683.00 - - -
70 Larutan Karbol Fuksin Botol 100 ml 150,000.00 - - -
71 Larutan Metilan Biru Botol 100 ml 90,000.00 - - -
72 Larutan Turk Botol 100 ml 16,037.00 - - -
73 Metanol Botol 100 ml 95,000.00 - - -
74 Rapid Test DBD 1 Set /Set 60,000.00 - - -
75 Rapid Test MALARIA 1 Set /Set 40,000.00 - - -
- - -
III Obat Gigi -
76 Fletcher Liquid 100 Gram / Botol 60,000.00 1 1 1 -
77 Alvoghyl Botol 510,000.00 - - -
78 Bonding ktk 290,000.00 1 1 1 -
79 Caviton Botol / Kotak 195,000.00 1 1 1 -
80 Cresophate Botol 705,000.00 - - -
81 Caustinerf Rapide Forte Botol 525,000.00 - - -
82 Cotton Roll Box 42,000.00 - - -
83 Cresophen Botol 725,000.00 - - -
84 Devitasol Botol 175,000.00 - - -
85 Disclosing Gel Botol 85,000.00 1 1 1 -
86 ETSA Botol 260,000.00 - - -
87 Etil Klorida Spray Botol / 100 ml 180,000.00 2 2 2 - 5
88 Eugenol Cairan Btl 10 ml 18,333.00 1 1 1 -
89 Flour tablet 0,5 mg 100 Tablet / Botol 34.64 - - -
90 Forinilkresol (Pengganti TKF) 1 Pcs / Pcs 55,000.00 - - -
91 Formocresol 1 Pcs / Pcs 45,000.00 - - -
92 Flowable Komposit Monohydrit Warna A 2 1 Pcs / Pcs 155,000.00 1 1 1 -
93 Flowable Komposit Monohydrit Warna A3 1 Pcs / Pcs 155,000.00 1 1 1 -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
94 Fuji IX ART 1 Kotak / Kotak 855,000.00 1 1 1 -
95 Fuji VII Fissure Sealant 1 Kotak / Kotak 1,120,000.00 1 1 1 -
96 Iodorm Paste Botol 215,000.00 - - -
97 Jarum Citoject Dos@100 1,650.00 10 10 10 -
98 Kalsium Hidroksida Pasta ( Hydcal ) 1 Tube / Tube 165,000.00 1 1 1 -
99 Klorfenol Kamfer Menthol (CHKM) Botol 10 ml 48,762.00 - - -
100 Micro Aplicator Bruss Disposible Botol 71,000.00 1 1 1 -
101 Mummifying Pasta 1 Botol / Botol 193,600.00 - - -
102 Komposit Monohyrid warna A 3.5 1 Kotak / Kotak 375,000.00 1 1 1 -
103 Komposit Monohyrid warna A 3 1 Kotak / Kotak 375,000.00 1 1 1 -
104 Komposit Monohyrid warna A 2 1 Kotak / Kotak 375,000.00 1 1 1 -
105 Panaspray Oil 1 Botol / Botol 325,000.00 - - -
106 Pulperyl 1 Botol / Botol 395,000.00 - - -
107 Scandonest 2% 1 Pcs / Pcs 11,000.00 - - -
108 Spon Gelatin Cubicles 1x1x1 cm 35,000.00 - - -
109 Semen Seng Fospat serb dan cairan ( Dorident ) Set @ 30 gr/ Btl 102,850.00 - - -
110 Silver Amalgam Serbuk 65-75 % 1 oz / Botol 237,540.00 - - -
111 Tube 15 mg 78,000.00 - - -

Tropicaina Anestesi
112 Temporary Stopping Fletcher (Fletcher) serbuk Set @ 100 gr / Btl 30,000.00 - - -
- - -
IV Obat Injeksi - - -
113 Aminofilina Inj. 24 mg/ml - 10 ml 30 Ampul / Kotak 4,204.00 - - -
114 Ampisillin serbuk inj. (IM/IV) 1000 mg 1 Vial / Vial 5,610.00 - - -
115 Antalgin injeksi 250 mg/ml-2ml 30 Ampul / Kotak 1,764.00 - - -
116 Asam Tranexamat Injeksi 250 mg / 5 ml 10 Ampul / kotak 4,040.00 5 5 5 -
117 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ( 2013 ) 30 Ampul / Kotak 1,353.00 20 20 20 -
118 Aqua pro injeksi steril , bebas pirogen 1 Vial / Vial 2,200.00 7 7 7 -
119 Combivent 2,5 Nebulizer 20 pcs / Box 5,990.00 - - -
120 Deksametason injeksi 5 mg/ml- 1 ml 100 Ampul / Kotak 1,738.00 13 13 13 -
121 Difenhidramin HCL inj 10 mg/ml- 1 ml 30 Ampul / Kotak 1,160.00 24 24 24 -
122 Epinefrina HCL/Bitartrat ( Epinefrina/adrinalina ) 30 Ampul / Ampul 8,910.00 - - -

injeksi 0.1 % - 1 ml
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 1,723.00 8 8 8 -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
124 Furosemid injeksi 25 Ampul / ktk 2,012.00 - - -
125 Gentamicin Injeksi 80 mg/2ml 5 Ampul / Kotak 4,065.60 - - -
126 Ketorolac injeksi 10 mg 6 Ampul @ 1 ml 2,665.00 - - -
127 Kloroquin injeksi 100 Ampul / Kotak 3,954.72 - - -
128 Kuinin Dihidroksida
Lidokain injeksi 25 % - 2 ml
komp. Injeksi,kombinasi 30 Ampul / Kotak 6,820.00 - - -
129 Lidokain HCl 2% + Epinefrin 1 : 80.000- 30 Ampul / Kotak 1,250.33 28 28 28 -
2ml
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 929.00 36 36 36 -
131 Magnesium Sulfat inj. (IV) 20%-25ml 10 Vial / kotak 1,693.80 - - -
132 Magnesium Sulfat inj. (IV) 40%-25ml 10 Vial / kotak 2,142.70 - - -
133 Metamizole 500mg Injeksi 5 ampul / kotak 10,760.00 - - -
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak 1,503.33 13 13 13 -
135 Metochlopramid Inj 5 mg/ml 10 Ampul / Kotak 4,900.00 - - -
136 Neurotropik Vitamin (Neurobat) Injeksi 1 Ampul / Ampul 4,342.00 - - -
137 Ondansetron 4 mg/ 2 ml Injeksi 5 Ampul / Kotak 2,400.00 - - -
138 Oksitetrasiklin HCL Injeksi i.m 50 mg/ml-10 ml ktk 10 vial 3,751.00 - - -
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak 2,791.00 - - -
140 Pehacain Injeksi 10 Ampul / kotak 3,113.00 - - -
141 Piracetam Injeksi 1 gr/5ml 10 ampul / Kotak 5,500.00 - - -
142 Piracetam Injeksi 3 gr/15ml 4 ampul / Kotak 13,500.00 - - -
143 Prokain Benziloenicillin G 3jt UI/Vial ktk 30 vial @15 ml 6,160.00 16 16 16 -
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak 1,340.00 12 12 12 -
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 7,260.00 12 12 12 -
146 Sefotaksim inj 1 gr 1 Vial / Vial 6,750.00 - - -
147 Seftazidim injeksi 1 gr 2 Vial/ktk 41,382.00 - - -
148 Seftriaxone injeksi 1 gr kotak 2 vial 3,700.00 - - -
149 Sianokobalamin (vit.B12) injeksi 500 mcg/ml-1ml 100 Ampul / Kotak 1,332.00 129 129 129 -
150 Tiamin HCL (vit.B1) injeksi 100 mg/ml-1ml 30 Ampul / Kotak 847.00 - - -
151 Tramadol injeksi 50 mg/ml 5 Ampul / Kotak 2,680.00 - - -
- - -
V Syrup - - -
152 Albendazol Syrup Botol 4,234.00 - - -
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml 3,295.00 100 100 1 99 2
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 2,500.00 58 60 118 118 -
155 Ampisillin sirup kering 125mg/5ml Botol 60 ml 4,840.00 - - -
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 2,300.00 24 24 3 21 7
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
157 Apialys Drop / Truvit Botol 11,400.00 - - -
158 Cetirize Syrup Botol 8,799.00 - - -
159 Dexrofen Syrup Botol 8,047.00 - - -
160 Dekstrometorpan sirup 10 mg/5 ml Botol 60 ml 3,152.00 - - -
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 3,490.00 55 55 4 51 9
162 Domperidon Drop ( 2014 ) Botol 17,100.00 2 2 2 -
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 3,849.00 69 69 5 64 12
164 Ibuprofen Syrup 200 mg/ 5 ml Botol 60 ml 8,949.00 44 44 44 - -
165 Erytromicin sirup 200 mg/5 ml Botol 60 ml 8,090.00 6 6 6 -
166 Kaolin Pectin Syrup/ Guanistrep Syrup Botol 3,500.00 - - -
167 Kloramfenicol suspensi 125 mg/5ml ( 2013 ) Botol 60 ml 5,198.00 - - -
168 Kotrimoksazol suspensi komb: sulfametoksazol Botol 60 ml 2,298.00 63 63 4 59 9

200 mg + Trimetoprim 40 mg / 5 ml
169 Laksatif Syrup (Laxadine) Botol 12,450.00 - - -
170 Mebendazol sirup 100 mg/5 ml (Obat Cacing Anak btl 30 ml 3,740.00 - - -
171 Metochlopramid Sirup 5 mg/ml Botol 60 ml 8,800.00 - - -
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 30,800.00 20 20 20 -
173 Obat Batuk Hitam (OBH) cairan Botol 100 ml 2,145.00 21 21 21 -
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 1,535.00 39 39 39 -
175 Parasetamol drops Botol 5,720.00 11 11 11 -
176 Pyrantel Suspensi 10 ml Botol 9,100.00 - - -
177 Recovital Syrup Botol 5,830.00 - - -
178 Sefadroksil sirup ( 2013 ) Btl 60 ml 5,286.00 43 43 5 38 12
179 Sefadroksil Forte sirup Btl 60 ml 6,285.00 - - -
180 Sefiksim dry sirup Botol 30 ml 36,602.50 - - -
181 Zinc Syr 20 mg / 5 ml Btl 60 ml 8,140.00 - - -
- - -
VI Cairan - - -
182 Aquadest Steril Infus Botol 500 ml 12,250.00 - - -
183 Dextrose 5 1/2 N S Btl 500 ml 8,470.00 - - -
184 Dextrose 5 1/4 N S Btl 500 ml 8,470.00 7 7 7 - -
185 Etakridina (Rivanol) larutan 0.1 % Botol 300 ml 3,328.00 1 1 1 -
186 Etanol 70 % Botol 1000 ml 28,058.00 3 3 1 2 2
187 Etanol 70 % Botol 100 ml 2,625.00 8 8 2 6 5
188 Glukosa larutan infus 5 % steril Botol / Plastik 500 ml 5,720.00 54 54 54 -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
189 Glukosa larutan infus 10 % steril Botol / Plastik 500 ml 6,300.00 - - -
190 Ka-en 3B Infus Botol 500 mg 10,000.00 - - -
191 Lisol,mengandung kresol tersabun 50 % Botol 1000 ml 49,862.00 5 5 5 -
192 Metronidazol infus 500 mg/100 ml 100 ml / Botol 12,980.00 - - -
193 Natrium Klorida larutan infus 0,9 % steril Botol / 500 ml 5,170.00 16 16 16 -
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml 5,720.00 18 18 11 7 25
195 TetraHES larutan Infus 1 Pack / Pack 220,700.00 - - -
- - -
VII Obat Luar (Salep & Tetes) - - -
196 Anti Bakteri DOEN salep kombinasi: 25 Tube 5 g / Ktk 2,767.00 5 5 5 - -
Basitrasin 500IU/g+Polimiksin 10.000IU/g
197 Anti Hemaroid DOEN Kombinasi 10 Supp / Kotak 2,420.00 28 28 28 -
198 Antifungi DOEN kombinasi: 24 Pot 30 g / Ktk 2,741.00 - - -
Asam Benzoat 6%+Asam Salisilat 3%
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 3,150.00 36 36 15 21 35
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml 8,300.00 10 10 10 -
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 1,558.00 44 44 6 38 14
202 Bioplacenton cream 1 Tube / Tube 14,250.00 - - -
203 Desoksimethasone 0,25% Cream 1 Tube / Tube 9,983.00 - - -
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml 2,246.00 33 33 3 30 7
205 Gentamicin Salep Kulit 1 Tube / Tube 1,850.00 30 30 30 -
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube 2,786.00 - - -
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml 2,924.00 21 21 3 18 7
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak 2,868.00 - - -
209 Ketokonazole Cream 2 % Tube 15 mg 5,150.00 21 21 4 17 9
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak 7,558.00 30 30 30 -
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 7,558.00 4 10 14 2 12 5
212 Kloramfenicol salep mata 1 % 5 gr / Tube 1,640.00 - - -
213 Litrol Tetes Mata/ Kortikosteroid Botol 18,300.00 - - -
214 Levetran Salep / Minyak Ikan Pot 2,813.00 - - -
215 Lidocain Jelly 2% (Xylocaine 2%) 1 Pcs / Pcs 40,000.00 - - -
216 Minyak Angin Safe Care Botol 13,600.00 - - -
217 Miconazol cream 2 % ( 2013 ) 24 Tube @ 10 mg 3,075.00 5 5 5 -
218 Mydric Tetes Mata botol 26,000.00 - - -
219 Oksitetrasiklin HCL salep mata 1 % ( 2013 ) 25 Tube / Kotak 1,640.00 - - -
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak 2,010.00 - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
221 Pilocarpine Tetes Mata Botol 20,400.00 - - -
222 Polidemisin Tetes Mata Botol 23,550.00 - - -
223 Polikresulen (Kondensasi Metakresol Sulfonat Botol 10 ml 18,635.00 5 5 5 - 12
dan Metanol), Albothyl
224 Povidon Iodida 10 % Botol 30 ml 2,640.00 27 27 1 26 2
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml 3,588.00 5 30 35 35 -
226 Povidon iodida 10% Botol 300 ml 15,386.00 - - -
227 Povidon iodida 10% Botol 1000 ml 40,202.00 16 16 16 -
228 Salep 2-4 kombinasi: 24 Pot @ 30 g / Kotak 2,200.00 49 49 49 -
Asam Salisilat 2% + Belerang endap 4%
229 Salisil Bedak 2 % 50 Gram / Kotak 1,350.00 30 30 30 -
230 Scabicid Cream Tube 15 mg 11,475.00 - - -
231 Sulfasetamida Natrium tetes mata 15 % 24 Btl @ 5 ml / Kotak 3,789.79 - - -
232 Trombophop Gel Tube 15 mg 52,800.00 2 2 2 -
233 Temefos 1% Bungkus / 1 kg 93,200.00 - - -
234 Tetracain Tetes Mata Botol 89,000.00 - - -
235 Timolol Tetes Mata Botol 63,000.00 - - -
236 Voltadex Gel 1 Tube / Tube 21,450.00 - - -
237 Voltaren Gel 1 Tube / Tube 25,850.00 - - -
- - -
VIII Obat-Obatan - - -
238 Albendazol tablet 400 mg ktk 5 x 6 tablet 231.00 48 48 48 - 110
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk 90.00 325 325 30 295 69
240 Alopurinol tablet 300 mg ( 2013 ) Ktk 3 x 10 tablet 225.00 - - -
241 Ambroxol Tablet 30 mg 100 Tab / Kotak 125.00 5,000 5,000 30 4,970 69
242 Aminofilin tablet 200 mg 100 Tablet / Botol 86.00 1,000 1,000 1,000 -
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak 352.00 420 420 115 305 265
244 Amoksisillin kapsul 250 mg 120 Tab/ktk 289.00 848 848 848 -
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 279.00 1,681 1,681 715 966 1,645
246 Antalgin
Antasida(Metampiron) tablet 500
DOEN tab kombinasi : mg 100 Tablet / Kotak 151.00 - - -
247 Mg Hidroksida 200 mg + Al 100 tablet / kotak 78.00 540 540 440 100 1,012
Hidroksida
248 Antimalaria DOEN Kombinasi : Pirimetamin 25 100 Tablet / kotak 520.30 - - -
mg + Sulfadoxin 500mg
249 Asam Asetilsalisilat 80mg Tab 100 Tablet / kotak 503.00 - - -
250 Asetosal 100 mg (Asam Asetilsalisilat) 100 Tablet / kotak 127.00 - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 105.00 1,135 1,135 237 898 545
252 Amlodipine 5 mg ( 2013 ) 30 Tablet / Kotak 197.00 400 400 190 210 437
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol 52.00 460 460 80 380 184
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 176.00 1,446 1,446 900 546 2,070
255 Asam Tranexamat Tablet 500 mg 100 tablet / kotak 13,062.00 - - -
256 Asiclovir 200 mg 100 Tablet/ ktk 245.00 1,300 1,300 1,300 -
257 Asiclovir 400 mg 100 Tab/ktk 354.00 443 443 200 243 460
258 Asifit Kaplet 100 Tab/Ktk 43,350.00 - - -
259 Attapulgit 50 Tab/ktk 220.00 1,300 1,300 1,300 -
260 Attapulgit + Pectin Tablet (Kombinasi) 100 Tablet/ ktk 1,146.00 - - -
261 Atropin Sulfat tablet 0,5 mg 500 Tablet / Botol 81.00 - - -
262 Betahistin Mesilat 5 mg 30 tablet / kotak 1,271.00 164 900 1,064 1,064 -
263 Bisacodil Tablet Kotak / 18 Tablet 836.11 18 18 18 -
264 Bisoprolol tablet 5 mg Ktk 3 x 10 tablet 2,553.83 - - -
265 Bromhexin Tablet (Hustab) 100 tablet / kotak 200.00 600 600 600 -
266 Captopril tablet 25 mg 100 tablet / kotak 97.00 2,530 2,530 850 1,680 1,955
267 Captopril tablet 12,5 mg 100 Tablet / kotak 69.00 2,154 2,154 2,154 -
268 Cetop Zink 100 Tablet / kotak 1,925.00 - - -
269 Cetrizine 10 mg 50 Tablet/ ktk 190.00 1,672 1,672 45 1,627 104
270 Cimetidin tablet 200 mg 100 tablet / kotak 127.05 1,285 1,285 40 1,245 92
271 Ciprovloxsacin 500 mg 100 tablet / kotak 473.00 610 610 100 510 230
272 Clindamisin 150 mg Kapsul 50 Kapsul / kotak 405.00 - - -
273 Clindamisin 300 mg Kapsul 50 Kapsul / kotak 580.00 - - -
274 Clonidin 0,15 mg 100 tablet / kotak 224.00 - - -
275 Curcuma Tablet 100 tablet / kotak 845.00 - - -
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 68.00 1,063 1,063 250 813 575
277 Dekstrometorpan tablet 15 mg 100 tablet / kotak 121.00 - - -
278 Dietilkarbamazin sitrat tablet 100 mg 100 Tablet / kotak 262.00 - - -
279 Digoksin tablet 0,25 mg 100 Tablet / Botol 103.00 560 560 560 - -
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 137.00 2,030 2,030 110 1,920 253
281 Dimenhidrinat tab 50 mg 100 Tab / Botol 106.00 200 200 200 - 460
282 Doksisiklin kapsul 100 mg 100 kapsul / kotak 278.30 - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
283 Domperidon Tablet 10 mg 100 Tablet / Ktk 174.00 800 800 60 740 138
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 1,023.00 200 200 40 160 92
285 Erytromisin Kapsul 250 mg 100 tab / Kotak 509.00 - - -
286 Ekstrak Belladon tablet 10 mg 1000 Tablet / Botol 348.48 - - -
287 Etambutol HCL tablet 250 mg 200 Tablet / kotak 350.90 - - -
288 Famotidin 20 mg 50 Tablet / Kotak 214.17 - - -
289 Fenilbutazon/Novazon 1000 Tablet / Botol 98.10 - - -
290 Fenitoin Natrium kapsul 30 mg 250 Kapsul / Botol 88.40 - - -
291 Fenitoin Natrium kapsul 100 mg 250 Kapsul / Botol 146.00 - - -
Fitomenadion (Vit K) tablet salut gula 10 mg
292 100 Tablet / Botol 749.00 1,000 1,000 10 990 23
293 Furosemid tablet 40 mg ( 2013 ) 100 Tablet / Kotak 84.00 565 565 10 555 23
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak 418.00 2,070 2,070 708 1,362 1,628
295 Gemfibrozil 300 mg 120 kaps / kotak 318.00 - - -
296 Gemfibrozil 600 mg 100 kaps / kotak 747.00 - - -
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 126.00 1,960 1,960 390 1,570 897
298 Glimepiride tablet 1 mg 50 Tablet / Kotak 272.00 - - -
299 Glimepiride tablet 2 mg 50 Tablet / Kotak 447.00 430 430 80 350 184
300 Glimepiride tablet 4 mg 50 Tablet / Kotak 441.00 595 595 30 565 69
301 Gliquidon tablet 30 mg 100 tablet / kotak 709.80 - - -
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 53.00 3,000 3,000 890 2,110 2,047
303 Griseofulvin tablet 125 mg, micronizet 100 Tablet / Botol 224.00 - - -
304 Hidroclortiazid ( HCT ) tablet 25 mg 1000 Tablet / Botol 39.93 - - -
305 Hyosine-N-Butilbromid 10 mg 100 Tablet / Kotak 330.00 - - -
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 127.00 1,990 1,990 30 1,960 69
307 Ibuprofen tablet 400 mg 100 Tablet / Botol 157.00 348 348 348 - 800
308 Inlacta DHA 30 Softcapsul / Kotak 3,573.00 - - -
309 Isoniazide 100 mg 1000 tab / Botol 45.00 1,000 1,000 1,000 -
310 Isosorbid dinitrat tablet sublingual 5 mg 100 Tablet / Botol 98.00 1,140 1,140 1,140 -
311 Kalium permanganat serbuk 25 Botol / 5 gram - - -
312 Kalium Diklopenak 50 mg 50 Tablet / Kotak 708.00 1,000 1,000 1,000 -
313 Kalium Diklopenak 25 mg 50 Tablet / Kotak 429.92 300 300 300 -
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 76.00 1,725 1,000 2,725 2,725 -
315 Ketokonazole 200 mg 50 Tablet / Kotak 320.00 910 910 40 870 92
316 Ketoprofen Tab 100 mg 100 Tab / Kotak 1,485.00 100 100 100 -
317 Kloramfenikol kapsul 250 mg 250 Kapsul / Botol 275.00 - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol 26.00 490 2,000 2,490 226 2,264 520
319 Kloroquin tablet 150 mg 1000 Tablet / Botol 102.85 - - -
320 Kotrimoksazol tablet komb: sulfametoksazol 400 100 Tablet / Botol 152.00 1,970 1,970 65 1,905 150
mg + Trimetoprim 80 mg
Kotrimoksazol tablet pedriatik kombinasi:
321 Sulfametoksazol 100 mg + Trimetoprim 100 Tablet / Botol 79.00 - - -
20 mg
322 Klokuin tablet 250 mg 1000 Tablet / Botol 127.00 500 500 500 -
323 Kuinin sulfat tablet 222 mg(7 H2O) 1000 Tablet/botol 670.00 - - -
324 Kuinin (kina) tablet 200 mg 60 Tab / ktk 706.00 - - -
325 Lanzoprazole kaps 30 mg ( 2013 ) 20 kapsul / kotak 521.00 410 410 50 360 115
326 Levofloxacin 500 mg 50 tablet / kotak 1,396.00 - - -
327 Lodecon tablet (Obat Flu Kombinasi) Tablet 300.00 - - -
328 Loperamid tablet 2 mg ( Novadium ) 100 tablet / kotak 97.00 530 530 10 520 23
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 170.00 740 740 40 700 92
330 Magnesium Sulfat serbuk 30 gram 10 Sase / Kotak 1,242.23 - - -
331 Mebendazol tablet 100 mg 30 Tab/ktk 254.10 - - -
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 690.00 1,120 1,120 60 1,060 138
333 Meloxicam 15 mg ( 2013 ) 50 Tablet/ Kotak 1,180.00 - - -
334 Metformin tab 500 mg 100 tablet / kotak 200.00 830 830 130 700 299
335 Metformin tab 850 mg 100 tablet / kotak 363.00 715 715 250 465 575
336 Metil Ergometrin Maleat Tab.sal 0,125 mg 100 Tab/ktk 169.00 128 200 328 328 -
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 230.00 2,000 2,000 2,000 -
338 Metochlopramid tablet 10 mg 100 tablet / kotak 100.00 320 320 320 -
339 Metronidazol tablet 250 mg 100 Tablet / Botol 116.00 - - -
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak 169.00 920 920 150 770 345
341 Mineral Mix ktk 40 sachet 2,722.50 - - -
342 Multivitamin Tablet 100 tablet / kotak 2,166.67 - - -
343 Multivitamin Antioksidan Tablet (Univoxy) 30 Tablet / kotak 7,033.00 - - -
344 Multivitamin Lansia (Pehavral) 30 Tablet / Botol 2,166.67 - - -
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 798.00 550 600 1,150 800 350 1,840
346 Multivitamin penambah kalsium 100 Tablet / Kotak 580.00 - - -
347 Natural Anti inflamasi Tablet 60 Tablet / kotak 6,325.00 - - -
348 Natrium Bikarbonat tablet 500 mg 1000 Tablet / Botol 17.30 - - -
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 146.00 2,000 2,000 2,000 -
350 Natrium diklofenak tablet 50 mg 50 Tablet/ ktk 263.30 - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
351 Neurotropik Vitamin 100 Tab / ktk 1,222.00 - - -
352 Nipedipin tablet 10 mg 100 tablet / kotak 110.00 2,700 2,700 35 2,665 81
353 Nistatin tablet salut 500.000 IU 100 Tab/ktk 704.00 - - -
354 Nistatin tablet vaginal 100.000 IU/g 100 Tab/ktk 379.00 - - -
355 Noza 398.75 - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak 221.00 940 940 76 864 175
357 Ofloxacin 400 mg tab 50 kaps / Kotak 700.00 - - -
DOKUMEN NOMOR TANGGAL
DINKES
GFK
PUSKESMAS
PERMINTAAN PEMBERIAN KET

