LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

DINAS KESEHATAN KABUPATEN MUKOMUKO

PUSKESMAS : PONDOK SUGUH BULAN : DESEMBER

KECAMATAN : PONDOK SUGUH TAHUN : 2018
KABUPATEN : MUKO MUKO
PROVINSI : BENGKULU

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KETERANGAN

a b c d e f=d+e g h=f-g i j
1 Acyclovir Krim Tube 25 24 49 25 24
2 Acyclovir tablet 200 mg Tab 1,700 0 1,700 0 1,700
3 Acyclovir tablet 400 mg Tab 950 0 950 250 700
4 Ac Swab Buah 0 500 500 200 300
5 Air untuk injeksi amp 20 ml Ampul 0 0 0 0 0
6 Air untuk injeksi amp 25 ml Ampul
84 120 204 18 186
7 Albendazol susp 200 mg/5 ml Botol 0 0 0 0 0
8 Albendazol tab 400 mg Tab 0 0 0 0 0
9 Alopurinol tab 100 mg Tab 4,400 0 4,400 0 4,400
10 Alopurinol tab 300 mg Tab 300 300 600 300 300
11 Alprazolam tab 1 mg Tab
0 300 300 0 300
12 Ambroxol Hcl Tab 0 0 0 0 0
13 Aminofilin inj 24 mg/ml Ampul 120 0 120 30 90
14 Aminofilin Tab 200 mg Tab 0 0 0 0 0
15 Amitriptilin tab sal 25 mg Tab sal 0 500 500 0 500
16 Amlodipin tab 10 mg Tab 3,030 0 3,030 600 2,430
17 Amlodipin tab 5 mg Tab 600 0 600 600 0
18 Amoksisilin drops 100 mg/ml Botol 0 0 0 0 0
19 Amoksisilin sir forte 250 mg/5 ml Botol 0 0 0 0 0
20 Amoksisilin sir kering 125 mg/5 ml Botol 374 0 374 0 374
21 Amoksisilin tab 250 mg Tab 9,800 0 9,800 8,900 900
22 Amoksisilin tab 500 mg Tab
200 3,000 3,200 1,200 2,000
23 Ampisilin serb inj 250 mg/vial Vial 0 0 0 0 0
Anestetik lokal gigi kombinasi : lidokain hcl 2% + Vial
24 epinefrin 1 : 80.000 inj 2 ml 0 0 0 0 0
25 Antalgin tab 500 mg Tab
0 0 0 0 0
26 Antasida Doen Tab 5,800 0 5,800 800 5,000
27 Antasida 60 mg Sir Botol
35 200 235 35 200
Antibakteri, kombinasi : basitrasin 500 UI/g+ Polimiskin Tube
28 B 10.000 UI/g
0 0 0 0 0
29 Anti Bisa Ular (ABU) Vial
0 0 0 0 0
Antifungi salep, kombinasi : asam benzoat 6%+ asam
30 salisilat 3% Tube
24 0 24 0 24
Antihemoroid, kombinasi: bismut subgalat 150 mg +
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng
31 Botol
oksida 120 mg + sup ad 2 g
0 0 0 0 0
Antimalaria, Kombinasi : Sulfadoksin 500 mg + Tab
32 Pirimetamin 25 mg
0 0 0 0 0
33 Anti Tetanus Serum (ATS) Ampul 0 0 0 0 0
34 Asam asetilsalisilat (asetosal) tab 80 mg Tab
0 0 0 0 0
35 Asam askorbat (vitamin C) tab 250 mg Tab
0 0 0 0 0
36 Asam askorbat (vitamin C) tab 50 mg Tab 5,300 0 5,300 2,000 3,300
37 Asam folat tab 0,4 mg Tab 1,200 1,600 2,800 0 2,800
38 Asam folat tab 1 mg Tab 0 0 0 0 0
39 Asam mefenamat kaps 250 mg Kaps 0 0 0 0 0
40 Asam mefenamat kaps 500 mg Kaps
3,700 0 3,700 500 3,200
41 Asam Pipemidat 400 mg Tab 0 0 0 0 0
42 Asam Traneksamat inj 50 mg/ml Ampul 30 0 30 0 30
43 Atapulgit 600 mg Tab 0 0 0 0 0
44 Atapulgit tablet 650 mg Tab 2,000 0 2,000 0 2,000
45 Atenolol tab 100 mg Tab 0 0 0 0 0
46 Atenolol tab 50 mg Tab 0 0 0 0 0
47 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 0 0 0 0
48 Atropin tab 0,5 mg Tab 0 0 0 0 0
49 Azitromisin syr kering 200 mg/ 5 ml Botol 28 0 28 0 28
50 Betahistin 6 mg Tab 2,000 0 2,000 0 2,000
51 Betametason krim 0,1% Tube 0 0 0 0 0
52 Betametason tts mata 1 mg/ml Botol 0 0 0 0 0
53 Bisakodil sup 10 mg Botol 0 0 0 0 0
54 Bisakodil sup 5 mg Botol 0 0 0 0 0
55 Bisakodil tab sal 5 mg Tab sal 0 0 0 0 0
56 Bisoprolol tab 5 mg Tab 540 0 540 0 540
57 Calcium glukonat inj 100 mg/ml Ampul 0 0 0 0 0
58 Calcium karbonat tab 500 mg Tab
0 0 0 0 0
59 Calcium laktat (kalk) tab 500 mg Tab 0 0 0 0 0
60 Canamisin inj Vial 0 0 0 0 0
61 Captopril tab 12,5 mg Tab 0 2,000 2,000 1,000 1,000
62 Captopril tab 25 mg Tab 0 0 0 0 0
63 Captopril tab 50 mg Tab
0 0 0 0 0
64 Cefadroxil 500 mg Tab 5,000 0 5,000 0 5,000
65 Cetirizin sir 5 mg/5 ml Botol 100 60 160 0 160
66 Cetirizin tab 10 mg Tab 750 0 750 750 0
67 Cefadroksil sir kering 125 mg/5 ml Botol 130 0 130 130
68 Cefotaksim serbuk inj 1000 mg Vial
0 0 0 0 0
69 Cefiksim Kap 100 mg Kap 0 0 0 0 0
70 Cefiksim sir 100 mg/ 5 ml Botol 0 0 0 0 0
71 Ceftriakson Serbuk inj 1000 mg Vial 0 0 0 0 0
72 Clindamicin kaps 150 mg Kaps 0 0 0 0 0
73 Chloramfenikol kaps 250 mg Kaps 1,800 0 1,800 0 1,800
74 Chloramfenikol kaps 500 mg Kaps 0 0 0 0 0
75 Chloramfenikol salep kulit 2% Tube 0 0 0 0 0
76 Chloramfenikol salep mata 1% Tube 48 0 48 0 48
77 Chloramfenikol susp 125 mg/5 ml Botol 100 0 100 0 100
78 Chloramfenikol tetes telinga 3% Botol 0 0 0 0 0
79 Chloramfenikol tts mata 0,5% Botol 6 0 6 6 0
80 Chloramfenikol tts mata 1% Botol 0 0 0 0 0
81 Chlorfenol kamfer mentol (CHKM) Botol 0 0 0 0 0
82 Chlorpromazin inj 25 mg/ml (i.m.) Ampul 0 0 0 0 0
83 Chlorpromazin inj 5 mg/ml (i.m.) Ampul 0 0 0 0 0
84 Chlorpromazin tab sal 100 mg Tab sal
0 300 300 200 100
85 Chlorpromazin tab sal 25 mg Tab sal 0 0 0 0 0
86 Chloramfenamin Maleat 4 mg Tab 1,700 0 1,700 1,700 0
87 Ciprofloxacin 500 mg Tab
1,800 0 1,800 500 1,300
88 Ciprofloxacin Infus 200 mg Fls 0 0 0 0 0
89 Ciprofloksasin tetes mata 3 mg/ml Botol
0 0 0 0 0
90 Clopidogril Tab
0 0 0 0 0
91 Clobazam 10 mg Tab
0 0 0 0 0
92 Codein tab 10 mg Tab
1,900 0 1,900 0 1,900
Cotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 Tab
93 mg+ trimetoprim 80 mg
2,900 0 2,900 0 2,900
94 Cotrimoksazol DOEN Pediatrik Kombinasi Tab
0 0 0 0 0
95 Cotrimoksazol Sir Botol 700 0 700 0 700
96 Deksametason inj 5 mg/ml (i.v./i.m.) Ampul 150 0 150 5 145
97 Deksametason tab 0,5 mg Tab 8,400 0 8,400 1,000 7,400
98 Desoksimetason 0,25% krim Tube
0 0 0 0 0
99 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul
17 100 117 1 116
100 Diazepam larutan rektal 5mg/2,5 ml (Stesolid) Tube
0 0 0 0 0
101 Diazepam tab 2 mg Tab 0 0 0 0 0
102 Diazepam tab 5 mg Tab 0 100 100 100 0
103 Dietilkarbamazin tab 100 mg Tab
0 0 0 0 0
104 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 180 0 180 90 90
105 Digoksin tab 0,25 mg Tab 400 0 400 0 400
106 Diklofenak Sodium 25 mg Tab 5,750 0 5,750 0 5,750
107 Diklofenak Sodium 50 mg Tab 0 2,800 2,800 0 2,800
108 Dimenhidrat tab 50 mg Tab 0 0 0 0 0
109 Doksisiklin kaps 100 mg Kaps 0 0 0 0 0
110 Domperidon 60 mg sir Botol 0 200 200 0 200
111 Domperidon Tab 2,300 2,000 4,300 0 4,300
112 Dulcolac Susp Tube 50 0 50 0 50
113 Efedrin inj 50 mg / ml Ampul 50 0 50 50 0
114 Ekstrak Belladon tab 10 mg Tab 0 0 0 0 0
115 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul 158 0 158 0 158
116 Ergotamin tab 1 mg Tab 0 0 0 0 0
117 Eritromisin kaps 250 mg Kaps 0 0 0 0 0
118 Eritromisin sir 60 mg Botol 75 0 75 0 75
119 Eritromisin tab 500 mg Tab
1,500 2,500 4,000 200 3,800
120 Eugenol Botol 5 0 5 0 5
121 Fenobarbital inj 50 mg Ampul 0 90 90 0 90
122 Fenobarbital tab 30 mg Tab
0 100 100 0 100
123 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab 0 0 0 0 0
124 Ferro sulfat sir. 15 mg/5 ml Botol 0 0 0 0 0
125 Ferro sulfat tab salut 300 mg (TTD) Tab sal
0 0 0 0 0
126 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 125 0 125 0 125
127 Furosemid tab 40 mg Tab 600 0 600 0 600
Garam oralit kombinasi : natrium klorida 0,52 g +
