DAFTAR PERMINTAAN BAHAN MEDIS HABIS PAKAI DAN REAGENSIA DANA BOK TAHUN 2017

HARGA/ SATUAN PERMINTAAN

NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
1 Alkohol 70% 1 liter botol 33,000 3 3 99,000
2 Povidon Iodine 30 cc botol 3,500 3 3 10,500
3 Povidon Iodine 60 cc botol 4,300 2 2 8,600
4 Povidon Iodine 300 cc botol 21,000 1 1 21,000
5 Aseptan 500 cc + dispenser (tanpa bilas) botol 40,000 1 1 40,000
6 Aseptic Gel 500 cc + dispenser (tanpa bilas) botol 25,500 1 1 25,500
Onescrub 500 cc + dispenser (Chlorhexidine
7 botol 72,000 1 1
glukonate 4%) (bilas) 72,000
Sabun anti bakteri (Triclosan 0,3%) (Bilas) 500
8 botol 33,000 0
cc 0
One step solution (cairan pembersih luka dan
9 botol 33,000 0
perawatan luka bakar) 500 cc 0
Odex (antiseptik pada perawatan dan luka bakar)
10 botol 110,000 0
500 cc 0
11 Rivanol 300 cc botol 3,600 6 6 21,600
12 Lysol 1 liter botol 47,200 6 6 283,200
13 Ultrasonic Gel 250 ml botol 16,000 0 0
14 Syringe 1 cc buah 1,100 0 0
15 Syringe 2,5 cc buah 800 300 300 240,000
16 Syringe 3 cc buah 800 370 370 296,000
17 Syringe 5 cc buah 900 100 100 90,000
18 Syringe 10 cc buah 1,100 100 100 110,000
100
19 Blood Lancet 26G 16,100 1 1
buah/box 16,100
100
20 Blood Lancet 28G 16,100 1 1
buah/box 16,100
21 Kasa Hydrofil 40 x 80 m roll 116,000 1 1 116,000
22 Kasa Pembalut Hydrofil 4 m x 3 cm roll 650 11 11 7,150
23 Kasa Pembalut Hydrofil 4 m x 5 cm roll 850 10 10 8,500
24 Kasa Pembalut Hydrofil 4 m x 10 cm roll 1,700 10 10 17,000
25 Kasa Pembalut Hydrofil 4 m x 15 cm roll 2,400 10 10 24,000
26 Kasa Steril uk 16 x 16 cm box/16 9,000 5 5 45,000
27 Kasa kompres 40 x 40 pcs 1,800 30 30 54,000
28 Kasa Steril 5 x 5 cm, 8 ply 1 x 5's pouch 3,200 20 20 64,000
29 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 5's pouch 3,500 5 5 17,500
30 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 10's pouch 7,200 5 5 36,000
31 Kasa Steril 10 x 10 cm, 8 ply 1 x 10's pouch 10,400 5 5 52,000
32 Kapas Berlemak 500 gram rolll 18,200 5 5 91,000
33 Kapas Pembalut putih250 gram roll 13,800 5 5 69,000
34 Kapas Pembalut 500 gram roll 30,050 3 3 90,150
35 Surgical Mask earloop box/50 20,400 10 10 204,000
 HARGA/ SATUAN PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
36 Surgical Mask tie on box/50 20,400 10 10 204,000
37 Alkohol swab (ethyl alkohol 70%) box/100 12,000 60 60 720,000
AC swab (ethyl alkohol 70% + Chlorhexidine
38 box/100 18,000 60 60
Glukonate 2%) 1,080,000
Catgut plain 2/0 + jarum 1/2 GT 35 mm, panjang
39 box 147,500 6 6
75 cm 885,000
Catgut plain 3/0 + jarum 1/2 GT 35 mm, panjang
40 box 147,500 6 6
75 cm 885,000
Catgut chromic 2/0 + jarum 1/2 GT 35 mm,
41 box 147,500 6 6
panjang 75 cm 885,000
Catgut chromic 3/0 + jarum 1/2 GT 35 mm,
