BERITA ACARA

PEMERIKSAAN BARANG PERSEDIAAN

Pada hari ini Kamis Tanggal 16 (enam belas) Bulan Januari Tahun dua ribu dua puluh, saya yang
bertanda tangan dibawah ini :

1. Nama : Supriadi
NIP : 197511212000031003
Jabatan : Ketua Tim
2. Nama : Hendri Eka M.
NIP : 197405062008041001
Jabatan : Anggota Tim

3. Nama : Olivia Putri

NIP : 199209012019032002
Jabatan : Anggota Tim

Sesuai dengan Surat Tugas Inspektur Kabupaten Musi Rawas Nomor: 101/09/Inspektorat/04/01/2020
tanggal 10 Januari 2020, telah melakukan pemeriksaaan fisik barang persediaan (Stock Opname) akhir
Tahun Anggaran 2019 yang ada disimpan dalam gudang yang dikuasai oleh :

Nama Lengkap : Lekat, S.Kep.

NIP :-
Jabatan : Penanggungjawab/Gudang Obat Puskesmas Pian Raya

Berdasarkan Keputusan Kepala UPT PuskesmasPian Raya Nomor : 800/059/KPTS/PKM.PR/1/2019

tanggal 08 Januari 2019 yang ditugaskan sebagai Penanggungjawab Gudang Obat pada UPT
Puskesmas Pian Raya Kabupaten Musi Rawas.

Berdasarkan hasil pemeriksaan fisik barang-barang persediaan serta bukti-bukti/catatan yang berada
dalam pengurusan itu, dengan hasil sebagaimana terlampir sebagai bagian yang tidak terpisah dari Berita
Acara ini.
Muara Beliti, 16 Januari 2020
Yang diperiksa Yang Memeriksa,
Penanggungjawab Gudang Obat
1. Supriadi 1. ………
NIP 197511212000031003

Lekat, S.Kep. 2. Hendri Eka M 2. ……..

NIP 197405062008041001

3. Olivia Putri 3. ……..

NIP 199209012019032002
Mengetahui/Menyetujui
Kepala UPT Puskesmas Pian Raya

dr. Syarifah Nadya Assagaf

Penata
NIP. 198009032014092002
 Contoh Format Lampiran III

Lampiran Berita Acara Pemeriksaan

Barang Persediaan (Stock Opname)
DAFTAR PERSEDIAAN
BARANG PUSKESMAS PIAN RAYA
PER 31 DESEMBER 2019

PEMBELIAN / PENGADAAN PEMAKAIAN / PENGELUARAN

SALDO AWAL PER 1 JANUARI 2019 SALDO AKHIR PER 31 DESEMBER 2019
TAHUN 2019 TAHUN 2019
NO URAIAN JENIS / RINCIAN BARANG PERSEDIAAN KET
JUMLAH HARGA NILAI JUMLAH HARGA NILAI JUMLAH HARGA NILAI JUMLAH HARGA NILAI
BARANG SATUAN (Rp) BARANG SATUAN (Rp) BARANG SATUAN (Rp) BARANG SATUAN (Rp)
1 2 3 4 5 6 7 8 9 10 11
Obat-obatan dan Alkes
I Obat-obatan
1 Alopurinol tab 100mg 1,400 113 158,200 0 113.00 - 1,400 113.00 158,200 0 113.00 -
2 Alpara tab 500 755.33 377,665 3000 755.33 2,265,990 3,500 755.33 2,643,655 0 755.33 -
3 Alprazolam 0,5mg 0 88.00 - 0 88.00 - - 88.00 - 0 88.00 -
4 Ambroxol 30mg 0 213.40 - 2500 213.40 533,500 2,500 213.40 533,500 0 213.40 -
5 Aminofilin tab 200mg 400 92.00 36,800 500 96.00 48,000 400 96.00 38,400 500 96.00 48,000
6 Amitriptiline 0 168.00 - 0 168.00 - - 168.00 - 0 168.00 -
7 Amlodipin tab 5mg 1,500 73.00 109,500 2580 78.00 201,240 3,480 78.00 271,440 600 78.00 46,800
8 Amoksisillin kapl 500mg 5,800 245.00 1,421,000 11000 261.00 2,871,000 14,800 261.00 3,862,800 2,000 261.00 522,000
9 Antasida DOEN tablet, kombinasi : 3,600 56.00 201,600 6000 60.00 360,000 8,200 60.00 492,000 1,400 60.00 84,000
10 Asam asetyl Salisilat 80 mg 0 - - 0 105.00 - - 105.00 - 0 105.00 -
11 Asam Askorbat ( Vit.C ) tab 50mg 1,800 110.00 198,000 2500 110.00 275,000 3,200 110.00 352,000 1,100 110.00 121,000
12 Asam Folat 1 mg 0 - - 0 79.00 - - 79.00 - 0 79.00 -
13 Asam Mefenamat tab 500mg 1,000 102 102,000 3000 288.00 864,000 3,400 288.00 979,200 600 288.00 172,800
14 Asetyl Systein tab 0 357 - 2000 381.00 762,000 600 381.00 228,600 1,400 381.00 533,400
15 Asiclovir tab 200mg 2,400 245.00 588,000 1300 245.00 318,500 2,400 245.00 588,000 1,300 245.00 318,500
16 Asiclovir tab 400mg 2,300 380.00 874,000 1300 380.00 494,000 2,600 380.00 988,000 1,000 380.00 380,000
17 Atapulgit tab 600mg/ Antides 800 145.00 116,000 3500 155.00 542,500 2,900 155.00 449,500 1,400 155.00 217,000
18 Betahistin mesilat tab 6mg 1,470 110 161,700 2600 110.00 286,000 2,370 110.00 260,700 1,700 110.00 187,000

