PENGAKUAN JENIS PERSEDIAAN PADA NERACA

1.1.7.
1.1.7.01.
1.1.7.01.01.
1.1.7.01.02.
1.1.7.01.03.
1.1.7.01.05.
1.1.7.01.06.
1.1.7.01.07.
1.1.7.01.08.
1.1.7.01.09.
1.1.7.01.10.
1.1.7.01.11.
1.1.7.01.12.
1.1.7.01.13.
1.1.7.01.14.
1.1.7.01.15.
1.1.7.01.16.
1.1.7.01.17.
1.1.7.01.18.
1.1.7.01.19.
1.1.7.01.20.
1.1.7.02.
1.1.7.02.01.
1.1.7.02.02.
1.1.7.02.03.
1.1.7.02.04.
1.1.7.02.05.
1.1.7.02.06.
1.1.7.02.07.
1.1.7.02.08.
1.1.7.02.09.
1.1.7.02.10.
1.1.7.02.11.
1.1.7.02.12.
1.1.7.02.13.
1.1.7.02.14.
1.1.7.02.15.
1.1.7.03.
1.1.7.03.01.
1.1.7.03.02.
1.1.7.03.03.
1.1.7.03.04.
1.1.7.03.05.
1.1.7.04.
1.1.7.04.01.
1.1.7.04.02.
1.1.7.05.
1.1.7.05.01.
1.1.7.05.02.
1.1.7.05.03.
1.1.7.05.04.
1.1.7.05.05.
1.1.7.05.06.
1.1.7.05.07.
1.1.7.05.08.
1.1.7.05.09.
1.1.7.05.10.
1.1.7.05.11.
1.1.7.06.
1.1.7.06.01.
1.1.7.06.02.
1.1.7.06.03.
1.1.7.06.04.
1.1.7.06.05.
1.1.7.06.06.
1.1.7.06.07.
1.1.7.06.08.
1.1.7.06.09.
 PENGAKUAN JENIS PERSEDIAAN PADA NERACA

Persediaan
Persediaan Bahan Pakai Habis
Persediaan Alat Tulis Kantor
Persediaan Dokumen/Administrasi Tender
Persediaan Alat Listrik dan elektronik ( lampu pijar, battery kering)
Persediaan Peralatan kebersihan dan bahan pembersih
Persediaan Bahan Bakar Minyak/Gas
Persediaan Isi tabung pemadam kebakaran
Persediaan Isi tabung gas
Persediaan Spanduk Baliho, Billboard, Papan Nama/Plang dan Sejenisnya
Persediaan Plakat/Piala/Tropy/Piagam/Karangan Bunga
Persediaan Kelengkapan Alat-Alat Olahraga
Persediaan Seminar KIT
Persediaan Kemasan, Kantong Plastik, Dus, dan Sejenisnya
Persediaan air bersih
Persediaan Alat Kesehatan Habis Pakai
Persediaan Gas Oksigen Medik (O2)
Persediaan Dekorasi
Persediaan Alat-ALat Pertanian, Peternakan, Perikanan dan Kelautan
Persediaan Alat, Peralatan dan Kelengkapan Pemilihan Kepala Desa
dst...........
Persediaan Bahan/Material
Persediaan Bahan baku bangunan
Persediaan Bahan/bibit tanaman
Persediaan Bibit ternak
Persediaan Bahan obat-obatan
Persediaan Bahan kimia
Persediaan Bahan Makanan Pokok
Persediaan Bahan Pakan Ternak
Persediaan Bahan Uji Laboratorium
Persediaan Bahan-bahan Logistik Rumah Sakit
Persediaan Bahan Penunjang Eksplorasi
Persediaan Bahan Pameran
Persediaan Bahan dan Alat Pelatihan Keterampilan
Persediaan Bahan Uji Radiologi
Persediaan Darah
dst.....
Persediaan Barang Lainnya
Persediaan Barang Yang Akan di Berikan Kepada Pihak Ketiga
Persediaan Barang Yang Akan Diserahkan Kepada Masyarakat
Persediaan Suku Cadang
Persediaan Peralatan Lainnya
 Dst.....
Persediaan Barang Cetakan dan Penggandaan
Persedian Barang Cetakan
Dst.....
Persediaan Pakaian Dinas dan Atributnya
Persediaan pakaian Dinas KDH dan WKDH
Persediaan Pakaian Sipil Harian (PSH)
Persediaan Pakaian Sipil Lengkap (PSL)
Persediaan Pakaian Dinas Harian (PDH)
Persediaan Pakaian Dinas Upacara (PDU)
Persediaan Pakaian Sipil Resmi (PSR)
Persediaan Kelengkapan/Atribut Pakaian Dinas
Persediaan pakaian kerja lapangan
Persediaan pakaian kerja Laboratorium
Persediaan Kelengkapan/Atribut Pakaian Kerja
Dst.....
Persediaan Pakaian khusus dan hari-hari tertentu
Persediaan pakaian KORPRI
Persediaan pakaian adat daerah
Persediaan pakaian batik tradisional
Persediaan pakaian olahraga
Pesediaan Pakaian/Busana Keagamaan
Persediaan Pakaian Seragam PKK/Dharma Wanita
Persediaan Pakaian Seragam PKK/Dharma Wanita
Persediaan Pakaian Pramuka
dst.........
 PEMERINTAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
PUSKESMAS CARITA
JL.Raya Carita – Labuan KM 6 Telepon ( 0253 ) 802354 Kode Pos 42264

BERITA ACARA PEMERIKSAAN BARANG PERSEDIAAN (STOCK OPNAME)

Nomor : ....

Pada hari ini ..... tanggal ..... Bulan ..... Tahun Dua Ribu ... yang bertanda tangan di bawah ini :

1. Nama : Ivan Sofiyana, Amd.Kep

NIP : 19811027 200801 1 006
2. Nama : Veny Vebriyani
NIP : 19830213 200212 2 001
3. Nama : Ade Mimin Jakiyah
NIP :

Sesuai dengan Surat Tugas Kepala ........ Kabupaten Pandeglang Nomor ....... Tanggal ...... kami melakukan
pemeriksaan terhadap Persediaan Barang yang diurus oleh :

Nama : Ifa Fatoni,SKM

NIP : 19830516 201001 1 007
Jabatan : Pengurus Barang Pengguna
Berdasarkan hasil pemeriksaan kami menemukan kenyataan seperti diuraikan pada lampiran berita acara ini.
Demikian Berita Acara ini dibuat, sebagai bahan tindak lanjut.

Yang Diperiksa Tim Pemeriksa,

Pengurus Barang Pengguna

1 Ivan Sofiyana, Amd.Kep

NIP 19811027 200801 1 006
Ifa Fatoni,SKM
NIP 19830516 201001 1 007
2 Veny Vebriyani
NIP 19830213 200212 2 001
Mengetahui
Kepala Puskesmas Carita
Kabupaten Pandeglang 3 Ade Mimin Jakiyah
NIP

Angga Iskandarwinata, S.Kep

NIP : 19850102 200902 1 001
TAH KABUPATEN PANDEGLANG
DINAS KESEHATAN
PUSKESMAS CARITA
buan KM 6 Telepon ( 0253 ) 802354 Kode Pos 42264
 REKAPITULASI PERHITUNGAN SALDO PERSEDIAAN PER 31 MARET 2019
UPT PUSKESMAS CARITA

Jenis Persediaan

Peralatan Kemasan, Alkes Habis

No Lokasi Persediaan Alat Listrik dan Kebersihan dan Kantong Plastik, Pakai/ Gas Oksigen Bahan obat- Bahan Makanan Bahan Uji Jumlah
ATK Barang Cetakan dst… dst…
Elektonik Bahan Dus, dan Perbenkes/ Medik (O2) obatan Pokok Laboratorium
Pembersih Sejenisnya BMHP

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
SUMBER PEMBIAYAAN : APBD (JKN, BOP, OPS)
1 Gudang Obat Puskesmas - - - - - - - - - - - - -
2 Pustu Cinoyong - - - - - - 2,852,866 - - - - - 2,852,866
3 Poskesdes Sindanglaut - - - - - - 1,134,877 - - - - - 1,134,877
4 Pustu Sukanagara - - - - - - 51,554,923 - - - - - 51,554,923
5 Poli-Poli di Puskesmas - - - - - - 9,586,394 - - - - - 9,586,394
JUMLAH (1) - - - - - - 65,129,060 - - - - - 65,129,060
Keterangan

