Laporan Lplpo Terbaru 2016

PEMERINTAH KABUPATEN BOMBANA
DINAS KESEHATAN DAN KELUARGA BERENCANA

UPTD INSTALASI FARMASI
Jln.Mesjid Raya No.7 RUMBIA
Website:www.bombanakab.go.id, email : dinkesbombana@yahoo.com
JUDUL LAPORAN
LANJUTAN JUDUL KALAU ADA LAGI
NO NAMA OBAT SATUAN HARGA SATUAN JUDUL JUDUL JUDUL JUMLAH KETERANGAN
(a) (b) (c) (d) (e) (f) (g) (h) (i)

A.OBAT-OBATAN
1 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul 6,050

2 Albendazol tab 400 mg Tab 363
3 Alopurinol tab 100 mg Tab 90
4 Alprazolam tab 1 mg Tab 245
5 Albothyl cairan Botol 18,635
6 Ambroksol tablet 30 mg Tab 138
7 Ambroksol sirup Botol 2,722
8 Aminofilin inj 24 mg/ml Ampul 420,400
9 Aminofilin tab 200 mg Tab 86
10 Amitriptilin tab sal 25 mg Tab sal 123
11 Amlodipin tab 10 mg Tab 352
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560
14 Amoksisilin tab 250 mg Tab 220
Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : 80.000 Ampul 1,499
inj 2 ml
16
Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Tab kunyah
hidroksida 200 mg 78
17
Antasida, kombinasi : aluminium hidroksida 200 mg + magnesium Botol
hidroksida 200 mg Suspensi 2,213
18
Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin B 10.000 UI/g Tube
2,767
19
Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat 3% Tube
2,096
20
Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen 2,5 Suppo
mg + lidokain lidokain 10 mg+ seng oksida 120 mg + sup ad 2 g 33,000
21
Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps 1,650

22
23 Anti Migren, kombinasi : ergotamin 1 mg+ kafein 50 mg Tab 149
24 Antalgin (metampirom) tablet 500 mg Tab 155
25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul 1,346
26 Asam asetilsalisilat (asetosal) tab 100 mg Tab 110
28 Asam asetilsalisilat (asetosal) tab 80 mg (Miniaspi 80) Tab 163
29 Asam askorbat (vitamin C) tab 50 mg Tab 105
30 Asam folat tab 1 mg Tab 52
31 Asam mefenamat kaps 250 mg Kaps
32 Asam mefenamat kaps 500 mg Kaps 127
33 Asam traneksamat inj 50 mg/ml Ampul 3,650
34 Asam traneksamat tab 500 mg Tab 1,265
35 Asering larutan infus Botol 9,000
36 Asiklovir salep kulit Tube 2,367
37 Asiklovir tab 200 mg Tab 251
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,400
39 Atropin tab 0,5 mg Tab 81
40 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol 13,500
41 Bedak salisil serb 2% Botol 1,180
Besi (II) sulfat 200 mg + asam folat 0.25 mg (tablet tambah darah) Sachet 2,200
42
43 Becefort syrup Botol 22,727
44 Betametason krim 0,1% Tube 1,596
45 Betahistin mesilate tablet tablet
46 Bisakodil sup 10 mg (Stolax) Botol 6,045
47 Bisakodil tab sal 5 mg Tab sal
48 Bismecon salep tube
49 Budesonid-formoterol (fixed combination)* ih 80/4,5 mcg Botol 110,500
50 Bromheksin tablet tablet
51 Deksametason tab 0,5 mg Tab 68
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,738
53 Desoksimetason salep 0,25% Tube 9,983
54 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 2,578
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol 18,461
56 Diazepam supposutoria suppo
57 Diazepam tab 2 mg Tab 28
59 Dietilkarbamazin tab 100 mg Tab 104
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160
61 Digoksin tab 0,25 mg Tab 103
62 Diltiazem kaps SR 100 mg Kaps 4,033
63 Diltiazem tab 30 mg Tab 141
64 Doksisiklin tablet 100 mg Tab 278
65 Domperidon susp 5 mg/5 ml Botol 3,490
66 Domperidon tab 10 mg Tab 174
67 Efedrin HCl tablet Tab 56
68 Ekstrak belladon tablet 10 mg tab 42
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 8,910
70 Eritromisin kaps 250 mg Kaps 522
71 Eritromisin sir 200 mg/5 ml Botol 8,090
72 Eritromisin tab 500 mg Tab 1,023
73 Etanol 70% cairan 70% Botol 2,625
74 Etakridin (rivanol) larutan 0.1% Botol 4,695
75 Etil klorida semprot 100 ml Botol 105,000
76 Famotidin tablet 20 mg Tab 124
77 Fenitoin Na inj 50 mg/ml Ampul 20,857
78 Fenitoin Na kaps 100 mg Kaps 146
79 Fenobarbital inj 50 mg/ml Ampul 1,980
80 Fenobarbital tab 100 mg Tab 1,075
81 Fenobarbital tab 30 mg Tab 37
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 1,723
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 698
84 Flukonazol kaps 150 mg Kaps 24,200
85 Flusinolon asetonid krim 0,025% Tube 2,700
86 Flunarizin tablet tablet
87 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 2,012
88 Furosemid tab 40 mg Tab 84
Garam oralit kombinasi : natrium klorida 0,52 g + kalium klorida 0,30 g Sachet
+ trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g 317
89
90 Gameksan lotion 1 % Botol 2,420
91 Gemfibrozil kaps 300 mg Kaps 318
93 Gentamisin inj 10 mg/ml Ampul 3,739
94 Gentamisin salep mata 0,3% Tube 2,340
95 Gentamisin salep Kulit Tube
96 Gentamisin tts mata 0,3% Botol 3,513
97 Glibenklamid tab 5 mg Tab 61
98 Glimepirid tab 4 mg Tab 452
99 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab 3,000
100 Gliseril Guaiakolat tab 100 mg Tab 31
101 Gliserin lar 50% Botol 5,867
102 Glukosamin tablet 500 mg Tab 660
103 Glukosa Larutan Infus 5% steril Botol 5,720
106 Griseofulvin (micronized) tab 125 mg Tab 230
107 Haloperidol tab 0,5 mg Tab 62
109 Haloperidol tab 5 mg Tab 105
110 Hidrogen peroksida (H2O2) cairan 3% Botol 38,500
111 Hidroklorotiazid (HCT) tab 25 mg Tab 40
112 Hidrokortison krim 2,5% Tube 3,200
113 Hiosina butilbromida tab 10 mg Tab
114 Ibuprofen susp 100 mg/5 ml Botol 3,849
115 Ibuprofen tab 200 mg Tab 127
Ipratropium bromida nebulizer 0,025% (Atroven sol. for inhalation Botol 90,000
0.025%)
117
118 Isoniazid tab 300 mg Tab 174
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 36,960
120 Isosorbid dinitrat tab 5 mg Tab 98
121 KA-EN 3B Cairan Infus Botol 10,000
122 Kalsium glukonat inj 100 mg/ml Ampul 7,800
123 Kalsium laktat (kalk) tab 500 mg Tab 51
124 Kaptopril tab 12,5 mg Tab 69
125 Kaptopril tab 25 mg Tab 97
126 Karbamazepin tab 200 mg Tab 269
127 Karbo adsorben (Norit) tab 500 mg Tab
128 Ketamin inj 50 mg/ml (i.v.) Ampul 110,000
129 Ketokonazol tab 200 mg Tab 320
130 Ketokonazol krim 2% Tube 5,150
131 Ketorolak inj 10 mg/ml Ampul 2,665
132 Klaritromisin tab 500 mg Tab 3,600
133 Klindamisin kaps 150 mg Kaps 405
134 Kloramfenikol tts mata 0,5% Botol 1,680
135 Kloramfenikol kaps 250 mg Kaps 275
136 Kloramfenikol salep mata 1% Tube 1,680
137 Kloramfenikol susp 125 mg/5 ml Botol 4,016
138 Klorfeniramin (CTM) tab 4 mg Tab 26
139 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,210
140 Klorpromazin tab sal 100 mg Tab sal 152
142 Kombinasi : Pirimethamin 25 mg + sulfadoksin Tab 531
Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules Vial 5,990
(Combivent UDV)
143
Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ Tab
trimetoprim 80 mg 152
144
Kotrimoksazol (anak) kombinasi : sulfametoksazol 100 mg+ Tab
trimetoprim 20 mg 79
145
Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi : Botol
sulfametoksazol 200 mg + trimetoprim 40 mg 2,298
146
147 Kuinin inj 25% (i.v.) Vial 6,820
148 Kloroquin tab 250 mg Tab 116
149 Lansoprazol kaps 30 mg Kaps 521
150 Levofloksasin tab 500 mg Tab 581
151 Lidokain gel 2% Tube 40,000
152 Lidokain inj 2% (hcl) Vial 929
153 Lisol Botol 54,995
154 Loperamid tab 2 mg Tab 97
155 Loratadin tab 10 mg Tab 170
156 Magnesium sulfat inj 20% Vial 7,260
158 Magnesium sulfat serb, ktg 30 g Sachet 1,130
159 Mebendazol sir 50 mg/ml Botol 3,887
160 Mebendazol tab 100 mg Tan 248
161 Metformin tab 500 mg Tab 125
163 Metilergometrin inj 0,2 mg/ml Ampul 1,639
164 Metilergometrin tab salut 0,125 mg Tab sal 169
165 Metilprednisolon tab 4 mg Tab 230
166 Metoklopramid inj 5 mg/ml Vial
167 Metoklopramid sir 5 mg/5 ml (Lexapram sirup) Botol 2,900
168 Metoklopramid tab 10 mg Tab 100
169 Metronidazol supposutoria 500 mg suppo 3,655
170 Metronidazol larutan infus Botol 12,980
171 Metronidazol tab 250 mg Tab 116
173 Mikonazol krim 2% Tube 3,150
174 Natrium diklofenak tab 25 mg Tab 146
176 NaCl 0,9% Larutan infus Botol 5,170
177 Nifedipin kaps 10 mg Kaps 127
178 Nistatin tab salut 500.000 UI Tab 704
179 Nistatin tab vaginal 100.000 UI Tab 448
180 Obat Batuk Hitam (OBH) Botol 2,310
181 Ofloksasin tab 200 mg Tab 440
183 Oksitetrasiklin hcl inj 500 mg/ml Vial 3,410
184 Oksitetrasiklin hcl salep kulit 3% Tube 1,646
185 Oksitetrasiklin hcl salep mata 1 % Tube 2,772
186 Oksitosin inj 10 UI/ml Ampul 6,875
187 Omeprazol kaps 20 mg Kaps 221
188 Papaverin tablet 40 mg Tab 109
189 Parasetamol sir 120 mg/5 ml Botol 1,535
190 Parasetamol tab 100 mg Tab 105
192 Parasetamol rectal suppo
193 Pehavral tablet multivitamin Tab 297
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25,350
195 Phenylbutazon tablet 200 mg Tab 107
196 Piracetam tablet 800 mg Tab 963,60
197 Piracetam tablet 1200 mg Tab 854
198 Piracetam injeksi 1 g/5 ml Ampul 6,050
199 Pirantel pamoat susp 125 mg/5 ml Botol 9,100
200 Pirantel pamoat tab scored 125 mg Tab 318
201 Piridoksin (vitamin B6) tab 25 mg Tab 19
202 Piroksikam tablet 20 mg Tab 116
203 Polikresulen Botol 18,635
204 Povidon iodin lar 100 mg/ml Botol 30 ml 2,344
207 Prednison tab 5 mg Tab 98
208 Primakuin tab 15 mg Tab 125
209 Procurma syrup Botol 12,021
210 Propiltiourasil tab 100 mg Tab 297
211 Propranolol tab 40 mg Tab 114
212 Ranitidin inj 25 mg/ml Ampul 1,340
213 Ranitidin tab 150 mg Tab 128
214 Reserpin tablet 0.25 mg Tab 968
215 Rifampisin kaps 300 mg Kaps 440
216 Rifampisin tab 450 mg Tab 624
218 Ringer Laktat Larutan infus Botol 5,720
219 Salbutamol tab 2 mg Tab 92
221 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % Tube 1,980
222 Scabicid salep Tube
223 Sefadroksil kaps 250 mg Vial 564
224 Sefadroksil kaps/tab 500 mg Tab 548
225 Sefadroksil sir kering 125 mg/5 ml Botol 6,285
226 Sefiksim kapsul 100 mg Tab 1,000
227 Sefotaksim serb inj 1.000 mg/vial Vial 3,500
228 Seftriakson serb inj 1.000 mg/vial Vial 3,900
229 Setirizin tab 10 mg Tab 190
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial 1,451
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15
232 Simetidin tablet 200 mg Tab 138
233 Simvastatin tab sal 10 mg Tab sal 117
235 Siprofloksasin inf 2 mg/ml Botol 22,000
236 Siprofloksasin tab scored 500 mg Tab 290
237 Spironolakton tab 100 mg Tab 1,000
238 Sulfasetamid Natrium Tetes mata 1.5% Botol 3,549
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol 14,450
240 Sukralfat tab 500 mg (Ulsidex) Tab 477
241 Teofilin tab SR 300 mg (Rethapyl) Tab 1,155
242 Tetrasiklin kaps 250 mg Kaps 162
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab
246 Tramadol inj 50 mg/ml Ampul 2,680
247 Tramadol tablet 500 mg Tab 363
248 Triheksifenidil tab 2 mg Tab 45
249 Vitamin B12 tablet 50 mcg Tab 15
250 Vitamin B kompleks injeksi Vial 7,392
251 Vitamin B kompleks Tab 112
252 Zinc tab disp 20 mg Tab 521
253 Zinc sirup 20 mg / 5 ml Botol 8,140
JUMLAH OBAT-OBATAN (A)
B.OBAT GIGI
1 Bonding Botol 765,000
2 Calcium hidrosida cement pasta (hycal) Kotak 242,000
3 Comfosite Tube 338,800
4 Devitalisasi Pasta (Non Arsen) Kotak 390
5 Eugenol cair Botol 18,333
6 Etil Klorida spray Botol 105,000
7 Etza Tube 170,000
8 Glass Ionomer Cement ART Set 197,895
9 Klorfenol Kamfer Menthol (CHKM) Botol 55
10 Semen Seng Fosfat serbuk dan cairan Set 93,500
11 Temporari stoping pletcher Set 34,000
12 Mummiyng pasta Kotak 176
JUMLAH OBAT GIGI (B)
C.OBAT PROGRAM
1 Albedazole 400mg Tab 363
2 Artemether inj 80 mg/ml Ampul
3 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 27,569
5 Imersion oil Botol 825,000
6 Iodina Test Botol 4,545
7 Obat Anti Tuberculosis FDC Kategori Anak Paket 236,490
8 Obat Anti Tuberculosis FDC Kategori I Paket 396,000
9 Obat Anti Tuberculosis FDC Kategori II Paket 1,319,990
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 175,990
11 Reagen Zenit Nelson Botol 145,000
12 RDT Dangue DBD Set 150,000
13 RDT malaria (care star ) Set 168,300
14 RDT HIV (intec) Set 46,200
15 RDT HIV (vikia) Set 45,560
16 RDT HIV (Oncoprobe) Set 42,350
17 Taburia Kotak 20,454
18 Quinina injeksi Ampul
19 Vaksin BCG inj (i.k) Vial
20 Vaksin campak inj (s.k.) Vial
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial
22 Vaksin jerap difteri tetanus (DT) Vial
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial
24 Vaksin polio drops 10 dosis Vial 285,000
25 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster Vial 78,000
JUMLAH OBAT PROGRAM (C)
D.BAHAN MEDIS HABIS PAKAI (BHMP)
1 Alat suntik sekali pakai 1 ml Set 990
2 Alat suntik sekali pakai 2,5 ml Set 650
5 Bisturi no. 20 Buah 2,099
7 Catgut No 2/0 Set 6,400
9 Handscoen no. 6 Pasang 6,595
10 Handscoen no. 6,5 Pasang 6,595
13 Infuset dewasa Set 3,500
14 Infusion set anak Set 4,000
15 IV Catheter No.16 G Set 7,018
17 IV Catheter No. 20 G Set 7,018
19 Folley Catheter 16 Set 8,000
20 Folley catheter 22 Set 8,000
22 Kapas Berlemak 250 gram Rol 7,500
24 Kasa Pembalut 4m x 3 cm Rol 800
28 Kasa Kompres 40/40 steril Buah 1,800
29 Kasa Steril 16 X 16 Buah 7,900
30 Kasa pembalut 2 x 80 Rol 7,600
31 Kasa Pembalut 40 x 80 Rol 104,500
32 Kasa Pembalut 36 x 80 cm Rol 55,200
33 Pembalut Gips Buah 32,500
34 Plester 5 yard x 2 inc Rol 23,625
35 Silk Set 5,082
36 Selang oksigen anak Set
37 Selang oksigen dewasa Set
38 Sofratulle Set
39 Urine bag Set 4,000
40 Wing Needle No. 21 G Set 5,770
42 Wing Needle No.25 G Set 5,770
44 NGT No. 3 ( Feeding Tube ) Set 22,000
46 Masker Buah 1,125
47 Tes gula darah Set 8,018
48 Tes Narkoba 3 parameter Set 68,181
JUMLAH BHMP ( D )
JUMLAH TOTAL ( A + B + C +D )
Mengetahui, Rumbia,
Kepala Dinas Kesehatan dan Keluarga Berencana Kepala UPTD Instalasi Farmasi
Kabupaten Bombana Kabupaten Bombana
dr.H.SUNANDAR,MM.Kes. MUH.ALWI,S.Si.,MM,Apt.
Pembina Tk.I , IV/b NIP.197903192005021005
NIP.196907162000031004
* CATATAN : Item obat yang belum tercantum ditambahkan dikolom paling bawah dari setiap
kategori,harga obat disesuaikan tahun berjalan.
DIPERHATIKAN …….!!!!!!!!!!!!!!!!
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
tahun 2017
KODE PUSKESMAS :
KECAMATAN : POLEANG TENGAH
KABUPATEN : BOMBANA
PROPINSI : SULAWESI TENGGARA
PEMAKAIAN SISA STOK
Satuan / Harga STOCK PENERI PERSE
No Nama Obat
Kemasan Satuan (Rp) AWAL MAAN DIAAN JAN PEB MAR RATA-RATA GUDANG
1 2 3 4 4 5 6 7 8 9 10=(7+8+9)/3 11
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul 2,200 107 107 - - - 0 102
2 Albendazol tab 400 mg Tab 363 120 120 6 - - 3 30
3 Alopurinol tab 100 mg Tab 90 169 169 - - - 0 -
4 Alprazolam tab 1 mg Tab 245 300 300 10 - - 5 200
5 Albothyl cairan Botol 18,635 - - - - - 0 -
6 Ambroksol tablet 30 mg Tab 138 448 448 70 - - 35 400
7 Ambroksol sirup Botol 2,722 - - 5 - - 3 -
8 Aminofilin inj 24 mg/ml Ampul 4,204 441 441 - - - 0 390
9 Aminofilin tab 200 mg Tab 86 260 260 - - - 0
10 Amitriptilin tab sal 25 mg Tab sal 123 - - - - - 0 -
11 Amlodipin tab 10 mg Tab 352 - - - - - 0 -
12 Amlodipin tab 5 mg Tab 197 - - - - - 0 -
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 - - 6 - - 3 -
14 Amoksisilin tab 250 mg Tab 220 345 345 120 - - 60 300
15 Amoksisilin tab 500 mg Tab 279 2,767 2,767 420 - - 210 2,700
16 Anestetik lokal gigi kombinasi : lidokain hcl 2% +
epinefrin 1 : 80.000 inj 2 ml Ampul 1,499 - - - - - 0 -
17 Antasida, kombinasi : aluminium hidroksida 200 mg +
magnesium hidroksida 200 mg Tab kunyah 78 370 370 140 - - 70 300
magnesium hidroksida 200 mg Suspensi Botol 2,213 - - - - - 0 -
19 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin
B 10.000 UI/g Tube 2,767 24 24 - - - 0 5
20 Antifungi salep, kombinasi : asam benzoat 6%+ asam
salisilat 3% Tube 2,096 68 68 3 - - 2 50
21 Antihemoroid, kombinasi: bismut subgalat 150 mg +
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng Suppo 33,000 126 126 - - - 0 120
oksida 120 mg + sup ad 2 g
22 Anti Parkinson kombinasi : benzerasid 25 mg +
levodopa 100 mg Kaps 1,650 - - - - - 0 -
23 Anti Migren, kombinasi : ergotamin 1 mg+ kafein 50 mg
Tab 149 1,008 1,008 - - - 0 900
24 Antalgin (metampirom) tablet 500 mg Tab 155 1,270 1,270 - - - 0 1,000
25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul 1,346 200 200 - - - 0 60
26 Asam asetilsalisilat (asetosal) tab 100 mg Tab 127 - - - - - 0 -
27 Asam asetilsalisilat (asetosal) tab 500 mg Tab 178 - - - - - 0 -
28 Asam asetilsalisilat (asetosal) tab 80 mg (Miniaspi 80) Tab 163 - - - - - 0
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 1,238 1,238 60 - - 30 1,200
30 Asam folat tab 1 mg Tab 52 635 635 - - - 0 400
31 Asam mefenamat kaps 250 mg Kaps - - - - - 0
32 Asam mefenamat kaps 500 mg Kaps 127 1,460 1,460 310 - - 155 1,400
33 Asam traneksamat inj 50 mg/ml Ampul 3,650 10 10 - - - 0 10
34 Asam traneksamat tab 500 mg Tab 1,265 - - - - - 0 -
35 Asering larutan infus Botol 9,000 - - - - - 0
36 Asiklovir salep kulit Tube 2,367 30 30 3 - - 2 25
37 Asiklovir tab 200 mg Tab 251 1,479 1,479 - - - 0 1,400
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,400 28 28 - - - 0
39 Atropin tab 0,5 mg Tab 81 150 150 - - - 0
40 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol 13,500 - - - - - 0
41 Bedak salisil serb 2% Botol 1,180 - - 2 - - 1 -
42 Besi (II) sulfat 200 mg + asam folat 0.25 mg (tablet
tambah darah) Sachet 55 16,755 16,755 300 - - 150 6,250
43 Becefort syrup Botol 22,727 - - - - - 0 -
44 Betametason krim 0,1% Tube 1,596 12 12 10 - - 5 10
45 Betahistin mesilate tablet tablet 600 - - - - - 0
46 Bisakodil sup 10 mg (Stolax) Botol 6,045 - - - - - 0
47 Bisakodil tab sal 5 mg Tab sal 4,990 - - - - - 0
48 Bismecon salep tube - - - - - 0
49 Budesonid-formoterol (fixed combination)* ih 80/4,5
mcg Botol 110,500 - - - - - 0
50 Bromheksin tablet tablet 42 360 360 10 - - 5 300
51 Deksametason tab 0,5 mg Tab 68 198 198 100 - - 50 -
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,738 - - - - - 0 -
53 Desoksimetason salep 0,25% Tube 9,983 5 5 - - - 0 5
54 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 2,578 16 16 - - 0 -
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol 18,461 - - - - - 0
56 Diazepam supposutoria suppo - - - - - 0
57 Diazepam tab 2 mg Tab 47 565 565 60 - - 30 200
58 Diazepam tab 5 mg Tab 53 557 557 - - - 0 250
59 Dietilkarbamazin tab 100 mg Tab 104 - - - - - 0
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 66 66 - - - 0 30
61 Digoksin tab 0,25 mg Tab 103 148 148 - - - 0 100
62 Diltiazem kaps SR 100 mg Kaps 4,033 100 100 - - - 0
63 Diltiazem tab 30 mg Tab 141 - - - - - 0
64 Doksisiklin tablet 100 mg Tab 298 570 570 - - - 0 500
65 Domperidon susp 5 mg/5 ml Botol 3,490 - - - - - 0 -
66 Domperidon tab 10 mg Tab 174 537 537 30 - - 15 300
67 Efedrin HCl tablet Tab 56 396 396 - - - 0 300
68 Ekstrak belladon tablet 10 mg tab 42 3,300 3,300 - - - 0 2,000
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 8,910 - - - - - 0 -
70 Eritromisin kaps 250 mg Kaps 522 129 129 - - - 0 100
71 Eritromisin sir 200 mg/5 ml Botol 8,090 - - - - - 0
72 Eritromisin tab 500 mg Tab 1,013 590 590 90 - - 45 500
73 Etanol 70% cairan 70% Botol 2,625 2 2 2 - - 1 2
74 Etakridin (rivanol) larutan 0.1% Botol 4,695 2 2 2 - - 1 2
75 Etil klorida semprot 100 ml Botol 105,000 1 1 1 - - 1 -
76 Famotidin tablet 20 mg Tab 124 - - - - - 0 -
77 Fenitoin Na inj 50 mg/ml Ampul 20,857 10 10 - - - 0 10
78 Fenitoin Na kaps 100 mg Kaps 146 - - - - - 0
79 Fenobarbital inj 50 mg/ml Ampul 1,980 - - - - - 0
80 Fenobarbital tab 100 mg Tab 37 980 980 - - - 0 -
81 Fenobarbital tab 30 mg Tab 37 - - - - - 0
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 3,754 28 28 - - - 0 -
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 698 1,350 1,350 - - - 0 1,200
84 Flukonazol kaps 150 mg Kaps 24,200 140 140 - - - 0 100
85 Flusinolon asetonid krim 0,025% Tube 2,700 - - - - - 0
86 Flunarizin tablet tablet 2,400 - - - - - 0
87 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 2,012 - - - - - 0 -
88 Furosemid tab 40 mg Tab 84 1,100 1,100 - - - 0 1,000
89 Garam oralit kombinasi : natrium klorida 0,52 g +
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa Sachet 317 890 890 10 - - 5 700
anhidrat 2,7 g
90 Gameksan lotion 1 % Botol 2,420 - - - - - 0
91 Gemfibrozil kaps 300 mg Kaps 323 290 290 - - - 0 -
92 Gemfibrozil kaps 600 mg Kaps 747 - - - - - 0
93 Gentamisin inj 10 mg/ml Ampul 3,739 - - - - - 0
94 Gentamisin salep mata 0,3% Tube 2,786 - - - - - 0
95 Gentamisin salep Kulit Tube 1,469 56 56 5 - - 3 10
96 Gentamisin tts mata 0,3% Botol 3,194 - - - - - 0
97 Glibenklamid tab 5 mg Tab 61 - - - - - 0 -
98 Glimepirid tab 4 mg Tab 452 - - - - - 0
99 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab 3,000 - - - - - 0
100 Gliseril Guaiakolat tab 100 mg Tab 31 2,184 2,184 75 - - 38 2,100
101 Gliserin lar 50% Botol 5,867 - - - - - 0
102 Glukosamin tablet 500 mg Tab 660 - - - - - 0
103 Glukosa Larutan Infus 5% steril Botol 5,720 28 28 - - - 0
104 Glukosa Larutan Infus 10% steril Botol 6,270 18 18 - - - 0 -
105 Glukosa Larutan Infus 40% steril Botol 6,270 - - - - - 0
106 Griseofulvin (micronized) tab 125 mg Tab 230 270 270 70 - - 35 200
107 Haloperidol tab 0,5 mg Tab 62 680 680 - - - 0 600
108 Haloperidol tab 1,5 mg Tab 76 280 280 80 - - 40 200
109 Haloperidol tab 5 mg Tab 105 190 190 60 - - 30 100
110 Hidrogen peroksida (H2O2) cairan 3% Botol 38,500 2 2 1 - - 1 2
111 Hidroklorotiazid (HCT) tab 25 mg Tab 40 1,000 1,000 - - - 0 -
112 Hidrokortison krim 2,5% Tube 2,938 29 29 4 - - 2 25
113 Hiosina butilbromida tab 10 mg Tab 330 200 200 - - - 0
114 Ibuprofen susp 100 mg/5 ml Botol 3,849 4 4 - - - 0 -
115 Ibuprofen tab 200 mg Tab 121 660 660 340 - - 170 500
116 Ibuprofen tab 400 mg Tab 157 170 170 40 - - 20 100
117 Ipratropium bromida nebulizer 0,025% (Atroven sol. for
Botol 90,000 - - - - - 0 -
inhalation 0.025%)
118 Isoniazid tab 300 mg Tab 174 - - - - - 0
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 36,960 4 4 - - - 0 4
120 Isosorbid dinitrat tab 5 mg Tab 98 49 49 - - - 0
121 KA-EN 3B Cairan Infus Botol 10,000 - - - - - 0
122 Kalsium glukonat inj 100 mg/ml Ampul 7,800 - - - - - 0
123 Kalsium laktat (kalk) tab 500 mg Tab 76 45 45 170 - - 85 -
124 Kaptopril tab 12,5 mg Tab 69 200 200 - - - 0 100
125 Kaptopril tab 25 mg Tab 97 360 360 60 - - 30 300
126 Karbamazepin tab 200 mg Tab 269 - - - - - 0
127 Karbo adsorben (Norit) tab 500 mg Tab - - - - - 0
128 Ketamin inj 50 mg/ml (i.v.) Ampul 63,400 - - - - - 0
129 Ketokonazol tab 200 mg Tab 320 624 624 - - - 0 200
130 Ketokonazol krim 2% Tube 5,150 - - - - - 0 -
131 Ketorolak inj 10 mg/ml Ampul 2,665 - - - - - 0
132 Klaritromisin tab 500 mg Tab 3,600 - - - - - 0
133 Klindamisin kaps 150 mg Kaps 405 90 90 - - - 0 -
134 Kloramfenikol tts mata 0,5% Botol 1,680 - - - - - 0
135 Kloramfenikol kaps 250 mg Kaps 275 230 230 - - - 0 -
136 Kloramfenikol salep mata 1% Tube 1,680 - - - - - 0
137 Kloramfenikol susp 125 mg/5 ml Botol 4,016 6 6 - - - 0 5
138 Klorfeniramin (CTM) tab 4 mg Tab 26 9,554 9,554 370 - - 185 8,000
139 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,210 30 30 - - - 0 -
140 Klorpromazin tab sal 100 mg Tab sal 162 4,830 4,830 120 - - 60 4,700
141 Klorpromazin tab sal 25 mg Tab sal 75 240 240 - - - 0 200
142 Kombinasi : Pirimethamin 25 mg + sulfadoksin Tab 531 200 200 - - - 0 200
143 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg
nebules (Combivent UDV) Vial 5,990 4 4 - - - 0 4
144 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol
400 mg+ trimetoprim 80 mg Tab 152 1,360 1,360 90 - - 45 1,300
145 Kotrimoksazol (anak) kombinasi : sulfametoksazol
100 mg+ trimetoprim 20 mg Tab 79 2,251 2,251 - - - 0 2,100
146 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi :

sulfametoksazol 200 mg + trimetoprim 40 mg Botol 2,298 5 5 2 - - 1 5
147 Kuinin inj 25% (i.v.) Vial 6,820 - - - - - 0

148 Kloroquin tab 150 mg Tab 116 1,000 1,000 - - - 0 100
149 Lansoprazol kaps 30 mg Kaps 521 - - - - - 0
150 Levofloksasin tab 500 mg Tab 581 150 150 20 - - 10 100
151 Lidokain gel 2% Tube 40,000 - - - - - 0
152 Lidokain inj 2% (hcl) Vial 929 218 218 12 - - 6 200
153 Lisol Botol 54,995 - - - - - 0 -
154 Loperamid tab 2 mg Tab 97 200 200 30 - - 15 200
155 Loratadin tab 10 mg Tab 170 400 400 40 - - 20 300
156 Magnesium sulfat inj 20% Vial 7,260 - - - - - 0
157 Magnesium sulfat inj 40% Vial 7,260 2 2 - - - 0
158 Magnesium sulfat serb, ktg 30 g Sachet 1,130 5 5 - - - 0
159 Mebendazol sir 50 mg/ml Botol 3,887 4 4 - - - 0 3
160 Mebendazol tab 100 mg Tan 248 30 30 - - - 0 30
161 Metformin tab 500 mg Tab 125 - - - - - 0
162 Metformin tab 850 mg Tab 280 - - - - - 0
163 Metilergometrin inj 0,2 mg/ml Ampul 2,750 - - - - - 0 -
164 Metilergometrin tab salut 0,125 mg Tab sal 169 170 170 100 - - 50 100
165 Metilprednisolon tab 4 mg Tab 230 - - - - - 0 -
166 Metoklopramid inj 5 mg/ml Vial 1,100 - - - - - 0
167 Metoklopramid sir 5 mg/5 ml (Lexapram sirup) Botol 2,900 - - - - - 0
168 Metoklopramid tab 10 mg Tab 100 269 269 - - - 0 200
169 Metronidazol supposutoria 500 mg suppo 3,655 - - - - - 0
170 Metronidazol larutan infus Botol 12,980 - - - - - 0
171 Metronidazol tab 250 mg Tab 116 48 48 - - - 0 -
172 Metronidazol tab 500 mg Tab 169 620 620 100 - - 50 500
173 Mikonazol krim 2% Tube 3,150 46 46 9 - - 5 40
174 Natrium diklofenak tab 25 mg Tab 146 50 50 90 - - 45 -
175 Natrium diklofenak tab 50 mg Tab 193 285 285 110 - - 55 250
176 NaCl 0,9% Larutan infus Botol 5,170 47 47 4 - - 2 46
177 Nifedipin kaps 10 mg Kaps 127 960 960 20 - - 10 900
178 Nistatin tab salut 500.000 UI Tab 704 378 378 - - - 0 300
179 Nistatin tab vaginal 100.000 UI Tab 528 42 42 - - - 0 -
180 Obat Batuk Hitam (OBH) Botol 2,310 - - 6 - - 3 15
181 Ofloksasin tab 200 mg Tab 440 222 222 - - - 0 150
182 Ofloksasin tab 400 mg Tab 700 345 345 - - - 0 300
183 Oksitetrasiklin hcl inj 500 mg/ml Vial 3,410 - - - - - 0
184 Oksitetrasiklin hcl salep kulit 3% Tube 1,646 52 52 - - - 0 28
185 Oksitetrasiklin hcl salep mata 1 % Tube 2,772 25 25 - - - 0 25
186 Oksitosin inj 10 UI/ml Ampul 1,900 216 216 10 - - 5 30
187 Omeprazol kaps 20 mg Kaps 221 10 10 60 - - 30 30
188 Papaverin tablet 40 mg Tab 109 6,605 6,605 - - - 0 4,000
189 Parasetamol sir 120 mg/5 ml Botol 1,535 - - - - - 0 -
190 Parasetamol tab 100 mg Tab 105 17 17 81 - - 41 -
191 Parasetamol tab 500 mg Tab 88 1,610 1,610 485 - - 243 2,100
192 Parasetamol rectal suppo - - - - - 0
193 Pehavral tablet multivitamin Tab 297 - - - - - 0 -
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25,350 - - 20 - - 10
195 Phenylbutazon tablet 200 mg Tab 107 2,290 2,290 - - - 0 2,200
196 Piracetam tablet 800 mg Tab 964 460 460 - - - 0 400
197 Piracetam tablet 1200 mg Tab 854 540 540 - - - 0 480
198 Piracetam injeksi 1 g/5 ml Ampul 6,050 420 420 - - - 0 420
199 Pirantel pamoat susp 125 mg/5 ml Botol 9,100 - - - - - 0
200 Pirantel pamoat tab scored 125 mg Tab 318 419 419 36 - - 18 330
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 9,065 9,065 20 - - 10 7,000
202 Piroksikam tablet 20 mg Tab 116 659 659 240 - - 120 800
Piroksikam tablet 10 mg Tab - - - - - 0
203 Polikresulen Botol 18,635 - - - - - 0
204 Povidon iodin lar 100 mg/ml Botol 30 ml 2,344 58 58 2 - - 1 53
205 Povidon iodin lar 100 mg/ml Botol 300 ml 15,386 30 30 1 - - 1 30
206 Povidon iodin lar 100 mg/ml Botol 1000 ml 40,202 15 15 - - - 0 15
207 Prednison tab 5 mg Tab 98 850 850 300 - - 150 500
208 Primakuin tab 15 mg Tab 125 - - - - - 0 -
209 Procurma syrup Botol 12,021 - - 2 - - 1 -
210 Propiltiourasil tab 100 mg Tab 351 300 300 100 - - 50 200
211 Propranolol tab 40 mg Tab 80 950 950 - - - 0 800
212 Ranitidin inj 25 mg/ml Ampul 1,340 - - - - - 0
213 Ranitidin tab 150 mg Tab 128 160 160 140 - - 70 200
214 Reserpin tablet 0.25 mg Tab 968 - - - - - 0
215 Rifampisin kaps 300 mg Kaps 440 - - - - - 0
216 Rifampisin tab 450 mg Tab 624 - - - - - 0
217 Rifampisin tab 600 mg Tab 863 200 200 - - - 0 200
218 Ringer Laktat Larutan infus Botol 5,720 53 53 8 - - 4 43
219 Salbutamol tab 2 mg Tab 65 396 396 10 - - 5 200
220 Salbutamol tab 4 mg Tab 93 665 665 - - - 0 600
221 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang
endap 4 % Tube 2,200 44 44 2 - - 1 24
222 Scabicid salep Tube - - - - - 0
223 Sefadroksil kaps 250 mg Vial 564 - - - - - 0
224 Sefadroksil kaps/tab 500 mg Tab 548 810 810 240 - - 120 1,000
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 35 35 9 - - 5 50
226 Sefiksim kapsul 100 mg Tab 1,000 - - - - - 0
227 Sefotaksim serb inj 1.000 mg/vial Vial 3,500 - - - - - 0
228 Seftriakson serb inj 1.000 mg/vial Vial 3,900 - - - - - 0
229 Setirizin tab 10 mg Tab 190 - - - - - 0
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial 1,150 399 399 9 - - 5 200
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 - - 80 - - 40
232 Simetidin tablet 200 mg Tab 138 483 483 10 - - 5 400
233 Simvastatin tab sal 10 mg Tab sal 177 - - - - - 0
234 Simvastatin tab sal 20 mg Tab sal 480 - - - - - 0
235 Siprofloksasin inf 2 mg/ml Botol 22,000 - - - - - 0
236 Siprofloksasin tab scored 500 mg Tab 312 - - - - - 0
237 Spironolakton tab 100 mg Tab 350 - - - - - 0 -
238 Sulfasetamid Natrium Tetes mata 1.5% Botol 3,549 - - - - - 0
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol 14,450 - - - - - 0
240 Ulsidex Tablet 477 160 160 - - - 0 -
241 Retapyl SR Kapsul 1,155 180 180 - - - 0 -
242 Tetrasiklin kaps 250 mg Kaps 183 700 700 - - - 0 600
243 Tetrasiklin kaps 500 mg Kaps 283 280 280 - - - 0 200
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 6,030 6,030 - - - 0 5,000
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab 770 - - - - - 0
246 Tramadol inj 50 mg/ml Ampul 2,680 128 128 - - - 0 -
247 Tramadol tablet 500 mg Tab 363 587 587 - - - 0 400
248 Triheksifenidil tab 2 mg Tab 45 (60) (60) 150 - - 75 -
249 Vitamin B12 tablet 50 mcg Tab 63 1,370 1,370 - - - 0 200
250 Vitamin B kompleks injeksi Vial 7,392 115 115 - - - 0 110
251 Vitamin B kompleks Tab 112 383 383 80 - - 40 300
252 Zinc tab disp 20 mg Tab 521 300 300 20 - - 10 300
253 Zinc sirup 20 mg / 5 ml Botol 8,140 - - - - - 0
254 Larutan PK botol 6,975 16 16 - - - 0 12
255 Kanamisin inj Vial 5,929 50 50 - - - 0 50
256 Antalgin 500mg tab 141 - - - - - 0
257 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,210 - - - - - 0
258 Kalsium laktat (kalk) tab 500 mg Tab 76 - - - - - 0
259 Kloroquin tab 250 mg Tab 572 - - - - - 0 -
260 Klonidin 0,15 mg Tab 193 - - - - - 0
261 Kloramfenikol kaps 250 mg Kaps 275 - - - - - 0
262 Klorpromazin tab sal 100 mg Tab sal 162 - - - - - 0
263 Fenolgliserol TT 10% Kotak 1,109 138 138 - - - 0 96
264 Tetrasiklin kaps 250 mg Kaps 162 - - - - - 0
265 Kloroquin tab 250 mg 112 - - - - - 0
266 Papaverin tablet 40 mg 167 - - - - - 0
267 Prednison tab 5 mg Tab 125 - - - - - 0
268 Pirantel pamoat tab scored 125 mg Tab 318 - - - - - 0
269 Hidroklorotiazid (HCT) tab 25 mg Tab 109 - - - - - 0
270 Triheksifenidil tab 2 mg Tab 45 - - - - - 0
271 Piracetam tablet 1200 mg Tab 854 - - - - - 0
272 Vical Multivitamin Botol 42,727 - - - - - 0 -
273 Lexavit tab 1,480 - - - - - 0 -
274 Gliseril Guaiakolat tab 100 mg Tab 31 - - - - - 0
275 Efedrin HCl tablet Tab - - - - - 0
276 Kloroquin Tablet 150 mg Tab 537 537 - - - 0 300
277 Aptyl Btl - - - - - 0 -
278 Levopar Tablet 100 100 - - - 0 50
280 Pytogin inj Ampul 10 10 - - - 0 -
281 Phenytoin Sodium Kapsul 130 130 20 - - 10 100
Etanol 300% cairan Botol 33 - - - - - 0 -
JUMLAH OBAT-OBATAN (A) 146 165 77

B. OBAT GIGI - -
1 Bonding Botol - - - - - 0
2 Calcium hidrosida cement pasta (hycal) Kotak - - - - - 0
3 Comfosite Tube - - - - - 0
4 Devitalisasi Pasta (Non Arsen) Kotak 390,000 - - - - - 0
5 Eugenol cair Botol 18,333 - - - - - 0
6 Etil Klorida spray Botol 105,000 - - - - - 0
7 Etza Tube 170,000 - - - - - 0
8 Glass Ionomer Cement ART Set 395,000 - - - - - 0
9 Klorfenol Kamfer Menthol (CHKM) Botol 55,000 5 5 - - - 0 -
10 Semen Seng Fosfat serbuk dan cairan Set 93,500 1 1 - - - 0
11 Temporari stoping pletcher Set 34,000 1 1 - - - 0 1
12 Mummiyng pasta Kotak 176,000 - - - - 0
JUMLAH OBAT GIGI ( B ) 4 0
C. OBAT PROGRAM -
1 Albedazole 400mg Tab 363 - - - - - 0 -
2 Artemether inj 80 mg/ml Ampul - - - - - 0 -
3 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 27,569 - - - - - 0 -
4 Dietilkarbamazin tab 100 mg Tab 104 3,000 3,000 - - - 0 3,000
5 Imersion oil Botol - - - - - 0
6 Iodina Test Botol - - - - - 0
7 Obat Anti Tuberculosis FDC Kategori Anak Paket 236,490 - - - - - 0
8 Obat Anti Tuberculosis FDC Kategori I Paket 396,000 - - - - - 0
9 Obat Anti Tuberculosis FDC Kategori II Paket 1,319,990 - - - - - 0
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 175,899 - - - - - 0
11 Reagen Zenit Nelson Botol 145,000 - - - - - 0
12 RDT Dangue DBD Set 150,000 - - - - - 0
13 RDT malaria (care star ) Set 168,300 - - - - - 0
14 RDT HIV (intec) Set 46,200 - - - - - 0
15 RDT HIV (vikia) Set 45,560 - - - - - 0
16 RDT HIV (Oncoprobe) Set 42,350 - - - - - 0
17 Taburia Kotak 20,454 - - - - - 0
18 Quinina injeksi Ampul 4,438 - - - - - 0
19 Vaksin BCG inj (i.k) Vial - - - - - 0 -
20 Vaksin campak inj (s.k.) Vial - - - - - 0
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial - - - - - 0
22 Vaksin jerap difteri tetanus (DT) Vial - - - - - 0
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial 2 2 - - - 0
24 Vaksin polio drops 10 dosis Vial 2 2 - - - 0
25 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster
Vial 695,752 - - - - - 0
26 Retinol (Vit.A) 200.000 IU kap lunak 412 - - - - - 0 -
27 Retinol (Vit.A) 100.000 IU kap lunak 286 - - - - - 0
28 zink tab.20mg 497 - - - - - 0
29 Doxiciklin tab - - - - - 0
30 Garam Oralit 45 45 - - - 0 -
31 Kina - - - - - 0 -
32 Gentamicin Inj. - - - - - 0 -
33 Pitomenadion Inj. - - - - - 0 -
34 Diazepam Inj 713 713 - - - 0 60
35 Glukonas Kalsikas 98 98 - - - 0 48
36 Phenobarbital Inj. 150 150 - - - 0 -
37 Ampiciline Sodium Inj - - - - - 0 -
38 Benzatin B Penicilin Inj. 311 311 - - - 0 90
39 Mg So4 20 % 438 438 - - - 0 43
40 Mg So4 40 % 62 62 - - - 0 27
41 Zinc 20 mg 1,245 1,245 - - - 0 1,000
42 Pyrantel Tab 125 mg 300 300 - - - 0 200
43 Alat Suntik 0,5 ml 200 200 - - - 0 100
44 Alat Suntik 5 ml 100 100 - - - 0 100
45 Kotrimoksasol 480 mg 1,600 1,600 - - - 0 1,500
46 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol - - - - - 0
47 Retinol (Vitamin A) 200.000 IU Kapsul Lunak Botol - - - - - 0
JUMLAH OBAT PROGRAM ( C ) 22 0
D. BAHAN MEDIS HABIS PAKAI (BHMP) -
1 Alat suntik sekali pakai 1 ml Set 1,093 720 720 - - - 0 700
2 Alat suntik sekali pakai 2,5 ml Set 848 270 270 6 - - 3 200
3 Alat suntik sekali pakai 3 ml Set 848 120 120 15 - - 8 -
4 Alat suntik sekali pakai 5 ml Set 979 634 634 - - - 0 550
5 Bisturi no. 20 Buah 2,099 311 311 10 - - 5 200
6 Bisturi no. 15 Buah 2,099 487 487 7 - - 4 450
7 Catgut No 2/0 Set 25,920 52 52 2 - - 1 24
8 Catgut No 3/0 Set 5,900 31 31 - - - 0 30
9 Handscoen no. 6 Pasang - - - - 0 -
10 Handscoen no. 6,5 Pasang - - - - 0 -
11 Handscoen no. 7 Pasang 7,684 - - - - - 0 -
12 Handscoen no. 7,5 Pasang 7,684 - - 25 - - 13 -
13 Infuset dewasa Set 4,176 61 61 - - - 0 50
14 Infusion set anak Set 4,568 33 33 - - - 0 16
15 IV Catheter No.16 G Set - - - - - 0 -
16 IV Catheter No.18 G Set 7,937 42 42 1 - - 1 14
17 IV Catheter No.24 G Set 7,937 3 3 - - - 0 -
18 IV Catheter No. 20 G Set 7,787 72 72 2 - - 1 39
19 IV Catheter No. 22 G Set 7,937 24 24 2 - - 1 4
20 Folley Catheter 16 Set - - - - - 0 -
21 Folley Catheter 18 Set 8,495 - - - - - 0 -
22 Folley catheter 22 Set 8,495 - - - - - 0 -
23 Folley catheter 24 Set 495 - - - - - 0 -
24 Kapas Berlemak 250 gram Rol 7,500 1 1 - - - 0 -
25 Kapas Berlemak 500 gram Rol 17,250 10 10 - - - 0 10
26 Kasa Pembalut 4m x 3 cm Rol 800 - - - - - 0 -
27 Kasa Pembalut 4m x 5 cm Rol 887 15 15 1 - - 1 15
28 Kasa Pembalut 4m x 10 cm Rol 6,121 30 30 1 - - 1 30
29 Kasa Pembalut 4m x 15 cm Rol 887 - - - - 0 -
30 Kasa Kompres 40/40 steril Buah 1,871 - - - - - 0 -
31 Kasa Steril 16 X 16 Buah 8,600 - - - - - 0 -
32 Kasa pembalut 2 x 80 Rol 13,221 - - - - - 0 -
33 Kasa Pembalut 40 x 80 Rol 137,025 - - - - - 0
34 Kasa Pembalut 36 x 80 cm Rol 133,821 2 2 1 - - 1 2
35 Pembalut Gips Buah 32,500 - - - - - 0
36 Plester 5 yard x 2 inc Rol 23,625 2 2 2 - - 1 2
37 Silk Set 5,082 45 45 2 - - 1 28
38 Selang oksigen anak Set - - - - - 0
39 Selang oksigen dewasa Set - - - - - 0
40 Sofratulle Set - - - - - 0
41 Urine bag Set 4,000 4 4 - - - 0 4
42 Wing Needle No. 21 G Set 5,770 100 100 - - - 0 100
43 Wing Needle No. 23 G Set 5,770 - - - - - 0
44 Wing Needle No.25 G Set 5,770 30 30 - - - 0 30
45 Wing Needle No. 27 G Set 5,770 - - - - - 0
46 NGT No. 3 ( Feeding Tube ) Set 22,000 - - - - - 0
47 NGT No. 5 ( Feeding Tube ) Set 22,000 - - - - - 0
48 Masker Buah 1,125 - - - - - 0 -
49 Tes gula darah Set 200,455 84 84 - - - 0 75
50 Tes Narkoba 3 parameter Set 68,181 - - - - - 0
51 Tes Narkoba 5 parameter Set 68,181 - - - - - 0
52 Tes Kehamilan Sachet 6,825 17 17 5 - - 3 15
JUMLAH BAHAN MEDIS HABIS PAKAI (BHMP) (D)
JUMLAH TOTAL ( A + B + C +D ) 146 0
TIDAK
BAYAR ASKES JUMLAH
BAYAR Mengetahui :
JUMLAH KUNJUNGAN RESEP
Kepala Puskesmas Poleang Tengah ,
9 170 14 193
KETERANGAN
Rumus permintaan Obat
→Tingkat kecukupan (TK) = Sisa stok gudang / Pemakaian Rata - Rata Perbulan
→Jika TK > 4 , Tidak perlu melakukan permintaan Obat RUSTAM, AMK

Jika TK ≤ 4, minta Obat NIP. 1974 0410 199502 1 002
Jadi : (4 - TK ) X Pemakaian rata-rata perbulan

DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
ahun 2017
BULAN : JANUARI 2017
SISA STOK TINGKAT PERMI PEMBERIAN

TOTAL
KECUKUPA EXP KET
SUB. UNIT STOK JPKMM APBD LAIN2 JML
N NTAAN
12 13=11+12 14=11/10 15 16 17 18 19 20 21
5 107 #DIV/0! #DIV/0!

