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MENU UTAMA
PROGRAM PENGELOLAAN OBAT PUSKESMAS
PUSKESMAS : CIKEUSIK
KABUPATEN : PANDEGLANG KATA PENGANTAR
PROVINSI : BANTEN
TAHUN : 2019
DATA DASAR
LAPORAN PEMAKAIAN DAN LEMBARAN PULDAT RESEP LAPORAN TRIWULAN OBAT

PERMINTAAN OBAT (LPLPO)
OBAT GENERIK
LAPORAN ANTI BISA ULAR
JANUARI MEI SEPTEMBER
JAN MEI SEP
LAPORAN STOK OPNAM OBAT
PEBRUARI JUNI OKTOBER PEB JUN

OKT LAPORAN DISTRIBUSI OBAT
MARET MAR JUL NOV

JULI NOVEMBER JANUARI MEI SEPTEMBER
APRIL APR AGS DES

AGUSTUS DESEMBER PEBRUARI JUNI OKTOBER
DATA DASAR PUSKESMAS
PUSKESMAS: CIKEUSIK MENU

KABUPATEN: PANDEGLANG
PROVINSI: BANTEN
TAHUN: 2019
KEPALA DINAS KESEHATAN: RATU DEWI INDISARI,S.SOS
NIP. 19680917 199103 1 004
KEPALA GUDANG FARMASI: SYLVYANTI TRI MAHARANI,MPH,Apt
NIP.19860706 201001 2 010
KEPALA PUSKESMAS: Hj.IYOT SA'DIAH,S.ST
NIP. 19710804 199103 2 002
PENGELOLA OBAT: YUYUN YUNENGSIH, S.Kep
NIP. 19820422 200801 2 006
FORM : LPLPO
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
MENU
PUSKESMAS
PUSKESMAS : CIKEUSIK DOKUMEN NOMOR TANGGAL

KECAMATAN : CIKEUSIK DINKES KAB
KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE :: JANUARI 2019 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : : PEBRUARI 2019 PUSKESMAS
PEMBERIAN
STOK PENERI- PERSE- PEMA- STOK STOK PERMIN-
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ LAIN- JUMLAH
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Alopurinol tablet 100 mg Tab 1500 0 1500 500 1000 1000
2 Aminofilin tablet 200 mg Tab 900 0 900 100 800 Rusak 100 0
3 Albendazol Tab 90 300 390 0 390 0
4 Aminofilin injeksi 24mg/ml-10ml Amp 0 0 0 0 0 0
5 Amitriptilin HCL Tab. Salut 25 mg Tab 500 0 500 0 500 0
6 Amlodipine 10 mg Tablet Tab 1720 0 1720 510 1210 500
7 Amlodipine Besilate 5mg tablet Tab 1200 0 1200 0 1200 500
8 Alkacide 1 L High Level Desinfectant(Alkapham Ferance Btl 2 0 2 0 2 0
9 Amoksisillin Kapsul 500 mg Tab 7200 5000 12200 5100 7100 5000
Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 0 0 0 0 400

10
Alkazyme Sachet 25mg(Alkapham France) Pack 2 0 2 0 2 0
11
Amoksilin sk Forte Tab 154 180 334 280 54 300
12
Ampisillin Injeksi 1 gram Vial 0 0 0 0 0 0
13
Antalgin (Metampiron) Tab. 500 mg Tab 0 0 0 0 0 0
14
PEMBERIAN
NO NAMA OBAT SATUAN AWAL DAU/ JUMLAH
ASKES PROG BUFFER
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
15 Antasida DOEN tablet Tab 2500 3500 6000 5800 200 6000
16 Antasida DOEN suspensi Btl 50 200 250 190 60 200
17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 115 0 115 25 90 0
18 Anti Hemoroid DOEN Kombinasi Supp 30 0 30 0 30 0
19 Antifungi DOEN Kombinasi Pot 0 0 0 0 0 0
20 Antimigren DOEN Kombinasi Tab 0 0 0 0 0 0
21 Antiparkinson DOEN tab. Kombinasi Tab 0 0 0 0 0 0
22 Aqua roinjek Steril Btl 6 20 26 10 16 20
23 Acyclopir Krim 5%- 5gr Tube 108 0 108 37 71 0
24 Acyclopir Tablet 200mg Tab 1600 0 1600 900 700 0
25 Acyclopir Tablet 400 mg Tab 700 0 700 0 700 0
26 Akita/Molagit Tablet Tab 600 0 600 0 600 1000
27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 0 0 0 0 0
28 Asam asetilsalisilat 100mg tablet Tab 400 0 400 0 400 0
29 Asam Mefenamat 500mg Tab 900 2000 2900 2300 600 3000
30 Alprazolam 1mg Tab 0 0 0 0 0 0
31 Ambroksol tab tab 0 0 0 0 0 3000
32 Ambroksol syr Btl 0 0 0 0 0 300
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 1000 0 1000 400 600 1000
34 Asering Infus Tab 48 0 48 0 48 0
35 Asam Folat tablet 01mg Tab 0 0 0 0 0 0

36 Asam Folat tablet 5 mg Tab 800 0 800 0 800 0
37 Artesunat Inj Vial 0 0 0 0 0 0
38 Asam traneksamat Inj 5 % Amp 10 20 30 20 10 20
39 Asetosal Tablet 500 mg Tab 0 0 0 0 0 0
40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 100 0 0 0 0 0
41 Atropin Sulfat Tablet 0,5 mg Tab 0 0 0 0 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 0 0 0 0 0
43 Akohol 1 l Botol 1 0 1 0 1 5
44 Betadin Salf Antiseptik Tube 24 0 24 0 24 0
45 Betametason Krim 0,1% - 5 gr Tube 100 0 100 45 55 48
46 Bisacodril sup Botol 48 0 48 2 46 0
47 Bisoprolol 5mg tab Tab 570 0 570 0 570 0
48 Captopril Tablet 12,5 mg Tab 850 0 850 400 450 1000
49 Captopril Tablet 25 mg Tab 1650 0 1650 1150 500 1000
50 Carbamazefine Tab 0 400 400 100 300 1000
51 Cefadroxil 500mg Tab 0 0 0 0 0 0
52 Cetrizin syr Btl 0 0 0 0 0 100
53 Cefixim Tab 0 0 0 0 0 2000
54 Ciprofloxacin Infus Btl 0 0 0 0 0 10
55 Ciprofloxacin Tablet 500mg Tab 2100 1000 3100 2150 950 2000
56 D-Artepp Tab Tab 0 0 0 0 0 0
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 100 0 100 0 100 2000
58 Deksametasone Tablet 0,5 mg Tab 1200 4000 5200 3300 1900 0
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 0 0 0 0 0
60 Diazetpam Rectal 2mg Tube 0 0 0 0 0 10

61 Diazepam Injeksi 5 mg/ml - 2ml Amp 57 0 57 0 57 0
62 Diazepam Tablet 2 mg Tab 0 0 0 0 0 0
64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 0 0 0 0 0
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 43 0 43 0 43 0
66 Digoksin Tablet 0,25 mg Tab 300 0 300 0 300 0
67 Domperidon 10 mgtablet Tab 700 0 700 500 200 1000
68 Dimenhidrinat Tablet 50 mg Tab 0 0 0 0 0 0
PEMBERIAN
STOK PENERI- PERSE- PEMA- STOK STOK PERMIN- DAU/
NO NAMA OBAT SATUAN AWAL JUMLAH
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
69 Dasabion Tablet Tab 0 0 0 0 0 0
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 0 0 0 0 50
71 Efedrin HCL Tablet 25 mg Tab 0 0 0 0 0 0
72 Ekstrak Belladona Tablet 10 mg Tab 0 0 0 0 0 0
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 105 0 105 0 105 0
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 7 0 7 0 7 0
75 Lisinofril 10 mg Tab 0 0 0 0 0 0
76 Lisinofril 5mg Tab 0 0 0 0 0 0
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 0
78 Eritromisin Kapsul 500 mg Kap 600 0 600 0 600 0
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 80 0 80 0 80 0
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 0 0 0 0 0
81 Fenitoin Natrium Kapsul 100 mg Kap 0 0 0 0 0 0
83 Fenobarbital Injeksi- 2ml Amp 52 0 52 0 52 0
84 Fenobarbital Tablet 30 mg Tab 100 0 100 0 100 0
86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 0 0 0 0 0
87 Fluflenazine decanoat inj 25mg/ml Amp 20 0 20 0 20 0
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 30 0 30 0 30 0
89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 400 0 400 300 100 500
90 Gentamisin SM Tube 0 0 0 0 0 0
91 Furosemida Tablet 40 mg Tab 0 0 0 0 0 0
92 Garam Oralit 200 ml air Ktg 150 0 150 0 150 0
93 Glimepirid 2mg Tablet Tab 0 0 0 0 0 0
94 Glibenklamida Tablet 5 mg Tab 1300 0 1300 600 700 500
95 Asetil Sistein 200mg Tab 1600 5280 6880 4740 2140 3000
STOK PENERI- PERSE- PEMA- STOK STOK PERMIN- PEMBERIAN

MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/
ASKES PROG BUFFER LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Glikazid 80 mg Btl 550 0 550 0 550 0
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 44 0 44 0 44 0
99 Griseofulvin Tablet 500 mg, Tab 0 0 0 0 0 0
100 Griseofulvin Tablet 125 mg, Micron Tab 490 0 490 0 490 0
101 Gentamisin S.K 0.1%-5 gr Tube 0 0 0 0 0 0
102 Gentamisin tetes Mata Botol 0 72 72 29 43 0
103 Haloperidol 2 mg Tablet Tab 1000 0 1000 300 700 0
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 200 500 700 0 700 0
106 Hidrokortison Krim 2,5%-5 gr Tab 38 96 134 84 50 0
107 Ibuprofen Tablet 200 mg Tab 500 0 500 500 0 2000
109 Ibufropen syr Btl 0 0 0 0 0 0
110 Haloporidol Decanoate Inj 50mg Amp 25 0 25 0 25 0
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 1600 0 1600 0 1600 0
112 Ketokonazol krem Tube 50 0 50 40 10 0
113 Ketokonazol tab 200mg Tab 950 0 950 450 500 500
114 Ketorolac Inj 30mg Vial 100 0 100 0 100 0
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 1400 0 1400 1300 100 0
116 KN-3B Labu 42 0 42 0 42 0
117 Karbihidrat +Elektrolit Labu 40 0 40 0 40 0
118 Karbogliserin Tetes telinga Btl 36 0 36 0 36 0
119 Kloramfenikol tetes Mata Btl 0 0 0 0 0 0
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 3200 0 3200 1500 1700 2000
121 Klozapine 25 Mg Tab 998 0 998 0 998 0
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 0 0 0 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
123 Klorpromazin HCL Tablet Salut 25 mg Tab 0 0 0 0 0 0
125 klorpeson Slasf tube 0 0 0 0 0 0
126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 0 0 0 0 0
127 Kotrimoksazol Tablet 480mg Tab 350 1000 1350 250 1100 1000
128 Kotrimoksazol Suspensi Kombinasi Btl 120 0 120 0 120 0
129 Metpormin 500mg Tab 1200 1500 2700 1000 1700 1000
130 Methyilprednisolon 8mg Tab 0 0 0 0 0 0
131 Kloramfenikol Salep Mata 1%-5gram Tube 54 0 54 25 29 100
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0 0 0 0 0 0
133 Kuinin Injeksi 25%-2ml Amp 5 0 5 0 5 0
134 Levoploxasin 500mh Dus 0 0 0 0 0 0
135 Lidokain Komp. Injeksi, Kombinasi Amp 80 0 80 0 80 100
136 Lisol, Kresol Tersabun 50%- 1000ml Btl 0 0 0 0 0 0
137 Loperamide Hcl 2mg Tanlet Tab 550 1000 1550 200 1350 0
138 Magnesium Sulfat Injk 25 ml Vial 32 0 32 2 30 30
139 Metamizol 500mg Tab 800 1500 2300 2100 200 2500
140 Metilergometrin Maleat Tab. 0,125 g Tab 400 500 900 900 0 500
141 Metilergometrin M inj. 0,200mg- 1ml Amp 40 0 40 0 40 0
142 Metoklorpropamid Tablet 10 mg Tab 0 0 0 0 0 0
143 Mikonazol Krim/ Salep 2%-10gram Tube 59 0 59 36 23 0
144 Multivitamin Anak Btl 11 50 61 50 11 50
145 Multivitamin Dewasa Tab 0 0 0 0 0 0
146 Metronidazol Infus 500mg/100ml Btl 0 0 0 0 0 0
147 Metronidazol Tablet 500mg Tab 0 0 0 0 0 0
148 Metokloramid Syr Btl 0 60 60 0 60 0
149 Metronidazol syr Btl 40 0 40 0 40 0
150 Natrium Bikarbonat Tablet 500mg Tab 0 0 0 0 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 60 0 60 20 40 40
152 Natrium Diclopenac 20mg Amp 0 0 0 0 0 1000
153 Nistatin Vaginal sup 25 0 25 20 5 0
154 Nistatin Tablet Salut 500.000 IU tab 0 0 0 0 0 0
155 Natrium Diclopenac 50mg Tab 2300 1000 3300 2750 550 3000
156 Nifedipine Tab 10mg Tab 150 0 150 0 150 0
157 Multivitamin Anti Oksidan Tab 2900 1200 4100 2200 1900 2000
158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 15 16 31 8 23 0
159 Obat Anti Tuberkulosis Kat. 2 Pkt 1 3 4 1 3 0
160 Obat Anti Tuberkulosis Kat.Anak Pkt 2 3 5 2 3 0
161 Ofloksasin Tetes telinga Btl 4 0 4 0 4 0
162 Omeprazol inj 40mg/10ml Btl 0 0 0 0 0 20
163 Omeprazol Kapsul 20mg Kap 1770 1200 2970 1760 1210 2000
164 Ondansetron Inj 4mg Vial 0 0 0 0 0 100
165 Onadansetron 8mg Tablet Tab 0 0 0 0 0 0
167 Obat Batuk Flu Dewasa Pkt 1800 3000 4800 3300 1500 3000
168 Obat Batuk Hitam (OBH) Cairan Btl 0 0 0 0 0 0
169 Obat Batuk Dewasa syr Btl 0 0 0 0 0 0
170 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 0 0 0 0 0
171 Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 0 0 0 0 0
172 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 0 0 0 0 0
173 Oksitosin Injeksi 10 IU/ml- 1ml Amp 26 100 126 18 108 0
174 OBAT Anti Diare suspensi Btl 0 0 0 0 0 0
175 parasetamol drops 15 ml btl 46 56 102 10 92 0
176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 200 300 500 210 290 300
177 Parasetamol tab 100mg Tab 0 0 0 0 0 0
178 Parasetamol Tablet 500mg Tab 1750 6000 7750 6800 950 7000
179 Permetin Krim/Skabisid 5 % Tube 0 0 0 0 0 20
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
180 pirantel syr Btl 23 0 23 0 23 0
181 Pirantel Tablet 125mg Tab 435 0 435 0 435 0
182 piroksikam Tablet 10 mg Tab 0 0 0 0 0 2000
183 Piroksikam Tablet 20 mg Tab 0 0 0 0 0 2000
184 Propiltiourasil Tablet 100mg Tab 600 0 600 0 600 0
185 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 700 0 700 250 450 0
186 Povidon Iodida 10% 300ml Btl 20 0 20 4 16 0
188 Prednison Tablet 5mg Tab 1100 2000 3100 2000 1100 2000
189 Primakuin Tablet 15mg Tab 0 0 0 0 0 0
190 Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 0 0 0 0 0
191 propanolol HCL Tablet 10mg Tab 1000 0 1000 1000 0 Exf 0
192 Propanolol HCL Tablet 40mg Tab 0 0 0 0 0 0
193 Povidon Iodida 10% 60ml Botol 2 0 2 0 2 0
194 Retinol (Vitamin A) Kapsul 100.000 IU Kap 650 0 650 650 0 500
196 MDT MB/ Kusta Dewasa Blister 0 0 0 0 0 0
197 MDT PB/ Kusta Dewasa Blister 0 0 0 0 0 0
198 Risperidon 2mg Tab 320 0 320 0 320 0
199 Ranitidin Injeksi 25 mg/ 2ml Vial 65 0 65 50 15 100
200 Ranitidin Tablet 150 mg Tab 1800 2000 3800 2900 900 3000
201 Ringer Laktat Lar. Inf. Steril - 500ml Btl 44 160 204 136 68 0
202 Salbutamol Tablet 2mg Tab 1800 0 1800 900 900 1000
204 Salep 2-4, Kombinasi Pot 58 0 58 10 48 0
205 Salisil Bedak 2% Ktk 0 100 100 20 80 0
206 Serum Anti Bisa Ular Polivalen Inj.5ml Vial 20 0 20 5 15 0
207 Stimuno Botol 48 0 48 14 34 0
208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 4 10 14 11 3 10
209 Sukrafat 500mg Tab 0 0 0 0 0 3000
210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 45 0 45 20 25 100
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
211 Simvastatin Tablet 20 mg Tab 500 500 1000 500 500 500
213 Sukralfat Syr Botol 0 0 0 0 0 0
214 Sulfasetamida Natrium TM 15%- 5ml Btl 0 0 0 0 0 0
215 Sabutamol Nebulizer Amp 0 0 0 0 0 50
216 Spiranolakton tab tab 0 0 0 0 0 0
217 Salf Kombinasi Tube 0 0 0 0 0 100
218 Sinbio Set 0 0 0 0 0 0
219 Setrizin tablet 10 mg Tab 680 620 1300 1300 0 2000
220 Tablet Tambah Darah Komb. Tab 2160 15120 17280 16350 930 0
221 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 0 0 0 0 0
222 Tetrasiklin HCL Kapsul 250 mg Kap 700 0 700 700 0 exf 0
223 Tetrasiklin HCL Kapsul 500 mg Kap 0 0 0 0 0 0
224 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 1000 1000 2000 1100 900 2000
225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 30 0 30 30 0 exf 0
226 Triheksifenidil Hidroklorida Tab. 2mg Tab 500 0 500 200 300 0
227 Vitamin B Komplek Tablet Tab 1500 1500 3000 3000 0 3000
228 Zink Syr Botol 53 0 53 32 21 0
229 Zink Tablet 20mg Tab 800 0 800 450 350 0
II PERBEKALAN KESEHATAN 0
1 Alat Suntik Sekali Pakai 1 ml Set 125 0 125 50 75 0
4 Catgut/ Benang Bedah No. 2/0 Set 25 72 97 10 87 0
5 I.V. Catheter No. 20 Set 157 0 157 48 109 0
8 I.V. Cateter No 26 set 87 100 187 10 177 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
9 Infusion Set Anak Set 135 0 135 10 125 0

10 Infusion Set Dewasa Set 153 0 153 118 35 100
11 E.Care Film I.V Dresing Pcs 0 400 400 0 400 0
12 Silk (Benang Bedah Sutera) No. 3/0 Biji 118 0 118 0 118 0
13 Saraya Alsof A 500 ml Botol 0 0 0 0 0 15
14 Kapas Pembalut/Absorben 250 gram Set 3 10 13 0 13 0
15 Kasa Kompres 40/40 lembar 100 0 100 93 7 0
16 Kasa Pembalut 2 m x 80 cm pak 20 0 20 0 20 0
17 Kasa Pembalut Hidrofil 36 m x 80 cm rol 2 3 5 0 5 0
18 Kasa Steril 16/16 kotak 0 200 200 100 100 100
19 Masker biji 500 0 500 0 500 0
20 Plester 5 yard x 2 inch rol 59 0 59 15 44 0
21 Sarung Tangan No 7 Steril pasang 0 0 0 0 0 300
22 Sarung Tangan No 6.5 Steril pasang 200 0 200 50 150 100
23 Sarung tangan no 6 1/2 Pasng 0 0 0 0 0 500
24 Folly cateter No 16 Pcs 19 0 19 5 14 0
26 Sarung tangan Gynecolog no 7 Sashet 80 0 80 0 80 0
27 Alkohol Swab bok 3 5 8 4 4 5
28 Underpad Lembar 30 100 130 20 110 0
29 Urine Bag Biji 12 10 22 0 22 0
30 Catgut/ Benang Bedah No. 3/0 Botol 72 36 108 0 108 0
31 Antiseptik Surgical Hand Scrab Botol 0 5 5 5 0 10
32 Cairan pembersih Botol 2 6 8 0 8 0
33 Jely kateter biji 33 0 33 0 33 0
34 Jarum Insulin Biji 129 0 129 0 129 0
III OBAT GIGI
1 Air Raksa Dental Use Botol 0 0 0 0 0 1
2 Etil Klorida Semprot-100 ml 0 0 0 0 0 1
3 Eugenol Cairan - 10 ml 0 0 0 0 0 1
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR JUMLAH
ASKES PROG BUFFER
OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
4 Forinokresol 0 0 1
5 Glass Ionomer Cement (GC IX) 0 0 1
6 Gutta Percha Point 0 0 1
7 Kalsium Hidroksida Pasta 0 0 1
8 Monoklorkamfer Menthol Cairan 10ml 0 0 1
9 Semen Seng Fosfat Srbk dan Cairn30 gr 0 0 1
10 Silver Amalgan 0 0 1
11 Temporary SF Serbuk & Cairan -100 gr 0 0 1
KET : LB 1 HARAP DILAMPIRKAN
JUMLAH KUNJUNGAN RESEP UMUM ASKES JUMLAH

BAYAR TIDAK
BAYAR
1831 1823 13 3667
Mengetahui / Menyetujui : Cikeusik 31 Januari 2019

Kepala Dinas Kesehatan Kab. Kota Yang Menyerahkan Yang Meminta : Yang Meminta :
Pandeglang Kepala UPT Gudang Farmasi Kepala Puskesmas Petugas Puskesmas
RATU DEWI INDISARI,S.SOS SYLVYANTI TRI MAHARANI,MPH,Apt Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep
NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
Lembar Putih : UPT Gudang Farmasi Kabupaten
Lembar Biru/Hijau : Dinas Kabupaten
Lembar Kuning : Puskesmas
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE :: PEBRUARI 2019 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : : MARET, 2019 PUSKESMAS
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ JUMLAH
PROG BUFFER LAIN-
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2 Aminofilin tablet 200 mg Tab 800 0 800 0 800 0
3 Albendazol Tab 390 0 390 0 390 0

10
11 Alkazyme Sachet 25mg(Alkapham France) Pack 2 0 2 0 2 1

12
13
14
PROG BUFFER
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ LAIN-
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
SATUAN STOK PENERI- PERSE- PEMA- STOK STOK PERMIN- DAU/
NO NAMA OBAT JUMLAH
PROG BUFFER
AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN LAIN-
APBD ASKES STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 Akohol 1 l Botol 1 0 1 1 0 5
53 Cefixim Tab 0 0 0 0 0 2000
60 Diazetpam Rectal 2mg Tube 0 0 0 0 0 `10
PEMBERIAN
PROG BUFFER
OPTIMUM TAAN LAIN-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 20

PROG BUFFER LAIN-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Glikazid 80 mg Btl 550 0 550 0 550 0
116 KN-3B Labu 42 0 42 18 24 0
121 Klozapine 25 Mg Tab 998 0 998 0 998 0
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
129 Metpormin 500mg Tab 1700 0 1700 1500 200 2000
139 Metamizol 500mg Tab 200 2500 2700 2500 200 3000
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
PROG BUFFER
OPTIMUM TAAN LAIN-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
191 propanolol HCL Tablet 10mg Tab 0 0 0 0 0 0
207 Stimuno Botol 34 0 34 9 25 0
209 Sukrafat 500mg Tab 0 0 0 0 0 0
PEMBERIAN
PROG BUFFER
OPTIMUM TAAN LAIN-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
218 Sinbio Set 0 0 0 0 0 0
225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 0 0 0 0 0 0
228 Zink Syr Botol 21 0 21 10 11 50
II PERBEKALAN KESEHATAN
2 Alat Suntik Sekali Pakai 3 ml Set 0 0 0 0 0
9 I.V. Cateter No 26 set 177 0 177 30 147 0
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

13 Policlean Handrub Botol 0 0 0 0 0 20
19 Masker biji 500 0 500 250 250 500
28 Underpad Lembar 110 0 110 60 50 80
29 Urine Bag Biji 22 0 22 6 16 10
III OBAT GIGI
PEMBERIAN
NO NAMA OBAT JUMLAH
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
4 Forinokresol 0 0 0 0 0 1
5 Glass Ionomer Cement (GC IX) 0 0 0 0 0 1
6 Gutta Percha Point 0 0 0 0 0 1
7 Kalsium Hidroksida Pasta 0 0 0 0 0 1
8 Monoklorkamfer Menthol Cairan 10ml 0 0 0 0 0 1
9 Semen Seng Fosfat Srbk dan Cairn30 gr 0 0 0 0 0 1
10 Silver Amalgan 0 0 0 0 0 1
11 Temporary SF Serbuk & Cairan -100 gr 0 0 0 0 0 1
UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK
BAYAR
1517
Mengetahui / Menyetujui : Cikeusik,04 Maret 2019

NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE :: MARET 2019 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE :: - PUSKESMAS
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM DAU/ JUMLAH
PROG BUFFER
TAAN LAIN-
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 390 0 390 0 390 0

10
11
12
13
14

PROG BUFFER
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 Akohol 1 l Botol 0 0 0 0 0 5
53 Cefixim Tab 0 0 0 0 0 1000
PEMBERIAN
PROG BUFFER
APBD ASKES
STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 0

PROG BUFFER LAIN-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Glikazid 80 mg Btl 550 0 550 0 550 0
116 KN-3B Labu 24 0 24 18 6 0
121 Klozapine 25 Mg Tab 998 0 998 0 998 0
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
129 Metpormin 500mg Tab 200 0 200 200 0 2000
139 Metamizol 500mg Tab 200 3000 3200 2300 900 0
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
PROG BUFFER
OPTIMUM TAAN LAIN-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
207 Stimuno Botol 25 0 25 19 6 0
209 Sukrafat 500mg Tab 0 0 0 0 0 0
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
218 Sinbio Set 0 0 0 0 0 0
228 Zink Syr Botol 11 0 11 11 0 50
II PERBEKALAN KESEHATAN 0 0 0 0
2 Alat Suntik Sekali Pakai 2.5 ml Set 0 300 300 90 210 0
9 I.V. Cateter No 26 set 147 0 147 70 77 100
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

20 Masker biji 250 500 750 350 400 300
29 Underpad Lembar 50 50 100 70 30 100
30 Urine Bag Biji 16 30 46 5 41 0
III OBAT GIGI
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
UMUM
ASKES JUMLAH
BAYAR
1434 0 0 1434
Mengetahui / Menyetujui : Cikeusik,30 Maret 2019

Kepala Dinas Kesehatan Kab. Kota Yang Menyerahkan Yang Meminta : Yang Meminta
Pandeglang Kepala UPT Gudang Farmasi Kepala Puskesmas Petugas Obat Puskesmas
NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : : APRIL 2019 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : : MEI 2019 PUSKESMAS
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN DAU/ JUMLAH
PROG BUFFER
KAIAN AKHIR OPTIMUM TAAN LAIN-
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 390 10350 10740 10350 390 0

10
11
12
13
14

PROG BUFFER
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
NO NAMA OBAT SATUAN AWAL BUFFER LAIN- JUMLAH
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN APBD ASKES PROG STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 Akohol 1 l Botol 0 3 3 0 3 0
53 Cefixim Tab 0 0 0 0 0 2000
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 0

PROG BUFFER LAIN-
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Glikazid 80 mg Btl 550 0 550 0 550 0
116 KN-3B Labu 6 0 6 0 6 0
121 Klozapine 25 Mg Tab 998 0 998 0 998 0
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
129 Metpormin 500mg Tab 0 0 0 0 0 2000
139 Metamizol 500mg Tab 900 0 900 0 900 2000
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
160 Obat Anti Tuberkulosis Kat.Anak Pkt 5 0 5 1 4
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
207 Stimuno Botol 6 0 6 0 6 0
209 Sukrafat 500mg Tab 0 0 0 0 0 2000
PEMBERIAN
NO NAMA OBAT STOK PENERI- PERSE-
SATUAN AWAL PEMA- STOK STOK PERMIN- DAU/ JUMLAH
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
218 Sinbio Set 0 0 0 0 0 0
228 Zink Syr Botol 0 0 0 0 0 100
II PERBEKALAN KESEHATAN
9 I.V. Cateter No 26 set 77 100 177 0 177 0
PEMBERIAN
PROG BUFFER
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

20 Masker biji 400 300 700 150 550 0
29 Underpad Lembar 30 100 130 15 115 0
30 Urine Bag Biji 41 50 91 15 76 0
III OBAT GIGI
PROG BUFFER LAIN-
NO NAMA OBAT SATUAN AWAL APBD ASKES JUMLAH
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
UMUM
ASKES JUMLAH
BAYAR
1341 1625 33 2999
Mengetahui / Menyetujui : Cikeusik,05 Mei 2019

NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : MEI 2019 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : juni 2019 PUSKESMAS
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN JUMLAH
PROG BUFFER LAIN-
DAU/ APBD ASKES STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 390 0 390 0 390 0
8 Alkacide 1 L High Level Desinfectant(Alkapham Ferance Kap 3 0 3 0 3 0
9 Amoksisillin Kapsul 500 mg Kap 10400 0 10400 3100 7300 0
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 0 0 0 0 400
11 Alkazyme Sachet 25mg(Alkapham France) Amp 3 0 3 0 3 0
12 Amoksilin sk Forte Botol 334 0 334 324 10 350
13 Ampisillin Injeksi 1 gram Vial 0 0 0 0 0 0

14 Antalgin (Metampiron) Tab. 500 mg Tab 0 0 0 0 0 0

NO NAMA OBAT SATUAN AWAL BUFFER JUMLAH
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ APBD ASKES PROG LAIN-LAIN
STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 Antasida DOEN suspensi Botol 340 100 440 250 190 200
22 Aqua roinjek Steril Botol 26 0 26 0 26 0
27 Antalgin (Metampiron) Inj. 250mg/2ml Amp 0 0 0 0 0 0
31 Ambroksol tab Amp 0 0 0 0 0 3000
32 Ambroksol syr Vial 0 0 0 0 0 200
37 Artesunat Inj Tab 0 0 0 0 0 0
38 Asam traneksamat Inj 5 % Tab 21 0 21 10 11 0
PEMBERIAN
STOK PENERI- PERSE- PEMA- STOK STOK PERMIN- DAU/ APBD
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN ASKES PROG BUFFER
STOK LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 Akohol 1 l Tab 3 0 3 0 3 0
44 Betadin Salf Antiseptik Vial 24 0 24 0 24 0
50 Carbamazefine Tube 0 100 100 0 100 500
52 Cetrizin syr Tab 0 0 0 0 0 0
53 Cefixim Btl 0 0 0 0 0 0
54 Ciprofloxacin Infus Labu 0 0 0 0 0 0
60 Diazetpam Rectal 2mg Tab 0 0 0 0 0 5
PEMBERIAN
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN ASKES PROG BUFFER LAIN-LAIN
STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 0
87 Fluflenazine decanoat inj 25mg/ml Tab 20 0 20 0 20 0
90 Gentamisin SM Tab 0 0 0 0 0 84

MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ APBD
ASKES PROG BUFFER
STOK LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Glikazid 80 mg Btl 550 0 550 550 0 0
99 Griseofulvin Tablet 500 mg, Btl 0 0 0 0 0 0
102 Gentamisin tetes Mata Amp 20 0 20 20 0 84
109 Ibufropen syr Tab 0 0 0 0 0 100
110 Haloporidol Decanoate Inj 50mg Tab 25 0 25 0 25 0
114 Ketorolac Inj 30mg Amp 60 0 60 10 50 0
116 KN-3B Vial 6 0 6 2 4 0
117 Karbihidrat +Elektrolit Kap 40 0 40 0 40 0
118 Karbogliserin Tetes telinga btl 48 0 48 0 48 0
121 Klozapine 25 Mg Tab 998 0 998 150 848 0
PEMBERIAN
STOK LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
125 klorpeson Slasf Tab 0 0 0 0 0 0
129 Metpormin 500mg Tab 0 2000 2000 800 1200 2000
137 Loperamide Hcl 2mg Tanlet Ktg 900 0 900 450 450 0
138 Magnesium Sulfat Injk 25 ml Btl 24 0 24 0 24 0
139 Metamizol 500mg Tab 900 2000 2900 1000 1900 0
146 Metronidazol Infus 500mg/100ml Labu 0 0 0 0 0 0
148 Metokloramid Syr Amp 57 0 57 40 17 50
PEMBERIAN
STOK LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
153 Nistatin Vaginal Tab 5 0 5 0 5 0
154 Nistatin Tablet Salut 500.000 IU Tab 0 0 0 0 0 0
155 Natrium Diclopenac 50mg Tube 1500 1000 2500 1250 1250 2000
156 Nifedipine Tab 10mg Btl 150 0 150 0 150 0
157 Multivitamin Anti Oksidan Pkt 2000 2000 4000 1600 2400 0
161 Ofloksasin Tetes telinga Amp 4 0 4 4 0 10
162 Omeprazol inj 40mg/10ml Kap 0 0 0 0 0 50
163 Omeprazol Kapsul 20mg Amp 1720 1500 3220 1600 1620 1500
164 Ondansetron Inj 4mg Tab 0 0 0 0 0 100
166 Onadansetron 4mg Tablet Pkt 60 0 60 60 0 0
167 Obat Batuk Flu Dewasa Btl 1450 0 1450 1200 250 3000
169 Obat Batuk Dewasa syr Vial 100 0 100 47 53 50
170 Oksitetrasiklin HCL Inj. i.m 50mg10ml Tube 0 0 0 0 0 0
172 Oksitetrasiklin HCL Salep 3%- 5gram Amp 0 0 0 0 0 0
173 Oksitosin Injeksi 10 IU/ml- 1ml Btl 93 0 93 87 6 100
174 OBAT Anti Diare suspensi Tab 0 0 0 0 0 30
175 parasetamol drops 15 ml Btl 83 0 83 10 73 0
176 Parasetamol Syrup 120mg/ 5ml-60ml Tab 845 0 845 504 341 200
178 Parasetamol Tablet 500mg Amp 12150 0 12150 7700 4450 3500
179 Permetin Krim/Skabisid 5 % Btl 0 0 0 0 0 30
PEMBERIAN
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN ASKES PROG BUFFER LAIN-LAIN
STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
180 pirantel syr Tab 23 0 23 0 23 0
185 Piridoksin HCL (Vit. B6) Tablet 10mg Btl 300 0 300 300 0 1000
187 Povidon Iodida 10% 1000ml Tab 0 0 0 0 0 3
189 Primakuin Tablet 15mg Vial 0 0 0 0 0 0
190 Prokain Benzil Penisilin 3 Juta IU Inj. Tab 0 0 0 0 0 0
193 Povidon Iodida 10% 60ml Kap 2 0 2 1 1 0
196 MDT MB/ Kusta Dewasa Kap 0 0 0 0 0 0
197 MDT PB/ Kusta Dewasa Kap 0 0 0 0 0 0
198 Risperidon 2mg Amp 320 0 320 320 0 0
199 Ranitidin Injeksi 25 mg/ 2ml Tab 210 0 210 70 140 0
200 Ranitidin Tablet 150 mg Btl 2150 1000 3150 1350 1800 2000
201 Ringer Laktat Lar. Inf. Steril - 500ml Tab 90 160 250 135 115 80
203 Salbutamol Tablet 4mg Pot 100 0 100 0 100 500
204 Salep 2-4, Kombinasi Ktk 24 0 24 24 0 84
205 Salisil Bedak 2% Vial 35 0 35 10 25 0
207 Stimuno Amp 6 0 6 0 6 0
208 Serum Anti Tetanus Inj. 1500 IU/amp. Vial 3 10 13 3 10 0
209 Sukrafat 500mg Amp 0 0 0 0 0 2000
210 Sianokobalamin (Vit. B12) Inj 500mcg Tab 0 0 0 0 0 100
PEMBERIAN
NO NAMA OBAT SATUAN JUMLAH
AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN ASKES PROG BUFFER LAIN-LAIN
STOK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
212 Simvastatin Tablet 10 mg Vial 870 0 870 0 870 0
213 Sukralfat Syr Btl 0 0 0 0 0 50
215 Sabutamol Nebulizer 0 20 20 20 0 60
216 Spiranolakton tab Btl 0 0 0 0 0 0
217 Salf Kombinasi Set 0 0 0 0 0 0
218 Sinbio Amp 0 0 0 0 0 0
220 Tablet Tambah Darah Komb. Btl 720 13440 14160 13300 860 13440
221 Tetrakain HCL Tetes Mata 0.5%- 5ml Kap 0 0 0 0 0 0
223 Tetrasiklin HCL Kapsul 500 mg Tab 0 0 0 0 0 0
224 Tiamin HCL/(Vit. B1) Tab. 50mg Amp 1400 0 1400 0 1400 0
226 Triheksifenidil Hidroklorida Tab. 2mg Amp 200 500 700 200 500 0
228 Zink Syr Tab 0 0 0 0 0 50
PERBEKALAN KESEHATAN 0 0
9 I.V. Cateter No 26 Set 177 0 177 40 137
PEMBERIAN
SATUAN STOK PENERI- PERSE- PEMA- STOK STOK PERMIN- DAU/ APBD
NO NAMA OBAT JUMLAH
AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN ASKES PROG BUFFER
STOK LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

20 Masker biji 550 400 950 450 500 500
29 Underpad Lembar 115 0 115 115 0 200
30 Urine Bag Biji 76 0 76 0 76 0
III OBAT GIGI 0
PEMBERIAN
OPTIMUM TAAN ASKES PROG BUFFER
STOK LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
UMUM
ASKES JUMLAH
BAYAR
0

NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : Juni 2019 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : juli 2019 PUSKESMAS
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ LAIN- JUMLAH
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 390 0 390 0 390 0


ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN
PROG BUFFER
APBD LAIN-
ASKES STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 Akohol 1 l Tab 3 0 3 1 2 0
53 Cefixim Btl 0 0 0 0 0 0

ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 0

APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Glikazid 80 mg Btl 0 0 0 0 0 0
116 KN-3B Vial 4 0 4 0 4 0
121 Klozapine 25 Mg Tab 848 0 848 548 300 0
PEMBERIAN
ASKES PROG BUFFER
OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Pkt 0 0 0 0 0 0
Komb. Artesunate 50mg+Amodiaquin 200mg
129 Metpormin 500mg Tab 1200 2000 3200 1700 1500 2000
134 kloramfenikol salep kulit tube 15 96 111 39 72 0
139 Metamizol 500mg Tab 1900 0 1900 900 1000 0
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

207 Stimuno Amp 6 0 6 6 0 0
209 Sukrafat 500mg Amp 0 0 0 0 0 2000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
215 Salbutamol Nebulizer amp 0 40 40 20 20 60
218 Sinbio Amp 0 0 0 0 0 0
228 Zink Syr Tab 0 0 0 0 0 50
PERBEKALAN KESEHATAN 0 0 0
9 I.V. Cateter No 26 Set 137 0 137 20 117

MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ ASKES PROG BUFFER LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Kapas Pembalut/Absorben 250 gram Set 0
15 10 0 10 7 3
20 Masker biji 500 500 1000 200 800 500
29 Underpad Lembar 0 0 0 0 0 200
30 Urine Bag Biji 76 40 116 11 105 0
III OBAT GIGI 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
UMUM
ASKES JUMLAH
BAYAR
1395 30 1425

NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : AGUSTUS 2015 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : SEPTEMBER-OKTOBER 15 PUSKESMAS
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ BUFFER LAIN- JUMLAH
ASKES PROG
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 120 0 120 150 -30 0
11 Am oxsillin aserbuk 1gr Inj Amp 6 0 6 20 -14 100

NO NAMA OBAT SATUAN AWAL DAU/ BUFFER LAIN- JUMLAH
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN ASKES PROG
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
15 Antasida DOEN tablet Tab 0 0 0 200 -200 0
17 Anti Bakteri DOEN Salep Kombinasi Tube 0 0 0 0 0 200
23 Acyclopir Krim 5%- 5gr Tube 0 0 0 20 -20 50
25 Acyclopir Tablet 400 mg Tab 0 0 0 200 -200 500
26 Akita Tablet Tab 400 0 400 0 400 2000
30 Asmacare Tablet 2mg Tab 0 0 0 0 0 0
31 Artemeter Injeksi 80 mg/ml Amp 0 0 0 0 0 0
32 Artesunate Injeksi 60 mg/ml Vial 0 0 0 0 0 0
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 Atenolol Tablet 50 mg Tab 6 0 6 0 6 0
44 Benzatin Benzil Penisilin Inj. 2,4 Juta Vial 29 0 29 0 29 30
48 Captopril Tablet 12,5 mg Tab 0 0 0 450 -450 1000
50 Chloramfecort- H Cream - 10gr Tube 0 0 0 0 0 50
53 Cefadroxil syr Btl 0 0 0 0 0 100
56 Dapson Tablet 100 mg (Antilepra) Tab 160 0 160 0 160 0
58 Deksametasone Tablet 0,5 mg Tab 0 0 0 1100 -1100 2000
60 Dekstromethorfan Tablet 15 mg Tab 57 0 57 0 57 100
66 Digoksin Tablet 0,25 mg Tab 0 0 0 300 -300 0
PEMBERIAN
NO NAMA OBAT SATUAN BUFFER LAIN- JUMLAH
AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN APBD ASKES PROG STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
72 Ekstrak Belladona Tablet 10 mg Tab 13 0 13 600 -587 1000
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 0 0 9 -9 10
75 Etambutol HCL Tablet 250 mg Tab 0 0 0 0 0 0
77 Etanol 70%- 1000 ml Btl 29 0 29 0 29 50
83 Fenobarbital Injeksi 50 mg/ml- 2ml Amp 0 0 0 0 0 0
90 Flour Tablet 0,5 mg Tab 100 0 100 0 100 0
94 Glibenklamida Tablet 5 mg Tab 0 0 0 300 -300 0
95 Gliseril Guaiakolat Tablet 100 mg Tab 0 0 0 1000 -1000 1000

MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/ BUFFER LAIN-
APBD ASKES PROG STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Gliserin - 100 ml Btl 0 0 0 0 0 0
102 Gentamisin Injeksi Amp 250 0 250 0 250 0
103 Haloperidol 0,5 mg Tablet Tab 45 0 45 0 45 0
106 Hidrokortison Krim 2,5%-5 gr Tab 0 0 0 21 -21 50
109 Isoniazid Tablet 100 mg Tab 50 0 50 0 50 0
112 Ketokonazol krom Tube 0 0 0 0 0 50
113 Ketokonazol tab 200mg Tab 0 0 0 150 -150 500
116 Ketamin 10 mg/ml Injeksi- 10 ml Vial 0 0 0 0 0 0
117 Klofazimin, mikronize Kapsul 100 mg Kap 950 0 950 0 950 0
118 Kloramfenikol Kapsul 250 mg Kap 0 0 0 0 0 0
119 Kloramfenikol Suspensi 125 mg/60 ml Btl 0 0 0 0 0 50
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 0 0 0 1000 -1000 1000
121 Klorokuin Tablet 150 mg Tab 0 0 0 0 0 0
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp STOK AKHIR 0 #VALUE! 0 #VALUE! 0
PEMBERIAN
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN APBD ASKES PROG
STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
123 Klorpromazin HCL Tablet Salut 25 mg Tab 0 0 0 200 -200 0
125 Kodein HCL Tablet 10 mg Tab 0 0 0 0 0 0
128 Kotrimoksazol Suspensi Kombinasi Btl 30 0 30 85 -55 100
129 Kotrimoksazol Tab. Kombinasi Tab 0 0 0 0 0 500
130 Kuinin (Kina) Tablet 200 mg Tab 0 0 0 0 0 0
131 Kloramfenikol Salep Mata 1%-5gram Tube 18 0 18 40 -22 100
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0 0 0 20 -20 50
134 Levoploxasin 500mh Dus 73 0 73 100 -27 1000
135 Lidokain Komp. Injeksi, Kombinasi Amp 0 0 0 20 -20 50
138 Mebendazol Syrup/5ml - 30ml Btl 0 0 0 0 0 100
139 Mebendazol Tablet 100mg Tab 0 0 0 0 0 600
142 Metoklorpropamid Tablet 10 mg Tab 0 0 0 300 -300 500
143 Mikonazol Krim/ Salep 2%-10gram Tube 0 0 0 9 -9 0
144 Multivitamin Anak Btl 0 0 0 45 -45 100
145 Multivitamin Dewasa Tab 0 0 0 200 -200 500
147 Metronidazol Tablet 500mg Tab 0 0 0 450 -450 1000
148 Magnesium Sulfat Inj. 25 ml Amp 0 0 0 0 0 50
149 Minyak kayu putih Btl 0 0 0 0 0 10
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 5 0 5 13 -8 50
155 Nisagon Cream 5 gram Tube 47 0 47 0 47 50
156 Novadryl Syrup/ Holydril Syrup-60ml Btl 960 0 960 0 960 50
160 OAT Sisipan Dewasa Pkt 0 0 0 0 0 0
161 Omeprazol inj 40mg/10ml Amp 0 0 0 0 0 100
163 Ondansetron Inj 4mg Amp 0 0 0 0 0 100
166 OAT Kategori Anak Pkt 128 0 128 0 128 0
168 Obat Batuk Dewasa Btl 14 0 14 30 -16 100
172 Oksitosin Injeksi 10 IU/ml- 1ml Amp 0 0 0 11 -11 3000
174 Paraformaldehid Tablet 1gram Tab 0 0 0 0 0 0
175 Parasetamol Syrup 120mg/ 5ml-60ml Btl 0 0 0 150 -150 600
177 Parasetamol Tablet 500mg Tab 0 0 0 1500 -1500 500
178 Petidin HCL Injeksi 50mg/ ml-2ml Amp 0 0 0 0 0 0
179 Pilokarpin HCI/Nitrat TM 2%- 5ml Btl STOK AKHIR 0 #VALUE! 0 #VALUE! 0
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
180 Pirantel Tablet 125mg Tab 0 0 0 100 -100 500
181 piroksikam Tablet 10 mg Tab 0 0 0 250 -250 500
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 0 0 1100 -1100 1000
190 propanolol HCL Tablet 10mg Tab 0 0 0 100 -100 500
192 Reserpin Tablet 0,25mg Tab 0 0 0 0 0 300
195 Rifampisin Kapsul 300mg Kap 500 0 500 0 500 0
198 Ranitidin Injeksi 25 mg/ 2ml Amp 0 0 0 20 -20 100
199 Ranitidin Tablet 150 mg Tab 9 0 9 300 -291 1000
202 Salbutamol Tablet 4mg Tab 0 0 0 50 -50 100
203 Salep 2-4, Kombinasi Pot 0 0 0 24 -24 0
206 Serum Anti Rabies Vial 0 0 0 0 0 5
208 Serum Anti Tetanus Inj. 20.000 IU/vial Vial STOK AKHIR 0 #VALUE! 0 #VALUE! 30
209 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 0 0 35 -35 50
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
211 Simvastatin Tablet 10 mg Tab 0 0 0 200 -200 500
212 Streptomisin Sulfat Serbuk Inj.1000mg Vial 0 0 0 0 0 10
214 Sanadril syr Btl 0 0 0 0 0 30
215 Sanbe ters 0 0 0 0 0 0
216 Sanvita B syr Btl 500 0 500 0 500 0
217 Sinbio Set 0 0 0 0 0 100
218 Seftriakson inj. 1g Amp 1000 0 1000 0 1000 0
222 Tetrasiklin HCL Kapsul 500 mg Kap 0 0 0 100 -100 5000
223 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 197 0 197 500 -303 3000
224 Tiopental Natrium Serbuk Inj 1.000mg Amp 0 0 0 0 0 0
225 TiaminTabbblet 50 mg Tab 310 0 310 0 310 0
226 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Amp 200 0 200 0 200 0
228 Vitamin B Komplek Tablet Tab 113 0 113 300 -187 0
229 Zink Tlet 20mg ab Tab 136 0 136 300 -164 500
PERBEKALAN KESEHATAN 100 0 100 0 100
232 Alat Suntik Sekali Pakai 5 ml Set 0 0 0 30 -30 0
233 Catgut/ Benang Bedah No. 2/0 - 3/0 Set 0 0 0 19 -19 30
234 I.V. Catheter No. 20 Set 0 0 0 10 -10 50
236 I.V. Catheter No. 24 Set STOK AKHIR 0 #VALUE! 10 #VALUE! 50
237 Infusion Set Anak Set 0 0 0 30 -30 100
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
238 Infusion Set Dewasa Set 3 0 3 15 -12 100
239 Implant Set 17 0 17 0 17 0
240 Jarum Jahit (Bedah) No. 9 s/d 14 set 950 0 950 0 950 50
241 Jarum Suntik (Neddle) set 12 0 12 0 12 50
243 Kasa Kompres 40/40 Steril biji 0 0 0 0 0 50
244 Kasa Pembalut 2 m x 80 cm biji 10 0 10 20 -10 50
246 Kasa Steril 16/16 biji 0 0 0 30 -30 50
247 Masker biji 180 0 180 50 130 50
248 Plester 5 yard x 2 inch biji 12 0 12 3 9 30
249 Sarung Tangan n0 7 pasang 80 0 80 50 30 100
250 Silk (Benang Bedah Sutera) No. 3/0 Set 105 0 105 0 105 50
UMUM
ASKES JUMLAH
BAYAR
765 1687 10 2462
Mengetahui / Menyetujui : Cikeusik,30 Agustus 2015

Kepala Dinas Kesehatan Kab. Kota Yang Menyerahkan Yang meminta : Yang Meminta :
Pandeglang Kepala UPT Gudang Parmasi Kepala Puskesmas Petugas Puskesmas
Drs.H.DEDEN KUSWAN,MM SYLVYANTI TRI MAHARANI,MPH,Apt Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep
NIP.19570701 198603 1007 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : SEPTEMBER, 2015 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : - PUSKESMAS
PEMBERIAN
PROG BUFFER LAIN-
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab -30 300 270 170 100 0
11 Am oxsillin aserbuk 1gr Inj Amp -14 0 -14 20 -34 0
13 Ampisillin Injeksi 1 gram Vial 0 0 0 60 -60 0


ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
15 Antasida DOEN tablet Tab -200 7000 6800 2000 4800 0
23 Acyclopir Krim 5%- 5gr Tube -20 0 -20 0 -20 0
25 Acyclopir Tablet 400 mg Tab -200 500 300 300 0 0
26 Akita Tablet Tab 400 0 400 0 400 0
41 Atropin Sulfat Tablet 0,5 mg Tab 0 0 0 100 -100 0
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
48 Captopril Tablet 12,5 mg Tab -450 0 -450 0 -450 0
58 Deksametasone Tablet 0,5 mg Tab -1100 2000 900 1900 -1000 0
66 Digoksin Tablet 0,25 mg Tab -300 500 200 200 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
72 Ekstrak Belladona Tablet 10 mg Tab -587 2000 1413 1400 13 0
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl -9 50 41 21 20 0
77 Etanol 70%- 1000 ml Btl 29 0 29 0 29 0
85 Fenobarbital Tablet 30 mg Tab 15 0 15 20 -5 0
94 Glibenklamida Tablet 5 mg Tab -300 1000 700 550 150 0
95 Gliseril Guaiakolat Tablet 100 mg Tab -1000 0 -1000 0 -1000 0

APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Gliserin - 100 ml Btl 0 0 0 0 0 0
106 Hidrokortison Krim 2,5%-5 gr Tab -21 0 -21 0 -21 0
113 Ketokonazol tab 200mg Tab -150 500 350 150 200 0
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab -1000 0 -1000 1000 -2000 0
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp #VALUE! 0 #VALUE! 0 #VALUE! 0
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
123 Klorpromazin HCL Tablet Salut 25 mg Tab -200 1000 800 380 420 0
128 Kotrimoksazol Suspensi Kombinasi Btl -55 300 245 110 135 0
131 Kloramfenikol Salep Mata 1%-5gram Tube -22 144 122 70 52 0
132 Kloramfenikol Tetes Telinga 3%-5ml Btl -20 96 76 40 36 0
134 Levoploxasin 500mh Dus -27 200 173 100 73 0
135 Lidokain Komp. Injeksi, Kombinasi Amp -20 120 100 100 0 0
142 Metoklorpropamid Tablet 10 mg Tab -300 600 300 280 20 0
143 Mikonazol Krim/ Salep 2%-10gram Tube -9 0 -9 0 -9 0
144 Multivitamin Anak Btl -45 96 51 55 -4 0
145 Multivitamin Dewasa Tab -200 500 300 300 0 0
147 Metronidazol Tablet 500mg Tab -450 1000 550 350 200 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl -8 60 52 27 25 0
168 Obat Batuk Dewasa Btl -16 60 44 30 14 0
172 Oksitosin Injeksi 10 IU/ml- 1ml Amp -11 0 -11 0 -11 0
175 Parasetamol Syrup 120mg/ 5ml-60ml Btl -150 0 -150 0 -150 0
177 Parasetamol Tablet 500mg Tab -1500 17500 16000 6000 10000 0
179 Pilokarpin HCI/Nitrat TM 2%- 5ml Btl #VALUE! 0 #VALUE! 0 #VALUE! 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
180 Pirantel Tablet 125mg Tab -100 0 -100 100 -200 0
181 piroksikam Tablet 10 mg Tab -250 1000 750 750 0 0
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab -1100 4000 2900 1900 1000 0
190 propanolol HCL Tablet 10mg Tab -100 600 500 310 190 0
198 Ranitidin Injeksi 25 mg/ 2ml Amp -20 0 -20 0 -20 0
199 Ranitidin Tablet 150 mg Tab -291 0 -291 0 -291 0
202 Salbutamol Tablet 4mg Tab -50 500 450 200 250 0
203 Salep 2-4, Kombinasi Pot -24 0 -24 0 -24 0
208 Serum Anti Tetanus Inj. 20.000 IU/vial Vial #VALUE! 0 #VALUE! 0 #VALUE! 0
209 Sianokobalamin (Vit. B12) Inj 500mcg Amp -35 100 65 65 0 0
PEMBERIAN
ASKES PROG BUFFER
OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
211 Simvastatin Tablet 10 mg Tab -200 500 300 100 200 0
215 Sanbe ters 0 0 0 0 0 0
216 Sanvita B syr Btl 500 0 500 0 500 0
217 Sinbio Set 0 0 0 0 0 0
222 Tetrasiklin HCL Kapsul 500 mg Kap -100 0 -100 0 -100 0
223 Tiamin HCL/(Vit. B1) Tab. 50mg Tab -303 4000 3697 1400 2297 0
228 Vitamin B Komplek Tablet Tab -187 5000 4813 3700 1113 0
229 Zink Tlet 20mg ab Tab -164 0 -164 0 -164 0
232 Alat Suntik Sekali Pakai 5 ml Set -30 500 470 200 270 0
233 Catgut/ Benang Bedah No. 2/0 - 3/0 Set -19 48 29 0 29 0
234 I.V. Catheter No. 20 Set -10 50 40 15 25 0
236 I.V. Catheter No. 24 Set #VALUE! 50 #VALUE! 15 #VALUE! 0
237 Infusion Set Anak Set -30 0 -30 0 -30 0
PEMBERIAN
ASKES PROG BUFFER
OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
238 Infusion Set Dewasa Set -12 0 -12 0 -12 0
239 Implant Set 17 0 17 0 17 0
244 Kasa Pembalut 2 m x 80 cm biji -10 0 -10 0 -10 0
246 Kasa Steril 16/16 biji -30 0 -30 100 248 0
247 Masker biji 130 200 330 100 230 0
UMUM
ASKES JUMLAH
BAYAR
755 1714 8 2477
Mengetahui / Menyetujui : Cikeusik, 30 September 2015

Pandeglang Kepala UPT Gudang Farmasi, Kepala Puskesmas, Petugas Puskesmas
NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : OKTOBER, 2015 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : NOVEMBER & DESEMBER PUSKESMAS
2015
PEMBERIAN
PROG BUFFER LAIN-
ASKES
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 130 0 130 130 0 0
11 Am oxsillin aserbuk 1gr Inj Amp 57 0 57 0 57 100

PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
25 Acyclopir Tablet 400 mg Tab 0 0 0 200 -200 500
26 Akita Tablet Tab 400 0 400 0 400 5000
41 Atropin Sulfat Tablet 0,5 mg Tab -100 0 -100 0 -100 100
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
58 Deksametasone Tablet 0,5 mg Tab -1000 0 -1000 100 -1100 2000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
72 Ekstrak Belladona Tablet 10 mg Tab 13 0 13 600 -587 2000
77 Etanol 70%- 1000 ml Btl 29 0 29 0 29 0
85 Fenobarbital Tablet 30 mg Tab -5 0 -5 0 -5 5000
94 Glibenklamida Tablet 5 mg Tab 150 0 150 300 -150 0

APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Gliserin - 100 ml Btl 0 0 0 0 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
131 Kloramfenikol Salep Mata 1%-5gram Tube 52 0 52 55 -3 100
144 Multivitamin Anak Btl -4 0 -4 41 -45 100
145 Multivitamin Dewasa Tab 0 0 0 200 -200 5000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
160 OAT Sisipan Dewasa Pkt 0 0 0 0 0
168 Obat Batuk Dewasa Btl 14 0 14 30 -16 0
PEMBERIAN
NO NAMA OBAT JUMLAH
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
181 piroksikam Tablet 10 mg Tab 0 0 0 250 -250 500
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 1000 0 1000 1100 -100 100
194 Retinol (Vitamin A) Kapsul 200.000 IU Kap 60 0 60 0 60
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
211 Simvastatin Tablet 10 mg Tab 200 0 200 250 -50 500
215 Sanbe ters 0 0 0 0 0 30
216 Sanvita B syr Btl 500 0 500 0 500 0
217 Sinbio Set 0 0 0 0 0 100
233 Catgut/ Benang Bedah No. 2/0 - 3/0 Set 29 0 29 19 10 10
PEMBERIAN
SATUAN STOK PENERI- PERSE- PEMA- STOK STOK PERMIN-
NO NAMA OBAT JUMLAH
AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN
PROG BUFFER
APBD ASKES
STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
239 Implant Set 17 0 17 0 17 100
246 Kasa Steril 16/16 biji 248 0 248 100 148 50
247 Masker biji 230 0 230 100 130 100
UMUM
ASKES JUMLAH
BAYAR
864 1766 7 2637
Mengetahui / Menyetujui : Cikeusik, 30 Oktober 2015

NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : NOVEMBER, 2015 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : PUSKESMAS
PEMBERIAN
ASKES PROG
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 0 300 300 200 100 0

PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
22 Aqua roinjek Steril Botol 2 0 2 5 -3 0
25 Acyclopir Tablet 400 mg Tab -200 0 -200 0 -200 0
26 Akita Tablet Tab 400 0 400 0 400 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
66 Digoksin Tablet 0,25 mg Tab -300 500 200 200 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
72 Ekstrak Belladona Tablet 10 mg Tab -587 4000 3413 400 3013 0
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 3 0 3 7 -4 0
77 Etanol 70%- 1000 ml Btl 29 0 29 0 29 0
92 Garam Oralit 200 ml air Ktg 0 0 0 50 -50 0
94 Glibenklamida Tablet 5 mg Tab -150 0 -150 0 -150 0

AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN DAU/
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Gliserin - 100 ml Btl 0 0 0 0 0 0
113 Ketokonazol tab 200mg Tab -150 600 450 150 300 0
PEMBERIAN
ASKES PROG BUFFER
OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
131 Kloramfenikol Salep Mata 1%-5gram Tube -3 144 141 40 101 0
134 Levoploxasin 500mh Dus -27 200 173 100 73 0
135 Lidokain Komp. Injeksi, Kombinasi Amp -20 120 100 100 0 0
142 Metoklorpropamid Tablet 10 mg Tab -300 600 300 280 20 0
144 Multivitamin Anak Btl -45 144 99 55 44 0
145 Multivitamin Dewasa Tab -200 150 -50 150 -200 0
147 Metronidazol Tablet 500mg Tab -250 1000 750 350 400 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
168 Obat Batuk Dewasa Btl -16 0 -16 0 -16 0
179 Pilokarpin HCI/Nitrat TM 2%- 5ml Btl #VALUE! #VALUE! 0 #VALUE! 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
181 piroksikam Tablet 10 mg Tab -250 0 -250 0 -250 0
183 Propiltiourasil Tablet 100mg Tab 0 0 0 0 0
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab -100 4000 3900 1900 2000 0
209 Sianokobalamin (Vit. B12) Inj 500mcg Amp -35 100 65 65 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
211 Simvastatin Tablet 10 mg Tab -50 500 450 100 350 5
215 Sanbe ters 0 0 0 0 0 0
216 Sanvita B syr Btl 500 0 500 0 500 0
217 Sinbio Set 0 0 0 0 0 0
233 Catgut/ Benang Bedah No. 2/0 - 3/0 Set 10 0 10 0 10 0
PEMBERIAN
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN
MAAN DIAAN KAIAN AKHIR OPTIMUM TAAN APBD ASKES PROG
STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
239 Implant Set 17 0 17 0 17 0
243 Kasa Kompres 40/40 Steril biji 0 0 0 20 -20 0
246 Kasa Steril 16/16 biji 148 0 148 50 98 0
247 Masker biji 130 200 330 50 280 0
UMUM
ASKES JUMLAH
BAYAR
864 1693 9 2566
Mengetahui / Menyetujui : Cikeusik, 30 November 2015

Dra,HJ.INDAH DINARSIANI,M.Pd SYLVYANTI TRI MAHARANI,MPH,Apt Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep
NIP.19610123 198612 2 001 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : DESEMBER 2015 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : JANUARI-FEBRUARI 2016 PUSKESMAS
PEMBERIAN
ASKES PROG
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 100 0 100 0 100 0

PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
22 Aqua roinjek Steril Botol -3 0 -3 5 -8 0
25 Acyclopir Tablet 400 mg Tab -200 0 -200 0 -200 1000
26 Akita Tablet Tab 400 0 400 0 400 3000
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 0 0 300 -300 1000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
48 Captopril Tablet 12,5 mg Tab -450 700 250 700 -450 2000
67 Domperidon 10 mgtablet Tab 300 300 0 300 10000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl -4 0 -4 7 -11 0
77 Etanol 70%- 1000 ml Btl 29 0 29 0 29 0
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 0 0 10 -10 100
92 Garam Oralit 200 ml air Ktg -50 0 -50 50 -100 300
94 Glibenklamida Tablet 5 mg Tab -150 0 -150 0 -150 1000

APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Gliserin - 100 ml Btl 0 0 0 0 0 100
103 Haloperidol 0,5 mg Tablet Tab 45 0 45 200 -155 1000
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab -2000 19000 17000 2000 15000 0
PEMBERIAN
ASKES PROG BUFFER
OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 4 0 4 20 -16 20
145 Multivitamin Dewasa Tab -200 0 -200 0 -200 500
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
168 Obat Batuk Dewasa Btl -16 0 -16 0 -16 0
174 Paraformaldehid Tablet 1gram Btl 0 0 0 0 0 50
176 ParasetamolDrof 100mg Btl 0 224 224 30 194 1000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
181 piroksikam Tablet 10 mg Tab -250 0 -250 0 -250 500
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
215 Sanbe ters 0 0 0 0 0 0
216 Sanvita B syr Btl 500 0 500 0 500 0
217 Sinbio Set 0 0 0 0 0 100
PERBEKALAN KESEHATAN 100 0 100 0 100 0
233 Catgut/ Benang Bedah No. 2/0 - 3/0 Set 10 0 10 19 -9 100
237 Infusion Set Anak Set -30 100 70 30 40 50
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
238 Infusion Set Dewasa Set -12 150 138 30 108 100
239 Implant Set 17 0 17 0 17 0
243 Kasa Kompres 40/40 Steril biji -20 0 -20 20 -40 50
246 Kasa Steril 16/16 biji 98 0 98 50 48 100
247 Masker biji 280 0 280 100 180 0
UMUM
ASKES JUMLAH
BAYAR
706 1636 5 2347
Mengetahui / Menyetujui : Cikeusik, 31 Desember 2015

Dra,Hj INDAH DINARSIANI,M.Pd SYLVYANTI TRI MAHARANI,MPH,Apt Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep
NIP.19610123 198612 2 001 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
FORM : LPLPO
MENU
PUSKESMAS

KAB / KOTA : PANDEGLANG PELAPORAN BULAN/PERIODE : juli 2019 GFK KAB/KOTA
PROPINSI : BANTEN PERMINTAAN BULAN/PERIODE : agustus 2019 PUSKESMAS
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR OPTIMUM DAU/ BUFFER LAIN- JUMLAH
TAAN ASKES PROG
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Albendazol Tab 390 0 390 270 120 0

ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 Akohol 1 l Tab 2 0 2 2 0 5
53 Cefixim Btl 0 0 0 0 0 0
PEMBERIAN
NO NAMA OBAT SATUAN AWAL MAAN DIAAN KAIAN AKHIR BUFFER LAIN- JUMLAH
OPTIMUM TAAN APBD ASKES PROG STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 20

APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
96 Glikazid 80 mg Btl 0 0 0 0 0 0
116 KN-3B Vial 4 0 4 4 0 0
121 Klozapine 25 Mg Tab 300 0 300 300 0 0
PEMBERIAN
ASKES PROG BUFFER
OPTIMUM TAAN LAIN-
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Pkt 0 0 0 0 0 0
Komb. Artesunate 50mg+Amodiaquin 200mg
129 Metpormin 500mg Tab 1500 2000 3500 900 2600 2000
134 kloramfenikol salep kulit tube 72 96 168 75 93 96
139 Metamizol 500mg Tab 1000 0 1000 1000 0 2000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

207 Stimuno Amp 0 0 0 0 0 0
209 Sukrafat 500mg TAB 0 0 0 0 0 1000
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
215 Salbutamol Nebulizer amp 20 60 80 0 80 0
218 Sinbio Amp 0 0 0 0 0 0
228 Zink Syr Tab 0 0 0 0 0 100
PERBEKALAN KESEHATAN 0 0 0 0
9 I.V. Cateter No 26 Set 117 0 117 49 68 0

ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Botol 20
14 Policlean Handrub 9 5 14 7 7
20 Masker biji 800 500 1300 350 950 0
29 Underpad Lembar 0 100 100 20 80 100
30 Urine Bag Biji 105 0 105 0 105 0
III OBAT GIGI 0 0 0 0
PEMBERIAN
ASKES PROG BUFFER
APBD STOK LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
UMUM
ASKES JUMLAH
BAYAR
Mengetahui / Menyetujui : Cikeusik, 31 Juli 2019

NIP. 19680917 199103 1 004 NIP.19860706 201001 2 010 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
KETERANGAN :
LAPORAN TRIWULAN PENERIMAAN DAN PEMAKAIAN OBAT LAPORAN BULANAN PENERIMAAN OB
PUSKESMAS CIKEUSIK PUSKESMAS CIKEUSIK
MENU TAHUN 2019 TAHUN 2019
TRIWULAN I TRIWULAN II TRIWULAN III TRIWULAN IV BUL
Penerimaan
Penerimaan
Penerimaan
Penerimaan
SATUAN
Pemakaian
Pemakaian
Pemakaian
Pemakaian
Stok Akhir
Stok akhir
Stok akhir
Stok akhir
Stok awal
Stok awal
Stok awal
Stok awal
Pebruari
Januari
NO NAMA OBAT N0 NAMA OBAT
Maret
April
Mei
1 Alopurinol tablet 100 mg Tab 1500 0 1500 0 0 0 1000 -1000 -1000 0 0 -1000 -1000 0 0 0 1 Alopurinol tablet 100 mg 0 1000 0 0 0
2 Aminofilin tablet 200 mg Tab 900 0 100 800 800 0 0 800 800 0 100 700 700 0 200 500 2 Aminofilin tablet 200 mg 0 0 0 0 0
3 Albendazol Tab 90 300 0 390 390 10350 10350 390 390 0 590 -200 -200 0 330 -530 3 Albendazol 300 0 0 10350 0
4 Aminofilin injeksi 24mg/ Amp 0 0 0 0 0 0 0 0 0 0 60 -60 -60 0 60 -120 4 Aminofilin injeksi 24mg/ml-10ml 0 0 0 0 0
5 Amitriptilin HCL Tab. Sal Tab 500 0 0 500 500 0 200 300 300 0 0 300 300 0 100 200 5 Amitriptilin HCL Tab. Salut 25 mg 0 0 0 0 0
6 Amlodipine 10 mg Tablet Tab 1720 1500 2060 1160 1160 1200 1750 610 610 1200 640 1170 1170 0 730 440 6 Amlodipine 10 mg Tablet 0 600 900 0 1200
7 Amlodipine Besilate 5mg Tab 1200 600 300 1500 1500 1200 2700 0 0 1200 600 600 600 0 920 -320 7 Amlodipine Besilate 5mg tablet 0 600 0 0 1200
8 Alkacide 1 L High Level Btl 2 1 0 3 3 0 1 2 2 2 0 4 4 0 0 4 8 Alkacide 1 L High Level Desinfectant(Alkapham Fer 0 0 1 0 0
9 Amoksisillin Kapsul 500 Tab 7200 16000 17700 5500 5500 10000 5100 10400 10400 6500 8700 8200 8200 0 14500 -6300 9 Amoksisillin Kapsul 500 mg 5000 5000 6000 10000 0
10 Amoksisillin SK 125 mg/5 Btl 0 0 0 0 0 0 90 -90 -90 0 240 -330 -330 0 560 -890 10 Amoksisillin SK 125 mg/5 ml-60 ml 0 0 0 0 0
11 Alkazyme Sachet 25mg(A Pack 2 1 0 3 3 0 1 2 2 4 60 -54 -54 0 40 -94 11 Alkazyme Sachet 25mg(Alkapham France) 0 0 1 0 0
12 Amoksilin sk Forte Tab 154 780 890 44 44 900 410 534 534 360 100 794 794 0 0 794 12 Amoksilin sk Forte 180 300 300 600 0
13 Ampisillin Injeksi 1 gram Vial 0 40 0 40 40 0 30 10 10 0 90 -80 -80 0 60 -140 13 Ampisillin Injeksi 1 gram 0 0 0 0 0
14 Antalgin (Metampiron) T Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 500 -500 14 Antalgin (Metampiron) Tab. 500 mg 0 0 0 0 0
Antasida DOEN tablet Tab 2500 14500 16600 400 400 13000 6100 7300 7300 0 3000 4300 4300 0 8500 -4200 Antasida DOEN tablet 3500 6000 5000 6000 5000
15 15
Antasida DOEN suspensi Btl 50 600 650 0 0 800 360 440 440 500 300 640 640 0 240 400 Antasida DOEN suspensi 200 200 200 500 100
16 16
Anti Bakteri DOEN Salep Tube 115 0 25 90 90 0 90 0 0 0 0 0 0 0 60 -60 Anti Bakteri DOEN Salep Kombinasi (basitrasin) 0 0 0 0 0
Kombinasi (basitrasin)
17 17
18 Anti Hemoroid DOEN KomSupp 30 0 0 30 30 0 10 20 20 0 0 20 20 0 0 20 18 Anti Hemoroid DOEN Kombinasi 0 0 0 0 0
Antifungi DOEN Pot 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Antifungi DOEN Kombinasi 0 0 0 0 0
19 Kombinasi 19
Antimigren DOEN
Tab 0 300 0 300 300 0 100 200 200 0 0 200 200 0 0 200 Antimigren DOEN Kombinasi 0 0 300 0 0
20 Kombinasi 20
Antiparkinson DOEN Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 tab. Kombinasi 21 Antiparkinson DOEN tab. Kombinasi
22 Aqua roinjek Steril Btl 6 30 10 26 26 0 12 14 14 0 12 2 2 0 10 -8 22 Aqua roinjek Steril 20 10 0 0 0
23 Acyclopir Krim 5%- 5gr Tube 108 50 111 47 47 0 47 0 0 0 20 -20 -20 0 0 -20 23 Acyclopir Krim 5%- 5gr 0 0 50 0 0
24 Acyclopir Tablet 200mg Tab 1600 0 900 700 700 0 200 500 500 0 500 0 0 0 300 -300 24 Acyclopir Tablet 200mg 0 0 0 0 0
25 Acyclopir Tablet 400 mg Tab 700 0 200 500 500 0 500 0 0 200 700 -500 -500 0 200 -700 25 Acyclopir Tablet 400 mg 0 0 0 0 0
26 Akita/Molagit Tablet Tab 600 0 0 600 600 1000 100 1500 1500 0 1100 400 400 0 0 400 26 Akita/Molagit Tablet 0 0 0 1000 0
27 Antalgin (Metampiron) I Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 27 Antalgin (Metampiron) Inj. 250mg/2ml 0 0 0 0 0
28 Asam asetilsalisilat 100m Tab 400 0 0 400 400 0 400 0 0 0 0 0 0 0 0 0 28 Asam asetilsalisilat 100mg tablet 0 0 0 0 0
29 Asam Mefenamat 500mg Tab 900 8000 8300 600 600 6000 4500 2100 2100 2000 2700 1400 1400 0 200 1200 29 Asam Mefenamat 500mg 2000 3000 3000 2000 2000
30 Alprazolam 1mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 Alprazolam 1mg 0 0 0 0 0
31 Ambroksol tab tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 Ambroksol tab 0 0 0 0 0
32 Ambroksol syr Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32 Ambroksol syr 0 0 0 0 0
33 Asam Askorbat (Vit. C) T Tab 1000 2000 2400 600 600 0 400 200 200 400 600 0 0 0 300 -300 33 Asam Askorbat (Vit. C) Tablet 50 mg 0 1000 1000 0 0
34 Asering Infus Tab 48 40 20 68 68 0 10 58 58 0 31 27 27 0 0 27 34 Asering Infus 0 0 40 0 0
35 Asam Folat tablet 01mg Tab 0 0 0 0 0 0 0 0 0 1000 850 150 150 0 700 -550 35 Asam Folat tablet 01mg 0 0 0 0 0
36 Asam Folat tablet 5 mg Tab 800 0 0 800 800 0 800 0 0 0 0 0 0 0 0 0 36 Asam Folat tablet 5 mg 0 0 0 0 0
37 Artesunat Inj Vial 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 37 Artesunat Inj 0 0 0 0 0
38 Asam traneksamat Inj 5 Amp 10 40 29 21 21 0 21 0 0 10 0 10 10 0 0 10 38 Asam traneksamat Inj 5 % 20 20 0 0 0
39 Asetosal Tablet 500 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 39 Asetosal Tablet 500 mg 0 0 0 0 0
40 Atropin Sulfat Inj. 0,25 Amp 100 0 0 100 100 100 0 200 200 100 0 300 300 0 0 300 40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml 0 0 0 0 0
41 Atropin Sulfat Tablet 0,5 Tab 0 0 0 0 0 0 0 0 0 0 100 -100 -100 0 0 -100 41 Atropin Sulfat Tablet 0,5 mg 0 0 0 0 0
42 Atropin Sulfat Tetes Mata Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 42 Atropin Sulfat Tetes Mata 1% - 5 ml 0 0 0 0 0
43 Alkohol 70% 1 Liter Btl 1 0 1 0 0 3 1 2 2 0 2 0 0 0 0 0 43 Alkohol 70% 1 Liter 0 0 0 3 0
44 Betadin Salf Antiseptik Tube 24 0 0 24 24 0 0 24 24 0 18 6 6 0 0 6 44 Betadin Salf Antiseptik 0 0 0 0 0
45 Betametason Krim 0,1% - Tube 100 150 206 44 44 100 205 -61 -61 100 71 -32 -32 0 40 -72 45 Betametason Krim 0,1% - 5 gr 0 50 100 100 0
46 Bisacodril sup Supp 48 0 2 46 46 0 37 9 9 0 47 -38 -38 0 34 -72 46 Bisacodril sup 0 0 0 0 0
47 Bisoprolol 2,5mg tab Tab 570 0 0 570 570 0 0 570 570 0 360 210 210 0 0 210 47 Bisoprolol 2,5mg tab 0 0 0 0 0
48 Captopril Tablet 12,5 mg Tab 850 2500 2200 1150 1150 1800 2550 400 400 1000 1300 0 0 700 700 0 48 Captopril Tablet 12,5 mg 0 1000 1500 1000 500
49 Captopril Tablet 25 mg Tab 1650 0 1650 0 0 0 0 0 0 0 250 0 0 0 0 0 49 Captopril Tablet 25 mg 0 0 0 0 0
50 Carbamazefine Tab 0 400 400 0 0 600 0 600 600 0 ### Err:509 Err:509 0 0 Err:509 50 Carbamazefine 400 0 0 0 100
51 Cefadroxil 500mg Tab 0 0 0 0 0 0 ### #VALUE! #VALUE! 0 ### #VALUE! #VALUE! 0 0 #VALUE! 51 Cefadroxil 500mg 0 0 0 0 0
52 Cetrizin syr Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 52 Cetrizin syr 0 0 0 0 0
53 Cefixim Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 53 Cefixim 0 0 0 0 0
54 Ciprofloxacin Infus Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 54 Ciprofloxacin Infus 0 0 0 0 0
55 Ciprofloxacin Tablet 500 Tab 2100 5000 5350 1750 1750 4000 3700 2050 2050 1000 0 3050 3050 0 0 3050 55 Ciprofloxacin Tablet 500mg 1000 2000 2000 1000 3000
56 D-Artepp Tab Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 D-Artepp Tab 0 0 0 0 0
57 Deksametasone Injeksi 5 Amp 100 100 20 180 180 0 635 -455 -455 0 1050 -1505 -1505 0 0 -1505 57 Deksametasone Injeksi 5 mg/ml - 1ml 0 100 0 0 0
58 Deksametasone Tablet 0, Tab 1200 10000 11000 200 200 7000 4800 2400 2400 3000 3000 2400 2400 0 100 2300 58 Deksametasone Tablet 0,5 mg 4000 2000 4000 3000 2000
59 Dekstromethorfan Sirup Btl 0 0 0 0 0 0 20 -20 -20 0 0 -20 -20 0 0 -20 59 Dekstromethorfan Sirup 10 mg/ 60 ml 0 0 0 0 0
60 Diazetpam Rectal 2mg Tube 0 0 0 0 0 0 2800 -2800 -2800 0 3000 -5800 -5800 0 0 -5800 60 Diazetpam Rectal 2mg 0 0 0 0 0
61 Diazepam Injeksi 5 mg/ml Amp 57 0 0 57 57 0 0 57 57 0 0 57 57 0 10 47 61 Diazepam Injeksi 5 mg/ml - 2ml 0 0 0 0 0

62 Diazepam Tablet 2 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 -100 62 Diazepam Tablet 2 mg 0 0 0 0 0
Tab 0 100 0 100 100 0 0 100 100 0 0 100 100 0 20 80 100 0 0 0 0

63 Diazepam Tablet 5 mg 63 Diazepam Tablet 5 mg
64 Dietilkarbamazin Sitrat T Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 64 Dietilkarbamazin Sitrat Tablet 100 mg 0 0 0 0 0
65 Difenhidramin HCL Inj. 1 Amp 43 0 0 43 43 0 0 43 43 0 60 -17 -17 0 40 -57 65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml 0 0 0 0 0
66 Digoksin Tablet 0,25 mg Tab 300 200 0 500 500 0 0 500 500 0 500 0 0 0 800 -800 66 Digoksin Tablet 0,25 mg 0 0 200 0 0
67 Domperidon 10 mgtablet Tab 700 0 700 0 0 0 0 0 0 0 43 -43 -43 0 200 -243 67 Domperidon 10 mgtablet 0 0 0 0 0
68 Dimenhidrinat Tablet 50 Tab 0 0 0 0 0 0 0 0 0 0 270 -270 -270 0 0 -270 68 Dimenhidrinat Tablet 50 mg 0 0 0 0 0
69 Dasabion Tablet Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 69 Dasabion Tablet 0 0 0 0 0
70 Domperidon Suspensi 5m Btl 0 0 6 -6 -6 0 0 -6 -6 0 0 -6 -6 0 0 -6 70 Domperidon Suspensi 5mg/ 5ml- 60ml 0 0 0 0 0
71 Efedrin HCL Tablet 25 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 71 Efedrin HCL Tablet 25 mg 0 0 0 0 0
72 Ekstrak Belladona Tablet Tab 0 0 0 0 0 0 900 -900 -900 0 2000 -2900 -2900 0 1000 -3900 72 Ekstrak Belladona Tablet 10 mg 0 0 0 0 0
73 Epinefrina HCL/Bitartrat Amp 105 0 0 105 105 0 0 105 105 100 0 205 205 0 0 205 73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml 0 0 0 0 0
74 Etakridin (Rivanol) Lar. Btl 7 24 0 31 31 0 0 31 31 0 30 1 1 0 31 -30 74 Etakridin (Rivanol) Lar. 0,1%-300 ml 0 0 24 0 0
75 Lisinofril 10 mg Tab 0 0 0 0 0 0 0 0 0 0 5 -5 -5 0 0 -5 75 Lisinofril 10 mg 0 0 0 0 0
76 Lisinofril 5mg Tab 0 0 0 0 0 0 0 0 0 0 18 -18 -18 0 0 -18 76 Lisinofril 5mg 0 0 0 0 0
77 Etanol 70%- 100 ml Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 77 Etanol 70%- 100 ml 0 0 0 0 0
78 Eritromisin Kapsul 500 m Kap 600 0 0 600 600 0 0 600 600 0 0 600 600 0 0 600 78 Eritromisin Kapsul 500 mg 0 0 0 0 0
79 Eritromisin Syrup 200 mg Btl 80 0 0 80 80 0 0 80 80 0 0 80 80 0 0 80 79 Eritromisin Syrup 200 mg/5 ml-60 ml 0 0 0 0 0
80 Fenitoin Natrium Injeksi Amp 0 0 0 0 0 0 0 0 0 0 270 -270 -270 0 0 -270 80 Fenitoin Natrium Injeksi 50 mg/ 1 ml 0 0 0 0 0
81 Fenitoin Natrium Kapsul Kap 0 0 0 0 0 0 6 -6 -6 0 45 -51 -51 0 0 -51 81 Fenitoin Natrium Kapsul 100 mg 0 0 0 0 0
82 Fenitoin Natrium Kapsul Kap 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82 Fenitoin Natrium Kapsul 30 mg 0 0 0 0 0
83 Fenobarbital Injeksi- 2ml Amp 52 0 0 52 52 0 0 52 52 0 0 52 52 0 0 52 83 Fenobarbital Injeksi- 2ml 0 0 0 0 0
84 Fenobarbital Tablet 30 m Tab 100 0 0 100 100 0 0 100 100 0 0 100 100 0 0 100 84 Fenobarbital Tablet 30 mg 0 0 0 0 0
85 Fenobarbital Tablet 30 m Tab 0 0 0 0 0 0 20 -20 -20 0 40 -60 -60 0 10 -70 85 Fenobarbital Tablet 30 mg 0 0 0 0 0
LAPORAN PENERIMAAN DAN PEMAKAIAN OBAT LAPORAN PENERIMAAN OBAT PUSKESM


