LPLPO Des

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO) TAHUN 2018

KODE PUSKESMAS :
PUSKESMAS : KARANG INTAN 2
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE : JANUARI TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : FEBRUARI
PROPINSI : KALIMANTAN SELATAN
SISA STOK PEMBERIAN KET

HARGA STOK PENERI PERSEDI PEMAKA STOK PERMINT
NO NAMA OBAT SATUAN KEMASAN
SATUAN AWAL MAAN AAN IAN TOTAL OPT AAN TOTAL
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
1 ALBENDAZOLE 400 MG 30 box @ 30 tablet 323 95 0 95 - 95 30,685
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 59 0 59 2 57 252,282
3 ALOPURINOL TABLET 100 MG 100 box, 10 strip @ 10 tablet 95 - - - - 200

4 ALOPURINOL TABLET 300 MG 100 box, 10 strip @ 10 tablet 244 260 0 260 10 250 61,000
5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 30 Dus 30 ampul @ 10 ml 4,204 - - - -
6 AMITRIPTILIN HCL TABLET SALUT 25 MG 100 Dus, 10 strip @ 10 tss 123 140 0 140 - 140 17,220
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 240 0 240 180 60 9,780 150
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 480 600 1,080 690 390 40,950 450
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 1,400 500 1,900 900 1,000 233,000 500
10 AMOKSISILIN SERBUK INJEKSI 1000 MG 1 10 vial / kotak 8,135 - - - -
11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 Btl @ 60 ml 2,200 55 0 55 5 50 110,000
12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 60 0 60 28 32 67,392
13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 300 500 800 600 200 11,800 800
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 13 0 13 5 8 28,016
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 50 0 50 - 50 67,500
16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - 0 - - - -
17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - 0 - - - -
18 ASAM ASETILSALISILAT 100 MG (ASETOSAL) 100 Tablet 153 90 0 90 - 90 13,770
LPLPO Halaman 1
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 700 0 700 400 300 36,000 500
20 ASAM FOLAT 1 MG 100 Tablet 68 900 0 900 62 838 56,984
21 ASAM MEFENAMAT TABLET 250 MG 100 Tablet 150 - - -
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 800 1,000 1,800 1,200 600 67,800 1,000
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 2 0 2 - 2 5,072
24 ASIKLOVIR 200 MG TABLET 100 ktk 10 x 10 tablet 272 90 0 90 - 90 24,480
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 - - - -
27 ANTIBAKTERI DOEN SALEP KOMBINASI (BASITRACIN) 1 box @ 25 tube 3,365 45 0 45 1 44 148,060
28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 1 box @ 24 tube 4,782 10 0 10 - 10 47,820
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - - 50

30 BETAHISTINE TABLET 30 box @ 30 tablet 170 50 0 50 - 50 8,500
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 15 25 40 24 16 23,200 24

32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 82 0 82 - 82 25,994
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 - 0 - - - -
34 CETRIZINE SIRUP 5 MG/5 ML 1 botol 60 ml 7,756 86 0 86 46 40 310,240 50

35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 600 200 800 300 500 77,000 300
36 CLOZAPINE 25 MG 100 Tablet 1,550 110 0 110 - 110 170,500
37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 37 0 37 4 33 57,354
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 1,000 0 1,000 100 900 43,200
39 DIAZEPAM INJEKSI 5 MG / ML 1 Ampul 4,598 18 0 18 - 18 82,764
Dus, 5 alubag @ 1 tube

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5
@ 2,5 ml
12,751 - - - - 5
41 DIAZEPAM TABLET 2 MG 100 100 tablet/botol 46 76 0 76 43 33 1,518 100
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 1 Ampul @ 1 ml 1,355 88 0 88 88 119,240
43 DIGOKSIN TABLET 0,25 MG 100 box 10 x 10 tablet 103 165 0 165 - 165 16,995
44 DILTIAZEM HCL TABLET 30 MG 100 ktk 10 x 10 tablet 137 150 0 150 - 150 20,550
LPLPO Halaman 2
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 - 0 - - - -
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 36 0 36 18 18 62,820
47 DOMPERIDONE TABLET 10 MG 100 Strip, ktk 10 x 10 tablet 133 110 0 110 50 60 7,980 100
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 - 0 - - - -
49 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 Dus @ 30 ampul 2,354 - 0 - - - - 30

50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 - 0 - - - - 100
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 - 5 5 - 5 35,195
52 FENITOIN NATRIUM KAPSUL 100 MG 100 Botol @ 100 154 - - - -
53 FENOBARBITAL INJEKSI 50 MG/ML-2ML 30 ktk 30 ampul @ 1 ml 1,980 - - - -
54 FENOBARBITAL TABLET 30 MG 100 100 tablet/botol 68 - - - -
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 22 0 22 5 17 69,411
56 FITOMENADION (VIT.K1) TABLET SALUT 10 MG 100 100 tablet/botol 796 100 0 100 - 100 79,600
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 20 0 20 6 14 30,506
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 77 100 177 16 161 44,114
59 GENTAMISIN TETES MATA 0,3% 1 Botol 4,600 53 0 53 9 44 202,400
60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 - - - - 100

61 GLIMEPIRIDE 4MG TABLET 50 box @ 50 tablet 330 - - - -
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 0 20 - 20 138,000
63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 100 ktk 10 x 10 tablet 224 100 0 100 - 100 22,400
64 HALOPERIDOL TABLET 0,5 MG 100 Dus, 10 blister @ 10 tablet 64 - - - -
65 HALOPERIDOL TABLET 1,5 MG 100 Dus, 10 blister @ 10 tablet 76 380 200 580 270 310 23,560 100
66 HALOPERIDOL TABLET 5 MG 100 Dus, 10 blister @ 10 tablet 105 - - -
67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 100 Tablet 171 170 0 170 - 170 29,070
68 HIDROKORTISON KRIM 2,5% 1 Tube 2,868 34 0 34 10 24 68,832
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 10 0 10 10 - - 10

70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 - - - 50
LPLPO Halaman 3
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - 1,000

72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - 1,000
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 120 200 320 100 220 21,560
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 200 500 700 400 300 20,700 200
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 280 0 280 200 80 5,520 200
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 - - - 200
77 KARBAMAZEPIN TABLET 200 MG 100 Dus, 10 strip @ 10 tablet 306 240 0 240 60 180 55,080
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 6 0 6 - 6 15,000
79 KETOKENAZOLE CREAM 2% 1 tube 10 gr 2,605 24 0 24 6 18 46,890
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 280 0 280 - 280 184,800
81 KLORAMFENIKOL KAPSUL 500 MG 100 Kapsul 1,155 110 0 110 - 110 127,050
82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 11 24 35 11 24 39,360
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 - - - 25

84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 13 0 13 6 7 28,000
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 1,100 0 1,100 800 300 13,500 1,000
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 380 200 580 220 360 64,440 200
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 100 Tablet 170 0 0 - - - -
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 0 - - - 100

89 KODEIN 20 MG TABLET 100 Tablet 1,210 0 - - -
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 28 0 28 8 20 44,500
91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 100 Strip, ktk 10 x 10 tablet 158 118 0 118 18 100 15,800
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 20 200 220 60 160 54,560
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 35 0 35 35 - -
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 58 0 58 2 56 118,832
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 50 200 250 16 234 21,060
96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - - - - 300
LPLPO Halaman 4
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
97 MAGNESIUM SULFAT INJEKSI 20% (MGSO4 20%) (2017) 1 vial 3,200 - - - -
98 MANITOL LARUTAN INFUS 20% 1 Botol 44,000 - - - - 1

99 METAMIZOL INJEKSI (ANTALGIN) 500 MG/ML 1 box @ 100 ampul 3,050 - - - - 50
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 200 500 700 400 300 35,700 200
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 230 0 230 100 130 31,200
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 900 0 900 300 600 125,400
103 METILERGOMETRIN MALEAT INJEKSI 0,2 MG / ML 100 Dus, @ 100 ampul 2,684 83 0 83 - 83 222,772
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 100 Ktk 10 x 10 tablet salut 169 80 0 80 - 80 13,520
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 14 0 14 - 14 72,800
106 METOCLOPRAMIDE SIRUP 5MG/ML (LEXAPRAM) 1 botol 60 ml 2,750 - - - -
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 170 0 170 10 160 16,000
108 METRONIDAZOL TABLET 250 MG 100 10 strip @ 10 tablet 116 120 0 120 50 70 8,120
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 - - - -
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 24 0 24 9 15 56,055
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 - - - - 2,000

112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 600 0 600 200 400 64,400
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 - - -
Dus, 10 strip @ 10 tablet

114 NIFEDIPIN TABLET 10 MG 100 salut selaput 123 100 0 100 - 100 12,300
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 0 - - - 100
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 - - - - 100
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 84 0 84 - 84 159,600
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 77 0 77 77 - - 112

119 PARASETAMOL SIRUP 120 MG/5 ML 1 Btl @ 60 ml 1,013 113 150 263 108 155 157,015
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 2,100 1,000 3,100 1,500 1,600 92,800 1,000
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 8 0 8 1 7 85,085
122 PIRANTEL TABLET SCORE (BASE) 125 MG 100 Dus, 10 strip @ 10 tablet 318 - - - -
LPLPO Halaman 5
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 160 0 160 50 110 14,960
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 4 0 4 - 4 74,540
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 6 0 6 1 5 11,720
126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 - - - -
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 1 0 1 - 1 15,386
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 190 0 190 120 70 5,950 100
129 PROPANOLOL TABLET 10 MG (HCL) 100 Dus, 10 strip @ 10 tablet 80 100 100 100 8,000
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - - - - 100

131 RANITIDIN TABLET l50 MG 100
salut selaput
119 500 500 1,000 800 200 23,800 1,000
132 RETINOL (VITAMIN A) 100.000 IU 50 Botol 50 kapsul 286 - - - -
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 40 140 180 - 180 1,287,000
Dus, 4 x 5 botol plastik @

135 SALBUTAMOL CAIRAN IH 0,1% (VENTOLIN) 20
2,5 ml
4,000 20 0 20 - 20 80,000
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 200 200 400 300 100 6,800 300
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 100 0 100 100 - -
138 SALEP 2 - 4 KOMBINASI 1 pot @ 30 gr 2,200 15 0 15 0 15 33,000
139 SALISIL BEDAK 2 %- 50 G 1 Dus @ 50 gr 1,066 0 - - -
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 160 0 160 60 100 55,700
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 28 0 28 16 12 56,952 50

142 SEFOTAKSIM SERBUK INJEKSI 500 MG 1 Vial 6,485 28 - -
100
28 0 28
143 SIANOKOBALAMIN (VIT B12) INJEKSI 500 MCG 1 Ampul 1,226 - - -

0
144 SIANOKOBALAMIN (VIT B12) TABLET 50 MCG 100 Dus, 10 strip @ 10 tablet 63 250 250 15,750
250 0 0
145 SIFIKSIM 100 MG 100 Kapsul 899 190 140 125,860

190 0 50
146 SIMVASTATIN 10 MG TABLET 30 box @ 30 tablet 135 680 540 72,900

80 600 140
147 SIPROFLAKSASIN TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 298 140 110 32,780
40 100 30
148 SPIRONOLACTONE 100 MG (2016) 100 Tablet 1,000 - - -

0
LPLPO Halaman 6
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
149 TABLET TAMBAH DARAH ( SF ) 30 box @ 30 tablet 410 - - -

300
0
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 - - -
0
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 100 Tablet 91 - - -

0
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 - - -

0
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 1,200 300 39,600
1000
700 500 900
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 200 100 59,200
200 0 100
155 ZINC DSIRUP 20MG/ML (ZIRCUM KID) 1 botol 60 ml 6,500 71 60 390,000

71 0 11
OBAT GIGI
1 ARTICULATING PAPER 1 kotak/12 strip 128,700 - - -
2 BODING LIQUID (MASTERBOND) 1 botol 281,404 - - -
3 CELULOID PASTA 1 strip 150,000 - - -
4 COMPOSIT A 2 (SOLARE X2) 2ml (kemasan plastik) 1 tube 214,300 - - -
5 COMPOSIT A 3 (SOLARE X3) 2ml (kemasan plastik) 1 tube 214,300 - - -
6 COMPOSIT A 2 (SOLARE X2) 4ml (kemasan kotak) 1 tube 303,050 - - -
7 COMPOSIT A 3 (SOLARE X3) 4ml (kemasan kotak) 1 tube 303,050 - - -
8 DEVITALISASI PASTA (NON ARSEN) / PULP-X 1 cup 216,469 - - -
9 ETCHING (ETCHING GEL) / SCHOTCHBOND 1 tube 175,120 - - -
10 ETIL KLORIDA SPRAY 100 ML 1 vial/Can/ 100 ml 110,000 - - -
11 EUGENOL CAIRAN 10 ML 1 botol 20,815 - - -
12 GLASS IONOMER CEMENT (FUJI GC IX) 1 5 gr/kotak 512,859 - - -
13 IODOFORM PASTA 1 kotak 216,465 - - -
14 KALSIUM HIDROKSIDA PASTA (CALPUS)/ (HYDCAL) 1 kotak 78,716 - - -
15 MONOKLORKAMFER MENTOL CAIRAN 10 ML / CHKM (CHAMFENOL) 1 botol 54,117 - - -
16 SEMEN SENG FOSFAT SERBUK DAN CAIRAN- 30 G 1 botol 162,349 - - -
17 TAMBALAN SEMENTARA, premix (CAVITON)/ (CAVIT-W) 1 cup 128,895 - - -
LPLPO Halaman 7
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
18 TKF 1 kotak 64,939 - - -
19 ZINC PHOSPHAT 1 pot 198,000 - - -
20 CRESOPHENE (CRESOTIN) LIQUID 1 botol 303,050 - - -
OBAT PENUNJANG
1 AMBROXOL SIRUP 15 MG/ML 1 botol 60 ml 3,412 120 100 341,200
20 100 20
2 AMBROXOL TABLET 30 MG 100 box 10 x 10 tablet 139 1,400 800 111,200

200
1400 0 600
3 ANTI FUNGI DOEN KOMBINASI (2016) 24 kotak @ 24 pot 3,960 10 10 39,600

10 0 0
4 ANTIMIGRAIN (ERGOTAMINE) TABLET 100 botol 100 tablet 134 200 200 26,800
200 0 0
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 100 100 169,400
100 0 0
6 ASIKLOVIR KRIM 5% 25 box 25 tube 4,465 23 23 102,695

23 0 0
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 - - -

0
8 DIAZEPAM 2MG TABLET (2017) 100 botol @ 100 tablet 50 - - -

0
9 BISAKODIL TABLET 5 MG (MELAXAN) (2015) 40 40 tablet/kotak 675 82 82 55,350

82 0 0
10 FENOBARBITAL 30 MG TABLET (2017) 100 botol @ 100 tablet 216 - - -

0
11 FUROSEMID 40 MG 200 box 200 tablet 111 125 40 4,440

100
125 0 85
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 34 20 53,720

34 0 14
13 GENTIAN VIOLET 1% 10 ML 1 botol 3,218 30 21 67,578

30 0 9
14 GLIBENKLAMIDA TABLET 5 MG 100 box 100 tablet 92 600 400 36,800

600 0 200
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 2100 0 2,100 600 1,500 297,000
16 HYOSCINE-N- BUTILBROMIDE 10 mg TABLET (SCOPMA) 100 kotak 10 x 10 tablet 1,036 180 0 180 6 174 180,264
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 0 - - -
18 KLORAMFENIKOL 250MG KAPSUL 100 box 10 x 10 tablet 1,320 0 - - -
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 0 - - -
20 KLORAMFENIKOL TETES TELINGA (RECO) (2016) 24 kotak @ 24 botol 6,600 56 0 56 6 50 330,000
21 MAGNESIUM SULFAT INJEKSI (2016) 1 botol 2,530 0 - - -
LPLPO Halaman 8
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
22 MELOXICAM 15 MG TABLET 50 kotak 5 x 10 tablet 617 80 0 80 80 - - 500

23 METAMIZOL INJEKSI (NORAGES) (2016) 5 5 ampul/kotak 9,680 0 - - - 50
24 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2017) 100 box 10 x 10 tablet 271 0 - - -
25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 50 20 70 30 40 193,600 40

26 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 7,700 80 0 80 20 60 462,000
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 0 1000 1,000 160 840 155,400
28 OBH SIRUP 1 botol 100 ml 2,750 5 5 10 5 5 13,750
29 OKSITETRASIKLIN SALEP KULIT 25 kotak @ 25 tube 2,000 36 0 36 6 30 60,000
30 OKSITETRASIKLIN SALEP MATA 1% 3,5 ML 25 kotak @ 25 tube 2,772 28 0 28 3 25 69,300
31 PAPAVERIN TABLET 100 box 10 x 10 tablet 330 - - -
32 PARASETAMOL TABLET 100 MG 100 kotak 10 x 10 tablet 55 - - -
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 - - -
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 3 0 3 0 3 146,850
35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 - - -
36 PREDNISON TABLET 5 MG (2016) 100 kotak 10 x 10 tablet 132 - - -
37 PROPILTIOURASIL TABLET 100 MG 100 box 100 tablet 330 - - -
38 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 vial 5 ml 591,250 - - -
39 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 1 vial 10 ml 1,050,280 - - -
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 15 96 111 51 60 256,980
41 SIRUP TAMBAH DARAH ANAK (SUPRABION) 1 botol 60 ml 7,750 0 - - -
42 TABLET FLU (MASFLU) 100 box 100 tablet 300 0 - - - 1000

43 TABLET FLU KOMBINASI (FLU DAN BATUK / RAMAFLU)) 100 kotak 10 x 10 tablet 400 0 - - - 1000
44 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 1000 botol @ 1000 tablet 79 0 - - -
45 THIAMFENIKOL 500 MG KAPSUL 100 box 10 x 10 tablet 985 0 - - -
46 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER)(2016) 1000 botol @ 1000 tablet 396 344 0 344 270 74 29,304
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - - - 100
LPLPO Halaman 9
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - - - 1000
BAKHP
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 41 0 41 0 41 43,624
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 0 200 200 200 - -
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 15 200 215 116 99 88,704
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 15 0 15 15 - - 100

5 ALKOHOL 70% 1 botol 1000 ml 23,650 1 0 1 1 - - 2
6 ASEPTAN + DISPENSER 1 500 cc 33,000 1 0 1 0 1 33,000
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 3 0 3 1 2 48,400
8 CATGUT BEDAH NO. 3/0 + JARUM 1/2 GT 35 MM 24 1 24 X 75 cm/kotak 6,421 28 0 28 4 24 154,104
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 0 100 100 0 100 803,300
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 0 100 100 0 100 41,000
11 INFUSET ANAK 1 Set/kantong 4,025 0 20 20 0 20 80,500
12 INFUSET DEWASA 1 Set/kantong 3,680 0 100 100 0 100 368,000
13 IV CATHETER NO. 18 G 1 50 Buah/kotak 4,370 - - -
14 IV CATHETER NO. 20 G 1 50 Buah/kotak 4,370 81 0 81 45 36 157,320 50

17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 Bungkus 14,375 3 0 3 1 2 28,750 2
18 KASA HIDROFIL 36 M X 80 CM 1 Rol 120,750 1 0 1 1 - - 1
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 - - -
20 KASA PEMBALUT HIDROFIL 4 M X 10 CM 1 Rol 667 10 0 10 3 7 4,669
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 8 0 8 8 - - 10

22 MASKER 50 50 pcs/kotak 506 100 200 300 200 100 50,600 100
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 5 0 5 3 2 54,648 2
LPLPO Halaman 10
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
24 POLLY CATETER 2 WAY N0. 16 1 pcs 9,200 0 - - -
25 POLLY CATETER 2 WAY N0. 18 1 pcs 9,200 5 0 5 0 5 46,000
26 RIVANOL 1 botol 300 cc 3,600 - - -
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 - - -
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 50 0 50 0 50 57,500
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 30 0 30 0 30 143,640
30 URINE BAG 1 Pcs 3,450 3 0 3 0 3 10,350
31 SAFETY BOX 1 kotak 18,073 0 - - -
32 NEEDLE TERUMO 22 G 100 kotak 330 - - -
33 NEEDLE TERUMO 25 G 100 kotak 330 - - -
34 3M 1870+AURA N95 GENERAL RESPIRATOR (MASKER P2TB) 1 box @20pcs 21,000 - - -
REAGEN LABORATORIUM
1 ABATE 1 pail 25 kg - - -
2,750,000
2 ALKOHOL SWAP 1 kotak isi 100

113
- - -
3 BLOOD LANCETS 1 kotak isi 100 - - -

158
4 DENGUE IgG / IgM 1 set isi 25 - - -

1,265,000
5 DENGUE NS1 1 box 25 test - - -

4,585,000
6 HB SAHLI 1 pcs - - -
151,250
7 LARUTAM EOSIN 2% 100 ML 1 botol 100 ml - - -

176,225
8 LARUTAN ASAM ASETAT 6% 1 botol 100 ml

20,000
- - -
9 LARUTAN ASAM KLORIDA 0,1 N 100 ML/HCL 1 botol 100 ml - - -

12,672
10 LARUTAN ASAM SULFO 20% 1 botol 100 ml - - -

273,600
11 LARUTAN BENEDICT 100 ML 1 botol 100 ml - - -

32,061
12 LARUTAN EDTA 1 botol 100 ml - - -

74,100
13 LARUTAN GIEMSA STAIN 100 ML 1 botol 100 ml - - -

375,685
LPLPO Halaman 11
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
14 LARUTAN H2O2 1 botol 100 ml - - -

18,800
15 LARUTAN HAYEM 1 botol 100 ml - - -

19,800
16 LARUTAN METANOL 1 botol 50 cc - - -

39,050
17 LARUTAN OIL EMERSI 1 botol 50 cc - - -

367,650
18 LARUTAN POCK-PACK D (II) 1 botol - - -

720,500
19 LARUTAN POCK-PACK L (II) 1 botol 500 ml - - -

2,310,000
20 LARUTAN RAESSECHER 100 ML 1 botol 100 ml - - -

42,350
21 LARUTAN TURK 100 ML 1 botol 100 ml - - -

23,750
22 LYSOL 1 botol 1 liter - - -

49,200
23 LIDI SWABB 1 pcs

1,669
- - -
24 ONE CLEAN 1 boto 1 liter - - -

16,520
25 PP TEST 1 50 strip/kotak - - -
2,132
26 REAGEN GOLONGAN DARAH ANTI A 1 1 set/10 ml - - -

71,450
27 REAGEN GOLONGAN DARAH ANTI B 1 1 set/10 ml - - -

71,450
28 REAGEN WIDAL TEST 1 kit 20 ml - - -

279,640
29 STIK GLUKO DR 1 kotak isi 50 - - -

6,379
30 STIK PEMERIKSAAN ASAM URAT 1 kotak isi 25 - - -

5,239
31 STIK PEMERIKSAAN HB 1 kotak isi 50 - - -

8,400
32 STIK PEMERIKSAAN KOLESTEROL 1 kotak isi 10 - - -

23,566
33 STIK PEMERIKSAAN TRIGLISERIDA (TG) 1 kotak isi 25 - - -

37,892
34 STIK URINE PARAMETER 3 1 kotak 100 - - -

1,265
35 STIK URINE PROTEIN 1 kotak - - -

1,202
36 STIK AMPHETAMINE 1 kotak @25 pcs - - -

31,700
37 STIK BENZODIAZEPINE 1 kotak @25 pcs - - -

31,700
38 STIK THC 1 kotak @25 pcs - - -

31,700
39 REAGEN DIRUI CLEANSER 1 botol - - -

1,163,800
LPLPO Halaman 12
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
40 REAGEN DIRUI DILUENT 1 botol - - -

2,340,000
41 REAGEN DIRUI LYSE 1 botol - - -

3,782,000
42 REAGEN FOTOMETER ASAM URAT 1 botol - - -

2,365,000
43 REAGEN FOTOMETER GLUCOSA 1 botol - - -

1,733,000
44 REAGEN FOTOMETER KOLESTEROL 1 botol - - -

2,643,000
45 REAGEN FOTOMETER TRIGLISERID 1 botol - - -

3,820,000
46 TISUE LENSA MIKROSKOP 1 pcs - - -

3,032
47 XYLOL 1 botol/100 ml 69,400 - - -
48 ZIEHL NELSEN 1 set - - -

223,850
49 HIV TEST 1 kotak @25 pcs - - -

65,900
50 SPIRITUS 1 botol 1 liter - - -

49,200
51 SPECULUM ONEMED UK. S, M, L 1 pcs - - -

9,400
52 WATER ONE/AQUDEST 1 botol 1 liter - - -

31,400
OBAT BUFFER PROPINSI

1 ABATE 1 kaleng 25 kg 2,340,000 - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - -
3 AMOKSISILIN KAPLET 500 MG 100 ktk 10 x 10 kaplet 279 - - -
4 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 botol 60 ml 2,560 - - -
5 ASAM MEFENAMAT 500 MG 100 kotak 10 x 10 tablet 113 - - -
6 BIONEURON TABLET 100 kotak 10 x 10 tablet 1,081 - - -
7 BISTURI (Pisau Bedah) 1 ktk 100 50,000 - - -
8 FENOBARBITAL TABLET 30 MG 1 botol 100 tablet 68 - - -
9 HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU 1 vial 170,000 - - -
10 IV CATHETER NO. 22 G 1 kotak 50 buah 8,566 - - -
11 IV CATHETER NO. 24 G 1 kotak 50 buah 8,566 - - -
LPLPO Halaman 13
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
12 KAPAS PEMBALUT 250 GR (2017) 1 bungkus 8,250 - - -
13 KASA PEMBALUT HIDROFIL 4 m x 10 cm 50 roll/50 668 - - -
14 KOTRIMOKSAZOL SUSPENSI 60 ML 1 botol 60 ml 2,225 - - -
15 LIVRON B-PLEK TABLET 100 kotak 10 x 10 tablet 237 - - -
16 NEDDLE NO. 23 1 ktk 100 275 - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - -
18 NISTATIN TABLET SALUT 500.000 UI/G 100 ktk 10 x 10 tablet 704 - - -
19 NISTATIN VAGINAL TABLET SALUT 100.000 UI/G 100 ktk 10 x 10 tablet 448 - - -
20 PARASETAMOL 500 MG TABLET 100 kotak 10 x 10 tablet 88 - - -
21 PARASETAMOL DROPS 1 botol 15 ml 5,980 - - -
22 PERMETRIN KRIM 5% (SCABIMITE CREAM) 1 tube 11,475 - - -
23 RINGER LAKTAT LARUTAN INFUS 1 botol 500 ml 7,150 - - -
24 SALBUTAMOL CAIRAN IH 0,1% (VENTOLIN NEBULIZER) 1 botol 7,260 - - -
25 SALEP 2 - 4 KOMBINASI 1 pot 2,200 - - -
26 SEFADROKSIL TABLET 500 MG 100 ktk 10 x 10 tablet 557 - - -
27 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 ampul 520,300 - - -
28 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 1 ampul 1,050,280 - - -
29 SURGICAL MASK (MASKER) 1 box / 50 36,300 - - -
30 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 vial 139,150 - - -
31 UNDERPAD STERIL 60 X 90 CM 1 pcs 7,626 - - -
32 VAKSIN RABIES 1 vial 78,000 - - -
33 VITAMIN B KOMPLEK 1000 botol 1000 tablet 31 - - -
34 ANTASIDA DOEN TABLET KUNYAH 100 box 10 x 10 tablet 59 - - -
35 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 box @ 100 ampul 1,848 - - -
36 FLUOXETIN TABLET 20MG (ELIZAC) 30 box @ 30 tablet 668 - - -
37 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 13,200 - - -
LPLPO Halaman 14
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
38 MULTIVITAMIN NEUROTROPIK TABLET (TRIFANEURON) 100 box @ 100 tablet 828 - - -
39 OXYMETAZOLINE HCL/ILIADIN SPRAY TETES HIDUNG 0,05% 1 botol 37,900 - - -
40 OXYMETAZOLINE HCL/ILIADIN DROP TETES HIDUNG 0,025% 1 botol 36,000 - - -
41 RISPERIDON TABLET 2 MG 100 box 10 x 10 tablet 347 - - -
42 SPIRONOLACTONE 100 MG TABLET (2017) 100 box 10 x 10 tablet 745 - - -
43 TRIFLUOPERAZINE DIHYDROCHLORIDE TABLET 5 MG 100 box 10 x 10 tablet 294 - - -
44 URINE BAG 1 PCS 3,150 - - -
OBAT YANG TIDAK TERBUAT DALAM FORM

