HARGA
TOTAL HARGA
NO NAMA BARANG SAT JML SATUAN
(Rp)
(Rp)
DAFTAR R
JUML
NO NAMA BARANG SATUAN AHIGD SIM&RM UMUM ANAK GIGI KIA KB
Jumlah Total
DUKUNG
JUMLAH HARGA
JML TOTAL HARGA
APOTEK KEUANGAN SATPAM DRIVER RADIOLOGI PERKIRAAN SATUAN
10 120 Rp 4,500 Rp 540,000
24 288 Rp 35,000 Rp 10,080,000
24 288 Rp 30,000 Rp 8,640,000
48 576 Rp 7,000 Rp 4,032,000
12 144 Rp 12,000 Rp 1,728,000
6 72 Rp 25,000 Rp 1,800,000
12 144 Rp 7,000 Rp 1,008,000
1 12 Rp 12,583 Rp 150,996
48 576 Rp 18,000 Rp 10,368,000
240 2880 Rp 1,000 Rp 2,880,000
24 288 Rp 10,000 Rp 2,880,000
10 120 Rp 10,000 Rp 1,200,000
12 144 Rp 12,500 Rp 1,800,000
20 240 Rp 10,000 Rp 2,400,000
10 120 Rp 15,000 Rp 1,800,000
10 120 Rp 2,000 Rp 240,000
6 72 Rp 12,500 Rp 900,000
30 360 Rp 10,000 Rp 3,600,000
30 360 Rp 150,000 Rp 54,000,000
10 120 Rp 25,000 Rp 3,000,000
30 360 Rp 19,000 Rp 6,840,000
30 360 Rp 19,000 Rp 6,840,000
50 600 Rp 5,000 Rp 3,000,000
20 240 Rp 15,000 Rp 3,600,000
12 144 Rp 40,000 Rp 5,760,000
12 144 Rp 50,000 Rp 7,200,000
6 72 Rp 15,000 Rp 1,080,000
522 6264 Rp 500 Rp 3,132,000
4 48 Rp 7,000 Rp 336,000
4 48 Rp 7,000 Rp 336,000
8 96 Rp 7,000 Rp 672,000
10 120 Rp 3,500 Rp 420,000
10 120 Rp 2,500 Rp 300,000
10 120 Rp 3,000 Rp 360,000
4 48 Rp 150,000 Rp 7,200,000
8 96 Rp 135,000 Rp 12,960,000
5 60 Rp 50,000 Rp 3,000,000
6 72 Rp 35,500 Rp 2,556,000
12 144 Rp 25,000 Rp 3,600,000
12 144 Rp 10,000 Rp 1,440,000
30 360 Rp 20,000 Rp 7,200,000
30 360 Rp 12,500 Rp 4,500,000
24 288 Rp 8,000 Rp 2,304,000
24 288 Rp 85,000 Rp 24,480,000
34 408 Rp 75,000 Rp 30,600,000
JUMLAH HARGA
JML TOTAL HARGA
APOTEK KEUANGAN SATPAM DRIVER RADIOLOGI PERKIRAAN SATUAN
20 240 Rp 150,000 Rp 36,000,000
12 144 Rp 8,000 Rp 1,152,000
24 288 Rp 11,000 Rp 3,168,000
6 72 Rp 15,000 Rp 1,080,000
6 72 Rp 50,000 Rp 3,600,000
2 24 Rp 200,000 Rp 4,800,000
50 600 Rp 13,000 Rp 7,800,000
12 144 Rp 5,000 Rp 720,000
20 240 Rp 10,000 Rp 2,400,000
10 120 Rp 15,000 Rp 1,800,000
12 144 Rp 20,000 Rp 2,880,000
36 432 Rp 10,000 Rp 4,320,000
Rp 322,482,996
322483000
KEPOLISIAN NEGARA REPUBLIK INDONESIA
DAERAH JAWA TIMUR
BIDANG KEDOKTERAN DAN KESEHATAN
RUMAH SAKIT BHAYANGKARA TK. III LUMAJANG
UNIT : ………………..
