Note : 1.

Form lampiran Rencana Kebutuhan Obat , BHP tidak boleh diubah, jika ad
diluar Form, tolong dibuat Kolom sendiri
2. Data wajib dibawa pada waktu pertemuan

RENCANA KEBUTUHAN OBAT, BHP DAN REAGEN JKN

TW 3 DAN 4 T.A 2017

Nama Puskesmas :
Jumlah Dana

No Nama Item Kemasan

1 Abocart No 18 G Box 50 buah
2 Abocart No 20 G Box 50 buah
3 Abocart No 22 G Box 50 buah
4 Abocart No 24 G Box 50 Buah
5 Abocart No 26 G Box 50 Buah
6 Alkohol Swabs Box 24 pcs
7 Alkohol 100 ml Btl Btl
8 Aseptic Gel 500 cc + dispenser Btl 12 btl
9 Alkohol 70% 1 Liter Dus 12 btl
10 Aqua proinjeksi steril,bebas pirogen Btl 10 ml
11 Aquadest steril Btl 10 ml
12 Blood Lancet Box 100 pcs
13 Bisturi No. 10 Box 10 pcs
14 Blade Bbraun Aesculap Box 100 pcs
15 Catgut Cromic 3/0 w Needle Serenity Pcs 24 pcs
16 Catgut Plain 3/0 Needle Serenity Pcs 24 pcs
17 Catgut Bedah No.3/0 Plain & Chromic Box 24 set
18 CHIRUGIC GLOVES , Size 6,5 Box Pcs
19 CHIRUGIC GLOVES , Size 7,5 Box Pcs
20 Chloretyl Spray Dus Botol
21 Daryantule Dus 10 lbr
22 Dermafix 5x7 Box 100 pcs
23 EXAMINATION Gloves , Size S Box 100 Psc
24 EXAMINATION Gloves , Size M Box 100 Pcs
25 EXAMINATION Gloves , Size L Box 100 Pcs
26 Folikateter 16 Dus 10 pcs
27 Folikateter 18 Dus 10 pcs
28 Female Cateter No. 18 AXIMED Pcs Pcs
29 Female Cateter No. 16 AXIMED Pcs Pcs
30 Feeding Tube 40 cm No.8 Aximed Pcs Pcs
31 Feeding Tube 40 cm No.10 Aximed Pcs Pcs
32 Feeding Tube 100 cm No.8 Aximed Pcs Pcs
33 Framycetin Dus 10 lbr
34 Feeding Tube 100 cm No.8 Aximed Pcs Pcs
35 Infus Set Semillas 3D Semillas Pcs Pcs
36 Infusion Set Anak ( Pediatric ) Set set
37 Infusion Set Dewasa ( Adult ) Set set
38 Infusion Set Type-Y Set 50 Pcs
39 Intrafix Primelin type Mikrodroper Set set
40 Jarum jahit (bedah) No 12 Box 24 set
41 Jarum jahit (bedah) No 13 Box 24 set
42 Jarum jahit (bedah) No 9 Box 24 set
43 Kapas Berlemak 500 gram Bks bks
44 Kapas Pembalut Absorben 250 gram Bks bks
45 Kasa Panjang Rol Rol
46 Kasa Pembalut Hidrofil 40 m x 80 cm Dus Rol
47 Kasa pembalut Hidrofil 2 m x 80 cm Dus Rol
48 Kasa pembalut hidropil 4 m x 15 cm Dus Rol
49 Kasa Pembalut Hidropil 4 m x 3 cm Dus Rol
50 Kasa Pembalut Hidropil 4 m x 5 cm Dus Rol
51 Kasa Pembalut Hidropil 4 m x 10 cm Dus Rol
52 Kasa Steril 10 x 10 cm ply 1x10's Dus kotak
53 Kasa Hydrophil steril uk 18x22 Dus kotak
54 Kasa Steril 16 cm x 16 cm Rol 100 pcs
55 Kertas Puyer Pak 100 pcs
56 Masker Oxygen Dewasa Serenity Pcs Pcs
57 Masker Oxygen Anak Serenity Pcs Pcs
58 Masker Oxygen Bayi Serenity Pcs Pcs
59 Mucus Extractor Serenity Pcs Pcs
60 Masker Box 50 pcs
61 Masker Nebulizer Dewasa Pcs Pcs
62 Masker Nebulizer Anak Pcs Pcs
63 Nasal Oxygen, 02 Canula Size M Bks Pcs
64 Nasal Oxygen, 02 Canula Size S Bks Pcs
65 Nasal Oxygen, 02 Canula Size L Bks Pcs
66 Nasal Oxygen, 02 Canula Size XS Bks Pcs
67 Needle 23 Box 100 set
68 Needle 25 Box 100 set
69 Non Woven Fixation 10 x10 cm Aximed Pcs Pcs
70 Non Woven Fixation 5 x10 cm Aximed Pcs Pcs
71 One Srub 4% 100 cc Btl btl
72 Oxyflow Nasal Oxygen Bayi Bks Pcs
73 Oxyflow Nasal Oxygen Anak Bks Pcs
74 Oxyflow Nasal Oxygen Dewasa Bks Pcs
75 Paper Tape 2,5 cm 9,14 m Aximed Pcs Pcs
76 Rivanol 300 cc Botol ml
77 Plester 5 yard x 2 inch Box 6 rol
78 Safety box Buah Buah
79 SEMILAS Non-Woven Medical Tape 10x12 cm Dus Roll
80 SEMILAS Non-Woven Medical Tape 15x500 cm Dus Roll
81 SEMILAS Non-Woven I.V. Dressing Dus Roll
82 SEMILAS Non-Woven Medical Tape 5x500cm Dus Roll
83 SEMILAS Non-Woven Medical Tape 20x500cm Dus Roll
84 SEMILAS Non-Woven Medical Tape 4,4x4,4 cm Dus Roll
SEMILAS Non-Woven Wound Dressing 6x8 cm ( with pad
85 ) Dus Roll
86 Silk 3/0 + jarum 1/2 GT 35 mm Box 35 set
87 Syringe 1 cc Box 100 pcs
88 Syringe 3 cc Box 100 Pcs
89 Syringe 5 cc Box 100 pcs
90 Syringe 10 cc Box 100 Pcs
91 Strip Glukosa On Call Plus Dus Set
92 Stomach Tube 85 cm No. 12 Box Set
93 Stomach Tube 85 cm No. 18 Box Set
94 Suction Cthaheter no. 10 Box Set
95 Suction Cthaheter no. 12 Box Set
96 Surgical Film Drape 15x20 cm Box Set
97 Surgical Film Drape 20x30 cm Box Set
98 Surgical Film Drape 30x40 cm Box Set
99 Surgical Film Drape 40x50 cm Box Set
100 Test Kehamilan Box Pcs
101 Test HIV Device Box Pcs
102 Tansparant Wound Dressing 6x7 cm Box Set
103 Tansparant Wound Dressing with pad 10x25 Box Set
104 Tansparant Wound Dressing with pad 9x16 Box Set
105 Underpads Bks 10 pcs
106 Vasofix B Brown Ktk 50 pcs
Wayson Medical Semillas Transparant IV Dressing
107 6cmx7cm Pcs Pcs
Wayson Medical Semillas Transparant Wound Dressing
108 w/pad 6cmx7cm Pcs Pcs
109 Waterproof Tansparant Medical Tape 5 x 500 Box Rol
110 Waterproof Tansparant Medical Tape 15 x 500 Box Rol
111 Waterproof Tansparant Medical Tape 20 x 500 Box Rol
112 Wing nedle 23 Set Set
113 Wing nedle 25 Set Set
114 With Pad 3x4 cm Box rol
115 Yodium Povidon 10% 30 ml Btl 1.000 ml
116 Yodium povidon 10% 60 ml Btl 30 ml
117 Yodium povidon 10% 300 ml Btl 60 ml
118 Yodium povidon 10% 1000 ml Btl 300ml