19 Captopril tab 50mg 0 - - 0 - - - 0 0.00 -

20 Captopril 25mg 2,200 77 169,400 3500 94.00 329,000 5,400 94.00 507,600 300 94.00 28,200

21 Carbamazepin 200mg 0 231 - 0 231.00 - - 231.00 - 0 231.00 -

22 Cefadroxil kaps 500mg 1,000 488 488,000 4500 760.00 3,420,000 3,800 760.00 2,888,000 1,700 760.00 1,292,000

23 Cefixime kaps 100mg 0 230 - 0 - - - 0 0.00 -

24 Cetirizine tab 10mg 3,400 94 319,600 7500 101.00 757,500 7,700 101.00 777,700 3,200 101.00 323,200

25 Clobazam 10mg tab 0 1,017 - 0 1,017.00 - - 1,017.00 - 0 1,017.00 -

26 Clozapine 25mg 0 1,121 - 0 1,121.00 - - 1,121.00 - 0 1,121.00 -

27 Cyprofloksasin tab 500mg 5,100 272 1,387,200 2500 272.00 680,000 6,400 272.00 1,740,800 1,200 272.00 326,400

28 Deksametason tab 0,5mg 5,300 43 227,900 6500 43.00 279,500 10,300 43.00 442,900 1,500 43.00 64,500

29 Diazepam tab 2mg 100 45 4,500 100 45.00 4,500 200 45.00 9,000 0 45.00 -

30 Diazepam tab 5mg 0 109 - 100 109.00 10,900 100 109.00 10,900 0 109.00 -
31 Digoksin tab 0.25mg 700 107 74,900 600 107.00 64,200 1,300 107.00 139,100 0 107.00 -
32 Domperidone tab 10mg 2,000 86.00 172,000 3500 86.00 301,000 4,500 86.00 387,000 1,000 86.00 86,000