128 kalium klorida 0,30 g + trinatrium sitrat 0,58 g + Sachet
glukosa anhidrat 2,7 g
2,800 0 2,800 0 2,800
129 Gentamicin krim 0,3% Tube
24 24 48 24 24
130 Gentamicin inj 40 mg Ampul 0 0 0 0 0
131 Gentamicin Sulfat Tetes Mata 0,3% Botol 36 0 36 0 36
132 Gentian Violet Botol 0 0 0 0 0
133 Glibenclamid tab 5 mg Tab 0 2,000 2,000 1,000 1,000
134 Glimepirid tab 1 mg Tab
0 0 0 0 0
135 Glimepirid tab 2 mg Tab 0 0 0 0 0
136 Glipizid tab 5 mg Tab 0 0 0 0 0
137 Glyserol Obat Luar Botol 50 0 50 0 50
138 Glukosa Larutan Infus 5% steril 100 ml Botol 40 100 140 60 80
139 Glukosa Larutan Infus 10% steril 100 ml Botol 0 0 0 0 0
140 Griseofulvin (micronized) tab 125 mg Tab 800 0 800 0 800
141 Griseofulvin (micronized) tab scored 250 mg Tab 0 0 0 0 0
142 Haloperidol inj 5 mg/ml (i.m.) Vial 107 0 107 1 106
143 Haloperidol tab 0,5 mg Tab 0 0 0 0 0
144 Haloperidol tab 1,5 mg Tab 60 0 60 30 30
145 Haloperidol tab 2 mg Tab 0 0 0 0 0
146 Haloperidol tab 5 mg Tab 930 0 930 10 920
147 Haloperidol tts 2 mg/ml Botol 0 0 0 0 0
148 Hidroklorotiazid tab 25 mg Tab
600 0 600 0 600
149 Hidrokortison krim 2,5% Tube
0 0 0 0 0
150 Hidrokortison serb inj 100 mg/vial Vial
0 0 0 0 0
151 Hiosina butilbromida tab 10 mg Tab
0 0 0 0 0
152 Ibuprofen sir 100 mg/5 ml Botol
115 0 115 0 115
153 Ibuprofen sir 200 mg/5 ml Botol 0 0 0 0 0
154 Ibuprofen tab 200 mg Tab
2,600 0 2,600 500 2,100
155 Ibuprofen tab 200 mg Botol
0 0 0 0 0
156 Ibuprofen tab 400 mg Tab
1,600 0 1,600 0 1,600
157 Irbesartan tab 150 mg Tab
0 0 0 0 0
158 Irbesartan tab 300 mg Tab
0 0 0 0 0
159 Isoniazid tab 100 mg Tab
0 0 0 0 0
160 Isoniazid tab 300 mg Tab
1,000 0 1,000 0 1,000
161 Isosorbid dinitrat tab 5 mg Tab
800 0 800 800 0
162 Kanamisin Inj Ampul
0 40 40 20 20
163 Karbamazepin sir 100 mg/5 ml Botol
0 0 0 0 0
164 Karbamazepin tab 200 mg Tab
0 0 0 0 0
165 Karbogliserin tts telinga 10 % (Phenol Glycerol) Botol
0 0 0 0 0
166 Ketokonazol tab 200 mg Tab
1,000 0 1,000 0 1,000
167 Ketokonazol krim Tube
67 0 67 0 67
168 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab
0 0 0 0 0
169 Kombinasi : ferro sulfat 200 mg+ as. Folat 0,25 mg Tab sal
0 0 0 0 0
170 Laktulosa syr 3,335 g/ 5 ml Botol
0 0 0 0 0
171 Lansoperazol tab 30 mg Tab
0 0 0 0 0
172 Levofloxacin Tab
0 1,000 1,000 0 1,000
173 Lexagin Tab
0 0 0 0 0
174 Lidocain Inj Ampul
3,210 0 3,210 70 3,140
175 Loperamid tab 2 mg Tab
3,200 0 3,200 0 3,200
176 Loratadin tab 10 mg Tab
0 0 0 0 0
177 Lugol Botol
0 0 0 0 0
178 Magnesium sulfat inj 20% Vial
0 120 120 30 90
179 Magnesium sulfat inj 40% Vial
0 120 120 0 120
180 Mebendazol sir 50 mg/ml Botol
0 0 0 0 0
181 Mebendazol tab 100 mg Tan
0 0 0 0 0
182 Mebendazol tab 500 mg (Vermox) Tab
48 0 48 0 48
183 Metformin tab 500 mg Tab
6,300 0 6,300 0 6,300
184 Metformin tab 850 mg Tab
0 0 0 0 0
185 Metilergometrin inj 0,2 mg/ml Ampul
300 0 300 0 300
186 Metilergometrin tab salut 0,125 mg Tab sal
0 0 0 0 0
187 Metilprednisolon tab 4 mg Tab
500 0 500 0 500
188 Metilprednisolon sebuk inj 125 mg Vial
5 0 5 5 0
189 Metoklopramid tab 10 mg Tab
2,200 2,200 0 2,200
190 Metoklopramid 10 mg Inj Ampul
0 50 50 50 0
191 Metoklopramid sir 5 mg/5 ml Botol
0 0 0 0 0
192 Metronidazol lar inf 5 mg/ml Botol
0 0 0 0 0
193 Metronidazol sir 125 mg/5 Ml Botol
36 0 36 0 36
194 Metronidazol tab 250 mg Tab
4,200 0 4,200 100 4,100
195 Metronidazol tab 500 mg Tab
0 0 0 0 0
196 Mikonazol krim 2% Tube
22 0 22 0 22
197 Mineral Mix Tab
0 0 0 0 0
198 NaCl 0,9% Larutan Botol
300 100 400 40 360
199 Natrium Bicarbonat inj 8,4% Botol
0 0 0 0 0
200 Nifedipin kaps 10 mg Kaps
2,200 0 2,200 0 2,200
201 Nistatin susp 100.000 UI/ml Botol
0 0 0 0 0
202 Nistatin tab salut 500.000 UI Tab
1,700 0 1,700 0 1,700
203 Nistatin tab vaginal 100.000 UI Tab
500 0 500 0 500
204 Obat Anti Tuberculosis FDC Kategori Anak Paket
0 4 4 1 3
205 Obat Anti Tuberculosis FDC Kategori II Paket
2 5 7 0 7
206 Obat Anti Tuberculosis Kategori I Paket
0 5 5 1 4
207 Obat Batuk Hitam Botol
0 0 0 0 0
208 Ofloksasin Tablet
0 0 0 0 0
209 Oksitosin inj 10 UI/ml Ampul
258 0 258 20 238
210 Omeprazol kaps 20 mg Kaps
4,650 0 4,650 300 4,350
211 Ondansetron tab 4 mg Tab
0 0 0 0 0
212 Ondansetron inj 2 mg/ml Ampul
50 0 50 50 0
213 Parasetamol sir 120 mg/5 ml Botol
265 0 265 25 240
214 Parasetamol tab 500 mg Tab
0 6,600 6,600 2,100 4,500
215 Parasetamol tts 60 mg/0,6 ml Botol
0 0 0 0 0
216 Phytomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial
60 120 180 0 180
217 Phytomenadion (vitamin K 1) tab sal 10 mg Tab sal
2,200 1,000 3,200 1,200 2,000
218 Phytomenadion (vitamin K1) 10 mg Botol
0 0 0 0 0
219 Pirantel pamoat susp 125 mg/5 ml Botol
69 0 69 0 69
220 Pirantel pamoat tab scored 125 mg Tab
900 0 900 0 900
221 Piridoksin (vitamin B6) inj 100 mg/ml Ampul
0 0 0 0 0
222 Piridoksin (vitamin B6) tab 10 mg Tab
3,200 0 3,200 400 2,800
223 Piridoksin (vitamin B6) Botol
0 0 0 0 0
224 Piroksikam Tab 20 mg Tab
0 0 0 0 0
225 Prednison tab 5 mg Tab
2,500 0 2,500 500 2,000
226 Primakuin tab 15 mg Tab
1,100 0 1,100 0 1,100
227 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) Vial 0 0 0 0 0
228 Propiltiourasil tab 100 mg Tab
0 0 0 0 0
229 Propranolol tab 10 mg Tab
2,300 0 2,300 400 1,900
230 Propranolol tab 40 mg Botol
0 2,000 2,000 2,000 0
231 Ranitidin tab 150 mg Tab
2,600 0 2,600 500 2,100
232 Ranitidin inj Ampul
190 140 330 100 230
233 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak
0 5,000 5,000 0 5,000
234 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak 0 5,000 5,000 0 5,000
235 Rifampisin kaps 300 mg Kaps 0 0 0 0 0
236 Ringer Laktat Larutan Botol 60 500 560 60 500
237 Risperidon tab 1 mg Tab
100 100 200 0 200
238 Risperidon tab 2 mg Tab
20 300 320 0 320
239 Salbutamol sir 2 mg/5 ml Botol
29 98 127 10 117
240 Salbutamol tab 2 mg Tab
3,200 0 3,200 0 3,200
Salbutamol tab 4 mg Tab
241
0 0 0 0 0
242 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang Pot
endap 4 % 137 0 137 24 113
243 Sianokobalamin (vitamin B12) tab 50 mcg Tab
0 0 0 0 0
244 Sianokobalamin (vitamin B12) inj 500 mcg/ml Ampul
0 200 200 100 100
245 Simvastatin tab sal 10 mg Tab sal
750 0 750 0 750
246 Simvastatin tab sal 20 mg Tab sal
2,400 0 2,400 0 2,400
247 Spironolakton tab 25 mg Tab
0 0 0 0 0
248 Streptomicin inj 1000 mg/ml Ampul
0 0 0 0 0
249 Suclarfat Botol
0 0 0 0 0
250 Tablet Tambah Darah Neo Tab
900 0 900 0 900
251 Tablet Tambah Darah Tab
1,430 0 1,430 1,430 0
252 Tetrasiklin kaps 250 mg Kaps
0 0 0 0 0
253 Tetrasiklin kaps 500 mg Kaps
1,400 0 1,400 100 1,300
254 Tiamin (vitamin B1) tab 50 mg Tab
700 0 700 700 0
255 Tramadol Inj 50 mg/1ml Ampul
120 0 120 30 90
256 Triheksifenidil tab 2 mg Tab
380 500 880 40 840
257 Urinter Tab
1,900 0 1,900 500 1,400
258 Urotractin Tab
0 0 0 0 0
259 Valsartan 80 mg Tab
0 0 0 0 0
260 Vitamin B kompleks Botol
5,700 0 5,700 0 5,700
261 Zinc sir 10 mg/ml Botol
0 30 30 0 30
262 Zinc sir 20 mg/60 ml Botol
0 0 0 0 0
263 Zinc tab disp 20 mg Tab
0 3,000 3,000 0 3,000

