Lplpo Benteng 2018

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
KODE PUSKESMAS :P73010210

PUSKESMAS : Benteng
KECAMATAN : Benteng BULAN JANUARI
KABUPATEN : Kepulauan Selayar TRI WULAN
PROPINSI : Sulawesi Selatan TAHUN 2
BULAN 1-3
NO SAT/ STOK PENE PERSE PEMA
KODE OBAT NAMA OBAT KMS HARGA NILAI NILAI NILAI NILAI
URUT N AWAL RIMAAN DIAAN KAIAN
1 2 3 4 5 6 7 8 9 10 11 12 13
1 21.01.01.415ALBENDAZOL TABLET 400 MG Tab 363.00 2428 881,364.00 - 2428 881,364.00 50 18,150.00
2 21.01.01.415ALBENDAZOL SIRUP Btl 4,234.00 0 - - 0 - -
3 17.09.01.390ALBOTHYL KONSENTRAT Tube 18,635.00 3.5 83,857.50 - 3.5 65,222.50 2.25 41,928.75
4 07.01.02.504ALOPURINOL TABLET 100 MG Tab 90.00 3206 288,540.00 1000 90,000.00 4206 378,540.00 3206 288,540.00
ALOPURINOL TABLET 100 MG Tab 117.00 500 500 13 1,521.00
5 07.01.02.504ALOPURINOL TABLET 300 MG Tab 230.00 0 - 500 115,000.00 500 115,000.00 -
6 22.01.01.515AMINOFILIN INJEKSI 24 MG/ML Amp 3,314.52 26 86,177.52 - 26 86,177.52 -
7 22.01.01.515AMINOFILIN TABLET 200 MG Tab 86.00 372 31,992.00 - 372 31,992.00 72 6,192.00
8 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 24 2,832.00 - 24 2,832.00 -
9 22.01.01.516AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 700 115,500.00 - 700 115,500.00 -
10 22.01.01.515AMBROKSOL TAB 30 MG Tab 190.63 3986 759,851.18 - 3986 759,851.18 3008 573,415.04
11 22.01.01.515AMBROKSOL SIRUP Btl 2,722.00 0 - - 0 - -
12 AMLODIPIN 5 MG Tab 105.00 3081 323,505.00 3600 378,000.00 6681 701,505.00 2368 248,640.00
13 01.01.04.510AMOKSISILIN KAPSUL 250 MG Kap 220.00 0 - - 0 - -
14 AMOKSISILIN KAPSUL 250 MG Kap 207.00 420 86,940.00 - 420 86,940.00 81 16,767.00
15 AMOKSISILLIN KAPLET 500 MG Kap 233.00 4704 1,096,032.00 20000 4,660,000.00 24704 5,756,032.00 20907.5 4,871,447.50
16 01.01.04.510AMOKSISILIN KAPLET 500 MG/RAMOXYL Kap 608.00 0 - - 0 - -
17 01.01.04.510AMOKSISILIN VIAL 1 G Vial 8,135.00 0 - - 0 - -
18 01.01.04.510AMOKSISILIN SIROP KERING 125 Btl 2,560.00 88 225,280.00 340 870,400.00 428 1,095,680.00 390 998,400.00
19 01.01.04.513AMPICILIN SERBUK INJ 1 G Vial 5,905 0 - - 0 - -
20 01.01.04.513AMPICILIN KAPLET 250 MG Kap 0 - - 0 - -
21 01.01.04.513AMPICILIN KAPLET 500 MG Kap 419.10 0 - - 0 -
22 ANTASIDA DOEN TABLET KUNYAH Tab 64.00 1763 112,832.00 3000 192,000.00 4763 304,832.00 2899 185,536.00
23 ANTASIDA DOEN TABLET KUNYAH Tab 78.00 1000 78,000.00 - 1000 78,000.00 1000 78,000.00
24 15.01.01.533ANTASIDA DOEN II SUSPENSI Btl 2,106.00 92 193,752.00 100 210,600.00 192 404,352.00 141 296,946.00
21893.5 7,625,483.29
BULAN 1-3
25 01.01.00.533ANTI BAKTERI DOEN SALEP KOMBINASI Pot 2,767.00 24 66,408.00 - 24 66,408.00 24 66,408.00
26 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 50 168,250.00 - 50 168,250.00 9 30,285.00
27 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 19.8 94,683.60 - 19.8 94,683.60 1.8 8,607.60
28 12.05.01.534ANTIHEMOROID DOEN KOMBINASI Pot 3,502.00 38 133,076.00 - 38 133,076.00 -
29 10.02.01.533ANTIMIGREN Tab 135.00 145 19,575.00 - 145 19,575.00 82 11,070.00
ANTIMIGREN Tab 179.00 100 100 0
30 22.01.01.516AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 39 226,200.00 - 39 226,200.00 32 185,600.00
31 22.01.01.516ARTESUNATE INJEKSI VIAL 60 MG Amp 0 - - 0 - -
32 ARTESUNATE DEWASA Tab 0 - - 0 - -
33 07.01.02.504ASAM ASETIL SALISILAT 100 MG Tab 127.00 383 48,641.00 - 383 48,641.00 383 48,641.00
34 ASAM ASKORBAT (VIT C) 25 MG 51.00 4776 243,576.00 14000 714,000.00 18776 957,576.00 12928 659,328.00
35 05.03.07.516ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 300 31,500.00 - 300 31,500.00 290 30,450.00
36 22.01.01.516AS.MEFENAMAT TABLET SALUT 500 MG Tab 113.00 0 - - 0 - -
37 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 2993.5 305,337.00 15000 1,530,000.00 17993.5 1,835,337.00 11417 1,164,534.00
38 22.01.01.516ASIKLOVIR KRIM 5 % Tube 2,367.00 0 - - 0 - -
39 22.01.01.516ASIKLOVIR TABLET 200 MG Tab 251.00 20 5,020.00 - 20 5,020.00 -
40 ASIKLOVIR TABLET 400 MG Tab 362.00 0 - - 0 - -
41 22.01.01.516ASIKLOVIR TABLET 400 MG Tab 381.00 967 368,427.00 - 967 368,427.00 100 s
42 07.07.02.504ATROPIN TETES MATA 0.5 % Btl 0 - - 0 - -
43 22.01.01.517BETAMETASON KRIM 0,1 % Tube 1,435.00 122 175,070.00 72 103,320.00 194 278,390.00 108 154,980.00
44 BETAHISTIN MESILAT TAB 6 MG/HISTIGO TAB 760.00 1260 957,600.00 - 1260 957,600.00 98 74,480.00
45 BISAKODIL SUPPOSITORIA SUPP 6,045.00 0 - - 0 - -
46 BISOPROLOL FUMARATE Tab 695.00 0 - - 0 - -
47 CARBAMAZEPIN TAB 200 MG Tab 269.00 457 122,933.00 - 457 122,933.00 57 15,333.00
48 CETIRIZINE TAB Tab 154.00 1396 214,984.00 - 1396 214,984.00 1386 213,444.00
CETIRIZINE TAB Tab 115.00 1000 115,000.00 1000
49 CETIRIZINE SIRUP Btl 7,756.00 60 465,360.00 - 60 465,360.00 60 465,360.00
50 CLOBAZAM TAB 10 MG Tab 1,045.00 0 - - 0 - -
51 CHATHEJELL Tab 4,284.80 0 - 10 42,848.00 10 42,848.00 3 12,854.40
52 22.01.01.517DEKSAMETASON INJ 5 MG/ML Amp 1,738.00 95 165,110.00 - 95 165,110.00 92 159,896.00
DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 20 34,800.00 20 -
53 DEKSAMETASON TAB Tab 48.00 3211 154,128.00 6000 288,000.00 9211 442,128.00 7591 364,368.00
54 22.01.01.517DIAZEPAM INJ 2 MG/ML Amp 2,605 0 - - 0 - -
55 22.01.01.517DIAZEPAM TABLET 2 MG Tab 39.00 106 4,134.00 1000 39,000.00 1106 43,134.00 687 26,793.00
56 DIAZEPAM RECTAL Tube 12,749.00 14 178,486.00 - 14 178,486.00 -
57 22.01.01.517DIAZEPAM RECTAL Tube 13,384.00 0 - 10 133,840.00 10 133,840.00 -
16476.3
BULAN 1-3
58 22.01.01.518DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 -
59 22.01.01.518DIGOKSIN TABLET 0,25 MG Tab 103.00 308 31,724.00 - 308 31,724.00 16 1,648.00
60 22.01.01.518DILTIAZEM TAB 30 MG Tab 141.00 0 - - 0 - -
61 22.01.01.518DIMENHIDRINAT TAB 50 MG Tab 109.00 0 - - 0 - -
62 DIMENHIDRINAT TAB 50 MG Tab 114.00 100 11,400.00 - 100 11,400.00 24 2,736.00
63 22.01.01.518DOMPORIDON SIRUP Btl 3,490.00 0 - - 0 - -
64 22.01.01.518DOKSISIKLIN KAPSUL 100 MG Kap 309.00 88 27,192.00 - 88 27,192.00 10 3,090.00
65 22.01.01.518DOMPERIDON TABLET 10 MG Tab 174.00 766 133,284.00 - 766 133,284.00 362 62,988.00
66 22.01.01.518EKSTRAK BELLADONA TABLET 10 MG Tab 42.00 0 - - 0 - -
67 22.01.01.518ERITROMISIN KAPSUL 250 MG Kap 522.00 61 31,842.00 - 61 31,842.00 43.5 22,707.00
68 22.01.01.518ERITROMISIN KAPSUL 500 MG Kap 1,023.00 381.5 390,274.50 - 381.5 390,274.50 158 161,634.00
69 22.01.01.518ERITROMISIN SIROP 200 MG/ 5 ML Btl 8,090.00 0 - - 0 - -
70 ERITROMISIN SIROP 200 MG/ 5 ML Btl 7,581.00 48 363,888.00 - 48 363,888.00 22 166,782.00
71 22.01.01.519ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 Btl 3,750.00 22 82,500.00 - 22 82,500.00 3.5 13,125.00
72 22.01.01.519ETANOL 70 % 100 ml Btl 2,625.00 37 97,125.00 100 262,500.00 137 359,625.00 50.25 131,906.25
73 22.01.01.519ETANOL 70 % 1000 ml Btl 0 - - 0 - -
74 ETHYLIS CHLORIDUM SEMPROT Btl 81,400.00 0 - - 0 - -
75 20.02.01.526EUGENOL CAIRAN Btl 18,333.00 0 - - 0 - -
76 07.02.01.505FENOBARBITAL AMPUL 2 ML Btl 1,980 30 59,400.00 - 30 59,400.00 -
77 07.02.01.505FENOBARBITAL TABLET 30 MG Tab 177.00 200 35,400.00 - 200 35,400.00 -
78 05.03.13.519FITOMENADION (VIT K) TABLET 10 MG Tab 690.00 369 254,610.00 - 369 254,610.00 62 42,780.00
79 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 0 - - 0 - -
80 05.03.13.519FITOMENADION (VIT K) INJ 10 MG/ML Amp 1,888.00 155 292,640.00 - 155 292,640.00 114 215,232.00
FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 60 60 60
81 FUROSEMIDA TABLET 40 MG Tab 84.00 0 - - 0 - -
82 16.02.01.352FUROSEMIDA TABLET 40 MG Tab 91.00 464 42,224.00 - 464 42,224.00 132 12,012.00
83 15.03.01.520GARAM ORALIT I SERBUK Sac 322.00 380 122,360.00 - 380 122,360.00 380 122,360.00
84 GARAM ORALIT I SERBUK Sac 274.00 0 - 500 137,000.00 500 137,000.00 21 5,754.00
85 22.01.01.520GEMFIBROZIL KAPSUL 300 MG Kap 306.00 975 298,350.00 - 975 298,350.00 20 6,120.00
86 17.09.01.520GENTAMISIN INJ 80 MG/ML Amp 4,066 5 20,330.00 - 5 20,330.00 -
87 17.09.01.520GENTAMISIN SALEP KULIT Pot 1,469.00 0 - - 0 - -
88 17.09.01.520GENTAMISIN SULFAT TETES MATA 0,3 % Pot 3,513.00 0 - - 0 - -
89 22.01.01.520GENTIAN VIOLET 1 % Btl 985.00 2 1,970.00 - 2 1,970.00 -
90 22.01.01.520GLIBENKLAMIDA TABLET 5 MG Tab 61.00 2053 125,233.00 - 2053 125,233.00 841 51,301.00
6531.5
BULAN 1-3
91 GLIMEPIRIDE 2 MG Tab 502.00 167 83,834.00 - 167 83,834.00 12 6,024.00
92 GLIMEPIRIDE 2 MG Tab 297.00 300 89,100.00 - 300 89,100.00 -
93 22.01.01.520GLISERIL GUALAKOLAT TABLET 100 MG Tab 30.69 1733 53,185.77 - 1733 53,185.77 1733 53,185.77
94 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 5000 354,750.00 - 5000 354,750.00 1486 105,431.70
95 04.02.01.520GLUKOSA LARUTAN INFUS 10 % Btl 6,270.00 0 - - 0 - -
97 04.02.01.520GLUKOSA LARUTAN INFUS 5 % Btl 5,720.00 76 434,720.00 - 76 434,720.00 14 80,080.00
98 GRANTUSIF Tab 405.00 4387 1,776,735.00 7000 2,835,000.00 11387 4,611,735.00 7655 3,100,275.00
99 22.01.01.520GRISEOFULVIN TABLET 125 MG Tab 241.00 564 135,924.00 - 564 135,924.00 564 135,924.00
100 GRISEOFULVIN TABLET 125 MG Tab 506.00 0 - 500 253,000.00 500 253,000.00 32 16,192.00
101 22.01.01.521HALOPERIDOL TABLET 1.5 MG Tab 65.00 500 32,500.00 - 500 32,500.00 60 3,900.00
102 12.01.01.508HIDROKLOROTIAZIDA TABLET 25 MG Tab 171.00 100 17,100.00 - 100 17,100.00 -
103 22.01.01.521HIDROKORTISON KRIM 2 % Tube 2,938.00 97 284,986.00 - 97 284,986.00 97 284,986.00
104 HIDROKORTISON KRIM 2 % Tube 2,812.00 0 - 120 337,440.00 120 17 47,804.00
105 07.01.02.504IBUPROFEN TABLET 200 MG Tab 121.00 738 89,298.00 - 738 89,298.00 199 24,079.00
106 IBUPROFEN TABLET 400 MG Tab 133.00 525 69,825.00 - 525 69,825.00 525 69,825.00
107 IBUPROFEN TABLET 400 MG Tab 227.00 3000 681,000.00 - 3000 681,000.00 3000
IBUPROFEN TABLET 400 MG Tab 157.00 5000 785,000.00 5000 785,000.00 2021 317,297.00
108 IBUPROFEN SIRUP 15 MG/ML Btl 106.70 0 - - 0 - -
109 22.01.01.521ISONIAZID TABLET 300 MG Tab 106.70 0 - - 0 - -
110 22.01.01.521ISOSORBID DINITRAT TABLET 5 MG Tab 98.00 240 23,520.00 - 240 23,520.00 116 11,368.00
111 KALIUM DIKLOFENAK TAB 50 MG Tab 425.00 0 - - 0 - -
112 KALSIUM GLUCONAS INJ Amp 10,437 0 - - 0 - -
113 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 67.00 1698 113,766.00 3000 201,000.00 4698 314,766.00 4151 278,117.00
114 12.06.01.506KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - -
115 12.06.01.506KAPTOPRIL 25 MG Tab 72.00 3674 264,528.00 - 3674 264,528.00 1411 101,592.00
116 12.06.01.506KAPTOPRIL 50 MG Tab 143.00 342 48,906.00 - 342 48,906.00 176 25,168.00
117 KETOKENAZOL TAB 200 MG Tab 320.00 0 - - 0 - -
118 KETOKENAZOL KRIM Tube 3,135.00 0 - - 0 - -
119 KETOROLAC INJ Amp 1,383.00 7 9,681.00 - 7 9,681.00 3 4,149.00
120 22.01.01.522KLONIDIN TABLET 0.15 MG Tab 224.00 0 - - 0 - -
121 KLONIDIN TABLET 0.15 MG Tab 145.00 372 53,940.00 - 372 53,940.00 19 2,755.00
122 01.01.02.522KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 18 33,300.00 - 18 33,300.00 10 18,500.00
123 01.01.02.522KLORAMFENIKOL TETES TELINGA 3 % Tube 1,759.00 12 21,108.00 - 12 21,108.00 12 21,108.00
23550
BULAN 1-3
124 KLORAMFENIKOL TETES TELINGA 3 % Tube 7,300.00 24 175,200.00 - 24 175,200.00 11 80,300.00
125 01.01.02.522KLORAMFENIKOL TETES MATA 0.5 % Tube 0 - - 0 - -
126 01.01.02.522KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,016.00 0 - - 0 - 0
127 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,000.00 45 180,000.00 - 45 180,000.00 19 76,000.00
128 01.01.02.522KLORAMFENIKOL KAPSUL 250 MG Kap 250.00 316 79,000.00 - 316 79,000.00 288 72,000.00
129 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 200 124,322.00 200
130 KLORAMFENIKOL KAPSUL 500 MG Kap 1,155.00 94 108,570.00 300 346,500.00 394 455,070.00 337 389,235.00
131 22.01.01.522KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 5659 305,586.00 - 5659 305,586.00 5659 305,586.00
132 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 5000 225,000.00 5000 2483.5 111,757.50
133 KLORPROMAZIN TAB SALUT 25 MG Tab 50.00 108 5,400.00 - 108 5,400.00 38 1,900.00
134 22.01.01.522KLORPROMAZIN TAB SALUT 100 MG Tab 165.00 466 76,890.00 - 466 76,890.00 300 49,500.00
135 01.06.01.514KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 6 13,788.00 - 6 13,788.00 6 13,788.00
136 KOTRIMOKSAZOL SUSPENSI Btl 2,462.00 150 369,300.00 - 150 369,300.00 150 369,300.00
137 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 50 111,250.00 50 3 6,675.00
138 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 152.00 947 143,944.00 - 947 143,944.00 947 143,944.00
139 01.06.01.514KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 1000 131,000.00 - 1000 131,000.00 272 35,632.00
140 01.06.01.514KOTRIMOKSAZOL DOEN II (ANAK) Tab 79.00 0 - - 0 - -
141 19.02.01.506KUINIDIN 100 MG TABLET Tab 0 - - 0 - -
143 01.02.01.523KUININ (KINA) TABLET 200 MG Tab 0 - - 0 - -
144 01.02.01.523KUININ INJEKSI 25 % Tab 0 - - 0 - -
145 01.02.01.523KUININ SULFAT TAB 222 MG (7 H2O) Tab 641.67 0 - - 0 - -
146 LANSOPRAZOL 30 MG KAP 521.00 5 2,605.00 200 104,200.00 205 106,805.00 5 2,605.00
147 LANSOPRAZOL SIRUP Btl 0 - - 0 - -
148 22.01.01.523LIDOKAIN INJ 2 % Amp 929.00 26 24,154.00 - 26 24,154.00 16 14,864.00
149 22.01.01.523LISOL DENGAN KRESOL SABUN 50 % Btl 31,800.00 0 - - 0 - -
150 LOPERAMIDE Tab 90.00 420 37,800.00 - 420 37,800.00 10 900.00
151 LORATADIN TAB Tab 170.00 252 42,840.00 - 252 42,840.00 252 42,840.00
152 LORATADIN TAB Tab 134.00 100 13,400.00 100 62 8,308.00
153 MgSO4 20% Btl 3,200 0 - 24 76,800.00 24 76,800.00 -
154 MgSO4 40% Btl 3,650 0 - 6 21,900.00 6 21,900.00 -
155 22.01.01.524MEBENDAZOL SIROP 100 MG/ 5 ML Btl 0 - - 0 - -
156 22.01.01.524MEBENDAZOL TABLET 100 MG Tab 0 - - 0 - -
157 MELOXICAM 7,5 mg Tab 680 196 133,280.00 1200 816,000.00 1396 949,280.00 588 399,840.00
158 MELOXICAM 15 mg Tab 875 969 847,875.00 1000 875,000.00 1969 1,722,875.00 1100 962,500.00
159 07.01.02.504METAMPIRON TABLET 500 MG (ANTALGIN) Tab 141.85 0 - - 0 - -
160 22.01.01.524METILERGOMETRIN MALEAT TAB 0.125 MGTab 133.10 0 - - 0 - -
10683
BULAN 1-3
161 22.01.01.524METILERGOMETRIN MALEAT INJ 0.2 MG Amp 8,500.00 60 510,000.00 - 60 510,000.00 -
162 METILPREDNISOLON TAB 4 MG Tab 200.00 2695 539,000.00 - 2695 539,000.00 2695 539,000.00
163 METILPREDNISOLON TAB 4 MG Tab 165.00 3000 495,000.00 3000 1060
164 METILPREDNISOLON TAB16 MG Tab 850.00 41 34,850.00 - 41 34,850.00 -
165 METFORMIN TAB 500 MG Tab 118.50 945 111,982.50 - 945 111,982.50 602 71,337.00
166 22.01.01.524METFORMIN TAB 500 MG Tab 115.00 0 - 1000 115,000.00 1000 115,000.00 -
167 METOKLOPRAMIDE TAB 10 MG TAB 110.00 600 66,000.00 - 600 66,000.00 98 10,780.00
168 METOKLOPRAMIDE TAB 10 MG TAB 100.00 0 - - 0 -
169 22.01.01.524MULTIVITAMIN TAB Tab 1654 0 - 1000 1,654,000.00 1000 1,654,000.00 60 99,240.00
170 22.01.01.524METRONIDAZOL TABLET 500 MG Tab 169.00 252 42,588.00 - 252 42,588.00 229 38,701.00
171 METRONIDAZOL TABLET 500 MG Tab 140.00 200 28,000.00 200
173 MIKONAZOLE KREAM Tube 3,150.00 47 148,050.00 24 75,600.00 71 223,650.00 64 201,600.00
174 MIKONAZOLE POWDER POT 26,950.00 56 1,509,200.00 - 56 1,509,200.00 -
175 MINERAL MIX Bks 2,723 0 - - 0 - -
176 05.03.02.525NATRIUM DKLOFENAK TABLET 25 MG Tab 0 - - 0 - -
177 05.03.02.525NATRIUM DKLOFENAK TABLET 50 MG Tab 193.00 0 - - 0 - -
178 NA. DIKLOFENAK 50 MG/DIK.SODIUM Tab 161.00 496 79,856.00 2000 322,000.00 2496 401,856.00 992 159,712.00
179 05.03.02.525NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 95.5 602,540.00 40 256,400.00 135.5 868,555.00 63.75 408,637.50
180 NIPEDIFINE TAB 10 MG Tab 123.00 571 70,233.00 - 571 70,233.00 170 20,910.00
181 NISTATIN 500.000 IU Tab 704.00 80 56,320.00 - 80 56,320.00 20 14,080.00
182 NISTATIN 100.000 IU Tab 448.00 60 26,880.00 - 60 26,880.00 9 4,032.00
183 15.05.01.525OBAT ANTITUBERKULOSIS SISIPAN DEWASATab 175,980 0 - - 0 - -
184 15.05.01.525OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 3 4,139,952.00 - 3 4,139,952.00 1 1,379,984.00
185 15.05.01.525OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 413,984 0 - - 0 - -
186 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 15 5,938,500.00 32 12,668,800.00 47 18,607,300.00 36 14,252,400.00
187 15.05.01.525OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 4 946,000.00 - 4 946,000.00 1 236,500.00
188 14.02.01.525OBAT BATUK HITAM CAIRAN Btl 1,339.80 0 - - 0 - -
189 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 1,680.00 91 152,880.00 - 91 152,880.00 45 75,600.00
190 22.01.01.527OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,630.00 - - 0 - -
191 OKSITETRASIKLIN HCL SALEP 3 % Tube 1,646.00 114 187,644.00 - 114 187,644.00 54 88,884.00
192 OMEPRAZOL Kap 221.00 682 150,722.00 1050 232,050.00 1732 382,772.00 1376 304,096.00
193 OMEPRAZOL Kap 164.00 0 - 480 78,720.00 480 78,720.00 -
194 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 0 -
7312.5
BULAN 1-3
195 22.01.01.527PAPAVERIN TABLET 40 MG Tab 128.00 2339 299,392.00 - 2339 299,392.00 750 96,000.00
196 PAPAVERIN TABLET 40 MG Tab 208.78 0 - - 0 - -
197 PARASETAMOLDROPS Btl 5,980.00 57 340,860.00 280 1,674,400.00 337 2,015,260.00 324 1,937,520.00
198 14.04.01.527PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,535.00 134 205,690.00 - 134 205,690.00 134 205,690.00
199 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 200 223,800.00 200 138 154,422.00
200 14.04.01.527PARASETAMOL SIROP 120 MG/ 5 ML Btl 1013 0 - 100 101,300.00 100 101,300.00 -
201 PARASETAMOL TABLET 500 MG Tab 86.00 10249 881,414.00 10000 860,000.00 20249 1,741,414.00 19452 1,672,872.00
202 PARASETAMOL TABLET 500 MG Tab 51.00 0 - 2000 102,000.00 2000 102,000.00 -
203 PEHACAIN INJ Amp 4,850.00 112 543,200.00 100 485,000.00 212 1,028,200.00 122 591,700.00
204 PENISILLIN PROKAIN INJ Vial 6,618.00 0 - - 0 - -
205 22.01.01.527PIRANTEL TABLET SCORE 125 MG Tab 318.00 0 - - 0 - -
206 22.01.01.527PIRANTEL SIRUP btl 9,100.00 0 - - 0 - -
207 22.01.01.527PIRASETAM 400 Tab 194.00 0 - - 0 - -
208 PIRASETAM 1200 Tab 854.00 0 - - 0 - -
209 05.03.06.528PIRIDOKSIN (VIT B6) TAB 10 MG Tab 124.00 3574 443,176.00 3000 372,000.00 6574 815,176.00 4629 573,996.00
210 22.01.01.528PIROKSIKAM TABLET 10 MG Tab 145.00 1024 148,480.00 - 1024 148,480.00 573 83,085.00
211 PIROKSIKAM TABLET 20 MG Tab 97.99 243 23,811.57 - 243 23,811.57 169 16,560.31
212 22.01.01.528PIROKSIKAM TABLET 20 MG Tab 189.50 0 - - 0 - -
213 16.03.01.354PITOGIN AMPUL 1 ML Amp 9,100.00 89 809,900.00 - 89 809,900.00 52 473,200.00
214 POLIDEMICIN TETES MATA 0 - - 0 - -
215 22.01.01.528POVIDON IODIDA 10 % 1000 ML Btl 40,202.00 1 40,202.00 - 1 40,202.00 1 40,202.00
216 22.01.01.528POVIDON IODIDA 10 % 300 ML Btl 15,386.00 35 538,510.00 - 35 538,510.00 35 538,510.00
217 POVIDON IODIDA 10 % 300 ML Btl 22,500.00 12 270,000.00 12 3 67,500.00
218 22.01.01.528POVIDON IODIDA 10 % 30 ML Btl 2,344.00 0 - - 0 - -
219 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 19 68,875.00 50 181,250.00 69 250,125.00 9.25 33,531.25
220 PREDNISON TABLET 5 MG Tab 125.00 3669.5 458,687.50 - 3669.5 458,687.50 3669.5 458,687.50
221 PREDNISON TABLET 5 MG Tab 123.20 7000 862,400.00 7000 4321 532,347.20
222 22.01.01.528PRIMAKUIN TABLET 15 MG Tab 0 - - 0 - -
223 22.01.01.528PROPANOLOL TABLET 40 MG Tab 119.00 134 15,946.00 - 134 15,946.00 134 15,946.00
224 22.01.01.528PROPANOLOL TABLET 10 MG Tab 69.00 0 - 1100 75,900.00 1100 75,900.00 75 5,175.00
225 22.01.01.528PROPILITIOURASIL TABLET 100 MG Tab 351.00 650 228,150.00 100 35,100.00 750 263,250.00 393 137,943.00
226 RANITIDIN TABLET 150 MG Tab 115.00 7520 864,800.00 - 7520 864,800.00 3590 412,850.00
227 15.01.01.318RANITIDIN INJ 25 MG / 2 ML Amp 1,600.00 0 - - 0 - -
228 RANITIDIN INJ 25 MG / 2 ML Amp 3,150.00 14 44,100.00 - 14 44,100.00 -
229 REAGEN PEWARNA Pkt 270,000.00 0 - - 0 - -
230 REAGENSIA ZN Pkt 276,600.00 11 3,042,600.00 10 2,766,000.00 21 5,808,600.00 21 5,808,600.00
29874.5 8,997,794.07
BULAN 1-3
231 22.01.01.529RINGER LAKTAT INFUS Btl 7,150.00 79 564,850.00 40 286,000.00 119 850,850.00 90 643,500.00
232 SALBUTAMOL SYRUP 2 MG Btl 5,463.00 142 775,746.00 - 142 775,746.00 9 49,167.00
233 22.01.01.529SALBUTAMOL TABLET 2 MG Tab 65.00 627 40,755.00 - 627 40,755.00 338.5 22,002.50
234 22.01.01.529SALBUTAMOL TABLET 4 MG Tab 88.00 353 31,064.00 - 353 31,064.00 140 12,320.00
235 SALEP 2-4 KOMBINASI Tube 2,797.00 36 100,692.00 - 36 100,692.00 21 58,737.00
236 SALISIL BEDAK 2 % Pot 1,071.00 20 21,420.00 30 32,130.00 50 53,550.00 28.2 30,202.20
237 22.01.01.529SALISIL BEDAK 2 % Pot 1,066.00 14.8 15,776.80 - 14.8 15,776.80 11.8 12,578.80
238 22.01.01.529SEFADROKSIL SIROP KERING 125 MG / 5 MLBtl 4,133.00 39 161,187.00 - 39 161,187.00 21 86,793.00
239 SEFADROKSIL KAPSUL 500 MG Kap 557.00 2442 1,360,194.00 1000 557,000.00 3442 1,917,194.00 2930 1,632,010.00
SEFADROKSIL KAPSUL 500 MG Kap 455.00 1000 1000
240 22.01.01.530SEFOTAKSIM 1000 MG Tab 3,500.00 20 70,000.00 - 20 70,000.00 -
241 22.01.01.530SEFTRIAKSON SERBUK INJ 1000 MG Pot 2,578.00 0 - - 0 - -
242 SIANOKOBALAMIN VIT B12 INJ 500 (PLACO Amp 1,050.00 83 87,150.00 - 83 52 54,600.00
243 22.01.01.530SIANOKOBALAMIN TABLET 50 MCG Tab 15.00 5014 75,210.00 - 5014 75,210.00 5014 75,210.00
244 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 10000 550,000.00 10000 3282 180,510.00
245 22.01.01.531SIMVASTATIN TABLET 10 MG Tab 135.00 0 - - 0 - -
246 SIMVASTATIN TABLET 10 MG Tab 177.00 8451 1,495,827.00 - 8451 1,495,827.00 1899 336,123.00
247 16.01.01.515SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 2572 766,456.00 1000 298,000.00 3572 1,064,456.00 2015 600,470.00
248 01.06.01.515SULFADIMIDINE TABLET 500 MG Tab 0 - - 0 - -
249 22.01.01.531SULFASETAMIDA NATRIUM TETES MATA 15 Pot 3,549.00 0 - - 0 - -
250 SCABIMITE CREAM Tube 12,155.00 58 704,990.00 - 58 704,990.00 3 36,465.00
251 12.02.01.531TABLET TAMBAH DARAH KOMBINASI Tab 121.00 10742 1,299,782.00 18000 2,178,000.00 28742 3,477,782.00 23113 2,796,673.00
252 TABLET TAMBAH DARAH KOMBINASI Tab 367.00 0 - 3000 1,101,000.00 3000 1,101,000.00 -
253 TABLET TAMBAH DARAH (HUFABION) Tab 405.00 0 - - 0 - -
254 01.01.06.532TETRASIKLIN KAPSUL 250 MG Kap 162.00 5 810.00 - 5 810.00 5 810.00
255 TETRASIKLIN KAPSUL 250 MG Kap 181.00 2000 362,000.00 - 2000 362,000.00 1516 274,396.00
256 01.01.06.532TETRASIKLIN KAPSUL 500 MG Kap 325.00 106 34,450.00 - 106 34,450.00 80 26,000.00
257 22.01.01.532TIAMFENIKOL KAPSUL 500 MG Kap 440.00 0 - - 0 - -
258 05.03.05.532TIAMIN (VIT B1) INJ 100 MG/ML Amp 730.00 0 - - 0 - -
259 05.03.05.532TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 4372 397,852.00 10000 910,000.00 14372 1,307,852.00 11535 1,049,685.00
260 TIURAZOL 5 mg TAB Tab 563.00 0 - - 0 - -
261 TIURAZOL 10 mg TAB Tab 1,195.00 75 89,625.00 - 75 89,625.00 15 17,925.00
262 TRAMADOL KAPS Tab 196.35 0 - - 0 - -
263 TRAMADOL INJ Tab 6,000.00 0 - - 0 - -
264 TRIHEKSIFENIDIL 25 MG TAB/ARKINE Tab 691.19 279 192,842.01 - 279 192,842.01 45 31,103.55
37529.8 8,648,678.81
BULAN 1-3
265 VIT A MERAH kap 505.00 410 207,050.00 1850 934,250.00 2260 1,141,300.00 1620 818,100.00
266 VIT A BIRU kap 286.00 265 75,790.00 - 265 75,790.00 265 75,790.00
VIT A BIRU kap 327.00 50 50 24
267 05.03.06.533VITAMIN B KOMPLEKS TABLET Tab 112.00 3613 404,656.00 - 3613 404,656.00 3613 404,656.00
268 VITAMIN B KOMPLEKS TABLET Tab 132.00 0 - 18800 2,481,600.00 18800 2,481,600.00 9944 1,312,608.00
269 19.07.01.412ZIN TAB Tab 521.00 495 257,895.00 - 495 257,895.00 495 257,895.00
270 ZIN TAB Tab 592.00 1000 592,000.00 1000 250 148,000.00
271 ZIN SIRUP Btl 6,600.00 27 178,200.00 44 290,400.00 71 468,600.00 37 244,200.00
- -
PERBEKALAN KESEHATAN - -
1 ALAT SUNTIK SEKALI PAKAI 0,5 ML Set 1,240.00 1911 2,369,640.00 - 1911 2,369,640.00 984 1,220,160.00
2 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 2,530.813 83 210,057.48 - 83 210,057.48 83 210,057.48
4 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,287.00 263 338,481.00 - 263 338,481.00 125 160,875.00
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 100
6 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 1,300.00 739 960,700.00 200 260,000.00 939 1,220,700.00 444 577,200.00
7 ALAT SUNTIK SEKALI PAKAI 5 ML Set 750.00 0 - - 0 - -
8 ALAT SUNTIK SEKALI PAKAI 5 ML Set 963.00 213 205,119.00 - 213 205,119.00 72 69,336.00
9 ALAT SUNTIK SEKALI PAKAI 5 ML Set 1,223.75 100 122,375.00 100
11 BISTURI NO. 19 Bh 3,000 128 384,000.00 - 128 384,000.00 9 27,000.00
12 BISTURI NO.20 Bh 3,000 77 231,000.00 - 77 231,000.00 9 27,000.00
13 BISTURI NO.21 Bh 3,000 65 195,000.00 - 65 195,000.00 7 21,000.00
14 BISTURI NO.23 Bh 3,000 67 201,000.00 - 67 201,000.00 16 48,000.00
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 -
16 CATGUT NO 2/0 Pcs 27,758.00 100 2,775,800.00 - 100 2,775,800.00 10 277,580.00
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - -
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - -
19 CATGUT NO 3/0 Pcs 8,895.83 123 1,094,187.09 - 123 1,094,187.09 19 169,020.77
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - -
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 -
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 0 -
23 FOLEY CATETER 18 Bh 10,000.00 11 110,000.00 10 100,000.00 21 210,000.00 12 120,000.00
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 -
25 HIV TEST Set 0 - - 0 - -
26 INFUSION SET ANAK SET 4,375.00 16 70,000.00 - 16 70,000.00 -
27 INFUSION SET DEWASA Set 4,000.00 100 400,000.00 - 100 400,000.00 41 164,000.00
28 IV CATHETER NO 18 G Set 9,123.00 53 483,519.00 - 53 483,519.00 6 54,738.00
9467
BULAN 1-3
31 IV CATHETER NO 22 G Set 9,123.00 50 456,150.00 - 50 456,150.00 -
34 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 11,400.00 0 - - 0 - -
35 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 10 303,050.00 10 319,000.00 20 638,000.00 7.75 247,225.00
36 KASA KOMPRES 40/40 STERIL Bks 1,679.15 1 1,679.15 - 1 1,679.15 1 1,679.15
38 KASA PEMBALUT 2 M X 80 CM Bks 10,000.00 24 240,000.00 - 24 240,000.00 10 100,000.00
39 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASTIBks 864.00 63 54,432.00 - 63 54,432.00 19 16,416.00
40 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTBks 4,104.00 214 878,256.00 - 214 878,256.00 121 496,584.00
41 KASA PEMBALUT HIDROFIL 16 M X 16 CM EBks 8,532.00 10 85,320.00 - 10 85,320.00 3 25,596.00
42 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 10 1,563,000.00 10 1,563,000.00 20 3,126,000.00 8 1,250,400.00
43 PLESTER YARD Roll 43,700.00 14 611,800.00 20 874,000.00 34 1,485,800.00 20.5 895,850.00
44 HANDSCON 7 STERIL Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 86 510,840.00
45 HANDSCON 7 STERIL Bks 6,237.00 50 311,850.00 - 50 311,850.00 50 311,850.00
46 HANDSCON 71/2 Bks 6,237.00 75 467,775.00 - 75 467,775.00 68 424,116.00
47 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 0 -
48 HANDSCON 6,5 Bks 0 - - 0 - -
49 HANDSCON S Pcs 1,188.00 400 475,200.00 500 594,000.00 900 1,069,200.00 550 653,400.00
50 HANDSCON L Pcs 890.50 509 453,264.50 500 445,250.00 1009 898,514.50 336 299,208.00
51 HANDSCON M Pcs 890.50 230 204,815.00 500 445,250.00 730 650,065.00 426 379,353.00
52 URINE BAG BH 3,000.00 17 51,000.00 - 17 51,000.00 2 6,000.00
53 MASKER IKAT Bh 700.00 43 30,100.00 - 43 30,100.00 43 30,100.00
54 MASKER KARET Pcs 700.00 523 366,100.00 500 350,000.00 1023 716,100.00 520 364,000.00
55 SILK 2/0 SET 21,875.00 130 2,843,750.00 - 130 2,843,750.00 5 109,375.00
56 SILK 3/0 SET 21,875.00 124 2,712,500.00 - 124 2,712,500.00 28 612,500.00
57 SILK 3/0 SET 35,331.00 14 494,634.00 - 14 494,634.00 14 494,634.00
58 STOMACH TUBE / MAAG SLANG NO. 3,5 Pcs 18,000.00 0 - - 0 - -
59 STOMACH TUBE / MAAG SLANG NO. 5 Pcs 18,000.00 0 - - 0 - -
62 WING NEEDLE NO.21 Pcs 1,400.00 0 - - 0 - -
3289
BULAN 1-3
66 POT SPUTUM Pcs 2,930.00 157 460,010.00 400 1,172,000.00 557 1,632,010.00 371 1,087,030.00
67 RDT MALARIA ( Monotest ) Pcs 1,190,450.00 0 - - 0 - -
68 RDT DBD IGG/IGM DOS 1,562,500.00 6 9,375,000.00 - 6 9,375,000.00 6 9,375,000.00
69 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 6
70 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - -
71 STRIP GULA DARAH DOS 420,000.00 1 12 5,040,000.00 13 5,460,000.00 3.5 1,470,000.00
72 VAKSIN RABIES AMP 270,600.00 0 20 5,412,000.00 20 5,412,000.00 20 5,412,000.00
73 STRIP ASAM URAT DOS 452,000.00 2 904,000.00 2 1
74 KOLESTEROL STRIP DOS 319,000.00 13 4,147,000.00 13 13
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 -

2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 -
5 EUGENOL Pcs 175,000.00 3.5 612,500.00 2 350,000.00 5.5 962,500.00 3.75 656,250.00
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 3 1,950,000.00 - 3 1,950,000.00 0.25 162,500.00
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - -
8 CHKM 10 ML Pcs 210,000.00 3.5 735,000.00 - 3.5 735,000.00 0.5 105,000.00
9 OCCO Pcs 245,000.00 2 490,000.00 - 2 490,000.00 0.5 122,500.00
10 DYCAL Pcs 800,000.00 1 800,000.00 - 1 800,000.00 0.5 400,000.00
11 HEMOSPON Pcs 76,500.00 10 765,000.00 - 10 765,000.00 5 382,500.00
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 -
13 SEPTOJEK Pcs 0 - - 0 - -
14 CAVITON Btl 325,000.00 1.5 487,500.00 - 1.5 487,500.00 1 325,000.00
TOTAL HARGA OBAT DAN BHP 199.5 116,311,847.03 73,408,845.00 180,354,004.67 101,115,214.51
BPJS UMUM JMLH

JUMLAH KUNJUNGAN RESEP
10233 1055 11288
Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

Kepala Dinas Kesehatan Kepala Gudang Farmasi Kepala Puskesmas Petugas Puskesmas
dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
( LPLPO )

PUSKESMAS : Benteng
KECAMATAN : Benteng BULAN APRIL
TRI WULAN II 2018
1 2 3 4 6 8 9 10 12
1 21.01.01.415ALBENDAZOL TABLET 400 MG Tab 363.00 2378 863,214.00 - 2378 863,214.00 34 12,342.00
2 21.01.01.415ALBENDAZOL SIRUP Btl 4,234.00 0 - - 0 - -
3 17.09.01.390ALBOTHYL KONSENTRAT Tube 18,635.00 1.25 23,293.75 - 1.25 23,293.75 -
4 07.01.02.504ALOPURINOL TABLET 100 MG Tab 90.00 0 - - 0 - -
5 ALOPURINOL TABLET 100 MG Tab 117.00 1487 173,979.00 - 1487 173,979.00 890 104,130.00
6 07.01.02.504ALOPURINOL TABLET 300 MG Tab 230.00 500 115,000.00 - 500 115,000.00 100 23,000.00
7 ALOPURINOL TABLET 300 MG Tab 244.00 2000 488,000.00 2000 488,000.00 -
8 22.01.01.515AMINOFILIN INJEKSI 24 MG/ML Amp 3,314.52 26 86,177.52 - 26 86,177.52 -
9 22.01.01.515AMINOFILIN TABLET 200 MG Tab 86.00 300 25,800.00 - 300 25,800.00 58 4,988.00
10 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 24 2,832.00 - 24 2,832.00 24 2,832.00
11 22.01.01.516AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 700 115,500.00 - 700 115,500.00 9 1,485.00
12 22.01.01.515AMBROKSOL TAB 30 MG Tab 190.63 978 186,436.14 4000 762,520.00 4978 948,956.14 2789 531,667.07
13 22.01.01.515AMBROKSOL SIRUP Btl 2,722.00 0 - - 0 -
14 AMLODIPIN 5 MG Tab 105.00 4313 452,865.00 - 4313 452,865.00 3219 337,995.00
15 01.01.04.510AMOKSISILIN KAPSUL 250 MG Kap 220.00 0 - - 0 - -
16 AMOKSISILIN KAPSUL 250 MG Kap 207.00 339 70,173.00 500 103,500.00 839 173,673.00 357 73,899.00
17 AMOKSISILLIN KAPLET 500 MG Kap 233.00 3796.5 884,584.50 23000 5,359,000.00 26796.5 6,243,584.50 17780.5 4,142,856.50
18 01.01.04.510AMOKSISILIN KAPLET 500 MG Kap 608.00 0 - - 0 - -
19 01.01.04.510AMOKSISILIN VIAL 1 G Vial 8,135.00 0 - - 0 - -
20 01.01.04.510AMOKSISILIN SIROP KERING 125 Btl 2,560.00 38 97,280.00 100 256,000.00 138 353,280.00 138 353,280.00
21 AMOKSISILIN SIROP KERING 125 Btl 2,200.00 400 880,000.00 400 880,000.00 165 363,000.00
22 01.01.04.513AMPICILIN SERBUK INJ 1 G Vial 5,905 0 - - 0 - -
23 01.01.04.513AMPICILIN KAPLET 250 MG Kap 0 - - 0 - -
24 01.01.04.513AMPICILIN KAPLET 500 MG Kap 419.10 0 - - 0 - -
25 ANTASIDA DOEN TABLET KUNYAH Tab 64.00 1864 119,296.00 6000 384,000.00 7864 503,296.00 4437 283,968.00
26 ANTASIDA DOEN TABLET KUNYAH Tab 78.00 0 - - 0 - -
27 15.01.01.533ANTASIDA DOEN II SUSPENSI Btl 2,106.00 51 107,406.00 150 315,900.00 201 423,306.00 111 233,766.00
16796
TRI WULAN II 2018

28 01.01.00.533ANTI BAKTERI DOEN SALEP KOMBINASI Pot 2,767.00 0 - - 0 - -
29 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 41 137,965.00 - 41 137,965.00 6 20,190.00
30 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 18 86,076.00 24 114,768.00 42 200,844.00 4 19,128.00
31 12.05.01.534ANTIHEMOROID DOEN KOMBINASI Pot 3,502.00 38 133,076.00 - 38 133,076.00 4 14,008.00
32 10.02.01.533ANTIMIGREN Tab 135.00 63 8,505.00 - 63 8,505.00 52 7,020.00
33 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 -
34 22.01.01.516AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 7 40,600.00 60 348,000.00 67 388,600.00 12 69,600.00
35 22.01.01.516AQUA PRO INJEKSI STERIL 25 ML Vial 2750 0 - 30 82,500.00 30 82,500.00 -
37 07.01.02.504ASAM ASETIL SALISILAT 100 MG Tab 127.00 0 - - 0 - -
38 ASAM ASETIL SALISILAT 100 MG Tab 149.00 1000 149,000.00 1000 149,000.00 100 14,900.00
40 05.03.07.516ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 10 1,050.00 - 10 1,050.00 -
41 22.01.01.516AS.MEFENAMAT TABLET SALUT 500 MG Tab 113.00 0 - - 0 - -
42 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 6576.5 670,803.00 8000 816,000.00 14576.5 1,486,803.00 11876.5 1,211,403.00
43 22.01.01.516ASIKLOVIR KRIM 5 % Tube 2,367.00 0 - - 0 - -
44 22.01.01.516ASIKLOVIR TABLET 200 MG Tab 251.00 20 5,020.00 - 20 5,020.00 -
46 22.01.01.516ASIKLOVIR TABLET 400 MG Tab 381.00 867 330,327.00 - 867 330,327.00 236 89,916.00
47 07.07.02.504ATROPIN TETES MATA 0.5 % Btl 0 - - 0 - -
48 22.01.01.517BETAMETASON KRIM 0,1 % Tube 1,435.00 86 123,410.00 96 137,760.00 182 261,170.00 79 113,365.00
53 CETIRIZINE TAB Tab 154.00 10 1,540.00 1000 154,000.00 1010 155,540.00 1010 155,540.00
54 CETIRIZINE TAB KAP 115.00 1000 115,000.00 - 1000 115,000.00 113 12,995.00
55 CETIRIZINE SIRUP Btl 7,756.00 0 - - 0 - -
56 CHATHEJELL Tab 4,284.80 7 29,993.60 10 42,848.00 17 72,841.60 5 21,424.00
57 22.01.01.517DEKSAMETASON INJ 5 MG/ML Amp 1,738.00 3 5,214.00 - 3 5,214.00 3 5,214.00
58 DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 20 34,800.00 - 20 34,800.00 1 1,740.00
60 22.01.01.517DIAZEPAM INJ 2 MG/ML Amp 2,605 0 - - 0 - -
61 22.01.01.517DIAZEPAM TABLET 2 MG Tab 39.00 419 16,341.00 1000 39,000.00 1419 55,341.00 562 21,918.00
62 DIAZEPAM RECTAL Tube 12,749.00 14 178,486.00 - 14 178,486.00 14 178,486.00
63 22.01.01.517DIAZEPAM RECTAL Tube 13,384.00 10 133,840.00 - 10 133,840.00 -
TRI WULAN II 2018

64 22.01.01.518DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 55 63,580.00
65 22.01.01.518DIGOKSIN TABLET 0,25 MG Tab 103.00 292 30,076.00 - 292 30,076.00 38 3,914.00
66 22.01.01.518DILTIAZEM TAB 30 MG Tab 141.00 0 - - 0 - -
67 22.01.01.518DIMENHIDRINAT TAB 50 MG Tab 109.00 0 - - 0 - -
68 DIMENHIDRINAT TAB 50 MG Tab 114.00 76 8,664.00 - 76 8,664.00 -
69 22.01.01.518DOMPORIDON SIRUP Btl 3,490.00 0 - - 0 - -
70 22.01.01.518DOKSISIKLIN KAPSUL 100 MG Kap 309.00 78 24,102.00 - 78 24,102.00 20 6,180.00
71 22.01.01.518DOMPERIDON TABLET 10 MG Tab 174.00 404 70,296.00 - 404 70,296.00 149 25,926.00
72 22.01.01.518ERITROMISIN KAPSUL 250 MG Kap 651.00 0 100 65,100.00 100 65,100.00 5 3,255.00
73 22.01.01.518ERITROMISIN KAPSUL 250 MG Kap 522.00 17.5 9,135.00 - 17.5 9,135.00 17.5 9,135.00
74 22.01.01.518ERITROMISIN KAPSUL 500 MG Kap 1,023.00 223.5 228,640.50 100 102,300.00 323.5 330,940.50 55 56,265.00
75 22.01.01.518ERITROMISIN SIROP 200 MG/ 5 ML Btl 6,461.00 0 - 50 323,050.00 50 323,050.00 -
77 22.01.01.519ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 Btl 3,750.00 18.5 69,375.00 - 18.5 69,375.00 2.5 9,375.00
78 22.01.01.519ETANOL 70 % 100 ml Btl 2,625.00 86.75 227,718.75 100 262,500.00 186.75 490,218.75 46.75 122,718.75
79 22.01.01.519ETANOL 70 % 1000 ml Btl 0 - - 0 - -
80 ETHYLIS CHLORIDUM SEMPROT Btl 81,400.00 - - 0 - -
81 20.02.01.526EUGENOL CAIRAN Btl 18,333.00 0 - - 0 - -
82 07.02.01.505FENOBARBITAL AMPUL 2 ML Btl 1,980 30 59,400.00 - 30 59,400.00 -
83 07.02.01.505FENOBARBITAL TABLET 30 MG Tab 177.00 200 35,400.00 - 200 35,400.00 -
84 05.03.13.519FITOMENADION (VIT K) TABLET 10 MG Tab 690.00 307 211,830.00 - 307 211,830.00 157 108,330.00
85 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 0 - 200 159,200.00 200 159,200.00 -
86 05.03.13.519FITOMENADION (VIT K) INJ 10 MG/ML Amp 1,888.00 41 77,408.00 - 41 77,408.00 41 77,408.00
87 FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 0 - 90 367,470.00 90 367,470.00 51 208,233.00
88 FUROSEMIDA TABLET 40 MG Tab 84.00 0 - 200 16,800.00 200 16,800.00 -
89 16.02.01.352FUROSEMIDA TABLET 40 MG Tab 91.00 332 30,212.00 - 332 30,212.00 56 5,096.00
90 15.03.01.520GARAM ORALIT I SERBUK Sac 273.00 0 - 300 81,900.00 300 81,900.00 -
91 GARAM ORALIT I SERBUK Sac 274.00 479 131,246.00 200 54,800.00 679 186,046.00 621 170,154.00
92 22.01.01.520GEMFIBROZIL KAPSUL 300 MG Kap 306.00 955 292,230.00 - 955 292,230.00 25 7,650.00
93 17.09.01.520GENTAMISIN INJ 80 MG/ML Amp 4,066 5 20,330.00 - 5 20,330.00 5 20,330.00
94 17.09.01.520GENTAMISIN SALEP KULIT Pot 1,469.00 0 - - 0 - -
95 17.09.01.520GENTAMISIN SULFAT TETES MATA 0,3 % Pot 3,513.00 0 - - 0 - -
96 22.01.01.520GENTIAN VIOLET 1 % Btl 985.00 2 1,970.00 - 2 1,970.00 -
97 22.01.01.520GLIBENKLAMIDA TABLET 5 MG Tab 61.00 1212 73,932.00 1000 61,000.00 2212 134,932.00 991 60,451.00
4872.25
TRI WULAN II 2018

100 22.01.01.520GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.00 0 - 3000 210,000.00 3000 210,000.00 -
101 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 3514 249,318.30 - 3514 249,318.30 2614.5 185,498.78
104 04.02.01.520GLUKOSA LARUTAN INFUS 5 % Btl 5,720.00 62 354,640.00 - 62 354,640.00 20 114,400.00
105 GRANTUSIF Tab 405.00 3732 1,511,460.00 7000 2,835,000.00 10732 4,346,460.00 7185 2,909,925.00
106 22.01.01.520GRISEOFULVIN TABLET 125 MG Tab 241.00 0 - - 0 - -
107 GRISEOFULVIN TABLET 125 MG Tab 506.00 468 236,808.00 1000 506,000.00 1468 742,808.00 537 271,722.00
108 22.01.01.521HALOPERIDOL TABLET 1.5 MG Tab 65.00 440 28,600.00 - 440 28,600.00 304 19,760.00
109 12.01.01.508HIDROKLOROTIAZIDA TABLET 25 MG Tab 171.00 100 17,100.00 - 100 17,100.00 -
110 22.01.01.521HIDROKORTISON KRIM 2 % Tube 2,938.00 0 - 120 352,560.00 120 352,560.00 25 73,450.00
111 HIDROKORTISON KRIM 2 % Tube 2,812.00 103 289,636.00 - 103 289,636.00 103 289,636.00
112 HYOSIN BUTIL BROMIDA TAB 10 MG Tab 330.00 0 - - 0 - -
113 07.01.02.504IBUPROFEN TABLET 200 MG Tab 121.00 539 65,219.00 - 539 65,219.00 9 1,089.00
114 IBUPROFEN TABLET 400 MG Tab 133.00 0 - 5000 665,000.00 5000 665,000.00 4755 632,415.00
115 IBUPROFEN TABLET 400 MG Tab 227.00 0 - - 0 - -
116 IBUPROFEN TABLET 400 MG Tab 157.00 2979 467,703.00 - 2979 467,703.00 -
118 22.01.01.521ISOSORBID DINITRAT TABLET 5 MG Tab 93.00 0 - 100 9,300.00 100 9,300.00 -
119 22.01.01.521ISOSORBID DINITRAT TABLET 5 MG Tab 98.00 124 12,152.00 - 124 12,152.00 -
121 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 57 0 - 5000 285,000.00 5000 285,000.00 1611 91,827.00
123 12.06.01.506KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - -
124 12.06.01.506KAPTOPRIL 25 MG Tab 72.00 2263 162,936.00 1000 72,000.00 3263 234,936.00 1265 91,080.00
125 12.06.01.506KAPTOPRIL 50 MG Tab 143.00 166 23,738.00 100 14,300.00 266 38,038.00 103 14,729.00
129 22.01.01.522KLONIDIN TABLET 0.15 MG Tab 224.00 0 - - 0 - -
131 01.01.02.522KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 8 14,800.00 - 8 14,800.00 1 1,850.00
132 01.01.02.522KLORAMFENIKOL TETES TELINGA 3 % Tube 1,759.00 0 - - 0 - -
15857
TRI WULAN II 2018

134 01.01.02.522KLORAMFENIKOL TETES MATA 0.5 % Tube 0 - - 0 - -
135 01.01.02.522KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,016.00 0 - - 0 - -
136 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,000.00 26 104,000.00 20 80,000.00 46 184,000.00 8 32,000.00
137 01.01.02.522KLORAMFENIKOL KAPSUL 250 MG Kap 250.00 28 7,000.00 - 28 7,000.00 28 7,000.00
138 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 200 124,322.00 500 310,805.00 700 435,127.00 160 99,457.60
140 22.01.01.522KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 0 - - 0 - -
141 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 2516.5 113,242.50 12000 540,000.00 14516.5 653,242.50 7159.5 322,177.50
142 KLORPROMAZIN TAB SALUT 25 MG Tab 50.00 70 3,500.00 - 70 3,500.00 -
143 22.01.01.522KLORPROMAZIN TAB SALUT 100 MG Tab 165.00 166 27,390.00 - 166 27,390.00 166 27,390.00
144 01.06.01.514KLORPROMAZIN TAB SALUT 100 MG Tab 179.00 0 - 500 89,500.00 500 89,500.00 60 10,740.00
145 KOTRIMOKSAZOL SUSPENSI Btl 2,462.00 0 - - 0 - -
146 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 47 104,575.00 200 445,000.00 247 549,575.00 121 269,225.00
147 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 158.00 0 - - 0 - -
148 01.06.01.514KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 728 95,368.00 2000 262,000.00 2728 357,368.00 875.5 114,690.50
149 01.06.01.514KOTRIMOKSAZOL DOEN II (ANAK) Tab 79.00 0 - - 0 - -
152 01.02.01.523KUININ (KINA) TABLET 200 MG Tab 0 - - 0 - -
153 01.02.01.523KUININ INJEKSI 25 % Tab 0 - - 0 - -
154 01.02.01.523KUININ SULFAT TAB 222 MG (7 H2O) Tab 641.67 0 - - 0 - -
155 LANSOPRAZOL 30 MG KAP 521.00 200 104,200.00 - 200 104,200.00 112 58,352.00
157 22.01.01.523LIDOKAIN INJ 2 % Amp 929.00 10 9,290.00 - 10 9,290.00 2 1,858.00
158 22.01.01.523LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 0 - 120 254,640.00 120 254,640.00 110 233,420.00
159 LOPERAMIDE Tab 90.00 410 36,900.00 - 410 36,900.00 10 900.00
160 LORATADIN TAB Tab 170.00 0 - - 0 - -
161 LORATADIN TAB Tab 134.00 38 5,092.00 800 107,200.00 838 112,292.00 240 32,160.00
162 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 -
163 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 -
164 22.01.01.524MEBENDAZOL SIROP 100 MG/ 5 ML Btl 0 - - 0 - -
165 22.01.01.524MEBENDAZOL TABLET 100 MG Tab 0 - - 0 - -
166 MELOXICAM 7,5 mg Tab 680 808 549,440.00 - 808 549,440.00 808 549,440.00
167 MELOXICAM 15 mg Tab 875 869 760,375.00 300 262,500.00 1169 1,022,875.00 1169 1,022,875.00
168 07.01.02.504METAMPIRON TABLET 500 MG (ANTALGIN) Tab 141.85 0 - - 0 - -
169 22.01.01.524METILERGOMETRIN MALEAT TAB 0.125 MGTab 245.00 0 - 1000 245,000.00 1000 245,000.00 -
6216.5
TRI WULAN II 2018
170 22.01.01.524METILERGOMETRIN MALEAT INJ 0.2 MG Amp 8,500.00 60 510,000.00 - 60 510,000.00 -
171 METILPREDNISOLON TAB 4 MG Tab 200.00 0 - - 0 - -
172 METILPREDNISOLON TAB 4 MG Tab 165.00 1940 320,100.00 3500 577,500.00 5440 897,600.00 3345 551,925.00
173 METILPREDNISOLON TAB16 MG Tab 850.00 41 34,850.00 - 41 34,850.00 30 25,500.00
175 22.01.01.524METFORMIN TAB 500 MG Tab 115.00 1000 115,000.00 500 57,500.00 1500 172,500.00 140 16,100.00
177 METOKLOPRAMIDE TAB 10 MG TAB 100.00 0 - - 0 - -
178 22.01.01.524MULTIVITAMIN TAB Tab 1654 940 1,554,760.00 1000 1,654,000.00 1940 3,208,760.00 878 1,452,212.00
180 METRONIDAZOL TABLET 500 MG Tab 140.00 200 28,000.00 200 28,000.00 400 56,000.00 165 23,100.00
183 MIKONAZOLE POWDER POT 26,950.00 56 1,509,200.00 - 56 1,509,200.00 2 53,900.00
184 MINERAL MIX Bks 2,723 0 - - 0 - -
185 05.03.02.525NATRIUM DKLOFENAK TABLET 25 MG Tab 0 - - 0 - -
186 05.03.02.525NATRIUM DKLOFENAK TABLET 50 MG Tab 193.00 0 - - 0 - -
188 05.03.02.525NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 71.75 459,917.50 40 256,400.00 111.75 716,317.50 44 282,040.00
190 NISTATIN 500.000 IU Tab 704.00 60 42,240.00 - 60 42,240.00 10 7,040.00
191 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 100 85,700.00 -
192 NISTATIN 100.000 IU Tab 448.00 51 22,848.00 - 51 22,848.00 18 8,064.00
193 15.05.01.525NISTATIN 100.000 IU Tab 627 0 - 100 62,700.00 100 62,700.00 -
194 15.05.01.525OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 2 2,759,968.00 - 2 2,759,968.00 2 2,759,968.00
195 15.05.01.525OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,435,180 0 - 5 7,175,900.00 5 7,175,900.00 2 2,870,360.00
196 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 11 4,354,900.00 - 11 4,354,900.00 11 4,354,900.00
OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 413,984 16 16 8
197 15.05.01.525OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 3 709,500.00 - 3 709,500.00 1 236,500.00
OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,685.00 50 184,250.00 50 1 3,685.00
199 22.01.01.527OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 0 - 50 180,000.00 50 180,000.00 -
201 OMEPRAZOL Kap 221.00 356 78,676.00 - 356 78,676.00 356 78,676.00
202 OMEPRAZOL Kap 164.00 480 78,720.00 1500 246,000.00 1980 324,720.00 1132 185,648.00
203 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 5 92,685.00
8487.75
TRI WULAN II 2018

