Blangko Rko 2020 Puskesmas New

DINAS KESEHATAN KOTA BANJARMASIN
RENCANA KEBUTUHAN OBAT TAHUN 2020

PUSKESMAS : ............................................
TOTAL SISA PEMAKAIAN PEMAKAIAN TOTAL PREDIKSI

SISA STOK OBAT SISA STOK OBAT PREDIKSI SISA RENCANA USULAN
STOK OBAT RATA2/BULAN RATA2/BULAN PEMAKAIAN PENERIMAAN
NO NAMA OBAT SATUAN APBD JKN STOK PER KEBUTUHAN OBAT PENGADAAN 2020
PER 31 OBAT APBD OBAT JKN RATA2 / BULAN NOV & DES
31 OKT 2019 31 OKT 2019 DESEMBER 2019 TAHUN 2020 (PEMBULATAN)
OKTOBER 2019 2019
1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13

A OBAT
1 Albendazol tablet 400 mg* tablet 0 0 0 -

2 Allopurinol tablet 100 mg tablet 0 0 0 -
3 Aminofilin injeksi 24 mg/ml-10 ml ampul 0 0 0 -
4 Aminofilin tablet 200 mg tablet 0 0 0 -
5 Amitriptilin Hcl tablet salut 25 mg tablet 0 0 0 -
6 Amlodipin 5 mg tablet 0 0 0 -
7 Amoksisilin 500 mg kaplet tablet 0 0 0 -
8 Amoksisilin Sirup kering 125 mg/5 ml botol 0 0 0 -
9 Ampisilin serbuk injeksi i.m.i.v 1000 mg/ml vial 0 0 0 -
10 Antasida doen tablet kombinasi tablet 0 0 0 -
11 Antasida sirup botol 0 0 0 -
12 Antifungi doen kombinasi tube 0 0 0 -
13 Artemether injeksi 80 Mg* ampul 0 0 0 -
14 Artesunate cairan injeksi 60 mg* ampul 0 0 0 -

15 Asam Askorbat(vit C) tablet 50 mg tablet 0 0 0 -
16 Asam Folat 1 mg tablet tablet 0 0 0 -
17 Asam mefenamat 500 mg kaplet tablet 0 0 0 -
18 Asiklovir 200 mg tablet tablet 0 0 0 -
19 Asiklovir 400 mg tablet tablet 0 0 0 -
20 Atropin Sulfat tablet 0,5 mg tablet 0 0 0 -
21 Benzatin Benzil Penisilin inj 1,2 juta iu/vial vial 0 0 0 -
22 Benzatin Benzil Penisilin inj 1,4 juta iu/vial vial 0 0 0 -
23 Betametason krim 0,1 % tube 0 0 0 -
24 Clindamisin kapsul 300 mg kapsul 0 0 0 -
25 Deksametason tablet 0,5 mg tablet 0 0 0 -
26 Deksametason inj 5 mg/ml-1 ml ampul 0 0 0 -
Page 1 of 52
OKTOBER 2019 2019
DHP / Darplex / D-Artepp (Dehidro artemisin 0 0 0 -

27 Piperaquin) tab* tablet
28 Diazepam inj 5 mg/ml-2 ml ampul 0 0 0 -
29 Diazepam tablet 2 mg tablet 0 0 0 -
30 Diazepam tablet 5 mg tablet 0 0 0 -
31 Dietilkarbamazin sitrat tablet 100 mg* tablet 0 0 0 -
32 Difenhidramin Hcl inj 10 mg/ml-1 ml ampul 0 0 0 -
33 Digoksin tablet 0,25 mg tablet 0 0 0 -
34 Dimenhidrinate tablet tablet 0 0 0 -
35 Doksisiklin 100 mg kapsul kapsul 0 0 0 -
36 Domperidon 10 mg tablet 0 0 0 -
37 Epinefrin Hcl/Bitartrat(adrenalin)inj 0,1 %-1 ml ampul 0 0 0 -
38 Erytromisin sirup botol 0 0 0 -
39 Erytromisin 500 mg kaplet tablet 0 0 0 -
40 Etambutol 500 mg tablet tablet 0 0 0 -
41 Fenitoin kapsul 50 mg kapsul 0 0 0 -
42 Fenobarbital inj 50 mg / ml - 2 ml ampul 0 0 0 -
43 Fenobarbital tablet 30 mg tablet 0 0 0 -
44 Ferrous sulphate tab selaput 300 mg tablet 0 0 0 -
Ferro folat tab sal selaput 200 mg + 0,25 mg 0 0 0 -

45 (Tablet tambah darah komb.) tablet
46 Fitomenadion ( vit k 1 ) tablet salut 10 mg tablet 0 0 0 -
47 Fitomenadion ( vit k 1 ) inj 10 mg / ml - 1 ml ampul 0 0 0 -
48 Furosemid tablet 40 mg tablet 0 0 0 -
49 Furosemid Cairan Injeksi 10 mg/ml ampul 0 0 0 -
50 Garam oralit untuk 200 ml air sachet 0 0 0 -
51 Gentamisin inj 40 mg/2 ml* ampul 0 0 0 -
52 Gentamisin inj 80 mg/2 ml* ampul 0 0 0 -
53 Glibenklamid tablet 5 mg tablet 0 0 0 -
54 Glimepirid tab 1 mg tablet 0 0 0 -
55 Griseofulvin tablet 125 mg micronized tablet 0 0 0 -
56 Haloperidol tablet 0,5 mg tablet 0 0 0 -
57 Haloperidol tablet 5 mg tablet 0 0 0 -
58 Hidroklortiazid ( Hct ) tablet 25 mg tablet 0 0 0 -
Page 2 of 52
OKTOBER 2019 2019
59 Hidrokortison krim 2,5 % tube 0 0 0 -

60 Ibuprofen tablet 200 mg tablet 0 0 0 -
61 Ibuprofen tablet 400 mg tablet 0 0 0 -
62 Isoniazid tablet 100 mg tablet 0 0 0 -
63 Isoniazid tablet 300 mg tablet 0 0 0 -
64 Isosorbit dinitrat tablet sublingual 5 mg tablet 0 0 0 -
65 Kalsium Gluconas inj* ampul 0 0 0 -
66 Kalsium Karbonat tablet 500 mg tablet 0 0 0 -
67 Kaptopril 25 mg tablet tablet 0 0 0 -
68 Karbamazepin tablet 200 mg tablet 0 0 0 -
69 Ketokenazol 200 mg tablet tablet 0 0 0 -
70 Kloramfenikol kapsul 250 mg kapsul 0 0 0 -
71 Kloramfenikol salep 2 % tube 0 0 0 -
72 Kloramfenikol salep mata 1 % tube 0 0 0 -
73 Kloramfenikol sirup botol 0 0 0 -
74 Klorfeniramin maleat ( CTM ) tablet 4 mg tablet 0 0 0 -
75 Klorpromazin Hcl inj 5 mg / ml - 2 ml ampul 0 0 0 -
76 Klorpromazin Hcl tablet salut 100 mg tablet 0 0 0 -
77 Kodein tablet 10 mg tablet 0 0 0 -
78 Kotrimoksazol DOEN I (dewasa) tablet tablet 0 0 0 -
79 Kotrimoksazol suspensi botol 0 0 0 -
80 Kuinine tablet salut selaput 200 mg* tablet 0 0 0 -
81 Kuinine Dihydrochloride cairan inj 25%-2 ml* ampul 0 0 0 -
82 Lidocain injeksi 2 % ampul 0 0 0 -
83 Lidokain kompositum injeksi ampul 0 0 0 -
84 Loratadin tablet tablet 0 0 0 -
85 Magnesium sulfat inj ( 1V ) 20 % - 25 ml* vial 0 0 0 -
86 Magnesium sulfat inj ( 1V ) 40 % - 25 ml* vial 0 0 0 -
87 Mebendazol tablet 100 mg (vermox) tablet 0 0 0 -
88 Metformin tab 500 mg tablet 0 0 0 -
89 Metformin tab 850 mg tablet 0 0 0 -
90 Metilergometrin maleat tablet salut 0,125 mg tablet 0 0 0 -
91 Metilergometrin maleat inj 0,200 mg - 1 ml ampul 0 0 0 -
Page 3 of 52
OKTOBER 2019 2019
92 Metilprednisolon 4 mg tablet tablet 0 0 0 -

93 Metilprednisolon 16 mg tablet tablet 0 0 0 -
94 Metoklorpropamid tablet tablet 0 0 0 -
95 Metronidazol tablet 250 mg tablet 0 0 0 -
96 Metronidazol tablet 500 mg tablet 0 0 0 -
97 Metronidazol suspension 125 mg/ml botol 0 0 0 -
98 Miconazol krim tube 0 0 0 -
99 Mineral mix serbuk 8 gr* sachet 0 0 0 -
100 Natrium Bikarbonat tablet 500 mg tablet 0 0 0 -
101 Natrium Diklofenak tablet 25 mg tablet 0 0 0 -
102 Natrium Diklofenak tablet 50 mg tablet 0 0 0 -
Natrium Tiroksin (Levotiroksin) tablet 100 mg 0 0 0 -

103 (Euthyrox) tablet
104 Nipedipin 10 mg tablet tablet 0 0 0 -
105 Nicotinamida tablet 20 mg tablet 0 0 0 -
106 Nistatin 100.000 iu /g tablet vagina tablet 0 0 0 -
107 Obat antituberkolusis katagori 1* paket 0 0 0 -
108 Obat antituberkolusis katagori 2* paket 0 0 0 -
109 Obat antituberkulosis anak* paket 0 0 0 -
110 Obat FDC Kategori 1* paket 0 0 0 -
111 obat FDC KATEGORI 2* paket 0 0 0 -
112 Oksitetrasiklin Hcl salep mata 1 % tube 0 0 0 -
113 Oksitosin injeksi 10 iu / ml ampul 0 0 0 -
114 Omeprazol inj 40 mg/10 ml ampul 0 0 0 -
115 Omeprazole 20 mg capsul kapsul 0 0 0 -
116 Parasetamol sirup 120 mg / 5 ml botol 0 0 0 -
117 Parasetamol tablet 500 mg tablet 0 0 0 -
118 Pirantel pamoat 125 mg tablet tablet 0 0 0 -
119 Pirantel suspensi 5 mg/ml botol 0 0 0 -
120 Piridoksin Hcl tablet 10 mg tablet 0 0 0 -
121 Piridoksin Hcl tablet 25 mg tablet 0 0 0 -
122 Prednison tablet 5 mg tablet 0 0 0 -
123 Primakuin tablet 15 mg* tablet 0 0 0 -
124 Prokain benzil penisilin 3 juta iu / vial injeksi vial 0 0 0 -
Page 4 of 52
OKTOBER 2019 2019
125 Propanolol Hcl tablet 40 mg tablet 0 0 0 -

126 Propiltiourasil tablet 100 mg tablet 0 0 0 -
127 Ranitidin tablet tablet 0 0 0 -
128 Retinol ( Vit A ) 100.000 IU kapsul* kapsul 0 0 0 -
129 Retinol ( Vit A ) 200.000 IU kapsul* kapsul 0 0 0 -
130 Salbutamol tablet 2 mg tablet 0 0 0 -
131 Salbutamol tablet 4 mg tablet 0 0 0 -
132 Salep 2 - 4 kombinasi tablet 0 0 0 -
133 Sefadroxil kapsul 500 mg tablet 0 0 0 -
134 Sefadroxil syp kering 125 ml / 5 ml botol 0 0 0 -
135 Sianokobalamin ( Vit.B.12 ) inj 500 mcg / ml ampul 0 0 0 -
136 Simpastatin 10 mg tablet tablet 0 0 0 -
137 Siprofloksasin 500 mg tablet tablet 0 0 0 -
138 Tetrasiklin Hcl kapsul 250 mg kapsul 0 0 0 -
139 Tetrasiklin Hcl kapsul 500 mg kapsul 0 0 0 -
140 Thiamin Hcl monohidrat ( Vit B1 ) 50 mg tablet 0 0 0 -
141 Triheksilfenidil hidroklorida tablet 2 mg tablet 0 0 0 -
142 Vitamin B komplek tablet tablet 0 0 0 -
143 Zink 20 mg tablet (generik) tablet 0 0 0 -
144 Vaksin BCG* vial 0 0 0 -
145 Vaksin Jerap D T* vial 0 0 0 -
146 Vaksin CAMPAK 10 Dosis* vial 0 0 0 -
147 Vaksin POLIO 10 Dosis* vial 0 0 0 -
148 Vaksin HEPATITIS B 0,5 ml ADS* vial 0 0 0 -
149 Pentabio Vaksin DTP-HB-HIB inj* vial 0 0 0 -
150 Vaksin Td* vial 0 0 0 -
Vaksin IPV (Poliomyelitis Vaccine inj 0 0 0 -

151 (ShanIPV)* vial
152 Vaksin MR* vial 0 0 0 -
153 Acdat salep tube 0 0 0 -
154 Air untuk irigasi lar infus 1000 ml botol 0 0 0 -
155 Akarbose tablet 100 mg tablet 0 0 0 -
156 Albendazol suspensi 200mg/5 ml botol 0 0 0 -
Page 5 of 52
OKTOBER 2019 2019
157 Alprazolam 0,5 mg tablet 0 0 0 -