- - -
1
- - -
2
- - -
3
- -
4
- - -
5
- - -
6
- - -
7
- - -
8
- - -
9
- - -
10
JUMLAH JUMLAH
13,236,201
HARGA HARGA
JUMLAH KUNJUNGAN RESEP UMUM

BPJS JUMLAH
BAYAR PKD-G
Martapura, 25 Januari 2018
LPLPO Halaman 15
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Mengetahui / Menyetujui : Yang Menyerahkan : Yang Menerima / Melapor Yang Meminta
Kabid.Yankes Ka. Gudang Farmasi Kesehatan Pimpinan Puskesmas Karang Intan 2 Petugas Puskesmas
Dedi Kurniadi, SKM, MM Arief Rachman, S.Si, Apt , M.Mkes Rida Husni, S.Kep, Ns Nadya Aldiani Mulfah, A.Md, Farm
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 16
(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE : FEBRUARI TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : MARET

HARGA STOK PENERI PERSEDI PEMAKA STOK
NO NAMA OBAT SATUAN KEMASAN PERMINTAAN
SATUAN AWAL MAAN AAN IAN TOTAL OPT TOTAL
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
1 ALBENDAZOLE 400 MG 30 box @ 30 tablet 323 95 0 95 - 95 30,685 10
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 57 0 57 57 - - 57 20

3 ALOPURINOL TABLET 100 MG 100 box, 10 strip @ 10 tablet 95 - 200 200 200 - - 200 300
4 ALOPURINOL TABLET 300 MG 100 box, 10 strip @ 10 tablet 244 250 0 250 150 100 24,400 150 100
5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 30 Dus 30 ampul @ 10 ml 4,204 - 0 - - - - 1 30
6 AMITRIPTILIN HCL TABLET SALUT 25 MG 100 Dus, 10 strip @ 10 tss 123 140 0 140 30 110 13,530 30
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 60 150 210 95 115 18,745 180
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 390 450 840 720 120 12,600 730 900
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 1,000 500 1,500 900 600 139,800 900 900
10 AMOKSISILIN SERBUK INJEKSI 1000 MG 1 10 vial / kotak 8,135 - - - - -
11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 Btl @ 60 ml 2,200 50 0 50 50 - - 50 50

12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 32 0 32 24 8 16,848 32 50
13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 200 800 1,000 700 300 17,700 700 600
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 8 0 8 8 - - 8 10
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 50 0 50 - 50 67,500 10
16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - - - - -
17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - - - - -
18 ASAM ASETILSALISILAT 100 MG (ASETOSAL) 100 Tablet 153 90 0 90 - 90 13,770 10
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 300 0 300 200 100 12,000 400 500
20 ASAM FOLAT 1 MG 100 Tablet 68 838 0 838 110 728 49,504 110
LPLPO Halaman 17
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
21 ASAM MEFENAMAT TABLET 250 MG 100 Tablet 150 - - - - -
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 600 1,000 1,600 1,400 200 22,600 1,400 2,000
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 2 0 2 2 - - 2
24 ASIKLOVIR 200 MG TABLET 100 ktk 10 x 10 tablet 272 90 0 90 90 - - 90 100

25 ASIKLOVIR 400 MG TABLET 100 ktk 10 x 10 tablet 368 200 0 200 100 100 36,800 100 100
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 - - - - -
27 ANTIBAKTERI DOEN SALEP KOMBINASI (BASITRACIN) 1 box @ 25 tube 3,365 44 0 44 19 25 84,125 19
28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 1 box @ 24 tube 4,782 10 0 10 - 10 47,820 2
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - - - 20

30 BETAHISTINE TABLET 30 box @ 30 tablet 170 50 0 50 - 50 8,500 -
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 16 25 41 26 15 21,750 26 25

32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 82 0 82 - 82 25,994 5
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 - - - -
35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 500 0 500 400 100 15,400 400 500
36 CLOZAPINE 25 MG 100 Tablet 1,550 110 0 110 - 110 170,500 30
37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 33 0 33 - 33 57,354 5
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 900 0 900 700 200 9,600 700 500
39 DIAZEPAM INJEKSI 5 MG / ML 1 Ampul 4,598 18 0 18 1 17 78,166 1
@ 2,5 ml
12,751 - - - - - 10
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 1 Ampul @ 1 ml 1,355 88 0 88 28 60 81,300 28
43 DIGOKSIN TABLET 0,25 MG 100 box 10 x 10 tablet 103 165 0 165 - 165 16,995 20
44 DILTIAZEM HCL TABLET 30 MG 100 ktk 10 x 10 tablet 137 150 0 150 - 150 20,550 20
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 - 200 200 - 200 22,800 100
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 18 0 18 8 10 34,900 8
47 DOMPERIDONE TABLET 10 MG 100 Strip, ktk 10 x 10 tablet 133 60 100 160 130 30 3,990 130 100
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 - 6 6 1 5 28,350 1
LPLPO Halaman 18
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
49 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 Dus @ 30 ampul 2,354 - - - - 2 30

50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 - - - - -
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 5 0 5 - 5 35,195 -
52 FENITOIN NATRIUM KAPSUL 100 MG 100 Botol @ 100 154 - - - - -
53 FENOBARBITAL INJEKSI 50 MG/ML-2ML 30 ktk 30 ampul @ 1 ml 1,980 - - - - -
54 FENOBARBITAL TABLET 30 MG 100 100 tablet/botol 68 - - - - -
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 17 0 17 17 - - 17 ED
56 FITOMENADION (VIT.K1) TABLET SALUT 10 MG 100 100 tablet/botol 796 100 0 100 100 - - 100 30
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 14 0 14 - 14 30,506 - 100
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 161 0 161 116 45 12,330 116
59 GENTAMISIN TETES MATA 0,3% 1 Botol 4,600 44 0 44 8 36 165,600 8 100

60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 - 100 100 - 100 29,600 -
61 GLIMEPIRIDE 4MG TABLET 50 box @ 50 tablet 330 - - - - -
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 0 20 - 20 138,000 20 20

63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 100 ktk 10 x 10 tablet 224 100 0 100 40 60 13,440 40
64 HALOPERIDOL TABLET 0,5 MG 100 Dus, 10 blister @ 10 tablet 64 - - - - -
66 HALOPERIDOL TABLET 5 MG 100 Dus, 10 blister @ 10 tablet 105 - - - - -
67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 100 Tablet 171 170 0 170 - 170 29,070 -
68 HIDROKORTISON KRIM 2,5% 1 Tube 2,868 24 0 24 5 19 54,492 5
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 - 10 10 - 10 49,500 -
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 - 50 50 10 40 102,400 10
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - - -
72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - - - 1,000

73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 220 0 220 120 100 9,800 120
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 300 200 500 500 - - 500 500
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 80 200 280 190 90 6,210 90 100
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 - - - - -
LPLPO Halaman 19
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
77 KARBAMAZEPIN TABLET 200 MG 100 Dus, 10 strip @ 10 tablet 306 180 0 180 30 150 45,900 30
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 6 0 6 - 6 15,000 -
79 KETOKENAZOLE CREAM 2% 1 tube 10 gr 2,605 18 0 18 10 8 20,840 10
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 280 0 280 - 280 184,800 -
81 KLORAMFENIKOL KAPSUL 500 MG 100 Kapsul 1,155 110 0 110 - 110 127,050 -
82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 24 0 24 5 19 31,160 5
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 - 30 30 - 30 115,500 -
84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 7 0 7 7 - - - 50

85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 300 1,000 1,300 900 400 18,000 900 1,000
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 100 Tablet 170 - - - - -
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 - - - - - 100

89 KODEIN 20 MG TABLET 100 Tablet 1,210 - - - - -
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 20 0 20 15 5 11,125 5 50

91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 100 Strip, ktk 10 x 10 tablet 158 100 0 100 10 90 14,220 10
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 160 0 160 160 - - 400 400
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 - - - - -
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 56 0 56 7 49 103,978 7
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 234 0 234 128 106 9,540 128
96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - 300 300 - 300 44,700 -
97 MAGNESIUM SULFAT INJEKSI 20% (MGSO4 20%) (2017) 1 vial 3,200 10 0 10 - 10 32,000 -
98 MANITOL LARUTAN INFUS 20% 1 Botol 44,000 - - - - - 1

99 METAMIZOL INJEKSI (ANTALGIN) 500 MG/ML 1 box @ 100 ampul 3,050 - - - - - 100
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 300 200 500 500 - - 500 700
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 130 0 130 100 30 7,200 100 100
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 600 0 600 200 400 83,600 200
103 METILERGOMETRIN MALEAT INJEKSI 0,2 MG / ML 100 Dus, @ 100 ampul 2,684 83 0 83 43 40 107,360 43
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 100 Ktk 10 x 10 tablet salut 169 80 0 80 50 30 5,070 50 100
LPLPO Halaman 20
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 14 0 14 4 10 52,000 4
106 METOCLOPRAMIDE SIRUP 5MG/ML (LEXAPRAM) 1 botol 60 ml 2,750 - - - - -
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 160 0 160 116 44 4,400 116 100
108 METRONIDAZOL TABLET 250 MG 100 10 strip @ 10 tablet 116 70 0 70 70 - - 70
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 - - - - -
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 15 0 15 5 10 37,370 5
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 - - - - - 500

112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 400 0 400 400 - - 400 600
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 - - - - -
114 NIFEDIPIN TABLET 10 MG 100
salut selaput
123 100 0 100 50 50 6,150 50
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 - - - - - 100
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 - - - - - 100
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 84 0 84 - 84 159,600 -
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 - - - - - 112

119 PARASETAMOL SIRUP 120 MG/5 ML 1 Btl @ 60 ml 1,013 155 150 305 193 112 113,456 193 150
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 1,600 1,000 2,600 2,200 400 23,200 2,200 2,000
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 7 0 7 1 6 72,930 1
122 PIRANTEL TABLET SCORE (BASE) 125 MG 100 Dus, 10 strip @ 10 tablet 318 - - - - -
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 110 0 110 70 40 5,440 70
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 4 0 4 - 4 74,540 -
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 5 0 5 3 2 4,688 3 3

126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 - - - - - 2
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 1 0 1 1 - - 1
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 70 100 170 90 80 6,800 90 200
129 PROPANOLOL TABLET 10 MG (HCL) 100 Dus, 10 strip @ 10 tablet 80 100 0 100 - 100 8,000 -
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - - - - - 100

131 RANITIDIN TABLET l50 MG 100 Dus, 10 strip @ 10 tablet
salut selaput
119 200 1,000 1,200 1,000 200 23,800 1,200 1,000
132 RETINOL (VITAMIN A) 100.000 IU 50 Botol 50 kapsul 286 - - - - -
LPLPO Halaman 21
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 180 0 180 140 40 286,000 160 160
2,5 ml
4,000 20 0 20 - 20 80,000 -
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 100 300 400 400 - - 400
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 - - - - 0
138 SALEP 2 - 4 KOMBINASI 1 pot @ 30 gr 2,200 15 0 15 3 12 26,400 3
139 SALISIL BEDAK 2 %- 50 G 1 Dus @ 50 gr 1,066 - - - - 0 20

140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 100 0 100 75 25 13,925 75 200
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 12 60 72 12 60 284,760 12 50
142 SEFOTAKSIM SERBUK INJEKSI 500 MG 1 Vial 6,485 - 100 90 583,650
100 10 10
143 SIANOKOBALAMIN (VIT B12) INJEKSI 500 MCG 1 Ampul 1,226 - - - -
0
144 SIANOKOBALAMIN (VIT B12) TABLET 50 MCG 100 Dus, 10 strip @ 10 tablet 63 250 250 250 15,750
0 0 0
145 SIFIKSIM 100 MG 100 Kapsul 899 140 140 110 98,890
0 30 30
146 SIMVASTATIN 10 MG TABLET 30 box @ 30 tablet 135 540 540 300 40,500
0 240 240
147 SIPROFLAKSASIN TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 298 110
0
110
80
30 8,940
80 100
148 SPIRONOLACTONE 100 MG (2016) 100 Tablet 1,000 - - - -
0
149 TABLET TAMBAH DARAH ( SF ) 30 box @ 30 tablet 410 - 1,920 1,590 651,900
1920 330 330
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 - - - -
0 1
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 100 Tablet 91 - - - -
0
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 - - - -
0
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 300
1000
1,300
900
400 52,800
900 1000
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 100
0
100
100
- -
100 200
155 ZINC DSIRUP 20MG/ML (ZIRCUM KID) 1 botol 60 ml 6,500 60 60 48 312,000
0 12 12
- - - -
OBAT GIGI - - - -
1 ARTICULATING PAPER 1 kotak/12 strip 128,700 - - - -
2 BODING LIQUID (MASTERBOND) 1 botol 281,404 - - - -
3 CELULOID PASTA 1 strip 150,000 - - - -
LPLPO Halaman 22
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
4 COMPOSIT A 2 (SOLARE X2) 2ml (kemasan plastik) 1 tube 214,300 - - - -
6 COMPOSIT A 2 (SOLARE X2) 4ml (kemasan kotak) 1 tube 303,050 - - - -
8 DEVITALISASI PASTA (NON ARSEN) / PULP-X 1 cup 216,469 - 1 - -

1 1
9 ETCHING (ETCHING GEL) / SCHOTCHBOND 1 tube 175,120 - - - -
10 ETIL KLORIDA SPRAY 100 ML 1 vial/Can/ 100 ml 110,000 - - - -

2
11 EUGENOL CAIRAN 10 ML 1 botol 20,815 -
1
1
1
- -
1
12 GLASS IONOMER CEMENT (FUJI GC IX) 1 5 gr/kotak 512,859 - - - -
13 IODOFORM PASTA 1 kotak 216,465 - - - -

1
14 KALSIUM HIDROKSIDA PASTA (CALPUS)/ (HYDCAL) 1 kotak 78,716 - - - -
15 MONOKLORKAMFER MENTOL CAIRAN 10 ML / CHKM (CHAMFENOL) 1 botol 54,117 - - - -
16 SEMEN SENG FOSFAT SERBUK DAN CAIRAN- 30 G 1 botol 162,349 - - - -
17 TAMBALAN SEMENTARA, premix (CAVITON)/ (CAVIT-W) 1 cup 128,895 - - - -

1
18 TKF 1 kotak 64,939 - - - -
19 ZINC PHOSPHAT 1 pot 198,000 - - - -
20 CRESOPHENE (CRESOTIN) LIQUID 1 botol 303,050 - - - -

1
- - - -
OBAT PENUNJANG - - - -
1 AMBROXOL SIRUP 15 MG/ML 1 botol 60 ml 3,412 100

0
100
60
40 136,480
60 50
2 AMBROXOL TABLET 30 MG 100 box 10 x 10 tablet 139 800
0
800
700
100 13,900
700 700
3 ANTI FUNGI DOEN KOMBINASI (2016) 24 kotak @ 24 pot 3,960 10 10 8 31,680
0 2 2
4 ANTIMIGRAIN (ERGOTAMINE) TABLET 100 botol 100 tablet 134 200 200 200 26,800
0 0 0
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 100 100 100 169,400
0 0 0
6 ASIKLOVIR KRIM 5% 25 box 25 tube 4,465 23 23 23 102,695
0 0 0
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 - - - -
0
8 DIAZEPAM 2MG TABLET (2017) 100 botol @ 100 tablet 50 - - - -
0 0
9 BISAKODIL TABLET 5 MG (MELAXAN) (2015) 40 40 tablet/kotak 675 82 82 82 55,350
0 0 0
LPLPO Halaman 23
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
10 FENOBARBITAL 30 MG TABLET (2017) 100 botol @ 100 tablet 216 - - - -

0
11 FUROSEMID 40 MG 200 box 200 tablet 111 40
200
240
200
40 4,440
200 200
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 20
0
20
10
10 26,860
20 10
13 GENTIAN VIOLET 1% 10 ML 1 botol 3,218 21 21 18 57,924
0 3 3
14 GLIBENKLAMIDA TABLET 5 MG 100 box 100 tablet 92 400
0
400
200
200 18,400
300 100
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 1,500 0 1,500 1000 500 99,000 1000 1000
16 HYOSCINE-N- BUTILBROMIDE 10 mg TABLET (SCOPMA) 100 kotak 10 x 10 tablet 1,036 174 0 174 70 104 107,744 70
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 - 10 10 0 10 99,000 0
18 KLORAMFENIKOL 250MG KAPSUL 100 box 10 x 10 tablet 1,320 - - - - 0
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 - - - - 0
20 KLORAMFENIKOL TETES TELINGA (RECO) (2016) 24 kotak @ 24 botol 6,600 50 0 50 0 50 330,000 0
21 MAGNESIUM SULFAT INJEKSI (2016) 1 botol 2,530 - - - - 0
22 MELOXICAM 15 MG TABLET 50 kotak 5 x 10 tablet 617 - - - - 0
23 METAMIZOL INJEKSI (NORAGES) (2016) 5 5 ampul/kotak 9,680 - - - - 0
24 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2017) 100 box 10 x 10 tablet 271 - - - - 0
26 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 7,700 60 0 60 50 10 77,000 50 50

27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 840 0 840 840 - - 840 800
28 OBH SIRUP 1 botol 100 ml 2,750 5 0 5 0 5 13,750 0
29 OKSITETRASIKLIN SALEP KULIT 25 kotak @ 25 tube 2,000 30 0 30 0 30 60,000 0
30 OKSITETRASIKLIN SALEP MATA 1% 3,5 ML 25 kotak @ 25 tube 2,772 25 0 25 15 10 27,720 15 25

31 PAPAVERIN TABLET 100 box 10 x 10 tablet 330 - - - - 0
32 PARASETAMOL TABLET 100 MG 100 kotak 10 x 10 tablet 55 - - - - 0
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 - - - - 0
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 3 0 3 2 1 48,950 2 1

35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 - - - - 0
36 PREDNISON TABLET 5 MG (2016) 100 kotak 10 x 10 tablet 132 - - - - 0
37 PROPILTIOURASIL TABLET 100 MG 100 box 100 tablet 330 - - - - 0
LPLPO Halaman 24
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
38 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 vial 5 ml 591,250 - - - - 0
39 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 1 vial 10 ml 1,050,280 - - - - 0
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 60 0 60 45 15 64,245 45 50

41 SIRUP TAMBAH DARAH ANAK (SUPRABION) 1 botol 60 ml 7,750 - - - - 0
42 TABLET FLU (MASFLU) 100 box 100 tablet 300 - - - - 0
43 TABLET FLU KOMBINASI (FLU DAN BATUK / RAMAFLU)) 100 kotak 10 x 10 tablet 400 - - - - 0
44 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 1000 botol @ 1000 tablet 79 - - - - 0
45 THIAMFENIKOL 500 MG KAPSUL 100 box 10 x 10 tablet 985 - - - - 0
46 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER)(2016) 1000 botol @ 1000 tablet 396 74 0 74 74 - - 74 300
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - - - - 0
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - - - - 0
- - - -
BAKHP - - - -
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 41 0 41 10 31 32,984 10
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - - - - 200 200
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 99 0 99 99 - - 200 200
5 ALKOHOL 70% 1 botol 1000 ml 23,650 - - - - 2 2
6 ASEPTAN + DISPENSER 1 500 cc 33,000 1 0 1 0 1 33,000 0
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 2 0 2 2 - - 2 2

8 CATGUT BEDAH NO. 3/0 + JARUM 1/2 GT 35 MM 24 1 24 X 75 cm/kotak 6,421 24 0 24 7 17 109,157 7
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 100 0 100 0 100 803,300 0
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 100 0 100 100 - - 100 100
11 INFUSET ANAK 1 Set/kantong 4,025 20 0 20 3 17 68,425 3
12 INFUSET DEWASA 1 Set/kantong 3,680 100 0 100 50 50 184,000 100 50

13 IV CATHETER NO. 18 G 1 50 Buah/kotak 4,370 - - - - 0
LPLPO Halaman 25
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
18 KASA HIDROFIL 36 M X 80 CM 1 Rol 120,750 - - - - 0
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 - - - - 0
20 KASA PEMBALUT HIDROFIL 4 M X 10 CM 1 Rol 667 7 0 7 0 7 4,669 0
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 - - - - 0
22 MASKER 50 50 pcs/kotak 506 100 0 100 0 100 50,600 100
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 2 0 2 2 - - 2
24 POLLY CATETER 2 WAY N0. 16 1 pcs 9,200 - - - - 0
25 POLLY CATETER 2 WAY N0. 18 1 pcs 9,200 5 0 5 0 5 46,000 0
26 RIVANOL 1 botol 300 cc 3,600 - - - - 0
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 - - - - 0
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 50 0 50 0 50 57,500 0
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 30 0 30 0 30 143,640 0
30 URINE BAG 1 Pcs 3,450 3 0 3 0 3 10,350 0
31 SAFETY BOX 1 kotak 18,073 - - - - 0
32 NEEDLE TERUMO 22 G 100 kotak 330 46 0 46 0 46 15,180 10
33 NEEDLE TERUMO 25 G 100 kotak 330 53 53 53 17,490

0 0 10
34 3M 1870+AURA N95 GENERAL RESPIRATOR (MASKER P2TB) 1 box @20pcs 21,000 - - - -
- - - -
REAGEN LABORATORIUM - - - -
1 ABATE 1 pail 25 kg - - - -
2,750,000
2 ALKOHOL SWAP 1 kotak isi 100 - - - -

113
3 BLOOD LANCETS 1 kotak isi 100 - - - -

158
4 DENGUE IgG / IgM 1 set isi 25 - - - -

1,265,000
5 DENGUE NS1 1 box 25 test - - - -

4,585,000
6 HB SAHLI 1 pcs - - - -
151,250
7 LARUTAM EOSIN 2% 100 ML 1 botol 100 ml - - - -

176,225
LPLPO Halaman 26
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

20,000
- - - -
9 LARUTAN ASAM KLORIDA 0,1 N 100 ML/HCL 1 botol 100 ml - - - -

12,672
10 LARUTAN ASAM SULFO 20% 1 botol 100 ml

273,600
- - - -
11 LARUTAN BENEDICT 100 ML 1 botol 100 ml

32,061
- - - -
12 LARUTAN EDTA 1 botol 100 ml

74,100
- - - -
13 LARUTAN GIEMSA STAIN 100 ML 1 botol 100 ml - - - -

375,685
14 LARUTAN H2O2 1 botol 100 ml

18,800
- - - -
15 LARUTAN HAYEM 1 botol 100 ml

19,800
- - - -
16 LARUTAN METANOL 1 botol 50 cc

39,050
- - - -
17 LARUTAN OIL EMERSI 1 botol 50 cc - - - -

367,650
18 LARUTAN POCK-PACK D (II) 1 botol - - - -

720,500
19 LARUTAN POCK-PACK L (II) 1 botol 500 ml - - - -

2,310,000
20 LARUTAN RAESSECHER 100 ML 1 botol 100 ml

42,350
- - - -
21 LARUTAN TURK 100 ML 1 botol 100 ml

23,750
- - - -
22 LYSOL 1 botol 1 liter - 4 - -

49,200 4 4
23 LIDI SWABB 1 pcs

1,669
- 5 - -
5 5
24 ONE CLEAN 1 boto 1 liter - - - -

16,520
25 PP TEST 1 50 strip/kotak - - - -
2,132
26 REAGEN GOLONGAN DARAH ANTI A 1 1 set/10 ml - - - -

71,450
27 REAGEN GOLONGAN DARAH ANTI B 1 1 set/10 ml

71,450
- - - -
28 REAGEN WIDAL TEST 1 kit 20 ml - - - -

279,640
29 STIK GLUKO DR 1 kotak isi 50 - - - -

6,379
30 STIK PEMERIKSAAN ASAM URAT 1 kotak isi 25 - - - -

5,239
31 STIK PEMERIKSAAN HB 1 kotak isi 50 - - - -

8,400
32 STIK PEMERIKSAAN KOLESTEROL 1 kotak isi 10 - - - -

23,566
33 STIK PEMERIKSAAN TRIGLISERIDA (TG) 1 kotak isi 25 - - - -

37,892
34 STIK URINE PARAMETER 3 1 kotak 100 - - - -

1,265
35 STIK URINE PROTEIN 1 kotak - - - -

1,202
LPLPO Halaman 27
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
36 STIK AMPHETAMINE 1 kotak @25 pcs - - - -

31,700
37 STIK BENZODIAZEPINE 1 kotak @25 pcs - - - -

31,700
38 STIK THC 1 kotak @25 pcs - - - -

31,700
39 REAGEN DIRUI CLEANSER 1 botol - - - -

1,163,800
40 REAGEN DIRUI DILUENT 1 botol - - - -

2,340,000
41 REAGEN DIRUI LYSE 1 botol - - - -

3,782,000
42 REAGEN FOTOMETER ASAM URAT 1 botol - - - -

2,365,000
43 REAGEN FOTOMETER GLUCOSA 1 botol - - - -

1,733,000
44 REAGEN FOTOMETER KOLESTEROL 1 botol - - - -

2,643,000
45 REAGEN FOTOMETER TRIGLISERID 1 botol - - - -

3,820,000
46 TISUE LENSA MIKROSKOP 1 pcs - - - -

3,032
47 XYLOL 1 botol/100 ml 69,400 - - - -
48 ZIEHL NELSEN 1 set - - - -

223,850
49 HIV TEST 1 kotak @25 pcs - - - -

65,900
50 SPIRITUS 1 botol 1 liter - - - -

49,200
51 SPECULUM ONEMED UK. S, M, L 1 pcs - - - -

9,400
52 WATER ONE/AQUDEST 1 botol 1 liter - - - -

31,400
- - - -
OBAT BUFFER PROPINSI - - - -
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - 2 - -

2 2
3 AMOKSISILIN KAPLET 500 MG 100 ktk 10 x 10 kaplet 279 - - - -
4 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 botol 60 ml 2,560 - - - -
5 ASAM MEFENAMAT 500 MG 100 kotak 10 x 10 tablet 113 - - - -
6 BIONEURON TABLET 100 kotak 10 x 10 tablet 1,081 - - - -
7 BISTURI (Pisau Bedah) 1 ktk 100 50,000 - - - -
8 FENOBARBITAL TABLET 30 MG 1 botol 100 tablet 68 - - - -
9 HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU 1 vial 170,000 - - - -
LPLPO Halaman 28
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
10 IV CATHETER NO. 22 G 1 kotak 50 buah 8,566 - - - -
12 KAPAS PEMBALUT 250 GR (2017) 1 bungkus 8,250 - - - -
13 KASA PEMBALUT HIDROFIL 4 m x 10 cm 50 roll/50 668 - - - -
14 KOTRIMOKSAZOL SUSPENSI 60 ML 1 botol 60 ml 2,225 - - - -
15 LIVRON B-PLEK TABLET 100 kotak 10 x 10 tablet 237 - - - -
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
18 NISTATIN TABLET SALUT 500.000 UI/G 100 ktk 10 x 10 tablet 704 - - - -
19 NISTATIN VAGINAL TABLET SALUT 100.000 UI/G 100 ktk 10 x 10 tablet 448 - - - -
20 PARASETAMOL 500 MG TABLET 100 kotak 10 x 10 tablet 88 - - - -
21 PARASETAMOL DROPS 1 botol 15 ml 5,980 - - - -
22 PERMETRIN KRIM 5% (SCABIMITE CREAM) 1 tube 11,475 - - - -
23 RINGER LAKTAT LARUTAN INFUS 1 botol 500 ml 7,150 - 60 - -

60 60
24 SALBUTAMOL CAIRAN IH 0,1% (VENTOLIN NEBULIZER) 1 botol 7,260 - - - -
25 SALEP 2 - 4 KOMBINASI 1 pot 2,200 - - - -
26 SEFADROKSIL TABLET 500 MG 100 ktk 10 x 10 tablet 557 - - - -
27 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 ampul 520,300 - - - -
28 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 1 ampul 1,050,280 - - - -
29 SURGICAL MASK (MASKER) 1 box / 50 36,300 - 100 - -

