REKAPITULASI LAPORAN PERHITUNGAN STOCK OPNAME

PER 01 JANUARI sd. 31 DESEMBER TAHUN 2017

STOCK OPNAME TANGGAL 09 JANUARI 2018

PERSEDIAAN
Qty Harga
NO NAMA BARANG Satuan BARANG per Jumlah (Rp)
Rusak/ (Rp)
31/12/17
Sisa Penambahan Distribusi
Usang
1 2 3 4 5 6 7 8 (4-5+6+7) 9 10(9x10)
1 Vaksin PKM.Kramatwatu 8786 0 0 0 8786 Rp 163,216,904.00

2 ATK Puskesmas Kramatwatu 558 0 0 0 558 Rp 21,209,450.00

3 Alat Pakai Habis Lab 7427 0 0 0 7427 Rp 37,277,667.10

4 Alkon dari BKBPMP 3171 0 0 0 3171 Rp 28,746,201.00

5 Alat Habis Pakai Kebersihan

dan Obat 698 0 0 0 698 Rp 10,832,800.00

6 Alat Listrik 28 0 0 0 28 Rp 1,141,352.00

7 Alat BHP Pembersih 50 0 0 0 50 Rp 5,529,830.00

8 Obat dari Gudang obat Dinkes 0 0 0 0 0 Rp 108,068,401.18

Rp 376,022,605.28

Mengetahui, Kramatwatu, 09 Januari 2018 TIM PEMERIKSA :

Kepala UPTD PKM KRAMATWATU Petugas Pengurus Barang PKM Kramatwatu 1. Drs. H. Jajang Kusmara, M.Pd
NIP. 19651101 199301 1 001

2. Drs. Monang Nababan

NIP. 19670810 199403 1 014
dr.Enik Utmawati Sukron Malawi,A.Md.Kep
NIP. 19770404200701 2 011 NIP. 198411152009022001 3. Kokom Sunarsih, S.Sos
NIP. 19700610 200312 1 004

