LPLPO Pustu

LAPORAN PEMAKAIAN DAN LEMBAR PERM
(LPLPO)
KODE PUSKESMAS : 3506070

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI
PROPINSI : JAWA TIMUR
KELAS STOK PENERI- PERSE- PEMAKAI

NO NAMA OBAT SATUAN
TERAPI AWAL MAAN DIAAN AN
1 2 3 4 5 6 7 8
0101 Albendasol Tablet 400 mg 6.1.1 Tablet - -
0102 Alopurinol Tablet 100 mg 1.3 Tablet 608 608 126
0103 Ambroxol sirup 15 mg/ml 26.1 Botol - -
0104 Ambroxol Tablet 30 mg 26.1 Tablet 1,002 1,002 385
0105 Aminofilin Tablet 200 mg 26.1 Tablet 7,402 7,402 141
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul 68 68 38
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet 711 711
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol 245 245 53
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 13,199 13,199 719
0110 Amoksisilin Kapsul 500 mg 6.2.1 Kaplet 15,246 15,246 3,118
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial 51 51 -
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet 7,273 7,273 2,208
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul 172 172 -
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet 30,022 30,022 4,907
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol - -
0116 Anti Bakteri DOEN, Salep Kombinasi 18.2 Tube 70 70
0117 Antifungi DOEN Kombinasi:Asam Benzoat 6%18.3 Pot 130 130
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria - -
0119 Antimigrain Doen Kombinasi 7.2 Tablet - -
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol 70 70 20
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet 26,023 26,023 364
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet 6,283 6,283 1,814
0123 Asam Traneksamat 500 mg 10.3 Tablet - -
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul - -
0125 Asetosal Tablet 100 mg 1.2 Tablet 1,310 1,310 110
0126 Asetosal Tablet 500 mg 1.2 Tablet 105 105
0127 Asiklovir Tablet 400 mg 6.6.1 Tablet 1,480 1,480 80
0129 Asiklovir Krim 5 % 6.6.1 Tube 50 50 25
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml 25.4 Ampul 81 81 51
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet - -
0132 Attapulgite Pektin 25.1 Tablet - -
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial - -
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet 360 360 -
0203 Betametason Krim 0,1 % 18.4 Tube 165 165 8
Page 1 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0204 Bisacodyl 5 mg 25.6 Tablet - -
0205 Bromheksin Tablet 8 mg 26.3 Tablet 1,255 1,255
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul 2,888 2,888 -
0302 Deksametason Tablet 0,5 mg 16.4 Tablet 9,064 9,064 2,411
0303 Dekstrometorfan HBR Sirup 10 mg/5 ml 26.2 Botol 187 187 7
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet 2,363 2,363 350
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul 52 52
0306 Diazepam Tablet 2 mg 2.3 Tablet 3,207 3,207 30
0307 Diazepam Tablet 5 mg 2.3 Tablet 740 740 19
0308 Dietilkarbamazin Sitrat Tablet 100 mg 6.1.2 Tablet - -
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul 426 426 246
0310 Digoksin Tablet 0,25 mg 17.5 Tablet 2,392 2,392 6
0311 Diltiazem HCl Tablet 30 mg 17.1 Tablet 582 582
0312 Dimenhidrinat Tablet 25.2 Tablet 1,379 1,379 8
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 3,310 3,310
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol 3 3
0315 Domperidon Tablet 10 mg 25.2 Tablet 804 804
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet - -
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 16,197 16,197 15,600
0402 Ekstrak Belladon Tablet 10 mg 25.4 Tablet - -
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul 164 164
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul 1,600 1,600
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet 442 442
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol 9 9
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol 11 11 2
0408 Etambutol HCL Tablet 250 mg 6.2.4 Tablet - -
0501 Famotidin Tablet 20 mg 25.1 Tablet 154 154
0502 Fenitoin Natrium Injeksi 50 mg/ml 5 Ampul - -
0503 Fenitoin Natrium Kapsul 100 mg 5 Kapsul - -
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul 32 32 32
0506 Fenobarbital Tablet 100 mg 5 Tablet - -
0507 Fenobarbital Tablet 30 mg 5 Tablet 943 943
0508 Fenoksimetil Penisilina Tablet 250 mg 6.2.1 Tablet - -
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol - -
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul 117 117 -
0512 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 10.2 Tablet 403 403 142
0513 Fluconazole Kapsul 150 mg 0 Kapsul - -
0514 Fluor Tablet 0,5 mg 14.1 Tablet - -
0515 Furosemid Tablet 40 mg 14 Tablet 1,513 1,513
0516 Furosemid Injeksi i.v / i.m 10 mg/ml 14 Ampul - -
0601 Gameksan Emulsi 1 % 18.5 Botol - -
0602 Garam Oralit 200 ml Air 20.1 Sachet 1,918 1,918 126
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul 47 47
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube 20 20 5
Page 2 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0605 Gentian Violet Larutan 1 % 14.2 Botol 210 210 8
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 903 903 264
0607 Gliseril Guayakolat Tablet 100 mg 26.3 Tablet 17,031 17,031 2,537
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol 229 229 16
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol 134 134
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 118 118
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet - -
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet 904 904 120
0702 Haloperidol Tablet 1,5 mg 23.4 Tablet - -
0703 Haloperidol Tablet 2 mg 23.4 Tablet 400 400 20
0704 Haloperidol Tablet 5 mg 23.4 Tablet - -
0705 Haloperidol Dekanoat Injeksi 23.4 Ampul - -
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet 7,006 7,006 138
0707 Hidrokortison Krim 2,5 % 18.4 Tube 162 162 37
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet - -
0801 Ibuprofen Tablet 200 mg 1.2 Tablet 4,878 4,878 208
0802 Ibuprofen Tablet 400 mg 1.2 Tablet 6,956 6,956 1,076
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet 301 301
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet 1,328 1,328
0902 Kalium Permanganat Serbuk 13.1 Pot - -
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet 5,196 5,196 2,872
0904 Kaolin Pektin Sirup 25.1 Botol - -
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet 3,002 3,002 294
0905 Kaptopril Tablet 25 mg 17.3 Tablet 3,505 3,505 682
0906 Kaptopril Tablet 50 mg 17.3 Tablet - -
0907 Karbamazepin Tablet 200 mg 5 Tablet 200 200
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet 408 408 58
0909 Ketokonazol Krim 2% 6.4.1 Tube 17 17
0910 Ketorolac Injeksi 10 mg 1.2 Ampul 6 6
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 480 480
0912 Klofazimin Kapsul 100 mg, Micronized 6.2.3 Kapsul - -
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 10,393 10,393
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol 38 38
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol - -
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube 174 174
0917 Kloramfenikol Tetes Telinga 3 % 28.1 Botol 189 189 9
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 3 Tablet 44,071 44,071 2,712
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet 9,000 9,000
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul 44 44 44
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml 23.4 Ampul - -
0922 Klorpromazin HCL Tablet Salut 100 mg 23.4 Tablet 5,343 5,343 210
0923 Klorpromazin HCL Tablet Salut 25 mg 23.4 Tablet 5,686 5,686
0924 Klorpropamid Tablet 100 mg 16.1.1 Tablet - -
0925 Kodein HCl Tablet 10 mg 26.2 Tablet 812 812 10
0926 Kodein HCl Tablet 15 mg 26.3 Tablet -
0927 Kotrimoksasol Pediatrik Tablet 6.2.2 Tablet 1,393 1,393 73
Page 3 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0928 Kotrimoksasol Suspensi 6.2.2 Botol 250 250 8
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet 6,020 6,020 397
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml 6.4.2.2 Ampul - -
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) 6.4.2.2 Tablet - -
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet 240 240 20
1002 Lidokain Kompositum Injeksi 14.1 Ampul 36 36
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul 165 165
1004 Loratadin Tablet 10 mg 25.1 Tablet 380 380
1005 Loperamid Tablet 25.5 Tablet 549 549 263
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml 5 Ampul 1 1 1
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml 5 Ampul 22 22
1103 Mebendasol Sirup 100 mg/5 ml 6.1.1 Botol - -
1104 Mebendasol Tablet 100 mg 6.1.1 Tablet - -
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet - -
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 535 535 20
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 74 74
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet - -
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet 3,863 3,863 724
1110 Metoklopramide Tablet 10 mg 25.2 Tablet 402 402 92
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul - -
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 37 37
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet 1,700 1,700 310
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol 14 14 -
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube 26 26 4
1117 Multivitamin Sirup 29 Botol - -
1118 Multivitamin tablet 29 Tablet - -
1201 Natrium Bikarbonat Tablet 500 mg 4.1 Tablet - -
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 2,606 2,606 1,142
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol 36 36 12
1204 Nifedipin Tablet 10 mg 17.3 Tablet 5,504 5,504 -
1205 Nistatin 100.000 IU/G Tablet Vaginal 6.3 Tablet 76 76 76
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet 310 310
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket 6 6
1302 Obat Antituberkulosis Kategori 2 6.2.4 Paket - -
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket - -
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol 201 201 50
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet - -
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 106.2.2 Ampul 86 86 56
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube 100 100 8
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube 154 154 4
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 56 56
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul 94 94 6
1401 Papaverin Tablet 40 mg 25.4 Tablet 2,340 2,340 31
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul 245 245 45
1403 Paraformaldehid Tablet 1 Gram 13.2 Tablet - -
Page 4 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1404 Parasetamol Drops 1.2 Botol 111 111 1
1405 Parasetamol Sirup 120 mg/5 ml 1.2 Botol 202 202 58
1406 Parasetamol Tablet 100 mg 1.2 Tablet 2,275 2,275
1407 Parasetamol Tablet 500 mg 1.2 Tablet 17,064 17,064 5,636
1408 Perfenazin Tablet 16 mg 23.4 Tablet - -
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul 43 43
1411 Piracetam Tablet 400 mg 29 Tablet 888 888 6
1412 Piracetam Tablet 800 mg 29 Tablet 180 180
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet 112 112 12
1414 Piridoksin HCL Tablet 10 mg 29 Tablet 34,017 34,017 3,408
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul 1,868 1,868 206
1416 Piroksikam Tablet 20 mg 25.7 Tablet 1,301 1,301
1417 Polikresulen 14.2 Botol 3 3
1418 Prednison Tablet 5 mg 16.4 Tablet 19,007 19,007 1,530
1419 Primakuin Tablet 15 mg 6.4.2.2 Tablet - -
1420 Propiltiourasil Tablet 100 mg 16.3 Tablet 100 100
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 3,404 3,404
1501 Ranitidin Tablet 150 mg 25.1 Tablet 5,919 5,919 710
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul - -
1503 Reserpin Tablet 0,10 mg 17.3 Tablet - -
1504 Reserpin Tablet 0,25 mg 17.3 Tablet 994 994 994
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul 25 500 525
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul 800 4,900 5,700
1507 Rifampisin Kapsul 300 mg 6.2.4 Kapsul - -
1508 Ringer Asetat Cairan Infus 20.2 Botol - -
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol 197 197 154
1601 Salbutamol Tablet 4 mg 26.1 Tablet 1,290 1,290 6
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + 18.4 Pot 179 179 5
1603 Salisil Bedak 2 % 18.8 Kotak 87 87 8
1604 Salisil Spiritus 10 % 18.3 Botol - -
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol 72 72 1
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul 150 150 -
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet - -
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul 450 450
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket - -
1610 Sefotaksim Injeksi 1 g 6.2.1 Vial 78 78 8
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial 6 6 1
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( ABU 27.1 Vial - -
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A.D.S )27.1 Vial - -
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul 3 3 2
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial 2 2
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul 264 264
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg 10.1 Tablet 12,542 12,542 472
1618 Simetidin Tablet 200 mg 25.1 Tablet 604 604
1619 Simvastatin Tablet 10 mg 17.8 Tablet - -
Page 5 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet 15,047 15,047 240
1621 Sulfadimidin Tablet 500 mg 6.2.2 Tablet - -
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol 280 280 16
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet 24,993 28,260 53,253
1702 Terbutalin tablet 2,5 mg 26.1 Tablet - -
1703 Tetrasiklin HCL Kapsul 250 mg 6.2.2 Kapsul 550 550
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul 309 309 150
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol - -
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul 158 158 120
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet 5,093 5,093 4,435
1709 Tramadol Injeksi 50 mg/ml 1.1 Ampul 48 48
1710 Tramadol Kapsul 50 mg 1.1 Kapsul 996 996
1711 Triamcinolone Acetonide 1 mg 16.4 Tube - -
1712 Triheksifenidil Tablet 2 mg 9 Tablet 612 612 360
1801 Vitamin B Komplek Tablet 29 Tablet 6,190 6,190 1,273
1901 Yodium Povidon Larutan 10 % 30 ml 13.1 Botol 13 13
1903 Yodium Povidon Larutan 10 % 300 ml 13.1 Botol 11 11 1
1904 Yodium Povidon Larutan 10 % 1000 ml 13.1 Botol - -
2001 Zinc Tablet 20 mg 25.5 Tablet 634 634 230
0 OBAT GIGI 0 0 - -
2101 Air Raksa Dental Use 14.1 Botol 2 2
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol 2 2
2103 Etil Klorida Spray 14.1 Vial 5 5
2104 Eugenol Cairan 14.1 Botol 1 1
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set 1 1
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube 1 1
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol 1 1
2108 Mummifying Pasta 14.1 Botol 3 3
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol 2 2
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol 1 1
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol 1 1
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set 1 1
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol 1 1
2114 Tumpatan Tetap dengan Sinar Set 14.1 Set - -
0 REAGEN LABORATORIUM 0 0 - -
2201 EDTA 10% cair 31 Botol - -
2202 Ether Alkohol: Ether 80% - Alkohol 20% 31 Botol - -
2203 Golongan darah Test ( set 3 vial @10 ml ) 31 Set - -
2204 HCL 0,1 N 31 Botol - -
2205 KOH 10% 31 Botol - -
2206 Larutan Benedict 31 Botol 1 1
2207 Larutan Buffer Giemsa 31 Botol - -
2208 Larutan Eosin 2% 31 Botol - -
2209 Larutan Etanol Asam 31 Botol 1 1
Page 6 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2210 Larutan Giemsa Stain 31 Botol - -
2211 Larutan Hayem 31 Botol - -
2212 Larutan Karbol Fuksin 31 Botol - -
2213 Larutan Metilen Biru 31 Botol - -
2214 Larutan Rees Ecker 31 Botol - -
2215 Larutan Turk 31 Botol - -
2216 Lens Tissu 31 Set - -
2217 Metanol 31 Botol - -
2218 Reagen SD-HIV 31 Set -
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol 2 2
2220 Rapid Plasma Reagen Test Kit 31 Set - -
2221 Sifilis Kit 31 Set 21 21
2222 Tuberkulin 31 Set -
2223 Widal slide test ( set a vial @ 5 ml ) Salmon 31 Set - -
PERBEKALAN KESEHATAN - -
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set - - -
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set 1,200 1,200
2303 Alat Suntik Sekali Pakai 1 ml 32 Set - -
2304 Alat Suntik Sekali Pakai 2,5 ml 32 Set 449 449 240
2305 Alat Suntik Sekali Pakai 3 ml 32 Set 269 269
2307 Alat Suntik Sekali Pakai 10 ml 32 Set 90 90 90
2308 Alkohol 95% 32 Botol 2 2
2309 Blood Lancet 32 Pcs - -
2310 Blood Transfusion set 32 Set - -
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak 28 28 28
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol - -
2313 Etanol (Alkohol 70%) 32 Botol 36 36 2
2314 Infusion Set Anak 32 Set 102 102 2
2315 Infusion Set Dewasa 32 Set 158 158 12
2316 Infusion Set Anak Elasty Ball 32 Set 36 36
2317 Infusion Set Dewasa Elasty Ball 32 Set 161 161
2318 Jarum Infus (i.v. Catheter) Dewasa No 20 32 Biji 156 156
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 Biji 83 83 12
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji 116 116 2
2321 Kapas Berlemak 500 Gram 32 Bungkus 1 1 1
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus 32 32 15
2323 Kasa Kompres 40/40 Steril 32 Bungkus 20 20 20
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus - -
2325 Kasa Pembalut 2 m x 80 cm 32 Rol 6 6 1
2326 Kasa Pembalut Elastic 3 inchi 32 Rol - -
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol 50 50 50
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol - -
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol - -
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol 1 1 1
2331 Kateter (Folley / Urine) No. 10 32 Biji 3 3
Page 7 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2334 Klem tali pusat 32 Pcs - -
2335 Lisol 32 Botol 7 7 2
2336 Masker 32 Set 80 80
2337 Mess / Pisau scalpel no 11 32 Pcs - -
2338 Plester 5 yards x 2 inch 32 Rol 5 5
2339 Sarung Tangan Karet Sekali Pakai S 32 Set 560 560 100
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 234 234 -
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 200 200
2342 Silk / Benang Sutra no. 3/0 dengan Jarum Be 32 Sak 130 130 50
2343 Urine Bag 32 Set 56 56
2344 Wing Needle No. 25 G 32 Buah - -
-
-
-
-
-
-
-
-
-
JUMLAH KUNJUNGAN RESEP
Mengetahui / Menyetujui Yang Menyerahkan

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi dan Alkes
Kabupaten Kediri
dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 8 of 278
AR PERMINTAAN OBAT PUSTU
O)
BULAN : JANUARI
719 TAHUN : 2013
STOK PERMIN- PEMBERIAN

SISA STOK KET
OPTIMUM TAAN DAU JPKMM ASKES PROGRAM JUMLAH
9 10 11 12 13 14 15 16 17
-
482 996
- 89 100
617 952 500
7,261 418
30 7
711 320
192 241 100
12,480 1,880
12,128 12,369 5,000
51
5,065 2,576
172 43
25,115 8,822
- 67 100
70 10
130 5
- 38 50
- 347 500
50 110 50
25,659 5,580
4,469 8,617 5,000
- 1,000
-
1,200 497
105 132
1,400 107
3,585 348
25 82 100
30 32
- - 1,000
- 5,000
-
360 85
157 121
Page 9 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
- -
1,255 48
2,888 400
6,653 21,920 15,000
180 75
2,013 4,800 3,000
52 3
3,177 76
721 3
- -
180 78
2,386 366
582 73
1,371 85
3,310 9,023 10,000
3 2
804 281
-
597 3,292 5,000
- -
164 35
1,600 133
442 786
9 5
9 15 10
- -
154 282
- -
- -
- -
- - 50
- -
943 1,499
- -
- -
- 304 100
117 466 100
261 299 300
- -
- -
1,513 159
- 1
- - 100
1,792 864
47 26
15 20 50
Page 10 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
202 59
639 1,396 1,000
14,494 11,404 5,000
213 92
134 29
118 64
- 169 200
784 1,594 500
- -
380 267
- - 500
- - 10
6,868 1,386
125 207 100
- -
4,670 1,707
5,880 4,431
301 223
1,328 224
- -
2,324 8,754 10,000
- - 100
2,708 1,081
2,823 3,248 1,000
- 100
200 33
350 127
17 10
6 -
480 73
- -
10,393 1,770
38 4
- 79 100
174 54
180 114
41,359 21,258
9,000 -
- 5 50
- -
5,133 1,728
5,686 438
- -
802 59
- -
1,320 1,436
Page 11 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
242 77
5,623 2,470
- -
- -
220 37
36 248
165 212
380 7
286 1,378 1,500
- -
22 6
- -
- -
- 50 100
515 650 300
74 117 30
- 133 500
3,139 164
310 33
- 22 50
37 8
1,390 989
2,037 1,090
14 9
22 82 100
- -
- -
- -
1,464 631
24 180 150
5,504 198
- 475 100
310 63
6 10
- -
- -
151 251 -
- -
30 21
92 67 50
150 42
56 59
88 29
2,309 875
200 18
- -
Page 12 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
110 38
144 209 100
2,275 575
11,428 25,018 15,000
- -
- -
43 2
882 163
180 40
100 253 100
30,609 6,653
1,662 97
1,301 66
3 2
17,477 16,981
- -
100 117
3,404 1,065
5,209 2,195
- 117 150
- 1,167
- 37,763 10,000
525 302
5,700 2,537
- -
- -
43 255 200
1,284 210
174 79
79 34
- -
71 93 50
150 283 150
- 667 1,000
450 313
- -
70 114 100
5 1
- -
- -
1 6 5
2 0
264 112
12,070 819
604 65
- 622 1,000
Page 13 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
14,807 2,147
- -
264 110
53,253 44,663
- -
550 150
596 135
159 354 500
- -
38 237
658 17,832 20,000
48 5
996 101
- -
252 949 1,000
4,917 12,445 10,000
13 9
4 2
10 3
- -
404 2,561 2,000
- -
2 1
2 1
5 12
1 28
1 2
1 1
1 2
3 1
2 3
1 1
1 1
1 1
1 5
- -
- -
- -
- -
- 1
- 2
- 0
1 0
- -
- 0
1 0
Page 14 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
- 1
- -
- 0
- -
- 17
- 2
- 2
- 43
- -
2 -
- -
21 -
-
- -
-
- -
1,200 933
- 173 100
209 237
269 396 200
169 204 200
- 37 100
2
-
-
- 23 100
- 50
34 18
100 78
146 115
36 5
161 13
156 118
71 84 50
114 88
- -
17 12
- 96 100
- -
5 12 50
- -
- 17 50
- 1
- 257 200
- -
3 -
Page 15 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
88 7
50 -
- - 100
5 2
80 173 50
- -
5 18 12
460 527 200
234 945 300
200 200
80 28 50
56 5
-
-
-
-
-
-
-
-
-
-
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-
Yang Menerima / Melapor Yang Menerima

Plh Kepala UPTD Puskesmas Wates Petugas Puskesmas
dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.

NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 16 of 278
LAPORAN PEMAKAIAN DAN LEMBAR P
(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0101 Albendasol Tablet 400 mg 6.1.1 Tablet - - -
0103 Ambroxol sirup 15 mg/ml 26.1 Botol - 100 100 2
0104 Ambroxol Tablet 30 mg 26.1 Tablet 617 500 1,117 110
0105 Aminofilin Tablet 200 mg 26.1 Tablet 7,261 4,800 12,061 82
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul 30 30 -
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet 711 711 -
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol 192 144 336 49
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 12,480 6,840 19,320 369
0110 Amoksisilin Kapsul 500 mg 6.2.1 Kaplet 12,128 5,000 17,128 2,824
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet 5,065 5,065 602
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul 172 172 10
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet 25,115 14,000 39,115 1,443
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol - 100 100 86
0116 Anti Bakteri DOEN, Salep Kombinasi 18.2 Tube 70 70 -
0117 Antifungi DOEN Kombinasi:Asam Benzoat 6%18.3 Pot 130 130 -
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria - 50 50 -
0119 Antimigrain Doen Kombinasi 7.2 Tablet - - -
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol 50 50 100 12
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet 25,659 14,000 39,659 705
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet 4,469 5,000 9,469 1,404
0123 Asam Traneksamat 500 mg 10.3 Tablet - 200 200 -
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul - 30 30 -
0126 Asetosal Tablet 500 mg 1.2 Tablet 105 105 -
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet 3,585 3,585 -
0129 Asiklovir Krim 5 % 6.6.1 Tube 25 100 125 1
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml 25.4 Ampul 30 30 -
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet - 1,000 1,000 -
0132 Attapulgite Pektin 25.1 Tablet - 600 600 -
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial - 100 100 -
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet 360 360 6
Page 19 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0204 Bisacodyl 5 mg 25.6 Tablet - 252 252 -
0205 Bromheksin Tablet 8 mg 26.3 Tablet 1,255 1,255 284
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul 2,888 600 3,488 22
0302 Deksametason Tablet 0,5 mg 16.4 Tablet 6,653 15,000 21,653 1,438
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet 2,013 3,000 5,013 334
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul 52 52 -
0306 Diazepam Tablet 2 mg 2.3 Tablet 3,177 3,177 -
0308 Dietilkarbamazin Sitrat Tablet 100 mg 6.1.2 Tablet - - -
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul 180 180 -
0311 Diltiazem HCl Tablet 30 mg 17.1 Tablet 582 582 -
0312 Dimenhidrinat Tablet 25.2 Tablet 1,371 1,371 -
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 3,310 5,000 8,310 -
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol 3 3 -
0315 Domperidon Tablet 10 mg 25.2 Tablet 804 804 -
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet - 150 150 -
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 597 5,000 5,597 363
0402 Ekstrak Belladon Tablet 10 mg 25.4 Tablet - - -
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul 164 164 -
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul 1,600 1,600 -
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet 442 442 6
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol 9 9 -
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol 9 10 19 2
0408 Etambutol HCL Tablet 250 mg 6.2.4 Tablet - - -
0501 Famotidin Tablet 20 mg 25.1 Tablet 154 154 -
0502 Fenitoin Natrium Injeksi 50 mg/ml 5 Ampul - - -
0503 Fenitoin Natrium Kapsul 100 mg 5 Kapsul - - -
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul - 60 60 -
0506 Fenobarbital Tablet 100 mg 5 Tablet - - -
0507 Fenobarbital Tablet 30 mg 5 Tablet 943 943 -
0508 Fenoksimetil Penisilina Tablet 250 mg 6.2.1 Tablet - - -
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol - 96 96 -
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul 117 120 237 -
0512 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 10.2 Tablet 261 300 561 34
0513 Fluconazole Kapsul 150 mg 0 Kapsul - - -
0514 Fluor Tablet 0,5 mg 14.1 Tablet - - -
0515 Furosemid Tablet 40 mg 14 Tablet 1,513 1,513 -
0516 Furosemid Injeksi i.v / i.m 10 mg/ml 14 Ampul - - -
0601 Gameksan Emulsi 1 % 18.5 Botol - 24 24 -
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul 47 47 -
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube 15 20 35 3
Page 20 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 639 1,000 1,639 178
0607 Gliseril Guayakolat Tablet 100 mg 26.3 Tablet 14,494 5,000 19,494 2,479
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol 134 134 -
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 118 118 -
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet - 200 200 -
0702 Haloperidol Tablet 1,5 mg 23.4 Tablet - - -
0703 Haloperidol Tablet 2 mg 23.4 Tablet 380 380 -
0704 Haloperidol Tablet 5 mg 23.4 Tablet - 500 500 -
0705 Haloperidol Dekanoat Injeksi 23.4 Ampul - - -
0707 Hidrokortison Krim 2,5 % 18.4 Tube 125 96 221 38
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet - 300 300 -
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet 301 301 16
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet 1,328 1,328 84
0902 Kalium Permanganat Serbuk 13.1 Pot - - -
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet 2,324 10,000 12,324 1,637
0904 Kaolin Pektin Sirup 25.1 Botol - 60 60 -
0905 Kaptopril Tablet 25 mg 17.3 Tablet 2,823 1,000 3,823 587
0906 Kaptopril Tablet 50 mg 17.3 Tablet - - -
0907 Karbamazepin Tablet 200 mg 5 Tablet 200 200 -
0909 Ketokonazol Krim 2% 6.4.1 Tube 17 17 -
0910 Ketorolac Injeksi 10 mg 1.2 Ampul 6 6 -
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 480 480 -
0912 Klofazimin Kapsul 100 mg, Micronized 6.2.3 Kapsul - - -
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 10,393 10,250 20,643 20
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol 38 38 -
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol - 100 100 1
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube 174 174 7
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 3 Tablet 41,359 25,000 66,359 2,643
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet 9,000 9,000 -
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul - 30 30 -
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml 23.4 Ampul - - -
0923 Klorpromazin HCL Tablet Salut 25 mg 23.4 Tablet 5,686 5,686 -
0924 Klorpropamid Tablet 100 mg 16.1.1 Tablet - - -
0925 Kodein HCl Tablet 10 mg 26.2 Tablet 802 802 -
0926 Kodein HCl Tablet 15 mg 26.3 Tablet - - -
Page 21 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0928 Kotrimoksasol Suspensi 6.2.2 Botol 242 150 392 8
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml 6.4.2.2 Ampul - - -
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) 6.4.2.2 Tablet - - -
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet 220 220 -
1002 Lidokain Kompositum Injeksi 14.1 Ampul 36 36 -
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul 165 165 -
1004 Loratadin Tablet 10 mg 25.1 Tablet 380 380 -
1005 Loperamid Tablet 25.5 Tablet 286 1,500 1,786 172
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml 5 Ampul - - -
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml 5 Ampul 22 22 -
1103 Mebendasol Sirup 100 mg/5 ml 6.1.1 Botol - - -
1104 Mebendasol Tablet 100 mg 6.1.1 Tablet - - -
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet - 90 90 6
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 515 500 1,015 -
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 74 74 -
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet - 500 500 23
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet 3,139 1,800 4,939 10
1110 Metoklopramide Tablet 10 mg 25.2 Tablet 310 310 -
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul - 60 60 -
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 37 37 -
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol 14 20 34 -
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube 22 96 118 3
1117 Multivitamin Sirup 29 Botol - 60 60 -
1118 Multivitamin tablet 29 Tablet - 600 600 -
1201 Natrium Bikarbonat Tablet 500 mg 4.1 Tablet - - -
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 1,464 1,464 242
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol 24 200 224 24
1204 Nifedipin Tablet 10 mg 17.3 Tablet 5,504 3,700 9,204 -
1205 Nistatin 100.000 IU/G Tablet Vaginal 6.3 Tablet - - -
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet 310 310 46
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket 6 6 -
1302 Obat Antituberkulosis Kategori 2 6.2.4 Paket - - -
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket - - -
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet - 900 900 -
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 106.2.2 Ampul 30 30 -
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube 92 50 142 5
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 56 56 -
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul 88 88 -
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul 200 200 -
1403 Paraformaldehid Tablet 1 Gram 13.2 Tablet - - -
Page 22 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1405 Parasetamol Sirup 120 mg/5 ml 1.2 Botol 144 100 244 47
1406 Parasetamol Tablet 100 mg 1.2 Tablet 2,275 2,275 71
1407 Parasetamol Tablet 500 mg 1.2 Tablet 11,428 18,000 29,428 5,349
1408 Perfenazin Tablet 16 mg 23.4 Tablet - - -
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul 43 43 -
1411 Piracetam Tablet 400 mg 29 Tablet 882 882 6
1412 Piracetam Tablet 800 mg 29 Tablet 180 180 -
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet 100 100 200 -
1414 Piridoksin HCL Tablet 10 mg 29 Tablet 30,609 3,000 33,609 732
1416 Piroksikam Tablet 20 mg 25.7 Tablet 1,301 1,301 -
1417 Polikresulen 14.2 Botol 3 3 -
1419 Primakuin Tablet 15 mg 6.4.2.2 Tablet - - -
1420 Propiltiourasil Tablet 100 mg 16.3 Tablet 100 100 -
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 3,404 3,404 -
1501 Ranitidin Tablet 150 mg 25.1 Tablet 5,209 3,100 8,309 286
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul - 200 200 -
1503 Reserpin Tablet 0,10 mg 17.3 Tablet - - -
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul 525 525 -
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul 5,700 5,700 -
1507 Rifampisin Kapsul 300 mg 6.2.4 Kapsul - - -
1508 Ringer Asetat Cairan Infus 20.2 Botol - 40 40 -
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol 43 200 243 22
1601 Salbutamol Tablet 4 mg 26.1 Tablet 1,284 1,284 -
1604 Salisil Spiritus 10 % 18.3 Botol - - -
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol 71 50 121 5
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul 150 200 350 50
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet - 600 600 -
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul 450 450 -
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket - 50 50 -
1610 Sefotaksim Injeksi 1 g 6.2.1 Vial 70 100 170 12
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial 5 5 -
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( ABU 27.1 Vial - - -
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A.D.S )27.1 Vial - - -
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul 1 1 -
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial 2 2 -
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul 264 264 -
1618 Simetidin Tablet 200 mg 25.1 Tablet 604 604 -
1619 Simvastatin Tablet 10 mg 17.8 Tablet - 600 600 -
Page 23 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1621 Sulfadimidin Tablet 500 mg 6.2.2 Tablet - - -
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol 264 432 696 11
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet 53,253 53,253 28
1702 Terbutalin tablet 2,5 mg 26.1 Tablet - - -
1703 Tetrasiklin HCL Kapsul 250 mg 6.2.2 Kapsul 550 550 -
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul 159 500 659 24
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol - 50 50 -
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul 38 38 -
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet 658 20,000 20,658 1,612
1709 Tramadol Injeksi 50 mg/ml 1.1 Ampul 48 48 -
1710 Tramadol Kapsul 50 mg 1.1 Kapsul 996 996 -
1711 Triamcinolone Acetonide 1 mg 16.4 Tube - - -
1712 Triheksifenidil Tablet 2 mg 9 Tablet 252 1,000 1,252 100
1801 Vitamin B Komplek Tablet 29 Tablet 4,917 4,000 8,917 1,462
1901 Yodium Povidon Larutan 10 % 30 ml 13.1 Botol 13 13 -
1903 Yodium Povidon Larutan 10 % 300 ml 13.1 Botol 10 5 15 -
1904 Yodium Povidon Larutan 10 % 1000 ml 13.1 Botol - 4 4 -
2001 Zinc Tablet 20 mg 25.5 Tablet 404 2,000 2,404 112
0 OBAT GIGI 0 0 - - -
2101 Air Raksa Dental Use 14.1 Botol 2 2 -
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol 2 2 -
2103 Etil Klorida Spray 14.1 Vial 5 10 15 -
2104 Eugenol Cairan 14.1 Botol 1 10 11 -
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set 1 1 -
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube 1 1 -
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol 1 1 -
2108 Mummifying Pasta 14.1 Botol 3 3 -
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol 2 2 -
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol 1 1 -
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol 1 1 -
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set 1 1 -
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol 1 1 -
2114 Tumpatan Tetap dengan Sinar Set 14.1 Set - - -
0 REAGEN LABORATORIUM 0 0 - - -
2201 EDTA 10% cair 31 Botol - - -
2202 Ether Alkohol: Ether 80% - Alkohol 20% 31 Botol - - -
2203 Golongan darah Test ( set 3 vial @10 ml ) 31 Set - - -
2204 HCL 0,1 N 31 Botol - - -
2205 KOH 10% 31 Botol - 10 10 -
2206 Larutan Benedict 31 Botol 1 1 -
2207 Larutan Buffer Giemsa 31 Botol - - -
2208 Larutan Eosin 2% 31 Botol - - -
2209 Larutan Etanol Asam 31 Botol 1 1 -
Page 24 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2210 Larutan Giemsa Stain 31 Botol - - -
2211 Larutan Hayem 31 Botol - - -
2212 Larutan Karbol Fuksin 31 Botol - - -
2213 Larutan Metilen Biru 31 Botol - - -
2214 Larutan Rees Ecker 31 Botol - - -
2215 Larutan Turk 31 Botol - - -
2216 Lens Tissu 31 Set - - -
2217 Metanol 31 Botol - - -
2218 Reagen SD-HIV 31 Set - - -
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol 2 2 -
2220 Rapid Plasma Reagen Test Kit 31 Set - - -
2221 Sifilis Kit 31 Set 21 100 121 -
2222 Tuberkulin 31 Set - - -
2223 Widal slide test ( set a vial @ 5 ml ) Salmon 31 Set - - -
PERBEKALAN KESEHATAN - - -
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set - 900 900 -
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set 1,200 4,000 5,200 -
2303 Alat Suntik Sekali Pakai 1 ml 32 Set - 200 200 -
2304 Alat Suntik Sekali Pakai 2,5 ml 32 Set 209 300 509 -
2305 Alat Suntik Sekali Pakai 3 ml 32 Set 269 200 469 57
2306 Alat Suntik Sekali Pakai 5 ml 32 Set 169 300 469 -
2307 Alat Suntik Sekali Pakai 10 ml 32 Set - 150 150 -
2308 Alkohol 95% 32 Botol 2 2 2
2309 Blood Lancet 32 Pcs - 100 100 -
2310 Blood Transfusion set 32 Set - 1 1 -
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak - 96 96 -
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol - 1 1 -
2316 Infusion Set Anak Elasty Ball 32 Set 36 36 -
2317 Infusion Set Dewasa Elasty Ball 32 Set 161 161 -
2318 Jarum Infus (i.v. Catheter) Dewasa No 20 32 Biji 156 100 256 24
2321 Kapas Berlemak 500 Gram 32 Bungkus - - -
2323 Kasa Kompres 40/40 Steril 32 Bungkus - 20 20 2
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus - - -
2325 Kasa Pembalut 2 m x 80 cm 32 Rol 5 5 -
2326 Kasa Pembalut Elastic 3 inchi 32 Rol - 5 5 -
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol - 30 30 -
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol - - -
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol - 50 50 10
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol - - -
2331 Kateter (Folley / Urine) No. 10 32 Biji 3 3 -
Page 25 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2334 Klem tali pusat 32 Pcs - - -
2335 Lisol 32 Botol 5 5 10 -
2336 Masker 32 Set 80 100 180 -
2337 Mess / Pisau scalpel no 11 32 Pcs - - -
2338 Plester 5 yards x 2 inch 32 Rol 5 12 17 1
2339 Sarung Tangan Karet Sekali Pakai S 32 Set 460 500 960 100
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 234 500 734 302
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 200 200 -
2342 Silk / Benang Sutra no. 3/0 dengan Jarum Be 32 Sak 80 72 152 -
2343 Urine Bag 32 Set 56 56 -
2344 Wing Needle No. 25 G 32 Buah - - -
-
-
-
-
-
-
-
-
-

Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 26 of 278
DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
BULAN : FEBRUARI
TAHUN : 2013

