LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DANA JKN

( LPLPO ) DANA JKN

PUSKESMAS : PELAPORAN BULAN :
SUB UNIT : PERMINTAAN BULAN :
KECAMATAN : TAHUN :
KABUPATEN :
PROPINSI :

HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK

TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

OBAT-OBATAN
Dus, 25 tube @ 5
1 Acyclovir Cream 5 % gram 2015 2,725
dus,10 botol @ 10
2 Albendazole suspensi 200 mg / 5 ml 2015 3,849
ml suspensi
dus,10 botol @ 10
3 Albendazole suspensi 200 mg / 5 ml 2016 3,849
ml suspensi
box,10 strips @ 10
4 Alopurinol tablet 100 mg tablets 2015 86
dus, 10 blister @ 10
5 Alopurinol tablet 300 mg tablet 2015 200
6 Alprazolam tablet 0,25 mg box / 100 tab 2015 380
7 Alprazolam tablet 0,5 mg ktk 10 x 10 tablet 2015 214
8 Ambroxol 30 mg box 10 x 10's 2015 114
9 Ambroxol sirup 15 mg/ml botol 60 ml 2015 2,997
dus 30 ampul @ 10
10 Aminofilin injeksi 24 mg/ml ml 2015 3,822
dus 30 ampul @ 10
11 Aminofilin injeksi 24 mg/ml ml 2016 3,345
12 Aminoflin tablet scored 200 mg . botol @ 100 tab 2015 80
13 Aminoflin tablet scored 200 mg . botol @ 100 tab 2016 114
dus, 10 strip @ 10
14 Amitriptilin tablet salut 25 mg (HCl) tss 2015 112
dus, 10 strip @ 10
15 Amitriptilin tablet salut 25 mg (HCl) tss 2016 143
box, 3 strip @ 10
16 Amlodipin tablet 10 mg tablets 2015 330
box, 3 strip @ 10
17 Amlodipin tablet 5 mg tablets 2015 187
box, 3 strip @ 10
18 Amlodipin tablet 5 mg tablets 2016 105
19 Amoksisilin sirup kering 125 mg/ 5 ml btl @ 60 ml 2015 2,445
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
20 Amoksisilin sirup kering 125 mg/ 5 ml btl @ 60 ml 2016 2,080
21 Amoksisilin sirup kering forte 250 mg/5 ml dus, botol 60 ml 2015 4,070
22 Amoksisilin sirup kering forte 250 mg/5 ml dus, botol 60 ml 2016 3,984
23 Amoksisilin tablet scored 500 mg ktk 10 x 10 tablet 2015 261
dus, 10 strip @ 10
24 Amoksisilin tablet scored 500 mg tablet 2016 325
25 Ampisilin serbuk injeksi I,v. 1000 mg/vial dus,10 vial @ 1g 2015 5,100
26 Ampisilin serbuk injeksi I,v. 1000 mg/vial dus,10 vial @ 1g 2016 8,000
27 Analgesik Krim tube @ 15 gram 2015 12,000
28 Analgesik Non Narkotika Krim Topikal (Coverpain) tube @ 15 gram 2016 12,000
kotak 5 ampul @ 2
29 Analgesik Non Narkotik Injeksi ml 2015 9,000
kotak 5 ampul @ 2
30 Analgesik Non Narkotik Injeksi (NOVALDO) ml 2016 7,200
31 Anestesi Lokal gigi kombinasi Dus, 20 ampul 2015 2,830
32 Antalgin tablet 500 mg dus 10 x 10 tablet 2015 125
33 Antalgin tablet 500 mg dus 10 x 10 tablet 2016 135
Antasida DOEN I tablet kunyah, kombinasi : dus, 10 strip @ 10
34 Aluminium Hidroksida 200 mg Magnesium tablet 2015 72
Antasida DOEN I tablet kunyah, kombinasi : dus, 10 strip @ 10
Hidroksida 200 mg
35 Aluminium Hidroksida 200 mg Magnesium tablet 2016 62
Antasida DOEN II suspensi, kombinasi : Aluminium
Hidroksida 200 mg
36 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 botol @ 60 ml 2015 2,160
Antasida DOEN II suspensi, kombinasi : Aluminium
mg/5ml
37 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 botol @ 60 ml 2016 5,450
mg/5ml
38 Anti Bisa Ular ( ABU ) vial 5 ml 2015 430,000
39 Anti influenza kaplet box 150's 2015 313
40 Anti influenza kaplet (MOLEXFLU) box 150's 2016 360
41 Anti Inflamasi Emulgel (BUFAFLAM EMULGEL) tube @ 20 g 2016 20,000
42 Antibiotika mata + kortikosteroid botol @ 5 ml 2015 15,000
Anti mikroba + kortikosteroid tetas mata (LITROL
43 TETES MATA) botol @ 5 ml 2016 15,000
44 Anti Hemoroid (HEMOGARD) dus/ 3 blister x 10's 2016 1,400
45 Anti Bakteri Topikal Tetes telinga (RECO) botol @ 10 ml 2016 6,500
Antifungi salep, kombinasi : asam benzoat 6%+
46 asam salisilat 3% ( WHITFIELD) Pot @ 30 gram 2016 4,158
47 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg btl 100 tablet 2015 135
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Antiparkinson DOEN tablet kombinasi : Benserazid dus, 5 strip @ 10
48 25 mg Levodopa 100 mg tablet 2015 1,500
Antiparkinson DOEN tablet kombinasi : Benserazid dus, 5 strip @ 10
49 25 mg Levodopa 100 mg (LEVOPAR) tablet 2016 1,298
50 Antispasmodik box 100 kaplet 2015 1,540
51 Antispasmodik (DORMI COMPOSITUM) box 100 kaplet 2016 1,540
kotak 10 vial @ 20
52 Aqua pro injeksi steril, bebas pirogen ml 2015 5,000
53 Aqua pro injeksi steril, bebas pirogen(OTSU 25) Ampul @ 25 ml 2016 2,750
54 Asam Ascorbat (vitamin C) tablet 50 mg dus 10 strip x 10 tab 2015 95
55 Asam Ascorbat (vitamin C) tablet 50 mg botol @ 100 tablet 2016 39
