AMPRAHAN

PEMERINTAH KABUPATEN
DINAS KESEHA
Seketariat : Kantor Dinas Kesehatan K
LAPORAN PEMAKAIAN DAN LEMBAR PE
KODE PUSKESMAS : ………………………….
NAMA PUSKESMAS : PUSKESMAS LASOLO
KECAMATAN : LASOLO
KABUPATEN : KONAWE UTARA
PROPINSI : SULAWESI TENGGARA
KEMASAN SATUAN
NO. NAMA OBAT STOK AWAL PENERIMAAN
SATUAN HARGA
1 2 3 4 5 6
1 Allopurinol tablet 100 mg Kotak, 10 x 10 Tablet 90.00
2 Allopurinol Tablet 100 Mg Kotak, 10 x 10 Tablet 142.00 1100 0
Aminofilin injeksi 24 mg/ml Kotak, 30 ampul @ 10 ml 4,204.00 45

3
4 Amitriptilin 25 mg tab Kotak 10 x 10 Tablet 123.00
5 Amlodipin tablet 5 mg Kotak, 3 x 10 Tablet 105.00
6 Amlodipin tablet 5 mg Kotak, 3 x 10 Tablet 200.00 390 0
7 Amoksisilin kapsul/kaplet 250 mg Kotak 10 x 12 Kaplet 220.00
8 Amoksisilin kapsul/kaplet 250 mg Kotak 10 x 10 Tablet 215.00 900 0
9 Amoksisilin Kaplet 500 mg Kotak 10 x 10 Tablet 192.00 2700 0
10 Amoxicilliyn Syrup 125 mg/ml Botol, 30 ml 5,075.00 15 0
11 Antasida DOEN I tablet kunyah, kombinasi Ktk, 10 strip @ 10 tab 78.00 0
12 Antasida Tablet Kotak, 10 x 10 Tablet 96.00 900 0
Antihemoroid DOEN kombinasi : Bismut subgalat 150 mg Ktk 10 supp @ 2 gr 3,350.00 10

13
14 Antimalaria DOEN kombinasi : Ktk, 10 Blister @ 10 tab 572.00 100
Antimigren tablet : Ergotamin Tartat 1 mg + Kofein 50 mg Btl 100 tablet 149.00

15
Asam Asetilsalisilat 80 mg (Asetosal) / Miniaspi tab Ktk, 10 strip @ 10 tab 125.00

16
17 Asam Asetilsalisilat tablet 100 mg (Asetosal) Ktk, 10 strip @ 10 tab 157.00
18 Asam askorbat 50 mg Ktk, 10 strip @ 10 tab 105.00
19 Asam Askorbat (Vit C) 50 mg Kotak 10 x 10 Tablet 125.00
20 Asam Askorbat (Vit C) 250 mg Kotak 10 x 10 Tablet 139.00 50 0
21 Asam Folat tablet 1 mg Btl 100 tablet 52.00
22 Asam Mefenamat kaplet 500 mg Ktk, 10 strip @ 10 tab 127.00
23 Asam Mefenamat 500 mg Kotak, 10 x 10 Tablet 211.00 3200 0
24 Asam Tranexamat Inj Box 10 Ampul 3,650.00
25 Aseptan 500 ml + Dispenser Btl 500 ml 39,150
26 Asiklovir tablet 200 mg Ktk, 10 strip @ 10 tab 251.00
27 Asiklovir tablet 200 mg Kotak 10 x 10 Tablet 276.00
28 Asiklovir tablet 400 mg Ktk, 10 strip @ 10 tab 362.00 100

29 Asiklovir tablet 400 mg Kotak, 10 x 10 Tab 387.00
30 Bacitracin Salep Tube @ 5 g 2,767.00
31 Bedak Salisil Serbuk 2% Kotak 1,350.00
32 Bedak Salisil Serbuk 2% Kotak 1,081.00 80 0

Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
1 sase @ 30 tab 45.00
33 (tablet tambah darah kombinasi )
34 Betametason krim 0.1 % (sebagai Valerat) ktk, 25 tube @ 5 g 1,596.00 0 0
35 Betametason krim 0.1 % (sebagai Valerat) Ktk, 25 tube @ 5 g 1,444.00 100 0
36 Betametason krim 0.5 mg/g (Skizon) Tube 3,575.00
37 Bisakodil Suppositoria 10 mg (Stolax Supp) ktk, 6 Supp @ 10 mg 6,045.00
38 Calcium Laktate (Kalk) tablet 500 mg Dus, 10 Blister x 10 tab 72.00 0
39 Calcium Laktate (Kalk) tablet 500 mg Kotak, 10 x10 Tablet 187.00 800 0
40 Captopril 12.5 mg Kotak, 10 x 10 Tablet 69.00 0
41 Captopril 12.5 mg Kotak, 10 x 10 Tablet 72.00 600 0
42 Captopril 25 mg Kotak, 10 x 10 Tablet 127.00 1000 0
44 Cetirizin Syrup (Trisela Syrup) Botol 22,500.00
45 Ciprofloxacin tab 500 Mg Kotak. 10 x 10 Tab 264.00 400 0
46 Clindamycin Kapsul 300 mg Dus, 5 Blister @ 10 kps 693.00
47 Deksametason injeksi i.v. 5 mg/ml ktk 100 amp @ 1 ml 1,738.00 0
48 Deksametason injeksi i.v./i.m 5 mg/ml Kotak 100 Amp 1,820.00
49 Deksametason tablet 0,5 mg Ktk, 10 strip @ 10 tab 68.00
50 Deksamethason Tablet 0.5 mg Kotak, 10 x 10 Tablet 162.00 0
51 Diazepam injeksi 5 mg/ml Ktk, 30 amp @ 2 ml 2,578.00 0
52 Difenhidramin Inj i.v/i.m 10 mg/ml (Hcl) Kotak, 30 ampul 1,415.00
53 Digoksin 0.25 mg Kotak 10 x 10 Tablet 110.00 50 0
54 Diltiazem HCl tablet 30 mg Ktk, 10 strip @ 10 tab 141.00
55 Diltiazem HCl tablet 30 mg Kotak 10 x 10 Tablet 143.00
56 Domperidon suspensi 5 mg/5 ml Dus, 50 btl @ 60 ml 3,490.00
57 Domperidon suspensi 5 mg/5 ml Kotak 50 Botol @ 60 ml 3,300.00 46 0
58 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 174.00
59 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 138.00 600 0
60 Dulcolax 10 Mg Supp Ktk, 50 Suppo 5,800.00 12 0
61 Dulcolax 5 Mg Supp Ktk, 6 Suppo 5,670.00 0
62 Dulcolax 5 Mg Supp Ktk, 6 Suppo 16,291.67
63 Epinefrin (Adrenalin) Inj i.v/s.k./i.m 1 mg/ml Ampul 2,354.00 0
64 Eritromisin Kaplet 500 mg Kotak, 10 x 10 Kaplet 771.00 1800 0
65 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ktk 30 amp @ 1 ml 1,980.00
66 Fenobarbital tablet 30 mg Ktk, 10 strip @ 10 tab 74.00 0

Ferro Fumarat 60 mg + as.Folat 0.4 mg Tablet salut gula
Kotak, 3 x 10 Tablet 430.00
67 (Tablet Tambah Darah)
68 Furosemid injeksi i.v./i.m. 10 mg/ml Ktk, 25 amp @ 2 ml 2,012.00
69 Furosemid injeksi i.v./i.m. 10 mg/ml Kotak, 25 Ampul 2,992.00 35 0
70 Furosemid Tablet 40 mg Kotak, 10 x 10 Tablet 117.00 100 0
71 Fitomenadion (Vit.K1) tablet salut gula 10 mg Btl 100 tablet 698.00
72 Fitomenadion (Vit.K1) tablet salut gula 10 mg Kotak, 10 x 10 Tablet 835.00 500 0

73 Fitomenadion (Vit.K1) Inj. i.m 2 mg/ml Ktk, 30 Amp @ 2 ml 3,754.00
74 Fitomenadion (Vit.K1) Inj. i.m 2 mg/ml Kotak 30 Ampul 4,260.00 30 0
Garam Oralit Kombinasi : natrium klorida 0.52 g + kalium

klorida 0.030 g + trinatrium sitrar 0.58 g + glukosa Kotak 100 Sachet 278.00 65 0
anhidrat 2.7 g
75
76 Gentamisin Sulfat tetes mata 0,3 % ktk 10 btl @ 5 ml 3,513.00
77 Glibenclamide Tablet 5 mg Kotak, 10 x 10 Tablet 126.00 1100 0
78 Glukosa larutan infus 5 % steril Botol 500 ml 6,900.00
80 Glukosa larutan infus 10 % steril Botol 500 ml 7,500.00 0 0
81 Glyceryl Guaiacolate (GG) Botol, 100 Tablet 41.00
82 Griseofulvin tablet 125 mg Dus, 10 Blister x 10 tab 258.00
83 Griseofulvin tablet 125 mg Dus, 10 x 10 tablet 230.00 0
84 Griseofulvin tablet 125 mg Kotak, 10 x 10 Tablet 266.00
85 Haloperidol tablet 0,5 mg ktk 10 x 10 tab 62.00
86 Hidroklorotiazida (HCT) tablet 25 mg btl 1000 tablet 36.30
87 Hidroklorotiazida (HCT) tablet 25 mg Kotak, 100 Tablet 179.00
88 Hidrokortison 2.5 % Krim Kotak, 24 Tube 2,848.00
89 Ibuprofen tablet 200 mg Kotak 10 x 10 Tablet 116.00 700 0
90 Ibuprofen Tablet 400 mg Kotak 10 x 10 Tablet 193.00 800 0
91 Isosorbid Dinitrat tablet sublingual 5 mg Dus, 10 Strip @ 10 tab 98.00
92 Isosorbid Dinitrat 5 mg Kotak 10 x 10 Tablet 96.00 100 0
93 Karbamazepin tablet 200 mg Dus, 10 Strip @ 10 tab 315.00 0
94 Ketokonazole Krim Tube 2,554.00
95 Ketokonazol tab 200 Mg Kotak, 5 x 10 Tablet 308.00
96 Kloramfenikol kapsul 250 mg Ktk 10 x 10 kapsul 275.00
97 Kloramfenikol suspensi 125 mg/ 5 ml Botol 60 ml 5,500.00
98 Kloramfenikol suspensi 125 mg/ 5 ml Botol 5,170.00
99 Kloramfenikol 1% Salep Mata Tube 1,900.00 8 0
100 Kloramfenikol tetes telinga 3 % Btl 5 ml 1,759.00
101 Klorfeniramina Maleat (CTM) tablet 4 mg ktk 10 x 10 tablet 54.00 0
102 Klorfeniramina Maleat (CTM) tablet 4 mg ktk 10 x 10 tablet 46.00
103 Klorpromazin Tab 25 mg Kotak, 10 x 10 tablet 178.00
104 Klorpromazin Inj i.m 25 mh/ml (HCL) Kotak 30 Ampul 1,489.00
105 Kodein tablet 10 mg Ktk 10 x 10 tablet 517.00
106 Kotrimoksazol DOEN I (dewasa) kombinasi : Strik 10 x 10 tablet 152.00
107 Kotrimoxazole Tablet 480 mg Kotak, 10 x 10 Tablet 152.00
108 Kotrimoxazole Tablet 480 mg Kotak, 10 x 10 Tablet 192.00 1400 0

Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg
Botol 60 ml 2,298.00
109 + Trimetoprim 40 mg / 5 ml
110 Kotrimoksazol Syr Botol 4,200.00 17 0
111 Loperamid tablet 2 mg Kotak, 10 x 10 Tablet 97.00 500 0
112 Loperamid tablet 2 mg Kotak, 10 x 10 Tablet 609.00
113 Metformin HCl tablet 500 mg ktk 10 x 10 tablet 195.00 0
114 Metformin HCl tablet 500 mg Kotak, 10 x 10 Tablet 120.00 300 0
115 Methylprednisolone 4 mg Kotak, 10 x 10 Tablet 364.00 900 0

116 Methyl Ergometrin Inj 0.2 mg/ml Kotak, 100 Amp 2,684.00 60 0
117 Metoklopramide tablet 10 mg Ktk 10 x 10 tablet 110.00 800 0
118 Metoclopramide tablet 10 mg Kotak, 10 x 10 Tablet 93.00
119 Metoklopramide Drops 10 ml (Gavistal Drops) Botol 10 ml 5,830.00
120 Metronidazol tablet 500 mg ktk 100 tab 169.00
121 Metronidazol tablet 500 mg Kotak, 10 x10 Tablet 102.00 200 0
122 Mikonazol krim/salep 2 % (Nitrat) ktk 24 tube 3,150.00
123 Mikonazole Krim 2% 5 gr Kotak, 24 Tube 2,030.00 29 0
124 Natrium Diklofenak tablet 25 mg ktk 5 x 10 tablet 146.00
125 Natrium Diklofenak 25 mg Kotak 5 x 10 Tablet 178.00 250 0
127 Natrium Klorida larutan infus 0,9 % Botol 500 ml 6,410.00 42 0
128 New Antides Tablet (Atapulgit) Dus, 10 x 10 tablet 199.00
129 Neodin 10 % 30 ml Botol 30 ml 3,112.50 60 0
130 Neodin 10 % 300 ml Botol 300 ml 19,000.00
132 Nifedipin tablet 10 mg ktk 10 x 10 tablet 127.00
134 Nifedipin Kapsul 10 mg Kotak, 10 x 10 Kapsul 203.00 180 0
Nistatin vaginal tablet 100.000 IU/ g ktk 10 x 10 tablet vaginal 528.00 150 0
135
136 Nistatin vaginal tablet 100.000 IU/ g Kotak 10 x 10 Tablet 628.00
137 Nistatin Tablet 500.000 IU/g Kotak 10 x 10 Tablet 895.00 150 0
138 Novaxifen Syrup (Ibuprofen Syr) Botol, 60 ml 5,538.00 7 0
139 Omeprazol kapsul 20 mg ktk 3 x 10 kapsul 221.00
140 Omeprazol kapsul 20 mg Kotak 3 x 10 Kapsul 176.00 930 0
141 Oxytetraciklin Salep Kulit 3% Tube 1,800.00
142 Oxytetraciklin Salep Mata 1% Tube 2,580.00
143 Oxytocin Inj 10 UI/ml Kotak, 100 Amp 1,900.00 135 0
144 Parasetamol drops Botol 15 ml 6,240.00
145 Parasetamol drops (Sanmol Drop) Botol 21,000.00 5 0
146 Parasetamol Sirup 120 mg / 5 ml Btl 60 ml 1,535.00
147 Parasetamol Sirup 120 mg / 5 ml Dus 84 Btl @ 60 ml 1,338.00 130 0
148 Parasetamol tablet 500 mg Strip 10 x 10 tablet 88.00
149 Parasetamol Tablet 500 mg Kotak, 10 x 10 Tablet 186.00 2400 0
150 Pirantel sirup 125 mg/5 ml Btl 60 ml 9,100.00
151 Pirantel tablet score (base) 125 mg ktk25 blister @ 4 tab 318.00 0
152 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Ktk 10 x 10 Tablet 121.00
153 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Kotak 10 x 10 Tablet 142.00 100 0
154 Polikrisulen (Aptil) Btl 18,635.00
155 Povidon iodine 10% Botol 60 ml 7,040.00 0 0
156 Povidon Iodine 300 ml (Kokodin) Botol 300 ml 13,987.00 0
157 povidon iodine 10% (kokodin) Btl 300 ml 15,386.00

160 Prednisone Tablet 5 mg Botol, 1000 Tablet 86.00 1550 0
161 Propanolol tablet 40 mg (HCl) box 100 tab 114.00
162 Propiltiourasil tablet 100 mg Btl plastik @ 100 tablet 351.00
163 Propiltiourasil tablet 100 mg Kotak, 10 x 10 Tablet 650.00
164 Pyrazinamide 500 mg tab ktk 10 x 10 tablet 225.00
165 Ranitidin injeksi 25 mg/2 ml ktk 10 amp @ 2 ml 1,340.00 90 0
166 Ranitidin tablet 150 mg ktk 10 x 10 tablet 128.00 800 0
167 Ranitidin tablet 150 mg ktk 10 x 10 tablet 119.00
168 Retinol (Vitamin A) 100.000 UI Botol, 50 Caps 341.00
170 Ringer Laktat larutan infuse Botol 500 ml 5,720.00
171 Ringer Laktat larutan infuse Botol 500 ml 7,150.00 220 0
172 Rivanol Botol 300 ml 3,327.75 0 0
173 Salbutamol tablet 2 mg (sebagai Sulfat) Ktk 10 x 10 tablet 65.00
174 Salbutamol tablet 2 mg (sebagai Sulfat) Kotak 10 x 10 Tablet 69.00 300 0
175 Salbutamol tablet 4 mg (sebagai Sulfat) Ktk 10 x 10 tablet 93.00 0
177 Sefiksim sirup kering 100 mg/ 5 ml btl 30 ml 9,400.00
178 Sefotaksim injeksi 1 g Ktk 10 vial 3,500.00 70 0
179 Seftriakson serbuk injeksi 1 g/ vial ktk 10 vial 3,900.00
180 Sianokobalamin (vit B 12) tablet 50 mg Ktk 10 x 10 tablet 63.00 0
181 Simvastatin 20 mg Kotak 5 x 10 Tablet 252.00 0
182 Simvastatin Tablet 10 mg Kotak, 3 x 10 tablet 373.00 360 0
183 Spironolactone tab 100 mg ktk 10 x 10 tablet 878.00
184 Tetrasiklin kapsul/kaplet 250 mg Ktk 10 x 10 kapsul 162.00
185 Tetrasiklin kapsul 250 mg Kotak 10 x 10 Tablet 178.00
186 Tetrasiklin kapsul 500 mg ktk 10 str x 10 kapsul 325.00
187 Tetrasiklin 500 mg Kotak 10 str x 10 kapsul 341.00
188 Tiamin ( Vitamin B1) 50 mg Ktk 10 x 10 tablet 85.00 500 0
189 Vitamin B Kompleks Kotak 10 x 10 Tablet 138.00 1900 0
190 Zinc tablet 20 mg Dus, 10 Stip @ 10 tab 618.00
191 Zinc tablet 20 mg Kotak, 10 x 10 Tablet 700.00
192 Zinkid 10mg/5ml Syrup Dus 24 Botol @ 100 ml 16,478.00
193 Zinc Syrup 10mg/ml Botol 41,333.00

Obat Brendit -
1 Alpamol Syr Botol 60 ml 7,300.00 5 -
2 Alpara Syr Botol 60 ml 11,200.00
3 Anaria Syr Botol 60 ml 14,213.00
4 Anaton Syr Botol 60 ml 12,012.00 0
5 Becefor Tablet Ktk, 10 x 10 caps 1,407.75
6 Becefort Tablet Kotak 10 x 10 Tablet 1,380.00 0
7 Becefor Syr Botol 60 ml 15,787.00
8 Benovit C Dragee Kotak 10 x 10 Tablet 1,652.30 0
9 Cetrin 10 mg Kotak, 3 x 10 Tab 550.00 0
10 Dextral Kaplet Kotak 15 x 10 Kaplet 460.00 300 -