100 100
30 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 vial 139,150 - - - -
31 UNDERPAD STERIL 60 X 90 CM 1 pcs 7,626 - - - -
32 VAKSIN RABIES 1 vial 78,000 - - - -
33 VITAMIN B KOMPLEK 1000 botol 1000 tablet 31 - - - -
34 ANTASIDA DOEN TABLET KUNYAH 100 box 10 x 10 tablet 59 - - - -
35 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 box @ 100 ampul 1,848 - - - -
36 FLUOXETIN TABLET 20MG (ELIZAC) 30 box @ 30 tablet 668 - - - -
37 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 13,200 - - - -
LPLPO Halaman 29
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
38 MULTIVITAMIN NEUROTROPIK TABLET (TRIFANEURON) 100 box @ 100 tablet 828 - - - -
39 OXYMETAZOLINE HCL/ILIADIN SPRAY TETES HIDUNG 0,05% 1 botol 37,900 - - - -
40 OXYMETAZOLINE HCL/ILIADIN DROP TETES HIDUNG 0,025% 1 botol 36,000 - - - -
41 RISPERIDON TABLET 2 MG 100 box 10 x 10 tablet 347 - - - -
42 SPIRONOLACTONE 100 MG TABLET (2017) 100 box 10 x 10 tablet 745 - - - -
43 TRIFLUOPERAZINE DIHYDROCHLORIDE TABLET 5 MG 100 box 10 x 10 tablet 294 - - - -
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
OBAT YANG TIDAK TERBUAT DALAM FORM - - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- - - -
7
- - - -
8
- - - -
9
10
JUMLAH JUMLAH
10,992,935
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 25 Februari 2018
LPLPO Halaman 30
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 31
(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE : MARET TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : APRIL

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 - 20 20 - 20 88,520 57
3 ALOPURINOL TABLET 100 MG 100 box, 10 strip @ 10 tablet 95 - 300 300 110 190 18,050 200 100
4 ALOPURINOL TABLET 300 MG 100 box, 10 strip @ 10 tablet 244 100 0 100 - 100 24,400 150
5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 30 Dus 30 ampul @ 10 ml 4,204 - 0 - - - - 1
6 AMITRIPTILIN HCL TABLET SALUT 25 MG 100 Dus, 10 strip @ 10 tss 123 110 0 110 - 110 13,530 30
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 120 1,200 1,320 810 510 53,550 730 600 BON 900
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 600 900 1,500 1,100 400 93,200 900 1,000
11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 Btl @ 60 ml 2,200 - 60 60 13 47 103,400 50
12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 8 0 8 8 - - 32 50

13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 300 1,000 1,300 1,200 100 5,900 700
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 - 20 20 7 13 45,526 8 10 BON 10
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 50 0 50 - 50 67,500 10
16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - - - - -
17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - - - - -
18 ASAM ASETILSALISILAT 100 MG (ASETOSAL) 100 Tablet 153 90 0 90 90 - - 10 100

23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 - - - - 2 30
24 ASIKLOVIR 200 MG TABLET 100 ktk 10 x 10 tablet 272 - 100 100 - 100 27,200 90
25 ASIKLOVIR 400 MG TABLET 100 ktk 10 x 10 tablet 368 100 100 200 50 150 55,200 100
LPLPO Halaman 32
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 - 100 100 100 - - - 200 BON 100
28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 1 box @ 24 tube 4,782 10 0 10 7 3 14,346 2 24

29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - - - 50
30 BETAHISTINE TABLET 30 box @ 30 tablet 170 50 0 50 20 30 5,100 -

32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 82 0 82 20 62 19,654 5
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 - - - - 60

35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 100 100 200 200 - - 400 1,000
36 CLOZAPINE 25 MG 100 Tablet 1,550 110 0 110 40 70 108,500 30
37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 33 0 33 15 18 31,284 5
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 200 500 700 360 340 16,320 700 200
39 DIAZEPAM INJEKSI 5 MG / ML 1 Ampul 4,598 17 0 17 - 17 78,166 1
@ 2,5 ml
12,751 - 0 - - - - - 2
43 DIGOKSIN TABLET 0,25 MG 100 box 10 x 10 tablet 103 165 0 165 10 155 15,965 20
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 200 200 400 400 - - 100 200
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 10 0 10 5 5 17,450 8 50
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 5 0 5 2 3 17,010 1 6
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 - - - - -
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 5 0 5 1 4 28,156 -
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 - - - - 17 30 ED
56 FITOMENADION (VIT.K1) TABLET SALUT 10 MG 100 100 tablet/botol 796 - 100 100 100 - - 100 200
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 14 0 14 - 14 30,506 -
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 45 100 145 71 74 20,276 116 100
LPLPO Halaman 33
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 100 0 100 - 100 29,600 -
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 20 40 20 20 138,000 20
68 HIDROKORTISON KRIM 2,5% 1 Tube 2,868 19 0 19 11 8 22,944 5 24

69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 10 0 10 10 - - - 20
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 40 0 40 24 16 40,960 10 50
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - - - 1,000
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 100 0 100 - 100 9,800 120
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 - 800 800 500 300 20,700 500 400
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 90 600 690 600 90 6,210 90 700
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 - - - - -
77 KARBAMAZEPIN TABLET 200 MG 100 Dus, 10 strip @ 10 tablet 306 150 0 150 - 150 45,900 30
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 6 0 6 5 1 2,500 - 24
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 280 0 280 20 260 171,600 -
82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 19 0 19 3 16 26,240 5
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 30 0 30 15 15 57,750 - 25

84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 - 50 50 2 48 192,000 -
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 400 1,000 1,400 1,400 - - 900 2,000
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 100 Tablet 170 - - - - -
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 - - - - - 100

89 KODEIN 20 MG TABLET 100 Tablet 1,210 - - - - - 100
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 5 50 55 - 55 122,375 5
91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 100 Strip, ktk 10 x 10 tablet 158 90 0 90 - 90 14,220 10
LPLPO Halaman 34
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 - 500 500 220 280 95,480 400 300 BON 200
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 - - - - - 100

94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 49 0 49 - 49 103,978 7
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 106 0 106 106 - - 128 200
96 LORATADINE TABLET 100 box 10 x 10 tablet 149 300 0 300 100 200 29,800 -
98 MANITOL LARUTAN INFUS 20% 1 Botol 44,000 - - - - - 1

100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 - 700 700 300 400 47,600 500 300
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 30 100 130 - 130 31,200 100
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 400 0 400 400 - - 200
103 METILERGOMETRIN MALEAT INJEKSI 0,2 MG / ML 100 Dus, @ 100 ampul 2,684 40 40 40 107,360 43
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 100 Ktk 10 x 10 tablet salut 169 30 30 30 5,070 50
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 10 0 10 - 10 52,000 4
108 METRONIDAZOL TABLET 250 MG 100 10 strip @ 10 tablet 116 - - - - 70
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 - 300 300 200 100 14,000 - BON 300
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 10 0 10 10 - - 5 24

111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 - - - - - 2,000
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 - - - - 400 1,000
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 - - - - -
salut selaput
123 50 0 50 - 50 6,150 50
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 - - - - - 100
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 - - - - - 100
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 - - - - - 150

120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 400 3,000 3,400 2,600 800 46,400 2,200 2,500
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 4 0 4 - 4 74,540 -
LPLPO Halaman 35
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 2 2 4 3 1 2,344 3 2

126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 - - - - - 1
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 - - - - 1 2

salut selaput
119 200 1,500 1,700 1,500 200 23,800 1,200 1,500
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 40 120 160 160 - - 160
2,5 ml
4,000 20 0 20 20 - - - 20
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 - - - - 400 300
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 - - - - 0 200
139 SALISIL BEDAK 2 %- 50 G 1 Dus @ 50 gr 1,066 - 20 20 6 14 14,924 0
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 60 60 120 - 120 569,520 12
142 SEFOTAKSIM SERBUK INJEKSI 500 MG 1 Vial 6,485 90 90 76 492,860

0 14 10
143 SIANOKOBALAMIN (VIT B12) INJEKSI 500 MCG 1 Ampul 1,226 100 100 100 122,600
0 0 0
0 0 0
145 SIFIKSIM 100 MG 100 Kapsul 899 110
300
410
120
290 260,710
30 300 BON 300
146 SIMVASTATIN 10 MG TABLET 30 box @ 30 tablet 135 300
0
300
210
90 12,150
240 240
147 SIPROFLAKSASIN TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 298 30 130 80 23,840
100 50 80
0
149 TABLET TAMBAH DARAH ( SF ) 30 box @ 30 tablet 410 1,590 1,590 690 282,900
0 900 330
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 - 1 - -
1 1 0
0
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 - 300 130 12,610
300 170 0
1000
1,400
1300
100 13,200
1500 1500
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 - 200 100 59,200
200 100 100
0 6 12
- - - -
OBAT GIGI - - - -
LPLPO Halaman 36
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1
6 COMPOSIT A 2 (SOLARE X2) 4ml (kemasan kotak) 1 tube 303,050 - - - - 1

8 DEVITALISASI PASTA (NON ARSEN) / PULP-X 1 cup 216,469 - - - -

3
11 EUGENOL CAIRAN 10 ML 1 botol 20,815 -
1
1
1
- -
1
1
13 IODOFORM PASTA 1 kotak 216,465 - 1 - -
1 1
17 TAMBALAN SEMENTARA, premix (CAVITON)/ (CAVIT-W) 1 cup 128,895 -

1
1
1
- -
1
18 TKF 1 kotak 64,939 - - - -
20 CRESOPHENE (CRESOTIN) LIQUID 1 botol 303,050 - 1 - -

1 1
- - - -
1 AMBROXOL SIRUP 15 MG/ML 1 botol 60 ml 3,412 90 90 64 218,368

0 26 60
0
100
100
- -
700 700
3 ANTI FUNGI DOEN KOMBINASI (2016) 24 kotak @ 24 pot 3,960 - - - -
2
0 0 0
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 100
0
100
60
40 67,760
100 100
0 5 0
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 - - - -
0
0
0 20 0
0
11 FUROSEMID 40 MG 200 box 200 tablet 111 40 40 40 4,440
0 0 200
LPLPO Halaman 37
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 10 20 - -

10 20 20
13 GENTIAN VIOLET 1% 10 ML 1 botol 3,218 18
0
18
12
6 19,308
3 25
100
300
100
200 18,400
300 200
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 500 0 500 200 300 59,400 1000 1000
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 10 0 10 10 - - 0
22 MELOXICAM 15 MG TABLET 50 kotak 5 x 10 tablet 617 - - - - 0 1000

23 METAMIZOL INJEKSI (NORAGES) (2016) 5 5 ampul/kotak 9,680 - - - - 0 100
25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 80 0 80 70 10 48,400 0 100

27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 - 2800 2,800 0 2,800 518,000 840
30 OKSITETRASIKLIN SALEP MATA 1% 3,5 ML 25 kotak @ 25 tube 2,772 10 25 35 1 34 94,248 15
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 - - - - 0
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 1 1 2 0 2 97,900 2

41 SIRUP TAMBAH DARAH ANAK (SUPRABION) 1 botol 60 ml 7,750 - - - - 0 20
42 TABLET FLU (MASFLU) 100 box 100 tablet 300 - - - - 0 1000
43 TABLET FLU KOMBINASI (FLU DAN BATUK / RAMAFLU)) 100 kotak 10 x 10 tablet 400 - - - - 0 1000
LPLPO Halaman 38
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
46 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER)(2016) 1000 botol @ 1000 tablet 396 - - - - 74
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - - - - 0 100
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - - - - 0 1000
- - - -
BAKHP - - - -
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 31 0 31 31 - - 10 100

2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - 200 200 200 149,600 200 100
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 - 200 200 200 179,200 200 300
5 ALKOHOL 70% 1 botol 1000 ml 23,650 - 2 2 2 47,300 2 3
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 - 2 2 2 - - 2 3

8 CATGUT BEDAH NO. 3/0 + JARUM 1/2 GT 35 MM 24 1 24 X 75 cm/kotak 6,421 17 0 17 10 7 44,947 7 24
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 100 0 100 50 50 401,650 0 50
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 - 100 100 100 41,000 100 200
11 INFUSET ANAK 1 Set/kantong 4,025 17 0 17 15 2 8,050 3 50
15 IV CATHETER NO. 22 G 1 50 Buah/kotak 4,370 56 50 106 77 29 126,730 22 100

17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 Bungkus 14,375 2 0 2 1 1 14,375 0 2
18 KASA HIDROFIL 36 M X 80 CM 1 Rol 120,750 - - - - 0 2
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 - - - - 0
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 - - - - 0
22 MASKER 50 50 pcs/kotak 506 100 0 100 100 - - 100 200

23 PHARMAFIX 5 X 500 CM 1 roll 27,324 - - - - 2 3
26 RIVANOL 1 botol 300 cc 3,600 - - - - 0
LPLPO Halaman 39
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30 URINE BAG 1 Pcs 3,450 3 0 3 0 3 10,350 0
31 SAFETY BOX 1 kotak 18,073 - - - - 0
32 NEEDLE TERUMO 22 G 100 kotak 330 46 0 46 46 - - 10 100

33 NEEDLE TERUMO 25 G 100 kotak 330 53
0
53
53
- -
10 100
- - - -
1 ABATE 1 pail 25 kg - - - -
2,750,000

113
- - - -
3
3 BLOOD LANCETS 1 kotak isi 100
158
- - - -
3
4 DENGUE IgG / IgM 1 set isi 25
1,265,000
- - - -
1
5 DENGUE NS1 1 box 25 test
4,585,000
- - - -
1
151,250

176,225

20,000
- - - -
1
9 LARUTAN ASAM KLORIDA 0,1 N 100 ML/HCL 1 botol 100 ml
12,672
- - - -

273,600
- - - -

32,061
- - - -

74,100
- - - -

375,685

18,800
- - - -

19,800
- - - -

39,050
- - - -

367,650
18 LARUTAN POCK-PACK D (II) 1 botol

720,500
- - - -
1
19 LARUTAN POCK-PACK L (II) 1 botol 500 ml
2,310,000
- - - -
1
42,350
- - - -
1
23,750
- - - -
1
22 LYSOL 1 botol 1 liter - - - -
49,200
23 LIDI SWABB 1 pcs

1,669
- - - -
1
24 ONE CLEAN 1 boto 1 liter
16,520
- - - - 1
LPLPO Halaman 40
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2,132
26 REAGEN GOLONGAN DARAH ANTI A 1 1 set/10 ml

71,450
- - - -

71,450
- - - -

279,640
29 STIK GLUKO DR 1 kotak isi 50

6,379
- - - -
3
30 STIK PEMERIKSAAN ASAM URAT 1 kotak isi 25
5,239
- - - - 1
31 STIK PEMERIKSAAN HB 1 kotak isi 50
8,400
- - - - 3
32 STIK PEMERIKSAAN KOLESTEROL 1 kotak isi 10
23,566
- - - -
3
37,892
34 STIK URINE PARAMETER 3 1 kotak 100

1,265
- - - -
1
1,202

31,700

31,700

31,700

1,163,800

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000
46 TISUE LENSA MIKROSKOP 1 pcs

3,032
- - - -
47 XYLOL 1 botol/100 ml 69,400 - - - -

223,850

65,900

49,200

9,400
52 WATER ONE/AQUDEST 1 botol 1 liter

31,400
- - - -
1
- - - -
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - -
LPLPO Halaman 41
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
23 RINGER LAKTAT LARUTAN INFUS 1 botol 500 ml 7,150 - - - -
29 SURGICAL MASK (MASKER) 1 box / 50 36,300 - - - -
LPLPO Halaman 42
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- - - -
7
- - - -
8
- - -
9
JUMLAH JUMLAH
10,066,261
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 25 Maret 2018
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 43
(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE : MARET TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : APRIL

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 20 0 20 - 20 88,520 57
3 ALOPURINOL TABLET 100 MG 100 box, 10 strip @ 10 tablet 95 190 100 290 50 240 22,800 200
5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 30 Dus 30 ampul @ 10 ml 4,204 - - - - 1
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 25 0 25 25 - - 180 600

8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 510 600 1,110 1,050 60 6,300 730 1,500
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 400 1,000 1,400 1,100 300 69,900 900 1,500
10 AMOKSISILIN SERBUK INJEKSI 1000 MG 1 10 vial / kotak 8,135 - 0 - - - - 0
11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 Btl @ 60 ml 2,200 47 0 47 37 10 22,000 50 50

12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 - 0 - - - - 32 50
13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 100 1,500 1,600 800 800 47,200 700 200
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 13 30 43 13 30 105,060 8
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 50 0 50 40 10 13,500 10 100

16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - - - - 0
17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - - - - 0
18 ASAM ASETILSALISILAT 100 MG (ASETOSAL) 100 Tablet 153 - 100 100 - 100 15,300 10
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 400 0 400 200 200 24,000 400 200
21 ASAM MEFENAMAT TABLET 250 MG 100 Tablet 150 - - - - 0
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 100 2,000 2,100 2,100 - - 1400 2,500
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 - 30 30 5 25 63,400 2
24 ASIKLOVIR 200 MG TABLET 100 ktk 10 x 10 tablet 272 100 0 100 - 100 27,200 90
LPLPO Halaman 44
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 - 100 100 - 100 17,300 0
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - - 0 20

30 BETAHISTINE TABLET 30 box @ 30 tablet 170 30 0 30 30 - - 0 60
34 CETRIZINE SIRUP 5 MG/5 ML 1 botol 60 ml 7,756 62 0 62 51 11 85,316 40 50

35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 - - - - 400
37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 18 0 18 11 7 12,166 5 100
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 340 400 740 100 640 30,720 700

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 - - - - 0
@ 2,5 ml
41 DIAZEPAM TABLET 2 MG 100 100 tablet/botol 46 106 0 106 - 106 4,876 22
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 1 Ampul @ 1 ml 1,355 30 0 30 - 30 40,650 28
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 - 200 200 100 100 11,400 100
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 3 0 3 - 3 17,010 1

50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 - - - - 0 100
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 4 0 4 - 4 28,156 0
52 FENITOIN NATRIUM KAPSUL 100 MG 100 Botol @ 100 154 - - - - 0
53 FENOBARBITAL INJEKSI 50 MG/ML-2ML 30 ktk 30 ampul @ 1 ml 1,980 - - - - 0
54 FENOBARBITAL TABLET 30 MG 100 100 tablet/botol 68 - - - - 0
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 - - - - 17 30

56 FITOMENADION (VIT.K1) TABLET SALUT 10 MG 100 100 tablet/botol 796 - 200 200 - 200 159,200 100
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 14 0 14 14 30,506 0
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 74 100 174 74 100 27,400 116
LPLPO Halaman 45
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
59 GENTAMISIN TETES MATA 0,3% 1 Botol 4,600 19 24 43 19 24 110,400 8
60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 100 0 100 - 100 29,600 0
61 GLIMEPIRIDE 4MG TABLET 50 box @ 50 tablet 330 - 0 - - - - 0
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 0 20 - 20 138,000 20
63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 100 ktk 10 x 10 tablet 224 40 0 40 10 30 6,720 40 100
64 HALOPERIDOL TABLET 0,5 MG 100 Dus, 10 blister @ 10 tablet 64 - - - - 0
65 HALOPERIDOL TABLET 1,5 MG 100 Dus, 10 blister @ 10 tablet 76 200 300 500 340 160 12,160 90 300
66 HALOPERIDOL TABLET 5 MG 100 Dus, 10 blister @ 10 tablet 105 - - - - 0
67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 100 Tablet 171 170 0 170 - 170 29,070 0
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 - - - - 0
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 16 50 66 34 32 81,920 10 50

71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - - 0
72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - - 0 1,000

73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 100 0 100 100 - - 120 200
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 300 400 700 700 - - 500 1,000
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 90 0 90 - 90 6,210 90
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 - 500 500 400 100 7,200 0 500
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 1 24 25 - 25 62,500 0
79 KETOKENAZOLE CREAM 2% 1 tube 10 gr 2,605 6 0 6 6 - - 10 20

80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 260 0 260 15 245 161,700 0
81 KLORAMFENIKOL KAPSUL 500 MG 100 Kapsul 1,155 110 0 110 - 110 127,050 0
82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 16 0 16 - 16 26,240 5
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 15 20 35 15 20 77,000 0
84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 48 0 48 1 47 188,000 0
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 - 1,500 1,500 1,200 300 13,500 900 1,000
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 245 0 245 240 5 895 220 300
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 100 Tablet 170 - - - - 0
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 - - - - 0 100

89 KODEIN 20 MG TABLET 100 Tablet 1,210 - - - - 0 100
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 55 0 55 - 55 122,375 5
LPLPO Halaman 46
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 - 100 100 100 92,900 0
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 49 0 49 19 30 63,660 7
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 - - - - 128
96 LORATADINE TABLET 100 box 10 x 10 tablet 149 200 0 200 200 - - 0 600
97 MAGNESIUM SULFAT INJEKSI 20% (MGSO4 20%) (2017) 1 vial 3,200 10 0 10 - 10 32,000 0
99 METAMIZOL INJEKSI (ANTALGIN) 500 MG/ML 1 box @ 100 ampul 3,050 - - - - 0 100
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 400 300 700 600 100 11,900 500 600
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 130 0 130 - 130 31,200 100
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 - - - - 200 1,000
103 METILERGOMETRIN MALEAT INJEKSI 0,2 MG / ML 100 Dus, @ 100 ampul 2,684 40 0 40 - 40 107,360 43
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 100 Ktk 10 x 10 tablet salut 169 30 0 30 - 30 5,070 50
106 METOCLOPRAMIDE SIRUP 5MG/ML (LEXAPRAM) 1 botol 60 ml 2,750 - - - - 0
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 30 200 230 30 200 20,000 116
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 100 0 100 - 100 14,000 0
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 - 24 24 24 89,688 5
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 - 2,040 2,040 1,230 810 383,940 0 600
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 - - - - 500 500
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 - - - - 0
salut selaput
123 50 0 50 10 40 4,920 50
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 - - - - 0 100
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 - - - - 0 100
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 84 0 84 - 84 159,600 0
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 - - - - 0
119 PARASETAMOL SIRUP 120 MG/5 ML 1 Btl @ 60 ml 1,013 135 150 285 104 181 183,353 193
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 800 2,000 2,800 2,200 600 34,800 2200 2,000
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 5 0 5 - 5 60,775 1
122 PIRANTEL TABLET SCORE (BASE) 125 MG 100 Dus, 10 strip @ 10 tablet 318 - - - - 0
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 60 0 60 60 - - 70 500

124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 4 0 4 1 3 55,905 0
LPLPO Halaman 47
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 1 0 1 1 - - 3
126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 - 1 1 1 - - 0
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 - 2 2 1 1 15,386 1
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 170 200 370 370 31,450 90
129 PROPANOLOL TABLET 10 MG (HCL) 100 Dus, 10 strip @ 10 tablet 80 100 100 100 8,000 0
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - - - - 0 100

salut selaput
119 200 1,000 1,200 1,200 - - 1200 1,500
132 RETINOL (VITAMIN A) 100.000 IU 50 Botol 50 kapsul 286 - - - - 0
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 - 160 160 160 - - 160
2,5 ml
4,000 - 20 20 - 20 80,000 0
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 - 300 300 100 200 13,600 400
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 - 0 - 0 - - 0
139 SALISIL BEDAK 2 %- 50 G 1 Dus @ 50 gr 1,066 14 0 14 1 13 13,858 0
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 40 200 240 90 150 83,550 75
142 SEFOTAKSIM SERBUK INJEKSI 500 MG 1 Vial 6,485 76

0
76
72
4 25,940 10 70
143 SIANOKOBALAMIN (VIT B12) INJEKSI 500 MCG 1 Ampul 1,226 100 100 100 122,600 0
0 0
144 SIANOKOBALAMIN (VIT B12) TABLET 50 MCG 100 Dus, 10 strip @ 10 tablet 63 250 250 250 15,750 0
0 0
145 SIFIKSIM 100 MG 100 Kapsul 899 290 290 240 215,760 30
0 50
146 SIMVASTATIN 10 MG TABLET 30 box @ 30 tablet 135 90 330 150 20,250 240
240 180

0
80
50
30 8,940 80 100
148 SPIRONOLACTONE 100 MG (2016) 100 Tablet 1,000 - - - - 0
149 TABLET TAMBAH DARAH ( SF ) 30 box @ 30 tablet 410 690 690 210 86,100 330
0 480
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 - - - - 0
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 100 Tablet 91 - - - - 0
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 130

0
130
130
- - 0 300
0
100
20
80 10,560 1500 1700
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 100 100 80 47,360 100
0 20
155 ZINC DSIRUP 20MG/ML (ZIRCUM KID) 1 botol 60 ml 6,500 42

0
42
26
16 104,000 12 50
- - - - 0
OBAT GIGI - - - - 0
LPLPO Halaman 48
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 ARTICULATING PAPER 1 kotak/12 strip 128,700 - - - - 0
2 BODING LIQUID (MASTERBOND) 1 botol 281,404 -

1
1
1
- - 0 1
3 CELULOID PASTA 1 strip 150,000 - - - - 0
4 COMPOSIT A 2 (SOLARE X2) 2ml (kemasan plastik) 1 tube 214,300 - - - - 0 1

5 COMPOSIT A 3 (SOLARE X3) 2ml (kemasan plastik) 1 tube 214,300 -
1
1
1
- - 0 1
6 COMPOSIT A 2 (SOLARE X2) 4ml (kemasan kotak) 1 tube 303,050 - 1 - - 0
1 1
8 DEVITALISASI PASTA (NON ARSEN) / PULP-X 1 cup 216,469 - - - - 0
9 ETCHING (ETCHING GEL) / SCHOTCHBOND 1 tube 175,120 - - - - 0 1

10 ETIL KLORIDA SPRAY 100 ML 1 vial/Can/ 100 ml 110,000 - - - - 0 1
11 EUGENOL CAIRAN 10 ML 1 botol 20,815 - - - - 0
12 GLASS IONOMER CEMENT (FUJI GC IX) 1 5 gr/kotak 512,859 - 1 - - 0

1 1
13 IODOFORM PASTA 1 kotak 216,465 - - - - 0 2

14 KALSIUM HIDROKSIDA PASTA (CALPUS)/ (HYDCAL) 1 kotak 78,716 - - - - 0
15 MONOKLORKAMFER MENTOL CAIRAN 10 ML / CHKM (CHAMFENOL) 1 botol 54,117 - - - - 0
16 SEMEN SENG FOSFAT SERBUK DAN CAIRAN- 30 G 1 botol 162,349 - - - - 0

1
1
1
- - 0 1
18 TKF 1 kotak 64,939 - - - - 0
19 ZINC PHOSPHAT 1 pot 198,000 - - - - 0
20 CRESOPHENE (CRESOTIN) LIQUID 1 botol 303,050 - - - - 0
- - - - 0
OBAT PENUNJANG - - - - 0
1 AMBROXOL SIRUP 15 MG/ML 1 botol 60 ml 3,412 64 64 64 218,368 60
2 AMBROXOL TABLET 30 MG 100 box 10 x 10 tablet 139 -

500
500
400
100 13,900 700 1000
3 ANTI FUNGI DOEN KOMBINASI (2016) 24 kotak @ 24 pot 3,960 - - - - 2
4 ANTIMIGRAIN (ERGOTAMINE) TABLET 100 botol 100 tablet 134 200 200 200 26,800 0
0 0
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 40 140 100 169,400 100
100 40
6 ASIKLOVIR KRIM 5% 25 box 25 tube 4,465 18 18 16 71,440 0

0 2
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 - - - - 0
8 DIAZEPAM 2MG TABLET (2017) 100 botol @ 100 tablet 50 - - - - 0
9 BISAKODIL TABLET 5 MG (MELAXAN) (2015) 40 40 tablet/kotak 675 62 62 62 41,850 0

0 0
10 FENOBARBITAL 30 MG TABLET (2017) 100 botol @ 100 tablet 216 - - - - 0
11 FUROSEMID 40 MG 200 box 200 tablet 111 40 440 370 41,070 200
400 70
LPLPO Halaman 49
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 - - - - 20

0
6
6
- - 3 24
200
400
200
200 18,400 300 200
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 300 0 300 300 - - 1000 1000
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 - - - - 0 100


25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 10 0 10 10 - - 0 100

27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 2,800 0 2,800 2300 500 92,500 840 1800
29 OKSITETRASIKLIN SALEP KULIT 25 kotak @ 25 tube 2,000 20 0 20 15 5 10,000 0 24

33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 - - - - 0 100

35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 - - - - 0 3


LPLPO Halaman 50
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
- - - - 0
BAKHP - - - - 0
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 - 100 100 0 100 106,400 10
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 200 100 300 200 100 74,800 200 100
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 200 0 200 200 - - 200 300
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 - - - - 100
5 ALKOHOL 70% 1 botol 1000 ml 23,650 2 1 3 2 1 23,650 2 2

