REKAPTULASI USULAN PUSKESMAN 2019

No. NAMA OBAT Satuan

A OBAT FASKES I
1 Allupurinol 100 mg tablet tablet
2 Aminofilin 200 mg tablet tablet
3 Amitriptilin 25 mg tablet salut tablet
4 Amlodipin* 10 mg tablet tablet
5 Amlodipin* 5 mg tablet tablet
6 Amoksisilin sirup kering 125 mg/ml botol
7 Amoksisilin 500 mg Kaplet kaplet
8 Amoksisilin serbuk injeksi 1000 mg/vial vial
9 Amoksisilin sirup kering 250 mg/ml botol
10 Ampisillin serb inj 1000 mg/vial vial
11 Antasida DOEN Tablet Kunyah tablet
12 Anti influensa Syrup Kombinasi: Parasetamol 125 mg, Phenylpropanolamin HCl 3,125 mg botol
dan Klorphenaramin maleat 0, 5 mg
13 Anti influensa Tablet Kombinasi: Parasetamol 500 mg, Phenylpropanolamin HCl 12,5 mg tablet
dan Klorphenaramin maleat 2 mg
14 Anti Migrain tablet tablet
15 Anti Parkinson kapsul kombinasi : Brnzerazid 25 mg dan Levodopa 100 mg kapsul Kapsul
16
Antidiare sirup Kombinasi : Kaolin 700 mg dan Pektin 66 mg botol

17
Antidiare tablet fitofarmaka kombinasi : Psidii folium ekstrak 150 mg, Curcuma domestica
kapsul
ekstrak, Coptidis rhizoma ekstrak 30 mg dan Granati pericarpium ekstrak 50 mg

18 Antidire tablet kombinasi : Attapulgit 300 mg, Psidii folium ekstrak 50 mg dan Curcuma
tablet
domestika ekstrak 7,5 mg
19
Antifungi, kombinasi : Asam Benzoat 6 % dan Asam Salisilat 3 % (salep) tube
20 Antihemorid, Fito farmaka kombinasi : Ekstrak Graptophylli 14 mg dan ekstrak Citrus kapsul
sinensis fruktus 50 mg kapsul ( Haemorogard)
21 Antihemoroid, kombinasi: Bismut sub galat 150 mg, Heksaklorofen 2,5 mg, Lidokain supp
10mg, Zeng oksida 120 mg sup ad 2 gram

22 Antihipertensi kaps fitofarmaka /Tensigard kapsul

23 AQUA botol/25 ml
24 Asam Asetilsalisilat (asetosal) 80 mg tablet tablet
25 Asam Askorbat (vitamin C) 50 mg tablet tablet
26 Asam Folat 0,4 mg tablet
27 Asam Folat 1 mg tablet
28 Asam Mefenamat 500 mg kaplet
29 Asam Salisilat 5 % salep tube
30 Asiklovir 200 mg tablet tablet
31 Asikovir Krim tube
32 Atapulgit tablet tablet
33 Atropin 0,5 mg tablet tablet
34 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) ampul
35 Bedak salisil 2 % Serbuk pot
36 Betahistin 6 mg tablet tablet
37 Betametason 0,5 mg/g krim tube
38 Bisakodil 10 mg supp supp
39 Bisakodil 5 mg tablet salut tablet
40 Ciprofloksasin 500 mg tablet tablet
41 Deksametason 0,5 mg tablet tablet
No. NAMA OBAT Satuan

