LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OB

(LPLPO) DAK
KODE PUSKESMAS: 6
PUSKESMAS : KOTOBANGON
KECAMATAN KOTAMOBAGU TIMUR
KAB/KOTAÂ : KOTAMOBAGU
PROVINSI : SULAWESI UTARA

HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

1 3-WAY (2018) Pcs Rp 11,809.60 0 0

2 Abocath No. 14 (2017) Pcs Rp 16,000.00 0 0
3 Abocath No. 16 (2017) Pcs Rp 16,000.00 0 0
4 Abocath No. 18 (2015) Pcs Rp 4,959.00 69 0
5 Abocath No. 18 (2016) Pcs Rp 9,490.00 0 0
6 Abocath No. 18 (2017) Pcs Rp 16,000.00 100 0
7 Abocath No. 18 (2018) Pcs Rp 7,320.00 0 0
8 Abocath No. 20 (2015) Pcs Rp 4,959.00 25 0
9 Abocath No. 20 (2016) Pcs Rp 9,490.00 58 0
10 Abocath No. 20 (2017) Pcs Rp 16,000.00 0 0
11 Abocath No. 20 (2018) Pcs Rp 7,320.00 150 0
12 Abocath No. 22 (2017) Pcs Rp 16,000.00 0 0
13 Abocath No. 22 (2018) Pcs Rp 7,320.00 0 0
14 Abocath No. 24 (2015) Pcs Rp 4,959.00 351 0
15 Abocath No. 24 (2017) Pcs Rp 16,000.00 0 0
16 Abocath No. 24 (2018) Pcs Rp 7,320.00 0 0
17 Abocath No. 26 (2017) Pcs Rp 19,500.00 0 0
18 Abocath No. 26 (2018) Pcs Rp 9,394.00 0 0
19 Acyclovir (Acifar) Salep Kulit (2017) Tube Rp 9,926.00 0 0
20 Acyclovir (Acifar) Salep Kulit (2018) Tube Rp 9,500.00 0 250
21 Acyclovir 200 mg (2012) Tablet Rp 533.00 0 0
22 Acyclovir 200 mg (2013) Tablet Rp 251.00 0 0
23 Acyclovir 200 mg (2017) Tablet Rp 272.00 1670 0
24 Acyclovir 400 mg (2015) Tablet Rp 362.00 60 0
25 Acyclovir 400 mg (2016) Tablet Rp 381.00 9650 0
26 Acyclovir 400 mg (2017) Tablet Rp 381.00 0 0
27 Acyclovir salep Kulit (2012) Tube Rp 3,300.00 0 0
28 Acyclovir salep Kulit (2013) Tube Rp 2,367.00 0 0
29 Alat Suntik 1 mL (2016) Pcs Rp 822.00 0 0
30 Alat Suntik 1 mL (2017) Pcs Rp 776.31 0 0
31 alat suntik 10 cc (2016) Pcs Rp 1,163.00 0 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

32 alat suntik 10 cc (2018) Pcs Rp 1,500.00 0 100

33 Alat Suntik 3 mL (2015) Pcs Rp 771.13 0 0
34 Alat Suntik 3 mL (2015) Pcs Rp 848.25 72 0
35 Alat Suntik 3 mL (2016) Pcs Rp 862.00 0 0
36 Alat Suntik 3 mL (2017) Pcs Rp 783.00 2420 0
37 Alat Suntik 3 mL (2018) Pcs Rp 1,006.50 0 0
38 Alat Suntik 5 mL (2015) Pcs Rp 978.75 0 0
39 Alat Suntik 5 mL (2016) Pcs Rp 963.00 0 0
40 Alat Suntik 5 mL (2017) Pcs Rp 931.62 0 0
41 Alat Suntik 5 mL (2018) Pcs Rp 1,132.16 0 0
42 Alkohol swab (2018) Pcs Rp 134.20 2500 0
43 Allopurinol 100 mg (2012) Tablet Rp 145.00 0 0
44 Allopurinol 100 mg (2013) Tablet Rp 106.00 0 0
45 Allopurinol 100 mg (2017) Tablet Rp 95.00 8819 0
46 Allopurinol 100 mg (2018) Tablet Rp 99.00 0 0
47 Ambroxol (Roverton) Sirup (2017) Botol 60 mL Rp 9,600.00 6 0
48 Ambroxol 30 mg (2013) Tablet Rp 89.31 0 0
49 Ambroxol 30 mg (2018) Tablet Rp 143.00 4661 2700
50 Ambroxol 30 mg (Selebrox) (2017) Tablet Rp 550.00 0 0
51 Ambroxol Sirup (2018) Botol 60 mL Rp 3,960.00 150 0
52 Aminophyllin 200 mg (2014) Tablet Rp 86.00 0 0
53 Aminophyllin 200 mg (2015) Tablet Rp 86.00 0 0
54 Amitriptylline 25 mg (2015) Tablet Rp 123.00 100 0
55 Amlodipine (Selescardio) 5 mg (2017) Tablet Rp 1,333.33 145 0
56 Amlodipine 10 mg (2018) Tablet Rp 95.00 0 18000
57 Amlodipine 5 mg (2014) Tablet Rp 197.00 0 0
58 Amlodipine 5 mg (2018) Tablet Rp 75.00 2440 14400
59 Amoxycillin 500 mg (2012) Kaplet Rp 407.00 0 0
60 Amoxycillin 500 mg (2014) Kaplet Rp 279.00 0 0
61 Amoxycillin 500 mg (2015) Kaplet Rp 279.00 0 0
62 Amoxycillin 500 mg (2016) Kaplet Rp 279.00 45417 0
63 Amoxycillin Sirup Kering 125 mg (2013) Botol 60 mL Rp 2,511.00 0 0
64 Amoxycillin Sirup Kering 125 mg (2014) Botol 60 mL Rp 2,560.00 0 0
65 Amoxycillin Sirup Kering 125 mg (2015) Botol 60 mL Rp 2,560.00 0 0
66 Amoxycillin Sirup Kering 125 mg (Yusimox) (2017) Botol 60 mL Rp 8,500.00 60 60
67 Amoxycillin Sirup Kering 250 mg (2017) Botol 60 mL Rp 4,147.00 182 0
68 Antalgin 500 mg (2012) Tablet Rp 164.00 0 0
69 Antasida sirup (2014) Botol 60 mL Rp 2,213.00 0 0
70 Antasida sirup (2015) Botol 60 mL Rp 2,213.00 0 0
71 Antasida sirup (2017) Botol 60 mL Rp 2,106.00 533 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

