LEMBAR TAMBAHAN

JUMLAH STOCK BULAN INI PENGELUARAN BULAN INI SISA

STOCK HARGA SATUAN JUMLAH HARGA
NO NAMA OBAT SATUAN/ KEMASAN (Rp) (Rp)
Sisa Stock Bulan Penerimaan BULAN INI
Jumlah PUSKESMAS Pustu Poskesdes Jumlah
............... Bulan ini
1 2 3 4 5 6(4+5) 7 8 9 10(7+8+9) 11(6-10) 12 13(11x12)
doxycycline 500 - 500 500
nystatin tablet vaginal 100.000 iu 300 - 300 300 ED
tablet tambah darah 450 450 - 450
hydrocortizone salp 70 70 22 - 48
dyspo 2,5 580 580 45 100 35
vit A 500.0000 iu 1,000 1,000 - 1000
phenylbutazon 400 400 400
hydrocortiazide 2 mg 240 240 240
atropin inj 19 19 19
eritromicin syr 7 7 7

MENGETAHUI ;
KEPALA PUSKESMAS PENGELOLA OBAT PUSKESMAS
.. ...
NIP : .. NIP : ..
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
TAHUN 2017

NAMA PUSKESMAS : Panca Makmur

KODE PUSKESMAS :
PERIODE LAPORAN (BULAN) : Juli
JUMLAH PUSTU YANG DILAYANI/MELAPOR :5

PENGELUARAN BULAN INI

Harga Satuan SISA STOK SISA STOCK
NO NAMA OBAT SATUAN (Rp) BULAN juni Penerimaan BULAN INI
Jumlah PUSKESMAS Pustu Poskesdes Jumlah
Bulan ini

1 2 3 4 6 7(5+6) 8 9 10 11(8+9+10) 12(7-11)