56 Asam asetilsalisilat (asetosal) tab 80 mg(MINIASPI) dus 10 strip x 10 tab 2016 114
dus, 10 strip @ 10
57 Asam Folat tablet 0,4 mg tablet 2015 84
dus, 10 strip @ 10
58 Asam Folat tablet 0,4 mg tablet 2016 63
59 Asam Folat tablet 1 mg botol @ 100 tablet 2015 48
60 Asam Mefenamat kaplet 500 mg dus 10 strip x 10 tab 2015 112
61 Asam Mefenamat kaplet 500 mg dus 10 strip x 10 tab 2016 106
dus, 10 ampul @ 5
62 Asam traneksamat injeksi 50 mg/ml ml 2015 2,950
dus, 10 ampul @ 5
63 Asam traneksamat injeksi 50 mg/ml ml 2016 2,445
64 Asam traneksamat tablet 500 mg dus, 10 x 10 tablet 2015 790
dus, 10 blister @ 10
65 Asiklovir tablet 200 mg tablet 2015 237
dus, 10 blister @ 10
66 Asiklovir tablet 200 mg tablet 2016 249
dus,5 strip @ 10
67 Asiklovir tablet 400 mg tablet 2015 336
dus,10 strip @ 10
68 Asiklovir tablet 400 mg tablet 2016 349
69 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) dus 100 ampul@1ml 2016 1,672
dus 5 strip @ 10
70 Atapulgit tablet 600 mg tablet 2015 190
71 ATS 1500 UI ampul 1 ml 2015 115,000
72 Bahan tumpat sementara jar 2015 171,600
73 Bahan tumpat sementara (CAVIT W) jar 2016 181,815
74 Bedak Salisil serbuk 2% dus @ 50 gram 2015 1,250
75 Bedak Salisil serbuk 2% dus @ 50 gram 2016 2,200
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
76 Betametason krim 0,1 % (sebagai valerat ) tube 5 gram 2015 1,520
77 Betametason krim 0,1 % (sebagai valerat ) tube 5 gram 2016 1,840
78 Bisakodil suppositoria 10 mg supp 2015 6,045
79 Bisoprolol tablet 5 mg box 3 x 10 tab 2015 645
80 Bonding kit 2015 1,000,000
81 Carbazochrome Sodium Sulfonat 10 mg (Saldona) dus 10 strip x 10 tab 2016 1,450
82 Calsium hydrokside box 2015 240,000
dus, 100 ampul @ 1
83 Deksametason injeksi i.v/i.m 5 mg/ml ml 2015 1,580
dus, 100 ampul @ 1
84 Deksametason injeksi i.v/i.m 5 mg/ml ml 2016 1,518
dus, 10 srtip @ 10
85 Deksametason tablet 0,5 mg tablet 2015 62
dus, 10 srtip @ 10
86 Deksametason tablet 0,5 mg tablet 2016 44
87 Diazepam tablet 2 mg btl 100 2015 45
dus, 10 srtip @ 10
88 Diazepam tablet 5 mg tablet 2016 130
89 Diazepam lar rektal 10 mg/2,5 ml (STESOLID) dus 5 alubag @ 1 tube @ 2,5ml2016 16,742
90 Diazepam lar rektal 5 mg/2,5 ml (STESOLID) dus 5 alubag @ 1 tube @ 2,5ml2016 11,517
91 Diazepam inj 5 mg/ml (iv/im) (Stesolid injeksi) ampul 2016 11,440
92 Diclofenac Diethylamin emulgel tube @ 20 g 2015 20,000
93 Difenhidramin injeksi i.v/i.m. 10 mg/ml (HCl) dus @ 30 ampul 2015 1,050
94 Difenhidramin injeksi i.v/i.m. 10 mg/ml (HCl) dus @ 30 ampul 2016 1,175
95 Digoksin tablet 0,25 mg Box 10 x 10 tab 2015 97
96 Digoksin tablet 0,25 mg Box 10 x 10 tab 2016 105
97 Dimenhidrinat tablet 50 mg btl 100 tablet 2015 104
box 10 strip @ 10
98 Dimenhidrinat tablet 50 mg tablet 2016 85
99 Domperidon suspensi/sirup 5 mg/ml btl @ 60 ml 2015 3,333
100 Domperidon tablet 10 mg dus 10 x 10's 2015 167
101 Domperidon tablet 10 mg dus 10 x 10's 2016 118
102 Epinefrin (Adrenalin) injeksi i.v/s.k/i.m 1 mg/ml dus @ 30 ampul 2015 2,100
103 Epinefrin (Adrenalin) injeksi i.v/s.k/i.m 1 mg/ml dus @ 30 ampul 2016 2,204
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dus, 10 blister @ 10
104 Eritromisin kaplet 500 mg kss 2015 930
105 Eritromisin kapsul 250 mg ktk 10 x 10 kapsul 2015 497
106 Eritromisin kapsul 250 mg ktk 10 x 10 kapsul 2016 566
107 Eritromisin sirup kering 200 mg/5 ml botol @ 60 ml 2015 7,700
108 Eritromisin sirup kering 200 mg/5 ml botol @ 60 ml 2016 6,700
box 10 strip @ 10
109 Ergotamin tab 1 mg tablet 2016 121
110 Etanol 70 % cairan btl @ 100 ml 2015 2,500
111 Etil Klorida semprot 100 ml btl @ 100 ml 2016 95,455
112 Fenobarbital injeksi i.m/i.v. 50 mg/ml dus @ 30 ampul 2015 1,800
113 Fenobarbital injeksi i.m/i.v. 50 mg/ml dus @ 30 ampul 2016 1,969
114 Fenoksimetil penisilin (penisilin V) tablet 250 mg dus @ 10 x 10's 2015 290
115 Fenoksimetil penisilin (penisilin V) tablet 250 mg dus @ 10 x 10's 2016 350
116 Fenoksimetil penisilin (penisilin V) tablet 500 mg dus @ 10 x 10's 2015 510
117 Fenoksimetil penisilin (penisilin V) tablet 500 mg dus @ 10 x 10's 2016 605
118 Fitomenadion (vitamin K1) injeksi i.m. 2 mg/ml dus @ 30 ampul 2015 3,417
119 Fitomenadion (vitamin K1) injeksi i.m. 2 mg/ml dus @ 30 ampul 2016 3,550
120 Fitomenadion (vitamin K1) tablet salut gula 10 mg dus@ 10 x 10 's 2015 630
121 Fitomenadion (vitamin K1) tablet salut gula 10 mg dus@ 10 x 10 's 2016 691
122 Fluocinolone Acetonide, Neomycin sulfat cream tube @ 5 g 2015 14,000
dus, 25 ampul @ 2