158 Alprazolam 1 mg tablet 0 0 0 -
159 Alvit drops botol 0 0 0 -
160 Ambroxol sirup botol 0 0 0 -
161 Ambroxol tablet tablet 0 0 0 -
162 Amlodipin 10 mg tablet 0 0 0 -
163 Amoksisilin 250 mg tablet 0 0 0 -
164 Anemolat 1 mg tablet tablet 0 0 0 -
165 Antalgin (Metampiron) tablet 500 mg tablet 0 0 0 -
166 Antalgin injeksi 250 mg/5 ml ampul 0 0 0 -
167 Anti bakteri doen salep kombinasi tube 0 0 0 -
168 Antihemaroid doen kombinasi supp 0 0 0 -
169 Antimigrain doen kombinasi tablet 0 0 0 -
170 Antiparkinson doen tablet kombinasi tablet 0 0 0 -
171 Antrain inj ampul 0 0 0 -
172 Apialis Drops botol 0 0 0 -
173 Apialys sirup botol 0 0 0 -
174 Aqua proinjeksi steril,bebas pirogen vial 0 0 0 -
175 Arkavit tablet 0 0 0 -
176 Asam Asetilsalisilat tablet 100 mg (Asetosal) tablet 0 0 0 -
177 Asam Asetilsalisilat tablet 500 mg (Asetosal) tablet 0 0 0 -
178 Asam askorbat(vit C) tablet 250 mg tablet 0 0 0 -
179 Asam Folat 5 mg tablet tablet 0 0 0 -
180 Asam Traneksamat 500 mg kapsul kapsul 0 0 0 -
181 Asam Traneksamat injeksi 5 % 250 mg/ 5 ml ampul 0 0 0 -
182 Asiklovir salep kulit tube 0 0 0 -
183 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ampul 0 0 0 -
184 Atropin Sulfat tetes mata 0,5 % botol 0 0 0 -
185 Atrovent HFA kotak 0 0 0 -
186 Azitromisin 500 mg tablet tablet 0 0 0 -
187 Baby Cough sirup botol 0 0 0 -
188 Betahistin mesilat tablet 6 mg tablet 0 0 0 -
189 Bioplacenton Cream tube 0 0 0 -
Page 6 of 52
OKTOBER 2019 2019
190 Bisoprolol tablet 5 mg tablet 0 0 0 -

191 Buscopan tablet tablet 0 0 0 -
192 Cendo Augentonic tetes mata botol 0 0 0 -
193 Cendo Catarlent tetes mata botol 0 0 0 -
194 Cendo Edta tetes mata botol 0 0 0 -
195 Cendo Floxa tetes mata botol 0 0 0 -
196 Cendo fungicide tetes mata botol 0 0 0 -
197 Cendo Homatrol tetes mata botol 0 0 0 -
198 Cendo Lyteers tetes mata botol 0 0 0 -
199 Cendo mydriatil tetes mata botol 0 0 0 -
200 Cendo Tobroson tetes mata botol 0 0 0 -
201 Cendo tropin tetes mata botol 0 0 0 -
202 Cendo Xytrol tetes mata botol 0 0 0 -
203 Cetop-zink kaplet tablet 0 0 0 -
204 Clopidogrel 75 mg tablet tablet 0 0 0 -
205 Curcuma tablet tablet 0 0 0 -
206 Dekstran 70 larutan infus 6 % steril botol 0 0 0 -
207 Depakene sirup botol 0 0 0 -
208 Depakote tablet tablet 0 0 0 -
209 Desoksimetason 0,25 mg (Denomix) tube 0 0 0 -
210 Dextamine tablet tablet 0 0 0 -
211 Dextrofen sirup botol 0 0 0 -
212 Diamicron MR 30 mg tablet tablet 0 0 0 -
213 Diltiazem tablet tablet 0 0 0 -
214 Domperidon Suspensi 5 mg/5 ml botol 0 0 0 -
215 Dopamet (metildopa) tablet 0 0 0 -
216 Dulcolax 10 mg supp supp 0 0 0 -
217 Dulcolax 5 mg tablet tablet 0 0 0 -
218 Efedrin Hcl tablet 25 mg tablet 0 0 0 -
219 Erytromisin 250 mg kapsul kapsul 0 0 0 -
220 Etakridin ( Rivanol ) larutan 0,1 % botol 0 0 0 -
221 Etambutol Hcl tablet 250 mg tablet 0 0 0 -
222 Famotidin 40 mg tablet tablet 0 0 0 -
Page 7 of 52
OKTOBER 2019 2019
223 Fenitoin natrium inj 50 mg / ml ampul 0 0 0 -

224 Fenitoin natrium kapsul 100 mg kapsul 0 0 0 -
225 Fenobarbital tablet 100 mg tablet 0 0 0 -
226 Fenofibrat kaps 100 mg tablet 0 0 0 -
227 Fenol gliserol tetes telinga 10 % botol 0 0 0 -
228 Flukonazol tab 150 mg tablet 0 0 0 -
229 Fluor tablet 0,5 mg tablet 0 0 0 -
230 Fucilex ointment (natrium fusidat) tube 0 0 0 -
231 Fungasol 2 % botol 0 0 0 -
232 Fuson ointment tube 0 0 0 -
233 Gemfibrozil 300 mg tablet 0 0 0 -
234 Gentamisin salep kulit tube 0 0 0 -
235 Gentamisin salep mata tube 0 0 0 -
236 Gentamisin Tetes mata botol 0 0 0 -
237 Gentian violet larutan 1 % pot 0 0 0 -
238 Glimepirid tab 2 mg tablet 0 0 0 -
239 Gliseril guayakolat tablet 100 mg tablet 0 0 0 -
240 Gliserin larutan 50% botol 0 0 0 -
241 Glukosa larutan infus 10 % steril botol 0 0 0 -
244 Glukosamin 250 mg tablet (osmin) tablet 0 0 0 -
245 H.Booster sirup botol 0 0 0 -
246 Haloperidol tablet 1,5 mg tablet 0 0 0 -
247 Hemafort tablet tablet 0 0 0 -
248 HEXADOL (Larutan Hexetidine) botol 0 0 0 -
249 Hidrokortison krim 1% tube 0 0 0 -
250 Hyorex 10 mg tablet tablet 0 0 0 -
251 Hyoscine N Butilbromida 10 mg tablet tablet 0 0 0 -
252 Ibuprofen syr 100 mg/5ml botol 0 0 0 -
253 Ichtyol salep tube 0 0 0 -
254 Inhitril 10 mg tablet 0 0 0 -
255 Inhitril 5 mg tablet 0 0 0 -
Page 8 of 52
OKTOBER 2019 2019
256 Interhistin tablet tablet 0 0 0 -

257 Irbesartan tab 150 mg tablet 0 0 0 -
258 Kalsium laktat ( Kalk ) tablet 500 mg tablet 0 0 0 -
259 Kandesartan 8 mg tablet tablet 0 0 0 -
260 Kandesartan 16 mg tablet tablet 0 0 0 -
261 Kandistatin drops (nistatin 100.000IU) botol 0 0 0 -
262 Kaptopril 12,5 mg tablet tablet 0 0 0 -
263 Kaptopril 50 mg tablet tablet 0 0 0 -
264 Ketokonazol Krim tube 0 0 0 -
265 Ketoprofen 100 mg tablet tablet 0 0 0 -
266 Klindamisin 150 mg tablet tablet 0 0 0 -
267 Klobazam 10 mg tablet tablet 0 0 0 -
268 Klonidin 0,15 mg tablet tablet 0 0 0 -
269 Kloramfenikol tetes telinga 3 % botol 0 0 0 -
270 Klorpromazin Hcl inj 25 mg / ml - 12 ml ampul 0 0 0 -
271 Klorpromazin Hcl tablet salut 25 mg tablet 0 0 0 -
272 Klozapin 25 mg tablet tablet 0 0 0 -
275 Kombinasi pirimetamin 25 mg / sulfadoksin 50 tablet 0 0 0 -
276 Kombipak Azitromycin-Cefixim paket 0 0 0 -
277 Kotrimoksazol DOEN II (pedriatik) tablet tablet 0 0 0 -
278 Lanzoprazol tablet 0 0 0 -
279 Lapalos Cream tube 0 0 0 -
280 Laxadine emulsi botol 0 0 0 -
281 L-Bio sachet sachet 0 0 0 -
282 Levofloksasin tab 500 mg tablet 0 0 0 -
283 Lexapram sirup botol 0 0 0 -
284 Lidocain jeli 2 % (Xylocaine Jelly 2%) syringe 0 0 0 -
285 Lincomisin 500 mg tablet 0 0 0 -
286 Lisinopril 10 mg tablet tablet 0 0 0 -
287 Lisinopril 5 mg tablet tablet 0 0 0 -
288 Lisol botol 0 0 0 -
Page 9 of 52
OKTOBER 2019 2019
289 Livertran salep tube 0 0 0 -

290 Longatin 25 mg tablet 0 0 0 -
291 Loperamida tablet tablet 0 0 0 -
292 Lorazepam (Merlopam) 2 mg tablet tablet 0 0 0 -
293 MDT Combi paket 0 0 0 -
294 Mebendazol sirup 100 mg / 5 ml botol 0 0 0 -
295 Meloxikam 15 mg tablet tablet 0 0 0 -
296 Meloxikam 7,5 mg tablet tablet 0 0 0 -
297 Mersibion injeksi ampul 0 0 0 -
298 Metoklorpropamid sirup botol 0 0 0 -
299 Metronidazol infus 500 mg/100 ml botol 0 0 0 -
300 Metronidazol supp 500 mg (Flagyl supp) supp 0 0 0 -
301 Miniaspi 80 mg tablet 0 0 0 -
302 Misoprostol 200 mg (gastrul) tablet 0 0 0 -
303 Mixaria sachet 0 0 0 -
304 Moksifloksasin tetes mata 0,5% (Vigamox) botol 0 0 0 -
305 Mometason furoat krim 0,1 % tube 0 0 0 -
306 Natrium klorida larutan infus 0,9 % steril botol 0 0 0 -
307 Neo Diaform tablet 0 0 0 -
308 Neurodex tablet tablet 0 0 0 -
309 New Diatabs tablet 0 0 0 -
310 Nistatin 500.000 iu /g tablet salut tablet 0 0 0 -
311 Nitral (gliseril trinitras sublingual 0.5 mg) tablet 0 0 0 -
312 Nopres 20 mg tablet tablet 0 0 0 -
313 Norages Injeksi ampul 0 0 0 -
314 novadium tablet 0 0 0 -
315 Novastan sirup botol 0 0 0 -
316 Noza tablet tablet 0 0 0 -
317 Obat antituberkulosis kat.3* paket 0 0 0 -
318 Obat antituberkulosis kat.sisipan* paket 0 0 0 -
319 Obat Batuk Hitam ( OBH ) cairan botol 0 0 0 -
320 Obat suntik KB I (3 bulan) ampul 0 0 0 -
321 Obat suntik KB II (1 bulan) ampul 0 0 0 -
Page 10 of 52
OKTOBER 2019 2019
322 Ofloksasin tab 400 mg tablet 0 0 0 -
Oksimetazolin tts hidung 0,025% (Iliadin 0 0 0 -

323 drops) botol
324 Oksitetrasiklin Hcl salep kulit 3 % tube 0 0 0 -
325 Ondansetron inj 4 mg/2ml ampul 0 0 0 -
326 Ondansetron tab 4 mg tablet 0 0 0 -
327 Optiflox tetes mata botol 0 0 0 -
328 Pamol supp supp 0 0 0 -
329 Pantocain 0,5 % TM botol 0 0 0 -
330 Papaverin 40 mg tablet tablet 0 0 0 -
331 Parasetamol Drop 100 mg/ml botol 0 0 0 -
332 Pedialyte botol 0 0 0 -
333 Pehacain injeksi ampul 0 0 0 -
334 Pil KB I tablet 0 0 0 -

335 Pil KB II / Laktasi tablet 0 0 0 -
336 Pim-Tra-Kol sirup botol 0 0 0 -
337 Pirazinamid tab 500 mg tablet 0 0 0 -
338 Piroksikam 10 mg tablet tablet 0 0 0 -
339 Piroksikam 20 mg tablet tablet 0 0 0 -
340 Polikresulen botol 0 0 0 -
341 Povidon Iodida larutan 10 % 30 ml botol 0 0 0 -
342 Povidon Iodida larutan 10 % 300 ml botol 0 0 0 -
343 Povidon Iodida Larutan 1000 ml botol 0 0 0 -
344 Povidon Iodida Larutan 60 ml botol 0 0 0 -
345 PP Isoniazide 100 mg* tablet 0 0 0 -
346 Prazikuantel tablet 600 mg tablet 0 0 0 -
347 Prenatin DF tablet tablet 0 0 0 -
348 Primolut N tablet 0 0 0 -
349 Protofen supp supp 0 0 0 -
350 Protofen tablet tablet 0 0 0 -
351 Pularex tablet tablet 0 0 0 -
352 Pulmicort respules ampul 0 0 0 -
353 Pulmicort turbuhaler kotak 0 0 0 -
Page 11 of 52
OKTOBER 2019 2019
354 Ramabion tab tablet 0 0 0 -

355 Ranitidin inj 25mg/2ml ampul 0 0 0 -
356 Recovit sirup botol 0 0 0 -
357 Reserpin tablet 0,25 mg tablet 0 0 0 -
358 Rifampisin kaplet 600 mg tablet 0 0 0 -
359 Rifampisin kapsul 300 mg tablet 0 0 0 -
360 Rifampisin kapsul 450 mg tablet 0 0 0 -
361 Ringer laktat larutan infus steril botol 0 0 0 -
362 Risperidon 2 mg tab tablet 0 0 0 -
363 Salisil bedak 2 % kotak 0 0 0 -
364 Sandepril 50 mg tablet 0 0 0 -
365 Sangobion kids drop botol 0 0 0 -
366 Sangobion Kids Sirup botol 0 0 0 -
367 Scabicid cream 10 gram tube 0 0 0 -
368 Scabimite cream 10 gram tube 0 0 0 -
369 Scopma tablet tablet 0 0 0 -
370 Sefaleksin kapsul 500 mg kapsul 0 0 0 -
371 Sefiksim kapsul 100 mg kapsul 0 0 0 -
372 Sefiksim syr kering 100mg/5ml botol 0 0 0 -
373 Seretide Inhaler 50 mcg kotak 0 0 0 -
374 Serum anti bisa ular polivalen inj 5 ml ( ABU I ) vial 0 0 0 -
375 Serum anti bisa ular polivalen inj 50 ml ( ABU II vial 0 0 0 -
376 Serum anti defteri inj 1000 mg / vial vial 0 0 0 -
377 Serum anti tetanus inj 1.500 IU / ampul ( ATS ) ampul 0 0 0 -
378 Serum anti tetanus inj 20.000 IU / ampul ( ATS ampul 0 0 0 -
379 Setirizin sirup 5 mg/ml botol 0 0 0 -
380 Setirizine tablet 10 mg tablet 0 0 0 -
381 Simetidin tablet tablet 0 0 0 -
382 Simpastatin 20 mg tablet tablet 0 0 0 -
383 Sohobion tablet tablet 0 0 0 -
384 Spiramisin 500 mg tablet tablet 0 0 0 -
385 Spironolakton tab 25 mg tablet 0 0 0 -
386 Stesolid rectal 5 mg supp 0 0 0 -
Page 12 of 52
OKTOBER 2019 2019
387 Stimuno Forte tablet tablet 0 0 0 -