OBAT (TABLET, SIRUP, SALEP, INFUS, NEBULES)

1 Albendazol 200 mg/5ml suspensi Btl 5 ml

2 Albendazol Tablet 400 mg Box 100 tab
3 Alprazolam Tablet 1 mg Box 100 tab
4 Alopurinol Tablet 300 mg Box 100 tab
5 Alopurinol Tablet 100 mg Box 100 tab
6 Ambroxol tab Box 100 tab
7 Aminofilin injeksi 24 mg/ml -10 ml Box 30 Amp
8 Aminofilin tablet 200 mg Btl 100 tab
9 Amitriptilin hcl tablet salut 25 mg Box 100 tab
10 Amlodipin Tablet 10 mg Box 100 tab
11 Amoksisilin syr kering 125 mg/5 ml Btl 60 ml
12 Amoksisilin syr kering 250 mg/5 ml Forte Btl 60 ml
13 Amoxcilin 500 Mg Box 100 tab
14 Ampicilin Injeksi Box 10 Vial
15 Acarbose 100 mg Ktk 100 tab
16 Acyclovir 200 mg Tab 100 tab
17 Anstrep Syr Btl Botol
18 Anabion Syrup Btl 60 ml
19 Antalgin (metampiron) tablet 500 mg Btl 1000 tab
20 Antalgin injeksi 250 mg/ml -2 ml Box 30 Amp
21 Antasida doen sirup Btl 60 ml
22 Antasida doen tablet,kombinasi Btl 1000 tab
23 Antibakteri doen salep kombinasi Box 25 tube
24 Antifungi doen kombinasi Box 24 pot
25 Antihemoroid doen kombinasi Box 10 Supp
26 Antimigren ( Ergotamin Caffein ) Box tab
27 Asam Ascorbat Tab 50 mg Btl 1000 tab
28 Asam askorbat (vit c) tablet 250 mg Btl 1000 tab
29 Asam traneksamat inj 100mg/ml Box Amp
30 Asam Folat tablet 1 mg Btl 100 tab
31 Anaflu Tablet Box 100 tab
32 Asam Mefenamat 500 Mg Box 100 tab
33 Asetosal tablet 100 mg Box 100 tab
34 Asetosal tablet 500 mg Box 100 tab
35 Atropin sulfat injeksi 0,25 mg/mil -1 ml Box 30 Amp
36 Atropin sulfat tablet 0,5 mg Btl 1000 tab
37 Atropen Spray Btl 20 mg
38 Benzatin Benzil Penicillin inj Box 10 Vial
39 Bacitrim-polycitrim zalf Box 24 tube
40 Betametason krim 0,1 % Box 25 tube
41 Bisoprolol 5 Mg Box 30 tab
42 Betahistin Maleat Box 50 tab
43 Carbamazepine 200 mg Box 100 Tab
44 Combivent Nebules box 20 vial
45 Cloramex Capsul Box 100 tab
46 Cefadoxil 500 mg Box 100 kap
47 Cefadoxil Sy Btl 60 ml
48 Cetrizine 10 mg Ktk 100 tab
49 Cetrizine Sy Dus Botol
50 Chloramfenicol sy Box Kotak
51 Cimetidin 200 Mg Box 100 tab
52 Ciprofloxacin 500 Mg Box 100 tab
53 Codein 10 mg Box 50 tab
54 Clozapine 100 Mg box 100 tab
55 Clozapine 25 Mg Box 50 Tab
56 Doxicixline Cap Box 100 Cap
57 Decasetin Tetes Mata 0,5 % Btl btl
58 Daneuron Box 100 tab
61 Deksametason injeksi 5 mg/ml - 1 ml Box 100 Amp
62 Deksametason tablet 0,5 mg Btl 1000 tab
63 Deksoksimetason Zalf 15 gram Box 15 gram
64 Dermazin zalf Box tube
65 Diazepam injeksi mg /ml -2 ml Box 30 Amp
66 Diazepam tablet 5 mg Btl 1000 tab
67 Diazpam tablet 2 mg Btl 1000 tab
68 Difenhidramin hcl injeksi 10 mg/ml-1 ml Box 30 Amp
69 Digoksin tablet 0,25 mg Box 100 tab
70 Diltiazem HCL Tablet 30 mg Box 100 tab
71 Doksisiklin 100 mg capsul Box 100 kap
72 Domperidon Drops Btl 10 ml
73 Domperidon Suspensi 5 Mg/5Ml Box 60 ml
75 Domperidon tablet Box 100 tab
76 Dopamet Tablet Box tab
77 Efedrin hcl Inj Box Amp
