RANCANANGAN KEBUTUHAN OBAT TAHUN 2019

PUSKESMAS :

STOK AWAL PENERIMAAN

NO NAMA OBAT SATUAN HARGA JANUARI (JAN-DES)

TABLET
1 Adalat Oros 20 mg TABLET 3,255.00
2 Alopurinol 100 mg TABLET 97.00
3 Alopurinol 300 mg TABLET 210.00
4 Amilodipin 5 mg TABLET 105.00
5 Aminofilina 200 mg TABLET 91.00
6 Amoksilin 250 mg KAPSUL 195.00
7 Amoksilin 500 mg KAPLET 233.00
8 Antasida (MgOH 200mg+AlOH 200mg) TABLET 54.00
9 Anti Hemoroid (Bismut
subgallat150mg+Heksaklorofen2,5mg) 3,167.00
10 Antimigran (Ergotamin Tartrat 1mg + Kofein TABLET
50mg) 100.00
11 Asam Askorbat ( Vit C ) 50 mg TABLET 105.00
12 Asam Askorbat (Vit C) 250 mg TABLET 125.00
13 Asam folat 1 mg TABLET 48.00
14 Asam mefenamat 500mg TABLET 103.00
15 Asetosal 100 mg TABLET 130.00
16 Asiklovir 400mg TABLET 380.00
17 Betahistin mesilat 5 mg TABLET 110.00
18 Bisoprolol tablet 5 mg TABLET 236.00
19 Cetirizin 10mg TABLET 90.00
20 Deksametason 0,5 mg TABLET 41.00
21 Digoksin 0,25 mg TABLET 105.00
22 Diltiazem 30 mg TABLET 127.00
23 Dimenhidrinat tablet 50mg 105.00
24 Doksisiklin 100mg KAPSUL 268.00
25 Domperidon tablet 10 mg TABLET 118.00
26 Eritromisin 500mg 750.00
27 Fitomenadion (Vit K1) 10mg TABLET 710.00
28 Furosemid 40 mg 70.00
29 Glibenklamid 5 mg 119.00
30 Glimepiride tablet 2 mg TABLET 289.00
31 Griseofulvin 125 mg TABLET 210.00
32 Hidroklorotiazid (HCT) 25 mg TABLET 149.00
33 Ibuprofen 400 mg TABLET 127.00
34 Ibuprofen 200 mg TABLET 105.00
35 Isosorbid Dinitrat sublingual 5 mg TABLET 88.00
36 Kalium Diklofenac 50mg TABLET 105.00
37 Kalsium Laktat (Kalk) 500 mg 59.00
38 Kaptopril 25 mg TABLET 84.00
39 Kaptopril 12,5 mg TABLET 62.00
40 Ketokonazol 200mg tablet TABLET 270.00
41 Klindamisin kapsul 150 mg KAPSUL 715.00
42 Klopidogrel TABLET 2,000.00
43 Kloramfenikol kapsul 250 mg KAPSUL 361.00
44 Klorfeniramin Maleat (CTM) 4 mg TABLET 36.00
45 Kotrimoksazol dewasa kombinasi : TABLET
Sulfametoksazol400mg+Trimetoprim80mg 151.00
46 Levofloksasin 500 mg TABLET 495.00
47 Lisinopril 5mg tablet TABLET 259.00
48 Loratadin tablet 10 mg TABLET 123.00
49 Metformin 500mg tablet 100.00
50 Metil Prednisolon 4 mg 134.00
51 Metilergometrin Maleat 0,125 mg TABLET 210.00
52 Metoklopramid 5mg TABLET 123.00
53 Metronidazol 250 mg TABLET 154.00
54 Metronidazol 500mg TABLET 133.00
55 Natrium Diklofenac 25 mg TABLET 132.00
56 Natrium Diklofenac 50 mg TABLET 115.00
57 Nifedipin 10 mg tablet TABLET 104.00
58 Nistatin tablet vaginal 100.000 IU/g TABLET 509.10
59 Omeprazole 20mg TABLET 160.00
60 Parasetamol 500 mg TABLET 53.00
61 Pirantel 125 mg TABLET 269.00
62 Piridoksin HCL (Vit B6) tablet 10 mg TABLET 123.00
63 Prednison tablet 5 mg TABLET 68.00
64 Propanolol HCL tablet 10 mg TABLET 65.00
65 Propiltiourasil tablet 100 mg (Thyrozol) TABLET 1,225.00
66 Ranitidin tablet 150 mg TABLET 89.09
67 Salbutamol tablet 2 mg TABLET 63.00
68 Salbutamol tablet 4 mg TABLET 89.00
69 Simvastatin 10 mg TABLET 131.00
70 Siprofloksazin tablet 500 mg TABLET 265.00
71 Tablet Tambah Darah Kombinasi : Besi sulfat TABLET
200mg+Asam folat 0,25mg 354.00
72 Tetrasiklin HCL kapsul 250 mg TABLET 163.00
73 Tetrasiklin HCL kapsul 500 mg TABLET 310.00
74 Tiamin HCL (VitB1) 50 mg TABLET 85.00
75 Vitamin B Kompleks TABLET 83.00
76 Zinc 10 mg TABLET 524.00
77 Acar bose TABLET 779.00
78 Spironolactone 25mg TABLET 244.00
79 Ondansetron 4 mg TABLET 472.00
80 Irbesartan 150 mg TABLET 244.00
81 Loperamid 2 mg TABLET 472.00
82 Candesartan 8 mg TABLET 519.00
83 Cefadroxil 500mg TABLET 516.00
84 Asetilsistein TABLET 350.00
85 Clindamycin 300mg KAPSUL 516.00
86 Gemfibrozil 600mg KAPLET 679.00
87 Metformin 850mg tablet TABLET 156.00
88 Metoklopramid 10mg TABLET 87.00
89 Amlodipin 10 mg TABLET 156.00
90 Asam tranexamat tablet AMPUL 1,584.00
1 Aminofilina 24 mg/ml - 10 ml AMPUL 3,822.00
2 Amoksisilin serbuk injeksi 1000mg VIAL 8,237.00
3 Ampisillin im/iv 1000mg/ml VIAL 8,237.00
4 Atropin sulfat 0,25mg/ml-1 ml AMPUL 1,595.00
5 Calsium Gluconas injeksi 10 % BOTOL 10,351.00
6 Ceftriaxone 1 gr injeksi VIAL 1,672.00
7 Deksametason injeksi 5 mg/ml-1ml AMPUL 1,097.00
8 Difenhidramin HCL Inj 10mg/ml-1 ml 1,175.00
9 Epinefrin injeksi 1,408.00
10 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL 3,550.00
11 Furosemid injeksi AMPUL 1,333.00
12 Gentamisin injeksi 3,509.00
13 Hyosin n butilbromid inj 250mg/ml AMPUL 2,300.00
14 Lidocain comp inj 2% AMPUL 1,040.91
15 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL 3,200.00
16 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL 1,937.00
17 Metilergometrin Maleat inj. 0,200mg-1ml 2,959.00
18 Metoklopramid inj. 5mg / ml AMPUL 3,395.00
19 Oksitosin injeksi 10 IU/ml - 1 ml 1,199.00
20 Ondansetron injeksi AMPUL 1,650.00
21 Piracetam injeksi 1 gr / 5 ml BOTOL 1,900.00
22 Piracetam injeksi 3 gr / 5 ml BOTOL 1,650.00
23 Ranitidin injeksi 25mg/2ml AMPUL 1,155.00
24 Sefotaksim injeksi 1 gram VIAL 4,200.00
25 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL 1,098.00
26 Streptomisin serbuk injeksi iv 1000mg/ml VIAL 3,650.00
27 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL 1,098.00
28 Omeprazol injeksi 9,898.00
29 Asam tranexamat injeksi AMPUL 1,945.00
30 Procain Benzil Penisilin inj 3 jt iu VIAL 7,190.00
31 Benzatin Benzil Penisilin inj 1.2 jt iu vial 9,727.00
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT 4,323.00
2 Asiklovir krim 5% TUBE 4,000.00
 3 Basitrasin Polimixin B SK TUBE 2,924.00
4 Betametason krim 0,1 % TUBE 1,340.00
5 Gameksan emulsi 1 % 30ml TUBE 2,924.00
6 Gentamisin salep kulit 0.1%-5gr TUBE 1,349.00
7 Gentamisin salep mata 0,3% TUBE 2,600.00
8 Hidrokortison krim 2,5 % TUBE 2,798.00
9 Ketokonazol krim 2% TUBE 2,000.00
10 Kloramfenikol salep mata 1 % TUBE 2,650.00
11 Miconazol cream 2 % TUBE 3,414.00
12 Oksitetrasiklin HCL 1 % salep mata TUBE 1,810.00
13 Oksitetrasiklin HCL salep 3 % TUBE 3,000.00
14 Salep 2-4 Komb: As salisilat2%+Belerang POT
endap4% 2,620.00
15 Perak Sulfadiazin krim TUBE 20,700.00
16 Garam oralit untuk 200 ml air SACHET 288.00
17 Salisil Bedak 2 % POT 1,025.00
18 Amoksilin 125mg/5ml VIAL 1,881.00
19 Antasida syr (MgOH 200mg/5ml+AlOH BOTOL
200mg/5ml) 1,995.00
20 Cetirizin syr BOTOL 2,850.00
21 Eritromisin sirup BOTOL 7,220.00
22 Ibuprofen suspensi 100mg/5ml 2,550.00
23 Kloramfenikol suspensi 125mg/5ml BOTOL 4,700.00