388 Stimuno Sirup botol 0 0 0 -
389 Sucralfate 500 mg/5 ml suspensi botol 0 0 0 -
390 Sulfasetamid natrium tetes mata 15 % botol 0 0 0 -
401 Thiamin Hcl ( Vit B1 ) inj.100 mg / ml - 1 ml ampul 0 0 0 -
402 Thrombophob gel tube 0 0 0 -
403 Timolol tetes mata 0,5% botol 0 0 0 -
404 Tramadol 50 mg kapsul kapsul 0 0 0 -
405 Tramadol inj 50 mg/ml ampul 0 0 0 -
406 Triflouperazin 5mg tablet tablet 0 0 0 -
407 Truvit drops botol 0 0 0 -
408 Truvit sirup botol 0 0 0 -
409 Ulsafate sirup botol 0 0 0 -
410 Ulsidex tablet tablet 0 0 0 -
411 Urea krim (Soft U derm) botol 0 0 0 -

412 Urotractin (asam pipemidat) 400 mg tablet 0 0 0 -
413 Vagizol ovula (metronidazol ovula) ovula 0 0 0 -
414 valisanbe 2 mg tablet 0 0 0 -
415 Valsartan tab 80 mg (Diovan 80mg) tablet 0 0 0 -
416 Vastral tablet 0 0 0 -
417 Ventolin inhaler kotak 0 0 0 -
418 Ventolin Nebulizer ampul 0 0 0 -

419 Vitamin A6000IU tablet 0 0 0 -
420 Vitamin B 12 tablet tablet 0 0 0 -
421 Vitonorm tablet tablet 0 0 0 -
422 Xylocain spray kotak 0 0 0 -
423 Yodium Test botol 0 0 0 -
424 Zincpro drops botol 0 0 0 -
425 Zincum Kid sirup botol 0 0 0 -
426 Zoloral SS (ketokonazol scalp sol 2 %) botol 0 0 0 -
Page 13 of 52

PUSKESMAS : ............................................
USULAN TOTAL
NO NAMA OBAT SATUAN HARGA OBAT PROYEKSI PENGADAAN TOTAL RUPIAH
PENGADAAN 2020 PENGADAAN
APBD total Rp APBD JKN total Rp JKN
1 2 3 4 5 6 7=5*6 8 9= 5*8 10 = 7 + 9 11 = 5 * 10
A OBAT
1 Albendazol tablet 400 mg* tablet - 463 - - - -
2 Allopurinol tablet 100 mg tablet - 99 - - - -
3 Aminofilin injeksi 24 mg/ml-10 ml ampul - 2,878 - - - -
4 Aminofilin tablet 200 mg tablet - 145 - - - -
5 Amitriptilin Hcl tablet salut 25 mg tablet - 168 - - - -
6 Amlodipin 5 mg tablet - 76 - - - -
7 Amoksisilin 500 mg kaplet tablet - 248 - - - -
8 Amoksisilin Sirup kering 125 mg/5 ml botol - 1,919 - - - -
9 Ampisilin serbuk injeksi i.m.i.v 1000 mg/ vial - 9,473 - - - -
10 Antasida doen tablet kombinasi tablet - 56 - - - -
11 Antasida sirup botol - 2,098 - - - -
12 Antifungi doen kombinasi tube - 5,170 - - - -
13 Artemether injeksi 80 Mg* ampul - 34,419 - - - -
14 Artesunate cairan injeksi 60 mg* ampul - 33,835 - - - -
15 Asam Askorbat(vit C) tablet 50 mg tablet - 120 - - - -
16 Asam Folat 1 mg tablet tablet - 81 - - - -
17 Asam mefenamat 500 mg kaplet tablet - 103 - - - -
18 Asiklovir 200 mg tablet tablet - 236 - - - -
19 Asiklovir 400 mg tablet tablet - 425 - - - -
20 Atropin Sulfat tablet 0,5 mg tablet - 81 - - - -
21 Benzatin Benzil Penisilin inj 1,2 juta iu/vi vial - 10,780 - - - -
22 Benzatin Benzil Penisilin inj 1,4 juta iu/vi vial - 14,740 - - - -
23 Betametason krim 0,1 % tube - 1,373 - - - -
24 Clindamisin kapsul 300 mg kapsul - 583 - - - -
25 Deksametason tablet 0,5 mg tablet - 34 - - - -

26 Deksametason inj 5 mg/ml-1 ml ampul - 1,210 - - - -
DHP / Darplex / D-Artepp (Dehidro - - - - -

27 artemisin Piperaquin) tab* tablet 2,000
Page 14 of 52
USULAN TOTAL
28 Diazepam inj 5 mg/ml-2 ml ampul - 1,913 - - - -
29 Diazepam tablet 2 mg tablet - 86 - - - -
30 Diazepam tablet 5 mg tablet - 109 - - - -
31 Dietilkarbamazin sitrat tablet 100 mg* tablet - 182 - - - -
32 Difenhidramin Hcl inj 10 mg/ml-1 ml ampul - 1,262 - - - -
33 Digoksin tablet 0,25 mg tablet - 104 - - - -
34 Dimenhidrinate tablet tablet - 121 - - - -
35 Doksisiklin 100 mg kapsul kapsul - 264 - - - -
36 Domperidon 10 mg tablet - 90 - - - -
37 Epinefrin Hcl/Bitartrat(adrenalin)inj 0,1 ampul - 1,518 - - - -
38 Erytromisin sirup botol - 6,390 - - - -
39 Erytromisin 500 mg kaplet tablet - 781 - - - -
40 Etambutol 500 mg tablet tablet - 375 - - - -
41 Fenitoin kapsul 50 mg kapsul - 183 - - - -
42 Fenobarbital inj 50 mg / ml - 2 ml ampul - 2,135 - - - -
43 Fenobarbital tablet 30 mg tablet - 197 - - - -
44 Ferrous sulphate tab selaput 300 mg tablet - 1 - - - -
Ferro folat tab sal selaput 200 mg + - - - - -

45 0,25 mg (Tablet tambah darah komb.) tablet 409
46 Fitomenadion ( vit k 1 ) tablet salut 10 tablet - 818 - - - -
47 Fitomenadion ( vit k 1 ) inj 10 mg / ml - ampul - 4,236 - - - -
48 Furosemid tablet 40 mg tablet - 79 - - - -
49 Furosemid Cairan Injeksi 10 mg/ml ampul - 1,555 - - - -
50 Garam oralit untuk 200 ml air sachet - 263 - - - -
51 Gentamisin inj 40 mg/2 ml* ampul - 4,036 - - - -
52 Gentamisin inj 80 mg/2 ml* ampul - 2,750 - - - -
53 Glibenklamid tablet 5 mg tablet - 137 - - - -
54 Glimepirid tab 1 mg tablet - 174 - - - -
55 Griseofulvin tablet 125 mg micronized tablet - 223 - - - -
56 Haloperidol tablet 0,5 mg tablet - 55 - - - -
57 Haloperidol tablet 5 mg tablet - 56 - - - -
58 Hidroklortiazid ( Hct ) tablet 25 mg tablet - 178 - - - -
59 Hidrokortison krim 2,5 % tube - 2,533 - - - -
60 Ibuprofen tablet 200 mg tablet - 112 - - - -
Page 15 of 52
USULAN TOTAL
61 Ibuprofen tablet 400 mg tablet - 127 - - - -
62 Isoniazid tablet 100 mg tablet - 79 - - - -
63 Isoniazid tablet 300 mg tablet - 170 - - - -
64 Isosorbit dinitrat tablet sublingual 5 mg tablet - 89 - - - -
65 Kalsium Gluconas inj* ampul - 10,351 - - - -
66 Kalsium Karbonat tablet 500 mg tablet - 59 - - - -
67 Kaptopril 25 mg tablet tablet - 80 - - - -
68 Karbamazepin tablet 200 mg tablet - 234 - - - -
69 Ketokenazol 200 mg tablet tablet - 286 - - - -
70 Kloramfenikol kapsul 250 mg kapsul - 329 - - - -
71 Kloramfenikol salep 2 % tube - 3,360 - - - -
72 Kloramfenikol salep mata 1 % tube - 1,925 - - - -
73 Kloramfenikol sirup botol - 4,985 - - - -
74 Klorfeniramin maleat ( CTM ) tablet 4 m tablet - 24 - - - -
75 Klorpromazin Hcl inj 5 mg / ml - 2 ml ampul - 1,735 - - - -
76 Klorpromazin Hcl tablet salut 100 mg tablet - 170 - - - -
77 Kodein tablet 10 mg tablet - 657 - - - -
78 Kotrimoksazol DOEN I (dewasa) tablet tablet - 125 - - - -

79 Kotrimoksazol suspensi botol - 2,052 - - - -
80 Kuinine tablet salut selaput 200 mg* tablet - 801 - - - -
81 Kuinine Dihydrochloride cairan inj 25%- ampul - 2,616 - - - -
82 Lidocain injeksi 2 % ampul - 1,319 - - - -
83 Lidokain kompositum injeksi ampul - 1,317 - - - -
84 Loratadin tablet tablet - 127 - - - -
85 Magnesium sulfat inj ( 1V ) 20 % - 25 ml vial - 3,328 - - - -
86 Magnesium sulfat inj ( 1V ) 40 % - 25 ml vial - 3,796 - - - -
87 Mebendazol tablet 100 mg (vermox) tablet - 9,150 - - - -

88 Metformin tab 500 mg tablet - 102 - - - -
89 Metformin tab 850 mg tablet - 167 - - - -
90 Metilergometrin maleat tablet salut 0,1 tablet - 243 - - - -
91 Metilergometrin maleat inj 0,200 mg - 1 ampul - 3,399 - - - -
92 Metilprednisolon 4 mg tablet tablet - 139 - - - -
93 Metilprednisolon 16 mg tablet tablet - 548 - - - -
94 Metoklorpropamid tablet tablet - 124 - - - -
Page 16 of 52
USULAN TOTAL
95 Metronidazol tablet 250 mg tablet - 93 - - - -
96 Metronidazol tablet 500 mg tablet - 127 - - - -
97 Metronidazol suspension 125 mg/ml botol - 3,950 - - - -
98 Miconazol krim tube - 3,926 - - - -
99 Mineral mix serbuk 8 gr* sachet - 2,920 - - - -
100 Natrium Bikarbonat tablet 500 mg tablet - 10 - - - -
101 Natrium Diklofenak tablet 25 mg tablet - 142 - - - -
102 Natrium Diklofenak tablet 50 mg tablet - 136 - - - -
Natrium Tiroksin (Levotiroksin) tablet - - - - -

103 100 mg (Euthyrox) tablet 1,021
104 Nipedipin 10 mg tablet tablet - 110 - - - -
105 Nicotinamida tablet 20 mg tablet - 1 - - - -
106 Nistatin 100.000 iu /g tablet vagina tablet - 645 - - - -
107 Obat antituberkolusis katagori 1* paket - 447,747 - - - -
108 Obat antituberkolusis katagori 2* paket - 1,492,574 - - - -
109 Obat antituberkulosis anak* paket - 267,400 - - - -
110 Obat FDC Kategori 1* paket - 447,747 - - - -
111 obat FDC KATEGORI 2* paket - 1,492,574 - - - -
112 Oksitetrasiklin Hcl salep mata 1 % tube - 2,600 - - - -
113 Oksitosin injeksi 10 iu / ml ampul - 1,232 - - - -
114 Omeprazol inj 40 mg/10 ml ampul - 11,868 - - - -
115 Omeprazole 20 mg capsul kapsul - 138 - - - -
116 Parasetamol sirup 120 mg / 5 ml botol - 1,160 - - - -
117 Parasetamol tablet 500 mg tablet - 60 - - - -
118 Pirantel pamoat 125 mg tablet tablet - 331 - - - -
119 Pirantel suspensi 5 mg/ml botol - 11,050 - - - -
120 Piridoksin Hcl tablet 10 mg tablet - 141 - - - -
121 Piridoksin Hcl tablet 25 mg tablet - 41 - - - -
122 Prednison tablet 5 mg tablet - 74 - - - -
123 Primakuin tablet 15 mg* tablet - 125 - - - -