HARGA
NO NAMA BARANG SATUAN JML TOTAL HARGA
SATUAN
1 Bed paramount unit 8 Rp 44,000,000 Rp 352,000,000
2 Bed paramount bayi unit 2 Rp 7,000,000 Rp 14,000,000
3 Blander obat unit 1 Rp 1,700,000 Rp 1,700,000
4 Dopler buah 1 Rp 2,000,000 Rp 2,000,000
5 ECG unit 1 Rp 47,000,000 Rp 47,000,000
6 Head box buah 5 Rp 880,000 Rp 4,400,000
7 Infus pump unit 2 Rp 47,470,000 Rp 94,940,000
8 Monitor pasien unit 2 Rp 19,000,000 Rp 38,000,000
9 Regulator buah 21 Rp 350,000 Rp 7,350,000
10 Sterilisator buah 2 Rp 4,800,000 Rp 9,600,000
11 Suction pump unit 2 Rp 5,000,000 Rp 10,000,000
12 Syrenge pump unit 2 Rp 28,280,000 Rp 56,560,000
13 Tensi dewasa buah 5 Rp 1,980,000 Rp 9,900,000
Jumlah Total Rp 647,450,000
Rp 630,000,000
KEPOLISIAN NEGARA REPUBLIK INDONESIA
DAERAH JAWA TIMUR
BIDANG KEDOKTERAN DAN KESEHATAN
RUMAH SAKIT BHAYANGKARA TK. III LUMAJANG
UNIT : ………………..
Rp 139,067,000
NO RUANG / UNIT
1 IGD
2 SIM & RM
3 POLI UMUM
4 POLI ANAK
5 POLI GIGI
6 POLI KIA KB
7 POLI SPESIALIS
8 MATKES
9 URMIN
10 BPJS & KASIR
11 POS 1
12 POS 2
13 POS 3
14 POS 4
15 PERINATOLOGI
16 ICU
17 INSTALASI GIZI
18 LABORATORIUM
19 CLEANING SERVICE
20 LOUNDRY
21 APOTEK
22 KEUANGAN
23 SATPAM
24 DRIVER
KEPOLISIAN NEGARA REPUBLIK INDONESIA
DAERAH JAWA TIMUR
BIDANG KEDOKTERAN DAN KESEHATAN
RUMAH SAKIT BHAYANGKARA TK. III LUMAJANG
HARGA
TOTAL HARGA
NO NAMA BARANG SAT JML SATUAN KETERANGAN
(Rp)
(Rp)
1 Amplop Coklat Besar box 30 17,500 525,000 Kerjasama
2 Amplop Coklat Panjang box 48 6,500 312,000 dengan UD
Venus
3 Amplop Putih Besar Paperline box 74 17,500 1,295,000
4 Amplop Putih Kecil Paperline box 102 12,500 1,275,000
5 Bak Stempel buah 63 7,500 472,500
6 Balpoint buah 309 1,500 463,500
7 Baterai AAA (A3) pak 128 8,500 1,088,000
8 Baterai Besar buah 146 4,500 657,000
9 Baterai Kecil (Jam) buah 58 1,750 101,500
10 Baterai Kamera (A2) pak 128 9,000 1,152,000
11 Binder Klip 155 pak 39 9,000 351,000
12 Binder Klip 200 pak 30 12,000 360,000
13 Binder Klip 260 pak 30 15,000 450,000
14 Box CD buah 24 2,000 48,000
15 Buffalo Biru rim 37 22,500 832,500
16 Buffalo Kuning rim 44 22,500 990,000
17 Buku Expedisi buah 176 10,000 1,760,000
18 Buku Folio Besar 200 buah 123 20,000 2,460,000
19 Buku Folio Besar 100 buah 18 12,000 216,000
20 Buku Tulis Kwarto buah 22 5,500 121,000
21 Buku Tulis Biasa buah 245 2,000 490,000
22 Buku Kas buah 53 15,000 795,000
23 Catridge Epson Lq-2190 buah 2 100,000 200,000
24 CD RW buah 100 3,000 300,000
25 Cutter Besar buah 92 13,500 1,242,000
26 Double Tip buah 40 6,000 240,000
27 Etiket Stiker Besar pak 37 2,000 74,000
28 Etiket Stiker Kecil pak 70 2,000 140,000
29 Gunting Besar buah 74 10,000 740,000
30 Isi Staples Besar buah 18 17,500 315,000
31 Isi Staples No 10 pak 842 2,000 1,684,000
32 Isi Staples No 3 buah 56 4,500 252,000
33 Isolasi Besar buah 110 6,000 660,000
34 Jam Dinding buah 15 40,000 600,000
35 Kalkulator buah 20 80,000 1,600,000
36 Kertas 3 Play dos 7 350,000 2,450,000
