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DINAS KESEHATAN KABUPATEN INDRAMAYU

UPTD PUSKESMAS SUKRA

Jalan Raya Sukra Wetan No. 2 Telp / Fax .(0234) 272057 INDRAMAYU

BERITA ACARA
STOK OPNAME OBAT DAN ALKES DI UPTD PUSKESMAS SUKRA
PER 31 Maret 2015
NOMOR :

Pada hari ini Selasa tanggal empat belas bulan April Tahun Dua ribu lima belas ( 14 - 04 - 2015 ), yang bertanda tangan dibawah ini :

1 dr. H. Rosyid M. Noer : Plt. Ka UPTD Puskesmas Sukra

NIP : 19690911 201412 1 001
2 Sandy Amd.far : Petugas Pengelola Obat
NIP : 19900813 201101 1 001
3 Nafsiah, AMG : Petugas Pengelola Obat Program Gizi
NIP : 19780329 200501 2 004
4 Hj. Bawon Amd,keb : Petugas Pengelola Obat Program KIA
NIP : 19690709 198903 2 004
5 Tati Hikmah Am,kep : Petugas Pengelola Obat Program Diare
NIP : 19790714 200204 2 021
6 Toriah Am,kep : Petugas Pengelola Obat Program ISPA
NIP : 19730903 200604 2 013

Telah melaksanakan Stok Opname terhadap Obat-obatan dan Alat Kesehatan pada UPTD Puskesmas Sukra Dinas Kesehatan Kabupaten Indramayu dan telah ditemukan saldo
sebesar Rp. 125,611,372.35 ,- dengan perincian sebagai berikut :

HARGA STOK AWAL PENERIMAAN PENGELUARAN STOK AKHIR

NO NAMA OBAT SATUAN
SATUAN
VOL JUMLAH VOL JUMLAH VOL JUMLAH VOL JUMLAH
1 Air Raksa Dental use botol 103,536 - - - -
2 Alat suntik sekali pakai 1 ml set 1,093 - - 500 546,250 500 546,250 - -
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3 Alat suntik sekali pakai 2,5 ml set 1,038 - - 500 519,000 300 311,400 200 207,600.00
4 Alat suntik sekali pakai 5 ml set 1,038 - - 500 519,000 200 207,600 300 311,400.00
5 Albendazol tablet 400 mg tablet 407 12,510 5,087,316.60 - - - - -
6 Allopurinol tablet 100 mg tablet 105 - - - - - - -
7 Aminofilin tablet 200 mg tablet 87 437 38,084.55 - - 437 38,085 - -
8 Aminofilin injeksi 24 mg/ml ampul 3,240 - - - - - - -
9 Amitripilin tablet salut 25 mg (HCL) tablet 102 100 10,200.00 - - 63 6,426 37 3,774.00
10 Amoksisillin kapsul 250 mg kapsul 289 - - 20,000 5,775,000 4,220 1,218,525 1,780 513,975.00
11 Amoksisillin kapsul 500 mg kapsul 370 800 296,000.00 6,000 2,220,000 11,270 4,169,900 4,240 1,568,800.00
12 Amoksisillin sirup kering 125 mg/ 5 mg botol 2,300 630 1,449,000.00 1,000 2,300,000 1,430 3,289,000 200 460,000.00
13 Ampisillin kapsul 500 mg kapsul - - - - - - -
14 Ampisillin sirup kering 125 mg/5 ml botol - - - - - - -
15 Antalgin tablet 500 mg tablet 124 1,200 149,064.00 20,000 2,484,400 22,500 2,794,950 9,600 1,192,512.00
16 Antalgin injeksi 250 mg/ml ampul 1,200 - - - - - - -
17 Antasida DOEN I tablet kunyah, kombinasi :Aluminium Hi tablet 78 6,400 498,816.00 - - 6,400 498,816 - -
18 Antibakteri DOEN salep kombinasi : Basitrasin 500 IU/g + p tube 2,491 80 199,280.00 100 249,100 110 274,010 70 174,370.00
19 Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + supp 200 24 4,800.00 20 4,000 53 10,600 - -
20 Antifungi DOEN Kombinasi : Asam Benzoat 6% + Asam Salis pot 1,904 56 106,646.40 - - 23 43,801 33 62,845.20
21 Antimigren : Ergotamin tartrat 1 mg + Kofein 50 mg tablet - - - - - - -
22 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg tablet - - - - - - -
23 Aqua Pro Injeksi Steril, bebas pirogen vial 5,000 20 100,000.00 - - 20 100,000 - -
24 Aquadest steril - 500 ml botol - - - - - - -
25 Asam Askorbat tablet 50 mg tablet 32 - - 15,000 480,000 2,670 85,440 4,500 144,000.00
26 Asam Askorbat tablet 250 mg tablet - - - - - - -
27 Asam Klorida 0.1 N - 100 ml botol - - - - - - -
28 Asam Sulfosalisilat 20 % - 100 ml botol - - - - - - -
29 Asetosal tablet 100 mg tablet 100 - - - - - - -
30 Asetosal tablet 500 mg tablet - - - - - - -
31 Atropin Sulfat tablet 0,5 mg tablet 68 - - - - - - -
32 Atropin tetes mata 0,5% botol - - - - - - -
33 Atropin sulfat injeksi l.m/lv/s.k. 0,25 mg/mL - 1 mL ampul 1,230 19 23,370.00 - - - 19 23,370.00
34 Benzatin Benzil Pen inj 1,2 jt IU/vial ampul - - - - - - -
35 Benzatin Benzil Pen inj 2,4 jt IU/vial ampul - - - - - - -
36 Besi sirup botol - - - - - - -
37 Betametason krim 0,1 % tube 1,520 144 218,880.00 100 152,000 134 203,680 110 167,200.00