124 Prokain benzil penisilin 3 juta iu / vial inj vial - 1 - - - -
125 Propanolol Hcl tablet 40 mg tablet - 84 - - - -
126 Propiltiourasil tablet 100 mg tablet - 297 - - - -
127 Ranitidin tablet tablet - 122 - - - -
128 Retinol ( Vit A ) 100.000 IU kapsul* kapsul - 327 - - - -
Page 17 of 52
USULAN TOTAL
129 Retinol ( Vit A ) 200.000 IU kapsul* kapsul - 505 - - - -
130 Salbutamol tablet 2 mg tablet - 64 - - - -
131 Salbutamol tablet 4 mg tablet - 77 - - - -
132 Salep 2 - 4 kombinasi tablet - 3,017 - - - -
133 Sefadroxil kapsul 500 mg tablet - 492 - - - -
134 Sefadroxil syp kering 125 ml / 5 ml botol - 4,086 - - - -
135 Sianokobalamin ( Vit.B.12 ) inj 500 mcg ampul - 1,087 - - - -
136 Simpastatin 10 mg tablet tablet - 110 - - - -
137 Siprofloksasin 500 mg tablet tablet - 281 - - - -
138 Tetrasiklin Hcl kapsul 250 mg kapsul - 200 - - - -
139 Tetrasiklin Hcl kapsul 500 mg kapsul - 310 - - - -
140 Thiamin Hcl monohidrat ( Vit B1 ) 50 mg tablet - 88 - - - -
141 Triheksilfenidil hidroklorida tablet 2 mg tablet - 95 - - - -
142 Vitamin B komplek tablet tablet - 135 - - - -
143 Zink 20 mg tablet (generik) tablet - 604 - - - -
144 Vaksin BCG* vial - 59,950 - - - -
145 Vaksin Jerap D T* vial - 17,798 - - - -
146 Vaksin CAMPAK 10 Dosis* vial - 28,204 - - - -
147 Vaksin POLIO 10 Dosis* vial - 19,954 - - - -

148 Vaksin HEPATITIS B 0,5 ml ADS* vial - 20,900 - - - -
149 Pentabio Vaksin DTP-HB-HIB inj* vial - 76,285 - - - -
150 Vaksin Td* vial - 16,500 - - - -
Vaksin IPV (Poliomyelitis Vaccine inj - - - - -

151 (ShanIPV)* vial 152,900
152 Vaksin MR* vial - 141,648 - - - -
153 Acdat salep tube - 4,889 - - - -
154 Air untuk irigasi lar infus 1000 ml botol - 12,100 - - - -
155 Akarbose tablet 100 mg tablet - 900 - - - -
156 Albendazol suspensi 200mg/5 ml botol - 4,600 - - - -
157 Alprazolam 0,5 mg tablet - 88 - - - -

158 Alprazolam 1 mg tablet - 120 - - - -
159 Alvit drops botol - 12,500 - - - -
160 Ambroxol sirup botol - 3,300 - - - -
161 Ambroxol tablet tablet - 157 - - - -
162 Amlodipin 10 mg tablet - 95 - - - -
Page 18 of 52
USULAN TOTAL
163 Amoksisilin 250 mg tablet - 196 - - - -
164 Anemolat 1 mg tablet tablet - 81 - - - -
165 Antalgin (Metampiron) tablet 500 mg tablet - 67 - - - -
166 Antalgin injeksi 250 mg/5 ml ampul - 408 - - - -
167 Anti bakteri doen salep kombinasi tube - 3,490 - - - -
168 Antihemaroid doen kombinasi supp - 3,642 - - - -
169 Antimigrain doen kombinasi tablet - 199 - - - -
170 Antiparkinson doen tablet kombinasi tablet - 1,035 - - - -
171 Antrain inj ampul - 11,999 - - - -
172 Apialis Drops botol - 21,175 - - - -
173 Apialys sirup botol - 30,613 - - - -
174 Aqua proinjeksi steril,bebas pirogen vial - 2,860 - - - -
175 Arkavit tablet - 370 - - - -
176 Asam Asetilsalisilat tablet 100 mg (Aseto tablet - 154 - - - -
177 Asam Asetilsalisilat tablet 500 mg (Aseto tablet - 100 - - - -
178 Asam askorbat(vit C) tablet 250 mg tablet - 163 - - - -
179 Asam Folat 5 mg tablet tablet - 63 - - - -
180 Asam Traneksamat 500 mg kapsul kapsul - 1,784 - - - -
181 Asam Traneksamat injeksi 5 % 250 mg/ ampul - 1,813 - - - -

182 Asiklovir salep kulit tube - 3,623 - - - -
183 Atropin Sulfat injeksi 0,25 mg/ml-1 ml ampul - 1,815 - - - -
184 Atropin Sulfat tetes mata 0,5 % botol - 13,500 - - - -
185 Atrovent HFA kotak - 86,600 - - - -
186 Azitromisin 500 mg tablet tablet - 1,778 - - - -
187 Baby Cough sirup botol - 4,657 - - - -
188 Betahistin mesilat tablet 6 mg tablet - 16,650 - - - -
189 Bioplacenton Cream tube - 248 - - - -
190 Bisoprolol tablet 5 mg tablet - 1,626 - - - -
191 Buscopan tablet tablet - 998 - - - -
192 Cendo Augentonic tetes mata botol - 30,990 - - - -
193 Cendo Catarlent tetes mata botol - 28,000 - - - -
194 Cendo Edta tetes mata botol - 37,500 - - - -
195 Cendo Floxa tetes mata botol - 38,500 - - - -
196 Cendo fungicide tetes mata botol - 18,500 - - - -
Page 19 of 52
USULAN TOTAL
197 Cendo Homatrol tetes mata botol - 18,000 - - - -
198 Cendo Lyteers tetes mata botol - 19,125 - - - -
199 Cendo mydriatil tetes mata botol - 36,500 - - - -
200 Cendo Tobroson tetes mata botol - 57,040 - - - -
201 Cendo tropin tetes mata botol - 13,875 - - - -
202 Cendo Xytrol tetes mata botol - 34,000 - - - -
203 Cetop-zink kaplet tablet - 2,478 - - - -
204 Clopidogrel 75 mg tablet tablet - 1,469 - - - -
205 Curcuma tablet tablet - 1,119 - - - -
206 Dekstran 70 larutan infus 6 % steril botol - 35,526 - - - -
207 Depakene sirup botol - 17,789 - - - -
208 Depakote tablet tablet - 1,200 - - - -
209 Desoksimetason 0,25 mg (Denomix) tube - 11,500 - - - -
210 Dextamine tablet tablet - 1,815 - - - -
211 Dextrofen sirup botol - 9,022 - - - -
212 Diamicron MR 30 mg tablet tablet - 2,992 - - - -
213 Diltiazem tablet tablet - 136 - - - -
214 Domperidon Suspensi 5 mg/5 ml botol - 2,862 - - - -
215 Dopamet (metildopa) tablet - 1,088 - - - -

216 Dulcolax 10 mg supp supp - 5,900 - - - -
217 Dulcolax 5 mg tablet tablet - 316 - - - -
218 Efedrin Hcl tablet 25 mg tablet - 2,074 - - - -
219 Erytromisin 250 mg kapsul kapsul - 636 - - - -
220 Etakridin ( Rivanol ) larutan 0,1 % botol - 5,295 - - - -
221 Etambutol Hcl tablet 250 mg tablet - 375 - - - -
222 Famotidin 40 mg tablet tablet - 192 - - - -
223 Fenitoin natrium inj 50 mg / ml ampul - 4,121 - - - -
224 Fenitoin natrium kapsul 100 mg kapsul - 158 - - - -
225 Fenobarbital tablet 100 mg tablet - 242 - - - -
226 Fenofibrat kaps 100 mg tablet - 1,116 - - - -
227 Fenol gliserol tetes telinga 10 % botol - 2,590 - - - -
228 Flukonazol tab 150 mg tablet - 21,528 - - - -
229 Fluor tablet 0,5 mg tablet - 33 - - - -
230 Fucilex ointment (natrium fusidat) tube - 4,889 - - - -
Page 20 of 52
USULAN TOTAL
231 Fungasol 2 % botol - - - - -
232 Fuson ointment tube - 4,889 - - - -
233 Gemfibrozil 300 mg tablet - 428 - - - -
234 Gentamisin salep kulit tube - 1,469 - - - -
235 Gentamisin salep mata tube - 3,075 - - - -
236 Gentamisin Tetes mata botol - 4,885 - - - -
237 Gentian violet larutan 1 % pot - 985 - - - -
238 Glimepirid tab 2 mg tablet - 207 - - - -
239 Gliseril guayakolat tablet 100 mg tablet - 92 - - - -
240 Gliserin larutan 50% botol - 5,867 - - - -
241 Glukosa larutan infus 10 % steril botol - 7,500 - - - -
242 Glukosa larutan infus 40 % steril botol - 988 - - - -
243 Glukosa larutan infus 5 % steril botol - 6,900 - - - -
244 Glukosamin 250 mg tablet (osmin) tablet - 1,085 - - - -
245 H.Booster sirup botol - 14,168 - - - -
246 Haloperidol tablet 1,5 mg tablet - 59 - - - -
247 Hemafort tablet tablet - 725 - - - -
248 HEXADOL (Larutan Hexetidine) botol - 11,385 - - - -
249 Hidrokortison krim 1% tube - 2,934 - - - -

250 Hyorex 10 mg tablet tablet - 1,626 - - - -
251 Hyoscine N Butilbromida 10 mg tablet tablet - 1,626 - - - -
252 Ibuprofen syr 100 mg/5ml botol - 2,678 - - - -
253 Ichtyol salep tube - 6,200 - - - -
254 Inhitril 10 mg tablet - 323 - - - -
255 Inhitril 5 mg tablet - 238 - - - -
256 Interhistin tablet tablet - 814 - - - -
257 Irbesartan tab 150 mg tablet - 425 - - - -
258 Kalsium laktat ( Kalk ) tablet 500 mg tablet - 59 - - - -
259 Kandesartan 8 mg tablet tablet - 599 - - - -
260 Kandesartan 16 mg tablet tablet - 6,225 - - - -
261 Kandistatin drops (nistatin 100.000IU) botol - 44,000 - - - -
262 Kaptopril 12,5 mg tablet tablet - 65 - - - -
263 Kaptopril 50 mg tablet tablet - 143 - - - -
264 Ketokonazol Krim tube - 2,577 - - - -
Page 21 of 52
USULAN TOTAL
265 Ketoprofen 100 mg tablet tablet - 1,485 - - - -
266 Klindamisin 150 mg tablet tablet - 754 - - - -
267 Klobazam 10 mg tablet tablet - 872 - - - -
268 Klonidin 0,15 mg tablet tablet - 201 - - - -
269 Kloramfenikol tetes telinga 3 % botol - 8,800 - - - -
270 Klorpromazin Hcl inj 25 mg / ml - 12 ml ampul - 1,435 - - - -
271 Klorpromazin Hcl tablet salut 25 mg tablet - 170 - - - -
272 Klozapin 25 mg tablet tablet - 1,121 - - - -
273 Kodein tablet 15 mg tablet - 1,135 - - - -
274 Kodein tablet 20 mg tablet - 1,494 - - - -
275 Kombinasi pirimetamin 25 mg / sulfadok tablet - 708 - - - -
276 Kombipak Azitromycin-Cefixim paket - 31,231 - - - -
277 Kotrimoksazol DOEN II (pedriatik) tablet tablet - 79 - - - -
278 Lanzoprazol tablet - 330 - - - -
279 Lapalos Cream tube - 15,700 - - - -
280 Laxadine emulsi botol - 5,555 - - - -
281 L-Bio sachet sachet - 6,646 - - - -
282 Levofloksasin tab 500 mg tablet - 449 - - - -
283 Lexapram sirup botol - 2,700 - - - -

284 Lidocain jeli 2 % (Xylocaine Jelly 2%) syringe - 41,600 - - - -
285 Lincomisin 500 mg tablet - 1,514 - - - -
286 Lisinopril 10 mg tablet tablet - 323 - - - -
287 Lisinopril 5 mg tablet tablet - 238 - - - -
288 Lisol botol - 52,604 - - - -
289 Livertran salep tube - 4,000 - - - -
290 Longatin 25 mg tablet - 2,713 - - - -
291 Loperamida tablet tablet - 85 - - - -
292 Lorazepam (Merlopam) 2 mg tablet tablet - 932 - - - -
293 MDT Combi* paket - 31,570 - - - -
294 Mebendazol sirup 100 mg / 5 ml botol - 2,035 - - - -
295 Meloxikam 15 mg tablet tablet - 1,379 - - - -
296 Meloxikam 7,5 mg tablet tablet - 796 - - - -
297 Mersibion injeksi ampul - 6,000.0 - - - -
298 Metoklorpropamid sirup botol - 2,700 - - - -
Page 22 of 52
USULAN TOTAL
299 Metronidazol infus 500 mg/100 ml botol - 8,250 - - - -
300 Metronidazol supp 500 mg (Flagyl supp) supp - 3,655 - - - -
301 Miniaspi 80 mg tablet - 99 - - - -
302 Misoprostol 200 mg (gastrul) tablet - 12,300 - - - -
303 Mixaria sachet - 1,260 - - - -
304 Moksifloksasin tetes mata 0,5% (Vigamo botol - 81,000 - - - -
305 Mometason furoat krim 0,1 % tube - 7,912 - - - -
306 Natrium klorida larutan infus 0,9 % steril botol - 5,170 - - - -
307 Neo Diaform tablet - 63 - - - -
308 Neurodex tablet tablet - 679 - - - -
309 New Diatabs tablet - 605 - - - -
310 Nistatin 500.000 iu /g tablet salut tablet - 910 - - - -
311 Nitral (gliseril trinitras sublingual 0.5 mg) tablet - 1,400 - - - -
312 Nopres 20 mg tablet tablet - 475 - - - -
313 Norages Injeksi ampul - 10,000 - - - -
314 novadium tablet - 200 - - - -
315 Novastan sirup botol - 12,650 - - - -
316 Noza tablet tablet - 894 - - - -
317 Obat antituberkulosis kat.3* paket - 154,000 - - - -

318 Obat antituberkulosis kat.sisipan* paket - 198,986 - - - -
319 Obat Batuk Hitam ( OBH ) cairan botol - 2,608 - - - -
320 Obat suntik KB I (3 bulan) ampul - 4,950 - - - -
321 Obat suntik KB II (1 bulan) ampul - 6,342 - - - -
322 Ofloksasin tab 400 mg tablet - 709 - - - -
Oksimetazolin tts hidung 0,025% - - - - -