24 Kotrimoksazol Suspensi komb: Sulfametoksazol

200mg+Trimetoprim40mg/5ml
2,286.00
25 Obat Batuk Hitam ( O B H ) cairan BOTOL 4,840.00
26 Parasetamol sirup 120mg/5ml BOTOL 1,107.00
27 Metronidazol syrup BOTOL 9,950.00
28 Cefadroxil syr 125mg/5ml BOTOL 3,980.00
29 Fenol Gliserol tetes telinga 10 % BOTOL 2,590.00
30 Gentamisin tetes mata 0.3% BOTOL 4,232.00
31 Gentian violet larutan 1 % BOTOL 2,500.00
32 Kloramfenikol tetes mata BOTOL 4,170.00
33 Kloramfenikol tetes telinga 3 % BOTOL 900.00
34 Parasetamol drop 100mg/ml btl @ 15ml BOTOL 6,649.00
35 Polikresulen ( Albothyl ) BOTOL 1,540.00
36 Sulfasetamid Natrium tetes mata 15 % BOTOL 5,200.00
1 Alat suntik sekali pakai 1 ml SET 990.00
2 Alat suntik sekali pakai 3 ml SET 792.00
3 Alat suntik sekali pakai 5 ml SET 979.00
4 Alat suntik sekali pakai 10 ml 1,298.00
5 Alat suntik sekali pakai 20 ml PCS 977.00
6 Alat suntik sekali pakai 50ml pcs 5,621.00
7 Alkohol swab PAK 11,000.00
 8 Aqua pro injeksi BOTOL 2,860.00
9 Blood Tranfusion set PCS 14,300.00
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET 34,170.00
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET 35,740.00
12 Biplacenton tulle LEMBAR 10,400.00
13 Etanol 70 % 100 ml BOTOL 2,500.00
14 Etanol 70 % 1000 ml BOTOL 10,400.00
15 Foley Catheter no.16 18,450.00
16 Folley cath no. 18 PCS 18,450.00
17 NITRILE POWDER-FREE EXAM GLOVE M KOTAK/50 77,493.00
18 Handscoon M "50 KOTAK/50 70,862.00
19 Hanschoen steril no 6.5 9,854.00
20 Hanschoen steril no 7 9,854.00
21 I.V. Catheter No 18 PCS 8,700.00
22 I.V. Catheter No 20 PCS 8,700.00
23 I.V. Catheter No 22 PCS 8,700.00
24 I.V. Catheter No 24 safety PCS 8,700.00
25 iv cath no 26 safety PCS 16,346.00
26 Infusion set OI-34 PCS 7,920.00
27 Otsu Y set PCS 7,920.00
28 Kapas Pembalut / Absorben 250 gr ROL 24,000.00
29 Kasa Pembalut 2 m x 80 cm ROL 4,800.00
30 Kasa Pembalut elastic 3 inchi ROL 28,530.00
31 Kasa Pembalut Hidrofil 4 m x 15 cm ROL 3,800.00
32 Kasa Steril 16 x 16 PAK 7,900.00
33 Kasa 4cm x 5m rol 1,100.00
34 New DRC 4Y x 80 cm plain ROL 149,158.00
35 Lisol, mengandung Kresol tersabun 50% BOTOL 41,000.00
36 One Clean 1 ltr BOTOL 14,520.00
37 Masker karet KTK/50 21,945.00
38 Masker karet KOTAK/50 18,200.00
39 Masker oxygen (dewasa) PCS 19,800.00
40 Masker oxygen dewasa pcs 15,700.00
41 Masker oxygen anak pcs 15,700.00
42 NGT 7 x 75/80 PCS 21,945.00
43 One Med H2 O2 3 % BOTOL 6,600.00
44 One Med Surgical Blade PCS -
38 Plester kertas aximed 1,25 cm 4,454.00
39 Plester kertas aximed 2,5 cm ROL 7,409.00
40 Plester infus tegaderm PCS 224,200.00
109 Plester infus cannofix 6 x 8 cm pcs 8,470.00
110 Rivanol larutan 0,1 % 300ml BOTOL 3,000.00
111 Silk ( Benang Bedah Sutera ) No. 3/0 35,740.00
39 Tensocrepe (FM crepe) PAK 43,987.00
40 Urine Bag PCS 5,500.00
 41 Wing Needle No. 18 - 27 SACHET 43,987.00
112 Yodium Povidon larutan 10 % 30 ml BOTOL 2,900.00
113 Yodium Povidon larutan 10 % 60 ml BOTOL 6,000.00
114 Yodium Povidon larutan 10 % 300 ml BOTOL 18,000.00
40 Policlean handrub 500ml BOTOL 60,800.00
41 Nurse cap PCS 667.80
42 Surgical gown (M) PCS 20,966.00
115 Surgical gown (L) PCS 20,966.00
116 Glucose protein test SACHET 1,045.00
117 Underpad LEMBAR 4,620.00
41 Nasal kanul L SET 6,600.00
42 Nasal kanul S SET 6,600.00
43 Nasal kanul XS SET 7,300.00
118 Handrub refill 5L GALON 580,000.00
119 Umbilical cord PAK 65,000.00
120 Umbilical cord pak 137,500.00
42 Dermafix T 5x7 PAK 580,000.00
43 Tegaderm pad 269,933.00
44 Plesterin SET 26,950.00
121 Plesterin 30,800.00
122 Stomach tube no 16 SET 15,373.00
123 Stomach tube no 18 PAK 15,373.00
43 Nonwoven fixation 5cmx10m KOTAK/50 43,850.00
44 Polifix 5cmx5m PAK 18,000.00
45 Pharmafix 10cm x 500m rol 77,550.00
124 Handscoon L "50 KOTAK/50 46,200.00
125 Handscoon S "50 ROL 77,493.00
126 Handscoon S "50 Ansell 70,862.00
44 Leukoplast (2,5cm x 4,5m) ROL 12,076.00
45 Hansaplast rol (5cmx4,5m) PCS 25,404.00
46 Leukoplast (7,5cm x 4,5m) ROL 35,532.00
127 Hansaplast rol (7,5cmx4,5m) PCS 31,265.00
128 Plester infus (e care + pot) KOTAK/50 220,000.00
129 Masker tali (Aximed) KOTAK/50 22,000.00
45 Masker tali (MI) KOTAK/50 17,900.00
46 My jelly 82 gram KOTAK/50 29,550.00
47 Surgical mask plus 3 ply (hijab) KOTAK/50 22,000.00
130 Surgical mask plus 3 ply HIJAB MMP KOTAK/50 36,300.00
131 Sarung tangan obgyn steril BOTOL 19,360.00
132 USG gel 5 L BOTOL 156,640.00
46 Ecodine 1 L PCS 79,650.00
47 Extradine 5L 475,200.00
48 Poliwash 500ml PCS 55,569.00
133 Poliwash 5L PCS 566,532.00
134 Viorex Liquid soap 2% 5L PCS 554,400.00
 135 Female cath no 16 PCS 5,720.00
47 Female cath no 18 PCS 5,720.00
48 Cavilon film 1ml wipe 160,500.00
49 Hi oxy mask dewasa / NRBM KOTAK/50 24,640.00
136 Hi oxy mask Anak / NRBM PCS 24,640.00
137 Masker JET Nebulizer Anak PCS 22,000.00
138 Masker JET Nebulizer Dewasa PCS 22,000.00
48 MASKER N95 (3M) PCS 390,000.00
49 MASKER N95 (onemed) PCS 130,240.00
50 SPALK PCS 61,600.00
139 Threeway trovenoflow stopcock pcs 16,500.00
140 Steri strip pak 187,071.00
141 Aqua gel 82gr pak 42,588.00
49 ID Band child pink pcs 1,078.00
50 ID Band child blue pcs 1,078.00
51 ID Band child yellow pcs 1,078.00
142 ID Band adult pink pcs 1,078.00
143 ID Band adult blue pcs 1,078.00
144 ID Band adult yellow pcs 1,078.00
50 Waterone 1L f 14,960.00
51 Guedel airway pcs 12,574.39
145 Asering Larutan infus BOTOL 9,275.00
146 Glukosa larutan infus 10 % steril BOTOL 7,500.00
147 Glukosa larutan infus 40 % steril BOTOL 9,275.00
51 Glukosa larutan infus 5 % steril BOTOL 6,900.00
52 KAEN 3B BOTOL 7,000.00
53 KAEN 4B BOTOL 6,900.00
148 Metronidazol infus BOTOL 9,950.00
149 Natrium Klorida larutan infus 0,9 % steril BOTOL 6,410.00
150 Ringer Lactate infus steril BOTOL 7,150.00
52 Paracetamol infus BOTOL 12,940.00
#REF! Albothyl BOTOL 23,100.00
152 Bisakodil suppositoria 10mg BIJI 5,800.00
153 Bufacomb TUBE 14,175.00
53 Cendo Lyters tetes mata BOTOL 5,800.00
54 Cendo Xitrol tetes mata BOTOL 15,000.00
55 Citicholin inj. 250 mg / 2ml AMPUL 15,750.00
154 Laxadin sirup BOTOL 7,700.00
155 Lactodiar SACHET 15,000.00
156 Lytamin syrup BOTOL 5,000.00
54 Mecobion tablet TABLET 1,000.00
55 Metamizole injeksi 500mg AMPUL 5,000.00
56 Microlax BIJI 1,000.00
157 Neurotropik injeksi 5000mcg (Mersibion) AMPUL 4,300.00
158 Biocombin inj 5,000.00
159 Novalgin/Antrain injeksi AMPUL 14,500.00
55 Noza TABLET 362.00
56 Obat Batuk Anak sirup (babycough) BOTOL 3,575.00
57 Parasetamol supp BIJI 362.00
160 Pehacain injeksi AMPUL 3,575.00
161 Permetrin/Scabicid krim 5% TUBE 12,155.00
162 Permetrin/Scabicid krim 5% TUBE 11,825.00
56 Salbutamol rotacaps KAPSUL 2,590.00
57 Salbutamol rotahaler PCS 5,867.00
58 Spasminal TABLET 1,360.00
163 Selesdiar (Puralex) TABLET 190.00
164 Selesdiar (Puralex) TABLET 152.00
165 Ventolin nebuliser BOTOL 1,360.00
57 Zirkum syr BOTOL 14,980.00
58 Miniaspi (Asetosal 80mg) TABLET 148.00
59 Ulsidex 500mg TABLET 14,980.00
166 Combiven nebulizer AMPUL 5,700.00
167 Dulcolax supp 5 mg (anak) SUPP 5,670.00
168 Bufacetin salep TUBE 3,091.00
58 Pantocain TM BOTOL 11,500.00
59 Chloramex 500mg KAPSUL 1,007.00
60 Chloramex 500mg KAPSUL 1,090.00
169 Euthyrox (Levotiroksin 100mcg) TABLET 11,500.00
170 Dionicol 500mg KAPSUL 1,007.00
171 Sotatic inj (metoclopramid inj) AMPUL 850.00
59 Gricin TABLET 737.00
60 Amoxsan serbuk injeksi VIAL 4,620.00
61 Daryantulle 8,990.00
172 Calporosis 430.00
173 Reco TT 3% 6,600.00
60 Devitalisasi Pasta ( Non Arsen ) BOTOL -
61 Xylocain spray BOTOL 177,216.00
62 Eugenol cairan BOTOL 100,000.00
175 Glass Ionomer Cemen ( GC IX ) BOTOL -
176 Kalsium Hidroksida Pasta TUBE -
177 Monoklorkamfer Mentol Cairan BOTOL -
61 Mummifying Pasta TUBE -
62 Semen Seng Fosfat serbuk dan cairan BOTOL -
63 Silver Amalgam serbuk 65 - 75 % BOTOL -
178 Temporary Stopping Fletcher serbuk dan cairan BOTOL
-
179 Trikresol Formalin (TKF) cairan BOTOL -
180 Alkacide SACHET 2,702,700.00
62 Alkacide SACHET 2,702,700.00
63 Alkazym BOTOL 801,000.00
 64 Alkazym BOTOL 801,000.00
f. JIWA
1 Amitriptilin HCL 25 mg TABLET 102.00
1 Amitriptilin HCL 25 mg TABLET 167.00
2 Clobazam 10mg tab TABLET 967.00
3 Fenitoin Natrium inj. 50 mg/ml AMPUL 20,250.00
4 Fenitoin Natrium 100 mg KAPSUL 154.00
5 Fenitoin Natrium 30 mg KAPSUL 93.00
6 Haldol decanoat 50mg/ml inj AMPUL 97,500.00
7 Haloperidol 1,5 mg TABLET 69.00
8 Haloperidol 5 mg TABLET 96.00
9 Karbamazepin 200 mg TABLET 245.00
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL -
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL -
12 Klorpromazin HCL tablet salut 100 mg TABLET 144.00
13 Klorpromazin HCL tablet salut 100 mg TABLET 147.00
13 Klorpromazin HCL tablet salut 25 mg TABLET 68.00
14 Lodomer 5mg/ml inj AMPUL 6,250.00
15 Risperidone 2mg TABLET 1,008.00
15 Risperidone 2mg TABLET 347.00
15 Risperidone 2mg TABLET 273.00
16 Sikzonoat 25mg/ml inj AMPUL 57,500.00
17 Trifluoperazin tablet 5 mg TABLET 405.00
17 Trifluoperazin tablet 5 mg 775.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET 88.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET 80.00
19 Triheksifenidil Hidroklorida tab 2 mg TABLET 85.00
19 Clozapin 25 mg tab TABLET 1,550.00
19 Clozapin 25 mg tab TABLET 1,121.00
20 Fluoksetin/Nopres 20 mg KAPSUL 950.00
21 Haloperidol 0,5 mg TABLET 88.00
22 Haloperidol tts 2 mg/ml (Lodomer drop) BOTOL 16,500.00
23 Stelazin 1 mg TABLET 6,250.00
24 Haldol 5 mg /ml inj 347.00
j. PSIKOTROPIKA NARKOTIKA
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL 4,180.00
2 Diazepam 2 mg TABLET 42.00
3 Diazepam 5 mg TABLET 107.00
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL 1,980.00
5 Fenobarbital 30 mg TABLET 610.29
6 Kodein tablet 10mg TABLET 500.00
7 Kodein tablet 10mg TABLET 571.00
7 Stesolid rectal supp 5 mg (EXPIRED DATE) BIJI 11,517.00
8 Alprazolam 1mg TABLET 233.00
9 Stesolid rectal supp 10 mg BIJI 16,742.00
l. SERUM
1 SABU (Biosave) VIAL 479,996.00
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) Ampul -
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS)
ampul 176,800.00
JUMLAH

