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)

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

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

JUMLAH STOCK BULAN INI PENGELUARAN BULAN INI

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

1 2 3 4 5 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
2 Alopurinol tablet/kapsul/kaplet 100 mg tablet Rp 90
3 Alprazolam 0,5 mg
4 Alprazolam tablet/kapsul/kaplet 1 mg tablet Rp 245
5 Ambroxol sirup 15 mg / ml
6 Ambroxol Tablet tablet Rp 150
7 Aminofilin injeksi 24 mg/ml ampul Rp 4,204
8 Aminofilin tablet scored 200 mg tablet Rp 86
9 Amitriptilyn 25 Mg tablet Rp 123
10 Amlodipin tablet 10 mg
11 Amlodipin tablet 5 mg
12 Amoksisilin kapsul/kaplet 250 mg tablet Rp 220
13 Amoksisilin sirup kering 125 mg/ 5 ml
14 Amoxillin 500 Mg tablet Rp 279
15 Ampisillin 500 mg
16 Ampisillin sirup kering 125 mg / ml
17 Antalgin 500 mg
Antasida DOEN I tablet kunyah, kombinasi :
18 Aluminium Hidroksida 200 mg tablet Rp 78
Magnesium Hidroksida 200 mg
 Antasida DOEN II suspensi, kombinasi :
19 Aluminium Hidroksida 200 mg/5 ml
Magnesium Hidroksida 200 mg/5 ml
20 Antifungi doen kombinasi: asam Benzoat
tube Rp 2,516
6%
Antimalaria DOEN kombinasi : Pirimetamin
21 25 mg tablet Rp 572
Sulfadoksin 500 mg
22 Antimigren:
tablet Rp 149
Ergotamin Tartrat 1 mg + Kofein 50 mg
23 Aqua pro injeksi steril ampul Rp 2,900
24 Asam Askorbat (Vit C) 50 mg tablet Rp 105
25 Asam Askorbat 250 mg
26 Asam Mefenamat kapsul/kaplet 500 mg tablet Rp 127
27 Asam traneksamat injeksi 100 mg/ml
28 Asiklovir krim 5 %
29 Asiklovir tablet/kapsul/kaplet 200 mg tablet Rp 251
30 Asiklovir tablet/kapsul/kaplet 400 mg tablet Rp 362
31 Atropine 0,5 Mg tablet Rp 81
32 Bacitracyn Polymyxin B Salep Kulit tube Rp 2,767
33 Bedak salisil serbuk 2%
34 Benedon Inj (Adimidon injeksi)
35 Benzatin Benzil Penisilin 1,2 juta IU/ vial
36 Betahistin masilate 6 mg tablet Rp 924
37 Betametason krim 0,1% (sebagai Valerat) tube Rp 1,596
38 Calsidol Sirup
39 Captopril 12,5 Mg tablet Rp 69
40 Cimetidine 200 mg tablet Rp 145
41 Citikolin inj ampul Rp 18,150
42 Clindamycin 150 Mg tablet Rp 405
43 Clindamycin 300 Mg tablet Rp 619
44 Curcuma tablet Rp 600
45 Deksametason tablet 0,5 mg tablet Rp 68
46 Dexamethasone Inj ampul Rp 1,738
47 Diazepam 2 mg tablet Rp 47
48 Diazepam 5 mg
49 Diazepam inj 5 mg / ml
50 Difenhidramin injeksi i.v./i.m. 10 mg/ml
ampul Rp 1,160
(HCl)
51 Digoksin tablet 0,25 mg tablet Rp 103
52 Diltiazem HCl tablet 30 mg tablet Rp 141
53 Domperidon suspensi/sirup 5 mg/5 ml botol Rp 3,490
54 Domperidon tablet 10 mg tablet Rp 174
55 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1
mg/ml
56 Eritromisin kapsul/kaplet 250 mg
57 Eritromisin kapsul/kaplet 500 mg tablet Rp 1,023
58 Etakridine larutan 0,1 % botol Rp 2,500