84 114 10.00 (18)
169 169 #DIV/0! #DIV/0!
90 290 40.00 (180)
- - #DIV/0! #DIV/0!
(22) 378 11.43 (260)
(5) (5) 0.00 10
51 441 #DIV/0! #DIV/0!
260 260 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
(6) (6) 0.00 12
(75) 225 5.00 (60)
(353) 2,347 12.86 (1,860)
- - #DIV/0! #DIV/0!
(70) 230 4.29 (20)
- - #DIV/0! #DIV/0!
19 24 #DIV/0! #DIV/0!
15 65 33.33 (44)
6 126 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
108 1,008 #DIV/0! #DIV/0!

270 1,270 #DIV/0! #DIV/0!
140 200 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
(22) 1,178 40.00 (1,080)
235 635 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
(250) 1,150 9.03 (780)
- 10 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
2 27 16.67 (19)
79 1,479 #DIV/0! #DIV/0!
28 28 #DIV/0! #DIV/0!
150 150 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
(2) (2) 0.00 4
10,205 16,455 41.67 (5,650)
- - #DIV/0! #DIV/0!
(8) 2 2.00 10
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
50 350 60.00 (280)
98 98 0.00 200
- - #DIV/0! #DIV/0!
- 5 #DIV/0! #DIV/0!
16 16 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
305 505 6.67 (80)
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48 148 #DIV/0! #DIV/0!
100 100 #DIV/0! #DIV/0!
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70 570 #DIV/0! #DIV/0!
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207 507 20.00 (240)
96 396 #DIV/0! #DIV/0!
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29 129 #DIV/0! #DIV/0!
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100 1,100 #DIV/0! #DIV/0!
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290 290 #DIV/0! #DIV/0!
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9 2,109 56.00 (1,950)
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28 28 #DIV/0! #DIV/0!
18 18 #DIV/0! #DIV/0!
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80 680 #DIV/0! #DIV/0!
- 200 5.00 (40)
30 130 3.33 20
(1) 1 4.00 0
1,000 1,000 #DIV/0! #DIV/0!
- 25 12.50 (17)
200 200 #DIV/0! #DIV/0!
4 4 #DIV/0! #DIV/0!
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30 130 5.00 (20)
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100 200 #DIV/0! #DIV/0!
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424 624 #DIV/0! #DIV/0!
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30 30 #DIV/0! #DIV/0!
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40 240 #DIV/0! #DIV/0!
- 200 #DIV/0! #DIV/0!
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151 2,251 #DIV/0! #DIV/0!
(2) 3 5.00 (1)
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900 1,000 #DIV/0! #DIV/0!
- - #DIV/0! #DIV/0!
30 130 10.00 (60)
- - #DIV/0! #DIV/0!
6 206 33.33 (176)
- - #DIV/0! #DIV/0!
(30) 170 13.33 (140)
60 360 15.00 (220)
- - #DIV/0! #DIV/0!
2 2 #DIV/0! #DIV/0!
5 5 #DIV/0! #DIV/0!
1 4 #DIV/0! #DIV/0!
- 30 #DIV/0! #DIV/0!
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69 269 #DIV/0! #DIV/0!
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48 48 #DIV/0! #DIV/0!
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(3) 37 8.89 (22)
(40) (40) 0.00 180
(75) 175 4.55 (30)
(3) 43 23.00 (38)
40 940 90.00 (860)
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42 42 #DIV/0! #DIV/0!
(21) (6) 5.00 (3)
72 222 #DIV/0! #DIV/0!
45 345 #DIV/0! #DIV/0!
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24 52 #DIV/0! #DIV/0!
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176 206 6.00 (10)
(80) (50) 1.00 90
2,605 6,605 #DIV/0! #DIV/0!
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(64) (64) 0.00 162
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90 2,290 #DIV/0! #DIV/0!
60 460 #DIV/0! #DIV/0!
60 540 #DIV/0! #DIV/0!
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(1) 29 60.00 (28)
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(2) (2) 0.00 4
- 200 4.00 0
150 950 #DIV/0! #DIV/0!
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(180) 20 2.86 80
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2 45 10.75 (27)
186 386 40.00 (180)
65 665 #DIV/0! #DIV/0!
18 42 24.00 (20)
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(430) 570 8.33 (520)
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160 160 #DIV/0! #DIV/0!
180 180 #DIV/0! #DIV/0!
100 700 #DIV/0! #DIV/0!
80 280 #DIV/0! #DIV/0!
1,030 6,030 #DIV/0! #DIV/0!
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128 128 #DIV/0! #DIV/0!
187 587 #DIV/0! #DIV/0!
(210) (210) 0.00 300
1,170 1,370 #DIV/0! #DIV/0!
5 115 #DIV/0! #DIV/0!
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(20) 280 30.00 (260)
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50 100 #DIV/0! #DIV/0!
10 10 #DIV/0! #DIV/0!
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50 98 #DIV/0! #DIV/0!
150 150 #DIV/0! #DIV/0!
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221 311 #DIV/0! #DIV/0!
395 438 #DIV/0! #DIV/0!
35 62 #DIV/0! #DIV/0!
245 1,245 #DIV/0! #DIV/0!
100 300 #DIV/0! #DIV/0!
100 200 #DIV/0! #DIV/0!
- 100 #DIV/0! #DIV/0!
100 1,600 #DIV/0! #DIV/0!
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-
20 720 #DIV/0! #DIV/0!
64 264 66.67 (188)
105 105 0.00 30
84 634 #DIV/0! #DIV/0!
101 301 40.00 (180)
30 480 128.57 (436)
26 50 24.00 (20)
1 31 #DIV/0! #DIV/0!
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17 33 #DIV/0! #DIV/0!
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27 41 28.00 (12)
3 3 #DIV/0! #DIV/0!
31 70 39.00 (35)
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(3) 12 6.00 (5)
Mulaeno, 31 JANUARI 2017
Pembuat Laporan
Puskesmas Poleang Tengah
I D R I S
NIP. -
LAPO
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / Harga STOCK

No Nama Obat
Kemasan Satuan (Rp) AWAL
1 2 3 4 4
A. OBAT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
KETERANGAN
→Jika TK > 4 , Tidak perlu melakukan permintaan Obat
Jika TK ≤ 4, minta Obat
LAPORAN PERMINTAAN OBAT ANTARA
tahun 2016
PEMAKAIAN SISA STOK

PENERI PERSE TOTAL
MAAN DIAAN RATA- STOK
APRIL MEI JUNI RATA
GUDANG SUB. UNIT
5 6 7 8 9 10=(7+8+9)/3 11 12 13=11+12
Mengetahui :
JAFARUDDIN, AMK
NIP. 19740906 199502 1 003
TINGKAT PERMI PEMBERIAN

KECUKUPA EXP KET
N NTAAN JPKMM APBD LAIN2 JML
14=11/10 15 16 17 18 19 20 21
Mulaeno, 30 JANUARI 2016
Pembuat Laporan
Puskesmas Poleang Tengah
I D R I S
NIP. -
KODE PUSKESMAS :
KABUPATEN : BOMBANA
PROPINSI : SULAWESI TENGGAR
Satuan /
No Nama Obat
Kemasan
1 2 3
A. OBAT
1 Ibuprofen tab 200 mg Tab
2 Prednison tab 5 mg Tab
3 Amoksisilin tab 500 mg
Tab
4 Klorfeniramin (CTM) tab 4 mg Tab
5 Parasetamol tab 500 mg Tab
6 Propiltiourasil tab 100 mg Tab
tambah darah) Sachet
8 Vitamin B kompleks Tab
9 Piroksikam tablet 20 mg Tab
magnesium hidroksida 200 mg Tab kunyah
12 Sefadroksil kaps/tab 500 mg Tab
13 Klorpromazin tab sal 100 mg Tab sal
14 Triheksifenidil tab 2 mg Tab
15 Amoksisilin tab 250 mg Tab
16 Kalsium laktat (kalk) tab 500 mg Tab
17 Natrium diklofenak tab 50 mg Tab
18 Gliseril Guaiakolat tab 100 mg Tab
19 Kaptopril tab 25 mg Tab
21 Loratadin tab 10 mg Tab
22 Ranitidin tab 150 mg Tab
23 Eritromisin tab 500 mg Tab
24 Haloperidol tab 1,5 mg Tab
25 Domperidon tab 10 mg Tab
400 mg+ trimetoprim 80 mg Tab
28 Asam askorbat (vitamin C) tab 50 mg Tab
29 Griseofulvin (micronized) tab 125 mg Tab
30 Ambroksol tablet 30 mg Tab
31 Diazepam tab 2 mg Tab
32 Metronidazol tab 500 mg Tab
33 Tramadol tablet 500 mg Tab
34 Vitamin B12 tablet 50 mcg Tab
36 Haloperidol tab 5 mg Tab
37 Metilergometrin tab salut 0,125 mg Tab sal
38 Omeprazol kaps 20 mg Kaps
39 Phenylbutazon tablet 200 mg Tab
40 Piridoksin (vitamin B6) tab 25 mg Tab
41 Tiamin (vitamin B1) mononitrat tab 50 mg Tab
42 Levofloksasin tab 500 mg Tab
43 Alat suntik sekali pakai 3 ml Set
44 Bisturi no. 20 Buah
45 Efedrin HCl tablet Tab
46 Obat Batuk Hitam (OBH) Botol
47 Pirantel pamoat tab scored 125 mg Tab
Tab
49 Asiklovir tab 200 mg Tab
50 Betametason krim 0,1% Tube
51 Lidokain inj 2% (hcl) Vial
52 Sefadroksil sir kering 125 mg/5 ml Botol
53 Simetidin tablet 200 mg Tab
54 Masker Buah
55 Procurma syrup Botol
58 Ambroksol sirup Botol
60 Alat suntik sekali pakai 2,5 ml Set
61 Mikonazol krim 2% Tube
62 IV Catheter No.18 G Set
63 Kasa Pembalut 4m x 5 cm Rol
salisilat 3% Tube
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng Suppo
sulfametoksazol 200 mg + trimetoprim 40 mg Botol

69 IV Catheter No. 20 G Set
70 Plester 5 yard x 2 inc Rol
71 Silk Set
72 Tes Kehamilan Sachet
73 Asiklovir salep kulit Tube
74 Etil klorida semprot 100 ml Botol
75 Hidrokortison krim 2,5% Tube
76 Kloramfenikol susp 125 mg/5 ml Botol
77 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial
79 Kasa Pembalut 36 x 80 cm Rol
80 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul
81 Albendazol tab 400 mg Tab
82 Alopurinol tab 100 mg Tab
83 Alprazolam tab 1 mg Tab
84 Albothyl cairan Botol
85 Aminofilin inj 24 mg/ml Ampul
86 Aminofilin tab 200 mg Tab
87 Amitriptilin tab sal 25 mg Tab sal
88 Amlodipin tab 10 mg Tab
90 Amoksisilin sir kering 125 mg/5 ml Botol
epinefrin 1 : 80.000 inj 2 ml Ampul
magnesium hidroksida 200 mg Suspensi Botol
B 10.000 UI/g Tube
levodopa 100 mg Kaps
95 Antalgin (metampirom) tablet 500 mg Tab
96 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul
97 Asam asetilsalisilat (asetosal) tab 100 mg Tab
99 Asam asetilsalisilat (asetosal) tab 80 mg (Miniaspi 80)
Tab
100 Asam folat tab 1 mg Tab
102 Asam traneksamat inj 50 mg/ml Ampul
103 Asam traneksamat tab 500 mg Tab
104 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul
105 Atropin tab 0,5 mg Tab
106 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol
107 Bedak salisil serb 2% Botol
108 Becefort syrup Botol
110 Bisakodil sup 10 mg (Stolax) Botol
mcg Botol
115 Deksametason tab 0,5 mg Tab
116 Deksametason inj 5 mg/ml (i.v./i.m.) Vial
117 Desoksimetason salep 0,25% Tube
118 Diazepam inj 5 mg/ml (i.v./i.m.) Vial
119 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol
122 Dietilkarbamazin tab 100 mg Tab
123 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul
124 Digoksin tab 0,25 mg Tab
125 Diltiazem kaps SR 100 mg Kaps
126 Diltiazem tab 30 mg Tab
127 Doksisiklin tablet 100 mg Tab
128 Domperidon susp 5 mg/5 ml Botol
129 Ekstrak belladon tablet 10 mg tab
130 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul
131 Eritromisin kaps 250 mg Kaps
132 Eritromisin sir 200 mg/5 ml Botol
133 Etanol 70% cairan 70% Botol
134 Etakridin (rivanol) larutan 0.1% Botol
135 Famotidin tablet 20 mg Tab
136 Fenitoin Na inj 50 mg/ml Ampul
137 Fenitoin Na kaps 100 mg Kaps
138 Fenobarbital inj 50 mg/ml Ampul
139 Fenobarbital tab 100 mg Tab
141 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial
142 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal
143 Flukonazol kaps 150 mg Kaps
144 Flusinolon asetonid krim 0,025% Tube
146 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul
147 Furosemid tab 40 mg Tab
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa Sachet
anhidrat 2,7 g
149 Gameksan lotion 1 % Botol
150 Gemfibrozil kaps 300 mg Kaps
152 Gentamisin inj 10 mg/ml Ampul
153 Gentamisin salep mata 0,3% Tube
154 Gentamisin tts mata 0,3% Botol
155 Glibenklamid tab 5 mg Tab
156 Glimepirid tab 4 mg Tab
157 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab
158 Gliserin lar 50% Botol
159 Glukosamin tablet 500 mg Tab
160 Glukosa Larutan Infus 5% steril Botol
163 Hidrogen peroksida (H2O2) cairan 3% Botol
164 Hidroklorotiazid (HCT) tab 25 mg Tab
166 Ibuprofen susp 100 mg/5 ml Botol
inhalation 0.025%) Botol
169 Isoniazid tab 300 mg Tab
170 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial
171 Isosorbid dinitrat tab 5 mg Tab
172 KA-EN 3B Cairan Infus Botol
173 Kalsium glukonat inj 100 mg/ml Ampul
174 Kaptopril tab 12,5 mg Tab
175 Karbamazepin tab 200 mg Tab
177 Ketamin inj 50 mg/ml (i.v.) Ampul
178 Ketokonazol tab 200 mg Tab
179 Ketokonazol krim 2% Tube
180 Ketorolak inj 10 mg/ml Ampul
181 Klaritromisin tab 500 mg Tab
182 Klindamisin kaps 150 mg Kaps
183 Kloramfenikol tts mata 0,5% Botol
184 Kloramfenikol kaps 250 mg Kaps
185 Kloramfenikol salep mata 1% Tube
186 Klorpromazin inj 25 mg/ml (i.m.) Ampul
188 Kombinasi : Pirimethamin 25 mg + sulfadoksin Tab
nebules (Combivent UDV) Vial
100 mg+ trimetoprim 20 mg Tab
191 Kloroquin tab 150 mg Tab
192 Lansoprazol kaps 30 mg Kaps
193 Lidokain gel 2% Tube
194 Lisol Botol
195 Loperamid tab 2 mg Tab
196 Magnesium sulfat inj 20% Vial
198 Magnesium sulfat serb, ktg 30 g Sachet
199 Mebendazol sir 50 mg/ml Botol
200 Mebendazol tab 100 mg Tan
201 Metformin tab 500 mg Tab
Metilergometrin inj 0,2 mg/ml Ampul
203 Metilprednisolon tab 4 mg Tab
205 Metoklopramid sir 5 mg/5 ml (Lexapram sirup) Botol
206 Metoklopramid tab 10 mg Tab
207 Metronidazol supposutoria 500 mg suppo
208 Metronidazol larutan infus Botol
210 NaCl 0,9% Larutan infus Botol
211 Nifedipin kaps 10 mg Kaps
212 Nistatin tab salut 500.000 UI Tab
213 Nistatin tab vaginal 100.000 UI Tab
214 Ofloksasin tab 200 mg Tab
216 Oksitetrasiklin hcl inj 500 mg/ml Vial
217 Oksitetrasiklin hcl salep kulit 3% Tube
218 Oksitetrasiklin hcl salep mata 1 % Tube
219 Oksitosin inj 10 UI/ml Ampul
220 Papaverin tablet 40 mg Tab
221 Parasetamol sir 120 mg/5 ml Botol
223 Pehavral tablet multivitamin Tab
224 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube
225 Piracetam tablet 800 mg Tab
227 Piracetam injeksi 1 g/5 ml Ampul
228 Pirantel pamoat susp 125 mg/5 ml Botol
230 Polikresulen Botol
231 Povidon iodin lar 100 mg/ml Botol 30 ml
234 Primakuin tab 15 mg Tab
235 Propranolol tab 40 mg Tab
236 Ranitidin inj 25 mg/ml Ampul
237 Reserpin tablet 0.25 mg Tab
238 Rifampisin kaps 300 mg Kaps
239 Rifampisin tab 450 mg Tab
241 Ringer Laktat Larutan infus Botol
242 Salbutamol tab 2 mg Tab
endap 4 % Tube
246 Sefadroksil kaps 250 mg Vial
247 Sefiksim kapsul 100 mg Tab
248 Sefotaksim serb inj 1.000 mg/vial Vial
249 Seftriakson serb inj 1.000 mg/vial Vial
250 Setirizin tab 10 mg Tab
251 Sianokobalamin (vitamin B12) tab 50 mcg Tab
252 Simvastatin tab sal 10 mg Tab sal
254 Siprofloksasin inf 2 mg/ml Botol
255 Siprofloksasin tab scored 500 mg Tab
256 Spironolakton tab 100 mg Tab
257 Sulfasetamid Natrium Tetes mata 1.5% Botol
258 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol
259 Ulsidex Tablet
260 Retapyl SR Kapsul
261 Tetrasiklin kaps 250 mg Kaps
264 Tramadol inj 50 mg/ml Ampul
265 Vitamin B kompleks injeksi Vial
266 Zinc tab disp 20 mg Tab
267 Zinc sirup 20 mg / 5 ml Botol
268 Larutan PK botol
269 Kanamisin inj Vial
270 Antalgin 500mg tab
274 Klonidin 0,15 mg Tab
277 Fenolgliserol TT 10% Kotak
280 Kloroquin tab 250 mg
281 Papaverin tablet 40 mg
Prednison tab 5 mg Tab
Pirantel pamoat tab scored 125 mg Tab
Hidroklorotiazid (HCT) tab 25 mg Tab
B. Triheksifenidil tab 2 mg Tab
2 Vical Multivitamin Botol
3 Lexavit tab
6 Kloroquin Tablet 150 mg Tab
7 Aptyl Btl
8 Levopar Tablet
9 Pytogin inj Ampul
10 Phenytoin Sodium Kapsul
11 Etanol 300% cairan Botol
12 Bonding Botol
Calcium hidrosida cement pasta (hycal) Kotak
C. Comfosite Tube
1 Devitalisasi Pasta (Non Arsen) Kotak
2 Eugenol cair Botol
3 Etil Klorida spray Botol
4 Etza Tube
5 Glass Ionomer Cement ART Set
6 Klorfenol Kamfer Menthol (CHKM) Botol
7 Semen Seng Fosfat serbuk dan cairan Set
8 Temporari stoping pletcher Set
9 Mummiyng pasta Kotak
10 Albedazole 400mg Tab
12 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial
14 Imersion oil Botol
15 Iodina Test Botol
16 Obat Anti Tuberculosis FDC Kategori Anak Paket
17 Obat Anti Tuberculosis FDC Kategori I Paket
18 Obat Anti Tuberculosis FDC Kategori II Paket
19 Obat Anti Tuberculosis FDC Kategori Sisipan Paket
20 Reagen Zenit Nelson Botol
21 RDT Dangue DBD Set
22 RDT malaria (care star ) Set
23 RDT HIV (intec) Set
24 RDT HIV (vikia) Set
25 RDT HIV (Oncoprobe) Set
26 Taburia Kotak
33 Vaksin polio drops 10 dosis Vial
Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster
34 Vial
35 Retinol (Vit.A) 200.000 IU kap lunak
37 zink tab.20mg
38 Doxiciklin tab
39 Garam Oralit
40 Kina
41 Gentamicin Inj.
42 Pitomenadion Inj.
43 Diazepam Inj
44 Glukonas Kalsikas
45 Phenobarbital Inj.
46 Ampiciline Sodium Inj
47 Benzatin B Penicilin Inj.
Mg So4 20 %
D. Mg So4 40 %
1 Zinc 20 mg
2 Pyrantel Tab 125 mg
3 Alat Suntik 0,5 ml
4 Alat Suntik 5 ml
5 Kotrimoksasol 480 mg
6 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol
8 Catgut No 2/0 Set
9 Catgut No 3/0 Set
10 Handscoen no. 6 Pasang
11 Handscoen no. 6,5 Pasang
14 Infuset dewasa Set
15 Infusion set anak Set
18 Folley Catheter 16 Set
20 Folley catheter 22 Set
22 Kapas Berlemak 250 gram Rol
26 Kasa Kompres 40/40 steril Buah
27 Kasa Steril 16 X 16 Buah
28 Kasa pembalut 2 x 80 Rol
29 Kasa Pembalut 40 x 80 Rol
30 Pembalut Gips Buah
33 Sofratulle Set
34 Urine bag Set
35 Wing Needle No. 21 G Set
37 Wing Needle No.25 G Set
39 NGT No. 3 ( Feeding Tube ) Set
41 Tes gula darah Set
42 Tes Narkoba 3 parameter Set
44 Asering larutan infus Botol
45 Kuinin inj 25% (i.v.) Vial
46
47 JUMLAH OBAT-OBATAN (A)
48 OBAT GIGI
49 JUMLAH OBAT GIGI ( B )
50 OBAT PROGRAM
51 JUMLAH OBAT PROGRAM ( C )
52 BAHAN MEDIS HABIS PAKAI (BHMP)
BAYAR
18
KETERANGAN
393,300
948,300
1,341,600
380,000
920,000
1,300,000
POLEANG TENGAH
BOMBANA
SULAWESI TENGGARA
NOP
8
550
425
400
315
310
300
260
230
210
200
200
150
130
130
120
120
120
115
110
103
80
80
70
70
60
60
60
55
50
40
40
40
40
40
30
30
30
30
30
30
30
20
20
15
12
12
12
10
10
10
10
10
10
10
8
8
8
7
7
6
4
3
3
3
2
2
2
2
2
2
1
1
1
1
1
1
1
-
-
-
-
-
-
-
-
-
-
-
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-
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rekapan penggunaan obat DAN PERBEKES
puskesmas selama 1 tahun
tahun 2015
SKPD : PUSKESMAS POLEANG TENGAH

KABUPATEN : BOMBANA
PROVINSI : SULAWESI TENGARA
Saldo Awal 2015 Mutasi Masuk Mutasi Pengeluaran

1 Desember 2015 Bulan Desember 2015 Bulan Desember 2015
No Nama Obat Satuan / Kemasan Harga Harga Harga
Jumlah Satuan Nilai (Rp) Jumlah Satuan Nilai ( Rp) Jumlah Satuan
(Rp) (Rp) (Rp)
1 2 3 4 5 6 7 8 9 10 11
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul 30 2,200 66,000 0 2,200 - 0 2,200
2 Albendazol tab 400 mg Tab 200 363 72,600 0 363 - 0 363
3 Alopurinol tab 100 mg Tab 0 90 - 0 90 - 0 90
4 Alprazolam tab 1 mg Tab 0 245 - 0 245 - 0 245
200 245 49,000 0 245 - 0 245
5 Albothyl cairan Botol 0 18,635 - 0 18,635 - 0 18,635
6 Ambroksol tablet 30 mg Tab 200 138 27,516 0 138 - 0 138
7 Ambroksol sirup Botol 30 2,722 81,660 0 2,722 - 0 2,722
8 Aminofilin inj 24 mg/ml Ampul 24 4,204 100,896 0 4,204 - 0 4,204
9 Aminofilin tab 200 mg Tab 100 86 8,600 0 86 - 0 86
10 Amitriptilin tab sal 25 mg Tab sal 100 123 12,300 0 123 - 0 123
500 123 61,500
11 Amlodipin tab 10 mg Tab 0 352 - 0 352 - 0 352
12 Amlodipin tab 5 mg Tab 0 197 - 0 197 - 0 197
13 Amoksisilin sir kering 125 mg/5 ml Botol 50 2,560 128,000 0 2,560 - 40 2,560
14 Amoksisilin tab 250 mg Tab 500 220 110,000 0 220 - 200 220
15 Amoksisilin tab 500 mg Tab 800 279 223,200 0 279 - 300 279
16 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefri Ampul 0 1,499 - 0 1,499 - 0 1,499
17 Antasida, kombinasi : aluminium hidroksida 200 m Tab kunyah ### 78 132,600 0 78 - 0 78
18 Antasida, kombinasi : aluminium hidroksida 200 Botol 10 2,213 22,130 0 2,213 - 0 2,213
19 Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin Tube 15 2,767 41,505 0 2,767 - 0 2,767
20 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilatTube
3% 19 2,096 39,824 0 2,096 - 0 2,096
21 Antihemoroid, kombinasi: bismut subgalat 150 mg + heksaklorofen
Suppo 2,5 0 2,200 - 0 2,200 - 0 2,200
22 Anti Parkinson kombinasi : benzerasid 25 mg + le Kaps 100 1,650 165,000 0 1,650 - 0 1,650
23 Anti Migren, kombinasi : ergotamin 1 mg+ kafein 5 Tab 100 149 14,900 0 149 - 0 149
24 Antalgin (metampirom) tablet 100 mg Tab 0 155 - 0 155 - 0 155
25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul 600 1,346 807,600 0 1,346 - 0 1,346
26 Asam asetilsalisilat (asetosal) tab 100 mg Tab 900 127 114,300 0 127 - 0 127
27 Asam asetilsalisilat (asetosal) tab 500 mg Tab 0 178 - 0 178 - 0 178
28 Asam asetilsalisilat (asetosal) tab 80 mg (Miniaspi Tab 0 163 - 0 163 - 0 163
29 Asam askorbat (vitamin C) tab 50 mg Tab 400 105 42,000 0 105 - 0 105
30 Asam folat tab 1 mg Tab 300 52 15,600 0 52 - 0 52
31 Asam mefenamat kaps 250 mg Kaps 0 - 0 - 0
32 Asam mefenamat kaps 500 mg Kaps ### 127 127,000 0 127 - 0 127
33 Asam traneksamat inj 50 mg/ml Ampul 10 3,650 36,500 0 3,650 - 0 3,650
34 Asam traneksamat tab 500 mg Tab 300 1,265 379,500 0 1,265 - 0 1,265
35 Asering larutan infus Botol 0 9,000 - 0 9,000 - 0 9,000
36 Asiklovir salep kulit Tube 0 2,367 - 0 2,367 - 0 2,367
37 Asiklovir tab 200 mg Tab 150 251 37,650 0 251 - 0 251
750 251 188,250 0 251 - 0 251
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 1,400 - 0 1,400 - 0 1,400
39 Atropin tab 0,5 mg Tab 0 81 - 0 81 - 0 81
40 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol 0 13,500 - 0 13,500 - 0 13,500
41 Bedak salisil serb 2% Botol 10 1,350 13,500 0 1,350 - 0 1,350
42 Besi (II) sulfat 200 mg + asam folat 0.25 mg (table Sachet ### 55 858,000 0 55 - 0 55
43 Becefort syrup Botol 10 22,727 227,270 0 22,727 - 0 22,727
44 Betametason krim 0,1% Tube 24 1,596 38,304 0 1,596 - 0 1,596
45 Betahistin mesilate tablet tablet 0 600 - 0 600 - 0 600
46 Bisakodil sup 10 mg (Stolax) Botol 0 6,045 - 0 6,045 - 0 6,045
47 Bisakodil tab sal 5 mg Tab sal 0 4,990 - 0 4,990 - 0 4,990
48 Bismecon salep tube 0 - 0 - 0
49 Budesonid-formoterol ( fixed combination)* ih 80/4,5 mcg Botol 0 110,500 - 0 110,500 - 0 110,500
50 Bromheksin tablet tablet 100 42 4,237 0 42 - 0 42
51 Deksametason tab 0,5 mg Tab 500 68 34,000 0 68 - 300 68
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 100 1,738 173,800 0 1,738 - 0 1,738
53 Desoksimetason salep 0,25% Tube 0 9,983 - 0 9,983 - 0 9,983
54 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 0 2,578 - 0 2,578 - 0 2,578
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol 0 18,461 - 0 18,461 - 0 18,461
56 Diazepam supposutoria suppo 0 - 0 - 0
57 Diazepam tab 2 mg Tab 600 47 28,200 0 47 - 0 47
58 Diazepam tab 5 mg Tab 0 53 - 0 53 - 0 53
59 Dietilkarbamazin tab 100 mg Tab 0 104 - 0 104 - 0 104
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 30 1,160 34,800 0 1,160 - 0 1,160
61 Digoksin tab 0,25 mg Tab 0 103 - 0 103 - 0 103
100 103 10,300 0 103 - 0 103
62 Diltiazem kaps SR 100 mg Kaps 0 4,033 - 0 4,033 - 0 4,033
63 Diltiazem tab 30 mg Tab 0 - 0 - 0
64 Doksisiklin tablet 100 mg Tab 0 298 - 0 298 - 0 298
65 Domperidon susp 5 mg/5 ml Botol 0 3,490 - 0 3,490 - 0 3,490
66 Domperidon tab 10 mg Tab 200 174 34,800 0 174 - 0 174
200 174 34,800 0 174 - 0 174
67 Efedrin HCl tablet Tab 500 56 28,000 0 56 - 0 56
68 Ekstrak belladon tablet 10 mg tab 0 42 - 0 42 - 0 42
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 600 8,910 5,346,000 0 8,910 - 0 8,910
70 Eritromisin kaps 250 mg Kaps 0 522 - 0 522 - 0 522
71 Eritromisin sir 200 mg/5 ml Botol 0 8,090 - 0 8,090 - 0 8,090
72 Eritromisin tab 500 mg Tab 700 1,023 716,100 0 1,023 - 0 1,023
73 Etanol 70% cairan 70% Botol 0 2,625 - 0 2,625 - 0 2,625
74 Etakridin (rivanol) larutan 0.1% Botol 0 4,695 - 0 4,695 - 0 4,695
75 Etil klorida semprot 100 ml Botol 0 105,000 - 0 105,000 - 0 105,000
76 Famotidin tablet 20 mg Tab 0 124 - 0 124 - 0 124
77 Fenitoin Na inj 50 mg/ml Ampul 0 20,857 - 0 20,857 - 0 20,857
78 Fenitoin Na kaps 100 mg Kaps 0 146 - 0 146 - 0 146
79 Fenobarbital inj 50 mg/ml Ampul 0 1,980 - 0 1,980 - 0 1,980
80 Fenobarbital tab 100 mg Tab 0 1,075 - 0 1,075 - 0 1,075
81 Fenobarbital tab 30 mg Tab 0 37 - 0 37 - 0 37
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 30 3,754 112,620 0 3,754 - 0 3,754
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 100 698 69,800 0 698 - 0 698
84 Flukonazol kaps 150 mg Kaps 100 24,200 2,420,000 0 24,200 - 0 24,200
85 Flusinolon asetonid krim 0,025% Tube 0 2,700 - 0 2,700 - 0 2,700
86 Flunarizin tablet tablet 0 2,400 - 0 2,400 - 0 2,400
87 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 25 2,012 50,300 0 2,012 - 0 2,012
25 2,012 50,300 0 2,012 - 0 2,012
88 Furosemid tab 40 mg Tab 400 84 33,600 0 84 - 0 84
800 84 67,200 0 84 - 0 84
89 Garam oralit kombinasi : natrium klorida 0,52 g + kalium kl Sachet 80 317 25,360 0 317 - 0 317
600 317 190,200 0 317 - 0 317
90 Gameksan lotion 1 % Botol 0 2,420 - 0 2,420 - 0 2,420
91 Gemfibrozil kaps 300 mg Kaps 300 323 96,900 0 323 - 0 323
92 Gemfibrozil kaps 600 mg Kaps 0 747 - 0 747 - 0 747
93 Gentamisin inj 10 mg/ml Ampul 0 3,739 - 0 3,739 - 0 3,739
94 Gentamisin salep mata 0,3% Tube 0 2,786 - 0 2,786 - 0 2,786
95 Gentamisin salep Kulit Tube 75 1,469 110,175 0 1,469 - 0 1,469
96 Gentamisin tts mata 0,3% Botol 0 3,513 - 0 3,513 - 0 3,513
97 Glibenklamid tab 5 mg Tab 400 61 24,400 0 61 - 100 61
98 Glimepirid tab 4 mg Tab 0 452 - 0 452 - 0 452
99 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab 0 3,000 - 0 3,000 - 0 3,000
100 Gliseril Guaiakolat tab 100 mg Tab ### 31 62,000 0 31 - 0 31
101 Gliserin lar 50% Botol 0 5,867 - 0 5,867 - 0 5,867
102 Glukosamin tablet 500 mg Tab 0 660 - 0 660 - 0 660
103 Glukosa Larutan Infus 5% steril Botol 0 5,720 - 0 5,720 - 0 5,720
106 Griseofulvin (micronized) tab 125 mg Tab 100 230 23,000 0 230 - 0 230
107 Haloperidol tab 0,5 mg Tab 200 62 12,400 0 62 - 0 62
108 Haloperidol tab 1,5 mg Tab 0 76 - 0 76 - 0 76
109 Haloperidol tab 5 mg Tab 300 105 31,500 0 105 - 0 105
110 Hidrogen peroksida (H2O2) cairan 3% Botol 0 38,500 - 0 38,500 - 0 38,500
111 Hidroklorotiazid (HCT) tab 25 mg Tab 0 40 - 0 40 - 0 40
112 Hidrokortison krim 2,5% Tube 0 2,938 - 0 2,938 - 0 2,938
113 Hiosina butilbromida tab 10 mg Tab 0 330 - 0 330 - 0 330
114 Ibuprofen susp 100 mg/5 ml Botol 15 3,849 57,735 0 3,849 - 0 3,849
115 Ibuprofen tab 200 mg Tab 200 121 24,200 0 121 - 0 121
116 Ibuprofen tab 400 mg Tab 0 157 - 0 157 - 0 157
117 Ipratropium bromida nebulizer 0,025% (Atroven sol. Botol 0 90,000 - 0 90,000 - 0 90,000
118 Isoniazid tab 300 mg Tab 0 174 - 0 174 - 0 174
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 0 36,960 - 0 36,960 - 0 36,960
120 Isosorbid dinitrat tab 5 mg Tab 0 98 - 0 98 - 0 98
121 KA-EN 3B Cairan Infus Botol 0 10,000 - 0 10,000 - 0 10,000
122 Kalsium glukonat inj 100 mg/ml Ampul 0 7,800 - 0 7,800 - 0 7,800
123 Kalsium laktat (kalk) tab 500 mg Tab 300 76 22,800 0 76 - 0 76
124 Kaptopril tab 12,5 mg Tab 200 69 13,800 0 69 - 0 69
125 Kaptopril tab 25 mg Tab 0 97 - 0 97 - 0 97
126 Karbamazepin tab 200 mg Tab 0 269 - 0 269 - 0 269
127 Karbo adsorben (Norit) tab 500 mg Tab 0 - 0 - 0
128 Ketamin inj 50 mg/ml (i.v.) Ampul 0 63,400 - 0 63,400 - 0 63,400
129 Ketokonazol tab 200 mg Tab 300 320 96,000 0 320 - 0 320
130 Ketokonazol krim 2% Tube 0 5,150 - 0 5,150 - 0 5,150
131 Ketorolak inj 10 mg/ml Ampul 0 2,665 - 0 2,665 - 0 2,665
132 Klaritromisin tab 500 mg Tab 0 3,600 - 0 3,600 - 0 3,600
133 Klindamisin kaps 150 mg Kaps 100 405 40,500 0 405 - 0 405
134 Kloramfenikol tts mata 0,5% Botol 0 1,680 - 0 1,680 - 0 1,680
135 Kloramfenikol kaps 250 mg Kaps 0 275 - 0 275 - 0 275
136 Kloramfenikol salep mata 1% Tube 0 1,680 - 0 1,680 - 0 1,680
137 Kloramfenikol susp 125 mg/5 ml Botol 10 4,016 40,160 0 4,016 - 0 4,016
138 Klorfeniramin (CTM) tab 4 mg Tab ### 26 26,400 0 26 - 0 26
139 Klorpromazin inj 25 mg/ml (i.m.) Ampul 0 1,210 - 0 1,210 - 0 1,210
140 Klorpromazin tab sal 100 mg Tab sal 0 162 - 0 162 - 0 162
142 Kombinasi : Pirimethamin 25 mg + sulfadoksin Tab 0 531 - 0 531 - 0 531
143 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules
Vial(Com 0 5,990 - 0 5,990 - 0 5,990
144 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400Tab
mg+ 700 152 106,400 0 152 - 0 152
145 Kotrimoksazol (anak) kombinasi : sulfametoksazol 100 mg+
Tabtr 100 79 7,900 0 79 - 0 79
300 79 23,700 0 79 - 0 79
146 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspen Botol 0 2,298 - 0 2,298 - 0 2,298
147 Kuinin inj 25% (i.v.) Vial 0 6,820 - 0 6,820 - 0 6,820
148 Kloroquin tab 150 mg Tab 0 112 - 0 112 - 0 112
149 Lansoprazol kaps 30 mg Kaps 0 521 - 0 521 - 0 521
150 Levofloksasin tab 500 mg Tab 200 581 116,200 0 581 - 0 581
151 Lidokain gel 2% Tube 0 40,000 - 0 40,000 - 0 40,000
152 Lidokain inj 2% (hcl) Vial 170 929 157,930 0 929 - 0 929
153 Lisol Botol 3 54,995 164,985 0 54,995 - 0 54,995
154 Loperamid tab 2 mg Tab 200 97 19,400 0 97 - 0 97
155 Loratadin tab 10 mg Tab 210 170 35,700 0 170 - 0 170
156 Magnesium sulfat inj 20% Vial 0 7,260 - 0 7,260 - 0 7,260
157 Magnesium sulfat inj 40% Vial 0 7,260 - 0 7,260 - 0 7,260
158 Magnesium sulfat serb, ktg 30 g Sachet 0 1,130 - 0 1,130 - 0 1,130
159 Mebendazol sir 50 mg/ml Botol 3 3,887 11,661 0 3,887 - 0 3,887
160 Mebendazol tab 100 mg Tan 0 248 - 0 248 - 0 248
161 Metformin tab 500 mg Tab 0 125 - 0 125 - 0 125
162 Metformin tab 850 mg Tab 0 280 - 0 280 - 0 280
163 Metilergometrin inj 0,2 mg/ml Ampul 0 2,750 - 0 2,750 - 0 2,750
164 Metilergometrin tab salut 0,125 mg Tab sal 0 169 - 0 169 - 0 169
200 169 33,800 0 169 - 0 169
165 Metilprednisolon tab 4 mg Tab 0 230 - 0 230 - 0 230
166 Metoklopramid inj 5 mg/ml Vial 0 1,100 - 0 1,100 - 0 1,100
167 Metoklopramid sir 5 mg/5 ml (Lexapram sirup) Botol 0 2,900 - 0 2,900 - 0 2,900
168 Metoklopramid tab 10 mg Tab 200 100 20,000 0 100 - 0 100
169 Metronidazol supposutoria 500 mg suppo 0 3,655 - 0 3,655 - 0 3,655
170 Metronidazol larutan infus Botol 0 12,980 - 0 12,980 - 0 12,980
171 Metronidazol tab 250 mg Tab 0 116 - 0 116 - 0 116
172 Metronidazol tab 500 mg Tab 0 169 - 0 169 - 0 169
173 Mikonazol krim 2% Tube 20 3,150 63,000 0 3,150 - 0 3,150
174 Natrium diklofenak tab 25 mg Tab 200 146 29,200 0 146 - 0 146
175 Natrium diklofenak tab 50 mg Tab 200 193 38,600 0 193 - 0 193
176 NaCl 0,9% Larutan infus Botol 70 5,170 361,900 0 5,170 - 0 5,170
177 Nifedipin kaps 10 mg Kaps 0 127 - 0 127 - 0 127
178 Nistatin tab salut 500.000 UI Tab 0 704 - 0 704 - 0 704
179 Nistatin tab vaginal 100.000 UI Tab 0 528 - 0 528 - 0 528
180 Obat Batuk Hitam (OBH) Botol 20 2,310 46,200 0 2,310 - 0 2,310
181 Ofloksasin tab 200 mg Tab 0 440 - 0 440 - 0 440
182 Ofloksasin tab 400 mg Tab 150 700 105,000 0 700 - 0 700
183 Oksitetrasiklin hcl inj 500 mg/ml Vial 0 3,410 - 0 3,410 - 0 3,410
184 Oksitetrasiklin hcl salep kulit 3% Tube 0 1,646 - 0 1,646 - 0 1,646
185 Oksitetrasiklin hcl salep mata 1 % Tube 0 2,772 - 0 2,772 - 0 2,772
186 Oksitosin inj 10 UI/ml Ampul 0 1,900 - 0 1,900 - 0 1,900
187 Omeprazol kaps 20 mg Kaps 0 221 - 0 221 - 0 221
188 Papaverin tablet 40 mg Tab ### 109 109,450 0 109 - 0 109
189 Parasetamol sir 120 mg/5 ml Botol 0 1,535 - 0 1,535 - 0 1,535
190 Parasetamol tab 100 mg Tab 500 105 52,500 0 105 - 0 105
191 Parasetamol tab 500 mg Tab 700 88 61,600 0 88 - 200 88
192 Parasetamol rectal suppo 0 - 0 - 0
193 Pehavral tablet multivitamin Tab 0 297 - 0 297 - 0 297
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 0 25,350 - 0 25,350 - 0 25,350
195 Phenylbutazon tablet 200 mg Tab 0 107 - 0 107 - 0 107
196 Piracetam tablet 800 mg Tab 0 964 - 0 964 - 0 964
198 Piracetam injeksi 1 g/5 ml Ampul 0 6,050 - 0 6,050 - 0 6,050
199 Pirantel pamoat susp 125 mg/5 ml Botol 0 9,100 - 0 9,100 - 0 9,100
200 Pirantel pamoat tab scored 125 mg Tab 80 318 25,440 0 318 - 20 318
201 Piridoksin (vitamin B6) tab 25 mg Tab ### 19 76,000 0 19 - 0 19
202 Piroksikam tablet 20 mg Tab 0 116 - 0 116 - 0 116
203 Polikresulen Botol 0 18,635 - 0 18,635 - 0 18,635
204 Povidon iodin lar 100 mg/ml Botol 30 ml 7 2,344 16,408 0 2,344 - 0 2,344
205 Povidon iodin lar 100 mg/ml Botol 300 ml 2 15,386 30,772 0 15,386 - 0 15,386
206 Povidon iodin lar 100 mg/ml Botol 1000 ml 0 40,202 - 0 40,202 - 0 40,202
207 Prednison tab 5 mg Tab ### 98 294,000 0 98 - 0 98
208 Primakuin tab 15 mg Tab ### 125 250,000 0 125 - 0 125
209 Procurma syrup Botol 0 12,021 - 0 12,021 - 0 12,021
210 Propiltiourasil tab 100 mg Tab 600 351 210,600 0 351 - 0 351
211 Propranolol tab 40 mg Tab 0 114 - 0 114 - 0 114
212 Ranitidin inj 25 mg/ml Ampul 0 1,340 - 0 1,340 - 0 1,340
213 Ranitidin tab 150 mg Tab 0 128 - 0 128 - 0 128
214 Reserpin tablet 0.25 mg Tab 0 968 - 0 968 - 0 968
215 Rifampisin kaps 300 mg Kaps 0 440 - 0 440 - 0 440
216 Rifampisin tab 450 mg Tab 0 624 - 0 624 - 0 624
217 Rifampisin tab 600 mg Tab 0 863 - 0 863 - 0 863
218 Ringer Laktat Larutan infus Botol 60 5,720 343,200 0 5,720 - 0 5,720
219 Salbutamol tab 2 mg Tab 100 92 9,243 0 92 - 0 92
200 65 13,000 0 65 - 0 65
220 Salbutamol tab 4 mg Tab 100 93 9,300 0 93 - 0 93
200 93 18,600 0 93 - 0 93
221 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang Tube 24 2,200 52,800 0 2,200 - 0 2,200
222 Scabicid salep Tube 0 - 0 - 0
223 Sefadroksil kaps 250 mg Vial 0 564 - 0 564 - 0 564
224 Sefadroksil kaps/tab 500 mg Tab 500 548 274,000 0 548 - 0 548
225 Sefadroksil sir kering 125 mg/5 ml Botol 20 5,286 105,720 0 5,286 - 0 5,286
226 Sefiksim kapsul 100 mg Tab 0 1,000 - 0 1,000 - 0 1,000
227 Sefotaksim serb inj 1.000 mg/vial Vial 0 3,500 - 0 3,500 - 0 3,500
228 Seftriakson serb inj 1.000 mg/vial Vial 0 3,900 - 0 3,900 - 0 3,900
229 Setirizin tab 10 mg Tab 0 190 - 0 190 - 0 190
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial 0 1,150 - 0 1,150 - 0 1,150
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 0 15 - 0 15 - 0 15
232 Simetidin tablet 200 mg Tab 300 138 41,367 0 138 - 0 138
233 Simvastatin tab sal 10 mg Tab sal 0 177 - 0 177 - 0 177
234 Simvastatin tab sal 20 mg Tab sal 0 480 - 0 480 - 0 480
235 Siprofloksasin inf 2 mg/ml Botol 0 22,000 - 0 22,000 - 0 22,000
236 Siprofloksasin tab scored 500 mg Tab 0 290 - 0 290 - 0 290
237 Spironolakton tab 100 mg Tab 200 350 70,000 0 350 - 0 350
238 Sulfasetamid Natrium Tetes mata 1.5% Botol 0 3,549 - 0 3,549 - 0 3,549
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol 0 14,450 - 0 14,450 - 0 14,450
240 Sukralfat tab 500 mg (Ulsidex) Tab 0 477 - 0 477 - 0 477
241 Teofilin tab SR 300 mg (Rethapyl) Tab 0 1,155 - 0 1,155 - 0 1,155
242 Tetrasiklin kaps 250 mg Kaps 0 183 - 0 183 - 0 183
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab ### 42 84,000 0 42 - 0 42
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab 0 770 - 0 770 - 0 770
246 Tramadol inj 50 mg/ml Ampul 30 2,680 80,400 0 2,680 - 0 2,680
60 2,680 160,800 0 2,680 - 0 2,680
247 Tramadol tablet 500 mg Tab 0 363 - 0 363 - 0 363
248 Triheksifenidil tab 2 mg Tab 400 45 18,000 0 45 - 0 45
249 Vitamin B12 tablet 50 mcg Tab 800 63 50,400 0 63 - 0 63
250 Vitamin B kompleks injeksi Vial 25 7,392 184,800 0 7,392 - 0 7,392
251 Vitamin B kompleks Tab 700 112 78,400 0 112 - 0 112
252 Zinc tab disp 20 mg Tab 100 521 52,100 0 521 - 0 521
253 Zinc sirup 20 mg / 5 ml Botol 0 8,140 - 0 8,140 - 0 8,140
254 Larutan PK botol 12 6,975 83,700 0 6,975 - 0 6,975
255 Kanamisin inj Vial 0 5,929 - 0 5,929 - 0 5,929
256 Antalgin 500mg tab 800 141 112,800 0 141 - 0 141
257 Klorpromazin inj 25 mg/ml (i.m.) Ampul 0 1,210 - 0 1,210 - 0 1,210
258 Kalsium laktat (kalk) tab 500 mg Tab 0 76 - 0 76 - 0 76
259 Kloroquin tab 150 mg Tab 0 572 - 0 572 - 0 572
260 Klonidin 0,15 mg Tab 0 193 - 0 193 - 0 193
261 Kloramfenikol kaps 250 mg Kaps 0 275 - 0 275 - 0 275
263 Fenolgliserol TT 10% Kotak 96 1,109 106,464 0 1,109 - 0 1,109
266 Kloroquin tab 250 mg 0 112 - 0 112 - 0 112
267 Papaverin tablet 40 mg 0 167 - 0 167 - 0 167
268 Prednison tab 5 mg Tab 0 125 - 0 125 - 0 125
269 Pirantel pamoat tab scored 125 mg Tab 0 318 - 0 318 - 0 318
270 Hidroklorotiazid (HCT) tab 25 mg Tab 0 109 - 0 109 - 0 109
271 Triheksifenidil tab 2 mg Tab 0 45 - 0 45 - 0 45
273 Vical suspensi btl 0 22,727 - 0 22,727 - 0 22,727
274 Lexavit tab 0 480 - 0 480 - 0 480
275 Gliseril Guaiakolat tab 100 mg Tab 0 31 - 0 31 - 0 31
276 Efedrin HCl tablet Tab 0 56 - 0 56 - 0 56
B. OBAT GIGI
1 Bonding Botol 0 765,000 - 0 765,000 - 0 765,000
2 Calcium hidrosida cement pasta (hycal) Kotak 0 242,000 - 0 242,000 - 0 242,000
3 Comfosite Tube 0 338,000 - 0 338,000 - 0 338,000
4 Devitalisasi Pasta (Non Arsen) Kotak 0 390,000 - 0 390,000 - 0 390,000
5 Eugenol cair Botol 0 18,333 - 0 18,333 - 0 18,333
6 Etil Klorida spray Botol 0 105,000 - 0 105,000 - 0 105,000
7 Etza Tube 0 170,000 - 0 170,000 - 0 170,000
8 Glass Ionomer Cement ART Set 0 197,895 - 0 197,895 - 0 197,895
9 Klorfenol Kamfer Menthol (CHKM) Botol 0 55,000 - 0 55,000 - 0 55,000
10 Semen Seng Fosfat serbuk dan cairan Set 0 93,500 - 0 93,500 - 0 93,500
11 Temporari stoping pletcher Set 1 34,000 34,000 0 34,000 - 0 34,000
12 Mummiyng pasta Kotak 0 176,000 - 0 176,000 - 0 176,000
JUMLAH OBAT GIGI (B)
C. OBAT PROGRAM
1 Albedazole 400mg Tab 600 363 217,800 0 363 - 0 363
2 Artemether inj 80 mg/ml Ampul 0 24,384 - 0 24,384 - 0 24,384
3 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 0 27,569 - 0 27,569 - 0 27,569
4 Dietilkarbamazin tab 100 mg Tab 300 104 31,200 0 104 - 0 104
5 Imersion oil Botol 0 825,000 - 0 825,000 - 0 825,000
6 Iodina Test Botol 0 4,545 - 0 4,545 - 0 4,545
7 Obat Anti Tuberculosis FDC Kategori Anak Paket 0 236,490 - 0 236,490 - 0 236,490
8 Obat Anti Tuberculosis FDC Kategori I Paket 0 396,000 - 0 396,000 - 0 396,000
9 Obat Anti Tuberculosis FDC Kategori II Paket 0 1,319,990 - 0 1,319,990 - 0 1,319,990
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 0 175,990 - 0 175,990 - 0 175,990
11 Reagen Zenit Nelson Botol 0 145,000 - 0 145,000 - 0 145,000
12 RDT Dangue DBD Set 0 150,000 - 0 150,000 - 0 150,000
13 RDT malaria (care star ) Set 0 168,300 - 0 168,300 - 0 168,300
14 RDT HIV (intec) Set 0 46,200 - 0 46,200 - 0 46,200
15 RDT HIV (vikia) Set 0 45,560 - 0 45,560 - 0 45,560
16 RDT HIV (Oncoprobe) Set 0 42,350 - 0 42,350 - 0 42,350
17 Taburia Kotak 0 20,454 - 0 20,454 - 0 20,454
18 Quinina injeksi Ampul 0 - 0 - 0
19 Vaksin BCG inj (i.k) Vial 0 - 0 - 0
20 Vaksin campak inj (s.k.) Vial 0 - 0 - 0
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial 0 - 0 - 0
22 Vaksin jerap difteri tetanus (DT) Vial 0 - 0 - 0
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial 0 - 0 - 0
24 Vaksin polio drops 10 dosis Vial 0 285,000 - 0 285,000 - 0 285,000
25 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + bo Vial 0 78,000 - 0 78,000 - 0 78,000
26 Retinol (Vit.A) 200.000 IU kap lunak 0 505 - 0 505 - 0 505
27 Retinol (Vit.A) 100.000 IU kap lunak 0 286 - 0 286 - 0 286
28 zink tab.20mg ### 512 614,400 0 512 - 0 512
29 Doxiciklin tab 0 - 0 - 0
JUMLAH OBAT PROGRAM (C)
D. BAHAN MEDIS HABIS PAKAI (BHMP)
1 Alat suntik sekali pakai 1 ml Set 0 1,093 - 0 1,093 - 0 1,093
600 848 508,950 0 848 - 0 848
2 Alat suntik sekali pakai 2,5 ml Set 100 848 84,825 0 848 - 50 848
3 Alat suntik sekali pakai 3 ml Set 200 848 169,650 0 848 - 0 848
4 Alat suntik sekali pakai 5 ml Set 50 979 48,938 0 979 - 0 979
5 Bisturi no. 20 Buah 0 2,099 - 0 2,099 - 0 2,099
6 Bisturi no. 15 Buah 0 2,099 - 0 2,099 - 0 2,099
300 2,100 630,000 0 2,100 - 0 2,100
7 Catgut No 2/0 Set 24 25,920 622,080 0 25,920 - 0 25,920
8 Catgut No 3/0 Set 36 5,900 212,400 0 5,900 - 0 5,900
9 Handscoen no. 6 Pasang 0 6,595 - 0 6,595 - 0 6,595
10 Handscoen no. 6,5 Pasang 0 6,595 - 0 6,595 - 0 6,595
11 Handscoen no. 7 Pasang 0 7,684 - 0 7,684 - 0 7,684
12 Handscoen no. 7,5 Pasang 50 7,684 384,200 0 7,684 - 0 7,684
13 Infuset dewasa Set 40 4,176 167,040 0 4,176 - 0 4,176
14 Infusion set anak Set 20 4,568 91,360 0 4,568 - 0 4,568
15 IV Catheter No.16 G Set 0 7,937 - 0 7,937 - 0 7,937
16 IV Catheter No.18 G Set 4 7,937 31,748 0 7,937 - 0 7,937
17 IV Catheter No.24 G Set 0 7,937 - 0 7,937 - 0 7,937
18 IV Catheter No. 20 G Set 37 7,787 288,119 0 7,787 - 0 7,787
35 7,787 272,545 0 7,787 - 0 7,787
19 IV Catheter No. 22 G Set 4 7,937 31,748 0 7,937 - 0 7,937
20 Folley Catheter 16 Set 0 10,440 - 0 10,440 - 0 10,440
21 Folley Catheter 18 Set 0 10,440 - 0 10,440 - 0 10,440
22 Folley catheter 22 Set 0 10,440 - 0 10,440 - 0 10,440
23 Folley catheter 24 Set 0 10,440 - 0 10,440 - 0 10,440
24 Kapas Berlemak 250 gram Rol 0 27,821 - 0 27,821 - 0 27,821
25 Kapas Berlemak 500 gram Rol 0 21,533 - 0 21,533 - 0 21,533
26 Kasa Pembalut 4m x 3 cm Rol 0 800 - 0 800 - 0 800
27 Kasa Pembalut 4m x 5 cm Rol 0 4,921 - 0 4,921 - 0 4,921
28 Kasa Pembalut 4m x 10 cm Rol 20 6,121 122,420 0 6,121 - 5 6,121
29 Kasa Pembalut 4m x 15 cm Rol 0 887 - 0 887 - 0 887
30 Kasa Kompres 40/40 steril Buah 0 5,621 - 0 5,621 - 0 5,621
31 Kasa Steril 16 X 16 Buah 0 11,724 - 0 11,724 - 0 11,724
32 Kasa pembalut 2 x 80 Rol 2 13,221 26,442 0 13,221 - 1 13,221
33 Kasa Pembalut 40 x 80 Rol 0 137,025 - 0 137,025 - 0 137,025
34 Kasa Pembalut 36 x 80 cm Rol 1 133,821 133,821 0 133,821 - 0 133,821
35 Pembalut Gips Buah 0 32,500 - 0 32,500 - 0 32,500
36 Plester 5 yard x 2 inc Rol 2 23,625 47,250 0 23,625 - 0 23,625
37 Silk Set 0 18,781 - 0 18,781 - 0 18,781
38 Selang oksigen anak Set 0 - 0 - 0
39 Selang oksigen dewasa Set 0 - 0 - 0
40 Sofratulle Set 0 - 0 - 0
41 Urine bag Set 6 4,000 24,000 0 4,000 - 0 4,000
42 Wing Needle No. 21 G Set 0 5,770 - 0 5,770 - 0 5,770
44 Wing Needle No.25 G Set 0 5,770 - 0 5,770 - 0 5,770
46 NGT No. 3 ( Feeding Tube ) Set 0 22,000 - 0 22,000 - 0 22,000
47 NGT No. 5 ( Feeding Tube ) Set 0 22,000 - 0 22,000 - 0 22,000
48 Masker Buah 70 1,125 78,750 0 1,125 - 70 1,125
49 Tes gula darah Set 0 8,018 - 0 8,018 - 0 8,018
50 Tes Narkoba 3 parameter Set 0 68,181 - 0 68,181 - 0 68,181
51 Tes Narkoba 5 parameter Set 0 68,181 - 0 68,181 - 0 68,181
52 Tes Kehamilan Sachet 11 3,413 37,543 0 3,413 - 11 3,413
TOTAL 23,717,761 -
naan obat DAN PERBEKES
as selama 1 tahun
ahun 2015
Mutasi Pengeluaran Saldo Akhir