NAMA KEPALA PUSKESMAS

 RATA2
PENGELUARAN Jumlah
(JAN-DES) PERENCANAAN
NAMA PENANGGUNG JAWAB
 RANCANANGAN KEBUTUHAN OBAT TAHUN 2019
PUSKESMAS :

SISA
NO NAMA OBAT SATUAN HARGA DESEMBER
PERENCANAAN

TABLET
1 Adalat Oros 20 mg TABLET 3,255.00
2 Alopurinol 100 mg TABLET 97.00
3 Alopurinol 300 mg TABLET 210.00
4 Amilodipin 5 mg TABLET 105.00
5 Aminofilina 200 mg TABLET 91.00
6 Amoksilin 250 mg KAPSUL 195.00
7 Amoksilin 500 mg KAPLET 233.00
8 Antasida (MgOH 200mg+AlOH 200mg) TABLET 54.00
9 Anti Hemoroid (Bismut
subgallat150mg+Heksaklorofen2,5mg) 3,167.00
10 Antimigran (Ergotamin Tartrat 1mg + Kofein TABLET
50mg) 100.00
11 Asam Askorbat ( Vit C ) 50 mg TABLET 105.00
12 Asam Askorbat (Vit C) 250 mg TABLET 125.00
13 Asam folat 1 mg TABLET 48.00
14 Asam mefenamat 500mg TABLET 103.00
15 Asetosal 100 mg TABLET 130.00
16 Asiklovir 400mg TABLET 380.00
17 Betahistin mesilat 5 mg TABLET 110.00
18 Bisoprolol tablet 5 mg TABLET 236.00
19 Cetirizin 10mg TABLET 90.00
20 Deksametason 0,5 mg TABLET 41.00
21 Digoksin 0,25 mg TABLET 105.00
22 Diltiazem 30 mg TABLET 127.00
23 Dimenhidrinat tablet 50mg 105.00
24 Doksisiklin 100mg KAPSUL 268.00
25 Domperidon tablet 10 mg TABLET 118.00
26 Eritromisin 500mg 750.00
27 Fitomenadion (Vit K1) 10mg TABLET 710.00
28 Furosemid 40 mg 70.00
29 Glibenklamid 5 mg 119.00
30 Glimepiride tablet 2 mg TABLET 289.00
31 Griseofulvin 125 mg TABLET 210.00
32 Hidroklorotiazid (HCT) 25 mg TABLET 149.00
33 Ibuprofen 400 mg TABLET 127.00
34 Ibuprofen 200 mg TABLET 105.00
35 Isosorbid Dinitrat sublingual 5 mg TABLET 88.00
36 Kalium Diklofenac 50mg TABLET 105.00
37 Kalsium Laktat (Kalk) 500 mg 59.00
38 Kaptopril 25 mg TABLET 84.00
39 Kaptopril 12,5 mg TABLET 62.00
40 Ketokonazol 200mg tablet TABLET 270.00
41 Klindamisin kapsul 150 mg KAPSUL 715.00
42 Klopidogrel TABLET 2,000.00
43 Kloramfenikol kapsul 250 mg KAPSUL 361.00
44 Klorfeniramin Maleat (CTM) 4 mg TABLET 36.00
45 Kotrimoksazol dewasa kombinasi : TABLET
Sulfametoksazol400mg+Trimetoprim80mg 151.00
46 Levofloksasin 500 mg TABLET 495.00
47 Lisinopril 5mg tablet TABLET 259.00
48 Loratadin tablet 10 mg TABLET 123.00
49 Metformin 500mg tablet 100.00
50 Metil Prednisolon 4 mg 134.00
51 Metilergometrin Maleat 0,125 mg TABLET 210.00
52 Metoklopramid 5mg TABLET 123.00
53 Metronidazol 250 mg TABLET 154.00
54 Metronidazol 500mg TABLET 133.00
55 Natrium Diklofenac 25 mg TABLET 132.00
56 Natrium Diklofenac 50 mg TABLET 115.00
57 Nifedipin 10 mg tablet TABLET 104.00
58 Nistatin tablet vaginal 100.000 IU/g TABLET 509.10
59 Omeprazole 20mg TABLET 160.00
60 Parasetamol 500 mg TABLET 53.00
61 Pirantel 125 mg TABLET 269.00
62 Piridoksin HCL (Vit B6) tablet 10 mg TABLET 123.00
63 Prednison tablet 5 mg TABLET 68.00
64 Propanolol HCL tablet 10 mg TABLET 65.00
65 Propiltiourasil tablet 100 mg (Thyrozol) TABLET 1,225.00
66 Ranitidin tablet 150 mg TABLET 89.09
67 Salbutamol tablet 2 mg TABLET 63.00
68 Salbutamol tablet 4 mg TABLET 89.00
69 Simvastatin 10 mg TABLET 131.00
70 Siprofloksazin tablet 500 mg TABLET 265.00
71 Tablet Tambah Darah Kombinasi : Besi sulfat TABLET
200mg+Asam folat 0,25mg 354.00
72 Tetrasiklin HCL kapsul 250 mg TABLET 163.00
73 Tetrasiklin HCL kapsul 500 mg TABLET 310.00
74 Tiamin HCL (VitB1) 50 mg TABLET 85.00
75 Vitamin B Kompleks TABLET 83.00
76 Zinc 10 mg TABLET 524.00
77 Acar bose TABLET 779.00
78 Spironolactone 25mg TABLET 244.00
79 Ondansetron 4 mg TABLET 472.00
80 Irbesartan 150 mg TABLET 244.00
81 Loperamid 2 mg TABLET 472.00
82 Candesartan 8 mg TABLET 519.00
83 Cefadroxil 500mg TABLET 516.00
84 Asetilsistein TABLET 350.00
85 Clindamycin 300mg KAPSUL 516.00
86 Gemfibrozil 600mg KAPLET 679.00
87 Metformin 850mg tablet TABLET 156.00
88 Metoklopramid 10mg TABLET 87.00
89 Amlodipin 10 mg TABLET 156.00
90 Asam tranexamat tablet AMPUL 1,584.00
1 Aminofilina 24 mg/ml - 10 ml AMPUL 3,822.00
2 Amoksisilin serbuk injeksi 1000mg VIAL 8,237.00
3 Ampisillin im/iv 1000mg/ml VIAL 8,237.00
4 Atropin sulfat 0,25mg/ml-1 ml AMPUL 1,595.00
5 Calsium Gluconas injeksi 10 % BOTOL 10,351.00
6 Ceftriaxone 1 gr injeksi VIAL 1,672.00
7 Deksametason injeksi 5 mg/ml-1ml AMPUL 1,097.00
8 Difenhidramin HCL Inj 10mg/ml-1 ml 1,175.00
9 Epinefrin injeksi 1,408.00
10 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL 3,550.00
11 Furosemid injeksi AMPUL 1,333.00
12 Gentamisin injeksi 3,509.00
13 Hyosin n butilbromid inj 250mg/ml AMPUL 2,300.00
14 Lidocain comp inj 2% AMPUL 1,040.91
15 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL 3,200.00
16 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL 1,937.00
17 Metilergometrin Maleat inj. 0,200mg-1ml 2,959.00
18 Metoklopramid inj. 5mg / ml AMPUL 3,395.00
19 Oksitosin injeksi 10 IU/ml - 1 ml 1,199.00
20 Ondansetron injeksi AMPUL 1,650.00
21 Piracetam injeksi 1 gr / 5 ml BOTOL 1,900.00
22 Piracetam injeksi 3 gr / 5 ml BOTOL 1,650.00
23 Ranitidin injeksi 25mg/2ml AMPUL 1,155.00
24 Sefotaksim injeksi 1 gram VIAL 4,200.00
25 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL 1,098.00
26 Streptomisin serbuk injeksi iv 1000mg/ml VIAL 3,650.00
27 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL 1,098.00
28 Omeprazol injeksi 9,898.00
29 Asam tranexamat injeksi AMPUL 1,945.00
30 Procain Benzil Penisilin inj 3 jt iu VIAL 7,190.00
31 Benzatin Benzil Penisilin inj 1.2 jt iu vial 9,727.00
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT 4,323.00
2 Asiklovir krim 5% TUBE 4,000.00
 3 Basitrasin Polimixin B SK TUBE 2,924.00
4 Betametason krim 0,1 % TUBE 1,340.00
5 Gameksan emulsi 1 % 30ml TUBE 2,924.00
6 Gentamisin salep kulit 0.1%-5gr TUBE 1,349.00
7 Gentamisin salep mata 0,3% TUBE 2,600.00
8 Hidrokortison krim 2,5 % TUBE 2,798.00
9 Ketokonazol krim 2% TUBE 2,000.00
10 Kloramfenikol salep mata 1 % TUBE 2,650.00
11 Miconazol cream 2 % TUBE 3,414.00
12 Oksitetrasiklin HCL 1 % salep mata TUBE 1,810.00
13 Oksitetrasiklin HCL salep 3 % TUBE 3,000.00
14 Salep 2-4 Komb: As salisilat2%+Belerang POT
endap4% 2,620.00
15 Perak Sulfadiazin krim TUBE 20,700.00
16 Garam oralit untuk 200 ml air SACHET 288.00
17 Salisil Bedak 2 % POT 1,025.00
18 Amoksilin 125mg/5ml VIAL 1,881.00
19 Antasida syr (MgOH 200mg/5ml+AlOH BOTOL
200mg/5ml) 1,995.00
20 Cetirizin syr BOTOL 2,850.00
21 Eritromisin sirup BOTOL 7,220.00
22 Ibuprofen suspensi 100mg/5ml 2,550.00
23 Kloramfenikol suspensi 125mg/5ml BOTOL 4,700.00