7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 - - - - 2
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 100 0 100 50 50 20,500 100 50

17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 Bungkus 14,375 1 2 3 2 1 14,375 0 2

18 KASA HIDROFIL 36 M X 80 CM 1 Rol 120,750 - 2 2 2 - - 0 2
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 - 20 20 13 7 64,400 0 10
20 KASA PEMBALUT HIDROFIL 4 M X 10 CM 1 Rol 667 7 0 7 7 - - 0 10
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 - - - - 0 20
22 MASKER 50 50 pcs/kotak 506 - - - - 200 200
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 - 3 3 3 - - 5 5
26 RIVANOL 1 botol 300 cc 3,600 - - - - 0
LPLPO Halaman 51
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 50 0 50 50 57,500 0
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 30 0 30 30 143,640 0
30 URINE BAG 1 Pcs 3,450 3 0 3 3 10,350 0
31 SAFETY BOX 1 kotak 18,073 - - - - 0
32 NEEDLE TERUMO 22 G 100 kotak 330 - - - - 10 100

33 NEEDLE TERUMO 25 G 100 kotak 330 - - - - 10 100
34 3M 1870+AURA N95 GENERAL RESPIRATOR (MASKER P2TB) 1 box @20pcs 21,000 - - - - 0 20
- - - - 0
REAGEN LABORATORIUM - - - - 0
1 ABATE 1 pail 25 kg - - - - 0
2,750,000

113
-
3
3
3
- - 0 2
158
-
3
3
3
- - 0 2
4 DENGUE IgG / IgM 1 set isi 25 - - - - 0
1,265,000
5 DENGUE NS1 1 box 25 test - - - - 0

4,585,000
6 HB SAHLI 1 pcs - - - - 0
151,250
7 LARUTAM EOSIN 2% 100 ML 1 botol 100 ml - - - - 0

176,225
8 LARUTAN ASAM ASETAT 6% 1 botol 100 ml - 1 - - 0

20,000 1 1

12,672
- - - - 0

273,600
- - - - 0

32,061
- - - - 0

74,100
- - - - 0 1
13 LARUTAN GIEMSA STAIN 100 ML 1 botol 100 ml - - - - 0
375,685

18,800
- - - - 0

19,800
- - - - 0

39,050
- - - - 0
17 LARUTAN OIL EMERSI 1 botol 50 cc - - - - 0

367,650

720,500
- - - - 0 3
2,310,000
- - - - 0 3
42,350
-
1
1
1
- - 0 2
23,750
-
1
1
1
- - 0 2
22 LYSOL 1 botol 1 liter - - - - 0
49,200 0
23 LIDI SWABB 1 pcs

1,669
- - - - 0

16,520
-
1
1
1
- - 0 3
LPLPO Halaman 52
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
25 PP TEST 1 50 strip/kotak - - - - 0
2,132

71,450
- - - - 0 1
71,450
- - - - 0 1
28 REAGEN WIDAL TEST 1 kit 20 ml
279,640
- - - - 0 1
6,379
-
3
3
3
- - 0 3
30 STIK PEMERIKSAAN ASAM URAT 1 kotak isi 25 - 1 - - 0
5,239 1 1
31 STIK PEMERIKSAAN HB 1 kotak isi 50 - 1 - - 0

8,400 1 1

23,566
-
3
3
3
- - 0 2
33 STIK PEMERIKSAAN TRIGLISERIDA (TG) 1 kotak isi 25 - - - - 0
37,892
34 STIK URINE PARAMETER 3 1 kotak 100 - - - - 0

1,265
35 STIK URINE PROTEIN 1 kotak - - - - 0

1,202
36 STIK AMPHETAMINE 1 kotak @25 pcs - - - - 0

31,700
37 STIK BENZODIAZEPINE 1 kotak @25 pcs - - - - 0

31,700
38 STIK THC 1 kotak @25 pcs - - - - 0

31,700
39 REAGEN DIRUI CLEANSER 1 botol

1,163,800
- - - - 0 3
40 REAGEN DIRUI DILUENT 1 botol
2,340,000
- - - - 0 3
41 REAGEN DIRUI LYSE 1 botol - - - - 0
3,782,000
42 REAGEN FOTOMETER ASAM URAT 1 botol - - - - 0

2,365,000
43 REAGEN FOTOMETER GLUCOSA 1 botol - - - - 0

1,733,000
44 REAGEN FOTOMETER KOLESTEROL 1 botol - - - - 0

2,643,000
45 REAGEN FOTOMETER TRIGLISERID 1 botol - - - - 0

3,820,000

3,032
- - - - 0
47 XYLOL 1 botol/100 ml 69,400 - - - - 0
48 ZIEHL NELSEN 1 set - - - - 0

223,850
49 HIV TEST 1 kotak @25 pcs - - - - 0

65,900
50 SPIRITUS 1 botol 1 liter

49,200
- - - - 0 1
51 SPECULUM ONEMED UK. S, M, L 1 pcs - - - - 0
9,400

31,400
- - - - 0 2
- - - - 0
OBAT BUFFER PROPINSI - - - - 0
1 ABATE 1 kaleng 25 kg 2,340,000 - - - - 0
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - - 0
3 AMOKSISILIN KAPLET 500 MG 100 ktk 10 x 10 kaplet 279 - - - - 0
LPLPO Halaman 53
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
4 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 botol 60 ml 2,560 - - - - 0
5 ASAM MEFENAMAT 500 MG 100 kotak 10 x 10 tablet 113 - - - - 0
6 BIONEURON TABLET 100 kotak 10 x 10 tablet 1,081 - - - - 0
7 BISTURI (Pisau Bedah) 1 ktk 100 50,000 - - - - 0
8 FENOBARBITAL TABLET 30 MG 1 botol 100 tablet 68 - - - - 0
9 HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU 1 vial 170,000 - - - - 0
10 IV CATHETER NO. 22 G 1 kotak 50 buah 8,566 - - - - 0
12 KAPAS PEMBALUT 250 GR (2017) 1 bungkus 8,250 - - - - 0
13 KASA PEMBALUT HIDROFIL 4 m x 10 cm 50 roll/50 668 - - - - 0
14 KOTRIMOKSAZOL SUSPENSI 60 ML 1 botol 60 ml 2,225 - - - - 0
15 LIVRON B-PLEK TABLET 100 kotak 10 x 10 tablet 237 - - - - 0
16 NEDDLE NO. 23 1 ktk 100 275 - - - - 0
17 NEDDLE NO. 25 1 ktk 100 275 - - - - 0
18 NISTATIN TABLET SALUT 500.000 UI/G 100 ktk 10 x 10 tablet 704 - - - - 0
19 NISTATIN VAGINAL TABLET SALUT 100.000 UI/G 100 ktk 10 x 10 tablet 448 - - - - 0
20 PARASETAMOL 500 MG TABLET 100 kotak 10 x 10 tablet 88 - - - - 0
21 PARASETAMOL DROPS 1 botol 15 ml 5,980 - - - - 0
22 PERMETRIN KRIM 5% (SCABIMITE CREAM) 1 tube 11,475 - - - - 0
23 RINGER LAKTAT LARUTAN INFUS 1 botol 500 ml 7,150 - - - - 0
24 SALBUTAMOL CAIRAN IH 0,1% (VENTOLIN NEBULIZER) 1 botol 7,260 - - - - 0
25 SALEP 2 - 4 KOMBINASI 1 pot 2,200 - - - - 0
26 SEFADROKSIL TABLET 500 MG 100 ktk 10 x 10 tablet 557 - - - - 0
27 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 ampul 520,300 - - - - 0
28 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 1 ampul 1,050,280 - - - - 0
29 SURGICAL MASK (MASKER) 1 box / 50 36,300 - - - - 0
30 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 vial 139,150 - - - - 0
31 UNDERPAD STERIL 60 X 90 CM 1 pcs 7,626 - - - - 0
32 VAKSIN RABIES 1 vial 78,000 - - - - 0
33 VITAMIN B KOMPLEK 1000 botol 1000 tablet 31 - - - - 0
34 ANTASIDA DOEN TABLET KUNYAH 100 box 10 x 10 tablet 59 - - - - 0
35 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 box @ 100 ampul 1,848 - - - - 0
36 FLUOXETIN TABLET 20MG (ELIZAC) 30 box @ 30 tablet 668 - - - - 0
LPLPO Halaman 54
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
37 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 13,200 - - - - 0
38 MULTIVITAMIN NEUROTROPIK TABLET (TRIFANEURON) 100 box @ 100 tablet 828 - - - - 0
39 OXYMETAZOLINE HCL/ILIADIN SPRAY TETES HIDUNG 0,05% 1 botol 37,900 - - - - 0
40 OXYMETAZOLINE HCL/ILIADIN DROP TETES HIDUNG 0,025% 1 botol 36,000 - - - - 0
41 RISPERIDON TABLET 2 MG 100 box 10 x 10 tablet 347 - - - - 0
42 SPIRONOLACTONE 100 MG TABLET (2017) 100 box 10 x 10 tablet 745 - - - - 0
43 TRIFLUOPERAZINE DIHYDROCHLORIDE TABLET 5 MG 100 box 10 x 10 tablet 294 - - - - 0
44 URINE BAG 1 PCS 3,150 - - - - 0
- - - - 0
OBAT YANG TIDAK TERBUAT DALAM FORM - - - - 0
- - - - 0
1
- - - - 0
2
- - - - 0
3
- - - - 0
4
- - - - 0
5
- - - - 0
6
- - - - 0
7
- - - -
8
- - - -
9
JUMLAH JUMLAH
10,233,848
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 25 April 2018
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 55
(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE MEI TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : JUNI

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 60 0 60 - 60 265,560 57
5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 30 Dus 30 ampul @ 10 ml 4,204 - 0 - - - - 1
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 - 210 210 60 150 24,450 180
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 300 1,000 1,300 800 500 116,500 900 1,000
10 AMOKSISILIN SERBUK INJEKSI 1000 MG 1 10 vial / kotak 8,135 - - - - 0
11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 Btl @ 60 ml 2,200 10 60 70 40 30 66,000 50 50

12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 - - - - 32 50
13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 800 1,200 2,000 1,500 500 29,500 700 1,500
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 10 100 110 110 - - 10 200
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 200 200 400 400 - - 400 500
20 ASAM FOLAT 1 MG 100 Tablet 68 400 0 400 - 400 27,200 110
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 - 3,000 3,000 1,400 1,600 180,800 1400 1,000 BON 1500
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 25 0 25 - 25 63,400 2
LPLPO Halaman 56
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 100 0 100 - 100 17,300 0
27 ANTIBAKTERI DOEN SALEP KOMBINASI (BASITRACIN) 1 box @ 25 tube 3,365 15 0 15 11 4 13,460 19 25

29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - - 0 50

30 BETAHISTINE TABLET 30 box @ 30 tablet 170 - 60 60 10 50 8,500 0
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 - 50 50 25 25 36,250 26

35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 - - - - 400 1,000
36 CLOZAPINE 25 MG 100 Tablet 1,550 70 0 70 60 10 15,500 30 200

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 - - - - 0
@ 2,5 ml
44 DILTIAZEM HCL TABLET 30 MG 100 ktk 10 x 10 tablet 137 150 0 150 10 140 19,180 20
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 100 0 100 - 100 11,400 100
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 3 0 3 - 3 17,010 1 10
49 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 Dus @ 30 ampul 2,354 - - - - 2
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 - - - - 0
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 4 0 4 - 4 28,156 0
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 - 30 30 3 27 110,241 17
56 FITOMENADION (VIT.K1) TABLET SALUT 10 MG 100 100 tablet/botol 796 200 0 200 - 200 159,200 100
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 14 0 14 - 14 30,506 0
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 100 0 100 100 - - 116 100
LPLPO Halaman 57
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 100 0 100 50 50 14,800 0
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 0 20 20 - - 20 40

63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 100 ktk 10 x 10 tablet 224 30 0 30 10 20 4,480 40 100
67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 100 Tablet 171 170 0 170 - 170 29,070 0 24
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 32 50 82 27 55 140,800 10
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - - 0 1,000

72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - - 0 1,000
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 - 200 200 - 200 19,600 120
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 - 1,000 1,000 600 400 27,600 500 400
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 90 0 90 - 90 6,210 90 200
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 100 500 600 500 100 7,200 0 500
77 KARBAMAZEPIN TABLET 200 MG 100 Dus, 10 strip @ 10 tablet 306 100 0 100 60 40 12,240 30 200
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 25 0 25 10 15 37,500 0
79 KETOKENAZOLE CREAM 2% 1 tube 10 gr 2,605 - 25 25 5 20 52,100 10
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 245 0 245 - 245 161,700 0
81 KLORAMFENIKOL KAPSUL 500 MG 100 Kapsul 1,155 110 0 110 70 40 46,200 0 100
82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 16 0 16 10 6 9,840 5 25
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 20 0 20 6 14 53,900 0
84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 47 0 47 - 47 188,000 0
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 300 1,000 1,300 1,000 300 13,500 900 100
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 - 100 100 - 100 55,000 0
89 KODEIN 20 MG TABLET 100 Tablet 1,210 - 100 100 - 100 121,000 0
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 55 0 55 2 53 117,925 5
91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 100 Strip, ktk 10 x 10 tablet 158 90 0 90 60 30 4,740 10 200
LPLPO Halaman 58
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 - 800 800 300 500 170,500 400
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 100 0 100 - 100 92,900 0
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 30 0 30 - 30 63,660 7
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 - - - - 128 100

96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - - - - 0 1,000
98 MANITOL LARUTAN INFUS 20% 1 Botol 44,000 - - - - 0 1

99 METAMIZOL INJEKSI (ANTALGIN) 500 MG/ML 1 box @ 100 ampul 3,050 - - - - 0 100
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 130 0 130 139 (9) (2,160) 100 300
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 - 500 500 400 100 20,900 200 1,000
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 100 Ktk 10 x 10 tablet salut 169 30 100 130 5 125 21,125 50
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 5 0 5 - 5 26,000 4
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 100 0 100 70 30 4,200 0 200
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 24 0 24 22 2 7,474 5 24
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 810 600 1,410 60 1,350 639,900 0
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 - 1,500 1,500 350 1,150 185,150 500
salut selaput
123 40 0 40 20 20 2,460 50 100
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 - 100 100 - 100 70,400 0
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 - 100 100 - 100 44,800 0
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 84 0 84 12 72 136,800 0
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 600 2,000 2,600 2,400 200 11,600 2200 2,500
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 - 500 500 210 290 39,440 70
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 3 0 3 2 1 18,635 0
LPLPO Halaman 59
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 - - - - 3
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 1 0 1 - 1 15,386 1
129 PROPANOLOL TABLET 10 MG (HCL) 100 Dus, 10 strip @ 10 tablet 80 100 0 100 - 100 8,000 0
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - - - - 0 100

131 RANITIDIN TABLET l50 MG 100 Dus, 10 strip @ 10 tablet 119 - 1,200 1,200 1,100 100 11,900 1200
salut selaput
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 - - - - 160 160
2,5 ml
4,000 20 0 20 10 10 40,000 0
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 200 0 200 200 - - 400 300
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 150 0 150 150 - - 75 300
142 SEFOTAKSIM SERBUK INJEKSI 500 MG 1 Vial 6,485 4 74 24 155,640 10

70 50
0 10
0 0
145 SIFIKSIM 100 MG 100 Kapsul 899 240

0
240
240
- - 30 300
0
150
150
- - 240 300
100
130
130
- - 80 200
149 TABLET TAMBAH DARAH ( SF ) 30 box @ 30 tablet 410 210 210 - - 330
0 210
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 - - - - 0 1
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 100 Tablet 91 - - - - 0
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 -

300
300
260
40 3,880 0 300
1500
1,580
1480
100 13,200 1500 1500
0
80
80
- - 100 200
155 ZINC DSIRUP 20MG/ML (ZIRCUM KID) 1 botol 60 ml 6,500 16 66 10 65,000 12
50 56
- - - - 0
OBAT GIGI - - - - 0
LPLPO Halaman 60
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2 BODING LIQUID (MASTERBOND) 1 botol 281,404 - 1 - - 0

1 1
4 COMPOSIT A 2 (SOLARE X2) 2ml (kemasan plastik) 1 tube 214,300 - 1 - - 0

1 1
5 COMPOSIT A 3 (SOLARE X3) 2ml (kemasan plastik) 1 tube 214,300 - 1 - - 0

1 1
9 ETCHING (ETCHING GEL) / SCHOTCHBOND 1 tube 175,120 - 1 - - 0

1 1
10 ETIL KLORIDA SPRAY 100 ML 1 vial/Can/ 100 ml 110,000 - 1 - - 0

1 1
12 GLASS IONOMER CEMENT (FUJI GC IX) 1 5 gr/kotak 512,859 - - - - 0
13 IODOFORM PASTA 1 kotak 216,465 - 2 - - 0

2 2
17 TAMBALAN SEMENTARA, premix (CAVITON)/ (CAVIT-W) 1 cup 128,895 - 1 - - 0

1 1
18 TKF 1 kotak 64,939 - - - - 0
- - - - 0

0
64
46
18 61,416 60 50
0
100
100
- - 700 1000
0 0
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 100 100 50 84,700 100
0 50
6 ASIKLOVIR KRIM 5% 25 box 25 tube 4,465 16

0
16
11
5 22,325 0 25
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 - - - - 0

0 0
0 0
LPLPO Halaman 61
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 - - - - 20
13 GENTIAN VIOLET 1% 10 ML 1 botol 3,218 - - - - 3

100
300
200
100 9,200 300 300
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 - - - - 1000
16 HYOSCINE-N- BUTILBROMIDE 10 mg TABLET (SCOPMA) 100 kotak 10 x 10 tablet 1,036 30 0 30 30 - - 70 200

17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 - 100 100 41 59 584,100 0
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 - 25 25 11 14 106,400 0 5

25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 - - - - 0 100

26 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 7,700 43 0 43 8 35 269,500 50
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 500 1800 2,300 800 1,500 277,500 840
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 - 100 100 40 60 205,440 0
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 2 0 2 2 - - 2 5

35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 - 3 3 3 115,500 0

LPLPO Halaman 62
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
- - - - 0
BAKHP - - - - 0
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 - 300 300 0 300 268,800 200
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 - - - - 100
5 ALKOHOL 70% 1 botol 1000 ml 23,650 1 2 3 1 2 47,300 2
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 - - - - 2
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 50 100 150 100 50 20,500 100
11 INFUSET ANAK 1 Set/kantong 4,025 50 50 50 - - 3
12 INFUSET DEWASA 1 Set/kantong 3,680 14 50 64 64 - - 100
18 KASA HIDROFIL 36 M X 80 CM 1 Rol 120,750 - 2 2 1 1 120,750 0
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 7 10 17 6 11 101,200 0
20 KASA PEMBALUT HIDROFIL 4 M X 10 CM 1 Rol 667 - 10 10 10 - - 0
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 - 20 20 20 - - 0
22 MASKER 50 50 pcs/kotak 506 - 200 200 100 100 50,600 200
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 - 5 5 4 1 27,324 5
26 RIVANOL 1 botol 300 cc 3,600 - - - - 0
LPLPO Halaman 63
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30 URINE BAG 1 Pcs 3,450 3 0 3 2 1 3,450 0
31 SAFETY BOX 1 kotak 18,073 - - - - 0
32 NEEDLE TERUMO 22 G 100 kotak 330 - 100 100 0 100 33,000 10
33 NEEDLE TERUMO 25 G 100 kotak 330 - 100 100 33,000 10

100 0
34 3M 1870+AURA N95 GENERAL RESPIRATOR (MASKER P2TB) 1 box @20pcs 21,000 - 20 - - 0

20 20
- - - - 0
1 ABATE 1 pail 25 kg - - - - 0
2,750,000

113
- 2 - - 0
2 2

158
- 2 - - 0
2 2
4 DENGUE IgG / IgM 1 set isi 25 - - - - 0

1,265,000
5 DENGUE NS1 1 box 25 test - - - - 0

4,585,000
6 HB SAHLI 1 pcs - - - - 0
151,250

176,225
8 LARUTAN ASAM ASETAT 6% 1 botol 100 ml - - - - 0

20,000

12,672
- - - - 0

273,600
- - - - 0

32,061
- - - - 0

74,100
- - - - 0

375,685

18,800
- - - - 0

19,800
- - - - 0

39,050
- - - - 0
17 LARUTAN OIL EMERSI 1 botol 50 cc - - - - 0

367,650
18 LARUTAN POCK-PACK D (II) 1 botol - - - - 0

720,500
19 LARUTAN POCK-PACK L (II) 1 botol 500 ml - - - - 0

2,310,000

42,350
- 1 - - 0
1 1

23,750
- 1 - - 0
1 1

49,200
23 LIDI SWABB 1 pcs

1,669
- - - - 0

16,520
- 1 - - 0
1 1
LPLPO Halaman 64
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
25 PP TEST 1 50 strip/kotak - - - - 0
2,132

71,450
- - - - 0

71,450
- - - - 0
28 REAGEN WIDAL TEST 1 kit 20 ml - 1 - - 0

279,640 1 1
29 STIK GLUKO DR 1 kotak isi 50 - 3 - - 0

6,379 3 3
30 STIK PEMERIKSAAN ASAM URAT 1 kotak isi 25 - - - - 0

5,239
31 STIK PEMERIKSAAN HB 1 kotak isi 50 - - - - 0

8,400
32 STIK PEMERIKSAAN KOLESTEROL 1 kotak isi 10 - 2 - - 0

23,566 2 2

37,892
34 STIK URINE PARAMETER 3 1 kotak 100 - - - - 0

1,265

1,202

31,700

31,700

31,700
39 REAGEN DIRUI CLEANSER 1 botol - - - - 0

1,163,800
40 REAGEN DIRUI DILUENT 1 botol - - - - 0

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - - 0
47 XYLOL 1 botol/100 ml 69,400 - - - - 0

223,850

65,900
50 SPIRITUS 1 botol 1 liter - 1 - - 0

49,200 1 1

9,400
52 WATER ONE/AQUDEST 1 botol 1 liter - 1 - - 0

31,400 1 1
- - - - 0
1 ABATE 1 kaleng 25 kg 2,340,000 - - - - 0
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - - 0
LPLPO Halaman 65
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - - 0
17 NEDDLE NO. 25 1 ktk 100 275 - - - - 0
LPLPO Halaman 66
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - - 0
- - - - 0
- - - - 0
1
- - - - 0
2
- - - - 0
3
- - - - 0
4
- - - - 0
5
- - - - 0
6
- - 0
7
- - - -
8
- - - -
9
JUMLAH JUMLAH
11,015,565
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 25 April 2018
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 67
(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE JUNI TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : JULI

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 60 0 60 - 60 265,560
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 150 0 150 150 - - 300

8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 200 600 800 800 - - 900
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 500 500 1,000 1,000 - - 2,000
12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 - - - - 50

13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 500 1,500 2,000 1,000 1,000 59,000
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 - 30 30 - 30 105,060
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 - - - - 300

16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - - - -
17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - - - -
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 - 600 600 600 - - 600
20 ASAM FOLAT 1 MG 100 Tablet 68 400 0 400 - 400 27,200
21 ASAM MEFENAMAT TABLET 250 MG 100 Tablet 150 - - - -
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 1,600 1,000 2,600 1,700 900 101,700 1,000
LPLPO Halaman 68
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 100 0 100 - 100 17,300
28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 1 box @ 24 tube 4,782 27 0 27 2 25 119,550
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - - 100

30 BETAHISTINE TABLET 30 box @ 30 tablet 170 50 0 50 50 - - 200
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 25 0 25 15 10 14,500 25
32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 62 0 62 32 30 9,510 30
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 - - - -

35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 - - - - 1,000
36 CLOZAPINE 25 MG 100 Tablet 1,550 10 200 210 210 325,500
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 300 0 300 100 200 9,600
39 DIAZEPAM INJEKSI 5 MG / ML 1 Ampul 4,598 17 0 17 3 14 64,372

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 - 5 5 - 5 63,755
@ 2,5 ml
41 DIAZEPAM TABLET 2 MG 100 100 tablet/botol 46 88 0 88 37 51 2,346
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 1 Ampul @ 1 ml 1,355 10 0 10 - 10 13,550
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 100 0 100 100 - - 200
47 DOMPERIDONE TABLET 10 MG 100 Strip, ktk 10 x 10 tablet 133 130 0 130 30 100 13,300
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 3 0 3 3 - - 10

49 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 Dus @ 30 ampul 2,354 - - - -
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 - - - -
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 4 0 4 - 4 28,156
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 27 0 27 - 27 110,241
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 14 0 14 - 14 30,506
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 - - - - 200
LPLPO Halaman 69
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 50 0 50 - 50 14,800
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 - 40 40 20 20 138,000 20

65 HALOPERIDOL TABLET 1,5 MG 100 Dus, 10 blister @ 10 tablet 76 250 200 450 180 270 20,520
66 HALOPERIDOL TABLET 5 MG 100 Dus, 10 blister @ 10 tablet 105 - - - -
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 - 20 20 - 20 99,000
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 55 50 105 31 74 189,440
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - - 1,000

72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - - 1,000
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 200 0 200 - 200 19,600
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 400 400 800 - 800 55,200
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 90 0 90 90 - - 200

76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 100 500 600 300 300 21,600
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 15 0 15 5 10 25,000
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 245 0 245 30 215 141,900
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 14 0 14 4 10 38,500
84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 47 0 47 - 47 188,000
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 300 1,000 1,300 800 500 22,500 1,000
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 180 0 180 - 180 32,220
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 100 Tablet 170 - - - -
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 100 0 100 - 100 55,000
89 KODEIN 20 MG TABLET 100 Tablet 1,210 100 0 100 - 100 121,000
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 53 200 253 123 130 289,250
LPLPO Halaman 70
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 500 0 500 500 - -
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 100 0 100 - 100 92,900
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 30 0 30 - 30 63,660
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 - 100 100 - 100 9,000
96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - 0 - - - -
97 MAGNESIUM SULFAT INJEKSI 20% (MGSO4 20%) (2017) 1 vial 3,200 10 0 10 10 32,000
98 MANITOL LARUTAN INFUS 20% 1 Botol 44,000 - - - -
99 METAMIZOL INJEKSI (ANTALGIN) 500 MG/ML 1 box @ 100 ampul 3,050 - - - -
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 200 400 600 400 200 23,800
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 - 300 300 - 300 72,000
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 100 500 600 400 200 41,800
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 5 0 5 5 - -
106 METOCLOPRAMIDE SIRUP 5MG/ML (LEXAPRAM) 1 botol 60 ml 2,750 - 0 - - - -
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 30 200 230 - 230 23,000
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 30 200 230 - 230 32,200
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 2 24 26 - 26 97,162
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 1,350 0 1,350 450 900 426,600
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 1,150 0 1,150 450 700 112,700
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 - 40 40 - 40 256,400

salut selaput
123 20 100 120 - 120 14,760
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 100 0 100 10 90 63,360
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 100 0 100 - 100 44,800
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 - 56 56 56 - - 112

119 PARASETAMOL SIRUP 120 MG/5 ML 1 Btl @ 60 ml 1,013 40 100 140 64 76 76,988
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 200 2,500 2,700 1,300 1,400 81,200
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 4 0 4 1 3 36,465
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 290 0 290 - 290 39,440
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 1 0 1 1 - -
LPLPO Halaman 71
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 100 300 400 400 34,000
129 PROPANOLOL TABLET 10 MG (HCL) 100 Dus, 10 strip @ 10 tablet 80 100 0 100 100 8,000
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - - - - 100

salut selaput
119 100 1,200 1,300 1,300 - - 1,500
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 - - - - 100
2,5 ml
4,000 10 0 10 10 - - 20
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 - 400 400 200 200 13,600

139 SALISIL BEDAK 2 %- 50 G 1 Dus @ 50 gr 1,066 7 0 7 2 5 5,330
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 - 200 200 200 - - 300
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 80 0 80 6 74 351,204

20
44
44
- -
100
0 0
0 0
145 SIFIKSIM 100 MG 100 Kapsul 899 - - - -

300
146 SIMVASTATIN 10 MG TABLET 30 box @ 30 tablet 135 - 300 210 28,350
300 90
147 SIPROFLAKSASIN TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 298 - 200 200 59,600
200 0
149 TABLET TAMBAH DARAH ( SF ) 30 box @ 30 tablet 410 - - - -
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 - 1 1 170,000
1 0
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 40 540 540 52,380
500
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 100 1,600 800 105,600
1500 800
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 -