SISA STOK KET
OPTIMUM TAAN DAU DAK ASKES BUFFER JUMLAH
9 10 11 12 13 14 15 16 17
-
418
98
1,007
11,979
30
711
287
18,951
14,304
51
4,463
162
37,672
14
70
130
50
-
88
38,954
8,065
200
30
1,144
105
1,391
3,585
124
30
1,000
600
100
354
150
Page 27 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
252
971
3,466
20,215
170
4,679
52
3,177
697
-
180
2,364
582
1,371
8,310
3
804
150
5,234
-
164
1,600
436
9
17
-
154
-
-
-
60
-
943
-
-
96
237
527
-
-
1,513
-
24
1,703
47
32
Page 28 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
197
1,461
17,015
197
134
118
200
714
-
380
500
-
6,627
183
300
4,438
5,584
285
1,244
-
10,687
60
2,568
3,236
-
200
342
17
6
480
-
20,623
38
99
167
179
63,716
9,000
30
-
4,953
5,686
-
802
-
1,287
Page 29 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
384
5,417
-
-
220
36
165
380
1,614
-
22
-
-
84
1,015
74
477
4,929
310
60
37
1,384
1,855
34
115
60
600
-
1,222
200
9,204
-
264
6
-
-
101
900
30
137
148
56
88
2,288
200
-
Page 30 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
105
197
2,204
24,079
-
-
43
876
180
200
32,877
1,650
1,301
3
16,281
-
100
3,404
8,023
200
-
-
525
5,700
-
40
221
1,284
162
71
-
116
300
600
450
50
158
5
-
-
1
2
264
11,074
604
600
Page 31 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
14,691
-
685
53,225
-
550
596
635
50
38
19,046
48
996
-
1,152
7,455
13
4
15
4
2,292
-
2
2
15
11
1
1
1
3
2
1
1
1
1
-
-
-
-
-
-
10
1
-
-
1
Page 32 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
-
-
-
-
-
-
-
-
-
2
-
121
-
-
-
900
5,200
200
509
412
469
150
-
100
1
96
1
29
94
128
36
161
232
117
108
-
15
18
-
5
5
30
-
40
-
3
Page 33 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
88
50
-
10
180
-
16
860
432
200
152
56
-
-
-
-
-
-
-
-
-
-
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-


NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 34 of 278
LAPORAN PEMAKAIAN DAN LEMBAR PER
(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0103 Ambroxol sirup 15 mg/ml 26.1 Botol 98 98 31
0104 Ambroxol Tablet 30 mg 26.1 Tablet 1,007 1,007 272
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 18,951 18,951 646
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol 14 14 12
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria 50 50 3
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet 38,954 38,954 1,302
0123 Asam Traneksamat 500 mg 10.3 Tablet 200 200 -
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul 30 30 -
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet 1,000 1,000 -
0132 Attapulgite Pektin 25.1 Tablet 600 600 -
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial 100 100 -
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet 354 354 57
Page 37 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0204 Bisacodyl 5 mg 25.6 Tablet 252 252 -
0205 Bromheksin Tablet 8 mg 26.3 Tablet 971 971 30
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul 3,466 3,466 120
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 8,310 8,310 210
0315 Domperidon Tablet 10 mg 25.2 Tablet 804 804 16
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet 150 150 -
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 5,234 5,234 302
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet 436 436 -
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul 60 60 -
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol 96 96 -
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul 237 237 2
0515 Furosemid Tablet 40 mg 14 Tablet 1,513 1,513 -
0601 Gameksan Emulsi 1 % 18.5 Botol 24 24 -
Page 38 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 1,461 1,461 402
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 118 118 -
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet 200 200 83
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet 300 300 -
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet 285 285 -
0904 Kaolin Pektin Sirup 25.1 Botol 60 60 -
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet 342 342 -
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 480 480 70
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 20,623 20,623 426
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol 99 99 9
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul 30 30 -
Page 39 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0928 Kotrimoksasol Suspensi 6.2.2 Botol 384 384 -
1002 Lidokain Kompositum Injeksi 14.1 Ampul 36 36 20
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul 165 165 30
1005 Loperamid Tablet 25.5 Tablet 1,614 1,614 93
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet 84 84 12
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 1,015 1,015 60
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 74 74 50
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet 477 477 106
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet 4,929 4,929 -
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul 60 60 18
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 37 37 -
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol 34 34 -
1117 Multivitamin Sirup 29 Botol 60 60 1
1118 Multivitamin tablet 29 Tablet 600 600 -
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 1,222 1,222 334
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket 6 6 2
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet 900 900 80
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube 148 148 -
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 56 56 24
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul 88 88 48
1401 Papaverin Tablet 40 mg 25.4 Tablet 2,288 2,288 -
Page 40 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet 200 200 -
1414 Piridoksin HCL Tablet 10 mg 29 Tablet 32,877 32,877 450
1417 Polikresulen 14.2 Botol 3 3 1
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 3,404 3,404 1,120
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul 200 200 120
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul 5,700 5,700 1,200
1508 Ringer Asetat Cairan Infus 20.2 Botol 40 40 -
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol 221 221 12
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul 300 300 260
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet 600 600 120
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket 50 50 -
1619 Simvastatin Tablet 10 mg 17.8 Tablet 600 600 12
Page 41 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol 50 50 -
1712 Triheksifenidil Tablet 2 mg 9 Tablet 1,152 1,152 160
2001 Zinc Tablet 20 mg 25.5 Tablet 2,292 2,292 135
0 OBAT GIGI 0 0 - - -
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol 2 2 -
2103 Etil Klorida Spray 14.1 Vial 15 15 -
2104 Eugenol Cairan 14.1 Botol 11 11 1
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set 1 1 -
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube 1 1 -
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol 1 1 -
2108 Mummifying Pasta 14.1 Botol 3 3 -
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol 2 2 -
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol 1 1 -
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol 1 1 -
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set 1 1 -
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol 1 1 -
2114 Tumpatan Tetap dengan Sinar Set 14.1 Set - - -
2201 EDTA 10% cair 31 Botol - - -
2204 HCL 0,1 N 31 Botol - - -
2205 KOH 10% 31 Botol 10 10 1
Page 42 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2221 Sifilis Kit 31 Set 121 121 2
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set 5,200 5,200 1,150
2303 Alat Suntik Sekali Pakai 1 ml 32 Set 200 200 -
2304 Alat Suntik Sekali Pakai 2,5 ml 32 Set 509 509 -
2308 Alkohol 95% 32 Botol - - -
2309 Blood Lancet 32 Pcs 100 100 -
2310 Blood Transfusion set 32 Set 1 1 -
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol 1 1 -
2325 Kasa Pembalut 2 m x 80 cm 32 Rol 5 5 -
2326 Kasa Pembalut Elastic 3 inchi 32 Rol 5 5 3
Page 43 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2335 Lisol 32 Botol 10 10 1
2336 Masker 32 Set 180 180 50
2338 Plester 5 yards x 2 inch 32 Rol 16 16 3
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 432 432 100
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 200 200 -
2343 Urine Bag 32 Set 56 56 -
- -
-
-
-
-
-
-
-
-

Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 44 of 278
(LPLPO)
BULAN : MARET
TAHUN : 2013

SISA STOK PROGRA KET
OPTIMUM TAAN DAU DAK BUFFER JUMLAH
M
9 10 11 12 13 14 15 16 17
-
73
67
735
11,844
30
711
209
18,305
11,086
51
4,395
150
35,159
2
70
130
47
-
82
37,652
5,735
200
30
1,119
105
1,191
3,585
114
30
1,000
600
100
297
141
Page 45 of 278
M
9 10 11 12 13 14 15 16 17
252
941
3,346
17,556
141
4,149
52
3,177
685
-
180
2,320
582
1,371
8,100
3
788
150
4,932
-
164
1,600
436
9
15
-
154
-
-
-
60
-
943
-
-
96
235
429
-
-
1,513
-
24
1,590
47
31
Page 46 of 278
M
9 10 11 12 13 14 15 16 17
191
1,059
12,776
169
134
118
117
554
-
360
500
-
6,377
134
300
3,898
4,832
285
1,178
-
8,128
60
2,261
2,485
-
200
342
17
6
410
-
20,197
38
90
163
161
58,587
9,000
30
-
4,773
5,486
-
802
-
1,151
Page 47 of 278
M
9 10 11 12 13 14 15 16 17
384
4,945
-
-
210
16
135
380
1,521
-
20
-
-
72
955
24
371
4,929
310
42
37
1,213
1,579
34
114
59
600
-
888
176
9,204
-
259
4
-
-
33
820
30
127
148
32
40
2,288
200
-
Page 48 of 278
M
9 10 11 12 13 14 15 16 17
100
122
1,987
16,858
-
-
43
876
180
200
32,427
1,644
1,301
2
14,542
-
100
2,284
7,461
80
-
-
525
4,500
-
40
209
1,284
119
55
-
100
40
480
450
50
108
5
-
-
1
2
264
10,516
604
588
Page 49 of 278
M
9 10 11 12 13 14 15 16 17
14,549
-
651
52,912
-
550
596
520
50
38
14,861
48
996
-
992
4,724
11
2
14
4
2,157
-
2
2
15
10
1
1
1
3
2
1
1
1
1
-
-
-
-
-
-
9
1
-
-
1
Page 50 of 278
M
9 10 11 12 13 14 15 16 17
-
-
-
-
-
-
-
-
-
2
-
119
-
-
-
780
4,050
200
509
292
259
150
-
100
1
84
1
24
89
100
36
161
208
113
100
-
14
13
-
5
2
28
-
20
-
3
Page 51 of 278
M
9 10 11 12 13 14 15 16 17
88
50
-
9
130
-
13
760
332
200
148
56
-
-
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-


NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 52 of 278
LAPORAN PEMAKAIAN DAN LEMBAR PER
(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0103 Ambroxol sirup 15 mg/ml 26.1 Botol 67 67 14
0104 Ambroxol Tablet 30 mg 26.1 Tablet 735 735 50
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul 30 30 2
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet 711 711 30
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 18,305 18,305 1,167
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol 2 2 2
0132 Attapulgite Pektin 25.1 Tablet 600 600 200
Page 55 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0204 Bisacodyl 5 mg 25.6 Tablet 252 252 60
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 8,100 8,100 120
0315 Domperidon Tablet 10 mg 25.2 Tablet 788 788 -
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet 150 150 -
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 4,932 4,932 442
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul 235 235 112
0515 Furosemid Tablet 40 mg 14 Tablet 1,513 1,513 5
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul 47 47 10
Page 56 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 1,059 1,059 185
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 118 118 20
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet 117 117 4
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet 554 554 -
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet 6,377 6,377 2,181
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet 300 300 -
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 410 410 100
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 20,197 20,197 174
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol 90 90 10
Page 57 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet 210 210 -
1002 Lidokain Kompositum Injeksi 14.1 Ampul 16 16 -
1005 Loperamid Tablet 25.5 Tablet 1,521 1,521 247
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet 72 72 48
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 955 955 50
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 24 24 10
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet 371 371 102
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul 42 42 42
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 37 37 5
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol 34 34 4
1117 Multivitamin Sirup 29 Botol 59 59 -
1118 Multivitamin tablet 29 Tablet 600 600 30
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 888 888 366
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet 820 820 820
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 32 32 2
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul 200 200 5
Page 58 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 2,284 2,284 1,120
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul 80 100 180 100
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul 40 40 40
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet 480 480 480
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg 10.1 Tablet 10,516 10,516 1,345
Page 59 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul 38 38 2
1712 Triheksifenidil Tablet 2 mg 9 Tablet 992 992 340
2001 Zinc Tablet 20 mg 25.5 Tablet 2,157 2,157 34
0 OBAT GIGI 0 0 - - -
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol 1 1
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol 1 1
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol 1 1
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol 1 1
2204 HCL 0,1 N 31 Botol - -
2205 KOH 10% 31 Botol 9 9 2
Page 60 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2218 Reagen SD-HIV 31 Set - -
2221 Sifilis Kit 31 Set 119 119 3
2222 Tuberkulin 31 Set - -
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set 4,050 4,050 3,960
2308 Alkohol 95% 32 Botol - - -
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol 1 1 1
2325 Kasa Pembalut 2 m x 80 cm 32 Rol 5 5 5
2326 Kasa Pembalut Elastic 3 inchi 32 Rol 2 2 2
2331 Kateter (Folley / Urine) No. 10 32 Biji 3 3 1
Page 61 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2335 Lisol 32 Botol 9 9 3
2336 Masker 32 Set 130 130 100
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 332 332 200
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 200 200 50
2343 Urine Bag 32 Set 56 56 2
- -
- -
- -
- -
- -
- -
- -
- -
- -

Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 62 of 278
(LPLPO)
BULAN : APRIL
TAHUN : 2013

SISA STOK KET
OPTIMUM TAAN DAU DAK BUFFER PROGRAM JUMLAH
9 10 11 12 13 14 15 16 17
- -
- 996 1,000
53 89 100
685 952 500
11,673 418
28 7
681 320
153 241 100
17,138 1,880
7,341 12,369 10,000
51 -
4,374 2,576
130 43
32,996 8,822
- 67 100
70 10
130 5
41 38
- 347 300
52 110 50
35,968 5,580
3,959 8,617 10,000
200 -
30 -
1,083 497
105 132
1,114 107
3,585 348
100 82
30 32
1,000 -
400 -
100 -
297 85
128 121 50
Page 63 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
192 -
841 48
3,226 400
15,189 21,920 7,000
113 75
3,423 4,800 3,000
52 3
3,177 76
617 3
- -
180 78
2,299 366
582 73
1,371 85
7,980 9,023
3 2
788 281
150 -
4,490 3,292
- -
164 35
1,600 133
436 786
9 5
12 15
- -
154 282
- -
- -
- -
60 -
- -
943 1,499
- -
- -
96 304
123 466
319 299
- -
- -
1,508 159
- 1
24 -
1,473 864
37 26
26 20
Page 64 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
187 59
874 1,396 1,000
9,421 11,404 5,000
109 92
134 29
98 64
113 169
554 1,594 1,000
- -
240 267 500
500 -
- - 50
4,196 1,386
104 207
300 -
3,209 1,707
4,342 4,431
253 223
1,148 224
- -
4,718 8,754 10,000
60 -
2,107 1,081
1,961 3,248 2,000
- 100
200 33
284 127
17 10
6 -
310 73 500
- -
20,023 1,770
38 4
80 79
158 54
135 114
47,878 21,258
9,000 -
30 5
- -
4,623 1,728
5,486 438
- -
802 59
- -
1,024 1,436
Page 65 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
372 77
4,535 2,470
- -
- -
210 37
16 248 200
105 212 100
380 7
1,274 1,378 500
- -
17 6
- -
- -
24 50 100
905 650
14 117 50
269 133 500
4,709 164
310 33
- 22 50
32 8
1,183 989
1,185 1,090 500
30 9
106 82
59 -
570 -
- -
522 631 500
156 180 50
9,204 198
- 475
229 63
2 10
- -
- -
- 251 100
- - 2,000
30 21
113 67
146 42
30 59 50
40 29
2,258 875
195 18
- -
Page 66 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
99 38
88 209 200
1,890 575
10,676 25,018 20,000
- -
- -
43 2
876 163
180 40
200 253
21,843 6,653 5,000
1,638 97
1,301 66
2 2
13,315 16,981 5,000
- -
100 117
1,164 1,065
6,890 2,195
80 117 100
- 1,167
- 37,763 5,000
525 302
4,500 2,537
- -
40 -
322 255 100
1,284 210
102 79
44 34
- -
86 93 50
- 283 500
- 667 1,000
450 313
50 -
77 114 100
5 1
- -
- -
1 6
2 0
264 112
9,171 819
604 65
536 622
Page 67 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
14,149 2,147
- -
642 110
52,542 44,663
- -
550 150
596 135
- 354 1,000
50 -
36 237
10,384 17,832 10,000
48 5
996 101
- -
652 949 1,000
2,249 12,445 15,000
8 9
1 2 10
13 3
4 -
2,123 2,561
- -
1
1
12
28
2
1
2
1
3
1
1
1
5
-
-
- -
- -
- 1
- 2
7 0
1 0
- -
- 0
1 0
Page 68 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
- 1
- -
- 0
- -
- 17
- 2
- 2
- 43
- -
2 -
- -
116 -
- -
- -
- -
260 -
90 933
200 173
409 237
192 396 200
159 204
150 37
- - 5
100 -
1 -
69 23 20
- - 5
19 18
74 78
75 115 100
36 5
161 13
183 118 100
101 84 100
80 88 100
- -
11 12
- 96 100
- - 100
- 12 20
- - 10
25 17
- 1
- 257 200
- -
2 -
Page 69 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
88 7
50 -
- - 100
6 2
30 173 100
- -
8 18 12
660 527
132 945
150 200
120 28
54 5
- - 50
- -
- -
- -
- -
- -
- -
- -
- -
- -
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-


NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 70 of 278
LAPORAN PEMAKAIAN DAN LEMBAR PE
(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0102 Alopurinol Tablet 100 mg 1.3 Tablet - 1,000 1,000 -
0103 Ambroxol sirup 15 mg/ml 26.1 Botol 53 50 103 23
0104 Ambroxol Tablet 30 mg 26.1 Tablet 685 500 1,185 412
0105 Aminofilin Tablet 200 mg 26.1 Tablet 11,673 11,673 2,887
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol 153 100 253 63
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 17,138 17,138 5,538
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial 51 51 12
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet 4,374 4,374 1,304
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul 130 270 400 -
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet 32,996 40,000 72,996 14,320
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol - 100 100 5
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol 52 120 172 45
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet 35,968 11,000 46,968 12,360
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet 3,959 10,000 13,959 2,342
0125 Asetosal Tablet 100 mg 1.2 Tablet 1,083 1,083 -
0132 Attapulgite Pektin 25.1 Tablet 400 400 230
0203 Betametason Krim 0,1 % 18.4 Tube 128 50 178 2
Page 73 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0204 Bisacodyl 5 mg 25.6 Tablet 192 192 48
0302 Deksametason Tablet 0,5 mg 16.4 Tablet 15,189 7,000 22,189 4,504
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet 3,423 5,000 8,423 1,024
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul 52 20 72 -
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 7,980 7,980 -
0315 Domperidon Tablet 10 mg 25.2 Tablet 788 788 160
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet 150 150 120
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 4,490 7,000 11,490 120
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul 1,600 200 1,800 -
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol 12 12 -
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul 123 30 153 -
0515 Furosemid Tablet 40 mg 14 Tablet 1,508 1,508 24
Page 74 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0605 Gentian Violet Larutan 1 % 14.2 Botol 187 187 -
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 874 1,000 1,874 172
0607 Gliseril Guayakolat Tablet 100 mg 26.3 Tablet 9,421 10,000 19,421 2,240
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol 134 134 2
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 98 480 578 -
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet 113 113 -
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet 554 554 -
0703 Haloperidol Tablet 2 mg 23.4 Tablet 240 500 740 210
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet 4,196 12,000 16,196 -
0707 Hidrokortison Krim 2,5 % 18.4 Tube 104 120 224 12
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet 300 300 80
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet 253 253 -
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet 1,148 1,148 -
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet 4,718 10,000 14,718 712
0905 Kaptopril Tablet 25 mg 17.3 Tablet 1,961 2,000 3,961 754
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet 284 284 -
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 310 500 810 -
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 20,023 20,023 3,520
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol 80 75 155 48
0917 Kloramfenikol Tetes Telinga 3 % 28.1 Botol 135 24 159 11
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 3 Tablet 47,878 21,000 68,878 9,820
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet 9,000 9,000 120
0925 Kodein HCl Tablet 10 mg 26.2 Tablet 802 802 10
0927 Kotrimoksasol Pediatrik Tablet 6.2.2 Tablet 1,024 1,000 2,024 -
Page 75 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet 4,535 4,535 -
1002 Lidokain Kompositum Injeksi 14.1 Ampul 16 210 226 24
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul 105 100 205 32
1005 Loperamid Tablet 25.5 Tablet 1,274 3,000 4,274 1,100
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml 5 Ampul 17 17 -
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet 24 90 114 24
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 905 200 1,105 -
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 14 14 -
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet 269 300 569 150
1110 Metoklopramide Tablet 10 mg 25.2 Tablet 310 700 1,010 -
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul - 48 48 12
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 32 32 3
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet 1,183 1,183 -
1114 Metronidasol Tablet 500 mg 6.2.2 Tablet 1,185 1,000 2,185 280
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube 106 106 -
1117 Multivitamin Sirup 29 Botol 59 59 5
1118 Multivitamin tablet 29 Tablet 570 570 220
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 522 500 1,022 -
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol 156 60 216 24
1204 Nifedipin Tablet 10 mg 17.3 Tablet 9,204 3,200 12,404 -
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol - 120 120 12
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet - 1,200 1,200 780
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube 146 250 396 30
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 30 100 130 -
Page 76 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1406 Parasetamol Tablet 100 mg 1.2 Tablet 1,890 1,890 -
1407 Parasetamol Tablet 500 mg 1.2 Tablet 10,676 25,000 35,676 8,120
1414 Piridoksin HCL Tablet 10 mg 29 Tablet 21,843 7,000 28,843 11,200
1418 Prednison Tablet 5 mg 16.4 Tablet 13,315 5,000 18,315 6,220
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 1,164 1,300 2,464 -
1501 Ranitidin Tablet 150 mg 25.1 Tablet 6,890 6,890 1,450
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul 80 200 280 40
1601 Salbutamol Tablet 4 mg 26.1 Tablet 1,284 1,284 240
1603 Salisil Bedak 2 % 18.8 Kotak 44 44 -
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol 86 50 136 12
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul - 500 500 -
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet - 500 500 24
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul 450 450 10
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul 1 3 4 -
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul 264 264 12
Page 77 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet 14,149 14,149 4,100
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet 52,542 52,542 -
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul - 500 500 120
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet 10,384 10,000 20,384 4,210
1712 Triheksifenidil Tablet 2 mg 9 Tablet 652 500 1,152 -
1801 Vitamin B Komplek Tablet 29 Tablet 2,249 4,000 6,249 2,230
2001 Zinc Tablet 20 mg 25.5 Tablet 2,123 2,123 1,620
0 OBAT GIGI 0 0 - - -
2103 Etil Klorida Spray 14.1 Vial 7 5 12
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set - 2 2
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol - -
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol - -
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol - -
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set - 1 1
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol - -
2201 EDTA 10% cair 31 Botol - - -
2204 HCL 0,1 N 31 Botol - - -
2205 KOH 10% 31 Botol 7 7 1
Page 78 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2221 Sifilis Kit 31 Set 116 116 24
2304 Alat Suntik Sekali Pakai 2,5 ml 32 Set 409 409 -
2308 Alkohol 95% 32 Botol - - -
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak 69 69 -
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol - 1 1 -
2314 Infusion Set Anak 32 Set 74 74 -
2315 Infusion Set Dewasa 32 Set 75 100 175 24
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji 80 100 180 -
2323 Kasa Kompres 40/40 Steril 32 Bungkus - 20 20 12
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus - 160 160 -
2325 Kasa Pembalut 2 m x 80 cm 32 Rol - - -
2326 Kasa Pembalut Elastic 3 inchi 32 Rol - 10 10 -
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol 25 25 -
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol - 20 20 5
Page 79 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2332 Kateter (Folley / Urine) No. 16 32 Biji 88 88 2
2335 Lisol 32 Botol 6 6 -
2336 Masker 32 Set 30 600 630 100
2338 Plester 5 yards x 2 inch 32 Rol 8 12 20 2
2339 Sarung Tangan Karet Sekali Pakai S 32 Set 660 200 860 200
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 132 600 732 100
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 150 100 250 -
2343 Urine Bag 32 Set 54 54 -
2344 Wing Needle No. 25 G 32 Buah - 50 50 -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -

Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 80 of 278
(LPLPO)
BULAN : MEI
TAHUN : 2013

SISA STOK KET
9 10 11 12 13 14 15 16 17
-
1,000
80
773
8,786
28
681
190
11,600
12,611
39
3,070
400
58,676
95
70
130
30
-
127
34,608
11,617
200
30
1,083
105
1,114
3,021
94
30
1,000
170
100
297
176
Page 81 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
144
729
3,006
17,685
101
7,399
72
3,177
597
-
180
2,287
582
1,371
7,980
3
628
30
11,370
-
164
1,800
436
9
12
-
154
-
-
-
60
-
943
-
-
96
153
307
-
-
1,484
-
24
1,453
37
23
Page 82 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
187
1,702
17,181
107
132
578
113
554
-
530
500
-
16,196
212
220
2,679
4,222
253
1,148
-
14,006
60
1,809
3,207
-
200
284
17
6
810
-
16,503
38
107
144
148
59,058
8,880
30
-
4,513
5,486
-
792
-
2,024
Page 83 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
368
4,535
-
-
160
202
173
380
3,174
-
17
-
-
90
1,105
14
419
3,729
1,010
36
29
1,183
1,905
18
106
54
350
-
1,022
192
12,404
-
217
1
-
-
108
420
30
110
366
130
40
2,178
195
-
Page 84 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
94
246
1,890
27,556
-
-
43
876
180
200
17,643
1,528
1,301
2
12,095
-
100
2,464
5,440
240
-
-
-
-
-
40
458
1,044
79
44
-
124
500
476
440
50
337
5
-
-
4
2
252
5,151
604
180
Page 85 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
10,049
-
588
-
-
550
596
380
50
36
16,174
48
996
-
1,152
4,019
8
11
11
-
503
-
1
-
-
-
-
-
6
1
-
-
1
Page 86 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
-
-
-
-
-
-
-
-
-
2
-
92
-
-
-
140
36
580
409
292
159
150
-
100
1
69
1
18
74
151
36
161
263
97
180
-
9
8
160
-
10
25
-
15
-
2
Page 87 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
86
50
-
6
530
-
18
660
632
250
100
54
50
-
-
-
-
-
-
-
-
-
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-


NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 88 of 278
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
KODE PUSKESMAS :
PUSKESMAS :
KECAMATAN :
KABUPATEN : KEDIRI
KELAS STOK PENERI- PERSE- PEMAKAI STOK PERMIN- PEMBERIAN

NO NAMA OBAT SATUAN SISA STOK
TERAPI AWAL MAAN DIAAN AN OPTIMUM TAAN DAU JPKMM ASKES
1 2 3 4 5 6 7 8 9 10 11 12 13 14
0101 Albendasol Tablet 400 mg 6.1.1 Tablet - - Err:509 Err:509
0102 Alopurinol Tablet 100 mg 1.3 Tablet 1,000 1,000 Err:509 Err:509
0103 Ambroxol sirup 15 mg/ml 26.1 Botol 80 80 32 Err:509
0104 Ambroxol Tablet 30 mg 26.1 Tablet 773 773 Err:509 Err:509
0105 Aminofilin Tablet 200 mg 26.1 Tablet 8,786 8,786 Err:509 Err:509
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul 28 28 Err:509 Err:509
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet 681 681 Err:509 Err:509
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol 190 190 Err:509 Err:509
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 11,600 11,600 Err:509 Err:509
0110 Amoksisilin Kapsul 500 mg 6.2.1 Kaplet 12,611 12,611 12,611 -
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial 39 39 39 -
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet 3,070 3,070 Err:509 Err:509
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul 400 400 Err:509 Err:509
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet 58,676 58,676 Err:509 Err:509
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol 95 95 Err:509 Err:509
0116 Anti Bakteri DOEN, Salep Kombinasi 18.2 Tube 70 70 Err:509 Err:509
0117 Antifungi DOEN Kombinasi:Asam Benzoat 6%18.3 Pot 130 130 Err:509 Err:509
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria 30 30 Err:509 Err:509
0119 Antimigrain Doen Kombinasi 7.2 Tablet - - Err:509 Err:509
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol 127 127 Err:509 Err:509
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet 34,608 34,608 Err:509 Err:509
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet 11,617 11,617 11,617 -
0123 Asam Traneksamat 500 mg 10.3 Tablet 200 200 Err:509 Err:509
Page 91 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul 30 30 Err:509 Err:509
0125 Asetosal Tablet 100 mg 1.2 Tablet 1,083 1,083 Err:509 Err:509
0126 Asetosal Tablet 500 mg 1.2 Tablet 105 105 Err:509 Err:509
0127 Asiklovir Tablet 400 mg 6.6.1 Tablet 1,114 1,114 Err:509 Err:509
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet 3,021 3,021 Err:509 Err:509
0129 Asiklovir Krim 5 % 6.6.1 Tube 94 94 Err:509 Err:509
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml 25.4 Ampul 30 30 Err:509 Err:509
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet 1,000 1,000 Err:509 Err:509
0132 Attapulgite Pektin 25.1 Tablet 170 170 Err:509 Err:509
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial 100 100 Err:509 Err:509
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet 297 297 Err:509 Err:509
0203 Betametason Krim 0,1 % 18.4 Tube 176 176 Err:509 Err:509
0204 Bisacodyl 5 mg 25.6 Tablet 144 144 48 Err:509
0205 Bromheksin Tablet 8 mg 26.3 Tablet 729 729 Err:509 Err:509
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul 3,006 3,006 Err:509 Err:509
0302 Deksametason Tablet 0,5 mg 16.4 Tablet 17,685 17,685 Err:509 Err:509
0303 Dekstrometorfan HBR Sirup 10 mg/5 ml 26.2 Botol 101 101 Err:509 Err:509
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet 7,399 7,399 Err:509 Err:509
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul 72 72 Err:509 Err:509
0306 Diazepam Tablet 2 mg 2.3 Tablet 3,177 3,177 Err:509 Err:509
0307 Diazepam Tablet 5 mg 2.3 Tablet 597 597 Err:509 Err:509
0308 Dietilkarbamazin Sitrat Tablet 100 mg 6.1.2 Tablet - - Err:509 Err:509
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul 180 180 Err:509 Err:509
0310 Digoksin Tablet 0,25 mg 17.5 Tablet 2,287 2,287 Err:509 Err:509
0311 Diltiazem HCl Tablet 30 mg 17.1 Tablet 582 582 Err:509 Err:509
0312 Dimenhidrinat Tablet 25.2 Tablet 1,371 1,371 Err:509 Err:509
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 7,980 7,980 Err:509 Err:509
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol 3 3 Err:509 Err:509
0315 Domperidon Tablet 10 mg 25.2 Tablet 628 628 Err:509 Err:509
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet 30 30 Err:509 Err:509
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 11,370 11,370 Err:509 Err:509
0402 Ekstrak Belladon Tablet 10 mg 25.4 Tablet - - Err:509 Err:509
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul 164 164 Err:509 Err:509
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul 1,800 1,800 Err:509 Err:509
Page 92 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet 436 436 Err:509 Err:509
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol 9 9 Err:509 Err:509
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol 12 12 Err:509 Err:509
0408 Etambutol HCL Tablet 250 mg 6.2.4 Tablet - - Err:509 Err:509
0501 Famotidin Tablet 20 mg 25.1 Tablet 154 154 Err:509 Err:509
0502 Fenitoin Natrium Injeksi 50 mg/ml 5 Ampul - - Err:509 Err:509
0503 Fenitoin Natrium Kapsul 100 mg 5 Kapsul - - Err:509 Err:509
0504 Fenitoin Natrium Kapsul 30 mg 5 Kapsul - - Err:509 Err:509
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul 60 60 Err:509 Err:509
0506 Fenobarbital Tablet 100 mg 5 Tablet - - Err:509 Err:509
0507 Fenobarbital Tablet 30 mg 5 Tablet 943 943 Err:509 Err:509
0508 Fenoksimetil Penisilina Tablet 250 mg 6.2.1 Tablet - - Err:509 Err:509
0509 Fenoksimetil Penisilina Tablet 500 mg 6.2.1 Tablet - - Err:509 Err:509
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol 96 96 Err:509 Err:509
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul 153 153 Err:509 Err:509
0512 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 10.2 Tablet 307 307 Err:509 Err:509
0513 Fluconazole Kapsul 150 mg 0 Kapsul - - Err:509 Err:509
0514 Fluor Tablet 0,5 mg 14.1 Tablet - - Err:509 Err:509
0515 Furosemid Tablet 40 mg 14 Tablet 1,484 1,484 Err:509 Err:509
0516 Furosemid Injeksi i.v / i.m 10 mg/ml 14 Ampul - - Err:509 Err:509
0601 Gameksan Emulsi 1 % 18.5 Botol 24 24 Err:509 Err:509
0602 Garam Oralit 200 ml Air 20.1 Sachet 1,453 1,453 Err:509 Err:509
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul 37 37 Err:509 Err:509
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube 23 23 23 Err:509
0605 Gentian Violet Larutan 1 % 14.2 Botol 187 187 Err:509 Err:509
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 1,702 1,702 Err:509 Err:509
0607 Gliseril Guayakolat Tablet 100 mg 26.3 Tablet 17,181 17,181 Err:509 Err:509
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol 107 107 Err:509 Err:509
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol 132 132 Err:509 Err:509
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 578 578 Err:509 Err:509
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet 113 113 Err:509 Err:509
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet 554 554 Err:509 Err:509
0702 Haloperidol Tablet 1,5 mg 23.4 Tablet - - Err:509 Err:509
0703 Haloperidol Tablet 2 mg 23.4 Tablet 530 530 240 Err:509
Page 93 of 278
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0704 Haloperidol Tablet 5 mg 23.4 Tablet 500 500 Err:509 Err:509
0705 Haloperidol Dekanoat Injeksi 23.4 Ampul - - Err:509 Err:509
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet 16,196 16,196 Err:509 Err:509
0707 Hidrokortison Krim 2,5 % 18.4 Tube 212 212 Err:509 Err:509
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet 220 220 Err:509 Err:509
0801 Ibuprofen Tablet 200 mg 1.2 Tablet 2,679 2,679 600 Err:509
0802 Ibuprofen Tablet 400 mg 1.2 Tablet 4,222 4,222 Err:509 Err:509
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet 253 253 Err:509 Err:509
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet 1,148 1,148 Err:509 Err:509
0902 Kalium Permanganat Serbuk 13.1 Pot - - Err:509 Err:509
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet 14,006 14,006 Err:509 Err:509
0904 Kaolin Pektin Sirup 25.1 Botol 60 60 Err:509 Err:509
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet 1,809 1,809 Err:509 Err:509
0905 Kaptopril Tablet 25 mg 17.3 Tablet 3,207 3,207 Err:509 Err:509
0906 Kaptopril Tablet 50 mg 17.3 Tablet - - Err:509 Err:509
0907 Karbamazepin Tablet 200 mg 5 Tablet 200 200 Err:509 Err:509
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet 284 284 Err:509 Err:509
0909 Ketokonazol Krim 2% 6.4.1 Tube 17 17 Err:509 Err:509
0910 Ketorolac Injeksi 10 mg 1.2 Ampul 6 6 Err:509 Err:509
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 810 810 Err:509 Err:509
0912 Klofazimin Kapsul 100 mg, Micronized 6.2.3 Kapsul - - Err:509 Err:509
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 16,503 16,503 Err:509 Err:509
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol 38 38 Err:509 Err:509
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol 107 107 Err:509 Err:509
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube 144 144 Err:509 Err:509
0917 Kloramfenikol Tetes Telinga 3 % 28.1 Botol 148 148 Err:509 Err:509
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 3 Tablet 59,058 59,058 Err:509 Err:509
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet 8,880 8,880 Err:509 Err:509
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul 30 30 Err:509 Err:509
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml 23.4 Ampul - - Err:509 Err:509
0922 Klorpromazin HCL Tablet Salut 100 mg 23.4 Tablet 4,513 4,513 Err:509 Err:509
0923 Klorpromazin HCL Tablet Salut 25 mg 23.4 Tablet 5,486 5,486 Err:509 Err:509
0924 Klorpropamid Tablet 100 mg 16.1.1 Tablet - - Err:509 Err:509
0925 Kodein HCl Tablet 10 mg 26.2 Tablet 792 792 Err:509 Err:509
Page 94 of 278
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0926 Kodein HCl Tablet 15 mg 26.3 Tablet - - Err:509 Err:509
0927 Kotrimoksasol Pediatrik Tablet 6.2.2 Tablet 2,024 2,024 Err:509 Err:509
0928 Kotrimoksasol Suspensi 6.2.2 Botol 368 368 Err:509 Err:509
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet 4,535 4,535 Err:509 Err:509
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml 6.4.2.2 Ampul - - Err:509 Err:509
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) 6.4.2.2 Tablet - - Err:509 Err:509
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet 160 160 Err:509 Err:509
1002 Lidokain Kompositum Injeksi 14.1 Ampul 202 202 Err:509 Err:509
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul 173 173 Err:509 Err:509
1004 Loratadin Tablet 10 mg 25.1 Tablet 380 380 Err:509 Err:509
1005 Loperamid Tablet 25.5 Tablet 3,174 3,174 Err:509 Err:509
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml 5 Ampul - - Err:509 Err:509
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml 5 Ampul 17 17 Err:509 Err:509
1103 Mebendasol Sirup 100 mg/5 ml 6.1.1 Botol - - Err:509 Err:509
1104 Mebendasol Tablet 100 mg 6.1.1 Tablet - - Err:509 Err:509
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet 90 90 Err:509 Err:509
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 1,105 1,105 1,105 -
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 14 14 14 -
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet 419 419 Err:509 Err:509
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet 3,729 3,729 Err:509 Err:509
1110 Metoklopramide Tablet 10 mg 25.2 Tablet 1,010 1,010 Err:509 Err:509
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul 36 36 Err:509 Err:509
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 29 29 Err:509 Err:509
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet 1,183 1,183 Err:509 Err:509
1114 Metronidasol Tablet 500 mg 6.2.2 Tablet 1,905 1,905 Err:509 Err:509
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol 18 18 Err:509 Err:509
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube 106 106 Err:509 Err:509
1117 Multivitamin Sirup 29 Botol 54 54 Err:509 Err:509
1118 Multivitamin tablet 29 Tablet 350 350 Err:509 Err:509
1201 Natrium Bikarbonat Tablet 500 mg 4.1 Tablet - - Err:509 Err:509
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 1,022 1,022 Err:509 Err:509
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol 192 192 Err:509 Err:509
1204 Nifedipin Tablet 10 mg 17.3 Tablet 12,404 12,404 Err:509 Err:509
1205 Nistatin 100.000 IU/G Tablet Vaginal 6.3 Tablet - - Err:509 Err:509
Page 95 of 278
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1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet 217 217 Err:509 Err:509
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket 1 1 Err:509 Err:509
1302 Obat Antituberkulosis Kategori 2 6.2.4 Paket - - Err:509 Err:509
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket - - Err:509 Err:509
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol 108 108 Err:509 Err:509
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet 420 420 Err:509 Err:509
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 106.2.2 Ampul 30 30 Err:509 Err:509
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube 110 110 Err:509 Err:509
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube 366 366 Err:509 Err:509
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 130 130 130 -
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul 40 40 Err:509 Err:509
1401 Papaverin Tablet 40 mg 25.4 Tablet 2,178 2,178 Err:509 Err:509
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul 195 195 Err:509 Err:509
1403 Paraformaldehid Tablet 1 Gram 13.2 Tablet - - Err:509 Err:509
1404 Parasetamol Drops 1.2 Botol 94 94 Err:509 Err:509
1405 Parasetamol Sirup 120 mg/5 ml 1.2 Botol 246 246 Err:509 Err:509
1406 Parasetamol Tablet 100 mg 1.2 Tablet 1,890 1,890 Err:509 Err:509
1407 Parasetamol Tablet 500 mg 1.2 Tablet 27,556 27,556 27,556 -
1408 Perfenazin Tablet 16 mg 23.4 Tablet - - Err:509 Err:509
1409 Perfenazin Tablet 4 mg 23.4 Tablet - - Err:509 Err:509
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul 43 43 Err:509 Err:509
1411 Piracetam Tablet 400 mg 29 Tablet 876 876 Err:509 Err:509
1412 Piracetam Tablet 800 mg 29 Tablet 180 180 Err:509 Err:509
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet 200 200 Err:509 Err:509
1414 Piridoksin HCL Tablet 10 mg 29 Tablet 17,643 17,643 Err:509 Err:509
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul 1,528 1,528 Err:509 Err:509
1416 Piroksikam Tablet 20 mg 25.7 Tablet 1,301 1,301 Err:509 Err:509
1417 Polikresulen 14.2 Botol 2 2 Err:509 Err:509
1418 Prednison Tablet 5 mg 16.4 Tablet 12,095 12,095 Err:509 Err:509
1419 Primakuin Tablet 15 mg 6.4.2.2 Tablet - - Err:509 Err:509
1420 Propiltiourasil Tablet 100 mg 16.3 Tablet 100 100 Err:509 Err:509
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 2,464 2,464 Err:509 Err:509
1501 Ranitidin Tablet 150 mg 25.1 Tablet 5,440 5,440 Err:509 Err:509
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul 240 240 Err:509 Err:509
Page 96 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1503 Reserpin Tablet 0,10 mg 17.3 Tablet - - Err:509 Err:509
1504 Reserpin Tablet 0,25 mg 17.3 Tablet - - Err:509 Err:509
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul - - Err:509 Err:509
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul - - Err:509 Err:509
1507 Rifampisin Kapsul 300 mg 6.2.4 Kapsul - - Err:509 Err:509
1508 Ringer Asetat Cairan Infus 20.2 Botol 40 40 Err:509 Err:509
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol 458 458 Err:509 Err:509
1601 Salbutamol Tablet 4 mg 26.1 Tablet 1,044 1,044 Err:509 Err:509
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + 18.4 Pot 79 79 Err:509 Err:509
1603 Salisil Bedak 2 % 18.8 Kotak 44 44 Err:509 Err:509
1604 Salisil Spiritus 10 % 18.3 Botol - - Err:509 Err:509
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol 124 124 Err:509 Err:509
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul 500 500 Err:509 Err:509
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet 476 476 Err:509 Err:509
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul 440 440 Err:509 Err:509
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket 50 50 Err:509 Err:509
1610 Sefotaksim Injeksi 1 g 6.2.1 Vial 337 337 Err:509 Err:509
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial 5 5 Err:509 Err:509
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( ABU 27.1 Vial - - Err:509 Err:509
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A.D.S )27.1 Vial - - Err:509 Err:509
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul 4 4 Err:509 Err:509
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial 2 2 Err:509 Err:509
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul 252 252 Err:509 Err:509
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg 10.1 Tablet 5,151 5,151 Err:509 Err:509
1618 Simetidin Tablet 200 mg 25.1 Tablet 604 604 Err:509 Err:509
1619 Simvastatin Tablet 10 mg 17.8 Tablet 180 180 Err:509 Err:509
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet 10,049 10,049 Err:509 Err:509
1621 Sulfadimidin Tablet 500 mg 6.2.2 Tablet - - Err:509 Err:509
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol 588 588 Err:509 Err:509
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet - - Err:509 Err:509
1702 Terbutalin tablet 2,5 mg 26.1 Tablet - - Err:509 Err:509
1703 Tetrasiklin HCL Kapsul 250 mg 6.2.2 Kapsul 550 550 Err:509 Err:509
1704 Tetrasiklin HCL Kapsul 500 mg 6.2.2 Kapsul 596 596 Err:509 Err:509
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul 380 380 Err:509 Err:509
Page 97 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol 50 50 Err:509 Err:509
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul 36 36 Err:509 Err:509
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet 16,174 16,174 Err:509 Err:509
1709 Tramadol Injeksi 50 mg/ml 1.1 Ampul 48 48 Err:509 Err:509
1710 Tramadol Kapsul 50 mg 1.1 Kapsul 996 996 Err:509 Err:509
1711 Triamcinolone Acetonide 1 mg 16.4 Tube - - Err:509 Err:509
1712 Triheksifenidil Tablet 2 mg 9 Tablet 1,152 1,152 Err:509 Err:509
1801 Vitamin B Komplek Tablet 29 Tablet 4,019 4,019 Err:509 Err:509
1902 Yodium Povidon Larutan 10 % 60 ml 13.1 Botol 11 11 Err:509 Err:509
1903 Yodium Povidon Larutan 10 % 300 ml 13.1 Botol 11 11 Err:509 Err:509
1904 Yodium Povidon Larutan 10 % 1000 ml 13.1 Botol - - Err:509 Err:509
2001 Zinc Tablet 20 mg 25.5 Tablet 503 503 Err:509 Err:509
0 OBAT GIGI 0 0 - - Err:509 Err:509
2101 Air Raksa Dental Use 14.1 Botol 1 1 Err:509 Err:509
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol - - Err:509 Err:509
2103 Etil Klorida Spray 14.1 Vial - - Err:509 Err:509
2104 Eugenol Cairan 14.1 Botol - - Err:509 Err:509
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set - - Err:509 Err:509
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube - - Err:509 Err:509
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol - - Err:509 Err:509
2108 Mummifying Pasta 14.1 Botol - - Err:509 Err:509
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol - - Err:509 Err:509
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol - - Err:509 Err:509
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol - - Err:509 Err:509
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set - - Err:509 Err:509
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol - - Err:509 Err:509
2114 Tumpatan Tetap dengan Sinar Set 14.1 Set - - Err:509 Err:509
0 REAGEN LABORATORIUM 0 0 - - Err:509 Err:509
2201 EDTA 10% cair 31 Botol - - Err:509 Err:509
2202 Ether Alkohol: Ether 80% - Alkohol 20% 31 Botol - - Err:509 Err:509
2203 Golongan darah Test ( set 3 vial @10 ml ) 31 Set - - Err:509 Err:509
2204 HCL 0,1 N 31 Botol - - Err:509 Err:509
2205 KOH 10% 31 Botol 6 6 Err:509 Err:509
Page 98 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14
2206 Larutan Benedict 31 Botol 1 1 Err:509 Err:509
2207 Larutan Buffer Giemsa 31 Botol - - Err:509 Err:509
2208 Larutan Eosin 2% 31 Botol - - Err:509 Err:509
2209 Larutan Etanol Asam 31 Botol 1 1 Err:509 Err:509
2210 Larutan Giemsa Stain 31 Botol - - Err:509 Err:509
2211 Larutan Hayem 31 Botol - - Err:509 Err:509
2212 Larutan Karbol Fuksin 31 Botol - - Err:509 Err:509
2213 Larutan Metilen Biru 31 Botol - - Err:509 Err:509
2214 Larutan Rees Ecker 31 Botol - - Err:509 Err:509
2215 Larutan Turk 31 Botol - - Err:509 Err:509
2216 Lens Tissu 31 Set - - Err:509 Err:509
2217 Metanol 31 Botol - - Err:509 Err:509
2218 Reagen SD-HIV 31 Set - - Err:509 Err:509
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol 2 2 Err:509 Err:509
2220 Rapid Plasma Reagen Test Kit 31 Set - - Err:509 Err:509
2221 Sifilis Kit 31 Set 92 92 Err:509 Err:509
2222 Tuberkulin 31 Set - - Err:509 Err:509
2223 Widal slide test ( set a vial @ 5 ml ) Salmon 31 Set - - Err:509 Err:509
PERBEKALAN KESEHATAN - - Err:509 Err:509
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set 140 140 Err:509 Err:509
2303 Alat Suntik Sekali Pakai 1 ml 32 Set 580 580 Err:509 Err:509
2305 Alat Suntik Sekali Pakai 3 ml 32 Set 292 292 292 -
2308 Alkohol 95% 32 Botol - - Err:509 Err:509
2309 Blood Lancet 32 Pcs 100 100 Err:509 Err:509
2310 Blood Transfusion set 32 Set 1 1 1 -
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak 69 69 69 -
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol 1 1 1 -
2313 Etanol (Alkohol 70%) 32 Botol 18 18 18 -
2314 Infusion Set Anak 32 Set 74 74 74 -
2315 Infusion Set Dewasa 32 Set 151 151 151 -
Page 99 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14
2316 Infusion Set Anak Elasty Ball 32 Set 36 36 Err:509 Err:509
2317 Infusion Set Dewasa Elasty Ball 32 Set 161 161 Err:509 Err:509
2318 Jarum Infus (i.v. Catheter) Dewasa No 20 32 Biji 263 263 263 -
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 Biji 97 97 Err:509 Err:509
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji 180 180 180 -
2321 Kapas Berlemak 500 Gram 32 Bungkus - - Err:509 Err:509
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus 9 9 9 -
2323 Kasa Kompres 40/40 Steril 32 Bungkus 8 8 Err:509 Err:509
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus 160 160 160 -
2325 Kasa Pembalut 2 m x 80 cm 32 Rol - - - -
2326 Kasa Pembalut Elastic 3 inchi 32 Rol 10 10 Err:509 Err:509
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol 25 25 Err:509 Err:509
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol - - - -
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol 15 15 15 -
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol - - - -
2331 Kateter (Folley / Urine) No. 10 32 Biji 2 2 Err:509 Err:509
2332 Kateter (Folley / Urine) No. 16 32 Biji 86 86 86 -
2333 Kateter (Folley / Urine) No. 18 32 Biji 50 50 Err:509 Err:509
2334 Klem tali pusat 32 Pcs - - - -
2335 Lisol 32 Botol 6 6 6 -
2336 Masker 32 Set 530 530 530 -
2337 Mess / Pisau scalpel no 11 32 Pcs - - Err:509 Err:509
2338 Plester 5 yards x 2 inch 32 Rol 18 18 18 -
2339 Sarung Tangan Karet Sekali Pakai S 32 Set 660 660 Err:509 Err:509
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 632 632 632 -
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 250 250 250 -
2342 Silk / Benang Sutra no. 3/0 dengan Jarum Be 32 Sak 100 100 100 -
2343 Urine Bag 32 Set 54 54 54 -
2344 Wing Needle No. 25 G 32 Buah 50 50 50 -
- #REF! #REF!
- #REF! #REF!
- #REF! #REF!
- #REF! #REF!
- #REF! #REF!
Page 100 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14
- #REF! #REF!
- #REF! #REF!
- #REF! #REF!
- #REF! #REF!
UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor Yang Men