OBAT OBATAN
1 Albendazol tablet/kapsul/kaplet 400 mg tablet Rp 363.00 540 0 540 540 0 0 540 0
2 Alopurinol tablet/kapsul/kaplet 100 mg tablet Rp 90.00 1900 0 1900 300 0 100 400 1500
3 Alprazolam 0,5 mg 0 0 0 0 0 0 0 0
4 Alprazolam tablet/kapsul/kaplet 1 mg tablet Rp 245.00 0 0 0 0 0 0 0 0
5 Ambroxol sirup 15 mg / ml 0 0 0 0 0 0 0 0
6 Ambroxol Tablet tablet Rp 150.00 2100 0 2100 300 400 700 1400
7 Aminofilin injeksi 24 mg/ml ampul Rp 4,204.00 0 0 0 0 0 0 0 0
8 Aminofilin tablet scored 200 mg tablet Rp 86.00 0 0 0 0 0 0 0 0
9 Amitriptilyn 25 Mg tablet Rp 123.00 100 0 100 0 0 0 0 100
10 Amlodipin tablet 10 mg 120 0 120 0 0 0 0 120
11 Amlodipin tablet 5 mg 0 0 0 0 0 0 0 0
12 Amoksisilin kapsul/kaplet 250 mg tablet Rp 220.00 4700 0 4700 0 840 840 3860
13 Amoksisilin sirup kering 125 mg/ 5 ml 40 0 40 0 0 0 0 40
14 Amoxillin 500 Mg tablet Rp 279.00 0 0 0 0 0 0 0 0
15 Ampisillin 500 mg 100 0 100 100 0 0 100 0
16 Ampisillin sirup kering 125 mg / ml 0 0 0 0 0 0 0 0
17 Antalgin 500 mg 400 0 400 0 0 0 0 400
Antasida DOEN I tablet kunyah, kombinasi :
18 Aluminium Hidroksida 200 mg tablet Rp 78.00 2300 0 2300 200 0 0 200 2100
Magnesium Hidroksida 200 mg
 Antasida DOEN II suspensi, kombinasi :
19 Aluminium Hidroksida 200 mg/5 ml 60 0 60 0 0 0 0 60
Magnesium Hidroksida 200 mg/5 ml
20 Antifungi doen kombinasi: asam Benzoat 0 24 0 0 0 0 24
tube Rp 2,515.63 24
6%
Antimalaria DOEN kombinasi : Pirimetamin
21 25 mg tablet Rp 572.00 0 0 0 0 0 0 0 0
Sulfadoksin 500 mg
22 Antimigren: 0 200 0 0 0 0 200
tablet Rp 149.00 200
Ergotamin Tartrat 1 mg + Kofein 50 mg
23 Aqua pro injeksi steril ampul Rp 2,900.00 35 0 35 0 0 0 0 35
24 Asam Askorbat (Vit C) 50 mg tablet Rp 105.00 0 0 0 0 0 0 0 0
25 Asam Askorbat 250 mg 0 0 0 0 0 0 0 0
26 Asam Mefenamat kapsul/kaplet 500 mg tablet Rp 127.00 1200 0 1200 100 0 0 100 1100
27 Asam traneksamat injeksi 100 mg/ml 0 0 0 0 0
28 Asiklovir krim 5 % 10 0 10 0 0 0 0 10
29 Asiklovir tablet/kapsul/kaplet 200 mg tablet Rp 251.00 300 0 300 0 0 0 0 300
30 Asiklovir tablet/kapsul/kaplet 400 mg tablet Rp 362.00 2500 0 2500 0 0 0 0 2500
31 Atropine 0,5 Mg tablet Rp 81.00 0 0 0 0 0
32 Bacitracyn Polymyxin B Salep Kulit tube Rp 2,767.00 15 0 15 0 0 0 0 15
33 Bedak salisil serbuk 2% 0 0 0 0 0 0 0 0
34 Benedon Inj (Adimidon injeksi) 0 0 0 0 0 0 0 0
35 Benzatin Benzil Penisilin 1,2 juta IU/ vial 0 0 0 0 0
36 Betahistin masilate 6 mg tablet Rp 924.00 270 0 270 0 0 60 60 210
37 Betametason krim 0,1% (sebagai Valerat) tube Rp 1,596.00 130 0 130 0 0 0 0 130
38 Calsidol Sirup 0 0 0 0 0
39 Captopril 12,5 Mg tablet Rp 69.00 3300 0 3300 0 0 0 0 3300
40 Cimetidine 200 mg tablet Rp 145.00 200 0 200 0 0 0 0 200
41 Citikolin inj ampul Rp18,150.00 0 0 0 0 0
42 Clindamycin 150 Mg tablet Rp 405.00 300 0 300 0 0 0 0 300
43 Clindamycin 300 Mg tablet Rp 619.00 0 0 0 0 0 0 0 0
44 Curcuma tablet Rp 600.00 0 0 0 0 0 0 0 0
45 Deksametason tablet 0,5 mg tablet Rp 68.00 3800 0 3800 200 0 200 400 3400
46 Dexamethasone Inj ampul Rp 1,738.00 64 0 64 0 0 0 0 64
47 Diazepam 2 mg tablet Rp 47.00 39 0 39 0 0 0 0 39
48 Diazepam 5 mg 250 0 250 0 0 0 0 250
49 Diazepam inj 5 mg / ml 0 0 0 0 0 0 0 0
50 Difenhidramin injeksi i.v./i.m. 10 mg/ml 0 140 0 0 0 0 140
ampul Rp 1,160.00 140
(HCl)
51 Digoksin tablet 0,25 mg tablet Rp 103.00 270 0 270 70 0 0 70 200
52 Diltiazem HCl tablet 30 mg tablet Rp 141.00 0 0 0 0 0
53 Domperidon suspensi/sirup 5 mg/5 ml botol Rp 3,490.00 69 0 69 0 0 0 0 69
54 Domperidon tablet 10 mg tablet Rp 174.00 100 0 100 0 0 0 0 100
55 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 0 29 0 0 0 0 29
29
mg/ml
56 Eritromisin kapsul/kaplet 250 mg 0 0 0 0 0 0 0 0
57 Eritromisin kapsul/kaplet 500 mg tablet Rp 1,023.00 500 0 500 0 0 0 0 500
58 Etakridine larutan 0,1 % botol Rp 2,500.00 0 0 0 0 0 0 0 0
59 Etanol 70% cairan botol Rp 2,625.00 0 0 0 0 0 0 0 0
60 Etil Chlorida 0 0 0 0 0 0 0 0
61 Eugenol cairan botol Rp18,333.00 7 0 7 0 0 0 0 7
62 Fenobarbital injeksi i.m./i.v. 50 mg/ml ampul Rp 1,980.00 0 0 0 0 0 0 0 0
63 Fenobarbital tablet 30 mg 100 0 100 0 0 0 0 100
64 Fitomenadion (Vit K 1) inj 150 0 150 0 0 0 0 150
65 Fitomenadion (Vit.K1) tablet salut gula 10 0 0 0 0 0 0 0
tablet Rp 697.00 0
mg
66 Furosemid tablet 40 mg tablet Rp 98.00 700 0 700 0 0 0 0 700
67 Furosemide 10 mg/ml Injeksi ampul Rp 2,012.00 0 0 0 0 0
Garam Oralit I serbuk, kombinasi : Natrium
68 klorida 0,52 g kalium klorida 0,30 g 0 525 0 0 0 0 525
sachet Rp 317.00 525
Trinatrium sitrat dihidrat 0,58 g Glukosa
Anhidrat 2,70 g
69 Gemvibrozil 300 Mg 200 0 200 200 0 0 200 0
70 Gentamicin 40 mg/ml Injeksi ampul Rp 3,739.00 0 0 0 0 0 0 0 0
71 Glibenclamide 5 Mg tablet Rp 61.00 2600 0 2600 100 0 0 100 2500
72 Gliseruil guaikolate (GG) tablet Rp 40.00 2000 0 2000 0 0 0 0 2000
73 Glukosa larutan infus 10 % steril 0 0 0 0 0
74 Glukosa larutan infus 5 % steril botol Rp 5,720.00 157 0 157 0 157
75 Griseofulvin tablet 125 mg tablet Rp 230.00 200 0 200 0 0 0 0 200
76 Haloperidol 0,5 Mg tablet Rp 62.00 0 0 0 0 0
77 Haloperidol 1,5 Mg tablet Rp 76.00 0 0 0 0 0
78 Haloperidol 5 Mg tablet Rp 105.00 0 0 0 0 0
79 Hcl 0,5 % botol ### 2 0 2 0 2
80 Ibuprofen 200 mg tablet Rp 121.00 1000 0 1000 0 0 0 0 1000
81 Ibuprofen tablet 400 mg 600 0 600 0 0 0 0 600
82 Isosorbide Dinintrate 5 Mg tablet Rp 98.00 700 0 700 0 0 0 0 700
83 Kalsium laktate (KALAK) 0 0 0 0 0 0 0 0
84 Kalsium laktate (KALAK) tablet Rp 76.00 3100 0 3100 300 0 0 300 2800
85 Kaptopril tablet scored 25 mg tablet Rp 97.00 300 0 300 0 0 0 0 300
86 Karbamazepin tablet 200 mg tablet Rp 269.00 0 0 0 0 0
87 Ketokonazol krim 2% tube 10 gram tube Rp 2,697.00 5 0 5 2 0 0 2 3
88 Ketokonazol tablet 200 mg tablet Rp 320.00 150 0 150 0 0 100 100 50
89 Ketorolac Inj 30 mg / ml ampul Rp 2,665.00 0 0 0 0 0 0 0 0
90 Kloramfenikol kapsul/kaplet 250 mg 1500 0 1500 0 0 0 0 1500
91 Kloramfenikol salep mata 1 % tube Rp 1,680.00 0 0 0 0 0 0 0 0
92 Kloramfenikol suspensi 125 mg/ 5 ml botol Rp 6,600.00 49 0 49 0 0 0 0 49
93 Kloramfenikol Tetes Telinga 0 0 0 0 0 0 0 0
94 Kloramfeniramin maleat (CTM) 4 mg tablet Rp 35.00 0 0 0 0 0 0 0 0
95 Klorpromazin tablet salut 100 mg (HCl) tablet Rp 156.00 0 0 0 0 0 0 0 0
96 Klorpromazin injeksi i.m. 25 mg/ml (HCl) 0 0 0 0 0 0 0 0
97 Kodein tablet 10 mg tablet Rp 550.00 0 0 0 0 0 0 0 0
98 Kodein tablet 15 mg tablet Rp 935.00 0 0 0 0 0 0 0 0
99 Kodein tablet 20 mg tablet Rp 1,210.00 0 0 0 0 0 0 0 0
Kotrimoksazol DOEN I (dewasa) kombinasi :
100 Sulfametoksazol 400 mg tablet Rp 152.00 200 0 200 0 0 100 100 100
Trimetoprim 80 mg
Kotrimoksazol Suspensi komb:
101 Sulfametoksazol 200 mg + Trimetoprim 40 215 0 215 0 0 0 0 215
mg / 5 ml
102 Kuinin (Kina) tablet 200 mg tablet Rp 737.00 0 0 0 0 0 0 0
103 Kuinin injeksi i.v. 25% (sebagai 2 HCl) 0 0 0 0 0 0 0
104 Kuinin tablet 222 mg (H2SO4.7H2O) 0 0 0 0 0 0 0
105 Lanzoprazol kapsul/kaplet 30 mg 80 0 80 40 0 0 40 40
106 Larutan Asam Asetat botol Rp84,000.00 1 0 1 0 0 1
107 Larutan Benedic botol ### 1 0 1 0 0 1
108 Larutan Natrium Sitrat 3,6% botol ### 1 0 1 0 0 1
109 Levofloksasin tablet 500 mg tablet Rp 581.00 0 0 0 0 0 0
110 Lidokain injeksi 2% (HCL) ampul Rp 929.00 105 0 105 0 0 0 0 105
111 Livitan Syr 0 0 0 0 0
112 Loperamide 2 Mg tablet Rp 97.00 2500 0 2500 2500 0 0 2500 0
113 Magnesium sulfat injeksi (IV) 40- % - 25 ml ampul Rp 5,175.00 0 0 0 0 0
114 Meloxicam 15 mg 0 0 0 0 0
115 Metformin Tab tablet Rp 450.00 3400 0 3400 0 0 0 0 3400
116 Metformin Tab kotak Rp13,530.00 0 0 0 0 0