11 Etil Clorida Spray 100 ml Botol 100 ml 115,000.00
12 Etil Clorida Spray 100 ml Botol 100 ml 124,000.00 0
13 Extra Flu Kotak 100 Kaplet 480.00 0
14 Fervital Tab Kotak 10 x 10 Tablet 860.00 0
15 Fevrin Syrup Botol 60 ml 18,120.00
16 Hemafort Tablet Ktk 10 x 10 Tablet 759.00 0
17 Hexavask 10 Ktk 3 x 10 Tab 1,666.67 0
18 Hustab P Syr Btl 60 ml 7,315.00
19 Hustab P Syr Botol 60 ml 8,778.00
21 Itranervit.E Kotak 10 x 10 Tablet 1,045.55 0
22 Livcopec Kotak 100 Kaplet 600.40
23 Livron B Pleks Ktk 10 x 10 Tab 220.00
24 Livron B Pleks Kotak 10 x 10 Tablet 264.00 0
25 Molagit Tablet Ktk, 150 Tab 601.02 50 -
26 Molagit Tablet Kotak 15 x 10 tab 437.34
27 Molexflu Kaplet Kotak 15 x 10 tab 360.67 0
28 Molexflu Syr Botol 60 ml 6,100.00
29 Neokaminal Suspensi Botol 60 ml 7,200.00 0 -
30 Novadiar Syr botol 60 ml 7,650.00
31 Novapyron tablet Dus, 10 Stip @ 10 tab 645.50 0
32 Noza Tablet Ktk, 25 x 4 Tab 725.00
33 Noza Tablet kotak 25 x 4 Tablet 870.00
34 Otsu MgSO4 20% vial 25 ml 6,000.00 0 -
35 Pehacain Inj Kotak, 20 Ampul 3,396.05 80 -
36 Pehacain Inj Kotak, 20 Ampul 2,830.00
37 Pehavral Tablet Ktk, 10 x 10 Tablet 740.00 0
38 Pehachlor tab (ctm) Btl 1500 tab 70.92 1000 -
39 Poncolin Syrup Botol 60 ml 16,850.00
40 Poconeuron Tablet Ktk 10 x 10 Tablet 1,285.00 0
41 Pritagesic Kaplet Kotak 10 x 10 kaplet 518.00 0
42 Procurma Plus Syr Botol 60 ml 11,500.00 0
43 Tensi Gard Tablet Ktk, 30 Tablet 1,950.00 0
44 Anaton Tab Ktk,10 Strip @ 10 Kaptab 971.52
45 Butasal Tab Ktk, 10 Strip @10 Kapl 592.02
46 Fervital Tab Ktk, 10 Strip @ 10 Kaps 989.74 0
47 Guanistrep Syr Botol 60 ml 15,300.00
48 Itrabat Syr Botol 60 ml 25,428.00
49 Itracycline 250 mg Btl @ 1000 Capsul 291.46
50 Itracycline 250 mg Ktk, 10 Strip @ 10 caps 737.84
51 Itracycline 500 mg Ktk, 10 Strip @ 10 caps 1,272.89
52 Itramag 500 mg Btl @ 1000 Capsul 183.82 200 -
53 Itramag Plus Ktk,10 Strip @ 10 Kaptab 684.62
54 Itramol Tab Ktk,10 Strip @ 10 Kaptab 515.55
55 Itramycetine 250 mg Ktk, 10 Strip @ 10 caps 1,236.54

56 Itramycetine Syr botol 60 ml 20,184.00
57 Itranervit.E Ktk, 10 Strip @ 10 caps 1,202.40
58 Itranidazal 500 mg Ktk, 10 Strip @ 10 Kapl 971.25
59 Midix Tab Ktk, 10 Strip @ 10 caps 607.20
60 Salfenal 200 mg Ktk, 10 Strip @ 10 Kapl 592.02
61 Salfenal Forte 400 mg Ktk, 10 Strip @ 10 Kapl 1,068.05
62 Saltrim Tab Ktk, 10 Strip @ 10 Kapl 755.08
63 Saltrim Syr Botol 13,023.00
64 Wibrom Syr Botol 60 ml 9,501.00
65 Wiros 20 mg Botol @ 1000 Caps 327.40
66 Wiros 20 mg Ktk, 10 Strip @ 10 caps 829.59
67 Witranal 250 mg Botol @ 500 Caps 457.02 150 -
68 Witranal 500 mg Ktk, 10 Strip @ 10 Kapl 798.47

Bahan Medis Habis Pakai
1 Alat Suntik 0.05 ml Kotak 100 Pcs 1,456.00
2 Alat Suntik 1 ml (Cosmo Med) 100 Pcs / Kotak 883.92 38.00 -
3 Alat Suntik 2.5 ml (Stera) pcs 747.5 0
4 Alat Suntik 3 ml (Cosmo Med) 100 Pcs / Kotak 915.24 200.00 -
5 Alat Suntik 3 ml (Skifa) 100 Pcs / Kotak 1,452.00 0
6 Alat Suntik sekali pakai 5 ml (Stera) 100 set / kotak 978.75 125 -
7 Alat Suntik Sekali Pakai 5 ml (with needle) 100 set / kotak 2,394.00 0
8 alat suntik sekali pakai 5 ml (Onemed) 100 set / kotak 1,037.00
9 alat suntik sekali pakai 5 ml (KDL) 100 set / kotak 1,142.00
10 Alat Suntik 5 ml (Cosmo Med) 100 Pcs / Kotak 973.24
11 alat suntik sekali pakai 10 ml (KDL) 100 set / kotak 1,142.00 0 -
12 Alat Suntik 10 ml (Cosmo Med) 100 Pcs / Kotak 1,458.12
13 Bloog Bag (Urine Bag) Set 4,400.00 1 -
Catgut Plain 2/0 + Jarum 1/2 GT 35 mm (Onemed) Kotak 174,870.00

14
15 catgut / benang bedah no 2/0 cromic 24 x 75 cm / kotak 649,000.00

16
17 Catgut Chromic 2/0 HR 26 MM Kotak @12 pcs 410,220.00
19 Catgut Chromic 2/0 + Jarum 1/2 GT 35 mm Kotak 154,100.00 1 -
21 Catgut Plain 3/0 HR 26 MM Kotak @12 pcs 428,220.00 9 -
22 Catgut Plain 3/0 HR 37 MM Kotak @12 pcs 445,500.00
23 Folley Cateter 10 FR Kotak, 10 Pcs 22,150.00
26 Folley Catheter No.16 Ktk, 10 pcs 10,440.00
27 Folley Catheter No.18 (Gea) pcs 13,125.00
29 Folley Catheter No.20 Ktk, 10 pcs 10,440.00 6

31 Folley Catheter 2 Way No. 24 10 buah/kotak 10,440.00 4 -
32 Hanscoen (Aximed Chirurgic) No.7 Kotak, 50 Pcs 9,500.00 65 -
33 Hanscoen (Aximed Chirurgic) No.7,5 Kotak, 50 Pcs 9,500.00 45 -

Hanscoen Non Steril ( Aximed Examination Gloves) Size
Kotak, 100 Pcs 577.50 0 -
35 M
36 Handscoen Non Steril Uk.S 100 set / kotak 800.00
37 Handscoen Non Steril Uk.M 100 set / kotak 800.00 0 -
38 Handscoen Non Steril Uk.L 100 set / kotak 800.00
39 Hanscoen Non Steril Exam Uk.Xs (Cosmo Med) Kotak, 100 Pcs 578.84
40 Hanscoen Non Steril Exam Uk.S (Cosmo Med) Kotak, 100 Pcs 578.84
41 Hanscoen Non Steril Exam Uk.M (Cosmo Med) Kotak, 100 Pcs 578.84
42 Hanscoen Non Steril Exam Uk.L (Cosmo Med) Kotak, 100 Pcs 578.84 0 -
43 IV Cateter No.18 G (Jelco) Kotak, 50 Pcs 9,060.00
44 Iv cateter no 20 g (OneMed) 50 buah/kotak 8,564.00
45 IV Catheter No. 20 (Stera) Kotak, 50 Pcs 4,959.00
46 IV Cateter No.20 G (Jelco) Kotak 50 Pcs 9,060.00 15 -
47 IV Catheter No. 22 G (Onemed) 50 buah/kotak 7,784.40
48 iv cateter no 22 g (Gea) Kotak, 50 Pcs 8,564.00
51 IV Catheter No. 24 G (Onionex/OneMed) Kotak, 50 Pcs 7,784.00 130 -
52 iv cateter no 24 g (GEA) 50 buah/kotak 8,564.00
54 IV Cateter No.24 G (Jelco) Kotak 50 Pcs 9,060.00
55 Infuset Anak ( Cosmo Med) pcs 5,104.00 80 -
56 Infusion set dewasa (Stera) 50 buah/kotak 4,176.00 140 -
57 Kapas 250 g Roll 16,312.50 1
58 Kapas 500 g Roll 31,372.00 1 -
59 Kasa Hydrofil 16x16 cm (Onemed) Roll 7,569.00
60 Kasa Hydrofil DRC 36 m x 80 cm (Ahmadaris) Roll 145,700.00
61 Kasa Hydrofil DRC 36 m x 80 cm (Ahmadaris) Roll 145,600.00 0 -
62 Kasa Hydrofil 40 x 80 cm (Onemed) Roll 137,025.00 1 -
63 Kasa pembalut 2 m x 80 cm Roll 10,048.50
64 Kasa Kompres 40 X 40 Rol 2,088.00
65 Masker (Surgical Mask-plus 3 ply Plus earloop) Ktk, 50 pcs 574.20 85 -
66 Masker (Aximed Face Mask Ear Loop) Kotak 50 Pcs 495.00
67 Masker (Aximed Face Mask Ties On) Kotak 50 Pcs 600.00
68 Masker Oksigen ( Cosmo Med) Pcs 11,020.00 6 -
69 Oxyflow Soft (Buble) Dewasa Bh 7,177.50
70 Polifix 10 cm x 5 m Roll 78,279.11 4 -
71 Silk 2/0 + Jarum 1/2 GT 35 mm Kotak 36 Pcs 143,550.00 1 -
72 Silk 3/0 + Jarum 1/2 GT 35 mm Kotak 36 Pcs 143,550.00 0
73 Silk Black 3/0 HR 26 MM Kotak, 12 Pcs 253,020.00
74 pembalut gips 4 inci pcs 35,640.00