NON GENERIK
1 Alletron Botol 0 0 0 0 0
2 Alpara sir Botol 0 0 0 0 0
3 Batugin sir Botol 76 0 76 15 61
4 Biovitan sir Botol 80 50 130 10 120
5 Brocon Tab 0 0 0 0 0
6 Calortusin Syr Botol 25 50 75 25 50
7 Corsagrip/Calortusin Tab 0 1,000 1,000 200 800
8 Farizol sir Botol 0 0 0 0 0
9 Neocenta gel Tube - 0 0 0 0
10 Novapiron Tab 0 0 0 0 0
11 Novatusin sir Botol 0 0 0 0 0
12 Novaxicam Tab 300 0 300 300 0
13 Nuvopec Tab Tab 0 0 0 0 0
14 Nuvopec sir Botol 20 45 65 65 0
15 Omegesic Tab 300 1,000 1,300 0 1,300
16 Panviton tab Tab 0 0 0 0 0
17 Plasmodin tab Tab 800 0 800 0 800
18 Pritagesik Tab 0 0 0 0 0
19 Pronalges supp Supp 0 0 0 0 0
20 Remco Baby Cough Botol 8 50 58 58 0
21 Rosidon syr Botol 0 0 0 0 0
22 Stimuno syr Botol 48 48 96 0 96
23 Superhoid supp Supp 204 0 204 6 198
24 Tera F tab Tab 400 0 400 400 0
25 Vagizol Supp 15 0 15 0 15
26 Vitalamin Tab 0 0 0 0 0
27 Wicold tab Tab 0 0 0 0 0

BMHP
1 Alat Suntik sekali pakai 0,5 ml pcs 0 0 0 0 0
2 Alat Suntik sekali pakai 1 ml Set 1,100 0 1,100 0 1,100
3 Alat Suntik sekali pakai 3 ml Set 299 1,000 1,299 299 1,000
4 Alat Suntik sekali pakai 5 ml Set 600 1,000 1,600 100 1,500
5 Betadine Salep Antiseptik 5 gr Botol 0 0 0 0 0
6 Betadine Antiseptik Solution 1000 ml Botol 0 0 0 0 0
7 Bioplacenton Tulle 10 x 10 pcs 0 0 0 0 0
8 Blood Lanset kotak 3 10 13 0 13
9 Catgut plain no.2/0 Sak 0 0 0 0 0
10 Catgut plain no.3/0 Sak 0 0 0 0 0
11 Chromic Catgut 2/0 Pcs 250 0 250 0 250
12 Chromic Catgut 3/0 Pcs 260 0 260 48 212
13 Chatheter Norta 2 Way No 16 Pcs 40 0 40 0 40
14 Chatheter Norta 2 Way No 17 Pcs 90 0 90 0 90
15 Chatheter Norta 2 Way No 20 Pcs 0 0 0 0 0
16 COLOMBIA Leukoplast 2,5 cm x 4,5 cm Rol 0 0 0 0 0
17 Derby Dental DD391 - 15 Scalpel Blade (Bisturi) Box 0 0 0 0 0
18 Descodermp Pcs 0 0 0 0 0
19 Etakrida (Rivanol) larutan 0,1 % Btl 77 0 77 0 77
20 Etanol 70 % 100 ml Btl 141 0 141 5 136
21 Etanol 70 % 300 ml Btl 44 0 44 3 41
22 Etanol 70% 1000 ml Btl 19 0 19 0 19
23 Handscoon Non Steril M Box 0 0 0 0 0
24 Handscoon Non Steril L Box 0 0 0 0 0
25 Handscond 6 pcs 0 0 0 0 0
26 Handscoond 6,5 pcs 0 0 0 0 0
27 Handscoond 7 pcs 0 50 50 0 50
28 Handscoond 7,5 pcs 400 1,000 1,400 100 1,300
29 Hipafix / Fixomul Stretch 10 cm x 5 cm pcs 0 10 10 2 8
30 Human Hexagon Syphilis test 0 0 0 0 0
31 Humansens Plus Cholesterol Test Trips kotak 0 0 0 0 0
32 Humansens Plus Glukose Test Trips kotak 0 0 0 0 0
33 Humansens Plus Uric Acid Test Trips kotak 0 0 0 0 0
34 Infusion set anak Set 438 0 438 0 438
35 Infusion set dewasa Set 200 200 400 100 300
36 IV Chateter /Albocath No.24 Set 0 300 300 50 250
37 IV Chateter /Albocath No.22 Set 0 0 0 0 0
38 IV Chateter /Albocath No.20 Set 80 0 80 30 50
39 IV Chateter /Albocath No.18 Set 0 50 50 0 50
40 Jarum jahit / Silk 3/0 Pcs 35 0 35 0 35
41 Kapas berlemak 500 mg Bks 43 0 43 0 43
42 Kapas pembalut absorben 250 mg Bks 13 3 16 5 11
43 Kasa kompres 40mx 40cm Rol 300 0 300 100 200
44 Kasa pembalut 2 m x 80 cm Rol 19 0 19 5 14
45 Kasa pembalut hirofil 4 m x 3 cm Rol 0 0 0 0 0
46 Kasa pembalut hirofil 4 m x 15 cm Rol 0 0 0 0 0
47 Kasa pembalut hirofil 40 m x 80 cm Rol 13 0 13 3 10
48 kasa gulung 40 yard x 80 cm rol 0 0 0 0 0
49 Kasa Pembalut Elastis rol 0 0 0 0 0
50 Kasa Steril 10 x 10 cm (16 ply) Pack 0 0 0 0 0
51 Kolesterol Test kotak 0 0 0 0 0
52 Lisol Btl 3 10 13 1 12
53 Masker pcs 500 0 500 200 300
54 Merkuri Btl 0 0 0 0 0
55 Nonwoven Fixation 10 cm x 10 m Rol 0 0 0 0 0
56 Nasal Oxygen Canula - Adult Strainghrt pcs 20 0 20 0 20
57 Nasal Oxygen Canula - Child Strainghrt pcs 20 0 20 0 20
58 Needle 24 G Pcs 400 0 400 0 400
59 Paper Tape 12,5 cm x 9,14 m Rol 0 0 0 0 0
60 Plester 5 yard x 2 inchi Rol 0 0 0 0 0
61 Plester 2,5 X 4,5 cm Rol 0 50 50 5 45
62 Pot Sputum pcs 80 0 80 0 80
63 Reagen Ziehl Nielsen Paket 0 0 0 0 0
64 Salisil bedak Ktk 146 0 146 0 146
65 Slides Set 504 0 504 0 504
66 SMI SILK BLACK 3/0 HR 30 MM Sachet 0 0 0 0 0
67 SMI SILK BLACK 2/0 HR 30 MM Sachet 0 0 0 0 0
68 Stamper Unit 0 0 0 0 0
69 Supratul / Cuticell Clasic 10 cm x 10 cm Pcs 290 0 290 0 290
70 Suture Needle 9-14 Pcs 0 0 0 0 0
71 Swab 4- ply Box 0 0 0 0 0
72 Tisue Pcs 0 0 0 0 0
73 Umbilical Cord Klem Steril Nylon Pcs 100 0 100 0 100
74 Underpad Pcs 0 50 50 0 50
75 Urine Bag Pcs 90 0 90 0 90
76 Wing no 22 Pcs 0 0 0 0 0
77 Wings Needle no 23 G Pcs 0 0 0 0 0
 78 Wing Needle No 25 Pcs 0 0 0 0 0
79 Xpert MTB / Cartridge test 0 0 0 0 0
80 Yodium povidon larutan 10 % 30 ml Btl 97 0 97 0 97
81 Yodium povidon larutan 10 % 60 ml Btl 96 0 96 0 96
82 Yodium povidon larutan 10 % 300 ml Btl 23 0 23 0 23
83 Yodium povidon larutan 10 % 1000 ml Btl 34 0 34 0 34