78 Efedrin hcl tablet 25 mg Btl 1000 tab
79 Epineprin hcl /bitatrant (adrenalin ) inj 0,1 % - 1 ml Box 100 Amp
80 Erytromisin sirup Btl 60 ml
81 Erlamicetin tetes mata Box 5 ml
82 Farizole Syrup Btl 60 ml
83 Fenitoin sodium 50 mg inj Dus Vial
84 Fenitoin natrium kapsul 30 mg Btl 100 Cap
85 Fenobarbital injeksi 50 mg / ml-2 ml Box 30 Amp
86 Fenobarbital tablet 100 mg Btl 1000 tab
87 Fenobarbital tablet 30 mg Btl 1000 tab
88 Fenol gliserol tetes telinga 10 % Box 24 tube
89 Fitomenadion ( Vit k ) injeksi 2mg / ml Box 30 Amp
90 Fitomenadion (vit k) tablet salut 10 mg Btl 100 tab
91 Furosemid Injeksi 10 mg Ktk 25 Amp
92 Gliquidone tab 30 mg Box 100 Tab
93 Garam oralit untuk 200 ml air Box 100 bks
94 Genalten Cream Dus Set
95 Genoin Zalf Mata 0,3% Box Tube
96 Gentamicin Injeksi Box Amp
97 Gentamicin Zalf Mata 0,3% Box Tube
98 Gentian violet larutan 1% Box 24 btl
99 Glimepiride Tab 2 mg Ktk 2 mg
100 Glibenklamid tablet 5 mg Box 100 tab
101 Gliclazide (Glicab) Tablet Ktk 80 mg
102 Gliseril Guayakolat Tablet 100 mg Btl 1000 tab
103 Gliserin Btl 100 ml
104 Glukosa larutan infus 10% steril Btl 1000 ml
105 Glukosa larutan infus 5 % steril Btl 1000 ml
106 Grantusif Tab 100 tab
107 Griseofulvin tablet 125 mg micronized Btl 100 tab
108 H2O2 Larutan Btl 1.000 ml
109 Haloperidol tablet 0,5 mg Box 100 tab
110 Haloperidol tablet 1,5 mg Box 100 tab
111 Haloperidol tablet 5 mg Box 100 tab
112 Hidroklorotiazid (HCT) tablet 25 mg Btl 1000 tab
113 Hidrokortison krim 1 % Box Tube
114 Hidrokortison krim 2,5 % Box 24 Tube
115 Hidrokortison krim 5 % Box Tube
116 Histigo Tablet Box 100 tab
117 Irbesartan Tab 300 mg Ktk 300 mg
118 Ibuprofen Suspensi 100 mg/5 ml Btl 60 ml
119 Ibuprofen tablet 400 mg Box 100 tab
120 Ibuprofen tablet 200 mg Box 100 tab
121 Imuno Syrup Btl 60 ml
122 Isosorbid dinitrat tablet sublingual 5 mg Box 100 tab
123 Komolas Syr Btl botol
124 Kaen 3A Infus Dus 20 kolf
125 Kaen 3B Infus Dus 20 kolf
126 Kalium Diklofenak 25 mg Box 50 Tab
127 kalsium laktat (kalk) tablet 500 mg Btl 1000 tab
128 Katopril 12,5 mg Box 100 tab
129 Katopril 25 Mg Box 60 tab
130 Katopril 50 Mg Box 100 tab
131 Ketokonazol 200 mg Box 50 Tab
132 Ketokonazole zalf Box tube
133 Ketorolac Injeksi 30 mg/ml Amp 1 mg
134 Kidikol sirup Box 60 ml
135 Kloramfenikol TTM / Reco TTM Box botol
136 Kloramfenicol kapsul 500 mg Box 500 cap
137 Kloramfenikol kapsul 250 mg Btl 250 Cap
138 Kloramfenikol Zalf mata 1% Box 24 tube
139 Kloramfenikol Syr Dus Botol
140 Kloramfenikol tetes telinga 3% Box 24 btl
141 Klorfeniramin Maleat ( CTM ) Tablet 5 mg Box 100 tab
142 Klorokuin fosfat tablet 150 mg Btl 1000 tab
143 Klorpromazin hcl inj 25 mg/ml-1 ml Box 30 Amp
144 Klorpromazin hcl tablet salut 100 mg Btl 1000 tab
145 Klorpromazin hcl tablet salut 25 mg Btl 1000 tab
146 Kodein hcl tablet 10 mg Btl 250 tab

