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RENCANA KEBUTUHAN OBAT DAN PERBEKALAN KESEHATAN (JKN)

TAHUN 2020

PUSKESMAS PEGAMBIRAN
RATA-RATA
KEBUTUHAN OBAT
(RKO) Klasifikasi
NO NAMA OBAT DAN PERBEKALAN KESEHATAN KODE Satuan (Satuan)
Per per 12 Fornas Doen
bulan bulan hal. hal.
NAMA GENERIK/NAMA DAGANG
1 Amoksisilin sirup kering forte 250 mg / 5 ml 2106 Botol - 14 0
2 Anti diare sirup (Kaotin sirup) 3054 Botol 50 600
3 Antihemoroid DOEN supp 1017 Supp 50 600 87 66
4 Asam folat tablet 1 mg 3048 Tablet 1,000 12,000 43 57
5 Attapulgit tablet 600 mg (Pularex) 2108 Tablet 250 3,000 87 66
6 Bisakodil Suppositoria 10 mg (Stolax) 2109 Supp - 88 67
7 Glimepirid tablet 2 mg 2111 Tablet 1,000 12,000 58
8 Hidrokortison krim 2,5% 1086 Tube 48 576 43 62
9 Ibuprofen Sirup 100 mg/ 5 ml 2128 Botol 100 1,200 6 50
10 Magnesium Sulfat inj (IV) 40 % 1137 vial 17 200 11 51
11 Mikonazol krim/salep 2% (nitrat) -10 g 2046 Tube 72 864 73 62
12 Paracetamol drops 60 mg/ 0.6 mL 2135 Botol 181 2,176 7 50
13 Permetrim krim 5 % (scabimite) 2114 Tube - 74 63
14 Povidon Iodida 1%, obat kumur 3041 Botol -
15 Zinc Sirup 20 mg / 5 ml 2118 Botol 250 3,000 88
16 Zinc tablet 20 mg 2084 Tablet - 88 67
17 Vitamin k Inj 400
18 Methylergometrin Inj 200
19 Dopamet tablet 100
20 Misoprostol Tablet 200

PERBEKALAN KESEHATAN
1 Alat Suntik 1 ml (insulin/tuberculin) 1002 Buah 25 300
2 Alat Suntik 5 ml 1004 Buah 33 400
3 Bisturi No. 10 3003 pcs -
4 Catgut benang bedah 2-0 3009 buah 42 300
5 I.V Catheter No. 18 3001 pcs 42 500
6 I.V Catheter No. 20 3072 pcs 42 500
7 Infus Set Anak 1089 Buah -
8 Infus set dewasa 1090 Set 50 200
9 Kasa Hidrofil 4 x 5 cm 2092 Roll 17 200
10 Kasa Kompres 40/40 steril 1102 Roll 42 500
11 Kasa Pembalut 2mx80cm 1103 Roll 17 200
12 Kasa Pembalut Hidrofil 4m x 15cm 1105 Roll 42 500
13 Plester 5 yard x 2 inch 1176 Roll 8 100
14 Urine Bag 400
15 Folley Cateter Dewasa 400
16 Fimale Catheter 400
17 Lakmus Test 2
18 Stik Pemeriksaan Protein Urine 12
19 Stik Pemeriksaan Hb 12
20 Spuit 10 cc 200
21 Selang Oksigen Bayi 50
22 Selang Oksigen Dewasa 50
23 USG Gell 200
24 Kertas CTG 12
25 Kertas USG 12
26 Sarung Tangan Ginekologi 100
27 Sarung Tangan Rumah Tangga 100
28 Jarum Hecting 20
29 Alkohol Swab 400

OBAT DAN BAHAN GIGI


1 Air Raksa Dental Use 100 g 1001 Botol -
3 Devitalisasi Pasta (non arsen) 1041 Botol - 56 59
4 Etil Klorid Semprot - 100 ml 1055 Botol 2 20 56 59
5 Eugenol 10 ml 1056 Botol - 54 58
6 Glass Ionomer Cement ART 5 gram 3063 Buah 2 24 55 59
7 Kalsium Hidroksida pasta (set 2 tube) 1097 Set - 54 58
8 Klorfenol Kamfer Mentol (CHKM) 1145 Botol 1 6 54 58
10 Mummifying pasta 1146 Botol -
12 Obat Tambal Gigi Sementara 3038 buah 1 12 55
13 Plastik Saliva Ejector 3039 buah -
14 Semen Seng Fosfat & Cairan (set 2 btl @ 30 g) 1199 Set -
16 Temporary S Fletcher (set 100 g) 1218 Botol -
-
-