204 22.01.01.527PAPAVERIN TABLET 40 MG Tab 128.00 1589 203,392.00 - 1589 203,392.00 486 62,208.00
205 PAPAVERIN TABLET 40 MG Tab 208.00 0 - 1000 208,000.00 1000 208,000.00 -
206 PARASETAMOLDROPS Btl 5,980.00 13 77,740.00 146 873,080.00 159 950,820.00 98 586,040.00
207 14.04.01.527PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,013.00 100 101,300.00 - 100 101,300.00 100 101,300.00
208 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 62 69,378.00 300 335,700.00 362 405,078.00 140 156,660.00
209 14.04.01.527PARASETAMOL TABLET 100 MG Tab 0 - - 0 - -
210 PARASETAMOL TABLET 500 MG Tab 86.00 797 68,542.00 20800 1,788,800.00 21597 1,857,342.00 12898.5 1,109,271.00
211 PARASETAMOL TABLET 500 MG Btl 51.00 2000 102,000.00 - 2000 102,000.00 2000 102,000.00
212 PEHACAIN INJ Amp 4,850.00 90 436,500.00 - 90 436,500.00 88 426,800.00
214 22.01.01.527PIRANTEL TABLET SCORE 125 MG Tab 318.00 0 - - 0 - -
215 22.01.01.527PIRANTEL SIRUP btl 9,100.00 0 - - 0 - -
216 22.01.01.527PIRASETAM 400 Tab 194.00 0 - - 0 - -
217 PIRASETAM 1200 Tab 854.00 0 - - 0 - -
218 05.03.06.528PIRIDOKSIN (VIT B6) TAB 10 MG Tab 124.00 1945 241,180.00 5000 620,000.00 6945 861,180.00 3479 431,396.00
219 22.01.01.528PIROKSIKAM TABLET 10 MG Tab 145.00 451 65,395.00 - 451 65,395.00 351 50,895.00
221 22.01.01.528PIROKSIKAM TABLET 20 MG Tab 189.50 0 - 500 94,750.00 500 94,750.00 154 29,183.00
222 16.03.01.354PITOGIN AMPUL 1 ML Amp 9,100.00 37 336,700.00 120 1,092,000.00 157 1,428,700.00 66 600,600.00
223 PITOGIN AMPUL 1 ML amp 1,963.30 0 - - 0 - -
225 22.01.01.528POVIDON IODIDA 10 % 300 ML Btl 15,386.00 0 - 24 369,264.00 24 369,264.00 2 30,772.00
226 POVIDON IODIDA 10 % 300 ML Btl 22,500.00 9 202,500.00 - 9 202,500.00 9 202,500.00
228 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 59.75 216,593.75 - 59.75 216,593.75 8.75 31,718.75
229 PREDNISON TABLET 5 MG Tab 125.00 0 - - 0 - -
230 PREDNISON TABLET 5 MG Tab 123.20 2679 330,052.80 10000 1,232,000.00 12679 1,562,052.80 5318.5 655,239.20
231 22.01.01.528RESPIRIDON 25 MG Tab 347 0 - 200 69,400.00 200 69,400.00 120 41,640.00
232 22.01.01.528PROPANOLOL TABLET 40 MG Tab 119.00 0 - - 0 - -
233 22.01.01.528PROPANOLOL TABLET 10 MG Tab 69.00 1025 70,725.00 - 1025 70,725.00 286 19,734.00
234 22.01.01.528PROPILITIOURASIL TABLET 100 MG Tab 351.00 357 125,307.00 - 357 125,307.00 302 106,002.00
235 RANITIDIN TABLET 150 MG Tab 115.00 3930 451,950.00 5000 575,000.00 8930 1,026,950.00 4260 489,900.00
236 15.01.01.318RANITIDIN INJ 25 MG / 2 ML Amp 1,600.00 0 - - 0 - -
239 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - -
15232
TRI WULAN II 2018

240 22.01.01.529RINGER LAKTAT INFUS Btl 7,150.00 29 207,350.00 70 500,500.00 99 707,850.00 42 300,300.00
242 22.01.01.529SALBUTAMOL TABLET 2 MG Tab 65.00 288.5 18,752.50 1000 65,000.00 1288.5 83,752.50 407.5 26,487.50
243 22.01.01.529SALBUTAMOL TABLET 4 MG Tab 88.00 213 18,744.00 700 61,600.00 913 80,344.00 798 70,224.00
244 SALEP 2-4 KOMBINASI Tube 2,797.00 15 41,955.00 24 67,128.00 39 109,083.00 23 64,331.00
245 SALISIL BEDAK 2 % Pot 1,071.00 21.8 23,347.80 - 21.8 23,347.80 21.8 23,347.80
246 22.01.01.529SALISIL BEDAK 2 % Pot 1,066.00 3 3,198.00 50 53,300.00 53 56,498.00 9 9,594.00
247 22.01.01.529SEFADROKSIL SIROP KERING 125 MG / 5 MLBtl 4,133.00 18 74,394.00 48 198,384.00 66 272,778.00 22 90,926.00
248 SEFADROKSIL KAPSUL 500 MG Kap 557.00 512 285,184.00 1000 557,000.00 1512 842,184.00 1512 842,184.00
249 SEFADROKSIL KAPSUL 500 MG Kap 455.00 1000 455,000.00 2000 910,000.00 3000 1,365,000.00 1535 698,425.00
250 22.01.01.530SEFOTAKSIM 1000 MG Tab 3,500.00 20 70,000.00 - 20 70,000.00 -
251 22.01.01.530SIANOKOBALAMIN VIT B12 INJ 500 (PLACO Amp 1,117.00 0 - 100 111,700.00 100 111,700.00 15 16,755.00
252 SIANOKOBALAMIN VIT B12 INJ 500 (PLACO Amp 1,050.00 31 32,550.00 - 31 32,550.00 22 23,100.00
253 22.01.01.530SIANOKOBALAMIN TABLET 50 MCG Tab 15.00 0 - - 0 - -
254 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 6718 369,490.00 10000 550,000.00 16718 919,490.00 4298 236,390.00
255 22.01.01.531SIMVASTATIN TABLET 10 MG Tab 135.00 0 - - 0 - -
257 16.01.01.515SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 1557 463,986.00 4000 1,192,000.00 5557 1,655,986.00 2229 664,242.00
258 01.06.01.515SULFADIMIDINE TABLET 500 MG Tab 0 - - 0 - -
259 22.01.01.531SULFASETAMIDA NATRIUM TETES MATA 15 Pot 3,549.00 0 - - 0 - -
261 12.02.01.531TABLET TAMBAH DARAH KOMBINASI Tab 121.00 5629 681,109.00 18000 2,178,000.00 23629 2,859,109.00 7857 950,697.00
262 TABLET TAMBAH DARAH KOMBINASI Tab 367.00 3000 1,101,000.00 - 3000 1,101,000.00 3000 1,101,000.00
263 TABLET TAMBAH DARAH KOMBINASI Tab 410.00 0 - 6000 2,460,000.00 6000 2,460,000.00 6000 2,460,000.00
264 01.01.06.532TETRASIKLIN KAPSUL 250 MG Kap 162.00 0 - - 0 - -
265 TETRASIKLIN KAPSUL 250 MG Kap 181.00 484 87,604.00 3000 543,000.00 3484 630,604.00 1051 190,231.00
266 01.01.06.532TETRASIKLIN KAPSUL 500 MG Kap 325.00 26 8,450.00 - 26 8,450.00 -
267 22.01.01.532TIAMFENIKOL KAPSUL 500 MG Kap 440.00 0 - - 0 - -
268 05.03.05.532TIAMIN (VIT B1) INJ 100 MG/ML Amp 730.00 0 - - 0 - -
269 05.03.05.532TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 2837 258,167.00 12000 1,092,000.00 14837 1,350,167.00 8915 811,265.00
271 TIURAZOL 10 mg TAB Tab 1,195.00 60 71,700.00 100 119,500.00 160 191,200.00 60 71,700.00
273 TRIHEKSIFENIDIL 25 MG TAB Tab 80.00 0 - 200 16,000.00 200 16,000.00 21 1,680.00
29436.3
TRI WULAN II 2018

278 VIT A MERAH kap 505.00 640 323,200.00 100 50,500.00 740 373,700.00 76 38,380.00
279 VIT A BIRU kap 286.00 0 - - 0 - -
280 VTT A BIRU kap 327.00 26 8,502.00 50 16,350.00 76 24,852.00 -
281 05.03.06.533VITAMIN B KOMPLEKS TABLET Tab 112.00 0 - - 0 - -
282 VITAMIN B KOMPLEKS TABLET Tab 132.00 8856 1,168,992.00 9400 1,240,800.00 18256 2,409,792.00 11977 1,580,964.00
283 19.07.01.412ZIN TAB Tab 521.00 0 - - 0 - -
284 ZIN TAB Tab 592.00 750 444,000.00 500 296,000.00 1250 740,000.00 687 406,704.00
285 ZIN SIRUP Btl 6,600.00 34 224,400.00 - 34 224,400.00 25 165,000.00
0 - - 0 - -
PERBEKALAN KESEHATAN 0 - - 0 - -
1 ALAT SUNTIK SEKALI PAKAI 0,5 ML Set 1,240.00 927 1,149,480.00 - 927 1,149,480.00 730 905,200.00
2 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 2,530.813 0 - - 0 - -
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 262 381,472.00 500 728,000.00 762 1,109,472.00 239 347,984.00
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 100 123,750.00 200 247,500.00 62 76,725.00
9 ALAT SUNTIK SEKALI PAKAI 5 ML Set 1,223.75 100 122,375.00 - 100 122,375.00 -
11 BISTURI NO. 19 Bh 3,000 119 357,000.00 - 119 357,000.00 13 39,000.00
12 BISTURI NO.20 Bh 3,000 68 204,000.00 - 68 204,000.00 6 18,000.00
13 BISTURI NO.21 Bh 3,000 58 174,000.00 - 58 174,000.00 6 18,000.00
14 BISTURI NO.23 Bh 3,000 51 153,000.00 - 51 153,000.00 6 18,000.00
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 2 5,200.00
16 CATGUT NO 2/0 Pcs 27,758.00 90 2,498,220.00 - 90 2,498,220.00 39 1,082,562.00
18 CATGUT NO 2/0 Pcs 28,000.00 0 - 36 1,008,000.00 36 1,008,000.00 -
19 CATGUT NO 3/0 Pcs 8,895.83 104 925,166.32 - 104 925,166.32 48 426,999.84
20 CATGUT NO 3/0 Pcs 30,188.00 0 - 36 1,086,768.00 36 1,086,768.00 -
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 -
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 -
23 FOLEY CATETER 18 Bh 10,000.00 9 90,000.00 20 200,000.00 29 290,000.00 9 90,000.00
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 -
25 HIV TEST Set 0 - - 0 - -
26 INFUSION SET ANAK SET 4,375.00 16 70,000.00 - 16 70,000.00 5 21,875.00
28 INFUSION SET DEWASA Set 6,218.75 50 310,937.50 50 310,937.50 -
29 IV CATHETER NO 18 G Set 9,123.00 47 428,781.00 50 456,150.00 97 884,931.00 19 173,337.00
TRI WULAN II 2018

30 IV CATHETER NO 20 G Set 7,700.00 0 - 50 385,000.00 50 385,000.00 -
36 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 12.25 390,775.00 10 319,000.00 22.25 709,775.00 7.5 239,250.00
37 KASA KOMPRES 40/40 STERIL Bks 3,100.00 0 - 100 310,000.00 100 310,000.00 10 31,000.00
40 KASA PEMBALUT 2 M X 80 CM Bks 10,152.00 50 507,600.00 50 507,600.00 -
41 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASTIBks 864.00 44 38,016.00 50 43,200.00 94 81,216.00 15 12,960.00
42 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTBks 4,104.00 93 381,672.00 100 410,400.00 193 792,072.00 100 410,400.00
43 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTBks 4,500.00 50 225,000.00 50 225,000.00 -
44 KASA PEMBALUT HIDROFIL 16 M X 16 CM EBks 8,532.00 7 59,724.00 - 7 59,724.00 -
45 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 12 1,875,600.00 10 1,563,000.00 22 3,438,600.00 12 1,875,600.00
46 PLESTER YARD Roll 43,700.00 13.5 589,950.00 - 13.5 589,950.00 13.5 589,950.00
47 PLESTER YARD Roll 49,632.00 24 1,191,168.00 24 1,191,168.00 7 347,424.00
48 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 200 1,247,400.00 -
49 HANDSCON 7 STERIL psg 5,940.00 164 974,160.00 - 164 974,160.00 121 718,740.00
50 HANDSCON 7 STERIL psg 6,118.20 0 - 200 1,223,640.00 200 1,223,640.00 -
51 HANDSCON 71/2 psg 6,237.00 7 43,659.00 - 7 43,659.00 7 43,659.00
52 HANDSCON 71/2 psg 5,940.00 250 1,485,000.00 - 250 1,485,000.00 19 112,860.00
53 HANDSCON 71/2 psg 6,118.20 0 - 200 1,223,640.00 200 1,223,640.00 141 862,666.20
54 HANDSCON S psg 1,188.00 350 415,800.00 100 118,800.00 450 534,600.00 450 534,600.00
55 HANDSCON S psg 854.74 400 341,896.00 400 341,896.00 104 88,892.96
56 HANDSCON L psg 890.50 673 599,306.50 - 673 599,306.50 148 131,794.00
57 HANDSCON M psg 890.50 304 270,712.00 500 445,250.00 804 715,962.00 504 448,812.00
58 HANDSCON M psg 1,188.00 200 - 200 237,600.00 200 237,600.00
59 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 -
60 MASKER KARET Pcs 700.00 503 352,100.00 800 560,000.00 1303 912,100.00 683 478,100.00
61 SILK 2/0 SET 21,875.00 125 2,734,375.00 36 787,500.00 161 3,521,875.00 22 481,250.00
62 SILK 3/0 SET 21,875.00 96 2,100,000.00 - 96 2,100,000.00 57 1,246,875.00
63 SILK 3/0 SET 21,458.33 0 - 36 772,500.02 36 772,500.02 -
TRI WULAN II 2018

64 POT SPUTUM Pcs 2,930.00 186 544,980.00 248 726,640.00 434 1,271,620.00 268 785,240.00
66 RDT DBD IGG/IGM DOS 1,562,500.00 0 - - 0 - -
67 RDT DBD NS1 DOS 2,400,000.00 0 - - 0 - -
68 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - -
69 STRIP GULA DARAH DOS 420,000.00 9.5 3,990,000.00 3 1,260,000.00 12.5 5,250,000.00 3.5 1,470,000.00
70 VAKSIN RABIES AMP 270,600.00 0 - - 0 - -
71 STRIP ASAM URAT DOS 452,000.00 1 452,000.00 15 6,780,000.00 16 7,232,000.00 3 1,356,000.00
72 KOLESTEROL STRIP DOS 319,000.00 0 - 21 6,699,000.00 21 6,699,000.00 18 5,742,000.00
BAHAN GIGI - - 0 - -
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0.1875 126,562.50
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0.1875 126,562.50
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0.1875 126,562.50
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0.1875 126,562.50
5 EUGENOL Pcs 175,000.00 1.75 306,250.00 - 1.75 306,250.00 0.5 87,500.00
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 2.75 1,787,500.00 - 2.75 1,787,500.00 0.75 487,500.00
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - -
8 CHKM 10 ML Pcs 210,000.00 3 630,000.00 - 3 630,000.00 0.25 52,500.00
9 OCCO Pcs 245,000.00 1.5 367,500.00 - 1.5 367,500.00 0.75 183,750.00
10 DYCAL Pcs 800,000.00 0.5 400,000.00 - 0.5 400,000.00 -
11 HEMOSPON Pcs 76,500.00 5 382,500.00 30 2,295,000.00 35 2,677,500.00 4 306,000.00
12 PULP-10 Pcs 495,000.00 1 495,000.00 3 1,485,000.00 4 1,980,000.00 0.25 123,750.00
14 CAVITON Btl 325,000.00 0.5 162,500.00 3 975,000.00 3.5 1,137,500.00 0.5 162,500.00
BPJS UMUM JMLH

8786 656 9442

Kepala Dinas Kesehatan An. Kepala Seksi Kefarmasian Kepala Puskesmas Petugas Puskesmas
dr. H. Husaini, M. Kes Baso Dahri,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

Nip. 196551214 199803 1 005 19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
FEB MARET
0 1
0 1 8
HAL1
SISA PERMIN
NILAI KET
STOK TAAN
14 15 16 17
2378 863,214.00
0 -
1.25 23,293.75
1000 90,000.00 EX .1380
487 56,979.00
500 115,000.00 2000
26 86,177.52
300 25,800.00
24 2,832.00
700 115,500.00
978 186,436.14 5000
0 -
4313 452,865.00
0 -
339 70,173.00 500
3796.5 884,584.50 25000
0 -
0 -
38 97,280.00 450
0 -
0 -
0 -
1864 119,296.00 4000 EX 160
0 -
51 107,406.00 250
16795.75
HAL 2
SISA PERMIN
NILAI KET
STOK TAAN
0 - Exp 10
41 137,965.00
18 86,076.00 10
38 133,076.00
63 8,505.00
100 17,900.00
7 40,600.00 100 EX.18
0 -
0 -
0 - 500 EX.302
5848 298,248.00 15000
10 1,050.00 EX.160
0 -
6576.5 670,803.00 15000
0 -
20 5,020.00
0 -
867 330,327.00
0 -
86 123,410.00 100
1162 883,120.00
0 -
0 -
400 107,600.00
10 1,540.00
1000 115,000.00 1000
0 - EX.51
0 -
7 29,993.60 20
3 5,214.00 EX. 92
20 34,800.00
1620 77,760.00 10000 EX.190
0 -
419 16,341.00 1000
14 178,486.00
10 133,840.00
18339.5
HAL 3
SISA PERMIN
NILAI KET
STOK TAAN
87 100,572.00
292 30,076.00
0 -
0 -
76 8,664.00
0 -
78 24,102.00
404 70,296.00 RSK 46
0 -
17.5 9,135.00 100
223.5 228,640.50 100
0 -
26 197,106.00 50
18.5 69,375.00
86.75 227,718.75 50
0 -
0 -
0 -
30 59,400.00
200 35,400.00
307 211,830.00
0 -
41 77,408.00 EX 116
0 - 90
0 -
332 30,212.00
0 - exp.17
479 131,246.00 400
955 292,230.00
5 20,330.00
0 -
0 -
2 1,970.00
1212 73,932.00
4872.25
hal 4 Hal 4
SISA PERMIN
NILAI KET
STOK TAAN
155 77,810.00
300 89,100.00
0 -
3514 249,318.30
0 -
0 -
62 354,640.00 EX 1
3732 1,511,460.00 7000
0 -
468 236,808.00
440 28,600.00
100 17,100.00
0 -
103 289,636.00 72
539 65,219.00
0 -
0 -
2979 467,703.00 5000
0 -
0 -
124 12,152.00 100 EX.90
0 -
0 -
547 36,649.00 5000
0 -
2263 162,936.00 1000
166 23,738.00 100
0 -
0 -
4 5,532.00 10
0 -
353 51,185.00
8 14,800.00 EX 6
0 - 36 EX 13
15857
Hal 5
SISA PERMIN
NILAI KET
STOK TAAN
13 94,900.00
0 -
0 -
26 104,000.00 20
28 7,000.00 500
200 124,322.00
57 65,835.00 500
0 -
2516.5 113,242.50 10000
70 3,500.00
166 27,390.00 500
0 - EX 5
0 -
47 104,575.00 200
0 -
728 95,368.00 2000
0 -
0 -
0 -
0 -
0 -
0 -
200 104,200.00
0 -
10 9,290.00
0 -
410 36,900.00
0 -
38 5,092.00 300
24 76,800.00
6 21,900.00
0 -
0 -
808 549,440.00
869 760,375.00 300
0 -
0 -
6216.5
HAL 6
SISA PERMIN
NILAI KET
STOK TAAN
60 510,000.00
0 -
1940 320,100.00 3000
41 34,850.00
343 40,645.50
1000 115,000.00 500
502 55,220.00
0 -
940 1,554,760.00
23 3,887.00 200
200 28,000.00
325 37,700.00 200
7 22,050.00 72
56 1,509,200.00
0 -
0 -
0 -
1504 242,144.00 3000
71.75 459,917.50 40
401 49,323.00
60 42,240.00 100
51 22,848.00 100
0 -
2 2,759,968.00 5
0 -
11 4,354,900.00
3 709,500.00
0 -
46 77,280.00 100
0 -
60 98,760.00 50 ex.20
356 78,676.00 1500
480 78,720.00
5 92,685.00
8487.75
Hal 7
SISA PERMIN
NILAI KET
STOK TAAN
1589 203,392.00
0 -
13 77,740.00 280
0 -
62 69,378.00
100 101,300.00 300
797 68,542.00
2000 102,000.00 20000
90 436,500.00 120
0 -
0 -
0 -
0 -
0 -
1945 241,180.00 5000
451 65,395.00 500 ex.250
74 7,251.26 500
0 -
37 336,700.00 100
0 -
0 -
0 - exp.29
9 202,500.00 24
0 -
59.75 216,593.75
0 - ex.911,5
2679 330,052.80 10000
0 -
0 -
1025 70,725.00
357 125,307.00 1000
3930 451,950.00 5000
0 -
14 44,100.00
0 -
0 -
15231.75
Hal 8
SISA PERMIN
NILAI KET
STOK TAAN
29 207,350.00 60
133 726,579.00
288.5 18,752.50 500
213 18,744.00 200
15 41,955.00 10
21.8 23,347.80
3 3,198.00 50
18 74,394.00 50
512 285,184.00
1000 455,000.00 3000
20 70,000.00
0 -
31 32,550.00 100
0 -
6718 369,490.00 12000
0 -
6552 1,159,704.00
1557 463,986.00 4000
0 -
0 -
55 668,525.00
5629 681,109.00
3000 1,101,000.00 18000
0 -
0 - exp.56
484 87,604.00 3000
26 8,450.00 1000
0 -
0 -
2837 258,167.00 12000
0 -
60 71,700.00 100
0 -
0 -
234 161,738.46
29436.3
Hal 9
SISA PERMIN
NILAI KET
STOK TAAN
640 323,200.00 100
0 - 50
26 8,502.00
0 - EX.110
8856 1,168,992.00 12000
0 -
750 444,000.00 500
34 224,400.00 10
-
-
927 1,149,480.00
0 -
262 381,472.00 500
138 177,606.00 300
100 123,750.00
495 643,500.00 500
0 -
141 135,783.00
100 122,375.00
81 131,422.50
119 357,000.00
68 204,000.00
58 174,000.00
51 153,000.00
230 598,000.00
90 2,498,220.00
0 -
0 -
104 925,166.32
0 -
48 1,512,000.00
10 80,000.00
9 90,000.00 20
28 224,000.00
0 -
16 70,000.00
59 236,000.00 50
47 428,781.00 50
13487
HAL 10
SISA PERMIN
NILAI KET
STOK TAAN
0 - ex.1
26 237,198.00 50
23 87,400.00 ex.2
50 456,150.00
34 129,200.00
50 456,150.00
0 -
12.25 390,775.00 10
0 -
74 143,856.00 50
14 140,000.00 50
44 38,016.00 100
93 381,672.00 100
7 59,724.00
12 1,875,600.00 10
13.5 589,950.00 20
164 974,160.00 200
0 -
7 43,659.00 200
250 1,485,000.00
0 - 200
350 415,800.00 500
673 599,306.50
304 270,712.00 500
15 45,000.00
0 -
503 352,100.00 500
125 2,734,375.00 36
96 2,100,000.00
0 -
0 -
0 -
0 -
0 -
0 -
0 -
2939.75
HAL 11
SISA PERMIN
NILAI KET
STOK TAAN
0 -
0 -
186 544,980.00 400
0 -
0 - EX 6
0 - EX 6
0 -
9.5 3,990,000.00 10
0 -
1 452,000.00 50
0 - 50
-
1 675,000.00
1 675,000.00
1 675,000.00
1 675,000.00
1.75 306,250.00 EX 3
2.75 1,787,500.00
0 -
3 630,000.00
1.5 367,500.00
0.5 400,000.00
5 382,500.00 30
1 495,000.00 3
0 -
0.5 162,500.00 3
216.5 76,877,862.45
JUNI JULI
0 2
0 1 8
HAL 1
SISA PERMIN
NILAI KET
STOK TAAN
14 16 17
2344 850,872.00
0 -
1.25 23,293.75
0 -
597 69,849.00
400 92,000.00
2000 488,000.00
26 86,177.52
242 20,812.00
0 -
691 114,015.00
2189 417,289.07
0 -
1094 114,870.00
0 -
482 99,774.00
9016 2,100,728.00 10000
0 -
0 -
0 -
235 517,000.00 300
0 -
0 -
0 -
3427 219,328.00 2000
0 -
90 189,540.00 100
HAL 2
SISA PERMIN
NILAI KET
STOK TAAN
0 -
35 117,775.00
38 181,716.00
34 119,068.00
11 1,485.00
100 17,900.00
55 319,000.00
30 82,500.00
0 -
0 -
900 134,100.00
2663 135,813.00 10000
10 1,050.00
0 -
2700 275,400.00 10000
0 -
20 5,020.00
0 -
631 240,411.00
0 -
103 147,805.00
1033 785,080.00
0 -
0 -
305 82,045.00
0 -
887 102,005.00 500
0 -
12 51,417.60 5
0 - ex.3
19 33,060.00
7221 346,608.00 2000
0 -
857 33,423.00
0 - ex 14
10 133,840.00
HAL 3
SISA PERMIN
NILAI KET
STOK TAAN
32 36,992.00 EX.55
254 26,162.00
0 -
0 -
76 8,664.00
0 -
58 17,922.00
255 44,370.00 100
95 61,845.00
0 - 100 EX.17,5
268.5 274,675.50 100
50 323,050.00
9 68,229.00 EX.6
16 60,000.00
140 367,500.00
0 -
0 -
0 -
30 59,400.00
200 35,400.00
150 103,500.00
200 159,200.00
0 - 30
39 159,237.00
200 16,800.00
276 25,116.00
300 81,900.00
58 15,892.00 500 EX.201
930 284,580.00
0 - EX.5
0 -
0 -
2 1,970.00
1221 74,481.00
HAL 4
SISA PERMIN
NILAI KET
STOK TAAN
0 - 300 EX.279
97 28,809.00
3000 210,000.00
899.5 63,819.53
0 -
0 -
42 240,240.00 5
3547 1,436,535.00 5000
0 -
931 471,086.00
136 8,840.00
100 17,100.00
95 279,110.00 48
0 -
0 -
530 64,130.00
245 32,585.00
0 -
2979 467,703.00 3000
0 -
100 9,300.00
124 12,152.00 100
0 -
3389 193,173.00 2000
0 -
0 -
1998 143,856.00
163 23,309.00 100
0 -
0 -
1 1,383.00
0 -
326 47,270.00
7 12,950.00
0 -
HAL 5
SISA PERMIN
NILAI KET
STOK TAAN
1 7,300.00 ex11
0 -
0 -
38 152,000.00
0 -
540 335,669.40
0 - 300 EX.100
0 -
7357 331,065.00 3000
70 3,500.00
0 -
440 78,760.00
0 -
126 280,350.00 100
0 -
1852.5 242,677.50
0 -
0 -
0 -
0 -
0 -
0 -
88 45,848.00 20
0 -
8 7,432.00
10 21,220.00 120
400 36,000.00
0 -
598 80,132.00
24 76,800.00
6 21,900.00
0 -
0 -
0 - EX.446
0 - EX298
0 -
1000 245,000.00 500
HAL 6
SISA PERMIN
NILAI KET
STOK TAAN
60 510,000.00
0 -
2095 345,675.00 3000
11 9,350.00
0 -
1360 156,400.00
318 34,980.00 100
0 -
1062 1,756,548.00 500
0 -
235 32,900.00 200
120 13,920.00 100
48 151,200.00 72
54 1,455,300.00
0 -
0 -
0 -
2857 459,977.00
67.75 434,277.50 40
366 45,018.00
50 35,200.00
100 85,700.00
33 14,784.00
100 62,700.00
0 -
3 4,305,540.00
0 -
8 3,311,872.00
2 473,000.00
0 -
49 180,565.00
50 180,000.00
40 65,840.00
0 -
848 139,072.00 600
0 - EX.5
HAL 7
SISA PERMIN
NILAI KET
STOK TAAN
1103 141,184.00
1000 208,000.00
61 364,780.00
0 -
222 248,418.00 100
0 -
8698.5 748,071.00 5000
0 -
2 9,700.00
0 -
0 -
0 -
0 -
0 -
3466 429,784.00 1000
100 14,500.00 EX.11
0 - 2000
346 65,567.00
91 828,100.00
0 -
0 -
22 338,492.00
0 -
0 -
51 184,875.00
0 -
7360.5 906,813.60 3000
80 27,760.00 300
0 -
739 50,991.00
55 19,305.00
4670 537,050.00 4000 EX1150
0 -
14 44,100.00
0 -
0 -
HAL 8
SISA PERMIN
NILAI KET
STOK TAAN
57 407,550.00
33 180,279.00 EX.95
881 57,265.00
115 10,120.00 EX659
16 44,752.00
0 -
44 46,904.00
44 181,852.00
0 -
1465 666,575.00 2000
20 70,000.00
85 94,945.00
9 9,450.00
0 -
12420 683,100.00
0 -
4293 759,861.00
3328 991,744.00 500
0 -
0 -
48 583,440.00
15772 1,908,412.00 6000
0 -
0 -
0 -
2433 440,373.00
26 8,450.00
0 -
0 -
5922 538,902.00 7000
0 -
100 119,500.00 EX.60
0 -
179 14,320.00 300
0 -
HAL 9
SISA PERMIN
NILAI KET
STOK TAAN
664 335,320.00 1700
0 - 200
76 24,852.00
0 -
6279 828,828.00 7000
0 -
563 333,296.00 500
9 59,400.00 50
0 -
0 -
197 244,280.00 700
0 -
523 761,488.00 300
0 -
138 170,775.00 500
688 894,400.00
0 -
94 90,522.00
100 122,375.00
72 116,820.00
106 318,000.00
62 186,000.00
52 156,000.00
45 135,000.00
228 592,800.00
51 1,415,658.00
36 1,008,000.00
56 498,166.48 100
36 1,086,768.00
48 1,512,000.00
10 80,000.00
20 200,000.00
28 224,000.00
0 -
11 48,125.00 10
2 8,000.00
50 310,937.50 20
78 711,594.00 EX.3
HAL 10
SISA PERMIN
NILAI KET
STOK TAAN
50 385,000.00
11 100,353.00
22 83,600.00
50 456,150.00
31 117,800.00
50 456,150.00
14.75 470,525.00 10
90 279,000.00
59 114,696.00
5 50,000.00
50 507,600.00
79 68,256.00
93 381,672.00 100
50 225,000.00
7 59,724.00
10 1,563,000.00 10
0 -
17 843,744.00 20
200 1,247,400.00
43 255,420.00
200 1,223,640.00
0 -
231 1,372,140.00
59 360,973.80
0 -
296 253,003.04 500
525 467,512.50 500
300 267,150.00 500
0 -
15 45,000.00
620 434,000.00 500
139 3,040,625.00 100
39 853,125.00
36 772,500.02
HAL 11
SISA PERMIN
NILAI KET
STOK TAAN
166 486,380.00
0 -
0 -
0 -
0 -
9 3,780,000.00
0 -
13 5,876,000.00
3 957,000.00 30
0 -
0.8125 548,437.50
0.8125 548,437.50
0.8125 548,437.50
0.8125 548,437.50
1.25 218,750.00
2 1,300,000.00
0 -
2.75 577,500.00
0.75 183,750.00
0.5 400,000.00
31 2,371,500.00
3.75 1,856,250.00
0 -
3 975,000.00
239.25 94,435,107.30
#REF!
s
( LPLPO )

PUSKESMAS : Benteng
KECAMATAN : Benteng BULAN 1
KABUPATEN : Kepulauan Selayar TRI WULAN 0
PROPINSI : Sulawesi Selatan TAHUN 2 0
BULAN 12
NO SAT/K STOK PENERI PERSE PEMA SISA
KODE OBAT NAMA OBAT HARGA NILAI NILAI NILAI NILAI
MSN AWAL
URUT MAAN DIAAN KAIAN STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 21.01.01.4154.02 ALBENDAZOL TABLET 400 MG Tab 363.00 2438 884,994.00 - 2438 884,994.00 10 3,630.00 2428
2 21.01.01.4154.03 ALBENDAZOL SIRUP Btl 4,234.00 0 - - 0 - - 0
3 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 3.5 65,222.50 - 3.5 65,222.50 0 - 3.5
4 07.01.02.5044.01 ALOPURINOL TABLET 100 MG Tab 90.00 3688 331,920.00 - 3688 331,920.00 482 43,380.00 3206
5 07.01.02.5044.02 ALOPURINOL TABLET 300 MG Tab 224.50 0 - - 0 - - 0
6 22.01.01.5159.01 AMINOFILIN INJEKSI 24 MG/ML Amp 3,314.52 26 86,177.52 - 26 86,177.52 - 26
7 22.01.01.5159.03 AMINOFILIN TABLET 200 MG Tab 86.00 394 33,884.00 - 394 33,884.00 22 1,892.00 372
8 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 24 2,832.00 - 24 2,832.00 - 24
9 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 700 115,500.00 - 700 115,500.00 - 700
10 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 4596.5 876,230.80 - 4596.5 876,230.80 610.5 116,379.62 3986
11 22.01.01.5158.02 AMBROKSOL SIRUP Btl 2,722.00 0 - - 0 - - 0
12 AMLODIPIN 5 MG Tab 105.00 3728 391,440.00 - 3728 391,440.00 647 67,935.00 3081
13 01.01.04.5100.01 AMOKSISILIN KAPSUL 250 MG Kap 220.00 0 - - 0 - - 0
14 AMOKSISILIN KAPSUL 250 MG Kap 207.00 420 86,940.00 - 420 86,940.00 - 420
15 AMOKSISILLIN KAPLET 500 MG Kap 233.00 10640 2,479,120.00 - 10640 2,479,120.00 5936 1,383,088.00 4704
16 01.01.04.5100.02 AMOKSISILIN KAPLET 500 MG/RAMOXYL Kap 608.00 0 - - 0 - - 0
17 01.01.04.5100.03 AMOKSISILIN VIAL 1 G Vial 8,135.00 0 - - 0 - - 0
18 01.01.04.5100.04 AMOKSISILIN SIROP KERING 125 Btl 2,560.00 182 465,920.00 - 182 465,920.00 94 240,640.00 88
19 01.01.04.5131.02 AMPICILIN SERBUK INJ 1 G Vial 5,905 0 - - 0 - - 0
20 01.01.04.5131.05 AMPICILIN KAPLET 250 MG Kap 0 - - 0 - - 0
21 01.01.04.5131.06 AMPICILIN KAPLET 500 MG Kap 419.10 0 - - 0 - 0
22 ANTASIDA DOEN TABLET KUNYAH Tab 64.00 2845 182,080.00 - 2845 182,080.00 1082 69,248.00 1763
23 ANTASIDA DOEN TABLET KUNYAH Tab 78.00 0 - 1000 78,000.00 1000 78,000.00 - 1000
24 15.01.01.5334.02 ANTASIDA DOEN II SUSPENSI Btl 2,106.00 78 164,268.00 50 105,300.00 128 269,568.00 36 75,816.00 92
BULAN 12
URUT MSN AWAL MAAN DIAAN KAIAN STOK
25 01.01.00.5335.01 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 2,767.00 27 74,709.00 - 27 74,709.00 3 8,301.00 24
26 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 50 168,250.00 - 50 168,250.00 0 - 50
27 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 23.3 111,420.60 - 23.3 111,420.60 3.5 16,737.00 19.8
28 12.05.01.5340.01 ANTIHEMOROID DOEN KOMBINASI Pot 3,502.00 38 133,076.00 - 38 133,076.00 0 - 38
29 10.02.01.5338.01 ANTIMIGREN Tab 135.00 169 22,815.00 - 169 22,815.00 24 3,240.00 145
30 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 44 255,200.00 - 44 255,200.00 5 29,000.00 39
31 22.01.01.5163.01 ARTESUNATE INJEKSI VIAL 60 MG Amp 0 - - 0 - 0 - 0
32 ARTESUNATE DEWASA Tab 0 - - 0 - 0 - 0
33 07.01.02.5041.01 ASAM ASETIL SALISILAT 100 MG Tab 127.00 433 54,991.00 - 433 54,991.00 50 6,350.00 383
34 ASAM ASKORBAT (VIT C) 25 MG 51.00 3020 154,020.00 5000 255,000.00 8020 409,020.00 3244 165,444.00 4776
35 05.03.07.5164.02 ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 520 54,600.00 - 520 54,600.00 220 23,100.00 300
36 22.01.01.5166.02 AS.MEFENAMAT TABLET SALUT 500 MG Tab 113.00 2515 284,195.00 - 2515 284,195.00 2515 284,195.00 0
37 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 0 - 4000 408,000.00 4000 408,000.00 1006.5 102,663.00 2993.5
38 22.01.01.5168.01 ASIKLOVIR KRIM 5 % Tube 2,367.00 0 - - 0 - 0 - 0
39 22.01.01.5168.02 ASIKLOVIR TABLET 200 MG Tab 251.00 20 5,020.00 - 20 5,020.00 0 - 20
40 ASIKLOVIR TABLET 400 MG Tab 362.00 0 - - 0 - 0 - 0
41 22.01.01.5168.03 ASIKLOVIR TABLET 400 MG Tab 381.00 1037 395,097.00 - 1037 395,097.00 70 26,670.00 967
42 07.07.02.5049.04 ATROPIN TETES MATA 0.5 % Btl 0 - - 0 - 0 - 0
43 22.01.01.5172.01 BETAMETASON KRIM 0,1 % Tube 1,435.00 154 220,990.00 - 154 220,990.00 32 45,920.00 122
44 BETAHISTIN MESILAT TAB 6 MG/HISTIGO TAB 760.00 1293 982,680.00 - 1293 982,680.00 33 25,080.00 1260
45 BISAKODIL SUPPOSITORIA SUPP 6,045.00 0 - - 0 - 0 - 0
46 BISOPROLOL FUMARATE Tab 695.00 0 - - 0 - 0 - 0
47 CARBAMAZEPIN TAB 200 MG Tab 269.00 457 122,933.00 - 457 122,933.00 0 - 457
48 CETIRIZINE TAB Tab 154.00 1977 304,458.00 - 1977 304,458.00 581 89,474.00 1396
49 CETIRIZINE SIRUP Btl 7,756.00 60 465,360.00 - 60 465,360.00 0 - 60
50 CLOBAZAM TAB 10 MG Tab 1,045.00 0 - - 0 - 0 - 0
51 CURCUMA TAB Tab 1,150.00 0 - - 0 - 0 - 0
52 22.01.01.5176.01 DEKSAMETASON INJ 5 MG/ML Amp 1,738.00 95 165,110.00 - 95 165,110.00 0 - 95
53 DEKSAMETASON TAB Tab 48.00 4835 232,080.00 - 4835 232,080.00 1624 77,952.00 3211
54 22.01.01.5179.01 DIAZEPAM INJ 2 MG/ML Amp 2,605 0 - - 0 - 0 - 0
55 22.01.01.5179.02 DIAZEPAM TABLET 2 MG Tab 39.00 246 9,594.00 - 246 9,594.00 140 5,460.00 106
56 DIAZEPAM RECTAL Tube 12,749.00 4 50,996.00 20 254,980.00 24 305,976.00 10 127,490.00 14
57 22.01.01.5179.03 DIAZEPAM TABLET 5 MG Tab 65.00 0 - - 0 - 0 - 0
BULAN 12
MSN AWAL
URUT MAAN DIAAN KAIAN STOK
58 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 0 - 87

59 22.01.01.5181.01 DIGOKSIN TABLET 0,25 MG Tab 103.00 311 32,033.00 - 311 32,033.00 3 309.00 308
60 22.01.01.5182.01 DILTIAZEM TAB 30 MG Tab 141.00 0 - - 0 - 0 - 0
61 22.01.01.5183.01 DIMENHIDRINAT TAB 50 MG Tab 109.00 11 1,199.00 - 11 1,199.00 11 1,199.00 0
62 DIMENHIDRINAT TAB 50 MG Tab 114.00 0 - 100 11,400.00 100 11,400.00 0 - 100
63 22.01.01.5181.02 DOMPORIDON SIRUP Btl 3,490.00 0 - - 0 - 0 - 0
64 22.01.01.5185.01 DOKSISIKLIN KAPSUL 100 MG Kap 309.00 88 27,192.00 - 88 27,192.00 0 - 88
65 22.01.01.5186.01 DOMPERIDON TABLET 10 MG Tab 174.00 804 139,896.00 - 804 139,896.00 38 6,612.00 766
66 22.01.01.5188.01 EKSTRAK BELLADONA TABLET 10 MG Tab 42.00 0 - - 0 - 0 - 0
67 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 87 45,414.00 - 87 45,414.00 26 13,572.00 61
68 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 413.5 423,010.50 - 413.5 423,010.50 32 32,736.00 381.5
69 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 8,090.00 0 - - 0 - 0 - 0
70 ERITROMISIN SIROP 200 MG/ 5 ML Btl 7,581.00 48 363,888.00 - 48 363,888.00 0 - 48
71 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300Btl 3,750.00 23 86,250.00 - 23 86,250.00 1 3,750.00 22
72 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 62 162,750.00 - 62 162,750.00 25 65,625.00 37
73 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - 0 - 0
74 ETHYLIS CHLORIDUM SEMPROT Btl 81,400.00 0 - - 0 - 0 - 0
75 20.02.01.5261.01 EUGENOL CAIRAN Btl 18,333.00 0 - - 0 - 0 - 0
76 07.02.01.5051.03 FENOBARBITAL AMPUL 2 ML Btl 1,980 0 - 30 59,400.00 30 59,400.00 0 - 30
77 07.02.01.5051.01 FENOBARBITAL TABLET 30 MG Tab 177.00 0 - 200 35,400.00 200 35,400.00 0 - 200
78 05.03.13.5196.01 FITOMENADION (VIT K) TABLET 10 MG Tab 690.00 385 265,650.00 - 385 265,650.00 16 11,040.00 369
79 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 0 - - 0 - 0 - 0
80 05.03.13.5196.02 FITOMENADION (VIT K) INJ 10 MG/ML Amp 1,888.00 155 292,640.00 - 155 292,640.00 0 - 155
81 FUROSEMIDA TABLET 40 MG Tab 84.00 0 - - 0 - 0 - 0
82 16.02.01.3523.02 FUROSEMIDA TABLET 40 MG Tab 91.00 484 44,044.00 - 484 44,044.00 20 1,820.00 464
83 15.03.01.5200.01 GARAM ORALIT I SERBUK Sac 322.00 495 159,390.00 - 495 159,390.00 115 37,030.00 380
84 GARAM ORALIT I SERBUK Sac 274.00 0 - - 0 - 0 - 0
85 22.01.01.5201.01 GEMFIBROZIL KAPSUL 300 MG Kap 306.00 975 298,350.00 - 975 298,350.00 0 - 975
86 17.09.01.5202.01 GENTAMISIN INJ 80 MG/ML Amp 4,066 5 20,330.00 - 5 20,330.00 0 - 5
87 17.09.01.5202.02 GENTAMISIN SALEP KULIT Pot 1,469.00 0 - - 0 - 0 - 0
88 17.09.01.5202.03 GENTAMISIN SULFAT TETES MATA 0,3 % Pot 3,513.00 0 - - 0 - 0 - 0
89 22.01.01.5203.01 GENTIAN VIOLET 1 % Btl 985.00 2 1,970.00 - 2 1,970.00 0 - 2
90 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 61.00 2192 133,712.00 - 2192 133,712.00 139 8,479.00 2053
BULAN 12
91 GLIMEPIRIDE 2 MG Tab 502.00 167 83,834.00 - 167 83,834.00 0 - 167
93 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 30.69 2315.5 71,062.70 - 2315.5 71,062.70 582.5 17,876.93 1733
94 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 5000 354,750.00 - 5000 354,750.00 0 - 5000
95 04.02.01.5208.01 GLUKOSA LARUTAN INFUS 10 % Btl 6,270.00 0 - - 0 - 0 - 0
96 04.02.01.5208.02 GLUKOSA LARUTAN INFUS 40 % Btl 1,597.00 0 - - 0 - 0 - 0
97 04.02.01.5208.03 GLUKOSA LARUTAN INFUS 5 % Btl 5,720.00 79 451,880.00 - 79 451,880.00 3 17,160.00 76
98 GRANTUSIF Tab 405.00 6267 2,538,135.00 - 6267 2,538,135.00 1880 761,400.00 4387
99 22.01.01.5209.02 GRISEOFULVIN TABLET 125 MG Tab 241.00 660 159,060.00 - 660 159,060.00 96 23,136.00 564
100 GRISEOFULVIN TABLET 125 MG Tab 506.00 0 - - 0 - 0 - 0
101 22.01.01.5210.01 HALOPERIDOL TABLET 1.5 MG Tab 65.00 0 - 500 32,500.00 500 32,500.00 0 - 500
102 12.01.01.5089.01 HIDROKLOROTIAZIDA TABLET 25 MG Tab 171.00 0 - 100 17,100.00 100 17,100.00 0 - 100
103 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,938.00 125 367,250.00 - 125 367,250.00 28 82,264.00 97
104 HYOSIN BUTIL BROMIDA TAB 10 MG Tab 330.00 0 - - 0 - 0 - 0
105 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 738 89,298.00 - 738 89,298.00 0 - 738
106 IBUPROFEN TABLET 400 MG Tab 133.00 2041 271,453.00 - 2041 271,453.00 1516 201,628.00 525
107 IBUPROFEN TABLET 400 MG Tab 227.00 0 - 3000 681,000.00 3000 681,000.00 0 - 3000
108 IBUPROFEN SIRUP 15 MG/ML Btl 106.70 0 - - 0 - 0 - 0
109 22.01.01.5214.02 ISONIAZID TABLET 300 MG Tab 106.70 0 - - 0 - 0 - 0
110 22.01.01.5215.01 ISOSORBID DINITRAT TABLET 5 MG Tab 98.00 240 23,520.00 - 240 23,520.00 0 - 240
111 KALIUM DIKLOFENAK TAB 50 MG Tab 425.00 0 - - 0 - 0 - 0
112 KALSIUM GLUCONAS INJ Amp 10,437 0 - - 0 - 0 - 0
113 KALSIUM LAKTAT TABLET 500 MG/KALEN Tab 67.00 2815 188,605.00 - 2815 188,605.00 1117 74,839.00 1698
114 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - 0 - 0
115 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 4162 299,664.00 - 4162 299,664.00 488 35,136.00 3674
116 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 342 48,906.00 - 342 48,906.00 0 - 342
117 KETOKENAZOL TAB 200 MG Tab 320.00 0 - - 0 - 0 - 0
118 KETOKENAZOL KRIM Tube 3,135.00 0 - - 0 - 0 - 0
119 KETOROLAC INJ Amp 1,383.00 8 11,064.00 - 8 11,064.00 1 1,383.00 7
120 22.01.01.5224.01 KLONIDIN TABLET 0.15 MG Tab 224.00 0 - - 0 - 0 - 0
121 KLONIDIN TABLET 0.15 MG Tab 145.00 372 53,940.00 - 372 53,940.00 0 - 372
122 01.01.02.5225.02 KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 18 33,300.00 - 18 33,300.00 0 - 18
123 01.01.02.5225.05 KLORAMFENIKOL TETES TELINGA 3 % Tube 1,759.00 13 22,867.00 - 13 22,867.00 1 1,759.00 12
BULAN 12
124 KLORAMFENIKOL TETES TELINGA 3 % Tube 7,300.00 24 175,200.00 - 24 175,200.00 0 - 24
125 01.01.02.5225.04 KLORAMFENIKOL TETES MATA 0.5 % Tube 0 - - 0 - 0 - 0
126 01.01.02.5225.03 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,016.00 2 8,032.00 - 2 8,032.00 2 8,032.00 0
127 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,000.00 50 200,000.00 - 50 200,000.00 5 20,000.00 45
128 01.01.02.5225.01 KLORAMFENIKOL KAPSUL 250 MG Kap 250.00 334 83,500.00 - 334 83,500.00 18 4,500.00 316
129 KLORAMFENIKOL KAPSUL 500 MG Kap 1,155.00 179 206,745.00 - 179 206,745.00 85 98,175.00 94
130 22.01.01.5226.01 KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 7842.5 423,495.00 - 7842.5 423,495.00 2183.5 117,909.00 5659
131 KLORPROMAZIN TAB SALUT 25 MG Tab 50.00 155 7,750.00 - 155 7,750.00 47 2,350.00 108
132 22.01.01.5228.04 KLORPROMAZIN TAB SALUT 100 MG Tab 165.00 500 82,500.00 - 500 82,500.00 34 5,610.00 466
133 01.06.01.5142.03 KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 36 82,728.00 - 36 82,728.00 30 68,940.00 6
134 KOTRIMOKSAZOL SUSPENSI Btl 2,462.00 0 - 150 369,300.00 150 369,300.00 0 - 150
135 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 152.00 1403 213,256.00 - 1403 213,256.00 456 69,312.00 947
136 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 131.00 0 - 1000 131,000.00 1000 131,000.00 0 - 1000
137 01.06.01.5142.01 KOTRIMOKSAZOL DOEN II (ANAK) Tab 79.00 0 - - 0 - 0 - 0
138 19.02.01.5068.02 KUINIDIN 100 MG TABLET Tab 0 - - 0 - 0 - 0
139 19.02.01.5068.01 KUINIDIN 200 MG TABLET Tab 0 - - 0 - 0 - 0
140 01.02.01.5231.01 KUININ (KINA) TABLET 200 MG Tab 0 - - 0 - 0 - 0
141 01.02.01.5231.03 KUININ INJEKSI 25 % Tab 0 - - 0 - 0 - 0
142 01.02.01.5231.04 KUININ SULFAT TAB 222 MG (7 H2O) Tab 641.67 0 - - 0 - 0 - 0
143 LANSOPRAZOL 30 MG KAP 521.00 20 10,420.00 - 20 10,420.00 15 7,815.00 5
144 LANSOPRAZOL SIRUP Btl 0 - - 0 - 0 - 0
145 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 29 26,941.00 - 29 26,941.00 3 2,787.00 26
146 22.01.01.5237.01 LISOL DENGAN KRESOL SABUN 50 % Btl 31,800.00 0 - - 0 - 0 - 0
147 LOPERAMIDE Tab 90.00 420 37,800.00 - 420 37,800.00 0 - 420
148 LORATADIN TAB Tab 170.00 331 56,270.00 - 331 56,270.00 79 13,430.00 252
149 MgSO4 20% Btl 1,694 0 - - 0 - 0 - 0
150 MgSO4 40% Btl 2,143 0 - - 0 - 0 - 0
151 22.01.01.5240.01 MEBENDAZOL SIROP 100 MG/ 5 ML Btl 0 - - 0 - 0 - 0
152 22.01.01.5240.02 MEBENDAZOL TABLET 100 MG Tab 0 - - 0 - 0 - 0
153 MELOXICAM 7,5 mg Tab 680 394 267,920.00 - 394 267,920.00 198 134,640.00 196
154 MELOXICAM 15 mg Tab 875 267 233,625.00 1000 875,000.00 1267 1,108,625.00 298 260,750.00 969
155 07.01.02.5043.01 METAMPIRON TABLET 500 MG (ANTALGINTab 141.85 0 - - 0 - 0 - 0
156 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 Tab 133.10 0 - - 0 - 0 - 0
BULAN 12
157 22.01.01.5245.02 METILERGOMETRIN MALEAT INJ 0.2 MG Amp 8,500.00 60 510,000.00 - 60 510,000.00 0 - 60
158 METILPREDNISOLON TAB 4 MG Tab 200.00 3935 787,000.00 - 3935 787,000.00 1240 248,000.00 2695
159 METILPREDNISOLON TAB16 MG Tab 850.00 41 34,850.00 - 41 34,850.00 0 - 41
160 METFORMIN TAB 500 MG Tab 118.50 1011 119,803.50 - 1011 119,803.50 66 7,821.00 945
161 22.01.01.5246.04 METFORMIN TAB 850 MG Tab 240.00 0 - - 0 - 0 - 0
162 METOKLOPRAMIDE TAB 10 MG TAB 110.00 678 74,580.00 - 678 74,580.00 78 8,580.00 600
163 METOKLOPRAMIDE TAB 10 MG TAB 100.00 0 - - 0 0 - 0
164 22.01.01.5246.01 MULTIVITAMIN TAB Tab 0 - - 0 - 0 - 0
165 22.01.01.5247.02 METRONIDAZOL TABLET 500 MG Tab 169.00 351 59,319.00 - 351 59,319.00 99 16,731.00 252
167 MIKONAZOLE KREAM Tube 3,150.00 68 214,200.00 - 68 214,200.00 21 66,150.00 47
168 MIKONAZOLE POWDER POT 26,950.00 57 1,536,150.00 - 57 1,536,150.00 1 26,950.00 56
169 MINERAL MIX Bks 2,723 0 - - 0 - 0 - 0
170 05.03.02.5250.02 NATRIUM DKLOFENAK TABLET 25 MG Tab 0 - - 0 - 0 - 0
171 05.03.02.5250.01 NATRIUM DKLOFENAK TABLET 50 MG Tab 193.00 0 - - 0 - 0 - 0
172 NA. DIKLOFENAK 50 MG/DIK.SODIUM Tab 161.00 969 156,009.00 - 969 156,009.00 473 76,153.00 496
173 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 %Btl 6,410.00 69 442,290.00 40 256,400.00 110.5 708,305.00 15 96,150.00 95.5
174 NIPEDIFINE TAB 10 MG Tab 123.00 571 70,233.00 - 571 70,233.00 0 - 571
175 NISTATIN 500.000 IU Tab 704.00 80 56,320.00 - 80 56,320.00 0 - 80
176 NISTATIN 100.000 IU Tab 448.00 60 26,880.00 - 60 26,880.00 0 - 60
177 15.05.01.5258.05 OBAT ANTITUBERKULOSIS SISIPAN DEWASTab 175,980 0 - - 0 - 0 - 0
178 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 0 - 3 4,139,952.00 3 4,139,952.00 0 - 3
179 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 413,984 4 1,655,936.00 - 4 1,655,936.00 4 1,655,936.00 0
180 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 0 - 16 6,334,400.00 16 6,334,400.00 1 395,900.00 15
181 15.05.01.5258.04 OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 1 236,500.00 3 709,500.00 4 946,000.00 0 - 4
182 14.02.01.5259.01 OBAT BATUK HITAM CAIRAN Btl 1,339.80 0 - - 0 - 0 - 0
183 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 1,680.00 94 157,920.00 - 94 157,920.00 3 5,040.00 91
184 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,630.00 0 - - 0 - 0 -
185 OKSITETRASIKLIN HCL SALEP 3 % Tube 1,646.00 116 190,936.00 - 116 190,936.00 2 3,292.00 114
187 OMEPRAZOL Kap 221.00 576 127,296.00 600 132,600.00 1176 259,896.00 494 109,174.00 682
188 OMEPRAZOL Kap 164.00 0 - - 0 - - 0
189 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 0 - 5
BULAN 12
190 22.01.01.5273.02 PAPAVERIN TABLET 40 MG Tab 128.00 2560 327,680.00 - 2560 327,680.00 221 28,288.00 2339
191 PAPAVERIN TABLET 40 MG Tab 208.78 0 - - 0 - 0 - 0
192 PARASETAMOLDROPS Btl 5,980.00 50 299,000.00 112 669,760.00 162 968,760.00 105 627,900.00 57
193 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,535.00 193 296,255.00 - 193 296,255.00 59 90,565.00 134
194 14.04.01.5275.02 PARASETAMOL TABLET 100 MG Tab 0 - - 0 - 0 - 0
195 PARASETAMOL TABLET 500 MG Tab 86.00 14837 1,275,982.00 - 14837 1,275,982.00 4588 394,568.00 10249
196 PENOL GLISEROL TETES TELINGA Btl 2,246.00 0 - - 0 - 0 - 0
197 PEHACAIN INJ Amp 4,850.00 127 615,950.00 - 127 615,950.00 15 72,750.00 112
198 PENISILLIN PROKAIN INJ Vial 6,618.00 0 - - 0 - 0 - 0
199 22.01.01.5278.01 PIRANTEL TABLET SCORE 125 MG Tab 318.00 0 - - 0 - 0 - 0
200 22.01.01.5278.02 PIRANTEL SIRUP btl 9,100.00 0 - - 0 - 0 - 0
201 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - 0 - 0
202 PIRASETAM 1200 Tab 854.00 0 - - 0 - 0 - 0
203 05.03.06.5280.01 PIRIDOKSIN (VIT B6) TAB 10 MG Tab 124.00 1844 228,656.00 3000 372,000.00 4844 600,656.00 1270 157,480.00 3574
204 22.01.01.5281.01 PIROKSIKAM TABLET 10 MG Tab 145.00 1094 158,630.00 - 1094 158,630.00 70 10,150.00 1024
205 PIROKSIKAM TABLET 20 MG Tab 97.99 363 35,570.37 - 363 35,570.37 120 11,758.80 243
206 22.01.01.5281.02 PIROKSIKAM TABLET 20 MG Tab 189.50 0 - - 0 - 0 - 0
207 16.03.01.3543.01 PITOGIN AMPUL 1 ML Amp 9,100.00 97 882,700.00 - 97 882,700.00 8 72,800.00 89
208 POLIDEMICIN TETES MATA 0 - - 0 - 0 - 0
209 22.01.01.5283.01 POVIDON IODIDA 10 % 1000 ML Btl 40,202.00 1 40,202.00 - 1 40,202.00 0 - 1
210 22.01.01.5283.02 POVIDON IODIDA 10 % 300 ML Btl 15,386.00 39 600,054.00 - 39 600,054.00 4 61,544.00 35
212 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 20 72,500.00 - 20 72,500.00 1 3,625.00 19
213 PREDNISON TABLET 5 MG Tab 125.00 4971 621,375.00 - 4971 621,375.00 1301.5 162,687.50 3669.5
214 22.01.01.5285.01 PRIMAKUIN TABLET 15 MG Tab 0 - - 0 - 0 - 0
215 22.01.01.5288.01 PROPANOLOL TABLET 40 MG Tab 119.00 144 17,136.00 - 144 17,136.00 10 1,190.00 134
216 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 80.00 0 - - 0 - 0 - 0
217 22.01.01.5289.01 PROPILITIOURASIL TABLET 100 MG Tab 351.00 688 241,488.00 - 688 241,488.00 38 13,338.00 650
218 RANITIDIN TABLET 150 MG Tab 115.00 8675 997,625.00 - 8675 997,625.00 1155 132,825.00 7520
219 15.01.01.3184.02 RANITIDIN INJ 25 MG / 2 ML Amp 1,600.00 0 - - 0 - 0 - 0
220 RANITIDIN INJ 25 MG / 2 ML Amp 3,150.00 14 44,100.00 - 14 44,100.00 0 - 14
221 REAGEN PEWARNA Pkt 270,000.00 0 - - 0 - 0 - 0
222 REAGENSIA ZN Pkt 276,600.00 11 3,042,600.00 - 11 3,042,600.00 0 - 11
BULAN 12
223 22.01.01.5293.01 RINGER LAKTAT INFUS Btl 7,150.00 88 629,200.00 - 88 629,200.00 9 64,350.00 79
224 SALBUTAMOL SYRUP 2 MG Btl 5,463.00 148 808,524.00 - 148 808,524.00 6 32,778.00 142
225 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 65.00 778 50,570.00 - 778 50,570.00 151 9,815.00 627
227 SALEP 2-4 KOMBINASI Tube 2,797.00 39 109,083.00 - 39 109,083.00 3 8,391.00 36
228 SALISIL BEDAK 2 % Pot 1,071.00 0 - 20 21,420.00 20 21,420.00 0 - 20
229 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 25 26,650.00 - 25 26,650.00 10.2 10,873.20 14.8
230 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 Btl 4,133.00 0 - 48 198,384.00 48 198,384.00 9 37,197.00 39
231 SEFADROKSIL KAPSUL 500 MG Kap 557.00 1274 709,618.00 2000 1,114,000.00 3274 1,823,618.00 832 463,424.00 2442
232 22.01.01.5300.01 SEFOTAKSIM 1000 MG Tab 3,500.00 20 70,000.00 - 20 70,000.00 0 - 20
233 22.01.01.5301.01 SEFTRIAKSON SERBUK INJ 1000 MG Pot 2,578.00 0 - - 0 - 0 - 0
234 SIANOKOBALAMIN VIT B12 INJ 500 (PLAC Amp 1,050.00 93 97,650.00 - 93 10 10,500.00 83
235 22.01.01.5306.03 SIANOKOBALAMIN TABLET 50 MCG Tab 15.00 7276 109,140.00 - 7276 109,140.00 2262 33,930.00 5014
236 22.01.01.5310.01 SIMVASTATIN TABLET 10 MG Tab 135.00 0 - - 0 - - 0
237 SIMVASTATIN TABLET 10 MG Tab 177.00 8923 1,579,371.00 - 8923 1,579,371.00 472 83,544.00 8451
238 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 2899 863,902.00 - 2899 863,902.00 327 97,446.00 2572
239 01.06.01.5151.01 SULFADIMIDINE TABLET 500 MG Tab 0 - - 0 - 0 - 0
240 22.01.01.5316.01 SULFASETAMIDA NATRIUM TETES MATA 1Pot 3,549.00 0 - - 0 - 0 - 0
241 SCABIMITE CREAM Tube 12,155.00 58 704,990.00 - 58 704,990.00 0 - 58
242 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 14797 1,790,437.00 - 14797 1,790,437.00 4055 490,655.00 10742
243 TABLET TAMBAH DARAH (FONDAZEN) Tab 449.00 0 - - 0 - 0 - 0
244 TABLET TAMBAH DARAH (HUFABION) Tab 405.00 0 - - 0 - 0 - 0
245 01.01.06.5321.01 TETRASIKLIN KAPSUL 250 MG Kap 162.00 474 76,788.00 - 474 76,788.00 469 75,978.00 5
246 TETRASIKLIN KAPSUL 250 MG Kap 181.00 0 - 2000 362,000.00 2000 362,000.00 0 - 2000
248 22.01.01.5322.02 TIAMFENIKOL KAPSUL 500 MG Kap 440.00 0 - - 0 - 0 - 0
249 05.03.05.5323.01 TIAMIN (VIT B1) INJ 100 MG/ML Amp 730.00 0 - - 0 - 0 - 0
250 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 7492 681,772.00 - 7492 681,772.00 3120 283,920.00 4372
251 TIURAZOL 5 mg TAB Tab 563.00 0 - - 0 - 0 - 0
252 TIURAZOL 10 mg TAB Tab 1,195.00 105 125,475.00 - 105 125,475.00 30 35,850.00 75
253 TRAMADOL KAPS Tab 196.35 0 - - 0 - 0 - 0
254 TRAMADOL INJ Tab 6,000.00 0 - - 0 - 0 - 0
255 TRIHEKSIFENIDIL 25 MG TAB/ARKINE Tab 691.19 321 221,871.99 - 321 221,871.99 42 29,029.98 279
BULAN 12
256 VIT A MERAH kap 505.00 426 215,130.00 - 426 215,130.00 16 8,080.00 410
257 VIT A BIRU kap 286.00 265 75,790.00 - 265 75,790.00 0 - 265
258 05.03.06.5332.01 VITAMIN B KOMPLEKS TABLET Tab 112.00 5100 571,200.00 - 5100 571,200.00 1487 166,544.00 3613
259 VITAMIN B KOMPLEKS TABLET Tab 132.00 0 - 2000 264,000.00 2000 264,000.00 2000 264,000.00 0
260 19.07.01.4128.01 ZIN TAB Tab 521.00 640 333,440.00 - 640 333,440.00 145 75,545.00 495
261 ZIN SIRUP Btl 6,600.00 9 59,400.00 24 158,400.00 33 217,800.00 6 39,600.00 27
0 - 0
PERBEKALAN KESEHATAN 0 - 0
1 ALAT SUNTIK SEKALI PAKAI 0,5 ML Set 1,240.00 2153 2,669,720.00 - 2153 2,669,720.00 242 300,080.00 1911
2 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 2,530.813 117 296,105.12 - 117 296,105.12 34 86,047.64 83
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 0 - 300 436,800.00 300 436,800.00 0 - 300
4 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,287.00 346 445,302.00 - 346 445,302.00 83 106,821.00 263
5 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 1,300.00 843 1,095,900.00 - 843 1,095,900.00 104 135,200.00 739
6 ALAT SUNTIK SEKALI PAKAI 5 ML Set 750.00 0 - - 0 - 0 - 0
7 ALAT SUNTIK SEKALI PAKAI 5 ML Set 963.00 229 220,527.00 - 229 220,527.00 16 15,408.00 213
8 ALAT SUNTIK SEKALI PAKAI 10 ML Set 1,622.50 92 149,270.00 - 92 149,270.00 0 - 92
9 BISTURI NO. 19 Bh 3,000 130 390,000.00 - 130 390,000.00 2 6,000.00 128
10 BISTURI NO.20 Bh 3,000 85 255,000.00 - 85 255,000.00 8 24,000.00 77
11 BISTURI NO.21 Bh 3,000 72 216,000.00 - 72 216,000.00 7 21,000.00 65
12 BISTURI NO.23 Bh 3,000 67 201,000.00 - 67 201,000.00 0 - 67
13 JARUM HECTING Bh 2,600 238 618,800.00 - 238 618,800.00 8 20,800.00 230
14 CATGUT NO 2/0 Pcs 27,758.00 117 3,247,686.00 - 117 3,247,686.00 17 471,886.00 100
15 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - 0 - 0
16 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - 0 - 0
17 CATGUT NO 3/0 Pcs 8,895.83 138 1,227,624.54 - 138 1,227,624.54 15 133,437.45 123
18 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - 0 - 0
19 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 0 - 48
20 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 0 - 10
21 FOLEY CATETER 18 Bh 10,000.00 13 130,000.00 - 13 130,000.00 2 20,000.00 11
22 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 0 - 28
23 HIV TEST Set 0 - - 0 - 0 - 0
24 INFUSION SET ANAK SET 4,375.00 16 70,000.00 - 16 70,000.00 0 - 16
25 INFUSION SET DEWASA Set 4,000.00 111 444,000.00 - 111 444,000.00 11 44,000.00 100
26 IV CATHETER NO 18 G Set 9,123.00 53 483,519.00 - 53 483,519.00 0 - 53
27 IV CATHETER NO 20 G Set 3,800.00 19 72,200.00 - 19 72,200.00 8 30,400.00 11
33 KAPAS PEMBALUT / ABSORBEN 250 GRA Set 11,400.00 2 22,800.00 - 2 22,800.00 2 22,800.00 0
34 KAPAS PEMBALUT / ABSORBEN 250 GRA Set 31,900.00 10.5 334,950.00 - 10.5 334,950.00 0.5 15,950.00 10
35 KASA KOMPRES 40/40 STERIL Bks 1,679.51 18 30,231.18 - 18 30,231.18 17 28,551.67 1
36 KASA KOMPRES 40/40 STERIL Bks 1,944.00 0 - 100 194,400.00 100 194,400.00 0 - 100
37 KASA PEMBALUT 2 M X 80 CM Bks 10,000.00 28 280,000.00 - 28 280,000.00 4 40,000.00 24
38 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASBks 864.00 73 63,072.00 - 73 63,072.00 10 8,640.00 63
39 KASA PEMBALUT HIDROFIL 4 X 15 CM ELABks 4,104.00 242 993,168.00 - 242 993,168.00 28 114,912.00 214
40 KASA PEMBALUT HIDROFIL 16 M X 16 CMBks 8,532.00 10 85,320.00 - 10 85,320.00 0 - 10
41 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 14 2,188,200.00 0 - 14 2,188,200.00 4 625,200.00 10
42 PLESTER YARD Roll 43,700.00 23 1,005,100.00 - 23 1,005,100.00 9 393,300.00 14
43 HANDSCON 7 STERIL Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 0 - 250
44 HANDSCON 7 STERIL Bks 6,237.00 122 760,914.00 - 122 760,914.00 72 449,064.00 50
45 HANDSCON 71/2 Bks 6,237.00 109 679,833.00 - 109 679,833.00 34 212,058.00 75
46 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 0 - 250
47 HANDSCON 8 Bks 3,960.00 0 - - 0 - 0 - 0
48 HANDSCON S Pcs 1,188.00 500 594,000.00 - 500 594,000.00 100 118,800.00 400
49 HANDSCON L Pcs 890.50 600 534,300.00 - 600 534,300.00 91 81,035.50 509
50 HANDSCON M Pcs 890.50 480 427,440.00 - 480 427,440.00 250 222,625.00 230
51 URINE BAG BH 3,000.00 17 51,000.00 - 17 51,000.00 0 - 17
52 MASKER IKAT Bh 700.00 87 60,900.00 - 87 60,900.00 44 30,800.00 43
53 MASKER KARET Pcs 700.00 644 450,800.00 - 644 450,800.00 121 84,700.00 523
54 SILK 2/0 SET 21,875.00 107 2,340,625.00 48 1,050,000.00 155 3,390,625.00 25 546,875.00 130
55 SILK 3/0 SET 21,875.00 52 1,137,500.00 72 1,575,000.00 124 2,712,500.00 0 - 124
56 SILK 3/0 SET 35,331.00 38 1,342,578.00 0 - 38 1,342,578.00 24 847,944.00 14
57 STOMACH TUBE / MAAG SLANG NO. 3,5 Pcs 18,000.00 0 - - 0 - - 0
58 STOMACH TUBE / MAAG SLANG NO. 5 Pcs 18,000.00 0 - - 0 - - 0
61 WING NEEDLE NO.21 Pcs 1,400.00 0 - - 0 - - 0