Bulan Desember 2015 Per 31 Desember 2015
Harga
Nilai (Rp) Jumlah Satuan Nilai (Rp)
(Rp)
12 13 14 15
- 30 2,200 66,000
- 200 363 72,600
- 0 90 -
- 0 245 -
- 200 245 49,000
- 0 18,635 -
- 200 138 27,516
- 30 2,722 81,660
- 24 4,204 100,896
- 100 86 8,600
- 100 123 12,300
500 123 61,500
- 0 352 -
- 0 197 -
102,400 10 2,560 25,600
44,000 300 220 66,000
83,700 500 279 139,500
- 0 1,499 -
- ### 78 132,600
- 10 2,213 22,130
- 15 2,767 41,505
- 19 2,096 39,824
- 0 2,200 -
- 100 1,650 165,000
- 100 149 14,900
- 0 155 -
- 600 1,346 807,600
- 900 127 114,300
- 0 178 -
- 0 163 -
- 400 105 42,000
- 300 52 15,600
- 0 -
- ### 127 127,000
- 10 3,650 36,500
- 300 1,265 379,500
- 0 9,000 -
- 0 2,367 -
- 150 251 37,650
- 750 251 188,250
- 0 1,400 -
- 0 81 -
- 0 13,500 -
- 10 1,350 13,500
- ### 55 858,000
- 10 22,727 227,270
- 24 1,596 38,304
- 0 600 -
- 0 6,045 -
- 0 4,990 -
- 0 -
- 0 110,500 -
- 100 42 4,237
20,400 200 68 13,600
- 100 1,738 173,800
- 0 9,983 -
- 0 2,578 -
- 0 18,461 -
- 0 -
- 600 47 28,200
- 0 53 -
- 0 104 -
- 30 1,160 34,800
- 0 103 -
- 100 103 10,300
- 0 4,033 -
- 0 -
- 0 298 -
- 0 3,490 -
- 200 174 34,800
- 200 174 34,800
- 500 56 28,000
- 0 42 -
- 600 8,910 5,346,000
- 0 522 -
- 0 8,090 -
- 700 1,023 716,100
- 0 2,625 -
- 0 4,695 -
- 0 105,000 -
- 0 124 -
- 0 20,857 -
- 0 146 -
- 0 1,980 -
- 0 1,075 -
- 0 37 -
- 30 3,754 112,620
- 100 698 69,800
- 100 24,200 2,420,000
- 0 2,700 -
- 0 2,400 -
- 25 2,012 50,300
- 25 2,012 50,300
- 400 84 33,600
- 800 84 67,200
- 80 317 25,360
- 600 317 190,200
- 0 2,420 -
- 300 323 96,900
- 0 747 -
- 0 3,739 -
- 0 2,786 -
- 75 1,469 110,175
- 0 3,513 -
6,100 300 61 18,300
- 0 452 -
- 0 3,000 -
- ### 31 62,000
- 0 5,867 -
- 0 660 -
- 0 5,720 -
- 0 6,270 -
- 0 6,270 -
- 100 230 23,000
- 200 62 12,400
- 0 76 -
- 300 105 31,500
- 0 38,500 -
- 0 40 -
- 0 2,938 -
- 0 330 -
- 15 3,849 57,735
- 200 121 24,200
- 0 157 -
- 0 90,000 -
- 0 174 -
- 0 36,960 -
- 0 98 -
- 0 10,000 -
- 0 7,800 -
- 300 76 22,800
- 200 69 13,800
- 0 97 -
- 0 269 -
- 0 -
- 0 63,400 -
- 300 320 96,000
- 0 5,150 -
- 0 2,665 -
- 0 3,600 -
- 100 405 40,500
- 0 1,680 -
- 0 275 -
- 0 1,680 -
- 10 4,016 40,160
- ### 26 26,400
- 0 1,210 -
- 0 162 -
- 0 75 -
- 0 531 -
- 0 5,990 -
- 700 152 106,400
- 100 79 7,900
- 300 79 23,700
- 0 2,298 -
- 0 6,820 -
- 0 112 -
- 0 521 -
- 200 581 116,200
- 0 40,000 -
- 170 929 157,930
- 3 54,995 164,985
- 200 97 19,400
- 210 170 35,700
- 0 7,260 -
- 0 7,260 -
- 0 1,130 -
- 3 3,887 11,661
- 0 248 -
- 0 125 -
- 0 280 -
- 0 2,750 -
- 0 169 -
- 200 169 33,800
- 0 230 -
- 0 1,100 -
- 0 2,900 -
- 200 100 20,000
- 0 3,655 -
- 0 12,980 -
- 0 116 -
- 0 169 -
- 20 3,150 63,000
- 200 146 29,200
- 200 193 38,600
- 70 5,170 361,900
- 0 127 -
- 0 704 -
- 0 528 -
- 20 2,310 46,200
- 0 440 -
- 150 700 105,000
- 0 3,410 -
- 0 1,646 -
- 0 2,772 -
- 0 1,900 -
- 0 221 -
- ### 109 109,450
- 0 1,535 -
- 500 105 52,500
17,600 500 88 44,000
- 0 -
- 0 297 -
- 0 25,350 -
- 0 107 -
- 0 964 -
- 0 854 -
- 0 6,050 -
- 0 9,100 -
6,360 60 318 19,080
- ### 19 76,000
- 0 116 -
- 0 18,635 -
- 7 2,344 16,408
- 2 15,386 30,772
- 0 40,202 -
- ### 98 294,000
- ### 125 250,000
- 0 12,021 -
- 600 351 210,600
- 0 114 -
- 0 1,340 -
- 0 128 -
- 0 968 -
- 0 440 -
- 0 624 -
- 0 863 -
- 60 5,720 343,200
- 100 92 9,243
- 200 65 13,000
- 100 93 9,300
- 200 93 18,600
- 24 2,200 52,800
- 0 -
- 0 564 -
- 500 548 274,000
- 20 5,286 105,720
- 0 1,000 -
- 0 3,500 -
- 0 3,900 -
- 0 190 -
- 0 1,150 -
- 0 15 -
- 300 138 41,367
- 0 177 -
- 0 480 -
- 0 22,000 -
- 0 290 -
- 200 350 70,000
- 0 3,549 -
- 0 14,450 -
- 0 477 -
- 0 1,155 -
- 0 183 -
- 0 283 -
- ### 42 84,000
- 0 770 -
- 30 2,680 80,400
- 60 2,680 160,800
- 0 363 -
- 400 45 18,000
- 800 63 50,400
- 25 7,392 184,800
- 700 112 78,400
- 100 521 52,100
- 0 8,140 -
- 12 6,975 83,700
- 0 5,929 -
- 800 141 112,800
- 0 1,210 -
- 0 76 -
- 0 572 -
- 0 193 -
- 0 275 -
- 0 162 -
- 96 1,109 106,464
- 0 162 -
- 0 112 -
- 0 167 -
- 0 125 -
- 0 318 -
- 0 109 -
- 0 45 -
- 0 854 -
- 0 22,727 -
- 0 480 -
- 0 31 -
- 0 56 -
- 0 765,000 -
- 0 242,000 -
- 0 338,000 -
- 0 390,000 -
- 0 18,333 -
- 0 105,000 -
- 0 170,000 -
- 0 197,895 -
- 0 55,000 -
- 0 93,500 -
- 1 34,000 34,000
- 0 176,000 -
- 600 363 217,800

- 0 24,384 -
- 0 27,569 -
- 300 104 31,200
- 0 825,000 -
- 0 4,545 -
- 0 236,490 -
- 0 396,000 -
- 0 1,319,990 -
- 0 175,990 -
- 0 145,000 -
- 0 150,000 -
- 0 168,300 -
- 0 46,200 -
- 0 45,560 -
- 0 42,350 -
- 0 20,454 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 -
- 0 285,000 -
- 0 78,000 -
- 0 505 -
- 0 286 -
- ### 512 614,400
- 0 -
- 0 1,093 -
- 600 848 508,950
42,413 50 848 42,413
- 200 848 169,650
- 50 979 48,938
- 0 2,099 -
- 0 2,099 -
- 300 2,100 630,000
- 24 25,920 622,080
- 36 5,900 212,400
- 0 6,595 -
- 0 6,595 -
- 0 7,684 -
- 50 7,684 384,200
- 40 4,176 167,040
- 20 4,568 91,360
- 0 7,937 -
- 4 7,937 31,748
- 0 7,937 -
- 37 7,787 288,119
- 35 7,937 277,795
- 4 7,937 31,748
- 0 10,440 -
- 0 10,440 -
- 0 10,440 -
- 0 10,440 -
- 0 27,821 -
- 0 21,533 -
- 0 800 -
- 0 4,921 -
30,605 15 6,121 91,815
- 0 887 -
- 0 5,621 -
- 0 11,724 -
13,221 1 13,221 13,221
- 0 137,025 -
- 1 133,821 133,821
- 0 32,500 -
- 2 23,625 47,250
- 0 18,781 -
- 0 -
- 0 -
- 0 -
- 6 4,000 24,000
- 0 5,770 -
- 0 5,770 -
- 0 5,770 -
- 0 5,700 -
- 0 22,000 -
- 0 22,000 -
78,750 0 1,125 -
- 0 8,018 -
- 0 68,181 -
- 0 68,181 -
37,543 0 3,413 -
483,092 23,234,669
PUSKESMAS POLEANG TENGAH
Ja. Pendidikan No. ….. Desa Mulaeno Kode Pos 93772
KODE PUSKESMAS
No
HARGA STOK
Nama Obat SATUAN SATUAN AKHIR
( Rp.) 2015
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul 2,200 30
2 Albendazol tab 400 mg Tab 363 200
3 Alopurinol tab 100 mg Tab 90 0
4 Alprazolam tab 1 mg Tab 245 200
5 Albothyl cairan Botol 18,635 0
6 Ambroksol tablet 30 mg Tab 138 200
7 Ambroksol sirup Botol 2,722 30
8 Aminofilin inj 24 mg/ml Ampul 4,204 24
9 Aminofilin tab 200 mg Tab 86 100
10 Amitriptilin tab sal 25 mg Tab sal 123 600
11 Amlodipin tab 10 mg Tab 352 0
12 Amlodipin tab 5 mg Tab 197 0
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 10
14 Amoksisilin tab 250 mg Tab 220 300
epinefrin 1 : 80.000 inj 2 ml Ampul 1,499 0
magnesium hidroksida 200 mg Tab kunyah 78 1,700
magnesium hidroksida 200 mg Suspensi Botol 2,213 10
B 10.000 UI/g Tube 2,767 15
salisilat 3% Tube 2,096 19
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng Suppo 33,000 0
levodopa 100 mg Kaps 1,650 100
Tab 149 100
24 Antalgin (metampirom) tablet 100 mg Tab 155 0
25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul 1,346 600
26 Asam asetilsalisilat (asetosal) tab 100 mg Tab 127 900
Tab 163 0
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 400
30 Asam folat tab 1 mg Tab 52 300
32 Asam mefenamat kaps 500 mg Kaps 127 1,000
33 Asam traneksamat inj 50 mg/ml Ampul 3,650 10
34 Asam traneksamat tab 500 mg Tab 1,265 300
35 Asering larutan infus Botol 9,000 0
36 Asiklovir salep kulit Tube 2,367 0
37 Asiklovir tab 200 mg Tab 251 900
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,400 0
39 Atropin tab 0,5 mg Tab 81 0
40 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol 13,500 0
41 Bedak salisil serb 2% Botol 1,350 10
tambah darah) Sachet 55 15,600
43 Becefort syrup Botol 22,727 10
44 Betametason krim 0,1% Tube 1,596 24
45 Betahistin mesilate tablet tablet 600 0
46 Bisakodil sup 10 mg (Stolax) Botol 6,045 0
47 Bisakodil tab sal 5 mg Tab sal 4,990 0
48 Bismecon salep tube 0
mcg Botol 110,500 0
50 Bromheksin tablet tablet 42 100
51 Deksametason tab 0,5 mg Tab 68 200
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,738 100
53 Desoksimetason salep 0,25% Tube 9,983 0
54 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 2,578 0
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol 18,461 0
56 Diazepam supposutoria suppo 0
57 Diazepam tab 2 mg Tab 47 600
59 Dietilkarbamazin tab 100 mg Tab 104 0
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 30
61 Digoksin tab 0,25 mg Tab 103 100
62 Diltiazem kaps SR 100 mg Kaps 4,033 0
63 Diltiazem tab 30 mg Tab 141 0
64 Doksisiklin tablet 100 mg Tab 298 0
65 Domperidon susp 5 mg/5 ml Botol 3,490 0
66 Domperidon tab 10 mg Tab 174 400
67 Efedrin HCl tablet Tab 56 500
68 Ekstrak belladon tablet 10 mg tab 42 0
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 8,910 600
70 Eritromisin kaps 250 mg Kaps 522 0
71 Eritromisin sir 200 mg/5 ml Botol 8,090 0
72 Eritromisin tab 500 mg Tab 1,013 700
73 Etanol 70% cairan 70% Botol 2,625 0
74 Etakridin (rivanol) larutan 0.1% Botol 4,695 0
75 Etil klorida semprot 100 ml Botol 105,000 0
76 Famotidin tablet 20 mg Tab 124 0
77 Fenitoin Na inj 50 mg/ml Ampul 20,857 0
78 Fenitoin Na kaps 100 mg Kaps 146 0
79 Fenobarbital inj 50 mg/ml Ampul 1,980 0
80 Fenobarbital tab 100 mg Tab 37 0
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 3,754 30
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 698 100
84 Flukonazol kaps 150 mg Kaps 24,200 100
85 Flusinolon asetonid krim 0,025% Tube 2,700 0
86 Flunarizin tablet tablet 2,400 0
87 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 2,012 50
88 Furosemid tab 40 mg Tab 84 1,200
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa Sachet 317 680
anhidrat 2,7 g
90 Gameksan lotion 1 % Botol 2,420 0
91 Gemfibrozil kaps 300 mg Kaps 323 300
93 Gentamisin inj 10 mg/ml Ampul 3,739 0
94 Gentamisin salep mata 0,3% Tube 2,786 0
95 Gentamisin salep Kulit Tube 1,469 75
96 Gentamisin tts mata 0,3% Botol 3,194 0
97 Glibenklamid tab 5 mg Tab 61 300
98 Glimepirid tab 4 mg Tab 452 0
99 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab 3,000 0
100 Gliseril Guaiakolat tab 100 mg Tab 31 2,000
101 Gliserin lar 50% Botol 5,867 0
102 Glukosamin tablet 500 mg Tab 660 0
103 Glukosa Larutan Infus 5% steril Botol 5,720 0
106 Griseofulvin (micronized) tab 125 mg Tab 230 100
107 Haloperidol tab 0,5 mg Tab 62 200
109 Haloperidol tab 5 mg Tab 105 300
110 Hidrogen peroksida (H2O2) cairan 3% Botol 38,500 0
111 Hidroklorotiazid (HCT) tab 25 mg Tab 40 0
112 Hidrokortison krim 2,5% Tube 2,938 0
113 Hiosina butilbromida tab 10 mg Tab 330 0
114 Ibuprofen susp 100 mg/5 ml Botol 3,849 15
115 Ibuprofen tab 200 mg Tab 121 200
inhalation 0.025%) Botol 90,000 0
118 Isoniazid tab 300 mg Tab 174 0
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 36,960 0
120 Isosorbid dinitrat tab 5 mg Tab 98 0
121 KA-EN 3B Cairan Infus Botol 10,000 0
122 Kalsium glukonat inj 100 mg/ml Ampul 7,800 0
123 Kalsium laktat (kalk) tab 500 mg Tab 76 300
124 Kaptopril tab 12,5 mg Tab 69 200
125 Kaptopril tab 25 mg Tab 97 0
126 Karbamazepin tab 200 mg Tab 269 0
127 Karbo adsorben (Norit) tab 500 mg Tab 0
128 Ketamin inj 50 mg/ml (i.v.) Ampul 63,400 0
129 Ketokonazol tab 200 mg Tab 320 300
130 Ketokonazol krim 2% Tube 5,150 0
131 Ketorolak inj 10 mg/ml Ampul 2,665 0
132 Klaritromisin tab 500 mg Tab 3,600 0
133 Klindamisin kaps 150 mg Kaps 405 100
134 Kloramfenikol tts mata 0,5% Botol 1,680 0
135 Kloramfenikol kaps 250 mg Kaps 275 0
136 Kloramfenikol salep mata 1% Tube 1,680 0
137 Kloramfenikol susp 125 mg/5 ml Botol 4,016 10
138 Klorfeniramin (CTM) tab 4 mg Tab 26 1,000
139 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,210 0
140 Klorpromazin tab sal 100 mg Tab sal 162 0
142 Kombinasi : Pirimethamin 25 mg + sulfadoksin
Tab 531 0

nebules (Combivent UDV) Vial 5,990 0
400 mg+ trimetoprim 80 mg Tab 152 700
sulfametoksazol 200 mg + trimetoprim 40 mg Botol 2,298 0
147 Kuinin inj 25% (i.v.) Vial 6,820 0

148 Kloroquin tab 150 mg Tab 112 0
149 Lansoprazol kaps 30 mg Kaps 521 0
150 Levofloksasin tab 500 mg Tab 581 200
151 Lidokain gel 2% Tube 40,000 0
152 Lidokain inj 2% (hcl) Vial 929 170
153 Lisol Botol 54,995 3
154 Loperamid tab 2 mg Tab 97 200
155 Loratadin tab 10 mg Tab 170 210
156 Magnesium sulfat inj 20% Vial 7,260 0
158 Magnesium sulfat serb, ktg 30 g Sachet 1,130 0
159 Mebendazol sir 50 mg/ml Botol 3,887 3
160 Mebendazol tab 100 mg Tan 248 0
161 Metformin tab 500 mg Tab 125 0
162 Metformin tab 850 mg Tab 280 0
163 Metilergometrin inj 0,2 mg/ml Ampul 2,750 0
164 Metilergometrin tab salut 0,125 mg Tab sal 169 200
165 Metilprednisolon tab 4 mg Tab 230 0
166 Metoklopramid inj 5 mg/ml Vial 1,100 0
167 Metoklopramid sir 5 mg/5 ml (Lexapram sirup) Botol 2,900 0
168 Metoklopramid tab 10 mg Tab 100 200
169 Metronidazol supposutoria 500 mg suppo 3,655 0
170 Metronidazol larutan infus Botol 12,980 0
171 Metronidazol tab 250 mg Tab 116 0
173 Mikonazol krim 2% Tube 3,150 20
174 Natrium diklofenak tab 25 mg Tab 146 200
176 NaCl 0,9% Larutan infus Botol 5,170 70
177 Nifedipin kaps 10 mg Kaps 127 0
178 Nistatin tab salut 500.000 UI Tab 704 0
179 Nistatin tab vaginal 100.000 UI Tab 528 0
180 Obat Batuk Hitam (OBH) Botol 2,310 20
181 Ofloksasin tab 200 mg Tab 440 0
183 Oksitetrasiklin hcl inj 500 mg/ml Vial 3,410 0
184 Oksitetrasiklin hcl salep kulit 3% Tube 1,646 0
185 Oksitetrasiklin hcl salep mata 1 % Tube 2,772 0
186 Oksitosin inj 10 UI/ml Ampul 1,900 0
187 Omeprazol kaps 20 mg Kaps 221 0
188 Papaverin tablet 40 mg Tab 109 1,000
189 Parasetamol sir 120 mg/5 ml Botol 1,535 0
190 Parasetamol tab 100 mg Tab 105 500
192 Parasetamol rectal suppo 0
193 Pehavral tablet multivitamin Tab 297 0
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25,350 0
195 Phenylbutazon tablet 200 mg Tab 107 0
196 Piracetam tablet 800 mg Tab 964 0
198 Piracetam injeksi 1 g/5 ml Ampul 60,500 0
199 Pirantel pamoat susp 125 mg/5 ml Botol 9,100 0
200 Pirantel pamoat tab scored 125 mg Tab 318 60
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 4,000
202 Piroksikam tablet 20 mg Tab 116 0
Piroksikam tablet 10 mg Tab 0
203 Polikresulen Botol 18,635 7
204 Povidon iodin lar 100 mg/ml
Botol 30 ml 2,344 2
205 Povidon iodin lar 100 mg/ml Botol 300
15,386 0
ml
40,202 3,000
ml
207 Prednison tab 5 mg Tab 98 2,000
208 Primakuin tab 15 mg Tab 125 0
209 Procurma syrup Botol 12,021 600
Vical Multivitamin Botol 0
210 Propiltiourasil tab 100 mg Tab 351 0
211 Propranolol tab 40 mg Tab 80 0
212 Ranitidin inj 25 mg/ml Ampul 1,340 0
213 Ranitidin tab 150 mg Tab 128 0
214 Reserpin tablet 0.25 mg Tab 968 0
215 Rifampisin kaps 300 mg Kaps 440 0
216 Rifampisin tab 450 mg Tab 624 60
218 Ringer Laktat Larutan infus Botol 5,720 60
219 Salbutamol tab 2 mg Tab 65 300
endap 4 % Tube 2,200 25
222 Scabicid salep Tube 0
223 Sefadroksil kaps 250 mg Vial 564 0
224 Sefadroksil kaps/tab 500 mg Tab 548 500
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 20
226 Sefiksim kapsul 100 mg Tab 1,000 0
227 Sefotaksim serb inj 1.000 mg/vial Vial 3,500 0
228 Seftriakson serb inj 1.000 mg/vial Vial 3,900 0
229 Setirizin tab 10 mg Tab 190 0
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial 1,150 0
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 0
232 Simetidin tablet 200 mg Tab 138 300
233 Simvastatin tab sal 10 mg Tab sal 177 0
234 Simvastatin tab sal 20 mg Tab sal 480 0
235 Siprofloksasin inf 2 mg/ml Botol 22,000 0
236 Siprofloksasin tab scored 500 mg Tab 312 0
237 Spironolakton tab 100 mg Tab 350 200
238 Sulfasetamid Natrium Tetes mata 1.5% Botol 3,549 0
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol 14,450 0
240 Sukralfat tab 500 mg (Ulsidex) Tab 477 200
241 Teofilin tab SR 300 mg (Rethapyl) Tab 1,155 200
242 Tetrasiklin kaps 250 mg Kaps 183 0
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 2,000
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab 770 0
246 Tramadol inj 50 mg/ml Ampul 2,680 90
247 Tramadol tablet 500 mg Tab 363 0
248 Triheksifenidil tab 2 mg Tab 45 400
249 Vitamin B12 tablet 50 mcg Tab 63 800
250 Vitamin B kompleks injeksi Vial 7,392 25
251 Vitamin B kompleks Tab 112 700
252 Zinc tab disp 20 mg Tab 521 100
253 Zinc sirup 20 mg / 5 ml Botol 8,140 0
254 Larutan PK botol 6,975 12
255 Kanamisin inj Vial 5,929 0
256 Antalgin 500mg tab 141 800
259 Kloroquin tab 250 mg Tab 572 0
260 Klonidin 0,15 mg Tab 193 0
263 Fenolgliserol TT 10% Kotak 1,109 96
265 Kloroquin tab 250 mg 112 0
266 Papaverin tablet 40 mg 167 0
267 Prednison tab 5 mg Tab 125 0
272 Vical suspensi btl 0
273 Lexavit tab 0
274 Gliseril Guaiakolat tab 100 mg Tab 31 0
276 Kloroquin Tablet 150 mg Tab 300
277 Aptyl Btl 0
278 Levopar Tablet 100
280 Pytogin inj Ampul 10
281 Phenytoin Sodium Kapsul 100
282 Ulsidex Tablet
283 Scopma Kaplet 200
JUMLAH OBAT-OBATAN (A) 0
B. OBAT GIGI 0
1 Bonding Botol
2 Calcium hidrosida cement pasta (hycal) Kotak
3 Comfosite Tube
4 Devitalisasi Pasta (Non Arsen) Kotak 390,000
7 Etza Tube 170,000
9 Klorfenol Kamfer Menthol (CHKM) Botol 55,000 0
10 Semen Seng Fosfat serbuk dan cairan Set 93,500 0
11 Temporari stoping pletcher Set 34,000 1
12 Mummiyng pasta Kotak 176,000 0
JUMLAH OBAT GIGI ( B )
C. OBAT PROGRAM
1 Albedazole 400mg Tab 363 600
2 Artemether inj 80 mg/ml Ampul 0
3 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 27,569 0
5 Imersion oil Botol 0
6 Iodina Test Botol 0
7 Obat Anti Tuberculosis FDC Kategori Anak Paket 236,490 0
8 Obat Anti Tuberculosis FDC Kategori I Paket 396,000 0
9 Obat Anti Tuberculosis FDC Kategori II Paket 1,319,990 0
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 175,899 0
11 Reagen Zenit Nelson Botol 145,000 0
12 RDT Dangue DBD Set 150,000 0
13 RDT malaria (care star ) Set 168,300 0
14 RDT HIV (intec) Set 46,200 0
15 RDT HIV (vikia) Set 45,560 0
16 RDT HIV (Oncoprobe) Set 42,350 0
17 Taburia Kotak 20,454 0
18 Quinina injeksi Ampul 4,438 0
19 Vaksin BCG inj (i.k) Vial 0
20 Vaksin campak inj (s.k.) Vial 0
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial 0
22 Vaksin jerap difteri tetanus (DT) Vial 0
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial 0
24 Vaksin polio drops 10 dosis Vial 0
Vial 695,752
26 Retinol (Vit.A) 200.000 IU kap lunak 412
28 zink tab.20mg 497
29 Doxiciklin tab
30 Garam Oralit 2,900
31 Kina 420
32 Gentamicin Inj. 20
33 Pitomenadion Inj. 30
34 Diazepam Inj 60
35 Glukonas Kalsikas 48
36 Phenobarbital Inj. 60
37 Ampiciline Sodium Inj 180
38 Benzatin B Penicilin Inj. 90
39 Mg So4 20 % 43
40 Mg So4 40 % 27
41 Zinc 20 mg 1,200
42 Pyrantel Tab 125 mg 300
43 Alat Suntik 0,5 ml 200
44 Alat Suntik 5 ml 100
45 Kotrimoksasol 480 mg 1,600
JUMLAH OBAT PROGRAM ( C )
D. BAHAN MEDIS HABIS PAKAI (BHMP) 0
1 Alat suntik sekali pakai 1 ml Set 1,093 600
2 Alat suntik sekali pakai 2,5 ml Set 848 50
3 Alat suntik sekali pakai 3 ml Set 848 200
5 Bisturi no. 20 Buah 2,099 0
7 Catgut No 2/0 Set 25,920 24
8 Catgut No 3/0 Set 5,900 40
9 Handscoen no. 6 Pasang 0
10 Handscoen no. 6,5 Pasang 0
11 Handscoen no. 7 Pasang 7,684 0
12 Handscoen no. 7,5 Pasang 7,684 50
13 Infuset dewasa Set 4,176 40
14 Infusion set anak Set 4,568 35
15 IV Catheter No.16 G Set 0
16 IV Catheter No.18 G Set 7,937 30
17 IV Catheter No.24 G Set 7,937 15
18 IV Catheter No. 20 G Set 7,787 37
19 IV Catheter No. 22 G Set 7,937 35
20 Folley Catheter 16 Set 4
21 Folley Catheter 18 Set 8,495 0
22 Folley catheter 22 Set 8,495 0
23 Folley catheter 24 Set 495 0
24 Kapas Berlemak 250 gram Rol 7,500 0
26 Kasa Pembalut 4m x 3 cm Rol 800 0
28 Kasa Pembalut 4m x 10 cm Rol 6,121 10
30 Kasa Kompres 40/40 steril Buah 1,871 0
31 Kasa Steril 16 X 16 Buah 8,600 0
32 Kasa pembalut 2 x 80 Rol 13,221 1
33 Kasa Pembalut 40 x 80 Rol 137,025 0
34 Kasa Pembalut 36 x 80 cm Rol 133,821 1
35 Pembalut Gips Buah 32,500 0
36 Plester 5 yard x 2 inc Rol 23,625 2
37 Silk Set 5,082 0
38 Selang oksigen anak Set 0
39 Selang oksigen dewasa Set 0
40 Sofratulle Set 0
41 Urine bag Set 4,000 6
42 Wing Needle No. 21 G Set 5,770 0
44 Wing Needle No.25 G Set 5,770 0
46 NGT No. 3 ( Feeding Tube ) Set 22,000 0
47 NGT No. 5 ( Feeding Tube ) Set 22,000 0
48 Masker Buah 1,125 0
49 Tes gula darah Set 200,455 0
50 Tes Narkoba 3 parameter Set 68,181 0
51 Tes Narkoba 5 parameter Set 68,181 0
52 Tes Kehamilan Sachet 6,825
JAN FEB MAR
MASUK KELUAR AKHIR MASUK KELUAR AKHIR MASUK KELUAR AKHIR
- 30 - 30
170 30 - 30
- - - -
100 100 200 140 60
- - - -
200 - 100 100 -
30 - - -
- 24 - 24
100 -
- 600 - 600
- - - -
- - - -
60 30 40 50 40 50
100 200 200 -
1,000 800 700 600 700 600
- - - -
1,400 300 200 100
50 15 45 10 28 27
25 15 25 5 20
19 - - -
- - 100 20 80
100 - - -
100 -
(800) 800 - 800