4. Rukma Alfiana, SE.,M.Si

NIP. 19700610 200312 1 004

5. Iyos Rosandi, S.Pd

NIP. 19690505 200003 1 006

6. Nawa Ratri Rahayu, SE

NIP. 19740329 200604 2 004

7. Eriya Dewanti, S.Pd.

NIP. 19780402 200902 2 002
Lampiran 4 : Format Laporan Perhitungan Stock Opname

SKPD : PUSKESMAS KRAMATWATU

KABUPATEN : SERANG
PROVINSI : BANTEN

LAPORAN PERHITUNGAN STOCK OPNAME

PER 01 JANUARI sd. 31 DESEMBER TAHUN 2017

STOCK OPNAME
TANGGAL 09 JANUARI PERSEDIAAN
NO NAMA BARANG Satuan 2018
Rusak/ BARANG per Qty Harga (Rp) Jumlah (Rp)
Penamba Distrib 31/12/17
Sisa
han usi
Usang
1 2 3 4 5 6 7 8 (4-5+6+7) 9 10(9x10)
I VAKSIN
1 BCG Vial 310 0 0 0 310 Rp 59,950.00 Rp 18,584,500.00
2 HBU UNIJEK Vial 52 0 0 0 52 Rp 20,900.00 Rp 1,086,800.00
3 POLIO (bOPV) Vial 349 0 0 0 349 Rp 42,300.00 Rp 14,762,700.00
4 POLIO (IPV) - 302 0 0 0 302 Rp 137,610.00 Rp 41,558,220.00
5 CAMPAK Vial 345 0 0 0 345 Rp 95,700.00 Rp 33,016,500.00
6 TT/Td Vial 446 0 0 0 446 Rp 22,637.00 Rp 10,096,102.00
7 COMBO (DPT-HB) Vial 0 0 0 0 0 Rp 76,253.00 Rp -
8 DPT HB-HIB Vial 445 0 0 0 445 Rp 76,285.00 Rp 33,946,825.00
9 ADS 5 ml Buah 477 0 0 0 477 Rp 2,041.00 Rp 973,557.00
10 ADS 0,5 ml Buah 4830 0 0 0 4830 Rp 1,395.00 Rp 6,737,850.00
11 ADS 0,05 ml Buah 1230 0 0 0 1230 Rp 1,995.00 Rp 2,453,850.00
12 SAFETY BOX 2,5 Ltr Box 0 0 0 0 0 Rp 22,880.00 Rp -
SUB TOTAL Rp 163,216,904.00
II ATK JKN
13 Amplop besar pak 10 0 0 0 10 Rp 17,500.00 Rp 175,000.00
14 Amplop sedang pak 4 0 0 0 4 Rp 12,500.00 Rp 50,000.00
15 Ballpoint Standard biru box 5 0 0 0 5 Rp 18,000.00 Rp 90,000.00
16 Ballpoint Standard hitam box 105 0 0 0 105 Rp 18,000.00 Rp 1,890,000.00
17 Ballpoint Standard merah box 2 0 0 0 2 Rp 18,000.00 Rp 36,000.00
18 Battery pak 0 0 0 0 0 Rp 264,000.00 Rp -
19 Battery buah 15 0 0 0 15 Rp 6,900.00 Rp 103,500.00
20 Binder clip pak 0 0 0 0 0 Rp 54,300.00 Rp -
21 Binder clip pak 0 0 0 0 0 Rp 73,900.00 Rp -
22 Binder clip pak 0 0 0 0 0 Rp 188,500.00 Rp -
23 Box file biru buah 0 0 0 0 0 Rp 24,000.00 Rp -
24 Buku doble folio buah 0 0 0 0 0 Rp 28,950.00 Rp -
25 Buku ekspedisi buah 7 0 0 0 7 Rp 7,550.00 Rp 52,850.00
26 Buku Folio buah 0 0 0 0 0 Rp 12,300.00 Rp -
27 Buku Folio kecil buah 10 0 0 0 10 Rp 4,400.00 Rp 44,000.00
28 Buku Kas buah 0 0 0 0 0 Rp 6,300.00 Rp -
29 Copy save pack 10 0 0 0 10 Rp 139,000.00 Rp 1,390,000.00
30 Hekter buah 0 0 0 0 0 Rp 14,500.00 Rp -
31 Isi Hekter no. 10 box 5 0 0 0 5 Rp 24,900.00 Rp 124,500.00
32 Kertas HVS A4 rim 5 0 0 0 5 Rp 34,200.00 Rp 171,000.00
33 Kertas HVS F4 rim 30 0 0 0 30 Rp 38,500.00 Rp 1,155,000.00
34 Kertas HVS F4 warna rim 2 0 0 0 2 Rp 54,200.00 Rp 108,400.00
35 Kertas HVS F4 warna rim 2 0 0 0 2 Rp 54,200.00 Rp 108,400.00
36 Kertas HVS F4 warna rim 2 0 0 0 2 Rp 54,200.00 Rp 108,400.00
37 Kertas skotlet lembar 7 0 0 0 7 Rp 81,700.00 Rp 571,900.00