33 Erythromicin kaps 500mg 200 765.00 153,000 700 785.00 549,500 700 785.00 549,500 200 785.00 157,000

34 Fenitoin Natrium kaps 100mg 0 154.00 - 0 158.00 - - 158.00 - 0 158.00 -

35 Ferro Fumaratkapsul lunak 300mg 0 - - 0 372.00 - - 372.00 - 0 372.00 -
36 Fitomenadion ( Vit.K1 ) tablet salut 10mg 600 747 448,200 1200 797.00 956,400 1,100 797.00 876,700 700 797.00 557,900
37 Furosemide tab 0 0 - 0 82.00 - - 82.00 - 0 82.00 -
38 Glibenklamide 5mg 0 0 - 0 125.00 - - 125.00 - 0 125.00 -
39 Glimepiride tab 3mg 1,100 245.00 269,500 1500 245.00 367,500 2,000 245.00 490,000 600 245.00 147,000
40 Grisiofulvin tablet 125 mg, micronized 600 230.00 138,000 100 232.00 23,200 700 232.00 162,400 0 232.00 -
41 Haloperidol tab 1,5mg 1,500 59.00 88,500 2500 59.00 147,500 4,000 59.00 236,000 0 59.00 -
42 Haloperidol tab 5mg 00 00 - 00 56.00 - -- 56.00 - 00 56.00 -
43 Hemafort kapsul - - - 0.00 -
44 Hidroklortiazide (HCT) 900 156 140,400 2300 156.00 358,800 2,200 156.00 343,200 1,000 156.00 156,000
45 Hustab P 0 0 - 0 256.67 - - 256.67 - 0 256.67 -
46 Hustap 0 0 - 0 - - - 0 0.00 -
47 Hyosin Butilbromide 500 1465 732,500 500 1,465.00 732,500 1,000 1,465.00 1,465,000 0 1,465.00 -
48 Ibuprofen tab 200mg 1,000 108 108,000 1000 108.00 108,000 2,000 108.00 216,000 0 108.00 -
49 Ibuprofen tab 400mg 0 0 - 2500 608.00 1,520,000 2,100 608.00 1,276,800 400 608.00 243,200
50 Isosorbid Dinitrat tablet sublingual 5mg 200 93 18,600 1700 93.00 158,100 1,300 93.00 120,900 600 93.00 55,800
51 Kalsium Laktat tab 500mg 2,000 59.00 118,000 2500 63.00 157,500 3,900 63.00 245,700 600 63.00 37,800
52 Ketokonazole tab 200mg 2,300 320.00 736,000 2300 320.00 736,000 3,300 320.00 1,056,000 1,300 320.00 416,000
53 Klindamycin 300mg 0 0 - 0 589.00 - - 589.00 - 0 589.00 -
54 Kloramfenicol kaps 500mg 700 1145 801,500 1800 1,222.00 2,199,600 1,700 1,222.00 2,077,400 800 1,222.00 977,600
55 Klorfeniramin maleat (CTM) 4mg 2,400 23 55,200 1900 25.00 47,500 3,400 25.00 85,000 900 25.00 22,500
56 Klorpromazine 100mg 0 0 - 0 155.00 - - 155.00 - 0 155.00 -
57 Kodein tab 10mg 0 0 - 200 525.00 105,000 200 525.00 105,000 0 525.00 -
58 Komb(Pirimetamin 25 mg + Sulfadoxin 500 mg Tab 0 0 - 0 - - - 0 0.00 -
59 Kotrimoksazol tab 480mg 7,700 131 1,008,700 0 133.00 - 7,700 133.00 1,024,100 0 133.00 -
60 Lansoprazole kaps 30mg 100 0 - 600 323.00 193,800 200 323.00 64,600 500 323.00 161,500
61 Lexavit kaplet 0 528 - 1000 - 1,000 - 0 0.00 -
62 Loperamide tab 2mg 400 264 105,600 800 264.00 211,200 1,100 264.00 290,400 100 264.00 26,400
63 Loratadine 10mg 0 0 - 0 125.00 - - 125.00 - 0 125.00 -
64 Meloxicam 7,5 0 0 - 0 825.00 - - 825.00 - 0 825.00 -
65 Metformin 500mg 2,000 99 198,000 2500 106.00 265,000 4,200 106.00 445,200 300 106.00 31,800
66 Methylprednisolon 4mg 0 160 - 0 146.00 - - 146.00 - 0 146.00 -
67 Metilergometrin Maleat tab 700 162 113,400 800 237.00 189,600 1,100 237.00 260,700 400 237.00 94,800
68 Metoklopramide 200 80 16,000 500 80.00 40,000 300 80.00 24,000 400 80.00 32,000
69 Metronidazole tab 500mg 500 394.35 197,175 3000 250.00 750,000 2,300 250.00 575,000 1,200 250.00 300,000
70 Molaneuron tab 0 0 - 500 - 500 - 0 0.00 -
71 Molexflu Kaplet 0 0 - 0 - - - 0 0.00 -
72 Na Diklofenac tab 25mg 1,250 132 165,000 4000 141.00 564,000 3,650 141.00 514,650 1,600 141.00 225,600
73 Nipedipin tab 10mg 0 0 - 0 145.00 - - 145.00 - 0 145.00 -
74 Nistatin tablet vagina 100.000 IU/g 1,200 590.00 708,000 300 630.00 189,000 1,300 630.00 819,000 200 630.00 126,000