123 Furosemid injeksi i.v/i.m.10 mg/ml ml 2015 1,829
dus, 10 strip @ 10
124 Furosemid tablet 40 mg tablet 2015 85
125 Garam Oralit Aroma Jeruk
Garam Oralit I serbuk ,kombinasi : Natrium Klorida box 25 sachet 2015 1,000
126 0,52 g Kalium Klorida 0,30 g Trinatrium sitrat dihidrat dus @ 100 Sachet 2015 288
0,58 g Glukosa Anhidrat 2,70 g dus, 10 blister @ 12
127 Gemfibrozil kapsul 300 mg kapsul 2015 289
dus, 10 blister @ 10
128 Gemfibrozil kapsul 300 mg kapsul 2016 380
129 Gentamisin salep mata 0,3 % tube @ 3,5 gr 2015 2,600
130 Glassionomer (bahan tumpat tanpa sinar) kit 2015 565,208
Glassionomer (bahan tumpat tanpa sinar) (Ketac
131 Molar Easymix) kit 2016 568,182
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dus, 10 blister @ 10
132 Glibenklamid tablet 5 mg kaptab 2015 56
box 10 strip @ 10
133 Glibenklamid tablet 5 mg tablet 2016 78
134 Glikazid tablet 80mg (GLUCODEX) dus, 100 tablet 2015 236
135 Glikazid tablet 80mg (GLUCODEX) dus, 100 tablet 2016 235
136 Glimepiride tablet 1 mg ktk 5x10 tablet 2015 265
137 Glimepiride tablet 1 mg ktk 10x10 tablet 2016 218
138 Glimepiride tablet 2 mg ktk 5x10 tablet 2015 436
dus 5 strip @ 10
139 Glimepiride tablet 2 mg tablet 2016 289
140 Glimepiride tablet 3 mg ktk 5x10 tablet 2015 404
141 Glukosa larutan infus 10 % steril botol @ 500 ml 2015 5,700
142 Glukosa larutan infus 10 % steril botol @ 500 ml 2016 7,500
143 Glukosa larutan infus 5 % steril botol @ 500 ml 2015 5,200
144 Glukosa larutan infus 5 % steril botol @ 500 ml 2016 6,900
145 Glukosa larutan infus 5 % steril botol @ 100 ml 2016 11,000
146 Griseofulvin tablet 125 mg dus @ 10 x 10's 2015 209
147 Griseofulvin tablet 125 mg (GRICIN) dus @ 10 x 10's 2016 340
148 Gutta percha point box 200 pcs 2015 82,000
149 Gutta percha point box 120pcs 2016 82,000
150 Haloperidol inj 50 mg/ml dus 5 ampul@1ml 2015 83,333
dus, 10 blister @ 10
151 Haloperidol tablet 0,5 mg tablet 2015 59
dus, 10 blister @ 10
152 Haloperidol tablet 0,5 mg tablet 2016 59
dus, 10 blister @ 10
153 Haloperidol tablet 1,5 mg tablet 2015 69
dus, 10 blister @ 10
154 Haloperidol tablet 5 mg tablet 2015 96
155 Hidrokortison krim 2,5 % tube 5 gr 2015 2,798
156 Hiosin butilbromid injeksi 20 mg/ml box 5 ampul @ 1ml 2015 4,500
157 Ibuprofen tablet 200 mg botol @ 100 tablet 2015 110
158 Ibuprofen tablet 200 mg dus 10 x 10's 2016 105
159 Ibuprofen tablet 400 mg dus 10 x 10's 2015 150
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
160 Ibuprofen tablet 400 mg dus 10 x 10's 2016 127
dus, 10 strip @ 10
161 Isosorbid Dinitrat tablet sublingual 5 mg tablet 2015 88
dus, 10 strip @ 10
162 Isosorbid Dinitrat tablet sublingual 5 mg tablet 2016 88
163 Kalisum Hidroksida bubuk, pasta (CALCIDOR) box 2016 240,000
dus 24 ampul @ 10
164 Kalsium glukonat inj 100 mg/ml ml 2016 9,955
dus 10 strip @ 10
165 Kalsium laktat (kalk) tab 500 mg 2016 63
dus, 10tablet
strip @ 10
166 Kaptopril tablet scored 12,5 mg tablet 2015 62
dus, 10 strip @ 10
167 Kaptopril tablet scored 25 mg tablet 2015 84
dus, 10 strip @ 10
168 Kaptopril tablet scored 25 mg tablet 2016 68
dus, 10 blister @ 10
169 Karbamazepin tablet 200 mg tablet 2015 245
dus, 10 blister @ 10
170 Karbamazepin tablet 200 mg tablet 2016 270
171 Karbogliserin tetes telinga 10 % Fenol 100 mg / 1 ml 2015 2,042
172 Ketokonazol krim 2 % tube 10 gr 2015 2,569
dus, 5 strip @ 10
173 Ketokonazol tablet 200 mg tablet 2015 300
dus, 5 strip @ 10
174 Ketokonazol tablet 200 mg tablet 2016 185
dus, 10 strip @ 10
175 Klobazam tablet 10 mg tablet 2015 900
dus, 10 strip @ 10
176 Klobazam tablet 10 mg tablet 2016 970
177 Kloramfenikol kaplet 250 mg ktk 10 x 10 tablet 2015 249
178 Kloramfenikol kaplet 250 mg ktk 10 x 10 tablet 2016 342
179 Kloramfenikol salep mata 1 % tube 5 gr 2015 1,600
180 Kloramfenikol salep mata 1 % tube 5 gr 2016 1,405
181 Kloramfenikol suspensi 125 mg/ 5 ml botol, 60 ml 2015 3,680
182 Kloramfenikol suspensi 125 mg/ 5 ml botol, 60 ml 2016 3,955
183 Klorfenol kamfer mentol (CHKM) botol @ 10 ml 2016 70,000
184 Klorfeniramina Maleat ( CTM ) tablet 4 mg box 10 x 10 "s 2015 83
185 Klorfeniramina Maleat ( CTM ) tablet 4 mg box 10 x 10 "s 2016 42
186 Klorpromazin injeksi i.m 25 mg/ml (HCl) dus @ 30 ampul 2015 1,100
187 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) dus @ 30 ampul 2015 1,050
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
188 Klozapin 25 mg kotak @ 5 x 10 tab 2015 1,550
189 Kodein tablet 10 mg ktk 10x10 tablet 2015 500