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi dan Alkes Kepala UPTD Puskesmas ..... Petugas Pus
Kabupaten Kediri
dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt (…………………………………..) (……………………
NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010 NIP. NIP.
Page 101 of 278

(LPLPO)
BULAN : JANUARI
TAHUN : 2013
PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 102 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 103 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 104 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 105 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 106 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 107 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 108 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 109 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 110 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
Page 111 of 278

PEMBERIAN
KET
PROGRAM JUMLAH
15 16 17
JUMLAH
Yang Menerima
Petugas Puskesmas
(……………………….……………)
Page 112 of 278

(LPLPO)
UNIT
BULAN
TAHUN
PENERI- PERSE- PEMAKAI

NO NAMA OBAT STOK AWAL
MAAN DIAAN AN
1 2 3 4 5 6
1 Amoksisilin Kapsul 500 mg
2 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml
3 Asam Mefenamat Tablet 500 mg
4 Metil Ergometrin Maleat Tablet Salut 0,125 mg
5 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml
6 Oksitosin Injeksi 10 IU/ml - 1 ml
7 Parasetamol Tablet 500 mg
8 Yodium Povidon Larutan 10 % 30 ml
1 Alat Suntik Sekali Pakai 3 ml

2 Blood Transfusion set
3 Catgut / Benang Bedah No. 3/0 dengan jarum bedah
4 Dresing penutup luka berperekat 5cm x 5m
5 Etanol (Alkohol 70%)
6 Infusion Set Anak
7 Infusion Set Dewasa
8 Jarum Infus (i.v. Catheter) Dewasa No 20
9 Jarum Infus (i.v. Catheter) Anak No 24
10 Kapas Pembalut / Absorben 250 gram
11 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar)
12 Kasa Pembalut 2 m x 80 cm
13 Kasa Pembalut Hidrofil 4 m x 10 cm
15 Kasa Hidrofil uk. 36 m x 80 cm
16 Kateter (Folley / Urine) No. 16
17 Klem tali pusat
18 Lisol
19 Masker
20 Plester 5 yards x 2 inch
21 Sarung Tangan Karet Sekali Pakai M
22 Sarung Tangan Karet Sekali Pakai L
23 Silk / Benang Sutra no. 3/0 dengan Jarum Bedah
24 Urine Bag
25 Wing Needle No. 25 G
JUMLAH UMUM
KUNJUNGAN BAYAR
RESEP TOTAL
Petugas
OBAT
SISA STOK
7
(LPLPO)
UNIT : UGD & RAWAT INAP

PUSKESMAS : WATES
BULAN :
TAHUN: 2019
STOK PENERI- PERSE- PEMAKAI SISA PERMIN

NO NAMA OBAT
AWAL MAAN DIAAN AN STOK TAAN
1 Aminofilin Tablet 200 mg
2 Aminofilin Injeksi 24 mg/ml - 10 ML
3 Amoksisilin Sirup Kering 125 mg/5 ml
5 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ -
6 Antasida DOEN Tablet Kombinasi :
7 Antasida DOEN II suspensi,kombinasi: A -
8 Anti Bakteri DOEN, Salep Kombinasi
9 Aqua Proinjeksi Steril, Bebas Pirogen
10 Asam Askorbat ( Vit C ) Tablet 50 mg
12 Asam Traneksamat 500 mg
13 Asam Traneksamat injeksi 250 mg
14 Asetosal Tablet 100 mg
15 Asiklovir Tablet 400 mg
16 Asiklovir Krim 5 %
17 Attapulgite Pektin
18 Deksametason Inj.5 mg/ml - 1 ml
19 Deksametason Tablet 0,5 mg
20 Difenhidramin HCL Inj. 10 mg/ml - 1 ml
21 Digoksin Tablet 0,25 mg
22 Dimenhidrinat Tablet
23 Domperidon Suspensi 5 mg/ 5 ml
24 Domperidon Tablet 10 mg
25 Efedrin HCL Tablet 25 mg
26 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0 -
27 Fenol Gliserol Tetes Telinga 10 %
28 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
29 Furosemid Tablet 40 mg
30 Furosemid Injeksi i.v / i.m 10 mg/ml
31 Garam Oralit 200 ml Air
32 Glibenklamid Tablet 5 mg
33 Gliseril Guayakolat Tablet 100 mg
34 Glukosa Larutan Infus 5 % Steril (Produk lokal)
36 Glukosa Larutan Infus 40 % Steril
37 Hidroklorotiazid ( HCT ) Tablet 25 mg
38 Hidrokortison Krim 2,5 %
39 Hyoscine Butylbromide 10 mg Methampy -
40 Ibuprofen Tablet 400 mg
41 Isosorbid Dinitrat Tablet Sublingual 5 mg
42 Kalsium Laktat ( Kalk ) Tablet 500 mg
43 Kaolin Pektin Sirup
44 Kaptopril Tablet 25 mg
45 Ketorolac Injeksi 10 mg
46 Kloramfenikol Salep Mata 1 %
47 Kloramfenikol Tetes Telinga 3 %
48 Klorfeniramin Maleat ( CTM ) Tablet 4 mg
49 Kotrimoksasol Suspensi
50 Kotrimoksasol Dewasa Tablet
51 Lidokain Hcl Injeksi 2 %
52 Loperamid Tablet
53 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml
54 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml
56 Metoklopramide Injeksi 5 mg/ml
57 Metronidasol Tablet 500 mg
58 Metronidazol Infus 500 mg/100 ml
59 Multivitamin Sirup
60 Multivitamin tablet
61 Natrium Klorida Larutan Infus 0,9 % Steril

62 Obat Batuk Hitam ( O.B.H ) Cairan
63 Obat Flu Kombinasi (Alpara)
64 Omeprazol Kapsul 20 mg
65 Papaverin Tablet 40 mg
66 Papaverin Injeksi 40 mg/ml
67 Parasetamol Sirup 120 mg/5 ml
69 Piracetam Injeksi 1 g/5 ml
70 Piracetam Tablet 400 mg
71 Prednison Tablet 5 mg
72 Ranitidin Tablet 150 mg
73 Ranitidin Injeksi 25 mg/2 ml
74 Ringer Laktat Larutan Infus Steril
75 Salbutamol Tablet 4 mg
76 Sefotaksim Injeksi 1 g
77 Siprofloksasin Tablet 500 mg
82 Zinc Tablet 20 mg
83 Alat Suntik Sekali Pakai 2,5 ml
87 Alkohol 95%
88 Catgut / Benang Bedah No. 3/0 dengan jarum bedah
91 Infusion Set Anak
93 Jarum infus (iv Catheter) No 18
96 Jarum Infus (i.v. Catheter) Anak No 24
99 Kasa Pembalut 2 m x 80 cm
102 Kateter (Folley / Urine) No. 16
103 Lisol
104 Masker
105 Mess / Pisau scalpel no 11
106 Plester 5 yards x 2 inch
107 Sarung Tangan Karet Sekali Pakai S
109 Sarung Tangan Karet Sekali Pakai L
110 Silk / Benang Sutra no. 3/0 dengan Jarum Bedah
111 Urine Bag
UMUM
JUMLAH KUNJUNGAN RESEP BPJS
TOTAL
Petugas
N OBAT
PEMBERI
KET.
AN
PUSTU/PPOLINDES :
PUSKESMAS :
BULAN :
TAHUN: 2017
PENERI- PERSE- PEMAKAI SISA PERMIN PEMBER

MAAN DIAAN AN STOK TAAN IAN
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0115 Antasida DOEN Syrup
0604 Gentamisin Salep Kulit 0,1 %
0605 Gentian Violet Larutan 1 %
0915 Kloramfenikol Tetes Mata 0,5 %
1116 Mikonazol Krim/Salep 2 %
1306 Oksitetrasiklin HCL Salep 3 %
1307 Oksitetrasiklin HCL Salep Mata
1404 Parasetamol Drops
1414 Piridoksin HCL Tablet 10 mg
1417 Polikresulen
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU
1602 Salep 2-4
1603 Salisil Bedak 2 %
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg
1622 Sulfasetamid Natrium Tetes Mata 15 %
1701 Tablet Tambah Darah Kombinasi
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg
1801 Vitamin B Komplek Tablet
PERBEKALAN KESEHATAN
2308 Alkohol 95%
2314 Infusion Set Anak
2335 Lisol
Page 122 of 278
PENERI- PERSE- PEMAKAI SISA PERMIN PEMBER
MAAN DIAAN AN STOK TAAN IAN
Underpad
Petugas Pustu/Polindes UMUM

JUMLAH
KUNJUNGAN RESEP BPJS
TOTAL
Page 123 of 278

LEMBAR PERMINTAAN OBAT
KET
Page 124 of 278

KET
Page 125 of 278

POLINDES :
PUSKESMAS :
BULAN :
TAHUN: 2019
PENERI- PERSE- PEMAKAI SISA PERMIN

MAAN DIAAN AN STOK TAAN
9 Glukosa Larutan Infus 5%
25 Polikresulen
27 Salep 2-4
2 Alkohol 95%
5 Infusion Set Anak
10 Lisol
13 Underpad
Petugas Pustu/Polindes UMUM

JUMLAH
KUNJUNGAN RESEP BPJS
TOTAL
Page 126 of 278
PENERI- PERSE- PEMAKAI SISA PERMIN
MAAN DIAAN AN STOK TAAN
Page 127 of 278

AN LEMBAR PERMINTAAN OBAT
PEMBER
KET
IAN
Page 128 of 278

PUSTU :
PUSKESMAS :
KECAMATAN :
BULAN :
TAHUN: 2019
PENERI- PERSE- PEMAKAIA PERMIN

NO NAMA OBAT STOK AWAL SISA STOK
MAAN DIAAN N TAAN
1 Alopurinol Tablet 100 mg
2 Aminophyllin Tablet
5 Antalgin ( metampiron ) Tablet 500 mg
11 Asiklovir Tablet 400 mg
12 Asiklovir Krim 5 %
13 Betametason Krim 0,1 %
14 Deksametason Tablet 0,5 mg
16 Efedrin HCL Tablet 25 mg
18 Furosemid Tablet 40 mg
20 Gentamisin Salep Kulit 0,1 %
22 Glibenklamid Tablet 5 mg
26 Hidrokortison Krim 2,5 %
27 Ibuprofen Tablet 400 mg
29 Kaptopril Tablet 25 mg
34 Kotrimoksasol Suspensi
35 Kotrimoksasol Dewasa Tablet
36 Loperamid Tablet
39 Metronidasol Tablet 500 mg
48 Prednison Tablet 5 mg
49 Ranitidin Tablet 150 mg
51 Salbutamol Tablet 4 mg
52 Salep 2-4
Page 129 of 278

PENERI- PERSE- PEMAKAIA PERMIN
NO NAMA OBAT STOK AWAL SISA STOK
MAAN DIAAN N TAAN
55 Simvastatin Tablet 10 mg
56 Siprofloksasin Tablet 500 mg
2 Alkohol 95%
5 Infusion Set Anak
10 Lisol
13 Underpad
UMUM
JUMLAH KUNJUNGAN
RESEP BPJS
TOTAL
Petugas Pustu/Ponkesdes
NIP.
Page 130 of 278

ERMINTAAN OBAT
PEMBER
KET
IAN
Page 131 of 278

PEMBER
KET
IAN
Page 132 of 278

(LPLPO)
PUSKESMAS :
KECAMATAN :
BULAN :
TAHUN : 2019
STOK PENERI- PERSE- PEMAKAI PERMIN-

NO NAMA OBAT SISA STOK
AWAL MAAN DIAAN AN TAAN
1 2 3 4 5 6 7 8
OBAT GIGI
1 Air Raksa Dental Use
2 Devitalisasi Pasta ( Non Arsen )
3 Etil Klorida Spray
4 Eugenol Cairan
5 Glass Ionomer Cement Universal Restorativ -
6 Kalsium Hidroksida Pasta (Kalsidor)
7 Monoklorkamfer Mentol Cairan (CHKM)
8 Mummifying Pasta
9 Semen Seng Fosfat Serbuk dan Cairan
10 Silver Amalgam Serbuk 65-75 %
11 Temporary Filling Material / Hydraulic Temp -
12 Temporary Stopping Fletcher Serbuk dan Cai -
13 Trikresol Formalin ( TKF ) Cairan
14 Tumpatan Tetap dengan Sinar Set
15 Lidokain Kompositum Injeksi
1 Alat Suntik Sekali Pakai 2,5 ml
8 Masker
PASIEN
JUMLAH KUNJUNGAN RESEP UMUM BPJS
Petugas
Page 133 of 278

1 2 3 4 5 6 7 8
NIP.
Page 134 of 278

PERMINTAAN OBAT
PEMBERI
KET
AN
9 10
TOTAL
Page 135 of 278

PEMBERI
KET
AN
9 10
Page 136 of 278

(LPLPO)
PUSKESMAS :
KECAMATAN :
BULAN :
TAHUN : 2018

1 2 3 4 5 6 7 8
REAGEN LABORATORIUM
1 EDTA 10% cair
2 Ether Alkohol: Ether 80% - Alkohol 20%
3 Golongan darah Test ( set 3 vial @10 ml )
4 HCL 0,1 N
5 KOH 10% -
6 Larutan Benedict
7 Larutan Buffer Giemsa
8 Larutan Eosin 2%
9 Larutan Etanol Asam
10 Larutan Giemsa Stain
11 Larutan Hayem -
12 Larutan Karbol Fuksin -
13 Larutan Metilen Biru
14 Larutan Rees Ecker
15 Larutan Turk
16 Lens Tissu
17 Metanol
18 Reagen SD-HIV
19 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs -
20 Rapid Plasma Reagen Test Kit
21 Sifilis Kit
22 Tuberkulin
23 Widal slide test ( set a vial @ 5 ml ) Salmon -
25 Masker
PASIEN
JUMLAH KUNJUNGAN RESEP UMUM BPJS
Petugas
NIP.
Page 137 of 278

PERMINTAAN OBAT
PEMBERI
KET
AN
9 10
TOTAL
Page 138 of 278

LAPORAN PEMAKAIAN DAN LEMBAR
(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI
KELAS STOK PENERI- PERSE-

NO NAMA OBAT SATUAN
TERAPI AWAL MAAN DIAAN
1 2 3 4 5 6 7
0101 Albendasol Tablet 400 mg 6.1.1 Tablet - 450 450
0102 Alopurinol Tablet 100 mg 1.3 Tablet 646 1,000 1,646
0103 Ambroxol sirup 15 mg/ml 26.1 Botol 100 200
0104 Ambroxol Tablet 30 mg 26.1 Tablet -
0105 Aminofilin Tablet 200 mg 26.1 Tablet 5,910 5,910
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul 28 28
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet 85 85
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 4,952 4,952
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial 10 10
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet 1,843 1,843
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul 400 400
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet 44,824 44,824
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol 95 95
0116 Anti Bakteri DOEN, Salep Kombinasi 18.2 Tube 22 22
0117 Antifungi DOEN Kombinasi:Asam Benzoat 6%18.3 Pot 120 120
0119 Antimigrain Doen Kombinasi 7.2 Tablet - -
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol 87 87
0123 Asam Traneksamat 500 mg 10.3 Tablet 200 200
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul 30 30
0127 Asiklovir Tablet 400 mg 6.6.1 Tablet 1,100 1,100
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet 3,021 3,021
0129 Asiklovir Krim 5 % 6.6.1 Tube 84 84
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml 25.4 Ampul 30 30
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet 1,000 1,000
0132 Attapulgite Pektin 25.1 Tablet 170 170
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial 100 100
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet 240 240
0203 Betametason Krim 0,1 % 18.4 Tube 150 150
0204 Bisacodyl 5 mg 25.6 Tablet 96 96
0205 Bromheksin Tablet 8 mg 26.3 Tablet 577 1,000 1,577
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul 2,766 700 3,466
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet 7,041 7,041
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul 20 20
0306 Diazepam Tablet 2 mg 2.3 Tablet 2,065 2,000 3,065
0307 Diazepam Tablet 5 mg 2.3 Tablet 3,000 3,000
0308 Dietilkarbamazin Sitrat Tablet 100 mg 6.1.2 Tablet - -
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul 150 150
0310 Digoksin Tablet 0,25 mg 17.5 Tablet 200 500 700
0311 Diltiazem HCl Tablet 30 mg 17.1 Tablet 582 582
0312 Dimenhidrinat Tablet 25.2 Tablet 1,371 1,371
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 7,980 7,980
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol 3 3
0315 Domperidon Tablet 10 mg 25.2 Tablet 410 410
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet 30 30
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 10,370 7,000 17,370
0402 Ekstrak Belladon Tablet 10 mg 25.4 Tablet - -
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul 164 164
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul 1,500 1,700 3,200
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet 436 900 1,336
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol 9 9
0408 Etambutol HCL Tablet 250 mg 6.2.4 Tablet - -
0501 Famotidin Tablet 20 mg 25.1 Tablet 154 500 654
0502 Fenitoin Natrium Injeksi 50 mg/ml 5 Ampul - -
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul 60 60
0506 Fenobarbital Tablet 100 mg 5 Tablet - -
0507 Fenobarbital Tablet 30 mg 5 Tablet 943 943
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol 96 96
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 153 300 453
0512 Fitomenadion='H:\Documents
( Vit. K ) Tablet Salut
and Settings\DINKES\My
10 mg 10.2 Documents\PKM\[DATABASE_2.xlsx]DAFTAR
1,000 1,000
OBAT'!E85
0513 Fluconazole Kapsul 150 mg 0 Kapsul - -
0514 Fluor Tablet 0,5 mg 14.1 Tablet - -
0515 Furosemid Tablet 40 mg 14 Tablet 808 808
0516 Furosemid Injeksi i.v / i.m 10 mg/ml 14 Ampul - -
0601 Gameksan Emulsi 1 % 18.5 Botol 24 24
0602 Garam Oralit 200 ml Air 20.1 Sachet 2,382 2,382
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul 37 10 47
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube 100 100
0605 Gentian Violet Larutan 1 % 14.2 Botol 187 187
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 1,162 1,000 2,162
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol 102 102
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol 130 130
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 578 240 818
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet 113 113
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet 354 354
0702 Haloperidol Tablet 1,5 mg 23.4 Tablet - -
0703 Haloperidol Tablet 2 mg 23.4 Tablet 290 290
0704 Haloperidol Tablet 5 mg 23.4 Tablet 500 500
0705 Haloperidol Dekanoat Injeksi 23.4 Ampul - -
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet 16,016 12,000 18,016
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet 220 220
0801 Ibuprofen Tablet 200 mg 1.2 Tablet 1,537 1,537
0802 Ibuprofen Tablet 400 mg 1.2 Tablet 3,542 3,542
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet 572 2,500 3,072
0902 Kalium Permanganat Serbuk 13.1 Pot - -
0904 Kaolin Pektin Sirup 25.1 Botol 60 60
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet 633 633
0905 Kaptopril Tablet 25 mg 17.3 Tablet 2,211 2,000 4,211
0906 Kaptopril Tablet 50 mg 17.3 Tablet - -
0907 Karbamazepin Tablet 200 mg 5 Tablet 200 200
0909 Ketokonazol Krim 2% 6.4.1 Tube 12 20 32
0910 Ketorolac Injeksi 10 mg 1.2 Ampul 6 33 39
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 450 600 1,050
0912 Klofazimin Kapsul 100 mg, Micronized 6.2.3 Kapsul - -
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 15,581 15,581
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol 38 38
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol 24 24
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet 8,880 8,880
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul 30 30
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml 23.4 Ampul - -
0924 Klorpropamid Tablet 100 mg 16.1.1 Tablet - -
0925 Kodein HCl Tablet 10 mg 26.2 Tablet 716 716
0926 Kodein HCl Tablet 15 mg 26.3 Tablet - -
0927 Kotrimoksasol Pediatrik Tablet 6.2.2 Tablet 1,724 700 2,424
0928 Kotrimoksasol Suspensi 6.2.2 Botol 360 360
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet 4,335 9,700 14,035
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml 6.4.2.2 Ampul - -
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) 6.4.2.2 Tablet - -
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet 150 150
1002 Lidokain Kompositum Injeksi 14.1 Ampul 177 210 387
1004 Loratadin Tablet 10 mg 25.1 Tablet 380 380
1005 Loperamid Tablet 25.5 Tablet 2,374 2,374
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml 5 Ampul - -
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml 5 Ampul 17 17
1103 Mebendasol Sirup 100 mg/5 ml 6.1.1 Botol - -
1104 Mebendasol Tablet 100 mg 6.1.1 Tablet - -
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet 90 90
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 1,105 1,105
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 14 14
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet 200 200
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet 2,859 2,859
1110 Metoklopramide Tablet 10 mg 25.2 Tablet 1,010 1,500 2,510
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul 19 19
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 18 18
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet 797 797
1114 Metronidasol Tablet 500 mg 6.2.2 Tablet 1,593 500 2,093
1117 Multivitamin Sirup 29 Botol 19 19
1118 Multivitamin tablet 29 Tablet 350 350
1201 Natrium Bikarbonat Tablet 500 mg 4.1 Tablet - -
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 762 762
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol 169 169
1204 Nifedipin Tablet 10 mg 17.3 Tablet 3,104 3,104
1205 Nistatin 100.000 IU/G Tablet Vaginal 6.3 Tablet - -
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet 217 217
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket 10 10
1302 Obat Antituberkulosis Kategori 2 6.2.4 Paket - -
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket - -
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet 1,500 1,500
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 106.2.2 Ampul 30 30
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 70 70
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul 40 40
1401 Papaverin Tablet 40 mg 25.4 Tablet 2,025 2,025
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul
1403 Paraformaldehid Tablet 1 Gram 13.2 Tablet - -
1404 Parasetamol Drops 1.2 Botol 90 90
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul 33 33
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet 200 200
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul 1,068 1,068
1416 Piroksikam Tablet 20 mg 25.7 Tablet 1,301 1,301
1417 Polikresulen 14.2 Botol 2 2
1419 Primakuin Tablet 15 mg 6.4.2.2 Tablet - -
1420 Propiltiourasil Tablet 100 mg 16.3 Tablet 100 100
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 2,100 2,100
1501 Ranitidin Tablet 150 mg 25.1 Tablet 3,388 3,388
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul 350 250 600
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul 200 200
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul 400 400
1507 Rifampisin Kapsul 300 mg 6.2.4 Kapsul - -
1508 Ringer Asetat Cairan Infus 20.2 Botol 40 40
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol 568 568
1601 Salbutamol Tablet 4 mg 26.1 Tablet 824 824
1604 Salisil Spiritus 10 % 18.3 Botol - -
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul 150 150
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet 2,000 2,000
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul 88 500 588
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket 50 50
1610 Sefotaksim Injeksi 1 g 6.2.1 Vial 400 400
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial 3 3
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( ABU 27.1 Vial - -
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A.D.S )27.1 Vial - -
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul 2 2
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial 2 2
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul 252 252
1618 Simetidin Tablet 200 mg 25.1 Tablet 494 494
1619 Simvastatin Tablet 10 mg 17.8 Tablet 1,800 1,800
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet 1,000 1,000
1621 Sulfadimidin Tablet 500 mg 6.2.2 Tablet - -
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol 96 96
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet 51,342 51,342
1702 Terbutalin tablet 2,5 mg 26.1 Tablet - -
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol 50 50
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul 36 36
1709 Tramadol Injeksi 50 mg/ml 1.1 Ampul
1710 Tramadol Kapsul 50 mg 1.1 Kapsul 996 996
1711 Triamcinolone Acetonide 1 mg 16.4 Tube - 72 72
1712 Triheksifenidil Tablet 2 mg 9 Tablet 816 500 1,316
1904 Yodium Povidon Larutan 10 % 1000 ml 13.1 Botol
2001 Zinc Tablet 20 mg 25.5 Tablet 1,593 1,200 2,793
0 OBAT GIGI 0 0 - -
2204 HCL 0,1 N 31 Botol - -
2205 KOH 10% 31 Botol 5 5
2208 Larutan Eosin 2% 31 Botol - 5
2221 Sifilis Kit 31 Set 92 92
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set 140 140
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set 36 36
2304 Alat Suntik Sekali Pakai 2,5 ml 32 Set -
2308 Alkohol 95% 32 Botol - -
2309 Blood Lancet 32 Pcs 100 100
2310 Blood Transfusion set 32 Set 1 1
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak 69 69
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol 1 1
2314 Infusion Set Anak 32 Set 74 74
2315 Infusion Set Dewasa 32 Set 111 111
2316 Infusion Set Anak Elasty Ball 32 Set 36 36
2317 Infusion Set Dewasa Elasty Ball 32 Set 161 161
2321 Kapas Berlemak 500 Gram 32 Bungkus - -
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus 7 7
2323 Kasa Kompres 40/40 Steril 32 Bungkus 7 7
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus 160 160 320
2325 Kasa Pembalut 2 m x 80 cm 32 Rol - -
2326 Kasa Pembalut Elastic 3 inchi 32 Rol 10 10
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol 25 25
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol - 50 50
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol - 2 2
2334 Klem tali pusat 32 Pcs - -
2335 Lisol 32 Botol 3 3
2336 Masker 32 Set 150 150
2337 Mess / Pisau scalpel no 11 32 Pcs - 100 100
2339 Sarung Tangan Karet Sekali Pakai S 32 Set 310 310
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 432 432
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 150 150
2342 Silk / Benang Sutra no. 3/0 dengan Jarum Be 32 Sak 70 70
2343 Urine Bag 32 Set 20 20
2344 Wing Needle No. 25 G 32 Buah 36 42 78
- -
- -
- -
- -
- -
- -
- -
- -
- -

Kabupaten Kediri
NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
IAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
BULAN :
TAHUN :
PEMAKAI STOK PERMIN- PEMBERIAN