Cirebon, 19 Juni 2019

Mengetahui,
Kepala Puskesmas ............. Dokter Umum Dokter Gigi Pengelola Obat

Eyo Karmulya,SKM.Kes dr. Ratna Indarsari drg. Syafiga Fitrie Widiastuti S.Farm
NIP 196221002 198503 1 007 NIP 19839820715 200902 2 007 NIP 19751208 200604 2 009 NIP.19890508 201903 2
a Obat

ti S.Farm Apt
201903 2 008
RENCANA KEBUTUHAN OBAT DAN PERBEKALAN KESEHATAN
TAHUN 2020

PUSKESMAS PEGAMBIRAN

KEBUTUHAN OBAT Klasifikasi


(RKO)
NO NAMA OBAT DAN PERBEKALAN KESEHATAN KODE Satuan per 12 Fornas Doen
Per bulan bulan
hal. hal.

NAMA GENERIK/NAMA DAGANG

1 Alopurinol tablet 100 mg 1005 Tablet 400.0 4,800.0 7 50


2 Ambroxol sirup 15 mg/ml- 60 ml 2002 Botol 150.0 1,800.0
3 Ambroxol tablet 30 mg 2003 Tablet -
4 Aminofilin tablet 200 mg 1006 Tablet - 89 67
5 Amitriptilin tablet 25 mg 1007 Tablet - 81 64
6 Amlodipin tablet 5 mg 2085 Tablet 5,000.0 60,000.0 65 61
7 Amoksisilin kaplet 500 mg 1009 Kaplet 5,000.0 60,000.0 13 52
8 Amoksisilin sirup kering 125 mg/5 ml 60 ml 1010 Botol 100.0 1,200.0 14 52
9 Antasida DOEN I tablet kunyah ( Blister ) 2095 Tablet 4,000.0 48,000.0 85 65
10 Antasida DOEN II suspensi 60 ml 2007 Botol 100.0 1,200.0 85 0
11 Antibakteri DOEN 1016 Tube 75.0 900.0 62
12 Antifungi DOEN 1018 Pot 24.0 288.0 73 62
13 Antimigren DOEN 1019 Tablet 20.0 240.0 30 56
14 Aqua pro injeksi steril bebas pirogen 20 ml 1021 Vial 12.0 144.0 77 63
15 Asam Askorbat (Vitamin C) tablet 50 mg (blis 2107 Tablet 6,000.0 72,000.0 98 69
16 Asam Mefenamat tablet salut selaput 500 m 2009 Tablet 2,000.0 24,000.0 6
17 Asiklovir krim 5%- 5 g 2010 Tube 30.0 360.0
18 Asiklovir tablet 200 mg 2011 Tablet - 27 56
19 Asiklovir tablet 400 mg 2012 Tablet 50.0 600.0 27 56
20 Betametason krim 0,1% 1033 Tube 75.0 900.0 73 62
21 Borax Gliserin 8 ml 3004 Botol 30.0 360.0
22 Clobazam tablet 10 mg 2126 Tablet -
23 Clozapine tablet 25 mg 2127 Tablet -
24 Deksametason injeksi i.v. 5 mg/ml 1036 Ampul 10.0 10 67
25 Deksametason tab 0,5 mg ( Blister ) 2096 Tablet 3,000.0 36,000.0 63 60
26 Diazepam tablet 5 mg 1044 Tablet - 81 64
27 Diazepam Rektal 10 mg/tube (stesolid) 3042 Tube - 11 51
28 Diazepam Rektal 5 mg/tube (stesolid) 3043 Tube 5.0 11 51
29 Diazepam tablet 2 mg (blister) 2097 Tablet 30.0 360.0 81 64
30 Digoksin tablet 0,25 mg 1047 Tablet - 64/ 69 61
31 Dimenhidrinat tablet 50 mg 2086 Tablet 30.0 360.0 86 66
32 Doksisiklin kapsul 100 mg 2014 Kapsul - 16/ 25 52
33 Domperidon suspensi 5 mg/5 ml- 60 ml 2015 Botol 100.0 1,200.0 86 66
34 Domperidon tablet 10 mg 2016 Tablet 500.0 6,000.0 86 66