600 - - -
- 900 - 900
- - - -
- -
300 100 100 -

100 200 - 200
- -
1,000 1,200 800 300 500
- 10 - 10
300 - - -
- -
25 - 25 6 19
200 700 - 700
- -
- -
- -
10 - 20 - 20
- 15,600 5,880 9,720

10 - - -
9 15 10 5
- -
- -
- -
- -
- -
- 100 - 100
500 300 400 800 400 800
- 100 - 100
- -
- -
- -
- -
600 - - -
250 - 250 - 250
- -
- 30 - 30
- 100 - 100
- -
- -
- -
- - - -
500 400 500 150 350
- 500 100 400
- - - -
600 - - -
- -
- -
- 700 - 700
- - - -
- - - -
- - 5 - 5
- - - -
- - - -
- -
- -
- - - -
- -
- 30 5 25
- 100 - 100
- 100 - 100
- -
- -
- 50 25 25
- 1,200 - 1,200
- 680 210 470
- -
- 300 300 -
- -
- -
- -
- 75 40 35
- -
100 200 200 -
- -
- -
2,000 - - -
- -
- -
- -
- - - -
- -
100 - 200 - 200
500 - 700 - 700
300 100 200 100 100
100 200 - 200
- 1 - 1
- -
- 25 1 24
- -
- 15 15 -
500 500 200 500 100 600
500 500 - 300 - 300
- - - -
- -
- -
- -
- -
- -
100 - 400 - 400
- 200 100 100
- - 200 - 200
- -
- -
- -
- 300 100 200
- - - -
- -
- -
- 100 - 100
- -
- - - -
- -
- 10 5 5
2,000 1,000 2,000 5,000 2,000 5,000
- - - -
4,000 - 4,000 - 4,000
100 100 - - -
- -
- -
100 600 1,000 100 1,500
- 400 300 - 700
- - - -
- -
- -
- -
- 200 100 100
- -
- 170 50 120
- 3 2 1
- 200 100 100
300 300 210 500 160 550
- -
- -
- -
- 3 - 3
- - - -
- -
- -
- - - -
- 200 200 -
- - -
- -
- -
- 200 - 200
- -
- -
- - - -
1,000 1,000 - - -
- 20 24 4 40
200 - 100 100 -
- 200 150 200 150
5 65 5 60
100 - 100 - 100
- - - -
- - - -
- 20 - 20
- - - -
50 - 200 - 200
- -
28 - 28 - 28
- - - -
- - - -
180 180 - - -
- 1,000 - 1,000
- - 84 69 15
- 500 0 - 500
500 - 1,200 700 500
- -
- - - -
- -
- - - -
- 200 100 100
- -
- 20 - 20
- -
10 50 150 50 150
- 4,000 2,000 2,000
500 500 - 700 - 700
- -
7 -
(5) 7 7 -
(2) 2 - 2
3,000 - - -
- 2,000 - 2,000
(2,000) 2,000 2,000 -
20 620 - 30 20 10
30 30 - - -
300 - 300 100 200
- -
- -
- - 600 300 300
- -
- -
60 -
100 -
- 60 20 40
- 300 - 300
- 300 - 300
- 25 - 25
- -
- -
100 400 800 300 900
50 50 20 5 - 25
- -
- -
- -
- -
- - - -
- -
- 300 200 100
- -
- -
- -
- -
- 200 100 100
- -
- -
- 200 - 200
- 200 - 200
- -
- - - -
- 2,000 1,000 1,000
- -
- 90 90 -
- - - -
- 400 100 500 -
- 800 800 -
- 25 5 20
2,000 2,100 600 1,000 600 1,000
- 100 100 - 200
- -
- 12 - 12
- -
- 800 - 800
- -
- -
- 1,000 - 1,000
- -
- -
- -
- 96 - 96
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 200 200
- -
- -
- 300 - 300
- - - -
- 100 - 100
-
- 10 - 10
- 100 - 100
-
- 200 - 200
0 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- - - -
- -
- 1 - 1
- -
0 - -
- -
- 600 - 600
- -
- -
- 300 - 300
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- - - -
- -
- -
- -
- -
- -
- -
- 900 900
- 150 150
- -
- -
- 2,900 - 2,900
- 420 - 420
- 20 - 20
- 30 - 30
- 60 - 60
- 48 - 48
- 60 - 60
- 180 - 180
- 90 - 90
- 43 - 43
- 27 - 27
- 1,200 - 1,200
- 300 - 300
- 200 - 200
- 100 - 100
- 1,600 - 1,600
- -
- -
0 - -
- -
100 - 700 100 100 700
- 50 30 20
- 200 100 100 200
- 50 - 50
- - 45 - 45
- 300 - 300
- 24 24 - 48
- 40 5 35
- - - -
- - - -
- - - -
- 50 30 20 60
- 40 11 29
- 35 - 35
- - - -
- 30 15 15
- 15 - 15
- 37 - 37
20 15 - 15
4 - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - 20 10 10
- 10 25 5 30
15 -
- - - -
- - - -
1 - - -
- -
1 - - -
- -
1 1 - 1
36 - 36 36 36 36
- -
- -
- -
- 6 2 4
- - - -
- -
- - - -
- -
- -
- -
- - - -
- -
- -
- -
- 35 - 35
LAPORAN PENERIMAAN OBAT
SALDO AKHIR OBAT PERBULAN

APR MEI JUN JUL
MASUK KELUAR AKHIR MASUK KELUAR AKHIR MASUK KELUAR AKHIR MASUK
PERBULAN
JUL AGUST SEP OKT
KELUAR AKHIR MASUK KELUAR AKHIR MASUK KELUAR AKHIR MASUK KELUAR
OKT NOP DES
AKHIR MASUK KELUAR AKHIR MASUK KELUAR AKHIR

Mutasi Masuk
BULAN DESEMBER 2015
No Nama Obat
Satuan / Kemasan
Harga Harga
mlah Satuan Nilai (Rp) mlah Satuan
(Rp) (Rp)
1 2 3 4 5 6 7 8
Mutasi Masuk Mutasi Pengeluaran Saldo Akhir
DESEMBER 2015 BULAN DESEMBER 2015 Per 31 DESEMBER 2015
Harga Harga
Nilai ( Rp)mlah Satuan Nilai (Rp) mlah Satuan Nilai (Rp)
(Rp) (Rp)
9 10 11 12 13 14 15
Ja. Pendidikan No. ….. Desa Mulaeno Kode Pos 93772
KODE PUSKESMAS :
KABUPATEN : BOMBANA
JUMLAH PENERIMAAN OBAT PERBULAN

Satuan / Harga
No Nama Obat
Kemasan Satuan (Rp) JAN PEB MAR APR MEI JUN JUL AGUST SEPT OKT NOP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
A. OBAT
6 Ambroksol tablet 30 mg Tab 138 ###
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 60 50
15 Amoksisilin tab 500 mg Tab 279 1,000 ###
epinefrin 1 : 80.000 inj 2 ml Ampul 1,499
magnesium hidroksida 200 mg Tab kunyah 78
magnesium hidroksida 200 mg Suspensi Botol 2,213 50 10
B 10.000 UI/g Tube 2,767 25
salisilat 3% Tube 2,096
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng Suppo 33,000 ###
levodopa 100 mg Kaps 1,650
Tab 149
25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul 1,346
Tab 163
tambah darah) Sachet 55
45 Betahistin mesilate tablet tablet 600
47 Bisakodil tab sal 5 mg Tab sal 4,990
mcg Botol 110,500
50 Bromheksin tablet tablet 42
51 Deksametason tab 0,5 mg Tab 68 500 ###
86 Flunarizin tablet tablet 2,400
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa Sachet 317
anhidrat 2,7 g
95 Gentamisin salep Kulit Tube 1,469
106 Griseofulvin (micronized) tab 125 mg Tab 230 ###
109 Haloperidol tab 5 mg Tab 105
113 Hiosina butilbromida tab 10 mg Tab 330
115 Ibuprofen tab 200 mg Tab 121 500 ###
116 Ibuprofen tab 400 mg Tab 157 500 ###
inhalation 0.025%) Botol 90,000
125 Kaptopril tab 25 mg Tab 97 ###
138 Klorfeniramin (CTM) tab 4 mg Tab 26 2,000 ###
Tab 531

nebules (Combivent UDV) Vial 5,990
400 mg+ trimetoprim 80 mg Tab 152 ###
100 mg+ trimetoprim 20 mg Tab 79 ###
sulfametoksazol 200 mg + trimetoprim 40 mg Botol 2,298

155 Loratadin tab 10 mg Tab 170 300 ###
166 Metoklopramid inj 5 mg/ml Vial 1,100
172 Metronidazol tab 500 mg Tab 169 1,000
174 Natrium diklofenak tab 25 mg Tab 146 ###
175 Natrium diklofenak tab 50 mg Tab 193 ###
191 Parasetamol tab 500 mg Tab 88 ###
196 Piracetam tablet 800 mg Tab 964 ###
200 Pirantel pamoat tab scored 125 mg Tab 318 ###
202 Piroksikam tablet 20 mg Tab 116 500 ###
Piroksikam tablet 10 mg Tab
Botol 30 ml 2,344
15,386
ml
40,202
ml
209 Procurma syrup Botol 12,021 20 30
Vical Multivitamin Botol 30
213 Ranitidin tab 150 mg Tab 128 ###
endap 4 % Tube 2,200
224 Sefadroksil kaps/tab 500 mg Tab 548 ###
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 50 5
237 Spironolakton tab 100 mg Tab 350
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab 770
248 Triheksifenidil tab 2 mg Tab 45 ###
251 Vitamin B kompleks Tab 112 2,000 ###
252 Zinc tab disp 20 mg Tab 521 ###
254 Larutan PK botol 6,975
255 Kanamisin inj Vial 5,929
256 Antalgin 500mg tab 141
259 Kloroquin tab 250 mg Tab 572 ###
260 Klonidin 0,15 mg Tab 193
263 Fenolgliserol TT 10% Kotak 1,109
265 Kloroquin tab 250 mg 112
266 Papaverin tablet 40 mg 167
272 Vical suspensi btl
273 Lexavit tab ###
277 Aptyl Btl
278 Levopar Tablet
280 Pytogin inj Ampul
282 Ulsidex Tablet
283 Scopma Kaplet
B. OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube 170,000
9 Klorfenol Kamfer Menthol (CHKM) Botol 55,000
12 Mummiyng pasta Kotak 176,000
JUMLAH OBAT GIGI ( B ) 0
C. OBAT PROGRAM
6 Iodina Test Botol
18 Quinina injeksi Ampul 4,438
Vial 695,752
26 Retinol (Vit.A) 200.000 IU kap lunak 412 ###
27 Retinol (Vit.A) 100.000 IU kap lunak 286 ###
29 Doxiciklin tab
30 Garam Oralit
31 Kina
32 Gentamicin Inj.
34 Diazepam Inj
39 Mg So4 20 %
40 Mg So4 40 %
41 Zinc 20 mg
44 Alat Suntik 5 ml
JUMLAH OBAT PROGRAM ( C ) 0
1 Alat suntik sekali pakai 1 ml Set 1,093 ###
3 Alat suntik sekali pakai 3 ml Set 848 ###
7 Catgut No 2/0 Set 25,920 24
12 Handscoen no. 7,5 Pasang 7,684 30
23 Folley catheter 24 Set 495
31 Kasa Steril 16 X 16 Buah 8,600 Rumbia,
32 Kasa pembalut 2 x 80 Rol 13,221 Kepala UPTD Instalasi Farma
33 Kasa Pembalut 40 x 80 Rol 137,025 Kabupaten Bombana
37 Silk Set 5,082 36 36 MUH.ALWI,S.Si.,MM,Apt.
38 Selang oksigen anak Set NIP.197903192005021005
40 Sofratulle Set
52 Tes Kehamilan Sachet 6,825 35
JUMLAH BAHAN MEDIS HABIS PAKAI (BHMP) (D) 0
JUMLAH TOTAL ( A + B + C +D ) 0
TIDAK
BAYAR JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR
23 209 232
KETERANGAN

HARGA
TOTAL KETERANGAN
( Rp. )
DES
16 17 18
- -
- -
- -
- -
100 24,500
- -
100 13,758
- -
- -
- -
- -
- -
- -
110 281,600
- -
1,600 446,400
- -
- -
60 132,780
25 69,175
- -
100 3,300,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,000 127,000
- -
- -
- -
25 59,175
- -
- -
- -
- -
20 900
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,300 88,400
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
500 87,000
- -
- -
- -
- -
- -
- -
- -
- -
5 525,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
200 46,000
500 31,000
300 22,800
- -
1 38,500
- -
25 73,450
- -
- -
1,000 121,000
800 125,600
- -
- -
- -
- -
- -
- -
- -
- -
200 19,400
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
7,000 184,800
- -
- -
100 7,500
- -
- -
1,000 152,000
300 23,700
- -
- -
- -
- -
- -
- -
- -
- -
- -
800 136,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,000 169,000
24 75,600
100 14,600
150 28,950
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
180 39,780
- -
84 128,940
- -
1,200 105,600
- -
- -
- -
- -
200 192,720
- -
20 1,210,000
- -
150 47,700
- -
1,200 138,600
- -
- -
- -
- -
- -
- -
- -
50 601,050
30 -
- -
- -
- -
600 76,800
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
800 438,400
55 290,730
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
100 4,538
- -
- -
3,000 336,000
100 52,100
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
200 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
900 370,800
150 42,900
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
100 109,250
- -
100 84,825
- -
45 94,455
- -
24 622,080
- -
- -
- -
- -
30 230,520
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
20 17,740
11,661,116
Kepala UPTD Instalasi Farmasi

Kabupaten Bombana
MUH.ALWI,S.Si.,MM,Apt.
NIP.197903192005021005
(LPLPO)
tahun 2016
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / Harga STOCK PEMAKAIAN OBAT TAHUN 2016

No Nama Obat
Kemasan Satuan (Rp) AWAL JAN FEB MAR APR MEI JUN AGUST SEP
1 2 3 4 4 7
A. OBAT
2 Albendazol tab 400 mg Tab 363 330 120
4 Alprazolam tab 1 mg Tab 245 240 120 60
5 Albothyl cairan Botol 18,635 -
6 Ambroksol tablet 30 mg Tab 138 243 168 125
7 Ambroksol sirup Botol 2,722 38 27 6
10 Amitriptilin tab sal 25 mg Tab sal 123 830 70
11 Amlodipin tab 10 mg Tab 352 -
12 Amlodipin tab 5 mg Tab 197 -
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 20 26 38
14 Amoksisilin tab 250 mg Tab 220 391 133 185
15 Amoksisilin tab 500 mg Tab 279 677 670 740
epinefrin 1 : 80.000 inj 2 ml Ampul 1,499 -
17 Antasida, kombinasi : aluminium hidroksida 200 mg
+ magnesium hidroksida 200 mg Tab kunyah 78 2,652 250 292
18 Antasida, kombinasi : aluminium hidroksida 200 mg
+ magnesium hidroksida 200 mg Suspensi Botol 2,213 12 5 17
19 Antibakteri, kombinasi : basitrasin 500 UI/g+
Polimiskin B 10.000 UI/g Tube 2,767 17
20 Antifungi salep, kombinasi : asam benzoat 6%+
asam salisilat 3% Tube 2,096 27 3
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ Suppo 33,000 10 10
seng oksida 120 mg + sup ad 2 g
23 Anti Migren, kombinasi : ergotamin 1 mg+ kafein 50
mg Tab 149 19
24 Antalgin (metampirom) tablet 100 mg Tab 155 920 60
26 Asam asetilsalisilat (asetosal) tab 100 mg Tab 127 957 10
27 Asam asetilsalisilat (asetosal) tab 500 mg Tab 178 - -
28 Asam asetilsalisilat (asetosal) tab 80 mg (Miniaspi
80) Tab 163 - -
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 903 370 120
30 Asam folat tab 1 mg Tab 52 505 60
31 Asam mefenamat kaps 250 mg Kaps -
32 Asam mefenamat kaps 500 mg Kaps 127 1,140 740 480
34 Asam traneksamat tab 500 mg Tab 1,265 475 90 20
35 Asering larutan infus Botol 9,000 -
36 Asiklovir salep kulit Tube 2,367 - 4
37 Asiklovir tab 200 mg Tab 251 1,009 70
40 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol 13,500 -
41 Bedak salisil serb 2% Botol 1,350 2 2
tambah darah) Sachet 55 18,275 535 370
43 Becefort syrup Botol 22,727 11 11
44 Betametason krim 0,1% Tube 1,596 44 25 13
45 Betahistin mesilate tablet tablet 600 -
46 Bisakodil sup 10 mg (Stolax) Botol 6,045 -
47 Bisakodil tab sal 5 mg Tab sal 4,990 -
mcg Botol 110,500 -
51 Deksametason tab 0,5 mg Tab 68 350 400 352
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,738 246 6 7
53 Desoksimetason salep 0,25% Tube 9,983 -
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol 18,461 -
56 Diazepam supposutoria suppo -
57 Diazepam tab 2 mg Tab 47 770 80 70
58 Diazepam tab 5 mg Tab 53 557 -
59 Dietilkarbamazin tab 100 mg Tab 104 -
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 75 3
63 Diltiazem tab 30 mg Tab 141 -
64 Doksisiklin tablet 100 mg Tab 298 80 10
65 Domperidon susp 5 mg/5 ml Botol 3,490 -
66 Domperidon tab 10 mg Tab 174 400 140 93
67 Efedrin HCl tablet Tab 56 710 157 84
68 Ekstrak belladon tablet 10 mg tab 42 1,300
71 Eritromisin sir 200 mg/5 ml Botol 8,090 -
72 Eritromisin tab 500 mg Tab 1,013 970 10 20
75 Etil klorida semprot 100 ml Botol 105,000 -
76 Famotidin tablet 20 mg Tab 124 -
77 Fenitoin Na inj 50 mg/ml Ampul 20,857 -
78 Fenitoin Na kaps 100 mg Kaps 146 -
79 Fenobarbital inj 50 mg/ml Ampul 1,980 -
81 Fenobarbital tab 30 mg Tab 37 -
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial 3,754 103 2
85 Flusinolon asetonid krim 0,025% Tube 2,700 -
86 Flunarizin tablet tablet 2,400 -
88 Furosemid tab 40 mg Tab 84 1,200
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + Sachet 317 1,026 64 35
glukosa anhidrat 2,7 g
90 Gameksan lotion 1 % Botol 2,420 -
92 Gemfibrozil kaps 600 mg Kaps 747 -
93 Gentamisin inj 10 mg/ml Ampul 3,739 -
94 Gentamisin salep mata 0,3% Tube 2,786 -
95 Gentamisin salep Kulit Tube 1,469 99 6 4
96 Gentamisin tts mata 0,3% Botol 3,194 -
97 Glibenklamid tab 5 mg Tab 61 390 150 120
98 Glimepirid tab 4 mg Tab 452 -
99 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab 3,000 -
100 Gliseril Guaiakolat tab 100 mg Tab 31 2,166 311 384
101 Gliserin lar 50% Botol 5,867 -
102 Glukosamin tablet 500 mg Tab 660 -
105 Glukosa Larutan Infus 40% steril Botol 6,270 -
106 Griseofulvin (micronized) tab 125 mg Tab 230 110 20 30
108 Haloperidol tab 1,5 mg Tab 76 - 60 130
109 Haloperidol tab 5 mg Tab 105 560 110 20
111 Hidroklorotiazid (HCT) tab 25 mg Tab 40 -
112 Hidrokortison krim 2,5% Tube 2,938 -
115 Ibuprofen tab 200 mg Tab 121 200 110
116 Ibuprofen tab 400 mg Tab 157 - 70 430
117 Ipratropium bromida nebulizer 0,025% (Atroven sol.
for inhalation 0.025%) Botol 90,000
118 Isoniazid tab 300 mg Tab 174 -
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 36,960 -
121 KA-EN 3B Cairan Infus Botol 10,000 -
122 Kalsium glukonat inj 100 mg/ml Ampul 7,800 -
123 Kalsium laktat (kalk) tab 500 mg Tab 76 955 170 60
124 Kaptopril tab 12,5 mg Tab 69 300 40
125 Kaptopril tab 25 mg Tab 97 160 70 80
126 Karbamazepin tab 200 mg Tab 269 -
127 Karbo adsorben (Norit) tab 500 mg Tab -
128 Ketamin inj 50 mg/ml (i.v.) Ampul 63,400 -
129 Ketokonazol tab 200 mg Tab 320 710 10 6
130 Ketokonazol krim 2% Tube 5,150 - -
131 Ketorolak inj 10 mg/ml Ampul 2,665 -
132 Klaritromisin tab 500 mg Tab 3,600 -
134 Kloramfenikol tts mata 0,5% Botol 1,680 -
136 Kloramfenikol salep mata 1% Tube 1,680 - -
137 Kloramfenikol susp 125 mg/5 ml Botol 4,016 10 3
138 Klorfeniramin (CTM) tab 4 mg Tab 26 1,982 251 582
140 Klorpromazin tab sal 100 mg Tab sal 162 4,500 100 120
141 Klorpromazin tab sal 25 mg Tab sal 75 - 30 70
Tab 531 -
143 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5

mg nebules (Combivent UDV) Vial 5,990 -
400 mg+ trimetoprim 80 mg Tab 152 710 80 80
100 mg+ trimetoprim 20 mg Tab 79 491 20
146 Kotrimoksazol (dewasa) kombinasi tiap 5 ml
suspensi : sulfametoksazol 200 mg + trimetoprim 40 Botol 2,298 - -
mg
147 Kuinin inj 25% (i.v.) Vial 6,820 -
148 Kloroquin tab 150 mg Tab 112 -
149 Lansoprazol kaps 30 mg Kaps 521 -
150 Levofloksasin tab 500 mg Tab 581 260 50 110
151 Lidokain gel 2% Tube 40,000 -
152 Lidokain inj 2% (hcl) Vial 929 193 10 13
153 Lisol Botol 54,995 3 1
154 Loperamid tab 2 mg Tab 97 250 60
155 Loratadin tab 10 mg Tab 170 250 3 70
156 Magnesium sulfat inj 20% Vial 7,260 -
160 Mebendazol tab 100 mg Tan 248 20 20
161 Metformin tab 500 mg Tab 125 -
162 Metformin tab 850 mg Tab 280 -
164 Metilergometrin tab salut 0,125 mg Tab sal 169 500 10 20
165 Metilprednisolon tab 4 mg Tab 230 -
166 Metoklopramid inj 5 mg/ml Vial 1,100 -
167 Metoklopramid sir 5 mg/5 ml (Lexapram sirup) Botol 2,900 -
168 Metoklopramid tab 10 mg Tab 100 219 10
169 Metronidazol supposutoria 500 mg suppo 3,655 -
170 Metronidazol larutan infus Botol 12,980 -
172 Metronidazol tab 500 mg Tab 169 50 60 50
173 Mikonazol krim 2% Tube 3,150 22 3
174 Natrium diklofenak tab 25 mg Tab 146 160 160 100
175 Natrium diklofenak tab 50 mg Tab 193 315 70 50
176 NaCl 0,9% Larutan infus Botol 5,170 72 3
177 Nifedipin kaps 10 mg Kaps 127 220 30 30
183 Oksitetrasiklin hcl inj 500 mg/ml Vial 3,410 -
185 Oksitetrasiklin hcl salep mata 1 % Tube 2,772 -
186 Oksitosin inj 10 UI/ml Ampul 1,900 210 1 2
187 Omeprazol kaps 20 mg Kaps 221 - 110
188 Papaverin tablet 40 mg Tab 109 1,605
189 Parasetamol sir 120 mg/5 ml Botol 1,535 29 29 65
190 Parasetamol tab 100 mg Tab 105 685 10 50
191 Parasetamol tab 500 mg Tab 88 670 610 710
192 Parasetamol rectal suppo -
193 Pehavral tablet multivitamin Tab 297 -
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25,350 -
196 Piracetam tablet 800 mg Tab 964 - - 30
198 Piracetam injeksi 1 g/5 ml Ampul 60,500 -
199 Pirantel pamoat susp 125 mg/5 ml Botol 9,100 -
200 Pirantel pamoat tab scored 125 mg Tab 318 72 16 18
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 4,350 30 20
202 Piroksikam tablet 20 mg Tab 116 159 200 170
203 Polikresulen Botol 18,635 -
Botol 30 ml 2,344 7
15,386 8 1
ml
40,202 1
ml
207 Prednison tab 5 mg Tab 98 3,085 425 120
208 Primakuin tab 15 mg Tab 125 2,000
209 Procurma syrup Botol 12,021 - 39
Vical Multivitamin Botol - 11
210 Propiltiourasil tab 100 mg Tab 351 620 300 100
212 Ranitidin inj 25 mg/ml Ampul 1,340 - - -
213 Ranitidin tab 150 mg Tab 128 30 30 240
214 Reserpin tablet 0.25 mg Tab 968 -
215 Rifampisin kaps 300 mg Kaps 440 -
216 Rifampisin tab 450 mg Tab 624 -
217 Rifampisin tab 600 mg Tab 863 -
218 Ringer Laktat Larutan infus Botol 5,720 89 15 16
219 Salbutamol tab 2 mg Tab 65 356 20
220 Salbutamol tab 4 mg Tab 93 395 10
endap 4 % Tube 2,200 31
222 Scabicid salep Tube -
223 Sefadroksil kaps 250 mg Vial 564 -
224 Sefadroksil kaps/tab 500 mg Tab 548 500 70 310
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 27 14 8
226 Sefiksim kapsul 100 mg Tab 1,000 -
227 Sefotaksim serb inj 1.000 mg/vial Vial 3,500 -
228 Seftriakson serb inj 1.000 mg/vial Vial 3,900 -
229 Setirizin tab 10 mg Tab 190 -
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial 1,150 224 2
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 -
232 Simetidin tablet 200 mg Tab 138 383 130
233 Simvastatin tab sal 10 mg Tab sal 177 -
234 Simvastatin tab sal 20 mg Tab sal 480 -
235 Siprofloksasin inf 2 mg/ml Botol 22,000 -
236 Siprofloksasin tab scored 500 mg Tab 312 -
238 Sulfasetamid Natrium Tetes mata 1.5% Botol 3,549 -
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol 14,450 -
240 Sukralfat tab 500 mg (Ulsidex) Tab 477 -
241 Teofilin tab SR 300 mg (Rethapyl) Tab 1,155 -
242 Tetrasiklin kaps 250 mg Kaps 183 -
243 Tetrasiklin kaps 500 mg Kaps 283 -
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 2,340 110 30
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab 770 -
248 Triheksifenidil tab 2 mg Tab 45 550 60 40
249 Vitamin B12 tablet 50 mcg Tab 63 1,580 100
251 Vitamin B kompleks Tab 112 631 890 880
252 Zinc tab disp 20 mg Tab 521 193 25 60
253 Zinc sirup 20 mg / 5 ml Botol 8,140 -
273 Lexavit tab 90
277 Aptyl Btl -
279 Retapyl SR Kapsul 200
281 Phenytoin Sodium Kapsul 190 30
282 Ulsidex Tablet 200
283 Scopma Kaplet 200
B. OBAT GIGI -
1 Bonding Botol -
2 Calcium hidrosida cement pasta (hycal) Kotak -
3 Comfosite Tube -
4 Devitalisasi Pasta (Non Arsen) Kotak 390,000 -
5 Eugenol cair Botol 18,333 -
6 Etil Klorida spray Botol 105,000 -
7 Etza Tube 170,000 -
8 Glass Ionomer Cement ART Set 395,000 -
12 Mummiyng pasta Kotak 176,000 -
JUMLAH OBAT GIGI ( B ) 68
C. OBAT PROGRAM
2 Artemether inj 80 mg/ml Ampul -
3 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 27,569 -
5 Imersion oil Botol -
6 Iodina Test Botol -
7 Obat Anti Tuberculosis FDC Kategori Anak Paket 236,490 -
8 Obat Anti Tuberculosis FDC Kategori I Paket 396,000 -
9 Obat Anti Tuberculosis FDC Kategori II Paket 1,319,990 -
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 175,899 -
11 Reagen Zenit Nelson Botol 145,000 -
12 RDT Dangue DBD Set 150,000 -
13 RDT malaria (care star ) Set 168,300 -
14 RDT HIV (intec) Set 46,200 -
15 RDT HIV (vikia) Set 45,560 -
16 RDT HIV (Oncoprobe) Set 42,350 -
17 Taburia Kotak 20,454 -
18 Quinina injeksi Ampul 4,438 -
19 Vaksin BCG inj (i.k) Vial -
20 Vaksin campak inj (s.k.) Vial -
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial -
22 Vaksin jerap difteri tetanus (DT) Vial -
25 Vaksin rabies, untuk manusia serb inj (s.k./i.k) +
booster Vial 695,752 -
26 Retinol (Vit.A) 200.000 IU kap lunak 412 900
29 Doxiciklin tab
30 Garam Oralit 2,945
31 Kina 475
34 Diazepam Inj 713
39 Mg So4 20 % 438
40 Mg So4 40 % 62
41 Zinc 20 mg 1,245
46 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol 45
47 Retinol (Vitamin A) 200.000 IU Kapsul Lunak Botol 55
JUMLAH OBAT PROGRAM ( C ) 68
D. BAHAN MEDIS HABIS PAKAI (BHMP) -
1 Alat suntik sekali pakai 1 ml Set 1,093 727 15 14
2 Alat suntik sekali pakai 2,5 ml Set 848 91 30 25
3 Alat suntik sekali pakai 3 ml Set 848 212 20 18
4 Alat suntik sekali pakai 5 ml Set 979 159 5 4
5 Bisturi no. 20 Buah 2,099 187 4 12
6 Bisturi no. 15 Buah 2,099 379 8 9
7 Catgut No 2/0 Set 25,920 54 4 2
8 Catgut No 3/0 Set 5,900 43 3 2
9 Handscoen no. 6 Pasang -
10 Handscoen no. 6,5 Pasang -
11 Handscoen no. 7 Pasang 7,684 -
12 Handscoen no. 7,5 Pasang 7,684 67 15 19
13 Infuset dewasa Set 4,176 44 4 8
14 Infusion set anak Set 4,568 43 4 3
15 IV Catheter No.16 G Set -
16 IV Catheter No.18 G Set 7,937 42 6 1
17 IV Catheter No.24 G Set 7,937 26 4 3
18 IV Catheter No. 20 G Set 7,787 97 2
19 IV Catheter No. 22 G Set 7,937 20 5
20 Folley Catheter 16 Set -
21 Folley Catheter 18 Set 8,495 -
22 Folley catheter 22 Set 8,495 -
23 Folley catheter 24 Set 495 -
25 Kapas Berlemak 500 gram Rol 17,250 -
26 Kasa Pembalut 4m x 3 cm Rol 800 3 3
27 Kasa Pembalut 4m x 5 cm Rol 887 2 2 3
28 Kasa Pembalut 4m x 10 cm Rol 6,121 15 5 5
29 Kasa Pembalut 4m x 15 cm Rol 887 -
30 Kasa Kompres 40/40 steril Buah 1,871 -
31 Kasa Steril 16 X 16 Buah 8,600 -
32 Kasa pembalut 2 x 80 Rol 13,221 1 1
33 Kasa Pembalut 40 x 80 Rol 137,025 -
34 Kasa Pembalut 36 x 80 cm Rol 133,821 -
35 Pembalut Gips Buah 32,500 -
36 Plester 5 yard x 2 inc Rol 23,625 2 1 -
37 Silk Set 5,082 4 3 2
38 Selang oksigen anak Set -
39 Selang oksigen dewasa Set -
40 Sofratulle Set -
41 Urine bag Set 4,000 6 2
42 Wing Needle No. 21 G Set 5,770 -
44 Wing Needle No.25 G Set 5,770 -
46 NGT No. 3 ( Feeding Tube ) Set 22,000 -
47 NGT No. 5 ( Feeding Tube ) Set 22,000 -
48 Masker Buah 1,125 - -
50 Tes Narkoba 3 parameter Set 68,181 -
51 Tes Narkoba 5 parameter Set 68,181 -
52 Tes Kehamilan Sachet 6,825 19 4
JUMLAH BAHAN MEDIS HABIS PAKAI (BHMP) (D) 68
TIDAK
BAYAR ASKES
JUMLAH KUNJUNGAN RESEP BAYAR Mengetahui :
23 209 24 Kepala Puskesmas Poleang Tengah ,
KETERANGAN
→Jika TK > 4 , Tidak perlu melakukan permintaan Obat JAFARUDDIN, AMK

Jika TK ≤ 4, minta Obat NIP. 19740906 199502 1 003

016
OKT NOP DES JUMLAH
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / Harga
No Nama Obat
Kemasan Satuan (Rp) JAN FEB
1 2 3 4 20
A. OBAT
4 Alprazolam tab 1 mg Tab 245
6 Ambroksol tablet 30 mg Tab 138
magnesium hidroksida 200 mg Tab kunyah 78 2,000
magnesium hidroksida 200 mg Suspensi Botol 2,213
B 10.000 UI/g Tube 2,767
Tab 149
Tab 163
36 Asiklovir salep kulit Tube 2,367
mcg Botol 110,500
50 Bromheksin tablet tablet 42
66 Domperidon tab 10 mg Tab 174
anhidrat 2,7 g
95 Gentamisin salep Kulit Tube 1,469
100 Gliseril Guaiakolat tab 100 mg Tab 31 1,000
106 Griseofulvin (micronized) tab 125 mg Tab 230
112 Hidrokortison krim 2,5% Tube 2,938
125 Kaptopril tab 25 mg Tab 97
138 Klorfeniramin (CTM) tab 4 mg Tab 26
142 Kombinasi : Pirimethamin 25 mg + sulfadoksin Tab 531
nebules (Combivent UDV) Vial 5,990
400 mg+ trimetoprim 80 mg Tab 152

155 Loratadin tab 10 mg Tab 170
173 Mikonazol krim 2% Tube 3,150
198 Piracetam injeksi 1 g/5 ml Ampul 60,500
202 Piroksikam tablet 20 mg Tab 116
Botol 30 ml 2,344
15,386
ml
40,202
ml
208 Primakuin tab 15 mg Tab 125 2,000
209 Procurma syrup Botol 12,021
Vical Multivitamin Botol
224 Sefadroksil kaps/tab 500 mg Tab 548
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286
273 Lexavit tab
277 Aptyl Btl
278 Levopar Tablet
282 Ulsidex Tablet
283 Scopma Kaplet
B. OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube 170,000
C. OBAT PROGRAM
6 Iodina Test Botol
Vial 695,752
29 Doxiciklin tab
30 Garam Oralit
31 Kina
32 Gentamicin Inj.
34 Diazepam Inj
39 Mg So4 20 %
40 Mg So4 40 %
41 Zinc 20 mg
44 Alat Suntik 5 ml
1 Alat suntik sekali pakai 1 ml Set 1,093
28 Kasa Pembalut 4m x 10 cm Rol 6,121
37 Silk Set 5,082
40 Sofratulle Set
TIDAK
BAYAR
23 209
KETERANGAN

OBAT EXPAYER TAHUN 2016
MAR APR MEI JUN JUL AGUST SEP OKT NOP DES
JUMLAH
LAPORAN PENERIMAAN, PENGELUARAN OBAT DI GUDANG
KEADAAN OBAT BULAN : DESEMBER 2016
STOCK PENERIMAAN PENGELUARAN STOK AKHIR EXPIRE DATE

NO NAMA OBAT SATUAN
AWAL TGL JUMLAH TGL JUMLAH TGL JUMLAH I II III
1 2 3 4 5 6 7 8 9 10 11 12 13
A. OBAT-OBATAN
Anestetik lokal gigi kombinasi : lidokain hcl
16 2% + epinefrin 1 : 80.000 inj 2 ml Ampul
Antasida, kombinasi : aluminium hidroksida 200

17 Tab kunyah
mg + magnesium hidroksida 200 mg
Antasida, kombinasi : aluminium hidroksida 200

18 Botol
mg + magnesium hidroksida 200 mg Suspensi
Antibakteri, kombinasi : basitrasin 500 UI/g+

19 Tube
Polimiskin B 10.000
Antifungi salep, UI/g : asam benzoat 6%+
kombinasi
asam salisilat 3%
20 Tube
mg + heksaklorofen 2,5 mg + lidokain lidokain
10 mg+ seng oksida 120 mg + sup ad 2 g
21 Suppo
Anti Parkinson kombinasi : benzerasid 25 mg +

22 Kaps
levodopa 100 mg
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
Anti Migren, kombinasi : ergotamin 1 mg+ kafein
23 Tab
50 mg
Asam asetilsalisilat (asetosal) tab 80 mg
28 Tab
(Miniaspi 80)
Besi (II) sulfat 200 mg + asam folat 0.25 mg
42 Sachet
(tablet tambah darah)
Budesonid-formoterol (fixed combination)* ih
49 Botol
80/4,5 mcg
53 Desoksimetason salep 0,25% Tube
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
62 Diltiazem kaps SR 100 mg Kaps
63 Diltiazem tab 30 mg Tab
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g
89 Sachet
+ glukosa anhidrat 2,7 g
90 Gameksan lotion 1 % Botol

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
102 Glukosamin tablet 500 mg Tab
Ipratropium bromida nebulizer 0,025% (Atroven
117 Botol
sol. for inhalation 0.025%)
121 KA-EN 3B Cairan Infus Botol
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
131 Ketorolak inj 10 mg/ml Ampul
132 Klaritromisin tab 500 mg Tab
Kombinasi: ipratropium Br 0,5 mg+ salbutamol
2,5 mg nebules (Combivent UDV)
143 Vial
Kotrimoksazol (dewasa) kombinasi :

sulfametoksazol 400 mg+ trimetoprim 80 mg
144 Tab
Kotrimoksazol (anak) kombinasi :

sulfametoksazol 100 mg+ trimetoprim 20 mg
145 Tab
Kotrimoksazol (dewasa) kombinasi tiap 5 ml

146 suspensi : sulfametoksazol 200 mg + Botol
trimetoprim 40 mg
147 Kuinin inj 25% (i.v.) Vial
153 Lisol Botol
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
163 Metilergometrin inj 0,2 mg/ml Ampul
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube
Salep 2-4, kombinasi : asam salisilat 2 %+
221 Tube
belerang endap 4 %
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol
240 Sukralfat tab 500 mg (Ulsidex) Tab
241 Teofilin tab SR 300 mg (Rethapyl) Tab
Kloroquin Tablet 150 mg Tab
Larutan PK Botol
Fenol Gliserol tetes telinga 10% Btl
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
B.OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube
JUMLAH OBAT GIGI (B) 12

C.OBAT PROGRAM
6 Iodina Test Botol
17 Taburia Kotak
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m. Vial
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
Vaksin rabies, untuk manusia serb inj (s.k./i.k) +
25 Vial
booster
Retinol (Vitamin A) 100.000 IU Kapsul Lunak btl 50 Kapsul Lunak
Retinol (Vitamin A) 200.000 IU Kapsul Lunak btl 50 Kapsul Lunak
JUMLAH OBAT PROGRAM (C) 27

D.BAHAN MEDIS HABIS PAKAI (BHMP)
7 Catgut No 2/0 Set
8 Catgut No 3/0 Set
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8 9 10 11 12 13
35 Silk Set
38 Sofratulle Set
39 Urine bag Set
46 Masker Buah
Tes kehamilan Strip
JUMLAH BHMP ( D ) 50
KETERANGAN
→Tingkat kecukupan (TK) = Sisa stok gudang / Pemakain Rata - Rata Perbulan

ENGELUARAN OBAT DI GUDANG
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
EXPIRE DATE
IV V
14 15
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / Daftar DOEN

No Nama Obat KET.
Kemasan
YA TIDAK
1 2 3
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul Ö
2 Albendazol tab 400 mg Tab Ö
3 Alopurinol tab 100 mg Tab Ö
4 Alprazolam tab 1 mg Tab Ö
5 Albothyl cairan Botol Ö
6 Ambroksol tablet 30 mg Tab Ö
7 Ambroksol sirup Botol Ö
8 Aminofilin inj 24 mg/ml Ampul Ö
9 Aminofilin tab 200 mg Tab Ö
10 Amitriptilin tab sal 25 mg Tab sal Ö
13 Amoksisilin sir kering 125 mg/5 ml Botol Ö
15 Amoksisilin tab 500 mg Tab Ö
epinefrin 1 : 80.000 inj 2 ml Ampul Ö

magnesium hidroksida 200 mg Tab kunyah Ö

magnesium hidroksida 200 mg Suspensi Botol Ö

B 10.000 UI/g Tube Ö

salisilat 3% Tube Ö

heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng Suppo Ö
Tab Ö
24 Antalgin (metampirom) tablet 500 mg Tab Ö

25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul Ö
26 Asam asetilsalisilat (asetosal) tab 100 mg Tab Ö
29 Asam askorbat (vitamin C) tab 50 mg Tab Ö
30 Asam folat tab 1 mg Tab Ö
32 Asam mefenamat kaps 500 mg Kaps Ö
33 Asam traneksamat inj 50 mg/ml Ampul Ö
34 Asam traneksamat tab 500 mg Tab Ö
36 Asiklovir salep kulit Tube Ö
37 Asiklovir tab 200 mg Tab Ö
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul Ö
39 Atropin tab 0,5 mg Tab Ö
41 Bedak salisil serb 2% Botol Ö
tambah darah) Sachet Ö
43 Becefort syrup Botol Ö

44 Betametason krim 0,1% Tube Ö
47 Bisakodil tab sal 5 mg Tab sal Ö
50 Bromheksin tablet tablet Ö
51 Deksametason tab 0,5 mg Tab Ö
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial Ö
54 Diazepam inj 5 mg/ml (i.v./i.m.) Vial Ö
57 Diazepam tab 2 mg Tab Ö
59 Dietilkarbamazin tab 100 mg Tab Ö
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul Ö
61 Digoksin tab 0,25 mg Tab Ö
62 Diltiazem kaps SR 100 mg Kaps Ö
64 Doksisiklin tablet 100 mg Tab Ö
65 Domperidon susp 5 mg/5 ml Botol Ö
66 Domperidon tab 10 mg Tab Ö
67 Efedrin HCl tablet Tab Ö
68 Ekstrak belladon tablet 10 mg tab Ö
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul Ö
70 Eritromisin kaps 250 mg Kaps Ö
71 Eritromisin sir 200 mg/5 ml Botol Ö
72 Eritromisin tab 500 mg Tab Ö
73 Etanol 70% cairan 70% Botol Ö
74 Etakridin (rivanol) larutan 0.1% Botol Ö
75 Etil klorida semprot 100 ml Botol Ö
80 Fenobarbital tab 100 mg Tab Ö
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial Ö
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal Ö
84 Flukonazol kaps 150 mg Kaps Ö
87 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul Ö
88 Furosemid tab 40 mg Tab Ö
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa Sachet Ö
anhidrat 2,7 g
91 Gemfibrozil kaps 300 mg Kaps Ö
95 Gentamisin salep Kulit Tube Ö
97 Glibenklamid tab 5 mg Tab Ö
100 Gliseril Guaiakolat tab 100 mg Tab Ö
103 Glukosa Larutan Infus 5% steril Botol Ö
106 Griseofulvin (micronized) tab 125 mg Tab Ö
107 Haloperidol tab 0,5 mg Tab Ö
109 Haloperidol tab 5 mg Tab Ö
110 Hidrogen peroksida (H2O2) cairan 3% Botol Ö
111 Hidroklorotiazid (HCT) tab 25 mg Tab Ö
112 Hidrokortison krim 2,5% Tube Ö
113 Hiosina butilbromida tab 10 mg Tab Ö
114 Ibuprofen susp 100 mg/5 ml Botol Ö
115 Ibuprofen tab 200 mg Tab Ö
120 Isosorbid dinitrat tab 5 mg Tab Ö
123 Kalsium laktat (kalk) tab 500 mg Tab Ö
124 Kaptopril tab 12,5 mg Tab Ö
125 Kaptopril tab 25 mg Tab Ö
126 Karbamazepin tab 200 mg Tab Ö
129 Ketokonazol tab 200 mg Tab Ö
130 Ketokonazol krim 2% Tube Ö
133 Klindamisin kaps 150 mg Kaps Ö
135 Kloramfenikol kaps 250 mg Kaps Ö
137 Kloramfenikol susp 125 mg/5 ml Botol Ö
138 Klorfeniramin (CTM) tab 4 mg Tab Ö
139 Klorpromazin inj 25 mg/ml (i.m.) Ampul Ö
140 Klorpromazin tab sal 100 mg Tab sal Ö
400 mg+ trimetoprim 80 mg Tab Ö


sulfametoksazol 200 mg + trimetoprim 40 mg Botol Ö
150 Levofloksasin tab 500 mg Tab Ö