42 box 147,500 6 6
panjang 75 cm 885,000
43 Silk 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm box 121,000 0 0
44 Silk 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm box 121,000 0 0
45 Folley Catheter 2 way no. 12 box/10 88,000 0 0
46 Folley Catheter 2 way no. 14 box/10 88,000 0 0
47 Folley Catheter 2 way no. 16 box/10 88,000 0 0
48 Folley Catheter 2 way no. 18 box/10 88,000 0 0
49 Folley Catheter 2 way no. 20 box/10 88,000 0 0
50 Folley Catheter 2 way no. 22 box/10 88,000 0 0
51 Folley Catheter 2 way no. 24 box/10 88,000 0 0
52 Folley Catheter 3 way no. 20 box/10 358,000 0 0
53 Folley Catheter 3 way no. 22 box/10 358,000 0 0
54 Folley Catheter 3 way no. 24 box/10 358,000 0 0
55 Folley Catheter Pediatric no. 6 box/10 410000 0 0
56 Folley Catheter Pediatric no. 8 box/10 350,000 0 0
57 Folley Catheter Pediatric no. 10 box/10 350,000 0 0
58 IV Catheter No. 18 G x 32 mm pcs 4,200 0 0
59 IV Catheter No. 20 G x 1 1/4" pcs 4,200 0 0
60 IV Catheter No. 22 G x 1" pcs 4,200 0 0
61 IV Catheter No. 24 G x 3/4" pcs 4,200 0 0
62 IV Catheter No. 26 G x 1/2" pcs 4550 0 0
63 Infusion set dewasa (20 drops/ml) pcs 3,550 0 0
64 Infusion set Anak (60 drops/ml) pcs 3,900 0 0
65 Infusion set Dewasa (Y Tube) pcs 7,000 0 0
66 Blood Transfusion set pcs 4,000 0 0
67 Three Way Stop Cock tanpa tube (50 buah/box) box 110,000 0 0
68 Three Way Stop Cock dengan tube (50 buah/box) box 18,000 0 0
69 Urine bag standard steril 2 Liter pcs 3,500 0 0
70 Oxyflow Bubble (Bubble Nasal Canula) buah 6,500 0 0
Maxiflow Bayi (masker oksigen bayi + tubing),
71 set 16,500 0
panjang 2 m 0
 HARGA/ SATUAN PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
Maxiflow Anak (masker oksigen bayi + tubing),
72 set 15,500 0
panjang 2 m 0
Maxiflow Dewasa (masker oksigen bayi +
73 set 15,500 0
tubing), panjang 2 m 0
74 Makes Nebulizer Set Anak set 23,000 0 0
75 Makes Nebulizer Set Dewasa set 23,000 0 0
76 Hi Oxygen Masker anak set 28,000 0 0
77 Hi Oxygen Masker Dewasa set 28,000 0 0
78 Examination Glove box/100 39,200 0 0
79 Examination Glove No Powder box/100 64,200 0 0
80 Surgical Steril Pre Powder No. 7/7,5 pasang 4,600 65 65 299,000
81 Sarung Tangan Obgyn Steril pasang 23,500 24 24 564,000
82 Wing Needle 19 G pcs 1,600 50 50 80,000
83 Wing Needle 21 G pcs 1,600 50 50 80,000
84 Wing Needle 23 G pcs 1,600 50 50 80,000
85 Wing Needle 25 G pcs 1,600 50 50 80,000
86 Wing Needle 27 G pcs 1,600 50 50 80,000
87 Suction Catether No. 6 pcs 4,800 30 30 144,000
88 Suction Catether No. 8 pcs 4,800 30 30 144,000
89 Suction Catether No. 10 pcs 4,800 30 30 144,000
90 Suction Catether No. 12 pcs 4,800 30 30 144,000
91 Suction Catether No. 14 pcs 4,800 30 30 144,000
92 Suction Catether No. 16 pcs 4,800 30 30 144,000