117 Metilergometrin Maleat (Metilergometrin) 0 30 0 0 0 0 30

tablet Rp 169.00 30
tablet salut 0,125 mg
118 Metilprednisolon 4 Mg tablet Rp 330.00 700 0 700 0 0 0 0 700
119 Metoklopramide tablet 5 mg tablet Rp 113.00 600 0 600 0 0 0 0 600
120 Metronidazol tablet 250 mg tablet Rp 116.00 600 0 600 100 0 0 100 500
121 Metronidazol tablet 500 mg tablet Rp 169.00 700 0 700 0 0 0 0 700
122 Metthyl Ergometrin inj 0 0 0 0 0
123 Mikonazol krim/salep 2 % (Nitrat) 39 0 39 1 0 0 1 38
124 Miraneuron Kapsul 0 0 0 0 0
125 Nacl 0,9 % botol Rp 5,170.00 78 0 78 0 0 0 0 78
126 Natrium Diklofenak tablet 25 mg tablet Rp 146.00 300 0 300 0 0 0 0 300
127 Natrium Diklofenak tablet 50 mg tablet Rp 193.00 0 0 0 0 0 0 0 0
128 Nifedipin tablet/kapsul 10 mg tablet Rp 127.00 1800 0 1800 1800 0 0 1800 0
129 Nistatin tablet salut 500.000 IU/ g tablet Rp 704.00 0 0 0 0 0 0 0 0
130 Novabion Tablet tablet Rp 783.50 0 0 0 0 0 0 0 0
131 Obat Antituberkulosis FDC Kategori 1 paket ### 12 0 12 0 0 0 0 12
132 Obat Antituberkulosis FDC Kategori 2 0 0 0 0 0
133 Obat Antituberkulosis FDC Kategori Anak 0 0 0 0 0
134 Obat Batuk Hitam (OBH) 5 0 5 0 0 0 0 5
135 Oksitetrasiklin Salep Mata 1 % 0 0 0 0 0
136 Omeprazol kapsul/kaplet 20 mg 0 0 0 0 0
137 Oxitetrasiklin salep kulit 3 % tube Rp 1,649.36 0 0 0 0 0 0 0 0
138 Oxitosin injeksi ampul Rp 2,613.64 2 0 2 0 0 0 0 2
139 Papaverin 40 mg tablet Rp 155.22 0 0 0 0 0 0 0 0
140 Parasetamol sirup 120 mg / 5 ml 231 0 231 0 0 10 10 221
141 Parasetamol tablet 500 mg tablet Rp 88.00 1900 0 1900 300 600 900 1000
142 Piracetam 400 mg 0 0 0 0 0
143 Pirantel suspensi 125 mg/5 ml 15 0 15 0 0 0 0 15
144 Pirantel tablet score (base) 125 mg tablet Rp 318.00 200 0 200 100 0 0 100 100
145 Piridoxine (vit B6) 10 mg tablet Rp 26.00 0 0 0 0 0 0 0 0
146 Piroxicam 10 mg 0 0 0 0 0 0 0 0
147 Piroxicam 20 mg tablet Rp 145.00 100 0 100 100 0 0 100 0
148 Povidon iodine 10 % 1000 botol Rp40,202.00 2 0 2 0 2
149 Povidon iodine 10 % 30 0 0 0 0 0
150 Povidon iodine 10 % 300 botol Rp15,386.00 0 0 0 0 0
151 Prednison tablet 5 mg 0 0 0 0 0
152 Prednison tablet 5 mg tablet Rp 125.00 2000 0 2000 0 0 400 400 1600
153 Propiltiourasil 100 mg tablet Rp 344.51 500 0 500 0 0 0 0 500
154 Propiltiourasil 100 mg 100 0 100 0 0 0 0 100
155 Propranolol tablet 40 mg (HCl) tablet Rp 114.00 0 0 0 0 0
156 Ranitidin injeksi 25 mg/2 ml ampul Rp 1,340.00 30 0 30 0 0 0 0 30
157 Ranitidin Tablet 150 Mg tablet Rp 132.00 2000 0 2000 2000 0 0 2000 0
158 Reco Salep Mata tube Rp11,000.00 0 0 0 0 0 0 0 0
159 Reco Tetes Mata 0 0 0 0 0
160 Reco Tetes Telinga 0 0 0 0 0
161 Recodril Inj ampul Rp12,500.00 30 0 30 0 0 0 0 30
162 Retinol (Vitamin A) 100.000 IU 2150 0 2150 0 0 0 0 2150
163 Ringer Laktat larutan infus botol Rp 5,720.00 33 0 33 0 33
164 Salbutamol 2 Mg tablet Rp 65.00 0 0 0 0 0
165 Salbutamol 4 mg tablet Rp 93.00 3100 0 3100 0 0 0 0 3100
166 Salep 2-4 tube Rp 2,200.00 4 0 4 0 0 0 0 4
167 Sefadroksil sirup kering 125 mg/5ml 30 0 30 0 0 0 0 30
168 Sefadroksil kapsul/kaplet 250 mg tablet Rp 564.00 200 0 200 0 0 0 0 200
169 Sefadroksil kapsul/kaplet 500 mg 900 0 900 0 0 100 100 800
170 Sefotaksim injeksi 0,5 g 0 0 0 0 0
171 Sefotaksim injeksi 1 g 0 0 0 0 0
172 Seftriakson serbuk injeksi 1 g/vial 0 0 0 0 0
 173 Setrizine 10 Mg tablet Rp 190.00 0 0 0 0 0 0 0 0
174 Sianokobalamin (vitamin B12) injeksi 500 0 110 0 0 0 0 110
ampul Rp 1,035.96 110
mg
Sianokobalamin (vitamin B12) Tablet 50
175 tablet Rp 26.70 1000 0 1000 0 0 0 0 1000
mcg
176 Simvastatin scored tablet 10 mg tablet Rp 177.00 2400 0 2400 200 0 0 200 2200
177 Siobion 0 0 0 0 0
178 Siprofloksasin tablet 500 mg (sebagai HCl) 0 0 0 0 0
179 Siprofloksasin tablet 500 mg (sebagai HCl) tablet Rp 443.00 300 0 300 0 0 0 0 300
180 Stesolid Inj 0 0 0 0 0
181 Superhoid (Antihemoroid) suppo Rp 3,833.33 11 0 11 0 11
182 Tetrasiklin 500 mg 0 0 0 0 0
183 Tetrasiklin 500 mg 0 0 0 0 0
184 Tetrasiklin kapsul/kaplet 250 mg tablet Rp 162.00 1900 0 1900 0 0 0 0 1900
185 Tiamin (Vitamin B1) Injeksi ampul Rp 1,267.00 0 0 0 0 0 0 0 0
186 Tiamin (Vitamin B1) tablet 50 mg (HCl/ 0 3000 0 0 0 0 3000
tablet Rp 60.00 3000
Nitrat)
187 Tramadol injeksi 50 mg/ml ampul Rp 2,680.00 0 0 0 0 0
188 Tramadol kapsul 50 mg 0 0 0 0 0
189 Triheksiphenidil 2 mg 100 0 100 0 0 0 0 100
190 Urinalisasi Reagent Strip 0 0 0 0 0
191 Vaksin Vero 0 0 0 0 0
192 Vaksin Vero 0 0 0 0 0
193 Vitabiol Sirup 0 0 0 0 0
194 Vitamin B Complex tablet Rp 112.00 0 0 0 0 0 0 0 0
195 Zinc 20 Mg tablet Rp 521.00 5900 0 5900 0 0 0 0 5900
196 BCG 20 ds/Ampul ampul Rp55,506.00 14 0 14 2 0 0 2 12
197 Polio 10 ds/Vial vial Rp18,997.00 23 0 23 5 0 0 5 18
198 DPT-HB-HIB vial Rp70,323.00 10 0 10 7 0 0 7 3
199 IPV vial 2 0 2 1 0 0 1 1
200 Hep. B1 ds/Vial vial 5 0 5 3 0 0 3 2
201 Campak 10 ds/Vial vial Rp 26,896.00 13 0 13 4 0 0 4 9
202 DT 10 ds/Vial vial Rp 17,105.00 6 0 6 0 0 0 0 6
203 Td 10 ds/Vial vial Rp 16,181.00 18 0 18 1 0 0 1 17