Penerimaan
Penerimaan
Penerimaan
Penerimaan
SATUAN
Pemakaian
Pemakaian
Pemakaian
Pemakaian
Stok akhir
Stok akhir
Stok akhir
Stok akhir
Stok awal
Stok awal
Stok awal
Stok awal
Pebruari
Januari
Maret
April
Mei
86 Fenoksimetil Penisilina T Tab 0 0 0 0 0 0 0 0 0 0 100 -100 -100 0 0 -100 86 Fenoksimetil Penisilina Tablet 250 mg 0 0 0 0 0
87 Fluflenazine decanoat in Amp 20 0 0 20 20 0 0 20 20 0 0 20 20 0 0 20 87 Fluflenazine decanoat inj 25mg/ml 0 0 0 0 0
88 Fitomenadion (Vit. K1) In Amp 30 0 0 30 30 0 30 0 0 0 0 0 0 0 40 -40 88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml 0 0 0 0 0
89 Fitomenadion (Vit. K1) T Tab 400 0 300 100 100 500 5 595 595 1000 0 1595 1595 0 550 1045 89 Fitomenadion (Vit. K1) Tab. 10 mg 0 0 0 0 0
90 Gentamisin SM Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 Gentamisin SM 0 0 0 0 0
91 Furosemida Tablet 40 mg Tab 0 0 0 0 0 0 0 0 0 400 750 -350 -350 0 0 -350 91 Furosemida Tablet 40 mg 0 0 0 0 0
92 Garam Oralit 200 ml air Ktg 150 200 100 250 250 0 0 250 250 0 0 250 250 0 100 150 92 Garam Oralit 200 ml air 0 0 200 0 0
93 Glimepirid 2mg Tablet Tab 0 0 0 0 0 1000 0 1000 1000 2000 200 2800 2800 0 450 2350 93 Glimepirid 2mg Tablet 0 0 0 0 0
Glibenklamida Tablet 5 Tab 1300 500 1300 500 500 0 500 0 0 0 994 -994 -994 0 300 -1294 0 500 0 0 0
94 mg 94 Glibenklamida Tablet 5 mg
95 Asetil Sistein 200mg Tab 1600 13200 14660 140 140 13200 9000 4340 4340 0 1000 3340 3340 0 0 3340 95 Asetil Sistein 200mg 5280 2640 5280 5280 5280
96 Glikazid 80 mg Btl 550 0 0 550 550 0 550 0 0 0 0 0 0 0 0 0 96 Glikazid 80 mg 0 0 0 0 0
97 Glukosa Lar. Infus 5% Ster Btl 44 20 20 44 44 20 3000 -2936 -2936 0 902 -3838 -3838 0 87 -3925 97 Glukosa Lar. Infus 5% Steril - 500 ml 0 0 20 0 20
98 Glukosa Lar. Infus 10% Ste Btl 0 0 0 0 0 0 0 0 0 0 55 -55 -55 0 120 -175 98 Glukosa Lar. Infus 10% Steril - 500 ml 0 0 0 0 0
99 Griseofulvin Tablet 500 m Tab 0 0 0 0 0 0 0 0 0 0 45 -45 -45 0 0 -45 99 Griseofulvin Tablet 500 mg, 0 0 0 0 0
100 Griseofulvin Tablet 125 Tab 490 0 0 490 490 0 0 490 490 0 0 490 490 0 0 490 100 Griseofulvin Tablet 125 mg, Micron 0 0 0 0 0
101 Gentamisin S.K 0.1%-5 gr Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 101 Gentamisin S.K 0.1%-5 gr 0 0 0 0 0
102 Gentamisin tetes Mata btlo 0 72 58 14 14 24 120 -82 -82 0 270 -352 -352 0 0 -352 102 Gentamisin tetes Mata 72 0 0 24 0
103 Haloperidol 2 mg Tablet Tab 1000 500 1300 200 200 500 400 300 300 0 0 300 300 0 400 -100 103 Haloperidol 2 mg Tablet 0 0 500 0 500
104 Haloperidol 5 mg Tablet Tab 0 0 0 0 0 500 0 500 500 0 0 500 500 0 0 500 104 Haloperidol 5 mg Tablet 0 0 0 0 0
105 Hidroklortiazid (HCT) Tab Tab 200 500 0 700 700 0 300 400 400 0 0 400 400 0 0 400 105 Hidroklortiazid (HCT) Tablet 25 mg 500 0 0 0 0
106 Hidrokortison Krim 2,5%- Tab 38 96 134 0 0 0 0 0 0 96 21 75 75 0 0 75 106 Hidrokortison Krim 2,5%-5 gr 96 0 0 0 0
107 Ibuprofen Tablet 200 mg Tab 500 0 500 0 0 0 0 0 0 0 ### Err:509 Err:509 0 0 Err:509 107 Ibuprofen Tablet 200 mg 0 0 0 0 0
108 Ibuprofen Tablet 400 mg Tab 0 0 0 0 0 0 0 0 0 0 ### Err:509 Err:509 0 0 Err:509 108 Ibuprofen Tablet 400 mg 0 0 0 0 0
109 Ibufropen syr Btl 0 0 0 0 0 0 ### #VALUE! #VALUE! 0 ### #VALUE! #VALUE! 0 0 #VALUE! 109 Ibufropen syr 0 0 0 0 0
110 Haloporidol Decanoate I Amp 25 0 0 25 25 0 0 25 25 0 51 -26 -26 0 0 -26 110 Haloporidol Decanoate Inj 50mg 0 0 0 0 0
111 Isosorbid Dinitrat Tab. S Tab 1600 500 0 2100 2100 0 1800 300 300 0 0 300 300 0 0 300 111 Isosorbid Dinitrat Tab. Sub. 5 mg 0 0 500 0 0
112 Ketokonazol krem Tube 50 0 40 10 10 0 0 10 10 100 85 25 25 0 120 -95 112 Ketokonazol krem 0 0 0 0 0
113 Ketokonazol tab 200mg Tab 950 1500 1850 600 600 1000 900 700 700 1000 300 1400 1400 0 850 550 113 Ketokonazol tab 200mg 0 500 1000 0 500
114 Ketorolac Inj 30mg Vial 100 0 20 80 80 0 35 45 45 0 47 -2 -2 0 46 -48 114 Ketorolac Inj 30mg 0 0 0 0 0
115 Kalsium Laktat (Kalk) Tab Tab 1400 0 1300 100 100 3000 2900 200 200 0 0 200 200 0 0 200 115 Kalsium Laktat (Kalk) Tablet 500 mg 0 0 0 3000 0
116 KN-3B Labu 42 0 36 6 6 0 12 -6 -6 0 50 -56 -56 0 0 -56 116 KN-3B 0 0 0 0 0
117 Karbihidrat +Elektrolit Labu 40 0 0 40 40 0 650 -610 -610 0 650 -1260 -1260 0 0 -1260 117 Karbihidrat +Elektrolit 0 0 0 0 0
118 Karbogliserin Tetes teling Btl 36 48 36 48 48 0 20 28 28 0 10 18 18 0 0 18 118 Karbogliserin Tetes telinga 0 0 48 0 0
119 Kloramfenikol tetes Mata Btl 0 0 0 0 0 0 200 -200 -200 0 0 -200 -200 0 0 -200 119 Kloramfenikol tetes Mata 0 0 0 0 0
120 Klorfeniramin Maleat (CT Tab 3200 5000 7200 1000 1000 5000 3600 2400 2400 2500 3000 1900 1900 0 2000 -100 120 Klorfeniramin Maleat (CTM) Tab. 4 mg 0 2000 3000 2000 3000
121 Klozapine 25 Mg Tab 998 0 0 998 998 0 150 848 848 0 0 848 848 0 0 848 121 Klozapine 25 Mg 0 0 0 0 0
122 Klorpromazin HCL Inj. 2 Amp 0 0 0 0 0 0 0 0 0 0 48 -48 -48 0 0 -48 122 Klorpromazin HCL Inj. 25 mg/ml- 1ml 0 0 0 0 0
123 Klorpromazin HCL Tablet Tab 0 0 0 0 0 0 0 0 0 0 580 -580 -580 0 300 -880 123 Klorpromazin HCL Tablet Salut 25 mg 0 0 0 0 0
124 Klorpromazin HCL Tablet Tab 600 300 500 400 400 0 2700 -2300 -2300 0 1930 -4230 -4230 0 300 -4530 124 Klorpromazin HCL Tablet Salut 100 mg 0 0 300 0 0
125 klorpeson Slasf tube 0 0 0 0 0 0 548 -548 -548 0 300 -848 -848 0 0 -848 125 klorpeson Slasf 0 0 0 0 0
126 Komb. Artesunate 50mg Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 126 Komb. Artesunate 50mg+Amodiaquin 200mg 0 0 0 0 0
Kotrimoksazol Tablet
127 480mg Tab 350 3000 250 3100 3100 2000 3000 2100 2100 2000 0 4100 4100 0 1100 3000 127 Kotrimoksazol Tablet 480mg 1000 1000 1000 0 1000
Kotrimoksazol Suspensi Btl 120 0 120 100 100 0 100 0 0 500 280 220 220 0 100 0 Kotrimoksazol Suspensi Kombinasi 0 0 0 0 0
128 Kombinasi 128
129 Metpormin 500mg Tab 1200 1500 2700 0 0 4000 800 3200 3200 2000 0 5200 5200 0 0 5200 129 Metpormin 500mg 1500 0 0 0 2000
130 Methyilprednisolon 8mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 130 Methyilprednisolon 8mg 0 0 0 0 0

Kloramfenikol Salep
131 Mata 1%-5gram Tube 54 0 45 9 9 0 2050 -2041 -2041 96 160 -2105 -2105 0 150 -2255 131 Kloramfenikol Salep Mata 1%-5gram 0 0 0 0 0
132 Kloramfenikol Tetes Teli Btl 0 0 0 0 0 0 26 -26 -26 0 60 -86 -86 0 52 -138 132 Kloramfenikol Tetes Telinga 3%-5ml 0 0 0 0 0
133 Kuinin Injeksi 25%-2ml Amp 5 0 0 5 5 0 1700 -1695 -1695 0 900 -2595 -2595 0 0 -2595 133 Kuinin Injeksi 25%-2ml 0 0 0 0 0
134 Kloramfenikol Salep kulit Tube 0 72 0 72 72 96 57 111 111 96 200 7 7 0 300 -293 134 Kloramfenikol Salep kulit 15 grm 0 0 72 0 0
135 Lidokain Komp. Injeksi, Amp 80 90 60 110 110 100 144 66 66 90 181 -25 -25 0 140 -165 135 Lidokain Komp. Injeksi, Kombinasi 0 90 0 100 0
136 Lisol, Kresol Tersabun 5 Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 136 Lisol, Kresol Tersabun 50%- 1000ml 0 0 0 0 0
137 Loperamide Hcl 2mg Tanl Tab 550 1000 200 1350 1350 0 900 450 450 0 0 450 450 0 600 -150 137 Loperamide Hcl 2mg Tanlet 1000 0 0 0 0
138 Magnesium Sulfat Injk 25 Vial 32 0 2 30 30 0 45 -15 -15 0 75 -90 -90 0 0 -90 138 Magnesium Sulfat Injk 25 ml 0 0 0 0 0
139 Metamizol 500mg Tab 800 7000 6900 900 900 2000 1075 1825 1825 0 60 1765 1765 0 0 1765 139 Metamizol 500mg 1500 2500 3000 0 2000
Metilergometrin Maleat Tab
140 Tab. 0,125 g 400 1500 1350 550 550 0 0 550 550 0 0 550 550 0 0 550 140 Metilergometrin Maleat Tab. 0,125 g 500 500 500 0 0
141 Metilergometrin M inj. Amp 40 100 27 113 113 0 504 -391 -391 100 0 -291 -291 0 0 -291 141 Metilergometrin M inj. 0,200mg- 1ml 0 0 100 0 0
142 Metoklorpropamid Table Tab 0 0 0 0 0 0 6 -6 -6 0 580 -586 -586 0 720 -1306 142 Metoklorpropamid Tablet 10 mg 0 0 0 0 0
143 Mikonazol Krim/ Salep 2 Tube 59 48 84 23 23 0 920 -897 -897 96 1009 -1810 -1810 0 0 -1810 143 Mikonazol Krim/ Salep 2%-10gram 0 0 48 0 0
144 Multivitamin Anak Btl 11 150 131 30 30 50 75 5 5 0 370 -365 -365 0 137 -502 144 Multivitamin Anak 50 50 50 50 0
145 Multivitamin Dewasa Tab 0 0 0 0 0 0 59 -59 -59 0 527 -586 -586 0 350 -936 145 Multivitamin Dewasa 0 0 0 0 0
146 Metronidazol Infus 500 Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30 -30 146 Metronidazol Infus 500mg/100ml 0 0 0 0 0
147 Metronidazol Tablet 500 Tab 0 0 0 0 0 0 3 -3 -3 0 837 -840 -840 0 1250 -2090 147 Metronidazol Tablet 500mg 0 0 0 0 0
148 Metokloramid Syr Btl 0 60 48 12 12 120 60 72 72 120 0 192 192 0 0 192 148 Metokloramid Syr (lexapram) 60 0 0 60 0
149 Metronidazol syr Btl 40 0 0 40 40 0 0 40 40 0 0 40 40 0 0 40 149 Metronidazol syr 0 0 0 0 0
150 Natrium Bikarbonat Tabl Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 150 Natrium Bikarbonat Tablet 500mg 0 0 0 0 0
151 Natrum Klorida Lar. Inf. Btl 60 0 48 12 12 160 48 124 124 80 40 164 164 0 26 138 151 Natrum Klorida Lar. Inf. 0,9% -500ml 0 0 0 80 0
152 Natrium Diclopenac 20m Amp 0 0 0 0 0 0 30 -30 -30 0 105 -135 -135 0 0 -135 152 Natrium Diclopenac 20mg 0 0 0 0 0
153 Nistatin Vaginal sup 25 0 20 5 5 0 15 -10 -10 0 25 -35 -35 0 0 -35 153 Nistatin Vaginal 0 0 0 0 0
154 Nistatin Tablet Salut 500 tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 850 -850 154 Nistatin Tablet Salut 500.000 IU 0 0 0 0 0
155 Natrium Diclopenac 50m Tab 2300 4000 5900 400 400 5000 2170 3230 3230 2000 47 5183 5183 0 0 5183 155 Natrium Diclopenac 50mg 1000 1000 2000 2000 1000
156 Nifedipine Tab 10mg Tab 150 0 0 150 150 0 0 150 150 0 0 150 150 0 0 150 156 Nifedipine Tab 10mg 0 0 0 0 0
157 Multivitamin Anti Oksid Tab 2900 5000 6100 1800 1800 3800 3200 2400 2400 0 5 2395 2395 0 0 2395 157 Multivitamin Anti Oksidan 1200 2000 1800 1800 2000
158 Obat Anti Tuberkulosis Ka Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 158 Obat Anti Tuberkulosis Kat. 1 (FDC) 0 0 0 0 0
159 Obat Anti Tuberkulosis Ka Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 159 Obat Anti Tuberkulosis Kat. 2 0 0 0 0 0
160 Obat Anti Tuberkulosis K Pkt 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 160 Obat Anti Tuberkulosis Kat.Anak 0 0 0 0 0
161 Ofloksasin Tetes telinga Btl 4 0 0 4 4 0 4 0 0 0 15 -15 -15 0 55 -70 161 Ofloksasin Tetes telinga 0 0 0 0 0
162 Omeprazol inj 40mg/10m Btl 0 0 0 0 0 0 0 0 0 50 ### Err:509 Err:509 0 300 Err:509 162 Omeprazol inj 40mg/10ml 0 0 0 0 0
163 Omeprazol Kapsul 20mg Kap 1770 4800 5480 1090 1090 3900 2470 2520 2520 1500 ### Err:509 Err:509 0 80 Err:509 163 Omeprazol Kapsul 20mg 1200 2100 1500 1500 1500
164 Ondansetron Inj 4mg Vial 0 0 0 0 0 0 0 0 0 0 ### #VALUE! #VALUE! 0 200 #VALUE! 164 Ondansetron Inj 4mg 0 0 0 0 0
165 Onadansetron 8mg Table Tab 0 0 0 0 0 0 ### #VALUE! #VALUE! 0 ### #VALUE! #VALUE! 0 200 #VALUE! 165 Onadansetron 8mg Tablet 0 0 0 0 0
166 Onadansetron 4mg Table Tab 72 840 852 60 60 0 60 0 0 900 0 900 900 0 0 900 166 Onadansetron 4mg Tablet 600 0 240 0 0
167 Obat Batuk Flu Dewasa Pkt 1800 9000 9800 1000 1000 3000 3750 250 250 0 0 250 250 0 0 250 167 Obat Batuk Flu Dewasa 3000 3000 3000 3000 0
168 Obat Batuk Hitam (OBH) Btl 0 0 0 0 0 0 0 0 0 0 60 -60 -60 0 30 -90 168 Obat Batuk Hitam (OBH) Cairan 0 0 0 0 0
169 Obat Batuk Dewasa syr Btl 0 0 0 0 0 180 127 53 53 0 3 50 50 0 0 50 169 Obat Batuk Dewasa syr 0 0 0 180 0
170 Oksitetrasiklin HCL Inj. Vial 0 0 0 0 0 0 1650 -1650 -1650 0 1410 -3060 -3060 0 0 -3060 170 Oksitetrasiklin HCL Inj. i.m 50mg10ml 0 0 0 0 0


Penerimaan
Penerimaan
Penerimaan
Penerimaan
SATUAN
Pemakaian
Pemakaian
Pemakaian
Pemakaian
Stok akhir
Stok akhir
Stok akhir
Stok akhir
Stok awal
Stok awal
Stok awal
Stok awal
Pebruari
Januari
Maret
April
Mei
171 Oksitetrasiklin HCL SM 1 Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 171 Oksitetrasiklin HCL SM 1%-3,5gram 0 0 0 0 0
172 Oksitetrasiklin HCL Sale Tube 0 0 0 0 0 0 40 -40 -40 0 11 -51 -51 0 0 -51 172 Oksitetrasiklin HCL Salep 3%- 5gram 0 0 0 0 0
Oksitosin Injeksi 10
173 IU/ml- 1ml Amp 26 100 79 47 47 200 54 193 193 100 0 293 293 0 0 293 173 Oksitosin Injeksi 10 IU/ml- 1ml 100 0 0 100 0
OBAT Anti Diare Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

174 suspensi 174 OBAT Anti Diare suspensi
175 parasetamol drops 15 ml btl 46 168 106 108 108 0 315 -207 -207 0 290 -497 -497 0 240 -737 175 parasetamol drops 15 ml 56 0 112 0 0
176 Parasetamol Syrup 120m Btl 200 900 1100 0 0 1200 205 995 995 200 50 1145 1145 0 30 1115 176 Parasetamol Syrup 120mg/ 5ml-60ml 300 300 300 1000 0
177 Parasetamol tab 100mg Tab 0 0 0 0 0 0 3000 -3000 -3000 0 9500 -12500 -12500 0 14100 -26600 177 Parasetamol tab 100mg 0 0 0 0 0
178 Parasetamol Tablet 500m Tab 1750 21000 21700 1050 1050 20300 5700 15650 15650 7000 0 22650 22650 0 0 22650 178 Parasetamol Tablet 500mg 6000 7000 8000 16800 0
179 Permetin Krim/Skabisid 5 Tube 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 179 Permetin Krim/Skabisid 5 % 0 0 0 0 0
180 pirantel syr Btl 23 0 0 23 23 0 300 -277 -277 0 400 -677 -677 0 400 -1077 180 pirantel syr 0 0 0 0 0
181 Pirantel Tablet 125mg Tab 435 0 0 435 435 0 1000 -565 -565 0 1750 -2315 -2315 0 250 -2565 181 Pirantel Tablet 125mg 0 0 0 0 0
182 piroksikam Tablet 10 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 182 piroksikam Tablet 10 mg 0 0 0 0 0
183 Piroksikam Tablet 20 mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 183 Piroksikam Tablet 20 mg 0 0 0 0 0

184 Propiltiourasil Tablet 10 Tab 600 0 0 600 600 0 3400 -2800 -2800 0 4900 -7700 -7700 0 4100 -11800 184 Propiltiourasil Tablet 100mg 0 0 0 0 0
185 Piridoksin HCL (Vit. B6) Tab 700 0 400 300 300 0 2 298 298 1000 0 1298 1298 0 0 1298 185 Piridoksin HCL (Vit. B6) Tablet 10mg 0 0 0 0 0
186 Povidon Iodida 10% 300m Btl 20 0 4 16 16 0 2 14 14 0 0 14 14 0 0 14 186 Povidon Iodida 10% 300ml 0 0 0 0 0
187 Povidon Iodida 10% 100 Btl 0 0 0 0 0 0 4300 -4300 -4300 0 5800 -10100 -10100 0 4800 -14900 187 Povidon Iodida 10% 1000ml 0 0 0 0 0
188 Prednison Tablet 5mg Tab 1100 6000 6200 900 900 5000 2300 3600 3600 0 0 3600 3600 0 0 3600 188 Prednison Tablet 5mg 2000 2000 2000 2500 2500
189 Primakuin Tablet 15mg Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 189 Primakuin Tablet 15mg 0 0 0 0 0
190 Prokain Benzil Penisilin 3 Vial 0 0 0 0 0 0 150 -150 -150 0 460 -610 -610 0 100 -710 190 Prokain Benzil Penisilin 3 Juta IU Inj. 0 0 0 0 0
191 propanolol HCL Tablet 1 Tab 1000 0 1000 0 0 0 0 0 0 0 0 0 0 0 0 0 191 propanolol HCL Tablet 10mg 0 0 0 0 0
192 Propanolol HCL Tablet 4 Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 192 Propanolol HCL Tablet 40mg 0 0 0 0 0
193 Povidon Iodida 10% 60ml Botol 2 0 0 2 2 0 0 2 2 0 0 2 2 0 0 2 193 Povidon Iodida 10% 60ml 0 0 0 0 0
194 Retinol (Vitamin A) Kapsu Kap 650 500 650 500 500 0 0 500 500 0 0 500 500 0 0 500 194 Retinol (Vitamin A) Kapsul 100.000 IU 0 500 0 0 0
195 Retinol (Vitamin A) Kapsu Kap 8000 0 4000 4000 4000 0 0 4000 4000 0 0 4000 4000 0 0 4000 195 Retinol (Vitamin A) Kapsul 200.000 IU 0 0 0 0 0
196 MDT MB/ Kusta Dewasa Blister 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 196 MDT MB/ Kusta Dewasa 0 0 0 0 0
197 MDT PB/ Kusta Dewasa Blister 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 197 MDT PB/ Kusta Dewasa 0 0 0 0 0
198 Risperidon 2mg Tab 320 0 0 320 320 0 50 0 0 0 30 -30 -30 0 0 -30 198 Risperidon 2mg 0 0 0 0 0
199 Ranitidin Injeksi 25 mg/ Vial 65 100 120 45 45 200 835 0 0 0 1000 -1000 -1000 0 0 -1000 199 Ranitidin Injeksi 25 mg/ 2ml 0 100 0 200 0
200 Ranitidin Tablet 150 mg Tab 1800 7500 6300 3000 3000 5000 2945 5055 5055 2000 0 7055 7055 0 50 7005 200 Ranitidin Tablet 150 mg 2000 3000 2500 2000 1000
201 Ringer Laktat Lar. Inf. Ste Btl 44 320 264 100 100 240 690 -350 -350 80 80 -350 -350 0 0 -350 201 Ringer Laktat Lar. Inf. Steril - 500ml 160 0 160 80 160
202 Salbutamol Tablet 2mg Tab 1800 1000 2700 100 100 1000 600 500 500 500 350 650 650 0 600 50 202 Salbutamol Tablet 2mg 0 1000 0 1000 0
203 Salbutamol Tablet 4mg Tab 1150 2500 3050 600 600 0 548 52 52 1000 48 0 0 0 0 0 203 Salbutamol Tablet 4mg 0 1500 1000 0 0
204 Salep 2-4, Kombinasi Pot 58 0 34 24 24 0 100 -76 -76 0 0 -76 -76 0 0 -76 204 Salep 2-4, Kombinasi 0 0 0 0 0
205 Salisil Bedak 2% Ktk 0 100 40 60 60 0 28 32 32 0 4 28 28 0 11 17 205 Salisil Bedak 2% 100 0 0 0 0
206 Serum Anti Bisa Ular Poli Vial 20 0 13 7 7 10 5 12 12 10 0 22 22 0 0 22 206 Serum Anti Bisa Ular Polivalen Inj.5ml 0 0 0 0 5
207 Stimuno Botol 48 0 42 6 6 0 0 6 6 0 3 3 3 0 0 3 207 Stimuno 0 0 0 0 0
208 Serum Anti Tetanus Inj. Amp 4 10 11 3 3 10 0 13 13 10 0 23 23 0 0 23 208 Serum Anti Tetanus Inj. 1500 IU/amp. 10 0 0 0 10
209 Sukrafat 500mg Tab 0 0 0 0 0 0 65 -65 -65 0 130 -195 -195 0 135 -330 209 Sukrafat 500mg 0 0 0 0 0
210 Sianokobalamin (Vit. B12 Amp 45 0 40 5 5 0 405 -400 -400 0 120 -520 -520 0 700 -1220 210 Sianokobalamin (Vit. B12) Inj 500mcg 0 0 0 0 0
211 Simvastatin Tablet 20 mg Tab 500 1000 500 1000 1000 0 300 700 700 0 400 300 300 0 350 -50 211 Simvastatin Tablet 20 mg 500 500 0 0 0
212 Simvastatin Tablet 10 mg Tab 270 2400 1800 870 870 0 0 870 870 0 0 870 870 0 0 870 212 Simvastatin Tablet 10 mg 1500 900 0 0 0
213 Sukralfat Syr Botol 0 0 0 0 0 0 38 -38 -38 100 0 62 62 0 0 62 213 Sukralfat Syr 0 0 0 0 0
214 Sulfasetamida Natrium Btl 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 214 Sulfasetamida Natrium TM 15%- 5ml 0 0 0 0 0
215 Sabutamol Nebulizer Amp 0 0 0 0 0 60 0 60 60 60 0 120 120 0 0 120 215 Sabutamol Nebulizer 0 0 0 0 20
216 Spiranolakton tab tab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 216 Spiranolakton tab 0 0 0 0 0
217 Salf Kombinasi Tube 0 0 0 0 0 0 120 -120 -120 0 0 -120 -120 0 0 -120 217 Salf Kombinasi 0 0 0 0 0
218 Sinbio Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 218 Sinbio 0 0 0 0 0
219 Setrizin tablet 10 mg Tab 680 3100 3780 0 0 620 600 20 20 0 400 -380 -380 0 200 -580 219 Setrizin tablet 10 mg 620 1240 1240 620 0
220 Tablet Tambah Darah Kom Tab 2160 30240 32120 280 280 42000 13000 29280 29280 15120 0 44400 44400 0 0 44400 220 Tablet Tambah Darah Komb. 15120 0 15120 13440 13440
221 Tetrakain HCL Tetes Mata Btl 0 0 0 0 0 0 1000 -1000 -1000 0 2050 -3050 -3050 0 800 -3850 221 Tetrakain HCL Tetes Mata 0.5%- 5ml 0 0 0 0 0
222 Tetrasiklin HCL Kapsul 2 Kap 700 0 700 0 0 0 400 -400 -400 0 300 -700 -700 0 0 -700 222 Tetrasiklin HCL Kapsul 250 mg 0 0 0 0 0
223 Tetrasiklin HCL Kapsul 5 Kap 0 0 0 0 0 0 4000 -4000 -4000 0 3900 -7900 -7900 0 600 -8500 223 Tetrasiklin HCL Kapsul 500 mg 0 0 0 0 0
224 Tiamin HCL/(Vit. B1) Tab Tab 1000 5000 5000 1000 1000 1000 600 1400 1400 0 0 1400 1400 0 0 1400 224 Tiamin HCL/(Vit. B1) Tab. 50mg 1000 2000 2000 1000 0
225 Tiamin HCL (Vit. B1) Inj. Tab 30 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml 0 0 0 0 0
226 Triheksifenidil Hidroklor Tab 500 500 800 200 200 2000 0 2200 2200 0 0 2200 2200 0 0 2200 226 Triheksifenidil Hidroklorida Tab. 2mg 0 0 500 0 500
227 Vitamin B Komplek Table Tab 1500 6500 8000 0 0 3000 2200 800 800 2000 0 2800 2800 0 0 2800 227 Vitamin B Komplek Tablet 1500 3000 2000 3000 0
228 Zink Syr Botol 53 0 53 0 0 0 5000 -5000 -5000 0 7700 -12700 -12700 0 1400 -14100 228 Zink Syr 0 0 0 0 0
229 Zink Tablet 20mg Tab 800 0 800 0 0 0 500 -500 -500 0 500 -1000 -1000 0 190 -1190 229 Zink Tablet 20mg 0 0 0 0 0
PERBEKALAN KESEHATAN PERBEKALAN KESEHATAN 0 0 0 0 0
Alat Suntik Sekali Pakai 1 Set 125 100 180 45 45 100 0 145 145 100 30 215 215 0 100 115 Alat Suntik Sekali Pakai 1 ml 0 0 100 0 100
1 1
2 Alat Suntik Sekali Pakai 2.5 ml 300 600 2 Alat Suntik Sekali Pakai 2.5 ml 0 0 300 200 100
Alat Suntik Sekali Pakai 3 Set 100 700 750 50 50 200 450 -200 -200 300 430 -330 -330 0 100 -430 Alat Suntik Sekali Pakai 3 ml 200 300 200 0 0
2 3
Alat Suntik Sekali Pakai 5 Set 250 0 60 190 190 0 220 -30 -30 200 430 -260 -260 0 30 -290 Alat Suntik Sekali Pakai 5 ml 0 0 0 0 0
3 4
Catgut/ Benang Bedah No Set 25 72 36 61 61 72 22 111 111 0 34 77 77 0 38 39 Catgut/ Benang Bedah No. 2/0 72 0 0 72 0
4 5
I.V. Catheter No. 20 Set 157 100 151 106 106 100 38 168 168 100 35 233 233 0 38 195 I.V. Catheter No. 20 0 0 100 100 0
5 6
6 7
7 8
I.V. Cateter No 26 set 87 100 110 77 77 100 40 137 137 0 50 87 87 0 30 57 I.V. Cateter No 26 100 0 0 100 0
8 9
Infusion Set Anak Set 135 0 66 69 69 0 55 14 14 100 30 84 84 0 30 54
9 10 Infusion Set Anak 0 0 0 0 0
153
10 Infusion Set Dewasa Set 200 276 77 77 500 68 509 509 200 0 709 709 0 0 709 11 Infusion Set Dewasa 0 100 100 100 200
0
11 E.Care Film I.V Dresing Pcs 600 300 300 300 400 300 400 400 0 0 400 400 0 0 400 12 E.Care Film I.V Dresing 400 0 200 0 400
118
12 Silk (Benang Bedah Suter Biji 0 20 98 98 0 5 93 93 0 0 93 93 0 0 93 13 Silk (Benang Bedah Sutera) No. 3/0 0 0 0 0 0
Botol 0 12 6 6 6 12 0 18 18 5 0 23 23 0 0 23 0 0 12 12 0
13 Policlean Handrub 14 Policlean Handrub
3
14 Kapas Pembalut/Absorbe Set 10 1 12 12 0 41 -29 -29 0 0 -29 -29 0 40 -69 15 Kapas Pembalut/Absorben 250 gram 10 0 0 0 0
100
15 Kasa Kompres 40/40 lembar 0 93 7 7 0 10 -3 -3 0 25 -28 -28 0 20 -48 16 Kasa Kompres 40/40 0 0 0 0 0
20
16 Kasa Pembalut 2 m x 80 pak 0 0 20 20 100 30 90 90 0 0 90 90 0 20 70 17 Kasa Pembalut 2 m x 80 cm 0 0 0 100 0
2
17 Kasa Pembalut Hidrofil 3 rol 5 5 2 2 3 30 -25 -25 0 90 -115 -115 0 200 -315 18 Kasa Pembalut Hidrofil 36 m x 80 cm 3 0 2 3 0
0
18 Kasa Steril 16/16 kotak 300 145 155 155 100 45 210 210 10 200 20 20 0 200 -180 19 Kasa Steril 16/16 200 100 0 100 0
500
19 Masker biji 500 600 400 400 1200 156 1444 1444 500 9 1935 1935 0 8 1927 20 Masker 0 0 500 300 400
59
20 Plester 5 yard x 2 inch rol 0 58 1 1 36 111 -74 -74 12 180 -242 -242 0 195 -437 21 Plester 5 yard x 2 inch 0 0 0 36 0
0
21 Sarung Tangan No 7 Steripasang 0 0 0 0 0 36 -36 -36 0 20 -56 -56 0 10 -66 22 Sarung Tangan No 7 Steril 0 0 0 0 0

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22 Sarung Tangan No 6.5 Stepasang 200 300 0 500 0 0 0 0 0 0 0 0 300 0 23 Sarung Tangan No 6.5 Steril 0 100 200 0 0
23 Sarung tangan no 6 1/2 Pasng 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24 Sarung tangan no 6 1/2 0 0 0 0 10
24 Folly cateter No 16 Pcs 19 0 0 19 0 0 0 0 0 0 0 0 0 0 25 Folly cateter No 16 0 0 0 40 0
25 Folly cateter No 14 Pcs 1 0 0 1 0 0 0 0 0 0 0 0 0 0 26 Folly cateter No 14 0 0 0 0 0
26 Sarung tangan GynecologSashet 80 80 0 160 0 0 0 0 0 0 0 0 80 0 27 Sarung tangan Gynecolog no 7 0 80 0 0 0
27 Alkohol Swab bok 3 10 0 13 0 0 0 0 0 0 0 0 10 0 28 Alkohol Swab 5 5 0 5 0
28 Underpad Lembar 30 150 0 180 0 0 0 0 0 0 0 0 150 0 29 Underpad 100 0 50 100 0
29 Urine Bag Biji 12 40 0 52 0 0 0 0 0 0 0 0 40 0 30 Urine Bag 10 0 30 50 0
30 Catgut/ Benang Bedah NoBotol 72 36 0 108 0 0 0 0 0 0 0 0 36 0 31 Catgut/ Benang Bedah No. 3/0 36 0 0 72 0
31 Antiseptik Surgical Hand Botol 0 5 0 5 0 0 0 0 0 0 0 0 5 0 32 Antiseptik Surgical Hand Scrab 5 0 0 0 0
32 Cairan pembersih Botol 2 6 0 8 0 0 0 0 0 0 0 0 6 0 33 Cairan pembersih 6 0 0 0 0
33 Jely kateter biji 33 20 0 53 0 0 0 0 0 0 0 0 20 0 34 Jely kateter 0 0 20 30 0
34 Jarum Insulin Biji 129 35 Jarum Insulin
III OBAT GIGI III OBAT GIGI
1 Air Raksa Dental Use BotoBOTol 0 1 Air Raksa Dental Use Botol
2 Etil Klorida Semprot-100 BOTol 0 2 Etil Klorida Semprot-100 ml
3 Eugenol Cairan - 10 ml BOTol 0 3 Eugenol Cairan - 10 ml
4 Forinokresol 0 4 Forinokresol
5 Glass Ionomer Cement (GC IX) 0 5 Glass Ionomer Cement (GC IX)
6 Gutta Percha Point 0 6 Gutta Percha Point
7 Kalsium Hidroksida Pasta Pcs 0 7 Kalsium Hidroksida Pasta
8 Monoklorkamfer Menthol Cairan 0 8 Monoklorkamfer Menthol Cairan 10ml
9 Semen Seng Fosfat Srbk dan Cair 0 9 Semen Seng Fosfat Srbk dan Cairn30 gr
10 Silver Amalgan 0 10 Silver Amalgan
11 Temporary SF Serbuk & Cairan -1 0 11 Temporary SF Serbuk & Cairan -100 gr
Mengetahui Mengetahui
Kepala Puskesmas Pengelola Obat Kepala Puskesmas
Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep Hj.IYOT SA'DIAH,S.ST

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006 NIP. 19710804 199103 2 002
PUSKESMAS KECAMATAN CIKEUSIK
TAHUN 2011
MAAN OBAT LAPORAN BULANAN PEMAKAIAN OBAT
K PUSKESMAS CIKEUSIK
TAHUN 2019
BULAN BULAN
September
September
Jumlah
Jumlah
November
November
Desember
Desember
Pebruari
Oktober
Oktober
Agustus
Agustus
Januari
NO NAMA OBAT NO
Maret
April
Juni
Juni
Mei
Juli
Juli
0 0 0 0 0 0 0 1000 1 Alopurinol tablet 100 mg 500 1000 0 0 300 700 0 0 0 0 0 0 2500 1
0 0 0 0 0 0 0 0 2 Aminofilin tablet 200 mg 100 0 0 0 0 0 0 0 100 0 200 0 400 2
0 0 0 0 0 0 0 10650 3 Albendazol 0 0 0 10350 0 0 270 150 170 130 200 0 11270 3
0 0 0 0 0 0 0 0 4 Aminofilin injeksi 24mg/ml-10ml 0 0 0 0 0 0 0 0 60 0 60 0 120 4
0 0 0 0 0 0 0 0 5 Amitriptilin HCL Tab. Salut 25 mg 0 0 0 0 0 200 0 0 0 0 100 0 300 5
0 1200 0 0 0 0 0 3900 6 Amlodipine 10 mg Tablet 510 950 600 450 650 650 270 20 350 250 350 130 5180 6
0 1200 0 0 0 0 0 3000 7 Amlodipine Besilate 5mg tablet 0 300 0 450 550 1700 270 50 280 320 280 320 4520 7
0 2 0 0 0 0 0 3 8 Alkacide 1 L High Level Desinfectant(Alkapham Feran 0 0 0 0 0 1 0 0 0 0 0 0 1 8
0 6500 0 0 0 0 0 32500 9 Amoksisillin Kapsul 500 mg 5100 6000 6600 5100 0 0 4500 2200 2000 4500 5000 5000 46000 9
0 0 0 0 0 0 0 0 10 Amoksisillin SK 125 mg/5 ml-60 ml 0 0 0 0 50 40 0 0 240 150 250 160 890 10
0 4 0 0 0 0 0 5 11 Alkazyme Sachet 25mg(Alkapham France) 0 0 0 0 0 1 20 20 20 0 20 20 101 11
300 360 0 0 0 0 0 2040 12 Amoksilin sk Forte 280 300 310 310 50 50 50 50 0 0 0 0 1400 12
0 0 0 0 0 0 0 0 13 Ampisillin Injeksi 1 gram 0 0 0 0 30 0 30 0 60 0 60 0 180 13
0 0 0 0 0 0 0 0 14 Antalgin (Metampiron) Tab. 500 mg 0 0 0 0 0 0 0 0 0 0 0 500 500 14
2000 0 0 0 0 0 0 27500 Antasida DOEN tablet 5800 4700 6100 4100 1000 1000 800 200 2000 2500 3000 3000 34200
15 15
200 500 0 0 0 0 0 1900 Antasida DOEN suspensi 190 205 255 160 150 50 120 60 120 60 120 60 1550
16 16
0 0 0 0 0 0 0 0 Anti Bakteri DOEN Salep Kombinasi (basitrasin) 25 0 0 0 90 0 0 0 0 0 0 60 175

17 17
0 0 0 0 0 0 0 0 18 Anti Hemoroid DOEN Kombinasi 0 0 0 0 10 0 0 0 0 0 0 0 10 18
0 0 0 0 0 0 0 0 Antifungi DOEN Kombinasi 0 0 0 0 0 0 0 0 0 0 0 0 0

19 19
0 0 0 0 0 0 0 300 Antimigren DOEN Kombinasi 0 0 0 0 0 100 0 0 0 0 0 0 100

20 20
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Antiparkinson DOEN tab. Kombinasi 21
0 0 0 0 0 0 0 30 22 Aqua roinjek Steril 10 0 0 0 0 12 12 0 0 0 5 5 44 22
0 0 0 0 0 0 0 50 23 Acyclopir Krim 5%- 5gr 37 47 27 47 0 0 0 20 0 0 0 0 178 23
0 0 0 0 0 0 0 0 24 Acyclopir Tablet 200mg 900 0 0 0 0 200 0 300 200 300 0 0 1900 24
0 200 0 0 0 0 0 200 25 Acyclopir Tablet 400 mg 0 0 200 500 0 0 200 200 300 200 0 0 1600 25
0 0 0 0 0 0 0 1000 26 Akita/Molagit Tablet 0 0 0 0 0 100 1100 0 0 0 0 0 1200 26
0 0 0 0 0 0 0 0 27 Antalgin (Metampiron) Inj. 250mg/2ml 0 0 0 0 0 0 0 0 0 0 0 0 0 27
0 0 0 0 0 0 0 0 28 Asam asetilsalisilat 100mg tablet 0 0 0 0 400 0 0 0 0 0 0 0 400 28
2000 2000 0 0 0 0 0 16000 29 Asam Mefenamat 500mg 2300 3000 3000 2200 1200 1100 2200 200 300 200 0 0 15700 29
0 0 0 0 0 0 0 0 30 Alprazolam 1mg 0 0 0 0 0 0 0 0 0 0 0 0 0 30
0 0 0 0 0 0 0 0 31 Ambroksol tab 0 0 0 0 0 0 0 0 0 0 0 0 0 31
0 0 0 0 0 0 0 0 32 Ambroksol syr 0 0 0 0 0 0 0 0 0 0 0 0 0 32
0 400 0 0 0 0 0 2400 33 Asam Askorbat (Vit. C) Tablet 50 mg 400 1000 1000 0 0 400 450 150 0 0 0 300 3700 33
0 0 0 0 0 0 0 40 34 Asering Infus 0 0 20 0 0 10 31 0 0 0 0 0 61 34
0 1000 0 0 0 0 0 1000 35 Asam Folat tablet 01mg 0 0 0 0 0 0 450 300 100 300 100 300 1550 35
0 0 0 0 0 0 0 0 36 Asam Folat tablet 5 mg 0 0 0 0 800 0 0 0 0 0 0 0 800 36
0 0 0 0 0 0 0 0 37 Artesunat Inj 0 0 0 0 0 0 0 0 0 0 0 0 0 37
0 10 0 0 0 0 0 50 38 Asam traneksamat Inj 5 % 20 9 0 0 10 11 0 0 0 0 0 0 50 38
0 0 0 0 0 0 0 0 39 Asetosal Tablet 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 39
100 100 0 0 0 0 0 200 40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml 0 0 0 0 0 0 0 0 0 0 0 0 0 40
0 0 0 0 0 0 0 0 41 Atropin Sulfat Tablet 0,5 mg 0 0 0 0 0 0 0 0 100 0 0 0 100 41
0 0 0 0 0 0 0 0 42 Atropin Sulfat Tetes Mata 1% - 5 ml 0 0 0 0 0 0 0 0 0 0 0 0 0 42
0 0 0 0 0 0 0 3 43 Alkohol 70% 1 Liter 0 1 0 0 0 1 2 0 0 0 0 0 4 43
0 0 0 0 0 0 0 0 44 Betadin Salf Antiseptik 0 0 0 0 0 0 18 0 0 0 0 0 18 44
0 100 0 0 0 0 0 350 45 Betametason Krim 0,1% - 5 gr 45 70 91 71 61 73 71 0 0 0 0 40 522 45
0 0 0 0 0 0 0 0 46 Bisacodril sup 2 0 0 0 3 34 33 0 14 10 14 10 120 46
0 0 0 0 0 0 0 0 47 Bisoprolol 2,5mg tab 0 0 0 0 0 0 270 90 0 0 0 0 360 47
300 1000 0 0 0 0 0 5300 48 Captopril Tablet 12,5 mg 400 850 950 950 950 650 850 450 0 0 0 700 6750 48
0 0 0 0 0 0 0 0 49 Captopril Tablet 25 mg 1150 500 0 0 0 0 0 250 0 0 0 0 1900 49
500 0 0 0 0 0 0 1000 50 Carbamazefine 100 100 200 0 0 0 Err:509 0 0 0 0 0 Err:509 50
0 0 0 0 0 0 0 0 51 Cefadroxil 500mg 0 0 0 0 0 JUMLAHJUMLAH 0 0 0 0 0 0 51
0 0 0 0 0 0 0 0 52 Cetrizin syr 0 0 0 0 0 0 0 0 0 0 0 0 0 52
0 0 0 0 0 0 0 0 53 Cefixim 0 0 0 0 0 0 0 0 0 0 0 0 0 53
0 0 0 0 0 0 0 0 54 Ciprofloxacin Infus 0 0 0 0 0 0 0 0 0 0 0 0 0 54
0 1000 0 0 0 0 0 10000 55 Ciprofloxacin Tablet 500mg 2150 1800 1400 2100 1600 0 0 0 0 0 0 0 9050 55
0 0 0 0 0 0 0 0 56 D-Artepp Tab 0 0 0 0 0 0 0 0 0 0 0 0 0 56
0 0 0 0 0 0 0 100 57 Deksametasone Injeksi 5 mg/ml - 1ml 0 0 20 0 35 600 1050 0 0 0 0 0 1705 57
2000 3000 0 0 0 0 0 20000 58 Deksametasone Tablet 0,5 mg 3300 3900 3800 2400 2400 0 0 1100 1900 100 0 0 18900 58
0 0 0 0 0 0 0 0 59 Dekstromethorfan Sirup 10 mg/ 60 ml 0 0 0 0 0 20 0 0 0 0 0 0 20 59
0 0 0 0 0 0 0 0 60 Diazetpam Rectal 2mg 0 0 0 0 0 2800 3000 0 0 0 0 0 5800 60
0 0 0 0 0 0 0 0 61 Diazepam Injeksi 5 mg/ml - 2ml 0 0 0 0 0 0 0 0 0 0 0 10 10 61
0 0 0 0 0 0 0 0 62 Diazepam Tablet 2 mg 0 0 0 0 0 0 0 0 0 0 100 0 100 62
0 0 0 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 20 20
63 Diazepam Tablet 5 mg 63
0 0 0 0 0 0 0 0 64 Dietilkarbamazin Sitrat Tablet 100 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 64
0 0 0 0 0 0 0 0 65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml 0 0 0 0 0 0 0 40 20 40 0 0 100 65
0 0 0 0 0 0 0 200 66 Digoksin Tablet 0,25 mg 0 0 0 0 0 0 0 300 200 300 200 300 1300 66
0 0 0 0 0 0 0 0 67 Domperidon 10 mgtablet 500 200 0 0 0 0 43 0 0 0 200 0 943 67
0 0 0 0 0 0 0 0 68 Dimenhidrinat Tablet 50 mg 0 0 0 0 0 0 270 0 0 0 0 0 270 68
0 0 0 0 0 0 0 0 69 Dasabion Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 69
0 0 0 0 0 0 0 0 70 Domperidon Suspensi 5mg/ 5ml- 60ml 0 0 6 0 0 0 0 0 0 0 0 0 6 70
0 0 0 0 0 0 0 0 71 Efedrin HCL Tablet 25 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 71
0 0 0 0 0 0 0 0 72 Ekstrak Belladona Tablet 10 mg 0 0 0 0 900 0 0 600 1400 600 400 0 3900 72
0 100 0 0 0 0 0 100 73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml 0 0 0 0 0 0 0 0 0 0 0 0 0 73
0 0 0 0 0 0 0 24 74 Etakridin (Rivanol) Lar. 0,1%-300 ml 0 0 0 0 0 0 0 9 21 17 7 7 61 74
0 0 0 0 0 0 0 0 75 Lisinofril 10 mg 0 0 0 0 0 0 5 0 0 0 0 0 5 75
0 0 0 0 0 0 0 0 76 Lisinofril 5mg 0 0 0 0 0 0 18 0 0 0 0 0 18 76
0 0 0 0 0 0 0 0 77 Etanol 70%- 100 ml 0 0 0 0 0 0 0 0 0 0 0 0 0 77
0 0 0 0 0 0 0 0 78 Eritromisin Kapsul 500 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 78
0 0 0 0 0 0 0 0 79 Eritromisin Syrup 200 mg/5 ml-60 ml 0 0 0 0 0 0 0 0 0 0 0 0 0 79
0 0 0 0 0 0 0 0 80 Fenitoin Natrium Injeksi 50 mg/ 1 ml 0 0 0 0 0 0 270 0 0 0 0 0 270 80
0 0 0 0 0 0 0 0 81 Fenitoin Natrium Kapsul 100 mg 0 0 0 0 0 6 45 0 0 0 0 0 51 81
0 0 0 0 0 0 0 0 82 Fenitoin Natrium Kapsul 30 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 82
0 0 0 0 0 0 0 0 83 Fenobarbital Injeksi- 2ml 0 0 0 0 0 0 0 0 0 0 0 0 0 83
0 0 0 0 0 0 0 0 84 Fenobarbital Tablet 30 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 84
0 0 0 0 0 0 0 0 85 Fenobarbital Tablet 30 mg 0 0 0 0 20 0 20 0 20 0 10 0 70 85
T PUSKESMAS LAPORAN BULANAN PEMAKAIAN OBAT

TAHUN 2019
BULAN BULAN
September
September
Jumlah
Jumlah
November
November
Desember
Desember
Pebruari
Oktober
Oktober
Agustus
Agustus
NO NAMA OBAT NO
Januari
Maret
April
Juni
Juni
Mei
Juli
Juli
0 0 0 0 0 0 0 0 86 Fenoksimetil Penisilina Tablet 250 mg 0 0 0 0 0 0 100 0 0 0 0 0 100 86
0 0 0 0 0 0 0 0 87 Fluflenazine decanoat inj 25mg/ml 0 0 0 0 0 0 0 0 0 0 0 0 0 87
0 0 0 0 0 0 0 0 88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml 0 0 0 30 0 0 0 0 0 20 10 10 70 88
500 1000 0 0 0 0 0 1500 89 Fitomenadion (Vit. K1) Tab. 10 mg 300 0 0 0 0 5 0 0 0 200 250 100 855 89
0 0 0 0 0 0 0 0 90 Gentamisin SM 0 0 0 0 0 0 0 0 0 0 0 0 0 90
0 400 0 0 0 0 0 400 91 Furosemida Tablet 40 mg 0 0 0 0 0 0 750 0 0 0 0 0 750 91
0 0 0 0 0 0 0 200 92 Garam Oralit 200 ml air 0 100 0 0 0 0 0 0 0 0 50 50 200 92
1000 2000 0 0 0 0 0 3000 93 Glimepirid 2mg Tablet 0 0 0 0 0 0 200 0 0 0 300 150 650 93
0 0 0 0 0 0 0 500 600 500 200 500 0 0 144 300 550 300 0 0 3094
94 Glibenklamida Tablet 5 mg 94
2640 0 0 0 0 0 0 26400 95 Asetil Sistein 200mg 4740 4570 5350 5160 3240 600 0 1000 0 0 0 0 24660 95
0 0 0 0 0 0 0 0 96 Glikazid 80 mg 0 0 0 0 550 0 0 0 0 0 0 0 550 96
0 0 0 0 0 0 0 40 97 Glukosa Lar. Infus 5% Steril - 500 ml 0 0 20 0 0 3000 860 0 42 15 57 15 4009 97
0 0 0 0 0 0 0 0 98 Glukosa Lar. Infus 10% Steril - 500 ml 0 0 0 0 0 0 0 0 55 25 70 25 175 98
0 0 0 0 0 0 0 0 99 Griseofulvin Tablet 500 mg, 0 0 0 0 0 0 45 0 0 0 0 0 45 99
0 0 0 0 0 0 0 0 100 Griseofulvin Tablet 125 mg, Micron 0 0 0 0 0 0 0 0 0 0 0 0 0 100
0 0 0 0 0 0 0 0 101 Gentamisin S.K 0.1%-5 gr 0 0 0 0 0 0 0 0 0 0 0 0 0 101
0 0 0 0 0 0 0 96 102 Gentamisin tetes Mata 29 5 24 10 20 90 270 0 0 0 0 0 448 102
0 0 0 0 0 0 0 1000 103 Haloperidol 2 mg Tablet 300 500 500 0 400 0 0 0 0 200 0 200 2100 103
500 0 0 0 0 0 0 500 104 Haloperidol 5 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 104
0 0 0 0 0 0 0 500 105 Hidroklortiazid (HCT) Tablet 25 mg 0 0 0 0 0 300 0 0 0 0 0 0 300 105
0 96 0 0 0 0 0 192 106 Hidrokortison Krim 2,5%-5 gr 84 44 6 0 0 0 0 21 0 0 0 0 155 106
0 0 0 0 0 0 0 0 107 Ibuprofen Tablet 200 mg 500 0 0 0 0 0 Err:509 0 0 0 0 0 Err:509 107
0 0 0 0 0 0 0 0 108 Ibuprofen Tablet 400 mg 0 0 0 0 0 0 Err:509 100 0 0 0 0 Err:509 108
0 0 0 0 0 0 0 0 109 Ibufropen syr 0 0 0 0 0 JUMLAHJUMLAH 0 0 0 0 0 0 109
0 0 0 0 0 0 0 0 110 Haloporidol Decanoate Inj 50mg 0 0 0 0 0 0 51 0 0 0 0 0 51 110
0 0 0 0 0 0 0 500 111 Isosorbid Dinitrat Tab. Sub. 5 mg 0 0 0 900 900 0 0 0 0 0 0 0 1800 111
0 100 0 0 0 0 0 100 112 Ketokonazol krem 40 0 0 0 0 0 60 0 25 30 65 25 245 112
500 1000 0 0 0 0 0 3500 113 Ketokonazol tab 200mg 450 950 450 450 450 0 0 150 150 350 150 350 3900 113
0 0 0 0 0 0 0 0 114 Ketorolac Inj 30mg 0 0 20 20 10 5 0 0 47 10 26 10 148 114
0 0 0 0 0 0 0 3000 115 Kalsium Laktat (Kalk) Tablet 500 mg 1300 0 0 1800 1100 0 0 0 0 0 0 0 4200 115
0 0 0 0 0 0 0 0 116 KN-3B 0 18 18 0 2 10 50 0 0 0 0 0 98 116
0 0 0 0 0 0 0 0 117 Karbihidrat +Elektrolit 0 0 0 0 0 650 650 0 0 0 0 0 1300 117
0 0 0 0 0 0 0 48 118 Karbogliserin Tetes telinga 0 0 36 0 0 20 10 0 0 0 0 0 66 118
0 0 0 0 0 0 0 0 119 Kloramfenikol tetes Mata 0 0 0 0 0 200 0 0 0 0 0 0 200 119
0 2500 0 0 0 0 0 12500 120 Klorfeniramin Maleat (CTM) Tab. 4 mg 1500 2300 3400 2300 1300 0 1000 1000 1000 0 0 2000 15800 120
0 0 0 0 0 0 0 0 121 Klozapine 25 Mg 0 0 0 0 150 0 0 0 0 0 0 0 150 121
0 0 0 0 0 0 0 0 122 Klorpromazin HCL Inj. 25 mg/ml- 1ml 0 0 0 0 0 0 48 0 0 0 0 0 48 122
0 0 0 0 0 0 0 0 123 Klorpromazin HCL Tablet Salut 25 mg 0 0 0 0 0 0 0 200 380 300 0 0 880 123
0 0 0 0 0 0 0 300 124 Klorpromazin HCL Tablet Salut 100 mg 200 200 100 0 300 2400 1550 0 380 300 0 0 5430 124
0 0 0 0 0 0 0 0 125 klorpeson Slasf 0 0 0 0 0 548 300 0 0 0 0 0 848 125
0 0 0 0 0 0 0 0 126 Komb. Artesunate 50mg+Amodiaquin 200mg 0 0 0 0 0 0 0 0 0 0 0 0 0 126
1000 2000 0 0 0 0 0 7000 127 Kotrimoksazol Tablet 480mg 250 0 0 1800 1200 0 0 0 0 0 700 400 4350 127
0 0 0 0 0 0 0 0 Kotrimoksazol Suspensi Kombinasi 0 120 0 0 0 100 85 85 110 100 0 0 600

128 128
2000 2000 0 0 0 0 0 7500 129 Metpormin 500mg 1000 1500 200 0 800 0 0 0 0 0 0 0 3500 129
0 0 0 0 0 0 0 0 130 Methyilprednisolon 8mg 0 0 0 0 0 0 0 0 0 0 0 0 0 130
0 96 0 0 0 0 0 96 131 Kloramfenikol Salep Mata 1%-5gram 25 0 20 0 50 2000 50 40 70 55 40 55 2405 131
0 0 0 0 0 0 0 0 132 Kloramfenikol Tetes Telinga 3%-5ml 0 0 0 0 15 11 0 20 40 15 17 20 138 132
0 0 0 0 0 0 0 0 133 Kuinin Injeksi 25%-2ml 0 0 0 0 0 1700 900 0 0 0 0 0 2600 133
96 96 0 0 0 0 0 264 134 Levoploxasin 500mh 0 0 0 20 37 0 0 100 100 100 100 100 557 134
0 90 0 0 0 0 0 280 135 Lidokain Komp. Injeksi, Kombinasi 0 60 0 20 115 9 61 20 100 20 100 20 525 135
0 0 0 0 0 0 0 0 136 Lisol, Kresol Tersabun 50%- 1000ml 0 0 0 0 0 0 0 0 0 0 0 0 0 136
0 0 0 0 0 0 0 1000 137 Loperamide Hcl 2mg Tanlet 200 0 0 450 450 0 0 0 0 0 300 300 1700 137
0 0 0 0 0 0 0 0 138 Magnesium Sulfat Injk 25 ml 2 0 0 6 0 39 75 0 0 0 0 0 122 138
0 0 0 0 0 0 0 9000 139 Metamizol 500mg 2100 2500 2300 0 1000 75 60 0 0 0 0 0 8035 139
0 0 0 0 0 0 0 1500 140 Metilergometrin Maleat Tab. 0,125 g 900 0 450 0 0 0 0 0 0 0 0 0 1350 140
0 100 0 0 0 0 0 200 141 Metilergometrin M inj. 0,200mg- 1ml 0 27 0 27 27 450 0 0 0 0 0 0 531 141
0 0 0 0 0 0 0 0 142 Metoklorpropamid Tablet 10 mg 0 0 0 0 0 6 0 300 280 320 280 120 1306 142
0 96 0 0 0 0 0 144 143 Mikonazol Krim/ Salep 2%-10gram 36 0 48 10 10 900 1000 9 0 0 0 0 2013 143
0 0 0 0 0 0 0 200 144 Multivitamin Anak 50 10 71 20 55 0 270 45 55 41 55 41 713 144
0 0 0 0 0 0 0 0 145 Multivitamin Dewasa 0 0 0 0 0 59 27 200 300 200 150 0 936 145
0 0 0 0 0 0 0 0 146 Metronidazol Infus 500mg/100ml 0 0 0 0 0 0 0 0 0 10 10 10 30 146
0 0 0 0 0 0 0 0 147 Metronidazol Tablet 500mg 0 0 0 0 0 3 37 450 350 450 350 450 2090 147
60 120 0 0 0 0 0 300 148 Metokloramid Syr 0 28 20 15 40 5 0 0 0 0 0 0 108 148
0 0 0 0 0 0 0 0 149 Metronidazol syr 0 0 0 0 0 0 0 0 0 0 0 0 0 149
0 0 0 0 0 0 0 0 150 Natrium Bikarbonat Tablet 500mg 0 0 0 0 0 0 0 0 0 0 0 0 0 150
80 80 0 0 0 0 0 240 151 Natrum Klorida Lar. Inf. 0,9% -500ml 20 10 18 18 20 10 0 13 27 13 0 13 162 151
0 0 0 0 0 0 0 0 152 Natrium Diclopenac 20mg 0 0 0 0 0 30 105 0 0 0 0 0 135 152
0 0 0 0 0 0 0 0 153 Nistatin Vaginal 20 0 0 0 0 15 25 0 0 0 0 0 60 153
0 0 0 0 0 0 0 0 154 Nistatin Tablet Salut 500.000 IU 0 0 0 0 0 0 0 0 0 0 750 100 850 154
2000 2000 0 0 0 0 0 11000 155 Natrium Diclopenac 50mg 2750 1150 2000 900 1250 20 47 0 0 0 0 0 8117 155
0 0 0 0 0 0 0 0 156 Nifedipine Tab 10mg 0 0 0 0 0 0 0 0 0 0 0 0 0 156
0 0 0 0 0 0 0 8800 157 Multivitamin Anti Oksidan 2200 2200 1700 1600 1600 0 5 0 0 0 0 0 9305 157
0 0 0 0 0 0 0 0 158 Obat Anti Tuberkulosis Kat. 1 (FDC) 0 0 0 0 0 0 0 0 0 0 0 0 0 158
0 0 0 0 0 0 0 0 159 Obat Anti Tuberkulosis Kat. 2 0 0 0 0 0 0 0 0 0 0 0 0 0 159
0 0 0 0 0 0 0 0 160 Obat Anti Tuberkulosis Kat.Anak 0 0 0 0 0 0 0 0 0 0 0 0 0 160
0 0 0 0 0 0 0 0 161 Ofloksasin Tetes telinga 0 0 0 0 4 0 0 0 15 20 15 20 74 161
0 50 0 0 0 0 0 50 162 Omeprazol inj 40mg/10ml 0 0 0 0 0 0 Err:509 0 0 0 0 300 Err:509 162
900 1500 0 0 0 0 0 10200 163 Omeprazol Kapsul 20mg 1760 1800 1920 870 1600 0 Err:509 0 20 30 20 30 Err:509 163
0 0 0 0 0 0 0 0 164 Ondansetron Inj 4mg 0 0 0 0 0 0 JUMLAH 0 0 0 200 0 200 164
0 0 0 0 0 0 0 0 165 Onadansetron 8mg Tablet 0 0 0 0 0 JUMLAHErr:509 0 0 0 200 0 Err:509 165
0 900 0 0 0 0 0 1740 166 Onadansetron 4mg Tablet 72 240 540 0 60 0 0 0 0 0 0 0 912 166
0 0 0 0 0 0 0 12000 167 Obat Batuk Flu Dewasa 3300 3300 3200 2550 1200 0 0 0 0 0 0 0 13550 167
0 0 0 0 0 0 0 0 168 Obat Batuk Hitam (OBH) Cairan 0 0 0 0 0 0 0 30 30 30 0 0 90 168
0 0 0 0 0 0 0 180 169 Obat Batuk Dewasa syr 0 0 0 80 47 0 3 0 0 0 0 0 130 169
0 0 0 0 0 0 0 0 170 Oksitetrasiklin HCL Inj. i.m 50mg10ml 0 0 0 0 0 1650 1410 0 0 0 0 0 3060 170

TAHUN 2019
BULAN BULAN
September
September
Jumlah
Jumlah
November
November
Desember
Desember
Pebruari
Oktober
Oktober
Agustus
Agustus
NO NAMA OBAT NO
Januari
Maret
April
Juni
Juni
Mei
Juli
Juli
0 0 0 0 0 0 0 0 171 Oksitetrasiklin HCL SM 1%-3,5gram 0 0 0 0 0 0 0 0 0 0 0 0 0 171
0 0 0 0 0 0 0 0 172 Oksitetrasiklin HCL Salep 3%- 5gram 0 0 0 0 20 20 0 11 0 0 0 0 51 172
100 100 0 0 0 0 0 400 18 1 4 5 0 0 0 0 0 0 0 0 133
173 Oksitosin Injeksi 10 IU/ml- 1ml 8 3 4 173
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
174 OBAT Anti Diare suspensi 174
8 1 2 8
0 0 0 0 0 0 0 168 175 parasetamol drops 15 ml 10 3 5 1
140 150 140 150 0 0 160 951 175
6 0 5 0
3
200 200 0 0 0 0 0 2300 176 Parasetamol Syrup 120mg/ 5ml-60ml 210 4 5 5 0 50 50 0 0 0 0 1385 176
0
0 0 5
0 0 0 0 0 0 0 0 177 Parasetamol tab 100mg 0 7 0 0
7 0
5 2000 1000 2000 1500 6000 5000 4100 5000 26600 177
4 4 7
3500 7000 0 0 0 0 0 48300 178 Parasetamol Tablet 500mg 6800 0 0 0 0 0 0 0 0 27400 178
5 5 0
0 0 0 0 0 0 0 0 179 Permetin Krim/Skabisid 5 % 0 0 0 0 0 0 0 0 0 0 0 0 0 0 179
0 0 0 0 0 0 0 0 180 pirantel syr 0 0 0 0 200 100 200 100 100 100 200 100 1100 180
0 0 0 0 0 0 0 0 181 Pirantel Tablet 125mg 0 0 0 0 750 250 750 250 750 250 0 0 3000 181
0 0 0 0 0 0 0 0 182 piroksikam Tablet 10 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 182
0 0 0 0 0 0 0 0 183 Piroksikam Tablet 20 mg 0 0 0 0 0 0 0 0 0 0 0 0 0 183
0 0 0 0 0 0 0 0 184 Propiltiourasil Tablet 100mg 0 0 0 0 1900 1500 1900 1100 1900 1100 1900 1100 12400 184
1
0 1000 0 0 0 0 0 1000 185 Piridoksin HCL (Vit. B6) Tablet 10mg 250 0 5 0 0 2 0 0 0 0 0 0 402 185
0
0 0 0 0 0 0 0 0 186 Povidon Iodida 10% 300ml 4 0 0 2 0 0 0 0 0 0 0 0 6 186
0 0 0 0 0 0 0 0 187 Povidon Iodida 10% 1000ml 0 0
1 0
2 0
2 2800 1500 2800 200 2800 1000 2800 1000 14900 187
8 4 3
0 0 0 0 0 0 0 11000 188 Prednison Tablet 5mg 2000 0 0 0 0 0 0 0 0 8500 188
0 0 0
0 0 0 0 0 0 0 0 189 Primakuin Tablet 15mg 0 0 0 0 0 0 0 0 0 0 0 0 0 189
0 0 0 0 0 0 0 0 190 Prokain Benzil Penisilin 3 Juta IU Inj. 0 0 0 0 50 100 50 100 310 100 0 0 710 190
0 0 0 0 0 0 0 0 191 propanolol HCL Tablet 10mg 1000 0 0 0 0 0 0 0 0 0 0 0 1000 191
0 0 0 0 0 0 0 0 192 Propanolol HCL Tablet 40mg 0 0 0 0 0 0 0 0 0 0 0 0 0 192
0 0 0 0 0 0 0 0 193 Povidon Iodida 10% 60ml 0 0 0 0 0 0 0 0 0 0 0 0 0 193
0 0 0 0 0 0 0 500 194 Retinol (Vitamin A) Kapsul 100.000 IU 650 0 0 0 0 0 0 0 0 0 0 0 650 194
0 0 0 0 0 0 0 0 195 Retinol (Vitamin A) Kapsul 200.000 IU 4000 0 0 0 0 0 0 0 0 0 0 0 4000 195
0 0 0 0 0 0 0 0 196 MDT MB/ Kusta Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 196
0 0 0 0 0 0 0 0 197 MDT PB/ Kusta Dewasa 0 0 0 0 0 0 0 0 0 0 0 0 0 197
0 0 0 0 0 0 0 0 198 Risperidon 2mg 0 0 0 0 10 40 10 20 0 0 0 0 80 198
3 4 3
0 0 0 0 0 0 0 300 199 Ranitidin Injeksi 25 mg/ 2ml 50 2 1 2 700 100 700 300 0 0 0 0 1955 199
0
0 0
4 5
8 5
2000 2000 0 0 0 0 0 14500 200 Ranitidin Tablet 150 mg 2900 60 35 0 0 0 0 0 9295 200
0 0 5 0
6 6 9
0 80 0 0 0 0 0 640 201 Ringer Laktat Lar. Inf. Steril - 500ml 136 0 0 0 500 100 80 0 0 0 0 0 1034 201
8
9 0
9 0
0 500 0 0 0 0 0 2500 202 Salbutamol Tablet 2mg 900 0
1 0 0 550 50 100 50 200 200 200 200 4250 202
9 5
0 0
0 1000 0 0 0 0 0 3500 203 Salbutamol Tablet 4mg 1150 0 0 24 24 24 24 0 0 0 0 3646 203
0
2 0 0
0 0 0 0 0 0 0 0 204 Salep 2-4, Kombinasi 10 0 0 0 68 32 0 0 0 0 0 0 134 204
4
2 2
0 0 0 0 0 0 0 100 205 Salisil Bedak 2% 20 0 2 1 2 0 2 2 3 6 83 205
0 5
5 10 0 0 0 0 0 20 206 Serum Anti Bisa Ular Polivalen Inj.5ml 5 3 5 5 0 0 0 0 0 0 0 0 18 206
1
0 0 0 0 0 0 0 0 207 Stimuno 14 9 0 0 0 0 0 3 0 0 0 45 207
9
0 10 0 0 0 0 0 30 208 Serum Anti Tetanus Inj. 1500 IU/amp. 11 0 0 0 0 0 0 0 0 0 0 0 11 208
6 3
0 0 0 0 0 0 0 0 209 Sukrafat 500mg 0 0 0 0 30 35 30 35 65 35 330 209
5 5
2
0 0 0 0 0 0 0 0 210 Sianokobalamin (Vit. B12) Inj 500mcg 20 0 5 100 300 20 0 100 400 100 200 1265 210
0
0 0 0 0 0 0 0 1000 211 Simvastatin Tablet 20 mg 500 0 0 0 100 200 100 200 100 250 100 0 1550 211
3
0 0 0 0 0 0 0 2400 212 Simvastatin Tablet 10 mg 500 1000 0 0 0 0 0 0 0 0 0 0 1800 212
0
0 100 0 0 0 0 0 100 213 Sukralfat Syr 0 0 0 0 0 38 0 0 0 0 0 0 38 213
0 0 0 0 0 0 0 0 214 Sulfasetamida Natrium TM 15%- 5ml 0 0 0 0 0 0 0 0 0 0 0 0 0 214
40 60 0 0 0 0 0 120 215 Sabutamol Nebulizer 0 0 0 0 0 0 0 0 0 0 0 0 0 215
0 0 0 0 0 0 0 0 216 Spiranolakton tab 0 0 0 0 0 0 0 0 0 0 0 0 0 216
0 0 0 0 0 0 0 0 217 Salf Kombinasi 0 0 0 0 85 35 0 0 0 0 0 0 120 217
0 0 0 0 0 0 0 0 218 Sinbio 0 0 0
1 0 0 0 0 0 0 0 0 0 0 218
1
7
0 0 0 0 0 0 0 3720 219 Setrizin tablet 10 mg 1300 700 300 200 100 200 0 200 200 0 0 4980 219
4
8
15120 15120 0 0 0 0 0 87360 220 Tablet Tambah Darah Komb. 16350 900 8
0 13000 0 0 0 0 0 0 0 0 45120 220
7
0
0 0 0 0 0 0 0 0 221 Tetrakain HCL Tetes Mata 0.5%- 5ml 0 0 0 0 850 150 850 0 1200 800 0 0 3850 221
0 0 0 0 0 0 0 0 222 Tetrasiklin HCL Kapsul 250 mg 700 0 0 0 200 200 200 100 0 0 0 0 1400 222
0 0 0 0 0 0 0 0 223 Tetrasiklin HCL Kapsul 500 mg 0 0 1
0 0 2700 1300 2000 500 1400 600 0 0 8500 223
8
0 0 0 0 0 0 0 6000 224 Tiamin HCL/(Vit. B1) Tab. 50mg 1100 2100 600 0 0 0 0 0 0 0 0 5600 224
0
0 0 0 0 0 0 0 0 225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml 30 0 0 0 0 0 0 0 0 0 0 0 30 225
4
1500 0 0 0 0 0 0 2500 226 Triheksifenidil Hidroklorida Tab. 2mg 200 200 0
2 0 0 0 0 0 0 0 0 0 800 226
0
8
0 2000 0 0 0 0 0 11500 227 Vitamin B Komplek Tablet 3000 2200 2200 0 0 0 0 0 0 0 0 10200 227
0
1
0 0 0 0 0 0 0 0 228 Zink Syr 32 10 0 0 3700 1300 3700 300 3700 800 0 600 14153 228
1
0 0 0 0 0 0 0 0 229 Zink Tablet 20mg 450 350 0 0 200 300 200 300 0 0 0 190 1990 229
0 0 0 0 0 0 0 PERBEKALAN KESEHATAN 0 0
1
0 100 0 0 0 0 0 300 1 Alat Suntik Sekali Pakai 1 ml 50 30 0 0 0 0 0 0 30 50 0 50 310 1
9
0
300 0 2 Alat Suntik Sekali Pakai 2.5 ml 0 0
1
140
0
200 300 0 0 0 0 0 1200 3 Alat Suntik Sekali Pakai 3 ml 290 310 5 50 280 120 200 0 230 100 0 0 1730 2
0 200 0 0 0 0 0 200 Alat Suntik Sekali Pakai 5 ml 20 40
0
0 20 200 0 200 30 200 30 0 0 740
4 3
0 0 0 0 0 0 0 144 Catgut/ Benang Bedah No. 2/0 10 8
1 12 5 5 5 19 10 19 0 19 130
5 8 4
5
0 100 0 0 0 0 0 300 6 I.V. Catheter No. 20 48 53 18 10 10 10 10 15 19 0 19 262 5
0
3
200 0 0 0 0 0 0 400 7 I.V. Catheter No. 22 55 50 40 10 10 10 0 15 20 0 20 265 6
5
1
0 0 0 0 0 0 0 100 8 I.V. Catheter No. 24 0 20 20 10 10 10 10 15 15 0 15 140 7
5
7
0 0 0 0 0 0 0 200 9 I.V. Cateter No 26 10 30 0 20 20 20 30 0 0 0 30 230 8
0
3
0 100 0 0 0 0 0 100 10 Infusion Set Anak 10 18 10 15 30 15 15 0 0 0 30 181 9
8
8
200 200 0 0 0 0 0 900 11 Infusion Set Dewasa 118 78 68 0 0 0 0 0 0 0 0 344 10
1
0
0 0 0 0 0 0 0 1000 12 E.Care Film I.V Dresing 0 200 0 300 0 0 0 0 0 0 0 0 600 11
1
0
0 0 0 0 0 0 0 0 13 Silk (Benang Bedah Sutera) No. 3/0 0 10 5 0 0 0 0 0 0 0 0 25 12
0
0 5 0 0 0 0 0 29 14 Policlean Handrub 0 0 6 0 0 0 0 0 0 0 0 0 6 13
0 0 0 0 0 0 0 10 15 Kapas Pembalut/Absorben 250 gram 0 1 0 1 10 30 0 0 0 0 20 20 82 14
0 0 0 0 0 0 0 0 16 Kasa Kompres 40/40 93 0 0 0 5 5 5 20 0 0 0 20 148 15
0 0 0 0 0 0 0 100 17 Kasa Pembalut 2 m x 80 cm 0 0 0 0 10 20 0 0 0 0 0 20 50 16
0 0 0 0 0 0 0 8 18 Kasa Pembalut Hidrofil 36 m x 80 cm 0 2 3 0 10 20 10 30 50 100 50 50 325 17
0 10 0 0 0 0 0 410 19 Kasa Steril 16/16 100 45 0 45 0 0 0 50 150 100 0 100 590 18
3
500 500 0 0 0 0 0 2200 20 Masker 0 250 5 150 3 3 3 3 3 3 0 5 773 19
2
0
0 12 0 0 0 0 0 48 21 Plester 5 yard x 2 inch 15 23 11 50 50 50 50 80 50 95 50 544 20
0
0 0 0 0 0 0 0 0 22 Sarung Tangan No 7 Steril 0 0 0 0 20 16 20 0 0 0 0 10 66 21

TAHUN 2019
BULAN BULAN
September
September
Jumlah
Jumlah
November
November
Desember
Desember
Pebruari
Oktober
Oktober
Agustus
Agustus
NO NAMA OBAT NO
Januari
Maret
April
Juni
Juni
Mei
Juli
Juli
0 0 0 0 0 0 0 300 23 Sarung Tangan No 6.5 Steril 50 150 100 200 0 0 0 0 0 0 0 0 500 22
10 10 0 0 0 0 0 30 24 Sarung tangan no 6 1/2 0 0 0 0 0 0 0 0 0 0 0 0 0 23
40 50 0 0 0 0 0 130 25 Folly cateter No 16 5 12 0 15 0 0 0 0 0 0 0 0 32 24
0 0 0 0 0 0 0 0 26 Folly cateter No 14 0 0 0 0 0 0 0 0 0 0 0 0 0 25
120 100 0 0 0 0 0 300 27 Sarung tangan Gynecolog no 7 0 0 0 80 0 0 0 0 0 0 0 0 80 26
10 10 0 0 0 0 0 35 28 Alkohol Swab 4 4 2 2 0 0 0 0 0 0 0 0 12 27
0 100 0 0 0 0 0 350 29 Underpad 20 60 70 15 0 0 0 0 0 0 0 0 165 28
40 0 0 0 0 0 0 130 30 Urine Bag 0 6 5 15 0 0 0 0 0 0 0 0 26 29
0 72 0 0 0 0 0 180 31 Catgut/ Benang Bedah No. 3/0 0 0 10 10 0 0 0 0 0 0 0 0 20 30
0 3 0 0 0 0 0 8 32 Antiseptik Surgical Hand Scrab 5 0 0 0 0 0 0 0 0 0 0 0 5 31
0 0 0 0 0 0 0 6 33 Cairan pembersih 0 0 0 0 0 0 0 0 0 0 0 0 0 32
20 0 0 0 0 0 0 70 34 Jely kateter 0 3 0 0 0 0 0 0 0 0 0 0 3 33
35 Jarum Insulin 0 0 0 0 34
III OBAT GIGI III
1 Air Raksa Dental Use Botol 1
2 Etil Klorida Semprot-100 ml 2
3 Eugenol Cairan - 10 ml 3
4 Forinokresol 4
5 Glass Ionomer Cement (GC IX) 5
6 Gutta Percha Point 6
7 Kalsium Hidroksida Pasta 7
8 Monoklorkamfer Menthol Cairan 10ml 8
9 Semen Seng Fosfat Srbk dan Cairn30 gr 9
10 Silver Amalgan 10
11 Temporary SF Serbuk & Cairan -100 gr 11
Mengetahui
Pengelola Obat Kepala Puskesmas Pengelola Obat
YUYUN YUNENGSIH, S.Kep Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep

NIP. 19820422 200801 2 006 NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN OBAT LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN OBAT
TAHUN 2015 TAHUN 2015
JUMLAH
NAMA OBAT PEMAKAIAN RATA-RATA 10% KEBUTUHAN NO NAMA OBAT PENERIMAAN RATA-RATA PEMAKAIAN
TAHUN DEPAN
Alopurinol tablet 100 mg 2500 208.3 250.0 2750.0 1 Alopurinol tablet 100 mg 1000 208.4 2500
Aminofilin tablet 200 mg 400 33.3 40.0 440.0 2 Aminofilin tablet 200 mg 0 8.5 400
Albendazol 11270 939.2 1127.0 12397.0 3 Albendazol 10650 887.8 11270
Aminofilin injeksi 24mg/ml-10ml 120 10.0 12.0 132.0 4 Aminofilin injeksi 24mg/ml-10ml 0 0.3 120
Amitriptilin HCL Tab. Salut 25 mg 300 25.0 30.0 330.0 5 Amitriptilin HCL Tab. Salut 25 mg 0 0.4 300
Amlodipine 10 mg Tablet 5180 431.7 518.0 5698.0 6 Amlodipine 10 mg Tablet 3900 497.2 5180
Amlodipine Besilate 5mg tablet 4520 376.7 452.0 4972.0 7 Amlodipine Besilate 5mg tablet 3000 275.6 4520
Alkacide 1 L High Level Desinfectant(Alkapham Ferance) 1 0.1 0.1 1.1 8 Alkacide 1 L High Level Desinfectant(Alkapham Ferance) 3 0.9 1
Amoksisillin Kapsul 500 mg 46000 3833.3 4600.0 50600.0 9 Amoksisillin Kapsul 500 mg 32500 4184.1 46000
Amoksisillin SK 125 mg/5 ml-60 ml 890 74.2 89.0 979.0 10 Amoksisillin SK 125 mg/5 ml-60 ml 0 0.8 890
Alkazyme Sachet 25mg(Alkapham France) 101 8.4 10.1 111.1 11 Alkazyme Sachet 25mg(Alkapham France) 5 1.3 101
Amoksilin sk Forte 1400 116.7 140.0 1540.0 12 Amoksilin sk Forte 2040 245.2 1400
Ampisillin Injeksi 1 gram 180 15.0 18.0 198.0 13 Ampisillin Injeksi 1 gram 0 1.1 180
Antalgin (Metampiron) Tab. 500 mg 500 41.7 50.0 550.0 14 Antalgin (Metampiron) Tab. 500 mg 0 1.2 500
Antasida DOEN tablet 34200 2850.0 3420.0 37620.0 Antasida DOEN tablet 27500 3676.3 34200
15
Antasida DOEN suspensi 1550 129.2 155.0 1705.0 Antasida DOEN suspensi 1900 213.8 1550
16
Anti Bakteri DOEN Salep Kombinasi (basitrasin) 175 14.6 17.5 192.5 Anti Bakteri DOEN Salep Kombinasi (basitrasin) 0 3.5 175
17
Anti Hemoroid DOEN Kombinasi 10 0.8 1.0 11.0 18 Anti Hemoroid DOEN Kombinasi 0 1.5 10
Antifungi DOEN Kombinasi 0 0.0 0.0 0.0 Antifungi DOEN Kombinasi 0 1.6 0
19
Antimigren DOEN Kombinasi 100 8.3 10.0 110.0 Antimigren DOEN Kombinasi 300 26.7 100
20
0 0.0 0.0 0.0 0 1.8 0