75 Plester (Fescoplast) Roll 15,175.00 6 -
76 Transfusi Set pcs 24,375.00
77 Urine Bag Steril (Cosmo Med) Pcs 5,452.00
78 Wing needle no 21 G ktk 100 sase 6,336.00
79 Wing Needle No.23 G (Onemed) Ktk 1,827.00
80 Wing Needle No.23 G ktk 100 sase 5,760.00
81 Wing Needle no 23 G ktk 100 sase 6,336.00
82 Wing Needle no 23 G pcs 1,610.00
85 Wing Nedlle No 25 g ktk 100 sase 6,336.00
88 Wing Needle No.27 G pcs 1,610.00

Obat Gigi
1 Etanol 70% btl @ 100 ml 2,625.00 26 -
2 Alkohol 70% 100 ml Botol 100 ml 3,200.00
3 Alkohol 70% Btl 1000 ml 28,057.50
4 Eugenol Cairan btl 10 ml 18,333.00 0
5 Eugenol Cairan Botol 10 ml 21,720.00
6 Kalsium Hidroksida Pasta 2 tube / ktk 242,000.00
7 Temporeri Stoping Fletcher Serbuk & cairan set @ 100 gram / btl 34,000.00
8 Semen seng fosfat serbuk dan cairan Set 93,500.00

TOTAL
Mengetahui,
Kepala Puskesmas Lasolo
Kabupaten Konawe Utara
NURSANIAH, SKM
NIP. 19860212 200903 2 003
ERINTAH KABUPATEN KONAWE UTARA
DINAS KESEHATAN
: Kantor Dinas Kesehatan Kabupaten Konawe Utara
EMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
BULAN : OKTOBER
TAHUN : 2018
PEMAKAIAN TINGKAT TOTAL

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN
RATA RATA KECUKUPAN HARGA
7 = 5+6 8 9 = 7-8 10 = 8/3(bln) 11 = 9/8 12 13 14 = 4x9
-
1100 500 600 85,200.00
45 0 45
189,180.00
0 0 -
0 0 -
390 150 240 48,000.00
0 0 -
900 200 700 150,500.00
2700 900 1800 345,600.00
15 11 4 20,300.00
0 0 0 -
900 0 900 86,400.00
10 0 10
33,500.00
100 0 100 57,200.00
0 0
-
0 0
-
0 0 -
0 0 -
0 0 -
50 50 0 -
0 0 -
0 0 -
3200 1200 2000 422,000.00
0 0 -
0 0 -
0 0 -
0 0 -
100 30 70 25,340.00
0 0 -
0 0 -
0 0 -
80 24 56 60,536.00
0 0
-
0 0 0 -
100 35 65 93,860.00
0 0 -
0 0 -
0 0 0 -
800 400 400 74,800.00
0 0 0 -
600 200 400 28,800.00
1000 400 600 76,200.00
400 100 300 43,200.00
0 0 -
400 250 150 39,600.00
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 0 -
0 0 -
50 30 20 2,200.00
0 0 -
0 0 -
0 0 -
46 11 35 115,500.00
0 0 -
600 200 400 55,200.00
12 10 2 11,600.00
0 0 0 -
0 0 -
0 0 0 -
1800 200 1600 1,233,600.00
0 0 -
0 0 0 -
0 0
-
0 0 -
35 0 35 104,720.00
100 0 100 11,700.00
0 0 -
500 0 500
0 0 -
30 0 30 127,800.00
65 20 45
12,510.00
0 0 -
1100 200 900 113,400.00
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
700 200 500 58,000.00
800 400 400 77,200.00
0 0 -
100 0 100 9,600.00
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
8 3 5 9,500.00
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
1400 300 1100 211,200.00
0 0
-
17 17 0 -
500 200 300 29,100.00
0 0
0 0 0 -
300 0 300 36,000.00
900 600 300 109,200.00
60 0 60 161,040.00
800 100 700 77,000.00
0 0 0 -
0 0 -
0 0 -
200 200 0 -
0 0 -
29 15 14 28,420.00
0 0 -
250 150 100 17,800.00
250 0 250 40,500.00
42 7 35 224,350.00
0 0 -
60 20 40 124,500.00
0 0 -
3 0 3 159,000.00
0 0 -
0 0 -
180 130 50 10,150.00
150 0 150
79,200.00
0 0 -
150 0 150 134,250.00
7 7 0 -
0 0 -
930 240 690 121,440.00
0 0 -
0 0 -
135 0 135 256,500.00
0 0 -
5 5 0 -
0 0 -
130 23 107 143,166.00
0 0 -
2400 1100 1300 241,800.00
0 0 -
0 0 0 -
0 0 -
100 100 0 -
0 0 -
0 0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
1550 550 1000 86,000.00
0 0 -
0 0 -
0 0 -
0 0 -
90 30 60 80,400.00
800 400 400 51,200.00
0 0 -
0 0 -
0 0 -
0 0 -
220 120 100 715,000.00
0 0 0 -
0 0 -
300 100 200 13,800.00
0 0 0 -
400 200 200 17,800.00
0 0 -
70 0 70 245,000.00
0 0 -
0 0 0 -
0 0 0 -
360 240 120 44,760.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
500 100 400 34,000.00
1900 900 1000 138,000.00
0 0 -
0 0 -
0 0 -
0 0 -
0 -
5 0 5 36,500.00
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 0 -
0 0 0 -
300 300 0 -
0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 -
0 0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 -
50 30 20 12,020.40
0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 -
80 20 60 203,763.00
0 0 -
0 0 0 -
1000 400 600 42,551.40
0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
200 0 200 36,764.20
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
150 20 130 59,412.60
0 0 -
0 0 -
38 10 28 24,749.76
0 0 0 -
200 100 100 91,524.00
0 0 0 -
125 50 75 73,406.25
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
1 0 1 4,400.00
0 0
-
0 0 -
0 0
-
0 0 -
0 0 -
1 0 1 154,100.00
0 0 -
9 2 7 2,997,540.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
6 0 6 62,640.00
0 0 -
4 0 4 41,760.00
65 65 0 -
45 35 10 95,000.00
100 47 53 503,500.00
0 0 0
-
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
15 15 0 -
0 0 -
0 0 -
0 0 -
64 57 7 63,420.00
130 68 62 482,608.00
0 0 -
0 0 -
0 0 -
80 20 60 306,240.00
140 35 105 438,480.00
1 1 0 -
1 1 0 -
0 0 -
0 0 -
0 0 0 -
1 1 0 -
0 0 -
0 0 -
85 35 50 28,710.00
0 0 -
0 0 -
6 0 6 66,120.00
0 0 -
4 1 3 234,837.32
1 0 1 143,550.00
0 0 0 -
0 0 -
0 0 -
6 1 5 75,875.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
26 14 12 31,500.00
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
Lasolo, 1 NOVEMBER 2018
Pembuat Daftar,
Penanggung Jawab Gudang Obat
Puskesmas Lasolo
EVA ANGGRAENI, AMF

NIP. -
EXPIRE DATE KET
15 16
EMBER 2018
wab Gudang Obat
AENI, AMF
PEMERINTAH KABUPATEN
DINAS KESEHA
Seketariat : Kantor Dinas Kesehatan K
LAPORAN PEMAKAIAN DAN LEMBAR PE
KODE PUSKESMAS : ………………………….
NAMA PUSKESMAS : PUSKESMAS LASOLO
KECAMATAN : LASOLO
KABUPATEN : KONAWE UTARA
PROPINSI : SULAWESI TENGGARA
KEMASAN SATUAN
NO. NAMA OBAT STOK AWAL PENERIMAAN
SATUAN HARGA
1 2 3 4 5 6
1 Allopurinol tablet 100 mg Kotak, 10 x 10 Tablet 90.00
2 Allopurinol Tablet 100 Mg Kotak, 10 x 10 Tablet 142.00 600 0
Aminofilin injeksi 24 mg/ml Kotak, 30 ampul @ 10 ml 4,204.00 45

3
4 Amitriptilin 25 mg tab Kotak 10 x 10 Tablet 123.00
5 Amlodipin tablet 5 mg Kotak, 3 x 10 Tablet 105.00
6 Amlodipin tablet 5 mg Kotak, 3 x 10 Tablet 200.00 240 0
7 Amoksisilin kapsul/kaplet 250 mg Kotak 10 x 12 Kaplet 220.00
8 Amoksisilin kapsul/kaplet 250 mg Kotak 10 x 10 Tablet 215.00 700 0
9 Amoksisilin Kaplet 500 mg Kotak 10 x 10 Tablet 192.00 1800 0
10 Amoxicilliyn Syrup 125 mg/ml Botol, 30 ml 5,075.00 4 0
11 Antasida DOEN I tablet kunyah, kombinasi Ktk, 10 strip @ 10 tab 78.00 0
12 Antasida Tablet Kotak, 10 x 10 Tablet 96.00 900 0
Antihemoroid DOEN kombinasi : Bismut subgalat 150 mg Ktk 10 supp @ 2 gr 3,350.00 10

13
14 Antimalaria DOEN kombinasi : Ktk, 10 Blister @ 10 tab 572.00 100
Antimigren tablet : Ergotamin Tartat 1 mg + Kofein 50 mg Btl 100 tablet 149.00

15
Asam Asetilsalisilat 80 mg (Asetosal) / Miniaspi tab Ktk, 10 strip @ 10 tab 125.00

16
17 Asam Asetilsalisilat tablet 100 mg (Asetosal) Ktk, 10 strip @ 10 tab 157.00
18 Asam askorbat 50 mg Ktk, 10 strip @ 10 tab 105.00
19 Asam Askorbat (Vit C) 50 mg Kotak 10 x 10 Tablet 125.00
20 Asam Askorbat (Vit C) 250 mg Kotak 10 x 10 Tablet 139.00 0 0
21 Asam Folat tablet 1 mg Btl 100 tablet 52.00
22 Asam Mefenamat kaplet 500 mg Ktk, 10 strip @ 10 tab 127.00
23 Asam Mefenamat 500 mg Kotak, 10 x 10 Tablet 211.00 2000 0
24 Asam Tranexamat Inj Box 10 Ampul 3,650.00
25 Aseptan 500 ml + Dispenser Btl 500 ml 39,150
26 Asiklovir tablet 200 mg Ktk, 10 strip @ 10 tab 251.00
27 Asiklovir tablet 200 mg Kotak 10 x 10 Tablet 276.00
28 Asiklovir tablet 400 mg Ktk, 10 strip @ 10 tab 362.00 70