63 WING NEEDLE NO.25 Pcs 1,400.00 0 - - 0 - 0 - 0
64 WING NEEDLE NO.27 Pcs 1,400.00 0 - - 0 - 0 - 0
65 POT SPUTUM Pcs 2,930.00 170 498,100.00 33 96,690.00 203 594,790.00 46 134,780.00 157
66 RDT MALARIA ( Monotest ) Pcs 1,190,450.00 0 - - 0 - 0 - 0
67 RDT DBD IGG/IGM DOS 1,562,500.00 6 9,375,000.00 - 6 9,375,000.00 0 - 6
68 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 0 - 6
69 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - 0 - 0
70 STRIP GULA DARAH DOS 420,000.00 1 420,000.00 - 1 420,000.00 0 - 1
71 VAKSIN RABIES AMP 270,600.00 0 - - 0 - 0 - 0
72
OBAT GIGI 0 - - 0
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0 - 1
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0 - 1
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0 - 1
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0 - 1
5 EUGENOL Pcs 175,000.00 3.5 612,500.00 - 3.5 612,500.00 0 - 3.5
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 1 650,000.00 2 1,300,000.00 3 1,950,000.00 0 - 3
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - 0 - 0
8 CHKM 10 ML Pcs 210,000.00 3.5 735,000.00 - 3.5 735,000.00 0 - 3.5
9 OCCO Pcs 245,000.00 2.25 551,250.00 - 2.25 551,250.00 0.25 61,250.00 2
10 DYCAL Pcs 800,000.00 1 800,000.00 - 1 800,000.00 0 - 1
11 HEMOSPON Pcs 76,500.00 10 765,000.00 - 10 765,000.00 0 - 10
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 0 - 1
13 SEPTOJEK Pcs 0 - - 0 - 0 - 0
14 CAVITON Btl 325,000.00 0.75 243,750.00 1 325,000.00 1.75 568,750.00 0.25 81,250.00 1.5
TOTAL HARGA OBAT DAN BHP 110,994,758.31 23,024,086.00 133,930,809.31 17,716,612.28 199.5
BPJS UMUM JMLH

2207 305 2512


Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
( LPLPO )

PUSKESMAS : Benteng
BULAN 1
NO SAT/K STOK PENE PERSE PEMA SISA
MSN AWAL
URUT RIMAAN DIAAN KAIAN STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14
3 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 3.5 83,857.50 - 3.5 65,222.50 0.25 4,658.75 3.25
10 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 3986 759,851.18 - 3986 759,851.18 843 160,701.09 3143
12 AMLODIPIN 5 MG Tab 105.00 3081 323,505.00 - 3081 323,505.00 712 74,760.00 2369
14 AMOKSISILIN KAPSUL 250 MG Kap 207.00 420 86,940.00 - 420 86,940.00 9 1,863.00 411
15 AMOKSISILLIN KAPLET 500 MG Kap 233.00 4704 1,096,032.00 15000 3,495,000.00 19704 4,591,032.00 6946.5 1,618,534.50 12757.5
16 01.01.04.5100.02 AMOKSISILIN KAPLET 500 MG/RAMOXYL Kap 608.00 0 - - 0 - - 0
18 01.01.04.5100.04 AMOKSISILIN SIROP KERING 125 Btl 2,560.00 88 225,280.00 240 614,400.00 328 839,680.00 125 320,000.00 203
21 01.01.04.5131.06 AMPICILIN KAPLET 500 MG Kap 419.10 0 - - 0 - - 0
23 ANTASIDA DOEN TABLET KUNYAH Tab 78.00 1000 78,000.00 - 1000 78,000.00 - 1000
24 15.01.01.5334.02 ANTASIDA DOEN II SUSPENSI Btl 2,106.00 92 193,752.00 - 92 193,752.00 43 90,558.00 49
26 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 50 168,250.00 - 50 168,250.00 - 50
27 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 19.8 94,683.60 - 19.8 94,683.60 1.2 5,738.40 18.6
BULAN 1
KODE OBAT NAMA OBAT
MSN HARGA NILAI NILAI NILAI NILAI
URUT AWAL RIMAAN DIAAN KAIAN STOK
28 12.05.01.5340.01 ANTIHEMOROID DOEN KOMBINASI Pot 3,502.00 38 133,076.00 - 38 133,076.00 - 38
29 10.02.01.5338.01 ANTIMIGREN Tab 135.00 145 19,575.00 - 145 19,575.00 39 5,265.00 106
31 22.01.01.5163.01 ARTESUNATE INJEKSI VIAL 60 MG Amp 0 - - 0 - - 0
32 ARTESUNATE DEWASA Tab 0 - - 0 - - 0
36 22.01.01.5166.02 AS.MEFENAMAT TABLET SALUT 500 MG Tab 113.00 0 - - 0 - - 0
37 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 2993.5 305,337.00 10000 1,020,000.00 12993.5 1,325,337.00 3800 387,600.00 9193.5
38 22.01.01.5168.01 ASIKLOVIR KRIM 5 % Tube 2,367.00 0 - - 0 - - 0
39 22.01.01.5168.02 ASIKLOVIR TABLET 200 MG Tab 251.00 20 5,020.00 - 20 5,020.00 - 20
40 ASIKLOVIR TABLET 400 MG Tab 362.00 0 - - 0 - - 0
42 07.07.02.5049.04 ATROPIN TETES MATA 0.5 % Btl 0 - - 0 - - 0
45 BISAKODIL SUPPOSITORIA SUPP 6,045.00 0 - - 0 - - 0
46 BISOPROLOL FUMARATE Tab 695.00 0 - - 0 - - 0
47 CARBAMAZEPIN TAB 200 MG Tab 269.00 457 122,933.00 - 457 122,933.00 - 457
49 CETIRIZINE SIRUP Btl 7,756.00 60 465,360.00 - 60 465,360.00 - 60
50 CLOBAZAM TAB 10 MG Tab 1,045.00 0 - - 0 - - 0
51 CHATHEJELL Tab 4,284.80 0 - - 0 - - 0
52 22.01.01.5176.01 DEKSAMETASON INJ 5 MG/ML Amp 1,738.00 95 165,110.00 - 95 165,110.00 - 95
53 DEKSAMETASON TAB Tab 48.00 3211 154,128.00 5000 240,000.00 8211 394,128.00 2048 98,304.00 6163
54 22.01.01.5179.01 DIAZEPAM INJ 2 MG/ML Amp 2,605 0 - - 0 - - 0
55 22.01.01.5179.02 DIAZEPAM TABLET 2 MG Tab 39.00 106 4,134.00 500 19,500.00 606 23,634.00 241 9,399.00 365
56 DIAZEPAM RECTAL Tube 12,749.00 14 178,486.00 - 14 178,486.00 - 14
57 22.01.01.5179.03 DIAZEPAM RECTAL Tube 13,384.00 0 - 10 133,840.00 10 133,840.00 - 10
58 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 - 87
59 22.01.01.5181.01 DIGOKSIN TABLET 0,25 MG Tab 103.00 308 31,724.00 - 308 31,724.00 - 308
60 22.01.01.5182.01 DILTIAZEM TAB 30 MG Tab 141.00 0 - - 0 - - 0
61 22.01.01.5183.01 DIMENHIDRINAT TAB 50 MG Tab 109.00 0 - - 0 - - 0
62 DIMENHIDRINAT TAB 50 MG Tab 114.00 100 11,400.00 - 100 11,400.00 24 2,736.00 76
63 22.01.01.5181.02 DOMPORIDON SIRUP Btl 3,490.00 0 - - 0 - - 0
64 22.01.01.5185.01 DOKSISIKLIN KAPSUL 100 MG Kap 309.00 88 27,192.00 - 88 27,192.00 - 88
BULAN 1
URUT MSN AWAL RIMAAN DIAAN KAIAN STOK
66 22.01.01.5188.01 EKSTRAK BELLADONA TABLET 10 MG Tab 42.00 0 - - 0 - - 0
67 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 61 31,842.00 - 61 31,842.00 1.5 783.00 59.5
69 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 8,090.00 0 - - 0 - - 0
70 ERITROMISIN SIROP 200 MG/ 5 ML Btl 7,581.00 48 363,888.00 - 48 363,888.00 10 75,810.00 38
71 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300Btl 3,750.00 22 82,500.00 - 22 82,500.00 2.5 9,375.00 19.5
72 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 37 97,125.00 100 262,500.00 137 359,625.00 18 47,250.00 119
73 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
74 ETHYLIS CHLORIDUM SEMPROT Btl 81,400.00 0 - - 0 - - 0
75 20.02.01.5261.01 EUGENOL CAIRAN Btl 18,333.00 0 - - 0 - - 0
76 07.02.01.5051.03 FENOBARBITAL AMPUL 2 ML Btl 1,980 30 59,400.00 - 30 59,400.00 - 30
77 07.02.01.5051.01 FENOBARBITAL TABLET 30 MG Tab 177.00 200 35,400.00 - 200 35,400.00 - 200
79 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 0 - - 0 - - 0
80 05.03.13.5196.02 FITOMENADION (VIT K) INJ 10 MG/ML Amp 1,888.00 155 292,640.00 - 155 292,640.00 26 49,088.00 129
81 FUROSEMIDA TABLET 40 MG Tab 84.00 0 - - 0 - - 0
84 GARAM ORALIT I SERBUK Sac 274.00 0 - 300 82,200.00 300 82,200.00 - 300
85 22.01.01.5201.01 GEMFIBROZIL KAPSUL 300 MG Kap 306.00 975 298,350.00 - 975 298,350.00 - 975
86 17.09.01.5202.01 GENTAMISIN INJ 80 MG/ML Amp 4,066 5 20,330.00 - 5 20,330.00 - 5
87 17.09.01.5202.02 GENTAMISIN SALEP KULIT Pot 1,469.00 0 - - 0 - - 0
88 17.09.01.5202.03 GENTAMISIN SULFAT TETES MATA 0,3 % Pot 3,513.00 0 - - 0 - - 0
89 22.01.01.5203.01 GENTIAN VIOLET 1 % Btl 985.00 2 1,970.00 - 2 1,970.00 - 2
91 GLIMEPIRIDE 2 MG Tab 502.00 167 83,834.00 - 167 83,834.00 9 4,518.00 158
92 GLIMEPIRIDE 2 MG Tab 297.00 300 89,100.00 - 300 89,100.00 - 300
93 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 30.69 1733 53,185.77 - 1733 53,185.77 926 28,418.94 807
94 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 5000 354,750.00 - 5000 354,750.00 - 5000
95 04.02.01.5208.01 GLUKOSA LARUTAN INFUS 10 % Btl 6,270.00 0 - - 0 - - 0
98 GRANTUSIF Tab 405.00 4387 1,776,735.00 5000 2,025,000.00 9387 3,801,735.00 2955.5 1,196,977.50 6431.5
100 GRISEOFULVIN TABLET 125 MG Tab 506.00 0 - 500 253,000.00 500 253,000.00 - 500
101 22.01.01.5210.01 HALOPERIDOL TABLET 1.5 MG Tab 65.00 500 32,500.00 - 500 32,500.00 - 500
102 12.01.01.5089.01 HIDROKLOROTIAZIDA TABLET 25 MG Tab 171.00 100 17,100.00 - 100 17,100.00 - 100
BULAN 1
104 HYOSIN BUTIL BROMIDA TAB 10 MG Tab 330.00 0 - - 0 - - 0
105 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 738 89,298.00 - 738 89,298.00 129 15,609.00 609
IBUPROFEN TABLET 400 MG Tab 157.00 5000 785,000.00 5000 785,000.00 0 - 5000
108 IBUPROFEN SIRUP 15 MG/ML Btl 106.70 0 - - 0 - - 0
109 22.01.01.5214.02 ISONIAZID TABLET 300 MG Tab 106.70 0 - - 0 - - 0
110 22.01.01.5215.01 ISOSORBID DINITRAT TABLET 5 MG Tab 98.00 240 23,520.00 - 240 23,520.00 - 240
111 KALIUM DIKLOFENAK TAB 50 MG Tab 425.00 0 - - 0 - - 0
112 KALSIUM GLUCONAS INJ Amp 10,437 0 - - 0 - - 0
113 KALSIUM LAKTAT TABLET 500 MG/KALEN Tab 67.00 1698 113,766.00 2000 134,000.00 3698 247,766.00 1288 86,296.00 2410
114 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
115 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 3674 264,528.00 - 3674 264,528.00 529 38,088.00 3145
116 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 342 48,906.00 - 342 48,906.00 54 7,722.00 288
117 KETOKENAZOL TAB 200 MG Tab 320.00 0 - - 0 - - 0
118 KETOKENAZOL KRIM Tube 3,135.00 0 - - 0 - - 0
120 22.01.01.5224.01 KLONIDIN TABLET 0.15 MG Tab 224.00 0 - - 0 - - 0
121 KLONIDIN TABLET 0.15 MG Tab 145.00 372 53,940.00 - 372 53,940.00 3 435.00 369
122 01.01.02.5225.02 KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 18 33,300.00 - 18 33,300.00 1 1,850.00 17
125 01.01.02.5225.04 KLORAMFENIKOL TETES MATA 0.5 % Tube 0 - - 0 - - 0
126 01.01.02.5225.03 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,016.00 0 - - 0 - 0 - 0
129 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 200 124,322.00 200 124,322.00 - 200
130 KLORAMFENIKOL KAPSUL 500 MG Kap 1,155.00 94 108,570.00 100 115,500.00 194 224,070.00 91 105,105.00 103
131 22.01.01.5226.01 KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 5659 305,586.00 - 5659 305,586.00 2726 147,204.00 2933
132 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 4000 180,000.00 4000 180,000.00 - 4000
133 KLORPROMAZIN TAB SALUT 25 MG Tab 50.00 108 5,400.00 - 108 5,400.00 - 108
135 01.06.01.5142.03 KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 6 13,788.00 - 6 13,788.00 6 13,788.00 0
136 KOTRIMOKSAZOL SUSPENSI Btl 2,462.00 150 369,300.00 - 150 369,300.00 67 164,954.00 83
137 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 50 111,250.00 50 111,250.00 - 50
139 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 131.00 1000 131,000.00 - 1000 131,000.00 - 1000
140 01.06.01.5142.01 KOTRIMOKSAZOL DOEN II (ANAK) Tab 79.00 0 - - 0 - - 0
BULAN 1
141 19.02.01.5068.02 KUINIDIN 100 MG TABLET Tab 0 - - 0 - - 0
143 01.02.01.5231.01 KUININ (KINA) TABLET 200 MG Tab 0 - - 0 - - 0
144 01.02.01.5231.03 KUININ INJEKSI 25 % Tab 0 - - 0 - - 0
145 01.02.01.5231.04 KUININ SULFAT TAB 222 MG (7 H2O) Tab 641.67 0 - - 0 - - 0
146 LANSOPRAZOL 30 MG KAP 521.00 5 2,605.00 200 104,200.00 205 106,805.00 5 2,605.00 200
147 LANSOPRAZOL SIRUP Btl 0 - - 0 - - 0
148 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 26 24,154.00 - 26 24,154.00 4 3,716.00 22
149 22.01.01.5237.01 LISOL DENGAN KRESOL SABUN 50 % Btl 31,800.00 0 - - 0 - - 0
150 LOPERAMIDE Tab 90.00 420 37,800.00 - 420 37,800.00 10 900.00 410
152 LORATADIN TAB Tab 134.00 100 13,400.00 100 13,400.00 - 100
153 MgSO4 20% Btl 3,200 0 - 24 76,800.00 24 76,800.00 - 24
154 MgSO4 40% Btl 3,650 0 - 6 21,900.00 6 21,900.00 - 6
155 22.01.01.5240.01 MEBENDAZOL SIROP 100 MG/ 5 ML Btl 0 - - 0 - - 0
156 22.01.01.5240.02 MEBENDAZOL TABLET 100 MG Tab 0 - - 0 - - 0
157 MELOXICAM 7,5 mg Tab 680 196 133,280.00 200 136,000.00 396 269,280.00 194 131,920.00 202
158 MELOXICAM 15 mg Tab 875 969 847,875.00 - 969 847,875.00 617 539,875.00 352
159 07.01.02.5043.01 METAMPIRON TABLET 500 MG (ANTALGINTab 141.85 0 - - 0 - - 0
160 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 Tab 133.10 0 - - 0 - - 0
161 22.01.01.5245.02 METILERGOMETRIN MALEAT INJ 0.2 MG Amp 8,500.00 60 510,000.00 - 60 510,000.00 - 60
163 METILPREDNISOLON TAB 4 MG Tab 165.00 3000 495,000.00 3000 495,000.00 - 3000
164 METILPREDNISOLON TAB16 MG Tab 850.00 41 34,850.00 - 41 34,850.00 - 41
166 22.01.01.5246.04 METFORMIN TAB 850 MG Tab 240.00 0 - - 0 - - 0
168 METOKLOPRAMIDE TAB 10 MG TAB 100.00 0 - - 0 - - 0
169 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 0 - 1000 1,654,000.00 1000 1,654,000.00 10 16,540.00 990
171 METRONIDAZOL TABLET 500 MG Tab 140.00 200 28,000.00 200 28,000.00 - 200
173 MIKONAZOLE KREAM Tube 3,150.00 47 148,050.00 24 75,600.00 71 223,650.00 24 75,600.00 47
174 MIKONAZOLE POWDER POT 26,950.00 56 1,509,200.00 - 56 1,509,200.00 - 56
175 MINERAL MIX Bks 2,723 0 - - 0 - - 0
176 05.03.02.5250.02 NATRIUM DKLOFENAK TABLET 25 MG Tab 0 - - 0 - - 0
177 05.03.02.5250.01 NATRIUM DKLOFENAK TABLET 50 MG Tab 193.00 0 - - 0 - - 0
178 NA. DIKLOFENAK 50 MG/DIK.SODIUM Tab 161.00 496 79,856.00 1000 161,000.00 1496 240,856.00 324 52,164.00 1172
BULAN 1
MSN AWAL
179 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 %Btl 6,410.00 95.5 602,540.00 40 256,400.00 135.5 868,555.00 29.25 187,492.50 106.25
180 NIPEDIFINE TAB 10 MG Tab 123.00 571 70,233.00 - 571 70,233.00 149 18,327.00 422
181 NISTATIN 500.000 IU Tab 704.00 80 56,320.00 - 80 56,320.00 15 10,560.00 65
182 NISTATIN 100.000 IU Tab 448.00 60 26,880.00 - 60 26,880.00 9 4,032.00 51
183 15.05.01.5258.05 OBAT ANTITUBERKULOSIS SISIPAN DEWASTab 175,980 0 - - 0 - - 0
184 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 3 4,139,952.00 - 3 4,139,952.00 1 1,379,984.00 2
185 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 413,984 0 - - 0 - - 0
186 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 15 5,938,500.00 16 6,334,400.00 31 12,272,900.00 26 10,293,400.00 5
187 15.05.01.5258.04 OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 4 946,000.00 - 4 946,000.00 0 - 4
188 14.02.01.5259.01 OBAT BATUK HITAM CAIRAN Btl 1,339.80 0 - - 0 - - 0
190 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,630.00 - - 0 - - 0
192 OMEPRAZOL Kap 221.00 682 150,722.00 1050 232,050.00 1732 382,772.00 514 113,594.00 1218
193 OMEPRAZOL Kap 164.00 0 - - 0 - - 0
194 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 0 - 5
196 PAPAVERIN TABLET 40 MG Tab 208.78 0 - - 0 - - 0
197 PARASETAMOLDROPS Btl 5,980.00 57 340,860.00 280 1,674,400.00 337 2,015,260.00 127 759,460.00 210
199 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 200 223,800.00 200 223,800.00 - 200
200 14.04.01.5275.02 PARASETAMOL TABLET 100 MG Tab 0 - - 0 - - 0
201 PARASETAMOL TABLET 500 MG Tab 86.00 10249 881,414.00 10000 860,000.00 20249 1,741,414.00 7191 618,426.00 13058
202 PENOL GLISEROL TETES TELINGA Btl 2,246.00 0 - - 0 - - 0
203 PEHACAIN INJ Amp 4,850.00 112 543,200.00 100 485,000.00 212 1,028,200.00 46 223,100.00 166
204 PENISILLIN PROKAIN INJ Vial 6,618.00 0 - - 0 - - 0
205 22.01.01.5278.01 PIRANTEL TABLET SCORE 125 MG Tab 318.00 0 - - 0 - - 0
206 22.01.01.5278.02 PIRANTEL SIRUP btl 9,100.00 0 - - 0 - - 0
207 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - - 0
208 PIRASETAM 1200 Tab 854.00 0 - - 0 - - 0
212 22.01.01.5281.02 PIROKSIKAM TABLET 20 MG Tab 189.50 0 - - 0 - - 0
214 POLIDEMICIN TETES MATA 0 - - 0 - - 0
215 22.01.01.5283.01 POVIDON IODIDA 10 % 1000 ML Btl 40,202.00 1 40,202.00 - 1 40,202.00 - 1
BULAN 1
MSN AWAL
217 POVIDON IODIDA 10 % 300 ML Btl 22,500.00 12 270,000.00 12 270,000.00 - 12
218 22.01.01.5283.04 POVIDON IODIDA 10 % 30 ML Btl 2,344.00 0 - - 0 - - 0
219 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 19 68,875.00 50 181,250.00 69 250,125.00 3 10,875.00 66
220 PREDNISON TABLET 5 MG Tab 125.00 3669.5 458,687.50 - 3669.5 458,687.50 3617.5 452,187.50 52
221 PREDNISON TABLET 5 MG Tab 123.20 5000 616,000.00 5000 616,000.00 - 5000
222 22.01.01.5285.01 PRIMAKUIN TABLET 15 MG Tab 0 - - 0 - - 0
224 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 80.00 0 - - 0 - - 0
227 15.01.01.3184.02 RANITIDIN INJ 25 MG / 2 ML Amp 1,600.00 0 - - 0 - - 0
228 RANITIDIN INJ 25 MG / 2 ML Amp 3,150.00 14 44,100.00 - 14 44,100.00 - 14
229 REAGEN PEWARNA Pkt 270,000.00 0 - - 0 - - 0
230 REAGENSIA ZN Pkt 276,600.00 11 3,042,600.00 10 2,766,000.00 21 5,808,600.00 21 5,808,600.00 0
231 22.01.01.5293.01 RINGER LAKTAT INFUS Btl 7,150.00 79 564,850.00 40 286,000.00 119 850,850.00 31 221,650.00 88
233 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 65.00 627 40,755.00 - 627 40,755.00 151.5 9,847.50 475.5
236 SALISIL BEDAK 2 % Pot 1,071.00 20 21,420.00 - 20 21,420.00 0 - 20
237 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 14.8 15,776.80 - 14.8 15,776.80 11.8 12,578.80 3
238 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 Btl 4,133.00 39 161,187.00 - 39 161,187.00 2 8,266.00 37
239 SEFADROKSIL KAPSUL 500 MG Kap 557.00 2442 1,360,194.00 1000 557,000.00 3442 1,917,194.00 1070 595,990.00 2372
240 22.01.01.5300.01 SEFOTAKSIM 1000 MG Tab 3,500.00 20 70,000.00 - 20 70,000.00 - 20
241 22.01.01.5301.01 SEFTRIAKSON SERBUK INJ 1000 MG Pot 2,578.00 0 - - 0 - - 0
242 SIANOKOBALAMIN VIT B12 INJ 500 (PLAC Amp 1,050.00 83 87,150.00 - 83 87,150.00 17 17,850.00 66
244 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 2000 110,000.00 2000 110,000.00 - 2000
248 01.06.01.5151.01 SULFADIMIDINE TABLET 500 MG Tab 0 - - 0 - - 0
249 22.01.01.5316.01 SULFASETAMIDA NATRIUM TETES MATA 1Pot 3,549.00 0 - - 0 - - 0
250 SCABIMITE CREAM Tube 12,155.00 58 704,990.00 - 58 704,990.00 - 58
251 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 10742 1,299,782.00 12000 1,452,000.00 22742 2,751,782.00 12461 1,507,781.00 10281
252 TABLET TAMBAH DARAH (FONDAZEN) Tab 449.00 0 - - 0 - - 0
253 TABLET TAMBAH DARAH (HUFABION) Tab 405.00 0 - - 0 - - 0
BULAN 1
MSN AWAL
254 01.01.06.5321.01 TETRASIKLIN KAPSUL 250 MG Kap 162.00 5 810.00 - 5 810.00 5 810.00 0
255 TETRASIKLIN KAPSUL 250 MG Kap 181.00 2000 362,000.00 - 2000 362,000.00 374 67,694.00 1626
257 22.01.01.5322.02 TIAMFENIKOL KAPSUL 500 MG Kap 440.00 0 - - 0 - - 0
258 05.03.05.5323.01 TIAMIN (VIT B1) INJ 100 MG/ML Amp 730.00 0 - - 0 - - 0
259 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 4372 397,852.00 5000 455,000.00 9372 852,852.00 4010 364,910.00 5362
260 TIURAZOL 5 mg TAB Tab 563.00 0 - - 0 - - 0
261 TIURAZOL 10 mg TAB Tab 1,195.00 75 89,625.00 - 75 89,625.00 - 75
262 TRAMADOL KAPS Tab 196.35 0 - - 0 - - 0
263 TRAMADOL INJ Tab 6,000.00 0 - - 0 - - 0
265 VIT A MERAH kap 505.00 410 207,050.00 - 410 207,050.00 10 5,050.00 400
266 VIT A BIRU kap 286.00 265 75,790.00 - 265 75,790.00 - 265
267 05.03.06.5332.01 VITAMIN B KOMPLEKS TABLET Tab 112.00 3613 404,656.00 - 3613 404,656.00 3613 404,656.00 0
268 VITAMIN B KOMPLEKS TABLET Tab 132.00 0 - 18800 2,481,600.00 18800 2,481,600.00 1163 153,516.00 17637
269 19.07.01.4128.01 ZIN TAB Tab 521.00 495 257,895.00 - 495 257,895.00 265 138,065.00 230
270 ZIN TAB Tab 592.00 500 296,000.00 500 296,000.00 - 500
271 ZIN SIRUP Btl 6,600.00 27 178,200.00 - 27 178,200.00 14 92,400.00 13
- 0
PERBEKALAN KESEHATAN - 0
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 300 436,800.00 - 300 436,800.00 - 300
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 100 123,750.00 - 100
6 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 1,300.00 739 960,700.00 200 260,000.00 939 1,220,700.00 129 167,700.00 810
7 ALAT SUNTIK SEKALI PAKAI 5 ML Set 750.00 0 - - 0 - - 0
11 BISTURI NO. 19 Bh 3,000 128 384,000.00 - 128 384,000.00 4 12,000.00 124
12 BISTURI NO.20 Bh 3,000 77 231,000.00 - 77 231,000.00 8 24,000.00 69
13 BISTURI NO.21 Bh 3,000 65 195,000.00 - 65 195,000.00 6 18,000.00 59
14 BISTURI NO.23 Bh 3,000 67 201,000.00 - 67 201,000.00 5 15,000.00 62
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 - 230
16 CATGUT NO 2/0 Pcs 27,758.00 100 2,775,800.00 - 100 2,775,800.00 10 277,580.00 90
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - - 0
BULAN 1
KODE OBAT NAMA OBAT MSN HARGA NILAI NILAI NILAI NILAI
SAT/K
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - - 0
19 CATGUT NO 3/0 Pcs 8,895.83 123 1,094,187.09 - 123 1,094,187.09 12 106,749.96 111
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - - 0
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 - 10
23 FOLEY CATETER 18 Bh 10,000.00 11 110,000.00 - 11 110,000.00 3 30,000.00 8
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
25 HIV TEST Set 0 - - 0 - - 0
26 INFUSION SET ANAK SET 4,375.00 16 70,000.00 - 16 70,000.00 - 16
28 IV CATHETER NO 18 G Set 9,123.00 53 483,519.00 - 53 483,519.00 - 53
34 KAPAS PEMBALUT / ABSORBEN 250 GRA Set 11,400.00 0 - - 0 - - 0
35 KAPAS PEMBALUT / ABSORBEN 250 GRA Set 31,900.00 10 303,050.00 10 319,000.00 20 638,000.00 2.5 79,750.00 17.5
41 KASA PEMBALUT HIDROFIL 16 M X 16 CMBks 8,532.00 10 85,320.00 - 10 85,320.00 - 10
42 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 10 1,563,000.00 10 1,563,000.00 20 3,126,000.00 3 468,900.00 17
43 PLESTER YARD Roll 43,700.00 14 611,800.00 20 874,000.00 34 1,485,800.00 6.5 284,050.00 27.5
44 HANDSCON 7 STERIL Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 - 250
46 HANDSCON 71/2 Bks 6,237.00 75 467,775.00 - 75 467,775.00 27 168,399.00 48
47 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 0 - 250
48 HANDSCON 8 Bks 3,960.00 0 - - 0 - - 0
49 HANDSCON S Pcs 1,188.00 400 475,200.00 500 594,000.00 900 1,069,200.00 220 261,360.00 680
50 HANDSCON L Pcs 890.50 509 453,264.50 500 445,250.00 1009 898,514.50 118 105,079.00 891
51 HANDSCON M Pcs 890.50 230 204,815.00 500 445,250.00 730 650,065.00 150 133,575.00 580
52 URINE BAG BH 3,000.00 17 51,000.00 - 17 51,000.00 - 17
53 MASKER IKAT Bh 700.00 43 30,100.00 - 43 30,100.00 24 16,800.00 19
BULAN 1
MSN AWAL
54 MASKER KARET Pcs 700.00 523 366,100.00 500 350,000.00 1023 716,100.00 175 122,500.00 848
55 SILK 2/0 SET 21,875.00 130 2,843,750.00 - 130 2,843,750.00 5 109,375.00 125
56 SILK 3/0 SET 21,875.00 124 2,712,500.00 - 124 2,712,500.00 - 124
57 SILK 3/0 SET 35,331.00 14 494,634.00 - 14 494,634.00 14 494,634.00 0
66 POT SPUTUM Pcs 2,930.00 157 460,010.00 200 586,000.00 357 1,046,010.00 93 272,490.00 264
67 RDT MALARIA ( Monotest ) Pcs 1,190,450.00 0 - - 0 - - 0
68 RDT DBD IGG/IGM DOS 1,562,500.00 6 9,375,000.00 - 6 9,375,000.00 - 6
69 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 - 6
70 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - - 0
71 STRIP GULA DARAH DOS 420,000.00 1 2 840,000.00 3 1,260,000.00 - 3
72 VAKSIN RABIES AMP 270,600.00 0 20 5,412,000.00 20 5,412,000.00 20 5,412,000.00 0
73 STRIP ASAM URAT DOS 452,000.00 2 904,000.00 2 904,000.00 - 2
74 KOLESTEROL STRIP DOS 319,000.00 1 319,000.00 1 319,000.00 - 1
- 0 - - 0
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 - 1
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 - 1
5 EUGENOL Pcs 175,000.00 3.5 612,500.00 - 3.5 612,500.00 0.25 43,750.00 3.25
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 3 1,950,000.00 - 3 1,950,000.00 - 3
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3.5 735,000.00 - 3.5 735,000.00 - 3.5
9 OCCO Pcs 245,000.00 2 490,000.00 - 2 490,000.00 - 2
10 DYCAL Pcs 800,000.00 1 800,000.00 - 1 800,000.00 - 1
11 HEMOSPON Pcs 76,500.00 10 765,000.00 - 10 765,000.00 - 10
BULAN 1
MSN AWAL
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 - 1
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 1.5 487,500.00 - 1.5 487,500.00 - 1.5
TOTAL HARGA OBAT DAN BHP 116,311,847.03 45,434,937.00 161,746,784.03 42,366,876.71
BPJS UMUM JMLH

5494 372 5866
5494 372 5866


Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024

( LPLPO )

PUSKESMAS : Benteng
BULAN 2
MSN AWAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14
3 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 3.25 60,563.75 - 3.25 60,563.75 - 3.25
5 ALOPURINOL TABLET 100 MG Tab 117.00 - 1000 117,000.00 1000 117,000.00 0 - 1000
13 AMLODIPIN 5 MG Tab 105.00 2369 248,745.00 - 2369 248,745.00 828 86,940.00 1541
16 AMOKSISILLIN KAPLET 500 MG Kap 233.00 12757.5 2,972,497.50 - 12757.5 2,972,497.50 6732 1,568,556.00 6025.5
17 01.01.04.5100.02 AMOKSISILIN KAPLET 500 MG Kap 608.00 0 - - 0 - - 0
23 ANTASIDA DOEN TABLET KUNYAH Tab 64.00 124 7,936.00 2000 128,000.00 2124 135,936.00 1010 64,640.00 1114
BULAN 2
MSN AWAL
27 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 18.6 88,945.20 - 18.6 88,945.20 0.6 2,869.20 18
29 10.02.01.5338.01 ANTIMIGREN Tab 135.00 106 14,310.00 - 106 14,310.00 31 4,185.00 75
ANTIMIGREN Tab 179.00 - 100 17,900.00 100 17,900.00 - 100
33 07.01.02.5041.01 ASAM ASETIL SALISILAT 100 MG Tab 127.00 358 45,466.00 - 358 45,466.00 3 381.00 355
37 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 9193.5 937,737.00 - 9193.5 937,737.00 3980 405,960.00 5213.5
47 CARBAMAZEPIN TAB 200 MG Tab 269.00 457 122,933.00 - 457 122,933.00 33 8,877.00 424
49 CETIRIZINE SIRUP Btl 7,756.00 60 465,360.00 - 60 465,360.00 6 46,536.00 54
51 CHATHEJELL Tab 42,848.00 0 - 10 428,480.00 10 428,480.00 1 42,848.00 9
52 22.01.01.5176.01 DEKSAMETASON INJ 5 MG/ML Amp 1,738.00 95 165,110.00 - 95 165,110.00 10 17,380.00 85
DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 - - - -
57 22.01.01.5179.03 DIAZEPAM RECTAL Tube 13,384.00 10 133,840.00 - 10 133,840.00 - 10
BULAN 2
MSN AWAL
59 22.01.01.5181.01 DIGOKSIN TABLET 0,25 MG Tab 103.00 308 31,724.00 - 308 31,724.00 16 1,648.00 292
62 DIMENHIDRINAT TAB 50 MG Tab 114.00 76 8,664.00 - 76 8,664.00 - 76
67 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 59.5 31,059.00 - 59.5 31,059.00 33 17,226.00 26.5
71 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300Btl 3,750.00 19.5 73,125.00 - 19.5 73,125.00 0 - 19.5
72 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 119 312,375.00 - 119 312,375.00 17 44,625.00 102
73 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 - 60 244,980.00 60 244,980.00 - 60
GARAM ORALIT I SERBUK Sac 274.00 300 82,200.00 - 300 82,200.00 - 300
85 22.01.01.5201.01 GEMFIBROZIL KAPSUL 300 MG Kap 306.00 975 298,350.00 - 975 298,350.00 20 6,120.00 955
BULAN 2
MSN AWAL
94 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 5000 354,750.00 - 5000 354,750.00 209.5 14,864.03 4790.5
98 GRANTUSIF Tab 405.00 6431.5 2,604,757.50 - 6431.5 2,604,757.50 2496 1,010,880.00 3935.5
100 GRISEOFULVIN TABLET 125 MG Tab 506.00 500 253,000.00 - 500 253,000.00 - 500
101 22.01.01.5210.01 HALOPERIDOL TABLET 1.5 MG Tab 65.00 500 32,500.00 - 500 32,500.00 30 1,950.00 470
HIDROKORTISON KRIM 2 % Tube 2,812.00 - 48 134,976.00 48 134,976.00 - 48
105 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 609 73,689.00 - 609 73,689.00 - 609
106 IBUPROFEN TABLET 400 MG Tab 133.00 0 - - 0 - - 0
IBUPROFEN TABLET 400 MG Tab 157.00 5000 785,000.00 - 5000 785,000.00 - 5000
110 22.01.01.5215.01 ISOSORBID DINITRAT TABLET 5 MG Tab 98.00 240 23,520.00 - 240 23,520.00 60 5,880.00 180
114 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
115 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 3145 226,440.00 - 3145 226,440.00 443 31,896.00 2702
116 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 288 41,184.00 - 288 41,184.00 72 10,296.00 216
119 KETOROLAC INJ Amp 1,383.00 5 6,915.00 - 5 6,915.00 - 5
121 KLONIDIN TABLET 0.15 MG Tab 145.00 369 53,505.00 - 369 53,505.00 - 369
122 01.01.02.5225.02 KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 17 31,450.00 - 17 31,450.00 - 17
BULAN 2
MSN AWAL
124 KLORAMFENIKOL TETES TELINGA 3 % Tube 7,300.00 24 175,200.00 - 24 175,200.00 - 24
129 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 200 124,322.00 - 200 124,322.00 - 200
131 22.01.01.5226.01 KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 2933 158,382.00 - 2933 158,382.00 2603.5 140,589.00 329.5
132 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 4000 180,000.00 - 4000 180,000.00 - 4000
135 01.06.01.5142.03 KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 0 - - 0 - 0 - 0
137 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 50 111,250.00 - 50 111,250.00 - 50
139 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 131.00 1000 131,000.00 - 1000 131,000.00 0 - 1000
146 LANSOPRAZOL 30 MG KAP 521.00 200 104,200.00 - 200 104,200.00 - 200
148 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 22 20,438.00 - 22 20,438.00 10 9,290.00 12
150 LOPERAMIDE Tab 90.00 410 36,900.00 - 410 36,900.00 - 410
152 LORATADIN TAB Tab 134.00 100 13,400.00 - 100 13,400.00 - 100
153 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
154 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
157 MELOXICAM 7,5 mg Tab 680 202 137,360.00 - 202 137,360.00 202 137,360.00 0
158 MELOXICAM 15 mg Tab 875 352 308,000.00 - 352 308,000.00 222 194,250.00 130
160 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 Tab 133.10 0 - - 0 - 0 - 0
BULAN 2
MSN AWAL
169 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 990 1,637,460.00 - 990 1,637,460.00 50 82,700.00 940
171 METRONIDAZOL TABLET 500 MG Tab 140.00 200 28,000.00 - 200 28,000.00 - 200
175 MINERAL MIX Bks 2,723 0 - - 0 - - 0
179 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 %Btl 6,410.00 106.25 681,062.50 - 106.25 681,062.50 17.25 110,572.50 89
181 NISTATIN 500.000 IU Tab 704.00 65 45,760.00 - 65 45,760.00 0 - 65
182 NISTATIN 100.000 IU Tab 448.00 51 22,848.00 - 51 22,848.00 - 51
184 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 2 2,759,968.00 - 2 2,759,968.00 - 2
186 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 5 1,979,500.00 - 5 1,979,500.00 - 5
187 15.05.01.5258.04 OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 4 946,000.00 - 4 946,000.00 - 4
190 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,630.00 0 - - 0 - - 0
192 OMEPRAZOL Kap 221.00 1218 269,178.00 - 1218 269,178.00 409 90,389.00 809
193 OMEPRAZOL Kap 164.00 0 - - 0 - - 0
194 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 - 5
BULAN 2
197 PARASETAMOLDROPS Btl 5,980.00 210 1,255,800.00 - 210 1,255,800.00 87 520,260.00 123
199 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 200 223,800.00 - 200 223,800.00 53 59,307.00 147
203 PEHACAIN INJ Amp 4,850.00 166 805,100.00 - 166 805,100.00 24 116,400.00 142
207 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - - 0
208 PIRASETAM 1200 Tab 854.00 0 - - 0 - - 0
209 05.03.06.5280.01 PIRIDOKSIN (VIT B6) TAB 10 MG Tab 124.00 2904 360,096.00 - 2904 360,096.00 1452 180,048.00 1452
220 PREDNISON TABLET 5 MG Tab 125.00 52 6,500.00 - 52 6,500.00 52 6,500.00 0
225 22.01.01.5289.01 PROPILITIOURASIL TABLET 100 MG Tab 351.00 509 178,659.00 100 35,100.00 609 213,759.00 146 51,246.00 463
230 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - - 0
BULAN 2
233 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 65.00 475.5 30,907.50 - 475.5 30,907.50 62 4,030.00 413.5
236 SALISIL BEDAK 2 % Pot 1,071.00 20 21,420.00 - 20 21,420.00 9 9,639.00 11
237 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 3 3,198.00 - 3 3,198.00 - 3
239 SEFADROKSIL KAPSUL 500 MG Kap 557.00 2372 1,321,204.00 - 2372 1,321,204.00 990 551,430.00 1382
244 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 2000 110,000.00 3000 165,000.00 5000 275,000.00 731 40,205.00 4269
250 SCABIMITE CREAM Tube 12,155.00 58 704,990.00 - 58 704,990.00 3 36,465.00 55
254 01.01.06.5321.01 TETRASIKLIN KAPSUL 250 MG Kap 162.00 0 - - 0 - - 0
256 01.01.06.5321.02 TETRASIKLIN KAPSUL 500 MG Kap 325.00 26 8,450.00 - 26 8,450.00 0 - 26
263 TRAMADOL INJ Tab 6,000.00 0 - - 0 - - 0
BULAN 2
MSN AWAL
265 VIT A MERAH kap 505.00 400 202,000.00 1850 934,250.00 2250 1,136,250.00 1478 746,390.00 772
266 VIT A BIRU kap 286.00 265 75,790.00 - 265 75,790.00 242 69,212.00 23
VTT A BIRU kap 327.00 - 50 16,350.00 50 16,350.00 - 50
267 05.03.06.5332.01 VITAMIN B KOMPLEKS TABLET Tab 112.00 0 - - 0 - - 0
268 VITAMIN B KOMPLEKS TABLET Tab 132.00 17637 2,328,084.00 - 17637 2,328,084.00 4267 563,244.00 13370
269 19.07.01.4128.01 ZIN TAB Tab 521.00 230 119,830.00 - 230 119,830.00 220 114,620.00 10
270 ZIN TAB Tab 592.00 500 296,000.00 - 500 296,000.00 - 500
271 ZIN SIRUP Btl 6,600.00 13 85,800.00 10 66,000.00 23 151,800.00 10 66,000.00 13
0 - - 0 - - 0
PERBEKALAN KESEHATAN 0 - - 0 - - 0
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 - 100 123,750.00 - 100
11 BISTURI NO. 19 Bh 3,000 124 372,000.00 - 124 372,000.00 - 124
12 BISTURI NO.20 Bh 3,000 69 207,000.00 - 69 207,000.00 - 69
13 BISTURI NO.21 Bh 3,000 59 177,000.00 - 59 177,000.00 1 3,000.00 58
14 BISTURI NO.23 Bh 3,000 62 186,000.00 - 62 186,000.00 2 6,000.00 60
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 - 230
16 CATGUT NO 2/0 Pcs 27,758.00 90 2,498,220.00 - 90 2,498,220.00 - 90
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - - 0
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - - 0
19 CATGUT NO 3/0 Pcs 8,895.83 111 987,437.13 - 111 987,437.13 7 62,270.81 104
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - - 0
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 0 - 10
23 FOLEY CATETER 18 Bh 10,000.00 8 80,000.00 10 100,000.00 18 180,000.00 5 50,000.00 13
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
25 HIV TEST Set 0 - - 0 - - 0
26 INFUSION SET ANAK SET 4,375.00 16 70,000.00 - 16 70,000.00 1 4,375.00 15
BULAN 2
MSN AWAL
35 KAPAS PEMBALUT / ABSORBEN 250 GRA Set 31,900.00 17.5 558,250.00 - 17.5 558,250.00 2 63,800.00 15.5
36 KASA KOMPRES 40/40 STERIL Bks 1,679.15 0 - - 0 - - 0
41 KASA PEMBALUT HIDROFIL 16 M X 16 CMBks 8,532.00 10 85,320.00 - 10 85,320.00 1 8,532.00 9
42 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 17 2,657,100.00 - 17 2,657,100.00 3 468,900.00 14
43 PLESTER YARD Roll 43,700.00 27.5 1,201,750.00 - 27.5 1,201,750.00 9 393,300.00 18.5
44 HANDSCON 7 STERIL Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 51 302,940.00 199
46 HANDSCON 71/2 Bks 6,237.00 48 299,376.00 - 48 299,376.00 14 87,318.00 34
47 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 - 250
48 HANDSCON 8 Bks 3,960.00 0 - - 0 - - 0
49 HANDSCON S Pcs 1,188.00 680 807,840.00 - 680 807,840.00 160 190,080.00 520
50 HANDSCON L Pcs 890.50 891 793,435.50 - 891 793,435.50 108 96,174.00 783
51 HANDSCON M Pcs 890.50 580 516,490.00 - 580 516,490.00 170 151,385.00 410
52 URINE BAG BH 3,000.00 17 51,000.00 - 17 51,000.00 1 3,000.00 16
53 MASKER IKAT Bh 700.00 19 13,300.00 - 19 13,300.00 9 6,300.00 10
54 MASKER KARET Pcs 700.00 848 593,600.00 - 848 593,600.00 183 128,100.00 665
55 SILK 2/0 SET 21,875.00 125 2,734,375.00 - 125 2,734,375.00 - 125
56 SILK 3/0 SET 21,875.00 124 2,712,500.00 - 124 2,712,500.00 15 328,125.00 109
57 SILK 3/0 SET 35,331.00 0 - - 0 - - 0
BULAN 2
MSN AWAL
66 POT SPUTUM Pcs 2,930.00 264 773,520.00 - 264 773,520.00 200 586,000.00 64
69 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 - 6
70 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - - 0
71 STRIP GULA DARAH DOS 420,000.00 3 1,260,000.00 10 4,200,000.00 13 5,460,000.00 - 13
72 VAKSIN RABIES AMP 270,600.00 0 - - 0 - - 0
73 STRIP ASAM URAT DOS 452,000.00 2 904,000.00 - 2 904,000.00 1 452,000.00 1
74 KOLESTEROL STRIP DOS 319,000.00 1 319,000.00 12 3,828,000.00 13 4,147,000.00 10 3,190,000.00 3
- - -
5 EUGENOL Pcs 175,000.00 3.25 568,750.00 - 3.25 568,750.00 3.25 568,750.00 0
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3.5 735,000.00 - 3.5 735,000.00 0.25 52,500.00 3.25
9 OCCO Pcs 245,000.00 2 490,000.00 - 2 490,000.00 0.25 61,250.00 1.75
10 DYCAL Pcs 800,000.00 1 800,000.00 - 1 800,000.00 0.25 200,000.00 0.75
11 HEMOSPON Pcs 76,500.00 10 765,000.00 - 10 765,000.00 1 76,500.00 9
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 - 1
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 1.5 487,500.00 - 1.5 487,500.00 0.5 162,500.00 1
BPJS UMUM JMLH

4701 667 5368
4701 667 5368


Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
( LPLPO )