190 Kodein tablet 20 mg ktk 10x10 tablet 2015 1,100
191 Kombinasi suspensi : Parafin+gliserin+fenolftalein botol @ 60 ml 2015 12,450
Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg dus, 100 Sachet @
192 Asam Folat 0,25 mg 30 tablet 2015 42
Kombinasi tablet salut : Fero sulfat 200 mg Asam
193 Folat 0,25 mg kotak @ 10 x 10 tab 2016 364
194 Komposit ( bahan tumpat dengan sinar) kit 2015 1,993,200
Komposit ( bahan tumpat dengan sinar) (Filtek Z250
195 Universal) kit 2016 2,443,182
Kotrimoksazol DOEN I (dewasa) kombinasi dus, 10 strip @ 10
196 :Sulfametoksazol 400 mg Trimetoprim 80 mg tablet 2015 138
Kotrimoksazol DOEN I (dewasa) kombinasi dus, 10 strip @ 10
197 :Sulfametoksazol 400 mg Trimetoprim 80 mg tablet 2016 151
Kotrimoksazol suspensi komb.: Sulfametoksazol 200
198 mg + Trimetoprim 40 mg / 5 ml botol, 60 ml 2015 2,167
Kotrimoksazol suspensi komb.: Sulfametoksazol 200
199 mg + Trimetoprim 40 mg / 5 ml botol, 60 ml 2016 3,460
Larutan mengandung Asam Amino ( asam amino 30 Double Chamber
200 g,glukosa 7,3 % dan elektrolit ) Softbag 500 ml 2015 61,600
Larutan mengandung elektrolit (Na 139 mEq, Cl 109
201 mEq, Ca 3 mEq, Asetat 28 mEq) plastic bottle 500 ml 2015 9,000
Larutan mengandung Karbohidrat + elektrolit
202 (Glukosa: 55,0 g; NaCl: 2.25 g) botol @ 500 ml 2015 7,700
Larutan Mengandung Karbohidrat+Elektrolit (WIDA
203 D5-1/4NS) botol @ 500 ml 2016 9,350
Larutan mengandung Karbohidrat + elektrolit (NaCl
204 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr ,Dextrosa 27 plastic bottle 500 ml 2015 10,000
gr)
Larutan mengandung Karbohidrat + elektrolit (NaCl 1.75 gr,
205 KCl 1.5 gr, Na Lactat 2.24 gr ,Dextrosa 27 gr) (KAEN 3 B)plastic bottle 500 ml 2016 10,050
dus 100 ampul @
206 Lidocain Injeksi 2 % (HCl) 2016 860
dus, 30 2ml
ampul @ 2
207 Lidokain injeksi 2 % (HCl) + Epinefrin 1:.80000 - 2 ml ml 2015 1,363
dus, 30 ampul @ 2
208 Lidokain injeksi 2 % (HCl) + Epinefrin 1:.80000 - 2 ml ml 2016 1,845
dus,10 strip @ 10
209 Loperamid tablet 2 mg tablet 2015 89
dus,10 strip @ 10
210 Loperamid tablet 2 mg tablet 2016 85
dus, 5 strip @ 10
211 Loratadin tablet 10 mg tablet 2015 154
dus, 5 strip @ 10
212 Loratadin tablet 10 mg tablet 2016 134
213 Lorazepam tablet 2 mg ktk @ 10 x 10 tab 2015 1,341
214 Magnesium sulfat inj 20% (OTSU -MgSO4) ampul @ 25 ml 2016 3,200
dus, 10 blister @ 10
215 Metformin HCl tablet 500 mg tablet 2015 113
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dus, 10 blister @ 10
216 Metformin HCl tablet 500 mg tablet 2016 100
Metilergometrin Maleat (metilergometrin) tablet salut ktk 10 x 10 tablet
217 salut 2015 154
0,125 mg
Metilergometrin Maleat (metilergometrin) tablet salut ktk 10 x 10 tablet
218 salut 2016 133
0,125 mg
dus 100 ampul @
219 Metilergometrin inj 0,2 mg/ml 2016 2,684
1ml
220 Metilprednisolon tablet 16 mg strip 2015 635
dus, 10 blister @ 10
221 Metilprednisolon tablet 4 mg tablet 2015 205
dus, 10 blister @ 10
222 Metilprednisolon tablet 4 mg tablet 2016 194
dus, 10 blister @ 10
223 Metilprednisolon tablet 8 mg tablet 2015 300
224 Metoklopramide tablet 5 mg ktk 10 x 10 tablet 2015 108
dus, 1 botol @ 100
225 Metronidazol infus 500 mg/100 ml ml 2015 9,950
226 Metronidazol lar inf 5 mg/ml botol @ 100 ml 2016 9,000
dus, 2 blister @ 5
227 Metronidazol suppositoria 500 mg suppositoria 2015 3,220
228 Metronidazol tablet 250 mg 10 strip @ 10 tablet 2015 110
229 Metronidazol tablet 500 mg 10 strip @ 10 tablet 2015 160
230 Metronidazol tablet 500 mg 11 strip @ 10 tablet 2016 215
231 Mikonazol krim/salep 2 % (Nitrat) tube 10 gr 2015 3,000
232 Mukolitik dan Ekspektoran sirup (OBH MOLEX) botol 60 ml 2016 5,000
233 Multivitamin + Mineral Drops botol @ 10 ml 2015 5,500
234 Multivitamin + Mineral Drops (RECOVIT DROPS) botol @ 10 ml 2016 5,500
235 Multivitamin sirop botol 60 ml 2015 15,787
236 Multivitamin sirup (BECEFORT) botol 60 ml 2016 15,785
237 Multivitamin dengan Kalsium (CALCIMET) botol 50 ml 2016 6,818
238 Nacl 0,9 % Larutan infus botol 500 ml 2015 4,700
239 Nacl 0,9 % Larutan infus botol 500 ml 2016 6,410
240 Nacl 0,9 % Larutan infus botol 100 ml 2016 11,000
241 Natrium Diklofenak tablet 25 mg dus @ 5 x 10's 2015 133
242 Natrium Diklofenak tablet 25 mg dus @ 5 x 10's 2016 145
243 Natrium Diklofenak tablet 50 mg dus @ 5 x 10's 2015 176
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
244 Natrium Diklofenak tablet 50 mg dus @ 5 x 10's 2016 159
dus, 10 strip @ 10
245 Nifedipin tablet 10 mg tablet ss 2015 110