OBAT-OBATAN (e-KATALOG) 2016

1 AMINOPHILIN INJ AMPUL Rp 3,349.00
2 ANTASIDA DOEN TABLET Rp 64.00
3 ANTASIDA SUSPENSI
4 ASAM FOLAT TABLET 0,4 MG
5 AMOXILLIN SIRUP 125 MG / 5 ML
 6 ALOPURINOL 100 MG
7 AMLODIPIN 10 MG TABLET Rp 163.00
8 AMLODIPIN TABLET 5 MG TABLET Rp 105.00
9 AMOXILLIN 500 MG KAPLET Rp 233.00
10 ASAM MEFENAMAT KAPLET 500 MG TABLET Rp 113.00
11 AQUA PRO INJEKSI
12 ALBENDAZOLE TABLET 400 MG TABLET Rp 323.00
13 ANTIHEMOROID KOMBINASI SUPO Rp 3,502.00
14 ANTIFUNGI DOEN SALEP TUBE Rp 4,782.00
15 BEDAK SALICIL
16 BETAMETASON KRIM 0,1 % TUBE Rp 1,435.00
17 CTM TABLET Rp 45.00
18 DIPHENHIDRAMIN INJ AMPUL Rp 1,356.00
19 DEKSAMETASON TABLET 0,5 MG TABLET Rp 48.00
20 DOMPERIDON SUSPENSI BOTOL Rp 3,180.00
21 DOMPERIDON TABLET 10 MG TABLET Rp 133.00
22 DEXAMETASON INJ
23 ERITROMISIN KAPSUL 250 MG KAPSUL Rp 651.00
24 ERITROMISIN KAPLET 500 MG
25 FENOBARBITAL INJEKSI
26 GEMVIBROZIL TABLET 300 MG TABLET Rp 436.00
27 HIDROCORTIZON KRIM 2,5 % TUBE Rp 2,812.00
28 HIDROCORTIAZID 25 MG TABLET Rp 171.00
29 Ibuprofen 400 mg TABLET Rp 133.00
30 KETOCONAZOLE KRIM 2 % TUBE Rp 2,738.00
31 KOTRIMOXASOLE SUSPENSI BOTOL Rp 2,225.00
32 KOTROMOXAZOLE DEWASA TABLET Rp 158.00
33 KLORAMFENIKOL SALEP MATA 1 % TUBE Rp 1,850.00
34 KLORAMFENIKOL SUSPENSI 125 MG/ 5ML TUBE Rp 4,000.00
35 LIDOCAIN INJ 2 % AMPUL Rp 875.00
36 LEVOFLOXASIN 500 MG TABLET Rp 525.00
37 LIDOKAIN 2% + EPINEFRIN INJ AMPUL Rp 2,122.00
38 METFORMIN 500MG TABLET Rp 119.00
39 METRONIDAZOLE 250 MG TABLET Rp 98.00
40 METRONIDAZOLE 500 MG TABLET Rp 98.00
41 MIKONAZOLE SALEP 2 % TUBE Rp 3,737.00
42 NATRIUM DIKLOFENAK 50 MG TABLET Rp 161.00
43 NATRIUM DIKLOFENAK 25 MG TABLET Rp 167.00
44 OMEPRAZOLE TABLET TABLET Rp 164.00
45 PARASETAMOL SYR AMPUL Rp 1,119.00
46 PHITOMENADION INJ AMPUL Rp 4,083.00
47 PROPANOLOL TABLET 10 MG TABLET Rp 69.00
 48 PROPANOLOL TABLET 40 MG TABLET Rp 318.00
49 RANITIDIN TABLET 150 MG TABLET Rp 119.00
50 RETINOL (VIT A) 100.000 UI KAPSUL Rp 327.00
51 SALEP 24 POT Rp 2,797.00
52 SEFADROXIL 500 MG CAPSUL Rp 557.00
53 SIMVASTATIN 20 MG TABLET Rp 252.00
54 SIPROFLOXASIN 500 MG TABLET Rp 298.00
55 VITAMIN B KOMPLEKS TABLET Rp 132.00
56 VIT B6 TABLET 10 MG TABLET Rp 136.00
57 VIT B12 INJEKSI AMPUL Rp 1,226.00
58 VIT C 50 MG TABLET Rp 120.00
59 VIT C 250 MG TABLET Rp 139.00
60 VIT K TABLET 10 MG TABLET Rp 800.00
61 ZINK 20 MG TABLET Rp 592.00