93 Suction Catether No. 18 pcs 4,800 30 30 144,000
Dermafix S (untuk pemasangan IV Catheter)
94 blister 2,300 500 500
ukuran 6 X 7 cm 1,150,000
95 Dermafix T (plester transparan) 5 X 7 cm buah 1,900 0 0
96 Dermafix T (plester transparan) 10 X 8 cm buah 4,700 0 0
97 Dermafix T (plester transparan) 10 X 12 cm buah 7,100 0 0
98 Dermafix T (plester transparan) 10 X 145 cm buah 9,200 0 0
99 Dermafix T (plester transparan) 10 X 20 cm buah 11,000 0 0
100 Dermafix T (plester transparan) 10 X 25 cm buah 17,000 0 0
Plesterin Bulat (digunakan setelah pengambilan 200
101 35,000 0
darah sample) pcs/box 0
102 Plesterin Roll 5 cm X 5 m roll 28,000 0 0
103 Plesterin Roll 10 cm X 5 m roll 48,000 0 0
104 Plesterin Roll 15 cm X 5 m roll 80,000 0 0
105 Plesterin Roll 20 cm X 5 m roll 92,000 0 0
106 Object Glass box/72 pcs 20,000 0 0
pak/10
107 Cover Glass 22 x 22 mm box @ 100 160,000 0
pcs 0
box isi 100
108 EDTA K3 Tubes 250,000 0
pcs 0
 HARGA/ SATUAN PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
box isi 100
109 Nurse Cap 50,000 0
pcs 0
110 Softpad (underpad) 60 X 90 pack isi 10 50,000 0 0
111 Arm Sling (tersedia ukuran S,M,L) buah 20,000 0 0
Bracket Hand Wash ABS (keranjang tempat
112 buah 20,000 0
aseptic gel) 0
113 Reagensia Autocheck 3 in 1 (Glukosa) box/25 120,000 2 2 240,000
114 Reagensia Autocheck 3 in 1 (Asam Urat) box/25 150,000 2 2 300,000
115 Reagensia Autocheck 3 in 1 (Cholesterol) box/10 250,000 1 1 250,000
116 Test Hamil box/50's buah 2,300 0 0
117 Rapit test Gluko Protein Test bos/50's buah 1,200 0 0
118 Detecto HBs Ag Hepatitis B buah 5,500 0 0
119 Rapid Test HIV 25 test/box 560,000 0 0
120 Salmonella Thyphi H Widal Test (vial 5 ml) vial 80,000 0 0
121 Salmonella Thyphi O Widal Test (vial 5 ml) vial 80,000 0 0
122 Salmonella Thyphi AO Widal Test (vial 5 ml) vial 80,000 0 0
123 Salmonella Thyphi BO Widal Test (vial 5 ml) vial 80,000 0 0
124 Salmonella Thyphi CO Widal Test (vial 5 ml) vial 80,000 0 0
125 Salmonella Thyphi AH Widal Test (vial 5 ml) vial 80,000 0 0
126 Salmonella Thyphi BH Widal Test (vial 5 ml) vial 80,000 0 0
127 Salmonella Thyphi CH Widal Test (vial 5 ml) vial 80,000 0 0
128 Anti-A Monoclonal Golongan Darah (vial 10 ml) vial 80,000 0 0
129 Anti-B Monoclonal Golongan Darah (vial 10 ml) vial 80,000 0 0
Anti-A,B Monoclonal Golongan Darah (vial 10
130 vial 105,000 0
ml) 0
131 Anti-D Duoclone Golongan Darah (vial 10 ml) vial 130,000 0 0
132 Larutan HCl 0,1N 100 ml/botol botol 14,000 0 0
Larutan Ziehl Neelsen, tiap set terdiri atas :
1 botol Carbol Fuchsin 0,3% , 100 ml
133 set 260,000 0 0
3 botol Etanol Asam 3,0% , 100 ml
1 botol Methylene Blue 0,3% , 100 ml
TOTAL 11,999,900
KAPITASI 12,000,000
SISA KAPITASI 100