A OBAT FASKES I
42 Deksamethason inj 5 mg/mL (i.v./i.m.) ampul
43 Dextrose 10% botol
44 Dextrose 5 % botol
45 Diazepam 2 mg tablet tablet
46 Diazepam inj 5 mg/mL (i.v./i.m.) ampul
47 Digoksin 0,25 mg tablet tablet
48 Dimenhidrinat 50 mg tablet tablet
49 Dipphenhidramin inj 10 mg/mL (i.v./i.m.) ampul
50 Domperidon 10 mg tablet tablet
51 Ekstrak Curcuma xanthoriza 20 mg tablet salut tablet
52 Epineprin inj 0,1% (i.v./s.k./i.m.) ampul
53 Eritromisin Kapsul 250 mg kapsul
54 Etanol 70% botol
55 Fenitoin Na 100 mg Kapsul kapsul
56 Fenobarbital 30 mg tablet
57 Furosemid 40 mg tablet tablet
58 Garam oralit, untuk 200 ml air Sackset
59 Gilbenklamide 5 mg tablet tablet
60 Gliseril Guaijacolat 100 mg tablet tablet
61 Griseovulfin 125 mg tablet scored tablet
62 Haloperidol 1,5 mg tablet tablet
63 Haloperidol 5 mg tablet tablet
64 Hidroklorotiazid* 25 mg tablet tablet
65 Hidrokortison 1 % krim tube
66 Hiosina butilbromida 10 mg injeksi vial
67 Hiosina butilbromida 10 mg tablet tablet
68 Ibuprofen 200 mg tablet tablet
69 Ikhtiol salp tablet
70 Isosorbid dinitrat 5 mg tablet tablet
71 Kalsium glukonat 100 mg/ml injeksi vial
72 Kalsium laktat (kalk) tablet 500 mg tablet
73 Kaptopril* 12,5 mg tablet tablet
74 Kaptopril* 25 mg tablet tablet
75 Ketokonazole tab 200 mg tablet
76 Klonidin* 0,15 mg tablet tablet
77 Kloramfenikol 0,5 % tetes mata botol
78 Kloramfenikol 1 % salep mata tube
79 Kloramfenikol salep kulit 2 % tube
80 Klorampenikol kaps 250 mg kapsul
81 Klorfeniramin maleat tab 4 mg tablet
82 Kodein 10 mg tablet tablet
83 Kotrimoksazol suspensi kombinasi tiap 5 ml mengandung: sulfametoksazol 200 mg dan
trimetropim 40 mg botol
84
Kotrimoksazol tablet dewasa kombinasi: sulfametoksazol 400 mg dan trimetropim 80 mg tablet
85 LIDOKAIN INJ
86 Mebendazol 100 mg tablet tablet
87 Mebendazol 500 mg tablet tablet
88 Meloksikam 15 mg tablet tablet
89 Meloksikam 7,5 mg tablet tablet
90 Metformin 500 mg table tablet
91 Metilergometrin 0,125 mg tablet salut tablet
92 Metilergometrin 0,2 mg/ml injeksi ampul
93 Metoklopramid 10 mg tablet tablet
No. NAMA OBAT Satuan

A OBAT FASKES I
94 Metronodazole 250 mg tablet
95 Metronodazole 500 mg tablet
96 MgSO4 Inj. 20 % vial
97 MgSO4 Inj. 40 % vial
98 Mikonazol 2 % krim tube
99 NaCl 0,9% larutan infus botol
100 Natrium Bikarbonat 500 mg tablet tablet
101 Natrium diklofenak 50 mg tablet
102 Natrium tiosulfat inj 25 % I.V. ampul
103 Nifedipin* 10 mg tablet tablet
104 Nistatin drop 100.000 IU botol
105 Nistatin tab salut 500.000 UI tablet
106 Nistatin tablet vaginal 100.000 UI/tab tab vag
107 Obat batuk sirup kombinasi : Dekstrometorfan HBr 10 mg, Difenhidramin HCl 12,5 mg,
Phenilpropanolamina HCl 125 mg dan Natrii Citras 50 mg tablet
108 Obat batuk sirup kombinasi : Dekstrometorfan HBr 10 mg, Difenhidramin HCl 5 mg, botol
Amonium Clorida 62,5 mg dan Natrii Citras 25 mg
109 OBH Syrup botol
110 Oksitoksin 10 UI/ml injeksi tablet
111 Omeprazol 20 mg kapsul vial
112 Parasetamol sirup 120 mg/5 ml kapsul
113 Parasetamol drop 60 mg/0,6 ml botol
114 Parasetamol tab 500 mg botol
115 Perak Sulfadiasin 1 % krim (untuk luka bakar) tablet
116 Permetrim 5 % Krim tube
117 Phenoksimetil penisilin tab 500 mg tube
118 Pirantel Pamoat tab Scored 125 mg tablet
119 Pirantel Pamoat tab Scored 250 mg tablet
120 Piroksikam 10 mg kapsul tablet
121 Piroksikam 20 mg kapsul kapsul
122 Povidon Iodin larutan 60 ml kapsul
123 Prednison 5 mg tablet botol
124 Propanolol 10 mg tablet tablet
125 Ranitidin 150 mg tablet tablet
126 Ringer Laktat larutan infus tablet
127 Salbutamol 2 mg tablet botol
128 Salbutamol 4 mg tablet tablet
129 Salbutamol cairan inhaler 0,1 % tablet
130 Salbutamol larutan inhaler 0,5 % botol
131 Salep 2-4, kombinasi : Asam Salisilat 2 % dan Belerang endap 4 % salep botol
132 SEFTRIAKSON INJ. tube
133 Serum ABU (anti bisa ular) vial
134 Serum Antitetanus A.T.S 1500 UI/amp (i.m.) ampul
135 Simvastatin 10 mg tablet salut ampul
136 Simvastatin 20 mg tablet salut tablet
137 Tetrasiklin 250 mg Kapsul tablet
138 Tetrasiklin 500 mg Kapsul kapsul
139 Triheksilpenidil (THP) 2 mg tablet kapsul
140 VIT K INJ 10 MG/ML tablet
141 VIT K INFANT INJ ampul
142 VIT K TAB ampul
143 Vitamin B 12 (Sianokobalamin) 50 mcg tablet ampul
144 Vitamin B kompleks tablet tablet
145 Vitamin B1 (Tiamin) 50 mg tablet tablet
No. NAMA OBAT Satuan