72 Antasida sirup (2018) Botol 60 mL Rp 2,098.00 0 0

73 Antasida tab (2012) Tablet Rp 178.00 0 0
74 Antasida tab (2014) Tablet Rp 78.00 0 0
75 Antasida tab (2015) Tablet Rp 78.00 0 0
76 Antasida tab (2016) Tablet Rp 64.00 26226 0
77 Anti Tetanus (Tetagam P) 1 mL (250 IU) (2018) Dispo 0.5 mL Rp 242,000.00 0 0
78 Antifungi Doen Kombinasi Salep Kulit (2017) Pot 30 gram Rp 4,782.00 0 0
79 Aquadest 25 cc (2018) Kolf Rp 6,050.00 149 0
80 Asam Ascorbat (Vitamin C) 50 mg (2014) Tablet Rp 105.00 0 0
81 Asam Ascorbat (Vitamin C) 50 mg (2016) Tablet Rp 120.00 32189 0
82 Asam Folat (Anelat) (2017) Kaplet Rp 360.00 1060 0
83 Asam Folat (Selfolic) (2018) Kaptab Rp 500.00 0 5000
84 Asam Mefenamat 500 mg (2012) Kaplet Rp 194.00 0 0
85 Asam Mefenamat 500 mg (2014) Kaplet Rp 122.00 0 0
86 Asam Mefenamat 500 mg (2016) Kaplet Rp 113.00 0 0
87 Asam Mefenamat 500 mg (2017) Kaplet Rp 102.00 21845 0
88 Asering (2018) Botol 500 mL Rp 9,646.00 72 0
89 Baby Cough / pacdin sirup (2014) Botol 60 mL Rp 7,900.00 0 0
90 Baby Cough / pacdin sirup (2016) Botol 60 mL Rp 8,800.00 20 0
91 Besi II Sulfat (2012) Tablet Rp 24.00 0 0
92 Betahistine Mesilate (Histigo) (2018) Kaplet Rp 1,400.00 0 4000
93 Betametasone 0,1 % (Orsaderm) Salep Kulit (2017) Tube Rp 6,000.00 2 0
94 Betametasone salep Kulit 0,5% (2013) Tube Rp 1,670.00 0 0
95 Betametasone salep Kulit 0,5% (2014) Tube Rp 1,596.00 0 0
96 Betametasone salep Kulit 0,5% (2018) Tube Rp 3,350.00 650 0
97 Bisacodyl 5 mg (2018) Tablet Salut Rp 316.00 0 270
98 Bromheksin HCl 8 mg (2012) Tablet Rp 42.00 0 0
99 Bromheksin HCl 8 mg (Novaheksin) (2018) Tablet Rp 198.00 690 0
100 Cairan Antiseptik (Ortoviro) (2016) Botol 40 mL Rp 268,400.00 0 0
101 Cairan Luka (Diaviro) (2016) Botol 40 mL Rp 264,000.00 0 0
102 Captopril 12,5 mg (2012) Tablet Rp 99.00 0 0
103 Captopril 12,5 mg (2017) Tablet Rp 69.00 2830 0
104 Captopril 12,5 mg (2018) Tablet Rp 68.00 0 0
105 Captopril 25 mg (2012) Tablet Rp 152.00 0 0
106 Captopril 25 mg (2015) Tablet Rp 97.00 3540 0
107 Catgut Chromic No. 2/0 (2015) Pcs Rp 7,286.25 0 0
108 Catgut Chromic No. 2/0 (2016) Pcs Rp 6,420.83 417 0
109 Catgut Chromic No. 3/0 (2015) Pcs Rp 7,286.25 0 0
110 Catgut Chromic No. 3/0 (2016) Pcs Rp 6,420.83 226 0
111 Catgut Plain No. 2/0 (2015) Pcs Rp 7,286.25 0 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

112 Catgut Plain No. 2/0 (2016) Pcs Rp 6,420.83 265 0

113 catgut Plain No. 3/0 (2016) Pcs Rp 6,420.83 510 0
114 Cefadroxil 500 mg (2013) Kapsul Rp 521.00 0 0
115 Cefadroxil 500 mg (2014) Kapsul Rp 529.00 250 0
116 Cefixime 100 mg (2014) Tablet Rp 899.00 0 0
117 Cefotaxime 1 gram (2018) Vial Rp 4,410.00 0 0
118 Ceftriaxone 1 gram (2018) Vial Rp 4,822.00 0 0
119 Cetirizin 2HCl (Lerzin) (2018) Kapsul Rp 1,105.00 0 0
120 Cetirizine 10 mg (2013) Tablet Rp 188.00 0 0
121 Cetirizine 10 mg (2016) Tablet Rp 154.00 719 0
122 Cimetidine 200 mg (2012) Tablet Rp 126.00 0 0
123 Co-Amoxyclav 625 mg (2013) Kaplet Rp 5,283.00 0 0
124 Curbion sirup (2014) Botol 60 mL Rp 17,800.00 0 0
125 Curbion sirup (2016) Botol 60 mL Rp 12,100.00 0 0
126 Cyprofloxacin 250 mg (2013) Tablet Rp 261.00 0 0
127 Cyprofloxacin 500 mg (2018) Tablet Rp 281.00 2392 0
128 Cyprofloxacin 500 mg (Ramavex) (2017) Kaplet Rp 1,200.00 0 0
129 Dexamethasone (Ifidex) 0.5 mg (2017) Tablet Rp 190.00 0 0
130 Dexamethasone 0,5 mg (2015) Tablet Rp 68.00 0 0
131 Dexamethasone 0,5 mg (2018) Tablet Rp 34.00 38164 0
132 Diltiazem 30 mg (2012) Tablet Rp 167.00 0 0
133 Diltiazem 30 mg (2016) Tablet Rp 135.00 730 0
134 Diphenhidramine HCl Inj (2015) Ampul Rp 1,156.00 0 0
135 Diphenhidramine HCl Inj (2017) Ampul Rp 1,354.00 0 0
136 Diphenhidramine HCl Inj (2018) Ampul Rp 1,262.00 28 0
137 Domperidone 10 mg (Vesperum) (2017) Tablet Rp 580.00 2430 0
138 Domperidone 10 mg tab (2012) Tablet Rp 444.00 0 0
139 Domperidone 10 mg tab (2018) Tablet Rp 90.00 0 0
140 Dumin (Parasetamol) 250 mg / 4 mL (2016) Rektal Tube Rp 20,900.00 3 0
141 Efedrin 25 mg (2012) Tablet Rp 22.82 0 0
142 Elastic Medicreb (2012) Rol Rp 7,700.00 18 0
143 Epinefrin Inj (2013) Ampul Rp 1,650.00 0 0
144 Epinefrin Inj (2016) Ampul Rp 2,354.00 32 0
145 Epinefrin Inj (2018) Ampul Rp 1,518.00 0 0
146 Ergotamin tartrate 1,0 mg + Caffein 50 mg (2014) Tablet Rp 149.00 0 0
147 Erythromicyn 500 mg (2012) Kaplet Rp 1,023.00 0 0
148 Etakridin (Rivanol) (2012) Botol 300 mL Rp 1,980.00 0 0
149 Etakridin (Rivanol) (2015) Botol 300 mL Rp 3,328.00 0 0
150 Etakridin (Rivanol) (2015) Botol 300 mL Rp 3,025.45 0 0
151 Etakridin (Rivanol) (2016) Botol 300 mL Rp 3,600.00 43 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