200
200
200
- -
200
100 20
- - - -
OBAT GIGI - - - -
LPLPO Halaman 72
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

2

1
1
1
2
2
11 EUGENOL CAIRAN 10 ML 1 botol 20,815 - - - -

2

1
1
2
2 2 257,790
2
18 TKF 1 kotak 64,939 -
1
1 1 64,939
1
1
1
- - - -

0
18
18
- -
100
2 AMBROXOL TABLET 30 MG 100 box 10 x 10 tablet 139 - - - -
1000
0 0

25 25

25 0
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 - 5 4 149,600

5 1

0 30
0 20
LPLPO Halaman 73
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 - - - -

25
13 GENTIAN VIOLET 1% 10 ML 1 botol 3,218 - - - -
25
14 GLIBENKLAMIDA TABLET 5 MG 100 box 100 tablet 92 100 400 400 36,800
300 0
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 - - - - 1000
16 HYOSCINE-N- BUTILBROMIDE 10 mg TABLET (SCOPMA) 100 kotak 10 x 10 tablet 1,036 - 200 200 50 150 155,400
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 59 0 59 11 48 475,200
18 KLORAMFENIKOL 250MG KAPSUL 100 box 10 x 10 tablet 1,320 - - - -
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 14 0 14 4 10 76,000
21 MAGNESIUM SULFAT INJEKSI (2016) 1 botol 2,530 - - - -
22 MELOXICAM 15 MG TABLET 50 kotak 5 x 10 tablet 617 - - - -

24 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2017) 100 box 10 x 10 tablet 271 - - - -
25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 - 100 100 60 40 193,600 100

26 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 7,700 35 0 35 35 - - 100
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 1,500 0 1,500 600 900 166,500
28 OBH SIRUP 1 botol 100 ml 2,750 5 0 5 0 5 13,750
31 PAPAVERIN TABLET 100 box 10 x 10 tablet 330 - - - -
32 PARASETAMOL TABLET 100 MG 100 kotak 10 x 10 tablet 55 - - - -
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 60 0 60 0 60 205,440
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 - 5 5 2 3 146,850
35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 3 0 3 0 3 115,500
36 PREDNISON TABLET 5 MG (2016) 100 kotak 10 x 10 tablet 132 - - - -
37 PROPILTIOURASIL TABLET 100 MG 100 box 100 tablet 330 - - - -
38 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 vial 5 ml 591,250 - - - -
39 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 1 vial 10 ml 1,050,280 - - - -
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 27 0 27 27 - - 100

44 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 1000 botol @ 1000 tablet 79 - - - -
LPLPO Halaman 74
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
45 THIAMFENIKOL 500 MG KAPSUL 100 box 10 x 10 tablet 985 - - - -
46 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER)(2016) 1000 botol @ 1000 tablet 396 - - - -
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - - - - 100
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - - - - 1000
- - - -
BAKHP - - - -
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - 200 200 200 - - 200
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 300 0 300 100 200 179,200
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 - 100 100 0 100 86,300
5 ALKOHOL 70% 1 botol 1000 ml 23,650 2 0 2 1 1 23,650 1

7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 - - - -
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 50 0 50 50 - -
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 50 100 150 100 50 20,500 50
11 INFUSET ANAK 1 Set/kantong 4,025 - 20 20 0 20 80,500
12 INFUSET DEWASA 1 Set/kantong 3,680 - 50 50 50 - - 50

13 IV CATHETER NO. 18 G 1 50 Buah/kotak 4,370 - 50 50 0 50 218,500
14 IV CATHETER NO. 20 G 1 50 Buah/kotak 4,370 34 0 34 18 16 69,920
17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 Bungkus 14,375 3 0 3 3 - -
18 KASA HIDROFIL 36 M X 80 CM 1 Rol 120,750 1 0 1 1 - -
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 11 0 11 6 5 46,000
20 KASA PEMBALUT HIDROFIL 4 M X 10 CM 1 Rol 667 - 10 10 5 5 3,335
22 MASKER 50 50 pcs/kotak 506 100 100 200 200 - - 200

23 PHARMAFIX 5 X 500 CM 1 roll 27,324 1 5 6 3 3 81,972
24 POLLY CATETER 2 WAY N0. 16 1 pcs 9,200 - 5 5 3 2 18,400
26 RIVANOL 1 botol 300 cc 3,600 - - - -
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 - 36 36 0 36 189,756
LPLPO Halaman 75
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 50 0 50 0 50 57,500
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 30 0 30 0 30 143,640
30 URINE BAG 1 Pcs 3,450 1 0 1 0 1 3,450
31 SAFETY BOX 1 kotak 18,073 - - - -
32 NEEDLE TERUMO 22 G 100 kotak 330 100 0 100 0 100 33,000

0 0
- - - -
1 ABATE 1 pail 25 kg
2,750,000
- - - -
3
113
- - - -
3
158
- - - -
1
1,265,000
- - - -
1
4,585,000
151,250

176,225
8 LARUTAN ASAM ASETAT 6% 1 botol 100 ml - - - -

20,000

12,672
- - - -

273,600
- - - -

32,061
- - - -

74,100
- - - -

375,685

18,800
- - - -

19,800
- - - -

39,050
- - - -

367,650

720,500
- - - -
2
2,310,000
- - - -
1
42,350
- - - -
1
23,750
- - - -
1
49,200
23 LIDI SWABB 1 pcs

1,669
- - - -
2
16,520
- - - -
LPLPO Halaman 76
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2,132

71,450
- - - -

71,450
- - - -

279,640

6,379
- - - -
2
5,239
- - - - 1
8,400
- - - - 2
23,566
- - - -
3
37,892

1,265

1,202

31,700

31,700

31,700

1,163,800

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - -
47 XYLOL 1 botol/100 ml 69,400 - - - -

223,850

65,900

49,200

9,400

31,400
STIK URINE PARAMETER 10 PARAMETER - - - -

1
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - -
LPLPO Halaman 77
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
LPLPO Halaman 78
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- -
7
- - - -
8
- - - -
9
JUMLAH JUMLAH
13,055,957
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 25 Juni 2018
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 79
(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE JUNI TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : JULI

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
4 ALOPURINOL TABLET 300 MG 100 box, 10 strip @ 10 tablet 244 30 0 30 30 - - 100
5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 30 Dus 30 ampul @ 10 ml 4,204 - 0 - - - -
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 - - - -
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 - 1,500 1,500 1,200 300 31,500 1,200
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 - - - -
11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 Btl @ 60 ml 2,200 46 0 46 32 14 30,800 50

12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 - 50 50 30 20 42,120 50
13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 1,000 1,000 2,000 1,600 400 23,600 1,500
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 30 0 30 15 15 52,530
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 - 0 - - - - 300

16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - 0 - - - -
17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - 0 - - - -
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 - - - -
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 900 900 900 101,700
LPLPO Halaman 80
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
27 ANTIBAKTERI DOEN SALEP KOMBINASI (BASITRACIN) 1 box @ 25 tube 3,365 25 0 25 - 25 84,125
28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 1 box @ 24 tube 4,782 25 0 25 - 25 119,550
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - -
30 BETAHISTINE TABLET 30 box @ 30 tablet 170 - - - -
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 10 24 34 15 19 27,550
32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 30 0 30 - 30 9,510
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 - 0 - - - -
34 CETRIZINE SIRUP 5 MG/5 ML 1 botol 60 ml 7,756 82 82 82 635,992
35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 - - - -
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 200 0 200 200 - - 500


40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 5 0 5 - 5 63,755
@ 2,5 ml
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 - 200 200 100 100 11,400
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 46 0 46 46 160,540
47 DOMPERIDONE TABLET 10 MG 100 Strip, ktk 10 x 10 tablet 133 100 0 100 100 - - 200
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 - - - -
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 - - - -
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 4 0 4 4 - - 5

57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 14 0 14 14 - - 20

58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 - - - -
LPLPO Halaman 81
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 100 ktk 10 x 10 tablet 224 20 0 20 10 10 2,240
65 HALOPERIDOL TABLET 1,5 MG 100 Dus, 10 blister @ 10 tablet 76 270 270 180 90 6,840
67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 100 Tablet 171 170 0 170 10 160 27,360
68 HIDROKORTISON KRIM 2,5% 1 Tube 2,868 32 32 32 91,776
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 20 20 20 99,000
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 74 0 74 74 - - 100

71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - - 2,000
72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - - 2,000
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 200 0 200 100 100 9,800
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 - - - -
77 KARBAMAZEPIN TABLET 200 MG 100 Dus, 10 strip @ 10 tablet 306 290 290 290 88,740
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 10 10 10 25,000
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 215 0 215 10 205 135,300
81 KLORAMFENIKOL KAPSUL 500 MG 100 Kapsul 1,155 140 0 140 50 90 103,950
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 10 0 10 - 10 38,500
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 500 0 500 - 500 22,500
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 180 0 180 - 180 32,220
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 100 Tablet 170 - 0 - - - -
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 100 0 100 40 60 33,000
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 130 0 130 130 289,250
91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 100 Strip, ktk 10 x 10 tablet 158 130 130 130 20,540
LPLPO Halaman 82
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 - 1,000 1,000 700 300 102,300 500
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 100 0 100 25 75 69,675
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 30 0 30 14 16 33,952
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 100 0 100 100 - - 300
96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - - - -
97 MAGNESIUM SULFAT INJEKSI 20% (MGSO4 20%) (2017) 1 vial 3,200 10 0 10 - 10 32,000
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 200 300 500 400 100 11,900 400
103 METILERGOMETRIN MALEAT INJEKSI 0,2 MG / ML 100 Dus, @ 100 ampul 2,684 40 40 40 107,360
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 - - - -
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 230 0 230 230 - - 300
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 26 26 26 97,162
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 900 0 900 900 - - 2,000
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 700 0 700 700 - - 1,000
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 40 0 40 20 20 128,200

salut selaput
123 120 0 120 20 100 12,300
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 90 0 90 - 90 63,360
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 100 0 100 5 95 42,560

120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 1,400 2,000 3,400 2,300 1,100 63,800

123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 290 0 290 - 290 39,440
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 - - - -
LPLPO Halaman 83
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
129 PROPANOLOL TABLET 10 MG (HCL) 100 Dus, 10 strip @ 10 tablet 80 100 0 100 - 100 8,000
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - - - -
131 RANITIDIN TABLET l50 MG 100 Dus, 10 strip @ 10 tablet 119 - - - -

salut selaput
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 - - - - 60
2,5 ml
4,000 - - - -
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 200 0 200 200 - - 500
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 - - - -
138 SALEP 2 - 4 KOMBINASI 1 pot @ 30 gr 2,200 7 7 7 15,400
139 SALISIL BEDAK 2 %- 50 G 1 Dus @ 50 gr 1,066 5 5 5 5,330
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 - 300 300 200 100 55,700 200
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 74 0 74 24 50 237,300
142 SEFOTAKSIM SERBUK INJEKSI 500 MG 1 Vial 6,485 - - - -
0 0
0 50

0
210
150
60 8,100
150
0
200
200
- -
200
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 1 1 - -
0 1
0 470
0
800
800
- -
1000
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 - - - -

0 79
- - - -
OBAT GIGI - - - -
LPLPO Halaman 84
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
17 TAMBALAN SEMENTARA, premix (CAVITON)/ (CAVIT-W) 1 cup 128,895 2 2 2 257,790
18 TKF 1 kotak 64,939 1 1 1 64,939
- - - -
1 AMBROXOL SIRUP 15 MG/ML 1 botol 60 ml 3,412 - - - -
0 0

0
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 4 4 4 149,600
0 10
LPLPO Halaman 85
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0 30
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 - - - -
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 48 0 48 48 475,200
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 10 10 10 76,000
23 METAMIZOL INJEKSI (NORAGES) (2016) 5 5 ampul/kotak 9,680 - - - -
25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 40 0 40 40 193,600
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 900 0 900 900 - -
28 OBH SIRUP 1 botol 100 ml 2,750 5 0 5 5 - -
29 OKSITETRASIKLIN SALEP KULIT 25 kotak @ 25 tube 2,000 20 20 20 40,000
30 OKSITETRASIKLIN SALEP MATA 1% 3,5 ML 25 kotak @ 25 tube 2,772 33 33 33 91,476
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 60 60 60 205,440
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 3 3 3 146,850
35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 3 3 3 115,500
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 - - - -
41 SIRUP TAMBAH DARAH ANAK (SUPRABION) 1 botol 60 ml 7,750 - - - -
42 TABLET FLU (MASFLU) 100 box 100 tablet 300 - - - -
43 TABLET FLU KOMBINASI (FLU DAN BATUK / RAMAFLU)) 100 kotak 10 x 10 tablet 400 - - - -
LPLPO Halaman 86
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - - - -
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - - - -
- - - -
BAKHP - - - -
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 71 0 71 71 - -
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - - - -
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 200 0 200 200 - -
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 100 0 100 100 - -
5 ALKOHOL 70% 1 botol 1000 ml 23,650 1 0 1 1 - -
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 - - - -
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 - - - -
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 50 0 50 50 - -
11 INFUSET ANAK 1 Set/kantong 4,025 20 20 20 80,500
12 INFUSET DEWASA 1 Set/kantong 3,680 - - - -
13 IV CATHETER NO. 18 G 1 50 Buah/kotak 4,370 50 50 50 218,500
17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 Bungkus 14,375 - - - -
18 KASA HIDROFIL 36 M X 80 CM 1 Rol 120,750 - - - -
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 5 5 5 46,000
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 20 20 20 17,260
22 MASKER 50 50 pcs/kotak 506 - - - -
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 3 0 3 1 2 54,648
24 POLLY CATETER 2 WAY N0. 16 1 pcs 9,200 2 2 2 18,400
26 RIVANOL 1 botol 300 cc 3,600 - - - -
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 36 36 36 189,756
LPLPO Halaman 87
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 50 50 50 57,500
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 30 30 30 143,640
30 URINE BAG 1 Pcs 3,450 1 1 1 3,450
31 SAFETY BOX 1 kotak 18,073 - - - -
- - - -
1 ABATE 1 pail 25 kg - - - -
2,750,000

113
- - - -

158
- - - -

1,265,000

4,585,000
151,250

176,225

20,000

12,672
- - - -

273,600
- - - -

32,061
- - - -

74,100
- - - -

375,685

18,800
- - - -

19,800
- - - -

39,050
- - - -

367,650

720,500

2,310,000

42,350
- - - -

23,750
- - - -

49,200
23 LIDI SWABB 1 pcs

1,669
- - - -

16,520
- - - -
LPLPO Halaman 88
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2,132

71,450
- - - -

71,450
- - - -

279,640

6,379

5,239

8,400

23,566

37,892

1,265

1,202

31,700

31,700

31,700

1,163,800

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - -
47 XYLOL 1 botol/100 ml 69,400 - - - -

223,850

65,900

49,200

9,400

31,400
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - -
LPLPO Halaman 89
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
LPLPO Halaman 90
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- - - -
7
- - - -
8
- - - -
9
JUMLAH JUMLAH
9,998,261
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 91
(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE AGUSTUS TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : SEPTEMBER

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 60 0 60 30 30 132,780 57
4 ALOPURINOL TABLET 300 MG 100 box, 10 strip @ 10 tablet 244 - 90 90 60 30 7,320 150 200
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 300 1,200 1,500 1,200 300 31,500 730 1,200
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 1,100 1,000 2,100 1,300 800 186,400 900 1,000
12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 20 50 70 20 50 105,300 32
13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 400 1,000 1,400 1,400 - - 700 2,000
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 - 0 - - - - 10 1,000
16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - 0 - - - - -
17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - 0 - - - - -
18 ASAM ASETILSALISILAT 100 MG (ASETOSAL) 100 Tablet 153 100 0 100 50 50 7,650 10
20 ASAM FOLAT 1 MG 100 Tablet 68 200 0 200 - 200 13,600 110 300
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 25 0 25 5 20 50,720 2
25 ASIKLOVIR 400 MG TABLET 100 ktk 10 x 10 tablet 368 160 0 160 80 80 29,440 100 100
LPLPO Halaman 92
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 100 0 100 50 50 8,650 - 100
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - 20 20 20 - - - 20

30 BETAHISTINE TABLET 30 box @ 30 tablet 170 110 0 110 84 26 4,420 - 300
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 19 0 19 19 - - 26 25
32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 - 0 - - - - 5
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 - 200 200 - 200 139,000

35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 400 1,000 1,400 700 700 107,800 400 300
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 - 1,000 1,000 300 700 33,600 700
39 DIAZEPAM INJEKSI 5 MG / ML 1 Ampul 4,598 14 0 14 1 13 59,774 1

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 5 0 5 - 5 63,755 -
@ 2,5 ml
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 1 Ampul @ 1 ml 1,355 10 0 10 10 - - 28 20

45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 100 0 100 - 100 11,400 100 300
47 DOMPERIDONE TABLET 10 MG 100 Strip, ktk 10 x 10 tablet 133 - 300 300 - 300 39,900 130
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 - - - - 1 20

50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 80 0 80 - 80 61,280 -
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 - 5 5 - 5 35,195 -
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 57 0 57 - 57 232,731 17
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 - - - - -
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 - - - - 116 200
LPLPO Halaman 93
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 50 0 50 - 50 14,800 -
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 0 20 - 20 138,000 20
63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 100 ktk 10 x 10 tablet 224 10 100 110 - 110 24,640 40
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 - 0 - - - - -
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 - - - - 10
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - 2,000 2,000 700 1,300 144,300 -

74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 300 500 800 700 100 6,900 500 700
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 - - - - 90 200
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 300 0 300 200 100 7,200 - 200
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 10 10 10 25,000 -
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 205 0 205 - 205 135,300 -
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 10 0 10 5 5 19,250 -
84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 46 0 46 4 42 168,000 -
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 500 3,000 3,500 1,800 1,700 76,500 900
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 180 300 480 220 260 46,540 220 100
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 100 Tablet 170 - 0 - - - - -
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 60 0 60 40 20 11,000 - 100

89 KODEIN 20 MG TABLET 100 Tablet 1,210 100 0 100 - 100 121,000 -
LPLPO Halaman 94
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 300 500 800 300 500 170,500 400
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 75 0 75 - 75 69,675 -
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 16 0 16 16 - - 7
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 - - - - 128 300

96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - - - - -
98 MANITOL LARUTAN INFUS 20% 1 Botol 44,000 - - - - -

101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 200 0 200 40 160 38,400 100
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 100 600 700 500 200 41,800 200 500
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 - 500 500 260 240 24,000 116
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 200 0 200 40 160 22,400 -

111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 - 3,000 3,000 360 2,640 1,251,360 -
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 - - - - 400 200

113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 20 0 20 20 - - - 20
salut selaput
123 100 0 100 100 - - 50
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 90 0 90 90 63,360 -
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 95 0 95 - 95 42,560 -
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 40 0 40 40 - - - 112

120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 1,100 2,000 3,100 1,800 1,300 75,400 2,200
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 1 0 1 1 - - 1 5

123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 290 0 290 - 290 39,440 70
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 - - - - -
LPLPO Halaman 95
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 - 5 5 5 - - 3 5

126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 - 3 3 - 3 20,100 -
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 1 0 1 1 - - 1 2


salut selaput
119 - - - - 1,200 2,000
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 - 200 200 140 60 429,000 160 100
2,5 ml
4,000 - 20 20 10 10 40,000 - 10
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 - 500 500 300 200 13,600 400 200
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 100 500 600 240 360 200,520 75

0
40
20
20 129,700
10 20
0 0 0
0 100 0
30 300
300
360
270
90 12,150
240 300
147 SIPROFLAKSASIN TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 298 - 300 300 89,400
300 0 80
0
330
0
0
500 0
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 - 2,000 1,100 145,200
2000 900 900
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 -
500
500
300
200 118,400
100 500
100 47 12
- - - -
OBAT GIGI - - - -
LPLPO Halaman 96
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 ARTICULATING PAPER 1 kotak/12 strip 128,700 - 1 - -

1 1
15 MONOKLORKAMFER MENTOL CAIRAN 10 ML / CHKM (CHAMFENOL) 1 botol 54,117 - 1 - -

1 1
18 TKF 1 kotak 64,939 - - - -
- - - -

60 100
700 1000
2
0 0 0
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 50
0
50
50
- -
0 100
0 5 0
5 3 0
0
0 2 0
0
0 80 200
LPLPO Halaman 97
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

20 25
3 25
0 70 300
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 - - - - 1000 2000
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 48 0 48 33 15 148,500 0
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 10 0 10 5 5 38,000 0 10

27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 - 2000 2,000 900 1,100 203,500 840
28 OBH SIRUP 1 botol 100 ml 2,750 - - - - 0
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 60 100 160 60 100 342,400 0
35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 3 0 3 3 - - 0
38 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 vial 5 ml 591,250 - 1 1 1 - - 0
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 - - - - 45 100


LPLPO Halaman 98
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
- - - -
BAKHP - - - -
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 - - - - 10 100

2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - 100 100 100 - - 200 100
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 - 300 300 100 200 179,200 200
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 - 100 100 0 100 86,300 100
5 ALKOHOL 70% 1 botol 1000 ml 23,650 - 2 2 1 1 23,650 2
6 ASEPTAN + DISPENSER 1 500 cc 33,000 5 0 5 5 - - 0
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 - 5 5 2 3 72,600 2
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 - - - - 0 200

12 INFUSET DEWASA 1 Set/kantong 3,680 - 50 50 50 - - 100
17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 Bungkus 14,375 - 0 - - - 0
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 5 0 5 5 - - 0 20

22 MASKER 50 50 pcs/kotak 506 - 200 200 100 100 50,600 100 100
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 2 0 2 2 - - 2 5
26 RIVANOL 1 botol 300 cc 3,600 - - - - 0
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 36 0 36 0 36 189,756 0
LPLPO Halaman 99
JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30 URINE BAG 1 Pcs 3,450 1 20 21 1 20 69,000 0
31 SAFETY BOX 1 kotak 18,073 - - - - 0

0 50 10
- - - -
1 ABATE 1 pail 25 kg - 3 - -
2,750,000 3 3

113
- 3 - -
3 3

158
- 1 - -
1 1
4 DENGUE IgG / IgM 1 set isi 25 - 1 - -

1,265,000 1 1

4,585,000
151,250

176,225

20,000

12,672
- - - -

273,600
- - - -

32,061
- - - -

74,100
- - - -

375,685

18,800
- - - -

19,800
- - - -

39,050
- - - -

367,650

720,500

2,310,000

42,350
- - - -

23,750
- - - -

49,200
23 LIDI SWABB 1 pcs

1,669
- - - -

16,520
- - - -
LPLPO Halaman 100

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2,132

71,450
- - - -

71,450
- - - -

279,640

6,379
30 STIK PEMERIKSAAN ASAM URAT 1 kotak isi 25 - 1 - -

5,239 1 1
31 STIK PEMERIKSAAN HB 1 kotak isi 50 - 2 - -

8,400 2 2
32 STIK PEMERIKSAAN KOLESTEROL 1 kotak isi 10 - 3 - -

23,566 3 3

37,892

1,265

1,202

31,700

31,700

31,700

1,163,800

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - -
47 XYLOL 1 botol/100 ml 69,400 - - - -

223,850

65,900

49,200

9,400

31,400
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - -
LPLPO Halaman 101

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
LPLPO Halaman 102

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- - - -
7
- - -
8
- - - -
9
JUMLAH JUMLAH
13,255,310
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 103

(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE SEPTEMBER TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : OKTOBER

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
1 ALBENDAZOLE 400 MG 30 box @ 30 tablet 323 95 0 95 95 - - 100
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 30 0 30 30 - - 20
4 ALOPURINOL TABLET 300 MG 100 box, 10 strip @ 10 tablet 244 30 210 240 - 240 58,560
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 30 210 240 90 150 24,450
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 300 1,200 1,500 900 600 63,000 900
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 800 1,000 1,800 1,000 800 186,400 1,500

13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 - 2,000 2,000 1,400 600 35,400 1,500
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 - 20 20 10 10 35,020
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 - - - - 300

22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 100 2,000 2,100 1,400 700 79,100 1,500
LPLPO Halaman 104

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 50 300 350 150 200 34,600

29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - 20 20 10 10 23,100
30 BETAHISTINE TABLET 30 box @ 30 tablet 170 26 300 326 126 200 34,000
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 - 25 25 25 - - 50

32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 - - - -
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 200 0 200 - 200 139,000

35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 700 300 1,000 600 400 61,600 500
37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 97 0 97 97 - - 100 ED
39 DIAZEPAM INJEKSI 5 MG / ML 1 Ampul 4,598 13 0 13 2 11 50,578

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 5 10 15 5 10 127,510
@ 2,5 ml
41 DIAZEPAM TABLET 2 MG 100 100 tablet/botol 46 33 33 33 1,518
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 1 Ampul @ 1 ml 1,355 - - - -
44 DILTIAZEM HCL TABLET 30 MG 100 ktk 10 x 10 tablet 137 140 0 140 10 130 17,810
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 100 100 200 100 100 11,400
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 80 80 80 61,280
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 5 5 5 35,195
56 FITOMENADION (VIT.K1) TABLET SALUT 10 MG 100 100 tablet/botol 796 200 0 200 30 170 135,320
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 - - - -
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 - 200 200 - 200 54,800
LPLPO Halaman 105

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 100 ktk 10 x 10 tablet 224 110 0 110 70 40 8,960
65 HALOPERIDOL TABLET 1,5 MG 100 Dus, 10 blister @ 10 tablet 76 170 500 670 670 50,920
68 HIDROKORTISON KRIM 2,5% 1 Tube 2,868 31 0 31 - 31 88,908
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 - - - -
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 - 200 200 117 83 212,480
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 1,300 0 1,300 800 500 55,500 1,000
72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - -
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 - 200 200 100 100 6,900 100
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 100 200 300 300 - - 500
77 KARBAMAZEPIN TABLET 200 MG 100 Dus, 10 strip @ 10 tablet 306 280 0 280 280 85,680
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 10 0 10 10 25,000
82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 17 0 17 - 17 27,880
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 5 0 5 5 - - 25

85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 1,700 0 1,700 1,100 600 27,000 1,000
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 260 400 660 660 118,140
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 20 100 120 120 66,000
89 KODEIN 20 MG TABLET 100 Tablet 1,210 100 100 100 121,000
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 36 36 36 80,100
LPLPO Halaman 106

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 500 0 500 320 180 61,380 400
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 75 75 75 69,675
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 - - - -
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 - - - -
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 100 400 500 500 - - 700
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 160 0 160 - 160 38,400
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 100 Ktk 10 x 10 tablet salut 169 125 0 125 10 115 19,435
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 34 0 34 - 34 176,800
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 2,640 0 2,640 2,100 540 255,960 2,100
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 - - - -
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 1 Botol @ 500 ml 6,410 - - - -

salut selaput
123 - - - -
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 90 90 90 63,360
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 72 72 72 136,800
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 - - - -
119 PARASETAMOL SIRUP 120 MG/5 ML 1 Btl @ 60 ml 1,013 60 60 60 60,780
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 1,300 3,000 4,300 2,700 1,600 92,800 300
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 - - - -
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 290 0 290 20 270 36,720
LPLPO Halaman 107

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 3 3 3 20,100
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 - 2 2 2 30,772
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 200 0 200 100 100 8,500
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - 50 50 40 10 13,400 50

salut selaput
119 - 1,200 1,200 700 500 59,500 700
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 60 100 160 60 100 715,000

2,5 ml
4,000 10 10 20 10 10 40,000
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 200 200 400 200 200 13,600
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 - - - -

140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 360 360 360 200,520
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 40 0 40 40 189,840
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 1,100 2,100 1,400 184,800
1000 700
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 200 700 500 296,000
500 200
- - - -
OBAT GIGI - - - -
LPLPO Halaman 108

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
18 TKF 1 kotak 64,939 - - - -
- - - -
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 - - - -

0 5

0 0
0 0
LPLPO Halaman 109

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
14 GLIBENKLAMIDA TABLET 5 MG 100 box 100 tablet 92 300 300 - -