59 Etanol 70% cairan botol Rp 2,625
60 Etil Chlorida
61 Eugenol cairan botol Rp 18,333
62 Fenobarbital injeksi i.m./i.v. 50 mg/ml ampul Rp 1,980
63 Fenobarbital tablet 30 mg
64 Fitomenadion (Vit K 1) inj
65 Fitomenadion (Vit.K1) tablet salut gula 10
tablet Rp 697
mg
66 Furosemid tablet 40 mg tablet Rp 98
67 Furosemide 10 mg/ml Injeksi ampul Rp 2,012
Garam Oralit I serbuk, kombinasi : Natrium
68 klorida 0,52 g kalium klorida 0,30 g
sachet Rp 317
Trinatrium sitrat dihidrat 0,58 g Glukosa
Anhidrat 2,70 g
69 Gemvibrozil 300 Mg
70 Gentamicin 40 mg/ml Injeksi ampul Rp 3,739
71 Glibenclamide 5 Mg tablet Rp 61
72 Gliseruil guaikolate (GG) tablet Rp 40
73 Glukosa larutan infus 10 % steril
74 Glukosa larutan infus 5 % steril botol Rp 5,720
75 Griseofulvin tablet 125 mg tablet Rp 230
76 Haloperidol 0,5 Mg tablet Rp 62
77 Haloperidol 1,5 Mg tablet Rp 76
78 Haloperidol 5 Mg tablet Rp 105
79 Hcl 0,5 % botol Rp 184,800
80 Ibuprofen 200 mg tablet Rp 121
81 Ibuprofen tablet 400 mg
82 Isosorbide Dinintrate 5 Mg tablet Rp 98
83 Kalsium laktate (KALAK)
84 Kalsium laktate (KALAK) tablet Rp 76
85 Kaptopril tablet scored 25 mg tablet Rp 97
86 Karbamazepin tablet 200 mg tablet Rp 269
87 Ketokonazol krim 2% tube 10 gram tube Rp 2,697
88 Ketokonazol tablet 200 mg tablet Rp 320
89 Ketorolac Inj 30 mg / ml ampul Rp 2,665
90 Kloramfenikol kapsul/kaplet 250 mg
91 Kloramfenikol salep mata 1 % tube Rp 1,680
92 Kloramfenikol suspensi 125 mg/ 5 ml botol Rp 6,600
93 Kloramfenikol Tetes Telinga
94 Kloramfeniramin maleat (CTM) 4 mg tablet Rp 35
95 Klorpromazin tablet salut 100 mg (HCl) tablet Rp 156
96 Klorpromazin injeksi i.m. 25 mg/ml (HCl)
97 Kodein tablet 10 mg tablet Rp 550
98 Kodein tablet 15 mg tablet Rp 935
99 Kodein tablet 20 mg tablet Rp 1,210
Kotrimoksazol DOEN I (dewasa) kombinasi :
100 Sulfametoksazol 400 mg tablet Rp 152
Trimetoprim 80 mg
Kotrimoksazol Suspensi komb:
101 Sulfametoksazol 200 mg + Trimetoprim 40
mg / 5 ml
102 Kuinin (Kina) tablet 200 mg tablet Rp 737
103 Kuinin injeksi i.v. 25% (sebagai 2 HCl)
104 Kuinin tablet 222 mg (H2SO4.7H2O)
105 Lanzoprazol kapsul/kaplet 30 mg
106 Larutan Asam Asetat botol Rp 84,000
107 Larutan Benedic botol Rp 300,000
108 Larutan Natrium Sitrat 3,6% botol Rp 252,000
109 Levofloksasin tablet 500 mg tablet Rp 581
110 Lidokain injeksi 2% (HCL) ampul Rp 929
111 Livitan Syr
112 Loperamide 2 Mg tablet Rp 97
113 Magnesium sulfat injeksi (IV) 40- % - 25 ml ampul Rp 5,175
114 Meloxicam 15 mg
115 Metformin Tab tablet Rp 450
116 Metformin Tab kotak Rp 13,530
117 Metilergometrin Maleat (Metilergometrin)
tablet Rp 169
tablet salut 0,125 mg
118 Metilprednisolon 4 Mg tablet Rp 330
119 Metoklopramide tablet 5 mg tablet Rp 113
120 Metronidazol tablet 250 mg tablet Rp 116
121 Metronidazol tablet 500 mg tablet Rp 169