OBAT-OBATAN (NON KATALOG) 2016

1 Ambroxol sirup 15 mg / ml
2 Ambroxol Tablet Box 100 tab Rp16,676.00
3 Curcuma Btl 100 tab ###
4 Oxitetrasiklin salep kulit 3 % Tube Rp 2,543.00
5 Oxitetrasiklin Salep Mata 1 % Tube Rp 3,264.00
6 Papaverin 40 mg btl 1000 tab ###
7 Piroxicam 10 mg box 100 tab Rp15,070.00
8 Piroxicam 20 mg box 100 tab Rp18,836.00
9 Ponconeuron tab TABLET Rp 1,372.00
10 Sefotaxim Inj 1 gr vial @1gr Rp11,246.00
11 Seftriaxone Serbuk Inj 1 gr/via vial @1gr Rp10,906.00
12 Vitabiol Sirup Botol 60 Ml Rp16,445.00
13 Vaksin verrorab Box ###
14 Prednison Tablet Box 100 tab Rp12,500.00
15 Metoklopramid Tablet Box 100 tab Rp11,300.00
16 Griseofulvin Tablet Box 100 tab Rp23,000.00
17 Nifedipin 10mg Tablet Box 100 tab Rp12,700.00
18 Chlorpromazine 100mg Box 100 tab Rp15,600.00
19 Pyrantel Tablet Box 100 tab Rp31,800.00
20 Retinol Vit A 200.000 IU Kapsul Rp 505.00
21 Paracetamol 500mg Tablet Box 100 tab Rp 8,800.00
22 Asam Mefenamat 500 mg Tablet Box 100 tab Rp12,700.00
23 Kloramfenikol Syrup Botol Rp 5,500.00
24 Sulfadoxin Tablet Box 100 tab Rp57,200.00
25 Pyrantel Syrup Botol Rp 9,100.00
BAHAN HABIS PAKAI THN 2015 ( E-KATALOG )
1 STERA Syringe 1 cc tuberculin 27G x 1/2 " kotak @100 pcs Rp 848.00 490 0 490 0 0 0 0 490
2 STERA 10 cc x 21G x 1 1/2" 0 0 0 0 0
3 STERA 20 cc ec kotak @50 pcs Rp 1,957.00 0 0 0 0 0
4 STERA 3 cc x 23G x 1 1/4" kotak @100 pcs Rp 848.00 180 0 180 35 0 100 135 45
5 STERA 5 cc x 22G x 1 1/4" kotak @100 pcs Rp 978.00 204 0 204 79 0 0 79 125
6 STERA 50 cc ec tip kotak @20 pcs Rp 4,437.00 0 0 0 0 0
7 ONEMED Alkohol 70 % 1 liter botol Rp 28,058.00 4 0 4 0 0 0 0 4
8 ONEMED Aseptan 500 cc + dispenser botol Rp 39,150.00 0 0 0 0 0 0 0 0
9 STERA Blood transfusion set 0 0 0 0 0
10 ONEMED Catgut plain 2/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286.00 158 0 158 0 0 0 0 158
11 ONEMED Catgut plain 3/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286.00 128 0 128 22 0 0 22 106
12 ONEMED Catgut Chromic 2/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286.00 113 0 113 0 0 0 0 113
13 ONEMED Catgut Chromic 3/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286.00 100 0 100 0 0 0 0 100
14 SAFEGLOVE Examination glove kotak @100 pcs Rp 42,413.00 100 0 100 100 0 0 100 0
15 ONEMED Folley Catheter 2 way no. 12 kotak @10 pcs Rp 10,440.00 0 0 0 0
16 ONEMED Folley Catheter 2 way no. 14 kotak @10 pcs Rp 10,440.00 0 0 0 0
17 ONEMED Folley Catheter 2 way no. 16 kotak @10 pcs Rp 10,440.00 3 0 3 0 0 0 0 3
18 ONEMED Folley Catheter 2 way no. 18 0 0 0 0
19 ONEMED Folley Catheter 2 way no. 20 0 0 0 0
20 ONEMED Folley Catheter 2 way no. 22 0 0 0 0
21 ONEMED Folley Catheter 2 way no. 24 kotak @10 pcs Rp 10,440.00 0 0 0 0
22 ONEMED Folley Catheter ped no. 10 kotak @10 pcs Rp 39,150.00 0 0 0 0
23 ONEMED Folley Catheter ped no. 6 kotak @10 pcs Rp 47,632.00 0 0 0 0
24 ONEMED Folley Catheter ped no. 8 kotak @10 pcs Rp 39,150.00 0 0 0 0
25 STERA I.V Catheter no. 18 G x 32 mm pcs Rp 4,959.00 0 0 0 0 0 0 0 0
26 STERA I.V Catheter no. 20 G x 11/4" pcs Rp 4,959.00 0 0 0 0 0 0 0 0
27 STERA I.V Catheter no. 22 G x 1" pcs Rp 4,959.00 20 0 20 0 0 0 0 20
28 STERA I.V Catheter no. 24 G x 3/4" pcs Rp 4,959.00 26 0 26 2 0 0 2 24
29 STERA I.V Catheter no. 26 G x 1/2" pcs Rp 5,351.00 0 0 0 0 0
30 STERA Infusion Set dewasa ( 20 drops/ml ) 184 0 184 1 1 183
31 STERA Infusion Set pediatric ( 60 drops/ml ) pcs Rp 4,568.00 22 0 22 0 0 0 0 22
32 ONEMED Kapas berlemak 500 gr roll Rp 21,533.00 3 0 3 0 0 0 0 3
33 ONEMED Kasa hydrophil steril uk 18 x 22 roll Rp 7,700.00 0 0 0 0 0 0 0 0
34 ONEMED Kasa Hydrophil 40 x 80 cm 0 0 0 0 0
35 ONEMED Kasa hydrophil steril uk 16 x 16 0 0 0 0 0
36 ONEMED Kasa kompress steril 40 x 40 0 0 0 0 0
37 ONEMED Kapas pembalut / absorben 250 gr roll Rp 16,313.00 1 0 1 1 0 0 1 0
38 ONEMED Kasa pembalut 2 m x 80 cm roll Rp 10,049.00 0 0 0 0 0 0 0 0
39 ONEMED Kasa Pembalut hydrophil 4 m x 10 cm kotak @50 roll Rp 1,958.00 0 0 0 0 0
40 ONEMED Kasa Pembalut hydrophil 4 m x 15 cm kotak @50 roll Rp 2,741.00 125 0 125 0 0 0 0 125
 41 ONEMED Povidone iodine 30 cc botol Rp 3,785.00 0 0 0 0
42 ONEMED Povidone iodine 300 cc botol Rp 23,490.00 0 0 0 0 0 0 0 0