323 (Iliadin drops) botol 37,433
324 Oksitetrasiklin Hcl salep kulit 3 % tube - 1,486 - - - -
325 Ondansetron inj 4 mg/2ml ampul - 1,198 - - - -
326 Ondansetron tab 4 mg tablet - 406 - - - -
327 Optiflox tetes mata botol - 14,005 - - - -

328 Pamol supp supp - 18,999 - - - -
329 Pantocain 0,5 % TM botol - 11,500 - - - -
330 Papaverin 40 mg tablet tablet - 148 - - - -
331 Parasetamol Drop 100 mg/ml botol - 7,646 - - - -
332 Pedialyte botol - 30,800 - - - -
Page 23 of 52
USULAN TOTAL
333 Pehacain injeksi ampul - 3,891 - - - -
334 Pil KB I tablet - 1,350 - - - -
335 Pil KB II / Laktasi tablet - 10,500 - - - -
336 Pim-Tra-Kol sirup botol - 11,499 - - - -
337 Pirazinamid tab 500 mg tablet - 233 - - - -
338 Piroksikam 10 mg tablet tablet - 124 - - - -
339 Piroksikam 20 mg tablet tablet - 5 - - - -
340 Polikresulen botol - 18,635 - - - -
341 Povidon Iodida larutan 10 % 30 ml botol - 2,344 - - - -
342 Povidon Iodida larutan 10 % 300 ml botol - 14,350 - - - -
343 Povidon Iodida Larutan 1000 ml botol - 42,000 - - - -
344 Povidon Iodida Larutan 60 ml botol - 6,700 - - - -
345 PP Isoniazide 100 mg* tablet - 79 - - - -
346 Prazikuantel tablet 600 mg tablet - 2,295 - - - -
347 Prenatin DF tablet tablet - 3,392 - - - -
348 Primolut N tablet - 2,618 - - - -
349 Protofen supp supp - 2,380 - - - -
350 Protofen tablet tablet - 1,485 - - - -
351 Pularex tablet tablet - 175 - - - -

352 Pulmicort respules ampul - 9,725 - - - -
353 Pulmicort turbuhaler kotak - 105,040 - - - -
354 Ramabion tab tablet - 6,490 - - - -
355 Ranitidin inj 25mg/2ml ampul - 1,155 - - - -
356 Recovit sirup botol - 8,650 - - - -
357 Reserpin tablet 0,25 mg tablet - 114 - - - -
358 Rifampisin kaplet 600 mg tablet - 1,134 - - - -
359 Rifampisin kapsul 300 mg tablet - 834 - - - -
360 Rifampisin kapsul 450 mg tablet - 923 - - - -
361 Ringer laktat larutan infus steril botol - 7,150 - - - -
362 Risperidon 2 mg tab tablet - 273 - - - -
363 Salisil bedak 2 % kotak - 1,071 - - - -
364 Sandepril 50 mg tablet - 3,476 - - - -
365 Sangobion kids drop botol - 35,000 - - - -
366 Sangobion Kids Sirup botol - 27,158 - - - -
Page 24 of 52
USULAN TOTAL
367 Scabicid cream 10 gram tube - 11,475 - - - -
368 Scabimite cream 10 gram tube - 11,475 - - - -
369 Scopma tablet tablet - 1,626 - - - -
370 Sefaleksin kapsul 500 mg kapsul - 1,400 - - - -
371 Sefiksim kapsul 100 mg kapsul - 923 - - - -
372 Sefiksim syr kering 100mg/5ml botol - 5,710 - - - -
373 Seretide Inhaler 50 mcg kotak - 55,000 - - - -
374 Serum anti bisa ular polivalen inj 5 ml ( vial - 479,996 - - - -
375 Serum anti bisa ular polivalen inj 50 ml ( vial - 28,468,086 - - - -
376 Serum anti defteri inj 1000 mg / vial vial - 204,112 - - - -
377 Serum anti tetanus inj 1.500 IU / ampul ampul - 130,999 - - - -
378 Serum anti tetanus inj 20.000 IU / ampul ampul - 604,670 - - - -
379 Setirizin sirup 5 mg/ml botol - 2,993 - - - -
380 Setirizine tablet 10 mg tablet - 97 - - - -
381 Simetidin tablet tablet - 132 - - - -
382 Simpastatin 20 mg tablet tablet - 225 - - - -
383 Sohobion tablet tablet - 1,764 - - - -
384 Spiramisin 500 mg tablet tablet - 1,877 - - - -
385 Spironolakton tab 25 mg tablet - 212 - - - -
386 Stesolid rectal 5 mg supp - 14,459 - - - -
387 Stimuno Forte tablet tablet - 2,639 - - - -
388 Stimuno Sirup botol - 18,500 - - - -
389 Sucralfate 500 mg/5 ml suspensi botol - 7,338 - - - -
390 Sulfasetamid natrium tetes mata 15 % botol - 4,358 - - - -
391 Susuk KB II set - 198,450 - - - -
392 Symbicort turbuhaler 160/4.5 mg kotak - 125,840 - - - -
393 Symbicort turbuhaler 80/4.5 mg kotak - 125,840 - - - -
394 Synarcus krim tube - 2,534 - - - -
395 Taburia sachet - 2,056 - - - -
396 Tanapress 5 mg (imidapril ) tablet - 2,530 - - - -
397 Tensigard tablet tablet - 2,385 - - - -
398 Terra Flu tablet tablet - 361 - - - -
399 Tetagam ampul - 176,800 - - - -
400 Thiamfenicol 500 mg kapsul kapsul - 440 - - - -
401 Thiamin Hcl ( Vit B1 ) inj.100 mg / ml - 1 ampul - 730 - - - -
Page 25 of 52
USULAN TOTAL
402 Thrombophob gel tube - 60,214 - - - -
403 Timolol tetes mata 0,5% botol - 11,275 - - - -
404 Tramadol 50 mg kapsul kapsul - 439 - - - -
405 Tramadol inj 50 mg/ml ampul - 1,764 - - - -
406 Triflouperazin 5mg tablet tablet - 309 - - - -
407 Truvit drops botol - 17,019 - - - -
408 Truvit sirup botol - 11,400 - - - -
409 Ulsafate sirup botol - 7,338 - - - -
410 Ulsidex tablet tablet - 296 - - - -
411 Urea krim (Soft U derm) botol - 6,809 - - - -
412 Urotractin (asam pipemidat) 400 mg tablet - 1,400 - - - -
413 Vagizol ovula (metronidazol ovula) ovula - 3,590 - - - -

414 valisanbe 2 mg tablet - 236 -
415 Valsartan tab 80 mg (Diovan 80mg) tablet - 795 -
416 Vastral tablet - 605 -
417 Ventolin inhaler kotak - 31,200 -

418 Ventolin Nebulizer ampul - 4,000 -
Page 26 of 52

PUSKESMAS : ....................
TOTAL SISA PEMAKAIAN PEMAKAIAN TOTAL PREDIKSI PREDIKSI SISA

SISA STOK SISA STOK RENCANA USULAN
STOK OBAT RATA2/BULAN RATA2/BULAN PEMAKAIAN PENERIMAAN STOK PER
NO NAMA OBAT SATUAN OBAT APBD OBAT JKN KEBUTUHAN OBAT PENGADAAN 2020 HARGA OBAT
PER 31 OKT OBAT APBD OBAT JKN RATA2 / BULAN NOV & DES DESEMBER
31 OKT 2019 31 OKT 2019 GIGI TAHUN 2020 (PEMBULATAN)
2019 2019 2019
1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13 14
B OBAT GIGI
1 Achatit/Fuji II kotak 0 0 0 - Rp 939,400.00

2 acid etching kotak 0 0 0 - Rp 376,035.00
3 Air raksa dental use botol 0 0 0 - Rp 437,500.00
4 Alveogyl kotak 0 0 0 - Rp 789,800.00
5 Aplicator kotak 0 0 0 - Rp 61,600.00
6 Arsenic Pasta 10 gr/pot 0 0 0 - Rp 942,040.00
7 Articulating paper kotak 0 0 0 - Rp 195,800.00
8 Bond strenght kotak 0 0 0 - Rp 330,000.00
9 Caviton kotak 0 0 0 - Rp 210,100.00
10 Citodur (Bahan tambalan sementara) kotak 0 0 0 - Rp 200,200.00
11 Cotton pelet pack 0 0 0 - Rp 247,500.00
12 Cotton roll pack 0 0 0 - Rp 88,880.00
13 Cresofen / endoseptone pack 0 0 0 - Rp 605,000.00
14 Dental floss kotak 0 0 0 - Rp 30,250.00
15 Dentin conditioning kotak 0 0 0 - Rp 366,465.00
16 Devitalisasi pasta (non arsen) / D.Pulp botol 0 0 0 - Rp 752,400.00
17 Devitalisasi pasta (non arsen) / Devitec kotak 0 0 0 - Rp 698,500.00
Dysclosing agent / Disclosing gel (GC tri 0 0 0 -
18 plaque ID Gel) botol Rp 345,950.00
19 Ethyl klorida semprot botol 0 0 0 - Rp 125,000.00
20 Eugenol cairan botol 0 0 0 - Rp 136,400.00
21 Flour sediaan topical botol 0 0 0 - Rp 170,000.00
22 Formokresol botol 0 0 0 - Rp 60,000.00
23 G aenial bond kotak 0 0 0 - Rp 1,000,000.00
24 Glass Ionomer cemen ( GC IX ) kotak 0 0 0 - Rp 711,700.00
25 Glass Ionomer cemen / ketakmolar kotak 0 0 0 - Rp 880,000.00
NO NAMA OBAT SATUAN OBAT APBD OBAT JKN KEBUTUHAN OBAT PENGADAAN 2020 HARGA OBAT
2019 2019 2019
26 Glass Ionomer Light cured Universal restorati kotak 0 0 0 - Rp 500,000.00

27 Gutta perchha point 15-40 mm kotak 0 0 0 - Rp 51,700.00
28 Gutta perchha point 45-80 mm kotak 0 0 0 - Rp 50,000.00
29 Jarum Dental cytoject pcs 0 0 0 - Rp 2,662.00
30 Kalsium hidroksida pasta kotak 0 0 0 - Rp 150,000.00
31 Marbalet/neocones botol 0 0 0 - Rp 1,361,800.00
32 Masker Gigi box 0 0 0 - Rp 34,650.00
33 Monoklorkamfer mentol cairan (camphenol) kotak 0 0 0 - Rp 55,000.00
34 Monoklorkamfer mentol cairan (CHKM) kotak 0 0 0 - Rp 75,240.00
35 Mummifying pasta kotak 0 0 0 - Rp 451,000.00
36 Oco Tooth Clensing botol 0 0 0 - Rp 160,000.00
37 Paper point 15-40 mm kotak 0 0 0 - Rp 47,300.00
38 Paper point 45-80 mm kotak 0 0 0 - Rp 47,300.00
39 Pasta pengisi saluran akar kotak 0 0 0 - Rp 451,000.00
40 Rockless kotak 0 0 0 - Rp 1,135,200.00
41 Sarung tangan box 0 0 0 - Rp 89,100.00
42 Scandonest kotak 0 0 0 - Rp 881,100.00
43 selang saliva eyector pack 0 0 0 - Rp 157,300.00
44 Semen seng fosfat serbuk dan cairan kotak 0 0 0 - Rp 225,500.00
45 Silver amalgam serbuk 65 - 75 % kotak 0 0 0 - Rp 937,500.00
46 Surgical ginggival pack (Coe Pak) kotak 0 0 0 - Rp 669,350.00
47 Tambalan sinar solare A2 kotak 0 0 0 - Rp 420,200.00
48 Tambalan sinar solare A3 kotak 0 0 0 - Rp 420,200.00
49 Tambalan sinar solare A3,5 kotak 0 0 0 - Rp 420,200.00
50 Tampon pack 0 0 0 - Rp 302,500.00
51 Temporary stopping fletcher serbuk dan caira set 0 0 0 - Rp 62,150.00
52 Topical anastesi pasta kotak 0 0 0 - Rp 102,300.00
53 Trikesol Formalin ( TKF ) cairan botol 0 0 0 - Rp 82,720.00
54 Varnish box 0 0 0 - Rp 165,440.00

TOTAL
MENGETAHUI :
KEPALA PUSKESMAS PENGELOLA OBAT PUSKESMAS

PUSKESMAS : ....................