APBD II BS PROP PROGRAM JUMLAH
11=10-9 12 13 14 15=12+13+14 16
(91)
-
(31)
-
(28)
-
(24)
(24)
-
-
-
-
(5)
(54)
(0)
(23)
-
-
-
11=10-9 12 13 14 15=12+13+14 16
-
-
-
-
-
-
(19)
-
-
-
-
-
-
(300)
(24)
(24)
-
(1)
(1)
-
(4)
(6)
(2)
(1)
-
(36)
(16)
(43)
(43)
-
(1)
-
-
11=10-9 12 13 14 15=12+13+14 16
-
-
-
-
-
-
-
-
-
-
-
-
-
(1)
-
(1)
(1)
-
-
-
-
-
(1)
-
(1)
-
-
-
(1)
(1)
11=10-9 12 13 14 15=12+13+14 16
(1)
(1)
-
(10)
(1)
-
(1)
-
(1)
(1)
(1)
-
-
-
-
-
-
-
-
-
-
-
-
(5)
(20)
(7)
-
(13)
(24)
(8)
11=10-9 12 13 14 15=12+13+14 16
-
-
-
-
-
(28)
(36)
-
-
-
(13)
-
-
-
-
-
-
-
-
(16)
(12)
(12)
-
-
-
(129)
-
-
-
-
-
(97)
(118)
-
(14)
11=10-9 12 13 14 15=12+13+14 16
-
-
-
-
(42)
(2)
(53)
-
(6)
-
-
(50)
-
-
-
(20)
(21)
(39)
(11)
-
-
(27)
-
-
-
-
-
-
-
-
(1)
(54)
11=10-9 12 13 14 15=12+13+14 16
-
-
(5)
-
(16)
-
-
-
-
(28)
-
14
(10)
(24)
-
-
(23)
(30)
-
(11)
-
(8)
(30)
(7)
-
-
-
-
-
(5)
-
-
-
11=10-9 12 13 14 15=12+13+14 16
-
-
(24)
(35)
-
(16)
(49)
(30)
-
-
(2)
-
-
-
-
-
-
-
(226)
-
(4,901)
(1,000)
(41)
(848)
-
-
-
11=10-9 12 13 14 15=12+13+14 16
(353)
(196)
-
(1,300)
-
(1,300)
-
-
(1,064)
(18)
-
(600)
(2,154)
-
(1,524)
(1,153)
(280)
-
-
-
-
(238)
-
-
-
(1,667)
-
11=10-9 12 13 14 15=12+13+14 16
(602)
(68)
-
-
-
-
-
-
-
(967)
(532)
-
-
(673)
-
(166)
(496)
-
(63)
-
-
-
(1,891)
-
-
(1,140)
-
(1,000)
(300)
(2,725)
(778)
(100)
-
11=10-9 12 13 14 15=12+13+14 16
(1,744)
-
(1,756)
(500)
-
-
(245)
-
-
(497)
(608)
-
-
(922)
-
(401)
110
(2,000)
(320)
-
(425)
-
-
-
-
1,490
-
-
-
(2,000)
-
11=10-9 12 13 14 15=12+13+14 16
-
(2,585)
-
-
-
(689)
-
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
358 Paraformaldehid tablet 1 gram 100 Tablet / Botol 63.00 - - -
359 Parasetamol tablet 100 mg 100 Tablet / Botol 41.80 - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 88.00 2,436 1,000 3,436 1,021 2,415 2,348
361 Papaverin Tablet 40 mg btl 1000 tab 102.00 - - -
362 Pharmaton Formula 2,753.00 - - -
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak 451.00 - - -
364 Piracetam tablet 800 mg ( 2013 ) 100 tablet / kotak 321.00 - - -
365 Pirantel tablet 125 mg 60 Tab/ktk 318.00 79 79 79 -
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 32.00 1,190 1,190 68 1,122 156
367 Piroksikam kapsul 10 mg ( 2013 ) 120 / Kotak 72.47 58 58 48 10 110
368 Prednison tablet 5 mg 1000 Tablet / Botol 57.00 1,239 1,239 149 1,090 343
369 Propiltiourasil tablet 100 mg 100 Tablet / Botol 330.00 153 300 453 453 -
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 114.00 940 940 486 454 1,118
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 132.00 1,622 1,622 180 1,442 414
372 Reserpin tablet 0,10 mg 250 Tablet / Botol 91.00 - - -
373 Reserpin tablet 0,25 mg 1000 Tablet / Botol 114.00 - - -
374 Retinol (Vitamin A) kapsul 100.000 IU 50 kaps / Botol 286.00 - - -
375 Retinol (Vitamin A) 200.000 IU kapsul lunak 50 kaps / Botol 505.00 - - -
376 Retinol tablet 50000 IU 1000 Tablet / Botol 193.60 - - -
377 Rifampisin kapsul 300 mg 120 Kapsul / Kotak 465.85 - - -
378 Rifampisin kaplet 450 mg 100 Kaplet / Kotak 665.50 - - -
379 Rifampisin kaplet 600 mg 100 Kaplet / Kotak 938.00 - - -
380 Salbutamol tablet 2 mg 100 tablet / kotak 65.00 805 805 154 651 354
381 Salbutamol tablet 4 mg 100 tablet / kotak 91.00 712 712 95 617 219
382 Sangobion 800.00 - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 840.00 580 580 580 -
384 Sefiksim kaps 100 mg 50 kaps / ktk 2,897.50 - - -
385 Sianokobalamin (vitamin B12) Tablet 50 mcg btl 1000 tab 15.00 415 1,000 1,415 365 1,050 840
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 177.00 985 985 230 755 529
387 Spiramisin tab 500 mg 50 Tablet/ ktk 1,621.40 - - -
388 Spironolakton tab 25 mg 100 Tab / Kotak 350.00 - - -
389 Spironolakton tab 100 mg 100 Tab / Kotak 1,000.00 - - -
390 Sulfadimidin tablet 500 mg 1000 Tablet / Botol 141.40 - - -
391 Tablet tambah darah kombinasi Tablet 80.00 - - -
392 Tetrasiklin HCL kapsul 250 mg 1000 Kapsul / Botol 183.90 - - -
393 Tetrasiklin HCL kapsul 500 mg 100 Kaps/,ktk 302.50 - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
394 Tensigard 1,796.60 - - -
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol 74.00 2,154 2,154 51 2,103 117
396 Thiamfenicol 500 mg 100 kaps / ktk 619.00 188 188 188 -
397 Tramadol tab 50 mg 50 tab / kotak 196.00 80 80 10 70 23
398 Vitamin B Kompleks 1000 Tablet / Botol 126.00 1,220 1,220 650 570 1,495
399 Zink Tablet 20 mg 100 Tab / ktk 521.00 1,035 1,035 1,035 -
- - -
IX Serum & Vaksin - -
400 Serum anti Bisa Ular Polivalen injeksi 5 ml ( ABU I 1 Vial / Kotak 473,000.00 - -
401 Serum anti Bisa Ular Polivalen injeksi 50 ml ( ABU I 1 Vial / Kotak 55,660,000.00 - -
402 Serum Anti Difteri inj. 20.000 IU/Vial (A.D.S) 10 Vial / Kotak 697,950.00 - -
403 Serum Anti Tetanus injeksi 1.500 IU/amp (ATS) 1 Ampul / Kotak 126,500.00 - -
404 Serum Anti Tetanus injeksi 20.000 IU/Vial(ATS) 1 Vial / Kotak 525,800.00 - -
405 Vaksin Rabies Vero 1 Vial / Kotak 78,500.00 - -
- -
X Psikotropika - -
406 Alprazolam 0,5 mg 100 tablet / kotak 435.00 - -
407 Amitriptillin
Antimigren :HCL tablet salut 25 mg 100 Tab/ktk 123.00 180 180 180
408 Ergotamin Tartrat 1mg + Kofein 50mg 100 Tablet / Botol 135.63 - -
409 Clobazam tab 10 mg 100 tablet / kotak 900.00 - -
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak 4,598.00 - -
411 Diazepam tablet 2 mg btl 100 Tablet 46.00 238 238 238
412 Diazepam tablet 5 mg 1000 Tablet / Botol 52.80 - -
413 Diazepam Rectal 5 mg / ml Tube 23,760.00 9 9 9
414 Diazepam Rectal 10 mg / ml Tube 1,879.18 - -
415 Efedrin HCL tablet 25 mg 250 Tablet / Btl 56.00 - -
416 Fenitoin Natrium injeksi 50 mg/ml Ampul @ 2 ml 20,857.00 - -
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak 1,980.00 - -
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 70.00 70 70 31 39
419 Fenobarbital tablet 100 mg 250 tablet / Botol 63.72 - -
420 Flufenazine Inj (Sikzonoate) 25 mg/ml 1 Ampul / Ampul 55,000.00 - -
421 Fluoksetine 10 mgTablet Box 30's 1,540.00 - -
422 Haloperidol tablet 0.5 mg 100 Tab/ktk 66.00 - -
423 Haloperidol tablet 1.5 mg 100 Tab/ktk 76.00 378 378 45 333
424 Haloperidol tablet 5 mg 100 Tab/ktk 105.00 - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10
425 Haloperidol 50 mg/ ml Inj Dus 5 Ampul @ 1 ml 91,666.00 - -
426 Karbamazepin tablet 200 mg 100 Tab/ktk 267.00 1,000 1,000 1,000
427 Klorpromazen HCL injeksi 25 mg/ml-1ml 30 Ampul / Kotak 1,210.00 5 5 5
428 Klorpromazen HCL tablet salut 25 mg 1000 Tablet / Botol 134.00 523 523 523
429 Klorpromazen HCL tablet salut 100 mg 1000 Tablet / Botol 162.00 70 70 70
430 Klozapin 25 mg Kotak 5 x 10 tab 1,550.00 - -
431 Risperidon 2 mg Kotak 5 x 10 Tab 1,069.00 200 200 200
432 Triheksifenidil Hidroklorida tablet 2 mg 100 Tab / ktk 297.00 51 51 10 41
- -
XI Narkotika - -
433 Codeine 10 mg Box / 100 550.00 - - -
UMUM PERSED.
JAMKESMAS ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP TIDAK BAYAR BAYAR PERSED.
345 TOTAL
JUMLAH R/ GENERIK 828
JUMLAH R/ TOTAL 867
Mengetahui/menyetujui Yang Menyerahkan Yang Meminta

Kepala Dinas Kesehatan Petugas GFK Pimpinan Puskesmas
Kabupaten Tabalong
Jayosno, S.Kep.MM
NIP. 19701002 199002 1 001
11=10-9 12 13 14 15=12+13+14 16
-
-
(67)
-
-
-
-
(79)
(966)
100
(747)
(453)
(1,028)
-
-
-
-
-
-
-
-
(297)
(399)
-
(580)
-
(211)
(226)
-
-
-
-
-
-
-
11=10-9 12 13 14 15=12+13+14 16
-
(1,986)
(188)
(47)
(1,035)
-
-
-
-
-
-
-
-
-
-
-
(180)
-
-
-
(238)
-
(9)
-
-
-
-
(39)
-
-
-
-
(333)
-
11=10-9 12 13 14 15=12+13+14 16
-
(1,000)
(5)
(523)
(70)
-
(200)
(41)
-
-
-
OBAT Rp 25,231,381.02
GENERIK Rp 23,186,081.02
PERSEDIAAN Rp 44,936,246.02
Yang Menerima
Petugas Puskesmas
Arifah Rahayu
NIP. 19910610 201001 2 001
PUSKESMAS : Pugaan DOKUMEN NOMOR
KECAMATAN : Pugaan PELAPORAN BULAN/PERIODE : PEBRUARI 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : PEBRUARI 2016 GFK
PROPINSI : KALIMANTAN SELATAN PUSKESMAS
NO NAMA OBAT KEMASAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN NON SISA STOK PERMINTAAN PEMBERIAN
PEMAKAIAN STOK OPTIMUM APBD II BS PROP PROGRAM
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
1 Alat Suntik sekali pakai 1 ml 100 set / kotak 100 100 18 82 41 (41)
2 Alat Suntik sekali pakai 2.5 ml 100 set / kotak - - - - -
3 Alat Suntik sekali pakai 3 ml 100 set / kotak 50 50 36 14 83
5 Alat Suntik sekali pakai 10 ml 100 set / kotak - - - - -
6 Alkohol Swab Box - - - - -
7 Bisturi 1 Pcs / Pcs 28 28 28 - (28)
8 Catgut/Benang Bedah No 2/0 dg Jarum bedah 24 x 70 cm / ktk - - - - -
9 Catgut PLAIN No 2/0 dg Jarum bedah 1 Saset / Saset - - - - -
10 Catgut/Benang Bedah No 3/0 dg Jarum bedah 24 x 70 cm / ktk 24 24 24 - (24)
11 Catgut PLAIN No 3/0 dg Jarum bedah 1 Saset / Saset 24 24 24 - (24)
12 Catgut/Benang Bedah No 2/0 Chromic rol 1 Roll / Roll - - - - -
14 Ceplast Gauze aerofilm pack - - - - -
15 Foley Catheter No 12 Pcs - - - - -
20 Foley Catheter No 24 Pcs 5 5 5 - (5)
21 Infusion set anak Set / kantong 28 28 5 23 12 (12)
22 Infusion set dewasa Set / kantong 54 54 10 44 23 (21)
23 Kapas Pembalut/absorben 250 mg Bungkus 5 5 5 - (5)
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak 25 25 9 16 21
25 Kasa Hidrofil steril 18 cm x 22 cm ISI 12 pack - - - - -
26 Kasa hidrofil 4 m x 10 cm Rol - - - - -
27 Kasa hidrofil 36 m x 80 cm Rol 1 1 1 - (1)
28 Kasa Kompres 40/40 steril Bungkus - - - - -
29 Kasa Pembalut 2 m x 80 cm Rol - - - - -
30 Kasa Pembalut Hidrofil 4 m x 3 cm elastic Rol - - - - -
32 Kertas Puyer 1200 pcs / pack - - - - -
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
35 Needle No 25 Pcs - - - - -
36 Plester 5 yards x 2 inch Rol 19 19 1 18 2 (16)
37 Plester Kecil Rol - - - - -
38 Plester Sedang Rol - - - - -
39 Policrepe 10 cm x 4,55 M Rol - - - - -
40 Sarung Tangan STERIL S (6) Bks - - - - -
41 Sarung Tangan STERIL M (7) Bks - - - - -
42 Sarung Tangan STERIL L (8) Bks - - - - -
43 Sarung tangan Non Steril No S 50 Psg / Kotak 50 50 50 - 115
44 Sarung tangan Non Steril No M 50 Psg / Kotak 200 200 200 - (200)
45 Sarung tangan Non Steril No L 50 Psg / Kotak 300 300 100 200 230
46 Silk (Benang bedah sutera) No.2/0 dg jarum bedah 1 Pcs / Pcs 24 24 24 - (24)
47 Silk (Benang bedah sutera) No.3/0 dg jarum bedah 12 x 3 x 75 cm/ktk 24 24 24 - (24)
48 Transfusion set Set / kantong - - - - -
49 Ultrafix 5 cm x 1 m Rol 1 1 1 - (1)
51 Umbelical Klem / Tali Pusat Pcs - - - - -
52 Underpad Ibu Nifas Pcs 4 4 4 - (4)
53 Urine bag Steril 2 ltr Pcs 6 6 6 - (6)
54 Jarum jahit no 9 dzn 2 2 2 - (2)
56 Jarum jahit no 11 dzn - - - - -
57 IV Catheter No 18 ( Surflo ) 50 Steril / Kotak 43 43 43 - (43)
58 IV Catheter No 20 ( Surflo ) 50 Steril / Kotak 32 32 2 30 5 (25)
61 Oksigen Tabung Kecil kubik - - - - -
62 Tabung Oksigen Kecil Botol Tabung 1 1 1 - (1)
63 Surgical Masker Ear Loop 3 Ply ( 2013 ) 50 Pcs / kotak 150 150 94 56 216
- - - - -
II Reagensia - - - - -
64 Asam klorida 0,1 N Botol - - - - -
65 Asam Sulfosalisilat 20 % Botol - - - - -
66 Larutan Benedict Botol 100 ml - - - - -
67 Larutan Eosin 2 % Botol 100 ml - - - - -
68 Larutan Etanol Asam Botol 100 ml - - - - -
69 Larutan Giemsa Stain Botol 100 ml - - - - -
70 Larutan Karbol Fuksin Botol 100 ml - - - - -
71 Larutan Metilan Biru Botol 100 ml - - - - -
72 Larutan Turk Botol 100 ml - - - - -
73 Metanol Botol 100 ml - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
74 Rapid Test DBD 1 Set /Set - - - - -
75 Rapid Test MALARIA 1 Set /Set - - - - -
- - - - -
III Obat Gigi - - - - -
76 Fletcher Liquid 100 Gram / Botol 1 1 1 - (1)
77 Alvoghyl Botol - - - - -
78 Bonding ktk 1 1 1 - (1)
79 Caviton Botol / Kotak 1 1 1 - (1)
80 Cresophate Botol - - - - -
81 Caustinerf Rapide Forte Botol - - - - -
82 Cotton Roll Box - - - - -
83 Cresophen Botol - - - - -
84 Devitasol Botol - - - - -
85 Disclosing Gel Botol 1 1 1 - (1)
86 ETSA Botol - - - - -
87 Etil Klorida Spray Botol / 100 ml - - - - -
88 Eugenol Cairan Btl 10 ml 1 1 1 - (1)
89 Flour tablet 0,5 mg 100 Tablet / Botol - - - - -
90 Forinilkresol (Pengganti TKF) 1 Pcs / Pcs - - - - -
91 Formocresol 1 Pcs / Pcs - - - - -
92 Flowable Komposit Monohydrit Warna A 2 1 Pcs / Pcs 1 1 1 - (1)
93 Flowable Komposit Monohydrit Warna A3 1 Pcs / Pcs 1 1 1 - (1)
94 Fuji IX ART 1 Kotak / Kotak 1 1 1 - (1)
95 Fuji VII Fissure Sealant 1 Kotak / Kotak 1 1 1 - (1)
96 Iodorm Paste Botol - - - - -
97 Jarum Citoject Dos@100 10 10 10 - (10)
98 Kalsium Hidroksida Pasta ( Hydcal ) 1 Tube / Tube 1 1 1 - (1)
99 Klorfenol Kamfer Menthol (CHKM) Botol 10 ml - - - - -
100 Micro Aplicator Bruss Disposible Botol 1 1 1 - (1)
101 Mummifying Pasta 1 Botol / Botol - - - - -
102 Komposit Monohyrid warna A 3.5 1 Kotak / Kotak 1 1 1 - (1)
103 Komposit Monohyrid warna A 3 1 Kotak / Kotak 1 1 1 - (1)
105 Panaspray Oil 1 Botol / Botol - - - - -
106 Pulperyl 1 Botol / Botol - - - - -
107 Scandonest 2% 1 Pcs / Pcs - - - - -
108 Spon Gelatin Cubicles 1x1x1 cm - - - - -
109 Semen Seng Fospat serb dan cairan ( Dorident ) Set @ 30 gr/ Btl - - - - -
110 Silver Amalgam Serbuk 65-75 % 1 oz / Botol - - - - -
111 Tropicaina Anestesi Tube 15 mg - - - - -
112 Temporary Stopping Fletcher (Fletcher) serbuk Set @ 100 gr / Btl - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
IV Obat Injeksi - - - - -
113 Aminofilina Inj. 24 mg/ml - 10 ml 30 Ampul / Kotak - - - - -
114 Ampisillin serbuk inj. (IM/IV) 1000 mg 1 Vial / Vial - - - - -
115 Antalgin injeksi 250 mg/ml-2ml 30 Ampul / Kotak - - - - -
116 Asam Tranexamat Injeksi 250 mg / 5 ml 10 Ampul / kotak 5 5 5 - (5)
117 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ( 2013 ) 30 Ampul / Kotak 20 20 20 - (20)
118 Aqua pro injeksi steril , bebas pirogen 1 Vial / Vial 7 7 7 - (7)
119 Combivent 2,5 Nebulizer 20 pcs / Box - - - - -
120 Deksametason injeksi 5 mg/ml- 1 ml 100 Ampul / Kotak 13 13 1 12 2 (10)
121 Difenhidramin HCL inj 10 mg/ml- 1 ml 30 Ampul / Kotak 24 24 24 - (24)
122 Epinefrina HCL/Bitartrat ( Epinefrina/adrinalina ) 30 Ampul / Ampul - - - - -
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 8 8 5 3 12
124 Furosemid injeksi 25 Ampul / ktk - - - - -
125 Gentamicin Injeksi 80 mg/2ml 5 Ampul / Kotak - - - - -
126 Ketorolac injeksi 10 mg 6 Ampul @ 1 ml - - - - -
127 Kloroquin injeksi 100 Ampul / Kotak - - - - -
128 Kuinin Dihidroksida injeksi 25 % - 2 ml 30 Ampul / Kotak - - - - -
129 Lidokain komp. Injeksi,kombinasi 30 Ampul / Kotak 28 28 7 21 16 (5)
Lidokain HCl 2% + Epinefrin 1 : 80.000-2ml
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 36 36 32 4 74
131 Magnesium Sulfat inj. (IV) 20%-25ml 10 Vial / kotak - - - - -
133 Metamizole 500mg Injeksi 5 ampul / kotak - - - - -
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak 13 13 13 - (13)
135 Metochlopramid Inj 5 mg/ml 10 Ampul / Kotak - - - - -
136 Neurotropik Vitamin (Neurobat) Injeksi 1 Ampul / Ampul - - - - -
137 Ondansetron 4 mg/ 2 ml Injeksi 5 Ampul / Kotak - - - - -
138 Oksitetrasiklin HCL Injeksi i.m 50 mg/ml-10 ml ktk 10 vial - - - - -
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak - - - - -
140 Pehacain Injeksi 10 Ampul / kotak - - - - -
141 Piracetam Injeksi 1 gr/5ml 10 ampul / Kotak - - - - -
143 Prokain Benziloenicillin G 3jt UI/Vial ktk 30 vial @15 ml 16 16 16 - - -
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak 12 12 2 10 5 (5)
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 12 12 4 8 9
146 Sefotaksim inj 1 gr 1 Vial / Vial - - - - -
147 Seftazidim injeksi 1 gr 2 Vial/ktk - - - - -
148 Seftriaxone injeksi 1 gr kotak 2 vial - - - - -
149 Sianokobalamin (vit.B12) injeksi 500 mcg/ml-1ml 100 Ampul / Kotak 129 129 129 - (129)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
150 Tiamin HCL (vit.B1) injeksi 100 mg/ml-1ml 30 Ampul / Kotak - - - - -
151 Tramadol injeksi 50 mg/ml 5 Ampul / Kotak - - - - -
- - - - -
V Syrup - - - - -
152 Albendazol Syrup Botol - - - - -
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml 99 99 10 89 23 (66)
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 118 118 24 94 55 (39)
155 Ampisillin sirup kering 125mg/5ml Botol 60 ml - - - - -
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 21 21 20 1 46
157 Apialys Drop / Truvit Botol - - - - -
158 Cetirize Syrup Botol - - - - -
159 Dexrofen Syrup Botol - - - - -
160 Dekstrometorpan sirup 10 mg/5 ml Botol 60 ml - - - - -
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 51 51 6 45 14 (31)
162 Domperidon Drop ( 2014 ) Botol 2 2 2 - (2)
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 64 64 29 35 67
164 Ibuprofen Syrup 200 mg/ 5 ml Botol 60 ml - - - - -
165 Erytromicin sirup 200 mg/5 ml Botol 60 ml 6 6 6 - (6)
166 Kaolin Pectin Syrup/ Guanistrep Syrup Botol - - - - -
167 Kloramfenicol suspensi 125 mg/5ml ( 2013 ) Botol 60 ml - - - - -
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Botol 60 ml 59 59 4 55 9 (46)
Trimetoprim 40 mg / 5 ml
169 Laksatif Syrup (Laxadine) Botol - - - - -
170 Mebendazol sirup 100 mg/5 ml (Obat Cacing Anak) btl 30 ml - - - - -
171 Metochlopramid Sirup 5 mg/ml Botol 60 ml - - - - -
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 20 20 12 8 28
173 Obat Batuk Hitam (OBH) cairan Botol 100 ml 21 21 21 - (21)
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 39 39 39 - (39)
175 Parasetamol drops Botol 11 11 11 - (11)
176 Pyrantel Suspensi 10 ml Botol - - - - -
177 Recovital Syrup Botol - - - - -
178 Sefadroksil sirup ( 2013 ) Btl 60 ml 38 38 5 33 12 (22)
179 Sefadroksil Forte sirup Btl 60 ml - - - - -
180 Sefiksim dry sirup Botol 30 ml - - - - -
181 Zinc Syr 20 mg / 5 ml Btl 60 ml - - - - -
- - - - -
VI Cairan - - - - -
182 Aquadest Steril Infus Botol 500 ml - - - - -
183 Dextrose 5 1/2 N S Btl 500 ml - - - - -
185 Etakridina (Rivanol) larutan 0.1 % Botol 300 ml 1 1 1 - (1)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
186 Etanol 70 % Botol 1000 ml 2 2 2 - (2)
187 Etanol 70 % Botol 100 ml 6 6 6 - (6)
188 Glukosa larutan infus 5 % steril Botol / Plastik 500 ml 54 54 19 35 44
189 Glukosa larutan infus 10 % steril Botol / Plastik 500 ml - - - - -
190 Ka-en 3B Infus Botol 500 mg - - - - -
191 Lisol,mengandung kresol tersabun 50 % Botol 1000 ml 5 5 5 - (5)
192 Metronidazol infus 500 mg/100 ml 100 ml / Botol - - - - -
193 Natrium Klorida larutan infus 0,9 % steril Botol / 500 ml 16 16 16 - (16)
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml 7 7 7 - 16
195 TetraHES larutan Infus 1 Pack / Pack - - - - -
- - - - -
VII Obat Luar (Salep & Tetes) - - - - -
196 Anti Bakteri DOEN salep kombinasi: 25 Tube 5 g / Ktk - - - - -
197 Anti Hemaroid DOEN Kombinasi 10 Supp / Kotak 28 28 5 23 12 (12)
198 Antifungi DOEN kombinasi: 24 Pot 30 g / Ktk - - - - -
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 21 21 4 17 9 (8)
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml 10 10 8 2 18
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 38 38 33 5 76
202 Bioplacenton cream 1 Tube / Tube - - - - -
203 Desoksimethasone 0,25% Cream 1 Tube / Tube - - - - -
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml 30 30 8 22 18 (4)
205 Gentamicin Salep Kulit 1 Tube / Tube 30 30 12 18 28
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube - - - - -
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml 18 18 6 12 14
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak - - - - -
209 Ketokonazole Cream 2 % Tube 15 mg 17 17 15 2 35
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak 30 30 2 28 5 (23)
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 12 12 5 7 12
212 Kloramfenicol salep mata 1 % 5 gr / Tube - - - - -
213 Litrol Tetes Mata/ Kortikosteroid Botol - - - - -
214 Levetran Salep / Minyak Ikan Pot - - - - -
215 Lidocain Jelly 2% (Xylocaine 2%) 1 Pcs / Pcs - - - - -
216 Minyak Angin Safe Care Botol - - - - -
217 Miconazol cream 2 % ( 2013 ) 24 Tube @ 10 mg 5 5 5 - (5)
218 Mydric Tetes Mata botol - - - - -
219 Oksitetrasiklin HCL salep mata 1 % ( 2013 ) 25 Tube / Kotak - - - - -
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak - - - - -
221 Pilocarpine Tetes Mata Botol - - - - -
222 Polidemisin Tetes Mata Botol - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
223 Polikresulen (Kondensasi Metakresol Sulfonat dan Botol 10 ml - - - - -
Metanol), Albothyl
224 Povidon Iodida 10 % Botol 30 ml 26 26 4 22 9 (13)
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml 35 35 7 28 16 (12)
226 Povidon iodida 10% Botol 300 ml - - - - -
227 Povidon iodida 10% Botol 1000 ml 16 16 16 - (16)
228 Salep 2-4 kombinasi: Asam 24 Pot @ 30 g / Kotak 49 49 20 29 46
Salisilat 2% + Belerang endap 4%
229 Salisil Bedak 2 % 50 Gram / Kotak 30 30 10 20 23
230 Scabicid Cream Tube 15 mg - - - - -
231 Sulfasetamida Natrium tetes mata 15 % 24 Btl @ 5 ml / Kotak - - - - -
232 Trombophop Gel Tube 15 mg 2 2 1 1 2
233 Temefos 1% Bungkus / 1 kg - - - - -
234 Tetracain Tetes Mata Botol - - - - -
235 Timolol Tetes Mata Botol - - - - -
236 Voltadex Gel 1 Tube / Tube - - - - -
237 Voltaren Gel 1 Tube / Tube - - - - -
- - - - -
VIII Obat-Obatan - - - - -
238 Albendazol tablet 400 mg ktk 5 x 6 tablet - - - - -
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk 295 295 60 235 138 (97)
240 Alopurinol tablet 300 mg ( 2013 ) Ktk 3 x 10 tablet - - - - -
241 Ambroxol Tablet 30 mg 100 Tab / Kotak 4,970 4,970 363 4,607 835 (3,772)
242 Aminofilin tablet 200 mg 100 Tablet / Botol 1,000 1,000 1,000 - (1,000)
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak 305 305 115 190 265
244 Amoksisillin kapsul 250 mg 120 Tab/ktk 848 848 131 717 301 (416)
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 966 966 475 491 1,093
246 Antalgin (Metampiron) tablet 500 mg 100 Tablet / Kotak - - - - -
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 100 100 100 - (100)
Mg Hidroksida 200 mg + Al Hidroksida
248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -
Sulfadoxin 500mg
249 Asam Asetilsalisilat 80mg Tab 100 Tablet / kotak - - - - -
250 Asetosal 100 mg (Asam Asetilsalisilat) 100 Tablet / kotak - - - - -
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 898 898 139 759 320 (439)
252 Amlodipine 5 mg ( 2013 ) 30 Tablet / Kotak 210 210 160 50 368
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol 380 380 60 320 138 (182)
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 546 546 546 - (546)
255 Asam Tranexamat Tablet 500 mg 100 tablet / kotak - - - - -
256 Asiclovir 200 mg 100 Tablet/ ktk 1,300 1,300 1,300 - (1,300)
257 Asiclovir 400 mg 100 Tab/ktk 243 243 75 168 173
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
258 Asifit Kaplet 100 Tab/Ktk - - - - -
259 Attapulgit 50 Tab/ktk 1,300 1,300 40 1,260 92 (1,168)
260 Attapulgit + Pectin Tablet (Kombinasi) 100 Tablet/ ktk - - - - -
261 Atropin Sulfat tablet 0,5 mg 500 Tablet / Botol - - - - -
262 Betahistin Mesilat 5 mg 30 tablet / kotak 1,064 1,064 90 974 207 (767)
263 Bisacodil Tablet Kotak / 18 Tablet 18 18 4 14 9 (5)
264 Bisoprolol tablet 5 mg Ktk 3 x 10 tablet - - - - -
265 Bromhexin Tablet 100 tablet / kotak 600 600 600 - (600)
266 Captopril tablet 25 mg 100 tablet / kotak 1,680 1,680 1,680 - (1,680)
267 Captopril tablet 12,5 mg 100 Tablet / kotak 2,154 2,154 180 1,974 414 (1,560)
268 Cetop Zink 100 Tablet / kotak - - - - -
269 Cetrizine 10 mg 50 Tablet/ ktk 1,627 1,627 165 1,462 380 (1,083)
270 Cimetidin tablet 200 mg 100 tablet / kotak 1,245 1,245 20 1,225 46 (1,179)
271 Ciprovloxsacin 500 mg 100 tablet / kotak 510 510 150 360 345 (15)
272 Clindamisin 150 mg Kapsul 50 Kapsul / kotak - - - - -
274 Clonidin 0,15 mg 100 tablet / kotak - - - - -
275 Curcuma Tablet 100 tablet / kotak - - - - -
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 813 813 464 349 1,067
277 Dekstrometorpan tablet 15 mg 100 tablet / kotak - - - - -
278 Dietilkarbamazin sitrat tablet 100 mg 100 Tablet / kotak - - - - -
279 Digoksin tablet 0,25 mg 100 Tablet / Botol - - - - -
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 1,920 1,920 1,920 - (1,920)
281 Dimenhidrinat tab 50 mg 100 Tab / Botol - - - - -
282 Doksisiklin kapsul 100 mg 100 kapsul / kotak - - - - -
283 Domperidon Tablet 10 mg 100 Tablet / Ktk 740 740 30 710 69 (641)
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 160 160 35 125 81 (45)
285 Erytromisin Kapsul 250 mg 100 tab / Kotak - - - - -
286 Ekstrak Belladon tablet 10 mg 1000 Tablet / Botol - - - - -
287 Etambutol HCL tablet 250 mg 200 Tablet / kotak - - - - -
288 Famotidin 20 mg 50 Tablet / Kotak - - - - -
289 Fenilbutazon/Novazon 1000 Tablet / Botol - - - - -
290 Fenitoin Natrium kapsul 30 mg 250 Kapsul / Botol - - - - -
292 Fitomenadion (Vit K) tablet salut gula 10 mg 100 Tablet / Botol 990 990 35 955 81 (875)
293 Furosemid tablet 40 mg ( 2013 ) 100 Tablet / Kotak 555 555 20 535 46 (489)
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak 1,362 1,362 30 1,332 69 (1,263)
295 Gemfibrozil 300 mg 120 kaps / kotak - - - - -
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 1,570 1,570 250 1,320 575 (745)
298 Glimepiride tablet 1 mg 50 Tablet / Kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
299 Glimepiride tablet 2 mg 50 Tablet / Kotak 350 350 350 - (350)
301 Gliquidon tablet 30 mg 100 tablet / kotak - - - - -
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 2,110 2,110 246 1,864 566 (1,298)
303 Griseofulvin tablet 125 mg, micronizet 100 Tablet / Botol - - - - -
304 Hidroclortiazid ( HCT ) tablet 25 mg 1000 Tablet / Botol - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
305 Hyosine-N-Butilbromid 10 mg 100 Tablet / Kotak - - - - -
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 1,960 1,960 470 1,490 1,081 (409)
307 Ibuprofen tablet 400 mg 100 Tablet / Botol - - - - -
308 Inlacta DHA 30 Softcapsul / Kotak - - - - -
309 Isoniazide 100 mg 1000 tab / Botol - - - - -
310 Isosorbid dinitrat tablet sublingual 5 mg 100 Tablet / Botol 1,140 1,140 1,140 - (1,140)
311 Kalium permanganat serbuk 25 Botol / 5 gram - - - - -
312 Kalium Diklopenak 50 mg 50 Tablet / Kotak 1,000 1,000 1,000 - (1,000)
313 Kalium Diklopenak 25 mg 50 Tablet / Kotak 300 300 300 - (300)
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 2,725 2,725 1,210 1,515 2,783
315 Ketokonazole 200 mg 50 Tablet / Kotak 870 870 80 790 184 (606)
316 Ketoprofen Tab 100 mg 100 Tab / Kotak 100 100 100 - (100)
317 Kloramfenikol kapsul 250 mg 250 Kapsul / Botol - - - - -
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol 2,264 2,264 374 1,890 860 (1,030)
319 Kloroquin tablet 150 mg 1000 Tablet / Botol - - - - -
320 Kotrimoksazol tablet komb: sulfametoksazol 400 mg + 100 Tablet / Botol 1,905 1,905 50 1,855 115 (1,740)
Trimetoprim 80tablet
Kotrimoksazol mg pedriatik kombinasi:
321 Sulfametoksazol 100 mg + Trimetoprim 20 mg 100 Tablet / Botol - - - - -
322 Klokuin tablet 250 mg 1000 Tablet / Botol 500 500 500 - (500)
323 Kuinin sulfat tablet 222 mg(7 H2O) 1000 Tablet/botol - - - - -
324 Kuinin (kina) tablet 200 mg 60 Tab / ktk - - - - -
325 Lanzoprazole kaps 30 mg ( 2013 ) 20 kapsul / kotak 360 360 360 - (360)
326 Levofloxacin 500 mg 50 tablet / kotak - - - - -
327 Lodecon tablet (Obat Flu Kombinasi) Tablet - - - - -
328 Loperamid tablet 2 mg ( Novadium ) 100 tablet / kotak 520 520 520 - (520)
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 700 700 115 585 265 (321)
330 Magnesium Sulfat serbuk 30 gram 10 Sase / Kotak - - - - -
331 Mebendazol tablet 100 mg 30 Tab/ktk - - - - -
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 1,060 1,060 1,060 - (1,060)
333 Meloxicam 15 mg ( 2013 ) 50 Tablet/ Kotak - - - - -
334 Metformin tab 500 mg 100 tablet / kotak 700 700 100 600 230 (370)
335 Metformin tab 850 mg 100 tablet / kotak 465 465 120 345 276 (69)
336 Metil Ergometrin Maleat Tab.sal 0,125 mg 100 Tab/ktk 328 328 328 - (328)
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 2,000 2,000 40 1,960 92 (1,868)
338 Metochlopramid tablet 10 mg 100 tablet / kotak 320 320 100 220 230
339 Metronidazol tablet 250 mg 100 Tablet / Botol - - - - -
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak 770 770 185 585 426 (160)
341 Mineral Mix ktk 40 sachet - - - - -
342 Multivitamin Tablet 100 tablet / kotak - - - - -
343 Multivitamin Antioksidan Tablet (Univoxy) 30 Tablet / kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
344 Multivitamin Lansia (Pehavral) 30 Tablet / Botol - - - - -
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 350 350 325 25 748
346 Multivitamin penambah kalsium 100 Tablet / Kotak - - - - -
347 Natural Anti inflamasi Tablet 60 Tablet / kotak - - - - -
348 Natrium Bikarbonat tablet 500 mg 1000 Tablet / Botol - - - - -
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 2,000 2,000 140 1,860 322 (1,538)
350 Natrium diklofenak tablet 50 mg 50 Tablet/ ktk - - - - -
351 Neurotropik Vitamin 100 Tab / ktk - - - - -
352 Nipedipin tablet 10 mg 100 tablet / kotak 2,665 2,665 20 2,645 46 (2,599)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
353 Nistatin tablet salut 500.000 IU 100 Tab/ktk - - - - -
354 Nistatin tablet vaginal 100.000 IU/g 100 Tab/ktk - - - - -
355 Noza - - - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak 864 864 864 - (864)
357 Ofloxacin 400 mg tab 50 kaps / Kotak - - - - -
358 Paraformaldehid tablet 1 gram 100 Tablet / Botol - - - - -
359 Parasetamol tablet 100 mg 100 Tablet / Botol - - - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 2,415 2,415 1,154 1,261 2,654
361 Papaverin Tablet 40 mg btl 1000 tab - - - - -
362 Pharmaton Formula - - - - -
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak - - - - -
365 Pirantel tablet 125 mg 60 Tab/ktk 79 79 67 12 154
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 1,122 1,122 570 552 1,311
367 Piroksikam kapsul 10 mg ( 2013 ) 120 / Kotak 10 10 10 - (10)
368 Prednison tablet 5 mg 1000 Tablet / Botol 1,090 1,090 114 976 262 (714)
369 Propiltiourasil tablet 100 mg 100 Tablet / Botol 453 453 94 359 216 (143)
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 454 454 454 - (454)
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 1,442 1,442 157 1,285 361 (924)
372 Reserpin tablet 0,10 mg 250 Tablet / Botol - - - - -
374 Retinol (Vitamin A) kapsul 100.000 IU 50 kaps / Botol - - - - -
375 Retinol (Vitamin A) 200.000 IU kapsul lunak 50 kaps / Botol - - - - -
376 Retinol tablet 50000 IU 1000 Tablet / Botol - - - - -
377 Rifampisin kapsul 300 mg 120 Kapsul / Kotak - - - - -
378 Rifampisin kaplet 450 mg 100 Kaplet / Kotak - - - - -
380 Salbutamol tablet 2 mg 100 tablet / kotak 651 651 651 - (651)
381 Salbutamol tablet 4 mg 100 tablet / kotak 617 617 75 542 173 (370)
382 Sangobion - - - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 580 580 110 470 253 (217)
384 Sefiksim kaps 100 mg 50 kaps / ktk - - - - -
385 Sianokobalamin (vitamin B12) Tablet 50 mcg btl 1000 tab 1,050 1,050 1,050 - (1,050)
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 755 755 185 570 426 (145)
387 Spiramisin tab 500 mg 50 Tablet/ ktk - - - - -
388 Spironolakton tab 25 mg 100 Tab / Kotak - - - - -
390 Sulfadimidin tablet 500 mg 1000 Tablet / Botol - - - - -
391 Tablet tambah darah kombinasi Tablet - - - - -
392 Tetrasiklin HCL kapsul 250 mg 1000 Kapsul / Botol - - - - -
393 Tetrasiklin HCL kapsul 500 mg 100 Kaps/,ktk - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
394 Tensigard - - - - -
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol 2,103 2,103 2,103 - (2,103)
396 Thiamfenicol 500 mg 100 kaps / ktk 188 188 15 173 35 (139)
397 Tramadol tab 50 mg 50 tab / kotak 70 70 40 30 92
398 Vitamin B Kompleks 1000 Tablet / Botol 570 570 530 40 1,219
399 Zink Tablet 20 mg 100 Tab / ktk 1,035 1,035 50 985 115 (870)
- - - - -
IX Serum & Vaksin - - - - -
400 Serum anti Bisa Ular Polivalen injeksi 5 ml ( ABU I ) 1 Vial / Kotak - - - - -
401 Serum anti Bisa Ular Polivalen injeksi 50 ml ( ABU II ) 1 Vial / Kotak - - - - -
402 Serum Anti Difteri inj. 20.000 IU/Vial (A.D.S) 10 Vial / Kotak - - - - -
403 Serum Anti Tetanus injeksi 1.500 IU/amp (ATS) 1 Ampul / Kotak - - - - -
404 Serum Anti Tetanus injeksi 20.000 IU/Vial(ATS) 1 Vial / Kotak - - - - -
405 Vaksin Rabies Vero 1 Vial / Kotak - - - - -
- - - - -
X Psikotropika - - - - -
406 Alprazolam 0,5 mg 100 tablet / kotak - - - - -
407 Amitriptillin
Antimigren :HCL tablet salut 25 mg 100 Tab/ktk 180 180 10 170 23 (147)
408 Ergotamin Tartrat 1mg + Kofein 50mg 100 Tablet / Botol - - - - -
409 Clobazam tab 10 mg 100 tablet / kotak - - - - -
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak - - - - -
411 Diazepam tablet 2 mg btl 100 Tablet 238 238 9 229 21 (208)
412 Diazepam tablet 5 mg 1000 Tablet / Botol - - - - -
413 Diazepam Rectal 5 mg / ml Tube 9 9 9 - (9)
414 Diazepam Rectal 10 mg / ml Tube - - - - -
415 Efedrin HCL tablet 25 mg 250 Tablet / Btl - - - - -
416 Fenitoin Natrium injeksi 50 mg/ml Ampul @ 2 ml - - - - -
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak - - - - -
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 39 39 39 - 90
419 Fenobarbital tablet 100 mg 250 tablet / Botol - - - - -
420 Flufenazine Inj (Sikzonoate) 25 mg/ml 1 Ampul / Ampul - - - - -
421 Fluoksetine 10 mgTablet Box 30's - - - - -
422 Haloperidol tablet 0.5 mg 100 Tab/ktk - - - - -
423 Haloperidol tablet 1.5 mg 100 Tab/ktk 333 333 333 - (333)
424 Haloperidol tablet 5 mg 100 Tab/ktk - - - - -
425 Haloperidol 50 mg/ ml Inj Dus 5 Ampul @ 1 ml - - - - -
426 Karbamazepin tablet 200 mg 100 Tab/ktk 1,000 1,000 1,000 - (1,000)
427 Klorpromazen HCL injeksi 25 mg/ml-1ml 30 Ampul / Kotak 5 5 5 - (5)
428 Klorpromazen HCL tablet salut 25 mg 1000 Tablet / Botol 523 523 523 - (523)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
430 Klozapin 25 mg Kotak 5 x 10 tab - - - - -
431 Risperidon 2 mg Kotak 5 x 10 Tab 200 200 200 - (200)
432 Triheksifenidil Hidroklorida tablet 2 mg 100 Tab / ktk 41 41 41 - (41)
- - - - -
XI Narkotika - - - - -
433 Codeine 10 mg Box / 100 - - - - -
UMUM PERSED. OBAT Rp 21,690,285