24 Kotrimoksazol Suspensi komb: Sulfametoksazol

200mg+Trimetoprim40mg/5ml
2,286.00
25 Obat Batuk Hitam ( O B H ) cairan BOTOL 4,840.00
26 Parasetamol sirup 120mg/5ml BOTOL 1,107.00
27 Metronidazol syrup BOTOL 9,950.00
28 Cefadroxil syr 125mg/5ml BOTOL 3,980.00
29 Fenol Gliserol tetes telinga 10 % BOTOL 2,590.00
30 Gentamisin tetes mata 0.3% BOTOL 4,232.00
31 Gentian violet larutan 1 % BOTOL 2,500.00
32 Kloramfenikol tetes mata BOTOL 4,170.00
33 Kloramfenikol tetes telinga 3 % BOTOL 900.00
34 Parasetamol drop 100mg/ml btl @ 15ml BOTOL 6,649.00
35 Polikresulen ( Albothyl ) BOTOL 1,540.00
36 Sulfasetamid Natrium tetes mata 15 % BOTOL 5,200.00
1 Alat suntik sekali pakai 1 ml SET 990.00
2 Alat suntik sekali pakai 3 ml SET 792.00
3 Alat suntik sekali pakai 5 ml SET 979.00
4 Alat suntik sekali pakai 10 ml 1,298.00
5 Alat suntik sekali pakai 20 ml PCS 977.00
6 Alat suntik sekali pakai 50ml pcs 5,621.00
7 Alkohol swab PAK 11,000.00
 8 Aqua pro injeksi BOTOL 2,860.00
9 Blood Tranfusion set PCS 14,300.00
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET 34,170.00
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET 35,740.00
12 Biplacenton tulle LEMBAR 10,400.00
13 Etanol 70 % 100 ml BOTOL 2,500.00
14 Etanol 70 % 1000 ml BOTOL 10,400.00
15 Foley Catheter no.16 18,450.00
16 Folley cath no. 18 PCS 18,450.00
17 NITRILE POWDER-FREE EXAM GLOVE M KOTAK/50 77,493.00
18 Handscoon M "50 KOTAK/50 70,862.00
19 Hanschoen steril no 6.5 9,854.00
20 Hanschoen steril no 7 9,854.00
21 I.V. Catheter No 18 PCS 8,700.00
22 I.V. Catheter No 20 PCS 8,700.00
23 I.V. Catheter No 22 PCS 8,700.00
24 I.V. Catheter No 24 safety PCS 8,700.00
25 iv cath no 26 safety PCS 16,346.00
26 Infusion set OI-34 PCS 7,920.00
27 Otsu Y set PCS 7,920.00
28 Kapas Pembalut / Absorben 250 gr ROL 24,000.00
29 Kasa Pembalut 2 m x 80 cm ROL 4,800.00
30 Kasa Pembalut elastic 3 inchi ROL 28,530.00
31 Kasa Pembalut Hidrofil 4 m x 15 cm ROL 3,800.00
32 Kasa Steril 16 x 16 PAK 7,900.00
33 Kasa 4cm x 5m rol 1,100.00
34 New DRC 4Y x 80 cm plain ROL 149,158.00
35 Lisol, mengandung Kresol tersabun 50% BOTOL 41,000.00
36 One Clean 1 ltr BOTOL 14,520.00
37 Masker karet KTK/50 21,945.00
38 Masker karet KOTAK/50 18,200.00
39 Masker oxygen (dewasa) PCS 19,800.00
40 Masker oxygen dewasa pcs 15,700.00
41 Masker oxygen anak pcs 15,700.00
42 NGT 7 x 75/80 PCS 21,945.00
43 One Med H2 O2 3 % BOTOL 6,600.00
44 One Med Surgical Blade PCS -
38 Plester kertas aximed 1,25 cm 4,454.00
39 Plester kertas aximed 2,5 cm ROL 7,409.00
40 Plester infus tegaderm PCS 224,200.00
109 Plester infus cannofix 6 x 8 cm pcs 8,470.00
110 Rivanol larutan 0,1 % 300ml BOTOL 3,000.00
111 Silk ( Benang Bedah Sutera ) No. 3/0 35,740.00
39 Tensocrepe (FM crepe) PAK 43,987.00
40 Urine Bag PCS 5,500.00
 41 Wing Needle No. 18 - 27 SACHET 43,987.00
112 Yodium Povidon larutan 10 % 30 ml BOTOL 2,900.00
113 Yodium Povidon larutan 10 % 60 ml BOTOL 6,000.00
114 Yodium Povidon larutan 10 % 300 ml BOTOL 18,000.00
40 Policlean handrub 500ml BOTOL 60,800.00
41 Nurse cap PCS 667.80
42 Surgical gown (M) PCS 20,966.00
115 Surgical gown (L) PCS 20,966.00
116 Glucose protein test SACHET 1,045.00
117 Underpad LEMBAR 4,620.00
41 Nasal kanul L SET 6,600.00
42 Nasal kanul S SET 6,600.00
43 Nasal kanul XS SET 7,300.00
118 Handrub refill 5L GALON 580,000.00
119 Umbilical cord PAK 65,000.00
120 Umbilical cord pak 137,500.00
42 Dermafix T 5x7 PAK 580,000.00
43 Tegaderm pad 269,933.00
44 Plesterin SET 26,950.00
121 Plesterin 30,800.00
122 Stomach tube no 16 SET 15,373.00
123 Stomach tube no 18 PAK 15,373.00
43 Nonwoven fixation 5cmx10m KOTAK/50 43,850.00
44 Polifix 5cmx5m PAK 18,000.00
45 Pharmafix 10cm x 500m rol 77,550.00
124 Handscoon L "50 KOTAK/50 46,200.00
125 Handscoon S "50 ROL 77,493.00
126 Handscoon S "50 Ansell 70,862.00
44 Leukoplast (2,5cm x 4,5m) ROL 12,076.00
45 Hansaplast rol (5cmx4,5m) PCS 25,404.00
46 Leukoplast (7,5cm x 4,5m) ROL 35,532.00
127 Hansaplast rol (7,5cmx4,5m) PCS 31,265.00
128 Plester infus (e care + pot) KOTAK/50 220,000.00
129 Masker tali (Aximed) KOTAK/50 22,000.00
45 Masker tali (MI) KOTAK/50 17,900.00
46 My jelly 82 gram KOTAK/50 29,550.00
47 Surgical mask plus 3 ply (hijab) KOTAK/50 22,000.00
130 Surgical mask plus 3 ply HIJAB MMP KOTAK/50 36,300.00
131 Sarung tangan obgyn steril BOTOL 19,360.00
132 USG gel 5 L BOTOL 156,640.00
46 Ecodine 1 L PCS 79,650.00
47 Extradine 5L 475,200.00
48 Poliwash 500ml PCS 55,569.00
133 Poliwash 5L PCS 566,532.00
134 Viorex Liquid soap 2% 5L PCS 554,400.00
 135 Female cath no 16 PCS 5,720.00
47 Female cath no 18 PCS 5,720.00
48 Cavilon film 1ml wipe 160,500.00
49 Hi oxy mask dewasa / NRBM KOTAK/50 24,640.00
136 Hi oxy mask Anak / NRBM PCS 24,640.00
137 Masker JET Nebulizer Anak PCS 22,000.00
138 Masker JET Nebulizer Dewasa PCS 22,000.00
48 MASKER N95 (3M) PCS 390,000.00
49 MASKER N95 (onemed) PCS 130,240.00
50 SPALK PCS 61,600.00
139 Threeway trovenoflow stopcock pcs 16,500.00
140 Steri strip pak 187,071.00