38 kwitansi Besar Pak 8 0 0 0 4 Rp 32,700.00 Rp 130,800.00
39 kwitansi kecil Pak 4 0 0 0 4 Rp 15,100.00 Rp 60,400.00
40 Label Tom & jerry no 103 set 4 0 0 0 4 Rp 5,200.00 Rp 20,800.00
41 Label Tom & jerry no 123 set 5 0 0 0 5 Rp 5,200.00 Rp 26,000.00
42 Label Tom & jerry no 112 set 5 0 0 0 5 Rp 5,200.00 Rp 26,000.00
43 Label Tom & jerry no 110 set 5 0 0 0 5 Rp 5,200.00 Rp 26,000.00
44 Lakban besar hitam roll 6 0 0 0 6 Rp 14,200.00 Rp 85,200.00
45 Lem stik buah 2 0 0 0 2 Rp 4,400.00 Rp 8,800.00
46 Map Kertas pak 0 0 0 0 0 Rp 85,500.00 Rp -
47 Map plastik busines file buah 54 0 0 0 54 Rp 4,600.00 Rp 248,400.00
48 Map plastik snelheckter kaku pak 6 0 0 0 6 Rp 9,000.00 Rp 54,000.00
49 odner pcs 10 0 0 0 10 Rp 27,500.00 Rp 275,000.00
50 odner tebal 10 cm pcs 16 0 0 0 16 Rp 87,500.00 Rp 1,400,000.00
51 Pemotong isolasi no. 100 buah 1 0 0 0 1 Rp 23,900.00 Rp 23,900.00
52 Post-it warna pronto 1 cm pcs 17 0 0 0 17 Rp 10,100.00 Rp 171,700.00
53 Post-it Plastik 1 cm pcs 0 0 0 0 0 Rp 10,100.00 Rp -
54 Post-it kertas 1 cm pcs 30 0 0 0 30 Rp 10,100.00 Rp 303,000.00
55 Styrofoam warna buah 4 0 0 0 4 Rp 13,850.00 Rp 55,400.00
56 Tinta Epson T6641 black botol 6 0 0 0 6 Rp 94,250.00 Rp 565,500.00
57 tinta refill hitam canon botol 10 0 0 0 10 Rp 36,000.00 Rp 360,000.00
58 tinta refill warna canon botol 27 0 0 0 27 Rp 38,500.00 Rp 1,039,500.00
59 Tinta stempel botol 0 0 0 0 0 Rp 8,800.00 Rp -
60 Tinta stempel violet biasa botol 8 0 0 0 8 Rp 9,000.00 Rp 72,000.00
61 Tip-ex Kertas Shadato buah 0 0 0 0 0 Rp 6,300.00 Rp -
62 Trigonal Kotak 0 0 0 0 0 Rp 2,200.00 Rp -
63 Drawing Pen Hitam No.0.1 Buah 5 0 0 0 5 Rp 9,000.00 Rp 45,000.00
64 Drawing Pen Hitam No.0.3 Buah 4 0 0 0 4 Rp 9,000.00 Rp 36,000.00
65 Drawing Pen Biru No. 0.1 Buah 2 0 0 0 2 Rp 9,000.00 Rp 18,000.00
66 Drawing Pen Biru No.0.3 Buah 3 0 0 0 3 Rp 9,000.00 Rp 27,000.00
67 Perforator No.40XL Buah 5 0 0 0 5 Rp 42,500.00 Rp 212,500.00
68 Buku Kwarto Buah 10 0 0 0 10 Rp 10,000.00 Rp 100,000.00
69 Gunting Buah 2 0 0 0 2 Rp 13,500.00 Rp 27,000.00
70 Hekter Besar HD-50 Max Buah 1 0 0 0 1 Rp 61,600.00 Rp 61,600.00
71 Isi Hekter Besar No.3 Kangoro Buah 0 0 0 0 0 Rp 66,000.00 Rp -
72 Label Tom & jerry no 107 Set 0 0 0 0 0 Rp 5,200.00 Rp -
73 Map plastik busines file F4E-209 Buah 0 0 0 0 0 Rp 4,600.00 Rp -
74 Map clear Buah 0 0 0 0 0 Rp 17,000.00 Rp -
75 Tempat pulpen T-20 Vivid Holder Unit 0 0 0 0 0 Rp 33,500.00 Rp -
76 Kertas Jilid Uk.F4 Box 0 0 0 0 0 Rp 47,500.00 Rp -
77 Plastik jilid Uk.F4 Box 0 0 0 0 0 Rp 47,500.00 Rp -
78 Lakban hitam 3 inch Roll 0 0 0 0 0 Rp 25,500.00 Rp -
79 Doble tip 2 inch Roll 0 0 0 0 0 Rp 15,500.00 Rp -
80 Map Kertas Batik Uk.A4 Buah 8 0 0 0 8 Rp 8,500.00 Rp 68,000.00
81 Tinta Canon Black Botol 8 0 0 0 8 Rp 38,500.00 Rp 308,000.00
82 Kertas Oracal Uk.100cmx60cm lembar 0 0 0 0 0 Rp 45,000.00 Rp -