JUMLAH KUNJUNGAN RESEP UMUM BPJS JUMLAH

BAYAR TIDAK BAYAR

Mengetahui Mukomuko,
Kepala Puskesmas Pondok Suguh Pengelola Gudang Obat
Puskesmas Pondok Suguh

dr. Hj. Vipi Sosilawati, MM Neliana, S.Kep NS

NIP. 197012152003122002 NIP. 198202122010012019
 REKAPITULASI PENERIMAAN DAN PENGELUARAN SERTA SISA STOK OBAT
PUSKESMAS PONDOK SUGUH
PER 31 AGUSTUS 2019

PENERIMAAN 2019
PENGELUARAN 2018
SISA STOK PER BUFFER STOCK SISA STOK PER JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA SATUAN PERSEDIAAN 2019
31 DES 2018 UPTD GUDANG JUMLAH HARGA 31 AGUSTUS 2019 (Rp)
LAIN2 JUMLAH
FARMASI (Rp)
JUMLAH
PROV PUSAT JUMLAH HARGA (Rp)
PENGELUARAN

a b c d e f g h i j k=j*d l=e+j m n=m*d o=l-m p=o*d

1 Acyclovir Krim Tube Rp3,619 25 0 0 25 25 90,475 - -
2 Acyclovir tablet 200 mg Tab Rp239 1,700 0 0 1,700 900 215,100 800 191,200
3 Acyclovir tablet 400 mg Tab Rp345 700 1,000 345,000 1,700 800 276,000 900 310,500
4 Air untuk injeksi amp 20 ml Botol - 0 0 0 0 0 - -
5 Air untuk injeksi amp 25 ml Botol Rp2,750 186 360 990,000 546 372 1,023,000 174 478,500
6 Albendazol susp 200 mg/5 ml Botol Rp4,041 - 0 0 0 0 0 - -
7 Albendazol tab 400 mg Tab Rp413 - 2,800 1,156,400 2,800 200 82,600 2,600 1,073,800
8 Alprazolam Tab Rp400 300 200 80,000 500 340 136,000 160 64,000
9 Alopurinol tab 100 mg Tab Rp113 3,800 0 0 3,800 1,900 214,700 1,900 214,700
10 Alopurinol tab 300 mg Tab Rp234 300 990 231,660 1,290 1,170 273,780 120 28,080
11 Ambroxol tab Tab Rp250 - 0 0 0 0 0 - -
12 Aminofilin inj 24 mg/ml Ampul Rp3,349 90 0 0 90 90 301,410 - -
13 Aminofilin Tab 200 mg Tab Rp86 - 0 0 0 0 0 - -
14 Amitriptilin tab sal 25 mg Tab sal Rp117 500 500 58,500 1,000 450 52,650 550 64,350
15 Amlodipin tab 10 mg Tab Rp106 1,830 9,000 954,000 10,830 10,830 1,147,980 - -
16 Amlodipin tab 5 mg Tab Rp105 - 3,900 409,500 3,900 3,900 409,500 - -
17 Amoksisilin drops 100 mg/ml Botol - 0 0 0 0 0 - -
18 Amoksisilin sir forte 250 mg/5 ml Botol Rp4,128 - 0 0 0 0 0 - -
19 Amoksisilin sir kering 125 mg/5 ml Botol Rp1,920 374 0 0 374 374 718,080 - -
20 Amoksisilin tab 250 mg Tab Rp185 9,000 2,000 370,000 11,000 4,900 906,500 6,100 1,128,500
21 Amoksisilin tab 500 mg Tab Rp191 200 12,500 2,387,500 12,700 10,900 2,081,900 1,800 343,800
22 Ampisilin serb inj 250 mg/vial Vial Rp3,075 - 0 0 0 0 0 - -
23 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 Vial Rp2,037 - 0 0 0 0 0 - -
:Antalgin
80.000 inj
tab2500
ml mg Tab -
24 Rp172 1,100 189,200 1,100 600 103,200 500 86,000
25 Antasida, kombinasi : aluminium hidroksida 200 mg + Tab Rp63 5,000 6,000 378,000 11,000 11,000 693,000 - -
magnesium hidroksida
Antasida, kombinasi 200 mg hidroksida 200 mg +
: aluminium Botol 200
26 Rp1,962 300 588,600 500 500 981,000 - -
magnesium kombinasi
Antibakteri, hidroksida :200 mg 500 UI/g+ Polimiskin B
basitrasin Tube -
27 Rp2,767 0 0 0 0 0 - -
10.000
Anti BisaUI/g
Ular (ABU) Vial -
28 Rp462,000 0 0 0 0 0 - -
29 Antifungi salep, kombinasi : asam benzoat 6%+ asam Tube Rp4,366 24 0 0 24 0 0 24 104,784
salisilat 3% kombinasi: bismut subgalat 150 mg +
Antihemoroid, Botol -
30 Rp3,197 0 0 0 0 0 - -
heksaklorofen 2,5 mg(ATS)
Anti Tetanus Serum + lidokain lidokain 10 mg+ seng Ampul -
31 Rp170,000 0 0 0 0 0 - -
oksida 120 mg + sup ad 2 g
32 Asam asetilsalisilat (asetosal) tab 80 mg Tab Rp23 - 0 0 0 0 0 - -
33 Asam askorbat (vitamin C) tab 250 mg Tab Rp125 - 0 0 0 0 0 - -
34 Asam askorbat (vitamin C) tab 50 mg Tab Rp100 3,300 1,500 150,000 4,800 4,800 480,000 - -
35 Asam folat tab 0,4 mg Tab Rp60 2,800 2,000 120,000 4,800 4,200 252,000 600 36,000
36 Asam folat tab 1 mg Tab Rp70 - 0 0 0 0 0 - -
37 Asam mefenamat kaps 250 mg Kaps Rp96 - 0 0 0 0 0 - -
38 Asam mefenamat kaps 500 mg Kaps Rp102 3,200 1,500 153,000 4,700 4,700 479,400 - -
39 Asam Pipemidat 400 mg Tab Rp1,348 - 0 0 0 0 0 - -
40 Asam Traneksamat inj 50 mg/ml Ampul Rp2,045 30 100 204,500 130 40 81,800 90 184,050
41 Atapulgit 600 mg Tab Rp210 2,000 500 105,000 2,500 1,600 336,000 900 189,000
42 Atapulgit tablet 650 mg Tab Rp210 - 0 0 0 0 0 - -
43 Atenolol tab 100 mg Tab Rp792 - 0 0 0 0 0 - -
44 Atenolol tab 50 mg Tab Rp330 - 0 0 0 0 0 - -
45 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul Rp1,540 75 0 0 75 75 115,500 - -
46 Atropin tab 0,5 mg Tab Rp77 - 0 0 0 0 0 - -
47 Azithromisin 500 mg Tab Rp15,110 - 700 10,577,000 700 80 1,208,800 620 9,368,200
48 Azithromisin sirup Botol Rp30,000 28 112 3,360,000 140 140 4,200,000 - -
49 Betahistin 6 mg Tab Rp162 2,000 2,000 324,000 4,000 2,800 453,600 1,200 194,400
50 Betametason krim 0,5 mg/g Tube Rp1,349 - 125 168,625 125 125 168,625 - -
51 Betametason tts mata 1 mg/ml Botol - 0 0 0 0 0 - -
52 Bisakodil sup 10 mg Botol Rp5,800 - 0 0 0 0 0 - -
53 Bisakodil sup 5 mg Botol Rp5,800 - 0 0 0 0 0 - -
54 Bisakodil tab sal 5 mg Tab sal - 0 0 0 0 0 - -
55 Bisoprolol tab 5 mg Tab Rp363 540 0 0 540 60 21,780 480 174,240
56 Deksametason inj 5 mg/ml (i.v./i.m.) Vial Rp1,605 145 140 224,700 285 187 300,135 98 157,290
57 Deksametason tab 0,5 mg Tab Rp43 7,400 5,000 215,000 12,400 8,200 352,600 4,200 180,600
58 Desoksimetason 0,25% krim Tube Rp9,983 - 0 0 0 0 0 - -
59 Diazepam inj 5 mg/ml (i.v./i.m.) Vial Rp4,389 116 100 438,900 216 18 79,002 198 869,022
60 Diazepam larutan rektal 5mg/2,5 ml Ampul Rp12,155 - 0 0 0 0 0 - -
61 Diazepam tab 2 mg Tab Rp43 - 0 0 0 0 0 - -
62 Diazepam tab 5 mg Tab Rp105 - 0 0 0 0 0 - -
63 Dietilkarbamazin tab 100 mg Tab Rp119 - 0 0 0 0 0 - -
64 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul Rp1,114 90 900 1,002,600 990 990 1,102,860 - -
65 Digoksin tab 0,25 mg Tab Rp106 400 5,000 530,000 5,400 0 0 5,400 572,400
66 Dimenhidrinat tab 50 mg Tab Rp104 - 0 0 0 0 0 - -
67 Doksisiklin kaps 100 mg Kaps Rp288 - 0 0 0 0 0 - -
68 Domperidon susp 5 mg/5 ml Botol Rp6,303 200 0 0 200 150 945,450 50 315,150
69 Domperidon tab 10 mg Tab Rp95 4,300 1,000 95,000 5,300 4,000 380,000 1,300 123,500
70 Ekstrak Belladon tab 10 mg Tab Rp30 - 0 0 0 0 0 - -
71 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) Ampul Rp1,749 158 0 0 158 58 101,442 100 174,900
72 Ergotamin tab 1 mg Tab Rp117 - 0 0 0 0 0 - -
73 Eritromisin kaps 250 mg Kaps Rp594 - 0 0 0 0 0 - -
74 Eritromisin sir 200 mg/5 ml Botol Rp6,303 75 0 0 75 75 472,725 - -
75 Eritromisin tab 500 mg Tab Rp751 3,800 5,000 3,755,000 8,800 4,700 3,529,700 4,100 3,079,100
76 Eugenol Botol Rp17,500 5 0 0 5 0 0 5 87,500
77 Fenobarbital inj Ampul Rp2,068 90 60 124,080 150 5 10,340 145 299,860
78 Fenobarbital tab 30 mg Tab Rp145 90 100 14,500 190 190 27,550 - -