16
Lampiran
Berita Acara Pemeriksaan Persediaan
Lokasi Persediaan : Gudang Obat

PERHITUNGAN PERSEDIA
PER 29 JUNI 2019

Harga Satuan
No Uraian Satuan
(Rp) Reviu
Administrasi
Fisik
1 2 3 4 5 6
TOTAL PERSEDIAAN
PERSEDIAAN SUMBER APBD
1.1.7. Persediaan
1.1.7.01. Persediaan Bahan Pakai Habis
1.1.7.01.15.Persediaan Alat Kesehatan Habis Pakai
1 Alat suntik 1 ml Pcs 777 - -
2 Alat suntik 10 ml Pcs 1,067
3 Alat suntik 2,5 ml Pcs 649
4 Alat suntik 20 ml Pcs 2,650
5 Alat suntik 3 ml Pcs 825
6 Alat suntik 5 ml Pcs 856
7 Alat suntik syrine 3 cc (Remedi ) Pcs 816
8 Alkohol 70 % 1 L Botol 32,600
9 Cat Gut no 2/0 Sachet 24,992
10 Cat Gut no 3/0 Sachet 60,622
11 Cathetter Jelly Biji 44,953
12 Demetech Silk 3/0 Sachet 41,600
13 E Care 1.V dresing Lembar 3,825
14 Folly No 14 Catether Pcs 6,850
15 Folly No 16 Catether Pcs 16,610
16 I.V Cathetter No. 20 Set 12,036
17 I.V Cathetter No. 22 Set 4,783
18 I.V Cathetter No. 24 Set 12,232
19 I.V Cathetter No. 26 Set 4,783
20 Infuset Anak Set 13,464
21 Infuset Dewasa Set 3,498
22 Infuset Dewasa ( Otsuka ) Set 4,147
23 Jarum Insulin Pcs 7,920
24 Kapas Berlemak 250 gr Bungkus 2,083
25 Kasa 4 m x 10 cm Pak 298,250
26 Kasa Hidrofil 36 x 80 cm Pak 1,440
27 Kasa Steril 16 x 16 cm Pak 127,600
28 Masker Ear LOOP Tub 7,370
29 Masker karet Sachet 364
30 Masker tali (E Care Surgical Mask Tie On) Tub 740
31 Plester 1" Rol 549
32 Plester 2,5 cm Rol 8,167
33 Plester kertas Rol 7,624
34 Policik 5 x 5 cm x1 m rol 8,019
 1 2 3 4 5 6
35 Sarung Tangan Gloves 6,5 Steril Pasang 17,748
36 Sarung Tangan Gynecolog no 7 Pasang 7,931
37 Sarung tangan M (Non Steril) Aximed Pasang 17,748
38 Sarung tangan no 6,5 Cosmo Pasang 924
39 Underpad lembar 1,018
40 Urine Bag 4,162
41 Kasa Kompres 40 x 40 Pak 7,038
42 Kasa Pembalut 2 m x 80 cm Pak 1,800
43 Lysol 9,400
44 Plester Coklat 5 Cm x 5 M Rol 40,997
23,760
1.1.7.02. Persediaan Bahan/Material
1.1.7.02.04.Persediaan Bahan obat-obatan
1 Albendazol Tablet 400 mg Tabet 296
2 Allopurinol tablet 100 mg Tablet -
3 Ambroxol sirup Botol -
4 Aminofilin Tablet 200 mg Tablet -
5 Aminofilina injeksi 24 mg/ml - 10 ml Ampul -
6 Amitripilin 25 mg tablet tablet 70
7 Amlodipin 5 mg Tablet 93
8 Amlodipin 10 mg tablet 233
9 Amoksisilin 500 mg tablet teblet 3,400
10 Amoksisilin Forte sirup kering 250mg botol -
11 Amoksisillin Sirup Kering 125 mg/5 ml Botol -
12 Ampisilin Injeksi 1 gr vial -
13 Analog insulin Long Acting pen -
14 Analog insulin Mix Acting pen 3,035
15 Antasida Doen Suspensi Botol 1,995
16 Antasida Doen Tablet tablet 54
17 Anti bakteri doen salep kombinasi tube -
18 Anti parkinson ( revovar ) tablet -
19 Aqua Pro Injeksi vial -
20 Artermether injeksi vial 105
21 Asam Asetil Salicilat 100 mg tablet tablet 55
22 Asetyel cysteine kapsul -
23 Asam Askorbat tablet 50 mg tablet 103
24 Asam Folat botol -
25 Asam Fusidat Cream tube 9,649
26 Asam Mefenamat 500 mg tablet 8,800
27 Asam Traneksamat Inj 5% ampul 237
28 Asering Botol 380
29 Asiklovir Cream 5% tube 358
30 Asiklovir tablet 200 mg tablet -
31 Asiklovir tablet 400 mg tablet 1,349
32 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ampul 5,800
33 Betametason krim 0,1 % tube 263
34 Bisakodil Suppositoria Supp -
35 Bisoprolol 2,5MG tablet 62
36 Bisoprolol 5 mg tablet 72
37 Cairan Pembersih ( Protektor ) Botol 269
38 Captopril Tablet 12,5 mg tablet -
39 Captopril Tablet 25 mg tablet -
40 Carbamazepin 200 mg tablet tablet -
41 Cefadroxil Capsul 500 mg capsul -
42 Cefixime Capsul 100 mg capsul -
43 Cefixime Sirup botol 265
 1 2 3 4 5 6
44 Cefotaksime 1 gr Injeksi vial -
45 Cetirizine sirup 5 mg/5 ml Botol 1,540
46 Ciprofloxcacin 500 mg tablet tablet 32
47 Clozapine 25 mg Tablet tablet 109
48 Deksametason injeksi 1 ml Ampul 17,350
49 Deksametason tablet 0,5 mg tablet -
50 Diazepam injeksi 2 ml Ampul 1,176
51 Diazepam Rektal 0,5 mg Supp -
52 Diazepam Tablet , 5 mg tablet -
53 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul -
54 Digoksin tablet 0,25 mg tablet -
55 Domperidon 10mg Tablet tablet 730
56 Doksisiklin Kapsul 100 mg capsul 553
57 Epinefrina HCL/Bitartrat Injeksi ampul -
58 Erytromicin kapsul 500 mg capsul -
59 Etil Klorida Semprot botol 2,590
60 Fenitoin Kapsul capsul -
61 Fenobarbital injeksi 50 mg/ml - 2 ml ampul -
62 Fenobarbital Tablet 30 mg tablet 3,550
63 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml ampul -
64 Flufenazine deconat inj 25 mg/ml ampul 264
65 Garam Oralit Sachet -
66 Gemfibrozil 300 mg tablet -
67 Gentamicin Salep Kulit tube 119
68 Glibenclamid tablet 5 mg tablet -
69 Guaiafenisin tablet 100 mg tablet -
70 Glikazid 80 mg Tablet tablet -
71 Glimepiride 2 mg tablet -
72 Glukosa larutan infus 5 % steril botol 210
73 Griseofulvin tablet 250 mg, tablet -
74 Griseofulvin tablet 500 mg, tablet -
75 Griseofulvin tablet 125 mg tablet 149
76 Hidroklorotiazid (HCT) tab. 25 mg tablet -
77 Hidrokortison krim 2,5% tube -
78 Heloperidol 1,5mg tablet -
79 Ibuprofen tablet 200 mg tablet -
80 Imunomodulator sirup (STIMUNO) Botol 9,400
81 Isosorbid Dinitrat tablet sublingual 5 mg tablet -
82 Kaen 3 B cairan infus Botol -
83 Kalsium Glukonas Injeksi Ampul -
84 Kalsium Laktat (Kalk) tablet 500 mg tablet 2,500
85 Karbolgliserol Tetes Telinga Botol 270
86 Ketokonazol Kream tube -
87 Ketokonazol Tablet 200 mg tablet -
88 Ketorolac inj Ampul 310
89 Kloramfenikol 250 mg capsul 3,008
90 Kloramfenikol salep mata 1 % tube -
91 Kloramfenikol salep kulit botol -
92 Kloramphenicol 500 mg tablet -
93 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 125
94 Kotrimoksazol Suspensi Botol -
95 Kotrimoksazol Dewasa Tablet 480 MG tablet -
96 Klorpromazin HCL tab salut 25mg tablet 1,140
97 Lactobacilus serbuk Sachet -
98 Lidocain 2%+efinefrin injeksi Ampul 1,140
99 Lidocain injeksi 2 ml Ampul -
100 Lisinopril 10 mg tablet tablet -
101 Lisinopril 5 mg tablet tablet -
102 Loperamid 2 mg tablet tablet -
103 Magnesium Sulfat injeksi 25 ml Ampul -
 1 2 3 4 5 6
104 Metampiron tablet 500 mg tablet -
105 Metformin 500 mg Tablet tablet -
106 Metilergometrin Injeksi 1 mg ampul -
107 Metilergometrin tablet tablet 3,414
108 Metoklopramid Suspensi botol -
109 Metronidazol 500 mg tablet -
110 Metronidazol Ovula Supp -
111 Metronidazol suspensi botol -
112 Mikonazol kream tube -
113 Multivitamin Anak ( Sanbe Kids ) botol 36,000
114 Multivitamin Dewasa Antioksidan ( Becom c ) tablet 100
115 Natrium diklofenak 50mg tablet 1,440
116 Natrium Klorida Cairan Infus ( NaCl ) botol 6,410
117 Nifedipine Tablet 10 mg tablet -
118 Obat Anti Diare Tablet (Akita / Molagit ) tablet 115
119 Obat Antituberkulosis Kat.Anak (FDC ) paket -
120 Obat Batuk Flu Kapsul capsul -
121 Obat Batuk Sirup Herbal ( Herbacop ) botol -
122 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 396
123 Omeprazol injeksi Ampul -
124 Omeprazol Kapsul 20 mg capsul -
125 Ondancentron injeksi 4 mg Ampul -
126 Ondancentron Tablet 4 mg tablet -
127 Paracetamol Drop botol 130
128 Paracetamol Sirup 120 mg/5 ml botol 471
129 Parasetamol tablet 500 mg tablet -
130 Permetrin Krim 5 % tube -
131 Pirantel Tablet 125 mg tablet -
132 Piridoksin HCL (VIT B6) tablet 10mg tablet 6,649
133 Piroksikam tablet 10 mg tablet 53
134 Povidon lodida 10% 300 ml Ampul 1,107
135 Povidon lodida 10% 60 ml Ampul 123
136 Prednison Tablet 5 mg tablet 73,700
137 Primakuin tablet -
138 Propanolol HCL tablet 10 mg tablet -
139 Ranitidin injeksi Ampul -
140 Ranitidin tablet tablet -
141 Retinol ( Vit A ) kapsul 200.000 iu capsul -
142 Resperidone 2 mg tablet tablet 76
143 Ringer Laktat cairan infus botol -
144 Salbutamol Nebulizer ( Ventolin ) vial -
145 Salbutamol Tablet 2 mg tablet -
146 Salbutamol tablet 4mg tablet 105
 1 2 3 4 5 6
147 Salep 2-4 tube 1,155
148 Salep Kombinasi tube 505
149 Salicil bedak kotak 7,150
150 Serum Anti Bisa Ular Inj. 5ml vial 505
151 Serum Anti Tetanus ( TETAGAM ) vial -
152 Setirizin Tablet 10 mg tablet 83
153 Sianokobalamin Injeksi Ampul 1,025
154 Simvastatin 10 mg tablet tablet -
155 Simvastatin 20 mg tablet tablet -
156 Tablet Penambah Darah tablet -
157 Tetrasiklin 250 mg capsul capsul 2,527
158 Triheksilfenidil Hcl 2 mg tablet tablet -
159 Thiamin Tb tablet -
160 Vitamin B komplek tablet -
161 Zink sirup botol 1,098
162 Zink tablet 20 mg tablet -
163 Berotec 0.1 Mg tablet -
164 Bisoprolol 5 Mg tablet 110
165 Decacetin ( Kloram Tetes Mata ) botol -
166 Methilprednisolon 4 Mg tablet 205
167 Rivanol botol -
168 Saraye Alsoft A 500 Ml Ampul 352
169 Saraye Alsoft Pure 500 Ml Ampul -
170 Sukralfat Sirup botol 85
171 Thiamin Tablet 50 Mg tablet 4,162

PERSEDIAAN SUMBER NON APBD (HIBAH)

1.1.7. Persediaan
1.1.7.02. Persediaan Bahan/Material
1.1.7.02.04.Persediaan Bahan obat-obatan
Obat KB
1 Suntik Pcs 6,090 650 650
2 Pil KB Blister 1,518 700 700
3 IUD Pcs 11,800
4 Implan Pcs 212,500
5 kondom Dus/pcs 96,000 1 1
6 Disposible Pcs 669 250 250
7 Safety Box Box 21,395
8 Hand scoon Box 4,180 58 58
9 Lidocain' Ampul 860 40 40
10 Dermatik Tube 4,633 40 40
11 Pavidon Botol 4,070 5 5
Asam Fenamat Strip 1,030 40 40
1 2 3 4 5 6
Obat Program Jiwa
1 Haloperidol Tablet 1.5 mg Tablet 59 - -
2 Amiitripilin 25 mg Tablet 167 - -
3 Klorpromazin HCL Tab 100 mg Tablet 147 - -
4 Triheksipendil 2 mg Tablet Tablet 80 - -
5 Amitriptylin 25 mg ( Program ) Tablet 167 - -
6 Carbamazepin 200 mg tablet ( Program ) Tablet 228 - -
7 Clobazam 10 mg Tablet Tablet 739 - -
8 Haloperidol Injeksi Tablet 97,500 - -
9 Haloperidol 2 mg tablet Tablet 126 - -
10 Haloperidol 5 mg Tablet Tablet 96 - -
11 Resperidone 2 mg tablet ( Program ) Tablet 273 - -
12 Triheksilfenidil Hcl 2 mg tablet ( Program ) Tablet 88 - -
13 Flufenazine deconat inj 25 mg/ml Tablet 55,000 - -
Obat Program P2 HIV AIDS IMS
1 Duviral 300/150 mg Tablet 222,000 - -
2 Efavirenz ( EFV ) 200 mg Tablet 288,201 - -
3 Lamivudine ( 3TC ) 150 mg Tablet 90,000 - -
4 TDF + 3TC +EFV (300/300/600 ) Tablet 98,273 - -
5 Tenofir ( TDF ) 300 mg Tablet 243,000 - -
Obat Program Penanganan Penyakit TB
1 Obat Antituberkulosis Kat.1 ( FDC ) Tab/Box Paket 317,018 - -
2 Obat Antituberkulosis Kat.2 ( FDC ) Tab/Box Paket 1,297,894 - -
3 Obat Antituberkulosis Kat.Anak ( FDC ) Tab/Box Paket 214,985 - -
4 POT Dahak Steril POT 5,890 - -
5 Isoniazid tablet 100 mg ( Program ) Tablet 125 - -
- -
Obat Program Penanganan Penyakit Kusta
1 MDT MB Anak Tablet Tablet 21,750 - -
2 MDT MB Dewasa Tablet Tablet 31,570
3 MDT PB Dewasa Tablet Tablet 9,770 - -
Obat Program Gizi Gizi
1 Retinol (Vitamin A) kapsul 100.000 IU IU 284 - -
2 Retinol (Vitamin A) kapsul 200.000 IU IU 505
3 Tablet Penambah Darah ( Program ) Program ) 352 - -
Persediaan Bahan Uji Labolatorium Labolatorium
Cell Pack 20 L 1,760,000
Stromatolyear 1,210,000
Fibrile Antigen H 25,924
Fibrile Antigen H-A 25,924
Fibrile Antigen H-B 25,924
Fibrile Antigen H-c 25,924
Fibrile Antigen o 25,924
Fibrile Antigen O-A 25,924
Fibrile Antigen O-B 25,924
Fibrile Antigen 0-C 25,924
Anti A monoclonal 71,825
Anti B monoclonal 71,825
Anti A-B monoclonal 96,135
Anti D monoclonal 117,695
1 2 3 4 5 6
Obat VK
oxitosin inj 1,199.00 75 75
metergin inj 2,840.00 20 20
sianocobolamin inj 1,199.00 0 0
spuit 10 cc 1,067.00 1 1
under pad 4,162.00 30 30
chateter no.16 41,600.00 0 0
chateter jeli 12,036.00 0 0
policlean 74,494 0 0
kasa steril 16x16 7,370.00 5 5
handskun steril 7.0 0 0
fitomenadion inj 3,550.00 0 0
povidon lolida 10% 17,996 1 1
RL cairan infus 7,150 20 20
plester kertas 2,5 7,624.00 0 0
rivanol 300 ml 2,992.00 0 0
handskun steril6,5 10,351.00 0 0
lidocain inj 2 ml 1,140 10 10
alat suntik 3 ml 816.00 55 55
alkohol swab 32,600.00 130 130
alkohol 70% 25,000.00 0 0
iv cateter no.20 4,783.00 80 80
kasa pembalut 2mx80cm 20,600.00 0 0
infuset anak 3,498.00 0 0
kalsium gukonas inj 10,351.00 3 3
magnesium sulfat ( MgSo4) inj 3,328.00 14 14
alat suntik 2,5 ml 649.00 30 30
diazepam inj 17,350.00 0 0
Nacl infus 10 10
cat gut no. 2/0 52,000 0 0
E. care iv dressing 6,850.00 30 30
folly cateter no. 16 12,036.00 0 0
infuset dewasa 4,147.00 30 30
kasa pembalut 2x10 9,400.00 1 1
kasa hidrofil 36x80 cm 127,600.00 2 2
plester non woven 23760 0 0
polifix 5 cm x 1m 7,370.00 0 0
urine bag 7,038.00 8 8
cat gut no. 3/0 44,953 0 0
Cateter no. 26 13,464.00 0 0