JUMLAH KUNJUNGAN RESEP TIDAK BAYAR BAYAR PERSED. GENERIK Rp 20,283,385
332 TOTAL PERSEDIAAN Rp 38,835,707
JUMLAH R/ TOTAL 758
Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Petugas GFK Pimpinan Puskesmas Petugas Puskesmas
Jayosno, S.Kep.MM Arifah Rahayu

NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
21,690,285.46
20,283,385.46
38,835,707.46
KECAMATAN : Pugaan PELAPORAN BULAN/PERIODE : MARET 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : APRIL 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
1 Alat Suntik sekali pakai 1 ml 100 set / kotak 82 82 82 - (82)
7 Bisturi 1 Pcs / Pcs 28 28 28 - (28)
21 Infusion set anak Set / kantong 23 23 23 - (23)
22 Infusion set dewasa Set / kantong 44 44 44 - (44)
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak 16 16 16 - (16)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
36 Plester 5 yards x 2 inch Rol 18 18 18 - (18)
40 Sarung Tangan STERIL S (6) Bks - - - - 30
41 Sarung Tangan STERIL M (7) Bks - - - - 30
42 Sarung Tangan STERIL L (8) Bks - - - - 30
43 Sarung tangan Non Steril No S 50 Psg / Kotak - - - - -
45 Sarung tangan Non Steril No L 50 Psg / Kotak 200 200 200 - (200)
63 Surgical Masker Ear Loop 3 Ply ( 2013 ) 50 Pcs / kotak 56 56 56 - (56)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
78 Bonding ktk 1 1 1 - (1)
86 ETSA Botol - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
120 Deksametason injeksi 5 mg/ml- 1 ml 100 Ampul / Kotak 12 12 12 - (12)
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 3 3 1 2 2 30
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
129 Lidokain komp. Injeksi,kombinasi 30 Ampul / Kotak 21 21 21 - (21)
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 4 4 4 - 30
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak 13 13 2 11 5 (6)
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak - - - - 100
140 Pehacain Injeksi 10 Ampul / kotak - - - - -
143 Prokain Benziloenicillin G 3jt UI/Vial ktk 30 vial @15 ml - - - - -
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak 10 10 7 3 16 15
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 8 8 2 6 5 (1)
- - - - -
V Syrup - - - - -
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 94 94 94 - (94)
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 1 1 1 - 2 90
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
162 Domperidon Drop ( 2014 ) Botol 2 2 2 - (2)
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 35 35 14 21 32 30
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 8 8 2 6 5 (1)
173 Obat Batuk Hitam (OBH) cairan Botol 100 ml 21 21 21 - 48 60
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 39 39 39 - 90 90
175 Parasetamol drops Botol 11 11 11 - 25 200
178 Sefadroksil sirup ( 2013 ) Btl 60 ml 33 33 33 - (33)
- - - - -
VI Cairan - - - - -
185 Etakridina (Rivanol) larutan 0.1 % Botol 300 ml 1 1 1 - 2
186 Etanol 70 % Botol 1000 ml 2 2 2 - 5 5
187 Etanol 70 % Botol 100 ml 6 6 6 - (6)
188 Glukosa larutan infus 5 % steril Botol / Plastik 500 ml 35 35 35 - (35)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml - - - - 60
- - - - -
197 Anti Hemaroid DOEN Kombinasi 10 Supp / Kotak 23 23 23 - (23)
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 17 17 7 10 16 60
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml 2 2 2 - (2)
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 5 5 5 - 12 100
205 Gentamicin Salep Kulit 1 Tube / Tube 18 18 16 2 37 100
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml 12 12 12 - (12)
209 Ketokonazole Cream 2 % Tube 15 mg 2 2 2 - 5 100
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 7 7 6 1 14 30
217 Miconazol cream 2 % ( 2013 ) 24 Tube @ 10 mg 5 5 5 - 12 100
219 Oksitetrasiklin HCL salep mata 1 % ( 2013 ) 25 Tube / Kotak - - - - 100
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak - - - - 100
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
224 Povidon Iodida 10 % Botol 30 ml 22 22 22 - (22)
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml 28 28 28 - (28)
228 Salep 2-4 kombinasi: Asam 24 Pot @ 30 g / Kotak 29 29 29 - (29)
229 Salisil Bedak 2 % 50 Gram / Kotak 20 20 10 10 23 30
231 Sulfasetamida Natrium tetes mata 15 % 24 Btl @ 5 ml / Kotak - - - - 24
232 Trombophop Gel Tube 15 mg 1 1 1 - (1)
- - - - -
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk 235 235 235 - (235)
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak 190 190 190 - (190)
244 Amoksisillin kapsul 250 mg 120 Tab/ktk 717 717 717 - (717)
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 491 491 391 100 899 5,000
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 100 100 100 - 230 5,000

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 759 759 184 575 423 (152)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 546 546 236 310 543 3,000
257 Asiclovir 400 mg 100 Tab/ktk 168 168 165 3 380 500
262 Betahistin Mesilat 5 mg 30 tablet / kotak 974 974 974 - (974)
263 Bisacodil Tablet Kotak / 18 Tablet 14 14 14 - (14)
265 Bromhexin Tablet 100 tablet / kotak 600 600 150 450 345 (105)
266 Captopril tablet 25 mg 100 tablet / kotak 1,680 1,680 660 1,020 1,518 3,000
269 Cetrizine 10 mg 50 Tablet/ ktk 1,462 1,462 1,462 - (1,462)
270 Cimetidin tablet 200 mg 100 tablet / kotak 1,225 1,225 100 1,125 230 (895)
271 Ciprovloxsacin 500 mg 100 tablet / kotak 360 360 180 180 414 3,000
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 349 349 349 - 803 5,000
283 Domperidon Tablet 10 mg 100 Tablet / Ktk 710 710 600 110 1,380 1,000
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 125 125 10 115 23 1,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak 1,332 1,332 1,332 - (1,332)
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 1,320 1,320 200 1,120 460 (660)
299 Glimepiride tablet 2 mg 50 Tablet / Kotak 350 350 110 240 253 1,000
300 Glimepiride tablet 4 mg 50 Tablet / Kotak 565 565 290 275 667 1,000
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 1,864 1,864 343 1,521 789 (732)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 1,490 1,490 149 1,341 343 (998)
307 Ibuprofen tablet 400 mg 100 Tablet / Botol - - - - 3,000
312 Kalium Diklopenak 50 mg 50 Tablet / Kotak 1,000 1,000 1,000 - (1,000)
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 1,515 1,515 205 1,310 472 (839)
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol 1,890 1,890 325 1,565 748 (818)
325 Lanzoprazole kaps 30 mg ( 2013 ) 20 kapsul / kotak 360 360 5 355 12 (344)
328 Loperamid tablet 2 mg ( Novadium ) 100 tablet / kotak 520 520 20 500 46 (454)
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 1,060 1,060 257 803 591 (212)
334 Metformin tab 500 mg 100 tablet / kotak 600 600 180 420 414 2,000
335 Metformin tab 850 mg 100 tablet / kotak 345 345 325 20 748 2,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 1,960 1,960 470 1,490 1,081 (409)
338 Metochlopramid tablet 10 mg 100 tablet / kotak 220 220 10 210 23 (187)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak 585 585 85 500 196 (305)
344 Multivitamin Lansia (Pehavral) 30 Tablet / Botol - - - - 1,000
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 25 25 25 - 58 3,000
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 1,860 1,860 230 1,630 529 (1,101)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
352 Nipedipin tablet 10 mg 100 tablet / kotak 2,645 2,645 2,645 - (2,645)
355 Noza - - - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak 864 864 146 718 336 (382)
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 1,261 1,261 882 379 2,029 5,000
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak - - - - 3,000
365 Pirantel tablet 125 mg 60 Tab/ktk 12 12 12 - (12)
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 552 552 21 531 48 (483)
368 Prednison tablet 5 mg 1000 Tablet / Botol 976 976 346 630 796 166
369 Propiltiourasil tablet 100 mg 100 Tablet / Botol 359 359 359 - (359)
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 1,285 1,285 170 1,115 391 (724)
382 Sangobion - - - - -
385 Sianokobalamin (vitamin B12) Tablet 50 mcg btl 1000 tab 1,050 1,050 465 585 1,070 485
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 570 570 210 360 483 123
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
391 Tablet tambah darah kombinasi Tablet - - - - -
394 Tensigard - - - - -
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol 2,103 2,103 103 2,000 237 (1,763)
397 Tramadol tab 50 mg 50 tab / kotak 30 30 10 20 23 3
398 Vitamin B Kompleks 1000 Tablet / Botol 40 40 40 - 92 5,000
399 Zink Tablet 20 mg 100 Tab / ktk 985 985 35 950 81 (870)
- - - - -
- - - - -
407 Amitriptillin HCL tablet salut 25 mg 100 Tab/ktk 170 170 10 160 23 (137)
Antimigren :
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak - - - - -
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol - - - - 500
426 Karbamazepin tablet 200 mg 100 Tab/ktk 1,000 1,000 50 950 115 (835)
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

JUMLAH R/ TOTAL 762

Kepala Dinas Kesehatan Petugas GFK Pimpinan Puskesmas Petugas Puskesmas
Kabupaten Tabalong
Jayosno, S.Kep.MM Arifah Rahayu

NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
98,017,801.43
97,892,707.90
46,013,293.21
PUSKESMAS : PUGAAN DOKUMEN NOMOR
KECAMATAN : PUGAAN PELAPORAN BULAN/PERIODE : APRIL 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : MEI 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
7 Bisturi 1 Pcs / Pcs 28 28 28 - (28)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
40 Sarung Tangan STERIL S (6) Bks - 30 30 30 - (30)
41 Sarung Tangan STERIL M (7) Bks - 30 30 30 - (30)
42 Sarung Tangan STERIL L (8) Bks - 30 30 30 - (30)
43 Sarung tangan Non Steril No S 50 Psg / Kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
78 Bonding ktk 1 1 1 - (1)
86 ETSA Botol - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 2 30 32 32 - (32)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 4 30 34 34 - (34)
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak 11 11 11 - (11)
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak - 100 100 100 - (100)
140 Pehacain Injeksi 10 Ampul / kotak - 100 100 100 - (100)
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak 3 15 18 18 - (18)
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 6 6 6 - (6)
- - - - -
V Syrup - - - - -
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 94 94 42 52 97
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml - 100 100 11 89 25 (64)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 42 42 42 - (42)
162 Domperidon Drop ( 2014 ) Botol 2 2 1 1 (1)
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 21 50 71 10 61 23 (38)
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 6 6 2 4 5
173 Obat Batuk Hitam (OBH) cairan Botol 100 ml - - - - -
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml - 100 100 2 98 5 (93)
175 Parasetamol drops Botol - 168 168 21 147 48 (99)
- - - - -
VI Cairan - - - - -
185 Etakridina (Rivanol) larutan 0.1 % Botol 300 ml - - - - -
186 Etanol 70 % Botol 1000 ml - 5 5 5 - (5)
187 Etanol 70 % Botol 100 ml 6 6 6 - (6)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml - 60 60 60 - (60)
- - - - -
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 10 50 60 60 - (60)
201 Betametason krim 0.1% ktk 25 tube @ 5 gram - 100 100 100 - (100)
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml 18 18 18 - (18)
205 Gentamicin Salep Kulit 1 Tube / Tube 2 100 102 102 - (102)
209 Ketokonazole Cream 2 % Tube 15 mg - 100 100 100 - (100)
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak 26 26 26 - (26)
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 1 30 31 31 - (31)
217 Miconazol cream 2 % ( 2013 ) 24 Tube @ 10 mg - 96 96 96 - (96)
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak - 100 100 100 - (100)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
229 Salisil Bedak 2 % 50 Gram / Kotak 10 20 30 30 - (30)
- - - - -
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk 235 235 185 50 426
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 100 5,000 5,100 30 5,070 69 (5,001)
247 Antasida DOEN tab kombinasi : 100 tablet / kotak - 5,000 5,000 630 4,370 1,449 (2,921)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 575 575 575 - (575)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol 290 290 220 70 506
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 310 3,000 3,310 350 2,960 805 (2,155)
257 Asiclovir 400 mg 100 Tab/ktk 3 500 503 23 480 53 (427)
259 Attapulgit 50 Tab/ktk 1,220 1,220 1,220 - (1,220)
266 Captopril tablet 25 mg 100 tablet / kotak 1,020 3,000 4,020 430 3,590 989 (2,601)
267 Captopril tablet 12,5 mg 100 Tablet / kotak 1,814 1,814 294 1,520 676 (844)
269 Cetrizine 10 mg 50 Tablet/ ktk 1,462 1,462 153 1,309 352 (957)
270 Cimetidin tablet 200 mg 100 tablet / kotak 1,125 1,125 1,125 - (1,125)
271 Ciprovloxsacin 500 mg 100 tablet / kotak 180 3,000 3,180 3,180 - (3,180)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak - 5,000 5,000 579 4,421 1,332 (3,089)
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 1,920 1,920 205 1,715 472 (1,244)
283 Domperidon Tablet 10 mg 100 Tablet / Ktk 110 500 610 610 - (610)
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 115 1,000 1,115 1,115 - (1,115)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
293 Furosemid tablet 40 mg ( 2013 ) 100 Tablet / Kotak 505 505 505 - (505)
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 1,120 1,120 350 770 805
299 Glimepiride tablet 2 mg 50 Tablet / Kotak 240 240 30 210 69 (141)
300 Glimepiride tablet 4 mg 50 Tablet / Kotak 275 1,000 1,275 40 1,235 92 (1,143)
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 1,521 1,521 141 1,380 324 (1,056)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
307 Ibuprofen tablet 400 mg 100 Tablet / Botol - 1,000 1,000 110 890 253 (637)
312 Kalium Diklopenak 50 mg 50 Tablet / Kotak 1,000 1,000 20 980 46 (934)
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 1,310 1,310 1,310 - (1,310)
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol 1,565 1,565 489 1,076 1,125
320 Kotrimoksazol tablet komb: sulfametoksazol 400 mg + 100 Tablet / Botol 1,835 1,835 1,835 - (1,835)
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 500 500 215 285 495
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 803 803 300 503 690
334 Metformin tab 500 mg 100 tablet / kotak 420 500 920 375 545 863
335 Metformin tab 850 mg 100 tablet / kotak 20 1,500 1,520 80 1,440 184 (1,256)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 1,490 1,490 280 1,210 644 (566)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak 500 500 220 280 506 226
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak - 3,000 3,000 30 2,970 69 (2,901)
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 1,630 1,630 600 1,030 1,380 350
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 379 5,000 5,379 1,367 4,012 3,144 (868)
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak - 100 100 60 40 138
368 Prednison tablet 5 mg 1000 Tablet / Botol 630 630 630 630 -
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 1,115 1,115 395 720 909
382 Sangobion - - - - -
385 Sianokobalamin (vitamin B12) Tablet 50 mcg btl 1000 tab 585 1,000 1,585 110 1,475 253 (1,222)
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 360 360 360 - (360)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
391 Tablet tambah darah kombinasi Tablet - 15,000 15,000 15,000 - (15,000)
394 Tensigard - - - - -
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol 2,000 2,000 645 1,355 1,484
397 Tramadol tab 50 mg 50 tab / kotak 20 20 20 - 46
398 Vitamin B Kompleks 1000 Tablet / Botol - 2,000 2,000 635 1,365 1,461
- - - - -
- - - - -
407 Amitriptillin HCL tablet salut 25 mg 100 Tab/ktk 160 160 160 - (160)
Antimigren :
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak - 5 5 5 - (5)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak - 5 5 5 - (5)
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol - 1,000 1,000 1,000 - (1,000)
426 Karbamazepin tablet 200 mg 100 Tab/ktk 950 950 30 920 69 (851)
- - - - -
433 Codeine 10 mg Box / 100 - - - - -
UMUM PERSED. OBAT Rp 1,959,723,535