Antiparkinson DOEN tab. Kombinasi 21 Antiparkinson DOEN tab. Kombinasi
Aqua roinjek Steril 44 3.7 4.4 48.4 22 Aqua roinjek Steril 30 5.2 44
Acyclopir Krim 5%- 5gr 178 14.8 17.8 195.8 23 Acyclopir Krim 5%- 5gr 50 15.3 178
Acyclopir Tablet 200mg 1900 158.3 190.0 2090.0 24 Acyclopir Tablet 200mg 0 77.0 1900
Acyclopir Tablet 400 mg 1600 133.3 160.0 1760.0 25 Acyclopir Tablet 400 mg 200 35.4 1600
Akita/Molagit Tablet 1200 100.0 120.0 1320.0 26 Akita/Molagit Tablet 1000 85.5 1200
Antalgin (Metampiron) Inj. 250mg/2ml 0 0.0 0.0 0.0 27 Antalgin (Metampiron) Inj. 250mg/2ml 0 2.3 0
Asam asetilsalisilat 100mg tablet 400 33.3 40.0 440.0 28 Asam asetilsalisilat 100mg tablet 0 2.3 400
Asam Mefenamat 500mg 15700 1308.3 1570.0 17270.0 29 Asam Mefenamat 500mg 16000 2027.4 15700
Alprazolam 1mg 0 0.0 0.0 0.0 30 Alprazolam 1mg 0 2.5 0
Ambroksol tab 0 0.0 0.0 0.0 31 Ambroksol tab 0 2.6 0
Ambroksol syr 0 0.0 0.0 0.0 32 Ambroksol syr 0 2.7 0
Asam Askorbat (Vit. C) Tablet 50 mg 3700 308.3 370.0 4070.0 33 Asam Askorbat (Vit. C) Tablet 50 mg 2400 402.8 3700
Asering Infus 61 5.1 6.1 67.1 34 Asering Infus 40 7.8 61
Asam Folat tablet 01mg 1550 129.2 155.0 1705.0 35 Asam Folat tablet 01mg 1000 86.3 1550
Asam Folat tablet 5 mg 800 66.7 80.0 880.0 36 Asam Folat tablet 5 mg 0 3.0 800
Artesunat Inj 0 0.0 0.0 0.0 37 Artesunat Inj 0 3.1 0
Asam traneksamat Inj 5 % 50 4.2 5.0 55.0 38 Asam traneksamat Inj 5 % 50 9.8 50
Asetosal Tablet 500 mg 0 0.0 0.0 0.0 39 Asetosal Tablet 500 mg 0 3.3 0
Atropin Sulfat Inj. 0,25 mg/ml - 1 ml 0 0.0 0.0 0.0 40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml 200 20.0 0
Atropin Sulfat Tablet 0,5 mg 100 8.3 10.0 110.0 41 Atropin Sulfat Tablet 0,5 mg 0 3.4 100
Atropin Sulfat Tetes Mata 1% - 5 ml 0 0.0 0.0 0.0 42 Atropin Sulfat Tetes Mata 1% - 5 ml 0 3.5 0
Alkohol 70% 1 Liter 4 0.3 0.4 4.4 43 Alkohol 70% 1 Liter 3 3.9 4
Betadin Salf Antiseptik 18 1.5 1.8 19.8 44 Betadin Salf Antiseptik 0 3.7 18
Betametason Krim 0,1% - 5 gr 522 43.5 52.2 574.2 45 Betametason Krim 0,1% - 5 gr 350 50.1 522
Bisacodril sup 120 10.0 12.0 132.0 46 Bisacodril sup 0 4.0 120
Bisoprolol 2,5mg tab 360 30.0 36.0 396.0 47 Bisoprolol 2,5mg tab 0 3.9 360
Captopril Tablet 12,5 mg 6750 562.5 675.0 7425.0 48 Captopril Tablet 12,5 mg 5300 629.0 6750
Captopril Tablet 25 mg 1900 158.3 190.0 2090.0 49 Captopril Tablet 25 mg 0 141.6 1900
Carbamazefine Err:509 Err:509 Err:509 Err:509 50 Carbamazefine 1000 120.8 Err:509
Cefadroxil 500mg #VALUE! #VALUE! #VALUE! #VALUE! 51 Cefadroxil 500mg 0 4.3 0
Cetrizin syr 0 0.0 0.0 0.0 52 Cetrizin syr 0 4.3 0
Cefixim 0 0.0 0.0 0.0 53 Cefixim 0 4.4 0
Ciprofloxacin Infus 0 0.0 0.0 0.0 54 Ciprofloxacin Infus 0 4.5 0
Ciprofloxacin Tablet 500mg 9050 754.2 905.0 9955.0 55 Ciprofloxacin Tablet 500mg 10000 1283.8 9050
D-Artepp Tab 0 0.0 0.0 0.0 56 D-Artepp Tab 0 4.7 0
Deksametasone Injeksi 5 mg/ml - 1ml 1705 142.1 170.5 1875.5 57 Deksametasone Injeksi 5 mg/ml - 1ml 100 14.8 1705
Deksametasone Tablet 0,5 mg 18900 1575.0 1890.0 20790.0 58 Deksametasone Tablet 0,5 mg 20000 2588.2 18900
Dekstromethorfan Sirup 10 mg/ 60 ml 20 1.7 2.0 22.0 59 Dekstromethorfan Sirup 10 mg/ 60 ml 0 4.9 20
Diazetpam Rectal 2mg 5800 483.3 580.0 6380.0 60 Diazetpam Rectal 2mg 0 5.0 5800
Diazepam Injeksi 5 mg/ml - 2ml 10 0.8 1.0 11.0 61 Diazepam Injeksi 5 mg/ml - 2ml 0 5.1 10
Diazepam Tablet 2 mg 100 8.3 10.0 110.0 62 Diazepam Tablet 2 mg 0 5.2 100
20 1.7 2.0 22.0 100 13.6 20

Diazepam Tablet 5 mg 63 Diazepam Tablet 5 mg
Dietilkarbamazin Sitrat Tablet 100 mg 0 0.0 0.0 0.0 64 Dietilkarbamazin Sitrat Tablet 100 mg 0 5.3 0
Difenhidramin HCL Inj. 10 mg/ml- 1 ml 100 8.3 10.0 110.0 65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml 0 5.4 100
Digoksin Tablet 0,25 mg 1300 108.3 130.0 1430.0 66 Digoksin Tablet 0,25 mg 200 22.2 1300
Domperidon 10 mgtablet 943 78.6 94.3 1037.3 67 Domperidon 10 mgtablet 0 63.9 943
Dimenhidrinat Tablet 50 mg 270 22.5 27.0 297.0 68 Dimenhidrinat Tablet 50 mg 0 5.7 270
Dasabion Tablet 0 0.0 0.0 0.0 69 Dasabion Tablet 0 5.8 0
Domperidon Suspensi 5mg/ 5ml- 60ml 6 0.5 0.6 6.6 70 Domperidon Suspensi 5mg/ 5ml- 60ml 0 6.3 6
Efedrin HCL Tablet 25 mg 0 0.0 0.0 0.0 71 Efedrin HCL Tablet 25 mg 0 5.9 0
Ekstrak Belladona Tablet 10 mg 3900 325.0 390.0 4290.0 72 Ekstrak Belladona Tablet 10 mg 0 6.0 3900
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml 0 0.0 0.0 0.0 73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml 100 14.4 0
Etakridin (Rivanol) Lar. 0,1%-300 ml 61 5.1 6.1 67.1 74 Etakridin (Rivanol) Lar. 0,1%-300 ml 24 8.2 61
Lisinofril 10 mg 5 0.4 0.5 5.5 75 Lisinofril 10 mg 0 6.3 5
Lisinofril 5mg 18 1.5 1.8 19.8 76 Lisinofril 5mg 0 6.3 18
Etanol 70%- 100 ml 0 0.0 0.0 0.0 77 Etanol 70%- 100 ml 0 6.4 0
Eritromisin Kapsul 500 mg 0 0.0 0.0 0.0 78 Eritromisin Kapsul 500 mg 0 6.5 0
Eritromisin Syrup 200 mg/5 ml-60 ml 0 0.0 0.0 0.0 79 Eritromisin Syrup 200 mg/5 ml-60 ml 0 6.6 0
Fenitoin Natrium Injeksi 50 mg/ 1 ml 270 22.5 27.0 297.0 80 Fenitoin Natrium Injeksi 50 mg/ 1 ml 0 6.7 270
Fenitoin Natrium Kapsul 100 mg 51 4.3 5.1 56.1 81 Fenitoin Natrium Kapsul 100 mg 0 6.8 51
Fenitoin Natrium Kapsul 30 mg 0 0.0 0.0 0.0 82 Fenitoin Natrium Kapsul 30 mg 0 6.8 0
Fenobarbital Injeksi- 2ml 0 0.0 0.0 0.0 83 Fenobarbital Injeksi- 2ml 0 6.9 0
Fenobarbital Tablet 30 mg 0 0.0 0.0 0.0 84 Fenobarbital Tablet 30 mg 0 7.0 0
Fenobarbital Tablet 30 mg 70 5.8 7.0 77.0 85 Fenobarbital Tablet 30 mg 0 7.1 70
LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN OBAT LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN
JUMLAH
TAHUN DEPAN
Fenoksimetil Penisilina Tablet 250 mg 100 8.3 10.0 110.0 86 Fenoksimetil Penisilina Tablet 250 mg 0 7.2 100
Fluflenazine decanoat inj 25mg/ml 0 0.0 0.0 0.0 87 Fluflenazine decanoat inj 25mg/ml 0 7.3 0
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml 70 5.8 7.0 77.0 88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml 0 7.3 70
Fitomenadion (Vit. K1) Tab. 10 mg 855 71.3 85.5 940.5 89 Fitomenadion (Vit. K1) Tab. 10 mg 1500 157.4 855
Gentamisin SM 0 0.0 0.0 0.0 90 Gentamisin SM 0 7.5 0
Furosemida Tablet 40 mg 750 62.5 75.0 825.0 91 Furosemida Tablet 40 mg 400 40.9 750
Garam Oralit 200 ml air 200 16.7 20.0 220.0 92 Garam Oralit 200 ml air 200 32.7 200
Glimepirid 2mg Tablet 650 54.2 65.0 715.0 93 Glimepirid 2mg Tablet 3000 257.8 650
3094 257.8 309.4 3403.4 500 157.8 3094

Glibenklamida Tablet 5 mg 94 Glibenklamida Tablet 5 mg
Asetil Sistein 200mg 24660 2055.0 2466.0 27126.0 95 Asetil Sistein 200mg 26400 3429.6 24660
Glikazid 80 mg 550 45.8 55.0 605.0 96 Glikazid 80 mg 0 8.0 550
Glukosa Lar. Infus 5% Steril - 500 ml 4009 334.1 400.9 4409.9 97 Glukosa Lar. Infus 5% Steril - 500 ml 40 13.1 4009
Glukosa Lar. Infus 10% Steril - 500 ml 175 14.6 17.5 192.5 98 Glukosa Lar. Infus 10% Steril - 500 ml 0 8.2 175
Griseofulvin Tablet 500 mg, 45 3.8 4.5 49.5 99 Griseofulvin Tablet 500 mg, 0 8.3 45
Griseofulvin Tablet 125 mg, Micron 0 0.0 0.0 0.0 100 Griseofulvin Tablet 125 mg, Micron 0 8.3 0
Gentamisin S.K 0.1%-5 gr 0 0.0 0.0 0.0 101 Gentamisin S.K 0.1%-5 gr 0 8.4 0
Gentamisin Injeksi 448 37.3 44.8 492.8 102 Gentamisin Injeksi 96 21.3 448
Haloperidol 2 mg Tablet 2100 175.0 210.0 2310.0 103 Haloperidol 2 mg Tablet 1000 200.3 2100
Haloperidol 5 mg Tablet 0 0.0 0.0 0.0 104 Haloperidol 5 mg Tablet 500 50.3 0
Hidroklortiazid (HCT) Tablet 25 mg 300 25.0 30.0 330.0 105 Hidroklortiazid (HCT) Tablet 25 mg 500 50.4 300
Hidrokortison Krim 2,5%-5 gr 155 12.9 15.5 170.5 106 Hidrokortison Krim 2,5%-5 gr 192 36.0 155
Ibuprofen Tablet 200 mg Err:509 Err:509 Err:509 Err:509 107 Ibuprofen Tablet 200 mg 0 50.6 Err:509
Ibuprofen Tablet 400 mg Err:509 Err:509 Err:509 Err:509 108 Ibuprofen Tablet 400 mg 0 9.0 Err:509
Ibufropen syr #VALUE! #VALUE! #VALUE! #VALUE! 109 Ibufropen syr 0 9.1 0
Haloporidol Decanoate Inj 50mg 51 4.3 5.1 56.1 110 Haloporidol Decanoate Inj 50mg 0 9.2 51
Isosorbid Dinitrat Tab. Sub. 5 mg 1800 150.0 180.0 1980.0 111 Isosorbid Dinitrat Tab. Sub. 5 mg 500 50.9 1800
Ketokonazol krem 245 20.4 24.5 269.5 112 Ketokonazol krem 100 21.0 245
Ketokonazol tab 200mg 3900 325.0 390.0 4290.0 113 Ketokonazol tab 200mg 3500 455.3 3900
Ketorolac Inj 30mg 148 12.3 14.8 162.8 114 Ketorolac Inj 30mg 0 11.2 148
Kalsium Laktat (Kalk) Tablet 500 mg 4200 350.0 420.0 4620.0 115 Kalsium Laktat (Kalk) Tablet 500 mg 3000 367.9 4200
KN-3B 98 8.2 9.8 107.8 116 KN-3B 0 12.7 98
Karbihidrat +Elektrolit 1300 108.3 130.0 1430.0 117 Karbihidrat +Elektrolit 0 9.8 1300
Karbogliserin Tetes telinga 66 5.5 6.6 72.6 118 Karbogliserin Tetes telinga 48 16.8 66
Kloramfenikol tetes Mata 200 16.7 20.0 220.0 119 Kloramfenikol tetes Mata 0 9.9 200
Klorfeniramin Maleat (CTM) Tab. 4 mg 15800 1316.7 1580.0 17380.0 120 Klorfeniramin Maleat (CTM) Tab. 4 mg 12500 1651.7 15800
Klozapine 25 Mg 150 12.5 15.0 165.0 121 Klozapine 25 Mg 0 10.1 150
Klorpromazin HCL Inj. 25 mg/ml- 1ml 48 4.0 4.8 52.8 122 Klorpromazin HCL Inj. 25 mg/ml- 1ml 0 10.2 48
Klorpromazin HCL Tablet Salut 25 mg 880 73.3 88.0 968.0 123 Klorpromazin HCL Tablet Salut 25 mg 0 10.3 880
Klorpromazin HCL Tablet Salut 100 mg 5430 452.5 543.0 5973.0 124 Klorpromazin HCL Tablet Salut 100 mg 300 77.0 5430
klorpeson Slasf 848 70.7 84.8 932.8 125 klorpeson Slasf 0 10.4 848
Komb. Artesunate 50mg+Amodiaquin 200mg 0 0.0 0.0 0.0 126 Komb. Artesunate 50mg+Amodiaquin 200mg 0 10.5 0
Kotrimoksazol Tablet 480mg 4350 362.5 435.0 4785.0 127 Kotrimoksazol Tablet 480mg 7000 614.8 4350
Kotrimoksazol Suspensi Kombinasi 600 50.0 60.0 660.0 Kotrimoksazol Suspensi Kombinasi 0 20.7 600
128
Metpormin 500mg 3500 291.7 350.0 3850.0 129 Metpormin 500mg 7500 860.8 3500
Methyilprednisolon 8mg 0 0.0 0.0 0.0 130 Methyilprednisolon 8mg 0 10.8 0
Kloramfenikol Salep Mata 1%-5gram 2405 200.4 240.5 2645.5 131 Kloramfenikol Salep Mata 1%-5gram 96 22.7 2405
Kloramfenikol Tetes Telinga 3%-5ml 138 11.5 13.8 151.8 132 Kloramfenikol Tetes Telinga 3%-5ml 0 11.0 138
Kuinin Injeksi 25%-2ml 2600 216.7 260.0 2860.0 133 Kuinin Injeksi 25%-2ml 0 11.1 2600
Levoploxasin 500mh 557 46.4 55.7 612.7 134 Levoploxasin 500mh 264 33.2 557
Lidokain Komp. Injeksi, Kombinasi 525 43.8 52.5 577.5 135 Lidokain Komp. Injeksi, Kombinasi 280 39.6 525
Lisol, Kresol Tersabun 50%- 1000ml 0 0.0 0.0 0.0 136 Lisol, Kresol Tersabun 50%- 1000ml 0 11.3 0
Loperamide Hcl 2mg Tanlet 1700 141.7 170.0 1870.0 137 Loperamide Hcl 2mg Tanlet 1000 111.4 1700
Magnesium Sulfat Injk 25 ml 122 10.2 12.2 134.2 138 Magnesium Sulfat Injk 25 ml 0 11.7 122
Metamizol 500mg 8035 669.6 803.5 8838.5 139 Metamizol 500mg 9000 1336.6 8035
Metilergometrin Maleat Tab. 0,125 g 1350 112.5 135.0 1485.0 140 Metilergometrin Maleat Tab. 0,125 g 1500 249.2 1350
Metilergometrin M inj. 0,200mg- 1ml 531 44.3 53.1 584.1 141 Metilergometrin M inj. 0,200mg- 1ml 200 30.7 531
Metoklorpropamid Tablet 10 mg 1306 108.8 130.6 1436.6 142 Metoklorpropamid Tablet 10 mg 0 11.8 1306
Mikonazol Krim/ Salep 2%-10gram 2013 167.8 201.3 2214.3 143 Mikonazol Krim/ Salep 2%-10gram 144 30.9 2013
Multivitamin Anak 713 59.4 71.3 784.3 144 Multivitamin Anak 200 39.6 713
Multivitamin Dewasa 936 78.0 93.6 1029.6 145 Multivitamin Dewasa 0 12.1 936
Metronidazol Infus 500mg/100ml 30 2.5 3.0 33.0 146 Metronidazol Infus 500mg/100ml 0 12.2 30
Metronidazol Tablet 500mg 2090 174.2 209.0 2299.0 147 Metronidazol Tablet 500mg 0 12.3 2090
Metokloramid Syr 108 9.0 10.8 118.8 148 Metokloramid Syr 300 41.3 108
Metronidazol syr 0 0.0 0.0 0.0 149 Metronidazol syr 0 12.4 0
Natrium Bikarbonat Tablet 500mg 0 0.0 0.0 0.0 150 Natrium Bikarbonat Tablet 500mg 0 12.5 0
Natrum Klorida Lar. Inf. 0,9% -500ml 162 13.5 16.2 178.2 151 Natrum Klorida Lar. Inf. 0,9% -500ml 240 36.6 162
Natrium Diclopenac 20mg 135 11.3 13.5 148.5 152 Natrium Diclopenac 20mg 0 12.7 135
Nistatin Vaginal 60 5.0 6.0 66.0 153 Nistatin Vaginal 0 14.4 60
Nistatin Tablet Salut 500.000 IU 850 70.8 85.0 935.0 154 Nistatin Tablet Salut 500.000 IU 0 12.8 850
Natrium Diclopenac 50mg 8117 676.4 811.7 8928.7 155 Natrium Diclopenac 50mg 11000 1421.3 8117
Nifedipine Tab 10mg 0 0.0 0.0 0.0 156 Nifedipine Tab 10mg 0 13.0 0
Multivitamin Anti Oksidan 9305 775.4 930.5 10235.5 157 Multivitamin Anti Oksidan 8800 1254.8 9305
Obat Anti Tuberkulosis Kat. 1 (FDC) 0 0.0 0.0 0.0 158 Obat Anti Tuberkulosis Kat. 1 (FDC) 0 13.2 0
Obat Anti Tuberkulosis Kat. 2 0 0.0 0.0 0.0 159 Obat Anti Tuberkulosis Kat. 2 0 13.3 0
Obat Anti Tuberkulosis Kat.Anak 0 0.0 0.0 0.0 160 Obat Anti Tuberkulosis Kat.Anak 0 13.3 0
Ofloksasin Tetes telinga 74 6.2 7.4 81.4 161 Ofloksasin Tetes telinga 0 13.4 74
Omeprazol inj 40mg/10ml Err:509 Err:509 Err:509 Err:509 162 Omeprazol inj 40mg/10ml 50 17.7 Err:509
Omeprazol Kapsul 20mg Err:509 Err:509 Err:509 Err:509 163 Omeprazol Kapsul 20mg 10200 1320.3 Err:509
Ondansetron Inj 4mg #VALUE! #VALUE! #VALUE! #VALUE! 164 Ondansetron Inj 4mg 0 13.7 200
Onadansetron 8mg Tablet #VALUE! #VALUE! #VALUE! #VALUE! 165 Onadansetron 8mg Tablet 0 13.8 Err:509
Onadansetron 4mg Tablet 912 76.0 91.2 1003.2 166 Onadansetron 4mg Tablet 1740 229.8 912
Obat Batuk Flu Dewasa 13550 1129.2 1355.0 14905.0 167 Obat Batuk Flu Dewasa 12000 1830.6 13550
Obat Batuk Hitam (OBH) Cairan 90 7.5 9.0 99.0 168 Obat Batuk Hitam (OBH) Cairan 0 14.0 90
Obat Batuk Dewasa syr 130 10.8 13.0 143.0 169 Obat Batuk Dewasa syr 180 29.1 130
Oksitetrasiklin HCL Inj. i.m 50mg10ml 3060 255.0 306.0 3366.0 170 Oksitetrasiklin HCL Inj. i.m 50mg10ml 0 14.2 3060
LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN OBAT LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN OBAT
JUMLAH
TAHUN DEPAN
Oksitetrasiklin HCL SM 1%-3,5gram 0 0.0 0.0 0.0 171 Oksitetrasiklin HCL SM 1%-3,5gram 0 14.3 0
Oksitetrasiklin HCL Salep 3%- 5gram 51 4.3 5.1 56.1 172 Oksitetrasiklin HCL Salep 3%- 5gram 0 14.3 51
Oksitosin Injeksi 10 IU/ml- 1ml 133 11.1 13.3 146.3 173 Oksitosin Injeksi 10 IU/ml- 1ml 400 54.3 133
0 0.0 0.0 0.0 0 14.5 0

OBAT Anti Diare suspensi 174 OBAT Anti Diare suspensi
parasetamol drops 15 ml 951 79.3 95.1 1046.1 175 parasetamol drops 15 ml 168 37.4 951
Parasetamol Syrup 120mg/ 5ml-60ml 1385 115.4 138.5 1523.5 176 Parasetamol Syrup 120mg/ 5ml-60ml 2300 298.0 1385
Parasetamol tab 100mg 26600 2216.7 2660.0 29260.0 177 Parasetamol tab 100mg 0 14.8 26600
Parasetamol Tablet 500mg 27400 2283.3 2740.0 30140.0 178 Parasetamol Tablet 500mg 48300 5848.2 27400
Permetin Krim/Skabisid 5 % 0 0.0 0.0 0.0 179 Permetin Krim/Skabisid 5 % 0 14.9 0
pirantel syr 1100 91.7 110.0 1210.0 180 pirantel syr 0 15.0 1100
Pirantel Tablet 125mg 3000 250.0 300.0 3300.0 181 Pirantel Tablet 125mg 0 15.1 3000
piroksikam Tablet 10 mg 0 0.0 0.0 0.0 182 piroksikam Tablet 10 mg 0 15.2 0
Piroksikam Tablet 20 mg 0 0.0 0.0 0.0 183 Piroksikam Tablet 20 mg 0 15.3 0
Propiltiourasil Tablet 100mg 12400 1033.3 1240.0 13640.0 184 Propiltiourasil Tablet 100mg 0 15.3 12400
Piridoksin HCL (Vit. B6) Tablet 10mg 402 33.5 40.2 442.2 185 Piridoksin HCL (Vit. B6) Tablet 10mg 1000 132.1 402
Povidon Iodida 10% 300ml 6 0.5 0.6 6.6 186 Povidon Iodida 10% 300ml 0 15.8 6
Prednison Tablet 5mg 8500 708.3 850.0 9350.0 188 Prednison Tablet 5mg 11000 1449.0 8500
Primakuin Tablet 15mg 0 0.0 0.0 0.0 189 Primakuin Tablet 15mg 0 15.8 0
Prokain Benzil Penisilin 3 Juta IU Inj. 710 59.2 71.0 781.0 190 Prokain Benzil Penisilin 3 Juta IU Inj. 0 15.8 710
propanolol HCL Tablet 10mg 1000 83.3 100.0 1100.0 191 propanolol HCL Tablet 10mg 0 99.3 1000
Propanolol HCL Tablet 40mg 0 0.0 0.0 0.0 192 Propanolol HCL Tablet 40mg 0 16.0 0
Retinol (Vitamin A) Kapsul 100.000 IU 650 54.2 65.0 715.0 194 Retinol (Vitamin A) Kapsul 100.000 IU 500 112.0 650
Retinol (Vitamin A) Kapsul 200.000 IU 4000 333.3 400.0 4400.0 195 Retinol (Vitamin A) Kapsul 200.000 IU 0 349.6 4000
MDT MB/ Kusta Dewasa 0 0.0 0.0 0.0 196 MDT MB/ Kusta Dewasa 0 16.3 0
MDT PB/ Kusta Dewasa 0 0.0 0.0 0.0 197 MDT PB/ Kusta Dewasa 0 16.4 0
Risperidon 2mg 80 6.7 8.0 88.0 198 Risperidon 2mg 0 16.5 80
Ranitidin Injeksi 25 mg/ 2ml 1955 162.9 195.5 2150.5 199 Ranitidin Injeksi 25 mg/ 2ml 300 51.6 1955
Ranitidin Tablet 150 mg 9295 774.6 929.5 10224.5 200 Ranitidin Tablet 150 mg 14500 1750.0 9295
Ringer Laktat Lar. Inf. Steril - 500ml 1034 86.2 103.4 1137.4 201 Ringer Laktat Lar. Inf. Steril - 500ml 640 92.1 1034
Salbutamol Tablet 2mg 4250 354.2 425.0 4675.0 202 Salbutamol Tablet 2mg 2500 450.2 4250
Salbutamol Tablet 4mg 3646 303.8 364.6 4010.6 203 Salbutamol Tablet 4mg 3500 562.8 3646
Salep 2-4, Kombinasi 134 11.2 13.4 147.4 204 Salep 2-4, Kombinasi 0 19.8 134
Salisil Bedak 2% 83 6.9 8.3 91.3 205 Salisil Bedak 2% 100 28.8 83
Serum Anti Bisa Ular Polivalen Inj.5ml 18 1.5 1.8 19.8 206 Serum Anti Bisa Ular Polivalen Inj.5ml 20 19.9 18
Stimuno 45 3.8 4.5 49.5 207 Stimuno 0 20.8 45
Serum Anti Tetanus Inj. 1500 IU/amp. 11 0.9 1.1 12.1 208 Serum Anti Tetanus Inj. 1500 IU/amp. 30 20.8 11
Sukrafat 500mg 330 27.5 33.0 363.0 209 Sukrafat 500mg 0 17.4 330
Sianokobalamin (Vit. B12) Inj 500mcg 1265 105.4 126.5 1391.5 210 Sianokobalamin (Vit. B12) Inj 500mcg 0 20.8 1265
Simvastatin Tablet 20 mg 1550 129.2 155.0 1705.0 211 Simvastatin Tablet 20 mg 1000 142.6 1550
Simvastatin Tablet 10 mg 1800 150.0 180.0 1980.0 212 Simvastatin Tablet 10 mg 2400 367.7 1800
Sukralfat Syr 38 3.2 3.8 41.8 213 Sukralfat Syr 100 26.1 38
Sulfasetamida Natrium TM 15%- 5ml 0 0.0 0.0 0.0 214 Sulfasetamida Natrium TM 15%- 5ml 0 17.8 0
Sabutamol Nebulizer 0 0.0 0.0 0.0 215 Sabutamol Nebulizer 120 27.9 0
Spiranolakton tab 0 0.0 0.0 0.0 216 Spiranolakton tab 0 18.0 0
Salf Kombinasi 120 10.0 12.0 132.0 217 Salf Kombinasi 0 18.1 120
Sinbio 0 0.0 0.0 0.0 218 Sinbio 0 18.2 0
Setrizin tablet 10 mg 4980 415.0 498.0 5478.0 219 Setrizin tablet 10 mg 3720 643.3 4980
Tablet Tambah Darah Komb. 45120 3760.0 4512.0 49632.0 220 Tablet Tambah Darah Komb. 87360 9975.0 45120
Tetrakain HCL Tetes Mata 0.5%- 5ml 3850 320.8 385.0 4235.0 221 Tetrakain HCL Tetes Mata 0.5%- 5ml 0 18.4 3850
Tetrasiklin HCL Kapsul 250 mg 1400 116.7 140.0 1540.0 222 Tetrasiklin HCL Kapsul 250 mg 0 76.8 1400
Tetrasiklin HCL Kapsul 500 mg 8500 708.3 850.0 9350.0 223 Tetrasiklin HCL Kapsul 500 mg 0 18.6 8500
Tiamin HCL/(Vit. B1) Tab. 50mg 5600 466.7 560.0 6160.0 224 Tiamin HCL/(Vit. B1) Tab. 50mg 6000 935.3 5600
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml 30 2.5 3.0 33.0 225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml 0 21.3 30
Triheksifenidil Hidroklorida Tab. 2mg 800 66.7 80.0 880.0 226 Triheksifenidil Hidroklorida Tab. 2mg 2500 293.8 800
Vitamin B Komplek Tablet 10200 850.0 1020.0 11220.0 227 Vitamin B Komplek Tablet 11500 1643.9 10200
Zink Syr 14153 1179.4 1415.3 15568.3 228 Zink Syr 0 23.4 14153
Zink Tablet 20mg 1990 165.8 199.0 2189.0 229 Zink Tablet 20mg 0 85.8 1990
PERBEKALAN KESEHATAN 0 0.0 0.0 0.0 PERBEKALAN KESEHATAN 0 0.0 0
Alat Suntik Sekali Pakai 1 ml 310 25.8 31.0 341.0 1 Alat Suntik Sekali Pakai 1 ml 300 40.1 310
Catgut/ Benang Bedah No. 2/0 130 10.8 13.0 143.0 4 Catgut/ Benang Bedah No. 2/0 144 15.4 130
I.V. Catheter No. 20 262 21.8 26.2 288.2 5 I.V. Catheter No. 20 300 38.1 262
I.V. Cateter No 26 230 19.2 23.0 253.0 8 I.V. Cateter No 26 200 26.6 230
Infusion Set Anak 181 15.1 18.1 199.1 9 Infusion Set Anak 100 14.7 181
Infusion Set Dewasa 344 28.7 34.4 378.4 10 Infusion Set Dewasa 900 98.9 344
E.Care Film I.V Dresing 600 50.0 60.0 660.0 11 E.Care Film I.V Dresing 1000 109.3 600
Silk (Benang Bedah Sutera) No. 3/0 25 2.1 2.5 27.5 12 Silk (Benang Bedah Sutera) No. 3/0 0 2.8 25
Policlean Handrub 6 0.5 0.6 6.6 13 Saraya Alsof A 500 ml 29 4.1 6

Kapas Pembalut/Absorben 250 gram 82 6.8 8.2 90.2 14 Kapas Pembalut/Absorben 250 gram 10 2.2 82
Kasa Kompres 40/40 148 12.3 14.8 162.8 15 Kasa Kompres 40/40 0 9.1 148
Kasa Pembalut 2 m x 80 cm 50 4.2 5.0 55.0 16 Kasa Pembalut 2 m x 80 cm 100 9.8 50
Kasa Pembalut Hidrofil 36 m x 80 cm 325 27.1 32.5 357.5 17 Kasa Pembalut Hidrofil 36 m x 80 cm 8 2.6 325
Kasa Steril 16/16 590 49.2 59.0 649.0 18 Kasa Steril 16/16 410 47.8 590
Masker 773 64.4 77.3 850.3 19 Masker 2200 235.0 773
Plester 5 yard x 2 inch 544 45.3 54.4 598.4 20 Plester 5 yard x 2 inch 48 10.6 544
Sarung Tangan No 7 Steril 66 5.5 6.6 72.6 21 Sarung Tangan No 7 Steril 0 1.8 66
LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN OBAT LAPORAN TAHUNAN PENERIMAAN DAN PEMAKAIAN
JUMLAH
TAHUN DEPAN
Sarung Tangan No 6.5 Steril 500 41.7 50.0 550.0 22 Sarung Tangan No 6.5 Steril 0
Sarung tangan no 6 1/2 0 0.0 0.0 0.0 23 Sarung tangan no 6 1/2 0
Folly cateter No 16 32 2.7 3.2 35.2 24 Folly cateter No 16 0
Folly cateter No 14 0 0.0 0.0 0.0 25 Folly cateter No 14 0
Sarung tangan Gynecolog no 7 80 6.7 8.0 88.0 26 Sarung tangan Gynecolog no 7 0
Alkohol Swab 12 1.0 1.2 13.2 27 Alkohol Swab 0
Underpad 165 13.8 16.5 181.5 28 Underpad 0
Urine Bag 26 2.2 2.6 28.6 29 Urine Bag 0
Catgut/ Benang Bedah No. 3/0 20 1.7 2.0 22.0 30 Catgut/ Benang Bedah No. 3/0 0
Antiseptik Surgical Hand Scrab 5 0.4 0.5 5.5 31 Antiseptik Surgical Hand Scrab 0
Cairan pembersih 0 0.0 0.0 0.0 32 Cairan pembersih 0
Jely kateter 3 0.3 0.3 3.3 33 Jely kateter 0
Jarum Insulin 0 0.0 0.0 0.0 34 Jarum Insulin
OBAT GIGI III OBAT GIGI
Air Raksa Dental Use Botol 1 Air Raksa Dental Use Botol
Etil Klorida Semprot-100 ml 2 Etil Klorida Semprot-100 ml
Eugenol Cairan - 10 ml 3 Eugenol Cairan - 10 ml
Forinokresol 4 Forinokresol
Glass Ionomer Cement (GC IX) 5 Glass Ionomer Cement (GC IX)
Gutta Percha Point 6 Gutta Percha Point
Kalsium Hidroksida Pasta 7 Kalsium Hidroksida Pasta
Monoklorkamfer Menthol Cairan 10ml 8 Monoklorkamfer Menthol Cairan 10ml
Semen Seng Fosfat Srbk dan Cairn30 gr 9 Semen Seng Fosfat Srbk dan Cairn30 gr
Silver Amalgan 10 Silver Amalgan
Temporary SF Serbuk & Cairan -100 gr 11 Temporary SF Serbuk & Cairan -100 gr
Kepala Puskesmas Pengelola Obat Kepala uskesmas
Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep SYARIPUDDIN RACHMAN,MM

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006 NIP.19610426 19820112 1 001
KAIAN OBAT
JUMLAH
RATA-RATA 10% KEBUTUHAN
TAHUN DEPAN
208.3 250.0 2750.0

33.3 40.0 440.0
939.2 1127.0 12397.0
10.0 12.0 132.0
25.0 30.0 330.0
431.7 518.0 5698.0
376.7 452.0 4972.0
0.1 0.1 1.1
3833.3 4600.0 50600.0
74.2 89.0 979.0
8.4 10.1 111.1
116.7 140.0 1540.0
15.0 18.0 198.0
41.7 50.0 550.0
2850.0 3420.0 37620.0
129.2 155.0 1705.0
14.6 17.5 192.5
0.8 1.0 11.0
0.0 0.0 0.0
8.3 10.0 110.0
0.0 0.0 0.0
3.7 4.4 48.4

14.8 17.8 195.8
158.3 190.0 2090.0
133.3 160.0 1760.0
100.0 120.0 1320.0
0.0 0.0 0.0
33.3 40.0 440.0
1308.3 1570.0 17270.0
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
308.3 370.0 4070.0
5.1 6.1 67.1
129.2 155.0 1705.0
66.7 80.0 880.0
0.0 0.0 0.0
4.2 5.0 55.0
0.0 0.0 0.0
0.0 0.0 0.0
8.3 10.0 110.0
0.0 0.0 0.0
0.3 0.4 4.4
1.5 1.8 19.8
43.5 52.2 574.2
10.0 12.0 132.0
30.0 36.0 396.0
562.5 675.0 7425.0
158.3 190.0 2090.0
Err:509 Err:509 Err:509
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
754.2 905.0 9955.0
0.0 0.0 0.0
142.1 170.5 1875.5
1575.0 1890.0 20790.0
1.7 2.0 22.0
483.3 580.0 6380.0
0.8 1.0 11.0
8.3 10.0 110.0
1.7 2.0 22.0
0.0 0.0 0.0

8.3 10.0 110.0
108.3 130.0 1430.0
78.6 94.3 1037.3
22.5 27.0 297.0
0.0 0.0 0.0
0.5 0.6 6.6
0.0 0.0 0.0
325.0 390.0 4290.0
0.0 0.0 0.0
5.1 6.1 67.1
0.4 0.5 5.5
1.5 1.8 19.8
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
22.5 27.0 297.0
4.3 5.1 56.1
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
5.8 7.0 77.0
N PEMAKAIAN OBAT
K
JUMLAH
TAHUN DEPAN
8.3 10.0 110.0

0.0 0.0 0.0
5.8 7.0 77.0
71.3 85.5 940.5
0.0 0.0 0.0
62.5 75.0 825.0
16.7 20.0 220.0
54.2 65.0 715.0
257.8 309.4 3403.4
2055.0 2466.0 27126.0

45.8 55.0 605.0
334.1 400.9 4409.9
14.6 17.5 192.5
3.8 4.5 49.5
0.0 0.0 0.0
0.0 0.0 0.0
37.3 44.8 492.8
175.0 210.0 2310.0
0.0 0.0 0.0
25.0 30.0 330.0
12.9 15.5 170.5
Err:509 Err:509 Err:509
Err:509 Err:509 Err:509
0.0 0.0 0.0
4.3 5.1 56.1
150.0 180.0 1980.0
20.4 24.5 269.5
325.0 390.0 4290.0
12.3 14.8 162.8
350.0 420.0 4620.0
8.2 9.8 107.8
108.3 130.0 1430.0
5.5 6.6 72.6
16.7 20.0 220.0
1316.7 1580.0 17380.0
12.5 15.0 165.0
4.0 4.8 52.8
73.3 88.0 968.0
452.5 543.0 5973.0
70.7 84.8 932.8
0.0 0.0 0.0
362.5 435.0 4785.0
50.0 60.0 660.0
291.7 350.0 3850.0

0.0 0.0 0.0
200.4 240.5 2645.5
11.5 13.8 151.8
216.7 260.0 2860.0
46.4 55.7 612.7
43.8 52.5 577.5
0.0 0.0 0.0
141.7 170.0 1870.0
10.2 12.2 134.2
669.6 803.5 8838.5
112.5 135.0 1485.0
44.3 53.1 584.1
108.8 130.6 1436.6
167.8 201.3 2214.3
59.4 71.3 784.3
78.0 93.6 1029.6
2.5 3.0 33.0
174.2 209.0 2299.0
9.0 10.8 118.8
0.0 0.0 0.0
0.0 0.0 0.0
13.5 16.2 178.2
11.3 13.5 148.5
5.0 6.0 66.0
70.8 85.0 935.0
676.4 811.7 8928.7
0.0 0.0 0.0
775.4 930.5 10235.5
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
6.2 7.4 81.4
Err:509 Err:509 Err:509
Err:509 Err:509 Err:509
16.7 20.0 220.0
Err:509 Err:509 Err:509
76.0 91.2 1003.2
1129.2 1355.0 14905.0
7.5 9.0 99.0
10.8 13.0 143.0
255.0 306.0 3366.0
KAIAN OBAT
JUMLAH
TAHUN DEPAN
0.0 0.0 0.0

4.3 5.1 56.1
11.1 13.3 146.3
0.0 0.0 0.0
79.3 95.1 1046.1

115.4 138.5 1523.5
2216.7 2660.0 29260.0
2283.3 2740.0 30140.0
0.0 0.0 0.0
91.7 110.0 1210.0
250.0 300.0 3300.0
0.0 0.0 0.0
0.0 0.0 0.0
1033.3 1240.0 13640.0
33.5 40.2 442.2
0.5 0.6 6.6
1241.7 1490.0 16390.0
708.3 850.0 9350.0
0.0 0.0 0.0
59.2 71.0 781.0
83.3 100.0 1100.0
0.0 0.0 0.0
0.0 0.0 0.0
54.2 65.0 715.0
333.3 400.0 4400.0
0.0 0.0 0.0
0.0 0.0 0.0
6.7 8.0 88.0
162.9 195.5 2150.5
774.6 929.5 10224.5
86.2 103.4 1137.4
354.2 425.0 4675.0
303.8 364.6 4010.6
11.2 13.4 147.4
6.9 8.3 91.3
1.5 1.8 19.8
3.8 4.5 49.5
0.9 1.1 12.1
27.5 33.0 363.0
105.4 126.5 1391.5
129.2 155.0 1705.0
150.0 180.0 1980.0
3.2 3.8 41.8
0.0 0.0 0.0
0.0 0.0 0.0
0.0 0.0 0.0
10.0 12.0 132.0
0.0 0.0 0.0
415.0 498.0 5478.0
3760.0 4512.0 49632.0
320.8 385.0 4235.0
116.7 140.0 1540.0
708.3 850.0 9350.0
466.7 560.0 6160.0
2.5 3.0 33.0
66.7 80.0 880.0
850.0 1020.0 11220.0
1179.4 1415.3 15568.3
165.8 199.0 2189.0
0.0 0.0 0.0
25.8 31.0 341.0
144.2 173.0 1903.0

61.7 74.0 814.0
10.8 13.0 143.0
21.8 26.2 288.2
22.1 26.5 291.5
11.7 14.0 154.0
19.2 23.0 253.0
15.1 18.1 199.1
28.7 34.4 378.4
50.0 60.0 660.0
2.1 2.5 27.5
0.5 0.6 6.6
6.8 8.2 90.2
12.3 14.8 162.8
4.2 5.0 55.0
27.1 32.5 357.5
49.2 59.0 649.0
64.4 77.3 850.3
45.3 54.4 598.4
5.5 6.6 72.6
N PEMAKAIAN OBAT
K
JUMLAH
TAHUN DEPAN
Pengelola obat
YUYUN YUNENGSIH,S.Kep
NIP.19820422 200801 2 006
PEMERINTAH KABUPATEN PANDEGLANG
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang
SURAT BUKTI BARANG KELUAR

Nomor :800/ /SBBK-LPLPO/PKM-CKS/ VII/2019
Telah diserahkan Kepada : PENGELOLA PROGRAM GIZI

Keperluan Bulan : Juli 2019
NO JENIS BARANG SATUAN JUMLAH HARGA TOTAL
I OBAT-- OBATAN
1 Retinol (Vitamin A) Kapsul 100.000 IU Kap 0 284 -
3 Tablet Tambah Darah Komb. Tab 17280 352 6,082,560

JUMLAH Rp 6,082,560
Cikeusik, 29 Juli 2019
Yang Menyerahkan Yang Menerima
YUYUN YUNENGSIH,Amd Kep DINI RUFLIKA,Amd Keb
NIP.19820422 2008 01 2 006 TKS

PUSKESMAS CIKEUSIK

Nomor :800/ 38 /SBBK-LPLPO/PKM-CKS/VII /2019
Telah diserahkan Kepada : PENGELOLA LABORATORIUM

NO JENIS BARANG SATUAN JUMLAH HARGA
I BMHP
1 Alkohol swab box 3 32,600

II Reagn (Program) 0
1 Rafid HbsAg TES 0 9,850
2 Vaksin Hblg Vial 0 1,325,000

JUMLAH
Cikeusik, 29 Juli 2019
YUYUN YUNENGSIH,S.Kep.Ners ELAH NURHAYATI,Amd Keb

NIP.19820422 200801 2006
G PEMERINTAH KABUPATEN PANDEGLANG
PUSKESMAS CIKEUSIK
deglang Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang

/2019 Nomor :800/ 39 /SBBK-LPLPO/PKM-CKS/VII /2019
Telah diserahkan Kepada : PENGELOLA KECACINGAN

TOTAL NO JENIS BARANG SATUAN JUMLAH HARGA
I OBAT-OBATAN
97,800 3 Albendazol Tab 404

JUMLAH
- 97,800 Cikeusik, 20 Juli 2019
#REF! Yang Menyerahkan Yang Menerima
Cikeusik, 29 Juli 2019 YUYUN YUNENGSIH,Amd Kep ELAH NURHAYATI,Amd Keb
Yang Menerima
ELAH NURHAYATI,Amd Keb

TOTAL
Rp -
k, 20 Juli 2019
ng Menerima
URHAYATI,Amd Keb
DINAS KESEHATAN
PUSAT KESEHATAN MASYARAKAT CIKEUSIK
Jl. Raya alun-alun Cikeusik - Kabupaten Pandeglang
LAPORAN BULANAN PENGGUNAAN SERUM ANTI BISA ULAR

PUSKESMAS CIKEUSIK
MENU BULAN : JANUARI 2019
JUMLAH PENGGUNAAN
NO STOK AWAL PENERIMAAN PERSEDIAAN SISA STOK KET
NAMA PASIEN UMUR ALAMAT JUMLAH PETUGAS
1 20 0 20 NURANI 51TH KP.CIRIRIGI DS SUKA SENENG 1 PETUGAS UGD 19 14/1/2019
2 19 0 19 WENDA 60TH KP CIBULUH DS CIKEUSIK 1 PETUGAS UGD 18 24/1/2019
3 18 0 18 NADIANA 17TH KP.LEWI PWRIUK DS.PWRUNGKOKOSAN 1 PETUGAS UGD 17 24/01/2019
4 17 0 17 TARLIM 60TH KP.CILANCAR DS NANGGALA 2 PETUGAS UGD 15 30/01/2019
JUMLAH 5
Mengetahui, Cikeusik, 31 Januari 201

Kepala Puskesmas Cikeusik Pengelola Obat
Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : FEBRUARI 2019
JUMLAH PENGGUNAAN
1 15 0 15 An.Ridwan 8 th Curug Ciung 1 PETUGAS JAGA UGD 14 15/02/19
2 14 0 14 Tn.Jai 43 th Kp.Ciapus Ds.Nanggala 2 PETUGAS JAGA UGD 12 22/02/19
JUMLAH 3
Mengetahui, Cikeusik, 28 Februari 2019


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : MARET 2019
JUMLAH PENGGUNAAN
1 12 0 12 TN.DIDING 40TH KP.SUKA JAYA DS.NANGGALA 2 PETUGAS JAGA 10 2/3/2019
2 10 0 10 TN.TISNA 50TH KP.DAHU DS.CIHANJUNGAN 1 PETUGAS JAGA 9 12/3/2019
3 9 0 9 TN.ATANG 50TH KP.SUKAJADI 1 PETUGAS JAGA 8 12/3/2019
4 8 0 8 NY.SANIAH 60TH KP.KENDAL DS.CIKEUSIK 1 PETUGAS JAGA 7 28/3/19
JUMLAH 5
Mengetahui, Cikeusik, 30 Maret 2019

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : APRIL 2019
JUMLAH PENGGUNAAN
1 7 0 7 TN.ABRAHAM 75TH DS SUMURBATU 5 ADE SUHENDI 2 4/4/2019
JUMLAH 5
Mengetahui, Cikeusik,30 April 2019

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : MEI 2019
JUMLAH PENGGUNAAN
1 0 5 5 NY.SANIEM 43 KP CIKEUSIK KALER DS CIKEUSIK 1 Asep Saepullah 4 15/05/2019
2 4 0 4 TN. PUDINI 27 KP BENGER DS NANGGALA 1 Asep Saepullah 3 26/05/2019
JUMLAH 2
Mengetahui, Cikeusik, 31 Mei 2019

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : JUNI 2019
JUMLAH PENGGUNAAN
1 3 5 8 Ali 6th Lewi balang 3 Petugas Piket 5 19/06/2019
2 5 5 Ahmad 67 Nanggala 2 Petugas Piket 3 9/6/2019
JUMLAH 5
Mengetahui, Cikeusik,30 Juni 2019


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : JULI 2019
JUMLAH PENGGUNAAN
NO STOK AWAL PENERIMAAN SISA STOK KET
PERSEDIAAN NAMA PASIEN UMUR ALAMAT JUMLAH PETUGAS
1 3 10 13 MUNAS 55 SUKASENENG 1 Asep Saepullah 12 18/7/19
2 12 0 12 RUKAYAH 56 KP. CIBEREM. CIKADONGDONG 1 Asep Saepullah 11 25/7/19
11 0 11 MUNAS 55 SUKASENENG 1 Asep Saepullah 10 26/7/19
10 0 10 ADIT 38 CURUGCIUNG 1 Asep Saepullah 9 28/7/19
JUMLAH 4
Mengetahui, Cikeusik, 31 Juli 2019

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : AGUSTUS 2019
JUMLAH PENGGUNAAN
NO STOK AWAL PENERIMAAN SISA STOK KET
PERSEDIAAN NAMA PASIEN UMUR ALAMAT JUMLAH PETUGAS
1 -
2
3
4
5
JUMLAH 0
Mengetahui, Cikeusik, Agustus 2019

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : SEPTEMBER 2019
JUMLAH PENGGUNAAN
1 0 10 10 TN.ARSAM 45TH KP NANGELA DS NANGGALA 1 ASEP S,AMK 9
2 9 0 9 NY.ARMAENAH 47TH SUKASENENG 1 AEP F,S.Kep 8
JUMLAH 2
Mengetahui, Cikeusik, 31 September 2019


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : OKTOBER 2019
JUMLAH PENGGUNAAN
1 8 0 8 NY.JASIH 70TH Kp Ciririgi Ds Sukaseneng 1 Iing K,SKM 7
2 7 0 7 AN.RUDI 10 TH Ds Sumur batu Kc Ciekusik 1 Ade Suhendi,SKM 6
JUMLAH 2
Mengetahui, Cikeusik,30 Oktober 2019


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : NOVEMBER 2019
JUMLAH PENGGUNAAN
1 6 5 11 Tn Wahab 38 Ds Suka Mulya 1 Arrdin,Amd Kep 10
2 10 0 10 Sarnata 30 Kp.Parungkosan Ds.arungkokosan 1 Maman Suherman 9
3 9 0 9 Ade 28 Kp Cirigi Ds.Suka Seneng 1 Melani 8
JUMLAH 3
Mengetahui, Cikeusik,31 November 2019


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006

DINAS KESEHATAN

PUSKESMAS CIKEUSIK
MENU BULAN : DESEMBER 2019
JUMLAH PENGGUNAAN
1 8 0 8 Tn Nurpiatman 49th Ds Cikeusik 1 Angga 7
2 7 0 7 Darsono 40th Pamatang Ds Cikeusik 1 Asep S 6
3 6 0 6 Ardja 20th Ds Sukamulya 1 Ardin 5
4 5 0 5 Djalin 29th Kp Cibuluh Ds cikeusik 1 Dr Cecep 4
5 4 0 4 ruyati 55th Kp benger Ds Nanggala 1 Aep S 3
6 3 0 3 An Samudi 12 Th KP Cikeusik 1 Piket PKM 2
JUMLAH 6
Mengetahui, Cikeusik,30 Desember 2019


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
PUSKESMAS CIKEUSIK

Nomor :800/ 01 /SBBK-LPLPO/PKM-CKS/I/2019 MENU
Telah diserahkan Kepada : Puskesmas Induk Cikeusik

Keperluan Bulan : Januari 2019
1 Alopurinol tablet 100 mg Tab 500 99 49,500
2 Aminofilin tablet 200 mg Tab 0 91 -
3 Albendazol Tab 0 404 -

4 Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245 -
5 Amitriptilin HCL Tab. Salut 25 mg Tab 0 167 -
6 Amlodipine 10 mg Tablet Tab 60 93 5,580
7 Amlodipine Besilate 5mg tablet Tab 0 70 -
8 Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 0 2,702,700 -
9 Amoksisillin Kapsul 500 mg Tab 2000 233 466,000
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 1,881 -
11 Alkazyme Sachet 25mg(Alkapham France) Pack 0 801,000 -
12 Amoksilin sk Forte Tab 180 3,400 612,000
13 Ampisillin Injeksi 1 gram Vial 0 3,850 -
14 Antalgin (Metampiron) Tab. 500 mg Tab 0 205 -
15 Antasida DOEN tablet Tab 3800 54 205,200
16 Antasida DOEN suspensi Btl 100 1,923 192,300
17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 0 3,035 -
18 Anti Hemoroid DOEN Kombinasi Supp 0 3,167 -
19 Antifungi DOEN Kombinasi Pot 0 3,035 -
20 Antimigren DOEN Kombinasi Tab 0 135 -
21 Antiparkinson DOEN tab. Kombinasi Tab 0 1,500 -
22 Aqua roinjek Steril Btl 10 2,860 28,600

23 Acyclopir Krim 5%- 5gr Tube 10 8,800 88,000
24 Acyclopir Tablet 200mg Tab 0 237 -
25 Acyclopir Tablet 400 mg Tab 0 380 -
26 Akita/Molagit Tablet Tab 0 450 -
27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 305 -
28 Asam asetilsalisilat 100mg tablet Tab 0 130 -
29 Asam Mefenamat 500mg Tab 500 103 51,500
30 Alprazolam 1mg Tab 0 233 -
31 Ambroksol tab tab 0 169 -
32 Ambroksol syr Btl 0 9,883 -
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 105 -
34 Asering Infus Tab 0 9,646 -
35 Asam Folat tablet 01mg Tab 0 63 -
36 Asam Folat tablet 5 mg Tab 0 55 -
37 Artesunat Inj Vial 0 14,250 -
38 Asam traneksamat Inj 5 % Amp 20 24,449 488,980
39 Asetosal Tablet 500 mg Tab 0 - -
40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1,595 -
41 Atropin Sulfat Tablet 0,5 mg Tab 0 74 -
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 - -
43 Alkohol 70% 1 Liter Btl 0 24,992 -
44 Betadin Salf Antiseptik Tube 0 7,039 -
45 Betametason Krim 0,1% - 5 gr Tube 0 1,349 -
46 Bisacodril sup Supp 2 5,800 11,600
47 Bisoprolol 2,5mg tab Tab 0 650 -
48 Captopril Tablet 12,5 mg Tab 200 62 12,400
49 Captopril Tablet 25 mg Tab 400 72 28,800 Rp2,240,460
50 Carbamazefine Tab 100 269 26,900
51 Cefadroxil 500mg Tab 516 -
52 Cetrizin syr Btl 2,849 -
53 Cefixim Tab 590 -
54 Ciprofloxacin Infus Btl 39,900 -
55 Ciprofloxacin Tablet 500mg Tab 1000 255 255,000
56 D-Artepp Tab Tab 1,000 -
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 1,097 -
58 Deksametasone Tablet 0,5 mg Tab 1000 32 32,000
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 6,600 -
60 Diazetpam Rectal 2mg Tube 11,516 -
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 17,350 -
62 Diazepam Tablet 2 mg Tab 45 -
63 Diazepam Tablet 5 mg Tab - -
64 Dietilkarbamazin Sitrat Tablet 100 mg Tab - -
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 1,176 -
66 Digoksin Tablet 0,25 mg Tab 105 -
67 Domperidon 10 mgtablet Tab 500 85 42,500
68 Dimenhidrinat Tablet 50 mg Tab - -
69 Dasabion Tablet Tab - -
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 3,333 -
71 Efedrin HCL Tablet 25 mg Tab 51 -
72 Ekstrak Belladona Tablet 10 mg Tab 31 -
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 1,408 -
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 1,800 -
75 Lisinofril 10 mg Tab 448 -
76 Lisinofril 5mg Tab 375 -
77 Etanol 70%- 100 ml Btl 2,500 -
78 Eritromisin Kapsul 500 mg Kap 730 -
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 6,700 -
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp - -
81 Fenitoin Natrium Kapsul 100 mg Kap 154 -
82 Fenitoin Natrium Kapsul 30 mg Kap - -
83 Fenobarbital Injeksi- 2ml Amp 1,740 -
84 Fenobarbital Tablet 30 mg Tab 165 -
85 Fenobarbital Tablet 30 mg Tab - -
86 Fenoksimetil Penisilina Tablet 250 mg Tab - -
87 Fluflenazine decanoat inj 25mg/ml Amp 57,500 -
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 3,550 -
89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 300 710 213,000
90 Gentamisin SM Tube 2,600 -
91 Furosemida Tablet 40 mg Tab 75 -
92 Garam Oralit 200 ml air Ktg 264 -
93 Glimepirid 2mg Tablet Tab 288 -
94 Glibenklamida Tablet 5 mg Tab 600 119 71,400
95 Asetil Sistein 200mg Tab 900 358 322,200
96 Glikazid 80 mg Btl 235 -
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 6,900 -
98 Glukosa Lar. Infus 10% Steril - 500 ml Btl 5,700 -
99 Griseofulvin Tablet 500 mg, Tab 2,200 -
100 Griseofulvin Tablet 125 mg, Micron Tab 210 -
101 Gentamisin S.K 0.1%-5 gr Tube 2,800 -
102 Gentamisin Tetes Mata Vial 24 3,696 88,704
103 Haloperidol 2 mg Tablet Tab 300 126 37,800
104 Haloperidol 5 mg Tablet Tab 96 -
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 149 - Rp1,089,504

106 Hidrokortison Krim 2,5%-5 gr Tab 39 2,639 102,921
107 Ibuprofen Tablet 200 mg Tab 500 105 52,500
108 Ibuprofen Tablet 400 mg Tab 205 -
109 Ibufropen syr Btl 3,499 -
110 Haloporidol Decanoate Inj 50mg Amp 9,750 -
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 89 -
112 Ketokonazol krem Tube 40 2,545 101,800
113 Ketokonazol tab 200mg Tab 270 -
114 Ketorolac Inj 30mg Vial 1,045 -
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 59 -
116 KN-3B Labu 10,050 -
117 Karbihidrat +Elektrolit Labu 1,007 -
118 Karbogliserin Tetes telinga Btl 2,500 -
119 Kloramfenikol tetes Mata Btl 3,250 -
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 1000 22 22,000
121 Klozapine 25 Mg Tab 1,121 -
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp - -
123 Klorpromazin HCL Tablet Salut 25 mg Tab 148 -
124 Klorpromazin HCL Tablet Salut 100 mg Tab 200 147 29,400
125 klorpeson Slasf tube 7,750 -
126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt - -
127 Kotrimoksazol Tablet 480mg Tab 125 -
128 Kotrimoksazol Suspensi Kombinasi Btl 2,052 -
129 Metpormin 500mg Tab 1000 100 100,000
130 Methyilprednisolon 8mg Tab 150 -
131 Kloramfenikol Salep Mata 1%-5gram Tube 25 1,881 47,025
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 1,797 -
133 Kuinin Injeksi 25%-2ml Amp 6,200 -
134 Levoploxasin 500mh Dus 528 -
135 Lidokain Komp. Injeksi, Kombinasi Amp 1,140 -
136 Lisol, Kresol Tersabun 50%- 1000ml Btl 3,360 -
137 Loperamide Hcl 2mg Tanlet Tab 85 -
138 Magnesium Sulfat Injk 25 ml Vial 2 3,328 6,656
139 Metamizol 500mg Tab 1000 473 473,000
140 Metilergometrin Maleat Tab. 0,125 g Tab 210 -
141 Metilergometrin M inj. 0,200mg- 1ml Amp 2,840 -
142 Metoklorpropamid Tablet 10 mg Tab 91 -
143 Mikonazol Krim/ Salep 2%-10gram Tube 3,414 -
144 Multivitamin Anak Btl 50 12,100 605,000
145 Multivitamin Dewasa Tab 1,316 -
146 Metronidazol Infus 500mg/100ml Btl 9,950 -
147 Metronidazol Tablet 500mg Tab 113 -
148 Metokloramid Syr Btl 2,345 -
149 Metronidazol syr Btl 3,799 -
150 Natrium Bikarbonat Tablet 500mg Tab 514 -
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 20 6,410 128,200
152 Natrium Diclopenac 20mg Amp 0 145 -
153 Nistatin Vaginal sup 20 480 9,600
154 Nistatin Tablet Salut 500.000 IU tab - -
155 Natrium Diclopenac 50mg Tab 2500 115 287,500
156 Nifedipine Tab 10mg Tab 108 -
157 Multivitamin Anti Oksidan Tab 1000 1,440 1,440,000
158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 317,018 - Rp3,405,602
159 Obat Anti Tuberkulosis Kat. 2 Pkt 0 1,297,894 -
160 Obat Anti Tuberkulosis Kat.Anak Pkt 0 214,985 -
161 Ofloksasin Tetes telinga Btl 0 45,089 -
162 Omeprazol inj 40mg/10ml Btl 0 16,997 -
163 Omeprazol Kapsul 20mg Kap 1700 130 221,000
164 Ondansetron Inj 4mg Vial 0 1,660 -
165 Onadansetron 8mg Tablet Tab 0 1,189 -
166 Onadansetron 4mg Tablet Tab 72 471 33,912
167 Obat Batuk Flu Dewasa Pkt 1500 413 619,500
168 Obat Batuk Hitam (OBH) Cairan Btl 0 5,000 -
169 Obat Batuk Dewasa syr Btl 0 5,500 -
170 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 7,840 -
171 Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1,920 -
172 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1,545 -
173 Oksitosin Injeksi 10 IU/ml- 1ml Amp 0 1,199 -
174 OBAT Anti Diare suspensi Btl 0 6,500 -
175 parasetamol drops 15 ml btl 10 6,649 66,490
176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 100 1,107 110,700
177 Parasetamol tab 100mg Tab 0 41 -
178 Parasetamol Tablet 500mg Tab 5300 53 280,900
179 Permetin Krim/Skabisid 5 % Tube 0 12,155 -
180 pirantel syr Btl 0 9,700 -
181 Pirantel Tablet 125mg Tab 0 291 -
182 piroksikam Tablet 10 mg Tab 0 234 -
183 Piroksikam Tablet 20 mg Tab 0 105 -
184 Propiltiourasil Tablet 100mg Tab 0 319 -
185 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 123 -
186 Povidon Iodida 10% 300ml Btl 4 17,996 71,984
187 Povidon Iodida 10% 1000ml Btl 0 - -
188 Prednison Tablet 5mg Tab 1500 68 102,000
189 Primakuin Tablet 15mg Tab 0 224 -
190 Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 6,016 -
191 propanolol HCL Tablet 10mg Tab 0 60 -
192 Propanolol HCL Tablet 40mg Tab 0 121 -
193 Povidon Iodida 10% 60ml Botol 0 6,550 -
196 MDT MB/ Kusta Dewasa Blister 0 30,595 -
197 MDT PB/ Kusta Dewasa Blister 0 9,770 -
198 Risperidon 2mg Tab 0 347 -
199 Ranitidin Injeksi 25 mg/ 2ml Vial 50 1,155 57,750
200 Ranitidin Tablet 150 mg Tab 2700 105 283,500
201 Ringer Laktat Lar. Inf. Steril - 500ml Btl 136 7,150 972,400
202 Salbutamol Tablet 2mg Tab 0 63 -
203 Salbutamol Tablet 4mg Tab 250 70 17,500
204 Salep 2-4, Kombinasi Pot 10 2,621 26,210
205 Salisil Bedak 2% Ktk 20 1,025 20,500
206 Serum Anti Bisa Ular Polivalen Inj.5ml Vial 5 479,996 2,399,980
207 Stimuno Botol 5 23,540 117,700
208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 11 170,000 1,870,000
209 Sukrafat 500mg Tab 0 368 -
210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 20 1,035 20,700 Rp7,292,726

211 Simvastatin Tablet 20 mg Tab 500 205 102,500
213 Sukralfat Syr Botol 0 8,338 -
214 Sulfasetamida Natrium TM 15%- 5ml Btl 0 3,226 -
215 Sabutamol Nebulizer Amp 0 110 -
216 Spiranolakton tab tab 0 899 -
217 Salf Kombinasi Tube 0 11,000 -
218 Sinbio Set 0 4,500 -
219 Setrizin tablet 10 mg Tab 1900 90 171,000
220 Tablet Tambah Darah Komb. Tab 1050 352 369,600
221 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 - -
222 Tetrasiklin HCL Kapsul 250 mg Kap 0 163 -
224 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 0 85 -
225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 0 1,455 -
226 Triheksifenidil Hidroklorida Tab. 2mg Tab 200 88 17,600
227 Vitamin B Komplek Tablet Tab 2000 118 236,000
228 Zink Syr Botol 26 2,972 77,272
229 Zink Tablet 20mg Tab 0 514 -
PERBEKALAN KESEHATAN 0 -
1 Alat Suntik Sekali Pakai 1 ml Set 50 777 38,850
4 Catgut/ Benang Bedah No. 2/0 Set 10 60,622 606,220
5 I.V. Catheter No. 20 Set 30 4,783 143,490
7 I.V. Catheter No. 24 Set 0 4,784 -
8 I.V. Cateter No 26 set 10 13,464 134,640
9 Infusion Set Anak Set 10 3,498 34,980
10 Infusion Set Dewasa Set 100 4,147 414,700
11 E.Care Film I.V Dresing Pcs 0 6,850 -
12 Silk (Benang Bedah Sutera) No. 3/0 Biji 0 44,953 -
13 Saraya Alsof A 500 ml Botol 0 72,047 -
14 Kapas Pembalut/Absorben 250 gram Set 0 12,250 -
15 Kasa Kompres 40/40 lembar 93 1,800 167,400
16 Kasa Pembalut 2 m x 80 cm pak 0 9,400 -
17 Kasa Pembalut Hidrofil 36 m x 80 cm rol 0 127,600 -
18 Kasa Steril 16/16 kotak 100 7,370 737,000
19 Masker biji 0 549 -
20 Plester 5 yard x 2 inch rol 15 8,167 122,505
21 Sarung Tangan No 7 Steril pasang 0 792 -
22 Sarung Tangan No 6.5 Steril pasang 50 7,931 396,550
23 Sarung tangan no 6 1/2 Pasng 0 924 -
24 Folly cateter No 16 Pcs 5 12,036 60,180
25 Folly cateter No 14 Pcs 0 16,610 -
26 Sarung tangan Gynecolog no 7 Sashet 0 17,748 -
27 Alkohol Swab bok 4 32,600 130,400
28 Underpad Lembar 20 4,162 83,240
29 Urine Bag Biji 0 7,038 -
30 Catgut/ Benang Bedah No. 3/0 Botol 0 68,433 -
31 Antiseptik Surgical Hand Scrab Botol 5 74,000 370,000
32 Cairan pembersih Botol 0 22,000 -
33 Jely kateter biji 0 41,600 -
34 Jarum Insulin Biji 0 2,083 - Rp5,324,007
TOTAL PENGELUARAN Rp19,352,299

Cikeusik, 26 Januari 2019
YUYUN YUNENGSIH, S.Kep IRMA TRISNAWATI,Amd Keb

NIP. 19820422 200801 2 006 NIP.19890729 2001704 2 001
Mengetahui
Kepala Puskesmas Cikeusik
HJ,IYOT SA'DIAH,S.ST
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 02 /SBBK-LPLPO/PKM-CKS/I/2019
Telah diserahkan Kepada : Pustu Cikiruhwetan

1 Alopurinol tablet 100 mg Tab 0 99 -

22 Aqua roinjek Steril Btl 0 2,860 -

24 Acyclopir Tablet 200mg Tab 100 237 23,700
38 Asam traneksamat Inj 5 % Amp 0 24,449 -
45 Betametason Krim 0,1% - 5 gr Tube 5 1,349 6,745
46 Bisacodril sup Supp 0 5,800 -
48 Captopril Tablet 12,5 mg Tab 0 62 -
49 Captopril Tablet 25 mg Tab 50 72 3,600 Rp219,625
50 Carbamazefine Tab 0 269 -
51 Cefadroxil 500mg Tab 0 516 -
52 Cetrizin syr Btl 0 2,849 -
53 Cefixim Tab 0 590 -
54 Ciprofloxacin Infus Btl 0 39,900 -
56 D-Artepp Tab Tab 0 1,000 -
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1,097 -
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6,600 -
60 Diazetpam Rectal 2mg Tube 0 11,516 -
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0 17,350 -
62 Diazepam Tablet 2 mg Tab 0 45 -
63 Diazepam Tablet 5 mg Tab 0 - -
64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 - -
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 1,176 -
66 Digoksin Tablet 0,25 mg Tab 0 105 -
67 Domperidon 10 mgtablet Tab 0 85 -
68 Dimenhidrinat Tablet 50 mg Tab 0 - -
69 Dasabion Tablet Tab 0 - -
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3,333 -
71 Efedrin HCL Tablet 25 mg Tab 0 51 -
72 Ekstrak Belladona Tablet 10 mg Tab 0 31 -
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1,408 -
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 1,800 -
75 Lisinofril 10 mg Tab 0 448 -
76 Lisinofril 5mg Tab 0 375 -
77 Etanol 70%- 100 ml Btl 0 2,500 -
78 Eritromisin Kapsul 500 mg Kap 0 730 -
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 6,700 -
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 - -
81 Fenitoin Natrium Kapsul 100 mg Kap 0 154 -
82 Fenitoin Natrium Kapsul 30 mg Kap 0 - -
83 Fenobarbital Injeksi- 2ml Amp 0 1,740 -
84 Fenobarbital Tablet 30 mg Tab 0 165 -
85 Fenobarbital Tablet 30 mg Tab 0 - -
86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 - -
87 Fluflenazine decanoat inj 25mg/ml Amp 0 57,500 -
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3,550 -
89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 710 -
90 Gentamisin SM Tube 0 2,600 -
91 Furosemida Tablet 40 mg Tab 0 75 -
92 Garam Oralit 200 ml air Ktg 0 264 -
93 Glimepirid 2mg Tablet Tab 0 288 -
94 Glibenklamida Tablet 5 mg Tab 0 119 -
96 Glikazid 80 mg Btl 0 235 -
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 6,900 -
99 Griseofulvin Tablet 500 mg, Tab 0 2,200 -
100 Griseofulvin Tablet 125 mg, Micron Tab 0 210 -
101 Gentamisin S.K 0.1%-5 gr Tube 0 2,800 -
102 Gentamisin Injeksi Vial 0 3,696 -
103 Haloperidol 2 mg Tablet Tab 0 126 -
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - Rp160,780

107 Ibuprofen Tablet 200 mg Tab 0 105 -
109 Ibufropen syr Btl 0 3,499 -
110 Haloporidol Decanoate Inj 50mg Amp 0 9,750 -
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 89 -
112 Ketokonazol krem Tube 0 2,545 -
113 Ketokonazol tab 200mg Tab 50 270 13,500
114 Ketorolac Inj 30mg Vial 0 1,045 -
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 100 59 5,900
116 KN-3B Labu 0 10,050 -
117 Karbihidrat +Elektrolit Labu 0 1,007 -
118 Karbogliserin Tetes telinga Btl 0 2,500 -
119 Kloramfenikol tetes Mata Btl 0 3,250 -
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 0 22 -
121 Klozapine 25 Mg Tab 0 1,121 -
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 - -
123 Klorpromazin HCL Tablet Salut 25 mg Tab 0 148 -
125 klorpeson Slasf tube 0 7,750 -
126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 - -
127 Kotrimoksazol Tablet 480mg Tab 0 125 -
128 Kotrimoksazol Suspensi Kombinasi Btl 0 2,052 -
129 Metpormin 500mg Tab 0 100 -
130 Methyilprednisolon 8mg Tab 0 150 -
131 Kloramfenikol Salep Mata 1%-5gram Tube 0 1,881 -
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1,797 -
133 Kuinin Injeksi 25%-2ml Amp 0 6,200 -
134 Levoploxasin 500mh Dus 0 528 -
135 Lidokain Komp. Injeksi, Kombinasi Amp 0 1,140 -
136 Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3,360 -
137 Loperamide Hcl 2mg Tanlet Tab 0 85 -
138 Magnesium Sulfat Injk 25 ml Vial 0 3,328 -
139 Metamizol 500mg Tab 100 473 47,300
140 Metilergometrin Maleat Tab. 0,125 g Tab 100 210 21,000
141 Metilergometrin M inj. 0,200mg- 1ml Amp 0 2,840 -
142 Metoklorpropamid Tablet 10 mg Tab 0 91 -
143 Mikonazol Krim/ Salep 2%-10gram Tube 4 3,414 13,656
144 Multivitamin Anak Btl 0 12,100 -
145 Multivitamin Dewasa Tab 0 1,316 -
146 Metronidazol Infus 500mg/100ml Btl 0 9,950 -
147 Metronidazol Tablet 500mg Tab 0 113 -
148 Metokloramid Syr Btl 0 2,345 -
149 Metronidazol syr Btl 0 3,799 -
150 Natrium Bikarbonat Tablet 500mg Tab 0 514 -
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 6,410 -
153 Nistatin Vaginal sup 0 480 -
154 Nistatin Tablet Salut 500.000 IU tab 0 - -
155 Natrium Diclopenac 50mg Tab 0 115 -
156 Nifedipine Tab 10mg Tab 0 108 -
157 Multivitamin Anti Oksidan Tab 100 1,440 144,000
158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018 - Rp258,551
163 Omeprazol Kapsul 20mg Kap 0 130 -
166 Onadansetron 4mg Tablet Tab 0 471 -
173 Oksitosin Injeksi 10 IU/ml- 1ml Amp 2 1,199 2,398
175 parasetamol drops 15 ml btl 0 6,649 -
186 Povidon Iodida 10% 300ml Btl 0 17,996 -
188 Prednison Tablet 5mg Tab 0 68 -
199 Ranitidin Injeksi 25 mg/ 2ml Vial 0 1,155 -
200 Ranitidin Tablet 150 mg Tab 0 105 -
201 Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 7,150 -
204 Salep 2-4, Kombinasi Pot 0 2,621 -
205 Salisil Bedak 2% Ktk 0 1,025 -
206 Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 479,996 -
207 Stimuno Botol 1 23,540 23,540
208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 170,000 -
210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035 - Rp117,558

211 Simvastatin Tablet 20 mg Tab 0 205 -
218 Sinbio Set 0 4,500 -
219 Setrizin tablet 10 mg Tab 0 90 -
220 Tablet Tambah Darah Komb. Tab 0 352 -
224 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 100 85 8,500
226 Triheksifenidil Hidroklorida Tab. 2mg Tab 0 88 -
228 Zink Syr Botol 0 2,972 -
229 Zink Tablet 20mg Tab 50 514 25,700
1 Alat Suntik Sekali Pakai 1 ml Set 0 777 -
4 Catgut/ Benang Bedah No. 2/0 Set 0 60,622 -
8 I.V. Cateter No 26 set 0 13,464 -
9 Infusion Set Anak Set 0 3,498 -
15 Kasa Kompres 40/40 lembar 0 1,800 -
18 Kasa Steril 16/16 kotak 0 7,370 -
20 Plester 5 yard x 2 inch rol 0 8,167 -
22 Sarung Tangan No 6.5 Steril pasang 0 7,931 -
27 Alkohol Swab bok 0 32,600 -
28 Underpad Lembar 0 4,162 -
31 Antiseptik Surgical Hand Scrab Botol 0 74,000 -
34 Jarum Insulin Biji 0 2,083 - Rp72,110
TOTAL PENGELUARAN Rp828,624
YUYUN YUNENGSIH, S.Kep YAYAH JUNAYAH,Amd Keb

NIP. 19820422 200801 2 006 NIP.19891004 2007042 002
Mengetahui
Hj.IYOT SA'DIAH,S.ST
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Poskesdes Sumurbatu



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -
YUYUN YUNENGSIH, S.Kep SITI ASIAH,Amd Keb

NIP. 19820422 200801 2 006 NIP.19870416 201704 2 003
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 04 /SBBK-LPLPO/PKM-CKS/I/2019
Telah diserahkan Kepada : Pustu Rancaseneng



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -
YUYUN YUNENGSIH, S.Kep ELIS FEBRIANI,Amd.Keb

NIP. 19820422 200801 2 006 NIP.19910222 201704 2 001
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Pustu Nanggala



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -
YUYUN YUNENGSIH, S.Kep NS.MASUDIN SANJAYA,S.Kep

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Poskesdes Tanjungan 1 Telah diserahkan

Keperluan Bulan : Januari 2019 Keperluan Bulan
NO JENIS BARANG SATUAN JUMLAH HARGA TOTAL NO
1 Alopurinol tablet 100 mg Tab 0 99 - 1
2 Aminofilin tablet 200 mg Tab 0 91 - 2
3 Albendazol Tab 0 404 - 3

4 Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245 - 4
5 Amitriptilin HCL Tab. Salut 25 mg Tab 0 167 - 5
6 Amlodipine 10 mg Tablet Tab 50 93 4,650 6
7 Amlodipine Besilate 5mg tablet Tab 0 70 - 7
8 Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 0 2,702,700 - 8
9 Amoksisillin Kapsul 500 mg Tab 300 233 69,900 9
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 1,881 - 10
11 Alkazyme Sachet 25mg(Alkapham France) Pack 0 801,000 - 11
12 Amoksilin sk Forte Tab 10 3,400 34,000 12
13 Ampisillin Injeksi 1 gram Vial 0 3,850 - 13
14 Antalgin (Metampiron) Tab. 500 mg Tab 0 205 - 14
15 Antasida DOEN tablet Tab 200 54 10,800 15
16 Antasida DOEN suspensi Btl 10 1,923 19,230 16
17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 0 3,035 - 17
18 Anti Hemoroid DOEN Kombinasi Supp 0 3,167 - 18
19 Antifungi DOEN Kombinasi Pot 0 3,035 - 19
20 Antimigren DOEN Kombinasi Tab 0 135 - 20
21 Antiparkinson DOEN tab. Kombinasi Tab 0 1,500 - 21
22 Aqua roinjek Steril Btl 0 2,860 - 22

23 Acyclopir Krim 5%- 5gr Tube 3 8,800 26,400 23
24 Acyclopir Tablet 200mg Tab 100 237 23,700 24
25 Acyclopir Tablet 400 mg Tab 0 380 - 25
26 Akita/Molagit Tablet Tab 0 450 - 26
27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 305 - 27
28 Asam asetilsalisilat 100mg tablet Tab 0 130 - 28
29 Asam Mefenamat 500mg Tab 200 103 20,600 29
30 Alprazolam 1mg Tab 0 233 - 30
31 Ambroksol tab tab 0 169 - 31
32 Ambroksol syr Btl 0 9,883 - 32
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 105 - 33
34 Asering Infus Tab 0 9,646 - 34
35 Asam Folat tablet 01mg Tab 0 63 - 35
36 Asam Folat tablet 5 mg Tab 0 55 - 36
37 Artesunat Inj Vial 0 14,250 - 37
38 Asam traneksamat Inj 5 % Amp 0 24,449 - 38
39 Asetosal Tablet 500 mg Tab 0 - - 39
40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1,595 - 40
41 Atropin Sulfat Tablet 0,5 mg Tab 0 74 - 41
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 - - 42
43 Alkohol 70% 1 Liter Btl 0 24,992 - 43
44 Betadin Salf Antiseptik Tube 0 7,039 - 44
45 Betametason Krim 0,1% - 5 gr Tube 5 1,349 6,745 45
46 Bisacodril sup Supp 0 5,800 - 46
47 Bisoprolol 2,5mg tab Tab 0 650 - 47
48 Captopril Tablet 12,5 mg Tab 0 62 - 48
49 Captopril Tablet 25 mg Tab 50 72 3,600 Rp219,625 49
50 Carbamazefine Tab 0 269 - 50
51 Cefadroxil 500mg Tab 0 516 - 51
52 Cetrizin syr Btl 0 2,849 - 52
53 Cefixim Tab 0 590 - 53
54 Ciprofloxacin Infus Btl 0 39,900 - 54
55 Ciprofloxacin Tablet 500mg Tab 100 255 25,500 55
56 D-Artepp Tab Tab 0 1,000 - 56
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1,097 - 57
58 Deksametasone Tablet 0,5 mg Tab 200 32 6,400 58
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6,600 - 59
60 Diazetpam Rectal 2mg Tube 0 11,516 - 60
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0 17,350 - 61
62 Diazepam Tablet 2 mg Tab 0 45 - 62
63 Diazepam Tablet 5 mg Tab 0 - - 63
64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 - - 64
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 1,176 - 65
66 Digoksin Tablet 0,25 mg Tab 0 105 - 66
67 Domperidon 10 mgtablet Tab 0 85 - 67
68 Dimenhidrinat Tablet 50 mg Tab 0 - - 68
69 Dasabion Tablet Tab 0 - - 69
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3,333 - 70
71 Efedrin HCL Tablet 25 mg Tab 0 51 - 71
72 Ekstrak Belladona Tablet 10 mg Tab 0 31 - 72
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1,408 - 73
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 1,800 - 74
75 Lisinofril 10 mg Tab 0 448 - 75
76 Lisinofril 5mg Tab 0 375 - 76
77 Etanol 70%- 100 ml Btl 0 2,500 - 77
78 Eritromisin Kapsul 500 mg Kap 0 730 - 78
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 6,700 - 79
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 - - 80
81 Fenitoin Natrium Kapsul 100 mg Kap 0 154 - 81
82 Fenitoin Natrium Kapsul 30 mg Kap 0 - - 82
83 Fenobarbital Injeksi- 2ml Amp 0 1,740 - 83
84 Fenobarbital Tablet 30 mg Tab 0 165 - 84
85 Fenobarbital Tablet 30 mg Tab 0 - - 85
86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 - - 86
87 Fluflenazine decanoat inj 25mg/ml Amp 0 57,500 - 87
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3,550 - 88
89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 710 - 89
90 Gentamisin SM Tube 0 2,600 - 90
91 Furosemida Tablet 40 mg Tab 0 75 - 91
92 Garam Oralit 200 ml air Ktg 0 264 - 92
93 Glimepirid 2mg Tablet Tab 0 288 - 93
94 Glibenklamida Tablet 5 mg Tab 0 119 - 94
95 Asetil Sistein 200mg Tab 360 358 128,880 95
96 Glikazid 80 mg Btl 0 235 - 96
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 6,900 - 97
99 Griseofulvin Tablet 500 mg, Tab 0 2,200 - 99
100 Griseofulvin Tablet 125 mg, Micron Tab 0 210 - 100
101 Gentamisin S.K 0.1%-5 gr Tube 0 2,800 - 101
102 Gentamisin Injeksi Vial 0 3,696 - 102
103 Haloperidol 2 mg Tablet Tab 0 126 - 103
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - Rp160,780 105