29 Asiklovir tablet 400 mg Kotak, 10 x 10 Tab 387.00
30 Bacitracin Salep Tube @ 5 g 2,767.00
31 Bedak Salisil Serbuk 2% Kotak 1,350.00
32 Bedak Salisil Serbuk 2% Kotak 1,081.00 56 0

Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
1 sase @ 30 tab 45.00
33 (tablet tambah darah kombinasi )
34 Betametason krim 0.1 % (sebagai Valerat) ktk, 25 tube @ 5 g 1,596.00 0 0
35 Betametason krim 0.1 % (sebagai Valerat) Ktk, 25 tube @ 5 g 1,444.00 65 0
36 Betametason krim 0.5 mg/g (Skizon) Tube 3,575.00
37 Bisakodil Suppositoria 10 mg (Stolax Supp) ktk, 6 Supp @ 10 mg 6,045.00
38 Calcium Laktate (Kalk) tablet 500 mg Dus, 10 Blister x 10 tab 72.00 0
39 Calcium Laktate (Kalk) tablet 500 mg Kotak, 10 x10 Tablet 187.00 400 0
40 Captopril 12.5 mg Kotak, 10 x 10 Tablet 69.00 0
41 Captopril 12.5 mg Kotak, 10 x 10 Tablet 72.00 400 0
44 Cetirizin Syrup (Trisela Syrup) Botol 22,500.00
45 Ciprofloxacin tab 500 Mg Kotak. 10 x 10 Tab 264.00 150 0
46 Clindamycin Kapsul 300 mg Dus, 5 Blister @ 10 kps 693.00
47 Deksametason injeksi i.v. 5 mg/ml ktk 100 amp @ 1 ml 1,738.00 0
48 Deksametason injeksi i.v./i.m 5 mg/ml Kotak 100 Amp 1,820.00
49 Deksametason tablet 0,5 mg Ktk, 10 strip @ 10 tab 68.00
50 Deksamethason Tablet 0.5 mg Kotak, 10 x 10 Tablet 162.00 0
51 Diazepam injeksi 5 mg/ml Ktk, 30 amp @ 2 ml 2,578.00 0
52 Difenhidramin Inj i.v/i.m 10 mg/ml (Hcl) Kotak, 30 ampul 1,415.00
53 Digoksin 0.25 mg Kotak 10 x 10 Tablet 110.00 20 0
54 Diltiazem HCl tablet 30 mg Ktk, 10 strip @ 10 tab 141.00
55 Diltiazem HCl tablet 30 mg Kotak 10 x 10 Tablet 143.00
56 Domperidon suspensi 5 mg/5 ml Dus, 50 btl @ 60 ml 3,490.00
57 Domperidon suspensi 5 mg/5 ml Kotak 50 Botol @ 60 ml 3,300.00 35 0
58 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 174.00
59 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 138.00 400 0
60 Dulcolax 10 Mg Supp Ktk, 50 Suppo 5,800.00 2 0
61 Dulcolax 5 Mg Supp Ktk, 6 Suppo 5,670.00 0
62 Dulcolax 5 Mg Supp Ktk, 6 Suppo 16,291.67
63 Epinefrin (Adrenalin) Inj i.v/s.k./i.m 1 mg/ml Ampul 2,354.00 0
64 Eritromisin Kaplet 500 mg Kotak, 10 x 10 Kaplet 771.00 1600 0
65 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ktk 30 amp @ 1 ml 1,980.00
66 Fenobarbital tablet 30 mg Ktk, 10 strip @ 10 tab 74.00 0

Ferro Fumarat 60 mg + as.Folat 0.4 mg Tablet salut gula
Kotak, 3 x 10 Tablet 430.00
67 (Tablet Tambah Darah)
68 Furosemid injeksi i.v./i.m. 10 mg/ml Ktk, 25 amp @ 2 ml 2,012.00
69 Furosemid injeksi i.v./i.m. 10 mg/ml Kotak, 25 Ampul 2,992.00 35 0
70 Furosemid Tablet 40 mg Kotak, 10 x 10 Tablet 117.00 100 0
71 Fitomenadion (Vit.K1) tablet salut gula 10 mg Btl 100 tablet 698.00
72 Fitomenadion (Vit.K1) tablet salut gula 10 mg Kotak, 10 x 10 Tablet 835.00 500 0

73 Fitomenadion (Vit.K1) Inj. i.m 2 mg/ml Ktk, 30 Amp @ 2 ml 3,754.00
74 Fitomenadion (Vit.K1) Inj. i.m 2 mg/ml Kotak 30 Ampul 4,260.00 30 0
Garam Oralit Kombinasi : natrium klorida 0.52 g + kalium

klorida 0.030 g + trinatrium sitrar 0.58 g + glukosa Kotak 100 Sachet 278.00 45 0
anhidrat 2.7 g
75
76 Gentamisin Sulfat tetes mata 0,3 % ktk 10 btl @ 5 ml 3,513.00
77 Glibenclamide Tablet 5 mg Kotak, 10 x 10 Tablet 126.00 900 0
80 Glukosa larutan infus 10 % steril Botol 500 ml 7,500.00 0 0
81 Glyceryl Guaiacolate (GG) Botol, 100 Tablet 41.00
82 Griseofulvin tablet 125 mg Dus, 10 Blister x 10 tab 258.00
83 Griseofulvin tablet 125 mg Dus, 10 x 10 tablet 230.00 0
84 Griseofulvin tablet 125 mg Kotak, 10 x 10 Tablet 266.00
85 Haloperidol tablet 0,5 mg ktk 10 x 10 tab 62.00
86 Hidroklorotiazida (HCT) tablet 25 mg btl 1000 tablet 36.30
87 Hidroklorotiazida (HCT) tablet 25 mg Kotak, 100 Tablet 179.00
88 Hidrokortison 2.5 % Krim Kotak, 24 Tube 2,848.00
89 Ibuprofen tablet 200 mg Kotak 10 x 10 Tablet 116.00 500 0
90 Ibuprofen Tablet 400 mg Kotak 10 x 10 Tablet 193.00 400 0
91 Isosorbid Dinitrat tablet sublingual 5 mg Dus, 10 Strip @ 10 tab 98.00
92 Isosorbid Dinitrat 5 mg Kotak 10 x 10 Tablet 96.00 100 0
93 Karbamazepin tablet 200 mg Dus, 10 Strip @ 10 tab 315.00 0
94 Ketokonazole Krim Tube 2,554.00
95 Ketokonazol tab 200 Mg Kotak, 5 x 10 Tablet 308.00
96 Kloramfenikol kapsul 250 mg Ktk 10 x 10 kapsul 275.00
97 Kloramfenikol suspensi 125 mg/ 5 ml Botol 60 ml 5,500.00
98 Kloramfenikol suspensi 125 mg/ 5 ml Botol 5,170.00
99 Kloramfenikol 1% Salep Mata Tube 1,900.00 5 0
100 Kloramfenikol tetes telinga 3 % Btl 5 ml 1,759.00
101 Klorfeniramina Maleat (CTM) tablet 4 mg ktk 10 x 10 tablet 54.00 0
102 Klorfeniramina Maleat (CTM) tablet 4 mg ktk 10 x 10 tablet 46.00
103 Klorpromazin Tab 25 mg Kotak, 10 x 10 tablet 178.00
104 Klorpromazin Inj i.m 25 mh/ml (HCL) Kotak 30 Ampul 1,489.00
105 Kodein tablet 10 mg Ktk 10 x 10 tablet 517.00
106 Kotrimoksazol DOEN I (dewasa) kombinasi : Strik 10 x 10 tablet 152.00
107 Kotrimoxazole Tablet 480 mg Kotak, 10 x 10 Tablet 152.00
108 Kotrimoxazole Tablet 480 mg Kotak, 10 x 10 Tablet 192.00 1100 0

Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg
Botol 60 ml 2,298.00
109 + Trimetoprim 40 mg / 5 ml
110 Kotrimoksazol Syr Botol 4,200.00 0 0
111 Loperamid tablet 2 mg Kotak, 10 x 10 Tablet 97.00 300 0
112 Loperamid tablet 2 mg Kotak, 10 x 10 Tablet 609.00
113 Metformin HCl tablet 500 mg ktk 10 x 10 tablet 195.00 0
114 Metformin HCl tablet 500 mg Kotak, 10 x 10 Tablet 120.00 300 0
115 Methylprednisolone 4 mg Kotak, 10 x 10 Tablet 364.00 300 0