152 Lidokain inj 2% (hcl) Vial Ö
153 Lisol Botol Ö
154 Loperamid tab 2 mg Tab Ö
155 Loratadin tab 10 mg Tab Ö
157 Magnesium sulfat inj 40% Vial Ö
158 Magnesium sulfat serb, ktg 30 g Sachet Ö
159 Mebendazol sir 50 mg/ml Botol Ö
160 Mebendazol tab 100 mg Tan Ö
164 Metilergometrin tab salut 0,125 mg Tab sal Ö
165 Metilprednisolon tab 4 mg Tab Ö
168 Metoklopramid tab 10 mg Tab Ö
171 Metronidazol tab 250 mg Tab Ö
173 Mikonazol krim 2% Tube Ö
174 Natrium diklofenak tab 25 mg Tab Ö
176 NaCl 0,9% Larutan infus Botol Ö
177 Nifedipin kaps 10 mg Kaps Ö
178 Nistatin tab salut 500.000 UI Tab Ö
179 Nistatin tab vaginal 100.000 UI Tab Ö
180 Obat Batuk Hitam (OBH) Botol Ö
181 Ofloksasin tab 200 mg Tab Ö
184 Oksitetrasiklin hcl salep kulit 3% Tube Ö
186 Oksitosin inj 10 UI/ml Ampul Ö
187 Omeprazol kaps 20 mg Kaps Ö
188 Papaverin tablet 40 mg Tab Ö
189 Parasetamol sir 120 mg/5 ml Botol Ö
190 Parasetamol tab 100 mg Tab Ö
193 Pehavral tablet multivitamin Tab Ö
195 Phenylbutazon tablet 200 mg Tab Ö
196 Piracetam tablet 800 mg Tab Ö
198 Piracetam injeksi 1 g/5 ml Ampul Ö
200 Pirantel pamoat tab scored 125 mg Tab Ö
201 Piridoksin (vitamin B6) tab 25 mg Tab Ö
202 Piroksikam tablet 20 mg Tab Ö
204 Povidon iodin lar 100 mg/ml Botol 30 ml Ö
207 Prednison tab 5 mg Tab Ö
209 Procurma syrup Botol Ö
210 Propiltiourasil tab 100 mg Tab Ö
211 Propranolol tab 40 mg Tab Ö
212 Ranitidin inj 25 mg/ml Ampul Ö
213 Ranitidin tab 150 mg Tab Ö
218 Ringer Laktat Larutan infus Botol Ö
219 Salbutamol tab 2 mg Tab Ö
endap 4 % Tube Ö
224 Sefadroksil kaps/tab 500 mg Tab Ö

225 Sefadroksil sir kering 125 mg/5 ml Botol Ö
228 Seftriakson serb inj 1.000 mg/vial Vial Ö
229 Setirizin tab 10 mg Tab Ö
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial Ö
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab Ö
232 Simetidin tablet 200 mg Tab Ö
237 Spironolakton tab 100 mg Tab Ö
240 Ulsidex Tablet Ö
241 Retapyl SR Kapsul Ö
242 Tetrasiklin kaps 250 mg Kaps Ö
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab Ö
246 Tramadol inj 50 mg/ml Ampul Ö
247 Tramadol tablet 500 mg Tab Ö
248 Triheksifenidil tab 2 mg Tab Ö
249 Vitamin B12 tablet 50 mcg Tab Ö
250 Vitamin B kompleks injeksi Vial Ö
251 Vitamin B kompleks Tab Ö
252 Zinc tab disp 20 mg Tab Ö
254 Larutan PK botol Ö
255 Kanamisin inj Vial Ö
263 Fenolgliserol TT 10% Kotak Ö
273 Lexavit tab Ö
276 Kloroquin Tablet 150 mg Tab Ö
278 Levopar Tablet Ö
280 Pytogin inj Ampul Ö

B. OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube
C. OBAT PROGRAM
1 Albedazole 400mg Tab Ö
7 Obat Anti Tuberculosis FDC Kategori Anak Paket Ö
8 Obat Anti Tuberculosis FDC Kategori I Paket Ö
9 Obat Anti Tuberculosis FDC Kategori II Paket Ö
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket Ö
19 Vaksin BCG inj (i.k) Vial Ö
20 Vaksin campak inj (s.k.) Vial Ö
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial Ö
22 Vaksin jerap difteri tetanus (DT) Vial Ö
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial Ö
24 Vaksin polio drops 10 dosis Vial Ö
Vial Ö
26 Retinol (Vit.A) 200.000 IU kap lunak Ö

28 zink tab.20mg Ö
29 Doxiciklin tab Ö
30 Garam Oralit Ö
31 Kina Ö
32 Gentamicin Inj. Ö
33 Pitomenadion Inj. Ö
34 Diazepam Inj Ö
35 Glukonas Kalsikas Ö
36 Phenobarbital Inj. Ö
37 Ampiciline Sodium Inj Ö
38 Benzatin B Penicilin Inj. Ö
39 Mg So4 20 % Ö
40 Mg So4 40 % Ö
41 Zinc 20 mg Ö
42 Pyrantel Tab 125 mg Ö
43 Alat Suntik 0,5 ml Ö
44 Alat Suntik 5 ml Ö
45 Kotrimoksasol 480 mg Ö
46 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol Ö
212
KODE PUSKESMAS :
KABUPATEN : BOMBANA
STOCK PENERI
Satuan / Harga AWAL MAAN
No Nama Obat
Kemasan Satuan (Rp)
1 2 3 4 4 5
A. OBAT
2 Albendazol tab 400 mg Tab 363 210
5 Albothyl cairan Botol 18,635 0
7 Ambroksol sirup Botol 2,722 35
10 Amitriptilin tab sal 25 mg Tab sal 123 1260
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 0
0
magnesium hidroksida 200 mg Tab kunyah 78
800
0
B 10.000 UI/g Tube 2,767
32
24
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng Suppo 33,000
oksida 120 mg + sup ad 2 g 84
Tab 149
518
24 Antalgin (metampirom) tablet 500 mg Tab 155 1270
32 Asam mefenamat kaps 500 mg Kaps 127 1430
15230
43 Becefort syrup Botol 22,727 0
44 Betametason krim 0,1% Tube 1,596 45
47 Bisakodil tab sal 5 mg Tab sal 4,990 0
51 Deksametason tab 0,5 mg Tab 68 828
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,738 220
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 66
65 Domperidon susp 5 mg/5 ml Botol 3,490 0
68 Ekstrak belladon tablet 10 mg tab 42 3300
71 Eritromisin sir 200 mg/5 ml Botol 8,090 0
72 Eritromisin tab 500 mg Tab 1,013 780
88 Furosemid tab 40 mg Tab 84 1190
anhidrat 2,7 g 845
97 Glibenklamid tab 5 mg Tab 61 0
124 Kaptopril tab 12,5 mg Tab 69 290
126 Karbamazepin tab 200 mg Tab 269 0
129 Ketokonazol tab 200 mg Tab 320 624
130 Ketokonazol krim 2% Tube 5,150 0
137 Kloramfenikol susp 125 mg/5 ml Botol 4,016 7
138 Klorfeniramin (CTM) tab 4 mg Tab 26 5787
1280
751
16
153 Lisol Botol 54,995 0
160 Mebendazol tab 100 mg Tan 248 30
165 Metilprednisolon tab 4 mg Tab 230 0
176 NaCl 0,9% Larutan infus Botol 5,170 61
188 Papaverin tablet 40 mg Tab 109 6605
193 Pehavral tablet multivitamin Tab 297 0
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 4210
204 Povidon iodin lar 100 mg/ml Botol 30 ml 2,344 8
207 Prednison tab 5 mg Tab 98 2170
210 Propiltiourasil tab 100 mg Tab 351 700
212 Ranitidin inj 25 mg/ml Ampul 1,340 0
213 Ranitidin tab 150 mg Tab 128 850
44
224 Sefadroksil kaps/tab 500 mg Tab 548 960
228 Seftriakson serb inj 1.000 mg/vial Vial 3,900 0
229 Setirizin tab 10 mg Tab 190 0
240 Ulsidex Tablet 477 160
241 Retapyl SR Kapsul 1,155 180
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 2100
249 Vitamin B12 tablet 50 mcg Tab 63 1480
251 Vitamin B kompleks Tab 112 2333
252 Zinc tab disp 20 mg Tab 521 323
255 Kanamisin inj Vial 5,929 50
273 Lexavit tab 1,480 100

B. OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube 170,000
C. OBAT PROGRAM
7 Obat Anti Tuberculosis FDC Kategori Anak Paket 236,490 0
8 Obat Anti Tuberculosis FDC Kategori I Paket 396,000 0
9 Obat Anti Tuberculosis FDC Kategori II Paket 1,319,990 0
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 175,899 0
19 Vaksin BCG inj (i.k) Vial 0
20 Vaksin campak inj (s.k.) Vial 0
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial 0
22 Vaksin jerap difteri tetanus (DT) Vial 0
Vial 695,752
0
28 zink tab.20mg 497 0
29 Doxiciklin tab
30 Garam Oralit 2945
31 Kina 475
34 Diazepam Inj 713
39 Mg So4 20 % 438
40 Mg So4 40 % 62
41 Zinc 20 mg 1245
45 Kotrimoksasol 480 mg 1600
28 Kasa Pembalut 4m x 10 cm Rol 6,121
37 Silk Set 5,082
40 Sofratulle Set
PERSE
DIAAN
39
210
169
130
0
498
35
263
260
1260
0
2677
800
32
24
84
518
1270
170
647
943
445
1430
10
225
9
829
28
150
12
15230
0
45
0
230
828
220
16
610
557
66
148
100
170
517
407
3300
69
780
3
5
4
980
28
761
140
50
1190
845
290
75
0
4260
28
18
190
710
230
240
0
5000
19
200
16
815
1470
49
545
290
450
624
0
240
230
7
5787
30
4160
240
1280
751
16
140
109
80
547
2
5
4
30
280
0
199
48
970
34
240
455
61
110
578
42
22
72
255
55
211
40
6605
33
370
1955
0
1350
160
120
20
251
4210
729
8
3
2170
20
700
150
0
850
55
336
385
44
960
61
311
343
200
160
180
700
280
2100
128
227
280
1480
25
2333
323
16
50
138
100
537
100
10
165
5
1
1
700
3000
0
0
0
0
0
0
0
0
10
10
0
450
0
0
2945
475
20
30
713
98
210
294
311
438
62
1245
300
200
100
1600
202
203
LAPORAN PENERIMAAN, PENGELUARAN OBAT DI GUDANG
KEADAAN OBAT BULAN : ………………………………………

NO NAMA OBAT SATUAN
AWAL TGL JUMLAH TGL JUMLAH TGL JUMLAH I II III IV V
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
A. OBAT
16 Anestetik lokal gigi kombinasi : lidokain hcl 2% + Ampul
epinefrin 1 : 80.000 inj 2 ml
17 Antasida, kombinasi : aluminium hidroksida 200 mg Tab kunyah
+ magnesium hidroksida 200 mg
18 Antasida,Syrup Botol
19 Antibakteri, Basitracin Tube
20 Antifungi salep, kombinasi : asam benzoat 6%+ Tube
asam salisilat 3%
21 Antihemoroid, kombinasi: bismut subgalat 150 mg + Suppo
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+
22 Anti
sengParkinson
oksida 120kombinasi
mg + sup: benzerasid
ad 2 g 25 mg + Kaps
levodopa 100 mg
23 Anti Migren, kombinasi : ergotamin 1 mg+ kafein 50 Tab
mg
28 Asam asetilsalisilat (asetosal) tab 80 mg (Miniaspi Tab
80)
42 Besi (II) sulfat 200 mg + asam folat 0.25 mg (tablet Sachet
tambah darah)
89 Garam oralit kombinasi : natrium klorida 0,52 g + Sachet
kalium klorida 0,30 g + trinatrium sitrat 0,58 g +
90 Gameksan lotion 2,7
glukosa anhidrat 1 %g Botol
143 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 Vial
mg nebules (Combivent UDV)
144 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol Tab
400 mg+ trimetoprim 80 mg
145 Kotrimoksazol (anak) kombinasi : sulfametoksazol Tab
100 mg+ trimetoprim 20 mg
146 Kotrimoksazol (dewasa) kombinasi tiap 5 ml Botol
suspensi : sulfametoksazol 200 mg + trimetoprim 40
147 Kuinin
mg inj 25% (i.v.) Vial
153 Lisol Botol
163 Metilergometrin inj 0,2 mg/ml Ampul
ml
ml
Vical Multivitamin Botol
221 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang Tube
endap 4 %
241 Teofilin tab SR 300 mg (Rethapyl) Tab
254 Larutan PK botol
255 Kanamisin inj Vial
256 Antalgin 500mg tab
260 Klonidin 0,15 mg Tab
263 Fenolgliserol TT 10% Kotak
273 Lexavit tab
277 Aptyl Btl
278 Levopar Tablet
282 Ulsidex Tablet
283 Scopma Kaplet
B. OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube
C. OBAT PROGRAM
6 Iodina Test Botol
17 Taburia Kotak
25 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + Vial
booster
28 zink tab.20mg
29 Doxiciklin tab
30 Garam Oralit
31 Kina
32 Gentamicin Inj.
34 Diazepam Inj
39 Mg So4 20 %
40 Mg So4 40 %
41 Zinc 20 mg
44 Alat Suntik 5 ml

7 Catgut No 2/0 Set
8 Catgut No 3/0 Set
37 Silk Set
41 Urine bag Set
48 Masker Buah
LAPORAN PERMINTAAN OBAT
tahun 2016
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Harga
Satuan / STOCK PENERI
No Nama Obat Satuan
Kemasan AWAL MAAN
(Rp)
1 2 3 4 4 5
1 Albedazole 400mg Tab Rp 363 50

2 Dietilkarbamazin tab 100 mg Tab 104 3,000
3 Retinol (Vit.A) 200.000 IU kap lunak Kapsul Rp 412 0
4 Retinol (Vit.A) 100.000 IU kap lunak Kapsul Rp 286 0
5
BULAN : AGUSTUS 2016
PEMBERIAN
PERSE PERMI
EXP KET
DIAAN NTAAN
JPKMM APBD LAIN2 JML
6 15 16 17 18 19 20 21
50
3,000
0 550
0 100
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / Daftar DOEN

No Nama Obat KET.
Kemasan YA TIDAK
1 2 3
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul Ö
2 Albendazol tab 400 mg Tab Ö
3 Alopurinol tab 100 mg Tab Ö
4 Alprazolam tab 1 mg Tab Ö
5 Albothyl cairan Botol Ö
6 Ambroksol tablet 30 mg Tab Ö
7 Ambroksol sirup Botol Ö
8 Aminofilin inj 24 mg/ml Ampul Ö
9 Aminofilin tab 200 mg Tab Ö
10 Amitriptilin tab sal 25 mg Tab sal Ö
11 Amlodipin tab 10 mg Tab Ö
12 Amlodipin tab 5 mg Tab Ö
13 Amoksisilin sir kering 125 mg/5 ml Botol Ö
epinefrin 1 : 80.000 inj 2 ml Ampul Ö

magnesium hidroksida 200 mg Tab kunyah Ö

magnesium hidroksida 200 mg Suspensi Botol
B 10.000 UI/g Tube Ö

salisilat 3% Tube Ö

heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng Suppo Ö
levodopa 100 mg Kaps Ö

Tab Ö
24 Antalgin (metampirom) tablet 500 mg Tab Ö

25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml Ampul Ö
Tab Ö
29 Asam askorbat (vitamin C) tab 50 mg Tab Ö

30 Asam folat tab 1 mg Tab Ö
33 Asam traneksamat inj 50 mg/ml Ampul Ö
34 Asam traneksamat tab 500 mg Tab Ö
35 Asering larutan infus Botol Ö
36 Asiklovir salep kulit Tube Ö
37 Asiklovir tab 200 mg Tab Ö
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul Ö
39 Atropin tab 0,5 mg Tab Ö
40 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol Ö
41 Bedak salisil serb 2% Botol Ö
tambah darah) Sachet Ö
43 Becefort syrup Botol Ö

44 Betametason krim 0,1% Tube Ö
45 Betahistin mesilate tablet tablet Ö
46 Bisakodil sup 10 mg (Stolax) Botol Ö
47 Bisakodil tab sal 5 mg Tab sal Ö
48 Bismecon salep tube Ö
mcg Botol Ö
50 Bromheksin tablet tablet Ö

51 Deksametason tab 0,5 mg Tab Ö
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial Ö
53 Desoksimetason salep 0,25% Tube Ö
54 Diazepam inj 5 mg/ml (i.v./i.m.) Vial Ö
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol Ö
56 Diazepam supposutoria suppo Ö
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul Ö
61 Digoksin tab 0,25 mg Tab Ö
62 Diltiazem kaps SR 100 mg Kaps Ö
63 Diltiazem tab 30 mg Tab Ö
64 Doksisiklin tablet 100 mg Tab Ö
65 Domperidon susp 5 mg/5 ml Botol Ö
66 Domperidon tab 10 mg Tab Ö
68 Ekstrak belladon tablet 10 mg tab Ö
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul Ö
70 Eritromisin kaps 250 mg Kaps Ö
71 Eritromisin sir 200 mg/5 ml Botol Ö
72 Eritromisin tab 500 mg Tab Ö
73 Etanol 70% cairan 70% Botol Ö
74 Etakridin (rivanol) larutan 0.1% Botol Ö
75 Etil klorida semprot 100 ml Botol Ö
76 Famotidin tablet 20 mg Tab Ö
77 Fenitoin Na inj 50 mg/ml Ampul Ö
78 Fenitoin Na kaps 100 mg Kaps Ö
79 Fenobarbital inj 50 mg/ml Ampul Ö
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial Ö
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal Ö
84 Flukonazol kaps 150 mg Kaps Ö
85 Flusinolon asetonid krim 0,025% Tube Ö
86 Flunarizin tablet tablet Ö
87 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul Ö
88 Furosemid tab 40 mg Tab Ö
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa Sachet Ö
anhidrat 2,7 g
90 Gameksan lotion 1 % Botol Ö
93 Gentamisin inj 10 mg/ml Ampul Ö
94 Gentamisin salep mata 0,3% Tube Ö
95 Gentamisin salep Kulit Tube Ö
96 Gentamisin tts mata 0,3% Botol Ö
97 Glibenklamid tab 5 mg Tab Ö
98 Glimepirid tab 4 mg Tab Ö
99 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab Ö
101 Gliserin lar 50% Botol Ö
102 Glukosamin tablet 500 mg Tab Ö
106 Griseofulvin (micronized) tab 125 mg Tab Ö
109 Haloperidol tab 5 mg Tab Ö
110 Hidrogen peroksida (H2O2) cairan 3% Botol Ö
112 Hidrokortison krim 2,5% Tube Ö
113 Hiosina butilbromida tab 10 mg Tab Ö
114 Ibuprofen susp 100 mg/5 ml Botol Ö
inhalation 0.025%) Botol Ö
118 Isoniazid tab 300 mg Tab Ö

119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial Ö
120 Isosorbid dinitrat tab 5 mg Tab Ö
121 KA-EN 3B Cairan Infus Botol Ö
122 Kalsium glukonat inj 100 mg/ml Ampul Ö
124 Kaptopril tab 12,5 mg Tab Ö
125 Kaptopril tab 25 mg Tab Ö
126 Karbamazepin tab 200 mg Tab Ö
127 Karbo adsorben (Norit) tab 500 mg Tab Ö
128 Ketamin inj 50 mg/ml (i.v.) Ampul Ö
129 Ketokonazol tab 200 mg Tab Ö
130 Ketokonazol krim 2% Tube Ö
131 Ketorolak inj 10 mg/ml Ampul Ö
132 Klaritromisin tab 500 mg Tab Ö
133 Klindamisin kaps 150 mg Kaps Ö
134 Kloramfenikol tts mata 0,5% Botol Ö
136 Kloramfenikol salep mata 1% Tube Ö
137 Kloramfenikol susp 125 mg/5 ml Botol Ö
138 Klorfeniramin (CTM) tab 4 mg Tab Ö
142 Kombinasi : Pirimethamin 25 mg + sulfadoksin Tab Ö
nebules (Combivent UDV) Vial Ö



sulfametoksazol 200 mg + trimetoprim 40 mg Botol Ö
147 Kuinin inj 25% (i.v.) Vial Ö

148 Kloroquin tab 150 mg Tab Ö
149 Lansoprazol kaps 30 mg Kaps Ö
150 Levofloksasin tab 500 mg Tab Ö
151 Lidokain gel 2% Tube Ö
152 Lidokain inj 2% (hcl) Vial Ö
153 Lisol Botol Ö
154 Loperamid tab 2 mg Tab Ö
155 Loratadin tab 10 mg Tab Ö
158 Magnesium sulfat serb, ktg 30 g Sachet Ö
159 Mebendazol sir 50 mg/ml Botol Ö
160 Mebendazol tab 100 mg Tan Ö
161 Metformin tab 500 mg Tab Ö
162 Metformin tab 850 mg Tab Ö
163 Metilergometrin inj 0,2 mg/ml Ampul Ö
164 Metilergometrin tab salut 0,125 mg Tab sal Ö
165 Metilprednisolon tab 4 mg Tab Ö
166 Metoklopramid inj 5 mg/ml Vial Ö
167 Metoklopramid sir 5 mg/5 ml (Lexapram sirup) Botol Ö
168 Metoklopramid tab 10 mg Tab Ö
169 Metronidazol supposutoria 500 mg suppo Ö
170 Metronidazol larutan infus Botol Ö
173 Mikonazol krim 2% Tube Ö
176 NaCl 0,9% Larutan infus Botol Ö
177 Nifedipin kaps 10 mg Kaps Ö
178 Nistatin tab salut 500.000 UI Tab Ö
179 Nistatin tab vaginal 100.000 UI Tab Ö
180 Obat Batuk Hitam (OBH) Botol Ö
183 Oksitetrasiklin hcl inj 500 mg/ml Vial Ö
184 Oksitetrasiklin hcl salep kulit 3% Tube Ö
185 Oksitetrasiklin hcl salep mata 1 % Tube Ö
186 Oksitosin inj 10 UI/ml Ampul Ö
187 Omeprazol kaps 20 mg Kaps Ö
188 Papaverin tablet 40 mg Tab Ö
189 Parasetamol sir 120 mg/5 ml Botol Ö
192 Parasetamol rectal suppo Ö
193 Pehavral tablet multivitamin Tab Ö
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube Ö
195 Phenylbutazon tablet 200 mg Tab Ö
198 Piracetam injeksi 1 g/5 ml Ampul Ö
199 Pirantel pamoat susp 125 mg/5 ml Botol Ö
201 Piridoksin (vitamin B6) tab 25 mg Tab Ö
202 Piroksikam tablet 20 mg Tab Ö
Piroksikam tablet 10 mg Tab Ö
203 Polikresulen Botol Ö
208 Primakuin tab 15 mg Tab Ö
209 Procurma syrup Botol Ö
210 Propiltiourasil tab 100 mg Tab Ö
211 Propranolol tab 40 mg Tab Ö
212 Ranitidin inj 25 mg/ml Ampul Ö
213 Ranitidin tab 150 mg Tab Ö
214 Reserpin tablet 0.25 mg Tab Ö
215 Rifampisin kaps 300 mg Kaps Ö
216 Rifampisin tab 450 mg Tab Ö
217 Rifampisin tab 600 mg Tab Ö
218 Ringer Laktat Larutan infus Botol Ö
endap 4 % Tube Ö
222 Scabicid salep Tube Ö

223 Sefadroksil kaps 250 mg Vial Ö
224 Sefadroksil kaps/tab 500 mg Tab Ö
225 Sefadroksil sir kering 125 mg/5 ml Botol Ö
226 Sefiksim kapsul 100 mg Tab Ö
227 Sefotaksim serb inj 1.000 mg/vial Vial Ö
228 Seftriakson serb inj 1.000 mg/vial Vial Ö
229 Setirizin tab 10 mg Tab Ö
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml Vial Ö
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab Ö
232 Simetidin tablet 200 mg Tab Ö
233 Simvastatin tab sal 10 mg Tab sal Ö
234 Simvastatin tab sal 20 mg Tab sal Ö
235 Siprofloksasin inf 2 mg/ml Botol Ö
236 Siprofloksasin tab scored 500 mg Tab Ö
237 Spironolakton tab 100 mg Tab Ö
238 Sulfasetamid Natrium Tetes mata 1.5% Botol Ö
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol Ö
240 Ulsidex Tablet Ö
241 Retapyl SR Kapsul Ö
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab Ö
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab Ö
246 Tramadol inj 50 mg/ml Ampul Ö
247 Tramadol tablet 500 mg Tab Ö
249 Vitamin B12 tablet 50 mcg Tab Ö
250 Vitamin B kompleks injeksi Vial Ö
251 Vitamin B kompleks Tab Ö
252 Zinc tab disp 20 mg Tab Ö
253 Zinc sirup 20 mg / 5 ml Botol Ö
254 Larutan PK botol Ö
255 Kanamisin inj Vial Ö
256 Antalgin 500mg tab Ö
259 Kloroquin tab 250 mg Tab Ö
260 Klonidin 0,15 mg Tab Ö
263 Fenolgliserol TT 10% Kotak Ö
265 Kloroquin tab 250 mg Ö
266 Papaverin tablet 40 mg Ö
272 Vical Multivitamin Botol Ö
273 Lexavit tab Ö
276 Kloroquin Tablet 150 mg Tab Ö
277 Aptyl Btl Ö
278 Levopar Tablet Ö
280 Pytogin inj Ampul Ö
281 Phenytoin Sodium Kapsul Ö
Etanol 300% cairan Botol Ö

B. OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube
C. OBAT PROGRAM
1 Albedazole 400mg Tab Ö
2 Artemether inj 80 mg/ml Ampul Ö
3 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial Ö
5 Imersion oil Botol Ö
6 Iodina Test Botol Ö
7 Obat Anti Tuberculosis FDC Kategori Anak Paket Ö
8 Obat Anti Tuberculosis FDC Kategori I Paket Ö
9 Obat Anti Tuberculosis FDC Kategori II Paket Ö
10 Obat Anti Tuberculosis FDC Kategori Sisipan Paket Ö
11 Reagen Zenit Nelson Botol Ö
12 RDT Dangue DBD Set Ö
13 RDT malaria (care star ) Set Ö
14 RDT HIV (intec) Set Ö
15 RDT HIV (vikia) Set Ö
16 RDT HIV (Oncoprobe) Set Ö
17 Taburia Kotak Ö
18 Quinina injeksi Ampul Ö
19 Vaksin BCG inj (i.k) Vial Ö
20 Vaksin campak inj (s.k.) Vial Ö
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.) Vial Ö
22 Vaksin jerap difteri tetanus (DT) Vial Ö
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial Ö
24 Vaksin polio drops 10 dosis Vial Ö
Vial Ö

28 zink tab.20mg Ö
29 Doxiciklin tab Ö
30 Garam Oralit Ö
31 Kina Ö
32 Gentamicin Inj. Ö
33 Pitomenadion Inj. Ö
34 Diazepam Inj Ö
35 Glukonas Kalsikas Ö
36 Phenobarbital Inj. Ö
37 Ampiciline Sodium Inj Ö
38 Benzatin B Penicilin Inj. Ö
39 Mg So4 20 % Ö
40 Mg So4 40 % Ö
41 Zinc 20 mg Ö
42 Pyrantel Tab 125 mg Ö
43 Alat Suntik 0,5 ml Ö
44 Alat Suntik 5 ml Ö
45 Kotrimoksasol 480 mg Ö
7 Catgut No 2/0 Set
8 Catgut No 3/0 Set
37 Silk Set
40 Sofratulle Set
41 Urine bag Set
48 Masker Buah

(LPLPO)
tahun 2016
KODE PUSKESMAS :
KABUPATEN : BOMBANA
P
E
M
Harga A
Satuan / STOCK PENERI PERSE
No Nama Obat Satuan
Kemasan AWAL MAAN DIAAN K
(Rp) A
I
A
N
J
U
L
I
1 2 3 4 4 5 ###
6
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi)Ampul 2200 39 39
###
2 Alat Suntik 5 ml 100 100
###
3 Alat Suntik 0,5 ml 200 200
###
4 Albedazole 400mg Tab 363 700 700
###
5 Albendazol tab 400 mg Tab 363 210 210
###
6 Albothyl cairan Botol 18635 0 ###
0
7 Alopurinol tab 100 mg Tab 90 169 169
###
8 Alprazolam tab 1 mg Tab 245 130 130
###
9 Ambroksol sirup Botol 2722 35 35
###
10 Ambroksol tablet 30 mg Tab 137.58 498 498
###
11 Aminofilin inj 24 mg/ml Ampul 4204 263 263
###
12 Aminofilin tab 200 mg Tab 86 260 260
###
13 Amitriptilin tab sal 25 mg Tab sal 123 1260 1260
###
14 Amlodipin tab 10 mg Tab 352 0 ###
0
15 Amlodipin tab 5 mg Tab 197 0 ###
0
16 Amoksisilin sir kering 125 mg/5 ml Botol 2560 0 ###
0
17 Amoksisilin tab 250 mg Tab 220 0 ###
0
18 Amoksisilin tab 500 mg Tab 279 2677 2677
###
19 Ampiciline Sodium Inj 294 294
###
20 Anestetik lokal gigi kombinasi : lidokain hcl Ampul
2% + ep 1499 0 ###
0
21 Antalgin (metampirom) injeksi 250 mg/ml-2 Ampul 1346 170 170
###
22 Antalgin (metampirom) tablet 500 mg Tab 155 1270 1270
###
23 Antalgin 500mg tab 141 0 ###
0
24 Antasida, kombinasi : aluminium hidroksida Tab kunyah 78 800 800
###
25 Antasida, kombinasi : aluminium hidroksida Botol 2213 0 ###
0
26 Anti Migren, kombinasi : ergotamin 1 mg+ kaTab 149 518 518
###
27 Anti Parkinson kombinasi : benzerasid 25 mg Kaps 1650 0 ###
0
28 Antibakteri, kombinasi : basitrasin 500 UI/g+ Tube
Polim 2767 32 32
###
29 Antifungi salep, kombinasi : asam benzoat 6%+ Tube
asam salisilat2096
3% 24 24
###
30 Antihemoroid, kombinasi: bismut subgalat 150 Suppo
mg + heksaklorofe
33000 84 84
###
31 Aptyl Btl 0 ###
0
32 Artemether inj 80 mg/ml Ampul 0 ###
0
33 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 27569 0 ###
0
34 Asam asetilsalisilat (asetosal) tab 100 mg Tab 127 647 647
###
35 Asam asetilsalisilat (asetosal) tab 500 mg Tab 178 0 ###
0
36 Asam asetilsalisilat (asetosal) tab 80 mg (MinTab 163 0 ###
0
37 Asam askorbat (vitamin C) tab 50 mg Tab 105 943 943
###
38 Asam folat tab 1 mg Tab 52 445 445
###
39 Asam mefenamat kaps 250 mg Kaps 0 ###
0
40 Asam mefenamat kaps 500 mg Kaps 127 1430 1430
###
41 Asam traneksamat inj 50 mg/ml Ampul 3650 10 10
###
42 Asam traneksamat tab 500 mg Tab 1265 225 225
###
43 Asering larutan infus Botol 9000 0 ###
0
44 Asiklovir salep kulit Tube 2367 9 ###
9
45 Asiklovir tab 200 mg Tab 251 829 829
###
46 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1400 28 28
###
47 Atropin tab 0,5 mg Tab 81 150 150
###
48 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol 13500 0 ###
0
49 Becefort syrup Botol 22727 0 ###
0
50 Bedak salisil serb 2% Botol 1180 12 12
###
51 Benzatin B Penicilin Inj. 311 311
###
52 Besi (II) sulfat 200 mg + asam folat 0.25 mg Sachet 55 15230 15230
###
53 Betahistin mesilate tablet tablet 600 0 ###
0
54 Betametason krim 0,1% Tube 1596 45 45
###
55 Bisakodil sup 10 mg (Stolax) Botol 6045 0 ###
0
56 Bisakodil tab sal 5 mg Tab sal 4990 0 ###
0
57 Bismecon salep tube 0 ###
0
58 Bonding Botol 0 ###
0
59 Bromheksin tablet tablet 42.37 230 230
###
60 Budesonid-formoterol (fixed combination)* i Botol 110500 0 ###
0
61 Calcium hidrosida cement pasta (hycal) Kotak 0 ###
0
62 Comfosite Tube 0 ###
0
63 Deksametason tab 0,5 mg Tab 68 828 828
###
64 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1738 220 220
###
65 Desoksimetason salep 0,25% Tube 9983 0 ###
0
66 Devitalisasi Pasta (Non Arsen) Kotak 390000 0 ###
0
67 Diazepam Inj 713 713
###
68 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 2578 16 16
###
69 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol 18461 0 ###
0
70 Diazepam supposutoria suppo 0 ###
0
71 Diazepam tab 2 mg Tab 47 610 610
###
72 Diazepam tab 5 mg Tab 53 557 557
###
73 Dietilkarbamazin tab 100 mg Tab 104 0 ###
0
74 Dietilkarbamazin tab 100 mg Tab 104 3000 3000
###
75 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1160 66 66
###
76 Digoksin tab 0,25 mg Tab 103 148 148
###
77 Diltiazem kaps SR 100 mg Kaps 4033 100 100
###
78 Diltiazem tab 30 mg Tab 141 0 ###
0
79 Doksisiklin tablet 100 mg Tab 298 170 170
###
80 Domperidon susp 5 mg/5 ml Botol 3490 0 ###
0
81 Domperidon tab 10 mg Tab 174 517 517
###
82 Doxiciklin tab 0 ###
0
83 Efedrin HCl tablet Tab 56 407 407
###
84 Efedrin HCl tablet Tab 0 ###
0
85 Ekstrak belladon tablet 10 mg tab 42 3300 3300
###
86 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 8910 0 ###
0
87 Eritromisin kaps 250 mg Kaps 522 69 69
###
88 Eritromisin sir 200 mg/5 ml Botol 8090 0 ###
0
89 Eritromisin tab 500 mg Tab 1013 780 780
###
90 Etakridin (rivanol) larutan 0.1% Botol 4695 5 ###
5
91 Etanol 70% cairan 70% Botol 2625 3 ###
3
92 Etanol 300% cairan Botol 33 0 0
93 Etil klorida semprot 100 ml Botol 105000 4 ###
4
94 Etil Klorida spray Botol 105000 0 ###
0
95 Etza Tube 170000 0 ###
0
96 Eugenol cair Botol 18333 0 ###
0
97 Famotidin tablet 20 mg Tab 124 0 ###
0
98 Fenitoin Na inj 50 mg/ml Ampul 20857 0 ###
0
99 Fenitoin Na kaps 100 mg Kaps 146 0 ###
0
100 Fenobarbital inj 50 mg/ml Ampul 1980 0 ###
0
101 Fenobarbital tab 100 mg Tab 37.16 980 980
###
102 Fenobarbital tab 30 mg Tab 37 0 ###
0
103 Fenolgliserol TT 10% Kotak 1109 138 138
###
104 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.Vial 3754 28 28
###
105 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 698 761 761
###
106 Flukonazol kaps 150 mg Kaps 24200 140 140
###
107 Flunarizin tablet tablet 2400 0 ###
0
108 Flusinolon asetonid krim 0,025% Tube 2700 0 ###
0
109 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 2012 50 50
###
110 Furosemid tab 40 mg Tab 84 1190 1190
###
111 Gameksan lotion 1 % Botol 2420 0 ###
0
112 Garam Oralit 2945 2945
###
113 Garam oralit kombinasi : natrium klorida 0,52Sachet
g + ka 317 845 845
###
114 Gemfibrozil kaps 300 mg Kaps 323 290 290
###
115 Gemfibrozil kaps 600 mg Kaps 747 0 ###
0
116 Gentamicin Inj. 20 20
###
117 Gentamisin inj 10 mg/ml Ampul 3739 0 ###
0
118 Gentamisin salep Kulit Tube 1469 75 75
###
119 Gentamisin salep mata 0,3% Tube 2786 0 ###
0
120 Gentamisin tts mata 0,3% Botol 3194 0 ###
0
121 Glass Ionomer Cement ART Set 395000 0 ###
0
122 Glibenklamid tab 5 mg Tab 61 0 ###
0
123 Glimepirid tab 4 mg Tab 452 0 ###
0
124 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab 3000 0 ###
0
125 Gliseril Guaiakolat tab 100 mg Tab 31 4260 4260
###
126 Gliseril Guaiakolat tab 100 mg Tab 31 0 ###
0
127 Gliserin lar 50% Botol 5867 0 ###
0
128 Glukonas Kalsikas 98 98
###
129 Glukosa Larutan Infus 10% steril Botol 6270 18 18
###
130 Glukosa Larutan Infus 40% steril Botol 6270 0 ###
0
131 Glukosa Larutan Infus 5% steril Botol 5720 28 28
###
132 Glukosamin tablet 500 mg Tab 660 0 ###
0
133 Griseofulvin (micronized) tab 125 mg Tab 230 190 190
###
134 Haloperidol tab 0,5 mg Tab 62 710 710
###
135 Haloperidol tab 1,5 mg Tab 76 230 230
###
136 Haloperidol tab 5 mg Tab 105 240 240
###
137 Hidrogen peroksida (H2O2) cairan 3% Botol 38500 0 ###
0
138 Hidroklorotiazid (HCT) tab 25 mg Tab 39.93 5000 5000
###
139 Hidroklorotiazid (HCT) tab 25 mg Tab 109 0 ###
0
140 Hidrokortison krim 2,5% Tube 2938 19 19
###
141 Hiosina butilbromida tab 10 mg Tab 330 200 200
###
142 Ibuprofen susp 100 mg/5 ml Botol 3849 16 16
###
###
###
145 Imersion oil Botol 0 ###
0
146 Iodina Test Botol 0 ###
0
147 Ipratropium bromida nebulizer 0,025% (Atrove Botol 90000 0 ###
0
148 Isoniazid tab 300 mg Tab 174 0 ###
0
149 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 36960 0 ###
0
150 Isosorbid dinitrat tab 5 mg Tab 98 49 49
###
151 JUMLAH OBAT GIGI ( B ) ###
4
152 JUMLAH OBAT PROGRAM ( C ) 22
###
153 JUMLAH OBAT-OBATAN (A) 146 165
###
154 KA-EN 3B Cairan Infus Botol 10000 0 ###
0
155 Kalsium glukonat inj 100 mg/ml Ampul 7800 0 ###
0
156 Kalsium laktat (kalk) tab 500 mg Tab 76 545 545
###
157 Kalsium laktat (kalk) tab 500 mg Tab 76 0 ###
0
158 Kanamisin inj Vial 5929 50 50
###
159 Kaptopril tab 12,5 mg Tab 69 290 290
###
160 Kaptopril tab 25 mg Tab 97 450 450
###
161 Karbamazepin tab 200 mg Tab 269 0 ###
0
162 Karbo adsorben (Norit) tab 500 mg Tab 0 ###
0
163 Ketamin inj 50 mg/ml (i.v.) Ampul 63400 0 ###
0
164 Ketokonazol tab 200 mg Tab 320 624 624
###
165 Ketokonazol krim 2% Tube 5150 0 ###
0
166 Ketorolak inj 10 mg/ml Ampul 2665 0 ###
0
167 Kina 475 475
###
168 Klaritromisin tab 500 mg Tab 3600 0 ###
0
169 Klindamisin kaps 150 mg Kaps 405 240 240
###
170 Klonidin 0,15 mg Tab 193 0 ###
0
171 Kloramfenikol tts mata 0,5% Botol 1680 0 ###
0
172 Kloramfenikol kaps 250 mg Kaps 275 230 230
###
173 Kloramfenikol kaps 250 mg Kaps 275 0 ###
0
174 Kloramfenikol salep mata 1% Tube 1680 0 ###
0
175 Kloramfenikol susp 125 mg/5 ml Botol 4016 7 ###
7
176 Klorfeniramin (CTM) tab 4 mg Tab 26.4 5787 5787
###
177 Klorfenol Kamfer Menthol (CHKM) Botol 55000 5 ###
5
178 Kloroquin tab 150 mg Tab 112 0 ###
0
179 Kloroquin tab 250 mg Tab 572 0 ###
0
180 Kloroquin tab 250 mg 112 0 ###
0
181 Kloroquin Tablet 150 mg Tab 537 537
###
182 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1210 30 30
###
183 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1210 0 ###
0
184 Klorpromazin tab sal 100 mg Tab sal 162 4160 4160
###
185 Klorpromazin tab sal 100 mg Tab sal 162 0 ###
0
186 Klorpromazin tab sal 25 mg Tab sal 75 240 240
###
187 Kombinasi : Pirimethamin 25 mg + sulfadoksiTab 530.75 0 ###
0
188 Kombinasi: ipratropium Br 0,5 mg+ salbutamol
Vial2,5 mg nebules
5990 0 ###
0
189 Kotrimoksasol 480 mg 1600 1600
###
Tab 100 m 79 751 751
###
Tab 40 152 1280 1280
###
192 Kotrimoksazol (dewasa) kombinasi tiap 5 ml Botol 2298 16 16
###
193 Kuinin inj 25% (i.v.) Vial 6820 0 ###
0
194 Lansoprazol kaps 30 mg Kaps 521 0 ###
0
195 Larutan PK botol 6975 16 16
###
196 Levofloksasin tab 500 mg Tab 581 140 140
###
197 Levopar Tablet 100 100
###
198 Lexavit tab 1480 100 100
###
199 Lidokain gel 2% Tube 40000 0 ###
0
200 Lidokain inj 2% (hcl) Vial 929 109 109
###
201 Lisol Botol 54995 0 ###
0
202 Loperamid tab 2 mg Tab 97 80 80
###
Loratadin tab 10 mg Tab 170 547 547
###
203 Magnesium sulfat inj 20% Vial 7260 0 ###
0
204 Magnesium sulfat inj 40% Vial 7260 2 ###
2
205 Magnesium sulfat serb, ktg 30 g Sachet 1130 5 ###
5
206 Mebendazol sir 50 mg/ml Botol 3887 4 ###
4
207 Mebendazol tab 100 mg Tan 248 30 30
###
208 Metformin tab 500 mg Tab 124.5 0 ###
0
209 Metformin tab 850 mg Tab 280 0 ###
0
210 Metilergometrin inj 0,2 mg/ml Ampul 2750 0 ###
0
211 Metilergometrin tab salut 0,125 mg Tab sal 169 280 280
###
212 Metilprednisolon tab 4 mg Tab 230 0 ###
0
213 Metoklopramid inj 5 mg/ml Vial 1100 0 ###
0
214 Metoklopramid sir 5 mg/5 ml (Lexapram siru Botol 2900 0 ###
0
215 Metoklopramid tab 10 mg Tab 100 199 199
###
216 Metronidazol larutan infus Botol 12980 0 ###
0
217 Metronidazol supposutoria 500 mg suppo 3655 0 ###
0
218 Metronidazol tab 250 mg Tab 116 48 48
###
219 Metronidazol tab 500 mg Tab 169 970 970
###
220 Mg So4 20 % 438 438
###
221 Mg So4 40 % 62 62
###
222 Mikonazol krim 2% Tube 3150 34 34
###
223 Mummiyng pasta Kotak 176000 0 ###
224 NaCl 0,9% Larutan infus Botol 5170 61 61
###
225 Natrium diklofenak tab 25 mg Tab 146 240 240
###
226 Natrium diklofenak tab 50 mg Tab 193 455 455
###
227 Nifedipin kaps 10 mg Kaps 127 110 110
###
228 Nistatin tab salut 500.000 UI Tab 704 578 578
###
229 Nistatin tab vaginal 100.000 UI Tab 528 42 42
###
230 Obat Anti Tuberculosis FDC Kategori Anak Paket 236490 0 ###
0
231 Obat Anti Tuberculosis FDC Kategori I Paket 396000 0 ###
0
232 Obat Anti Tuberculosis FDC Kategori II Paket 1319990 0 ###
0
233 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 175899 0 ###
0
234 Obat Batuk Hitam (OBH) Botol 2310 22 22
###
235 OBAT GIGI 0 ###
236 OBAT PROGRAM 0
237 Ofloksasin tab 200 mg Tab 440 72 72
###
238 Ofloksasin tab 400 mg Tab 700 255 255
###
239 Oksitetrasiklin hcl inj 500 mg/ml Vial 3410 0 ###
0
240 Oksitetrasiklin hcl salep kulit 3% Tube 1646 55 55
###
241 Oksitetrasiklin hcl salep mata 1 % Tube 2772 0 ###
0
242 Oksitosin inj 10 UI/ml Ampul 1900 211 211
###
243 Omeprazol kaps 20 mg Kaps 221 40 40
###
244 Papaverin tablet 40 mg Tab 109.45 6605 6605
###
245 Papaverin tablet 40 mg 167 0 ###
0
246 Parasetamol rectal suppo 0 ###
0
247 Parasetamol sir 120 mg/5 ml Botol 1535 33 33
###
248 Parasetamol tab 100 mg Tab 105 370 370
###
249 Parasetamol tab 500 mg Tab 88 1955 1955
###
250 Pehavral tablet multivitamin Tab 297 0 ###
0
251 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25350 0 ###
0
252 Phenobarbital Inj. 210 210
###
253 Phenylbutazon tablet 200 mg Tab 107 1350 1350
###
254 Phenytoin Sodium Kapsul 130 130
###
255 Piracetam injeksi 1 g/5 ml Ampul 60500 20 20
###
256 Piracetam tablet 1200 mg Tab 854 120 120
###
257 Piracetam tablet 1200 mg Tab 854 0 ###
0
258 Piracetam tablet 800 mg Tab 963.6 160 160
###
259 Pirantel pamoat susp 125 mg/5 ml Botol 9100 0 ###
0
260 Pirantel pamoat tab scored 125 mg Tab 318 251 251
###
261 Pirantel pamoat tab scored 125 mg Tab 318 0 ###
0
262 Piridoksin (vitamin B6) tab 25 mg Tab 19 4210 4210
###
263 Piroksikam tablet 10 mg Tab 0 ###
0
264 Piroksikam tablet 20 mg Tab 115.5 729 729
###
265 Pitomenadion Inj. 30 30
###
266 Polikresulen Botol 18635 0 ###
0
267 Povidon iodin lar 100 mg/ml Botol 30 m 2344 8 ###
8
268 Povidon iodin lar 100 mg/ml Botol 300 15386 3 ###
3
269 Povidon iodin lar 100 mg/ml Botol 1000 40202 0 ###
0
270 Prednison tab 5 mg Tab 97.5 2170 2170
###
271 Prednison tab 5 mg Tab 125 0 ###
0
272 Primakuin tab 15 mg Tab 125 0 ###
0
273 Procurma syrup Botol 12021 20 20
###
274 Propiltiourasil tab 100 mg Tab 351 700 700
###
275 Propranolol tab 40 mg Tab 80 150 150
###
276 Pyrantel Tab 125 mg 300 300
###
277 Pytogin inj Ampul 10 10
###
278 Quinina injeksi Ampul 4438 0 ###
0
280 Ranitidin inj 25 mg/ml Ampul 1340 0 ###
0
281 Ranitidin tab 150 mg Tab 128 850 850
###
RDT Dangue DBD Set 150000 0 ###
0
RDT HIV (intec) Set 46200 0 ###
0
RDT HIV (Oncoprobe) Set 42350 0 ###
0
B. RDT HIV (vikia) Set 45560 0 ###
0
1 RDT malaria (care star ) Set 168300 0 ###
0
2 Reagen Zenit Nelson Botol 145000 0 ###
0
3 Reserpin tablet 0.25 mg Tab 968 0 ###
0
4 Retapyl SR Kapsul 1155 180 180
###
5 Retinol (Vit.A) 100.000 IU kap lunak 286 0 ###
0
6 Retinol (Vit.A) 200.000 IU kap lunak 412 450 450
###
7 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol 0 ###
0
8 Retinol (Vitamin A) 200.000 IU Kapsul Lunak Botol 0 ###
0
9 Rifampisin kaps 300 mg Kaps 440 0 ###
0
10 Rifampisin tab 450 mg Tab 624 0 ###
0
11 Rifampisin tab 600 mg Tab 863 0 ###
0
12 Ringer Laktat Larutan infus Botol 5720 55 55
###
Salbutamol tab 2 mg Tab 65 336 336
###
C. Salbutamol tab 4 mg Tab 93 385 385
###
1 Salep 2-4, kombinasi : asam salisilat 2 %+ bele
Tube 2200 44 44
###
2 Scabicid salep Tube 0 ###
0
3 Sefadroksil kaps 250 mg Vial 564 0 ###
0
4 Sefadroksil kaps/tab 500 mg Tab 548 960 960
###
5 Sefadroksil sir kering 125 mg/5 ml Botol 5286 61 61
###
6 Sefiksim kapsul 100 mg Tab 1000 0 ###
0
7 Sefotaksim serb inj 1.000 mg/vial Vial 3500 0 ###
0
8 Seftriakson serb inj 1.000 mg/vial Vial 3900 0 ###
0
9 Semen Seng Fosfat serbuk dan cairan Set 93500 1 ###
1
10 Setirizin tab 10 mg Tab 190 0 ###
0
11 Sianokobalamin (vitamin B12) inj 500 mcg/mVial 1150 311 311
###
12 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 0 ###
0
13 Simetidin tablet 200 mg Tab 137.89 343 343
###
14 Simvastatin tab sal 10 mg Tab sal 177 0 ###
0
15 Simvastatin tab sal 20 mg Tab sal 480 0 ###
0
16 Siprofloksasin inf 2 mg/ml Botol 22000 0 ###
0
17 Siprofloksasin tab scored 500 mg Tab 312.4 0 ###
0
18 Spironolakton tab 100 mg Tab 350 200 200
###
19 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol 14450 0 ###
0
20 Sulfasetamid Natrium Tetes mata 1.5% Botol 3549 0 ###
0
21 Taburia Kotak 20454 0 ###
0
22 Temporari stoping pletcher Set 34000 1 ###
1
23 Tetrasiklin kaps 250 mg Kaps 183.425 700 700
###
24 Tetrasiklin kaps 250 mg Kaps 162 0 ###
0
25 Tetrasiklin kaps 500 mg Kaps 282.7 280 280
###
26 Tiamin (vitamin B1) injeksi 100 mg/ml Tab 770 0 ###
0
27 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 41.58 2100 2100
###
28 Tramadol inj 50 mg/ml Ampul 2680 128 128
###
29 Tramadol tablet 500 mg Tab 363 227 227
###
30 Triheksifenidil tab 2 mg Tab 45.38 280 280
###
31 Triheksifenidil tab 2 mg Tab 45 0 ###
0
32 Ulsidex Tablet 477 160 160
###
33 Vaksin BCG inj (i.k) Vial 0 ###
0
34 Vaksin campak inj (s.k.) Vial 0 ###
0
35 Vaksin jerap difteri tetanus pertusis (DTP) injVial 0 ###
0
36 Vaksin jerap difteri tetanus (DT) Vial 0 ###
0
37 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial 10 10
###
38 Vaksin polio drops 10 dosis Vial 10 10
###
39 Vaksin rabies, untuk manusia serb inj (s.k./i.kVial 695752 0 ###
0
40 Vical Multivitamin Botol 42727 0 ###
0
41 Vitamin B kompleks Tab 112 2333 2333
###
42 Vitamin B kompleks injeksi Vial 7392 25 25
###
43 Vitamin B12 tablet 50 mcg Tab 63 1480 1480
###
44 Zinc 20 mg 1245 1245
###
45 Zinc tab disp 20 mg Tab 521 323 323
###
46 Zinc sirup 20 mg / 5 ml Botol 8140 0 ###
0
47 zink tab.20mg 496.5 0 ###
0