Persediaan Bahan Makanan Pokok

Makanan Pendamping
1 PMT Ibu Hamil Dus
2 PMT Balita Dus

Mengetahui, Pembantu Pengur

Kepala Puskesmas Carita Puskesm
Kabupaten Pandeglang
1 2 3 4 5 6

Ifa Fa
Angga Iskandarwinata, S.Kep NIP 1983051
NIP : 19850102 200902 1 001
HITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Perhitungan Persediaan :
Penjelasan Selisih
Mutasi
Selisih Jumlah Fisik Nilai Persediaan
(+) (-)
7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
7,917,000
3,958,500
3,958,500
3,958,500
-
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
-
-
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -

3,958,500
3,958,500
3,958,500
3,958,500
3,958,500
- - - 650 3,958,500
- - - 700 1,062,600
- - - - -
- - - - -
- - - 1 96,000
- - - 250 167,250
- - - - -
- - - 58 242,440
- - - 40 34,400
- - - 40 185,320
- - - 5 20,350
- - 40 41,200
- - - -
7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
-
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
-
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
-
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
-
- - - - -
- - - - -
- - - - -
-
- - - - -
- - - - -
- - - - -

- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
-
 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
- - - -
- - 75 89,925
- - 20 56,800
- - - -
- - 1 1,067
- - 30 124,860
- - - -
- - - -
- - - -
- - 5 36,850
- - - -
- - - -
- - 1 17,996
- - 20 143,000
- - - -
- - - -
- - - -
- - 10 11,400
- - 55 44,880
- - 130 4,238,000
- - - -
- - 80 382,640
- - - -
- - - -
- - 3 31,053
- - 14 46,592
- - 30 19,470
- - - -
- - 10 -
- - - -
- - 30 205,500
- - - -
- - 30 124,410
- - 1 9,400
- - 2 255,200
- - - -
- - - -
- - 8 56,304
- - - -
- - - -

-
- - - - -
- - - - -

Yang diperiksa
Pembantu Pengurus Barang Pengguna Tim Pemeriksa,
Puskesmas Carita

1 Ivan Sofiyana, Amd.Kep

 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10) 12
NIP : 19811027 200801 1 006
Ifa Fatoni,SKM
NIP 19830516 201001 1 007
2 Hadaningsih
NIP : 19730815 199203 2 001

3 Siti Suryatakariah
NIP : 19651028 198803 2 010
Lampiran
Berita Acara Pemeriksaan Persediaan
Lokasi Persediaan : Poskesdes Sindanglaut

PERHITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Harga Perhitungan Persed

No Uraian Satuan Satuan
Administra Reviu Mutasi
(Rp) Selisih
si Fisik (+)
1 2 3 4 5 6 7 = (5-6) 8
TOTAL PERSEDIAAN
PERSEDIAAN SUMBER APBD
1.1.7. Persediaan
1.1.7.01. Persediaan Bahan Pakai Habis
1.1.7.01.15. Persediaan Alat Kesehatan Habis Pakai
1 - -
2 - -
3 - -
4 - -
5 - -
6 - -

1.1.7.02. Persediaan Bahan/Material

1.1.7.02.04. Persediaan Bahan obat-obatan
1 Allopurinol tablet 100 mg Tablet 99 - - - -
2 Amlodipin 5 mg Tablet 70 - - - -
3 Amlodipin 10 mg Tablet 93 - - - -
4 Amoksisilin 500 mg tablet Tablet 233 100 100 - -
5 Amoksisilin Forte sirup kering 250mg Botol 3,400 - - - -
6 antalgin 500 mg Tablet 1,995 - - - -
7 Antasida Doen Tablet Tablet 473 - - - -
8 Akita / Molagit Tablet 54 20 20 - -
9 Asam Mefenamat 500 mg Tablet 103 50 50 - -
10 Acityl Systen Kapsul 103 300 300 - -
11 Asiklovir Cream 5% Tube 358 - - - -
12 Asiklovir tablet 200 mg Tablet 481 - - - -
13 Asiklovir tablet 400 mg Tablet 8,800 20 20 - -
14 B.6 Tablet 237 - - - -
15 Contri 480 mg Tablet 380 50 50 - -
16 Contri syp Botol 1,349 5 5 - -
17 Cloram salep mata Tube 45 2 2 - -
18 Captopril / 2 mg Tablet 2,286 - - - -
19 Ciprofloxcacin 500 mg tablet Tablet 125 - - - -
20 cetrizin Tablet 62 - - - -
21 Captopril Tablet 25 mg Tablet 240 - - - -
22 Deksametason injeksi 1 ml Ampul 90 - - - -
23 Deksametason tablet 0,5 mg Tablet 72 50 50 - -
24 Diazepam injeksi 2 ml Ampul 1,097 - - - -
25 Gliseril Guayacolat Tablet 32 100 100 - -
26 Griseofulvin tablet 500 mg, Tablet 1,176 20 20 - -
27 Gentamicin Salep Kulit Tube 132 2 2 - -
28 Hidrokortison krim 2,5% Tablet 210 3 3 - -
 Harga Perhitungan Persed
No Uraian Satuan Satuan
Administra Reviu Mutasi
(Rp) Selisih
si Fisik (+)
29 Kalsium Laktat (Kalk) tablet 500 mg Tablet 2,639 50 50 - -
30 Kloramfenikol 250 mg Kapsul 54 50 50 - -
31 Kloramphenicol 500 mg Kapsul 310 - - - -
32 Kloramphenicol Tetes Telinga Botol 1,048 2 2 - -
33 Kloramphenicol salep mata Tube 22 2 2 - -
34 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 1,810 50 50 - -
35 Oralit Shaset 22 5 5 - -
36 Metronidazol 500 mg Tablet 413 50 50 - -
37 Paracetamol Drop Botol 264 4 4 - -
38 Prednison Tablet 5 mg Tablet 130 - - - -
39 Parasetamol tablet 500 mg Tablet 1,107 100 100 - -
40 Ranitidin injeksi Ampul 53 - - - -
41 Ibuforfen 200mg Botol 68 20 20 - -
42 Ranitidin tablet Tablet 8,167 50 50 - -
43 Salbutamol Tablet 2 mg Tablet 1,155 - - - -
44 Salbutamol tablet 4mg Tablet 105 - - - -
45 Salep 2-4 Tablet 63 3 3 - -
46 silk Pcs 70 - - - -
47 Salicil bedak Pot 2,621 5 5 - -
48 Simvastatin 10 mg tablet Tablet 3,825 - - - -
49 Simpastatin 20 mg tablet Tablet 1,025 - - - -
50 Tiamin B1 Tablet 205 50 50 - -
51 Vitamin B komplek Tablet 110 50 50 - -
52 Vitamin C 50 mg Tablet 85 - - - -
53 Vitamin B 12 Injeck ampul 118 3 3 - -
54 Natrium Klorida Cairan Infus ( NaCl ) Kolf 1,098 2 2 - -
55 Abocat 20 Pcs 6,550 - - - -
56 Abocat 26 Pcs 4,794 - - - -
57 Abocat 24 Pcs 4,794 - - - -
58 Cat Gut Pcs 4,794 - - - -
59 Lidokain Ampul 5,200 3 3 - -
60 Plester Pcs 1,140 - - - -
61 bethadine Botol 8,167 1 1 - -
62 ringer laktat Kolf 7,150 - - - -
63 Spuit 3 cc Pcs 816 5 5 - -
64 Spuit 2,5 cc Pcs 649 - - - -
65 Spuit 1 cc Pcs 777 - - - -
66 Infuset Dewasa Pcs 4,147 3 3 - -
67 Spuit 5 cc Pcs 856 - - - -

1.1.7.04. Persediaan Barang Cetakan dan Penggandaan

1.1.7.04.01. Persedian Barang Cetakan
1 Karcis Retribusi Blok - - - - -
2 Sisa Karcis Lembar 194 67 67 - -
PERSEDIAAN SUMBER NON APBD (HIBAH)
1.1.7. Persediaan
1.1.7.02. Persediaan Bahan/Material
1.1.7.02.04. Persediaan Bahan obat-obatan
Obat Program Gizi

Mengetahui, Yang diperiksa

Kepala Puskesmas Carita Pembantu Pengurus Barang Pengguna
Kabupaten Pandeglang Puskesmas Carita

Angga Iskandarwinata, S.Kep Ifa Fatoni,SKM

NIP : 19850102 200902 1 001 NIP 19830516 201001 1 007
HITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Perhitungan Persediaan :
Penjelasan Selisih
Mutasi Nilai
Jumlah Fisik
(-) Persediaan
9 10 (6-8+9) 11 (5 x 10) 12
1,147,875
1,147,875
1,147,875
-
-
- - -
- - -
- - -
- - -
- - -
- - -

1,134,877
1,134,877
- - -
- - -
- - -
- 100 23,300
- - -
- - -
- - -
- 20 1,080
- 50 5,150
- 300 30,900
- - -
- - -
- 20 176,000
- - -
- 50 19,000
- 5 6,745
- 2 90
- - -
- - -
- - -
- - -
- - -
- 50 3,600
- - -
- 100 3,200
- 20 23,520
- 2 264
- 3 630
 Perhitungan Persediaan :
Penjelasan Selisih
Mutasi Nilai
Jumlah Fisik
(-) Persediaan
- 50 131,950
- 50 2,700
- - -
- 2 2,096
- 2 44
- 50 90,500
- 5 110
- 50 20,650
- 4 1,056
- - -
- 100 110,700
- - -
- 20 1,360
- 50 408,350
- - -
- - -
- 3 189
- - -
- 5 13,105
- - -
- - -
- 50 10,250
- 50 5,500
- - -
- 3 354
- 2 2,196
- - -
- - -
- - -
- - -
- 3 15,600
- - -
- 1 8,167
- - -
- 5 4,080
- - -
- - -
- 3 12,441
- - -

12,998
12,998
- - -
- 67 12,998
-
-
-
-

Pembantu Pengurus Barang Pengguna Tim Pemeriksa,

1 Ivan Sofiyana, Amd.Kep

NIP : 19811027 200801 1 006

2 Hadaningsih
NIP : 19730815 199203 2 001
Perhitungan Persediaan :
Penjelasan Selisih
Mutasi Nilai
Jumlah Fisik
(-) Persediaan

3 Siti Suryatakariah
NIP : 19651028 198803 2 010
Lampiran
Berita Acara Pemeriksaan Persediaan
Lokasi Persediaan : Pustu Cinoyong

PERHITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Harga Perhitungan Persediaan :

No Uraian Satuan Satuan
Administr Reviu Mutasi Jumlah Nilai
(Rp) Selisih
asi Fisik (+) (-) Fisik Persediaan
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
TOTAL PERSEDIAAN 2,864,700
PERSEDIAAN SUMBER APBD 2,864,700
1.1.7. Persediaan 2,864,700
1.1.7.01. Persediaan Bahan Pakai Habis -
1.1.7.01.15. Persediaan Alat Kesehatan Habis Pakai -
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -

1.1.7.02. Persediaan Bahan/Material 2,852,866

1.1.7.02.04. Persediaan Bahan obat-obatan 2,852,866
1 Albendazol Tablet 400 mg 93 - - - - -
2 Allopurinol tablet 100 mg 99 80 80 - - - 80 7,920
3 Ambroxol sirup 9,883 - - - - -
4 Aminofilin Tablet 200 mg 91 - - - - -
5 Aminofilina injeksi 24 mg/ml - 10 ml 3,345 - - - - -
6 Amlodipin 5 mg 143 - - - - -
7 Amlodipin 10 mg 93 - - - - -
8 Amoksisilin 500 mg tablet 233 1,120 1,120 - - - 1,120 260,960
9 Amoksisilin Forte sirup kering 250mg 3,400 53 53 - - - 53 180,200
10 Amoksisillin Sirup Kering 125 mg/5 ml 1,881 - - - - -
11 Ampisilin Injeksi 1 gr 5,368 - - - - -
12 Analog insulin Long Acting 425,000 - - - - -
13 Analog insulin Mix Acting 550,000 - - - - -
14 Antasida Doen Suspensi 1,995 98 98 - - - 98 195,510
15 Antasida Doen Tablet 54 170 170 - - - 170 9,180
16 Aqua Pro Injeksi 2,860 - - - - -
17 Artermether injeksi 1,000 - - - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
18 Asam Asetil Salicilat 100 mg tablet 130 - - - - -
19 Asam Askorbat tablet 50 mg 105 290 290 - - - 290 30,450
20 Asam Folat 55 - - - - -
21 Asam Fusidat Cream 5,506 - - - - -
22 Asam Mefenamat 500 mg 103 560 560 - - - 560 57,680
23 Acityl Systen 358 560 560 - - - 560 200,480
24 Asam Traneksamat Inj 5% 24,449 - - - - -
25 Asering 9,646 - - - - -
26 Asiklovir Cream 5% 8,800 - - - - -
27 Asiklovir tablet 200 mg 237 - - - - -
28 Asiklovir tablet 400 mg 380 - - - - -
29 Atropin Sulfat injeksi 0,25 mg/ml-1 ml 1,595 - - - - -
30 Betametason krim 0,1 % 1,349 38 38 - - - 38 51,262
31 Bisakodil Suppositoria 5,800 - - - - -
32 Bisoprolol 2,5MG 650 - - - - -
33 Cairan Pembersih ( Protektor ) 22,000 - - - - -
34 Captopril Tablet 12,5 mg 62 - - - - -
35 Captopril Tablet 25 mg 72 - - - - -
36 Carbamazepin 200 mg tablet 269 - - - - -
37 Cefadroxil Capsul 500 mg 516 - - - - -
38 Cefixime Capsul 100 mg 590 - - - - -
39 Cefixime Sirup 7,490 100 100 - - - 100 749,000
40 Cefotaksime 1 gr Injeksi 4,200 - - - - -
41 Cetirizine sirup 5 mg/5 ml 2,849 - - - - -
42 Ciprofloxcacin 500 mg tablet 265 - - - - -
43 Clozapine 25 mg Tablet 1,121 - - - - -
44 Demetech Silk 3/0 3,825 - - - - -
45 Deksametason injeksi 1 ml 1,097 - - - - -
46 Deksametason tablet 0,5 mg 32 - - - - -
47 Diazepam injeksi 2 ml 17,350 - - - - -
48 Diazepam Rektal 0,5 mg 11,516 - - - - -
49 Diazepam Tablet , 5 mg - - - - -
50 Difenhidramin HCL injeksi 10 mg/ml - 1ml 1,176 - - - - -
51 Digoksin tablet 0,25 mg 105 200 200 - - - 200 21,000
52 Domperidon 10mg Tablet 85 - - - - -
53 Doksisiklin Kapsul 100 mg 268 - - - - -
54 Epinefrina HCL/Bitartrat Injeksi 1,408 - - - - -
55 Ecare Pilm 6,859 - - - - -
56 Erytromicin kapsul 500 mg 730 - - - - -
57 Etil Klorida Semprot 137,500 - - - - -
58 Fenitoin Kapsul 154 - - - - -
59 Fenobarbital injeksi 50 mg/ml - 2 ml 1,740 - - - - -
60 Fenobarbital Tablet 30 mg 165 - - - - -
61 Fenol glisrero / tts telinga 2,590 25 25 - - - 25 64,750
62 fitomenadion 713 - - - - -
63 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml 3,550 - - - - -
64 Flufenazine deconat inj 25 mg/ml 57,500 - - - - -
65 Garam Oralit 264 - - - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
66 Gemfibrozil 300 mg 380 - - - - -
67 Gentamicin Salep Kulit 2,800 16 16 - - - 16 44,800
68 Gentamicin Tetas Mata 4,232 - - - - -
69 Glibenclamid tablet 5 mg 119 - - - - -
70 Guaiafenisin tablet 100 mg 132 - - - - -
71 Glikazid 80 mg Tablet 235 - - - - -
72 Glimepiride 2 mg 288 - - - - -
73 Glukosa larutan infus 5 % steril 6,900 - - - - -
74 Gliseril Guayacolat 368 - - - - -
75 Griseofulvin tablet 250 mg, 1,705 - - - - -
76 Griseofulvin tablet 500 mg, 2,200 90 90 - - - 90 198,000
77 Hidroklorotiazid (HCT) tab. 25 mg 149 - - - - -
78 Hidrokortison krim 2,5% 2,639 23 23 - - - 23 60,697
79 Ibuprofen tablet 200 mg 105 - - - - -
80 Imunomodulator sirup (STIMUNO) 23,540 - - - - -
81 Isosorbid Dinitrat tablet sublingual 5 mg 89 - - - - -
82 Kaen 3 B cairan infus 10,050 - - - - -
83 Kalsium Glukonas Injeksi 10,351 - - - - -
84 Kalsium Laktat (Kalk) tablet 500 mg 59 180 180 - - - 180 10,620
85 Karbolgliserol Tetes Telinga 2,500 - - - - -
86 Ketokonazol Kream 2,545 - - - - -
87 Ketokonazol Tablet 200 mg 270 18 18 - - - 18 4,860
88 Ketorolac inj 1,045 13 13 - - - 13 13,585
89 Kloramfenikol 250 mg 310 28 28 - - - 28 8,680
90 Klormfenikol 3 mg 1,810 - - - - -
91 Kloramfenikol salep mata 1 % 1,881 32 32 - - - 32 60,192
92 Kloramfenikol salep kulit 3,008 16 16 - - - 16 48,128
93 Kloramphenicol 500 mg 1,048 - - - - -
94 Klorfeniramin Maleat (CTM) tablet 4 mg 22 960 960 - - - 960 21,120
95 Kotrimoksazol Suspensi 2,052 17 17 - - - 17 34,884
96 Kotrimoksazol Dewasa Tablet 480 MG 125 230 230 - - - 230 28,750
97 Lactobacilus serbuk 14,707 - - - - -
98 Lidocain 2%+efinefrin injeksi 1,140 14 14 - - - 14 15,960
99 Lidocain injeksi 2 ml 1,140 - - - - -
100 Lisinopril 10 mg tablet 448 - - - - -
101 Lisinopril 5 mg tablet 375 - - - - -
102 Loperamid 2 mg tablet 85 - - - - -
103 Magnesium Sulfat injeksi 25 ml 3,328 - - - - -
104 Metampiron tablet 500 mg 305 - - - - -
105 Metformin 500 mg Tablet 100 - - - - -
106 Metilergometrin Injeksi 1 mg 2,840 - - - - -
107 Metilergometrin tablet 210 - - - - -
108 Metoklopramid Suspensi 2,345 - - - - -
109 Metronidazol 500 mg 113 - - - - -
110 Metronidazol Ovula 4,100 - - - - -
111 Metronidazol suspensi 3,799 - - - - -
112 Mikonazol kream 3,414 - - - - -
113 Multivitamin Anak ( Sanbe Kids ) 12,100 - - - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
114 Multivitamin Dewasa Antioksidan ( Becom c ) 1,440 - - - - -
115 Natrium Klorida Cairan Infus ( NaCl ) 6,410 - - - - -
116 Natrium Diklof 115 - - - - -
117 Nifedipine Tablet 10 mg 108 - - - - -
118 Obat Anti Diare Tablet (Akita / Molagit ) 450 100 100 - - - 100 45,000
119 Obat Antituberkulosis Kat.Anak (FDC ) 223,585 - - - - -
120 Obat Batuk Flu Kapsul 413 - - - - -
121 Obat Batuk Sirup Herbal ( Herbacop ) 12,000 - - - - -
122 Oksitosin injeksi 10 IU/ml - 1 ml 1,199 - - - - -
123 Omeprazol injeksi 16,997 - - - - -
124 Omeprazol Kapsul 20 mg 130 - - - - -
125 Omeprazol 1,010 90 90 - - - 90 90,900
126 Ondancentron injeksi 4 mg 1,650 - - - - -
127 Ondancentron Tablet 4 mg 471 - - - - -
128 Paracetamol Drop 6,649 - - - - -
129 Paracetamol Sirup 120 mg/5 ml 1,107 69 69 - - - 69 76,383
130 Parasetamol tablet 500 mg 53 450 450 - - - 450 23,850
131 Permetrin Krim 5 % 12,155 - - - - -
132 Pirantel Tablet 125 mg 291 - - - - -
133 Piridoksin HCL (VIT B6) tablet 10mg 123 180 189 (9) - - 189 23,247
134 Piroksikam tablet 10 mg 234 - - - - -
135 Povidon lodida 10% 300 ml 17,996 - - - - -
136 Povidon lodida 10% 60 ml 6,550 - - - - -
137 Prednison 45 - - - - -
138 Prednison Tablet 5 mg 68 700 700 - - - 700 47,600
139 Primakuin 224 - - - - -
140 Propanolol HCL tablet 10 mg 60 - - - - -
141 Karbo Gliseril 2,500 - - - - -
142 Ranitidin injeksi 1,155 4 4 - - - 4 4,620
143 Ranitidin tablet 105 240 240 - - - 240 25,200
144 Resperidone 2 mg tablet 347 - - - - -
145 Ringer Laktat cairan infus 7,150 - - - - -
146 Salbutamol Nebulizer ( Ventolin ) 110 - - - - -
147 Salbutamol Tablet 2 mg 63 - - - - -
148 Salbutamol tablet 4mg 70 - - - - -
149 Salep 2-4 2,621 - - - - -
150 Salep Kombinasi 11,000 - - - - -
151 Salicil bedak 1,025 - - - - -
152 Serum Anti Bisa Ular Inj. 5ml 479,996 - - - - -
153 Serum Anti Tetanus ( TETAGAM ) 170,000 - - - - -
154 Setirizin Tablet 10 mg 90 - - - - -
155 Sukralfat Sirup 85 - - - - -
156 Sianokobalamin Injeksi 1,035 - - - - -
157 Simvastatin 10 mg tablet 110 - - - - -
158 Simvastatin 20 mg tablet 368 160 160 - - - 160 58,880
159 Tablet Penambah Darah 352 - - - - -
160 Tetrasiklin 250 mg capsul 163 - - - - -
161 Tiamin B1 85 190 190 - - - 190 16,150
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
162 Triheksilfenidil Hcl 2 mg tablet 88 - - - - -
163 Vitamin B komplek 118 50 50 - - - 50 5,900
164 Zink sirup 2,972 10 19 (9) - - 19 56,468
165 - - - - -
166 - - - - -
167 - - - - -
168 - - - - -
169 - - - - -
170 - - - - -
171 - - - - -
172 - - - - -
173 - - - - -
174 - - - - -
175 - - - - -
176 - - - - -
177 - - - - -
178 - - - - - - -

1.1.7.04. Persediaan Barang Cetakan dan Penggandaan 11,834

1.1.7.04.01. Persedian Barang Cetakan 11,834
1 Karcis Retribusi Blok - - - - -
2 Sisa Karcis Lembar 194 61 61 - - - 61 11,834
PERSEDIAAN SUMBER HIBAH/NON APBD

NIHI
Mengetahui,
Kepala Puskesmas Carita
Kabupaten Pandeglang L Yang diperiksa
Pembantu Pengurus Barang Pengguna
Puskesmas Carita
Tim Pemeriksa,

1 Ivan Sofiyana, Amd.Kep

NIP : 19811027 200801 1 006
Angga Iskandarwinata, S.Kep Ifa Fatoni,SKM
NIP : 19850102 200902 1 001 NIP 19830516 201001 1 007
2 Hadaningsih
NIP : 19730815 199203 2 001

3 Siti Suryatakariah
NIP : 19651028 198803 2 010
PERHITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Penjelasan Selisih

12
12
12
12
 12

Ivan Sofiyana, Amd.Kep

NIP : 19811027 200801 1 006

NIP : 19730815 199203 2 001

Siti Suryatakariah
NIP : 19651028 198803 2 010
Lampiran
Berita Acara Pemeriksaan Persediaan
Lokasi Persediaan : Pustu Sukanagara

PERHITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Harga Perhitungan Persediaan :

No Uraian Satuan Satuan
Administra Reviu Mutasi Jumlah
(Rp) Selisih Nilai Persediaan
si Fisik (+) (-) Fisik
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
TOTAL PERSEDIAAN 51,586,351
PERSEDIAAN SUMBER APBD 51,586,351
1.1.7. Persediaan 51,586,351
1.1.7.01. Persediaan Bahan Pakai Habis -
1.1.7.01.15. Persediaan Alat Kesehatan Habis Pakai -
1 - - - - -