141 Aqua gel 82gr pak 42,588.00
49 ID Band child pink pcs 1,078.00
50 ID Band child blue pcs 1,078.00
51 ID Band child yellow pcs 1,078.00
142 ID Band adult pink pcs 1,078.00
143 ID Band adult blue pcs 1,078.00
144 ID Band adult yellow pcs 1,078.00
50 Waterone 1L f 14,960.00
51 Guedel airway pcs 12,574.39
145 Asering Larutan infus BOTOL 9,275.00
146 Glukosa larutan infus 10 % steril BOTOL 7,500.00
147 Glukosa larutan infus 40 % steril BOTOL 9,275.00
51 Glukosa larutan infus 5 % steril BOTOL 6,900.00
52 KAEN 3B BOTOL 7,000.00
53 KAEN 4B BOTOL 6,900.00
148 Metronidazol infus BOTOL 9,950.00
149 Natrium Klorida larutan infus 0,9 % steril BOTOL 6,410.00
150 Ringer Lactate infus steril BOTOL 7,150.00
52 Paracetamol infus BOTOL 12,940.00
#REF! Albothyl BOTOL 23,100.00
152 Bisakodil suppositoria 10mg BIJI 5,800.00
153 Bufacomb TUBE 14,175.00
53 Cendo Lyters tetes mata BOTOL 5,800.00
54 Cendo Xitrol tetes mata BOTOL 15,000.00
55 Citicholin inj. 250 mg / 2ml AMPUL 15,750.00
154 Laxadin sirup BOTOL 7,700.00
155 Lactodiar SACHET 15,000.00
156 Lytamin syrup BOTOL 5,000.00
54 Mecobion tablet TABLET 1,000.00
55 Metamizole injeksi 500mg AMPUL 5,000.00
56 Microlax BIJI 1,000.00
157 Neurotropik injeksi 5000mcg (Mersibion) AMPUL 4,300.00
158 Biocombin inj 5,000.00
159 Novalgin/Antrain injeksi AMPUL 14,500.00
55 Noza TABLET 362.00
56 Obat Batuk Anak sirup (babycough) BOTOL 3,575.00
57 Parasetamol supp BIJI 362.00
160 Pehacain injeksi AMPUL 3,575.00
161 Permetrin/Scabicid krim 5% TUBE 12,155.00
162 Permetrin/Scabicid krim 5% TUBE 11,825.00
56 Salbutamol rotacaps KAPSUL 2,590.00
57 Salbutamol rotahaler PCS 5,867.00
58 Spasminal TABLET 1,360.00
163 Selesdiar (Puralex) TABLET 190.00
164 Selesdiar (Puralex) TABLET 152.00
165 Ventolin nebuliser BOTOL 1,360.00
57 Zirkum syr BOTOL 14,980.00
58 Miniaspi (Asetosal 80mg) TABLET 148.00
59 Ulsidex 500mg TABLET 14,980.00
166 Combiven nebulizer AMPUL 5,700.00
167 Dulcolax supp 5 mg (anak) SUPP 5,670.00
168 Bufacetin salep TUBE 3,091.00
58 Pantocain TM BOTOL 11,500.00
59 Chloramex 500mg KAPSUL 1,007.00
60 Chloramex 500mg KAPSUL 1,090.00
169 Euthyrox (Levotiroksin 100mcg) TABLET 11,500.00
170 Dionicol 500mg KAPSUL 1,007.00
171 Sotatic inj (metoclopramid inj) AMPUL 850.00
59 Gricin TABLET 737.00
60 Amoxsan serbuk injeksi VIAL 4,620.00
61 Daryantulle 8,990.00
172 Calporosis 430.00
173 Reco TT 3% 6,600.00
60 Devitalisasi Pasta ( Non Arsen ) BOTOL -
61 Xylocain spray BOTOL 177,216.00
62 Eugenol cairan BOTOL 100,000.00
175 Glass Ionomer Cemen ( GC IX ) BOTOL -
176 Kalsium Hidroksida Pasta TUBE -
177 Monoklorkamfer Mentol Cairan BOTOL -
61 Mummifying Pasta TUBE -
62 Semen Seng Fosfat serbuk dan cairan BOTOL -
63 Silver Amalgam serbuk 65 - 75 % BOTOL -
178 Temporary Stopping Fletcher serbuk dan cairan BOTOL
-
179 Trikresol Formalin (TKF) cairan BOTOL -
180 Alkacide SACHET 2,702,700.00
62 Alkacide SACHET 2,702,700.00
63 Alkazym BOTOL 801,000.00
 64 Alkazym BOTOL 801,000.00
f. JIWA
1 Amitriptilin HCL 25 mg TABLET 102.00
1 Amitriptilin HCL 25 mg TABLET 167.00
2 Clobazam 10mg tab TABLET 967.00
3 Fenitoin Natrium inj. 50 mg/ml AMPUL 20,250.00
4 Fenitoin Natrium 100 mg KAPSUL 154.00
5 Fenitoin Natrium 30 mg KAPSUL 93.00
6 Haldol decanoat 50mg/ml inj AMPUL 97,500.00
7 Haloperidol 1,5 mg TABLET 69.00
8 Haloperidol 5 mg TABLET 96.00
9 Karbamazepin 200 mg TABLET 245.00
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL -
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL -
12 Klorpromazin HCL tablet salut 100 mg TABLET 144.00
13 Klorpromazin HCL tablet salut 100 mg TABLET 147.00
13 Klorpromazin HCL tablet salut 25 mg TABLET 68.00
14 Lodomer 5mg/ml inj AMPUL 6,250.00
15 Risperidone 2mg TABLET 1,008.00
15 Risperidone 2mg TABLET 347.00
15 Risperidone 2mg TABLET 273.00
16 Sikzonoat 25mg/ml inj AMPUL 57,500.00
17 Trifluoperazin tablet 5 mg TABLET 405.00
17 Trifluoperazin tablet 5 mg 775.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET 88.00
18 Triheksifenidil Hidroklorida tab 2 mg TABLET 80.00
19 Triheksifenidil Hidroklorida tab 2 mg TABLET 85.00
19 Clozapin 25 mg tab TABLET 1,550.00
19 Clozapin 25 mg tab TABLET 1,121.00
20 Fluoksetin/Nopres 20 mg KAPSUL 950.00
21 Haloperidol 0,5 mg TABLET 88.00
22 Haloperidol tts 2 mg/ml (Lodomer drop) BOTOL 16,500.00
23 Stelazin 1 mg TABLET 6,250.00
24 Haldol 5 mg /ml inj 347.00
j. PSIKOTROPIKA NARKOTIKA
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL 4,180.00
2 Diazepam 2 mg TABLET 42.00
3 Diazepam 5 mg TABLET 107.00
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL 1,980.00
5 Fenobarbital 30 mg TABLET 610.29
6 Kodein tablet 10mg TABLET 500.00
7 Kodein tablet 10mg TABLET 571.00
7 Stesolid rectal supp 5 mg (EXPIRED DATE) BIJI 11,517.00
8 Alprazolam 1mg TABLET 233.00
9 Stesolid rectal supp 10 mg BIJI 16,742.00
l. SERUM
1 SABU (Biosave) VIAL 479,996.00
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) Ampul -
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS)
ampul 176,800.00
JUMLAH