Kombinasi pirimetamin 25 mg + sulfadoksiin 500 mg

147 Box 100 tab
148 Kotrimoksazol Syrup Btl 60 ml
149 Kotrimoksazol Tablet Dewasa 480 mg Box 100 tab
150 Kuinin dihidroklorida inj.25% -2 ml Box 30 Amp
151 Kuinin sulfat tablet 222 mg (7 h2o) Box 60 tab
152 Levopar Btl 100 ml
153 Levofloksasin 500 mg Box 100 tab
154 Lidokain inj 2 % box 100 Amp
155 Lidokain Kompositum injeksi Box 30 Amp
156 Lisol Btl 1000 ml
157 Lodomer Inj 5 mg Box Amp
158 Loperamid Tab 2 mg Box Tab
159 Loratadine Tablet 10 mg Box Tab
160 Lytamin Syr Dus Botol
161 Meloxicam tab Tab Tab
162 Metformin Hcl 500 mg Box 100 tab
Metilergometrin maleat inj.0,200 mg - 1 ml/ Myomergin
163 Inj Box 30 Amp
164 Metilergometrin maleat tablet salut 0,125 mg Box 100 tab
165 Metilprednisolone 4 mg Bos 100 tab
166 Metilprednisolone 8 mg Ktk 100 Tab
167 Metoclopramide HCL Tablet 5 mg Ktk 100 Tab
168 Metildopa Tablet Salut 250 mg Ktk 100 tab
169 Miniaspri Tab 80 mg Ktk 80 mg
170 Metrodinazol Infus Btl 100 ml
171 Metronidazol syrup 125 mg/ml Btl 60 ml
172 Metronidazol tablet 500 mg Box 100 tab
173 MgSO4 20% Dus Kolf
174 MgSO4 40% Dus Kolf
175 Miconazole zalf Tube Kolf
176 mirabion tablet Box 100 tab
177 Mirasic drop Btl 30 ml
178 Multivitamin Dewasa Box tab
179 My Jelly 82 gram tube tube
180 Myomergin Injeksi Box amp
181 Natrium Bikarbonat Tablet 500 mg Btl 1000 tab
182 Natrium Diklofenak tab 25 mg Box 100 tab
183 Natrium Diklofenak tab 50 mg Box 50 tab
184 Natrium klorida larutan infus 0,9 % steril Btl 500 ml
185 Neurotropic Tab Box tab
186 Neocenta Gel / Jel Luka Bakar 5 gr Tube Tube
187 Neo Kaominal Sy Btl 60 ml
188 Neo-K Inj Amp Amp
189 Nifedipin Tab Ktk 10 mg
190 Nistatin 100.000 iu tablet vaginal Box 100 tab
191 Nistatin 500.000 iu tablet salut Box 100 tab
192 Obat batuk hitam (o.b.h)cairan Btl 60 ml
193 Oksitetrasiklin hcl salep mata 1 % Box 25 tube
194 Oksitetrasiklin hcl.inj.i.m.50 mg/ml- 10 ml Box 10 Vial
195 Oksitosin injeksi 10 iu/ml - 1 ml Box 30 Amp
196 Omeprazole tab Tab Kap
197 Omecough Syr Dus 50 btl
198 OAT Kategori I Paket Paket
199 OAT Kategori II Paket Paket
200 Ondansetron Inj Amp 4 mg
201 Oratifed Syr Dus 50 btl
202 Oxybiotic Injeksi Box 10 Vial
203 Oxytetra Salep Tube Tube
204 Paramidon Inj / Adimidon Inj Box 10 Vial
205 Parasetamol syrup 120 mg/5 ml Btl 60 ml
206 Parasetamol tablet 500 mg / Novagesic Btl 1000 Tab
207 Pehacain inj 2% Box Amp
208 Panvit - C Box 100 tab
209 Pirantel pamoat tablet 365 mg Box 60 tab
210 Pirantel pamoat tablet 125 mg Box Tab
211 Pirantel Syrup Box Btl
212 Piridoksin hcl tablet 10 mg Btl 1000 tab
213 Piroksicam capsul Box 100 cap
214 Pularex Tab Ktk 630 mg
215 Plutamol sirup Btl 60 ml
216 Prednison tablet 5 mg Btl 1000 tab
217 Primakuin tablet 15 mg Btl 1000 tab
218 Primpen Suspensi Btl 60 ml
219 Propiltioltiourasil tablet 100 mg Btl 100 tab
220 Propranolol hcl tablet 40 mg Box 100 tab
221 Propranolol hcl tablet 10 mg Box 100 tab
222 Pytogin Injeksi Box 10 Vial
223 Ranitidin 150 mg tab Box 100 tab
224 Recolpar Tablet 0,5 mg Box 30 tab
225 Reserpin tablet 0,25 mg Btl 1000 tab
226 Resperidone 2 mg Tablet Box 50 tab
227 Ringer laktat larutan infus steril Btl 100 ml
228 Salbutamol syrup Botol ml
229 Salbutamol tablet 2 mg Box 100 tab
230 Salbutamol tablet 4 mg Box 100 tab
231 Salep 2- 4 kombinasi Box 24 tube