dus, 10 strip @ 10
246 Nifedipin tablet 10 mg tablet ss 2016 104
247 Nistatin tablet salut 500.000 IU/g dus @ 10 x 10's 2015 640
248 Nistatin tablet salut 500.000 IU/g dus @ 10 x 10's 2016 745
249 Nistatin vaginal tablet 100.000 IU/g dus @ 10 x 10's 2015 480
250 Nistatin vaginal tablet 100.000 IU/g dus @ 10 x 10's 2016 523
251 Obat Batuk dan Flu sirop botol 60 ml 2015 14,414
252 Obat Batuk sirup botol 100 ml 2015 6,800
253 Obat Batuk sirup (DEXMOLEX) botol 100 ml 2016 7,500
254 Obat Batuk dan Antihistamin (DEXTROFEN) botol 60 ml 2016 7,315
255 Obat Demam dan Influenza (FEBRYNEX SYRUP) botol 60 ml 2016 14,414
256 Obat Demam dan Influenza (FEBRYNEX SACHET) dus / 10 sachet 2016 1,000
Obat Radang Kulit + Anti Bakteri (BRAVODERM N
257 CREAM) tube @ 5 g 2016 14,000
258 Obat Sariawan dan Radang rongga mulut box 24 tube @ 5 gr 2015 14,500
Obat Sariawan dan Radang rongga mulut
259 (Bufacomb) tube @ 5 g 2016 14,500
260 OBH sirup botol 60 ml 2015 5,000
dus 100 ampul @ 1
261 Oksitosin inj 10 UI/ml ml 2016 1,900
262 Oksitetrasiklin salep mata 1 % steril tube @ 5 g 2016 2,520
263 Oksitetrasiklin salep kulit 1 % tube @ 5 g 2016 1,827
dus strip 3 x 10
264 Omeprazol kaps 20 mg kapsul 2016 160
265 Ondansetron inj. 4 mg/ 2 ml dus,5 ampul @ 2 ml 2015 2,400
266 Paper point box 120 pcs 2015 62,000
267 Paper point box 120 pcs 2016 59,800
Parasetamol drop 100 mg/ml btl @ 15 ml (60
268 ml/0,6ml ) dus, 15 botol 2015 5,200
269 Parasetamol Sirup 120 mg / 5 ml botol 60 ml 2015 1,438
270 Parasetamol Sirup 120 mg / 5 ml botol 60 ml 2016 1,074
dus, 10 strip @ 10
271 Parasetamol tablet 500 mg kss 2015 79
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dus, 10 strip @ 10
272 Parasetamol tablet 500 mg kss 2016 56
273 Permetrin krim tube @ 10 g 2015 11,475
dus, 25 blister @ 4
274 Pirantel tablet score ( base) 125 mg tablet 2015 298
dus, 25 blister @ 4
275 Pirantel tablet score ( base) 125 mg tablet 2016 291
botol plastik @ 100
276 Piridoksin (vitamin B6) tab 10 mg tablet 2016 45
277 Prednison tab 5 mg kotak @ 10 x 10 tab 2016 96
278 Piroksikam kapsul/kaplet/tablet 20 mg box 10 strip@ 10 2015 114
279 Piroksikam kapsul/kaplet/tablet 20 mg box 10 strip@ 10 2016 118
280 Povidon Iodida larutan 10% 30 ml botol @ 30 ml 2015 2,163
281 Povidon Iodida larutan 10% 300 ml botol @ 300 ml 2015 14,203
282 Povidon Iodida larutan 10% 60 ml botol 60 ml 2015 5,998
Prebiotik + Probiotik dalam sachet ( pelihara Polybag @ 10 sachet @
283 kesehatan pencernaan anak ) 1g 2015 3,500
dus, 10 strip @ 10
284 Propanolol tablet 10 mg (HCl) tablet 2015 65
dus, 10 strip @ 10
285 Propanolol tablet 10 mg (HCl) tablet 2016 60
dus, 10 strip @ 10
286 Propanolol tablet 40 mg (HCl) tablet 2015 107
287 Propiltourasil tb 100 mg kotak @ 10 x 10 tab 2016 327
dus, 10 ampul @ 2
288 Ranitidin injeksi 25 mg/ 2ml ml 2015 1,140
dus, 10 ampul @ 2
289 Ranitidin injeksi 25 mg/ 2ml ml 2016 1,390
dus, 10 strip @ 10
290 Ranitidin tablet 150 mg tss 2015 120
dus, 10 strip @ 10
291 Ranitidin tablet 150 mg tss 2016 105
292 Ringer Laktat larutan Infus botol 500 ml 2015 5,200
293 Ringer Laktat larutan Infus botol 500 ml 2016 7,150
294 Ringer Laktat larutan Infus (Otsu) botol 500 ml 2016 6,500
295 Ringer Asetat (ASERING) botol 500 ml 2016 9,275
296 Rivanol 300 cc botol 2016 3,000
297 Salbutamol cairan inh. 0,1 % dus, 4 x 5 botol plastik @ 2,5 ml2015 6,600
298 Salbutamol cairan inh. 0,1 %(VENTOLIN NEBULE)
dus, 4 x 5 botol plastik @ 2,5 ml2016 4,000
299 Salbutamol inhalasi / aerosol 100 mcg /dosis dus, botol 200 dosis 2015 63,750
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
300 Salbutamol tablet 2 mg ( sebagai sulfat ) strip @ 10 tablet 2015 59
301 Salbutamol tablet 2 mg ( sebagai sulfat ) strip @ 10 tablet 2016 66
302 Salbutamol tablet 4 mg ( sebagai sulfat ) ktk 10 x 10 tablet 2015 89
303 Serum Anti Bisa Ular (A B U) (BIOSAVE) vial @ 5 ml 2016 427,273
Serum Anti Tetanus (ATS) cairan i.m 1500UI
304 (BIOSAT) ampul 1 ml 2016 104,545
Salep 2-4 , Kombinasi : Asam Salisilat 2 % +
305 Belerang endap 4 % Pot @ 30 gram 2015 2,000
Salep 2-4 , Kombinasi : Asam Salisilat 2 % +
306 Belerang endap 4 % Pot @ 30 gram 2016 2,429
dus, 10 strip@ 10
307 Sefadroksil kapsul 500 mg kapsul 2015 509
dus, 10 strip@ 10
308 Sefadroksil kapsul 500 mg kapsul 2016 590
309 Sefadroksil sir kering 250 mg/5 ml dus, botol 60 ml 2015 5,940
310 Sefotaksim injeksi 1 gram dus, 10 vial @ 1g 2015 2,950