A OBAT FASKES I
146 Vitamin B12 (Sianokobalamin) 500 Mcg/ml inkeksi tablet
147 Vitamin B6 (Piridoksin) 10 mg tablet tablet
148 Vitamin B6 (Piridoksin) 100 mg/ml injeksi tablet
149 Zinc sir 10 mg/mL ampul
150 Zinc tablet ampul
tablet
B OBAT DAN BAHAN UNTUK GIGI
1 Anestetik lokal gigi kombinasi : Lidokain HCl 2 % + Epinefrin 1 : 80.000 injeksi 2 ml
2 Bahan tambal gigi : zink phosphat semen set (liquid + powder) ampul
3 Etil klorida semprot 100 ml botol
4 Eugenol Cairan botol
5 Fluor 1 mg kalet botol
6 Glass ionomer ART (Atraumatic Restorative Treatment) serbuk dan larutan tablet
7 Kalsium Hidroksida pasta botol
8 Klorfenol kamfer mentol (CHKM) cairan tube
9
Lidokain HCl 5 % pasta botol
10
Pasta devitalisasi (non arsen) tube
11 Pasta pengisi saluran akar/putrex tube
12 Polikresulen, kombinaso asam metakresol sulfonat dan formaldehida 3,6 mg tube
13 Sponge gelatin (antiperdarahan) botol
14 Topikal anestesi gel botol
tube
C ALAT KESEHATAN
1 ABBOCATH NO. 18
2 ABBOCATH NO. 20 SET
3 ABBOCATH NO. 22 SET
4 ABBOCATH NO. 24 SET
5 ABBOCATH NO. 26 SET
6 ADS 0,05 ML SET
7 ADS 0,5 ML SET
8 ALAT SUNTIK DISPOSIBLE 1 ML SET
9 ALAT SUNTIK DISPOSIBLE 2,5 ML SET
10 ALAT SUNTIK DISPOSIBLE 5 ML SET
11 ALAT SUNTIK DISPOSIBLE 10 ML SET
12 ALAT SUNTIK DISPOSIBLE 20 ML SET
13 CATGUT SET
14 FOLLEY CATHETER NO 14 SACHET
15 FOLLEY CATHETER NO 16 SET
16 INFUSION SET ANAK SET
17 INFUSION SET DEWASA SET
18 KAPAS PEMBALUT 250 GRAM SET
19 KASA HIDROFIL STERIL 16 X 16 BKS
20 KASA PEMBALUT 2 M X 80 CM ROL
21 KASA PEMBALUT 4 M X 10 CM ROL
22 KASA PEMBALUT 4 M X 5 CM ROL
23 MASKER ROL
24 NEEDLE 23 G SET
25 PLESTER SET
26 SILK ROL
27 TRANFUSI SET KTK
28 URINE BAG SET
29 HANDSCOEN SET
30 HANDSCOEN PARTUS SET
No. NAMA OBAT Satuan