PUSKESMAS : Benteng
BULAN 3
MSN AWAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14
3 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 3.25 60,563.75 - 3.25 60,563.75 2 37,270.00 1.25
ALOPURINOL TABLET 100 MG Tab 117.00 1000 117,000.00 500 58,500.00 1500 13 1,521.00 1487
5 07.01.02.5044.02 ALOPURINOL TABLET 300 MG Tab 230.00 0 - 500 115,000.00 500 115,000.00 - 500
12 AMLODIPIN 5 MG Tab 105.00 1541 161,805.00 3600 378,000.00 5141 539,805.00 828 86,940.00 4313
15 AMOKSISILLIN KAPLET 500 MG Kap 233.00 6025.5 1,403,941.50 5000 1,165,000.00 11025.5 2,568,941.50 7229 1,684,357.00 3796.5
21 01.01.04.5131.06 AMPICILIN KAPLET 500 MG Kap 419.10 0 - - 0 - 0
BULAN 3
MSN AWAL
26 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 50 168,250.00 - 50 168,250.00 9 30,285.00 41
27 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 18 86,076.00 - 18 86,076.00 - 18
29 10.02.01.5338.01 ANTIMIGREN Tab 135.00 75 10,125.00 - 75 10,125.00 12 1,620.00 63
ANTIMIGREN Tab 179.00 100 17,900.00 - 100 100
37 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 5213.5 531,777.00 5000 510,000.00 10213.5 1,041,777.00 3637 370,974.00 6576.5
43 22.01.01.5172.01 BETAMETASON KRIM 0,1 % Tube 1,435.00 47 67,445.00 72 103,320.00 119 170,765.00 33 47,355.00 86
CETIRIZINE TAB KAP 115.00 - 1000 115,000.00 1000 0 1000
51 CHATHEJELL Tab 42,848.00 9 385,632.00 - 9 385,632.00 2 85,696.00 7
DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 - 20 34,800.00 20 0 - 20
BULAN 3
MSN AWAL
64 22.01.01.5185.01 DOKSISIKLIN KAPSUL 100 MG Kap 309.00 88 27,192.00 - 88 27,192.00 10 3,090.00 78
71 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300Btl 3,750.00 19.5 73,125.00 - 19.5 73,125.00 1 3,750.00 18.5
72 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 102 267,750.00 - 102 267,750.00 15.25 40,031.25 86.75
73 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
74 ETHYLIS CHLORIDUM SEMPROT Btl 81,400.00 - - 0 -
FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 60 244,980.00 - 60 60 0
GARAM ORALIT I SERBUK Sac 274.00 300 82,200.00 200 54,800.00 500 137,000.00 21 5,754.00 479
BULAN 3
93 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 30.69 0 - - 0 - - 0
94 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 4790.5 339,885.98 - 4790.5 339,885.98 1276.5 90,567.68 3514
98 GRANTUSIF Tab 405.00 3935.5 1,593,877.50 2000 810,000.00 5935.5 2,403,877.50 2203.5 892,417.50 3732
100 GRISEOFULVIN TABLET 125 MG Tab 506.00 500 253,000.00 - 500 253,000.00 32 16,192.00 468
HIDROKORTISON KRIM 2 % Tube 2,812.00 48 134,976.00 72 202,464.00 120 17 47,804.00 103
104 HYOSIN BUTIL BROMIDA TAB 10 MG Tab 330.00 0 - - 0 - 0
IBUPROFEN TABLET 400 MG Tab 157.00 5000 785,000.00 - 5000 785,000.00 2021 317,297.00 2979
114 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
115 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2702 194,544.00 - 2702 194,544.00 439 31,608.00 2263
116 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 216 30,888.00 - 216 30,888.00 50 7,150.00 166
121 KLONIDIN TABLET 0.15 MG Tab 145.00 369 53,505.00 - 369 53,505.00 16 2,320.00 353
BULAN 3
MSN AWAL
124 KLORAMFENIKOL TETES TELINGA 3 % Tube 7,300.00 24 175,200.00 - 24 175,200.00 11 80,300.00 13
126 01.01.02.5225.03 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,016.00 0 - - 0 - 0
129 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 200 124,322.00 - 200 200
132 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 4000 180,000.00 1000 45,000.00 5000 2483.5 111,757.50 2516.5
133 KLORPROMAZIN TAB SALUT 25 MG Tab 50.00 70 3,500.00 - 70 3,500.00 0 - 70
135 01.06.01.5142.03 KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 0 - - 0 - - 0
137 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 50 111,250.00 - 50 3 6,675.00 47
139 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 131.00 1000 131,000.00 - 1000 131,000.00 272 35,632.00 728
148 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 12 11,148.00 - 12 11,148.00 2 1,858.00 10
150 LOPERAMIDE Tab 90.00 410 36,900.00 - 410 36,900.00 - 410
152 LORATADIN TAB Tab 134.00 100 13,400.00 - 100 62 38
153 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
154 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
157 MELOXICAM 7,5 mg Tab 680 0 - 1000 680,000.00 1000 680,000.00 192 130,560.00 808
158 MELOXICAM 15 mg Tab 875 130 113,750.00 1000 875,000.00 1130 988,750.00 261 228,375.00 869
BULAN 3
162 METILPREDNISOLON TAB 4 MG Tab 200.00 0 - - 0 - - 0
163 METILPREDNISOLON TAB 4 MG Tab 165.00 2987 492,855.00 - 2987 1047 1940
166 22.01.01.5246.04 METFORMIN TAB 500 MG Tab 115.00 0 - 1000 115,000.00 1000 115,000.00 - 1000
168 METOKLOPRAMIDE TAB 10 MG TAB 100.00 0 - - 0 - 0
169 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 940 1,554,760.00 - 940 1,554,760.00 - 940
171 METRONIDAZOL TABLET 500 MG Tab 140.00 200 28,000.00 - 200 200
175 MINERAL MIX Bks 2,723 0 - - 0 - - 0
179 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 %Btl 6,410.00 89 570,490.00 - 89 570,490.00 17.25 110,572.50 71.75
180 NIPEDIFINE TAB 10 MG Tab 123.00 401 49,323.00 - 401 49,323.00 - 401
181 NISTATIN 500.000 IU Tab 704.00 65 45,760.00 - 65 45,760.00 5 3,520.00 60
182 NISTATIN 100.000 IU Tab 448.00 51 22,848.00 - 51 22,848.00 - 51
187 15.05.01.5258.04 OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 4 946,000.00 - 4 946,000.00 1 236,500.00 3
192 OMEPRAZOL Kap 221.00 809 178,789.00 - 809 178,789.00 453 100,113.00 356
193 OMEPRAZOL Kap 164.00 0 - 480 78,720.00 480 78,720.00 - 480
BULAN 3
MSN AWAL
197 PARASETAMOLDROPS Btl 5,980.00 123 735,540.00 - 123 735,540.00 110 657,800.00 13
198 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,013.00 0 - 100 101,300.00 100 101,300.00 - 100
199 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 147 164,493.00 - 147 85 95,115.00 62
201 PARASETAMOL TABLET 500 MG Tab 86.00 6705 576,630.00 - 6705 576,630.00 5908 508,088.00 797
202 PARASETAMOL TABLET 500 MG Btl 51.00 0 - 2000 102,000.00 2000 102,000.00 - 2000
203 PEHACAIN INJ Amp 4,850.00 142 688,700.00 - 142 688,700.00 52 252,200.00 90
207 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - - 0
208 PIRASETAM 1200 Tab 854.00 0 - - 0 - - 0
217 POVIDON IODIDA 10 % 300 ML Btl 22,500.00 11 247,500.00 - 11 2 9
219 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 63 228,375.00 - 63 228,375.00 3.25 11,781.25 59.75
220 PREDNISON TABLET 5 MG Tab 125.00 0 - - 0 - - 0
221 PREDNISON TABLET 5 MG Tab 123.20 3262 401,878.40 2000 246,400.00 5262 2583 318,225.60 2679
224 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 69.00 0 - 1100 75,900.00 1100 75,900.00 75 5,175.00 1025
226 RANITIDIN TABLET 150 MG Tab 115.00 5173 594,895.00 5173 594,895.00 1243 142,945.00 3930
230 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - - 0
BULAN 3
MSN AWAL
236 SALISIL BEDAK 2 % Pot 1,071.00 11 11,781.00 30 32,130.00 41 43,911.00 19.2 20,563.20 21.8
239 SEFADROKSIL KAPSUL 500 MG Kap 557.00 1382 769,774.00 - 1382 769,774.00 870 484,590.00 512
SEFADROKSIL KAPSUL 500 MG Kap 455.00 - 1000 455,000.00 1000 1000
242 SIANOKOBALAMIN VIT B12 INJ 500 (PLAC Amp 1,050.00 49 51,450.00 - 49 18 18,900.00 31
243 22.01.01.5306.03 SIANOKOBALAMIN TABLET 50 MCG Tab 15.00 0 - - 0 - - 0
244 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 4269 234,795.00 5000 275,000.00 9269 2551 140,305.00 6718
247 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 1326 395,148.00 1000 298,000.00 2326 693,148.00 769 229,162.00 1557
251 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 5465 661,265.00 6000 726,000.00 11465 1,387,265.00 5836 706,156.00 5629
252 TABLET TAMBAH DARAH KOMBINASI Tab 367.00 0 - 3000 1,101,000.00 3000 1,101,000.00 - 3000
256 01.01.06.5321.02 TETRASIKLIN KAPSUL 500 MG Kap 325.00 26 8,450.00 - 26 8,450.00 - 26
263 TRAMADOL INJ Tab 6,000.00 0 - - 0 - - 0
264 TRIHEKSIFENIDIL 25 MG TAB/ARKINE Tab 691.19 234 161,738.46 - 234 161,738.46 - 234
BULAN 3
MSN AWAL
265 VIT A MERAH kap 505.00 772 389,860.00 - 772 389,860.00 132 66,660.00 640
266 VIT A BIRU kap 286.00 23 6,578.00 - 23 6,578.00 23 6,578.00 0
VTT A BIRU kap 327.00 50 16,350.00 - 50 24 26
267 05.03.06.5332.01 VITAMIN B KOMPLEKS TABLET Tab 112.00 0 - - 0 - 0
269 19.07.01.4128.01 ZIN TAB Tab 521.00 10 5,210.00 - 10 5,210.00 10 5,210.00 0
270 ZIN TAB Tab 592.00 500 296,000.00 500 296,000.00 1000 250 750
271 ZIN SIRUP Btl 6,600.00 13 85,800.00 34 224,400.00 47 310,200.00 13 85,800.00 34
0 - - 0 - 0
PERBEKALAN KESEHATAN 0 - - 0 - 0
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 - 100 100
6 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 1,300.00 733 952,900.00 - 733 952,900.00 238 309,400.00 495
9 ALAT SUNTIK SEKALI PAKAI 5 ML Set 1,223.75 100 122,375.00 - 100 100
11 BISTURI NO. 19 Bh 3,000 124 372,000.00 - 124 372,000.00 5 15,000.00 119
12 BISTURI NO.20 Bh 3,000 69 207,000.00 - 69 207,000.00 1 3,000.00 68
13 BISTURI NO.21 Bh 3,000 58 174,000.00 - 58 174,000.00 - 58
14 BISTURI NO.23 Bh 3,000 60 180,000.00 - 60 180,000.00 9 27,000.00 51
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 - 230
16 CATGUT NO 2/0 Pcs 27,758.00 90 2,498,220.00 - 90 2,498,220.00 - 90
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - - 0
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - - 0
19 CATGUT NO 3/0 Pcs 8,895.83 104 925,166.32 - 104 925,166.32 - 104
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - - 0
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 - 10
23 FOLEY CATETER 18 Bh 10,000.00 13 130,000.00 - 13 130,000.00 4 40,000.00 9
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
25 HIV TEST Set 0 - - 0 - - 0
BULAN 3
MSN AWAL
28 IV CATHETER NO 20 G Set 3,800.00 0 - - 0 - - 0
35 KAPAS PEMBALUT / ABSORBEN 250 GRA Set 31,900.00 15.5 494,450.00 - 15.5 494,450.00 3.25 103,675.00 12.25
38 KASA PEMBALUT 2 M X 80 CM Bks 10,000.00 14 140,000.00 - 14 140,000.00 - 14
41 KASA PEMBALUT HIDROFIL 16 M X 16 CMBks 8,532.00 9 76,788.00 - 9 76,788.00 2 17,064.00 7
43 PLESTER YARD Roll 43,700.00 18.5 808,450.00 - 18.5 808,450.00 5 218,500.00 13.5
45 HANDSCON 7 STERIL Bks 6,237.00 0 - - 0 - - 0
46 HANDSCON 71/2 Bks 6,237.00 34 212,058.00 - 34 212,058.00 27 168,399.00 7
47 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 - 250
48 HANDSCON 8 Bks 3,960.00 0 - - 0 - - 0
49 HANDSCON S Pcs 1,188.00 520 617,760.00 - 520 617,760.00 170 201,960.00 350
50 HANDSCON L Pcs 890.50 783 697,261.50 - 783 697,261.50 110 97,955.00 673
51 HANDSCON M Pcs 890.50 410 365,105.00 - 410 365,105.00 106 94,393.00 304
52 URINE BAG BH 3,000.00 16 48,000.00 - 16 48,000.00 1 3,000.00 15
53 MASKER IKAT Bh 700.00 10 7,000.00 - 10 7,000.00 10 7,000.00 0
54 MASKER KARET Pcs 700.00 665 465,500.00 - 665 465,500.00 162 113,400.00 503
55 SILK 2/0 SET 21,875.00 125 2,734,375.00 - 125 2,734,375.00 - 125
56 SILK 3/0 SET 21,875.00 109 2,384,375.00 - 109 2,384,375.00 13 284,375.00 96
57 SILK 3/0 SET 35,331.00 0 - - 0 - - 0
BULAN 3
MSN AWAL
64 POT SPUTUM Pcs 2,930.00 64 187,520.00 200 586,000.00 264 773,520.00 78 228,540.00 186
66 RDT DBD IGG/IGM DOS 1,562,500.00 6 9,375,000.00 - 6 9,375,000.00 6 9,375,000.00 0
67 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 6 0
68 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - - 0
69 STRIP GULA DARAH DOS 420,000.00 13 5,460,000.00 - 13 5,460,000.00 3.5 1,470,000.00 9.5
71 STRIP ASAM URAT DOS 452,000.00 1 452,000.00 - 1 1
72 KOLESTEROL STRIP DOS 319,000.00 3 957,000.00 - 3 3 0
-
5 EUGENOL Pcs 175,000.00 0 - 2 350,000.00 2 350,000.00 0.25 43,750.00 1.75
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 3 1,950,000.00 - 3 1,950,000.00 0.25 162,500.00 2.75
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3.25 682,500.00 - 3.25 682,500.00 0.25 52,500.00 3
9 OCCO Pcs 245,000.00 1.75 428,750.00 - 1.75 428,750.00 0.25 61,250.00 1.5
10 DYCAL Pcs 800,000.00 0.75 600,000.00 - 0.75 600,000.00 0.25 200,000.00 0.5
11 HEMOSPON Pcs 76,500.00 9 688,500.00 - 9 688,500.00 4 306,000.00 5
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 - 1
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 1 325,000.00 - 1 325,000.00 0.5 162,500.00 0.5
TOTAL HARGA OBAT DAN BHP 116.75 107,920,410.91 17,997,634.00 119,657,606.51 32,759,349.06 216.5
BPJS UMUM JMLH

4606 422 5028


Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024

( LPLPO )

PUSKESMAS : Benteng
BULAN 4
MSN AWAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14
5 ALOPURINOL TABLET 100 MG Tab 117.00 1487 173,979.00 - 1487 173,979.00 392 45,864.00 1095
6 07.01.02.5044.02 ALOPURINOL TABLET 300 MG Tab 230.00 500 115,000.00 - 500 115,000.00 - 500
7 ALOPURINOL TABLET 300 MG Tab 244.00 2000 488,000.00 2000 488,000.00 - 2000
10 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 24 2,832.00 - 24 2,832.00 17 2,006.00 7
12 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 978 186,436.14 4000 762,520.00 4978 948,956.14 845 161,082.35 4133
14 AMLODIPIN 5 MG Tab 105.00 4313 452,865.00 - 4313 452,865.00 1248 131,040.00 3065
16 AMOKSISILIN KAPSUL 250 MG Kap 207.00 339 70,173.00 500 103,500.00 839 173,673.00 327 67,689.00 512
17 AMOKSISILLIN KAPLET 500 MG Kap 233.00 3796.5 884,584.50 13000 3,029,000.00 16796.5 3,913,584.50 7018.5 1,635,310.50 9778
21 AMOKSISILIN SIROP KERING 125 Btl 2,200.00 400 880,000.00 400 880,000.00 - 400
26 ANTASIDA DOEN TABLET KUNYAH Tab 78.00 0 - - 0 - - 0
16795.75
BULAN 4
KODE OBAT NAMA OBAT
MSN HARGA NILAI NILAI NILAI NILAI
28 01.01.00.5335.01 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 2,767.00 0 - - 0 - - 0
30 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 18 86,076.00 24 114,768.00 42 200,844.00 2.8 13,389.60 39.2
31 12.05.01.5340.01 ANTIHEMOROID DOEN KOMBINASI Pot 3,502.00 38 133,076.00 - 38 133,076.00 1 3,502.00 37
32 10.02.01.5338.01 ANTIMIGREN Tab 135.00 63 8,505.00 - 63 8,505.00 9 1,215.00 54
33 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 - 100
34 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 7 40,600.00 60 348,000.00 67 388,600.00 5 29,000.00 62
35 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 0 - 30 82,500.00 30 82,500.00 - 30
37 07.01.02.5041.01 ASAM ASETIL SALISILAT 100 MG Tab 127.00 0 - - 0 - - 0
38 ASAM ASETIL SALISILAT 100 MG Tab 149.00 1000 149,000.00 1000 149,000.00 40 5,960.00 960
40 05.03.07.5164.02 ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 10 1,050.00 - 10 1,050.00 - 10
42 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 6576.5 670,803.00 5000 510,000.00 11576.5 1,180,803.00 4833.5 493,017.00 6743
53 CETIRIZINE TAB Tab 154.00 10 1,540.00 1000 154,000.00 1010 155,540.00 481 74,074.00 529
54 CETIRIZINE TAB KAP 115.00 1000 115,000.00 - 1000 115,000.00 - 1000
55 CETIRIZINE SIRUP Btl 7,756.00 0 - - 0 - - 0
56 CHATHEJELL Tab 4,284.80 7 29,993.60 10 42,848.00 17 72,841.60 2 8,569.60 15
58 DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 20 34,800.00 - 20 34,800.00 - 20
62 DIAZEPAM RECTAL Tube 12,749.00 14 178,486.00 - 14 178,486.00 12 152,988.00 2
BULAN 4
MSN AWAL
72 22.01.01.5188.01 ERITROMISIN KAPSUL 250 MG Kap 651.00 0 100 65,100.00 100 65,100.00 - 100
73 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 17.5 9,135.00 - 17.5 9,135.00 - 17.5
74 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 223.5 228,640.50 100 102,300.00 323.5 330,940.50 46 47,058.00 277.5
75 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 6,461.00 0 - 50 323,050.00 50 323,050.00 - 50
76 ERITROMISIN SIROP 200 MG/ 5 ML Btl 7,581.00 26 197,106.00 - 26 197,106.00 - 26
77 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300Btl 3,750.00 18.5 69,375.00 - 18.5 69,375.00 1.5 5,625.00 17
78 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 86.75 227,718.75 100 262,500.00 186.75 490,218.75 13.25 34,781.25 173.5
79 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
80 ETHYLIS CHLORIDUM SEMPROT Btl 81,400.00 - - 0 - - 0
87 FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 0 - 90 367,470.00 90 367,470.00 - 90
89 16.02.01.3523.02 FUROSEMIDA TABLET 40 MG Tab 91.00 332 30,212.00 - 332 30,212.00 3 273.00 329
90 15.03.01.5200.01 GARAM ORALIT I SERBUK Sac 322.00 0 - - 0 - - 0
91 GARAM ORALIT I SERBUK Sac 274.00 479 131,246.00 200 54,800.00 679 186,046.00 195 53,430.00 484
4872.25
BULAN 4
MSN AWAL
101 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 3514 249,318.30 - 3514 249,318.30 1069 75,845.55 2445
105 GRANTUSIF Tab 405.00 3732 1,511,460.00 7000 2,835,000.00 10732 4,346,460.00 2598 1,052,190.00 8134
106 22.01.01.5209.02 GRISEOFULVIN TABLET 125 MG Tab 241.00 0 - - 0 - - 0
110 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,938.00 0 - 72 211,536.00 72 211,536.00 - 72
111 HIDROKORTISON KRIM 2 % Tube 2,812.00 103 289,636.00 - 103 289,636.00 49 137,788.00 54
114 IBUPROFEN TABLET 400 MG Tab 133.00 0 - 5000 665,000.00 5000 665,000.00 2051 272,783.00 2949
116 IBUPROFEN TABLET 400 MG Tab 157.00 2979 467,703.00 - 2979 467,703.00 - 2979
118 22.01.01.5214.02 ISOSORBID DINITRAT TABLET 5 MG Tab 93.00 0 - 100 9,300.00 100 9,300.00 - 100
121 KALSIUM LAKTAT TABLET 500 MG/KALEN Tab 57 0 - 5000 285,000.00 5000 285,000.00 - 5000
123 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
124 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2263 162,936.00 1000 72,000.00 3263 234,936.00 468 33,696.00 2795
125 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 166 23,738.00 100 14,300.00 266 38,038.00 49 7,007.00 217
132 01.01.02.5225.05 KLORAMFENIKOL TETES TELINGA 3 % Tube 1,759.00 0 - - 0 - - 0
BULAN 4
MSN AWAL
135 01.01.02.5225.03 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,016.00 0 - - 0 - - 0
136 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,000.00 26 104,000.00 20 80,000.00 46 184,000.00 1 4,000.00 45
138 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 200 124,322.00 500 310,805.00 700 435,127.00 22 13,675.42 678
140 22.01.01.5226.01 KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 0 - - 0 - - 0
141 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 2516.5 113,242.50 12000 540,000.00 14516.5 653,242.50 2649 119,205.00 11867.5
144 01.06.01.5142.03 KLORPROMAZIN TAB SALUT 100 MG Tab 179.00 0 - 500 89,500.00 500 89,500.00 - 500
145 KOTRIMOKSAZOL SUSPENSI Btl 2,462.00 0 - - 0 - - 0
146 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 47 104,575.00 200 445,000.00 247 549,575.00 35 77,875.00 212
147 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 158.00 0 - - 0 - - 0
148 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 131.00 728 95,368.00 2000 262,000.00 2728 357,368.00 341.5 44,736.50 2386.5
157 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 10 9,290.00 - 10 9,290.00 1 929.00 9
158 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 0 - 120 254,640.00 120 254,640.00 - 120
159 LOPERAMIDE Tab 90.00 410 36,900.00 - 410 36,900.00 10 900.00 400
160 LORATADIN TAB Tab 170.00 0 - - 0 - - 0
161 LORATADIN TAB Tab 134.00 38 5,092.00 300 40,200.00 338 45,292.00 27 3,618.00 311
162 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
163 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
166 MELOXICAM 7,5 mg Tab 680 808 549,440.00 - 808 549,440.00 308 209,440.00 500
167 MELOXICAM 15 mg Tab 875 869 760,375.00 300 262,500.00 1169 1,022,875.00 240 210,000.00 929
6216.5
BULAN 4
MSN AWAL
172 METILPREDNISOLON TAB 4 MG Tab 165.00 1940 320,100.00 1500 247,500.00 3440 567,600.00 1377 227,205.00 2063
173 METILPREDNISOLON TAB16 MG Tab 850.00 41 34,850.00 - 41 34,850.00 9 7,650.00 32
175 22.01.01.5246.04 METFORMIN TAB 500 MG Tab 115.00 1000 115,000.00 500 57,500.00 1500 172,500.00 - 1500
180 METRONIDAZOL TABLET 500 MG Tab 140.00 200 28,000.00 200 28,000.00 400 56,000.00 51 7,140.00 349
184 MINERAL MIX Bks 2,723 0 - - 0 - - 0
188 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 %Btl 6,410.00 71.75 459,917.50 40 256,400.00 111.75 716,317.50 13 83,330.00 98.75
190 NISTATIN 500.000 IU Tab 704.00 60 42,240.00 - 60 42,240.00 10 7,040.00 50
191 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 100 85,700.00 - 100
192 NISTATIN 100.000 IU Tab 448.00 51 22,848.00 - 51 22,848.00 18 8,064.00 33
193 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 0 - 100 62,700.00 100 62,700.00 - 100
195 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,435,180 0 - 5 7,175,900.00 5 7,175,900.00 - 5
196 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 11 4,354,900.00 - 11 4,354,900.00 7 2,771,300.00 4
199 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 0 - 50 180,000.00 50 180,000.00 - 50
201 OMEPRAZOL Kap 221.00 356 78,676.00 - 356 78,676.00 356 78,676.00 0
202 OMEPRAZOL Kap 164.00 480 78,720.00 1500 246,000.00 1980 324,720.00 166 27,224.00 1814
8487.75
BULAN 4
MSN AWAL
207 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,013.00 100 101,300.00 - 100 101,300.00 - 100
208 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 62 69,378.00 300 335,700.00 362 405,078.00 102 114,138.00 260
210 PARASETAMOL TABLET 500 MG Tab 86.00 797 68,542.00 20800 1,788,800.00 21597 1,857,342.00 3702.5 318,415.00 17894.5
211 PARASETAMOL TABLET 500 MG Btl 51.00 2000 102,000.00 - 2000 102,000.00 2000 102,000.00 0
212 PEHACAIN INJ Amp 4,850.00 90 436,500.00 - 90 436,500.00 45 218,250.00 45
216 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - - 0
217 PIRASETAM 1200 Tab 854.00 0 - - 0 - - 0
220 PIROKSIKAM TABLET 20 MG Tab 97.99 74 7,251.26 - 74 7,251.26 - 74
222 16.03.01.3543.01 PITOGIN AMPUL 1 ML Amp 9,100.00 37 336,700.00 120 1,092,000.00 157 1,428,700.00 35 318,500.00 122
223 PITOGIN AMPUL 1 ML amp 1,963.30 0 - - 0 - - 0
225 22.01.01.5283.02 POVIDON IODIDA 10 % 300 ML Btl 15,386.00 0 - 24 369,264.00 24 369,264.00 - 24
228 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 59.75 216,593.75 - 59.75 216,593.75 2.75 9,968.75 57
230 PREDNISON TABLET 5 MG Tab 123.20 2679 330,052.80 10000 1,232,000.00 12679 1,562,052.80 1884.5 232,170.40 10794.5
231 22.01.01.5285.01 RESPIRIDON 25 MG Tab 0 - - 0 - - 0
235 RANITIDIN TABLET 150 MG Tab 115.00 3930 451,950.00 5000 575,000.00 8930 1,026,950.00 981 112,815.00 7949
239 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - - 0
15231.75
BULAN 4
MSN AWAL
242 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 65.00 288.5 18,752.50 1000 65,000.00 1288.5 83,752.50 96.5 6,272.50 1192
243 22.01.01.5295.02 SALBUTAMOL TABLET 4 MG Tab 88.00 213 18,744.00 700 61,600.00 913 80,344.00 74 6,512.00 839
244 SALEP 2-4 KOMBINASI Tube 2,797.00 15 41,955.00 24 67,128.00 39 109,083.00 9 25,173.00 30
245 SALISIL BEDAK 2 % Pot 1,071.00 21.8 23,347.80 - 21.8 23,347.80 17.8 19,063.80 4
246 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 3 3,198.00 50 53,300.00 53 56,498.00 - 53
247 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 Btl 4,133.00 18 74,394.00 48 198,384.00 66 272,778.00 11 45,463.00 55
249 SEFADROKSIL KAPSUL 500 MG Kap 455.00 1000 455,000.00 2000 910,000.00 3000 1,365,000.00 641 291,655.00 2359
251 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLAC Amp 1,117.00 0 - 100 111,700.00 100 111,700.00 15 16,755.00 85
252 SIANOKOBALAMIN VIT B12 INJ 500 (PLAC Amp 1,050.00 31 32,550.00 - 31 32,550.00 - 31
257 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 1557 463,986.00 4000 1,192,000.00 5557 1,655,986.00 865 257,770.00 4692
261 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 5629 681,109.00 18000 2,178,000.00 23629 2,859,109.00 1086 131,406.00 22543
262 TABLET TAMBAH DARAH KOMBINASI Tab 367.00 3000 1,101,000.00 - 3000 1,101,000.00 3000 1,101,000.00 0
263 TABLET TAMBAH DARAH KOMBINASI Tab 410.00 0 - 6000 2,460,000.00 6000 2,460,000.00 6000 2,460,000.00 0
265 TETRASIKLIN KAPSUL 250 MG Kap 181.00 484 87,604.00 3000 543,000.00 3484 630,604.00 496 89,776.00 2988
269 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 2837 258,167.00 12000 1,092,000.00 14837 1,350,167.00 3148 286,468.00 11689
271 TIURAZOL 10 mg TAB Tab 1,195.00 60 71,700.00 100 119,500.00 160 191,200.00 - 160
273 TRAMADOL INJ Tab 6,000.00 0 - - 0 - - 0
29436.3
BULAN 4
MSN AWAL
278 VIT A MERAH kap 505.00 640 323,200.00 100 50,500.00 740 373,700.00 40 20,200.00 700
279 VIT A BIRU kap 286.00 0 - - 0 - - 0
280 VTT A BIRU kap 327.00 26 8,502.00 50 16,350.00 76 24,852.00 - 76
282 VITAMIN B KOMPLEKS TABLET Tab 132.00 8856 1,168,992.00 9400 1,240,800.00 18256 2,409,792.00 5031 664,092.00 13225
283 19.07.01.4128.01 ZIN TAB Tab 521.00 0 - - 0 - - 0
284 ZIN TAB Tab 592.00 750 444,000.00 500 296,000.00 1250 740,000.00 227 134,384.00 1023
285 ZIN SIRUP Btl 6,600.00 34 224,400.00 - 34 224,400.00 6 39,600.00 28
0 - - 0 - - 0
2 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 2,530.813 0 - - 0 - - 0
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 262 381,472.00 500 728,000.00 762 1,109,472.00 53 77,168.00 709
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 100 123,750.00 200 247,500.00 - 200
11 BISTURI NO. 19 Bh 3,000 119 357,000.00 - 119 357,000.00 9 27,000.00 110
12 BISTURI NO.20 Bh 3,000 68 204,000.00 - 68 204,000.00 3 9,000.00 65
13 BISTURI NO.21 Bh 3,000 58 174,000.00 - 58 174,000.00 4 12,000.00 54
14 BISTURI NO.23 Bh 3,000 51 153,000.00 - 51 153,000.00 4 12,000.00 47
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 2 5,200.00 228
16 CATGUT NO 2/0 Pcs 27,758.00 90 2,498,220.00 - 90 2,498,220.00 16 444,128.00 74
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - - 0
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - - 0
19 CATGUT NO 3/0 Pcs 8,895.83 104 925,166.32 - 104 925,166.32 20 177,916.60 84
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - - 0
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 - 10
23 FOLEY CATETER 18 Bh 10,000.00 9 90,000.00 20 200,000.00 29 290,000.00 5 50,000.00 24
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
25 HIV TEST Set 0 - - 0 - - 0
28 INFUSION SET DEWASA Set 6,218.75 50 310,937.50 50 310,937.50 - 50
29 IV CATHETER NO 18 G Set 9,123.00 47 428,781.00 50 456,150.00 97 884,931.00 14 127,722.00 83
BULAN 4
MSN AWAL
30 IV CATHETER NO 20 G Set 7,700.00 0 - 50 385,000.00 50 385,000.00 - 50
36 KAPAS PEMBALUT / ABSORBEN 250 GRA Set 31,900.00 12.25 390,775.00 10 319,000.00 22.25 709,775.00 3 95,700.00 19.25
37 KASA KOMPRES 40/40 STERIL Bks 3,100.00 0 - 100 310,000.00 100 310,000.00 - 100
40 KASA PEMBALUT 2 M X 80 CM Bks 10,152.00 50 507,600.00 50 507,600.00 - 50
41 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASBks 864.00 44 38,016.00 50 43,200.00 94 81,216.00 6 5,184.00 88
43 KASA PEMBALUT HIDROFIL 4 X 15 CM ELABks 4,500.00 50 225,000.00 50 225,000.00 - 50
46 PLESTER YARD Roll 43,700.00 13.5 589,950.00 - 13.5 589,950.00 7.5 327,750.00 6
47 PLESTER YARD Roll 49,632.00 24 1,191,168.00 24 1,191,168.00 - 24
48 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 200 1,247,400.00 - 200
49 HANDSCON 7 STERIL psg 5,940.00 164 974,160.00 - 164 974,160.00 50 297,000.00 114
50 HANDSCON 7 STERIL psg 6,118.20 0 - 200 1,223,640.00 200 1,223,640.00 - 200
51 HANDSCON 71/2 psg 6,237.00 7 43,659.00 - 7 43,659.00 7 43,659.00 0
52 HANDSCON 71/2 psg 5,940.00 250 1,485,000.00 - 250 1,485,000.00 19 112,860.00 231
53 HANDSCON 71/2 psg 6,118.20 0 - 200 1,223,640.00 200 1,223,640.00 - 200
54 HANDSCON S psg 1,188.00 350 415,800.00 100 118,800.00 450 534,600.00 225 267,300.00 225
55 HANDSCON S psg 854.74 400 341,896.00 400 341,896.00 - 400
56 HANDSCON L psg 890.50 673 599,306.50 - 673 599,306.50 8 7,124.00 665
57 HANDSCON M psg 890.50 304 270,712.00 - 304 270,712.00 278 247,559.00 26
58 HANDSCON M psg 1,188.00 200 237,600.00 200 237,600.00 - 200
59 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 - 15
60 MASKER KARET Pcs 700.00 503 352,100.00 300 210,000.00 803 562,100.00 245 171,500.00 558
61 SILK 2/0 SET 21,875.00 125 2,734,375.00 36 787,500.00 161 3,521,875.00 16 350,000.00 145
62 SILK 3/0 SET 21,875.00 96 2,100,000.00 - 96 2,100,000.00 21 459,375.00 75
63 SILK 3/0 SET 35,331.00 0 - - 0 - - 0
BULAN 4
MSN AWAL
64 POT SPUTUM Pcs 2,930.00 186 544,980.00 248 726,640.00 434 1,271,620.00 29 84,970.00 405
66 RDT DBD IGG/IGM DOS 1,562,500.00 0 - - 0 - - 0
67 RDT DBD NS1 DOS 2,400,000.00 0 - - 0 - - 0
68 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - - 0
69 STRIP GULA DARAH DOS 420,000.00 9.5 3,990,000.00 3 1,260,000.00 12.5 5,250,000.00 - 12.5
71 STRIP ASAM URAT DOS 452,000.00 1 452,000.00 15 6,780,000.00 16 7,232,000.00 1 452,000.00 15
72 KOLESTEROL STRIP DOS 319,000.00 0 - 15 4,785,000.00 15 4,785,000.00 - 15
BAHAN GIGI - - 0 - - 0
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0.0625 42,187.50 0.9375
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 0.0625 42,187.50 0.9375
5 EUGENOL Pcs 175,000.00 1.75 306,250.00 - 1.75 306,250.00 - 1.75
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 2.75 1,787,500.00 - 2.75 1,787,500.00 0.75 487,500.00 2
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3 630,000.00 - 3 630,000.00 - 3
9 OCCO Pcs 245,000.00 1.5 367,500.00 - 1.5 367,500.00 0.5 122,500.00 1
10 DYCAL Pcs 800,000.00 0.5 400,000.00 - 0.5 400,000.00 - 0.5
11 HEMOSPON Pcs 76,500.00 5 382,500.00 30 2,295,000.00 35 2,677,500.00 3 229,500.00 32
12 PULP-10 Pcs 495,000.00 1 495,000.00 3 1,485,000.00 4 1,980,000.00 - 4
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 0.5 162,500.00 3 975,000.00 3.5 1,137,500.00 0.25 81,250.00 3.25
TOTAL HARGA OBAT DAN BHP 216.5 76,904,862.45 74,998,824.50 151,903,686.95 27,649,349.50 498.75
BPJS UMUM JMLH

3375 281 3656


Nip. 196551214 199803 1 005 19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024

( LPLPO )

PUSKESMAS : Benteng
BULAN 5
MSN AWAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14
7 ALOPURINOL TABLET 300 MG Tab 244.00 2000 488,000.00 - 2000 488,000.00 - 2000
10 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 7 826.00 - 7 826.00 7 826.00 0
11 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 700 115,500.00 - 700 115,500.00 6 990.00 694
14 AMLODIPIN 5 MG Tab 105.00 3065 321,825.00 - 3065 321,825.00 1064 111,720.00 2001
16 AMOKSISILLIN KAPLET 500 MG Kap 233.00 9778 2,278,274.00 10000 2,330,000.00 19778 4,608,274.00 6114 1,424,562.00 13664
19 AMOKSISILIN SIROP KERING 125 Btl 2,200.00 400 880,000.00 - 400 880,000.00 82 180,400.00 318
22 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 40 134,600.00 - 40 134,600.00 0 - 40
23 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 39.2 187,454.40 - 39.2 187,454.40 1 4,782.00 38.2
25 10.02.01.5338.01 ANTIMIGREN Tab 135.00 54 7,290.00 - 54 7,290.00 22 2,970.00 32
26 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 - 100
28 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 30 82,500.00 - 30 82,500.00 - 30
BULAN 5
MSN AWAL
29 ASAM ASETIL SALISILAT 100 MG Tab 149.00 960 143,040.00 - 960 143,040.00 60 8,940.00 900
30 ASAM ASKORBAT (VIT C) 25 MG 51.00 8256 421,056.00 - 8256 421,056.00 3204 163,404.00 5052
32 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 6743 687,786.00 3000 306,000.00 9743 993,786.00 3853 393,006.00 5890
42 CHATHEJELL Tab 4,284.80 15 64,272.00 - 15 64,272.00 1 4,284.80 14
50 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 49 56,644.00 38
56 22.01.01.5188.01 ERITROMISIN KAPSUL 250 MG Kap 651.00 100 65,100.00 - 100 65,100.00 - 100
57 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 17.5 9,135.00 - 17.5 9,135.00 17.5 9,135.00 0
59 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 6,461.00 50 323,050.00 - 50 323,050.00 0 - 50
61 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300Btl 3,750.00 17 63,750.00 - 17 63,750.00 0 - 17
62 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 173.5 455,437.50 - 173.5 455,437.50 12.5 32,812.50 161
63 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
BULAN 5
MSN AWAL
69 FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 90 367,470.00 - 90 367,470.00 19 77,577.00 71
71 GARAM ORALIT I SERBUK Sac 274.00 484 132,616.00 - 484 132,616.00 92 25,208.00 392
75 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 61.00 840 51,240.00 1000 61,000.00 1840 112,240.00 319 19,459.00 1521
78 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.00 0 - 3000 210,000.00 3000 210,000.00 - 3000
81 GRANTUSIF Tab 405.00 8134 3,294,270.00 - 8134 3,294,270.00 2575 1,042,875.00 5559
82 GRISEOFULVIN TABLET 125 MG Tab 506.00 245 123,970.00 1000 506,000.00 1245 629,970.00 153 77,418.00 1092
94 KALSIUM LAKTAT TABLET 500 MG/KALEN Tab 57 5000 285,000.00 - 5000 285,000.00 644 36,708.00 4356
96 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
97 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2795 201,240.00 - 2795 201,240.00 376 27,072.00 2419
98 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 217 31,031.00 - 217 31,031.00 42 6,006.00 175
BULAN 5
MSN AWAL
104 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 678 421,451.58 - 678 421,451.58 35 21,756.35 643
106 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 11867.5 534,037.50 - 11867.5 534,037.50 2454 110,430.00 9413.5
111 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 131.00 2386.5 312,631.50 - 2386.5 312,631.50 176 23,056.00 2210.5
114 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 9 8,361.00 - 9 8,361.00 0 - 9
115 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 120 254,640.00 - 120 254,640.00 37 78,514.00 83
116 LOPERAMIDE Tab 90.00 400 36,000.00 - 400 36,000.00 - 400
118 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
119 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
120 MELOXICAM 7,5 mg Tab 680 500 340,000.00 - 500 340,000.00 500 340,000.00 0
121 MELOXICAM 15 mg Tab 875 929 812,875.00 - 929 812,875.00 679 594,125.00 250
127 22.01.01.5246.04 METFORMIN TAB 500 MG Tab 115.00 1500 172,500.00 - 1500 172,500.00 100 11,500.00 1400
129 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 519 858,426.00 - 519 858,426.00 242 400,268.00 277
130 METRONIDAZOL TABLET 500 MG Tab 140.00 349 48,860.00 - 349 48,860.00 61 8,540.00 288
135 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 %Btl 6,410.00 98.75 632,987.50 - 98.75 632,987.50 13 83,330.00 85.75
137 NISTATIN 500.000 IU Tab 704.00 50 35,200.00 - 50 35,200.00 - 50
138 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 - 100 85,700.00 - 100
139 NISTATIN 100.000 IU Tab 448.00 33 14,784.00 - 33 14,784.00 - 33
140 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 100 62,700.00 - 100 62,700.00 - 100
BULAN 5
MSN AWAL
143 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 4 1,583,600.00 - 4 1,583,600.00 1 395,900.00 3
146 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,685.00 - 50 184,250.00 50 184,250.00 - 50
147 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 50 180,000.00 - 50 180,000.00 - 50
149 OMEPRAZOL Kap 221.00 0 - - 0 - - 0
150 OMEPRAZOL Kap 164.00 1814 297,496.00 - 1814 297,496.00 609 99,876.00 1205
151 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 5 92,685.00 0
153 PAPAVERIN TABLET 40 MG Tab 208.00 0 - 1000 208,000.00 1000 208,000.00 - 1000
156 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 260 290,940.00 - 260 290,940.00 - 260
157 PARASETAMOL TABLET 500 MG Tab 86.00 17894.5 1,538,927.00 - 17894.5 1,538,927.00 5312 456,832.00 12582.5
158 PEHACAIN INJ Amp 4,850.00 45 218,250.00 - 45 218,250.00 43 208,550.00 2
161 PIROKSIKAM TABLET 20 MG Tab 97.99 74 7,251.26 - 74 7,251.26 0 - 74
162 16.03.01.3543.01 PITOGIN AMPUL 1 ML Amp 9,100.00 122 1,110,200.00 - 122 1,110,200.00 16 145,600.00 106
163 22.01.01.5283.02 POVIDON IODIDA 10 % 300 ML Btl 15,386.00 24 369,264.00 - 24 369,264.00 - 24
166 PREDNISON TABLET 5 MG Tab 123.20 10794.5 - 10794.5 1,329,882.40 2193 270,177.60 8601.5
170 15.01.01.3184.02 RESPIRIDON 2 MG Amp 347.00 0 - 200 69,400.00 200 69,400.00 60 20,820.00 140
173 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - - 0
BULAN 5
MSN AWAL
180 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 53 56,498.00 - 53 56,498.00 2 2,132.00 51
182 SEFADROKSIL KAPSUL 500 MG Kap 557.00 0 - 1000 557,000.00 1000 557,000.00 1000 557,000.00 0
185 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLAC Amp 1,117.00 85 94,945.00 - 85 94,945.00 - 85
188 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 14675 807,125.00 - 14675 807,125.00 1234 67,870.00 13441
189 SIMVASTATIN TABLET 10 MG Tab 177.00 5361 948,897.00 - 5361 948,897.00 564 99,828.00 4797
190 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 4692 1,398,216.00 - 4692 1,398,216.00 883 263,134.00 3809
196 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 11689 1,063,699.00 - 11689 1,063,699.00 3275 298,025.00 8414
199 TRIHEKSIFENIDIL 25 MG TAB Tab 80.00 0 - 200 16,000.00 200 16,000.00 - 200
201 VIT A MERAH kap 505.00 700 353,500.00 - 700 353,500.00 16 8,080.00 684
202 05.03.06.5332.01 VTT A BIRU kap 327.00 76 24,852.00 - 76 24,852.00 - 76
203 19.07.01.4128.01 VITAMIN B KOMPLEKS TABLET Tab 132.00 13225 1,745,700.00 - 13225 1,745,700.00 3704 488,928.00 9521
204 ZIN TAB Tab 592.00 1023 605,616.00 - 1023 605,616.00 188 111,296.00 835
205 ZIN SIRUP Btl 6,600.00 28 184,800.00 - 28 184,800.00 13 85,800.00 15
0
1 PERBEKALAN KESEHATAN 0
2 ALAT SUNTIK SEKALI PAKAI 0,5 ML Set 1,240.00 639 792,360.00 639 792,360.00 233 288,920.00 406
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 709 1,032,304.00 709 1,032,304.00 67 97,552.00 642
4 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,287.00 58 74,646.00 58 74,646.00 57 73,359.00 1
6 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 1,300.00 856 1,112,800.00 856 1,112,800.00 102 132,600.00 754
BULAN 5
MSN AWAL
10 BISTURI NO. 19 Bh 3,000 110 330,000.00 - 110 330,000.00 - 110
11 BISTURI NO.20 Bh 3,000 65 195,000.00 - 65 195,000.00 1 3,000.00 64
12 BISTURI NO.21 Bh 3,000 54 162,000.00 - 54 162,000.00 2 6,000.00 52
13 BISTURI NO.23 Bh 3,000 47 141,000.00 - 47 141,000.00 2 6,000.00 45
14 JARUM HECTING Bh 2,600 228 592,800.00 - 228 592,800.00 - 228
15 CATGUT NO 2/0 Pcs 27,758.00 74 2,054,092.00 - 74 2,054,092.00 12 333,096.00 62
16 CATGUT NO 2/0 Pcs 28,000.00 0 - 36 1,008,000.00 36 1,008,000.00 - 36
17 CATGUT NO 3/0 Pcs 8,895.83 84 747,249.72 - 84 747,249.72 12 106,749.96 72
18 CATGUT NO 3/0 Pcs 30,188.00 0 - 36 1,086,768.00 36 1,086,768.00 - 36
19 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
20 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 - 10
21 FOLEY CATETER 18 Bh 10,000.00 24 240,000.00 - 24 240,000.00 2 20,000.00 22
22 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
23 HIV TEST Set 0 - - 0 - - 0
26 INFUSION SET DEWASA Set 6,218.75 50 310,937.50 - 50 310,937.50 - 50
36 KASA KOMPRES 40/40 STERIL Bks 1,944.00 68 132,192.00 - 68 132,192.00 - 68
40 KASA PEMBALUT HIDROFIL 4 X 15 CM ELABks 4,104.00 55 225,720.00 100 410,400.00 155 636,120.00 34 139,536.00 121
41 KASA PEMBALUT HIDROFIL 4 X 15 CM ELABks 4,500.00 50 225,000.00 - 50 225,000.00 - 50
BULAN 5
MSN AWAL
44 PLESTER YARD Roll 43,700.00 6 262,200.00 - 6 262,200.00 6 262,200.00 0
45 PLESTER YARD Roll 49,632.00 24 1,191,168.00 - 24 1,191,168.00 - 24
46 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 - 200 1,247,400.00 - 200
48 HANDSCON 7 STERIL psg 6,118.20 200 1,223,640.00 - 200 1,223,640.00 - 200
49 HANDSCON 71/2 psg 5,940.00 231 1,372,140.00 - 231 1,372,140.00 - 231
50 HANDSCON 71/2 psg 6,118.20 200 1,223,640.00 - 200 1,223,640.00 69 422,155.80 131
51 HANDSCON S psg 1,188.00 225 267,300.00 - 225 267,300.00 225 267,300.00 0
52 HANDSCON S psg 854.74 400 341,896.00 - 400 341,896.00 4 3,418.96 396
53 HANDSCON L psg 890.50 665 592,182.50 - 665 592,182.50 6 5,343.00 659
54 HANDSCON M psg 890.50 26 23,153.00 500 445,250.00 526 468,403.00 - 526
55 HANDSCON M psg 1,188.00 200 237,600.00 - 200 237,600.00 76 90,288.00 124
56 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 - 15
57 MASKER KARET Pcs 700.00 558 390,600.00 - 558 390,600.00 247 172,900.00 311
58 SILK 2/0 SET 21,875.00 145 3,171,875.00 - 145 3,171,875.00 1 21,875.00 144
59 SILK 3/0 SET 21,875.00 75 1,640,625.00 - 75 1,640,625.00 14 306,250.00 61
60 SILK 3/0 SET 21,458.33 0 - 36 772,500.02 36 772,500.02 - 36
61 POT SPUTUM Pcs 2,930.00 405 1,186,650.00 - 405 1,186,650.00 239 700,270.00 166
62 STRIP GULA DARAH DOS 420,000.00 12.5 5,250,000.00 - 12.5 5,250,000.00 2.5 1,050,000.00 10
64 STRIP ASAM URAT DOS 452,000.00 15 6,780,000.00 - 15 6,780,000.00 2 904,000.00 13
65 STRIP ASAM URAT DOS 290,000.00 - - 0 - - 0
66 KOLESTEROL STRIP DOS 319,000.00 15 4,785,000.00 6 1,914,000.00 21 6,699,000.00 13 4,147,000.00 8
BULAN 5
BAHAN GIGI
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00 0.8125
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00 0.8125
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00 0.8125
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00 0.8125
5 EUGENOL Pcs 175,000.00 1.75 306,250.00 - 1.75 306,250.00 0.25 43,750.00 1.5
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3 630,000.00 - 3 630,000.00 0.25 52,500.00 2.75
9 OCCO Pcs 245,000.00 1 245,000.00 - 1 245,000.00 0.25 61,250.00 0.75
10 DYCAL Pcs 800,000.00 0.5 400,000.00 - 0.5 400,000.00 - 0.5
11 HEMOSPON Pcs 76,500.00 32 2,448,000.00 - 32 2,448,000.00 1 76,500.00 31
12 PULP-10 Pcs 495,000.00 4 1,980,000.00 - 4 1,980,000.00 0.25 123,750.00 3.75
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 3.25 1,056,250.00 - 3.25 1,056,250.00 0.25 81,250.00 3
BPJS UMUM JMLH

3179 204 3383

Nip. 196551214 199803 1 005 19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024

( LPLPO )

PUSKESMAS : Benteng
BULAN 6
MSN AWAL
1 2 3 4 6 8 10 12 14
2 21.01.01.4154.03 ALBENDAZOL SIRUP Btl 4,234.00 0 - - 0 - 0 - 0
6 ALOPURINOL TABLET 300 MG Tab 244.00 2000 488,000.00 - 2000 488,000.00 0 - 2000
7 22.01.01.5159.01 AMINOFILIN INJEKSI 24 MG/ML Amp 3,314.52 26 86,177.52 - 26 86,177.52 0 - 26
9 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 694 114,510.00 - 694 114,510.00 3 495.00 691
11 22.01.01.5158.02 AMBROKSOL SIRUP Btl 2,722.00 0 - - 0 - 0 - 0
12 AMLODIPIN 5 MG Tab 105.00 2001 210,105.00 - 2001 210,105.00 907 95,235.00 1094
19 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 38.2 182,672.40 - 38.2 182,672.40 0.2 956.40 38
21 10.02.01.5338.01 ANTIMIGREN Tab 135.00 32 4,320.00 - 32 4,320.00 21 2,835.00 11
22 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 - 100
24 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 30 82,500.00 - 30 82,500.00 - 30
25 ASAM ASETIL SALISILAT 100 MG Tab 149.00 900 134,100.00 - 900 134,100.00 - 900
28 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 5890 600,780.00 - 5890 600,780.00 3190 325,380.00 2700
BULAN 6-18
MSN AWAL
1 2 3 4 6 8 10 12 14
35 CETIRIZINE TAB KAP 115.00 1000 115,000.00 - 1000 115,000.00 113 12,995.00 887
36 CHATHEJELL Tab 4,284.80 14 59,987.20 - 14 59,987.20 2 8,569.60 12
38 DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 20 34,800.00 - 20 34,800.00 1 1,740.00 19
41 22.01.01.5179.03 DIAZEPAM RECTAL Tube 13,384.00 10 133,840.00 - 10 133,840.00 0 - 10
42 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 38 43,928.00 - 38 43,928.00 6 6,936.00 32
43 22.01.01.5181.01 DIGOKSIN TABLET 0,25 MG Tab 103.00 260 26,780.00 - 260 26,780.00 6 618.00 254
44 DIMENHIDRINAT TAB 50 MG Tab 114.00 76 8,664.00 - 76 8,664.00 0 - 76
46 22.01.01.5185.01 DOKSISIKLIN KAPSUL 100 MG Kap 309.00 58 17,922.00 - 58 17,922.00 0 - 58
48 22.01.01.5188.01 ERITROMISIN KAPSUL 250 MG Kap 651.00 100 65,100.00 - 100 65,100.00 5 3,255.00 95
49 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 268.5 274,675.50 - 268.5 274,675.50 0 - 268.5
52 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300Btl 3,750.00 17 63,750.00 - 17 63,750.00 1 3,750.00 16
53 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 161 422,625.00 - 161 422,625.00 21 55,125.00 140
54 07.02.01.5051.03 FENOBARBITAL AMPUL 2 ML Btl 1,980 30 59,400.00 - 30 59,400.00 0 - 30
55 07.02.01.5051.01 FENOBARBITAL TABLET 30 MG Tab 177.00 200 35,400.00 - 200 35,400.00 0 - 200
57 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 - 200 159,200.00 200 159,200.00 0 - 200
58 FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 71 289,893.00 - 71 289,893.00 32 130,656.00 39
60 FUROSEMIDA TABLET 40 MG Tab 84.00 - 200 16,800.00 200 16,800.00 0 - 200
62 GARAM ORALIT I SERBUK Sac 273.00 - 300 81,900.00 300 81,900.00 0 - 300
64 17.09.01.5202.01 GENTAMISIN INJ 80 MG/ML Amp 4,066 5 20,330.00 - 5 20,330.00 5 20,330.00 0
BULAN 6-18
MSN AWAL
1 2 3 4 5 6 8 9 10 12 14
69 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.00 3000 210,000.00 - 3000 210,000.00 0 - 3000
72 GRANTUSIF Tab 405.00 5559 2,251,395.00 - 5559 2,251,395.00 2012 814,860.00 3547
75 12.01.01.5089.01 HIDROKLOROTIAZIDA TABLET 25 MG Tab 171.00 100 17,100.00 - 100 17,100.00 0 - 100
76 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,938.00 71 208,598.00 48 141,024.00 119 349,622.00 24 70,512.00 95
77 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 530 64,130.00 - 530 64,130.00 0 - 530
79 IBUPROFEN TABLET 400 MG Tab 157.00 2979 467,703.00 - 2979 467,703.00 0 - 2979
83 KALSIUM LAKTAT TABLET 500 MG/KALEN Tab 57 4356 248,292.00 - 4356 248,292.00 967 55,119.00 3389
84 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2419 174,168.00 - 2419 174,168.00 421 30,312.00 1998
85 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 175 25,025.00 - 175 25,025.00 12 1,716.00 163
86 KETOROLAC INJ Amp 1,383.00 1 1,383.00 - 1 1,383.00 0 - 1
91 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 643 399,695.23 - 643 399,695.23 103 64,025.83 540
93 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 9413.5 423,607.50 - 9413.5 423,607.50 2056.5 92,542.50 7357
97 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125Tab 131.00 2210.5 289,575.50 - 2210.5 289,575.50 358 46,898.00 1852.5
98 LANSOPRAZOL 30 MG KAP 521.00 88 45,848.00 - 88 45,848.00 0 - 88
99 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 9 8,361.00 - 9 8,361.00 1 929.00 8
100 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 83 176,126.00 - 83 176,126.00 73 154,906.00 10
BULAN 6-18
MSN AWAL
1 2 3 4 5 6 8 10 12 14
101 LOPERAMIDE Tab 90.00 400 36,000.00 - 400 36,000.00 0 - 400
103 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 0 - 24
104 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 0 - 6
105 MELOXICAM 15 mg Tab 875 250 218,750.00 - 250 218,750.00 250 218,750.00 0
106 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 Tab 245.00 0 - 1000 245,000.00 1000 245,000.00 0 - 1000
112 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 277 458,158.00 1000 1,654,000.00 1277 2,112,158.00 215 355,610.00 1062
116 MIKONAZOLE POWDER POT 26,950.00 54 1,455,300.00 - 54 1,455,300.00 0 - 54
118 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 %Btl 6,410.00 85.75 549,657.50 - 85.75 549,657.50 18 115,380.00 67.75
119 NIPEDIFINE TAB 10 MG Tab 123.00 370 45,510.00 - 370 45,510.00 4 492.00 366
120 NISTATIN 500.000 IU Tab 704.00 50 35,200.00 - 50 35,200.00 0 - 50
121 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 - 100 85,700.00 0 - 100
122 NISTATIN 100.000 IU Tab 448.00 33 14,784.00 - 33 14,784.00 0 - 33
123 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 100 62,700.00 - 100 62,700.00 0 - 100
124 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 1 DWS Tab 413,984 0 - 16 6,623,744.00 16 6,623,744.00 8 3,311,872.00 8
125 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 2 DWS Tab 1,435,180 5 7,175,900.00 - 5 7,175,900.00 2 2,870,360.00 3
126 OBAT ANTITUBERKULOSIS KAT 1 DWS Tab 395,900 3 1,187,700.00 - 3 1,187,700.00 3 1,187,700.00 0
128 OKSITETRASIKLIN HCL SALP MATA 1 % Tube 1,680.00 11 18,480.00 - 11 18,480.00 11 18,480.00 0
130 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 50 180,000.00 - 50 180,000.00 0 - 50
132 OMEPRAZOL Kap 164.00 1205 197,620.00 - 1205 197,620.00 357 58,548.00 848
134 PAPAVERIN TABLET 40 MG Tab 208.00 1000 208,000.00 - 1000 208,000.00 0 - 1000
135 PARASETAMOLDROPS Btl 5,980.00 61 364,780.00 - 61 364,780.00 0 - 61
BULAN 6-18
MSN AWAL
1 2 3 4 5 6 8 10 12 14
138 PARASETAMOL TABLET 500 MG Tab 86.00 12582.5 1,082,095.00 - 12582.5 1,082,095.00 3884 334,024.00 8698.5
139 PEHACAIN INJ Amp 4,850.00 2 9,700.00 - 2 9,700.00 0 - 2
143 PIROKSIKAM TABLET 20 MG Tab 189.50 - 500 94,750.00 500 94,750.00 154 29,183.00 346
148 PREDNISON TABLET 5 MG Tab 123.20 8601.5 1,059,704.80 - 8601.5 1,059,704.80 1241 152,891.20 7360.5
152 15.01.01.3184.02 RESPIRIDON 2 MG Amp 347.00 140 48,580.00 - 140 48,580.00 60 20,820.00 80
162 22.01.01.5300.01 SEFOTAKSIM 1000 MG Tab 3,500.00 20 70,000.00 - 20 70,000.00 0 - 20
163 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLAC Amp 1,117.00 85 94,945.00 - 85 94,945.00 0 - 85
167 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 3809 1,135,082.00 - 3809 1,135,082.00 481 143,338.00 3328
BULAN 6-18
MSN AWAL
1 2 3 4 5 6 8 10 12 14
173 TIURAZOL 10 mg TAB Tab 1,195.00 100 119,500.00 - 100 119,500.00 0 - 100
174 TRIHEKSIFENIDIL 25 MG TAB Tab 80.00 200 16,000.00 - 200 16,000.00 21 1,680.00 179
176 VIT A MERAH kap 505.00 684 345,420.00 - 684 345,420.00 20 10,100.00 664
177 05.03.06.5332.01 VTT A BIRU kap 327.00 76 24,852.00 - 76 24,852.00 0 - 76
179 ZIN TAB Tab 592.00 835 494,320.00 - 835 494,320.00 272 161,024.00 563
180 ZIN SIRUP Btl 6,600.00 15 99,000.00 - 15 99,000.00 6 39,600.00 9
1 PERBEKALAN KESEHATAN
8 ALAT SUNTIK SEKALI PAKAI 5 ML Set 1,223.75 100 122,375.00 - 100 122,375.00 0 - 100
10 BISTURI NO. 19 Bh 3,000 110 330,000.00 - 110 330,000.00 4 12,000.00 106
11 BISTURI NO.20 Bh 3,000 64 192,000.00 - 64 192,000.00 2 6,000.00 62
12 BISTURI NO.21 Bh 3,000 52 156,000.00 - 52 156,000.00 0 - 52
13 BISTURI NO.23 Bh 3,000 45 135,000.00 - 45 135,000.00 0 - 45
14 JARUM HECTING Bh 2,600 228 592,800.00 - 228 592,800.00 0 - 228
15 CATGUT NO 2/0 Pcs 27,758.00 62 1,720,996.00 - 62 1,720,996.00 11 305,338.00 51
16 CATGUT NO 2/0 Pcs 28,000.00 36 1,008,000.00 - 36 1,008,000.00 0 - 36
17 CATGUT NO 3/0 Pcs 8,895.83 72 640,499.76 - 72 640,499.76 16 142,333.28 56
18 CATGUT NO 3/0 Pcs 30,188.00 36 1,086,768.00 - 36 1,086,768.00 0 - 36
19 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 0 - 48
20 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 0 - 10
21 FOLEY CATETER 18 Bh 10,000.00 22 220,000.00 - 22 220,000.00 2 20,000.00 20
22 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 0 - 28
BULAN 6-18
1 2 3 4 5 6 8 10 12 14
25 INFUSION SET DEWASA Set 6,218.75 50 310,937.50 - 50 310,937.50 0 - 50
34 KASA KOMPRES 40/40 STERIL Bks 3,100.00 90 279,000.00 - 90 279,000.00 0 - 90
37 KASA PEMBALUT 2 M X 80 CM Bks 10,152.00 50 507,600.00 - 50 507,600.00 0 - 50
40 KASA PEMBALUT HIDROFIL 4 X 15 CM ELABks 4,500.00 50 225,000.00 - 50 225,000.00 0 - 50
41 KASA PEMBALUT HIDROFIL 16 M X 16 CMBks 8,532.00 7 59,724.00 - 7 59,724.00 0 - 7
44 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 - 200 1,247,400.00 0 - 200
46 HANDSCON 7 STERIL psg 6,118.20 200 1,223,640.00 - 200 1,223,640.00 0 - 200
47 HANDSCON 71/2 psg 5,940.00 231 1,372,140.00 - 231 1,372,140.00 0 - 231
48 HANDSCON 71/2 psg 6,118.20 131 801,484.20 - 131 801,484.20 72 440,510.40 59
49 HANDSCON S psg 854.74 396 338,477.04 - 396 338,477.04 100 85,474.00 296
50 HANDSCON L psg 890.50 659 586,839.50 - 659 586,839.50 134 119,327.00 525
51 HANDSCON M psg 890.50 526 468,403.00 - 526 468,403.00 226 201,253.00 300
52 HANDSCON M psg 1,188.00 124 147,312.00 - 124 147,312.00 124 147,312.00 0
53 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 0 - 15
54 MASKER KARET Pcs 700.00 311 217,700.00 500 350,000.00 811 567,700.00 191 133,700.00 620
55 SILK 2/0 SET 21,875.00 144 3,150,000.00 - 144 3,150,000.00 5 109,375.00 139
56 SILK 3/0 SET 21,875.00 61 1,334,375.00 - 61 1,334,375.00 22 481,250.00 39
57 SILK 3/0 SET 21,458.33 36 772,500.02 - 36 772,500.02 0 - 36
58 POT SPUTUM Pcs 2,930.00 166 486,380.00 - 166 486,380.00 0 - 166
59 STRIP GULA DARAH DOS 420,000.00 10 4,200,000.00 - 10 4,200,000.00 1 420,000.00 9
60 STRIP ASAM URAT DOS 452,000.00 13 5,876,000.00 - 13 5,876,000.00 0 - 13
61 KOLESTEROL STRIP DOS 319,000.00 8 2,552,000.00 - 8 2,552,000.00 5 1,595,000.00 3
BULAN 6-18
MSN AWAL
BAHAN GIGI
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 0.8125 548,437.50 - 0.8125 548,437.50 0 - 0.8125
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 0.8125 548,437.50 - 0.8125 548,437.50 0 - 0.8125
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 0.8125 548,437.50 - 0.8125 548,437.50 0 - 0.8125
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 0.8125 548,437.50 - 0.8125 548,437.50 0 - 0.8125
5 EUGENOL Pcs 175,000.00 1.5 262,500.00 - 1.5 262,500.00 0.25 43,750.00 1.25
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 2 1,300,000.00 - 2 1,300,000.00 0 - 2
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - 0 - 0
8 CHKM 10 ML Pcs 210,000.00 2.75 577,500.00 - 2.75 577,500.00 0 - 2.75
9 OCCO Pcs 245,000.00 0.75 183,750.00 - 0.75 183,750.00 0 - 0.75
10 DYCAL Pcs 800,000.00 0.5 400,000.00 - 0.5 400,000.00 0 - 0.5
11 HEMOSPON Pcs 76,500.00 31 2,371,500.00 - 31 2,371,500.00 0 - 31
12 PULP-10 Pcs 495,000.00 3.75 1,856,250.00 - 3.75 1,856,250.00 0 - 3.75
13 SEPTOJEK Pcs 0 - - 0 - 0 - 0
14 CAVITON Btl 325,000.00 3 975,000.00 - 3 975,000.00 0 - 3
BPJS UMUM JMLH