JUMLAH KUNJUNGAN RESEP TIDAK BAYAR BAYAR PERSED. GENERIK Rp 1,958,272,127
388 49 23 460 TOTAL PERSEDIAAN Rp 2,008,709,027
JUMLAH R/ TOTAL 866
Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
59,723,535.43
58,272,127.40
08,709,027.21
PUSKESMAS : PUGAAN DOKUMEN NOMOR
KECAMATAN : PUGAAN PELAPORAN BULAN/PERIODE : MEI 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : JUNI 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
2 Alat Suntik sekali pakai 2.5 ml 100 set / kotak - - - - 100
3 Alat Suntik sekali pakai 3 ml 100 set / kotak 14 14 14 - 32 200
7 Bisturi 1 Pcs / Pcs 28 28 28 - (28)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
40 Sarung Tangan STERIL S (6) Bks 30 30 30 - (30)
41 Sarung Tangan STERIL M (7) Bks 30 30 30 - (30)
42 Sarung Tangan STERIL L (8) Bks 30 30 30 - (30)
43 Sarung tangan Non Steril No S 50 Psg / Kotak - - - - 200
44 Sarung tangan Non Steril No M 50 Psg / Kotak 200 200 200 - 460 200
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
78 Bonding ktk 1 1 1 - (1)
86 ETSA Botol - - - - -
87 Etil Klorida Spray Botol / 100 ml - - - - 3
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 32 32 10 22 23 1
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 34 34 34 - (34)
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak 11 11 11 - - 100
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak 100 100 100 - (100)
140 Pehacain Injeksi 10 Ampul / kotak 100 100 100 - (100)
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak 18 18 18 - (18)
149 Sianokobalamin (vit.B12) injeksi 500 mcg/ml-1ml 100 Ampul / Kotak 129 129 129 - - -
- - - - -
V Syrup - - - - -
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 52 52 35 17 81 64
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 89 89 2 87 5 (82)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
162 Domperidon Drop ( 2014 ) Botol 1 1 1 - - -
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 61 61 23 38 53 15
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 4 4 4 - (4)
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 98 98 83 15 191 176
175 Parasetamol drops Botol 147 147 22 125 51 (74)
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml 5 5 5 - (5)
187 Etanol 70 % Botol 100 ml 6 6 6 - (6)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml 60 60 60 - (60)
- - - - -
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 60 60 60 - (60)
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 100 100 100 - (100)
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml 18 18 18 - (18)
205 Gentamicin Salep Kulit 1 Tube / Tube 102 102 102 - (102)
209 Ketokonazole Cream 2 % Tube 15 mg 100 100 100 - (100)
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 31 31 31 - (31)
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak 100 100 100 - (100)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
229 Salisil Bedak 2 % 50 Gram / Kotak 30 30 30 - 69 69
- - - - -
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk 50 50 50 - 115 1,000
241 Ambroxol Tablet 30 mg 100 Tab / Kotak 4,108 4,108 4,108 - (4,108)
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 5,070 5,070 1,136 3,934 2,613 (1,321)
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 4,370 4,370 415 3,955 955 (3,001)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 575 575 575 - 1,323 2,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol 70 70 68 2 156 154
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 2,960 2,960 855 2,105 1,967 (139)
257 Asiclovir 400 mg 100 Tab/ktk 480 480 201 279 462 200
266 Captopril tablet 25 mg 100 tablet / kotak 3,590 3,590 880 2,710 2,024 (686)
269 Cetrizine 10 mg 50 Tablet/ ktk 1,309 1,309 273 1,036 628 (408)
270 Cimetidin tablet 200 mg 100 tablet / kotak 1,125 1,125 315 810 725 (86)
271 Ciprovloxsacin 500 mg 100 tablet / kotak 3,180 3,180 3,180 - (3,180)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 4,421 4,421 809 3,612 1,861 (1,751)
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 1,715 1,715 210 1,505 483 (1,022)
283 Domperidon Tablet 10 mg 100 Tablet / Ktk 610 610 610 - (610)
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 1,115 1,115 75 1,040 173 (868)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 770 770 770 - (770)
300 Glimepiride tablet 4 mg 50 Tablet / Kotak 1,235 1,235 245 990 564 (427)
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 1,380 1,380 339 1,041 780 (261)
307 Ibuprofen tablet 400 mg 100 Tablet / Botol 890 890 280 610 644
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 1,310 1,310 600 710 1,380 670
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol 1,076 1,076 1,076 - (1,076)
Trimetoprim 80 mg
1 Kotrimoksazol tablet pedriatik 2kombinasi: 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 285 285 285 - (285)
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 503 503 156 347 359
334 Metformin tab 500 mg 100 tablet / kotak 545 545 545 - 1,254 2,000
335 Metformin tab 850 mg 100 tablet / kotak 1,440 1,440 100 1,340 230 (1,110)
336 Metil Ergometrin Maleat Tab.sal 0,125 mg 100 Tab/ktk 328 328 18 310 41 (269)
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 1,210 1,210 270 940 621 (319)
338 Metochlopramid tablet 10 mg 100 tablet / kotak 198 198 198 - (198)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak 280 280 280 - 644 1,000
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 2,970 2,970 660 2,310 1,518 (792)
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 1,030 1,030 245 785 564 (222)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 4,012 4,012 1,052 2,960 2,420 (540)
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak 40 40 40 - (40)
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 482 482 152 330 350 20
368 Prednison tablet 5 mg 1000 Tablet / Botol 630 630 630 - (630)
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 454 454 39 415 90 (325)
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 720 720 280 440 644 500
382 Sangobion - - - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 330 330 140 190 322 132
385 Sianokobalamin (vitamin B12) Tablet 50 mcg btl 1000 tab 1,475 1,475 250 1,225 575 (650)
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 360 360 360 - 828 2,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
391 Tablet tambah darah kombinasi Tablet 15,000 15,000 15,000 - (15,000)
394 Tensigard - - - - -
397 Tramadol tab 50 mg 50 tab / kotak - - - - -
398 Vitamin B Kompleks 1000 Tablet / Botol 1,365 1,365 1,150 215 2,645 2,430
399 Zink Tablet 20 mg 100 Tab / ktk 914 914 914 - (914)
- - - - -
- - - - -
Antimigren :
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak 5 5 5 - (5)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak 5 5 5 - (5)
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 1,000 1,000 1,000 - (1,000)
426 Karbamazepin tablet 200 mg 100 Tab/ktk 920 920 125 795 288 (508)
428 Klorpromazen HCL tablet salut 25 mg 1000 Tablet / Botol 523 523 5 518 12 (507)
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

0 TOTAL PERSEDIAAN Rp 1,522,575,060
JUMLAH R/ TOTAL 1087


NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
73,589,568.87
72,149,496.14
22,575,060.65
KECAMATAN : Pugaan PELAPORAN BULAN/PERIODE : JUNI 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : JULI 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
3 Alat Suntik sekali pakai 3 ml 100 set / kotak - 300 300 300 - (300)
7 Bisturi 1 Pcs / Pcs 28 28 28 - (28)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
43 Sarung tangan Non Steril No S 50 Psg / Kotak - 200 200 200 - (200)
44 Sarung tangan Non Steril No M 50 Psg / Kotak - 200 200 200 - (200)
62 Tabung Oksigen Kecil Botol Tabung 1 1 1 - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
78 Bonding ktk 1 1 1 - (1)
86 ETSA Botol - - - - -
87 Etil Klorida Spray Botol / 100 ml - 3 3 3 - (3)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 22 22 22 - (22)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak - - - - -
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 6 20 26 26 - (26)
149 Sianokobalamin (vit.B12) injeksi 500 mcg/ml-1ml 100 Ampul / Kotak - - - - -
- - - - -
V Syrup - - - - -
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 17 50 67 17 50 39 (11)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
162 Domperidon Drop ( 2014 ) Botol - - - - -
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 38 50 88 11 77 25 (52)
164 Ibuprofen Syrup 200 mg/ 5 ml Botol 60 ml - 50 50 50 - (50)
165 Erytromicin sirup 200 mg/5 ml Botol 60 ml 6 6 3 3 7 4
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Botol 60 ml 40 40 37 7 (30)
Trimetoprim 40 mg / 5 ml 3
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 4 4 4 - (4)
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 15 200 215 37 178 85 (93)
181 Zinc Syr 20 mg / 5 ml Btl 60 ml - 10 10 10 - (10)
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml 5 5 5 - (5)
187 Etanol 70 % Botol 100 ml 6 6 6 - (6)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
197 Anti Hemaroid DOEN Kombinasi 10 Supp / Kotak 23 23 3 20 7 (13)
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 60 60 14 46 32 (14)
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 100 100 30 70 69 (1)
205 Gentamicin Salep Kulit 1 Tube / Tube 102 102 13 89 30 (59)
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube - - 5 (5) 12 17
209 Ketokonazole Cream 2 % Tube 15 mg 100 100 7 93 16 (77)
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 31 31 7 24 16 (8)
217 Miconazol cream 2 % ( 2013 ) 24 Tube @ 10 mg 96 96 3 93 7 (86)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
229 Salisil Bedak 2 % 50 Gram / Kotak - - - - -
- - - - -
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk - 1,000 1,000 20 980 46 (934)
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 3,934 3,934 400 3,534 920 (2,614)
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 3,955 3,955 3,635 736 (2,899)
Mg Hidroksida 200 mg + Al Hidroksida 320
Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak - 2,000 2,000 47 1,953 108 (1,845)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol 2 200 202 50 152 115 (37)
256 Asiclovir 200 mg 100 Tablet/ ktk 1,300 1,300 33 1,267 76 (1,191)
257 Asiclovir 400 mg 100 Tab/ktk 279 200 479 106 373 244 (129)
262 Betahistin Mesilat 5 mg 30 tablet / kotak 974 974 30 944 69 (875)
269 Cetrizine 10 mg 50 Tablet/ ktk 1,036 1,036 180 856 414 (442)
270 Cimetidin tablet 200 mg 100 tablet / kotak 810 810 810 - (810)
271 Ciprovloxsacin 500 mg 100 tablet / kotak 3,180 3,180 100 3,080 230 (2,850)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 3,612 3,612 569 3,043 1,309 (1,734)
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 1,505 1,505 230 1,275 529 (746)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 770 770 250 520 575 55
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 1,041 1,041 269 772 619 (153)
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 1,024 1,024 80 944 184 (760)
307 Ibuprofen tablet 400 mg 100 Tablet / Botol 610 610 210 400 483 83
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 710 700 1,410 260 1,150 598 (552)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol 1,076 2,000 3,076 396 2,680 911 (1,769)
320 Kotrimoksazol tablet komb: sulfametoksazol 400 mg + 100 Tablet / Botol 1,718 1,718 1,608 253 (1,355)
Kotrimoksazol mg pedriatik kombinasi: 110
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 285 285 170 115 391 276
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 347 347 205 142 472 330
334 Metformin tab 500 mg 100 tablet / kotak - 2,000 2,000 280 1,720 644 (1,076)
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 940 940 307 633 706 73
339 Metronidazol tablet 250 mg 100 Tablet / Botol - 1,000 1,000 1,000 - (1,000)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak - - 180 (180) 414
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 2,310 2,310 255 2,055 587 (1,469)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 785 785 235 550 541 (10)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 2,960 2,960 742 2,218 1,707 (511)
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak 40 40 10 30 23 (7)
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 415 415 120 295 276 (19)
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 440 500 940 130 810 299 (511)
382 Sangobion - - - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 190 200 390 60 330 138 (192)
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak - - 25 (25) 58 83
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
391 Tablet tambah darah kombinasi Tablet 15,000 15,000 280 14,720 644 (14,076)
394 Tensigard - - - - -
398 Vitamin B Kompleks 1000 Tablet / Botol 215 215 215 - (215)
- - - - -
- - - - -
Antimigren :
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 1,000 1,000 30 970 69 (901)
426 Karbamazepin tablet 200 mg 100 Tab/ktk 795 795 795 - (795)
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

JUMLAH R/ TOTAL 1252


NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
01,459,972.11
00,141,667.28
51,832,018.69
KECAMATAN : Pugaan PELAPORAN BULAN/PERIODE : JULI 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : AGUSTUS 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
1 Alat Suntik sekali pakai 1 ml 100 set / kotak 82 82 55 27 127
4 Alat Suntik sekali pakai 5 ml 100 set / kotak 32 32 32 - 74
7 Bisturi 1 Pcs / Pcs 28 28 1 27 2 (25)
10 Catgut/Benang Bedah No 3/0 dg Jarum bedah 24 x 70 cm / ktk 24 24 24 - 55
11 Catgut PLAIN No 3/0 dg Jarum bedah 1 Saset / Saset 24 24 24 - 55
22 Infusion set dewasa Set / kantong 44 44 19 25 44
23 Kapas Pembalut/absorben 250 mg Bungkus 5 5 4 1 9
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak 16 16 16 - 37
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
40 Sarung Tangan STERIL S (6) Bks 30 30 2 28 5 (23)
41 Sarung Tangan STERIL M (7) Bks 30 30 15 15 35
43 Sarung tangan Non Steril No S 50 Psg / Kotak 200 200 200 - (200)
46 Silk (Benang bedah sutera) No.2/0 dg jarum bedah 1 Pcs / Pcs 24 24 24 - 55
47 Silk (Benang bedah sutera) No.3/0 dg jarum bedah 12 x 3 x 75 cm/ktk 24 24 24 - 55
49 Ultrafix 5 cm x 1 m Rol 1 1 1 - 2
50 Ultrafix 10 cm x 5 m Rol 1 1 1 - 2
58 IV Catheter No 20 ( Surflo ) 50 Steril / Kotak 30 30 18 12 41
62 Tabung Oksigen Kecil Botol Tabung 1 1 1 - 2
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
78 Bonding ktk 1 1 1 - (1)
86 ETSA Botol - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
117 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ( 2013 ) 30 Ampul / Kotak 20 20 20 - 46
120 Deksametason injeksi 5 mg/ml- 1 ml 100 Ampul / Kotak 12 12 12 - 28
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 22 22 5 17 12 (6)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 34 34 31 3 71
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak 100 100 29 71 67 (4)
140 Pehacain Injeksi 10 Ampul / kotak 100 100 38 62 87 25
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak 18 18 5 13 12 (2)
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 26 26 8 18 18 0
- - - - -
V Syrup - - - - -
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 50 50 22 28 51
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 33 33 11 22 25 3
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 77 77 6 71 14 (57)
164 Ibuprofen Syrup 200 mg/ 5 ml Botol 60 ml 50 50 50 - (50)
165 Erytromicin sirup 200 mg/5 ml Botol 60 ml 6 6 6 - 14
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 4 4 4 - 9
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 178 178 79 99 182
181 Zinc Syr 20 mg / 5 ml Btl 60 ml 10 10 8 2 18
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml 5 5 5 - 12
187 Etanol 70 % Botol 100 ml 6 6 6 - 14 14
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
191 Lisol,mengandung kresol tersabun 50 % Botol 1000 ml 5 5 1 4 2 (2)
193 Natrium Klorida larutan infus 0,9 % steril Botol / 500 ml 16 16 7 9 16
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml 60 60 41 19 94
- - - - -
197 Anti Hemaroid DOEN Kombinasi 10 Supp / Kotak 23 23 14 9 32
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 60 60 45 15 104
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml 89 89 76 13 175
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 100 100 92 8 212
203 Desoksimethasone 0,25% Cream 1 Tube / Tube 5 5 5 - (5)
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml 18 18 18 - 41
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml 12 12 12 - 28
209 Ketokonazole Cream 2 % Tube 15 mg 100 100 25 75 58 (18)
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak 26 26 10 16 23
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 31 31 23 8 53
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak 100 100 32 68 74
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
224 Povidon Iodida 10 % Botol 30 ml 22 22 5 17 12 (6)
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml 28 28 5 23 12 (12)
228 Salep 2-4 kombinasi: Asam 24 Pot @ 30 g / Kotak 29 29 3 26 7 (19)
232 Trombophop Gel Tube 15 mg 1 1 1 - 2
- - - - -
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk 1,000 1,000 100 900 230 (670)
240 Alopurinol tablet 300 mg ( 2013 ) Ktk 3 x 10 tablet - - - -
241 Ambroxol Tablet 30 mg 100 Tab / Kotak 4,108 4,108 1,155 2,953 2,657 (297)
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak 190 190 190 - 437
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 3,934 3,934 581 3,353 1,336 (2,017)
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 3,955 3,955 625 3,330 1,438 (1,893)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 1,953 1,953 68 1,885 156 (1,729)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
252 Amlodipine 5 mg ( 2013 ) 30 Tablet / Kotak 50 50 50 - 115
257 Asiclovir 400 mg 100 Tab/ktk 373 373 373 - (373)
259 Attapulgit 50 Tab/ktk 1,190 1,190 160 1,030 368 (662)
263 Bisacodil Tablet Kotak / 18 Tablet 14 14 14 - 32
266 Captopril tablet 25 mg 100 tablet / kotak 2,710 2,710 1,165 1,545 2,680
269 Cetrizine 10 mg 50 Tablet/ ktk 1,036 1,036 359 677 826
270 Cimetidin tablet 200 mg 100 tablet / kotak 810 810 15 795 35 (761)
271 Ciprovloxsacin 500 mg 100 tablet / kotak 3,180 3,180 540 2,640 1,242 (1,398)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 3,612 3,612 212 3,400 488 (2,912)
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 1,505 1,505 170 1,335 391 (944)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak 1,319 1,319 119 1,200 274 (926)
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 770 770 770 - 1,771
299 Glimepiride tablet 2 mg 50 Tablet / Kotak 205 205 155 50 357
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 1,041 1,041 481 560 1,106
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 1,024 1,024 100 924 230 (694)
307 Ibuprofen tablet 400 mg 100 Tablet / Botol 610 610 370 240 851
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 710 710 710 - (710)
315 Ketokonazole 200 mg 50 Tablet / Kotak 500 500 500 - (500)
316 Ketoprofen Tab 100 mg 100 Tab / Kotak 100 100 100 - 230

332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 347 347 56 291 129 (162)
335 Metformin tab 850 mg 100 tablet / kotak 1,340 1,340 230 1,110 529 (581)
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 940 940 490 450 1,127
339 Metronidazol tablet 250 mg 100 Tablet / Botol 1,000 1,000 300 700 690 (10)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak - - - - -
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 2,310 2,310 525 1,785 1,208 (578)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 785 785 325 460 748
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak 40 40 40 - 92
365 Pirantel tablet 125 mg 60 Tab/ktk 12 12 12 - 28
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 330 330 330 - (330)
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 415 415 245 170 564 394
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 440 440 440 - (440)
382 Sangobion - - - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 190 190 190 - (190)
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
391 Tablet tambah darah kombinasi Tablet 15,000 15,000 960 14,040 2,208 (11,832)
394 Tensigard - - - - -
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol 1,290 1,290 1,290 - - -
398 Vitamin B Kompleks 1000 Tablet / Botol 215 215 215 - 495
399 Zink Tablet 20 mg 100 Tab / ktk 914 914 374 540 860 320
- - - - -
- - - - -
407 Amitriptillin HCL tablet salut 25 mg 100 Tab/ktk 160 160 10 150 23 (127)
Antimigren :
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak 5 5 1 4 2 (2)
413 Diazepam Rectal 5 mg / ml Tube 9 9 1 8 2 (6)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak 5 5 1 4 2 (2)
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 1,000 1,000 40 960 92 (868)
426 Karbamazepin tablet 200 mg 100 Tab/ktk 795 795 445 350 1,024
427 Klorpromazen HCL injeksi 25 mg/ml-1ml 30 Ampul / Kotak 5 5 5 - - -
432 Triheksifenidil Hidroklorida tablet 2 mg 100 Tab / ktk 41 41 41 - 94
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

JUMLAH R/ TOTAL 848


NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
00,989,882.38
99,671,577.55
50,821,928.96
PUSKESMAS :Pugaan DOKUMEN NOMOR
KECAMATAN : Pugaan PELAPORAN BULAN/PERIODE : AGUSTUS 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : SEPTEMBER 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
7 Bisturi 1 Pcs / Pcs 27 27 27 - (27)
23 Kapas Pembalut/absorben 250 mg Bungkus 1 1 1 - 2 5
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak - - - - 30
25 Kasa Hidrofil steril 18 cm x 22 cm ISI 12 pack - - - - 5
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
46 Silk (Benang bedah sutera) No.2/0 dg jarum bedah 1 Pcs / Pcs - - - - -
47 Silk (Benang bedah sutera) No.3/0 dg jarum bedah 12 x 3 x 75 cm/ktk - - - - -
49 Ultrafix 5 cm x 1 m Rol - - - - -
61 Oksigen Tabung Kecil kubik - - - - 2
62 Tabung Oksigen Kecil Botol Tabung - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
78 Bonding ktk 1 1 1 - (1)
86 ETSA Botol - - - - -
87 Etil Klorida Spray Botol / 100 ml - - - - 2
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
117 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ( 2013 ) 30 Ampul / Kotak - - - - -
120 Deksametason injeksi 5 mg/ml- 1 ml 100 Ampul / Kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 3 3 3 - 7 100
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak - - - - 30
- - - - -
V Syrup - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 22 22 8 14 18 10
165 Erytromicin sirup 200 mg/5 ml Botol 60 ml - - - - -
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml - - - - -
181 Zinc Syr 20 mg / 5 ml Btl 60 ml 2 2 2 - 5 5
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml - - - - 5
187 Etanol 70 % Botol 100 ml - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml 19 19 3 16 7 40
- - - - -
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml 13 13 13 - 30 30
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 8 8 8 - 18 100
202 Bioplacenton cream 1 Tube / Tube - - - - 2
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml - - - - 100
205 Gentamicin Salep Kulit 1 Tube / Tube 102 102 102 - 235 100
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube - - - - 30
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml - - - - 60
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak - - - - 60
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 8 8 8 - 18 30
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
231 Sulfasetamida Natrium tetes mata 15 % 24 Btl @ 5 ml / Kotak - - - - 24
232 Trombophop Gel Tube 15 mg - - - - -
- - - - -
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak - - - - 1,000
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 3,353 3,353 195 3,158 449 (2,710)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 1,885 1,885 40 1,845 92 (1,753)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
252 Amlodipine 5 mg ( 2013 ) 30 Tablet / Kotak - - - - 1,000
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol 141 141 141 - (141)
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 1,528 1,528 228 1,300 524 (776)
263 Bisacodil Tablet Kotak / 18 Tablet - - - - -
266 Captopril tablet 25 mg 100 tablet / kotak 1,545 1,545 115 1,430 265 (1,166)
267 Captopril tablet 12,5 mg 100 Tablet / kotak 1,010 1,010 1,010 - (1,010)
269 Cetrizine 10 mg 50 Tablet/ ktk 677 677 31 646 71 (575)
271 Ciprovloxsacin 500 mg 100 tablet / kotak 2,640 2,640 560 2,080 1,288 (792)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 3,400 3,400 736 2,664 1,693 (971)
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 1,015 1,015 45 970 104 (867)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
292 Fitomenadion (Vit K) tablet salut gula 10 mg 100 Tablet / Botol 796 796 796 - (796)
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol - - - - 3,000
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 560 560 120 440 276 1,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 924 924 29 895 67 (828)
307 Ibuprofen tablet 400 mg 100 Tablet / Botol 240 240 240 - 552 1,000
316 Ketoprofen Tab 100 mg 100 Tab / Kotak - - - - -
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 220 220 140 80 322 500
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 291 291 19 272 44 (228)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 450 450 110 340 253 (87)
339 Metronidazol tablet 250 mg 100 Tablet / Botol 700 700 40 660 92 (568)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak - - - - 1,000
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 1,785 1,785 161 1,624 370 (1,254)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 1,650 1,650 55 1,595 127 (1,469)
364 Piracetam tablet 800 mg ( 2013 ) 100 tablet / kotak - - - - 500
365 Pirantel tablet 125 mg 60 Tab/ktk - - - -
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 330 330 160 170 368 1,000
367 Piroksikam kapsul 10 mg ( 2013 ) 120 / Kotak 10 10 10 - 23 1,000
368 Prednison tablet 5 mg 1000 Tablet / Botol 630 630 630 - - -
382 Sangobion - - - - -
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak - - - - 3,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
394 Tensigard - - - - -
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol - - - - -
396 Thiamfenicol 500 mg 100 kaps / ktk 118 118 118 - (118)
397 Tramadol tab 50 mg 50 tab / kotak - - - - 500
398 Vitamin B Kompleks 1000 Tablet / Botol - - - - 3,000
- - - - -
- - - - -
Antimigren :
411 Diazepam tablet 2 mg btl 100 Tablet 163 163 163 - (163)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 960 960 203 757 467 (290)
426 Karbamazepin tablet 200 mg 100 Tab/ktk 350 350 150 200 345 145
427 Klorpromazen HCL injeksi 25 mg/ml-1ml 30 Ampul / Kotak - - - - -
432 Triheksifenidil Hidroklorida tablet 2 mg 100 Tab / ktk - - - - 200
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

JUMLAH R/ TOTAL 647


NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
22,514,957.98
21,619,998.48
43,204,289.09
PUSKESMAS : pugaan DOKUMEN NOMOR
KECAMATAN : pugaan PELAPORAN BULAN/PERIODE : SEPTEMBER 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : OKTOBER 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
7 Bisturi 1 Pcs / Pcs 27 27 27 - (27)
23 Kapas Pembalut/absorben 250 mg Bungkus - 5 5 5 - (5)
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak - 30 30 30 - (30)
28 Kasa Kompres 40/40 steril Bungkus - 5 5 5 - (5)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
76 Fletcher Liquid 100 Gram / Botol 1 1 1 - 2
77 Alvoghyl Botol - - - -
78 Bonding ktk 1 1 1 - 2
79 Caviton Botol / Kotak 1 1 1 - 2
80 Cresophate Botol - - - -
81 Caustinerf Rapide Forte Botol - - - -
82 Cotton Roll Box - - - -
83 Cresophen Botol - - - -
84 Devitasol Botol - - - -
85 Disclosing Gel Botol 1 1 1 - 2
86 ETSA Botol - - - -
87 Etil Klorida Spray Botol / 100 ml - 2 2 2 - (2)
88 Eugenol Cairan Btl 10 ml 1 1 1 - 2
89 Flour tablet 0,5 mg 100 Tablet / Botol - - - -
90 Forinilkresol (Pengganti TKF) 1 Pcs / Pcs - - - -
91 Formocresol 1 Pcs / Pcs - - - -
92 Flowable Komposit Monohydrit Warna A 2 1 Pcs / Pcs 1 1 1 - 2
93 Flowable Komposit Monohydrit Warna A3 1 Pcs / Pcs 1 1 1 - 2
94 Fuji IX ART 1 Kotak / Kotak 1 1 1 - 2
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
95 Fuji VII Fissure Sealant 1 Kotak / Kotak 1 1 1 - 2
96 Iodorm Paste Botol - - - -
97 Jarum Citoject Dos@100 10 10 10 - 23
98 Kalsium Hidroksida Pasta ( Hydcal ) 1 Tube / Tube 1 1 1 - 2
99 Klorfenol Kamfer Menthol (CHKM) Botol 10 ml - - - -
100 Micro Aplicator Bruss Disposible Botol 1 1 1 - 2
101 Mummifying Pasta 1 Botol / Botol - - - -
102 Komposit Monohyrid warna A 3.5 1 Kotak / Kotak 1 1 1 - 2
103 Komposit Monohyrid warna A 3 1 Kotak / Kotak 1 1 1 - 2
104 Komposit Monohyrid warna A 2 1 Kotak / Kotak 1 1 1 - 2
105 Panaspray Oil 1 Botol / Botol - - - -
106 Pulperyl 1 Botol / Botol - - - -
107 Scandonest 2% 1 Pcs / Pcs - - - -
108 Spon Gelatin Cubicles 1x1x1 cm - - - -
109 Semen Seng Fospat serb dan cairan ( Dorident ) Set @ 30 gr/ Btl - - - -
110 Silver Amalgam Serbuk 65-75 % 1 oz / Botol - - - -
111 Tropicaina Anestesi Tube 15 mg - - - -
- - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
130 Lidokain Injeksi 2 % 100 Ampul / Kotak - 100 100 100 - (100)
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 18 20 38 38 - (38)
- - - - -
V Syrup - - - - -
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml 47 47 47 - (47)
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 19 50 69 69 - (69)
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 75 75 75 - (75)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 14 10 24 24 - (24)
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Botol 60 ml 29 29 29 - (29)
181 Zinc Syr 20 mg / 5 ml Btl 60 ml - 10 10 10 - (10)
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml - 5 5 5 - (5)
187 Etanol 70 % Botol 100 ml - 5 5 5 - (5)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml 16 40 56 56 - (56)
- - - - -
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml - 30 30 30 - (30)
201 Betametason krim 0.1% ktk 25 tube @ 5 gram - 100 100 100 - (100)
205 Gentamicin Salep Kulit 1 Tube / Tube - 100 100 100 - (100)
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube - 30 30 30 - (30)
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml - 60 60 60 - (60)
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak - 60 60 60 - (60)
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml - 30 30 30 - (30)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
229 Salisil Bedak 2 % 50 Gram / Kotak - 20 20 20 - (20)
- - - - -
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak - - - - -
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 3,158 3,158 3,158 - (3,158)
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 3,237 3,237 3,237 - (3,237)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 1,845 1,845 1,845 - (1,845)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 1,300 1,300 1,300 - (1,300)
263 Bisacodil Tablet Kotak / 18 Tablet - - - - 18
269 Cetrizine 10 mg 50 Tablet/ ktk 646 646 646 - (646)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 2,664 2,664 2,664 - (2,664)
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 970 970 970 - (970)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol - 3,000 3,000 3,000 - (3,000)
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 440 440 440 - (440)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 895 500 1,395 1,395 - (1,395)
327 Lodecon tablet (Obat Flu Kombinasi) Tablet - 200 200 200 - (200)
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 80 1,000 1,080 80 1,000 184 1,000
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 272 272 272 - (272)
334 Metformin tab 500 mg 100 tablet / kotak 1,600 1,600 1,600 - (1,600)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 340 1,000 1,340 340 1,000 782 1,000
339 Metronidazol tablet 250 mg 100 Tablet / Botol 660 660 660 - (660)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak - - - - -
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 1,624 1,624 1,624 - (1,624)
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 430 430 430 - (430)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak 330 330 330 - (330)
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 1,595 5,000 6,595 1,595 5,000 3,669
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak - 200 200 200 - (200)
365 Pirantel tablet 125 mg 60 Tab/ktk - - - - -
367 Piroksikam kapsul 10 mg ( 2013 ) 120 / Kotak - - - - -
368 Prednison tablet 5 mg 1000 Tablet / Botol - - - - -
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 135 500 635 635 - (635)
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 440 1,000 1,440 440 1,000 1,012
382 Sangobion - - - - -
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak - 2,000 2,000 2,000 - 2,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
394 Tensigard - - - - -
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol - 1,000 1,000 1,000 - 1,000
397 Tramadol tab 50 mg 50 tab / kotak - 500 500 500 - (500)
398 Vitamin B Kompleks 1000 Tablet / Botol - 3,000 3,000 3,000 - (3,000)
- - - - -
- - - - -
Antimigren :
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 757 757 757 - (757)
432 Triheksifenidil Hidroklorida tablet 2 mg 100 Tab / ktk - 200 200 200 - (200)
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