106 Hidrokortison Krim 2,5%-5 gr Tab 5 2,639 13,195 106
107 Ibuprofen Tablet 200 mg Tab 0 105 - 107
109 Ibufropen syr Btl 0 3,499 - 109
110 Haloporidol Decanoate Inj 50mg Amp 0 9,750 - 110
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 89 - 111
112 Ketokonazol krem Tube 0 2,545 - 112
113 Ketokonazol tab 200mg Tab 50 270 13,500 113
114 Ketorolac Inj 30mg Vial 0 1,045 - 114
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 100 59 5,900 115
116 KN-3B Labu 0 10,050 - 116
117 Karbihidrat +Elektrolit Labu 0 1,007 - 117
118 Karbogliserin Tetes telinga Btl 0 2,500 - 118
119 Kloramfenikol tetes Mata Btl 0 3,250 - 119
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 0 22 - 120
121 Klozapine 25 Mg Tab 0 1,121 - 121
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 - - 122
123 Klorpromazin HCL Tablet Salut 25 mg Tab 0 148 - 123
125 klorpeson Slasf tube 0 7,750 - 125
126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 - - 126
127 Kotrimoksazol Tablet 480mg Tab 0 125 - 127
128 Kotrimoksazol Suspensi Kombinasi Btl 0 2,052 - 128
129 Metpormin 500mg Tab 0 100 - 129
130 Methyilprednisolon 8mg Tab 0 150 - 130
131 Kloramfenikol Salep Mata 1%-5gram Tube 0 1,881 - 131
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1,797 - 132
133 Kuinin Injeksi 25%-2ml Amp 0 6,200 - 133
134 Levoploxasin 500mh Dus 0 528 - 134
135 Lidokain Komp. Injeksi, Kombinasi Amp 0 1,140 - 135
136 Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3,360 - 136
137 Loperamide Hcl 2mg Tanlet Tab 0 85 - 137
138 Magnesium Sulfat Injk 25 ml Vial 0 3,328 - 138
139 Metamizol 500mg Tab 100 473 47,300 139
140 Metilergometrin Maleat Tab. 0,125 g Tab 100 210 21,000 140
141 Metilergometrin M inj. 0,200mg- 1ml Amp 0 2,840 - 141
142 Metoklorpropamid Tablet 10 mg Tab 0 91 - 142
143 Mikonazol Krim/ Salep 2%-10gram Tube 4 3,414 13,656 143
144 Multivitamin Anak Btl 0 12,100 - 144
145 Multivitamin Dewasa Tab 0 1,316 - 145
146 Metronidazol Infus 500mg/100ml Btl 0 9,950 - 146
147 Metronidazol Tablet 500mg Tab 0 113 - 147
148 Metokloramid Syr Btl 0 2,345 - 148
149 Metronidazol syr Btl 0 3,799 - 149
150 Natrium Bikarbonat Tablet 500mg Tab 0 514 - 150
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 6,410 - 151
152 Natrium Diclopenac 20mg Amp 0 145 - 152
153 Nistatin Vaginal sup 0 480 - 153
154 Nistatin Tablet Salut 500.000 IU tab 0 - - 154
155 Natrium Diclopenac 50mg Tab 0 115 - 155
156 Nifedipine Tab 10mg Tab 0 108 - 156
157 Multivitamin Anti Oksidan Tab 100 1,440 144,000 157
158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018 - Rp258,551 158
159 Obat Anti Tuberkulosis Kat. 2 Pkt 0 1,297,894 - 159
160 Obat Anti Tuberkulosis Kat.Anak Pkt 0 214,985 - 160
161 Ofloksasin Tetes telinga Btl 0 45,089 - 161
162 Omeprazol inj 40mg/10ml Btl 0 16,997 - 162
163 Omeprazol Kapsul 20mg Kap 0 130 - 163
164 Ondansetron Inj 4mg Vial 0 1,660 - 164
165 Onadansetron 8mg Tablet Tab 0 1,189 - 165
166 Onadansetron 4mg Tablet Tab 0 471 - 166
167 Obat Batuk Flu Dewasa Pkt 150 413 61,950 167
168 Obat Batuk Hitam (OBH) Cairan Btl 0 5,000 - 168
169 Obat Batuk Dewasa syr Btl 0 5,500 - 169
170 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 7,840 - 170
171 Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1,920 - 171
172 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1,545 - 172
173 Oksitosin Injeksi 10 IU/ml- 1ml Amp 2 1,199 2,398 173
174 OBAT Anti Diare suspensi Btl 0 6,500 - 174
175 parasetamol drops 15 ml btl 0 6,649 - 175
176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 10 1,107 11,070 176
177 Parasetamol tab 100mg Tab 0 41 - 177
178 Parasetamol Tablet 500mg Tab 100 53 5,300 178
179 Permetin Krim/Skabisid 5 % Tube 0 12,155 - 179
180 pirantel syr Btl 0 9,700 - 180
181 Pirantel Tablet 125mg Tab 0 291 - 181
182 piroksikam Tablet 10 mg Tab 0 234 - 182
183 Piroksikam Tablet 20 mg Tab 0 105 - 183
184 Propiltiourasil Tablet 100mg Tab 0 319 - 184
185 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 123 - 185
186 Povidon Iodida 10% 300ml Btl 0 17,996 - 186
187 Povidon Iodida 10% 1000ml Btl 0 - - 187
188 Prednison Tablet 5mg Tab 0 68 - 188
189 Primakuin Tablet 15mg Tab 0 224 - 189
190 Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 6,016 - 190
191 propanolol HCL Tablet 10mg Tab 0 60 - 191
192 Propanolol HCL Tablet 40mg Tab 0 121 - 192
193 Povidon Iodida 10% 60ml Botol 0 6,550 - 193
194 Retinol (Vitamin A) Kapsul 100.000 IU Kap 0 284 - 194
196 MDT MB/ Kusta Dewasa Blister 0 30,595 - 196
197 MDT PB/ Kusta Dewasa Blister 0 9,770 - 197
198 Risperidon 2mg Tab 0 347 - 198
199 Ranitidin Injeksi 25 mg/ 2ml Vial 0 1,155 - 199
200 Ranitidin Tablet 150 mg Tab 0 105 - 200
201 Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 7,150 - 201
202 Salbutamol Tablet 2mg Tab 100 63 6,300 202
204 Salep 2-4, Kombinasi Pot 0 2,621 - 204
205 Salisil Bedak 2% Ktk 0 1,025 - 205
206 Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 479,996 - 206
207 Stimuno Botol 1 23,540 23,540 207
208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 170,000 - 208
209 Sukrafat 500mg Tab 0 368 - 209
210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035 - Rp117,558 210

211 Simvastatin Tablet 20 mg Tab 0 205 - 211
213 Sukralfat Syr Botol 0 8,338 - 213
214 Sulfasetamida Natrium TM 15%- 5ml Btl 0 3,226 - 214
215 Sabutamol Nebulizer Amp 0 110 - 215
216 Spiranolakton tab tab 0 899 - 216
217 Salf Kombinasi Tube 0 11,000 - 217
218 Sinbio Set 0 4,500 - 218
219 Setrizin tablet 10 mg Tab 0 90 - 219
220 Tablet Tambah Darah Komb. Tab 0 352 - 220
221 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 - - 221
222 Tetrasiklin HCL Kapsul 250 mg Kap 0 163 - 222
224 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 100 85 8,500 224
225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 0 1,455 - 225
226 Triheksifenidil Hidroklorida Tab. 2mg Tab 0 88 - 226
227 Vitamin B Komplek Tablet Tab 100 118 11,800 227
228 Zink Syr Botol 0 2,972 - 228
229 Zink Tablet 20mg Tab 50 514 25,700 229
1 Alat Suntik Sekali Pakai 1 ml Set 0 777 - 1
2 Alat Suntik Sekali Pakai 3 ml Set 10 825 8,250 2
4 Catgut/ Benang Bedah No. 2/0 Set 0 60,622 - 4
5 I.V. Catheter No. 20 Set 2 4,783 9,566 5
6 I.V. Catheter No. 22 Set 0 12,232 - 6
8 I.V. Cateter No 26 set 0 13,464 - 8
9 Infusion Set Anak Set 0 3,498 - 9
10 Infusion Set Dewasa Set 2 4,147 8,294 10
11 E.Care Film I.V Dresing Pcs 0 6,850 - 11
12 Silk (Benang Bedah Sutera) No. 3/0 Biji 0 44,953 - 12
13 Saraya Alsof A 500 ml Botol 0 72,047 - 13
14 Kapas Pembalut/Absorben 250 gram Set 0 12,250 - 14
15 Kasa Kompres 40/40 lembar 0 1,800 - 15
16 Kasa Pembalut 2 m x 80 cm pak 0 9,400 - 16
17 Kasa Pembalut Hidrofil 36 m x 80 cm rol 0 127,600 - 17
18 Kasa Steril 16/16 kotak 0 7,370 - 18
19 Masker biji 0 549 - 19
20 Plester 5 yard x 2 inch rol 0 8,167 - 20
21 Sarung Tangan No 7 Steril pasang 0 792 - 21
22 Sarung Tangan No 6.5 Steril pasang 0 7,931 - 22
23 Sarung tangan no 6 1/2 Pasng 0 924 - 23
24 Folly cateter No 16 Pcs 0 12,036 - 24
26 Sarung tangan Gynecolog no 7 Sashet 0 17,748 - 26
27 Alkohol Swab bok 0 32,600 - 27
28 Underpad Lembar 0 4,162 - 28
29 Urine Bag Biji 0 7,038 - 29
30 Catgut/ Benang Bedah No. 3/0 Botol 0 68,433 - 30
31 Antiseptik Surgical Hand Scrab Botol 0 74,000 - 31
32 Cairan pembersih Botol 0 22,000 - 32
33 Jely kateter biji 0 41,600 - 33
34 Jarum Insulin Biji 0 2,083 - Rp72,110 34
TOTAL PENGELUARAN Rp828,624 TOTA
YUYUN YUNENGSIH, S.Kep N.SITI ROHMAH

NIP. 19820422 200801 2 006 NR.TKK
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 07 /SBBK-LPLPO/PKM-CKS/I/2019
Telah diserahkan Kepada : Leuwibalang

JENIS BARANG SATUAN JUMLAH HARGA TOTAL NO
Alopurinol tablet 100 mg Tab 0 99 - 1
Aminofilin tablet 200 mg Tab 0 91 - 2
Albendazol Tab 0 404 - 3
Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245 - 4
Amitriptilin HCL Tab. Salut 25 mg Tab 0 167 - 5
Amlodipine 10 mg Tablet Tab 50 93 4,650 6
Amlodipine Besilate 5mg tablet Tab 0 70 - 7
Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 0 2,702,700 - 8
Amoksisillin Kapsul 500 mg Tab 300 233 69,900 9
Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 1,881 - 10
Alkazyme Sachet 25mg(Alkapham France) Pack 0 801,000 - 11
Amoksilin sk Forte Tab 10 3,400 34,000 12
Ampisillin Injeksi 1 gram Vial 0 3,850 - 13
Antalgin (Metampiron) Tab. 500 mg Tab 0 205 - 14
Antasida DOEN tablet Tab 200 54 10,800 15
Antasida DOEN suspensi Btl 10 1,923 19,230 16
Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 0 3,035 - 17
Anti Hemoroid DOEN Kombinasi Supp 0 3,167 - 18
Antifungi DOEN Kombinasi Pot 0 3,035 - 19
Antimigren DOEN Kombinasi Tab 0 135 - 20
Antiparkinson DOEN tab. Kombinasi Tab 0 1,500 - 21
Aqua roinjek Steril Btl 0 2,860 - 22

Acyclopir Krim 5%- 5gr Tube 3 8,800 26,400 23
Acyclopir Tablet 200mg Tab 100 237 23,700 24
Acyclopir Tablet 400 mg Tab 0 380 - 25
Akita/Molagit Tablet Tab 0 450 - 26
Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 305 - 27
Asam asetilsalisilat 100mg tablet Tab 0 130 - 28
Asam Mefenamat 500mg Tab 200 103 20,600 29
Alprazolam 1mg Tab 0 233 - 30
Ambroksol tab tab 0 169 - 31
Ambroksol syr Btl 0 9,883 - 32
Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 105 - 33
Asering Infus Tab 0 9,646 - 34
Asam Folat tablet 01mg Tab 0 63 - 35
Asam Folat tablet 5 mg Tab 0 55 - 36
Artesunat Inj Vial 0 14,250 - 37
Asam traneksamat Inj 5 % Amp 0 24,449 - 38
Asetosal Tablet 500 mg Tab 0 - - 39
Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1,595 - 40
Atropin Sulfat Tablet 0,5 mg Tab 0 74 - 41
Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 - - 42
Alkohol 70% 1 Liter Btl 0 24,992 - 43
Betadin Salf Antiseptik Tube 0 7,039 - 44
Betametason Krim 0,1% - 5 gr Tube 5 1,349 6,745 45
Bisacodril sup Supp 0 5,800 - 46
Bisoprolol 2,5mg tab Tab 0 650 - 47
Captopril Tablet 12,5 mg Tab 0 62 - 48
Captopril Tablet 25 mg Tab 50 72 3,600 Rp219,625 49
Carbamazefine Tab 0 269 - 50
Cefadroxil 500mg Tab 0 516 - 51
Cetrizin syr Btl 0 2,849 - 52
Cefixim Tab 0 590 - 53
Ciprofloxacin Infus Btl 0 39,900 - 54
Ciprofloxacin Tablet 500mg Tab 100 255 25,500 55
D-Artepp Tab Tab 0 1,000 - 56
Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1,097 - 57
Deksametasone Tablet 0,5 mg Tab 200 32 6,400 58
Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6,600 - 59
Diazetpam Rectal 2mg Tube 0 11,516 - 60
Diazepam Injeksi 5 mg/ml - 2ml Amp 0 17,350 - 61
Diazepam Tablet 2 mg Tab 0 45 - 62
Diazepam Tablet 5 mg Tab 0 - - 63
Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 - - 64
Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 1,176 - 65
Digoksin Tablet 0,25 mg Tab 0 105 - 66
Domperidon 10 mgtablet Tab 0 85 - 67
Dimenhidrinat Tablet 50 mg Tab 0 - - 68
Dasabion Tablet Tab 0 - - 69
Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3,333 - 70
Efedrin HCL Tablet 25 mg Tab 0 51 - 71
Ekstrak Belladona Tablet 10 mg Tab 0 31 - 72
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1,408 - 73
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 1,800 - 74
Lisinofril 10 mg Tab 0 448 - 75
Lisinofril 5mg Tab 0 375 - 76
Etanol 70%- 100 ml Btl 0 2,500 - 77
Eritromisin Kapsul 500 mg Kap 0 730 - 78
Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 6,700 - 79
Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 - - 80
Fenitoin Natrium Kapsul 100 mg Kap 0 154 - 81
Fenitoin Natrium Kapsul 30 mg Kap 0 - - 82
Fenobarbital Injeksi- 2ml Amp 0 1,740 - 83
Fenobarbital Tablet 30 mg Tab 0 165 - 84
Fenobarbital Tablet 30 mg Tab 0 - - 85
Fenoksimetil Penisilina Tablet 250 mg Tab 0 - - 86
Fluflenazine decanoat inj 25mg/ml Amp 0 57,500 - 87
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3,550 - 88
Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 710 - 89
Gentamisin SM Tube 0 2,600 - 90
Furosemida Tablet 40 mg Tab 0 75 - 91
Garam Oralit 200 ml air Ktg 0 264 - 92
Glimepirid 2mg Tablet Tab 0 288 - 93
Glibenklamida Tablet 5 mg Tab 0 119 - 94
Asetil Sistein 200mg Tab 360 358 128,880 95
Glikazid 80 mg Btl 0 235 - 96
Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 6,900 - 97
Griseofulvin Tablet 500 mg, Tab 0 2,200 - 99
Griseofulvin Tablet 125 mg, Micron Tab 0 210 - 100
Gentamisin S.K 0.1%-5 gr Tube 0 2,800 - 101
Gentamisin Injeksi Vial 0 3,696 - 102
Haloperidol 2 mg Tablet Tab 0 126 - 103
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - Rp160,780 105
Hidrokortison Krim 2,5%-5 gr Tab 5 2,639 13,195 106
Ibuprofen Tablet 200 mg Tab 0 105 - 107
Ibufropen syr Btl 0 3,499 - 109
Haloporidol Decanoate Inj 50mg Amp 0 9,750 - 110
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 89 - 111
Ketokonazol krem Tube 0 2,545 - 112
Ketokonazol tab 200mg Tab 50 270 13,500 113
Ketorolac Inj 30mg Vial 0 1,045 - 114
Kalsium Laktat (Kalk) Tablet 500 mg Tab 100 59 5,900 115
KN-3B Labu 0 10,050 - 116
Karbihidrat +Elektrolit Labu 0 1,007 - 117
Karbogliserin Tetes telinga Btl 0 2,500 - 118
Kloramfenikol tetes Mata Btl 0 3,250 - 119
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 0 22 - 120
Klozapine 25 Mg Tab 0 1,121 - 121
Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 - - 122
Klorpromazin HCL Tablet Salut 25 mg Tab 0 148 - 123
klorpeson Slasf tube 0 7,750 - 125
Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 - - 126
Kotrimoksazol Tablet 480mg Tab 0 125 - 127
Kotrimoksazol Suspensi Kombinasi Btl 0 2,052 - 128
Metpormin 500mg Tab 0 100 - 129
Methyilprednisolon 8mg Tab 0 150 - 130
Kloramfenikol Salep Mata 1%-5gram Tube 0 1,881 - 131
Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1,797 - 132
Kuinin Injeksi 25%-2ml Amp 0 6,200 - 133
Levoploxasin 500mh Dus 0 528 - 134
Lidokain Komp. Injeksi, Kombinasi Amp 0 1,140 - 135
Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3,360 - 136
Loperamide Hcl 2mg Tanlet Tab 0 85 - 137
Magnesium Sulfat Injk 25 ml Vial 0 3,328 - 138
Metamizol 500mg Tab 100 473 47,300 139
Metilergometrin Maleat Tab. 0,125 g Tab 100 210 21,000 140
Metilergometrin M inj. 0,200mg- 1ml Amp 0 2,840 - 141
Metoklorpropamid Tablet 10 mg Tab 0 91 - 142
Mikonazol Krim/ Salep 2%-10gram Tube 4 3,414 13,656 143
Multivitamin Anak Btl 0 12,100 - 144
Multivitamin Dewasa Tab 0 1,316 - 145
Metronidazol Infus 500mg/100ml Btl 0 9,950 - 146
Metronidazol Tablet 500mg Tab 0 113 - 147
Metokloramid Syr Btl 0 2,345 - 148
Metronidazol syr Btl 0 3,799 - 149
Natrium Bikarbonat Tablet 500mg Tab 0 514 - 150
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 6,410 - 151
Natrium Diclopenac 20mg Amp 0 145 - 152
Nistatin Vaginal sup 0 480 - 153
Nistatin Tablet Salut 500.000 IU tab 0 - - 154
Natrium Diclopenac 50mg Tab 0 115 - 155
Nifedipine Tab 10mg Tab 0 108 - 156
Multivitamin Anti Oksidan Tab 100 1,440 144,000 157
Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018 - Rp258,551 158
Obat Anti Tuberkulosis Kat. 2 Pkt 0 1,297,894 - 159
Obat Anti Tuberkulosis Kat.Anak Pkt 0 214,985 - 160
Ofloksasin Tetes telinga Btl 0 45,089 - 161
Omeprazol inj 40mg/10ml Btl 0 16,997 - 162
Omeprazol Kapsul 20mg Kap 0 130 - 163
Ondansetron Inj 4mg Vial 0 1,660 - 164
Onadansetron 8mg Tablet Tab 0 1,189 - 165
Onadansetron 4mg Tablet Tab 0 471 - 166
Obat Batuk Flu Dewasa Pkt 150 413 61,950 167
Obat Batuk Hitam (OBH) Cairan Btl 0 5,000 - 168
Obat Batuk Dewasa syr Btl 0 5,500 - 169
Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 7,840 - 170
Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1,920 - 171
Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1,545 - 172
Oksitosin Injeksi 10 IU/ml- 1ml Amp 2 1,199 2,398 173
OBAT Anti Diare suspensi Btl 0 6,500 - 174
parasetamol drops 15 ml btl 0 6,649 - 175
Parasetamol Syrup 120mg/ 5ml-60ml Btl 10 1,107 11,070 176
Parasetamol tab 100mg Tab 0 41 - 177
Parasetamol Tablet 500mg Tab 100 53 5,300 178
Permetin Krim/Skabisid 5 % Tube 0 12,155 - 179
pirantel syr Btl 0 9,700 - 180
Pirantel Tablet 125mg Tab 0 291 - 181
piroksikam Tablet 10 mg Tab 0 234 - 182
Piroksikam Tablet 20 mg Tab 0 105 - 183
Propiltiourasil Tablet 100mg Tab 0 319 - 184
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 123 - 185
Povidon Iodida 10% 300ml Btl 0 17,996 - 186
Povidon Iodida 10% 1000ml Btl 0 - - 187
Prednison Tablet 5mg Tab 0 68 - 188
Primakuin Tablet 15mg Tab 0 224 - 189
Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 6,016 - 190
propanolol HCL Tablet 10mg Tab 0 60 - 191
Propanolol HCL Tablet 40mg Tab 0 121 - 192
Povidon Iodida 10% 60ml Botol 0 6,550 - 193
Retinol (Vitamin A) Kapsul 100.000 IU Kap 0 284 - 194
MDT MB/ Kusta Dewasa Blister 0 30,595 - 196
MDT PB/ Kusta Dewasa Blister 0 9,770 - 197
Risperidon 2mg Tab 0 347 - 198
Ranitidin Injeksi 25 mg/ 2ml Vial 0 1,155 - 199
Ranitidin Tablet 150 mg Tab 0 105 - 200
Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 7,150 - 201
Salbutamol Tablet 2mg Tab 100 63 6,300 202
Salep 2-4, Kombinasi Pot 0 2,621 - 204
Salisil Bedak 2% Ktk 0 1,025 - 205
Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 479,996 - 206
Stimuno Botol 1 23,540 23,540 207
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 170,000 - 208
Sukrafat 500mg Tab 0 368 - 209
Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035 - Rp117,558 210

Simvastatin Tablet 20 mg Tab 0 205 - 211
Sukralfat Syr Botol 0 8,338 - 213
Sulfasetamida Natrium TM 15%- 5ml Btl 0 3,226 - 214
Sabutamol Nebulizer Amp 0 110 - 215
Spiranolakton tab tab 0 899 - 216
Salf Kombinasi Tube 0 11,000 - 217
Sinbio Set 0 4,500 - 218
Setrizin tablet 10 mg Tab 0 90 - 219
Tablet Tambah Darah Komb. Tab 0 352 - 220
Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 - - 221
Tetrasiklin HCL Kapsul 250 mg Kap 0 163 - 222
Tiamin HCL/(Vit. B1) Tab. 50mg Tab 100 85 8,500 224
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 0 1,455 - 225
Triheksifenidil Hidroklorida Tab. 2mg Tab 0 88 - 226
Vitamin B Komplek Tablet Tab 100 118 11,800 227
Zink Syr Botol 0 2,972 - 228
Zink Tablet 20mg Tab 50 514 25,700 229
Alat Suntik Sekali Pakai 1 ml Set 0 777 - 1
Alat Suntik Sekali Pakai 3 ml Set 10 825 8,250 2
Catgut/ Benang Bedah No. 2/0 Set 0 60,622 - 4
I.V. Catheter No. 20 Set 2 4,783 9,566 5
I.V. Catheter No. 22 Set 0 12,232 - 6
I.V. Cateter No 26 set 0 13,464 - 8
Infusion Set Anak Set 0 3,498 - 9
Infusion Set Dewasa Set 2 4,147 8,294 10
E.Care Film I.V Dresing Pcs 0 6,850 - 11
Silk (Benang Bedah Sutera) No. 3/0 Biji 0 44,953 - 12
Saraya Alsof A 500 ml Botol 0 72,047 - 13
Kapas Pembalut/Absorben 250 gram Set 0 12,250 - 14
Kasa Kompres 40/40 lembar 0 1,800 - 15
Kasa Pembalut 2 m x 80 cm pak 0 9,400 - 16
Kasa Pembalut Hidrofil 36 m x 80 cm rol 0 127,600 - 17
Kasa Steril 16/16 kotak 0 7,370 - 18
Masker biji 0 549 - 19
Plester 5 yard x 2 inch rol 0 8,167 - 20
Sarung Tangan No 7 Steril pasang 0 792 - 21
Sarung Tangan No 6.5 Steril pasang 0 7,931 - 22
Sarung tangan no 6 1/2 Pasng 0 924 - 23
Folly cateter No 16 Pcs 0 12,036 - 24
Sarung tangan Gynecolog no 7 Sashet 0 17,748 - 26
Alkohol Swab bok 0 32,600 - 27
Underpad Lembar 0 4,162 - 28
Urine Bag Biji 0 7,038 - 29
Catgut/ Benang Bedah No. 3/0 Botol 0 68,433 - 30
Antiseptik Surgical Hand Scrab Botol 0 74,000 - 31
Cairan pembersih Botol 0 22,000 - 32
Jely kateter biji 0 41,600 - 33
Jarum Insulin Biji 0 2,083 - Rp72,110 34
TOTAL PENGELUARAN Rp828,624 TOTAL P
YUYUN YUNENGSIH, S.Kep ANGGA PERMANA, AMK

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PEMERINTAH KABUPATEN PANDEGLANG PEM
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Alun-a
REKAPITULASI PENGELUARAN OBAT Nomor

BULAN JANUARI 2019
Telah diserahkan Kepada : Po
Alopurinol tablet 100 mg Tab 500 99 49,500 1
Aminofilin tablet 200 mg Tab 100 91 9,100 Rusak 2
Amoksisillin Kapsul 500 mg Tab 5100 233 1,188,300 9
Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 25 3,035 75,875 17
Aqua roinjek Steril Btl 10 2,860 28,600 22

Asam Askorbat (Vit. C) Tablet 50 mg Tab 400 105 42,000 33
Asam traneksamat Inj 5 % Amp 20 24,449 488,980 38
Bisacodril sup Supp 2 5,800 11,600 46
Captopril Tablet 12,5 mg Tab 400 62 24,800 48
Captopril Tablet 25 mg Tab 1150 72 82,800 Rp4,516,060 49
Carbamazefine Tab 100 269 26,900 50
Domperidon 10 mgtablet Tab 500 85 42,500 67
Etanol 70%- 100 ml Btl 0 2,500 - 77
Fitomenadion (Vit. K1) Tab. 10 mg Tab 300 710 213,000 89
Glibenklamida Tablet 5 mg Tab 600 119 71,400 94
Asetil Sistein 200mg Tab 4740 358 1,696,920 95
Gentamisin Injeksi Vial 29 3,696 107,184 102
Haloperidol 2 mg Tablet Tab 300 126 37,800 103
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - Rp2,849,554 105
Ibuprofen Tablet 200 mg Tab 500 105 52,500 107
Ketokonazol krem Tube 40 2,545 101,800 112
KN-3B Labu 0 10,050 - 116
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 1500 22 33,000 120
Klorpromazin HCL Tablet Salut 100 mg Tab 200 147 29,400 124
Kotrimoksazol Tablet 480mg Tab 250 125 31,250 127
Metpormin 500mg Tab 1000 100 100,000 129
Kloramfenikol Salep Mata 1%-5gram Tube 25 1,881 47,025 131
Loperamide Hcl 2mg Tanlet Tab 200 85 17,000 137
Magnesium Sulfat Injk 25 ml Vial 2 3,328 6,656 138
Metamizol 500mg Tab 2100 473 993,300 139
Multivitamin Anak Btl 50 12,100 605,000 144
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 20 6,410 128,200 151
Nistatin Vaginal sup 20 480 9,600 153
Natrium Diclopenac 50mg Tab 2750 115 316,250 155
Multivitamin Anti Oksidan Tab 2200 1,440 3,168,000 157
Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018 - Rp6,370,761 158
Omeprazol Kapsul 20mg Kap 1760 130 228,800 163
Onadansetron 4mg Tablet Tab 72 471 33,912 166
Obat Batuk Flu Dewasa Pkt 3300 413 1,362,900 167
parasetamol drops 15 ml btl 10 6,649 66,490 175
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 250 123 30,750 185
Povidon Iodida 10% 300ml Btl 4 17,996 71,984 186
Prednison Tablet 5mg Tab 2000 68 136,000 188
propanolol HCL Tablet 10mg Tab 1000 60 60,000 Exf 191
Retinol (Vitamin A) Kapsul 100.000 IU Kap 650 284 184,600 194
Retinol (Vitamin A) Kapsul 200.000 IU Kap 4000 505 2,020,000 195
Ranitidin Injeksi 25 mg/ 2ml Vial 50 1,155 57,750 199
Ranitidin Tablet 150 mg Tab 2900 105 304,500 200
Ringer Laktat Lar. Inf. Steril - 500ml Btl 136 7,150 972,400 201
Salep 2-4, Kombinasi Pot 10 2,621 26,210 204
Salisil Bedak 2% Ktk 20 1,025 20,500 205
Serum Anti Bisa Ular Polivalen Inj.5ml Vial 5 479,996 2,399,980 206
Stimuno Botol 14 23,540 329,560 207
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 11 170,000 1,870,000 208
Sianokobalamin (Vit. B12) Inj 500mcg Amp 20 1,035 20,700 Rp10,948,688 210

Simvastatin Tablet 20 mg Tab 500 205 102,500 211
Sinbio Set 0 4,500 - 218
Setrizin tablet 10 mg Tab 1300 90 117,000 219
Tablet Tambah Darah Komb. Tab 16350 352 5,755,200 220
Tetrasiklin HCL Kapsul 250 mg Kap 700 163 114,100 Exf 222
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 30 1,455 43,650 exf 225
Triheksifenidil Hidroklorida Tab. 2mg Tab 200 88 17,600 226
Zink Syr Botol 32 2,972 95,104 228
Catgut/ Benang Bedah No. 2/0 Set 10 60,622 606,220 4
I.V. Cateter No 26 set 10 13,464 134,640 8
Infusion Set Anak Set 10 3,498 34,980 9
Kasa Kompres 40/40 lembar 93 1,800 167,400 15
Kasa Steril 16/16 kotak 100 7,370 737,000 18
Plester 5 yard x 2 inch rol 15 8,167 122,505 20
Sarung Tangan No 6.5 Steril pasang 50 7,931 396,550 22
Folly cateter No 16 Pcs 5 12,036 60,180 24
Alkohol Swab bok 4 32,600 130,400 27
Underpad Lembar 20 4,162 83,240 28
Antiseptik Surgical Hand Scrab Botol 5 74,000 370,000 31
Jarum Insulin Biji 0 2,083 - Rp11,508,979 34
TOTAL PENGELUARAN Rp36,194,042 TOTAL PENGELUA
Kepala Puskesmas Cikeusik Yang Menerima

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
PUSKESMAS CIKEUSIK

Nomor : 800/ 08 /SBBK-LPLPO/PKM-CKS/I/2019 Nomor
lah diserahkan Kepada : Poskesdes Parungkokosan Telah diserahkan Kepada : PU

eperluan Bulan : Januari 2019 Keperluan Bulan : Januari 201
Alkacide 1 L High Level Desinfectant(Alkapham Fera Btl 0 2,702,700 - 8

Captopril Tablet 25 mg Tab 50 72 3,600 Rp 219,625 49
Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 0 10,050 - 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
TOTAL PENGELUARAN Rp828,624 TOTAL PENGELUA
YUYUN YUNENGSIH, S.Kep HAYATI,Amd.Keb

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Alu

Nomor :800/ 09 /SBBK-LPLPO/PKM-CKS/I/2019 Nom
lah diserahkan Kepada : PUSLING Telah diserahkan Kepada

eperluan Bulan : Januari 2019 Keperluan Bulan : Januar
Amlodipine 10 mg Tablet Tab 0 93 - 6
Antasida DOEN suspensi Btl 0 1,923 - 16

Acyclopir Krim 5%- 5gr Tube 0 8,800 - 23
Acyclopir Tablet 200mg Tab 0 237 - 24
Asam Mefenamat 500mg Tab 0 103 - 29
Betametason Krim 0,1% - 5 gr Tube 0 1,349 - 45
Captopril Tablet 25 mg Tab 300 72 21,600 49
Etanol 70%- 100 ml Btl 0 2,500 - 77
Gentamisin Tetes mata Vial 5 3,696 18,480 102
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - 105
Hidrokortison Krim 2,5%-5 gr Tab 0 2,639 - 106
Ketokonazol tab 200mg Tab 0 270 - 113
KN-3B Labu 0 10,050 - 116
Metamizol 500mg Tab 200 473 94,600 139
Metilergometrin Maleat Tab. 0,125 g Tab 0 210 - 140
Mikonazol Krim/ Salep 2%-10gram Tube 0 3,414 - 143
Oksitosin Injeksi 10 IU/ml- 1ml Amp 0 1,199 - 173
Salbutamol Tablet 2mg Tab 0 63 - 202
Stimuno Botol 0 23,540 - 207

Sinbio Set 0 4,500 - 218
Tablet Tambah Darah Komb. Tab 180 352 63,360 220
Zink Syr Botol 6 2,972 17,832 228
Zink Tablet 20mg Tab 0 514 - 229
Infusion Set Dewasa Set 0 4,147 - 10
TOTAL PENGELUARAN Rp1,076,232 TOTAL PENG
YUYUN YUNENGSIH, S.Kep ARDIN, Amd.Kep

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PEMERINTAH KABUPATEN PANDEGLANG PEMERIN
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Alun-alun C

lah diserahkan Kepada : Curugciung

eperluan Bulan : Januari 2019

Captopril Tablet 25 mg Tab 50 72 3,600 49
Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 0 10,050 - 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
TOTAL PENGELUARAN Rp448,219 TOTAL PENGELUARAN
YUYUN YUNENGSIH, S.Kep SITI HASANAH,Amd Keb

NIP. 19820422 200801 2 006 NIP.19910820 201704 2 001
Mengetahui
NIP. 19710804 199103 2 002
PEMERINTAH KABUPATEN PANDEGLANG PEMER
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Alun-alun
PENERIMAAN
BULAN JANUARI 2019

Aminofilin tablet 200 mg Tab 900 91 81,900 2
Albendazol Tab 390 404 157,560 3
Amitriptilin HCL Tab. Salut 25 mg Tab 500 167 83,500 5
Amlodipine Besilate 5mg tablet Tab 1200 70 84,000 7
Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 2 2,702,700 5,405,400 8
Alkazyme Sachet 25mg(Alkapham France) Pack 2 801,000 1,602,000 11
Amoksilin sk Forte Tab 334 3,400 1,135,600 12
Anti Hemoroid DOEN Kombinasi Supp 30 3,167 95,010 18

Acyclopir Tablet 400 mg Tab 700 380 266,000 25
Akita/Molagit Tablet Tab 600 450 270,000 26
Asam asetilsalisilat 100mg tablet Tab 400 130 52,000 28
Asering Infus Tab 48 9,646 463,008 34
Asam Folat tablet 5 mg Tab 800 55 44,000 36
Alkohol 70% 1 Liter Btl 1 24,992 24,992 43
Betadin Salf Antiseptik Tube 24 7,039 168,936 44
Bisoprolol 2,5mg tab Tab 570 650 370,500 47
Deksametasone Injeksi 5 mg/ml - 1ml Amp 100 1,097 109,700 57
Diazepam Injeksi 5 mg/ml - 2ml Amp 57 17,350 988,950 61
Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 43 1,176 50,568 65
Digoksin Tablet 0,25 mg Tab 300 105 31,500 66
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 105 1,408 147,840 73
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 7 1,800 12,600 74
Etanol 70%- 100 ml Btl 0 2,500 - 77
Eritromisin Kapsul 500 mg Kap 600 730 438,000 78
Eritromisin Syrup 200 mg/5 ml-60 ml Btl 80 6,700 536,000 79
Fenobarbital Injeksi- 2ml Amp 52 1,740 90,480 83
Fenobarbital Tablet 30 mg Tab 100 165 16,500 84
Fluflenazine decanoat inj 25mg/ml Amp 20 57,500 1,150,000 87
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 30 3,550 106,500 88
Garam Oralit 200 ml air Ktg 150 264 39,600 92
Glikazid 80 mg Btl 550 235 129,250 96
Glukosa Lar. Infus 5% Steril - 500 ml Btl 44 6,900 303,600 97
Griseofulvin Tablet 125 mg, Micron Tab 490 210 102,900 100
Gentamisin Injeksi Vial 72 3,696 266,112 102
Hidroklortiazid (HCT) Tablet 25 mg Tab 700 149 104,300 Rp8,776,140 105
Ibuprofen Tablet 200 mg Tab 500 105 52,500 107
Haloporidol Decanoate Inj 50mg Amp 25 9,750 243,750 110
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 1600 89 142,400 111
Ketorolac Inj 30mg Vial 100 1,045 104,500 114
KN-3B Labu 42 10,050 422,100 116
Karbihidrat +Elektrolit Labu 40 1,007 40,280 117
Karbogliserin Tetes telinga Btl 36 2,500 90,000 118
Klozapine 25 Mg Tab 998 1,121 1,118,758 121
Kotrimoksazol Suspensi Kombinasi Btl 120 2,052 246,240 128
Metpormin 500mg Tab 2700 100 270,000 129
Kuinin Injeksi 25%-2ml Amp 5 6,200 31,000 133
Lidokain Komp. Injeksi, Kombinasi Amp 80 1,140 91,200 135
Metamizol 500mg Tab 2300 473 1,087,900 139
Metilergometrin M inj. 0,200mg- 1ml Amp 40 2,840 113,600 141
Metokloramid Syr Btl 60 2,345 140,700 148
Metronidazol syr Btl 40 3,799 151,960 149
Nifedipine Tab 10mg Tab 150 108 16,200 156
Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 31 317,018 9,827,558 Rp23,486,418 158
Obat Anti Tuberkulosis Kat. 2 Pkt 4 1,297,894 5,191,576 159
Obat Anti Tuberkulosis Kat.Anak Pkt 5 214,985 1,074,925 160
Ofloksasin Tetes telinga Btl 4 45,089 180,356 161
pirantel syr Btl 23 9,700 223,100 180
Pirantel Tablet 125mg Tab 435 291 126,585 181
Propiltiourasil Tablet 100mg Tab 600 319 191,400 184
propanolol HCL Tablet 10mg Tab 1000 60 60,000 191
Povidon Iodida 10% 60ml Botol 2 6,550 13,100 193
Risperidon 2mg Tab 320 347 111,040 198
Ringer Laktat Lar. Inf. Steril - 500ml Btl 204 7,150 1,458,600 201
Stimuno Botol 48 23,540 1,129,920 207
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 14 170,000 2,380,000 208

Sinbio Set 0 4,500 - 218
Tetrasiklin HCL Kapsul 250 mg Kap 700 163 114,100 222
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 30 1,455 43,650 225
Zink Syr Botol 53 2,972 157,516 228
Catgut/ Benang Bedah No. 2/0 Set 97 60,622 5,880,334 4
I.V. Catheter No. 22 Set 179 12,232 2,189,528 6
I.V. Cateter No 26 set 187 13,464 2,517,768 8
E.Care Film I.V Dresing Pcs 400 6,850 2,740,000 11
Silk (Benang Bedah Sutera) No. 3/0 Biji 118 44,953 5,304,454 12
Kapas Pembalut/Absorben 250 gram Set 13 12,250 159,250 14
Kasa Pembalut 2 m x 80 cm pak 20 9,400 188,000 16
Kasa Pembalut Hidrofil 36 m x 80 cm rol 5 127,600 638,000 17
Kasa Steril 16/16 kotak 200 7,370 1,474,000 18
Masker biji 500 549 274,500 19
Sarung Tangan No 6.5 Steril pasang 200 7,931 1,586,200 22
Sarung tangan Gynecolog no 7 Sashet 80 17,748 1,419,840 26
Alkohol Swab bok 8 32,600 260,800 27
Underpad Lembar 130 4,162 541,060 28
Urine Bag Biji 22 7,038 154,836 29
Catgut/ Benang Bedah No. 3/0 Botol 108 68,433 7,390,764 30
Antiseptik Surgical Hand Scrab Botol 5 74,000 370,000 31
Cairan pembersih Botol 8 22,000 176,000 32
Jely kateter biji 33 41,600 1,372,800 33
Jarum Insulin Biji 129 2,083 268,707 Rp46,616,743 34
TOTAL PENGELUARAN Rp128,684,016 TOTAL PENGELUARAN
Mengetahui Cikeusik, 26 Januari 2019
Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH,S.Kep

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
SISA OBAT Nomor

BULAN JANUARI 2019
Telah diserahkan Kepada : Tan

Etanol 70%- 100 ml Btl 0 2,500 - 77
Glikazid 80 mg Btl 550 235 129,250 96
Gentamisin Tetes Mata Vial 43 3,696 158,928 102
KN-3B Labu 42 10,050 422,100 116
Klozapine 25 Mg Tab 998 1,121 1,118,758 121
Metpormin 500mg Tab 1700 100 170,000 129
Metamizol 500mg Tab 200 473 94,600 139
Obat Anti Tuberkulosis Kat.Anak Pkt 5 214,985 1,074,925 160
pirantel syr Btl 23 9,700 223,100 180
Stimuno Botol 34 23,540 800,360 207
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 3 170,000 510,000 208

Sinbio Set 0 4,500 - 218
Vitamin B Komplek Tablet Tab 0 118 - 227
Zink Syr Botol 21 2,972 62,412 228
I.V. Cateter No 26 set 177 13,464 2,383,128 8
Masker biji 500 549 274,500 19
Alkohol Swab bok 4 32,600 130,400 27
Underpad Lembar 110 4,162 457,820 28
Urine Bag Biji 22 7,038 154,836 29
TOTAL PENGELUARAN Rp92,489,974 TOTAL PENGELUA

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln.

Nomor :800/ 11 /SBBK-LPLPO/PKM-CKS/I/2019 N
lah diserahkan Kepada : Tanjungan 2 Telah diserahkan Kepada : PE

eperluan Bulan : Januari 2019 Keperluan Bulan : Januari 20
Alopurinol tablet 100 mg Tab 0 99 - I
Amitriptilin HCL Tab. Salut 25 mg Tab 0 167 -
Amlodipine 10 mg Tablet Tab 50 93 4,650
Amlodipine Besilate 5mg tablet Tab 0 70 -
Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 0 2,702,700 -
Amoksisillin Kapsul 500 mg Tab 300 233 69,900
Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 1,881 -
Alkazyme Sachet 25mg(Alkapham France) Pack 0 801,000 -
Amoksilin sk Forte Tab 10 3,400 34,000
Ampisillin Injeksi 1 gram Vial 0 3,850 -
Antalgin (Metampiron) Tab. 500 mg Tab 0 205 -
Antasida DOEN tablet Tab 200 54 10,800
Antasida DOEN suspensi Btl 10 1,923 19,230
Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 0 3,035 -
Anti Hemoroid DOEN Kombinasi Supp 0 3,167 -
Antifungi DOEN Kombinasi Pot 0 3,035 -
Antimigren DOEN Kombinasi Tab 0 135 -
Antiparkinson DOEN tab. Kombinasi Tab 0 1,500 -
Aqua roinjek Steril Btl 0 2,860 -

Acyclopir Krim 5%- 5gr Tube 3 8,800 26,400
Acyclopir Tablet 200mg Tab 100 237 23,700
Acyclopir Tablet 400 mg Tab 0 380 -
Akita/Molagit Tablet Tab 0 450 -
Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 305 -
Asam asetilsalisilat 100mg tablet Tab 0 130 -
Asam Mefenamat 500mg Tab 200 103 20,600
Alprazolam 1mg Tab 0 233 -
Ambroksol tab tab 0 169 -
Ambroksol syr Btl 0 9,883 -
Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 105 -
Asering Infus Tab 0 9,646 -
Asam Folat tablet 01mg Tab 0 63 -
Asam Folat tablet 5 mg Tab 0 55 -
Artesunat Inj Vial 0 14,250 -
Asam traneksamat Inj 5 % Amp 0 24,449 -
Asetosal Tablet 500 mg Tab 0 - -
Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1,595 -
Atropin Sulfat Tablet 0,5 mg Tab 0 74 -
Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 - -
Alkohol 70% 1 Liter Btl 0 24,992 -
Betadin Salf Antiseptik Tube 0 7,039 -
Betametason Krim 0,1% - 5 gr Tube 5 1,349 6,745
Bisacodril sup Supp 0 5,800 -
Bisoprolol 2,5mg tab Tab 0 650 -
Captopril Tablet 12,5 mg Tab 0 62 -
Captopril Tablet 25 mg Tab 50 72 3,600 Rp219,625
JENIS BARANG SATUAN JUMLAH HARGA TOTAL
Carbamazefine Tab 0 269 -
Cefadroxil 500mg Tab 0 516 -
Cetrizin syr Btl 0 2,849 -
Cefixim Tab 0 590 -
Ciprofloxacin Infus Btl 0 39,900 -
Ciprofloxacin Tablet 500mg Tab 100 255 25,500
D-Artepp Tab Tab 0 1,000 -
Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1,097 -
Deksametasone Tablet 0,5 mg Tab 200 32 6,400
Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6,600 -
Diazetpam Rectal 2mg Tube 0 11,516 -
Diazepam Injeksi 5 mg/ml - 2ml Amp 0 17,350 -
Diazepam Tablet 2 mg Tab 0 45 -
Diazepam Tablet 5 mg Tab 0 - -
Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 - -
Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 1,176 -
Digoksin Tablet 0,25 mg Tab 0 105 -
Domperidon 10 mgtablet Tab 0 85 -
Dimenhidrinat Tablet 50 mg Tab 0 - -
Dasabion Tablet Tab 0 - -
Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3,333 -
Efedrin HCL Tablet 25 mg Tab 0 51 -
Ekstrak Belladona Tablet 10 mg Tab 0 31 -
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1,408 -
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 1,800 -
Lisinofril 10 mg Tab 0 448 -
Lisinofril 5mg Tab 0 375 -
Etanol 70%- 100 ml Btl 0 2,500 -
Eritromisin Kapsul 500 mg Kap 0 730 -
Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 6,700 -
Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 - -
Fenitoin Natrium Kapsul 100 mg Kap 0 154 -
Fenitoin Natrium Kapsul 30 mg Kap 0 - -
Fenobarbital Injeksi- 2ml Amp 0 1,740 -
Fenobarbital Tablet 30 mg Tab 0 165 -
Fenobarbital Tablet 30 mg Tab 0 - -
Fenoksimetil Penisilina Tablet 250 mg Tab 0 - -
Fluflenazine decanoat inj 25mg/ml Amp 0 57,500 -
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3,550 -
Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 710 -
Gentamisin SM Tube 0 2,600 -
Furosemida Tablet 40 mg Tab 0 75 -
Garam Oralit 200 ml air Ktg 0 264 -
Glimepirid 2mg Tablet Tab 0 288 -
Glibenklamida Tablet 5 mg Tab 0 119 -
Asetil Sistein 200mg Tab 360 358 128,880
Glikazid 80 mg Btl 0 235 -
Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 6,900 -
Griseofulvin Tablet 500 mg, Tab 0 2,200 -
Griseofulvin Tablet 125 mg, Micron Tab 0 210 -
Gentamisin S.K 0.1%-5 gr Tube 0 2,800 -
Gentamisin Injeksi Vial 0 3,696 -
Haloperidol 2 mg Tablet Tab 0 126 -
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - Rp160,780
Hidrokortison Krim 2,5%-5 gr Tab 5 2,639 13,195
Ibuprofen Tablet 200 mg Tab 0 105 -
Ibufropen syr Btl 0 3,499 -
Haloporidol Decanoate Inj 50mg Amp 0 9,750 -
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 89 -
Ketokonazol krem Tube 0 2,545 -
Ketokonazol tab 200mg Tab 50 270 13,500
Ketorolac Inj 30mg Vial 0 1,045 -
Kalsium Laktat (Kalk) Tablet 500 mg Tab 100 59 5,900
KN-3B Labu 0 10,050 -
Karbihidrat +Elektrolit Labu 0 1,007 -
Karbogliserin Tetes telinga Btl 0 2,500 -
Kloramfenikol tetes Mata Btl 0 3,250 -
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 0 22 -
Klozapine 25 Mg Tab 0 1,121 -
Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 - -
Klorpromazin HCL Tablet Salut 25 mg Tab 0 148 -
klorpeson Slasf tube 0 7,750 -
Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 - -
Kotrimoksazol Tablet 480mg Tab 0 125 -
Kotrimoksazol Suspensi Kombinasi Btl 0 2,052 -
Metpormin 500mg Tab 0 100 -
Methyilprednisolon 8mg Tab 0 150 -
Kloramfenikol Salep Mata 1%-5gram Tube 0 1,881 -
Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1,797 -
Kuinin Injeksi 25%-2ml Amp 0 6,200 -
Levoploxasin 500mh Dus 0 528 -
Lidokain Komp. Injeksi, Kombinasi Amp 0 1,140 -
Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3,360 -
Loperamide Hcl 2mg Tanlet Tab 0 85 -
Magnesium Sulfat Injk 25 ml Vial 0 3,328 -
Metamizol 500mg Tab 100 473 47,300
Metilergometrin Maleat Tab. 0,125 g Tab 100 210 21,000
Metilergometrin M inj. 0,200mg- 1ml Amp 0 2,840 -
Metoklorpropamid Tablet 10 mg Tab 0 91 -
Mikonazol Krim/ Salep 2%-10gram Tube 4 3,414 13,656
Multivitamin Anak Btl 0 12,100 -
Multivitamin Dewasa Tab 0 1,316 -
Metronidazol Infus 500mg/100ml Btl 0 9,950 -
Metronidazol Tablet 500mg Tab 0 113 -
Metokloramid Syr Btl 0 2,345 -
Metronidazol syr Btl 0 3,799 -
Natrium Bikarbonat Tablet 500mg Tab 0 514 -
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 6,410 -
Natrium Diclopenac 20mg Amp 0 145 -
Nistatin Vaginal sup 0 480 -
Nistatin Tablet Salut 500.000 IU tab 0 - -
Natrium Diclopenac 50mg Tab 0 115 -
Nifedipine Tab 10mg Tab 0 108 -
Multivitamin Anti Oksidan Tab 100 1,440 144,000
Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018 - Rp258,551
Obat Anti Tuberkulosis Kat. 2 Pkt 0 1,297,894 -
Obat Anti Tuberkulosis Kat.Anak Pkt 0 214,985 -
Ofloksasin Tetes telinga Btl 0 45,089 -
Omeprazol inj 40mg/10ml Btl 0 16,997 -
Omeprazol Kapsul 20mg Kap 0 130 -
Ondansetron Inj 4mg Vial 0 1,660 -
Onadansetron 8mg Tablet Tab 0 1,189 -
Onadansetron 4mg Tablet Tab 0 471 -
Obat Batuk Flu Dewasa Pkt 150 413 61,950
Obat Batuk Hitam (OBH) Cairan Btl 0 5,000 -
Obat Batuk Dewasa syr Btl 0 5,500 -
Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 7,840 -
Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1,920 -
Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1,545 -
Oksitosin Injeksi 10 IU/ml- 1ml Amp 2 1,199 2,398
OBAT Anti Diare suspensi Btl 0 6,500 -
parasetamol drops 15 ml btl 0 6,649 -
Parasetamol Syrup 120mg/ 5ml-60ml Btl 10 1,107 11,070
Parasetamol tab 100mg Tab 0 41 -
Parasetamol Tablet 500mg Tab 200 53 10,600
Permetin Krim/Skabisid 5 % Tube 0 12,155 -
pirantel syr Btl 0 9,700 -
Pirantel Tablet 125mg Tab 0 291 -
piroksikam Tablet 10 mg Tab 0 234 -
Piroksikam Tablet 20 mg Tab 0 105 -
Propiltiourasil Tablet 100mg Tab 0 319 -
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 123 -
Povidon Iodida 10% 300ml Btl 0 17,996 -
Povidon Iodida 10% 1000ml Btl 0 - -
Prednison Tablet 5mg Tab 0 68 -
Primakuin Tablet 15mg Tab 0 224 -
Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 6,016 -
propanolol HCL Tablet 10mg Tab 0 60 -
Propanolol HCL Tablet 40mg Tab 0 121 -
Povidon Iodida 10% 60ml Botol 0 6,550 -
Retinol (Vitamin A) Kapsul 100.000 IU Kap 0 284 -
MDT MB/ Kusta Dewasa Blister 0 30,595 -
MDT PB/ Kusta Dewasa Blister 0 9,770 -
Risperidon 2mg Tab 0 347 -
Ranitidin Injeksi 25 mg/ 2ml Vial 0 1,155 -
Ranitidin Tablet 150 mg Tab 0 105 -
Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 7,150 -
Salbutamol Tablet 2mg Tab 100 63 6,300
Salep 2-4, Kombinasi Pot 0 2,621 -
Salisil Bedak 2% Ktk 0 1,025 -
Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 479,996 -
Stimuno Botol 1 23,540 23,540
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 170,000 -
Sukrafat 500mg Tab 0 368 -
Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035 - Rp122,858

Simvastatin Tablet 20 mg Tab 0 205 -
Sukralfat Syr Botol 0 8,338 -
Sulfasetamida Natrium TM 15%- 5ml Btl 0 3,226 -
Sabutamol Nebulizer Amp 0 110 -
Spiranolakton tab tab 0 899 -
Salf Kombinasi Tube 0 11,000 -
Sinbio Set 0 4,500 -
Setrizin tablet 10 mg Tab 0 90 -
Tablet Tambah Darah Komb. Tab 0 352 -
Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 - -
Tetrasiklin HCL Kapsul 250 mg Kap 0 163 -
Tiamin HCL/(Vit. B1) Tab. 50mg Tab 100 85 8,500
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 0 1,455 -
Triheksifenidil Hidroklorida Tab. 2mg Tab 0 88 -
Vitamin B Komplek Tablet Tab 100 118 11,800
Zink Syr Botol 0 2,972 -
Zink Tablet 20mg Tab 50 514 25,700
Alat Suntik Sekali Pakai 1 ml Set 0 777 -
Alat Suntik Sekali Pakai 3 ml Set 10 825 8,250
Catgut/ Benang Bedah No. 2/0 Set 0 60,622 -
I.V. Catheter No. 20 Set 2 4,783 9,566
I.V. Catheter No. 22 Set 0 12,232 -
I.V. Cateter No 26 set 0 13,464 -
Infusion Set Anak Set 0 3,498 -
Infusion Set Dewasa Set 2 4,147 8,294
E.Care Film I.V Dresing Pcs 0 6,850 -
Silk (Benang Bedah Sutera) No. 3/0 Biji 0 44,953 -
Saraya Alsof A 500 ml Botol 0 72,047 -
Kapas Pembalut/Absorben 250 gram Set 0 12,250 -
Kasa Kompres 40/40 lembar 0 1,800 -
Kasa Pembalut 2 m x 80 cm pak 0 9,400 -
Kasa Pembalut Hidrofil 36 m x 80 cm rol 0 127,600 -
Kasa Steril 16/16 kotak 0 7,370 -
Masker biji 0 549 -
Plester 5 yard x 2 inch rol 0 8,167 -
Sarung Tangan No 7 Steril pasang 0 792 -
Sarung Tangan No 6.5 Steril pasang 0 7,931 -
Sarung tangan no 6 1/2 Pasng 0 924 -
Folly cateter No 16 Pcs 0 12,036 -
Sarung tangan Gynecolog no 7 Sashet 0 17,748 -
Alkohol Swab bok 0 32,600 -
Underpad Lembar 0 4,162 -
Urine Bag Biji 0 7,038 -
Catgut/ Benang Bedah No. 3/0 Botol 0 68,433 -
Antiseptik Surgical Hand Scrab Botol 0 74,000 -
Cairan pembersih Botol 0 22,000 -
Jely kateter biji 0 41,600 -
Jarum Insulin Biji 0 2,083 - Rp72,110
YUYUN YUNENGSIH,Amd Kep NUNUNG. H,Amd Keb

NIP.19820422 2008 01 2 006 NIP.19860222 201704 2 002
Mengetahui
HJ.IYOT SA'DIAH,S.ST
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

ah diserahkan Kepada : PENGELOLA PROGRAM GIZI

perluan Bulan : Januari 2019
OBAT-- OBATAN
Retinol (Vitamin A) Kapsul 100.000 IU Kap 650 284 184,600

Retinol (Vitamin A) Kapsul 200.000 IU Kap 4000 505 2,020,000
Tablet Tambah Darah Komb. Tab 15120 352 5,322,240
JUMLAH Rp 7,526,840


NIP.19820422 2008 01 2 006 TKS
PUSKESMAS CIKEUSIK

Nomor :800/ 13 /SBBK-LPLPO/PKM-CKS/II/2019 MENU

Keperluan Bulan : Februari 2019
8 Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 0 2,702,700 `

33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 1000 105 105,000
43 Alkohol 70% 1 Liter Btl 1 24,992 24,992
45 Betametason Krim 0,1% - 5 gr Tube 0 1,349 -
49 Captopril Tablet 25 mg Tab 500 72 36,000 Rp2,412,342
67 Domperidon 10 mgtablet Tab 200 85 17,000
77 Etanol 70%- 100 ml Btl 0 2,500 -
92 Garam Oralit 200 ml air Ktg 100 264 26,400
102 Gentamisin Tetes Mata Vial 0 3,696 -

115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 59 -
116 KN-3B Labu 0 10,050 -
128 Kotrimoksazol Suspensi Kombinasi Btl 120 2,052 246,240
129 Metpormin 500mg Tab 1500 100 150,000
135 Lidokain Komp. Injeksi, Kombinasi Amp 60 1,140 68,400
139 Metamizol 500mg Tab 1300 473 614,900
140 Metilergometrin Maleat Tab. 0,125 g Tab 0 210 -
143 Mikonazol Krim/ Salep 2%-10gram Tube 0 3,414 -
148 Metokloramid Syr Btl 28 2,345 65,660
158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018 - Rp3,002,716
207 Stimuno Botol 0 23,540 -
210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035 - Rp4,207,726

218 Sinbio Set 0 4,500 -
PERBEKALAN KESEHATAN -
8 I.V. Cateter No 26 set 30 13,464 403,920
11 E.Care Film I.V Dresing Pcs 200 6,850 1,370,000
12 Silk (Benang Bedah Sutera) No. 3/0 Biji 10 44,953 449,530
14 Kapas Pembalut/Absorben 250 gram Set 1 12,250 12,250
17 Kasa Pembalut Hidrofil 36 m x 80 cm rol 2 127,600 255,200
19 Masker biji 250 549 137,250
22 Sarung Tangan No 6.5 Steril pasang 150 7,931 1,189,650
27 Alkohol Swab bok 4 32,600 130,400
29 Urine Bag Biji 6 7,038 42,228
33 Jely kateter biji 3 41,600 124,800

Cikeusik, 26 Februari 2019

NIP. 19820422 200801 2 006 NIP.19890729 2001704 2 001
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 14 /SBBK-LPLPO/PKM-CKS/II/2019


49 Captopril Tablet 25 mg Tab 0 72 - Rp210,259
77 Etanol 70%- 100 ml Btl 0 2,500 -

106 Hidrokortison Krim 2,5%-5 gr Tab 0 2,639 -
116 KN-3B Labu 2 10,050 20,100
139 Metamizol 500mg Tab 100 473 47,300
141 Metilergometrin M inj. 0,200mg- 1ml Amp 3 2,840 8,520
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -

NIP. 19820422 200801 2 006 NIP.19891004 2007042 002
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 2 10,050 20,100
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -

NIP. 19820422 200801 2 006 NIP.19870416 201704 2 003
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 8800/ 16 /SBBK-LPLPO/PKM-CKS/II/2019


77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 2 10,050 20,100
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -

NIP. 19820422 200801 2 006 NIP.19910222 201704 2 001
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Pustu Nanggala Telah diserahkan

Keperluan Bulan : Februari 2019 Keperluan Bulan

24 Acyclopir Tablet 200mg Tab 0 237 - 24
38 Asam traneksamat Inj 5 % Amp 1 24,449 24,449 38
48 Captopril Tablet 12,5 mg Tab 50 62 3,100 48
49 Captopril Tablet 25 mg Tab 0 72 - Rp210,259 49
77 Etanol 70%- 100 ml Btl 0 2,500 - 77
102 Gentamisin Tetes Mata Vial 0 3,696 - 102

106 Hidrokortison Krim 2,5%-5 gr Tab 0 2,639 - 106
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 59 - 115
116 KN-3B Labu 2 10,050 20,100 116
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 100 22 2,200 120
121 Klozapine 25 Mg Tab 0 1,121 - 121
134 Levoploxasin 500mh Dus 0 528 - 134
139 Metamizol 500mg Tab 100 473 47,300 139
140 Metilergometrin Maleat Tab. 0,125 g Tab 0 210 - 140
141 Metilergometrin M inj. 0,200mg- 1ml Amp 3 2,840 8,520 141
143 Mikonazol Krim/ Salep 2%-10gram Tube 0 3,414 - 143
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 2 6,410 12,820 151
163 Omeprazol Kapsul 20mg Kap 30 130 3,900 163
188 Prednison Tablet 5mg Tab 100 68 6,800 188
207 Stimuno Botol 1 23,540 23,540 207
209 Sukrafat 500mg Tab 0 368 - 209

218 Sinbio Set 0 4,500 - 218
228 Zink Syr Botol 0 2,972 - 228
229 Zink Tablet 20mg Tab 0 514 - 229
2 Alat Suntik Sekali Pakai 3 ml Set 10 825 8,250 2
4 Catgut/ Benang Bedah No. 2/0 Set 0 60,622 - 4
5 I.V. Catheter No. 20 Set 2 4,783 9,566 5
8 I.V. Cateter No 26 set 0 13,464 - 8
9 Infusion Set Anak Set 2 3,498 6,996 9
10 Infusion Set Dewasa Set 2 4,147 8,294 10
13 Saraya Alsof A 500 ml Botol 0 72,047 - 13
18 Kasa Steril 16/16 kotak 5 7,370 36,850 18
TOTAL PENGELUARAN Rp840,643 TO

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jl

Nomor : 800/ 18 /SBBK-LPLPO/PKM-CKS/II/2019
Telah diserahkan Kepada : Poskesdes Tanjungan I Telah diserahkan Kepad

Keperluan Bulan : Februari 2019 Keperluan Bulan : Febr

Captopril Tablet 25 mg Tab 0 72 - Rp210,259 49
Etanol 70%- 100 ml Btl 0 2,500 - 77
Gentamisin Tetes Mata Vial 0 3,696 - 102
Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 59 - 115
KN-3B Labu 2 10,050 20,100 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
TOTAL PENGELUARAN Rp840,643 TOTAL PENG

NIP. 19820422 200801 2 006 NR.TKK
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK



Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 2 10,050 20,100 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PEMERINTAH KABUPATEN PANDEGLANG P
PUSKESMAS CIKEUSIK
REKAPITULASI PENGELUARAN OBAT Nom

BULAN FEBRUARI 2019
Telah diserahkan Kepada : P

Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 18 10,050 180,900 116
Metpormin 500mg Tab 1500 100 150,000 129
Metamizol 500mg Tab 2500 473 1,182,500 139
Stimuno Botol 9 23,540 211,860 207
Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035 - Rp5,789,768 210

Sinbio Set 0 4,500 - 218
Zink Syr Botol 10 2,972 29,720 228
I.V. Cateter No 26 set 30 13,464 403,920 8
Silk (Benang Bedah Sutera) No. 3/0 Biji 10 44,953 449,530 12
Masker biji 250 549 137,250 19
Alkohol Swab bok 4 32,600 130,400 27
Urine Bag Biji 6 7,038 42,228 29
Jely kateter biji 3 41,600 124,800 33
TOTAL PENGELUARAN Rp27,040,138 TOTAL PENGELU

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
PUSKESMAS CIKEUSIK

Nomor : 800/ 20 /SBBK-LPLPO/PKM-CKS/II/2019 N
ah diserahkan Kepada : Poskesdes Parungkokosan Telah diserahkan Kepada

perluan Bulan : Februari 2019 Keperluan Bulan : Febru

Captopril Tablet 25 mg Tab 0 72 - Rp 210,259 49
Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 2 10,050 20,100 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
TOTAL PENGELUARAN Rp679,863 TOTAL PEN

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 21 /SBBK-LPLPO/PKM-CKS/II/2019 N
ah diserahkan Kepada : PUSLING Telah diserahkan Kepada

perluan Bulan : Februari 2019 Keperluan Bulan : Febru

Captopril Tablet 25 mg Tab 0 72 - 49
Etanol 70%- 100 ml Btl 0 2,500 - 77
Asetil Sistein 200mg Tab 0 358 - 95
KN-3B Labu 0 10,050 - 116
Metamizol 500mg Tab 300 473 141,900 139

Sinbio Set 0 4,500 - 218
Zink Syr Botol 10 2,972 29,720 228
TOTAL PENGELUARAN Rp1,321,040 TOTAL PEN

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln

ah diserahkan Kepada : Curugciung

perluan Bulan : Februari 2019

Captopril Tablet 25 mg Tab 0 72 - 49
Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 2 10,050 20,100 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
TOTAL PENGELUARAN Rp469,604 TOTAL PEN

NIP. 19820422 200801 2 006 NIP.19910820 201704 2 001
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
PERSEDIAAN OBAT
BULAN FEBRUARI 2019


Etanol 70%- 100 ml Btl 0 2,500 - 77
Glikazid 80 mg Btl 550 235 129,250 96
KN-3B Labu 42 10,050 422,100 116
Klozapine 25 Mg Tab 998 1,121 1,118,758 121
Metpormin 500mg Tab 1700 100 170,000 129
Metamizol 500mg Tab 2700 473 1,277,100 139
Obat Anti Tuberkulosis Kat.Anak Pkt 3 214,985 644,955 160
pirantel syr Btl 23 9,700 223,100 180
Stimuno Botol 34 23,540 800,360 207

Sinbio Set 0 4,500 - 218
Zink Syr Botol 21 2,972 62,412 228
I.V. Cateter No 26 set 177 13,464 2,383,128 8
Masker biji 500 549 274,500 19
Alkohol Swab bok 9 32,600 293,400 27
Underpad Lembar 110 4,162 457,820 28
Urine Bag Biji 22 7,038 154,836 29
Mengetahui Cikeusik, 26 Februari 2019

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
SISA OBAT N
BUALAN FEBRUARI 2019
Telah diserahkan Kepada
Keperluan Bulan : Februa

Captopril Tablet 25 mg Tab 0 72 - Rp12,840,413 49
Deksametasone Tablet 0,5 mg Tab 0 32 - 58
Etanol 70%- 100 ml Btl 0 2,500 - 77
Glikazid 80 mg Btl 550 235 129,250 96
KN-3B Labu 24 10,050 241,200 116
Klozapine 25 Mg Tab 998 1,121 1,118,758 121
Metpormin 500mg Tab 200 100 20,000 129
Metamizol 500mg Tab 200 473 94,600 139
Obat Anti Tuberkulosis Kat.Anak Pkt 3 214,985 644,955 160
pirantel syr Btl 23 9,700 223,100 180
Stimuno Botol 25 23,540 588,500 207

Sinbio Set 0 4,500 - 218
Zink Syr Botol 11 2,972 32,692 228
I.V. Cateter No 26 set 147 13,464 1,979,208 8
Masker biji 250 549 137,250 19
Alkohol Swab bok 5 32,600 163,000 27
Urine Bag Biji 16 7,038 112,608 29
TOTAL PENGELUARAN Rp80,023,518 TOTAL PEN
Mengetahui Cikeusik, 26 Februari 2019

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Al

Nomor :800/ 23 /SBBK-LPLPO/PKM-CKS/II /2019 Nom
ah diserahkan Kepada : Tanjungan 2 Telah diserahkan Kepada : PE

perluan Bulan : Februari 2019 Keperluan Bulan : Februari 20
Alopurinol tablet 100 mg Tab 0 99 - I
Amlodipine Besilate 5mg tablet Tab 0 70 -

Acyclopir Tablet 200mg Tab 0 237 -
Asam traneksamat Inj 5 % Amp 1 24,449 24,449
Captopril Tablet 12,5 mg Tab 50 62 3,100
Captopril Tablet 25 mg Tab 0 72 - Rp210,259
Cefixim Tab 0 590 -
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 1,800 -
Etanol 70%- 100 ml Btl 0 2,500 -
Gentamisin Injeksi Vial 0 3,696 -
Hidrokortison Krim 2,5%-5 gr Tab 0 2,639 -
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 89 -
Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 59 -
KN-3B Labu 2 10,050 20,100
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 100 22 2,200
Kotrimoksazol Tablet 480mg Tab 0 125 -
Levoploxasin 500mh Dus 0 528 -
Loperamide Hcl 2mg Tanlet Tab 0 85 -
Metamizol 500mg Tab 100 473 47,300
Metilergometrin Maleat Tab. 0,125 g Tab 0 210 -
Metilergometrin M inj. 0,200mg- 1ml Amp 3 2,840 8,520
Mikonazol Krim/ Salep 2%-10gram Tube 0 3,414 -
Multivitamin Anak Btl 0 12,100 -
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 2 6,410 12,820
Multivitamin Anti Oksidan Tab 100 1,440 144,000
Omeprazol Kapsul 20mg Kap 30 130 3,900
Prednison Tablet 5mg Tab 100 68 6,800
Ranitidin Tablet 150 mg Tab 0 105 -
Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 7,150 -
Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 479,996 -
Stimuno Botol 1 23,540 23,540

Zink Tablet 20mg Tab 0 514 -
Infusion Set Anak Set 2 3,498 6,996
Saraya Alsof A 500 ml Botol 0 72,047 -
Kasa Steril 16/16 kotak 5 7,370 36,850
Masker biji 0 549 -
Underpad Lembar 0 4,162 -

NIP.19820422 2008 01 2 006 NIP.19860222 201704 2 002
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 24 /SBBK-LPLPO/PKM-CKS/II /2019
ah diserahkan Kepada : PENGELOLA PROGRAM GIZI

perluan Bulan : Februari 2019
OBAT-- OBATAN
JUMLAH Rp -


NIP.19820422 2008 01 2 006 TKS
PUSKESMAS CIKEUSIK

Nomor :800/ 25 /SBBK-LPLPO/PKM-CKS/III/2019 MENU

Keperluan Bulan : Maret 2019


23 Acyclopir Krim 5%- 5gr Tube 0 8,800 -
34 Asering Infus Tab 20 9,646 192,920
49 Captopril Tablet 25 mg Tab 0 72 - Rp2,587,824
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 20 1,097 21,940
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 6 3,333 19,998
77 Etanol 70%- 100 ml Btl 0 2,500 -
95 Asetil Sistein 200mg Tab 2830 358 1,013,140
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 20 6,900 138,000
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - Rp1,597,882

113 Ketokonazol tab 200mg Tab 0 270 -
114 Ketorolac Inj 30mg Vial 20 1,045 20,900
116 KN-3B Labu 0 10,050 -
118 Karbogliserin Tetes telinga Btl 36 2,500 90,000
129 Metpormin 500mg Tab 200 100 20,000
134 Kloramfenikol Salep kulit 15 grm Tube 0 528 -
139 Metamizol 500mg Tab 1100 473 520,300
185 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 150 123 18,450
207 Stimuno Botol 10 23,540 235,400

218 Sinbio Set 0 4,500 -
228 Zink Syr Botol 11 2,972 32,692
2 Alat Suntik Sekali Pakai 2.5 ml Set 0 649 -
9 I.V. Cateter No 26 set 50 13,464 673,200
12 E.Care Film I.V Dresing Pcs 100 6,850 685,000
14 Policlean Handrub Botol 6 72,047 432,282
20 Masker biji 350 549 192,150
28 Alkohol Swab bok 2 32,600 65,200
30 Urine Bag Biji 5 7,038 35,190
31 Catgut/ Benang Bedah No. 3/0 Botol 10 68,433 684,330

Cikeusik, 20 Maret 2019

NIP. 19820422 200801 2 006 NIP.19890729 2001704 2 001
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 26 /SBBK-LPLPO/PKM-CKS/III/2019



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 2 10,050 20,100
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -
2 Alat Suntik Sekali Pakai 2.5 ml Set 10 649 6,490
9 I.V. Cateter No 26 set 2 13,464 26,928
11 Infusion Set Dewasa Set 0 4,147 -
14 Policlean Handrub Botol 0 72,047 -

NIP. 19820422 200801 2 006 NIP.19891004 2007042 002
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 27 /SBBK-LPLPO/PKM-CKS/III/2019



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 2 10,050 20,100
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -
9 I.V. Cateter No 26 set 2 13,464 26,928

NIP. 19820422 200801 2 006 NIP.19870416 201704 2 003
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK




77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 2 10,050 20,100
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -
9 I.V. Cateter No 26 set 2 13,464 26,928

NIP. 19820422 200801 2 006 NIP.19910222 201704 2 001
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 29/SBBK-LPLPO/PKM-CKS/III/2019

Keperluan Bulan : Maret 2019 Keperluan Bulan


24 Acyclopir Tablet 200mg Tab 0 237 - 24
38 Asam traneksamat Inj 5 % Amp 0 24,449 - 38
48 Captopril Tablet 12,5 mg Tab 50 62 3,100 48
49 Captopril Tablet 25 mg Tab 0 72 - Rp185,810 49
77 Etanol 70%- 100 ml Btl 0 2,500 - 77
102 Gentamisin Tetes Mata Vial 0 3,696 - 102

106 Hidrokortison Krim 2,5%-5 gr Tab 0 2,639 - 106
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 59 - 115
116 KN-3B Labu 2 10,050 20,100 116
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 100 22 2,200 120
121 Klozapine 25 Mg Tab 0 1,121 - 121
134 Kloramfenikol Salep kulit 15 grm Tube 0 528 - 134
139 Metamizol 500mg Tab 100 473 47,300 139
140 Metilergometrin Maleat Tab. 0,125 g Tab 50 210 10,500 140
141 Metilergometrin M inj. 0,200mg- 1ml Amp 3 2,840 8,520 141
143 Mikonazol Krim/ Salep 2%-10gram Tube 0 3,414 - 143
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 2 6,410 12,820 151
163 Omeprazol Kapsul 20mg Kap 30 130 3,900 163
188 Prednison Tablet 5mg Tab 100 68 6,800 188
207 Stimuno Botol 1 23,540 23,540 207
209 Sukrafat 500mg Tab 0 368 - 209

218 Sinbio Set 0 4,500 - 218
228 Zink Syr Botol 0 2,972 - 228
229 Zink Tablet 20mg Tab 0 514 - 229
2 Alat Suntik Sekali Pakai 2.5 ml Set 10 649 6,490 2
5 Catgut/ Benang Bedah No. 2/0 Set 2 60,622 121,244 5
9 I.V. Cateter No 26 set 2 13,464 26,928 9
10 Infusion Set Anak Set 2 3,498 6,996 10
11 Infusion Set Dewasa Set 0 4,147 - 11
14 Policlean Handrub Botol 0 72,047 - 14
19 Kasa Steril 16/16 kotak 0 7,370 - 19

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Poskesdes Tanjungan 1 Telah diserahkan Kepad

Keperluan Bulan : Maret 2019 Keperluan Bulan : Mare

Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 2 10,050 20,100 116
Kloramfenikol Salep kulit 15 grm Tube 0 528 - 134
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
Alat Suntik Sekali Pakai 2.5 ml Set 10 649 6,490 2
I.V. Cateter No 26 set 2 13,464 26,928 9
Policlean Handrub Botol 0 72,047 - 14

NIP. 19820422 200801 2 006 NR.TKK
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK



Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 2 10,050 20,100 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
I.V. Cateter No 26 set 2 13,464 26,928 9
TOTAL PENGELUARAN Rp895,436 TOTAL PE

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Alun-al
REKAPITULASI PENGELUARAN OBAT Nomor : 8

BULAN MARET 2019
Telah diserahkan Kepada :

Captopril Tablet 25 mg Tab 0 72 - Rp4,569,544 49
Domperidon Suspensi 5mg/ 5ml- 60ml Btl 6 3,333 19,998 70
Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 18 10,050 180,900 116
Metpormin 500mg Tab 200 100 20,000 129
Metamizol 500mg Tab 2300 473 1,087,900 139
Stimuno Botol 19 23,540 447,260 207

Sinbio Set 0 4,500 - 218
Zink Syr Botol 11 2,972 32,692 228
I.V. Cateter No 26 set 70 13,464 942,480 9
E.Care Film I.V Dresing Pcs 100 6,850 685,000 12
Silk (Benang Bedah Sutera) No. 3/0 Biji 10 44,953 449,530 13
Policlean Handrub Botol 6 72,047 432,282 14
Masker biji 350 549 192,150 20
Alkohol Swab bok 2 32,600 65,200 28
Urine Bag Biji 5 7,038 35,190 30
Catgut/ Benang Bedah No. 3/0 Botol 10 68,433 684,330 31
TOTAL PENGELUARAN Rp33,471,653 TOTAL PENGELUARA

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
PEMERINTAH KABUPATEN PANDEGLANG PEME
PUSKESMAS CIKEUSIK
Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Alun-alu
SURAT BUKTI BARANG KELUAR S

Nomor : 800/ 32 /SBBK-LPLPO/PKM-CKS/III/2019 Nomor :8
ah diserahkan Kepada : Poskesdes Parungkokosan Telah diserahkan Kepada : PUSLI

perluan Bulan : Maret 2019 Keperluan Bulan : Maret 2019
Alkacide 1 L High Level Desinfectan Btl 0 2,702,700 - 8
Alkazyme Sachet 25mg(Alkapham Fr Pack 0 801,000 - 11
Anti Bakteri DOEN Salep Kombinasi Tube 0 3,035 - 17
(basitrasin)
Antiparkinson DOEN tab.
Kombinasi Tab 0 1,500 - 21

Antalgin (Metampiron) Inj. 250mg/ Tab 0 305 - 27
Captopril Tablet 25 mg Tab 0 72 - Rp 185,810 49
Deksametasone Injeksi 5 mg/ml - 1m Amp 0 1,097 - 57
Dekstromethorfan Sirup 10 mg/ 60 Btl 0 6,600 - 59
Dietilkarbamazin Sitrat Tablet 100 m Tab 0 - - 64
Difenhidramin HCL Inj. 10 mg/ml- 1 Amp 0 1,176 - 65
Domperidon Suspensi 5mg/ 5ml- 60 Btl 0 3,333 - 70
Epinefrina HCL/Bitartrat Inj. 0,1%- 1 Amp 0 1,408 - 73
Etanol 70%- 100 ml Btl 0 2,500 - 77
Eritromisin Syrup 200 mg/5 ml-60 m Btl 0 6,700 - 79
Fenitoin Natrium Injeksi 50 mg/ 1 m Amp 0 - - 80
Fenoksimetil Penisilina Tablet 250 m Tab 0 - - 86
Fitomenadion (Vit. K1) Inj. 10 mg/1 Amp 0 3,550 - 88
Glukosa Lar. Infus 10% Steril - 500 m Btl 0 5,700 - 98
KN-3B Labu 2 10,050 20,100 116
Klorfeniramin Maleat (CTM) Tab. 4 Tab 100 22 2,200 120
Klorpromazin HCL Inj. 25 mg/ml- 1m Amp 0 - - 122
Klorpromazin HCL Tablet Salut 25 Tab 0 148 - 123
Klorpromazin HCL Tablet Salut 100 Tab 0 147 - 124
Komb. Artesunate 50mg+Amodiaqu Pkt 0 - - 126
Kloramfenikol Salep Mata 1%-
5gram Tube 0 1,881 - 131
Metamizol 500mg Tab 100 473 47,300 139
Metilergometrin Maleat Tab. 0,125 Tab 50 210 10,500 140
g
Metilergometrin M inj. 0,200mg- 1m Amp 3 2,840 8,520 141
Oksitetrasiklin HCL Inj. i.m 50mg10m Vial 0 7,840 - 170
Parasetamol Syrup 120mg/ 5ml-60m Btl 10 1,107 11,070 176
Retinol (Vitamin A) Kapsul 100.000 I Kap 0 284 - 194
Retinol (Vitamin A) Kapsul 200.000 I Kap 0 505 - 195
Serum Anti Bisa Ular Polivalen Inj.5m Vial 0 479,996 - 206
Stimuno Botol 1 23,540 23,540 207
Serum Anti Tetanus Inj. 1500 IU/amp Amp 0 170,000 - 208
Sianokobalamin (Vit. B12) Inj 500mc Amp 0 1,035 - Rp130,908 210

Sulfasetamida Natrium TM 15%- 5m Btl 0 3,226 - 214
Sinbio Set 0 4,500 - 218
I.V. Cateter No 26 set 2 13,464 26,928 9

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PEMERINTAH KABUPATEN PANDEGLANG P
PUSKESMAS CIKEUSIK

Nomor :800/ 32 /SBBK-LPLPO/PKM-CKS/III/2019 Nomo
ah diserahkan Kepada : PUSLING Telah diserahkan Kepada : C

perluan Bulan : Maret 2019 Keperluan Bulan : Maret 20

Betametason Krim 0,1% - 5 gr Tube 0 1,349 - 45
Ciprofloxacin Tablet 500mg Tab 0 255 - 55
Etanol 70%- 100 ml Btl 0 2,500 - 77
Asetil Sistein 200mg Tab 0 358 - 95
KN-3B Labu 0 10,050 - 116
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 500 22 11,000.0 120
Metamizol 500mg Tab 300 473 141,900.0 139
Multivitamin Anti Oksidan Tab 300 1,440 432,000.0 157
Omeprazol Kapsul 20mg Kap 150 130 19,500.0 163
Obat Batuk Flu Dewasa Pkt 450 413 185,850.0 167
parasetamol drops 15 ml btl 10 6,649 66,490.0 175
Parasetamol Syrup 120mg/ 5ml-60ml Btl 15 1,107 16,605.0 176
Parasetamol Tablet 500mg Tab 600 53 31,800.0 178
Prednison Tablet 5mg Tab 500 68 34,000.0 188
Ranitidin Tablet 150 mg Tab 400 105 42,000.0 200

Sinbio Set 0 4,500 - 218
Tiamin HCL/(Vit. B1) Tab. 50mg Tab 300 85 25,500.0 224
Vitamin B Komplek Tablet Tab 200 118 23,600.0 227
Alat Suntik Sekali Pakai 2.5 ml Set 0 649 - 2
I.V. Cateter No 26 set 2 13,464 26,928.0 9
Sarung Tangan No 7 Steril pasang 792 - 22
Sarung Tangan No 6.5 Steril pasang 7,931 - 23
Sarung tangan no 6 1/2 Pasng 924 - 24
Folly cateter No 16 Pcs 12,036 - 25
Folly cateter No 14 Pcs 16,610 - 26
Sarung tangan Gynecolog no 7 Sashet 17,748 - 27
Alkohol Swab bok 32,600 - 28
Underpad Lembar 4,162 - 29
Urine Bag Biji 7,038 - 30
Catgut/ Benang Bedah No. 3/0 Botol 68,433 - 31
Antiseptik Surgical Hand Scrab Botol 74,000 - 32
Cairan pembersih Botol 22,000 - 33
Jely kateter biji 41,600 - 34