2232 171 2403


Nip. 196551214 199803 1 005 19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
2
4
1 7
HAL1
PERMIN
NILAI KET
TAAN
15 16 17
881,364.00
-
65,222.50
288,540.00
-
86,177.52
31,992.00
2,832.00
115,500.00
759,851.18
-
323,505.00
-
86,940.00
1,096,032.00
-
-
225,280.00 exp.4
-
-
-
112,832.00
78,000.00 BON
193,752.00 BON
HAL 2
PERMIN
NILAI KET
TAAN
66,408.00
168,250.00
94,683.60
133,076.00
19,575.00
226,200.00
-
-
48,641.00
243,576.00 BON
31,500.00 exp 40
-
305,337.00 BON
-
5,020.00
-
368,427.00
-
175,070.00
957,600.00
-
-
122,933.00
214,984.00
465,360.00
-
-
165,110.00
154,128.00
-
4,134.00
178,486.00 BON
-
HAL 3
PERMIN
NILAI KET
TAAN
100,572.00
31,724.00
-
-
11,400.00 BON
-
27,192.00
133,284.00
-
31,842.00
390,274.50
-
363,888.00
82,500.00
97,125.00
-
-
-
59,400.00 BON
35,400.00 BON
254,610.00
-
292,640.00
-
42,224.00
122,360.00 exp.30
-
298,350.00
20,330.00
-
-
1,970.00
125,233.00
hal 4 Hal 4
PERMIN
NILAI KET
TAAN
83,834.00
89,100.00
53,185.77
354,750.00
-
-
434,720.00
1,776,735.00
135,924.00 exp.21
-
32,500.00 BON
17,100.00 BON
284,986.00
-
89,298.00
69,825.00
681,000.00 BON
-
-
23,520.00
-
-
113,766.00
-
264,528.00
48,906.00
-
-
9,681.00
-
53,940.00
33,300.00
21,108.00
hal 5 Hal 5
PERMIN
NILAI KET
TAAN
175,200.00
-
-
180,000.00
79,000.00
108,570.00
305,586.00
5,400.00
76,890.00
13,788.00
369,300.00 BON
143,944.00
131,000.00 BON
-
-
-
-
-
-
2,605.00
-
24,154.00
-
37,800.00
42,840.00
-
-
-
-
133,280.00
847,875.00 BON
-
-
hal 6 Hal 6
PERMIN
NILAI KET
TAAN
510,000.00
539,000.00
34,850.00
111,982.50
-
66,000.00
-
-
42,588.00
46,400.00
148,050.00
1,509,200.00
-
-
-
79,856.00
612,155.00 BON
70,233.00
56,320.00
26,880.00
-
4,139,952.00 BON
-
5,938,500.00 BON
946,000.00 BON
-
152,880.00
-
187,644.00
150,722.00 BON
-
92,685.00
hal 7 Hal 7
PERMIN
NILAI KET
TAAN
299,392.00
-
340,860.00 BON
205,690.00
-
881,414.00
-
543,200.00
-
-
-
-
-
443,176.00 BON
148,480.00
23,811.57
-
809,900.00
-
40,202.00
538,510.00
-
68,875.00
458,687.50
-
15,946.00
-
228,150.00
864,800.00
-
44,100.00
-
3,042,600.00
Hal 8
PERMIN
NILAI KET
TAAN
564,850.00
775,746.00
40,755.00
31,064.00
100,692.00
21,420.00 BON
15,776.80
161,187.00 BON
1,360,194.00 BON
70,000.00
-
87,150.00
75,210.00
-
1,495,827.00
766,456.00
-
-
704,990.00
1,299,782.00
-
-
810.00 exp.260
362,000.00 BON
34,450.00
-
-
397,852.00
-
89,625.00
-
-
192,842.01
HAL9 Hal 9
PERMIN
NILAI KET
TAAN
207,050.00
75,790.00
404,656.00
- BON
257,895.00
178,200.00 BON
2,369,640.00
210,057.48
436,800.00 BON
338,481.00
960,700.00
-
205,119.00
149,270.00
384,000.00
231,000.00
195,000.00
201,000.00
598,000.00
2,775,800.00
-
-
1,094,187.09
-
1,512,000.00
80,000.00
110,000.00
224,000.00
-
70,000.00
400,000.00
483,519.00
HAL 10
PERMIN
NILAI KET
TAAN
41,800.00
456,150.00
125,400.00
456,150.00
129,200.00
456,150.00
-
319,000.00
1,679.51
194,400.00 BON
240,000.00
54,432.00
878,256.00
85,320.00
1,563,000.00
611,800.00
1,485,000.00
311,850.00
467,775.00
1,485,000.00
-
475,200.00
453,264.50
204,815.00
51,000.00
30,100.00
366,100.00
2,843,750.00 BON
2,712,500.00
494,634.00 BON
-
-
-
-
-
-
HAL 11
PERMIN
NILAI KET
TAAN
-
-
460,010.00 BON
-
9,375,000.00
14,400,000.00
-
420,000.00
-
675,000.00
675,000.00
675,000.00
675,000.00
612,500.00
1,950,000.00 BON
-
735,000.00
490,000.00
800,000.00
765,000.00
495,000.00
-
487,500.00 BON
116,311,847.03
1
1
1 8
HAL1
PERMIN
NILAI KET
TAAN
15 16 17
877,371.00
-
60,563.75
244,170.00 1000
-
86,177.52
30,100.00
2,832.00
115,500.00
599,150.09
-
248,745.00
-
85,077.00
2,972,497.50
-
-
519,680.00
-
-
-
7,936.00 2000
78,000.00 BON
103,194.00 100 BON
30,437.00 Exp 10
168,250.00
88,945.20
HAL 2
PERMIN
NILAI KET
TAAN
133,076.00
14,310.00 100
208,800.00
-
-
45,466.00
257,040.00 1000 BON
21,000.00
-
937,737.00 BON
-
5,020.00
-
342,900.00
-
116,235.00
937,080.00
-
-
122,933.00
130,746.00
465,360.00
-
- 10
165,110.00
295,824.00
-
14,235.00
178,486.00 BON
133,840.00
100,572.00
31,724.00
-
-
8,664.00 BON
-
27,192.00
96,048.00
HAL 3
PERMIN
NILAI KET
TAAN
-
31,059.00
359,584.50
-
288,078.00
73,125.00
312,375.00
-
-
-
59,400.00 BON
35,400.00 BON
242,190.00
-
243,552.00 60
-
40,404.00
81,788.00 exp.17
82,200.00
298,350.00
20,330.00
-
-
1,970.00
109,068.00
79,316.00
89,100.00
24,766.83
354,750.00
-
-
423,280.00
2,604,757.50
75,674.00
253,000.00
32,500.00 BON
17,100.00 BON
164,528.00 48
hal 4
PERMIN
NILAI KET
TAAN
-
73,689.00
-
389,078.00 BON
785,000.00
-
-
23,520.00
-
-
161,470.00
-
226,440.00
41,184.00
-
-
6,915.00
-
53,505.00
31,450.00
14,072.00
175,200.00
-
-
164,000.00
55,750.00
124,322.00
118,965.00 200
158,382.00
180,000.00
5,400.00
69,960.00
-
204,346.00 BON
111,250.00
59,432.00
131,000.00 BON
-
Hal 5
PERMIN
NILAI KET
TAAN
-
-
-
-
-
104,200.00
-
20,438.00
-
36,900.00
26,010.00
13,400.00
76,800.00
21,900.00
-
-
137,360.00
308,000.00 BON
-
-
510,000.00
235,800.00
495,000.00
34,850.00
90,415.50
-
59,730.00
-
1,637,460.00
23,660.00
28,000.00
41,760.00
148,050.00
1,509,200.00
-
-
-
188,692.00
hal 6
PERMIN
NILAI KET
TAAN
681,062.50 BON
51,906.00
45,760.00
22,848.00
-
2,759,968.00 BON
-
1,979,500.00 BON
946,000.00 BON
-
126,000.00
-
138,264.00 ex.20
269,178.00 BON
-
92,685.00
258,048.00
-
1,255,800.00 BON
47,585.00
223,800.00
-
1,122,988.00
-
805,100.00
-
-
-
-
-
360,096.00 BON
113,680.00 ex.170
20,871.87
-
618,800.00
-
40,202.00
430,808.00 exp.2
HAL 7
PERMIN
NILAI KET
TAAN
270,000.00
-
239,250.00
6,500.00 ex.821,5
616,000.00
-
11,424.00
-
178,659.00 100
730,250.00
-
44,100.00
-
-
629,200.00
759,357.00
30,907.50
27,104.00
83,910.00
21,420.00 BON
3,198.00
152,921.00 BON
1,321,204.00 BON
70,000.00
-
69,300.00
27,120.00 3000
110,000.00
-
1,381,839.00
623,416.00
-
-
704,990.00
1,244,001.00
-
-
HAL 8
PERMIN
NILAI KET
TAAN
- exp.56
294,306.00 BON
8,450.00
-
-
487,942.00 3000
-
89,625.00
-
-
182,474.16
202,000.00 1850
75,790.00 50
-
2,328,084.00 BON
119,830.00
296,000.00
85,800.00 10 BON
-
-
1,829,000.00
91,109.27
436,800.00 BON
266,409.00
123,750.00
1,053,000.00
-
166,599.00
122,375.00
142,780.00
372,000.00
207,000.00
177,000.00
186,000.00
598,000.00
2,498,220.00
-
HAL 9
PERMIN
NILAI KET
NILAI KET
TAAN
-
987,437.13
-
1,512,000.00
80,000.00
80,000.00 10
224,000.00
-
70,000.00
344,000.00
483,519.00
11,400.00 ex.1
456,150.00
117,800.00 ex.2
456,150.00
129,200.00
456,150.00
-
558,250.00
-
188,568.00 BON
190,000.00
47,520.00
697,680.00
85,320.00
2,657,100.00
1,201,750.00
1,485,000.00
6,237.00
299,376.00
1,485,000.00
-
807,840.00
793,435.50
516,490.00
51,000.00
13,300.00
HAL 10
PERMIN
NILAI KET
TAAN
593,600.00
2,734,375.00 BON
2,712,500.00
- BON
-
-
-
-
-
-
-
-
773,520.00 BON
-
9,375,000.00
14,400,000.00
-
1,260,000.00 2
-
904,000.00
319,000.00 12
-
675,000.00
675,000.00
675,000.00
675,000.00
568,750.00
1,950,000.00 BON
-
735,000.00
490,000.00
800,000.00
765,000.00
HAL 11
PERMIN
NILAI KET
TAAN
495,000.00
-
487,500.00 BON
119,379,907.32
2
1
1 8
HAL 1
PERMIN
NILAI KET
TAAN
15 16 17
871,200.00
-
60,563.75
146,880.00 1000 ex.280
117,000.00
-
86,177.52
28,208.00
2,832.00
115,500.00
428,726.87
-
161,805.00
-
79,488.00
1,403,941.50
-
-
176,640.00
-
-
-
71,296.00 2000 ex.160
78,000.00 BON
210,600.00 100 BON
HAL 2
PERMIN
NILAI KET
TAAN
2,767.00
168,250.00
86,076.00
133,076.00
10,125.00 100
17,900.00
191,400.00
-
-
45,085.00
84,762.00 1000 BON
2,100.00 exp.160
-
531,777.00 BON
-
5,020.00
-
339,090.00
-
67,445.00
922,640.00
-
-
114,056.00
56,210.00
418,824.00
-
385,632.00
147,730.00 20 Exp 10
-
150,624.00 exp190
-
6,786.00
178,486.00 BON
133,840.00
HAL 3
PERMIN
NILAI KET
TAAN
100,572.00
30,076.00
-
-
8,664.00 BON
-
27,192.00
84,390.00
-
13,833.00
277,744.50
-
250,173.00
73,125.00
267,750.00
-
-
59,400.00 BON
35,400.00 BON
220,110.00
-
113,280.00 60 exp.56
244,980.00
-
35,035.00
41,860.00
82,200.00
292,230.00
20,330.00
-
-
1,970.00
92,720.00
Hal 4
PERMIN
NILAI KET
TAAN
79,316.00
89,100.00
-
339,885.98
-
-
366,080.00
1,593,877.50
28,438.00
253,000.00
30,550.00 BON
17,100.00 BON
64,636.00 48
134,976.00
-
73,689.00
-
24,289.00 BON
785,000.00
-
-
17,640.00 exp 60
-
-
74,035.00
-
194,544.00
30,888.00
-
-
6,915.00
-
53,505.00
31,450.00
12,313.00
Hal 5
PERMIN
NILAI KET
TAAN
175,200.00
-
-
120,000.00
22,250.00
124,322.00
190,575.00 200
17,793.00
180,000.00
3,500.00
51,315.00
-
86,170.00 BON
111,250.00
4,256.00
131,000.00 BON
-
-
-
-
-
-
104,200.00
-
11,148.00
-
36,900.00
8,840.00
13,400.00
76,800.00
21,900.00
-
-
-
113,750.00 BON
-
-
Hal 6
PERMIN
NILAI KET
TAAN
510,000.00
-
492,855.00
34,850.00
77,143.50
-
56,980.00
-
1,554,760.00
13,858.00
28,000.00
40,020.00
91,350.00
1,509,200.00
-
-
-
118,174.00
570,490.00 BON
49,323.00
45,760.00
22,848.00
-
2,759,968.00 BON
-
1,979,500.00 BON
946,000.00 BON
-
105,840.00
-
125,096.00
178,789.00 BON
-
92,685.00
Hal 7
PERMIN
NILAI KET
TAAN
231,552.00
-
735,540.00 BON
-
164,493.00
-
576,630.00
-
688,700.00
-
-
-
-
-
180,048.00 BON
87,435.00 ex.80
17,932.17
-
555,100.00
-
-
- exp.27
247,500.00
-
228,375.00
- ex.90
401,878.40
-
6,545.00
-
162,513.00 100
594,895.00
-
44,100.00
-
-
Hal 8
PERMIN
NILAI KET
TAAN
378,950.00
753,894.00
26,877.50
23,144.00
67,128.00
11,781.00 BON
3,198.00
78,527.00 BON
769,774.00 BON
70,000.00
-
51,450.00
- 3000
234,795.00
-
1,269,267.00
395,148.00
-
-
668,525.00
661,265.00
-
-
-
182,086.00 BON
8,450.00
-
-
405,951.00 3000
-
89,625.00
-
-
161,738.46
Hal 9
PERMIN
NILAI KET
TAAN
389,860.00 1850
6,578.00 50
16,350.00
- BON
1,764,840.00 exp.110
5,210.00
296,000.00 BON
85,800.00 10
-
-
1,471,880.00
27,838.94 BON
436,800.00
223,938.00
123,750.00
952,900.00
-
151,191.00
122,375.00
137,912.50
372,000.00
207,000.00
174,000.00
180,000.00
598,000.00
2,498,220.00
-
-
925,166.32
-
1,512,000.00
80,000.00
130,000.00 10
224,000.00
-
65,625.00
296,000.00
483,519.00
HAL 10
PERMIN
NILAI KET
TAAN
-
337,551.00
87,400.00
456,150.00
129,200.00
456,150.00
-
494,450.00
-
167,184.00 BON
140,000.00
43,200.00
517,104.00
76,788.00
2,188,200.00
808,450.00
1,182,060.00
-
212,058.00
1,485,000.00
-
617,760.00
697,261.50
365,105.00
48,000.00
7,000.00
465,500.00
2,734,375.00 BON
2,384,375.00
- BON
-
-
-
-
-
-
HAL 11
PERMIN
NILAI KET
TAAN
-
-
187,520.00 BON
-
9,375,000.00
14,400,000.00
-
5,460,000.00 2
-
452,000.00
957,000.00 12
-
675,000.00
675,000.00
675,000.00
675,000.00
- exp.3
1,950,000.00
-
682,500.00
428,750.00
600,000.00
688,500.00
495,000.00
-
325,000.00 BON
107,916,035.91
###
3
1
1 8
HAL 1
PERMIN
NILAI KET
TAAN
15 16 17
863,214.00
-
23,293.75
- EX.1100
173,979.00
115,000.00
86,177.52
25,800.00
2,832.00
115,500.00
186,436.14
-
452,865.00
-
70,173.00
884,584.50
-
-
97,280.00
-
-
-
119,296.00
-
107,406.00
HAL 2
PERMIN
NILAI KET
TAAN
-
137,965.00
86,076.00
133,076.00
8,505.00
17,900.00
40,600.00 EX.18
-
-
- EX.302
298,248.00
1,050.00
-
670,803.00
-
5,020.00
-
330,327.00
-
123,410.00
883,120.00
-
-
107,600.00
1,540.00
115,000.00
- EX.51
-
299,936.00
5,214.00 EX.82
34,800.00
77,760.00
-
16,341.00
178,486.00
133,840.00
HAL 3
PERMIN
NILAI KET
TAAN
100,572.00
30,076.00
-
-
8,664.00
-
24,102.00
70,296.00 RSK 46
-
9,135.00
228,640.50
-
197,106.00
69,375.00
227,718.75
-
-
-
59,400.00
35,400.00
211,830.00
-
77,408.00 EX.60
-
-
30,212.00
-
131,246.00
292,230.00
20,330.00
-
-
1,970.00
73,932.00
Hal 4
PERMIN
NILAI KET
TAAN
77,810.00
89,100.00
-
249,318.30
-
-
354,640.00 EX.1
1,511,460.00
-
236,808.00
28,600.00
17,100.00
-
289,636.00
-
65,219.00
-
-
467,703.00
-
-
12,152.00 EX.30
-
-
36,649.00
-
162,936.00
23,738.00
-
-
5,532.00
-
51,185.00
14,800.00 EX.6
-
Hal 5
PERMIN
NILAI KET
TAAN
94,900.00 EX.13
-
-
104,000.00
7,000.00
124,322.00
65,835.00
-
113,242.50
3,500.00
27,390.00
-
-
104,575.00 EX.5
-
95,368.00
-
-
-
-
-
-
104,200.00
-
9,290.00
-
36,900.00
-
5,092.00
76,800.00
21,900.00
-
-
549,440.00
760,375.00
-
-
Hal 6
PERMIN
NILAI KET
TAAN
510,000.00
-
320,100.00
34,850.00
40,645.50
115,000.00
55,220.00
-
1,554,760.00
3,887.00
28,000.00
37,700.00
22,050.00
1,509,200.00
-
-
-
242,144.00
459,917.50
49,323.00
42,240.00
22,848.00
-
2,759,968.00
-
4,354,900.00
709,500.00
-
77,280.00
-
98,760.00
78,676.00
78,720.00
92,685.00
Hal 7
PERMIN
NILAI KET
TAAN
203,392.00
-
77,740.00
101,300.00
69,378.00
-
68,542.00
102,000.00
436,500.00
-
-
-
-
-
241,180.00
65,395.00
7,251.26
-
336,700.00
-
-
-
202,500.00
-
216,593.75
-
330,052.80
-
-
70,725.00
125,307.00
451,950.00
-
44,100.00
-
-
Hal 8
PERMIN
NILAI KET
TAAN
207,350.00
726,579.00
18,752.50
18,744.00
41,955.00
23,347.80
3,198.00
74,394.00
285,184.00
455,000.00
70,000.00
-
32,550.00
-
369,490.00
-
1,159,704.00
463,986.00
-
-
668,525.00
681,109.00
1,101,000.00
-
-
87,604.00
8,450.00
-
-
258,167.00
-
71,700.00
-
-
161,738.46
Hal 9
PERMIN
NILAI KET
TAAN
323,200.00
-
8,502.00
-
1,168,992.00
-
444,000.00
224,400.00
-
-
1,149,480.00
-
381,472.00
177,606.00
123,750.00
643,500.00
-
135,783.00
122,375.00
131,422.50
357,000.00
204,000.00
174,000.00
153,000.00
598,000.00
2,498,220.00
-
-
925,166.32
-
1,512,000.00
80,000.00
90,000.00
224,000.00
-
70,000.00
236,000.00
428,781.00
HAL 10
PERMIN
NILAI KET
TAAN
-
237,198.00
87,400.00
456,150.00
129,200.00
456,150.00
-
390,775.00
-
143,856.00
140,000.00
38,016.00
381,672.00
59,724.00
1,875,600.00
589,950.00
974,160.00
-
43,659.00
1,485,000.00
-
415,800.00
599,306.50
270,712.00
45,000.00
-
352,100.00
2,734,375.00
2,100,000.00
-
-
-
-
-
-
-
HAL 11
PERMIN
NILAI KET
TAAN
544,980.00
-
- EX.6
- EX.6
-
3,990,000.00
-
452,000.00
-
-
675,000.00
675,000.00
675,000.00
675,000.00
306,250.00
1,787,500.00
-
630,000.00
367,500.00
400,000.00
382,500.00
495,000.00
-
162,500.00
77,174,804.85
4
2
1 8
HAL 1
PERMIN
NILAI KET
TAAN
15 16 17
855,228.00
-
23,293.75
-
128,115.00
115,000.00
488,000.00
86,177.52
24,252.00
826.00
115,500.00
787,873.79
-
321,825.00
-
105,984.00
2,278,274.00 10000
-
-
71,680.00
880,000.00
-
-
-
408,704.00
-
341,172.00
HAL 2
PERMIN
NILAI KET
TAAN
-
134,600.00
187,454.40
129,574.00
7,290.00
17,900.00
359,600.00
82,500.00
-
-
143,040.00
421,056.00
1,050.00
-
687,786.00
-
5,020.00
-
290,322.00
-
213,815.00
821,560.00
-
-
95,495.00
81,466.00
115,000.00
-
64,272.00
5,214.00
34,800.00
538,992.00
-
47,190.00
25,498.00 ex 12
133,840.00
HAL 3
PERMIN
NILAI KET
TAAN
100,572.00
28,016.00
-
-
8,664.00
-
17,922.00
59,160.00
65,100.00
9,135.00
283,882.50
323,050.00
197,106.00
63,750.00
455,437.50
-
-
-
59,400.00
35,400.00
181,470.00
-
1,888.00
367,470.00
-
29,939.00
-
132,616.00
284,580.00
20,330.00
-
-
1,970.00
51,240.00
HAL 4
PERMIN
NILAI KET
TAAN
47,188.00
89,100.00
-
173,472.75
-
-
337,480.00
3,294,270.00
-
123,970.00 500
20,995.00
17,100.00
211,536.00
151,848.00
-
64,130.00
392,217.00
-
467,703.00
-
9,300.00
12,152.00
-
285,000.00
25,058.00
-
201,240.00
31,031.00
-
-
1,383.00
-
50,315.00
14,800.00
-
HAL 5
PERMIN
NILAI KET
TAAN
21,900.00 ex10
-
-
180,000.00
-
421,451.58
262,185.00
-
534,037.50
3,500.00
9,570.00
89,500.00
-
471,700.00
-
312,631.50
-
-
-
-
-
-
79,713.00
-
8,361.00
254,640.00
36,000.00
-
41,674.00
76,800.00
21,900.00
-
-
340,000.00
812,875.00
-
-
HAL 6
PERMIN
NILAI KET
TAAN
510,000.00
-
340,395.00
27,200.00
3,910.50
172,500.00
48,180.00
-
858,426.00
-
48,860.00
30,740.00
302,400.00
1,455,300.00
-
-
-
586,845.00
632,987.50
46,863.00
35,200.00
85,700.00
14,784.00
62,700.00
1,379,984.00
7,175,900.00
1,583,600.00
473,000.00
23,520.00
180,000.00
79,008.00
-
297,496.00
92,685.00
HAL 7
PERMIN
NILAI KET
TAAN
177,792.00
-
544,180.00
101,300.00
290,940.00
-
1,538,927.00
-
218,250.00
-
-
-
-
-
654,224.00
43,645.00 500
7,251.26
-
1,110,200.00
-
-
369,264.00
90,000.00
-
206,625.00
-
1,329,882.40
- 200
-
62,445.00
104,247.00
914,135.00
-
44,100.00
-
-
HAL 8
PERMIN
NILAI KET
TAAN
622,050.00
715,653.00
77,480.00
73,832.00
83,910.00
4,284.00
56,498.00
227,315.00
-
1,073,345.00
70,000.00
94,945.00
32,550.00
-
807,125.00
-
948,897.00
1,398,216.00
-
-
619,905.00
2,727,703.00
-
-
-
540,828.00
8,450.00
-
-
1,063,699.00
-
191,200.00
-
-
111,972.78
HAL 9
PERMIN
NILAI KET
TAAN
353,500.00
-
24,852.00
-
1,745,700.00
-
605,616.00
184,800.00
-
-
792,360.00
-
1,032,304.00
74,646.00
247,500.00
1,112,800.00
-
128,079.00
122,375.00
128,177.50
330,000.00
195,000.00
162,000.00
141,000.00
592,800.00
2,054,092.00
-
-
747,249.72
-
1,512,000.00
80,000.00
240,000.00
224,000.00
-
61,250.00
148,000.00
310,937.50
757,209.00
HAL 10
PERMIN
NILAI KET
TAAN
385,000.00
100,353.00
87,400.00
456,150.00
129,200.00
456,150.00
614,075.00
310,000.00
132,192.00
90,000.00
507,600.00
76,032.00
225,720.00
225,000.00
59,724.00
3,126,000.00
262,200.00
1,191,168.00
1,247,400.00
677,160.00
1,223,640.00
-
1,372,140.00
1,223,640.00
267,300.00
341,896.00
592,182.50
23,153.00
237,600.00
45,000.00
390,600.00
3,171,875.00
1,640,625.00
-
HAL 11
PERMIN
NILAI KET
TAAN
1,186,650.00
-
-
-
-
5,250,000.00
-
6,780,000.00
4,785,000.00
-
632,812.50
632,812.50
632,812.50
632,812.50
306,250.00
1,300,000.00
-
630,000.00
245,000.00
400,000.00
2,448,000.00
1,980,000.00
-
1,056,250.00
124,254,337.45
-
5
2
1 8
HAL 1
PERMIN
NILAI KET
TAAN
15 16 17
851,961.00
-
23,293.75
-
96,291.00
115,000.00
488,000.00
86,177.52
22,360.00
-
114,510.00
558,545.90
-
210,105.00
102,258.00
3,183,712.00
-
-
699,600.00
290,880.00
265,356.00
134,600.00
182,672.40
129,574.00
4,320.00
17,900.00
348,000.00
82,500.00
HAL 2
PERMIN
NILAI KET
TAAN
134,100.00
257,652.00
1,050.00
600,780.00
-
5,020.00
259,461.00
176,505.00
804,840.00
88,770.00
23,870.00
115,000.00
-
59,987.20
5,214.00
34,800.00
421,200.00
-
38,103.00
- ex 2
133,840.00
43,928.00 ex49
26,780.00
8,664.00
-
17,922.00
49,938.00
65,100.00
- ex 17,5
274,675.50
323,050.00
68,229.00 ex 6
63,750.00
422,625.00
-
-
59,400.00
35,400.00
HAL 3
PERMIN
NILAI KET
TAAN
129,030.00
-
289,893.00
27,846.00
107,408.00
284,580.00
20,330.00
1,970.00
92,781.00
41,164.00
89,100.00
210,000.00
105,928.35
326,040.00
2,251,395.00
552,552.00 500
13,520.00
17,100.00
208,598.00
-
64,130.00
193,515.00
467,703.00
-
9,300.00
12,152.00
-
248,292.00
-
-
174,168.00
25,025.00
1,383.00
47,705.00
12,950.00
14,600.00
168,000.00
HAL 4
PERMIN
NILAI KET
TAAN
399,695.23
172,095.00
423,607.50
3,500.00
-
81,803.00
364,900.00
289,575.50
45,848.00
-
8,361.00
176,126.00
36,000.00
23,852.00
76,800.00
21,900.00
- ex 446
218,750.00 ex208
-
510,000.00
529,980.00
9,350.00
-
161,000.00
42,130.00
458,158.00
40,320.00
23,780.00
198,450.00
1,455,300.00
492,499.00
549,657.50
45,510.00
35,200.00
85,700.00
14,784.00
62,700.00
HAL 5
PERMIN
NILAI KET
TAAN
-
7,175,900.00
1,187,700.00
473,000.00
18,480.00
184,250.00
180,000.00
69,132.00
-
197,620.00
- e.5
154,496.00
208,000.00
364,780.00
32,416.00
290,940.00
1,082,095.00
9,700.00
533,448.00
27,695.00 500
7,251.26
964,600.00
369,264.00
22,500.00
195,750.00
1,059,704.80
54,579.00
58,968.00
627,555.00 E1100
48,580.00
44,100.00
-
-
572,000.00
704,727.00
-
HAL 6
PERMIN
NILAI KET
TAAN
71,370.00
18,920.00 E559
72,722.00
-
54,366.00
210,783.00
-
1,051,050.00
70,000.00
94,945.00
14,700.00
-
739,255.00
849,069.00
1,135,082.00
595,595.00
2,306,381.00
480,193.00
8,450.00
-
765,674.00
-
119,500.00 E60
16,000.00
45,618.54
345,420.00
24,852.00
1,256,772.00
494,320.00
99,000.00
-
-
503,440.00
934,752.00
1,287.00
247,500.00
980,200.00
HAL 7
PERMIN
NILAI KET
TAAN
104,004.00
122,375.00
120,065.00
330,000.00
192,000.00
156,000.00
135,000.00
592,800.00
1,720,996.00
1,008,000.00
640,499.76
1,086,768.00
1,512,000.00
80,000.00
220,000.00
224,000.00
-
52,500.00
76,000.00
310,937.50
757,209.00
385,000.00
100,353.00
83,600.00
456,150.00
117,800.00
456,150.00
558,250.00
279,000.00
132,192.00
90,000.00
507,600.00
72,576.00
496,584.00
225,000.00
59,724.00
2,500,800.00
HAL 8
PERMIN
NILAI KET
TAAN
-
1,191,168.00
1,247,400.00
451,440.00
1,223,640.00
1,372,140.00
801,484.20
-
338,477.04
586,839.50
468,403.00
147,312.00
45,000.00
217,700.00
3,150,000.00
1,334,375.00
772,500.02
486,380.00
4,200,000.00
-
5,876,000.00
-
2,552,000.00
HAL 9
PERMIN
NILAI KET
TAAN
548,437.50
548,437.50
548,437.50
548,437.50
262,500.00
1,300,000.00
-
577,500.00
183,750.00
400,000.00
2,371,500.00
1,856,250.00
-
975,000.00
108,963,649.97
6
2
1 8
HAL 1
PERMIN
NILAI KET
TAAN
16 17
850,872.00
-
23,293.75
69,849.00
92,000.00
488,000.00
86,177.52
20,812.00
114,015.00
417,289.07
-
114,870.00
99,774.00
2,100,728.00
517,000.00
219,328.00
189,540.00
117,775.00
181,716.00
119,068.00
1,485.00
17,900.00
319,000.00
82,500.00
134,100.00
135,813.00
1,050.00
275,400.00
HAL 2
PERMIN
NILAI KET
TAAN
16 17
5,020.00
240,411.00
147,805.00
785,080.00
82,045.00
-
102,005.00
51,417.60
- ex.3
33,060.00
346,608.00
33,423.00
133,840.00
36,992.00 ex.6
26,162.00
8,664.00
-
17,922.00
44,370.00
61,845.00
274,675.50
323,050.00
68,229.00
60,000.00
367,500.00
59,400.00
35,400.00
103,500.00
159,200.00
159,237.00
25,116.00
16,800.00
15,892.00 ex.201
81,900.00
284,580.00
- ex. 5
HAL 3
PERMIN
NILAI KET
TAAN
16 17
1,970.00
74,481.00
- ex.279
28,809.00
210,000.00
63,819.53
240,240.00
1,436,535.00
471,086.00
8,840.00
17,100.00
279,110.00
64,130.00
32,585.00
467,703.00
9,300.00
12,152.00
-
193,173.00
143,856.00
23,309.00
1,383.00
47,270.00
12,950.00
7,300.00 ex.1
152,000.00
335,669.40
- ex 100
331,065.00
3,500.00
78,760.00
280,350.00
242,677.50
45,848.00
7,432.00
21,220.00
HAL 4
PERMIN
NILAI KET
TAAN
16 17
36,000.00
80,132.00
76,800.00
21,900.00
- ex.90
245,000.00
510,000.00
345,675.00
9,350.00
156,400.00
34,980.00
1,756,548.00
32,900.00
13,920.00
151,200.00
1,455,300.00
459,977.00
434,277.50
45,018.00
35,200.00
85,700.00
14,784.00
62,700.00
3,311,872.00
4,305,540.00
-
473,000.00
-
180,565.00
180,000.00
65,840.00
139,072.00
141,184.00
208,000.00
364,780.00
HAL 5
PERMIN
NILAI KET
TAAN
16 17
-
248,418.00
748,071.00
9,700.00
429,784.00
14,500.00 ex.11
-
65,567.00
828,100.00
338,492.00
-
184,875.00
906,813.60
50,991.00
19,305.00
537,050.00 ex.50
27,760.00
44,100.00
407,550.00
180,279.00 ex.95
57,265.00
10,120.00 ex.100
44,752.00
46,904.00
181,852.00
666,575.00
70,000.00
94,945.00
9,450.00
683,100.00
759,861.00
991,744.00
583,440.00
1,908,412.00
440,373.00
HAL 6
PERMIN
NILAI KET
TAAN
16 17
8,450.00
538,902.00
119,500.00
14,320.00
-
335,320.00
24,852.00
828,828.00
333,296.00
59,400.00
-
-
244,280.00
761,488.00
-
170,775.00
894,400.00
90,522.00
122,375.00
116,820.00
318,000.00
186,000.00
156,000.00
135,000.00
592,800.00
1,415,658.00
1,008,000.00
498,166.48
1,086,768.00
1,512,000.00
80,000.00
200,000.00
224,000.00
48,125.00
8,000.00
HAL 7
PERMIN
NILAI KET
TAAN
16 17
310,937.50
711,594.00 ex.3
385,000.00
100,353.00
83,600.00
456,150.00
117,800.00
456,150.00
470,525.00
279,000.00
114,696.00
50,000.00
507,600.00
68,256.00
381,672.00
225,000.00
59,724.00
1,563,000.00
843,744.00
1,247,400.00
255,420.00
1,223,640.00
1,372,140.00
360,973.80
253,003.04
467,512.50
267,150.00
-
45,000.00
434,000.00
3,040,625.00
853,125.00
772,500.02
486,380.00
3,780,000.00
5,876,000.00
957,000.00
HAL 8
PERMIN
NILAI KET
TAAN
548,437.50
548,437.50
548,437.50
548,437.50
218,750.00
1,300,000.00
-
577,500.00
183,750.00
400,000.00
2,371,500.00
1,856,250.00
-
975,000.00
94,435,107.31
( LPLPO )

PUSKESMAS : Benteng
KECAMATAN : Benteng BULAN
BULAN 1
NO SAT/K STOK PENE PERSE PEMA
MSN AWAL
URUT RIMAAN DIAAN KAIAN
1 2 3 4 5 6 7 8 9 10 11 12 13
1 21.01.01.4154.02 ALBENDAZOL TABLET 400 MG Tab 363.00 2428 881,364.00 - 2428 881,364.00 11 3,993.00
2 21.01.01.4154.03 ALBENDAZOL SIRUP Btl 4,234.00 0 - - 0 - -
3 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 3.5 83,857.50 - 3.5 65,222.50 0.25 4,658.75
4 07.01.02.5044.01 ALOPURINOL TABLET 100 MG Tab 90.00 3206 288,540.00 - 3206 288,540.00 493 44,370.00
5 07.01.02.5044.02 ALOPURINOL TABLET 300 MG Tab 224.50 0 - - 0 - -
6 22.01.01.5159.01 AMINOFILIN INJEKSI 24 MG/ML Amp 3,314.52 26 86,177.52 - 26 86,177.52 -
7 22.01.01.5159.03 AMINOFILIN TABLET 200 MG Tab 86.00 372 31,992.00 - 372 31,992.00 22 1,892.00
8 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 24 2,832.00 - 24 2,832.00 -
9 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 700 115,500.00 - 700 115,500.00 -
10 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 3986 759,851.18 - 3986 759,851.18 843 160,701.09
11 22.01.01.5158.02 AMBROKSOL SIRUP Btl 2,722.00 0 - - 0 - -
12 AMLODIPIN 5 MG Tab 105.00 3081 323,505.00 - 3081 323,505.00 712 74,760.00
13 01.01.04.5100.01 AMOKSISILIN KAPSUL 250 MG Kap 220.00 0 - - 0 - -
15 AMOKSISILLIN KAPLET 500 MG Kap 233.00 4704 1,096,032.00 15000 3,495,000.00 19704 4,591,032.00 6946.5 1,618,534.50
16 01.01.04.5100.02 AMOKSISILIN KAPLET 500 MG/RAMOXYL Kap 608.00 0 - - 0 - -
17 01.01.04.5100.03 AMOKSISILIN VIAL 1 G Vial 8,135.00 0 - - 0 - -
18 01.01.04.5100.04 AMOKSISILIN SIROP KERING 125 Btl 2,560.00 88 225,280.00 240 614,400.00 328 839,680.00 125 320,000.00
19 01.01.04.5131.02 AMPICILIN SERBUK INJ 1 G Vial 5,905 0 - - 0 - -
20 01.01.04.5131.05 AMPICILIN KAPLET 250 MG Kap 0 - - 0 - -
21 01.01.04.5131.06 AMPICILIN KAPLET 500 MG Kap 419.10 0 - - 0 - -
23 ANTASIDA DOEN TABLET KUNYAH Tab 78.00 1000 78,000.00 - 1000 78,000.00 -
24 15.01.01.5334.02 ANTASIDA DOEN II SUSPENSI Btl 2,106.00 92 193,752.00 - 92 193,752.00 43 90,558.00
25 01.01.00.5335.01 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 2,767.00 24 66,408.00 - 24 66,408.00 13 35,971.00
26 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 50 168,250.00 - 50 168,250.00 -
27 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 19.8 94,683.60 - 19.8 94,683.60 1.2 5,738.40
BULAN 1
MSN AWAL
28 12.05.01.5340.01 ANTIHEMOROID DOEN KOMBINASI Pot 3,502.00 38 133,076.00 - 38 133,076.00 -
29 10.02.01.5338.01 ANTIMIGREN Tab 135.00 145 19,575.00 - 145 19,575.00 39 5,265.00
30 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 39 226,200.00 - 39 226,200.00 3 17,400.00
31 22.01.01.5163.01 ARTESUNATE INJEKSI VIAL 60 MG Amp 0 - - 0 - -
33 07.01.02.5041.01 ASAM ASETIL SALISILAT 100 MG Tab 127.00 383 48,641.00 - 383 48,641.00 25 3,175.00
35 05.03.07.5164.02 ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 300 31,500.00 - 300 31,500.00 100 10,500.00
36 22.01.01.5166.02 AS.MEFENAMAT TABLET SALUT 500 MG Tab 113.00 0 - - 0 - -
37 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 2993.5 305,337.00 10000 1,020,000.00 12993.5 1,325,337.00 3800 387,600.00
38 22.01.01.5168.01 ASIKLOVIR KRIM 5 % Tube 2,367.00 0 - - 0 - -
39 22.01.01.5168.02 ASIKLOVIR TABLET 200 MG Tab 251.00 20 5,020.00 - 20 5,020.00 -
41 22.01.01.5168.03 ASIKLOVIR TABLET 400 MG Tab 381.00 967 368,427.00 - 967 368,427.00 67 25,527.00
42 07.07.02.5049.04 ATROPIN TETES MATA 0.5 % Btl 0 - - 0 - -
43 22.01.01.5172.01 BETAMETASON KRIM 0,1 % Tube 1,435.00 122 175,070.00 - 122 175,070.00 41 58,835.00
47 CARBAMAZEPIN TAB 200 MG Tab 269.00 457 122,933.00 - 457 122,933.00 -
49 CETIRIZINE SIRUP Btl 7,756.00 60 465,360.00 - 60 465,360.00 -
50 CLOBAZAM TAB 10 MG Tab 1,045.00 0 - - 0 - -
51 CHATHEJELL Tab 4,284.80 0 - - 0 - -
52 22.01.01.5176.01 DEKSAMETASON INJ 5 MG/ML Amp 1,738.00 95 165,110.00 - 95 165,110.00 -
54 22.01.01.5179.01 DIAZEPAM INJ 2 MG/ML Amp 2,605 0 - - 0 - -
55 22.01.01.5179.02 DIAZEPAM TABLET 2 MG Tab 39.00 106 4,134.00 500 19,500.00 606 23,634.00 241 9,399.00
56 DIAZEPAM RECTAL Tube 12,749.00 14 178,486.00 - 14 178,486.00 -
57 22.01.01.5179.03 DIAZEPAM RECTAL Tube 13,384.00 0 - 10 133,840.00 10 133,840.00 -
58 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 -
59 22.01.01.5181.01 DIGOKSIN TABLET 0,25 MG Tab 103.00 308 31,724.00 - 308 31,724.00 -
60 22.01.01.5182.01 DILTIAZEM TAB 30 MG Tab 141.00 0 - - 0 - -
61 22.01.01.5183.01 DIMENHIDRINAT TAB 50 MG Tab 109.00 0 - - 0 - -
62 DIMENHIDRINAT TAB 50 MG Tab 114.00 100 11,400.00 - 100 11,400.00 24 2,736.00
63 22.01.01.5181.02 DOMPORIDON SIRUP Btl 3,490.00 0 - - 0 - -
64 22.01.01.5185.01 DOKSISIKLIN KAPSUL 100 MG Kap 309.00 88 27,192.00 - 88 27,192.00 -
65 22.01.01.5186.01 DOMPERIDON TABLET 10 MG Tab 174.00 766 133,284.00 - 766 133,284.00 214 37,236.00
BULAN 1
URUT MSN AWAL RIMAAN DIAAN KAIAN
66 22.01.01.5188.01 EKSTRAK BELLADONA TABLET 10 MG Tab 42.00 0 - - 0 - -
67 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 61 31,842.00 - 61 31,842.00 1.5 783.00
68 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 381.5 390,274.50 - 381.5 390,274.50 30 30,690.00
69 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 8,090.00 0 - - 0 - -
71 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 22 82,500.00 - 22 82,500.00 2.5 9,375.00
72 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 37 97,125.00 100 262,500.00 137 359,625.00 18 47,250.00
73 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - -
75 20.02.01.5261.01 EUGENOL CAIRAN Btl 18,333.00 0 - - 0 - -
76 07.02.01.5051.03 FENOBARBITAL AMPUL 2 ML Btl 1,980 30 59,400.00 - 30 59,400.00 -
77 07.02.01.5051.01 FENOBARBITAL TABLET 30 MG Tab 177.00 200 35,400.00 - 200 35,400.00 -
78 05.03.13.5196.01 FITOMENADION (VIT K) TABLET 10 MG Tab 690.00 369 254,610.00 - 369 254,610.00 18 12,420.00
79 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 0 - - 0 - -
80 05.03.13.5196.02 FITOMENADION (VIT K) INJ 10 MG/ML Amp 1,888.00 155 292,640.00 - 155 292,640.00 26 49,088.00
81 FUROSEMIDA TABLET 40 MG Tab 84.00 0 - - 0 - -
82 16.02.01.3523.02 FUROSEMIDA TABLET 40 MG Tab 91.00 464 42,224.00 - 464 42,224.00 20 1,820.00
83 15.03.01.5200.01 GARAM ORALIT I SERBUK Sac 322.00 380 122,360.00 - 380 122,360.00 126 40,572.00
84 GARAM ORALIT I SERBUK Sac 274.00 0 - 300 82,200.00 300 82,200.00 -
85 22.01.01.5201.01 GEMFIBROZIL KAPSUL 300 MG Kap 306.00 975 298,350.00 - 975 298,350.00 -
86 17.09.01.5202.01 GENTAMISIN INJ 80 MG/ML Amp 4,066 5 20,330.00 - 5 20,330.00 -
87 17.09.01.5202.02 GENTAMISIN SALEP KULIT Pot 1,469.00 0 - - 0 - -
88 17.09.01.5202.03 GENTAMISIN SULFAT TETES MATA 0,3 % Pot 3,513.00 0 - - 0 - -
89 22.01.01.5203.01 GENTIAN VIOLET 1 % Btl 985.00 2 1,970.00 - 2 1,970.00 -
90 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 61.00 2053 125,233.00 - 2053 125,233.00 265 16,165.00
93 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 30.69 1733 53,185.77 - 1733 53,185.77 926 28,418.94
94 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 5000 354,750.00 - 5000 354,750.00 -
95 04.02.01.5208.01 GLUKOSA LARUTAN INFUS 10 % Btl 6,270.00 0 - - 0 - -
96 04.02.01.5208.02 GLUKOSA LARUTAN INFUS 40 % Btl 1,597.00 0 - - 0 - -
97 04.02.01.5208.03 GLUKOSA LARUTAN INFUS 5 % Btl 5,720.00 76 434,720.00 - 76 434,720.00 2 11,440.00
98 GRANTUSIF Tab 405.00 4387 1,776,735.00 5000 2,025,000.00 9387 3,801,735.00 2955.5 1,196,977.50
99 22.01.01.5209.02 GRISEOFULVIN TABLET 125 MG Tab 241.00 564 135,924.00 - 564 135,924.00 250 60,250.00
100 GRISEOFULVIN TABLET 125 MG Tab 506.00 0 - 500 253,000.00 500 253,000.00 -
101 22.01.01.5210.01 HALOPERIDOL TABLET 1.5 MG Tab 65.00 500 32,500.00 - 500 32,500.00 -
102 12.01.01.5089.01 HIDROKLOROTIAZIDA TABLET 25 MG Tab 171.00 100 17,100.00 - 100 17,100.00 -
103 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,938.00 97 284,986.00 - 97 284,986.00 41 120,458.00
BULAN 1
URUT MSN AWAL RIMAAN DIAAN KAIAN
104 HYOSIN BUTIL BROMIDA TAB 10 MG Tab 330.00 0 - - 0 - -
105 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 738 89,298.00 - 738 89,298.00 129 15,609.00
IBUPROFEN TABLET 400 MG Tab 157.00 5000 785,000.00 5000 785,000.00 0 -
109 22.01.01.5214.02 ISONIAZID TABLET 300 MG Tab 106.70 0 - - 0 - -
110 22.01.01.5215.01 ISOSORBID DINITRAT TABLET 5 MG Tab 98.00 240 23,520.00 - 240 23,520.00 -
112 KALSIUM GLUCONAS INJ Amp 10,437 0 - - 0 - -
114 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - -
115 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 3674 264,528.00 - 3674 264,528.00 529 38,088.00
116 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 342 48,906.00 - 342 48,906.00 54 7,722.00
120 22.01.01.5224.01 KLONIDIN TABLET 0.15 MG Tab 224.00 0 - - 0 - -
121 KLONIDIN TABLET 0.15 MG Tab 145.00 372 53,940.00 - 372 53,940.00 3 435.00
122 01.01.02.5225.02 KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 18 33,300.00 - 18 33,300.00 1 1,850.00
123 01.01.02.5225.05 KLORAMFENIKOL TETES TELINGA 3 % Tube 1,759.00 12 21,108.00 - 12 21,108.00 4 7,036.00
124 KLORAMFENIKOL TETES TELINGA 3 % Tube 7,300.00 24 175,200.00 - 24 175,200.00 0 -
125 01.01.02.5225.04 KLORAMFENIKOL TETES MATA 0.5 % Tube 0 - - 0 - -
126 01.01.02.5225.03 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,016.00 0 - - 0 - 0 -
128 01.01.02.5225.01 KLORAMFENIKOL KAPSUL 250 MG Kap 250.00 316 79,000.00 - 316 79,000.00 93 23,250.00
129 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 200 124,322.00 200 124,322.00 -
131 22.01.01.5226.01 KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 5659 305,586.00 - 5659 305,586.00 2726 147,204.00
132 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 4000 180,000.00 4000 180,000.00 -
134 22.01.01.5228.04 KLORPROMAZIN TAB SALUT 100 MG Tab 165.00 466 76,890.00 - 466 76,890.00 42 6,930.00
135 01.06.01.5142.03 KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 6 13,788.00 - 6 13,788.00 6 13,788.00
137 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 50 111,250.00 50 111,250.00 -
138 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 152.00 947 143,944.00 - 947 143,944.00 556 84,512.00
139 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 1000 131,000.00 - 1000 131,000.00 -
140 01.06.01.5142.01 KOTRIMOKSAZOL DOEN II (ANAK) Tab 79.00 0 - - 0 - -
BULAN 1
MSN AWAL
141 19.02.01.5068.02 KUINIDIN 100 MG TABLET Tab 0 - - 0 - -
142 19.02.01.5068.01 KUINIDIN 200 MG TABLET Tab 0 - - 0 - -
143 01.02.01.5231.01 KUININ (KINA) TABLET 200 MG Tab 0 - - 0 - -
144 01.02.01.5231.03 KUININ INJEKSI 25 % Tab 0 - - 0 - -
145 01.02.01.5231.04 KUININ SULFAT TAB 222 MG (7 H2O) Tab 641.67 0 - - 0 - -
146 LANSOPRAZOL 30 MG KAP 521.00 5 2,605.00 200 104,200.00 205 106,805.00 5 2,605.00
148 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 26 24,154.00 - 26 24,154.00 4 3,716.00
149 22.01.01.5237.01 LISOL DENGAN KRESOL SABUN 50 % Btl 31,800.00 0 - - 0 - -
150 LOPERAMIDE Tab 90.00 420 37,800.00 - 420 37,800.00 10 900.00
152 LORATADIN TAB Tab 134.00 100 13,400.00 100 13,400.00 -
153 MgSO4 20% Btl 3,200 0 - 24 76,800.00 24 76,800.00 -
154 MgSO4 40% Btl 3,650 0 - 6 21,900.00 6 21,900.00 -
155 22.01.01.5240.01 MEBENDAZOL SIROP 100 MG/ 5 ML Btl 0 - - 0 - -
156 22.01.01.5240.02 MEBENDAZOL TABLET 100 MG Tab 0 - - 0 - -
157 MELOXICAM 7,5 mg Tab 680 196 133,280.00 200 136,000.00 396 269,280.00 194 131,920.00
158 MELOXICAM 15 mg Tab 875 969 847,875.00 - 969 847,875.00 617 539,875.00
159 07.01.02.5043.01 METAMPIRON TABLET 500 MG (ANTALGIN) Tab 141.85 0 - - 0 - -
160 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 133.10 0 - - 0 - -
161 22.01.01.5245.02 METILERGOMETRIN MALEAT INJ 0.2 MG Amp 8,500.00 60 510,000.00 - 60 510,000.00 -
162 METILPREDNISOLON TAB 4 MG Tab 200.00 2695 539,000.00 - 2695 539,000.00 1516 303,200.00
163 METILPREDNISOLON TAB 4 MG Tab 165.00 3000 495,000.00 3000 495,000.00 -
166 22.01.01.5246.04 METFORMIN TAB 850 MG Tab 240.00 0 - - 0 - -
168 METOKLOPRAMIDE TAB 10 MG TAB 100.00 0 - - 0 - -
169 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 0 - 1000 1,654,000.00 1000 1,654,000.00 10 16,540.00
170 22.01.01.5247.02 METRONIDAZOL TABLET 500 MG Tab 169.00 252 42,588.00 - 252 42,588.00 112 18,928.00
171 METRONIDAZOL TABLET 500 MG Tab 140.00 200 28,000.00 200 28,000.00 -
175 MINERAL MIX Bks 2,723 0 - - 0 - -
176 05.03.02.5250.02 NATRIUM DKLOFENAK TABLET 25 MG Tab 0 - - 0 - -
177 05.03.02.5250.01 NATRIUM DKLOFENAK TABLET 50 MG Tab 193.00 0 - - 0 - -
BULAN 1
MSN AWAL
179 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 95.5 602,540.00 40 256,400.00 135.5 868,555.00 29.25 187,492.50
181 NISTATIN 500.000 IU Tab 704.00 80 56,320.00 - 80 56,320.00 15 10,560.00
182 NISTATIN 100.000 IU Tab 448.00 60 26,880.00 - 60 26,880.00 9 4,032.00
183 15.05.01.5258.05 OBAT ANTITUBERKULOSIS SISIPAN DEWASA Tab 175,980 0 - - 0 - -
184 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 3 4,139,952.00 - 3 4,139,952.00 1 1,379,984.00
185 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 413,984 0 - - 0 - -
186 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 15 5,938,500.00 16 6,334,400.00 31 12,272,900.00 26 10,293,400.00
187 15.05.01.5258.04 OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 4 946,000.00 - 4 946,000.00 0 -
188 14.02.01.5259.01 OBAT BATUK HITAM CAIRAN Btl 1,339.80 0 - - 0 - -
190 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,630.00 - - 0 - -
192 OMEPRAZOL Kap 221.00 682 150,722.00 1050 232,050.00 1732 382,772.00 514 113,594.00
193 OMEPRAZOL Kap 164.00 0 - - 0 - -
194 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 0 -
195 22.01.01.5273.02 PAPAVERIN TABLET 40 MG Tab 128.00 2339 299,392.00 - 2339 299,392.00 323 41,344.00
196 PAPAVERIN TABLET 40 MG Tab 208.78 0 - - 0 - -
197 PARASETAMOLDROPS Btl 5,980.00 57 340,860.00 280 1,674,400.00 337 2,015,260.00 127 759,460.00
198 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,535.00 134 205,690.00 - 134 205,690.00 103 158,105.00
199 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 200 223,800.00 200 223,800.00 -
200 14.04.01.5275.02 PARASETAMOL TABLET 100 MG Tab 0 - - 0 - -
201 PARASETAMOL TABLET 500 MG Tab 86.00 10249 881,414.00 10000 860,000.00 20249 1,741,414.00 7191 618,426.00
202 PENOL GLISEROL TETES TELINGA Btl 2,246.00 0 - - 0 - -
203 PEHACAIN INJ Amp 4,850.00 112 543,200.00 100 485,000.00 212 1,028,200.00 46 223,100.00
205 22.01.01.5278.01 PIRANTEL TABLET SCORE 125 MG Tab 318.00 0 - - 0 - -
206 22.01.01.5278.02 PIRANTEL SIRUP btl 9,100.00 0 - - 0 - -
207 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - -
208 PIRASETAM 1200 Tab 854.00 0 - - 0 - -
209 05.03.06.5280.01 PIRIDOKSIN (VIT B6) TAB 10 MG Tab 124.00 3574 443,176.00 1000 124,000.00 4574 567,176.00 1670 207,080.00
210 22.01.01.5281.01 PIROKSIKAM TABLET 10 MG Tab 145.00 1024 148,480.00 - 1024 148,480.00 240 34,800.00
212 22.01.01.5281.02 PIROKSIKAM TABLET 20 MG Tab 189.50 0 - - 0 - -
213 16.03.01.3543.01 PITOGIN AMPUL 1 ML Amp 9,100.00 89 809,900.00 - 89 809,900.00 21 191,100.00
214 POLIDEMICIN TETES MATA 0 - - 0 - -
215 22.01.01.5283.01 POVIDON IODIDA 10 % 1000 ML Btl 40,202.00 1 40,202.00 - 1 40,202.00 -
216 22.01.01.5283.02 POVIDON IODIDA 10 % 300 ML Btl 15,386.00 35 538,510.00 - 35 538,510.00 7 107,702.00
BULAN 1
MSN AWAL
217 POVIDON IODIDA 10 % 300 ML Btl 22,500.00 12 270,000.00 12 270,000.00 -
218 22.01.01.5283.04 POVIDON IODIDA 10 % 30 ML Btl 2,344.00 0 - - 0 - -
219 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 19 68,875.00 50 181,250.00 69 250,125.00 3 10,875.00
220 PREDNISON TABLET 5 MG Tab 125.00 3669.5 458,687.50 - 3669.5 458,687.50 3617.5 452,187.50
221 PREDNISON TABLET 5 MG Tab 123.20 5000 616,000.00 5000 616,000.00 -
222 22.01.01.5285.01 PRIMAKUIN TABLET 15 MG Tab 0 - - 0 - -
223 22.01.01.5288.01 PROPANOLOL TABLET 40 MG Tab 119.00 134 15,946.00 - 134 15,946.00 38 4,522.00
224 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 80.00 0 - - 0 - -
225 22.01.01.5289.01 PROPILITIOURASIL TABLET 100 MG Tab 351.00 650 228,150.00 - 650 228,150.00 141 49,491.00
227 15.01.01.3184.02 RANITIDIN INJ 25 MG / 2 ML Amp 1,600.00 0 - - 0 - -
230 REAGENSIA ZN Pkt 276,600.00 11 3,042,600.00 10 2,766,000.00 21 5,808,600.00 21 5,808,600.00
231 22.01.01.5293.01 RINGER LAKTAT INFUS Btl 7,150.00 79 564,850.00 40 286,000.00 119 850,850.00 31 221,650.00
233 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 65.00 627 40,755.00 - 627 40,755.00 151.5 9,847.50
234 22.01.01.5295.02 SALBUTAMOL TABLET 4 MG Tab 88.00 353 31,064.00 - 353 31,064.00 45 3,960.00
236 SALISIL BEDAK 2 % Pot 1,071.00 20 21,420.00 - 20 21,420.00 0 -
237 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 14.8 15,776.80 - 14.8 15,776.80 11.8 12,578.80
238 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 ML Btl 4,133.00 39 161,187.00 - 39 161,187.00 2 8,266.00
239 SEFADROKSIL KAPSUL 500 MG Kap 557.00 2442 1,360,194.00 1000 557,000.00 3442 1,917,194.00 1070 595,990.00
240 22.01.01.5300.01 SEFOTAKSIM 1000 MG Tab 3,500.00 20 70,000.00 - 20 70,000.00 -
241 22.01.01.5301.01 SEFTRIAKSON SERBUK INJ 1000 MG Pot 2,578.00 0 - - 0 - -
242 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,050.00 83 87,150.00 - 83 87,150.00 17 17,850.00
243 22.01.01.5306.03 SIANOKOBALAMIN TABLET 50 MCG Tab 15.00 5014 75,210.00 - 5014 75,210.00 3206 48,090.00
244 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 2000 110,000.00 2000 110,000.00 -
245 22.01.01.5310.01 SIMVASTATIN TABLET 10 MG Tab 135.00 0 - - 0 - -
247 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 2572 766,456.00 - 2572 766,456.00 480 143,040.00
248 01.06.01.5151.01 SULFADIMIDINE TABLET 500 MG Tab 0 - - 0 - -
249 22.01.01.5316.01 SULFASETAMIDA NATRIUM TETES MATA 15 % Pot 3,549.00 0 - - 0 - -
250 SCABIMITE CREAM Tube 12,155.00 58 704,990.00 - 58 704,990.00 -
251 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 10742 1,299,782.00 12000 1,452,000.00 22742 2,751,782.00 12461 1,507,781.00
252 TABLET TAMBAH DARAH (FONDAZEN) Tab 449.00 0 - - 0 - -
253 TABLET TAMBAH DARAH (HUFABION) Tab 405.00 0 - - 0 - -
BULAN 1
MSN AWAL
254 01.01.06.5321.01 TETRASIKLIN KAPSUL 250 MG Kap 162.00 5 810.00 - 5 810.00 5 810.00
256 01.01.06.5321.02 TETRASIKLIN KAPSUL 500 MG Kap 325.00 106 34,450.00 - 106 34,450.00 80 26,000.00
257 22.01.01.5322.02 TIAMFENIKOL KAPSUL 500 MG Kap 440.00 0 - - 0 - -
258 05.03.05.5323.01 TIAMIN (VIT B1) INJ 100 MG/ML Amp 730.00 0 - - 0 - -
259 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 4372 397,852.00 5000 455,000.00 9372 852,852.00 4010 364,910.00
261 TIURAZOL 10 mg TAB Tab 1,195.00 75 89,625.00 - 75 89,625.00 -
263 TRAMADOL INJ Tab 6,000.00 0 - - 0 - -
265 VIT A MERAH kap 505.00 410 207,050.00 - 410 207,050.00 10 5,050.00
266 VIT A BIRU kap 286.00 265 75,790.00 - 265 75,790.00 -
267 05.03.06.5332.01 VITAMIN B KOMPLEKS TABLET Tab 112.00 3613 404,656.00 - 3613 404,656.00 3613 404,656.00
268 VITAMIN B KOMPLEKS TABLET Tab 132.00 0 - 18800 2,481,600.00 18800 2,481,600.00 1163 153,516.00
269 19.07.01.4128.01 ZIN TAB Tab 521.00 495 257,895.00 - 495 257,895.00 265 138,065.00
270 ZIN TAB Tab 592.00 500 296,000.00 500 296,000.00 -
271 ZIN SIRUP Btl 6,600.00 27 178,200.00 - 27 178,200.00 14 92,400.00
-
PERBEKALAN KESEHATAN -
1 ALAT SUNTIK SEKALI PAKAI 0,5 ML Set 1,240.00 1911 2,369,640.00 - 1911 2,369,640.00 436 540,640.00
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 300 436,800.00 - 300 436,800.00 -
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 100 123,750.00 -
11 BISTURI NO. 19 Bh 3,000 128 384,000.00 - 128 384,000.00 4 12,000.00
12 BISTURI NO.20 Bh 3,000 77 231,000.00 - 77 231,000.00 8 24,000.00
13 BISTURI NO.21 Bh 3,000 65 195,000.00 - 65 195,000.00 6 18,000.00
14 BISTURI NO.23 Bh 3,000 67 201,000.00 - 67 201,000.00 5 15,000.00
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 -
16 CATGUT NO 2/0 Pcs 27,758.00 100 2,775,800.00 - 100 2,775,800.00 10 277,580.00
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - -
BULAN 1
MSN AWAL
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - -
19 CATGUT NO 3/0 Pcs 8,895.83 123 1,094,187.09 - 123 1,094,187.09 12 106,749.96
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - -
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 -
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 -
23 FOLEY CATETER 18 Bh 10,000.00 11 110,000.00 - 11 110,000.00 3 30,000.00
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 -
25 HIV TEST Set 0 - - 0 - -
26 INFUSION SET ANAK SET 4,375.00 16 70,000.00 - 16 70,000.00 -
34 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 11,400.00 0 - - 0 - -
35 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 10 303,050.00 10 319,000.00 20 638,000.00 2.5 79,750.00
39 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASTIS Bks 864.00 63 54,432.00 - 63 54,432.00 8 6,912.00
40 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,104.00 214 878,256.00 - 214 878,256.00 44 180,576.00
41 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS Bks 8,532.00 10 85,320.00 - 10 85,320.00 -
42 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 10 1,563,000.00 10 1,563,000.00 20 3,126,000.00 3 468,900.00
43 PLESTER YARD Roll 43,700.00 14 611,800.00 20 874,000.00 34 1,485,800.00 6.5 284,050.00
44 HANDSCON 7 STERIL Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 -
45 HANDSCON 7 STERIL Bks 6,237.00 50 311,850.00 - 50 311,850.00 49 305,613.00
46 HANDSCON 71/2 Bks 6,237.00 75 467,775.00 - 75 467,775.00 27 168,399.00
47 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 0 -
48 HANDSCON 8 Bks 3,960.00 0 - - 0 - -
49 HANDSCON S Pcs 1,188.00 400 475,200.00 500 594,000.00 900 1,069,200.00 220 261,360.00
50 HANDSCON L Pcs 890.50 509 453,264.50 500 445,250.00 1009 898,514.50 118 105,079.00
51 HANDSCON M Pcs 890.50 230 204,815.00 500 445,250.00 730 650,065.00 150 133,575.00
52 URINE BAG BH 3,000.00 17 51,000.00 - 17 51,000.00 -
53 MASKER IKAT Bh 700.00 43 30,100.00 - 43 30,100.00 24 16,800.00
BULAN 1
MSN AWAL
54 MASKER KARET Pcs 700.00 523 366,100.00 500 350,000.00 1023 716,100.00 175 122,500.00
55 SILK 2/0 SET 21,875.00 130 2,843,750.00 - 130 2,843,750.00 5 109,375.00
56 SILK 3/0 SET 21,875.00 124 2,712,500.00 - 124 2,712,500.00 -
57 SILK 3/0 SET 35,331.00 14 494,634.00 - 14 494,634.00 14 494,634.00
58 STOMACH TUBE / MAAG SLANG NO. 3,5 Pcs 18,000.00 0 - - 0 - -
66 POT SPUTUM Pcs 2,930.00 157 460,010.00 200 586,000.00 357 1,046,010.00 93 272,490.00
68 RDT DBD IGG/IGM DOS 1,562,500.00 6 9,375,000.00 - 6 9,375,000.00 -
69 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 -
70 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - -
71 STRIP GULA DARAH DOS 420,000.00 1 2 840,000.00 3 1,260,000.00 -
72 VAKSIN RABIES AMP 270,600.00 0 20 5,412,000.00 20 5,412,000.00 20 5,412,000.00
73 STRIP ASAM URAT DOS 452,000.00 2 904,000.00 2 904,000.00 -
74 KOLESTEROL STRIP DOS 319,000.00 1 319,000.00 1 319,000.00 -
- 0 - -
5 EUGENOL Pcs 175,000.00 3.5 612,500.00 - 3.5 612,500.00 0.25 43,750.00
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 3 1,950,000.00 - 3 1,950,000.00 -
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - -
8 CHKM 10 ML Pcs 210,000.00 3.5 735,000.00 - 3.5 735,000.00 -
9 OCCO Pcs 245,000.00 2 490,000.00 - 2 490,000.00 -
10 DYCAL Pcs 800,000.00 1 800,000.00 - 1 800,000.00 -
11 HEMOSPON Pcs 76,500.00 10 765,000.00 - 10 765,000.00 -
BULAN 1
MSN AWAL
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 -
14 CAVITON Btl 325,000.00 1.5 487,500.00 - 1.5 487,500.00 -
BPJS UMUM JMLH