266 41 48 355 TOTAL PERSEDIAAN Rp 2,381,523,631
JUMLAH R/ TOTAL 645

Kabupaten Tabalong

NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
60,225,150.87
59,346,619.27
81,523,631.98
PUSKESMAS : DOKUMEN NOMOR
KECAMATAN : PELAPORAN BULAN/PERIODE : OKTOBER 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : NOPEMBER 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
1 Alat Suntik sekali pakai 1 ml 100 set / kotak 27 200 227 227 - (227)
7 Bisturi 1 Pcs / Pcs 27 27 27 - (27)
28 Kasa Kompres 40/40 steril Bungkus 5 5 5 - (5)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
76 Fletcher Liquid 100 Gram / Botol - - - -
78 Bonding ktk - - - - -
79 Caviton Botol / Kotak - - - - -
85 Disclosing Gel Botol - - - - -
86 ETSA Botol - - - - -
87 Etil Klorida Spray Botol / 100 ml 2 2 2 - (2)
88 Eugenol Cairan Btl 10 ml - - - - -
92 Flowable Komposit Monohydrit Warna A 2 1 Pcs / Pcs - - - - -
93 Flowable Komposit Monohydrit Warna A3 1 Pcs / Pcs - - - - -
94 Fuji IX ART 1 Kotak / Kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
95 Fuji VII Fissure Sealant 1 Kotak / Kotak - - - - -
97 Jarum Citoject Dos@100 - - - - -
98 Kalsium Hidroksida Pasta ( Hydcal ) 1 Tube / Tube - - - - -
100 Micro Aplicator Bruss Disposible Botol - - - - -
102 Komposit Monohyrid warna A 3.5 1 Kotak / Kotak - - - - -
103 Komposit Monohyrid warna A 3 1 Kotak / Kotak - - - - -
- - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
V Syrup - - - - -
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml 47 50 97 97 - (97)
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 69 50 119 119 - (119)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 24 50 74 74 - (74)
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Botol 60 ml 29 50 79 79 - (79)
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 99 100 199 199 - (199)
175 Parasetamol drops Botol 72 200 272 272 - (272)
181 Zinc Syr 20 mg / 5 ml Btl 60 ml 10 10 10 - (10)
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml 5 5 10 10 - (10)
187 Etanol 70 % Botol 100 ml 5 8 13 13 - (13)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml - - - - -
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube 30 30 30 - (30)
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak 60 60 60 - (60)
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak 16 24 40 40 - (40)
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak 68 25 93 93 - (93)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml 23 10 33 33 - (33)
229 Salisil Bedak 2 % 50 Gram / Kotak 20 20 20 - (20)
- - - - -
241 Ambroxol Tablet 30 mg 100 Tab / Kotak 2,879 2,879 1,039 1,840 2,390
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 3,158 3,158 1,553 1,605 3,572
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 3,237 3,237 957 2,280 2,201 (79)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 1,845 1,845 887 958 2,040
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 1,300 1,300 1,300 - (1,300)
257 Asiclovir 400 mg 100 Tab/ktk 373 373 6 367 14 (353)
266 Captopril tablet 25 mg 100 tablet / kotak 1,430 2,200 3,630 1,910 1,720 4,393
267 Captopril tablet 12,5 mg 100 Tablet / kotak 1,010 1,000 2,010 450 1,560 1,035 (525)
269 Cetrizine 10 mg 50 Tablet/ ktk 646 600 1,246 756 490 1,739
270 Cimetidin tablet 200 mg 100 tablet / kotak 795 795 20 775 46 (729)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 2,664 1,000 3,664 1,974 1,690 4,540
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 1,335 1,335 650 685 1,495
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 970 970 255 715 587 (129)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
293 Furosemid tablet 40 mg ( 2013 ) 100 Tablet / Kotak 460 460 197 263 453 190
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 3,000 3,000 210 2,790 483 (2,307)
299 Glimepiride tablet 2 mg 50 Tablet / Kotak 50 500 550 30 520 69 (451)
300 Glimepiride tablet 4 mg 50 Tablet / Kotak 750 1,000 1,750 665 1,085 1,530
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 440 440 440 - (440)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 1,395 1,395 1,395 - (1,395)
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 710 710 200 510 460 (50)
320 Kotrimoksazol tablet komb: sulfametoksazol 400 mg + 100 Tablet / Botol 1,588 1,588 435 1,153 1,001 (153)
327 Lodecon tablet (Obat Flu Kombinasi) Tablet 200 200 400 400 - (400)
328 Loperamid tablet 2 mg ( Novadium ) 100 tablet / kotak 455 455 260 195 598
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 1,000 1,000 140 860 322 (538)
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 272 272 272 - (272)
334 Metformin tab 500 mg 100 tablet / kotak 1,600 500 2,100 820 1,280 1,886
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 1,000 1,000 110 890 253 (637)
339 Metronidazol tablet 250 mg 100 Tablet / Botol 660 500 1,160 330 830 759 (71)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak - 1,000 1,000 1,000 - (1,000)
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 1,624 1,624 854 770 1,964 1,194
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 430 1,000 1,430 650 780 1,495 715
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak 330 330 265 65 610
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak 200 200 130 70 299
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 170 300 470 180 290 414
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 635 500 1,135 275 860 633 (228)
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 1,000 1,000 56 944 129 (815)
381 Salbutamol tablet 4 mg 100 tablet / kotak 302 500 802 104 698 239 (459)
382 Sangobion - - - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 170 500 670 670 - (670)
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 2,000 2,000 2,000 - (2,000)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
394 Tensigard - - - - -
397 Tramadol tab 50 mg 50 tab / kotak 500 500 500 - (500)
398 Vitamin B Kompleks 1000 Tablet / Botol 3,000 3,000 1,640 1,360 3,772
399 Zink Tablet 20 mg 100 Tab / ktk 540 1,000 1,540 535 1,005 1,231
- - - - -
- - - - -
407 Amitriptillin HCL tablet salut 25 mg 100 Tab/ktk 150 200 350 350 - (350)
Antimigren :
411 Diazepam tablet 2 mg btl 100 Tablet 163 163 77 86 177
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 757 757 125 632 288 (345)
423 Haloperidol tablet 1.5 mg 100 Tab/ktk 333 333 20 313 46 (267)
428 Klorpromazen HCL tablet salut 25 mg 1000 Tablet / Botol 518 518 18 500 41 (459)
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

JUMLAH R/ GENERIK 0
JUMLAH R/ TOTAL

Kabupaten Tabalong

NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
20,761,426.57
19,869,144.97
41,534,308.92
KECAMATAN : PELAPORAN BULAN/PERIODE : NOPEMBER 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : DESEMBER 2016 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
3 Alat Suntik sekali pakai 3 ml 100 set / kotak 222 222 132 90 304 100
7 Bisturi 1 Pcs / Pcs 27 27 2 25 5 (20)
22 Infusion set dewasa Set / kantong 25 25 16 9 37 28
23 Kapas Pembalut/absorben 250 mg Bungkus 5 5 1 4 2 (2)
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak 30 30 13 17 30
28 Kasa Kompres 40/40 steril Bungkus 5 5 1 4 2 (2)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
36 Plester 5 yards x 2 inch Rol 18 18 12 6 28
40 Sarung Tangan STERIL S (6) Bks 28 28 2 26 5 (21)
41 Sarung Tangan STERIL M (7) Bks 15 15 9 6 21
42 Sarung Tangan STERIL L (8) Bks 30 30 4 26 9 (17)
43 Sarung tangan Non Steril No S 50 Psg / Kotak 200 200 100 100 230 200
44 Sarung tangan Non Steril No M 50 Psg / Kotak 200 200 200 - 460 100
45 Sarung tangan Non Steril No L 50 Psg / Kotak 200 200 200 - 460 100
54 Jarum jahit no 9 dzn 2 2 2 - 5 5
55 Jarum jahit no 10 dzn 1 1 1 - 2 2
58 IV Catheter No 20 ( Surflo ) 50 Steril / Kotak 12 12 12 - 28 50
59 IV Catheter No 22 ( Surflo ) 50 Steril / Kotak 31 31 14 17 32
61 Oksigen Tabung Kecil kubik - - - - 1
63 Surgical Masker Ear Loop 3 Ply ( 2013 ) 50 Pcs / kotak 56 56 52 4 120 100
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
76 Fletcher Liquid 100 Gram / Botol - - - - -
86 ETSA Botol - - - - -
87 Etil Klorida Spray Botol / 100 ml 2 2 1 1 2 1
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak 71 71 71 - - 100
- - - - -
V Syrup - - - - -
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml 97 97 48 49 110 61
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 75 75 33 42 76 34
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Botol 60 ml 79 79 31 48 71 23
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 199 199 136 63 313 250
175 Parasetamol drops Botol 272 272 100 172 230 58
178 Sefadroksil sirup ( 2013 ) Btl 60 ml 20 20 18 2 41 39
181 Zinc Syr 20 mg / 5 ml Btl 60 ml 10 10 4 6 9 3
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml 10 10 6 4 14 10
187 Etanol 70 % Botol 100 ml 13 13 11 2 25
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml 30 30 17 13 39 26
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 100 100 75 25 173 150
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube 30 30 30 - 69 69
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml 60 60 16 44 37 (7)
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak 60 60 23 37 53 16
209 Ketokonazole Cream 2 % Tube 15 mg 75 75 25 50 58 7
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak 40 40 16 24 37 13
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 30 30 13 17 30 13
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak 93 93 32 61 74 13
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
224 Povidon Iodida 10 % Botol 30 ml 17 17 6 11 14 3
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml 33 33 27 6 62
227 Povidon iodida 10% Botol 1000 ml 16 16 2 14 5 (9)
229 Salisil Bedak 2 % 50 Gram / Kotak 20 20 2 18 5 (13)
- - - - -
241 Ambroxol Tablet 30 mg 100 Tab / Kotak 1,840 1,840 340 1,500 782 (718)
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 1,605 1,605 345 1,260 794 (467)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 958 958 298 660 685
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 1,300 1,300 1,300 - 2,990 2,990
257 Asiclovir 400 mg 100 Tab/ktk 367 367 52 315 120 (195)
269 Cetrizine 10 mg 50 Tablet/ ktk 490 490 40 450 92 (358)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 1,690 1,690 383 1,307 881 (426)
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 685 685 355 330 817 500
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak 1,200 1,200 638 562 1,467
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 2,790 2,790 90 2,700 207 (2,493)
300 Glimepiride tablet 4 mg 50 Tablet / Kotak 1,085 1,085 305 780 702 (79)
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 440 440 440 - 1,012 2,000
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 1,395 1,395 1,040 355 2,392 2,037
312 Kalium Diklopenak 50 mg 50 Tablet / Kotak 980 980 80 900 184 (716)
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 510 510 85 425 196 (230)
320 Kotrimoksazol tablet komb: sulfametoksazol 400 mg + 100 Tablet / Botol 1,153 1,153 125 1,028 288 (741)
325 Lanzoprazole kaps 30 mg ( 2013 ) 20 kapsul / kotak 265 265 135 130 311 200
327 Lodecon tablet (Obat Flu Kombinasi) Tablet 400 400 400 - (400)
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 272 272 272 - 626 1,000
334 Metformin tab 500 mg 100 tablet / kotak 1,280 1,280 520 760 1,196 436
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 890 890 180 710 414 (296)
339 Metronidazol tablet 250 mg 100 Tablet / Botol 830 830 30 800 69 (731)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak 1,000 1,000 80 920 184 (736)
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 770 770 200 570 460 (110)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak 65 65 65 - 150 500
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 3,105 3,105 665 2,440 1,530 (911)
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 944 944 194 750 446 (304)
382 Sangobion - - - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 670 670 390 280 897 500
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 2,000 2,000 270 1,730 621 (1,109)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
391 Tablet tambah darah kombinasi Tablet 14,040 14,040 2,040 12,000 4,692 (7,308)
394 Tensigard - - - - -
397 Tramadol tab 50 mg 50 tab / kotak 500 500 20 480 46 (434)
398 Vitamin B Kompleks 1000 Tablet / Botol 1,360 1,360 330 1,030 759 (271)
399 Zink Tablet 20 mg 100 Tab / ktk 1,005 1,005 50 955 115 (840)
- - - - -
- - - - -
407 Amitriptillin HCL tablet salut 25 mg 100 Tab/ktk 350 350 110 240 253
Antimigren :
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

JUMLAH R/ GENERIK 0
JUMLAH R/ TOTAL

Kabupaten Tabalong

NIP. NIP. 19701002 199002 1 001 NIP. 19910610 201001 2 001
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
45,108,858.41
44,373,091.91
65,881,740.76
KECAMATAN : PELAPORAN BULAN/PERIODE : DESEMBER 2016 DINKES
KABUPATEN : TABALONG PERMINTAAN BULAN/PERIODE : JANUARI 2017 GFK
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
I Alat Kesehatan
7 Bisturi 1 Pcs / Pcs 25 25 25 - (25)
28 Kasa Kompres 40/40 steril Bungkus 4 4 4 - (4)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
33 Masker N 95 Pcs - - - - -
34 Needle No 23 Pcs - - - - -
35 Needle No 25 Pcs - - - - -
44 Sarung tangan Non Steril No M 50 Psg / Kotak - - - - -
45 Sarung tangan Non Steril No L 50 Psg / Kotak - - - - -
58 IV Catheter No 20 ( Surflo ) 50 Steril / Kotak - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
- - - - -
76 Fletcher Liquid 100 Gram / Botol - - - - -
86 ETSA Botol - - - - -
87 Etil Klorida Spray Botol / 100 ml 1 1 1 - (1)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak - - - - -
- - - - -
V Syrup - - - - -
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml 49 49 49 - (49)
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 72 72 72 - (72)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 53 53 53 - (53)
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Botol 60 ml 48 48 48 - (48)
181 Zinc Syr 20 mg / 5 ml Btl 60 ml 6 6 6 - (6)
- - - - -
VI Cairan - - - - -
186 Etanol 70 % Botol 1000 ml 4 4 4 - (4)
187 Etanol 70 % Botol 100 ml 2 2 2 - (2)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml - - - - -
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak 37 37 37 - (37)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
Metanol), Albothyl
229 Salisil Bedak 2 % 50 Gram / Kotak 18 18 18 - (18)
- - - - -
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 1,260 1,260 1,260 - (1,260)
247 Antasida DOEN tab kombinasi : 100 tablet / kotak 2,130 2,130 2,130 - (2,130)

Sulfadoxin 500mg
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 660 660 660 - (660)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak - - - - -
269 Cetrizine 10 mg 50 Tablet/ ktk 450 450 450 - (450)
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 1,307 1,307 1,307 - (1,307)
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 330 330 330 - (330)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak 562 562 562 - (562)
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 2,700 2,700 2,700 - (2,700)
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol - - - - -
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 355 355 355 - (355)
327 Lodecon tablet (Obat Flu Kombinasi) Tablet 400 400 400 - (400)
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 620 620 620 - (620)
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak - - - - -
334 Metformin tab 500 mg 100 tablet / kotak 760 760 760 - (760)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
337 Metil Prednisolon 4 mg ( 2013 ) 100 Tab / Kotak 710 710 710 - (710)
339 Metronidazol tablet 250 mg 100 Tablet / Botol 800 800 800 - (800)
340 Metronidazol tablet 500 mg ( 2014 ) 100 tablet / kotak 920 920 920 - (920)
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 570 570 570 - (570)
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 565 565 565 - (565)
TANGGAL
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
355 Noza - - - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak - - - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 2,440 2,440 2,440 - (2,440)
382 Sangobion - - - - -
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 1,730 1,730 1,730 - (1,730)
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
394 Tensigard - - - - -
397 Tramadol tab 50 mg 50 tab / kotak 480 480 480 - (480)
398 Vitamin B Kompleks 1000 Tablet / Botol 1,030 1,030 1,030 - (1,030)
- - - - -
- - - - -
Antimigren :
1 2 3 4 5 6=4+5 7 8 9=6-(7+8) 10 11=10-9 12 13 14
- - - - -
433 Codeine 10 mg Box / 100 - - - - -

JUMLAH R/ GENERIK 0
JUMLAH R/ TOTAL

Kabupaten Tabalong
dr. H. Syarifudin Basri, Sp.OG

NIP. 19631106 199703 1 004 NIP. NIP. NIP.
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
KET
JUMLAH
15=12+13+14 16
91,125,824.29
90,426,057.79
00,614,209.23
REKAP PEMAKAIAN OBAT DAN P
PUSKESMAS :
KECAMATAN : TAHUN 2016
KABUPATEN : TABALONG
NO NAMA OBAT KEMASAN