232 Salisil bedak 2 % Box 100 gr
233 scopma tablet Btl 100 tab
234 Sefotaxime inj 1000 mg Box Amp
235 Serum anti bisa ular polivalen inj.5 ml (abu i) Box 10 Amp
236 Serum anti difteri inj. 20.000 iu/vial (a.d.s) Box 10 Amp
237 Serum anti tetanus inj.1.500 iu/Amp (a.t.s) Box 10 Amp
238 Serum anti tetanus inj.20.000 iu/Amp (a.t.s) Box 10 Amp
239 Sianokobalamin (vib.b 12)inj.500 mcg/ml Box 100 Amp
240 Sianokobalamin (Vit.B12 ) Tablet Btl 1000 tab
241 Simvastatin Tablet 10 mg Box Tab
242 Simvastatin Tablet 20 mg Box Tab
243 Spironolactone 25 mg Ktk 25 mg
244 Stelazin 5 Mg tab Box 100 tab
245 Stesolit Rectal 10 mg tube Box 5 tube
246 Stesolit Rectal 5 mg tube Box 5 tube
247 Tablet tambah darah kombinasi Box 3000 tab
248 Tetagam Human Tetanus Imunoglobin inj 250 Iu Box vail
249 Tetrasiklin Hidrokortison Cream 2,5 % ( Terikortin ) Tube tube
250 Tetrasiklin hcl kapsul 500 mg/Novabiotik 500 mg Box 100 Cap
251 Thiamfenicol 500 Mg Box 100 cap
252 Tiamin hcl (vib b.1)inj.100 mg/ml -1 ml Box 30 Amp
253 Tiamin hcl monohitrat (vib b 1)tablet 50 mg Btl 1000 tab
254 Trifalgin 500 Mg ( Antalgin ) Btl 1000 tab
255 Trifastan 500 mg tab Box 100 tab
256 Trifluperazin Tab 5 mg Box 59 tab
257 Triheksifenidil Hidroklorida tablet 2 mg Box 100 tab
258 Ulcusan Syrup (Ulsafate) Btl 60 ml
259 Vaksin Hepatitis B Dewasa Box vial
260 Vaksin rabies vero Box vial
261 Ventolin Nebules Box amp
262 Vicanatal Box 100 tab
263 Vitamin B kompleks tablet Btl 1000 tab
264 Vitamin B kompleks Injeksi Box vial
265 Vitamin Neutropik inj Box vial
266 Vitamin Syrup Dewasa Botol ml
267 Zinc Tablet Box 100 tab
268 Zyrcum Syr Btl ml
REAGEN DAN PERALATAN GIGI
1 Aroma Fine Normal Dus Pack
2 Bonding agent ( g-Bond ) Botol ml
3 Caviton Pink Box Pot
4 Charisma Smart Kit Box Set
5 Dentin Conditioner 25 gr Box Botol
6 Diluent Hematology Analyzer Box Set
7 EDTA Tab 3 ml Dus Tabung
8 Eugenol cairan Box 12 Btl
9 EZ Cleanser Box Botol
10 Fuji VII, Pink Dus Set
11 Fuji VII, Putih Dus Set
12 Fuji IX extra StrengthA2 Dus Set
13 HBSAb Rapid Test Box Set
14 HBSAg Rapid Test Box Set
15 Hemoglobin Strip Test Mission Box Set
16 HCG Strip Test Box Set
17 HCG Pregnancy Test Box 50 Pcs
18 HCI 0,1 N Dus Botol
19 Larutan Asam Asetat 6% Btl 100 ml
20 Larutan Bennedict Btl 100 ml
21 Larutan Drabkins Btl 500 ml
22 Larutan Erlich Btl 100 ml
23 Larutan Garam, Pewarna Gram Set 3x100 ml
24 Larutan KOH 10% Btl 100 ml
25 Larutan Natrium sitrat Btl 100 ml
26 Larutan Rees Ecker Btl 100 ml
27 Larutan Sulfosalisilat 20% Btl 100 ml
28 Larutan TURK Btl 100 ml
29 Lyse Hematology Analyzer Box Set
30 Multi Drugs 6 Panel Box 25 Pcs
31 Mucus Extractor Serenity Pcs Pcs
32 RDT ( igg/lgm ) Box 25 pcs
33 RDT ( NS1 ) Box 25 pcs
34 Reagen Urine Strip 11 G Botol Set
35 Reagen Ziehl Neelsen Set 3x100 ml
36 Reagen Glukosa kit 4x100 ml
37 Reagen Asam Urat kit 4x100 ml
38 Reagen Total Cholesterol kit 4x100 mlk
39 Reagen SGPT Box Set
40 Reagen SGOT Box Set
41 Reagen Trygliceride Box Set
42 Rinse Hematology Analyzer Set Set
43 Saliva Ejector Set Set
44 Stick Pemeriksaan Cholesterol Easy Touch Dus Set
45 Stick Pemeriksaan Glucose Easy Touch Dus Set
46 Strip Glukosa On Call Plus Dus Set
47 Stick Pemeriksaan Uric Acid Easy Touch Dus Set
48 Test Kehamilan Box Pcs
49 Test HIV Device Box Pcs
50 Urine Test Reagen Box box