disusun oleh : diketahui oleh :

Petugas Obat KUPT Puskesmas Sibolangit
Puskesmas : Sibolangit Kecamatan Sibolangit

Franciskus Dohude dr. Tomo Edy

NIP : 198503242010011013 NIP : 197907222010011012
 DAFTAR PERMINTAAN BAHAN MEDIS HABIS PAKAI DAN REAGENSIA DANA BPJS TAHUN 2017
Bulan : januari - maret 2017

HARGA/ SATUAN PERMINTAAN

NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
1 Alkohol 70% 1 liter botol 33,000 0 0
2 Povidon Iodine 30 cc botol 3,500 0 0
3 Povidon Iodine 60 cc botol 4,300 0 0
4 Povidon Iodine 300 cc botol 21,000 0 0
5 Aseptan 500 cc + dispenser (tanpa bilas) botol 40,000 0 0
6 Aseptic Gel 500 cc + dispenser (tanpa bilas) botol 25,500 0 0
Onescrub 500 cc + dispenser (Chlorhexidine
7 botol 72,000 0
glukonate 4%) (bilas) 0
Sabun anti bakteri (Triclosan 0,3%) (Bilas) 500
8 botol 33,000 0
cc 0
One step solution (cairan pembersih luka dan
9 botol 33,000 0
perawatan luka bakar) 500 cc 0
Odex (antiseptik pada perawatan dan luka bakar)
10 botol 110,000 0
500 cc 0
11 Rivanol 300 cc botol 3,600 0 0
12 Lysol 1 liter botol 47,200 0 0
13 Ultrasonic Gel 250 ml botol 16,000 0 0
14 Syringe 1 cc buah 1,100 0 0
15 Syringe 2,5 cc buah 800 0 0
16 Syringe 3 cc buah 800 0 0
17 Syringe 5 cc buah 900 0 0
18 Syringe 10 cc buah 1,100 0 0
100
19 Blood Lancet 26G 16,100 0
buah/box 0
100
20 Blood Lancet 28G 16,100 0
buah/box 0
21 Kasa Hydrofil 40 x 80 m roll 116,000 0 0
22 Kasa Pembalut Hydrofil 4 m x 3 cm roll 650 0 0
23 Kasa Pembalut Hydrofil 4 m x 5 cm roll 850 0 0
24 Kasa Pembalut Hydrofil 4 m x 10 cm roll 1,700 0 0
25 Kasa Pembalut Hydrofil 4 m x 15 cm roll 2,400 0 0
26 Kasa Steril uk 16 x 16 cm box/16 9,000 0 0
27 Kasa kompres 40 x 40 pcs 1,800 0 0
28 Kasa Steril 5 x 5 cm, 8 ply 1 x 5's pouch 3,200 0 0
29 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 5's pouch 3,500 0 0
30 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 10's pouch 7,200 0 0
31 Kasa Steril 10 x 10 cm, 8 ply 1 x 10's pouch 10,400 0 0
32 Kapas Berlemak 500 gram rolll 18,200 0 0
33 Kapas Pembalut putih250 gram roll 13,800 0 0