79 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab Rp368 - 0 0 0 0 0 - -
80 Ferro sulfat sir. 15 mg/5 ml Botol Rp400 - 0 0 0 0 0 - -
81 Ferro sulfat tab salut 300 mg (TTD) Tab sal Rp360 - 0 0 0 0 0 - -
82 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) Vial Rp3,728 180 150 559,200 330 330 1,230,240 - -
83 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal Rp721 - 5,800 4,181,800 5,800 4,800 3,460,800 1,000 721,000
84 Fitomenadion (vitamin K 1) tab sal 10 mg Botol Rp721 3,200 0 0 3,200 2,500 1,802,500 700 504,700
85 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m) Ampul Rp4,167 - 0 0 0 0 0 - -
86 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul Rp1,920 125 300 576,000 425 425 816,000 - -
87 Furosemid tab 40 mg Tab Rp120 600 200 24,000 800 0 0 800 96,000
88 Garam oralit kombinasi : natrium klorida 0,52 g + kalium Sachet Rp303 2,800 2,000 606,000 4,800 2,900 878,700 1,900 575,700
89 klorida 0,30 krim
Gentamicin g + trinatrium
0,3% sitrat 0,58 g + glukosa anhidrat Tube Rp4,380 24 0 0 24 24 105,120 - -
90 2,7 g
Gentamicin inj 40 mg Ampul Rp3,556 - 300 1,066,800 300 200 711,200 100 355,600
91 Gentamicin Sulfat Tetes Mata 0,3% Botol Rp3,110 - 0 0 0 0 0 - -
92 Gentian Violet Botol Rp606 - 0 0 0 0 0 - -
93 Glibenklamid tab 1 mg Tab Rp58 - 0 0 0 0 0 - -
94 Glibenklamid tab 5 mg Tab Rp58 1,000 5,000 290,000 6,000 3,700 214,600 2,300 133,400
95 Glimepirid tab 1 mg Tab Rp220 - 0 0 0 0 0 - -
96 Glimepirid tab 2 mg Tab Rp290 - 0 0 0 0 0 - -
97 Glipizid tab 5 mg Tab Rp825 - 0 0 0 0 0 - -
98 Glukosa Larutan Infus 5% steril 100 ml Botol Rp6,900 80 500 3,450,000 580 580 4,002,000 - -
99 Glukosa Larutan Infus 10% steril 100 ml Botol Rp6,900 - 0 0 0 0 0 - -
100 Griseofulvin (micronized) tab 125 mg Tab Rp219 800 5,000 1,095,000 5,800 2,300 503,700 3,500 766,500
101 Griseofulvin (micronized) tab scored 250 mg Tab Rp387 - 0 0 0 0 0 - -
102 Gliserol Botol Rp8,000 50 0 0 50 50 400,000 - -
103 Haloperidol inj 5 mg/ml (i.m.) Vial Rp4,000 106 0 0 106 106 424,000 - -
104 Haloperidol tab 0,5 mg Tab Rp58 - 200 11,600 200 200 11,600 - -
105 Haloperidol tab 1,5 mg Tab Rp63 30 0 0 30 30 1,890 - -
106 Haloperidol tab 2 mg Tab Rp94 - 0 0 0 0 0 - -
107 Haloperidol tab 5 mg Tab Rp74 920 0 0 920 920 68,080 - -
108 Haloperidol tts 2 mg/ml Botol Rp18,100 - 0 0 0 0 0 - -
109 Hidroklorotiazid tab 25 mg Tab Rp156 600 2,000 312,000 2,600 0 0 2,600 405,600
110 Hidrokortison krim 2,5% Tube Rp2,650 - 0 0 0 0 0 - -
111 Hidrokortison serb inj 100 mg/vial Vial - 0 0 0 0 0 - -
112 Hiosina butilbromida tab 10 mg Tab - 0 0 0 0 0 - -
113 Ibuprofen sir 100 mg/5 ml Botol Rp2,550 115 200 510,000 315 80 204,000 235 599,250
114 Ibuprofen sir 200 mg/5 ml Botol - 0 0 0 0 0 - -
115 Ibuprofen tab 200 mg Botol Rp105 - 0 0 0 0 0 - -
116 Ibuprofen tab 200 mg Tab Rp105 2,100 4,900 514,500 7,000 4,900 514,500 2,100 220,500
117 Ibuprofen tab 400 mg Tab Rp130 1,600 1,100 143,000 2,700 2,300 299,000 400 52,000
118 Irbesartan tab 150 mg Tab Rp1,496 - 0 0 0 0 0 - -
119 Irbesartan tab 300 mg Tab Rp2,593 - 0 0 0 0 0 - -
120 Isoniazid tab 100 mg Tab Rp75 - 0 0 0 0 0 - -
121 Isoniazid tab 300 mg Tab Rp170 1,000 0 0 1,000 0 0 1,000 170,000
122 Isosorbid dinitrat tab 5 mg Tab Rp93 - 3,000 279,000 3,000 500 46,500 2,500 232,500
123 Kalsium glukonat inj 100 mg/ml Ampul Rp7,800 - 0 0 0 0 0 - -
124 Kalsium karbonat tab 500 mg Tab - 0 0 0 0 0 - -
125 Kalsium laktat (kalk) tab 500 mg Tab Rp57 - 1,000 57,000 1,000 1,000 57,000 - -
126 Kanmisin inj Vial Rp4,900 30 0 0 30 30 147,000 - -
127 Kaptopril tab 12,5 mg Tab Rp63 1,000 400 25,200 1,400 1,400 88,200 - -
128 Kaptopril tab 25 mg Tab Rp89 - 3,000 267,000 3,000 1,900 169,100 1,100 97,900
129 Kaptopril tab 50 mg Tab Rp131 - 0 0 0 0 0 - -
130 Karbamazepin sir 100 mg/5 ml Botol - 0 0 0 0 0 - -
131 Karbamazepin tab 100 mg Tab - 0 0 0 0 0 - -
132 Karbogliserin tts telinga 10 % (Phenol Glycerol) Botol Rp2,500 - 0 0 0 0 0 - -
133 Ketokonazol tab 200 mg Tab Rp288 1,000 0 0 1,000 300 86,400 700 201,600
134 Ketokonazol krim Tube Rp2,599 67 25 64,975 92 92 239,108 - -
135 Klindamisin kaps 150 mg Kaps Rp1,076 - 2,500 2,690,000 2,500 500 538,000 2,000 2,152,000
136 Kloramfenikol kaps 250 mg Kaps Rp262 1,800 0 0 1,800 1,800 471,600 - -
137 Kloramfenikol kaps 500 mg Kaps Rp1,056 - 0 0 0 0 0 - -
138 Kloramfenikol salep kulit 2% Tube Rp3,223 - 0 0 0 0 0 - -
139 Kloramfenikol salep mata 1% Tube Rp1,810 48 96 173,760 144 144 260,640 - -
140 Kloramfenikol susp 125 mg/5 ml Botol Rp4,841 100 200 968,200 300 225 1,089,225 75 363,075
141 Kloramfenikol tetes telinga 3% Botol - 0 0 0 0 0 - -
142 Kloramfenikol tts mata 0,5% Botol Rp3,500 6 16 56,000 22 22 77,000 - -
143 Kloramfenikol tts mata 1% Botol - 0 0 0 0 0 - -
144 Klorfeniramin Maleat (CTM) tab 4 mg Tab Rp37 - 8,400 310,800 8,400 6,700 247,900 1,700 62,900
145 Klorfenol kamfer mentol (CHKM) Botol Rp55,000 - 0 0 0 0 0 - -
146 Klorpromazin inj 25 mg/ml (i.m.) Ampul Rp1,300 - 0 0 0 0 0 - -
147 Klorpromazin inj 5 mg/ml (i.m.) Ampul Rp1,483 - 0 0 0 0 0 - -
148 Klorpromazin tab sal 100 mg Tab sal Rp148 100 500 74,000 600 235 34,780 365 54,020
149 Klorpromazin tab sal 25 mg Tab sal Rp155 - 0 0 0 0 0 - -
150 Kodein tab 10 mg Tab Rp577 1,000 0 0 1,000 0 0 1,000 577,000
151 Kodein tab 10 mg Botol Rp577 - 0 0 0 0 0 - -
152 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tab - 0 0 0 0 0 - -
153 Kombinasi : ferro sulfat 200 mg+ as. Folat 0,25 mg Tab sal - 0 0 0 0 0 - -
154 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 Tab Rp131 - 0 0 0 0 0 - -
155 mg+ trimetoprim
Kotrimoksazol 80 mgPediatrik Kombinasi
DOEN Tab Rp102 2,900 0 0 2,900 2,900 295,800 - -
156 Kotrimoksazol (dewasa) kombinasi tiap 5 ml suspensi : Botol Rp2,222 700 0 0 700 700 1,555,400 - -
157 sulfametoksazol
Lansoperazol tab200 30 mg + trimetoprim 40 mg Tab Rp473 - 0 0 0 0 0 - -
158 Levofloxacin Tab Rp350 1,000 3,000 1,050,000 4,000 400 140,000 3,600 1,260,000
159 Lexagin Tab Rp140 - 0 0 0 0 0 - -
160 Lidocain Ampul Rp10,000 2,140 0 0 2,140 890 8,900,000 1,250 12,500,000
161 Loperamid tab 2 mg Tab Rp82 3,200 3,000 246,000 6,200 1,400 114,800 4,800 393,600
162 Loratadin tab 10 mg Tab Rp139 - 0 0 0 0 0 - -
163 Lugol Botol - 0 0 0 0 0 - -
164 Magnesium sulfat inj 20% Vial Rp3,200 90 60 192,000 150 150 480,000 - -
165 Magnesium sulfat inj 40% Vial Rp3,650 120 60 219,000 180 18 65,700 162 591,300
166 Mebendazol sir 50 mg/ml Botol - 0 0 0 0 0 - -
167 Mebendazol tab 100 mg Tan - 0 0 0 0 0 - -