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38 Catgut / Benang Bedah No. 2/0 - 3/0 set 640,000 - - 120 76,800,000 96 61,440,000 24 15,360,000.00
39 Dapson tablet 100 mg tablet - - - - - - - -
40 Deksametason Injeksi I.v. 5 mg/ml ampul 1,400 40 56,000.00 - - 40 56,000 - -
41 Deksametason tablet 0,5 mg tablet 53 13,500 709,830.00 15,000 788,700 23,950 1,259,291 4,550 239,239.00
42 Dekstran 70-larutan infus 6% steril botol 39,079 - - 20 781,580 - - -
43 Dekstrometorfan sirup 10 mg/5 ml (HBr) botol 1,379 - - - - - - -
44 Dekstrometorfan tablet 15 mg (HBr) tablet 90 - - - - - - -
45 Devitalisai Pasta (Non Arsen) botol 390,000 - - - - - - -
46 Diazepam Injeksi 5mg/ml ampul 2,344 120 281,280.00 - - - 120 281,280.00
47 Diazepam tablet 2 mg tablet 35 2,761 96,635.00 - - 10 350 2,751 96,285.00
48 Diazepam tablet 5 mg tablet 56 1,598 89,488.00 - - - 1,598 89,488.00
49 Dietilkarbamazin Sitrat tablet 100 mg tablet - - - - - - -
50 Difenhidramin injeksi I.M. 10 mg/ml (HCL) ampul 960 - - - - - - -
51 Digoksin tablet 0,25 mg tablet 91 800 72,800.00 - - 270 24,570 530 48,230.00
52 Efedrin tablet 25 mg (HCL) tablet 51 - - - - - - -
53 Ekstrak Belladona tablet 10 mg tablet - - - - - - -
54 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul 1,500 15 22,500.00 - - 15 22,500 - -
55 Etakridin larutan 0,1% botol 2,212 3 6,636.48 15 33,182 7 15,485 8 17,697.28
56 Etambutol HCl tablet 250 mg tablet - - - - - - -
57 Etanol 70% botol 14,959 - - - - - - -
58 Eter Anestetik botol - - - - - - -
59 Etil Klorida botol 105,000 2 210,000.00 - - 3 315,000 4 420,000.00
60 Eugenol cairan botol 45,833 - - - - - - -
61 Fenitoin Natrium Injeksi 50 mg/ml ampul - - - - - - -
62 Fenitoin Natrium kapsul 100 mg kapsul 73 - - - - - - -
63 Fenitoin Natrium Injeksi 30 mg ampul 121 - - - - - - -
64 Fenobarbital injeksi I.m/I.v 50 mg/ml ampul 1,716 - - - - - - -
65 Fenobarbital tablet 100 mg tablet 144 - - - - - - -
66 Fenobarbital tablet 30 mg tablet 61 10,990 670,390.00 - - - 10,990 670,390.00
67 Fenoksimetil Pen tablet 250 mg tablet - - - - - - -
68 Fenoksimetil Pen tablet 500 mg tablet - - - - - - -
69 Fenol Gliserol tetes telinga 10% botol 1,008 - - - - - - -
70 Fitomenadion injeksi 10 mg/ml ampul 1,566 445 696,870.00 - - - 445 696,870.00
71 Fitomenadion tablet salut 10 mg tablet 579 - - - - - - -
72 Fluor tablet 0,5 mg tablet - - - - - - -