0 300
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 - - - -
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 15 15 15 148,500
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 5 5 5 38,000
20 KLORAMFENIKOL TETES TELINGA (RECO) (2016) 24 kotak @ 24 botol 6,600 24 24 24 158,400
23 METAMIZOL INJEKSI (NORAGES) (2016) 5 5 ampul/kotak 9,680 - - - -
25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 40 40 40 193,600
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 1,100 0 1,100 700 400 74,000
28 OBH SIRUP 1 botol 100 ml 2,750 - - - -
29 OKSITETRASIKLIN SALEP KULIT 25 kotak @ 25 tube 2,000 25 25 25 50,000
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 100 100 100 342,400
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 3 3 3 146,850
35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 - - - -
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 - - - -
42 TABLET FLU (MASFLU) 100 box 100 tablet 300 - - - -
LPLPO Halaman 110

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - - - -
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - - - -
- - - -
BAKHP - - - -
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 - 100 100 0 100 106,400
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - 100 100 100 - -
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 200 0 200 200 - -
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 100 0 100 0 100 86,300
5 ALKOHOL 70% 1 botol 1000 ml 23,650 1 1 1 23,650
6 ASEPTAN + DISPENSER 1 500 cc 33,000 - - - -
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 3 0 3 0 3 72,600
8 CATGUT BEDAH NO. 3/0 + JARUM 1/2 GT 35 MM 24 1 24 X 75 cm/kotak 6,421 11 11 11 70,631
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 - 200 200 200 1,606,600
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 - 200 200 200 82,000
12 INFUSET DEWASA 1 Set/kantong 3,680 - - - -
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 - 20 20 4 16 147,200
20 KASA PEMBALUT HIDROFIL 4 M X 10 CM 1 Rol 667 - 50 50 50 33,350
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 20 20 20 17,260
22 MASKER 50 50 pcs/kotak 506 100 100 200 100 100 50,600
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 - - - -
26 RIVANOL 1 botol 300 cc 3,600 - - - -
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 36 36 36 189,756
LPLPO Halaman 111

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 50 50 50 57,500
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 30 30 30 143,640
30 URINE BAG 1 Pcs 3,450 20 20 20 69,000
31 SAFETY BOX 1 kotak 18,073 - - - -
- - - -
1 ABATE 1 pail 25 kg - - - -
2,750,000

113
- - - -

158
- - - -

1,265,000

4,585,000
151,250

176,225

20,000

12,672
- - - -

273,600
- - - -

32,061
- - - -

74,100
- - - -

375,685

18,800
- - - -

19,800
- - - -

39,050
- - - -

367,650

720,500

2,310,000

42,350
- - - -

23,750
- - - -

49,200
23 LIDI SWABB 1 pcs

1,669
- - - -

16,520
- - - -
LPLPO Halaman 112

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2,132

71,450
- - - -

71,450
- - - -

279,640

6,379

5,239

8,400

23,566

37,892

1,265

1,202

31,700

31,700

31,700

1,163,800

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - -
47 XYLOL 1 botol/100 ml 69,400 - - - -

223,850

65,900

49,200

9,400

31,400
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - -
LPLPO Halaman 113

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
LPLPO Halaman 114

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- - - -
7
- - - -
8
JUMLAH JUMLAH
14,305,360
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 115

(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE : OKTOBER TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : NOVEMBER

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
1 ALBENDAZOLE 400 MG 30 box @ 30 tablet 323 - - - - 10
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 - 20 20 - 20 88,520 57
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 150 0 150 150 - - 180 180
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 600 900 1,500 1,500 - - 3000 3,000
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 800 1,000 1,800 1,000 800 186,400 1500 1,500
10 AMOKSISILIN SERBUK INJEKSI 1000 MG 1 10 vial / kotak 8,135 - - - - 0
12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 14 50 64 37 27 56,862 50 50

13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 600 1,000 1,600 1,200 400 23,600 1200 1,000
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 10 0 10 5 5 17,510 10 10
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 - - - - 10 300
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 100 300 400 400 - - 500 500
20 ASAM FOLAT 1 MG 100 Tablet 68 300 0 300 200 100 6,800 200 200
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 700 1,000 1,700 1,200 500 56,500 1400 1,500
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 20 0 20 10 10 25,360 2
LPLPO Halaman 116

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 290 0 290 - 290 50,170 0

29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 10 0 10 5 5 11,550 0 20

30 BETAHISTINE TABLET 30 box @ 30 tablet 170 200 0 200 140 60 10,200 140 90
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 - 50 50 25 25 36,250 26
32 BISAKODIL TABLET 5 MG (2017) 30 box @ 30 317 - - - - 5
33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 200 0 200 - 200 139,000 0
35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 400 500 900 800 100 15,400 1000 1,000
37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 - 100 100 - 100 173,800 5

@ 2,5 ml
12,751 10 0 10 10 - - 0 10
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 1 Ampul @ 1 ml 1,355 - - - - 28
44 DILTIAZEM HCL TABLET 30 MG 100 ktk 10 x 10 tablet 137 130 0 130 10 120 16,440 20
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 100 0 100 100 - - 100 200
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 12 0 12 12 - - 8 50
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 1 box @ 6 supp 5,670 - - - - 1 20
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 80 0 80 - 80 61,280 0
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 5 5 10 10 - - 0 20

55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 30 0 30 - 30 122,490 17
57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 - - - - 0
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 200 0 200 - 200 54,800 116
LPLPO Halaman 117

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 50 0 50 30 20 5,920 0
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 0 20 20 - - 20 20

67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 100 Tablet 171 160 0 160 - 160 27,360 0
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 83 50 133 50 83 212,480 10
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 500 1,000 1,500 1,200 300 33,300 0 1,500
72 IBUPROFEN TABLET 400 MG 100 Strip, ktk 10 x 10 tablet 157 - - - - 0
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 200 600 800 800 - - 500 1,000
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 100 100 200 100 100 6,900 90
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 - 500 500 200 300 21,600 0
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 10 0 10 10 - - 0 24

79 KETOKENAZOLE CREAM 2% 1 tube 10 gr 2,605 21 0 21 - 21 54,705 10
80 KLINDAMISIN KAPSUL 300 MG 50 box @ 50 tablet 660 205 0 205 45 160 105,600 0
81 KLORAMFENIKOL KAPSUL 500 MG 100 Kapsul 1,155 90 0 90 10 80 92,400 0
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 - - - - 0 24

84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 1 botol 60 ml 4,000 28 0 28 4 24 96,000 0
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 600 1,000 1,600 1,000 600 27,000 1000 1,000
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 660 200 860 580 280 50,120 220 300
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 120 0 120 20 100 55,000 0
89 KODEIN 20 MG TABLET 100 Tablet 1,210 100 0 100 - 100 121,000 0
91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 100 Strip, ktk 10 x 10 tablet 158 30 0 30 20 10 1,580 10
LPLPO Halaman 118

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 75 0 75 25 50 46,450 0
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 - - - - 7
95 LOPERAMIDE TABLET 2 MG 100 Dus, 10 strip@ 10 tablet 90 - 100 100 - 100 9,000 128
96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - - - - 0
99 METAMIZOL INJEKSI (ANTALGIN) 500 MG/ML 1 box @ 100 ampul 3,050 - - - - 0
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 - 400 400 400 - - 500 500
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 160 500 660 130 530 127,200 100
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 300 400 700 400 300 62,700 600 300
103 METILERGOMETRIN MALEAT INJEKSI 0,2 MG / ML 100 Dus, @ 100 ampul 2,684 40 0 40 10 30 80,520 43
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 70 0 70 40 30 4,200 100 100
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 540 2,040 2,580 300 2,280 1,080,720 0
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 - - - - 1,000 1,000

salut selaput
123 - - - - 50
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 90 0 90 - 90 63,360 0
116 NISTATIN TABLET VAGINAL 100.000 IU/G 100 ktk 10 x 10 tablet vaginal 448 87 0 87 - 87 38,976 0
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 72 0 72 - 72 136,800 0
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 - - - - 0 100

120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 1,600 3,000 4,600 2,000 2,600 150,800 2200 500
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 - - - - 1
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 1 Dus, botol @ 10 ml 18,635 - - - - 0
LPLPO Halaman 119

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 3 3 6 3 3 20,100 0
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 2 1 3 2 1 15,386 1
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 100 0 100 100 - - 300 300
129 PROPANOLOL TABLET 10 MG (HCL) 100 Dus, 10 strip @ 10 tablet 80 100 0 100 - 100 8,000 0
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 10 110 120 80 40 53,600 100 100
salut selaput
119 500 700 1,200 1,200 - - 1200 1,500
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 100 60 160 100 60 429,000 160 100
2,5 ml
4,000 10 0 10 10 - - 0 10
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 200 0 200 200 - - 400 400
142 SEFOTAKSIM SERBUK INJEKSI 500 MG 1 Vial 6,485 20 20 20 129,700 10

0 0
0 10
0 0
145 SIFIKSIM 100 MG 100 Kapsul 899 - - - - 30 300

146 SIMVASTATIN 10 MG TABLET 30 box @ 30 tablet 135 90 90 90 12,150 240
0
300
200
100 29,800 80 200
149 TABLET TAMBAH DARAH ( SF ) 30 box @ 30 tablet 410 - - - - 330
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 1 Prefilled syringe 170,000 - - - - 0 1
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 100 Tablet 91 - - - - 0 300
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 570
300
870
730
140 13,580 0 600
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 1,400
0
1,400
1400
- - 1500 1500
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 500 500 300 177,600 100
0 200
155 ZINC DSIRUP 20MG/ML (ZIRCUM KID) 1 botol 60 ml 6,500 64 64 50 325,000 12

0 14
- - - - 0
OBAT GIGI - - - - 0
LPLPO Halaman 120

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
2 BODING LIQUID (MASTERBOND) 1 botol 281,404 - - - - 0 2

4 COMPOSIT A 2 (SOLARE X2) 2ml (kemasan plastik) 1 tube 214,300 - - - - 0
5 COMPOSIT A 3 (SOLARE X3) 2ml (kemasan plastik) 1 tube 214,300 - - - - 0 3

9 ETCHING (ETCHING GEL) / SCHOTCHBOND 1 tube 175,120 - - - - 0 2

10 ETIL KLORIDA SPRAY 100 ML 1 vial/Can/ 100 ml 110,000 - - - - 0
12 GLASS IONOMER CEMENT (FUJI GC IX) 1 5 gr/kotak 512,859 - - - - 0 1

13 IODOFORM PASTA 1 kotak 216,465 - - - - 0
17 TAMBALAN SEMENTARA, premix (CAVITON)/ (CAVIT-W) 1 cup 128,895 - - - - 0 1

18 TKF 1 kotak 64,939 - - - - 0
1 AMBROXOL SIRUP 15 MG/ML 1 botol 60 ml 3,412 -

100
100
60
40 136,480 60 50
2 AMBROXOL TABLET 30 MG 100 box 10 x 10 tablet 139 - - - - 700 1000
0 0
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 100 ktk 10 x 10 tablet 1,694 - - - - 100 100
6 ASIKLOVIR KRIM 5% 25 box 25 tube 4,465 20 20 17 75,905 0
0 3
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 1 botol 37,400 6 6 6 224,400 0

0 0

0 0
0 100
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 - - - - 20 25
LPLPO Halaman 121

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
13 GENTIAN VIOLET 1% 10 ML 1 botol 3,218 - 24 19 61,142 3

24 5
14 GLIBENKLAMIDA TABLET 5 MG 100 box 100 tablet 92 -

500
500
400
100 9,200 500 500
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 - 2000 2,000 800 1,200 237,600 1000 500
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 1 kotak @ 10 ampul 9,900 15 0 15 10 5 49,500 0
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 5 0 5 5 - - 0 25


25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 40 0 40 40 - - 0 100

26 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 7,700 57 60 117 20 97 746,900 50
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 400 500 900 900 - - 1000 1000
28 OBH SIRUP 1 botol 100 ml 2,750 - - - - 0 5
33 PEHACAIN INJEKSI 1 box @ 20 ampul 3,424 100 0 100 80 20 68,480 0 60

38 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 1 vial 5 ml 591,250 - - - - 0 1

39 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 1 vial 10 ml 1,050,280 - - - - 0 1
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 - - - - 45 150
LPLPO Halaman 122

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - 500 500 500 - - 0 1000
- - - - 0
BAKHP - - - - 0
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - 100 100 0 100 74,800 200
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 - 300 300 200 100 89,600 200 100
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 100 0 100 0 100 86,300 100
5 ALKOHOL 70% 1 botol 1000 ml 23,650 1 2 3 2 1 23,650 2 1

6 ASEPTAN + DISPENSER 1 500 cc 33,000 - - - - 0
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 3 0 3 2 1 24,200 2 2

9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 200 0 200 200 - - 0 300
12 INFUSET DEWASA 1 Set/kantong 3,680 - 50 50 50 184,000 100

15 IV CATHETER NO. 22 G 1 50 Buah/kotak 4,370 40 0 40 40 - - 22 100

17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 Bungkus 14,375 - - - - 0 5

19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 16 0 16 16 - - 0 20

22 MASKER 50 50 pcs/kotak 506 100 0 100 100 - - 200 300
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 - - - - 5 5
25 POLLY CATETER 2 WAY N0. 18 1 pcs 9,200 3 0 3 3 - - 0
26 RIVANOL 1 botol 300 cc 3,600 - - - - 0
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 36 0 36 36 - - 0
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 50 0 50 50 - - 0
LPLPO Halaman 123

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
30 URINE BAG 1 Pcs 3,450 20 0 20 10 10 34,500 0
31 SAFETY BOX 1 kotak 18,073 - - - - 0
33 NEEDLE TERUMO 25 G 100 kotak 330 50 50 50 16,500 10

0 0
34 3M 1870+AURA N95 GENERAL RESPIRATOR (MASKER P2TB) 1 box @20pcs 21,000 - - - - 0
- - - - 0
1 ABATE 1 pail 25 kg - - - - 0
2,750,000

113
- - - - 0 3
158
- - - - 0 3
1,265,000
- - - - 0 1
5 DENGUE NS1 1 box 25 test
4,585,000
- - - - 0 1
6 HB SAHLI 1 pcs - - - - 0
151,250

176,225

20,000
- - - - 0
9 LARUTAN ASAM KLORIDA 0,1 N 100 ML/HCL 1 botol 100 ml - - - - 0

12,672

273,600
- - - - 0

32,061
- - - - 0

74,100
- - - - 0

375,685

18,800
- - - - 0

19,800
- - - - 0

39,050
- - - - 0
17 LARUTAN OIL EMERSI 1 botol 50 cc

367,650
- - - - 0 1
720,500
- - - - 0 1
19 LARUTAN POCK-PACK L (II) 1 botol 500 ml - - - - 0
2,310,000

42,350
- - - - 0

23,750
- - - - 0

49,200
23 LIDI SWABB 1 pcs

1,669
- - - - 0 1
16,520
- - - - 0
25 PP TEST 1 50 strip/kotak
2,132
- - - - 0 1
LPLPO Halaman 124

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

71,450
- - - - 0

71,450
- - - - 0
28 REAGEN WIDAL TEST 1 kit 20 ml - - - - 0

279,640

6,379
- - - - 0 2
5,239
- - - - 0 1
8,400
- - - - 0 2
23,566
- - - - 0 3
37,892
34 STIK URINE PARAMETER 3 1 kotak 100

1,265
- - - - 0 1
1,202

31,700

31,700

31,700
39 REAGEN DIRUI CLEANSER 1 botol - - - - 0

1,163,800
40 REAGEN DIRUI DILUENT 1 botol - - - - 0

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - - 0
47 XYLOL 1 botol/100 ml 69,400 - - - - 0

223,850

65,900
50 SPIRITUS 1 botol 1 liter - - - - 0

49,200

9,400

31,400
- - - - 0 1
STIK URINE PARAMETER 10 PARAMETER - - - - 0
1 ABATE 1 kaleng 25 kg 2,340,000 - - - - 0
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - - 0
LPLPO Halaman 125

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - - 0
17 NEDDLE NO. 25 1 ktk 100 275 - - - - 0
LPLPO Halaman 126

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - - 0
- - - - 0
- - - - 0
1
- - - - 0
2
- - - - 0
3
- - - - 0
4
- - - - 0
5
- - - - 0
6
- - - - 0
7
- - - -
8
JUMLAH JUMLAH
11,064,659
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 25 Oktober 2018
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 127

(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE : NOVEMBER TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : DESEMBER

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
1 ALBENDAZOLE 400 MG 30 box @ 30 tablet 323 - 0 - - - -
6 AMITRIPTILIN HCL TABLET SALUT 25 MG 100 Dus, 10 strip @ 10 tss 123 110 0 110 60 50 6,150
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 - 180 180 120 60 9,780 90

8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 - 3,000 3,000 1,800 1,200 126,000 900
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 800 0 800 800 - - 1,500

13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 400 1,000 1,400 1,000 400 23,600 800
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 5 10 15 15 - - 20
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 - - - 300
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 - 500 500 200 300 36,000
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 500 0 500 500 - - 1,500
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 1 Ampul 2,536 10 0 10 5 5 12,680

LPLPO Halaman 128

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
27 ANTIBAKTERI DOEN SALEP KOMBINASI (BASITRACIN) 1 box @ 25 tube 3,365 20 25 45 - 45 151,425
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 5 0 5 - 5 11,550
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 25 0 25 25 - - 25


35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 100 900 1,000 500 500 77,000
37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 100 0 100 80 20 34,760 50
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 400 0 400 - 400 19,200

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 - - - -
@ 2,5 ml
41 DIAZEPAM TABLET 2 MG 100 100 tablet/botol 46 103 0 103 - 103 4,738
43 DIGOKSIN TABLET 0,25 MG 100 box 10 x 10 tablet 103 135 0 135 75 60 6,180
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 - - - -
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 - - - -
47 DOMPERIDONE TABLET 10 MG 100 Strip, ktk 10 x 10 tablet 133 100 100 200 100 100 13,300
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 80 0 80 - 80 61,280
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 - - - -
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 200 0 200 - 200 54,800
LPLPO Halaman 129

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 - 20 20 - 20 138,000
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 83 0 83 35 48 122,880
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 300 1,500 1,800 300 1,500 166,500
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 14 0 14 - 14 1,372
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 - - - -
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 100 0 100 - 100 6,900
76 KAPTOPRIL 25 MG TABLET 100 Dus @ 10 X 10 tablet 72 300 0 300 - 300 21,600
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 - 24 24 14 10 25,000 25
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 - - - -
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 600 1,000 1,600 900 700 31,500 500
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 100 0 100 30 70 38,500
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 3 0 3 3 - - 20

LPLPO Halaman 130

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 - 600 600 440 160 54,560 400
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 50 0 50 19 31 28,799
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 - - - - 500
101 METFORMINE HCL TABLET 850 MG 100 Tablet 240 530 0 530 - 530 127,200
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 300 300 600 600 - - 1,000
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 100 Ktk 10 x 10 tablet salut 169 115 0 115 115 - - 100 ED
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 20 0 20 2 18 93,600
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 200 0 200 100 100 10,000
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 30 0 30 - 30 4,200
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 2,280 0 2,280 240 2,040 966,960
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 - - - -

salut selaput
123 - - - -
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 90 0 90 10 80 56,320
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 72 0 72 9 63 119,700

119 PARASETAMOL SIRUP 120 MG/5 ML 1 Btl @ 60 ml 1,013 50 100 150 150 - - 200
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 2,600 0 2,600 2,200 400 23,200 2,000
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 - - - - 5
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 150 0 150 150 - - 300
LPLPO Halaman 131

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 3 0 3 3 - -
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 1 0 1 - 1 15,386 1
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 - 300 300 300 - - 500
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 40 100 140 103 37 49,580 100
salut selaput
119 - 1,500 1,500 1,000 500 59,500 1,000
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 60 100 160 160 - - 200
2,5 ml
4,000 - - - -
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 - 400 400 300 100 6,800 300
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 - 100 100 0 100 8,400
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 100 0 100 100 - - 200
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 23 0 23 23 - - 30
0 0
0 0
0 0

300
0 600
200 100
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 100 Tablet 91 -

600
600
400
200 18,200
200
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 140 1,640 1,000 97,000
1500 640
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 - - - -
0
300
200
100 59,200
200
0 5
- - - -
OBAT GIGI - - - -
LPLPO Halaman 132

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
18 TKF 1 kotak 64,939 - - - -

50 0
2 AMBROXOL TABLET 30 MG 100 box 10 x 10 tablet 139 - 1,000 500 69,500

1000 500

0 2
0 0

0 7

0 0

0 0
0 10
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 -

20
20
20
- - 20
LPLPO Halaman 133

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

0
19
14
5 16,090
25
500 100
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 1,200 0 1,200 0 1,200 237,600
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 - - - -
22 MELOXICAM 15 MG TABLET 50 kotak 5 x 10 tablet 617 - 300 300 50 250 154,250
23 METAMIZOL INJEKSI (NORAGES) (2016) 5 5 ampul/kotak 9,680 - 50 50 30 20 193,600 40

25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 - 100 100 40 60 290,400
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 - 1000 1,000 800 200 37,000 800
28 OBH SIRUP 1 botol 100 ml 2,750 - - - - 5
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 3 0 3 3 - - 3

35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 - - - -

40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 - 60 60 40 20 85,660

42 TABLET FLU (MASFLU) 100 box 100 tablet 300 - 1000 1,000 700 300 90,000 500
LPLPO Halaman 134

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - 40 40 40 - - 100
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 - 1000 1,000 800 200 54,000 800
- - - -
BAKHP - - - -
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 100 100 200 100 100 89,600 100
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 100 0 100 0 100 86,300
5 ALKOHOL 70% 1 botol 1000 ml 23,650 1 1 2 0 2 47,300
6 ASEPTAN + DISPENSER 1 500 cc 33,000 - - - -
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 1 2 3 3 - - 3

9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 - 300 300 100 200 1,606,600
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 - 300 300 200 100 41,000 100
11 INFUSET ANAK 1 Set/kantong 4,025 20 0 20 0 20 80,500
12 INFUSET DEWASA 1 Set/kantong 3,680 50 100 150 0 150 552,000
15 IV CATHETER NO. 22 G 1 50 Buah/kotak 4,370 - 100 100 50 50 218,500
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 - 20 20 15 5 46,000 20

22 MASKER 50 50 pcs/kotak 506 - 300 300 100 200 101,200
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 - - - - 5

25 POLLY CATETER 2 WAY N0. 18 1 pcs 9,200 - - - -
26 RIVANOL 1 botol 300 cc 3,600 - - - -
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 - - - -
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 - - - -
LPLPO Halaman 135

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 20 0 20 20 - - 20

30 URINE BAG 1 Pcs 3,450 10 0 10 0 10 34,500
31 SAFETY BOX 1 kotak 18,073 - - - -

0 0
- - - -
1 ABATE 1 pail 25 kg - - - -
2,750,000

113
- - - -

158
- - - -

1,265,000

4,585,000
151,250

176,225

20,000
- - - -
9 LARUTAN ASAM KLORIDA 0,1 N 100 ML/HCL 1 botol 100 ml - - - -

12,672

273,600
- - - -

32,061
- - - -

74,100
- - - -

375,685

18,800
- - - -

19,800
- - - -

39,050
- - - -

367,650

720,500

2,310,000

42,350
- - - -

23,750
- - - -

49,200
23 LIDI SWABB 1 pcs

1,669
- - - -

16,520
- - - -
2,132
LPLPO Halaman 136

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

71,450
- - - -

71,450
- - - -

279,640

6,379

5,239

8,400

23,566

37,892

1,265

1,202

31,700

31,700

31,700

1,163,800

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - -
47 XYLOL 1 botol/100 ml 69,400 - - - -

223,850

65,900

49,200

9,400

31,400
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - -
LPLPO Halaman 137

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
LPLPO Halaman 138

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- - - -
7
- - - -
8
- - - -
9
JUMLAH JUMLAH
13,665,228
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 26 Desember 2018
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 139

(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE : DESEMBER TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : JANUARI

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GENERIK
1 ALBENDAZOLE 400 MG 30 box @ 30 tablet 323 - - - -
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 20 20 20 88,520
7 AMLODIPIN 10 MG TABLET 30 box @ 30 tablet 163 60 90 150 140 10 1,630
8 AMLODIPIN 5 MG TABLET 30 box @ 30 tablet 105 1,200 900 2,100 300 1,800 189,000
9 AMOKSISILIN KAPLET 500 MG 100 Kotak @ 10 x 10 tablet 233 - - - -
12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 20 50 70 62 8 16,848
13 ANTASIDA DOEN TABLET KUNYAH 100 ktk 10 x 10 tablet 59 400 800 1,200 800 400 23,600
14 ANTI HEMAROID SUPOSITORIA 10 Dus, 10 supp @ 2 gram 3,502 - 20 20 20 70,040
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 - - - -
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 100 Dus, 10 strip x 10 tablet 120 300 0 300 200 100 12,000
20 ASAM FOLAT 1 MG 100 Tablet 68 200 0 200 - 200 13,600
22 ASAM MEFENAMAT TABLET 500 MG 100 Dus, 10 blister @ 10 Kaplet 113 - 1,500 1,500 700 800 90,400
LPLPO Halaman 140

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 100 Dus, 10 strip @ 10 tablet 173 290 0 290 120 170 29,410
28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 1 box @ 24 tube 4,782 17 17 17 81,294
29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 5 5 5 11,550
31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 - 25 25 15 10 14,500
34 CETRIZINE SIRUP 5 MG/5 ML 1 botol 60 ml 7,756 40 50 90 50 40 310,240
35 CETRIZINE TABLET 10 MG 100 ktk 10 x 10 tablet 154 500 0 500 200 300 46,200
36 CLOZAPINE 25 MG 100 Tablet 1,550 200 200 200 310,000
38 DEKSAMETASON TABLET 0,5 MG 100 10 X 10 tablet/kotak 48 400 0 400 100 300 14,400

40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 5 12,751 - - - -
@ 2,5 ml
43 DIGOKSIN TABLET 0,25 MG 100 box 10 x 10 tablet 103 60 0 60 10 50 5,150
44 DILTIAZEM HCL TABLET 30 MG 100 ktk 10 x 10 tablet 137 120 0 120 20 100 13,700
45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 200 0 200 - 200 22,800
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 37 0 37 - 37 129,130
47 DOMPERIDONE TABLET 10 MG 100 Strip, ktk 10 x 10 tablet 133 150 0 150 - 150 19,950
50 ERYTHROMICIN 500MG TABLET 100 box 10 x 10 tablet 766 80 80 80 61,280
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 1 botol 60 ml 7,039 16 0 16 - 16 112,624
58 GARAM ORALIT UTK 200 ML AIR 100 Dus @ 100 sachet 274 200 0 200 60 140 38,360
LPLPO Halaman 141

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 20 20 138,000
67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 100 Tablet 171 160 0 160 25 135 23,085
68 HIDROKORTISON KRIM 2,5% 1 Tube 2,868 20 20 20 57,360
70 IBUPROFEN SIRUP 100MG/5ML 1 botol 60 ml 2,560 244 244 244 624,640
71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 1,500 0 1,500 600 900 99,900
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 Dus, 10 strip @ 10 tablet 98 14 14 14 1,372
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 1,000 1000 tablet/botol 69 - - - -
75 KAPTOPRIL 12,5 MG TABLET 100 Dus, 10 strip @ 10 tablet 69 100 0 100 - 100 6,900
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 1 box @ 24 tube 2,500 10 10 10 25,000
81 KLORAMFENIKOL KAPSUL 500 MG 100 Kapsul 1,155 80 0 80 20 60 69,300
82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 50 50 50 82,000
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 - - - -
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 1,000 Tablet 45 700 500 1,200 500 700 31,500
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 100 ktk 10 x 10 tablet 179 300 200 500 180 320 57,280
88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 70 0 70 - 70 38,500
90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 - - - -
91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 100 Strip, ktk 10 x 10 tablet 158 80 0 80 - 80 12,640
LPLPO Halaman 142

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 160 400 560 560 190,960
93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 39 0 39 - 39 36,231
100 METFORMINE HCL TABLET 500 MG 100 Dus, 10 blister @ 10 tablet 119 - - - -
102 METHYL PREDNISOLON 4 MG 100 Dus, 10 blister @ 10 tablet 209 - - - -
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 18 0 18 6 12 62,400
107 METOKLOPRAMIDE TABLET 10 MG 100 Dus @ 10 X 10 tablet 100 100 100 100 10,000
109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 30 30 30 4,200
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 15 15 15 56,055
111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 2,040 0 2,040 360 1,680 796,320
112 NATRIUM DIKLOFENAK TABLET 50 MG 50 Dus @ 5 x 10 tablet 161 200 200 200 32,200

salut selaput
123 20 0 20 - 20 2,460
115 NISTATIN TABLET SALUT 500.000 IU 100 ktk 10 x 10 tablet salut 704 90 0 90 - 90 63,360
117 OKSITOSIN INJEKSI 10 IU/ML 1 Dus, 10 ampul @ 1 ml 1,900 63 63 63 119,700
118 PARASETAMOL DROPS 1 btl 15 ml 5,980 - - - -
119 PARASETAMOL SIRUP 120 MG/5 ML 1 Btl @ 60 ml 1,013 - 200 200 116 84 85,092
120 PARASETAMOL TABLET 500 MG 100 100 tablet/ktk 58 400 0 400 400 - -
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 Tube @ 10 g 12,155 - - - -
123 PIRIDOKSIN (VITAMIN B6) TABLET 100 Tablet 136 - - - -
LPLPO Halaman 143