122 Metthyl Ergometrin inj
123 Mikonazol krim/salep 2 % (Nitrat)
124 Miraneuron Kapsul
125 Nacl 0,9 % botol Rp 5,170
126 Natrium Diklofenak tablet 25 mg tablet Rp 146
127 Natrium Diklofenak tablet 50 mg tablet Rp 193
128 Nifedipin tablet/kapsul 10 mg tablet Rp 127
129 Nistatin tablet salut 500.000 IU/ g tablet Rp 704
130 Novabion Tablet tablet Rp 784
131 Obat Antituberkulosis FDC Kategori 1 paket Rp 395,900
132 Obat Antituberkulosis FDC Kategori 2
133 Obat Antituberkulosis FDC Kategori Anak
134 Obat Batuk Hitam (OBH)
135 Oksitetrasiklin Salep Mata 1 %
136 Omeprazol kapsul/kaplet 20 mg
137 Oxitetrasiklin salep kulit 3 % tube Rp 1,649
138 Oxitosin injeksi ampul Rp 2,614
139 Papaverin 40 mg tablet Rp 155
140 Parasetamol sirup 120 mg / 5 ml
141 Parasetamol tablet 500 mg tablet Rp 88
142 Piracetam 400 mg
143 Pirantel suspensi 125 mg/5 ml
144 Pirantel tablet score (base) 125 mg tablet Rp 318
145 Piridoxine (vit B6) 10 mg tablet Rp 26
146 Piroxicam 10 mg
147 Piroxicam 20 mg tablet Rp 145
148 Povidon iodine 10 % 1000 botol Rp 40,202
149 Povidon iodine 10 % 30
150 Povidon iodine 10 % 300 botol Rp 15,386
151 Prednison tablet 5 mg
152 Prednison tablet 5 mg tablet Rp 125
153 Propiltiourasil 100 mg tablet Rp 345
154 Propiltiourasil 100 mg
155 Propranolol tablet 40 mg (HCl) tablet Rp 114
156 Ranitidin injeksi 25 mg/2 ml ampul Rp 1,340
157 Ranitidin Tablet 150 Mg tablet Rp 132
158 Reco Salep Mata tube Rp 11,000
159 Reco Tetes Mata
160 Reco Tetes Telinga
161 Recodril Inj ampul Rp 12,500
162 Retinol (Vitamin A) 100.000 IU
163 Ringer Laktat larutan infus botol Rp 5,720
164 Salbutamol 2 Mg tablet Rp 65
165 Salbutamol 4 mg tablet Rp 93
166 Salep 2-4 tube Rp 2,200
167 Sefadroksil sirup kering 125 mg/5ml
168 Sefadroksil kapsul/kaplet 250 mg tablet Rp 564
169 Sefadroksil kapsul/kaplet 500 mg
170 Sefotaksim injeksi 0,5 g
171 Sefotaksim injeksi 1 g
172 Seftriakson serbuk injeksi 1 g/vial
 173 Setrizine 10 Mg tablet Rp 190
174 Sianokobalamin (vitamin B12) injeksi 500
ampul Rp 1,036
mg
Sianokobalamin (vitamin B12) Tablet 50
175 tablet Rp 27
mcg
176 Simvastatin scored tablet 10 mg tablet Rp 177
177 Siobion
178 Siprofloksasin tablet 500 mg (sebagai HCl)
179 Siprofloksasin tablet 500 mg (sebagai HCl) tablet Rp 443
180 Stesolid Inj
181 Superhoid (Antihemoroid) suppo Rp 3,833
182 Tetrasiklin 500 mg
183 Tetrasiklin 500 mg
184 Tetrasiklin kapsul/kaplet 250 mg tablet Rp 162
185 Tiamin (Vitamin B1) Injeksi ampul Rp 1,267
186 Tiamin (Vitamin B1) tablet 50 mg (HCl/
tablet Rp 60
Nitrat)
187 Tramadol injeksi 50 mg/ml ampul Rp 2,680
188 Tramadol kapsul 50 mg
189 Triheksiphenidil 2 mg
190 Urinalisasi Reagent Strip
191 Vaksin Vero
192 Vaksin Vero
193 Vitabiol Sirup
194 Vitamin B Complex tablet Rp 112
195 Zinc 20 Mg tablet Rp 521