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73 Furosemid tablet 40 mg tablet 78 1,500 117,000.00 - - 1,500 117,000 - -
74 Ferinokresol botol - - - - - - -
75 Gameksan lotion 1 % botol - - - - - - -
76 Garam Oralit 200 ml air kantong 992 10,300 9,399,187.50 - - 900 892,800 9,400 9,324,800.00
77 Garam Oralit 1000 ml air kantong - - - - - - -
78 Gentian Violet Larutan 1 % botol 895 18 16,110.00 - - 18 16,110 - -
79 Glass Ionomer Cement (GC IX) set 395,000 - - - - - - -
80 Glibenklamida tablet 5 mg tablet 54 490 26,460.00 - - 460 24,840 30 1,620.00
81 Gliseril Guayakolat tablet 100 mg tablet 28 - - 20,000 558,000 17,700 493,830 2,300 64,170.00
82 Gliserin botol - - - - - - -
83 Glukosa larutan infus 5% botol 5,313 20 106,260.00 - - - 20 106,260.00
84 Glukosa larutan infus 10% botol 5,727 - - 134 767,418 - 134 767,418.00
85 Glukosa larutan infus 40% steril botol 1,960 - - - - - - -
86 Griseofulvin tablet 125 mg tablet 228 780 177,840.00 - - 120 27,360 660 150,480.00
87 Gutta Percha Points stik - - - - - - -
88 Haloperidol tablet 0,5 mg tablet 53 - - - - - - -
89 Haloperidol tablet 1,5 mg tablet 60 - - - - - - -
90 Hidroklortiazida tablet 25 mg tablet 36 - - - - - -
91 Hidrokortison krim 2,5% tube 2,541 - - 240 609,840 370 940,170 42 106,722.00
92 Ibuprofen tablet 200 mg tablet 93 - - - - - - -
93 Ibuprofen tablet 400 mg tablet 145 - - 5,000 725,000 2,430 352,350 30,220 4,381,900.00
94 Infusion set anak set 4,000 450 1,800,000.00 - - - - -
95 Infusion set dewasa set 3,500 - - 150 525,000 150 525,000 - -
96 Insulin Reguler injeksi 40 IU/ml vial - - - - - - -
97 Idiol Kapsul Lunak kapsul - - - - - - -
98 Ipeka 0,14 % syr botol - - - - - - -
99 Isoniazid tablet 300 mg tablet - - - - - - -
100 Isosorbid Dinitrat tab subl 5 mg tablet 92 - - - - - - -
101 Jarum jahit (Bedah No. 9 s/d 14) kotak - - - - - - -
102 Kalium Permanganat serbuk - 5 mg set - - - - - - -
103 Kalsium Hidroksida Pasta kotak 242,000 - - - - - - -
104 Kalsium Laktat tablet 500 mg tablet 52 - - 20,000 1,040,000 8,300 431,600 11,700 608,400.00
105 Kapas Berlemak 500 gram roll - - - - - - -
106 Kapas Pembalut/Absorben 250 g roll 7,500 - - 10 75,000 3 22,500 7 52,500.00
107 Karbamazepin tablet 200 mg tablet 243 - - - - - - -