152 Etanol 70% (2013) Botol 1 Liter Rp 30,200.00 0 0

153 Etanol 70% (2014) Botol 100 mL Rp 2,625.00 0 0
154 Etanol 70% (2015) Botol 1 Liter Rp 28,058.00 49 0
155 Etanol 70% (2015) Botol 1 Liter Rp 25,507.27 0 0
156 Ethyl Chlorida (2016) Botol 100 mL Rp 126,500.00 3 0
157 Ethyl Chlorida (2018) Botol 100 mL Rp 220,000.00 0 0
158 FDC Categori Sisipan (2017) Paket Rp 183,988.00 0 0
159 Fitomenadion 10 mg (2015) Tablet Rp 690.00 0 0
160 Fitomenadion 10 mg (2017) Tablet Rp 796.00 110 0
161 Fitomenadion 10 mg/mL (2013) Ampul Rp 1,723.00 0 0
162 Furosemide 40 mg (2012) Tablet Rp 100.00 0 0
163 Furosemide 40 mg (2013) Tablet Rp 89.63 0 0
164 Furosemide 40 mg (2015) Tablet Rp 84.00 1198 0
165 Furosemide 40 mg (2018) Tablet Rp 82.00 0 600
166 Garam Oralit 200 (2015) Sachet Rp 317.00 0 0
167 Garam Oralit 200 (2017) Sachet Rp 274.00 1629 0
168 Gentian Violet lar 1 % (2013) Botol 5 mL Rp 985.00 0 0
169 Gentian Violet lar 1 % (2015) Botol 5 mL Rp 1,750.00 1045 0
170 Glibenclamide 5 mg (2015) Tablet Rp 61.00 0 0
171 Glibenclamide 5 mg (2018) Tablet Rp 137.00 0 0
172 Glibenclamide 5 mg (Latibet) (2017) Tablet Rp 201.00 1980 0
173 Gliseril Guaiacolas (GG) 100 mg (2012) Tablet Rp 26.00 0 0
174 Gliseril Guaiacolas (GG) 100 mg (2017) Tablet Rp 90.00 2081 0
175 Gliseril Guaiacolas (GG) 100 mg (2018) Tablet Rp 100.00 0 10000
176 Gliserin Larutan (2016) Botol 100 mL Rp 6,600.00 22 0
177 Glucosa 5 % / Dextrose 5% (2014) Botol 500 mL Rp 5,720.00 0 0
178 Glucosa 5 % / Dextrose 5% (2015) Botol 500 mL Rp 5,720.00 312 0
179 Glucosa 5 % / Dextrose 5% (2016) Botol 500 mL Rp 6,900.00 0 0
180 Griseofulvin 125 mg (2013) Tablet Rp 258.00 0 0
181 Griseofulvin 125 mg (2014) Tablet Rp 230.00 70 0
182 Griseofulvin 125 mg (2018) Tablet Rp 223.00 2800 0
183 Griseofulvin 125 mg (Rexavin) (2017) Kaplet Rp 1,298.00 100 0
184 Halloperidol 0,5 mg (2012) Tablet Rp 66.00 0 0
185 Halloperidol 0,5 mg (2013) Tablet Rp 55.70 0 0
186 Halloperidol 1,5 mg (2012) Tablet Rp 91.00 0 0
187 Halloperidol 1,5 mg (2016) Tablet Rp 74.00 0 0
188 Hydrocortisone 2,5 % (2015) Tube Rp 2,938.00 19 0
189 Hydrocortisone 2,5 % (2017) Tube Rp 2,812.00 0 0
190 Hydrocortisone 2,5 % (2018) Tube Rp 2,648.00 266 0
191 Ibuprofen 400 mg (2012) Tablet Rp 226.00 0 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