35 Efedrin tablet 25 mg (HCl) 1048 Tablet 100.0 1,200.0
36 Epinefrin (Adrenalin) injeksi 0,1% (HCl) 1 ml 1050 Ampul 10.0 10 51
37 Eritromisin kapsul 500 mg 2018 Kapsul 200.0 2,400.0 18
38 Eritromisin sirup 200 mg/5 ml -60 ml 2019 Botol - 18 53
39 Etanol 70 % 1000 ml 2022 Botol 3.0 36.0 53 58
40 Fe Fumarat + As. Folat 0,4 mg tablet 2140 Tablet 4,000.0 48,000.0
41 Fenobarbital tablet 30 mg 1062 Tablet - 11 51
42 Fenol Gliserol tetes telinga 10% 1065 Botol -
43 Fitomenadion (Vit.K1) tablet salut gula 10 m 1067 Tablet 70.0 840.0 45 57
44 Furosemide tablet 40 mg 1069 Tablet - 56/ 70 59
45 Garam Oralit 1071 Sachet 500.0 6,000.0 76 63
46 Gentamisin salep kulit 0,1% 2025 Tube 70.0 840.0
47 Gentamisin sulfat TM 0,3% 5 ml 2026 Botol 72.0 864.0
48 Glibenklamida tablet 5 mg 1075 Tablet - 58 60
49 Glukosa larutan infus 5 % 500 ml 1078 Botol 2.0 24.0 76 63
50 Guafenesin tablet 100 mg 2139 Tablet 4,000.0 48,000.0
51 Haloperidol tablet 5 mg 2028 Tablet 200.0 2,400.0 82 65
52 Haloperidol tablet 1,5 mg 1084 Tablet - 82 65
53 Hidroklorotiazida tablet 25 mg 1085 Tablet 50.0 600.0 56 59
54 Ibuprofen tablet 200 mg 1087 Tablet - 6 50
55 Ibuprofen tablet 400 mg 1088 Tablet 2,000.0 24,000.0 6 50
56 Isorbid Dinitrat tablet sublingual 5 mg 1094 Tablet - 64 61
57 Kalsium Laktat (Kalk) tablet 500 mg 1098 Tablet 4,000.0 48,000.0 99 69
58 Kaptopril tablet 12,5 mg 2032 Tablet - 66/ 70 61
59 Kaptopril tablet 25 mg 2033 Tablet - 66 61
60 Karbamazepin tablet 200 mg 1101 Tablet - 12 51
61 Karbogliserin tetes telinga 10 % 2129 Botol - 57 69
62 Ketokonazol tablet 200 mg 2034 Tablet 150.0 1,800.0 24
63 Klindamisin kapsul 150 mg 2035 Kapsul 200.0 2,400.0 18
64 Kloramfenikol kapsul 250 mg 1108 Kapsul - 17 53
65 Kloramfenikol salep mata 1% 1109 Tube 48.0 576.0 77 64
66 Kloramfenikol suspensi 125 mg/5 ml - 60 ml 2036 Botol - 17 53
67 Kloramfenikol tetes telinga 3% 1110 Botol 24.0 288.0 98
68 Klorfeniramina Maleat (CTM) tablet 4 mg 2103 Tablet 6,000.0 72,000.0 10 51
69 Klorpromazin tablet salut 25 mg (HCl) 1115 Tablet - 86 65
70 Kodein tablet 10 mg (blister) 2112 Tablet - 5 67
71 Kotrimoksazol DOEN I (dewasa) 1122 Tablet 300.0 3,600.0 17 53
72 Kotrimoksazol suspensi 60 ml 1121 Botol 100.0 1,200.0 17 53
73 Lidocain Comp 1134 Ampul 30.0 360.0 8 59
74 Linkomisin kapsul 500 mg 2040 Kapsul -
75 Livertan salep kulit 15 g 3029 Pot -
76 Loratadin tablet 10 mg 2113 Tablet 1,000.0 12,000.0 10 51
77 Metampiron tablet 500 mg ( Blister ) 2098 Tablet -
78 Metformin HCl tablet 500 mg 2042 Tablet 3,500.0 42,000.0 58 60