A OBAT FASKES I

D OBAT JIWA
1 Haloperidol TAB. 5 MG tablet
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Halperidol inj 5 mg / ml ampul
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tablet tablet
 ADIWERNA BALAPULANG BANGUNGALIH BOJONG BUMIJAWA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK

botol/25 ml
 ADIWERNA BALAPULANG BANGUNGALIH BOJONG BUMIJAWA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 ADIWERNA BALAPULANG BANGUNGALIH BOJONG BUMIJAWA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 ADIWERNA BALAPULANG BANGUNGALIH BOJONG BUMIJAWA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 ADIWERNA BALAPULANG BANGUNGALIH BOJONG BUMIJAWA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 DANASARI DUKUHTURI DUKUWARU JATIBOGOR JATINEGARA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 DANASARI DUKUHTURI DUKUWARU JATIBOGOR JATINEGARA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 DANASARI DUKUHTURI DUKUWARU JATIBOGOR JATINEGARA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 DANASARI DUKUHTURI DUKUWARU JATIBOGOR JATINEGARA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 DANASARI DUKUHTURI DUKUWARU JATIBOGOR JATINEGARA

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK

-
 USULAN KEBUTUHAN OBAT PUSKERSMAS TAHUN 2017
KABUPATEN TEGAL

KALADAWA KALIBAKUNG KAMBANGAN KEDUNGBANTENG KESAMBI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KALADAWA KALIBAKUNG KAMBANGAN KEDUNGBANTENG KESAMBI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KALADAWA KALIBAKUNG KAMBANGAN KEDUNGBANTENG KESAMBI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KALADAWA KALIBAKUNG KAMBANGAN KEDUNGBANTENG KESAMBI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KALADAWA KALIBAKUNG KAMBANGAN KEDUNGBANTENG KESAMBI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK

-
-
017

KESAMIRAN KRAMAT KUPU LEBAKSIU MARGASARI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KESAMIRAN KRAMAT KUPU LEBAKSIU MARGASARI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KESAMIRAN KRAMAT KUPU LEBAKSIU MARGASARI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KESAMIRAN KRAMAT KUPU LEBAKSIU MARGASARI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 KESAMIRAN KRAMAT KUPU LEBAKSIU MARGASARI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
PAGERBARANG PAGIYANTEN PANGKAH PENUSUPAN SLAWI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
PAGERBARANG PAGIYANTEN PANGKAH PENUSUPAN SLAWI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
PAGERBARANG PAGIYANTEN PANGKAH PENUSUPAN SLAWI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
PAGERBARANG PAGIYANTEN PANGKAH PENUSUPAN SLAWI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
PAGERBARANG PAGIYANTEN PANGKAH PENUSUPAN SLAWI

Usulan DESK Usulan DESK Usulan DESK Usulan DESK Usulan DESK
 SURODADI TALANG TARUB WARUREJO Jumlah
USULAN
Usulan DESK Usulan DESK Usulan DESK Usulan DESK

14,400 14,400
9,000 9,000
- -
18,000 18,000
9,000 9,000
3,240 3,240
180,000 180,000
180 180
450 450
180 180
108,000 108,000
1,440
1,440
9,000
9,000
100 100
100 100
1,080
1,080

10,800 10,800

14,400 14,400
864
864
1,080
1,080
50
50
27,000 27,000
450 450
1,200 1,200
144,000 144,000
- -
- -
54,000 54,000
432 432
3,600 3,600
900 900
9,000 9,000
100 100
10 10
1,620 1,620
1,620 1,620
1,620 1,620
10 10
3,600 3,600
3,600 3,600
144,000 144,000
 SURODADI TALANG TARUB WARUREJO Jumlah
USULAN
Usulan DESK Usulan DESK Usulan DESK Usulan DESK

50 50
20 20
360 360
100 100
10 10
100 100
3,600 3,600
20 20
1,800 1,800
10,800 10,800
50 50
1,000 1,000
3 3
- -
100 100
3,600 3,600
36,000 36,000
27,000 27,000
162,000 162,000
1,000 1,000
- -
- -
1,000 1,000
900 900
10 10
1,800 1,800
14,400 14,400
180 180
200 200
- -
126,000 126,000
- -
27,000 27,000
1,000 1,000
9,000 9,000
1,440 1,440
1,728 1,728
1,800 1,800
9,000 9,000
180,000 180,000
100 100

2,700 2,700

9,000 9,000
540 540
200 200
200 200
1,620 1,620
- -
27,000 27,000
1,200 1,200
20 20
3,600 3,600
 SURODADI TALANG TARUB WARUREJO Jumlah
USULAN
Usulan DESK Usulan DESK Usulan DESK Usulan DESK

5,400 5,400
5,400 5,400
- -
- -
864 864
40 40
- -
18,000 18,000
- -
9,000 9,000
100 100
100 100
- -