34 Kapas Pembalut 500 gram roll 30,050 0 0
 HARGA/ SATUAN PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
35 Surgical Mask earloop box/50 20,400 0 0
36 Surgical Mask tie on box/50 20,400 0 0
37 Alkohol swab (ethyl alkohol 70%) box/100 12,000 3 3 36,000
AC swab (ethyl alkohol 70% + Chlorhexidine
38 box/100 18,000 0
Glukonate 2%) 0
Catgut plain 2/0 + jarum 1/2 GT 35 mm, panjang
39 box 147,500 2 2
75 cm 295,000
Catgut plain 3/0 + jarum 1/2 GT 35 mm, panjang
40 box 147,500 2 2
75 cm 295,000
Catgut chromic 2/0 + jarum 1/2 GT 35 mm,
41 box 147,500 2 2
panjang 75 cm 295,000
Catgut chromic 3/0 + jarum 1/2 GT 35 mm,
42 box 147,500 2 2
panjang 75 cm 295,000
43 Silk 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm box 121,000 0 0
44 Silk 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm box 121,000 0 0
45 Folley Catheter 2 way no. 12 box/10 88,000 1 1 88,000
46 Folley Catheter 2 way no. 14 box/10 88,000 1 1 88,000
47 Folley Catheter 2 way no. 16 box/10 88,000 1 1 88,000
48 Folley Catheter 2 way no. 18 box/10 88,000 1 1 88,000
49 Folley Catheter 2 way no. 20 box/10 88,000 1 1 88,000
50 Folley Catheter 2 way no. 22 box/10 88,000 1 1 88,000
51 Folley Catheter 2 way no. 24 box/10 88,000 1 1 88,000
52 Folley Catheter 3 way no. 20 box/10 358,000 0 0
53 Folley Catheter 3 way no. 22 box/10 358,000 0 0
54 Folley Catheter 3 way no. 24 box/10 358,000 0 0
55 Folley Catheter Pediatric no. 6 box/10 410000 0 0
56 Folley Catheter Pediatric no. 8 box/10 350,000 0 0
57 Folley Catheter Pediatric no. 10 box/10 350,000 0 0
58 IV Catheter No. 18 G x 32 mm pcs 4,200 20 20 84,000
59 IV Catheter No. 20 G x 1 1/4" pcs 4,200 20 20 84,000
60 IV Catheter No. 22 G x 1" pcs 4,200 20 20 84,000
61 IV Catheter No. 24 G x 3/4" pcs 4,200 20 20 84,000
62 IV Catheter No. 26 G x 1/2" pcs 4550 20 20 91,000
63 Infusion set dewasa (20 drops/ml) pcs 3,550 0 0
64 Infusion set Anak (60 drops/ml) pcs 3,900 0 0
65 Infusion set Dewasa (Y Tube) pcs 7,000 0 0
66 Blood Transfusion set pcs 4,000 0 0
67 Three Way Stop Cock tanpa tube (50 buah/box) box 110,000 0 0