168 Mebendazol tab 500 mg (Vermox) Tab Rp880 48 0 0 48 0 0 48 42,240
169 Metformin tab 500 mg Tab Rp99 6,300 0 0 6,300 6,300 623,700 - -
170 Metformin tab 850 mg Tab Rp170 - 0 0 0 0 0 - -
171 Metilergometrin inj 0,2 mg/ml Ampul Rp2,992 300 0 0 300 0 0 300 897,600
172 Metilergometrin tab salut 0,125 mg Tab sal Rp162 - 0 0 0 0 0 - -
173 Metilprednisolon tab 4 mg Tab Rp160 500 500 80,000 1,000 1,000 160,000 - -
174 Metoklopramid tab 10 mg Tab Rp98 2,200 1,000 98,000 3,200 1,100 107,800 2,100 205,800
175 Metoklopramid tab 5 mg Tab - 0 0 0 0 0 - -
176 Metoklopramid inj 5 mg/ml Ampul Rp3,565 - 0 0 0 0 0 - -
177 Metoklopramid sir 5 mg/5 ml Botol Rp2,650 - 0 0 0 0 0 - -
178 Metronidazol lar inf 5 mg/ml Botol Rp10,250 - 0 0 0 0 0 - -
179 Metronidazol sir 125 mg/5 Ml Botol Rp3,800 36 50 190,000 86 86 326,800 - -
180 Metronidazol tab 250 mg Tab Rp96 4,100 6,000 576,000 10,100 5,400 518,400 4,700 451,200
181 Metronidazol tab 500 mg Tab Rp114 15 100 11,400 115 115 13,110 - -
182 Mikonazol krim 2% Tube Rp3,410 22 0 0 22 22 75,020 - -
183 NaCl 0,9% Larutan Botol Rp6,410 360 600 3,846,000 960 600 3,846,000 360 2,307,600
184 Natrium Bicarbonat inj Botol Rp6,510 - 0 0 0 0 0 - -
185 Natrium diklofenak tab 25 mg Tab Rp157 5,750 1,000 157,000 6,750 3,350 525,950 3,400 533,800
186 Natrium diklofenak tab 50 mg Tab Rp160 2,800 300 48,000 3,100 2,100 336,000 1,000 160,000
187 Nifedipin kaps 10 mg Kaps Rp110 2,200 0 0 2,200 1,000 110,000 1,200 132,000
188 Nistatin susp 100.000 UI/ml Botol - 0 0 0 0 0 - -
189 Nistatin tab salut 500.000 UI Tab Rp782 1,700 0 0 1,700 1,700 1,329,400 - -
190 Nistatin tab vaginal 100.000 UI Tab Rp549 500 0 0 500 170 93,330 330 181,170
191 Obat Anti Tuberculosis FDC Kategori Anak Paket Rp234,764 3 0 0 3 0 0 3 704,292
192 Obat Anti Tuberculosis FDC Kategori II Paket Rp1,310,380 7 0 0 7 5 6,551,900 2 2,620,760
193 Obat Anti Tuberculosis Kategori I Paket Rp377,986 - 4 1,511,944 4 0 0 4 1,511,944
194 Oksitosin inj 10 UI/ml Ampul Rp1,900 238 200 380,000 438 438 832,200 - -
195 Omeprazol kaps 20 mg Kaps Rp164 43,500 3,000 492,000 46,500 46,500 7,626,000 - -
196 Ondansetron inj Ampul Rp4,500 - 400 1,800,000 400 300 1,350,000 100 450,000
197 Parasetamol sir 120 mg/5 ml Botol Rp1,013 60 150 151,950 210 210 212,730 - -
198 Parasetamol tab 500 mg Tab Rp51 4,500 23,500 1,198,500 28,000 22,200 1,132,200 5,800 295,800
199 Parasetamol tts 60 mg/0,6 ml Botol Rp5,460 - 0 0 0 0 0 - -
200 Pirantel pamoat susp 125 mg/5 ml Botol Rp9,885 900 0 0 900 900 8,896,500 - -
201 Pirantel pamoat tab scored 125 mg Tab Rp288 69 0 0 69 41 11,808 28 8,064
202 Piridoksin (vitamin B6) inj 100 mg/ml Ampul - 0 0 0 0 0 - -
203 Piridoksin (vitamin B6) tab 10 mg Botol Rp124 - 0 0 0 0 0 - -
204 Piridoksin (vitamin B6) tab 10 mg Tab Rp124 - 0 0 0 0 0 - -
205 Piridoksin (vitamin B6) tab 25 mg Tab - 0 0 0 0 0 - -
206 Piroksikam Tab 20 mg Tab Rp130 - 0 0 0 0 0 - -
207 Prednison tab 5 mg Tab Rp82 2,000 1,000 82,000 3,000 3,000 246,000 - -
208 Primakuin tab 15 mg Tab Rp235 1,100 1,000 235,000 2,100 2,100 493,500 - -
209 Prokain benzilpenisilin serb inj 3 juta UI/vial (i.m.) Vial Rp9,046 - 0 0 0 0 0 - -
210 Propiltiourasil tab 100 mg Botol Rp292 - 0 0 0 0 0 - -
211 Propranolol tab 10 mg Tab Rp57 1,900 8,000 456,000 9,900 3,900 222,300 6,000 342,000
212 Propranolol tab 40 mg Tab Rp110 - 0 0 0 0 0 - -
213 Ranitidin tab 150 mg Tab Rp105 2,100 0 0 2,100 2,100 220,500 - -
214 Ranitidin inj Ampul Rp1,532 230 50 76,600 280 280 428,960 - -
215 Retinol (vitamin A) kaps lunak 100.000 UI Kaps lunak Rp298 5,000 4,000 1,192,000 9,000 5,750 1,713,500 3,250 968,500
216 Retinol (vitamin A) kaps lunak 200.000 UI Kaps lunak Rp534 5,000 5,000 2,670,000 10,000 6,600 3,524,400 3,400 1,815,600
217 Rifampisin kaps 300 mg Kaps - 0 0 0 0 0 - -
218 Ringer Laktat Larutan Botol Rp7,150 500 520 3,718,000 1,020 1,020 7,293,000 - -
219 Risperidon tab 1 mg Tab Rp336 200 0 0 200 160 53,760 40 13,440
220 Risperidon tab 2 mg Tab Rp347 320 300 104,100 620 600 208,200 20 6,940
221 Salbutamol sir 2 mg/5 ml Botol Rp4,489 117 49 219,961 166 166 745,174 - -
222 Salbutamol tab 2 mg Tab Rp67 3,200 7,000 469,000 10,200 3,900 261,300 6,300 422,100
223 Salbutamol tab 4 mg Tab Rp95 - 0 0 0 0 0 - -
224 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap Pot Rp2,554 113 228 582,312 341 101 257,954 240 612,960
225 4Setirizin
% sir 5 mg/5 ml. Botol Rp3,200 160 0 0 160 160 512,000 - -
226 Setirizin tab 10 mg Tab Rp96 - 2,000 192,000 2,000 2,000 192,000 - -
227 Sefadroksil tab 500 mg Tab Rp451 5,000 0 0 5,000 3,900 1,758,900 1,100 496,100
228 Sefadroksil tab sir kering 125 mg/5 ml Botol Rp4,100 130 50 205,000 180 180 738,000 - -
229 Sefotaksim serbuk inj 1000 mg Vial Rp5,500 - 520 2,860,000 520 280 1,540,000 240 1,320,000
230 Sefiksim Kap 100 mg Kap Rp626 - 0 0 0 0 0 - -
231 Seftriason inj Ampul Rp5,500 100 520 2,860,000 620 400 2,200,000 220 1,210,000
232 Sianokobalamin (vitamin B12) tab 50 mcg Tab Rp52 - 0 0 0 0 0 - -
233 Sianokobalamin (vitamin B12) 500 mcg inj Ampul Rp1,132 100 300 339,600 400 300 320 100 113,200
234 Simvastatin tab sal 10 mg Tab sal Rp113 750 0 0 750 750 84,750 - -
235 Simvastatin tab sal 20 mg Tab sal Rp252 2,400 0 0 2,400 2,400 604,800 - -
236 Siprofloksasin infus2% Fls Rp15,000 - 0 0 0 0 0 - -
237 Siprofloksasin tab scored 500 mg Tab Rp247 1,300 5,500 1,358,500 6,800 5,300 1,309,100 1,500 370,500
238 Siprofloksasin tetes mata 3 mg/ml Botol - 0 0 0 0 0 - -
239 Spironolakton tab 25 mg Tab Rp304 - 0 0 0 0 0 - -
240 Streptomicin inj 1000 mg/ml Ampul Rp5,250 - 0 0 0 0 0 - -
241 Tablet Tambah Darah Tab Rp350 - 4,320 1,512,000 4,320 4,320 1,512,000 - -
242 Tablet Tambah Darah Neo Tab Rp400 - 15,400 6,160,000 15,400 14,500 5,800,000 900 360,000
243 Tetrasiklin kaps 250 mg Kaps Rp169 - 0 0 0 0 0 - -
244 Tetrasiklin kaps 500 mg Kaps Rp319 1,400 7,000 2,233,000 8,400 700 223,300 7,700 2,456,300
245 Tiamin (vitamin B1) tab 50 mg Tab Rp84 - 1,500 126,000 1,500 1,500 126,000 - -
246 Tramadol Inj 100 mg/ml Ampul Rp2,520 90 300 756,000 390 235 592,200 155 390,600
247 Triheksifenidil tab 2 mg Tab Rp80 840 500 40,000 1,340 980 78,400 360 28,800
248 Urinter Tab Rp700 1,400 0 0 1,400 200 140,000 1,200 840,000
249 Urotractin Tab Rp750 - 0 0 0 0 0 - -
250 Vitamin B kompleks Tab Rp121 5,700 4,900 592,900 10,600 10,600 1,282,600 - -
251 Zinc sir 10 mg/ml Botol Rp6,600 30 43 283,800 73 73 481,800 - -
252 Zinc sir 20 mg/5 ml Botol - 0 0 0 0 0 - -
253 Zinc tab disp 20 mg Tab Rp540 3,000 3,000 1,620,000 6,000 2,000 1,080,000 4,000 2,160,000