2,700 2,700

- -
2,160 2,160
- -
1,620 1,620
3,600 3,600
560 560
324,000 324,000
180 180
180 180
- -
200 200
200 200
10,800 10,800
12,600 12,600
12 12
18,000 18,000
500 500
9,000 9,000
360 360
7,200 7,200
5,400 5,400
10 10
15 15
- -
-
-
- -
12 12
1,080 1,080
1,080 1,080
- -
1,000 1,000
- -
- -
- -
1,800 1,800
144,000 144,000
108,000 108,000
180,000 180,000
 SURODADI TALANG TARUB WARUREJO Jumlah
USULAN
Usulan DESK Usulan DESK Usulan DESK Usulan DESK

- -
9,000 9,000
- -
900 900
36,000 36,000
-
-
120 120
4 4
30 30
6 6
2 2
4 4
- -
2 2
-
-
4
4
2
2
-
-
4 4
4 4
-
-
550 550
600 600
600 600
50 50
50 50
- -
- -
1,200 1,200
2,400 2,400
1,400 1,400
150 150
100 100
150 150
150 150
150 150
200 200
920 920
90 90
720 720
980 980
560 560
560 560
250 250
1 1
20 20
4 4
100 100
300 300
2,600 2,600
2,600 2,600
 SURODADI TALANG TARUB WARUREJO Jumlah
USULAN
Usulan DESK Usulan DESK Usulan DESK Usulan DESK

-
-
-
3,000 3,000
3,000 3,000
3,000 3,000
300 300
- -
-
- -
3,000 3,000
3,000 3,000
 JUMLAH Keterangan
HASIL DESK

-
-
-
-
-
-
-
-
-
-
-

-
-
-

-
-

-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
 JUMLAH Keterangan
HASIL DESK

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-

-
-
-
-
-
-
-
-
-
-
 JUMLAH Keterangan
HASIL DESK

-
-
-

-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 JUMLAH Keterangan
HASIL DESK

-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 JUMLAH Keterangan
HASIL DESK

-
-
-
-
-
-
-
-
-
-
-
-
 USULAN KEBUTUHAN OBAT PUSKERSMAS TAHUN 2019
KABUPATEN TEGAL

No. NAMA OBAT Satuan

A OBAT FASKES I
1 Allupurinol 100 mg tablet tablet
2 Aminofilin 200 mg tablet tablet
3 Amitriptilin 25 mg tablet salut tablet
4 Amlodipin* 10 mg tablet tablet
5 Amlodipin* 5 mg tablet tablet
6 Amoksisilin sirup kering 125 mg/ml botol
7 Amoksisilin 500 mg Kaplet kaplet
8 Amoksisilin serbuk injeksi 1000 mg/vial vial
9 Amoksisilin sirup kering 250 mg/ml botol
10 Ampisillin serb inj 1000 mg/vial vial
11 Antasida DOEN Tablet Kunyah tablet
12 Anti influensa Syrup Kombinasi: Parasetamol 125 mg, Phenylpropanolamin HCl 3,125 mg botol
dan Klorphenaramin maleat 0, 5 mg
13 Anti influensa Tablet Kombinasi: Parasetamol 500 mg, Phenylpropanolamin HCl 12,5 mg tablet
dan Klorphenaramin maleat 2 mg
14 Anti Migrain tablet tablet
15 Anti Parkinson kapsul kombinasi : Brnzerazid 25 mg dan Levodopa 100 mg kapsul Kapsul
16 Antidiare sirup Kombinasi : Kaolin 700 mg dan Pektin 66 mg botol
17
Antidiare tablet fitofarmaka kombinasi : Psidii folium ekstrak 150 mg, Curcuma domestica
kapsul
ekstrak, Coptidis rhizoma ekstrak 30 mg dan Granati pericarpium ekstrak 50 mg