192 Ibuprofen 400 mg (2013) Tablet Rp 152.50 0 0

193 Ibuprofen 400 mg (2014) Tablet Rp 157.00 0 0
194 Ibuprofen 400 mg (2015) Tablet Rp 157.00 0 0
195 Ibuprofen 400 mg (2017) Tablet Rp 133.00 200 0
196 Ichtyol 15 gram (2015) POT Rp 6,016.66 0 0
197 Ichtyol 15 gram (2016) POT Rp 6,600.00 0 0
198 Infus set Anak (2015) Pcs Rp 4,568.00 0 0
199 Infus set Anak (2015) Pcs Rp 4,152.73 0 0
200 Infus set Dewasa (2015) Pcs Rp 4,176.00 19 0
201 Infus set Dewasa (2015) Pcs Rp 3,796.36 0 0
202 Infus set Dewasa (2017) Pcs Rp 3,896.00 28 0
203 Infus set Dewasa (2018) Pcs Rp 5,856.00 150 0
204 Iodine Test (2016) Botol 10 mL Rp 45,100.00 0 0
205 Isosorbide Dinitrate 5 mg (2014) Tablet Rp 98.00 0 0
206 Isosorbide Dinitrate 5 mg (2018) Tablet Rp 89.00 380 0
207 Kalsium Laktate 500 mg (2015) Tablet Rp 76.00 0 0
208 Kalsium Laktate 500 mg (2016) Tablet Rp 69.00 0 0
209 Kalsium Laktate 500 mg (2017) Tablet Rp 69.00 0 0
210 Kalsium Laktate 500 mg (2018) Tablet Rp 59.00 2770 0
211 Kapas Pembalut 250 gram (2015) Roll Rp 16,313.00 1 0
212 Kapas Pembalut 250 gram (2017) Roll Rp 15,050.00 12 0
213 Kapas Pembalut 250 gram (2018) Roll Rp 14,375.00 50 0
214 Karbamazepine 200 mg (2012) Tablet Rp 271.00 0 0
215 Karbamazepine 200 mg (2013) Tablet Rp 267.00 0 0
216 Karbamazepine 200 mg (2016) Tablet Rp 306.00 0 0
217 Karbamazepine 200 mg (2018) Tablet Rp 234.00 800 0
218 Kasa Hydrofil 3,6 x 5 m (2012) Roll Rp 388.00 0 0
219 Kasa Hydrofil 3,6 x 10 m (2012) Roll Rp 388.00 0 0
220 Kasa Hydrofil 36 x 80 (2013) Roll Rp 60,700.00 93 0
221 Kasa Hydrofil 4 x 3 m (2012) Roll Rp 334.00 0 0
222 Kasa Pembalut 2 x 80 (2016) Roll Rp 8,855.00 142 0
223 Kasa Pembalut 4 x 5 (2015) Roll Rp 979.00 0 0
224 Kasa Pembalut 4 x 5 (2017) Roll Rp 810.00 35 0
225 Kasa Penyerap (Envidress) (2016) Lembar Rp 162,800.00 0 0
226 Kasa Steril 10 x 10 cm (2018) Pack Rp 5,955.06 25 0
227 Kasa Steril 16 x 16 cm (2018) Kotak Rp 8,729.50 339 200
228 Kasa Steril 16/16 (2012) Kotak Rp 9,350.00 0 0
229 Kasa Steril 16/16 (2013) Kotak Rp 9,350.00 0 0
230 Kasa Steril 16/16 (2017) Kotak Rp 8,740.00 0 0
231 Kasa Steril 5 x 5 cm (2018) Pack Rp 3,325.80 190 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

232 Kasa Steril 7,5 x 7,5 cm (2018) Pack Rp 3,615.05 100 0

233 Ketoconazole 2 % (2013) Tube Rp 4,253.00 0 0
234 Ketoconazole 2 % (2014) Tube Rp 2,697.00 0 0
235 Ketoconazole 2 % (2015) Tube Rp 2,697.00 0 0
236 Ketoconazole 2 % (2018) Tube Rp 2,694.00 354 0
237 Ketoconazole 200 mg (2013) Tablet Rp 267.00 0 0
238 Ketoconazole 200 mg (2015) Tablet Rp 320.00 0 0
239 Ketoconazole 200 mg (2018) Tablet Rp 286.00 1130 0
240 Ketoconazole 200 mg (Picamic) (2017) Tablet Rp 1,914.00 0 0
241 Kloramfenikol (Bufacetin) Salep Kulit (2017) Tube Rp 3,409.00 12 0
242 Kloramfenikol (Bufacetin) Salep Kulit (2018) Tube Rp 3,360.00 276 0
243 Kloramfenikol (Erlamycetin) Tetes Telinga (2017) Botol 10 mL Rp 7,000.00 13 0
244 Kloramfenikol 0,1% Salep Mata (2014) Tube Rp 1,680.00 0 0
245 Kloramfenikol 0,1% Salep Mata (2015) Tube Rp 1,680.00 0 0
246 Kloramfenikol 0,1% Salep Mata (2016) Tube Rp 1,850.00 24 0
247 Kloramfenikol 1% Salep Mata (2017) Tube Rp 1,850.00 46 0
248 Kloramfenikol 1% Salep Mata (2018) Tube Rp 2,013.00 200 288
249 Kloramfenikol 250 mg (2012) Kapsul Rp 293.00 0 0
250 Kloramfenikol sirup (2013) Botol 60 mL Rp 4,016.00 0 0
251 klorfeniramin maleat (CTM) 4 mg (2018) Tablet Rp 24.00 42030 0
252 Klorfeniramin Maleat / CTM 4 mg (Alermax) (2017) Tablet Rp 178.00 0 0
253 Klorpromazin HCl 100 mg (2016) Tablet Rp 179.00 0 0
254 Klorpromazin HCl 100 mg (2017) Tablet Rp 179.00 553 0
255 Kotrimoksazole 120 mg (2012) Tablet Rp 83.00 0 0
256 Kotrimoksazole 120 mg (2013) Tablet Rp 79.00 0 0
257 Kotrimoksazole 480 mg (2012) Tablet Rp 182.00 0 0
258 Kotrimoksazole 480 mg (2015) Tablet Rp 152.00 0 0
259 Kotrimoksazole 480 mg (2016) Tablet Rp 158.00 0 0
260 Kotrimoksazole sirup (2017) Botol 60 mL Rp 2,225.00 590 0
261 Kotrimoksazole Suspensi (2018) Botol 60 mL Rp 2,052.00 0 0
262 Lidocain 2% HCl + Epinefrin Inj (2017) Ampul Rp 2,122.00 0 0
263 Lidocain Compositum (2013) Ampul Rp 1,485.00 0 0
264 Lidocain Compositum (2016) Ampul Rp 2,122.00 2511 0
265 Loperamide 2 mg (2013) Tablet Rp 100.00 470 0
266 Loperamide 2 mg (2014) Tablet Rp 97.00 0 0
267 Loperamide 2 mg (2016) Tablet Rp 90.00 17141 0
268 Loperamide 2 mg (2017) Tablet Rp 90.00 0 0
269 Loratadine 10 mg (2013) Tablet Rp 160.00 0 0
270 Magnesium Sulphate (MgSO4) 20% (2016) Kolf Rp 3,200.00 0 0
271 Magnesium Sulphate (MgSO4) 40% (2016) Kolf Rp 3,650.00 0 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