83 EPSON Black Ink Cartridge [T6641] Unit 10 0 0 0 10 79,500 Rp 795,000.00

84 EPSON Cyan Ink Cartridge [T6642] Unit 2 0 0 0 2 79,500 Rp 159,000.00

85 EPSON Magenta Ink Cartridge
[T6643] Unit 2 0 0 0 2 79,500 Rp 159,000.00
86
EPSON Yellow Ink Cartridge [T6644] Unit 2 0 0 0 2 79,500 Rp 159,000.00
87 HP Small Black Ink Cartridge 802
[CH561ZZ] Unit 19 0 0 0 19 93,000 Rp 1,767,000.00
88
HP Black Ink Cartridge 46 [CZ637AA] Unit 3 0 0 0 3 98,000 Rp 294,000.00
89
HP Color Ink Cartridge 46 [CZ638AA] Unit 4 0 0 0 4 98,000 Rp 392,000.00
90 HP 678 Black Ink Cartridge
[CZ107AA] Unit 4 0 0 0 4 105,000 Rp 420,000.00
91 HP 678 Tri-color Ink Cartridge
[CZ108AA] Unit 0 0 0 0 0 105,000 Rp -
92
HP 21 Black Ink Cartridge [C9351AA] Unit 5 0 0 0 5 225,000 Rp 1,125,000.00
93 HP 22 Tri-color Ink Cartridge
[C9352AA] Unit 9 0 0 0 9 225,000 Rp 2,025,000.00
94 HP 802 Tri-color Ink Cartridge
[CH564ZZ] Unit 5 0 0 0 5 376,000 Rp 1,880,000.00
95 SANDISK Cruzer Blade USB Flash
Drive CZ50 32GB [SDCZ50-032G-
B35] Unit 0 0 0 0 0 141,130 Rp -
 96 CANON Colour Ink Cartridge CL-811
[CL811] Unit 0 0 0 0 0 261,250 Rp -
SUB TOTAL Rp 21,209,450.00

III FOTO COPY dari JKN

98 Form Pemeriksaan odontogram lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
99 Form PU Register Pasien lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
100 Form Imunisasi lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
101 Register CM lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
102 Register pasien lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
103 Kartu berobat lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
104 Pedoman Pengelolaan Obat Publiklembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
105 Form Monitoring UKP lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
106 Form Laporan Insiden lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
107 Register Harian ISPA lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
108 Form Pemantauan lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
109 Jadwal Sterilisasi lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
110 Daftar Hadir lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
111 Form Penjaringan Kesehatan lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
112 PHBS rumah tangga sehat lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
113 Nota lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
114 Form SSH lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
115 Brosur lab lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
116 Family folder lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
117 Format data keluarga sehat lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
118 Lap.Pelayanan Jampersal lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
119 Register Pelyn Jampersal lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
120 Register RTK lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
121 Form SMD lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
122 Form Keluarga Sehat lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
123 Form Individu lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
124 Permohonan Lab TBC lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
125 Form Lab PKM lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
126 Form Saran lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
127 Buku Instrumen Akreditasi lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
SUB TOTAL NIHIL
IV CETAK dan JKN

128 Kertas Puyer Press sablon hijau Pak NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
129 Plastik Obat pak NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
130 Plastik Obat pak NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
131 Plastik Obat pak NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
132 KMS lansia lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
133 Kartu Stok obat lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
134 Form hasil Lab Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
135 Form permintaan periksa lab Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
Sertifikat Kader Kes
136 SD/SMP/SMA lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
137 Formulir Bayi Baru Lahir Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
138 Stempel Resti buah NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
139 Bagan MTBS lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
140 Bagan Diare lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
141 Bagan Ikterus lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
142 Kartu taksiran partus lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
143 Status Ibu Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
144 Stempel dokter buah NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
145 Stempel obat buah NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
146 Poster continuum of care lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
147 Poster obat lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
148 Leaflet/Brosur UKGMD lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
149 Poster Metode Kanguru lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
150 Leaflet/Brosur UKGS lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
151 Kuitansi pendaftaran 2 ply rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
152 Poster obat Besar lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
153 Kartu Berobat Lbr NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
154 Blangko Penjaringan Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

155 Blangko Rekapitulasi Penjaringan Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
156 Buku Resep Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
157 Buku Rujukan Internal Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
158 Blangko Form Permintaan Lab Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
159 Buku Hasil Laboratorium Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