18 Antidire tablet kombinasi : Attapulgit 300 mg, Psidii folium ekstrak 50 mg dan Curcuma
tablet
domestika ekstrak 7,5 mg
19
Antifungi, kombinasi : Asam Benzoat 6 % dan Asam Salisilat 3 % (salep) tube
20 Antihemorid, Fito farmaka kombinasi : Ekstrak Graptophylli 14 mg dan ekstrak Citrus kapsul
sinensis fruktus 50 mg kapsul ( Haemorogard)
21 Antihemoroid, kombinasi: Bismut sub galat 150 mg, Heksaklorofen 2,5 mg, Lidokain supp
10mg, Zeng oksida 120 mg sup ad 2 gram
22 Antihipertensi kaps fitofarmaka /Tensigard kapsul
23 AQUA botol/25 ml
24 Asam Asetilsalisilat (asetosal) 80 mg tablet tablet
25 Asam Askorbat (vitamin C) 50 mg tablet tablet
26 Asam Folat 0,4 mg tablet
27 Asam Folat 1 mg tablet
28 Asam Mefenamat 500 mg kaplet
29 Asam Salisilat 5 % salep tube
30 Asiklovir 200 mg tablet tablet
31 Asikovir Krim tube
32 Atapulgit tablet tablet
33 Atropin 0,5 mg tablet tablet
34 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) ampul
35 Bedak salisil 2 % Serbuk pot
36 Betahistin 6 mg tablet tablet
37 Betametason 0,5 mg/g krim tube
38 Bisakodil 10 mg supp supp
39 Bisakodil 5 mg tablet salut tablet
40 Ciprofloksasin 500 mg tablet tablet
41 Deksametason 0,5 mg tablet tablet
42 Deksamethason inj 5 mg/mL (i.v./i.m.) ampul
No. NAMA OBAT Satuan

A OBAT FASKES I
43 Dextrose 10% botol
44 Dextrose 5 % botol
45 Diazepam 2 mg tablet tablet
46 Diazepam inj 5 mg/mL (i.v./i.m.) ampul
47 Digoksin 0,25 mg tablet tablet
48 Dimenhidrinat 50 mg tablet tablet
49 Dipphenhidramin inj 10 mg/mL (i.v./i.m.) ampul
50 Domperidon 10 mg tablet tablet
51 Ekstrak Curcuma xanthoriza 20 mg tablet salut tablet
52 Epineprin inj 0,1% (i.v./s.k./i.m.) ampul
53 Eritromisin Kapsul 250 mg kapsul
54 Etanol 70% botol
55 Fenitoin Na 100 mg Kapsul kapsul
56 Fenobarbital 30 mg tablet
57 Furosemid 40 mg tablet tablet
58 Garam oralit, untuk 200 ml air Sackset
59 Gilbenklamide 5 mg tablet tablet
60 Gliseril Guaijacolat 100 mg tablet tablet
61 Griseovulfin 125 mg tablet scored tablet
62 Haloperidol 1,5 mg tablet tablet
63 Haloperidol 5 mg tablet tablet
64 Hidroklorotiazid* 25 mg tablet tablet
65 Hidrokortison 1 % krim tube
66 Hiosina butilbromida 10 mg injeksi vial
67 Hiosina butilbromida 10 mg tablet tablet
68 Ibuprofen 200 mg tablet tablet
69 Ikhtiol salp tablet
70 Isosorbid dinitrat 5 mg tablet tablet
71 Kalsium glukonat 100 mg/ml injeksi vial
72 Kalsium laktat (kalk) tablet 500 mg tablet
73 Kaptopril* 12,5 mg tablet tablet
74 Kaptopril* 25 mg tablet tablet
75 Ketokonazole tab 200 mg tablet
76 Klonidin* 0,15 mg tablet tablet
77 Kloramfenikol 0,5 % tetes mata botol
78 Kloramfenikol 1 % salep mata tube
79 Kloramfenikol salep kulit 2 % tube
80 Klorampenikol kaps 250 mg kapsul
81 Klorfeniramin maleat tab 4 mg tablet
82 Kodein 10 mg tablet tablet
83 Kotrimoksazol suspensi kombinasi tiap 5 ml mengandung: sulfametoksazol 200 mg dan
trimetropim 40 mg botol
84
Kotrimoksazol tablet dewasa kombinasi: sulfametoksazol 400 mg dan trimetropim 80 mg tablet
85 LIDOKAIN INJ
86 Mebendazol 100 mg tablet tablet
87 Mebendazol 500 mg tablet tablet
88 Meloksikam 15 mg tablet tablet
89 Meloksikam 7,5 mg tablet tablet
90 Metformin 500 mg table tablet
91 Metilergometrin 0,125 mg tablet salut tablet
92 Metilergometrin 0,2 mg/ml injeksi ampul
93 Metoklopramid 10 mg tablet tablet
94 Metronodazole 250 mg tablet
95 Metronodazole 500 mg tablet
No. NAMA OBAT Satuan