OBAT, BHP, REAGEN Diluar Daftar di atas

Diisi disini

No Nama Item Kemasan

51 E-2 clenser mindray
52 Tabung Venoject EDTA K3 3MI
53 Tabung Oksigen Besar/Keci Bh
54 Mikromotor atau Mesin Bor low speed Bh
55 Mata Bor Low speed Set
56 Stick Asam Urat Easy Touch
57 Ken Diluent
58 Mikropipet
59 Glindamicine 300 mg Box
60 Cateter Folly No 8 Pcs
61 Devitec Btl
62 CHKM Btl
63 Anting Tembak Bh
64 Alat Easy Touch Hemoglobin Bh
65 Stick HB Easy Touch Bh
66 Control Normal Hematologi Bh
67

Mengetahui
Kepala Puskesmas………………………

(………………………………………..)
P tidak boleh diubah, jika ada permintaan

P DAN REAGEN JKN

017

Harga Satuan Jumlah

Rp 6,600.00
Rp 6,000.00
Rp 7,500.00
Rp 8,566.00
Rp 7,700.00
Rp 10.00

Rp 22,000.00
Rp 25,000.00
Rp 1,650.00
Rp 2,500.00

Rp 3,000.00
Rp 3,000.00

Rp 5,583.00
Rp 7,600.00
Rp 7,370.00
Rp 114,700.00

Rp 1,629.00
Rp 462.00
Rp 462.00
Rp 462.00
Rp 8,000.00
Rp 8,000.00
Rp 3,500.00
Rp 4,800.00
Rp 7,590.00
Rp 17,391.00
Rp 2,750.00
Rp 2,750.00
Rp 2,750.00
Rp 16,500.00
Rp 12,500.00
Rp 145,000.00
Rp 105,000.00
Rp 10,010.00
Rp 2,100.00
Rp 590.00
Rp 750.00
Rp 1,500.00
Rp 9,431.00
Rp 7,500.00
Rp 7,900.00
Rp 7,000.00 400 pcs

Rp 19,800.00

Rp 6,600.00
Rp 6,600.00
Rp 6,600.00
Rp 6,600.00
Rp 1,400.00
Rp 1,400.00

Rp 5,500.00
Rp 5,500.00
Rp 5,500.00

Rp 3,000.00
Rp 4,300.00
Rp 15,715.00
Rp 8,855.00
Rp 180,950.00
Rp 70,000.00
Rp 21,753.00
Rp 53,900.00
Rp 1,925.00

Rp 4,235.00
Rp 3,056.00
Rp 830.00
Rp 825.00
Rp 928.00
Rp 1,302.00

Rp 7,370.00
Rp 7,370.00
Rp 7,370.00
Rp 7,370.00
Rp 52,745.00
Rp 57,365.00
Rp 64,680.00
Rp 75,845.00
Rp 163,350.00
Rp 1,375,000.00
Rp 211,750.00
Rp 18,480.00
Rp 10,973.00
Rp 7,626.00
Rp -

Rp 84,700.00
Rp 180,950.00
Rp 250,250.00
Rp 1,400.00
Rp 1,400.00
Rp 80,850.00
Rp 2,900.00
Rp 3,700.00
Rp 15,386.00
Rp -