1.1.7.02. Persediaan Bahan/Material 51,554,923

1.1.7.02.04. Persediaan Bahan obat-obatan 51,554,923
1 Albendazol Tablet 400 mg 93 100 100 - - - 100 9,300
2 Allopurinol tablet 100 mg 99 - - - - - - -
3 Ambroxol sirup 9,883 320 320 - - - 320 3,162,560
4 Aminofilin Tablet 200 mg 91 - - - - - - -
5 Aminofilina injeksi 24 mg/ml - 10 ml 3,345 20 20 - - - 20 66,900
6 Amlodipin 5 mg 70 230 230 - - - 230 16,100
7 Amlodipin 10 mg 93 100 100 - - - 100 9,300
8 Amoksisilin 500 mg tablet 233 10 10 - - - 10 2,330
9 Amoksisilin Forte sirup kering 250mg 3,400 - - - - - - -
10 Amoksisillin Sirup Kering 125 mg/5 ml 1,881 - - - - - - -
11 Ampisilin Injeksi 1 gr 5,368 - - - - - - -
12 Analog insulin Long Acting 425,000 - - - - - - -
13 Analog insulin Mix Acting 550,000 10 10 - - - 10 5,500,000
14 Antasid sirup 1,995 - - - - - - -
15 Antasida Doen Suspensi 1,923 250 250 - - - 250 480,750
16 Antasida Doen Tablet 54 - - - - - - -
17 Aqua Pro Injeksi 2,860 - - - - - - -
18 Artermether injeksi 1,000 - - - - - - -
19 Asam Asetil Salicilat 100 mg tablet 130 150 150 - - - 150 19,500
20 acetyl 358 200 200 - - - 200 71,600
21 Asam Askorbat tablet 50 mg 105 20 20 - - - 20 2,100
22 Asam Folat 55 - - - - - - -
23 Asam Fusidat Cream 5,506 - - - - - - -
24 Asam Mefenamat 500 mg 103 - - - - - - -
25 Asam Traneksamat Inj 5% 24,449 - - - - - - -
26 Asering 9,646 5 5 - - - 5 48,230
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
27 Asiklovir Cream 5% 8,800 100 100 - - - 100 880,000
28 Asiklovir tablet 200 mg 237 100 100 - - - 100 23,700
29 Asiklovir tablet 400 mg 380 - - - - - - -
30 Atropin Sulfat injeksi 0,25 mg/ml-1 ml 1,595 - - - - - - -
31 Aximed Policateter - 5 5 - - - 5 -
32 Betametason krim 0,1 % 1,349 12 12 - - - 12 16,188
33 Bisakodil Suppositoria 5,800 - - - - - - -
34 Bisoprolol 2,5MG 650 - - - - - - -
35 Cairan Pembersih ( Protektor ) 22,000 30 30 - - - 30 660,000
36 Captopril Tablet 12,5 mg 62 50 50 - - - 50 3,100
37 Captopril Tablet 25 mg 72 100 100 - - - 100 7,200
38 Carbamazepin 200 mg tablet 269 - - - - - - -
39 Cefadroxil Capsul 500 mg 516 - - - - - - -
40 Cefixime Capsul 100 mg 590 - - - - - - -
41 Cefixime Sirup 7,490 - - - - - - -
42 Cefotaksime 1 gr Injeksi 4,200 20 20 - - - 20 84,000
43 Cetirizine Tablet 10 mg 90 - - - - - - -
44 Cetirizine sirup 5 mg/5 ml 2,849 150 150 - - - 150 427,350
45 Ciprofloxcacin 500 mg tablet 265 - - - - - - -
46 Clozapine 25 mg Tablet 1,121 - - - - - - -
47 Demetech Silk 3/0 3,825 10 10 - - - 10 38,250
48 Deksametason injeksi 1 ml 1,097 200 200 - - - 200 219,400
49 Deksametason tablet 0,5 mg 32 - - - - - - -
50 Diazepam injeksi 2 ml 17,350 - - - - - - -
51 Diazepam Rektal 0,5 mg 11,516 - - - - - - -
52 Diazepam Tablet , 5 mg - 20 20 - - - 20 -
53 Difenhidramin HCL injeksi 10 mg/ml - 1ml 1,176 - - - - - - -
54 Digoksin tablet 0,25 mg 105 - - - - - - -
55 Domperidon 10mg Tablet 85 - - - - - - -
56 Doksisiklin Kapsul 100 mg 268 - - - - - - -
57 Epinefrina HCL/Bitartrat Injeksi 1,408 - - - - - - -
58 Ecare Pilm 6,859 100 100 - - - 100 685,900
59 Erytromicin kapsul 500 mg 730 - - - - - - -
60 Etil Klorida Semprot 137,500 - - - - - - -
61 Fenitoin Kapsul 154 - - - - - - -
62 Fenobarbital injeksi 50 mg/ml - 2 ml 1,740 - - - - - - -
63 Fenobarbital Tablet 30 mg 165 20 20 - - - 20 3,300
64 fitomenadion 713 - - - - - - -
65 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml 3,550 - - - - - - -
66 Flufenazine deconat inj 25 mg/ml 57,500 10 10 - - - 10 575,000
67 Garam Oralit 264 - - - - - - -
68 Gemfibrozil 300 mg 380 - - - - - - -
69 Gentamicin Salep Kulit 2,800 - - - - - - -
70 Glibenclamid tablet 5 mg 119 9 9 - - - 9 1,071
71 Gentamicin Salep mata 4,232 - - - - - - -
72 Guaiafenisin tablet 100 mg 132 - - - - - - -
73 Glikazid 80 mg Tablet 235 50 50 - - - 50 11,750
74 Glimepiride 2 mg 288 - - - - - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
75 Glukosa larutan infus 5 % steril 6,900 - - - - - - -
76 Gliseril Guayacolat 368 - - - - - - -
77 Griseofulvin tablet 250 mg, 1,705 50 50 - - - 50 85,250
78 Griseofulvin tablet 125mg, 210 - - - - - - -
79 Griseofulvin tablet 500 mg, 2,200 - - - - - - -
80 Griseofulvin 25 mg - - - - - - - -
81 Hidroklorotiazid (HCT) tab. 25 mg 149 5 5 - - - 5 745
82 Hidrokortison krim 2,5% 2,639 - - - - - - -
83 Ibuprofen tablet 200 mg 105 20 20 - - - 20 2,100
84 Isosorbid Dinitrat tablet sublingual 5 mg 89 - - - - - - -
85 Imunomodulator sirup (STIMUNO) 23,540 - - - - - - -
86 Isosorbid Dinitrat tablet sublingual 5 mg 89 - - - - - - -
87 Kaen 3 B cairan infus 10,050 - - - - - - -
88 Kalsium Glukonas Injeksi 10,351 10 10 - - - 10 103,510
89 Kalsium Laktat (Kalk) tablet 500 mg 59 - - - - - - -
90 Karbolgliserol Tetes Telinga 2,500 - - - - - - -
91 Ketokonazol Kream 2,545 50 50 - - - 50 127,250
92 Ketokonazol Tablet 200 mg 270 - - - - - - -
93 Ketorolac inj 1,045 100 100 - - - 100 104,500
94 Kloramfenikol 250 mg 310 - - - - - - -
95 Klormfenikol 3 mg 1,810 3 3 - - - 3 5,430
96 Klormfenikol Salep Kulit 3,008 - - - - - - -
97 Kloramfenikol salep mata 1 % 1,881 - - - - - - -
98 Kloramfenicol syp - - - - - - - -
99 Kloramphenicol 500 mg 1,048 200 200 - - - 200 209,600
100 Klorfeniramin Maleat (CTM) tablet 4 mg 22 - - - - - - -
101 Kotrimoksazol Suspensi 2,052 - - - - - - -
102 Kotrimoksazol Dewasa Tablet 480 MG 125 - - - - - - -
103 Lactobacilus serbuk 14,707 - - - - - - -
104 Lidocain 2%+efinefrin injeksi 1,140 50 50 - - - 50 57,000
105 Lidocain injeksi 2 ml 1,140 50 50 - - - 50 57,000
106 Lisinopril 10 mg tablet 448 - - - - - - -
107 Lisinopril 5 mg tablet 375 - - - - - - -
108 Loperamid 2 mg tablet 85 - - - - - - -
109 Magnesium Sulfat injeksi 25 ml 3,328 - - - - - - -
110 Metampiron tablet 500 mg 305 50 50 - - - 50 15,250
111 Metformin 500 mg Tablet 100 - - - - - - -
112 Metilergometrin Injeksi 1 mg 2,840 - - - - - - -
113 Metilergometrin tablet 210 - - - - - - -
114 Metoklopramid Suspensi 2,345 - - - - - - -
115 Metronidazol 500 mg 113 - - - - - - -
116 Metronidazol Ovula 4,100 - - - - - - -
117 Metronidazol suspensi 3,799 5 5 - - - 5 18,995
118 Mikonazol kream 3,414 5 5 - - - 5 17,070
119 Multivitamin Anak ( Sanbe Kids ) 12,100 50 50 - - - 50 605,000
120 Multivitamin Dewasa Antioksidan ( Becom c ) 1,440 - - - - - - -
121 Natrium Klorida Cairan Infus ( NaCl ) 6,410 - - - - - - -
122 Natrium Diklof 115 - - - - - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
123 Nifedipine Tablet 10 mg 108 - - - - - - -
124 Obat Anti Diare Tablet (Akita / Molagit ) 450 - - - - - - -
125 Obat Antituberkulosis Kat.Anak (FDC ) 223,585 150 150 - - - 150 33,537,750
126 Obat Batuk Flu Kapsul 413 - - - - - - -
127 Obat Batuk Sirup Herbal ( Herbacop ) 12,000 - - - - - - -
128 Oksitosin injeksi 10 IU/ml - 1 ml 1,199 - - - - - - -
129 Omeprazol injeksi 16,997 90 90 - - - 90 1,529,730
130 Omeprazol Kapsul 20 mg 130 - - - - - - -
131 Ondancentron injeksi 4 mg 1,650 6 6 - - - 6 9,900
132 Ondancentron Tablet 4 mg 471 5 5 - - - 5 2,355
133 Paracetamol Drop 6,649 10 10 - - - 10 66,490
134 Paracetamol Sirup 120 mg/5 ml 1,107 300 300 - - - 300 332,100
135 Parasetamol tablet 500 mg 53 - - - - - - -
136 Permetrin Krim 5 % 12,155 - - - - - - -
137 Pirantel Tablet 125 mg 291 - - - - - - -
138 Piridoksin HCL (VIT B6) tablet 10mg 123 - - - - - - -
139 Piroksikam tablet 10 mg 234 - - - - - - -
140 Povidon lodida 10% 300 ml 17,996 - - - - - - -
141 Povidon lodida 10% 60 ml 6,550 80 80 - - - 80 524,000
142 Prednison 45 100 100 - - - 100 4,500
143 Prednison Tablet 5 mg 68 - - - - - - -
144 Primakuin 224 - - - - - - -
145 Propanolol HCL tablet 10 mg 60 - - - - - - -
146 Karbo Gliseril 2,500 10 10 - - - 10 25,000
147 Renolgliserol 2,590 - - - - - - -
148 Ranitidin injeksi 1,155 100 100 - - - 100 115,500
149 Ranitidin tablet 105 - - - - - - -
150 Resperidone 2 mg tablet 347 5 5 - - - 5 1,735
151 Ringer Laktat cairan infus 7,150 - - - - - - -
152 Salbutamol Nebulizer ( Ventolin ) 110 - - - - - - -
153 Salbutamol Tablet 2 mg 63 - - - - - - -
154 Salbutamol tablet 4mg 70 2 2 - - - 2 140
155 Salep 2-4 3,035 - - - - - - -
156 Salep Kombinasi 11,000 - - - - - - -
157 Salicil bedak 1,025 - - - - - - -
158 Serum Anti Bisa Ular Inj. 5ml 479,996 - - - - - - -
159 Serum Anti Tetanus ( TETAGAM ) 170,000 - - - - - - -
160 Setirizin Tablet 10 mg 90 - - - - - - -
161 Sianokobalamin Injeksi 1,035 100 100 - - - 100 103,500
162 Simvastatin 10 mg tablet 110 - - - - - - -
163 Simvastatin 20 mg tablet 368 10 10 - - - 10 3,680
164 Tablet Penambah Darah 352 - - - - - - -
165 Tetrasiklin 250 mg capsul 163 50 50 - - - 50 8,150
166 Tiamin B1 85 - - - - - - -
167 Triheksilfenidil Hcl 2 mg tablet 88 100 100 - - - 100 8,800
168 Vitamin B komplek 118 10 10 - - - 10 1,180
169 Zink sirup 2,972 - - - - - - -
170 Zink tablet 20 mg 514 - - - - - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
171 Berotec 0.1 Mg 80,000 - - - - - - -
172 Bisoprolol 5 Mg 263 - - - - - - -
173 Decacetin ( Kloram Tetes Mata ) 3,250 - - - - - - -
174 Methilprednisolon 4 Mg 150 - - - - - - -
175 Rivanol 2,992 - - - - - - -
176 Saraye Alsoft A 500 Ml 72,047 - - - - - - -
177 Saraye Alsoft Pure 500 Ml 64,523 - - - - - - -
178 Sukralfat Sirup 6,789 - - - - - - -
179 Sianokobalamin - - - - - - - -
180 Thiamin Tablet 50 Mg 85 - - - - - - -
181 Cat Gut 3/0 68,433 5 5 - - - 5 342,165
182 Cat Gut 2/0 52,000 - - - - - - -
183 Alat suntik 1 ml 777 - - - - - - -
184 Alat suntik 10 ml 1,067 - - - - - - -
185 Alat suntik 2,5 ml 649 30 30 - - - 30 19,470
186 Alat suntik 20 ml 2,650 30 30 - - - 30 79,500
187 Alat suntik 3 ml 825 10 10 - - - 10 8,250
188 Alat suntik 5 ml 856 - - - - - - -
189 Kasa Steril 16 x 16 cm 7,370 - - - - - - -
190 Kasa 2x80 - - - - - - - -
191 Masker Ear LOOP 364 - - - - - - -
192 Sarung Tangan no 7.0 Steril 17,748 - - - - - - -
193 Folly No 14 Catether 16,610 - - - - - - -
194 Folly No 16 Catether 12,036 5 5 - - - 5 60,180
195 I.V Cathetter No. 20 4,783 5 5 - - - 5 23,915
196 I.V Cathetter No. 22 12,232 5 5 - - - 5 61,160
197 I.V Cathetter No. 24 4,783 - - - - - - -
198 I.V Cathetter No. 26 13,464 10 10 - - - 10 134,640
199 Infuset Dewasa 4,147 - - - - - - -
200 Infuset Dewasa ( Otsuka ) 7,920 - - - - - - -
201 Jarum Insulin 2,083 2 2 - - - 2 4,166
202 Kapas Berlemak 250 gr 298,250 - - - - - - -
203 Kasa 4 m x 10 cm 1,440 3 3 - - - 3 4,320
204 Kasa Hidrofil 36 x 80 cm 9,400 5 5 - - - 5 47,000
205 Kasa Steril 16 x 16 cm 7,370 - - - - - - -
206 Masker Ear LOOP 364 - - - - - - -
207 Masker karet 740 - - - - - - -
208 Masker tali (E Care Surgical Mask Tie On) 549 1 1 - - - 1 549
209 Policlean Handrub 74,494 - - - - - - -
210 Plester 1" 8,167 2 2 - - - 2 16,334
211 Plester 2,5 cm 7,624 - - - - - - -
212 Sarung Tangan no 6,5 cosmos 8,019 5 5 - - - 5 40,095
213 Sarung Tangan no 7.0 Steril 17,748 - - - - - - -
214 Sarung Tangan Gloves 6,5 Steril 7,931 - - - - - - -
215 Sarung Tangan Gynecolog no 7 17,748 - - - - - - -
216 Sarung tangan M (Non Steril) Aximed 924 - - - - - - -
217 Sarung tangan no 6,5 Cosmo 1,018 5 5 - - - 5 5,090
218 Rifvanol 300 ml 2,992 - - - - - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
219 Underpad 4,162 - - - - - - -
220 Urine Bag 7,038 - - - - - - -
221 Kasa Kompres 40 x 40 1,800 - - - - - - -
222 Kasa Pembalut 2 m x 80 cm 9,400 - - - - - - -
223 Lysol 40,997 - - - - - - -
224 Plester Coklat 5 Cm x 5 M 23,760 - - - - - - -