A OBAT FASKES I
96 MgSO4 Inj. 20 % vial
97 MgSO4 Inj. 40 % vial
98 Mikonazol 2 % krim tube
99 NaCl 0,9% larutan infus botol
100 Natrium Bikarbonat 500 mg tablet tablet
101 Natrium diklofenak 50 mg tablet
102 Natrium tiosulfat inj 25 % I.V. ampul
103 Nifedipin* 10 mg tablet tablet
104 Nistatin drop 100.000 IU botol
105 Nistatin tab salut 500.000 UI tablet
106 Nistatin tablet vaginal 100.000 UI/tab tab vag
107 Obat batuk sirup kombinasi : Dekstrometorfan HBr 10 mg, Difenhidramin HCl 12,5 mg,
Phenilpropanolamina HCl 125 mg dan Natrii Citras 50 mg tablet
108 Obat batuk sirup kombinasi : Dekstrometorfan HBr 10 mg, Difenhidramin HCl 5 mg, botol
Amonium Clorida 62,5 mg dan Natrii Citras 25 mg
109 OBH Syrup botol
110 Oksitoksin 10 UI/ml injeksi tablet
111 Omeprazol 20 mg kapsul vial
112 Parasetamol sirup 120 mg/5 ml kapsul
113 Parasetamol drop 60 mg/0,6 ml botol
114 Parasetamol tab 500 mg botol
115 Perak Sulfadiasin 1 % krim (untuk luka bakar) tablet
116 Permetrim 5 % Krim tube
117 Phenoksimetil penisilin tab 500 mg tube
118 Pirantel Pamoat tab Scored 125 mg
tablet
119 Pirantel Pamoat tab Scored 250 mg tablet
120 Piroksikam 10 mg kapsul tablet
121 Piroksikam 20 mg kapsul kapsul
122 Povidon Iodin larutan 60 ml kapsul
123 Prednison 5 mg tablet botol
124 Propanolol 10 mg tablet tablet
125 Ranitidin 150 mg tablet tablet
126 Ringer Laktat larutan infus tablet
127 Salbutamol 2 mg tablet botol
128 Salbutamol 4 mg tablet tablet
129 Salbutamol cairan inhaler 0,1 % tablet
130 Salbutamol larutan inhaler 0,5 % botol
131 Salep 2-4, kombinasi : Asam Salisilat 2 % dan Belerang endap 4 % salep botol
132 SEFTRIAKSON INJ. tube
133 Serum ABU (anti bisa ular) vial
134 Serum Antitetanus A.T.S 1500 UI/amp (i.m.) ampul
135 Simvastatin 10 mg tablet salut ampul
136 Simvastatin 20 mg tablet salut tablet
137 Tetrasiklin 250 mg Kapsul tablet
138 Tetrasiklin 500 mg Kapsul kapsul
139 Triheksilpenidil (THP) 2 mg tablet kapsul
140 VIT K INJ 10 MG/ML tablet
141 VIT K INFANT INJ ampul
142 VIT K TAB ampul
143 Vitamin B 12 (Sianokobalamin) 50 mcg tablet ampul
144 Vitamin B kompleks tablet tablet
145 Vitamin B1 (Tiamin) 50 mg tablet tablet
146 Vitamin B12 (Sianokobalamin) 500 Mcg/ml inkeksi tablet
No. NAMA OBAT Satuan