PEB MAR APR
1 2 3 4 5 6
I Alat Kesehatan
1 Alat Suntik sekali pakai 1 ml 100 set / kotak ### 4 18 -
2 Alat Suntik sekali pakai 2.5 ml 100 set / kotak ### - - -
5 Alat Suntik sekali pakai 10 ml 100 set / kotak ### 4 - -
6 Alkohol Swab Box ### - - -
7 Bisturi 1 Pcs / Pcs ### - - -
8 Catgut/Benang Bedah No 2/0 dg Jarum bedah 24 x 70 cm / ktk ### - - -
9 Catgut PLAIN No 2/0 dg Jarum bedah 1 Saset / Saset ### - - -
10 Catgut/Benang Bedah No 3/0 dg Jarum bedah 24 x 70 cm / ktk ### - - -
11 Catgut PLAIN No 3/0 dg Jarum bedah 1 Saset / Saset ### - - -
12 Catgut/Benang Bedah No 2/0 Chromic rol 1 Roll / Roll ### - - -
13 Catgut/Benang Bedah No 3/0 Chromic rol 1 Roll / Roll ### 1 - -
14 Ceplast Gauze aerofilm pack ### - - -
15 Foley Catheter No 12 Pcs ### 12 - -
16 Foley Catheter No 14 Pcs ### 3 - -
17 Foley Catheter No 16 Pcs ### - - -
21 Infusion set anak Set / kantong ### - 5 -
22 Infusion set dewasa Set / kantong ### - 10 -
23 Kapas Pembalut/absorben 250 mg Bungkus ### 2 - -
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak ### 1 9 -
25 Kasa Hidrofil steril 18 cm x 22 cm ISI 12 pack ### - - -
26 Kasa hidrofil 4 m x 10 cm Rol ### - - -
27 Kasa hidrofil 36 m x 80 cm Rol ### - - -
28 Kasa Kompres 40/40 steril Bungkus ### - - -
29 Kasa Pembalut 2 m x 80 cm Rol ### 7 - -
30 Kasa Pembalut Hidrofil 4 m x 3 cm elastic Rol ### - - -
31 Kasa Pembalut Hidrofil 4 m x 15 cm elastic Rol ### - - -
32 Kertas Puyer 1200 pcs / pack ### - - -
33 Masker N 95 Pcs ### - - -
34 Needle No 23 Pcs ### - - -
35 Needle No 25 Pcs ### - - -
36 Plester 5 yards x 2 inch Rol ### - 1 -
37 Plester Kecil Rol ### - - -
38 Plester Sedang Rol ### - - -
39 Policrepe 10 cm x 4,55 M Rol ### - - -
40 Sarung Tangan STERIL S (6) Bks ### - - -
PEB MAR APR
1 2 3 4 5 6
41 Sarung Tangan STERIL M (7) Bks ### - - -
42 Sarung Tangan STERIL L (8) Bks ### - - -
43 Sarung tangan Non Steril No S 50 Psg / Kotak ### 100 50 -
44 Sarung tangan Non Steril No M 50 Psg / Kotak ### 100 - -
45 Sarung tangan Non Steril No L 50 Psg / Kotak ### - 100 -
46 Silk (Benang bedah sutera) No.2/0 dg jarum bedah 1 Pcs / Pcs ### - - -
47 Silk (Benang bedah sutera) No.3/0 dg jarum bedah 12 x 3 x 75 cm/ktk### - - -
48 Transfusion set Set / kantong ### - - -
49 Ultrafix 5 cm x 1 m Rol ### - - -
50 Ultrafix 10 cm x 5 m Rol ### - - -
51 Umbelical Klem / Tali Pusat Pcs ### - - -
52 Underpad Ibu Nifas Pcs ### - - -
53 Urine bag Steril 2 ltr Pcs ### - - -
54 Jarum jahit no 9 dzn ### - - -
55 Jarum jahit no 10 dzn ### - - -
56 Jarum jahit no 11 dzn - - -
57 IV Catheter No 18 ( Surflo ) 50 Steril / Kotak 3 - -
58 IV Catheter No 20 ( Surflo ) 50 Steril / Kotak 7 2 -
59 IV Catheter No 22 ( Surflo ) 50 Steril / Kotak - 6 -
60 IV Catheter No 24 ( Surflo ) 50 Steril / Kotak ### - - -
61 Oksigen Tabung Kecil kubik ### - - -
62 Tabung Oksigen Kecil Botol Tabung ### - - -
63 Surgical Masker Ear Loop 3 Ply ( 2013 ) 50 Pcs / kotak ### - 94 -
### - - -
II Reagensia ### - - -
64 Asam klorida 0,1 N Botol ### - - -
65 Asam Sulfosalisilat 20 % Botol - - -
66 Larutan Benedict Botol 100 ml ### - - -
67 Larutan Eosin 2 % Botol 100 ml ### - - -
68 Larutan Etanol Asam Botol 100 ml - - -
69 Larutan Giemsa Stain Botol 100 ml - - -
70 Larutan Karbol Fuksin Botol 100 ml ### - - -
71 Larutan Metilan Biru Botol 100 ml ### - - -
72 Larutan Turk Botol 100 ml ### - - -
73 Metanol Botol 100 ml ### - - -
74 Rapid Test DBD 1 Set /Set ### - - -
75 Rapid Test MALARIA 1 Set /Set ### - - -
### - - -
III Obat Gigi ### - - -
76 Fletcher Liquid 100 Gram / Botol ### - - -
77 Alvoghyl Botol ### - - -
78 Bonding ktk ### - - -
79 Caviton Botol / Kotak ### - - -
80 Cresophate Botol ### - - -
81 Caustinerf Rapide Forte Botol - - -
82 Cotton Roll Box ### - - -
PEB MAR APR
1 2 3 4 5 6
83 Cresophen Botol ### - - -
84 Devitasol Botol ### - - -
85 Disclosing Gel Botol ### - - -
86 ETSA Botol ### - - -
87 Etil Klorida Spray Botol / 100 ml ### 2 - -
88 Eugenol Cairan Btl 10 ml ### - - -
89 Flour tablet 0,5 mg 100 Tablet / Botol ### - - -
90 Forinilkresol (Pengganti TKF) 1 Pcs / Pcs ### - - -
91 Formocresol 1 Pcs / Pcs ### - - -
92 Flowable Komposit Monohydrit Warna A 2 1 Pcs / Pcs ### - - -
93 Flowable Komposit Monohydrit Warna A3 1 Pcs / Pcs ### - - -
94 Fuji IX ART 1 Kotak / Kotak ### - - -
95 Fuji VII Fissure Sealant 1 Kotak / Kotak ### - - -
96 Iodorm Paste Botol - - -
97 Jarum Citoject Dos@100 - - -
98 Kalsium Hidroksida Pasta ( Hydcal ) 1 Tube / Tube ### - - -
99 Klorfenol Kamfer Menthol (CHKM) Botol 10 ml ### - - -
100 Micro Aplicator Bruss Disposible Botol ### - - -
101 Mummifying Pasta 1 Botol / Botol ### - - -
102 Komposit Monohyrid warna A 3.5 1 Kotak / Kotak ### - - -
103 Komposit Monohyrid warna A 3 1 Kotak / Kotak ### - - -
104 Komposit Monohyrid warna A 2 1 Kotak / Kotak ### - - -
105 Panaspray Oil 1 Botol / Botol ### - - -
106 Pulperyl 1 Botol / Botol ### - - -
107 Scandonest 2% 1 Pcs / Pcs ### - - -
108 Spon Gelatin Cubicles 1x1x1 cm ### - - -
109 Semen Seng Fospat serb dan cairan ( Dorident ) Set @ 30 gr/ Btl ### - - -
110 Silver Amalgam Serbuk 65-75 % 1 oz / Botol ### - - -
111 Tropicaina Anestesi Tube 15 mg ### - - -
112 Temporary Stopping Fletcher (Fletcher) serbuk Set @ 100 gr / Btl### - - -
### - - -
IV Obat Injeksi ### - - -
113 Aminofilina Inj. 24 mg/ml - 10 ml 30 Ampul / Kotak### - - -
114 Ampisillin serbuk inj. (IM/IV) 1000 mg 1 Vial / Vial ### - - -
115 Antalgin injeksi 250 mg/ml-2ml 30 Ampul / Kotak### - - -
116 Asam Tranexamat Injeksi 250 mg / 5 ml 10 Ampul / kotak ### - - -
117 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ( 2013 ) 30 Ampul / Kotak### - - -
118 Aqua pro injeksi steril , bebas pirogen 1 Vial / Vial ### - - -
119 Combivent 2,5 Nebulizer 20 pcs / Box ### - - -
120 Deksametason injeksi 5 mg/ml- 1 ml 100 Ampul / Kotak### - 1 -
121 Difenhidramin HCL inj 10 mg/ml- 1 ml 30 Ampul / Kotak### - - -
122 Epinefrina HCL/Bitartrat ( Epinefrina/adrinalina ) 30 Ampul / Ampul### - -
injeksi 0.1 % - 1 ml -
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak### - 5 1
124 Furosemid injeksi 25 Ampul / ktk ### - - -
125 Gentamicin Injeksi 80 mg/2ml 5 Ampul / Kotak ### - - -
126 Ketorolac injeksi 10 mg 6 Ampul @ 1 ml ### - - -
PEB MAR APR
1 2 3 4 5 6
127 Kloroquin injeksi 100 Ampul / Kotak### - - -
128 Kuinin Dihidroksida injeksi 25 % - 2 ml 30 Ampul / Kotak### - - -
129 Lidokain komp. Injeksi,kombinasi 30 Ampul / Kotak### - 7
Lidokain HCl 2% + Epinefrin 1 : 80.000-2ml -
130 Lidokain Injeksi 2 % 100 Ampul / Kotak### - 32 -
131 Magnesium Sulfat inj. (IV) 20%-25ml 10 Vial / kotak ### - - -
132 Magnesium Sulfat inj. (IV) 40%-25ml 10 Vial / kotak ### - - -
133 Metamizole 500mg Injeksi 5 ampul / kotak - - -
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak - - 2
135 Metochlopramid Inj 5 mg/ml 10 Ampul / Kotak### - - -
136 Neurotropik Vitamin (Neurobat) Injeksi 1 Ampul / Ampul ### - - -
137 Ondansetron 4 mg/ 2 ml Injeksi 5 Ampul / Kotak ### - - -
138 Oksitetrasiklin HCL Injeksi i.m 50 mg/ml-10 ml ktk 10 vial ### - - -
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak### - - -
140 Pehacain Injeksi 10 Ampul / kotak ### - - -
141 Piracetam Injeksi 1 gr/5ml 10 ampul / Kotak### - - -
142 Piracetam Injeksi 3 gr/15ml 4 ampul / Kotak ### - - -
143 Prokain Benziloenicillin G 3jt UI/Vial ktk 30 vial @15 ml### - - -
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak### - 2 7
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak### - 4 2
146 Sefotaksim inj 1 gr 1 Vial / Vial ### - - -
147 Seftazidim injeksi 1 gr 2 Vial/ktk ### - - -
148 Seftriaxone injeksi 1 gr kotak 2 vial ### - - -
149 Sianokobalamin (vit.B12) injeksi 500 mcg/ml-1ml 100 Ampul / Kotak### - - -
150 Tiamin HCL (vit.B1) injeksi 100 mg/ml-1ml 30 Ampul / Kotak### - - -
151 Tramadol injeksi 50 mg/ml 5 Ampul / Kotak ### - - -
### - - -
V Syrup ### - - -
152 Albendazol Syrup Botol ### - - -
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml ### 1 10 10
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml ### - 24 -
155 Ampisillin sirup kering 125mg/5ml Botol 60 ml - - -
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 3 20 1
157 Apialys Drop / Truvit Botol ### - - -
158 Cetirize Syrup Botol ### - - -
159 Dexrofen Syrup Botol ### - - -
160 Dekstrometorpan sirup 10 mg/5 ml Botol 60 ml ### - - -
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml ### 4 6 3
162 Domperidon Drop ( 2014 ) Botol ### - - -
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml ### 5 29 14
164 Ibuprofen Syrup 200 mg/ 5 ml Botol 60 ml ### - - -
165 Erytromicin sirup 200 mg/5 ml Botol 60 ml ### - - -
166 Kaolin Pectin Syrup/ Guanistrep Syrup Botol ### - - -
167 Kloramfenicol suspensi 125 mg/5ml ( 2013 ) Botol 60 ml ### - - -
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Botol 60 ml ### 4 4
Trimetoprim 40 mg / 5 ml 2
169 Laksatif Syrup (Laxadine) Botol ### - - -
PEB MAR APR
1 2 3 4 5 6
170 Mebendazol sirup 100 mg/5 ml (Obat Cacing Anak) btl 30 ml - - -
171 Metochlopramid Sirup 5 mg/ml Botol 60 ml - - -
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml ### - 12 2
173 Obat Batuk Hitam (OBH) cairan Botol 100 ml ### - - 21
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml### - - 39
175 Parasetamol drops Botol ### - - 11
176 Pyrantel Suspensi 10 ml Botol ### - - -
177 Recovital Syrup Botol ### - - -
178 Sefadroksil sirup ( 2013 ) Btl 60 ml ### 5 5 -
179 Sefadroksil Forte sirup Btl 60 ml ### - - -
180 Sefiksim dry sirup Botol 30 ml ### - - -
181 Zinc Syr 20 mg / 5 ml Btl 60 ml ### - - -
### - - -
VI Cairan ### - - -
182 Aquadest Steril Infus Botol 500 ml ### - - -
183 Dextrose 5 1/2 N S Btl 500 ml ### - - -
184 Dextrose 5 1/4 N S Btl 500 ml ### - - -
185 Etakridina (Rivanol) larutan 0.1 % Botol 300 ml ### - - 1
186 Etanol 70 % Botol 1000 ml ### 1 - 2
187 Etanol 70 % Botol 100 ml ### 2 - -
188 Glukosa larutan infus 5 % steril ###
Botol / Plastik 500 ml - 19 -
189 Glukosa larutan infus 10 % steril ###
Botol / Plastik 500 ml - - -
190 Ka-en 3B Infus Botol 500 mg ### - - -
191 Lisol,mengandung kresol tersabun 50 % Botol 1000 ml ### - - -
192 Metronidazol infus 500 mg/100 ml 100 ml / Botol ### - - -
193 Natrium Klorida larutan infus 0,9 % steril Botol / 500 ml ### - - -
194 Ringer Laktat larutan infus steril (Produk Lokal) ###
Botol / Plastik 500 ml 11 7 -
195 TetraHES larutan Infus 1 Pack / Pack ### - - -
### - - -
VII Obat Luar (Salep & Tetes) ### - - -
196 Anti Bakteri DOEN salep kombinasi: 25 Tube 5 g / Ktk### - -
Basitrasin 500IU/g+Polimiksin 10.000IU/g -
197 Anti Hemaroid DOEN Kombinasi 10 Supp / Kotak ### - 5 -
198 Antifungi DOEN kombinasi: 24 Pot 30 g / Ktk ### - -
Asam Benzoat 6%+Asam Salisilat 3% -
199 Asiclovir Cream 5 % ###
ktk 25 tube @ 5 gram 15 4 7
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ###
ml - 8 -
201 Betametason krim 0.1% ###
ktk 25 tube @ 5 gram 6 33 5
202 Bioplacenton cream 1 Tube / Tube - - -
203 Desoksimethasone 0,25% Cream 1 Tube / Tube - - -
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml ### 3 8 4
205 Gentamicin Salep Kulit 1 Tube / Tube ### - 12 16
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube ### - - -
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml ### 3 6 -
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak ### - - -
209 Ketokonazole Cream 2 % Tube 15 mg ### 4 15 2
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak ### - 2 2
PEB MAR APR
1 2 3 4 5 6
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml ### 2 5 6
212 Kloramfenicol salep mata 1 % 5 gr / Tube ### - - -
213 Litrol Tetes Mata/ Kortikosteroid Botol ### - - -
214 Levetran Salep / Minyak Ikan Pot ### - - -
215 Lidocain Jelly 2% (Xylocaine 2%) 1 Pcs / Pcs ### - - -
216 Minyak Angin Safe Care Botol ### - - -
217 Miconazol cream 2 % ( 2013 ) 24 Tube @ 10 mg### - - 5
218 Mydric Tetes Mata botol ### - - -
219 Oksitetrasiklin HCL salep mata 1 % ( 2013 ) 25 Tube / Kotak ### - - -
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak ### - - -
221 Pilocarpine Tetes Mata Botol ### - - -
222 Polidemisin Tetes Mata Botol ### - - -
223 Polikresulen (Kondensasi Metakresol Sulfonat dan Botol 10 ml ### 5 -
Metanol), Albothyl -
224 Povidon Iodida 10 % Botol 30 ml ### 1 4 -
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml ### - 7 -
226 Povidon iodida 10% Botol 300 ml ### - - -
227 Povidon iodida 10% Botol 1000 ml ### - - -
228 Salep 2-4 kombinasi: Asam
###
24 Pot @ 30 g / Kotak - 20
Salisilat 2% + Belerang endap 4% -
229 Salisil Bedak 2 % 50 Gram / Kotak ### - 10 10
230 Scabicid Cream Tube 15 mg ### - - -
231 Sulfasetamida Natrium tetes mata 15 % ###
24 Btl @ 5 ml / Kotak - - -
232 Trombophop Gel Tube 15 mg ### - 1 -
233 Temefos 1% Bungkus / 1 kg ### - - -
234 Tetracain Tetes Mata Botol ### - - -
235 Timolol Tetes Mata Botol ### - - -
236 Voltadex Gel 1 Tube / Tube ### - - -
237 Voltaren Gel 1 Tube / Tube ### - - -
### - - -
VIII Obat-Obatan ### - - -
238 Albendazol tablet 400 mg ktk 5 x 6 tablet ### 48 - -
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk ### 30 60 -
240 Alopurinol tablet 300 mg ( 2013 ) Ktk 3 x 10 tablet ### - - -
241 Ambroxol Tablet 30 mg 100 Tab / Kotak ### 30 363 293
242 Aminofilin tablet 200 mg 100 Tablet / Botol### - - -
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak ### 115 115 -
244 Amoksisillin kapsul 250 mg 120 Tab/ktk ### - 131 -
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak### 715 475 391
246 Antalgin (Metampiron) tablet 500 mg 100 Tablet / Kotak### - - -
247 Antasida DOEN tab kombinasi : 100 tablet / kotak### 440 -
Mg Hidroksida 200 mg + Al Hidroksida 100
248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak### - -
Sulfadoxin 500mg -
249 Asam Asetilsalisilat 80mg Tab 100 Tablet / kotak### - - -
250 Asetosal 100 mg (Asam Asetilsalisilat) 100 Tablet / kotak### - - -
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak### 237 139 184
252 Amlodipine 5 mg ( 2013 ) 30 Tablet / Kotak ### 190 160 -
PEB MAR APR
1 2 3 4 5 6
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol### 80 60 30
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak### 900 - 236
255 Asam Tranexamat Tablet 500 mg 100 tablet / kotak### - - -
256 Asiclovir 200 mg 100 Tablet/ ktk ### - - -
257 Asiclovir 400 mg 100 Tab/ktk ### 200 75 165
258 Asifit Kaplet 100 Tab/Ktk ### - - -
259 Attapulgit 50 Tab/ktk ### - 40 40
260 Attapulgit + Pectin Tablet (Kombinasi) 100 Tablet/ ktk ### - - -
261 Atropin Sulfat tablet 0,5 mg 500 Tablet / Botol ### - - -
262 Betahistin Mesilat 5 mg 30 tablet / kotak ### - 90 -
263 Bisacodil Tablet Kotak / 18 Tablet ### - 4 -
264 Bisoprolol tablet 5 mg Ktk 3 x 10 tablet ### - - -
265 Bromhexin Tablet 100 tablet / kotak### - - 150
266 Captopril tablet 25 mg 100 tablet / kotak### 850 - 660
267 Captopril tablet 12,5 mg 100 Tablet / kotak### - 180 160
268 Cetop Zink 100 Tablet / kotak### - - -
269 Cetrizine 10 mg 50 Tablet/ ktk ### 45 165 -
270 Cimetidin tablet 200 mg 100 tablet / kotak### 40 20 100
271 Ciprovloxsacin 500 mg 100 tablet / kotak 100 150 180
272 Clindamisin 150 mg Kapsul 50 Kapsul / kotak### - - -
273 Clindamisin 300 mg Kapsul 50 Kapsul / kotak### - - -
274 Clonidin 0,15 mg 100 tablet / kotak### - - -
275 Curcuma Tablet 100 tablet / kotak### - - -
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak### 250 464 349
277 Dekstrometorpan tablet 15 mg 100 tablet / kotak### - - -
278 Dietilkarbamazin sitrat tablet 100 mg 100 Tablet / kotak### - - -
279 Digoksin tablet 0,25 mg 100 Tablet / Botol ### - - -
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak ### 110 - -
281 Dimenhidrinat tab 50 mg 100 Tab / Botol ### 200 - -
282 Doksisiklin kapsul 100 mg 100 kapsul / kotak### - - -
283 Domperidon Tablet 10 mg 100 Tablet / Ktk ### 60 30 600
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk ### 40 35 10
285 Erytromisin Kapsul 250 mg 100 tab / Kotak ### - - -
286 Ekstrak Belladon tablet 10 mg 1000 Tablet / Botol### - - -
287 Etambutol HCL tablet 250 mg 200 Tablet / kotak### - - -
288 Famotidin 20 mg 50 Tablet / Kotak ### - - -
289 Fenilbutazon/Novazon 1000 Tablet / Botol### - - -
290 Fenitoin Natrium kapsul 30 mg 250 Kapsul / Botol### - - -
291 Fenitoin Natrium kapsul 100 mg 250 Kapsul / Botol### - - -
292 Fitomenadion (Vit K) tablet salut gula 10 mg 100 Tablet / Botol ### 10 35 10
293 Furosemid tablet 40 mg ( 2013 ) 100 Tablet / Kotak### 10 20 30
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak ### 708 30 -
295 Gemfibrozil 300 mg 120 kaps / kotak ### - - -
296 Gemfibrozil 600 mg 100 kaps / kotak ### - - -
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol ### 390 250 200
298 Glimepiride tablet 1 mg 50 Tablet / Kotak ### - - -
PEB MAR APR
1 2 3 4 5 6
299 Glimepiride tablet 2 mg 50 Tablet / Kotak ### 80 - 110
300 Glimepiride tablet 4 mg 50 Tablet / Kotak ### 30 - 290
301 Gliquidon tablet 30 mg 100 tablet / kotak### - - -
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol### 890 246 343
303 Griseofulvin tablet 125 mg, micronizet 100 Tablet / Botol ### - - -
304 Hidroclortiazid ( HCT ) tablet 25 mg 1000 Tablet / Botol### - - -
305 Hyosine-N-Butilbromid 10 mg 100 Tablet / Kotak### - - -
306 Ibuprofen tablet 200 mg 100 Tablet / Botol ### 30 470 149
307 Ibuprofen tablet 400 mg 100 Tablet / Botol ### 348 - -
308 Inlacta DHA ###
30 Softcapsul / Kotak - - -
309 Isoniazide 100 mg 1000 tab / Botol ### - - -
310 Isosorbid dinitrat tablet sublingual 5 mg 100 Tablet / Botol ### - - -
311 Kalium permanganat serbuk 25 Botol / 5 gram### - - -
312 Kalium Diklopenak 50 mg 50 Tablet / Kotak ### - - -
313 Kalium Diklopenak 25 mg 50 Tablet / Kotak ### - - -
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak### - 1,210 205
315 Ketokonazole 200 mg 50 Tablet / Kotak ### 40 80 60
316 Ketoprofen Tab 100 mg 100 Tab / Kotak ### - - -
317 Kloramfenikol kapsul 250 mg 250 Kapsul / Botol### - - -
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol### 226 374 325
319 Kloroquin tablet 150 mg 1000 Tablet / Botol### - - -
320 Kotrimoksazol tablet komb: sulfametoksazol 400 mg + 100 Tablet / Botol ### 65 50
Kotrimoksazol mg pedriatik kombinasi: 20
321 Sulfametoksazol 100 mg + Trimetoprim 20 mg 100 Tablet / Botol ### - -
-
322 Klokuin tablet 250 mg 1000 Tablet / Botol### - - -
323 Kuinin sulfat tablet 222 mg(7 H2O) 1000 Tablet/botol### - - -
324 Kuinin (kina) tablet 200 mg 60 Tab / ktk ### - - -
325 Lanzoprazole kaps 30 mg ( 2013 ) 20 kapsul / kotak### 50 - 5
326 Levofloxacin 500 mg 50 tablet / kotak ### - - -
327 Lodecon tablet (Obat Flu Kombinasi) Tablet ### - - -
328 Loperamid tablet 2 mg ( Novadium ) 100 tablet / kotak### 10 - 20
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak ### 40 115 85
330 Magnesium Sulfat serbuk 30 gram 10 Sase / Kotak ### - - -
331 Mebendazol tablet 100 mg 30 Tab/ktk ### - - -
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak ### 60 - 257
333 Meloxicam 15 mg ( 2013 ) 50 Tablet/ Kotak ### - - -
334 Metformin tab 500 mg 100 tablet / kotak### 130 100 180
335 Metformin tab 850 mg 100 tablet / kotak### 250 120 325
336 Metil Ergometrin Maleat Tab.sal 0,125 mg 100 Tab/ktk ### - - -
342 Multivitamin Tablet 100 tablet / kotak### - - -
343 Multivitamin Antioksidan Tablet (Univoxy) 30 Tablet / kotak ### - - -
344 Multivitamin Lansia (Pehavral) 30 Tablet / Botol ### - - -
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak### 800 325 25
346 Multivitamin penambah kalsium 100 Tablet / Kotak### - - -
347 Natural Anti inflamasi Tablet 60 Tablet / kotak ### - - -
348 Natrium Bikarbonat tablet 500 mg 1000 Tablet / Botol### - - -
PEB MAR APR
1 2 3 4 5 6
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol ### - 140 230
350 Natrium diklofenak tablet 50 mg 50 Tablet/ ktk ### - - -
351 Neurotropik Vitamin 100 Tab / ktk ### - - -
352 Nipedipin tablet 10 mg 100 tablet / kotak### 35 20 -
353 Nistatin tablet salut 500.000 IU 100 Tab/ktk ### - - -
354 Nistatin tablet vaginal 100.000 IU/g 100 Tab/ktk ### - - -
355 Noza ### - - -
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak ### 76 - 146
357 Ofloxacin 400 mg tab 50 kaps / Kotak ### - - -
358 Paraformaldehid tablet 1 gram 100 Tablet / Botol - - -
359 Parasetamol tablet 100 mg 100 Tablet / Botol - - -
360 Parasetamol tablet 500 mg 100 Tablet / Kotak### 1,021 1,154 882
361 Papaverin Tablet 40 mg btl 1000 tab ### - - -
362 Pharmaton Formula ### - - -
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak### - - -
364 Piracetam tablet 800 mg ( 2013 ) 100 tablet / kotak### - - -
365 Pirantel tablet 125 mg 60 Tab/ktk ### - 67 -
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 68 570 21
367 Piroksikam kapsul 10 mg ( 2013 ) 120 / Kotak 48 - -
368 Prednison tablet 5 mg 1000 Tablet / Botol### 149 114 346
369 Propiltiourasil tablet 100 mg 100 Tablet / Botol ### - 94 -
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol ### 486 - -
371 Ranitidin 150 mg ( 2013 ) ###
Kotak 10 x 10 Tablet 180 157 170
372 Reserpin tablet 0,10 mg 250 Tablet / Botol ### - - -
373 Reserpin tablet 0,25 mg 1000 Tablet / Botol### - - -
374 Retinol (Vitamin A) kapsul 100.000 IU 50 kaps / Botol ### - - -
375 Retinol (Vitamin A) 200.000 IU kapsul lunak 50 kaps / Botol ### - - -
376 Retinol tablet 50000 IU 1000 Tablet / Botol### - - -
377 Rifampisin kapsul 300 mg 120 Kapsul / Kotak### - - -
378 Rifampisin kaplet 450 mg 100 Kaplet / Kotak### - - -
379 Rifampisin kaplet 600 mg 100 Kaplet / Kotak### - - -
380 Salbutamol tablet 2 mg 100 tablet / kotak### 154 - 38
381 Salbutamol tablet 4 mg 100 tablet / kotak### 95 75 132
382 Sangobion ### - - -
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk ### - 110 100
384 Sefiksim kaps 100 mg 50 kaps / ktk ### - - -
385 Sianokobalamin (vitamin B12) Tablet 50 mcg btl 1000 tab ### 365 - 465
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 230 185 210
387 Spiramisin tab 500 mg 50 Tablet/ ktk - - -
388 Spironolakton tab 25 mg 100 Tab / Kotak - - -
389 Spironolakton tab 100 mg 100 Tab / Kotak - - -
390 Sulfadimidin tablet 500 mg 1000 Tablet / Botol - - -
391 Tablet tambah darah kombinasi Tablet - - -
392 Tetrasiklin HCL kapsul 250 mg 1000 Kapsul / Botol - - -
393 Tetrasiklin HCL kapsul 500 mg 100 Kaps/,ktk - - -
394 Tensigard - - -
PEB MAR APR
1 2 3 4 5 6
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol 51 - 103
396 Thiamfenicol 500 mg 100 kaps / ktk - 15 10
397 Tramadol tab 50 mg 50 tab / kotak 10 40 10
398 Vitamin B Kompleks 1000 Tablet / Botol 650 530 40
399 Zink Tablet 20 mg 100 Tab / ktk - 50 35
- - -
IX Serum & Vaksin - - -
400 Serum anti Bisa Ular Polivalen injeksi 5 ml ( ABU I ) 1 Vial / Kotak - - -
401 Serum anti Bisa Ular Polivalen injeksi 50 ml ( ABU II ) 1 Vial / Kotak - - -
402 Serum Anti Difteri inj. 20.000 IU/Vial (A.D.S) 10 Vial / Kotak - - -
403 Serum Anti Tetanus injeksi 1.500 IU/amp (ATS) 1 Ampul / Kotak - - -
404 Serum Anti Tetanus injeksi 20.000 IU/Vial(ATS) 1 Vial / Kotak - - -
405 Vaksin Rabies Vero 1 Vial / Kotak - - -
- - -
X Psikotropika - - -
406 Alprazolam 0,5 mg 100 tablet / kotak - - -
407 Amitriptillin HCL tablet salut 25 mg 100 Tab/ktk - 10 10
Antimigren :
408 Ergotamin Tartrat 1mg + Kofein 50mg 100 Tablet / Botol - -
-
409 Clobazam tab 10 mg 100 tablet / kotak - - -
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak - - -
411 Diazepam tablet 2 mg btl 100 Tablet - 9 23
412 Diazepam tablet 5 mg 1000 Tablet / Botol - - -
413 Diazepam Rectal 5 mg / ml Tube - - -
414 Diazepam Rectal 10 mg / ml Tube - - -
415 Efedrin HCL tablet 25 mg 250 Tablet / Btl - - -
416 Fenitoin Natrium injeksi 50 mg/ml Ampul @ 2 ml - - -
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak - - -
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 31 39 -
419 Fenobarbital tablet 100 mg 250 tablet / Botol - - -
420 Flufenazine Inj (Sikzonoate) 25 mg/ml 1 Ampul / Ampul - - -
421 Fluoksetine 10 mgTablet Box 30's - - -
422 Haloperidol tablet 0.5 mg 100 Tab/ktk - - -
423 Haloperidol tablet 1.5 mg 100 Tab/ktk 45 - -
424 Haloperidol tablet 5 mg 100 Tab/ktk - - -
425 Haloperidol 50 mg/ ml Inj Dus 5 Ampul @ 1 ml - - -
426 Karbamazepin tablet 200 mg 100 Tab/ktk - - 50
427 Klorpromazen HCL injeksi 25 mg/ml-1ml 30 Ampul / Kotak - - -
428 Klorpromazen HCL tablet salut 25 mg 1000 Tablet / Botol - - -
429 Klorpromazen HCL tablet salut 100 mg 1000 Tablet / Botol - - -
430 Klozapin 25 mg Kotak 5 x 10 tab - - -
431 Risperidon 2 mg Kotak 5 x 10 Tab - - -
432 Triheksifenidil Hidroklorida tablet 2 mg 100 Tab / ktk 10 - -
- - -
XI Narkotika - - -
433 Codeine 10 mg Box / 100 - - -
KAIAN OBAT DAN PERBEKKES
DOKUMEN NOMOR TANGGAL
DINKES
GFK
PUSKESMAS
PEMAKAIAN JUMLAH
MEI JUN JUL AGT SEP OKT NOV DES JAN'17
7 8 9 10 11 12 13 14 15 16
- - - 55 - - - 27 - 104
- - - - - - - - - -
- 14 - 78 - - - 132 - 285
- - - 32 - - - 2 - 36
- - - - - - - - - 4
- - - - - - - - - -
- - - 1 - - - 2 - 3
- - - - - - - - - -
- - - - - - - - - -
- - - 24 - - - - - 24
- - - 24 - - - - - 24
- - - - - - - - - -
- - - - - - - - - 1
- - - - - - - - - -
- - - - - - - - - 12
- - - - - - - - - 3
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 5
- - - 19 - - - 16 - 45
- - - 4 1 - - 1 - 8
- - - 16 - - - 13 - 39
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - 1 - 1
- - - - - - - - - 7
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - 12 - 13
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 2 - - - 2 - 4
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
- - - 15 - - - 9 - 24
- - - - - - - 4 - 4
- - - - - - - 100 - 250
- 200 - - - - - 200 - 500
- - - - - - - 200 - 300
- - - 24 - - - - - 24
- - - 24 - - - - - 24
- - - - - - - - - -
- - - 1 - - - - - 1
- - - 1 - - - - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - 2 - 2
- - - - - - - 1 - 1
- - - - - - - - - -
- - - 6 - - - 7 - 16
- - - 18 - - - 12 - 39
- - - 6 - - - 14 - 26
- - - 3 - - - 1 - 4
- - - - - - - - - -
- - - 1 - - - - - 1
- - - - - - - 52 - 146
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - 1 - - - 1
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
- - - - - - - - - -
- - - - - - - - - -
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - - - 1 - 3
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - 1 - - - 1
- - - - - 1 - - - 1
- - - - - 1 - - - 1
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - 10 - - - 10
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - 1 - - - 1
- - - - - 1 - - - 1
- - - - - 1 - - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 20 - - - - - 20
- - - - - - - - - -
- - - - - - - - - -
- - - 12 - - - - - 13
- - - - - - - - - -
- - - - - - - - - -
- 10 - 5 - - - - - 21
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 7
- - - 31 3 - - - - 66
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 2
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 29 - - - - - 29
- - - 38 - - - - - 38
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 5 - - - - - 14
- - - 8 - - - - - 14
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
5 16 7 8 3 - - 48 - 108
42 35 17 22 9 - - 47 - 196
- - - - - - - - - -
11 2 6 11 1 - - 33 - 88
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 9 4 11 8 - - 21 - 66
1 - - - - - - - - 1
10 23 11 6 3 - - 18 - 119
- - - - - - - 15 - 15
- - 3 6 - - - - - 9
- - - - - - - - - -
- - - - - - - - - -
1 12 3 5 6 - - 31 - 68
- - - - - - - - - -
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
- - - - - - - - - -
- - - - - - - - - -
2 - - 4 - - - - - 20
- - - - - - - - - 21
2 83 37 79 - - - 136 - 376
21 22 12 35 18 - - 100 - 219
- - - - - - - - - -
- - - - - - - - - -
2 7 4 4 - - - 18 - 45
- - - - - - - - - -
- - - - - - - - - -
- - - 8 2 - - 4 - 14
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 1
- - - 5 - - - 6 - 14
- - - 6 - - - 11 - 19
- - - - - - - - - 19
- - - - - - - - - -
- - - - - - - - - -
- - - 1 - - - - - 1
- - - - - - - - - -
- - - 7 - - - - - 7
- - - 41 3 - - - - 62
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 3 14 - - - - - 22
- - - - - - - - - -
- - 14 45 - - - - - 85
- - - 76 13 - - 17 - 114
- - 30 92 8 - - 75 - 249
- - - - - - - - - -
- - - - - - - - - -
- - 5 18 - - - - - 38
- - 13 - 102 - - - - 143
- - 5 - - - - 30 - 35
- - - 12 - - - 16 - 37
- - - - - - - 23 - 23
- - 7 25 - - - 25 - 78
- - 1 10 - - - 16 - 31
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
- - 7 23 8 - - 13 - 64
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 3 15 - - - 17 - 40
- - - - - - - - - -
- - - - - - - - - -
- - - 32 - - - 32 - 64
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 5
- - - 5 - - - 6 - 16
- - - 5 - - - 27 - 39
- - - - - - - - - -
- - - - - - - 2 - 2
- - - 3 - - - - - 23
- 30 - - - - - 2 - 52
- - - - - - - - - -
- - - - - - - - - -
- - - 1 - - - - - 2
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - 48
185 50 20 100 140 - 210 30 - 825
- - - - - - - - - -
206 - 251 1,155 74 - 1,039 340 - 3,751
- - - - - - - - - -
- - - 190 - - - - - 420
- 123 48 - 1 - 72 12 - 387
30 1,136 400 581 195 - 1,553 345 - 5,821
- - - - - - - - - -
630 415 320 625 93 - 957 150 - 3,730
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- 575 47 68 40 - 887 298 - 2,475
- - - 50 - - - - - 400
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
220 68 50 11 - - - - - 519
350 855 470 577 228 - - 1,300 - 4,916
- - - - - - - - - -
- - 33 70 - - - 58 - 161
23 201 106 - - - 6 52 - 828
- - - - - - - - - -
- 30 30 160 - - - - - 300
- - - - - - - - - -
- - - - - - - - - -
- - 30 60 - - 204 10 - 394
- - - 14 - - - - - 18
- - - - - - - - - -
10 30 - 60 30 - 70 - - 350
430 880 600 1,165 115 - 1,910 500 - 7,110
294 186 190 324 - - 450 100 - 1,884
- - - - - - - - - -
153 273 180 359 31 - 756 40 - 2,002
- 315 - 15 - - 20 - - 510
- - 100 540 560 - 134 186 - 1,950
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
579 809 569 212 736 - 1,974 383 - 6,325
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
205 210 230 170 - - 650 355 - 1,930
- - - - - - - - - 200
- - - - - - - - - -
- - 60 - - - - 100 - 850
- 75 15 25 45 - 255 - - 500
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
113 20 15 16 - - - 6 - 225
- 35 20 - 10 - 197 38 - 360
13 - 50 119 - - - 638 - 1,558
- - - - - - - - - -
- - - - - - - - - -
350 - 250 770 - - 210 90 - 2,510
- - - - - - - - - -
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
30 5 30 155 - - 30 15 - 455
40 245 90 115 125 - 665 305 - 1,905
- - - - - - - - - -
141 339 269 481 120 - - 440 - 3,269
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
240 77 80 100 29 - - 1,040 - 2,215
110 280 210 370 240 - - - - 1,558
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
20 - - - - - - 80 - 100
- - - - - - - - - -
- 600 260 - - - 200 85 - 2,560
110 120 100 - 45 - - 25 - 580
- - - 100 - - - - - 100
- - - - - - - - - -
489 - 396 - - - - - - 1,810
- - - - - - - - - -
- 117 110 110 20 - 435 125 - 1,052
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
20 25 30 45 - - - 135 - 310
- - - - - - - - - -
- - - - - - - - - -
10 10 - 5 20 - 260 15 - 350
215 - 170 65 140 80 140 240 - 1,290
- - - - - - - - - -
- - - - - - - - - -
300 156 205 56 19 - - 272 - 1,325
- - - - - - - - - -
375 545 280 60 60 - 820 520 - 3,070
80 100 60 230 60 - 40 10 - 1,275
- 18 - - - - - - - 18
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
30 660 255 525 161 - 854 200 - 3,835
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
600 245 235 325 30 - 650 215 - 2,670
- - - - - - - - - -
- - - - - - - - - -
20 - 5 - - - - - - 80
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
70 168 90 120 30 - 265 65 - 1,030
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
1,367 1,052 742 1,310 55 1,595 1,895 665 - 11,738
- - - - - - - - - -
- - - - - - - - - -
60 - 10 40 - - 130 - - 240
- - - - - - - - - -
- - - 12 - - - - - 79
49 152 50 - 160 - 180 60 - 1,310
- - - - 10 - - - - 58
- - - - - - - - - 609
90 30 30 - 30 - - 15 - 289
- 39 120 245 35 - 275 300 - 1,500
395 280 130 - - 440 56 194 - 2,002
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
10 - 12 23 - - 110 1 - 348
- 76 16 32 - - 104 50 - 580
- - - - - - - - - -
40 140 60 - 20 - - 390 - 860
- - - - - - - - - -
110 250 165 165 - - - - - 1,520
- 360 25 - - - - 270 - 1,280
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - 280 960 - - - 2,040 - 3,280
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
645 65 65 - - - - - - 929
10 25 10 10 - - - - - 80
20 - - - - - - 20 - 100
635 1,150 - 215 - - 1,640 330 - 5,190
36 - 110 374 - - 535 50 - 1,190
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 10 - - - 110 - 140
- - - - - - - - - -
- - - - - - - - - -
- - - 1 - - - - - 1
3 3 9 37 - - 77 7 - 168
- - - - - - - - - -
- - - 1 - - - - - 1
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 1 - - - - - 1
- - 30 40 203 - 125 - - 468
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - 20 - - 65
- - - - - - - - - -
- - - - - - - - - -
30 125 - 445 150 - - - - 800
- - - - - - - - - -
- 5 - - - - 18 - - 23
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - 41 - - - - - 51
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
PEMAKAIAN JUMLAH
7 8 9 10 11 12 13 14 15 16
Pimpinan Puskesmas Petugas Puskesmas
(.) (.)
NIP NIP
REKAP PEMAKAIAN O
PUSKESMAS :
KECAMATAN :
KABUPATEN : TABALONG
NO NAMA OBAT KEMASAN HARGA