311 Sefotaksim injeksi 1 gram dus, 10 vial @ 1g 2016 4,898
312 Seftriakson serbuk injeksi 1 g/vial dus, 10 vial @ 1g 2015 3,300
313 Semen Zink Phospate btl 2015 105,000
314 Semen Zink Phospate (Multifix P/L) btl 2016 140,636
box, 10 strips @ 10
315 Setirizin tablet 10 mg capsules 2015 181
316 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul @ 1 ml 2015 1,078
317 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul @ 1 ml 2016 1,098
dus 10 strip @ 10
318 Simetidin tab 200 mg tablet 2016 163
319 Simvastatin scored tablet 10 mg dus 3 strip@ 10 kss 2015 169
320 Simvastatin scored tablet 10 mg dus 3 strip@ 10 kss 2016 131
321 Simvastatin tablet 20 mg dus 3 strip@ 10 kss 2015 391
322 Siprofloksasin infus IV botol 2015 13,000
dus, 10 blister @ 10
323 Siprofloksasin tablet 500 mg (sebagai HCl) tab ss 2015 255
dus, 10 blister @ 10
324 Siprofloksasin tablet 500 mg (sebagai HCl) tab ss 2016 281
325 Tambalan sementara Btl 30 gr 2015 115,000
326 Tambalan sinar/Composite kit 2015 450,000
327 Tambalan sinar/Composite Flow kit 2015 480,000
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
328 Tetes Telinga Antibiotik ( Kloramfenikol 1 % ) botol @ 10 ml 2015 6,000
dus, 10 strip @ 10
329 Tetrasiklin kapsul 250 mg kapsul 2015 149
dus, 10 strip @ 10
330 Tetrasiklin kapsul 250 mg kapsul 2016 163
dus, 10 strip @ 10
331 Tetrasiklin kapsul 500 mg kapsul 2016 310
332 Trifluoroperazine tablet 5 mg strip 2015 405
dus, 10 strip @ 10
333 Tiamin ( Vitamin B1 ) tablet 50 mg tablet 2016 86
dus, 10 strip @ 10
334 Triheksifenidil tab 2 mg tablet 2016 88
335 Vitamin B-Complex injeksi vial @ 20 ml 2015 7,000
336 Vitamin B-Complex injeksi vial @ 20 ml 2016 6,000
botol plastik @ 100
337 Vitamin B-Complex Tab tablet 2016 43
338 Vitamin dengan Mineral suspensi (VICAL) botol @ 60 ml 2016 7,400
kotak 10 ampul @ 3
339 Vitamin Kombinasi injeksi ml 2015 5,000
Vitamin B Kombinasi injeksi (NEUROTROPIC 5000 kotak 10 ampul @ 3
340 ml 2016 6,500
injeksi) box 10 strip @ 10
341 Vitamin Kombinasi Kaplet kaplet 2015 1,550
Vitamin Kombinasi Kaplet (NEUROTROPIC 5000 box 10 strip @ 10
342 kaplet 2016 1,550
kap) kotak 10 strip @ 10
343 Vitamin tambah darah ( Anti Anemia ) dragee 2015 660
kotak 10 strip @ 10
344 Vitamin tambah darah ( Anti Anemia ) (HEMAFORT) dragee 2016 759
345 Zink 10 mg/5 ml sirup (Zink kids) botol @ 100 ml 2015 25,000
346 Zink 10 mg/5 ml sirup botol @ 100 ml 2016 6,290
347 Zink tablet dispesible 20 mg dus, 10 strip @ 10 tablet dispersible
2015 474
348 Zink tablet dispesible 20 mg dus, 10 strip @ 10 tablet dispersible
2016 514
BMHP
349 Alat suntik sekali pakai 1 ml 100 set / ktk 2015 990
350 Alat suntik sekali pakai 1 ml (NIPRO) 100 set / ktk 2016 990
351 Alat suntik sekali pakai 1 ml (TERUMO) 100 set / ktk 2016 1,540
352 Alat suntik 50cc catheter tip pcs 2015 6,350
353 Alat suntik sekali pakai 10 ml 100 set / ktk 2015 1,298
354 Alat suntik sekali pakai 10 ml (NIPRO) 100 set / ktk 2016 1,298
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
355 Alat suntik sekali pakai 20 ml tanpa jarum set 2015 2,680
356 Alat suntik sekali pakai 20 ml tanpa jarum (NIPRO) set 2016 2,541
357 Alat suntik sekali pakai 3 ml 100 set / ktk 2015 792
358 Alat suntik sekali pakai 3 ml (NIPRO) 100 set / ktk 2016 792
359 Alat suntik sekali pakai 3 ml (TERUMO) 100 set / ktk 2016 957
360 Alat suntik sekali pakai 5 ml 100 set / ktk 2015 979
361 Alat suntik sekali pakai 5 ml (NIRPO) 100 set / ktk 2016 979
362 Alat suntik sekali pakai 5 ml(TERUMO) 100 set / ktk 2016 1,348
363 Alat suntik sekali pakai 50 ml tanpa jarum 100 set / ktk 2015 750
364 Alkohol 70 % 1 liter botol 1 liter 2015 21,500
365 Alkohol 70 % 1 liter botol 1 liter 2016 25,000
366 Alkohol Swab box/100 2015 100
367 Alkohol Swab box/100 2015 158
368 Blood Lancet No.26 G box/100 2016 14,566
369 Blood transfusion set box/ 100 pcs 2015 13,420
370 Blood transfusion set box/ 100 pcs 2016 13,420
Chromic Cat Gut 2/0 75C + jarum 1/2 30m R
371 (Demetech) Box isi 12 2016 22,500
Chromic Cat Gut 3/0 75C + jarum 1/2 22m R
372 (Demetech) Box isi 12 2016 22,500
373 Cat Gut Chromic 2/0 + jarum 1/2 GT 35 mm box/24 2015 5,583
374 Cat Gut Chromic 3/0 + jarum 1/2 GT 35 mm box/24 2015 5,583
375 Cat Gut Chromic 0 HR-40 mm Box isi 12 sachet 2015 28,464
376 Cat Gut Chromic 1 HR-48 mm Box isi 12 sachet 2015 29,616
377 Cat Gut Chromic 1 HR-48 mm (SMI) Box isi 12 sachet 2016 42,900
378 Cat Gut Chromic 2/0 DS-24 mm Box isi 12 sachet 2015 27,756