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108 Kasa Hidrofil 18 m x 22 cm roll 1,386 - - 48 66,528 48 66,528 - -
109 Kasa Hidrofil Steril 80 cm x 36 cm roll 5,500 - - - - - - -
110 Kasa Pembalut Hidrofil 4 m x 10 cm roll 550 - - - - - - -
111 Kasa Pembalut Hidrofil 4 m x 5 cm roll 2,200 - - 150 330,000 100 220,000 50 110,000.00
112 Ketamin Injeksi 10 mg/ml vial - - - - - - -
113 Klofazimin kapsul 100 mg microzine kapsul - - - - - - -
114 Kloramfenikol kapsul 250 mg kapsul 240 6,000 1,440,000.00 - - 6,000 1,440,000 - -
115 Kloramfenikol salep mata 1% tube 1,562 - - - - - - -
116 Kloramfenikol tetes telinga 3 % botol 1,599 - - - - - - -
117 Klorfeniramin maleat (CTM) tab 4 mg tablet 26 17,200 447,200.00 10,000 260,000 22,400 582,400 4,860 126,360.00
118 Kloroquin Fosfat tablet 250 mg tablet - - - - - - -
119 Klorpromazin injeksi i.m 25 mg/ml-2ml (HCL) ampul 1,021 - - - - - - -
120 Klorpromazin injeksi i.m 5 mg/ml (HCL) ampul 950 - - - - - - -
121 Klorpromazin tablet salut 25 mg (HCL) tablet 45 - - - - - - -
122 Klorpromazin tablet salut 100 mg (HCl) tablet - - - - - - -
123 Klorpropamid tablet 100 mg tablet - - - - - - -
124 Kodein HCl tablet 10 mg tablet 470 - - - - - - -
125 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg tablet - - - - - - -
126 Kotrimoksazol pedia tablet 120 mg tablet 76 880 66,880.00 - - 880 66,880 - -
127 Kotrimoksazol suspensi 240 mg botol 2,574 1,150 2,960,100.00 500 1,287,000 790 2,033,460 860 2,213,640.00
128 Kotrimoksazol tablet 480 mg tablet 148 5,000 740,000.00 - - 2,660 393,680 2,340 346,320.00
129 Kuinin Di HCl injeksi 25%-2 ml ampul - - - - - - -
130 Kuinin (kina) tablet 200 mg tablet - - - - - - -
131 Larutan Benedict botol 27,445 - - - - - - -
132 Larutan Eosin 2% botol 105,036 - - - - - - -
133 Larutan Etanol Asam botol 29,216 - - - - - - -
134 Larutan Gabbet botol - - - - - - - -
135 Larutan Giemsa Stain botol 137,033 - - - - - - -
136 Larutan Karbol Fuksin botol 50,256 - - - - - - -
137 Larutan Kinyoun botol - - - - - - - -
138 Larutan Metilen Biru botol 21,580 - - - - - - -
139 Larutan Turk botol 20,749 - - - - - - -
140 Lidokain comp injeksi 2% (HCL) + Epinefrin 1 : 80.000-2 ml ampul 1,295 270 349,650.00 90 116,550 360 466,200 - -
141 Lisol botol 41,385 5 206,926.50 - - 3 124,156 2 82,770.60
142 Magnesium Sulfat inj (IV) 20%-25 ml vial 2,078 400 831,200.00 - - - 400 831,200.00

