RENCANA ANGGARAN BIAYA (RAB)

Kegiatan : JKN Puskesmas Songgon

Obyek Belanja : Belanja Peralatan dan Bahan kesehatan

Harga Satuan
No Jenis Obat Volume Satuan Jumlah Harga (Rp.)
(Rp.)
1 Masker Tali 200 biji 64,050 12,810,000
2 Glass Ionomer tipe 1 2 set/btl 377,000 754,000
3 CHKM 3 Btl 55,580 166,740
4 Jarum Kulit 16 Dozen 26,070 417,120
5 Jarum Otot 16 Dozen 25,960 415,360
6 IV Cateter 16 1 Box/50 1,614,050 1,614,050
7 IV Cateter 18 2 Box 1,614,050 3,228,100
8 IV Cateter 20 1 Box 1,614,050 1,614,050
9 IV Cateter 22 2 Box 1,614,050 3,228,100
10 IV Cateter 24 1 Box 1,370,100 1,370,100
11 Duk Lubang Besar2,5x2 mtr 5 Lembar 150,150 750,750
12 Duk Lubang Kecil 1x1 Mtr 5 Lembar 238,050 1,190,250
13 Gilet Goal 50 1 Biji 2,300 115,000
14 Hand Scoen 600 ktk/50 64,750 38,850,000
15 Kassa Steril 16x16 cm 600 Kotak 6,300 3,780,000
16 Needle / Jarum 25 G 1 Box 131,000 131,000
17 Silk 3 Kotak 237,050 711,150
18 Spuit 3 cc 150 Box 240,200 36,030,000
19 Spuit 0,05 cc 600 Pcs 2,900 1,740,000
20 Spuit 0,5 cc 3000 Pcs 2,600 7,800,000
21 Spuit 5 cc 5 Box 324,450 1,622,250
22 Catgut Chromic 3/0 1 Roll 1,510,500 1,510,500
23 Catgut Plain 2/0 1 Roll 1,510,500 1,510,500
24 Hand Scoen Panjang Siku 100 Pasang 12,650 1,265,000
25 Selang Oksigen 1 Box/50 470,900 470,900
26 Selang Oksigen Anak 1 Box/50 470,900 470,900
27 Celemek Plastik 5 buah 57,200 286,000
28 Lampu Senter 10 pcs 75,700 757,000
29 Meteran 15 Pcs 12,600 189,000
30 Selang Karet Untuk Anus 5 Pcs 63,100 315,500
31 Tes Buta Warna (Ishihara) 10 Pcs 264,300 2,643,000
32 H₂O₂ Cairan 3% 100 mg 10 Fls 4,400 44,000
33 Ky Jelly 10 Tube 50,700 507,000
34 F. Cateter 16 1 Box 113,500 113,500
35 F. Cateter 18 2 Box 113,500 227,000
36 F. Cateter 20 2 Box 113,500 227,000
37 Jarum/ Needle 23 G 10 Box 134,500 1,345,000
38 Infus Set Dewasa 2 Box/50 289,250 578,500
 Harga Satuan
No Jenis Obat Volume Satuan Jumlah Harga (Rp.)
(Rp.)
39 Infus Set Paediatrik 1 Box/50 1,076,350 1,076,350
40 Mess no 11 2 Box/100 277,500 555,000
41 Mess no 15 2 Box/100 277,500 555,000
42 Pap Smear Kit 420 Set 63,100 26,502,000
43 Transfusi Set 1 Box 1,481,140 1,481,140
44 Umbilical Clamp 244 Pcs 3,750 915,000
45 Underpad 10 Box 672,700 6,727,000
46 Urine Bag 4 Box 60,500 242,000
47 Kassa Pembalut 36 m X 80 cm 18 Roll 198,000 3,564,000
48 Plester 5 yard X 2 inch 31 Roll 24,900 771,900
49 Iodine Test 10 ml 51 ml 4,200 214,200
50 Devitalisasi Pasta Non Arsenic 2 Btl/Ktk 372,250 744,500
51 Mummifying Pasta 2 Btl/Ktk 221,550 443,100
52 Semen Seng 3 Btl 89,250 267,750
53 Spongostan 3 Box 683,750 2,051,250
54 Sound Timer 4 Pc 63,100 252,400
55 Kapas 55 Roll 16,450 904,750
56 Etil Klorida Semprot 50 100 ml/btl 93,200 4,660,000
JUMLAH TOTAL 182,725,660
PEMBULATAN 182,725,650
TERBILANG : SERATUS DELAPAN PULUH DUA JUTA TUJUH RATUS DUA PULUH LIMA RIBU ENAM RATUS LIMA PULUH RUPIAH