160 Buku Form Pencatatan Keg. Lab Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

161 Buku Keluarga Sehat Individual Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
162 Buku Keluarga Sehat KK Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
163 Plang Titik Kumpul Pcs NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
164 Pin HKN Pcs NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
165 Map Rekam Medis Pcs NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
166 Pin Smile Pcs NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
167 Blangko Form Konseling HIV Rim NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
168 Stiker Logo Puskesmas Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
SUB TOTAL NIHIL
V ALAT HABIS PAKAI LAB dari JKN
169 Aquadest Botol 0 0 0 0 0 Rp 37,000 Rp -
170 Restec Cupete Buah 0 0 0 0 0 Rp 8,500 Rp -
171 Reagen GDS Botol 8 0 0 0 8 Rp 187,000 Rp 1,496,000.00
172 Reagen Uric Acid Botol 4 0 0 0 4 Rp 1,573,000 Rp 6,292,000.00
173 Reagen Kolesterol Botol 3 0 0 0 3 Rp 1,760,000 Rp 5,280,000.00
174 Reagen HDL Botol 3 0 0 0 3 Rp 223,850 Rp 671,550.00
175 Reagen LDL 100 ml botol 0 0 0 0 0 Rp 5,167,000 Rp -
176 Reagen Triglicerid Botol 4 0 0 0 4 Rp 635,250 Rp 2,541,000.00
177 Reaagen SGOT Botol 8 0 0 0 8 Rp 213,125 Rp 1,705,000.00
178 Reagen SGPT Botol 7 0 0 0 7 Rp 213,125 Rp 1,491,875.00
179 Bilirubin 100 ml Botol 0 0 0 0 0 Rp 715,000 Rp -
180 Kreatin 100 ml Botol 0 0 0 0 0 Rp 617,100 Rp -

181 Reagen Kontrol Hematology 2 ml Botol 2 0 0 0 2 Rp 440,000 Rp 880,000.00

182 Reagen Cotrol Photometer 5 ml botol 0 0 0 0 0 Rp 194,752 Rp -

183 Dilwent 20 liter Box 1 0 0 0 1 Rp 1,760,000 Rp 1,760,000.00
184 Lyse 1000 ml Botol 3 0 0 0 3 Rp 1,635,500 Rp 4,906,500.00
185 Cleaner 100 ml Botol 2 0 0 0 2 Rp 302,500 Rp 605,000.00
186 Reagen HB 25 ml Botol 2 0 0 0 2 Rp 128,000 Rp 256,000.00
187 reagen Gol darah Botol 7 0 0 0 7 Rp 390,000 Rp 2,730,000.00
188 Strip GDS Strip 100 0 0 0 100 Rp 4,996 Rp 499,600.00
189 Strip Uric Acid Strip 50 0 0 0 50 Rp 10,966 Rp 548,300.00
190 Strip Kolesterol Strip 30 0 0 0 30 Rp 27,095 Rp 812,850.00
191 Strip Protein (Cybow) Strip 620 0 0 0 620 Rp 1,352 Rp 838,240.00
192 Kapas Sweb Hal 0 0 0 0 0 Rp 10,000 Rp -
193 Blood Lancet box 10 0 0 0 10 Rp 14,566 Rp 145,660.00
194 Tabung EDTA Box 6 0 0 0 6 Rp 169,092.00 Rp 1,014,552.00
195 Hcl 0.1 N Botol 1 0 0 0 1 Rp 100,000.00 Rp 100,000.00
196 Spuit 1cc Buah 27 0 0 0 27 Rp 650.00 Rp 17,550.00
197 Blue TIP 1000 mikron Tip 3000 0 0 0 3000 Rp 227.10 Rp 681,300.00
198 Yellow TIP 200 mikron Tip 50 0 0 0 50 Rp 175.75 Rp 8,787.50