68 Three Way Stop Cock dengan tube (50 buah/box) box 18,000 50 50
900,000
69 Urine bag standard steril 2 Liter pcs 3,500 50 50 175,000
70 Oxyflow Bubble (Bubble Nasal Canula) buah 6,500 0 0
 HARGA/ SATUAN PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
Maxiflow Bayi (masker oksigen bayi + tubing),
71 set 16,500 0
panjang 2 m 0
Maxiflow Anak (masker oksigen bayi + tubing),
72 set 15,500 0
panjang 2 m 0
Maxiflow Dewasa (masker oksigen bayi +
73 set 15,500 0
tubing), panjang 2 m 0
74 Makes Nebulizer Set Anak set 23,000 0 0
75 Makes Nebulizer Set Dewasa set 23,000 0 0
76 Hi Oxygen Masker anak set 28,000 0 0
77 Hi Oxygen Masker Dewasa set 28,000 0 0
78 Examination Glove box/100 39,200 0 0
79 Examination Glove No Powder box/100 64,200 0 0
80 Surgical Steril Pre Powder No. 7/7,5 pasang 4,600 0 0
81 Sarung Tangan Obgyn Steril pasang 23,500 0 0
82 Wing Needle 19 G pcs 1,600 10 10 16,000
83 Wing Needle 21 G pcs 1,600 10 10 16,000
84 Wing Needle 23 G pcs 1,600 10 10 16,000
85 Wing Needle 25 G pcs 1,600 5 5 8,000
86 Wing Needle 27 G pcs 1,600 5 5 8,000
87 Suction Catether No. 6 pcs 4,800 0 0
88 Suction Catether No. 8 pcs 4,800 0 0
89 Suction Catether No. 10 pcs 4,800 0 0
90 Suction Catether No. 12 pcs 4,800 0 0
91 Suction Catether No. 14 pcs 4,800 0 0
92 Suction Catether No. 16 pcs 4,800 0 0
93 Suction Catether No. 18 pcs 4,800 0 0
Dermafix S (untuk pemasangan IV Catheter)
94 blister 2,300 0
ukuran 6 X 7 cm 0
95 Dermafix T (plester transparan) 5 X 7 cm buah 1,900 0 0
96 Dermafix T (plester transparan) 10 X 8 cm buah 4,700 0 0
97 Dermafix T (plester transparan) 10 X 12 cm buah 7,100 0 0
98 Dermafix T (plester transparan) 10 X 145 cm buah 9,200 0 0
99 Dermafix T (plester transparan) 10 X 20 cm buah 11,000 0 0
100 Dermafix T (plester transparan) 10 X 25 cm buah 17,000 0 0
Plesterin Bulat (digunakan setelah pengambilan 200
101 35,000 0
darah sample) pcs/box 0
102 Plesterin Roll 5 cm X 5 m roll 28,000 0 0
103 Plesterin Roll 10 cm X 5 m roll 48,000 0 0
104 Plesterin Roll 15 cm X 5 m roll 80,000 0 0
105 Plesterin Roll 20 cm X 5 m roll 92,000 0 0
106 Object Glass box/72 pcs 20,000 0 0
pak/10
107 Cover Glass 22 x 22 mm box @ 100 160,000 0
pcs 0
 HARGA/ SATUAN PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
box isi 100
108 EDTA K3 Tubes 250,000 0
pcs 0
box isi 100
109 Nurse Cap 50,000 0
pcs 0
110 Softpad (underpad) 60 X 90 pack isi 10 50,000 0 0
111 Arm Sling (tersedia ukuran S,M,L) buah 20,000 0 0
Bracket Hand Wash ABS (keranjang tempat
112 buah 20,000 0
aseptic gel) 0
113 Reagensia Autocheck 3 in 1 (Glukosa) box/25 120,000 2 2 240,000
114 Reagensia Autocheck 3 in 1 (Asam Urat) box/25 150,000 2 2 300,000
115 Reagensia Autocheck 3 in 1 (Cholesterol) box/10 250,000 1 1 250,000
116 Test Hamil box/50's buah 2,300 100 100 230,000
117 Rapit test Gluko Protein Test bos/50's buah 1,200 0 0
118 Detecto HBs Ag Hepatitis B buah 5,500 0 0
119 Rapid Test HIV 25 test/box 560,000 0 0
120 Salmonella Thyphi H Widal Test (vial 5 ml) vial 80,000 0 0
121 Salmonella Thyphi O Widal Test (vial 5 ml) vial 80,000 0 0
122 Salmonella Thyphi AO Widal Test (vial 5 ml) vial 80,000 0 0
123 Salmonella Thyphi BO Widal Test (vial 5 ml) vial 80,000 0 0
124 Salmonella Thyphi CO Widal Test (vial 5 ml) vial 80,000 0 0
125 Salmonella Thyphi AH Widal Test (vial 5 ml) vial 80,000 0 0
126 Salmonella Thyphi BH Widal Test (vial 5 ml) vial 80,000 0 0
127 Salmonella Thyphi CH Widal Test (vial 5 ml) vial 80,000 0 0
128 Anti-A Monoclonal Golongan Darah (vial 10 ml) vial 80,000 0 0
129 Anti-B Monoclonal Golongan Darah (vial 10 ml) vial 80,000 0 0
Anti-A,B Monoclonal Golongan Darah (vial 10
130 vial 105,000 0
ml) 0
131 Anti-D Duoclone Golongan Darah (vial 10 ml) vial 130,000 0 0
132 Larutan HCl 0,1N 100 ml/botol botol 14,000 0 0
Larutan Ziehl Neelsen, tiap set terdiri atas :
1 botol Carbol Fuchsin 0,3% , 100 ml
133 set 260,000 0 0
3 botol Etanol Asam 3,0% , 100 ml
1 botol Methylene Blue 0,3% , 100 ml
TOTAL 4,418,000
KAPITASI 4,422,900
SISA KAPITASI 4,900