Banyuwangi, 11 Januari 2015

Mengetahui
Kuasa Pengguna Anggaran PenanggungJawab
Kepala Bidang Bina PKF Plt. Kepala Puskesmas Songgon

MUJITO,SKM dr. SAMSUL FUAD

Penata Penata Muda Tk. I
NIP. 19690524 199103 1 003 NIP.19770810 200806 1 031
1,481,130

(10)
 RENCANA ANGGARAN BIAYA (RAB)
Kegiatan : JKN Puskesmas Songgon
Obyek Belanja : Belanja Bahan Obat - Obatan

Harga Satuan Jumlah Harga

No Jenis Obat Volume Satuan
(Rp.) (Rp.)
1 Acyclovir Cream 50 Tube 3,150 157,500
2 Albendazole tablet 400 mg 5 5x6tab/box 10,320 51,600
3 Allopurinol tablet 100 mg 100 100tab/box 8,600 860,000
4 Aminophilin tablet 200 mg 100 100tab/botol 8,000 800,000
5 Amlodipin 10 mg tablet 5 3x10 tab/ktk 9,900 49,500
6 Amoxcilin Syrup 125 mg/ 5 ml 200 60 ml/btl 2,445 489,000
7 Amoxcilin 500 mg Kapsul 410 10x10 kaps/ktk 26,100 10,701,000
8 Antasid DOEN Syrup 100 btl 2,160 216,000
9 Antasid DOEN tablet kunyah 500 10x10 tab/ktk 7,200 3,600,000
10 Anti migren DOEN tablet 10 100/ btl 13,500 135,000
11 Antifungi DOEN 20 24 pot/kotak 45,300 906,000
12 Antihemoroid supp 2 g 50 10 supp/kotak 33,000 1,650,000
13 Asam Folat 1 mg tab 100 100 tab/ btl 4,800 480,000
14 Asam mefenamat 500 mg kaplet 500 10x10 tab/ktk 11,200 5,600,000
15 Asiklovir 400 mg tablet 10 50 tab/ktk 16,800 168,000
16 Bedak Salisil serbuk 2% 100 50 g/dus 1,250 125,000
17 Betametason cream 100 Tube 1,520 152,000
18 Deksametason injeksi i.v./i.m. 5 mg/ml 1 100 ampx1 ml 158,000 158,000
19 Deksametason tablet 0,5 mg 100 1000 tab/btl 62,000 6,200,000
20 Difenhidramin inj. 10 mg/ml 5 30 amp/box 31,500 157,500
21 Dimenhidrinat 50 mg tab 10 100 tab/ btl 10,400 104,000
22 Efedrin tablet 25 mg 2 250 tab/ btl 11,650 23,300
23 Ekstrabelladone 10 mg tablet 2 1000 tab/btl 31,475 62,950
24 Eritomicin 500 mg tablet 10 100/box 93,000 930,000
25 Eritomicin Syrup 200 mg/ 5 ml 50 btl 7,700 385,000
26 Etakridin larutan 0,1 % 10 300 ml/btl 1,900 19,000
27 Etaol 70 % 80 btl 100 ml 2,500 200,000
28 Fenolgliserol Tetes Telinga 50 btl 1,100 55,000
29 Fitominadion 1 mg / ml inj. 15 30 amp/box 37,400 561,000
30 Fitominadion 100 mg tablet 30 100 tab/ btl 74,800 2,244,000
 Harga Satuan Jumlah Harga
No Jenis Obat Volume Satuan
(Rp.) (Rp.)
31 Furosemid 40 mg tablet 100 10x10 tab/ktk 8,500 850,000
32 Garam Oralit 200 ml 40 100 sac/kotak 28,800 1,152,000
33 Gentamisin salep mata 0,3 % 50 Tube 2,600 130,000
34 Gentamisin tetes mata 0,3 % 50 btl 3,194 159,700
35 Gentian Violet 53 10 ml/botol 950 50,350
36 Glibenklamid tablet 5 mg 50 100 tab/ dus 5,600 280,000
37 Gresiofulfin 125 mg tab 10 10x10 tab 20,900 209,000
38 Ibuprofin 200 mg tab 300 100 tab/ btl 11,000 3,300,000