379 Cat Gut Chromic 3/0 HR-26 mm Box isi 12 sachet 2015 22,596
380 Cat Gut Chromic 3/0 HR-26 mm Box isi 12 sachet 2016 32,800
381 Cat Gut Plain 2 /0 + jarum 1/2 GT 35 mm box/24 2015 5,583
382 Cat Gut Plain 3/0 + jarum 1/2 GT 35 mm box/24 2015 5,583
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
383 Cat Gut Plain 2/0 DS-24 mm Box isi 12 sachet 2015 27,756
384 Cat Gut Plain 2/0 HR-26 mm Box isi 12 sachet 2015 23,688
385 Cat Gut Plain 2/0 HR-26 mm (SMI) Box isi 12 sachet 2016 34,300
386 Cat Gut Plain 2/0 HR-37 mm Box isi 12 sachet 2015 23,628
387 Cat Gut Plain 3/0 DS-24 mm Box isi 12 sachet 2015 27,756
388 Cat Gut Plain 3/0 HR-26 mm Box isi 12 sachet 2015 23,688
389 Cat Gut Plain 3/0 HR-26 mm (SMI) Box isi 12 sachet 2016 34,300
390 Dermafix T 10x25 (Onemed) box isi 10 pcs 2016 13,770
391 Dermafix T 10x15 (Onemed) box isi 10 pcs 2016 8,316
392 Dermafix T 10x8 (Onemed) box isi 10 pcs 2016 4,212
393 Dermafix T 5x7 (Onemed) box isi 10 pcs 2016 1,629
394 Disposible Needle No. 23 G x 1 1/4' 100 pcs/ktk 2015 304
395 Disposible Needle No. 23 G x 1 1/4' 101 pcs/ktk 2016 336
396 Disposible Needle No. 24 G x 1 1/4' 100 pcs/ktk 2015 304
397 Disposible Needle No. 24 G x 1 1/4' 101 pcs/ktk 2016 336
398 Disposible Needle No. 25 G x 1 1/4' 100 pcs/ktk 2015 304
399 Disposible Needle No. 25 G x 1 1/4' 101 pcs/ktk 2016 336
400 Gluco Protein Tes Urine box isi 10 pcs 2016 1,045
401 Infusion Set Dewasa ( 20 drops/ml ) set / kantong 2015 4,975
402 Infusion Set Dewasa ( 20 drops/ml ) (Nipro) set / kantong 2016 4,975
403 Infusion Set Dewasa ( 20 drops/ml ) (Otsu Y set) set / kantong 2016 7,920
404 Infusion Set Pediatric ( 60 drops/ml) set / kantong 2015 3,500
405 Infusion Set Pediatric ( 60 drops/ml) (Otsuka OI 34) set / kantong 2016 7,920
406 IV Cateter No. 18 G 50 bh / ktk 2015 7,018
407 IV Cateter No. 20 G 50 bh / ktk 2015 7,018
408 IV Cateter No. 20 G (Otsucath) 50 bh / ktk 2016 7,700
409 IV Cateter No. 22 G 50 bh / ktk 2015 7,018
410 IV Cateter No. 22 G (Otsucath) 50 bh / ktk 2016 7,700
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
411 IV Cateter No. 24 G 50 bh / ktk 2015 7,018
412 IV Cateter No. 26 G 50 bh / ktk 2015 8,500
413 IV Cateter No. 26 G WINFLON 50 bh / ktk 2016 5,753
414 IV Cateter No.14 G 50 bh / ktk 2015 7,018
415 IV Cateter No.16 G 50 bh / ktk 2015 7,018
416 kapas berlemak 500 gr roll 2015 16,500
417 Kapas Onemed 500 gram roll 2016 27,280
418 Kapas pembalut / absorben 250 mg roll 2015 12,500
419 Kapas pembalut / absorben 250 mg roll 2016 12,500
420 Kasa hydrofil Steril 16 x16 cm box / 16 2015 5,800
421 Kasa Steril 16cm x 16cm box / 16 2016 7,900
422 Kasa Pembalut Hidrofil 4 m x 10 cm roll 2015 1,500
423 Kasa Pembalut Hidrofil 4 m x 10 cm roll 2016 1,500
424 Kasa Pembalut Hidrofil 4 m x 10 cm roll 2016 2,300
425 Kasa Pembalut Hidrofil 4 m x 3 cm roll 2015 590
426 Kasa Pembalut Hidrofil 4 m x 3 cm roll 2016 590
427 Kasa Pembalut Hidrofil 4 m x 3 cm roll 2016 800
428 Kasa Hidrofil 36 m x 80 cm roll 2016 130,000
429 Kasa Hidrofil 2m x 80cm roll 2016 9,400
430 Kasa Hydrofil 40 x 80 cm roll 2015 105,000
431 Kasa Hydrofil 40 x 80 cm roll 2016 105,000
432 Kasa Hydrofil 40 x 16 cm roll 2015 32,000
433 Kasa Kompres steril 40 x 40 buah 2015 1,600
434 Kasa Kompres steril 40 x 40 buah 2016 1,600
435 Kasa Kompres 40 cm x 40 cm buah 2016 1,800
436 Kasa Pembalut Hidrofil 4 m x 15 cm roll 2015 2,100
437 Kasa Pembalut Hidrofil 4 m x 15 cm roll 2016 2,100
438 Kasa Pembalut Hidrofil 4 m x 15 cm roll 2016 3,800
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
439 Kasa Pembalut Hidrofil 4 m x 5 cm roll 2015 750
440 Kasa Pembalut Hidrofil 4 m x 5 cm roll 2016 1,100
441 Masker Nebulizer Anak 25 pcs/ karton 2015 67,000
442 Masker Nebulizer dewasa 20 pcs/karton 2015 61,000
443 Masker Oksigen pcs 2015 38,000
444 Masker Oksigen anak pcs 2016 23,650
445 Masker Oksigen dewasa pcs 2016 23,650
446 Nasal Canula Adult / selang oksigen dewasa 50 pcs/ karton 2015 17,000
447 Nasal Canula Child / selang Oksigen anak 50 pcs/ karton 2016 9,350
448 Nasal Canula Child / selang Oksigen anak 50 pcs/ karton 2015 17,000
449 Nasal Canula Adult / selang oksigen dewasa 50 pcs/ karton 2016 9,350
Plain Cat Gut 2/0 70C + jarum 1/2 25m R
450 (Demetech) Box isi 12 sachet 2016 26,667
Plain Cat Gut 3/0 70C + jarum 1/2 25m R
451 (Demetech) Box isi 12 sachet 2016 26,667
452 Safety Box pcs 2016 15,715
453 Selang Oksigen Anak pcs 2016 5,500
454 Selang Oksigen Bayi pcs 2016 5,500