1.1.7.04. Persediaan Barang Cetakan dan Penggandaan 31,428

1.1.7.04.01. Persedian Barang Cetakan 31,428
1 Karcis Retribusi Blok 194 162 162 - - - 162 31,428
2 Sisa Karcis Lembar
PERSEDIAAN SUMBER HIBAH/NON APBD

NIHI
Mengetahui,
Kepala Puskesmas Carita
Kabupaten Pandeglang L Yang diperiksa
Pembantu Pengurus Barang Pengguna
Puskesmas Carita
Tim Pemeriksa,

1 Ivan Sofiyana, Amd.Kep

NIP : 19811027 200801 1 006
Angga Iskandarwinata, S.Kep Ifa Fatoni,SKM
NIP : 19850102 200902 1 001 NIP 19830516 201001 1 007
2 Hadaningsih
NIP : 19730815 199203 2 001

3 Siti Suryatakariah
NIP : 19651028 198803 2 010
PERHITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Penjelasan Selisih

12
12
12
12
12
 12

Ivan Sofiyana, Amd.Kep

NIP : 19811027 200801 1 006

NIP : 19730815 199203 2 001

Siti Suryatakariah
NIP : 19651028 198803 2 010
Lampiran
Berita Acara Pemeriksaan Persediaan
Lokasi Persediaan : Poli-poli di Puskesmas

PERHITUNGAN PERSEDIAAN
PER 29 JUNI 2019

Harga Perhitungan Persediaan :

No Uraian Satuan Satuan
Reviu Mutasi Jumlah Nilai
(Rp) Administrasi Selisih
Fisik (+) (-) Fisik Persediaan
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)