5494 372 5866


Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
0 1
0 1
0 1 8
HAL1
SISA PERMIN
NILAI KET
STOK TAAN
14 15 16 17
2417 877,371.00
0 -
3.25 60,563.75
2713 244,170.00 1000
0 -
26 86,177.52
350 30,100.00
24 2,832.00
700 115,500.00
3143 599,150.09
0 -
2369 248,745.00
0 -
411 85,077.00
12757.5 2,972,497.50
0 -
0 -
203 519,680.00
0 -
0 -
0 -
124 7,936.00 2000
1000 78,000.00 BON
49 103,194.00 100 BON
11 30,437.00 Exp 10
50 168,250.00
18.6 88,945.20
HAL 2
SISA PERMIN
NILAI KET
STOK TAAN
38 133,076.00
106 14,310.00 100
36 208,800.00
0 -
0 -
358 45,466.00
5040 257,040.00 1000 BON
200 21,000.00
0 -
9193.5 937,737.00 BON
0 -
20 5,020.00
0 -
900 342,900.00
0 -
81 116,235.00
1233 937,080.00
0 -
0 -
457 122,933.00
849 130,746.00
60 465,360.00
0 -
0 - 10
95 165,110.00
6163 295,824.00
0 -
365 14,235.00
14 178,486.00 BON
10 133,840.00
87 100,572.00
308 31,724.00
0 -
0 -
76 8,664.00 BON
0 -
88 27,192.00
552 96,048.00
HAL 3
SISA PERMIN
NILAI KET
STOK TAAN
0 -
59.5 31,059.00
351.5 359,584.50
0 -
38 288,078.00
19.5 73,125.00
119 312,375.00
0 -
0 -
0 -
30 59,400.00 BON
200 35,400.00 BON
351 242,190.00
0 -
129 243,552.00 60
0 -
444 40,404.00
254 81,788.00 exp.17
300 82,200.00
975 298,350.00
5 20,330.00
0 -
0 -
2 1,970.00
1788 109,068.00
158 79,316.00
300 89,100.00
807 24,766.83
5000 354,750.00
0 -
0 -
74 423,280.00
6431.5 2,604,757.50
314 75,674.00
500 253,000.00
500 32,500.00 BON
100 17,100.00 BON
56 164,528.00 48
hal 4
SISA PERMIN
NILAI KET
STOK TAAN
0 -
609 73,689.00
0 -
1714 389,078.00 BON
5000 785,000.00
0 -
0 -
240 23,520.00
0 -
0 -
2410 161,470.00
0 -
3145 226,440.00
288 41,184.00
0 -
0 -
5 6,915.00
0 -
369 53,505.00
17 31,450.00
8 14,072.00
24 175,200.00
0 -
0 -
41 164,000.00
223 55,750.00
200 124,322.00
103 118,965.00 200
2933 158,382.00
4000 180,000.00
108 5,400.00
424 69,960.00
0 -
83 204,346.00 BON
50 111,250.00
391 59,432.00
1000 131,000.00 BON
0 -
Hal 5
SISA PERMIN
NILAI KET
STOK TAAN
0 -
0 -
0 -
0 -
0 -
200 104,200.00
0 -
22 20,438.00
0 -
410 36,900.00
153 26,010.00
100 13,400.00
24 76,800.00
6 21,900.00
0 -
0 -
202 137,360.00
352 308,000.00 BON
0 -
0 -
60 510,000.00
1179 235,800.00
3000 495,000.00
41 34,850.00
763 90,415.50
0 -
543 59,730.00
0 -
990 1,637,460.00
140 23,660.00
200 28,000.00
360 41,760.00
47 148,050.00
56 1,509,200.00
0 -
0 -
0 -
1172 188,692.00
hal 6
SISA PERMIN
NILAI KET
STOK TAAN
106.25 681,062.50 BON
422 51,906.00
65 45,760.00
51 22,848.00
0 -
2 2,759,968.00 BON
0 -
5 1,979,500.00 BON
4 946,000.00 BON
0 -
75 126,000.00
0 -
84 138,264.00 ex.20
1218 269,178.00 BON
0 -
5 92,685.00
2016 258,048.00
0 -
210 1,255,800.00 BON
31 47,585.00
200 223,800.00
0 -
13058 1,122,988.00
0 -
166 805,100.00
0 -
0 -
0 -
0 -
0 -
2904 360,096.00 BON
784 113,680.00 ex.170
213 20,871.87
0 -
68 618,800.00
0 -
1 40,202.00
28 430,808.00 exp.2
HAL 7
SISA PERMIN
NILAI KET
STOK TAAN
12 270,000.00
0 -
66 239,250.00
52 6,500.00 ex.821,5
5000 616,000.00
0 -
96 11,424.00
0 -
509 178,659.00 100
6350 730,250.00
0 -
14 44,100.00
0 -
0 -
88 629,200.00
139 759,357.00
475.5 30,907.50
308 27,104.00
30 83,910.00
20 21,420.00 BON
3 3,198.00
37 152,921.00 BON
2372 1,321,204.00 BON
20 70,000.00
0 -
66 69,300.00
1808 27,120.00 3000
2000 110,000.00
0 -
7807 1,381,839.00
2092 623,416.00
0 -
0 -
58 704,990.00
10281 1,244,001.00
0 -
0 -
HAL 8
SISA PERMIN
NILAI KET
STOK TAAN
0 - exp.56
1626 294,306.00 BON
26 8,450.00
0 -
0 -
5362 487,942.00 3000
0 -
75 89,625.00
0 -
0 -
264 182,474.16
400 202,000.00 1850
265 75,790.00 50
0 -
17637 2,328,084.00 BON
230 119,830.00
500 296,000.00
13 85,800.00 10 BON
0 -
0 -
1475 1,829,000.00
36 91,109.27
300 436,800.00 BON
207 266,409.00
100 123,750.00
810 1,053,000.00
0 -
173 166,599.00
100 122,375.00
88 142,780.00
124 372,000.00
69 207,000.00
59 177,000.00
62 186,000.00
230 598,000.00
90 2,498,220.00
0 -
HAL 9
SISA PERMIN
NILAI KET
STOK TAAN
0 -
111 987,437.13
0 -
48 1,512,000.00
10 80,000.00
8 80,000.00 10
28 224,000.00
0 -
16 70,000.00
86 344,000.00
53 483,519.00
3 11,400.00 ex.1
50 456,150.00
31 117,800.00 ex.2
50 456,150.00
34 129,200.00
50 456,150.00
0 -
17.5 558,250.00
0 -
97 188,568.00 BON
19 190,000.00
55 47,520.00
170 697,680.00
10 85,320.00
17 2,657,100.00
27.5 1,201,750.00
250 1,485,000.00
1 6,237.00
48 299,376.00
250 1,485,000.00
0 -
680 807,840.00
891 793,435.50
580 516,490.00
17 51,000.00
19 13,300.00
HAL 10
SISA PERMIN
NILAI KET
STOK TAAN
848 593,600.00
125 2,734,375.00 BON
124 2,712,500.00
0 - BON
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
264 773,520.00 BON
0 -
6 9,375,000.00
6 14,400,000.00
0 -
3 1,260,000.00 2
0 -
2 904,000.00
1 319,000.00 12
0 -
1 675,000.00
1 675,000.00
1 675,000.00
1 675,000.00
3.25 568,750.00
3 1,950,000.00 BON
0 -
3.5 735,000.00
2 490,000.00
1 800,000.00
10 765,000.00
HAL 11
SISA PERMIN
NILAI KET
STOK TAAN
1 495,000.00
0 -
1.5 487,500.00 BON
119,379,907.32
04 2 024
( LPLPO )

PUSKESMAS : Benteng
BULAN 2
1 2 3 4 5 6 7 8 9 10 11 12 13 14
5 ALOPURINOL TABLET 100 MG Tab 117.00 0 - 1000 117,000.00 1000 117,000.00 0 - 1000
13 AMLODIPIN 5 MG Tab 105.00 2369 248,745.00 - 2369 248,745.00 828 86,940.00 1541
16 AMOKSISILLIN KAPLET 500 MG Kap 233.00 12757.5 2,972,497.50 - 12757.5 2,972,497.50 6732 1,568,556.00 6025.5
28 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 18.6 88,945.20 - 18.6 88,945.20 0.6 2,869.20 18
30 10.02.01.5338.01 ANTIMIGREN Tab 135.00 106 14,310.00 - 106 14,310.00 31 4,185.00 75
31 ANTIMIGREN Tab 179.00 0 - 100 17,900.00 100 17,900.00 - 100
35 07.01.02.5041.01 ASAM ASETIL SALISILAT 100 MG Tab 127.00 358 45,466.00 - 358 45,466.00 3 381.00 355
BULAN 2
39 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 9193.5 937,737.00 - 9193.5 937,737.00 3980 405,960.00 5213.5
53 CHATHEJELL Tab 42,848.00 0 - 10 428,480.00 10 428,480.00 1 42,848.00 9
55 DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 0 - - 0 - - 0
74 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 19.5 73,125.00 - 19.5 73,125.00 0 - 19.5
75 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 119 312,375.00 - 119 312,375.00 17 44,625.00 102
76 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
BULAN 2
87 GARAM ORALIT I SERBUK Sac 274.00 300 82,200.00 - 300 82,200.00 - 300
101 GRANTUSIF Tab 405.00 6431.5 2,604,757.50 - 6431.5 2,604,757.50 2496 1,010,880.00 3935.5
103 GRISEOFULVIN TABLET 125 MG Tab 506.00 500 253,000.00 - 500 253,000.00 - 500
107 HIDROKORTISON KRIM 2 % Tube 2,812.00 0 - 48 134,976.00 48 134,976.00 - 48
118 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 67.00 2410 161,470.00 - 2410 161,470.00 1305 87,435.00 1105
119 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
120 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 3145 226,440.00 - 3145 226,440.00 443 31,896.00 2702
121 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 288 41,184.00 - 288 41,184.00 72 10,296.00 216
BULAN 2
136 22.01.01.5226.01 KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 2933 158,382.00 - 2933 158,382.00 2603.5 140,589.00 329.5
137 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 4000 180,000.00 - 4000 180,000.00 - 4000
140 01.06.01.5142.03 KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 0 - - 0 - 0 - 0
142 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 50 111,250.00 - 50 111,250.00 - 50
143 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 152.00 391 59,432.00 - 391 59,432.00 363 55,176.00 28
144 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 1000 131,000.00 - 1000 131,000.00 0 - 1000
153 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 22 20,438.00 - 22 20,438.00 10 9,290.00 12
155 LOPERAMIDE Tab 90.00 410 36,900.00 - 410 36,900.00 - 410
157 LORATADIN TAB Tab 134.00 100 13,400.00 - 100 13,400.00 - 100
158 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
159 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
162 MELOXICAM 7,5 mg Tab 680 202 137,360.00 - 202 137,360.00 202 137,360.00 0
163 MELOXICAM 15 mg Tab 875 352 308,000.00 - 352 308,000.00 222 194,250.00 130
164 07.01.02.5043.01 METAMPIRON TABLET 500 MG (ANTALGIN) Tab 141.85 0 - - 0 - - 0
165 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 133.10 0 - - 0 - 0 - 0
BULAN 2
180 MINERAL MIX Bks 2,723 0 - - 0 - - 0
184 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 106.25 681,062.50 - 106.25 681,062.50 17.25 110,572.50 89
186 NISTATIN 500.000 IU Tab 704.00 65 45,760.00 - 65 45,760.00 0 - 65
187 NISTATIN 100.000 IU Tab 448.00 51 22,848.00 - 51 22,848.00 - 51
188 15.05.01.5258.05 OBAT ANTITUBERKULOSIS SISIPAN DEWASA Tab 175,980 0 - - 0 - - 0
191 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 5 1,979,500.00 - 5 1,979,500.00 - 5
197 OMEPRAZOL Kap 221.00 1218 269,178.00 - 1218 269,178.00 409 90,389.00 809
198 OMEPRAZOL Kap 164.00 0 - - 0 - - 0
202 PARASETAMOLDROPS Btl 5,980.00 210 1,255,800.00 - 210 1,255,800.00 87 520,260.00 123
208 PEHACAIN INJ Amp 4,850.00 166 805,100.00 - 166 805,100.00 24 116,400.00 142
212 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - - 0
213 PIRASETAM 1200 Tab 854.00 0 - - 0 - - 0
BULAN 2
230 22.01.01.5289.01 PROPILITIOURASIL TABLET 100 MG Tab 351.00 509 178,659.00 100 35,100.00 609 213,759.00 146 51,246.00 463
235 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - - 0
243 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 ML Btl 4,133.00 37 152,921.00 - 37 152,921.00 18 74,394.00 19
247 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,050.00 66 69,300.00 - 66 69,300.00 17 17,850.00 49
254 22.01.01.5316.01 SULFASETAMIDA NATRIUM TETES MATA 15 % Pot 3,549.00 0 - - 0 - - 0
BULAN 2
268 TRAMADOL INJ Tab 6,000.00 0 - - 0 - - 0
270 VIT A MERAH kap 505.00 400 202,000.00 1850 934,250.00 2250 1,136,250.00 1478 746,390.00 772
271 VIT A BIRU kap 286.00 265 75,790.00 - 265 75,790.00 242 69,212.00 23
272 VTT A BIRU kap 327.00 0 - 50 16,350.00 50 16,350.00 - 50
275 19.07.01.4128.01 ZIN TAB Tab 521.00 230 119,830.00 - 230 119,830.00 220 114,620.00 10
276 ZIN TAB Tab 592.00 500 296,000.00 - 500 296,000.00 - 500
277 ZIN SIRUP Btl 6,600.00 13 85,800.00 10 66,000.00 23 151,800.00 10 66,000.00 13
0 - - 0 - - 0
11 BISTURI NO. 19 Bh 3,000 124 372,000.00 - 124 372,000.00 - 124
12 BISTURI NO.20 Bh 3,000 69 207,000.00 - 69 207,000.00 - 69
13 BISTURI NO.21 Bh 3,000 59 177,000.00 - 59 177,000.00 1 3,000.00 58
14 BISTURI NO.23 Bh 3,000 62 186,000.00 - 62 186,000.00 2 6,000.00 60
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 - 230
16 CATGUT NO 2/0 Pcs 27,758.00 90 2,498,220.00 - 90 2,498,220.00 - 90
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - - 0
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - - 0
19 CATGUT NO 3/0 Pcs 8,895.83 111 987,437.13 - 111 987,437.13 7 62,270.81 104
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - - 0
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 0 - 10
23 FOLEY CATETER 18 Bh 10,000.00 8 80,000.00 10 100,000.00 18 180,000.00 5 50,000.00 13
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
25 HIV TEST Set 0 - - 0 - - 0
BULAN 2
34 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 11,400.00 0 - - 0 - - 0
35 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 17.5 558,250.00 - 17.5 558,250.00 2 63,800.00 15.5
39 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASTIS Bks 864.00 55 47,520.00 - 55 47,520.00 5 4,320.00 50
40 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,104.00 170 697,680.00 - 170 697,680.00 44 180,576.00 126
41 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS Bks 8,532.00 10 85,320.00 - 10 85,320.00 1 8,532.00 9
43 PLESTER YARD Roll 43,700.00 27.5 1,201,750.00 - 27.5 1,201,750.00 9 393,300.00 18.5
46 HANDSCON 71/2 Bks 6,237.00 48 299,376.00 - 48 299,376.00 14 87,318.00 34
47 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 - 250
48 HANDSCON 8 Bks 3,960.00 0 - - 0 - - 0
49 HANDSCON S Pcs 1,188.00 680 807,840.00 - 680 807,840.00 160 190,080.00 520
50 HANDSCON L Pcs 890.50 891 793,435.50 - 891 793,435.50 108 96,174.00 783
51 HANDSCON M Pcs 890.50 580 516,490.00 - 580 516,490.00 170 151,385.00 410
52 URINE BAG BH 3,000.00 17 51,000.00 - 17 51,000.00 1 3,000.00 16
53 MASKER IKAT Bh 700.00 19 13,300.00 - 19 13,300.00 9 6,300.00 10
54 MASKER KARET Pcs 700.00 848 593,600.00 - 848 593,600.00 183 128,100.00 665
55 SILK 2/0 SET 21,875.00 125 2,734,375.00 - 125 2,734,375.00 - 125
56 SILK 3/0 SET 21,875.00 124 2,712,500.00 - 124 2,712,500.00 15 328,125.00 109
57 SILK 3/0 SET 35,331.00 0 - - 0 - - 0
66 POT SPUTUM Pcs 2,930.00 264 773,520.00 - 264 773,520.00 200 586,000.00 64
69 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 - 6
70 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - - 0
BULAN 2
71 STRIP GULA DARAH DOS 420,000.00 3 1,260,000.00 10 4,200,000.00 13 5,460,000.00 - 13
73 STRIP ASAM URAT DOS 452,000.00 2 904,000.00 - 2 904,000.00 1 452,000.00 1
74 KOLESTEROL STRIP DOS 319,000.00 1 319,000.00 12 3,828,000.00 13 4,147,000.00 10 3,190,000.00 3
- - 0 - - 0
5 EUGENOL Pcs 175,000.00 3.25 568,750.00 - 3.25 568,750.00 3.25 568,750.00 0
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3.5 735,000.00 - 3.5 735,000.00 0.25 52,500.00 3.25
9 OCCO Pcs 245,000.00 2 490,000.00 - 2 490,000.00 0.25 61,250.00 1.75
10 DYCAL Pcs 800,000.00 1 800,000.00 - 1 800,000.00 0.25 200,000.00 0.75
11 HEMOSPON Pcs 76,500.00 10 765,000.00 - 10 765,000.00 1 76,500.00 9
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 - 1
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 1.5 487,500.00 - 1.5 487,500.00 0.5 162,500.00 1
BPJS UMUM JMLH
4701 667 5368


Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
2
1
1 8
HAL 1
PERMIN
NILAI KET
TAAN
15 16 17
871,200.00
-
60,563.75
146,880.00 1000 ex.280
117,000.00
-
86,177.52
28,208.00
2,832.00
115,500.00
428,726.87
-
161,805.00
-
79,488.00
1,403,941.50
-
-
176,640.00
-
-
-
71,296.00 2000 ex.160
78,000.00 BON
210,600.00 100 BON
2,767.00
168,250.00
86,076.00
133,076.00
10,125.00 100
17,900.00
191,400.00
-
-
45,085.00
HAL 2
PERMIN
NILAI KET
TAAN
84,762.00 1000 BON
2,100.00 exp.160
-
531,777.00 BON
-
5,020.00
-
339,090.00
-
67,445.00
922,640.00
-
-
114,056.00
56,210.00
418,824.00
-
385,632.00
147,730.00 20 Exp 10
-
150,624.00 exp190
-
6,786.00
178,486.00 BON
133,840.00
100,572.00
30,076.00
-
-
8,664.00 BON
-
27,192.00
84,390.00
-
13,833.00
277,744.50
-
250,173.00
73,125.00
267,750.00
-
-
59,400.00 BON
35,400.00 BON
220,110.00
HAL 3
PERMIN
NILAI KET
TAAN
-
113,280.00 60 exp.56
244,980.00
-
35,035.00
41,860.00
82,200.00
292,230.00
20,330.00
-
-
1,970.00
92,720.00
79,316.00
89,100.00
-
339,885.98
-
-
366,080.00
1,593,877.50
28,438.00
253,000.00
30,550.00 BON
17,100.00 BON
64,636.00 48
134,976.00
-
73,689.00
-
24,289.00 BON
785,000.00
-
-
17,640.00 exp 60
-
-
74,035.00
-
194,544.00
30,888.00
-
-
6,915.00
-
Hal 4
PERMIN
NILAI KET
TAAN
53,505.00
31,450.00
12,313.00
175,200.00
-
-
120,000.00
22,250.00
124,322.00
190,575.00 200
17,793.00
180,000.00
3,500.00
51,315.00
-
86,170.00 BON
111,250.00
4,256.00
131,000.00 BON
-
-
-
-
-
-
104,200.00
-
11,148.00
-
36,900.00
8,840.00
13,400.00
76,800.00
21,900.00
-
-
-
113,750.00 BON
-
-
510,000.00
-
492,855.00
34,850.00
77,143.50
Hal 5
PERMIN
NILAI KET
TAAN
-
56,980.00
-
1,554,760.00
13,858.00
28,000.00
40,020.00
91,350.00
1,509,200.00
-
-
-
118,174.00
570,490.00 BON
49,323.00
45,760.00
22,848.00
-
2,759,968.00 BON
-
1,979,500.00 BON
946,000.00 BON
-
105,840.00
-
125,096.00
178,789.00 BON
-
92,685.00
231,552.00
-
735,540.00 BON
-
164,493.00
-
576,630.00
-
688,700.00
-
-
-
-
-
180,048.00 BON
87,435.00 ex.80
Hal 6
PERMIN
NILAI KET
TAAN
17,932.17
-
555,100.00
-
-
- exp.27
247,500.00
-
228,375.00
- ex.90
401,878.40
-
6,545.00
-
162,513.00 100
594,895.00
-
44,100.00
-
-
378,950.00
753,894.00
26,877.50
23,144.00
67,128.00
11,781.00 BON
3,198.00
78,527.00 BON
769,774.00 BON
70,000.00
-
51,450.00
- 3000
234,795.00
-
1,269,267.00
395,148.00
-
-
668,525.00
661,265.00
-
-
-
182,086.00 BON
Hal 7
PERMIN
NILAI KET
TAAN
8,450.00
-
-
405,951.00 3000
-
89,625.00
-
-
161,738.46
389,860.00 1850
6,578.00 50
16,350.00
- BON
1,764,840.00 exp.110
5,210.00
296,000.00 BON
85,800.00 10
-
-
1,471,880.00
27,838.94 BON
436,800.00
223,938.00
123,750.00
952,900.00
-
151,191.00
122,375.00
137,912.50
372,000.00
207,000.00
174,000.00
180,000.00
598,000.00
2,498,220.00
-
-
925,166.32
-
1,512,000.00
80,000.00
130,000.00 10
224,000.00
-
65,625.00
HAL 8
PERMIN
NILAI KET
TAAN
296,000.00
483,519.00
-
337,551.00
87,400.00
456,150.00
129,200.00
456,150.00
-
494,450.00
-
167,184.00 BON
140,000.00
43,200.00
517,104.00
76,788.00
2,188,200.00
808,450.00
1,182,060.00
-
212,058.00
1,485,000.00
-
617,760.00
697,261.50
365,105.00
48,000.00
7,000.00
465,500.00
2,734,375.00 BON
2,384,375.00
- BON
-
-
-
-
-
-
-
-
187,520.00 BON
-
9,375,000.00
14,400,000.00
-
HAL 9
PERMIN
NILAI KET
TAAN
5,460,000.00 2
-
452,000.00
957,000.00 12
-
675,000.00
675,000.00
675,000.00
675,000.00
- exp.3
1,950,000.00
-
682,500.00
428,750.00
600,000.00
688,500.00
495,000.00
-
325,000.00 BON
107,916,035.91
#REF!
( LPLPO )

PUSKESMAS : Benteng
BULAN 3
MSN AWAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14
3 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 3.25 60,563.75 - 3.25 60,563.75 2 37,270.00 1.25
ALOPURINOL TABLET 100 MG Tab 117.00 1000 117,000.00 500 58,500.00 1500 175,500.00 13 1,521.00 1487
5 07.01.02.5044.02 ALOPURINOL TABLET 300 MG Tab 230.00 0 - 500 115,000.00 500 115,000.00 - 500
12 AMLODIPIN 5 MG Tab 105.00 1541 161,805.00 3600 378,000.00 5141 539,805.00 828 86,940.00 4313
15 AMOKSISILLIN KAPLET 500 MG Kap 233.00 6025.5 1,403,941.50 5000 1,165,000.00 11025.5 2,568,941.50 7229 1,684,357.00 3796.5
BULAN 3
MSN AWAL
27 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 18 86,076.00 - 18 86,076.00 - 18
29 10.02.01.5338.01 ANTIMIGREN Tab 135.00 75 10,125.00 - 75 10,125.00 12 1,620.00 63
ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 - 100
37 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 5213.5 531,777.00 5000 510,000.00 10213.5 1,041,777.00 3637 370,974.00 6576.5
CETIRIZINE TAB KAP 115.00 - 1000 115,000.00 1000 115,000.00 0 - 1000
51 CHATHEJELL Tab 42,848.00 9 385,632.00 - 9 385,632.00 2 85,696.00 7
DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 - 20 34,800.00 20 34,800.00 0 - 20
BULAN 3
MSN AWAL
71 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 19.5 73,125.00 - 19.5 73,125.00 1 3,750.00 18.5
72 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 102 267,750.00 - 102 267,750.00 15.25 40,031.25 86.75
73 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
74 ETHYLIS CHLORIDUM SEMPROT Btl 81,400.00 - - 0 - - 0
FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 60 244,980.00 - 60 244,980.00 60 244,980.00 0
GARAM ORALIT I SERBUK Sac 274.00 300 82,200.00 200 54,800.00 500 137,000.00 21 5,754.00 479
98 GRANTUSIF Tab 405.00 3935.5 1,593,877.50 2000 810,000.00 5935.5 2,403,877.50 2203.5 892,417.50 3732
BULAN 3
HIDROKORTISON KRIM 2 % Tube 2,812.00 48 134,976.00 72 202,464.00 120 337,440.00 17 47,804.00 103
IBUPROFEN TABLET 400 MG Tab 157.00 5000 785,000.00 - 5000 785,000.00 2021 317,297.00 2979
113 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 67.00 1105 74,035.00 1000 67,000.00 2105 141,035.00 1558 104,386.00 547
114 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
115 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2702 194,544.00 - 2702 194,544.00 439 31,608.00 2263
116 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 216 30,888.00 - 216 30,888.00 50 7,150.00 166
132 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 4000 180,000.00 1000 45,000.00 5000 225,000.00 2483.5 111,757.50 2516.5
135 01.06.01.5142.03 KOTRIMOKSAZOL SUSPENSI Btl 2,298.00 0 - - 0 - - 0
138 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 152.00 28 4,256.00 - 28 4,256.00 28 4,256.00 0
BULAN 3
MSN AWAL
139 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 1000 131,000.00 - 1000 131,000.00 272 35,632.00 728
148 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 12 11,148.00 - 12 11,148.00 2 1,858.00 10
150 LOPERAMIDE Tab 90.00 410 36,900.00 - 410 36,900.00 - 410
153 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
154 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
157 MELOXICAM 7,5 mg Tab 680 0 - 1000 680,000.00 1000 680,000.00 192 130,560.00 808
158 MELOXICAM 15 mg Tab 875 130 113,750.00 1000 875,000.00 1130 988,750.00 261 228,375.00 869
160 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 133.10 0 - - 0 - - 0
166 22.01.01.5246.04 METFORMIN TAB 500 MG Tab 115.00 0 - 1000 115,000.00 1000 115,000.00 - 1000
169 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 940 1,554,760.00 - 940 1,554,760.00 - 940
175 MINERAL MIX Bks 2,723 0 - - 0 - - 0
BULAN 3
MSN AWAL
179 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 89 570,490.00 - 89 570,490.00 17.25 110,572.50 71.75
180 NIPEDIFINE TAB 10 MG Tab 123.00 401 49,323.00 - 401 49,323.00 - 401
181 NISTATIN 500.000 IU Tab 704.00 65 45,760.00 - 65 45,760.00 5 3,520.00 60
182 NISTATIN 100.000 IU Tab 448.00 51 22,848.00 - 51 22,848.00 - 51
183 15.05.01.5258.05 OBAT ANTITUBERKULOSIS SISIPAN DEWASA Tab 175,980 0 - - 0 - - 0
192 OMEPRAZOL Kap 221.00 809 178,789.00 - 809 178,789.00 453 100,113.00 356
193 OMEPRAZOL Kap 164.00 0 - 480 78,720.00 480 78,720.00 - 480
198 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,013.00 0 - 100 101,300.00 100 101,300.00 - 100
201 PARASETAMOL TABLET 500 MG Tab 86.00 6705 576,630.00 - 6705 576,630.00 5908 508,088.00 797
202 PARASETAMOL TABLET 500 MG Btl 51.00 0 - 2000 102,000.00 2000 102,000.00 - 2000
203 PEHACAIN INJ Amp 4,850.00 142 688,700.00 - 142 688,700.00 52 252,200.00 90
207 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - - 0
208 PIRASETAM 1200 Tab 854.00 0 - - 0 - - 0
BULAN 3
MSN AWAL
219 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 63 228,375.00 - 63 228,375.00 3.25 11,781.25 59.75
221 PREDNISON TABLET 5 MG Tab 123.20 3262 401,878.40 2000 246,400.00 5262 648,278.40 2583 318,225.60 2679
224 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 69.00 0 - 1100 75,900.00 1100 75,900.00 75 5,175.00 1025
230 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - - 0
236 SALISIL BEDAK 2 % Pot 1,071.00 11 11,781.00 30 32,130.00 41 43,911.00 19.2 20,563.20 21.8
SEFADROKSIL KAPSUL 500 MG Kap 455.00 0 - 1000 455,000.00 1000 455,000.00 - 1000
247 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 1326 395,148.00 1000 298,000.00 2326 693,148.00 769 229,162.00 1557
251 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 5465 661,265.00 6000 726,000.00 11465 1,387,265.00 5836 706,156.00 5629
252 TABLET TAMBAH DARAH KOMBINASI Tab 367.00 0 - 3000 1,101,000.00 3000 1,101,000.00 - 3000
BULAN 3
MSN AWAL
263 TRAMADOL INJ Tab 6,000.00 0 - - 0 - - 0
264 TRIHEKSIFENIDIL 25 MG TAB/ARKINE Tab 691.19 234 161,738.46 - 234 161,738.46 - 234
265 VIT A MERAH kap 505.00 772 389,860.00 - 772 389,860.00 132 66,660.00 640
266 VIT A BIRU kap 286.00 23 6,578.00 - 23 6,578.00 23 6,578.00 0
VTT A BIRU kap 327.00 50 16,350.00 - 50 16,350.00 24 7,848.00 26
269 19.07.01.4128.01 ZIN TAB Tab 521.00 10 5,210.00 - 10 5,210.00 10 5,210.00 0
270 ZIN TAB Tab 592.00 500 296,000.00 500 296,000.00 1000 592,000.00 250 148,000.00 750
271 ZIN SIRUP Btl 6,600.00 13 85,800.00 34 224,400.00 47 310,200.00 13 85,800.00 34
- - 0 - - 0
PERBEKALAN KESEHATAN - - 0 - - 0
11 BISTURI NO. 19 Bh 3,000 124 372,000.00 - 124 372,000.00 5 15,000.00 119
12 BISTURI NO.20 Bh 3,000 69 207,000.00 - 69 207,000.00 1 3,000.00 68
13 BISTURI NO.21 Bh 3,000 58 174,000.00 - 58 174,000.00 - 58
14 BISTURI NO.23 Bh 3,000 60 180,000.00 - 60 180,000.00 9 27,000.00 51
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 - 230
16 CATGUT NO 2/0 Pcs 27,758.00 90 2,498,220.00 - 90 2,498,220.00 - 90
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - - 0
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - - 0
19 CATGUT NO 3/0 Pcs 8,895.83 104 925,166.32 - 104 925,166.32 - 104
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - - 0
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 - 10
BULAN 3
MSN AWAL
23 FOLEY CATETER 18 Bh 10,000.00 13 130,000.00 - 13 130,000.00 4 40,000.00 9
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
25 HIV TEST Set 0 - - 0 - - 0
34 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 11,400.00 0 - - 0 - - 0
35 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 15.5 494,450.00 - 15.5 494,450.00 3.25 103,675.00 12.25
41 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS Bks 8,532.00 9 76,788.00 - 9 76,788.00 2 17,064.00 7
43 PLESTER YARD Roll 43,700.00 18.5 808,450.00 - 18.5 808,450.00 5 218,500.00 13.5
45 HANDSCON 7 STERIL Bks 6,237.00 0 - - 0 - - 0
46 HANDSCON 71/2 Bks 6,237.00 34 212,058.00 - 34 212,058.00 27 168,399.00 7
47 HANDSCON 71/2 Bks 5,940.00 250 1,485,000.00 - 250 1,485,000.00 - 250
48 HANDSCON 8 Bks 3,960.00 0 - - 0 - - 0
49 HANDSCON S Pcs 1,188.00 520 617,760.00 - 520 617,760.00 170 201,960.00 350
50 HANDSCON L Pcs 890.50 783 697,261.50 - 783 697,261.50 110 97,955.00 673
51 HANDSCON M Pcs 890.50 410 365,105.00 - 410 365,105.00 106 94,393.00 304
52 URINE BAG BH 3,000.00 16 48,000.00 - 16 48,000.00 1 3,000.00 15
53 MASKER IKAT Bh 700.00 10 7,000.00 - 10 7,000.00 10 7,000.00 0
54 MASKER KARET Pcs 700.00 665 465,500.00 - 665 465,500.00 162 113,400.00 503
55 SILK 2/0 SET 21,875.00 125 2,734,375.00 - 125 2,734,375.00 - 125
56 SILK 3/0 SET 21,875.00 109 2,384,375.00 - 109 2,384,375.00 13 284,375.00 96
57 SILK 3/0 SET 35,331.00 0 - - 0 - - 0
BULAN 3
MSN AWAL
64 POT SPUTUM Pcs 2,930.00 64 187,520.00 200 586,000.00 264 773,520.00 78 228,540.00 186
66 RDT DBD IGG/IGM DOS 1,562,500.00 6 9,375,000.00 - 6 9,375,000.00 6 9,375,000.00 0
67 RDT DBD NS1 DOS 2,400,000.00 6 14,400,000.00 - 6 14,400,000.00 6 14,400,000.00 0
68 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - - 0
69 STRIP GULA DARAH DOS 420,000.00 13 5,460,000.00 - 13 5,460,000.00 3.5 1,470,000.00 9.5
71 STRIP ASAM URAT DOS 452,000.00 1 452,000.00 - 1 452,000.00 - 1
72 KOLESTEROL STRIP DOS 319,000.00 3 957,000.00 - 3 957,000.00 3 957,000.00 0
- - 0 - - 0
5 EUGENOL Pcs 175,000.00 0 - 2 350,000.00 2 350,000.00 0.25 43,750.00 1.75
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3.25 682,500.00 - 3.25 682,500.00 0.25 52,500.00 3
9 OCCO Pcs 245,000.00 1.75 428,750.00 - 1.75 428,750.00 0.25 61,250.00 1.5
10 DYCAL Pcs 800,000.00 0.75 600,000.00 - 0.75 600,000.00 0.25 200,000.00 0.5
11 HEMOSPON Pcs 76,500.00 9 688,500.00 - 9 688,500.00 4 306,000.00 5
12 PULP-10 Pcs 495,000.00 1 495,000.00 - 1 495,000.00 - 1
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 1 325,000.00 - 1 325,000.00 0.5 162,500.00 0.5
BPJS UMUM JMLH

4606 422 5028


Nip. 196551214 199803 1 005 19791120 201407 2 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
3
1
1 8
HAL 1
PERMIN
NILAI KET
TAAN
15 16 17
863,214.00
-
23,293.75
- EX.1100
173,979.00
115,000.00
86,177.52
25,800.00
2,832.00
115,500.00
186,436.14
-
452,865.00
-
70,173.00
884,584.50
-
-
97,280.00
-
-
-
119,296.00
-
107,406.00
-
137,965.00
HAL 2
PERMIN
NILAI KET
TAAN
86,076.00
133,076.00
8,505.00
17,900.00
40,600.00 EX.18
-
-
- EX.302
298,248.00
1,050.00
-
670,803.00
-
5,020.00
-
330,327.00
-
123,410.00
883,120.00
-
-
107,600.00
1,540.00
115,000.00
- EX.51
-
299,936.00
5,214.00 EX.82
34,800.00
77,760.00
-
16,341.00
178,486.00
133,840.00
100,572.00
30,076.00
-
-
8,664.00
-
HAL 3
PERMIN
NILAI KET
TAAN
24,102.00
70,296.00 RSK 46
-
9,135.00
228,640.50
-
197,106.00
69,375.00
227,718.75
-
-
-
59,400.00
35,400.00
211,830.00
-
77,408.00 EX.60
-
-
30,212.00
-
131,246.00
292,230.00
20,330.00
-
-
1,970.00
73,932.00
77,810.00
89,100.00
-
249,318.30
-
-
354,640.00 EX.1
1,511,460.00
-
236,808.00
28,600.00
Hal 4
PERMIN
NILAI KET
TAAN
17,100.00
-
289,636.00
-
65,219.00
-
-
467,703.00
-
-
12,152.00 EX.30
-
-
36,649.00
-
162,936.00
23,738.00
-
-
5,532.00
-
51,185.00
14,800.00 EX.6
-
94,900.00 EX.13
-
-
104,000.00
7,000.00
124,322.00
65,835.00
-
113,242.50
3,500.00
27,390.00
-
-
104,575.00 EX.5
-
Hal 5
PERMIN
NILAI KET
TAAN
95,368.00
-
-
-
-
-
-
104,200.00
-
9,290.00
-
36,900.00
-
5,092.00
76,800.00
21,900.00
-
-
549,440.00
760,375.00
-
-
510,000.00
-
320,100.00
34,850.00
40,645.50
115,000.00
55,220.00
-
1,554,760.00
3,887.00
28,000.00
37,700.00
22,050.00
1,509,200.00
-
-
-
242,144.00
Hal 6
PERMIN
NILAI KET
TAAN
459,917.50
49,323.00
42,240.00
22,848.00
-
2,759,968.00
-
4,354,900.00
709,500.00
-
77,280.00
-
98,760.00
78,676.00
78,720.00
92,685.00
203,392.00
-
77,740.00
101,300.00
69,378.00
-
68,542.00
102,000.00
436,500.00
-
-
-
-
-
241,180.00
65,395.00
7,251.26
-
336,700.00
-
-
-
202,500.00
-
Hal 7
PERMIN
NILAI KET
TAAN
216,593.75
-
330,052.80
-
-
70,725.00
125,307.00
451,950.00
-
44,100.00
-
-
207,350.00
726,579.00
18,752.50
18,744.00
41,955.00
23,347.80
3,198.00
74,394.00
285,184.00
455,000.00
70,000.00
-
32,550.00
-
369,490.00
-
1,159,704.00
463,986.00
-
-
668,525.00
681,109.00
1,101,000.00
-
-
87,604.00
8,450.00
Hal 8
PERMIN
NILAI KET
TAAN
-
-
258,167.00
-
71,700.00
-
-
161,738.46
323,200.00
-
8,502.00
-
1,168,992.00
-
444,000.00
224,400.00
-
-
1,149,480.00
-
381,472.00
177,606.00
123,750.00
643,500.00
-
135,783.00
122,375.00
131,422.50
357,000.00
204,000.00
174,000.00
153,000.00
598,000.00
2,498,220.00
-
-
925,166.32
-
1,512,000.00
80,000.00
HAL 9
PERMIN
NILAI KET
TAAN
90,000.00
224,000.00
-
65,625.00
236,000.00
428,781.00
-
237,198.00
87,400.00
456,150.00
129,200.00
456,150.00
-
390,775.00
-
143,856.00
140,000.00
38,016.00
381,672.00
59,724.00
1,875,600.00
589,950.00
974,160.00
-
43,659.00
1,485,000.00
-
415,800.00
599,306.50
270,712.00
45,000.00
-
352,100.00
2,734,375.00
2,100,000.00
-
-
-
-
HAL 10
PERMIN
NILAI KET
TAAN
-
-
-
544,980.00
-
- EX.6
- EX.6
-
3,990,000.00
-
452,000.00
-
-
675,000.00
675,000.00
675,000.00
675,000.00
306,250.00
1,787,500.00
-
630,000.00
367,500.00
400,000.00
382,500.00
495,000.00
-
162,500.00
77,170,429.85
#REF!
( LPLPO )

PUSKESMAS : Benteng
BULAN 4
NO SAT/ STOK PENE PERSE PEMA SISA
URUT N AWAL RIMAAN DIAAN KAIAN STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14
7 ALOPURINOL TABLET 300 MG Tab 244.00 - 2000 488,000.00 2000 488,000.00 - 2000
10 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 24 2,832.00 - 24 2,832.00 17 2,006.00 7
12 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 978 186,436.14 4000 762,520.00 4978 948,956.14 845 161,082.35 4133
14 AMLODIPIN 5 MG Tab 105.00 4313 452,865.00 - 4313 452,865.00 1248 131,040.00 3065
16 AMOKSISILIN KAPSUL 250 MG Kap 207.00 339 70,173.00 500 103,500.00 839 173,673.00 327 67,689.00 512
17 AMOKSISILLIN KAPLET 500 MG Kap 233.00 3796.5 884,584.50 13000 3,029,000.00 16796.5 3,913,584.50 7018.5 1,635,310.50 9778
21 AMOKSISILIN SIROP KERING 125 Btl 2,200.00 - 400 880,000.00 400 880,000.00 - 400
26 ANTASIDA DOEN TABLET KUNYAH Tab 78.00 0 - - 0 - - 0
28 01.01.00.5335.01 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 2,767.00 0 - - 0 - - 0
BULAN 4
30 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 18 86,076.00 24 114,768.00 42 200,844.00 2.8 13,389.60 39.2
32 10.02.01.5338.01 ANTIMIGREN Tab 135.00 63 8,505.00 - 63 8,505.00 9 1,215.00 54
33 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 - 100
34 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 7 40,600.00 60 348,000.00 67 388,600.00 5 29,000.00 62
35 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 0 - 30 82,500.00 30 82,500.00 - 30
37 07.01.02.5041.01 ASAM ASETIL SALISILAT 100 MG Tab 127.00 0 - - 0 - - 0
38 ASAM ASETIL SALISILAT 100 MG Tab 149.00 - 1000 149,000.00 1000 149,000.00 40 5,960.00 960
42 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 6576.5 670,803.00 5000 510,000.00 11576.5 1,180,803.00 4833.5 493,017.00 6743
53 CETIRIZINE TAB Tab 154.00 10 1,540.00 1000 154,000.00 1010 155,540.00 481 74,074.00 529
56 CHATHEJELL Tab 42,848.00 7 299,936.00 10 428,480.00 17 728,416.00 2 85,696.00 15
BULAN 4
72 22.01.01.5188.01 ERITROMISIN KAPSUL 250 MG Kap 651.00 0 - 100 65,100.00 100 65,100.00 - 100
73 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 17.5 9,135.00 - 17.5 9,135.00 - 17.5
74 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 223.5 228,640.50 100 102,300.00 323.5 330,940.50 46 47,058.00 277.5
75 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 6,461.00 0 - 50 323,050.00 50 323,050.00 - 50
76 ERITROMISIN SIROP 200 MG/ 5 ML Btl 7,581.00 26 197,106.00 - 26 197,106.00 - 26
77 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 18.5 69,375.00 - 18.5 69,375.00 1.5 5,625.00 17
78 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 86.75 227,718.75 100 262,500.00 186.75 490,218.75 13.25 34,781.25 173.5
79 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - - 0
89 16.02.01.3523.02 FUROSEMIDA TABLET 40 MG Tab 91.00 332 30,212.00 - 332 30,212.00 3 273.00 329
90 15.03.01.5200.01 GARAM ORALIT I SERBUK Sac 322.00 0 - - 0 - - 0
105 GRANTUSIF Tab 405.00 3732 1,511,460.00 7000 2,835,000.00 10732 4,346,460.00 2598 1,052,190.00 8134
106 22.01.01.5209.02 GRISEOFULVIN TABLET 125 MG Tab 241.00 0 - - 0 - - 0
BULAN 4
110 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,938.00 0 - 72 211,536.00 72 211,536.00 - 72
114 IBUPROFEN TABLET 400 MG Tab 133.00 0 - 5000 665,000.00 5000 665,000.00 2051 272,783.00 2949
118 22.01.01.5214.02 ISOSORBID DINITRAT TABLET 5 MG Tab 93.00 0 - 100 9,300.00 100 9,300.00 - 100
121 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 57 0 - 5000 285,000.00 5000 285,000.00 - 5000
122 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 67.00 547 36,649.00 1000 67,000.00 1547 103,649.00 1173 78,591.00 374
123 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - - 0
124 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2263 162,936.00 1000 72,000.00 3263 234,936.00 468 33,696.00 2795
125 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 166 23,738.00 100 14,300.00 266 38,038.00 49 7,007.00 217
132 01.01.02.5225.05 KLORAMFENIKOL TETES TELINGA 3 % Tube 1,759.00 0 - - 0 - - 0
136 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,000.00 26 104,000.00 20 80,000.00 46 184,000.00 1 4,000.00 45
140 22.01.01.5226.01 KLORFENIRAMINA MALEAT TAB 4 MG Tab 54.00 0 - - 0 - - 0
141 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 2516.5 113,242.50 12000 540,000.00 14516.5 653,242.50 2649 119,205.00 11867.5
145 KOTRIMOKSAZOL SUSPENSI Btl 2,462.00 0 - - 0 - - 0
147 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 158.00 0 - - 0 - - 0
148 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 728 95,368.00 2000 262,000.00 2728 357,368.00 341.5 44,736.50 2386.5
BULAN 4
157 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 10 9,290.00 - 10 9,290.00 1 929.00 9
158 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 0 - 120 254,640.00 120 254,640.00 - 120
159 LOPERAMIDE Tab 90.00 410 36,900.00 - 410 36,900.00 10 900.00 400
160 LORATADIN TAB Tab 170.00 0 - - 0 - - 0
162 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
163 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
166 MELOXICAM 7,5 mg Tab 680 808 549,440.00 - 808 549,440.00 308 209,440.00 500
167 MELOXICAM 15 mg Tab 875 869 760,375.00 300 262,500.00 1169 1,022,875.00 240 210,000.00 929
169 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 133.10 0 - - 0 - - 0
175 22.01.01.5246.04 METFORMIN TAB 500 MG Tab 115.00 1000 115,000.00 500 57,500.00 1500 172,500.00 - 1500
184 MINERAL MIX Bks 2,723 0 - - 0 - - 0
188 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 71.75 459,917.50 40 256,400.00 111.75 716,317.50 13 83,330.00 98.75
BULAN 4
190 NISTATIN 500.000 IU Tab 704.00 60 42,240.00 - 60 42,240.00 10 7,040.00 50
191 NISTATIN 500.000 IU Tab 857.00 - 100 85,700.00 100 85,700.00 - 100
192 NISTATIN 100.000 IU Tab 448.00 51 22,848.00 - 51 22,848.00 18 8,064.00 33
193 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 0 - 100 62,700.00 100 62,700.00 - 100
195 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,435,180 0 - 5 7,175,900.00 5 7,175,900.00 - 5
196 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 11 4,354,900.00 - 11 4,354,900.00 7 2,771,300.00 4
199 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 0 - 50 180,000.00 50 180,000.00 - 50
201 OMEPRAZOL Kap 221.00 356 78,676.00 - 356 78,676.00 356 78,676.00 0
202 OMEPRAZOL Kap 164.00 480 78,720.00 1500 246,000.00 1980 324,720.00 166 27,224.00 1814
207 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,013.00 100 101,300.00 - 100 101,300.00 - 100
210 PARASETAMOL TABLET 500 MG Tab 86.00 797 68,542.00 20800 1,788,800.00 21597 1,857,342.00 3702.5 318,415.00 17894.5
211 PARASETAMOL TABLET 500 MG Btl 51.00 2000 102,000.00 - 2000 102,000.00 2000 102,000.00 0
212 PEHACAIN INJ Amp 4,850.00 90 436,500.00 - 90 436,500.00 45 218,250.00 45
216 22.01.01.5279.01 PIRASETAM 400 Tab 194.00 0 - - 0 - - 0
217 PIRASETAM 1200 Tab 854.00 0 - - 0 - - 0
220 PIROKSIKAM TABLET 20 MG Tab 97.99 74 7,251.26 - 74 7,251.26 - 74
222 16.03.01.3543.01 PITOGIN AMPUL 1 ML Amp 9,100.00 37 336,700.00 120 1,092,000.00 157 1,428,700.00 35 318,500.00 122
223 PITOGIN AMPUL 1 ML amp 1,963.30 0 - - 0 - - 0
225 22.01.01.5283.02 POVIDON IODIDA 10 % 300 ML Btl 15,386.00 0 - 24 369,264.00 24 369,264.00 - 24
228 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 59.75 216,593.75 - 59.75 216,593.75 2.75 9,968.75 57
BULAN 4
230 PREDNISON TABLET 5 MG Tab 123.20 2679 330,052.80 10000 1,232,000.00 12679 1,562,052.80 1884.5 232,170.40 10794.5
231 22.01.01.5285.01 RESPIRIDON 25 MG Tab 0 - - 0 - - 0
235 RANITIDIN TABLET 150 MG Tab 115.00 3930 451,950.00 5000 575,000.00 8930 1,026,950.00 981 112,815.00 7949
239 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - - 0
242 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 65.00 288.5 18,752.50 1000 65,000.00 1288.5 83,752.50 96.5 6,272.50 1192
243 22.01.01.5295.02 SALBUTAMOL TABLET 4 MG Tab 88.00 213 18,744.00 700 61,600.00 913 80,344.00 74 6,512.00 839
244 SALEP 2-4 KOMBINASI Tube 2,797.00 15 41,955.00 24 67,128.00 39 109,083.00 9 25,173.00 30
245 SALISIL BEDAK 2 % Pot 1,071.00 21.8 23,347.80 - 21.8 23,347.80 17.8 19,063.80 4
246 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 3 3,198.00 50 53,300.00 53 56,498.00 - 53
247 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 ML Btl 4,133.00 18 74,394.00 48 198,384.00 66 272,778.00 11 45,463.00 55
251 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,117.00 0 - 100 111,700.00 100 111,700.00 15 16,755.00 85
252 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,050.00 31 32,550.00 - 31 32,550.00 - 31
257 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 1557 463,986.00 4000 1,192,000.00 5557 1,655,986.00 865 257,770.00 4692
261 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 5629 681,109.00 18000 2,178,000.00 23629 2,859,109.00 1086 131,406.00 22543
262 TABLET TAMBAH DARAH KOMBINASI Tab 367.00 3000 1,101,000.00 - 3000 1,101,000.00 3000 1,101,000.00 0
263 TABLET TAMBAH DARAH KOMBINASI Tab 410.00 0 - 6000 2,460,000.00 6000 2,460,000.00 6000 2,460,000.00 0
265 TETRASIKLIN KAPSUL 250 MG Kap 181.00 484 87,604.00 3000 543,000.00 3484 630,604.00 496 89,776.00 2988
269 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 2837 258,167.00 12000 1,092,000.00 14837 1,350,167.00 3148 286,468.00 11689
BULAN 4
271 TIURAZOL 10 mg TAB Tab 1,195.00 60 71,700.00 100 119,500.00 160 191,200.00 - 160
273 TRAMADOL INJ Tab 6,000.00 0 - - 0 - - 0
278 VIT A MERAH kap 505.00 640 323,200.00 100 50,500.00 740 373,700.00 40 20,200.00 700
279 VIT A BIRU kap 286.00 0 - - 0 - - 0
280 VTT A BIRU kap 327.00 26 8,502.00 50 16,350.00 76 24,852.00 - 76
282 VITAMIN B KOMPLEKS TABLET Tab 132.00 8856 1,168,992.00 9400 1,240,800.00 18256 2,409,792.00 5031 664,092.00 13225
283 19.07.01.4128.01 ZIN TAB Tab 521.00 0 - - 0 - - 0
284 ZIN TAB Tab 592.00 750 444,000.00 500 296,000.00 1250 740,000.00 227 134,384.00 1023
285 ZIN SIRUP Btl 6,600.00 34 224,400.00 - 34 224,400.00 6 39,600.00 28
0 - - 0 - - 0
2 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 2,530.813 0 - - 0 - - 0
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 100 123,750.00 100 123,750.00 200 247,500.00 - 200
11 BISTURI NO. 19 Bh 3,000 119 357,000.00 - 119 357,000.00 9 27,000.00 110
12 BISTURI NO.20 Bh 3,000 68 204,000.00 - 68 204,000.00 3 9,000.00 65
13 BISTURI NO.21 Bh 3,000 58 174,000.00 - 58 174,000.00 4 12,000.00 54
14 BISTURI NO.23 Bh 3,000 51 153,000.00 - 51 153,000.00 4 12,000.00 47
15 JARUM HECTING Bh 2,600 230 598,000.00 - 230 598,000.00 2 5,200.00 228
16 CATGUT NO 2/0 Pcs 27,758.00 90 2,498,220.00 - 90 2,498,220.00 16 444,128.00 74
17 CATGUT NO 2/0 Pcs 11,403.33 0 - - 0 - - 0
18 CATGUT NO 2/0 Pcs 28,000.00 0 - - 0 - - 0
19 CATGUT NO 3/0 Pcs 8,895.83 104 925,166.32 - 104 925,166.32 20 177,916.60 84
20 CATGUT NO 3/0 Pcs 8,950.00 0 - - 0 - - 0
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 - 10
23 FOLEY CATETER 18 Bh 10,000.00 9 90,000.00 20 200,000.00 29 290,000.00 5 50,000.00 24
24 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
25 HIV TEST Set 0 - - 0 - - 0
BULAN 4
28 INFUSION SET DEWASA Set 6,218.75 - 50 310,937.50 50 310,937.50 - 50
29 IV CATHETER NO 18 G Set 9,123.00 47 428,781.00 50 456,150.00 97 884,931.00 14 127,722.00 83
30 IV CATHETER NO 20 G Set 7,700.00 0 - 50 385,000.00 50 385,000.00 - 50
36 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 12.25 390,775.00 10 319,000.00 22.25 709,775.00 3 95,700.00 19.25
37 KASA KOMPRES 40/40 STERIL Bks 3,100.00 0 - 100 310,000.00 100 310,000.00 - 100
40 KASA PEMBALUT 2 M X 80 CM Bks 10,152.00 - 50 507,600.00 50 507,600.00 - 50
41 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASTIS Bks 864.00 44 38,016.00 50 43,200.00 94 81,216.00 6 5,184.00 88
43 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,500.00 - 50 225,000.00 50 225,000.00 - 50
44 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS Bks 8,532.00 7 59,724.00 - 7 59,724.00 - 7
46 PLESTER YARD Roll 43,700.00 13.5 589,950.00 - 13.5 589,950.00 7.5 327,750.00 6
47 PLESTER YARD Roll 49,632.00 - 24 1,191,168.00 24 1,191,168.00 - 24
48 HANDSCON 6 1/2 psg 6,237.00 - 200 1,247,400.00 200 1,247,400.00 - 200
50 HANDSCON 7 STERIL psg 6,118.20 0 - 200 1,223,640.00 200 1,223,640.00 - 200
51 HANDSCON 71/2 psg 6,237.00 7 43,659.00 - 7 43,659.00 7 43,659.00 0
52 HANDSCON 71/2 psg 5,940.00 250 1,485,000.00 - 250 1,485,000.00 19 112,860.00 231
53 HANDSCON 71/2 psg 6,118.20 0 - 200 1,223,640.00 200 1,223,640.00 - 200
54 HANDSCON S psg 1,188.00 350 415,800.00 100 118,800.00 450 534,600.00 225 267,300.00 225
55 HANDSCON S psg 854.74 - 400 341,896.00 400 341,896.00 - 400
56 HANDSCON L psg 890.50 673 599,306.50 - 673 599,306.50 8 7,124.00 665
57 HANDSCON M psg 890.50 304 270,712.00 - 304 270,712.00 278 247,559.00 26
58 HANDSCON M psg 1,188.00 - 200 237,600.00 200 237,600.00 - 200
59 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 - 15
60 MASKER KARET Pcs 700.00 503 352,100.00 300 210,000.00 803 562,100.00 245 171,500.00 558
61 SILK 2/0 SET 21,875.00 125 2,734,375.00 36 787,500.00 161 3,521,875.00 16 350,000.00 145
62 SILK 3/0 SET 21,875.00 96 2,100,000.00 - 96 2,100,000.00 21 459,375.00 75
63 SILK 3/0 SET 35,331.00 0 - - 0 - - 0
64 POT SPUTUM Pcs 2,930.00 186 544,980.00 248 726,640.00 434 1,271,620.00 29 84,970.00 405
BULAN 4
66 RDT DBD IGG/IGM DOS 1,562,500.00 0 - - 0 - - 0
67 RDT DBD NS1 DOS 2,400,000.00 0 - - 0 - - 0
68 ALKOHOL SWAB BOX 17,303.00 0 - - 0 - - 0
69 STRIP GULA DARAH DOS 420,000.00 9.5 3,990,000.00 3 1,260,000.00 12.5 5,250,000.00 - 12.5
71 STRIP ASAM URAT DOS 452,000.00 1 452,000.00 15 6,780,000.00 16 7,232,000.00 1 452,000.00 15
72 KOLESTEROL STRIP DOS 319,000.00 0 - 15 4,785,000.00 15 4,785,000.00 - 15
BAHAN GIGI - - 0 - - 0
5 EUGENOL Pcs 175,000.00 1.75 306,250.00 - 1.75 306,250.00 - 1.75
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 2.75 1,787,500.00 - 2.75 1,787,500.00 0.75 487,500.00 2
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 3 630,000.00 - 3 630,000.00 - 3
9 OCCO Pcs 245,000.00 1.5 367,500.00 - 1.5 367,500.00 0.5 122,500.00 1
10 DYCAL Pcs 800,000.00 0.5 400,000.00 - 0.5 400,000.00 - 0.5
11 HEMOSPON Pcs 76,500.00 5 382,500.00 30 2,295,000.00 35 2,677,500.00 3 229,500.00 32
12 PULP-10 Pcs 495,000.00 1 495,000.00 3 1,485,000.00 4 1,980,000.00 - 4
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 0.5 162,500.00 3 975,000.00 3.5 1,137,500.00 0.25 81,250.00 3.25
BPJS UMUM JMLH