OBAT-OBATAN (e-KATALOG) 2016

1 AMINOPHILIN INJ AMPUL Rp 3,349
2 ANTASIDA DOEN TABLET Rp 64
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
8 AMLODIPIN TABLET 5 MG TABLET Rp 105
9 AMOXILLIN 500 MG KAPLET Rp 233
10 ASAM MEFENAMAT KAPLET 500 MG TABLET Rp 113
11 AQUA PRO INJEKSI
12 ALBENDAZOLE TABLET 400 MG TABLET Rp 323
13 ANTIHEMOROID KOMBINASI SUPO Rp 3,502
14 ANTIFUNGI DOEN SALEP TUBE Rp 4,782
15 BEDAK SALICIL
16 BETAMETASON KRIM 0,1 % TUBE Rp 1,435
17 CTM TABLET Rp 45
18 DIPHENHIDRAMIN INJ AMPUL Rp 1,356
19 DEKSAMETASON TABLET 0,5 MG TABLET Rp 48
20 DOMPERIDON SUSPENSI BOTOL Rp 3,180
21 DOMPERIDON TABLET 10 MG TABLET Rp 133
22 DEXAMETASON INJ
23 ERITROMISIN KAPSUL 250 MG KAPSUL Rp 651
24 ERITROMISIN KAPLET 500 MG
25 FENOBARBITAL INJEKSI
26 GEMVIBROZIL TABLET 300 MG TABLET Rp 436
27 HIDROCORTIZON KRIM 2,5 % TUBE Rp 2,812
28 HIDROCORTIAZID 25 MG TABLET Rp 171
29 Ibuprofen 400 mg TABLET Rp 133
30 KETOCONAZOLE KRIM 2 % TUBE Rp 2,738
31 KOTRIMOXASOLE SUSPENSI BOTOL Rp 2,225
32 KOTROMOXAZOLE DEWASA TABLET Rp 158
33 KLORAMFENIKOL SALEP MATA 1 % TUBE Rp 1,850
34 KLORAMFENIKOL SUSPENSI 125 MG/ 5ML TUBE Rp 4,000
35 LIDOCAIN INJ 2 % AMPUL Rp 875
36 LEVOFLOXASIN 500 MG TABLET Rp 525
37 LIDOKAIN 2% + EPINEFRIN INJ AMPUL Rp 2,122
38 METFORMIN 500MG TABLET Rp 119
39 METRONIDAZOLE 250 MG TABLET Rp 98
40 METRONIDAZOLE 500 MG TABLET Rp 98
41 MIKONAZOLE SALEP 2 % TUBE Rp 3,737
42 NATRIUM DIKLOFENAK 50 MG TABLET Rp 161
43 NATRIUM DIKLOFENAK 25 MG TABLET Rp 167
44 OMEPRAZOLE TABLET TABLET Rp 164
45 PARASETAMOL SYR AMPUL Rp 1,119
46 PHITOMENADION INJ AMPUL Rp 4,083
47 PROPANOLOL TABLET 10 MG TABLET Rp 69
48 PROPANOLOL TABLET 40 MG TABLET Rp 318
49 RANITIDIN TABLET 150 MG TABLET Rp 119
50 RETINOL (VIT A) 100.000 UI KAPSUL Rp 327
51 SALEP 24 POT Rp 2,797
52 SEFADROXIL 500 MG CAPSUL Rp 557
53 SIMVASTATIN 20 MG TABLET Rp 252
54 SIPROFLOXASIN 500 MG TABLET Rp 298
55 VITAMIN B KOMPLEKS TABLET Rp 132
56 VIT B6 TABLET 10 MG TABLET Rp 136
57 VIT B12 INJEKSI AMPUL Rp 1,226
58 VIT C 50 MG TABLET Rp 120
 59 VIT C 250 MG TABLET Rp 139
60 VIT K TABLET 10 MG TABLET Rp 800
61 ZINK 20 MG TABLET Rp 592