SISA STOK
AN OPTIMUM TAAN DAU DAK BUFFER PROGRAM JUMLAH
8 9 10 11 12 13 14 15 16
- 450
1,646
200
5,910
- 28
85
50 200
4,952
578 16,145
10
1,843
- 400
44,824
15 80
22
120
5 55
- -
87
33,038
2,618 13,677
200
- 30
293
- 105
1100
221 2,800
9 75
- 30
- 1,000
170
- 100
240 -
25 125
25 71
577 1,000
3,466
2,016 19,568
50 100
1,000 6,041
5 15
1,112 1,953
3,000
- -
150
700
- 582
- 1,371
- 7,980
- 3
410
30
17,370
- -
- 164
200 3,000
- 1,336
5 4
- 22
- -
- 654
- -
- -
- -
- 60 -
- - -
- 943
- -
- -
12 84
- 453
1,000
- - -
- - -
808
- -
24 - -
120 2,262
- 47
100
187
95 2,067
1,072 16,921
102
130
- 818
- 113
54 300
- - -
290
316 184 -
- - -
18,016
48 240
220 -
704 833
3,542
84 569
200 2,872
- - -
2,916 14,938
- 60 -
633
216 3,995
- -
- 200
- 784
32
- 39 -
350 700
- - -
250 15,331
- 38
24
270
68 118
2,316 58,114
8,880 -
- 30
- - -
4,398
2,917 2,569
- - -
24 692
- - -
2,424
360 -
14,035
- - -
- - -
10 140
10 243
- 380
2,374
- - -
17 -
- - -
- -
90 -
1,105 -
14 -
100 100
2,859
10 2,500
19
18
797
212 1,881
5 27
24 96
19
350
- -
762
169
3,104
- -
217
10
- -
- -
76 180
1,500
30 -
65
70
- 40
2,025
- -
1 89
196 200
1,690
2,812 18,916
- -
- -
33
- 876
60 120
- 200
12,443
68 1,000
- 1,301
- 2
2,012 12,143
- -
- 100
2,100
684 2,704
250 350
- -
- -
20 180
- -
40
24 800
97
- 94
- -
74 95
150 -
2,000
588
- 50
120 280
3
- -
- -
2
- 2 -
252
11,039
494
1,800
1,000
- - -
96
- - -
- 550
- 596
- 50 -
- 36
3,012 18,052
- 996
- 72 -
312 1,004
1,816 8,327
- 8
10
10
-
200 2,593
- - -
- 1
1
2 11
8
1
1
-
- - -
- - -
- - -
- -
- -
5 -
- 1 -
- - -
- 5 -
- 1 -
- -
- - -
- - -
- - -
- -
- -
- -
- -
- - -
- 2 -
- - -
92 -
- - -
- - -
- -
140
36
880
100
- 159
- 150
- - -
- 100 -
- 1 -
- 69
- 1 -
2 30
- 74
11 100
- 36
- 161
150
97
200
- - -
7
7
50 270 -
- -
- 10 -
- 25
- 50
110
- 2 -
2 - -
4 40
40 10 -
- - -
3
150
- 100 -
20
310
200 232
150
70
20
78 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
UMUM
ASKES JUMLAH
UNGAN RESEP BAYAR TIDAK BAYAR
-
an Yang Menerima / Melapor Yang Menerima

asi dan Alkes Plh Kepala UPTD Puskesmas Wates Petugas Puskesmas
Si., Apt dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.
1 2 010 NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
agustus
2013
KET
17
(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0101 Albendasol Tablet 400 mg 6.1.1 Tablet Err:509 Err:509 450
0102 Alopurinol Tablet 100 mg 1.3 Tablet 1,646 1,646 190
0103 Ambroxol sirup 15 mg/ml 26.1 Botol Err:509 Err:509 14
0104 Ambroxol Tablet 30 mg 26.1 Tablet Err:509 Err:509 -
0105 Aminofilin Tablet 200 mg 26.1 Tablet Err:509 Err:509 -
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul Err:509 Err:509 -
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet Err:509 Err:509 -
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol Err:509 Err:509 31
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul Err:509 Err:509 4,600
0110 Amoksisilin Kapsul 500 mg 6.2.1 Kaplet Err:509 Err:509 1,565
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial Err:509 Err:509 -
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet Err:509 Err:509 77
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul Err:509 Err:509 -
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet Err:509 Err:509 2,372
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol Err:509 Err:509 10
0116 Anti Bakteri DOEN, Salep Kombinasi 18.2 Tube Err:509 Err:509 -
0117 Antifungi DOEN Kombinasi:Asam Benzoat 6%18.3 Pot Err:509 Err:509 -
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria Err:509 Err:509 3
0119 Antimigrain Doen Kombinasi 7.2 Tablet Err:509 Err:509 -
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol Err:509 Err:509 -
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet Err:509 Err:509 1,044
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet Err:509 Err:509 1,669
0123 Asam Traneksamat 500 mg 10.3 Tablet Err:509 Err:509 20
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul Err:509 Err:509 -
0125 Asetosal Tablet 100 mg 1.2 Tablet Err:509 Err:509 65
0127 Asiklovir Tablet 400 mg 6.6.1 Tablet Err:509 Err:509 13
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet Err:509 Err:509 -
0129 Asiklovir Krim 5 % 6.6.1 Tube Err:509 Err:509 8
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml 25.4 Ampul Err:509 Err:509 -
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet Err:509 Err:509 -
0132 Attapulgite Pektin 25.1 Tablet Err:509 Err:509 -
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial Err:509 Err:509 -
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet Err:509 Err:509 -
0203 Betametason Krim 0,1 % 18.4 Tube Err:509 Err:509 33
0204 Bisacodyl 5 mg 25.6 Tablet Err:509 Err:509 3
0205 Bromheksin Tablet 8 mg 26.3 Tablet Err:509 Err:509 308
Page 165 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul Err:509 Err:509 -
0302 Deksametason Tablet 0,5 mg 16.4 Tablet Err:509 Err:509 1,363
0303 Dekstrometorfan HBR Sirup 10 mg/5 ml 26.2 Botol Err:509 Err:509 8
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet Err:509 Err:509 665
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul Err:509 Err:509 -
0306 Diazepam Tablet 2 mg 2.3 Tablet Err:509 Err:509 -
0307 Diazepam Tablet 5 mg 2.3 Tablet Err:509 Err:509 45
0308 Dietilkarbamazin Sitrat Tablet 100 mg 6.1.2 Tablet Err:509 Err:509 -
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul Err:509 Err:509 30
0310 Digoksin Tablet 0,25 mg 17.5 Tablet Err:509 Err:509 64
0311 Diltiazem HCl Tablet 30 mg 17.1 Tablet Err:509 Err:509 -
0312 Dimenhidrinat Tablet 25.2 Tablet Err:509 Err:509 36
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul Err:509 Err:509 -
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol Err:509 Err:509 -
0315 Domperidon Tablet 10 mg 25.2 Tablet Err:509 Err:509 -
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet Err:509 Err:509 -
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet Err:509 Err:509 277
0402 Ekstrak Belladon Tablet 10 mg 25.4 Tablet Err:509 Err:509 -
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul Err:509 Err:509 164
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul Err:509 Err:509 -
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet Err:509 Err:509 72
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol - - -
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol Err:509 Err:509 5
0408 Etambutol HCL Tablet 250 mg 6.2.4 Tablet Err:509 Err:509 -
0501 Famotidin Tablet 20 mg 25.1 Tablet Err:509 Err:509 -
0502 Fenitoin Natrium Injeksi 50 mg/ml 5 Ampul Err:509 Err:509 -
0503 Fenitoin Natrium Kapsul 100 mg 5 Kapsul Err:509 Err:509 -
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul Err:509 Err:509 -
0506 Fenobarbital Tablet 100 mg 5 Tablet Err:509 Err:509 -
0508 Fenoksimetil Penisilina Tablet 250 mg 6.2.1 Tablet Err:509 Err:509 -
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol Err:509 Err:509 -
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul Err:509 Err:509 -
0512 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 10.2 Tablet Err:509 Err:509 32
0513 Fluconazole Kapsul 150 mg 0 Kapsul Err:509 Err:509 -
0514 Fluor Tablet 0,5 mg 14.1 Tablet Err:509 Err:509 -
0515 Furosemid Tablet 40 mg 14 Tablet Err:509 Err:509 -
0516 Furosemid Injeksi i.v / i.m 10 mg/ml 14 Ampul Err:509 Err:509 -
0601 Gameksan Emulsi 1 % 18.5 Botol - -
0602 Garam Oralit 200 ml Air 20.1 Sachet Err:509 Err:509 139
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul Err:509 Err:509 -
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube Err:509 Err:509 9
0605 Gentian Violet Larutan 1 % 14.2 Botol Err:509 Err:509 -
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet Err:509 Err:509 106
0607 Gliseril Guayakolat Tablet 100 mg 26.3 Tablet Err:509 Err:509 1,286
Page 166 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol Err:509 Err:509 -
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol Err:509 Err:509 -
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial Err:509 Err:509 43
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet Err:509 Err:509 -
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet Err:509 Err:509 210
0702 Haloperidol Tablet 1,5 mg 23.4 Tablet Err:509 Err:509 -
0703 Haloperidol Tablet 2 mg 23.4 Tablet Err:509 Err:509 -
0705 Haloperidol Dekanoat Injeksi 23.4 Ampul Err:509 Err:509 -
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet Err:509 Err:509 103
0707 Hidrokortison Krim 2,5 % 18.4 Tube Err:509 Err:509 19
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet Err:509 Err:509 -
0801 Ibuprofen Tablet 200 mg 1.2 Tablet Err:509 Err:509 320
0802 Ibuprofen Tablet 400 mg 1.2 Tablet Err:509 Err:509 -
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet Err:509 Err:509 20
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet Err:509 Err:509 18
0902 Kalium Permanganat Serbuk 13.1 Pot Err:509 Err:509 -
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet Err:509 Err:509 1,894
0904 Kaolin Pektin Sirup 25.1 Botol Err:509 Err:509 -
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet Err:509 Err:509 633
0905 Kaptopril Tablet 25 mg 17.3 Tablet Err:509 Err:509 198
0906 Kaptopril Tablet 50 mg 17.3 Tablet Err:509 Err:509 -
0907 Karbamazepin Tablet 200 mg 5 Tablet Err:509 Err:509 -
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet Err:509 Err:509 -
0909 Ketokonazol Krim 2% 6.4.1 Tube Err:509 Err:509 15
0910 Ketorolac Injeksi 10 mg 1.2 Ampul Err:509 Err:509 3
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul Err:509 Err:509 20
0912 Klofazimin Kapsul 100 mg, Micronized 6.2.3 Kapsul Err:509 Err:509 -
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul Err:509 Err:509 284
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol Err:509 Err:509 -
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol Err:509 Err:509 -
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube Err:509 Err:509 2
0917 Kloramfenikol Tetes Telinga 3 % 28.1 Botol Err:509 Err:509 5
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 3 Tablet Err:509 Err:509 42,480
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet Err:509 Err:509 -
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul Err:509 Err:509 -
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml 23.4 Ampul Err:509 Err:509 -
0922 Klorpromazin HCL Tablet Salut 100 mg 23.4 Tablet Err:509 Err:509 210
0923 Klorpromazin HCL Tablet Salut 25 mg 23.4 Tablet Err:509 Err:509 -
0924 Klorpropamid Tablet 100 mg 16.1.1 Tablet Err:509 Err:509 -
0925 Kodein HCl Tablet 10 mg 26.2 Tablet Err:509 Err:509 -
0927 Kotrimoksasol Pediatrik Tablet 6.2.2 Tablet Err:509 Err:509 50
0928 Kotrimoksasol Suspensi 6.2.2 Botol Err:509 Err:509 -
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet Err:509 Err:509 197
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml 6.4.2.2 Ampul Err:509 Err:509 -
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) 6.4.2.2 Tablet Err:509 Err:509 -
Page 167 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet Err:509 Err:509 140
1002 Lidokain Kompositum Injeksi 14.1 Ampul Err:509 Err:509 -
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul Err:509 Err:509 -
1004 Loratadin Tablet 10 mg 25.1 Tablet Err:509 Err:509 -
1005 Loperamid Tablet 25.5 Tablet Err:509 Err:509 17
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml 5 Ampul Err:509 Err:509 -
1103 Mebendasol Sirup 100 mg/5 ml 6.1.1 Botol Err:509 Err:509 -
1104 Mebendasol Tablet 100 mg 6.1.1 Tablet Err:509 Err:509 -
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet - - -
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet - - -
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul - - -
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet Err:509 Err:509 -
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet Err:509 Err:509 76
1110 Metoklopramide Tablet 10 mg 25.2 Tablet Err:509 Err:509 200
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul Err:509 Err:509 19
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol Err:509 Err:509 -
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet Err:509 Err:509 497
1114 Metronidasol Tablet 500 mg 6.2.2 Tablet Err:509 Err:509 -
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol Err:509 Err:509 -
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube Err:509 Err:509 -
1117 Multivitamin Sirup 29 Botol Err:509 Err:509 19
1118 Multivitamin tablet 29 Tablet Err:509 Err:509 -
1201 Natrium Bikarbonat Tablet 500 mg 4.1 Tablet Err:509 Err:509 -
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet Err:509 Err:509 -
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol Err:509 Err:509 20
1204 Nifedipin Tablet 10 mg 17.3 Tablet Err:509 Err:509 -
1205 Nistatin 100.000 IU/G Tablet Vaginal 6.3 Tablet Err:509 Err:509 -
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet Err:509 Err:509 217
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket Err:509 10 Err:509 4
1302 Obat Antituberkulosis Kategori 2 6.2.4 Paket Err:509 Err:509 -
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket Err:509 1 Err:509 -
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol Err:509 Err:509 -
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet Err:509 Err:509 536
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 106.2.2 Ampul - - -
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube Err:509 Err:509 -
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube - - -
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul Err:509 Err:509 -
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul Err:509 Err:509 40
1401 Papaverin Tablet 40 mg 25.4 Tablet Err:509 Err:509 2,000
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul Err:509 Err:509 -
1403 Paraformaldehid Tablet 1 Gram 13.2 Tablet Err:509 Err:509 -
1404 Parasetamol Drops 1.2 Botol Err:509 Err:509 45
1405 Parasetamol Sirup 120 mg/5 ml 1.2 Botol Err:509 Err:509 -
1406 Parasetamol Tablet 100 mg 1.2 Tablet Err:509 Err:509 70
1407 Parasetamol Tablet 500 mg 1.2 Tablet Err:509 Err:509 4,432
1408 Perfenazin Tablet 16 mg 23.4 Tablet Err:509 Err:509 -
Page 168 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul Err:509 Err:509 33
1411 Piracetam Tablet 400 mg 29 Tablet Err:509 Err:509 -
1412 Piracetam Tablet 800 mg 29 Tablet Err:509 Err:509 60
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet Err:509 Err:509 200
1414 Piridoksin HCL Tablet 10 mg 29 Tablet Err:509 Err:509 696
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul Err:509 Err:509 -
1416 Piroksikam Tablet 20 mg 25.7 Tablet Err:509 Err:509 28
1417 Polikresulen 14.2 Botol Err:509 Err:509 -
1418 Prednison Tablet 5 mg 16.4 Tablet Err:509 Err:509 911
1419 Primakuin Tablet 15 mg 6.4.2.2 Tablet Err:509 Err:509 -
1420 Propiltiourasil Tablet 100 mg 16.3 Tablet Err:509 Err:509 -
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet Err:509 Err:509 800
1501 Ranitidin Tablet 150 mg 25.1 Tablet Err:509 Err:509 1,352
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul Err:509 Err:509 15
1503 Reserpin Tablet 0,10 mg 17.3 Tablet Err:509 Err:509 -
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul Err:509 Err:509 -
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul Err:509 Err:509 -
1507 Rifampisin Kapsul 300 mg 6.2.4 Kapsul Err:509 Err:509 -
1508 Ringer Asetat Cairan Infus 20.2 Botol Err:509 Err:509 -
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol Err:509 Err:509 20
1601 Salbutamol Tablet 4 mg 26.1 Tablet Err:509 Err:509 300
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + 18.4 Pot Err:509 Err:509 -
1603 Salisil Bedak 2 % 18.8 Kotak Err:509 Err:509 -
1604 Salisil Spiritus 10 % 18.3 Botol Err:509 Err:509 -
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol Err:509 Err:509 -
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul Err:509 Err:509 -
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet Err:509 Err:509 388
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul Err:509 Err:509 -
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket Err:509 Err:509 -
1610 Sefotaksim Injeksi 1 g 6.2.1 Vial 280 280 -
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial Err:509 Err:509 -
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( ABU 27.1 Vial Err:509 Err:509 -
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A.D.S )27.1 Vial Err:509 Err:509 -
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul Err:509 Err:509 -
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial Err:509 Err:509 -
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul Err:509 Err:509 -
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg 10.1 Tablet Err:509 Err:509 94
1618 Simetidin Tablet 200 mg 25.1 Tablet Err:509 Err:509 -
1619 Simvastatin Tablet 10 mg 17.8 Tablet Err:509 Err:509 48
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet Err:509 Err:509 632
1621 Sulfadimidin Tablet 500 mg 6.2.2 Tablet Err:509 Err:509 -
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol Err:509 Err:509 -
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet Err:509 Err:509 -
1702 Terbutalin tablet 2,5 mg 26.1 Tablet Err:509 Err:509 -
1703 Tetrasiklin HCL Kapsul 250 mg 6.2.2 Kapsul Err:509 Err:509 -
Page 169 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul Err:509 Err:509 -
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol Err:509 Err:509 25
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul Err:509 Err:509 -
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet Err:509 Err:509 4,093
1709 Tramadol Injeksi 50 mg/ml 1.1 Ampul Err:509 Err:509 -
1710 Tramadol Kapsul 50 mg 1.1 Kapsul Err:509 Err:509 -
1711 Triamcinolone Acetonide 1 mg 16.4 Tube Err:509 Err:509 -
1712 Triheksifenidil Tablet 2 mg 9 Tablet Err:509 Err:509 230
1801 Vitamin B Komplek Tablet 29 Tablet Err:509 Err:509 328
1901 Yodium Povidon Larutan 10 % 30 ml 13.1 Botol Err:509 Err:509 -
1902 Yodium Povidon Larutan 10 % 60 ml 13.1 Botol Err:509 Err:509 1
2001 Zinc Tablet 20 mg 25.5 Tablet Err:509 Err:509 232
0 OBAT GIGI 0 0 - - -
2101 Air Raksa Dental Use 14.1 Botol - -
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol - -
2104 Eugenol Cairan 14.1 Botol - -
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set - -
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube - -
2108 Mummifying Pasta 14.1 Botol - -
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol - -
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set - -
2204 HCL 0,1 N 31 Botol - -
2205 KOH 10% 31 Botol Err:509 Err:509 5
2206 Larutan Benedict 31 Botol Err:509 Err:509 1
2207 Larutan Buffer Giemsa 31 Botol Err:509 Err:509
2208 Larutan Eosin 2% 31 Botol Err:509 Err:509
2209 Larutan Etanol Asam 31 Botol Err:509 Err:509 1
2210 Larutan Giemsa Stain 31 Botol Err:509 Err:509
2211 Larutan Hayem 31 Botol Err:509 Err:509
2212 Larutan Karbol Fuksin 31 Botol Err:509 Err:509
2213 Larutan Metilen Biru 31 Botol Err:509 Err:509
2214 Larutan Rees Ecker 31 Botol Err:509 Err:509
2215 Larutan Turk 31 Botol Err:509 Err:509
2216 Lens Tissu 31 Set Err:509 Err:509
Page 170 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2217 Metanol 31 Botol Err:509 Err:509
2218 Reagen SD-HIV 31 Set Err:509 Err:509
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol Err:509 Err:509 2
2220 Rapid Plasma Reagen Test Kit 31 Set Err:509 Err:509
2221 Sifilis Kit 31 Set Err:509 Err:509 23
2222 Tuberkulin 31 Set Err:509 Err:509
2223 Widal slide test ( set a vial @ 5 ml ) Salmon 31 Set Err:509 Err:509
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set Err:509 Err:509 140
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set Err:509 Err:509 36
2303 Alat Suntik Sekali Pakai 1 ml 32 Set Err:509 Err:509 -
2305 Alat Suntik Sekali Pakai 3 ml 32 Set - - 100
2306 Alat Suntik Sekali Pakai 5 ml 32 Set Err:509 Err:509 50
2308 Alkohol 95% 32 Botol Err:509 Err:509 -
2309 Blood Lancet 32 Pcs Err:509 Err:509 -
2310 Blood Transfusion set 32 Set Err:509 Err:509 -
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak Err:509 Err:509 -
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol Err:509 Err:509 1
2313 Etanol (Alkohol 70%) 32 Botol - - -
2314 Infusion Set Anak 32 Set Err:509 Err:509 -
2316 Infusion Set Anak Elasty Ball 32 Set Err:509 Err:509 -
2317 Infusion Set Dewasa Elasty Ball 32 Set Err:509 Err:509 11
2318 Jarum Infus (i.v. Catheter) Dewasa No 20 32 Biji Err:509 Err:509 -
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 Biji Err:509 Err:509 97
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji Err:509 Err:509 -
2321 Kapas Berlemak 500 Gram 32 Bungkus Err:509 Err:509 -
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus - - 2
2323 Kasa Kompres 40/40 Steril 32 Bungkus Err:509 Err:509 7
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus - - 142
2325 Kasa Pembalut 2 m x 80 cm 32 Rol Err:509 Err:509 -
2326 Kasa Pembalut Elastic 3 inchi 32 Rol Err:509 Err:509 10
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol Err:509 Err:509 15
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol - - 15
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol Err:509 Err:509 2
2331 Kateter (Folley / Urine) No. 10 32 Biji Err:509 Err:509 -
2334 Klem tali pusat 32 Pcs Err:509 Err:509 -
2335 Lisol 32 Botol Err:509 Err:509 -
2336 Masker 32 Set - - -
2337 Mess / Pisau scalpel no 11 32 Pcs Err:509 Err:509 -
2338 Plester 5 yards x 2 inch 32 Rol Err:509 Err:509 3
2339 Sarung Tangan Karet Sekali Pakai S 32 Set - - -
Page 171 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2340 Sarung Tangan Karet Sekali Pakai M 32 Set Err:509 Err:509 132
2341 Sarung Tangan Karet Sekali Pakai L 32 Set Err:509 Err:509 -
2342 Silk / Benang Sutra no. 3/0 dengan Jarum Be 32 Sak Err:509 Err:509 -
2343 Urine Bag 32 Set Err:509 Err:509 -
2344 Wing Needle No. 25 G 32 Buah Err:509 Err:509 28
-

Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 172 of 278

(LPLPO)
BULAN : SEPTEMBER
TAHUN : 2013

OPTIMUM TAAN DAU JPKMM ASKES JUMLAH
M
9 10 11 12 13 14 15 16 17
Err:509
1,456
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
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Err:509
Err:509
Err:509
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Page 173 of 278
M
9 10 11 12 13 14 15 16 17
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-
Err:509
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-
Err:509
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Err:509
Page 174 of 278

M
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
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Err:509
184
Err:509
Err:509
Err:509
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Page 175 of 278

M
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
Err:509
Err:509
-
-
-
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
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Err:509
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Err:509
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-
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-
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Page 176 of 278

M
9 10 11 12 13 14 15 16 17
Err:509
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Err:509
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-
-
Err:509
Err:509
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Err:509
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280
Err:509
Err:509
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-
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Page 177 of 278

M
9 10 11 12 13 14 15 16 17
Err:509
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-
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Page 178 of 278

M
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
Err:509
Err:509
Err:509
-
(100)
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
Err:509
88
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
(2)
Err:509
(142)
Err:509
Err:509
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-
(15)
Err:509
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-
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-
Page 179 of 278

M
9 10 11 12 13 14 15 16 17
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UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-


NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 180 of 278

(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0101 Albendasol Tablet 400 mg 6.1.1 Tablet Err:509 Err:509 -
0105 Aminofilin Tablet 200 mg 26.1 Tablet Err:509 Err:509 -
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul Err:509 Err:509 -
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol Err:509 Err:509 40
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul Err:509 Err:509 -
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial Err:509 Err:509 10
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul Err:509 Err:509 -
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol Err:509 Err:509 40
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria Err:509 Err:509 -
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet Err:509 Err:509 1,654
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet Err:509 Err:509 341
0123 Asam Traneksamat 500 mg 10.3 Tablet Err:509 Err:509 -
0126 Asetosal Tablet 500 mg 1.2 Tablet Err:509 Err:509 -
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet Err:509 Err:509 -
0129 Asiklovir Krim 5 % 6.6.1 Tube Err:509 Err:509 8
0132 Attapulgite Pektin 25.1 Tablet Err:509 Err:509 -
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial Err:509 Err:509 100
0203 Betametason Krim 0,1 % 18.4 Tube Err:509 Err:509 56
0205 Bromheksin Tablet 8 mg 26.3 Tablet Err:509 Err:509 153
Page 181 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul Err:509 Err:509 300
0302 Deksametason Tablet 0,5 mg 16.4 Tablet Err:509 Err:509 1,353
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet Err:509 Err:509 412
0306 Diazepam Tablet 2 mg 2.3 Tablet Err:509 Err:509 -
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul Err:509 Err:509 30
0310 Digoksin Tablet 0,25 mg 17.5 Tablet Err:509 Err:509 14
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol Err:509 Err:509 3
0315 Domperidon Tablet 10 mg 25.2 Tablet Err:509 Err:509 -
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet Err:509 Err:509 30
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet Err:509 Err:509 468
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul Err:509 Err:509 -
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul Err:509 Err:509 45
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet Err:509 Err:509 45
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol - -
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol Err:509 Err:509 1
0501 Famotidin Tablet 20 mg 25.1 Tablet Err:509 Err:509 -
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul Err:509 Err:509 60
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul Err:509 Err:509 -
0601 Gameksan Emulsi 1 % 18.5 Botol - - -
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube Err:509 Err:509 -
0605 Gentian Violet Larutan 1 % 14.2 Botol Err:509 Err:509 10
Page 182 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol Err:509 Err:509 4
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial Err:509 Err:509 -
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet Err:509 Err:509 6
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet Err:509 Err:509 90
0703 Haloperidol Tablet 2 mg 23.4 Tablet Err:509 Err:509 -
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet Err:509 Err:509 68
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet Err:509 Err:509 -
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet Err:509 Err:509 1,855
0904 Kaolin Pektin Sirup 25.1 Botol Err:509 Err:509 5
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet Err:509 Err:509 -
0905 Kaptopril Tablet 25 mg 17.3 Tablet Err:509 Err:509 451
0907 Karbamazepin Tablet 200 mg 5 Tablet Err:509 Err:509 100
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet Err:509 Err:509 -
0909 Ketokonazol Krim 2% 6.4.1 Tube Err:509 Err:509 -
0910 Ketorolac Injeksi 10 mg 1.2 Ampul Err:509 Err:509 -
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul Err:509 Err:509 20
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul Err:509 Err:509 174
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol Err:509 Err:509 38
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol Err:509 Err:509 3
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube Err:509 Err:509 1
0928 Kotrimoksasol Suspensi 6.2.2 Botol Err:509 Err:509 -
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet Err:509 Err:509 251
Page 183 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet Err:509 Err:509 -
1002 Lidokain Kompositum Injeksi 14.1 Ampul Err:509 Err:509 100
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul Err:509 Err:509 100
1005 Loperamid Tablet 25.5 Tablet Err:509 Err:509 114
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet - - -
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet Err:509 Err:509 20
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet Err:509 Err:509 104
1110 Metoklopramide Tablet 10 mg 25.2 Tablet Err:509 Err:509 -
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul Err:509 Err:509 -
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol Err:509 Err:509 18
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube Err:509 Err:509 2
1117 Multivitamin Sirup 29 Botol Err:509 Err:509 -
1118 Multivitamin tablet 29 Tablet Err:509 Err:509 -
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet Err:509 Err:509 324
1204 Nifedipin Tablet 10 mg 17.3 Tablet Err:509 Err:509 16
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet Err:509 Err:509 -
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket Err:509 Err:509 1
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket Err:509 Err:509 -
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol Err:509 Err:509 29
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet Err:509 Err:509 633
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube Err:509 Err:509 6
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul Err:509 Err:509 -
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul Err:509 Err:509 -
1401 Papaverin Tablet 40 mg 25.4 Tablet Err:509 Err:509 25
1405 Parasetamol Sirup 120 mg/5 ml 1.2 Botol Err:509 Err:509 -
1406 Parasetamol Tablet 100 mg 1.2 Tablet Err:509 Err:509 -
1407 Parasetamol Tablet 500 mg 1.2 Tablet Err:509 Err:509 3,619
Page 184 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul Err:509 Err:509 -
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet Err:509 Err:509 -
1414 Piridoksin HCL Tablet 10 mg 29 Tablet Err:509 Err:509 1,011
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul Err:509 Err:509 60
1416 Piroksikam Tablet 20 mg 25.7 Tablet Err:509 Err:509 -
1417 Polikresulen 14.2 Botol Err:509 Err:509 1
1418 Prednison Tablet 5 mg 16.4 Tablet Err:509 Err:509 442
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet Err:509 Err:509 -
1501 Ranitidin Tablet 150 mg 25.1 Tablet Err:509 Err:509 348
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul - - -
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul - - -
1508 Ringer Asetat Cairan Infus 20.2 Botol Err:509 Err:509 -
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol Err:509 Err:509 548
1601 Salbutamol Tablet 4 mg 26.1 Tablet Err:509 Err:509 -
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + 18.4 Pot Err:509 Err:509 7
1603 Salisil Bedak 2 % 18.8 Kotak Err:509 Err:509 13
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol Err:509 Err:509 1
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul Err:509 Err:509 -
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket Err:509 Err:509 50
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial Err:509 Err:509 -
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul Err:509 Err:509 -
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial Err:509 Err:509 -
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul Err:509 Err:509 25
1619 Simvastatin Tablet 10 mg 17.8 Tablet Err:509 Err:509 1,752
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet Err:509 Err:509 368
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol Err:509 Err:509 16
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet - - -
Page 185 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol Err:509 Err:509 5
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet Err:509 Err:509 2,944
1711 Triamcinolone Acetonide 1 mg 16.4 Tube Err:509 Err:509 72
1801 Vitamin B Komplek Tablet 29 Tablet Err:509 Err:509 738
2001 Zinc Tablet 20 mg 25.5 Tablet Err:509 Err:509 35
0 OBAT GIGI 0 0 - - -
2101 Air Raksa Dental Use 14.1 Botol - -
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol - -
2103 Etil Klorida Spray 14.1 Vial - -
2104 Eugenol Cairan 14.1 Botol - -
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set - -
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube - -
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol - -
2204 HCL 0,1 N 31 Botol - -
2205 KOH 10% 31 Botol Err:509 Err:509
2206 Larutan Benedict 31 Botol Err:509 Err:509
2207 Larutan Buffer Giemsa 31 Botol Err:509 Err:509
2208 Larutan Eosin 2% 31 Botol Err:509 Err:509
2209 Larutan Etanol Asam 31 Botol Err:509 Err:509
2210 Larutan Giemsa Stain 31 Botol Err:509 Err:509
2211 Larutan Hayem 31 Botol Err:509 Err:509
2212 Larutan Karbol Fuksin 31 Botol Err:509 Err:509
2213 Larutan Metilen Biru 31 Botol Err:509 Err:509
2214 Larutan Rees Ecker 31 Botol Err:509 Err:509
2215 Larutan Turk 31 Botol Err:509 Err:509
2216 Lens Tissu 31 Set Err:509 Err:509
Page 186 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2217 Metanol 31 Botol Err:509 Err:509
2218 Reagen SD-HIV 31 Set Err:509 Err:509
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol Err:509 Err:509
2220 Rapid Plasma Reagen Test Kit 31 Set Err:509 Err:509
2221 Sifilis Kit 31 Set Err:509 Err:509 69
2222 Tuberkulin 31 Set Err:509 Err:509
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set Err:509 Err:509 -
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set Err:509 Err:509 -
2305 Alat Suntik Sekali Pakai 3 ml 32 Set (100) (100) -
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak Err:509 Err:509 3
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol Err:509 Err:509 -
2313 Etanol (Alkohol 70%) 32 Botol - - -
2314 Infusion Set Anak 32 Set Err:509 Err:509 12
2316 Infusion Set Anak Elasty Ball 32 Set Err:509 Err:509 36
2317 Infusion Set Dewasa Elasty Ball 32 Set Err:509 Err:509 10
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 Biji Err:509 Err:509 -
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji Err:509 Err:509 4
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus (2) (2) 3
2323 Kasa Kompres 40/40 Steril 32 Bungkus Err:509 Err:509 -
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus (142) (142) 28
2326 Kasa Pembalut Elastic 3 inchi 32 Rol Err:509 Err:509 -
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol Err:509 Err:509 1
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol - - 3
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol (15) (15) 50
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol Err:509 Err:509 -
2335 Lisol 32 Botol Err:509 Err:509 1
2336 Masker 32 Set - -
2338 Plester 5 yards x 2 inch 32 Rol Err:509 Err:509 6
2339 Sarung Tangan Karet Sekali Pakai S 32 Set - - 100
Page 187 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2340 Sarung Tangan Karet Sekali Pakai M 32 Set Err:509 Err:509 100
2344 Wing Needle No. 25 G 32 Buah Err:509 Err:509 -

Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 188 of 278

(LPLPO)
BULAN : OKTOBER
TAHUN : 2013

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509 -
1,222 996
Err:509 89
Err:509 952 1,000
Err:509 418
Err:509 7
Err:509 320
Err:509 241 150
Err:509 1,880 2,000
Err:509 12,369
Err:509 - 30
Err:509 2,576
Err:509 43
Err:509 8,822
Err:509 67 100
Err:509 10
Err:509 5
Err:509 38
Err:509 347 300
Err:509 110 50
Err:509 5,580
Err:509 8,617 5,000
Err:509 -
Err:509 -
Err:509 497
Err:509 132
Err:509 107
Err:509 348
Err:509 82 50
Err:509 32
Err:509 -
Err:509 -
Err:509 -
Err:509 85 300
Err:509 121 100
Err:509 -
Err:509 48 500
Page 189 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509 400
Err:509 21,920 6,000
Err:509 75
Err:509 4,800 6,000
Err:509 3
Err:509 76
Err:509 3
Err:509 -
Err:509 78
Err:509 366
Err:509 73
Err:509 85
Err:509 9,023
Err:509 2 25
Err:509 281
Err:509 -
Err:509 3,292
Err:509 -
Err:509 35 30
Err:509 133
Err:509 786
- 5
Err:509 15
Err:509 -
Err:509 282
Err:509 -
Err:509 -
Err:509 -
Err:509 - 30
Err:509 -
Err:509 1,499
Err:509 -
Err:509 -
Err:509 304
Err:509 466
Err:509 299
Err:509 -
Err:509 -
Err:509 159
Err:509 1
- -
Err:509 864
Err:509 26
Err:509 20
Err:509 59
Err:509 1,396
Err:509 11,404
Page 190 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509 92
Err:509 29
Err:509 64
Err:509 169 300
Err:509 1,594 2,000
Err:509 -
Err:509 267
184 -
Err:509 -
Err:509 1,386
Err:509 207
Err:509 -
Err:509 1,707
Err:509 4,431 1,000
Err:509 223
Err:509 224
Err:509 -
Err:509 8,754 5,000
Err:509 -
Err:509 1,081 1,000
Err:509 3,248 1,000
Err:509 100
Err:509 33
Err:509 127
Err:509 10
Err:509 -
Err:509 73
Err:509 -
Err:509 1,770
Err:509 4
Err:509 79 100
Err:509 54
Err:509 114 50
Err:509 21,258 10,000
Err:509 -
Err:509 5
Err:509 -
Err:509 1,728
Err:509 438
Err:509 -
Err:509 59
Err:509 - 100
Err:509 1,436
Err:509 77 100
Err:509 2,470
Err:509 -
Err:509 -
Page 191 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509 37
Err:509 248 300
Err:509 212 100
Err:509 7
Err:509 1,378
Err:509 -
- 6
Err:509 -
Err:509 -
- 50 100
- 650 600
- 117
Err:509 133 300
Err:509 164
Err:509 33
Err:509 22 50
Err:509 8 50
Err:509 989 500
Err:509 1,090
Err:509 9
Err:509 82
Err:509 - 50
Err:509 -
Err:509 -
Err:509 631 500
Err:509 180
Err:509 198
Err:509 475 100
Err:509 63 100
Err:509 10
Err:509 -
Err:509 -
Err:509 251
Err:509 - 1,000
- 21
Err:509 67 50
- 42
Err:509 59
Err:509 29 100
Err:509 875 1,000
Err:509 18 20
Err:509 -
Err:509 38
200 209 200
Err:509 575
Err:509 25,018 15,000
Err:509 -
Page 192 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509 -
Err:509 2 30
Err:509 163
Err:509 40
Err:509 253 500
Err:509 6,653
Err:509 97
Err:509 66
Err:509 2 2
Err:509 16,981 10,000
Err:509 -
Err:509 117
Err:509 1,065
Err:509 2,195 1,500
Err:509 117 50
Err:509 1,167
Err:509 37,763 2,000
- 302
- 2,537
Err:509 -
Err:509 -
Err:509 255 300
Err:509 210
Err:509 79
Err:509 34
Err:509 -
Err:509 93
Err:509 283
Err:509 667
Err:509 313
Err:509 -
230 114
Err:509 1
Err:509 -
Err:509 -
Err:509 6
Err:509 0
Err:509 112
Err:509 819
Err:509 65
Err:509 622 900
Err:509 2,147 2,500
Err:509 -
Err:509 110
- 44,663
Err:509 -
Err:509 150
Page 193 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509 135
Err:509 354 1,000
Err:509 -
Err:509 237
Err:509 17,832 10,000
Err:509 5
Err:509 101
Err:509 -
Err:509 949 500
Err:509 12,445
Err:509 9
Err:509 2
Err:509 3
Err:509 -
Err:509 2,561 1,000
- -
1
1
12
28
2
1
2
1
3
1
1
1
5
-
-
-
-
1
2
0
0
-
0
0
1
-
0
-
17
2
2
Page 194 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
43
-
-
-
-
-
-
- -
Err:509 -
Err:509 933
Err:509 173
- 237 200
(100) 396 400
Err:509 204 200
Err:509 37 100
Err:509 -
Err:509 -
Err:509 -
Err:509 23
Err:509 - 5
- 18
Err:509 78 100
68 115 100
Err:509 5
Err:509 13
Err:509 118
Err:509 84
Err:509 88
Err:509 -
(5) 12 10
Err:509 96 100
(170) -
Err:509 12 10
Err:509 - 5
Err:509 17 10
(3) 1
(65) 257 200
Err:509 -
Err:509 -
Err:509 7
Err:509 -
Err:509 -
Err:509 2
- 173
Err:509 -
Err:509 18 12
(100) 527 300
Page 195 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509 945 900
Err:509 200
Err:509 28
Err:509 5
Err:509 -
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-


NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 196 of 278

(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0101 Albendasol Tablet 400 mg 6.1.1 Tablet Err:509 Err:509 -
0105 Aminofilin Tablet 200 mg 26.1 Tablet Err:509 - Err:509 -
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul Err:509 120 Err:509 -
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol Err:509 150 Err:509 50
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul Err:509 Err:509 352
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial Err:509 50 Err:509 -
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul Err:509 60 Err:509 -
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol Err:509 100 Err:509 -
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria Err:509 Err:509 8
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet Err:509 2,000 Err:509 1,860
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet Err:509 7,200 Err:509 1,456
0123 Asam Traneksamat 500 mg 10.3 Tablet Err:509 Err:509 -
0126 Asetosal Tablet 500 mg 1.2 Tablet Err:509 Err:509 -
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet Err:509 Err:509
0129 Asiklovir Krim 5 % 6.6.1 Tube Err:509 50 Err:509 14
0132 Attapulgite Pektin 25.1 Tablet Err:509 Err:509 170
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial Err:509 Err:509 -
0203 Betametason Krim 0,1 % 18.4 Tube Err:509 100 Err:509 6
0205 Bromheksin Tablet 8 mg 26.3 Tablet Err:509 500 Err:509 51
Page 197 of 278
NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul Err:509 200 Err:509 2,000
0302 Deksametason Tablet 0,5 mg 16.4 Tablet Err:509 10,000 Err:509 2,285
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet Err:509 10,000 Err:509 1,324
0306 Diazepam Tablet 2 mg 2.3 Tablet Err:509 1,000 Err:509 -
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul Err:509 Err:509 -
0310 Digoksin Tablet 0,25 mg 17.5 Tablet Err:509 Err:509 -
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol Err:509 Err:509 -
0315 Domperidon Tablet 10 mg 25.2 Tablet Err:509 Err:509 100
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet Err:509 Err:509 -
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet Err:509 1,000 Err:509 170
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul Err:509 100 Err:509 -
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul Err:509 600 Err:509 6
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet Err:509 600 Err:509 58
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol - - -
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol Err:509 Err:509 -
0501 Famotidin Tablet 20 mg 25.1 Tablet Err:509 450 Err:509 -
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul Err:509 30 Err:509 -
0506 Fenobarbital Tablet 100 mg 5 Tablet Err:509 - Err:509 -
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul Err:509 30 Err:509 -
0601 Gameksan Emulsi 1 % 18.5 Botol - - -
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube Err:509 Err:509 -
0605 Gentian Violet Larutan 1 % 14.2 Botol Err:509 Err:509 4
Page 198 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol Err:509 - Err:509 -
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial Err:509 120 Err:509 -
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet Err:509 500 Err:509 6
0703 Haloperidol Tablet 2 mg 23.4 Tablet Err:509 Err:509 140
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet Err:509 Err:509 2,483
0802 Ibuprofen Tablet 400 mg 1.2 Tablet Err:509 2,000 Err:509 722
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet Err:509 Err:509 -
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet Err:509 10,000 Err:509 2,465
0904 Kaolin Pektin Sirup 25.1 Botol Err:509 Err:509 -
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet Err:509 1,100 Err:509 -
0905 Kaptopril Tablet 25 mg 17.3 Tablet Err:509 2,000 Err:509 651
0907 Karbamazepin Tablet 200 mg 5 Tablet Err:509 Err:509 -
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet Err:509 500 Err:509 -
0909 Ketokonazol Krim 2% 6.4.1 Tube Err:509 20 Err:509 27
0910 Ketorolac Injeksi 10 mg 1.2 Ampul Err:509 Err:509 36
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul Err:509 600 Err:509 20
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul Err:509 Err:509 5,000
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol Err:509 50 Err:509 -
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol Err:509 Err:509 6
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube Err:509 144 Err:509 6
0926 Kodein HCl Tablet 15 mg 26.3 Tablet Err:509 250 Err:509 -
0928 Kotrimoksasol Suspensi 6.2.2 Botol Err:509 100 Err:509 -
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet Err:509 9,800 Err:509 399
Page 199 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet Err:509 250 Err:509 -
1002 Lidokain Kompositum Injeksi 14.1 Ampul Err:509 300 Err:509 180
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul Err:509 200 Err:509 50
1005 Loperamid Tablet 25.5 Tablet Err:509 1,000 Err:509 158
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet - 600 600 -
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet Err:509 Err:509 -
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet Err:509 Err:509 2,679
1110 Metoklopramide Tablet 10 mg 25.2 Tablet Err:509 100 Err:509 -
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul Err:509 Err:509 -
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol Err:509 120 Err:509 -
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet Err:509 1,000 Err:509 78
1114 Metronidasol Tablet 500 mg 6.2.2 Tablet Err:509 400 Err:509 186
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube Err:509 Err:509 2
1117 Multivitamin Sirup 29 Botol Err:509 120 Err:509 -
1118 Multivitamin tablet 29 Tablet Err:509 Err:509 3
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet Err:509 Err:509 438
1204 Nifedipin Tablet 10 mg 17.3 Tablet Err:509 Err:509 -
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet Err:509 Err:509 -
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket Err:509 10 Err:509 1
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket Err:509 Err:509 -
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol Err:509 Err:509 23
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet Err:509 900 Err:509 178
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube Err:509 Err:509 6
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul Err:509 10 Err:509 -
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul Err:509 150 Err:509 -
1401 Papaverin Tablet 40 mg 25.4 Tablet Err:509 1,000 Err:509 19
1406 Parasetamol Tablet 100 mg 1.2 Tablet Err:509 Err:509 110
1407 Parasetamol Tablet 500 mg 1.2 Tablet Err:509 15,000 Err:509 4,246
Page 200 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul Err:509 Err:509 -
1412 Piracetam Tablet 800 mg 29 Tablet Err:509 120 Err:509 -
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet Err:509 500 Err:509 -
1414 Piridoksin HCL Tablet 10 mg 29 Tablet Err:509 Err:509 611
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul Err:509 Err:509 42
1416 Piroksikam Tablet 20 mg 25.7 Tablet Err:509 Err:509 -
1417 Polikresulen 14.2 Botol Err:509 2 Err:509 -
1418 Prednison Tablet 5 mg 16.4 Tablet Err:509 5,000 Err:509 617
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet Err:509 Err:509 1,300
1501 Ranitidin Tablet 150 mg 25.1 Tablet Err:509 Err:509 200
1508 Ringer Asetat Cairan Infus 20.2 Botol Err:509 Err:509 5
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol Err:509 300 Err:509 15
1601 Salbutamol Tablet 4 mg 26.1 Tablet Err:509 Err:509 -
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + 18.4 Pot Err:509 Err:509 9
1603 Salisil Bedak 2 % 18.8 Kotak Err:509 Err:509 11
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol Err:509 Err:509 1
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul Err:509 100 Err:509 -
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket Err:509 Err:509 -
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial Err:509 Err:509 2
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul Err:509 Err:509 2
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial Err:509 Err:509 2
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul Err:509 Err:509 -
1619 Simvastatin Tablet 10 mg 17.8 Tablet Err:509 Err:509 -
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet Err:509 Err:509 -
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol Err:509 Err:509 7
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet 5,342 5,342 -
1703 Tetrasiklin HCL Kapsul 250 mg 6.2.2 Kapsul Err:509 1,000 Err:509 -
Page 201 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol Err:509 Err:509 -
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet Err:509 10,000 Err:509 2,956
1711 Triamcinolone Acetonide 1 mg 16.4 Tube Err:509 24 Err:509 3
1801 Vitamin B Komplek Tablet 29 Tablet Err:509 Err:509 2,628
2001 Zinc Tablet 20 mg 25.5 Tablet Err:509 1,000 Err:509 5
0 OBAT GIGI 0 0 - - -
2204 HCL 0,1 N 31 Botol - -
2205 KOH 10% 31 Botol - -
2206 Larutan Benedict 31 Botol - -
2207 Larutan Buffer Giemsa 31 Botol - 1 1
2209 Larutan Etanol Asam 31 Botol - -
2215 Larutan Turk 31 Botol - 1 1
Page 202 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol - -
2221 Sifilis Kit 31 Set - -
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set Err:509 Err:509
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set Err:509 Err:509
2303 Alat Suntik Sekali Pakai 1 ml 32 Set Err:509 300 Err:509 -
2305 Alat Suntik Sekali Pakai 3 ml 32 Set (100) 500 400 100
2306 Alat Suntik Sekali Pakai 5 ml 32 Set Err:509 500 Err:509 100
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak Err:509 Err:509 1
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol Err:509 Err:509 -
2313 Etanol (Alkohol 70%) 32 Botol - 16 16 3
2314 Infusion Set Anak 32 Set Err:509 100 Err:509 21
2316 Infusion Set Anak Elasty Ball 32 Set Err:509 Err:509 -
2317 Infusion Set Dewasa Elasty Ball 32 Set Err:509 Err:509 -
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 Biji Err:509 Err:509
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji Err:509 Err:509 2
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus (5) 10 5 -
2323 Kasa Kompres 40/40 Steril 32 Bungkus Err:509 Err:509 -
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus (170) (170) 68
2326 Kasa Pembalut Elastic 3 inchi 32 Rol Err:509 5 Err:509 -
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol Err:509 Err:509 -
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol (3) (3) -
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol (65) (65) -
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol Err:509 Err:509 -
2335 Lisol 32 Botol Err:509 Err:509 -
2336 Masker 32 Set - - -
2338 Plester 5 yards x 2 inch 32 Rol Err:509 12 Err:509 8
2339 Sarung Tangan Karet Sekali Pakai S 32 Set (100) 500 400
Page 203 of 278

NO NAMA OBAT SATUAN
1 2 3 4 5 6 7 8
2340 Sarung Tangan Karet Sekali Pakai M 32 Set Err:509 1,000 Err:509 200
2344 Wing Needle No. 25 G 32 Buah Err:509 Err:509 -

Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
Page 204 of 278

(LPLPO)
BULAN : NOPEMBER
TAHUN : 2013

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509
962
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
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Page 205 of 278
SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
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Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
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Err:509
Err:509
Err:509
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Err:509
Err:509
Err:509
Err:509
-
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Page 206 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
184
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
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Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Page 207 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
Err:509
Err:509
-
600
-
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
Err:509
-
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
377
Err:509
Err:509
Err:509
Page 208 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
180
2,700
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
185
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
5,342
Err:509
Err:509
Page 209 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
1
1
5
8
1
1
-
-
1
-
-
-
-
-
-
-
-
-
-
-
-
1
-
-
-
-
-
-
-
1
-
Page 210 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
-
-
-
-
-
-
-
-
Err:509
Err:509
Err:509
-
300
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
13
Err:509
38
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
5
Err:509
(238)
Err:509
Err:509
Err:509
(3)
(65)
Err:509
Err:509
Err:509
Err:509
Err:509
Err:509
-
Err:509
Err:509
400
Page 211 of 278

SISA STOK KET
9 10 11 12 13 14 15 16 17
Err:509
Err:509
Err:509
Err:509
Err:509
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
-

Kepala UPTD Puskesmas Wates Petugas Puskesmas
0.. Dwi Mulyaningsih, S. Farm, Apt.

NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
Page 212 of 278

(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI BULAN : DESEMBER
PROPINSI : JAWA TIMUR TAHUN : 2013

TERAPI AWAL MAAN DIAAN AN OPTIMUM TAAN DAU JPKMM ASKES PROGRAM JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0101 Albendasol Tablet 400 mg 6.1.1 Tablet Err:509 Err:509 - Err:509
0102 Alopurinol Tablet 100 mg 1.3 Tablet 962 962 113 849
0103 Ambroxol sirup 15 mg/ml 26.1 Botol Err:509 Err:509 46 Err:509
0104 Ambroxol Tablet 30 mg 26.1 Tablet Err:509 Err:509 - Err:509
0105 Aminofilin Tablet 200 mg 26.1 Tablet Err:509 Err:509 - Err:509
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul Err:509 Err:509 - Err:509
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet Err:509 Err:509 - Err:509
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol Err:509 Err:509 42 Err:509
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul Err:509 Err:509 - Err:509
0110 Amoksisilin Kapsul 500 mg 6.2.1 Kaplet Err:509 Err:509 970 Err:509
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial Err:509 Err:509 - Err:509
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet Err:509 Err:509 - Err:509
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul Err:509 Err:509 60 Err:509
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet Err:509 Err:509 627 Err:509
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol Err:509 Err:509 50 Err:509
0116 Anti Bakteri DOEN, Salep Kombinasi 18.2 Tube Err:509 Err:509 - Err:509
0117 Antifungi DOEN Kombinasi:Asam Benzoat 6%18.3 Pot Err:509 Err:509 - Err:509
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria Err:509 Err:509 12 Err:509
0119 Antimigrain Doen Kombinasi 7.2 Tablet Err:509 Err:509 - Err:509
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol Err:509 Err:509 5 Err:509
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet Err:509 Err:509 194 Err:509
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet Err:509 Err:509 1,131 Err:509
0123 Asam Traneksamat 500 mg 10.3 Tablet Err:509 Err:509 - Err:509
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul Err:509 Err:509 - Err:509
0125 Asetosal Tablet 100 mg 1.2 Tablet Err:509 Err:509 - Err:509
Page 213 of 278
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0126 Asetosal Tablet 500 mg 1.2 Tablet Err:509 Err:509 - Err:509
0127 Asiklovir Tablet 400 mg 6.6.1 Tablet Err:509 Err:509 - Err:509
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet Err:509 Err:509 - Err:509
0129 Asiklovir Krim 5 % 6.6.1 Tube Err:509 Err:509 3 Err:509
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml 25.4 Ampul Err:509 Err:509 - Err:509
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet Err:509 Err:509 - Err:509
0132 Attapulgite Pektin 25.1 Tablet Err:509 Err:509 - Err:509
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial Err:509 Err:509 - Err:509
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet Err:509 Err:509 - Err:509
0203 Betametason Krim 0,1 % 18.4 Tube Err:509 Err:509 4 Err:509
0204 Bisacodyl 5 mg 25.6 Tablet Err:509 Err:509 - Err:509
0205 Bromheksin Tablet 8 mg 26.3 Tablet Err:509 Err:509 28 Err:509
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul Err:509 Err:509 300 Err:509
0302 Deksametason Tablet 0,5 mg 16.4 Tablet Err:509 Err:509 1,124 Err:509
0303 Dekstrometorfan HBR Sirup 10 mg/5 ml 26.2 Botol Err:509 Err:509 7 Err:509
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet Err:509 Err:509 157 Err:509
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul Err:509 Err:509 - Err:509
0306 Diazepam Tablet 2 mg 2.3 Tablet Err:509 Err:509 - Err:509
0307 Diazepam Tablet 5 mg 2.3 Tablet Err:509 Err:509 17 Err:509
0308 Dietilkarbamazin Sitrat Tablet 100 mg 6.1.2 Tablet Err:509 Err:509 - Err:509
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul Err:509 Err:509 - Err:509
0310 Digoksin Tablet 0,25 mg 17.5 Tablet Err:509 Err:509 10 Err:509
0311 Diltiazem HCl Tablet 30 mg 17.1 Tablet Err:509 Err:509 - Err:509
0312 Dimenhidrinat Tablet 25.2 Tablet Err:509 Err:509 30 Err:509
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul Err:509 Err:509 - Err:509
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol Err:509 Err:509 - Err:509
0315 Domperidon Tablet 10 mg 25.2 Tablet Err:509 Err:509 - Err:509
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet Err:509 Err:509 - Err:509
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet Err:509 Err:509 230 Err:509
0402 Ekstrak Belladon Tablet 10 mg 25.4 Tablet Err:509 Err:509 - Err:509
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul Err:509 Err:509 - Err:509
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul Err:509 Err:509 12 Err:509
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet Err:509 Err:509 262 Err:509
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol - - - -
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol Err:509 Err:509 1 Err:509
Page 214 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0408 Etambutol HCL Tablet 250 mg 6.2.4 Tablet Err:509 Err:509 - Err:509
0501 Famotidin Tablet 20 mg 25.1 Tablet Err:509 Err:509 - Err:509
0502 Fenitoin Natrium Injeksi 50 mg/ml 5 Ampul Err:509 Err:509 - Err:509
0503 Fenitoin Natrium Kapsul 100 mg 5 Kapsul Err:509 Err:509 - Err:509
0504 Fenitoin Natrium Kapsul 30 mg 5 Kapsul Err:509 Err:509 - Err:509
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul Err:509 Err:509 - Err:509
0506 Fenobarbital Tablet 100 mg 5 Tablet Err:509 Err:509 - Err:509
0507 Fenobarbital Tablet 30 mg 5 Tablet Err:509 Err:509 - Err:509
0508 Fenoksimetil Penisilina Tablet 250 mg 6.2.1 Tablet Err:509 Err:509 - Err:509
0509 Fenoksimetil Penisilina Tablet 500 mg 6.2.1 Tablet Err:509 Err:509 - Err:509
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol Err:509 Err:509 24 Err:509
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul Err:509 Err:509 80 Err:509
0512 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 10.2 Tablet Err:509 Err:509 55 Err:509
0513 Fluconazole Kapsul 150 mg 0 Kapsul Err:509 Err:509 - Err:509
0514 Fluor Tablet 0,5 mg 14.1 Tablet Err:509 Err:509 - Err:509
0515 Furosemid Tablet 40 mg 14 Tablet Err:509 Err:509 - Err:509
0516 Furosemid Injeksi i.v / i.m 10 mg/ml 14 Ampul Err:509 Err:509 - Err:509
0601 Gameksan Emulsi 1 % 18.5 Botol - - - -
0602 Garam Oralit 200 ml Air 20.1 Sachet Err:509 Err:509 70 Err:509
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul Err:509 Err:509 - Err:509
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube Err:509 Err:509 10 Err:509
0605 Gentian Violet Larutan 1 % 14.2 Botol Err:509 Err:509 5 Err:509
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet Err:509 Err:509 42 Err:509
0607 Gliseril Guayakolat Tablet 100 mg 26.3 Tablet Err:509 Err:509 836 Err:509
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol Err:509 Err:509 - Err:509
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol Err:509 Err:509 - Err:509
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial Err:509 Err:509 - Err:509
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet Err:509 Err:509 - Err:509
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet Err:509 Err:509 - Err:509
0702 Haloperidol Tablet 1,5 mg 23.4 Tablet Err:509 Err:509 - Err:509
0703 Haloperidol Tablet 2 mg 23.4 Tablet Err:509 Err:509 140 Err:509
0704 Haloperidol Tablet 5 mg 23.4 Tablet 184 184 184 -
0705 Haloperidol Dekanoat Injeksi 23.4 Ampul Err:509 Err:509 - Err:509
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet Err:509 Err:509 52 Err:509
0707 Hidrokortison Krim 2,5 % 18.4 Tube Err:509 Err:509 6 Err:509
Page 215 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet Err:509 Err:509 - Err:509
0801 Ibuprofen Tablet 200 mg 1.2 Tablet Err:509 Err:509 163 Err:509
0802 Ibuprofen Tablet 400 mg 1.2 Tablet Err:509 Err:509 486 Err:509
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet Err:509 Err:509 - Err:509
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet Err:509 Err:509 348 Err:509
0902 Kalium Permanganat Serbuk 13.1 Pot Err:509 Err:509 - Err:509
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet Err:509 Err:509 490 Err:509
0904 Kaolin Pektin Sirup 25.1 Botol Err:509 Err:509 - Err:509
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet Err:509 Err:509 48 Err:509
0905 Kaptopril Tablet 25 mg 17.3 Tablet Err:509 Err:509 370 Err:509
0906 Kaptopril Tablet 50 mg 17.3 Tablet Err:509 Err:509 - Err:509
0907 Karbamazepin Tablet 200 mg 5 Tablet Err:509 Err:509 30 Err:509
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet Err:509 Err:509 - Err:509
0909 Ketokonazol Krim 2% 6.4.1 Tube Err:509 Err:509 - Err:509
0910 Ketorolac Injeksi 10 mg 1.2 Ampul Err:509 Err:509 - Err:509
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul Err:509 Err:509 26 Err:509
0912 Klofazimin Kapsul 100 mg, Micronized 6.2.3 Kapsul Err:509 Err:509 - Err:509
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul Err:509 Err:509 120 Err:509
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol Err:509 Err:509 - Err:509
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol Err:509 Err:509 7 Err:509
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube Err:509 Err:509 7 Err:509
0917 Kloramfenikol Tetes Telinga 3 % 28.1 Botol Err:509 Err:509 13 Err:509
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 3 Tablet Err:509 Err:509 1,863 Err:509
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet Err:509 Err:509 - Err:509
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul Err:509 Err:509 - Err:509
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml 23.4 Ampul Err:509 Err:509 - Err:509
0922 Klorpromazin HCL Tablet Salut 100 mg 23.4 Tablet Err:509 Err:509 185 Err:509
0923 Klorpromazin HCL Tablet Salut 25 mg 23.4 Tablet Err:509 Err:509 - Err:509
0924 Klorpropamid Tablet 100 mg 16.1.1 Tablet Err:509 Err:509 - Err:509
0925 Kodein HCl Tablet 10 mg 26.2 Tablet Err:509 Err:509 - Err:509
0926 Kodein HCl Tablet 15 mg 26.3 Tablet Err:509 Err:509 - Err:509
0927 Kotrimoksasol Pediatrik Tablet 6.2.2 Tablet Err:509 Err:509 20 Err:509
0928 Kotrimoksasol Suspensi 6.2.2 Botol Err:509 Err:509 - Err:509
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet Err:509 Err:509 82 Err:509
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml 6.4.2.2 Ampul Err:509 Err:509 - Err:509
Page 216 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) 6.4.2.2 Tablet Err:509 Err:509 - Err:509
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet Err:509 Err:509 - Err:509
1002 Lidokain Kompositum Injeksi 14.1 Ampul Err:509 Err:509 100 Err:509
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul Err:509 Err:509 - Err:509
1004 Loratadin Tablet 10 mg 25.1 Tablet Err:509 Err:509 - Err:509
1005 Loperamid Tablet 25.5 Tablet Err:509 Err:509 14 Err:509
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml 5 Ampul Err:509 Err:509 - Err:509
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml 5 Ampul - - - -
1103 Mebendasol Sirup 100 mg/5 ml 6.1.1 Botol Err:509 Err:509 - Err:509
1104 Mebendasol Tablet 100 mg 6.1.1 Tablet Err:509 Err:509 - Err:509
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet - - - -
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 600 600 - 600
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul - - - -
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet Err:509 Err:509 - Err:509
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet Err:509 Err:509 - Err:509
1110 Metoklopramide Tablet 10 mg 25.2 Tablet Err:509 Err:509 - Err:509
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul Err:509 Err:509 - Err:509
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol Err:509 Err:509 5 Err:509
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet Err:509 Err:509 - Err:509
1114 Metronidasol Tablet 500 mg 6.2.2 Tablet Err:509 Err:509 203 Err:509
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol Err:509 Err:509 - Err:509
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube Err:509 Err:509 2 Err:509
1117 Multivitamin Sirup 29 Botol Err:509 Err:509 - Err:509
1118 Multivitamin tablet 29 Tablet Err:509 Err:509 - Err:509
1201 Natrium Bikarbonat Tablet 500 mg 4.1 Tablet Err:509 Err:509 - Err:509
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet Err:509 Err:509 - Err:509
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol Err:509 Err:509 20 Err:509
1204 Nifedipin Tablet 10 mg 17.3 Tablet Err:509 Err:509 - Err:509
1205 Nistatin 100.000 IU/G Tablet Vaginal 6.3 Tablet Err:509 Err:509 - Err:509
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet Err:509 Err:509 - Err:509
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket Err:509 Err:509 2 Err:509
1302 Obat Antituberkulosis Kategori 2 6.2.4 Paket Err:509 Err:509 - Err:509
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket Err:509 Err:509 1 Err:509
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol Err:509 Err:509 16 Err:509
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet Err:509 Err:509 36 Err:509
Page 217 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 106.2.2 Ampul - - - -
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube Err:509 Err:509 - Err:509
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube - - - -
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul Err:509 Err:509 - Err:509
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul Err:509 Err:509 - Err:509
1401 Papaverin Tablet 40 mg 25.4 Tablet Err:509 Err:509 - Err:509
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul Err:509 Err:509 - Err:509
1403 Paraformaldehid Tablet 1 Gram 13.2 Tablet Err:509 Err:509 - Err:509
1404 Parasetamol Drops 1.2 Botol Err:509 Err:509 - Err:509
1406 Parasetamol Tablet 100 mg 1.2 Tablet Err:509 Err:509 - Err:509
1407 Parasetamol Tablet 500 mg 1.2 Tablet Err:509 Err:509 2,098 Err:509
1408 Perfenazin Tablet 16 mg 23.4 Tablet Err:509 Err:509 - Err:509
1409 Perfenazin Tablet 4 mg 23.4 Tablet Err:509 Err:509 - Err:509
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul Err:509 Err:509 - Err:509
1411 Piracetam Tablet 400 mg 29 Tablet Err:509 Err:509 - Err:509
1412 Piracetam Tablet 800 mg 29 Tablet Err:509 Err:509 - Err:509
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet Err:509 Err:509 - Err:509
1414 Piridoksin HCL Tablet 10 mg 29 Tablet Err:509 Err:509 205 Err:509
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul Err:509 Err:509 30 Err:509
1416 Piroksikam Tablet 20 mg 25.7 Tablet Err:509 Err:509 - Err:509
1417 Polikresulen 14.2 Botol Err:509 Err:509 1 Err:509
1418 Prednison Tablet 5 mg 16.4 Tablet Err:509 Err:509 426 Err:509
1419 Primakuin Tablet 15 mg 6.4.2.2 Tablet Err:509 Err:509 - Err:509
1420 Propiltiourasil Tablet 100 mg 16.3 Tablet Err:509 Err:509 - Err:509
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet Err:509 Err:509 - Err:509
1501 Ranitidin Tablet 150 mg 25.1 Tablet Err:509 Err:509 652 Err:509
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul Err:509 Err:509 - Err:509
1503 Reserpin Tablet 0,10 mg 17.3 Tablet Err:509 Err:509 - Err:509
1504 Reserpin Tablet 0,25 mg 17.3 Tablet Err:509 Err:509 - Err:509
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul 180 180 - 180
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul 2,700 2,700 - 2,700
1507 Rifampisin Kapsul 300 mg 6.2.4 Kapsul Err:509 Err:509 - Err:509
1508 Ringer Asetat Cairan Infus 20.2 Botol Err:509 Err:509 - Err:509
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol Err:509 Err:509 40 Err:509
Page 218 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1601 Salbutamol Tablet 4 mg 26.1 Tablet Err:509 Err:509 - Err:509
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + 18.4 Pot Err:509 Err:509 1 Err:509
1603 Salisil Bedak 2 % 18.8 Kotak Err:509 Err:509 10 Err:509
1604 Salisil Spiritus 10 % 18.3 Botol Err:509 Err:509 - Err:509
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol Err:509 Err:509 3 Err:509
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul Err:509 Err:509 - Err:509
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet Err:509 Err:509 306 Err:509
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul Err:509 Err:509 - Err:509
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket Err:509 Err:509 - Err:509
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial Err:509 Err:509 - Err:509
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( ABU 27.1 Vial Err:509 Err:509 - Err:509
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A.D.S )27.1 Vial Err:509 Err:509 - Err:509
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul Err:509 Err:509 - Err:509
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial Err:509 Err:509 - Err:509
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul Err:509 Err:509 - Err:509
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg 10.1 Tablet Err:509 Err:509 117 Err:509
1618 Simetidin Tablet 200 mg 25.1 Tablet Err:509 Err:509 10 Err:509
1619 Simvastatin Tablet 10 mg 17.8 Tablet Err:509 Err:509 - Err:509
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet Err:509 Err:509 - Err:509
1621 Sulfadimidin Tablet 500 mg 6.2.2 Tablet Err:509 Err:509 - Err:509
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol Err:509 Err:509 - Err:509
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet 5,342 5,342 - 5,342
1702 Terbutalin tablet 2,5 mg 26.1 Tablet Err:509 Err:509 - Err:509
1703 Tetrasiklin HCL Kapsul 250 mg 6.2.2 Kapsul Err:509 Err:509 - Err:509
1704 Tetrasiklin HCL Kapsul 500 mg 6.2.2 Kapsul Err:509 Err:509 - Err:509
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul Err:509 Err:509 - Err:509
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol Err:509 Err:509 - Err:509
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul Err:509 Err:509 - Err:509
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet Err:509 Err:509 616 Err:509
1709 Tramadol Injeksi 50 mg/ml 1.1 Ampul Err:509 Err:509 - Err:509
1710 Tramadol Kapsul 50 mg 1.1 Kapsul Err:509 Err:509 - Err:509
1711 Triamcinolone Acetonide 1 mg 16.4 Tube Err:509 Err:509 1 Err:509
1712 Triheksifenidil Tablet 2 mg 9 Tablet Err:509 Err:509 140 Err:509
1801 Vitamin B Komplek Tablet 29 Tablet Err:509 Err:509 3,633 Err:509
Page 219 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1901 Yodium Povidon Larutan 10 % 30 ml 13.1 Botol Err:509 Err:509 1 Err:509
1902 Yodium Povidon Larutan 10 % 60 ml 13.1 Botol Err:509 Err:509 - Err:509
2001 Zinc Tablet 20 mg 25.5 Tablet Err:509 Err:509 17 Err:509
0 OBAT GIGI 0 0 - - - -
2101 Air Raksa Dental Use 14.1 Botol 1 1 - 1
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol 1 1 - 1
2103 Etil Klorida Spray 14.1 Vial 5 5 2 3
2104 Eugenol Cairan 14.1 Botol 8 8 1 7
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set 1 1 - 1
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube 1 1 - 1
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol - - - -
2108 Mummifying Pasta 14.1 Botol - - - -
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol 1 1 - 1
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol - - - -
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol - - - -
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set - - - -
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol - - - -
2114 Tumpatan Tetap dengan Sinar Set 14.1 Set - - - -
0 REAGEN LABORATORIUM 0 0 - - - -
2201 EDTA 10% cair 31 Botol - - - -
2202 Ether Alkohol: Ether 80% - Alkohol 20% 31 Botol - - - -
2203 Golongan darah Test ( set 3 vial @10 ml ) 31 Set - - - -
2204 HCL 0,1 N 31 Botol - - - -
2205 KOH 10% 31 Botol - - - -
2206 Larutan Benedict 31 Botol - - - -
2207 Larutan Buffer Giemsa 31 Botol 1 1 - 1
2208 Larutan Eosin 2% 31 Botol - - - -
2209 Larutan Etanol Asam 31 Botol - - - -
2210 Larutan Giemsa Stain 31 Botol - - - -
2211 Larutan Hayem 31 Botol - - - -
2212 Larutan Karbol Fuksin 31 Botol - - - -
2213 Larutan Metilen Biru 31 Botol - - - -
2214 Larutan Rees Ecker 31 Botol - - - -
Page 220 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2215 Larutan Turk 31 Botol 1 1 - 1
2216 Lens Tissu 31 Set - - - -
2217 Metanol 31 Botol - - - -
2218 Reagen SD-HIV 31 Set - - - -
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol - - - -
2220 Rapid Plasma Reagen Test Kit 31 Set - - - -
2221 Sifilis Kit 31 Set - - - -
2222 Tuberkulin 31 Set - - - -
2223 Widal slide test ( set a vial @ 5 ml ) Salmon 31 Set - - - -
PERBEKALAN KESEHATAN - - - -
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set Err:509 Err:509 - Err:509
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set Err:509 Err:509 - Err:509
2303 Alat Suntik Sekali Pakai 1 ml 32 Set Err:509 Err:509 - Err:509
2304 Alat Suntik Sekali Pakai 2,5 ml 32 Set - - - -
2306 Alat Suntik Sekali Pakai 5 ml 32 Set Err:509 Err:509 10 Err:509
2307 Alat Suntik Sekali Pakai 10 ml 32 Set Err:509 Err:509 - Err:509
2308 Alkohol 95% 32 Botol Err:509 Err:509 - Err:509
2309 Blood Lancet 32 Pcs Err:509 Err:509 - Err:509
2310 Blood Transfusion set 32 Set Err:509 Err:509 - Err:509
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak Err:509 Err:509 - Err:509
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol Err:509 Err:509 - Err:509
2313 Etanol (Alkohol 70%) 32 Botol 13 13 2 11
2314 Infusion Set Anak 32 Set Err:509 Err:509 3 Err:509
2315 Infusion Set Dewasa 32 Set 38 38 20 18
2316 Infusion Set Anak Elasty Ball 32 Set Err:509 Err:509 - Err:509
2317 Infusion Set Dewasa Elasty Ball 32 Set Err:509 Err:509 3 Err:509
2318 Jarum Infus (i.v. Catheter) Dewasa No 20 32 Biji Err:509 Err:509 - Err:509
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 Biji Err:509 Err:509 - Err:509
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji Err:509 Err:509 34 Err:509
2321 Kapas Berlemak 500 Gram 32 Bungkus Err:509 Err:509 - Err:509
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus 5 5 1 4
2323 Kasa Kompres 40/40 Steril 32 Bungkus Err:509 Err:509 - Err:509
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus (238) (238) - (238)
2325 Kasa Pembalut 2 m x 80 cm 32 Rol Err:509 Err:509 - Err:509
Page 221 of 278

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2326 Kasa Pembalut Elastic 3 inchi 32 Rol Err:509 Err:509 5 Err:509
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol Err:509 Err:509 - Err:509
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol (3) (3) 4 (7)
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol (65) (65) 5 (70)
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol Err:509 Err:509 - Err:509
2331 Kateter (Folley / Urine) No. 10 32 Biji Err:509 Err:509 - Err:509
2334 Klem tali pusat 32 Pcs Err:509 Err:509 - Err:509
2335 Lisol 32 Botol Err:509 Err:509 - Err:509
2336 Masker 32 Set - - - -
2337 Mess / Pisau scalpel no 11 32 Pcs Err:509 Err:509 - Err:509
2338 Plester 5 yards x 2 inch 32 Rol Err:509 Err:509 5 Err:509
2339 Sarung Tangan Karet Sekali Pakai S 32 Set 400 400 - 400
2340 Sarung Tangan Karet Sekali Pakai M 32 Set Err:509 Err:509 100 Err:509
2341 Sarung Tangan Karet Sekali Pakai L 32 Set Err:509 Err:509 - Err:509
2342 Silk / Benang Sutra no. 3/0 dengan Jarum Be 32 Sak Err:509 Err:509 - Err:509
2343 Urine Bag 32 Set Err:509 Err:509 - Err:509
2344 Wing Needle No. 25 G 32 Buah Err:509 Err:509 - Err:509
- - - -
UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
-
Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi dan Alkes Kepala UPTD Puskesmas Wates Petugas Puskesmas
Kabupaten Kediri
dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.
NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010 NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 011
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AN LEMBAR PERMINTAAN OBAT
LPLPO)
KET
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(LPLPO)

PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI
KELAS HARGA STOK PENERI- PERSE- PEMAKAI PEMBERIAN

NO NAMA OBAT SATUAN SISA STOK SISA (RUPIAH)
TERAPI SATUAN AWAL MAAN DIAAN AN DAU JPKMM ASKES
1 2 3 4 4 5 6 7 8 9 12 13 14
0101 Albendasol Tablet 400 mg 6.1.1 Tablet 406.67 - Err:509 Err:509 Err:509 Err:509 Err:509
0102 Alopurinol Tablet 100 mg 1.3 Tablet 132.00 846 Err:509 Err:509 997 Err:509 Err:509
0103 Ambroxol sirup 15 mg/ml 26.1 Botol 3,300.00 48 Err:509 Err:509 148 Err:509 Err:509
0104 Ambroxol Tablet 30 mg 26.1 Tablet 125.07 287 Err:509 Err:509 Err:509 Err:509 Err:509
0105 Aminofilin Tablet 200 mg 26.1 Tablet 80.30 5,910 Err:509 Err:509 Err:509 Err:509 Err:509
0106 Aminofilin Injeksi 24 mg/ml - 10 ML 26.1 Ampul 2,556.67 28 Err:509 Err:509 Err:509 Err:509 Err:509
0107 Amitriptilin HCL Tablet Salut 25 mg 23.2 Tablet 120.01 681 Err:509 Err:509 Err:509 Err:509 Err:509
0108 Amoksisilin Sirup Kering 125 mg/5 ml 6.2.1 Botol 3,700.00 120 Err:509 Err:509 Err:509 Err:509 Err:509
0109 Amoksisilin Kapsul 250 mg 6.2.1 Kapsul 238.00 5,128 Err:509 Err:509 Err:509 Err:509 Err:509
0110 Amoksisilin Kapsul 500 mg 6.2.1 Kaplet 370.00 7,599 Err:509 Err:509 Err:509 Err:509 Err:509
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg/ml 6.2.1 Vial 5,368.00 29 Err:509 Err:509 Err:509 Err:509 Err:509
0112 Antalgin ( metampiron ) Tablet 500 mg 1.2 Tablet 149.00 1,843 Err:509 Err:509 Err:509 Err:509 Err:509
0113 Antalgin Injeksi 250 mg/ml - 2 ml 1.2 Ampul 1,333.33 400 Err:509 Err:509 Err:509 Err:509 Err:509
0114 Antasida DOEN Tablet Kombinasi : 25.1 Tablet 134.97 46,136 Err:509 Err:509 Err:509 Err:509 Err:509
0115 Antasida DOEN II suspensi,kombinasi: Alum 25.1 Botol 3,850.00 95 Err:509 Err:509 Err:509 Err:509 Err:509
0116 Anti Bakteri DOEN, Salep Kombinasi 18.2 Tube 2,516.80 70 Err:509 Err:509 Err:509 Err:509 Err:509
0117 Antifungi DOEN Kombinasi:Asam Benzoat 6%18.3 Pot 1,718.75 - Err:509 Err:509 Err:509 Err:509 Err:509
0118 Antihemoroid DOEN Kombinasi:Bismut subgal 25.3 Supositoria 2,000.00 26 Err:509 Err:509 Err:509 Err:509 Err:509
0119 Antimigrain Doen Kombinasi 7.2 Tablet 102.80 - Err:509 Err:509 Err:509 Err:509 Err:509
0120 Aqua Proinjeksi Steril, Bebas Pirogen 20.3 Botol 5,500.00 97 Err:509 Err:509 Err:509 Err:509 Err:509
0121 Asam Askorbat ( Vit C ) Tablet 50 mg 29 Tablet 27.50 23,038 Err:509 Err:509 Err:509 Err:509 Err:509
0122 Asam Mefenamat Tablet 500 mg 1.2 Tablet 176.00 8,723 Err:509 Err:509 Err:509 Err:509 Err:509
0123 Asam Traneksamat 500 mg 10.3 Tablet 1,045.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0124 Asam Traneksamat injeksi 250 mg 10.3 Ampul 3,850.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0125 Asetosal Tablet 100 mg 1.2 Tablet 88.00 1,073 Err:509 Err:509 Err:509 Err:509 Err:509
0126 Asetosal Tablet 500 mg 1.2 Tablet 143.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0127 Asiklovir Tablet 400 mg 6.6.1 Tablet 630.50 1,114 Err:509 Err:509 Err:509 Err:509 Err:509
0128 Asiklovir Tablet 200 mg 6.6.1 Tablet 388.18 3,021 Err:509 Err:509 Err:509 Err:509 Err:509
0129 Asiklovir Krim 5 % 6.6.1 Tube 3,150.00 94 Err:509 Err:509 Err:509 Err:509 Err:509
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml 25.4 Ampul 1,265.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0131 Atropin Sulfat Tablet 0,5 mg 9 Tablet 60.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0132 Attapulgite Pektin 25.1 Tablet 319.00 170 Err:509 Err:509 Err:509 Err:509 Err:509
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial 6.2.1 Vial 11,400.00 100 Err:509 Err:509 Err:509 Err:509 Err:509
0202 Betahistin Mesilat Tablet 6 mg 1.2 Tablet 924.00 297 Err:509 Err:509 Err:509 Err:509 Err:509
0203 Betametason Krim 0,1 % 18.4 Tube 2,026.00 166 Err:509 Err:509 Err:509 Err:509 Err:509
0204 Bisacodyl 5 mg 25.6 Tablet 763.89 96 Err:509 Err:509 72 Err:509 Err:509
0205 Bromheksin Tablet 8 mg 26.3 Tablet 38.52 577 Err:509 Err:509 Err:509 Err:509 Err:509
0301 Deksametason Inj.5 mg/ml - 1 ml 16.4 Ampul 2,002.00 2,766 Err:509 Err:509 Err:509 Err:509 Err:509
0302 Deksametason Tablet 0,5 mg 16.4 Tablet 87.00 13,709 Err:509 Err:509 Err:509 Err:509 Err:509
0303 Dekstrometorfan HBR Sirup 10 mg/5 ml 26.2 Botol 2,865.00 85 Err:509 Err:509 Err:509 Err:509 Err:509
0304 Dekstrometorfan HBR Tablet 15 mg 26.2 Tablet 35.64 7,153 Err:509 Err:509 Err:509 Err:509 Err:509
0305 Diazepam Inj. 5 mg/ml - 2 ml 2.3 Ampul 2,368.10 72 Err:509 Err:509 Err:509 Err:509 Err:509
0306 Diazepam Tablet 2 mg 2.3 Tablet 25.96 3,177 Err:509 Err:509 Err:509 Err:509 Err:509
0307 Diazepam Tablet 5 mg 2.3 Tablet 66.00 573 Err:509 Err:509 Err:509 Err:509 Err:509
0308 Dietilkarbamazin Sitrat Tablet 100 mg 6.1.2 Tablet 73.64 - Err:509 Err:509 Err:509 Err:509 Err:509
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml 3 Ampul 799.33 180 Err:509 Err:509 Err:509 Err:509 Err:509
0310 Digoksin Tablet 0,25 mg 17.5 Tablet 83.21 2,281 Err:509 Err:509 Err:509 Err:509 Err:509
0311 Diltiazem HCl Tablet 30 mg 17.1 Tablet 151.62 - Err:509 Err:509 Err:509 Err:509 Err:509
0312 Dimenhidrinat Tablet 25.2 Tablet 84.50 - Err:509 Err:509 Err:509 Err:509 Err:509
0313 Doksisiklin Kapsul 100 mg 6.2.2.1 Kapsul 229.90 - Err:509 Err:509 Err:509 Err:509 Err:509
0314 Domperidon Suspensi 5 mg/ 5 ml 25.2 Botol 12,650.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0315 Domperidon Tablet 10 mg 25.2 Tablet 403.61 628 Err:509 Err:509 Err:509 Err:509 Err:509
0316 Echinacea purpurea 250mg, Zinc picolinate 1 31 Tablet 2,475.00 30 Err:509 Err:509 Err:509 Err:509 Err:509
0401 Efedrin HCL Tablet 25 mg 26.1 Tablet 42.59 11,370 Err:509 Err:509 Err:509 Err:509 Err:509
0402 Ekstrak Belladon Tablet 10 mg 25.4 Tablet 17.89 - Err:509 Err:509 Err:509 Err:509 Err:509
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. 0,1 3 Ampul 1,033.27 - Err:509 Err:509 Err:509 Err:509 Err:509
0404 Eritromisin Kapsul 250 mg 6.2.2.4 Kapsul 416.90 1,800 Err:509 Err:509 Err:509 Err:509 Err:509
0405 Eritromisin Tablet 500 mg 6.2.2.4 Tablet 710.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0406 Eritromisin Sirup 200 mg/5 mg 6.2.2.4 Botol 8,100.00 9 Err:509 Err:509 9 Err:509 Err:509
0407 Etakridin ( Rivanol ) Larutan 0,1 % 13.2 Botol 1,800.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0408 Etambutol HCL Tablet 250 mg 6.2.4 Tablet 308.67 - Err:509 Err:509 Err:509 Err:509 Err:509
0501 Famotidin Tablet 20 mg 25.1 Tablet 113.08 - Err:509 Err:509 Err:509 Err:509 Err:509
0502 Fenitoin Natrium Injeksi 50 mg/ml 5 Ampul 4,863.80 - Err:509 Err:509 Err:509 Err:509 Err:509
0503 Fenitoin Natrium Kapsul 100 mg 5 Kapsul 79.54 - Err:509 Err:509 Err:509 Err:509 Err:509
0504 Fenitoin Natrium Kapsul 30 mg 5 Kapsul 58.04 - Err:509 Err:509 Err:509 Err:509 Err:509
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml 5 Ampul 1,560.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0506 Fenobarbital Tablet 100 mg 5 Tablet 146.08 - Err:509 Err:509 Err:509 Err:509 Err:509
0507 Fenobarbital Tablet 30 mg 5 Tablet 25.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0508 Fenoksimetil Penisilina Tablet 250 mg 6.2.1 Tablet 210.92 - Err:509 Err:509 Err:509 Err:509 Err:509
0509 Fenoksimetil Penisilina Tablet 500 mg 6.2.1 Tablet 370.63 - Err:509 Err:509 Err:509 Err:509 Err:509
0510 Fenol Gliserol Tetes Telinga 10 % 28.2 Botol 1,008.33 - Err:509 Err:509 Err:509 Err:509 Err:509
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - 1 ml10.2 Ampul 1,740.00 153 Err:509 Err:509 Err:509 Err:509 Err:509
0512 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 10.2 Tablet 680.62 277 Err:509 Err:509 Err:509 Err:509 Err:509
0513 Fluconazole Kapsul 150 mg 0 Kapsul - - Err:509 Err:509 Err:509 Err:509 Err:509
0514 Fluor Tablet 0,5 mg 14.1 Tablet 32.91 - Err:509 Err:509 Err:509 Err:509 Err:509
0515 Furosemid Tablet 40 mg 14 Tablet 90.99 1,484 Err:509 Err:509 Err:509 Err:509 Err:509
0516 Furosemid Injeksi i.v / i.m 10 mg/ml 14 Ampul 1,839.64 - Err:509 Err:509 Err:509 Err:509 Err:509
0601 Gameksan Emulsi 1 % 18.5 Botol 2,200.00 24 Err:509 Err:509 24 Err:509 Err:509
0602 Garam Oralit 200 ml Air 20.1 Sachet 380.00 1,418 Err:509 Err:509 Err:509 Err:509 Err:509
0603 Gentamisin injeksi 40 mg/ml 6.2.2.5 Ampul 3,696.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0604 Gentamisin Salep Kulit 0,1 % 6.2.2.5 Tube 1,850.00 - Err:509 Err:509 19 Err:509 Err:509
0605 Gentian Violet Larutan 1 % 14.2 Botol 449.90 - Err:509 Err:509 Err:509 Err:509 Err:509
0606 Glibenklamid Tablet 5 mg 16.1.1 Tablet 59.99 1,490 Err:509 Err:509 Err:509 Err:509 Err:509
0607 Gliseril Guayakolat Tablet 100 mg 26.3 Tablet 23.23 14,069 Err:509 Err:509 Err:509 Err:509 Err:509
0608 Glukosa Larutan Infus 5 % Steril (Produk lokal20.2 Botol 3,630.00 102 Err:509 Err:509 Err:509 Err:509 Err:509
0609 Glukosa Larutan Infus 10 % Steril (Produk lok20.2 Botol 3,895.00 130 Err:509 Err:509 Err:509 Err:509 Err:509
0610 Glukosa Larutan Infus 40 % Steril 20.2 Vial 988.00 578 Err:509 Err:509 Err:509 Err:509 Err:509
0611 Griseofulvin Tablet 125 mg, Micronized 6.3 Tablet 240.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0701 Haloperidol Tablet 0,5 mg 23.4 Tablet 60.24 554 Err:509 Err:509 Err:509 Err:509 Err:509
0702 Haloperidol Tablet 1,5 mg 23.4 Tablet 82.58 - Err:509 Err:509 Err:509 Err:509 Err:509
0703 Haloperidol Tablet 2 mg 23.4 Tablet 95.25 290 Err:509 Err:509 280 Err:509 Err:509
0704 Haloperidol Tablet 5 mg 23.4 Tablet 122.29 - Err:509 Err:509 500 Err:509 Err:509
0705 Haloperidol Dekanoat Injeksi 23.4 Ampul - - Err:509 Err:509 Err:509 Err:509 Err:509
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg 15 Tablet 36.30 16,016 Err:509 Err:509 Err:509 Err:509 Err:509
0707 Hidrokortison Krim 2,5 % 18.4 Tube 3,000.00 188 Err:509 Err:509 Err:509 Err:509 Err:509
0708 Hyoscine Butylbromide 10 mg Methampyro 25.4 Tablet 1,320.00 220 Err:509 Err:509 Err:509 Err:509 Err:509
0801 Ibuprofen Tablet 200 mg 1.2 Tablet 105.00 2,097 Err:509 Err:509 Err:509 Err:509 Err:509
0802 Ibuprofen Tablet 400 mg 1.2 Tablet 205.04 3,958 Err:509 Err:509 Err:509 Err:509 Err:509
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg 17.1 Tablet 97.35 - Err:509 Err:509 Err:509 Err:509 Err:509
0901 Kalium Diklofenak Tablet 50 mg 1.2 Tablet 708.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0902 Kalium Permanganat Serbuk 13.1 Pot 312.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg 29 Tablet 52.00 13,030 Err:509 Err:509 Err:509 Err:509 Err:509
0904 Kaolin Pektin Sirup 25.1 Botol 5,445.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0904 Kaptopril Tablet 12,5 mg 17.3 Tablet 70.90 1,509 Err:509 Err:509 Err:509 Err:509 Err:509
0905 Kaptopril Tablet 25 mg 17.3 Tablet 137.75 2,395 Err:509 Err:509 Err:509 Err:509 Err:509
0906 Kaptopril Tablet 50 mg 17.3 Tablet 224.38 - Err:509 Err:509 Err:509 Err:509 Err:509
0907 Karbamazepin Tablet 200 mg 5 Tablet 246.45 - Err:509 Err:509 Err:509 Err:509 Err:509
0908 Ketokonazol Tablet 200 mg 6.4.1 Tablet 372.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0909 Ketokonazol Krim 2% 6.4.1 Tube 7,000.00 17 Err:509 Err:509 Err:509 Err:509 Err:509
0910 Ketorolac Injeksi 10 mg 1.2 Ampul 7,500.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0911 Klindamisin Kapsul 300 mg 6.2.2.4 Kapsul 509.98 790 Err:509 Err:509 Err:509 Err:509 Err:509
0912 Klofazimin Kapsul 100 mg, Micronized 6.2.3 Kapsul 2,194.28 - Err:509 Err:509 Err:509 Err:509 Err:509
0913 Kloramfenikol Kapsul 250 mg 6.2.2 Kapsul 209.97 15,793 Err:509 Err:509 Err:509 Err:509 Err:509
0914 Kloramfenikol Suspensi 125 mg/5 ml 6.2.2 Botol 3,999.60 - Err:509 Err:509 Err:509 Err:509 Err:509
0915 Kloramfenikol Tetes Mata 0,5 % 21.2.1 Botol 2,500.00 59 Err:509 Err:509 Err:509 Err:509 Err:509
0916 Kloramfenikol Salep Mata 1 % 21.2.1 Tube 1,562.00 126 Err:509 Err:509 Err:509 Err:509 Err:509
0917 Kloramfenikol Tetes Telinga 3 % 28.1 Botol 1,199.00 138 Err:509 Err:509 Err:509 Err:509 Err:509
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 3 Tablet 22.00 48,646 Err:509 Err:509 Err:509 Err:509 Err:509
0919 Klorokuin Fosfat Tablet 250 mg 6.4.2.1 Tablet 68.20 8,880 Err:509 Err:509 Err:509 Err:509 Err:509
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml 25.4 Ampul 733.33 - Err:509 Err:509 Err:509 Err:509 Err:509
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml 23.4 Ampul 723.33 - Err:509 Err:509 Err:509 Err:509 Err:509
0922 Klorpromazin HCL Tablet Salut 100 mg 23.4 Tablet 122.00 4,398 Err:509 Err:509 Err:509 Err:509 Err:509
0923 Klorpromazin HCL Tablet Salut 25 mg 23.4 Tablet 24.45 5,486 Err:509 Err:509 Err:509 Err:509 Err:509
0924 Klorpropamid Tablet 100 mg 16.1.1 Tablet 86.00 - Err:509 Err:509 Err:509 Err:509 Err:509
0925 Kodein HCl Tablet 10 mg 26.2 Tablet 727.98 772 Err:509 Err:509 Err:509 Err:509 Err:509
0926 Kodein HCl Tablet 15 mg 26.3 Tablet 727.98 - Err:509 Err:509 Err:509 Err:509 Err:509
0927 Kotrimoksasol Pediatrik Tablet 6.2.2 Tablet 69.99 1,724 Err:509 Err:509 Err:509 Err:509 Err:509
0928 Kotrimoksasol Suspensi 6.2.2 Botol 3,960.00 368 Err:509 Err:509 Err:509 Err:509 Err:509
0929 Kotrimoksasol Dewasa Tablet 6.2.2 Tablet 160.00 4,335 Err:509 Err:509 Err:509 Err:509 Err:509
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml 6.4.2.2 Ampul 1,171.17 - Err:509 Err:509 Err:509 Err:509 Err:509
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) 6.4.2.2 Tablet 249.52 - Err:509 Err:509 Err:509 Err:509 Err:509
1001 Levofloksasin Tablet 500 mg 6.2.1 Tablet 1,153.68 160 Err:509 Err:509 Err:509 Err:509 Err:509
1002 Lidokain Kompositum Injeksi 14.1 Ampul 1,136.67 177 Err:509 Err:509 Err:509 Err:509 Err:509
1003 Lidokain Hcl Injeksi 2 % 14.1 Ampul 1,010.00 153 Err:509 Err:509 Err:509 Err:509 Err:509
1004 Loratadin Tablet 10 mg 25.1 Tablet 333.08 - Err:509 Err:509 Err:509 Err:509 Err:509
1005 Loperamid Tablet 25.5 Tablet 91.54 2,374 Err:509 Err:509 Err:509 Err:509 Err:509
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 ml 5 Ampul 1,539.80 - Err:509 Err:509 Err:509 Err:509 Err:509
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 ml 5 Ampul 1,947.88 - Err:509 Err:509 17 Err:509 Err:509
1103 Mebendasol Sirup 100 mg/5 ml 6.1.1 Botol 2,035.00 - 2,305 2,305 1,200 1,105 2,248,675.00
1104 Mebendasol Tablet 100 mg 6.1.1 Tablet 141.03 - 14 14 - 14 1,974.42
1105 Meloksikam Tablet 7,5 mg 1.3 Tablet 691.90 - Err:509 Err:509 - Err:509 Err:509
1106 Metil Ergometrin Maleat Tablet Salut 0,125 22.1 Tablet 109.89 1,105 Err:509 Err:509 1,105 Err:509 Err:509
1107 Metil Ergometrin Maleat Inj. 0,200 mg - 1 ml22.1 Ampul 1,490.00 - Err:509 Err:509 14 Err:509 Err:509
1108 Metilprednisolon Tablet 4 mg 16.5 Tablet 440.55 277 Err:509 Err:509 Err:509 Err:509 Err:509
1109 Metformin HCl Tablet 500 mg 16.2.1 Tablet 165.00 2,859 Err:509 Err:509 Err:509 Err:509 Err:509
1110 Metoklopramide Tablet 10 mg 25.2 Tablet 110.00 1,010 Err:509 Err:509 Err:509 Err:509 Err:509
1111 Metoklopramide Injeksi 5 mg/ml 25.2 Ampul 1,000.00 24 Err:509 Err:509 Err:509 Err:509 Err:509
1112 Metoklopramide Sirup 5 mg/5ml 25.2 Botol 2,100.00 23 Err:509 Err:509 Err:509 Err:509 Err:509
1113 Metronidasol Tablet 250 mg 6.2.2 Tablet 130.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1114 Metronidasol Tablet 500 mg 6.2.2 Tablet 189.99 1,593 Err:509 Err:509 Err:509 Err:509 Err:509
1115 Metronidazol Infus 500 mg/100 ml 6.2.2 Botol 29,499.80 18 Err:509 Err:509 Err:509 Err:509 Err:509
1116 Mikonazol Krim/Salep 2 % 6.4.2 Tube 3,000.00 96 Err:509 Err:509 Err:509 Err:509 Err:509
1117 Multivitamin Sirup 29 Botol 6,380.00 49 Err:509 Err:509 Err:509 Err:509 Err:509
1118 Multivitamin tablet 29 Tablet 489.50 350 Err:509 Err:509 Err:509 Err:509 Err:509
1201 Natrium Bikarbonat Tablet 500 mg 4.1 Tablet 9.75 - Err:509 Err:509 Err:509 Err:509 Err:509
1202 Natrium Diklofenak Tablet 50 mg 1.2 Tablet 217.67 762 Err:509 Err:509 Err:509 Err:509 Err:509
1203 Natrium Klorida Larutan Infus 0,9 % Steril 20.2 Botol 4,132.00 169 Err:509 Err:509 Err:509 Err:509 Err:509
1204 Nifedipin Tablet 10 mg 17.3 Tablet 107.84 12,404 Err:509 Err:509 Err:509 Err:509 Err:509
1205 Nistatin 100.000 IU/G Tablet Vaginal 6.3 Tablet 288.91 - Err:509 Err:509 Err:509 Err:509 Err:509
1206 Nistatin 500.000 IU Tablet Salut 6.3 Tablet 600.00 217 Err:509 Err:509 Err:509 Err:509 Err:509
1301 Obat Antituberkulosis Kategori 1 6.2.4 Paket ### 1 Err:509 Err:509 8 Err:509 Err:509
1302 Obat Antituberkulosis Kategori 2 6.2.4 Paket ### - Err:509 Err:509 Err:509 Err:509 Err:509
1303 Obat Antituberkulosis Kategori Anak 6.2.4 Paket ### - Err:509 Err:509 Err:509 Err:509 Err:509
1304 Obat Batuk Hitam ( O.B.H ) Cairan 26.3 Botol 1,430.00 76 Err:509 Err:509 Err:509 Err:509 Err:509
1305 Obat Flu Kombinasi (Alpara) 26.3 Tablet 415.80 - Err:509 Err:509 1,383 Err:509 Err:509
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 106.2.2 Ampul 2,061.10 - Err:509 Err:509 30 Err:509 Err:509
1306 Oksitetrasiklin HCL Salep 3 % 18.2 Tube 1,674.20 86 Err:509 Err:509 Err:509 Err:509 Err:509
1307 Oksitetrasiklin HCL Salep Mata 21.2.2 Tube 2,100.00 342 Err:509 Err:509 342 Err:509 Err:509
1308 Oksitosin Injeksi 10 IU/ml - 1 ml 22.1 Ampul 1,785.00 130 Err:509 Err:509 130 Err:509 Err:509
1309 Omeprazol Kapsul 20 mg 25.4 Kapsul 408.33 - Err:509 Err:509 Err:509 Err:509 Err:509
1401 Papaverin Tablet 40 mg 25.4 Tablet 93.00 2,103 Err:509 Err:509 Err:509 Err:509 Err:509
1402 Papaverin Injeksi 40 mg/ml 25.4 Ampul 530.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1403 Paraformaldehid Tablet 1 Gram 13.2 Tablet 60.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1404 Parasetamol Drops 1.2 Botol 4,799.30 90 Err:509 Err:509 Err:509 Err:509 Err:509
1405 Parasetamol Sirup 120 mg/5 ml 1.2 Botol 2,300.00 196 Err:509 Err:509 Err:509 Err:509 Err:509
1406 Parasetamol Tablet 100 mg 1.2 Tablet 41.90 1,690 Err:509 Err:509 Err:509 Err:509 Err:509
1407 Parasetamol Tablet 500 mg 1.2 Tablet 105.00 17,444 Err:509 Err:509 Err:509 Err:509 Err:509
1408 Perfenazin Tablet 16 mg 23.4 Tablet - - Err:509 Err:509 Err:509 Err:509 Err:509
1409 Perfenazin Tablet 4 mg 23.4 Tablet 42.41 - Err:509 Err:509 Err:509 Err:509 Err:509
1410 Piracetam Injeksi 1 g/5 ml 29 Ampul 5,500.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1411 Piracetam Tablet 400 mg 29 Tablet 501.60 - Err:509 Err:509 Err:509 Err:509 Err:509
1412 Piracetam Tablet 800 mg 29 Tablet 880.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1413 Pirantel Pamoat Tablet 125 mg 6.1.1 Tablet 309.98 - Err:509 Err:509 Err:509 Err:509 Err:509
1414 Piridoksin HCL Tablet 10 mg 29 Tablet 17.40 2,443 Err:509 Err:509 Err:509 Err:509 Err:509
1415 Piroksikam Kapsul 10 mg 25.7 Kapsul 75.00 1,068 Err:509 Err:509 Err:509 Err:509 Err:509
1416 Piroksikam Tablet 20 mg 25.7 Tablet 104.94 - Err:509 Err:509 Err:509 Err:509 Err:509
1417 Polikresulen 14.2 Botol 24,500.00 3 Err:509 Err:509 3 Err:509 Err:509
1418 Prednison Tablet 5 mg 16.4 Tablet 57.50 4,971 Err:509 Err:509 Err:509 Err:509 Err:509
1419 Primakuin Tablet 15 mg 6.4.2.2 Tablet 30.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1420 Propiltiourasil Tablet 100 mg 16.3 Tablet 299.57 - Err:509 Err:509 Err:509 Err:509 Err:509
1421 Propanolol HCL Tablet 40 mg 7.1 Tablet 1,221.00 2,464 Err:509 Err:509 Err:509 Err:509 Err:509
1501 Ranitidin Tablet 150 mg 25.1 Tablet 209.99 3,600 Err:509 Err:509 Err:509 Err:509 Err:509
1502 Ranitidin Injeksi 25 mg/2 ml 25.1 Ampul 2,570.00 200 Err:509 Err:509 Err:509 Err:509 Err:509
1503 Reserpin Tablet 0,10 mg 17.3 Tablet 32.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1504 Reserpin Tablet 0,25 mg 17.3 Tablet 55.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU 29 Kapsul 286.00 200 Err:509 Err:509 Err:509 Err:509 Err:509
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU 29 Kapsul 462.00 400 Err:509 Err:509 Err:509 Err:509 Err:509
1507 Rifampisin Kapsul 300 mg 6.2.4 Kapsul 350.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1508 Ringer Asetat Cairan Infus 20.2 Botol 15,900.00 40 Err:509 Err:509 Err:509 Err:509 Err:509
1508 Ringer Laktat Larutan Infus Steril 20.2 Botol 5,199.70 394 Err:509 Err:509 Err:509 Err:509 Err:509
1601 Salbutamol Tablet 4 mg 26.1 Tablet 97.48 924 Err:509 Err:509 Err:509 Err:509 Err:509
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + 18.4 Pot 1,229.17 49 Err:509 Err:509 Err:509 Err:509 Err:509
1603 Salisil Bedak 2 % 18.8 Kotak 1,430.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1604 Salisil Spiritus 10 % 18.3 Botol 1,115.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1605 Sefadroxil Sirup Kering 125 mg/ml 6.2.1 Botol 8,200.00 109 Err:509 Err:509 Err:509 Err:509 Err:509
1606 Sefadroxil Kapsul 250 mg 6.2.1 Kapsul 445.05 500 Err:509 Err:509 Err:509 Err:509 Err:509
1607 Sefadroxil Kapsul 500 mg 6.2.1 Tablet 840.00 328 Err:509 Err:509 Err:509 Err:509 Err:509
1608 Sefiksim Kapsul 100 mg 6.2.1 Kapsul 2,394.60 430 Err:509 Err:509 Err:509 Err:509 Err:509
1609 Sefiksim 400 mg + Azitromisin 1000 mg 6.2.1 Paket 33,000.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1610 Sefotaksim Injeksi 1 g 6.2.1 Vial 6,930.00 297 Err:509 Err:509 277 Err:509 Err:509
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( ABU27.1 Vial ### - Err:509 Err:509 Err:509 Err:509 Err:509
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( ABU 27.1 Vial ### - Err:509 Err:509 Err:509 Err:509 Err:509
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A.D.S )27.1 Vial ### - Err:509 Err:509 Err:509 Err:509 Err:509
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( A.T.27.1 Ampul 52,500.00 4 Err:509 Err:509 Err:509 Err:509 Err:509
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A.T.S 27.1 Vial ### - Err:509 Err:509 Err:509 Err:509 Err:509
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg/ml 10.1 Ampul 1,037.00 252 Err:509 Err:509 Err:509 Err:509 Err:509
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg 10.1 Tablet 12.36 1,039 Err:509 Err:509 Err:509 Err:509 Err:509
1618 Simetidin Tablet 200 mg 25.1 Tablet 105.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1619 Simvastatin Tablet 10 mg 17.8 Tablet 513.00 - Err:509 Err:509 1,800 Err:509 Err:509
1620 Siprofloksasin Tablet 500 mg 6.2.2.6 Tablet 264.99 4,637 Err:509 Err:509 Err:509 Err:509 Err:509
1621 Sulfadimidin Tablet 500 mg 6.2.2 Tablet 12.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1622 Sulfasetamid Natrium Tetes Mata 15 % 21.2.2 Botol 3,445.25 488 Err:509 Err:509 Err:509 Err:509 Err:509
1701 Tablet Tambah Darah Kombinasi 10.1 Tablet 66.67 51,342 Err:509 Err:509 46,000 Err:509 Err:509
1702 Terbutalin tablet 2,5 mg 26.1 Tablet 97.38 - Err:509 Err:509 Err:509 Err:509 Err:509
1703 Tetrasiklin HCL Kapsul 250 mg 6.2.2 Kapsul 166.75 - Err:509 Err:509 Err:509 Err:509 Err:509
1704 Tetrasiklin HCL Kapsul 500 mg 6.2.2 Kapsul 249.70 - Err:509 Err:509 Err:509 Err:509 Err:509
1705 Tiamfenikol Kapsul 500 mg 6.2.2 Kapsul 580.00 260 Err:509 Err:509 Err:509 Err:509 Err:509
1706 Tiamfenikol sirup kering 125 mg / 5 ml 6.2.2 Botol 6,600.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 ml 29 Ampul 766.67 - Err:509 Err:509 Err:509 Err:509 Err:509
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 29 Tablet 37.80 11,064 Err:509 Err:509 Err:509 Err:509 Err:509
1709 Tramadol Injeksi 50 mg/ml 1.1 Ampul 6,707.40 - Err:509 Err:509 Err:509 Err:509 Err:509
1710 Tramadol Kapsul 50 mg 1.1 Kapsul 345.12 - Err:509 Err:509 Err:509 Err:509 Err:509
1711 Triamcinolone Acetonide 1 mg 16.4 Tube 12,100.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1712 Triheksifenidil Tablet 2 mg 9 Tablet 41.25 952 Err:509 Err:509 Err:509 Err:509 Err:509
1801 Vitamin B Komplek Tablet 29 Tablet 22.20 2,143 Err:509 Err:509 Err:509 Err:509 Err:509
1901 Yodium Povidon Larutan 10 % 30 ml 13.1 Botol 2,000.00 - Err:509 Err:509 Err:509 Err:509 Err:509
1902 Yodium Povidon Larutan 10 % 60 ml 13.1 Botol 3,500.00 11 Err:509 Err:509 Err:509 Err:509 Err:509
1903 Yodium Povidon Larutan 10 % 300 ml 13.1 Botol 14,500.00 11 Err:509 Err:509 Err:509 Err:509 Err:509
1904 Yodium Povidon Larutan 10 % 1000 ml 13.1 Botol 42,000.00 Err:509 Err:509 Err:509 Err:509 Err:509
2001 Zinc Tablet 20 mg 25.5 Tablet 475.00 303 Err:509 Err:509 Err:509 Err:509 Err:509
0 OBAT GIGI 0 0 - - Err:509 Err:509 Err:509 Err:509 Err:509
2101 Air Raksa Dental Use 14.1 Botol ### 1 Err:509 Err:509 Err:509 Err:509 Err:509
2102 Devitalisasi Pasta ( Non Arsen ) 14.1 Botol ### 1 Err:509 Err:509 Err:509 Err:509 Err:509
2103 Etil Klorida Spray 14.1 Vial ### 5 Err:509 Err:509 Err:509 Err:509 Err:509
2104 Eugenol Cairan 14.1 Botol 45,833.33 8 Err:509 Err:509 Err:509 Err:509 Err:509
2105 Glass Ionomer Cement Universal Restorativ 14.1 Set ### 1 Err:509 Err:509 - Err:509 Err:509
2106 Kalsium Hidroksida Pasta (Kalsidor) 14.1 Tube ### - Err:509 Err:509 Err:509 Err:509 Err:509
2107 Monoklorkamfer Mentol Cairan (CHKM) 14.1 Botol 55,000.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2108 Mummifying Pasta 14.1 Botol ### 1 Err:509 Err:509 1 Err:509 Err:509
2109 Semen Seng Fosfat Serbuk dan Cairan 14.1 Botol 93,500.00 1 Err:509 Err:509 - Err:509 Err:509
2110 Silver Amalgam Serbuk 65-75 % 14.1 Botol ### - Err:509 Err:509 Err:509 Err:509 Err:509
2111 Temporary Filling Material / Hydraulic Temp 14.1 Botol ### - Err:509 Err:509 Err:509 Err:509 Err:509
2112 Temporary Stopping Fletcher Serbuk dan Cai 14.1 Set 34,000.00 1 Err:509 Err:509 1 Err:509 Err:509
2113 Trikresol Formalin ( TKF ) Cairan 14.1 Botol 46,195.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2114 Tumpatan Tetap dengan Sinar Set 14.1 Set ### - Err:509 Err:509 Err:509 Err:509 Err:509
0 REAGEN LABORATORIUM 0 0 - - Err:509 Err:509 Err:509 Err:509 Err:509
2201 EDTA 10% cair 31 Botol 72,600.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2202 Ether Alkohol: Ether 80% - Alkohol 20% 31 Botol 44,547.80 - Err:509 Err:509 Err:509 Err:509 Err:509
2203 Golongan darah Test ( set 3 vial @10 ml ) 31 Set ### - Err:509 Err:509 Err:509 Err:509 Err:509
2204 HCL 0,1 N 31 Botol 19,800.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2205 KOH 10% 31 Botol 30,000.00 5 Err:509 Err:509 5 Err:509 Err:509
2206 Larutan Benedict 31 Botol 27,445.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2207 Larutan Buffer Giemsa 31 Botol 44,000.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2208 Larutan Eosin 2% 31 Botol 34,683.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2209 Larutan Etanol Asam 31 Botol 25,300.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2210 Larutan Giemsa Stain 31 Botol 60,038.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2211 Larutan Hayem 31 Botol 17,600.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2212 Larutan Karbol Fuksin 31 Botol 22,011.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2213 Larutan Metilen Biru 31 Botol 16,195.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2214 Larutan Rees Ecker 31 Botol 38,500.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2215 Larutan Turk 31 Botol 13,819.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2216 Lens Tissu 31 Set 440.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2217 Metanol 31 Botol 23,584.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2218 Reagen SD-HIV 31 Set - - Err:509 Err:509 Err:509 Err:509 Err:509
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolfuchs 31 Botol ### - Err:509 Err:509 Err:509 Err:509 Err:509
2220 Rapid Plasma Reagen Test Kit 31 Set ### - Err:509 Err:509 Err:509 Err:509 Err:509
2221 Sifilis Kit 31 Set 18,000.00 187 Err:509 Err:509 187 Err:509 Err:509
2222 Tuberkulin 31 Set - - Err:509 Err:509 Err:509 Err:509 Err:509
2223 Widal slide test ( set a vial @ 5 ml ) Salmon 31 Set ### - Err:509 Err:509 Err:509 Err:509 Err:509
PERBEKALAN KESEHATAN - Err:509 Err:509 Err:509 Err:509 Err:509
2301 Alat Suntik Sekali Pakai 0,05 ml 32 Set 2,900.00 140 Err:509 Err:509 Err:509 Err:509 Err:509
2302 Alat Suntik Sekali Pakai 0,5 ml 32 Set 2,100.00 36 700 736 480 256 537,600.00
2303 Alat Suntik Sekali Pakai 1 ml 32 Set 1,092.50 580 Err:509 Err:509 Err:509 Err:509 Err:509
2304 Alat Suntik Sekali Pakai 2,5 ml 32 Set 1,037.99 - Err:509 Err:509 Err:509 Err:509 Err:509
2305 Alat Suntik Sekali Pakai 3 ml 32 Set 593.94 192 Err:509 Err:509 312 Err:509 Err:509
2306 Alat Suntik Sekali Pakai 5 ml 32 Set 1,038.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2307 Alat Suntik Sekali Pakai 10 ml 32 Set 1,500.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2308 Alkohol 95% 32 Botol 32,450.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2309 Blood Lancet 32 Pcs 297.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2310 Blood Transfusion set 32 Set 25,300.00 - 61 61 54 7 177,100.00
2311 Catgut / Benang Bedah No. 3/0 dengan jaru 32 Sak 24,583.33 - Err:509 Err:509 Err:509 Err:509 Err:509
2312 Dresing penutup luka berperekat 5cm x 5m 32 Rol 52,437.00 1 405 406 312 94 4,929,078.00
2313 Etanol (Alkohol 70%) 32 Botol 18,698.00 16 Err:509 Err:509 Err:509 Err:509 Err:509
2314 Infusion Set Anak 32 Set 4,000.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2315 Infusion Set Dewasa 32 Set 3,499.10 127 Err:509 Err:509 109 Err:509 Err:509
2316 Infusion Set Anak Elasty Ball 32 Set 17,600.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2317 Infusion Set Dewasa Elasty Ball 32 Set 12,100.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2318 Jarum Infus (i.v. Catheter) Dewasa No 20 32 Biji 7,787.34 263 Err:509 Err:509 Err:509 Err:509 Err:509
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 Biji 7,787.34 97 15 112 9 103 802,096.02
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 Biji 7,787.50 180 Err:509 Err:509 Err:509 Err:509 Err:509
2321 Kapas Berlemak 500 Gram 32 Bungkus 17,250.00 - (230) (230) (518) 288 4,968,000.00
2322 Kapas Pembalut / Absorben 250 gram 32 Bungkus 7,500.00 7 Err:509 Err:509 6 Err:509 Err:509
2323 Kasa Kompres 40/40 Steril 32 Bungkus 1,393.00 8 Err:509 Err:509 Err:509 Err:509 Err:509
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lembar) 32 Bungkus 531.25 160 Err:509 Err:509 Err:509 Err:509 Err:509
2325 Kasa Pembalut 2 m x 80 cm 32 Rol 8,799.00 - 44 44 37 7 61,593.00
2326 Kasa Pembalut Elastic 3 inchi 32 Rol 7,000.00 10 (35) (25) (105) 80 560,000.00
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 Rol 733.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 Rol 607.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 Rol 3,373.00 10 Err:509 Err:509 70 Err:509 Err:509
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 Rol 55,200.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2331 Kateter (Folley / Urine) No. 10 32 Biji 8,495.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2332 Kateter (Folley / Urine) No. 16 32 Biji 7,260.00 84 Err:509 Err:509 Err:509 Err:509 Err:509
2333 Kateter (Folley / Urine) No. 18 32 Biji 8,494.20 - 150 150 150 - -
2334 Klem tali pusat 32 Pcs 2,750.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2335 Lisol 32 Botol 49,862.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2336 Masker 32 Set 1,125.00 430 Err:509 Err:509 Err:509 Err:509 Err:509
2337 Mess / Pisau scalpel no 11 32 Pcs 770.00 - Err:509 Err:509 Err:509 Err:509 Err:509
2338 Plester 5 yards x 2 inch 32 Rol 23,624.70 16 Err:509 Err:509 Err:509 Err:509 Err:509
2339 Sarung Tangan Karet Sekali Pakai S 32 Set 2,125.00 460 Err:509 Err:509 Err:509 Err:509 Err:509
2340 Sarung Tangan Karet Sekali Pakai M 32 Set 2,125.00 532 Err:509 Err:509 Err:509 Err:509 Err:509
2341 Sarung Tangan Karet Sekali Pakai L 32 Set 2,124.98 250 Err:509 Err:509 Err:509 Err:509 Err:509
2342 Silk / Benang Sutra no. 3/0 dengan Jarum Be 32 Sak 5,743.86 80 - 80 - 80 459,508.80
2343 Urine Bag 32 Set 4,000.00 - - - - - -
2344 Wing Needle No. 25 G 32 Buah 2,530.00 50 - 50 #VALUE! #VALUE! #VALUE!
- - - #VALUE! #VALUE! #VALUE!
- - - #VALUE! #VALUE! #VALUE!
- - - - - -
- - - - - -
ASKES JUMLAH
- - - - -
- - - - - -
- - - - -
- - - - -
- - #VALUE! #VALUE! #VALUE!
Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor Yang Menerima
Kepala Dinas Kesehatan Kepala UPTD Gudang Farmasi dan Alkes Kepala UPTD Puskesmas Wates Petugas Puskesmas
Kabupaten Kediri
dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, A
NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010 NIP. 19820312 201101 1 004 NIP. 19861101 201101 2 01
BULAN : DESEMBER
TAHUN : 2013
MBERIAN
KET
PROGRAM JUMLAH
15 16 17
JUMLAH
Yang Menerima
Petugas Puskesmas
Dwi Mulyaningsih, S. Farm, Apt.