75 Nistatin tablet vagina 500.000 IU/g 1,300 830.00 1,079,000 1000 886.00 886,000 1,900 886.00 1,683,400 400 886.00 354,400
76 OAT Kategori Anak 0 377,990.00 - 0 244,144.00 - - 244,144.00 - 0 244,144.00 -
77 OAT Kategori I/III 0 1,259,900.00 - 0 - - - 0 0.00 -
78 OAT Kategori II 0 244,144.00 - 0 - - - 0 0.00 -
79 Omeprazole kaps 30mg 3,330 134.00 446,220 900 134.00 120,600 4,230 134.00 566,820 0 134.00 -
80 Parasetamol tab 500mg 7,200 56 403,200 12500 157.00 1,962,500 16,000 157.00 2,512,000 3,700 157.00 580,900
81 Pehavral 0 0 - 0 990.00 - - 990.00 - 0 990.00 -
82 Pirantel tab 125mg 1,000 302 302,000 500 322.00 161,000 600 322.00 193,200 900 322.00 289,800
83 Piridoksin tab 10mg 700 129 90,300 1500 138.00 207,000 1,300 138.00 179,400 900 138.00 124,200
84 Prednison tab 5mg 2,200 72 158,400 3000 77.00 231,000 4,200 77.00 323,400 1,000 77.00 77,000
85 Propanolol tab 40mg 0 0 - 700 80.00 56,000 600 80.00 48,000 100 80.00 8,000
86 Propiltiourasil tab 100mg 500 292 146,000 700 495.00 346,500 1,000 495.00 495,000 200 495.00 99,000
87 Ranitidin tab 150mg 3,600 242 871,200 2000 214.00 428,000 5,600 214.00 1,198,400 0 214.00 -
88 Risperidone 2mg 0 0 - 0 287.00 - - 287.00 - 0 287.00 -
89 Salbutamol tab 2mg 2,700 63 170,100 4500 67.00 301,500 5,400 67.00 361,800 1,800 67.00 120,600
90 Simvastatin 10mg 2,060 110 226,600 900 117.00 105,300 2,060 117.00 241,020 900 117.00 105,300
91 Spinorolactone tab 25mg 0 0 - 600 195.00 117,000 600 195.00 117,000 0 195.00 -
92 Tiamin HCl/Mononitrat (Vit.B1) tab 50mg 2,000 86 172,000 0 92.00 - 1,000 92.00 92,000 1,000 92.00 92,000
93 Trifluoferazine 0 0 - 0 294.00 - - 294.00 - 0 294.00 -
94 Trihexypenidil 2 mg 0 0 - 0 93.00 - - 93.00 - 0 93.00 -
95 Vitamin B Komplek tablet 4,700 121 568,700 4500 121.00 544,500 7,700 121.00 931,700 1,500 121.00 181,500
96 Na Diklofenac tab 50mg 0 0 - 0 136.00 - - 136.00 - 0 136.00 -
97 Zink tablet 0 0 - 0 551.00 - - 551.00 - 0 551.00 -
98 ergotamin coffein 0 0 - 0 194.00 - - 194.00 - 0 194.00 -
99 Alpara syrup 30 13200 396,000 70 13,200.00 924,000 100 13,200.00 1,320,000 0 13,200.00 -
100 Ambroxol syrup 0 5500 - 80 2,475.00 198,000 80 2,475.00 198,000 0 2,475.00 -
101 Amoksisilin sirup kering 125 mg/5 ml 459 4666 2,141,694 180 4,666.00 839,880 639 4,666.00 2,981,574 0 4,666.00 -
102 Amoksisilin sirup kering 250 mg/5 ml 0 0 - 110 3,670.00 403,700 60 3,670.00 220,200 50 3,670.00 183,500
103 Antacida Doen Suspensi 0 2051 - 120 2,189.00 262,680 85 2,189.00 186,065 35 2,189.00 76,615
104 Cefadroxil syrup 250 mg/ml 20 5255 105,100 60 5,517.00 331,020 80 5,517.00 441,360 0 5,517.00 -
105 Cefixime Syr 100mg/5ml 0 0 - 0 0.00 - - 0.00 - 0 0.00 -
106 Cetirizine Syrup 25 2907 72,675 90 2,973.00 267,570 83 2,973.00 246,759 32 2,973.00 95,136
107 Dextrofen syrup 0 0 - 0 - - - 0 0.00 -
108 Domperidone Syrup 4 2781 11,124 100 2,781.00 278,100 69 2,781.00 191,889 35 2,781.00 97,335
109 Erythromicin Syrup 43 6303 271,029 180 6,303.00 1,134,540 129 6,303.00 813,087 94 6,303.00 592,482
110 Flucetin Syrup 0 0 - 0 - - - 0 0.00 -
111 Garam Oralit untuk 200 ml air 1,700 269 457,300 0 269.00 - 1,700 269.00 457,300 0 269.00 -
112 Ibuprefen suspensi 200mg/5ml 0 0 - 0 - - - 0 0.00 -
113 Klorampenikol 125mg/5ml suspensi 25 4843 121,075 20 5,168.00 103,360 25 5,168.00 129,200 20 5,168.00 103,360
114 Kotrimoksazole suspensi, kombinasi : 230 2364 543,720 0 2,364.00 - 230 2,364.00 543,720 0 2,364.00 -