SATUAN
1 2 3
I Alat Kesehatan
1 Alat Suntik sekali pakai 1 ml 100 set / kotak 1,540.00
2 Alat Suntik sekali pakai 2.5 ml 100 set / kotak 1,141.80
3 Alat Suntik sekali pakai 3 ml 100 set / kotak 957.00
6 Alkohol Swab Box 13,050.00
7 Bisturi 1 Pcs / Pcs 1,250.00
8 Catgut/Benang Bedah No 2/0 dg Jarum bedah 24 x 70 cm / ktk 7,287.00
9 Catgut PLAIN No 2/0 dg Jarum bedah 1 Saset / Saset 29,333.00
10 Catgut/Benang Bedah No 3/0 dg Jarum bedah 24 x 70 cm / ktk 7,287.00
11 Catgut PLAIN No 3/0 dg Jarum bedah 1 Saset / Saset 7,287.00
12 Catgut/Benang Bedah No 2/0 Chromic rol 1 Roll / Roll 1,100,000.00
13 Catgut/Benang Bedah No 3/0 Chromic rol 1 Roll / Roll 1,600,000.00
14 Ceplast Gauze aerofilm pack 99,000.00
15 Foley Catheter No 12 Pcs 12,100.00
21 Infusion set anak Set / kantong 4,568.00
22 Infusion set dewasa Set / kantong 4,176.00
23 Kapas Pembalut/absorben 250 mg Bungkus 28,235.00
24 Kasa Hidrofil steril 16 cm x 16 cm 1 Kotak / Kotak 7,569.00
25 Kasa Hidrofil steril 18 cm x 22 cm ISI 12 pack 5,225.00
26 Kasa hidrofil 4 m x 10 cm Rol 2,750.00
27 Kasa hidrofil 36 m x 80 cm Rol 142,946.00
28 Kasa Kompres 40/40 steril Bungkus 1,800.00
29 Kasa Pembalut 2 m x 80 cm Rol 10,443.00
30 Kasa Pembalut Hidrofil 4 m x 3 cm elastic Rol 842.60
31 Kasa Pembalut Hidrofil 4 m x 15 cm elastic Rol 2,741.00
32 Kertas Puyer 1200 pcs / pack 200.00
33 Masker N 95 Pcs 15,400.00
34 Needle No 23 Pcs 429.00
35 Needle No 25 Pcs 429.00
36 Plester 5 yards x 2 inch Rol 35,532.00
37 Plester Kecil Rol 1,375.00
38 Plester Sedang Rol 8,250.00
39 Policrepe 10 cm x 4,55 M Rol 822,300.00
40 Sarung Tangan STERIL S (6) Bks 4,675.00
SATUAN
1 2 3
41 Sarung Tangan STERIL M (7) Bks 9,000.00
42 Sarung Tangan STERIL L (8) Bks 9,000.00
43 Sarung tangan Non Steril No S 50 Psg / Kotak 849.00
44 Sarung tangan Non Steril No M 50 Psg / Kotak 849.00
45 Sarung tangan Non Steril No L 50 Psg / Kotak 849.00
46 Silk (Benang bedah sutera) No.2/0 dg jarum bedah 1 Pcs / Pcs 3,988.00
47 Silk (Benang bedah sutera) No.3/0 dg jarum bedah 12 x 3 x 75 cm/ktk 276,540.00
48 Transfusion set Set / kantong 9,396.00
49 Ultrafix 5 cm x 1 m Rol 27,000.00
50 Ultrafix 10 cm x 5 m Rol 115,800.00
51 Umbelical Klem / Tali Pusat Pcs 1,305.00
52 Underpad Ibu Nifas Pcs 7,000.00
53 Urine bag Steril 2 ltr Pcs 3,915.00
54 Jarum jahit no 9 dzn 25,000.00
57 IV Catheter No 18 ( Surflo ) 50 Steril / Kotak 8,355.00
61 Oksigen Tabung Kecil kubik 60,000.00
62 Tabung Oksigen Kecil Botol Tabung 1,920,000.00
63 Surgical Masker Ear Loop 3 Ply ( 2013 ) 50 Pcs / kotak 574.00
II Reagensia
64 Asam klorida 0,1 N Botol 20,000.00
65 Asam Sulfosalisilat 20 % Botol 775,000.00
66 Larutan Benedict Botol 100 ml 345,000.00
67 Larutan Eosin 2 % Botol 100 ml 40,250.00
68 Larutan Etanol Asam Botol 100 ml 35,000.00
69 Larutan Giemsa Stain Botol 100 ml 69,683.00
70 Larutan Karbol Fuksin Botol 100 ml 150,000.00
71 Larutan Metilan Biru Botol 100 ml 90,000.00
72 Larutan Turk Botol 100 ml 16,037.00
73 Metanol Botol 100 ml 95,000.00
74 Rapid Test DBD 1 Set /Set 60,000.00
75 Rapid Test MALARIA 1 Set /Set 40,000.00
III Obat Gigi

76 Fletcher Liquid 100 Gram / Botol 60,000.00
77 Alvoghyl Botol 510,000.00
78 Bonding ktk 290,000.00
79 Caviton Botol / Kotak 195,000.00
80 Cresophate Botol 705,000.00
81 Caustinerf Rapide Forte Botol 525,000.00
82 Cotton Roll Box 42,000.00
SATUAN
1 2 3
83 Cresophen Botol 725,000.00
84 Devitasol Botol 175,000.00
85 Disclosing Gel Botol 85,000.00
86 ETSA Botol 260,000.00
87 Etil Klorida Spray Botol / 100 ml 180,000.00
88 Eugenol Cairan Btl 10 ml 18,333.00
89 Flour tablet 0,5 mg 100 Tablet / Botol 34.64
90 Forinilkresol (Pengganti TKF) 1 Pcs / Pcs 55,000.00
91 Formocresol 1 Pcs / Pcs 45,000.00
92 Flowable Komposit Monohydrit Warna A 2 1 Pcs / Pcs 155,000.00
93 Flowable Komposit Monohydrit Warna A3 1 Pcs / Pcs 155,000.00
94 Fuji IX ART 1 Kotak / Kotak 855,000.00
95 Fuji VII Fissure Sealant 1 Kotak / Kotak 1,120,000.00
96 Iodorm Paste Botol 215,000.00
97 Jarum Citoject Dos@100 1,650.00
98 Kalsium Hidroksida Pasta ( Hydcal ) 1 Tube / Tube 165,000.00
99 Klorfenol Kamfer Menthol (CHKM) Botol 10 ml 48,762.00
100 Micro Aplicator Bruss Disposible Botol 71,000.00
101 Mummifying Pasta 1 Botol / Botol 193,600.00
102 Komposit Monohyrid warna A 3.5 1 Kotak / Kotak 375,000.00
103 Komposit Monohyrid warna A 3 1 Kotak / Kotak 375,000.00
104 Komposit Monohyrid warna A 2 1 Kotak / Kotak 375,000.00
105 Panaspray Oil 1 Botol / Botol 325,000.00
106 Pulperyl 1 Botol / Botol 395,000.00
107 Scandonest 2% 1 Pcs / Pcs 11,000.00
108 Spon Gelatin Cubicles 1x1x1 cm 35,000.00
109 Semen Seng Fospat serb dan cairan ( Dorident ) Set @ 30 gr/ Btl 102,850.00
110 Silver Amalgam Serbuk 65-75 % 1 oz / Botol 237,540.00
111 Tropicaina Anestesi Tube 15 mg 78,000.00
112 Temporary Stopping Fletcher (Fletcher) serbuk Set @ 100 gr / Btl 30,000.00
IV Obat Injeksi
113 Aminofilina Inj. 24 mg/ml - 10 ml 30 Ampul / Kotak 4,204.00
114 Ampisillin serbuk inj. (IM/IV) 1000 mg 1 Vial / Vial 5,610.00
115 Antalgin injeksi 250 mg/ml-2ml 30 Ampul / Kotak 1,764.00
116 Asam Tranexamat Injeksi 250 mg / 5 ml 10 Ampul / kotak 4,040.00
117 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ( 2013 ) 30 Ampul / Kotak 1,353.00
118 Aqua pro injeksi steril , bebas pirogen 1 Vial / Vial 2,200.00
119 Combivent 2,5 Nebulizer 20 pcs / Box 5,990.00
120 Deksametason injeksi 5 mg/ml- 1 ml 100 Ampul / Kotak 1,738.00
121 Difenhidramin HCL inj 10 mg/ml- 1 ml 30 Ampul / Kotak 1,160.00
122 Epinefrina HCL/Bitartrat ( Epinefrina/adrinalina ) injeksi 0.1 % - 30 Ampul / Ampul 8,910.00

1 ml
123 Fitomenadion (Vit K1) injeksi 30 Ampul / Kotak 1,723.00
124 Furosemid injeksi 25 Ampul / ktk 2,012.00
125 Gentamicin Injeksi 80 mg/2ml 5 Ampul / Kotak 4,065.60
126 Ketorolac injeksi 10 mg 6 Ampul @ 1 ml 2,665.00
SATUAN
1 2 3
127 Kloroquin injeksi 100 Ampul / Kotak 3,954.72
128 Kuinin Dihidroksida injeksi 25 % - 2 ml 30 Ampul / Kotak 6,820.00
129 Lidokain komp. Injeksi,kombinasi Lidokain HCl 30 Ampul / Kotak 1,250.33

2% + Epinefrin 1 : 80.000-2ml
130 Lidokain Injeksi 2 % 100 Ampul / Kotak 929.00
131 Magnesium Sulfat inj. (IV) 20%-25ml 10 Vial / kotak 1,693.80
132 Magnesium Sulfat inj. (IV) 40%-25ml 10 Vial / kotak 2,142.70
133 Metamizole 500mg Injeksi 5 ampul / kotak 10,760.00
134 Metil Ergometrin Maleat inj 0,200 mg - 1 ml 30 Ampul / Kotak 1,503.33
135 Metochlopramid Inj 5 mg/ml 10 Ampul / Kotak 4,900.00
136 Neurotropik Vitamin (Neurobat) Injeksi 1 Ampul / Ampul 4,342.00
137 Ondansetron 4 mg/ 2 ml Injeksi 5 Ampul / Kotak 2,400.00
138 Oksitetrasiklin HCL Injeksi i.m 50 mg/ml-10 ml ktk 10 vial 3,751.00
139 Oksitosin injeksi 10 IU/ml-1ml 100 Ampul / Kotak 2,791.00
140 Pehacain Injeksi 10 Ampul / kotak 3,113.00
141 Piracetam Injeksi 1 gr/5ml 10 ampul / Kotak 5,500.00
142 Piracetam Injeksi 3 gr/15ml 4 ampul / Kotak 13,500.00
143 Prokain Benziloenicillin G 3jt UI/Vial ktk 30 vial @15 ml 6,160.00
144 Ranitidin injeksi 25 mg/2 ml 10 Ampul / Kotak 1,340.00
145 Salbutamol 2.5 mg Nebules 20 Ampul / Kotak 7,260.00
146 Sefotaksim inj 1 gr 1 Vial / Vial 6,750.00
147 Seftazidim injeksi 1 gr 2 Vial/ktk 41,382.00
148 Seftriaxone injeksi 1 gr kotak 2 vial 3,700.00
149 Sianokobalamin (vit.B12) injeksi 500 mcg/ml-1ml 100 Ampul / Kotak 1,332.00
150 Tiamin HCL (vit.B1) injeksi 100 mg/ml-1ml 30 Ampul / Kotak 847.00
151 Tramadol injeksi 50 mg/ml 5 Ampul / Kotak 2,680.00
V Syrup
152 Albendazol Syrup Botol 4,234.00
153 Ambroxol Sirup 15 mg/ml Botol/ 60 ml 3,295.00
154 Amoksisillin sirup kering 125mg/5ml ( 2013 ) Botol 60 ml 2,500.00
155 Ampisillin sirup kering 125mg/5ml Botol 60 ml 4,840.00
156 Antasida DOEN II Suspensi ( 2013 ) Botol 60 ml 2,300.00
157 Apialys Drop / Truvit Botol 11,400.00
158 Cetirize Syrup Botol 8,799.00
159 Dexrofen Syrup Botol 8,047.00
160 Dekstrometorpan sirup 10 mg/5 ml Botol 60 ml 3,152.00
161 Domperidon Suspensi 5mg/5ml ( 2013 ) Botol 60 ml 3,490.00
162 Domperidon Drop ( 2014 ) Botol 17,100.00
163 Ibuprofen Syrup 100 mg/ 5 ml Botol 60 ml 3,849.00
164 Ibuprofen Syrup 200 mg/ 5 ml Botol 60 ml 8,949.00
165 Erytromicin sirup 200 mg/5 ml Botol 60 ml 8,090.00
166 Kaolin Pectin Syrup/ Guanistrep Syrup Botol 3,500.00
167 Kloramfenicol suspensi 125 mg/5ml ( 2013 ) Botol 60 ml 5,198.00
168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Trimetoprim Botol 60 ml 2,298.00

40 mg / 5 ml
169 Laksatif Syrup (Laxadine) Botol 12,450.00
SATUAN
1 2 3
170 Mebendazol sirup 100 mg/5 ml (Obat Cacing Anak) btl 30 ml 3,740.00
171 Metochlopramid Sirup 5 mg/ml Botol 60 ml 8,800.00
172 Multivitamin Anak Syrup (Lysmin) Botol 60 ml 30,800.00
173 Obat Batuk Hitam (OBH) cairan Botol 100 ml 2,145.00
174 Parasetamol sirup 120 mg/5ml Botol Plastik 60 ml 1,535.00
175 Parasetamol drops Botol 5,720.00
176 Pyrantel Suspensi 10 ml Botol 9,100.00
177 Recovital Syrup Botol 5,830.00
178 Sefadroksil sirup ( 2013 ) Btl 60 ml 5,286.00
179 Sefadroksil Forte sirup Btl 60 ml 6,285.00
180 Sefiksim dry sirup Botol 30 ml 36,602.50
181 Zinc Syr 20 mg / 5 ml Btl 60 ml 8,140.00
VI Cairan
182 Aquadest Steril Infus Botol 500 ml 12,250.00
183 Dextrose 5 1/2 N S Btl 500 ml 8,470.00
184 Dextrose 5 1/4 N S Btl 500 ml 8,470.00
185 Etakridina (Rivanol) larutan 0.1 % Botol 300 ml 3,328.00
186 Etanol 70 % Botol 1000 ml 28,058.00
187 Etanol 70 % Botol 100 ml 2,625.00
188 Glukosa larutan infus 5 % steril Botol / Plastik 500 ml 5,720.00
189 Glukosa larutan infus 10 % steril Botol / Plastik 500 ml 6,300.00
190 Ka-en 3B Infus Botol 500 mg 10,000.00
191 Lisol,mengandung kresol tersabun 50 % Botol 1000 ml 49,862.00
192 Metronidazol infus 500 mg/100 ml 100 ml / Botol 12,980.00
193 Natrium Klorida larutan infus 0,9 % steril Botol / 500 ml 5,170.00
194 Ringer Laktat larutan infus steril (Produk Lokal) Botol / Plastik 500 ml 5,720.00
195 TetraHES larutan Infus 1 Pack / Pack 220,700.00
VII Obat Luar (Salep & Tetes)

196 Anti Bakteri DOEN salep kombinasi: Basitrasin 25 Tube 5 g / Ktk 2,767.00
500IU/g+Polimiksin 10.000IU/g
197 Anti Hemaroid DOEN Kombinasi 10 Supp / Kotak 2,420.00
198 Antifungi DOEN kombinasi: Asam 24 Pot 30 g / Ktk 2,741.00

Benzoat 6%+Asam Salisilat 3%
199 Asiclovir Cream 5 % ktk 25 tube @ 5 gram 3,150.00
200 Gentamicin Sulfat Tetes Mata 0,3 % ( 2013 ) Kotak 10 Botol @ 5 ml 8,300.00
201 Betametason krim 0.1% ktk 25 tube @ 5 gram 1,558.00
202 Bioplacenton cream 1 Tube / Tube 14,250.00
203 Desoksimethasone 0,25% Cream 1 Tube / Tube 9,983.00
204 Fenol gliserol tetes telinga 10 % Botol @ 5 ml 2,246.00
205 Gentamicin Salep Kulit 1 Tube / Tube 1,850.00
206 Gentamicin 0,3% Salep Mata 1 Tube / Tube 2,786.00
207 Gentian Violet larutan 1 % ( 2013 ) Botol 10 ml 2,924.00
208 Hidrokortison krim 2.5 % ( 2013 ) 24 Tube / Kotak 2,868.00
209 Ketokonazole Cream 2 % Tube 15 mg 5,150.00
210 Kloramfenikol tetes telinga 3 % 24 Botol / Kotak 7,558.00
SATUAN
1 2 3
211 Kloramfenikol tetes mata 0,5 % Botol 5 ml 7,558.00
212 Kloramfenicol salep mata 1 % 5 gr / Tube 1,640.00
213 Litrol Tetes Mata/ Kortikosteroid Botol 18,300.00
214 Levetran Salep / Minyak Ikan Pot 2,813.00
215 Lidocain Jelly 2% (Xylocaine 2%) 1 Pcs / Pcs 40,000.00
216 Minyak Angin Safe Care Botol 13,600.00
217 Miconazol cream 2 % ( 2013 ) 24 Tube @ 10 mg 3,075.00
218 Mydric Tetes Mata botol 26,000.00
219 Oksitetrasiklin HCL salep mata 1 % ( 2013 ) 25 Tube / Kotak 1,640.00
220 Oksitetrasiklin salep kulit 3 % ( 2013 ) 25 Tube / Kotak 2,010.00
221 Pilocarpine Tetes Mata Botol 20,400.00
222 Polidemisin Tetes Mata Botol 23,550.00
223 Polikresulen (Kondensasi Metakresol Sulfonat dan Metanol), Botol 10 ml 18,635.00

Albothyl
224 Povidon Iodida 10 % Botol 30 ml 2,640.00
225 Povidon Iodida 10 % ( 2013 ) Botol 60 ml 3,588.00
226 Povidon iodida 10% Botol 300 ml 15,386.00
227 Povidon iodida 10% Botol 1000 ml 40,202.00
228 Salep 2-4 kombinasi: Asam Salisilat 24 Pot @ 30 g / Kotak 2,200.00

2% + Belerang endap 4%
229 Salisil Bedak 2 % 50 Gram / Kotak 1,350.00
230 Scabicid Cream Tube 15 mg 11,475.00
231 Sulfasetamida Natrium tetes mata 15 % 24 Btl @ 5 ml / Kotak 3,789.79
232 Trombophop Gel Tube 15 mg 52,800.00
233 Temefos 1% Bungkus / 1 kg 93,200.00
234 Tetracain Tetes Mata Botol 89,000.00
235 Timolol Tetes Mata Botol 63,000.00
236 Voltadex Gel 1 Tube / Tube 21,450.00
237 Voltaren Gel 1 Tube / Tube 25,850.00
VIII Obat-Obatan
238 Albendazol tablet 400 mg ktk 5 x 6 tablet 231.00
239 Alopurinol tablet 100 mg ( 2013 ) 100 Tab/,ktk 90.00
240 Alopurinol tablet 300 mg ( 2013 ) Ktk 3 x 10 tablet 225.00
241 Ambroxol Tablet 30 mg 100 Tab / Kotak 125.00
242 Aminofilin tablet 200 mg 100 Tablet / Botol 86.00
243 Amlodipine 10 mg ( 2013 ) 30 Tablet / Kotak 352.00
244 Amoksisillin kapsul 250 mg 120 Tab/ktk 289.00
245 Amoksisillin kapsul 500 mg 100 kaplet / kotak 279.00
246 Antalgin (Metampiron) tablet 500 mg 100 Tablet / Kotak 151.00
247 Antasida DOEN tab kombinasi : Mg 100 tablet / kotak 78.00

Hidroksida 200 mg + Al Hidroksida
248 100 Tablet / kotak 520.30
Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + Sulfadoxin 500mg
249 Asam Asetilsalisilat 80mg Tab 100 Tablet / kotak 503.00
250 Asetosal 100 mg (Asam Asetilsalisilat) 100 Tablet / kotak 127.00
251 Asam ascorbat (Vit C) tablet 50 mg 100 Tablet / Kotak 105.00
252 Amlodipine 5 mg ( 2013 ) 30 Tablet / Kotak 197.00
SATUAN
1 2 3
253 Asam Folat 1 mg / Folid Acid 100 Tablet / Botol 52.00
254 Asam Mefenamat kapsul 500 mg 100 Kapsul / Kotak 176.00
255 Asam Tranexamat Tablet 500 mg 100 tablet / kotak 13,062.00
256 Asiclovir 200 mg 100 Tablet/ ktk 245.00
257 Asiclovir 400 mg 100 Tab/ktk 354.00
258 Asifit Kaplet 100 Tab/Ktk 43,350.00
259 Attapulgit 50 Tab/ktk 220.00
260 Attapulgit + Pectin Tablet (Kombinasi) 100 Tablet/ ktk 1,146.00
261 Atropin Sulfat tablet 0,5 mg 500 Tablet / Botol 81.00
262 Betahistin Mesilat 5 mg 30 tablet / kotak 1,271.00
263 Bisacodil Tablet Kotak / 18 Tablet 836.11
264 Bisoprolol tablet 5 mg Ktk 3 x 10 tablet 2,553.83
265 Bromhexin Tablet 100 tablet / kotak 200.00
266 Captopril tablet 25 mg 100 tablet / kotak 97.00
267 Captopril tablet 12,5 mg 100 Tablet / kotak 69.00
268 Cetop Zink 100 Tablet / kotak 1,925.00
269 Cetrizine 10 mg 50 Tablet/ ktk 190.00
270 Cimetidin tablet 200 mg 100 tablet / kotak 127.05
271 Ciprovloxsacin 500 mg 100 tablet / kotak 473.00
272 Clindamisin 150 mg Kapsul 50 Kapsul / kotak 405.00
273 Clindamisin 300 mg Kapsul 50 Kapsul / kotak 580.00
274 Clonidin 0,15 mg 100 tablet / kotak 224.00
275 Curcuma Tablet 100 tablet / kotak 845.00
276 Deksametason tablet 0.5 mg 100 Tablet / Kotak 68.00
277 Dekstrometorpan tablet 15 mg 100 tablet / kotak 121.00
278 Dietilkarbamazin sitrat tablet 100 mg 100 Tablet / kotak 262.00
279 Digoksin tablet 0,25 mg 100 Tablet / Botol 103.00
280 Diltiazem HCL tab 30 mg 100 Tab / Kotak 137.00
281 Dimenhidrinat tab 50 mg 100 Tab / Botol 106.00
282 Doksisiklin kapsul 100 mg 100 kapsul / kotak 278.30
283 Domperidon Tablet 10 mg 100 Tablet / Ktk 174.00
284 Erytromisin Kapsul 500 mg 100 Tablet / ktk 1,023.00
285 Erytromisin Kapsul 250 mg 100 tab / Kotak 509.00
286 Ekstrak Belladon tablet 10 mg 1000 Tablet / Botol 348.48
287 Etambutol HCL tablet 250 mg 200 Tablet / kotak 350.90
288 Famotidin 20 mg 50 Tablet / Kotak 214.17
289 Fenilbutazon/Novazon 1000 Tablet / Botol 98.10
290 Fenitoin Natrium kapsul 30 mg 250 Kapsul / Botol 88.40
291 Fenitoin Natrium kapsul 100 mg 250 Kapsul / Botol 146.00
292 Fitomenadion (Vit K) tablet salut gula 10 mg 100 Tablet / Botol 749.00
293 Furosemid tablet 40 mg ( 2013 ) 100 Tablet / Kotak 84.00
294 Garam Oralit untuk 200 ml air 100 Kantong / Kotak 418.00
295 Gemfibrozil 300 mg 120 kaps / kotak 318.00
296 Gemfibrozil 600 mg 100 kaps / kotak 747.00
297 Glibenklamid tablet 5 mg ( 2013 ) 100 Tablet / Botol 126.00
298 Glimepiride tablet 1 mg 50 Tablet / Kotak 272.00
SATUAN
1 2 3
301 Gliquidon tablet 30 mg 100 tablet / kotak 709.80
302 Gliseril Guayakolat tablet 100 mg 1000 Tablet / Botol 53.00
303 Griseofulvin tablet 125 mg, micronizet 100 Tablet / Botol 224.00
304 Hidroclortiazid ( HCT ) tablet 25 mg 1000 Tablet / Botol 39.93
305 Hyosine-N-Butilbromid 10 mg 100 Tablet / Kotak 330.00
306 Ibuprofen tablet 200 mg 100 Tablet / Botol 127.00
307 Ibuprofen tablet 400 mg 100 Tablet / Botol 157.00
308 Inlacta DHA 30 Softcapsul / Kotak 3,573.00
309 Isoniazide 100 mg 1000 tab / Botol 45.00
310 Isosorbid dinitrat tablet sublingual 5 mg 100 Tablet / Botol 98.00
311 Kalium permanganat serbuk 25 Botol / 5 gram
312 Kalium Diklopenak 50 mg 50 Tablet / Kotak 708.00
313 Kalium Diklopenak 25 mg 50 Tablet / Kotak 429.92
314 Kalsium laktat (Kalk) tablet 500 mg 100 Tablet / Kotak 76.00
315 Ketokonazole 200 mg 50 Tablet / Kotak 320.00
316 Ketoprofen Tab 100 mg 100 Tab / Kotak 1,485.00
317 Kloramfenikol kapsul 250 mg 250 Kapsul / Botol 275.00
318 Klorfeniramin Maleat (CTM) tablet 4 mg 1000 Tablet / Botol 26.00
319 Kloroquin tablet 150 mg 1000 Tablet / Botol 102.85
320 Kotrimoksazol tablet komb: sulfametoksazol 400 mg + Trimetoprim 100 Tablet / Botol 152.00
80 mg
321 Kotrimoksazol tablet pedriatik kombinasi: 100 Tablet / Botol 79.00