NON GENERIK
1 Alpara sir Botol Rp24,000 - 0 0 0 0 0 - -
2 Batugin sir Botol Rp25,000 61 0 0 61 61 1,525,000 - -
3 Biovitan sir Botol Rp8,800 120 50 440,000 170 170 1,496,000 - -
4 Brocon Tab Rp600 - 0 0 0 0 0 - -
5 Calortusin Tab Rp7,500 800 0 0 800 800 6,000,000 - -
6 Calortusin Sir Botol Rp10,000 50 89 890,000 139 139 1,390,000 - -
7 Denicam tab 20 mg Tab Rp148 - 0 0 0 0 0 - -
8 Dulcolac supp Supp Rp3,200 50 0 0 50 28 89,600 22 70,400
9 Farizol sir Botol Rp4,200 - 0 0 0 0 0 - -
10 Melocid tab tab Rp2,000 - 0 0 0 0 0 - -
11 Molaneuron tab Tab Rp400 - 0 0 0 0 0 - -
12 Molapect tab Tab Rp666 - 0 0 0 0 0 - -
13 Neocenta gel Tube Rp15,000 - 0 0 0 0 0 - -
14 Novapiron Tab Rp950 - 0 0 0 0 0 - -
15 Novatusin sir Botol Rp7,500 - 0 0 0 0 0 - -
16 Nuvopec Tab tab Rp150 - 315 47,250 315 315 47,250 - -
17 Nuvopec sir Botol Rp5,000 - 0 0 0 0 0 - -
18 Omegesic Tab Rp7,700 1,300 0 0 1,300 1,100 8,470,000 200 1,540,000
19 Panviton tab Tab Rp500 - 0 0 0 0 0 - -
20 Plasmodin tab Tab Rp2,350 800 0 0 800 800 1,880,000 - -
21 Pritagesik kap Kap Rp518 - 0 0 0 0 0 - -
22 Pronalges supp Supp Rp11,900 - 0 0 0 0 0 - -
23 Remco Cough sir Botol Rp10,000 - 0 0 0 0 0 - -
24 Rosidon syr Botol Rp17,000 200 0 0 200 150 2,550,000 50 850,000
25 Stimuno syr Botol Rp22,000 96 48 1,056,000 144 132 2,904,000 12 264,000
26 Superhoid supp Supp Rp3,300 198 0 0 198 72 237,600 126 415,800
27 Tera-F Tab Rp7,500 - 1,000 7,500,000 1,000 1,000 7,500,000 - -
28 Vitalamin Tab Rp7,500 - 1,700 12,750,000 1,700 1,700 12,750,000 - -
29 Vagizol Supp Rp4,043 15 100 404,300 115 115 464,945 - -
30 Wicold tab Tab Rp720 - 0 0 0 0 0 - -
Mengetahui Mukomuko,
Kepala Puskesmas Pondok Suguh Pengelola Gudang Obat
Puskesmas Pondok Suguh