272 Masker (2012) Pcs Rp 1,225.00 0 0

273 Masker (2013) Pcs Rp 1,236.50 26 0
274 Masker (2015) Pcs Rp 430.66 1671 0
275 Masker (2016) Pcs Rp 856.52 0 0
276 Masker N95 (2018) Pcs Rp 7,488.80 580 0
277 Mecobalamin (Nufacobal) (2018) Kapsul Rp 1,900.00 0 1700
278 Meloxicam 15 mg (2014) Tablet Rp 1,470.00 0 0
279 Meloxicam 15 mg (2015) Tablet Rp 1,336.00 40 0
280 Meloxicam 15 mg (2016) Tablet Rp 638.00 13228 0
281 Metachlor 4 mg (2015) Tablet Rp 125.00 0 0
282 Metachlor 4 mg (2016) Tablet Rp 275.00 10 0
283 Metformin 500 mg (2012) Tablet Rp 182.00 0 0
284 Metformin 500 mg (2013) Tablet Rp 105.00 0 0
285 Metformin 500 mg (2016) Tablet Rp 119.00 21670 0
286 Metformin 500 mg (2017) Tablet Rp 103.00 0 0
287 Metformin HCl (Diabit) 500 mg (2018) Tablet Rp 462.00 0 0
288 Metformin HCl (Glikos) 500 mg (2018) Kaplet Rp 462.00 0 0
289 Methyl Ergometrin 0,125 mg (2014) Tablet Rp 169.00 0 0
290 Methyl Ergometrin Inj (2016) Ampul Rp 2,684.00 186 0
291 Metoclopramide 10 mg (2012) Tablet Rp 121.00 0 0
292 Metoclopramide 10 mg (2013) Tablet Rp 93.00 0 0
293 Metoclopramide 10 mg (2016) Tablet Rp 100.00 151 0
294 Metronidazole 500 mg (2013) Tablet Rp 174.00 0 0
295 Metronidazole 500 mg (2015) Tablet Rp 169.00 0 0
296 Metronidazole 500 mg (2016) Tablet Rp 140.00 0 0
297 Metronidazole 500 mg (Selesnizol) (2017) Kapsul Rp 750.00 2390 5000
298 Miconazole 2 % (2013) Tube Rp 3,300.00 0 0
299 Miconazole 2 % (2014) Tube Rp 3,150.00 0 0
300 Mulsanol Sirup (2017) Botol 60 mL Rp 8,800.00 0 0
301 Multivitamin Ibu Hamil (Vitalamin) (2018) Kaplet Rp 726.00 2620 0
302 Multivitamin Sirup (Curbion) (2018) Botol 60 mL Rp 12,100.00 511 0
303 Natrium Chlorida (NaCl) 0,9% (2014) Botol 500 mL Rp 5,170.00 0 0
304 Natrium Chlorida (NaCl) 0,9% (2016) Botol 500 mL Rp 6,410.00 29 0
305 Natrium Chlorida (NaCl) 0,9% (2017) Botol 500 mL Rp 6,410.00 95 0
306 Natrium Diklofenak 50 mg (2013) Tablet Rp 206.00 0 0
307 Natrium Diklofenak 50 mg (2017) Tablet Rp 161.00 1446 400
308 Nifedipine 10 mg (2016) Tablet Rp 123.00 1168 0
309 Nifedipine 10 mg (Farmalat) (2018) Tablet Salut Rp 450.00 0 700
310 Novaheksin (2016) Tablet Rp 198.00 40 0
311 OAT FDC Categori I (2017) Paket Rp 413,984.00 0 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

312 Oksitetrasiklin 1 % Salep Mata (2013) Tube Rp 1,680.00 0 0

313 Oksitetrasiklin 1 % Salep Mata (2016) Tube Rp 3,850.00 0 0
314 Oksitetrasiklin 3% Salep Kulit (2013) Tube Rp 1,646.00 0 0
315 Oksitosin Inj (2016) Ampul Rp 1,900.00 846 0
316 Oksitosin Inj (2018) Ampul Rp 1,232.00 0 0
317 Omecal +D (2016) Tablet Rp 429.00 1304 600
318 Omecought Sirup (2014) Botol 60 mL Rp 7,100.00 0 0
319 Omekur (2015) Tablet Rp 280.00 0 0
320 Omekur (2016) Tablet Rp 302.50 1849 0
321 Omeneuron (2014) Tablet Rp 629.00 0 0
322 Omeneuron (2015) Tablet Rp 645.00 0 0
323 Omeneuron (2016) Tablet Rp 704.00 0 0
324 Omeprazole 20 mg (2013) Kapsul Rp 265.00 0 0
325 Omeprazole 20 mg (2014) Kapsul Rp 221.00 0 0
326 Omeprazole 20 mg (2015) Kapsul Rp 221.00 0 0
327 Omeprazole 20 mg (2016) Kapsul Rp 164.00 12094 0
328 Omeretik 20 mg (2015) Kapsul Rp 400.00 80 0
329 Omeretik 20 mg (2016) Kapsul Rp 440.00 6812 0
330 Ondansetron 4 mg/ 2 mL (2018) Ampul Rp 1,198.00 0 150
331 Panvit C (2016) Kaplet Rp 1,100.00 0 0
332 Panviton (2016) Kaplet Rp 1,320.00 309 0
333 Paper Tape (2018) Roll Rp 5,978.00 0 0
334 Paracetamol 500 mg (2012) Pcs Rp 116.00 0 0
335 Paracetamol 500 mg (2015) Pcs Rp 88.00 0 0
336 Paracetamol 500 mg (2016) Pcs Rp 58.00 0 0
337 Paracetamol 500 mg (2017) Pcs Rp 58.00 17227 16800
338 Paracetamol Drops 100 mg/ml (2018) Botol 15 mL Rp 7,646.00 7 0
339 Paracetamol sirup 120 mg (2014) Botol 60 mL Rp 1,535.00 0 0
340 Paracetamol sirup 120 mg (2018) Botol 60 mL Rp 1,160.00 529 0
341 Phenilbutazon 200 mg (2012) Tablet Rp 89.00 0 0
342 Phenobarbital 30 mg (2012) Tablet Rp 48.82 0 0
343 Piroxicam 20 mg (Selmatic) (2017) Kapsul Rp 600.00 0 0
344 Piroxicam 20 mg (Yasiden) (2018) Kapsul Rp 440.00 0 0
345 Plester 5 yard x 2 inci (2012) Roll Rp 23,626.00 0 0
346 Plester 5 yard x 2 inci (2014) Roll Rp 23,250.00 0 0
347 Prednison 5 mg (2012) Tablet Rp 69.00 0 0
348 Prednison 5 mg (2015) Tablet Rp 125.00 0 0
349 Prednison 5 mg (2018) Tablet Rp 74.00 0 0
350 Prednison 5 mg (Ifison) (2017) Tablet Rp 182.00 10629 5000
351 Propranolol 10 mg (2012) Tablet Rp 85.00 0 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