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143 Magnesium Sulfat inj (IV) 40%-25 ml vial 2,629 400 1,051,600.00 - - - 400 1,051,600.00
144 Magnesium Sulfat serbuk 30 gram kotak - - - - - - -
145 Mebendazol sirup 100 mg / 5 ml botol - - - - - - -
146 Mebendazol tablet 100 mg tablet - - - - - - -
147 Metanol botol - - - - - - -
148 Metilergometrin Maleat tablet salut 0,125 mg tablet 140 - - 500 70,000 30 4,200 470 65,800.00
149 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 1,490 - - - - - - -
150 Metronidazol tablet 250 mg tablet 123 4,100 503,480.00 1,160 142,448 4,000 491,200 1,160 142,448.00
151 Monoklor Kamfer Menthol ( CHKM ) botol 44,000 - - - - - - -
152 Mummifying Pasta kotak 140,800 - - - - - - -
153 Natrium Bikarbonat tablet 500 mg tablet 14 - - - - - - -
154 Natrium Fluoresein tetes mata 2 % botol - - - - - - -
155 Natrium Klorida larutan infus 0,9 % botol 4,900 20 98,000.00 - - - 20 98,000.00
156 Natrium Thiosulfat injeksi I.v. 25 % ampul - - - - - - -
157 Nistatin tablet salut 500.000 IU/g tablet 640 25 16,000.00 100 64,000 55 35,200 70 44,800.00
158 Nistatin Vaginal tablet salut 100.000 IU/g tablet 407 - - - - - - -
159 OAT Katagori 1 dewasa paket - - - - - - -
160 OAT Katagori 2 dewasa paket - - - - - - -
161 OAT Katagori 3 dewasa paket - - - - - - -
162 OAT Sisipan dewasa paket - - - - - - -
163 OAT Katagori anak paket - - - - - - -
164 Obat Batuk Hitam ( O.B.H.) botol 1,259 - - - - - - -
165 Oksigen Gas dalam tabung tabung - - - - - - -
166 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml vial 3,100 - - - - - -
167 Oksitetrasiklin HCL salep mata 1 % tube 2,350 - - 200 470,000 196 460,600 54 126,900.00
168 Oksitetrasiklin HCL salep kulit 3 % tube 1,529 175 267,575.00 - - 87 133,023 88 134,552.00
169 Oksitosin injeksi 10 UI/ml-1 ml ampul 1,785 - - 10 17,850 10 17,850 - -
170 Paraformaldehid tablet 1 g tablet - - - - - - -
171 Parasetamol sirup 120 mg / 5 ml botol 1,319 106 139,803.40 1,000 1,318,900 1,106 1,458,703 - -
172 Parasetamol tablet 100 mg tablet 32 1,000 32,230.00 - - 1,000 32,230 - -
173 Parasetamol tablet 500 mg tablet 84 19,400 1,628,242.00 30,000 2,517,900 44,250 3,713,903 51,510 4,323,234.30
174 Pembalut Gips roll - - - - - - -
175 Perfenazin tablet 4 mg tablet - - - - - - -
176 Perfenazin tablet 16 mg tablet - - - - - - -
177 Petidin HCl injeksi 50 mgml - 2 ml ampul 13,191 - - - - - - -

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178 Pilokarpin tetes mata 2 % (HCL/Nitrat) botol - - - - - - -
179 Piperazin sirup 20 % botol - - - - - - -
180 Piperazin tablet 500 mg tablet - - - - - - -
181 Pirantel tab score (base) 125 mg tablet 311 - - - - - - -
182 Piridoksin tablet 10 mg (HCl) tablet 17 2,600 45,240.00 10,000 174,000 11,320 196,968 1,280 22,272.00
183 Plester 5 yards x 2 inch roll 23,625 7 165,375.00 - - 7 165,375 - -
184 Polikresulen botol - - - - - - -
185 Polipeptida kombinasi DOEN Lar infus botol - - - - - - -
186 Povidon Iodida lar 10 % - 10 ml botol - - - - - -
187 Povidon Iodida lar 10 % - 30 ml botol 2,000 26 52,000.00 - - - 26 52,000.00
188 Povidon Iodida lar 10 % - 300 ml botol 14,000 - - 10 140,000 6 84,000 4 56,000.00
189 Povidon Iodida lar 10 % - 1000 ml botol - - - - - - -
190 Prazikuantel tablet 600 mg tablet - - - - - -
191 Prednison tablet 5 mg tablet 52 2,900 150,800.00 10,000 520,000 8,240 428,480 4,660 242,320.00
192 Primakuin tablet 15 mg tablet 109 - - - - - - -
193 Prokain Benzil Pen 3 jt IU / vial inj vial 6,100 - - - - - - -
194 Propanolol tablet 40 mg (HCL) tablet 108 150 16,200.00 - - 50 5,400 100 10,800.00
195 Propiltiourasil tablet 100 mg tablet - - - - - - -
196 Rabies Immune Globulin (Human) 150 IU/ml vial - - - - - - -
197 Reserpin tablet 0,10 mg tablet - - - - - - -
198 Reserpin tablet 0,25 mg tablet - - - - - - -
199 Retinol (Vit. A) 100.000 IU kapsul kapsul 242 - - - - - - -
200 Retinol (Vit. A) 200.000 IU kapsul kapsul 432 - - - - - - -
201 Rifampisin kapsul 300 mg tablet - - - - - - -
202 Rifampisin kapsul 450 mg tablet - - - - - - -
203 Rifampisin kapsul 600 mg tablet - - - - - - -
204 Ringer Laktat larutan infus botol 5,200 180 936,000.00 260 1,352,000 370 1,924,000 70 364,000.00
205 Salbutamol tab 2 mg tablet 60 550 32,901.00 2,500 149,550 1,670 99,899 1,380 82,551.60
206 Salep 2-4, kombinasi: Asam Salisilat 2% + Belerang endap pot 825 - - - - 59 48,670 405 334,092.60
207 Salisil bedak 2% kotak 1,120 40 44,800.00 100 112,000 140 156,800 - -
208 Salisil Spritus 10% botol - - - - - - -
209 Semen Seng Fosfat serbuk dan cairan kotak - - - - - - -
210 Serum ABU I polivalen inj 5 ml vial 277,200 - - - - - - -
211 Serum ABU II Polivalen inj 50 ml vial - - - - - - - -
212 Serum Anti Rabies Injeksi vial - - - - - - - -