199 ves-tec cuvete Tabung 200 0 0 0 200 Rp 8,500.00 Rp 1,700,000.00

200 transfer Pipet 3 ml Buah 0 0 0 0 0 Rp 363.00 Rp -
201 Sampel Cup Buah 50 0 0 0 50 Rp 3,500.00 Rp 175,000.00
202 Mikrotainer Buah 30 0 0 0 30 Rp 3,423.42 Rp 102,702.60
203 Spuit 3 cc Buah 28 0 0 0 28 Rp 650.00 Rp 18,200.00
204 Spirtus Botol 0 0 0 0 0 Rp - Rp -
SUB TOTAL Rp 37,277,667.10
VI ALAT KONTRASEPSI dari BKBPMP
205 IUD Dus 26 0 0 0 26 Rp 13,156.00 Rp 342,056.00
206 PIL Strip 1805 0 0 0 1805 Rp 2,059.00 Rp 3,716,495.00
207 Susuk Implan Set 45 0 0 0 45 Rp 257,500.00 Rp 11,587,500.00
208 Suntik Vial 1197 0 0 0 1197 Rp 6,090.00 Rp 7,289,730.00
209 Kondom Gros 98 0 0 0 98 Rp 59,290.00 Rp 5,810,420.00
SUB TOTAL Rp 28,746,201.00
ALAT HABIS PAKAI
VII KEBERSIHAN DAN OBAT
(KANTONG PLASTIK) dari JKN
Kantong Plastik Hitam 45cm x
210 55cm (Kresek Biasa) Pak 30 0 0 0 30 Rp 18,500.00 Rp 555,000.00
Kantong Plastik Hitam Jumbo
211 Sampah 60cm x 100cm Pak 67 0 0 0 67 Rp 26,000.00 Rp 1,742,000.00

Kantong Plastik Kuning Jumbo

212 Sampah 60cm x 100cm Pak 100 0 0 0 100 Rp 26,000.00 Rp 2,600,000.00
Kantong Plastik Putih 25cm x
213 15cm Pak 10 0 0 0 10 Rp 22,000.00 Rp 220,000.00
Kantong Plastik Merah 35cm x
214 27cm Pak 0 0 0 0 0 Rp 22,000.00 Rp -
Kantong Plastik Merah 40cm x
215 50cm Pak 6 0 0 0 6 Rp 22,000.00 Rp 132,000.00
Kantong Plastik Bening 20cm x
216 15cm Kg 0 0 0 0 0 Rp 38,000.00 Rp -
Kantong Plastik Bening 10cm x
217 6cm Kg 0 0 0 0 0 Rp 41,000.00 Rp -
218 Plastik Klip polos 10cm x 7cm bks 50 0 0 0 50 Rp 7,000.00 Rp 350,000.00

219 Plastik Klip polos 13cm x 8,7cm bks 200 0 0 0 200 Rp 12,000.00 Rp 2,400,000.00
220 Gelas Plastik 200ml buah 0 0 0 0 0 Rp 200.00 Rp -
Kantong Plastik Putih 25cm x
221 15cm Pak 20 0 0 0 20 Rp 22,000.00 Rp 440,000.00
Kantong Plastik Merah 35cm x
222 27cm Pak 0 0 0 0 0 Rp 22,000.00 Rp -
Kantong Plastik Merah 40cm x
223 50cm Pak 0 0 0 0 0 Rp 22,000.00 Rp -
224 Plastik Klip polos 10cm x 7cm bks 100 0 0 0 100 Rp 7,000.00 Rp 700,000.00