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 - 3 3 3 7,032
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 1 botol @ 300 ml 15,386 1 1 1 15,386
128 PREDNISON TABLET 5 MG (2017) 100 ktk 10 x 10 tablet 85 - 500 500 500 42,500
130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 37 100 137 47 90 120,600
131 RANITIDIN TABLET l50 MG 100 Dus, 10 strip @ 10 tablet 119 500 1,000 1,500 300 1,200 142,800
salut selaput
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 1 Botol @ 500 ml 7,150 - 300 300 300 2,145,000

2,5 ml
4,000 - - - -
136 SALBUTAMOL TABLET 2 MG 100 ktk 10 x 10 tablet 68 100 300 400 120 280 19,040
137 SALBUTAMOL TABLET 4 MG 100 Tablet 84 100 0 100 0 100 8,400
140 SEFADROKSIL KAPSUL 500 MG 100 Dus, 10 strip @ 10 kapsul 557 - 200 200 30 170 94,690
141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 - 30 30 9 21 99,666

0 16
0 0
144 SIANOKOBALAMIN (VIT B12) TABLET 50 MCG 100 Dus, 10 strip @ 10 tablet 63 100 100 - -
0 100
146 SIMVASTATIN 10 MG TABLET 30 box @ 30 tablet 135 300 300 - -

0 300
0 0
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 100 Tablet 91 200 400 400 36,400
200
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 100 Tablet 97 1,000 1,000 330 32,010
0 670
153 VITAMIN B KOMPLEKS TABLET 100 Dus, 10 strip x 10 tablet 132 260 260 260 34,320
0 0
154 ZINC DISPERSIBLE 20 MG TABLET 100 Dus, 10 strip @ 10 tablet 592 500 700 600 355,200
200 100

0 11
- - - -
OBAT GIGI - - - -
LPLPO Halaman 144

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
18 TKF 1 kotak 64,939 - - - -

0 25
2 AMBROXOL TABLET 30 MG 100 box 10 x 10 tablet 139 500 500 200 27,800
0 300

0 5
0 0

0 5

0 1
0 20
12 GENTAMISIN SALEP KULIT 0,1% 25 kotak @ 25 tube 2,686 - 20 13 34,918

20 7
LPLPO Halaman 145

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
13 GENTIAN VIOLET 1% 10 ML 1 botol 3,218 5 29 19 61,142

24 10
0 0
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 1,000 botol 1000 tablet 198 1,200 0 1,200 0 1,200 237,600
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 24 kotak @ 24 botol 7,600 - - - -
22 MELOXICAM 15 MG TABLET 50 kotak 5 x 10 tablet 617 250 0 250 170 80 49,360
23 METAMIZOL INJEKSI (NORAGES) (2016) 5 5 ampul/kotak 9,680 40 0 40 0 40 387,200
24 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2017) 100 box 10 x 10 tablet 271 - 100 100 100 27,100
25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 1 ampul 4,840 60 0 60 40 20 96,800
26 MULTIVITAMIN SIRUP ANAK (TRUVIT) 1 botol 60 ml 7,700 50 40 90 90 693,000
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 100 box 100 tablet 185 200 800 1,000 880 120 22,200
28 OBH SIRUP 1 botol 100 ml 2,750 - 5 5 2 3 8,250
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 1 tube 35 gr 48,950 - 3 3 0 3 146,850
35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 1 botol @ 300 ml 38,500 - 1 1 0 1 38,500
36 PREDNISON TABLET 5 MG (2016) 100 kotak 10 x 10 tablet 132 700 0 700 0 700 92,400
37 PROPILTIOURASIL TABLET 100 MG 100 box 100 tablet 330 90 0 90 0 90 29,700
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 1 botol 60 ml 4,283 20 20 20 85,660
42 TABLET FLU (MASFLU) 100 box 100 tablet 300 300 500 800 0 800 240,000
44 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 1000 botol @ 1000 tablet 79 - 40 40 0 40 3,160
LPLPO Halaman 146

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 1 kotak 10 ampul 9,415 - 100 100 0 100 941,500
48 VITAMIN NEUROTROPIK TABLET 100 kotak 10 x 10 tablet 270 200 800 1,000 900 100 27,000
- - - -
BAKHP - - - -
1 ALAT SUNTIK 10 ML 1 Pcs 1,064 50 50 50 53,200
2 ALAT SUNTIK SEKALI PAKAI 1 ML 100 100 Buah/kotak 748 - 200 200 200 149,600
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 100 100 Buah/kotak 896 100 200 300 300 268,800
4 ALAT SUNTIK SEKALI PAKAI 5 ML 100 100 Buah/kotak 863 100 100 100 86,300
5 ALKOHOL 70% 1 botol 1000 ml 23,650 2 0 2 0 2 47,300
7 ASEPTAN GEL + DISPENSER 1 500 cc 24,200 - 3 3 0 3 72,600
8 CATGUT BEDAH NO. 3/0 + JARUM 1/2 GT 35 MM 24 1 24 X 75 cm/kotak 6,421 8 8 8 51,368
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 50 50 pcs/kotak 8,033 200 200 200 1,606,600
10 HANDSCOON (SEFAGLOVE) NON STERIL 100 box/100 pcs 410 100 100 200 200 82,000
12 INFUSET DEWASA 1 Set/kantong 3,680 150 150 150 552,000
19 KASA HYDROPIL STERIL 16 X 16 1 kotak 9,200 5 0 5 5 - -
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 1 Rol 863 10 0 10 10 8,630
22 MASKER 50 50 pcs/kotak 506 200 150 350 350 177,100
23 PHARMAFIX 5 X 500 CM 1 roll 27,324 - 5 5 5 136,620
25 POLLY CATETER 2 WAY N0. 18 1 pcs 9,200 - - - -
26 RIVANOL 1 botol 300 cc 3,600 1 0 1 0 1 3,600
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 1 Rol/100 meter 5,271 - - - -
28 UMBILICAL CORD KLEM STERIL NYLON 50 Kotak 1,150 - - - -
LPLPO Halaman 147

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
29 UNDERPAD STERIL 60 X 90 CM 1 Pcs 4,788 - 20 20 20 95,760
30 URINE BAG 1 Pcs 3,450 10 10 10 34,500
31 SAFETY BOX 1 kotak 18,073 - - - -
34 3M 1870+AURA N95 GENERAL RESPIRATOR (MASKER P2TB) 1 box @20pcs 21,000 - 80 80 1,680,000
80
- - - -
1 ABATE 1 pail 25 kg - - - -
2,750,000

113
- - - -

158
- - - -

1,265,000
5 DENGUE NS1 1 box 25 test - 15 15 68,775,000

4,585,000 15
151,250

176,225

20,000
- 9 9 180,000
9
9 LARUTAN ASAM KLORIDA 0,1 N 100 ML/HCL 1 botol 100 ml - 1 1 12,672

12,672 1

273,600
- 1 1 273,600
1

32,061
- - - -

74,100
- - - -
13 LARUTAN GIEMSA STAIN 100 ML 1 botol 100 ml - 1 1 375,685

375,685 1

18,800
- 1 1 18,800
1

19,800
- 1 1 19,800
1

39,050
- 1 1 39,050
1
17 LARUTAN OIL EMERSI 1 botol 50 cc - 1 1 367,650

367,650 1
18 LARUTAN POCK-PACK D (II) 1 botol - 8 8 5,764,000

720,500 8
19 LARUTAN POCK-PACK L (II) 1 botol 500 ml - 4 4 9,240,000

2,310,000 4

42,350
- - - -

23,750
- - - -

49,200
23 LIDI SWABB 1 pcs

1,669
- - - -

16,520
- 1 1 16,520
1
2,132
LPLPO Halaman 148

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

71,450
- - - -

71,450
- - - -

279,640

6,379

5,239

8,400
32 STIK PEMERIKSAAN KOLESTEROL 1 kotak isi 10 - 6 6 141,396

23,566 6

37,892

1,265

1,202

31,700

31,700

31,700

1,163,800

2,340,000

3,782,000

2,365,000

1,733,000

2,643,000

3,820,000

3,032
- - - -
47 XYLOL 1 botol/100 ml 69,400 - 1 1 69,400

1
48 ZIEHL NELSEN 1 set - 7 7 1,566,950

223,850 7

65,900

49,200

9,400

31,400
1 ABATE 1 kaleng 25 kg 2,340,000 - - - -
2 ALKOHOL 70% (2017) 1 botol 1000 ml 28,058 - - - -
3 AMOKSISILIN KAPLET 500 MG 100 ktk 10 x 10 kaplet 279 - 1,500 1,500 418,500
1500
LPLPO Halaman 149

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
14 KOTRIMOKSAZOL SUSPENSI 60 ML 1 botol 60 ml 2,225 - 50 50 111,250

50
16 NEDDLE NO. 23 1 ktk 100 275 - - - -
17 NEDDLE NO. 25 1 ktk 100 275 - - - -
20 PARASETAMOL 500 MG TABLET 100 kotak 10 x 10 tablet 88 - 2,000 800 70,400

2000 1200
LPLPO Halaman 150

JUMLAH JUMLAH
HARGA HARGA
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
44 URINE BAG 1 PCS 3,150 - - - -
- - - -
- - - -
1
- - - -
2
- - - -
3
- - - -
4
- - - -
5
- - - -
6
- - - -
7
- - - -
8
- - - -
9
JUMLAH JUMLAH
108,501,867
HARGA HARGA

BPJS JUMLAH
BAYAR PKD-G
Martapura, 26 Desember 2018
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 151

(LPLPO) TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : KARANG INTAN PELAPORAN BULAN/PERIODE SEPTEMBER TAHUN : 2018
KABUPATEN KOTA : BANJAR PERMINTAAN BULAN/PERIODE : OKTOBER
NO NAMA OBAT JAN FEB MAR APR MEI JUN JUL

AGT SEPT TOTAL RATA2
1 2 3 4 5 6 7 8 9 10 11 14 15 16
OBAT GENERIK
1 ALBENDAZOLE 400 MG 0 0 - - 0 - - - - - -
2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 2 57 - - 0 - - 30 - 89 9.89
3 ALOPURINOL TABLET 100 MG 0 200 110 50 50 60 90 140 90 790 87.78
4 ALOPURINOL TABLET 300 MG 10 150 - 25 30 15 30 60 110 430 47.78
5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 0 0 - - 0 - - - - - -
6 AMITRIPTILIN HCL TABLET SALUT 25 MG 0 30 - - 0 - - - - 30 3.33
7 AMLODIPIN 10 MG TABLET 180 95 90 25 60 150 - 210 140 950 105.56
8 AMLODIPIN 5 MG TABLET 690 720 810 1,050 760 800 1,200 1,200 300 7,530 836.67
9 AMOKSISILIN KAPLET 500 MG 900 900 1,100 1,100 800 1,000 - 1,300 - 7,100 788.89
10 AMOKSISILIN SERBUK INJEKSI 1000 MG 0 0 - - 0 - - - - - -
11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 5 50 13 37 40 44 32 14 20 255 28.33
12 ANTASIDA DOEN SUSPENSI 28 24 8 - 0 - 30 20 62 172 19.11
13 ANTASIDA DOEN TABLET KUNYAH 600 700 1,200 800 1,500 1,000 1,600 1,400 800 9,600 1,066.67
14 ANTI HEMAROID SUPOSITORIA 5 8 7 13 30 - 15 15 - 93 10.33
15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 0 0 - 40 110 - - - - 150 16.67
16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 0 0 - - 0 - - - - - -
17 ARTESUNATE INJEKSI 60 MG / ML 0 0 - - 0 - - - - - -
18 ASAM ASETILSALISILAT 100 MG (ASETOSAL) 0 0 90 - 0 - - 50 - 140 15.56
19 ASAM ASKORBAT (VIT C) TABLET 50 MG 400 200 200 200 400 600 - 200 200 2,400 266.67
20 ASAM FOLAT 1 MG 62 110 128 200 0 - 200 - - 700 77.78
21 ASAM MEFENAMAT TABLET 250 MG 0 0 - - 0 - - - - - -
22 ASAM MEFENAMAT TABLET 500 MG 1,200 1,400 2,100 2,100 1,400 1,700 - 1,800 700 12,400 1,377.78
23 ASAM TRANEKSAMAT INJEKSI 50 MG / ML 0 2 - 5 0 - - 5 - 12 1.33
24 ASIKLOVIR 200 MG TABLET 0 90 - - 0 - - 20 - 110 12.22
25 ASIKLOVIR 400 MG TABLET 0 100 50 20 0 70 - 80 - 320 35.56
LPLPO Halaman 152

1 2 3 4 5 6 7 8 9 10 11 14 15 16
26 ATAPULGIT TABLET 600 MG (NEW DIATES) 0 0 100 - 0 - - 50 120 270 30.00
27 ANTIBAKTERI DOEN SALEP KOMBINASI (BASITRACIN) 1 19 5 5 11 4 - 10 1 56 6.22
28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 0 0 7 - 0 2 - - - 9 1.00
29 AQUA PRO INJEKSI 0 0 - - 0 - - 20 - 20 2.22
30 BETAHISTINE TABLET 0 0 20 30 10 50 - 84 70 264 29.33
31 BETAMETASON KRIM 0.1 %- 5 MG 24 26 22 18 25 15 15 19 15 179 19.89
32 BISAKODIL TABLET 5 MG (2017) 0 0 20 - 0 32 - - - 52 5.78
33 BISOPROLOL 5 MG TABLET 0 0 - - 0 - - - - - -
34 CETRIZINE SIRUP 5 MG/5 ML 46 40 38 51 37 42 - 66 50 370 41.11
35 CETRIZINE TABLET 10 MG 300 400 200 - 0 - - 700 200 1,800 200.00
36 CLOZAPINE 25 MG 0 0 40 - 60 - - - - 100 11.11
37 DEKSAMETASON INJ 5 MG/ML-1ML 4 0 15 11 0 12 6 - 50 98 10.89 ED
38 DEKSAMETASON TABLET 0,5 MG 100 700 360 100 340 100 200 300 100 2,300 255.56
39 DIAZEPAM INJEKSI 5 MG / ML 0 1 - - 0 3 - 1 - 5 0.56
40 DIAZEPAM LARUTAN REKTAL 5 MG/2,5 ML (STESOLID REKTAL) 0 0 - - 0 - - - - - -
41 DIAZEPAM TABLET 2 MG 43 22 5 - 18 37 11 7 10 153 17.00
42 DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1 ML 0 28 30 - 20 - - 10 - 88 9.78
43 DIGOKSIN TABLET 0,25 MG 0 0 10 10 10 - - - 10 40 4.44
44 DILTIAZEM HCL TABLET 30 MG 0 0 - - 10 - - - 20 30 3.33
45 DIMENHIDRINAT TABLET 50 MG 0 0 400 100 0 100 100 - - 700 77.78
46 DOMPERIDONE SUSPENSI 5 MG/5 ML 18 8 5 1 2 6 - 22 - 62 6.89
47 DOMPERIDONE TABLET 10 MG 50 130 30 60 10 30 100 - - 410 45.56
48 DULCOLAX SUPP INFANT (BISAKODIL SUPP 5MG) 0 1 2 - 0 3 - - - 6 0.67
49 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 0 0 - - 0 - - - - - -
50 ERYTHROMICIN 500MG TABLET 0 0 - - 0 - - - - - -
51 ERYTHROMICIN SIRUP 200 MG / 5 ML 0 0 1 - 0 - 4 - - 5 0.56
52 FENITOIN NATRIUM KAPSUL 100 MG 0 0 - - 0 - - - - - -
53 FENOBARBITAL INJEKSI 50 MG/ML-2ML 0 0 - - 0 - - - - - -
54 FENOBARBITAL TABLET 30 MG 0 0 - - 0 - - - - - -
55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 5 17 - - 3 - - - 1 26 2.89
56 FITOMENADION (VIT.K1) TABLET SALUT 10 MG 0 100 100 - 0 - - - - 200 22.22
57 FUROSEMIDE INJEKSI 10 MG / ML 6 0 - - 0 - 14 - - 20 2.22
58 GARAM ORALIT UTK 200 ML AIR 16 116 71 74 100 - - - 60 437 48.56
LPLPO Halaman 153

1 2 3 4 5 6 7 8 9 10 11 14 15 16
59 GENTAMISIN TETES MATA 0,3% 9 8 17 19 2 10 12 14 12 103 11.44
60 GLIMEPIRIDE 2MG TABLET 0 0 - - 50 - - - - 50 5.56
61 GLIMEPIRIDE 4MG TABLET 0 0 - - 0 - - - - - -
62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 0 0 20 - 20 20 - - - 60 6.67
63 GRISEOFULVIN TABLET 125 MG,MICRONIZED 0 40 20 10 10 - 10 - - 90 10.00
64 HALOPERIDOL TABLET 0,5 MG 0 0 - - 0 - - - - - -
65 HALOPERIDOL TABLET 1,5 MG 270 90 120 340 210 180 180 220 210 1,820 202.22
66 HALOPERIDOL TABLET 5 MG 0 0 - - 0 - - - - - -
67 HIDROKLOROTIAZID 25 MG (HCT) TABLET 0 0 - - 0 - 10 - 25 35 3.89
68 HIDROKORTISON KRIM 2,5% 10 5 11 8 13 3 - 1 - 51 5.67
69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 10 0 10 - 0 - - - - 20 2.22
70 IBUPROFEN SIRUP 100MG/5ML 0 10 24 34 27 31 74 - - 200 22.22
71 IBUPROFEN TABLET 200 MG 0 0 - - 0 - - 700 600 1,300 144.44
72 IBUPROFEN TABLET 400 MG 0 0 - - 0 - - - - - -
73 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG 100 120 - 100 0 - 100 14 - 434 48.22
74 KALSIUM LAKTAT (KALK) TABLET 500 MG 400 500 500 700 600 - 500 700 - 3,900 433.33
75 KAPTOPRIL 12,5 MG TABLET 200 190 600 - 0 90 - - - 1,080 120.00
76 KAPTOPRIL 25 MG TABLET 0 0 - 400 500 300 300 200 200 1,900 211.11
77 KARBAMAZEPIN TABLET 200 MG 60 30 - 50 60 50 - 10 20 280 31.11
78 KARBOGLISERIN TETES TELINGA 10% (FENOL TT) 0 0 5 - 10 5 - - - 20 2.22
79 KETOKENAZOLE CREAM 2% 6 10 2 6 5 2 9 8 3 51 5.67
80 KLINDAMISIN KAPSUL 300 MG 0 0 20 15 0 30 10 - - 75 8.33
81 KLORAMFENIKOL KAPSUL 500 MG 0 0 - - 70 - 50 - 20 140 15.56
82 KLORAMFENIKOL SALEP MATA 1 % 11 5 3 - 10 6 8 - - 43 4.78
83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 0 0 15 15 6 4 - 5 - 45 5.00
84 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML 6 7 2 1 0 - 1 4 1 22 2.44
85 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG 800 900 1,400 1,200 1,000 800 - 1,800 500 8,400 933.33
86 KLORPROMAZIN HCL TABLET SALUT 100 MG 220 85 230 240 125 - - 220 180 1,300 144.44
87 KLORPROMAZINE HCL TABLET SALUT 25 MG 0 0 - - 0 - - - - - -
88 KODEIN 10 MG TABLET 0 0 - - 0 - 40 40 - 80 8.89
89 KODEIN 20 MG TABLET 0 0 - - 0 - - - - - -
90 KOTRIMOKSAZOL SUSPENSI 60 ML 8 15 - - 2 123 - 2 - 150 16.67
91 KOTRIMOKSAZOL TABLET KOMBINASI 480 MG 18 10 - - 60 100 - - - 188 20.89
LPLPO Halaman 154

1 2 3 4 5 6 7 8 9 10 11 14 15 16
92 LANZOPRAZOLE 30 MG 60 160 220 580 300 500 700 300 - 2,820 313.33
93 LIDOCAIN INJEKSI 35 0 - - 0 - 25 - - 60 6.67
94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 2 7 - 19 0 - 14 16 - 58 6.44
95 LOPERAMIDE TABLET 2 MG 16 128 106 - 0 - 100 - 40 390 43.33
96 LORATADINE TABLET 0 0 100 200 0 - - - - 300 33.33
97 MAGNESIUM SULFAT INJEKSI 20% (MGSO4 20%) (2017) 0 0 - - 0 - - - - - -
98 MANITOL LARUTAN INFUS 20% 0 0 - - 0 - - - - - -
99 METAMIZOL INJEKSI (ANTALGIN) 500 MG/ML 0 0 - - 0 - - - - - -
100 METFORMINE HCL TABLET 500 MG 400 500 300 600 400 400 400 400 - 3,400 377.78
101 METFORMINE HCL TABLET 850 MG 100 100 - - 139 - 100 40 250 729 81.00
102 METHYL PREDNISOLON 4 MG 300 200 400 - 400 400 600 500 - 2,800 311.11
103 METILERGOMETRIN MALEAT INJEKSI 0,2 MG / ML 0 43 - - 0 - - - - 43 4.78
104 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2016) 0 50 - - 5 - - - - 55 6.11
105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 0 4 - 5 0 5 - 6 6 26 2.89
106 METOCLOPRAMIDE SIRUP 5MG/ML (LEXAPRAM) 0 0 - - 0 - - - - - -
107 METOKLOPRAMIDE TABLET 10 MG 10 116 114 30 170 - 230 260 - 930 103.33
108 METRONIDAZOL TABLET 250 MG 50 70 - - 0 - - - - 120 13.33
109 METRONIDAZOL TABLET 500 MG 0 0 200 - 70 - 30 40 - 340 37.78
110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 9 5 10 - 22 - - 15 - 61 6.78
111 N-ASETIL SISTEIN 200 MG TABLET 0 0 - 1,230 60 450 900 360 360 3,360 373.33
112 NATRIUM DIKLOFENAK TABLET 50 MG 200 400 - - 350 450 700 - - 2,100 233.33
113 NATRIUM KLORIDA LARUTAN INFUS 0,9 STERIL 500 ML (NACL) 0 0 - - 0 - 20 20 - 40 4.44
114 NIFEDIPIN TABLET 10 MG 0 50 - 10 20 - 20 100 - 200 22.22
115 NISTATIN TABLET SALUT 500.000 IU 0 0 - - 0 10 - - - 10 1.11
116 NISTATIN TABLET VAGINAL 100.000 IU/G 0 0 - - 0 - 5 - 6 11 1.22
117 OKSITOSIN INJEKSI 10 IU/ML 0 0 - - 12 - - - - 12 1.33
118 PARASETAMOL DROPS 77 0 - - 0 56 - 40 - 173 19.22
119 PARASETAMOL SIRUP 120 MG/5 ML 108 193 77 104 141 64 44 22 116 869 96.56
120 PARASETAMOL TABLET 500 MG 1,500 2,200 2,600 2,200 2,400 1,300 2,300 1,800 400 16,700 1,855.56
121 PERMETRIN KRIM 5% (SCABIMITE CREAM 10) 1 1 1 - 1 1 2 1 - 8 0.89
122 PIRANTEL TABLET SCORE (BASE) 125 MG 0 0 - - 0 - - - - - -
123 PIRIDOKSIN (VITAMIN B6) TABLET 50 70 30 60 210 - - - - 420 46.67
124 POLIKRESULEN (METAKRESOL) 360 MG/G- 10 ML (APTIL) 0 0 - 1 2 1 - - - 4 0.44
LPLPO Halaman 155

1 2 3 4 5 6 7 8 9 10 11 14 15 16
125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 3 3 1 0 - - 5 - 13 1.44
126 POVIDON IODIDA LARUTAN 10 % 60 ML 0 0 - 1 0 - - - - 1 0.11
127 POVIDON IODIDA LARUTAN 10 % 300 ML (2016) 0 1 - 1 0 - - 1 - 3 0.33
128 PREDNISON TABLET 5 MG (2017) 120 90 60 - 270 - 200 100 - 840 93.33
129 PROPANOLOL TABLET 10 MG (HCL) 0 0 - - 0 - - - - - -
130 RANITIDIN INJEKSI 25 MG/ 2 ML 0 0 - - 0 - - - 47 47 5.22
131 RANITIDIN TABLET l50 MG 800 1,000 1,500 1,200 1,100 1,300 - - 300 7,200 800.00
132 RETINOL (VITAMIN A) 100.000 IU 0 0 - - 0 - - - - - -
133 RETINOL (VITAMIN A) 200.000 IU 0 0 - - 0 - - - - - -
134 RINGER LAKTAT LARUTAN INFUS STERIL- 500 ML 0 140 160 160 0 - - 140 - 600 66.67
135 SALBUTAMOL CAIRAN IH 0,1% (VENTOLIN) 0 0 20 - 10 10 - 10 - 50 5.56
136 SALBUTAMOL TABLET 2 MG 300 400 - 100 200 200 200 300 120 1,820 202.22
137 SALBUTAMOL TABLET 4 MG 100 0 - - 0 - - - - 100 11.11
138 SALEP 2 - 4 KOMBINASI 0 3 - 4 0 1 - 3 - 11 1.22
139 SALISIL BEDAK 2 %- 50 G 0 0 6 1 6 2 - - - 15 1.67
140 SEFADROKSIL KAPSUL 500 MG 60 75 185 90 150 200 200 240 30 1,230 136.67
141 SEFADROKSIL SYRUP 125 MG / 5 ML 16 12 - 6 34 6 24 10 9 117 13.00
142 SEFOTAKSIM SERBUK INJEKSI 500 MG 28 10 14 72 50 44 - 20 16 254 28.22
143 SIANOKOBALAMIN (VIT B12) INJEKSI 500 MCG 0 0 - - 10 - - - - 10 1.11
144 SIANOKOBALAMIN (VIT B12) TABLET 50 MCG 0 0 - - 0 - 50 100 100 250 27.78
145 SIFIKSIM 100 MG 50 30 120 50 240 - - - - 490 54.44
146 SIMVASTATIN 10 MG TABLET 140 240 210 180 150 90 150 270 300 1,730 192.22
147 SIPROFLAKSASIN TABLET 500 MG 30 80 50 50 130 - 200 - - 540 60.00
148 SPIRONOLACTONE 100 MG (2016) 0 0 - - 0 - - - - - -
149 TABLET TAMBAH DARAH ( SF ) 0 330 900 480 210 - - - - 1,920 213.33
150 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 0 0 1 - 0 - 1 - - 2 0.22
151 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 0 0 - - 0 - - - - - -
152 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER) (2017) 0 0 170 130 260 - 470 - 670 1,700 188.89
153 VITAMIN B KOMPLEKS TABLET 900 900 1,300 20 1,480 800 800 900 - 7,100 788.89
154 ZINC DISPERSIBLE 20 MG TABLET 100 100 100 20 80 200 - 300 100 1,000 111.11
155 ZINC DSIRUP 20MG/ML (ZIRCUM KID) 11 12 6 26 56 20 79 47 11 268 29.78
0 0 - - 0 - - - - - -
OBAT GIGI 0 0 - - 0 - - - - - -
LPLPO Halaman 156

