PEMERINTAH KABUPATEN KONAWE UTARA

DINAS KESEHATAN
Jl. Kompleks Perkantoran Pemda Kel.Wanggudu Kec.Asera. E-mail : konutkessos
WANGGUDU

SURAT BUKTI BARANG KELUAR

No. 03.082 / IF-KU / VII / 2016

DIKIRIM KEPADA : Puskesmas Matandahi

BULAN : Juli
BARANG BERUPA : Obat dan Bahan Medis Habis Pakai

HARGA TOTAL
No. NAMA OBAT KEMASAN QUANTUM
SATUAN HARGA
1 Albendazol suspensi 200 mg/5 ml Dus, @ 10 btl 4,234.00 40 169,360.00
2 Amoksisilin kapsul/kaplet 250 mg Ktk, 10 blister @ 12 kap 220.00 1,200 264,000.00
3 Amoksisilin kaplet 500 mg Ktk, 10 strip @ 10 tab 279.00 2,000 558,000.00
4 Antasida DOEN II suspensi, kombi : Dus, 50 btl @ 60ml 2,213.00 50 110,650.00
5 Antimalaria DOEN kombinasi : Ktk, 10 Blister @ 10 tab 572.00 500 286,000.00
6 Asam Folat tablet 1 mg Btl 100 tablet 52.00 500 26,000.00
7 Asam Mefenamat kaplet 500 mg Ktk, 10 strip @ 10 tab 127.00 2,000 254,000.00
Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet (tablet
8 1 sase @ 30 tab 45.00 300 13,500.00
tambah darah kombinasi )
9 Cetirizine sirup 5 mg/5 ml Dus, 50 btl @ 60 ml 8,799.00 5 43,995.00
10 Deksametason tablet 0,5 mg Ktk, 10 strip @ 10 tab 68.00 1,000 68,000.00
11 Domperidon suspensi 5 mg/5 ml Dus, 50 btl @ 60 ml 3,490.00 50 174,500.00
12 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 174.00 300 52,200.00
13 Fenol Gliserol tetes telinga 10% Ktk 24 btl @ 5 ml 1,108.80 24 26,611.20
14 Fitomenadion (Vit.K1) tablet salut gula 10 mg Btl 100 tablet 698.00 300 209,400.00
15 Gliseril guaiakolat tablet 100 mg btl 1000 tablet 41.00 200 8,200.00
16 Ibuprofen tablet 400 mg ktk 10 str x 10 tablet 157.00 1,000 157,000.00
17 Kaptopril tablet 25 mg Dus, 10 Strip @ 10 tab 97.00 500 48,500.00
18 Lidokain injeksi 2 % ktk 100 amp @ 2 ml 929.00 100 92,900.00
19 Loperamid tablet 2 mg ktk 10x10 tab 97.00 500 48,500.00
Metilergometrin Maleat (Metilergometrin) tablet salut 0,125
20 ktk 10 x 10 tablet 169.00 300 50,700.00
mg
21 Natrium Diklofenak tablet 25 mg ktk 5 x 10 tablet 146.00 500 73,000.00
22 natrium diklo 50 mg ktk 5 x 10 tablet 193.00 300 57,900.00
23 Omeprazol kapsul 20 mg ktk 3 x 10 kapsul 221.00 90 19,890.00
24 Parasetamol drops Botol 15 ml 5,720.00 20 114,400.00
25 Parasetamol Sirup 120 mg / 5 ml Btl 60 ml 1,535.00 100 153,500.00
26 Parasetamol tablet 500 mg Strip 10 x 10 tablet 88.00 2,000 176,000.00
27 Pirantel sirup 125 mg/5 ml Btl 60 ml 9,100.00 20 182,000.00
28 Pirantel tablet score (base) 125 mg ktk25 blister @ 4 tab 318.00 100 31,800.00
29 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Ktk 10 x 10 Tablet 121.00 1,000 121,000.00
30 povidon iodine 10% (kokodin) Btl 300 ml 15,386.00 5 76,930.00
31 povidon iodine 10% (kokodin) Btl 1000 ml 41,201.00 4 164,804.00
32 Ranitidin injeksi 25 mg/2 ml ktk 10 amp @ 2 ml 1,340.00 20 26,800.00
33 Ranitidin tablet 150 mg ktk 10 x 10 tablet 128.00 1,500 192,000.00
34 Ringer Laktat larutan infuse Botol 500 ml 5,720.00 40 228,800.00
35 Salbutamol tablet 2 mg (sebagai Sulfat) Ktk 10 x 10 tablet 65.00 500 32,500.00
 HARGA TOTAL
No. NAMA OBAT KEMASAN QUANTUM
SATUAN HARGA
36 Salisil Bedak 2 % ktk 50 g 1,350.00 25 33,750.00
37 Sefiksim sirup kering 100 mg/ 5 ml btl 30 ml 9,400.00 25 235,000.00
38 Sefotaksim injeksi 1 g Ktk 10 vial 3,500.00 20 70,000.00
39 Seftriakson serbuk injeksi 1 g/ vial ktk 10 vial 3,900.00 20 78,000.00
40 Sianokobalamin (vit B 12) tablet 50 mg Ktk 10 x 10 tablet 63.00 1,000 63,000.00
41 Siprofloksasin tablet 500 mg (sebagai HCl) ktk 10 x 10 tablet 290.00 500 145,000.00
42 Zinc tablet 20 mg Dus, 10 Stip @ 10 tab 521.00 200 104,200.00
Bahan Medis Habis Pakai
1 Masker (Surgical Mask-plus 3 ply Plus earloop) Ktk, 50 pcs 574.20 200 114,840.00
TOTAL 5,157,130.20

Wanggudu, 18 Juli 2016

Yang Menerima Yang Menyerahkan,
Petugas Farmasi Puskesmas Matandahi Petugas Instalasi farmasi
Kabupaten Konawe Utara Kabupaten Konawe Utara

Abdiyanzahnur, AMK Rita Sandi, S.Farm, Apt

NIP. 19871106 201402 1 001 NIP. 19840410 201101 2 025
AH KABUPATEN KONAWE UTARA
DINAS KESEHATAN
n Pemda Kel.Wanggudu Kec.Asera. E-mail : konutkessos
WANGGUDU

RAT BUKTI BARANG KELUAR

No. 03.082 / IF-KU / VII / 2016

KET
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