115 Metronidazole Syrup 0 0 - 80 3,950.00 316,000 30 3,950.00 118,500 50 3,950.00 197,500
116 Obat Batuk Hitam ( OBH ) Syrup 180 5564 1,001,520 288 5,564.00 1,602,432 384 5,564.00 2,136,576 84 5,564.00 467,376
117 Parasetamol Drop 20 6981 139,620 60 6,981.00 418,860 80 6,981.00 558,480 0 6,981.00 -
118 Parasetamol Syrup 120 mg/5 ml 170 1110 188,700 450 1,184.00 532,800 470 1,184.00 556,480 150 1,184.00 177,600
119 Pirantel 125 mg/ml suspensi 27 10100 272,700 0 10,100.00 - 27 10,100.00 272,700 0 10,100.00 -
120 Recovit syrup 11 7810 85,910 100 7,920.00 792,000 93 7,920.00 736,560 18 7,920.00 142,560
121 Vical Syrup 0 0 - 0 - - - 0 0.00 -
122 Zinc (Zirkum) Syrup 20mg/5ml 41 3122 128,002 180 3,322.00 597,960 185 3,322.00 614,570 36 3,322.00 119,592
123 Aminofillin inj 24mg/ml-10ml 29 2998 86,942 270 2,998.00 809,460 244 2,998.00 731,512 55 2,998.00 164,890
124 Aqua pro inj steril, bebas Pirogen 8 6600 52,800 60 2,860.00 171,600 48 2,860.00 137,280 20 2,860.00 57,200
125 Asam Traneksamat inj 100mg/ml 10 1957 19,570 100 2,088.00 208,800 70 2,088.00 146,160 40 2,088.00 83,520
126 Asetyl Systein ( Flumucil) inj 0 0 - 40 13,175.00 527,000 20 13,175.00 263,500 20 13,175.00 263,500
127 Atropin Sulfat inj 0,25mg/ml - 1ml 0 0 - 200 1,694.00 338,800 200 1,694.00 338,800 0 1,694.00 -
128 Benzatin Penisillin inj 0 0 - 30 11,235.00 337,050 30 11,235.00 337,050 0 11,235.00 -
129 Cefotaxim inj 1gr 6 4284 25,704 60 4,571.00 274,260 56 4,571.00 255,976 10 4,571.00 45,710
130 Deksametason inj 5mg/ml - 1ml 100 1605 160,500 1300 1,605.00 2,086,500 1,100 1,605.00 1,765,500 300 1,605.00 481,500
131 Diazepam inj lar 5mg/2,5ml rec 10 13202 132,020 10 13,202.00 132,020 20 13,202.00 264,040 0 13,202.00 -
132 Diazepam injeksi 0 0 - 10 1,822.00 18,220 10 1,822.00 18,220 0 1,822.00 -
133 Difenhidramin HCl inj 10mg/ml-1ml 210 1145 240,450 120 1,145.00 137,400 270 1,145.00 309,150 60 1,145.00 68,700
134 Epinefrin HCl inj 0,1% 100 1408 140,800 100 1,408.00 140,800 200 1,408.00 281,600 0 1,408.00 -
135 Fitomenadion (Vit.K) inj 2mg/ml - 1ml 145 3867 560,715 270 3,867.00 1,044,090 325 3,867.00 1,256,775 90 3,867.00 348,030
136 Furosemide inj 0 1333 - 50 1,333.00 66,650 25 1,333.00 33,325 25 1,333.00 33,325
137 Gentamisin inj 25 3685 92,125 80 3,685.00 294,800 105 3,685.00 386,925 0 3,685.00 -
138 Haloperidol Decanoas 0 0 - 0 101,300.00 - - 101,300.00 - 0 101,300.00 -
139 Hyosin Butilbromide 0 0 - 0 9,768.00 - - 9,768.00 - 0 9,768.00 -
140 Lidocain2% + Efineprin injeksi 0 0 - 0 1,286.00 - - 1,286.00 - 0 1,286.00 -
141 Magnesium Sulfat inj (IV) 40%-25ml 0 3796 - 40 3,796.00 151,840 12 3,796.00 45,552 28 3,796.00 106,288
142 Metilergometrin Maleat inj 200 2750 550,000 100 3,102.00 310,200 300 3,102.00 930,600 0 3,102.00 -
143 Oksitosin inj 60 1199 71,940 400 1,199.00 479,600 460 1,199.00 551,540 0 1,199.00 -
144 Omeprazole injeksi 0 0 - 0 10,670.00 - - 10,670.00 - 0 10,670.00 -
145 Ondansetron inj 4mg/2ml 10 1098 10,980 130 1,153.00 149,890 100 1,153.00 115,300 40 1,153.00 46,120
146 Pehacain inj 90 0 - 450 - 360 - 180 -
147 Ranitidine injeksi 0 0 - 0 1,188.00 - - 1,188.00 - 0 1,188.00 -
148 Serum Anti Bisa Ular Polivalen inj.5ml(ABU I) 0 479960 - 7 512,204.00 3,585,428 7 512,204.00 3,585,428 0 512,204.00 -
149 Serum Anti Tetanus inj.1.500 IU/ampul (ATS) 9 126500 1,138,500 0 - 9 - 0 0.00 -
150 Sianokobalamin (Vit.B12) inj 500mcg/ml-1ml 230 1065 244,950 200 1,136.00 227,200 350 1,136.00 397,600 80 1,136.00 90,880