39 Ibuprofin 400 mg tab 100 100 tab/Bx 15,000 1,500,000
40 Ibuprofin Suspensi 100 mg/ 5 ml 50 btl 3,499 174,950
41 ISDN 5 mg tablet 5 100/box 15,015 75,075
42 Klak 500 mg 20 1000 tab/btl 47,100 942,000
43 Kaptropil 25 mg tab 300 100/box 80,400 24,120,000
44 Karbamazepin 200 mg 2 10x10 tab/ktk 24,500 49,000
45 Ketokonazole 200 mg 10 50/box 15,000 150,000
46 Ketokonazole Cream 2 % 51 tube 10 gr 4,250 216,750
47 Klindamicin Capsul 300 mg 50 5 x 10 Caps/ktk 27,650 1,382,500
48 Klorampinikol 250 mg Kapsul 10 100 tab/ktk 24,900 249,000
49 Klorampinikol Suspensi 125 mg/5 ml 100 btl 3,680 368,000
50 Klorfeniramin maleat tab 4 mg 40 1000 tab/btl 26,400 1,056,000
51 Kotrimoksasol 480 mg tabl 30 100 tab/ktk 13,800 414,000
52 Kotrimoksasol Syrup 100 60 ml/btl 2,167 216,700
53 Lidokain inj. + Epineprin 20 30 amp/box 40,890 817,800
54 Ioratadine 10 mg tab 20 5x10tab/ktk 7,700 154,000
55 Metilergometrin 0,125 mg tab 6 10x10tab/box 15,400 92,400
56 Metroklopramid 5 mg 5 10x10/tab/kotak 10,800 54,000
57 Metronidasol 250 mg tab 20 100/box 11,000 220,000
58 Metronidasol 500 mg tab 30 100/box 16,000 480,000
59 Miconazole cream 100 tube 3,000 300,000
60 Na Diklofenak 25 mg tablet 400 50/box 6,650 2,660,000
61 Na Diklofenak 50 mg tablet 400 50/box 8,800 3,520,000
62 Nifedipin Tab 10 gr 3 100 tab/duz 11,000 33,000
63 Omeprazole 20 mg 20 3x10 tab/ktk 6,330 126,600
64 Paracetamol 500 mg 750 10x10tab/box 7,900 5,925,000
 Harga Satuan Jumlah Harga
No Jenis Obat Volume Satuan
(Rp.) (Rp.)
65 Paracetamol drop 100 mg/ml mg 50 15 bot/duz 5,200 260,000
66 Paracetamol syrup 130 botol 1,438 186,940
67 Piridoksin HCI 10 mg tab 10 1000 tab/btl 22,900 229,000
68 Povidon Iodida lart 10 % 300 ml 10 botol 14,203 142,030
69 Prednison 5 mg tab 20 1000 tab/btl 45,700 914,000
70 Ranitidin 150 mg tablet 150 10 Ampx1 ml 12,000 1,800,000
71 Ranitidin injeksi 10 3x10 tab/ktk 11,400 114,000
72 Salbutamol 4 mg tab 50 10x10tab/box 8,900 445,000
73 Salep 2 - 4 160 Pot 2,000 320,000
74 Setirizin Syrup 15 botol 60 ml 7,999 119,985
75 Sianokobalamin 500 mg tab 30 1000 tab/klg 14,471 434,130
76 Sianokobalamin injeksi 1 100 ampx1 ml 107,800 107,800
77 Simvastatin 10 mg tab. Salut 100 3x10 tab/ktk 11,730 1,173,000
78 Siprofloksasin Tablet scored 500 mg 50 10x10tab/box 25,500 1,275,000
79 Tetrasiklin 250 mg kapsul 10 10x10tab/box 14,900 149,000
80 Thiamin HCI 150 mg tab 30 1000tab/klg 63,636 1,909,080
81 Vit B Compleks tab 20 10x10 tab/ktk 10,700 214,000
82 Zinc Dispersible tablet 10 10x10tab/box 47,400 474,000
JUMLAH TOTAL 98,935,140
PEMBULATAN 98,935,100
TERBILANG : SEMBILAN PULUH DELAPAN JUTA SEMBILANRATUS TIGA PULUH LIMA RIBU RUPIAH