NAMA OBAT SATUAN OBAT APBD OBAT JKN KEBUTUHAN OBAT PENGADAAN 2020 HARGA OBAT PROYEKSI PENGADAAN
2019 2019 2019
APBD total Rp APBD
2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13 14 15 16 = 14 * 15
OBAT GIGI
Achatit/Fuji II kotak 0 0 0 - Rp 939,400.00 - -
acid etching kotak 0 0 0 - Rp 376,035.00 - -
Air raksa dental use botol 0 0 0 - Rp 437,500.00 - -
Alveogyl kotak 0 0 0 - Rp 789,800.00 - -
Aplicator kotak 0 0 0 - Rp 61,600.00 - -
Arsenic Pasta 10 gr/pot 0 0 0 - Rp 942,040.00 - -
Articulating paper kotak 0 0 0 - Rp 195,800.00 - -
Bond strenght kotak 0 0 0 - Rp 330,000.00 - -

Caviton kotak 0 0 0 - Rp 210,100.00 - -
Citodur (Bahan tambalan sementara) kotak 0 0 0 - Rp 200,200.00 - -
Cotton pelet pack 0 0 0 - Rp 247,500.00 - -
Cotton roll pack 0 0 0 - Rp 88,880.00 - -
Cresofen / endoseptone pack 0 0 0 - Rp 605,000.00 - -

Dental floss kotak 0 0 0 - Rp 30,250.00 - -
Dentin conditioning kotak 0 0 0 - Rp 366,465.00 - -
Devitalisasi pasta (non arsen) / D.Pulp botol 0 0 0 - Rp 752,400.00 - -

Devitalisasi pasta (non arsen) / Devitec kotak 0 0 0 - Rp 698,500.00 - -
Dysclosing agent / Disclosing gel (GC tri 0 0 0 - - -
plaque ID Gel) botol Rp 345,950.00
Ethyl klorida semprot botol 0 0 0 - Rp 125,000.00 - -
Eugenol cairan botol 0 0 0 - Rp 136,400.00 - -
Flour sediaan topical botol 0 0 0 - Rp 170,000.00 - -
Formokresol botol 0 0 0 - Rp 60,000.00 - -
G aenial bond kotak 0 0 0 - Rp 1,000,000.00 - -
Glass Ionomer cemen ( GC IX ) kotak 0 0 0 - Rp 711,700.00 - -
Glass Ionomer cemen / ketakmolar kotak 0 0 0 - Rp 880,000.00 - -
NAMA OBAT SATUAN OBAT APBD OBAT JKN KEBUTUHAN OBAT PENGADAAN 2020 HARGA OBAT PROYEKSI PENGADAAN
2019 2019 2019
APBD total Rp APBD

Glass Ionomer Light cured Universal restorati kotak 0 0 0 - Rp 500,000.00 - -
Gutta perchha point 15-40 mm kotak 0 0 0 - Rp 51,700.00 - -
Gutta perchha point 45-80 mm kotak 0 0 0 - Rp 50,000.00 - -
Jarum Dental cytoject pcs 0 0 0 - Rp 2,662.00 - -
Kalsium hidroksida pasta kotak 0 0 0 - Rp 150,000.00 - -
Marbalet/neocones botol 0 0 0 - Rp 1,361,800.00 - -
Masker Gigi box 0 0 0 - Rp 34,650.00 - -
Monoklorkamfer mentol cairan (camphenol) kotak 0 0 0 - Rp 55,000.00 - -
Monoklorkamfer mentol cairan (CHKM) kotak 0 0 0 - Rp 75,240.00 - -
Mummifying pasta kotak 0 0 0 - Rp 451,000.00 - -
Oco Tooth Clensing botol 0 0 0 - Rp 160,000.00 - -
Paper point 15-40 mm kotak 0 0 0 - Rp 47,300.00 - -
Paper point 45-80 mm kotak 0 0 0 - Rp 47,300.00 - -
Pasta pengisi saluran akar kotak 0 0 0 - Rp 451,000.00 - -
Rockless kotak 0 0 0 - Rp 1,135,200.00 - -
Sarung tangan box 0 0 0 - Rp 89,100.00 - -
Scandonest kotak 0 0 0 - Rp 881,100.00 - -
selang saliva eyector pack 0 0 0 - Rp 157,300.00 - -
Semen seng fosfat serbuk dan cairan kotak 0 0 0 - Rp 225,500.00 - -
Silver amalgam serbuk 65 - 75 % kotak 0 0 0 - Rp 937,500.00 - -
Surgical ginggival pack (Coe Pak) kotak 0 0 0 - Rp 669,350.00 - -
Tambalan sinar solare A2 kotak 0 0 0 - Rp 420,200.00 - -
Tambalan sinar solare A3 kotak 0 0 0 - Rp 420,200.00 - -
Tambalan sinar solare A3,5 kotak 0 0 0 - Rp 420,200.00 - -
Tampon pack 0 0 0 - Rp 302,500.00 - -
Temporary stopping fletcher serbuk dan caira set 0 0 0 - Rp 62,150.00 - -
Topical anastesi pasta kotak 0 0 0 - Rp 102,300.00 - -
Trikesol Formalin ( TKF ) cairan botol 0 0 0 - Rp 82,720.00 - -
Varnish box 0 0 0 - Rp 165,440.00 - -
TOTAL -
MENGETAHUI :
KEPALA PUSKESMAS PENGELOLA OBAT PUSKESMAS
RENCANA KEBUTUHAN BMHP TAHUN 2020

PUSKESMAS : .....................................
TOTAL SISA PEMAKAIAN PEMAKAIAN TOTAL

SISA STOK SISA STOK
STOK BMHP RATA2/BULAN RATA2/BULAN PEMAKAIAN
NO NAMA OBAT SATUAN BMHP APBD BMHP JKN
PER 31 OKT BMHP APBD BMHP JKN RATA2 / BULAN
31 OKT 2019 31 OKT 2019
2019
1 2 3 4 5 6=4+5 7 8 9=7+8
C BMHP
1 Alat suntik sekali pakai 1 ml pcs 0 0
3 Alat suntik sekali pakai 2,5 ml pcs 0 0
6 Albothyl botol 0 0
7 Alkohol Swab lembar 0 0
8 Bioplacenton tulle pcs 0 0
9 Bistruri/scalpel balde No 10 pcs 0 0
10 Bistruri/scalpel balde No 11 pcs 0 0
11 Bisturi/scalpel balde No 15 pcs 0 0
12 Blood Lancet pcs 0 0
13 Blood transfusion set pcs 0 0
14 Blue Tip pack 0 0
15 Box slide TB kotak 0 0
16 canula dewasa pcs 0 0
17 Cat Gut chromic No 1 pcs 0 0
18 Catgut/benang bedah no 2/0 chronic pcs 0 0
19 Catgut/benang bedah no 2/0 plain pcs 0 0
20 Catgut/benang bedah no 3/0 chronic pcs 0 0
21 Catgut/benang bedah no 3/0 plain pcs 0 0
22 Celulid strip pcs 0 0
23 Cetride 5 Liter galon 0 0
24 Clorheksidin 2,5 % botol 0 0
25 Coverplast pcs 0 0
26 Deck glass / objek glass 20 x 20 mm pack 0 0
27 Deck glass / objek glass 22 x 22 mm pack 0 0
28 Deck gelas / objek glass 24 x 24 mm pack 0 0
29 Disposibel vagina speculum pcs 0 0
30 D-Pierce X12 box 0 0
31 ECG 112 mm x 30 mm x 16 mm roll 0 0
32 ECG 58 mm x 25 mm x 16 mm roll 0 0
33 Film Rontgen 24 x 30 cm lembar 0 0
36 Fixomull pcs 0 0
37 Foley cateter no 16 pcs 0 0
38 Foley cateter no 18 pcs 0 0
39 Fukuda M.E.ECG Paper pcs 0 0
40 handiplast pcs 0 0
41 Holder tube vacutainer pcs 0 0
42 Hypafix uk. Kecil 5 cm x 5 m pcs 0 0
43 IUD set 0 0
44 Infusiun set anak pcs 0 0
45 Infusiun set dewasa pcs 0 0
46 IV Catheter no 18 G pcs 0 0
50 Jarum (Needle) no 23 pcs 0 0
51 Jarum (Needle) no 25 pcs 0 0
52 Jarum Jahit kulit no 10 GT pack 0 0
53 Jarum Jahit Kulit No 11 GT pack 0 0
54 Jarum Jahit kulit no 12 GT pack 0 0
57 jarum K-File no 15-40 kotak 0 0
60 Jelly (Aquagel) botol 0 0
61 kantongan plastik pack 0 0
62 Kapas berlemak 500 mg roll 0 0
63 Kapas pembalut / absorben 250 mg roll 0 0
64 Kasa kompres 40 / 40 steril pcs 0 0
65 Kasa pembalut 2 m x80 cm pcs 0 0
66 Kasa pembalut hidrofil 4m x 15 cm pcs 0 0
67 Kasa pembalut hidrofil 4m x 3 cm pcs 0 0
68 Kasa steril 16 cm x 16 cm box 0 0
69 Kertas EKG (uk 80 x 90 x 280) lembar 0 0
70 Kertas Puyer lembar 0 0
71 Kertas Thermal roll 0 0
72 kertas thermal 50 mm x 57 mm roll 0 0
73 Kertas thermal mindray 50mm x 50 mm roll 0 0
74 Kertas thermal mindray 80 x 50 roll 0 0
75 Kertas thermal mindray 80 x 80 roll 0 0
76 Klorin botol 0 0
77 Kondom pcs 0 0
78 Larutan antiseptik (Aseptan) botol 0 0
79 Lidi Kapas/cotton swab pcs 0 0
80 Markerpen pcs 0 0
81 Masker N 95 3M 1860 pcs 0 0
82 Masker N 95 3M 1860S pcs 0 0
83 Masker N 95 3M 1870 pcs 0 0
84 masker nebule dewasa pcs 0 0
85 masker oksigen anak pcs 0 0
86 masker oksigen dewasa pcs 0 0
87 Mata Bor high speed pack 0 0
88 Microtube 1,5 cc pack 0 0
89 Minyak handpiece 500 ml botol 0 0
90 Mouthpiece sterilbreath 250s box 0 0
91 NaOcl 2,5 % untuk sal irigasi botol 0 0
92 Needle flashback pcs 0 0
93 Obyek glass* biasa pack 0 0
94 Open akses bur pcs 0 0
95 Pembalut gips pcs 0 0
96 Penjepit tali pusat pcs 0 0
97 Pharmafix pcs 0 0
98 pipet ESR citotes pcs 0 0
99 Plastik klip sedang pack/100s 0 0
100 Plastik Obat kecil (uk. 8 cm x 5 cm) pack 0 0
101 Plastik Obat pembungkus puyer (uk. Besar) pack 0 0
102 Plester (hansaplast 5 cm x 4,5 m) pcs 0 0
103 Plesterin pcs 0 0
104 Pot Sputum pcs 0 0
105 safety box* pcs 0 0
106 sealing wax pcs 0 0
107 Serum gel tes tube 5 ml / tabung gel & cloat acti pcs 0 0
108 Silk ( benang bedah sutra ) no.3/0 pcs 0 0
109 silk no 2/0 pcs 0 0
110 Spon gelatin cubicle 1 x 1 x 1 cm pcs 0 0
111 Spuit 0,05 ml pcs 0 0
112 Spuit 0,5 ml pcs 0 0
113 Steril Pouch 9 x 26 cm kotak 0 0
114 Suction tips pack 0 0
115 Surflo No 18 pcs 0 0
119 Surgical Glove No 6,5 pcs 0 0
120 Surgical Glove No 8 pcs 0 0
121 Surgical Glove obsgyn / gynecolog No 6,5 pcs 0 0
122 Surgical Glove obsgyn / gynecolog No 7 pcs 0 0

123 Surgical Gloves non steril uk L pcs 0 0
pcs 0 0
124 Surgical Gloves non steril uk M
125 Surgical Gloves non steril uk S pcs 0 0
126 Surgical mask 3 ply tie on pcs 0 0
127 Surgical mask-plus 3 ply plus earloop (Jilbab) pcs 0 0
128 Surgikal Gloves No 7 pcs 0 0
129 Surgikal Gloves No 7.5 pcs 0 0
130 Tabung EDTA K-3 pcs 0 0
131 Tabung EdtA K-3 micro 0,5 cc pcs 0 0

132 Tabung hematokrit pack 0 0
133 Tabung reaksi / Test tube 75 x 100 dia 1 cm pcs 0 0
HATAN KOTA BANJARMASIN
BUTUHAN BMHP TAHUN 2020

S : .....................................
PREDIKSI RENCANA USULAN

PREDIKSI SISA
PENERIMAAN KEBUTUHAN PENGADAAN
STOK PER
NOV & DES BMHP TAHUN 2020
DESEMBER 2019
2019 2020 (PEMBULATAN)
10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
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0 -
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0 -
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0 -
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0 -
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0 -
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0 -
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0 -
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0 -
0 -
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0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
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0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
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0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
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0 -
0 -
0 -
0 -
0 -
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0 -
0 -
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0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
0 -
RENCANA KEBUTUHAN BMHP TAHUN 2020

PUSKESMAS : .............................................
USULAN
NO NAMA BMHP SATUAN PENGADAAN HARGA BMHP PROYEKSI PENGADAAN
2020
APBD total Rp APBD JKN

1 2 3 4 5 6 7=5*6 8
C BMHP
1 Alat suntik sekali pakai 1 ml pcs - 1,614 -
2 Alat suntik sekali pakai 10 ml pcs - 605 -
3 Alat suntik sekali pakai 2,5 ml pcs - 1,138 -

6 Albothyl botol - 45,000 -
7 Alkohol Swab lembar - 105 -
8 Bioplacenton tulle pcs - 10,920 -
9 Bistruri/scalpel balde No 10 pcs - 3,300 -
10 Bistruri/scalpel balde No 11 pcs - 3,450 -
11 Bisturi/scalpel balde No 15 pcs - 850 -

12 Blood Lancet pcs - 176 -
13 Blood transfusion set pcs - 4,698 -
14 Blue Tip pack - 139,500 -
15 Box slide TB kotak - 36,000 -
16 canula dewasa pcs - 1 -
17 Cat Gut chromic No 1 pcs - 1 -
18 Catgut/benang bedah no 2/0 chronic pcs - 5,863 -
19 Catgut/benang bedah no 2/0 plain pcs - 5,863 -
20 Catgut/benang bedah no 3/0 chronic pcs - 5,863 -
21 Catgut/benang bedah no 3/0 plain pcs - 5,863 -
22 Celulid strip pcs - 73,700 -
23 Cetride 5 Liter galon - 774,972 -
24 Clorheksidin 2,5 % botol - 618,750 -
25 Coverplast pcs - 470 -
26 Deck glass / objek glass 20 x 20 mm pack - 48,000 -
27 Deck glass / objek glass 22 x 22 mm pack - 52,300 -
28 Deck gelas / objek glass 24 x 24 mm pack - 48,000 -