352 Propranolol 10 mg (2016) Tablet Rp 69.00 0 0

353 Propylthiouracyl (PTU) 100 mg (2012) Tablet Rp 330.00 0 0
354 Propylthiouracyl (PTU) 100 mg (2013) Tablet Rp 297.00 0 0
355 Propylthiouracyl (PTU) 100 mg (2015) Tablet Rp 351.00 0 0
356 Propylthiouracyl (PTU) 100 mg (2018) Tablet Rp 605.00 500 0
357 Pseudoephedrine HCl (Devosix) Drops (2017) Botol 15 mL Rp 25,000.00 48 0
358 Pseudoephedrine HCl (Devosix) Drops (2018) Botol 15 mL Rp 24,200.00 0 20
359 Pyrantel pamoat 125 mg (2017) Tablet Rp 318.00 1222 0
360 Pyrantel pamoat 125 mg (2018) Tablet Rp 331.00 0 0
361 Pyridoxin 10 mg (2012) Tablet Rp 19.00 0 0
362 Pyridoxin 10 mg (2016) Tablet Rp 136.00 500 0
363 Pyridoxin 10 mg (2017) Tablet Rp 52.00 43757 0
364 Pytovon 30 mg (2015) Tablet Rp 199.09 0 0
365 Ranitidin 150 mg (2013) Tablet Rp 119.00 0 0
366 Ranitidin 150 mg (2016) Tablet Rp 119.00 0 0
367 Ranitidin 150 mg (2017) Tablet Rp 110.00 100 0
368 Ranitidin 150 mg (2018) Tablet Rp 231.00 28 0
369 Ranitidin 5 mg/2 mL (2013) Ampul Rp 1,157.00 0 0
370 Ranitidine 150 mg (Hufadine) (2018) Kaplet Rp 660.00 10000 0
371 Ringer Lactate (RL) (2014) Botol 1 Liter Rp 8,000.00 0 0
372 Ringer Lactate (RL) (2015) Botol 500 mL Rp 5,720.00 0 0
373 Ringer Lactate (RL) (2016) Botol 500 mL Rp 7,150.00 0 0
374 Ringer Lactate (RL) (2018) Botol 500 mL Rp 7,150.00 136 0
375 Salbutamol 2 mg (2012) Tablet Rp 92.00 0 0
376 Salbutamol 2 mg (2013) Tablet Rp 70.00 0 0
377 Salbutamol 2 mg (2017) Tablet Rp 68.00 5580 0
378 Salbutamol 4 mg (2012) Tablet Rp 107.00 0 0
379 Salbutamol 4 mg (2013) Tablet Rp 89.00 0 0
380 Salbutamol 4 mg (2017) Tablet Rp 88.00 2980 0
381 Salbutamol 4 mg (2018) Tablet Rp 77.00 1400 1000
382 Salep 2-4 (2012) POT Rp 1,352.00 14 0
383 Salep 2-4 (2015) POT Rp 2,200.00 0 0
384 Salep 2-4 (2017) POT Rp 2,797.00 0 0
385 Salisyl Bedak (2014) Kotak Rp 1,350.00 0 0
386 Salisyl Bedak (2015) Kotak Rp 1,350.00 0 0
387 Salisyl Bedak (2017) Kotak Rp 1,066.00 136 100
388 Sarung tangan nonsteril (2012) Pasang Rp - 0 0
389 Sarung tangan nonsteril (2015) Pasang Rp 424.13 0 0
390 Sarung tangan steril 7 (2012) Pasang Rp 4,674.00 0 0
391 Sarung tangan steril 7 (2018) Pasang Rp 9,272.00 0 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

392 Sarung tangan steril 7,5 (2016) Pasang Rp 4,807.00 750 0

393 Sarung tangan steril 8 (2016) Pasang Rp 4,807.00 2012 0
394 Selfero (2017) Kapsul Rp 725.00 590 0
395 Seltiford Kids (2014) Botol 60 mL Rp 9,900.00 0 0
396 Sianocobalamin (vitamin B12) tab (2013) Tablet Rp 14.40 0 0
397 Sianocobalamin (vitamin B12) tab (2015) Tablet Rp 63.00 0 0
398 Silk 2/0 Braided GEA (2018) Pcs Rp 6,250.00 0 0
399 Silk 2/0 Braided Suture (2018) Pcs Rp 6,250.00 0 120
400 Silk 3/0 Braided GEA (2018) Pcs Rp 6,250.00 0 0
401 Silk 3/0 Braided Suture (2018) Pcs Rp 6,250.00 0 144
402 Silk Black No. 2/0 (2015) Pcs Rp 3,987.50 0 0
403 Silk Black No. 3/0 (2012) Pcs Rp 6,983.00 0 0
404 Silk Black No. 3/0 (2015) Pcs Rp 3,987.50 15 0
405 Simvastatin (Selvim) 10 mg (2017) Kaplet Rp 880.00 240 0
406 Simvastatin 10 mg (2014) Tablet Rp 177.00 0 0
407 Simvastatin 10 mg (2016) Tablet Rp 135.00 0 0
408 Simvastatin 10 mg (2018) Tablet Rp 110.00 6720 0
409 Simvastatin 20 mg (2017) Tablet Rp 252.00 4833 0
410 Stesolid 2 mg (2012) Tablet Rp 968.00 0 0
411 Test Strip Blood Glucose (Autocheck) (2018) Botol 25 Strip Rp 154,000.00 0 0
412 Test Strip Total Cholesterol (Autocheck) (2018) Botol 10 Strip Rp 242,000.00 0 0
413 Test Strip Uric Acid (Autocheck) (2018) Botol 25 Strip Rp 143,000.00 0 0
414 Tetrasiklin HCl 250 mg (2012) Kapsul Rp 183.00 0 0
415 Thiamin HCl 50 mg (2018) Tablet Rp 90.00 1890 1400
416 Tilomix (2016) Tablet Rp 1,210.00 0 0
417 Trianta Tablet (2017) Tablet Rp 359.00 0 0
418 Trihexyphenidil (THP) 2 mg (2013) Tablet Rp 44.00 0 0
419 Trihexyphenidil (THP) 2 mg (2017) Tablet Rp 97.00 529 0
420 Ultrafix 5x5 (2016) Rol Rp 22,462.00 31 0
421 Urine Bag (2012) Pcs Rp 4,400.00 0 0
422 Vaksin Rabies (Verorab) inj (2018) Vial-1 Dosis Rp 247,500.00 0 4
423 Vidabion (2016) Kapsul Rp 616.00 500 0
424 Vitacaps (2017) Kapsul Rp 2,000.00 80 0
425 Vitamin A (retinol) biru 100.000 UI (2016) Kapsul Rp 327.00 0 0
426 Vitamin A (retinol) biru 100.000 UI (2017) Kapsul Rp 327.00 0 0
427 Vitamin B Complex (2012) Tablet Rp 24.00 0 0
428 Vitamin B Complex (2015) Tablet Rp 112.00 0 0
429 Vitamin B Complex (2016) Tablet Rp 132.00 0 0
430 Vitamin B Complex (2017) Tablet Rp 49.00 47230 0
431 Yodium Povidon 1 Liter (2017) Botol 1 Liter Rp 105,000.00 2 0
 HARGA SATUAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAAN
(Rp)