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK


perluan Bulan : Maret 2019

Etanol 70%- 100 ml Btl 0 2,500 - 77
KN-3B Labu 2 10,050 20,100 116
Metamizol 500mg Tab 100 473 47,300 139
Stimuno Botol 1 23,540 23,540 207

Sinbio Set 0 4,500 - 218
I.V. Cateter No 26 set 2 13,464 26,928 9

NIP. 19820422 200801 2 006 NIP.19910820 201704 2 001
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
PERSEDIAAN OBAT
BULAN MARET 2019

Alopurinol tablet 100 mg Tab 1000 99 99,000
Aminofilin tablet 200 mg Tab 800 91 72,800
Albendazol Tab 390 404 157,560
Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245 -
Amitriptilin HCL Tab. Salut 25 mg Tab 500 167 83,500
Amlodipine Besilate 5mg tablet Tab 1500 70 105,000
Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 3 2,702,700 8,108,100
Amoksisillin Kapsul 500 mg Tab 12100 233 2,819,300
Alkazyme Sachet 25mg(Alkapham France) Pack 3 801,000 2,403,000
Amoksilin sk Forte Tab 354 3,400 1,203,600
Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 90 3,035 273,150
Anti Hemoroid DOEN Kombinasi Supp 30 3,167 95,010
Antimigren DOEN Kombinasi Tab 300 135 40,500
Aqua roinjek Steril Btl 26 2,860 74,360

Acyclopir Tablet 200mg Tab 700 237 165,900
Acyclopir Tablet 400 mg Tab 700 380 266,000
Akita/Molagit Tablet Tab 600 450 270,000
Asam asetilsalisilat 100mg tablet Tab 400 130 52,000
Asam Askorbat (Vit. C) Tablet 50 mg Tab 1600 105 168,000
Asering Infus Tab 88 9,646 848,848
Asam Folat tablet 5 mg Tab 800 55 44,000
Asam traneksamat Inj 5 % Amp 21 24,449 513,429
Betadin Salf Antiseptik Tube 24 7,039 168,936
Bisacodril sup Supp 46 5,800 266,800
Bisoprolol 2,5mg tab Tab 570 650 370,500
Captopril Tablet 25 mg Tab 0 72 - Rp21,008,653
Carbamazefine Tab 200 269 53,800
Cefixim Tab 0 590 -
Deksametasone Injeksi 5 mg/ml - 1ml Amp 200 1,097 219,400
Diazepam Injeksi 5 mg/ml - 2ml Amp 57 17,350 988,950
Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 43 1,176 50,568
Digoksin Tablet 0,25 mg Tab 500 105 52,500
Domperidon Suspensi 5mg/ 5ml- 60ml Btl 6 3,333 19,998
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 105 1,408 147,840
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 31 1,800 55,800
Etanol 70%- 100 ml Btl 0 2,500 -
Eritromisin Kapsul 500 mg Kap 600 730 438,000
Eritromisin Syrup 200 mg/5 ml-60 ml Btl 80 6,700 536,000
Fenobarbital Injeksi- 2ml Amp 52 1,740 90,480
Fenobarbital Tablet 30 mg Tab 100 165 16,500
Fluflenazine decanoat inj 25mg/ml Amp 20 57,500 1,150,000
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 30 3,550 106,500
Fitomenadion (Vit. K1) Tab. 10 mg Tab 100 710 71,000
Garam Oralit 200 ml air Ktg 250 264 66,000
Glibenklamida Tablet 5 mg Tab 700 119 83,300
Asetil Sistein 200mg Tab 5490 358 1,965,420
Glikazid 80 mg Btl 550 235 129,250
Glukosa Lar. Infus 5% Steril - 500 ml Btl 64 6,900 441,600
Griseofulvin Tablet 125 mg, Micron Tab 490 210 102,900
Gentamisin Tetes Mata Vial 30 3,696 110,880
Haloperidol 2 mg Tablet Tab 700 126 88,200
Hidroklortiazid (HCT) Tablet 25 mg Tab 700 149 104,300 Rp8,020,436
Hidrokortison Krim 2,5%-5 gr Tab 6 2,639 15,834
Haloporidol Decanoate Inj 50mg Amp 25 9,750 243,750
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 2100 89 186,900
Ketokonazol krem Tube 10 2,545 25,450
Ketorolac Inj 30mg Vial 100 1,045 104,500
KN-3B Labu 24 10,050 241,200
Karbihidrat +Elektrolit Labu 40 1,007 40,280
Karbogliserin Tetes telinga Btl 84 2,500 210,000
Klozapine 25 Mg Tab 998 1,121 1,118,758
Klorpromazin HCL Tablet Salut 100 mg Tab 500 147 73,500
Kotrimoksazol Tablet 480mg Tab 3100 125 387,500
Metpormin 500mg Tab 200 100 20,000
Kloramfenikol Salep Mata 1%-5gram Tube 29 1,881 54,549
Kuinin Injeksi 25%-2ml Amp 5 6,200 31,000
Kloramfenikol Salep kulit 15 grm Tube 72 528 38,016
Lidokain Komp. Injeksi, Kombinasi Amp 110 1,140 125,400
Loperamide Hcl 2mg Tanlet Tab 1350 85 114,750
Magnesium Sulfat Injk 25 ml Vial 30 3,328 99,840
Metamizol 500mg Tab 3200 473 1,513,600
Metilergometrin Maleat Tab. 0,125 g Tab 1000 210 210,000
Mikonazol Krim/ Salep 2%-10gram Tube 71 3,414 242,394
Multivitamin Anak Btl 101 12,100 1,222,100
Metokloramid Syr Btl 32 2,345 75,040
Metronidazol syr Btl 40 3,799 151,960
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 30 6,410 192,300
Nistatin Vaginal sup 5 480 2,400
Natrium Diclopenac 50mg Tab 2400 115 276,000
Nifedipine Tab 10mg Tab 150 108 16,200
Multivitamin Anti Oksidan Tab 3500 1,440 5,040,000
Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 19 317,018 6,023,342 Rp18,803,683
Obat Anti Tuberkulosis Kat. 2 Pkt 2 1,297,894 2,595,788
Obat Anti Tuberkulosis Kat.Anak Pkt 7 214,985 1,504,895
Ofloksasin Tetes telinga Btl 4 45,089 180,356
Onadansetron 4mg Tablet Tab 600 471 282,600
Obat Batuk Flu Dewasa Pkt 4200 413 1,734,600
parasetamol drops 15 ml btl 118 6,649 784,582
pirantel syr Btl 23 9,700 223,100
Pirantel Tablet 125mg Tab 435 291 126,585
Propiltiourasil Tablet 100mg Tab 600 319 191,400
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 450 123 55,350
Povidon Iodida 10% 300ml Btl 16 17,996 287,936
Povidon Iodida 10% 60ml Botol 2 6,550 13,100
Retinol (Vitamin A) Kapsul 100.000 IU Kap 500 284 142,000
Retinol (Vitamin A) Kapsul 200.000 IU Kap 4000 505 2,020,000
Risperidon 2mg Tab 320 347 111,040
Ranitidin Injeksi 25 mg/ 2ml Vial 85 1,155 98,175
Ranitidin Tablet 150 mg Tab 4400 105 462,000
Ringer Laktat Lar. Inf. Steril - 500ml Btl 160 7,150 1,144,000
Salep 2-4, Kombinasi Pot 24 2,621 62,904
Salisil Bedak 2% Ktk 60 1,025 61,500
Serum Anti Bisa Ular Polivalen Inj.5ml Vial 12 479,996 5,759,952
Stimuno Botol 25 23,540 588,500
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 3 170,000 510,000
Sianokobalamin (Vit. B12) Inj 500mcg Amp 25 1,035 25,875 Rp20,917,198

Simvastatin Tablet 20 mg Tab 1000 205 205,000
Simvastatin Tablet 10 mg Tab 1170 110 128,700
Setrizin tablet 10 mg Tab 1780 90 160,200
Triheksifenidil Hidroklorida Tab. 2mg Tab 600 88 52,800
Zink Syr Botol 11 2,972 32,692
Alat Suntik Sekali Pakai 2.5 ml Set 300 649
Catgut/ Benang Bedah No. 2/0 Set 79 60,622 4,789,138
I.V. Catheter No. 22 Set 174 12,232 2,128,368
I.V. Cateter No 26 set 147 13,464 1,979,208
Infusion Set Anak Set 107 3,498 374,286
E.Care Film I.V Dresing Pcs 400 6,850 2,740,000
Silk (Benang Bedah Sutera) No. 3/0 Biji 108 44,953 4,854,924
Policlean Handrub Botol 12 72,047 864,564
Kapas Pembalut/Absorben 250 gram Set 12 12,250 147,000
Kasa Kompres 40/40 lembar 7 1,800 12,600
Kasa Pembalut 2 m x 80 cm pak 20 9,400 188,000
Kasa Pembalut Hidrofil 36 m x 80 cm rol 5 127,600 638,000
Kasa Steril 16/16 kotak 155 7,370 1,142,350
Masker biji 750 549 411,750
Plester 5 yard x 2 inch rol 21 8,167 171,507
Sarung Tangan No 6.5 Steril pasang 300 7,931 2,379,300
Folly cateter No 16 Pcs 2 12,036 24,072
Folly cateter No 14 Pcs 1 16,610 16,610
Sarung tangan Gynecolog no 7 Sashet 160 17,748 2,839,680
Alkohol Swab bok 5 32,600 163,000
Underpad Lembar 100 4,162 416,200
Urine Bag Biji 46 7,038 323,748
Catgut/ Benang Bedah No. 3/0 Botol 108 68,433 7,390,764
Cairan pembersih Botol 8 22,000 176,000
Jely kateter biji 50 41,600 2,080,000
Jarum Insulin Biji 129 2,083 268,707 Rp45,234,972
Mengetahui Cikeusik, 20 Maret 2019

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
SISA OBAT
BULAN MARET 2019

2 Aminofilin tablet 200 mg Tab 800 91 72,800
3 Albendazol Tab 390 404 157,560

5 Amitriptilin HCL Tab. Salut 25 mg Tab 500 167 83,500
7 Amlodipine Besilate 5mg tablet Tab 1500 70 105,000
8 Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 3 2,702,700 8,108,100
9 Amoksisillin Kapsul 500 mg Tab 5500 233 1,281,500
11 Alkazyme Sachet 25mg(Alkapham France) Pack 3 801,000 2,403,000
16 Antasida DOEN suspensi Btl 0 1,923 -
17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 90 3,035 273,150
18 Anti Hemoroid DOEN Kombinasi Supp 30 3,167 95,010
20 Antimigren DOEN Kombinasi Tab 300 135 40,500

25 Acyclopir Tablet 400 mg Tab 500 380 190,000
26 Akita/Molagit Tablet Tab 600 450 270,000
28 Asam asetilsalisilat 100mg tablet Tab 400 130 52,000
36 Asam Folat tablet 5 mg Tab 800 55 44,000
44 Betadin Salf Antiseptik Tube 24 7,039 168,936
47 Bisoprolol 2,5mg tab Tab 570 650 370,500
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 57 17,350 988,950
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 43 1,176 50,568
66 Digoksin Tablet 0,25 mg Tab 500 105 52,500
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 105 1,408 147,840
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 31 1,800 55,800
77 Etanol 70%- 100 ml Btl 0 2,500 -
78 Eritromisin Kapsul 500 mg Kap 600 730 438,000
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 80 6,700 536,000
83 Fenobarbital Injeksi- 2ml Amp 52 1,740 90,480
84 Fenobarbital Tablet 30 mg Tab 100 165 16,500
87 Fluflenazine decanoat inj 25mg/ml Amp 20 57,500 1,150,000
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 30 3,550 106,500
96 Glikazid 80 mg Btl 550 235 129,250
100 Griseofulvin Tablet 125 mg, Micron Tab 490 210 102,900
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 700 149 104,300 Rp5,217,294

110 Haloporidol Decanoate Inj 50mg Amp 25 9,750 243,750
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 2100 89 186,900
116 KN-3B Labu 6 10,050 60,300
117 Karbihidrat +Elektrolit Labu 40 1,007 40,280
121 Klozapine 25 Mg Tab 998 1,121 1,118,758
127 Kotrimoksazol Tablet 480mg Tab 3100 125 387,500
133 Kuinin Injeksi 25%-2ml Amp 5 6,200 31,000
134 Kloramfenikol Salep kulit 15 grm Tube 72 528 38,016
137 Loperamide Hcl 2mg Tanlet Tab 1350 85 114,750
139 Metamizol 500mg Tab 900 473 425,700
149 Metronidazol syr Btl 40 3,799 151,960
156 Nifedipine Tab 10mg Tab 150 108 16,200
158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 19 317,018 6,023,342 Rp13,093,737
159 Obat Anti Tuberkulosis Kat. 2 Pkt 2 1,297,894 2,595,788
160 Obat Anti Tuberkulosis Kat.Anak Pkt 7 214,985 1,504,895
161 Ofloksasin Tetes telinga Btl 4 45,089 180,356
176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 0 1,107 -
180 pirantel syr Btl 23 9,700 223,100
181 Pirantel Tablet 125mg Tab 435 291 126,585
184 Propiltiourasil Tablet 100mg Tab 600 319 191,400
193 Povidon Iodida 10% 60ml Botol 2 6,550 13,100
194 Retinol (Vitamin A) Kapsul 100.000 IU Kap 500 284 142,000
195 Retinol (Vitamin A) Kapsul 200.000 IU Kap 4000 505 2,020,000
198 Risperidon 2mg Tab 320 347 111,040
207 Stimuno Botol 6 23,540 141,240
208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 3 170,000 510,000

218 Sinbio Set 0 4,500 -
227 Vitamin B Komplek Tablet Tab 0 118 -
2 Alat Suntik Sekali Pakai 2.5 ml Set 210 649
5 Catgut/ Benang Bedah No. 2/0 Set 61 60,622 3,697,942
7 I.V. Catheter No. 22 Set 139 12,232 1,700,248
9 I.V. Cateter No 26 set 77 13,464 1,036,728
13 Silk (Benang Bedah Sutera) No. 3/0 Biji 98 44,953 4,405,394
17 Kasa Pembalut 2 m x 80 cm pak 20 9,400 188,000
19 Kasa Steril 16/16 kotak 155 7,370 1,142,350
20 Masker biji 400 549 219,600
27 Sarung tangan Gynecolog no 7 Sashet 160 17,748 2,839,680
30 Urine Bag Biji 41 7,038 288,558
31 Catgut/ Benang Bedah No. 3/0 Botol 98 68,433 6,706,434
33 Cairan pembersih Botol 8 22,000 176,000
34 Jely kateter biji 50 41,600 2,080,000
35 Jarum Insulin Biji 129 2,083 268,707 Rp31,643,138
Mengetahui Cikeusik, 20 Maret 2019

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK

Nomor : 800/34 /SBBK-LPLPO/PKM-CKS/III/2019 N
Telah diserahkan Kepada : Tanjungan 2 Telah diserahkan Kepa

Keperluan Bulan : Maret 2019 Keperluan Bulan : Ma
1 Alopurinol tablet 100 mg Tab 0 99 - I


77 Etanol 70%- 100 ml Btl 0 2,500 -
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 -

116 KN-3B Labu 2 10,050 20,100
139 Metamizol 500mg Tab 100 473 47,300
207 Stimuno Botol 1 23,540 23,540

218 Sinbio Set 0 4,500 -
9 I.V. Cateter No 26 set 2 13,464 26,928

NIP.19820422 2008 01 2 006 NIP.19860222 201704 2 002
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 24 /SBBK-LPLPO/PKM-CKS/III /2019 N
ah diserahkan Kepada : PENGELOLA PROGRAM GIZI Telah diserahkan Kepada

perluan Bulan : Maret 2019 Keperluan Bulan : Maret
OBAT-- OBATAN I
JUMLAH Rp 4,970,240


NIP.19820422 2008 01 2 006 TKS
PUSKESMAS CIKEUSIK

Nomor :800/ 25 /SBBK-LPLPO/PKM-CKS/III /2019
ah diserahkan Kepada : PENGELOLA LABORATORIUM

perluan Bulan : Maret 2019
Reagen
Rafid 1 HIV (SD Bioline ) TES 100 11,975 1,197,500

JUMLAH Rp 1,197,500

YUYUN YUNENGSIH,Amd Kep ELAH NURHAYATI,Amd Keb

NIP.19820422 2008 01 2 006 TKS
PUSKESMAS CIKEUSIK

Nomor : 800/ 26 /SBBK-LPLPO/PKM-CKS/IV/2019 MENU

Keperluan Bulan : April 2019
1 Alopurinol tablet 100 mg Tab 0 99 0
2 Aminofilin tablet 200 mg Tab 0 91 0

3 Albendazol Tab 0 404 0
4 Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245 0
5 Amitriptilin HCL Tab. Salut 25 mg Tab 0 167 0
6 Amlodipine 10 mg Tablet Tab 0 93 0
7 Amlodipine Besilate 5mg tablet Tab 0 70 0
9 Amoksisillin Kapsul 500 mg Tab 2000 233 466000
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 1,881 0
11 Alkazyme Sachet 25mg(Alkapham France) Pack 0 801,000 0
12 Amoksilin sk Forte Tab 120 3,400 408000
13 Ampisillin Injeksi 1 gram Vial 0 3,850 0
14 Antalgin (Metampiron) Tab. 500 mg Tab 0 205 0
15 Antasida DOEN tablet Tab 2000 54 108000
16 Antasida DOEN suspensi Btl 50 1,923 96150
17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 0 3,035 0
18 Anti Hemoroid DOEN Kombinasi Supp 0 3,167 0
19 Antifungi DOEN Kombinasi Pot 0 3,035 0
20 Antimigren DOEN Kombinasi Tab 0 135 0
21 Antiparkinson DOEN tab. Kombinasi Tab 0 1,500 0
22 Aqua roinjek Steril Btl 0 2,860 0

23 Acyclopir Krim 5%- 5gr Tube 10 8,800 88000
24 Acyclopir Tablet 200mg Tab 0 237 0
25 Acyclopir Tablet 400 mg Tab 500 380 190000
26 Akita/Molagit Tablet Tab 0 450 0
27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 305 0
28 Asam asetilsalisilat 100mg tablet Tab 0 130 0
29 Asam Mefenamat 500mg Tab 2000 103 206000
30 Alprazolam 1mg Tab 0 233 0
31 Ambroksol tab tab 0 169 0
32 Ambroksol syr Btl 0 9,883 0
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 105 0
34 Asering Infus Tab 0 9,646 0
35 Asam Folat tablet 01mg Tab 0 63 0
36 Asam Folat tablet 5 mg Tab 0 55 0
37 Artesunat Inj Vial 0 14,250 0
38 Asam traneksamat Inj 5 % Amp 0 24,449 0
39 Asetosal Tablet 500 mg Tab 0 - 0
40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1,595 0
41 Atropin Sulfat Tablet 0,5 mg Tab 0 74 0
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 - 0
43 Alkohol 70% 1 Liter Btl 0 24,992 0
44 Betadin Salf Antiseptik Tube 0 7,039 0
45 Betametason Krim 0,1% - 5 gr Tube 24 1,349 32376
46 Bisacodril sup Supp 0 5,800 0
47 Bisoprolol 2,5mg tab Tab 0 650 0
48 Captopril Tablet 12,5 mg Tab 0 62 0
49 Captopril Tablet 25 mg Tab 0 72 0 Rp1,594,526
50 Carbamazefine Tab 0 269 0
51 Cefadroxil 500mg Tab 0 516 0
52 Cetrizin syr Btl 0 2,849 0
53 Cefixim Tab 0 590 0
54 Ciprofloxacin Infus Btl 0 39,900 0
55 Ciprofloxacin Tablet 500mg Tab 1000 255 255000
56 D-Artepp Tab Tab 0 1,000 0
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1,097 0
58 Deksametasone Tablet 0,5 mg Tab 1000 32 32000
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6,600 0
60 Diazetpam Rectal 2mg Tube 0 11,516 0
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0 17,350 0
62 Diazepam Tablet 2 mg Tab 0 45 0
63 Diazepam Tablet 5 mg Tab 0 - 0
64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 - 0
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 1,176 0
66 Digoksin Tablet 0,25 mg Tab 0 105 0
67 Domperidon 10 mgtablet Tab 0 85 0
68 Dimenhidrinat Tablet 50 mg Tab 0 - 0
69 Dasabion Tablet Tab 0 - 0
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3,333 0
71 Efedrin HCL Tablet 25 mg Tab 0 51 0
72 Ekstrak Belladona Tablet 10 mg Tab 0 31 0
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1,408 0
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 1,800 0
75 Lisinofril 10 mg Tab 0 448 0
76 Lisinofril 5mg Tab 0 375 0
77 Etanol 70%- 100 ml Btl 0 2,500 0
78 Eritromisin Kapsul 500 mg Kap 0 730 0
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 6,700 0
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 - 0
81 Fenitoin Natrium Kapsul 100 mg Kap 0 154 0
82 Fenitoin Natrium Kapsul 30 mg Kap 0 - 0
83 Fenobarbital Injeksi- 2ml Amp 0 1,740 0
84 Fenobarbital Tablet 30 mg Tab 0 165 0
85 Fenobarbital Tablet 30 mg Tab 0 - 0
86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 - 0
87 Fluflenazine decanoat inj 25mg/ml Amp 0 57,500 0
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 30 3,550 106500
89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 710 0
90 Gentamisin SM Tube 0 2,600 0
91 Furosemida Tablet 40 mg Tab 0 75 0
92 Garam Oralit 200 ml air Ktg 0 264 0
93 Glimepirid 2mg Tablet Tab 0 288 0
94 Glibenklamida Tablet 5 mg Tab 500 119 59500
95 Asetil Sistein 200mg Tab 3360 358 1202880
96 Glikazid 80 mg Btl 0 235 0
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 6,900 0
99 Griseofulvin Tablet 500 mg, Tab 0 2,200 0
100 Griseofulvin Tablet 125 mg, Micron Tab 0 210 0
101 Gentamisin S.K 0.1%-5 gr Tube 0 2,800 0
102 Gentamisin Tetes Mata Vial 0 3,696 0
103 Haloperidol 2 mg Tablet Tab 0 126 0
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 0 Rp1,655,880

116 KN-3B Labu 0 10,050 -
139 Metamizol 500mg Tab 0 473 -
169 Obat Batuk Dewasa syr Btl 60 5,500 330,000
176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 0 1,107 -

218 Sinbio Set 0 4,500 -
PERBEKALAN KESEHATAN

20 Masker biji 150 549 82,350
30 Urine Bag Biji 15 7,038 105,570

Cikeusik, 23 April 2019

NIP. 19820422 200801 2 006 NIP.19890729 2001704 2 001
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 27 /SBBK-LPLPO/PKM-CKS/IV/2019



29 Asam Mefenamat 500mg Tab 0 103 -
77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 NIP.19891004 2007042 002
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 29 /SBBK-LPLPO/PKM-CKS/IV/2019



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 NIP.19870416 201704 2 003
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK




77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 NIP.19910222 201704 2 001
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/31 /SBBK-LPLPO/PKM-CKS/IV/2019



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Poskesdes Tanjungan



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 NR.TKK
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK




77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK
REKAPITULASI PENGELUARAN OBAT

BULAN APRIL 2019


3 Albendazol Tab 10350 404 4,181,400
12 Amoksilin sk Forte Tab 310 3,400 1,054,000

77 Etanol 70%- 100 ml Btl 0 2,500 -
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 - Rp2,662,540

116 KN-3B Labu 0 10,050 -
167 Obat Batuk Flu Dewasa Pkt 2550 413 1,053,150

218 Sinbio Set 0 4,500 -

20 Masker biji 150 549 82,350
30 Urine Bag Biji 15 7,038 105,570

NIP.19710804 199103 2 002 NIP. 19820422 200801 2 006
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Poskesdes Parungkokosan



49 Captopril Tablet 25 mg Tab 0 72 - Rp 210,976
77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 83/SBBK-LPLPO/PKM-CKS/IV/2015
Telah diserahkan Kepada : PUSLING


6 Amlodipine 10 mg Tablet Tab 0 93 -

49 Captopril Tablet 25 mg Tab 0 72 - Rp 334,950
77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -

2 Alat Suntik Sekali Pakai 2.5 ml Set 0 649 -

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Curugciung



49 Captopril Tablet 25 mg Tab 0 Rp 687 - Rp 210,976
77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -


NIP. 19820422 200801 2 006 NIP.19910820 201704 2 001
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK
PERSEDIAAN OBAT
BULAN APRIL 2019


3 Albendazol Tab 10740 404 4,338,960

77 Etanol 70%- 100 ml Btl 0 2,500 -
96 Glikazid 80 mg Btl 550 235 129,250

116 KN-3B Labu 6 10,050 60,300
121 Klozapine 25 Mg Tab 998 1,121 1,118,758
139 Metamizol 500mg Tab 900 473 425,700
167 Obat Batuk Flu Dewasa Pkt 4000 413 1,652,000
176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 1000 1,107 1,107,000
180 pirantel syr Btl 23 9,700 223,100
201 Ringer Laktat Lar. Inf. Steril - 500ml Btl 180 7,150 1,287,000
207 Stimuno Botol 6 23,540 141,240

218 Sinbio Set 0 4,500 -

9 I.V. Cateter No 26 set 177 13,464 2,383,128
14 Policlean Handrub Botol 18 72,047 1,296,846
17 Kasa Pembalut 2 m x 80 cm pak 120 9,400 1,128,000
20 Masker biji 700 549 384,300
28 Alkohol Swab bok 8 32,600 260,800
29 Underpad Lembar 130 4,162 541,060
30 Urine Bag Biji 91 7,038 640,458
Mengetahui Cikeusik, 23 April 2019

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
SISA OBAT
BULAN APRIL 2019


3 Albendazol Tab 390 404 157,560

77 Etanol 70%- 100 ml Btl 0 2,500 -
96 Glikazid 80 mg Btl 550 235 129,250

116 KN-3B Labu 6 10,050 60,300
121 Klozapine 25 Mg Tab 998 1,121 1,118,758
139 Metamizol 500mg Tab 900 473 425,700
180 pirantel syr Btl 23 9,700 223,100
206 Serum Anti Bisa Ular Polivalen Inj.5ml Vial 2 479,996 959,992
207 Stimuno Botol 6 23,540 141,240

218 Sinbio Set 0 4,500 -

9 I.V. Cateter No 26 set 177 13,464 2,383,128
14 Policlean Handrub Botol 18 72,047 1,296,846
17 Kasa Pembalut 2 m x 80 cm pak 120 9,400 1,128,000
20 Masker biji 550 549 301,950
28 Alkohol Swab bok 6 32,600 195,600
29 Underpad Lembar 115 4,162 478,630
30 Urine Bag Biji 76 7,038 534,888
Mengetahui Cikeusik, 23 April 2019

NIP.19710804 199103 2 002 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Tanjungan 2



77 Etanol 70%- 100 ml Btl 0 2,500 -

116 KN-3B Labu 0 10,050 -

218 Sinbio Set 0 4,500 -

YUYUN YUNENGSIH,S.Kep NUNUNG. H,Amd Keb

NIP.19820422 200801 2 006 NIP.19860222 201704 2 002
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 37 /SBBK-LPLPO/PKM-CKS/IV /2019
Telah diserahkan Kepada : PENGELOLA PROGRAM GIZI Telah diserahkan Kepa

Keperluan Bulan : April 2019 Keperluan Bulan : Apr
I OBAT-- OBATAN I

2 Retinol (Vitamin A) Kapsul 200.000 IU Kap 0 505 - II
3 Tablet Tambah Darah Komb. Tab 13000 352 4,576,000 1
JUMLAH Rp 4,576,000 2


NIP.19820422 2008 01 2 006 TKS
PUSKESMAS CIKEUSIK

Nomor :800/ 38 /SBBK-LPLPO/PKM-CKS/IV /2019 N
ah diserahkan Kepada : PENGELOLA LABORATORIUM Telah diserahkan Kepad

perluan Bulan : April 2019 Keperluan Bulan : April
BMHP I
Alkohol swab box 2 32,600 65,200 3
Reagn (Program) 65,200
Rafid HbsAg TES 200 9,850 1,970,000
Vaksin Hblg Vial 2 1,325,000 2,650,000 4,620,000
JUMLAH Rp 4,685,200


NIP.19820422 200801 2006
PUSKESMAS CIKEUSIK

Nomor :800/ 39 /SBBK-LPLPO/PKM-CKS/IV /2019
ah diserahkan Kepada : PENGELOLA KECACINGAN

perluan Bulan : April 2019
OBAT-OBATAN
Albendazol Tab 10350 404 4,181,400

JUMLAH Rp 4,181,400

YUYUN YUNENGSIH,Amd Kep ELAH NURHAYATI,Amd Keb

PUSKESMAS CIKEUSIK

Nomor : 800/ 26 /SBBK-LPLPO/PKM-CKS/V/2019 MENU

Keperluan Bulan : Mei 2019
4 Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245 0
9 Amoksisillin Kapsul 500 mg Tab 0 233 0
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 1,881 0
11 Alkazyme Sachet 25mg(Alkapham France) Pack 0 801,000 0
12 Amoksilin sk Forte Tab 269 3,400 914600
13 Ampisillin Injeksi 1 gram Vial 0 3,850 0
16 Antasida DOEN suspensi Btl 140 1,923 269220
17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 90 3,035 273150
18 Anti Hemoroid DOEN Kombinasi Supp 10 3,167 31670
19 Antifungi DOEN Kombinasi Pot 0 3,035 0
21 Antiparkinson DOEN tab. Kombinasi Tab 0 1,500 0
22 Aqua roinjek Steril Btl 0 2,860 0

23 Acyclopir Krim 5%- 5gr Tube 0 8,800 0
26 Akita/Molagit Tablet Tab 0 450 0
27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 305 0
28 Asam asetilsalisilat 100mg tablet Tab 0 130 0
30 Alprazolam 1mg Tab 0 233 0
31 Ambroksol tab tab 0 169 0
32 Ambroksol syr Btl 0 9,883 0
34 Asering Infus Tab 0 9,646 0
35 Asam Folat tablet 01mg Tab 0 63 0
37 Artesunat Inj Vial 0 14,250 0
38 Asam traneksamat Inj 5 % Amp 10 24,449 244490
39 Asetosal Tablet 500 mg Tab 0 - 0
40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1,595 0
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 - 0
43 Alkohol 70% 1 Liter Btl 0 24,992 0
44 Betadin Salf Antiseptik Tube 0 7,039 0
45 Betametason Krim 0,1% - 5 gr Tube 15 1,349 20235
46 Bisacodril sup Supp 3 5,800 17400
47 Bisoprolol 2,5mg tab Tab 0 650 0
50 Carbamazefine Tab 0 269 0
52 Cetrizin syr Btl 0 2,849 0
53 Cefixim Tab 0 590 0
54 Ciprofloxacin Infus Btl 0 39,900 0
56 D-Artepp Tab Tab 0 1,000 0
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 35 1,097 38395
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6,600 0
60 Diazetpam Rectal 2mg Tube 0 11,516 0
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0 17,350 0
63 Diazepam Tablet 5 mg Tab 0 - 0
64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 - 0
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 1,176 0
68 Dimenhidrinat Tablet 50 mg Tab 0 - 0
69 Dasabion Tablet Tab 0 - 0
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3,333 0
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1,408 0
74 Etakridin (RVanol) Lar. 0,1%-300 ml Btl 0 1,800 0
75 Lisinofril 10 mg Tab 0 448 0
76 Lisinofril 5mg Tab 0 375 0
77 Etanol 70%- 100 ml Btl 0 2,500 0
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 6,700 0
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 - 0
82 Fenitoin Natrium Kapsul 30 mg Kap 0 - 0
83 Fenobarbital Injeksi- 2ml Amp 0 1,740 0
85 Fenobarbital Tablet 30 mg Tab 0 - 0
86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 - 0
87 Fluflenazine decanoat inj 25mg/ml Amp 0 57,500 0
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3,550 0
90 Gentamisin SM Tube 0 2,600 0
95 Asetil Sistein 200mg Tab 1440 358 515520
96 Glikazid 80 mg Btl 0 235 0
99 Griseofulvin Tablet 500 mg, Tab 0 2,200 0
101 Gentamisin S.K 0.1%-5 gr Tube 0 2,800 0
102 Gentamisin Tetes Mata Vial 20 3,696 73920
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 0 Rp837,735

116 KN-3B Labu 2 10,050 20,100
121 Klozapine 25 Mg Tab 150 1,121 168,150
129 Metpormin 500mg Tab 800 100 80,000
139 Metamizol 500mg Tab 1000 473 473,000
144 MultVitamin Anak Btl 55 12,100 665,500
145 MultVitamin Dewasa Tab 0 1,316 -
157 MultVitamin Anti Oksidan Tab 500 1,440 720,000

206 Serum Anti Bisa Ular PolValen Inj.5ml Vial 5 479,996 2,399,980

215 Sabutamol Nebulizer Amp 20 110 2,200
218 Sinbio Set 0 4,500 -
PERBEKALAN KESEHATAN 0

9 I.V. Cateter No 26 set 40 13,464 538,560
20 Masker biji 450 549 247,050

24 Sarung tangan no 6 1/2 Pasng 7 924 6,468
Sarung tangan Gynecolog no 7 Sashet 55
27 17,748 976,140

29 Underpad Lembar 106 4,162 441,172


Cikeusik, 23 Mei 2019

NIP. 19820422 200801 2 006 NIP.19890729 2001704 2 001
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 27 /SBBK-LPLPO/PKM-CKS/V/2019


49 Captopril Tablet 25 mg Tab 0 72 -
74 Etakridin (RVanol) Lar. 0,1%-300 ml Btl 0 1,800 -
77 Etanol 70%- 100 ml Btl 0 2,500 -
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149 -

116 KN-3B Labu 0 10,050 -
144 MultVitamin Anak Btl 0 12,100 -
145 MultVitamin Dewasa Tab 0 1,316 -
157 MultVitamin Anti Oksidan Tab 100 1,440 144,000
158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018 -

206 Serum Anti Bisa Ular PolValen Inj.5ml Vial 0 479,996 -
210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035 -

218 Sinbio Set 0 4,500 -


27 17,748 -


35 Jarum Insulin Biji 0 2,083 -

NIP. 19820422 200801 2 006 NIP.19891004 2007042 002
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 29 /SBBK-LPLPO/PKM-CKS/V/2019

1 Alopurinol tablet 100 mg Tab 0 99
2 Aminofilin tablet 200 mg Tab 0 91
3 Albendazol Tab 0 404
4 Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245
5 Amitriptilin HCL Tab. Salut 25 mg Tab 0 167
6 Amlodipine 10 mg Tablet Tab 50 93
7 Amlodipine Besilate 5mg tablet Tab 50 70
8 Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 0 2,702,700
9 Amoksisillin Kapsul 500 mg Tab 300 233
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 1,881
11 Alkazyme Sachet 25mg(Alkapham France) Pack 0 801,000
12 Amoksilin sk Forte Tab 5 3,400
13 Ampisillin Injeksi 1 gram Vial 0 3,850
14 Antalgin (Metampiron) Tab. 500 mg Tab 0 205
15 Antasida DOEN tablet Tab 200 54
16 Antasida DOEN suspensi Btl 10 1,923
17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 0 3,035
18 Anti Hemoroid DOEN Kombinasi Supp 0 3,167
19 Antifungi DOEN Kombinasi Pot 0 3,035
20 Antimigren DOEN Kombinasi Tab 0 135
21 Antiparkinson DOEN tab. Kombinasi Tab 0 1,500
22 Aqua roinjek Steril Btl 0 2,860

23 Acyclopir Krim 5%- 5gr Tube 0 8,800
24 Acyclopir Tablet 200mg Tab 0 237
25 Acyclopir Tablet 400 mg Tab 0 380
26 Akita/Molagit Tablet Tab 0 450
27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 305
28 Asam asetilsalisilat 100mg tablet Tab 0 130
29 Asam Mefenamat 500mg Tab 0 103
30 Alprazolam 1mg Tab 0 233
31 Ambroksol tab tab 0 169
32 Ambroksol syr Btl 0 9,883
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 105
34 Asering Infus Tab 0 9,646
35 Asam Folat tablet 01mg Tab 0 63
36 Asam Folat tablet 5 mg Tab 0 55
37 Artesunat Inj Vial 0 14,250
38 Asam traneksamat Inj 5 % Amp 0 24,449
39 Asetosal Tablet 500 mg Tab 0 -
40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1,595
41 Atropin Sulfat Tablet 0,5 mg Tab 0 74
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 -
43 Alkohol 70% 1 Liter Btl 0 24,992
44 Betadin Salf Antiseptik Tube 0 7,039
45 Betametason Krim 0,1% - 5 gr Tube 4 1,349
46 Bisacodril sup Supp 0 5,800
47 Bisoprolol 2,5mg tab Tab 0 650
48 Captopril Tablet 12,5 mg Tab 50 62
Rp133,576 49 Captopril Tablet 25 mg Tab 0 72
50 Carbamazefine Tab 0 269
51 Cefadroxil 500mg Tab 0 516
52 Cetrizin syr Btl 0 2,849
53 Cefixim Tab 0 590
54 Ciprofloxacin Infus Btl 0 39,900
55 Ciprofloxacin Tablet 500mg Tab 100 255
56 D-Artepp Tab Tab 0 1,000
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1,097
58 Deksametasone Tablet 0,5 mg Tab 100 32
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6,600
60 Diazetpam Rectal 2mg Tube 0 11,516
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0 17,350
62 Diazepam Tablet 2 mg Tab 0 45
63 Diazepam Tablet 5 mg Tab 0 -
64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 -
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 1,176
66 Digoksin Tablet 0,25 mg Tab 0 105
67 Domperidon 10 mgtablet Tab 0 85
68 Dimenhidrinat Tablet 50 mg Tab 0 -
69 Dasabion Tablet Tab 0 -
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3,333
71 Efedrin HCL Tablet 25 mg Tab 0 51
72 Ekstrak Belladona Tablet 10 mg Tab 0 31
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1,408
74 Etakridin (RVanol) Lar. 0,1%-300 ml Btl 0 1,800
75 Lisinofril 10 mg Tab 0 448
76 Lisinofril 5mg Tab 0 375
77 Etanol 70%- 100 ml Btl 0 2,500
78 Eritromisin Kapsul 500 mg Kap 0 730
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 6,700
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 -
81 Fenitoin Natrium Kapsul 100 mg Kap 0 154
82 Fenitoin Natrium Kapsul 30 mg Kap 0 -
83 Fenobarbital Injeksi- 2ml Amp 0 1,740
84 Fenobarbital Tablet 30 mg Tab 0 165
85 Fenobarbital Tablet 30 mg Tab 0 -
86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 -
87 Fluflenazine decanoat inj 25mg/ml Amp 0 57,500
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3,550
89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 710
90 Gentamisin SM Tube 0 2,600
91 Furosemida Tablet 40 mg Tab 0 75
92 Garam Oralit 200 ml air Ktg 0 264
93 Glimepirid 2mg Tablet Tab 0 288
94 Glibenklamida Tablet 5 mg Tab 0 119
95 Asetil Sistein 200mg Tab 160 358
96 Glikazid 80 mg Btl 0 235
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 6,900
98 Glukosa Lar. Infus 10% Steril - 500 ml Btl 0 5,700
99 Griseofulvin Tablet 500 mg, Tab 0 2,200
100 Griseofulvin Tablet 125 mg, Micron Tab 0 210
101 Gentamisin S.K 0.1%-5 gr Tube 0 2,800
102 Gentamisin Tetes Mata Vial 0 3,696
103 Haloperidol 2 mg Tablet Tab 0 126
104 Haloperidol 5 mg Tablet Tab 0 96
Rp128,940 105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 149

106 Hidrokortison Krim 2,5%-5 gr Tab 0 2,639
107 Ibuprofen Tablet 200 mg Tab 0 105
108 Ibuprofen Tablet 400 mg Tab 0 205
109 Ibufropen syr Btl 0 3,499
110 Haloporidol Decanoate Inj 50mg Amp 0 9,750
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 100 89
112 Ketokonazol krem Tube 0 2,545
113 Ketokonazol tab 200mg Tab 50 270
114 Ketorolac Inj 30mg Vial 0 1,045
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 100 59
116 KN-3B Labu 0 10,050
117 Karbihidrat +Elektrolit Labu 0 1,007
118 Karbogliserin Tetes telinga Btl 0 2,500
119 Kloramfenikol tetes Mata Btl 0 3,250
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 100 22
121 Klozapine 25 Mg Tab 0 1,121
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 -
123 Klorpromazin HCL Tablet Salut 25 mg Tab 0 148
124 Klorpromazin HCL Tablet Salut 100 mg Tab 0 147
125 klorpeson Slasf tube 0 7,750
126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 -
127 Kotrimoksazol Tablet 480mg Tab 100 125
128 Kotrimoksazol Suspensi Kombinasi Btl 0 2,052
129 Metpormin 500mg Tab 0 100
130 Methyilprednisolon 8mg Tab 0 150
131 Kloramfenikol Salep Mata 1%-5gram Tube 0 1,881
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1,797
133 Kuinin Injeksi 25%-2ml Amp 0 6,200
134 Kloramfenikol Salep kulit 15 grm Tube 0 528
135 Lidokain Komp. Injeksi, Kombinasi Amp 0 1,140
136 Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3,360
137 Loperamide Hcl 2mg Tanlet Tab 50 85
138 Magnesium Sulfat Injk 25 ml Vial 0 3,328
139 Metamizol 500mg Tab 0 473
140 Metilergometrin Maleat Tab. 0,125 g Tab 0 210
141 Metilergometrin M inj. 0,200mg- 1ml Amp 3 2,840
142 Metoklorpropamid Tablet 10 mg Tab 0 91
143 Mikonazol Krim/ Salep 2%-10gram Tube 0 3,414
144 MultVitamin Anak Btl 0 12,100
145 MultVitamin Dewasa Tab 0 1,316
146 Metronidazol Infus 500mg/100ml Btl 0 9,950
147 Metronidazol Tablet 500mg Tab 0 113
148 Metokloramid Syr Btl 0 2,345
149 Metronidazol syr Btl 0 3,799
150 Natrium Bikarbonat Tablet 500mg Tab 0 514
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 6,410
152 Natrium Diclopenac 20mg Amp 0 145
153 Nistatin Vaginal sup 0 480
154 Nistatin Tablet Salut 500.000 IU tab 0 -
155 Natrium Diclopenac 50mg Tab 0 115
156 Nifedipine Tab 10mg Tab 0 108
157 MultVitamin Anti Oksidan Tab 100 1,440
Rp199,770 158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 317,018

159 Obat Anti Tuberkulosis Kat. 2 Pkt 0 1,297,894
160 Obat Anti Tuberkulosis Kat.Anak Pkt 0 214,985
161 Ofloksasin Tetes telinga Btl 0 45,089
162 Omeprazol inj 40mg/10ml Btl 0 16,997
163 Omeprazol Kapsul 20mg Kap 30 130
164 Ondansetron Inj 4mg Vial 0 1,660
165 Onadansetron 8mg Tablet Tab 0 1,189
166 Onadansetron 4mg Tablet Tab 0 471
167 Obat Batuk Flu Dewasa Pkt 50 413
168 Obat Batuk Hitam (OBH) Cairan Btl 0 5,000
169 Obat Batuk Dewasa syr Btl 2 5,500
170 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 7,840
171 Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1,920
172 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1,545
173 Oksitosin Injeksi 10 IU/ml- 1ml Amp 4 1,199
174 OBAT Anti Diare suspensi Btl 0 6,500
175 parasetamol drops 15 ml btl 0 6,649
176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 15 1,107
177 Parasetamol tab 100mg Tab 0 41
178 Parasetamol Tablet 500mg Tab 300 53
179 Permetin Krim/Skabisid 5 % Tube 0 12,155
180 pirantel syr Btl 0 9,700
181 Pirantel Tablet 125mg Tab 0 291
182 piroksikam Tablet 10 mg Tab 0 234
183 Piroksikam Tablet 20 mg Tab 0 105
184 Propiltiourasil Tablet 100mg Tab 0 319
185 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 123
186 Povidon Iodida 10% 300ml Btl 0 17,996
187 Povidon Iodida 10% 1000ml Btl 0 -
188 Prednison Tablet 5mg Tab 100 68
189 Primakuin Tablet 15mg Tab 0 224
190 Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 6,016
191 propanolol HCL Tablet 10mg Tab 0 60
192 Propanolol HCL Tablet 40mg Tab 0 121
193 Povidon Iodida 10% 60ml Botol 0 6,550
194 Retinol (Vitamin A) Kapsul 100.000 IU Kap 0 284
196 MDT MB/ Kusta Dewasa Blister 0 30,595
197 MDT PB/ Kusta Dewasa Blister 0 9,770
198 Risperidon 2mg Tab 0 347
199 Ranitidin Injeksi 25 mg/ 2ml Vial 0 1,155
200 Ranitidin Tablet 150 mg Tab 50 105
201 Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 7,150
202 Salbutamol Tablet 2mg Tab 0 63
204 Salep 2-4, Kombinasi Pot 0 2,621
205 Salisil Bedak 2% Ktk 0 1,025
206 Serum Anti Bisa Ular PolValen Inj.5ml Vial 0 479,996
207 Stimuno Botol 0 23,540
208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 170,000
209 Sukrafat 500mg Tab 0 368
Rp115,326 210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1,035

211 Simvastatin Tablet 20 mg Tab 0 205
213 Sukralfat Syr Botol 0 8,338
214 Sulfasetamida Natrium TM 15%- 5ml Btl 0 3,226
215 Sabutamol Nebulizer Amp 0 110
216 Spiranolakton tab tab 0 899
217 Salf Kombinasi Tube 0 11,000
218 Sinbio Set 0 4,500
219 Setrizin tablet 10 mg Tab 0 90
220 Tablet Tambah Darah Komb. Tab 0 352
221 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 -
222 Tetrasiklin HCL Kapsul 250 mg Kap 0 163
224 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 0 85
225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 0 1,455
226 Triheksifenidil Hidroklorida Tab. 2mg Tab 0 88
227 Vitamin B Komplek Tablet Tab 0 118
228 Zink Syr Botol 0 2,972
229 Zink Tablet 20mg Tab 0 514
1 Alat Suntik Sekali Pakai 1 ml Set 0 777

2 Alat Suntik Sekali Pakai 2.5 ml Set 10 649
5 Catgut/ Benang Bedah No. 2/0 Set 0 60,622
6 I.V. Catheter No. 20 Set 2 4,783
9 I.V. Cateter No 26 set 0 13,464
10 Infusion Set Anak Set 0 3,498
11 Infusion Set Dewasa Set 2 4,147
12 E.Care Film I.V Dresing Pcs 0 6,850
13 Silk (Benang Bedah Sutera) No. 3/0 Biji 0 44,953
14 Policlean Handrub Botol 0 72,047
15 Kapas Pembalut/Absorben 250 gram Set 0 12,250
16 Kasa Kompres 40/40 lembar 0 1,800
17 Kasa Pembalut 2 m x 80 cm pak 0 9,400
18 Kasa Pembalut Hidrofil 36 m x 80 cm rol 0 127,600
19 Kasa Steril 16/16 kotak 5 7,370
20 Masker biji 0 549
21 Plester 5 yard x 2 inch rol 0 8,167
22 Sarung Tangan No 7 Steril pasang 0 792

23 Sarung Tangan No 6.5 Steril pasang 0 7,931
24 Sarung tangan no 6 1/2 Pasng 0 924
25 Folly cateter No 16 Pcs 0 12,036
26 Folly cateter No 14 Pcs 0 16,610
27 17,748
28 Alkohol Swab bok 0 32,600

29 Underpad Lembar 0 4,162
30 Urine Bag Biji 0 7,038

31 Catgut/ Benang Bedah No. 3/0 Botol 0 68,433
32 Antiseptik Surgical Hand Scrab Botol 0 74,000
33 Cairan pembersih Botol 0 22,000
34 Jely kateter biji 0 41,600
Rp73,450 35 Jarum Insulin Biji 0 2,083

NIP. 19820422 200801 2 006 NIP.19870416 201704 2 003
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 8800/ 30 /SBBK-LPLPO/PKM-CKS/V/2019

TOTAL NO JENIS BARANG SATUAN JUMLAH
- 1 Alopurinol tablet 100 mg Tab 0
- 2 Aminofilin tablet 200 mg Tab 0
- 3 Albendazol Tab 0
- 4 Aminofilin injeksi 24mg/ml-10ml Amp 0
- 5 Amitriptilin HCL Tab. Salut 25 mg Tab 0
4,650 6 Amlodipine 10 mg Tablet Tab 50
3,500 7 Amlodipine Besilate 5mg tablet Tab 50
- 8 Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl 0
69,900 9 Amoksisillin Kapsul 500 mg Tab 300
- 10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0
- 11 Alkazyme Sachet 25mg(Alkapham France) Pack 0
17,000 12 Amoksilin sk Forte Tab 5
- 13 Ampisillin Injeksi 1 gram Vial 0
- 14 Antalgin (Metampiron) Tab. 500 mg Tab 0
10,800 15 Antasida DOEN tablet Tab 200
19,230 16 Antasida DOEN suspensi Btl 10
- 17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 0
- 18 Anti Hemoroid DOEN Kombinasi Supp 0
- 19 Antifungi DOEN Kombinasi Pot 0
- 20 Antimigren DOEN Kombinasi Tab 0
- 21 Antiparkinson DOEN tab. Kombinasi Tab 0
- 22 Aqua roinjek Steril Btl 0
- 23 Acyclopir Krim 5%- 5gr Tube 0
- 24 Acyclopir Tablet 200mg Tab 0
- 25 Acyclopir Tablet 400 mg Tab 0
- 26 Akita/Molagit Tablet Tab 0
- 27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0
- 28 Asam asetilsalisilat 100mg tablet Tab 0
- 29 Asam Mefenamat 500mg Tab 0

- 30 Alprazolam 1mg Tab 0
- 31 Ambroksol tab tab 0
- 32 Ambroksol syr Btl 0
- 33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0

- 34 Asering Infus Tab 0
- 35 Asam Folat tablet 01mg Tab 0
- 36 Asam Folat tablet 5 mg Tab 0
- 37 Artesunat Inj Vial 0

- 38 Asam traneksamat Inj 5 % Amp 0
- 39 Asetosal Tablet 500 mg Tab 0
- 40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0
- 41 Atropin Sulfat Tablet 0,5 mg Tab 0
- 42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0
- 43 Alkohol 70% 1 Liter Btl 0

- 44 Betadin Salf Antiseptik Tube 0
5,396 45 Betametason Krim 0,1% - 5 gr Tube 4
- 46 Bisacodril sup Supp 0

- 47 Bisoprolol 2,5mg tab Tab 0
3,100 48 Captopril Tablet 12,5 mg Tab 50
- Rp133,576 49 Captopril Tablet 25 mg Tab 0

- 50 Carbamazefine Tab 0
- 51 Cefadroxil 500mg Tab 0
- 52 Cetrizin syr Btl 0
- 53 Cefixim Tab 0
- 54 Ciprofloxacin Infus Btl 0
25,500 55 Ciprofloxacin Tablet 500mg Tab 100
- 56 D-Artepp Tab Tab 0
- 57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 0
3,200 58 Deksametasone Tablet 0,5 mg Tab 100
- 59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0
- 60 Diazetpam Rectal 2mg Tube 0
- 61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0
- 62 Diazepam Tablet 2 mg Tab 0
- 63 Diazepam Tablet 5 mg Tab 0
- 64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0
- 65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0
- 66 Digoksin Tablet 0,25 mg Tab 0
- 67 Domperidon 10 mgtablet Tab 0
- 68 Dimenhidrinat Tablet 50 mg Tab 0
- 69 Dasabion Tablet Tab 0
- 70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0
- 71 Efedrin HCL Tablet 25 mg Tab 0
- 72 Ekstrak Belladona Tablet 10 mg Tab 0
- 73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0
- 74 Etakridin (RVanol) Lar. 0,1%-300 ml Btl 0
- 75 Lisinofril 10 mg Tab 0
- 76 Lisinofril 5mg Tab 0
- 77 Etanol 70%- 100 ml Btl 0
- 78 Eritromisin Kapsul 500 mg Kap 0
- 79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0
- 80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0
- 81 Fenitoin Natrium Kapsul 100 mg Kap 0
- 82 Fenitoin Natrium Kapsul 30 mg Kap 0
- 83 Fenobarbital Injeksi- 2ml Amp 0
- 84 Fenobarbital Tablet 30 mg Tab 0

- 85 Fenobarbital Tablet 30 mg Tab 0
- 86 Fenoksimetil Penisilina Tablet 250 mg Tab 0
- 87 Fluflenazine decanoat inj 25mg/ml Amp 0
- 88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0
- 89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 0
- 90 Gentamisin SM Tube 0
- 91 Furosemida Tablet 40 mg Tab 0
- 92 Garam Oralit 200 ml air Ktg 0
- 93 Glimepirid 2mg Tablet Tab 0
- 94 Glibenklamida Tablet 5 mg Tab 0
57,280 95 Asetil Sistein 200mg Tab 160
- 96 Glikazid 80 mg Btl 0
- 97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 0
- 98 Glukosa Lar. Infus 10% Steril - 500 ml Btl 0

- 99 Griseofulvin Tablet 500 mg, Tab 0
- 100 Griseofulvin Tablet 125 mg, Micron Tab 0
- 101 Gentamisin S.K 0.1%-5 gr Tube 0
- 102 Gentamisin Tetes Mata Vial 0
- 103 Haloperidol 2 mg Tablet Tab 0
- 104 Haloperidol 5 mg Tablet Tab 0
- Rp85,980 105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0

- 106 Hidrokortison Krim 2,5%-5 gr Tab 0
- 107 Ibuprofen Tablet 200 mg Tab 0
- 108 Ibuprofen Tablet 400 mg Tab 0
- 109 Ibufropen syr Btl 0
- 110 Haloporidol Decanoate Inj 50mg Amp 0
8,900 111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 100
- 112 Ketokonazol krem Tube 0
13,500 113 Ketokonazol tab 200mg Tab 50
- 114 Ketorolac Inj 30mg Vial 0
5,900 115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 100
- 116 KN-3B Labu 0
- 117 Karbihidrat +Elektrolit Labu 0
- 118 Karbogliserin Tetes telinga Btl 0
- 119 Kloramfenikol tetes Mata Btl 0
2,200 120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 100
- 121 Klozapine 25 Mg Tab 0
- 122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0
- 123 Klorpromazin HCL Tablet Salut 25 mg Tab 0
- 124 Klorpromazin HCL Tablet Salut 100 mg Tab 0
- 125 klorpeson Slasf tube 0
- 126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0
12,500 127 Kotrimoksazol Tablet 480mg Tab 100
- 128 Kotrimoksazol Suspensi Kombinasi Btl 0
- 129 Metpormin 500mg Tab 0
- 130 Methyilprednisolon 8mg Tab 0
- 131 Kloramfenikol Salep Mata 1%-5gram Tube 0
- 132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0
- 133 Kuinin Injeksi 25%-2ml Amp 0
- 134 Kloramfenikol Salep kulit 15 grm Tube 0
- 135 Lidokain Komp. Injeksi, Kombinasi Amp 0
- 136 Lisol, Kresol Tersabun 50%- 1000ml Btl 0
4,250 137 Loperamide Hcl 2mg Tanlet Tab 50
- 138 Magnesium Sulfat Injk 25 ml Vial 0
- 139 Metamizol 500mg Tab 0
- 140 Metilergometrin Maleat Tab. 0,125 g Tab 0
8,520 141 Metilergometrin M inj. 0,200mg- 1ml Amp 3
- 142 Metoklorpropamid Tablet 10 mg Tab 0
- 143 Mikonazol Krim/ Salep 2%-10gram Tube 0
- 144 MultVitamin Anak Btl 0

- 145 MultVitamin Dewasa Tab 0
- 146 Metronidazol Infus 500mg/100ml Btl 0
- 147 Metronidazol Tablet 500mg Tab 0
- 148 Metokloramid Syr Btl 0
- 149 Metronidazol syr Btl 0
- 150 Natrium Bikarbonat Tablet 500mg Tab 0
- 151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0
- 152 Natrium Diclopenac 20mg Amp 0
- 153 Nistatin Vaginal sup 0
- 154 Nistatin Tablet Salut 500.000 IU tab 0
- 155 Natrium Diclopenac 50mg Tab 0
- 156 Nifedipine Tab 10mg Tab 0
144,000 157 MultVitamin Anti Oksidan Tab 100
- Rp199,770 158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0

- 159 Obat Anti Tuberkulosis Kat. 2 Pkt 0
- 160 Obat Anti Tuberkulosis Kat.Anak Pkt 0
- 161 Ofloksasin Tetes telinga Btl 0
- 162 Omeprazol inj 40mg/10ml Btl 0
3,900 163 Omeprazol Kapsul 20mg Kap 30
- 164 Ondansetron Inj 4mg Vial 0
- 165 Onadansetron 8mg Tablet Tab 0
- 166 Onadansetron 4mg Tablet Tab 0
20,650 167 Obat Batuk Flu Dewasa Pkt 50
- 168 Obat Batuk Hitam (OBH) Cairan Btl 0
11,000 169 Obat Batuk Dewasa syr Btl 2
- 170 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0
- 171 Oksitetrasiklin HCL SM 1%-3,5gram Tube 0
- 172 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0
4,796 173 Oksitosin Injeksi 10 IU/ml- 1ml Amp 4
- 174 OBAT Anti Diare suspensi Btl 0
- 175 parasetamol drops 15 ml btl 0
16,605 176 Parasetamol Syrup 120mg/ 5ml-60ml Btl 15
- 177 Parasetamol tab 100mg Tab 0
15,900 178 Parasetamol Tablet 500mg Tab 300
- 179 Permetin Krim/Skabisid 5 % Tube 0
- 180 pirantel syr Btl 0
- 181 Pirantel Tablet 125mg Tab 0
- 182 piroksikam Tablet 10 mg Tab 0
- 183 Piroksikam Tablet 20 mg Tab 0
- 184 Propiltiourasil Tablet 100mg Tab 0
- 185 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0
- 186 Povidon Iodida 10% 300ml Btl 0
- 187 Povidon Iodida 10% 1000ml Btl 0
6,800 188 Prednison Tablet 5mg Tab 100

- 189 Primakuin Tablet 15mg Tab 0
- 190 Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0
- 191 propanolol HCL Tablet 10mg Tab 0
- 192 Propanolol HCL Tablet 40mg Tab 0
- 193 Povidon Iodida 10% 60ml Botol 0
- 194 Retinol (Vitamin A) Kapsul 100.000 IU Kap 0
- 195 Retinol (Vitamin A) Kapsul 200.000 IU Kap 0
- 196 MDT MB/ Kusta Dewasa Blister 0
- 197 MDT PB/ Kusta Dewasa Blister 0
- 198 Risperidon 2mg Tab 0
- 199 Ranitidin Injeksi 25 mg/ 2ml Vial 0
5,250 200 Ranitidin Tablet 150 mg Tab 50
- 201 Ringer Laktat Lar. Inf. Steril - 500ml Btl 2
- 202 Salbutamol Tablet 2mg Tab 0
- 203 Salbutamol Tablet 4mg Tab 0
- 204 Salep 2-4, Kombinasi Pot 0
- 205 Salisil Bedak 2% Ktk 0
- 206 Serum Anti Bisa Ular PolValen Inj.5ml Vial 0
- 207 Stimuno Botol 0
- 208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0
- 209 Sukrafat 500mg Tab 0
- Rp84,901 210 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0

- 211 Simvastatin Tablet 20 mg Tab 0
- 212 Simvastatin Tablet 10 mg Tab 0
- 213 Sukralfat Syr Botol 0
- 214 Sulfasetamida Natrium TM 15%- 5ml Btl 0

- 215 Sabutamol Nebulizer Amp 0
- 216 Spiranolakton tab tab 0
- 217 Salf Kombinasi Tube 0
- 218 Sinbio Set 0
- 219 Setrizin tablet 10 mg Tab 0
- 220 Tablet Tambah Darah Komb. Tab 0
- 221 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0
- 222 Tetrasiklin HCL Kapsul 250 mg Kap 0
- 223 Tetrasiklin HCL Kapsul 500 mg Kap 0

- 224 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 0
- 225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab 0
- 226 Triheksifenidil Hidroklorida Tab. 2mg Tab 0
- 227 Vitamin B Komplek Tablet Tab 0
- 228 Zink Syr Botol 0
- 229 Zink Tablet 20mg Tab 0

- 1 Alat Suntik Sekali Pakai 1 ml Set 0

6,490 2 Alat Suntik Sekali Pakai 2.5 ml Set 10
- 5 Catgut/ Benang Bedah No. 2/0 Set 0
9,566 6 I.V. Catheter No. 20 Set 2
- 7 I.V. Catheter No. 22 Set 0
- 8 I.V. Catheter No. 24 Set 0
- 9 I.V. Cateter No 26 set 0
- 10 Infusion Set Anak Set 0
8,294 11 Infusion Set Dewasa Set 2
- 12 E.Care Film I.V Dresing Pcs 0
- 13 Silk (Benang Bedah Sutera) No. 3/0 Biji 0
- 14 Policlean Handrub Botol 0
- 15 Kapas Pembalut/Absorben 250 gram Set 0

- 16 Kasa Kompres 40/40 lembar 0
- 17 Kasa Pembalut 2 m x 80 cm pak 0
- 18 Kasa Pembalut Hidrofil 36 m x 80 cm rol 0

36,850 19 Kasa Steril 16/16 kotak 5
- 20 Masker biji 0
- 21 Plester 5 yard x 2 inch rol 0
- 22 Sarung Tangan No 7 Steril pasang 0
- 23 Sarung Tangan No 6.5 Steril pasang 0

- 24 Sarung tangan no 6 1/2 Pasng 0
- 25 Folly cateter No 16 Pcs 0
- 26 Folly cateter No 14 Pcs 0

- 27
- 28 Alkohol Swab bok 0
- 29 Underpad Lembar 3
- 30 Urine Bag Biji 0
- 31 Catgut/ Benang Bedah No. 3/0 Botol 0
- 32 Antiseptik Surgical Hand Scrab Botol 0
- 33 Cairan pembersih Botol 0

- 34 Jely kateter biji 0
- Rp61,200 35 Jarum Insulin Biji 0

23 Mei 2019 Cikeusik, 23 Mei 2
Menerima Yang Menyerahkan Yang Menerima
AH,Amd Keb YUYUN YUNENGSIH, S.Kep ELIS FEBRIANI,Amd.K

16 201704 2 003 NIP. 19820422 200801 2 006 NIP.19910222 201704
Mengetahui
NIP.19710804 199103 2 002
GLANG PEMERINTAH KABUPATEN PANDEGLANG
PUSKESMAS CIKEUSIK
b. Pandeglang Jln. Alun-alun Cikeusik Kec. Cikeusik Kab. Pandeg
AR SURAT BUKTI BARANG KELUAR

CKS/V/2019 Nomor : 800/31 /SBBK-LPLPO/PKM-CKS/V/20

HARGA TOTAL NO JENIS BARANG SATUAN
99 - 1 Alopurinol tablet 100 mg Tab
91 - 2 Aminofilin tablet 200 mg Tab
404 - 3 Albendazol Tab
3,245 - 4 Aminofilin injeksi 24mg/ml-10ml Amp
167 - 5 Amitriptilin HCL Tab. Salut 25 mg Tab
93 4,650 6 Amlodipine 10 mg Tablet Tab
70 3,500 7 Amlodipine Besilate 5mg tablet Tab
2,702,700 - 8 Alkacide 1 L High Level Desinfectant(Alkapham Feran Btl
233 69,900 9 Amoksisillin Kapsul 500 mg Tab
1,881 - 10 Amoksisillin SK 125 mg/5 ml-60 ml Btl
801,000 - 11 Alkazyme Sachet 25mg(Alkapham France) Pack
3,400 17,000 12 Amoksilin sk Forte Tab
3,850 - 13 Ampisillin Injeksi 1 gram Vial
205 - 14 Antalgin (Metampiron) Tab. 500 mg Tab
54 10,800 15 Antasida DOEN tablet Tab
1,923 19,230 16 Antasida DOEN suspensi Btl
3,035 - 17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube
3,167 - 18 Anti Hemoroid DOEN Kombinasi Supp
3,035 - 19 Antifungi DOEN Kombinasi Pot
135 - 20 Antimigren DOEN Kombinasi Tab
1,500 - 21 Antiparkinson DOEN tab. Kombinasi Tab
2,860 - 22 Aqua roinjek Steril Btl
8,800 - 23 Acyclopir Krim 5%- 5gr Tube
237 - 24 Acyclopir Tablet 200mg Tab
380 - 25 Acyclopir Tablet 400 mg Tab
450 - 26 Akita/Molagit Tablet Tab
305 - 27 Antalgin (Metampiron) Inj. 250mg/2ml Tab
130 - 28 Asam asetilsalisilat 100mg tablet Tab
103 - 29 Asam Mefenamat 500mg Tab

233 - 30 Alprazolam 1mg Tab
169 - 31 Ambroksol tab tab
9,883 - 32 Ambroksol syr Btl
105 - 33 Asam Askorbat (Vit. C) Tablet 50 mg Tab

9,646 - 34 Asering Infus Tab
63 - 35 Asam Folat tablet 01mg Tab
55 - 36 Asam Folat tablet 5 mg Tab
14,250 - 37 Artesunat Inj Vial

24,449 - 38 Asam traneksamat Inj 5 % Amp
- - 39 Asetosal Tablet 500 mg Tab
1,595 - 40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp
74 - 41 Atropin Sulfat Tablet 0,5 mg Tab
- - 42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl
24,992 - 43 Alkohol 70% 1 Liter Btl

7,039 - 44 Betadin Salf Antiseptik Tube
1,349 5,396 45 Betametason Krim 0,1% - 5 gr Tube
5,800 - 46 Bisacodril sup Supp

650 - 47 Bisoprolol 2,5mg tab Tab
62 3,100 48 Captopril Tablet 12,5 mg Tab
72 - Rp133,576 49 Captopril Tablet 25 mg Tab

269 - 50 Carbamazefine Tab
516 - 51 Cefadroxil 500mg Tab
2,849 - 52 Cetrizin syr Btl
590 - 53 Cefixim Tab
39,900 - 54 Ciprofloxacin Infus Btl
255 25,500 55 Ciprofloxacin Tablet 500mg Tab
1,000 - 56 D-Artepp Tab Tab
1,097 - 57 Deksametasone Injeksi 5 mg/ml - 1ml Amp
32 3,200 58 Deksametasone Tablet 0,5 mg Tab
6,600 - 59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl
11,516 - 60 Diazetpam Rectal 2mg Tube
17,350 - 61 Diazepam Injeksi 5 mg/ml - 2ml Amp
45 - 62 Diazepam Tablet 2 mg Tab
- - 63 Diazepam Tablet 5 mg Tab
- - 64 Dietilkarbamazin Sitrat Tablet 100 mg Tab
1,176 - 65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp
105 - 66 Digoksin Tablet 0,25 mg Tab
85 - 67 Domperidon 10 mgtablet Tab
- - 68 Dimenhidrinat Tablet 50 mg Tab
- - 69 Dasabion Tablet Tab
3,333 - 70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl
51 - 71 Efedrin HCL Tablet 25 mg Tab
31 - 72 Ekstrak Belladona Tablet 10 mg Tab
1,408 - 73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp
1,800 - 74 Etakridin (RVanol) Lar. 0,1%-300 ml Btl
448 - 75 Lisinofril 10 mg Tab
375 - 76 Lisinofril 5mg Tab
2,500 - 77 Etanol 70%- 100 ml Btl
730 - 78 Eritromisin Kapsul 500 mg Kap
6,700 - 79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl
- - 80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp
154 - 81 Fenitoin Natrium Kapsul 100 mg Kap
- - 82 Fenitoin Natrium Kapsul 30 mg Kap
1,740 - 83 Fenobarbital Injeksi- 2ml Amp
165 - 84 Fenobarbital Tablet 30 mg Tab

- - 85 Fenobarbital Tablet 30 mg Tab
- - 86 Fenoksimetil Penisilina Tablet 250 mg Tab
57,500 - 87 Fluflenazine decanoat inj 25mg/ml Amp
3,550 - 88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp
710 - 89 Fitomenadion (Vit. K1) Tab. 10 mg Tab
2,600 - 90 Gentamisin SM Tube
75 - 91 Furosemida Tablet 40 mg Tab
264 - 92 Garam Oralit 200 ml air Ktg
288 - 93 Glimepirid 2mg Tablet Tab
119 - 94 Glibenklamida Tablet 5 mg Tab
358 57,280 95 Asetil Sistein 200mg Tab
235 - 96 Glikazid 80 mg Btl
6,900 - 97 Glukosa Lar. Infus 5% Steril - 500 ml Btl
5,700 - 98 Glukosa Lar. Infus 10% Steril - 500 ml Btl

2,200 - 99 Griseofulvin Tablet 500 mg, Tab
210 - 100 Griseofulvin Tablet 125 mg, Micron Tab
2,800 - 101 Gentamisin S.K 0.1%-5 gr Tube
3,696 - 102 Gentamisin Tetes Mata Vial
126 - 103 Haloperidol 2 mg Tablet Tab
96 - 104 Haloperidol 5 mg Tablet Tab
149 - Rp85,980 105 Hidroklortiazid (HCT) Tablet 25 mg Tab

2,639 - 106 Hidrokortison Krim 2,5%-5 gr Tab
105 - 107 Ibuprofen Tablet 200 mg Tab
205 - 108 Ibuprofen Tablet 400 mg Tab
3,499 - 109 Ibufropen syr Btl
9,750 - 110 Haloporidol Decanoate Inj 50mg Amp
89 8,900 111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab
2,545 - 112 Ketokonazol krem Tube
270 13,500 113 Ketokonazol tab 200mg Tab
1,045 - 114 Ketorolac Inj 30mg Vial
59 5,900 115 Kalsium Laktat (Kalk) Tablet 500 mg Tab
10,050 - 116 KN-3B Labu
1,007 - 117 Karbihidrat +Elektrolit Labu
2,500 - 118 Karbogliserin Tetes telinga Btl
3,250 - 119 Kloramfenikol tetes Mata Btl
22 2,200 120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab
1,121 - 121 Klozapine 25 Mg Tab
- - 122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp
148 - 123 Klorpromazin HCL Tablet Salut 25 mg Tab
147 - 124 Klorpromazin HCL Tablet Salut 100 mg Tab
7,750 - 125 klorpeson Slasf tube
- - 126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt
125 12,500 127 Kotrimoksazol Tablet 480mg Tab
2,052 - 128 Kotrimoksazol Suspensi Kombinasi Btl
100 - 129 Metpormin 500mg Tab
150 - 130 Methyilprednisolon 8mg Tab
1,881 - 131 Kloramfenikol Salep Mata 1%-5gram Tube
1,797 - 132 Kloramfenikol Tetes Telinga 3%-5ml Btl
6,200 - 133 Kuinin Injeksi 25%-2ml Amp
528 - 134 Kloramfenikol Salep kulit 15 grm Tube
1,140 - 135 Lidokain Komp. Injeksi, Kombinasi Amp
3,360 - 136 Lisol, Kresol Tersabun 50%- 1000ml Btl
85 4,250 137 Loperamide Hcl 2mg Tanlet Tab
3,328 - 138 Magnesium Sulfat Injk 25 ml Vial
473 - 139 Metamizol 500mg Tab
210 - 140 Metilergometrin Maleat Tab. 0,125 g Tab
2,840 8,520 141 Metilergometrin M inj. 0,200mg- 1ml Amp
91 - 142 Metoklorpropamid Tablet 10 mg Tab
3,414 - 143 Mikonazol Krim/ Salep 2%-10gram Tube
12,100 - 144 MultVitamin Anak Btl

1,316 - 145 MultVitamin Dewasa Tab
9,950 - 146 Metronidazol Infus 500mg/100ml Btl
113 - 147 Metronidazol Tablet 500mg Tab
2,345 - 148 Metokloramid Syr Btl
3,799 - 149 Metronidazol syr Btl
514 - 150 Natrium Bikarbonat Tablet 500mg Tab
6,410 - 151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl
145 - 152 Natrium Diclopenac 20mg Amp
480 - 153 Nistatin Vaginal sup
- - 154 Nistatin Tablet Salut 500.000 IU tab
115 - 155 Natrium Diclopenac 50mg Tab
108 - 156 Nifedipine Tab 10mg Tab
1,440 144,000 157 MultVitamin Anti Oksidan Tab
317,018 - Rp199,770 158 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt

1,297,894 - 159 Obat Anti Tuberkulosis Kat. 2 Pkt
214,985 - 160 Obat Anti Tuberkulosis Kat.Anak Pkt
45,089 - 161 Ofloksasin Tetes telinga Btl
16,997 - 162 Omeprazol inj 40mg/10ml Btl
130 3,900 163 Omeprazol Kapsul 20mg Kap
1,660 - 164 Ondansetron Inj 4mg Vial
1,189 - 165 Onadansetron 8mg Tablet Tab
471 - 166 Onadansetron 4mg Tablet Tab
413 20,650 167 Obat Batuk Flu Dewasa Pkt
5,000 - 168 Obat Batuk Hitam (OBH) Cairan Btl
5,500 11,000 169 Obat Batuk Dewasa syr Btl
7,840 - 170 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial
1,920 - 171 Oksitetrasiklin HCL SM 1%-3,5gram Tube
1,545 - 172 Oksitetrasiklin HCL Salep 3%- 5gram Tube
1,199 4,796 173 Oksitosin Injeksi 10 IU/ml- 1ml Amp
6,500 - 174 OBAT Anti Diare suspensi Btl
6,649 - 175 parasetamol drops 15 ml btl
1,107 16,605 176 Parasetamol Syrup 120mg/ 5ml-60ml Btl
41 - 177 Parasetamol tab 100mg Tab
53 15,900 178 Parasetamol Tablet 500mg Tab
12,155 - 179 Permetin Krim/Skabisid 5 % Tube
9,700 - 180 pirantel syr Btl
291 - 181 Pirantel Tablet 125mg Tab
234 - 182 piroksikam Tablet 10 mg Tab
105 - 183 Piroksikam Tablet 20 mg Tab
319 - 184 Propiltiourasil Tablet 100mg Tab
123 - 185 Piridoksin HCL (Vit. B6) Tablet 10mg Tab
17,996 - 186 Povidon Iodida 10% 300ml Btl
- - 187 Povidon Iodida 10% 1000ml Btl
68 6,800 188 Prednison Tablet 5mg Tab

224 - 189 Primakuin Tablet 15mg Tab
6,016 - 190 Prokain Benzil Penisilin 3 Juta IU Inj. Vial
60 - 191 propanolol HCL Tablet 10mg Tab
121 - 192 Propanolol HCL Tablet 40mg Tab
6,550 - 193 Povidon Iodida 10% 60ml Botol
284 - 194 Retinol (Vitamin A) Kapsul 100.000 IU Kap
505 - 195 Retinol (Vitamin A) Kapsul 200.000 IU Kap
30,595 - 196 MDT MB/ Kusta Dewasa Blister
9,770 - 197 MDT PB/ Kusta Dewasa Blister
347 - 198 Risperidon 2mg Tab
1,155 - 199 Ranitidin Injeksi 25 mg/ 2ml Vial
105 5,250 200 Ranitidin Tablet 150 mg Tab
7,150 14,300 201 Ringer Laktat Lar. Inf. Steril - 500ml Btl
63 - 202 Salbutamol Tablet 2mg Tab
70 - 203 Salbutamol Tablet 4mg Tab
2,621 - 204 Salep 2-4, Kombinasi Pot
1,025 - 205 Salisil Bedak 2% Ktk
479,996 - 206 Serum Anti Bisa Ular PolValen Inj.5ml Vial
23,540 - 207 Stimuno Botol

170,000 - 208 Serum Anti Tetanus Inj. 1500 IU/amp. Amp
368 - 209 Sukrafat 500mg Tab
1,035 - Rp99,201 210 Sianokobalamin (Vit. B12) Inj 500mcg Amp

205 - 211 Simvastatin Tablet 20 mg Tab
110 - 212 Simvastatin Tablet 10 mg Tab
8,338 - 213 Sukralfat Syr Botol
3,226 - 214 Sulfasetamida Natrium TM 15%- 5ml Btl

110 - 215 Sabutamol Nebulizer Amp
899 - 216 Spiranolakton tab tab
11,000 - 217 Salf Kombinasi Tube
4,500 - 218 Sinbio Set
90 - 219 Setrizin tablet 10 mg Tab
352 - 220 Tablet Tambah Darah Komb. Tab
- - 221 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl
163 - 222 Tetrasiklin HCL Kapsul 250 mg Kap
300 - 223 Tetrasiklin HCL Kapsul 500 mg Kap

85 - 224 Tiamin HCL/(Vit. B1) Tab. 50mg Tab
1,455 - 225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Tab
88 - 226 Triheksifenidil Hidroklorida Tab. 2mg Tab
118 - 227 Vitamin B Komplek Tablet Tab
2,972 - 228 Zink Syr Botol
514 - 229 Zink Tablet 20mg Tab

777 - 1 Alat Suntik Sekali Pakai 1 ml Set

649 6,490 2 Alat Suntik Sekali Pakai 2.5 ml Set
60,622 - 5 Catgut/ Benang Bedah No. 2/0 Set
4,783 9,566 6 I.V. Catheter No. 20 Set
12,232 - 7 I.V. Catheter No. 22 Set
4,784 - 8 I.V. Catheter No. 24 Set
13,464 - 9 I.V. Cateter No 26 set
3,498 - 10 Infusion Set Anak Set
4,147 8,294 11 Infusion Set Dewasa Set
6,850 - 12 E.Care Film I.V Dresing Pcs
44,953 - 13 Silk (Benang Bedah Sutera) No. 3/0 Biji
72,047 - 14 Policlean Handrub Botol
12,250 - 15 Kapas Pembalut/Absorben 250 gram Set

1,800 - 16 Kasa Kompres 40/40 lembar
9,400 - 17 Kasa Pembalut 2 m x 80 cm pak
127,600 - 18 Kasa Pembalut Hidrofil 36 m x 80 cm rol

7,370 36,850 19 Kasa Steril 16/16 kotak
549 - 20 Masker biji
8,167 - 21 Plester 5 yard x 2 inch rol
792 - 22 Sarung Tangan No 7 Steril pasang
7,931 - 23 Sarung Tangan No 6.5 Steril pasang

924 - 24 Sarung tangan no 6 1/2 Pasng
12,036 - 25 Folly cateter No 16 Pcs
16,610 - 26 Folly cateter No 14 Pcs
Sarung tangan Gynecolog no 7 Sashet

17,748 - 27
32,600 - 28 Alkohol Swab bok
4,162 12,486 29 Underpad Lembar
7,038 - 30 Urine Bag Biji
68,433 - 31 Catgut/ Benang Bedah No. 3/0 Botol
74,000 - 32 Antiseptik Surgical Hand Scrab Botol
22,000 - 33 Cairan pembersih Botol

41,600 - 34 Jely kateter biji
2,083 - Rp73,686 35 Jarum Insulin Biji
Rp592,213 TOTAL PENGELUARAN Rp5

Yang Menerima Yang Menyerahkan
ELIS FEBRIANI,Amd.Keb YUYUN YUNENGSIH, S.Kep

NIP.19910222 201704 2 001 NIP. 19820422 200801 2 006
Mengetahui
2 NIP.19710804 199103 2 002
PATEN PANDEGLANG PEMERINTAH KABUPATEN PA
S CIKEUSIK PUSKESMAS CIKEUS
. Cikeusik Kab. Pandeglang Jln. Alun-alun Cikeusik Kec. Cikeusik
ARANG KELUAR SURAT BUKTI BARANG K

LPLPO/PKM-CKS/V/2019 Nomor :800/ 32 /SBBK-LPLPO/PK
Telah diserahkan Kepada : Poskesdes Tanjungan