NIP. 19861101 201101 2 011
LAPORAN PERSEDIAAAN DAN PEMAKAIAN OBAT TAHUN 2013
PUSKESMAS : WATES
KECAMATAN : WATES
KABUPATEN : KEDIRI
STOK
HARGA PENERI- PERSE-
NO NAMA OBAT SATUAN AWAL
SATUAN MAAN DIAAN
JUNI
1 2 4 5 6 7
0101 Albendasol Tablet 400 mg Tablet 406.67 - Err:509 Err:509
0102 Alopurinol Tablet 100 mg Tablet 132.00 846 Err:509 Err:509
0103 Ambroxol sirup 15 mg/ml Botol 3,300.00 48 Err:509 Err:509
0104 Ambroxol Tablet 30 mg Tablet 125.07 287 Err:509 Err:509
0105 Aminofilin Tablet 200 mg Tablet 80.30 5,910 Err:509 Err:509
0106 Aminofilin Injeksi 24 mg/ml - 10 ML Ampul 2,556.67 28 Err:509 Err:509
0107 Amitriptilin HCL Tablet Salut 25 mg Tablet 120.01 681 Err:509 Err:509
0108 Amoksisilin Sirup Kering 125 mg/5 ml Botol 3,700.00 120 Err:509 Err:509
0109 Amoksisilin Kapsul 250 mg Kapsul 238.00 5,128 Err:509 Err:509
0110 Amoksisilin Kapsul 500 mg Kaplet 370.00 7,599 10,000 17,599
0111 Ampisillin Serbuk Injeksi i.m/i.v 1000 mg Vial 5,368.00 29 50 79
0112 Antalgin ( metampiron ) Tablet 500 mg Tablet 149.00 1,843 Err:509 Err:509
0113 Antalgin Injeksi 250 mg/ml - 2 ml Ampul 1,333.33 400 Err:509 Err:509
0114 Antasida DOEN Tablet Kombinasi : Tablet 134.97 46,136 Err:509 Err:509
0115 Antasida DOEN II suspensi,kombinasi: Botol 3,850.00 95 Err:509 Err:509
0116 Anti Bakteri DOEN, Salep Kombinasi Tube 2,516.80 70 Err:509 Err:509
0117 Antifungi DOEN Kombinasi:Asam Benzoat Pot 1,718.75 130 Err:509 Err:509
0118 Antihemoroid DOEN Kombinasi:Bismut su Supositoria 2,000.00 26 Err:509 Err:509
0119 Antimigrain Doen Kombinasi Tablet 102.80 - Err:509 Err:509
0120 Aqua Proinjeksi Steril, Bebas Pirogen Botol 5,500.00 97 Err:509 Err:509
0121 Asam Askorbat ( Vit C ) Tablet 50 mg Tablet 27.50 23,038 Err:509 Err:509
0122 Asam Mefenamat Tablet 500 mg Tablet 176.00 8,723 17,200 25,923
0123 Asam Traneksamat 500 mg Tablet 1,045.00 200 Err:509 Err:509
0124 Asam Traneksamat injeksi 250 mg Ampul 3,850.00 30 Err:509 Err:509
0125 Asetosal Tablet 100 mg Tablet 88.00 1,073 Err:509 Err:509
0126 Asetosal Tablet 500 mg Tablet 143.00 105 Err:509 Err:509
0127 Asiklovir Tablet 400 mg Tablet 630.50 1,114 Err:509 Err:509
0128 Asiklovir Tablet 200 mg Tablet 388.18 3,021 Err:509 Err:509
0129 Asiklovir Krim 5 % tube 3,150.00 94 Err:509 Err:509
0130 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml Ampul 1,265.00 30 Err:509 Err:509
0131 Atropin Sulfat Tablet 0,5 mg Tablet 60.00 1,000 Err:509 Err:509
0132 Attapulgite Pektin Tablet 319.00 170 Err:509 Err:509
0201 Benzatin Benzil Penisilin 2,4 juta IU/vial Vial 11,400.00 100 Err:509 Err:509
0202 Betahistin Mesilat Tablet 6 mg Tablet 924.00 297 Err:509 Err:509
0203 Betametason Krim 0,1 % Tube 2,026.00 166 Err:509 Err:509
0204 Bisacodyl 5 mg Tablet 763.89 96 Err:509 Err:509
0205 Bromheksin Tablet 8 mg Tablet 38.52 577 Err:509 Err:509
0301 Deksametason Inj.5 mg/ml - 1 ml Ampul 2,002.00 2,766 Err:509 Err:509
0302 Deksametason Tablet 0,5 mg Tablet 87.00 13,709 Err:509 Err:509
0303 Dekstrometorfan HBR Sirup 10 mg/5 ml Botol 2,865.00 85 Err:509 Err:509
0304 Dekstrometorfan HBR Tablet 15 mg Tablet 35.64 7,153 Err:509 Err:509
0305 Diazepam Inj. 5 mg/ml - 2 ml Ampul 2,368.10 72 Err:509 Err:509
0306 Diazepam Tablet 2 mg Tablet 25.96 3,177 Err:509 Err:509
0307 Diazepam Tablet 5 mg Tablet 66.00 573 Err:509 Err:509
0308 Dietilkarbamazin Sitrat Tablet 100 mg Tablet 73.64 - Err:509 Err:509
0309 Difenhidramin HCL Inj. 10 mg/ml - 1 ml Ampul 799.33 180 Err:509 Err:509
0310 Digoksin Tablet 0,25 mg Tablet 83.21 2,281 Err:509 Err:509
0311 Diltiazem HCl Tablet 30 mg Tablet 151.62 582 Err:509 Err:509
0312 Dimenhidrinat Tablet Tablet 84.50 1,371 Err:509 Err:509
0313 Doksisiklin Kapsul 100 mg Kapsul 229.90 7,980 Err:509 Err:509
0314 Domperidon Suspensi 5 mg/ 5 ml Botol 12,650.00 3 Err:509 Err:509
0315 Domperidon Tablet 10 mg Tablet 403.61 628 Err:509 Err:509
0316 Echinacea purpurea 250mg, Zinc picolina Tablet 2,475.00 30 Err:509 Err:509
0401 Efedrin HCL Tablet 25 mg Tablet 42.59 11,370 Err:509 Err:509
0402 Ekstrak Belladon Tablet 10 mg Tablet 17.89 - Err:509 Err:509
0403 Epinefrin HCL/Bitartrat ( Adrenalin ) Inj. Ampul 1,033.27 164 Err:509 Err:509
0404 Eritromisin Kapsul 250 mg Kapsul 416.90 1,800 Err:509 Err:509
0405 Eritromisin Tablet 500 mg Tablet 710.00 436 Err:509 Err:509
0406 Eritromisin Sirup 200 mg/5 mg Botol 8,100.00 9 Err:509 Err:509
0407 Etakridin ( Rivanol ) Larutan 0,1 % Botol 1,800.00 12 Err:509 Err:509
0408 Etambutol HCL Tablet 250 mg Tablet 308.67 - Err:509 Err:509
0501 Famotidin Tablet 20 mg Tablet 113.08 154 Err:509 Err:509
0502 Fenitoin Natrium Injeksi 50 mg/ml Ampul 4,863.80 - Err:509 Err:509
0503 Fenitoin Natrium Kapsul 100 mg Kapsul 79.54 - Err:509 Err:509
0504 Fenitoin Natrium Kapsul 30 mg Kapsul 58.04 - Err:509 Err:509
0505 Fenobarbital Injeksi 50 mg/ml - 2 ml Ampul 1,560.00 60 Err:509 Err:509
0506 Fenobarbital Tablet 100 mg Tablet 146.08 - Err:509 Err:509
0507 Fenobarbital Tablet 30 mg Tablet 25.00 943 Err:509 Err:509
0508 Fenoksimetil Penisilina Tablet 250 mg Tablet 210.92 - Err:509 Err:509
0509 Fenoksimetil Penisilina Tablet 500 mg Tablet 370.63 - Err:509 Err:509
0510 Fenol Gliserol Tetes Telinga 10 % Botol 1,008.33 96 Err:509 Err:509
0511 Fitomenadion ( Vit. K 1 ) Inj. 10 mg/ml - Ampul 1,740.00 153 Err:509 Err:509
0512 Fitomenadion ( Vit. K ) Tablet Salut 10 m Tablet 680.62 277 Err:509 Err:509
0513 Fluconazole Kapsul 150 mg Kapsul - - Err:509 Err:509
0514 Fluor Tablet 0,5 mg Tablet 32.91 - Err:509 Err:509
0515 Furosemid Tablet 40 mg Tablet 90.99 1,484 Err:509 Err:509
0516 Furosemid Injeksi i.v / i.m 10 mg/ml Ampul 1,839.64 - Err:509 Err:509
0601 Gameksan Emulsi 1 % Botol 2,200.00 24 Err:509 Err:509
0602 Garam Oralit 200 ml Air Sachet 380.00 1,418 Err:509 Err:509
0603 Gentamisin injeksi 40 mg/ml Ampul 3,696.00 37 Err:509 Err:509
0604 Gentamisin Salep Kulit 0,1 % Tube 1,850.00 - Err:509 Err:509
0605 Gentian Violet Larutan 1 % Botol 449.90 187 Err:509 Err:509
0606 Glibenklamid Tablet 5 mg Tablet 59.99 1,490 Err:509 Err:509
0607 Gliseril Guayakolat Tablet 100 mg Tablet 23.23 14,069 Err:509 Err:509
0608 Glukosa Larutan Infus 5 % Steril (Produk Botol 3,630.00 102 Err:509 Err:509
0609 Glukosa Larutan Infus 10 % Steril (Produk Botol 3,895.00 130 Err:509 Err:509
0610 Glukosa Larutan Infus 40 % Steril Vial 988.00 578 Err:509 Err:509
0611 Griseofulvin Tablet 125 mg, Micronized Tablet 240.00 113 Err:509 Err:509
0701 Haloperidol Tablet 0,5 mg Tablet 60.24 554 Err:509 Err:509
0702 Haloperidol Tablet 1,5 mg Tablet 82.58 - Err:509 Err:509
0703 Haloperidol Tablet 2 mg Tablet 95.25 290 Err:509 Err:509
0704 Haloperidol Tablet 5 mg Tablet 122.29 500 Err:509 Err:509
0705 Haloperidol Dekanoat Injeksi Ampul - - Err:509 Err:509
0706 Hidroklorotiazid ( HCT ) Tablet 25 mg Tablet 36.30 16,016 Err:509 Err:509
0707 Hidrokortison Krim 2,5 % Tube 3,000.00 188 Err:509 Err:509
0708 Hyoscine Butylbromide 10 mg Methamp Tablet 1,320.00 220 Err:509 Err:509
0801 Ibuprofen Tablet 200 mg Tablet 105.00 2,097 Err:509 Err:509
0802 Ibuprofen Tablet 400 mg Tablet 205.04 3,958 Err:509 Err:509
0803 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 97.35 253 Err:509 Err:509
0901 Kalium Diklofenak Tablet 50 mg Tablet 708.00 1,148 Err:509 Err:509
0902 Kalium Permanganat Serbuk Pot 312.00 - Err:509 Err:509
0903 Kalsium Laktat ( Kalk ) Tablet 500 mg Tablet 52.00 13,030 Err:509 Err:509
0904 Kaolin Pektin Sirup Botol 5,445.00 60 Err:509 Err:509
0904 Kaptopril Tablet 12,5 mg Tablet 70.90 1,509 Err:509 Err:509
0905 Kaptopril Tablet 25 mg Tablet 137.75 2,395 Err:509 Err:509
0906 Kaptopril Tablet 50 mg Tablet 224.38 - Err:509 Err:509
0907 Karbamazepin Tablet 200 mg Tablet 246.45 200 Err:509 Err:509
0908 Ketokonazol Tablet 200 mg Tablet 372.00 284 Err:509 Err:509
0909 Ketokonazol Krim 2% Tube 7,000.00 17 Err:509 Err:509
0910 Ketorolac Injeksi 10 mg Ampul 7,500.00 6 Err:509 Err:509
0911 Klindamisin Kapsul 300 mg Kapsul 509.98 790 Err:509 Err:509
0912 Klofazimin Kapsul 100 mg, Micronized Kapsul 2,194.28 - Err:509 Err:509
0913 Kloramfenikol Kapsul 250 mg Kapsul 209.97 15,793 Err:509 Err:509
0914 Kloramfenikol Suspensi 125 mg/5 ml Botol 3,999.60 38 Err:509 Err:509
0915 Kloramfenikol Tetes Mata 0,5 % Botol 2,500.00 59 Err:509 Err:509
0916 Kloramfenikol Salep Mata 1 % Tube 1,562.00 126 Err:509 Err:509
0917 Kloramfenikol Tetes Telinga 3 % Botol 1,199.00 138 Err:509 Err:509
0918 Klorfeniramin Maleat ( CTM ) Tablet 4 m Tablet 22.00 48,646 Err:509 Err:509
0919 Klorokuin Fosfat Tablet 250 mg Tablet 68.20 8,880 Err:509 Err:509
0920 Klorpromazin HCL Inj. 25 mg/ml - 1ml Ampul 733.33 30 Err:509 Err:509
0921 Klorpromazin HCL Inj. 5 mg/ml - 2 ml Ampul 723.33 - Err:509 Err:509
0922 Klorpromazin HCL Tablet Salut 100 mg Tablet 122.00 4,398 Err:509 Err:509
0923 Klorpromazin HCL Tablet Salut 25 mg Tablet 24.45 5,486 Err:509 Err:509
0924 Klorpropamid Tablet 100 mg Tablet 86.00 - Err:509 Err:509
0925 Kodein HCl Tablet 10 mg Tablet 727.98 772 Err:509 Err:509
0926 Kodein HCl Tablet 15 mg Tablet 727.98 - Err:509 Err:509
0927 Kotrimoksasol Pediatrik Tablet Tablet 69.99 1,724 Err:509 Err:509
0928 Kotrimoksasol Suspensi Botol 3,960.00 368 Err:509 Err:509
0929 Kotrimoksasol Dewasa Tablet Tablet 160.00 4,335 Err:509 Err:509
0930 Kuinin Dihidroklorida Inj. 25 % - 2 ml Ampul 1,171.17 - Err:509 Err:509
0931 Kuinin Sulfa Tablet 222 mg ( 7 H2O ) Tablet 249.52 - Err:509 Err:509
1001 Levofloksasin Tablet 500 mg Tablet 1,153.68 160 Err:509 Err:509
1002 Lidokain Kompositum Injeksi Ampul 1,136.67 177 Err:509 Err:509
1003 Lidokain Hcl Injeksi 2 % Ampul 1,010.00 153 Err:509 Err:509
1004 Loratadin Tablet 10 mg Tablet 333.08 380 Err:509 Err:509
1005 Loperamid Tablet Tablet 91.54 2,374 Err:509 Err:509
1101 Magnesium Sulfat Injeksi ( IV ) 20 % - 25 Ampul 1,539.80 - Err:509 Err:509
1102 Magnesium Sulfat Injeksi ( IV ) 40 % - 25 Ampul 1,947.88 17 Err:509 Err:509
1103 Mebendasol Sirup 100 mg/5 ml Botol 2,035.00 - Err:509 Err:509
1104 Mebendasol Tablet 100 mg Tablet 141.03 - Err:509 Err:509
1105 Meloksikam Tablet 7,5 mg Tablet 691.90 - Err:509 Err:509
1106 Metil Ergometrin Maleat Tablet Salut 0, Tablet 109.89 1,105 600 1,705
1107 Metil Ergometrin Maleat Inj. 0,200 mg - Ampul 1,490.00 14 - 14
1108 Metilprednisolon Tablet 4 mg Tablet 440.55 277 Err:509 Err:509
1109 Metformin HCl Tablet 500 mg Tablet 165.00 2,859 Err:509 Err:509
1110 Metoklopramide Tablet 10 mg Tablet 110.00 1,010 Err:509 Err:509
1111 Metoklopramide Injeksi 5 mg/ml Ampul 1,000.00 24 Err:509 Err:509
1112 Metoklopramide Sirup 5 mg/5ml Botol 2,100.00 23 Err:509 Err:509
1113 Metronidasol Tablet 250 mg Tablet 130.00 1,183 Err:509 Err:509
1114 Metronidasol Tablet 500 mg Tablet 189.99 1,593 Err:509 Err:509
1115 Metronidazol Infus 500 mg/100 ml Tablet 29,499.80 18 Err:509 Err:509
1116 Mikonazol Krim/Salep 2 % Tube 3,000.00 96 Err:509 Err:509
1117 Multivitamin Sirup Botol 6,380.00 49 Err:509 Err:509
1118 Multivitamin tablet Tablet 489.50 350 Err:509 Err:509
1201 Natrium Bikarbonat Tablet 500 mg Tablet 9.75 - Err:509 Err:509
1202 Natrium Diklofenak Tablet 50 mg Tablet 217.67 762 Err:509 Err:509
1203 Natrium Klorida Larutan Infus 0,9 % Steri Botol 4,132.00 169 Err:509 Err:509
1204 Nifedipin Tablet 10 mg Tablet 107.84 12,404 Err:509 Err:509
1205 Nistatin 100.000 IU/G Tablet Vaginal Tablet 288.91 - Err:509 Err:509
1206 Nistatin 500.000 IU Tablet Salut Tablet 600.00 217 Err:509 Err:509
1301 Obat Antituberkulosis Kategori 1 Paket 259,600.00 1 Err:509 Err:509
1302 Obat Antituberkulosis Kategori 2 Paket 414,150.00 - Err:509 Err:509
1303 Obat Antituberkulosis Kategori Anak Paket 139,920.00 - Err:509 Err:509
1304 Obat Batuk Hitam ( O.B.H ) Cairan Botol 1,430.00 76 Err:509 Err:509
1305 Obat Flu Kombinasi (Alpara) Tablet 415.80 - Err:509 Err:509
1305 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml Ampul 2,061.10 30 Err:509 Err:509
1306 Oksitetrasiklin HCL Salep 3 % Tube 1,674.20 86 Err:509 Err:509
1307 Oksitetrasiklin HCL Salep Mata Tube 2,100.00 342 Err:509 Err:509
1308 Oksitosin Injeksi 10 IU/ml - 1 ml Ampul 1,785.00 130 80 210
1309 Omeprazol Kapsul 20 mg Kapsul 408.33 40 Err:509 Err:509
1401 Papaverin Tablet 40 mg Tablet 93.00 2,103 Err:509 Err:509
1402 Papaverin Injeksi 40 mg/ml Ampul 530.00 195 Err:509 Err:509
1403 Paraformaldehid Tablet 1 Gram Tablet 60.00 - Err:509 Err:509
1404 Parasetamol Drops Botol 4,799.30 90 Err:509 Err:509
1405 Parasetamol Sirup 120 mg/5 ml Botol 2,300.00 196 Err:509 Err:509
1406 Parasetamol Tablet 100 mg Tablet 41.90 1,690 Err:509 Err:509
1407 Parasetamol Tablet 500 mg Tablet 105.00 17,444 15,000 32,444
1408 Perfenazin Tablet 16 mg Tablet - - Err:509 Err:509
1409 Perfenazin Tablet 4 mg Tablet 42.41 - Err:509 Err:509
1410 Piracetam Injeksi 1 g/5 ml Ampul 5,500.00 43 Err:509 Err:509
1411 Piracetam Tablet 400 mg Tablet 501.60 876 Err:509 Err:509
1412 Piracetam Tablet 800 mg Tablet 880.00 180 Err:509 Err:509
1413 Pirantel Pamoat Tablet 125 mg Tablet 309.98 200 Err:509 Err:509
1414 Piridoksin HCL Tablet 10 mg Tablet 17.40 2,443 Err:509 Err:509
1415 Piroksikam Kapsul 10 mg Kapsul 75.00 1,068 Err:509 Err:509
1416 Piroksikam Tablet 20 mg Tablet 104.94 1,301 Err:509 Err:509
1417 Polikresulen Botol 24,500.00 3 Err:509 Err:509
1418 Prednison Tablet 5 mg Tablet 57.50 4,971 Err:509 Err:509
1419 Primakuin Tablet 15 mg Tablet 30.00 - Err:509 Err:509
1420 Propiltiourasil Tablet 100 mg Tablet 299.57 100 Err:509 Err:509
1421 Propanolol HCL Tablet 40 mg Tablet 1,221.00 2,464 Err:509 Err:509
1501 Ranitidin Tablet 150 mg Tablet 209.99 3,600 Err:509 Err:509
1502 Ranitidin Injeksi 25 mg/2 ml Ampul 2,570.00 200 Err:509 Err:509
1503 Reserpin Tablet 0,10 mg Tablet 32.00 - Err:509 Err:509
1504 Reserpin Tablet 0,25 mg Tablet 55.00 - Err:509 Err:509
1505 Retinol ( Vitamin A ) Kapsul 100.000 IU Kapsul 286.00 200 Err:509 Err:509
1506 Retinol ( Vitamin A ) Kapsul 200.000 IU Kapsul 462.00 400 Err:509 Err:509
1507 Rifampisin Kapsul 300 mg Kapsul 350.00 - Err:509 Err:509
1508 Ringer Asetat Cairan Infus Botol 15,900.00 40 Err:509 Err:509
1508 Ringer Laktat Larutan Infus Steril Botol 5,199.70 394 Err:509 Err:509
1601 Salbutamol Tablet 4 mg Tablet 97.48 924 Err:509 Err:509
1602 Salep 2 - 4 Kombinasi : Asam Salisilat 2 % + Pot 1,229.17 49 Err:509 Err:509
1603 Salisil Bedak 2 % Kotak 1,430.00 44 Err:509 Err:509
1604 Salisil Spiritus 10 % Botol 1,115.00 - Err:509 Err:509
1605 Sefadroxil Sirup Kering 125 mg/ml Botol 8,200.00 109 Err:509 Err:509
1606 Sefadroxil Kapsul 250 mg Kapsul 445.05 500 Err:509 Err:509
1607 Sefadroxil Kapsul 500 mg Kapsul 840.00 328 Err:509 Err:509
1608 Sefiksim Kapsul 100 mg Kapsul 2,394.60 430 Err:509 Err:509
1609 Sefiksim 400 mg + Azitromisin 1000 mg Paket 33,000.00 50 Err:509 Err:509
1610 Sefotaksim Injeksi 1 g Vial 6,930.00 297 Err:509 Err:509
1611 Serum Anti Bisa Ular Polivalen Inj. 5 ml ( Vial 240,449.00 5 Err:509 Err:509
1612 Serum Anti Bisa Ular Polivalen Inj. 50 ml ( Vial 26,983,968.00 - Err:509 Err:509
1613 Serum Anti Difteri Inj. 20.000 IU/Vial ( A. Vial 472,505.00 - Err:509 Err:509
1614 Serum Anti Tetanus Inj. 1.500 IU/Ampul ( Ampul 52,500.00 4 Err:509 Err:509
1615 Serum Anti Tetanus Inj. 20.000 IU/Vial ( A Vial 340,000.00 2 Err:509 Err:509
1616 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg Ampul 1,037.00 252 Err:509 Err:509
1617 Sianokobalamin (Vit.B12) Tablet 50 mcg Tablet 12.36 1,039 Err:509 Err:509
1618 Simetidin Tablet 200 mg Tablet 105.00 604 Err:509 Err:509
1619 Simvastatin Tablet 10 mg Tablet 513.00 - Err:509 Err:509
1620 Siprofloksasin Tablet 500 mg Tablet 264.99 4,637 Err:509 Err:509
1621 Sulfadimidin Tablet 500 mg Tablet 12.00 - Err:509 Err:509
1622 Sulfasetamid Natrium Tetes Mata 15 % Botol 3,445.25 488 Err:509 Err:509
1701 Tablet Tambah Darah Kombinasi Tablet 66.67 51,342 Err:509 Err:509
1702 Terbutalin tablet 2,5 mg Tablet 97.38 - Err:509 Err:509
1703 Tetrasiklin HCL Kapsul 250 mg Kapsul 166.75 550 Err:509 Err:509
1704 Tetrasiklin HCL Kapsul 500 mg Kapsul 249.70 596 Err:509 Err:509
1705 Tiamfenikol Kapsul 500 mg Kapsul 580.00 260 Err:509 Err:509
1706 Tiamfenikol sirup kering 125 mg / 5 ml Botol 6,600.00 50 Err:509 Err:509
1707 Tiamin HCL ( Vit. B1 ) Inj. 100 mg/ml - 1 Ampul 766.67 36 Err:509 Err:509
1708 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet Tablet 37.80 11,064 Err:509 Err:509
1709 Tramadol Injeksi 50 mg/ml Ampul 6,707.40 48 Err:509 Err:509
1710 Tramadol Kapsul 50 mg Kapsul 345.12 996 Err:509 Err:509
1711 Triamcinolone Acetonide 1 mg Tube 12,100.00 - Err:509 Err:509
1712 Triheksifenidil Tablet 2 mg Tablet 41.25 952 Err:509 Err:509
1801 Vitamin B Komplek Tablet Tablet 22.20 2,143 Err:509 Err:509
1901 Yodium Povidon Larutan 10 % 30 ml Botol 2,000.00 8 - 8
1902 Yodium Povidon Larutan 10 % 60 ml Botol 3,500.00 11 Err:509 Err:509
1903 Yodium Povidon Larutan 10 % 300 ml Botol 14,500.00 11 Err:509 Err:509
1904 Yodium Povidon Larutan 10 % 1000 ml Botol 42,000.00 Err:509 Err:509
2001 Zinc Tablet 20 mg Tablet 475.00 303 Err:509 Err:509
0 OBAT GIGI - - Err:509 Err:509
2101 Air Raksa Dental Use Tablet 103,536.00 1 Err:509 Err:509
2102 Devitalisasi Pasta ( Non Arsen ) Tablet 389,999.50 1 Err:509 Err:509
2103 Etil Klorida Spray Tablet 105,000.00 5 Err:509 Err:509
2104 Eugenol Cairan Tablet 45,833.33 8 Err:509 Err:509
2105 Glass Ionomer Cement Universal Restora Tablet 395,000.00 1 Err:509 Err:509
2106 Kalsium Hidroksida Pasta (Kalsidor) Tablet 242,000.00 1 Err:509 Err:509
2107 Monoklorkamfer Mentol Cairan (CHKM) Tablet 55,000.00 - Err:509 Err:509
2108 Mummifying Pasta Tablet 176,000.00 1 Err:509 Err:509
2109 Semen Seng Fosfat Serbuk dan Cairan Tablet 93,500.00 1 Err:509 Err:509
2110 Silver Amalgam Serbuk 65-75 % Tablet 227,310.60 - Err:509 Err:509
2111 Temporary Filling Material / Hydraulic Tablet 133,100.00 - Err:509 Err:509
2112 Temporary Stopping Fletcher Serbuk dan Tablet 34,000.00 1 Err:509 Err:509
2113 Trikresol Formalin ( TKF ) Cairan Tablet 46,195.00 - Err:509 Err:509
2114 Tumpatan Tetap dengan Sinar Set Tablet 1,705,000.00 - Err:509 Err:509
0 REAGEN LABORATORIUM Tablet - - Err:509 Err:509
2201 EDTA 10% cair Tablet 72,600.00 - Err:509 Err:509
2202 Ether Alkohol: Ether 80% - Alkohol 20% 14.1 44,547.80 - Err:509 Err:509
2203 Golongan darah Test ( set 3 vial @10 ml ) 0 205,700.00 - Err:509 Err:509
2204 HCL 0,1 N 31 19,800.00 - Err:509 Err:509
2205 KOH 10% 31 30,000.00 5 Err:509 Err:509
2206 Larutan Benedict 31 27,445.00 1 Err:509 Err:509
2207 Larutan Buffer Giemsa 31 44,000.00 - Err:509 Err:509
2208 Larutan Eosin 2% 31 34,683.00 - Err:509 Err:509
2209 Larutan Etanol Asam 31 25,300.00 1 Err:509 Err:509
2210 Larutan Giemsa Stain 31 60,038.00 - Err:509 Err:509
2211 Larutan Hayem 31 17,600.00 - Err:509 Err:509
2212 Larutan Karbol Fuksin 31 22,011.00 - Err:509 Err:509
2213 Larutan Metilen Biru 31 16,195.00 - Err:509 Err:509
2214 Larutan Rees Ecker 31 38,500.00 - Err:509 Err:509
2215 Larutan Turk 31 13,819.00 - Err:509 Err:509
2216 Lens Tissu 31 440.00 - Err:509 Err:509
2217 Metanol 31 23,584.00 - Err:509 Err:509
2218 Reagen SD-HIV Set - - Err:509 Err:509
2219 Reagen ZN Set: @ 1 btl 100cc lar. Carbolf 31 179,993.00 2 Err:509 Err:509
2220 Rapid Plasma Reagen Test Kit 31 1,000,000.00 - Err:509 Err:509
2221 Sifilis Kit 31 18,000.00 187 Err:509 Err:509
2222 Tuberkulin Set - - Err:509 Err:509
2223 Widal slide test ( set a vial @ 5 ml ) Sa 31 297,000.00 - Err:509 Err:509
PERBEKALAN KESEHATAN - Err:509 Err:509
2301 Alat Suntik Sekali Pakai 0,05 ml 31 2,900.00 140 Err:509 Err:509
2303 Alat Suntik Sekali Pakai 1 ml 0 1,092.50 580 Err:509 Err:509
2305 Alat Suntik Sekali Pakai 3 ml 32 593.94 192 500 692
2308 Alkohol 95% 32 32,450.00 - Err:509 Err:509
2309 Blood Lancet 32 297.00 100 Err:509 Err:509
2310 Blood Transfusion set 32 25,300.00 1 - 1
2311 Catgut / Benang Bedah No. 3/0 dengan 32 24,583.33 69 - 69
2312 Dresing penutup luka berperekat 5cm x 32 52,437.00 1 - 1
2313 Etanol (Alkohol 70%) 32 18,698.00 16 32 48
2314 Infusion Set Anak 32 4,000.00 74 100 174
2315 Infusion Set Dewasa 32 3,499.10 127 - 127
2316 Infusion Set Anak Elasty Ball 32 17,600.00 36 Err:509 Err:509
2317 Infusion Set Dewasa Elasty Ball 32 12,100.00 161 Err:509 Err:509
2318 Jarum Infus (i.v. Catheter) Dewasa No 20 32 7,787.34 263 - 263
2319 Jarum Infus (i.v. Catheter) Dewasa No 22 32 7,787.34 97 Err:509 Err:509
2320 Jarum Infus (i.v. Catheter) Anak No 24 32 7,787.50 180 100 280
2321 Kapas Berlemak 500 Gram 32 17,250.00 - Err:509 Err:509
2322 Kapas Pembalut / Absorben 250 gram 32 7,500.00 7 10 17
2323 Kasa Kompres 40/40 Steril 32 1,393.00 8 Err:509 Err:509
2324 Kasa Hidrofil Steril uk. 16x16 (isi 16 lemb 32 531.25 160 160 320
2325 Kasa Pembalut 2 m x 80 cm 32 8,799.00 - - -
2326 Kasa Pembalut Elastic 3 inchi 32 7,000.00 10 Err:509 Err:509
2327 Kasa Pembalut Hidrofil 4 m x 3 cm 32 733.00 25 Err:509 Err:509
2328 Kasa Pembalut Hidrofil 4 m x 10 cm 32 607.00 - 50 50
2329 Kasa Pembalut Hidrofil 4 m x 15 cm 32 3,373.00 10 100 110
2330 Kasa Hidrofil uk. 36 m x 80 cm 32 55,200.00 - 2 2
2331 Kateter (Folley / Urine) No. 10 32 8,495.00 2 Err:509 Err:509
2332 Kateter (Folley / Urine) No. 16 32 7,260.00 84 - 84
2333 Kateter (Folley / Urine) No. 18 32 8,494.20 50 Err:509 Err:509
2334 Klem tali pusat 32 2,750.00 - - -
2335 Lisol 32 49,862.00 6 - 6
2336 Masker 32 1,125.00 430 - 430
2337 Mess / Pisau scalpel no 11 32 770.00 - Err:509 Err:509
2338 Plester 5 yards x 2 inch 32 23,624.70 16 24 40
2339 Sarung Tangan Karet Sekali Pakai S 32 2,125.00 460 Err:509 Err:509
2340 Sarung Tangan Karet Sekali Pakai M 32 2,125.00 532 1,000 1,532
2341 Sarung Tangan Karet Sekali Pakai L 32 2,124.98 250 - 250
2342 Silk / Benang Sutra no. 3/0 dengan Jaru 32 5,743.86 80 - 80
2343 Urine Bag 32 4,000.00 54 - 54
2344 Wing Needle No. 25 G 32 2,530.00 50 42 92
- - -
Kabupaten Kediri