Banyuwangi, 11 Januari 2015

Mengetahui
Kuasa Pengguna Anggaran PenanggungJawab
Kepala Bidang Bina PKF Plt. Kepala Puskesmas Songgon

MUJITO,SKM dr. SAMSUL FUAD

Penata Penata Muda Tk. I
NIP. 19690524 199103 1 003 NIP.19770810 200806 1 031
 RENCANA ANGGARAN BIAYA (RAB)
Kegiatan : JKN Puskesmas Songgon
Obyek Belanja : Belanja Alat dan Bahan Laboratorium

Harga Satuan Jumlah Harga

No Jenis Obat Volume Satuan
(Rp.) (Rp.)
1 Reagen Golda 20 Set 285,585 5,711,700
2 Aquadest 2 Ktk 516,050 1,032,100
3 Stik Gula (Easy Touch) 60 Pack 75,000 4,500,000
4 Stik Asam Urat (Easy Touch) 60 Pack 75,000 4,500,000
5 Stik Kolesterol (Easy Touch) 60 Pack 140,000 8,400,000
6 Blood Lancet 10 Pack 25,000 250,000
7 HIV Test 10 Paket 4,500,000 45,000,000
8 Reagen Widal 2 Pack 79,000 158,000
9 Stik PP Test (Kehamilan 20 Box 338,500 6,770,000
JUMLAH TOTAL 76,321,800
PEMBULATAN 76,321,800
TERBILANG : TUJUH PULUH ENAM RIBU TIGA RATUS DUA PULUH SATU RIBU DELAPAN RATUS RUPIAH

Banyuwangi, 11 Januari 2015

Mengetahui
Kuasa Pengguna Anggaran PenanggungJawab
Kepala Bidang Bina PKF Plt. Kepala Puskesmas Songgon

MUJITO,SKM dr. SAMSUL FUAD

Penata Penata Muda Tk. I
NIP. 19690524 199103 1 003 NIP.19770810 200806 1 031
 285,585
-

-
 RENCANA ANGGARAN BIAYA (RAB)
Kegiatan : JKN Puskesmas Songgon
Obyek Belanja : Belanja Alat - Alat Kedokteran Umum