79 Metilergometrin Maleat (Metilergometrin) t 1142 Tablet 100.0 47 64
80 Metronidazol tablet 500 mg 2045 Tablet 300.0 3,600.0 20/ 25 53
81 Multivitamin sirup anak Botol 100.0 1,200.0
82 n - Asetil Sistein 200 mg Kapsul 3,000.0 36,000.0 94
83 Natrium Bikarbonat tablet 500 mg 1147 Tablet - 11 51
84 Natrium Diklofenak tablet 50 mg 2048 Tablet 1,000.0 12,000.0 7 50
85 Natrium Klorida larutan infus 0,9% 500 ml 1149 Botol 2.0 24.0 76
86 Nifedipin tablet 10 mg (adalat oros) 2050 Tablet 30.0 360.0 67 61
87 Nistatin Drop 12 ml, 100.000 UI/ml 3034 Botol 5.0 60.0 25 55
88 Nistatin tablet salut 500.000 IU/g 1152 Tablet - 25 55
89 Nistatin vaginal tablet 100.000 IU/g 1151 Tablet 30.0 360.0 73 62
90 Obat Batuk Exp (Daganak) sirup 100 ml 3012 Botol 150.0 1,800.0
91 Obat Batuk Hitam (O.B.H.) cairan 100 ml 1157 Botol -
92 Obat Batuk Pilek anak (coredryl) 3073 Botol 150.0 1,800.0
93 Oksitetrasiklin HCl salep kulit 3% 5 g 1161 Tube -
94 Oksitetrasiklin HCl salep mata 1% 1160 Tube -
95 Omeprazol kapsul 20 mg 2053 Kapsul 300.0 3,600.0 86 66
96 Papaverin tablet 40 mg 1163 Tablet 30.0 360.0
98 Parasetamol sirup 120 mg/5 ml- 60 ml 1164 Botol 400.0 4,800.0 7 50
99 Parasetamol tablet 500 mg ( Blister ) 2055 Tablet 20,000.0 240,000.0 7 50
100 Piridoksin (Vitamin B6) tablet 10 mg (HCl) 1175 Tablet 3,000.0 36,000.0 100 69
101 Piroksikam tablet 20 mg 2060 Tablet 1,000.0 12,000.0
102 Povidon Iodida larutan 10% 300 ml 1180 Botol 3.0 36.0 31 58
103 Prednison tablet 5 mg (blister) 2104 Tablet 3,000.0 36,000.0 63 61
104 Propanolol tablet 10 mg (HCl) 2061 Tablet - 30/ 64 61
105 Ranitidin tablet 150 mg 2064 Tablet 2,000.0 24,000.0 86 66
106 Ringer Laktat larutan infus 500 ml 500 ml 1194 Botol 20.0 240.0 76 63
107 Risperidon tablet 2 mg 3065 Tablet - 83
108 Salbutamol lar. Respirator utk Nebulizer 3050 vial 20.0 240.0 67
109 Salbutamol sirup 2 mg / 5 ml 2122 Botol 5.0 60.0
110 Salbutamol tablet 2 mg (sebagai sulfat) 1195 Tablet 500.0 6,000.0 92 67
111 Salep 2-4 1196 Tube 12.0 144.0 74 63
112 Salisil bedak 2% 50 g 1197 Kotak 50.0 600.0 75 63
113 Sefadroksil kapsul 500 mg 2069 Kapsul 500.0 6,000.0
114 Sefadroksil sirup kering 125 mg/5 ml - 60 ml 2070 Botol 100.0 1,200.0
115 Sefiksim kapsul 100 mg 2073 Kapsul -
116 Setirizin Sirup 5 mg/ 5 ml 2115 Botol 100.0 1,200.0 10 51
117 Sianokobalamin (Vitamin B12) tablet 50 mcg 2075 Tablet 2,500.0 30,000.0 44 57
118 Simvastatin tablet 10 mg 2077 Tablet 600.0 7,200.0 72 62
119 Siprofloksasin tablet 500 mg (sebagai HCl) 2079 Tablet 300.0 3,600.0 19 53
120 Tiamfenikol Dry Sirup : 125 mg/5 ml 60 ml 3045 Botol 50.0 600.0