OBAT-OBATAN (NON KATALOG) 2016

1 Ambroxol sirup 15 mg / ml
2 Ambroxol Tablet Box 100 tab Rp 16,676
3 Curcuma Btl 100 tab Rp 117,333
4 Oxitetrasiklin salep kulit 3 % Tube Rp 2,543
5 Oxitetrasiklin Salep Mata 1 % Tube Rp 3,264
6 Papaverin 40 mg btl 1000 tab Rp 184,690
7 Piroxicam 10 mg box 100 tab Rp 15,070
8 Piroxicam 20 mg box 100 tab Rp 18,836
9 Ponconeuron tab TABLET Rp 1,372
10 Sefotaxim Inj 1 gr vial @1gr Rp 11,246
11 Seftriaxone Serbuk Inj 1 gr/via vial @1gr Rp 10,906
12 Vitabiol Sirup Botol 60 Ml Rp 16,445
13 Vaksin verrorab Box Rp 195,658
14 Prednison Tablet Box 100 tab Rp 12,500
15 Metoklopramid Tablet Box 100 tab Rp 11,300
16 Griseofulvin Tablet Box 100 tab Rp 23,000
17 Nifedipin 10mg Tablet Box 100 tab Rp 12,700
18 Chlorpromazine 100mg Box 100 tab Rp 15,600
19 Pyrantel Tablet Box 100 tab Rp 31,800
20 Retinol Vit A 200.000 IU Kapsul Rp 505
21 Paracetamol 500mg Tablet Box 100 tab Rp 8,800
22 Asam Mefenamat 500 mg Tablet Box 100 tab Rp 12,700
23 Kloramfenikol Syrup Botol Rp 5,500
24 Sulfadoxin Tablet Box 100 tab Rp 57,200
25 Pyrantel Syrup Botol Rp 9,100

BAHAN HABIS PAKAI THN 2015 ( E-KATALOG )

1 STERA Syringe 1 cc tuberculin 27G x 1/2 " kotak @100 pcs Rp 848
2 STERA 10 cc x 21G x 1 1/2"
3 STERA 20 cc ec kotak @50 pcs Rp 1,957
4 STERA 3 cc x 23G x 1 1/4" kotak @100 pcs Rp 848
5 STERA 5 cc x 22G x 1 1/4" kotak @100 pcs Rp 978
6 STERA 50 cc ec tip kotak @20 pcs Rp 4,437
7 ONEMED Alkohol 70 % 1 liter botol Rp 28,058
8 ONEMED Aseptan 500 cc + dispenser botol Rp 39,150
9 STERA Blood transfusion set
10 ONEMED Catgut plain 2/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286
11 ONEMED Catgut plain 3/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286
12 ONEMED Catgut Chromic 2/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286
13 ONEMED Catgut Chromic 3/0 + jarum 1/2 GT 35 mm kotak @24 pcs Rp 7,286
14 SAFEGLOVE Examination glove kotak @100 pcs Rp 42,413
15 ONEMED Folley Catheter 2 way no. 12 kotak @10 pcs Rp 10,440
16 ONEMED Folley Catheter 2 way no. 14 kotak @10 pcs Rp 10,440
17 ONEMED Folley Catheter 2 way no. 16 kotak @10 pcs Rp 10,440
18 ONEMED Folley Catheter 2 way no. 18
19 ONEMED Folley Catheter 2 way no. 20
20 ONEMED Folley Catheter 2 way no. 22
21 ONEMED Folley Catheter 2 way no. 24 kotak @10 pcs Rp 10,440
22 ONEMED Folley Catheter ped no. 10 kotak @10 pcs Rp 39,150
23 ONEMED Folley Catheter ped no. 6 kotak @10 pcs Rp 47,632
24 ONEMED Folley Catheter ped no. 8 kotak @10 pcs Rp 39,150
25 STERA I.V Catheter no. 18 G x 32 mm pcs Rp 4,959
26 STERA I.V Catheter no. 20 G x 11/4" pcs Rp 4,959
27 STERA I.V Catheter no. 22 G x 1" pcs Rp 4,959
28 STERA I.V Catheter no. 24 G x 3/4" pcs Rp 4,959
29 STERA I.V Catheter no. 26 G x 1/2" pcs Rp 5,351
30 STERA Infusion Set dewasa ( 20 drops/ml )
31 STERA Infusion Set pediatric ( 60 drops/ml ) pcs Rp 4,568
32 ONEMED Kapas berlemak 500 gr roll Rp 21,533
33 ONEMED Kasa hydrophil steril uk 18 x 22 roll Rp 7,700
34 ONEMED Kasa Hydrophil 40 x 80 cm
35 ONEMED Kasa hydrophil steril uk 16 x 16
36 ONEMED Kasa kompress steril 40 x 40
37 ONEMED Kapas pembalut / absorben 250 gr roll Rp 16,313
38 ONEMED Kasa pembalut 2 m x 80 cm roll Rp 10,049
39 ONEMED Kasa Pembalut hydrophil 4 m x 10 cm kotak @50 roll Rp 1,958
40 ONEMED Kasa Pembalut hydrophil 4 m x 15 cm kotak @50 roll Rp 2,741
41 ONEMED Povidone iodine 30 cc botol Rp 3,785
42 ONEMED Povidone iodine 300 cc botol Rp 23,490
43 ONEMED Povidone iodine 60 cc botol Rp 4,829
44 ONEMED Rivanol 300 cc botol Rp 3,328
45 ONEMED Silk 2/0 + jarum 1/2 GT 35 mm kotak @36 pcs Rp 3,987
46 ONEMED Silk 3/0 + jarum 1/2 GT 35 mm kotak @36 pcs Rp 3,987
47 ONEMED Surgical Mask 3 ply Earloop kotak @50 pcs Rp 431
48 ONEMED Surgical Mask 3 ply Tie on kotak @50 pcs Rp 431
49 ONEMED Wing Needle 19 G pcs Rp 1,827
50 ONEMED Wing Needle 21 G pcs Rp 1,827
 51 ONEMED Wing Needle 23 G
52 ONEMED Wing Needle 25 G pcs Rp 1,827
53 ONEMED Wing Needle 27 G pcs Rp 1,827
54 Dispo 0,05 ml pcs Rp 4,500
55 Dispo 0,5 ml pcs Rp 4,500
56 Hypafix 5 x 5
57 Kapas 500 Gram roll Rp 72,600
58 ky jelly 82 gram botol Rp 75,600
59 Pembalut Gips 3 inchi
60 Plester 5 yerd x 2 inch
61 Pisau bisturi no 11
62 Needle 23 G kotak @100 pcs Rp 1,020