JUMLAH HARGA TOTAL NO JENIS BARANG
0 99 - 1 Alopurinol tablet 100 mg
0 91 - 2 Aminofilin tablet 200 mg
0 404 - 3 Albendazol
0 3,245 - 4 Aminofilin injeksi 24mg/ml-10ml
0 167 - 5 Amitriptilin HCL Tab. Salut 25 mg
50 93 4,650 6 Amlodipine 10 mg Tablet
50 70 3,500 7 Amlodipine Besilate 5mg tablet
0 2,702,700 - 8 Alkacide 1 L High Level Desinfectant(Alkapham Feran
300 233 69,900 9 Amoksisillin Kapsul 500 mg
0 1,881 - 10 Amoksisillin SK 125 mg/5 ml-60 ml
0 801,000 - 11 Alkazyme Sachet 25mg(Alkapham France)
5 3,400 17,000 12 Amoksilin sk Forte
0 3,850 - 13 Ampisillin Injeksi 1 gram
0 205 - 14 Antalgin (Metampiron) Tab. 500 mg
200 54 10,800 15 Antasida DOEN tablet
10 1,923 19,230 16 Antasida DOEN suspensi
0 3,035 - 17 Anti Bakteri DOEN Salep Kombinasi (basitrasin)
0 3,167 - 18 Anti Hemoroid DOEN Kombinasi
0 3,035 - 19 Antifungi DOEN Kombinasi
0 135 - 20 Antimigren DOEN Kombinasi
0 1,500 - 21 Antiparkinson DOEN tab. Kombinasi
0 2,860 - 22 Aqua roinjek Steril
0 8,800 - 23 Acyclopir Krim 5%- 5gr
0 237 - 24 Acyclopir Tablet 200mg
0 380 - 25 Acyclopir Tablet 400 mg
0 450 - 26 Akita/Molagit Tablet
0 305 - 27 Antalgin (Metampiron) Inj. 250mg/2ml
0 130 - 28 Asam asetilsalisilat 100mg tablet
0 103 - 29 Asam Mefenamat 500mg
0 233 - 30 Alprazolam 1mg
0 169 - 31 Ambroksol tab
0 9,883 - 32 Ambroksol syr
0 105 - 33 Asam Askorbat (Vit. C) Tablet 50 mg
0 9,646 - 34 Asering Infus
0 63 - 35 Asam Folat tablet 01mg
0 55 - 36 Asam Folat tablet 5 mg
0 14,250 - 37 Artesunat Inj
0 24,449 - 38 Asam traneksamat Inj 5 %
0 - - 39 Asetosal Tablet 500 mg
0 1,595 - 40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml
0 74 - 41 Atropin Sulfat Tablet 0,5 mg
0 - - 42 Atropin Sulfat Tetes Mata 1% - 5 ml
0 24,992 - 43 Alkohol 70% 1 Liter
0 7,039 - 44 Betadin Salf Antiseptik
4 1,349 5,396 45 Betametason Krim 0,1% - 5 gr
0 5,800 - 46 Bisacodril sup
0 650 - 47 Bisoprolol 2,5mg tab
50 62 3,100 48 Captopril Tablet 12,5 mg
0 72 - Rp133,576 49 Captopril Tablet 25 mg
0 269 - 50 Carbamazefine
0 516 - 51 Cefadroxil 500mg
0 2,849 - 52 Cetrizin syr
0 590 - 53 Cefixim
0 39,900 - 54 Ciprofloxacin Infus
100 255 25,500 55 Ciprofloxacin Tablet 500mg
0 1,000 - 56 D-Artepp Tab
0 1,097 - 57 Deksametasone Injeksi 5 mg/ml - 1ml
100 32 3,200 58 Deksametasone Tablet 0,5 mg
0 6,600 - 59 Dekstromethorfan Sirup 10 mg/ 60 ml
0 11,516 - 60 Diazetpam Rectal 2mg
0 17,350 - 61 Diazepam Injeksi 5 mg/ml - 2ml
0 45 - 62 Diazepam Tablet 2 mg
0 - - 63 Diazepam Tablet 5 mg
0 - - 64 Dietilkarbamazin Sitrat Tablet 100 mg
0 1,176 - 65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml
0 105 - 66 Digoksin Tablet 0,25 mg
0 85 - 67 Domperidon 10 mgtablet
0 - - 68 Dimenhidrinat Tablet 50 mg
0 - - 69 Dasabion Tablet
0 3,333 - 70 Domperidon Suspensi 5mg/ 5ml- 60ml
0 51 - 71 Efedrin HCL Tablet 25 mg
0 31 - 72 Ekstrak Belladona Tablet 10 mg
0 1,408 - 73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml
0 1,800 - 74 Etakridin (RVanol) Lar. 0,1%-300 ml
0 448 - 75 Lisinofril 10 mg
0 375 - 76 Lisinofril 5mg
0 2,500 - 77 Etanol 70%- 100 ml
0 730 - 78 Eritromisin Kapsul 500 mg
0 6,700 - 79 Eritromisin Syrup 200 mg/5 ml-60 ml
0 - - 80 Fenitoin Natrium Injeksi 50 mg/ 1 ml
0 154 - 81 Fenitoin Natrium Kapsul 100 mg
0 - - 82 Fenitoin Natrium Kapsul 30 mg
0 1,740 - 83 Fenobarbital Injeksi- 2ml
0 165 - 84 Fenobarbital Tablet 30 mg
0 - - 85 Fenobarbital Tablet 30 mg
0 - - 86 Fenoksimetil Penisilina Tablet 250 mg
0 57,500 - 87 Fluflenazine decanoat inj 25mg/ml
0 3,550 - 88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml
0 710 - 89 Fitomenadion (Vit. K1) Tab. 10 mg
0 2,600 - 90 Gentamisin SM
0 75 - 91 Furosemida Tablet 40 mg
0 264 - 92 Garam Oralit 200 ml air
0 288 - 93 Glimepirid 2mg Tablet
0 119 - 94 Glibenklamida Tablet 5 mg
160 358 57,280 95 Asetil Sistein 200mg
0 235 - 96 Glikazid 80 mg
0 6,900 - 97 Glukosa Lar. Infus 5% Steril - 500 ml
0 5,700 - 98 Glukosa Lar. Infus 10% Steril - 500 ml
0 2,200 - 99 Griseofulvin Tablet 500 mg,
0 210 - 100 Griseofulvin Tablet 125 mg, Micron
0 2,800 - 101 Gentamisin S.K 0.1%-5 gr
0 3,696 - 102 Gentamisin Tetes Mata
0 126 - 103 Haloperidol 2 mg Tablet
0 96 - 104 Haloperidol 5 mg Tablet
0 149 - Rp85,980 105 Hidroklortiazid (HCT) Tablet 25 mg

0 2,639 - 106 Hidrokortison Krim 2,5%-5 gr
0 105 - 107 Ibuprofen Tablet 200 mg
0 205 - 108 Ibuprofen Tablet 400 mg
0 3,499 - 109 Ibufropen syr
0 9,750 - 110 Haloporidol Decanoate Inj 50mg
100 89 8,900 111 Isosorbid Dinitrat Tab. Sub. 5 mg
0 2,545 - 112 Ketokonazol krem
50 270 13,500 113 Ketokonazol tab 200mg
0 1,045 - 114 Ketorolac Inj 30mg
100 59 5,900 115 Kalsium Laktat (Kalk) Tablet 500 mg
0 10,050 - 116 KN-3B
0 1,007 - 117 Karbihidrat +Elektrolit
0 2,500 - 118 Karbogliserin Tetes telinga
0 3,250 - 119 Kloramfenikol tetes Mata
100 22 2,200 120 Klorfeniramin Maleat (CTM) Tab. 4 mg
0 1,121 - 121 Klozapine 25 Mg
0 - - 122 Klorpromazin HCL Inj. 25 mg/ml- 1ml
0 148 - 123 Klorpromazin HCL Tablet Salut 25 mg
0 147 - 124 Klorpromazin HCL Tablet Salut 100 mg
0 7,750 - 125 klorpeson Slasf
0 - - 126 Komb. Artesunate 50mg+Amodiaquin 200mg
100 125 12,500 127 Kotrimoksazol Tablet 480mg
0 2,052 - 128 Kotrimoksazol Suspensi Kombinasi
0 100 - 129 Metpormin 500mg
0 150 - 130 Methyilprednisolon 8mg
0 1,881 - 131 Kloramfenikol Salep Mata 1%-5gram
0 1,797 - 132 Kloramfenikol Tetes Telinga 3%-5ml
0 6,200 - 133 Kuinin Injeksi 25%-2ml
0 528 - 134 Kloramfenikol Salep kulit 15 grm
0 1,140 - 135 Lidokain Komp. Injeksi, Kombinasi
0 3,360 - 136 Lisol, Kresol Tersabun 50%- 1000ml
50 85 4,250 137 Loperamide Hcl 2mg Tanlet
0 3,328 - 138 Magnesium Sulfat Injk 25 ml
0 473 - 139 Metamizol 500mg
0 210 - 140 Metilergometrin Maleat Tab. 0,125 g
3 2,840 8,520 141 Metilergometrin M inj. 0,200mg- 1ml
0 91 - 142 Metoklorpropamid Tablet 10 mg
0 3,414 - 143 Mikonazol Krim/ Salep 2%-10gram
0 12,100 - 144 MultVitamin Anak
0 1,316 - 145 MultVitamin Dewasa
0 9,950 - 146 Metronidazol Infus 500mg/100ml
0 113 - 147 Metronidazol Tablet 500mg
0 2,345 - 148 Metokloramid Syr
0 3,799 - 149 Metronidazol syr
0 514 - 150 Natrium Bikarbonat Tablet 500mg
0 6,410 - 151 Natrum Klorida Lar. Inf. 0,9% -500ml
0 145 - 152 Natrium Diclopenac 20mg
0 480 - 153 Nistatin Vaginal
0 - - 154 Nistatin Tablet Salut 500.000 IU
0 115 - 155 Natrium Diclopenac 50mg
0 108 - 156 Nifedipine Tab 10mg
100 1,440 144,000 157 MultVitamin Anti Oksidan
0 317,018 - Rp199,770 158 Obat Anti Tuberkulosis Kat. 1 (FDC)

0 1,297,894 - 159 Obat Anti Tuberkulosis Kat. 2
0 214,985 - 160 Obat Anti Tuberkulosis Kat.Anak
0 45,089 - 161 Ofloksasin Tetes telinga
0 16,997 - 162 Omeprazol inj 40mg/10ml
30 130 3,900 163 Omeprazol Kapsul 20mg
0 1,660 - 164 Ondansetron Inj 4mg
0 1,189 - 165 Onadansetron 8mg Tablet
0 471 - 166 Onadansetron 4mg Tablet
50 413 20,650 167 Obat Batuk Flu Dewasa
0 5,000 - 168 Obat Batuk Hitam (OBH) Cairan
2 5,500 11,000 169 Obat Batuk Dewasa syr
0 7,840 - 170 Oksitetrasiklin HCL Inj. i.m 50mg10ml
0 1,920 - 171 Oksitetrasiklin HCL SM 1%-3,5gram
0 1,545 - 172 Oksitetrasiklin HCL Salep 3%- 5gram
4 1,199 4,796 173 Oksitosin Injeksi 10 IU/ml- 1ml
0 6,500 - 174 OBAT Anti Diare suspensi
0 6,649 - 175 parasetamol drops 15 ml
15 1,107 16,605 176 Parasetamol Syrup 120mg/ 5ml-60ml
0 41 - 177 Parasetamol tab 100mg
300 53 15,900 178 Parasetamol Tablet 500mg
0 12,155 - 179 Permetin Krim/Skabisid 5 %
0 9,700 - 180 pirantel syr
0 291 - 181 Pirantel Tablet 125mg
0 234 - 182 piroksikam Tablet 10 mg
0 105 - 183 Piroksikam Tablet 20 mg
0 319 - 184 Propiltiourasil Tablet 100mg
0 123 - 185 Piridoksin HCL (Vit. B6) Tablet 10mg
0 17,996 - 186 Povidon Iodida 10% 300ml
0 - - 187 Povidon Iodida 10% 1000ml
100 68 6,800 188 Prednison Tablet 5mg
0 224 - 189 Primakuin Tablet 15mg
0 6,016 - 190 Prokain Benzil Penisilin 3 Juta IU Inj.
0 60 - 191 propanolol HCL Tablet 10mg
0 121 - 192 Propanolol HCL Tablet 40mg
0 6,550 - 193 Povidon Iodida 10% 60ml
0 284 - 194 Retinol (Vitamin A) Kapsul 100.000 IU
0 505 - 195 Retinol (Vitamin A) Kapsul 200.000 IU
0 30,595 - 196 MDT MB/ Kusta Dewasa
0 9,770 - 197 MDT PB/ Kusta Dewasa
0 347 - 198 Risperidon 2mg
0 1,155 - 199 Ranitidin Injeksi 25 mg/ 2ml
50 105 5,250 200 Ranitidin Tablet 150 mg
2 7,150 14,300 201 Ringer Laktat Lar. Inf. Steril - 500ml
0 63 - 202 Salbutamol Tablet 2mg
0 70 - 203 Salbutamol Tablet 4mg
0 2,621 - 204 Salep 2-4, Kombinasi
0 1,025 - 205 Salisil Bedak 2%
0 479,996 - 206 Serum Anti Bisa Ular PolValen Inj.5ml
0 23,540 - 207 Stimuno
0 170,000 - 208 Serum Anti Tetanus Inj. 1500 IU/amp.
0 368 - 209 Sukrafat 500mg
0 1,035 - Rp99,201 210 Sianokobalamin (Vit. B12) Inj 500mcg

0 205 - 211 Simvastatin Tablet 20 mg
0 110 - 212 Simvastatin Tablet 10 mg
0 8,338 - 213 Sukralfat Syr
0 3,226 - 214 Sulfasetamida Natrium TM 15%- 5ml
0 110 - 215 Sabutamol Nebulizer
0 899 - 216 Spiranolakton tab
0 11,000 - 217 Salf Kombinasi
0 4,500 - 218 Sinbio
0 90 - 219 Setrizin tablet 10 mg
0 352 - 220 Tablet Tambah Darah Komb.
0 - - 221 Tetrakain HCL Tetes Mata 0.5%- 5ml
0 163 - 222 Tetrasiklin HCL Kapsul 250 mg
0 300 - 223 Tetrasiklin HCL Kapsul 500 mg
0 85 - 224 Tiamin HCL/(Vit. B1) Tab. 50mg
0 1,455 - 225 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml
0 88 - 226 Triheksifenidil Hidroklorida Tab. 2mg
0 118 - 227 Vitamin B Komplek Tablet
0 2,972 - 228 Zink Syr
0 514 - 229 Zink Tablet 20mg
0 777 - 1 Alat Suntik Sekali Pakai 1 ml
10 649 6,490 2 Alat Suntik Sekali Pakai 2.5 ml
0 60,622 - 5 Catgut/ Benang Bedah No. 2/0
2 4,783 9,566 6 I.V. Catheter No. 20
0 12,232 - 7 I.V. Catheter No. 22
0 4,784 - 8 I.V. Catheter No. 24
0 13,464 - 9 I.V. Cateter No 26
0 3,498 - 10 Infusion Set Anak
2 4,147 8,294 11 Infusion Set Dewasa
0 6,850 - 12 E.Care Film I.V Dresing
0 44,953 - 13 Silk (Benang Bedah Sutera) No. 3/0
0 72,047 - 14 Policlean Handrub
0 12,250 - 15 Kapas Pembalut/Absorben 250 gram
0 1,800 - 16 Kasa Kompres 40/40
0 9,400 - 17 Kasa Pembalut 2 m x 80 cm
0 127,600 - 18 Kasa Pembalut Hidrofil 36 m x 80 cm
5 7,370 36,850 19 Kasa Steril 16/16
0 549 - 20 Masker
0 8,167 - 21 Plester 5 yard x 2 inch
0 792 - 22 Sarung Tangan No 7 Steril

0 7,931 - 23 Sarung Tangan No 6.5 Steril
0 924 - 24 Sarung tangan no 6 1/2
0 12,036 - 25 Folly cateter No 16
0 16,610 - 26 Folly cateter No 14
0 Sarung tangan Gynecolog no 7

17,748 - 27
0 32,600 - 28 Alkohol Swab
0 4,162 - 29 Underpad
0 7,038 - 30 Urine Bag

0 68,433 - 31 Catgut/ Benang Bedah No. 3/0
0 74,000 - 32 Antiseptik Surgical Hand Scrab
0 22,000 - 33 Cairan pembersih
0 41,600 - 34 Jely kateter
0 2,083 - Rp61,200 35 Jarum Insulin
Rp579,727 TOTAL PENGELUARAN

Yang Menerima Yang Menyerahkan
NS.MASUDIN SANJAYA,S.Kep YUYUN YUNENGSIH, S.Kep

TKS NIP. 19820422 200801 2 006
uskesmas Cikeusik Kepala Puskesmas Cik
OT SA'DIAH,S.ST HJ,IYOT SA'DIAH,S

0804 199103 2 002 NIP.19710804 199103
NTAH KABUPATEN PANDEGLANG PEMERINTAH KAB
PUSKESMAS CIKEUSIK PUSKESM
Cikeusik Kec. Cikeusik Kab. Pandeglang Jln. Alun-alun Cikeusik K
AT BUKTI BARANG KELUAR SURAT BUKTI

/ 32 /SBBK-LPLPO/PKM-CKS/V/2019 Nomor :800/ 33 /SBB
s Tanjungan Telah diserahkan Kepada : Leuwibalang

SATUAN JUMLAH HARGA TOTAL NO
Tab 0 99 - 1
Tab 0 91 - 2
Tab 0 404 - 3
Amp 0 3,245 - 4
Tab 0 167 - 5
Tab 50 93 4,650 6
Tab 50 70 3,500 7
Btl 0 2,702,700 - 8
Tab 300 233 69,900 9
Btl 0 1,881 - 10
Pack 0 801,000 - 11
Tab 5 3,400 17,000 12
Vial 0 3,850 - 13
Tab 0 205 - 14
Tab 200 54 10,800 15
Btl 10 1,923 19,230 16
Tube 0 3,035 - 17
Supp 0 3,167 - 18
Pot 0 3,035 - 19
Tab 0 135 - 20
Tab 0 1,500 - 21
Btl 0 2,860 - 22
Tube 0 8,800 - 23
Tab 0 237 - 24
Tab 0 380 - 25
Tab 0 450 - 26
Tab 0 305 - 27
Tab 0 130 - 28
Tab 0 103 - 29
Tab 0 233 - 30
tab 0 169 - 31
Btl 0 9,883 - 32
Tab 0 105 - 33
Tab 0 9,646 - 34
Tab 0 63 - 35
Tab 0 55 - 36
Vial 0 14,250 - 37
Amp 0 24,449 - 38
Tab 0 - - 39
Amp 0 1,595 - 40
Tab 0 74 - 41
Btl 0 - - 42
Btl 0 24,992 - 43
Tube 0 7,039 - 44
Tube 4 1,349 5,396 45
Supp 0 5,800 - 46
Tab 0 650 - 47
Tab 50 62 3,100 48
Tab 0 72 - Rp133,576 49
Tab 0 269 - 50
Tab 0 516 - 51
Btl 0 2,849 - 52
Tab 0 590 - 53
Btl 0 39,900 - 54
Tab 100 255 25,500 55
Tab 0 1,000 - 56
Amp 0 1,097 - 57
Tab 100 32 3,200 58
Btl 0 6,600 - 59
Tube 0 11,516 - 60
Amp 0 17,350 - 61
Tab 0 45 - 62
Tab 0 - - 63
Tab 0 - - 64
Amp 0 1,176 - 65
Tab 0 105 - 66
Tab 0 85 - 67
Tab 0 - - 68
Tab 0 - - 69
Btl 0 3,333 - 70
Tab 0 51 - 71
Tab 0 31 - 72
Amp 0 1,408 - 73
Btl 0 1,800 - 74
Tab 0 448 - 75
Tab 0 375 - 76
Btl 0 2,500 - 77
Kap 0 730 - 78
Btl 0 6,700 - 79
Amp 0 - - 80
Kap 0 154 - 81
Kap 0 - - 82
Amp 0 1,740 - 83
Tab 0 165 - 84
Tab 0 - - 85
Tab 0 - - 86
Amp 0 57,500 - 87
Amp 0 3,550 - 88
Tab 0 710 - 89
Tube 0 2,600 - 90
Tab 0 75 - 91
Ktg 0 264 - 92
Tab 0 288 - 93
Tab 0 119 - 94
Tab 160 358 57,280 95
Btl 0 235 - 96
Btl 0 6,900 - 97
Btl 0 5,700 - 98
Tab 0 2,200 - 99
Tab 0 210 - 100
Tube 0 2,800 - 101
Vial 0 3,696 - 102
Tab 0 126 - 103
Tab 0 96 - 104
Tab 0 149 - Rp85,980 105

Tab 0 2,639 - 106
Tab 0 105 - 107
Tab 0 205 - 108
Btl 0 3,499 - 109
Amp 0 9,750 - 110
Tab 100 89 8,900 111
Tube 0 2,545 - 112
Tab 50 270 13,500 113
Vial 0 1,045 - 114
Tab 100 59 5,900 115
Labu 0 10,050 - 116
Labu 0 1,007 - 117
Btl 0 2,500 - 118
Btl 0 3,250 - 119
Tab 100 22 2,200 120
Tab 0 1,121 - 121
Amp 0 - - 122
Tab 0 148 - 123
Tab 0 147 - 124
tube 0 7,750 - 125
Pkt 0 - - 126
Tab 100 125 12,500 127
Btl 0 2,052 - 128
Tab 0 100 - 129
Tab 0 150 - 130
Tube 0 1,881 - 131
Btl 0 1,797 - 132
Amp 0 6,200 - 133
Tube 0 528 - 134
Amp 0 1,140 - 135
Btl 0 3,360 - 136
Tab 50 85 4,250 137
Vial 0 3,328 - 138
Tab 0 473 - 139
Tab 0 210 - 140
Amp 3 2,840 8,520 141
Tab 0 91 - 142
Tube 0 3,414 - 143
Btl 0 12,100 - 144
Tab 0 1,316 - 145
Btl 0 9,950 - 146
Tab 0 113 - 147
Btl 0 2,345 - 148
Btl 0 3,799 - 149
Tab 0 514 - 150
Btl 0 6,410 - 151
Amp 0 145 - 152
sup 0 480 - 153
tab 0 - - 154
Tab 0 115 - 155
Tab 0 108 - 156
Tab 100 1,440 144,000 157
Pkt 0 317,018 - Rp199,770 158

Pkt 0 1,297,894 - 159
Pkt 0 214,985 - 160
Btl 0 45,089 - 161
Btl 0 16,997 - 162
Kap 30 130 3,900 163
Vial 0 1,660 - 164
Tab 0 1,189 - 165
Tab 0 471 - 166
Pkt 50 413 20,650 167
Btl 0 5,000 - 168
Btl 2 5,500 11,000 169
Vial 0 7,840 - 170
Tube 0 1,920 - 171
Tube 0 1,545 - 172
Amp 4 1,199 4,796 173
Btl 0 6,500 - 174
btl 0 6,649 - 175
Btl 15 1,107 16,605 176
Tab 0 41 - 177
Tab 300 53 15,900 178
Tube 0 12,155 - 179
Btl 0 9,700 - 180
Tab 0 291 - 181
Tab 0 234 - 182
Tab 0 105 - 183
Tab 0 319 - 184
Tab 0 123 - 185
Btl 0 17,996 - 186
Btl 0 - - 187
Tab 100 68 6,800 188
Tab 0 224 - 189
Vial 0 6,016 - 190
Tab 0 60 - 191
Tab 0 121 - 192
Botol 0 6,550 - 193
Kap 0 284 - 194
Kap 0 505 - 195
Blister 0 30,595 - 196
Blister 0 9,770 - 197
Tab 0 347 - 198
Vial 0 1,155 - 199
Tab 50 105 5,250 200
Btl 2 7,150 14,300 201
Tab 0 63 - 202
Tab 0 70 - 203
Pot 0 2,621 - 204
Ktk 0 1,025 - 205
Vial 0 479,996 - 206
Botol 0 23,540 - 207
Amp 0 170,000 - 208
Tab 0 368 - 209
Amp 0 1,035 - Rp99,201 210

Tab 0 205 - 211
Tab 0 110 - 212
Botol 0 8,338 - 213
Btl 0 3,226 - 214
Amp 0 110 - 215
tab 0 899 - 216
Tube 0 11,000 - 217
Set 0 4,500 - 218
Tab 0 90 - 219
Tab 0 352 - 220
Btl 0 - - 221
Kap 0 163 - 222
Kap 0 300 - 223
Tab 0 85 - 224
Tab 0 1,455 - 225
Tab 0 88 - 226
Tab 0 118 - 227
Botol 0 2,972 - 228
Tab 0 514 - 229
Set 0 777 - 1
Set 10 649 6,490 2
Set 0 825 - 3
Set 0 856 - 4
Set 0 60,622 - 5
Set 2 4,783 9,566 6
Set 0 12,232 - 7
Set 0 4,784 - 8
set 0 13,464 - 9
Set 0 3,498 - 10
Set 2 4,147 8,294 11
Pcs 0 6,850 - 12
Biji 0 44,953 - 13
Botol 0 72,047 - 14
Set 0 12,250 - 15
lembar 0 1,800 - 16
pak 0 9,400 - 17
rol 0 127,600 - 18
kotak 5 7,370 36,850 19
biji 0 549 - 20
rol 0 8,167 - 21
pasang 0 792 - 22
pasang 0 7,931 - 23
Pasng 0 924 - 24
Pcs 0 12,036 - 25
Pcs 0 16,610 - 26
Sashet 0 17,748 - 27
bok 0 32,600 - 28
Lembar 0 4,162 - 29
Biji 0 7,038 - 30
Botol 0 68,433 - 31
Botol 0 74,000 - 32
Botol 0 22,000 - 33
biji 0 41,600 - 34
Biji 0 2,083 - Rp61,200 35
Rp579,727 TOTAL PENGELUARAN

Yang Menerima
N.SITI ROHMAH
NR.TKK
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 33 /SBBK-LPLPO/PKM-CKS/V/2019

Alopurinol tablet 100 mg Tab 0 99 -
Aminofilin tablet 200 mg Tab 0 91 -
Albendazol Tab 0 404 -
Aminofilin injeksi 24mg/ml-10ml Amp 0 3,245 -
Amlodipine Besilate 5mg tablet Tab 50 70 3,500

Acyclopir Krim 5%- 5gr Tube 0 8,800 -
Acyclopir Tablet 200mg Tab 0 237 -
Asam Mefenamat 500mg Tab 0 103 -
Asam traneksamat Inj 5 % Amp 0 24,449 -
Captopril Tablet 25 mg Tab 0 72 - Rp133,576
Cefixim Tab 0 590 -
Etakridin (RVanol) Lar. 0,1%-300 ml Btl 0 1,800 -
Etanol 70%- 100 ml Btl 0 2,500 -
Gentamisin Tetes Mata Vial 0 3,696 -

Hidrokortison Krim 2,5%-5 gr Tab 0 2,639 -
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 100 89 8,900
KN-3B Labu 0 10,050 -
Kotrimoksazol Tablet 480mg Tab 100 125 12,500
Kloramfenikol Salep kulit 15 grm Tube 0 528 -
Loperamide Hcl 2mg Tanlet Tab 50 85 4,250
Metamizol 500mg Tab 0 473 -
Metilergometrin Maleat Tab. 0,125 g Tab 0 210 -
Mikonazol Krim/ Salep 2%-10gram Tube 0 3,414 -
MultVitamin Anak Btl 0 12,100 -
MultVitamin Dewasa Tab 0 1,316 -
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 6,410 -
MultVitamin Anti Oksidan Tab 100 1,440 144,000

Obat Batuk Dewasa syr Btl 2 5,500 11,000
Ranitidin Tablet 150 mg Tab 50 105 5,250
Ringer Laktat Lar. Inf. Steril - 500ml Btl 2 7,150 14,300
Salbutamol Tablet 2mg Tab 0 63 -
Salbutamol Tablet 4mg Tab 0 70 -
Serum Anti Bisa Ular PolValen Inj.5ml Vial 0 479,996 -
Stimuno Botol 0 23,540 -

Tiamin HCL/(Vit. B1) Tab. 50mg Tab 0 85 -
Vitamin B Komplek Tablet Tab 0 118 -
Alat Suntik Sekali Pakai 2.5 ml Set 10 649 6,490
Infusion Set Anak Set 0 3,498 -
Policlean Handrub Botol 0 72,047 -
Kasa Steril 16/16 kotak 5 7,370 36,850
Masker biji 0 549 -
Underpad Lembar 3 4,162 12,486

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP.19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 37 /SBBK-LPLPO/PKM-CKS/VI /2019
Telah diserahkan Kepada : PENGELOLA PROGRAM GIZI

Keperluan Bulan : juni 2019
I OBAT-- OBATAN

JUMLAH Rp 4,576,000
Cikeusik, 29 juni 2019
NIP.19820422 2008 01 2 006 TKS

PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : PENGELOLA LABORATORIUM

I BMHP
1 Alkohol swab box 3 32,600

II Reagn (Program) 0
1 Rafid HbsAg TES 0 9,850
2 Vaksin Hblg Vial 0 1,325,000

JUMLAH
Cikeusik, 29 juni 2019

NIP.19820422 200801 2006
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : PENGELOLA KECACINGAN

TOTAL NO JENIS BARANG SATUAN JUMLAH HARGA
I OBAT-OBATAN
97,800 3 Albendazol Tab 404

JUMLAH
- Cikeusik, 20 juni 2019
#REF! Yang Menyerahkan Yang Menerima
29 juni 2019 YUYUN YUNENGSIH,Amd Kep ELAH NURHAYATI,Amd Keb
g Menerima
RHAYATI,Amd Keb
TOTAL
Rp -
k, 20 juni 2019
ng Menerima
URHAYATI,Amd Keb
PUSKESMAS CIKEUSIK

Nomor : 800/106/SBBK-LPLPO/PKM-CKS/VIII/2015 MENU

Keperluan Bulan : Agustus 2015
4 Aminofilin injeksi 24mg/ml-10ml Amp 0 3240 0
8 Amoksisillin Kapsul 250 mg Kap 0 238 `
9 Amoksisillin Kapsul 500 mg Kap 1000 261 261000
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 2445 0
11 Am oxsillin aserbuk 1gr Inj Amp 20 7396 147920
12 Amoksilin sk Forte Botol 50 4045 202250
13 Ampisillin Injeksi 1 gram Vial 0 3850 0

16 Antasida DOEN suspensi Botol 18 2140 38520
17 Anti Bakteri DOEN Salep Kombinasi Tube 0 2516 0
18 Anti Hemoroid DOEN Kombinasi Supp 0 3045 0

19 Antifungi DOEN Kombinasi Pot 0 155 0
21 Antiparkinson DOEN tab. Kombinasi Tab 0 1500 0
22 Aqua roinjek Steril Botol 0 2200 0
23 Acyclopir Krim 5%- 5gr Tube 20 5049 100980
26 Akita Tablet Tab 0 418 0

27 Antalgin (Metampiron) Inj. 250mg/2ml Amp 0 109 0

30 Asmacare Tablet 2mg Tab 0 0 0
31 Artemeter Injeksi 80 mg/ml Amp 0 85 0
32 Artesunate Injeksi 60 mg/ml Vial 0 2700 0

37 Asetosal Tablet 80 mg Tab 0 800 0

40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1300 0
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 0 0
43 Atenolol Tablet 50 mg Tab 0 0 0
44 Benzatin Benzil Penisilin Inj. 2,4 Juta Vial 0 0 0
45 Betametason Krim 0,1% - 5 gr Tube 0 1520 0
46 Bisacodril sup Botol 10 5045 50450

47 Bisoprolol 5mg tab Tab 90 645 58050


50 Chloramfecort- H Cream - 10gr Tube 0 0 0
53 Cefadroxil syr Btl 0 5895 0
54 Ciprofloxacin Infus Labu 0 39900 0
56 Dapson Tablet 100 mg (Antilepra) Tab 0 2484 0
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1580 0
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6600 0
60 Dekstromethorfan Tablet 15 mg Tab 0 4000 0
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0 4180 0

64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 960 0
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 20 52 1040
68 Dimenhidrinat Tablet 50 mg Tab 0 8799 0
69 Dasabion Tablet Tab 0 0 0
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3333 0

73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1200 0
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 9 24 216
75 Etambutol HCL Tablet 250 mg Tab 0 0 0
77 Etanol 70%- 1000 ml Btl 0 1500 0

79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 1125 0
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 9900 0
83 Fenobarbital Injeksi 50 mg/ml- 2ml Amp 0 0 0

86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 0 0
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3417 0
90 Flour Tablet 0,5 mg Tab 0 895 0

95 Gliseril Guaiakolat Tablet 100 mg Tab 500 56 28000
96 Gliserin - 100 ml Btl 0 0 0
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 5200 0

101 Gentamisin S.K 0.1%-5 gr Tube 0 4113 0
102 Gentamisin Injeksi Amp 0 3696 0
103 Haloperidol 0,5 mg Tablet Tab 0 96 0

106 Hidrokortison Krim 2,5%-5 gr Tab 11 2798 30778
107 Ibuprofen Tablet 200 mg Tab 0 110 0
109 Isoniazid Tablet 100 mg Tab 0 88 0
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 2570 0
112 Ketokonazol krom Tube 20 2569 51380
113 Ketokonazol tab 200mg Tab 150 300 45000
114 Ketorolac Inj 30mg Amp 0 2300 0
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 47 0
116 Ketamin 10 mg/ml Injeksi- 10 ml Vial 0 5200 0
117 Klofazimin, mikronize Kapsul 100 mg Kap 0 97 0
118 Kloramfenikol Kapsul 250 mg Kap 0 733 0
119 Kloramfenikol Suspensi 125 mg/60 ml Btl 0 3800 0
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 500 0 0
121 Klorokuin Tablet 150 mg Tab 0 0 0
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 5744 0
123 Klorpromazin HCL Tablet Salut 25 mg Tab 200 0 0
125 Kodein HCL Tablet 10 mg Tab 0 250 0

126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 0 0
127 Kotrimoksazol Tablet 480mg Tab 0 700 0

128 Kotrimoksazol Suspensi Kombinasi Btl 70 2145 150150
129 Kotrimoksazol Tab. Kombinasi Tab 0 138 0
130 Kuinin (Kina) Tablet 200 mg Tab 0 7700 0

131 Kloramfenikol Salep Mata 1%-5gram Tube 20 1450 29000
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1797 0
133 Kuinin Injeksi 25%-2ml Amp 0 4750 0
134 Levoploxasin 500mh Dus 100 528 52800
135 Lidokain Komp. Injeksi, Kombinasi Amp 15 1295 19425
136 Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3360 0
137 Loperamide Hcl 2mg Tanlet Ktg 0 89
138 Mebendazol Syrup/5ml - 30ml Btl 0 4100
139 Mebendazol Tablet 100mg Tab 0 0

141 Metilergometrin M inj. 0,200mg- 1ml Amp 0 2750
143 Mikonazol Krim/ Salep 2%-10gram Tube 9 3000
144 Multivitamin Anak Btl 35 11500
145 Multivitamin Dewasa Tab 200 640
146 Metronidazol Infus 500mg/100ml Labu 0 9950
148 Magnesium Sulfat Inj. 25 ml Amp 0 0
149 Minyak kayu putih Btl 0 8000
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 11 4700

153 Nistatin Tablet Salut 500.000 IU Tab 0 0
155 Nisagon Cream 5 gram Tube 0 0
156 Novadryl Syrup/ Holydril Syrup-60ml Btl 0 0
157 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 359619

158 Obat Anti Tuberkulosis Kat. 2 Pkt 0 1199990

160 OAT Sisipan Dewasa Pkt 0 0
161 Omeprazol inj 40mg/10ml Amp 0 36000
163 Ondansetron Inj 4mg Amp 0 2400
166 OAT Kategori Anak Pkt 0 0
167 Obat Batuk Hitam (OBH) Cairan Btl 0 5663
168 Obat Batuk Dewasa Btl 5 5500
169 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 0
170 Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1750
171 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1450
172 Oksitosin Injeksi 10 IU/ml- 1ml Amp 0 2200
173 OBAT Anti Diare suspensi Btl 0 7150
174 Paraformaldehid Tablet 1gram Tab 0 0
175 Parasetamol Syrup 120mg/ 5ml-60ml Btl 100 1438
178 Petidin HCL Injeksi 50mg/ ml-2ml Amp 0 0
179 Pilokarpin HCI/Nitrat TM 2%- 5ml Btl 0 0
185 Povidon Iodida 10% 300ml Btl 0 14203
189 Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 0
192 Reserpin Tablet 0,25mg Tab 0 0
195 Rifampisin Kapsul 300mg Kap 0 0
198 Ranitidin Injeksi 25 mg/ 2ml Amp 0 1140
200 Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 5200
203 Salep 2-4, Kombinasi Pot 23 1229
204 Salisil Bedak 2% Ktk 0 1250
205 Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 591250
206 Serum Anti Rabies Vial 0 0
207 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 158125
208 Serum Anti Tetanus Inj. 20.000 IU/vial Vial 0 0
209 Sianokobalamin (Vit. B12) Inj 500mcg Amp 20 1078

212 Streptomisin Sulfat Serbuk Inj.1000mg Vial 0 0
213 Sulfasetamida Natrium TM 15%- 5ml Btl 0 3226
214 Sanadril syr Btl 0 5500
215 Sanbe ters 0 0
216 Sanvita B syr Btl 0 0
217 Sinbio Set 0 4500
218 Seftriakson inj. 1g Amp 0 0
220 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 1705
224 Tiopental Natrium Serbuk Inj 1.000mg Amp 0 0
225 TiaminTabbblet 50 mg Tab 0 6402
226 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Amp 0 1615
229 Zink Tlet 20mg ab Tab 200 474

233 Catgut/ Benang Bedah No. 2/0 - 3/0 Set 19 22500
234 I.V. Catheter No. 20 Set 10 7700
237 Infusion Set Anak Set 30 7920
238 Infusion Set Dewasa Set 15 7920
239 Implant Set 0 0
240 Jarum Jahit (Bedah) No. 9 s/d 14 set 0 0
241 Jarum Suntik (Neddle) set 0 1250
242 Kapas Pembalut/Absorben 250 gram Set 0 24000
243 Kasa Kompres 40/40 Steril biji 0 1200
244 Kasa Pembalut 2 m x 80 cm biji 20 9400
245 Kasa Pembalut Hidrofil 4 m x 15 cm rol 0 7900
246 Kasa Steril 16/16 biji 30 7900
248 Plester 5 yard x 2 inch biji 3 13000
249 Sarung Tangan n0 7 pasang 50 396
250 Silk (Benang Bedah Sutera) No. 3/0 Set 0
Cikeusik, Agustus 2015

YUYUN YUNENGSIH, S.Kep PAIZ ARDABILI,Amd.Far

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 002/SBBK-LPLPO/PKM-CKS/I/2015









49 Captopril Tablet 25 mg Tab 0 84 0 Rp0

61 0 Amp 0 4180 0


77 Etanol 70%- 1000 ml Btl 0 1500 0




105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp0









215 Sanbe ters 0 0

239 Implant Set 0 0
TOTAL PENGELUARAN Rp0
Cikeusik, Januari 2015

YUYUN YUNENGSIH, S.Kep AAN HASANAH, AMK

NIP. 19820422 200801 2 006 NIP.19670504 198803 2 009
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0

YUYUN YUNENGSIH, S.Kep SITI ASIAH, Amd. Keb.

NIP. 19820422 200801 2 006 NRPTT.29 4 04810957
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0

YUYUN YUNENGSIH, S.Kep DEWI NURHAYATI, AMK

NIP. 19820422 200801 2 006 NIP.19800216 200701 1 005
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK


1 Alopurinol tablet 100 mg Tab 0 86 0 1
2 Aminofilin tablet 200 mg Tab 0 80 0 2
3 Albendazol Tab 0 406 0 3
4 Aminofilin injeksi 24mg/ml-10ml Amp 0 3240 0 4
5 Amitriptilin HCL Tab. Salut 25 mg Tab 0 112 0 5
6 Amlodipine 10 mg Tablet Tab 0 330 0 6
7 Amlodipine Besilate 5mg tablet Tab 0 187 0 7
8 Amoksisillin Kapsul 250 mg Kap 0 238 0 8
10 Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 2445 0 10
11 Am oxsillin aserbuk 1gr Inj Amp 0 7396 0 11
12 Amoksilin sk Forte Botol 0 4045 0 12
13 Ampisillin Injeksi 1 gram Vial 0 3850 0 13
14 Antalgin (Metampiron) Tab. 500 mg Tab 0 0 0 14

15 Antasida DOEN tablet Tab 0 72 0 15
16 Antasida DOEN suspensi Botol 0 2140 0 16
17 Anti Bakteri DOEN Salep Kombinasi Tube 0 2516 0 17
18 Anti Hemoroid DOEN Kombinasi Supp 0 3045 0 18

19 Antifungi DOEN Kombinasi Pot 0 155 0 19
20 Antimigren DOEN Kombinasi Tab 0 135 0 20
21 Antiparkinson DOEN tab. Kombinasi Tab 0 1500 0 21
22 Aqua roinjek Steril Botol 0 2200 0 22
23 Acyclopir Krim 5%- 5gr Tube 0 5049 0 23
24 Acyclopir Tablet 200mg Tab 0 237 0 24
25 Acyclopir Tablet 400 mg Tab 0 336 0 25
26 Akita Tablet Tab 0 418 0 26

27 Antalgin (Metampiron) Inj. 250mg/2ml Amp 0 109 0 27
28 Asam Mefenamat 250mg Tab 0 0 0 28

30 Asmacare Tablet 2mg Tab 0 0 0 30
31 Artemeter Injeksi 80 mg/ml Amp 0 85 0 31
32 Artesunate Injeksi 60 mg/ml Vial 0 2700 0 32

33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 0 0 33
35 Asam Folat tablet 1 mg Tab 0 0 0 35
37 Asetosal Tablet 80 mg Tab 0 800 0 37

40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1300 0 40
41 Atropin Sulfat Tablet 0,5 mg Tab 0 74 0 41
42 Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 0 0 42
43 Atenolol Tablet 50 mg Tab 0 0 0 43
44 Benzatin Benzil Penisilin Inj. 2,4 Juta Vial 0 0 0 44
45 Betametason Krim 0,1% - 5 gr Tube 0 1520 0 45
46 Bisacodril sup Botol 0 5045 0 46

47 Bisoprolol 5mg tab Tab 0 645 0 47
48 Captopril Tablet 12,5 mg Tab 0 62 0 48

49 Captopril Tablet 25 mg Tab 0 84 0 Rp0 49

50 Chloramfecort- H Cream - 10gr Tube 0 0 0 50
51 Cefadroxil 500mg Tab 0 509 0 51
53 Cefadroxil syr Btl 0 5895 0 53
54 Ciprofloxacin Infus Labu 0 39900 0 54
55 Ciprofloxacin Tablet 500mg Tab 0 255 0 55
56 Dapson Tablet 100 mg (Antilepra) Tab 0 2484 0 56
57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1580 0 57
58 Deksametasone Tablet 0,5 mg Tab 0 62 0 58
59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6600 0 59
60 Dekstromethorfan Tablet 15 mg Tab 0 4000 0 60
61 Diazepam Injeksi 5 mg/ml - 2ml Amp 0 4180 0 61
62 Diazepam Tablet 2 mg Tab 0 45 0 62

64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 960 0 64
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 52 0 65
66 Digoksin Tablet 0,25 mg Tab 0 129 0 66
67 Domperidon 10 mgtablet Tab 0 167 0 67
68 Dimenhidrinat Tablet 50 mg Tab 0 8799 0 68
69 Dasabion Tablet Tab 0 0 0 69
70 Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3333 0 70

71 Efedrin HCL Tablet 25 mg Tab 0 8100 0 71
72 Ekstrak Belladona Tablet 10 mg Tab 0 31 0 72
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1200 0 73
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 24 0 74
75 Etambutol HCL Tablet 250 mg Tab 0 0 0 75
77 Etanol 70%- 1000 ml Btl 0 1500 0 77

78 Eritromisin Kapsul 250 mg Kap 0 930 0 78
79 Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 1125 0 79
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 9900 0 80
81 Fenitoin Natrium Kapsul 100 mg Kap 0 133 0 81
83 Fenobarbital Injeksi 50 mg/ml- 2ml Amp 0 0 0 83

84 Fenobarbital Tablet 100 mg Tab 0 130 0 84
86 Fenoksimetil Penisilina Tablet 250 mg Tab 0 0 0 86
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3417 0 88
89 Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 579 0 89
90 Flour Tablet 0,5 mg Tab 0 895 0 90
91 Furosemida Tablet 40 mg Tab 0 75 0 91
92 Garam Oralit 200 ml air Ktg 0 380 0 92

93 Glimepirid 4mg Tablet Tab 0 430 0 93
94 Glibenklamida Tablet 5 mg Tab 0 56 0 94
95 Gliseril Guaiakolat Tablet 100 mg Tab 0 56 0 95
96 Gliserin - 100 ml Btl 0 0 0 96
97 Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 5200 0 97
100 Griseofulvin Tablet 125 mg, Micron Tab 0 219 0 100

101 Gentamisin S.K 0.1%-5 gr Tube 0 4113 0 101
102 Gentamisin Injeksi Amp 0 3696 0 102
103 Haloperidol 0,5 mg Tablet Tab 0 96 0 103
105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp0 105

106 Hidrokortison Krim 2,5%-5 gr Tab 0 2798 0 106
107 Ibuprofen Tablet 200 mg Tab 0 110 0 107
109 Isoniazid Tablet 100 mg Tab 0 88 0 109
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 2570 0 111
112 Ketokonazol krom Tube 0 2569 0 112
113 Ketokonazol tab 200mg Tab 0 300 0 113
114 Ketorolac Inj 30mg Amp 0 2300 0 114
115 Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 47 0 115
116 Ketamin 10 mg/ml Injeksi- 10 ml Vial 0 5200 0 116
117 Klofazimin, mikronize Kapsul 100 mg Kap 0 97 0 117
118 Kloramfenikol Kapsul 250 mg Kap 0 733 0 118
119 Kloramfenikol Suspensi 125 mg/60 ml Btl 0 3800 0 119
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 0 0 0 120
121 Klorokuin Tablet 150 mg Tab 0 0 0 121
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 5744 0 122
123 Klorpromazin HCL Tablet Salut 25 mg Tab 0 0 0 123
125 Kodein HCL Tablet 10 mg Tab 0 250 0 125

126 Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 0 0 126
127 Kotrimoksazol Tablet 480mg Tab 0 700 0 127

128 Kotrimoksazol Suspensi Kombinasi Btl 0 2145 0 128
129 Kotrimoksazol Tab. Kombinasi Tab 0 138 0 129
130 Kuinin (Kina) Tablet 200 mg Tab 0 7700 0 130

131 Kloramfenikol Salep Mata 1%-5gram Tube 0 1450 0 131
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1797 0 132
133 Kuinin Injeksi 25%-2ml Amp 0 4750 0 133
134 Levoploxasin 500mh Dus 0 528 0 134
135 Lidokain Komp. Injeksi, Kombinasi Amp 0 1295 0 135
136 Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3360 0 136
137 Loperamide Hcl 2mg Tanlet Ktg 0 89 137
138 Mebendazol Syrup/5ml - 30ml Btl 0 4100 138
139 Mebendazol Tablet 100mg Tab 0 0 139

140 Metilergometrin Maleat Tab. 0,125 g Tab 0 154 140
141 Metilergometrin M inj. 0,200mg- 1ml Amp 0 2750 141
142 Metoklorpropamid Tablet 10 mg Tab 0 91 142
143 Mikonazol Krim/ Salep 2%-10gram Tube 0 3000 143
144 Multivitamin Anak Btl 0 11500 144
145 Multivitamin Dewasa Tab 0 640 145
146 Metronidazol Infus 500mg/100ml Labu 0 9950 146
147 Metronidazol Tablet 500mg Tab 0 160 147
148 Magnesium Sulfat Inj. 25 ml Amp 0 0 148
149 Minyak kayu putih Btl 0 8000 149
150 Natrium Bikarbonat Tablet 500mg Tab 0 0 150
151 Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 4700 151
152 Natrium Diclopenac 20mg Amp 0 133 152
153 Nistatin Tablet Salut 500.000 IU Tab 0 0 153
154 Natrium Diclopenac 50mg Tab 0 176 154
155 Nisagon Cream 5 gram Tube 0 0 155
156 Novadryl Syrup/ Holydril Syrup-60ml Btl 0 0 156
157 Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 359619 157

158 Obat Anti Tuberkulosis Kat. 2 Pkt 0 1199990 158

160 OAT Sisipan Dewasa Pkt 0 0 160
161 Omeprazol inj 40mg/10ml Amp 0 36000 161
162 Omeprazol Kapsul 20mg Kap 0 211 162
163 Ondansetron Inj 4mg Amp 0 2400 163
164 Onadansetron 8mg Tablet Tab 0 1189 164
166 OAT Kategori Anak Pkt 0 0 166
167 Obat Batuk Hitam (OBH) Cairan Btl 0 5663 167
168 Obat Batuk Dewasa Btl 0 5500 168
169 Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 0 169
170 Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1750 170
171 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1450 171
172 Oksitosin Injeksi 10 IU/ml- 1ml Amp 0 2200 172
173 OBAT Anti Diare suspensi Btl 0 7150 173
174 Paraformaldehid Tablet 1gram Tab 0 0 174
175 Parasetamol Syrup 120mg/ 5ml-60ml Btl 0 1438 175
176 Parasetamol Tablet 100mg Tab 0 5200 176
178 Petidin HCL Injeksi 50mg/ ml-2ml Amp 0 0 178
179 Pilokarpin HCI/Nitrat TM 2%- 5ml Btl 0 0 179
180 Pirantel Tablet 125mg Tab 0 296 180
181 piroksikam Tablet 10 mg Tab 0 138 181
182 Piroksikam Tablet 20 mg Tab 0 0 182
183 Propiltiourasil Tablet 100mg Tab 0 319 183
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 110 184
185 Povidon Iodida 10% 300ml Btl 0 14203 185
187 Prednison Tablet 5mg Tab 0 114 187
188 Primakuin Tablet 15mg Tab 0 0 188
189 Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 0 189
190 propanolol HCL Tablet 10mg Tab 0 77 190
191 Propanolol HCL Tablet 40mg Tab 0 121 191
192 Reserpin Tablet 0,25mg Tab 0 0 192
193 Retinol (Vitamin A) Kapsul 100.000 IU Kap 0 260 193
195 Rifampisin Kapsul 300mg Kap 0 0 195
198 Ranitidin Injeksi 25 mg/ 2ml Amp 0 1140 198
199 Ranitidin Tablet 150 mg Tab 0 120 199
200 Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 5200 200
201 Salbutamol Tablet 2mg Tab 0 59 201
203 Salep 2-4, Kombinasi Pot 0 1229 203
204 Salisil Bedak 2% Ktk 0 1250 204
205 Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 591250 205
206 Serum Anti Rabies Vial 0 0 206
207 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 158125 207
208 Serum Anti Tetanus Inj. 20.000 IU/vial Vial 0 0 208
209 Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1078 209
210 Simvastatin Tablet 20 mg Tab 0 391 210

212 Streptomisin Sulfat Serbuk Inj.1000mg Vial 0 0 212
213 Sulfasetamida Natrium TM 15%- 5ml Btl 0 3226 213
214 Sanadril syr Btl 0 5500 214
215 Sanbe ters 0 0 215
216 Sanvita B syr Btl 0 0 216
217 Sinbio Set 0 4500 217
218 Seftriakson inj. 1g Amp 0 0 218
219 Tablet Tambah Darah Komb. Tab 0 1260 219
220 Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 1705 220
221 Tetrasiklin HCL Kapsul 250 mg Kap 0 148 221
223 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 0 55 223
224 Tiopental Natrium Serbuk Inj 1.000mg Amp 0 0 224
225 TiaminTabbblet 50 mg Tab 0 6402 225
226 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Amp 0 1615 226
227 Triheksifenidil Hidroklorida Tab. 2mg Tab 0 0 227
228 Vitamin B Komplek Tablet Tab 0 107 228
229 Zink Tlet 20mg ab Tab 0 474 229
230 Alat Suntik Sekali Pakai 1 ml Set 0 748 230

233 Catgut/ Benang Bedah No. 2/0 - 3/0 Set 0 22500 233
234 I.V. Catheter No. 20 Set 0 7700 234
237 Infusion Set Anak Set 0 7920 237
238 Infusion Set Dewasa Set 0 7920 238
239 Implant Set 0 0 239
240 Jarum Jahit (Bedah) No. 9 s/d 14 set 0 0 240
241 Jarum Suntik (Neddle) set 0 1250 241
242 Kapas Pembalut/Absorben 250 gram Set 0 24000 242
243 Kasa Kompres 40/40 Steril biji 0 1200 243
244 Kasa Pembalut 2 m x 80 cm biji 0 9400 244
245 Kasa Pembalut Hidrofil 4 m x 15 cm rol 0 7900 245
246 Kasa Steril 16/16 biji 0 7900 246
247 Masker biji 0 439 247
248 Plester 5 yard x 2 inch biji 0 13000 248
249 Sarung Tangan n0 7 pasang 0 396 249
250 Silk (Benang Bedah Sutera) No. 3/0 Set 0 250
TOTAL PENGELUARAN Rp0 TO

YUYUN YUNENGSIH, S.Kep ELA FADILAH JUITASARI, AMK

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Telah diserahkan Kepada : Poskesdes Tanjungan Telah diserahkan Kepad

Keperluan Bulan : Januari 2015 Keperluan Bulan : Janu
Alopurinol tablet 100 mg Tab 0 86 0 1
Aminofilin tablet 200 mg Tab 0 80 0 2
Albendazol Tab 0 406 0 3
Aminofilin injeksi 24mg/ml-10ml Amp 0 3240 0 4
Amitriptilin HCL Tab. Salut 25 mg Tab 0 112 0 5
Amlodipine 10 mg Tablet Tab 0 330 0 6
Amlodipine Besilate 5mg tablet Tab 0 187 0 7
Amoksisillin Kapsul 250 mg Kap 0 238 0 8
Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 2445 0 10
Am oxsillin aserbuk 1gr Inj Amp 0 7396 0 11
Amoksilin sk Forte Botol 0 4045 0 12
Ampisillin Injeksi 1 gram Vial 0 3850 0 13
Antalgin (Metampiron) Tab. 500 mg Tab 0 0 0 14
Antasida DOEN tablet Tab 0 72 0 15
Antasida DOEN suspensi Botol 0 2140 0 16
Anti Bakteri DOEN Salep Kombinasi Tube 0 2516 0 17
Anti Hemoroid DOEN Kombinasi Supp 0 3045 0 18
Antifungi DOEN Kombinasi Pot 0 155 0 19
Antimigren DOEN Kombinasi Tab 0 135 0 20
Antiparkinson DOEN tab. Kombinasi Tab 0 1500 0 21
Aqua roinjek Steril Botol 0 2200 0 22

Acyclopir Krim 5%- 5gr Tube 0 5049 0 23
Acyclopir Tablet 200mg Tab 0 237 0 24
Acyclopir Tablet 400 mg Tab 0 336 0 25
Akita Tablet Tab 0 418 0 26
Antalgin (Metampiron) Inj. 250mg/2ml Amp 0 109 0 27
Asam Mefenamat 250mg Tab 0 0 0 28
Asmacare Tablet 2mg Tab 0 0 0 30
Artemeter Injeksi 80 mg/ml Amp 0 85 0 31
Artesunate Injeksi 60 mg/ml Vial 0 2700 0 32
Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 0 0 33
Asam Folat tablet 1 mg Tab 0 0 0 35
Asetosal Tablet 80 mg Tab 0 800 0 37
Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 0 1300 0 40
Atropin Sulfat Tablet 0,5 mg Tab 0 74 0 41
Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 0 0 42
Atenolol Tablet 50 mg Tab 0 0 0 43
Benzatin Benzil Penisilin Inj. 2,4 Juta Vial 0 0 0 44
Betametason Krim 0,1% - 5 gr Tube 0 1520 0 45
Bisacodril sup Botol 0 5045 0 46
Bisoprolol 5mg tab Tab 0 645 0 47
Captopril Tablet 12,5 mg Tab 0 62 0 48
Captopril Tablet 25 mg Tab 0 84 0 Rp0 49

Chloramfecort- H Cream - 10gr Tube 0 0 0 50
Cefadroxil 500mg Tab 0 509 0 51
Cefadroxil syr Btl 0 5895 0 53
Ciprofloxacin Infus Labu 0 39900 0 54
Ciprofloxacin Tablet 500mg Tab 0 255 0 55
Dapson Tablet 100 mg (Antilepra) Tab 0 2484 0 56
Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1580 0 57
Deksametasone Tablet 0,5 mg Tab 0 62 0 58
Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 6600 0 59
Dekstromethorfan Tablet 15 mg Tab 0 4000 0 60
Diazepam Injeksi 5 mg/ml - 2ml Amp 0 4180 0 61
Diazepam Tablet 2 mg Tab 0 45 0 62
Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 960 0 64
Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 0 52 0 65
Digoksin Tablet 0,25 mg Tab 0 129 0 66
Domperidon 10 mgtablet Tab 0 167 0 67
Dimenhidrinat Tablet 50 mg Tab 0 8799 0 68
Dasabion Tablet Tab 0 0 0 69
Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3333 0 70
Efedrin HCL Tablet 25 mg Tab 0 8100 0 71
Ekstrak Belladona Tablet 10 mg Tab 0 31 0 72
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1200 0 73
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 24 0 74
Etambutol HCL Tablet 250 mg Tab 0 0 0 75
Etanol 70%- 1000 ml Btl 0 1500 0 77
Eritromisin Kapsul 250 mg Kap 0 930 0 78
Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 1125 0 79
Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 0 9900 0 80
Fenitoin Natrium Kapsul 100 mg Kap 0 133 0 81
Fenobarbital Injeksi 50 mg/ml- 2ml Amp 0 0 0 83
Fenobarbital Tablet 100 mg Tab 0 130 0 84
Fenoksimetil Penisilina Tablet 250 mg Tab 0 0 0 86
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3417 0 88
Fitomenadion (Vit. K1) Tab. 10 mg Tab 0 579 0 89
Flour Tablet 0,5 mg Tab 0 895 0 90
Furosemida Tablet 40 mg Tab 0 75 0 91
Garam Oralit 200 ml air Ktg 0 380 0 92
Glimepirid 4mg Tablet Tab 0 430 0 93
Glibenklamida Tablet 5 mg Tab 0 56 0 94
Gliseril Guaiakolat Tablet 100 mg Tab 0 56 0 95
Gliserin - 100 ml Btl 0 0 0 96
Glukosa Lar. Infus 5% Steril - 500 ml Btl 0 5200 0 97
Griseofulvin Tablet 125 mg, Micron Tab 0 219 0 100
Gentamisin S.K 0.1%-5 gr Tube 0 4113 0 101
Gentamisin Injeksi Amp 0 3696 0 102
Haloperidol 0,5 mg Tablet Tab 0 96 0 103
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp0 105

Hidrokortison Krim 2,5%-5 gr Tab 0 2798 0 106
Ibuprofen Tablet 200 mg Tab 0 110 0 107
Isoniazid Tablet 100 mg Tab 0 88 0 109
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 2570 0 111
Ketokonazol krom Tube 0 2569 0 112
Ketokonazol tab 200mg Tab 0 300 0 113
Ketorolac Inj 30mg Amp 0 2300 0 114
Kalsium Laktat (Kalk) Tablet 500 mg Tab 0 47 0 115
Ketamin 10 mg/ml Injeksi- 10 ml Vial 0 5200 0 116
Klofazimin, mikronize Kapsul 100 mg Kap 0 97 0 117
Kloramfenikol Kapsul 250 mg Kap 0 733 0 118
Kloramfenikol Suspensi 125 mg/60 ml Btl 0 3800 0 119
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 0 0 0 120
Klorokuin Tablet 150 mg Tab 0 0 0 121
Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 5744 0 122
Klorpromazin HCL Tablet Salut 25 mg Tab 0 0 0 123
Kodein HCL Tablet 10 mg Tab 0 250 0 125
Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 0 0 126
Kotrimoksazol Tablet 480mg Tab 0 700 0 127
Kotrimoksazol Suspensi Kombinasi Btl 0 2145 0 128
Kotrimoksazol Tab. Kombinasi Tab 0 138 0 129
Kuinin (Kina) Tablet 200 mg Tab 0 7700 0 130
Kloramfenikol Salep Mata 1%-5gram Tube 0 1450 0 131
Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1797 0 132
Kuinin Injeksi 25%-2ml Amp 0 4750 0 133
Levoploxasin 500mh Dus 0 528 0 134
Lidokain Komp. Injeksi, Kombinasi Amp 0 1295 0 135
Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3360 0 136
Loperamide Hcl 2mg Tanlet Ktg 0 89 137
Mebendazol Syrup/5ml - 30ml Btl 0 4100 138
Mebendazol Tablet 100mg Tab 0 0 139
Metilergometrin Maleat Tab. 0,125 g Tab 0 154 140
Metilergometrin M inj. 0,200mg- 1ml Amp 0 2750 141
Metoklorpropamid Tablet 10 mg Tab 0 91 142
Mikonazol Krim/ Salep 2%-10gram Tube 0 3000 143
Multivitamin Anak Btl 0 11500 144
Multivitamin Dewasa Tab 0 640 145
Metronidazol Infus 500mg/100ml Labu 0 9950 146
Metronidazol Tablet 500mg Tab 0 160 147
Magnesium Sulfat Inj. 25 ml Amp 0 0 148
Minyak kayu putih Btl 0 8000 149
Natrium Bikarbonat Tablet 500mg Tab 0 0 150
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 0 4700 151
Natrium Diclopenac 20mg Amp 0 133 152
Nistatin Tablet Salut 500.000 IU Tab 0 0 153
Natrium Diclopenac 50mg Tab 0 176 154
Nisagon Cream 5 gram Tube 0 0 155
Novadryl Syrup/ Holydril Syrup-60ml Btl 0 0 156
Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 359619 157
Obat Anti Tuberkulosis Kat. 2 Pkt 0 1199990 158

OAT Sisipan Dewasa Pkt 0 0 160
Omeprazol inj 40mg/10ml Amp 0 36000 161
Omeprazol Kapsul 20mg Kap 0 211 162
Ondansetron Inj 4mg Amp 0 2400 163
Onadansetron 8mg Tablet Tab 0 1189 164
OAT Kategori Anak Pkt 0 0 166
Obat Batuk Hitam (OBH) Cairan Btl 0 5663 167
Obat Batuk Dewasa Btl 0 5500 168
Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 0 0 169
Oksitetrasiklin HCL SM 1%-3,5gram Tube 0 1750 170
Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1450 171
Oksitosin Injeksi 10 IU/ml- 1ml Amp 0 2200 172
OBAT Anti Diare suspensi Btl 0 7150 173
Paraformaldehid Tablet 1gram Tab 0 0 174
Parasetamol Syrup 120mg/ 5ml-60ml Btl 0 1438 175
Parasetamol Tablet 100mg Tab 0 5200 176
Petidin HCL Injeksi 50mg/ ml-2ml Amp 0 0 178
Pilokarpin HCI/Nitrat TM 2%- 5ml Btl 0 0 179
Pirantel Tablet 125mg Tab 0 296 180
piroksikam Tablet 10 mg Tab 0 138 181
Piroksikam Tablet 20 mg Tab 0 0 182
Propiltiourasil Tablet 100mg Tab 0 319 183
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 0 110 184
Povidon Iodida 10% 300ml Btl 0 14203 185
Prednison Tablet 5mg Tab 0 114 187
Primakuin Tablet 15mg Tab 0 0 188
Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 0 189
propanolol HCL Tablet 10mg Tab 0 77 190
Propanolol HCL Tablet 40mg Tab 0 121 191
Reserpin Tablet 0,25mg Tab 0 0 192
Retinol (Vitamin A) Kapsul 100.000 IU Kap 0 260 193
Rifampisin Kapsul 300mg Kap 0 0 195
Ranitidin Injeksi 25 mg/ 2ml Amp 0 1140 198
Ranitidin Tablet 150 mg Tab 0 120 199
Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 5200 200
Salbutamol Tablet 2mg Tab 0 59 201
Salep 2-4, Kombinasi Pot 0 1229 203
Salisil Bedak 2% Ktk 0 1250 204
Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 591250 205
Serum Anti Rabies Vial 0 0 206
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 0 158125 207
Serum Anti Tetanus Inj. 20.000 IU/vial Vial 0 0 208
Sianokobalamin (Vit. B12) Inj 500mcg Amp 0 1078 209
Simvastatin Tablet 20 mg Tab 0 391 210

Streptomisin Sulfat Serbuk Inj.1000mg Vial 0 0 212
Sulfasetamida Natrium TM 15%- 5ml Btl 0 3226 213
Sanadril syr Btl 0 5500 214
Sanbe ters 0 0 215
Sanvita B syr Btl 0 0 216
Sinbio Set 0 4500 217
Seftriakson inj. 1g Amp 0 0 218
Tablet Tambah Darah Komb. Tab 0 1260 219
Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 0 1705 220
Tetrasiklin HCL Kapsul 250 mg Kap 0 148 221
Tiamin HCL/(Vit. B1) Tab. 50mg Tab 0 55 223
Tiopental Natrium Serbuk Inj 1.000mg Amp 0 0 224
TiaminTabbblet 50 mg Tab 0 6402 225
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Amp 0 1615 226
Triheksifenidil Hidroklorida Tab. 2mg Tab 0 0 227
Vitamin B Komplek Tablet Tab 0 107 228
Zink Tlet 20mg ab Tab 0 474 229
Alat Suntik Sekali Pakai 1 ml Set 0 748 230
Catgut/ Benang Bedah No. 2/0 - 3/0 Set 0 22500 233
I.V. Catheter No. 20 Set 0 7700 234
Infusion Set Anak Set 0 7920 237
Infusion Set Dewasa Set 0 7920 238
Implant Set 0 0 239
Jarum Jahit (Bedah) No. 9 s/d 14 set 0 0 240
Jarum Suntik (Neddle) set 0 1250 241
Kapas Pembalut/Absorben 250 gram Set 0 24000 242
Kasa Kompres 40/40 Steril biji 0 1200 243
Kasa Pembalut 2 m x 80 cm biji 0 9400 244
Kasa Pembalut Hidrofil 4 m x 15 cm rol 0 7900 245
Kasa Steril 16/16 biji 0 7900 246
Masker biji 0 439 247
Plester 5 yard x 2 inch biji 0 13000 248
Sarung Tangan n0 7 pasang 0 396 249
Silk (Benang Bedah Sutera) No. 3/0 Set 0 250
TOTAL PENGELUARAN Rp0 TOTAL PENG

YUYUN YUNENGSIH, S.Kep EMA ELMAWATI, AM.Keb

NIP. 19820422 200801 2 006 NRPTT. 29 4 021110
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK




Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239
TOTAL PENGELUARAN Rp0 TOTAL P


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SU
BULAN AGUSTUS 2015

Captopril Tablet 25 mg Tab 250 84 21000 Rp1,516,060 49

Etanol 70%- 1000 ml Btl 0 1500 0 77
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp200,596 105



Sanbe ters 0 0 215
Implant Set 0 0 239

Hj.IYOT SA'DIAH,S.ST YUYUN YUNENGSIH, S.Kep YUYUN YUNENGS

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006 NIP. 19820422 200
PUSKESMAS CIKEUSIK

Nomor : 800/008/SBBK-LPLPO/PKM-CKS/VIII/2015 Nomor :80

perluan Bulan : Januari 2015 Keperluan Bulan : Agustus 2015
Kombinasi Tab 0 1500 0 21

Antalgin (Metampiron) Inj. 250mg/ Amp 0 109 0 27
Asam Askorbat (Vit. C) Tablet 250 m Tab 0 2368 0 34
Captopril Tablet 25 mg Tab 0 84 0 Rp - 49

Deksametasone Injeksi 5 mg/ml - 1m Amp 0 1580 0 57
Dekstromethorfan Sirup 10 mg/ 60 Btl 0 6600 0 59
Dietilkarbamazin Sitrat Tablet 100 m Tab 0 960 0 64
Difenhidramin HCL Inj. 10 mg/ml- 1 Amp 0 52 0 65
Domperidon Suspensi 5mg/ 5ml- 60 Btl 0 3333 0 70
Epinefrina HCL/Bitartrat Inj. 0,1%- 1 Amp 0 1200 0 73
Etanol 70%- 1000 ml Btl 0 1500 0 77
Eritromisin Syrup 200 mg/5 ml-60 m Btl 0 1125 0 79
Fenitoin Natrium Injeksi 50 mg/ 1 m Amp 0 9900 0 80
Fenoksimetil Penisilina Tablet 250 m Tab 0 0 0 86
Fitomenadion (Vit. K1) Inj. 10 mg/1 Amp 0 3417 0 88
Glukosa Lar. Infus 10% Steril - 500 m Btl 0 1675 0 98
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 105

Kloramfenikol Suspensi 125 mg/60 m Btl 0 3800 0 119
Klorfeniramin Maleat (CTM) Tab. 4 Tab 0 0 0 120
Klorpromazin HCL Inj. 25 mg/ml- 1m Amp 0 5744 0 122
Klorpromazin HCL Tablet Salut 25 Tab 0 0 0 123
Komb. Artesunate 50mg+Amodiaqu Pkt 0 0 0 126
5gram Tube 0 1450 0 131
Metilergometrin Maleat Tab. 0,125 Tab 0 154 140
g
Metilergometrin M inj. 0,200mg- 1m Amp 0 2750 141

Oksitetrasiklin HCL Inj. i.m 50mg10m Vial 0 0 169
Parasetamol Syrup 120mg/ 5ml-60m Btl 0 1438 175
Retinol (Vitamin A) Kapsul 100.000 I Kap 0 260 193
Serum Anti Bisa Ular Polivalen Inj.5m Vial 0 591250 205
Serum Anti Tetanus Inj. 1500 IU/amp Amp 0 158125 207
Serum Anti Tetanus Inj. 20.000 IU/vi Vial 0 0 208
Sianokobalamin (Vit. B12) Inj 500mc Amp 0 1078 209

Streptomisin Sulfat Serbuk Inj.1000 Vial 0 0 212
Sulfasetamida Natrium TM 15%- 5m Btl 0 3226 213
Sanbe ters 0 0 215
Tiopental Natrium Serbuk Inj 1.000 Amp 0 0 224
Alat Suntik Sekali Pakai 1 ml 0 748 230
Catgut/ Benang Bedah No. 2/0 - 3/0 0 22500 233
I.V. Catheter No. 20 0 7700 234
I.V. Catheter No. 22 0 7700 235
I.V. Catheter No. 24 0 7700 236
Infusion Set Anak 0 7920 237
Infusion Set Dewasa 0 7920 238
Implant 0 0 239
Jarum Jahit (Bedah) No. 9 s/d 14 0 0 240
Jarum Suntik (Neddle) 0 1250 241
Kapas Pembalut/Absorben 250 gram 0 24000 242
Kasa Kompres 40/40 Steril 0 1200 243
Kasa Pembalut 2 m x 80 cm 0 9400 244
Kasa Pembalut Hidrofil 4 m x 15 cm 0 7900 245
Kasa Steril 16/16 0 7900 246
Masker 0 439 247
Plester 5 yard x 2 inch 0 13000 248
Sarung Tangan n0 7 0 396 249
Silk (Benang Bedah Sutera) No. 3/0 0 250
TOTAL PENGELUARAN Rp0 TOTAL PENGELUARAN

YUYUN YUNENGSIH, S.Kep ELIS NURHAYATI,Amd.Keb

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 107/SBBK-LPLPO/PKM-CKS/VIII/2015 No

perluan Bulan : Agustus 2015 Keperluan Bulan : Janua

Captopril Tablet 25 mg Tab 100 84 8400 49

Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239
TOTAL PENGELUARAN Rp0 TOTAL PEN

YUYUN YUNENGSIH, S.Kep ANI SUBHANI, Amd.Kep

NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/010/SBBK-LPLPO/PKM-CKS/VIII/2015



Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239

YUYUN YUNENGSIH, S.Kep SITI HASANAH, AMK

NIP. 19820422 200801 2 006 PTT
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SISA OBAT



Chloramfecort- H Cream - 10gr Tube Err:509 0 Err:509 50
Cefadroxil 500mg Tab JUMLAH 509 #VALUE! 51
Etanol 70%- 1000 ml Btl 0 1500 0 77
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Err:509 105

Ibuprofen Tablet 200 mg Tab Err:509 110 Err:509 107
Ibuprofen Tablet 400 mg Tab Err:509 205 Err:509 108
Isoniazid Tablet 100 mg Tab JUMLAH 88 #VALUE! 109

Omeprazol Kapsul 20mg Kap Err:509 211 162
Ondansetron Inj 4mg Amp Err:509 2400 163
Onadansetron 4mg Tablet Tab JUMLAH 716 165

Sanbe ters Err:509 0 215
Sanvita B syr Btl Err:509 0 216
Sinbio Set Err:509 4500 217
Seftriakson inj. 1g Amp Err:509 0 218
Tablet Tambah Darah Komb. Tab JUMLAH 1260 219
Implant Set 197 0 239
TOTAL PENGELUARAN Err:509 TOTAL PENGELUAR
PUSKESMAS CIKEUSIK
SISA OBAT
AGUSTUS 2015

Alopurinol tablet 100 mg Tab 0 86 0
Aminofilin tablet 200 mg Tab 800 80 64000
Albendazol Tab -30 406 -12180
Aminofilin injeksi 24mg/ml-10ml Amp 0 3240 0
Amitriptilin HCL Tab. Salut 25 mg Tab -100 112 -11200
Amlodipine 10 mg Tablet Tab 1520 330 501600
Amlodipine Besilate 5mg tablet Tab 880 187 164560
Amoksisillin Kapsul 250 mg Kap 4 238 952
Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 2445 0
Am oxsillin aserbuk 1gr Inj Amp -29 7396 -214484
Amoksilin sk Forte Botol 190 4045 768550
Ampisillin Injeksi 1 gram Vial 0 3850 0
Antalgin (Metampiron) Tab. 500 mg Tab 0 0 0
Antasida DOEN tablet Tab -900 72 -64800
Antasida DOEN suspensi Botol 252 2140 539280
Anti Bakteri DOEN Salep Kombinasi Tube 0 2516 0
Anti Hemoroid DOEN Kombinasi Supp 20 3045 60900
Antifungi DOEN Kombinasi Pot 0 155 0
Antimigren DOEN Kombinasi Tab 200 135 27000
Antiparkinson DOEN tab. Kombinasi Tab 0 1500 0
Aqua roinjek Steril Botol 0 2200 0

Acyclopir Krim 5%- 5gr Tube -20 5049 -100980
Acyclopir Tablet 200mg Tab 200 237 47400
Acyclopir Tablet 400 mg Tab -200 336 -67200
Akita Tablet Tab 400 418 167200
Antalgin (Metampiron) Inj. 250mg/2ml Amp 0 109 0
Asam Mefenamat 250mg Tab 0 0 0
Asmacare Tablet 2mg Tab 0 0 0
Artemeter Injeksi 80 mg/ml Amp 0 85 0
Artesunate Injeksi 60 mg/ml Vial 0 2700 0
Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 0 0
Asam Folat tablet 1 mg Tab 250 0 0
Asetosal Tablet 80 mg Tab 0 800 0
Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 200 1300 260000
Atropin Sulfat Tablet 0,5 mg Tab 0 74 0
Atropin Sulfat Tetes Mata 1% - 5 ml Btl 0 0 0
Atenolol Tablet 50 mg Tab 0 0 0
Benzatin Benzil Penisilin Inj. 2,4 Juta Vial 6 0 0
Betametason Krim 0,1% - 5 gr Tube 29 1520 44080
Bisacodril sup Botol 2 5045 10090
Bisoprolol 5mg tab Tab 210 645 135450
Captopril Tablet 12,5 mg Tab 550 62 34100
Captopril Tablet 25 mg Tab -250 84 -21000 Rp3,339,654

Chloramfecort- H Cream - 10gr Tube 0 0 0
Cefadroxil 500mg Tab #VALUE! 509 #VALUE!
Cefadroxil 250mg Tab 500 513 256500
Cefadroxil syr Btl 0 5895 0
Ciprofloxacin Infus Labu 0 39900 0
Ciprofloxacin Tablet 500mg Tab 0 255 0
Dapson Tablet 100 mg (Antilepra) Tab 0 2484 0
Deksametasone Injeksi 5 mg/ml - 1ml Amp 0 1580 0
Deksametasone Tablet 0,5 mg Tab -1100 62 -68200
Dekstromethorfan Sirup 10 mg/ 60 ml Btl 160 6600 1056000
Dekstromethorfan Tablet 15 mg Tab 0 4000 0
Diazepam Injeksi 5 mg/ml - 2ml Amp 0 4180 0
Diazepam Tablet 2 mg Tab 0 45 0
Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 960 0
Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 60 52 3120
Digoksin Tablet 0,25 mg Tab -300 129 -38700
Domperidon 10 mgtablet Tab 0 167 0
Dimenhidrinat Tablet 50 mg Tab 230 8799 2023770
Dasabion Tablet Tab 0 0 0
Domperidon Suspensi 5mg/ 5ml- 60ml Btl 0 3333 0
Efedrin HCL Tablet 25 mg Tab 0 8100 0
Ekstrak Belladona Tablet 10 mg Tab -600 31 -18600
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Amp 0 1200 0
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl -9 24 -216
Etambutol HCL Tablet 250 mg Tab 200 0 0
Etanol 70%- 1000 ml Btl 0 1500 0
Eritromisin Kapsul 250 mg Kap 0 930 0
Eritromisin Syrup 200 mg/5 ml-60 ml Btl 0 1125 0
Fenitoin Natrium Injeksi 50 mg/ 1 ml Amp 330 9900 3267000
Fenitoin Natrium Kapsul 100 mg Kap 29 133 3857
Fenobarbital Injeksi 50 mg/ml- 2ml Amp 0 0 0
Fenobarbital Tablet 100 mg Tab 0 130 0
Fenoksimetil Penisilina Tablet 250 mg Tab 0 0 0
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Amp 0 3417 0
Fitomenadion (Vit. K1) Tab. 10 mg Tab 15 579 8685
Flour Tablet 0,5 mg Tab 0 895 0
Furosemida Tablet 40 mg Tab 850 75 63750
Garam Oralit 200 ml air Ktg 0 380 0
Glimepirid 4mg Tablet Tab 200 430 86000
Glibenklamida Tablet 5 mg Tab -200 56 -11200
Gliseril Guaiakolat Tablet 100 mg Tab 1400 56 78400
Gliserin - 100 ml Btl 0 0 0
Glukosa Lar. Infus 5% Steril - 500 ml Btl 1080 5200 5616000
Griseofulvin Tablet 125 mg, Micron Tab 0 219 0
Gentamisin S.K 0.1%-5 gr Tube 0 4113 0
Gentamisin Injeksi Amp 130 3696 480480
Haloperidol 0,5 mg Tablet Tab 0 96 0
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 #VALUE!