151 Tetagam human tetanus inj 10 176800 1,768,000 20 188,663.00 3,773,260 30 188,663.00 5,659,890 0 188,663.00 -
152 Vaksin Rabies Verorab 0 0 - 10 216,700.00 2,167,000 10 216,700.00 2,167,000 0 216,700.00 -
153 Glukosa larutan infus 5% steril 80 6900 552,000 120 7,363.00 883,560 148 7,363.00 1,089,724 52 7,363.00 382,876
154 Natrium Klorida larutan infus 0.9% steril 110 6410 705,100 60 6,840.00 410,400 156 6,840.00 1,067,040 14 6,840.00 95,760
155 Ringer Laktat larutan infus steril 70 7150 500,500 80 7,630.00 610,400 110 7,630.00 839,300 40 7,630.00 305,200
156 Wida WI Unicap 1000ml 0 0 - 0 - - - 0 0.00 -
157 Paracetamol infuse 0 0 - 0 12,389.00 - - 12,389.00 - 0 12,389.00 -
158 Acyclovir cream 0 0 - 175 3,300.00 577,500 100 3,300.00 330,000 75 3,300.00 247,500
159 Anti Haemorroid DOEN Kombinasi Supps 30 3325 99,750 40 3,325.00 133,000 70 3,325.00 232,750 0 3,325.00 -
160 Asam Fusidat krim 20mg/gr 0 5997 - 0 - - - 0 0.00 -
161 Betametason krim 0.1% 100 1340 134,000 300 1,340.00 402,000 300 1,340.00 402,000 100 1,340.00 134,000
162 Bisacodil Supp 10mg 0 5900 - 0 5,900.00 - - 5,900.00 - 0 5,900.00 -
163 Bisacodil Supp 5mg 0 6000 - 0 6,000.00 - - 6,000.00 - 0 6,000.00 -
164 Devitalisasi pasta 0 1375000 - 0 - - - 0 0.00 -
165 Etanol Swab Serenity 0 12600 - 0 - - - 0 0.00 -
166 Etanol 70% 4 2575 10,300 0 2,575.00 - 4 2,575.00 10,300 0 2,575.00 -
167 Etil Klorida semprot 3 180000 540,000 2 182,000.00 364,000 4 182,000.00 728,000 1 182,000.00 182,000
168 Fenol Gliserol tetes telinga 10% 64 2590 165,760 48 2,590.00 124,320 88 2,590.00 227,920 24 2,590.00 62,160
169 Gentamisin sulfat tetes mata 0.3% 64 4452 284,928 192 4,452.00 854,784 184 4,452.00 819,168 72 4,452.00 320,544
170 Hidrokortison krim 2.5% 120 2475 297,000 312 2,475.00 772,200 312 2,475.00 772,200 120 2,475.00 297,000
171 Kloramfenikol Salep Kulit 2% 48 3138 150,624 216 3,138.00 677,808 192 3,138.00 602,496 72 3,138.00 225,936
172 Kloramfenikol Salep Mata 1% 105 1881 197,505 168 1,181.00 198,408 225 1,181.00 265,725 48 1,181.00 56,688
173 Lysol/Kresol 50% 0 0 - 0 - - - 0 0.00 -
174 Mikonazol krim 2% 120 3585 430,200 216 3,585.00 774,360 288 3,585.00 1,032,480 48 3,585.00 172,080
175 Salep 2-4 kombinasi 96 2654 254,784 72 2,654.00 191,088 144 2,654.00 382,176 24 2,654.00 63,696
176 Salisyl Bedak 2% 57 2782 158,574 120 2,782.00 333,840 147 2,782.00 408,954 30 2,782.00 83,460
177 Ventolin Nebuler 0 - 5 11,533.40 57,667 5 11,533.40 57,667 0 11,533.40 -
178 Combivent neb 0 - 20 4,550.00 91,000 10 4,550.00 45,500 10 4,550.00 45,500
179 Eugenol cairan 10ml 0 - 0 21,091.00 - - 21,091.00 - 0 21,091.00 -
Jumlah I 107,418 33,854,150 148,951 65,596,035 207,987 83,030,528 48,382 17,269,519
II Alkes
178 Abbocath 20 GEA 0 3,300 - 0 3,300.00 - - 3,300.00 - 0 3,300.00 -
179 Abbocath 22 GEA 0 3,300.00 - 0 3,300.00 - - 3,300.00 - 0 3,300.00 -
180 Abbocath 24GEA 0 3,300.00 - 0 3,300.00 - - 3,300.00 - 0 3,300.00 -
181 Abocath No. 18 G Serenity 0 0.00 - 0 6,000.00 - - 6,000.00 - 0 6,000.00 -
182 Abocath No. 20 G jellco 55 8,700.00 478,500 150 8,700.00 1,305,000 115 8,700.00 1,000,500 90 8,700.00 783,000
183 Abocath No. 20 G Serenity 0 6,000.00 - 0 6,000.00 - - 6,000.00 - 0 6,000.00 -
184 Abocath No. 22 G jelco 70 8,700.00 609,000 200 8,700.00 1,740,000 180 8,700.00 1,566,000 90 8,700.00 783,000
185 Abocath No. 22 G Serenity 0 4,600.00 - 0 4,600.00 - - 4,600.00 - 0 4,600.00 -
186 Abocath No. 24 G Jelco 50 8,700.00 435,000 50 8,700.00 435,000 100 8,700.00 870,000 0 8,700.00 -