disusun oleh : diketahui oleh :

Petugas Obat KUPT Puskesmas Sibolangit
Puskesmas : Sibolangit Kecamatan Sibolangit
 HARGA/ SATUAN PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN (Harga Maksimum) HARGA TOTAL (Rp)
KEB STOK PESANAN
Franciskus Dohude dr. Tomo Edy
NIP : 198503242010011013 NIP : 197907222010011012
 DAFTAR PERMINTAAN BAHAN MEDIS HABIS PAKAI DAN REAGENSIA DAK TAHUN 2018

PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN
KEB STOK PESANAN
1 Alkohol 70% 1 liter botol 24 24
2 Povidon Iodine 30 cc botol 120 120
3 Povidon Iodine 60 cc botol 24 24
4 Povidon Iodine 300 cc botol 12 12
5 Aseptan 500 cc + dispenser (tanpa bilas) botol 12 12
6 Aseptic Gel 500 cc + dispenser (tanpa bilas) botol 12 12
Onescrub 500 cc + dispenser (Chlorhexidine
7 botol 12 12
glukonate 4%) (bilas)
Sabun anti bakteri (Triclosan 0,3%) (Bilas) 500
8 botol 12 12
cc
One step solution (cairan pembersih luka dan
9 botol 12 12
perawatan luka bakar) 500 cc
Odex (antiseptik pada perawatan dan luka bakar)
10 botol 12 12
500 cc
11 Rivanol 300 cc botol 72 72
12 Lysol 1 liter botol 60 60
13 Ultrasonic Gel 250 ml botol 0
14 Syringe 1 cc buah 3,600 3,600
15 Syringe 2,5 cc buah 36,000 36,000
16 Syringe 3 cc buah 36,000 36,000
17 Syringe 5 cc buah 24,000 24,000
18 Syringe 10 cc buah 6,000 6,000
100
19 Blood Lancet 26G 120 120
buah/box
100
20 Blood Lancet 28G 120 120
buah/box
21 Kasa Hydrofil 40 x 80 m roll 36 36
22 Kasa Pembalut Hydrofil 4 m x 3 cm roll 1,200 1,200
23 Kasa Pembalut Hydrofil 4 m x 5 cm roll 1,800 1,800
24 Kasa Pembalut Hydrofil 4 m x 10 cm roll 600 600
25 Kasa Pembalut Hydrofil 4 m x 15 cm roll 360 360
26 Kasa Steril uk 16 x 16 cm box/16 144 144
27 Kasa kompres 40 x 40 pcs 240 240
28 Kasa Steril 5 x 5 cm, 8 ply 1 x 5's pouch 240 240
29 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 5's pouch 240 240
30 Kasa Steril 7,5 x 7,5 cm, 8 ply 1 x 10's pouch 240 240
31 Kasa Steril 10 x 10 cm, 8 ply 1 x 10's pouch 240 240
32 Kapas Berlemak 500 gram rolll 120 120
33 Kapas Pembalut putih250 gram roll 120 120
34 Kapas Pembalut 500 gram roll 120 120
35 Surgical Mask earloop box/50 60 60
36 Surgical Mask tie on box/50 60 60
37 Alkohol swab (ethyl alkohol 70%) box/100 60 60
 PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN
KEB STOK PESANAN
AC swab (ethyl alkohol 70% + Chlorhexidine
38 box/100 60 60
Glukonate 2%)
Catgut plain 2/0 + jarum 1/2 GT 35 mm, panjang
39 box 60 60
75 cm
Catgut plain 3/0 + jarum 1/2 GT 35 mm, panjang
40 box 60 60
75 cm
Catgut chromic 2/0 + jarum 1/2 GT 35 mm,
41 box 60 60
panjang 75 cm
Catgut chromic 3/0 + jarum 1/2 GT 35 mm,
42 box 60 60
panjang 75 cm
43 Silk 2/0 + jarum 1/2 GT 35 mm, panjang 75 cm box 60 60
44 Silk 3/0 + jarum 1/2 GT 35 mm, panjang 75 cm box 60 60
45 Folley Catheter 2 way no. 12 box/10 60 60
46 Folley Catheter 2 way no. 14 box/10 60 60
47 Folley Catheter 2 way no. 16 box/10 60 60
48 Folley Catheter 2 way no. 18 box/10 60 60
49 Folley Catheter 2 way no. 20 box/10 60 60
50 Folley Catheter 2 way no. 22 box/10 60 60
51 Folley Catheter 2 way no. 24 box/10 60 60
52 Folley Catheter 3 way no. 20 box/10 60 60
53 Folley Catheter 3 way no. 22 box/10 60 60
54 Folley Catheter 3 way no. 24 box/10 60 60
55 Folley Catheter Pediatric no. 6 box/10 60 60
56 Folley Catheter Pediatric no. 8 box/10 60 60
57 Folley Catheter Pediatric no. 10 box/10 60 60
58 IV Catheter No. 18 G x 32 mm pcs 600 600
59 IV Catheter No. 20 G x 1 1/4" pcs 600 600
60 IV Catheter No. 22 G x 1" pcs 600 600
61 IV Catheter No. 24 G x 3/4" pcs 600 600
62 IV Catheter No. 26 G x 1/2" pcs 600 600
63 Infusion set dewasa (20 drops/ml) pcs 600 600
64 Infusion set Anak (60 drops/ml) pcs 600 600
65 Infusion set Dewasa (Y Tube) pcs 600 600
66 Blood Transfusion set pcs 0
67 Three Way Stop Cock tanpa tube (50 buah/box) box 12 12