NIP. 19621112 198903 1 017 NIP. 19740510 200501 2 010
AN OBAT TAHUN 2013
PERSEDIAAN PEMAK PEMAKAIAN SISA

SISA (RUPIAH)
(RUPIAH) AIAN (RUPIAH) STOK
8 9
Err:509 Err:509 Err:509 Err:509 Err:509
Err:509 997 131,604.00 Err:509 Err:509
Err:509 148 488,400.00 Err:509 Err:509
6,511,630.00 6,442 2,383,540.00 11,157 4,128,090.00
424,072.00 10 53,680.00 69 370,392.00
4,562,448.00 7,215 1,269,840.00 18,708 3,292,608.00
Err:509 72 55,000.08 Err:509 Err:509
Err:509 9 72,900.00 Err:509 Err:509
Err:509 24 52,800.00 Err:509 Err:509
Err:509 19 35,150.00 Err:509 Err:509
Err:509 280 26,670.00 Err:509 Err:509
Err:509 500 61,145.00 Err:509 Err:509
Err:509 17 33,113.96 Err:509 Err:509
Err:509 - - Err:509 Err:509
187,362.45 1,105 121,428.45 600 65,934.00
20,860.00 14 20,860.00 - -
Err:509 8 2,076,800.00 Err:509 Err:509
Err:509 1,383 575,051.40 Err:509 Err:509
Err:509 30 61,833.00 Err:509 Err:509
Err:509 342 718,200.00 Err:509 Err:509
374,850.00 130 232,050.00 80 142,800.00
3,406,620.00 17,207 1,806,735.00 15,237 1,599,885.00
Err:509 3 73,500.00 Err:509 Err:509
Err:509 277 1,919,610.00 Err:509 Err:509
Err:509 1,800 923,400.00 Err:509 Err:509
Err:509 46,000 3,066,820.00 Err:509 Err:509
16,000.00 1 2,000.00 7 14,000.00
- Err:509 - Err:509 -
Err:509 - - Err:509 Err:509
Err:509 1 176,000.00 Err:509 Err:509
Err:509 - - Err:509 Err:509
Err:509 1 34,000.00 Err:509 Err:509
Err:509 5 150,000.00 Err:509 Err:509
Err:509 187 3,366,000.00 Err:509 Err:509
411,006.48 312 185,309.28 380 225,697.20
25,300.00 - - 1 25,300.00
1,696,249.77 4 98,333.32 65 1,597,916.45
52,437.00 1 52,437.00 - -
897,504.00 7 130,886.00 41 766,618.00
696,000.00 36 144,000.00 138 552,000.00
444,385.70 109 381,401.90 18 62,983.80
2,048,070.42 60 467,240.40 203 1,580,830.02
2,180,500.00 40 311,500.00 240 1,869,000.00
127,500.00 6 45,000.00 11 82,500.00
170,000.00 288 153,000.00 32 17,000.00
- - - - -
30,350.00 7 4,249.00 43 26,101.00
371,030.00 70 236,110.00 40 134,920.00
110,400.00 2 110,400.00 - -
609,840.00 4 29,040.00 80 580,800.00
- - - - -
299,172.00 1 49,862.00 5 249,310.00
483,750.00 - - 430 483,750.00
944,988.00 22 519,743.40 18 425,244.60
3,255,500.00 732 1,555,500.00 800 1,700,000.00
531,245.00 - - 250 531,245.00
459,508.80 - - 80 459,508.80
216,000.00 - - 54 216,000.00
232,760.00 28 70,840.00 64 161,920.00
Err:509 Err:509 - Err:509
Farmasi dan Alkes
H, S.Si., Apt
00501 2 010
LAPORAN PERSEDIAAN OBAT DAN ALAT KESEHATAN SEMESTER 1 TAHUN 2014
UPTD PUSKESMAS : MOJO
PER 30 JUNI 2014
NO. NAMA OBAT SATUAN HARGA SATUAN STOK AWAL PENERIMAAN PERSEDIAAN
1 2 4 5 6 7
0101 Albendasol Tablet 400 mg Tablet 366.00 - 1,110 1,350
0102 Albendazol suspensi 200 mg/5Botol 3,811.00 849 60 60
0103 Alopurinol Tablet 100 mg Tablet 109.58 - 4,500 6,900
0104 Ambroxol sirup 15 mg/ml Botol 2,400.00 - 200 372
0105 Ambroxol Tablet 30 mg Tablet 85.93 - 7,000 7,200
0106 Aminofilin Tablet 200 mg Tablet 87.15 148 - 5,562
0107 Aminofilin Injeksi 24 mg/ml - Ampul 3,240.00 85 - 240
0108 Amitriptilin HCL Tablet Salut 2 Tablet 102.00 187 1,000 3,300
0109 Amlodipin tablet 5 mg Tablet 240.00 - 2,850 2,850
0110 Amoksisilin + As. Klavulanat 6 Tablet 4,550.00 10,281 600 600
0111 Amoksisilin Sirup Kering 125 Botol 2,300.00 50 400 703
0112 Amoksisilin Kapsul 250 mg Kapsul 190.00 1,581 2,400 2,400
0113 Amoksisilin Kapsul 500 mg Kaplet 220.00 400 25,000 65,129
0114 Ampisillin Serbuk Injeksi i.m/i Vial 4,000.00 34,486 - 29
0115 Ampisillin sirup kering 125 mg Botol 4,400.00 50 24 24
0116 Antalgin ( metampiron ) Table Tablet 145.00 22 5,000 20,460
0117 Antalgin Injeksi 250 mg/ml - 2 Ampul 1,200.00 120 - 494
0118 Antasida
Antasida DOEN
DOEN Tablet KombinasTablet Aluminium Hidroksida
II suspensi,kombinasi: 77.94 200 mg 32 20,000 62,200
0119 Magnesium Hidroksida 200 mgBotol 1,865.93 - - 142
0120 Anti Bakteri
Antifungi DOEN,
DOEN Salep KombTube
Kombinasi: 2,491.00 82 - 131
0121 Asam Benzoat 6% + Asam Salisilat Pot 3% 1,904.40 35,286 - 79
0122 Antihemoroid DOEN Kombinasi: Supositori 2,450.00 16,280 100 230
0123 Antimigrain Doen Kombinasi Tablet 102.80 180 - 197
0124 Aqua Proinjeksi Steril, Bebas P Botol 5,000.00 30 50 50
0125 Asam Askorbat ( Vit C ) Tablet Tablet 27.50 502 15,000 53,559
0126 Asam Mefenamat Tablet 500 Tablet 95.00 100 10,000 32,600
0127 Asam Traneksamat 500 mg Tablet 1,045.00 1,027 100 800
0128 Asam Traneksamat injeksi 250 Ampul 3,850.00 2,800 - 30
0129 Asetosal Tablet 100 mg Tablet 100.00 92 - 800
0130 Asetosal Tablet 500 mg Tablet 162.00 30 - 1,270
0131 Asiklovir Tablet 400 mg Tablet 350.00 1,000 1,000 2,500
0132 Asiklovir Tablet 200 mg Tablet 239.00 - - 2,027
0133 Asiklovir Krim 5 % Tube 2,152.00 - 125 407
0134 Atropin Sulfat Injeksi 0,25 mg/Ampul 1,230.00 - - 53
0135 Atropin Sulfat Tablet 0,5 mg Tablet 60.00 126 - -
0136 Attapulgite Pektin Tablet 319.00 24 600 4,350
0201 Benzatin Benzil Penisilin 2,4 jutVial 12,185.00 960 - -
0202 Besi (III) Hidroksida Polimal Botol 52,030.00 1,066 - -
0203 Besi (II) Sulfat 200 mg + Asam Tablet 44.00 23,443 75,000 109,063
0204 Betahistin Mesilat Tablet 6 mg Tablet 924.00 63 300 900
0205 Betametason Krim 0,1 % Tube 1,520.00 13,483 200 405
0206 Bisacodyl 5 mg Tablet 763.89 15 - 697
0207 Bisoprolol tablet 5mg Tablet 511.00 3,953 - -
0208 Bromheksin Tablet 8 mg Tablet 50.70 2,828 2,500 4,200
0301 Cetirizin sirup 5 mg/5 ml Botol 7,837.00 - 50 50
0302 Cetirizine tablet 10 mg Kapsul 225.00 90 800 800
0401 Deksametason Inj.5 mg/ml - 1 Ampul 1,400.00 612 200 1,135
0402 Deksametason Tablet 0,5 mg Tablet 68.98 582 20,000 48,491
0403 Dekstrometorfan HBR Sirup 10Botol 1,378.85 1,273 - 440
0404 Dekstrometorfan HBR Tablet 1Tablet 90.00 7,980 - 29,336
0405 Diazepam Inj. 5 mg/ml - 2 ml Ampul 2,344.00 - 150 223
0406 Diazepam Tablet 2 mg Tablet 35.00 310 3,000 9,365
0407 Diazepam Tablet 5 mg Tablet 56.00 - - 643
0408 Dietilkarbamazin Sitrat Tablet Tablet 93.00 17,225 - -
0409 Difenhidramin HCL Inj. 10 mg/m Ampul 960.00 - 240 504
0410 Digoksin Tablet 0,25 mg Tablet 91.00 100 1,500 3,900
0411 Diltiazem HCl Tablet 30 mg Tablet 123.00 3,537 - 610
0412 Dimenhidrinat Tablet Tablet 95.00 1,499 5,500 7,400
0413 Doksisiklin Kapsul 100 mg Kapsul 220.00 - - 3,500
0414 Domperidon Suspensi 5 mg/ 5Botol 3,624.00 15 200 214
0415 Domperidon Tablet 10 mg Tablet 176.00 - 2,500 4,600
0501 Echinacea purpurea 250mg, ZinTablet 2,690.60 1,104 150 998
0502 Efedrin HCL Tablet 25 mg Tablet 50.60 - 5,000 23,965
0503 Ekstrak Belladon Tablet 10 mg Tablet 38.00 - - -
0504 Epinefrin HCL/Bitartrat ( Adrena Ampul 1,500.00 - 210 618
0505 Eritromisin Kapsul 250 mg Kapsul 493.00 30 2,340 5,140
0506 Eritromisin Tablet 500 mg Tablet 864.25 - 5,500 6,800
0507 Eritromisin Sirup 200 mg/5 mgBotol 7,220.00 943 50 257
0508 Etakridin ( Rivanol ) Larutan 0, Botol 2,212.16 - - 15
0509 Etambutol HCL Tablet 250 mg Tablet 308.67 - - -
0601 Famotidin Tablet 20 mg Tablet 113.00 60 1,500 3,300
0602 Fenitoin Natrium Injeksi 50 m Ampul 48,368.00 403 - -
0603 Fenitoin Natrium Kapsul 100 mKapsul 79.54 779 - -
0604 Fenitoin Natrium Kapsul 30 mgKapsul 93.00 - - -
0605 Fenobarbital Injeksi 50 mg/ml Ampul 46,800.00 - - 74
0606 Fenobarbital Tablet 100 mg Tablet 146.08 808 - 223
0607 Fenobarbital Tablet 30 mg Tablet 62.00 - - -
0608 Fenoksimetil Penisilina Tablet Tablet 272.00 - - -
0609 Fenoksimetil Penisilina Tablet Tablet 370.63 1,867 - -
0610 Fenol Gliserol Tetes Telinga 10 Botol 1,008.00 47 48 60
0611 Fitomenadion ( Vit. K 1 ) Inj. 1 Ampul 1,740.00 81 - 412
0612 Fitomenadion ( Vit. K ) Tablet Tablet 579.00 168 500 2,500
0613 Fluconazole Kapsul 150 mg Kapsul 22,000.00 1,701 - -
0614 Fluphenazine Decanoate 25mgAmpul 66,000.00 10,723 40 40
0615 Fluor Tablet 0,5 mg Tablet 32.91 98 - -
0616 Furosemid Tablet 40 mg Tablet 90.00 130 3,000 4,570
0617 Furosemid Injeksi i.v / i.m 10 Ampul 1,839.64 895 - 38
0701 Gameksan Emulsi 1 % Botol 20,454.50 601 192 237
0702 Garam Oralit 200 ml Air Sachet 292.00 - - 5,715
0703 Gentamisin injeksi 40 mg/ml Ampul 3,104.00 - - 186
0704 Gentamisin Salep Kulit 0,1 % Tube 1,350.00 10 150 150
0705 Gentian Violet Larutan 1 % Botol 900.00 - - 171
0706 Glibenklamid Tablet 5 mg Tablet 54.00 - 4,000 6,500
0707 Gliseril Guayakolat Tablet 100 Tablet 27.50 25,310 - 37,260
0708 Glukosa Larutan Infus 5 % SteriBotol 5,313.00 188 500 500
0709 Glukosa Larutan Infus 10 % SterBotol 5,727.00 220 - 104
0710 Glukosa Larutan Infus 40 % SterVial 988.00 - 600 1,800
0711 Griseofulvin Tablet 125 mg, MiTablet 194.00 4,031 - 1,000
0801 Haloperidol Tablet 0,5 mg Tablet 52.52 549 - -
0802 Haloperidol Tablet 1,5 mg Tablet 73.00 2,170 - -
0803 Haloperidol Tablet 2 mg Tablet 94.60 - 2,000 2,000
0804 Haloperidol Tablet 5 mg Tablet 122.10 18,234 5,000 5,300
0805 Haloperidol Dekanoat Injeksi Ampul - 55 - -
0806 Hidroklorotiazid ( HCT ) Tablet Tablet 36.30 1,052 - 18,000
0807 Hidrokortison Krim 2,5 % Tube 2,541.00 4,325 96 385
0808 Hyoscine Butylbromide 10 m Tablet 1,320.00 - 500 2,800
0901 Ibuprofen suspensi 100 mg/5 Botol 3,465.00 70 100 100
0902 Ibuprofen Tablet 200 mg Tablet 92.57 1,284 - 1,145
0903 Ibuprofen Tablet 400 mg Tablet 144.00 10 15,000 24,000
0904 Isosorbid Dinitrat Tablet Subli Tablet 92.00 - 1,000 1,980
1001 Kalium Diklofenak Tablet 50 mTablet 425.00 1,214 2,000 4,200
1002 Kalium Permanganat Serbuk Pot 312.00 - - -
1003 Kalsium Laktat ( Kalk ) Tablet Tablet 51.70 9,753 10,000 25,576
1004 Kaolin Pektin Sirup Botol 5,720.00 50 - 209
1005 Kaptopril Tablet 12,5 mg Tablet 72.00 8 3,000 5,600
1006 Kaptopril Tablet 25 mg Tablet 88.00 296 4,000 10,264
1007 Kaptopril Tablet 50 mg Tablet 134.00 77 - 300
1008 Karbamazepin Tablet 200 mg Tablet 243.00 7,867 4,500 5,300
1009 Ketokonazol Tablet 200 mg Tablet 267.00 8,880 2,000 3,600
1010 Ketokonazol Krim 2% Tube 4,050.00 30 27 207
1011 Ketorolac Injeksi 10 mg Ampul 1,616.00 - - 147
1012 Klindamisin Kapsul 300 mg Kapsul 527.00 3,623 - 2,150
1013 Klofazimin Kapsul 100 mg, MicKapsul 2,194.28 2,569 - -
1014 Kloramfenikol Kapsul 250 mg Kapsul 227.00 - - 265
1015 Kloramfenikol Suspensi 125 m Botol 3,700.00 692 - 150
1016 Kloramfenikol Tetes Mata 0,5 Botol 2,499.20 250 150 150
1017 Kloramfenikol Salep Mata 1 % Tube 1,562.00 2,230 - 320
1018 Kloramfenikol Tetes Telinga 3 Botol 1,599.00 100 96 183
1019 Klorfeniramin Maleat ( CTM ) TTablet 26.00 22,906 25,000 49,493
1020 Klorokuin Fosfat Tablet 250 mgTablet 107.00 - - 8,812
1021 Klorpromazin HCL Inj. 25 mg/mAmpul 1,021.00 - 90 271
1022 Klorpromazin HCL Inj. 5 mg/mlAmpul 950.00 250 - -
1023 Klorpromazin HCL Tablet Salut Tablet 133.00 307 5,000 13,750
1024 Klorpromazin HCL Tablet Salut Tablet 45.00 293 - -
1025 Klorpropamid Tablet 100 mg Tablet 86.00 380 - -
1026 Kodein HCl Tablet 10 mg Tablet 470.00 3,071 1,000 2,404
1027 Kodein HCl Tablet 15 mg Tablet 727.98 - - -
1028 Kotrimoksasol Pediatrik Tablet Tablet 72.00 - - 1,200
1029 Kotrimoksasol Suspensi Botol 2,574.00 - 250 651
1030 Kotrimoksasol Dewasa Tablet Tablet 160.00 - 9,400 31,305
1031 Kuinin Dihidroklorida Inj. 25 % Ampul 4,227.00 - - -
1032 Kuinin Sulfa Tablet 222 mg ( 7 Tablet 399.30 600 - -
1101 Lanzoprazol kapsul/kaplet 30 Tablet 473.00 - 200 200
1102 Levofloksasin Tablet 500 mg Tablet 1,153.68 80 500 1,750
1103 Lidokain Kompositum Injeksi Ampul 1,295.00 - 210 870
1104 Lidokain Hcl Injeksi 2 % Ampul 850.00 2,400 500 688
1105 Loratadin Tablet 10 mg Tablet 160.00 - 1,000 1,300
1106 Loperamid Tablet Tablet 90.00 115 1,800 6,550
1201 Magnesium Sulfat Injeksi ( IV ) Ampul 2,078.00 1,160 - -
1202 Magnesium Sulfat Injeksi ( IV ) Ampul 2,629.00 1,709 - -
1203 Mebendasol Sirup 100 mg/5 mlBotol 3,534.00 27 - -
1204 Mebendasol Tablet 100 mg Tablet 225.00 90 - -
1205 Meloksikam Tablet 7,5 mg Tablet 234.00 120 1,800 1,800
1206 Metil Ergometrin Maleat TableTablet 109.89 347 1,000 1,490
1207 Metil Ergometrin Maleat Inj. 0 Ampul 1,489.40 - 180 283
1208 Metilprednisolon Tablet 4 mg Tablet 295.83 - 500 1,280
1209 Metformin HCl Tablet 500 mg Tablet 105.00 80 2,500 2,600
1210 Metoklopramide Tablet 10 mgTablet 110.00 3,088 - 1,910
1211 Metoklopramide Injeksi 5 mg Ampul 960.00 - 240 256
1212 Metoklopramide Sirup 5 mg/5 Botol 2,100.00 - - 95
1213 Metronidasol Tablet 250 mg Tablet 122.80 23 3,000 4,447
1214 Metronidasol Tablet 500 mg Tablet 163.74 - 3,000 5,805
1215 Metronidazol Infus 500 mg/10Botol 24,000.00 - - -
1216 Mikonazol Krim/Salep 2 % Tube 3,000.00 112 144 424
1217 Multivitamin Sirup Botol 6,380.00 1,017 - 194
1218 Multivitamin tablet Tablet 489.50 - - 1,100
1301 Natrium Bikarbonat Tablet 50 Tablet 14.30 53 - -
1302 Natrium Diklofenak Tablet 50 Tablet 210.00 - 4,000 4,202
1303 Natrium Klorida Larutan Infus 0Botol 4,900.00 80 - 265
1304 Nifedipin Tablet 10 mg Tablet 107.84 150 - 1,400
1305 Nistatin 100.000 IU/G Tablet VTablet 407.00 981 200 220
1306 Nistatin 500.000 IU Tablet SaluTablet 640.00 - 2,000 3,250
1401 Obat Antituberkulosis KategoriPaket 259,600.00 - 40 40
1402 Obat Antituberkulosis KategoriPaket 414,150.00 - - -
1403 Obat Antituberkulosis Kategor Paket 139,920.00 353 2 2
1404 Obat Batuk Hitam ( O.B.H ) CaiBotol 1,258.95 1,510 120 478
1405 Obat Flu Kombinasi (Alpara) Tablet 459.80 19,521 6,300 7,100
1406 Ofloxacin tablet 200 mg Tablet 413.00 - 200 200
1407 Oksitetrasiklin HCL Injeksi I.M Ampul 2,061.10 - - -
1408 Oksitetrasiklin HCL Salep 3 % Tube 1,529.00 - 100 250
1409 Oksitetrasiklin HCL Salep Mata Tube 1,600.00 876 150 548
1410 Oksitosin Injeksi 10 IU/ml - 1 mAmpul 1,785.00 180 700 804
1411 Omeprazol Kapsul 20 mg Kapsul 265.00 500 600 1,500
1412 Oseltamivir kapsul/kaplet 75 Kapsul 13,000.00 9,920 - -
1501 Papaverin Tablet 40 mg Tablet 119.00 868 - 10,000
1502 Papaverin Injeksi 40 mg/ml Ampul 1,150.00 1,273 - 185
1503 Paraformaldehid Tablet 1 Gra Tablet 60.00 2 - -
1504 Parasetamol Drops Botol 5,227.00 14,747 224 224
1505 Parasetamol Sirup 120 mg/5 mBotol 1,318.90 - 300 750
1506 Parasetamol Tablet 100 mg Tablet 32.23 100 2,000 3,800
1507 Parasetamol Tablet 500 mg Tablet 83.93 - 25,000 53,600
1508 Perfenazin Tablet 16 mg Tablet - 152 - -
1509 Perfenazin Tablet 4 mg Tablet 42.41 - - -
1510 Piracetam Injeksi 1 g/5 ml Ampul 1,925.00 - - 10
1511 Piracetam Tablet 400 mg Tablet 194.00 - 2,000 2,100
1512 Piracetam Tablet 800 mg Tablet 400.00 180 600 1,800
1513 Pirantel Pamoat Tablet 125 mgTablet 311.00 2,700 - -
1514 Piridoksin HCL Tablet 10 mg Tablet 16.50 - 10,000 15,608
1515 Piroksikam Kapsul 10 mg Kapsul 69.54 35 - 2,140
1516 Piroksikam Tablet 20 mg Tablet 91.96 245 3,000 4,100
1517 Polikresulen Botol 24,499.20 500 - 9
1518 Prednison Tablet 5 mg Tablet 64.00 80 - 14,038
1519 Primakuin Tablet 15 mg Tablet 114.00 60 - -
1520 Propiltiourasil Tablet 100 mg Tablet 264.00 - 1,000 1,100
1521 Propanolol HCL Tablet 40 mg Tablet 108.00 90 1,000 2,835
1601 Ranitidin Tablet 150 mg Tablet 105.00 - 5,000 5,000
1602 Ranitidin Injeksi 25 mg/2 ml Ampul 1,928.00 983 - 553
1603 Reserpin Tablet 0,10 mg Tablet 81.00 688 - -
1604 Reserpin Tablet 0,25 mg Tablet 103.00 - - -
1605 Retinol ( Vitamin A ) Kapsul 10 Kapsul 242.00 20 450 450
1606 Retinol ( Vitamin A ) Kapsul 20 Kapsul 431.54 1 5,100 5,100
1607 Rifampisin Kapsul 300 mg Kapsul 376.00 - - -
1608 Ringer Asetat Cairan Infus Botol 15,899.40 - - 20
1609 Ringer Laktat Larutan Infus SterBotol 5,200.00 - 600 789
1701 Salbutamol Tablet 4 mg Tablet 85.00 - 3,500 6,000
1702 Salep 2 - 4 Kombinasi : Asam Salisil
Pot 1,229.17 227 192 238
1703 Salisil Bedak 2 % Kotak 1,120.00 9,641 40 86
1704 Salisil Spiritus 10 % Botol 1,115.00 484 - -
1705 Sefadroxil Sirup Kering 125 mgBotol 5,200.00 - - 84
1706 Sefadroxil Kapsul 250 mg Kapsul 468.00 - 2,000 2,600
1707 Sefadroxil Kapsul 500 mg Tablet 510.00 - 5,500 5,500
1708 Sefiksim Kapsul 100 mg Kapsul 1,000.00 73 450 1,040
1709 Sefiksim 400 mg + Azitromisin Paket 33,000.00 5,342 - -
1710 Sefotaksim Injeksi 1 g Vial 6,800.00 - - 32
1711 Serum Anti Bisa Ular Polivalen VI ial 240,449.00 1,550 10 10
1712 Serum Anti Bisa Ular Polivalen VI ial 26,983,968.00 596 - -
1713 Serum Anti Difteri Inj. 20.000 IU
Vial 472,505.00 - - -
1714 Serum Anti Tetanus Inj. 1.500 IAmpul 52,499.70 20 13 15
1715 Serum Anti Tetanus Inj. 20.000Vial
I 340,000.00 36 - -
1716 Sianokobalamin ( Vit. B 12 ) In Ampul 916.00 17,443 - 408
1717 Sianokobalamin (Vit.B12) TableTablet 12.36 - - 18,036
1718 Simetidin Tablet 200 mg Tablet 110.84 996 2,000 2,000
1719 Simvastatin Tablet 10 mg Tablet 180.00 20 900 1,500
1720 Siprofloksasin Tablet 500 mg Tablet 250.00 304 4,500 4,500
1721 Sulfadimidin Tablet 500 mg Tablet 12.00 1,000 - -
1722 Sulfasetamid Natrium Tetes M Botol 3,226.00 7 240 668
1801 Terbutalin tablet 2,5 mg Tablet 97.38 9 - 1,000
1802 Tetrasiklin HCL Kapsul 250 mg Kapsul 166.75 10 1,000 3,839
1803 Tetrasiklin HCL Kapsul 500 mg Kapsul 206.00 - 1,000 2,000
1804 Tiamfenikol Kapsul 500 mg Kapsul 431.00 3,304 3,000 4,300
1805 Tiamfenikol sirup kering 125 mBotol 6,600.00 - - 233
1806 Tiamin HCL ( Vit. B1 ) Inj. 100 Ampul 680.00 1 - 270
1807 Tiamin HCL Mononitrat ( Vit B Tablet 37.80 1 7,000 20,344
1808 Tramadol Injeksi 50 mg/ml Ampul 5,200.00 3 - 9
1809 Tramadol Kapsul 50 mg Kapsul 345.12 7 - 1,050
1810 Triamcinolone Acetonide 1 mgTube 12,100.00 1 96 187
1811 Triheksifenidil Tablet 2 mg Tablet 40.00 1 7,000 7,400
1901 Vitamin B Komplek Tablet Tablet 22.00 - 15,000 29,863
2001 Yodium Povidon Larutan 10 % Botol 2,400.00 - 20 23
2002 Yodium Povidon Larutan 10 % Botol 3,500.00 1 10 36
2003 Yodium Povidon Larutan 10 % Botol 14,000.00 - 10 39
2004 Yodium Povidon Larutan 10 % Botol 42,000.00 - - -
2101 Zinc Tablet 20 mg Tablet 440.00 - 200 9,000
0 OBAT GIGI Botol - - - -
2201 Air Raksa Dental Use Botol 103,536.00 - - -
2202 Devitalisasi Pasta ( Non Arsen )Botol 389,950.00 - - -
2203 Etil Klorida Spray Vial 104,999.40 - 20 25
2204 Eugenol Cairan Botol 45,833.33 - - -
2205 Glass Ionomer Cement Universa Set 394,999.00 - 4 4
2206 Kalsium Hidroksida Pasta (KalsiTube 121,000.00 - - -
2207 Monoklorkamfer Mentol CairaBotol 55,000.00 - 4 4
2208 Mummifying Pasta Botol 176,000.00 - 4 4
2209 Semen Seng Fosfat Serbuk danBotol 93,500.00 1 4 4
2210 Silver Amalgam Serbuk 65-75 Botol 1,149,999.40 - - -
2211 Temporary Filling Material / Botol 126,500.00 - - -
2212 Temporary Stopping Fletcher SSet 33,990.00 - - -
2213 Trikresol Formalin ( TKF ) CairaBotol 66,000.00 - - -
2214 Tumpatan Tetap dengan Sinar Set 1,705,000.00 - 1 1
0 REAGEN LABORATORIUM Botol - - - -
2301 EDTA 10% cair Botol 72,600.00 - - -
2302 Ether Alkohol: Ether 80% - Alk Botol 44,550.00 1 - -
2303 Golongan darah Test ( set 3 vialSet
@10 205,700.00 - 5 5
2304 HCL 0,1 N Botol 19,800.00 - - -
2305 KOH 10% Botol 29,997.00 - - -
2306 Larutan Benedict Botol 27,445.00 - - -
2307 Larutan Buffer Giemsa Botol 44,000.00 - 1 1
2308 Larutan Eosin 2% Botol 34,650.00 - - -
2309 Larutan Etanol Asam Botol 32,340.00 - - -
2310 Larutan Giemsa Stain Botol 60,038.00 - - -
2311 Larutan Hayem Botol 17,600.00 - - -
2312 Larutan Karbol Fuksin Botol 22,000.00 - - -
2313 Larutan Metilen Biru Botol 16,192.00 - - -
2314 Larutan Rees Ecker Botol 38,500.00 1,100 - -
2315 Larutan Turk Botol 13,816.00 - - -
2316 Lens Tissu Set 440.00 380 - -
2317 Metanol Botol 14,993.00 390 - -
2318 Reagen SD (HIV) Set - - - -
2319 Reagen ZN Set: @ 1 btl 100cc laBotol 179,999.60 - - -
2320 Rapid Plasma Reagen Test Kit Set 999,900.00 100 - -
2321 Sifilis Kit Set 13,222.00 1 - -
2322 Tuberkulin Vial - 65 - -
2323 Widal slide test ( set a vial @ Set 418,000.00 - 5 5
0 PERBEKALAN KESEHATAN Set - 41 - -
2401 Alat Suntik Sekali Pakai 0,05 mlSet 2,900.00 138 - -
2402 Alat Suntik Sekali Pakai 0,5 ml Set 2,100.00 18 - -
2403 Alat Suntik Sekali Pakai 1 ml Set 1,092.50 - - 1,041
2404 Alat Suntik Sekali Pakai 2,5 ml Set 872.30 137 2,000 4,198
2405 Alat Suntik Sekali Pakai 3 ml Set 593.94 90 2,000 2,035
2406 Alat Suntik Sekali Pakai 5 ml Set 1,038.00 - - 994
2407 Alat Suntik Sekali Pakai 10 ml Set 1,210.00 160 - -
2408 Alkohol 95% Botol 49,500.00 - - 2
2409 Blood Lancet Pcs 297.00 11 - 400
2410 Blood Transfusion set Set 28,600.00 - 200 214
2411 Catgut / Benang Bedah No. 3/ Sak 19,582.20 32 384 384
2412 Dresing penutup luka berpere Rol 52,437.00 - - -
2413 Etanol (Alkohol 70%) Botol 22,299.20 - 26 161
2414 Infusion Set Anak Set 3,999.60 9 200 300
2415 Infusion Set Dewasa Set 3,499.10 43 400 400
2416 Infusion Set Anak Elasty Ball Set 17,600.00 40 - -
2417 Infusion Set Dewasa Elasty BalSet 12,100.00 - 200 200
2418 Jarum Infus (i.v. Catheter) DewBiji 7,786.90 - 250 361
2419 Jarum Infus (i.v. Catheter) DewBiji 7,786.90 40 400 400
2420 Jarum Infus (i.v. Catheter) Ana Biji 7,786.90 10 250 475
2421 Kapas Berlemak 500 Gram Bungkus 17,250.00 - - -
2422 Kapas Pembalut / Absorben 2 Bungkus 7,499.80 2 20 29
2423 Kasa Kompres 40/40 Steril Bungkus 1,393.00 150 - -
2424 Kasa Hidrofil Steril uk. 16x16 ( Bungkus 531.25 100 48 1,008
2425 Kasa Pembalut 2 m x 80 cm Rol 8,799.00 10 - -
2426 Kasa Pembalut Elastic 3 inchi Rol 7,000.00 710 20 109
2427 Kasa Pembalut Hidrofil 4 m x 3Rol 733.00 700 - -
2428 Kasa Pembalut Hidrofil 4 m x 5Rol 302.50 150 100 100
2429 Kasa Pembalut Hidrofil 4 m x Rol 607.00 70 230 632
2430 Kasa Pembalut Hidrofil 4 m x 1Rol 3,373.00 20 - 3
2431 Kasa Hidrofil uk. 36 m x 80 cm Rol 55,199.10 50 4 7
2432 Kateter (Folley / Urine) No. 10 Biji 8,494.20 - - -
2433 Kateter (Folley / Urine) No. 16 Biji 8,494.20 76 100 176
2434 Kateter (Folley / Urine) No. 18 Biji 8,494.20 95 - 95
2435 Klem tali pusat Pcs 2,750.00 150 - 150
2436 Lisol Botol 44,000.00 - 20 20
2437 Masker Set 1,124.20 55 - 55
2438 Mess / Pisau scalpel no 11 Pcs 770.00 492 100 592
2439 Plester 5 yards x 2 inch Rol 21,624.90 - 24 24
2440 Sarung Tangan Karet Sekali PakSet 734.80 761 1,500 2,261
2441 Sarung Tangan Karet Sekali Pa Set 2,125.00 2,216 1,500 3,716
2442 Sarung Tangan Karet Sekali PakSet 737.00 60 1,500 1,560
2443 Silk / Benang Sutra no. 3/0 d Pcs 6,982.80 283 108 391
2444 Sarung Tangan Karet Obgyn Seka Sak 7,799.00 - 100 100
2445 Urine Bag Set 4,000.00 173 200 373
2446 Under Pad 60x90 Steril Pcs 6,050.00 - 250 250
2447 Wing Needle No. 25 G Buah 2,530.00 117 - 117
JUMLAH
Mengetahui, Kediri, 30 Juni 2014

Kepala UPTD Puskesmas Mojo Pengelola Obat
dr. RINDANG FARIHAH IDANA DWI KRISTIYANI, S.Farm.,Apt

NIP. 19820728 200901 2 007 NIP : 19810630 201101 2 007
PEMAKAIAN SISA JML RUPIAH
8 9 10.00
- 1,350 494,100.00
- 60 228,660.00
4,700 2,200 241,076.00
105 267 640,800.00
5,420 1,780 152,955.40
5,562 - -
20 220 712,800.00
1,500 1,800 183,600.00
2,040 810 194,400.00
- 600 2,730,000.00
351 352 809,600.00
1,400 1,000 190,000.00
37,329 27,800 6,116,000.00
29 - -
- 24 105,600.00
12,460 8,000 1,160,000.00
14 480 576,000.00
46,420 15,780 1,229,893.20
142 - -
- 131 326,321.00
11 68 129,499.20
140 90 220,500.00
197 - -
10 40 200,000.00
41,319 12,240 336,600.00
30,300 2,300 218,500.00
430 370 386,650.00
- 30 115,500.00
100 700 70,000.00
200 1,070 173,340.00
1,671 829 290,150.00
1,197 830 198,370.00
122 285 613,320.00
10 43 52,890.00
- - -
2,400 1,950 622,050.00
- - -
- - -
16,080 92,983 4,091,252.00
690 210 194,040.00
155 250 380,000.00
139 558 426,250.00
- - -
2,500 1,700 86,190.00
10 40 313,480.00
100 700 157,500.00
527 608 851,200.00
24,741 23,750 1,638,275.00
90 350 482,597.50
24,336 5,000 450,000.00
103 120 281,280.00
519 8,846 309,610.00
- 643 36,008.00
- - -
326 178 170,880.00
1,800 2,100 191,100.00
610 - -
5,800 1,600 152,000.00
420 3,080 677,600.00
24 190 688,560.00
1,700 2,900 510,400.00
728 270 726,462.00
18,965 5,000 253,000.00
- - -
280 338 507,000.00
4,040 1,100 542,300.00
5,900 900 777,825.00
35 222 1,602,840.00
11 4 8,848.64
- - -
2,320 980 110,740.00
- - -
- - -
- - -
- 74 3,463,200.00
223 - -
- - -
- - -
- - -
12 48 48,384.00
375 37 64,380.00
1,405 1,095 634,005.00
- - -
10 30 1,980,000.00
- - -
1,370 3,200 288,000.00
10 28 51,509.92
117 120 2,454,540.00
1,335 4,380 1,278,960.00
86 100 310,400.00
60 90 121,500.00
4 167 150,300.00
3,690 2,810 151,740.00
14,260 23,000 632,500.00
248 252 1,338,876.00
- 104 595,608.00
215 1,585 1,565,980.00
500 500 97,000.00
- - -
- - -
1,200 800 75,680.00
1,200 4,100 500,610.00
- - -
18,000 - -
176 209 531,069.00
1,025 1,775 2,343,000.00
20 80 277,200.00
415 730 67,576.10
10,200 13,800 1,987,200.00
125 1,855 170,660.00
3,200 1,000 425,000.00
- - -
16,576 9,000 465,300.00
79 130 743,600.00
2,200 3,400 244,800.00
7,264 3,000 264,000.00
300 - -
3,400 1,900 461,700.00
2,380 1,220 325,740.00
67 140 567,000.00
147 - -
650 1,500 790,500.00
- - -
265 - -
7 143 529,100.00
- 150 374,880.00
103 217 338,954.00
84 99 158,301.00
42,093 7,400 192,400.00
20 8,792 940,744.00
92 179 182,759.00
- - -
3,600 10,150 1,349,950.00
- - -
- - -
601 1,803 847,410.00
- - -
900 300 21,600.00
365 286 736,164.00
5,705 25,600 4,095,872.00
- - -
- - -
- 200 94,600.00
700 1,050 1,211,364.00
560 310 401,450.00
324 364 309,400.00
400 900 144,000.00
2,250 4,300 387,000.00
- - -
- - -
- - -
- - -
850 950 222,300.00
290 1,200 131,868.00
158 125 186,175.00
80 1,200 354,996.00
900 1,700 178,500.00
1,910 - -
158 98 94,080.00
- 95 199,500.00
1,647 2,800 343,840.00
2,605 3,200 523,968.00
- - -
189 235 705,000.00
88 106 676,280.00
1,100 - -
- - -
4,002 200 42,000.00
15 250 1,225,000.00
1,400 - -
80 140 56,980.00
785 2,465 1,577,600.00
26 14 3,634,400.00
- - -
2 - -
165 313 394,051.35
5,300 1,800 827,640.00
- 200 82,600.00
- - -
99 151 230,879.00
433 115 184,000.00
409 395 705,075.00
360 1,140 302,100.00
- - -
1,000 9,000 1,071,000.00
110 75 86,250.00
- - -
29 195 1,019,265.00
530 220 290,158.00
2,200 1,600 51,568.00
37,600 16,000 1,342,880.00
- - -
- - -
10 - -
640 1,460 283,240.00
790 1,010 404,000.00
- - -
5,708 9,900 163,350.00
2,140 - -
1,200 2,900 266,684.00
9 - -
11,038 3,000 192,000.00
- - -
200 900 237,600.00
1,055 1,780 192,240.00
2,000 3,000 315,000.00
553 - -
- - -
- - -
450 - -
5,100 - -
- - -
- 20 317,988.00
679 110 572,000.00
3,600 2,400 204,000.00
46 192 236,000.00
56 30 33,600.00
- - -
- 84 436,800.00
1,710 890 416,520.00
3,200 2,300 1,173,000.00
600 440 440,000.00
- - -
32 - -
- 10 2,404,490.00
- - -
- - -
2 13 682,496.10
- - -
408 - -
7,036 11,000 135,955.60
300 1,700 188,428.00
1,020 480 86,400.00
2,350 2,150 537,500.00
- - -
548 120 387,120.00
100 900 87,642.00
339 3,500 583,625.00
770 1,230 253,380.00
2,220 2,080 896,480.00
33 200 1,320,000.00
270 - -
16,344 4,000 151,200.00
9 - -
230 820 282,998.40
67 120 1,452,000.00
3,200 4,200 168,000.00
11,863 18,000 396,000.00
18 5 12,000.00
20 16 56,000.00
18 21 294,000.00
- - -
2,760 6,240 2,745,600.00
- - -
- - -
- - -
19 6 629,996.40
- - -
4 - -
- - -
4 - -
4 - -
4 - -
- - -
- - -
- - -
- - -
1 - -
- - -
- - -
- - -
5 - -
- - -
- - -
- - -
1 - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
5 - -
- - -
- - -
- - -
- 1,041 1,137,292.50
590 3,608 3,147,258.40
1,529 506 300,533.64
424 570 591,660.00
- - -
- 2 99,000.00
260 140 41,580.00
56 158 4,518,800.00
32 352 6,892,934.40
- - -
- 161 3,590,171.20
219 81 323,967.60
80 320 1,119,712.00
- - -
- 200 2,420,000.00
202 159 1,238,117.10
305 95 739,755.50
335 140 1,090,166.00
- - -
17 12 89,997.60
- - -
975 33 17,531.25
- - -
109 - -
- - -
30 70 21,175.00
632 - -
3 - -
7 - -
- - -
84 92 781,466.40
95 - -
50 100 275,000.00
13 7 308,000.00
20 35 39,347.00
189 403 310,310.00
- 24 518,997.60
1,061 1,200 881,760.00
1,511 2,205 4,685,625.00
960 600 442,200.00
122 269 1,878,373.20
53 47 366,553.00
31 342 1,368,000.00
100 150 907,500.00
17 100 253,000.00
150,890,960.20
S.Farm.,Apt
01101 2 007

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LAPORAN PEMAKAIAN DAN LEMBAR PERM

KODE PUSKESMAS : 3506070

KELAS STOK PENERI- PERSE- PEMAKAI

JUMLAH KUNJUNGAN RESEP

Mengetahui / Menyetujui Yang Menyerahkan

dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt

STOK PERMIN- PEMBERIAN

Yang Menerima / Melapor Yang Menerima

dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.

KODE PUSKESMAS : 3506070

KELAS STOK PENERI- PERSE- PEMAKAI

JUMLAH KUNJUNGAN RESEP

Mengetahui / Menyetujui Yang Menyerahkan

dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt

STOK PERMIN- PEMBERIAN

Yang Menerima / Melapor Yang Menerima

dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.

KODE PUSKESMAS : 3506070

KELAS STOK PENERI- PERSE- PEMAKAI

JUMLAH KUNJUNGAN RESEP

Mengetahui / Menyetujui Yang Menyerahkan

dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt

STOK PERMIN- PEMBERIAN

Yang Menerima / Melapor Yang Menerima

dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.

KODE PUSKESMAS : 3506070

KELAS STOK PENERI- PERSE- PEMAKAI

JUMLAH KUNJUNGAN RESEP

Mengetahui / Menyetujui Yang Menyerahkan

dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt

STOK PERMIN- PEMBERIAN

Yang Menerima / Melapor Yang Menerima

dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.

KODE PUSKESMAS : 3506070

KELAS STOK PENERI- PERSE- PEMAKAI

JUMLAH KUNJUNGAN RESEP

Mengetahui / Menyetujui Yang Menyerahkan

dr. ADI LAKSONO, MMRS. HESTI SAUDAH, S.Si., Apt

STOK PERMIN- PEMBERIAN

Yang Menerima / Melapor Yang Menerima

dr. Eko Wahyudi Dwi Mulyaningsih, S. Farm, Apt.

KELAS STOK PENERI- PERSE- PEMAKAI STOK PERMIN- PEMBERIAN

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor Yang Men

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PENERI- PERSE- PEMAKAI

1 Alat Suntik Sekali Pakai 3 ml

UNIT : UGD & RAWAT INAP

STOK PENERI- PERSE- PEMAKAI SISA PERMIN

61 Natrium Klorida Larutan Infus 0,9 % Steril

PENERI- PERSE- PEMAKAI SISA PERMIN PEMBER

Petugas Pustu/Polindes UMUM

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