116 Methyl Ergometrin Inj 0.2 mg/ml Kotak, 100 Amp 2,684.00 60 0
117 Metoklopramide tablet 10 mg Ktk 10 x 10 tablet 110.00 700 0
118 Metoclopramide tablet 10 mg Kotak, 10 x 10 Tablet 93.00
119 Metoklopramide Drops 10 ml (Gavistal Drops) Botol 10 ml 5,830.00
120 Metronidazol tablet 500 mg ktk 100 tab 169.00
121 Metronidazol tablet 500 mg Kotak, 10 x10 Tablet 102.00 0 0
122 Mikonazol krim/salep 2 % (Nitrat) ktk 24 tube 3,150.00
123 Mikonazole Krim 2% 5 gr Kotak, 24 Tube 2,030.00 14 0
124 Natrium Diklofenak tablet 25 mg ktk 5 x 10 tablet 146.00
127 Natrium Klorida larutan infus 0,9 % Botol 500 ml 6,410.00 35 0
128 New Antides Tablet (Atapulgit) Dus, 10 x 10 tablet 199.00
130 Neodin 10 % 300 ml Botol 300 ml 19,000.00
134 Nifedipin Kapsul 10 mg Kotak, 10 x 10 Kapsul 203.00 50 0
Nistatin vaginal tablet 100.000 IU/ g ktk 10 x 10 tablet vaginal 528.00 150 0
135
136 Nistatin vaginal tablet 100.000 IU/ g Kotak 10 x 10 Tablet 628.00
137 Nistatin Tablet 500.000 IU/g Kotak 10 x 10 Tablet 895.00 150 0
138 Novaxifen Syrup (Ibuprofen Syr) Botol, 60 ml 5,538.00 0 0
139 Omeprazol kapsul 20 mg ktk 3 x 10 kapsul 221.00
140 Omeprazol kapsul 20 mg Kotak 3 x 10 Kapsul 176.00 690 0
141 Oxytetraciklin Salep Kulit 3% Tube 1,800.00
142 Oxytetraciklin Salep Mata 1% Tube 2,580.00
143 Oxytocin Inj 10 UI/ml Kotak, 100 Amp 1,900.00 135 0
144 Parasetamol drops Botol 15 ml 6,240.00
145 Parasetamol drops (Sanmol Drop) Botol 21,000.00 0 0
146 Parasetamol Sirup 120 mg / 5 ml Btl 60 ml 1,535.00
147 Parasetamol Sirup 120 mg / 5 ml Dus 84 Btl @ 60 ml 1,338.00 107 0
148 Parasetamol tablet 500 mg Strip 10 x 10 tablet 88.00
149 Parasetamol Tablet 500 mg Kotak, 10 x 10 Tablet 186.00 1300 0
150 Pirantel sirup 125 mg/5 ml Btl 60 ml 9,100.00
151 Pirantel tablet score (base) 125 mg ktk25 blister @ 4 tab 318.00 0
152 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Ktk 10 x 10 Tablet 121.00
153 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Kotak 10 x 10 Tablet 142.00 0 0
154 Polikrisulen (Aptil) Btl 18,635.00
155 Povidon iodine 10% Botol 60 ml 7,040.00 0 0
156 Povidon Iodine 300 ml (Kokodin) Botol 300 ml 13,987.00 0

160 Prednisone Tablet 5 mg Botol, 1000 Tablet 86.00 1000 0
161 Propanolol tablet 40 mg (HCl) box 100 tab 114.00
162 Propiltiourasil tablet 100 mg Btl plastik @ 100 tablet 351.00
163 Propiltiourasil tablet 100 mg Kotak, 10 x 10 Tablet 650.00
164 Pyrazinamide 500 mg tab ktk 10 x 10 tablet 225.00
165 Ranitidin injeksi 25 mg/2 ml ktk 10 amp @ 2 ml 1,340.00 60 0
166 Ranitidin tablet 150 mg ktk 10 x 10 tablet 128.00 400 0
167 Ranitidin tablet 150 mg ktk 10 x 10 tablet 119.00
170 Ringer Laktat larutan infuse Botol 500 ml 5,720.00
171 Ringer Laktat larutan infuse Botol 500 ml 7,150.00 100 0
172 Rivanol Botol 300 ml 3,327.75 0 0
173 Salbutamol tablet 2 mg (sebagai Sulfat) Ktk 10 x 10 tablet 65.00
175 Salbutamol tablet 4 mg (sebagai Sulfat) Ktk 10 x 10 tablet 93.00 0
177 Sefiksim sirup kering 100 mg/ 5 ml btl 30 ml 9,400.00
178 Sefotaksim injeksi 1 g Ktk 10 vial 3,500.00 70 0
179 Seftriakson serbuk injeksi 1 g/ vial ktk 10 vial 3,900.00
180 Sianokobalamin (vit B 12) tablet 50 mg Ktk 10 x 10 tablet 63.00 0
181 Simvastatin 20 mg Kotak 5 x 10 Tablet 252.00 0
182 Simvastatin Tablet 10 mg Kotak, 3 x 10 tablet 373.00 120 0
183 Spironolactone tab 100 mg ktk 10 x 10 tablet 878.00
184 Tetrasiklin kapsul/kaplet 250 mg Ktk 10 x 10 kapsul 162.00
185 Tetrasiklin kapsul 250 mg Kotak 10 x 10 Tablet 178.00
186 Tetrasiklin kapsul 500 mg ktk 10 str x 10 kapsul 325.00
187 Tetrasiklin 500 mg Kotak 10 str x 10 kapsul 341.00
188 Tiamin ( Vitamin B1) 50 mg Ktk 10 x 10 tablet 85.00 400 0
189 Vitamin B Kompleks Kotak 10 x 10 Tablet 138.00 1000 0
190 Zinc tablet 20 mg Dus, 10 Stip @ 10 tab 618.00
191 Zinc tablet 20 mg Kotak, 10 x 10 Tablet 700.00
192 Zinkid 10mg/5ml Syrup Dus 24 Botol @ 100 ml 16,478.00
193 Zinc Syrup 10mg/ml Botol 41,333.00
194 Acetylcysteine 200mg Kotak, 10 x 10 Tablet
195 Skizon SK Tube

Obat Brendit -
1 Alpamol Syr Botol 60 ml 7,300.00 5 -
2 Alpara Syr Botol 60 ml 11,200.00
3 Anaria Syr Botol 60 ml 14,213.00
4 Anaton Syr Botol 60 ml 12,012.00 0
5 Becefor Tablet Ktk, 10 x 10 caps 1,407.75
6 Becefort Tablet Kotak 10 x 10 Tablet 1,380.00 0
7 Becefor Syr Botol 60 ml 15,787.00
8 Benovit C Dragee Kotak 10 x 10 Tablet 1,652.30 0

9 Cetrin 10 mg Kotak, 3 x 10 Tab 550.00 0
10 Dextral Kaplet Kotak 15 x 10 Kaplet 460.00 0 -
11 Etil Clorida Spray 100 ml Botol 100 ml 115,000.00
12 Etil Clorida Spray 100 ml Botol 100 ml 124,000.00 0
13 Extra Flu Kotak 100 Kaplet 480.00 0
14 Fervital Tab Kotak 10 x 10 Tablet 860.00 0
15 Fevrin Syrup Botol 60 ml 18,120.00
16 Hemafort Tablet Ktk 10 x 10 Tablet 759.00 0
17 Hexavask 10 Ktk 3 x 10 Tab 1,666.67 0
18 Hustab P Syr Btl 60 ml 7,315.00
21 Itranervit.E Kotak 10 x 10 Tablet 1,045.55 0
22 Livcopec Kotak 100 Kaplet 600.40
23 Livron B Pleks Ktk 10 x 10 Tab 220.00
24 Livron B Pleks Kotak 10 x 10 Tablet 264.00 0
25 Molagit Tablet Ktk, 150 Tab 601.02 20 -
26 Molagit Tablet Kotak 15 x 10 tab 437.34
27 Molexflu Kaplet Kotak 15 x 10 tab 360.67 0
28 Molexflu Syr Botol 60 ml 6,100.00
29 Neokaminal Suspensi Botol 60 ml 7,200.00 0 -
30 Novadiar Syr botol 60 ml 7,650.00
31 Novapyron tablet Dus, 10 Stip @ 10 tab 645.50 0
32 Noza Tablet Ktk, 25 x 4 Tab 725.00
33 Noza Tablet kotak 25 x 4 Tablet 870.00
34 Otsu MgSO4 20% vial 25 ml 6,000.00 0 -
35 Pehacain Inj Kotak, 20 Ampul 3,396.05 60 -
36 Pehacain Inj Kotak, 20 Ampul 2,830.00
37 Pehavral Tablet Ktk, 10 x 10 Tablet 740.00 0
38 Pehachlor tab (ctm) Btl 1500 tab 70.92 600 -
39 Poncolin Syrup Botol 60 ml 16,850.00
40 Poconeuron Tablet Ktk 10 x 10 Tablet 1,285.00 0
41 Pritagesic Kaplet Kotak 10 x 10 kaplet 518.00 0
42 Procurma Plus Syr Botol 60 ml 11,500.00 0
43 Tensi Gard Tablet Ktk, 30 Tablet 1,950.00 0
44 Anaton Tab Ktk,10 Strip @ 10 Kaptab 971.52
45 Butasal Tab Ktk, 10 Strip @10 Kapl 592.02
46 Fervital Tab Ktk, 10 Strip @ 10 Kaps 989.74 0
47 Guanistrep Syr Botol 60 ml 15,300.00
48 Itrabat Syr Botol 60 ml 25,428.00
49 Itracycline 250 mg Btl @ 1000 Capsul 291.46
50 Itracycline 250 mg Ktk, 10 Strip @ 10 caps 737.84
51 Itracycline 500 mg Ktk, 10 Strip @ 10 caps 1,272.89
52 Itramag 500 mg Btl @ 1000 Capsul 183.82 200 -
53 Itramag Plus Ktk,10 Strip @ 10 Kaptab 684.62

54 Itramol Tab Ktk,10 Strip @ 10 Kaptab 515.55
55 Itramycetine 250 mg Ktk, 10 Strip @ 10 caps 1,236.54
56 Itramycetine Syr botol 60 ml 20,184.00
57 Itranervit.E Ktk, 10 Strip @ 10 caps 1,202.40
58 Itranidazal 500 mg Ktk, 10 Strip @ 10 Kapl 971.25
59 Midix Tab Ktk, 10 Strip @ 10 caps 607.20
60 Salfenal 200 mg Ktk, 10 Strip @ 10 Kapl 592.02
61 Salfenal Forte 400 mg Ktk, 10 Strip @ 10 Kapl 1,068.05
62 Saltrim Tab Ktk, 10 Strip @ 10 Kapl 755.08
63 Saltrim Syr Botol 13,023.00
64 Wibrom Syr Botol 60 ml 9,501.00
65 Wiros 20 mg Botol @ 1000 Caps 327.40
66 Wiros 20 mg Ktk, 10 Strip @ 10 caps 829.59
67 Witranal 250 mg Botol @ 500 Caps 457.02 130 -
68 Witranal 500 mg Ktk, 10 Strip @ 10 Kapl 798.47