1 Alat suntik sekali pakai 1 ml Set 1092.5 759 759
###
2 Alat suntik sekali pakai 2,5 ml Set 848.25 122 122
###
###
###
5 Bisturi no. 20 Buah 2099 264 264
###
6 Bisturi no. 15 Buah 2099 334 334
###
7 Catgut No 2/0 Set 25920 61 61
###
8 Catgut No 3/0 Set 5900 33 33
###
9 Handscoen no. 6 Pasang 0 ###
10 Handscoen no. 6,5 Pasang 0 ###
11 Handscoen no. 7 Pasang 7684 0 ###
0
12 Handscoen no. 7,5 Pasang 7684 0 ###
0
13 Infuset dewasa Set 4176 67 67
###
14 Infusion set anak Set 4568 33 33
###
15 IV Catheter No.16 G Set 0 ###
0
16 IV Catheter No.18 G Set 7937 50 50
###
17 IV Catheter No.24 G Set 7937 4 ###
4
18 IV Catheter No. 20 G Set 7787 76 76
###
19 IV Catheter No. 22 G Set 7937 24 24
###
20 Folley Catheter 16 Set 0 ###
0
21 Folley Catheter 18 Set 8495 0 ###
0
22 Folley catheter 22 Set 8495 0 ###
0
23 Folley catheter 24 Set 495 0 ###
0
24 Kapas Berlemak 250 gram Rol 7500 1 ###
1
25 Kapas Berlemak 500 gram Rol 17250 0 ###
0
26 Kasa Pembalut 4m x 3 cm Rol 800 0 ###
0
###
###
29 Kasa Pembalut 4m x 15 cm Rol 887 0 ###
0
30 Kasa Kompres 40/40 steril Buah 1871 0 ###
0
31 Kasa Steril 16 X 16 Buah 8600 0 ###
0
32 Kasa pembalut 2 x 80 Rol 13221 0 ###
0
33 Kasa Pembalut 40 x 80 Rol 137025 0 ###
0
34 Kasa Pembalut 36 x 80 cm Rol 133821 6 ###
6
35 Pembalut Gips Buah 32500 0 ###
0
36 Plester 5 yard x 2 inc Rol 23625 5 ###
5
37 Silk Set 5082 56 56
###
38 Selang oksigen anak Set 0 ###
0
39 Selang oksigen dewasa Set 0 ###
0
40 Sofratulle Set 0 ###
0
41 Urine bag Set 4000 4 ###
4
42 Wing Needle No. 21 G Set 5770 0 ###
0
0
44 Wing Needle No.25 G Set 5770 0 ###
0
0
46 NGT No. 3 ( Feeding Tube ) Set 22000 0 ###
0
47 NGT No. 5 ( Feeding Tube ) Set 22000 0 ###
0
48 Masker Buah 1125 0 ###
0
49 Tes gula darah Set 200455 16 16
###
50 Tes Narkoba 3 parameter Set 68181 0 ###
0
51 Tes Narkoba 5 parameter Set 68181 0 ###
0
52 Tes Kehamilan Sachet 6825 27 27
###
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAY ASKES JUMLAH

Mengetahui :
25 172 26 223 Kepala Puskesmas Pole
KETERANGAN
→Jika TK > 4 , Tidak perlu melakukan permintaan Obat JAFARUDDIN, AMK
Jika TK ≤ 4, minta Obat NIP. 19740906 199502

393300
948300
1341600
380000
920000
1300000
AGUST
0
0
0
0
0
0
0
30
8
70
0
0
0
0
0
0
0
900
0
0
0
0
0
100
0
0
0
3
2
6
0
0
0
0
0
0
40
0
0
290
0
0
0
0
0
0
0
0
0
4
0
420
0
8
0
0
0
0
0
0
0
0
440
0
0
0
0
0
0
0
50
0
0
0
0
0
0
0
0
0
50
0
47
0
0
0
0
0
110
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
11
0
0
0
0
90
0
0
30
0
0
0
0
9
0
0
0
0
0
0
340
0
0
0
0
0
0
0
90
0
0
30
0
0
0
5
0
12
365
530
0
0
0
0
0
0
0
0
140
0
0
60
110
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
560
0
0
0
0
0
0
0
30
0
0
0
0
0
0
140
4
0
0
0
30
0
0
0
30
0
30
187
0
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
100
0
0
1
0
3
110
140
30
0
0
0
0
0
0
0
0
0
0
0
0
0
40
0
0
0
27
50
420
0
0
0
0
0
0
0
0
0
0
0
0
30
0
100
0
0
0
0
0
190
0
0
10
100
0
0
0
0
0
190
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
11
0
20
0
0
0
230
26
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
0
0
0
0
0
0
0
0
0
0
570
0
0
0
20
0
0
10
27
16
3
14
17
2
1
0
0
0
0
2
0
0
3
0
0
0
0
0
0
0
0
0
0
4
4
0
0
0
0
0
1
0
1
5
0
0
0
0
0
0
0
0
0
0
0
7
0
0
5
Mengetahui :
JAFARUDDIN, AMK
NIP. 19740906 199502 1 003
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / Harga PENERI

No Nama Obat
Kemasan Satuan (Rp) MAAN
1 2 3 4 5
A. OBAT
8 Aminofilin inj 24 mg/ml Ampul 42 180
15 Amoksisilin tab 500 mg Tab 279 3,000
magnesium hidroksida 200 mg Tab kunyah 78 200
B 10.000 UI/g Tube 2,767
salisilat 3% Tube 2,096 48
levodopa 100 mg Kaps 1,650
Tab 149 500
Tab 163
tambah darah) Sachet 2,200 3,000
mcg Botol 110,500
53 Desoksimetason salep 0,25% Tube 9,983 5
77 Fenitoin Na inj 50 mg/ml Ampul 20,857 10
88 Furosemid tab 40 mg Tab 84 400
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa Sachet 317 700
anhidrat 2,7 g
115 Ibuprofen tab 200 mg Tab 121 1,200
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 36,960 4
138 Klorfeniramin (CTM) tab 4 mg Tab 26 6,000
140 Klorpromazin tab sal 100 mg Tab sal 152 1,000
142 Kombinasi : Pirimethamin 25 mg + sulfadoksin Tab 531 200
nebules (Combivent UDV) Vial 5,990 4
100 mg+ trimetoprim 20 mg Tab 79 1,500

148 Kloroquin tab 150 mg Tab 116 1,000
185 Oksitetrasiklin hcl salep mata 1 % Tube 2,772 25
191 Parasetamol tab 500 mg Tab 88 1,500
195 Phenylbutazon tablet 200 mg Tab 107 1,000
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 5,000
224 Sefadroksil kaps/tab 500 mg Tab 548 1,000
240 Ulsidex Tablet 477
241 Retapyl SR Kapsul 1,155
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 5,000
272 Vical Multivitamin Botol 42,727
273 Lexavit tab 1,480
277 Aptyl Btl
278 Levopar Tablet
Etanol 300% cairan Botol 33

B. OBAT GIGI
1 Bonding Botol
3 Comfosite Tube
7 Etza Tube 170,000
C. OBAT PROGRAM
6 Iodina Test Botol
Vial 695,752
29 Doxiciklin tab
30 Garam Oralit
31 Kina
32 Gentamicin Inj.
34 Diazepam Inj
39 Mg So4 20 %
40 Mg So4 40 %
41 Zinc 20 mg
44 Alat Suntik 5 ml
2 Alat suntik sekali pakai 2,5 ml Set 650 200
37 Silk Set 5,082
40 Sofratulle Set
44 Wing Needle No.25 G Set 5,770 30
TIDAK
BAYAR JUMLAH
0
KETERANGAN
393,300
948,300
1,341,600
380,000
920,000
1,300,000
435,600
-
-
49,000
-
27,516
-
7,560
-
-
-
-
-
44,000
837,000
15,600
100,608
1,650,000
74,500
-
40,380
-
-
-
52,500
10,400
-
139,700
-
-
-
59,175
175,700
-
-
-
-
6,600,000
-
-
-
-
-
-
-
84,600
-
-
49,915
-
-
-
2,800
-
-
-
-
-
-
111,200
-
34,800
5,600
-
-
52,200
-
-
-
9,390
-
-
208,570
-
-
-
-
-
418,800
-
-
-
-
33,600
221,900
-
-
-
-
-
35,130
-
-
-
-
3,100
-
-
-
-
-
92,000
-
15,200
10,500
77,000
-
76,800
-
-
145,200
15,700
-
-
147,840
-
-
-
-
-
29,100
-
-
-
-
-
-
-
-
-
-
-
-
158,400
-
152,000
-
106,150
23,960
76,000
118,500
-
-
116,000
-
58,100
-
92,900
-
19,400
68,000
-
-
-
-
-
-
-
-
-
-
-
-
10,000
-
-
-
-
75,600
29,200
48,250
-
114,300
211,200
-
20,790
66,000
70,000
-
-
69,300
137,500
-
-
-
-
132,000
-
-
-
107,000
289,080
358,680
2,420,000
-
66,780
95,000
80,850
-
-
117,200
461,580
603,030
-
-
120,210
-
91,200
-
-
-
-
-
172,600
114,400
9,200
27,900
-
-
-
548,000
314,250
-
-
-
-
145,100
-
27,578
-
-
-
-
-
-
-
-
-
-
-
207,900
-
-
145,200
-
-
665,280
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
130,000
-
293,625
209,900
419,800
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
172,500
-
11,000
23,000
-
-
-
-
-
-
-
-
-
-
-
-
-
577,000
-
173,100
-
-
-
-
601,350
-
-
-
23,973,027
KODE PUSKESMAS
KECAMATAN
KABUPATEN
PROPINSI
PENERI
No Nama Obat MAAN GUDANG
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi) 30
2 Albendazol tab 400 mg 30
3 Alopurinol tab 100 mg -
4 Alprazolam tab 1 mg -
5 Albothyl cairan -
6 Ambroksol tablet 30 mg 300
7 Ambroksol sirup 15
8 Aminofilin inj 24 mg/ml 210
9 Aminofilin tab 200 mg
10 Amitriptilin tab sal 25 mg -
11 Amlodipin tab 10 mg -
12 Amlodipin tab 5 mg -
13 Amoksisilin sir kering 125 mg/5 ml 10 -
14 Amoksisilin tab 250 mg 500 300
15 Amoksisilin tab 500 mg 1,100
epinefrin 1 : 80.000 inj 2 ml -
magnesium hidroksida 200 mg 500
magnesium hidroksida 200 mg Suspensi -
B 10.000 UI/g 5
salisilat 3% 2
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng 70
levodopa 100 mg -
500
24 Antalgin (metampirom) tablet 500 mg 1,000
25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml 30
26 Asam asetilsalisilat (asetosal) tab 100 mg -
27 Asam asetilsalisilat (asetosal) tab 500 mg -
29 Asam askorbat (vitamin C) tab 50 mg 800

30 Asam folat tab 1 mg 200
31 Asam mefenamat kaps 250 mg
32 Asam mefenamat kaps 500 mg 500
33 Asam traneksamat inj 50 mg/ml 10
34 Asam traneksamat tab 500 mg -
35 Asering larutan infus
36 Asiklovir salep kulit 7
37 Asiklovir tab 200 mg 700
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k)
39 Atropin tab 0,5 mg
40 Atropin tts mata 0,5% (Cendotropin 0,5%)
41 Bedak salisil serb 2% -
tambah darah) 3,250
43 Becefort syrup -
44 Betametason krim 0,1% 30
45 Betahistin mesilate tablet
46 Bisakodil sup 10 mg (Stolax)
47 Bisakodil tab sal 5 mg
48 Bismecon salep
mcg
50 Bromheksin tablet 200
51 Deksametason tab 0,5 mg -
52 Deksametason inj 5 mg/ml (i.v./i.m.) -
53 Desoksimetason salep 0,25% -
54 Diazepam inj 5 mg/ml (i.v./i.m.) -
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid)
56 Diazepam supposutoria
57 Diazepam tab 2 mg 100
58 Diazepam tab 5 mg 250
59 Dietilkarbamazin tab 100 mg
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) 30
61 Digoksin tab 0,25 mg 100
62 Diltiazem kaps SR 100 mg
63 Diltiazem tab 30 mg
64 Doksisiklin tablet 100 mg 100
65 Domperidon susp 5 mg/5 ml -
66 Domperidon tab 10 mg 100
67 Efedrin HCl tablet 300
68 Ekstrak belladon tablet 10 mg 2,000
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) -
70 Eritromisin kaps 250 mg
71 Eritromisin sir 200 mg/5 ml
72 Eritromisin tab 500 mg 600
73 Etanol 70% cairan 70% 2
74 Etakridin (rivanol) larutan 0.1% -
75 Etil klorida semprot 100 ml -
76 Famotidin tablet 20 mg -
77 Fenitoin Na inj 50 mg/ml -
78 Fenitoin Na kaps 100 mg
79 Fenobarbital inj 50 mg/ml
80 Fenobarbital tab 100 mg -
81 Fenobarbital tab 30 mg
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) -
83 Fitomenadion (vitamin K 1) tab sal 10 mg 600
84 Flukonazol kaps 150 mg 100
85 Flusinolon asetonid krim 0,025%
86 Flunarizin tablet
87 Furosemid inj 10 mg/ml (i.v./i.m.) -
88 Furosemid tab 40 mg 600
kalium klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa -
anhidrat 2,7 g
90 Gameksan lotion 1 %
91 Gemfibrozil kaps 300 mg -
92 Gemfibrozil kaps 600 mg
93 Gentamisin inj 10 mg/ml
94 Gentamisin salep mata 0,3%
95 Gentamisin salep Kulit -
96 Gentamisin tts mata 0,3%
97 Glibenklamid tab 5 mg -
98 Glimepirid tab 4 mg
99 Glipizid tablet 5 mg (Glucotrol 5 mg)
100 Gliseril Guaiakolat tab 100 mg 2,000
101 Gliserin lar 50%
102 Glukosamin tablet 500 mg
103 Glukosa Larutan Infus 5% steril
104 Glukosa Larutan Infus 10% steril -
105 Glukosa Larutan Infus 40% steril
106 Griseofulvin (micronized) tab 125 mg -
107 Haloperidol tab 0,5 mg 700
108 Haloperidol tab 1,5 mg 200
109 Haloperidol tab 5 mg 100
110 Hidrogen peroksida (H2O2) cairan 3% -
111 Hidroklorotiazid (HCT) tab 25 mg -
112 Hidrokortison krim 2,5% 10
113 Hiosina butilbromida tab 10 mg
114 Ibuprofen susp 100 mg/5 ml -
115 Ibuprofen tab 200 mg 100
116 Ibuprofen tab 400 mg 300
inhalation 0.025%) -
118 Isoniazid tab 300 mg
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid)
120 Isosorbid dinitrat tab 5 mg
121 KA-EN 3B Cairan Infus
122 Kalsium glukonat inj 100 mg/ml
123 Kalsium laktat (kalk) tab 500 mg 300
124 Kaptopril tab 12,5 mg 100
125 Kaptopril tab 25 mg 200
126 Karbamazepin tab 200 mg
127 Karbo adsorben (Norit) tab 500 mg
128 Ketamin inj 50 mg/ml (i.v.)
129 Ketokonazol tab 200 mg 200
130 Ketokonazol krim 2% -
131 Ketorolak inj 10 mg/ml
132 Klaritromisin tab 500 mg
133 Klindamisin kaps 150 mg -
134 Kloramfenikol tts mata 0,5%
135 Kloramfenikol kaps 250 mg -
136 Kloramfenikol salep mata 1%
137 Kloramfenikol susp 125 mg/5 ml 5
138 Klorfeniramin (CTM) tab 4 mg 2,000
139 Klorpromazin inj 25 mg/ml (i.m.) -
140 Klorpromazin tab sal 100 mg 4,000
141 Klorpromazin tab sal 25 mg 200
nebules (Combivent UDV)
400 mg+ trimetoprim 80 mg 1,000
100 mg+ trimetoprim 20 mg 600
sulfametoksazol 200 mg + trimetoprim 40 mg 5
147 Kuinin inj 25% (i.v.)

149 Lansoprazol kaps 30 mg
150 Levofloksasin tab 500 mg -
151 Lidokain gel 2%
152 Lidokain inj 2% (hcl) 100 100
153 Lisol -
154 Loperamid tab 2 mg -
155 Loratadin tab 10 mg 100 100
156 Magnesium sulfat inj 20%
157 Magnesium sulfat inj 40%
158 Magnesium sulfat serb, ktg 30 g
159 Mebendazol sir 50 mg/ml 3
160 Mebendazol tab 100 mg 30
161 Metformin tab 500 mg
162 Metformin tab 850 mg
163 Metilergometrin inj 0,2 mg/ml -
164 Metilergometrin tab salut 0,125 mg 100
165 Metilprednisolon tab 4 mg -
166 Metoklopramid inj 5 mg/ml
167 Metoklopramid sir 5 mg/5 ml (Lexapram sirup)
168 Metoklopramid tab 10 mg 100
169 Metronidazol supposutoria 500 mg
170 Metronidazol larutan infus
171 Metronidazol tab 250 mg -
172 Metronidazol tab 500 mg 500
173 Mikonazol krim 2% 30
174 Natrium diklofenak tab 25 mg 100
175 Natrium diklofenak tab 50 mg -
176 NaCl 0,9% Larutan infus 46
177 Nifedipin kaps 10 mg -
178 Nistatin tab salut 500.000 UI -
179 Nistatin tab vaginal 100.000 UI -
180 Obat Batuk Hitam (OBH) 15
181 Ofloksasin tab 200 mg -
182 Ofloksasin tab 400 mg 200
183 Oksitetrasiklin hcl inj 500 mg/ml
184 Oksitetrasiklin hcl salep kulit 3% 28
185 Oksitetrasiklin hcl salep mata 1 % -
186 Oksitosin inj 10 UI/ml 10
187 Omeprazol kaps 20 mg 90 60
188 Papaverin tablet 40 mg 4,000
189 Parasetamol sir 120 mg/5 ml -
190 Parasetamol tab 100 mg 200
191 Parasetamol tab 500 mg 800
192 Parasetamol rectal
193 Pehavral tablet multivitamin -
194 Perak sulfadiazin krim 1% (Burnazin 35 gr)
195 Phenylbutazon tablet 200 mg 1,000
196 Piracetam tablet 800 mg 100
197 Piracetam tablet 1200 mg 30
198 Piracetam injeksi 1 g/5 ml 20
199 Pirantel pamoat susp 125 mg/5 ml
200 Pirantel pamoat tab scored 125 mg 120
201 Piridoksin (vitamin B6) tab 25 mg 2,000
202 Piroksikam tablet 20 mg 300
Piroksikam tablet 10 mg
203 Polikresulen
204 Povidon iodin lar 100 mg/ml 3
205 Povidon iodin lar 100 mg/ml -
206 Povidon iodin lar 100 mg/ml -
207 Prednison tab 5 mg 1,000
208 Primakuin tab 15 mg -
209 Procurma syrup -
210 Propiltiourasil tab 100 mg 600
211 Propranolol tab 40 mg
212 Ranitidin inj 25 mg/ml
213 Ranitidin tab 150 mg 400
214 Reserpin tablet 0.25 mg
215 Rifampisin kaps 300 mg
216 Rifampisin tab 450 mg
217 Rifampisin tab 600 mg
218 Ringer Laktat Larutan infus 23
219 Salbutamol tab 2 mg 100
220 Salbutamol tab 4 mg 300
endap 4 % 24
222 Scabicid salep
223 Sefadroksil kaps 250 mg
224 Sefadroksil kaps/tab 500 mg 300
225 Sefadroksil sir kering 125 mg/5 ml 10 10
226 Sefiksim kapsul 100 mg
227 Sefotaksim serb inj 1.000 mg/vial
228 Seftriakson serb inj 1.000 mg/vial
229 Setirizin tab 10 mg
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml 100
231 Sianokobalamin (vitamin B12) tab 50 mcg
232 Simetidin tablet 200 mg 200
233 Simvastatin tab sal 10 mg
234 Simvastatin tab sal 20 mg
235 Siprofloksasin inf 2 mg/ml
236 Siprofloksasin tab scored 500 mg
237 Spironolakton tab 100 mg -
238 Sulfasetamid Natrium Tetes mata 1.5%
239 Sukralfat susp 500 mg/5 ml (Ulsafate)
240 Ulsidex -
241 Retapyl SR -
242 Tetrasiklin kaps 250 mg 600
243 Tetrasiklin kaps 500 mg 200
244 Tiamin (vitamin B1) mononitrat tab 50 mg -
245 Tiamin (vitamin B1) injeksi 100 mg/ml
246 Tramadol inj 50 mg/ml -
247 Tramadol tablet 500 mg -
248 Triheksifenidil tab 2 mg 200
249 Vitamin B12 tablet 50 mcg 200
250 Vitamin B kompleks injeksi 20
251 Vitamin B kompleks 900
252 Zinc tab disp 20 mg 300
253 Zinc sirup 20 mg / 5 ml
254 Larutan PK 12
255 Kanamisin inj 50
256 Antalgin 500mg
257 Klorpromazin inj 25 mg/ml (i.m.)
258 Kalsium laktat (kalk) tab 500 mg
259 Kloroquin tab 250 mg -
260 Klonidin 0,15 mg
261 Kloramfenikol kaps 250 mg
262 Klorpromazin tab sal 100 mg
263 Fenolgliserol TT 10% 96
264 Tetrasiklin kaps 250 mg
267 Prednison tab 5 mg
268 Pirantel pamoat tab scored 125 mg
269 Hidroklorotiazid (HCT) tab 25 mg
270 Triheksifenidil tab 2 mg
271 Piracetam tablet 1200 mg
272 Vical Multivitamin -
273 Lexavit -
274 Gliseril Guaiakolat tab 100 mg
275 Efedrin HCl tablet
276 Kloroquin Tablet 150 mg 300
277 Aptyl -
278 Levopar 50
280 Pytogin inj -
281 Phenytoin Sodium 100
Etanol 300% cairan -

B. OBAT GIGI
1 Bonding
2 Calcium hidrosida cement pasta (hycal)
3 Comfosite
4 Devitalisasi Pasta (Non Arsen)
5 Eugenol cair
6 Etil Klorida spray
7 Etza
8 Glass Ionomer Cement ART
9 Klorfenol Kamfer Menthol (CHKM) -
10 Semen Seng Fosfat serbuk dan cairan
11 Temporari stoping pletcher 1
12 Mummiyng pasta
C. OBAT PROGRAM
1 Albedazole 400mg -
2 Artemether inj 80 mg/ml
3 Artesunat serb inj 60 mg/ml (i.v./i.m.)
4 Dietilkarbamazin tab 100 mg 3,000
5 Imersion oil
6 Iodina Test
7 Obat Anti Tuberculosis FDC Kategori Anak
8 Obat Anti Tuberculosis FDC Kategori I
9 Obat Anti Tuberculosis FDC Kategori II
10 Obat Anti Tuberculosis FDC Kategori Sisipan
11 Reagen Zenit Nelson
12 RDT Dangue DBD
13 RDT malaria (care star )
14 RDT HIV (intec)
15 RDT HIV (vikia)
16 RDT HIV (Oncoprobe)
17 Taburia
18 Quinina injeksi
19 Vaksin BCG inj (i.k) -
20 Vaksin campak inj (s.k.)
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.m.)
22 Vaksin jerap difteri tetanus (DT)
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.)
24 Vaksin polio drops 10 dosis
26 Retinol (Vit.A) 200.000 IU kap lunak -

28 zink tab.20mg
29 Doxiciklin tab
30 Garam Oralit -
31 Kina -
32 Gentamicin Inj. -
33 Pitomenadion Inj. -
34 Diazepam Inj 60
36 Phenobarbital Inj. -
37 Ampiciline Sodium Inj -
39 Mg So4 20 % 43
40 Mg So4 40 % 27
41 Zinc 20 mg 1,000
46 Retinol (Vitamin A) 100.000 IU Kapsul Lunak
47 Retinol (Vitamin A) 200.000 IU Kapsul Lunak
1 Alat suntik sekali pakai 1 ml 700
2 Alat suntik sekali pakai 2,5 ml -
3 Alat suntik sekali pakai 3 ml -
4 Alat suntik sekali pakai 5 ml 250
5 Bisturi no. 20 100
6 Bisturi no. 15 250
7 Catgut No 2/0 24
8 Catgut No 3/0 30
9 Handscoen no. 6 -
10 Handscoen no. 6,5
11 Handscoen no. 7 -
12 Handscoen no. 7,5 50
13 Infuset dewasa 12
14 Infusion set anak 16
15 IV Catheter No.16 G -
16 IV Catheter No.18 G 14
17 IV Catheter No.24 G -
18 IV Catheter No. 20 G 39
19 IV Catheter No. 22 G 4
20 Folley Catheter 16 -
21 Folley Catheter 18 -
22 Folley catheter 22 -
23 Folley catheter 24 -
24 Kapas Berlemak 250 gram -
25 Kapas Berlemak 500 gram -
26 Kasa Pembalut 4m x 3 cm -
27 Kasa Pembalut 4m x 5 cm 10
28 Kasa Pembalut 4m x 10 cm 20
29 Kasa Pembalut 4m x 15 cm -
30 Kasa Kompres 40/40 steril -
31 Kasa Steril 16 X 16 -
32 Kasa pembalut 2 x 80 -
33 Kasa Pembalut 40 x 80
34 Kasa Pembalut 36 x 80 cm 4
35 Pembalut Gips
36 Plester 5 yard x 2 inc 4
37 Silk 28
38 Selang oksigen anak
39 Selang oksigen dewasa
40 Sofratulle
41 Urine bag 4
42 Wing Needle No. 21 G -
43 Wing Needle No. 23 G
44 Wing Needle No.25 G -
45 Wing Needle No. 27 G
46 NGT No. 3 ( Feeding Tube )
47 NGT No. 5 ( Feeding Tube )
48 Masker 50 40
49 Tes gula darah
50 Tes Narkoba 3 parameter
51 Tes Narkoba 5 parameter
52 Tes Kehamilan 20
JUMLAH
0

393,300
948,300
1,341,600
380,000
920,000
1,300,000
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / Harga PEMAKAIAN SISA STOK TINGKAT PERMI

STOCK PENERI PERSE TOTAL
No Nama Obat Kemasa Satuan AWAL MAAN DIAAN RATA- SUB. STOK
KECUKU
n (Rp) JAN PEB MAR GUDAN PAN NTAAN
RATA UNIT
G
1 2 3 4 4 5 6 7 8 9 10=(7+8+9)/3 11 12 13=11+12 14=11/10 15
A. OBAT
1 Air untuk injeksi amp 25 ml (aqua pro injeksi)
Ampul 2,200 107 107 - - - 0 102 5 107 #DIV/0! #DIV/0!
2 Albendazol tab 400 mg Tab 363 120 120 6 - - 3 30 84 114 10.00 (18)
3 Alopurinol tab 100 mg Tab 90 169 169 - - - 0 - 169 169 #DIV/0! #DIV/0!
4 Alprazolam tab 1 mg Tab 245 300 300 10 10 - 10 200 90 290 20.00 (160)
5 Albothyl cairan Botol 18,635 - - - - - 0 - - - #DIV/0! #DIV/0!
6 Ambroksol tablet 30 mg Tab 138 448 448 70 110 - 90 300 78 378 3.33 60
7 Ambroksol sirup Botol 2,722 - 18 18 - 5 - 3 - - - 0.00 10
8 Aminofilin inj 24 mg/ml Ampul 4,204 441 441 - - - 0 390 51 441 #DIV/0! #DIV/0!
9 Aminofilin tab 200 mg Tab 86 260 260 - - - 0 260 260 #DIV/0! #DIV/0!
10 Amitriptilin tab sal 25 mg Tab sal 123 - - - - - 0 - - - #DIV/0! #DIV/0!
11 Amlodipin tab 10 mg Tab 352 - - - - - 0 - - - #DIV/0! #DIV/0!
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 - 13 13 - 10 - 5 - 13 13 0.00 20
14 Amoksisilin tab 250 mg Tab 220 345 400 745 120 120 - 120 100 525 625 0.83 380
15 Amoksisilin tab 500 mg Tab 279 2,767 900 3,667 420 410 - 415 2,200 1,047 3,247 5.30 (540)
16 Anestetik lokal gigi kombinasi : lidokain hcl
2% + epinefrin 1 : 80.000 inj 2 ml Ampul 1,499 - - - - - 0 - - - #DIV/0! #DIV/0!
17 Antasida, kombinasi : aluminium hidroksida 200
mg + magnesium hidroksida 200 mg Tab
78 370 600 970 140 270 - 205 300 530 830 1.46 520
kunyah
mg + magnesium hidroksida 200 mg Suspensi Botol 2,213 - - - 1 - 1 - - - 0.00 2

Polimiskin B 10.000 UI/g Tube 2,767 24 24 - - - 0 5 19 24 #DIV/0! #DIV/0!
asam salisilat 3% Tube 2,096 68 68 3 1 - 2 50 15 65 25.00 (42)
21 Antihemoroid, kombinasi: bismut subgalat 150
10 mg+ seng oksida 120 mg + sup ad 2 g Suppo 33,000 126 126 - 5 - 3 120 6 126 48.00 (110)

levodopa 100 mg Kaps 1,650 - - - - - 0 - - - #DIV/0! #DIV/0!
23 Anti Migren, kombinasi : ergotamin 1 mg+
kafein 50 mg Tab 149 1,008 1,008 - - - 0 900 108 1,008 #DIV/0! #DIV/0!
24 Antalgin (metampirom) tablet 500 mg Tab 155 1,270 1,270 - - - 0 1,000 270 1,270 #DIV/0! #DIV/0!
25 Antalgin (metampirom) injeksi 250 mg/ml-2 ml
Ampul 1,346 200 200 - - - 0 60 140 200 #DIV/0! #DIV/0!
26 Asam asetilsalisilat (asetosal) tab 100 mg Tab 127 - - - - - 0 - - - #DIV/0! #DIV/0!
28 Asam asetilsalisilat (asetosal) tab 80 mg
(Miniaspi 80) Tab 163 - - - - - 0 - - #DIV/0! #DIV/0!
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 1,238 1,238 60 40 - 50 1,200 (22) 1,178 24.00 (1,000)
30 Asam folat tab 1 mg Tab 52 635 635 - - - 0 400 235 635 #DIV/0! #DIV/0!
31 Asam mefenamat kaps 250 mg Kaps - - - - - 0 - - #DIV/0! #DIV/0!
32 Asam mefenamat kaps 500 mg Kaps 127 1,460 ### 2,660 310 230 - 270 1,400 950 2,350 5.19 (320)
33 Asam traneksamat inj 50 mg/ml Ampul 3,650 10 10 - 2 - 1 10 - 10 10.00 (6)
34 Asam traneksamat tab 500 mg Tab 1,265 - - - - - 0 - - - #DIV/0! #DIV/0!
35 Asering larutan infus Botol 9,000 - - - - - 0 - - #DIV/0! #DIV/0!
36 Asiklovir salep kulit Tube 2,367 30 30 3 8 - 6 25 2 27 4.55 (3)
37 Asiklovir tab 200 mg Tab 251 1,479 1,479 - 30 - 15 1,400 79 1,479 93.33 (1,340)
38 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 1,400 28 28 - - - 0 28 28 #DIV/0! #DIV/0!
39 Atropin tab 0,5 mg Tab 81 150 150 - - - 0 150 150 #DIV/0! #DIV/0!
40 Atropin tts mata 0,5% (Cendotropin 0,5%) Botol 13,500 - - - - - 0 - - #DIV/0! #DIV/0!
41 Bedak salisil serb 2% Botol 1,180 - 4 4 2 3 - 3 - 2 2 0.00 10
42 Besi (II) sulfat 200 mg + asam folat 0.25 mg
(tablet tambah darah) Sachet 55 16,755 16,755 300 250 - 275 6,250 10,205 16,455 22.73 (5,150)
43 Becefort syrup Botol 22,727 - - - - - 0 - - - #DIV/0! #DIV/0!
44 Betametason krim 0,1% Tube 1,596 12 25 37 10 10 - 10 10 17 27 1.00 30
45 Betahistin mesilate tablet tablet 600 - - - - - 0 - - #DIV/0! #DIV/0!
46 Bisakodil sup 10 mg (Stolax) Botol 6,045 - - - - - 0 - - #DIV/0! #DIV/0!
47 Bisakodil tab sal 5 mg Tab sal 4,990 - - - - - 0 - - #DIV/0! #DIV/0!
48 Bismecon salep tube - - - - - 0 - #DIV/0! #DIV/0!
49 Budesonid-formoterol (fixed combination)* ih
80/4,5 mcg Botol 110,500 - - - - - 0 - - #DIV/0! #DIV/0!
50 Bromheksin tablet tablet 42 360 360 10 10 - 10 300 50 350 30.00 (260)
51 Deksametason tab 0,5 mg Tab 68 198 100 298 100 60 - 80 - 198 198 0.00 320
52 Deksametason inj 5 mg/ml (i.v./i.m.) Vial 1,738 - - - - - 0 - - - #DIV/0! #DIV/0!
53 Desoksimetason salep 0,25% Tube 9,983 5 5 - - - 0 5 - 5 #DIV/0! #DIV/0!
54 Diazepam inj 5 mg/ml (i.v./i.m.) Vial 2,578 16 16 - - 0 - 16 16 #DIV/0! #DIV/0!
55 Diazepam lar rektal 10 mg/2,5 ml (Stesolid) Botol 18,461 - - - - - 0 - - #DIV/0! #DIV/0!
56 Diazepam supposutoria suppo - - - - - 0 - - #DIV/0! #DIV/0!
57 Diazepam tab 2 mg Tab 47 565 100 665 60 50 - 55 200 405 605 3.64 20
58 Diazepam tab 5 mg Tab 53 557 557 - - - 0 250 307 557 #DIV/0! #DIV/0!
59 Dietilkarbamazin tab 100 mg Tab 104 - - - - - 0 - - #DIV/0! #DIV/0!
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 66 66 - - - 0 30 36 66 #DIV/0! #DIV/0!
61 Digoksin tab 0,25 mg Tab 103 148 148 - - - 0 100 48 148 #DIV/0! #DIV/0!
62 Diltiazem kaps SR 100 mg Kaps 4,033 100 100 - - - 0 100 100 #DIV/0! #DIV/0!
63 Diltiazem tab 30 mg Tab 141 - - - - - 0 - - #DIV/0! #DIV/0!
64 Doksisiklin tablet 100 mg Tab 298 570 570 - - - 0 500 70 570 #DIV/0! #DIV/0!
65 Domperidon susp 5 mg/5 ml Botol 3,490 - - - - - 0 - - - #DIV/0! #DIV/0!
66 Domperidon tab 10 mg Tab 174 537 537 30 - - 15 300 207 507 20.00 (240)
67 Efedrin HCl tablet Tab 56 396 396 - 2 - 1 300 96 396 300.00 (296)
68 Ekstrak belladon tablet 10 mg tab 42 3,300 3,300 - - - 0 2,000 1,300 3,300 #DIV/0! #DIV/0!
69 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 8,910 - - - - - 0 - - - #DIV/0! #DIV/0!
70 Eritromisin kaps 250 mg Kaps 522 129 129 - - - 0 100 29 129 #DIV/0! #DIV/0!
71 Eritromisin sir 200 mg/5 ml Botol 8,090 - - - - - 0 - - #DIV/0! #DIV/0!
72 Eritromisin tab 500 mg Tab 1,013 590 590 90 20 - 55 500 - 500 9.09 (280)
73 Etanol 70% cairan 70% Botol 2,625 2 2 - 2 - 1 2 - 2 2.00 2
74 Etakridin (rivanol) larutan 0.1% Botol 4,695 2 2 - 1 - 1 2 - 2 4.00 0
75 Etil klorida semprot 100 ml Botol 105,000 1 1 1 1 - 1 - - - 0.00 4
76 Famotidin tablet 20 mg Tab 124 - - - - - 0 - - - #DIV/0! #DIV/0!
77 Fenitoin Na inj 50 mg/ml Ampul 20,857 10 10 - - - 0 10 - 10 #DIV/0! #DIV/0!
78 Fenitoin Na kaps 100 mg Kaps 146 - - - - - 0 - - #DIV/0! #DIV/0!
79 Fenobarbital inj 50 mg/ml Ampul 1,980 - - - - - 0 - - #DIV/0! #DIV/0!
80 Fenobarbital tab 100 mg Tab 37 980 980 - - - 0 - 980 980 #DIV/0! #DIV/0!
81 Fenobarbital tab 30 mg Tab 37 - - - - - 0 - - #DIV/0! #DIV/0!
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.)
Vial 3,754 28 28 - - - 0 - 28 28 #DIV/0! #DIV/0!
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 698 1,350 1,350 - - - 0 1,200 150 1,350 #DIV/0! #DIV/0!
84 Flukonazol kaps 150 mg Kaps 24,200 140 140 - - - 0 100 40 140 #DIV/0! #DIV/0!
85 Flusinolon asetonid krim 0,025% Tube 2,700 - - - - - 0 - - #DIV/0! #DIV/0!
86 Flunarizin tablet tablet 2,400 - - - - - 0 - - #DIV/0! #DIV/0!
87 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 2,012 - - - - - 0 - - - #DIV/0! #DIV/0!
88 Furosemid tab 40 mg Tab 84 1,100 ### 2,100 - - - 0 1,000 1,100 2,100 #DIV/0! #DIV/0!
89 Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 317 890 890 10 10 - 10 700 180 880 70.00 (660)
90 Gameksan lotion 1 % Botol 2,420 - - - - - 0 - - #DIV/0! #DIV/0!
91 Gemfibrozil kaps 300 mg Kaps 323 290 290 - - - 0 - 290 290 #DIV/0! #DIV/0!
92 Gemfibrozil kaps 600 mg Kaps 747 - - - - - 0 - - #DIV/0! #DIV/0!
93 Gentamisin inj 10 mg/ml Ampul 3,739 - - - - - 0 - - #DIV/0! #DIV/0!
94 Gentamisin salep mata 0,3% Tube 2,786 - - - - - 0 - - #DIV/0! #DIV/0!
95 Gentamisin salep Kulit Tube 1,469 56 20 76 5 10 - 8 10 61 71 1.33 20
96 Gentamisin tts mata 0,3% Botol 3,194 - - - - - 0 - - #DIV/0! #DIV/0!
97 Glibenklamid tab 5 mg Tab 61 - - - - - 0 - - - #DIV/0! #DIV/0!
98 Glimepirid tab 4 mg Tab 452 - - - - - 0 - - #DIV/0! #DIV/0!
99 Glipizid tablet 5 mg (Glucotrol 5 mg) Tab 3,000 - - - - - 0 - - #DIV/0! #DIV/0!
100 Gliseril Guaiakolat tab 100 mg Tab 31 2,184 900 3,084 75 210 - 143 2,100 909 3,009 14.74 (1,530)
101 Gliserin lar 50% Botol 5,867 - - - - - 0 - - #DIV/0! #DIV/0!
102 Glukosamin tablet 500 mg Tab 660 - - - - - 0 - - #DIV/0! #DIV/0!
103 Glukosa Larutan Infus 5% steril Botol 5,720 28 28 - - - 0 28 28 #DIV/0! #DIV/0!
104 Glukosa Larutan Infus 10% steril Botol 6,270 18 18 - - - 0 - 18 18 #DIV/0! #DIV/0!
105 Glukosa Larutan Infus 40% steril Botol 6,270 - - - - - 0 - - #DIV/0! #DIV/0!
106 Griseofulvin (micronized) tab 125 mg Tab 230 270 200 470 70 50 - 60 200 200 400 3.33 40
107 Haloperidol tab 0,5 mg Tab 62 680 680 - - - 0 600 80 680 #DIV/0! #DIV/0!
108 Haloperidol tab 1,5 mg Tab 76 280 100 380 80 30 - 55 200 100 300 3.64 20
109 Haloperidol tab 5 mg Tab 105 190 100 290 60 60 - 60 100 130 230 1.67 140
110 Hidrogen peroksida (H2O2) cairan 3% Botol 38,500 2 2 - - - 0 2 - 2 #DIV/0! #DIV/0!
111 Hidroklorotiazid (HCT) tab 25 mg Tab 40 1,000 1,000 - - - 0 - 1,000 1,000 #DIV/0! #DIV/0!
112 Hidrokortison krim 2,5% Tube 2,938 29 29 4 1 - 3 25 - 25 10.00 (15)
113 Hiosina butilbromida tab 10 mg Tab 330 200 200 - - - 0 200 200 #DIV/0! #DIV/0!
114 Ibuprofen susp 100 mg/5 ml Botol 3,849 4 4 - - - 0 - 4 4 #DIV/0! #DIV/0!
115 Ibuprofen tab 200 mg Tab 121 660 ### 1,760 340 170 - 255 500 920 1,420 1.96 520
116 Ibuprofen tab 400 mg Tab 157 170 ### 1,170 40 480 - 260 100 1,030 1,130 0.38 940
117 Ipratropium bromida nebulizer 0,025% (Atroven
sol. for inhalation 0.025%) Botol 90,000 - - - - - 0 - - #DIV/0! #DIV/0!
118 Isoniazid tab 300 mg Tab 174 - - - - - 0 - - #DIV/0! #DIV/0!
119 Isosorbid dinitrat inj 10 mg/10 ml (Fasorbid) Vial 36,960 4 4 - - - 0 4 - 4 #DIV/0! #DIV/0!
120 Isosorbid dinitrat tab 5 mg Tab 98 49 49 - - - 0 49 49 #DIV/0! #DIV/0!
121 KA-EN 3B Cairan Infus Botol 10,000 - - - - - 0 - - #DIV/0! #DIV/0!
122 Kalsium glukonat inj 100 mg/ml Ampul 7,800 - - - - - 0 - - #DIV/0! #DIV/0!
123 Kalsium laktat (kalk) tab 500 mg Tab 76 45 45 40 100 - 70 5 5 0.00 280
124 Kaptopril tab 12,5 mg Tab 69 200 200 - 160 - 80 100 100 200 1.25 220
125 Kaptopril tab 25 mg Tab 97 360 300 660 60 190 - 125 300 300 600 2.40 200
126 Karbamazepin tab 200 mg Tab 269 - - - - - 0 - - #DIV/0! 200
127 Karbo adsorben (Norit) tab 500 mg Tab - - - - - 0 - - #DIV/0! #DIV/0!
128 Ketamin inj 50 mg/ml (i.v.) Ampul 63,400 - - - - - 0 - - #DIV/0! #DIV/0!
129 Ketokonazol tab 200 mg Tab 320 624 624 - 10 - 5 200 424 624 40.00 (180)
130 Ketokonazol krim 2% Tube 5,150 - - - - - 0 - - - #DIV/0! #DIV/0!
131 Ketorolak inj 10 mg/ml Ampul 2,665 - - - - - 0 - - #DIV/0! #DIV/0!
132 Klaritromisin tab 500 mg Tab 3,600 - - - - - 0 - - #DIV/0! #DIV/0!
133 Klindamisin kaps 150 mg Kaps 405 90 90 - - - 0 - 90 90 #DIV/0! #DIV/0!
134 Kloramfenikol tts mata 0,5% Botol 1,680 - - - - - 0 - - #DIV/0! #DIV/0!
135 Kloramfenikol kaps 250 mg Kaps 275 230 230 - - - 0 - 230 230 #DIV/0! #DIV/0!
136 Kloramfenikol salep mata 1% Tube 1,680 - - - - - 0 - - #DIV/0! #DIV/0!
137 Kloramfenikol susp 125 mg/5 ml Botol 4,016 6 6 - - - 0 5 1 6 #DIV/0! #DIV/0!
138 Klorfeniramin (CTM) tab 4 mg Tab 26 9,554 9,554 370 302 - 336 8,000 1,184 9,184 23.81 (6,656)
139 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,210 30 30 - - - 0 - 30 30 #DIV/0! #DIV/0!
140 Klorpromazin tab sal 100 mg Tab sal 162 4,830 4,830 120 70 - 95 4,700 10 4,710 49.47 (4,320)
141 Klorpromazin tab sal 25 mg Tab sal 75 240 240 - - - 0 200 40 240 #DIV/0! #DIV/0!
Tab 531 200 200 - - - 0 200 - 200 #DIV/0! #DIV/0!
2,5 mg nebules (Combivent UDV) Vial 5,990 4 4 - - - 0 4 - 4 #DIV/0! #DIV/0!
144 Kotrimoksazol (dewasa) kombinasi :