Hidrokortison Krim 2,5%-5 gr Tab -21 2798 -58758
Ibuprofen Tablet 200 mg Tab Err:509 110 Err:509
Ibuprofen Tablet 400 mg Tab Err:509 205 Err:509
Isoniazid Tablet 100 mg Tab #VALUE! 88 #VALUE!
Isoniazid Tablet 300 mg Tab 45 97 4365
Isosorbid Dinitrat Tab. Sub. 5 mg Tab 0 2570 0
Ketokonazol krom Tube -20 2569 -51380
Ketokonazol tab 200mg Tab -150 300 -45000
Ketorolac Inj 30mg Amp 20 2300 46000
Kalsium Laktat (Kalk) Tablet 500 mg Tab 300 47 14100
Ketamin 10 mg/ml Injeksi- 10 ml Vial 50 5200 260000
Klofazimin, mikronize Kapsul 100 mg Kap 400 97 38800
Kloramfenikol Kapsul 250 mg Kap 20 733 14660
Kloramfenikol Suspensi 125 mg/60 ml Btl 0 3800 0
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab -1100 0 0
Klorokuin Tablet 150 mg Tab 40 0 0
Klorpromazin HCL Inj. 25 mg/ml- 1ml Amp 0 5744 0
Klorpromazin HCL Tablet Salut 25 mg Tab -200 0 0
Klorpromazin HCL Tablet Salut 100 mg Tab 950 0 0
Kodein HCL Tablet 10 mg Tab 0 250 0
Komb. Artesunate 50mg+Amodiaquin 200mg Pkt 0 0 0
Kotrimoksazol Tablet 480mg Tab 0 700 0
Kotrimoksazol Suspensi Kombinasi Btl -85 2145 -182325
Kotrimoksazol Tab. Kombinasi Tab 0 138 0
Kuinin (Kina) Tablet 200 mg Tab 0 7700 0
Kloramfenikol Salep Mata 1%-5gram Tube 860 1450 1247000
Kloramfenikol Tetes Telinga 3%-5ml Btl 0 1797 0
Kuinin Injeksi 25%-2ml Amp 2600 4750 12350000
Levoploxasin 500mh Dus -100 528 -52800
Lidokain Komp. Injeksi, Kombinasi Amp 15 1295 19425
Lisol, Kresol Tersabun 50%- 1000ml Btl 0 3360 0
Loperamide Hcl 2mg Tanlet Ktg 5 89
Mebendazol Syrup/5ml - 30ml Btl 93 4100
Mebendazol Tablet 100mg Tab 30 0
Metilergometrin Maleat Tab. 0,125 g Tab 0 154
Metilergometrin M inj. 0,200mg- 1ml Amp 0 2750
Metoklorpropamid Tablet 10 mg Tab -282 91
Mikonazol Krim/ Salep 2%-10gram Tube -9 3000
Multivitamin Anak Btl 235 11500
Multivitamin Dewasa Tab -127 640
Metronidazol Infus 500mg/100ml Labu 0 9950
Metronidazol Tablet 500mg Tab -391 160
Magnesium Sulfat Inj. 25 ml Amp 0 0
Minyak kayu putih Btl 0 8000
Natrium Bikarbonat Tablet 500mg Tab 0 0
Natrum Klorida Lar. Inf. 0,9% -500ml Btl -13 4700
Natrium Diclopenac 20mg Amp 62 133
Nistatin Tablet Salut 500.000 IU Tab 0 0
Natrium Diclopenac 50mg Tab 0 176
Nisagon Cream 5 gram Tube 95 0
Novadryl Syrup/ Holydril Syrup-60ml Btl 0 0
Obat Anti Tuberkulosis Kat. 1 (FDC) Pkt 0 359619
Obat Anti Tuberkulosis Kat. 2 Pkt 0 1199990

OAT Sisipan Dewasa Pkt 0 0
Omeprazol inj 40mg/10ml Amp 0 36000
Omeprazol Kapsul 20mg Kap Err:509 211
Ondansetron Inj 4mg Amp Err:509 2400
Onadansetron 8mg Tablet Tab 0 1189
Onadansetron 4mg Tablet Tab #VALUE! 716
OAT Kategori Anak Pkt 1 0
Obat Batuk Hitam (OBH) Cairan Btl 4 5663
Obat Batuk Dewasa Btl -30 5500
Oksitetrasiklin HCL Inj. i.m 50mg10ml Vial 47 0
Oksitetrasiklin HCL SM 1%-3,5gram Tube 960 1750
Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 1450
Oksitosin Injeksi 10 IU/ml- 1ml Amp 0 2200
OBAT Anti Diare suspensi Btl 600 7150
Paraformaldehid Tablet 1gram Tab 0 0
Parasetamol Syrup 120mg/ 5ml-60ml Btl -150 1438
Parasetamol Tablet 100mg Tab 0 5200
Petidin HCL Injeksi 50mg/ ml-2ml Amp 0 0
Pilokarpin HCI/Nitrat TM 2%- 5ml Btl 0 0
Pirantel Tablet 125mg Tab 128 296
piroksikam Tablet 10 mg Tab -250 138
Piroksikam Tablet 20 mg Tab 14 0
Propiltiourasil Tablet 100mg Tab 171 319
Piridoksin HCL (Vit. B6) Tablet 10mg Tab -1100 110
Povidon Iodida 10% 300ml Btl 2100 14203
Prednison Tablet 5mg Tab -195 114
Primakuin Tablet 15mg Tab 0 0
Prokain Benzil Penisilin 3 Juta IU Inj. Vial 0 0
propanolol HCL Tablet 10mg Tab -100 77
Propanolol HCL Tablet 40mg Tab 0 121
Reserpin Tablet 0,25mg Tab 400 0
Retinol (Vitamin A) Kapsul 100.000 IU Kap 8 260
Rifampisin Kapsul 300mg Kap 0 0
Ranitidin Injeksi 25 mg/ 2ml Amp -20 1140
Ranitidin Tablet 150 mg Tab -300 120
Ringer Laktat Lar. Inf. Steril - 500ml Btl 0 5200
Salbutamol Tablet 2mg Tab 500 59
Salbutamol Tablet 4mg Tab -50 89
Salep 2-4, Kombinasi Pot -24 1229
Salisil Bedak 2% Ktk 0 1250
Serum Anti Bisa Ular Polivalen Inj.5ml Vial 0 591250
Serum Anti Rabies Vial 0 0
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 1700 158125
Serum Anti Tetanus Inj. 20.000 IU/vial Vial 60 0
Sianokobalamin (Vit. B12) Inj 500mcg Amp 465 1078
Simvastatin Tablet 20 mg Tab 0 391

Simvastatin Tablet 10 mg Tab -200 169
Streptomisin Sulfat Serbuk Inj.1000mg Vial 19 0
Sulfasetamida Natrium TM 15%- 5ml Btl 0 3226
Sanadril syr Btl 0 5500
Sanbe ters Err:509 0
Sanvita B syr Btl Err:509 0
Sinbio Set Err:509 4500
Seftriakson inj. 1g Amp Err:509 0
Tablet Tambah Darah Komb. Tab #VALUE! 1260
Tetrakain HCL Tetes Mata 0.5%- 5ml Btl 730 1705
Tetrasiklin HCL Kapsul 250 mg Kap 0 148
Tetrasiklin HCL Kapsul 500 mg Kap -25 300
Tiamin HCL/(Vit. B1) Tab. 50mg Tab -500 55
Tiopental Natrium Serbuk Inj 1.000mg Amp 80 0
TiaminTabbblet 50 mg Tab 0 6402
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Amp 0 1615
Triheksifenidil Hidroklorida Tab. 2mg Tab 0 0
Vitamin B Komplek Tablet Tab -300 107
Zink Tlet 20mg ab Tab -300 474
Alat Suntik Sekali Pakai 1 ml Set 0 748
Catgut/ Benang Bedah No. 2/0 - 3/0 Set -19 22500
I.V. Catheter No. 20 Set 990 7700
I.V. Catheter No. 24 Set -10 7700
Infusion Set Anak Set -30 7920
Infusion Set Dewasa Set -15 7920
Implant Set 197 0
Jarum Jahit (Bedah) No. 9 s/d 14 set 0 0
Jarum Suntik (Neddle) set 310 1250
Kapas Pembalut/Absorben 250 gram Set 200 24000
Kasa Kompres 40/40 Steril biji 74 1200
Kasa Pembalut 2 m x 80 cm biji 93 9400
Kasa Pembalut Hidrofil 4 m x 15 cm rol 136 7900
Kasa Steril 16/16 biji 70 7900
Masker biji 18 439
Plester 5 yard x 2 inch biji 33 13000
Sarung Tangan n0 7 pasang 292 396
Silk (Benang Bedah Sutera) No. 3/0 Set 400
TOTAL PENGELUARAN #VALUE!
PUSKESMAS CIKEUSIK

Nomor :800/ 108/SBBK-LPLPO/PKM-CKS/IX/2015 MENU

Keperluan Bulan : September 2015











77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0
Cikeusik, September 2015


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/109/SBBK-LPLPO/PKM-CKS/IX/2015

Keperluan Bulan : September-Oktober2015








49 Captopril Tablet 25 mg Tab 0 84 0 Rp154,420



77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0

YUYUN YUNENGSIH, S.Kep AAN NURHASANAH, AMK

NIP. 19820422 200801 2 006 NIP.19670504 198803 2 009
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NRPTT.29 4 04810957
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 111/SBBK-LPLPO/PKM-CKS/IX/2015












77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NIP.19800216 200701 1 005
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 112/SBBK-LPLPO/PKM-CKS/IX/2015

Keperluan Bulan : September-Oktober2015 Keperluan Bulan








49 Captopril Tablet 25 mg Tab 0 84 0 Rp163,200 49



77 Etanol 70%- 1000 ml Btl 0 1500 0 77



96 Gliserin - 100 ml Btl 0 0 0 96

105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp37,129 105








217 Sinbio Set 0 4500 217

246 Kasa Steril 16/16 biji 0 7900 246


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 113/SBBK-LPLPO/PKM-CKS/IV/2015

Keperluan Bulan : September-Oktober2015 Keperluan Bulan : Sept

Captopril Tablet 25 mg Tab 0 84 0 Rp143,640 49

Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 NRPTT. 29 4 021110
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK


Anti Bakteri DOEN Salep Kombinasi 0 0 2516 0 17


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SU
BULAN SEPTEMBER 2015
Keperluan Bulan : Septembe


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006 NIP. 19820422 200
PUSKESMAS CIKEUSIK

Nomor : 800/115/SBBK-LPLPO/PKM-CKS/IX/2015 Nomor :80

perluan Bulan : September-Oktober2015 Keperluan Bulan : September 20

Captopril Tablet 25 mg Tab 0 84 0 Rp 167,260 49

Etanol 70%- 1000 ml Btl 0 1500 0 77

5gram Tube 5 1450 7250 131
g


Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 116/SBBK-LPLPO/PKM-CKS/IX/2015 N

perluan Bulan : September 2015 Keperluan Bulan : Septe


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/117/SBBK-LPLPO/PKM-CKS/IX/2015

perluan Bulan : September-Oktober2015


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 PTT
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
PENERIMAAN



Etanol 70%- 1000 ml Btl 0 1500 0 77
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp1,373,230 105



Sanbe ters 0 0 215
Implant Set 0 0 239
TOTAL PENGELUARAN Rp8,982,542 TOTAL PENGELUAR

SYARIUDDIN RACHMAN,MM YUYUN YUNENGSIH,S.Kep

NIP.19610426 1982011 2 001 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
SISA OBAT

Albendazol Tab 130 406 52780
Amitriptilin HCL Tab. Salut 25 mg Tab 300 112 33600
Am oxsillin aserbuk 1gr Inj Amp 0 7396 0
Ampisillin Injeksi 1 gram Vial -60 3850 -231000
Antasida DOEN tablet Tab 5000 72 360000

Acyclopir Krim 5%- 5gr Tube 0 5049 0
Acyclopir Tablet 400 mg Tab 200 336 67200
Atropin Sulfat Tablet 0,5 mg Tab -100 74 -7400
Captopril Tablet 25 mg Tab 0 84 0 Rp2,880,390

Deksametasone Tablet 0,5 mg Tab 100 62 6200
Digoksin Tablet 0,25 mg Tab 300 129 38700
Ekstrak Belladona Tablet 10 mg Tab 600 31 18600
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 29 24 696
Etanol 70%- 1000 ml Btl 0 1500 0
Glibenklamida Tablet 5 mg Tab 450 56 25200
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp843,361

Hidrokortison Krim 2,5%-5 gr Tab 0 2798 0
Ibuprofen Tablet 200 mg Tab 0 110 0
Ketokonazol krom Tube 75 2569 192675
Ketokonazol tab 200mg Tab 350 300 105000
Kotrimoksazol Suspensi Kombinasi Btl 185 2145 396825
Levoploxasin 500mh Dus 100 528 52800
Metoklorpropamid Tablet 10 mg Tab 320 91
Mikonazol Krim/ Salep 2%-10gram Tube 0 3000
Multivitamin Dewasa Tab 200 640
Metronidazol Tablet 500mg Tab 650 160
Natrum Klorida Lar. Inf. 0,9% -500ml Btl 33 4700

Omeprazol Kapsul 20mg Kap 0 211
Ondansetron Inj 4mg Amp 30 2400
Obat Batuk Dewasa Btl 30 5500
Parasetamol Syrup 120mg/ 5ml-60ml Btl 0 1438
piroksikam Tablet 10 mg Tab 250 138
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 2100 110
Prednison Tablet 5mg Tab 1200 114
propanolol HCL Tablet 10mg Tab 290 77
Ranitidin Injeksi 25 mg/ 2ml Amp 0 1140
Ranitidin Tablet 150 mg Tab 0 120
Salep 2-4, Kombinasi Pot 0 1229

Sanbe ters 0 0
Sanvita B syr Btl 0 0
Sinbio Set 0 4500
Seftriakson inj. 1g Amp 0 0
Tablet Tambah Darah Komb. Tab 200 1260
Tiamin HCL/(Vit. B1) Tab. 50mg Tab 2600 55
Vitamin B Komplek Tablet Tab 1300 107
Zink Tlet 20mg ab Tab 0 474
Catgut/ Benang Bedah No. 2/0 - 3/0 Set 38 22500
Infusion Set Anak Set 0 7920
Infusion Set Dewasa Set 0 7920
Implant Set 0 0
Kasa Steril 16/16 biji -47 7900
Masker biji 150 439
Sarung Tangan n0 7 pasang -80 396
PUSKESMAS CIKEUSIK

Nomor : 800/118/SBBK-LPLPO/PKM-CKS/X/2015 MENU

Keperluan Bulan : Oktober 2015











77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0
Cikeusik, Oktober 2015


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK











61 0 Amp 0 4180 0


77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NIP.19670504 198803 2 009
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NRPTT.29 4 04810957
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NIP.19800216 200701 1 005
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0 77



96 Gliserin - 100 ml Btl 0 0 0 96









217 Sinbio Set 0 4500 217

246 Kasa Steril 16/16 biji 0 7900 246


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK




Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 NRPTT. 29 4 021110
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK




Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SU
REKAPITULASI PENGELUARAN OBAT Nomor :
BULAN OKTOBER 2015


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006 NIP. 19820422 200
Mengetahui
SYARIPUDDIN RACHMAN,MM
NIP.19610426 198212 1 001
PUSKESMAS CIKEUSIK

Nomor : 008/SBBK-LPLPO/PKM-CKS/I/2015 Nomor : 8

perluan Bulan : Januari 2015 Keperluan Bulan : Oktober 2015


Etanol 70%- 1000 ml Btl 0 1500 0 77

5gram Tube 0 1450 0 131
g


Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/119/SBBK-LPLPO/PKM-CKS/X/2015

perluan Bulan : Oktober 2015 Keperluan Bulan : Janua


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK




Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 PTT
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SISA OBAT

Ampisillin Injeksi 1 gram Vial -60 3850 -231000 13

Atropin Sulfat Tablet 0,5 mg Tab -100 74 -7400 41

Etanol 70%- 1000 ml Btl 0 1500 0 77

Klorfeniramin Maleat (CTM) Tab. 4 mg Tab -1800 0 0 120


Sanbe ters 0 0 215
Implant Set 0 0 239
Kasa Steril 16/16 biji -47 7900 246
Sarung Tangan n0 7 pasang -80 396 249
TOTAL PENGELUARAN Rp4,689,858 TOTAL PENGELUAR
PUSKESMAS CIKEUSIK
SISA OBAT
OKTOBER 2015

Albendazol Tab 0 406 0
Amitriptilin HCL Tab. Salut 25 mg Tab 0 112 0
Antasida DOEN tablet Tab 2500 72 180000

Atropin Sulfat Tablet 0,5 mg Tab -100 74 -7400
Captopril Tablet 25 mg Tab 0 84 0 Rp1,274,370

Digoksin Tablet 0,25 mg Tab 0 129 0
Ekstrak Belladona Tablet 10 mg Tab 0 31 0
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 12 24 288
Etanol 70%- 1000 ml Btl 0 1500 0
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp422,388

Ketokonazol tab 200mg Tab 0 300 0
Levoploxasin 500mh Dus 0 528 0
Metoklorpropamid Tablet 10 mg Tab 0 91
Multivitamin Dewasa Tab 0 640
Metronidazol Tablet 500mg Tab 200 160

Ondansetron Inj 4mg Amp 0 2400
Parasetamol Syrup 120mg/ 5ml-60ml Btl 0 1438
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 1000 110
Prednison Tablet 5mg Tab 200 114

Sanbe ters 0 0
Sinbio Set 0 4500
Implant Set 0 0
Masker biji 50 439
PUSKESMAS CIKEUSIK

Nomor :800/ 120/SBBK-LPLPO/PKM-CKS/X1/2015 MENU

Keperluan Bulan : November 2015











77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0
Cikeusik, November 2015


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/121/SBBK-LPLPO/PKM-CKS/XI/2015

Keperluan Bulan : November-Desember 2015











77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NIP.19670504 198803 2 009
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NRPTT.29 4 04810957
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 124/SBBK-LPLPO/PKM-CKS/XI/2015












77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NIP.19800216 200701 1 005
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/125/SBBK-LPLPO/PKM-CKS/XI/2015

Keperluan Bulan : November-Desember 2015 Keperluan Bulan








49 Captopril Tablet 25 mg Tab 0 84 0 Rp192,200 49



77 Etanol 70%- 1000 ml Btl 0 1500 0 77



96 Gliserin - 100 ml Btl 0 0 0 96

105 Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 Rp38,135 105








217 Sinbio Set 0 4500 217

246 Kasa Steril 16/16 biji 0 7900 246
250 Silk (Benang Bedah Sutera) No. 3/0 Set 0 20833 250


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK


Keperluan Bulan : November-Desember 2015 Keperluan Bulan : Nove


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239
Silk (Benang Bedah Sutera) No. 3/0 Set 0 20833 250


NIP. 19820422 200801 2 006 NRPTT. 29 4 021110
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 127/SBBK-LPLPO/PKM-CKS/XI/2015



Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SU
BULAN NOVEMBER 2015
Keperluan Bulan : Novembe


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006 NIP. 19820422 200
PUSKESMAS CIKEUSIK

Nomor : 800/128/SBBK-LPLPO/PKM-CKS/XI/2015 Nomor :80

perluan Bulan : November-Desember 2015 Keperluan Bulan : November 201

Captopril Tablet 25 mg Tab 0 84 0 Rp 200,320 49

Etanol 70%- 1000 ml Btl 0 1500 0 77

5gram Tube 0 1450 0 131
g


Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 129/SBBK-LPLPO/PKM-CKS/XI/2015 N

perluan Bulan : November 2015 Keperluan Bulan : Novem


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 230/SBBK-LPLPO/PKM-CKS/XI/2015

perluan Bulan : November-Desember 2015


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 PTT
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
PENERIMAAN
Nov-15

Ambroksol Tablet Kap 0 238 0 8


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239
TOTAL PENGELUARAN Rp256,900 TOTAL PENGELUAR

SYARIUDDIN RACHMAN,MM YUYUN YUNENGSIH,S.Kep

NIP.19610426 1982011 2 001 NIP.19820422 200801 2 006
PUSKESMAS CIKEUSIK
SISA OBAT
BULAN NOVEMBER

Aminofilin tablet 200 mg Tab -200 80 -16000
Aminofilin injeksi 24mg/ml-10ml Amp -60 3240 -194400
Amlodipine 10 mg Tablet Tab -350 330 -115500
Amlodipine Besilate 5mg tablet Tab -280 187 -52360
Amoksisillin Kapsul 500 mg Kap -3600 261 -939600
Amoksisillin SK 125 mg/5 ml-60 ml Btl -250 2445 -611250
Antasida DOEN suspensi Botol -120 2140 -256800
Anti Bakteri DOEN Salep Kombinasi Tube -110 2516 -276760
Aqua roinjek Steril Botol -5 2200 -11000

Asam Folat tablet 1 mg Tab -100 0 0
Bisacodril sup Botol -14 5045 -70630
Captopril Tablet 25 mg Tab 0 84 0 -Rp3,094,900

Diazepam Tablet 2 mg Tab -100 45 -4500
Domperidon 10 mgtablet Tab -200 167 -33400
Etanol 70%- 1000 ml Btl 0 1500 0
Fitomenadion (Vit. K1) Tab. 10 mg Tab -250 579 -144750
Garam Oralit 200 ml air Ktg -50 380 -19000
Glimepirid 4mg Tablet Tab -300 430 -129000
Glukosa Lar. Infus 5% Steril - 500 ml Btl -57 5200 -296400
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 -Rp782,668

Ketorolac Inj 30mg Amp -26 2300 -59800
Kotrimoksazol Tablet 480mg Tab -700 700 -490000
Kloramfenikol Salep Mata 1%-5gram Tube -20 1450 -29000
Lidokain Komp. Injeksi, Kombinasi Amp -100 1295 -129500
Loperamide Hcl 2mg Tanlet Ktg -300 89
Multivitamin Anak Btl -55 11500
Metronidazol Infus 500mg/100ml Labu -10 9950
Natrium Diclopenac 50mg Tab -750 176

Omeprazol inj 40mg/10ml Amp -15 36000
Ondansetron Inj 4mg Amp -20 2400
Onadansetron 8mg Tablet Tab -200 1189
Parasetamol Tablet 500mg Tab -4100 79
Pirantel Tablet 125mg Tab -50 296
Serum Anti Bisa Ular Polivalen Inj.5ml Vial -5 591250
Sianokobalamin (Vit. B12) Inj 500mcg Amp -65 1078

Sanbe ters 0 0
Sinbio Set 0 4500
Alat Suntik Sekali Pakai 1 ml Set -30 748
Implant Set 0 0
Kasa Kompres 40/40 Steril biji -20 1200
Kasa Pembalut 2 m x 80 cm biji -20 9400
Kasa Pembalut Hidrofil 4 m x 15 cm rol -20 7900
Masker biji -100 439
Plester 5 yard x 2 inch biji -5 13000
TOTAL PENGELUARAN -Rp4,593,753
PUSKESMAS CIKEUSIK

Nomor :800/ 131/SBBK-LPLPO/PKM-CKS/XII/2015 MENU

Keperluan Bulan : Desember 2015











77 Etanol 70%- 1000 ml Btl 0 1500 0












176 Parasetamol Drof/Tablet 100mg Tab 30 5200

215 Sanbe ters 0 0

239 Implant Set 0 0
Cikeusik, Desember 2015


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 002/SBBK-LPLPO/PKM-CKS/XII/2015










61 0 Amp 0 4180 0


77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NIP.19670504 198803 2 009
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NRPTT.29 4 04810957
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/ 004/SBBK-LPLPO/PKM-CKS/XII/2015












77 Etanol 70%- 1000 ml Btl 0 1500 0













215 Sanbe ters 0 0

239 Implant Set 0 0


NIP. 19820422 200801 2 006 NIP.19800216 200701 1 005
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK













77 Etanol 70%- 1000 ml Btl 0 1500 0 77



96 Gliserin - 100 ml Btl 0 0 0 96









217 Sinbio Set 0 4500 217

246 Kasa Steril 16/16 biji 0 7900 246
250 Silk (Benang Bedah Sutera) No. 3/0 Set 0 20833 250


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor : 800/006/SBBK-LPLPO/PKM-CKS/XII/2015



Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 NRPTT. 29 4 021110
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK




Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SU
REKAPITULASI PENGELUARAN OBAT Nomor :800
BULAN DESEMBER 2015


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006 NIP. 19820422 200
Mengetahui
SYARIPUDDIN RACHMAN,MM
NIP.19610426 198212 1 001
PUSKESMAS CIKEUSIK

Nomor :800/ 008/SBBK-LPLPO/PKM-CKS/XII/2015 Nomor :80

perluan Bulan : Januari 2015 Keperluan Bulan : Desember 201


Etanol 70%- 1000 ml Btl 0 1500 0 77

5gram Tube 0 1450 0 131
g


Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK

Nomor :800/ 2232/SBBK-LPLPO/PKM-CKS/XII/2015 No

perluan Bulan : Desember 2015 Keperluan Bulan : Janua


Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 TKS
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK




Etanol 70%- 1000 ml Btl 0 1500 0 77



Sanbe ters 0 0 215
Implant Set 0 0 239


NIP. 19820422 200801 2 006 PTT
Mengetahui
NIP. 19710804 199103 2 002
PUSKESMAS CIKEUSIK
SISA OBAT

Aminofilin tablet 200 mg Tab -200 80 -16000 2
Albendazol Tab -200 406 -81200 3
Aminofilin injeksi 24mg/ml-10ml Amp -60 3240 -194400 4
Amitriptilin HCL Tab. Salut 25 mg Tab -200 112 -22400 5
Amlodipine 10 mg Tablet Tab -350 330 -115500 6
Amlodipine Besilate 5mg tablet Tab -280 187 -52360 7
Amoksisillin Kapsul 500 mg Kap -3600 261 -939600 9
Amoksisillin SK 125 mg/5 ml-60 ml Btl -250 2445 -611250 10
Ampisillin Injeksi 1 gram Vial -60 3850 -231000 13
Antasida DOEN tablet Tab -3000 72 -216000 15
Antasida DOEN suspensi Botol -120 2140 -256800 16
Aqua roinjek Steril Botol -5 2200 -11000 22

Asam Folat tablet 1 mg Tab -100 0 0 35
Bisacodril sup Botol -14 5045 -70630 46
Captopril Tablet 25 mg Tab 0 84 0 -Rp1,461,740 49

Diazepam Tablet 2 mg Tab -100 45 -4500 62
Digoksin Tablet 0,25 mg Tab -200 129 -25800 66
Domperidon 10 mgtablet Tab -200 167 -33400 67
Ekstrak Belladona Tablet 10 mg Tab -400 31 -12400 72
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl -7 24 -168 74
Etanol 70%- 1000 ml Btl 0 1500 0 77
Fitomenadion (Vit. K1) Tab. 10 mg Tab -250 579 -144750 89
Garam Oralit 200 ml air Ktg -50 380 -19000 92
Glimepirid 4mg Tablet Tab -300 430 -129000 93
Glukosa Lar. Infus 5% Steril - 500 ml Btl -57 5200 -296400 97
Glukosa Lar. Infus 10% Steril - 500 ml Btl -70 1675 -117250 98
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 -Rp657,268 105

Ketokonazol tab 200mg Tab -150 300 -45000 113
Ketorolac Inj 30mg Amp -26 2300 -59800 114
Kotrimoksazol Tablet 480mg Tab -700 700 -490000 127
Kloramfenikol Salep Mata 1%-5gram Tube -20 1450 -29000 131
Levoploxasin 500mh Dus -100 528 -52800 134
Lidokain Komp. Injeksi, Kombinasi Amp -100 1295 -129500 135
Loperamide Hcl 2mg Tanlet Ktg -300 89 137
Metoklorpropamid Tablet 10 mg Tab -280 91 142
Multivitamin Anak Btl -55 11500 144
Multivitamin Dewasa Tab -150 640 145
Metronidazol Infus 500mg/100ml Labu -10 9950 146
Metronidazol Tablet 500mg Tab -350 160 147
Natrium Diclopenac 50mg Tab -750 176 154

Omeprazol inj 40mg/10ml Amp -15 36000 161
Ondansetron Inj 4mg Amp -20 2400 163
Onadansetron 8mg Tablet Tab -200 1189 164
Onadansetron 4mg Tablet Tab -200 716 165
Parasetamol Syrup 120mg/ 5ml-60ml Btl -150 1438 175
Parasetamol Drof /Tablet 100mg Tab 224 5200 176
Parasetamol Tablet 500mg Tab -4100 79 177
Pirantel Tablet 125mg Tab -50 296 180
Piridoksin HCL (Vit. B6) Tablet 10mg Tab -1900 110 184
Prednison Tablet 5mg Tab -2800 114 187
Salbutamol Tablet 4mg Tab -200 89 202
Serum Anti Bisa Ular Polivalen Inj.5ml Vial -5 591250 205
Sianokobalamin (Vit. B12) Inj 500mcg Amp -65 1078 209
Simvastatin Tablet 20 mg Tab -100 391 210

Simvastatin Tablet 10 mg Tab -100 169 211
Sanbe ters 0 0 215
Tetrasiklin HCL Kapsul 250 mg Kap -1200 148 221
Alat Suntik Sekali Pakai 1 ml Set -30 980 230
I.V. Catheter No. 20 Set -20 7700 234
Implant Set 0 0 239
Kasa Kompres 40/40 Steril biji -20 1200 243
Kasa Pembalut 2 m x 80 cm biji -20 9400 244
Kasa Steril 16/16 biji -50 7900 246
Masker biji -100 439 247
Plester 5 yard x 2 inch biji -5 13000 248
Sarung Tangan n0 7 pasang -95 396 249
TOTAL PENGELUARAN -Rp2,835,193 TOTAL PENGELUAR
PUSKESMAS CIKEUSIK
SISA OBAT
DESEMBER 2015

Aminofilin tablet 200 mg Tab -200 80 -16000
Aminofilin injeksi 24mg/ml-10ml Amp -60 3240 -194400
Amlodipine 10 mg Tablet Tab -600 330 -198000
Amlodipine Besilate 5mg tablet Tab -600 187 -112200
Amoksisillin Kapsul 500 mg Kap -5600 261 -1461600
Amoksisillin SK 125 mg/5 ml-60 ml Btl -400 2445 -978000
Antasida DOEN suspensi Botol -138 2140 -295320
Aqua roinjek Steril Botol -10 2200 -22000

Asam Folat tablet 1 mg Tab -400 0 0
Bisacodril sup Botol -24 5045 -121080
Captopril Tablet 25 mg Tab 0 84 0 -Rp3,013,640

Diazepam Tablet 2 mg Tab -100 45 -4500
Diazepam Tablet 5 mg Tab -20 0 0
Domperidon 10 mgtablet Tab -200 167 -33400
Etanol 70%- 1000 ml Btl 0 1500 0
Fitomenadion (Vit. K1) Tab. 10 mg Tab -350 579 -202650
Garam Oralit 200 ml air Ktg -100 380 -38000
Glimepirid 4mg Tablet Tab -450 430 -193500
Hidroklortiazid (HCT) Tablet 25 mg Tab 0 14 0 -Rp999,211

Ketorolac Inj 30mg Amp -36 2300 -82800
Klorfeniramin Maleat (CTM) Tab. 4 mg Tab 17000 0 0
Kotrimoksazol Tablet 480mg Tab -1100 700 -770000
Kloramfenikol Salep Mata 1%-5gram Tube -75 1450 -108750
Lidokain Komp. Injeksi, Kombinasi Amp -120 1295 -155400
Loperamide Hcl 2mg Tanlet Ktg -600 89
Multivitamin Anak Btl -96 11500
Metronidazol Infus 500mg/100ml Labu -20 9950
Natrium Diclopenac 50mg Tab -850 176

Omeprazol inj 40mg/10ml Amp -35 36000
Omeprazol Kapsul 20mg Kap -300 211
Ondansetron Inj 4mg Amp -50 2400
Parasetamol Tablet 500mg Tab -6100 79
Pirantel Tablet 125mg Tab -100 296
Serum Anti Bisa Ular Polivalen Inj.5ml Vial -5 591250
Sianokobalamin (Vit. B12) Inj 500mcg Amp -100 1078

Sanbe ters 0 0
Sinbio Set 0 4500
Zink Tlet 20mg ab Tab -100 474
Catgut/ Benang Bedah No. 2/0 - 3/0 Set -19 22500
Infusion Set Anak Set -30 7920
Implant Set 0 0
Kasa Kompres 40/40 Steril biji -40 1200
Kasa Pembalut 2 m x 80 cm biji -40 9400
Masker biji -250 439
Plester 5 yard x 2 inch biji -10 13000
Silk (Benang Bedah Sutera) No. 3/0 Set -10 20833
TOTAL PENGELUARAN -Rp5,359,711
LAPORAN PENGGUNAAN OBAT-OBAT GENERIK
MENU
PUSKESMAS : CIKEUSIK Bulan : April

KECAMATAN : CIKEUSIK Tahun : 2012
KABUPATEN : PANDEGLANG
PEMASUKAN PENGGUNAAN
NO NAMA SEDIAAN SATUAN SALDO AWAL SALDO AKHIR KET
DARI JUMLAH UNTUK JUMLAH
1 2 3 4 5 6 7 8 9 10
1 Alopurinol tablet 100 mg Tablet 1000 UPT.GUDANG FARMASI 0 PUSKESMAS 0 1000
2 Aminofilin tablet 200 mg Tablet 800 UPT.GUDANG FARMASI 0 PUSKESMAS 0 800
3 Aminofilin injeksi 24mg/ml-10ml Ampul 390 UPT.GUDANG FARMASI 10350 PUSKESMAS 10350 390
4 Amitriptilin HCL Tab. Salut 25 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
5 Amoksisillin Kapsul 250 mg Kapsul 500 UPT.GUDANG FARMASI 0 PUSKESMAS 0 500
7 Amoksisillin Sirup kering 125 mg/5 ml-60 ml Botol 1500 UPT.GUDANG FARMASI 0 PUSKESMAS 450 1050
8 Ampisillin Injeksi 1 gram Vial 3 UPT.GUDANG FARMASI 0 PUSKESMAS 0 3
9 Antalgin (Metampiron) Tab. 500 mg Tablet 5500 UPT.GUDANG FARMASI 10000 PUSKESMAS 5100 10400
Antasida DOEN tablet, kombinasi Magnesium

10 Hidroksida 200 mg + Alumunium Hidroksida 200 Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
mg
Anti Bakteri DOEN Salep Kombinasi :Basitrasin 500

11 IU/g + Poliksin 1000 IU-5 gr Tube 3 UPT.GUDANG FARMASI 0 PUSKESMAS 0 3
12 Anti Hemoroid DOEN Kombinasi Supp 44 UPT.GUDANG FARMASI 600 PUSKESMAS 310 334
Antifungi DOEN Kombinasi : Asam Benzoat 6% +
13 Pot 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
Asam Salisilat 3%-30 gr
Antimigren DOEN Kombinasi : Ergometrin Tartrat 1
14 Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
mg + Kofein 50 mg
15 Antiparkinson DOEN tablet Kombinasi: Karbidopa Tablet 400 UPT.GUDANG FARMASI 6000 PUSKESMAS 4100 2300
25 mg + Levodopa 250 mg
16 Aqua Pro Injeksi Steril, bebas pirogen -20 ml Ampul 0 UPT.GUDANG FARMASI 500 PUSKESMAS 160 340
17 Aquadest steril - 500 ml Botol 90 UPT.GUDANG FARMASI 0 PUSKESMAS 0 90
18 Artemeter Injeksi 80 mg/ml Ampul 30 UPT.GUDANG FARMASI 0 PUSKESMAS 0 30
19 Artesunate Injeksi 60 mg/ml Vial 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
20 Asam Askorbat (Vit. C) Tablet 50 mg Tablet 300 UPT.GUDANG FARMASI 0 PUSKESMAS 0 300
1 2 3 4 5 6 7 8 9 10
23 Asam Folat tablet 5 mg Tablet 26 UPT.GUDANG FARMASI 0 PUSKESMAS 0 26
24 Asetosal Tablet 80 mg Tablet 47 UPT.GUDANG FARMASI 0 PUSKESMAS 47 0
27 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml Ampul 600 UPT.GUDANG FARMASI 1000 PUSKESMAS 0 1600
28 Atropin Sulfat Tablet 1 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
29 Atropin Sulfat Tetes Mata 1% - 5 ml Botol 400 UPT.GUDANG FARMASI 0 PUSKESMAS 0 400
30 Atenolol Tablet 50 mg Tablet 600 UPT.GUDANG FARMASI 2000 PUSKESMAS 2200 400
31 Benzatin Benzil Penisilin Inj. 2,4 Juta IU/Vial Vial 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
32 Betametason Krim 0,1% - 5 gr Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
33 Captopril Tablet 12,5 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
34 Captopril Tablet 25 mg Tablet 600 UPT.GUDANG FARMASI 0 PUSKESMAS 0 600
35 Dapson Tablet 100 mg (Antilepra) Tablet 68 UPT.GUDANG FARMASI 0 PUSKESMAS 0 68
36 Deksametasone Injeksi 5 mg/ml - 1ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
37 Deksametasone Tablet 0,5 mg Tablet 800 UPT.GUDANG FARMASI 0 PUSKESMAS 0 800
38 Dekstromethorfan Sirup 10 mg/ 60 ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
39 Dekstromethorfan Tablet 15 mg Tablet 21 UPT.GUDANG FARMASI 0 PUSKESMAS 0 21
40 Diazepam Injeksi 5 mg/ml - 2ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
41 Diazepam Tablet 2 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
43 Dietilkarbamazin Sitrat Tablet 100 mg Tablet 0 UPT.GUDANG FARMASI 3 PUSKESMAS 0 3
44 Difenhidramin HCL Injeksi 10 mg/ml- 1 ml Ampul 24 UPT.GUDANG FARMASI 0 PUSKESMAS 0 24
45 Digoksin Tablet 0,25 mg Tablet 44 UPT.GUDANG FARMASI 100 PUSKESMAS 71 73
46 Dimenhidrinat Tablet 50 mg Tablet 46 UPT.GUDANG FARMASI 0 PUSKESMAS 0 46
47 Efedrin HCL Tablet 25 ng Tablet 570 UPT.GUDANG FARMASI 0 PUSKESMAS 0 570
48 Ekstrak Belladona Tablet 10 mg Tablet 1150 UPT.GUDANG FARMASI 1000 PUSKESMAS 950 1200
49 Epinefrina HCL/Bitartrat Injeksi 0,1%- 1ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
50 Etakridin (Rivanol) Larutan 0,1%-300 ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
51 Etambutol HCL Tablet 250 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
1 2 3 4 5 6 7 8 9 10
53 Etanol 70%- 1000 ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
54 Eritromisin Kapsul 250 mg Kapsul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
55 Eritromisin Syrup 200 mg/5 ml-60 ml Botol 1750 UPT.GUDANG FARMASI 1000 PUSKESMAS 2100 650
56 Fenitoin Natrium Injeksi 50 mg/ 1 ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
57 Fenitoin Natrium Kapsul 100 mg Kapsul 180 UPT.GUDANG FARMASI 0 PUSKESMAS 0 180
59 Fenobarbital Injeksi 50 mg/ml- 2ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
60 Fenobarbital Tablet 100 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
62 Fenoksimetil Penisilina Tablet 250 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
64 Fitomenadion (Vit. K1) Injeksi 10 mg/ml-1 ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
65 Fitomenadion (Vit. K1) Tab. Salut Gula 10 mg Tablet 43 UPT.GUDANG FARMASI 0 PUSKESMAS 0 43
66 Flour Tablet 0,5 mg Tablet 500 UPT.GUDANG FARMASI 0 PUSKESMAS 0 500
67 Furosemida Tablet 40 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
68 Garam Oralit 200 ml air Kantong 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
69 Glibenklamida Tablet 5 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
70 Gliseril Guaiakolat Tablet 100 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
71 Gliserin - 100 ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
72 Glukosa Larutan Infus 5% Steril - 500 ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
75 Griseofulvin Tablet 125 mg, Micronized Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
76 Haloperidol 0,5 mg Tablet Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
78 Hidroklortiazid (HCT) Tablet 25 mg Tablet 600 UPT.GUDANG FARMASI 0 PUSKESMAS 0 600
79 Hidrokortison Krim 2,5%-5 gr Tablet 80 UPT.GUDANG FARMASI 0 PUSKESMAS 0 80
80 Ibuprofen Tablet 200 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
1 2 3 4 5 6 7 8 9 10
82 Isoniazid Tablet 100 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
84 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 100 UPT.GUDANG FARMASI 0 PUSKESMAS 0 100
85 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
86 Ketamin 10 mg/ml Injeksi- 10 ml Vial 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
87 Klofazimin, mikronize Kapsul 100 mg Kapsul 20 UPT.GUDANG FARMASI 0 PUSKESMAS 0 20
88 Kloramfenikol Kapsul 250 mg Kapsul 30 UPT.GUDANG FARMASI 0 PUSKESMAS 30 0
89 Kloramfenikol Suspensi 125 mg/5 ml-60 ml Botol 100 UPT.GUDANG FARMASI 0 PUSKESMAS 0 100
90 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
91 Klorokuin Tablet 150 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
92 Klorpromazin HCL Injeksi 25 mg/ml- 1ml Ampul 250 UPT.GUDANG FARMASI 0 PUSKESMAS 0 250
93 Klorpromazin HCL Tablet Salut 25 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
95 Kodein HCL Tablet 10 mg Tablet 140 UPT.GUDANG FARMASI 5280 PUSKESMAS 5160 260
96 Paket 550 UPT.GUDANG FARMASI 0 PUSKESMAS 0 550

Kombinasi Artesunate 50mg+Amodiaquin 200mg
Kotrimoksazol Tablet Pediatrik, kombinasi :
Sulfametoksazol 100mg + Trimertopin
Kotrimoksazol Suspensi Kombinasi

98 Sulfametoksazol200mg+Trimetropin40mg/5ml-60 Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
ml
Kotrimoksazol Tab. Kombinasi Sulfametoksazol

400mg+Trimetropin 80mg
100 Kuinin (Kina) Tablet 200 mg Tablet 490 UPT.GUDANG FARMASI 0 PUSKESMAS 0 490
101 Kuinin Injeksi 25%-2ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
102 Levothyroxine Dus 6 UPT.GUDANG FARMASI 24 PUSKESMAS 10 20
103 Lidokain Komp. Injeksi, Kombinasi Ampul 200 UPT.GUDANG FARMASI 0 PUSKESMAS 0 200
104 Lisol, Kresol Tersabun 50%- 1000ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
105 Magnesium Sulfat Serbuk 30 grm Kantong 700 UPT.GUDANG FARMASI 0 PUSKESMAS 0 700
106 Mebendazol Syrup/5ml - 30ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
1 2 3 4 5 6 7 8 9 10
107 Mebendazol Tablet 100mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
Metilergometrin Maleat (Metilergometrin) Tablet
salut 0,125 gram
109 Metilergometrin Maleat inj. 0,200mg- 1ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
110 Metronidazol Tablet 250mg Tablet 25 UPT.GUDANG FARMASI 0 PUSKESMAS 0 25
111 Natrium Bikarbonat Tablet 500mg Tablet 2100 UPT.GUDANG FARMASI 0 PUSKESMAS 900 1200
112 Natrum Klorida Larutan Infus 0,9% Steril-500ml Botol 10 UPT.GUDANG FARMASI 0 PUSKESMAS 0 10
113 Natrium Tiosulfat Injeksi 25%- 10ml Ampul 600 UPT.GUDANG FARMASI 0 PUSKESMAS 450 150
114 Nistatin Tablet Salut 500.000 IU Tablet 80 UPT.GUDANG FARMASI 0 PUSKESMAS 20 60
115 Obat Anti Tuberkulosis Kat. 1 (FDC) Paket 100 UPT.GUDANG FARMASI 3000 PUSKESMAS 1800 1300
116 Obat Anti Tuberkulosis Kat. 2 Paket 6 UPT.GUDANG FARMASI 0 PUSKESMAS 0 6
118 Obat Anti Tuberkulosis Sisipan Dewasa Paket 48 UPT.GUDANG FARMASI 0 PUSKESMAS 0 48
119 Obat Anti Tuberkulosis Kategori Anak Paket 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
120 Obat Batuk Hitam (OBH) Cairan Botol 1000 UPT.GUDANG FARMASI 2000 PUSKESMAS 2300 700
121 Oksitetrasiklin HCL Inj. i.m 50mg/ml- 10ml Vial 998 UPT.GUDANG FARMASI 0 PUSKESMAS 0 998
122 Oksitetrasiklin HCL Salep Mata 1%-3,5gram Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
123 Oksitosin Injeksi 10 IU/ml- 1ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
124 Paraformaldehid Tablet 1gram Tablet 400 UPT.GUDANG FARMASI 0 PUSKESMAS 0 400
125 Parasetamol Syrup 120mg/ 5ml-60ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
126 Parasetamol Tablet 100mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
128 Petidin HCL Injeksi 50mg/ ml-2ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
129 Pilokarpin HCI/Nitrat Tetes Mata 2%- 5ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
130 Pirantel Tablet 125mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
131 Piridoksin HCL (Vit. B6) Tablet 10mg Tablet 9 UPT.GUDANG FARMASI 0 PUSKESMAS 0 9
132 Povidon Iodida 10% 300ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
134 Prednison Tablet 5mg Tablet 72 UPT.GUDANG FARMASI 0 PUSKESMAS 20 52
1 2 3 4 5 6 7 8 9 10
135 Primakuin Tablet 15mg Tablet 110 UPT.GUDANG FARMASI 100 PUSKESMAS 20 190
136 Prokain Benzil Penisilin 3 Juta IU/Vial Inj. -15ml Vial 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
137 Propanolol HCL Tablet 40mg Tablet 1350 UPT.GUDANG FARMASI 0 PUSKESMAS 450 900
138 Reserpin Tablet 0,25mg Tablet 30 UPT.GUDANG FARMASI 0 PUSKESMAS 6 24
139 Retinol (Vitamin A) Kapsul 100.000 IU Kapsul 900 UPT.GUDANG FARMASI 0 PUSKESMAS 0 900
141 Rifampisin Kapsul 300mg Kapsul 113 UPT.GUDANG FARMASI 0 PUSKESMAS 27 86
144 Ringer Laktat Larutan Infus Steril - 500ml Botol 30 UPT.GUDANG FARMASI 50 PUSKESMAS 20 60
145 Salbutamol Tablet 2mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
Salep 2-4, Kombinasi : As. Salisilat 2%+ Blerang
Endap 4% - 30gram
148 Salisil Bedak 2% Kotak 12 UPT.GUDANG FARMASI 60 PUSKESMAS 15 57
149 Serum Anti Bisa Ular Polivalen Inj. 5ml Vial 40 UPT.GUDANG FARMASI 0 PUSKESMAS 0 40
150 Serum Anti Rabies Vial 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
151 Serum Anti Tetanus Inj. 1500 IU/amp (ATS) Ampul 12 UPT.GUDANG FARMASI 80 PUSKESMAS 18 74
152 Serum Anti Tetanus Inj. 20.000 IU/vial (ATS) Vial 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
153 Sianokobalamin (Vit. B12) Injeksi 500mcg Ampul 5 UPT.GUDANG FARMASI 0 PUSKESMAS 0 5
154 Simvastatin Tablet 10 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
155 Streptomisin Sulfat Serbuk Inj. 1000mg/ Vial-15ml Vial 400 UPT.GUDANG FARMASI 2000 PUSKESMAS 900 1500
156 Sulfasetamida Natrium Tetes Mata 15%- 5ml Botol 150 UPT.GUDANG FARMASI 0 PUSKESMAS 0 150
157 Tablet Tambah Darah Komb. : Besi II Sulfat 7Ho Tablet 1800 UPT.GUDANG FARMASI 1800 PUSKESMAS 1600 2000
158 Tetrakain HCL Tetes Mata 0.5%- 5ml Botol 15 UPT.GUDANG FARMASI 0 PUSKESMAS 0 15
159 Tetrasiklin HCL Kapsul 250 mg Kapsul 1 UPT.GUDANG FARMASI 0 PUSKESMAS 0 1
161 Tiamin HCL/Mononitrat (Vit. B1) Tab. 50mg Tablet 4 UPT.GUDANG FARMASI 0 PUSKESMAS 0 4
162 Tiopental Natrium Serbuk Injeksi 1.000mg- 10ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
1 2 3 4 5 6 7 8 9 10
163 Triheksifenidil Hidroklorida Tablet 2mg Tablet 1090 UPT.GUDANG FARMASI 1500 PUSKESMAS 870 1720
164 Vitamin B Komplek Tablet Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
165 Acyclopir Krim 5%- 5gr Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
166 Acyclopir Tablet 200mg Tablet 60 UPT.GUDANG FARMASI 0 PUSKESMAS 0 60
167 Akita Tablet Tablet 1000 UPT.GUDANG FARMASI 3000 PUSKESMAS 2550 1450
168 Albendazol Tablet 400mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
169 Antalgin (Metampiron) Inj. 250mg/ml-2ml Ampul 0 UPT.GUDANG FARMASI 180 PUSKESMAS 80 100
Antasida DOEN II Suspensi, Kombinasi: Alumunium

170 Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
Hidroksida 200mg+Magnesium-60ml
171 Asam Mefenamat 250mg Kapsul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0

173 Asmacare Tablet 2mg Tablet 47 UPT.GUDANG FARMASI 100 PUSKESMAS 54 93
174 Chloramfecort- H Cream - 10gr Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
175 Ciprofloxacin Tablet 500mg Tablet 108 UPT.GUDANG FARMASI 0 PUSKESMAS 25 83
176 Dasabion Tablet Tablet 0 UPT.GUDANG FARMASI 1000 PUSKESMAS 155 845
177 Domperidon Suspensi 5mg/ 5ml- 60ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
178 Gentamisin S.K 0.1%-5 gr Tube 1050 UPT.GUDANG FARMASI 16800 PUSKESMAS 5700 12150
179 Gentamisin Injeksi Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
180 Kloramfenikol Salep Mata 1%-5gram Tube 23 UPT.GUDANG FARMASI 0 PUSKESMAS 0 23
181 Kloramfenikol Tetes Telinga 3%-5ml Botol 435 UPT.GUDANG FARMASI 0 PUSKESMAS 0 435
182 Metoklorpropamid Tablet 10 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
183 Mikonazol Krim/ Salep 2%-10gram Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
184 Multivitamin Anak Tablet 600 UPT.GUDANG FARMASI 0 PUSKESMAS 0 600
185 Multivitamin Dewasa Botol 300 UPT.GUDANG FARMASI 0 PUSKESMAS 0 300
186 Neuorovit E Tablet Tablet 16 UPT.GUDANG FARMASI 0 PUSKESMAS 2 14
187 Nisagon Cream 5 gram Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
188 Novadryl Syrup/ Holydril Syrup-60ml Botol 900 UPT.GUDANG FARMASI 2500 PUSKESMAS 2300 1100
189 Oksitetrasiklin HCL Salep 3%- 5gram Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
190 Piroksikam Tablet 20 mg Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
1 2 3 4 5 6 7 8 9 10
192 Ranitidin Injeksi 25 mg/ 2ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
193 Ranitidin Tablet 150 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
194 Tiamin HCL (Vit. B1) Injeksi 100mg/ 1ml Ampul 2 UPT.GUDANG FARMASI 0 PUSKESMAS 0 2
195 Magnesium Sulfat Inj. 25 ml Vial 500 UPT.GUDANG FARMASI 0 PUSKESMAS 0 500
196 Seftriakson inj. 1g Ampul 4000 UPT.GUDANG FARMASI 0 PUSKESMAS 0 4000
Mengetahui PANDEGLANG 10 Mei 2012

Kepala Puskesmas Pengelola Obat

NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
MENU
PUSKESMAS : CIKEUSIK Bulan : Mei

1 2 3 4 5 6 7 8 9 10

mg

mg + Kofein 50 mg
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10


ml

1 2 3 4 5 6 7 8 9 10
salut 0,125 gram
122 Oksitetrasiklin HCL Salep Mata 1%-3,5gram Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
1 2 3 4 5 6 7 8 9 10
Endap 4% - 30gram
1 2 3 4 5 6 7 8 9 10


179 Gentamisin Injeksi Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 0 0
1 2 3 4 5 6 7 8 9 10


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
MENU
PUSKESMAS : CIKEUSIK Bulan : Juni

1 2 3 4 5 6 7 8 9 10
1 Alopurinol tablet 100 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
2 Aminofilin tablet 200 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
3 Aminofilin injeksi 24mg/ml-10ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
4 Amitriptilin HCL Tab. Salut 25 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
5 Amoksisillin Kapsul 250 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
6 Amoksisillin Kapsul 500 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
7 Amoksisillin Sirup kering 125 mg/5 ml-60 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
8 Ampisillin Injeksi 1 gram Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
9 Antalgin (Metampiron) Tab. 500 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509

10 Hidroksida 200 mg + Alumunium Hidroksida 200 Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
mg

11 IU/g + Poliksin 1000 IU-5 gr Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
12 Anti Hemoroid DOEN Kombinasi Supp Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
13 Pot Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
14 Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
mg + Kofein 50 mg
15 Antiparkinson DOEN tablet Kombinasi: Karbidopa Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
16 Aqua Pro Injeksi Steril, bebas pirogen -20 ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
17 Aquadest steril - 500 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
18 Artemeter Injeksi 80 mg/ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
19 Artesunate Injeksi 60 mg/ml Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
20 Asam Askorbat (Vit. C) Tablet 50 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
21 Asam Askorbat (Vit. C) Tablet 250 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
1 2 3 4 5 6 7 8 9 10
22 Asam Folat tablet 1 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509
23 Asam Folat tablet 5 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
24 Asetosal Tablet 80 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
27 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
28 Atropin Sulfat Tablet 1 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
29 Atropin Sulfat Tetes Mata 1% - 5 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
30 Atenolol Tablet 50 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
31 Benzatin Benzil Penisilin Inj. 2,4 Juta IU/Vial Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
32 Betametason Krim 0,1% - 5 gr Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
33 Captopril Tablet 12,5 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
34 Captopril Tablet 25 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
35 Dapson Tablet 100 mg (Antilepra) Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
36 Deksametasone Injeksi 5 mg/ml - 1ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
37 Deksametasone Tablet 0,5 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
38 Dekstromethorfan Sirup 10 mg/ 60 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
39 Dekstromethorfan Tablet 15 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
40 Diazepam Injeksi 5 mg/ml - 2ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
41 Diazepam Tablet 2 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
42 Diazepam Tablet 5 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
43 Dietilkarbamazin Sitrat Tablet 100 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
44 Difenhidramin HCL Injeksi 10 mg/ml- 1 ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
45 Digoksin Tablet 0,25 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
46 Dimenhidrinat Tablet 50 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
47 Efedrin HCL Tablet 25 ng Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
48 Ekstrak Belladona Tablet 10 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
49 Epinefrina HCL/Bitartrat Injeksi 0,1%- 1ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
50 Etakridin (Rivanol) Larutan 0,1%-300 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
51 Etambutol HCL Tablet 250 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
1 2 3 4 5 6 7 8 9 10
52 Etambutol HCL Tablet 500 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
53 Etanol 70%- 1000 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
54 Eritromisin Kapsul 250 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
55 Eritromisin Syrup 200 mg/5 ml-60 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
56 Fenitoin Natrium Injeksi 50 mg/ 1 ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
57 Fenitoin Natrium Kapsul 100 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
58 Fenitoin Natrium Kapsul 30 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
59 Fenobarbital Injeksi 50 mg/ml- 2ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
60 Fenobarbital Tablet 100 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
61 Fenobarbital Tablet 30 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
62 Fenoksimetil Penisilina Tablet 250 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
63 Fenoksimetil Penisilina Tablet 500 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
64 Fitomenadion (Vit. K1) Injeksi 10 mg/ml-1 ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
65 Fitomenadion (Vit. K1) Tab. Salut Gula 10 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
66 Flour Tablet 0,5 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
67 Furosemida Tablet 40 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
68 Garam Oralit 200 ml air Kantong Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
69 Glibenklamida Tablet 5 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
70 Gliseril Guaiakolat Tablet 100 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
71 Gliserin - 100 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
72 Glukosa Larutan Infus 5% Steril - 500 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
75 Griseofulvin Tablet 125 mg, Micronized Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
76 Haloperidol 0,5 mg Tablet Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
77 Haloperidol 1,5 mg Tablet Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
78 Hidroklortiazid (HCT) Tablet 25 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
79 Hidrokortison Krim 2,5%-5 gr Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
80 Ibuprofen Tablet 200 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
1 2 3 4 5 6 7 8 9 10
81 Ibuprofen Tablet 400 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
82 Isoniazid Tablet 100 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
83 Isoniazid Tablet 300 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
84 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
85 Kalsium Laktat (Kalk) Tablet 500 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
86 Ketamin 10 mg/ml Injeksi- 10 ml Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
87 Klofazimin, mikronize Kapsul 100 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
88 Kloramfenikol Kapsul 250 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
89 Kloramfenikol Suspensi 125 mg/5 ml-60 ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
90 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
91 Klorokuin Tablet 150 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
92 Klorpromazin HCL Injeksi 25 mg/ml- 1ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
93 Klorpromazin HCL Tablet Salut 25 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
94 Klorpromazin HCL Tablet Salut 100 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
95 Kodein HCL Tablet 10 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
96 Paket Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509


98 Sulfametoksazol200mg+Trimetropin40mg/5ml-60 Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
ml

100 Kuinin (Kina) Tablet 200 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
101 Kuinin Injeksi 25%-2ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
102 Levothyroxine Dus Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
103 Lidokain Komp. Injeksi, Kombinasi Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
104 Lisol, Kresol Tersabun 50%- 1000ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
105 Magnesium Sulfat Serbuk 30 grm Kantong Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
106 Mebendazol Syrup/5ml - 30ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
1 2 3 4 5 6 7 8 9 10
107 Mebendazol Tablet 100mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
salut 0,125 gram
109 Metilergometrin Maleat inj. 0,200mg- 1ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
110 Metronidazol Tablet 250mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
111 Natrium Bikarbonat Tablet 500mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
112 Natrum Klorida Larutan Infus 0,9% Steril-500ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
113 Natrium Tiosulfat Injeksi 25%- 10ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
114 Nistatin Tablet Salut 500.000 IU Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
115 Obat Anti Tuberkulosis Kat. 1 (FDC) Paket Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
116 Obat Anti Tuberkulosis Kat. 2 Paket Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
117 Obat Anti Tuberkulosis Kat. 3 Paket Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
118 Obat Anti Tuberkulosis Sisipan Dewasa Paket Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
119 Obat Anti Tuberkulosis Kategori Anak Paket Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
120 Obat Batuk Hitam (OBH) Cairan Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
121 Oksitetrasiklin HCL Inj. i.m 50mg/ml- 10ml Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
122 Oksitetrasiklin HCL Salep Mata 1%-3,5gram Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
123 Oksitosin Injeksi 10 IU/ml- 1ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
124 Paraformaldehid Tablet 1gram Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
125 Parasetamol Syrup 120mg/ 5ml-60ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
126 Parasetamol Tablet 100mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
127 Parasetamol Tablet 500mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
128 Petidin HCL Injeksi 50mg/ ml-2ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
129 Pilokarpin HCI/Nitrat Tetes Mata 2%- 5ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
130 Pirantel Tablet 125mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
131 Piridoksin HCL (Vit. B6) Tablet 10mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
132 Povidon Iodida 10% 300ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
133 Povidon Iodida 10% 1000ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
134 Prednison Tablet 5mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
1 2 3 4 5 6 7 8 9 10
135 Primakuin Tablet 15mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
136 Prokain Benzil Penisilin 3 Juta IU/Vial Inj. -15ml Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
137 Propanolol HCL Tablet 40mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
138 Reserpin Tablet 0,25mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
139 Retinol (Vitamin A) Kapsul 100.000 IU Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
140 Retinol (Vitamin A) Kapsul 200.000 IU Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
141 Rifampisin Kapsul 300mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
144 Ringer Laktat Larutan Infus Steril - 500ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
145 Salbutamol Tablet 2mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
146 Salbutamol Tablet 4mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
147 Pot Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
Endap 4% - 30gram
148 Salisil Bedak 2% Kotak Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
149 Serum Anti Bisa Ular Polivalen Inj. 5ml Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
150 Serum Anti Rabies Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
151 Serum Anti Tetanus Inj. 1500 IU/amp (ATS) Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
152 Serum Anti Tetanus Inj. 20.000 IU/vial (ATS) Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
153 Sianokobalamin (Vit. B12) Injeksi 500mcg Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
154 Simvastatin Tablet 10 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
155 Streptomisin Sulfat Serbuk Inj. 1000mg/ Vial-15ml Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
156 Sulfasetamida Natrium Tetes Mata 15%- 5ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
157 Tablet Tambah Darah Komb. : Besi II Sulfat 7Ho Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
158 Tetrakain HCL Tetes Mata 0.5%- 5ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
159 Tetrasiklin HCL Kapsul 250 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
160 Tetrasiklin HCL Kapsul 500 mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
161 Tiamin HCL/Mononitrat (Vit. B1) Tab. 50mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
162 Tiopental Natrium Serbuk Injeksi 1.000mg- 10ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
1 2 3 4 5 6 7 8 9 10
163 Triheksifenidil Hidroklorida Tablet 2mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
164 Vitamin B Komplek Tablet Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
165 Acyclopir Krim 5%- 5gr Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
166 Acyclopir Tablet 200mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
167 Akita Tablet Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
168 Albendazol Tablet 400mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
169 Antalgin (Metampiron) Inj. 250mg/ml-2ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509

170 Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
171 Asam Mefenamat 250mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
172 Asam Mefenamat 500mg Kapsul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
173 Asmacare Tablet 2mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
174 Chloramfecort- H Cream - 10gr Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
175 Ciprofloxacin Tablet 500mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
176 Dasabion Tablet Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
177 Domperidon Suspensi 5mg/ 5ml- 60ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
178 Gentamisin S.K 0.1%-5 gr Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
179 Gentamisin Injeksi Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
180 Kloramfenikol Salep Mata 1%-5gram Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
181 Kloramfenikol Tetes Telinga 3%-5ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
182 Metoklorpropamid Tablet 10 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
183 Mikonazol Krim/ Salep 2%-10gram Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
184 Multivitamin Anak Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
185 Multivitamin Dewasa Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
186 Neuorovit E Tablet Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
187 Nisagon Cream 5 gram Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
188 Novadryl Syrup/ Holydril Syrup-60ml Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
189 Oksitetrasiklin HCL Salep 3%- 5gram Tube Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
190 Piroksikam Tablet 20 mg Botol Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
1 2 3 4 5 6 7 8 9 10
192 Ranitidin Injeksi 25 mg/ 2ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
193 Ranitidin Tablet 150 mg Tablet Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
194 Tiamin HCL (Vit. B1) Injeksi 100mg/ 1ml Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
195 Magnesium Sulfat Inj. 25 ml Vial Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509
196 Seftriakson inj. 1g Ampul Err:509 UPT.GUDANG FARMASI Err:509 PUSKESMAS Err:509 Err:509


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
MENU
PUSKESMAS : CIKEUSIK Bulan : Juli

1 2 3 4 5 6 7 8 9 10

mg

mg + Kofein 50 mg
1 2 3 4 5 6 7 8 9 10
22 Asam Folat tablet 1 mg Tablet 14 UPT.GUDANG FARMASI 0 PUSKESMAS 12
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10


ml

1 2 3 4 5 6 7 8 9 10
salut 0,125 gram
122 Oksitetrasiklin HCL Salep Mata 1%-3,5gram Tube STOK AWAL UPT.GUDANG FARMASI PENERI-MAAN PUSKESMAS PEMA-KAIAN #VALUE!
1 2 3 4 5 6 7 8 9 10
Endap 4% - 30gram
1 2 3 4 5 6 7 8 9 10

179 Gentamisin Injeksi Ampul STOK AWAL UPT.GUDANG FARMASI PENERI-MAAN PUSKESMAS PEMA-KAIAN #VALUE!
1 2 3 4 5 6 7 8 9 10
Mengetahui PANDEGLANG Juli 2012


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
MENU
PUSKESMAS : CIKEUSIK Bulan : Agustus

1 2 3 4 5 6 7 8 9 10
3 Aminofilin injeksi 24mg/ml-10ml Ampul 120 UPT.GUDANG FARMASI 0 PUSKESMAS 150 -30

mg

11 IU/g + Poliksin 1000 IU-5 gr Tube 6 UPT.GUDANG FARMASI 0 PUSKESMAS 20 -14
mg + Kofein 50 mg
15 Antiparkinson DOEN tablet Kombinasi: Karbidopa Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 200 -200
1 2 3 4 5 6 7 8 9 10
22 Asam Folat tablet 1 mg Tablet 2 UPT.GUDANG FARMASI 0 PUSKESMAS 0
23 Asam Folat tablet 5 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 20 -20
25 Asetosal Tablet 100 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 200 -200
48 Ekstrak Belladona Tablet 10 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 450 -450
1 2 3 4 5 6 7 8 9 10
58 Fenitoin Natrium Kapsul 30 mg Kapsul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 1100 -1100
66 Flour Tablet 0,5 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 300 -300
72 Glukosa Larutan Infus 5% Steril - 500 ml Botol 13 UPT.GUDANG FARMASI 0 PUSKESMAS 600 -587
74 Glukosa Larutan Infus 40% Steril - 25 ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 9 -9
1 2 3 4 5 6 7 8 9 10
94 Klorpromazin HCL Tablet Salut 100 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 300 -300
95 Kodein HCL Tablet 10 mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 1000 -1000


ml

106 Mebendazol Syrup/5ml - 30ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 21 -21
1 2 3 4 5 6 7 8 9 10
salut 0,125 gram
113 Natrium Tiosulfat Injeksi 25%- 10ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 150 -150
120 Obat Batuk Hitam (OBH) Cairan Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 1000 -1000
122 Oksitetrasiklin HCL Salep Mata 1%-3,5gram Tube STOK AKHIR UPT.GUDANG FARMASI 0 PUSKESMAS 0 #VALUE!
123 Oksitosin Injeksi 10 IU/ml- 1ml Ampul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 200 -200
128 Petidin HCL Injeksi 50mg/ ml-2ml Ampul 30 UPT.GUDANG FARMASI 0 PUSKESMAS 85 -55
131 Piridoksin HCL (Vit. B6) Tablet 10mg Tablet 18 UPT.GUDANG FARMASI 0 PUSKESMAS 40 -22
132 Povidon Iodida 10% 300ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 20 -20
134 Prednison Tablet 5mg Tablet 73 UPT.GUDANG FARMASI 0 PUSKESMAS 100 -27
1 2 3 4 5 6 7 8 9 10
135 Primakuin Tablet 15mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 20 -20
142 Rifampisin Kapsul 450mg Kapsul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 300 -300
143 Rifampisin Kapsul 600mg Kapsul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 9 -9
144 Ringer Laktat Larutan Infus Steril - 500ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 45 -45
145 Salbutamol Tablet 2mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 200 -200
147 Pot 0 UPT.GUDANG FARMASI 0 PUSKESMAS 450 -450
Endap 4% - 30gram
151 Serum Anti Tetanus Inj. 1500 IU/amp (ATS) Ampul 5 UPT.GUDANG FARMASI 0 PUSKESMAS 13 -8
1 2 3 4 5 6 7 8 9 10
168 Albendazol Tablet 400mg Tablet 14 UPT.GUDANG FARMASI 0 PUSKESMAS 30 -16

172 Asam Mefenamat 500mg Kapsul 0 UPT.GUDANG FARMASI 0 PUSKESMAS 11 -11
175 Ciprofloxacin Tablet 500mg Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 150 -150
177 Domperidon Suspensi 5mg/ 5ml- 60ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 1500 -1500
179 Gentamisin Injeksi Ampul STOK AKHIR UPT.GUDANG FARMASI 0 PUSKESMAS 0 #VALUE!
180 Kloramfenikol Salep Mata 1%-5gram Tube 0 UPT.GUDANG FARMASI 0 PUSKESMAS 100 -100
181 Kloramfenikol Tetes Telinga 3%-5ml Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 250 -250
184 Multivitamin Anak Tablet 0 UPT.GUDANG FARMASI 0 PUSKESMAS 1100 -1100
190 Piroksikam Tablet 20 mg Botol 0 UPT.GUDANG FARMASI 0 PUSKESMAS 100 -100
1 2 3 4 5 6 7 8 9 10


NIP. 19710804 199103 2 002 NIP. 19820422 200801 2 006
FORMULIR KOMPILASI DATA PERESEPAN TINGKAT KECAMATAN
MENU
Puskesmas : Cikeusik Bulan : Januari-Maret

Pengolahan Data : Puskesmas Cikeusik Tahun : 2012
JUMLAH R/ ANTIBIOTIK PADA ISPA NP ANTIBIOTIK PADA DIARE NS INJEKSI PADA MYALGIA JML GENERIK
JUMLAH
UNIT NAMA PUSKESMAS JUMLAH JUMLAH JUMLAH
SAMPEL TOTAL @ TOTAL % TOTAL % TOTAL % TOTAL %
SAMPEL SAMPEL SAMPEL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 PUSKESMAS INDUK 1020 4080 4 1005 1005 100.00 0 0 #DIV/0! 15 3 20.00 4080 100.00
TOTAL SAMPEL
RATA-RATA R/ KECAMATAN
PROSENTASE AB KECAMATAN
PROSENTASE INJ. KECAMATAN
PROSENTASE GENERIK
MENU
Kecamatan : Cikeusik Bulan : April-Juni

JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 PUSKESMAS 1376 4128 3 981 981 100 360 329 91.39 35 5 14.29 4128 100
TOTAL SAMPEL
PROSENTASE GENERIK
MENU
Kecamatan : Cikeusik Bulan : Juli

JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 PUSKESMAS 500 2000 4 200 200 100 200 100 0.5 100 10 10 2000 100
TOTAL SAMPEL
PROSENTASE GENERIK
MENU
Kecamatan : Bulan : Agustus

Pengolahan Data : Tahun : 2012
JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
TOTAL SAMPEL
PROSENTASE GENERIK
MENU
Kecamatan : Bulan : September

Pengolahan Data : Tahun : 2012
JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 PUSKESMAS INDUK
TOTAL SAMPEL
PROSENTASE GENERIK
DINAS KESEHATAN
UPT. PUSKESMAS CIKEUSIK Perhitungan Saldo Persediaan
per 31 Maret 2015
Alamat : Jl. Alun-alun Selatan No.4 Cikeusik-Pandeglang. Kode pos 42286
JUMLAH KUANTITAS PERSEDIAAN
NO NAMA / JENIS BARANG KODE SATUAN HARGA SATUAN Mutasi Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
II OBAT-OBATAN : II
1 Alopurinol tablet 100 mg Tab 86 0 0 0 0 - 1
2 Aminofilin tablet 200 mg Tab 80 800 0 0 800 64,000 2
3 Albendazol Amp 406 390 0 0 390 158,340 3
4 Aminofilin injeksi 24mg/ml-10ml Tab 3240 0 0 0 0 - 4
5 Amitriptilin HCL Tab. Salut 25 mg Kap 112 500 0 0 500 56,000 5
6 Amlodipine 10 mg Tablet Kap 330 1160 0 0 1160 382,800 6
7 Amlodipine Besilate 5mg tablet Btl 187 1500 0 0 1500 280,500 7
8 Amoksisillin Kapsul 250 mg Vial 238 3 0 0 3 714 8
9 Amoksisillin Kapsul 500 mg Tab 261 5500 0 0 5500 1,435,500 9
10 Amoksisillin SK 125 mg/5 ml-60 ml Tab 2445 0 0 0 0 - 10
11 Am oxsillin aserbuk 1gr Inj Tube 7396 3 0 0 3 22,188 11
12 Amoksilin sk Forte Supp 4045 44 0 0 44 177,980 12
13 Ampisillin Injeksi 1 gram Pot 3850 40 0 0 40 154,000 13
14 Antalgin (Metampiron) Tab. 500 mg Tab 0 0 0 0 0 - 14
15 Antasida DOEN tablet Tab 72 400 0 0 400 28,800 15
16 Antasida DOEN suspensi Ampl 2140 0 0 0 0 - 16
17 Anti Bakteri DOEN Salep Kombinasi Btl 2516 90 0 0 90 226,440 17
18 Anti Hemoroid DOEN Kombinasi Amp 3045 30 0 0 30 91,350 18
19 Antifungi DOEN Kombinasi Vial 155 0 0 0 0 - 19
20 Antimigren DOEN Kombinasi Tab 135 300 0 0 300 40,500 20
21 Antiparkinson DOEN tab. Kombinasi Tab 1500 0 0 0 0 - 21
22 Aqua roinjek Steril Tab 2200 26 0 0 26 57,200 22
23 Acyclopir Krim 5%- 5gr Tab 5049 47 0 0 47 237,303 23
24 Acyclopir Tablet 200mg Tab 237 700 0 0 700 165,900 24
25 Acyclopir Tablet 400 mg Tab 336 500 0 0 500 168,000 25
3,747,515

NO NAMA / JENIS BARANG KODE SATUAN HARGA SATUAN Mutasi
Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
26 Akita Tablet Tab 418 600 0 0 600 250,800 26
27 Antalgin (Metampiron) Inj. 250mg/2ml Amp 109 0 0 0 0 - 27
28 Asam Mefenamat 250mg Tab 0 400 0 0 400 - 28
29 Asam Mefenamat 500mg Btl 265 600 0 0 600 159,000 29
30 Asmacare Tablet 2mg Tab 0 0 0 0 0 - 30
31 Artemeter Injeksi 80 mg/ml Vial 85 0 0 0 0 - 31
32 Artesunate Injeksi 60 mg/ml Tube 2700 0 0 0 0 - 32
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 0 600 0 0 600 - 33
34 Asam Askorbat (Vit. C) Tablet 250 mg Tab 2368 68 0 0 68 161,024 34
35 Asam Folat tablet 1 mg Tab 0 0 0 0 0 - 35
36 Asam Folat tablet 5 mg Amp 0 800 0 0 800 - 36
37 Asetosal Tablet 80 mg Tab 800 0 0 0 0 - 37
38 Asetosal Tablet 100 mg Btl 12650 21 0 0 21 265,650 38
40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 1300 100 0 0 100 130,000 40
41 Atropin Sulfat Tablet 0,5 mg Tab 74 0 0 0 0 - 41
42 Atropin Sulfat Tetes Mata 1% - 5 ml Tab 0 0 0 0 0 - 42
43 Atenolol Tablet 50 mg Tab 0 0 0 0 0 - 43
44 Benzatin Benzil Penisilin Inj. 2,4 Juta Amp 0 24 0 0 24 - 44
45 Betametason Krim 0,1% - 5 gr Tab 1520 44 0 0 44 66,880 45
46 Bisacodril sup Tab 5045 46 0 0 46 232,070 46
47 Bisoprolol 5mg tab Tab 645 570 0 0 570 367,650 47
48 Captopril Tablet 12,5 mg Tab 62 1150 0 0 1150 71,300 48
49 Captopril Tablet 25 mg Amp 84 0 0 0 0 - 49
50 Chloramfecort- H Cream - 10gr Btl 0 0 0 0 0 - 50
51 Cefadroxil 500mg Tab 509 0 0 0 0 - 51
53 Cefadroxil syr Btl 5895 0 0 0 0 - 53
1,704,374

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
54 Ciprofloxacin Infus Kap 39900 0 0 0 0 - 54
55 Ciprofloxacin Tablet 500mg Btl 255 1750 0 0 1750 446,250 55
56 Dapson Tablet 100 mg (Antilepra) Amp 2484 0 0 0 0 - 56
57 Deksametasone Injeksi 5 mg/ml - 1ml Kap 1580 180 0 0 180 284,400 57
58 Deksametasone Tablet 0,5 mg Kap 62 200 0 0 200 12,400 58
59 Dekstromethorfan Sirup 10 mg/ 60 ml Amp 6600 0 0 0 0 - 59
60 Dekstromethorfan Tablet 15 mg Tab 4000 0 0 0 0 - 60
61 Diazepam Injeksi 5 mg/ml - 2ml Tab 4180 57 0 0 57 238,260 61
62 Diazepam Tablet 2 mg Tab 45 0 0 0 0 - 62
64 Dietilkarbamazin Sitrat Tablet 100 mg Amp 960 0 0 0 0 - 64
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 52 43 0 0 43 2,236 65
66 Digoksin Tablet 0,25 mg Tab 129 500 0 0 500 64,500 66
67 Domperidon 10 mgtablet Tab 167 0 0 0 0 - 67
68 Dimenhidrinat Tablet 50 mg Ktg 8799 0 0 0 0 - 68
69 Dasabion Tablet Tab 0 0 0 0 0 - 69
70 Domperidon Suspensi 5mg/ 5ml- 60ml Tab 3333 -6 0 0 -6 (19,998) 70
71 Efedrin HCL Tablet 25 mg Btl 8100 0 0 0 0 - 71
72 Ekstrak Belladona Tablet 10 mg Btl 31 0 0 0 0 - 72
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Btl 1200 105 0 0 105 126,000 73
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 24 31 0 0 31 744 74
75 Etambutol HCL Tablet 250 mg Tab 0 0 0 0 0 - 75
77 Etanol 70%- 1000 ml Tab 1500 0 0 0 0 - 77
78 Eritromisin Kapsul 250 mg Tab 930 600 0 0 600 558,000 78
79 Eritromisin Syrup 200 mg/5 ml-60 ml Tab 1125 80 0 0 80 90,000 79
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 9900 0 0 0 0 - 80
81 Fenitoin Natrium Kapsul 100 mg Tab 133 0 0 0 0 - 81
1,802,792

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
83 Fenobarbital Injeksi 50 mg/ml- 2ml Tab 0 52 0 0 52 - 83
84 Fenobarbital Tablet 100 mg Tab 130 100 0 0 100 13,000 84
85 Fenobarbital Tablet 30 mg Tab 0 0 0 0 0 - 85
86 Fenoksimetil Penisilina Tablet 250 mg Vial 0 0 0 0 0 - 86
87 Fenoksimetil Penisilina Tablet 500 mg Kap 7200 20 0 0 20 144,000 87
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Kap 3417 30 0 0 30 102,510 88
89 Fitomenadion (Vit. K1) Tab. 10 mg Btl 579 100 0 0 100 57,900 89
90 Flour Tablet 0,5 mg Tab 895 0 0 0 0 - 90
91 Furosemida Tablet 40 mg Tab 75 0 0 0 0 - 91
92 Garam Oralit 200 ml air Amp 380 250 0 0 250 95,000 92
93 Glimepirid 4mg Tablet Tab 430 0 0 0 0 - 93
94 Glibenklamida Tablet 5 mg Tab 56 500 0 0 500 28,000 94
95 Gliseril Guaiakolat Tablet 100 mg Tab 56 140 0 0 140 7,840 95
96 Gliserin - 100 ml Pkt 0 550 0 0 550 - 96
97 Glukosa Lar. Infus 5% Steril - 500 ml Tab 5200 44 0 0 44 228,800 97
98 Glukosa Lar. Infus 10% Steril - 500 ml Btl 1675 0 0 0 0 - 98
99 Glukosa Lar. Infus 40% Steril - 25 ml Tab 1785 0 0 0 0 - 99
100 Griseofulvin Tablet 125 mg, Micron Tab 219 490 0 0 490 107,310 100
101 Gentamisin S.K 0.1%-5 gr Amp 4113 0 0 0 0 - 101
102 Gentamisin Injeksi Dus 3696 14 0 0 14 51,744 102
103 Haloperidol 0,5 mg Tablet Amp 96 200 0 0 200 19,200 103
104 Haloperidol 1,5 mg Tablet Btl 126 0 0 0 0 - 104
105 Hidroklortiazid (HCT) Tablet 25 mg Ktg 14 700 0 0 700 9,800 105
106 Hidrokortison Krim 2,5%-5 gr Btl 2798 0 0 0 0 - 106
107 Ibuprofen Tablet 200 mg Tab 110 0 0 0 0 - 107
109 Isoniazid Tablet 100 mg Amp 88 0 0 0 0 - 109
865,104

NO NAMA / JENIS BARANG KODE SATUAN
HARGA SATUAN
Mutasi
Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
110 Isoniazid Tablet 300 mg Tab 97 25 0 0 25 2,425 110
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 2570 2100 0 0 2100 5,397,000 111
112 Ketokonazol krom Btl 2569 10 0 0 10 25,690 112
113 Ketokonazol tab 200mg Amp 300 600 0 0 600 180,000 113
114 Ketorolac Inj 30mg Tab 2300 80 0 0 80 184,000 114
115 Kalsium Laktat (Kalk) Tablet 500 mg Pkt 47 100 0 0 100 4,700 115
116 Ketamin 10 mg/ml Injeksi- 10 ml Pkt 5200 6 0 0 6 31,200 116
117 Klofazimin, mikronize Kapsul 100 mg Pkt 97 40 0 0 40 3,880 117
118 Kloramfenikol Kapsul 250 mg Pkt 733 48 0 0 48 35,184 118
119 Kloramfenikol Suspensi 125 mg/60 ml Pkt 3800 0 0 0 0 - 119
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Btl 0 1000 0 0 1000 - 120
121 Klorokuin Tablet 150 mg Vial 0 998 0 0 998 - 121
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 5744 0 0 0 0 - 122
123 Klorpromazin HCL Tablet Salut 25 mg Amp 0 0 0 0 0 - 123
124 Klorpromazin HCL Tablet Salut 100 mg Tab 0 400 0 0 400 - 124
125 Kodein HCL Tablet 10 mg Btl 250 0 0 0 0 - 125
126 Komb. Artesunate 50mg+Amodiaquin 200mg Tab 0 0 0 0 0 - 126
127 Kotrimoksazol Tablet 480mg Tab 700 3100 0 0 3100 2,170,000 127
128 Kotrimoksazol Suspensi Kombinasi Amp 2145 100 0 0 100 214,500 128
129 Kotrimoksazol Tab. Kombinasi Btl 138 0 0 0 0 - 129
130 Kuinin (Kina) Tablet 200 mg Tab 7700 0 0 0 0 - 130
131 Kloramfenikol Salep Mata 1%-5gram Tab 1450 9 0 0 9 13,050 131
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 1797 0 0 0 0 - 132
133 Kuinin Injeksi 25%-2ml Btl 4750 5 0 0 5 23,750 133
134 Levoploxasin 500mh Tab 528 72 0 0 72 38,016 134
135 Lidokain Komp. Injeksi, Kombinasi Tab 1295 110 0 0 110 142,450 135
136 Lisol, Kresol Tersabun 50%- 1000ml Vial 3360 0 0 0 0 - 136
137 Loperamide Hcl 2mg Tanlet Tab 89 1350 0 0 1350 120,150 137
8,585,995

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
138 Mebendazol Syrup/5ml - 30ml Tab 4100 30 0 0 30 123,000 138
139 Mebendazol Tablet 100mg Kap 0 900 0 0 900 - 139
140 Metilergometrin Maleat Tab. 0,125 g Kap 154 550 0 0 550 84,700 140
141 Metilergometrin M inj. 0,200mg- 1ml Kap 2750 113 0 0 113 310,750 141
142 Metoklorpropamid Tablet 10 mg Kap 91 0 0 0 0 - 142
143 Mikonazol Krim/ Salep 2%-10gram Kap 3000 23 0 0 23 69,000 143
144 Multivitamin Anak Btl 11500 30 0 0 30 345,000 144
145 Multivitamin Dewasa Tab 640 0 0 0 0 - 145
146 Metronidazol Infus 500mg/100ml Tab 9950 0 0 0 0 - 146
147 Metronidazol Tablet 500mg Pot 160 0 0 0 0 - 147
148 Magnesium Sulfat Inj. 25 ml Ktk 0 12 0 0 12 - 148
149 Minyak kayu putih Vial 8000 40 0 0 40 320,000 149
150 Natrium Bikarbonat Tablet 500mg Vial 0 0 0 0 0 - 150
151 Natrum Klorida Lar. Inf. 0,9% -500ml Amp 4700 12 0 0 12 56,400 151
152 Natrium Diclopenac 20mg Vial 133 0 0 0 0 - 152
153 Nistatin Tablet Salut 500.000 IU Amp 0 5 0 0 5 - 153
154 Natrium Diclopenac 50mg Tab 176 0 0 0 0 - 154
155 Nisagon Cream 5 gram Vial 0 400 0 0 400 - 155
156 Novadryl Syrup/ Holydril Syrup-60ml Btl 0 150 0 0 150 - 156
157 Obat Anti Tuberkulosis Kat. 1 (FDC) Tab 359619 1800 0 0 1800 647,314,200 157
158 Obat Anti Tuberkulosis Kat. 2 Btl 1199990 0 0 0 0 - 158
159 Obat Anti Tuberkulosis Kat. 3 Kap 0 0 0 0 0 - 159
160 OAT Sisipan Dewasa Kap 0 0 0 0 0 - 160
161 Omeprazol inj 40mg/10ml Tab 36000 4 0 0 4 144,000 161
162 Omeprazol Kapsul 20mg Amp 211 0 0 0 0 - 162
163 Ondansetron Inj 4mg Tab 2400 1090 0 0 1090 2,616,000 163
164 Onadansetron 8mg Tablet Tab 1189 0 0 0 0 - 164
165 Onadansetron 4mg Tablet Tube 716 0 0 0 0 - 165
651,383,050

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
166 OAT Kategori Anak Tab 0 60 0 0 60 - 166
167 Obat Batuk Hitam (OBH) Cairan Tab 5663 1000 0 0 1000 5,663,000 167
168 Obat Batuk Dewasa Tab 5500 0 0 0 0 - 168
169 Oksitetrasiklin HCL Inj. i.m 50mg10ml Amp 0 0 0 0 0 - 169
170 Oksitetrasiklin HCL SM 1%-3,5gram Btl 1750 0 0 0 0 - 170
171 Oksitetrasiklin HCL Salep 3%- 5gram Kap 1450 0 0 0 0 - 171
172 Oksitosin Injeksi 10 IU/ml- 1ml Kap 2200 0 0 0 0 - 172
173 OBAT Anti Diare suspensi Tab 7150 47 0 0 47 336,050 173
174 Paraformaldehid Tablet 1gram Tube 0 0 0 0 0 - 174
175 Parasetamol Syrup 120mg/ 5ml-60ml Tab 1438 108 0 0 108 155,304 175
176 Parasetamol Tablet 100mg Tab 5200 0 0 0 0 - 176
177 Parasetamol Tablet 500mg Btl 79 0 0 0 0 - 177
178 Petidin HCL Injeksi 50mg/ ml-2ml Tube 0 1050 0 0 1050 - 178
179 Pilokarpin HCI/Nitrat TM 2%- 5ml Amp 0 0 0 0 0 - 179
180 Pirantel Tablet 125mg Tube 296 23 0 0 23 6,808 180
181 piroksikam Tablet 10 mg Btl 138 435 0 0 435 60,030 181
182 Piroksikam Tablet 20 mg Tab 0 0 0 0 0 - 182
183 Propiltiourasil Tablet 100mg Tube 319 0 0 0 0 - 183
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 110 600 0 0 600 66,000 184
185 Povidon Iodida 10% 300ml Btl 14203 300 0 0 300 4,260,900 185
186 Povidon Iodida 10% 1000ml Tab 37109 16 0 0 16 593,744 186
187 Prednison Tablet 5mg Tube 114 0 0 0 0 - 187
188 Primakuin Tablet 15mg Btl 0 900 0 0 900 - 188
189 Prokain Benzil Penisilin 3 Juta IU Inj. Tube 0 0 0 0 0 - 189
190 propanolol HCL Tablet 10mg Btl 77 0 0 0 0 - 190
191 Propanolol HCL Tablet 40mg Tab 121 0 0 0 0 - 191
192 Reserpin Tablet 0,25mg Amp 0 0 0 0 0 - 192
193 Retinol (Vitamin A) Kapsul 100.000 IU Tab 260 2 0 0 2 520 193
11,142,356

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
194 Retinol (Vitamin A) Kapsul 200.000 IU Tab 469 500 0 0 500 234,500 194
195 Rifampisin Kapsul 300mg Tab 0 4000 0 0 4000 - 195
197 Rifampisin Kapsul 600mg Amp 0 0 0 0 0 - 197
198 Ranitidin Injeksi 25 mg/ 2ml Btl 1140 320 0 0 320 364,800 198
199 Ranitidin Tablet 150 mg Kap 120 45 0 0 45 5,400 199
200 Ringer Laktat Lar. Inf. Steril - 500ml Kap 5200 3000 0 0 3000 15,600,000 200
201 Salbutamol Tablet 2mg Tab 59 100 0 0 100 5,900 201
202 Salbutamol Tablet 4mg Tube 89 100 0 0 100 8,900 202
203 Salep 2-4, Kombinasi Tab 1229 600 0 0 600 737,400 203
204 Salisil Bedak 2% Tab 1250 24 0 0 24 30,000 204
205 Serum Anti Bisa Ular Polivalen Inj.5ml Btl 591250 60 0 0 60 35,475,000 205
206 Serum Anti Rabies Tube 0 7 0 0 7 - 206
207 Serum Anti Tetanus Inj. 1500 IU/amp. Amp 158125 6 0 0 6 948,750 207
208 Serum Anti Tetanus Inj. 20.000 IU/vial Tube 0 3 0 0 3 - 208
209 Sianokobalamin (Vit. B12) Inj 500mcg Btl 1078 0 0 0 0 - 209
210 Simvastatin Tablet 20 mg Tab 391 5 0 0 5 1,955 210
211 Simvastatin Tablet 10 mg Tube 169 1000 0 0 1000 169,000 211
212 Streptomisin Sulfat Serbuk Inj.1000mg Tab 0 870 0 0 870 - 212
213 Sulfasetamida Natrium TM 15%- 5ml Btl 3226 0 0 0 0 - 213
214 Sanadril syr Tab 5500 0 0 0 0 - 214
215 Sanbe ters Tube 0 0 0 0 0 - 215
216 Sanvita B syr Btl 0 0 0 0 0 - 216
217 Sinbio Tube 4500 0 0 0 0 - 217
218 Seftriakson inj. 1g Btl 0 0 0 0 0 - 218
219 Tablet Tambah Darah Komb. Tab 1260 0 0 0 0 - 219
220 Tetrakain HCL Tetes Mata 0.5%- 5ml Amp 1705 280 0 0 280 477,400 220
221 Tetrasiklin HCL Kapsul 250 mg Tab 148 0 0 0 0 - 221
54,059,005

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
222 Tetrasiklin HCL Kapsul 500 mg Tab 300 0 0 0 0 - 222
223 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 55 0 0 0 0 - 223
224 Tiopental Natrium Serbuk Inj 1.000mg Tab 0 1000 0 0 1000 - 224
225 TiaminTabbblet 50 mg Amp 6402 0 0 0 0 - 225
226 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Btl 1615 200 0 0 200 323,000 226
227 Triheksifenidil Hidroklorida Tab. 2mg Kap 0 0 0 0 0 - 227
228 Vitamin B Komplek Tablet Kap 107 0 0 0 0 - 228
229 Zink Tlet 20mg ab Tab 474 0 0 0 0 - 229
230 Alat Suntik Sekali Pakai 1 ml Tab 748 45 0 0 45 33,660 230
232 Alat Suntik Sekali Pakai 5 ml Btl 847 190 0 0 190 160,930 232
233 Catgut/ Benang Bedah No. 2/0 - 3/0 Tube 22500 61 0 0 61 1,372,500 233
234 I.V. Catheter No. 20 Amp 7700 106 0 0 106 816,200 234
235 I.V. Catheter No. 22 Tube 7700 139 0 0 139 1,070,300 235
236 I.V. Catheter No. 24 Btl 7700 68 0 0 68 523,600 236
237 Infusion Set Anak Tab 7920 77 0 0 77 609,840 237
238 Infusion Set Dewasa Tube 7920 69 0 0 69 546,480 238
239 Implant Tab 0 77 0 0 77 - 239
240 Jarum Jahit (Bedah) No. 9 s/d 14 Btl 0 300 0 0 300 - 240
241 Jarum Suntik (Neddle) Tab 1250 98 0 0 98 122,500 241
242 Kapas Pembalut/Absorben 250 gram Tube 24000 6 0 0 6 144,000 242
243 Kasa Kompres 40/40 Steril Btl 1200 12 0 0 12 14,400 243
244 Kasa Pembalut 2 m x 80 cm Tube 9400 7 0 0 7 65,800 244
245 Kasa Pembalut Hidrofil 4 m x 15 cm Btl 7900 20 0 0 20 158,000 245
246 Kasa Steril 16/16 Tab 7900 2 0 0 2 15,800 246
247 Masker Amp 439 155 0 0 155 68,045 247
248 Plester 5 yard x 2 inch Tab 13000 400 0 0 400 5,200,000 248
11,282,455

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/03/2015
(+) (-) 31/03/2015
249 Sarung Tangan n0 7 Amp 396 1 0 0 1 396 249
250 Silk (Benang Bedah Sutera) No. 3/0 Vial 20833 0 0 0 0 - 250
396
Total Rp 744,573,042
PANDEGLANG, 28 MARET 2015

MENGETAHUI : TIM PELAKSANA OPNAME FISIK PERSEDIAAN PENGE
PENGELOLA OBAT KEPALA UPT PUSKESMAS CIKEUSIK
YUYUN YU
YUYUN YUNENGSIH,S.Kep SYARIPUDDIN RACHMAN,MM KHAMDAN PRAMANA, S.ST NIP. 198204
NIP. 19820422 200801 2 006 NIP.19610426 19820112 1 001 NIP. 19761121 200604 1 007
Hj. DEWI SUHANDARIAH, SKM
NIP. 19700906 199003 2 003
JUJUM JUMIATI, Amd. Keb

NIP. 19780401 200604 2 020

DINAS KESEHATAN
per 30 Juni 2015
Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
II OBAT-OBATAN : II
1 Alopurinol tablet 100 mg Tab 86 -1000 0 0 -1000 (86,000) 1
3 Albendazol Amp 406 390 0 0 390 158,340 3
4 Aminofilin injeksi 24mg/ml-10ml Tab 3240 0 0 0 0 - 4
7 Amlodipine Besilate 5mg tablet Btl 187 0 0 0 0 - 7
10 Amoksisillin SK 125 mg/5 ml-60 ml Tab 2445 -90 0 0 -90 (220,050) 10
11 Am oxsillin aserbuk 1gr Inj Tube 7396 2 0 0 2 14,792 11
12 Amoksilin sk Forte Supp 4045 534 0 0 534 2,160,030 12
13 Ampisillin Injeksi 1 gram Pot 3850 10 0 0 10 38,500 13
16 Antasida DOEN suspensi Ampl 2140 440 0 0 440 941,600 16
17 Anti Bakteri DOEN Salep Kombinasi Btl 2516 0 0 0 0 - 17
23 Acyclopir Krim 5%- 5gr Tab 5049 0 0 0 0 - 23
24 Acyclopir Tablet 200mg Tab 237 500 0 0 500 118,500 24
25 Acyclopir Tablet 400 mg Tab 336 0 0 0 0 - 25
6,783,788

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
26 Akita Tablet Tab 418 1500 0 0 1500 627,000 26
35 Asam Folat tablet 1 mg Tab 0 0 0 0 0 - 35
38 Asetosal Tablet 100 mg Btl 12650 0 0 0 0 - 38
41 Atropin Sulfat Tablet 0,5 mg Tab 74 0 0 0 0 - 41
45 Betametason Krim 0,1% - 5 gr Tab 1520 -61 0 0 -61 (92,720) 45
46 Bisacodril sup Tab 5045 9 0 0 9 45,405 46
48 Captopril Tablet 12,5 mg Tab 62 400 0 0 400 24,800 48
50 Chloramfecort- H Cream - 10gr Btl 0 600 0 0 600 - 50
51 Cefadroxil 500mg Tab 509 #VALUE! 0 0 #VALUE! #VALUE! 51
#VALUE!