NAMA KEPALA PUSKESMAS NAMA PENANGGUNG JAWAB

LAPORAN PENGIRIMAN OBAT

SISA
NO NAMA OBAT SATUAN HARGA FORNAS
DESEMBER

TABLET
1 Adalat Oros 20 mg TABLET 3,255.00 x
2 Alopurinol 100 mg TABLET 97.00 v
3 Alopurinol 300 mg TABLET 210.00 v
4 Amilodipin 5 mg TABLET 105.00 v
5 Aminofilina 200 mg TABLET 91.00 v
6 Amoksilin 250 mg KAPSUL 195.00 v
7 Amoksilin 500 mg KAPLET 233.00 v
8 Antasida (MgOH 200mg+AlOH 200mg) TABLET 54.00 v
9 Anti Hemoroid (Bismut
subgallat150mg+Heksaklorofen2,5mg) 3,167.00 x
10 Antimigran (Ergotamin Tartrat 1mg + Kofein TABLET
50mg) 100.00 v
11 Asam Askorbat ( Vit C ) 50 mg TABLET 105.00 v
12 Asam Askorbat (Vit C) 250 mg TABLET 125.00 v
13 Asam folat 1 mg TABLET 48.00 v
14 Asam mefenamat 500mg TABLET 103.00 v
15 Asetosal 100 mg TABLET 130.00 x
16 Asiklovir 400mg TABLET 380.00 v
17 Betahistin mesilat 5 mg TABLET 110.00 x
18 Bisoprolol tablet 5 mg TABLET 236.00 x
19 Cetirizin 10mg TABLET 90.00 x
20 Deksametason 0,5 mg TABLET 41.00 v
21 Digoksin 0,25 mg TABLET 105.00 v
22 Diltiazem 30 mg TABLET 127.00 v
23 Dimenhidrinat tablet 50mg 105.00 v
24 Doksisiklin 100mg KAPSUL 268.00 v
25 Domperidon tablet 10 mg TABLET 118.00 v
26 Eritromisin 500mg 750.00 v
27 Fitomenadion (Vit K1) 10mg TABLET 710.00 v
28 Furosemid 40 mg 70.00 v
29 Glibenklamid 5 mg 119.00 v
30 Glimepiride tablet 2 mg TABLET 289.00 v
31 Griseofulvin 125 mg TABLET 210.00 v
32 Hidroklorotiazid (HCT) 25 mg TABLET 149.00 v
33 Ibuprofen 400 mg TABLET 127.00 v
34 Ibuprofen 200 mg TABLET 105.00 v
35 Isosorbid Dinitrat sublingual 5 mg TABLET 88.00 v
36 Kalium Diklofenac 50mg TABLET 105.00 v
37 Kalsium Laktat (Kalk) 500 mg 59.00 v
38 Kaptopril 25 mg TABLET 84.00 v
39 Kaptopril 12,5 mg TABLET 62.00 v
40 Ketokonazol 200mg tablet TABLET 270.00 v
41 Klindamisin kapsul 150 mg KAPSUL 715.00 √
42 Klopidogrel TABLET 2,000.00 x
43 Kloramfenikol kapsul 250 mg KAPSUL 361.00 v
44 Klorfeniramin Maleat (CTM) 4 mg TABLET 36.00 √
45 Kotrimoksazol dewasa kombinasi : TABLET
Sulfametoksazol400mg+Trimetoprim80mg 151.00 √
46 Levofloksasin 500 mg TABLET 495.00 X
47 Lisinopril 5mg tablet TABLET 259.00 X
48 Loratadin tablet 10 mg TABLET 123.00 √
49 Metformin 500mg tablet 100.00 √
50 Metil Prednisolon 4 mg 134.00 X
51 Metilergometrin Maleat 0,125 mg TABLET 210.00 √
52 Metoklopramid 5mg TABLET 123.00 √
53 Metronidazol 250 mg TABLET 154.00 √
54 Metronidazol 500mg TABLET 133.00 √
55 Natrium Diklofenac 25 mg TABLET 132.00 √
56 Natrium Diklofenac 50 mg TABLET 115.00 √
57 Nifedipin 10 mg tablet TABLET 104.00 √
58 Nistatin tablet vaginal 100.000 IU/g TABLET 509.10 √
59 Omeprazole 20mg TABLET 160.00 √
60 Parasetamol 500 mg TABLET 53.00 √
61 Pirantel 125 mg TABLET 269.00 √
62 Piridoksin HCL (Vit B6) tablet 10 mg TABLET 123.00 √
63 Prednison tablet 5 mg TABLET 68.00 √
64 Propanolol HCL tablet 10 mg TABLET 65.00 √
65 Propiltiourasil tablet 100 mg (Thyrozol) TABLET 1,225.00 √
66 Ranitidin tablet 150 mg TABLET 89.09 √
67 Salbutamol tablet 2 mg TABLET 63.00 √
68 Salbutamol tablet 4 mg TABLET 89.00 √
69 Simvastatin 10 mg TABLET 131.00 √
70 Siprofloksazin tablet 500 mg TABLET 265.00 √
71 Tablet Tambah Darah Kombinasi : Besi sulfat TABLET
200mg+Asam folat 0,25mg 354.00 √
72 Tetrasiklin HCL kapsul 250 mg TABLET 163.00 √
73 Tetrasiklin HCL kapsul 500 mg TABLET 310.00 √
74 Tiamin HCL (VitB1) 50 mg TABLET 85.00 √
75 Vitamin B Kompleks TABLET 83.00 √
76 Zinc 10 mg TABLET 524.00 √
77 Acar bose TABLET 779.00 X
78 Spironolactone 25mg TABLET 244.00 √
79 Ondansetron 4 mg TABLET 472.00 X
80 Irbesartan 150 mg TABLET 244.00 X
81 Loperamid 2 mg TABLET 472.00 X
82 Candesartan 8 mg TABLET 519.00 X
83 Cefadroxil 500mg TABLET 516.00 √
84 Asetilsistein TABLET 350.00 √
85 Clindamycin 300mg KAPSUL 516.00 √
86 Gemfibrozil 600mg KAPLET 679.00 X
87 Metformin 850mg tablet TABLET 156.00 √
88 Metoklopramid 10mg TABLET 87.00 √
89 Amlodipin 10 mg TABLET 156.00 √
90 Asam tranexamat tablet AMPUL 1,584.00 X
1 Aminofilina 24 mg/ml - 10 ml AMPUL 3,822.00 √
2 Amoksisilin serbuk injeksi 1000mg VIAL 8,237.00 X
3 Ampisillin im/iv 1000mg/ml VIAL 8,237.00 √
4 Atropin sulfat 0,25mg/ml-1 ml AMPUL 1,595.00 √
5 Calsium Gluconas injeksi 10 % BOTOL 10,351.00 √
6 Ceftriaxone 1 gr injeksi VIAL 1,672.00 X
7 Deksametason injeksi 5 mg/ml-1ml AMPUL 1,097.00 √
8 Difenhidramin HCL Inj 10mg/ml-1 ml 1,175.00 √
9 Epinefrin injeksi 1,408.00 √
10 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL 3,550.00 √
11 Furosemid injeksi AMPUL 1,333.00 √
12 Gentamisin injeksi 3,509.00 X
13 Hyosin n butilbromid inj 250mg/ml AMPUL 2,300.00 X
14 Lidocain comp inj 2% AMPUL 1,040.91 √
15 Magnesium sulfat injeksi (IV) 20 % - 25 ml BOTOL 3,200.00 √
16 Magnesium sulfat injeksi (IV) 40 % - 25 ml BOTOL 1,937.00 √
17 Metilergometrin Maleat inj. 0,200mg-1ml 2,959.00 √
18 Metoklopramid inj. 5mg / ml AMPUL 3,395.00 √
19 Oksitosin injeksi 10 IU/ml - 1 ml 1,199.00 √
20 Ondansetron injeksi AMPUL 1,650.00 X
21 Piracetam injeksi 1 gr / 5 ml BOTOL 1,900.00 X
22 Piracetam injeksi 3 gr / 5 ml BOTOL 1,650.00 X
23 Ranitidin injeksi 25mg/2ml AMPUL 1,155.00 X
24 Sefotaksim injeksi 1 gram VIAL 4,200.00 X
25 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL 1,098.00 √
26 Streptomisin serbuk injeksi iv 1000mg/ml VIAL 3,650.00 √
27 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL 1,098.00 X
28 Omeprazol injeksi 9,898.00 √
29 Asam tranexamat injeksi AMPUL 1,945.00 X
30 Procain Benzil Penisilin inj 3 jt iu VIAL 7,190.00 X
31 Benzatin Benzil Penisilin inj 1.2 jt iu vial 9,727.00 √
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT 4,323.00 √
2 Asiklovir krim 5% TUBE 4,000.00 X
 3 Basitrasin Polimixin B SK TUBE 2,924.00 X
4 Betametason krim 0,1 % TUBE 1,340.00 √
5 Gameksan emulsi 1 % 30ml TUBE 2,924.00 X
6 Gentamisin salep kulit 0.1%-5gr TUBE 1,349.00 X
7 Gentamisin salep mata 0,3% TUBE 2,600.00 √
8 Hidrokortison krim 2,5 % TUBE 2,798.00 √
9 Ketokonazol krim 2% TUBE 2,000.00 √
10 Kloramfenikol salep mata 1 % TUBE 2,650.00 √
11 Miconazol cream 2 % TUBE 3,414.00 √
12 Oksitetrasiklin HCL 1 % salep mata TUBE 1,810.00 X
13 Oksitetrasiklin HCL salep 3 % TUBE 3,000.00 X
14 Salep 2-4 Komb: As salisilat2%+Belerang POT
endap4% 2,620.00 √
15 Perak Sulfadiazin krim TUBE 20,700.00 √
16 Garam oralit untuk 200 ml air SACHET 288.00 X
17 Salisil Bedak 2 % POT 1,025.00 √
18 Amoksilin 125mg/5ml VIAL 1,881.00 X
19 Antasida syr (MgOH 200mg/5ml+AlOH BOTOL
200mg/5ml) 1,995.00 X
20 Cetirizin syr BOTOL 2,850.00 X
21 Eritromisin sirup BOTOL 7,220.00 √
22 Ibuprofen suspensi 100mg/5ml 2,550.00 X
23 Kloramfenikol suspensi 125mg/5ml BOTOL 4,700.00 √