BAHAN HABIS PAKAI THN 2016 ( E-KATALOG )

1 NIPRO Syringe 3 cc 23G x 1 pcs Rp 1,010
2 NIPRO IV Catheter 18G x 2 pcs Rp 8,948
3 NIPRO IV Catheter 20G x 1 pcs Rp 8,948
4 NIPRO IV Catheter 22G x 1 pcs Rp 8,948
5 NIPRO IV Catheter 24G x 1 pcs Rp 8,948
6 SURYA HUSADA Kasa kompres 40 x 40
7 SURYA HUSADA Kasa Hydr 16/16 cm
8 SURYA HUSADA Kasa Hydr 4Y x 15
9 SURYA HUSADA Kasa Hydr 2Y x 80
10 SURYA HUSADA Kasa Hydr 40Y x 80 roll Rp 138,880
11 AXIMED Urine Drainage Bag pcs Rp 5,775
12 AXIMED Nasal Oxygen, size xs pcs Rp 8,250
13 AXIMED Nasal Oxygen, size S pcs Rp 8,250
14 AXIMED Nasal Oxygen, Size L pcs Rp 8,250
15 AXIMED Pediatric Set pcs Rp 5,500
16 AXIMED Infuset pcs Rp 5,500
17 AXIMED Feeding Tube 40 cm No. 5
18 AXIMED Feeding Tube 40 cm No. 6 pcs Rp 9,213
19 AXIMED CHIRURGIC GLOVES, 7,0 psng Rp 8,663
20 AXIMED CHIRURGIC GLOVES, 7,5 psng Rp 8,663
21 AXIMED CHIRURGIC GLOVES, 8 psng Rp 8,663
22 AXIMED Face Mask Ties ON dus Rp 26,125
23 AXIMED Face Mask Ear Loop dus Rp 24,750
24 AXIMED Foleycath 2-way No.16
25 AXIMED Foleycath 2-way No.18
26 Strip glukosa (benechek) Kotak @ 50 Strip Rp 156,880
27 Strip Cholesterol (benechek) Kotak @ 10 Strip Rp 234,340
28 Strip Urid acid (benechek) Kotak @ 25 Strip Rp 129,650
 29 Alat Benecheck Pcs Rp 235,492
30 Leukoplast 7,5 cm x 4,5 m Roll Rp 35,532
31 Hypafix (Fixomull) 10 x 5 roll Rp 70,903
32 RDT MALARIA BOX Rp 476,373