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
57 Deksametasone Injeksi 5 mg/ml - 1ml Kap 1580 -455 0 0 -455 (718,900) 57
59 Dekstromethorfan Sirup 10 mg/ 60 ml Amp 6600 -20 0 0 -20 (132,000) 59
60 Dekstromethorfan Tablet 15 mg Tab 4000 -2800 0 0 -2800 (11,200,000) 60
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 52 43 0 0 43 2,236 65
66 Digoksin Tablet 0,25 mg Tab 129 500 0 0 500 64,500 66
67 Domperidon 10 mgtablet Tab 167 0 0 0 0 - 67
68 Dimenhidrinat Tablet 50 mg Ktg 8799 0 0 0 0 - 68
72 Ekstrak Belladona Tablet 10 mg Btl 31 -900 0 0 -900 (27,900) 72
77 Etanol 70%- 1000 ml Tab 1500 0 0 0 0 - 77
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 9900 0 0 0 0 - 80
81 Fenitoin Natrium Kapsul 100 mg Tab 133 -6 0 0 -6 (798) 81
(10,348,306)

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
85 Fenobarbital Tablet 30 mg Tab 0 -20 0 0 -20 - 85
86 Fenoksimetil Penisilina Tablet 250 mg Vial 0 0 0 0 0 - 86
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Kap 3417 0 0 0 0 - 88
91 Furosemida Tablet 40 mg Tab 75 0 0 0 0 - 91
93 Glimepirid 4mg Tablet Tab 430 1000 0 0 1000 430,000 93
94 Glibenklamida Tablet 5 mg Tab 56 0 0 0 0 - 94
96 Gliserin - 100 ml Pkt 0 0 0 0 0 - 96
97 Glukosa Lar. Infus 5% Steril - 500 ml Tab 5200 -2936 0 0 -2936 (15,267,200) 97
98 Glukosa Lar. Infus 10% Steril - 500 ml Btl 1675 0 0 0 0 - 98
99 Glukosa Lar. Infus 40% Steril - 25 ml Tab 1785 0 0 0 0 - 99
102 Gentamisin Injeksi Dus 3696 -82 0 0 -82 (303,072) 102
104 Haloperidol 1,5 mg Tablet Btl 126 500 0 0 500 63,000 104
106 Hidrokortison Krim 2,5%-5 gr Btl 2798 0 0 0 0 - 106
109 Isoniazid Tablet 100 mg Amp 88 #VALUE! 0 0 #VALUE! #VALUE! 109
#VALUE!

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
110 Isoniazid Tablet 300 mg Tab 97 25 0 0 25 2,425 110
111 Isosorbid Dinitrat Tab. Sub. 5 mg Tab 2570 300 0 0 300 771,000 111
114 Ketorolac Inj 30mg Tab 2300 45 0 0 45 103,500 114
116 Ketamin 10 mg/ml Injeksi- 10 ml Pkt 5200 -6 0 0 -6 (31,200) 116
117 Klofazimin, mikronize Kapsul 100 mg Pkt 97 -610 0 0 -610 (59,170) 117
119 Kloramfenikol Suspensi 125 mg/60 ml Pkt 3800 -200 0 0 -200 (760,000) 119
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 5744 0 0 0 0 - 122
123 Klorpromazin HCL Tablet Salut 25 mg Amp 0 0 0 0 0 - 123
124 Klorpromazin HCL Tablet Salut 100 mg Tab 0 -2300 0 0 -2300 - 124
125 Kodein HCL Tablet 10 mg Btl 250 -548 0 0 -548 (137,000) 125
128 Kotrimoksazol Suspensi Kombinasi Amp 2145 0 0 0 0 - 128
129 Kotrimoksazol Tab. Kombinasi Btl 138 3200 0 0 3200 441,600 129
131 Kloramfenikol Salep Mata 1%-5gram Tab 1450 -2041 0 0 -2041 (2,959,450) 131
132 Kloramfenikol Tetes Telinga 3%-5ml Btl 1797 -26 0 0 -26 (46,722) 132
133 Kuinin Injeksi 25%-2ml Btl 4750 -1695 0 0 -1695 (8,051,250) 133
135 Lidokain Komp. Injeksi, Kombinasi Tab 1295 66 0 0 66 85,470 135
(8,806,525)

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
138 Mebendazol Syrup/5ml - 30ml Tab 4100 -15 0 0 -15 (61,500) 138
141 Metilergometrin M inj. 0,200mg- 1ml Kap 2750 -391 0 0 -391 (1,075,250) 141
142 Metoklorpropamid Tablet 10 mg Kap 91 -6 0 0 -6 (546) 142
143 Mikonazol Krim/ Salep 2%-10gram Kap 3000 -897 0 0 -897 (2,691,000) 143
144 Multivitamin Anak Btl 11500 5 0 0 5 57,500 144
145 Multivitamin Dewasa Tab 640 -59 0 0 -59 (37,760) 145
147 Metronidazol Tablet 500mg Pot 160 -3 0 0 -3 (480) 147
152 Natrium Diclopenac 20mg Vial 133 -30 0 0 -30 (3,990) 152
153 Nistatin Tablet Salut 500.000 IU Amp 0 -10 0 0 -10 - 153
161 Omeprazol inj 40mg/10ml Tab 36000 0 0 0 0 - 161
162 Omeprazol Kapsul 20mg Amp 211 0 0 0 0 - 162
163 Ondansetron Inj 4mg Tab 2400 2520 0 0 2520 6,048,000 163
164 Onadansetron 8mg Tablet Tab 1189 0 0 0 0 - 164
165 Onadansetron 4mg Tablet Tube 716 #VALUE! 0 0 #VALUE! #VALUE! 165
#VALUE!

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
168 Obat Batuk Dewasa Tab 5500 0 0 0 0 - 168
170 Oksitetrasiklin HCL SM 1%-3,5gram Btl 1750 -1650 0 0 -1650 (2,887,500) 170
172 Oksitosin Injeksi 10 IU/ml- 1ml Kap 2200 -40 0 0 -40 (88,000) 172
173 OBAT Anti Diare suspensi Tab 7150 193 0 0 193 1,379,950 173
175 Parasetamol Syrup 120mg/ 5ml-60ml Tab 1438 -207 0 0 -207 (297,666) 175
176 Parasetamol Tablet 100mg Tab 5200 995 0 0 995 5,174,000 176
177 Parasetamol Tablet 500mg Btl 79 -3000 0 0 -3000 (237,000) 177
180 Pirantel Tablet 125mg Tube 296 -277 0 0 -277 (81,992) 180
181 piroksikam Tablet 10 mg Btl 138 -565 0 0 -565 (77,970) 181
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 110 -2800 0 0 -2800 (308,000) 184
187 Prednison Tablet 5mg Tube 114 -4300 0 0 -4300 (490,200) 187
190 propanolol HCL Tablet 10mg Btl 77 -150 0 0 -150 (11,550) 190
8,242,362

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
198 Ranitidin Injeksi 25 mg/ 2ml Btl 1140 0 0 0 0 - 198
199 Ranitidin Tablet 150 mg Kap 120 0 0 0 0 - 199
201 Salbutamol Tablet 2mg Tab 59 -350 0 0 -350 (20,650) 201
203 Salep 2-4, Kombinasi Tab 1229 52 0 0 52 63,908 203
204 Salisil Bedak 2% Tab 1250 -76 0 0 -76 (95,000) 204
209 Sianokobalamin (Vit. B12) Inj 500mcg Btl 1078 -65 0 0 -65 (70,070) 209
210 Simvastatin Tablet 20 mg Tab 391 -400 0 0 -400 (156,400) 210
213 Sulfasetamida Natrium TM 15%- 5ml Btl 3226 -38 0 0 -38 (122,588) 213
214 Sanadril syr Tab 5500 0 0 0 0 - 214
215 Sanbe ters Tube 0 60 0 0 60 - 215
216 Sanvita B syr Btl 0 0 0 0 0 - 216
217 Sinbio Tube 4500 -120 0 0 -120 (540,000) 217
219 Tablet Tambah Darah Komb. Tab 1260 20 0 0 20 25,200 219
220 Tetrakain HCL Tetes Mata 0.5%- 5ml Amp 1705 29280 0 0 29280 49,922,400 220
221 Tetrasiklin HCL Kapsul 250 mg Tab 148 -1000 0 0 -1000 (148,000) 221
95,410,850

HARGA SATUAN
Mutasi
Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
223 Tiamin HCL/(Vit. B1) Tab. 50mg Tab 55 -4000 0 0 -4000 (220,000) 223
226 Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Btl 1615 2200 0 0 2200 3,553,000 226
228 Vitamin B Komplek Tablet Kap 107 -5000 0 0 -5000 (535,000) 228
229 Zink Tlet 20mg ab Tab 474 -500 0 0 -500 (237,000) 229
PERBEKALAN KESEHATAN Tube 0 0 0 0 -
231 Alat Suntik Sekali Pakai 3 ml Tab 748 -200 0 0 -200 (149,600) 231
232 Alat Suntik Sekali Pakai 5 ml Btl 847 -30 0 0 -30 (25,410) 232
234 I.V. Catheter No. 20 Amp 7700 168 0 0 168 1,293,600 234
237 Infusion Set Anak Tab 7920 137 0 0 137 1,085,040 237
239 Implant Tab 0 509 0 0 509 - 239
243 Kasa Kompres 40/40 Steril Btl 1200 -29 0 0 -29 (34,800) 243
244 Kasa Pembalut 2 m x 80 cm Tube 9400 -3 0 0 -3 (28,200) 244
246 Kasa Steril 16/16 Tab 7900 -25 0 0 -25 (197,500) 246
247 Masker Amp 439 210 0 0 210 92,190 247
31,128,310

HARGA SATUAN
Mutasi
Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/06/2015
(+) (-) 30/06/2015
249 Sarung Tangan n0 7 Amp 700 -74 0 0 -74 (51,800) 249
250 Silk (Benang Bedah Sutera) No. 3/0 Vial 1948 -36 0 0 -36 (70,128) 250
3,632,630,400
TOTAL #VALUE!
PANDEGLANG, 30 Juni 2015
BENDAHARA BARANG KEPALA UPT PUSKESMAS CIKEUSIK
YUYUN YU
Hj. DEWI SUHANDARIAH, SKM SYARIPUDDIN RACHMAN,MM KHAMDAN PRAMANA, S.ST NIP. 198002
NIP. 19700906 199003 2 003 NIP.19610426 19820112 1 001 NIP. 19761121 200604 1 007
2. JUJUM JUMIATI, Amd. Keb.

NIP. 19780401 200604 2 020
ADE SUHENDI,SKM
NIP. 19800226 200902 1 001

DINAS KESEHATAN
per September 2015
HARGA SATUAN
Mutasi
Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
II OBAT-OBATAN : II
1 Alopurinol tablet 100 mg Tab 86 -1000 0 0 -1000 (86,000) 1
3 Albendazol Amp 406 -200 0 0 -200 (81,200) 3
4 Aminofilin injeksi 24mg/ml-10ml Tab 3240 -60 0 0 -60 (194,400) 4
7 Amlodipine Besilate 5mg tablet Btl 187 600 0 0 600 112,200 7
10 Amoksisillin SK 125 mg/5 ml-60 ml Tab 2445 -330 0 0 -330 (806,850) 10
11 Am oxsillin aserbuk 1gr Inj Tube 7396 -54 0 0 -54 (399,384) 11
13 Ampisillin Injeksi 1 gram Pot 3850 -80 0 0 -80 (308,000) 13
16 Antasida DOEN suspensi Ampl 2140 640 0 0 640 1,369,600 16
17 Anti Bakteri DOEN Salep Kombinasi Btl 2516 0 0 0 0 - 17
23 Acyclopir Krim 5%- 5gr Tab 5049 -20 0 0 -20 (100,980) 23
24 Acyclopir Tablet 200mg Tab 237 0 0 0 0 - 24
25 Acyclopir Tablet 400 mg Tab 336 -500 0 0 -500 (168,000) 25
5,567,468

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
26 Akita Tablet Tab 418 400 0 0 400 167,200 26
35 Asam Folat tablet 1 mg Tab 48 150 0 0 150 7,200 35
41 Atropin Sulfat Tablet 0,5 mg Tab 74 -100 0 0 -100 (7,400) 41
46 Bisacodril sup Tab 5045 -38 0 0 -38 (191,710) 46
48 Captopril Tablet 12,5 mg Tab 62 0 0 0 0 - 48
50 Chloramfecort- H Cream - 10gr Btl 0 Err:509 0 0 Err:509 Err:509 50
Err:509

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
57 Deksametasone Injeksi 5 mg/ml - 1ml Kap 1580 -1505 0 0 -1505 (2,377,900) 57
59 Dekstromethorfan Sirup 10 mg/ 60 ml Amp 6600 -20 0 0 -20 (132,000) 59
60 Dekstromethorfan Tablet 15 mg Tab 4000 -5800 0 0 -5800 (23,200,000) 60
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 52 -17 0 0 -17 (884) 65
66 Digoksin Tablet 0,25 mg Tab 129 0 0 0 0 - 66
67 Domperidon 10 mgtablet Tab 167 -43 0 0 -43 (7,181) 67
68 Dimenhidrinat Tablet 50 mg Ktg 8799 -270 0 0 -270 (2,375,730) 68
75 Etambutol HCL Tablet 250 mg Tab 0 -5 0 0 -5 - 75
76 Etambutol HCL Tablet 500 mg Tab 3500 -18 0 0 -18 (63,000) 76
77 Etanol 70%- 1000 ml Tab 1500 0 0 0 0 - 77
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 9900 -270 0 0 -270 (2,673,000) 80
81 Fenitoin Natrium Kapsul 100 mg Tab 133 -51 0 0 -51 (6,783) 81
(28,887,542)

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
85 Fenobarbital Tablet 30 mg Tab 0 -60 0 0 -60 - 85
86 Fenoksimetil Penisilina Tablet 250 mg Vial 0 -100 0 0 -100 - 86
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Kap 3417 0 0 0 0 - 88
91 Furosemida Tablet 40 mg Tab 75 -350 0 0 -350 (26,250) 91
93 Glimepirid 4mg Tablet Tab 430 2800 0 0 2800 1,204,000 93
94 Glibenklamida Tablet 5 mg Tab 56 -994 0 0 -994 (55,664) 94
96 Gliserin - 100 ml Pkt 0 0 0 0 0 - 96
98 Glukosa Lar. Infus 10% Steril - 500 ml Btl 1675 -55 0 0 -55 (92,125) 98
99 Glukosa Lar. Infus 40% Steril - 25 ml Tab 1785 -45 0 0 -45 (80,325) 99
102 Gentamisin Injeksi Dus 3696 -352 0 0 -352 (1,300,992) 102
104 Haloperidol 1,5 mg Tablet Btl 126 500 0 0 500 63,000 104
106 Hidrokortison Krim 2,5%-5 gr Btl 2798 75 0 0 75 209,850 106
107 Ibuprofen Tablet 200 mg Tab 110 Err:509 0 0 Err:509 Err:509 107
Err:509

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
110 Isoniazid Tablet 300 mg Tab 97 -26 0 0 -26 (2,522) 110
114 Ketorolac Inj 30mg Tab 2300 -2 0 0 -2 (4,600) 114
116 Ketamin 10 mg/ml Injeksi- 10 ml Pkt 5200 -56 0 0 -56 (291,200) 116
117 Klofazimin, mikronize Kapsul 100 mg Pkt 97 -1260 0 0 -1260 (122,220) 117
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 5744 -48 0 0 -48 (275,712) 122
123 Klorpromazin HCL Tablet Salut 25 mg Amp 0 -580 0 0 -580 - 123
125 Kodein HCL Tablet 10 mg Btl 250 -848 0 0 -848 (212,000) 125
128 Kotrimoksazol Suspensi Kombinasi Amp 2145 220 0 0 220 471,900 128
129 Kotrimoksazol Tab. Kombinasi Btl 138 5200 0 0 5200 717,600 129
131 Kloramfenikol Salep Mata 1%-5gram Tab 1450 -2105 0 0 -2105 (3,052,250) 131
133 Kuinin Injeksi 25%-2ml Btl 4750 -2595 0 0 -2595 (12,326,250) 133
135 Lidokain Komp. Injeksi, Kombinasi Tab 1295 -25 0 0 -25 (32,375) 135
(11,852,606)
NO NAMA / JENIS BARANG KODE SATUAN JUMLAH KUANTITAS PERSEDIAAN

HARGA SATUAN
Opname Fisik Mutasi
Nilai Persediaan NO
(Rp) Saldo 30/09/2015
(+) (-) 30/09/2015
141 Metilergometrin M inj. 0,200mg- 1ml Kap 2750 -291 0 0 -291 (800,250) 141
142 Metoklorpropamid Tablet 10 mg Kap 91 -586 0 0 -586 (53,326) 142
144 Multivitamin Anak Btl 11500 -365 0 0 -365 (4,197,500) 144
145 Multivitamin Dewasa Tab 640 -586 0 0 -586 (375,040) 145
147 Metronidazol Tablet 500mg Pot 160 -840 0 0 -840 (134,400) 147
152 Natrium Diclopenac 20mg Vial 133 -135 0 0 -135 (17,955) 152
153 Nistatin Tablet Salut 500.000 IU Amp 0 -35 0 0 -35 - 153
161 Omeprazol inj 40mg/10ml Tab 36000 -15 0 0 -15 (540,000) 161
162 Omeprazol Kapsul 20mg Amp 211 Err:509 0 0 Err:509 Err:509 162
163 Ondansetron Inj 4mg Tab 2400 Err:509 0 0 Err:509 Err:509 163
164 Onadansetron 8mg Tablet Tab 1189 #VALUE! 0 0 #VALUE! #VALUE! 164
Err:509
HARGA SATUAN
NO NAMA / JENIS BARANG KODE SATUAN JUMLAH KUANTITAS PERSEDIAAN
(Rp)
Nilai Persediaan NO
Opname Fisik Mutasi Saldo 30/09/2015
(+) (-) 30/09/2015
167 Obat Batuk Hitam (OBH) Cairan Kap 5663 250 0 0 250 1,415,750 167
168 Obat Batuk Dewasa Kap 5500 -60 0 0 -60 (330,000) 168
169 Oksitetrasiklin HCL Inj. i.m 50mg10ml Kap 0 50 0 0 50 - 169
170 Oksitetrasiklin HCL SM 1%-3,5gram Kap 1750 -3060 0 0 -3060 (5,355,000) 170
172 Oksitosin Injeksi 10 IU/ml- 1ml Btl 2200 -51 0 0 -51 (112,200) 172
174 Paraformaldehid Tablet 1gram Tab 0 0 0 0 0 - 174
175 Parasetamol Syrup 120mg/ 5ml-60ml Pot 1438 -497 0 0 -497 (714,686) 175
176 Parasetamol Tablet 100mg Ktk 5200 1145 0 0 1145 5,954,000 176
177 Parasetamol Tablet 500mg Vial 79 -12500 0 0 -12500 (987,500) 177
178 Petidin HCL Injeksi 50mg/ ml-2ml Vial 0 22650 0 0 22650 - 178
180 Pirantel Tablet 125mg Vial 296 -677 0 0 -677 (200,392) 180
181 piroksikam Tablet 10 mg Amp 138 -2315 0 0 -2315 (319,470) 181
183 Propiltiourasil Tablet 100mg Vial 319 0 0 0 0 - 183
184 Piridoksin HCL (Vit. B6) Tablet 10mg Btl 110 -7700 0 0 -7700 (847,000) 184
185 Povidon Iodida 10% 300ml Tab 14203 1298 0 0 1298 18,435,494 185
186 Povidon Iodida 10% 1000ml Btl 37109 14 0 0 14 519,526 186
187 Prednison Tablet 5mg Kap 114 -10100 0 0 -10100 (1,151,400) 187
188 Primakuin Tablet 15mg Kap 0 3600 0 0 3600 - 188
189 Prokain Benzil Penisilin 3 Juta IU Inj. Tab 0 0 0 0 0 - 189
190 propanolol HCL Tablet 10mg Amp 77 -610 0 0 -610 (46,970) 190
192 Reserpin Tablet 0,25mg Tab 0 0 0 0 0 - 192
193 Retinol (Vitamin A) Kapsul 100.000 IU Tube 260 2 0 0 2 520 193
18,355,622

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
198 Ranitidin Injeksi 25 mg/ 2ml Btl 1140 -30 0 0 -30 (34,200) 198
199 Ranitidin Tablet 150 mg Kap 120 -1000 0 0 -1000 (120,000) 199
203 Salep 2-4, Kombinasi Tab 1229 0 0 0 0 - 203
213 Sulfasetamida Natrium TM 15%- 5ml Btl 3226 62 0 0 62 200,012 213
214 Sanadril syr Tab 5500 0 0 0 0 - 214
215 Sanbe ters Tube 0 120 0 0 120 - 215
216 Sanvita B syr Btl 0 0 0 0 0 - 216
217 Sinbio Tube 4500 -120 0 0 -120 (540,000) 217
219 Tablet Tambah Darah Komb. Tab 1260 -380 0 0 -380 (478,800) 219
127,806,857

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
228 Vitamin B Komplek Tablet Kap 107 -12700 0 0 -12700 (1,358,900) 228
231 Alat Suntik Sekali Pakai 3 ml Tab 748 -330 0 0 -330 (246,840) 231
232 Alat Suntik Sekali Pakai 5 ml Btl 847 -260 0 0 -260 (220,220) 232
239 Implant Tab 0 709 0 0 709 - 239
246 Kasa Steril 16/16 Tab 7900 -115 0 0 -115 (908,500) 246
247 Masker Amp 439 20 0 0 20 8,780 247
34,428,710

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
30/09/2015
NO NAMA / JENIS BARANG KODE SATUAN HARGA SATUAN Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 30/09/2015
(+) (-) 30/09/2015
(278,488)
Total Err:509
PANDEGLANG, 30 september 2015

YUYUN YU
YUYUN YUNENGSIH,S.Kep SYARIPUDDIN RACHMAN,MM ADE SUHENDI,SKM NIP. 198204
NIP. 19820422 200801 2 006 NIP.19610426 19820112 1 001 NIP. 19800226 200902 1 001

NIP. 19700906 199003 2 003

NIP. 19780401 200604 2 020

DINAS KESEHATAN
per Desember 2015
NO NAMA / JENIS BARANG KODE SATUAN HARGA SATUAN JUMLAH KUANTITAS PERSEDIAAN
Nilai Persediaan NO
(Rp) 31/12/2015
Mutasi Saldo
Opname Fisik
(+) (-) 31/12/2015 m
II OBAT-OBATAN : II
1 Alopurinol tablet 100 mg Tab 86 0 0 0 0 - 1
3 Albendazol Amp 406 -530 0 0 -530 (215,180) 3
4 Aminofilin injeksi 24mg/ml-10ml Tab 3240 -120 0 0 -120 (388,800) 4
7 Amlodipine Besilate 5mg tablet Btl 187 -320 0 0 -320 (59,840) 7
9 Amoksisillin Kapsul 500 mg Tab 261 -6300 0 0 -6300 (1,644,300) 9
10 Amoksisillin SK 125 mg/5 ml-60 ml Tab 2445 -890 0 0 -890 (2,176,050) 10
11 Am oxsillin aserbuk 1gr Inj Tube 7396 -94 0 0 -94 (695,224) 11
13 Ampisillin Injeksi 1 gram Pot 3850 -140 0 0 -140 (539,000) 13
14 Antalgin (Metampiron) Tab. 500 mg Tab 0 -500 0 0 -500 - 14
15 Antasida DOEN tablet Tab 72 -4200 0 0 -4200 (302,400) 15
16 Antasida DOEN suspensi Ampl 2140 400 0 0 400 856,000 16
17 Anti Bakteri DOEN Salep Kombinasi Btl 2516 -60 0 0 -60 (150,960) 17
22 Aqua roinjek Steril Tab 2200 -8 0 0 -8 (17,600) 22
23 Acyclopir Krim 5%- 5gr Tab 5049 -20 0 0 -20 (100,980) 23
24 Acyclopir Tablet 200mg Tab 237 -300 0 0 -300 (71,100) 24
25 Acyclopir Tablet 400 mg Tab 336 -700 0 0 -700 (235,200) 25
(2,232,452)

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
26 Akita Tablet Tab 0 400 0 0 400 - 26
29 Asam Mefenamat 500mg Btl 0 1200 0 0 1200 - 29
33 Asam Askorbat (Vit. C) Tablet 50 mg Tab 90 -300 0 0 -300 (27,000) 33
35 Asam Folat tablet 1 mg Tab 0 -550 0 0 -550 - 35
41 Atropin Sulfat Tablet 0,5 mg Tab 26 -100 0 0 -100 (2,600) 41
44 Benzatin Benzil Penisilin Inj. 2,4 Juta Amp 800 6 0 0 6 4,800 44
46 Bisacodril sup Tab 0 -72 0 0 -72 - 46
48 Captopril Tablet 12,5 mg Tab 0 0 0 0 0 - 48
50 Chloramfecort- H Cream - 10gr Btl 1800 Err:509 0 0 Err:509 Err:509 50
Err:509

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
57 Deksametasone Injeksi 5 mg/ml - 1ml Kap 1580 -1505 0 0 -1505 (2,377,900) 57
58 Deksametasone Tablet 0,5 mg Kap 0 2300 0 0 2300 - 58
59 Dekstromethorfan Sirup 10 mg/ 60 ml Amp 0 -20 0 0 -20 - 59
60 Dekstromethorfan Tablet 15 mg Tab 0 -5800 0 0 -5800 - 60
62 Diazepam Tablet 2 mg Tab 0 -100 0 0 -100 - 62
65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 960 -57 0 0 -57 (54,720) 65
66 Digoksin Tablet 0,25 mg Tab 0 -800 0 0 -800 - 66
67 Domperidon 10 mgtablet Tab 0 -243 0 0 -243 - 67
68 Dimenhidrinat Tablet 50 mg Ktg 380 -270 0 0 -270 (102,600) 68
70 Domperidon Suspensi 5mg/ 5ml- 60ml Tab 23 -6 0 0 -6 (138) 70
73 Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Btl 0 205 0 0 205 - 73
74 Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 -30 0 0 -30 - 74
75 Etambutol HCL Tablet 250 mg Tab 200 -5 0 0 -5 (1,000) 75
76 Etambutol HCL Tablet 500 mg Tab 0 -18 0 0 -18 - 76
77 Etanol 70%- 1000 ml Tab 0 0 0 0 0 - 77
80 Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 0 -270 0 0 -270 - 80
81 Fenitoin Natrium Kapsul 100 mg Tab 0 -51 0 0 -51 - 81
(1,745,236)

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
84 Fenobarbital Tablet 100 mg Tab 0 100 0 0 100 - 84
85 Fenobarbital Tablet 30 mg Tab 52 -100 0 0 -100 (5,200) 85
86 Fenoksimetil Penisilina Tablet 250 mg Vial 0 -100 0 0 -100 - 86
87 Fenoksimetil Penisilina Tablet 500 mg Kap 0 20 0 0 20 - 87
88 Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Kap 210 -40 0 0 -40 (8,400) 88
91 Furosemida Tablet 40 mg Tab 0 -350 0 0 -350 - 91
92 Garam Oralit 200 ml air Amp 0 150 0 0 150 - 92
93 Glimepirid 4mg Tablet Tab 0 2350 0 0 2350 - 93
94 Glibenklamida Tablet 5 mg Tab 0 -1294 0 0 -1294 - 94
95 Gliseril Guaiakolat Tablet 100 mg Tab 0 3340 0 0 3340 - 95
96 Gliserin - 100 ml Pkt 0 0 0 0 0 - 96
98 Glukosa Lar. Infus 10% Steril - 500 ml Btl 5200 -175 0 0 -175 (910,000) 98
99 Glukosa Lar. Infus 40% Steril - 25 ml Tab 160 -45 0 0 -45 (7,200) 99
102 Gentamisin Injeksi Dus 0 -352 0 0 -352 - 102
103 Haloperidol 0,5 mg Tablet Amp 1033 -100 0 0 -100 (103,300) 103
104 Haloperidol 1,5 mg Tablet Btl 0 500 0 0 500 - 104
106 Hidrokortison Krim 2,5%-5 gr Btl 2797 75 0 0 75 209,775 106
Err:509

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
110 Isoniazid Tablet 300 mg Tab 130 -26 0 0 -26 (3,380) 110
112 Ketokonazol krom Btl 2569 -95 0 0 -95 (244,055) 112
113 Ketokonazol tab 200mg Amp 0 550 0 0 550 - 113
114 Ketorolac Inj 30mg Tab 0 -48 0 0 -48 - 114
116 Ketamin 10 mg/ml Injeksi- 10 ml Pkt 0 -56 0 0 -56 - 116
117 Klofazimin, mikronize Kapsul 100 mg Pkt 0 -1260 0 0 -1260 - 117
118 Kloramfenikol Kapsul 250 mg Pkt 0 18 0 0 18 - 118
120 Klorfeniramin Maleat (CTM) Tab. 4 mg Btl 51 -100 0 0 -100 (5,100) 120
122 Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 1920 -48 0 0 -48 (92,160) 122
123 Klorpromazin HCL Tablet Salut 25 mg Amp 1785 -880 0 0 -880 (1,570,800) 123
125 Kodein HCL Tablet 10 mg Btl 0 0 0 0 0 - 125
127 Kotrimoksazol Tablet 480mg Tab 105 3000 0 0 3000 315,000 127
128 Kotrimoksazol Suspensi Kombinasi Amp 0 0 0 0 0 - 128
129 Kotrimoksazol Tab. Kombinasi Btl 0 5200 0 0 5200 - 129
131 Kloramfenikol Salep Mata 1%-5gram Tab 14 -2255 0 0 -2255 (31,570) 131
133 Kuinin Injeksi 25%-2ml Btl 0 -2595 0 0 -2595 - 133
134 Levoploxasin 500mh Tab 57 -293 0 0 -293 (16,701) 134
135 Lidokain Komp. Injeksi, Kombinasi Tab 0 -165 0 0 -165 - 135
137 Loperamide Hcl 2mg Tanlet Tab 0 -150 0 0 -150 - 137
(2,643,152)

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
140 Metilergometrin Maleat Tab. 0,125 g Kap 0 550 0 0 550 - 140
141 Metilergometrin M inj. 0,200mg- 1ml Kap 0 -291 0 0 -291 - 141
142 Metoklorpropamid Tablet 10 mg Kap 91 -1306 0 0 -1306 (118,846) 142
144 Multivitamin Anak Btl 5200 -502 0 0 -502 (2,610,400) 144
145 Multivitamin Dewasa Tab 0 -936 0 0 -936 - 145
146 Metronidazol Infus 500mg/100ml Tab 97 -30 0 0 -30 (2,910) 146
147 Metronidazol Tablet 500mg Pot 160 -2090 0 0 -2090 (334,400) 147
148 Magnesium Sulfat Inj. 25 ml Ktk 1100 192 0 0 192 211,200 148
149 Minyak kayu putih Vial 240400 40 0 0 40 9,616,000 149
151 Natrum Klorida Lar. Inf. 0,9% -500ml Amp 0 138 0 0 138 - 151
152 Natrium Diclopenac 20mg Vial 0 -135 0 0 -135 - 152
153 Nistatin Tablet Salut 500.000 IU Amp 970 -35 0 0 -35 (33,950) 153
154 Natrium Diclopenac 50mg Tab 0 -850 0 0 -850 - 154
156 Novadryl Syrup/ Holydril Syrup-60ml Btl 3445 150 0 0 150 516,750 156
157 Obat Anti Tuberkulosis Kat. 1 (FDC) Tab 0 2395 0 0 2395 - 157
161 Omeprazol inj 40mg/10ml Tab 35 -70 0 0 -70 (2,450) 161
162 Omeprazol Kapsul 20mg Amp 0 Err:509 0 0 Err:509 Err:509 162
163 Ondansetron Inj 4mg Tab 0 Err:509 0 0 Err:509 Err:509 163
164 Onadansetron 8mg Tablet Tab 22 #VALUE! 0 0 #VALUE! #VALUE! 164
Err:509

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
168 Obat Batuk Dewasa Tab 5500 -90 0 0 -90 (495,000) 168
170 Oksitetrasiklin HCL SM 1%-3,5gram Btl 1750 -3060 0 0 -3060 (5,355,000) 170
172 Oksitosin Injeksi 10 IU/ml- 1ml Kap 2200 -51 0 0 -51 (112,200) 172
175 Parasetamol Syrup 120mg/ 5ml-60ml Tab 1438 -737 0 0 -737 (1,059,806) 175
176 Parasetamol Tablet 100mg Tab 5200 1115 0 0 1115 5,798,000 176
177 Parasetamol Tablet 500mg Btl 79 8000 0 0 8000 632,000 177
180 Pirantel Tablet 125mg Tube 296 -1077 0 0 -1077 (318,792) 180
181 piroksikam Tablet 10 mg Btl 138 -2565 0 0 -2565 (353,970) 181
184 Piridoksin HCL (Vit. B6) Tablet 10mg Tab 110 -11800 0 0 -11800 (1,298,000) 184
187 Prednison Tablet 5mg Tube 114 -14900 0 0 -14900 (1,698,600) 187
190 propanolol HCL Tablet 10mg Btl 77 -710 0 0 -710 (54,670) 190
18,150,202

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
198 Ranitidin Injeksi 25 mg/ 2ml Btl 1140 -30 0 0 -30 (34,200) 198
199 Ranitidin Tablet 150 mg Kap 120 -1000 0 0 -1000 (120,000) 199
200 Ringer Laktat Lar. Inf. Steril - 500ml Kap 5200 50 0 0 50 260,000 200
203 Salep 2-4, Kombinasi Tab 1229 0 0 0 0 - 203
211 Simvastatin Tablet 10 mg Tube 169 -50 0 0 -50 (8,450) 211
213 Sulfasetamida Natrium TM 15%- 5ml Btl 3226 62 0 0 62 200,012 213
214 Sanadril syr Tab 5500 0 0 0 0 - 214
215 Sanbe ters Tube 0 120 0 0 120 - 215
216 Sanvita B syr Btl 0 0 0 0 0 - 216
217 Sinbio Tube 4500 -120 0 0 -120 (540,000) 217
219 Tablet Tambah Darah Komb. Tab 1260 -580 0 0 -580 (730,800) 219
83,974,927

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
228 Vitamin B Komplek Tablet Kap 107 -14100 0 0 -14100 (1,508,700) 228
230 Alat Suntik Sekali Pakai 1 ml Tab 748 0 0 0 0 - 230
232 Alat Suntik Sekali Pakai 5 ml Btl 847 900 0 0 900 762,300 232
233 Catgut/ Benang Bedah No. 2/0 - 3/0 Tube 22500 39 0 0 39 877,500 233
239 Implant Tab 0 709 0 0 709 - 239
246 Kasa Steril 16/16 Tab 7900 -315 0 0 -315 (2,488,500) 246
247 Masker Amp 439 -180 0 0 -180 (79,020) 247
31,345,590

Nilai Persediaan NO
(Rp) Opname Fisik
Saldo 31/12/2015
(+) (-) 31/12/2015
(434,468)
Total Err:509
PANDEGLANG,31 Desember 2015

YUYUN YU
YUYUN YUNENGSIH,S.Kep SYARIPUDDIN RACHMAN,MM ADE SUHENDI,SKM NIP. 198204
NIP. 198204 22 200801 2 001 NIP.19610426 19820112 1 001 NIP. 19800226 200902 1 001
NIP. 19700906 199003 2 003

NIP. 19780401 200604 2 020
MENU DINAS KESEHATAN Lampiran Berita Acara
UPT. PUSKESMAS CIKEUSIK Opname Fisik Persediaan
per 31 Maret 2015
STOK AKHIR
HARGA SATUAN
NAMA / JENIS BARANG KODE SATUAN Penjelasan selisih
(Rp) Administrasi Fisik Selisih
OBAT-OBATAN
Albendazol Amp 406 390 390 0
Aminofilin injeksi 24mg/ml-10ml Tab 3240 0 0 0
Amitriptilin HCL Tab. Salut 25 mg Kap 112 500 500 0
Amlodipine 10 mg Tablet Kap 330 1160 1160 0
Amlodipine Besilate 5mg tablet Btl 187 1500 1500 0
Amoksisillin Kapsul 250 mg Vial 238 3 3 0
Amoksisillin Kapsul 500 mg Tab 261 5500 5500 0
Amoksisillin SK 125 mg/5 ml-60 ml Tab 2445 0 0 0
Am oxsillin aserbuk 1gr Inj Tube 7396 3 3 0
Amoksilin sk Forte Supp 4045 44 44 0
Ampisillin Injeksi 1 gram Pot 3850 40 40 0
Antasida DOEN suspensi Ampl 2140 0 0 0
Anti Bakteri DOEN Salep Kombinasi Btl 2516 90 90 0
Anti Hemoroid DOEN Kombinasi Amp 3045 30 30 0
Antifungi DOEN Kombinasi Vial 155 0 0 0
Aqua roinjek Steril Tab 2200 26 26 0

Acyclopir Krim 5%- 5gr Tab 5049 47 47 0
STOK AKHIR
HARGA SATUAN

Asam Mefenamat 500mg Btl 600 600 600 0
Artemeter Injeksi 80 mg/ml Vial 0 0 0 0
Artesunate Injeksi 60 mg/ml Tube 0 0 0 0
Asam Folat tablet 5 mg Amp 800 45 800 -755
Asetosal Tablet 100 mg Btl 21 21 21 0
Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 100 0 100 -100
Atropin Sulfat Tetes Mata 1% - 5 ml Tab 0 0 0 0
Benzatin Benzil Penisilin Inj. 2,4 Juta Amp 24 11 24 -13
Betametason Krim 0,1% - 5 gr Tab 44 150 44 106
Bisacodril sup Tab 46 46 46 0
Captopril Tablet 25 mg Amp 0 0 0 0
Chloramfecort- H Cream - 10gr Btl 0 0 0 0

HARGA SATUAN
Ciprofloxacin Infus Kap 39900 0 0 0

Ciprofloxacin Tablet 500mg Btl 255 1750 1750 0
Dapson Tablet 100 mg (Antilepra) Amp 2484 0 0 0
Deksametasone Injeksi 5 mg/ml - 1ml Kap 1580 180 180 0
Deksametasone Tablet 0,5 mg Kap 62 200 200 0
Dekstromethorfan Sirup 10 mg/ 60 ml Amp 6600 0 0 0
Diazepam Injeksi 5 mg/ml - 2ml Tab 4180 57 57 0

Dietilkarbamazin Sitrat Tablet 100 mg Amp 960 0 0 0
Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 52 43 43 0
Dimenhidrinat Tablet 50 mg Ktg 8799 0 0 0
Domperidon Suspensi 5mg/ 5ml- 60ml Tab 3333 -6 -6 0
Efedrin HCL Tablet 25 mg Btl 8100 0 0 0
Ekstrak Belladona Tablet 10 mg Btl 31 0 0 0
Epinefrina HCL/Bitartrat Inj. 0,1%- 1ml Btl 1200 105 105 0
Etanol 70%- 1000 ml Tab 1500 0 0 0
Eritromisin Kapsul 250 mg Tab 930 600 600 0
Eritromisin Syrup 200 mg/5 ml-60 ml Tab 1125 80 80 0
Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 9900 0 0 0
Fenitoin Natrium Kapsul 100 mg Tab 133 0 0 0

HARGA SATUAN

Fenobarbital Injeksi 50 mg/ml- 2ml Tab 0 52 52 0
Fenoksimetil Penisilina Tablet 250 mg Vial 0 0 0 0
Fenoksimetil Penisilina Tablet 500 mg Kap 7200 20 20 0
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Kap 3417 30 30 0
Fitomenadion (Vit. K1) Tab. 10 mg Btl 579 100 100 0
Garam Oralit 200 ml air Amp 380 250 250 0

Gliserin - 100 ml Pkt 0 550 550 0
Glukosa Lar. Infus 5% Steril - 500 ml Tab 5200 44 44 0
Gentamisin S.K 0.1%-5 gr Amp 4113 0 0 0
Gentamisin Injeksi Dus 3696 14 14 0

Haloperidol 0,5 mg Tablet Amp 96 200 200 0
Haloperidol 1,5 mg Tablet Btl 126 0 0 0
Hidroklortiazid (HCT) Tablet 25 mg Ktg 14 700 700 0
Hidrokortison Krim 2,5%-5 gr Btl 2798 0 0 0
Isoniazid Tablet 100 mg Amp 88 0 0 0

HARGA SATUAN

Ketokonazol krom Btl 2569 10 10 0
Ketokonazol tab 200mg Amp 300 600 600 0
Ketorolac Inj 30mg Tab 2300 80 80 0
Kalsium Laktat (Kalk) Tablet 500 mg Pkt 47 100 100 0
Ketamin 10 mg/ml Injeksi- 10 ml Pkt 5200 6 6 0
Klofazimin, mikronize Kapsul 100 mg Pkt 97 40 40 0
Kloramfenikol Kapsul 250 mg Pkt 733 48 48 0
Kloramfenikol Suspensi 125 mg/60 ml Pkt 3800 0 0 0
Klorfeniramin Maleat (CTM) Tab. 4 mg Btl 0 1000 1000 0
Klorokuin Tablet 150 mg Vial 0 998 998 0
Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 5744 0 0 0
Klorpromazin HCL Tablet Salut 25 mg Amp 0 0 0 0
Kodein HCL Tablet 10 mg Btl 250 0 0 0
Komb. Artesunate 50mg+Amodiaquin 200mg Tab 0 0 0 0

Kotrimoksazol Suspensi Kombinasi Amp 2145 100 100 0
Kotrimoksazol Tab. Kombinasi Btl 138 0 0 0
Kloramfenikol Salep Mata 1%-5gram Tab 1450 9 9 0

Kuinin Injeksi 25%-2ml Btl 4750 5 5 0
Levoploxasin 500mh Tab 528 72 72 0
Lidokain Komp. Injeksi, Kombinasi Tab 1295 110 110 0
Lisol, Kresol Tersabun 50%- 1000ml Vial 3360 0 0 0
Loperamide Hcl 2mg Tanlet Tab 89 1350 1350 0

HARGA SATUAN
Mebendazol Syrup/5ml - 30ml Tab 4100 30 30 0

Mebendazol Tablet 100mg Kap 0 900 900 0
Metilergometrin Maleat Tab. 0,125 g Kap 154 550 550 0
Metilergometrin M inj. 0,200mg- 1ml Kap 2750 113 113 0
Metoklorpropamid Tablet 10 mg Kap 91 0 0 0
Mikonazol Krim/ Salep 2%-10gram Kap 3000 23 23 0
Multivitamin Anak Btl 11500 30 30 0
Multivitamin Dewasa Tab 640 0 0 0
Metronidazol Infus 500mg/100ml Tab 9950 0 0 0
Metronidazol Tablet 500mg Pot 160 0 0 0
Magnesium Sulfat Inj. 25 ml Ktk 0 12 12 0
Minyak kayu putih Vial 8000 40 40 0
Natrium Bikarbonat Tablet 500mg Vial 0 0 0 0
Natrum Klorida Lar. Inf. 0,9% -500ml Amp 4700 12 12 0
Natrium Diclopenac 20mg Vial 133 0 0 0
Nistatin Tablet Salut 500.000 IU Amp 0 5 5 0
Natrium Diclopenac 50mg Tab 176 0 0 0
Nisagon Cream 5 gram Vial 0 400 400 0
Novadryl Syrup/ Holydril Syrup-60ml Btl 0 150 150 0
Obat Anti Tuberkulosis Kat. 1 (FDC) Tab 359619 1800 1800 0
Obat Anti Tuberkulosis Kat. 2 Btl 1199990 0 0 0
Obat Anti Tuberkulosis Kat. 3 Kap 0 0 0 0
OAT Sisipan Dewasa Kap 0 0 0 0
Omeprazol inj 40mg/10ml Tab 36000 4 4 0
Omeprazol Kapsul 20mg Amp 211 0 0 0
Ondansetron Inj 4mg Tab 2400 1090 1090 0
Onadansetron 8mg Tablet Tab 1189 0 0 0
Onadansetron 4mg Tablet Tube 716 0 0 0

HARGA SATUAN
OAT Kategori Anak Tab 0 60 60 0

Obat Batuk Hitam (OBH) Cairan Tab 5663 1000 1000 0
Obat Batuk Dewasa Tab 5500 0 0 0
Oksitetrasiklin HCL Inj. i.m 50mg10ml Amp 0 0 0 0
Oksitetrasiklin HCL SM 1%-3,5gram Btl 1750 0 0 0
Oksitetrasiklin HCL Salep 3%- 5gram Kap 1450 0 0 0
Oksitosin Injeksi 10 IU/ml- 1ml Kap 2200 0 0 0
OBAT Anti Diare suspensi Tab 7150 47 47 0

Paraformaldehid Tablet 1gram Tube 0 0 0 0
Parasetamol Syrup 120mg/ 5ml-60ml Tab 1438 108 108 0
Parasetamol Tablet 100mg Tab 5200 0 0 0
Parasetamol Tablet 500mg Btl 79 0 0 0
Petidin HCL Injeksi 50mg/ ml-2ml Tube 0 1050 1050 0
Pilokarpin HCI/Nitrat TM 2%- 5ml Amp 0 0 0 0
Pirantel Tablet 125mg Tube 296 23 23 0
piroksikam Tablet 10 mg Btl 138 435 435 0
Piroksikam Tablet 20 mg Tab 0 0 0 0
Propiltiourasil Tablet 100mg Tube 319 0 0 0
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 110 600 600 0
Povidon Iodida 10% 300ml Btl 14203 300 300 0
Povidon Iodida 10% 1000ml Tab 37109 16 16 0
Prednison Tablet 5mg Tube 114 0 0 0
Primakuin Tablet 15mg Btl 0 900 900 0
Prokain Benzil Penisilin 3 Juta IU Inj. Tube 0 0 0 0
propanolol HCL Tablet 10mg Btl 77 0 0 0
Propanolol HCL Tablet 40mg Tab 121 0 0 0
Reserpin Tablet 0,25mg Amp 0 0 0 0
Retinol (Vitamin A) Kapsul 100.000 IU Tab 260 2 2 0

HARGA SATUAN

Rifampisin Kapsul 300mg Tab 0 4000 4000 0
Rifampisin Kapsul 600mg Amp 0 0 0 0
Ranitidin Injeksi 25 mg/ 2ml Btl 1140 320 320 0
Ranitidin Tablet 150 mg Kap 120 45 45 0
Ringer Laktat Lar. Inf. Steril - 500ml Kap 5200 3000 3000 0
Salbutamol Tablet 2mg Tab 59 100 100 0
Salbutamol Tablet 4mg Tube 89 100 100 0
Salep 2-4, Kombinasi Tab 1229 600 600 0
Salisil Bedak 2% Tab 1250 24 24 0
Serum Anti Bisa Ular Polivalen Inj.5ml Btl 591250 60 60 0
Serum Anti Rabies Tube 0 7 7 0
Serum Anti Tetanus Inj. 1500 IU/amp. Amp 158125 6 6 0

Serum Anti Tetanus Inj. 20.000 IU/vial Tube 0 3 3 0
Sianokobalamin (Vit. B12) Inj 500mcg Btl 1078 0 0 0
Simvastatin Tablet 20 mg Tab 391 5 5 0
Simvastatin Tablet 10 mg Tube 169 1000 1000 0
Streptomisin Sulfat Serbuk Inj.1000mg Tab 0 870 870 0
Sulfasetamida Natrium TM 15%- 5ml Btl 3226 0 0 0
Sanadril syr Tab 5500 0 0 0
Sanbe ters Tube 0 0 0 0
Sanvita B syr Btl 0 0 0 0
Sinbio Tube 4500 0 0 0
Seftriakson inj. 1g Btl 0 0 0 0
Tablet Tambah Darah Komb. Tab 1260 0 0 0
Tetrakain HCL Tetes Mata 0.5%- 5ml Amp 1705 280 280 0
Tetrasiklin HCL Kapsul 250 mg Tab 148 0 0 0

HARGA SATUAN
Tetrasiklin HCL Kapsul 500 mg Tab 300 0 0 0

Tiamin HCL/(Vit. B1) Tab. 50mg Tab 55 0 0 0
Tiopental Natrium Serbuk Inj 1.000mg Tab 0 1000 1000 0
TiaminTabbblet 50 mg Amp 6402 0 0 0
Tiamin HCL (Vit. B1) Inj. 100mg/ 1ml Btl 1615 200 200 0
Triheksifenidil Hidroklorida Tab. 2mg Kap 0 0 0 0
Vitamin B Komplek Tablet Kap 107 0 0 0
Zink Tlet 20mg ab Tab 474 0 0 0
PERBEKALAN KESEHATAN 0 0
Alat Suntik Sekali Pakai 1 ml Tab 748 45 45 0
Alat Suntik Sekali Pakai 5 ml Btl 847 190 190 0
Catgut/ Benang Bedah No. 2/0 - 3/0 Tube 22500 61 61 0
I.V. Catheter No. 20 Amp 7700 106 106 0
I.V. Catheter No. 22 Tube 7700 139 139 0
I.V. Catheter No. 24 Btl 7700 68 68 0
Infusion Set Anak Tab 7920 77 77 0
Infusion Set Dewasa Tube 7920 69 69 0
Implant Tab 0 77 77 0
Jarum Jahit (Bedah) No. 9 s/d 14 Btl 0 300 300 0
Jarum Suntik (Neddle) Tab 1250 98 98 0

Kapas Pembalut/Absorben 250 gram Tube 24000 6 6 0
Kasa Kompres 40/40 Steril Btl 1200 12 12 0
Kasa Pembalut 2 m x 80 cm Tube 9400 7 7 0
Kasa Pembalut Hidrofil 4 m x 15 cm Btl 7900 20 20 0
Kasa Steril 16/16 Tab 7900 2 2 0
Masker Amp 439 155 155 0
Plester 5 yard x 2 inch Tab 13000 400 400 0

HARGA SATUAN
Sarung Tangan n0 7 Amp 700 1 1 0

Silk (Benang Bedah Sutera) No. 3/0 Vial 1948 0 0 0
PANDEGLANG, 28 MARET 2015

MENGETAHUI : TIM PELAKSANA OPNAME FISIK PERSEDIAAN
YUYUN YUNENGSIH,S.Kep SYARIPUDDIN RACHMAN,MM KHAMDAN PRAMANA, S.ST

NIP. 19820422 200801 2 006 NIP.19610426 19820112 1 001 NIP. 19761121 200604 1 007
NIP. 19700906 199003 2 003

NIP. 19780401 200604 2 020

UPT. PUSKESMAS CIKEUSIK Opname Fisik Persediaan
per 30 Juni 2015
STOK AKHIR
HARGA SATUAN
OBAT-OBATAN :
Alopurinol tablet 100 mg Tab 86 -1000 -1000 0
Albendazol Amp 406 390 390 0
Aminofilin injeksi 24mg/ml-10ml Tab 3240 0 0 0
Amoksisillin SK 125 mg/5 ml-60 ml Tab 2445 -90 -90 0
Am oxsillin aserbuk 1gr Inj Tube 7396 2 2 0
Ampisillin Injeksi 1 gram Pot 3850 10 10 0

Acyclopir Krim 5%- 5gr Tab 5049 0 0 0
STOK AKHIR
HARGA SATUAN

Asam Folat tablet 5 mg Amp 0 0 0 0
Benzatin Benzil Penisilin Inj. 2,4 Juta Amp 0 24 24 0
Betametason Krim 0,1% - 5 gr Tab 1520 -61 -61 0
Bisacodril sup Tab 5045 9 9 0
Chloramfecort- H Cream - 10gr Btl 0 600 600 0
Cefadroxil 500mg Tab 509 #VALUE! #VALUE! 0

HARGA SATUAN

Deksametasone Injeksi 5 mg/ml - 1ml Kap 1580 -455 -455 0
Dekstromethorfan Sirup 10 mg/ 60 ml Amp 6600 -20 -20 0
Dekstromethorfan Tablet 15 mg Tab 4000 -2800 -2800 0

Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 52 43 43 0
Dimenhidrinat Tablet 50 mg Ktg 8799 0 0 0
Ekstrak Belladona Tablet 10 mg Btl 31 -900 -900 0
Etanol 70%- 1000 ml Tab 1500 0 0 0
Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 9900 0 0 0
Fenitoin Natrium Kapsul 100 mg Tab 133 -6 -6 0

HARGA SATUAN

Fenobarbital Tablet 30 mg Tab 0 -20 -20 0
Fenoksimetil Penisilina Tablet 250 mg Vial 0 0 0 0

Gliserin - 100 ml Pkt 0 0 0 0
Glukosa Lar. Infus 5% Steril - 500 ml Tab 5200 -2936 -2936 0
Gentamisin Injeksi Dus 3696 -82 -82 0

Isoniazid Tablet 100 mg Amp 88 #VALUE! #VALUE! 0

HARGA SATUAN

Ketorolac Inj 30mg Tab 2300 45 45 0
Ketamin 10 mg/ml Injeksi- 10 ml Pkt 5200 -6 -6 0
Klofazimin, mikronize Kapsul 100 mg Pkt 97 -610 -610 0
Kloramfenikol Suspensi 125 mg/60 ml Pkt 3800 -200 -200 0
Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 5744 0 0 0
Klorpromazin HCL Tablet Salut 25 mg Amp 0 0 0 0
Klorpromazin HCL Tablet Salut 100 mg Tab 0 -2300 -2300 0
Kodein HCL Tablet 10 mg Btl 250 -548 -548 0

Kloramfenikol Salep Mata 1%-5gram Tab 1450 -2041 -2041 0

Kloramfenikol Tetes Telinga 3%-5ml Btl 1797 -26 -26 0
Kuinin Injeksi 25%-2ml Btl 4750 -1695 -1695 0
Lidokain Komp. Injeksi, Kombinasi Tab 1295 66 66 0

HARGA SATUAN
Mebendazol Syrup/5ml - 30ml Tab 4100 -15 -15 0

Metilergometrin M inj. 0,200mg- 1ml Kap 2750 -391 -391 0
Metoklorpropamid Tablet 10 mg Kap 91 -6 -6 0
Mikonazol Krim/ Salep 2%-10gram Kap 3000 -897 -897 0
Multivitamin Anak Btl 11500 5 5 0
Multivitamin Dewasa Tab 640 -59 -59 0
Metronidazol Tablet 500mg Pot 160 -3 -3 0
Natrium Diclopenac 20mg Vial 133 -30 -30 0
Nistatin Tablet Salut 500.000 IU Amp 0 -10 -10 0
Omeprazol inj 40mg/10ml Tab 36000 0 0 0
Omeprazol Kapsul 20mg Amp 211 0 0 0
Ondansetron Inj 4mg Tab 2400 2520 2520 0
Onadansetron 8mg Tablet Tab 1189 0 0 0
Onadansetron 4mg Tablet Tube 716 #VALUE! #VALUE! 0

HARGA SATUAN

Obat Batuk Dewasa Tab 5500 0 0 0
Oksitetrasiklin HCL SM 1%-3,5gram Btl 1750 -1650 -1650 0
Oksitosin Injeksi 10 IU/ml- 1ml Kap 2200 -40 -40 0

Parasetamol Syrup 120mg/ 5ml-60ml Tab 1438 -207 -207 0
Parasetamol Tablet 500mg Btl 79 -3000 -3000 0
Pirantel Tablet 125mg Tube 296 -277 -277 0
piroksikam Tablet 10 mg Btl 138 -565 -565 0
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 110 -2800 -2800 0
Prednison Tablet 5mg Tube 114 -4300 -4300 0
propanolol HCL Tablet 10mg Btl 77 -150 -150 0

HARGA SATUAN

Ranitidin Injeksi 25 mg/ 2ml Btl 1140 0 0 0
Ranitidin Tablet 150 mg Kap 120 0 0 0
Salbutamol Tablet 2mg Tab 59 -350 -350 0
Salisil Bedak 2% Tab 1250 -76 -76 0

Sianokobalamin (Vit. B12) Inj 500mcg Btl 1078 -65 -65 0
Simvastatin Tablet 20 mg Tab 391 -400 -400 0
Sulfasetamida Natrium TM 15%- 5ml Btl 3226 -38 -38 0
Sinbio Tube 4500 -120 -120 0
Tablet Tambah Darah Komb. Tab 1260 20 20 0
Tetrasiklin HCL Kapsul 250 mg Tab 148 -1000 -1000 0

HARGA SATUAN
NAMA / JENIS BARANG KODE SATUAN (Rp) Penjelasan selisih
Administrasi Fisik Selisih

Tiamin HCL/(Vit. B1) Tab. 50mg Tab 55 -4000 -4000 0
Vitamin B Komplek Tablet Kap 107 -5000 -5000 0
Zink Tlet 20mg ab Tab 474 -500 -500 0
PERBEKALAN KESEHATAN Tube 0 0 0
Alat Suntik Sekali Pakai 3 ml Tab 748 -200 -200 0
Alat Suntik Sekali Pakai 5 ml Btl 847 -30 -30 0

Kasa Kompres 40/40 Steril Btl 1200 -29 -29 0
Kasa Pembalut 2 m x 80 cm Tube 9400 -3 -3 0
Kasa Steril 16/16 Tab 7900 -25 -25 0
Masker Amp 439 210 210 0

HARGA SATUAN
Sarung Tangan n0 7 Amp 700 -74 -74 0

Silk (Benang Bedah Sutera) No. 3/0 Vial 1948 -36 -36 13
PANDEGLANG, 30 Juni 2015
YUYUN YUNENGSIH,S.Kep SYARIPUDDIN RACHMAN,MM KHAMDAN PRAMANA, S.ST

NIP. 19800226 200902 1 001 NIP.19610426 19820112 1 001 NIP. 19761121 200604 1 007

NIP. 19700906 199003 2 003

NIP. 19780401 200604 2 020

Opname Fisik Persediaan
UPT. PUSKESMAS CIKEUSIK per September 2015
STOK AKHIR
HARGA SATUAN
OBAT-OBATAN :
Alopurinol tablet 100 mg Tab 86 -1000 -1000 0
Albendazol Amp 406 -200 -200 0
Aminofilin injeksi 24mg/ml-10ml Tab 3240 -60 -60 0
Am oxsillin aserbuk 1gr Inj Tube 7396 -54 -54 0
Ampisillin Injeksi 1 gram Pot 3850 -80 -80 0

Acyclopir Krim 5%- 5gr Tab 5049 -20 -20 0
Acyclopir Tablet 400 mg Tab 336 -500 -500 0
STOK AKHIR
HARGA SATUAN

Atropin Sulfat Tablet 0,5 mg Tab 74 -100 -100 0
Bisacodril sup Tab 5045 -38 -38 0
Chloramfecort- H Cream - 10gr Btl 0 Err:509 Err:509 0

HARGA SATUAN


Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 52 -17 -17 0
Domperidon 10 mgtablet Tab 167 -43 -43 0
Dimenhidrinat Tablet 50 mg Ktg 8799 -270 -270 0
Etambutol HCL Tablet 250 mg Tab 0 -5 -5 0
Etanol 70%- 1000 ml Tab 1500 0 0 0
Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 9900 -270 -270 0

HARGA SATUAN

Fenoksimetil Penisilina Tablet 250 mg Vial 0 -100 -100 0
Furosemida Tablet 40 mg Tab 75 -350 -350 0
Glibenklamida Tablet 5 mg Tab 56 -994 -994 0

Glukosa Lar. Infus 10% Steril - 500 ml Btl 1675 -55 -55 0

Ibuprofen Tablet 200 mg Tab 110 Err:509 Err:509 0

HARGA SATUAN
Isoniazid Tablet 300 mg Tab 97 -26 -26 0

Ketorolac Inj 30mg Tab 2300 -2 -2 0
Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 5744 -48 -48 0
Klorpromazin HCL Tablet Salut 25 mg Amp 0 -580 -580 0
Kodein HCL Tablet 10 mg Btl 250 -848 -848 0


Lidokain Komp. Injeksi, Kombinasi Tab 1295 -25 -25 0
KODE SATUAN JUMLAH KUANTITAS PERSEDIAAN Penjelasan selisih

HARGA SATUAN
NAMA / JENIS BARANG (Rp) Administrasi Fisik Selisih

Multivitamin Anak Btl 11500 -365 -365 0
Omeprazol inj 40mg/10ml Tab 36000 -15 -15 0
Omeprazol Kapsul 20mg Amp 211 Err:509 Err:509 0
Ondansetron Inj 4mg Tab 2400 Err:509 Err:509 0
Onadansetron 8mg Tablet Tab 1189 #VALUE! #VALUE! 0
HARGA SATUAN
KODE SATUAN (Rp) JUMLAH KUANTITAS PERSEDIAAN Penjelasan selisih
NAMA / JENIS BARANG

Obat Batuk Hitam (OBH) Cairan Kap 5663 250 250 0
Obat Batuk Dewasa Kap 5500 -60 -60 0
Oksitetrasiklin HCL Inj. i.m 50mg10ml Kap 0 50 50 0
Oksitetrasiklin HCL SM 1%-3,5gram Kap 1750 -3060 -3060 0
Oksitosin Injeksi 10 IU/ml- 1ml Btl 2200 -51 -51 0

Paraformaldehid Tablet 1gram Tab 0 0 0 0
Parasetamol Syrup 120mg/ 5ml-60ml Pot 1438 -497 -497 0
Parasetamol Tablet 100mg Ktk 5200 1145 1145 0
Parasetamol Tablet 500mg Vial 79 -12500 -12500 0
Petidin HCL Injeksi 50mg/ ml-2ml Vial 0 22650 22650 0
Pirantel Tablet 125mg Vial 296 -677 -677 0
piroksikam Tablet 10 mg Amp 138 -2315 -2315 0
Propiltiourasil Tablet 100mg Vial 319 0 0 0
Piridoksin HCL (Vit. B6) Tablet 10mg Btl 110 -7700 -7700 0
Prednison Tablet 5mg Kap 114 -10100 -10100 0
Primakuin Tablet 15mg Kap 0 3600 3600 0
Prokain Benzil Penisilin 3 Juta IU Inj. Tab 0 0 0 0
propanolol HCL Tablet 10mg Amp 77 -610 -610 0
Reserpin Tablet 0,25mg Tab 0 0 0 0
Retinol (Vitamin A) Kapsul 100.000 IU Tube 260 2 2 0

NAMA / JENIS BARANG KODE SATUAN HARGA SATUAN Penjelasan selisih

Ranitidin Injeksi 25 mg/ 2ml Btl 1140 -30 -30 0
Ranitidin Tablet 150 mg Kap 120 -1000 -1000 0

Sinbio Tube 4500 -120 -120 0
Tablet Tambah Darah Komb. Tab 1260 -380 -380 0

HARGA SATUAN
Alat Suntik Sekali Pakai 3 ml Tab 748 -330 -330 0
Alat Suntik Sekali Pakai 5 ml Btl 847 -260 -260 0

Kasa Steril 16/16 Tab 7900 -115 -115 0
Masker Amp 439 20 20 0

HARGA SATUAN
HARGA SATUAN

PANDEGLANG, 30 September 2015

YUYUN YUNENGSIH,S.Kep SYARIPUDDIN RACHMAN,MM ADE SUHENDI,SKM

NIP. 19820422 200801 2 006 NIP.19610426 19820112 1 001 NIP. 19800226 200902 1 001

NIP. 19700906 199003 2 003

NIP. 19780401 200604 2 020

MENU
Opname Fisik Persediaan
UPT. PUSKESMAS CIKEUSIK per Desember 2015
HARGA SATUAN
NAMA / JENIS BARANG KODE SATUAN STOK AKHIR Penjelasan selisih
(Rp)
OBAT-OBATAN :
Albendazol Amp 406 -530 -530 0
Aminofilin injeksi 24mg/ml-10ml Tab 3240 -120 -120 0
Amlodipine Besilate 5mg tablet Btl 187 -320 -320 0
Amoksisillin Kapsul 500 mg Tab 261 -6300 -6300 0
Am oxsillin aserbuk 1gr Inj Tube 7396 -94 -94 0
Ampisillin Injeksi 1 gram Pot 3850 -140 -140 0
Antalgin (Metampiron) Tab. 500 mg Tab 0 -500 -500 0
Antasida DOEN tablet Tab 72 -4200 -4200 0
Anti Bakteri DOEN Salep Kombinasi Btl 2516 -60 -60 0
Aqua roinjek Steril Tab 2200 -8 -8 0

Acyclopir Krim 5%- 5gr Tab 5049 -20 -20 0
Acyclopir Tablet 200mg Tab 237 -300 -300 0
Acyclopir Tablet 400 mg Tab 336 -700 -700 0
STOK AKHIR
HARGA SATUAN

Asam Askorbat (Vit. C) Tablet 50 mg Tab 90 -300 -300 0
Asam Folat tablet 1 mg Tab 0 -550 -550 0
Atropin Sulfat Tablet 0,5 mg Tab 26 -100 -100 0
Bisacodril sup Tab 0 -72 -72 0
Chloramfecort- H Cream - 10gr Btl 1800 Err:509 Err:509 0

HARGA SATUAN

Diazepam Tablet 2 mg Tab 0 -100 -100 0

Difenhidramin HCL Inj. 10 mg/ml- 1 ml Tab 680 -57 -57 0
Digoksin Tablet 0,25 mg Tab 0 -800 -800 0
Domperidon 10 mgtablet Tab 0 -243 -243 0
Dimenhidrinat Tablet 50 mg Ktg 380 -270 -270 0
Etakridin (Rivanol) Lar. 0,1%-300 ml Btl 0 -30 -30 0
Etanol 70%- 1000 ml Tab 0 0 0 0
Fenitoin Natrium Injeksi 50 mg/ 1 ml Tab 0 -270 -270 0

HARGA SATUAN

Fenoksimetil Penisilina Tablet 250 mg Vial 0 -100 -100 0
Fitomenadion (Vit. K1) Inj. 10 mg/1 ml Kap 210 -40 -40 0
Furosemida Tablet 40 mg Tab 0 -350 -350 0
Glibenklamida Tablet 5 mg Tab 0 -1294 -1294 0

Glukosa Lar. Infus 10% Steril - 500 ml Btl 3500 -175 -175 0

Haloperidol 0,5 mg Tablet Amp 1033 -100 -100 0

HARGA SATUAN
Isoniazid Tablet 300 mg Tab 130 -26 -26 0

Ketokonazol krom Btl 4900 -95 -95 0
Ketorolac Inj 30mg Tab 0 -48 -48 0
Klorfeniramin Maleat (CTM) Tab. 4 mg Btl 1500 -100 -100 0
Klorpromazin HCL Inj. 25 mg/ml- 1ml Tube 1920 -48 -48 0
Klorpromazin HCL Tablet Salut 25 mg Amp 1785 -880 -880 0
Kodein HCL Tablet 10 mg Btl 2300 0 0 0


Levoploxasin 500mh Tab 57 -293 -293 0
Lidokain Komp. Injeksi, Kombinasi Tab 0 -165 -165 0
Loperamide Hcl 2mg Tanlet Tab 0 -150 -150 0

HARGA SATUAN

Multivitamin Anak Btl 5200 -502 -502 0
Metronidazol Infus 500mg/100ml Tab 97 -30 -30 0
Natrium Diclopenac 50mg Tab 0 -850 -850 0
Omeprazol inj 40mg/10ml Tab 35 -70 -70 0
Omeprazol Kapsul 20mg Amp 0 Err:509 Err:509 0
Ondansetron Inj 4mg Tab 0 Err:509 Err:509 0
Onadansetron 8mg Tablet Tab 22 #VALUE! #VALUE! 0

HARGA SATUAN

Obat Batuk Dewasa Tab 5500 -90 -90 0
Oksitetrasiklin HCL SM 1%-3,5gram Btl 1750 -3060 -3060 0
Oksitosin Injeksi 10 IU/ml- 1ml Kap 2200 -51 -51 0

Parasetamol Syrup 120mg/ 5ml-60ml Tab 1438 -737 -737 0
Parasetamol Tablet 500mg Btl 79 8000 8000 0
Pirantel Tablet 125mg Tube 296 -1077 -1077 0
piroksikam Tablet 10 mg Btl 138 -2565 -2565 0
Piridoksin HCL (Vit. B6) Tablet 10mg Tab 110 -11800 -11800 0
Prednison Tablet 5mg Tube 114 -14900 -14900 0
propanolol HCL Tablet 10mg Btl 77 -710 -710 0

HARGA SATUAN

Ranitidin Injeksi 25 mg/ 2ml Btl 1140 -30 -30 0
Ranitidin Tablet 150 mg Kap 120 -1000 -1000 0

Simvastatin Tablet 10 mg Tube 169 -50 -50 0
Sinbio Tube 4500 -120 -120 0
Tablet Tambah Darah Komb. Tab 1260 -580 -580 0

HARGA SATUAN

Alat Suntik Sekali Pakai 5 ml Btl 847 900 900 0

Kasa Steril 16/16 Tab 7900 -315 -315 0
Masker Amp 439 -180 -180 0

HARGA SATUAN
PANDEGLANG,31 Desember 2015

YUYUN YUNENGSIH,S.Kep SYARIPUDDIN RACHMAN,MM ADE SUHENDI,SKM

NIP. 198204 22 200801 2 001 NIP.19610426 19820112 1 001 NIP. 19800226 200902 1 001
NIP. 19700906 199003 2 003

NIP. 19780401 200604 2 020
LAPORAN NERACA STOK OBAT TAHUN 2014
UPT PUSKESMAS CIKEUSIK
SISA JUMLAH JUMLAH JUMLAH SISA AKHIR HARGA

NO NAMA OBAT SATUAN AWAL HARGA
PENERIMAAN PERSEDIAAN PENGELUARAN TAHUN SATUAN
TAHUN
LAPORAN BULANAN OBAT UPT PUSKESMAS CIKEUSIK
Bulan
PENGELUARAN
SISA AWAL PENERIMAAN
NO NAMA OBAT SAT JUMLAH PKM PUSTU PUSTU PUSTU PUSTU PUSTU PUSTU PUSTU JUMLAH
BULAN PUSLING
PERSEDIAAN INDUK CIKIRUHWETAN TANJUNGAN SUMURBATU RANCASENENG PARUNGKOKOSAN CURUGCIUNG LEUWIBALANG KELUAR

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MENU UTAMA

PROGRAM PENGELOLAAN OBAT PUSKESMAS

LAPORAN PEMAKAIAN DAN LEMBARAN PULDAT RESEP LAPORAN TRIWULAN OBAT

PEBRUARI JUNI OKTOBER PEB JUN

MARET MAR JUL NOV

APRIL APR AGS DES

PUSKESMAS: CIKEUSIK MENU

PUSKESMAS : CIKEUSIK DOKUMEN NOMOR TANGGAL

3 Albendazol Tab 90 300 390 0 390 0

4 Aminofilin injeksi 24mg/ml-10ml Amp 0 0 0 0 0 0

5 Amitriptilin HCL Tab. Salut 25 mg Tab 500 0 500 0 500 0

6 Amlodipine 10 mg Tablet Tab 1720 0 1720 510 1210 500

7 Amlodipine Besilate 5mg tablet Tab 1200 0 1200 0 1200 500

8 Alkacide 1 L High Level Desinfectant(Alkapham Ferance Btl 2 0 2 0 2 0

Amoksisillin SK 125 mg/5 ml-60 ml Btl 0 0 0 0 0 400

16 Antasida DOEN suspensi Btl 50 200 250 190 60 200

17 Anti Bakteri DOEN Salep Kombinasi (basitrasin) Tube 115 0 115 25 90 0

18 Anti Hemoroid DOEN Kombinasi Supp 30 0 30 0 30 0

19 Antifungi DOEN Kombinasi Pot 0 0 0 0 0 0

20 Antimigren DOEN Kombinasi Tab 0 0 0 0 0 0

21 Antiparkinson DOEN tab. Kombinasi Tab 0 0 0 0 0 0

22 Aqua roinjek Steril Btl 6 20 26 10 16 20

23 Acyclopir Krim 5%- 5gr Tube 108 0 108 37 71 0

24 Acyclopir Tablet 200mg Tab 1600 0 1600 900 700 0

25 Acyclopir Tablet 400 mg Tab 700 0 700 0 700 0

26 Akita/Molagit Tablet Tab 600 0 600 0 600 1000

27 Antalgin (Metampiron) Inj. 250mg/2ml Tab 0 0 0 0 0 0

28 Asam asetilsalisilat 100mg tablet Tab 400 0 400 0 400 0

30 Alprazolam 1mg Tab 0 0 0 0 0 0

31 Ambroksol tab tab 0 0 0 0 0 3000

32 Ambroksol syr Btl 0 0 0 0 0 300

34 Asering Infus Tab 48 0 48 0 48 0

35 Asam Folat tablet 01mg Tab 0 0 0 0 0 0

38 Asam traneksamat Inj 5 % Amp 10 20 30 20 10 20

39 Asetosal Tablet 500 mg Tab 0 0 0 0 0 0

40 Atropin Sulfat Inj. 0,25 mg/ml - 1 ml Amp 100 0 0 0 0 0

41 Atropin Sulfat Tablet 0,5 mg Tab 0 0 0 0 0 0

44 Betadin Salf Antiseptik Tube 24 0 24 0 24 0

45 Betametason Krim 0,1% - 5 gr Tube 100 0 100 45 55 48

46 Bisacodril sup Botol 48 0 48 2 46 0

47 Bisoprolol 5mg tab Tab 570 0 570 0 570 0

48 Captopril Tablet 12,5 mg Tab 850 0 850 400 450 1000

49 Captopril Tablet 25 mg Tab 1650 0 1650 1150 500 1000

50 Carbamazefine Tab 0 400 400 100 300 1000

51 Cefadroxil 500mg Tab 0 0 0 0 0 0

52 Cetrizin syr Btl 0 0 0 0 0 100

53 Cefixim Tab 0 0 0 0 0 2000

54 Ciprofloxacin Infus Btl 0 0 0 0 0 10

56 D-Artepp Tab Tab 0 0 0 0 0 0

57 Deksametasone Injeksi 5 mg/ml - 1ml Amp 100 0 100 0 100 2000

58 Deksametasone Tablet 0,5 mg Tab 1200 4000 5200 3300 1900 0

59 Dekstromethorfan Sirup 10 mg/ 60 ml Btl 0 0 0 0 0 0

60 Diazetpam Rectal 2mg Tube 0 0 0 0 0 10

62 Diazepam Tablet 2 mg Tab 0 0 0 0 0 0

63 Diazepam Tablet 5 mg Tab 0 100 100 0 100 0

64 Dietilkarbamazin Sitrat Tablet 100 mg Tab 0 0 0 0 0 0

65 Difenhidramin HCL Inj. 10 mg/ml- 1 ml Amp 43 0 43 0 43 0

66 Digoksin Tablet 0,25 mg Tab 300 0 300 0 300 0

67 Domperidon 10 mgtablet Tab 700 0 700 500 200 1000

68 Dimenhidrinat Tablet 50 mg Tab 0 0 0 0 0 0

STOK PENERI- PERSE- PEMA- STOK STOK PERMIN- PEMBERIAN

9 Infusion Set Anak Set 135 0 135 10 125 0

JUMLAH KUNJUNGAN RESEP UMUM ASKES JUMLAH