24 Kotrimoksazol Suspensi komb: Sulfametoksazol

200mg+Trimetoprim40mg/5ml
2,286.00 √
25 Obat Batuk Hitam ( O B H ) cairan BOTOL 4,840.00 X
26 Parasetamol sirup 120mg/5ml BOTOL 1,107.00 √
27 Metronidazol syrup BOTOL 9,950.00 √
28 Cefadroxil syr 125mg/5ml BOTOL 3,980.00 X
29 Fenol Gliserol tetes telinga 10 % BOTOL 2,590.00 X
30 Gentamisin tetes mata 0.3% BOTOL 4,232.00 √
31 Gentian violet larutan 1 % BOTOL 2,500.00 X
32 Kloramfenikol tetes mata BOTOL 4,170.00 √
33 Kloramfenikol tetes telinga 3 % BOTOL 900.00 X
34 Parasetamol drop 100mg/ml btl @ 15ml BOTOL 6,649.00 √
35 Polikresulen ( Albothyl ) BOTOL 1,540.00 X
36 Sulfasetamid Natrium tetes mata 15 % BOTOL 5,200.00 X
1 Alat suntik sekali pakai 1 ml SET 990.00 X
2 Alat suntik sekali pakai 3 ml SET 792.00 X
3 Alat suntik sekali pakai 5 ml SET 979.00 X
4 Alat suntik sekali pakai 10 ml 1,298.00 X
5 Alat suntik sekali pakai 20 ml PCS 977.00 X
6 Alat suntik sekali pakai 50ml pcs 5,621.00 X
7 Alkohol swab PAK 11,000.00 X
 8 Aqua pro injeksi BOTOL 2,860.00 X
9 Blood Tranfusion set PCS 14,300.00 X
10 Catgut chromic/benang bedah No. 2/0-3/0 SACHET 34,170.00 X
11 Catgut plain/benang bedah No. 2/0-3/0 SACHET 35,740.00 X
12 Biplacenton tulle LEMBAR 10,400.00 X
13 Etanol 70 % 100 ml BOTOL 2,500.00 X
14 Etanol 70 % 1000 ml BOTOL 10,400.00 X
15 Foley Catheter no.16 18,450.00 X
16 Folley cath no. 18 PCS 18,450.00 X
17 NITRILE POWDER-FREE EXAM GLOVE M KOTAK/50 77,493.00 X
18 Handscoon M "50 KOTAK/50 70,862.00 X
19 Hanschoen steril no 6.5 9,854.00 X
20 Hanschoen steril no 7 9,854.00 X
21 I.V. Catheter No 18 PCS 8,700.00 X
22 I.V. Catheter No 20 PCS 8,700.00 X
23 I.V. Catheter No 22 PCS 8,700.00 x
24 I.V. Catheter No 24 safety PCS 8,700.00 x
25 iv cath no 26 safety PCS 16,346.00 x
26 Infusion set OI-34 PCS 7,920.00 x
27 Otsu Y set PCS 7,920.00 x
28 Kapas Pembalut / Absorben 250 gr ROL 24,000.00 x
29 Kasa Pembalut 2 m x 80 cm ROL 4,800.00 x
30 Kasa Pembalut elastic 3 inchi ROL 28,530.00 x
31 Kasa Pembalut Hidrofil 4 m x 15 cm ROL 3,800.00 x
32 Kasa Steril 16 x 16 PAK 7,900.00 x
33 Kasa 4cm x 5m rol 1,100.00 x
34 New DRC 4Y x 80 cm plain ROL 149,158.00 x
35 Lisol, mengandung Kresol tersabun 50% BOTOL 41,000.00 x
36 One Clean 1 ltr BOTOL 14,520.00 x
37 Masker karet KTK/50 21,945.00 x
38 Masker karet KOTAK/50 18,200.00 x
39 Masker oxygen (dewasa) PCS 19,800.00 x
40 Masker oxygen dewasa pcs 15,700.00 x
41 Masker oxygen anak pcs 15,700.00 x
42 NGT 7 x 75/80 PCS 21,945.00 x
43 One Med H2 O2 3 % BOTOL 6,600.00 x
44 One Med Surgical Blade PCS - x
38 Plester kertas aximed 1,25 cm 4,454.00 x
39 Plester kertas aximed 2,5 cm ROL 7,409.00 x
40 Plester infus tegaderm PCS 224,200.00 x
109 Plester infus cannofix 6 x 8 cm pcs 8,470.00 x
110 Rivanol larutan 0,1 % 300ml BOTOL 3,000.00 x
111 Silk ( Benang Bedah Sutera ) No. 3/0 35,740.00 x
39 Tensocrepe (FM crepe) PAK 43,987.00 x
40 Urine Bag PCS 5,500.00 x
 41 Wing Needle No. 18 - 27 SACHET 43,987.00 x
112 Yodium Povidon larutan 10 % 30 ml BOTOL 2,900.00 x
113 Yodium Povidon larutan 10 % 60 ml BOTOL 6,000.00 x
114 Yodium Povidon larutan 10 % 300 ml BOTOL 18,000.00 x
40 Policlean handrub 500ml BOTOL 60,800.00 x
41 Nurse cap PCS 667.80 x
42 Surgical gown (M) PCS 20,966.00 x
115 Surgical gown (L) PCS 20,966.00 x
116 Glucose protein test SACHET 1,045.00 x
117 Underpad LEMBAR 4,620.00 x
41 Nasal kanul L SET 6,600.00 x
42 Nasal kanul S SET 6,600.00 x
43 Nasal kanul XS SET 7,300.00 x
118 Handrub refill 5L GALON 580,000.00 x
119 Umbilical cord PAK 65,000.00 x
120 Umbilical cord pak 137,500.00 x
42 Dermafix T 5x7 PAK 580,000.00 x
43 Tegaderm pad 269,933.00 x
44 Plesterin SET 26,950.00 x
121 Plesterin 30,800.00 x
122 Stomach tube no 16 SET 15,373.00 x
123 Stomach tube no 18 PAK 15,373.00 x
43 Nonwoven fixation 5cmx10m KOTAK/50 43,850.00 x
44 Polifix 5cmx5m PAK 18,000.00 x
45 Pharmafix 10cm x 500m rol 77,550.00 x
124 Handscoon L "50 KOTAK/50 46,200.00 x
125 Handscoon S "50 ROL 77,493.00 x
126 Handscoon S "50 Ansell 70,862.00 x
44 Leukoplast (2,5cm x 4,5m) ROL 12,076.00 x
45 Hansaplast rol (5cmx4,5m) PCS 25,404.00 x
46 Leukoplast (7,5cm x 4,5m) ROL 35,532.00 x
127 Hansaplast rol (7,5cmx4,5m) PCS 31,265.00 x
128 Plester infus (e care + pot) KOTAK/50 220,000.00 x
129 Masker tali (Aximed) KOTAK/50 22,000.00 x
45 Masker tali (MI) KOTAK/50 17,900.00 x
46 My jelly 82 gram KOTAK/50 29,550.00 x
47 Surgical mask plus 3 ply (hijab) KOTAK/50 22,000.00 x
130 Surgical mask plus 3 ply HIJAB MMP KOTAK/50 36,300.00 x
131 Sarung tangan obgyn steril BOTOL 19,360.00 x
132 USG gel 5 L BOTOL 156,640.00 x
46 Ecodine 1 L PCS 79,650.00 x
47 Extradine 5L 475,200.00 x
48 Poliwash 500ml PCS 55,569.00 x
133 Poliwash 5L PCS 566,532.00 x
134 Viorex Liquid soap 2% 5L PCS 554,400.00 x
 135 Female cath no 16 PCS 5,720.00 x
47 Female cath no 18 PCS 5,720.00 x
48 Cavilon film 1ml wipe 160,500.00 x
49 Hi oxy mask dewasa / NRBM KOTAK/50 24,640.00 x
136 Hi oxy mask Anak / NRBM PCS 24,640.00 x
137 Masker JET Nebulizer Anak PCS 22,000.00 x
138 Masker JET Nebulizer Dewasa PCS 22,000.00 x
48 MASKER N95 (3M) PCS 390,000.00 x
49 MASKER N95 (onemed) PCS 130,240.00 x
50 SPALK PCS 61,600.00 x
139 Threeway trovenoflow stopcock pcs 16,500.00 x