3375 281 3656


Nip. 196551214 199803 1 005 Nip.19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
4
2
1 8
HAL 1
PERMIN
NILAI KET
TAAN
15 16 17
855,228.00
-
23,293.75
-
128,115.00
115,000.00
488,000.00
86,177.52
24,252.00
826.00
115,500.00
787,873.79
-
321,825.00
-
105,984.00
2,278,274.00 10000
-
-
71,680.00
880,000.00
-
-
-
408,704.00
-
341,172.00
-
134,600.00
HAL 2
PERMIN
NILAI KET
TAAN
187,454.40
129,574.00
7,290.00
17,900.00
359,600.00
82,500.00
-
-
143,040.00
421,056.00
1,050.00
-
687,786.00
-
5,020.00
-
290,322.00
-
213,815.00
821,560.00
-
-
95,495.00
81,466.00
115,000.00
-
642,720.00
5,214.00
34,800.00
538,992.00
-
47,190.00
25,498.00 ex 12
133,840.00
100,572.00
28,016.00
-
-
8,664.00
-
HAL 3
PERMIN
NILAI KET
TAAN
17,922.00
59,160.00
65,100.00
9,135.00
283,882.50
323,050.00
197,106.00
63,750.00
455,437.50
-
-
-
59,400.00
35,400.00
181,470.00
-
1,888.00
367,470.00
-
29,939.00
-
132,616.00
284,580.00
20,330.00
-
-
1,970.00
51,240.00
47,188.00
89,100.00
-
173,472.75
-
-
337,480.00
3,294,270.00
-
123,970.00 500
20,995.00
17,100.00
HAL 4
PERMIN
NILAI KET
TAAN
211,536.00
151,848.00
-
64,130.00
392,217.00
-
467,703.00
-
9,300.00
12,152.00
-
285,000.00
25,058.00
-
201,240.00
31,031.00
-
-
1,383.00
-
50,315.00
14,800.00
-
21,900.00 ex10
-
-
180,000.00
-
421,451.58
262,185.00
-
534,037.50
3,500.00
9,570.00
89,500.00
-
471,700.00
-
312,631.50
-
HAL 5
PERMIN
NILAI KET
TAAN
-
-
-
-
-
79,713.00
-
8,361.00
254,640.00
36,000.00
-
41,674.00
76,800.00
21,900.00
-
-
340,000.00
812,875.00
-
-
510,000.00
-
340,395.00
27,200.00
3,910.50
172,500.00
48,180.00
-
858,426.00
-
48,860.00
30,740.00
302,400.00
1,455,300.00
-
-
-
586,845.00
632,987.50
46,863.00
HAL 6
PERMIN
NILAI KET
TAAN
35,200.00
85,700.00
14,784.00
62,700.00
1,379,984.00
7,175,900.00
1,583,600.00
473,000.00
23,520.00
180,000.00
79,008.00
-
297,496.00
92,685.00
177,792.00
-
544,180.00
101,300.00
290,940.00
-
1,538,927.00
-
218,250.00
-
-
-
-
-
654,224.00
43,645.00 500
7,251.26
-
1,110,200.00
-
-
369,264.00
90,000.00
-
206,625.00
-
HAL 7
PERMIN
NILAI KET
TAAN
1,329,882.40
- 200
-
62,445.00
104,247.00
914,135.00
-
44,100.00
-
-
622,050.00
715,653.00
77,480.00
73,832.00
83,910.00
4,284.00
56,498.00
227,315.00
-
1,073,345.00
70,000.00
94,945.00
32,550.00
-
807,125.00
-
948,897.00
1,398,216.00
-
-
619,905.00
2,727,703.00
-
-
-
540,828.00
8,450.00
-
-
1,063,699.00
HAL 8
PERMIN
NILAI KET
TAAN
-
191,200.00
-
-
111,972.78
353,500.00
-
24,852.00
-
1,745,700.00
-
605,616.00
184,800.00
-
-
792,360.00
-
1,032,304.00
74,646.00
247,500.00
1,112,800.00
-
128,079.00
122,375.00
128,177.50
330,000.00
195,000.00
162,000.00
141,000.00
592,800.00
2,054,092.00
-
-
747,249.72
-
1,512,000.00
80,000.00
240,000.00
224,000.00
-
HAL 9
PERMIN
NILAI KET
TAAN
56,875.00
148,000.00
310,937.50
757,209.00
385,000.00
100,353.00
87,400.00
456,150.00
129,200.00
456,150.00
614,075.00
310,000.00
132,192.00
90,000.00
507,600.00
76,032.00
225,720.00
225,000.00
59,724.00
3,126,000.00
262,200.00
1,191,168.00
1,247,400.00
677,160.00
1,223,640.00
-
1,372,140.00
1,223,640.00
267,300.00
341,896.00
592,182.50
23,153.00
237,600.00
45,000.00
390,600.00
3,171,875.00
1,640,625.00
-
1,186,650.00
-
HAL 10
PERMIN
NILAI KET
TAAN
-
-
-
5,250,000.00
-
6,780,000.00
4,785,000.00
-
632,812.50
632,812.50
632,812.50
632,812.50
306,250.00
1,300,000.00
-
630,000.00
245,000.00
400,000.00
2,448,000.00
1,980,000.00
-
1,056,250.00
124,828,410.45
( LPLPO )

PUSKESMAS : Benteng
BULAN 5
MSN AWAL
1 2 3 4 5 6 7 8 9 10 11 12 13
1 21.01.01.4154.02 ALBENDAZOL TABLET 400 MG Tab 363.00 2356 855,228.00 - 2356 855,228.00 9 3,267.00
3 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 1.25 23,293.75 - 1.25 23,293.75 0 -
5 ALOPURINOL TABLET 100 MG Tab 117.00 1095 128,115.00 - 1095 128,115.00 272 31,824.00
6 07.01.02.5044.02 ALOPURINOL TABLET 300 MG Tab 230.00 500 115,000.00 - 500 115,000.00 -
7 ALOPURINOL TABLET 300 MG Tab 244.00 2000 488,000.00 - 2000 488,000.00 -
9 22.01.01.5159.03 AMINOFILIN TABLET 200 MG Tab 86.00 282 24,252.00 - 282 24,252.00 22 1,892.00
10 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 7 826.00 - 7 826.00 7 826.00
11 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 700 115,500.00 - 700 115,500.00 6 990.00
12 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 4133 787,873.79 - 4133 787,873.79 1203 229,327.89
14 AMLODIPIN 5 MG Tab 105.00 3065 321,825.00 - 3065 321,825.00 1064 111,720.00
16 AMOKSISILLIN KAPLET 500 MG Kap 233.00 9778 2,278,274.00 10000 2,330,000.00 19778 4,608,274.00 6114 1,424,562.00
18 01.01.04.5100.04 AMOKSISILIN SIROP KERING 125 Btl 2,560.00 28 71,680.00 - 28 71,680.00 28 71,680.00
19 AMOKSISILIN SIROP KERING 125 Btl 2,200.00 400 880,000.00 - 400 880,000.00 82 180,400.00
21 15.01.01.5334.02 ANTASIDA DOEN II SUSPENSI Btl 2,106.00 162 341,172.00 - 162 341,172.00 36 75,816.00
22 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 40 134,600.00 - 40 134,600.00 0 -
23 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 39.2 187,454.40 - 39.2 187,454.40 1 4,782.00
25 10.02.01.5338.01 ANTIMIGREN Tab 135.00 54 7,290.00 - 54 7,290.00 22 2,970.00
26 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 -
27 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 62 359,600.00 - 62 359,600.00 2 11,600.00
28 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 30 82,500.00 - 30 82,500.00 -
29 ASAM ASETIL SALISILAT 100 MG Tab 149.00 960 143,040.00 - 960 143,040.00 60 8,940.00
BULAN 5
MSN AWAL
30 ASAM ASKORBAT (VIT C) 25 MG 51.00 8256 421,056.00 - 8256 421,056.00 3204 163,404.00
31 05.03.07.5164.02 ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 10 1,050.00 - 10 1,050.00 -
32 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 6743 687,786.00 3000 306,000.00 9743 993,786.00 3853 393,006.00
35 22.01.01.5168.03 ASIKLOVIR TABLET 400 MG Tab 381.00 762 290,322.00 - 762 290,322.00 81 30,861.00
36 22.01.01.5172.01 BETAMETASON KRIM 0,1 % Tube 1,435.00 149 213,815.00 - 149 213,815.00 26 37,310.00
40 CETIRIZINE TAB KAP 115.00 1000 115,000.00 - 1000 115,000.00 -
42 CHATHEJELL Tab 42,848.00 15 642,720.00 - 15 642,720.00 1 42,848.00
44 DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 20 34,800.00 - 20 34,800.00 -
45 DEKSAMETASON TAB Tab 48.00 11229 538,992.00 - 11229 538,992.00 2454 117,792.00
47 22.01.01.5179.02 DIAZEPAM TABLET 2 MG Tab 39.00 1210 47,190.00 - 1210 47,190.00 233 9,087.00
48 DIAZEPAM RECTAL Tube 12,749.00 2 25,498.00 - 2 25,498.00 2 25,498.00
49 22.01.01.5179.03 DIAZEPAM RECTAL Tube 13,384.00 10 133,840.00 - 10 133,840.00 -
50 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 49 56,644.00
51 22.01.01.5181.01 DIGOKSIN TABLET 0,25 MG Tab 103.00 272 28,016.00 - 272 28,016.00 12 1,236.00
55 22.01.01.5186.01 DOMPERIDON TABLET 10 MG Tab 174.00 340 59,160.00 - 340 59,160.00 53 9,222.00
56 22.01.01.5188.01 ERITROMISIN KAPSUL 250 MG Kap 651.00 100 65,100.00 - 100 65,100.00 -
57 22.01.01.5189.01 ERITROMISIN KAPSUL 250 MG Kap 522.00 17.5 9,135.00 - 17.5 9,135.00 17.5 9,135.00
58 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 277.5 283,882.50 - 277.5 283,882.50 9 9,207.00
59 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 6,461.00 50 323,050.00 - 50 323,050.00 0 -
61 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 17 63,750.00 - 17 63,750.00 0 -
62 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 173.5 455,437.50 - 173.5 455,437.50 12.5 32,812.50
63 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - -
67 05.03.13.5196.01 FITOMENADION (VIT K) TABLET 10 MG Tab 690.00 263 181,470.00 - 263 181,470.00 76 52,440.00
68 05.03.13.5196.02 FITOMENADION (VIT K) INJ 10 MG/ML Amp 1,888.00 1 1,888.00 - 1 1,888.00 1 1,888.00
BULAN 5
MSN AWAL
69 FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 90 367,470.00 - 90 367,470.00 19 77,577.00
70 16.02.01.3523.02 FUROSEMIDA TABLET 40 MG Tab 91.00 329 29,939.00 - 329 29,939.00 23 2,093.00
71 GARAM ORALIT I SERBUK Sac 274.00 484 132,616.00 - 484 132,616.00 92 25,208.00
75 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 61.00 840 51,240.00 1000 61,000.00 1840 112,240.00 319 19,459.00
78 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.00 0 - 3000 210,000.00 3000 210,000.00 -
79 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 2445 173,472.75 - 2445 173,472.75 952 67,544.40
80 04.02.01.5208.03 GLUKOSA LARUTAN INFUS 5 % Btl 5,720.00 59 337,480.00 - 59 337,480.00 2 11,440.00
81 GRANTUSIF Tab 405.00 8134 3,294,270.00 - 8134 3,294,270.00 2575 1,042,875.00
82 GRISEOFULVIN TABLET 125 MG Tab 506.00 245 123,970.00 1000 506,000.00 1245 629,970.00 153 77,418.00
83 22.01.01.5210.01 HALOPERIDOL TABLET 1.5 MG Tab 65.00 323 20,995.00 - 323 20,995.00 115 7,475.00
85 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,938.00 72 211,536.00 - 72 211,536.00 1 2,938.00
86 HIDROKORTISON KRIM 2 % Tube 2,812.00 54 151,848.00 - 54 151,848.00 54 151,848.00
87 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 530 64,130.00 - 530 64,130.00 -
94 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 57 5000 285,000.00 - 5000 285,000.00 644 36,708.00
95 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 67.00 374 25,058.00 - 374 25,058.00 374 25,058.00
96 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - -
97 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2795 201,240.00 - 2795 201,240.00 376 27,072.00
98 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 217 31,031.00 - 217 31,031.00 42 6,006.00
99 KETOROLAC INJ Amp 1,383.00 1 1,383.00 - 1 1,383.00 -
101 01.01.02.5225.02 KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 8 14,800.00 - 8 14,800.00 1 1,850.00
104 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 678 421,451.58 - 678 421,451.58 35 21,756.35
105 KLORAMFENIKOL KAPSUL 500 MG Kap 1,155.00 227 262,185.00 - 227 262,185.00 78 90,090.00
106 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 11867.5 534,037.50 - 11867.5 534,037.50 2454 110,430.00
BULAN 5
MSN AWAL
111 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 2386.5 312,631.50 - 2386.5 312,631.50 176 23,056.00
112 LANSOPRAZOL 30 MG KAP 521.00 153 79,713.00 - 153 79,713.00 65 33,865.00
114 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 9 8,361.00 - 9 8,361.00 0 -
115 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 120 254,640.00 - 120 254,640.00 37 78,514.00
116 LOPERAMIDE Tab 90.00 400 36,000.00 - 400 36,000.00 -
118 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 -
119 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 -
120 MELOXICAM 7,5 mg Tab 680 500 340,000.00 - 500 340,000.00 500 340,000.00
121 MELOXICAM 15 mg Tab 875 929 812,875.00 - 929 812,875.00 679 594,125.00
122 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 133.10 0 - - 0 - -
123 22.01.01.5245.02 METILERGOMETRIN MALEAT INJ 0.2 MG Amp 8,500.00 60 510,000.00 - 60 510,000.00 0 -
124 METILPREDNISOLON TAB 4 MG Tab 165.00 2063 340,395.00 2000 330,000.00 4063 670,395.00 851 140,415.00
125 METILPREDNISOLON TAB16 MG Tab 850.00 32 27,200.00 - 32 27,200.00 21 17,850.00
127 22.01.01.5246.04 METFORMIN TAB 500 MG Tab 115.00 1500 172,500.00 - 1500 172,500.00 100 11,500.00
129 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1654 519 858,426.00 - 519 858,426.00 242 400,268.00
130 METRONIDAZOL TABLET 500 MG Tab 140.00 349 48,860.00 - 349 48,860.00 61 8,540.00
132 MIKONAZOLE KREAM Tube 3,150.00 96 302,400.00 - 96 302,400.00 33 103,950.00
134 NA. DIKLOFENAK 50 MG/DIK.SODIUM Tab 161.00 3645 586,845.00 - 3645 586,845.00 586 94,346.00
135 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 98.75 632,987.50 - 98.75 632,987.50 13 83,330.00
137 NISTATIN 500.000 IU Tab 704.00 50 35,200.00 - 50 35,200.00 -
138 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 - 100 85,700.00 -
139 NISTATIN 100.000 IU Tab 448.00 33 14,784.00 - 33 14,784.00 -
140 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 100 62,700.00 - 100 62,700.00 -
141 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 1 1,379,984.00 - 1 1,379,984.00 1 1,379,984.00
142 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,435,180 5 7,175,900.00 - 5 7,175,900.00 -
143 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 4 1,583,600.00 - 4 1,583,600.00 1 395,900.00
144 15.05.01.5258.04 OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 2 473,000.00 - 2 473,000.00 -
146 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,685.00 - 50 184,250.00 50 184,250.00 -
BULAN 5
MSN AWAL
147 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 50 180,000.00 - 50 180,000.00 -
149 OMEPRAZOL Kap 221.00 0 - - 0 - -
150 OMEPRAZOL Kap 164.00 1814 297,496.00 - 1814 297,496.00 609 99,876.00
151 OMEPRAZOL INJ Amp 18,537.00 5 92,685.00 - 5 92,685.00 5 92,685.00
152 22.01.01.5273.02 PAPAVERIN TABLET 40 MG Tab 128.00 1389 177,792.00 - 1389 177,792.00 182 23,296.00
153 PAPAVERIN TABLET 40 MG Tab 208.00 0 - 1000 208,000.00 1000 208,000.00 -
154 PARASETAMOLDROPS Btl 5,980.00 91 544,180.00 - 91 544,180.00 30 179,400.00
155 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,013.00 100 101,300.00 - 100 101,300.00 68 68,884.00
156 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 260 290,940.00 - 260 290,940.00 -
157 PARASETAMOL TABLET 500 MG Tab 86.00 17894.5 1,538,927.00 - 17894.5 1,538,927.00 5312 456,832.00
158 PEHACAIN INJ Amp 4,850.00 45 218,250.00 - 45 218,250.00 43 208,550.00
159 05.03.06.5280.01 PIRIDOKSIN (VIT B6) TAB 10 MG Tab 124.00 5276 654,224.00 - 5276 654,224.00 974 120,776.00
160 22.01.01.5281.01 PIROKSIKAM TABLET 10 MG Tab 145.00 301 43,645.00 - 301 43,645.00 110 15,950.00
161 PIROKSIKAM TABLET 20 MG Tab 97.99 74 7,251.26 - 74 7,251.26 0 -
162 16.03.01.3543.01 PITOGIN AMPUL 1 ML Amp 9,100.00 122 1,110,200.00 - 122 1,110,200.00 16 145,600.00
166 PREDNISON TABLET 5 MG Tab 123.20 10794.5 1,329,882.40 - 10794.5 1,329,882.40 2193 270,177.60
167 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 69.00 905 62,445.00 - 905 62,445.00 114 7,866.00
168 22.01.01.5289.01 PROPILITIOURASIL TABLET 100 MG Tab 351.00 297 104,247.00 - 297 104,247.00 129 45,279.00
170 15.01.01.3184.02 RESPIRIDON 2 MG Amp 347.00 0 - 200 69,400.00 200 69,400.00 60 20,820.00
173 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - -
174 22.01.01.5293.01 RINGER LAKTAT INFUS Btl 7,150.00 87 622,050.00 - 87 622,050.00 7 50,050.00
179 SALISIL BEDAK 2 % Pot 1,071.00 4 4,284.00 - 4 4,284.00 4 4,284.00
180 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 53 56,498.00 - 53 56,498.00 2 2,132.00
181 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 ML Btl 4,133.00 55 227,315.00 - 55 227,315.00 4 16,532.00
182 SEFADROKSIL KAPSUL 500 MG Kap 557.00 0 - 1000 557,000.00 1000 557,000.00 1000 557,000.00
183 SEFADROKSIL KAPSUL 500 MG Kap 455.00 2359 1,073,345.00 - 2359 1,073,345.00 49 22,295.00
185 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,117.00 85 94,945.00 - 85 94,945.00 -
BULAN 5
MSN AWAL
186 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,050.00 31 32,550.00 - 31 32,550.00 17 17,850.00
187 22.01.01.5306.03 SIANOKOBALAMIN TABLET 50 MCG Tab 15.00 0 - - 0 - -
188 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 14675 807,125.00 - 14675 807,125.00 1234 67,870.00
189 SIMVASTATIN TABLET 10 MG Tab 177.00 5361 948,897.00 - 5361 948,897.00 564 99,828.00
190 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 4692 1,398,216.00 - 4692 1,398,216.00 883 263,134.00
192 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 22543 2,727,703.00 - 22543 2,727,703.00 3482 421,322.00
194 01.01.06.5321.02 TETRASIKLIN KAPSUL 500 MG Kap 325.00 26 8,450.00 - 26 8,450.00 -
196 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 11689 1,063,699.00 - 11689 1,063,699.00 3275 298,025.00
198 TIURAZOL 10 mg TAB Tab 1,195.00 160 191,200.00 - 160 191,200.00 60 71,700.00
199 TRIHEKSIFENIDIL 25 MG TAB Tab 80.00 0 - 200 16,000.00 200 16,000.00 -
201 VIT A MERAH kap 505.00 700 353,500.00 - 700 353,500.00 16 8,080.00
202 05.03.06.5332.01 VTT A BIRU kap 327.00 76 24,852.00 - 76 24,852.00 -
203 19.07.01.4128.01 VITAMIN B KOMPLEKS TABLET Tab 132.00 13225 1,745,700.00 - 13225 1,745,700.00 3704 488,928.00
204 ZIN TAB Tab 592.00 1023 605,616.00 - 1023 605,616.00 188 111,296.00
205 ZIN SIRUP Btl 6,600.00 28 184,800.00 - 28 184,800.00 13 85,800.00
-
1 PERBEKALAN KESEHATAN -
2 ALAT SUNTIK SEKALI PAKAI 0,5 ML Set 1,240.00 639 792,360.00 639 792,360.00 233 288,920.00
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 709 1,032,304.00 709 1,032,304.00 67 97,552.00
4 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,287.00 58 74,646.00 58 74,646.00 57 73,359.00
6 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 1,300.00 856 1,112,800.00 856 1,112,800.00 102 132,600.00
10 BISTURI NO. 19 Bh 3,000 110 330,000.00 - 110 330,000.00 -
11 BISTURI NO.20 Bh 3,000 65 195,000.00 - 65 195,000.00 1 3,000.00
12 BISTURI NO.21 Bh 3,000 54 162,000.00 - 54 162,000.00 2 6,000.00
13 BISTURI NO.23 Bh 3,000 47 141,000.00 - 47 141,000.00 2 6,000.00
14 JARUM HECTING Bh 2,600 228 592,800.00 - 228 592,800.00 -
15 CATGUT NO 2/0 Pcs 27,758.00 74 2,054,092.00 - 74 2,054,092.00 12 333,096.00
16 CATGUT NO 2/0 Pcs 28,000.00 0 - 36 1,008,000.00 36 1,008,000.00 -
17 CATGUT NO 3/0 Pcs 8,895.83 84 747,249.72 - 84 747,249.72 12 106,749.96
18 CATGUT NO 3/0 Pcs 30,188.00 0 - 36 1,086,768.00 36 1,086,768.00 -
BULAN 5
MSN AWAL
19 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 -
20 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 -
21 FOLEY CATETER 18 Bh 10,000.00 24 240,000.00 - 24 240,000.00 2 20,000.00
22 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 -
23 HIV TEST Set 0 - - 0 - -
24 INFUSION SET ANAK SET 4,375.00 13 56,875.00 - 13 56,875.00 2 8,750.00
26 INFUSION SET DEWASA Set 6,218.75 50 310,937.50 - 50 310,937.50 -
34 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 19.25 614,075.00 - 19.25 614,075.00 1.75 55,825.00
36 KASA KOMPRES 40/40 STERIL Bks 1,944.00 68 132,192.00 - 68 132,192.00 -
37 KASA PEMBALUT 2 M X 80 CM Bks 10,000.00 9 90,000.00 - 9 90,000.00 -
39 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASTIS Bks 864.00 88 76,032.00 - 88 76,032.00 4 3,456.00
40 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,104.00 55 225,720.00 100 410,400.00 155 636,120.00 34 139,536.00
41 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,500.00 50 225,000.00 - 50 225,000.00 -
43 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 20 3,126,000.00 - 20 3,126,000.00 4 625,200.00
44 PLESTER YARD Roll 43,700.00 6 262,200.00 - 6 262,200.00 6 262,200.00
45 PLESTER YARD Roll 49,632.00 24 1,191,168.00 - 24 1,191,168.00 -
46 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 - 200 1,247,400.00 -
47 HANDSCON 7 STERIL psg 5,940.00 114 677,160.00 - 114 677,160.00 38 225,720.00
48 HANDSCON 7 STERIL psg 6,118.20 200 1,223,640.00 - 200 1,223,640.00 -
49 HANDSCON 71/2 psg 5,940.00 231 1,372,140.00 - 231 1,372,140.00 -
50 HANDSCON 71/2 psg 6,118.20 200 1,223,640.00 - 200 1,223,640.00 69 422,155.80
51 HANDSCON S psg 1,188.00 225 267,300.00 - 225 267,300.00 225 267,300.00
52 HANDSCON S psg 854.74 400 341,896.00 - 400 341,896.00 4 3,418.96
53 HANDSCON L psg 890.50 665 592,182.50 - 665 592,182.50 6 5,343.00
54 HANDSCON M psg 890.50 26 23,153.00 500 445,250.00 526 468,403.00 -
55 HANDSCON M psg 1,188.00 200 237,600.00 - 200 237,600.00 76 90,288.00
56 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 -
57 MASKER KARET Pcs 700.00 558 390,600.00 - 558 390,600.00 247 172,900.00
BULAN 5
MSN AWAL
58 SILK 2/0 SET 21,875.00 145 3,171,875.00 - 145 3,171,875.00 1 21,875.00
59 SILK 3/0 SET 21,875.00 75 1,640,625.00 - 75 1,640,625.00 14 306,250.00
60 SILK 3/0 SET 21,458.33 0 - 36 772,500.02 36 772,500.02 -
61 POT SPUTUM Pcs 2,930.00 405 1,186,650.00 - 405 1,186,650.00 239 700,270.00
62 STRIP GULA DARAH DOS 420,000.00 12.5 5,250,000.00 - 12.5 5,250,000.00 2.5 1,050,000.00
64 STRIP ASAM URAT DOS 452,000.00 15 6,780,000.00 - 15 6,780,000.00 2 904,000.00
65 STRIP ASAM URAT DOS 290,000.00 - - 0 - -
66 KOLESTEROL STRIP DOS 319,000.00 15 4,785,000.00 6 1,914,000.00 21 6,699,000.00 13 4,147,000.00
BAHAN GIGI
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 0.9375 632,812.50 - 0.9375 632,812.50 0.125 84,375.00
5 EUGENOL Pcs 175,000.00 1.75 306,250.00 - 1.75 306,250.00 0.25 43,750.00
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 2 1,300,000.00 - 2 1,300,000.00 -
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - -
8 CHKM 10 ML Pcs 210,000.00 3 630,000.00 - 3 630,000.00 0.25 52,500.00
9 OCCO Pcs 245,000.00 1 245,000.00 - 1 245,000.00 0.25 61,250.00
10 DYCAL Pcs 800,000.00 0.5 400,000.00 - 0.5 400,000.00 -
11 HEMOSPON Pcs 76,500.00 32 2,448,000.00 - 32 2,448,000.00 1 76,500.00
12 PULP-10 Pcs 495,000.00 4 1,980,000.00 - 4 1,980,000.00 0.25 123,750.00
14 CAVITON Btl 325,000.00 3.25 1,056,250.00 - 3.25 1,056,250.00 0.25 81,250.00
BPJS UMUM JMLH

3179 204 3383

Nip. 196551214 199803 1 005 19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
0 5
0 2
0 1 8
HAL 1
SISA PERMIN
NILAI KET
STOK TAAN
14 15 16 17
2347 851,961.00
0 -
1.25 23,293.75
0 -
823 96,291.00
500 115,000.00
2000 488,000.00
26 86,177.52
260 22,360.00
0 -
694 114,510.00
2930 558,545.90
0 -
2001 210,105.00
494 102,258.00
13664 3,183,712.00
0 -
0 -
318 699,600.00
4545 290,880.00
126 265,356.00
40 134,600.00
38.2 182,672.40
37 129,574.00
32 4,320.00
100 17,900.00
60 348,000.00
30 82,500.00
900 134,100.00
HAL 2
SISA PERMIN
NILAI KET
STOK TAAN
5052 257,652.00
10 1,050.00
5890 600,780.00
0 -
20 5,020.00
681 259,461.00
123 176,505.00
1059 804,840.00
330 88,770.00
155 23,870.00
1000 115,000.00
0 -
14 599,872.00
3 5,214.00
20 34,800.00
8775 421,200.00
0 -
977 38,103.00
0 - ex 2
10 133,840.00
38 43,928.00 ex49
260 26,780.00
76 8,664.00
0 -
58 17,922.00
287 49,938.00
100 65,100.00
0 - ex 17,5
268.5 274,675.50
50 323,050.00
9 68,229.00 ex 6
17 63,750.00
161 422,625.00
0 -
0 -
30 59,400.00
200 35,400.00
187 129,030.00
0 -
HAL 3
SISA PERMIN
NILAI KET
STOK TAAN
71 289,893.00
306 27,846.00
392 107,408.00
930 284,580.00
5 20,330.00
2 1,970.00
1521 92,781.00
82 41,164.00
300 89,100.00
3000 210,000.00
1493 105,928.35
57 326,040.00
5559 2,251,395.00
1092 552,552.00 500
208 13,520.00
100 17,100.00
71 208,598.00
0 -
530 64,130.00
1455 193,515.00
2979 467,703.00
0 -
100 9,300.00
124 12,152.00
0 -
4356 248,292.00
0 -
0 -
2419 174,168.00
175 25,025.00
1 1,383.00
329 47,705.00
7 12,950.00
2 14,600.00
42 168,000.00
643 399,695.23
149 172,095.00
9413.5 423,607.50
70 3,500.00
HAL 4
SISA PERMIN
NILAI KET
STOK TAAN
0 -
457 81,803.00
164 364,900.00
2210.5 289,575.50
88 45,848.00
0 -
9 8,361.00
83 176,126.00
400 36,000.00
178 23,852.00
24 76,800.00
6 21,900.00
0 - ex 446
250 218,750.00 ex208
0 -
60 510,000.00
3212 529,980.00
11 9,350.00
0 -
1400 161,000.00
383 42,130.00
277 458,158.00
288 40,320.00
205 23,780.00
63 198,450.00
54 1,455,300.00
3059 492,499.00
85.75 549,657.50
370 45,510.00
50 35,200.00
100 85,700.00
33 14,784.00
100 62,700.00
0 -
5 7,175,900.00
3 1,187,700.00
2 473,000.00
11 18,480.00
50 184,250.00
HAL 5
SISA PERMIN
NILAI KET
STOK TAAN
50 180,000.00
42 69,132.00
0 -
1205 197,620.00
0 - e.5
1207 154,496.00
1000 208,000.00
61 364,780.00
32 32,416.00
260 290,940.00
12582.5 1,082,095.00
2 9,700.00
4302 533,448.00
191 27,695.00 500
74 7,251.26
106 964,600.00
24 369,264.00
1 22,500.00
54 195,750.00
8601.5 1,059,704.80
791 54,579.00
168 58,968.00
5457 627,555.00 E1100
140 48,580.00
14 44,100.00
0 -
0 -
80 572,000.00
129 704,727.00
1098 71,370.00
215 18,920.00 E559
26 72,722.00
0 -
51 54,366.00
51 210,783.00
0 -
2310 1,051,050.00
20 70,000.00
85 94,945.00
HAL 6
SISA PERMIN
NILAI KET
STOK TAAN
14 14,700.00
0 -
13441 739,255.00
4797 849,069.00
3809 1,135,082.00
49 595,595.00
19061 2,306,381.00
2653 480,193.00
26 8,450.00
0 -
8414 765,674.00
0 -
100 119,500.00 EX 60
200 16,000.00
66 45,618.54
684 345,420.00
76 24,852.00
9521 1,256,772.00
835 494,320.00
15 99,000.00
0 -
0 -
406 503,440.00
642 934,752.00
1 1,287.00
200 247,500.00
754 980,200.00
108 104,004.00
100 122,375.00
74 120,065.00
110 330,000.00
64 192,000.00
52 156,000.00
45 135,000.00
228 592,800.00
62 1,720,996.00
36 1,008,000.00
72 640,499.76
36 1,086,768.00
HAL 7
SISA PERMIN
NILAI KET
STOK TAAN
48 1,512,000.00
10 80,000.00
22 220,000.00
28 224,000.00
0 -
11 48,125.00
19 76,000.00
50 310,937.50
83 757,209.00
50 385,000.00
11 100,353.00
22 83,600.00
50 456,150.00
31 117,800.00
50 456,150.00
17.5 558,250.00
90 279,000.00
68 132,192.00
9 90,000.00
50 507,600.00
84 72,576.00
121 496,584.00
50 225,000.00
7 59,724.00
16 2,500,800.00
0 -
24 1,191,168.00
200 1,247,400.00
76 451,440.00
200 1,223,640.00
231 1,372,140.00
131 801,484.20
0 -
396 338,477.04
659 586,839.50
526 468,403.00
124 147,312.00
15 45,000.00
311 217,700.00
HAL 8
SISA PERMIN
NILAI KET
STOK TAAN
144 3,150,000.00
61 1,334,375.00
36 772,500.02
166 486,380.00
10 4,200,000.00
0 -
13 5,876,000.00
0 -
8 2,552,000.00
0.8125 548,437.50
0.8125 548,437.50
0.8125 548,437.50
0.8125 548,437.50
1.5 262,500.00
2 1,300,000.00
0 -
2.75 577,500.00
0.75 183,750.00
0.5 400,000.00
31 2,371,500.00
3.75 1,856,250.00
0 -
3 975,000.00
109,499,159.77
2 024
( LPLPO )

PUSKESMAS : Benteng
BULAN 5
MSN AWAL
1 2 3 4 5 6 7 9 10 11 12 13
1 21.01.01.4154.02 ALBENDAZOL TABLET 400 MG Tab 363.00 2347 851,961.00 - 2347 851,961.00 -
2 ALBENDAZOL TABLET 400 MG Tab 450.00 0 - 3540 1,593,000.00 3540 1,593,000.00 -
4 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 1.25 23,293.75 - 1.25 23,293.75 -
7 07.01.02.5044.02 ALOPURINOL TABLET 300 MG Tab 230.00 500 115,000.00 - 500 115,000.00 -
10 22.01.01.5159.03 AMINOFILIN TABLET 200 MG Tab 86.00 260 22,360.00 - 260 22,360.00 -
11 AMITRIPTILIN TABLET SALUT 25 MG Tab 118.00 0 - - 0 - -
12 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 694 114,510.00 - 694 114,510.00 -
13 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 2930 558,545.90 5000 953,150.00 7930 1,511,695.90 -
15 AMLODIPIN 5 MG Tab 105.00 2001 210,105.00 - 2001 210,105.00 -
16 AMLODIPIN 5 MG Tab 107.00 0 - 9000 963,000.00 9000 963,000.00 -
17 AMOKSISILIN KAPSUL 250 MG Kap 207.00 494 102,258.00 - 494 102,258.00 -
18 AMOKSISILLIN KAPLET 500 MG Kap 233.00 13664 3,183,712.00 30000 6,990,000.00 43664 10,173,712.00 -
20 01.01.04.5100.04 AMOKSISILIN SIROP KERING 125 Btl 2,560.00 0 - - 0 - -
21 AMOKSISILIN SIROP KERING 125 Btl 2,200.00 318 699,600.00 300 660,000.00 618 1,359,600.00 -
22 ANTASIDA DOEN TABLET KUNYAH Tab 64.00 4545 290,880.00 2000 128,000.00 6545 418,880.00 -
23 15.01.01.5334.02 ANTASIDA DOEN II SUSPENSI Btl 2,106.00 126 265,356.00 - 126 265,356.00 -
24 ANTASIDA DOEN II SUSPENSI Btl 2,098.00 0 - 100 209,800.00 100 209,800.00 -
25 ANTI BAKTERI DOEN SALEP KOMBINASI Pot 3,365.00 40 134,600.00 - 40 134,600.00 -
26 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 38.2 182,672.40 - 38.2 182,672.40 -
28 10.02.01.5338.01 ANTIMIGREN Tab 135.00 32 4,320.00 - 32 4,320.00 -
29 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 -
BULAN 5
MSN AWAL
33 ASAM ASKORBAT (VIT C) 25 MG 51.00 5052 257,652.00 10000 510,000.00 15052 767,652.00 -
30 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 60 348,000.00 - 60 348,000.00 -
31 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 30 82,500.00 - 30 82,500.00 -
32 ASAM ASETIL SALISILAT 100 MG Tab 149.00 900 134,100.00 - 900 134,100.00 -
34 05.03.07.5164.02 ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 10 1,050.00 - 10 1,050.00 -
35 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 5890 600,780.00 10000 1,020,000.00 15890 1,620,780.00 -
39 22.01.01.5172.01 BETAMETASON KRIM 0,1 % Tube 1,435.00 123 176,505.00 - 123 176,505.00 -
40 BETAHISTIN MESILAT TAB 6 MG/HISTIGO TAB 760.00 1059 804,840.00 - 1059 804,840.00 -
41 BISAKODIL SUPPOSITORIA/DULCOLAX SUPP 5,900.00 0 - 10 59,000.00 10 59,000.00 -
42 CARBAMAZEPIN TAB 200 MG Tab 269.00 330 88,770.00 - 330 88,770.00 -
43 CETIRIZINE TAB Tab 154.00 155 23,870.00 - 155 23,870.00 -
44 CETIRIZINE TAB KAP 115.00 1000 115,000.00 500 57,500.00 1500 172,500.00 -
47 DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 20 34,800.00 - 20 34,800.00 -
48 DEKSAMETASON TAB Tab 48.00 8775 421,200.00 2000 96,000.00 10775 517,200.00 -
50 22.01.01.5179.02 DIAZEPAM TABLET 2 MG Tab 39.00 977 38,103.00 - 977 38,103.00 -
51 DIAZEPAM RECTAL Tube 12,749.00 0 - - 0 - -
52 22.01.01.5179.03 DIAZEPAM RECTAL Tube 13,384.00 10 133,840.00 - 10 133,840.00 -
53 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 38 43,928.00 - 38 43,928.00 -
54 22.01.01.5181.01 DIGOKSIN TABLET 0,25 MG Tab 103.00 260 26,780.00 - 260 26,780.00 -
58 22.01.01.5186.01 DOMPERIDON TABLET 10 MG Tab 174.00 287 49,938.00 - 287 49,938.00 -
59 DOMPERIDON TABLET 10 MG Tab 116.00 0 - 100 11,600.00 100 11,600.00 -
60 22.01.01.5188.01 ERITROMISIN KAPSUL 250 MG Kap 651.00 100 65,100.00 100 65,100.00 200 130,200.00 -
61 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 268.5 274,675.50 - 268.5 274,675.50 -
62 ERITROMISIN KAPSUL 500 MG Kap 766.00 0 - 100 76,600.00 100 76,600.00 -
63 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 6,461.00 50 323,050.00 - 50 323,050.00 -
64 ERITROMISIN SIROP 200 MG/ 5 ML Btl 7,581.00 9 68,229.00 - 9 68,229.00 -
65 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 17 63,750.00 - 17 63,750.00 -
66 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 161 422,625.00 - 161 422,625.00 -
67 22.01.01.5192.02 ETANOL 70 % 1000 ml Btl 0 - - 0 - -
BULAN 5
MSN AWAL
71 05.03.13.5196.01 FITOMENADION (VIT K) TABLET 10 MG Tab 690.00 187 129,030.00 - 187 129,030.00 -
72 05.03.13.5196.02 FITOMENADION (VIT K) INJ 10 MG/ML Amp 1,888.00 0 - - 0 - -
73 FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 71 289,893.00 60 244,980.00 131 534,873.00 -
74 16.02.01.3523.02 FUROSEMIDA TABLET 40 MG Tab 91.00 306 27,846.00 - 306 27,846.00 -
75 GARAM ORALIT I SERBUK Sac 274.00 392 107,408.00 - 392 107,408.00 -
76 GARAM ORALIT I SERBUK Sac 273.00 0 - 500 136,500.00 500 136,500.00 -
80 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 61.00 1521 92,781.00 - 1521 92,781.00 -
81 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 151.00 0 - 500 75,500.00 500 75,500.00 -
84 GLIMEPIRIDE 2 MG Tab 231.00 0 - 300 69,300.00 300 69,300.00 -
85 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.00 3000 210,000.00 - 3000 210,000.00 -
86 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.95 1493 105,928.35 - 1493 105,928.35 -
87 04.02.01.5208.03 GLUKOSA LARUTAN INFUS 5 % Btl 5,720.00 57 326,040.00 - 57 326,040.00 -
88 04.02.01.5208.03 GLUKOSA LARUTAN INFUS 5 % Btl 7,500.00 0 - 5 37,500.00 5 37,500.00 -
89 GRANTUSIF Tab 405.00 5559 2,251,395.00 5000 2,025,000.00 10559 4,276,395.00 -
90 GRISEOFULVIN TABLET 125 MG Tab 506.00 1092 552,552.00 - 1092 552,552.00 -
91 22.01.01.5210.01 HALOPERIDOL TABLET 1.5 MG Tab 65.00 208 13,520.00 300 19,500.00 508 33,020.00 -
93 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,938.00 71 208,598.00 - 71 208,598.00 -
94 HIDROKORTISON KRIM 2 % Tube 2,812.00 0 - 48 134,976.00 48 134,976.00 -
95 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 530 64,130.00 - 530 64,130.00 -
96 IBUPROFEN TABLET 400 MG Tab 133.00 1455 193,515.00 3000 399,000.00 4455 592,515.00 -
99 22.01.01.5214.02 ISOSORBID DINITRAT TABLET 5 MG Tab 93.00 100 9,300.00 100 9,300.00 200 18,600.00 -
102 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 57 4356 248,292.00 2000 114,000.00 6356 362,292.00 -
103 12.06.01.5067.01 KAPTOPRIL 12.5 MG Tab 69.00 0 - - 0 - -
104 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 2419 174,168.00 - 2419 174,168.00 -
105 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 86.00 0 - 3000 258,000.00 3000 258,000.00 -
106 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 175 25,025.00 100 14,300.00 275 39,325.00 -
107 KETOROLAC INJ Amp 1,383.00 1 1,383.00 - 1 1,383.00 -
BULAN 5
MSN AWAL
108 KLONIDIN TABLET 0.15 MG Tab 145.00 329 47,705.00 - 329 47,705.00 -
109 01.01.02.5225.02 KLORAMFENIKOL SALEP MATA 1% Tube 1850.00 7 12,950.00 - 7 12,950.00 -
110 KLORAMFENIKOL TETES TELINGA 3 % Tube 7,300.00 2 14,600.00 - 2 14,600.00 -
111 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 4,000.00 42 168,000.00 - 42 168,000.00 -
112 KLORAMFENIKOL SUSP 125 MG/ 5 ML Btl 2,225.00 0 - 250 556,250.00 250 556,250.00 -
113 KLORAMFENIKOL KAPSUL 250 MG Kap 621.61 643 399,695.23 500 310,805.00 1143 710,500.23 -
114 KLORAMFENIKOL KAPSUL 500 MG Kap 1,155.00 149 172,095.00 - 149 172,095.00 -
115 KLORAMFENIMINA MALEAT TAB 4 MG Tab 45.00 9413.5 423,607.50 3000 135,000.00 12413.5 558,607.50 -
117 22.01.01.5228.04 KLORPROMAZIN TAB SALUT 100 MG Tab 165.00 0 - - 0 - -
118 01.06.01.5142.03 KLORPROMAZIN TAB SALUT 100 MG Tab 179.00 457 81,803.00 - 457 81,803.00 -
119 KOTRIMOKSAZOL SUSPENSI Btl 2,225.00 164 364,900.00 - 164 364,900.00 -
120 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 2210.5 289,575.50 - 2210.5 289,575.50 -
121 LANSOPRAZOL 30 MG KAP 521.00 88 45,848.00 20 10,420.00 108 56,268.00 -
123 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 9 8,361.00 - 9 8,361.00 -
124 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 83 176,126.00 120 254,640.00 203 430,766.00 -
125 22.01.01.5237.01 LIDOKAIN SPRAY Amp 177,216.00 0 - 5 886,080.00 5 886,080.00 -
126 LOPERAMIDE Tab 90.00 400 36,000.00 - 400 36,000.00 -
127 LORATADIN TAB Tab 134.00 178 23,852.00 - 178 23,852.00 -
128 LUBIRE Kaps 1,425.00 0 - 150 213,750.00 150 213,750.00 -
129 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 -
130 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 -
131 MELOXICAM 7,5 mg Tab 680 0 - - 0 - -
132 MELOXICAM 15 mg Tab 875 250 218,750.00 - 250 218,750.00 -
133 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 245.00 0 - 500 122,500.00 500 122,500.00 -
134 22.01.01.5245.02 METILERGOMETRIN MALEAT INJ 0.2 MG Amp 8,500.00 60 510,000.00 - 60 510,000.00 -
135 METILPREDNISOLON TAB 4 MG Tab 165.00 3212 529,980.00 3000 495,000.00 6212 1,024,980.00 -
137 METFORMIN TAB 500 MG Tab 118.50 0 - - 0 - -
138 22.01.01.5246.04 METFORMIN TAB 500 MG Tab 115.00 1400 161,000.00 - 1400 161,000.00 -
139 METOKLOPRAMIDE TAB 10 MG TAB 110.00 383 42,130.00 - 383 42,130.00 -
140 METOKLOPRAMIDE TAB 10 MG TAB 93.00 0 - 100 9,300.00 100 9,300.00 -
141 22.01.01.5246.01 MULTIVITAMIN TAB/VINERTON Tab 1,654.00 277 458,158.00 8000 13,232,000.00 8277 13,690,158.00 -
142 METRONIDAZOL TABLET 500 MG Tab 140.00 288 40,320.00 200 28,000.00 488 68,320.00 -
143 22.01.01.5247.01 METRONIDAZOL TABLET 250 MG Tab 116.00 205 23,780.00 - 205 23,780.00 -
144 22.01.01.5247.01 METRONIDAZOL TABLET 250 MG Tab 98.00 0 - 100 9,800.00 100 9,800.00 -
145 MIKONAZOLE KREAM Tube 3,150.00 63 198,450.00 - 63 198,450.00 -
146 MIKONAZOLE POWDER POT 26,950.00 54 1,455,300.00 72 1,940,400.00 126 3,395,700.00 -
BULAN 5
MSN AWAL
147 NA. DIKLOFENAK 50 MG/DIK.SODIUM Tab 161.00 3059 492,499.00 - 3059 492,499.00 -
148 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 85.75 549,657.50 40 256,400.00 125.75 806,057.50 -
149 NIPEDIFINE TAB 10 MG Tab 123.00 370 45,510.00 - 370 45,510.00 -
150 NISTATIN 500.000 IU Tab 704.00 50 35,200.00 - 50 35,200.00 -
151 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 - 100 85,700.00 -
152 NISTATIN 100.000 IU Tab 448.00 33 14,784.00 - 33 14,784.00 -
153 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 100 62,700.00 - 100 62,700.00 -
154 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,379,984 0 - - 0 - -
155 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 2 DEWASA Tab 1,435,180 5 7,175,900.00 - 5 7,175,900.00 -
156 OBAT ANTITUBERKULOSIS KAT 1 DEWASA Tab 395,900 3 1,187,700.00 - 3 1,187,700.00 -
157 15.05.01.5258.04 OBAT ANTITUBERKULOSIS KAT ANAK Tab 236,500 2 473,000.00 - 2 473,000.00 -
158 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 1,680.00 11 18,480.00 - 11 18,480.00 -
159 OKSITETRASIKLIN HCL SALEP MATA 1 % Tube 3,685.00 50 184,250.00 - 50 184,250.00 -
160 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 50 180,000.00 - 50 180,000.00 -
161 OKSITETRASIKLIN HCL SALEP 3 % Tube 1,646.00 42 69,132.00 - 42 69,132.00 -
162 OMEPRAZOL Kap 164.00 1205 197,620.00 600 98,400.00 1805 296,020.00 -
163 OMEPRAZOL INJ Amp 18,537.00 0 - - 0 - -
164 22.01.01.5273.02 PAPAVERIN TABLET 40 MG Tab 128.00 1207 154,496.00 - 1207 154,496.00 -
165 PAPAVERIN TABLET 40 MG Tab 208.00 1000 208,000.00 - 1000 208,000.00 -
166 PARASETAMOLDROPS Btl 5,980.00 61 364,780.00 - 61 364,780.00 -
167 14.04.01.5275.01 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,013.00 32 32,416.00 - 32 32,416.00 -
168 PARASETAMOL SIROP 120 MG/ 5 ML Btl 1,119.00 260 290,940.00 100 111,900.00 360 402,840.00 -
169 PARASETAMOL TABLET 500 MG Tab 86.00 12582.5 1,082,095.00 5000 430,000.00 17582.5 1,512,095.00 -
170 PEHACAIN INJ Amp 4,850.00 2 9,700.00 - 2 9,700.00 -
171 05.03.06.5280.01 PIRIDOKSIN (VIT B6) TAB 10 MG Tab 124.00 4302 533,448.00 1000 124,000.00 5302 657,448.00 -
172 22.01.01.5281.01 PIROKSIKAM TABLET 10 MG Tab 145.00 191 27,695.00 - 191 27,695.00 -
173 PIROKSIKAM TABLET 20 MG Tab 97.99 74 7,251.26 - 74 7,251.26 -
174 PIROKSIKAM TABLET 20 MG Tab 189.50 0 - 2000 379,000.00 2000 379,000.00 -
175 16.03.01.3543.01 PITOGIN AMPUL 1 ML Amp 9,100.00 106 964,600.00 - 106 964,600.00 -
177 POVIDON IODIDA 10 % 300 ML Btl 22,500.00 1 22,500.00 - 1 22,500.00 -
178 POVIDON IODIDA 10 % 30 ML Btl 3,625.00 54 195,750.00 - 54 195,750.00 -
179 PREDNISON TABLET 5 MG Tab 123.20 8601.5 1,059,704.80 3000 369,600.00 11601.5 1,429,304.80 -
180 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 69.00 791 54,579.00 - 791 54,579.00 -
181 22.01.01.5289.01 PROPILITIOURASIL TABLET 100 MG Tab 351.00 168 58,968.00 - 168 58,968.00 -
182 RANITIDIN TABLET 150 MG Tab 115.00 5457 627,555.00 - 5457 627,555.00 -
183 RANITIDIN TABLET 150 MG Tab 105.00 0 - 4000 420,000.00 4000 420,000.00 -
184 15.01.01.3184.02 RESPIRIDON 2 MG Amp 347.00 140 48,580.00 - 140 48,580.00 -
BULAN 5
MSN AWAL
187 REAGENSIA ZN Pkt 276,600.00 0 - - 0 - -
188 22.01.01.5293.01 RINGER LAKTAT INFUS Btl 7,150.00 80 572,000.00 100 715,000.00 180 1,287,000.00 -
189 SALBUTAMOL SYRUP 2 MG Btl 5,463.00 129 704,727.00 - 129 704,727.00 -
190 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 65.00 1098 71,370.00 - 1098 71,370.00 -
191 22.01.01.5295.02 SALBUTAMOL TABLET 4 MG Tab 88.00 215 18,920.00 - 215 18,920.00 -
192 SALEP 2-4 KOMBINASI Tube 2,797.00 26 72,722.00 - 26 72,722.00 -
193 SALISIL BEDAK 2 % Pot 1,071.00 0 - - 0 - -
194 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 51 54,366.00 - 51 54,366.00 -
195 22.01.01.5298.01 SEFADROKSIL SIROP KERING 125 MG / 5 ML Btl 4,133.00 51 210,783.00 - 51 210,783.00 -
196 SEFADROKSIL KAPSUL 500 MG Kap 455.00 2310 1,051,050.00 2000 910,000.00 4310 1,961,050.00 -
198 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,117.00 85 94,945.00 - 85 94,945.00 -
199 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,050.00 14 14,700.00 - 14 14,700.00 -
200 22.01.01.5306.03 SIANOKOBALAMIN TABLET 50 MCG Tab 15.00 0 - - 0 - -
201 SIANOKOBALAMIN TABLET 50 MCG Tab 55.00 13441 739,255.00 - 13441 739,255.00 -
202 SIMVASTATIN TABLET 10 MG Tab 177.00 4797 849,069.00 - 4797 849,069.00 -
203 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 3809 1,135,082.00 500 149,000.00 4309 1,284,082.00 -
204 SCABIMITE CREAM Tube 12,155.00 49 595,595.00 - 49 595,595.00 -
205 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 19061 2,306,381.00 6000 726,000.00 25061 3,032,381.00 -
206 TETRASIKLIN KAPSUL 250 MG Kap 181.00 2653 480,193.00 - 2653 480,193.00 -
207 01.01.06.5321.02 TETRASIKLIN KAPSUL 500 MG Kap 325.00 26 8,450.00 - 26 8,450.00 -
209 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 8414 765,674.00 7000 637,000.00 15414 1,402,674.00 -
211 TIURAZOL 10 mg TAB Tab 1,195.00 100 119,500.00 - 100 119,500.00 -
212 TRIHEKSIFENIDIL 25 MG TAB Tab 80.00 200 16,000.00 300 24,000.00 500 40,000.00 -
213 TRIHEKSIFENIDIL 25 MG TAB/ARKINE Tab 691.19 66 45,618.54 - 66 45,618.54 -
214 VIT A MERAH kap 505.00 684 345,420.00 1700 858,500.00 2384 1,203,920.00 -
215 05.03.06.5332.01 VTT A BIRU kap 327.00 76 24,852.00 200 65,400.00 276 90,252.00 -
216 19.07.01.4128.01 VITAMIN B KOMPLEKS TABLET Tab 132.00 9521 1,256,772.00 7000 924,000.00 16521 2,180,772.00 -
217 ZIN TAB Tab 592.00 835 494,320.00 500 296,000.00 1335 790,320.00 -
218 ZIN SIRUP Btl 6,600.00 15 99,000.00 - 15 99,000.00 -
0 -
1 PERBEKALAN KESEHATAN 0 -
2 ALAT SUNTIK SEKALI PAKAI 0,5 ML Set 1,240.00 406 503,440.00 700 868,000.00 1106 1,371,440.00 -
3 ALAT SUNTIK SEKALI PAKAI 0,05 ML Set 1,456.00 642 934,752.00 300 436,800.00 942 1,371,552.00 -
5 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 200 247,500.00 500 618,750.00 700 866,250.00 -
BULAN 5
MSN AWAL
6 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 1,300.00 754 980,200.00 - 754 980,200.00 -
7 ALAT SUNTIK SEKALI PAKAI 5 ML Set 963.00 108 104,004.00 - 108 104,004.00 -
8 ALAT SUNTIK SEKALI PAKAI 5 ML Set 1,223.75 100 122,375.00 759 928,826.25 859 1,051,201.25 -
9 ALKOHOL SWAB Pcs 206.64 0 - 300 61,992.00 300 61,992.00 -
10 BISTURI NO. 19 Bh 3,000 110 330,000.00 - 110 330,000.00 -
11 BISTURI NO.20 Bh 3,000 64 192,000.00 - 64 192,000.00 -
12 BISTURI NO.21 Bh 3,000 52 156,000.00 - 52 156,000.00 -
13 BISTURI NO.23 Bh 3,000 45 135,000.00 - 45 135,000.00 -
14 JARUM HECTING Bh 2,600 228 592,800.00 - 228 592,800.00 -
15 CATGUT NO 2/0 Pcs 27,758.00 62 1,720,996.00 - 62 1,720,996.00 -
16 CATGUT NO 2/0 Pcs 28,000.00 36 1,008,000.00 - 36 1,008,000.00 -
17 CATGUT NO 3/0 Pcs 8,895.83 72 640,499.76 - 72 640,499.76 -
18 CATGUT NO 3/0 Pcs 30,188.00 36 1,086,768.00 96 2,898,048.00 132 3,984,816.00 -
19 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 -
20 CHATHEJELL Tab 42,848.00 14 599,872.00 5 214,240.00 19 814,112.00 -
21 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 -
22 FOLEY CATETER 18 Bh 10,000.00 22 220,000.00 - 22 220,000.00 -
23 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 -
24 HIV TEST Set 0 - - 0 - -
25 INFUSION SET ANAK SET 4,375.00 11 48,125.00 10 43,750.00 21 91,875.00 -
26 INFUSION SET DEWASA Set 4,000.00 19 76,000.00 - 19 76,000.00 -
27 INFUSION SET DEWASA Set 6,218.75 50 310,937.50 20 124,375.00 70 435,312.50 -
35 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 17.5 558,250.00 10 319,000.00 27.5 877,250.00 -
40 KASA PEMBALUT HIDROFIL 4 X 3 CM ELASTIS Bks 864.00 84 72,576.00 - 84 72,576.00 -
41 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,104.00 121 496,584.00 - 121 496,584.00 -
42 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,500.00 50 225,000.00 100 450,000.00 150 675,000.00 -
BULAN 5
MSN AWAL
44 KASA PEMBALUT HIDROFIL 40 X 80 CM Roll 156,300.00 16 2,500,800.00 - 16 2,500,800.00 -
45 KASA PEMBALUT HIDROFIL 36 X 80 CM Roll 141,700.00 0 - 10 1,417,000.00 10 1,417,000.00 -
46 PLESTER YARD Roll 49,632.00 24 1,191,168.00 20 992,640.00 44 2,183,808.00 -
47 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 - 200 1,247,400.00 -
48 HANDSCON 7 STERIL psg 5,940.00 76 451,440.00 - 76 451,440.00 -
49 HANDSCON 7 STERIL psg 6,118.20 200 1,223,640.00 - 200 1,223,640.00 -
50 HANDSCON 71/2 psg 5,940.00 231 1,372,140.00 - 231 1,372,140.00 -
51 HANDSCON 71/2 psg 6,118.20 131 801,484.20 - 131 801,484.20 -
52 HANDSCON S psg 854.74 396 338,477.04 500 427,370.00 896 765,847.04 -
53 HANDSCON L psg 890.50 659 586,839.50 - 659 586,839.50 -
54 HANDSCON L psg 854.74 0 - 500 427,370.00 500 427,370.00 -
55 HANDSCON M psg 890.50 526 468,403.00 - 526 468,403.00 -
56 HANDSCON M psg 1,188.00 124 147,312.00 - 124 147,312.00 -
57 HANDSCON M psg 854.74 0 - 500 427,370.00 500 427,370.00 -
58 HAND RUB Btl 63,840.00 0 - 10 638,400.00 10 638,400.00 -
59 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 -
60 MASKER KARET Pcs 700.00 311 217,700.00 500 350,000.00 811 567,700.00 -
61 SILK 2/0 SET 21,875.00 144 3,150,000.00 96 2,100,000.00 240 5,250,000.00 -
62 SILK 3/0 SET 21,875.00 61 1,334,375.00 - 61 1,334,375.00 -
63 SILK 3/0 SET 21,458.33 36 772,500.02 - 36 772,500.02 -
64 POT SPUTUM Pcs 2,930.00 166 486,380.00 - 166 486,380.00 -
65 STRIP GULA DARAH DOS 420,000.00 10 4,200,000.00 - 10 4,200,000.00 -
67 STRIP ASAM URAT DOS 452,000.00 13 5,876,000.00 - 13 5,876,000.00 -
68 STRIP ASAM URAT DOS 290,000.00 0 - - 0 - -
69 KOLESTEROL STRIP DOS 319,000.00 8 2,552,000.00 - 8 2,552,000.00 -
70 KOLESTEROL STRIP NESCO Box 290,000.00 0 - 17 4,930,000.00 17 4,930,000.00 -
BAHAN GIGI
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 -
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 -
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 -
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 -
5 EUGENOL Pcs 175,000.00 1.5 262,500.00 - 1.5 262,500.00 -
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 2 1,300,000.00 2 1,300,000.00 4 2,600,000.00 -
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - -
8 CHKM 10 ML Pcs 210,000.00 2.75 577,500.00 - 2.75 577,500.00 -
9 OCCO Pcs 245,000.00 0.75 183,750.00 2 490,000.00 2.75 673,750.00 -
10 DYCAL Pcs 800,000.00 0.5 400,000.00 1 800,000.00 1.5 1,200,000.00 -
11 HEMOSPON Pcs 76,500.00 31 2,371,500.00 - 31 2,371,500.00 -
BULAN 5
URUT AWAL RIMAAN DIAAN KAIAN
12 PULP-10 Pcs 495,000.00 3.75 1,856,250.00 - 3.75 1,856,250.00 -
14 CAVITON Btl 325,000.00 3 975,000.00 - 3 975,000.00 -
TOTAL HARGA OBAT DAN BHP 109,499,159.77 69,292,682.25 178,791,842.02 -
BPJS UMUM JMLH