37 Kertas A4 rim 262 31,500 8,253,000
38 Kertas F4 rim 326 35,000 11,410,000
39 Kertas Fax roll 24 20,000 480,000
40 Kertas F4 Hijau rim 12 37,500 450,000
41 Kertas F4 Kuning rim 12 37,500 450,000
42 Kertas F4 Merah Muda rim 12 37,500 450,000
43 Klip Kertas Besar pak 46 3,500 161,000
44 Klip Kertas Kecil pak 38 2,000 76,000
45 Lakban Bening buah 39 12,000 468,000
46 Lakban Coklat buah 2 11,000 22,000
47 Lakban Hitam 1" (tanggung) roll 46 8,000 368,000
48 Lakban Hitam 2" (besar) roll 80 10,000 800,000
HARGA
TOTAL HARGA
NO NAMA BARANG SAT JML SATUAN KETERANGAN
(Rp)
(Rp)
49 Lem buah 113 2,000 226,000
50 Map Odner buah 181 15,000 2,715,000
51 Map Snailhegter buah 118 2,500 295,000
52 Pencil Red Blue buah 36 1,750 63,000
53 Penggaris buah 55 1,750 96,250
54 Penghapus Pencil buah 36 1,750 63,000
55 Pensil 2b biji 71 3,000 213,000
56 Perperator buah 31 15,000 465,000
57 Pita Printer Lx 300 buah 24 42,500 1,020,000
58 Senter buah 42 20,000 840,000
59 Silet pak 60 4,500 270,000
60 Spidol Board Biru buah 16 6,500 104,000
61 Spidol Board Hitam buah 142 6,500 923,000
62 Spidol Board Merah buah 10 6,500 65,000
63 Spidol Permanen Hitam buah 181 5,500 995,500
64 Spidol Permanen Hitam kecil buah 36 7,500 270,000
65 Stabillo buah 5 7,500 37,500
66 Staples buah 87 12,500 1,087,500
67 Tinta Printer Biru botol 54 75,000 4,050,000
68 Tinta Printer Hitam botol 115 75,000 8,625,000
69 Tinta Printer Kuning botol 54 75,000 4,050,000
70 Tinta Printer Merah botol 54 75,000 4,050,000
71 Tinta Stempel buah 55 7,000 385,000
72 Tipe X buah 105 5,000 525,000
73 Taner Stick buah 11 11,500 126,500
Sub Total Alat Tulis Kantor 81,660,250
1 Amplop Ekg Lbr 4,800 1,500 7,200,000
2 Amplop Hasil Laborat bdl 36 40,000 1,440,000
3 Amplop Putih Besar Kop RS Lbr 119 40,000 4,760,000
4 Amplop Ro Besar Lbr 4,000 2,500 10,000,000
5 Amplop Ro Kecil Lbr 2,000 2,000 4,000,000
6 Checklist Pre & Post Op (RM) bdl 12 20,000 240,000
7 Copi Resep bdl 84 8,000 672,000
8 Etiket Obat Luar (Apt) rim 6 50,000 300,000
9 Etiket Obat Sirup (Apt) rim 6 50,000 300,000
10 Etiket Obat Tablet (Apt) rim 24 50,000 1,200,000
11 Etiket Perkomen (Apt) rim 6 50,000 300,000
12 Karcis Parkir bdl 360 7,500 2,700,000
13 Karcis Poli Anak bdl 10 6,000 60,000
14 Karcis Poli Gigi bdl 10 6,000 60,000
15 Karcis Poli Kandungan bdl 10 6,000 60,000
16 Karcis Poli Spesialis bdl 25 6,000 150,000
17 Karcis PU 0001 (2015) bdl 25 6,000 150,000
18 Kartu Stock buah 500 1,000 500,000
19 KCO bdl 100 15,000 1,500,000
20 Kwitansi Dapur bdl 60 10,000 600,000
21 Kwitansi Kasir bdl 60 12,000 720,000
22 Kwitansi Kecil bdl 1,050 10,000 10,500,000
23 Lbr Biru Dokter bdl 60 15,000 900,000
24 Lbr Bon Askes bdl 10 15,000 150,000
25 Lbr Catatan Anestesi (RM) bdl 120 17,500 2,100,000
26 Lbr Catatan Dokter (RM) bdl 248 15,000 3,720,000
27 Lbr Catatan Naik Kelas bdl 120 17,500 2,100,000
28 Lbr Catatan Perawat (RM) bdl 248 15,000 3,720,000