(BHP NON Katalog) 2016

1 Kapas 500 Gram ROLL Rp 72,600
2 ky jelly 82 gram tube Rp 104,500
3 Pisau bisturi no 11 Dos Rp 412,500
4 Alkohol 70 % 300 Ml Botol Rp 18,010
5 Nedle No 23 Dos Rp 80,000
6 Etil Clorida Botol Rp 154,000
7 Hcl 0,5 % Botol Rp 274,560
8 Larutan Asam Asetat Botol Rp 101,493
9 Larutan Benedic Botol Rp 149,600
10 Larutan Natrium Sitrat 3,6 % Botol Rp 339,680
11 Jarum Lancet Benecheck Pcs Rp 44,920
12 Urinalisasi Reagent Strip Kotak Rp 675,000
13 Eosin 2% 100 mL Botol Rp 787,149
14 Immersion Oil Botol Rp 1,644,000
15 Giemsa Botol Rp 1,403,082
16 Nacl 0,86% (0,9%) 500 mL Botol Rp 132,214
17 Golongan darah - Tulip Kit Rp 607,103
18 Widal - Tulip Kit Rp 1,140,000
19 Glucosa Liquid 300 mL Botol Rp 1,460,000
20 Urid Acid Liquid 300 mL Botol Rp 1,890,482
21 Cholesterol Liquid 300 mL Botol Rp 2,217,581