225 Plastik Klip polos 13cm x 8,7cm bks 100 0 0 0 100 Rp 12,000.00 Rp 1,200,000.00
226 Gelas Plastik 200ml buah 0 0 0 0 0 Rp 200.00 Rp -
227 Facial Tissue (1000lbr/bks) bks 0 0 0 0 0 Rp 46,400.00 Rp -
228 Toilet Tissue (10 Roll/bks) bks 10 0 0 0 10 Rp 31,000.00 Rp 310,000.00
229 Tissue Makan pak 3 0 0 0 3 Rp 32,000.00 Rp 96,000.00
230 Stella Freshner Botol 2 0 0 0 2 Rp 43,900.00 Rp 87,800.00
231 HIGIN kantong sampah kecil Pack 0 0 0 0 0 Rp 88,200.00 Rp -
SUB TOTAL Rp 10,832,800.00
VIII ALAT LISTRIK dari JKN
232
Kabel Putih Eterna, 2 x 1,5 mm Roll 0 0 0 0 0 Rp 418,204.00 Rp -
233 Lampu Neon TL 60 Watt pcs 0 0 0 0 0 Rp 17,425.00 Rp -
234 Ballast/Starter neon TL elektrik
philips pcs 0 0 0 0 0 Rp 43,563.00 Rp -
235 Lampu hemat energi esential
LED, 11 Watt Pcs 15 0 0 0 15 Rp 40,659.00 Rp 609,885.00
236 Lampu hemat energi esential
LED, 18 Watt Pcs 11 0 0 0 11 Rp 45,015.00 Rp 495,165.00
237 MCB 20 A Pcs 2 0 0 0 2 Rp 18,151.00 Rp 36,302.00
238 MCB 3 pass, @20 A unit 0 0 0 0 0 Rp 63,345.00 Rp -
SUB TOTAL Rp 1,141,352.00
IX ALAT BHP GIGI dari JKN
239 Etsa Botol NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
240 Bonding Botol NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
241 ChKM Botol NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
242 Composit Syringe NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
243 Glass Ionomer cement Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
244 TKF Botol NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
245 Caviton Pot NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
246 Vaselin/Cocoa butter Pot NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
247 Alvogyl Pot NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
248 Celuloid strip Box NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
249 Saliva ejector Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
250 Tooth mousse tube NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
251 Microbrush set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
252 Matric band Roll NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
253 Polishing Bur Buah NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
254 Diamond Bur(high Speed) Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
255 Polishing Bur (Alpin bentuk
set
pear) NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
256 Devitalisasi Paste(Pulp X) Tube NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
257 High-speed handpiece W&H RC Botol
90 RM NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
258 W&H Low speed Alegra RM 4 Botol
Hole NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
259 pasta mumifikasi pot NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
260 Glass Ionomer cement Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
261 Tooth mousse tube NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
262 Diamond Bur(high Speed) Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
263 Paket Polishing(Disc Mini kit dan
Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
Spiral Kit)
264 Oil MD 400 WNH Botol NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
NIHIL
X SPANDUK dari JKN

265 Selamat datang lokbul Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
266 Selamat datang lokmin
tribulanan Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
267 Selamat datang tim Penyusun
PTP Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

268 Spanduk dukungan MTQ Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

269 BPJS gerakan revolusi mental Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
270 Selamat datang peserta lomba
Balita Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
271 Selamat datang Tim penilai
nakes teladan Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
272 Selamat Menjalankan ibadah
Puasa Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

273 Selamat Hari Raya Iedul Fitri Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

274 Akte Procot Gratis Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
275 Selamat datang Peserta
Pelatihan UKS Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
276 Selamat datang peserta lomba
kader Kes Sekolah Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

277 Imunisasi MR Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

278 Imunisasi MR Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

279 Play Ground Flexy 280 GSM Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

280 Play Ground Flexy 280 GSM Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
281
Posko Kesehatan Flexy 280 GSM Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
282 Sosialisasi Lintas Sektoral Flexy
280 GSM Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
283 Sselamat Datang Tim
Pendamping Flexy 280 GSM Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
284 Selamat Datang di Kawasan
Tanpa Roko Flexy 340 GSM
Dengan Pasang Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

285 Pintu Sanitasi Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

286 Jendela Sanitasi Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
Pintu Promkes Dan PKPR
287 Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
Jendela Promkes Dan PKPR
288 Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