187 Abocath No. 24G aximed 0 - - 150 6,000.00 900,000 60 6,000.00 360,000 90 6,000.00 540,000
188 Alat Suntik 1cc Aximed 500 652.51 326,255 500 830.00 415,000 300 830.00 249,000 700 830.00 581,000
189 Alat Suntik 3cc Aximed 0 825 - 0 825.00 - - 825.00 - 0 825.00 -
190 Alat Suntik 5cc Aximed 0 928 - 0 928.00 - - 928.00 - 0 928.00 -
191 Alat Suntik sekali pakai 1ml 1,000 762 762,000 1000 762.00 762,000 1,600 762.00 1,219,200 400 762.00 304,800
192 Alat Suntik sekali pakai 3ml 1,000 802.00 802,000 3800 802.00 3,047,600 3,400 802.00 2,726,800 1400 802.00 1,122,800
193 Alat Suntik sekali pakai 5ml 1,100 903.00 993,300 2000 903.00 1,806,000 1,900 903.00 1,715,700 1200 903.00 1,083,600
194 Auto Disable Syringe (ADS) 0,5ml 0 1,240.00 - 0 1,240.00 - - 1,240.00 - 0 1,240.00 -
195 Auto Disable Syringe (ADS) 5ml 0 - - 0 1,240.00 - - 1,240.00 - 0 1,240.00 -
196 Benecheck plus Cholesterol Test 50's 0 - - 0 230,303.03 - - 230,303.03 - 0 230,303.03 -
197 Benecheck plus Glucose Test 50's 0 231,000 - 0 148,484.85 - - 148,484.85 - 0 148,484.85 -
198 Benecheck plus monitoring system 3 in 1 0 - - 0 182,600.00 - - 182,600.00 - 0 182,600.00 -
199 Benecheck plus Urid Acid 50's 0 126,500 - 0 139,393.94 - - 139,393.94 - 0 139,393.94 -
200 Blood Lancet Twice Serenity 0 173,000 - 0 173,000.00 - - 173,000.00 - 0 173,000.00 -
201 Blood Tranfusi set 0 5,500 - 0 5,500.00 - - 5,500.00 - 0 5,500.00 -
202 Catgut Chromic3/0 HR 26MM 36 32,800 1,180,800 180 33,217.00 5,979,060 216 33,217.00 7,174,872 0 33,217.00 -
203 Catgut Chromic3/0 HR 26MM serenity 0 8,208 - 0 - - - 0 0.00 -
204 Catgut Cromic 2/0 sach Serenity 0 - - 0 6,000.00 - - 6,000.00 - 0 6,000.00 -
205 Catgut Cromic 3/0 HR 30 MM 0 34,300 - 0 34,300.00 - - 34,300.00 - 0 34,300.00 -
206 Catgut Plain 2/0 sach 0 6,000 - 0 34,300.00 - - 34,300.00 - 0 34,300.00 -
207 Catgut Plain 3/0 HR 26MM 36 34,300 1,234,800 120 34,300.00 4,116,000 120 34,300.00 4,116,000 36 34,300.00 1,234,800
208 Hand Scun L 0 - - 200 900.00 180,000 - 900.00 - 200 900.00 180,000
209 Hand Scun 7,5 Serenity 0 2,680.00 - 0 4,558.00 - - 4,558.00 - 0 4,558.00 -
210 Hand Scun XL 0 0.00 - 0 900.00 - - 900.00 - 0 900.00 -
211 Hand scuun 7,5 100 4,558.00 455,800 550 3,430.00 1,886,500 600 3,430.00 2,058,000 50 3,430.00 171,500
212 Infus set anak Serenity 0 3,800 - 0 3,800.00 - - 3,800.00 - 0 3,800.00 -
213 Infusion set anak 49 3,023 148,127 50 3,023.00 151,150 49 3,023.00 148,127 50 3,023.00 151,150
214 Infusion set dewasa 35 2930 102,550 100 2,930.00 293,000 85 2,930.00 249,050 50 2,930.00 146,500
215 Infusion set dewasa Serenity 0 3600 - 0 3,600.00 - - 3,600.00 - 0 3,600.00 -
216 Kapas Pembalut 250gram Onemed 0 12,500.00 - 0 28,530.00 - - 28,530.00 - 0 28,530.00 -
217 Kapas Pembalut 500gram Onemed 0 27,280.00 - 0 27,280.00 - - 27,280.00 - 0 27,280.00 -
218 Kapas Pembalut Hydrophyl 250gram 18 28,530.00 513,540 20 12,500.00 250,000 33 12,500.00 412,500 5 12,500.00 62,500
219 Kasa pembalut 16x16cm 23 5800 133,400 90 5,800.00 522,000 82 5,800.00 475,600 31 5,800.00 179,800
220 Kasa pembalut 16x16cm Onemed 0 8000 - 0 9,167.00 - - 9,167.00 - 0 9,167.00 -
221 Kassa 4 X 10cm 0 2300 - 0 1,708.33 - - 1,708.33 - 0 1,708.33 -
222 Kassa pembalut Hidrofil 4m x 10cm 200 2300 460,000 700 2,300.00 1,610,000 750 2,300.00 1,725,000 150 2,300.00 345,000
223 Masker 350 330 115,500 1700 330.00 561,000 1,200 330.00 396,000 850 330.00 280,500
224 Masker Aximed 0 480 - 0 - - - 0 0.00 -