432 Yodium Povidon 1 Liter (Betadine) (2018) Botol 1 Liter Rp 156,779.70 33 0

433 Yodium Povidon 300 mL (2014) Botol 300 mL Rp 15,386.00 0 0
434 Yodium Povidon 300 mL (2015) Botol 300 mL Rp 15,386.00 0 0
435 Zinc Dispersible 20 mg (2015) Tablet Rp 521.00 0 0
436 Zinc Dispersible 20 mg (2017) Tablet Rp 592.00 0 0
TOTAL
LEMBAR PERMINTAAN OBAT
O) DAK
BULAN: Januari
TAHUN: 2019

TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
69 5 Rp 24,795.00 64 64 0
0 0 Rp - 0 0 0
100 0 Rp - 100 100 0
0 0 Rp - 0 0 0
25 0 Rp - 25 25 0
58 5 Rp 47,450.00 53 53 0
0 0 Rp - 0 0 0
150 0 Rp - 150 150 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
351 7 Rp 34,713.00 344 344 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
250 0 Rp - 250 250 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
1670 100 Rp 27,200.00 1570 1570 0
60 50 Rp 18,100.00 10 10 0
9650 378 Rp 144,018.00 9272 9272 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

100 0 Rp - 100 100 0

0 0 Rp - 0 0 0
72 0 Rp - 72 72 0
0 0 Rp - 0 0 0
2420 130 Rp 101,790.00 2290 2290 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
2500 0 Rp - 2500 2500 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
8819 660 Rp 62,700.00 8159 8159 0
0 0 Rp - 0 0 0
6 4 Rp 38,400.00 2 2 0
0 0 Rp - 0 0 0
7361 3630 Rp 519,090.00 3731 3731 0
0 0 Rp - 0 0 0
150 0 Rp - 150 150 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
100 0 Rp - 100 100 0
145 45 Rp 59,999.85 100 100 0
18000 0 Rp - 18000 18000 0
0 0 Rp - 0 0 0
16840 1466 Rp 109,950.00 15374 15374 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
45417 7935 Rp 2,213,865.00 37482 37482 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
120 70 Rp 595,000.00 50 50 0
182 82 Rp 340,054.00 100 100 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
533 271 Rp 570,726.00 262 262 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
26226 4499 Rp 287,936.00 21727 21727 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
149 1 Rp 6,050.00 148 148 0
0 0 Rp - 0 0 0
32189 2256 Rp 270,720.00 29933 29933 0
1060 240 Rp 86,400.00 820 820 0
5000 0 Rp - 5000 5000 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
21845 3007 Rp 306,714.00 18838 18838 0
72 0 Rp - 72 72 0
0 0 Rp - 0 0 0
20 0 Rp - 20 20 0
0 0 Rp - 0 0 0
4000 0 Rp - 4000 4000 0
2 0 Rp - 2 2 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
650 142 Rp 475,700.00 508 508 0
270 0 Rp - 270 270 0
0 0 Rp - 0 0 0
690 560 Rp 110,880.00 130 130 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
2830 165 Rp 11,385.00 2665 2665 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
3540 380 Rp 36,860.00 3160 3160 0
0 0 Rp - 0 0 0
417 0 Rp - 417 417 0
0 0 Rp - 0 0 0
226 6 Rp 38,524.98 220 220 0
0 0 Rp - 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