OBAT BANTUAN PROVINSI

1 Albendazole kotak 30 tablet Rp 10,890
2 Amlodipin 5 mg
3 Amlodipin 10 mg
4 Amoxicilin 250 mg kotak 120 tablet Rp 26,400
5 Amoxicillin syrup botol Rp 2,511
6 Amitriptilyn 25 mg tab kotak 100 tab Rp 11,800
7 antasida suspensi botol Rp 5,717
8 Allupurinol 100 mg
9 Asam Askorbat 50 mg kotak 100 tablet Rp 10,500
10 Asam Mefenamat 500 mg kotak 100 tablet Rp 12,700
11 Asiklovir 400 mg kotak 100 tablet Rp 36,200
12 Aqua Pro Injeksi steril kotak 10 vial Rp 59,000
13 Atropin sulfat injeksi ampul Rp 1,931
14 Arthemeter inj 1 ml : 80 mg kotak 6 ampul Rp 147,778
15 Artesunate inj vial 60 mg kotak 8 vial Rp 220,833
16 Blood Slide (malaria) box Rp 20,000
17 Blood Lancet dos @200 Rp 200,000
18 Box Slide (TB) box Rp 36,000
19 Betametason krim tube Rp 3,000
20 Captopril 25 mg
21 Cefixim Tab kotak 100 tablet Rp 45,454
22 Ciprofloxacin 500 mg kotak 100 tablet Rp 9,999
23 Clindamycin 150 mg kotak 50 tablet Rp 25,499
24 Cimetidin tab kotak 100 tablet Rp 14,500
25 Clindamycin 150 mg kotak 50 tablet Rp 25,499
26 Clindamycin 300 mg kotak 50 tablet Rp 14,500
27 Combipak Tablet paket Rp 33,000
28 Chlorpromazine tab kotak 100 tab Rp 16,273
29 Doxicillin tab kotak 100 tab Rp 34,100
30 Dexametason inj ampul Rp 2,858
31 Dehydro Artenisin + piper kotak 9 tablet Rp 35,556
32 Dexametason tab kotak 100 tablet Rp 8,100
33 Diazepam Tablet 2 mg Botol 100 tablet Rp 42,900
34 Diazepam Tablet 5 mg Botol 250 tablet Rp 16,250
35 Diazepam Inj ampul Rp 2,604
36 Digoxin tab kotak 100 tab Rp 10,300
37 Diphenidramine inj kotak 30 ampul Rp 116,000
38 Dispo 1 ml pcs Rp 1,220
39 Dispo 3 ml pcs Rp 919
40 Emersi Oil 500 ml (Malaria) btl Rp 752,600
41 Efedrin HCl 25 mg kotak 100 tablet Rp 17,100
42 Epinefrin inj 0,1% Ampul Rp 8,910
43 Erytromisin syrup botol 60 ml Rp 9,400
44 Erytromisin 250 mg kotak 100 kaps Rp 52,200
45 Erytromisin 500 mg kotak 100 kaps Rp 101,300
46 Fenobarbital 50 mg/ml Injeksi ampul Rp 1,980
47 Fitomenadion (vit.K) inj 10 mg/ml ampul Rp 1,723
48 Fluconazole 150 mg kotak 10 caps Rp 297,004
49 Folley Catheter No. 16 pcs Rp 20,000
50 Folley Catheter No. 18 pcs Rp 19,800
51 Giemsa 500 ml (Malaria) botol Rp 350,000
52 GG Botol 100 tablet Rp 3,000
53 Gentamicin inj kotak 5 ampul Rp 54,975
54 Glukosa 5%
55 Garam oralit kotak 100 tablet Rp 31,700
56 Glukonas Kalsikus inj 10% ampul Rp 7,800
57 Gentian Violet 1%
58 Handscun 7,5 psg Rp 7,320
59 Handscun 6,5 psg Rp 7,320
60 Hydrokortison krim kotak 24 tube Rp 3,000
61 Infuset anak kotak 50 pcs Rp 9,000
62 Ibuprofen 400 mg kotak 100 tablet Rp 22,550
63 Ibuprofen 200 mg botol 100 tablet Rp 13,000
64 IV Chateter No. 20 G pcs Rp 7,610
65 Kasa Kompres 40 x 40 pcs Rp 10,098
66 Kalsium Laktat kotak 100 tab Rp 14,200
67 Kotrimoksazole syrup botol Rp 2,298
68 Kloramfenikol Tetes Telinga 3%
69 Kotrimoksazole tab kotak 100 tablet Rp 26,499
70 Loperamid tab kotak 100 tab Rp 9,700
71 Lidocaine epineprine 2%
72 MgSO4 inj 20% btl 25 ml Rp 2,800
73 MgSO4 inj 40% btl 25 ml Rp 2,629
74 Miconazole krim tube Rp 3,150
75 Mineral mix Sachet Rp 2,541
76 Metilergometrin inj ampul Rp 2,175
77 Metilergometrin tab ktk @100 tab Rp 13,319
78 Methylprednisolon 16 mg kotak 30 tablet Rp 38,999
79 Metronidazol 250 mg kotak 100 tablet Rp 12,800
80 Metronidazole 500 mg
81 Meloksikam 7,5 mg kotak 50 tablet Rp 38,000
82 MB Dewasa (kusta) blister Rp 20,906
83 MB Anak (kusta) blister Rp 14,862
84 Natrium Tiroksan 100 mg ktk @100 tab Rp 168,300
85 Nifedipin Tablet 10 mg Kotak 100 tablet Rp 12,700
86 Obat Anti Malaria (OAM) blister 9 tab Rp 35,556
87 Oxytetraciklin salep mata tube Rp 2,310
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
93 OBH Syrup botol 100 mL Rp 2,793
94 Piridoksin (vit. B6) kotak 100 tab Rp 12,100
95 PB Anak blister Rp 6,539
96 Pot Sputum pcs Rp 2,950
97 Prokain Benzil Penicilin G Injeksi 3JT vial Rp 8,880
 98 Primaquin kotak 100 tablet Rp 12,500
99 Phytoninadion (vit K)
100 Paracetamol syrup
101 Paracetamol tab kotak 100 tablet Rp 116
102 Prednison 5 mg kotak 100 tablet Rp 15,400
103 RDT Malaria tes Rp 19,760
104 RDT Malaria (care star) tes Rp 5,400
105 Ranitidine 150 mg kotak 100 tablet Rp 13,200
106 Rivanol btl Rp 2,610
107 Reagen ZN kit Rp 276,600
108 Slide box Rp 19,700
109 Simvastatin 20 mg
110 Salbutamol 4 mg kotak 100 tab Rp 9,300
111 Tablet Tambah darah tablet Rp 367
112 Thiampenicol Tablet kotak 100 tablet Rp 67,000
113 Triheksifenidil 2 mg
114 Vitamin A balita (merah) botol Rp 25,250
115 Vitamin A balita (biru) botol Rp 14,300
116 Vaksin Rabies (Rabipur)
117 Vaksin Rabies (Verorab) vial Rp 158,636
118 Zink 20 mg kotak 100 tablet Rp 52,100
Jumla Stok
Obat (Rp)

13 (4X12)
 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 NY. KHOLIS HATUL Pekerjaan

Alamat malino jaya Jenis Kelamin & Umur 26 Thn
No. Telp/HP TB/BB/Gol Darah

TERAPI CATATAN PELAYANAN

NO TANGGAL NAMA Pemeriksa KASUS
NAMA OBAT/DOSIS/CARA PEMBERIAN APOTEKER/PENGELOLA OBAT
5/7/2017 Yuliana,Skep.Ns RDT
 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