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213 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul 63,756 - - - - - - -
214 Serum Anti Tetanus Inj 20.000 IU/vial vial - - - - - - -
215 Sianokobalamin injeksi 500 mcg ampul 916 1,000 916,000.00 - - 200 183,200 800 732,800.00
216 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum bedah set 251,400 - - 180 45,252,000 108 27,151,200 72 18,100,800.00
217 Silver Amalgam serbuk set - - - - - - -
218 Spons Gelatin cubicles set 370,982 - - - - - - -
219 Streptomisin Sulfat serbuk injeksi 1000 mg vial - - - - - - -
220 Streptomisin Sulfat serbuk injeksi 1500 mg vial - - - - - - -
221 Sulfa Conus Kerucut (preparat) set - - - - - - -
222 Sulfadimidin tablet 500 mg tablet - - - - - - -
223 Sulfasetamida Natrium tetes mata 15 % botol 3,445 - - - - - - -
224 Suspensi Seng Insulin injeksi 40 IU/ml vial - - - - - - -
225 Syntetic Filling Material set - - - - - - -
226 Tablet Tambah Darah tablet 44 - - 52,410 2,306,040 16,410 722,040 36,000 1,584,000.00
227 Temporary Stopping Fletcher serbuk dan cairan set 34,000 - - - - - - -
228 Tetrakain HCl tetes mata 0,5% botol - - - - - - -
229 Tetrasiklin kapsul 250 mg kapsul - - 4,000 - 3,440 560 -
230 Tetrasiklin kapsul 500 mg kapsul 206 - - - - - - -
231 Tiamin injeksi 100 mg/ml ampul 680 - - - - - - -
232 Tiamin tablet 50 mg (HCL/Nitrat) tablet 38 - - 20,000 756,000 12,380 467,964 7,620 288,036.00
233 Tiopental Natrium serbuk injeksi 1000 mg/amp ampul - - - - - - -
234 Triheksifenidil tablet 2 mg tablet 40 40 1,600.00 - - 40 1,600.00
235 Trikresol Formalin (TKF) cairan set 21,818 - - - - - - -
236 Vaksin Rabies kering untuk manusia ampul - - - - - - -
237 Vaksin Rabies Vero set - - - - - - -
238 Vitamin B Kompleks tablet tablet 22 - - 15,000 333,000 15,120 335,664 2,430 53,946.00
239 Ambroxol tab 30 mg set 95.00 - - - - - - -
240 Amlodipin tab 5 mg tablet 440.00 - - - - - - -
241 Amoksisilin+As klavunalat 625mg tab tube 4,550.00 11,200 50,960,000.00 - - - 11,200 50,960,000.00
242 Ampisillin serb inj 1000 mg/ml tablet 4,000.00 - - - - - - -
243 Anti diare kapl tablet 330.00 600 198,000.00 750 247,500 725 239,250 625 206,250.00
244 Asiclovir cream tablet 2,152.00 250 538,000.00 100 215,200 170 365,840 200 430,400.00
245 Asiclovir tablet 200 mg tablet 239.00 230 54,970.00 - - 30 7,170 820 195,980.00
246 Captopril tablet 12.5 mg paket 72.00 750 54,000.00 2,000 144,000 2,580 185,760 170 12,240.00
247 Captopril tablet 25 mg tablet 88.00 1,730 152,240.00 2,000 176,000 3,730 328,240 - -