121 Tiamfenikol kapsul 500 mg 2081 Kapsul 200.0 2,400.0
122 Tiamin (Vitamin B1) tablet 50 mg (HCl/Nitrat 1223 Tablet 3,000.0 36,000.0 100 70
123 Triheksifenidil 2 mg 1225 Tablet 200.0 2,400.0 43 57
124 Vitamin B Kompleks tablet (blister) 2117 Tablet 6,000.0 72,000.0 100 70
Dextrofen syr Botol 150.0 1,800.0
................................................
................................................
OBAT PROGRAM
1 Albendazol tablet 400 mg 2001 Tablet 4,000.0 13 52
2 Fitomenadion injeksi 2 mg/amp 2137 ampul 45
3 Fluoxetin tablet 10 mg ( Fornasi ) 3068 Tablet 81
4 Impramine HCl tablet 25 mg ( Tofranil ) 3069 Tablet
5 Iodina Test 3027 Kit
6 Isoniazid tablet 100 mg 2138 tablet 21
7 Kombipak Azitromycin+sefixime 4015 Tablet
8 Kombipak Kategori I 2100 paket
9 MB Adult 4007 paket
10 MB Child 4008 paket
11 Mineral Mix 3055 Sachet
12 Natrium Tiroksida tablet 2135 tablet
13 OAT FDC Kategori 1 dewasa 1153 Paket 23 55
14 OAT FDC Kategori 2 dewasa 1154 Paket 23 55
15 OAT FDC Kategori Anak 1155 Paket 23 55
16 OAT FDC Sisipan 1156 Paket 23 55
17 Oksitosin injeksi 10 mg IU/ml - 1 ml 1162 Ampul 30.0 47 64
18 PB Adult 4010 paket
19 PB Child 4009 paket
20 Reagen Zhiel Nelson 4014 kit
21 Retinol (Vitamin A) 100.000 IU kapsul lunak 2065 Kapsul 650.0 100 70
22 Retinol (Vitamin A) 200.000 IU kapsul lunak 1190 Kapsul 3,800.0 100 70
23 Trifluoferazin tablet 5 mg ( Stelosi ) 3070 Tablet
................................................
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PERBEKALAN KESEHATAN
1 Alat Suntik 3 ml 1003 Buah 500.0 6,000.0
2 Hand Shoen Non Steril 3018 Pasang 300.0 3,600.0
3 Hand Shoen Steril 7, 7 1/2 3019 Pasang 100.0 1,200.0
4 Kaca Slide 4023 pcs 144.0 1,728.0
5 Kapas Pembalut 250 g 1100 Bungkus 2.0 24.0
6 Kasa Steril 16 x 16 cm 3028 pak 10.0 120.0
7 Masker Muka ( Face Mask ) 3031 buah 500.0 6,000.0
8 Pot Dahak 4022 pot 2,000.0
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REAGENSIA
1 Rapid Tes HIV Kit 1 3078 test 6.0
2 Rapid Tes HIV Kit 2 3079 test 2.0
3 Rapid Tes HIV Kit 3 3080 test 2.0

Cirebon, .........................

Mengetahui,
Kepala Puskesmas ............. Dokter Umum Dokter Gigi Pengelola Obat

Eyo Karmulya,SKM.Kes dr. Ratna Indarsari drg. Syafiga Fitrie Widiastuti S.Farm
NIP 196221002 198503 1 007 NIP 19839820715 200902 2 007 NIP 19751208 200604 2 009 NIP.19890508 201903
Mengetahui :
Kepala Puskesmas :………………… Penanggung Jawab Barang

(………………………………..) (………………………………..)
gelola Obat

astuti S.Farm Apt


508 201903 2 008