sulfametoksazol 400 mg+ trimetoprim 80 Tab 152 1,360 1,360 90 - - 45 900 370 1,270 20.00 (720)
mg
145 Kotrimoksazol (anak) kombinasi :
sulfametoksazol 100 mg+ trimetoprim 20 Tab 79 2,251 2,251 - - - 0 2,100 151 2,251 #DIV/0! #DIV/0!
mg
suspensi : sulfametoksazol 200 mg + Botol 2,298 5 5 - 20 - 10 5 - 5 0.50 35
trimetoprim 40 mg
147 Kuinin inj 25% (i.v.) Vial 6,820 - - - - - 0 - - #DIV/0! #DIV/0!
148 Kloroquin tab 150 mg Tab 116 1,000 1,000 - - - 0 100 900 1,000 #DIV/0! #DIV/0!
149 Lansoprazol kaps 30 mg Kaps 521 - - - - - 0 - - #DIV/0! #DIV/0!
150 Levofloksasin tab 500 mg Tab 581 150 150 20 20 - 20 100 30 130 5.00 (20)
151 Lidokain gel 2% Tube 40,000 - - - - - 0 - - #DIV/0! #DIV/0!
152 Lidokain inj 2% (hcl) Vial 929 218 218 12 12 - 12 200 6 206 16.67 (152)
153 Lisol Botol 54,995 - - - - - 0 - - - #DIV/0! #DIV/0!
154 Loperamid tab 2 mg Tab 97 200 200 30 10 - 20 200 (30) 170 10.00 (120)
155 Loratadin tab 10 mg Tab 170 400 400 40 150 - 95 300 60 360 3.16 80
156 Magnesium sulfat inj 20% Vial 7,260 - - - - - 0 - - #DIV/0! #DIV/0!
157 Magnesium sulfat inj 40% Vial 7,260 2 2 - - - 0 2 2 #DIV/0! #DIV/0!
158 Magnesium sulfat serb, ktg 30 g Sachet 1,130 5 5 - - - 0 5 5 #DIV/0! #DIV/0!
159 Mebendazol sir 50 mg/ml Botol 3,887 4 4 - - - 0 3 1 4 #DIV/0! #DIV/0!
160 Mebendazol tab 100 mg Tan 248 30 30 - - - 0 30 - 30 #DIV/0! #DIV/0!
161 Metformin tab 500 mg Tab 125 - - - - - 0 - - #DIV/0! #DIV/0!
163 Metilergometrin inj 0,2 mg/ml Ampul 2,750 - - - - - 0 - - - #DIV/0! #DIV/0!
164 Metilergometrin tab salut 0,125 mg Tab sal 169 170 170 100 - - 50 100 (30) 70 2.00 100
165 Metilprednisolon tab 4 mg Tab 230 - - - - - 0 - - - #DIV/0! #DIV/0!
166 Metoklopramid inj 5 mg/ml Vial 1,100 - - - - - 0 - - #DIV/0! #DIV/0!
Botol 2,900 - - - - - 0 - - #DIV/0! #DIV/0!
168 Metoklopramid tab 10 mg Tab 100 269 269 - - - 0 200 69 269 #DIV/0! #DIV/0!
169 Metronidazol supposutoria 500 mg suppo 3,655 - - - - - 0 - - #DIV/0! #DIV/0!
170 Metronidazol larutan infus Botol 12,980 - - - - - 0 - - #DIV/0! #DIV/0!
171 Metronidazol tab 250 mg Tab 116 48 48 - - - 0 - 48 48 #DIV/0! #DIV/0!
172 Metronidazol tab 500 mg Tab 169 620 620 100 50 - 75 500 20 520 6.67 (200)
173 Mikonazol krim 2% Tube 3,150 46 46 9 10 - 10 40 (3) 37 4.21 (2)
174 Natrium diklofenak tab 25 mg Tab 146 50 ### 1,050 90 70 - 80 - 960 960 0.00 320
175 Natrium diklofenak tab 50 mg Tab 193 285 ### 1,685 110 150 - 130 250 1,325 1,575 1.92 270
176 NaCl 0,9% Larutan infus Botol 5,170 47 47 4 4 - 4 31 12 43 7.75 (15)
177 Nifedipin kaps 10 mg Kaps 127 960 960 20 - - 10 900 40 940 90.00 (860)
178 Nistatin tab salut 500.000 UI Tab 704 378 378 - - - 0 300 78 378 #DIV/0! #DIV/0!
179 Nistatin tab vaginal 100.000 UI Tab 528 42 42 - - - 0 - 42 42 #DIV/0! #DIV/0!
180 Obat Batuk Hitam (OBH) Botol 2,310 - 41 41 6 - - 3 15 20 35 5.00 (3)
181 Ofloksasin tab 200 mg Tab 440 222 222 - - - 0 150 72 222 #DIV/0! #DIV/0!
183 Oksitetrasiklin hcl inj 500 mg/ml Vial 3,410 - - - - - 0 - - #DIV/0! #DIV/0!
184 Oksitetrasiklin hcl salep kulit 3% Tube 1,646 52 52 - - - 0 28 24 52 #DIV/0! #DIV/0!
185 Oksitetrasiklin hcl salep mata 1 % Tube 2,772 25 25 - - - 0 25 - 25 #DIV/0! #DIV/0!
186 Oksitosin inj 10 UI/ml Ampul 1,900 216 216 10 7 - 9 30 176 206 3.53 4
187 Omeprazol kaps 20 mg Kaps 221 10 150 160 60 100 - 80 30 70 100 0.38 290
188 Papaverin tablet 40 mg Tab 109 6,605 6,605 - - - 0 4,000 2,605 6,605 #DIV/0! #DIV/0!
189 Parasetamol sir 120 mg/5 ml Botol 1,535 - - - - - 0 - - - #DIV/0! #DIV/0!
190 Parasetamol tab 100 mg Tab 105 17 17 81 44 - 63 - (64) (64) 0.00 250
191 Parasetamol tab 500 mg Tab 88 1,610 ### 2,910 485 473 - 479 2,100 325 2,425 4.38 (184)
192 Parasetamol rectal suppo - - - - - 0 - - #DIV/0! #DIV/0!
193 Pehavral tablet multivitamin Tab 297 - - - - - 0 - - - #DIV/0! #DIV/0!
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25,350 - - - - - 0 - - #DIV/0! #DIV/0!
195 Phenylbutazon tablet 200 mg Tab 107 2,290 2,290 - 10 - 5 2,200 90 2,290 440.00 (2,180)
196 Piracetam tablet 800 mg Tab 964 460 460 - - - 0 400 60 460 #DIV/0! #DIV/0!
198 Piracetam injeksi 1 g/5 ml Ampul 6,050 420 420 - - - 0 420 - 420 #DIV/0! #DIV/0!
199 Pirantel pamoat susp 125 mg/5 ml Botol 9,100 - - - - - 0 - - #DIV/0! #DIV/0!
200 Pirantel pamoat tab scored 125 mg Tab 318 419 419 36 20 - 28 330 53 383 11.79 (218)
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 9,065 9,065 20 90 - 55 7,000 2,045 9,045 127.27 (6,780)
202 Piroksikam tablet 20 mg Tab 116 659 700 1,359 240 250 - 245 800 319 1,119 3.27 180
Piroksikam tablet 10 mg Tab - - - - - 0 - #DIV/0! #DIV/0!
203 Polikresulen Botol 18,635 - - - - - 0 - - #DIV/0! #DIV/0!
2,344 58 58 2 1 - 2 53 3 56 35.33 (47)
ml
15,386 30 30 1 1 - 1 30 (1) 29 30.00 (26)
ml
206 Povidon iodin lar 100 mg/ml Botol
40,202 15 15 - - - 0 15 - 15 #DIV/0! #DIV/0!
1000 ml
207 Prednison tab 5 mg Tab 98 850 ### 3,850 300 618 - 459 500 3,050 3,550 1.09 1,336
208 Primakuin tab 15 mg Tab 125 - - - - - 0 - - - #DIV/0! #DIV/0!
209 Procurma syrup Botol 12,021 - 3 3 2 3 - 3 - 1 1 0.00 10
210 Propiltiourasil tab 100 mg Tab 351 300 300 100 200 - 150 200 - 200 1.33 400
211 Propranolol tab 40 mg Tab 80 950 950 - - - 0 800 150 950 #DIV/0! #DIV/0!
212 Ranitidin inj 25 mg/ml Ampul 1,340 - - - - - 0 - - #DIV/0! #DIV/0!
213 Ranitidin tab 150 mg Tab 128 160 500 660 140 80 - 110 200 320 520 1.82 240
214 Reserpin tablet 0.25 mg Tab 968 - - - - - 0 - - #DIV/0! #DIV/0!
215 Rifampisin kaps 300 mg Kaps 440 - - - - - 0 - - #DIV/0! #DIV/0!
216 Rifampisin tab 450 mg Tab 624 - - - - - 0 - - #DIV/0! #DIV/0!
217 Rifampisin tab 600 mg Tab 863 200 200 - - - 0 200 - 200 #DIV/0! #DIV/0!
218 Ringer Laktat Larutan infus Botol 5,720 53 53 8 - - 4 43 2 45 10.75 (27)
219 Salbutamol tab 2 mg Tab 65 396 396 10 - - 5 200 186 386 40.00 (180)
220 Salbutamol tab 4 mg Tab 93 665 665 - 10 - 5 600 65 665 120.00 (580)
221 Salep 2-4, kombinasi : asam salisilat 2 %+
belerang endap 4 % Tube 2,200 44 44 2 1 - 2 24 18 42 16.00 (18)
222 Scabicid salep Tube - - - - - 0 - - #DIV/0! #DIV/0!
223 Sefadroksil kaps 250 mg Vial 564 - - - - - 0 - - #DIV/0! #DIV/0!
224 Sefadroksil kaps/tab 500 mg Tab 548 810 700 1,510 240 150 - 195 1,000 270 1,270 5.13 (220)
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 35 25 60 9 10 - 10 50 1 51 5.26 (12)
226 Sefiksim kapsul 100 mg Tab 1,000 - - - - - 0 - - #DIV/0! #DIV/0!
227 Sefotaksim serb inj 1.000 mg/vial Vial 3,500 - - - - - 0 - - #DIV/0! #DIV/0!
228 Seftriakson serb inj 1.000 mg/vial Vial 3,900 - - - - - 0 - - #DIV/0! #DIV/0!
229 Setirizin tab 10 mg Tab 190 - - - 4 - 2 - - 0.00 8
230 Sianokobalamin (vitamin B12) inj 500 mcg/ml
Vial 1,150 399 399 9 - - 5 200 190 390 44.44 (182)
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 - - - 50 - 25 - - 0.00 100
232 Simetidin tablet 200 mg Tab 138 483 483 10 10 - 10 400 73 473 40.00 (360)
233 Simvastatin tab sal 10 mg Tab sal 177 - - - - - 0 - - #DIV/0! #DIV/0!
235 Siprofloksasin inf 2 mg/ml Botol 22,000 - - - - - 0 - - #DIV/0! #DIV/0!
236 Siprofloksasin tab scored 500 mg Tab 312 - - - - - 0 - - #DIV/0! #DIV/0!
237 Spironolakton tab 100 mg Tab 350 - - - - - 0 - - - #DIV/0! #DIV/0!
238 Sulfasetamid Natrium Tetes mata 1.5% Botol 3,549 - - - - - 0 - - #DIV/0! #DIV/0!
239 Sukralfat susp 500 mg/5 ml (Ulsafate) Botol 14,450 - - - - - 0 - - #DIV/0! #DIV/0!
240 Ulsidex Tablet 477 160 160 - - - 0 - 160 160 #DIV/0! #DIV/0!
241 Retapyl SR Kapsul 1,155 180 180 - - - 0 - 180 180 #DIV/0! #DIV/0!
242 Tetrasiklin kaps 250 mg Kaps 183 700 700 - - - 0 600 100 700 #DIV/0! #DIV/0!
243 Tetrasiklin kaps 500 mg Kaps 283 280 100 380 - - - 0 200 180 380 #DIV/0! #DIV/0!
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 6,030 6,030 - 310 - 155 5,000 1,030 6,030 32.26 (4,380)
245 Tiamin (vitamin B1) injeksi 100 mg/ml Tab 770 - - - - - 0 - - #DIV/0! #DIV/0!
246 Tramadol inj 50 mg/ml Ampul 2,680 128 128 - - - 0 - 128 128 #DIV/0! #DIV/0!
247 Tramadol tablet 500 mg Tab 363 587 587 - 20 - 10 400 187 587 40.00 (360)
248 Triheksifenidil tab 2 mg Tab 45 (60) 500 440 150 90 - 120 - 290 290 0.00 480
249 Vitamin B12 tablet 50 mcg Tab 63 1,370 ### 3,370 - - - 0 200 3,170 3,370 #DIV/0! #DIV/0!
250 Vitamin B kompleks injeksi Vial 7,392 115 115 - - - 0 110 5 115 #DIV/0! #DIV/0!
251 Vitamin B kompleks Tab 112 383 383 80 483 - 282 300 3 303 1.07 826
252 Zinc tab disp 20 mg Tab 521 300 300 20 - - 10 300 (20) 280 30.00 (260)
253 Zinc sirup 20 mg / 5 ml Botol 8,140 - - - - - 0 - - #DIV/0! #DIV/0!
254 Larutan PK botol 6,975 16 16 - - - 0 12 4 16 #DIV/0! #DIV/0!
255 Kanamisin inj Vial 5,929 50 50 - - - 0 50 - 50 #DIV/0! #DIV/0!
256 Antalgin 500mg tab 141 - - - - - 0 - - #DIV/0! #DIV/0!
257 Klorpromazin inj 25 mg/ml (i.m.) Ampul 1,210 - - - - - 0 - - #DIV/0! #DIV/0!
258 Kalsium laktat (kalk) tab 500 mg Tab 76 - - - - - 0 - - #DIV/0! #DIV/0!
259 Kloroquin tab 250 mg Tab 572 - - - - - 0 - - - #DIV/0! #DIV/0!
260 Klonidin 0,15 mg Tab 193 - - - - - 0 - - #DIV/0! #DIV/0!
261 Kloramfenikol kaps 250 mg Kaps 275 - - - - - 0 - - #DIV/0! #DIV/0!
262 Klorpromazin tab sal 100 mg Tab sal 162 - - - - - 0 - - #DIV/0! #DIV/0!
263 Fenolgliserol TT 10% Kotak 1,109 138 138 - - - 0 96 42 138 #DIV/0! #DIV/0!
264 Tetrasiklin kaps 250 mg Kaps 162 - - - - - 0 - - #DIV/0! #DIV/0!
265 Kloroquin tab 250 mg 112 - - - - - 0 - - #DIV/0! #DIV/0!
266 Papaverin tablet 40 mg 167 - - - - - 0 - - #DIV/0! #DIV/0!
267 Prednison tab 5 mg Tab 125 - - - - - 0 - - #DIV/0! #DIV/0!
268 Pirantel pamoat tab scored 125 mg Tab 318 - - - - - 0 - - #DIV/0! #DIV/0!
269 Hidroklorotiazid (HCT) tab 25 mg Tab 109 - - - - - 0 - - #DIV/0! #DIV/0!
270 Triheksifenidil tab 2 mg Tab 45 - - - - - 0 - - #DIV/0! #DIV/0!
271 Piracetam tablet 1200 mg Tab 854 - - - - - 0 - - #DIV/0! #DIV/0!
272 Vical Multivitamin Botol 42,727 - - - - - 0 - - - #DIV/0! #DIV/0!
273 Lexavit tab 1,480 - 100 100 - 30 - 15 - 100 100 0.00 60
274 Gliseril Guaiakolat tab 100 mg Tab 31 - - - - - 0 - - #DIV/0! #DIV/0!
275 Efedrin HCl tablet Tab - - - - - 0 - - #DIV/0! #DIV/0!
276 Kloroquin Tablet 150 mg Tab 537 537 - - - 0 300 237 537 #DIV/0! #DIV/0!
277 Aptyl Btl - - - - - 0 - - - #DIV/0! #DIV/0!
278 Levopar Tablet 100 100 - - - 0 50 50 100 #DIV/0! #DIV/0!
280 Pytogin inj Ampul 10 10 - - - 0 - 10 10 #DIV/0! #DIV/0!
281 Phenytoin Sodium Kapsul 130 130 20 10 - 15 100 10 110 6.67 (40)
Etanol 300% cairan Botol 33 - - - - - 0 - - - #DIV/0! #DIV/0!
B. OBAT GIGI - -
1 Bonding Botol - - - - - 0 - - #DIV/0! #DIV/0!
2 Calcium hidrosida cement pasta (hycal) Kotak - - - - - 0 - - #DIV/0! #DIV/0!
3 Comfosite Tube - - - - - 0 - - #DIV/0! #DIV/0!
4 Devitalisasi Pasta (Non Arsen) Kotak 390,000 - - - - - 0 - - #DIV/0! #DIV/0!
5 Eugenol cair Botol 18,333 - - - - - 0 - - #DIV/0! #DIV/0!
6 Etil Klorida spray Botol 105,000 - - - - - 0 - - #DIV/0! #DIV/0!
7 Etza Tube 170,000 - - - - - 0 - - #DIV/0! #DIV/0!
8 Glass Ionomer Cement ART Set 395,000 - - - - - 0 - - #DIV/0! #DIV/0!
9 Klorfenol Kamfer Menthol (CHKM) Botol 55,000 5 5 - - - 0 - 5 5 #DIV/0! #DIV/0!
10 Semen Seng Fosfat serbuk dan cairan Set 93,500 1 1 - - - 0 1 1 #DIV/0! #DIV/0!
11 Temporari stoping pletcher Set 34,000 1 1 - - - 0 1 - 1 #DIV/0! #DIV/0!
12 Mummiyng pasta Kotak 176,000 - - - - 0 - - #DIV/0! #DIV/0!
C. OBAT PROGRAM -
1 Albedazole 400mg Tab 363 - - - - - 0 - - - #DIV/0! #DIV/0!
2 Artemether inj 80 mg/ml Ampul - - - - - 0 - - - #DIV/0! #DIV/0!
3 Artesunat serb inj 60 mg/ml (i.v./i.m.) Vial 27,569 - - - - - 0 - - - #DIV/0! #DIV/0!
4 Dietilkarbamazin tab 100 mg Tab 104 3,000 3,000 - - - 0 3,000 - 3,000 #DIV/0! #DIV/0!
5 Imersion oil Botol - - - - - 0 - - #DIV/0! #DIV/0!
6 Iodina Test Botol - - - - - 0 - - #DIV/0! #DIV/0!
7 Obat Anti Tuberculosis FDC Kategori Anak Paket 236,490 - - - - - 0 - - #DIV/0! #DIV/0!
8 Obat Anti Tuberculosis FDC Kategori I Paket 396,000 - - - - - 0 - - #DIV/0! #DIV/0!
9 Obat Anti Tuberculosis FDC Kategori II Paket 1,319,990 - - - - - 0 - - #DIV/0! #DIV/0!
Paket 175,899 - - - - - 0 - - #DIV/0! #DIV/0!
11 Reagen Zenit Nelson Botol 145,000 - - - - - 0 - - #DIV/0! #DIV/0!
12 RDT Dangue DBD Set 150,000 - - - - - 0 - - #DIV/0! #DIV/0!
13 RDT malaria (care star ) Set 168,300 - - - - - 0 - - #DIV/0! #DIV/0!
14 RDT HIV (intec) Set 46,200 - - - - - 0 - - #DIV/0! #DIV/0!
15 RDT HIV (vikia) Set 45,560 - - - - - 0 - - #DIV/0! #DIV/0!
16 RDT HIV (Oncoprobe) Set 42,350 - - - - - 0 - - #DIV/0! #DIV/0!
17 Taburia Kotak 20,454 - - - - - 0 - - #DIV/0! #DIV/0!
18 Quinina injeksi Ampul 4,438 - - - - - 0 - - #DIV/0! #DIV/0!
19 Vaksin BCG inj (i.k) Vial - - - - - 0 - - - #DIV/0! #DIV/0!
20 Vaksin campak inj (s.k.) Vial - - - - - 0 - - #DIV/0! #DIV/0!
21 Vaksin jerap difteri tetanus pertusis (DTP) inj (i.mVial - - - - - 0 - - #DIV/0! #DIV/0!
22 Vaksin jerap difteri tetanus (DT) Vial - - - - - 0 - - #DIV/0! #DIV/0!
23 Vaksin kombinasi DPT + hepatitis B inj (i.m.) Vial 2 2 - - - 0 2 2 #DIV/0! #DIV/0!
24 Vaksin polio drops 10 dosis Vial 2 2 - - - 0 2 2 #DIV/0! #DIV/0!
booster Vial 695,752 - - - - - 0 - - #DIV/0! #DIV/0!
26 Retinol (Vit.A) 200.000 IU kap lunak 412 - - - - - 0 - - - #DIV/0! #DIV/0!
27 Retinol (Vit.A) 100.000 IU kap lunak 286 - - - - - 0 - - #DIV/0! #DIV/0!
28 zink tab.20mg 497 - - - - - 0 - - #DIV/0! #DIV/0!
29 Doxiciklin tab - - - - - 0 - - #DIV/0! #DIV/0!
30 Garam Oralit 45 45 - - - 0 - 45 45 #DIV/0! #DIV/0!
31 Kina - - - - - 0 - - - #DIV/0! #DIV/0!
32 Gentamicin Inj. - - - - - 0 - - - #DIV/0! #DIV/0!
33 Pitomenadion Inj. - - - - - 0 - - - #DIV/0! #DIV/0!
34 Diazepam Inj 713 713 - - - 0 60 653 713 #DIV/0! #DIV/0!
35 Glukonas Kalsikas 98 98 - - - 0 48 50 98 #DIV/0! #DIV/0!
36 Phenobarbital Inj. 150 150 - - - 0 - 150 150 #DIV/0! #DIV/0!
37 Ampiciline Sodium Inj - - - - - 0 - - - #DIV/0! #DIV/0!
38 Benzatin B Penicilin Inj. 311 311 - - - 0 90 221 311 #DIV/0! #DIV/0!
39 Mg So4 20 % 438 438 - - - 0 43 395 438 #DIV/0! #DIV/0!
40 Mg So4 40 % 62 62 - - - 0 27 35 62 #DIV/0! #DIV/0!
41 Zinc 20 mg 1,245 1,245 - - - 0 1,000 245 1,245 #DIV/0! #DIV/0!
42 Pyrantel Tab 125 mg 300 300 - - - 0 200 100 300 #DIV/0! #DIV/0!
43 Alat Suntik 0,5 ml 200 200 - - - 0 100 100 200 #DIV/0! #DIV/0!
44 Alat Suntik 5 ml 100 100 - - - 0 100 - 100 #DIV/0! #DIV/0!
45 Kotrimoksasol 480 mg 1,600 1,600 - - - 0 1,500 100 1,600 #DIV/0! #DIV/0!
46 Retinol (Vitamin A) 100.000 IU Kapsul Lunak Botol - - - - - 0 - - #DIV/0! #DIV/0!
D. BAHAN MEDIS HABIS PAKAI (BHMP) - -
1 Alat suntik sekali pakai 1 ml Set 1,093 720 720 - 8 - 4 700 20 720 175.00 (684)
2 Alat suntik sekali pakai 2,5 ml Set 848 270 270 6 20 - 13 200 64 264 15.38 (148)
3 Alat suntik sekali pakai 3 ml Set 848 120 120 15 15 - 15 - 105 105 0.00 60
4 Alat suntik sekali pakai 5 ml Set 979 634 100 734 - 5 - 3 550 184 734 220.00 (540)
5 Bisturi no. 20 Buah 2,099 311 311 10 15 - 13 200 101 301 16.00 (150)
6 Bisturi no. 15 Buah 2,099 487 487 7 10 - 9 450 30 480 52.94 (416)
7 Catgut No 2/0 Set 25,920 52 52 2 - - 1 24 26 50 24.00 (20)
8 Catgut No 3/0 Set 5,900 31 31 - - - 0 30 1 31 #DIV/0! #DIV/0!
9 Handscoen no. 6 Pasang - - - - 0 - - - #DIV/0! #DIV/0!
10 Handscoen no. 6,5 Pasang - - - - 0 - - - #DIV/0! #DIV/0!
11 Handscoen no. 7 Pasang 7,684 - - - - - 0 - - - #DIV/0! #DIV/0!
12 Handscoen no. 7,5 Pasang 7,684 - - 30 - 15 - - - 0.00 60
13 Infuset dewasa Set 4,176 61 61 - - - 0 50 11 61 #DIV/0! #DIV/0!
14 Infusion set anak Set 4,568 33 33 - - - 0 16 17 33 #DIV/0! #DIV/0!
15 IV Catheter No.16 G Set - - - - - 0 - - - #DIV/0! #DIV/0!
16 IV Catheter No.18 G Set 7,937 42 42 1 - - 1 14 27 41 28.00 (12)
17 IV Catheter No.24 G Set 7,937 3 3 - - - 0 - 3 3 #DIV/0! #DIV/0!
18 IV Catheter No. 20 G Set 7,787 72 72 2 2 - 2 39 31 70 19.50 (31)
19 IV Catheter No. 22 G Set 7,937 24 24 2 - - 1 4 18 22 4.00 0
20 Folley Catheter 16 Set - - - - - 0 - - - #DIV/0! #DIV/0!
21 Folley Catheter 18 Set 8,495 - - - - - 0 - - - #DIV/0! #DIV/0!
22 Folley catheter 22 Set 8,495 - - - - - 0 - - - #DIV/0! #DIV/0!
23 Folley catheter 24 Set 495 - - - - - 0 - - - #DIV/0! #DIV/0!
24 Kapas Berlemak 250 gram Rol 7,500 1 1 - - - 0 - 1 1 #DIV/0! #DIV/0!
25 Kapas Berlemak 500 gram Rol 17,250 10 10 - - - 0 10 - 10 #DIV/0! #DIV/0!
26 Kasa Pembalut 4m x 3 cm Rol 800 - - - - - 0 - - - #DIV/0! #DIV/0!
27 Kasa Pembalut 4m x 5 cm Rol 887 15 15 1 2 - 2 13 1 14 8.67 (7)
28 Kasa Pembalut 4m x 10 cm Rol 6,121 30 30 1 - - 1 27 2 29 54.00 (25)
29 Kasa Pembalut 4m x 15 cm Rol 887 - - - - 0 - - - #DIV/0! #DIV/0!
30 Kasa Kompres 40/40 steril Buah 1,871 - - - - - 0 - - - #DIV/0! #DIV/0!
31 Kasa Steril 16 X 16 Buah 8,600 - - - - - 0 - - - #DIV/0! #DIV/0!
32 Kasa pembalut 2 x 80 Rol 13,221 - - - - - 0 - - - #DIV/0! #DIV/0!
33 Kasa Pembalut 40 x 80 Rol 137,025 - - - - - 0 - - #DIV/0! #DIV/0!
34 Kasa Pembalut 36 x 80 cm Rol 133,821 2 2 - - - 0 2 - 2 #DIV/0! #DIV/0!
35 Pembalut Gips Buah 32,500 - - - - - 0 - - #DIV/0! #DIV/0!
36 Plester 5 yard x 2 inc Rol 23,625 2 2 4 2 2 - 2 2 - 2 1.00 6
37 Silk Set 5,082 45 45 2 2 - 2 28 15 43 14.00 (20)
38 Selang oksigen anak Set - - - - - 0 - - #DIV/0! #DIV/0!
39 Selang oksigen dewasa Set - - - - - 0 - - #DIV/0! #DIV/0!
40 Sofratulle Set - - - - - 0 - - #DIV/0! #DIV/0!
41 Urine bag Set 4,000 4 4 - - - 0 4 - 4 #DIV/0! #DIV/0!
42 Wing Needle No. 21 G Set 5,770 100 100 - - - 0 100 - 100 #DIV/0! #DIV/0!
43 Wing Needle No. 23 G Set 5,770 - - - - - 0 - - #DIV/0! #DIV/0!
44 Wing Needle No.25 G Set 5,770 30 30 - - - 0 30 - 30 #DIV/0! #DIV/0!
46 NGT No. 3 ( Feeding Tube ) Set 22,000 - - - - - 0 - - #DIV/0! #DIV/0!
48 Masker Buah 1,125 - - - - - 0 - - - #DIV/0! #DIV/0!
49 Tes gula darah Set 200,455 84 84 - - - 0 75 9 84 #DIV/0! #DIV/0!
50 Tes Narkoba 3 parameter Set 68,181 - - - - - 0 - - #DIV/0! #DIV/0!
52 Tes Kehamilan Sachet 6,825 17 10 27 5 - - 3 15 7 22 6.00 (5)

RUSTAM, AMK
Jadi : (4 - TK ) X Pemakaian rata-rata perbulan NIP. 1974 0410 199502 1 002
PEMBERIAN
EXP KET
16 17 18 19 20 21
18
FITRIANI, S.Farm.,Apt
NIP. -
KODE PUSKESMAS :
KABUPATEN : BOMBANA
Satuan / PEMAKAIAN SISA STOK TINGKAT PERMI

Harga STOCK PENERI PERSE TOTAL
No Nama Obat Kemasa RATA- SUB. KECUKU
Satuan (Rp) AWAL MAAN DIAAN JAN PEB MAR GUDAN STOK
PAN NTAAN
n RATA UNIT
G
1 2 3 4 4 5 6 7 8 9 10=(7+8+9)/3 11 12 13=11+12 14=11/10 15
A. OBAT
Ampul 2,200 107 107 - - - 0 102 5 107 #DIV/0! #DIV/0!
6 Ambroksol tablet 30 mg Tab 138 378 378 70 110 - 90 100 168 268 1.11 260
7 Ambroksol sirup Botol 2,722 - 18 - - - - 0 - - - #DIV/0! #DIV/0!
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 13 13 - - - 0 - 13 13 #DIV/0! #DIV/0!
14 Amoksisilin tab 250 mg Tab 220 625 625 120 120 - 120 100 405 505 0.83 380
15 Amoksisilin tab 500 mg Tab 279 3,247 3,247 420 410 - 415 2,200 637 2,837 5.30 (540)
78 830 830 140 270 - 205 300 260 560 1.46 520
kunyah
mg + magnesium hidroksida 200 mg Suspensi Botol 2,213 - - - 1 - 1 - (1) (1) 0.00 2

10 mg+ seng oksida 120 mg + sup ad 2 g Suppo 33,000 126 126 - 5 - 3 120 1 121 48.00 (110)

Ampul 1,346 200 200 - - - 0 60 140 200 #DIV/0! #DIV/0!
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 1,178 1,178 60 40 - 50 1,200 (62) 1,138 24.00 (1,000)
32 Asam mefenamat kaps 500 mg Kaps 127 2,350 2,350 310 230 - 270 1,400 720 2,120 5.19 (320)
33 Asam traneksamat inj 50 mg/ml Ampul 3,650 10 10 - 2 - 1 10 (2) 8 10.00 (6)
36 Asiklovir salep kulit Tube 2,367 27 27 3 8 - 6 25 (6) 19 4.55 (3)
41 Bedak salisil serb 2% Botol 1,180 2 2 2 3 - 3 - (1) (1) 0.00 10
44 Betametason krim 0,1% Tube 1,596 27 27 10 10 - 10 10 7 17 1.00 30
80/4,5 mcg Botol 110,500 - - - - - 0 - - #DIV/0! #DIV/0!
50 Bromheksin tablet tablet 42 350 350 10 10 - 10 300 40 340 30.00 (260)
51 Deksametason tab 0,5 mg Tab 68 198 198 100 60 - 80 - 138 138 0.00 320
57 Diazepam tab 2 mg Tab 47 605 605 60 50 - 55 200 355 555 3.64 20
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 66 66 - - - 0 30 36 66 #DIV/0! #DIV/0!
65 Domperidon susp 5 mg/5 ml Botol 3,490 - - - - - 0 - - - #DIV/0! #DIV/0!
66 Domperidon tab 10 mg Tab 174 507 507 30 - - 15 300 207 507 20.00 (240)
72 Eritromisin tab 500 mg Tab 1,013 500 500 90 20 - 55 500 (20) 480 9.09 (280)
73 Etanol 70% cairan 70% Botol 2,625 2 2 2 2 - 2 2 (2) - 1.00 6
74 Etakridin (rivanol) larutan 0.1% Botol 4,695 2 2 2 1 - 2 2 (1) 1 1.33 4
75 Etil klorida semprot 100 ml Botol 105,000 - - 1 1 - 1 - (1) (1) 0.00 4
Vial 3,754 28 28 - - - 0 - 28 28 #DIV/0! #DIV/0!
88 Furosemid tab 40 mg Tab 84 2,100 2,100 - - - 0 1,000 1,100 2,100 #DIV/0! #DIV/0!
95 Gentamisin salep Kulit Tube 1,469 71 71 5 10 - 8 10 51 61 1.33 20
100 Gliseril Guaiakolat tab 100 mg Tab 31 3,009 3,009 75 210 - 143 2,100 699 2,799 14.74 (1,530)
106 Griseofulvin (micronized) tab 125 mg Tab 230 400 400 70 50 - 60 200 150 350 3.33 40
107 Haloperidol tab 0,5 mg Tab 62 680 680 - - - 0 600 80 680 #DIV/0! #DIV/0!
108 Haloperidol tab 1,5 mg Tab 76 300 300 80 30 - 55 200 70 270 3.64 20
109 Haloperidol tab 5 mg Tab 105 230 230 60 60 - 60 100 70 170 1.67 140
110 Hidrogen peroksida (H2O2) cairan 3% Botol 38,500 2 2 1 - - 1 2 - 2 4.00 0
112 Hidrokortison krim 2,5% Tube 2,938 25 25 4 1 - 3 25 (1) 24 10.00 (15)
114 Ibuprofen susp 100 mg/5 ml Botol 3,849 4 4 - - - 0 - 4 4 #DIV/0! #DIV/0!
115 Ibuprofen tab 200 mg Tab 121 1,420 1,420 340 170 - 255 500 750 1,250 1.96 520
116 Ibuprofen tab 400 mg Tab 157 1,130 1,130 40 480 - 260 100 550 650 0.38 940
123 Kalsium laktat (kalk) tab 500 mg Tab 76 5 5 170 100 - 135 - (95) (95) 0.00 540
124 Kaptopril tab 12,5 mg Tab 69 200 200 - 160 - 80 100 (60) 40 1.25 220
125 Kaptopril tab 25 mg Tab 97 600 600 60 190 - 125 300 110 410 2.40 200
138 Klorfeniramin (CTM) tab 4 mg Tab 26 9,184 9,184 370 302 - 336 8,000 882 8,882 23.81 (6,656)
140 Klorpromazin tab sal 100 mg Tab sal 162 4,710 4,710 120 70 - 95 4,700 (60) 4,640 49.47 (4,320)
Tab 531 200 200 - - - 0 200 - 200 #DIV/0! #DIV/0!

sulfametoksazol 400 mg+ trimetoprim 80 Tab 152 1,270 1,270 90 - - 45 1,300 (30) 1,270 28.89 (1,120)
mg
sulfametoksazol 100 mg+ trimetoprim 20 Tab 79 2,251 2,251 - - - 0 2,100 151 2,251 #DIV/0! #DIV/0!
mg
suspensi : sulfametoksazol 200 mg + Botol 2,298 5 5 2 20 - 11 5 (20) (15) 0.45 39
trimetoprim 40 mg
150 Levofloksasin tab 500 mg Tab 581 130 130 20 20 - 20 100 10 110 5.00 (20)
152 Lidokain inj 2% (hcl) Vial 929 206 206 12 12 - 12 200 (6) 194 16.67 (152)
153 Lisol Botol 54,995 - - - - - 0 - - - #DIV/0! #DIV/0!
154 Loperamid tab 2 mg Tab 97 170 170 30 10 - 20 200 (40) 160 10.00 (120)
155 Loratadin tab 10 mg Tab 170 360 360 40 150 - 95 300 (90) 210 3.16 80
Botol 2,900 - - - - - 0 - - #DIV/0! #DIV/0!
172 Metronidazol tab 500 mg Tab 169 520 520 100 50 - 75 500 (30) 470 6.67 (200)
174 Natrium diklofenak tab 25 mg Tab 146 960 960 90 70 - 80 - 890 890 0.00 320
175 Natrium diklofenak tab 50 mg Tab 193 1,575 1,575 110 150 - 130 250 1,175 1,425 1.92 270
176 NaCl 0,9% Larutan infus Botol 5,170 43 43 4 4 - 4 46 (7) 39 11.50 (30)
180 Obat Batuk Hitam (OBH) Botol 2,310 35 35 6 - - 3 15 20 35 5.00 (3)
187 Omeprazol kaps 20 mg Kaps 221 100 100 60 100 - 80 30 (30) - 0.38 290
189 Parasetamol sir 120 mg/5 ml Botol 1,535 - - - - - 0 - - - #DIV/0! #DIV/0!
190 Parasetamol tab 100 mg Tab 105 (64) (64) 81 44 - 63 - (108) (108) 0.00 250
191 Parasetamol tab 500 mg Tab 88 2,425 2,425 485 473 - 479 2,100 (148) 1,952 4.38 (184)
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25,350 - - 20 - - 10 - - 0.00 40
202 Piroksikam tablet 20 mg Tab 116 1,119 1,119 240 250 - 245 800 69 869 3.27 180
2,344 56 56 2 1 - 2 53 2 55 35.33 (47)
ml
15,386 29 29 1 1 - 1 30 (2) 28 30.00 (26)
ml
40,202 15 15 - - - 0 15 - 15 #DIV/0! #DIV/0!
1000 ml
207 Prednison tab 5 mg Tab 98 3,550 3,550 300 618 - 459 500 2,432 2,932 1.09 1,336
209 Procurma syrup Botol 12,021 1 1 2 3 - 3 - (2) (2) 0.00 10
210 Propiltiourasil tab 100 mg Tab 351 200 200 100 200 - 150 200 (200) - 1.33 400
213 Ranitidin tab 150 mg Tab 128 520 520 140 80 - 110 200 240 440 1.82 240
218 Ringer Laktat Larutan infus Botol 5,720 45 45 8 - - 4 43 2 45 10.75 (27)
224 Sefadroksil kaps/tab 500 mg Tab 548 1,270 1,270 240 150 - 195 1,000 120 1,120 5.13 (220)
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 51 51 9 10 - 10 50 (9) 41 5.26 (12)
229 Setirizin tab 10 mg Tab 190 - - - 4 - 2 (4) (4) 0.00 8
Vial 1,150 390 390 9 - - 5 200 190 390 44.44 (182)
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 - - 80 50 - 65 (50) (50) 0.00 260
236 Siprofloksasin tab scored 500 mg Tab 312 - - - - - 0 - - #DIV/0! #DIV/0!
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 6,030 6,030 - 310 - 155 5,000 720 5,720 32.26 (4,380)
248 Triheksifenidil tab 2 mg Tab 45 290 290 150 90 - 120 - 200 200 0.00 480
249 Vitamin B12 tablet 50 mcg Tab 63 3,370 3,370 - - - 0 200 3,170 3,370 #DIV/0! #DIV/0!
251 Vitamin B kompleks Tab 112 303 303 80 483 - 282 300 (480) (180) 1.07 826
273 Lexavit tab 1,480 100 100 - 30 - 15 - 70 70 0.00 60
277 Aptyl Btl - - - - - 0 - - - #DIV/0! #DIV/0!
281 Phenytoin Sodium Kapsul 110 110 20 10 - 15 100 - 100 6.67 (40)
B. OBAT GIGI - -
7 Etza Tube 170,000 - - - - - 0 - - #DIV/0! #DIV/0!
C. OBAT PROGRAM -
Paket 175,899 - - - - - 0 - - #DIV/0! #DIV/0!
31 Kina - - - - - 0 - - - #DIV/0! #DIV/0!
39 Mg So4 20 % 438 438 - - - 0 43 395 438 #DIV/0! #DIV/0!
40 Mg So4 40 % 62 62 - - - 0 27 35 62 #DIV/0! #DIV/0!
41 Zinc 20 mg 1,245 1,245 - - - 0 1,000 245 1,245 #DIV/0! #DIV/0!
4 Alat suntik sekali pakai 5 ml Set 979 734 734 - 5 - 3 550 179 729 220.00 (540)
5 Bisturi no. 20 Buah 2,099 301 301 10 15 - 13 200 86 286 16.00 (150)
6 Bisturi no. 15 Buah 2,099 480 480 7 10 - 9 450 20 470 52.94 (416)
7 Catgut No 2/0 Set 25,920 50 50 2 - - 1 24 26 50 24.00 (20)
11 Handscoen no. 7 Pasang 7,684 - - - - - 0 - - - #DIV/0! #DIV/0!
12 Handscoen no. 7,5 Pasang 7,684 - - 30 - 15 - (30) (30) 0.00 60
18 IV Catheter No. 20 G Set 7,787 70 70 2 2 - 2 39 29 68 19.50 (31)
27 Kasa Pembalut 4m x 5 cm Rol 887 14 14 1 2 - 2 15 (3) 12 10.00 (9)
28 Kasa Pembalut 4m x 10 cm Rol 6,121 29 29 1 - - 1 30 (1) 29 60.00 (28)
34 Kasa Pembalut 36 x 80 cm Rol 133,821 2 2 1 - - 1 2 - 2 4.00 0
36 Plester 5 yard x 2 inc Rol 23,625 2 2 2 2 - 2 2 (2) - 1.00 6
37 Silk Set 5,082 43 43 2 2 - 2 28 13 41 14.00 (20)
52 Tes Kehamilan Sachet 6,825 22 22 5 - - 3 15 7 22 6.00 (5)


BULAN : FEBRUARI 2017
PEMBERIAN
EXP KET
16 17 18 19 20 21
FITRIANI, S.Farm.,Apt
NIP. -
KODE PUSKESMAS :
KABUPATEN : BOMBANA