43 ONEMED Povidone iodine 60 cc botol Rp 4,829.00 0 0 0 0
44 ONEMED Rivanol 300 cc botol Rp 3,328.00 0 0 0 0
45 ONEMED Silk 2/0 + jarum 1/2 GT 35 mm kotak @36 pcs Rp 3,987.00 170 0 170 0 0 0 0 170
46 ONEMED Silk 3/0 + jarum 1/2 GT 35 mm kotak @36 pcs Rp 3,987.00 180 0 180 0 0 0 0 180
47 ONEMED Surgical Mask 3 ply Earloop kotak @50 pcs Rp 431.00 200 0 200 50 0 0 50 150
48 ONEMED Surgical Mask 3 ply Tie on kotak @50 pcs Rp 431.00 140 0 140 90 0 0 90 50
49 ONEMED Wing Needle 19 G pcs Rp 1,827.00 0 0 0 0
50 ONEMED Wing Needle 21 G pcs Rp 1,827.00 0 0 0 0
51 ONEMED Wing Needle 23 G 0 0 0 0
52 ONEMED Wing Needle 25 G pcs Rp 1,827.00 0 0 0 0
53 ONEMED Wing Needle 27 G pcs Rp 1,827.00 0 0 0 0
54 Dispo 0,05 ml pcs Rp 4,500.00 60 0 60 0 0 0 0 60
55 Dispo 0,5 ml pcs Rp 4,500.00 37 0 37 37 0 0 37 0
56 Hypafix 5 x 5 0 0 0 0 0
57 Kapas 500 Gram roll Rp 72,600.00 0 0 0 0 0
58 ky jelly 82 gram botol Rp 75,600.00 0 0 0 0 0
59 Pembalut Gips 3 inchi 0 0 0 0 0
60 Plester 5 yerd x 2 inch 0 0 0 0 0 0 0 0
61 Pisau bisturi no 11 0 0 0 0 0 0 0 0
62 Needle 23 G kotak @100 pcs Rp 1,020.00 200 0 200 100 0 0 100 100
0 0
BAHAN HABIS PAKAI THN 2016 ( E-KATALOG ) 0 0
1 NIPRO Syringe 3 cc 23G x 1 pcs Rp 1,010.00 0 0 0 0 0
2 NIPRO IV Catheter 18G x 2 pcs Rp 8,948.00 130 0 130 0 0 0 0 130
3 NIPRO IV Catheter 20G x 1 pcs Rp 8,948.00 100 0 100 0 0 0 0 100
4 NIPRO IV Catheter 22G x 1 pcs Rp 8,948.00 100 0 100 0 0 0 0 100
5 NIPRO IV Catheter 24G x 1 pcs Rp 8,948.00 100 0 100 0 0 0 0 100
6 SURYA HUSADA Kasa kompres 40 x 40 0 0 0 0 0
7 SURYA HUSADA Kasa Hydr 16/16 cm 0 0 0 0 0
8 SURYA HUSADA Kasa Hydr 4Y x 15 0 0 0 0 0
9 SURYA HUSADA Kasa Hydr 2Y x 80 0 0 0 0 0
10 SURYA HUSADA Kasa Hydr 40Y x 80 roll Rp 138,880.00 0 0 0 0 0
11 AXIMED Urine Drainage Bag pcs Rp 5,775.00 0 0 0 0 0
12 AXIMED Nasal Oxygen, size xs pcs Rp 8,250.00 0 0 0 0 0
13 AXIMED Nasal Oxygen, size S pcs Rp 8,250.00 0 0 0 0 0
14 AXIMED Nasal Oxygen, Size L pcs Rp 8,250.00 0 0 0 0 0
15 AXIMED Pediatric Set pcs Rp 5,500.00 0 0 0 0 0
16 AXIMED Infuset pcs Rp 5,500.00 0 0 0 0 0
17 AXIMED Feeding Tube 40 cm No. 5 0 0 0 0 0
18 AXIMED Feeding Tube 40 cm No. 6 pcs Rp 9,213.00 0 0 0 0 0
 19 AXIMED CHIRURGIC GLOVES, 7,0 psng Rp 8,663.00 0 0 0 0 0
20 AXIMED CHIRURGIC GLOVES, 7,5 psng Rp 8,663.00 100 0 100 15 0 0 15 85
21 AXIMED CHIRURGIC GLOVES, 8 psng Rp 8,663.00 0 0 0 0 0
22 AXIMED Face Mask Ties ON dus Rp 26,125.00 0 0 0 0 0
23 AXIMED Face Mask Ear Loop dus Rp 24,750.00 0 0 0 0 0
24 AXIMED Foleycath 2-way No.16 0 0 0 0 0
25 AXIMED Foleycath 2-way No.18 0 0 0 0 0
26 Strip glukosa (benechek) Kotak @ 50 Strip Rp 156,880.00 0 0 0 0 0
27 Strip Cholesterol (benechek) Kotak @ 10 Strip Rp 234,340.00 0 0 0 0 0
28 Strip Urid acid (benechek) Kotak @ 25 Strip Rp 129,650.00 0 0 0 0 0
29 Alat Benecheck Pcs Rp 235,492.00 0 0 0 0 0
30 Leukoplast 7,5 cm x 4,5 m Roll Rp 35,532.00 0 0 0 0 0
31 Hypafix (Fixomull) 10 x 5 roll Rp 70,903.00 1 0 1 0 0 0 0 1
32 RDT MALARIA BOX Rp 476,373.00 89 0 89 0 0 0 0 89
0 0
(BHP NON Katalog) 2016 0 0
1 Kapas 500 Gram ROLL Rp 72,600.00 0 0 0 0 0
2 ky jelly 82 gram tube Rp 104,500.00 0 0 0 0 0
3 Pisau bisturi no 11 Dos Rp 412,500.00 0 0 0 0 0
4 Alkohol 70 % 300 Ml Botol Rp 18,010.00 0 0 0 0 0
5 Nedle No 23 Dos Rp 80,000.00 0 0 0 0 0
6 Etil Clorida Botol Rp 154,000.00 0 0 0 0 0
7 Hcl 0,5 % Botol Rp 274,560.00 1 0 1 0 0 0 0 1
8 Larutan Asam Asetat Botol Rp 101,493.00 1 0 1 0 0 0 0 1
9 Larutan Benedic Botol Rp 149,600.00 1 0 1 0 0 0 0 1
10 Larutan Natrium Sitrat 3,6 % Botol Rp 339,680.00 1 0 1 0 0 0 0 1
11 Jarum Lancet Benecheck Pcs Rp 44,920.00 0 0 0 0 0
12 Urinalisasi Reagent Strip Kotak Rp 675,000.00 0 0 0 0 0
13 Eosin 2% 100 mL Botol Rp 787,149.00 0 0 0 0 0
14 Immersion Oil Botol Rp 1,644,000.00 1 0 1 0 0 0 0 1
15 Giemsa Botol Rp 1,403,082.00 0 0 0 0 0
16 Nacl 0,86% (0,9%) 500 mL Botol Rp 132,214.00 0 0 0 0 0
17 Golongan darah - Tulip Kit Rp 607,103.00 0 0 0 0 0
18 Widal - Tulip Kit Rp 1,140,000.00 0 0 0 0 0
19 Glucosa Liquid 300 mL Botol Rp 1,460,000.00 0 0 0 0 0
20 Urid Acid Liquid 300 mL Botol Rp 1,890,482.00 0 0 0 0 0
21 Cholesterol Liquid 300 mL Botol Rp 2,217,581.00 0 0 0 0 0