29 Disposibel vagina speculum pcs - 7,500 -
30 D-Pierce X12 box - 817,450 -
31 ECG 112 mm x 30 mm x 16 mm roll - 141,400 -
32 ECG 58 mm x 25 mm x 16 mm roll - 55,325 -
33 Film Rontgen 24 x 30 cm lembar - 21,970 -
36 Fixomull pcs - 37,440 -
37 Foley cateter no 16 pcs - 13,688 -
38 Foley cateter no 18 pcs - 13,688 -
39 Fukuda M.E.ECG Paper pcs - 56,567 -
40 handiplast pcs - 385 -
41 Holder tube vacutainer pcs - 6,940 -
42 Hypafix uk. Kecil 5 cm x 5 m pcs - 98,900 -
43 IUD set - 11,800 -
44 Infusiun set anak pcs - 2,970 -
45 Infusiun set dewasa pcs - 4,176 -
46 IV Catheter no 18 G pcs - 4,959 -
50 Jarum (Needle) no 23 pcs - 400 -
51 Jarum (Needle) no 25 pcs - 604 -
52 Jarum Jahit kulit no 10 GT pack - 38,000 -
53 Jarum Jahit Kulit No 11 GT pack - 32,500 -
54 Jarum Jahit kulit no 12 GT pack - 38,000 -
57 jarum K-File no 15-40 kotak - 150,700 -
60 Jelly (Aquagel) botol - 31,027 -
61 kantongan plastik pack - 2,500 -
62 Kapas berlemak 500 mg roll - 21,533 -
63 Kapas pembalut / absorben 250 mg roll - 13,000 -
64 Kasa kompres 40 / 40 steril pcs - 1,962 -
65 Kasa pembalut 2 m x80 cm pcs - 9,347 -
66 Kasa pembalut hidrofil 4m x 15 cm pcs - 2,457 -
67 Kasa pembalut hidrofil 4m x 3 cm pcs - 614 -
68 Kasa steril 16 cm x 16 cm box - 8,686 -
69 Kertas EKG (uk 80 x 90 x 280) lembar - 106,250 -
70 Kertas Puyer lembar - 92 -
71 Kertas Thermal roll - 94,500 -
72 kertas thermal 50 mm x 57 mm roll - 18,200 -
73 Kertas thermal mindray 50mm x 50 mm roll - 76,500 -
74 Kertas thermal mindray 80 x 50 roll - 24,250 -
75 Kertas thermal mindray 80 x 80 roll - 27,550 -
76 Klorin botol - 15,970 -
77 Kondom pcs - 717 -
78 Larutan antiseptik (Aseptan) botol - 37,950 -
79 Lidi Kapas/cotton swab pcs - 1,000 -
80 Markerpen pcs - 1 -
81 Masker N 95 3M 1860 pcs - 19,500 -
82 Masker N 95 3M 1860S pcs - 19,500 -
83 Masker N 95 3M 1870 pcs - 21,000 -
84 masker nebule dewasa pcs - 28,300 -
85 masker oksigen anak pcs - 19,800 -

86 masker oksigen dewasa pcs - 19,800 -
87 Mata Bor high speed pack - 154,000 -
88 Microtube 1,5 cc pack - 245,000 -
89 Minyak handpiece 500 ml botol - 561,000 -
90 Mouthpiece sterilbreath 250s box - 4,528 -
91 NaOcl 2,5 % untuk sal irigasi botol - 123,200 -
92 Needle flashback pcs - 3,170 -
93 Obyek glass* biasa pack - 37,446 -
94 Open akses bur pcs - 135,300 -
95 Pembalut gips pcs - 55,000 -
96 Penjepit tali pusat pcs - 3,025 -
97 Pharmafix pcs - 27,000 -
98 pipet ESR citotes pcs - 7,675 -
99 Plastik klip sedang pack/100s 3,950 -
118 Surflo No 24 pcs 8,355 -
119 Surgical Glove No 6,5 pcs 20,007 -
120 Surgical Glove No 8 pcs 5000 -
121 Surgical Glove obsgyn / gynecolog No 6,5 pcs 20006.7 -
122 Surgical Glove obsgyn / gynecolog No 7 pcs 20010 -

123 Surgical Gloves non steril uk L pcs 462 -
pcs 374 -
124 Surgical Gloves non steril uk M
125 Surgical Gloves non steril uk S pcs 462 -
126 Surgical mask 3 ply tie on pcs 462 -
127 Surgical mask-plus 3 ply plus earloop (Jilbab) pcs 462 -
128 Surgikal Gloves No 7 pcs 5000 -
TOTAL
AAN TOTAL RUPIAH
PENGADAAN
total Rp JKN
9= 5*8 10 = 6 + 8 11 = 5 * 10
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RENCANA KEBUTUHAN REAGEN TAHUN 2020

PUSKESMAS : .............................
PEMAKAIAN PEMAKAIAN
SISA STOK SISA STOK TOTAL SISA STOK
RATA2/BULAN RATA2/BULAN
NO NAMA OBAT SATUAN REAGEN APBD REAGEN JKN REAGEN PER 31
REAGEN APBD REAGEN JKN
31 OKT 2019 31 OKT 2019 OKT 2019
1 2 3 4 5 6=4+5 7 8
D REAGEN
1 Abate/temephos botol 0
2 ACS level I (control serum) botol 0
3 Aquadest steril botol 0
4 Asam klorida 0,1 N botol 0
5 Asam sulfosalisilat 20 % botol 0
6 bactive SL botol 0
7 Blood Analisir Clianac Detergen (Nihon kohd botol 0
8 Blood Analisir Hemolinac 3N Lysing (nihon botol 0
9 Blood Analisir Isotonac 3 Diluent (nihon koh botol 0
10 Blood Analisir Clianac Detergen (norma clea botol 0
11 Blood Analisir Hemolinac 3N Lysing (norma botol 0
12 Blood Analisir Isotonac 3 Diluent (norma dil botol 0
13 Carbol gentian violet botol 0
14 Cynoff 25 UL botol 0
15 Edta kering botol 0
16 Etanol 70 % 1 Liter botol 0
17 Etanol 70 % 100 ml botol 0
18 K-Othrine 20 EW / Cyflutrin botol 0
19 Kontrol darah botol 0
20 Kontrol norma low botol 0
21 Kontrol norma normal botol 0
22 kontrol norma high botol 0
23 Lab Pro reagen botol 0
24 Larutan Air Fuchsin botol 0
25 Larutan Alkohol 95 % botol 0
26 Larutan Alkohol 96 % botol 0
27 Larutan alkohol aseton botol 0
28 Larutan amonium oksalat botol 0
29 Larutan Anisol botol 0
30 Larutan Asam asetat 5% botol 0
31 Larutan Barium Klorida botol 0
32 Larutan Benedict botol 0
33 Larutan Buffer Fosfat botol 0
34 Larutan Developer botol 0
35 Larutan Edta 10% botol 0
36 Larutan Eosin 2 % botol 0
37 Larutan Etanol Asam botol 0
38 Larutan Eter alkohol botol 0
39 Larutan Fixer botol 0
40 Larutan Foucet botol 0
41 Larutan Giemsa Sain botol 0
42 Larutan hayem botol 0
43 Larutan Hidrogen Peroksida (H2O2) botol 0
44 Larutan Iodium 1 % botol 0
45 Larutan Karbol Fuksin botol 0
46 Larutan KOH 10 % botol 0
47 Larutan KOH 20 % botol 0
48 Larutan Lugol 1 % botol 0
49 Larutan Metilen Biru botol 0
50 Larutan Natrium Citrat 3,8 % botol 0

51 larutan safranin botol 0
52 Larutan sodium hipoklorid 1 L botol 0
53 Larutan sodium hipoklorid 100 ML botol 0
54 Larutan Turk botol 0
55 Larutan Xylol botol 0
56 Lipid Panel cardiocheck PA kotak 0
57 Lipid Pro pcs 0
58 M-30 CFL LYSE 500 ML Mindray botol 0
59 M-30 DILUENT Mindray botol 0
60 M-30 E-Z Cleanser Mindray botol 0
61 M-30 PROBE CLEANSER Mindray botol 0
62 M-30 RINSE Mindray botol 0
63 B30 Control Hematology Analyzer Mindray botol 0
64 Medonic Diluent 20 L botol 0
65 Medonic Lyse 5 L botol 0
66 Metanol botol 0
67 Norma cleaner botol 0
68 Norma diluent diff botol 0
69 Norma lyse diff botol 0
70 Oil Imersi botol 0
71 Pewarnaan Gram 1 % botol 0
72 Rapid 1 SD HIV 1/2 3.0 stik 0
73 Rapid 2 Intec HIV stik 0
74 Rapid 3 oncoprobe stik 0
75 Rapid 4 right sign HIV stik 0
76 Rapid 5 CTK Bioteck HIV stik 0
77 Rapid 6 HIV Vikia stik 0
78 Rapid 7 HIV Card Vcare stik 0
79 Rapid 8 Fokus HIV stik 0
80 Reagen Albumin biosystem kit 0
81 Reagen albumin agappe / mindray kit 0
82 Reagen Albumin randox kit 0
83 Reagen Asam Urat biosystem kit 0
84 Reagen Asam Urat agappe / mindray kit 0
85 Reagen Asam Urat randox kit 0
86 Reagen Bilirubin Direct biosystem kit 0
87 Reagen Bilirubin Direct agappe / mindray kit 0
88 Reagen Bilirubin Direct randox kit 0
89 Reagen Bilirubin Total biosystem kit 0
90 Reagen Bilirubin Total agappe / mindray kit 0
91 Reagen Bilirubin Total randox kit 0
92 Reagen Cholesterol biosystem kit 0
93 Reagen Cholesterol agappe / mindray kit 0
94 Reagen Cholesterol randox kit 0
95 Reagen Cholesterol HDL biosystem kit 0
96 Reagen Cholesterol HDL agappe / mindray kit 0
97 Reagen Cholesterol HDL randox kit 0
98 Reagen Creatinin biosystem kit 0
99 Reagen Creatinin agappe / mindray kit 0
100 Reagen Creatinin randox kit 0
101 Reagen Glucose biosystem kit 0
102 Reagen Glucose agappe / mindray kit 0
103 Reagen Glucose PAP randox kit 0
104 Reagen golongan darah set-2 0
105 Reagen golongan darah set-4 0
106 Reagen HB Cyanida kit 0
107 Reagen HB konsentrat biosystem kit 0
108 Reagen HB konsentrat randox kit 0
109 Reagen Protein Total biosystem kit 0
110 Reagen Protein Total agappe / mindray kit 0

111 Reagen Protein Total randox kit 0
112 Reagen SGOT / AST biosystem kit 0
113 Reagen SGOT / AST Mindray kit 0
114 Reagen SGOT / AST randox kit 0
115 Reagen SGPT / ALT biosystem kit 0
116 Reagen SGPT / ALT mindray kit 0
117 Reagen SGPT / ALT randox kit 0
118 Reagen Trigliseride biosystem kit 0
119 Reagen Trigliseride mindray kit 0
120 Reagen Trigliseride randox kit 0
121 Reagen Ureum biosystem kit 0

122 Reagen Urea Mindray kit 0
123 Reagen Ureum randox kit 0
124 Reagen Wright Stain kit 0
125 reagent cholesterol pap sl (microlab/elitech) kit 0
126 reagent cholesterol standar 200 mg/dl (micro kit 0
127 reagent glucose pap sl (microlab/elitech) kit 0
128 reagent glucose standar 100 mg/dl (microlab/ kit 0
129 reagent trigliserid mono sl (microlab/elitech) kit 0
130 reagent trigliserid standar 200 mg/dl (microla kit 0
131 reagent uric acid mono sl (microlab/elitech) kit 0
132 reagent uric acid standar (microlab/elitech) kit 0
133 Reagen Elitrol 1 Normal 1 x 5 ml (elitech) kit 0
134 Res eker botol 0
135 RPR syfilis randox botol 0
136 RPR syfilis Fokus Diagnostik botol 0
137 RPR syfilis "Human" botol 0
138 Serum kontrol mindray (Qualichek normal mi botol 0
139 Spiritus 1 L botol 0
140 Stik asam urat easy touch stik 0
141 Stik asam urat Nesco stik 0
142 Stik Cholesterol easy touch stik 0
143 Stik Cholesterol Nesco stik 0
144 Stik gula darah ( gluco dr autosensor) stik 0
145 Stik Gula Darah (Gluko DR supersensor) stik 0
146 Stik Gula Darah Accu cek stik 0
147 Stik HB BeneCheck stik 0
148 Stik HB Easy touch stik 0
149 Stik HBSAb merek Intec stik 0

150 Stik HBSAg merek SD stik 0
151 Stik HBSAg merek Intec stik 0
152 Stik Kehamilan stik 0
153 Stik syphilis 'SD' stik 0
154 Stik syphilis 'Monotest' stik 0
155 Stik syphilis 'Human hexagonal' stik 0
156 Stik urinalisa 10 parameter (Dirui) stik 0
TOTAL PREDIKSI PREDIKSI SISA RENCANA
USULAN
PEMAKAIAN PENERIMAAN STOK PER KEBUTUHAN
PENGADAAN 2020
RATA2 / BULAN NOV & DES DESEMBER REAGEN TAHUN
(PEMBULATAN)
2019 2019 2020
9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13
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RENCANA KEBUTUHAN REAGEN TAHUN 2020

PUSKESMAS : ...................
USULAN
NO NAMA REAGEN SATUAN PENGADAA HARGA REAGEN PROYEKSI PENGADAAN
N 2020
APBD total Rp APBD JKN

1 2 3 5 6 7 8=6*7 9
D REAGEN
1 Abate/temephos botol - 2,197,800 -
2 ACS level I (control serum) botol - 4,160,000 -
3 Aquadest steril botol - 22,000 -
4 Asam klorida 0,1 N botol - 24,200 -
5 Asam sulfosalisilat 20 % botol - 531,000 -