Bahan Medis Habis Pakai
1 Alat Suntik 0.05 ml Kotak 100 Pcs 1,456.00
2 Alat Suntik 1 ml (Cosmo Med) 100 Pcs / Kotak 883.92 28 -
3 Alat Suntik 2.5 ml (Stera) pcs 747.5 0
4 Alat Suntik 3 ml (Cosmo Med) 100 Pcs / Kotak 915.24 100 -
5 Alat Suntik 3 ml (Skifa) 100 Pcs / Kotak 1,452.00 0
6 Alat Suntik sekali pakai 5 ml (Stera) 100 set / kotak 978.75 75 -
7 Alat Suntik Sekali Pakai 5 ml (with needle) 100 set / kotak 2,394.00 0
8 alat suntik sekali pakai 5 ml (Onemed) 100 set / kotak 1,037.00
9 alat suntik sekali pakai 5 ml (KDL) 100 set / kotak 1,142.00
10 Alat Suntik 5 ml (Cosmo Med) 100 Pcs / Kotak 973.24
11 alat suntik sekali pakai 10 ml (KDL) 100 set / kotak 1,142.00 0 -
12 Alat Suntik 10 ml (Cosmo Med) 100 Pcs / Kotak 1,458.12
13 Bloog Bag (Urine Bag) Set 4,400.00 1 -

14
15 catgut / benang bedah no 2/0 cromic 24 x 75 cm / kotak 649,000.00

16
19 Catgut Chromic 2/0 + Jarum 1/2 GT 35 mm Kotak 154,100.00 1 -
21 Catgut Plain 3/0 HR 26 MM Kotak @12 pcs 428,220.00 7 -
22 Catgut Plain 3/0 HR 37 MM Kotak @12 pcs 445,500.00
27 Folley Catheter No.18 (Gea) pcs 13,125.00

29 Folley Catheter No.20 Ktk, 10 pcs 10,440.00 6
31 Folley Catheter 2 Way No. 24 10 buah/kotak 10,440.00 4 -
33 Hanscoen (Aximed Chirurgic) No.7,5 Kotak, 50 Pcs 9,500.00 10 -

Hanscoen Non Steril ( Aximed Examination Gloves) Size
Kotak, 100 Pcs 577.50 0 -
35 M
36 Handscoen Non Steril Uk.S 100 set / kotak 800.00
37 Handscoen Non Steril Uk.M 100 set / kotak 800.00 0 -
38 Handscoen Non Steril Uk.L 100 set / kotak 800.00
39 Hanscoen Non Steril Exam Uk.Xs (Cosmo Med) Kotak, 100 Pcs 578.84
40 Hanscoen Non Steril Exam Uk.S (Cosmo Med) Kotak, 100 Pcs 578.84
41 Hanscoen Non Steril Exam Uk.M (Cosmo Med) Kotak, 100 Pcs 578.84
42 Hanscoen Non Steril Exam Uk.L (Cosmo Med) Kotak, 100 Pcs 578.84 0 -
43 IV Cateter No.18 G (Jelco) Kotak, 50 Pcs 9,060.00
44 Iv cateter no 20 g (OneMed) 50 buah/kotak 8,564.00
47 IV Catheter No. 22 G (Onemed) 50 buah/kotak 7,784.40
48 iv cateter no 22 g (Gea) Kotak, 50 Pcs 8,564.00
51 IV Catheter No. 24 G (Onionex/OneMed) Kotak, 50 Pcs 7,784.00 62 -
52 iv cateter no 24 g (GEA) 50 buah/kotak 8,564.00
54 IV Cateter No.24 G (Jelco) Kotak 50 Pcs 9,060.00
55 Infuset Anak ( Cosmo Med) pcs 5,104.00 60 -
56 Infusion set dewasa (Stera) 50 buah/kotak 4,176.00 105 -
57 Kapas 250 g Roll 16,312.50 0
58 Kapas 500 g Roll 31,372.00 0 -
59 Kasa Hydrofil 16x16 cm (Onemed) Roll 7,569.00
60 Kasa Hydrofil DRC 36 m x 80 cm (Ahmadaris) Roll 145,700.00
61 Kasa Hydrofil DRC 36 m x 80 cm (Ahmadaris) Roll 145,600.00 0 -
62 Kasa Hydrofil 40 x 80 cm (Onemed) Roll 137,025.00 0 -
63 Kasa pembalut 2 m x 80 cm Roll 10,048.50
64 Kasa Kompres 40 X 40 Rol 2,088.00
65 Masker (Surgical Mask-plus 3 ply Plus earloop) Ktk, 50 pcs 574.20 50 -
66 Masker (Aximed Face Mask Ear Loop) Kotak 50 Pcs 495.00
67 Masker (Aximed Face Mask Ties On) Kotak 50 Pcs 600.00
68 Masker Oksigen ( Cosmo Med) Pcs 11,020.00 6 -
69 Oxyflow Soft (Buble) Dewasa Bh 7,177.50
70 Polifix 10 cm x 5 m Roll 78,279.11 3 -
71 Silk 2/0 + Jarum 1/2 GT 35 mm Kotak 36 Pcs 143,550.00 1 -
72 Silk 3/0 + Jarum 1/2 GT 35 mm Kotak 36 Pcs 143,550.00 0

73 Silk Black 3/0 HR 26 MM Kotak, 12 Pcs 253,020.00
74 pembalut gips 4 inci pcs 35,640.00
75 Plester (Fescoplast) Roll 15,175.00 5 -
76 Transfusi Set pcs 24,375.00
77 Urine Bag Steril (Cosmo Med) Pcs 5,452.00
78 Wing needle no 21 G ktk 100 sase 6,336.00
81 Wing Needle no 23 G ktk 100 sase 6,336.00
82 Wing Needle no 23 G pcs 1,610.00
85 Wing Nedlle No 25 g ktk 100 sase 6,336.00
88 Wing Needle No.27 G pcs 1,610.00

Obat Gigi
1 Etanol 70% btl @ 100 ml 2,625.00 12 -
2 Alkohol 70% 100 ml Botol 100 ml 3,200.00
3 Alkohol 70% Btl 1000 ml 28,057.50
4 Eugenol Cairan btl 10 ml 18,333.00 0
5 Eugenol Cairan Botol 10 ml 21,720.00
6 Kalsium Hidroksida Pasta 2 tube / ktk 242,000.00
7 Temporeri Stoping Fletcher Serbuk & cairan set @ 100 gram / btl 34,000.00
8 Semen seng fosfat serbuk dan cairan Set 93,500.00

TOTAL
Mengetahui,
Kepala Puskesmas Lasolo
Kabupaten Konawe Utara
NURSANIAH, SKM
NIP. 19860212 200903 2 003
ERINTAH KABUPATEN KONAWE UTARA
DINAS KESEHATAN
: Kantor Dinas Kesehatan Kabupaten Konawe Utara
EMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
BULAN : OKTOBER
TAHUN : 2018
PEMAKAIAN TINGKAT TOTAL

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN
RATA RATA KECUKUPAN HARGA
7 = 5+6 8 9 = 7-8 10 = 8/3(bln) 11 = 9/8 12 13 14 = 4x9
-
600 300 300 500 42,600.00
45 0 45
189,180.00
0 0 -
0 0 -
240 60 180 1000 36,000.00
0 0 -
700 100 600 2000 129,000.00
1800 1000 800 5000 153,600.00
4 0 4 100 20,300.00
0 0 0 -
900 300 600 3000 57,600.00
10 0 10
33,500.00
0 0 100 57,200.00
0 0
-
0 0
-
0 0 -
0 0 -
0 0 2000 -
0 0 0 1000 -
0 0 -
0 0 -
2000 800 1200 5000 253,200.00
0 0 -
0 0 -
0 0 500 -
0 0 -
70 0 70 500 25,340.00
0 0 -
0 0 -
0 0 -
56 5 51 100 55,131.00
0 0
-
0 0 0 -
65 15 50 100 72,200.00
0 0 -
0 0 -
0 0 0 -
400 0 400 1000 74,800.00
0 0 0 -
400 100 300 2000 21,600.00
600 200 400 1000 50,800.00
300 50 250 500 36,000.00
0 0 -
150 100 50 1000 13,200.00
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 5000 -
0 0 0 -
0 0 -
20 0 20 2,200.00
0 0 -
0 0 -
0 0 -
35 15 20 50 66,000.00
0 0 -
400 0 400 500 55,200.00
2 2 0 50 -
0 0 0 50 -
0 0 -
0 0 0 -
1600 100 1500 3000 1,156,500.00
0 0 -
0 0 0 -
0 0
-
0 0 -
35 5 30 89,760.00
100 0 100 300 11,700.00
0 0 -
500 0 500
0 0 -
30 0 30 127,800.00
45 10 35 300
9,730.00
0 0 -
900 100 800 300 100,800.00
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 100 -
500 300 200 1000 23,200.00
400 300 100 1000 19,300.00
0 0 -
100 30 70 300 6,720.00
0 0 0 -
0 0 100 -
0 0 -
0 0 -
0 0 -
0 0 -
5 4 1 100 1,900.00
0 0 100 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
1100 200 900 2000 172,800.00
0 0
-
0 0 0 100 -
300 0 300 700 29,100.00
0 0
0 0 0 -
300 100 200 1000 24,000.00
300 300 0 5000 -
60 0 60 161,040.00
700 0 700 500 77,000.00
0 0 0 -
0 0 -
0 0 -
0 0 0 1000 -
0 0 -
14 5 9 100 18,270.00
0 0 -
100 100 0 5000 -
250 200 50 5000 8,100.00
35 2 33 100 211,530.00
0 0 -
40 20 20 100 62,250.00
0 0 -
3 1 2 5 106,000.00
0 0 -
0 0 -
50 20 30 1000 6,090.00
150 0 150 500