Rp 4,426.00
Rp 323.00
Rp 184.00

Rp 95.00
Rp 89.00
Rp 4,200.00
Rp 115.00
Rp 165.00
Rp 352.00
Rp 2,560.00
Rp 4,730.00
Rp 279.00
Rp 5,905.00
Rp 990.00
Rp 245.00

Rp 10,350.00
Rp 154.00
Rp 1,500.00
Rp 4,235.00
Rp 78.00
Rp 2,741.00
Rp 2,096.00
Rp 2,200.00
Rp 113.00
Rp 105.00
Rp 163.00
Rp 2,789.00
Rp 52.00
Rp -
Rp 113.00
Rp 153.00
Rp 153.00
Rp 1,400.00
Rp 66.00
Rp 90,000.00

Rp 2,741.00
Rp 1,558.00
Rp 695.00

Rp 269.00

Rp 521.00
Rp 5,286.00
Rp 190.00
Rp 2,950.00
Rp 4,016.00
Rp 106.00
Rp 298.00
Rp 517.00

Rp 77,501.00

Rp 396.00
Rp 1,544.00
Rp 68.00
Rp 9,983.00
Rp -
Rp 2,605.00
Rp 44.00
Rp 39.00
Rp 1,056.00
Rp 103.00
Rp 137.00
Rp 298.00
Rp 17,100.00
Rp 3,180.00
Rp 118.00
Rp 150.00
Rp 1,137.00
Rp 47.00
Rp 1,650.00
Rp 8,090.00
Rp 650.00
Rp 4,350.00
Rp 208,570.00
Rp 80.00
Rp 1,888.00
Rp 140.00
Rp 51.00
Rp 2,042.00
Rp 3,754.00
Rp 690.00
Rp 2,012.00

Rp 317.00
Rp 5,390.00
Rp 4,500.00
Rp 3,739.00
Rp 4,600.00
Rp 495.00
Rp 447.00
Rp 61.00
Rp 251.00
Rp 31.00
Rp 5,867.00
Rp 6,270.00
Rp 5,720.00
Rp 45.00
Rp 224.00
Rp -
Rp 62.00
Rp 76.00
Rp 105.00
Rp 40.00
Rp 3,514.00
Rp 2,868.00
Rp 6,765.00
Rp 725.00
Rp 2,717.00
Rp 2,560.00
Rp 157.00
Rp 121.00
Rp 18,000.00 320 btl
Rp 98.00

Rp 10,000.00
Rp 10,000.00
Rp 146.00
Rp 69.00
Rp 69.00
Rp 72.00
Rp 141.00
Rp 320.00
Rp 2,633.00
Rp 2,665.00
Rp 6,325.00 320 btl
Rp 8,200.00
Rp 231.00
Rp 231.00
Rp 1,640.00
Rp 3,800.00
Rp 1,759.00
Rp 45.00
Rp 94.00
Rp 1,123.00
Rp 146.00
Rp 50.00
Rp 517.00

Rp 520.00
Rp 2,298.00
Rp 152.00
Rp 800.00
Rp 399.00
Rp 97.00
Rp 581.00

Rp 1,137.00
Rp 41,000.00
Rp 82,500.00
Rp 97.00
Rp 170.00
Rp -
Rp 234.00
Rp 119.00

Rp 2,684.00
Rp 169.00
Rp 209.00
Rp 390.00
Rp 111.00
Rp 880.00 400 tab
Rp 148.00
Rp 12,980.00
Rp 3,800.00
Rp 169.00
Rp 3,200.00
Rp 3,650.00
Rp 3,075.00
Rp 825.00
Rp 16,280.00
Rp 836.00
Rp 29,550.00
Rp 2,684.00
Rp 16.00
Rp 146.00
Rp 193.00
Rp 5,390.00
Rp 550.00
Rp 19,500.00 80 tube
Rp 5,500.00
Rp 13,950.00 15 Ktk
Rp 110.00
Rp 1.00
Rp 448.00
Rp 1,150.00
Rp 2,112.00
Rp 3,410.00
Rp 1,900.00
Rp 221.00
Rp 10,000.00 320 btl

Rp 1,650.00
Rp 6,500.00
Rp 11,000.00
Rp 8,950.00
Rp 9,000.00
Rp 1,119.00
Rp 88.00
Rp 1,499.00
Rp 836.00
Rp 318.00
Rp 318.00
Rp 9,100.00
Rp 136.00
Rp 115.00
Rp 220.00
Rp 11,000.00
Rp 125.00
Rp 125.00
Rp 11,000.00
Rp 351.00
Rp 114.00
Rp 114.00
Rp 52,910.00
Rp 128.00
Rp 4,345.00
Rp 97.00