Harga Satuan
No Jenis Obat Volume Satuan Jumlah Harga (Rp.)
(Rp.)
1 Stetoskop 12 Buah 551,550 6,618,600
2 Nebulizer 1 Unit 1,911,200 1,911,200
3 Doppler 5 Unit 2,869,000 14,345,000
4 Gunting Angkat Jahitan Smic 6 Buah 67,600 405,600
5 Hecting Set 2 Set 404,250 808,500
6 Pincet Telinga Smic 2 Buah 1,324,450 2,648,900
7 Tensimeter 20 Buah 257,950 5,159,000
8 Lampu Sorot 3 Buah 1,728,550 5,185,650
9 Palu Pengukur refleks 2 Pc 62,050 124,100
10 Gunting Pembalut 2 Pc 78,850 157,700
11 Pengukur Tinggi Badan 4 Pc 40,200 160,800
12 BKB Kit 1 Paket 2,551,200 2,551,200
13 Vaccine Carrier 2 Unit 2,102,200 4,204,400
14 Paket DDTK 2 Paket 286,750 573,500
15 Timbangan + Tinggi Badan 2 Pc 1,526,250 3,052,500
16 Timbangan Dewasa 6 Pc 88,300 529,800
17 Pinset Hidung 2 Buah 54,600 109,200
18 Bein Lurus Besar 1 Pc 165,750 165,750
19 Bor Intan 2 Pc 240,850 481,700
20 Pinset Gigi 2 Pc 45,650 91,300
21 Seluloid Kotak/ Strip 1 Pc 143,300 143,300
22 Tang Pencabutan Gigi Seri dan Taring 2 Pc
Bawah Anak 298,400 596,800
23 Tang Pencabut Geraham Besar Bawah 2 Pc 331,350 662,700
24 Tempat Alkohol ( Dappen Glass ) 1 Pc 9,200 9,200
25 Tabung Oksigen 2 Pcs 1,146,700 2,293,400
26 Timbangan Berat Badan Bayi 10 Pc 630,600 6,306,000
JUMLAH TOTAL 59,295,800
PEMBULATAN 59,295,800
TERBILANG : LIMA PULUH SEMBILAN JUTA DUA RATUS SEMBILAN PULUH LIMA RIBU DELAPAN RATUS RUPIAH

Mengetahui
Kuasa Pengguna Anggaran PenanggungJawab
Kepala Bidang Bina PKF Plt. Kepala Puskesmas Songgon

MUJITO,SKM dr. SAMSUL FUAD

 Penata Penata Muda Tk. I
NIP. 19690524 199103 1 003 NIP.19770810 200806 1 031
 1,324,450

1,146,700

1,728,550

- -

59,295,800
 RENCANA ANGGARAN BIAYA (RAB)
Kegiatan : JKN Puskesmas Songgon 2015
Obyek Belanja : Belanja Alat dan Bahan Laboratorium

Harga Satuan Jumlah Harga

No Jenis Obat Volume Satuan
(Rp.) (Rp.)
1 Reagen Golda 4 Set 774,000 3,096,000
2 Aquadest 2 Karton 512,025 1,024,050
3 Stik Gula (Easy Touch) 21 Tube 240,000 5,040,000
4 Stik Asam Urat (Easy Touch) 21 Tube 240,000 5,040,000
5 Stik Kolesterol (Easy Touch) 25 Tube 348,000 8,700,000
6 Blood Lancet 8 Box 191,100 1,528,800
7 HIV Test Oncoprobe 10 50 Test/Box 4,500,000 45,000,000
8 HIV Test Intec 1 40 Test/Box 2,800,000 2,800,000
9 Reagen Widal 1 Box 859,950 859,950
10 Stik PP Test (Kehamilan 20 Box 161,650 3,233,000
JUMLAH TOTAL 76,321,800
TERBILANG : TUJUH PULUH ENAM RIBU TIGA RATUS DUA PULUH SATU RIBU DELAPAN RATUS RUPIAH

Banyuwangi, 29 Desember 2014

Mengetahui
Kuasa Pengguna Anggaran PenanggungJawab
Kepala Bidang Bina PKF Plt. Kepala Puskesmas Songgon

MUJITO,SKM dr. SAMSUL FUAD

Penata Penata Muda Tk. I
NIP. 19690524 199103 1 003 NIP.19770810 200806 1 031
 508,000

#REF!

#REF!

#REF!