TOTAL PERSEDIAAN APBD DAN NON APBD 46,353,488

PERSEDIAAN SUMBER APBD 9,586,394

1.1.7. Persediaan 9,586,394

1.1.7.02. Persediaan Bahan/Material 9,586,394

1.1.7.02.04. Persediaan Bahan obat-obatan 9,586,394
UGD 6,763,408
1 Albendazol Tablet 400 mg 93 - - -
2 Allopurinol tablet 100 mg 99 55 55 - 55 5,445
3 Ambroxol sirup 9,883 - - -
4 Aminofilin Tablet 200 mg 91 - - -
5 Aminofilina injeksi 24 mg/ml - 10 ml 3,345 - - -
6 Amlodipin 5 mg 143 - - -
7 Amlodipin 10 mg 93 - - -
8 Amoksisilin 500 mg tablet 233 111 111 - 111 25,863
9 Amoksisilin Forte sirup kering 250mg 3,400 - - -
10 Amoksisillin Sirup Kering 125 mg/5 ml 1,881 - - -
11 Ampisilin Injeksi 1 gr 5,368 - - -
12 Analog insulin Long Acting 425,000 - - -
13 Analog insulin Mix Acting 550,000 - - -
14 Anti Bakteri Doen 3,035 - - -
15 Antasid sirup 1,995 192 - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
16 Antasida Doen Suspensi 1,923 - - -
17 Antasida Doen Tablet 54 - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
18 Aqua Pro Injeksi 2,860 - - -
19 Artermether injeksi 1,000 - - -
20 Asam Asetil Salicilat 100 mg tablet 130 - - -
21 acetyl 358 - - -
22 Asam Askorbat tablet 50 mg 105 46 46 - 46 4,830
23 Asam Folat 55 - - -
24 Asam Fusidat Cream 5,506 - - -
25 Asam Mefenamat 500 mg 103 142 142 - 142 14,626
26 Asam Traneksamat Inj 5% 24,449 - - -
27 Asering 9,646 54 54 - 54 520,884
28 Asiklovir Cream 5% 8,800 - - -
29 Asiklovir tablet 200 mg 237 - - -
30 Asiklovir tablet 400 mg 380 - - -
31 Atropin Sulfat injeksi 0,25 mg/ml-1 ml 1,595 20 20 - 20 31,900
32 Aximed Policateter 12,036 - - -
33 Betametason krim 0,1 % 1,349 32 32 - 32 43,168
34 Bisakodil Suppositoria 5,800 - - -
35 Bisoprolol 2,5MG 650 - - -
36 Cairan Pembersih ( Protektor ) 22,000 - - -
37 Captopril Tablet 12,5 mg 62 - - -
38 Captopril Tablet 25 mg 72 - - -
39 Carbamazepin 200 mg tablet 269 - - -
40 Cefadroxil Capsul 500 mg 516 - - -
41 Cefixime Capsul 100 mg 590 - - -
42 Cefixime Sirup 7,490 - - -
43 Cefotaksime 1 gr Injeksi 4,200 - - -
44 Cetirizine sirup 5 mg/5 ml 90 4 4 - 4 360
45 Cetirizine sirup 5 mg/5 ml 2,849 - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
46 Ciprofloxcacin 500 mg tablet 265 - - -
45 Cefadroxil Capsul 500 mg 64 -
1,100 64 - - 64 70,400
47 Clozapine 25 mg Tablet 1,121 - - -
48 Demetech Silk 3/0 3,825 - - -
49 Deksametason injeksi 1 ml 1,097 26 26 - 26 28,522
50 Deksametason tablet 0,5 mg 32 - - -
51 Dextral 9,570 - - -
52 Diazepam injeksi 2 ml 17,350 1 1 - 1 17,350
53 Diazepam Rektal 0,5 mg 11,516 2 2 - 2 23,032
54 Diazepam Tablet , 5 mg - - -
55 Difenhidramin HCL injeksi 10 mg/ml - 1ml 1,176 - - -
56 Digoksin tablet 0,25 mg 105 - - -
57 Domperidon 10mg Tablet 85 171 171 - 171 14,535
58 Doksisiklin Kapsul 100 mg 268 - - -
59 Epinefrina HCL/Bitartrat Injeksi 1,408 4 4 - 4 5,632
60 Ecare Pilm 6,859 - - -
61 Erytromicin kapsul 500 mg 730 - - -
62 Etil Klorida Semprot 137,500 - - -
63 Fenitoin Kapsul 154 - - -
64 Fenobarbital injeksi 50 mg/ml - 2 ml 1,740 - - -
65 Fenobarbital Tablet 30 mg 165 - - -
66 Fenol glisrero / tts telinga 2,590 - - -
67 fitomenadion 713 - - -
68 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml 3,550 - - -
69 Flufenazine deconat inj 25 mg/ml 57,500 - - -
70 Garam Oralit 264 - - -
71 Gemfibrozil 300 mg 380 - - -
72 Gentamicin Salep Kulit 2,800 - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
73 Glibenclamid tablet 5 mg 119 - - -
74 Gentamicin Salep mata 4,232 - - -
75 Guaiafenisin tablet 100 mg 132 - - -
76 Glikazid 80 mg Tablet 235 - - -
77 Glimepiride 2 mg 288 - - -
78 Glukosa larutan infus 5 % steril 6,900 - - -
79 Gliseril Guayacolat 368 - - -
80 Griseofulvin tablet 250 mg, 1,705 - - -
81 G Care surgial 6,850 - - -
82 Griseofulvin tablet 125mg, 210 - - -
83 Griseofulvin tablet 500 mg, 2,200 - - -
84 Griseofulvin 25 mg - - -
85 Hidroklorotiazid (HCT) tab. 25 mg 149 - - -
86 Hidrokortison krim 2,5% 2,639 2 2 - 2 5,278
87 Ibuprofen tablet 200 mg 105 - - -
88 Imunomodulator sirup (STIMUNO) 23,540 - - -
89 Isosorbid Dinitrat tablet sublingual 5 mg 89 - - -
90 Kaen 3 B cairan infus 10,050 - - -
91 Kalsium Glukonas Injeksi 10,351 - - -
92 Kalsium Laktat (Kalk) tablet 500 mg 59 85 85 - 85 5,015
93 Karbolgliserol Tetes Telinga 2,500 - - -
94 Ketokonazol Kream 2,545 12 12 - 12 30,540
95 Ketokonazol Tablet 200 mg 270 - - -
96 Ketorolac inj 1,045 44 44 - 44 45,980
97 Kloramfenikol 250 mg 310 - - -
98 Klormfenikol 3 mg 1,810 - - -
99 Klormfenikol Salep Kulit 3,008 11 11 - 11 33,088
100 Kloramfenikol salep mata 1 % 1,881 440 440 - 440 827,640
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
101 Kloramfenicol syp 2,052 8 8 - 8 16,416
102 Kloramphenicol 500 mg 1,048 - - -
103 Klorfeniramin Maleat (CTM) tablet 4 mg 22 - - -
104 Kotrimoksazol Suspensi 2,052 - - -
105 Kotrimoksazol Dewasa Tablet 480 MG 125 78 78 - 78 9,750
106 Lactobacilus serbuk 14,707 - - -
107 Lidocain 2%+efinefrin injeksi 1,140 - - -
108 Lidocain injeksi 2 ml 1,140 166 166 - 166 189,240
109 Lisinopril 10 mg tablet 448 - - -
110 Lisinopril 5 mg tablet 375 - - -
111 Loperamid 2 mg tablet 85 - - -
112 Magnesium Sulfat injeksi 25 ml 3,328 - - -
113 Metampiron tablet 500 mg 305 - - -
114 Metformin 500 mg Tablet 100 - - -
115 Metilergometrin Injeksi 1 mg 2,840 - - -
116 Metilergometrin tablet 210 - - -
117 Metoklopramid Suspensi 2,345 - - -
118 Metronidazol 500 mg 113 - - -
119 Metronidazol Ovula 4,100 - - -
120 Metronidazol suspensi 3,799 - - -
121 Mikonazol kream 3,414 - - -
122 Multivitamin Anak ( Sanbe Kids ) 12,100 - - -
123 Multivitamin Dewasa Antioksidan ( Becom c ) 1,440 - - -
124 Natrium Klorida Cairan Infus ( NaCl ) 6,410 4 4 - 4 25,640
125 Natrium Diklof 115 11 11 - 11 1,265
126 Nifedipine Tablet 10 mg 108 - - -
127 Obat Anti Diare Tablet (Akita / Molagit ) 481 44 44 - 44 21,164
128 Obat Antituberkulosis Kat.Anak (FDC ) 223,585 - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
129 Obat Batuk Flu Kapsul 413 - - -
130 Obat Batuk Sirup Herbal ( Herbacop ) 12,000 - - -
131 Oksitosin injeksi 10 IU/ml - 1 ml 1,199 - - -
132 Omeprazol injeksi 16,997 - - -
133 Omeprazol Kapsul 20 mg 130 - - -
134 Ondancentron injeksi 4 mg 1,650 25 25 - 25 41,250
135 Ondancentron Tablet 4 mg 471 - - -
136 Paracetamol Drop 6,649 - - -
137 Paracetamol Sirup 120 mg/5 ml 1,107 58 58 - 58 64,206
138 Parasetamol tablet 500 mg 53 328 328 - 328 17,384
139 Permetrin Krim 5 % 12,155 - - -
140 Pirantel Tablet 125 mg 291 - - -
141 Piridoksin HCL (VIT B6) tablet 10mg 123 52 52 - 52 6,396
142 Piroksikam tablet 10 mg 234 - - -
143 Povidon lodida 10% 300 ml 17,996 - - -
144 Povidon lodida 10% 60 ml 6,550 - - -
145 Prednison 45 - - -
146 Prednison Tablet 5 mg 68 242 242 - 242 16,456
147 Primakuin 224 - - -
148 Propanolol HCL tablet 10 mg 60 - - -
149 Karbo Gliseril 2,500 - - -
150 Ranitidin injeksi 1,553 65 65 - 65 100,945
151 Ranitidin tablet 105 117 117 - 117 12,285
152 Resperidone 2 mg tablet 347 - - -
153 Ringer Laktat cairan infus 7,150 65 65 - 65 464,750
154 Salbutamol Nebulizer ( Ventolin ) 110 - - -
155 Salbutamol Tablet 2 mg 63 45 45 - 45 2,835
156 Salbutamol tablet 4mg 70 - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
157 Salep 2-4 2,621 - - -
158 Salep Kombinasi 11,000 - - -
159 Silk 3,825 - - -
160 Salicil bedak 1,025 - - -
161 Serum Anti Bisa Ular Inj. 5ml 479,996 - - -
162 Serum Anti Tetanus ( TETAGAM ) 170,000 - - -
163 Setirizin Tablet 10 mg 90 - - -
164 Sianokobalamin Injeksi 1,035 - - -
165 Simvastatin 10 mg tablet 110 - - -
166 Simvastatin 20 mg tablet 368 - - -
167 Sukralfat Sirup 6,789 20 20 - 20 135,780
168 Tablet Penambah Darah 352 - - -
169 Tetrasiklin 250 mg capsul 163 - - -
170 Tiamin B1 85 67 67 - 67 5,695
171 Triheksilfenidil Hcl 2 mg tablet 88 - - -
172 Vitamin B komplek 118 - - -
173 Vitt B 1,440 113 113 - 113 162,720
174 Zink sirup 2,972 2 2 - 2 5,944
175 Zink tablet 20 mg 514 - - -
176 Berotec 0.1 Mg 80,000 - - -
177 Bisoprolol 5 Mg 263 - - -
178 Decacetin ( Kloram Tetes Mata ) 3,250 - - -
179 Methilprednisolon 4 Mg 150 - - -
180 Rivanol 2,992 - - -
181 Saraye Alsoft A 500 Ml 72,047 - - -
182 Saraye Alsoft Pure 500 Ml 64,523 - - -
183 Sukralfat Sirup 6,789 - - -
184 Sianokobalamin - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
185 Thiamin Tablet 50 Mg 85 - - -
186 Cat Gut 3/0 44,953 22 22 - 22 988,966
187 Cat Gut 2/0 52,000 - - -
188 Alat suntik 1 ml 777 38 38 - 38 29,526
189 Alat suntik 10 ml 1,067 - - -
190 Alat suntik 2,5 ml 649 135 135 - 135 87,615
191 Alat suntik 20 ml 2,650 - - -
192 Alat suntik 3 ml 825 129 129 - 129 106,425
193 Alat suntik 5 ml 856 - - -
194 Alkhol Swab 32,600 - - -
195 Kasa Steril 16 x 16 cm 7,370 - - -
196 Kasa Hidrofil 36 x 80 cm 9,400 11 11 - 11 103,400
197 E Care 1.V dresing 6,850.00 73 73 - 73 500,050
198 Masker Ear LOOP 364 - - -
199 Sarung Tangan no 7.0 Steril 17,748 - - -
200 Folly No 14 Catether 16,610 - - -
201 Folly No 16 Catether 12,036 3 3 - 3 36,108
202 I.V Cathetter No. 20 4,783 - - -
203 I.V Cathetter No. 22 12,232 82 82 - 82 1,003,024
204 I.V Cathetter No. 24 4,783 5 5 - 5 23,915
205 I.V Cathetter No. 26 13,464 - - -
206 Infuset Anak 3,498 - - -
207 Infuset Dewasa 4,147 - - -
208 Infuset Dewasa ( Otsuka ) 7,920 70 70 - 70 554,400
209 Cathetter Jelly 41,600.00 6 6 - 6 249,600
210 Jarum Insulin 2,083 - - -
211 Kapas Berlemak 250 gr 298,250 - - -
212 Kasa 4 m x 10 cm 1,440 - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
213 Kasa Hidrofil 36 x 80 cm 9,400 - - -
214 Kasa Steril 16 x 16 cm 7,370 - - -
215 Kasa Pembalut 2 m x 80 cm 9,400 2 2 - 2 18,800
216 Masker Ear LOOP 364 - - -
217 Masker karet 740 - - -
218 Masker tali (E Care Surgical Mask Tie On) 549 - - -
219 Policlean Handrub 74,494 - - -
220 Plester 1" 8,167 - - -
221 Policik 5 x 5 cm x1 m 7,370.00 1 1 - 1 7,370
222 Plester 2,5 cm 7,624
223 Sarung Tangan no 6,5 cosmos 8,019
224 Sarung Tangan no 7.0 Steril 17,748
225 Sarung Tangan Gloves 6,5 Steril 7,931
226 Sarung Tangan Gynecolog no 7 17,748
227 Sarung tangan M (Non Steril) Aximed 924
228 Sarung tangan no 6,5 Cosmo 1,018
229 Rifvanol 300 ml 2,992 - - -
230 Underpad 4,162 - - -
229 Urine Bag 7,038 - - -
229 Kasa Kompres 40 x 40 1,800 - - -
229 Kasa Pembalut 2 m x 80 cm 9,400 - - -
229 Lysol 40,997 - - -
229 Plester Coklat 5 Cm x 5 M 23,760
Apotik
2,822,986
1 Albendazol Tablet 400 mg - -
390 - - - -
2 Allopurinol tablet 100 mg 95 -
99 95 - - 95 9,405
3 Ambroxol sirup - -
9,883 - - - -
4 Aminofilin Tablet 200 mg - -
91 - - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
5 Aminofilina injeksi 24 mg/ml - 10 ml - -
3,345 - - - -
6 Amlodipin 5 mg 179 -
70 179 - - 179 12,530
7 Amlodipin 10 mg 189 -
93 189 - - 189 17,577
8 Amoksisilin 500 mg tablet 207 -
233 207 - - 207 48,231
9 Amoksisilin Forte sirup kering 250mg - -
3,400 - - - -
10 Amoksisillin Sirup Kering 125 mg/5 ml - -
1,881 - - - -
11 Ampisilin Injeksi 1 gr - -
5,368 - - - -
12 Analog insulin Long Acting - -
425,000 - - - -
13 Analog insulin Mix Acting - -
550,000 - - - -
14 Anti Bakteri Doen - -
3,035 - - - -
15 Antasid sirup 94 -
1,995 94 - - 94 187,530
16 Antasida Doen Suspensi - -
1,923 - - - -
17 Antasida Doen Tablet 1,014 -
54 1,014 - - 1,014 54,756
18 Aqua Pro Injeksi - -
2,860 - - - -
19 Artermether injeksi - -
1,000 - - - -
20 Asam Asetil Salicilat 100 mg tablet - -
130 - - - -
21 Antimigrain - -
- - - -
22 acetyl 1,014 -
358 1,014 - - 1,014 363,012
23 Asam Askorbat tablet 50 mg 82 -
105 82 - - 82 8,610
24 Asam Folat 85 -
52 85 - - 85 4,420
25 Asam Fusidat Cream - -
5,506 - - - -
26 Asam Mefenamat 500 mg 438 -
103 438 - - 438 45,114
27 Asam Traneksamat Inj 5% - -
24,449 - - - -
28 Asering - -
9,646 - - - -
29 Asiklovir Cream 5% - -
8,800 - - - -
30 Asiklovir tablet 200 mg - -
237 - - - -
31 Asiklovir tablet 400 mg - -
380 - - - -
32 Atropin Sulfat injeksi 0,25 mg/ml-1 ml - -
1,595 - - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
33 Aximed Policateter - -
12,036 - - - -
34 Betametason krim 0,1 % 8 -
1,349 8 - - 8 10,792
35 Bisakodil Suppositoria - -
5,800 - - - -
36 B Comlek - -
118 - - - -
37 Bisakodil Suppositoria - -
5,800 - - - -
38 Bisoprol 5 mg 84 -
236 84 - - 84 19,824
39 Bisoprolol 2,5MG - -
263 - - - -
40 Cairan Pembersih ( Protektor ) - -
22,000 - - - -
41 Clofeniramin Maleat - -
3,414 - - - -
42 Captopril Tablet 12,5 mg - -
62 - - - -
43 Captopril Tablet 25 mg - -
72 - - - -
44 Carbamazepin 200 mg tablet - -
269 - - - -
45 Cefadroxil Capsul 500 mg - -
1,100 - - - -
46 Cefixime Capsul 100 mg - -
590 - - - -
47 Cefixime Sirup - -
7,490 - - - -
48 Cefotaksime 1 gr Injeksi - -
4,200 - - - -
49 Cetirizine sirup 10 mg 209 -
90 209 - - 209 18,810
50 Cetirizine sirup 5 mg/5 ml - -
2,849 - - - -
51 Ciprofloxcacin 500 mg tablet 8 -
265 8 - - 8 2,120
52 Clozapine 25 mg Tablet - -
1,121 - - - -
53 Demetech Silk 3/0 - -
3,825 - - - -
54 Deksametason injeksi 1 ml - -
1,097 - - - -
55 Deksametason tablet 0,5 mg - -
32 - - - -
56 Dextral - -
9,570 - - - -
57 Diazepam injeksi 2 ml - -
17,350 - - - -
58 Diazepam Rektal 0,5 mg - -
11,516 - - - -
59 Diazepam Tablet , 5 mg - -
- - - -
60 Difenhidramin HCL injeksi 10 mg/ml - 1ml - -
1,176 - - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
61 Digoksin tablet 0,25 mg 81 -
105 81 - - 81 8,505
62 Domperidon 10mg Tablet 64 -
85 64 - - 64 5,440
63 Domperidon Sirup 154 -
154 - - 154 -
64 Doksisiklin Kapsul 100 mg - -
268 - - - -
65 Epinefrina HCL/Bitartrat Injeksi - -
1,408 - - - -
66 Ecare Pilm - -
6,859 - - - -
67 Erytromicin kapsul 500 mg 37 -
730 37 - - 37 27,010
68 Eriseopulpin 125 mg - -
210 - - - -
69 Etil Klorida Semprot - -
137,500 - - - -
70 Fenitoin Kapsul - -
154 - - - -
71 Fenobarbital injeksi 50 mg/ml - 2 ml - -
1,740 - - - -
72 Fenobarbital Tablet 30 mg - -
165 - - - -
73 Fenol glisrero / tts telinga 2 -
2,590 2 - - 2 5,180
74 fitomenadion 84 -
710 84 - - 84 59,640
75 Furosemid 40 mg 112 -
112 - - 112 -
76 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml - -
3,550 - - - -
77 Flufenazine deconat inj 25 mg/ml - -
57,500 - - - -
78 Garam Oralit 35 -
264 35 - - 35 9,240
79 Gemfibrozil 300 mg - -
380 - - - -
80 Gentamicin Salep Kulit - -
2,800 - - - -
81 Glibenclamid tablet 5 mg 199 -
119 199 - - 199 23,681
82 Gentamicin Salep mata 12 -
4,232 12 - - 12 50,784
83 Guaiafenisin tablet 100 mg - -
132 - - - -
84 Glikazid 80 mg Tablet - -
235 - - - -
85 Glioenlilamid - -
178 - - - -
86 Glimepiride 2 mg 175 -
207 175 - - 175 36,225
87 Glukosa larutan infus 5 % steril - -
6,900 - - - -
88 Gliseril Guayacolat - -
103 - - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
89 Griseofulvin tablet 250 mg, - -
1,705 - - - -
90 G Care surgial - -
6,850 - - - -
91 Griseofulvin tablet 125mg, - -
210 - - - -
92 Griseofulvin tablet 500 mg, 59 -
2,200 59 - - 59 129,800
93 Griseofulvin 25 mg - -
- - - -
94 Hidroklorotiazid (HCT) tab. 25 mg - -
149 - - - -
95 Hidrokortison krim 2,5% 18 -
38 18 - - 18 684
96 Ibuprofen tablet 200 mg - -
105 - - - -
97 Imunomodulator sirup (STIMUNO) - -
23,540 - - - -
98 Isosorbid Dinitrat tablet sublingual 5 mg 97 -
89 97 - - 97 8,633
99 Kaen 3 B cairan infus - -
10,050 - - - -
100 Karbogliserin T telinga - -
2,500 - - - -
101 Kalsium Glukonas Injeksi - -
10,351 - - - -
102 Kalsium Laktat (Kalk) tablet 500 mg 356 -
59 356 - - 356 21,004
103 Karbolgliserol Tetes Telinga - -
2,500 - - - -
104 Ketokonazol Kream 16 -
2,545 16 - - 16 40,720
105 Ketokonazol Tablet 200 mg - -
270 - - - -
106 Ketorolac inj - -
1,045 - - - -
107 Kloramfenikol 250 mg - -
310 - - - -
108 Klormfenikol 3 mg - -
1,810 - - - -
109 Klormfenikol Salep Kulit - -
3,008 - - - -
110 Kloramfenikol salep mata 1 % - -
3,008 - - - -
111 Kloramfenicol syp - -
- - - -
112 Kloramphenicol 500 mg - -
1,048 - - - -
113 Klorfeniramin Maleat (CTM) tablet 4 mg 566 -
22 566 - - 566 12,452
114 Kotrimoksazol Suspensi 10 -
2,052 10 - - 10 20,520
115 Kotri sirup - -
2,286 - - - -
116 Kotrimoksazol Dewasa Tablet 480 MG 116 -
125 116 - - 116 14,500
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
117 Lactobacilus serbuk - -
14,707 - - - -
118 Lidocain 2%+efinefrin injeksi - -
1,140 - - - -
119 Lidocain injeksi 2 ml - -
1,140 - - - -
120 Lisinopril 10 mg tablet - -
448 - - - -
121 Lisinopril 5 mg tablet - -
375 - - - -
122 Loperamid 2 mg tablet - -
85 - - - -
123 Magnesium Sulfat injeksi 25 ml - -
3,328 - - - -
124 Metampiron tablet 500 mg - -
305 - - - -
125 Metformin 500 mg Tablet 605 -
96 605 - - 605 58,080
126 Metilergometrin Injeksi 1 mg - -
2,840 - - - -
127 Metilergometrin tablet - -
210 - - - -
128 Metoklopramid Suspensi - -
2,345 - - - -
129 Mehylirednisolon 30 -
30 - - 30 -
130 Metaminazol teb - -
473 - - - -
131 Metronidazol 500 mg - -
204 - - - -
132 Metronidazol Ovula - -
4,100 - - - -
133 Metronidazol suspensi - -
3,799 - - - -
134 Mikonazol kream - -
3,414 - - - -
135 Multivitamin Anak ( Sanbe Kids ) - -
12,100 - - - -
136 Multivitamin Dewasa Antioksidan ( Becom c ) - -
1,414 - - - -
137 Natrium Klorida Cairan Infus ( NaCl ) - -
6,410 - - - -
138 Natrium Diklof 171 -
115 171 - - 171 19,665
139 Nifedipine Tablet 10 mg - -
108 - - - -
140 Obat Anti Diare Tablet (Akita / Molagit ) 182 -
120 182 - - 182 21,840
141 Obat Antituberkulosis Kat.Anak (FDC ) - -
223,585 - - - -
142 Obat Batuk Flu Kapsul - -
413 - - - -
143 Obat Batuk Sirup Herbal ( Herbacop ) - -
12,000 - - - -
144 Oksitosin injeksi 10 IU/ml - 1 ml - -
1,199 - - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
145 Omeprazol injeksi - -
16,997 - - - -
146 Omeprazol Kapsul 20 mg 66 -
130 66 - - 66 8,580
147 Ondancentron injeksi 4 mg - -
1,650 - - - -
148 Ondancentron Tablet 4 mg 65 -
471 65 - - 65 30,615
149 Paracetamol Drop 47 -
6,649 47 - - 47 312,503
150 Paracetamol Sirup 120 mg/5 ml 46 -
1,107 46 - - 46 50,922
151 Parasetamol tablet 500 mg 1,035 -
53 1,035 - - 1,035 54,855
152 Permetrin Krim 5 % 3 -
12,155 3 - - 3 36,465
153 Pirantel Tablet 125 mg - -
291 - - - -
154 Piridoksin HCL (VIT B6) tablet 10mg 236 -
123 236 - - 236 29,028
155 Piroksikam tablet 10 mg - -
234 - - - -
156 Povidon lodida 10% 300 ml - -
17,996 - - - -
157 Povidon lodida 10% 60 ml - -
6,550 - - - -
158 Prednison - -
45 - - - -
159 Prednison Tablet 5 mg 912 -
68 912 - - 912 62,016
160 Pirantel sirup - -
9,700 - - - -
161 Primakuin - -
224 - - - -
162 Propanolol HCL tablet 10 mg - -
60 - - - -
163 Karbo Gliseril - -
2,500 - - - -
164 Ranitidin injeksi - -
1,155 - - - -
165 Ranitidin tablet 368 -
105 368 - - 368 38,640
166 Resperidone 2 mg tablet - -
347 - - - -
167 Ristatin vaginal 49 -
49 - - 49 -
168 Ringer Laktat cairan infus - -
7,150 - - - -
169 Salbutamol Nebulizer ( Ventolin ) - -
110 - - - -
170 Salbutamol Tablet 2 mg 108 -
63 108 - - 108 6,804
171 Salbutamol tablet 4mg - -
70 - - - -
172 Salep 2-4 - -
2,621 - - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
173 Salep Kombinasi - -
11,000 - - - -
174 Silk - -
3,825 - - - -
175 Salicil bedak - -
1,025 - - - -
176 Serum Anti Bisa Ular Inj. 5ml - -
479,996 - - - -
177 Serum Anti Tetanus ( TETAGAM ) - -
170,000 - - - -
178 Sukralfat Sirup 59 -
6,789 59 - - 59 400,551
179 Setirizin Tablet 10 mg - -
90 - - - -
180 Sianokobalamin Injeksi - -
1,035 - - - -
181 Simvastatin 10 mg tablet 294 -
110 294 - - 294 32,340
182 Simvastatin 20 mg tablet - -
368 - - - -
183 Tablet Penambah Darah - -
352 - - - -
184 Tetrasiklin 250 mg capsul - -
163 - - - -
185 Tiamin B1 759 -
85 759 - - 759 64,515
186 Triheksilfenidil Hcl 2 mg tablet - -
88 - - - -
187 Vitamin B komplek 561 -
118 561 - - 561 66,198
188 Vitamein C - -
105 - - - -
189 Vitamin B komplek - -
118 - - - -
190 Zink sirup 85 -
2,972 85 - - 85 252,620
191 Zink tablet 20 mg - -
514 - - - -
192 Berotec 0.1 Mg - -
80,000 - - - -
193 Bisoprolol 5 Mg - -
263 - - - -
194 Decacetin ( Kloram Tetes Mata ) - -
3,250 - - - -
195 Methilprednisolon 4 Mg - -
150 - - - -
196 Rivanol - -
2,992 - - - -
197 Saraye Alsoft A 500 Ml - -
72,047 - - - -
198 Saraye Alsoft Pure 500 Ml - -
64,523 - - - -
199 Sukralfat Sirup - -
6,789 - - - -
200 Sianokobalamin - -
- - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
201 Thiamin Tablet 50 Mg - -
85 - - - -
202 -