79,200.00
0 0 -
150 0 150 500 134,250.00
0 0 0 100 -
0 0 -
690 300 390 3000 68,640.00
0 0 100 -
0 0 100 -
135 0 135 256,500.00
0 0 -
0 0 0 100 -
0 0 -
107 23 84 100 112,392.00
0 0 -
1300 900 400 5000 74,400.00
0 0 -
0 0 0 -
0 0 -
0 0 0 1000 -
0 0 -
0 0 0 50 -
0 0 0 20 -
0 0 -
0 0 -
0 0 5 -
1000 600 400 2000 34,400.00
0 0 -
0 0 -
0 0 -
0 0 -
60 0 60 500 80,400.00
400 200 200 1000 25,600.00
0 0 -
0 0 -
0 0 -
0 0 -
100 100 0 400 -
0 0 0 20 -
0 0 -
200 100 100 500 6,900.00
0 0 0 -
200 0 200 500 17,800.00
0 0 -
70 70 0 100 -
0 0 100 -
0 0 0 1000 -
0 0 0 1000 -
120 120 0 3000 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
400 0 400 1000 34,000.00
1000 400 600 2000 82,800.00
0 0 -
0 0 -
0 0 -
0 0 -
3000
200
0 -
5 5 0 -
0 0 -
0 0 -
0 0 0 20 -
0 0 -
0 0 0 -
0 0 -
0 0 0 -
0 0 0 1000 -
0 0 0 500 -
0 0 -
0 0 0 10 -
0 0 0 500 -
0 0 0 500 -
0 0 -
0 0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 0 500 -
0 0 -
0 0 -
0 0 0 -
20 20 0 -
0 0 -
0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 0 -
0 0 -
0 0 -
0 0 0 -
60 40 20 100 67,921.00
0 0 -
0 0 0 -
600 200 400 1500 28,367.60
0 0 -
0 0 0 -
0 0 0 500 -
0 0 0 -
0 0 0 -
0 0 1000 -
0 0 -
0 0 0 500 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
200 200 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 500 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
130 130 0 -
0 0 1000 -
0 0 -
28 23 5 200 4,419.60
0 0 0 -
100 79 21 500 19,220.04
0 0 0 -
75 30 45 500 44,043.75
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 0 50 -
0 0 -
1 0 1 4,400.00
0 0
-
0 0 -
0 0
-
0 0 -
0 0 -
1 1 0 5 -
0 0 -
7 1 6 20 2,569,320.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
6 0 6 62,640.00
0 0 -
4 0 4 41,760.00
0 0 0 100 -
10 10 0 100 -
53 53 0 100 -
0 0 0
100 -
0 0 300 -
0 0 0 300 -
0 0 300 -
0 0 200 -
0 0 100 -
0 0 200 -
0 0 0 100 -
0 0 -
0 0 -
0 0 -
0 0 0 200 -
0 0 -
0 0 -
0 0 -
7 7 0 200 -
62 62 0 100 -
0 0 -
0 0 -
0 0 -
60 7 53 200 270,512.00
105 34 71 500 296,496.00
0 0 0 50 -
0 0 0 50 -
0 0 -
0 0 -
0 0 0 5 -
0 0 0 -
0 0 -
0 0 -
50 50 0 300 -
0 0 300 -
0 0 300 -
6 0 6 66,120.00
0 0 -
3 2 1 10 78,279.11
1 0 1 50 143,550.00
0 0 0 50 -
0 0 -
0 0 -
5 3 2 20 30,350.00
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
12 12 0 50 -
0 0 -
0 0 10 -
0 0 0 -
0 0 -
0 0 -
0 0 -
0 0 -
Lasolo, 1 NOVEMBER 2018
Pembuat Daftar,
Penanggung Jawab Gudang Obat
Puskesmas Lasolo
EVA ANGGRAENI, AMF

NIP. -
EXPIRE DATE KET
15 16
EMBER 2018
wab Gudang Obat
AENI, AMF

AMPRAHAN

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PEMERINTAH KABUPATEN

1 Allopurinol tablet 100 mg Kotak, 10 x 10 Tablet 90.00

2 Allopurinol Tablet 100 Mg Kotak, 10 x 10 Tablet 142.00 1100 0

Aminofilin injeksi 24 mg/ml Kotak, 30 ampul @ 10 ml 4,204.00 45

5 Amlodipin tablet 5 mg Kotak, 3 x 10 Tablet 105.00

6 Amlodipin tablet 5 mg Kotak, 3 x 10 Tablet 200.00 390 0

7 Amoksisilin kapsul/kaplet 250 mg Kotak 10 x 12 Kaplet 220.00

8 Amoksisilin kapsul/kaplet 250 mg Kotak 10 x 10 Tablet 215.00 900 0

9 Amoksisilin Kaplet 500 mg Kotak 10 x 10 Tablet 192.00 2700 0

10 Amoxicilliyn Syrup 125 mg/ml Botol, 30 ml 5,075.00 15 0

11 Antasida DOEN I tablet kunyah, kombinasi Ktk, 10 strip @ 10 tab 78.00 0

12 Antasida Tablet Kotak, 10 x 10 Tablet 96.00 900 0

Antihemoroid DOEN kombinasi : Bismut subgalat 150 mg Ktk 10 supp @ 2 gr 3,350.00 10

Antimigren tablet : Ergotamin Tartat 1 mg + Kofein 50 mg Btl 100 tablet 149.00

Asam Asetilsalisilat 80 mg (Asetosal) / Miniaspi tab Ktk, 10 strip @ 10 tab 125.00

18 Asam askorbat 50 mg Ktk, 10 strip @ 10 tab 105.00

19 Asam Askorbat (Vit C) 50 mg Kotak 10 x 10 Tablet 125.00

20 Asam Askorbat (Vit C) 250 mg Kotak 10 x 10 Tablet 139.00 50 0

21 Asam Folat tablet 1 mg Btl 100 tablet 52.00

22 Asam Mefenamat kaplet 500 mg Ktk, 10 strip @ 10 tab 127.00

23 Asam Mefenamat 500 mg Kotak, 10 x 10 Tablet 211.00 3200 0

24 Asam Tranexamat Inj Box 10 Ampul 3,650.00

25 Aseptan 500 ml + Dispenser Btl 500 ml 39,150

26 Asiklovir tablet 200 mg Ktk, 10 strip @ 10 tab 251.00

27 Asiklovir tablet 200 mg Kotak 10 x 10 Tablet 276.00

28 Asiklovir tablet 400 mg Ktk, 10 strip @ 10 tab 362.00 100

30 Bacitracin Salep Tube @ 5 g 2,767.00

31 Bedak Salisil Serbuk 2% Kotak 1,350.00

32 Bedak Salisil Serbuk 2% Kotak 1,081.00 80 0

35 Betametason krim 0.1 % (sebagai Valerat) Ktk, 25 tube @ 5 g 1,444.00 100 0

36 Betametason krim 0.5 mg/g (Skizon) Tube 3,575.00

37 Bisakodil Suppositoria 10 mg (Stolax Supp) ktk, 6 Supp @ 10 mg 6,045.00

38 Calcium Laktate (Kalk) tablet 500 mg Dus, 10 Blister x 10 tab 72.00 0

40 Captopril 12.5 mg Kotak, 10 x 10 Tablet 69.00 0

41 Captopril 12.5 mg Kotak, 10 x 10 Tablet 72.00 600 0

42 Captopril 25 mg Kotak, 10 x 10 Tablet 127.00 1000 0

43 Captopril 50 mg Kotak, 5 x 10 Tablet 144.00 400 0

44 Cetirizin Syrup (Trisela Syrup) Botol 22,500.00

45 Ciprofloxacin tab 500 Mg Kotak. 10 x 10 Tab 264.00 400 0

46 Clindamycin Kapsul 300 mg Dus, 5 Blister @ 10 kps 693.00

47 Deksametason injeksi i.v. 5 mg/ml ktk 100 amp @ 1 ml 1,738.00 0

48 Deksametason injeksi i.v./i.m 5 mg/ml Kotak 100 Amp 1,820.00

49 Deksametason tablet 0,5 mg Ktk, 10 strip @ 10 tab 68.00

50 Deksamethason Tablet 0.5 mg Kotak, 10 x 10 Tablet 162.00 0

51 Diazepam injeksi 5 mg/ml Ktk, 30 amp @ 2 ml 2,578.00 0

52 Difenhidramin Inj i.v/i.m 10 mg/ml (Hcl) Kotak, 30 ampul 1,415.00

53 Digoksin 0.25 mg Kotak 10 x 10 Tablet 110.00 50 0

54 Diltiazem HCl tablet 30 mg Ktk, 10 strip @ 10 tab 141.00

55 Diltiazem HCl tablet 30 mg Kotak 10 x 10 Tablet 143.00

56 Domperidon suspensi 5 mg/5 ml Dus, 50 btl @ 60 ml 3,490.00

57 Domperidon suspensi 5 mg/5 ml Kotak 50 Botol @ 60 ml 3,300.00 46 0

58 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 174.00

59 Domperidon tablet 10 mg Ktk, 10 strip @ 10 tab 138.00 600 0

60 Dulcolax 10 Mg Supp Ktk, 50 Suppo 5,800.00 12 0

61 Dulcolax 5 Mg Supp Ktk, 6 Suppo 5,670.00 0

62 Dulcolax 5 Mg Supp Ktk, 6 Suppo 16,291.67

63 Epinefrin (Adrenalin) Inj i.v/s.k./i.m 1 mg/ml Ampul 2,354.00 0

64 Eritromisin Kaplet 500 mg Kotak, 10 x 10 Kaplet 771.00 1800 0

65 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ktk 30 amp @ 1 ml 1,980.00

66 Fenobarbital tablet 30 mg Ktk, 10 strip @ 10 tab 74.00 0

69 Furosemid injeksi i.v./i.m. 10 mg/ml Kotak, 25 Ampul 2,992.00 35 0

70 Furosemid Tablet 40 mg Kotak, 10 x 10 Tablet 117.00 100 0

71 Fitomenadion (Vit.K1) tablet salut gula 10 mg Btl 100 tablet 698.00