A OBAT FASKES I
147 Vitamin B6 (Piridoksin) 10 mg tablet tablet
148 Vitamin B6 (Piridoksin) 100 mg/ml injeksi tablet
149 Zinc sir 10 mg/mL ampul
150 Zinc tablet ampul
tablet
B OBAT DAN BAHAN UNTUK GIGI
1 Anestetik lokal gigi kombinasi : Lidokain HCl 2 % + Epinefrin 1 : 80.000 injeksi 2 ml
2 Bahan tambal gigi : zink phosphat semen set (liquid + powder) ampul
3 Etil klorida semprot 100 ml botol
4 Eugenol Cairan botol
5 Fluor 1 mg kalet botol
6 Glass ionomer ART (Atraumatic Restorative Treatment) serbuk dan larutan tablet
7 Kalsium Hidroksida pasta botol
8 Klorfenol kamfer mentol (CHKM) cairan tube
9 Lidokain HCl 5 % pasta botol
10 Pasta devitalisasi (non arsen) tube
11 Pasta pengisi saluran akar/putrex tube
12 Polikresulen, kombinaso asam metakresol sulfonat dan formaldehida 3,6 mg tube
13 Sponge gelatin (antiperdarahan) botol
14 Topikal anestesi gel botol
tube
C ALAT KESEHATAN
1 ABBOCATH NO. 18
2 ABBOCATH NO. 20 SET
3 ABBOCATH NO. 22 SET
4 ABBOCATH NO. 24 SET
5 ABBOCATH NO. 26 SET
6 ADS 0,05 ML SET
7 ADS 0,5 ML SET
8 ALAT SUNTIK DISPOSIBLE 1 ML SET
9 ALAT SUNTIK DISPOSIBLE 2,5 ML SET
10 ALAT SUNTIK DISPOSIBLE 5 ML SET
11 ALAT SUNTIK DISPOSIBLE 10 ML SET
12 ALAT SUNTIK DISPOSIBLE 20 ML SET
13 CATGUT SET
14 FOLLEY CATHETER NO 14 SACHET
15 FOLLEY CATHETER NO 16 SET
16 INFUSION SET ANAK SET
17 INFUSION SET DEWASA SET
18 KAPAS PEMBALUT 250 GRAM SET
19 KASA HIDROFIL STERIL 16 X 16 BKS
20 KASA PEMBALUT 2 M X 80 CM ROL
21 KASA PEMBALUT 4 M X 10 CM ROL
22 KASA PEMBALUT 4 M X 5 CM ROL
23 MASKER ROL
24 NEEDLE 23 G SET
25 PLESTER SET
26 SILK ROL
27 TRANFUSI SET KTK
28 URINE BAG SET
29 HANDSCOEN SET
30 HANDSCOEN PARTUS SET
No. NAMA OBAT Satuan

A OBAT FASKES I

D OBAT JIWA
1 Haloperidol Inj. ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Halperidol inj 5 mg / ml ampul
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tablet tablet
AHUN 2019

Jumlah Hasil Desk Keterangan

USULAN

14,400 -
9,000 -
- -
18,000 -
9,000 -
3,240 -
180,000 -
180 -
450 -
180 -
108,000 -

1,440 -

9,000 -
100 -

100 -
1,080 -

10,800 -

14,400 -

864 -

1,080 -

50 -
27,000 -
450 -
1,200 -
144,000 -
- -
- -
54,000 -
432 -
3,600 -
900 -
9,000 -
100 -
10 -
1,620 -
1,620 -
1,620 -
10 -
3,600 -
3,600 -
144,000 -
50 -
Jumlah Hasil Desk Keterangan
USULAN

20 -
360 -
100 -
10 -
100 -
3,600 -
20 -
1,800 -
10,800 -
50 -
1,000 -
3 -
- -
100 -
3,600 -
36,000 -
27,000 -
162,000 -
1,000 -
- -
- -
1,000 -
900 -
10 -
1,800 -
14,400 -
180 -
200 -
- -
126,000 -
- -
27,000 -
1,000 -
9,000 -
1,440 -
1,728 -
1,800 -
9,000 -
180,000 -
100 -

2,700 -

9,000 -
540 -
200 -
200 -
1,620 -
- -
27,000 -
1,200 -
20 -
3,600 -
5,400 -
5,400 -
Jumlah Hasil Desk Keterangan
USULAN

- -
- -
864 -
40 -
- -
18,000 -
- -
9,000 -
100 -
100 -
- -

2,700 -

- -
2,160 -
- -
1,620 -
3,600 -
560 -
324,000 -
180 -
180 -
- -
200 -
200 -
10,800 -
12,600 -
12 -
18,000 -
500 -
9,000 -
360 -
7,200 -
5,400 -
10 -
15 -
- -
- -
- -
12 -
1,080 -
1,080 -
- -
1,000 -
- -
- -
- -
1,800 -
144,000 -
108,000 -
180,000 -
- -
Jumlah Hasil Desk Keterangan
USULAN

9,000 -
- -
900 -
36,000 -

120 -
4 -
30 -
6 -
2 -
4 -
- -
2 -
- -
4 -
2 -
- -
4 -
4 -

550 -
600 -
600 -
50 -
50 -
- -
- -
1,200 -
2,400 -
1,400 -
150 -
100 -
150 -
150 -
150 -
200 -
920 -
90 -
720 -
980 -
560 -
560 -
250 -
1 -
20 -
4 -
100 -
300 -
2,600 -
2,600 -
-
 Jumlah Hasil Desk Keterangan
USULAN

-
-
3,000 -
3,000 -
3,000 -
300 -
- -
- -
- -
3,000 -
3,000 -

..........................., Desember 2017

Kepala Puskesmas

.........................................
NIP.