68 Three Way Stop Cock dengan tube (50 buah/box) box 12 12

69 Urine bag standard steril 2 Liter pcs 360 360

70 Oxyflow Bubble (Bubble Nasal Canula) buah 6 6
Maxiflow Bayi (masker oksigen bayi + tubing),
71 set 20 20
panjang 2 m
Maxiflow Anak (masker oksigen bayi + tubing),
72 set 0
panjang 2 m
Maxiflow Dewasa (masker oksigen bayi +
73 set 0
tubing), panjang 2 m
 PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN
KEB STOK PESANAN
74 Makes Nebulizer Set Anak set 30 30
75 Makes Nebulizer Set Dewasa set 30 30
76 Hi Oxygen Masker anak set 30 30
77 Hi Oxygen Masker Dewasa set 30 30
78 Examination Glove box/100 60 60
79 Examination Glove No Powder box/100 60 60
80 Surgical Steril Pre Powder No. 7/7,5 pasang 100 100
81 Sarung Tangan Obgyn Steril pasang 100 100
82 Wing Needle 19 G pcs 60 60
83 Wing Needle 21 G pcs 60 60
84 Wing Needle 23 G pcs 60 60
85 Wing Needle 25 G pcs 60 60
86 Wing Needle 27 G pcs 60 60
87 Suction Catether No. 6 pcs 60 60
88 Suction Catether No. 8 pcs 60 60
89 Suction Catether No. 10 pcs 60 60
90 Suction Catether No. 12 pcs 60 60
91 Suction Catether No. 14 pcs 60 60
92 Suction Catether No. 16 pcs 60 60
93 Suction Catether No. 18 pcs 60 60
Dermafix S (untuk pemasangan IV Catheter)
94 blister 800 800
ukuran 6 X 7 cm
95 Dermafix T (plester transparan) 5 X 7 cm buah 600 600
96 Dermafix T (plester transparan) 10 X 8 cm buah 600 600
97 Dermafix T (plester transparan) 10 X 12 cm buah 300 300
98 Dermafix T (plester transparan) 10 X 145 cm buah 300 300
99 Dermafix T (plester transparan) 10 X 20 cm buah 200 200
100 Dermafix T (plester transparan) 10 X 25 cm buah 200 200
Plesterin Bulat (digunakan setelah pengambilan 200
101 5 5
darah sample) pcs/box
102 Plesterin Roll 5 cm X 5 m roll 100 100
103 Plesterin Roll 10 cm X 5 m roll 100 100
104 Plesterin Roll 15 cm X 5 m roll 50 50
105 Plesterin Roll 20 cm X 5 m roll 50 50
106 Object Glass box/72 pcs 10 10
pak/10
107 Cover Glass 22 x 22 mm box @ 100 10 10
pcs
box isi 100
108 EDTA K3 Tubes 10 10
pcs
box isi 100
109 Nurse Cap 5 5
pcs
110 Softpad (underpad) 60 X 90 pack isi 10 10 10
111 Arm Sling (tersedia ukuran S,M,L) buah 10 10
 PERMINTAAN
NO NAMA/JENIS BMHP / REAGENSIA SATUAN
KEB STOK PESANAN
Bracket Hand Wash ABS (keranjang tempat
112 buah 10 10
aseptic gel)
113 Reagensia Autocheck 3 in 1 (Glukosa) box/25 20 20
114 Reagensia Autocheck 3 in 1 (Asam Urat) box/25 20 20
115 Reagensia Autocheck 3 in 1 (Cholesterol) box/10 20 20
116 Test Hamil box/50's buah 10 10
117 Rapit test Gluko Protein Test bos/50's buah 0
118 Detecto HBs Ag Hepatitis B buah 0
119 Rapid Test HIV 25 test/box 0
120 Salmonella Thyphi H Widal Test (vial 5 ml) vial 0
121 Salmonella Thyphi O Widal Test (vial 5 ml) vial 0
122 Salmonella Thyphi AO Widal Test (vial 5 ml) vial 0
123 Salmonella Thyphi BO Widal Test (vial 5 ml) vial 0
124 Salmonella Thyphi CO Widal Test (vial 5 ml) vial 0
125 Salmonella Thyphi AH Widal Test (vial 5 ml) vial 0
126 Salmonella Thyphi BH Widal Test (vial 5 ml) vial 0
127 Salmonella Thyphi CH Widal Test (vial 5 ml) vial 0
128 Anti-A Monoclonal Golongan Darah (vial 10 ml) vial 0
129 Anti-B Monoclonal Golongan Darah (vial 10 ml) vial 0

130 Anti-A,B Monoclonal Golongan Darah (vial 10 ml) vial 0

131 Anti-D Duoclone Golongan Darah (vial 10 ml) vial 0

132 Larutan HCl 0,1N 100 ml/botol botol 0
Larutan Ziehl Neelsen, tiap set terdiri atas :
1 botol Carbol Fuchsin 0,3% , 100 ml
133 set 0
3 botol Etanol Asam 3,0% , 100 ml
1 botol Methylene Blue 0,3% , 100 ml

disusun oleh : diketahui oleh :

Petugas Obat KUPT Puskesmas Sibolangit
Puskesmas : Sibolangit Kecamatan Sibolangit

Franciskus Dohude dr. Tomo Edy

NIP : 198503242010011013 NIP : 197907222010011012