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248 Cefadroxyl tablet 500 mg tablet 520.00 - - - - - - -
249 Cefixime 400 mg + Azithromicin 1000 mg botol 33,000.00 - - - - - - -
250 Ciprofloksasin tablet 500 mg botol 250.00 - - - - - - -
251 Dimehydrinate 50 mg tablet set 95.00 - - - - - - -
252 Fitomenadion inj infant 2 mg/ml set 6,600.00 - - - - - - -
253 Fluconazole tab 150 mg set 22,000.00 - - - - - - -
254 H2O2 Larutan roll 19,609.70 - - - - - - -
255 Haloperidol tab 5 mg roll 88.23 - - - - - - -
256 Handscoon No 7-7,5 roll 4,250.00 100 425,000.00 - - 100 425,000 - -
257 IV Catheter No 20 G roll 5,280.00 - - - - - - -
258 IV Catheter No 22 G tablet 3,182.72 20 63,654.36 - - 20 63,654 - -
259 IV Catheter No 24 G botol 3,182.72 - - - - - - -
260 Klindamycin 150 mg botol 382.00 - - - - - - -
261 Kloramfenicol susp 125 mg/5ml set 3,700.00 - - 200 740,000 - 200 740,000.00
262 Kloramfenicol TM galon 4,400.00 - - - - - - -
263 Masker botol 1,125.00 80 90,000.00 100 112,500 160 180,000 20 22,500.00
264 Metronadizol 500 mg infus botol 24,000.00 179 4,296,000.00 - - - 179 4,296,000.00
265 Miconazole cream 2 % kapsul 3,000.00 - - - - - - -
266 Multivit Anak Kurang Gizi ampul 7,920.00 - - 750 5,940,000 60 475,200 90 712,800.00
267 Multivit Gizi Buruk strip 5,104.00 - - - - - - -
268 Multivit Ibu Hamil pcs 580.80 - - - - - - -
269 Nifedipin tab 10 mg strip 112.00 1,050 117,600.00 - - 630 70,560 420 47,040.00
270 Polycatheter no. 18 kapsul 6,795.80 - - - - - - -
271 Ranitidin inj 25 mg/2ml set 2,055.99 - - - - - - -
272 Suplemen Balita gizi buruk set 440.00 - - - - - - -
273 Surgical Blade No. 10 set 600.01 - - - - - - -
274 Test Kehamilan set 2,860.00 - - - - - - -
275 Thiamfenicol kapsul 500 mg tablet 431.00 - - - - - - -
276 Urine Bag tablet 3,199.90 - - - - - - -
277 Wing Needle No 25 G tablet 5,770.00 65 375,050.00 - - - 65 375,050.00
278 Wing Needle No 27 G tablet 5,497.50 65 357,337.50 - - - 65 357,337.50
279 Zink tab 20 mg vial 455.00 - - - - - - -
280 Mineral mix kaplet 600 - - - - - -
281 Natrium Tiroksin tab 100 mg botol - - - - - - -
282 Klindamycin 300 mg set - - - - - - -

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283 Ethanol 70 % ampul - - - - - - -
284 Asam Mafenamat tab 500 mg ampul 95.00 - - - - - - -
285 kloramfenikol tetes mata tablet - - - - -
286 Ranitidin tab set - - - - -
JUMLAH 87,833,757.43 156,490,936.40 125,611,372.35 121,741,308.58

Indramayu, 14 April 2015.

MENGETAHUI 1 dr. H. Rosyid M. Noer 1
Kepala Dinas Kesehatan NIP 19690911 201412 1 001
Kabupaten Indramayu 2 Sandy 2
NIP
19900813 201101 1 001
3 Nafsiah 3
dr. H. Dedi Rohendi, MARS. NIP 19780329 200501 2 004
Pembina Utama Muda 4 Hj Bawon 4
NIP 1960810 198911 1 001 NIP 19690709 198903 2 004
5 Tati H 5
NIP 19790714 200204 2 021
6 Toriah 6
NIP 19730903 200604 2 013

367617463.xlsx