Sulfametoksazol 100 mg + Trimetoprim 20 mg
322 Klokuin tablet 250 mg 1000 Tablet / Botol 127.00
323 Kuinin sulfat tablet 222 mg(7 H2O) 1000 Tablet/botol 670.00
324 Kuinin (kina) tablet 200 mg 60 Tab / ktk 706.00
325 Lanzoprazole kaps 30 mg ( 2013 ) 20 kapsul / kotak 521.00
326 Levofloxacin 500 mg 50 tablet / kotak 1,396.00
327 Lodecon tablet (Obat Flu Kombinasi) Tablet 300.00
328 Loperamid tablet 2 mg ( Novadium ) 100 tablet / kotak 97.00
329 Loratadin 10 mg ( 2013 ) 50 Tablet / Kotak 170.00
330 Magnesium Sulfat serbuk 30 gram 10 Sase / Kotak 1,242.23
331 Mebendazol tablet 100 mg 30 Tab/ktk 254.10
332 Meloxicam 7.5 mg ( 2013 ) 50 Tablet / Kotak 690.00
333 Meloxicam 15 mg ( 2013 ) 50 Tablet/ Kotak 1,180.00
334 Metformin tab 500 mg 100 tablet / kotak 200.00
335 Metformin tab 850 mg 100 tablet / kotak 363.00
336 Metil Ergometrin Maleat Tab.sal 0,125 mg 100 Tab/ktk 169.00
342 Multivitamin Tablet 100 tablet / kotak 2,166.67
343 Multivitamin Antioksidan Tablet (Univoxy) 30 Tablet / kotak 7,033.00
344 Multivitamin Lansia (Pehavral) 30 Tablet / Botol 2,166.67
345 Multivitamin penambah darah (Trofifer) 100 Tablet / Kotak 798.00
346 Multivitamin penambah kalsium 100 Tablet / Kotak 580.00
347 Natural Anti inflamasi Tablet 60 Tablet / kotak 6,325.00
348 Natrium Bikarbonat tablet 500 mg 1000 Tablet / Botol 17.30
SATUAN
1 2 3
349 Natrium diklofenak tablet 25 mg 50 Tablet / Botol 146.00
350 Natrium diklofenak tablet 50 mg 50 Tablet/ ktk 263.30
351 Neurotropik Vitamin 100 Tab / ktk 1,222.00
352 Nipedipin tablet 10 mg 100 tablet / kotak 110.00
353 Nistatin tablet salut 500.000 IU 100 Tab/ktk 704.00
354 Nistatin tablet vaginal 100.000 IU/g 100 Tab/ktk 379.00
355 Noza 398.75
356 Omeprazole Tab 20 mg ( 2013 ) 30 kaps / Kotak 221.00
357 Ofloxacin 400 mg tab 50 kaps / Kotak 700.00
358 Paraformaldehid tablet 1 gram 100 Tablet / Botol 63.00
359 Parasetamol tablet 100 mg 100 Tablet / Botol 41.80
360 Parasetamol tablet 500 mg 100 Tablet / Kotak 88.00
361 Papaverin Tablet 40 mg btl 1000 tab 102.00
362 Pharmaton Formula 2,753.00
363 Piracetam tablet 400 mg ( 2013 ) 100 tablet / kotak 451.00
364 Piracetam tablet 800 mg ( 2013 ) 100 tablet / kotak 321.00
365 Pirantel tablet 125 mg 60 Tab/ktk 318.00
366 Piridoksin HCl ( Vit B6 ) tablet 10 mg 1000 Tablet / Botol 32.00
367 Piroksikam kapsul 10 mg ( 2013 ) 120 / Kotak 72.47
368 Prednison tablet 5 mg 1000 Tablet / Botol 57.00
369 Propiltiourasil tablet 100 mg 100 Tablet / Botol 330.00
370 Propanolol HCL tablet 40 mg (2013) 100 Tablet / Botol 114.00
371 Ranitidin 150 mg ( 2013 ) Kotak 10 x 10 Tablet 132.00
372 Reserpin tablet 0,10 mg 250 Tablet / Botol 91.00
373 Reserpin tablet 0,25 mg 1000 Tablet / Botol 114.00
374 Retinol (Vitamin A) kapsul 100.000 IU 50 kaps / Botol 286.00
375 Retinol (Vitamin A) 200.000 IU kapsul lunak 50 kaps / Botol 505.00
376 Retinol tablet 50000 IU 1000 Tablet / Botol 193.60
377 Rifampisin kapsul 300 mg 120 Kapsul / Kotak 465.85
378 Rifampisin kaplet 450 mg 100 Kaplet / Kotak 665.50
379 Rifampisin kaplet 600 mg 100 Kaplet / Kotak 938.00
380 Salbutamol tablet 2 mg 100 tablet / kotak 65.00
381 Salbutamol tablet 4 mg 100 tablet / kotak 91.00
382 Sangobion 800.00
383 Sefadroksil kaps 500 mg ( 2013 ) 50 kaps / ktk 840.00
384 Sefiksim kaps 100 mg 50 kaps / ktk 2,897.50
385 Sianokobalamin (vitamin B12) Tablet 50 mcg btl 1000 tab 15.00
386 Simvastatin 10 mg ( 2013 ) 30 Tab / Kotak 177.00
387 Spiramisin tab 500 mg 50 Tablet/ ktk 1,621.40
388 Spironolakton tab 25 mg 100 Tab / Kotak 350.00
389 Spironolakton tab 100 mg 100 Tab / Kotak 1,000.00
390 Sulfadimidin tablet 500 mg 1000 Tablet / Botol 141.40
391 Tablet tambah darah kombinasi Tablet 80.00
392 Tetrasiklin HCL kapsul 250 mg 1000 Kapsul / Botol 183.90
393 Tetrasiklin HCL kapsul 500 mg 100 Kaps/,ktk 302.50
394 Tensigard 1,796.60
SATUAN
1 2 3
395 Tiamin HCL/Mononitrat ( Vit.B1) tablet 50 mg 1000 Tablet / Botol 74.00
396 Thiamfenicol 500 mg 100 kaps / ktk 619.00
397 Tramadol tab 50 mg 50 tab / kotak 196.00
398 Vitamin B Kompleks 1000 Tablet / Botol 126.00
399 Zink Tablet 20 mg 100 Tab / ktk 521.00
IX Serum & Vaksin

400 Serum anti Bisa Ular Polivalen injeksi 5 ml ( ABU I ) 1 Vial / Kotak 473,000.00
401 Serum anti Bisa Ular Polivalen injeksi 50 ml ( ABU II ) 1 Vial / Kotak 55,660,000.00
402 Serum Anti Difteri inj. 20.000 IU/Vial (A.D.S) 10 Vial / Kotak 697,950.00
403 Serum Anti Tetanus injeksi 1.500 IU/amp (ATS) 1 Ampul / Kotak 126,500.00
404 Serum Anti Tetanus injeksi 20.000 IU/Vial(ATS) 1 Vial / Kotak 525,800.00
405 Vaksin Rabies Vero 1 Vial / Kotak 78,500.00
X Psikotropika
406 Alprazolam 0,5 mg 100 tablet / kotak 435.00
407 Amitriptillin HCL tablet salut 25 mg 100 Tab/ktk 123.00
408 Antimigren : Ergotamin 100 Tablet / Botol 135.63

Tartrat 1mg + Kofein 50mg
409 Clobazam tab 10 mg 100 tablet / kotak 900.00
410 Diazepam injeksi 5mg/ml-2 ml 30 Ampul / Kotak 4,598.00
411 Diazepam tablet 2 mg btl 100 Tablet 46.00
412 Diazepam tablet 5 mg 1000 Tablet / Botol 52.80
413 Diazepam Rectal 5 mg / ml Tube 23,760.00
414 Diazepam Rectal 10 mg / ml Tube 1,879.18
415 Efedrin HCL tablet 25 mg 250 Tablet / Btl 56.00
416 Fenitoin Natrium injeksi 50 mg/ml Ampul @ 2 ml 20,857.00
417 Fenobarbital injeksi 50 mg/ml-2 ml 30 Ampul / Kotak 1,980.00
418 Fenobarbital tablet 30 mg 1000 Tablet / Botol 70.00
419 Fenobarbital tablet 100 mg 250 tablet / Botol 63.72
420 Flufenazine Inj (Sikzonoate) 25 mg/ml 1 Ampul / Ampul 55,000.00
421 Fluoksetine 10 mgTablet Box 30's 1,540.00
422 Haloperidol tablet 0.5 mg 100 Tab/ktk 66.00
423 Haloperidol tablet 1.5 mg 100 Tab/ktk 76.00
424 Haloperidol tablet 5 mg 100 Tab/ktk 105.00
425 Haloperidol 50 mg/ ml Inj Dus 5 Ampul @ 1 ml 91,666.00
426 Karbamazepin tablet 200 mg 100 Tab/ktk 267.00
427 Klorpromazen HCL injeksi 25 mg/ml-1ml 30 Ampul / Kotak 1,210.00
428 Klorpromazen HCL tablet salut 25 mg 1000 Tablet / Botol 134.00
429 Klorpromazen HCL tablet salut 100 mg 1000 Tablet / Botol 162.00
430 Klozapin 25 mg Kotak 5 x 10 tab 1,550.00
431 Risperidon 2 mg Kotak 5 x 10 Tab 1,069.00
432 Triheksifenidil Hidroklorida tablet 2 mg 100 Tab / ktk 297.00
XI Narkotika
433 Codeine 10 mg Box / 100 550.00
TOTAL
PEMAKAIAN OBAT DAN PERBEKKES
TAHUN 2014 DOKUMEN NOMOR
DINKES
GFK
PUSKESMAS
STOK TOTAL JUMLAH TOTAL JUMLAH TOTAL STOK TOTAL

AWAL HARGA PENERIMAAN HARGA PEMAKAIAN HARGA OPNAME HARGA
16
- - 200.00 308,000.00 104 ### 96 147840

75.00 85,635.00 - - - - 75 85635
34.00 32,538.00 300.00 287,100.00 285 ### 49 46893
4.00 5,392.00 100.00 134,800.00 36 ### 68 91664
- - 100.00 179,000.00 4 ### 96 171840
28.00 365,400.00 - - - - 28 365400
- - - - 3 - (3) -3750
- - - - - - - 0
- - - - - - - 0
- - 24.00 174,888.00 24 ### - 0
- - 24.00 174,888.00 24 ### - 0
1.00 1,100,000.00 - - - - 1 1100000
- - - - 1 - (1) -1600000
12.00 1,188,000.00 - - - - 12 1188000
3.00 36,300.00 - - 12 - (9) -108900
- - - - 3 - (3) -31320
- - - - - - - 0
- - - - - - - 0
5.00 46,700.00 - - - - 5 46700
28.00 261,520.00 - - - - 28 261520
4.00 18,272.00 - - 5 - (1) -4568
2.00 8,352.00 50.00 208,800.00 45 ### 7 29232
1.00 28,235.00 10.00 282,350.00 8 ### 3 84705
- - 55.00 416,295.00 39 ### 16 121104
- - - - - - - 0
1.00 2,750.00 - - - - 1 2750
- - - - - - - 0
7.00 12,600.00 5.00 9,000.00 1 9,000.00 11 19800
- - - - 7 - (7) -73101
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
19.00 8,151.00 - - - - 19 8151
- - - - 13 - (13) -461916
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - 30.00 140,250.00 4 ### 26 121550
16
- - 30.00 270,000.00 24 ### 6 54000
50.00 450,000.00 30.00 270,000.00 4 ### 76 684000
300.00 254,700.00 300.00 254,700.00 250 ### 350 297150
300.00 254,700.00 200.00 169,800.00 500 ### - 0
24.00 20,376.00 - - 300 - (276) -234324
24.00 95,712.00 - - 24 - - 0
- - - - 24 - (24) -6636960
- - - - - - - 0
- - 1.00 27,000.00 1 27,000.00 - 0
- - 1.00 115,800.00 1 ### - 0
4.00 5,220.00 - - - - 4 5220
6.00 42,000.00 - - - - 6 42000
2.00 7,830.00 - - - - 2 7830
1.00 25,000.00 - - 2 - (1) -25000
- - - - 1 - (1) -13750
46.00 1,150,000.00 - - - - 46 1150000
39.00 325,845.00 - - 16 - 23 192165
43.00 359,265.00 - - 39 - 4 33420
43.00 359,265.00 - - 26 - 17 142035
- - - - 4 - (4) -33420
1.00 60,000.00 - - - - 1 60000
150.00 ### - - 2 - 148 2.84E+08
- - - - 146 - (146) -83804
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
1.00 - - - - - 1 0
- - - - 1 - (1) -60000
1.00 510,000.00 - - - - 1 510000
1.00 290,000.00 - - 1 - - 0
- - - - 1 - (1) -195000
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
16
- - - - - - - 0
1.00 175,000.00 - - - - 1 175000
- - - - 1 - (1) -85000
2.00 520,000.00 - - - - 2 520000
1.00 180,000.00 5.00 900,000.00 3 ### 3 540000
- - - - 1 - (1) -18333
- - - - - - - 0
- - - - - - - 0
1.00 45,000.00 - - - - 1 45000
1.00 155,000.00 - - 1 - - 0
1.00 155,000.00 - - 1 - - 0
1.00 855,000.00 - - 1 - - 0
- - - - 1 - (1) -1120000
10.00 2,150,000.00 - - - - 10 2150000
1.00 1,650.00 - - 10 - (9) -14850
- - - - 1 - (1) -165000
1.00 48,762.00 - - - - 1 48762
- - - - 1 - (1) -71000
1.00 193,600.00 - - - - 1 193600
1.00 375,000.00 - - 1 - - 0
1.00 375,000.00 - - 1 - - 0
- - - - 1 - (1) -375000
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
5.00 8,820.00 - - - - 5 8820
20.00 80,800.00 - - - - 20 80800
7.00 9,471.00 - - 20 - (13) -17589
- - - - - - - 0
13.00 77,870.00 - - - - 13 77870
24.00 41,712.00 - - 13 - 11 19118
- - - - - - - 0
8.00 71,280.00 - - - - 8 71280
- - 30.00 51,690.00 21 ### 9 15507
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
16
- - - - - - - 0
28.00 190,960.00 - - - - 28 190960
36.00 45,011.88 - - 7 - 29 36259.57
- - 130.00 120,770.00 66 ### 64 59456
- - - - - - - 0
- - - - - - - 0
13.00 139,880.00 - - - - 13 139880
- - - - 13 - (13) -19543.29
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - 100.00 279,100.00 100 ### - 0
- - 100.00 311,300.00 38 ### 62 193006
- - - - - - - 0
16.00 216,000.00 - - - - 16 216000
12.00 73,920.00 - - 16 - (4) -24640
12.00 16,080.00 15.00 20,100.00 14 ### 13 17420
- - 40.00 290,400.00 14 ### 26 188760
- - - - - - - 0
- - - - - - - 0
129.00 477,300.00 - - - - 129 477300
- - - - 129 - (129) -171828
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
58.00 191,110.00 150.00 494,250.00 108 ### 100 329500
- - 210.00 525,000.00 196 ### 14 35000
24.00 116,160.00 - - - - 24 116160
- - 100.00 230,000.00 88 ### 12 27600
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
55.00 173,360.00 - - - - 55 173360
2.00 6,980.00 60.00 209,400.00 66 ### (4) -13960
69.00 1,179,900.00 - - 2 - 67 1145700
44.00 169,356.00 100.00 384,900.00 119 ### 25 96225
6.00 53,694.00 50.00 447,450.00 59 ### (3) -26847
- - - - 9 - (9) -72810
- - - - - - - 0
63.00 327,474.00 - - - - 63 327474
- - 50.00 114,900.00 68 ### (18) -41364
- - - - - - - 0
16
- - - - - - - 0
- - - - - - - 0
21.00 646,800.00 20.00 616,000.00 20 ### 21 646800
39.00 83,655.00 - - 21 - 18 38610
11.00 16,885.00 400.00 614,000.00 376 ### 35 53725
- - 368.00 2,104,960.00 219 ### 149 852280
- - - - - - - 0
43.00 250,690.00 - - - - 43 250690
- - - - 45 - (45) -237870
- - - - - - - 0
- - - - - - - 0
- - 20.00 162,800.00 14 ### 6 48840
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
7.00 59,290.00 - - - - 7 59290
1.00 8,470.00 - - 7 - (6) -50820
3.00 9,984.00 - - 1 - 2 6656
8.00 224,464.00 15.00 420,870.00 14 ### 9 252522
54.00 141,750.00 13.00 34,125.00 19 ### 48 126000
- - - - 19 - (19) -108680
- - - - - - - 0
5.00 50,000.00 - - - - 5 50000
- - - - 1 - (1) -49862
16.00 207,680.00 - - - - 16 207680
18.00 93,060.00 - - 7 - 11 56870
- - 100.00 572,000.00 62 ### 38 217360
- - - - - - - 0
- - - - - - - 0
5.00 - - - - - 5 0
28.00 77,476.00 - - 5 - 23 63641
- - - - 22 - (22) -53240
36.00 98,676.00 - - - - 36 98676
- - 50.00 157,500.00 85 ### (35) -110250
44.00 365,200.00 40.00 332,000.00 114 ### (30) -249000
- - 200.00 311,600.00 249 ### (49) -76342
- - - - - - - 0
33.00 329,439.00 - - - - 33 329439
- - - - 38 - (38) -85348
- - 230.00 425,500.00 143 ### 87 160950
21.00 58,506.00 30.00 83,580.00 35 ### 16 44576
- - 60.00 175,440.00 37 ### 23 67252
21.00 60,228.00 60.00 172,080.00 23 ### 58 166344
- - 100.00 515,000.00 78 ### 22 113300
4.00 30,232.00 54.00 408,132.00 31 ### 27 204066
16
- - 70.00 529,060.00 64 ### 6 45348
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
5.00 68,000.00 - - - - 5 68000
- - 96.00 295,200.00 40 ### 56 172200
- - - - - - - 0
- - - - - - - 0
- - 125.00 251,250.00 64 ### 61 122610
- - - - - - - 0
5.00 117,750.00 - - - - 5 117750
27.00 503,145.00 - - 5 - 22 409970
5.00 13,200.00 - - 16 - (11) -29040
- - 40.00 143,520.00 39 ### 1 3588
16.00 246,176.00 - - - - 16 246176
49.00 1,969,898.00 - - 2 - 47 1889494
30.00 66,000.00 - - 23 - 7 15400
- - 40.00 54,000.00 52 ### (12) -16200
- - - - - - - 0
- - - - - - - 0
- - 2.00 105,600.00 2 ### - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
48.00 - - - - - 48 0
325.00 75,075.00 - - 48 - 277 63987
- - 1,000.00 90,000.00 825 ### 175 15750
- - - - - - - 0
1,000.00 125,000.00 5,000.00 625,000.00 3,751 ### 2,249 281125
420.00 36,120.00 - - - - 420 36120
848.00 298,496.00 - - 420 - 428 150656
1,681.00 485,809.00 - - 387 - 1,294 373966
- - 5,000.00 1,395,000.00 5,821 ### (821) -229059
540.00 81,540.00 - - - - 540 81540
- - 5,000.00 390,000.00 3,730 ### 1,270 99060
- - - - - - - 0
- - - - - - - 0
1,135.00 144,145.00 - - - - 1,135 144145
400.00 42,000.00 2,000.00 210,000.00 2,475 ### (75) -7875
460.00 90,620.00 - - 400 - 60 11820
16
1,446.00 75,192.00 200.00 10,400.00 519 ### 1,127 58604
- - 3,000.00 528,000.00 4,916 ### (1,916) -337216
1,300.00 16,980,600.00 - - - - 1,300 16980600
443.00 108,535.00 - - 161 - 282 69090
- - 700.00 247,800.00 828 ### (128) -45312
1,300.00 56,355,000.00 - - - - 1,300 56355000
- - - - 300 - (300) -66000
- - - - - - - 0
164.00 13,284.00 - - - - 164 13284
18.00 22,878.00 900.00 1,143,900.00 394 ### 524 666004
- - - - 18 - (18) -15049.98
- - - - - - - 0
2,530.00 506,000.00 600.00 120,000.00 350 ### 2,780 556000
2,154.00 208,938.00 5,200.00 504,400.00 7,110 ### 244 23668
- - 1,000.00 69,000.00 1,884 ### (884) -60996
1,672.00 3,218,600.00 - - - - 1,672 3218600
1,285.00 244,150.00 600.00 114,000.00 2,002 ### (117) -22230
610.00 77,500.50 - - 510 - 100 12705
- - 3,000.00 1,419,000.00 1,950 ### 1,050 496650
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
1,063.00 898,235.00 - - - - 1,063 898235
- - 6,000.00 408,000.00 6,325 ### (325) -22100
- - - - - - - 0
560.00 146,720.00 - - - - 560 146720
2,030.00 209,090.00 - - 560 - 1,470 151410
200.00 27,400.00 - - 1,930 - (1,730) -237010
- - - - 200 - (200) -21200
800.00 222,640.00 - - - - 800 222640
200.00 34,800.00 500.00 87,000.00 850 ### (150) -26100
- - 1,000.00 1,023,000.00 500 ### 500 511500
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
565.00 423,185.00 1,000.00 749,000.00 225 ### 1,340 1003660
2,070.00 173,880.00 - - 360 - 1,710 143640
- - - - 1,558 - (1,558) -651244
- - - - - - - 0
1,960.00 1,464,120.00 - - - - 1,960 1464120
- - 3,000.00 378,000.00 2,510 ### 490 61740
430.00 116,960.00 - - - - 430 116960
16
595.00 265,965.00 500.00 223,500.00 455 ### 640 286080
- - 2,000.00 882,000.00 1,905 ### 95 41895
- - - - - - - 0
- - 3,000.00 159,000.00 3,269 ### (269) -14257
- - - - - - - 0
- - - - - - - 0
1,990.00 656,700.00 - - - - 1,990 656700
348.00 44,196.00 500.00 63,500.00 2,215 ### (1,367) -173609
- - 1,000.00 157,000.00 1,558 ### (558) -87606
1,000.00 3,573,000.00 - - - - 1,000 3573000
1,140.00 51,300.00 - - 1,000 - 140 6300
- - - - - - - 0
- - - - - - - 0
- - 1,000.00 708,000.00 100 ### 900 637200
1,725.00 741,612.00 300.00 128,976.00 - - 2,025 870588
910.00 69,160.00 1,700.00 129,200.00 2,560 ### 50 3800
100.00 32,000.00 - - 580 - (480) -153600
- - - - 100 - (100) -148500
490.00 134,750.00 - - - - 490 134750
- - 4,000.00 104,000.00 1,810 ### 2,190 56940
1,970.00 202,614.50 - - - - 1,970 202614.5
- - - - 1,052 - (1,052) -159904
500.00 39,500.00 - - - - 500 39500
- - - - - - - 0
- - - - - - - 0
410.00 289,460.00 - - - - 410 289460
- - - - 310 - (310) -161510
- - - - - - - 0
530.00 159,000.00 400.00 120,000.00 - - 930 279000
740.00 71,780.00 - - 350 - 390 37830
- - 1,000.00 170,000.00 1,290 ### (290) -49300
- - - - - - - 0
1,120.00 284,592.00 - - - - 1,120 284592
- - - - 1,325 - (1,325) -914250
830.00 979,400.00 - - - - 830 979400
715.00 143,000.00 3,000.00 600,000.00 3,070 ### 645 129000
128.00 46,464.00 1,500.00 544,500.00 1,275 ### 353 128139
- - 200.00 33,800.00 18 ### 182 30758
- - - - - - - 0
- - - - - - - 0
550.00 1,191,668.50 - - - - 550 1191668.5
- - 3,600.00 2,872,800.00 3,835 ### (235) -187530
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
16
- - 3,000.00 438,000.00 2,670 ### 330 48180
- - - - - - - 0
2,700.00 3,299,400.00 - - - - 2,700 3299400
- - - - 80 - (80) -8800
- - - - - - - 0
- - - - - - - 0
940.00 374,825.00 - - - - 940 374825
- - - - 1,030 - (1,030) -227630
- - - - - - - 0
- - - - - - - 0
2,436.00 101,824.80 - - - - 2,436 101824.8
- - 11,000.00 968,000.00 11,738 ### (738) -64944
- - - - - - - 0
- - - - - - - 0
- - 300.00 135,300.00 240 ### 60 27060
79.00 25,359.00 - - - - 79 25359
1,190.00 378,420.00 - - 79 - 1,111 353298
58.00 1,856.00 300.00 9,600.00 1,310 ### (952) -30464
1,239.00 89,790.33 - - 58 - 1,181 85587.07
153.00 8,721.00 - - 1,239 - (1,086) -61902
940.00 310,200.00 300.00 99,000.00 289 ### 951 313830
1,622.00 184,908.00 1,000.00 114,000.00 1,500 ### 1,122 127908
- - 1,500.00 198,000.00 2,002 ### (502) -66264
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
805.00 755,090.00 - - - - 805 755090
712.00 46,280.00 - - 348 - 364 23660
- - 500.00 45,500.00 580 ### (80) -7280
580.00 464,000.00 - - - - 580 464000
- - 700.00 588,000.00 860 ### (160) -134400
415.00 1,202,462.50 - - - - 415 1202462.5
985.00 14,775.00 2,000.00 30,000.00 1,520 ### 1,465 21975
- - 2,000.00 354,000.00 1,280 ### 720 127440
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - 15,000.00 1,200,000.00 3,280 ### 11,720 937600
- - - - - - - 0
- - - - - - - 0
2,154.00 3,869,876.40 - - - - 2,154 3869876.4
16
188.00 13,912.00 1,000.00 74,000.00 2,219 ### (1,031) -76294
80.00 49,520.00 - - 80 - - 0
1,220.00 239,120.00 500.00 98,000.00 100 ### 1,620 317520
1,035.00 130,410.00 5,000.00 630,000.00 5,190 ### 845 106470
- - 1,000.00 521,000.00 1,190 ### (190) -98990
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
180.00 78,300.00 - - - - 180 78300
- - 200.00 24,600.00 140 ### 60 7380
- - - - - - - 0
- - - - - - - 0
238.00 1,094,324.00 5.00 22,990.00 1 22,990.00 242 1112716
- - - - 168 - (168) -7728
9.00 475.20 - - - - 9 475.2
- - - - 1 - (1) -23760
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
70.00 138,600.00 5.00 9,900.00 1 9,900.00 74 146520
- - 1,000.00 70,000.00 468 ### 532 37240
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
378.00 24,948.00 - - - - 378 24948
- - - - 65 - (65) -4940
- - - - - - - 0
- - - - - - - 0
5.00 1,335.00 1,000.00 267,000.00 800 ### 205 54735
523.00 632,830.00 - - 5 - 518 626780
70.00 9,380.00 - - 23 - 47 6298
- - - - - - - 0
200.00 310,000.00 - - - - 200 310000
51.00 54,519.00 - - - - 51 54519
- - 200.00 59,400.00 51 ### 149 44253
- - - - - - - 0
- - - - - - - 0
- - - - - - - 0
126,143.00 39,683,214.00 132,343.00 ### ### ###
16
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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

111 Tube 15 mg 78,000.00 - - -

122 Epinefrina HCL/Bitartrat ( Epinefrina/adrinalina ) 30 Ampul / Ampul 8,910.00 - - -

168 Kotrimoksazol suspensi komb: sulfametoksazol Botol 60 ml 2,298.00 63 63 4 59 9

PERMINTAAN PEMBERIAN KET

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta

UMUM PERSED. OBAT Rp 21,690,285

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Jayosno, S.Kep.MM Arifah Rahayu

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 498,017,801

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Jayosno, S.Kep.MM Arifah Rahayu

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 1,959,723,535

Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 1,473,589,568

Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

UMUM PERSED. OBAT Rp 1,101,459,972

Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

321 Sulfametoksazol 100 mg + Trimetoprim 20 mg 100 Tablet / Botol - - - - -

UMUM PERSED. OBAT Rp 1,100,989,882

Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 622,514,957

Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 2,360,225,150

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 1,820,761,426

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 1,145,108,858

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

JAYOSNO, S.Kep.MM ARIFAH RAHAYU

248 Antimalaria DOEN Kombinasi : Pirimetamin 25 mg + 100 Tablet / kotak - - - - -

UMUM PERSED. OBAT Rp 891,125,824

Mengetahui/menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

dr. H. Syarifudin Basri, Sp.OG

NO NAMA OBAT KEMASAN

630 415 320 625 93 - 957 150 - 3,730

- 117 110 110 20 - 435 125 - 1,052

NO NAMA OBAT KEMASAN HARGA

III Obat Gigi

122 Epinefrina HCL/Bitartrat ( Epinefrina/adrinalina ) injeksi 0.1 % - 30 Ampul / Ampul 8,910.00

129 Lidokain komp. Injeksi,kombinasi Lidokain HCl 30 Ampul / Kotak 1,250.33

168 Kotrimoksazol suspensi komb: sulfametoksazol 200 mg + Trimetoprim Botol 60 ml 2,298.00

VII Obat Luar (Salep & Tetes)

198 Antifungi DOEN kombinasi: Asam 24 Pot 30 g / Ktk 2,741.00

223 Polikresulen (Kondensasi Metakresol Sulfonat dan Metanol), Botol 10 ml 18,635.00

228 Salep 2-4 kombinasi: Asam Salisilat 24 Pot @ 30 g / Kotak 2,200.00

247 Antasida DOEN tab kombinasi : Mg 100 tablet / kotak 78.00

321 Kotrimoksazol tablet pedriatik kombinasi: 100 Tablet / Botol 79.00