1 2 3 4 5 6 7 8 9 10 11 14 15 16
1 ARTICULATING PAPER 0 0 - - 0 - - 1 - 1 0.11
2 BODING LIQUID (MASTERBOND) 0 0 - 1 1 - - - - 2 0.22
3 CELULOID PASTA 0 0 - - 0 - - - - - -
4 COMPOSIT A 2 (SOLARE X2) 2ml (kemasan plastik) 0 0 - - 1 - - - - 1 0.11
5 COMPOSIT A 3 (SOLARE X3) 2ml (kemasan plastik) 0 0 - 1 1 - - - - 2 0.22
6 COMPOSIT A 2 (SOLARE X2) 4ml (kemasan kotak) 0 0 - 1 0 - - - - 1 0.11
7 COMPOSIT A 3 (SOLARE X3) 4ml (kemasan kotak) 0 0 - - 0 - - - - - -
8 DEVITALISASI PASTA (NON ARSEN) / PULP-X 0 1 - - 0 - - - - 1 0.11
9 ETCHING (ETCHING GEL) / SCHOTCHBOND 0 0 - - 1 - - - - 1 0.11
10 ETIL KLORIDA SPRAY 100 ML 0 0 - - 1 - - - - 1 0.11
11 EUGENOL CAIRAN 10 ML 0 1 1 - 0 - - - - 2 0.22
12 GLASS IONOMER CEMENT (FUJI GC IX) 0 0 - 1 0 - - - - 1 0.11
13 IODOFORM PASTA 0 0 1 - 2 - - - - 3 0.33
14 KALSIUM HIDROKSIDA PASTA (CALPUS)/ (HYDCAL) 0 0 - - 0 - - - - - -
15 MONOKLORKAMFER MENTOL CAIRAN 10 ML / CHKM (CHAMFENOL) 0 0 - - 0 - - 1 - 1 0.11
16 SEMEN SENG FOSFAT SERBUK DAN CAIRAN- 30 G 0 0 - - 0 - - - - - -
17 TAMBALAN SEMENTARA, premix (CAVITON)/ (CAVIT-W) 0 0 1 1 1 - - - - 3 0.33
18 TKF 0 0 - - 0 - - - - - -
19 ZINC PHOSPHAT 0 0 - - 0 - - - - - -
20 CRESOPHENE (CRESOTIN) LIQUID 0 0 1 - 0 - - - - 1 0.11
0 0 - - 0 - - - #NAME? #NAME? #NAME?
OBAT PENUNJANG 0 0 - - 0 - - - - - -
1 AMBROXOL SIRUP 15 MG/ML 20 60 26 - 46 18 - - 25 195 21.67
2 AMBROXOL TABLET 30 MG 600 700 100 400 100 - - - 300 2,200 244.44
3 ANTI FUNGI DOEN KOMBINASI (2016) 0 2 - - 0 - - - 5 7 0.78
4 ANTIMIGRAIN (ERGOTAMINE) TABLET 0 0 - - 0 - - - - - -
5 ASAM TRANEKSAMAT 500 MG (NEXITRA) 0 0 60 40 50 25 - 50 - 225 25.00
6 ASIKLOVIR KRIM 5% 0 0 5 2 11 - - 5 5 28 3.11
7 ALBOTYL CONCENTRAT (POLIKRESOLEN 360 MG/G)) (2017) 0 0 - - 0 1 - 3 1 5 0.56
8 DIAZEPAM 2MG TABLET (2017) 0 0 - - 0 - - - - - -
9 BISAKODIL TABLET 5 MG (MELAXAN) (2015) 0 0 20 - 0 30 - 2 - 52 5.78
10 FENOBARBITAL 30 MG TABLET (2017) 0 0 - - 0 - - - - - -
11 FUROSEMID 40 MG 85 200 - 70 0 20 10 80 20 485 53.89
LPLPO Halaman 157

1 2 3 4 5 6 7 8 9 10 11 14 15 16
12 GENTAMISIN SALEP KULIT 0,1% 14 10 20 - 0 - - - 7 51 5.67
13 GENTIAN VIOLET 1% 10 ML 9 3 12 6 0 - - - 10 40 4.44
14 GLIBENKLAMIDA TABLET 5 MG 200 200 100 200 200 - 30 70 - 1,000 111.11
15 GLICERYL GUAIKOLAT TABLET 100 MG / GUAIFENISIN TABLET 600 1,000 200 300 0 - - - - 2,100 233.33
16 HYOSCINE-N- BUTILBROMIDE 10 mg TABLET (SCOPMA) 6 70 74 - 30 50 120 130 40 520 57.78
17 HYOSCINE-N- BUTILBROMIDE INJEKSI 20MG/ML (SPANISH) 0 0 10 - 41 11 - 33 - 95 10.56
18 KLORAMFENIKOL 250MG KAPSUL 0 0 - - 0 - - - - - -
19 KLORAMFENIKOL TETES MATA 0,5% (RECO) (2016) 0 0 - - 11 4 - 5 - 20 2.22
20 KLORAMFENIKOL TETES TELINGA (RECO) (2016) 6 0 2 8 4 9 - 3 8 40 4.44
21 MAGNESIUM SULFAT INJEKSI (2016) 0 0 - - 0 - - - - - -
22 MELOXICAM 15 MG TABLET 80 0 - - 0 - - - 170 250 27.78
23 METAMIZOL INJEKSI (NORAGES) (2016) 0 0 - - 0 - - - - - -
24 METILERGOMETRIN MALEAT TABLET SALUT 0,125 MG (2017) 0 0 - - 0 - - - - - -
25 METOKLOPRAMIDE INJEKSI (VERTIVOM) 30 0 70 10 0 60 - - 40 210 23.33
26 MULTIVITAMIN SIRUP ANAK (TRUVIT) 20 50 27 60 8 35 - 88 - 288 32.00
27 OBAT TAMBAH DARAH KOMBINASI (FONDAZEN/NOVOBION) 160 840 - 2,300 800 600 900 900 880 7,380 820.00
28 OBH SIRUP 5 0 - - 0 - 5 - 2 12 1.33
29 OKSITETRASIKLIN SALEP KULIT 6 0 10 15 6 4 - 20 15 76 8.44
30 OKSITETRASIKLIN SALEP MATA 1% 3,5 ML 3 15 1 - 1 - - 8 2 30 3.33
31 PAPAVERIN TABLET 0 0 - - 0 - - - - - -
32 PARASETAMOL TABLET 100 MG 0 0 - - 0 - - - - - -
33 PEHACAIN INJEKSI 0 0 - - 40 - - 60 - 100 11.11
34 PERAK SULFADIAZIN KRIM 1% (BURNAZIN CREAM) 0 2 - - 2 2 - - - 6 0.67
35 POVIDONE IODIDA LARUTAN 10% 300 ML (2017) 0 0 - - 0 - - 3 - 3 0.33
36 PREDNISON TABLET 5 MG (2016) 0 0 - - 0 - - - - - -
37 PROPILTIOURASIL TABLET 100 MG 0 0 - - 0 - - - - - -
38 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 0 0 - - 0 - - 1 - 1 0.11
39 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 0 0 - - 0 - - - - - -
40 SIRUP FLU ANAK KOMBINASI (FLUTOP C) 51 45 30 66 36 27 - - - 255 28.33
41 SIRUP TAMBAH DARAH ANAK (SUPRABION) 0 0 - - 0 - - - - - -
42 TABLET FLU (MASFLU) 0 0 - - 0 - - - - - -
43 TABLET FLU KOMBINASI (FLU DAN BATUK / RAMAFLU)) 0 0 - - 0 - - - - - -
44 THIAMIN HCL MONONITRAT (VIT.B1) TABLET 50 MG 0 0 - - 0 - - - - - -
LPLPO Halaman 158

1 2 3 4 5 6 7 8 9 10 11 14 15 16
45 THIAMFENIKOL 500 MG KAPSUL 0 0 - - 0 - - - - - -
46 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG (HEXYMER)(2016) 270 74 - - 0 - - - - 344 38.22
47 VITAMIN NEUROTROPIK INJEKSI (NEUROBION 5000 INJEKSI) 0 0 - - 0 - - - - - -
48 VITAMIN NEUROTROPIK TABLET 0 0 - - 0 - - - 900 900 100.00
0 0 - - 0 - - - - - -
BAKHP 0 0 - - 0 - - - - - -
1 ALAT SUNTIK 10 ML 0 10 31 - 29 - 71 - - 141 15.67
2 ALAT SUNTIK SEKALI PAKAI 1 ML 200 0 - 200 200 200 - 100 - 900 100.00
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML + 3 ML 116 99 - 200 0 100 200 100 - 815 90.56
4 ALAT SUNTIK SEKALI PAKAI 5 ML 15 0 - - 0 - 100 - - 115 12.78
5 ALKOHOL 70% 1 0 - 2 1 1 1 1 - 7 0.78
6 ASEPTAN + DISPENSER 0 0 - 5 1 - 2 5 - 13 1.44
7 ASEPTAN GEL + DISPENSER 1 2 2 - 0 - - 2 - 7 0.78
8 CATGUT BEDAH NO. 3/0 + JARUM 1/2 GT 35 MM 24 4 7 10 3 14 2 17 8 - 65 7.22
9 HANDSCOON (PF SEFAGLOVE NO. 7,5/7/6) STERIL 0 0 50 - 0 50 - - - 100 11.11
10 HANDSCOON (SEFAGLOVE) NON STERIL 0 100 - 50 100 100 50 50 - 450 50.00
11 INFUSET ANAK 0 3 15 2 50 - - - - 70 7.78
12 INFUSET DEWASA 0 50 36 30 64 50 - 50 - 280 31.11
13 IV CATHETER NO. 18 G 0 0 - - 0 - - - - - -
14 IV CATHETER NO. 20 G 45 0 - 2 0 18 - 33 47 145 16.11
15 IV CATHETER NO. 22 G 28 22 77 29 30 55 - 25 - 266 29.56
16 IV CATHETER NO. 24 G 24 16 30 11 13 38 - - - 132 14.67
17 KAPAS PEMBALUT / ABSORBEN 250 GRAM 1 0 1 2 0 3 - - - 7 0.78
18 KASA HIDROFIL 36 M X 80 CM 1 0 - 2 1 1 - - - 5 0.56
19 KASA HYDROPIL STERIL 16 X 16 0 0 - 13 6 6 - 5 5 35 3.89
20 KASA PEMBALUT HIDROFIL 4 M X 10 CM 3 0 - 7 10 5 3 2 20 50 5.56
21 KASA PEMBALUT HIDROFIL 4 M X 5 CM 8 0 - - 20 - - - - 28 3.11
22 MASKER 200 0 100 - 100 200 - 100 - 700 77.78
23 PHARMAFIX 5 X 500 CM 3 2 - 3 4 3 1 2 - 18 2.00
24 POLLY CATETER 2 WAY N0. 16 0 0 - - 0 3 - - - 3 0.33
25 POLLY CATETER 2 WAY N0. 18 0 0 - - 4 3 - - - 7 0.78
26 RIVANOL 0 0 - - 0 - - - - - -
27 SILK (Benang Bedah Sutera No. 2/0 + Jarum) 0 0 - - 0 - - - - - -
LPLPO Halaman 159

1 2 3 4 5 6 7 8 9 10 11 14 15 16
28 UMBILICAL CORD KLEM STERIL NYLON 0 0 - - 0 - - - - - -
29 UNDERPAD STERIL 60 X 90 CM 0 0 - - 0 - - - - - -
30 URINE BAG 0 0 - - 2 - - 1 - 3 0.33
31 SAFETY BOX 0 0 - - 0 - - - - - -
32 NEEDLE TERUMO 22 G 0 0 46 - 0 - 15 35 - 96 10.67
33 NEEDLE TERUMO 25 G 0 0 53 - 0 - - 50 - 103 11.44
34 3M 1870+AURA N95 GENERAL RESPIRATOR (MASKER P2TB) 0 0 - - 20 - - - - 20 2.22
0 0 - - 0 - - - - - -
REAGEN LABORATORIUM 0 0 - - 0 - - - - - -
1 ABATE 0 0 - - 0 - - 3 - 3 0.33
2 ALKOHOL SWAP 0 0 - 3 2 - - 3 - 8 0.89
3 BLOOD LANCETS 0 0 - 3 2 - - 1 - 6 0.67
4 DENGUE IgG / IgM 0 0 - - 0 - - 1 - 1 0.11
5 DENGUE NS1 0 0 - - 0 - - - - - -
6 HB SAHLI 0 0 - - 0 - - - - - -
7 LARUTAM EOSIN 2% 100 ML 0 0 - - 0 - - - - - -
8 LARUTAN ASAM ASETAT 6% 0 0 - 1 0 - - - - 1 0.11
9 LARUTAN ASAM KLORIDA 0,1 N 100 ML/HCL 0 0 - - 0 - - - - - -
10 LARUTAN ASAM SULFO 20% 0 0 - - 0 - - - - - -
11 LARUTAN BENEDICT 100 ML 0 0 - - 0 - - - - - -
12 LARUTAN EDTA 0 0 - - 0 - - - - - -
13 LARUTAN GIEMSA STAIN 100 ML 0 0 - - 0 - - - - - -
14 LARUTAN H2O2 0 0 - - 0 - - - - - -
15 LARUTAN HAYEM 0 0 - - 0 - - - - - -
16 LARUTAN METANOL 0 0 - - 0 - - - - - -
17 LARUTAN OIL EMERSI 0 0 - - 0 - - - - - -
18 LARUTAN POCK-PACK D (II) 0 0 - - 0 - - - - - -
19 LARUTAN POCK-PACK L (II) 0 0 - - 0 - - - - - -
20 LARUTAN RAESSECHER 100 ML 0 0 - 1 1 - - - - 2 0.22
21 LARUTAN TURK 100 ML 0 0 - 1 1 - - - - 2 0.22
22 LYSOL 0 4 - - 0 - - - - 4 0.44
23 LIDI SWABB 0 5 - - 0 - - - - 5 0.56
24 ONE CLEAN 0 0 - 1 1 - - - - 2 0.22
LPLPO Halaman 160

1 2 3 4 5 6 7 8 9 10 11 14 15 16
25 PP TEST 0 0 - - 0 - - - - - -
26 REAGEN GOLONGAN DARAH ANTI A 0 0 - - 0 - - - - - -
27 REAGEN GOLONGAN DARAH ANTI B 0 0 - - 0 - - - - - -
28 REAGEN WIDAL TEST 0 0 - - 1 - - - - 1 0.11
29 STIK GLUKO DR 0 0 - 3 3 - - - - 6 0.67
30 STIK PEMERIKSAAN ASAM URAT 0 0 - 1 0 - - 1 - 2 0.22
31 STIK PEMERIKSAAN HB 0 0 - 1 0 - - 2 - 3 0.33
32 STIK PEMERIKSAAN KOLESTEROL 0 0 - 3 2 - - 3 - 8 0.89
33 STIK PEMERIKSAAN TRIGLISERIDA (TG) 0 0 - - 0 - - - - - -
34 STIK URINE PARAMETER 3 0 0 - - 0 - - - - - -
35 STIK URINE PROTEIN 0 0 - - 0 - - - - - -
36 STIK AMPHETAMINE 0 0 - - 0 - - - - - -
37 STIK BENZODIAZEPINE 0 0 - - 0 - - - - - -
38 STIK THC 0 0 - - 0 - - - - - -
39 REAGEN DIRUI CLEANSER 0 0 - - 0 - - - - - -
40 REAGEN DIRUI DILUENT 0 0 - - 0 - - - - - -
41 REAGEN DIRUI LYSE 0 0 - - 0 - - - - - -
42 REAGEN FOTOMETER ASAM URAT 0 0 - - 0 - - - - - -
43 REAGEN FOTOMETER GLUCOSA 0 0 - - 0 - - - - - -
44 REAGEN FOTOMETER KOLESTEROL 0 0 - - 0 - - - - - -
45 REAGEN FOTOMETER TRIGLISERID 0 0 - - 0 - - - - - -
46 TISUE LENSA MIKROSKOP 0 0 - - 0 - - - - - -
47 XYLOL 0 0 - - 0 - - - - - -
48 ZIEHL NELSEN 0 0 - - 0 - - - - - -
49 HIV TEST 0 0 - - 0 - - - - - -
50 SPIRITUS 0 0 - - 1 - - - - 1 0.11
51 SPECULUM ONEMED UK. S, M, L 0 0 - - 0 - - - - - -
52 WATER ONE/AQUDEST 0 0 - - 1 - - - - 1 0.11
STIK URINE PARAMETER 10 PARAMETER 0 0 - - 0 - - - - -
OBAT BUFFER PROPINSI 0 0 - - 0 - - - - -
1 ABATE 0 0 - - 0 - - - - -
2 ALKOHOL 70% (2017) 0 2 - - 0 - - - 2 0.22
3 AMOKSISILIN KAPLET 500 MG 0 0 - - 0 - - - - -
LPLPO Halaman 161

1 2 3 4 5 6 7 8 9 10 11 14 15 16
4 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 0 0 - - 0 - - - - -
5 ASAM MEFENAMAT 500 MG 0 0 - - 0 - - - -
6 BIONEURON TABLET 0 0 - - 0 - - - -
7 BISTURI (Pisau Bedah) 0 0 - - 0 - - - -
8 FENOBARBITAL TABLET 30 MG 0 0 - - 0 - - - -
9 HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU 0 0 - - 0 - - - -
10 IV CATHETER NO. 22 G 0 0 - - 0 - - - -
11 IV CATHETER NO. 24 G 0 0 - - 0 - - - -
12 KAPAS PEMBALUT 250 GR (2017) 0 0 - - 0 - - - -
13 KASA PEMBALUT HIDROFIL 4 m x 10 cm 0 0 - - 0 - - - -
14 KOTRIMOKSAZOL SUSPENSI 60 ML 0 0 - - 0 - - - -
15 LIVRON B-PLEK TABLET 0 0 - - 0 - - - -
16 NEDDLE NO. 23 0 0 - - 0 - - - -
17 NEDDLE NO. 25 0 0 - - 0 - - - -
18 NISTATIN TABLET SALUT 500.000 UI/G 0 0 - - 0 - - - -
19 NISTATIN VAGINAL TABLET SALUT 100.000 UI/G 0 0 - - 0 - - - -
20 PARASETAMOL 500 MG TABLET 0 0 - - 0 - 1,200 1,200 133.33
21 PARASETAMOL DROPS 0 0 - - 0 - - - -
22 PERMETRIN KRIM 5% (SCABIMITE CREAM) 0 0 - - 0 - - - -
23 RINGER LAKTAT LARUTAN INFUS 0 60 - - 0 - - 60 6.67
24 SALBUTAMOL CAIRAN IH 0,1% (VENTOLIN NEBULIZER) 0 0 - - 0 - - - -
25 SALEP 2 - 4 KOMBINASI 0 0 - - 0 - - - -
26 SEFADROKSIL TABLET 500 MG 0 0 - - 0 - - - -
27 SERUM ANTI BISA ULAR POLIVALEN INJ. 5 ML (ABU I) 0 0 - - 0 - - - -
28 SERUM ANTI DIFTERI INJ 20.000 IU/VIAL (A D S) 0 0 - - 0 - - - -
29 SURGICAL MASK (MASKER) 0 100 - - 0 - - 100 11.11
30 TETAGRAM (HUMAN TETANUS IMUNOGLOBULIN INJEKSI I.M 250 IU) 0 0 - - 0 - - - -
31 UNDERPAD STERIL 60 X 90 CM 0 0 - - 0 - - - -
32 VAKSIN RABIES 0 0 - - 0 - - - -
33 VITAMIN B KOMPLEK 0 0 - - 0 - - - -
34 ANTASIDA DOEN TABLET KUNYAH 0 0 - - 0 - - - -
35 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 0 0 - - 0 - - - -
36 FLUOXETIN TABLET 20MG (ELIZAC) 0 0 - - 0 - - - -
LPLPO Halaman 162

1 2 3 4 5 6 7 8 9 10 11 14 15 16
37 MULTIVITAMIN SIRUP ANAK (TRUVIT) 0 0 - - 0 - - - -
38 MULTIVITAMIN NEUROTROPIK TABLET (TRIFANEURON) 0 0 - - 0 - - -
39 OXYMETAZOLINE HCL/ILIADIN SPRAY TETES HIDUNG 0,05% 0 0 - - 0 - - -
40 OXYMETAZOLINE HCL/ILIADIN DROP TETES HIDUNG 0,025% 0 0 - - 0 - - -
41 RISPERIDON TABLET 2 MG 0 0 - - 0 - - -
42 SPIRONOLACTONE 100 MG TABLET (2017) 0 0 - - 0 - - -
43 TRIFLUOPERAZINE DIHYDROCHLORIDE TABLET 5 MG 0 0 - - 0 - - -
44 URINE BAG 0 0 - - 0 - - -
0 0 - - 0 - - -
OBAT YANG TIDAK TERBUAT DALAM FORM 0 0 - - - - -
0 0 - - - - -
1
0 0 - - - - -
2
0 0 - - - - -
3
0 0 - - - - -
4
0 0 - - - -
5
0 0 - - -
6
-
7
JUMLAH
#NAME? JUMLAH HARGA
HARGA

BPJS JUMLAH
BAYAR PKD-G
Mengetahui / Menyetujui : Yang Menyerahkan : Yang Menerima / Melapor
Kabid.Yankes Ka. Gudang Farmasi Kesehatan Pimpinan Puskesmas Karang Intan 2
NIP.19660909 199003 1 013 NIP. 19810501 200501 1 012 NIP. 19691207 199103 1 004
LPLPO Halaman 163

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO) TAHUN 2018

SISA STOK PEMBERIAN KET

2 ALBENDAZOLE SUSPENSI 200 MG/5 ML 1 Botol 4,426 59 0 59 2 57 252,282

3 ALOPURINOL TABLET 100 MG 100 box, 10 strip @ 10 tablet 95 - - - - 200

5 AMINOFILINA INJEKSI 24 MG/ML - 10 ML 30 Dus 30 ampul @ 10 ml 4,204 - - - -

11 AMOKSISILIN SIRUP KERING 125 MG/5 ML- 6O ML 1 Btl @ 60 ml 2,200 55 0 55 5 50 110,000

12 ANTASIDA DOEN SUSPENSI 1 botol 60 ml 2,106 60 0 60 28 32 67,392

15 ANTIPARKISON DOEN KOMBINASI (LEVOPAR) 50 Tablet 1,350 50 0 50 - 50 67,500

16 ARTESUNATE 50 MG + AMODIAQUINE ANHYDRIDA 200 MG (ACT) 1 Tablet 3,600 - 0 - - - -

17 ARTESUNATE INJEKSI 60 MG / ML 1 Kotak 42,900 - 0 - - - -

18 ASAM ASETILSALISILAT 100 MG (ASETOSAL) 100 Tablet 153 90 0 90 - 90 13,770

21 ASAM MEFENAMAT TABLET 250 MG 100 Tablet 150 - - -

24 ASIKLOVIR 200 MG TABLET 100 ktk 10 x 10 tablet 272 90 0 90 - 90 24,480

27 ANTIBAKTERI DOEN SALEP KOMBINASI (BASITRACIN) 1 box @ 25 tube 3,365 45 0 45 1 44 148,060

28 ANTIFUNGI DOEN SALEP KOMBINASI (2017) 1 box @ 24 tube 4,782 10 0 10 - 10 47,820

29 AQUA PRO INJEKSI 1 box @ 10 vial 2,310 - - - - 50

31 BETAMETASON KRIM 0.1 %- 5 MG 1 Tube 5 gr 1,450 15 25 40 24 16 23,200 24

33 BISOPROLOL 5 MG TABLET 30 Box 3 x 10 tab 695 - 0 - - - -

34 CETRIZINE SIRUP 5 MG/5 ML 1 botol 60 ml 7,756 86 0 86 46 40 310,240 50

37 DEKSAMETASON INJ 5 MG/ML-1ML 100 ktk 100 ampul @ 1 ml 1,738 37 0 37 4 33 57,354

39 DIAZEPAM INJEKSI 5 MG / ML 1 Ampul 4,598 18 0 18 - 18 82,764

Dus, 5 alubag @ 1 tube

45 DIMENHIDRINAT TABLET 50 MG 100 botol/100 tablet 114 - 0 - - - -

46 DOMPERIDONE SUSPENSI 5 MG/5 ML 1 botol @ 60 ml 3,490 36 0 36 18 18 62,820

49 EPINEPRIN HCL/BITARTRAT(ADRENALINA)INJ 0,1%-1ML 1 Dus @ 30 ampul 2,354 - 0 - - - - 30

52 FENITOIN NATRIUM KAPSUL 100 MG 100 Botol @ 100 154 - - - -

53 FENOBARBITAL INJEKSI 50 MG/ML-2ML 30 ktk 30 ampul @ 1 ml 1,980 - - - -

54 FENOBARBITAL TABLET 30 MG 100 100 tablet/botol 68 - - - -

55 FITOMENADION (VIT.K1) INJEKSI 2 MG/-1ML 1 ktk 30 ampul @ 1 ml 4,083 22 0 22 5 17 69,411

57 FUROSEMIDE INJEKSI 10 MG / ML 1 Ampul 2,179 20 0 20 6 14 30,506

59 GENTAMISIN TETES MATA 0,3% 1 Botol 4,600 53 0 53 9 44 202,400

60 GLIMEPIRIDE 2MG TABLET 50 box @ 50 tablet 296 - - - - 100

62 GLUKOSA LARUTAN INFUS 5 % STERIL 500 ML 1 Botol @ 500 ml 6,900 20 0 20 - 20 138,000

64 HALOPERIDOL TABLET 0,5 MG 100 Dus, 10 blister @ 10 tablet 64 - - - -

68 HIDROKORTISON KRIM 2,5% 1 Tube 2,868 34 0 34 10 24 68,832

69 HIOSIN BUTIL BROMID INJEKSI 20 MG/ML 5 Box, 5 ampul @ 1 ml 4,950 10 0 10 10 - - 10

71 IBUPROFEN TABLET 200 MG 100 botol @ 100 tablet 111 - - - 1,000

79 KETOKENAZOLE CREAM 2% 1 tube 10 gr 2,605 24 0 24 6 18 46,890

82 KLORAMFENIKOL SALEP MATA 1 % 1 tube 5 gr 1,640 11 24 35 11 24 39,360

83 KLORAMFENIKOL TETES MATA 0,5% (DECACETIN) (2017) 1 botol 10 ml 3,850 - - - 25

88 KODEIN 10 MG TABLET 100 botol 100 tablet 550 0 - - - 100

90 KOTRIMOKSAZOL SUSPENSI 60 ML 1 Dus, botol @ 60 ml 2,225 28 0 28 8 20 44,500

92 LANZOPRAZOLE 30 MG 20 Dus, 2 strip @ 10 kapsul 341 20 200 220 60 160 54,560

93 LIDOCAIN INJEKSI 1 box @ 100 ampul 929 35 0 35 35 - -

94 LIDOKAIN INJEKSI 2% (HCL) + EPINEPRIN 2 ML 1 box @ 30 ampul 2,122 58 0 58 2 56 118,832

96 LORATADINE TABLET 100 box 10 x 10 tablet 149 - - - - 300

97 MAGNESIUM SULFAT INJEKSI 20% (MGSO4 20%) (2017) 1 vial 3,200 - - - -

98 MANITOL LARUTAN INFUS 20% 1 Botol 44,000 - - - - 1

105 METOCLOPRAMIDE DROP 10 ML (GAVISTAL) 1 botol 10 ml 5,200 14 0 14 - 14 72,800

106 METOCLOPRAMIDE SIRUP 5MG/ML (LEXAPRAM) 1 botol 60 ml 2,750 - - - -

109 METRONIDAZOL TABLET 500 MG 100 10 strip @ 10 tablet 140 - - - -

110 MICONAZOLE KRIM /SALEP 2 % ( NITRAT ) 1 1 tube 10 gram 3,737 24 0 24 9 15 56,055

111 N-ASETIL SISTEIN 200 MG TABLET 60 Kapsul 474 - - - - 2,000

Dus, 10 strip @ 10 tablet

118 PARASETAMOL DROPS 1 btl 15 ml 5,980 77 0 77 77 - - 112

125 POVIDON IODIDA LARUTAN 10 % 30 ML 1 botol @ 30 ml 2,344 6 0 6 1 5 11,720

126 POVIDON IODIDA LARUTAN 10 % 60 ML 1 botol @ 60 ml 6,700 - - - -

130 RANITIDIN INJEKSI 25 MG/ 2 ML 10 Dus, 10 ampul @ 2 ml 1,340 - - - - 100

133 RETINOL (VITAMIN A) 200.000 IU 50 Botol 50 kapsul 505 - - - -

Dus, 4 x 5 botol plastik @

138 SALEP 2 - 4 KOMBINASI 1 pot @ 30 gr 2,200 15 0 15 0 15 33,000

139 SALISIL BEDAK 2 %- 50 G 1 Dus @ 50 gr 1,066 0 - - -

141 SEFADROKSIL SYRUP 125 MG / 5 ML 1 Dus, botol @ 60 ml 4,746 28 0 28 16 12 56,952 50