225 Pembalut elastis Polycrepe 10cm x 4,55m 3 33000 99,000 0 33,000.00 - 3 33,000.00 99,000 0 33,000.00 -
226 Pembalut elastis Polycrepe 15cm x 4,55m 0 41910 - 12 41,910.00 502,920 4 41,910.00 167,640 8 41,910.00 335,280
227 Plester 5 yards x 2 inch/Polifix(hansaplas 2,5) 4 39217 156,868 51 39,217.00 2,000,067 45 39,217.00 1,764,765 10 39,217.00 392,170
228 Plester 5 yards x 2inch paper tape 26 8,150.00 211,900 48 8,150.00 391,200 38 8,150.00 309,700 36 8,150.00 293,400
229 Plester roll 1,25x 5m 0 0.00 - 0 5,789.00 - - 5,789.00 - 0 5,789.00 -
230 Plester roll 2,5x 5m 0 0 - 0 11,334.00 - - 11,334.00 - 0 11,334.00 -
231 Polygyp 10cm x 2,75m 0 21080 - 0 21,080.00 - - 21,080.00 - 0 21,080.00 -
232 Polygyp 15cm x 2,75m 0 27609 - 0 27,609.00 - - 27,609.00 - 0 27,609.00 -
233 Safety Onemed Box 50 15715.35 785,768 25 15,715.35 392,884 75 15,715.35 1,178,651 0 15,715.35 -
234 Selang Catheter no 12 0 9780 - 0 9,780.00 - - 9,780.00 - 0 9,780.00 -
235 Selang Catheter no 18 0 11000 - 0 11,000.00 - - 11,000.00 - 0 11,000.00 -
236 Selang Catheter no 24 0 11300 - 0 11,300.00 - - 11,300.00 - 0 11,300.00 -
237 Selang Catheter No.14 0 18450 - 0 18,450.00 - - 18,450.00 - 0 18,450.00 -
238 Selang Catheter No.14 Serenity 18 9780 176,040 30 - 39 - 9 18,450.00 166,050
239 Selang Catheter No.16 0 18450 - 0 18,450.00 - - 18,450.00 - 0 18,450.00 -
240 Selang Catheter No.16 Serenity 16 9780 156,480 20 - 29 - 7 18,450.00 129,150
241 Silk No.3/0 HR 26 MM 48 19700 945,600 0 20,117.00 - 36 20,117.00 724,212 12 20,117.00 241,404
242 Silk No.3/0 Serenity 48 - 0 - 36 - 12 19,700.00 236,400
243 Urine bag 16 5500 88,000 20 5,500.00 110,000 27 5,500.00 148,500 9 5,500.00 49,500
244 Urine bag Onemed 0 3000 - 0 - - - 0 0.00 -
245 Venflon No 18 0 22000 - 0 22,000.00 - - 22,000.00 - 0 22,000.00 -
246 Venflon No 24 0 22000 - 0 22,000.00 - - 22,000.00 - 0 22,000.00 -
247 Venflon No 26 0 8200 - 0 8,200.00 - - 8,200.00 - 0 8,200.00 -
248 Venflon No 20 0 22000 - 0 22,000.00 - - 22,000.00 - 0 22,000.00 -
249 Venflon No 22 0 22000 - 0 22,000.00 - - 22,000.00 - 0 22,000.00 -
250 Wing Neadle 25G 54 7140 385,560 0 1,400.00 - 54 1,400.00 75,600 0 1,400.00 -
251 Wing Neadle 27G 100 1,400.00 140,000 0 1,400.00 - 100 1,400.00 140,000 0 1,400.00 -
252 Etakridin ( Rivanol ) larutan 0.1% 18 3,000.00 54,000 58 3,000.00 174,000 66 3,000.00 198,000 10 3,000.00 30,000
253 Etanol 70% 1L 5 25,000.00 125,000 35 25,000.00 875,000 33 25,000.00 825,000 7 25,000.00 175,000
254 Lysol/Protektor 3 41,000.00 123,000 0 41,000.00 - 3 41,000.00 123,000 0 41,000.00 -
255 Yodium Povidon larutan 10% 300ml 0 18,000.00 - 10 18,000.00 180,000 1 18,000.00 18,000 9 18,000.00 162,000
256 Yodium Povidon larutan 10% 30ml 0 0.00 - 0 - - - 0 0.00 -
257 Yodium Povidon larutan 10% 60ml 35 3700 129,500 192 4,367.00 838,464 150 4,367.00 655,050 77 4,367.00 336,259
258 Cavit G rf 25G 0 0 - 0 124,965.00 - - 124,965.00 - 0 124,965.00 -
259 Ketac UniversalHM intro kit 0 0 - 0 451,947.00 - 0 451,947.00 - 0 451,947.00 -
260 Pramono Clorofenol Biodinamika 0 0 - 0 69,800.00 - 0 69,800.00 - 0 69,800.00 -
261 PulpX Denpo (Devitec) 0 0 - 0 221,800.00 - 221,800.00 - 0 221,800.00 -
262 Tricresolformalina (TKF) 0 0 - 0 76,800.00 - 0 76,800.00 - 0 76,800.00 -
Jumalh II 5,066 12,327,288 12,061 31,423,845 11,529 32,889,467 5,598 10,496,563
Jumlah (I+II) 112,484 46,181,438 161,012 97,019,880 219,516 115,919,995 53,980 27,766,082

Mengetahui, Penanggung Jawab Gudang Obat

Kepala UPT Puskemas Pian Raya Puskesmas Pian Raya