140 Steri strip pak 187,071.00 x
141 Aqua gel 82gr pak 42,588.00 x
49 ID Band child pink pcs 1,078.00 x
50 ID Band child blue pcs 1,078.00 x
51 ID Band child yellow pcs 1,078.00 x
142 ID Band adult pink pcs 1,078.00 x
143 ID Band adult blue pcs 1,078.00 x
144 ID Band adult yellow pcs 1,078.00 x
50 Waterone 1L f 14,960.00 x
51 Guedel airway pcs 12,574.39 x
145 Asering Larutan infus BOTOL 9,275.00 x
146 Glukosa larutan infus 10 % steril BOTOL 7,500.00 x
147 Glukosa larutan infus 40 % steril BOTOL 9,275.00 x
51 Glukosa larutan infus 5 % steril BOTOL 6,900.00 x
52 KAEN 3B BOTOL 7,000.00 x
53 KAEN 4B BOTOL 6,900.00 x
148 Metronidazol infus BOTOL 9,950.00 v
149 Natrium Klorida larutan infus 0,9 % steril BOTOL 6,410.00 x
150 Ringer Lactate infus steril BOTOL 7,150.00 x
52 Paracetamol infus BOTOL 12,940.00 v
#REF! Albothyl BOTOL 23,100.00 x
152 Bisakodil suppositoria 10mg BIJI 5,800.00 v
153 Bufacomb TUBE 14,175.00 x
53 Cendo Lyters tetes mata BOTOL 5,800.00 x
54 Cendo Xitrol tetes mata BOTOL 15,000.00 x
55 Citicholin inj. 250 mg / 2ml AMPUL 15,750.00 x
154 Laxadin sirup BOTOL 7,700.00 x
155 Lactodiar SACHET 15,000.00 x
156 Lytamin syrup BOTOL 5,000.00 x
54 Mecobion tablet TABLET 1,000.00 x
55 Metamizole injeksi 500mg AMPUL 5,000.00 x
56 Microlax BIJI 1,000.00 x
157 Neurotropik injeksi 5000mcg (Mersibion) AMPUL 4,300.00 x
158 Biocombin inj 5,000.00 x
159 Novalgin/Antrain injeksi AMPUL 14,500.00 x
55 Noza TABLET 362.00 x
56 Obat Batuk Anak sirup (babycough) BOTOL 3,575.00 x
57 Parasetamol supp BIJI 362.00 x
160 Pehacain injeksi AMPUL 3,575.00 x
161 Permetrin/Scabicid krim 5% TUBE 12,155.00 v
162 Permetrin/Scabicid krim 5% TUBE 11,825.00 v
56 Salbutamol rotacaps KAPSUL 2,590.00 v
57 Salbutamol rotahaler PCS 5,867.00 x
58 Spasminal TABLET 1,360.00 x
163 Selesdiar (Puralex) TABLET 190.00 x
164 Selesdiar (Puralex) TABLET 152.00 x
165 Ventolin nebuliser BOTOL 1,360.00 x
57 Zirkum syr BOTOL 14,980.00 x
58 Miniaspi (Asetosal 80mg) TABLET 148.00 x
59 Ulsidex 500mg TABLET 14,980.00 x
166 Combiven nebulizer AMPUL 5,700.00 x
167 Dulcolax supp 5 mg (anak) SUPP 5,670.00 x
168 Bufacetin salep TUBE 3,091.00 x
58 Pantocain TM BOTOL 11,500.00 x
59 Chloramex 500mg KAPSUL 1,007.00 x
60 Chloramex 500mg KAPSUL 1,090.00 x
169 Euthyrox (Levotiroksin 100mcg) TABLET 11,500.00 x
170 Dionicol 500mg KAPSUL 1,007.00 x
171 Sotatic inj (metoclopramid inj) AMPUL 850.00 x
59 Gricin TABLET 737.00 x
60 Amoxsan serbuk injeksi VIAL 4,620.00 x
61 Daryantulle 8,990.00 x
172 Calporosis 430.00 x
173 Reco TT 3% 6,600.00 x
60 Devitalisasi Pasta ( Non Arsen ) BOTOL - v
61 Xylocain spray BOTOL 177,216.00 x
62 Eugenol cairan BOTOL 100,000.00 v
175 Glass Ionomer Cemen ( GC IX ) BOTOL - v
176 Kalsium Hidroksida Pasta TUBE - v
177 Monoklorkamfer Mentol Cairan BOTOL - x
61 Mummifying Pasta TUBE - x
62 Semen Seng Fosfat serbuk dan cairan BOTOL - x
63 Silver Amalgam serbuk 65 - 75 % BOTOL - x
178 Temporary Stopping Fletcher serbuk dan cairan BOTOL
- x
179 Trikresol Formalin (TKF) cairan BOTOL - x
180 Alkacide SACHET 2,702,700.00 x
62 Alkacide SACHET 2,702,700.00 x
63 Alkazym BOTOL 801,000.00 x
 64 Alkazym BOTOL 801,000.00 x
f. JIWA -
1 Amitriptilin HCL 25 mg TABLET 102.00 v
1 Amitriptilin HCL 25 mg TABLET 167.00 v
2 Clobazam 10mg tab TABLET 967.00 x
3 Fenitoin Natrium inj. 50 mg/ml AMPUL 20,250.00 v
4 Fenitoin Natrium 100 mg KAPSUL 154.00 v
5 Fenitoin Natrium 30 mg KAPSUL 93.00 v
6 Haldol decanoat 50mg/ml inj AMPUL 97,500.00 x
7 Haloperidol 1,5 mg TABLET 69.00 v
8 Haloperidol 5 mg TABLET 96.00 v
9 Karbamazepin 200 mg TABLET 245.00 X
10 Klorpromazin HCL injeksi 25 mg/ml - 1 ml AMPUL - X
11 Klorpromazin HCL injeksi 5 mg/ml - 2 ml AMPUL - v
12 Klorpromazin HCL tablet salut 100 mg TABLET 144.00 v
13 Klorpromazin HCL tablet salut 100 mg TABLET 147.00 v
13 Klorpromazin HCL tablet salut 25 mg TABLET 68.00 v
14 Lodomer 5mg/ml inj AMPUL 6,250.00 x
15 Risperidone 2mg TABLET 1,008.00 v
15 Risperidone 2mg TABLET 347.00 v
15 Risperidone 2mg TABLET 273.00 v
16 Sikzonoat 25mg/ml inj AMPUL 57,500.00 x
17 Trifluoperazin tablet 5 mg TABLET 405.00 x
17 Trifluoperazin tablet 5 mg 775.00 x
18 Triheksifenidil Hidroklorida tab 2 mg TABLET 88.00 √
18 Triheksifenidil Hidroklorida tab 2 mg TABLET 80.00 √
19 Triheksifenidil Hidroklorida tab 2 mg TABLET 85.00 √
19 Clozapin 25 mg tab TABLET 1,550.00 x
19 Clozapin 25 mg tab TABLET 1,121.00 x
20 Fluoksetin/Nopres 20 mg KAPSUL 950.00 √
21 Haloperidol 0,5 mg TABLET 88.00 x
22 Haloperidol tts 2 mg/ml (Lodomer drop) BOTOL 16,500.00 v
23 Stelazin 1 mg TABLET 6,250.00 x
24 Haldol 5 mg /ml inj 347.00 x
j. PSIKOTROPIKA NARKOTIKA
1 Diazepam injeksi 5 mg/ml - 2 ml AMPUL 4,180.00 v
2 Diazepam 2 mg TABLET 42.00 v
3 Diazepam 5 mg TABLET 107.00 v
4 Fenobarbital injeksi 50 mg / ml - 2 ml AMPUL 1,980.00 v
5 Fenobarbital 30 mg TABLET 610.29 x
6 Kodein tablet 10mg TABLET 500.00 v
7 Kodein tablet 10mg TABLET 571.00 v
7 Stesolid rectal supp 5 mg (EXPIRED DATE) BIJI 11,517.00 x
8 Alprazolam 1mg TABLET 233.00 x
9 Stesolid rectal supp 10 mg BIJI 16,742.00 x
l. SERUM
1 SABU (Biosave) VIAL 479,996.00 x
2 Serum Anti Difteri inj. 20.000 IU/vial (ADS) Ampul - v
3 Serum Anti Tetanus inj. 1.500 IU/ampul (ATS)
ampul 176,800.00 v
JUMLAH
PERENCANAAN