289 Pintu PTM Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

290 Jendela PTM Onewa Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

291 Pintu Pojok Asi Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
292
Jendela Pojok Asi Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
293 Pintu Belakang Aula Oneway
Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
294
Pintu Utama Aula Oneway Stiker Lembar NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
NIHIL
XI BHP UGD dari JKN
295 GEA Oxygen Mask Adult /
Dewasa (100 Pcs/Box) Box NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
296 GEA Oxygen Mask Child / Anak
(100 Pcs/Box) Box NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
297
Aximed Female Catheter, No. 16 Piece NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
298
Aximed Female Catheter, No. 18 Piece NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
299 Suction Anak Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
300 Suction Dewasa Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
301 ETT No.6 Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
302 ETT No.7 Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
303 Pompa balon Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
304 Paket Spalk tangan dan kaki Set NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
SUB TOTAL NIHIL
XII BHP PEMBERSIH dari JKN
305 Rinso Anti Noda Powder
12x800g Karton 6 0 0 0 6 Rp 196,200.00 Rp 1,177,200.00
306 Vixal Pembersih Pors.Biru
800ml/12 Karton 0 0 0 0 0 Rp 168,000.00 Rp -
307
Wipol Lemon Pine Ref 800ml/12 Karton 7 0 0 0 7 Rp 158,400.00 Rp 1,108,800.00
308
Sunligth Lime New Ref 12x800ml Karton 1 0 0 0 1 Rp 164,400.00 Rp 164,400.00
309 Rinso Anti Noda Liquid Pch
12x800ml Karton 0 0 0 0 0 Rp 198,000.00 Rp -
310 Cling Pouch Glass Cleaner botol
425ml Botol 4 0 0 0 4 Rp 19,543.00 Rp 78,172.00
Bungku
311 Rapika Pouch 450ml s 13 0 0 0 13 Rp 13,959.00 Rp 181,467.00
312 Hand Soap ( Apple, Grape,
Lemon, Orange, Strawberry ) 3,7
liter 4 Jerigen Botol 4 0 0 0 4 Rp 139,594.00 Rp 558,376.00
313 Bayclin Reguler 4 L Botol 15 0 0 0 15 Rp 150,761.00 Rp 2,261,415.00
SUB TOTAL Rp 5,529,830.00
XIII BHP OBAT dari JKN
314 Stesolid RT 5 mg Tube (Box/5)
New Box NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
315 Stesolid RT 10 mg Tube (Box/5)
New Box NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
316
Diazepam 2mg, 100 tablet/botol Botol NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL

317 Loratadin 10mg,50 tablet/box Box NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
318 Vitamin B12 50mcg pot/1000 Pot NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
319 Kloramfenikol Tetes telinga Botol NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
NIHIL
XIV BHP BANGUNAN dari JKN
320 Kusen alumunium, Pintu P1 unit NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
321 Kusen alumunium, Jendela J1 unit NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
322 Kusen alumunium, Jendela J2 unit NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
323 Kusen alumunium, Jendela J3 unit NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
324 Gypsum board t.9 mm lbr NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
325 Coumpoun zak NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
326 Paku gypsum dus NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
327 Auning koridor penghubung m2 NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
328 Kayu kaso 4/6 m3 NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
329 Semen Gresik zak NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
330 Pasir truk NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
331 Bata bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
332 Batu split m3 NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
333 Besi beton Ø6 btg NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
334 Besi beton Ø8 btg NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
335 Paku kg NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
336 Keramik lantai 40x40 KW-1 dus NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
337 Cat tembok Catylak peil NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
338 Kuas cat 3" bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
339 Roll cat bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
340 Bak cat bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
341 Kabel listrik gl NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
342 T-dus bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
343 Solasi bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
344 Saklar Broco bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
345 Stop kontak Broco bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
346 Stop kontak AC Broco bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
347 Lampu SL 18 w bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
348 Lampu Downlight in-bow 9 w bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
349 Lampu Hias in-bow 22 w bh NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL NIHIL
NIHIL

Mengetahui, Kramatwatu, 09 Januari 2018 TIM PEMERIKSA :

Kepala UPT. PKM Kec. KRAMATWATU Petugas Pengurus Barang PKM Kramatwatu 1. Drs. H. Jajang Kusmara, M.Pd
NIP. 19651101 199301 1 001

2. Drs. Monang Nababan

NIP. 19670810 199403 1 014
dr.Enik Utmawati Sukron Malawi,S.Kep
NIP. 19770404200701 2 011 NIP. 198411152009022001 3. Kokom Sunarsih, S.Sos
NIP. 19700610 200312 1 004

4. Rukma Alfiana, SE.,M.Si

NIP. 19700610 200312 1 004

5. Iyos Rosandi, S.Pd

NIP. 19690505 200003 1 006

6. Nawa Ratri Rahayu, SE

NIP. 19740329 200604 2 004

7. Eriya Dewanti, S.Pd.

NIP. 19780402 200902 2 002