OBAT BANTUAN PROVINSI

1 Albendazole kotak 30 tablet Rp 10,890.00
2 Amlodipin 5 mg
3 Amlodipin 10 mg
 4 Amoxicilin 250 mg kotak 120 tablet Rp 26,400.00
5 Amoxicillin syrup botol Rp 2,511.00
6 Amitriptilyn 25 mg tab kotak 100 tab Rp 11,800.00
7 antasida suspensi botol Rp 5,717.00
8 Allupurinol 100 mg
9 Asam Askorbat 50 mg kotak 100 tablet Rp 10,500.00
10 Asam Mefenamat 500 mg kotak 100 tablet Rp 12,700.00
11 Asiklovir 400 mg kotak 100 tablet Rp 36,200.00
12 Aqua Pro Injeksi steril kotak 10 vial Rp 59,000.00
13 Atropin sulfat injeksi ampul Rp 1,931.00
14 Arthemeter inj 1 ml : 80 mg kotak 6 ampul Rp 147,778.00
15 Artesunate inj vial 60 mg kotak 8 vial Rp 220,833.00
16 Blood Slide (malaria) box Rp 20,000.00
17 Blood Lancet dos @200 Rp 200,000.00
18 Box Slide (TB) box Rp 36,000.00
19 Betametason krim tube Rp 3,000.00
20 Captopril 25 mg
21 Cefixim Tab kotak 100 tablet Rp 45,454.00
22 Ciprofloxacin 500 mg kotak 100 tablet Rp 9,999.00
23 Clindamycin 150 mg kotak 50 tablet Rp 25,499.00
24 Cimetidin tab kotak 100 tablet Rp 14,500.00
25 Clindamycin 150 mg kotak 50 tablet Rp 25,499.00
26 Clindamycin 300 mg kotak 50 tablet Rp 14,500.00
27 Combipak Tablet paket Rp 33,000.00
28 Chlorpromazine tab kotak 100 tab Rp 16,273.00
29 Doxicillin tab kotak 100 tab Rp 34,100.00
30 Dexametason inj ampul Rp 2,858.00
31 Dehydro Artenisin + piper kotak 9 tablet Rp 35,556.00
32 Dexametason tab kotak 100 tablet Rp 8,100.00
33 Diazepam Tablet 2 mg Botol 100 tablet Rp 42,900.00
34 Diazepam Tablet 5 mg Botol 250 tablet Rp 16,250.00
35 Diazepam Inj ampul Rp 2,604.00
36 Digoxin tab kotak 100 tab Rp 10,300.00
37 Diphenidramine inj kotak 30 ampul Rp 116,000.00
38 Dispo 1 ml pcs Rp 1,220.00
39 Dispo 3 ml pcs Rp 919.00
40 Emersi Oil 500 ml (Malaria) btl Rp 752,600.00
41 Efedrin HCl 25 mg kotak 100 tablet Rp 17,100.00
42 Epinefrin inj 0,1% Ampul Rp 8,910.00
43 Erytromisin syrup botol 60 ml Rp 9,400.00
44 Erytromisin 250 mg kotak 100 kaps Rp 52,200.00
45 Erytromisin 500 mg kotak 100 kaps Rp 101,300.00
46 Fenobarbital 50 mg/ml Injeksi ampul Rp 1,980.00
47 Fitomenadion (vit.K) inj 10 mg/ml ampul Rp 1,723.00
48 Fluconazole 150 mg kotak 10 caps Rp 297,004.00
49 Folley Catheter No. 16 pcs Rp 20,000.00
50 Folley Catheter No. 18 pcs Rp 19,800.00
51 Giemsa 500 ml (Malaria) botol Rp 350,000.00
52 GG Botol 100 tablet Rp 3,000.00
53 Gentamicin inj kotak 5 ampul Rp 54,975.00
54 Glukosa 5%
55 Garam oralit kotak 100 tablet Rp 31,700.00
56 Glukonas Kalsikus inj 10% ampul Rp 7,800.00
57 Gentian Violet 1%
58 Handscun 7,5 psg Rp 7,320.00
59 Handscun 6,5 psg Rp 7,320.00
60 Hydrokortison krim kotak 24 tube Rp 3,000.00
61 Infuset anak kotak 50 pcs Rp 9,000.00
62 Ibuprofen 400 mg kotak 100 tablet Rp 22,550.00
63 Ibuprofen 200 mg botol 100 tablet Rp 13,000.00
64 IV Chateter No. 20 G pcs Rp 7,610.00
65 Kasa Kompres 40 x 40 pcs Rp 10,098.00
66 Kalsium Laktat kotak 100 tab Rp 14,200.00
67 Kotrimoksazole syrup botol Rp 2,298.00
68 Kloramfenikol Tetes Telinga 3%
69 Kotrimoksazole tab kotak 100 tablet Rp 26,499.00
70 Loperamid tab kotak 100 tab Rp 9,700.00
71 Lidocaine epineprine 2%
72 MgSO4 inj 20% btl 25 ml Rp 2,800.00
73 MgSO4 inj 40% btl 25 ml Rp 2,629.00
74 Miconazole krim tube Rp 3,150.00
75 Mineral mix Sachet Rp 2,541.00
76 Metilergometrin inj ampul Rp 2,175.00
77 Metilergometrin tab ktk @100 tab Rp 13,319.00
78 Methylprednisolon 16 mg kotak 30 tablet Rp 38,999.00
79 Metronidazol 250 mg kotak 100 tablet Rp 12,800.00
80 Metronidazole 500 mg
81 Meloksikam 7,5 mg kotak 50 tablet Rp 38,000.00
82 MB Dewasa (kusta) blister Rp 20,906.00
83 MB Anak (kusta) blister Rp 14,862.00
84 Natrium Tiroksan 100 mg ktk @100 tab Rp 168,300.00
85 Nifedipin Tablet 10 mg Kotak 100 tablet Rp 12,700.00
86 Obat Anti Malaria (OAM) blister 9 tab Rp 35,556.00
87 Oxytetraciklin salep mata tube Rp 2,310.00
 88 Oksitosin inj 10 IU/ml
89 Obat OAT Kategori 1
90 Obat OAT Kategori 2 paket
91 Obat OAT Kategori Anak paket
92 Obat OAT Kategori 1 (Paduan) paket Rp 317,015.00
93 OBH Syrup botol 100 mL Rp 2,793.00
94 Piridoksin (vit. B6) kotak 100 tab Rp 12,100.00
95 PB Anak blister Rp 6,539.00
96 Pot Sputum pcs Rp 2,950.00
97 Prokain Benzil Penicilin G Injeksi 3JT vial Rp 8,880.00
98 Primaquin kotak 100 tablet Rp 12,500.00
99 Phytoninadion (vit K)
100 Paracetamol syrup
101 Paracetamol tab kotak 100 tablet Rp 116.00
102 Prednison 5 mg kotak 100 tablet Rp 15,400.00
103 RDT Malaria tes Rp 19,760.00
104 RDT Malaria (care star) tes Rp 5,400.00
105 Ranitidine 150 mg kotak 100 tablet Rp 13,200.00
106 Rivanol btl Rp 2,610.00
107 Reagen ZN kit Rp 276,600.00
108 Slide box Rp 19,700.00
109 Simvastatin 20 mg
110 Salbutamol 4 mg kotak 100 tab Rp 9,300.00
111 Tablet Tambah darah tablet Rp 367.00
112 Thiampenicol Tablet kotak 100 tablet Rp 67,000.00
113 Triheksifenidil 2 mg
114 Vitamin A balita (merah) botol Rp 25,250.00
115 Vitamin A balita (biru) botol Rp 14,300.00
116 Vaksin Rabies (Rabipur)
117 Vaksin Rabies (Verorab) vial Rp 158,636.00
118 Zink 20 mg kotak 100 tablet Rp 52,100.00
 Jumla Stok Obat
(Rp)