Persediaan Alat Tulis Kantor -

1 Kertas F4 46,000 -
- - - -
2 Kertas A4 40,000 - - -
- - - -
3 Buku Folio Besar 200,000 - - -
- - - -
4 Buku Folio Kecil 25,000 - - -
- - - -
5 Odner 25,000 -
- - - -
6 Map Snel Hecter 30,000 -
- - - -
7 Map Kertas 20,000 -
- - - -
8 Amplop Besar 16,000 - - -
- - - -
9 Amplop Kecil 10,000 - - -
- - - -
10 AmplopCoklat Tali 137,000 - - -
- - - -
11 Catridge Epson 250,000 - - -
- - - -
12 Tinta Isi Ulang Epson 100,000 - - -
- - - -
13 Balpoin 70,000 - - -
- - - -
14 Spidol 96,000 - - -
- - - -
15 Penggaris Butterfly 30cm Plastik 3,000 - - -
- - - -
16 Penggaris Besi Joyko 30cm 10,000 - - -
- - - -
17 Tipek 6,000 - - -
- - - -
18 Nota 6,000 -
- - - -
19 Kwitansi 10,000 - - -
- - - -
20 Stabilo 3,000 -
- - - -
21 Staples 10,000 - - -
- - - -
22 Isi steples 14,000 - - -
- - - -
23 Paper Klip Kecil 16,000 -
- - - -
24 Paper Klip Besar 32,000 - - -
- - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
25 Lakban Bening 12,000 - - -
- - - -
26 Label Kertas 6,000 -
- - - -
27 Lem Fox 11,000 -
- - - -

1.1.7.04. Persediaan Barang Cetakan dan Penggandaan -

1.1.7.04.01. Persedian Barang Cetakan -
1 Karcis Retribusi Blok 19,383 -
- - - -
2 Sisa Karcis Lembar 194 -
- - - -

Persediaan Barang alat listrik dan elektronik -

1 Lampu Tornado 24 watt 72,000 - - -

- - - -
2 Lampu Tornado 15 Watt 54,000 - - -
- - - -
3 Lampu Neon 11 Watt 60,000 - - -
- - - -
4 Kabel Listrik 8,000 -
- - - -
Persediaan Barang Materai dan Perangko -

1 Materai 6000 -
6,000.00 - - - -
2 Materai 3000 -
3,000.00 - - - -
Persediaan Barang Alat peralatan kebersihan dan pembersih -

1 Sabun Cuci Cair (tangan) 10,500 - - -

- - - -
2 Sabun Cuci Cair (piring) 10,000 - - -
- - - -
3 Sapu Lantai 16,000 - - -
- - - -
4 Tempat Sampah 20 Ltr 70,000 - - -
- - - -
5 Kemoceng 14,500 - - -
- - - -
6 Wipol 1000 ml 21,000 - - -
- - - -
7 Kamper 10,000 - - -
- - - -
8 Alat Pel 34,000 - - -
- - - -
Persedian Barang Cetakan -

1 Buku KIA -
- - - -
2 Buku Kas Umum -
- - - -
1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)
3 Buku Raportku -
- - - -
4 Kartu Penerus Disposisi -
- - - -
5 Poster Kesehatan Lingkungan -
- - - -
6 Poster Penyakit Tidak Menular -
- - - -
7 Poster Asi Eksklusif -
- - - -
8 Poster Kesehatan Ibu dan Anak -
- - - -
 1 2 3 4 5 6 7 = (5-6) 8 9 10 (6-8+9) 11 (5 x 10)

PERSEDIAAN SUMBER NON APBD (HIBAH) 27,180,700

1.1.7. Persediaan 27,180,700

1.1.7.02. Persediaan Bahan/Material 27,180,700

1.1.7.02.04. Persediaan Bahan obat-obatan 27,180,700
Program Vaksin
27,180,700
56,360 -
1 Vaksin BCG 32 32
- - 32 1,803,520
16,412 -
2 Vaksin DT 121 121
- - 121 1,985,852
21,810 -
3 Vaksin HB 0 26 26
- - 26 567,060
76,285 -
4 Vaksin Pentabio ( DPT - HB - Hib ) 164 164
- - 164 12,510,740
19,954 -
5 Vaksin Polio b OPV 32 32
- - 32 638,528
144,540 -
6 Vaksin Polio IPV 25 25
- - 25 3,613,500
15,450 -
7 Vaksin TD 21 21
- - 21 324,450
141,648 -
8 Vaksin Measless Rubella 34 34
- - 34 4,816,032
21,929 -
9 Safety Box 42 42
- - 42 921,018

Mengetahui,
Kepala Puskesmas…. Pengurus Barang Tim Pemeriksa,
Kabupaten Pandeglang Puskesmas….

1 Ivan Sofiyana, Am
NIP : 19811027 2008
Angga Iskandarwinata, S.Kep Ifa Fatoni,SKM
NIP : 19850102 200902 1 001 NIP 19830516 201001 1 007
2 Hadaningsih
NIP : 19730815 1992

3 Siti Suryatakariah
NIP : 19651028 1988
TUNGAN PERSEDIAAN
ER 29 JUNI 2019

Penjelasan Selisih

12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
 12

Ivan Sofiyana, Amd.Kep

NIP : 19811027 200801 1 006

NIP : 19730815 199203 2 001

Siti Suryatakariah
NIP : 19651028 198803 2 010