dr. Vipi Sosilawati, MM Neliana, S.Kep NS

NIP. 197012152003122002 NIP. 198202122010012019
 REKAPITULASI PENERIMAAN DAN PENGELUARAN SERTA SISA STOK BMHP
PUSKESMAS PONDOK SUGUH
PER 31 AGUSTUS 2019

PENERIMAAN 2019
PENGELUARAN 2019
SISA STOK PER BUFFER STOCK SISA STOK PER JUMLAH HARGA
NO NAMA OBAT SATUAN HARGA SATUAN PERSEDIAAN 2019
31 DES 2018 UPTD GUDANG JUMLAH HARGA 31 AGT 2019 (Rp)
LAIN2 JUMLAH
FARMASI (Rp)
JUMLAH
PROV PUSAT JUMLAH HARGA (Rp)
PENGELUARAN

a b c d e f g h i j k=j*d l=e+j m n=m*d o=l-m p=o*d

1 ACCU-CHEK Test Strip Kotak Rp420,000 - 0 0 0 - 0 - -
2 Ac Swab pcs Rp500 300 1,100 550,000 1,400 900 450,000 500 250,000
3 Alat Suntik sekali pakai 0,5 ml pcs Rp1,175 - 0 0 0 - 0 - -
4 Alat Suntik sekali pakai 1 ml Set Rp762 1,100 0 0 1,100 500 381,000 600 457,200
5 Alat Suntik sekali pakai 3 ml Set Rp789 1,000 2,000 1,578,000 3,000 2,900 2,288,100 100 78,900
6 Alat Suntik sekali pakai 5 ml Set Rp839 1,500 1,200 1,006,800 2,700 1,300 1,090,700 1,400 1,174,600
7 Aximed Paper Tape 12,5 cm pcs Rp30,000 - 144 4,320,000 144 26 780,000 118 3,540,000
8 Aximed Non woven Fixation pcs Rp100,000 - 20 2,000,000 20 10 1,000,000 10 1,000,000
9 Bioplacenton Tulle 10 x 10 pcs Rp10,400 - 198 2,059,200 198 150 1,560,000 48 499,200
10 Blood Lanset kotak Rp14,566 1,100 500 7,283,000 1,600 900 13,109,400 700 10,196,200
11 Catgut plain no.2/0 Sak Rp6,583 - 0 0 0 - 0 - -
12 Catgut plain no.3/0 Sak Rp6,583 - 0 0 0 - 0 - -
13 Chromic Catgut 2/0 Pcs Rp8,208 250 60 492,480 310 274 2,248,992 36 295,488
14 Chromic Catgut 3/0 Pcs Rp8,208 212 60 492,480 272 224 1,838,592 48 393,984
15 Chatheter Norta 2 Way No 16 Pcs Rp12,100 40 150 1,815,000 190 10 121,000 180 2,178,000
16 Chatheter Norta 2 Way No 18 Pcs Rp12,100 90 0 0 90 90 1,089,000 - -
17 Chatheter Norta 2 Way No 20 Pcs Rp12,860 - 0 0 0 - 0 - -
18 Descodermp Pcs Rp20,000 - 0 0 0 - 0 - -
19 Etakridina (rivanol) larutan 0,1 % Btl Rp3,000 77 0 0 77 46 138,000 31 93,000
20 Etanol 70 % 100 ml Btl Rp2,575 136 0 0 136 136 350,200 - -
21 Etanol 70 % 300 ml Btl Rp8,000 41 44 352,000 85 17 136,000 68 544,000
22 Etanol 70% 1000 ml Btl Rp21,000 19 6 126,000 25 9 189,000 16 336,000
23 Handscond 6 pcs Rp2,500 - 0 0 0 - 0 - -
24 Handscoond 6,5 pcs Rp7,500 - 0 0 0 - 0 - -
25 Handscoond 7 pcs Rp40,000 - 300 12,000,000 300 300 12,000,000 - -
26 Handscoond 7,5 pcs Rp7,500 - 350 2,625,000 350 350 2,625,000 - -
27 Handscoond Non Steril M pcs Rp7,500 50 1,200 9,000,000 1,250 1,250 9,375,000 - -
28 Handscoond Non Steril L pcs Rp7,500 - 100 750,000 100 100 750,000 - -
29 Hipafix / Fixomul Stretch 10 cm x 5 cm pcs Rp70,903 8 15 1,063,545 23 12 850,836 11 779,933
30 Human Hexagon Syphilis test Rp26,707 - 0 0 0 - 0 - -
31 Humansens Plus Cholesterol Test Trips kotak Rp541,900 - 0 0 0 - 0 - -
32 Humansens Plus Glukose Test Trips kotak Rp249,800 - 0 0 0 - 0 - -
33 Humansens Plus Uric Acid Test Trips kotak Rp548,300 - 0 0 0 - 0 - -
34 Infusion set anak Set Rp3,500 438 0 0 438 150 525,000 288 1,008,000
35 Infusion set dewasa Set Rp3,200 300 250 800,000 550 500 1,600,000 50 160,000
36 IV Chateter /Albocath No.22 Set Rp7,300 - 0 0 0 - 0 - -
37 IV Chateter /Albocath No.24 Set Rp7,300 250 0 0 250 250 1,825,000 - -
38 IV Chateter /Albocath No.20 Set Rp3,800 50 200 760,000 250 250 950,000 - -
39 IV Chateter /Albocath No.18 Set Rp3,800 50 0 0 50 50 190,000 - -
40 Jarum jahit / Silk 3/0 Pcs Rp8,897 35 0 0 35 5 44,485 30 266,910
41 Kapas berlemak 500 mg Bks Rp16,500 43 15 247,500 58 8 132,000 50 825,000
42 Kapas pembalut absorben 250 mg Bks Rp12,500 13 60 750,000 73 15 187,500 58 725,000
43 Kasa kompres 40mx 40cm Rol Rp1,600 200 200 320,000 400 200 320,000 200 320,000
44 Kasa pembalut 2 m x 80 cm Rol Rp7,700 14 0 0 14 8 61,600 6 46,200
45 Kasa pembalut hirofil 4 m x 3 cm Rol Rp59,700 - 0 0 0 - 0 - -
46 Kasa pembalut hirofil 4 m x 15 cm Rol Rp2,100 - 50 105,000 50 10 21,000 40 84,000
47 Kasa pembalut hirofil 40 m x 80 cm Rol Rp105,000 10 19 1,995,000 29 23 2,415,000 6 630,000
48 kasa gulung 40 yard x 80 cm rol Rp105,000 - 0 0 0 - 0 - -
49 Kasa Pembalut Elastis rol Rp17,500 - 0 0 0 - 0 - -
50 Kolesterol Test kotak Rp541,900 - 0 0 0 - 0 - -
51 Lisol Btl Rp41,000 12 5 205,000 17 17 697,000 - -
52 Masker pcs Rp330 300 1,150 379,500 1,450 1,450 478,500 - -
53 Masker N.95 Particulate Respirator pcs Rp10,000 - 120 1,200,000 120 120 1,200,000 - -
54 Merkuri Btl Rp187,000 - 0 0 0 - 0 - -
55 Nasal Oxygen Canula - Adult Strainghrt pcs Rp10,000 20 10 100,000 30 11 110,000 19 190,000
56 Nasal Oxygen Canula - Child Strainghrt pcs Rp10,000 20 10 100,000 30 13 130,000 17 170,000
57 Needle 24 G Pcs Rp330 400 100 33,000 500 500 165,000 - -
58 Plester 5 yard x 2 inchi Rol Rp25,404 - 0 0 0 - 0 - -
59 Plester 2,5 x 4,5 cm Rol Rp17,000 45 180 3,060,000 225 75 1,275,000 150 2,550,000
60 Pot Sputum pcs Rp2,300 80 100 230,000 180 - 0 180 414,000
61 Reagen Ziehl Nielsen Paket Rp277,500 - 0 0 0 - 0 - -
62 Salisil bedak Ktk Rp1,040 146 0 0 146 66 68,640 80 83,200
63 Slides Pcs Rp5,000 504 144 720,000 648 - 0 648 3,240,000
64 Stamper Unit Rp45,000 - 0 0 0 - 0 - -
65 Supratul / Cuticell Clasic 10 cm x 10 cm Pcs Rp5,198 - 0 0 0 - 0 - -
66 Suture Needle ( Jarum Bedah 9-14) Pcs Rp1,000 - 0 0 0 - 0 - -
67 Tissue Ktk Rp5,000 - 0 0 0 - 0 - -
68 Umbilical Cord Klem Steril Nylon Pcs Rp1,300 100 100 130,000 200 100 130,000 100 130,000
69 Underpad Pcs Rp7,800 50 20 156,000 70 20 156,000 50 390,000
70 Urine Bag Pcs Rp4,700 90 20 94,000 110 20 94,000 90 423,000
71 Wing no 22 Pcs Rp8,959 - 0 0 0 - 0 - -
72 Wings Needle no 23 G Pcs Rp500 - 0 0 0 - 0 - -
73 Wing No 24 Pcs Rp8,959 - 0 0 0 - 0 - -
74 Wings Needle 25 Pcs Rp8,959 - 0 0 0 - 0 - -
75 Xpert MTB / Cartridge test Rp190,960 - 0 0 0 - 0 - -
76 Yodium povidon larutan 10 % 30 ml Btl Rp2,900 97 0 0 97 97 281,300 - -
77 Yodium povidon larutan 10 % 60 ml Btl Rp3,700 94 0 0 94 24 88,800 70 259,000
78 Yodium povidon larutan 10 % 300 ml Btl Rp18,000 23 24 432,000 47 47 846,000 - -
79 Yodium povidon larutan 10 % 1000 ml Btl Rp79,650 34 0 0 34 34 2,708,100 - -

Mengetahui Mukomuko,
Kepala Puskesmas Pondok Suguh Pengelola Gudang Obat
Puskesmas Pondok Suguh

dr. Vipi Sosilawati, MM Neliana, S.Kep NS

NIP. 197012152003122002 NIP. 198202122010012019