6 bactive SL botol - 30,700 -
7 Blood Analisir Clianac Detergen (Nihon kohden) botol - 8,050,000 -
8 Blood Analisir Hemolinac 3N Lysing (nihon kohden) botol - 3,850,000 -
9 Blood Analisir Isotonac 3 Diluent (nihon kohden) botol - 4,290,000 -
10 Blood Analisir Clianac Detergen (norma clean NK) botol - 2,112,000 -

11 Blood Analisir Hemolinac 3N Lysing (norma lyse NK) botol - 5,240,000 -
12 Blood Analisir Isotonac 3 Diluent (norma diluent NK) botol - 3,696,000 -
13 Carbol gentian violet botol - 64,900 -
14 Cynoff 25 UL botol - 1,124,500 -
15 Edta kering botol - 121,000 -
16 Etanol 70 % 1 Liter botol - 41,800 -
17 Etanol 70 % 100 ml botol - 5,500 -
18 K-Othrine 20 EW / Cyflutrin botol - 1,000,000 -
19 Kontrol darah botol - 1,358,500 -
20 Kontrol norma low botol - 596,000 -
21 Kontrol norma normal botol - 596,000 -
22 kontrol norma high botol - 596,000 -
23 Lab Pro reagen botol - 203,500 -
24 Larutan Air Fuchsin botol - 32,500 -
25 Larutan Alkohol 95 % botol - 91,300 -

26 Larutan Alkohol 96 % botol - 48,500 -
27 Larutan alkohol aseton botol - 31,000 -
28 Larutan amonium oksalat botol - 48,400 -
29 Larutan Anisol botol - 231,000 -
30 Larutan Asam asetat 5% botol - 19,500 -
31 Larutan Barium Klorida botol - 26,400 -
32 Larutan Benedict botol - 84,700 -
33 Larutan Buffer Fosfat botol - 36,300 -
34 Larutan Developer botol - 1,183,000 -
35 Larutan Edta 10% botol - 151,250 -
36 Larutan Eosin 2 % botol - 447,700 -
37 Larutan Etanol Asam botol - 62,700 -
38 Larutan Eter alkohol botol - 68,200 -
39 Larutan Fixer botol - 801,900 -
40 Larutan Foucet botol - 176,000 -
41 Larutan Giemsa Sain botol - 378,125 -
42 Larutan hayem botol - 122,100 -
43 Larutan Hidrogen Peroksida (H2O2) botol - 60,500 -
44 Larutan Iodium 1 % botol - 27,500 -
45 Larutan Karbol Fuksin botol - 165,000 -
46 Larutan KOH 10 % botol - 29,700 -
47 Larutan KOH 20 % botol - 40,700 -
48 Larutan Lugol 1 % botol - 44,000 -
49 Larutan Metilen Biru botol - 84,700 -
50 Larutan Natrium Citrat 3,8 % botol - 44,000 -
51 larutan safranin botol - 157,300 -
52 Larutan sodium hipoklorid 1 L botol - 110,000 -
53 Larutan sodium hipoklorid 100 ML botol - 18,634 -
54 Larutan Turk botol - 39,600 -
55 Larutan Xylol botol - 30,800 -
56 Lipid Panel cardiocheck PA kotak - 1,721,517 -
57 Lipid Pro pcs - 836,000 -
58 M-30 CFL LYSE 500 ML Mindray botol - 2,100,000 -
59 M-30 DILUENT Mindray botol - 2,050,000 -
60 M-30 E-Z Cleanser Mindray botol - 1,500,000 -
61 M-30 PROBE CLEANSER Mindray botol - 130,000 -
62 M-30 RINSE Mindray botol - 2,050,000 -
63 B30 Control Hematology Analyzer Mindray botol - 1,336,500 -
64 Medonic Diluent 20 L botol - 3,400,100 -
65 Medonic Lyse 5 L botol - 5,550,600 -
66 Metanol botol - 24,645 -
67 Norma cleaner botol - 1,910,000 -
68 Norma diluent diff botol - 1,910,000 -
69 Norma lyse diff botol - 2,625,000 -
70 Oil Imersi botol - 580,000 -
71 Pewarnaan Gram 1 % botol - 518,100 -
72 Rapid 1 SD HIV 1/2 3.0 stik - 14,344 -
73 Rapid 2 Intec HIV stik - 40,800 -
74 Rapid 3 oncoprobe stik - 64,280 -
75 Rapid 4 right sign HIV stik - 35,120 -
76 Rapid 5 CTK Bioteck HIV stik - 30,250 -
77 Rapid 6 HIV Vikia stik - 21,818 -
78 Rapid 7 HIV Card Vcare stik - 30,250 -
79 Rapid 8 Fokus HIV stik - 4,179 -
80 Reagen Albumin biosystem kit - 800,000 -
81 Reagen albumin agappe / mindray kit - 1,400,000 -
82 Reagen Albumin randox kit - 917,250 -

83 Reagen Asam Urat biosystem kit - 2,805,000 -
84 Reagen Asam Urat agappe / mindray kit - 1,150,000 -
85 Reagen Asam Urat randox kit - 1,225,700 -
86 Reagen Bilirubin Direct biosystem kit - 2,090,000 -
87 Reagen Bilirubin Direct agappe / mindray kit - 900,000 -
88 Reagen Bilirubin Direct randox kit - 970,000 -
89 Reagen Bilirubin Total biosystem kit - 2,090,000 -
90 Reagen Bilirubin Total agappe / mindray kit - 1,450,000 -
91 Reagen Bilirubin Total randox kit - 897,000 -
92 Reagen Cholesterol biosystem kit - 759,000 -
93 Reagen Cholesterol agappe / mindray kit - 1,150,000 -
94 Reagen Cholesterol randox kit - 1,586,500 -
95 Reagen Cholesterol HDL biosystem kit - 2,040,000 -
96 Reagen Cholesterol HDL agappe / mindray kit - 8,225,000 -
97 Reagen Cholesterol HDL randox kit - 1,924,750 -
98 Reagen Creatinin biosystem kit - 1,572,725 -
99 Reagen Creatinin agappe / mindray kit - 850,000 -
100 Reagen Creatinin randox kit - 937,750 -
101 Reagen Glucose biosystem kit - 495,000 -
102 Reagen Glucose agappe / mindray kit - 1,450,000 -
103 Reagen Glucose PAP randox kit - 1,803,400 -
104 Reagen golongan darah set-2 - 142,650 -
105 Reagen golongan darah set-4 - 355,480 -
106 Reagen HB Cyanida kit - 165,000 -
107 Reagen HB konsentrat biosystem kit - 308,000 -
108 Reagen HB konsentrat randox kit - 1,498,700 -
109 Reagen Protein Total biosystem kit - 545,000 -
110 Reagen Protein Total agappe / mindray kit - 700,000 -
111 Reagen Protein Total randox kit - 880,000 -
112 Reagen SGOT / AST biosystem kit - 715,000 -
113 Reagen SGOT / AST Mindray kit - 1,625,000 -
114 Reagen SGOT / AST randox kit - 1,435,700 -
115 Reagen SGPT / ALT biosystem kit - 715,000 -
116 Reagen SGPT / ALT mindray kit - 1,625,000 -
117 Reagen SGPT / ALT randox kit - 1,200,000 -
118 Reagen Trigliseride biosystem kit - 3,768,792 -
119 Reagen Trigliseride mindray kit - 1,950,000 -
120 Reagen Trigliseride randox kit - 1,879,650 -
121 Reagen Ureum biosystem kit - 1,550,000 -
122 Reagen Urea Mindray kit - 1,150,000 -
123 Reagen Ureum randox kit - 2,380,150 -
124 Reagen Wright Stain kit - 290,400 -
125 reagent cholesterol pap sl (microlab/elitech) kit - 3,088,800 -
126 reagent cholesterol standar 200 mg/dl (microlab/elitech) kit - 633,600 -
127 reagent glucose pap sl (microlab/elitech) kit - 1,584,000 -
128 reagent glucose standar 100 mg/dl (microlab/elitech) kit - 448,800 -
129 reagent trigliserid mono sl (microlab/elitech) kit - 4,752,000 -
130 reagent trigliserid standar 200 mg/dl (microlab/elitech) kit - 475,200 -
131 reagent uric acid mono sl (microlab/elitech) kit - 3,168,000 -
132 reagent uric acid standar (microlab/elitech) kit - 580,800 -
133 Reagen Elitrol 1 Normal 1 x 5 ml (elitech) kit - 924,000 -
134 Res eker botol - 144,100 -
135 RPR syfilis randox botol - 1,555,920 -
136 RPR syfilis Fokus Diagnostik botol - 4,250 -
137 RPR syfilis "Human" botol - 5,684 -
138 Serum kontrol mindray (Qualichek normal mindray) botol - 1,200,000 -
139 Spiritus 1 L botol - 53,900 -
146 Stik Gula Darah Accu cek stik - 8,327 -
147 Stik HB BeneCheck stik - 7,955 -
148 Stik HB Easy touch stik - 6,688 -
149 Stik HBSAb merek Intec stik - 27,478 -

150 Stik HBSAg merek SD stik - 9,870 -
- 9,850 -
151 Stik HBSAg merek Intec stik
152 Stik Kehamilan stik - 1,947 -
153 Stik syphilis 'SD' stik - 35,429 -
154 Stik syphilis 'Monotest' stik - 10,758 -
155 Stik syphilis 'Human hexagonal' stik - 26,744 -
156 Stik urinalisa 10 parameter (Dirui) stik - 3,245 -
TOTAL
AAN PENGADAA TOTAL RUPIAH
N
total Rp JKN
10 = 6 * 9 11 = 7 + 9 12 = 6 * 11
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DINAS KESEHATAN KOTA BANJARMASIN

RENCANA KEBUTUHAN OBAT TAHUN 2020

TOTAL SISA PEMAKAIAN PEMAKAIAN TOTAL PREDIKSI

1 2 3 4 5 6=4+5 7 8 9=7+8 10 11 = (6+10)-(9X2) 12 = (9 * 18)- 11 13

1 Albendazol tablet 400 mg* tablet 0 0 0 -

14 Artesunate cairan injeksi 60 mg* ampul 0 0 0 -

DHP / Darplex / D-Artepp (Dehidro artemisin 0 0 0 -

Ferro folat tab sal selaput 200 mg + 0,25 mg 0 0 0 -

59 Hidrokortison krim 2,5 % tube 0 0 0 -

92 Metilprednisolon 4 mg tablet tablet 0 0 0 -

Natrium Tiroksin (Levotiroksin) tablet 100 mg 0 0 0 -

125 Propanolol Hcl tablet 40 mg tablet 0 0 0 -

Vaksin IPV (Poliomyelitis Vaccine inj 0 0 0 -

157 Alprazolam 0,5 mg tablet 0 0 0 -

190 Bisoprolol tablet 5 mg tablet 0 0 0 -

223 Fenitoin natrium inj 50 mg / ml ampul 0 0 0 -

256 Interhistin tablet tablet 0 0 0 -

289 Livertran salep tube 0 0 0 -

322 Ofloksasin tab 400 mg tablet 0 0 0 -

Oksimetazolin tts hidung 0,025% (Iliadin 0 0 0 -

334 Pil KB I tablet 0 0 0 -

354 Ramabion tab tablet 0 0 0 -

387 Stimuno Forte tablet tablet 0 0 0 -

401 Thiamin Hcl ( Vit B1 ) inj.100 mg / ml - 1 ml ampul 0 0 0 -

402 Thrombophob gel tube 0 0 0 -

403 Timolol tetes mata 0,5% botol 0 0 0 -

404 Tramadol 50 mg kapsul kapsul 0 0 0 -

405 Tramadol inj 50 mg/ml ampul 0 0 0 -

406 Triflouperazin 5mg tablet tablet 0 0 0 -

407 Truvit drops botol 0 0 0 -

408 Truvit sirup botol 0 0 0 -

409 Ulsafate sirup botol 0 0 0 -

410 Ulsidex tablet tablet 0 0 0 -

411 Urea krim (Soft U derm) botol 0 0 0 -

417 Ventolin inhaler kotak 0 0 0 -

418 Ventolin Nebulizer ampul 0 0 0 -

RENCANA KEBUTUHAN OBAT TAHUN 2020

25 Deksametason tablet 0,5 mg tablet - 34 - - - -

DHP / Darplex / D-Artepp (Dehidro - - - - -

Ferro folat tab sal selaput 200 mg + - - - - -

77 Kodein tablet 10 mg tablet - 657 - - - -

78 Kotrimoksazol DOEN I (dewasa) tablet tablet - 125 - - - -

87 Mebendazol tablet 100 mg (vermox) tablet - 9,150 - - - -

Natrium Tiroksin (Levotiroksin) tablet - - - - -

123 Primakuin tablet 15 mg* tablet - 125 - - - -

147 Vaksin POLIO 10 Dosis* vial - 19,954 - - - -

Vaksin IPV (Poliomyelitis Vaccine inj - - - - -

157 Alprazolam 0,5 mg tablet - 88 - - - -

181 Asam Traneksamat injeksi 5 % 250 mg/ ampul - 1,813 - - - -

215 Dopamet (metildopa) tablet - 1,088 - - - -

249 Hidrokortison krim 1% tube - 2,934 - - - -

283 Lexapram sirup botol - 2,700 - - - -

317 Obat antituberkulosis kat.3* paket - 154,000 - - - -

Oksimetazolin tts hidung 0,025% - - - - -

327 Optiflox tetes mata botol - 14,005 - - - -

351 Pularex tablet tablet - 175 - - - -

391 Susuk KB II set - 198,450 - - - -

392 Symbicort turbuhaler 160/4.5 mg kotak - 125,840 - - - -

393 Symbicort turbuhaler 80/4.5 mg kotak - 125,840 - - - -

394 Synarcus krim tube - 2,534 - - - -

395 Taburia sachet - 2,056 - - - -

396 Tanapress 5 mg (imidapril ) tablet - 2,530 - - - -

397 Tensigard tablet tablet - 2,385 - - - -