0


Nip. 196551214 199803 1 005 19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
0 5
0 2
0 1 8
HAL 1
SISA PERMIN
NILAI KET
STOK TAAN
14 15 16 17
2347 851,961.00
3540 1,593,000.00
0 -
1.25 23,293.75
0 -
823 96,291.00
500 115,000.00
2000 488,000.00
26 86,177.52
260 22,360.00
0 -
694 114,510.00
7930 1,511,695.90
0 -
2001 210,105.00
9000 963,000.00
494 102,258.00
43664 10,173,712.00
0 -
0 -
618 1,359,600.00
6545 418,880.00
126 265,356.00
100 209,800.00
40 134,600.00
38.2 182,672.40
37 129,574.00
32 4,320.00
100 17,900.00
HAL 2
SISA PERMIN
NILAI KET
STOK TAAN
15052 767,652.00
60 348,000.00
30 82,500.00
900 134,100.00
10 1,050.00
15890 1,620,780.00
0 -
20 5,020.00
681 259,461.00
123 176,505.00
1059 804,840.00
10 59,000.00
330 88,770.00
155 23,870.00
1500 172,500.00
0 -
3 5,214.00
20 34,800.00
10775 517,200.00
0 -
977 38,103.00
0 -
10 133,840.00
38 43,928.00
260 26,780.00
76 8,664.00
0 -
58 17,922.00
287 49,938.00
100 11,600.00
200 130,200.00
268.5 274,675.50
100 76,600.00
50 323,050.00
9 68,229.00
17 63,750.00
161 422,625.00
0 -
0 -
HAL 3
SISA PERMIN
NILAI KET
STOK TAAN
30 59,400.00
200 35,400.00
187 129,030.00
0 -
131 534,873.00
306 27,846.00
392 107,408.00
500 136,500.00
930 284,580.00
5 20,330.00
2 1,970.00
1521 92,781.00
500 75,500.00
82 41,164.00
300 89,100.00
300 69,300.00
3000 210,000.00
1493 105,928.35
57 326,040.00
5 37,500.00
10559 4,276,395.00
1092 552,552.00
508 33,020.00
100 17,100.00
71 208,598.00
48 134,976.00
530 64,130.00
4455 592,515.00
2979 467,703.00
0 -
200 18,600.00
124 12,152.00
0 -
6356 362,292.00
0 -
2419 174,168.00
3000 258,000.00
275 39,325.00
1 1,383.00
HAL 4
SISA PERMIN
NILAI KET
STOK TAAN
329 47,705.00
7 12,950.00
2 14,600.00
42 168,000.00
250 556,250.00
1143 710,500.23
149 172,095.00
12413.5 558,607.50
70 3,500.00
0 -
457 81,803.00
164 364,900.00
2210.5 289,575.50
108 56,268.00
0 -
9 8,361.00
203 430,766.00
5 886,080.00
400 36,000.00
178 23,852.00
150 213,750.00
24 76,800.00
6 21,900.00
0 -
250 218,750.00
500 122,500.00
60 510,000.00
6212 1,024,980.00
11 9,350.00
0 -
1400 161,000.00
383 42,130.00
100 9,300.00
8277 13,690,158.00
488 68,320.00
205 23,780.00
100 9,800.00
63 198,450.00
126 3,395,700.00
HAL 5
SISA PERMIN
NILAI KET
STOK TAAN
3059 492,499.00
125.75 806,057.50
370 45,510.00
50 35,200.00
100 85,700.00
33 14,784.00
100 62,700.00
0 -
5 7,175,900.00
3 1,187,700.00
2 473,000.00
11 18,480.00
50 184,250.00
50 180,000.00
42 69,132.00
1805 296,020.00
0 -
1207 154,496.00
1000 208,000.00
61 364,780.00
32 32,416.00
360 402,840.00
17582.5 1,512,095.00
2 9,700.00
5302 657,448.00
191 27,695.00
74 7,251.26
2000 379,000.00
106 964,600.00
24 369,264.00
1 22,500.00
54 195,750.00
11601.5 1,429,304.80
791 54,579.00
168 58,968.00
5457 627,555.00 E1100
4000 420,000.00 E1100
140 48,580.00
14 44,100.00
HAL 6
SISA PERMIN
NILAI KET
STOK TAAN
0 -
0 -
180 1,287,000.00
129 704,727.00
1098 71,370.00
215 18,920.00
26 72,722.00
0 -
51 54,366.00
51 210,783.00
4310 1,961,050.00
20 70,000.00
85 94,945.00
14 14,700.00
0 -
13441 739,255.00
4797 849,069.00
4309 1,284,082.00
49 595,595.00
25061 3,032,381.00
2653 480,193.00
26 8,450.00
0 -
15414 1,402,674.00
0 -
100 119,500.00
500 40,000.00
66 45,618.54
2384 1,203,920.00
276 90,252.00
16521 2,180,772.00
1335 790,320.00
15 99,000.00
0 -
0 -
1106 1,371,440.00
942 1,371,552.00
1 1,287.00
700 866,250.00
HAL 7
SISA PERMIN
NILAI KET
STOK TAAN
754 980,200.00
108 104,004.00
859 1,051,201.25
74 120,065.00
300 61,992.00
110 330,000.00
64 192,000.00
52 156,000.00
45 135,000.00
228 592,800.00
62 1,720,996.00
36 1,008,000.00
72 640,499.76
132 3,984,816.00
48 1,512,000.00
19 814,112.00
10 80,000.00
22 220,000.00
28 224,000.00
0 -
21 91,875.00
19 76,000.00
70 435,312.50
83 757,209.00
50 385,000.00
11 100,353.00
22 83,600.00
50 456,150.00
31 117,800.00
50 456,150.00
27.5 877,250.00
90 279,000.00
68 132,192.00
9 90,000.00
50 507,600.00
84 72,576.00
121 496,584.00
150 675,000.00
7 59,724.00
HAL 8
SISA PERMIN
NILAI KET
STOK TAAN
16 2,500,800.00
10 1,417,000.00
44 2,183,808.00
200 1,247,400.00
76 451,440.00
200 1,223,640.00
231 1,372,140.00
131 801,484.20
896 765,847.04
659 586,839.50
500 427,370.00
526 468,403.00
124 147,312.00
500 427,370.00
10 638,400.00
15 45,000.00
811 567,700.00
240 5,250,000.00
61 1,334,375.00
36 772,500.02
166 486,380.00
10 4,200,000.00
0 -
13 5,876,000.00
0 -
8 2,552,000.00
17 4,930,000.00
2.8125 1,898,437.50
2.8125 1,898,437.50
2.8125 1,898,437.50
2.8125 1,898,437.50
1.5 262,500.00
4 2,600,000.00
0 -
2.75 577,500.00
2.75 673,750.00
1.5 1,200,000.00
31 2,371,500.00
HAL 9
SISA PERMIN
NILAI KET
STOK TAAN
3.75 1,856,250.00
0 -
3 975,000.00
178,791,842.02
2 024
( LPLPO )

PUSKESMAS : Benteng
BULAN 7
MSN AWAL
2 21.01.01.4154.02 ALBENDAZOL TABLET 400 MG Tab 450.00 0 - 3540 1,593,000.00 3540 1,593,000.00 0 - 3540
3 21.01.01.4154.03 ALBENDAZOL SIRUP Btl 4,234.00 0 - - 0 - 0 - 0
4 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 1.25 23,293.75 - 1.25 23,293.75 1.25 23,293.75 0
7 ALOPURINOL TABLET 300 MG Tab 244.00 2000 488,000.00 - 2000 488,000.00 0 - 2000
8 22.01.01.5159.01 AMINOFILIN INJEKSI 24 MG/ML Amp 3,314.52 26 86,177.52 - 26 86,177.52 0 - 26
10 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 691 114,015.00 - 691 114,015.00 40 6,600.00 651
11 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 2189 417,289.07 5000 953,150.00 7189 1,370,439.07 864 164,704.32 6325
12 22.01.01.5158.02 AMBROKSOL SIRUP Btl 2,722.00 0 - - 0 - 0 - 0
13 AMLODIPIN 5 MG Tab 105.00 1094 114,870.00 - 1094 114,870.00 932 97,860.00 162
14 AMLODIPIN 10 MG Tab 107.00 0 - 9000 963,000.00 9000 963,000.00 3 321.00 8997
16 AMOKSISILLIN KAPLET 500 MG Kap 233.00 9016 2,100,728.00 30000 6,990,000.00 39016 9,090,728.00 7534 1,755,422.00 31482
17 AMOKSISILIN SIROP KERING 125 Btl 2,200.00 235 517,000.00 300 660,000.00 535 1,177,000.00 128 281,600.00 407
20 15.01.01.5334.02 ANTASIDA DOEN II SUSPENSI Btl 2,098.00 0 - 100 209,800.00 100 209,800.00 0 - 100
22 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 38 181,716.00 - 38 181,716.00 0 - 38
23 12.05.01.5340.01 ANTIHEMOROID DOEN KOMBINASI Pot 3,502.00 34 119,068.00 - 34 119,068.00 0 - 34
24 10.02.01.5338.01 ANTIMIGREN Tab 135.00 11 1,485.00 - 11 1,485.00 11 1,485.00 0
25 ANTIMIGREN Tab 179.00 100 17,900.00 - 100 17,900.00 18 3,222.00 82
26 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 55 319,000.00 - 55 319,000.00 0 - 55
27 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 30 82,500.00 - 30 82,500.00 9 24,750.00 21
BULAN 7-18
MSN AWAL
30 05.03.07.5164.02 ASAM ASKORBAT (VIT C) 50 MG Tab 105.00 10 1,050.00 - 10 1,050.00 0 - 10
31 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 2700 275,400.00 10000 1,020,000.00 12700 1,295,400.00 4207 429,114.00 8493
36 BISAKODIL SUPPOSITORIA/DULCOLAX SUPP 5,900.00 0 - 10 59,000.00 10 59,000.00 0 - 10
38 CETIRIZINE TAB KAP 115.00 887 102,005.00 500 57,500.00 1387 159,505.00 371 42,665.00 1016
39 DEKSAMETASON INJ 5 MG/ML Amp 1,740.00 19 33,060.00 - 19 33,060.00 0 - 19
42 22.01.01.5179.03 DIAZEPAM RECTAL Tube 13,384.00 10 133,840.00 - 10 133,840.00 0 - 10
43 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 32 36,992.00 - 32 36,992.00 0 - 32
45 DIMENHIDRINAT TAB 50 MG Tab 114.00 76 8,664.00 - 76 8,664.00 0 - 76
48 22.01.01.5186.01 DOMPERIDON TABLET 10 MG Tab 174.00 255 44,370.00 - 255 44,370.00 0 - 255
49 22.01.01.5186.01 DOMPERIDON TABLET 10 MG Tab 116.00 0 - 100 11,600.00 100 11,600.00 87 10,092.00 13
50 22.01.01.5188.01 ERITROMISIN KAPSUL 250 MG Kap 651.00 95 61,845.00 100 65,100.00 195 126,945.00 0 - 195
51 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 268.5 274,675.50 - 268.5 274,675.50 0 - 268.5
52 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 766.00 0 - 100 76,600.00 100 76,600.00 0 - 100
55 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 16 60,000.00 - 16 60,000.00 3.5 13,125.00 12.5
56 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 140 367,500.00 - 140 367,500.00 17.5 45,937.50 122.5
57 07.02.01.5051.03 FENOBARBITAL AMPUL 2 ML Btl 1,980 30 59,400.00 - 30 59,400.00 0 - 30
58 07.02.01.5051.01 FENOBARBITAL TABLET 30 MG Tab 177.00 200 35,400.00 - 200 35,400.00 0 - 200
60 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 200 159,200.00 - 200 159,200.00 0 - 200
61 FITOMENADION (VIT K) INJ 2 MG/ML Amp 4,083.00 39 159,237.00 60 244,980.00 99 404,217.00 7 28,581.00 92
63 FUROSEMIDA TABLET 40 MG Tab 84.00 200 16,800.00 - 200 16,800.00 0 - 200
67 17.09.01.5202.01 GENTAMISIN INJ 80 MG/ML Amp 4,066 0 - - 0 - 0 - 0
BULAN 7-18
MSN AWAL
69 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 61.00 1221 74,481.00 - 1221 74,481.00 0 - 1221
70 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 151.00 0 - 500 75,500.00 500 75,500.00 424 64,024.00 76
71 GLIMEPIRIDE 2 MG Tab 231.00 0 - 300 69,300.00 300 69,300.00 0 - 300
73 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.00 3000 210,000.00 - 3000 210,000.00 218.5 15,295.00 2781.5
76 04.02.01.5208.03 GLUKOSA LARUTAN INFUS 10 % Btl 7,500.00 0 - 5 37,500.00 5 37,500.00 0 - 5
77 GRANTUSIF Tab 405.00 3547 1,436,535.00 5000 2,025,000.00 8547 3,461,535.00 2552 1,033,560.00 5995
79 22.01.01.5210.01 HALOPERIDOL TABLET 1.5 MG Tab 65.00 136 8,840.00 300 19,500.00 436 28,340.00 240 15,600.00 196
80 12.01.01.5089.01 HIDROKLOROTIAZIDA TABLET 25 MG Tab 171.00 100 17,100.00 - 100 17,100.00 0 - 100
82 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,812.00 0 - 48 134,976.00 48 134,976.00 0 - 48
83 07.01.02.5046.01 IBUPROFEN TABLET 200 MG Tab 121.00 530 64,130.00 - 530 64,130.00 6 726.00 524
84 IBUPROFEN TABLET 400 MG Tab 133.00 245 32,585.00 3000 399,000.00 3245 431,585.00 1773 235,809.00 1472
85 IBUPROFEN TABLET 400 MG Tab 157.00 2979 467,703.00 - 2979 467,703.00 0 - 2979
86 22.01.01.5214.02 ISOSORBID DINITRAT TABLET 5 MG Tab 93.00 100 9,300.00 100 9,300.00 200 18,600.00 0 - 200
89 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 57 3389 193,173.00 2000 114,000.00 5389 307,173.00 1147 65,379.00 4242
90 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 1998 143,856.00 - 1998 143,856.00 685 49,320.00 1313
91 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 86.00 0 - 3000 258,000.00 3000 258,000.00 0 - 3000
92 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 163 23,309.00 100 14,300.00 263 37,609.00 127 18,161.00 136
93 KETOROLAC INJ Amp 1,383.00 1 1,383.00 - 1 1,383.00 0 - 1
99 KLORAMFENIKOL KAPSUL 500 MG Kap 1,155.00 0 - - 0 - 0 - 0
100 KLORAMFENIRAMINE MALEAT TAB 4 MG Tab 45.00 7357 331,065.00 3000 135,000.00 10357 466,065.00 2642.5 118,912.50 7714.5
104 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 1852.5 242,677.50 - 1852.5 242,677.50 580 75,980.00 1272.5
105 LANSOPRAZOL 30 MG KAP 521.00 88 45,848.00 20 10,420.00 108 56,268.00 40 20,840.00 68
106 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 8 7,432.00 - 8 7,432.00 8 7,432.00 0
107 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 10 21,220.00 120 254,640.00 130 275,860.00 52 110,344.00 78
BULAN 7 -18
MSN AWAL
108 22.01.01.5237.01 LIDOKAIN SPRAY Amp 177,216.00 0 - 5 886,080.00 5 886,080.00 1 177,216.00 4
109 LOPERAMIDE Tab 90.00 400 36,000.00 - 400 36,000.00 0 - 400
111 LUBIRE Kap 1,425.00 0 - 150 213,750.00 150 213,750.00 46 65,550.00 104
112 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 0 - 24
113 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 0 - 6
114 MELOXICAM 15 mg Tab 875 0 - - 0 - 0 - 0
115 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 245.00 1000 245,000.00 500 122,500.00 1500 367,500.00 100 24,500.00 1400
121 METOKLOPRAMIDE TAB 10 MG TAB 93.00 0 - 100 9,300.00 100 9,300.00 0 - 100
122 22.01.01.5246.01 MULTIVITAMIN TAB Tab 1,654.00 1062 1,756,548.00 8000 13,232,000.00 9062 14,988,548.00 296 489,584.00 8766
125 22.01.01.5247.01 METRONIDAZOL TABLET 250 MG Tab 98.00 0 - 100 9,800.00 100 9,800.00 0 - 100
129 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 67.75 434,277.50 40 256,400.00 107.75 690,677.50 15 96,150.00 92.75
131 NISTATIN 500.000 IU Tab 704.00 50 35,200.00 - 50 35,200.00 0 - 50
132 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 - 100 85,700.00 0 - 100
133 NISTATIN 100.000 IU Tab 448.00 33 14,784.00 - 33 14,784.00 0 - 33
134 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 100 62,700.00 - 100 62,700.00 0 - 100
135 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 1 DWS Tab 413,984 8 3,311,872.00 - 8 3,311,872.00 5 2,069,920.00 3
136 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 2 DWS Tab 1,435,180 3 4,305,540.00 - 3 4,305,540.00 0 - 3
139 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 50 180,000.00 - 50 180,000.00 5 18,000.00 45
140 OKSITETRASIKLIN HCL SALEP 3 % Tube 1,646.00 40 65,840.00 - 40 65,840.00 0 - 40
141 OMEPRAZOL Kap 164.00 848 139,072.00 600 98,400.00 1448 237,472.00 503 82,492.00 945
143 PAPAVERIN TABLET 40 MG Tab 208.00 1000 208,000.00 - 1000 208,000.00 0 - 1000
146 PARASETAMOL TABLET 500 MG Tab 86.00 8698.5 748,071.00 5000 430,000.00 13698.5 1,178,071.00 6717.5 577,705.00 6981
BULAN 7 - 18
MSN AWAL
147 PEHACAIN INJ Amp 4,850.00 2 9,700.00 - 2 9,700.00 0 - 2
150 PIROKSIKAM TABLET 20 MG Tab 189.50 346 65,567.00 2000 379,000.00 2346 444,567.00 482 91,339.00 1864
152 22.01.01.5283.02 POVIDON IODIDA 10 % 300 ML Btl 15,386.00 22 338,492.00 - 22 338,492.00 7.5 115,395.00 14.5
154 PREDNISON TABLET 5 MG Tab 123.20 7360.5 906,813.60 3000 369,600.00 10360.5 1,276,413.60 1885 232,232.00 8475.5
155 22.01.01.5288.02 PROPANOLOL TABLET 10 MG Tab 69.00 739 50,991.00 - 739 50,991.00 0 - 739
158 RANITIDIN TABLET 150 MG Tab 105.00 0 - 4000 420,000.00 4000 420,000.00 0 - 4000
159 15.01.01.3184.02 RESPIRIDON 2 MG Amp 347.00 80 27,760.00 - 80 27,760.00 60 20,820.00 20
161 22.01.01.5293.01 RINGER LAKTAT INFUS Btl 7,150.00 57 407,550.00 100 715,000.00 157 1,122,550.00 28 200,200.00 129
169 22.01.01.5300.01 SEFOTAKSIM 1000 MG Tab 3,500.00 20 70,000.00 - 20 70,000.00 20 70,000.00 0
170 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,117.00 85 94,945.00 - 85 94,945.00 1 1,117.00 84
174 16.01.01.5157.02 SIPROFLOKSASIN KAPLET 500 MG Kap 298.00 3328 991,744.00 500 149,000.00 3828 1,140,744.00 915 272,670.00 2913
176 12.02.01.5317.01 TABLET TAMBAH DARAH KOMBINASI Tab 121.00 15772 1,908,412.00 6000 726,000.00 21772 2,634,412.00 3464 419,144.00 18308
179 05.03.05.5323.02 TIAMIN (VIT B1) TABLET 50 MG Tab 91.00 5922 538,902.00 7000 637,000.00 12922 1,175,902.00 3073 279,643.00 9849
181 TRIHEKSIFENIDIL 25 MG TAB Tab 80.00 179 14,320.00 300 24,000.00 479 38,320.00 187 14,960.00 292
182 VIT A MERAH kap 505.00 664 335,320.00 1700 858,500.00 2364 1,193,820.00 30 15,150.00 2334
183 05.03.06.5332.01 VTT A BIRU kap 327.00 76 24,852.00 200 65,400.00 276 90,252.00 0 - 276
184 19.07.01.4128.01 VITAMIN B KOMPLEKS TABLET Tab 132.00 6279 828,828.00 7000 924,000.00 13279 1,752,828.00 4576 604,032.00 8703
185 ZIN TAB Tab 592.00 563 333,296.00 500 296,000.00 1063 629,296.00 424 251,008.00 639
BULAN 7 -18
MSN AWAL
186 ZIN SIRUP Btl 6,600.00 9 59,400.00 - 9 59,400.00 4 26,400.00 5
-
3 ALAT SUNTIK SEKALI PAKAI 1 ML Set 1,237.50 138 170,775.00 500 618,750.00 638 789,525.00 61 75,487.50 577
6 ALAT SUNTIK SEKALI PAKAI 5 ML Set 1,223.75 100 122,375.00 759 928,826.25 859 1,051,201.25 0 - 859
8 ALKOHOL SWAB Pcs 206.64 0 - 300 61,992.00 300 61,992.00 0 - 300
9 BISTURI NO. 19 Bh 3,000 106 318,000.00 - 106 318,000.00 1 3,000.00 105
10 BISTURI NO.20 Bh 3,000 62 186,000.00 - 62 186,000.00 3 9,000.00 59
11 BISTURI NO.21 Bh 3,000 52 156,000.00 - 52 156,000.00 4 12,000.00 48
12 BISTURI NO.23 Bh 3,000 45 135,000.00 - 45 135,000.00 1 3,000.00 44
13 JARUM HECTING Bh 2,600 228 592,800.00 - 228 592,800.00 0 - 228
14 CATGUT NO 2/0 Pcs 27,758.00 51 1,415,658.00 - 51 1,415,658.00 18 499,644.00 33
15 CATGUT NO 2/0 Pcs 28,000.00 36 1,008,000.00 - 36 1,008,000.00 0 - 36
16 CATGUT NO 3/0 Pcs 8,895.83 56 498,166.48 - 56 498,166.48 3 26,687.49 53
17 CATGUT NO 3/0 Pcs 30,188.00 36 1,086,768.00 96 2,898,048.00 132 3,984,816.00 0 - 132
18 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 0 - 48
19 CHATHEJELL Btl 4,284.80 12 51,417.60 - 12 51,417.60 0 - 12
20 CHATHEJELL Btl 42,848.00 0 - 5 214,240.00 5 214,240.00 0 - 5
21 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 0 - 10
22 FOLEY CATETER 18 Bh 10,000.00 20 200,000.00 - 20 200,000.00 3 30,000.00 17
23 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 0 - 28
24 INFUSION SET ANAK SET 4,375.00 11 48,125.00 10 43,750.00 21 91,875.00 0 - 21
26 INFUSION SET DEWASA Set 6,218.75 50 310,937.50 20 124,375.00 70 435,312.50 10 62,187.50 60
34 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 14.75 470,525.00 10 319,000.00 24.75 789,525.00 3 95,700.00 21.75
36 KASA KOMPRES 40/40 STERIL Bks 1,944.00 59 114,696.00 - 59 114,696.00 0 - 59
BULAN 7 -18
MSN AWAL
38 KASA PEMBALUT 2 M X 80 CM Bks 10,152.00 50 507,600.00 - 50 507,600.00 0 - 50
41 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,500.00 50 225,000.00 100 450,000.00 150 675,000.00 0 - 150
42 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS Bks 8,532.00 7 59,724.00 - 7 59,724.00 0 - 7
44 KASA PEMBALUT HIDROFIL 36 X 80 CM Roll 141,700.00 0 - 10 1,417,000.00 10 1,417,000.00 0 - 10
45 PLESTER YARD Roll 49,632.00 17 843,744.00 20 992,640.00 37 1,836,384.00 7 347,424.00 30
46 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 - 200 1,247,400.00 0 - 200
48 HANDSCON 7 STERIL psg 6,118.20 200 1,223,640.00 - 200 1,223,640.00 6 36,709.20 194
49 HANDSCON 71/2 psg 5,940.00 231 1,372,140.00 - 231 1,372,140.00 0 - 231
50 HANDSCON 71/2 psg 6,118.20 59 360,973.80 - 59 360,973.80 51 312,028.20 8
51 HANDSCON S psg 854.74 296 253,003.04 500 427,370.00 796 680,373.04 196 167,529.04 600
52 HANDSCON L psg 890.50 525 467,512.50 - 525 467,512.50 107 95,283.50 418
53 HANDSCON L psg 854.74 0 - 500 427,370.00 500 427,370.00 0 - 500
54 HANDSCON M psg 890.50 300 267,150.00 - 300 267,150.00 202 179,881.00 98
55 HANDSCON M psg 854.74 0 - 500 427,370.00 500 427,370.00 0 - 500
56 HAND RUB Btl 63,840.00 0 - 10 638,400.00 10 638,400.00 0 - 10
57 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 0 - 15
58 MASKER KARET Pcs 700.00 620 434,000.00 500 350,000.00 1120 784,000.00 140 98,000.00 980
59 SILK 2/0 SET 21,875.00 139 3,040,625.00 96 2,100,000.00 235 5,140,625.00 17 371,875.00 218
60 SILK 3/0 SET 21,875.00 39 853,125.00 - 39 853,125.00 22 481,250.00 17
61 SILK 3/0 SET 21,458.33 36 772,500.02 - 36 772,500.02 0 - 36
62 POT SPUTUM Pcs 2,930.00 166 486,380.00 - 166 486,380.00 10 29,300.00 156
63 STRIP GULA DARAH DOS 420,000.00 9 3,780,000.00 - 9 3,780,000.00 0.5 210,000.00 8.5
64 STRIP ASAM URAT DOS 452,000.00 13 5,876,000.00 - 13 5,876,000.00 3 1,356,000.00 10
65 KOLESTEROL STRIP DOS 319,000.00 3 957,000.00 - 3 957,000.00 3 957,000.00 0
66 KOLESTEROL STRIP NESCO Box 290,000.00 0 - 17 4,930,000.00 17 4,930,000.00 7 2,030,000.00 10
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 0 - 2.8125
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 0 - 2.8125
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 0 - 2.8125
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 0.8125 548,437.50 2 1,350,000.00 2.8125 1,898,437.50 0.3125 210,937.50 2.5
5 EUGENOL Pcs 175,000.00 1.25 218,750.00 - 1.25 218,750.00 0.25 43,750.00 1
6 FUJI IX MINI/ GOLD LABEL Pcs 650,000.00 2 1,300,000.00 2 1,300,000.00 4 2,600,000.00 0 - 4
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - 0 - 0
8 CHKM 10 ML Pcs 210,000.00 2.75 577,500.00 - 2.75 577,500.00 0.25 52,500.00 2.5
9 OCCO Pcs 245,000.00 0.75 183,750.00 2 490,000.00 2.75 673,750.00 0 - 2.75
BULAN 7 -18
MSN AWAL
BAHAN GIGI
10 DYCAL Pcs 800,000.00 0.5 400,000.00 1 800,000.00 1.5 1,200,000.00 0 - 1.5

11 HEMOSPON Pcs 76,500.00 31 2,371,500.00 - 31 2,371,500.00 1 76,500.00 30
12 PULP-10 Pcs 495,000.00 3.75 1,856,250.00 - 3.75 1,856,250.00 0.25 123,750.00 3.5
13 SEPTOJEK Pcs 0 - - 0 - 0 - 0
14 CAVITON Btl 325,000.00 3 975,000.00 - 3 975,000.00 0 - 3
BPJS UMUM JMLH

3323 304 3627


Nip. 196551214 199803 1 005 Nip.19810409 200803 1 002 Nip.19790926 200604 1 023 Nip.19801108 200604 2 024
7
3
1 8
HAL 1
PERMIN
NILAI KET
TAAN
835,263.00 EX.25
1,593,000.00
-
-
21,060.00 EX.120
67,160.00
488,000.00
86,177.52
18,232.00
107,415.00
1,205,734.75
-
17,010.00 EX.65
962,679.00
98,532.00
7,335,306.00
895,400.00
257,088.00
50,544.00
209,800.00
111,045.00
181,716.00
119,068.00
-
14,678.00
319,000.00
57,750.00 EX.2
129,183.00
468,129.00
HAL 2
PERMIN
NILAI KET
TAAN
1,050.00
866,286.00
5,020.00
204,216.00
103,320.00
742,520.00
59,000.00
76,665.00
116,840.00
33,060.00
331,248.00
21,411.00
133,840.00
36,992.00
23,690.00
8,664.00
-
9,888.00
44,370.00
1,508.00
126,945.00
274,675.50
76,600.00
323,050.00
68,229.00
46,875.00
321,562.50
59,400.00
35,400.00
88,320.00
159,200.00
375,636.00
15,106.00
16,800.00
-
201,201.00 EX.5
284,580.00
-
1,970.00
HAL 3
PERMIN
NILAI KET
TAAN
74,481.00
11,476.00
69,300.00
28,809.00
194,705.00
-
200,200.00
37,500.00
2,427,975.00
372,922.00
12,740.00
17,100.00
152,776.00
134,976.00
63,404.00
195,776.00
467,703.00
18,600.00
12,152.00
-
241,794.00
94,536.00
258,000.00
19,448.00
1,383.00
45,530.00
12,950.00
7,300.00
120,000.00
460,613.01
-
347,152.50
- EX.70
- EX.406
674,175.00
166,697.50
35,428.00
-
165,516.00
HAL 4
PERMIN
NILAI KET
TAAN
708,864.00
36,000.00
62,176.00
148,200.00
76,800.00
21,900.00
-
343,000.00
510,000.00
603,240.00
9,350.00
147,200.00
27,610.00
9,300.00
14,498,964.00
55,440.00
6,960.00 EX.30
9,800.00
324,450.00
1,401,400.00
348,565.00
594,527.50
43,542.00
35,200.00
85,700.00
14,784.00
62,700.00
1,241,952.00
4,305,540.00
473,000.00
151,085.00
162,000.00
65,840.00
154,980.00
93,312.00
208,000.00
29,900.00
247,299.00
600,366.00
HAL 5
PERMIN
NILAI KET
TAAN
9,700.00
431,148.00
7,250.00
353,228.00
564,200.00
223,097.00
174,000.00
1,044,181.60
50,991.00
8,775.00
15,295.00 EX.3404
420,000.00
6,940.00
44,100.00
922,350.00
27,315.00 EX.27
41,405.00
7,040.00 EX.25
27,970.00
37,310.00
169,453.00 EX.10
1,086,995.00
- EX.20
93,828.00
-
602,250.00
626,934.00
868,074.00
546,975.00
2,215,268.00
377,747.00
8,450.00
896,259.00
- EX.100
23,360.00
1,178,670.00
90,252.00
1,148,796.00
378,288.00
HAL 6
PERMIN
NILAI KET
TAAN
33,000.00
-
-
762,600.00
1,154,608.00
714,037.50
704,600.00
82,818.00
1,051,201.25
107,085.00
61,992.00
315,000.00
177,000.00
144,000.00
132,000.00
592,800.00
916,014.00
1,008,000.00
471,478.99
3,984,816.00
1,512,000.00
51,417.60
214,240.00
80,000.00
170,000.00
224,000.00
91,875.00
-
373,125.00
711,594.00
346,500.00
-
76,000.00
456,150.00
117,800.00
456,150.00
693,825.00
217,000.00
114,696.00
HAL 7
PERMIN
NILAI KET
TAAN
-
507,600.00
61,344.00
213,408.00
675,000.00
59,724.00
1,094,100.00
1,417,000.00
1,488,960.00
1,247,400.00
-
1,186,930.80
1,372,140.00
48,945.60
512,844.00
372,229.00
427,370.00
87,269.00
427,370.00
638,400.00
45,000.00
686,000.00
4,768,750.00
371,875.00
772,500.02
457,080.00
3,570,000.00
4,520,000.00
-
2,900,000.00
1,898,437.50
1,898,437.50
1,898,437.50
1,687,500.00
175,000.00
2,600,000.00
-
525,000.00
673,750.00
HAL 8
PERMIN
NILAI KET
TAAN
1,200,000.00
2,295,000.00
1,732,500.00
-
975,000.00
136,541,792.64
( LPLPO )

PUSKESMAS : Benteng
BULAN 8
MSN AWAL
2 21.01.01.4154.02 ALBENDAZOL TABLET 400 MG Tab 450.00 3540 1,593,000.00 - 3540 1,593,000.00 882 396,900.00 2658
4 17.09.01.3904.01 ALBOTHYL KONSENTRAT Tube 18,635.00 0 - - 0 - - 0
10 22.01.01.5160.01 AMITRIPTILIN TABLET SALUT 25 MG Tab 165.00 651 107,415.00 - 651 107,415.00 20 3,300.00 631
11 22.01.01.5158.01 AMBROKSOL TAB 30 MG Tab 190.63 6325 1,205,734.75 - 6325 1,205,734.75 1043 198,827.09 5282
13 AMLODIPIN 5 MG Tab 105.00 162 17,010.00 - 162 17,010.00 162 17,010.00 0
14 AMLODIPIN 10 MG Tab 107.00 8997 962,679.00 - 8997 962,679.00 704 75,328.00 8293
22 ANTIFUNGI DOEN KOMBINASI Pot 4,782.00 38 181,716.00 - 38 181,716.00 1 4,782.00 37
24 ANTIMIGREN Tab 179.00 82 14,678.00 - 82 14,678.00 36 6,444.00 46
25 22.01.01.5161.01 AQUA PRO INJEKSI STERIL 25 ML Vial 5,800.00 55 319,000.00 - 55 319,000.00 - 55
26 22.01.01.5163.01 AQUA PRO INJEKSI STERIL 25 ML Vial 2750 21 57,750.00 - 21 57,750.00 2 5,500.00 19
BULAN 8 - 18
MSN AWAL
30 AS.MEFENAMAT TABLET SALUT 500 MG Tab 102.00 8493 866,286.00 - 8493 866,286.00 4581 467,262.00 3912
33 22.01.01.5168.03 ASIKLOVIR TABLET 400 MG Tab 415.00 0 - 1000 415,000.00 1000 415,000.00 - 1000
36 BISAKODIL SUPPOSITORIA/DULCOLAX SUPP 5,900.00 10 59,000.00 - 10 59,000.00 - 10
38 CETIRIZINE TAB KAP 115.00 1016 116,840.00 - 1016 116,840.00 461 53,015.00 555
51 22.01.01.5189.02 ERITROMISIN KAPSUL 500 MG Kap 1,023.00 268.5 274,675.50 - 268.5 274,675.50 - 268.5
53 22.01.01.5189.03 ERITROMISIN SIROP 200 MG/ 5 ML Btl 6,461.00 50 323,050.00 - 50 323,050.00 - 50
55 22.01.01.5190.01 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml Btl 3,750.00 12.5 46,875.00 - 12.5 46,875.00 3.5 13,125.00 9
56 22.01.01.5192.01 ETANOL 70 % 100 ml Btl 2,625.00 122.5 321,562.50 - 122.5 321,562.50 19 49,875.00 103.5
60 FITOMENADION (VIT K) TABLET 10 MG Tab 796.00 200 159,200.00 - 200 159,200.00 - 200
61 FITOMENADION (VIT K) INJ 2 MG/ML Amp 4,083.00 92 375,636.00 90 367,470.00 182 743,106.00 92 375,636.00 90
62 FITOMENADION (VIT K) INJ 10 MG/ML Amp 4,083.00 0 - 30 122,490.00 30 122,490.00 1 4,083.00 29
64 FUROSEMIDA TABLET 40 MG Tab 84.00 200 16,800.00 200 16,800.00 400 33,600.00 - 400
67 17.09.01.5202.01 GENTAMISIN INJ 80 MG/ML Amp 4,066 0 - - 0 - - 0
BULAN 8 - 18
MSN AWAL
69 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 61.00 1221 74,481.00 - 1221 74,481.00 - 1221
70 22.01.01.5204.01 GLIBENKLAMIDA TABLET 5 MG Tab 151.00 76 11,476.00 1000 151,000.00 1076 162,476.00 391 59,041.00 685
73 22.01.01.5206.01 GLISERIL GUALAKOLAT TABLET 100 MG Tab 70.00 2781.5 194,705.00 - 2781.5 194,705.00 970 67,900.00 1811.5
75 04.02.01.5208.03 GLUKOSA LARUTAN INFUS 10 % Btl 7,500.00 5 37,500.00 - 5 37,500.00 - 5
76 GRANTUSIF Tab 405.00 5995 2,427,975.00 3000 1,215,000.00 8995 3,642,975.00 2510 1,016,550.00 6485
77 GRISEOFULVIN TABLET 125 MG Tab 506.00 737 372,922.00 1000 506,000.00 1737 878,922.00 305 154,330.00 1432
81 22.01.01.5211.01 HIDROKORTISON KRIM 2 % Tube 2,812.00 48 134,976.00 48 134,976.00 96 269,952.00 - 96
88 KALSIUM LAKTAT TABLET 500 MG/KALENG Tab 57 4242 241,794.00 - 4242 241,794.00 1181 67,317.00 3061
89 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 72.00 1313 94,536.00 - 1313 94,536.00 580 41,760.00 733
90 12.06.01.5067.02 KAPTOPRIL 25 MG Tab 86.00 3000 258,000.00 - 3000 258,000.00 - 3000
91 12.06.01.5067.03 KAPTOPRIL 50 MG Tab 143.00 136 19,448.00 - 136 19,448.00 20 2,860.00 116
98 KLORAMFENIKOL KAPSUL 250 MG Kap 329.00 0 - 500 164,500.00 500 164,500.00 479 157,591.00 21
99 KLORAMFENIKOL KAPSUL 500 MG Kap 1,155.00 0 - - 0 - - 0
100 KLORAMFENIRAMINE MALEAT TAB 4 MG Tab 45.00 7714.5 347,152.50 - 7714.5 347,152.50 2786 125,370.00 4928.5
101 KLORPROMAZIN TAB SALUT 25 MG Tab 50.00 0 - - 0 - - 0
104 01.06.01.5142.02 KOTRIMOKSAZOL DOEN I (DEWASA)+C125 Tab 131.00 1272.5 166,697.50 1000 131,000.00 2272.5 297,697.50 618 80,958.00 1654.5
106 22.01.01.5234.01 LIDOKAIN INJ 2 % Amp 929.00 0 - - 0 - - 0
107 22.01.01.5237.01 LIDOKAIN INJ 2 %+ efenefrin Amp 2,122.00 78 165,516.00 180 381,960.00 258 547,476.00 50 106,100.00 208
BULAN 8 - 18
MSN AWAL
108 22.01.01.5237.01 LIDOKAIN SPRAY Amp 177,216.00 4 708,864.00 - 4 708,864.00 - 4
109 LOPERAMIDE Tab 90.00 400 36,000.00 - 400 36,000.00 - 400
111 LUBIRE Kap 1,425.00 104 148,200.00 - 104 148,200.00 - 104
112 MgSO4 20% Btl 3,200 24 76,800.00 - 24 76,800.00 - 24
113 MgSO4 40% Btl 3,650 6 21,900.00 - 6 21,900.00 - 6
114 MELOXICAM 15 mg Tab 875 0 - - 0 - - 0
115 22.01.01.5245.01 METILERGOMETRIN MALEAT TAB 0.125 MG Tab 245.00 1400 343,000.00 - 1400 343,000.00 100 24,500.00 1300
122 22.01.01.5246.01 MULTIVITAMIN TAB/VINERTON Tab 1,654.00 8766 14,498,964.00 - 8766 14,498,964.00 498 823,692.00 8268
125 22.01.01.5247.01 METRONIDAZOL TABLET 250 MG Tab 98.00 100 9,800.00 - 100 9,800.00 - 100
129 05.03.02.5252.01 NATRIUM KLORIDA LARUTAN INFUS 0.9 % Btl 6,410.00 92.75 594,527.50 - 92.75 594,527.50 18 115,380.00 74.75
131 NISTATIN 500.000 IU Tab 704.00 50 35,200.00 - 50 35,200.00 - 50
132 NISTATIN 500.000 IU Tab 857.00 100 85,700.00 - 100 85,700.00 - 100
133 NISTATIN 100.000 IU Tab 448.00 33 14,784.00 - 33 14,784.00 - 33
134 15.05.01.5258.05 NISTATIN 100.000 IU Tab 627 100 62,700.00 - 100 62,700.00 - 100
135 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 1 DWS Tab 413,984 3 1,241,952.00 - 3 1,241,952.00 3 1,241,952.00 0
136 15.05.01.5258.02 OBAT ANTITUBERKULOSIS KAT 1 DWS Tab 395,900 0 - 16 6,334,400.00 16 6,334,400.00 5 1,979,500.00 11
137 15.05.01.5258.01 OBAT ANTITUBERKULOSIS KAT 2 DWS Tab 1,435,180 3 4,305,540.00 - 3 4,305,540.00 - 3
140 22.01.01.5270.01 OKSITETRASIKLIN HCL SALEP 3 % Tube 3,600.00 45 162,000.00 - 45 162,000.00 - 45
142 OMEPRAZOL Kap 164.00 945 154,980.00 900 147,600.00 1845 302,580.00 550 90,200.00 1295
144 PAPAVERIN TABLET 40 MG Tab 208.00 1000 208,000.00 - 1000 208,000.00 - 1000
BULAN 8 - 18
MSN AWAL
146 PARASETAMOL TABLET 500 MG Tab 86.00 6981 600,366.00 15000 1,290,000.00 21981 1,890,366.00 6468 556,248.00 15513
147 PEHACAIN INJ Amp 4,850.00 2 9,700.00 - 2 9,700.00 - 2
149 22.01.01.5281.01 PIROKSIKAM TABLET 10 MG Tab 145.00 50 7,250.00 - 50 7,250.00 - 50
150 PIROKSIKAM TABLET 20 MG Tab 189.50 1864 353,228.00 1000 189,500.00 2864 542,728.00 791 149,894.50 2073
152 22.01.01.5283.02 POVIDON IODIDA 10 % 300 ML Btl 15,386.00 14.5 223,097.00 - 14.5 223,097.00 3 46,158.00 11.5
154 PREDNISON TABLET 5 MG Tab 123.20 8475.5 1,044,181.60 - 8475.5 1,044,181.60 1711 210,795.20 6764.5
159 15.01.01.3184.02 RESPIRIDON 2 MG Amp 347.00 20 6,940.00 300 104,100.00 320 111,040.00 - 320
160 RANITIDIN INJ 25 MG / 2 ML Amp 3,150.00 14 44,100.00 - 14 44,100.00 1 3,150.00 13
164 22.01.01.5295.01 SALBUTAMOL TABLET 2 MG Tab 64.00 0 - 500 32,000.00 500 32,000.00 - 500
167 SALEP 2-4 KOMBINASI Tube 2,792.00 0 - 24 67,008.00 24 67,008.00 - 24
168 22.01.01.5297.01 SALISIL BEDAK 2 % Pot 1,066.00 35 37,310.00 - 35 37,310.00 10.6 11,299.60 24.4
170 SEFADROKSIL KAPSUL 500 MG Kap 455.00 2389 1,086,995.00 1000 455,000.00 3389 1,541,995.00 1071 487,305.00 2318
171 22.01.01.5300.01 SEFOTAKSIM 1000 MG Tab 3,500.00 0 - - 0 - - 0
172 22.01.01.5301.01 SIANOKOBALAMIN VIT B12 INJ 500 (PLACON) Amp 1,117.00 84 93,828.00 - 84 93,828.00 21 23,457.00 63
175 SIMVASTATIN TABLET 10 MG Tab 113.00 0 - 900 101,700.00 900 101,700.00 - 900
182 TIURAZOL 10 mg TAB Tab 1,195.00 0 - - 0 - - 0
183 TRIHEKSIFENIDIL 25 MG TAB Tab 80.00 292 23,360.00 - 292 23,360.00 50 4,000.00 242
184 VIT A MERAH kap 505.00 2334 1,178,670.00 - 2334 1,178,670.00 1246 629,230.00 1088
BULAN 8 - 18
MSN AWAL
185 05.03.06.5332.01 VTT A BIRU kap 327.00 276 90,252.00 - 276 90,252.00 126 41,202.00 150
187 ZIN TAB Tab 592.00 639 378,288.00 - 639 378,288.00 239 141,488.00 400
188 ZIN SIRUP Btl 6,600.00 5 33,000.00 - 5 33,000.00 5 33,000.00 0
-
5 ALAT SUNTIK SEKALI PAKAI 2.5 ML Set 990.00 0 - 200 198,000.00 200 198,000.00 - 200
7 ALAT SUNTIK SEKALI PAKAI 5 ML Set 1,223.75 859 1,051,201.25 - 859 1,051,201.25 208 254,540.00 651
9 ALKOHOL SWAB Pcs 206.64 300 61,992.00 - 300 61,992.00 100 20,664.00 200
10 BISTURI NO. 19 Bh 3,000 105 315,000.00 - 105 315,000.00 3 9,000.00 102
11 BISTURI NO.20 Bh 3,000 59 177,000.00 - 59 177,000.00 2 6,000.00 57
12 BISTURI NO.21 Bh 3,000 48 144,000.00 - 48 144,000.00 5 15,000.00 43
13 BISTURI NO.23 Bh 3,000 44 132,000.00 - 44 132,000.00 5 15,000.00 39
14 BLOOD LANCET ISI 100 BOX 20,000 0 - 5 100,000.00 5 100,000.00 - 5
15 JARUM HECTING Bh 2,600 228 592,800.00 - 228 592,800.00 - 228
16 CATGUT NO 2/0 Pcs 27,758.00 33 916,014.00 - 33 916,014.00 12 333,096.00 21
17 CATGUT NO 2/0 Pcs 28,000.00 36 1,008,000.00 - 36 1,008,000.00 - 36
18 CATGUT NO 2/0 Pcs 34,670.00 0 - 96 3,328,320.00 96 3,328,320.00 - 96
19 CATGUT NO 3/0 Pcs 8,895.83 53 471,478.99 - 53 471,478.99 14 124,541.62 39
20 CATGUT NO 3/0 Pcs 30,188.00 132 3,984,816.00 - 132 3,984,816.00 - 132
21 CATGUT NO 4/0 Pcs 31,500.00 48 1,512,000.00 - 48 1,512,000.00 - 48
22 CHATHEJELL Btl 4,284.80 12 51,417.60 - 12 51,417.60 - 12
23 CHATHEJELL Btl 42,848.00 5 214,240.00 - 5 214,240.00 1 42,848.00 4
24 FOLEY CATETER 16 Bh 8,000.00 10 80,000.00 - 10 80,000.00 - 10
25 FOLEY CATETER 18 Bh 10,000.00 17 170,000.00 - 17 170,000.00 4 40,000.00 13
26 FOLEY CATETER 20 Bh 8,000.00 28 224,000.00 - 28 224,000.00 - 28
28 INFUSION SET DEWASA Set 4,000.00 0 - - 0 - - 0
BULAN 8 - 18
MSN AWAL
37 KAPAS PEMBALUT / ABSORBEN 250 GRAM Set 31,900.00 21.75 693,825.00 - 21.75 693,825.00 2.25 71,775.00 19.5
38 KASA KOMPRES 40/40 STERIL Bks 3,100.00 70 217,000.00 - 70 217,000.00 - 70
43 KASA PEMBALUT HIDROFIL 4 X 15 CM ELASTIS Bks 4,500.00 150 675,000.00 - 150 675,000.00 - 150
44 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS Bks 8,532.00 7 59,724.00 - 7 59,724.00 - 7
46 KASA PEMBALUT HIDROFIL 36 X 80 CM Roll 141,700.00 10 1,417,000.00 - 10 1,417,000.00 - 10
48 HANDSCON 6 1/2 psg 6,237.00 200 1,247,400.00 - 200 1,247,400.00 - 200
49 HANDSCON 7 STERIL psg 5,940.00 0 - - 0 - - 0
50 HANDSCON 7 STERIL psg 6,118.20 194 1,186,930.80 - 194 1,186,930.80 61 373,210.20 133
51 HANDSCON 71/2 psg 5,940.00 231 1,372,140.00 - 231 1,372,140.00 43 255,420.00 188
52 HANDSCON 71/2 psg 6,118.20 8 48,945.60 - 8 48,945.60 8 48,945.60 0
53 HANDSCON S psg 854.74 600 512,844.00 500 427,370.00 1100 940,214.00 300 256,422.00 800
54 HANDSCON L psg 890.50 418 372,229.00 - 418 372,229.00 123 109,531.50 295
55 HANDSCON L psg 854.74 500 427,370.00 - 500 427,370.00 - 500
56 HANDSCON M psg 890.50 98 87,269.00 - 98 87,269.00 98 87,269.00 0
57 HANDSCON M psg 854.74 500 427,370.00 500 427,370.00 1000 854,740.00 714 610,284.36 286
58 HAND RUB Btl 63,840.00 10 638,400.00 10 638,400.00 20 1,276,800.00 7 446,880.00 13
59 URINE BAG BH 3,000.00 15 45,000.00 - 15 45,000.00 - 15
60 MASKER KARET Pcs 700.00 980 686,000.00 - 980 686,000.00 211 147,700.00 769
61 SILK 2/0 SET 21,875.00 218 4,768,750.00 - 218 4,768,750.00 9 196,875.00 209
62 SILK 3/0 SET 21,875.00 17 371,875.00 - 17 371,875.00 17 371,875.00 0
63 SILK 3/0 SET 21,458.33 36 772,500.02 - 36 772,500.02 1 21,458.33 35
64 POT SPUTUM Pcs 2,930.00 156 457,080.00 - 156 457,080.00 26 76,180.00 130
65 STRIP GULA DARAH DOS 420,000.00 8.5 3,570,000.00 - 8.5 3,570,000.00 1 420,000.00 7.5
66 STRIP ASAM URAT DOS 452,000.00 10 4,520,000.00 - 10 4,520,000.00 4 1,808,000.00 6
68 KOLESTEROL STRIP NESCO Box 290,000.00 10 2,900,000.00 1 290,000.00 11 3,190,000.00 10 2,900,000.00 1
BAHAN GIGI
1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 2.8125 1,898,437.50 - 2.8125 1,898,437.50 - 2.8125
2 COMPOSIT ANTERIOR A3 SOLARE Pcs 675,000.00 2.8125 1,898,437.50 - 2.8125 1,898,437.50 0.3125 210,937.50 2.5
3 COMPOSIT POSTERIOR A2 SOLARE Pcs 675,000.00 2.8125 1,898,437.50 - 2.8125 1,898,437.50 - 2.8125
BULAN 8 - 18
MSN AWAL
4 COMPOSIT ANTERIOR A2 SOLARE Pcs 675,000.00 2.5 1,687,500.00 - 2.5 1,687,500.00 0.5 337,500.00 2
5 EUGENOL Pcs 175,000.00 1 175,000.00 - 1 175,000.00 0.5 87,500.00 0.5
7 XYLESTESIN Pcs 795,000.00 0 - - 0 - - 0
8 CHKM 10 ML Pcs 210,000.00 2.5 525,000.00 - 2.5 525,000.00 0.25 52,500.00 2.25
9 OCCO Pcs 245,000.00 2.75 673,750.00 - 2.75 673,750.00 - 2.75
10 DYCAL Pcs 800,000.00 1.5 1,200,000.00 - 1.5 1,200,000.00 0.25 200,000.00 1.25
11 HEMOSPON Pcs 76,500.00 30 2,295,000.00 - 30 2,295,000.00 3 229,500.00 27
12 PULP-10 Pcs 495,000.00 3.5 1,732,500.00 - 3.5 1,732,500.00 0.25 123,750.00 3.25
13 SEPTOJEK Pcs 0 - - 0 - - 0
14 CAVITON Btl 325,000.00 3 975,000.00 - 3 975,000.00 - 3
BPJS UMUM JMLH

7673 343 8016

Kepala Dinas Kesehatan An. Kepala Seksi Kefarmasian An.Kepala Puskesmas Petugas Puskesmas
dr. H. Husaini, M. Kes Baso Dahri,S.Si.Apt Saribanong Mayanti,AMF
Nip. 196551214 199803 1 005 Nip.19810409 200803 1 002 Nip.19621231 198309 2 114 Nip.19801108 200604 2 024
8
3
1 8
HAL 1
PERMIN
NILAI KET
TAAN
-
1,196,100.00
-
-
- EX.100
-
464,332.00
86,177.52
15,996.00
104,115.00
1,006,907.66
-
- EX.52
887,351.00
96,048.00
5,614,834.00
596,200.00
162,304.00
-
163,644.00
94,220.00
176,934.00
101,558.00
8,234.00
319,000.00
52,250.00
123,521.00
284,427.00
-
HAL 2
PERMIN
NILAI KET
TAAN
399,024.00
5,020.00
163,068.00
415,000.00
167,895.00
713,640.00
59,000.00
- EX.267
63,825.00
33,060.00
215,184.00
16,146.00
133,840.00
36,992.00
19,776.00
8,664.00
-
9,888.00
40,542.00
-
126,945.00
274,675.50
76,600.00
323,050.00
60,648.00
33,750.00
271,687.50
59,400.00
35,400.00
63,480.00
159,200.00
367,470.00 EX.86
118,407.00
6,097.00
33,600.00
162,708.00 EX.7
282,744.00
-
1,970.00
HAL 3
PERMIN
NILAI KET
TAAN
74,481.00
103,435.00
69,300.00
13,959.00
126,805.00
177,320.00
37,500.00
2,626,425.00
724,592.00
6,890.00
17,100.00
2,938.00
269,952.00
63,404.00
-
449,491.00
18,600.00
9,702.00
-
174,477.00
52,776.00
258,000.00
16,588.00
-
45,530.00
9,250.00
7,300.00
92,000.00
460,613.01
6,909.00
-
221,782.50
-
43,200.00
562,925.00
216,739.50
25,008.00
-
441,376.00
HAL 4
PERMIN
NILAI KET
TAAN
708,864.00
36,000.00
49,178.00
148,200.00
76,800.00
21,900.00
-
318,500.00
510,000.00
347,985.00
- EX.11
139,150.00
21,340.00
- EX.80
13,675,272.00
34,160.00
5,800.00
9,800.00
201,600.00
1,374,450.00
269,675.00
479,147.50
41,082.00
35,200.00
85,700.00
14,784.00
62,700.00
-
4,354,900.00
4,305,540.00
473,000.00
114,235.00
162,000.00
47,734.00
212,380.00 EX.30
22,144.00 EX.298
208,000.00
-
139,875.00
HAL 5
PERMIN
NILAI KET
TAAN
1,334,118.00
9,700.00
262,508.00
7,250.00
392,833.50
91,000.00 EX.49
176,939.00
163,125.00
833,386.40
47,679.00
-
-
293,895.00
111,040.00
40,950.00
743,600.00 EX.18
5,463.00 EX.4
24,310.00
32,000.00
-
19,579.00
67,008.00
26,010.40
144,655.00
1,054,690.00
-
70,371.00
521,730.00
33,630.00 EX.2794
101,700.00
641,296.00
522,665.00
1,822,744.00
301,365.00
-
612,885.00
-
19,360.00
549,440.00
HAL 6
PERMIN
NILAI KET
TAAN
49,050.00
608,520.00
236,800.00
-
-
-
737,800.00
1,023,568.00
647,212.50
534,300.00
198,000.00
-
796,661.25
100,595.00
41,328.00
306,000.00
171,000.00
129,000.00
117,000.00
100,000.00
592,800.00
582,918.00
1,008,000.00
3,328,320.00
346,937.37
3,984,816.00
1,512,000.00
51,417.60
171,392.00
80,000.00
130,000.00
224,000.00
91,875.00
-
335,812.50
711,594.00
254,100.00
-
76,000.00
HAL 7
PERMIN
NILAI KET
TAAN
456,150.00
117,800.00
456,150.00
622,050.00
217,000.00
58,320.00
456,840.00
57,024.00
24,624.00
675,000.00
59,724.00
625,200.00
1,417,000.00
1,042,272.00
1,247,400.00
-
813,720.60
1,116,720.00
-
683,792.00
262,697.50
427,370.00
-
244,455.64
829,920.00
45,000.00
538,300.00
4,571,875.00
-
751,041.69
380,900.00
3,150,000.00
2,712,000.00
290,000.00
1,898,437.50
1,687,500.00
1,898,437.50
HAL 8
PERMIN
NILAI KET
TAAN
1,350,000.00
87,500.00
2,275,000.00
-
472,500.00
673,750.00
1,000,000.00
2,065,500.00
1,608,750.00
-
975,000.00
123,346,476.64

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE PUSKESMAS :P73010210

1 COMPOSIT POSTERIOR A3 SOLARE Pcs 675,000.00 1 675,000.00 - 1 675,000.00 -

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

KODE PUSKESMAS :P73010210

TRI WULAN II 2018

TRI WULAN II 2018

TRI WULAN II 2018

TRI WULAN II 2018

TRI WULAN II 2018

TRI WULAN II 2018

TRI WULAN II 2018

TRI WULAN II 2018

TRI WULAN II 2018

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Baso Dahri,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

KODE PUSKESMAS :P73010210

58 22.01.01.5180.01 DIFENHIDRAMIN INJ 10 MG/ML Amp 1,156.00 87 100,572.00 - 87 100,572.00 0 - 87

NO SAT/K STOK PENERI PERSE PEMA SISA

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Baso Dahri,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

dr. H. Husaini, M. Kes Baso Dahri,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Baso Dahri,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

KODE PUSKESMAS :P73010210

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF

KODE PUSKESMAS :P73010210

BPJS UMUM JMLH

Mengetahui Yang Menyerahkan, Yang Menerima/Melapor Yang Menerima

dr. H. Husaini, M. Kes Ummi Kalsum,S.Si.Apt dr. Frengki Wijaya Mayanti,AMF