Rp 7,150.00
Rp 5,463.00
Rp 91.00
Rp 91.00
Rp 1,980.00
Rp 1,350.00
Rp 420.00
Rp 5,884.00
Rp 543,950.00
Rp -
Rp 170,000.00
Rp 5,500.00
Rp 1,050.00
Rp 14.00
Rp 177.00
Rp 252.00
Rp 350.00
Rp 880.00
Rp 18,458.00
Rp 12,749.00
Rp 21,615.00
Rp 170,000.00
Rp 2,712.00
Rp 226.00
Rp 440.00
Rp 770.00
Rp 91.00
Rp 125.00
Rp 298.00
Rp 682.00
Rp 44.00
Rp 14,450.00
Rp 100.00
Rp -
Rp 4,000.00
Rp 472.00
Rp 112.00
Rp 8,250.00
Rp 7,150.00
Rp 17,800.00
Rp 592.00
Rp 16,478.00 200 btl

Rp 214,500.00
Rp 1,749,990.00
Rp 324,500.00
Rp 4,950,000.00
Rp 565,400.00
Rp 1,595,000.00
Rp 244,750.00
Rp 20,815.00
Rp 737,000.00
Rp 1,257,850.00
Rp 1,257,850.00
Rp 1,431,980.00
Rp 1,303,500.00
Rp 756,250.00
Rp 400,000.00
Rp 1,634.00
Rp 194.00
Rp 37,400.00
Rp 30,800.00
Rp 37,400.00
Rp 75,460.00
Rp 193,600.00
Rp 467,500.00
Rp 40,480.00
Rp 36,850.00
Rp 89,650.00
Rp 535,700.00
Rp 44,000.00
Rp 2,447,500.00
Rp 3,025,000.00

Rp 2,499,200.00
Rp 3,749,900.00
Rp 110,000.00
Rp 286,000.00
Rp 1,116,940.00
Rp 2,883,980.00
Rp 1,862,410.00
Rp 1,596,210.00
Rp 1,596,100.00
Rp 3,144,900.00
Rp 1,815,000.00
Rp 144,980.00
Rp 249,150.00 10 box
Rp 149,050.00 10 box

Rp 149,050.00
Rp 163,350.00
Rp 1,375,000.00

Harga Satuan Jumlah

2 btol
4 Pcs

1 bh
5 bok
2 bok
1

5 pcs
 1 bh
1 bh
1 bh
1 bh
100 5 ktk
1,100,000 1 Bh

Ngabang, Juli 2017

Pengelola Obat JKN

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1
RENCANANA KEBUTUHAN OBAT PUSKESMAS KARANGAN

NO NAMA OBAT HARGA SATUAN BANYAKNYA TOTAL

1 Chlorkol sy Rp 9,350 200 Rp 1,870,000
2 Biovitan SY Rp 10,120 200 Rp 2,024,000
3 Imco sy Rp 27,500 150 Rp 4,125,000
4 Tetes Mata Erlamicine Rp 30,250 100 Rp 3,025,000
5 Clidamicine 300 mg Rp 784,619 10 Rp 7,846,190
6 Salep Gentamicine Rp 16,159 200 Rp 3,231,800
7 Pirocxikam Rp 242 1000 Rp 242,000
8 Metildova Rp 257,125 10 Rp 2,571,250
9 Ceftriazone Rp 31,000 50 Rp 1,550,000
10 Cefotaxim Rp 11,500 50 Rp 575,000
11 Neurotropik inj Rp 8,400 50 Rp 420,000
12 E-Z Clenser Mindray k3 3 ml Rp 998,000 2 Rp 1,996,000
13 Tabung Venoject EDTA K3 3 ml Rp 178,035 4 Rp 712,140
14 Stick Glukosa Easy Touch Rp 97,240 10 Rp 972,400
15 Stick Cholesterol Easy Touch Rp 197,340 5 Rp 986,700
16 Stick Asam Urat Easy Touch Rp 100,100 5 Rp 500,500
17 Ken Diluent Rp 1,595,000 2 Rp 3,190,000
18 Mikropipet 500 mg Rp 2,473,900 1 Rp 2,473,900
19 Ken Rinse Rp 181,500 1 Rp 181,500
20 Control Normal Hemoglobine Rp 1,100,000 1 Rp 1,100,000
21 Stick HB Easy Touch Rp 100,100 5 Rp 500,500
22 Alat Easy Touch Hemoglobine Rp 437,800 1 Rp 437,800
23 Neo-k Rp 72,000 15 Rp 1,080,000
24 Anting Untuk Tembak Tindik 1 Rp -
25 Mikromotor atau Mesin Bor low speed Rp 4,800,000 1 Rp 4,800,000
26 Mata Bor Low speed Rp 349,250 1 Rp 349,250
27 Cateter Folly No 8 Rp 1,111 5 Rp 5,555
28 Devitec Rp 760 1 Rp 760
29 CHKM Rp 89,540 1 Rp 89,540
30 Pengisian Tabung O2 Besar Rp 175,000 7 Rp 1,225,000
31 Pengisian Tabung O2 Kecil Rp 75,000 8 Rp 600,000
32 Kertas Puyer Rp 15,000 5 Rp 75,000
33 Termometer Rp 19,500 2 Rp 39,000
Rp 48,795,785

Mengetahui Ngabang, Juli 2017

Kepala Puskesmas……………………… Pengelola Obat JKN

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