29 Lbr Catatan Perkembangan (RM) bdl 120 16,000 1,920,000
30 Lbr Catatan Tindakan bdl 120 15,000 1,800,000
HARGA
TOTAL HARGA
NO NAMA BARANG SAT JML SATUAN KETERANGAN
(Rp)
(Rp)
31 Lbr Disposisi bdl 20 12,500 250,000
32 Lbr Hasil Laboratorium rim 60 125,000 7,500,000
33 Lbr Hasil Laboratorium Manual bdl 10 20,000 200,000
34 Lbr Identitas Bayi (biru) RM bdl 140 20,000 2,800,000
35 Lbr Identitas Bayi (merah) RM bdl 140 20,000 2,800,000
36 Lbr Identifikasi Bayi (biru) bdl 140 20,000 2,800,000
37 Lbr Identifikasi Bayi (merah) bdl 140 20,000 2,800,000
38 Lbr Jaminan Asuransi bdl 180 15,000 2,700,000
39 Lbr Keterangan Imuninasi bdl 66 17,500 1,155,000
40 Lbr Konsultasi Dokter (RM) bdl 120 17,500 2,100,000
41 Lbr Laporan Anestesi (RM) bdl 120 17,500 2,100,000
42 Lbr Non DPHO Askes bdl 10 16,500 165,000
43 Lbr Observasi Besar bdl 72 20,000 1,440,000
44 Lbr Observasi Fototherapy (RM) bdl 72 20,000 1,440,000
45 Lbr Observasi Kala I (RM) bdl 60 20,000 1,200,000
46 Lbr P2 Askes bdl 10 8,500 85,000
47 Lbr P3 Askes bdl 10 15,000 150,000
48 Lbr Partograf (RM) bdl 10 25,000 250,000
49 Lbr Pemeriksaan fisik bayi bdl 140 25,000 3,500,000
50 Lbr Penolakan Tindakan (RM) bdl 166 17,500 2,905,000
51 Lbr Permintaan Laboratorium bdl 232 20,000 4,640,000
52 Lbr Permintaan RO bdl 86 19,800 1,702,800
53 Lbr Pers Anestesi (RM) bdl 120 20,000 2,400,000
54 Lbr Pers Pembedahan (RM) bdl 120 20,000 2,400,000
55 Lbr Rincian Igd bdl 80 10,000 800,000
56 Lbr Rincian Operasi bdl 120 16,500 1,980,000
57 Lbr Rincian Rawat Jalan bdl 212 8,500 1,802,000
58 Lbr Sebab Kematian (RM) bdl 78 17,500 1,365,000
59 Map Coklat Rumah Sakit buah 400 3,000 1,200,000
60 Map Narkoba buah 500 3,000 1,500,000
61 Nota Dapur bdl 60 16,500 990,000
62 Resep Askes bdl 60 8,000 480,000
63 Resep Buram bdl 132 2,500 330,000
64 Resep Kuning bdl 1,972 7,500 14,790,000
65 Resep Putih bdl 2,136 7,500 16,020,000
66 Rincian Penerimaan Umum bdl 360 21,000 7,560,000
67 Status R. Inap (RM) bdl 10,000 6,550 65,500,000
68 Status R. Inap Asuransi (RM) bdl 10,000 6,550 65,500,000
69 Status R. Jalan (RM) buah 10,000 3,530 35,300,000
70 Surat Kelahiran bdl 24 16,500 396,000
71 Surat Keterangan R. Inap bdl 68 16,500 1,122,000
72 Surat Keterangan Istirahat bdl 31 10,000 310,000
73 SKET Kesehatan Badan bdl 6 16,500 99,000
74 Surat Pesanan Obat Narkotika bdl 12 16,500 198,000
75 Surat Pesanan Obat Psikotropik bdl 6 16,500 99,000
76 Surat Pesanan Obat Umum bdl 36 16,500 594,000
77 Surat Rujukan bdl 28 16,500 462,000
78 Tracer Warna Hijau (RM) buah 200 1,500 300,000
79 Tracer Warna Merah (RM) buah 200 1,500 300,000
80 Usulan Bon Ruangan bdl 972 16,500 16,038,000
Sub Total Barang Percetakan 348,339,800
Jumlah Total 430,000,050
Mengetahui, 430,000,000
Lumajang, September 2014
KARUMKIT BHAYANGKARA TK. III LUMAJANG KAURJANGUM
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31002
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31002