455 Selang Oksigen Dewasa pcs 2016 5,500
456 Plester 1 inch x 10 yard rol / 9,4 m / box 2015 24,208
457 Rivanol 300 cc botol 2015 2,550
458 Sarung tangan L 100 bh / box 2015 325
459 Sarung Tangan No Powder L Box/100 pcs 2016 583
460 Sarung Tangan Non steril dengan Powder Size L Box/100 pcs 2016 594
461 Sarung tangan M 100 bh / box 2015 325
462 Sarung Tangan No Powder M Box/100 pcs 2016 583
Sarung Tangan Non steril dengan Powder Size M
463 (Ansell) Box/100 pcs 2016 594
464 Sarung tangan Panjang psg 2015 47,000
465 Sarung tangan S 100 bh / box 2015 325
466 Sarung Tangan No Powder S Box/100 pcs 2016 583
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
467 Sarung tangan Steril 7,0 100 psg/ box 2015 5,454
468 Sarung tangan XS 100 bh / box 2015 325
469 Sarung Tangan No Powder XS Box/100 pcs 2016 583
470 Sarung Tangan Steril dengan Powder Size 7-7.5 Box 50 pasang 2016 6,930
471 Sarung Tangan Steril Bebas Powder Size 6,5-7 Box 50 pasang 2016 9,647
472 Silk Black 0 HR - 37 mm Box isi 12 sachet 2015 1,179
473 Silk Black 1 DS - 24 mm Box isi 12 sachet 2015 1,374
474 Silk Black 1 HR - 37 mm Box isi 12 sachet 2015 1,192
475 Silk Black 2/0 DS - 24 mm Box isi 12 sachet 2015 1,339
476 Silk Black 2/0 HR - 20 mm Box isi 12 sachet 2015 1,167
477 Silk Black 2/0 HR - 26 mm Box isi 12 sachet 2015 1,167
478 Silk Black 2/0 HR - 26 mm Box isi 12 sachet 2016 1,691
479 Silk Black 3/0 DS - 24 mm Box isi 12 sachet 2015 1,291
480 Silk Black 3/0 HR - 20 mm Box isi 12 sachet 2015 1,135
481 Silk Black 3/0 HR -26 mm Box isi 12 sachet 2015 1,135
482 Silk Black 3/0 HR -26 mm Box isi 12 sachet 2016 1,641
483 Silk Black 4/0 DS - 19 mm Box isi 12 sachet 2015 1,295
484 Silk Black 4/0 HR - 20 mm Box isi 12 sachet 2015 1,135
485 Silk 2/0 75C + jarum 3/8 30m C (Demetech) Box isi 12 sachet 2016 15,000
486 Silk 3/0 75C + jarum 3/8 26m C (Demetech) Box isi 12 sachet 2016 15,000
487 Suction Catheter pcs 2015 4,345
488 Suction Cateter No.6 (ONEMED) pcs 2016 4,345
489 Suction Cateter No.8 (ONEMED) pcs 2016 4,345
490 Suction Cateter No.10 (ONEMED) pcs 2016 4,345
491 Suction Cateter No.12 (ONEMED) pcs 2016 4,345
492 Suction Cateter No.16 (ONEMED) pcs 2016 4,345
493 Suction Cateter No.18 (ONEMED) pcs 2016 4,345
494 Surgical Mask - Plus 3 Ply Plus Earloop ONEMED pcs 2015 440
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
495 Surgical Mask - Plus 3 Ply Plus Earloop ONEMED pcs 2016 440
496 Surgical Mask 3 ply Earloop box/50 2015 330
497 Surgical Mask 3 ply Earloop 3M box/50 2016 594
498 Surgical Mask 3 ply Tie on box/50 2015 600
499 Surgical Mask 3 ply Tie on 3M box/50 2016 600
500 Surgical mask-Masker Earloop BEAUTY KASATAMA dus/50 2016 439
501 Surgical mask-masker Tie On BEAUTY KASATAMA dus/50 2016 439
502 Underpad 60x90 pcs 2015 5,750
503 Underpad 60x90 pcs 2016 4,620
504 Urine Bag standard steril 2 lt ( T valve ) buah 2015 3,000
505 Urine Bag standard steril 2 lt ( T valve ) buah 2016 3,000
506 Urologi - Folley chateter 2 way no. 12 box/10 2015 8,000
507 Urologi - Folley chateter 2 way no. 12 box/10 2016 8,000
508 Urologi - Folley chateter 2 way no. 14 box/10 2015 8,000
509 Urologi - Folley chateter 2 way no. 14 box/10 2016 8,000
510 Urologi - Folley chateter 2 way no. 16 box/10 2015 8,000
511 Urologi - Folley chateter 2 way no. 16 box/10 2016 8,000
512 Urologi - Folley chateter 2 way no. 18 box/10 2015 8,000
513 Urologi - Folley chateter 2 way no. 18 box/10 2016 8,000
514 Urologi - Folley chateter 2 way no. 20 box/10 2015 8,000
515 Urologi - Folley chateter 2 way no. 20 box/10 2016 8,000
516 Urologi - Folley chateter 2 way no. 22 box/10 2015 8,000
517 Urologi - Folley chateter 2 way no. 22 box/10 2016 8,000
518 Urologi - Folley chateter 2 way no. 24 box/10 2015 8,000
519 Urologi - Folley chateter 3 way no. 22 box/10 2015 32,500
520 Urologi - Folley chateter 3 way no. 22 box/10 2016 32,500
521 Urologi - Folley Chateter ped no.10 box/10 2015 30,000
522 Urologi - Folley Chateter ped no.8 box/10 2015 30,000
 HARGA (Rp.) STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
TAHUN
per tablet
NO NAMA BARANG KEMASAN PENGADAA /vial/ampul/kap
N sul/kaplet/dst. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp. Banyak Rp.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Yang Menerima
Mengetahui / Menyetujui Petugas Puskesmas / sub unit
Yang Meminta / Mengetahui An. Kepala Dinas Tk II
Kepala Puskesmas Kepala Farkalkes

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