Satuan (Rp) AWAL MAAN DIAAN JAN PEB MAR GUDAN STOK
PAN NTAAN
n RATA UNIT
G
1 2 3 4 4 5 6 7 8 9 10=(7+8+9)/3 11 12 13=11+12 14=11/10 15
A. OBAT
Ampul 2,200 107 107 - - - 0 102 5 107 #DIV/0! #DIV/0!
6 Ambroksol tablet 30 mg Tab 138 268 268 70 110 30 105 100 138 238 0.95 320
7 Ambroksol sirup Botol 2,722 - - - - 4 2 - (4) (4) 0.00 8
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 13 15 28 - - 4 2 - 24 24 0.00 8
14 Amoksisilin tab 250 mg Tab 220 505 505 120 120 84 162 100 321 421 0.62 548
15 Amoksisilin tab 500 mg Tab 279 2,837 2,837 420 410 640 735 2,200 (3) 2,197 2.99 740
78 560 560 140 270 200 305 300 60 360 0.98 920
kunyah
mg + magnesium hidroksida 200 mg Suspensi Botol 2,213 (1) 15 14 - 1 8 5 - 6 6 0.00 18

10 mg+ seng oksida 120 mg + sup ad 2 g Suppo 33,000 121 121 - 5 8 7 120 (7) 113 18.46 (94)

Ampul 1,346 200 200 - - 12 6 60 128 188 10.00 (36)
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 1,138 1,138 60 40 80 90 1,200 (142) 1,058 13.33 (840)
32 Asam mefenamat kaps 500 mg Kaps 127 2,120 2,120 310 230 400 470 1,400 320 1,720 2.98 480
33 Asam traneksamat inj 50 mg/ml Ampul 3,650 8 8 - 2 2 2 10 (4) 6 5.00 (2)
41 Bedak salisil serb 2% Botol 1,180 (1) (1) 2 3 2 4 - (3) (3) 0.00 14
(tablet tambah darah) Sachet 55 16,205 16,205 300 250 370 460 6,250 9,585 15,835 13.59 (4,410)
44 Betametason krim 0,1% Tube 1,596 17 17 10 10 13 17 10 (6) 4 0.61 56
80/4,5 mcg Botol 110,500 - - - - - 0 - - #DIV/0! #DIV/0!
50 Bromheksin tablet tablet 42 340 340 10 10 20 20 300 20 320 15.00 (220)
51 Deksametason tab 0,5 mg Tab 68 138 500 638 100 60 100 130 - 538 538 0.00 520
57 Diazepam tab 2 mg Tab 47 555 555 60 50 30 70 200 325 525 2.86 80
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 66 66 - - 2 1 30 34 64 30.00 (26)
65 Domperidon susp 5 mg/5 ml Botol 3,490 - 15 15 - - 2 1 - 13 13 0.00 4
66 Domperidon tab 10 mg Tab 174 507 507 30 - 20 25 300 187 487 12.00 (200)
72 Eritromisin tab 500 mg Tab 1,013 480 480 90 20 10 60 500 (30) 470 8.33 (260)
73 Etanol 70% cairan 70% Botol 2,625 - - 2 2 1 3 2 (3) (1) 0.80 8
74 Etakridin (rivanol) larutan 0.1% Botol 4,695 1 1 2 1 - 2 2 (1) 1 1.33 4
75 Etil klorida semprot 100 ml Botol 105,000 (1) (1) 1 1 1 2 - (2) (2) 0.00 6
Vial 3,754 28 28 - - - 0 - 28 28 #DIV/0! #DIV/0!
95 Gentamisin salep Kulit Tube 1,469 61 61 5 10 6 11 10 45 55 0.95 32
100 Gliseril Guaiakolat tab 100 mg Tab 31 2,799 2,799 75 210 180 233 2,100 519 2,619 9.03 (1,170)
106 Griseofulvin (micronized) tab 125 mg Tab 230 350 350 70 50 30 75 200 120 320 2.67 100
107 Haloperidol tab 0,5 mg Tab 62 680 680 - - 10 5 600 70 670 120.00 (580)
108 Haloperidol tab 1,5 mg Tab 76 270 270 80 30 20 65 200 50 250 3.08 60
109 Haloperidol tab 5 mg Tab 105 170 170 60 60 120 120 100 (50) 50 0.83 380
110 Hidrogen peroksida (H2O2) cairan 3% Botol 38,500 2 2 1 - - 1 2 - 2 4.00 0
112 Hidrokortison krim 2,5% Tube 2,938 24 24 4 1 1 3 25 (2) 23 8.33 (13)
114 Ibuprofen susp 100 mg/5 ml Botol 3,849 4 15 19 - - - 0 - 19 19 #DIV/0! #DIV/0!
115 Ibuprofen tab 200 mg Tab 121 1,250 1,250 340 170 100 305 500 650 1,150 1.64 720
116 Ibuprofen tab 400 mg Tab 157 650 500 1,150 40 480 520 520 100 530 630 0.19 1,980
123 Kalsium laktat (kalk) tab 500 mg Tab 76 (95) (95) 170 100 170 220 - (265) (265) 0.00 880
124 Kaptopril tab 12,5 mg Tab 69 40 40 - 160 120 140 100 (180) (80) 0.71 460
125 Kaptopril tab 25 mg Tab 97 410 410 60 190 210 230 300 (100) 200 1.30 620
129 Ketokonazol tab 200 mg Tab 320 614 614 - 10 10 10 200 404 604 20.00 (160)
138 Klorfeniramin (CTM) tab 4 mg Tab 26 8,882 8,882 370 302 332 502 8,000 550 8,550 15.94 (5,992)
140 Klorpromazin tab sal 100 mg Tab sal 162 4,640 4,640 120 70 170 180 4,700 (230) 4,470 26.11 (3,980)
Tab 531 200 200 - - - 0 200 - 200 #DIV/0! #DIV/0!

sulfametoksazol 400 mg+ trimetoprim 80 Tab 152 1,270 1,270 90 - 10 50 1,300 (40) 1,260 26.00 (1,100)
mg
sulfametoksazol 100 mg+ trimetoprim 20 Tab 79 2,251 2,251 - - 2 1 2,100 149 2,249 2,100.00 (2,096)
mg
suspensi : sulfametoksazol 200 mg + Botol 2,298 (15) (15) 2 20 - 11 5 (20) (15) 0.45 39
trimetoprim 40 mg
150 Levofloksasin tab 500 mg Tab 581 110 110 20 20 10 25 100 - 100 4.00 0
152 Lidokain inj 2% (hcl) Vial 929 194 194 12 12 15 20 200 (21) 179 10.26 (122)
153 Lisol Botol 54,995 - 2 2 - - 1 1 - 1 1 0.00 2
154 Loperamid tab 2 mg Tab 97 160 160 30 10 10 25 200 (50) 150 8.00 (100)
155 Loratadin tab 10 mg Tab 170 210 210 40 150 - 95 300 (90) 210 3.16 80
Botol 2,900 - - - - - 0 - - #DIV/0! #DIV/0!
172 Metronidazol tab 500 mg Tab 169 470 470 100 50 90 120 500 (120) 380 4.17 (20)
173 Mikonazol krim 2% Tube 3,150 27 27 9 10 4 12 40 (17) 23 3.48 6
174 Natrium diklofenak tab 25 mg Tab 146 890 890 90 70 80 120 - 810 810 0.00 480
175 Natrium diklofenak tab 50 mg Tab 193 1,425 1,425 110 150 110 185 250 1,065 1,315 1.35 490
176 NaCl 0,9% Larutan infus Botol 5,170 39 39 4 4 2 5 46 (9) 37 9.20 (26)
180 Obat Batuk Hitam (OBH) Botol 2,310 35 35 6 - - 3 15 20 35 5.00 (3)
187 Omeprazol kaps 20 mg Kaps 221 - - 60 100 60 110 30 (90) (60) 0.27 410
189 Parasetamol sir 120 mg/5 ml Botol 1,535 - 20 20 - - 8 4 - 12 12 0.00 16
191 Parasetamol tab 500 mg Tab 88 1,952 1,952 485 473 440 699 2,100 (588) 1,512 3.00 696
194 Perak sulfadiazin krim 1% (Burnazin 35 gr) Tube 25,350 - - 20 - - 10 - - 0.00 40
200 Pirantel pamoat tab scored 125 mg Tab 318 363 363 36 20 14 35 330 19 349 9.43 (190)
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 8,955 8,955 20 90 120 115 7,000 1,835 8,835 60.87 (6,540)
202 Piroksikam tablet 20 mg Tab 116 869 869 240 250 220 355 800 (151) 649 2.25 620
2,344 55 55 2 1 1 2 53 1 54 26.50 (45)
ml
15,386 28 28 1 1 - 1 30 (2) 28 30.00 (26)
ml
40,202 15 15 - - - 0 15 - 15 #DIV/0! #DIV/0!
1000 ml
207 Prednison tab 5 mg Tab 98 2,932 2,932 300 618 410 664 500 2,022 2,522 0.75 2,156
209 Procurma syrup Botol 12,021 (2) (2) 2 3 3 4 - (5) (5) 0.00 16
210 Propiltiourasil tab 100 mg Tab 351 - - 100 200 - 150 200 (200) - 1.33 400
213 Ranitidin tab 150 mg Tab 128 440 440 140 80 100 160 200 140 340 1.25 440
218 Ringer Laktat Larutan infus Botol 5,720 45 20 65 8 - 5 7 43 17 60 6.62 (17)
224 Sefadroksil kaps/tab 500 mg Tab 548 1,120 1,120 240 150 180 285 1,000 (60) 940 3.51 140
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 41 41 9 10 6 13 50 (15) 35 4.00 0
229 Setirizin tab 10 mg Tab 190 (4) (4) - 4 - 2 (4) (4) 0.00 8
Vial 1,150 390 390 9 - 9 9 200 181 381 22.22 (164)
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 (50) (50) 80 50 100 115 (150) (150) 0.00 460
234 Simvastatin tab sal 20 mg Tab sal 480 - 250 250 - - - 0 250 250 #DIV/0! #DIV/0!
236 Siprofloksasin tab scored 500 mg Tab 312 - 300 300 - - 40 20 260 260 0.00 80
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 5,720 5,720 - 310 270 290 5,000 450 5,450 17.24 (3,840)
248 Triheksifenidil tab 2 mg Tab 45 200 200 150 90 150 195 - 50 50 0.00 780
251 Vitamin B kompleks Tab 112 (180) (180) 80 483 510 537 300 (990) (690) 0.56 1,846
273 Lexavit tab 1,480 70 70 - 30 80 55 - (10) (10) 0.00 220
277 Aptyl Btl - - - - - 0 - - - #DIV/0! #DIV/0!
281 Phenytoin Sodium Kapsul 100 100 20 10 - 15 100 - 100 6.67 (40)
-
B. OBAT GIGI - -
7 Etza Tube 170,000 - - - - - 0 - - #DIV/0! #DIV/0!
C. OBAT PROGRAM -
Paket 175,899 - - - - - 0 - - #DIV/0! #DIV/0!
31 Kina - - - - - 0 - - - #DIV/0! #DIV/0!
39 Mg So4 20 % 438 438 - - - 0 43 395 438 #DIV/0! #DIV/0!
40 Mg So4 40 % 62 62 - - - 0 27 35 62 #DIV/0! #DIV/0!
41 Zinc 20 mg 1,245 1,245 - - - 0 1,000 245 1,245 #DIV/0! #DIV/0!
5 Bisturi no. 20 Buah 2,099 286 286 10 15 - 13 200 86 286 16.00 (150)
6 Bisturi no. 15 Buah 2,099 470 470 7 10 - 9 450 20 470 52.94 (416)
7 Catgut No 2/0 Set 25,920 50 50 2 - - 1 24 26 50 24.00 (20)
11 Handscoen no. 7 Pasang 7,684 - 100 100 - - - 0 - 100 100 #DIV/0! #DIV/0!
12 Handscoen no. 7,5 Pasang 7,684 (30) (30) 30 - 15 - (30) (30) 0.00 60
18 IV Catheter No. 20 G Set 7,787 68 51 119 2 2 - 2 39 80 119 19.50 (31)
27 Kasa Pembalut 4m x 5 cm Rol 887 12 12 1 2 - 2 15 (3) 12 10.00 (9)
28 Kasa Pembalut 4m x 10 cm Rol 6,121 29 29 1 - - 1 30 (1) 29 60.00 (28)
34 Kasa Pembalut 36 x 80 cm Rol 133,821 2 2 1 - - 1 2 - 2 4.00 0
36 Plester 5 yard x 2 inc Rol 23,625 - - 2 2 - 2 2 (2) - 1.00 6
37 Silk Set 5,082 41 41 2 2 - 2 28 13 41 14.00 (20)
52 Tes Kehamilan Sachet 6,825 22 22 5 - 3 4 15 4 19 3.75 1


BULAN : MARET 2017
PEMBERIAN
EXP KET
16 17 18 19 20 21
FITRIANI
NIP. -
KODE PUSKESMAS :
KABUPATEN : BOMBANA

Satuan (Rp) AWAL MAAN DIAAN APR MEI JUNI GUDAN STOK
PAN NTAAN
n RATA UNIT
G
1 2 3 4 4 5 6 7 8 9 10=(7+8+9)/3 11 12 13=11+12 14=11/10 15
A. OBAT
Ampul 2,200 107 107 1 - - 1 102 4 106 204.00 (100)
6 Ambroksol tablet 30 mg Tab 138 238 238 30 110 30 85 100 108 208 1.18 240
7 Ambroksol sirup Botol 2,722 (4) (4) 4 - 4 4 - (8) (8) 0.00 16
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 24 15 39 8 - 4 6 - 31 31 0.00 24
14 Amoksisilin tab 250 mg Tab 220 421 421 60 120 84 132 100 261 361 0.76 428
15 Amoksisilin tab 500 mg Tab 279 2,197 2,197 500 410 640 775 2,200 (503) 1,697 2.84 900
78 360 360 70 270 200 270 300 (10) 290 1.11 780
kunyah
mg + magnesium hidroksida 200 mg Suspensi Botol 2,213 6 15 21 3 1 8 6 - 18 18 0.00 24

10 mg+ seng oksida 120 mg + sup ad 2 g Suppo 33,000 113 113 - 5 8 7 120 (7) 113 18.46 (94)

Ampul 1,346 188 188 - - 12 6 60 128 188 10.00 (36)
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 1,058 1,058 40 40 80 80 1,200 (182) 1,018 15.00 (880)
30 Asam folat tab 1 mg Tab 52 635 635 10 - - 5 400 225 625 80.00 (380)
32 Asam mefenamat kaps 500 mg Kaps 127 1,720 1,720 260 230 400 445 1,400 60 1,460 3.15 380
33 Asam traneksamat inj 50 mg/ml Ampul 3,650 6 6 - 2 2 2 10 (4) 6 5.00 (2)
37 Asiklovir tab 200 mg Tab 251 1,449 1,449 10 30 - 20 1,400 39 1,439 70.00 (1,320)
41 Bedak salisil serb 2% Botol 1,180 (3) (3) 2 3 2 4 - (5) (5) 0.00 14
(tablet tambah darah) Sachet 55 15,835 15,835 340 250 370 480 6,250 9,245 15,495 13.02 (4,330)
44 Betametason krim 0,1% Tube 1,596 4 4 8 10 13 16 10 (14) (4) 0.65 52
80/4,5 mcg Botol 110,500 - - - - - 0 - - #DIV/0! #DIV/0!
50 Bromheksin tablet tablet 42 320 320 10 10 20 20 300 10 310 15.00 (220)
51 Deksametason tab 0,5 mg Tab 68 538 500 1,038 252 60 100 206 - 786 786 0.00 824
57 Diazepam tab 2 mg Tab 47 525 525 25 50 30 53 200 300 500 3.81 10
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 64 64 2 - 2 2 30 32 62 15.00 (22)
65 Domperidon susp 5 mg/5 ml Botol 3,490 13 15 28 1 - 2 2 - 27 27 0.00 6
66 Domperidon tab 10 mg Tab 174 487 487 20 - 20 20 300 167 467 15.00 (220)
67 Efedrin HCl tablet Tab 56 394 394 10 2 - 6 300 84 384 50.00 (276)
72 Eritromisin tab 500 mg Tab 1,013 470 470 30 20 10 30 500 (60) 440 16.67 (380)
73 Etanol 70% cairan 70% Botol 2,625 (1) (1) 2 2 1 3 2 (5) (3) 0.80 8
74 Etakridin (rivanol) larutan 0.1% Botol 4,695 1 1 2 1 - 2 2 (3) (1) 1.33 4
75 Etil klorida semprot 100 ml Botol 105,000 (2) (2) 1 1 1 2 - (3) (3) 0.00 6
Vial 3,754 28 28 - - - 0 - 28 28 #DIV/0! #DIV/0!
95 Gentamisin salep Kulit Tube 1,469 55 55 2 10 6 9 10 43 53 1.11 26
100 Gliseril Guaiakolat tab 100 mg Tab 31 2,619 2,619 134 210 180 262 2,100 385 2,485 8.02 (1,052)
106 Griseofulvin (micronized) tab 125 mg Tab 230 320 320 20 50 30 50 200 100 300 4.00 0
107 Haloperidol tab 0,5 mg Tab 62 670 670 90 - 10 50 600 (20) 580 12.00 (400)
108 Haloperidol tab 1,5 mg Tab 76 250 250 30 30 20 40 200 20 220 5.00 (40)
109 Haloperidol tab 5 mg Tab 105 50 50 60 60 120 120 120 (130) (10) 1.00 360
112 Hidrokortison krim 2,5% Tube 2,938 23 23 2 1 1 2 25 (4) 21 12.50 (17)
114 Ibuprofen susp 100 mg/5 ml Botol 3,849 19 15 34 3 - - 2 - 31 31 0.00 6
115 Ibuprofen tab 200 mg Tab 121 1,150 1,150 340 170 100 305 500 310 810 1.64 720
116 Ibuprofen tab 400 mg Tab 157 630 500 1,130 320 480 520 660 100 710 810 0.15 2,540
123 Kalsium laktat (kalk) tab 500 mg Tab 76 (265) (265) 100 100 170 185 - (365) (365) 0.00 740
124 Kaptopril tab 12,5 mg Tab 69 (80) (80) 140 160 120 210 100 (320) (220) 0.48 740
125 Kaptopril tab 25 mg Tab 97 200 200 130 190 210 265 300 (230) 70 1.13 760
129 Ketokonazol tab 200 mg Tab 320 604 604 - 10 10 10 200 404 604 20.00 (160)
138 Klorfeniramin (CTM) tab 4 mg Tab 26 8,550 8,550 332 302 332 483 8,000 218 8,218 16.56 (6,068)
140 Klorpromazin tab sal 100 mg Tab sal 162 4,470 4,470 180 70 170 210 4,700 (410) 4,290 22.38 (3,860)
Tab 531 200 200 - - - 0 200 - 200 #DIV/0! #DIV/0!

mg
sulfametoksazol 100 mg+ trimetoprim 20 Tab 79 2,249 2,249 - - 2 1 2,100 149 2,249 2,100.00 (2,096)
mg
trimetoprim 40 mg
150 Levofloksasin tab 500 mg Tab 581 100 100 20 20 10 25 100 (20) 80 4.00 0
152 Lidokain inj 2% (hcl) Vial 929 179 179 10 12 15 19 200 (31) 169 10.81 (126)
153 Lisol Botol 54,995 1 2 3 - - 1 1 - 3 3 0.00 2
154 Loperamid tab 2 mg Tab 97 150 150 20 10 10 20 200 (70) 130 10.00 (120)
155 Loratadin tab 10 mg Tab 170 210 210 - 150 - 75 300 (90) 210 4.00 0
164 Metilergometrin tab salut 0,125 mg Tab sal 169 70 70 - - - 0 100 (30) 70 #DIV/0! #DIV/0!
Botol 2,900 - - - - - 0 - - #DIV/0! #DIV/0!
172 Metronidazol tab 500 mg Tab 169 380 380 60 50 90 100 500 (180) 320 5.00 (100)
173 Mikonazol krim 2% Tube 3,150 23 23 2 10 4 8 40 (19) 21 5.00 (8)
174 Natrium diklofenak tab 25 mg Tab 146 810 810 110 70 80 130 - 700 700 0.00 520
175 Natrium diklofenak tab 50 mg Tab 193 1,315 1,315 130 150 110 195 250 935 1,185 1.28 530
176 NaCl 0,9% Larutan infus Botol 5,170 37 37 2 4 2 4 46 (11) 35 11.50 (30)
177 Nifedipin kaps 10 mg Kaps 127 940 940 - - - 0 900 40 940 #DIV/0! #DIV/0!
180 Obat Batuk Hitam (OBH) Botol 2,310 35 35 8 - - 4 15 12 27 3.75 1
186 Oksitosin inj 10 UI/ml Ampul 1,900 199 199 6 7 - 7 30 163 193 4.62 (4)
187 Omeprazol kaps 20 mg Kaps 221 (60) (60) 50 100 60 105 30 (140) (110) 0.29 390
189 Parasetamol sir 120 mg/5 ml Botol 1,535 12 20 32 11 - 8 10 - 21 21 0.00 38
191 Parasetamol tab 500 mg Tab 88 1,512 1,512 315 473 440 614 2,100 (903) 1,197 3.42 356
196 Piracetam tablet 800 mg Tab 964 460 460 20 - - 10 400 40 440 40.00 (360)
200 Pirantel pamoat tab scored 125 mg Tab 318 349 349 8 20 14 21 330 11 341 15.71 (246)
201 Piridoksin (vitamin B6) tab 25 mg Tab 19 8,835 8,835 40 90 120 125 7,000 1,795 8,795 56.00 (6,500)
202 Piroksikam tablet 20 mg Tab 116 649 649 200 250 220 335 800 (351) 449 2.39 540
2,344 54 54 10 1 1 6 53 (9) 44 8.83 (29)
ml
15,386 28 28 - 1 - 1 30 (2) 28 60.00 (28)
ml
40,202 15 15 - - - 0 15 - 15 #DIV/0! #DIV/0!
1000 ml
207 Prednison tab 5 mg Tab 98 2,522 2,522 310 618 410 669 500 1,712 2,212 0.75 2,176
209 Procurma syrup Botol 12,021 (5) (5) - 3 3 3 - (5) (5) 0.00 12
210 Propiltiourasil tab 100 mg Tab 351 - - 100 200 - 150 200 (300) (100) 1.33 400
213 Ranitidin tab 150 mg Tab 128 340 340 130 80 100 155 200 10 210 1.29 420
218 Ringer Laktat Larutan infus Botol 5,720 60 20 80 2 - 5 4 43 35 78 12.29 (29)
219 Salbutamol tab 2 mg Tab 65 386 386 - - - 0 200 186 386 #DIV/0! #DIV/0!
220 Salbutamol tab 4 mg Tab 93 655 655 20 10 - 15 600 35 635 40.00 (540)
224 Sefadroksil kaps/tab 500 mg Tab 548 940 940 250 150 180 290 1,000 (310) 690 3.45 160
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 35 35 8 10 6 12 50 (23) 27 4.17 (2)
Vial 1,150 381 381 2 - 9 6 200 179 379 36.36 (178)
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 (150) (150) 100 50 100 125 (250) (250) 0.00 500
232 Simetidin tablet 200 mg Tab 138 463 463 - 10 - 5 400 63 463 80.00 (380)
234 Simvastatin tab sal 20 mg Tab sal 480 250 250 500 70 - - 35 430 430 0.00 140
236 Siprofloksasin tab scored 500 mg Tab 312 260 300 560 40 - 40 40 520 520 0.00 160
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 5,450 5,450 200 310 270 390 5,000 250 5,250 12.82 (3,440)
247 Tramadol tablet 500 mg Tab 363 567 567 20 20 - 20 400 147 547 20.00 (320)
248 Triheksifenidil tab 2 mg Tab 45 50 50 180 90 150 210 - (130) (130) 0.00 840
251 Vitamin B kompleks Tab 112 (690) (690) 490 483 510 742 300 (1,480) (1,180) 0.40 2,666
267 Prednison tab 5 mg Tab 125 - - 310 - - 155 (310) (310) 0.00 620
273 Lexavit tab 1,480 (10) (10) - 30 80 55 - (10) (10) 0.00 220
277 Aptyl Btl - - - - - 0 - - - #DIV/0! #DIV/0!
281 Phenytoin Sodium Kapsul 100 100 - 10 - 5 100 - 100 20.00 (80)
-
JUMLAH OBAT-OBATAN (A) 146 165 77 88
B. OBAT GIGI - - -
7 Etza Tube 170,000 - - - - - 0 - - #DIV/0! #DIV/0!
C. OBAT PROGRAM -
Paket 175,899 - - - - - 0 - - #DIV/0! #DIV/0!
31 Kina - - - - - 0 - - - #DIV/0! #DIV/0!
39 Mg So4 20 % 438 438 - - - 0 43 395 438 #DIV/0! #DIV/0!
40 Mg So4 40 % 62 62 - - - 0 27 35 62 #DIV/0! #DIV/0!
41 Zinc 20 mg 1,245 1,245 - - - 0 1,000 245 1,245 #DIV/0! #DIV/0!
1 Alat suntik sekali pakai 1 ml Set 1,093 712 712 5 8 - 7 700 7 707 107.69 (674)
5 Bisturi no. 20 Buah 2,099 286 286 12 15 - 14 200 74 274 14.81 (146)
6 Bisturi no. 15 Buah 2,099 470 470 - 10 - 5 450 20 470 90.00 (430)
11 Handscoen no. 7 Pasang 7,684 100 100 200 30 - - 15 - 170 170 0.00 60
12 Handscoen no. 7,5 Pasang 7,684 (30) (30) 30 - 15 - (30) (30) 0.00 60
13 Infuset dewasa Set 4,176 61 61 1 - - 1 50 10 60 100.00 (48)
14 Infusion set anak Set 4,568 33 33 1 - - 1 16 16 32 32.00 (14)
16 IV Catheter No.18 G Set 7,937 41 41 - - - 0 14 27 41 #DIV/0! #DIV/0!
18 IV Catheter No. 20 G Set 7,787 119 51 170 - 2 - 1 39 131 170 39.00 (35)
27 Kasa Pembalut 4m x 5 cm Rol 887 12 12 - 2 - 1 15 (3) 12 15.00 (11)
28 Kasa Pembalut 4m x 10 cm Rol 6,121 29 29 - - - 0 30 (1) 29 #DIV/0! #DIV/0!
34 Kasa Pembalut 36 x 80 cm Rol 133,821 2 2 1 - - 1 2 (1) 1 4.00 0
36 Plester 5 yard x 2 inc Rol 23,625 - - 3 2 - 3 2 (5) (3) 0.80 8
37 Silk Set 5,082 41 41 - 2 - 1 28 13 41 28.00 (24)
52 Tes Kehamilan Sachet 6,825 19 19 10 - 3 7 15 (6) 9 2.31 11


BULAN : APRIL 2017
PEMBERIAN
EXP KET
16 17 18 19 20 21
FITRIANI
NIP. -
KODE PUSKESMAS :
KABUPATEN : BOMBANA

Satuan (Rp) AWAL MAAN DIAAN APR MEI JUNI GUDAN STOK
PAN NTAAN
n RATA UNIT
G
1 2 3 4 4 5 6 7 8 9 10=(7+8+9)/3 11 12 13=11+12 14=11/10 15
A. OBAT
Ampul 2,200 106 106 1 1 - 1 102 3 105 102.00 (98)
6 Ambroksol tablet 30 mg Tab 138 208 208 30 70 50 100 38 138 2.00 100
7 Ambroksol sirup Botol 2,722 (8) (8) 4 - - 2 - (8) (8) 0.00 8
13 Amoksisilin sir kering 125 mg/5 ml Botol 2,560 31 15 46 8 12 - 10 - 34 34 0.00 40
14 Amoksisilin tab 250 mg Tab 220 361 361 60 100 - 80 100 161 261 1.25 220
15 Amoksisilin tab 500 mg Tab 279 1,697 1,697 500 510 - 505 2,200 (1,013) 1,187 4.36 (180)
78 290 290 70 100 - 85 300 (110) 190 3.53 40
kunyah
mg + magnesium hidroksida 200 mg Suspensi Botol 2,213 18 15 33 3 10 - 7 - 23 23 0.00 26

10 mg+ seng oksida 120 mg + sup ad 2 g Suppo 33,000 113 113 - 8 - 4 120 (15) 105 30.00 (104)

Ampul 1,346 188 188 - - - 0 60 128 188 #DIV/0! #DIV/0!
29 Asam askorbat (vitamin C) tab 50 mg Tab 105 1,018 1,018 40 72 - 56 1,200 (254) 946 21.43 (976)
30 Asam folat tab 1 mg Tab 52 625 625 10 110 - 60 400 115 515 6.67 (160)
32 Asam mefenamat kaps 500 mg Kaps 127 1,460 1,460 260 200 - 230 1,400 (140) 1,260 6.09 (480)
33 Asam traneksamat inj 50 mg/ml Ampul 3,650 6 6 - - - 0 10 (4) 6 #DIV/0! #DIV/0!
37 Asiklovir tab 200 mg Tab 251 1,439 1,439 10 40 - 25 1,400 (1) 1,399 56.00 (1,300)
41 Bedak salisil serb 2% Botol 1,180 (5) (5) 2 3 - 3 - (8) (8) 0.00 10
44 Betametason krim 0,1% Tube 1,596 (4) (4) 8 7 - 8 10 (21) (11) 1.33 20
80/4,5 mcg Botol 110,500 - - - - - 0 - - #DIV/0! #DIV/0!
50 Bromheksin tablet tablet 42 310 310 10 10 - 10 300 - 300 30.00 (260)
51 Deksametason tab 0,5 mg Tab 68 786 500 1,286 252 200 - 226 - 1,086 1,086 0.00 904
57 Diazepam tab 2 mg Tab 47 500 500 25 100 - 63 200 200 400 3.20 50
60 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 1,160 62 62 2 - - 1 30 32 62 30.00 (26)
65 Domperidon susp 5 mg/5 ml Botol 3,490 27 15 42 1 - - 1 - 42 42 0.00 2
66 Domperidon tab 10 mg Tab 174 467 467 20 40 - 30 300 127 427 10.00 (180)
67 Efedrin HCl tablet Tab 56 384 384 10 10 - 10 300 74 374 30.00 (260)
72 Eritromisin tab 500 mg Tab 1,013 440 440 30 - - 15 500 (60) 440 33.33 (440)
73 Etanol 70% cairan 70% Botol 2,625 (3) (3) 2 - - 1 2 (5) (3) 2.00 2
74 Etakridin (rivanol) larutan 0.1% Botol 4,695 (1) (1) 2 - - 1 2 (3) (1) 2.00 2
75 Etil klorida semprot 100 ml Botol 105,000 (3) (3) 1 1 - 1 - (4) (4) 0.00 4
Vial 3,754 28 28 - - - 0 - 28 28 #DIV/0! #DIV/0!
+ kalium klorida 0,30 g + trinatrium sitrat 0,58 g Sachet 317 865 865 5 - - 3 700 165 865 280.00 (690)
95 Gentamisin salep Kulit Tube 1,469 53 53 2 7 - 5 10 36 46 2.22 8
100 Gliseril Guaiakolat tab 100 mg Tab 31 2,485 2,485 134 293 - 214 2,100 92 2,192 9.84 (1,246)
106 Griseofulvin (micronized) tab 125 mg Tab 230 300 300 20 30 - 25 200 70 270 8.00 (100)
107 Haloperidol tab 0,5 mg Tab 62 580 580 90 90 - 90 600 (110) 490 6.67 (240)
108 Haloperidol tab 1,5 mg Tab 76 220 220 30 - - 15 200 20 220 13.33 (140)
109 Haloperidol tab 5 mg Tab 105 (10) (10) 60 30 - 45 100 (140) (40) 2.22 80
112 Hidrokortison krim 2,5% Tube 2,938 21 21 2 2 - 2 25 (6) 19 12.50 (17)
114 Ibuprofen susp 100 mg/5 ml Botol 3,849 31 15 46 3 5 - 4 - 41 41 0.00 16
115 Ibuprofen tab 200 mg Tab 121 810 810 340 80 - 210 500 230 730 2.38 340
116 Ibuprofen tab 400 mg Tab 157 810 500 1,310 320 500 - 410 100 710 810 0.24 1,540
123 Kalsium laktat (kalk) tab 500 mg Tab 76 (365) (365) 100 - - 50 - (365) (365) 0.00 200
124 Kaptopril tab 12,5 mg Tab 69 (220) (220) 140 20 - 80 100 (340) (240) 1.25 220
125 Kaptopril tab 25 mg Tab 97 70 70 130 120 - 125 300 (350) (50) 2.40 200
138 Klorfeniramin (CTM) tab 4 mg Tab 26 8,218 8,218 332 442 - 387 8,000 (224) 7,776 20.67 (6,452)
140 Klorpromazin tab sal 100 mg Tab sal 162 4,290 4,290 180 120 - 150 4,700 (530) 4,170 31.33 (4,100)
Tab 531 200 200 - - - 0 200 - 200 #DIV/0! #DIV/0!

mg
sulfametoksazol 100 mg+ trimetoprim 20 Tab 79 2,249 2,249 - 10 - 5 2,100 139 2,239 420.00 (2,080)
mg
trimetoprim 40 mg
150 Levofloksasin tab 500 mg Tab 581 80 80 20 - - 10 100 (20) 80 10.00 (60)
152 Lidokain inj 2% (hcl) Vial 929 169 169 10 10 - 10 200 (41) 159 20.00 (160)
153 Lisol Botol 54,995 3 2 5 - - - 0 - 5 5 #DIV/0! #DIV/0!
154 Loperamid tab 2 mg Tab 97 130 130 20 - - 10 200 (70) 130 20.00 (160)
155 Loratadin tab 10 mg Tab 170 210 210 - - - 0 300 (90) 210 #DIV/0! #DIV/0!
164 Metilergometrin tab salut 0,125 mg Tab sal 169 70 70 - - - 0 100 (30) 70 #DIV/0! #DIV/0!
165 Metilprednisolon tab 4 mg Tab 230 - - - 20 - 10 - (20) (20) 0.00 40
Botol 2,900 - - - - - 0 - - #DIV/0! #DIV/0!
172 Metronidazol tab 500 mg Tab 169 320 320 60 30 - 45 500 (210) 290 11.11 (320)
174 Natrium diklofenak tab 25 mg Tab 146 700 700 110 40 - 75 - 660 660 0.00 300
175 Natrium diklofenak tab 50 mg Tab 193 1,185 1,185 130 130 - 130 250 805 1,055 1.92 270
176 NaCl 0,9% Larutan infus Botol 5,170 35 35 2 3 - 3 46 (14) 32 18.40 (36)
177 Nifedipin kaps 10 mg Kaps 127 940 940 - - - 0 900 40 940 #DIV/0! #DIV/0!
180 Obat Batuk Hitam (OBH) Botol 2,310 27 27 8 10 - 9 15 2 17 1.67 21
186 Oksitosin inj 10 UI/ml (PitOgin Inj.) Ampul 1,900 193 193 6 3 - 5 30 160 190 6.67 (12)
187 Omeprazol kaps 20 mg Kaps 221 (110) (110) 50 - - 25 30 (140) (110) 1.20 70
189 Parasetamol sir 120 mg/5 ml Botol 1,535 21 20 41 11 13 - 12 - 28 28 0.00 48
191 Parasetamol tab 500 mg Tab 88 1,197 1,197 315 475 - 395 2,100 (1,378) 722 5.32 (520)
195 Phenylbutazon tablet 200 mg Tab 107 2,280 2,280 - - - 0 2,200 80 2,280 #DIV/0! #DIV/0!
196 Piracetam tablet 800 mg Tab 964 440 440 20 - - 10 400 40 440 40.00 (360)
202 Piroksikam tablet 20 mg Tab 116 449 449 200 120 - 160 800 (471) 329 5.00 (160)
2,344 44 44 10 - - 5 53 (9) 44 10.60 (33)
ml
15,386 28 28 - - - 0 30 (2) 28 #DIV/0! #DIV/0!
ml
40,202 15 15 - - - 0 15 - 15 #DIV/0! #DIV/0!
1000 ml
207 Prednison tab 5 mg Tab 98 2,212 2,212 310 160 - 235 500 1,552 2,052 2.13 440
209 Procurma syrup Botol 12,021 (5) (5) - - - 0 - (5) (5) #DIV/0! #DIV/0!
210 Propiltiourasil tab 100 mg Tab 351 (100) (100) 100 - - 50 200 (300) (100) 4.00 0
213 Ranitidin tab 150 mg Tab 128 210 210 130 150 - 140 200 (140) 60 1.43 360
218 Ringer Laktat Larutan infus Botol 5,720 78 20 98 2 7 - 5 43 48 91 9.56 (25)
219 Salbutamol tab 2 mg Tab 65 386 386 - - - 0 200 186 386 #DIV/0! #DIV/0!
220 Salbutamol tab 4 mg Tab 93 635 635 20 10 - 15 600 25 625 40.00 (540)
belerang endap 4 % Tube 2,200 40 40 1 - - 1 24 16 40 48.00 (22)
224 Sefadroksil kaps/tab 500 mg Tab 548 690 690 250 220 - 235 1,000 (530) 470 4.26 (60)
225 Sefadroksil sir kering 125 mg/5 ml Botol 5,286 27 27 8 12 - 10 50 (35) 15 5.00 (10)
Vial 1,150 379 379 2 1 - 2 200 178 378 133.33 (194)
231 Sianokobalamin (vitamin B12) tab 50 mcg Tab 15 (250) (250) 100 20 - 60 (270) (270) 0.00 240
232 Simetidin tablet 200 mg Tab 138 463 463 - - - 0 400 63 463 #DIV/0! #DIV/0!
234 Simvastatin tab sal 20 mg Tab sal 480 430 250 680 70 20 - 45 660 660 0.00 180
236 Siprofloksasin tab scored 500 mg Tab 312 520 300 820 40 40 40 60 780 780 0.00 240
244 Tiamin (vitamin B1) mononitrat tab 50 mg Tab 42 5,250 5,250 200 80 - 140 5,000 170 5,170 35.71 (4,440)
247 Tramadol tablet 500 mg Tab 363 547 547 20 - - 10 400 147 547 40.00 (360)
248 Triheksifenidil tab 2 mg Tab 45 (130) (130) 180 150 - 165 - (280) (280) 0.00 660
251 Vitamin B kompleks Tab 112 (1,180) (1,180) 490 720 - 605 300 (2,200) (1,900) 0.50 2,120
252 Zinc tab disp 20 mg Tab 521 270 270 10 10 - 10 300 (40) 260 30.00 (260)
267 Prednison tab 5 mg Tab 125 (310) (310) 310 - - 155 (310) (310) 0.00 620
273 Lexavit tab 1,480 (10) (10) - 60 - 30 - (70) (70) 0.00 120
277 Aptyl Btl - - - - - 0 - - - #DIV/0! #DIV/0!
281 Phenytoin Sodium Kapsul 100 100 - - - 0 100 - 100 #DIV/0! #DIV/0!
-
JUMLAH OBAT-OBATAN (A) 146 165 77 165
B. OBAT GIGI - - -
7 Etza Tube 170,000 - - - - - 0 - - #DIV/0! #DIV/0!
JUMLAH OBAT GIGI ( B ) 4 0 4
C. OBAT PROGRAM - -
Paket 175,899 - - - - - 0 - - #DIV/0! #DIV/0!
31 Kina - - - - - 0 - - - #DIV/0! #DIV/0!
39 Mg So4 20 % 438 438 - - - 0 43 395 438 #DIV/0! #DIV/0!
40 Mg So4 40 % 62 62 - - - 0 27 35 62 #DIV/0! #DIV/0!
41 Zinc 20 mg 1,245 1,245 - - - 0 1,000 245 1,245 #DIV/0! #DIV/0!
JUMLAH OBAT PROGRAM ( C ) 22 0 22
1 Alat suntik sekali pakai 1 ml Set 1,093 707 707 5 6 - 6 700 1 701 127.27 (678)
4 Alat suntik sekali pakai 5 ml Set 979 729 729 - - - 0 550 179 729 #DIV/0! #DIV/0!
5 Bisturi no. 20 Buah 2,099 274 274 12 14 - 13 200 60 260 15.38 (148)
6 Bisturi no. 15 Buah 2,099 470 470 - 2 - 1 450 18 468 450.00 (446)
11 Handscoen no. 7 Pasang 7,684 170 100 270 30 23 - 27 - 247 247 0.00 106
12 Handscoen no. 7,5 Pasang 7,684 (30) (30) - - 0 - (30) (30) #DIV/0! #DIV/0!
13 Infuset dewasa Set 4,176 60 60 1 4 - 3 50 6 56 20.00 (40)
14 Infusion set anak Set 4,568 32 32 1 2 - 2 16 14 30 10.67 (10)
16 IV Catheter No.18 G Set 7,937 41 41 - - - 0 14 27 41 #DIV/0! #DIV/0!
17 IV Catheter No.24 G Set 7,937 3 3 - 2 - 1 - 1 1 0.00 4
18 IV Catheter No. 20 G Set 7,787 170 51 221 - - - 0 39 182 221 #DIV/0! #DIV/0!
27 Kasa Pembalut 4m x 5 cm Rol 887 12 12 - - - 0 15 (3) 12 #DIV/0! #DIV/0!
28 Kasa Pembalut 4m x 10 cm Rol 6,121 29 29 - 1 - 1 30 (2) 28 60.00 (28)
29 Kasa Pembalut 4m x 15 cm Rol 887 - - 1 - 1 - (1) (1) 0.00 2
34 Kasa Pembalut 36 x 80 cm Rol 133,821 1 1 1 1 - 1 2 (2) - 2.00 2
36 Plester 5 yard x 2 inc Rol 23,625 (3) (3) 3 - - 2 2 (5) (3) 1.33 4
37 Silk Set 5,082 41 41 - 2 - 1 28 11 39 28.00 (24)
48 Masker Buah 1,125 - - - 21 - 11 - (21) (21) 0.00 42
52 Tes Kehamilan Sachet 6,825 9 9 10 - - 5 15 (6) 9 3.00 5

RUSTAM, AMK
Jadi : (4 - TK ) X Pemakaian rata-rata perbulan NIP. 1974 0410 199502 1 002
BULAN : MEI 2017
PEMBERIAN
EXP KET
16 17 18 19 20 21
FITRIANI
NIP. -

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PEMERINTAH KABUPATEN BOMBANA

DINAS KESEHATAN DAN KELUARGA BERENCANA

(a) (b) (c) (d) (e) (f) (g) (h) (i)

1 Air untuk injeksi amp 25 ml (aqua pro injeksi) Ampul 6,050

Anti Parkinson kombinasi : benzerasid 25 mg + levodopa 100 mg Kaps 1,650

146 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi :

147 Kuinin inj 25% (i.v.) Vial 6,820 - - - - - 0

JUMLAH OBAT-OBATAN (A) 146 165 77

JUMLAH TOTAL ( A + B + C +D ) 146 0

→Jika TK > 4 , Tidak perlu melakukan permintaan Obat RUSTAM, AMK

Jadi : (4 - TK ) X Pemakaian rata-rata perbulan

BULAN : JANUARI 2017

SISA STOK TINGKAT PERMI PEMBERIAN

5 107 #DIV/0! #DIV/0!

6 126 #DIV/0! #DIV/0!

108 1,008 #DIV/0! #DIV/0!

180 880 140.00 (680)

(30) 1,270 28.89 (1,120)

151 2,251 #DIV/0! #DIV/0!

(2) 3 5.00 (1)

Mulaeno, 31 JANUARI 2017

Satuan / Harga STOCK

PEMAKAIAN SISA STOK

TINGKAT PERMI PEMBERIAN

Mulaeno, 30 JANUARI 2016

68 Alat suntik sekali pakai 5 ml Set

Jadi : (4 - TK ) X Pemakaian rata-rata perbulan

SKPD : PUSKESMAS POLEANG TENGAH

Saldo Awal 2015 Mutasi Masuk Mutasi Pengeluaran

Mutasi Pengeluaran Saldo Akhir

- 600 363 217,800

143 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg

147 Kuinin inj 25% (i.v.) Vial 6,820 0

MASUK KELUAR AKHIR MASUK KELUAR AKHIR MASUK KELUAR AKHIR

1,400 300 200 100

(800) 800 - 800

300 100 100 -

- 15,600 5,880 9,720

- 680 210 470

100 600 1,000 100 1,500

- 400 300 - 700

SALDO AKHIR OBAT PERBULAN

AKHIR MASUK KELUAR AKHIR MASUK KELUAR AKHIR

JUMLAH PENERIMAAN OBAT PERBULAN

143 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg

147 Kuinin inj 25% (i.v.) Vial 6,820

Jadi : (4 - TK ) X Pemakaian rata-rata perbulan

Kepala UPTD Instalasi Farmasi

Satuan / Harga STOCK PEMAKAIAN OBAT TAHUN 2016

143 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5

JUMLAH TOTAL ( A + B + C +D ) 0 272

→Jika TK > 4 , Tidak perlu melakukan permintaan Obat JAFARUDDIN, AMK

Jadi : (4 - TK ) X Pemakaian rata-rata perbulan

147 Kuinin inj 25% (i.v.) Vial 6,820

Jadi : (4 - TK ) X Pemakaian rata-rata perbulan

KEADAAN OBAT BULAN : DESEMBER 2016

STOCK PENERIMAAN PENGELUARAN STOK AKHIR EXPIRE DATE

Antasida, kombinasi : aluminium hidroksida 200

Antasida, kombinasi : aluminium hidroksida 200

Antibakteri, kombinasi : basitrasin 500 UI/g+

Anti Parkinson kombinasi : benzerasid 25 mg +

90 Gameksan lotion 1 % Botol

Kotrimoksazol (dewasa) kombinasi :