265 7 Rp 44,945.81 258 258 0

510 0 Rp - 510 510 0
0 0 Rp - 0 0 0
250 0 Rp - 250 250 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
719 534 Rp 82,236.00 185 185 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
2392 602 Rp 169,162.00 1790 1790 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
38164 4392 Rp 149,328.00 33772 33772 0
0 0 Rp - 0 0 0
730 0 Rp - 730 730 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
28 5 Rp 6,310.00 23 23 0
2430 510 Rp 295,800.00 1920 1920 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
3 0 Rp - 3 3 0
0 0 Rp - 0 0 0
18 6 Rp 46,200.00 12 12 0
0 0 Rp - 0 0 0
32 0 Rp - 32 32 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
43 43 Rp 154,800.00 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
49 1 Rp 28,058.00 48 48 0
0 0 Rp - 0 0 0
3 0 Rp - 3 3 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
110 70 Rp 55,720.00 40 40 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
1198 100 Rp 8,400.00 1098 1098 0
600 0 Rp - 600 600 0
0 0 Rp - 0 0 0
1629 269 Rp 73,706.00 1360 1360 0
0 0 Rp - 0 0 0
1045 14 Rp 24,500.00 1031 1031 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
1980 20 Rp 4,020.00 1960 1960 0
0 0 Rp - 0 0 0
2081 1081 Rp 97,290.00 1000 1000 0
10000 0 Rp - 10000 10000 0
22 0 Rp - 22 22 0
0 0 Rp - 0 0 0
312 4 Rp 22,880.00 308 308 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
70 70 Rp 16,100.00 0 0 0
2800 456 Rp 101,688.00 2344 2344 0
100 30 Rp 38,940.00 70 70 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
19 10 Rp 29,380.00 9 9 0
0 0 Rp - 0 0 0
266 18 Rp 47,664.00 248 248 0
0 0 Rp - 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
200 40 Rp 5,320.00 160 160 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
19 0 Rp - 19 19 0
0 0 Rp - 0 0 0
28 2 Rp 7,792.00 26 26 0
150 10 Rp 58,560.00 140 140 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
380 30 Rp 2,670.00 350 350 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
2770 620 Rp 36,580.00 2150 2150 0
1 0 Rp - 1 1 0
12 0 Rp - 12 12 0
50 0 Rp - 50 50 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
800 0 Rp - 800 800 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
93 93 Rp 5,645,100.00 0 0 0
0 0 Rp - 0 0 0
142 0 Rp - 142 142 0
0 0 Rp - 0 0 0
35 0 Rp - 35 35 0
0 0 Rp - 0 0 0
25 5 Rp 29,775.30 20 20 0
539 130 Rp 1,134,835.00 409 409 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
190 5 Rp 16,629.00 185 185 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

100 0 Rp - 100 100 0

0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
354 63 Rp 169,722.00 291 291 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
1130 255 Rp 72,930.00 875 875 0
0 0 Rp - 0 0 0
12 0 Rp - 12 12 0
276 12 Rp 40,320.00 264 264 0
13 4 Rp 28,000.00 9 9 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
24 0 Rp - 24 24 0
46 1 Rp 1,850.00 45 45 0
488 51 Rp 102,663.00 437 437 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
42030 6485 Rp 155,640.00 35545 35545 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
553 53 Rp 9,487.00 500 500 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
590 72 Rp 160,200.00 518 518 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
2511 81 Rp 171,882.00 2430 2430 0
470 470 Rp 47,000.00 0 0 0
0 0 Rp - 0 0 0
17141 513 Rp 46,170.00 16628 16628 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

0 0 Rp - 0 0 0
26 0 Rp - 26 26 0
1671 184 Rp 79,241.44 1487 1487 0
0 0 Rp - 0 0 0
580 0 Rp - 580 580 0
1700 0 Rp - 1700 1700 0
0 0 Rp - 0 0 0
40 0 Rp - 40 40 0
13228 2302 Rp 1,468,676.00 10926 10926 0
0 0 Rp - 0 0 0
10 10 Rp 2,750.00 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
21670 611 Rp 72,709.00 21059 21059 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
186 0 Rp - 186 186 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
151 84 Rp 8,400.00 67 67 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
7390 2390 Rp 1,792,500.00 5000 5000 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
2620 370 Rp 268,620.00 2250 2250 0
511 42 Rp 508,200.00 469 469 0
0 0 Rp - 0 0 0
29 0 Rp - 29 29 0
95 5 Rp 32,050.00 90 90 0
0 0 Rp - 0 0 0
1846 226 Rp 36,386.00 1620 1620 0
1168 368 Rp 45,264.00 800 800 0
700 0 Rp - 700 700 0
40 0 Rp - 40 40 0
0 0 Rp - 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
846 120 Rp 228,000.00 726 726 0
0 0 Rp - 0 0 0
1904 1039 Rp 445,731.00 865 865 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
1849 229 Rp 69,272.50 1620 1620 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
12094 905 Rp 148,420.00 11189 11189 0
80 0 Rp - 80 80 0
6812 866 Rp 381,040.00 5946 5946 0
150 0 Rp - 150 150 0
0 0 Rp - 0 0 0
309 50 Rp 66,000.00 259 259 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
34027 4753 Rp 275,674.00 29274 29274 0
7 0 Rp - 7 7 0
0 0 Rp - 0 0 0
529 113 Rp 131,080.00 416 416 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
15629 1075 Rp 195,650.00 14554 14554 0
0 0 Rp - 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
500 0 Rp - 500 500 0
48 7 Rp 175,000.00 41 41 0
20 0 Rp - 20 20 0
1222 7 Rp 2,226.00 1215 1215 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
500 0 Rp - 500 500 0
43757 2457 Rp 127,764.00 41300 41300 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
100 80 Rp 8,800.00 20 20 0
28 28 Rp 6,468.00 0 0 0
0 0 Rp - 0 0 0
10000 820 Rp 541,200.00 9180 9180 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
136 22 Rp 157,300.00 114 114 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
5580 0 Rp - 5580 5580 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
2980 2980 Rp 262,240.00 0 0 0
2400 100 Rp 7,700.00 2300 2300 0
14 0 Rp - 14 14 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
236 80 Rp 85,280.00 156 156 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

750 29 Rp 139,403.00 721 721 0

2012 19 Rp 91,333.00 1993 1993 0
590 275 Rp 199,375.00 315 315 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
120 0 Rp - 120 120 0
0 0 Rp - 0 0 0
144 0 Rp - 144 144 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
15 1 Rp 3,987.50 14 14 0
240 40 Rp 35,200.00 200 200 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
6720 0 Rp - 6720 6720 0
4833 865 Rp 217,980.00 3968 3968 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
3290 1140 Rp 102,600.00 2150 2150 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
529 30 Rp 2,910.00 499 499 0
31 0 Rp - 31 31 0
0 0 Rp - 0 0 0
4 4 Rp 990,000.00 0 0 0
500 0 Rp - 500 500 0
80 10 Rp 20,000.00 70 70 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
47230 7986 Rp 391,314.00 39244 39244 0
2 0 Rp - 2 2 0
 TOTAL HARGA
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KET
PEMAKAIAN (Rp)

33 2 Rp 313,559.40 31 31 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
0 0 Rp - 0 0 0
Rp 26,116,577.78

Kotamobagu, 31 Januari 2019

Mengetahui
Kepala Puskesmas KOTOBANGON

Deyby Ch.D.Soemanta, SKM

Nip. 19731024 199303 2002