13 (4X12)

Rp - ED
Rp 135,000
Rp -
Rp -
Rp -
Rp 210,000
Rp -
Rp -
Rp 12,300
Rp -
Rp -
Rp 849,200
Rp -
Rp -
Rp -
Rp -
Rp -

Rp 163,800
Rp -

Rp 60,375

Rp -

Rp 29,800

Rp 101,500
Rp -
Rp -
Rp 139,700
Rp -
Rp -
Rp 75,300
Rp 905,000
Rp -
Rp 41,505
Rp -
Rp -
Rp -
Rp 194,040
Rp 207,480
Rp -
Rp 227,700
Rp 29,000
Rp -
Rp 121,500
Rp -
Rp -
Rp 231,200
Rp 111,232
Rp 1,833
Rp -
Rp -
Rp 162,400
Rp 20,600
Rp -
Rp 240,810
Rp 17,400
Rp -
Rp -
Rp 511,500
Rp -
Rp -
Rp -
Rp 128,331 ED
Rp -
Rp -
Rp -
Rp -
Rp 68,600
Rp -

Rp 166,425

Rp - ED
Rp -
Rp 152,500
Rp 80,000
Rp -
Rp 898,040
Rp 46,000
Rp -
Rp -
Rp -
Rp 369,600
Rp 121,000
Rp -
Rp 68,600
Rp -
Rp 212,800
Rp 29,100
Rp -
Rp 8,091
Rp 16,000
Rp -
Rp -
Rp -
Rp 323,400
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -

Rp 15,200

Rp -

Rp -
Rp -
Rp -
Rp -
Rp 84,000
Rp 300,000
Rp 252,000
Rp -
Rp 97,545
Rp -
Rp - ED
Rp -
Rp -
Rp 1,530,000
Rp -

Rp 5,070

Rp 231,000 ED
Rp 67,800
Rp 58,000
Rp 118,300
Rp -
Rp -
Rp -
Rp 403,260
Rp 43,800
Rp -
Rp - Ed
Rp -
Rp -
Rp 4,750,800
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 5,227
Rp -
Rp -
Rp 88,000
Rp -
Rp -
Rp 31,800 ed
Rp -
Rp -
Rp -
Rp 80,404
Rp -
Rp -
Rp -
Rp 200,000
Rp 172,255
Rp -
Rp -
Rp 40,200
Rp - ed
Rp -
Rp -
Rp -
Rp 375,000
Rp -
Rp 188,760
Rp -
Rp 288,300
Rp 8,800
Rp -
Rp 112,800
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 113,956
Rp 26,700 ED
Rp 389,400
Rp -
Rp -
Rp 132,900
Rp -
Rp 42,167
Rp -
Rp -
Rp 307,800
Rp -
Rp 180,000
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 3,073,900
Rp 666,072
Rp 341,946
Rp 210,969
Rp -
Rp -
Rp 242,064
Rp 102,630
Rp 275,077
Rp 415,520
Rp -
Rp -
Rp 38,160
Rp 122,250
Rp -
Rp 112,232
Rp -
Rp -
Rp 1,151,188
Rp 772,316
Rp 823,318
Rp 728,600
Rp -
Rp -
Rp -
Rp 31,320
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 99,180
Rp 119,016
Rp -
Rp -
Rp 100,496
Rp 64,599
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 342,625
Rp -
Rp -
Rp -
Rp -
Rp 677,790
Rp 717,660
Rp 64,650
Rp 21,550
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 270,000
Rp -
Rp -
Rp -
Rp -
#VALUE!
Rp -
Rp -
Rp 102,000
Rp -
Rp -
Rp -
Rp 1,163,240
Rp 894,800
Rp 894,800
Rp 894,800
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 736,355
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 70,903
Rp 42,397,197
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp 274,560
Rp 101,493
Rp 149,600
Rp 339,680
Rp -
Rp -
Rp -
Rp 1,644,000
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
Rp -
 LEMBAR CHECKLIST PEMBERIAN INFORMASI OBAT PASIEN RAWAT JALAN
PERIODE : ....................................

PUSKESMAS :
HARI/TANGGAL :

INFORMASI YANG DIBERIKAN

KONTRAINDIKASI
PENYIMPANAN
NAMA OBAT

CARA PAKAI

STABILITAS
SEDIAAN

INDIKASI
NO NAMA PASIEN UMUR POLI Dx PENUNJANG

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

N
EFEK SAMPING

INTERAKSI

LAIN-LAIN

PETUGAS

15 16 17 18
 KONSELING

CATATAN PENGOBATAN PASIEN

Nama/No.Reg Pekerjaan
Alamat Jenis Kelamin & Umur
No. Telp/HP TB/BB/Gol Darah

TERAPI CATATAN PELAYANAN

NO TANGGAL NAMA DOKTER KASUS
NAMA OBAT/DOSIS/CARA PEMBERIAN APOTEKER/PENGELOLA OBAT
 FROM PEMANTAUAN KETERSEDIAAN OBAT DAN VAKSIN INDIKATOR DI
PERIODE PELAPORAN:
NAMA PUSKESMAS:
KAB/KOTA:
PROVINSI:
NO NAMA OBAT BENTUK SEDIAAN
1 Albendazole tablet
2 Amoxicillin 500 mg tablet
3 Amoxicillin syp syrup
4 Deksamethason 0,5 mg tablet
5 Diazepam 5 mg/mL injeksi
6 Epinefrin (Adrenalin) 0,1% injeksi
7 Fitomenadion (vit K) inj injeksi
8 Furosemid 40 mg tablet
9 Garam Oralit serbuk
10 Glibenklamid tablet
11 Kaptopril 25 mg tablet
12 Magnesium Sulfat 20% injeksi
13 Metilergometrin Maleat inj injeksi
14 OAT Dewasa tablet
15 Oksitosin injeksi
16 Parasetamol 500 mg tablet
17 Tablet Tambah Darah tablet
18 Vaksin BCG injeksi
19 Vaksin DPT-HB-Hib injeksi
20 Vaksin Td injeksi
N VAKSIN INDIKATOR DI PUSKESMAS
BULAN:
PENANGGUNGJAWAB FARMASI:
NO HP:
EMAIL:
KETERSEDIAAN Ket